“So as Matt said this time, we’re just doing the same thing, elevated ileum, but it’s its relationship to the shoulder girdle and then shoulder dysfunction and other upper extremity type problems. But we’ll give some more specific examples, but just keep in mind that there could be a whole ton of different, dysfunctions that could come from just one simple thing, like an elevated ilium.”
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hello, everyone and happy new year. Thank you very much for attending. My name is Matt Callison. Hi, thanks for attending. I’m Brian Lau. We’re from ACU sport education and the sports medicine acupuncture certification program. Thank you to the American Acupuncture Council for having us. We have a sports acupuncture webinar. It’s always really fun to be able to do this once a month or every other month. This particular one, we’ve got more information for you. We have such a good time last month with Ian Armstrong, who’s the teacher of the postural assessment and corrective exercise class in the smack program. Brian and myself had a great time discussing elevated ilium and his contribution to medial knee pain had explored the different sinew channels and different acupuncture points and exercises that can be used to help to correct this. Then Brian, I was thinking that’d be great to be able to actually do something similar, looking at an elevated ilium and its contribution to a superior shift of the scapula or an elevated ilium and the injuries that that can cause. And some exercises that would be useful to apply after the acupuncturist acupuncture treatment. So, unfortunately though, Ian had some cut amendments, he wouldn’t be able to join us. So Brian and I are going to go ahead and take this over. Um, Brian, what do you think about us going to the intro slide? And if you have any words or so you want to share,
Uh, no, no, basically I guess just the small thing is that, um, elevated ilium could cause a whole ton of kind of, uh, potential pain patterns of low back pain, hip pain, a whole bunch of them. Last time we chose to see how it can relate to the lower extremities, especially the knee for medial knee pain. So it’s just an example, example to see how to start prescribing exercises, how to add them into the full, comprehensive treatment. So as Matt said this time, we’re just doing the same thing, elevated ileum, but it’s its relationship to the shoulder girdle and then shoulder dysfunction and other upper extremity type problems. But we’ll give some more specific examples, but just keep in mind that there could be a whole ton of different, uh, dysfunctions that could come from just one simple thing, like an elevated ilium. Hmm.
All right. Well, let’s go to the next slide. I think that’s a good segue for you. Want to go ahead and start with this one?
Yeah. So, uh, with this image, uh, again, we’re, we’re focusing in on a postural disparity, uh, we picked an elevated ilium cause it’s clinically relevant. It’s very common. You see it a lot in, uh, in clinic and you see both how it can relate. Like I said to, to local pain patterns, like low back pain, et cetera, but, but how it really becomes, you know, since so much weight transfers through the hip, it’s really one of the key structures, uh, that determined cemetery for a lot of the rest of the body. So if you can balance the pelvis that goes a long way in and of itself to balance the shoulder girdle, to balance the lower extremity knee position, foot position, et cetera. Uh, so it’s not the only thing. Um, but it’s a really a big thing. So we’ll look at its relationship to the shoulder girdle today and give some exercises review, uh, refer back to last times podcast where we looked at some exercises for the ilium itself.
Um, and then we’ll look at some exercises for shoulder girdle, but then how to combine those with acupuncture treatments. So in this image, you see this gentleman on the right there’s a elevated and you can kind of see the schematic, um, image. You can see that he has an elevated ilium on the left. So he follow, uh, you know, the line from the top of each, uh, iliac crest. You can see an elevated ilium on the left. We’ll look at some other ways you can measure it in the second, uh, then look at just for now the relationship that calm. And this is the most common way that it would present is that you’d have a balancing, you know, in the girdle of the shoulders, the shoulder girdle balance, where it’s going to start to compensate to that elevated ilium. And in this case, you see that elevated scapula on the right. And that’s probably the most common way that this would present. It could do it differently, but this is definitely the most common opposite elevated scapula or a superior shift. You might call that
Just want to emphasize as well that Brian was talking about balancing the elevated ilium or any kind of, uh, ileum type of partial disparities. I mean, the reason why it’s, you can see that it’s going to be the middle section of the skeleton. That’s going to affect what’s happening above and below in addition to housing, the dantien and the kidneys just above. So by balancing that aspect that helps, helps all kinds of different things they acupuncturist can be treating from pelvic floor dysfunction, lower jaw disharmony, OB GYN, middle job disharmony. So looking at balancing at the muscle skeletal systems, not just for orthopedic, it’s also for helping those on food. So that’s, that’s great. And this is what we emphasize in, in the smack program is trying to be able to get that elevated ilium or any kind of partial disparities and pelvis to go ahead and treat that first, which I’m sure a lot of practitioners will actually go for that as well. Yeah. Brian, before we go to the next slide. Okay.
Yeah, the we’re going to be zeroing in, in a second more on the shoulder and scapular position, but in this particular model, you can also really see the change in the position of the neck. And I’ll just give you a very simple way to see it. If you could picture that ilium elevated. I think I mirror image near my right hands up, but I’m trying to make it look like my left hand to kind of match this, this model, if, uh, the aliens elevated on the left, the person’s not going to stand in such a way that they’re, they’re leaning, you know, the leaning tower of PISA over on that side. And everything’s pointing, you know, uh, to the left, they’re going to find some place to compensate that someplace could be multiple places. It could be in the spine, which you see a little bit of in this model.
It can be in the shoulder girdle, it can be in the neck, they’re going to find some way to get their eye and their head and, um, ear position, you know, the equilibrium of the body a little bit more balanced. So if the shoulder girls are really fixed, maybe they’re going to find a way to do that all in the neck. Um, but the common one, the, the very frequent thing you see at least, um, that’s going to be part of this dynamic is the, uh, contralateral shoulder being higher and the, you know, compared to the hip, so left hip right shoulder, right hip left.
Great. As you can see the image on the right, the patient has an elevated ilium on the left and looks like there is elevation on the right as well. He does have a little lateral tilt to the right with the scapula quite. I mean, with the head that Brian was just talking about. So one of the muscles that we’re going to actually the only muscle that we’re talking about, primary muscle that we’re going to be talking about as well, the levator scapula. So can you see where the levator scapula attaches on the image on the left, the superior medial border of the scapula close to small tests in 13, and then it’s other attachment is going to be the transfers process of C1, C2, C3, C4. So the superior shift of the scapula, and you’ve got a shortening of that. Levator scapula, small tests and CGU channel that we’re going to get into a little bit more in this webinar, in a lock short position, it’s pulling the neck to the lateral side. So multitude of injuries can be occurring from this that we’re going to be getting into. All right. All right. Well then let’s go to the next slide. The quick review. This is what we talked about last month about measuring the ileum. Um, so you can see the middle image. There’s the hands are coming in on the side, on the lateral side, and the fingers are placed at a level line, right on top of that alien, it gives you an idea of where side is going to be elevated.
Well, I’m a person that, that doesn’t work for the camera position. So, well,
Go ahead, Brian. You can finish.
No, I just wanted to say that just for people to know that the, if you’re measuring that you’d be right behind the person that mats moved to the side to be able to see whatever his hands are. So just that heads up.
Yeah. True. And then functional anatomy from, um, OHS, overhead squat from the national Academy of sports medicine. Looking also at what happens with an elevated Dalian was usually an asymmetrical hip shift. And there’s a whole slew of sinew channel imbalances that occurs with this. And once we see this kind of posture where we’re automatically thinking of different acupuncture points that we can treat for locally adjacent and distant of the primary channels and the Sr channels, in addition to what this kind of Bosch is going to be doing to the organ.
All right, well, let’s go to the next slide please.
All right. So here, you’ve got elevated scapula or also called a superior shift of the scapula, and it’s going to be associated with a lock short levator scapula that we discussed earlier, which you see here on this individual’s left side. This individual has an elevated ilium on the right often like Brian was saying it’s probably most of the times, but not all the time. There’s never an always is that the opposing side will have a superior shift of the scapula. Sometimes you’ll see a superior shift of the scapula on the same side of an elevated ilium, but what we’re going to be discussing here will still apply. All right? So this posture can lead to many different muscle and channel imbalances that we’re going to be discussing just a few of them. Um, some of the injuries that can happen with this will be rotator cuff tendinopathy, but Ron boy, minor constrain thoracic outlet syndrome. And there’s more Brian, do you want to say anything before we go to the next line?
Uh, well, I think we also have, uh, in the slide or is this the next one? Yeah, the downward downwardly rotated, uh, scapular position. And I think we have a little bit more on the next slide, so we can go over it a bit more there. Um, but uh, if you look at the scapula in this position, the left side, that I’ve looked at the glenoid cavity. So the, um, I have a little scapula here, so, uh, I think this look more like my, uh, left side of your looking through the rib cage at the front surface of the scapula, the glenoid fossa would go up. That would be upward rotation. This patient has more of a downward rotation of the scapula. And that’s pretty typical when the levator scapula shorten. We’ll talk about this again in the next slide, but, um, but that’ll play into some of the, um, discussions we have coming up in a few, few slides also. Okay. So next please.
All right, so this video’s not playing, maybe if you click on it, it’ll play.
I see. Okay.
So it’s not playing unfortunately. Well, that’s what happens with technology sometimes. So let’s just walk there.
I think it’s coming, isn’t it? Oh yeah. I can see them working on it. It looks good. There it goes.
Thank you. Okay. So one of the actions of the levator scapula as the name suggests it’s going to elevate the scapula. Now, what this is not showing is that you do have elevation in the scapular, but if you look at the origin, the assertion or the distal proximal attachments, it will also downwardly rotate that scaffold. If you will, Brian, can, you should have downward rotation again in your scapula.
Yeah. So tell me, Matt. And you can tell me if this is a case, this is the right scapula, but I think since we’re on, I think everything’s mirrored image. I’m trying to look at, make it look like the same. So does that look like the right side?
Yes. But can you do us a favor? Can you go ahead and keep it in front of you? Because it blends very well with the white background. Yeah. Okay. That looks really great, but you don’t have to raise it up a little bit, at least on mine now. Okay, good.
Yeah. So you’re seeing through my rib cage to the front surface of the scapula levator scapula would be attaching here to see one, two, three, and four transverse processes, a muscle of the small intestines in your channel, and it would lift or elevate the scapula. And at the same time it would soaps and please me or imaging, it’s hard. It would bring the side of the neck down to that side to its side, bend the head, but we’re talking mainly about the scapular position. So elevating the scapula. Okay.
That’s great. So let’s go to the next slide, please. I don’t think we’re going to talk a little bit more about the rotation. Okay.
Yeah. And this one we’ll look at the downward rotation of the scapula
That’s there’s upward rotation downward. So when you see green about levator scapula, that’s when it’s shortening concentric contraction, it’s active and the Red’s going to be a lengthening contraction. So green is going to be upward, rotate downward rotation, and then you’ve got your upward rotation. So in a locked short levator scapula, you can see how it have a propensity to be stuck in a downward rotation, which will then when you’re raising the arm to shoulder abduction, like the scapula humeral rhythm, that images that’s on the right there, the greater tubercle, a big prominence on the humerus or the super spine EDIS and infraspinatus. And on the opposite side, the bicipital long head tendon can come up and hit that at chromium and cause a tendinopathy and impingement. There’s one more image. I think that will also be able to help with this. Um, can we go to the next slide?
Yeah, there we go.
Yeah. So then this would be when the levator scapula has been placing that scaffold into a downward rotation, as the arm goes into abduction, then the propensity for that greater tubercle to hit that a chromium is much, much higher leading to injuries that we were talking about. So all of this gives us actually protocols to be able to treat this, but for right now levator scapula is going to be a big one to do. Um, and we will talk about exercises here in a second. Brian, do you want to add anything to this?
Yeah. So, uh, the main thing we’re looking at those is very, I guess, biomechanical, we’re looking at particular muscles in this case, the levator scapula and how it’s going to elevate the scapula and how it’s going to tend to hold the scapula into that downer rotation of it’s shortened. It’s going to prevent the scapula from being able to follow the arm position, right. That would be normal movement to help keep that space between the acromion and the head of the humerus, uh, open. So it doesn’t pinch structures like the supraspinatus tendon, the bicep, uh, biceps tendon. So you’d want the scapula to be able to come upward and upward rotation as you’re going into AB duction. But if it’s kind of held too firmly in place by an overtight levator scapula and maybe some other structures, then it’s going to prevent that scapula from moving and then the arms going to bump into the chromium and, uh, that can lead to a lot of different pain patterns of the shoulder.
So that’s a very biomechanical view. That’s great, that’s great information and of itself, but then we have to remember that we have this whole, you know, really beautiful, intricate channel system. And, uh, the levator scapula, the muscle we’re kind of looking at in this case is a muscle of the small intestines and new channel. So we can needle it at the motor point, but we might include small intestine channel points to help contribute to a more thorough therapeutic outcome. We started with the elevated ilium, uh, and the quadratus lumborum is a big muscle that’s involved with the elevated ilium as are the AAD doctors, the thigh and hip add doctors. Those are muscles of the liver sinew channel. So we have this midday, midnight channel relationship that’s involved with, uh, maybe this local problem. We have a very, um, more comprehensive channel perspective that we can look at and start including points to directly affect the elevated Lam like the quadratus lumborum like add Dr. Longest liver channel points, maybe something like liver five, um, in combination with small intestine channel points and more local needling at the small intestine channel sinews. And then we can add other points in our acupuncture treatment based on the specific injury and other things we’re finding and you know, this person, blood deficient or inefficient or something like that. So this is starting to paint a more of a comprehensive picture that we’re looking at.
That’s something we find a lot in our own clinical practices, looking at the midday and midnight relationship between the liver on the small tests and channel, especially when there’s a shoulder abduction problems, such as what we’re seeing this slide, um, elevated ilium and shoulder abduction problems, pretty darn common. You’ll see that a lot in the clinic. Um, if you would, when you’re looking at the scapula, you guys, I take a look at that superior medial border of the scapula. That’s where the levator scap is going to be attaching where many people have that five Brodick tension in there that many of us will go ahead and needle right through that, um, that levator scapula, as we talked about before, it’s going to be attaching to the C1 through C4, transverse processes, attached to that. Then it goes down and it travels to the superior medial border.
Like I said, it blends in seamlessly with the super spy Natus muscle that’s located in the supraspinous fossa in this particular image. If you go disorder, large tests and 16 would be, then you’ve got large and tests and 15, just on the other side of the chromium, hopefully you guys are following along with this large test at 15 is where the super spine Natus tendon is going to be attaching. It’s usually about a quarter of an inch to an AF, probably five, eight, five eights of an inch wide blending into the capsule and attaching right onto the, um, a greater tubercle. Then from there, you’ve got your triceps part of the small test of senior channel, and then also going all the way down to flexor carpi on narrow switch. We talk a lot about the flexor carpi on there. Motor point is a magical, yeah, I’m going to use the word magical because it is empirical point that will soften the, um, a distal attachment, uh, levator scapula 99% of the time when you do actually get that flexor carpi on there’s motor point, right? It will soften that attachment side pretty dramatically. And this is something that we’ve been teaching in the program for probably about 10 years or so. It’s a really nice disappoint to use with levator scapula, shortening and pain at that proximal attachment. Brian, you wanna say anything else before we go on?
Oh, no, that’s good.
They were actually kind of moving right into, uh, exercises now. So the next slide, please.
Last month, these were some exercises or exercise, different levels of the, um, figure four crossover. That’s working quite a bit on the piriformis, this exercise. And a lot of the exercises that we use are based on [inaudible] work. Um, what we’ve done is we’ve actually looked at the different angles as far as the functional anatomy, the sinew channels, and we’ve modified his work, which actually happens quite a bit with people’s methods and techniques is that other people have good ideas about it. And then just kind of form it in a slightly different way. But we did want to give a shout out to Peter Garcia for his miraculous work and an exercise prescription, what he’s done over the years. Um, so again with this, this is what we’ve done for the elevated ilium one exercise, and that’s going to be discussed a lot further in last month’s podcast. And also we have a blog about it as well in the sports medicine, acupuncture.com website. Let’s go to the next side. We’ll talk about exercises where we can use for a levator scapula or a superior shifted the, um, this exercise for, um, elbow press is an exceptional exercise. Brian, do you want to start with that or do you want me to go?
Um, I can start and there’s a little bit of a, um, dialogues of you need to go back and look at it after the recording it’ll give a step-by-step, but the idea is you’re giving a little bit of a press of the elbows into the floor, but more importantly is you’re bringing this, the shoulder blades, the scapula together. So towards the midline in down. So, you know, in this case, levator scapula is going to tend to pull. It might be on one side, but pull that scapula up. So you’re D pressing using lower traps and using, uh, the, the rhomboids and middle traps to bring the shoulder blades together and down. So it’s the same time opening the chest and dropping the shoulder blades.
I don’t know if you got one dad, anything else about it, Matt?
Yeah, I was just looking at the image and how hands and Ian is enjoying it, and it’d be what the scapula is doing. And then 10% of it is going to actually be pressing into the floor. So this is a strong scapular stabilization exercise that works great after needling, um, or doing acupuncture to the levator scapula, pectoralis, minor, small tests and senior channel, um, a number of different points that we could use with this one. This is a simple exercise and kind of a triple star exercise that you can use even to advanced people, um, because it does require quite a bit of concentration to really get those scapulas to really form down and lock in. Then the next exercise is actually called just a second. Uh,
This is a short format, so we can’t go into too much, but, uh, if you go back at some point, if you want to look at the recording and look at the movements of the scapula, we were talking about levator scapula, but pec minor muscle of the lung sinew channel would be involved in a lot of these too, because it’s the antagonist agonist, antagonist relationship with levator scapula because it’s going to depress the scapula. So if it’s really short, maybe the levator scapula has to fight against it, but it also works with the levator scapula and downward rotation of the, of the scap. So I like this exercise in this case also because of that, um, opening and lengthening of the pec minor and kind of normalizing the tension of that, which is kind of a, not the direct channel we’re looking at, we’re looking at the small intestines in your channel, but how maybe the lungs and new channels coming in and relating to this picture, this exercise would be given after the acupuncture treatment. So maybe we’ve needled the pec minor on that side to make it more, um, accessible for the patient right away, you know, their body’s ready for the exercise kind of prime because we’ve reduced, um, tension in the pec minor and allow, or allowing them to more effortlessly do this exercise. Yeah. Cool.
And Brian, I’m sure we kind of rushed with this. There’s a lot of things that we really didn’t talk about. Like the lower trapezius being an antagonist to the levator scap elevation and depression and the literature, easiest being large attachments in your channel. So a size to be able to see that internal and externally related channels of the lung pectoralis, minor, lower trapezius, large intestine being called into Plex. What does that mean? Well, in our mind, if you would needle the motor points of each one of those, you’re already signaling those two mild fascial Sr channels. So therefore if you compliment that signal with more acupuncture points, adjacent and distal, it has to have an effect on those particular muscles. Cause it’s the signaling system that we use in acupuncture. Brian, you must anything about that? That’s good. All right. Cool. All right. So again, um, this elbow press is a great exercise to use as a preliminary exercise. So what about the next exercise please?
Yeah. Okay. This is one of our favorites. I would say triple star, maybe even quadruple started this. Um, this is an exercise that takes a lot of concentration and how we modified it a bit from how it was originally taught is we are increasing the, uh, or decreasing the thoracic flection. So we’re increasing thoracic extension. Let’s walk through that. So the first position the person’s going to have their knuckles on tide young, usually the middle finger there. They’re going to keep the wrist straight. The elbows are going to be out. As you can see, the knees are going to be at 90 degrees and hips are going to be at 90 degrees. We asked the person to go ahead and bring their elbows together toward the ceiling, keeping their fingers right at Thai Ong. All right. So by them doing that, you’ve got scapular protraction.
Then we ask the patient to begin the movement back down, bringing their elbows back down, leading with the rhomboids, leading with that medial border of the scapula and start to bring them together. All right. So you’ve got protraction and retraction. This exercise is really getting the agonist and the antagonist of those muscle groups working together. Now the emphasis, once the patient is able to do this success, now we actually increase it a little bit. We ask the patient to bring their elbows together when they’re going up to the ceiling, but above their nose. So what I’ll do is I’ll actually put my finger right above their nose and try to have the patient, bring their elbows up toward the nose, which is very, very difficult in order to do that. You really need quite a bit of thoracic extension, which is a wonderful thing to do when somebody has thoracic flection in those upper vertebrae, right?
For example, in upper cross syndrome and that head is forward. So this is a great exercise for that. It’s gonna, it’s gonna work the levator scapula quite a bit, a lot of the scapular stabilizers. And it’s, it’s definitely one of our favorites to use. This is also something that you may want to use with somebody who has upper jaw problems, for example, asthma or any kind of, of, uh, lung problems after COVID maybe C O P D, because how it’s working the front, move in the back shoe points and getting those muscles to be able to work in coordination. It’s going to work the channels as well and coordinate the channels.
Yeah. We had a question, uh, regarding this one, if somebody had a difficult timeline on the floor, so we cover stuff like this, a lot in the program where we have a multiple amounts of different exercises that can be done. That would be maybe a simpler exercise. If it’s somebody who has a difficult time of getting on the floor, cause maybe they’re not very conditioned. So I might go with a more simplistic exercise, but there is an actual variation of this, this, this exercise that that’s a little different, but it’s the same concept that can be done seated with a strap. It’s a little bit more isometric where you’re pushing out against the strap and lifting and doing some similar, similar, uh, focus. Um, but that would be, uh, adequate for somebody also, if, if that was, uh, you know, they were ready for that exercise, they could do the seated. Maybe they can’t get on the floor cause they have a shoulder injury and they, they can’t support himself. So you can definitely adapt this one to a seated position or you could just give them a more simple exercise.
Yeah. Cool. Good one. All right. So then what we talked about last time was using acupuncture as assessment, but also, um, using intradermal needles for increasing range of motion or decreasing the amount of pain during an exercise. For example, if somebody is having a hard time appropriate deceptively, trying to figure out how to do this exercise, or they may be limited in their range of motion, kind of stuck, or perhaps they’re feeling a little bit, um, slight pain or minimal pain with it, but it’s inhibiting them from doing the exercise. This is where intradermal needles on actual ordinary vessel points, but also you can use channel points to actual ordinary vessel points works pretty, pretty darn amazing. This is something that we teach in this program. And for those of you that have the sports medicine acupuncture textbook, let me think it’s in chapter four toward the end with, uh, exercise before treatment and exercise after treatment using intradermal needles. So it’s in that section chapter four. So what you’re about to see is a video of the smack program and the postural assessment and practice exercise. And there is a student there that’s having difficulty with actually doing this exercise. And so we’re applying intradermal needles based on what motion was the most painful or difficult. Okay. So let’s look at the next slide, the movie.
Now we know
That you can’t hear, let’s just read
[inaudible]. That is so awesome.
I still love her expressions so far. Um, yeah, so we can probably advance it to the next slide. We use a pine X needles from Sarah and, and you can get those from Lhasa OMS. Um, the point to a millimeters by 1.2 millimeter, um, that’s some of the best ones because it’s large enough to be able to create a sensation, but not large enough to be uncomfortable during movement. So those seem to be worked out pretty well with us. Yeah.
Uh, you can send them home with, uh, I mean, to keep them in for the patient for a few days to, while they’re performing the exercises to assist, you know, to keep that stimulation going. Yeah. Cool. Well, great. I think that’s,
Well, I mean, we could talk about this for hours, but no, I have, it’s regarded gone six minutes over that. So, um, thanks very much you guys, and I think we’re going to be scheduled again in February or March. Hopefully we’ll see you again then. Yeah.
And the next week, uh, Sam Collins is on, I’ll say I was going to be there. Awesome. Yeah,
I talk he’s, he’s hilarious. He’s really quite a sharp as a tack and he’s, he’s fun to listen to. So thank you very much. The American acupuncture council, Brian. You’re awesome as always. And thanks you guys. And hopefully we’ll be connecting again soon.
All right. Great. Thanks everyone. Goodbye.
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