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Hello, everyone. Thank you very much for attending our American Acupuncture Council webinar presentation. My name is Matt Callison. I am here with my esteem colleague, Brian Lau. I thank you. That. We’ve got a really fun topic today. It’s a proprioception at Extra Point Chonggu. Brian, can we go ahead and go to that first hetero slide?
Let’s get this slide.
So we’re going to be discussing is a needle technique for Extra Point, Chonggu, which is actually just one portion of a treatment for a upper cross syndrome posture. The upper cross syndrome posture, which we’re going to be elaborating here in just a little bit can lead to a multitude of different injuries.
And today is very short presentation. We’re gonna be. We’re going to be lecturing about how to actually needle this particular point and stimulate these lower cervical area that usually has a proprioceptive deficiency from this particular posture of a Ford, had an upper cross syndrome. So let’s go ahead and I think jump right into upper cross syndrome so we can discuss that.
So this term upper cross syndrome was coined by Vladimir Yonda close to 40 years ago. He is an osteopath in specializing in rehabilitative medicine, and he coined this term basically from looking at his patients that have a very unique type of posture that we actually see in our practice. And you as well, commonly, I would say every single.
It is looking at a forward head posture of a plumb line, increased thoracic kyphosis. So you can see that upper back really starting to curve without forward head. That’s going to lead to a number of different postural imbalances and agonist antagonist. So Bladimir, Yonda when he saw this, he actually coined this term is looking at it as a cross.
So you can see that the pectorals in purple here, the pectorals are going to be in a locked short position. Pulling on that humerus, making the humerus internally, rotate, collapsing the chest. Now going through that, you can see the next purple would be the neck extensors. Now those neck extensors are locked short, but they’re actually with through evolution, looking at portions of these neck, extension extensors are going to be locked short, and some of them will actually be locked long.
The longer part let’s say the lower cervical aspect of. That posture you’ll see that the neck extensors would be more in a lengthened position because of the forward head. Then the upper cervical region, the neck extensors actually be in a shortened position. So a little bit more on that with the next slide and just a little.
So that’s the purple aspect. Those are your locked short muscles. Now you’re locked long muscles will be, if you can see where the increase thoracic kyphosis would be your rhomboids, your middle trapezius, your lower trapezius, those muscles be very weak, allowing scapular, protraction, as well as that increased thoracic kyphosis.
Now, if we look on the Antar aspect of the body, you see the neck flexors. So it’s the deep neck flexors in particular that are going to be. Locked long or inhibited posture. If we look at the sternocleidomastoid, which will also be a neck flexor, that’d be more in a locked short position. So you have your general upper cross syndrome, but there’s also going to be just some variabilities within those muscle groups that will be locked long and locked.
So the point, the takeaway here is to look at as today’s presentation is that lower cervical region will be usually proprioceptive deficient in that forward head posture. It’s a lengthened area. So we’re going to use an acupuncture needle to try to reestablish some of that proprioception combined with an exercise to bring that forward, head back to neutral position.
Let’s look at a couple of models here. Let’s go to the next slide. There’ll be. So zeroing in on this upper cross syndrome or a common posture that lengthens the lower cervical region. So you can see how the head is really quite forward, but then it’s going to compress the tissues of the upper cervical region.
So if you could take two fingers and just put them right there at gallbladder 20, and once you have that, just simply start to look toward the ceiling. You might tilt the head back just a little bit. That’s called Qapital extension. So that’s different than cervical extension. Cervical extension is when you have all of the cervicals moving capital extension.
When you had your fingers there, gallbladder 20, you might have flipped those muscles. Just move just a little bit. When you’re looking up, that’s going to be looking at the upper neck extensors, especially the suboccipital triangle. And when those muscles get really quite taut that can lead to a number of different types of headaches, nerve and syndrome.
So the third occipital nerve, the greater occipital nerve, the suboccipital. Lots of different injuries that can occur from this particular posture. So you can see what the, both these models, if they got increased thoracic kyphosis, the head goes forward as a compensation for that forward head. The person’s just going to tilt their heads slightly upwards so they can see the horizon.
And that’s going to cause that capital extension and a number of different injuries. Now Brian’s going to go ahead and show a video that he did of himself to explain this a little bit more. Brian, do you want to take that away?
Yeah, sure. Videos just showing the relationship between the shoulder girdle movement, the scapular movement and the.
So there’s a ton of sinew channels that act on the position of the scapula and the movement of the scapula, not a ton, but there’s several. And we can go through them, but really, I just wanted to highlight in this video, how the spinal movement links with those scapular movements and the tie into what we’re seeing in these images here, before we go into the video, these models, as you see, have increased thoracic.
So their spine in that thoracic region and the upper, or excuse me, lower cervical region. The spine is stuck in flection. So we’re going to look at the relationship between the flection and extension components of the spine and how that relates to the scapular movement. Pretty short video. It’s an Instagram video.
It’s going to be on our Instagram channel or Instagram page. So it’s a minute long Instagram. Doesn’t give you a lot of time for these things, but it’s very brief. So let’s give it a look at. Okay there. We’re going to look at the relationship of the spine to the shoulder blade movement using this resistance band.
So as I go from protraction retraction, that movement likes to occur. As the spine comes out of flection, the cervical spine starts drying back and pact traction. That the spine will want to go into election retract. Buying comes out of flection, cervical spine throughout the back. Many people have a forward head posture.
So the spinal movements not coordinating with the entire movement of the body that sets them up for injury in the cervical spine angle, her girdle potential job problems, headaches. So they need to learn how to get rod, that surgical site back to encourage the entire.
all right. I’m gonna go back here for a second, a fun thing about filming things is you notice aspects that you wouldn’t notice otherwise. I had my mic here on the shirt. So when my head goes forward, of course, I go a little ways away from the. But I was acutely aware of how different my voice was and I was strained.
My voice became when I went into that forward head posture. So that was quite interesting, but yeah, just also noticing the the difference tension in the extensor suboccipital reason and how that sets you up for a whole host of different potential problems. But with that video you might notice the scapular movement and how much activity there, there occurs in the rhomboids lower trap.
It was mentioning those structures that are pulling the scapula back and retraction. So that can get us thinking about ways of treating this beyond just the technique we’re going to be highlighting. And I think Matt’s going to get into that on the next slide here. Okay. Okay. Thanks, Brian. That was good.
So just as an overview, what we’re looking at is just a portion of that upper cross syndrome, the increase thoracic kyphosis, which are going to, it’s going to have a lock long and weakened and. Rhomboids middle trapezius, lower trapezius. The head is going to be forward, which is going to be a lengthening of those lower cervical vertebra.
Then you have a shortening of the upper cervical tissues. So in this image, the head is neutral. Now, if we look at, if we can be able to take that head and just move it forward, we can start to see a little bit more of how. Lower cervical vertebrae going forward and how it would be great if there was a way for us to actually pull that lower segment of the cervical vertebra and all of the tissues that are highly appropriate, receptive your deep paraspinal muscles, your supraspinous ligament, your interspinous ligament, and encourage that to be able to come back while the person’s.
He is trying to strengthen the rhomboids, the lower trapezius, the middle trapezius, and add proprioception add sheet to that particular part of the. So I would say probably about 15 years ago. So I started playing around with this needle technique with the exercise and the combination is pretty profound.
And this is the reason why we wanted to share that with you today. Again, the takeaway here is this is one portion of the needle techniques or the points that we’d be using and the exercises that we’ll be using for upper cross syndrome. And Ford had an increased thoracic hypothesis, but it is a Pearl.
This is a big point. This is a great technique to be able to use. So it’s underneath the C6 vertebra. You’re inserting the needle through the skin, through the superficial fascia, the adipose tissue, and then the first tissue of resistance that you’ll feel would be the supraspinous ligament. Now, once you go through that, supraspinous ligament than the.
Long and wide interspinous ligament is going to be the next issue of resistance that you’ll feel with that acupuncture needle on most people, it’d be probably about, just about a one inch needle insertion, which is completely safe. You’re very far away from the spinal cord. Some patients when they’re laying on the table prone, it’s difficult to get to that C6 area because maybe they have a lot of tissue in the area or are just increase extension for some patients.
Some practitioners like to lower the head. To be able to open up that neck personally, as a patient. I don’t care for that very much. Having my head drop down a little bit. Doesn’t feel very good to me. Usually what I’ll do for patients is just to put a pillow underneath the chest and that’ll open up the neck.
So as a practitioner, just take your finger or two fingers and start feeling underneath that C6 vertebra separating the tissue so you can get an idea. On how to be able to put that needle up underneath the spinus process of C6 and get through those a formation, a four mentioned tissues. Once you get into that interspinous ligament, which is about, like I said, about an inch deep propagate Xi, and it may take a while actually for that patient to get to you because of the lack of appropriate.
Now, remember this is also going to be combined with other points for example, the wrong point motor point, the middle trapezius rotor point, the lower trapezius motor point you could use GB 20. There’s a number of different points that we can use depending on the patient’s case. So once you’re able to get an established Che at Extra Point Chonggu, then what we’ll do.
We’ll wrap the tissue around the needle by twisting the needle in one direction until the needle starts to get stuck. Once it’s stuck, then we’re gently going to start to pull that tissue back posterior where alongs. So we want that tissue to go back it’s lengthened because of the forward head position.
We want that tissue to go back at the same time as the. Doing an exercise, the prone and neck protraction exercise. So let’s go to the next slide there. Be
all right. So as that person is elongating that lower aspect of the cervical spine, bringing him back into extension, you’re pulling up with the needle so they can start to get an understanding of raising that lower cervical part of their body up toward the. They’re going to slowly just start to tuck their chin a little bit.
So that starts to get rid of some of that capital extension. And they set up this exercise by lowering and squeezing the scapulas together. Then engaging the middle trapezius, the rhomboids and the lower trapezius. So this is an exercise that you would do after all of the needles have been taken out with the exception of Extra Point, Chonggu.
Brian, is there anything that you wanted to add to that before we jump right into the video to show them. Yeah, you’ll you’ll see this a little bit on the video coming up that the tendency for the people who really need this technique in particular, the tendency, when people start to lift their chest by engaging the rhomboids middle lower traps they’re really tied into the idea, not even consciously, but just their body’s kind of stuck in it in a particular position to where they want to arch their neck.
And exaggerate the neck position that we’re trying to get them out of. It’s just something that’s very difficult for people who really need this technique. It’s difficult for them to find that movement where they both retract the scapula and bring the, draw the cervical spine back and lengthen that posterior portion of the cervical spine, especially the upper cervicals.
And now of course, the technique is designed to help with that, to help give them a signal and encourage them. But you have to look at the. And make sure that they’re not going further into capital extension, like trying to lift a lift up and going further into capital extension. So you have to coach them.
Now, the good news is the technique helps give a little cue and coach them at the same time, but sometimes verbally coaching is necessary. And you’ll see an example of that coming up. Yeah, that’s a really good point. A lot of people will go into that capital extension just because they’re used to doing that.
So thanks for saying that, Brian, by coaching the person, just to tuck their chin a little bit, that helps with it. Now, this technique also is useful. If you didn’t want to needle it by just pinching the tissue of Chong GU and lifting that. But it’s not as successful in my own opinion as actually using a stainless steel needle, going into the interspinous ligament propagating sheet.
To me, that’s the changing proprioception far better than just actually just lifting up that skin. Cool. All right. So let’s, and again, you’re in the blue channel, right? With the needle you’re in the do channel, you’re in the ligamentous tissue and you have a lot more sway on it. So you’re ready for the video.
Squeeze caplets together, race together and relax everything. So bring these guys to be a backbone because you put this together
for me and agree this.
all right. That video is up on our YouTube channel by the way. So if I noticed the birds are a little aggressive, they’re mad in your background, they’re making some noise and it might not have heard anything. This sounds a little put out by that, but we do have that up on our YouTube channel. If you wanted to check that out sports medicine acupuncture, and you can do that.
Oh, sorry, Brian, are you finished? Can I go? Okay. This was a recording that we just did in New Jersey to finish the 2019 2022 smack program. It was three years because of the smack of sorry for him because of the COVID. So we just finished this. This was a module for neck, shoulder, and upper extremity. This is one of the techniques that we’re using now.
Remember, we’re also going to be needling the other points as well, and that helps with proprioception. So the person gets an idea on how to be able to lower and squeeze the scapulas together. So that’s great. That’s, this is a really wonderful technique to be able to use. We’re going to be teaching this class again here in San Diego and that’s coming up in June four days and that will be wrapping up completely of the 2022.
So also what we’re going to be teaching with this is a wonderful myofascial technique that Brian has introduced into the program that works extremely well for that particular posture and opens up the tissue. Great mile fast, mild fascial technique to use after all the needling. Brian do want to take it away.
Yeah, sure. So this is a seated technique. It’s a interactive between you and the patient. So first and foremost, you want the patients sitting in a position that is going to help facilitate change in the body. So you don’t want to just slouching though. I am starting a little slouch. So if you look at the picture, there’s three images, the one in the left most image once you have the person stacked on their sit bones, you’re going to take your Louis kind of knuckles.
I usually use just the flat kind of inner phalanx of two fingers. And you’re going to place that approximately I’m not being really exact on any location, really, whatever real estate you can get in that upper cervical spine. And you want to allow the patient to drop their chest and go into the Capitol extension.
Why am I doing that? I’m doing that so that the tissue shortens and I can get a good investment of the tissue. I can hook, I can engage the fascia. I can sink into the fascia and then you’re coaching the patient to start a lift. The sternum, descend the scapula by engaging the rhomboids lower. And drawing the cervical spine back.
So they’re a long gating, the the posterior part of the cervical region, especially those lower cervical structures that we’re trying to to engage. So they’re doing that while you’re descending and gliding through the tissue. So again, just initial setup, they drop the, they exaggerate the posture, so you can get a hook on the tissue.
And then as you’re drawing that tissue down, And elongating, they’re doing the movement, bringing the cervical spine back and opening the chest. So you’ll see that in the technique, these just give you the kind of rundown and the instructions for that. But let’s look at the video.
this technique is a combination between the manual work that you’re doing and also the movement of the patient. So you want to coach them with the movement, first of all, so have them drop the chest. And serve a call extension. So that’s going to be the starting position, starting them with bad posture.
And then they lift the chest and the length and the posterior cervical spine. So they start an extension with the chest dropped and then lift the sternum, like in the back of the neck, the chin comes in. Many times patients will have a difficult time doing that. When they go to lift the sternum, the loss of go more into extensions and some patients you have to coach them to the movement of this technique is really a big part of it to starting them.
And this position is it let’s come back to neutral. I’m going to gently place my fingers up towards the occiput. Just any area of the cervical spine that I have access to. I’m going to take them into the starting point. That will shorten the tissue. It allow me to get a purchase of the tissue and now it’s a pin and they start to come out of that and I’m stretching the tissue in the posterior cervical spine associated with urinary bladder.
and another pass maybe slightly lateral or slightly medial is again, place your fingers on the deck. Take them into the starting position. That allows me to get a hook last meeting the hold of the tissue, because it’s in a short position now, as I bring the tissue to known where they come out of that position, lifting the sternum, bringing the chin, like the need of the posterior part of the neck.
And I can take it all the way down through the upper part of the thoracic spine.
all right. So this is a supine version. I guess time to the seated extensor technique. So in this one, we had the patients who I’m limited the ability for them to be as involved in it, by dropping the chest, by lifting the head. So it takes away a little bit of the re-education aspect, but at the same time, there are next, a little bit more relaxed or they’re in a more neutral position that way.
I can still take them into capital extension with them in capital extension. I can sink into the tissue pretty close to the occiput. And as I bring the tissue down and start spreading downward, I can bring their neck back into a neutral position. So it’s a little more passive on the patient’s arm and the seated.
so it might be appropriate if there was currently neck pain, that they were having a harder time in the seated position, or if you just don’t have time to put them into a seated position or to use the time of their place,
the two movements. With the hand where you’re bringing them in to flection
lengthening the posterior part of the neck. The other one with the other hand, simultaneous where you’re spreading downward descending, the aging.
So a question about how many times, or how long would you do this technique? It’s a short technique, two passes, three passes. You don’t need to do it really more than three passes. If I were to doing multiple passes, I would probably move slightly lateral or slightly medial and cover the same region but tissue that’s slightly medial to the first pass or silent lateral to the first.
These are short techniques. There are supplement to the acupuncture. They don’t need to be something you spend a lot of time with something else, especially with the seated technique that might not be apparent is when I was following the person, as they went into a kind of exaggerated drop chest capital, a extension I’m not cramped.
I’m not digging my hand in as deep as I can. I’m really just following it’s more of a pivot point is you’re guiding them and following you’re not trying to force them into that position. So I’m not using a lot of pressure. By doing that, I get a hook on the tissue and the pressure really comes from when they start coming out of that position.
So you don’t need to use a whole, a strong ton of pressure with it. It’s a pretty gentle. There’s four, so they’ll feel it, but it’s not anything that you’re driving them in or trying to sorta mobilize the spine by doing it. So it’s more just following, Hey, Brian. I also saw that same question about the needle techniques.
So I think I’ll go ahead and address that as well. Do you want to go to the next slide? Just so people can see that information?
There we go. It’s just has our information that you do, but general, we have a lot of these videos up there. We also post them on our Instagram account and Facebook page. So all sports medicine acupuncture. If you searched for that, you’ll find it. And then our webpages there. So to address the question about how often are you using the Chung goo lifting technique?
Until the patient actually has a really good command of the movement of going into prone, neck retraction. Once they have that, then you can go ahead and stop now. So we addressed this needling technique as basically for that forward head, but you can also use. This 0.4 disc problems, cervical disc problems.
Also, if there’s going to be tenderness to just in that local area, there’s an Oscher point. You can also just go ahead and needle that without actually the lifting technique is for when you see that forward head posture. But again, this point could be used for a number of different types of local injuries.
Brian, is there anything else that you want to add before we had. Just as the bounce off what you said. Yeah. It’s used when they’re, when they have that forward head posture. It might also be used when you say use that neck extension exercise that we highlighted and the person’s really struggling and they can’t figure out how to coordinate that movement to bring that portion of the spine back.
It’s very difficult. And actually I was teaching, I teach some online Teagan classes that was covering this today because there are people that do that very thing when they go to open the chest. Arched the neck up and you try to coach them and they have a very difficult time finding that region.
So it’s appropriate aseptic technique. It gives that a pointer to this tissue bring this back, without using words, they can feel that the noodle kind of pulling that region is oh, that’s what you’re asking me to do. You’re asking me to bring that back. It’s just, it becomes very clear.
It’s like a spotlight on that region. So yeah. Just use it, use the technique, but you might use it when you’re seeing people struggle with particular instruction that.
The guys that wraps it all up. If you have any questions whatsoever for Brian or myself, or you’re interested in the program or any of our classes and information, there’s our contact information that was there in those notes. Thank you so much for attending. Really appreciate it. I remember next week also, Sam Collins is going to end up being here.
I thank you again for the American Acupuncture council. And we’ll see again next, next month. Yes. Thanks everyone. Thanks everybody.