As our viewers can see the title of our talk today is Prolo acupuncture, and I’m guessing that stem from prolotherapy, but I’m not sure what that is. So you can tell us what that is.
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Hi, welcome to this week’s Facebook podcast show for the American Acupuncture Council. My name is Poney Chiang from neuro-meridian.net. I’m talking to you from Toronto Canada today. My guest is Dr. Anthony Von der Muhll who is joining us today from Al Cerrito, California. Anthony Von der Muhll graduated from the five branch university of TCM, 2002, and founded as Santa Cruz, acupuncture, orthopedic and sports medicine connect in three.
He now practices at the sports acupuncture connected in Berkeley, California. Anthony’s one of very few acupuncture in the United States with extensive experience serving as an expert witness for the California acupuncture board and civil mal. Practice litigations. He emphasizes the highest in safety.
Ethics is sustainability in his classes. He’s the founder of AOM Professional. Has taught certification acupuncture, orthopedics since 2015, he has served as a clinical supervisor at masters in doctoral levels for close to 20 years. And he has taught acupuncture, orthopedics and pain management programs at the doctoral level for.
Numerous, very highly prestigious academic institutions across the United States. I’ve invited Anthony to join us today for interview because he has a lot of experience with the, with orthopedics, but he does something that very few people talk about, which is using acupuncture to increase joint stabilization and increase joint mobilization.
So it is my honor. To have you here today, Anthony, my honor to be here. Thank you very much for the invitation let’s get started. As our viewers can see the title of our talk today is Prolo acupuncture, and I’m guessing that stem from prolotherapy, but I’m not sure what that is. So you can tell us what that is.
And how is pro acupuncture differs when. Yes. Yeah. Great question. Yeah. This name, Prolo acupuncture is basically what I call it. There, isn’t a a defined name for this technique in some classical text, but the technique has its correlates in ancient Chinese medicine. As best we can tell, or at least I can tell from reading descriptions of kneeling techniques, but I happened to learn it through a rather different route, which was another acupuncturist.
Who had studied extensively with I think primarily osteopathic physicians. The acupuncturists I learned from was Alan Marcus, who is now retired who specialized in orthopedics and what he learned from studying with some osteopaths and sports medicine physicians is the technique of probing lax, ligaments, and joint capsule.
To bring about tightening and re stabilization of the joint. And the same technique can also be used to remobilize a joint that is lost range of motions, say through adhesive capitis or joint contractual osteo. Although those are more difficult to treat than a joint that is simply lax in a, in, one or more planes.
And so the derivation of the name again is, proliferative therapy is the term is used by physicians who use this technique. Typically they’re injecting an irritant solution of some sort like Dex or salt water, or sometimes they have cocktail like MSM or Conroy and sulfate and they’re.
But a lot of the effect is actually from just simply the needle itself is the mechanical and various neuromuscular reflexes that occur from. Needling into particular tissue. And so it can be done with a dry needle, an acupuncture needle, a filoform needle, or sometimes occasionally a seven star needle.
Interesting. Are there any indications, counter indications for this type of technique? Yeah. Good question. So the indication is very simple, but it’s not intuitive. The indication is simply a joint that has an abnormality either hypomobility or hyper-mobility in one or more planes, not pain.
And so that I’m emphasizing that at underlining that because we are so wired by our training and education to to think about only pain and to respond to patient’s complaints about pain. But pain is a complex multifactorial phenomenon and there’s all kinds of ways to treat pain. But this is a technique that is very specific to restoring the function and the integrity of joints, which in my clinical experience.
And there’s a lot of, other clinical experience and evidence to support this, that joint hyper mobility or hypo mobility. Can be at the root of a lot of chronic pain and disability. So in some sense, it’s an indirect method, but the benefit of focusing on the joint rather than on pain is that you’re improving structure and function.
You’re not just providing temporary relief for addressing psychosocial factors that contribute to pain, which are important, but. Pain tends to come back until you improve structure and function in certainly in my experience. And so that’s why I gravitated to this technique is that it seemed to have a longer lasting effect on not just symptom relief, but actually bringing somebody back to their full functional capacity in everyday life work, et cetera.
That’s very interesting. Yeah. I I never thought about, stability or instability. Independently from pain. And it’s definitely making me very curious about the your method and your instruction. I’m curious about you mentioned seven star and needles.
So we can use this with our existing toolbox. There’s no special, copyrighted trademark products. I have to buy to, to take these courses. Okay. That’s very cool. Having said that, are there certain tools that you find work better for this. Sure. Sure. That’s a great question. So the one thing that’s a little different from what many of us are, were used to or experienced at say the master’s level training is that in general for probing deep into larger joints, we often used need to use larger gauge needles than some of you might be comfortable with.
And certainly I was comfortable with initially. And I’m talking, for example, a very large joint, like the knee joint, where we can do a lot of good in restabilizing a stretched out sprained anterior crucial ligament. I may use a 24 gauge needle. That’s much thicker than the 32 34 36 that are common in in more superficial acupuncture.
Using, classical locations. But the thickness and the stiffness of the needle are important because I don’t want that needle to bend or worst of all break off inside a joint. And I actually have better control and ability to direct the needle that might sound like it would be much more painful.
And actually repeatedly from both patients and my fellow practitioners to whom I’ve taught this technique, the response is surprisingly, it actually does. It feels different. It’s more like a blunt probe and a little less sharp and pokey than a very thin gauge needle. So it’s not necessarily any more painful.
It’s just different. So what type of a gauge are we talking? That’s at one end of it is a, a very large joint, like the hip or the knee on a large patient. I may need, I may reach for a 24 gauge needle, but more typically I’m using, a 30 gauge needle, a 28 gauge needle on small joints, like the fingers, a 32 or even a 34 will work.
Okay. But a deeper, larger joint needs a stiff. Thicker gauge needle to be both safe and effective in my experience is is the technique completely manual or is there like electrical stimulation in conjunction or depending? Sure. Good question. The answer is no, it doesn’t depend on anything else.
Besides the mechanical probing with your hands electrical stimulation can be useful for a patient who does have a lot of pain at the site of the joint hypermobility or hypermobility, but the essential technique. Itself is one of the reasons I began using it is that it works very fast. Under a minute worth of probing with a needle, and then you can take it out and you’ve accomplished your entire treatment effect.
You don’t need to retain the needle. On a very a joint that is badly sprained with, multiple planes that are hyper mobile. I might spend, four or five minutes, probing around till I get the joint stability I’m looking for. But again, once this is a. There is a, an immediate response that I’m looking for.
I can probe for a minute or so, withdraw the needle and recheck the joint through a manual technique called joint play testing, or end field testing. And I get immediate feedback. It’s oh, it’s either more stable or it’s not, if it’s not, I. Probably just didn’t quite get the angle. Right? Didn’t get the needle into the right location.
I can go back in probe around a little more, but with a little bit of experience, you get very fast and accurate at knowing exactly where to go with the needle and getting that re stabilization, take the needle out. You can move on to the next joint, or you can do something completely different. You can, do GU hour cupping or herbs or, treat a different condition like their I or whatever.
So I do retain the needle though on a patient who is experiencing either a lot of post needling discomfort or is just in severe pain and then I’ll hook up the electrical stem and that will provide some additional, that’ll provide the pain relief, but it doesn’t really, it’s not necessary for the effect on restabilizing or Reil the.
To help our viewers visualize, can you describe a little bit of what you’re doing with your hands? Certain change, intensity you’re feeling for, are pecking, are you going through resistance because most people have not learned this technique and we’re not asking you to teach us, but give us some idea.
What is the technical feel or the sensation that you expect the patients to feel while you’re operating this method? Sure. That’s a great question. So the technique there are basically two methods of physical exam that, that. Guide me to where the needle needs to go. The easiest one that comes, that is you need the least training for essentially is simply palpating the joint for tenderness.
And typically it’s the joint line, the crack or crevice in between two bones that span by ligaments and joint capsule. That’s where the palpation is most instructive. And for example the medial knee, extremely commonly sprained, the medial tryout of MC ACL and medial meniscus palpating along the tibio Foral joint line to find where is it most tender in its medial aspect tells me exactly where I need to go.
And then I will take that needle and I’m often asked a question, what’s the right angle is the angle that you need to get into the tender area. That in occasionally you have to be careful about bypassing a major artery, the hip joint, for example, we have to avoid the femoral artery.
So there’s some safety considerations there, but most joints, most of the time, it’s simply finding the tender aspect of the joint line and inserting directly into it. The second method that allows you to verify whether or not your technique has been effective is what I mentioned earlier. The joint play testing, and probably the best way I can do this actually is the, I’m just.
It’s basically a two handed technique, but I can grab a needle here and give you an idea of how I would do this. For example, say on my own, say I, sprained my thumb. And I wanna restabilize an inter financial joint there. And so I will, and it’s perfectly safe to do this on an uninjured joint, by the way.
So if for some reason, your history and physical exam guide you to a joint that doesn’t need this, you’re not gonna do any harm as long as you follow basic safety procedures of clean needle technique. And like I say, occasionally avoiding a major artery that’s in the area. So I’m gonna take my uninjured thumb here and I’ll show you how this would work.
I can palpate along the joint line, say, oh, ouch. And what I’m really looking for is a patient. I actually watch the patient’s face while I’m doing this. Cause what I’m looking for is reflexive unconscious, involuntary grimacing or wincing, not just them telling me verbally it’s tender, but I want, I’m looking for something like this.
I press in the joint line and they go, oh, Wow. Yeah, that’s it. That’s where it’s really sore. And then this is counterintuitive. I know, but remember, I’m not treating pain here. I’m treating structure and function. I’m gonna go right into that tender area. Will it be sore? Yes, actually. That’s how I know that I’ve got the needle where it needs to go.
Is that the patient says, oh, you’ve got it. You’ve produced my typical symptoms. That’s the bulls. And then I know I’m in an injured ligament because uninjured ligaments in joint capsules, oddly enough, won’t really hurt that much. You’ll feel a little poke as the needle goes through the skin, maybe a little pressure, a little mild achiness, but nothing beyond that.
But when the patient goes, ah, that’s it, that’s the pain I’ve been feeling. I know that the needle is where it needs to be. And then I can probe around a little bit pecking, but it’s not hard pecking, it’s more probing. And then. Like I say, typically within a minute, I can just take the needle out, recheck that joint and it’s rest stabilized.
I see. No, that’s very helpful. Thank you very much. Do you find that there are certain joints that you tend to apply your technique more often than others? Like the, for example, in other words, like other which joints in your clinical practice, do you find the most? Unstable and most able and or, or most hyper mobile.
Yeah. Great question. So the I’ll just mention three joints that really were where I first started using this or that really got my attention. I was introduced to this technique by being a demonstration patient for Alon Marcus. Some gosh. 1520 years ago where he, I was having a lot of chronic low back pain at the time.
And he needle into my posterior SAC, IC ligaments along the SAC IC joint line. And, within a couple minutes of probing around the needle, he took it out. I stood up off the table and I was like, Wow. I have never felt an acupuncture treatment like this. Not only was the pain down in my back, but my entire posture from head to toe felt completely realigned in a way that was more comfortable.
And required less energy and essentially to stay standing and that lasted for a good week or so, and then slowly dissipated. Like all of our acupuncture treatments, it does need to be repeated sometimes, but I was so I, I had felt completely different that I was like, wow, I wanna learn something about this, but the two joints where I’ve actually probably used it the most commonly that where I saw the biggest difference in.
Patient’s clinical outcomes was, number one is the acromioclavicular joint that small little crack in between the clavicle and the AROM which is very superficial, easy to find, easy to needle into safe to needle into as long as you don’t needle immediately towards the lungs. And I began to, I was having a lot of trouble with, chronic rotator.
Shoulder, pain and dysfunction and so on. And I was like, oh, that’s right. There’s that technique that Alan showed me, let me try that on the AC joint. And right away, I started getting, instead of 60%, improvement, et cetera, Mo almost invariably, most of my patients. I found through joint play testing had a loose AC joint that they weren’t even aware of.
It was not painful or symptomatic, but needling into it. Suddenly we got stability of that joint full range of motion in the shoulder. Very often, sometimes there was still some range of motion deficits coming from the GLE humeral joint, but improvements in range, muscle strength. Verified through manual strength testing very frequently, fully restored or greatly improved.
And interestingly neck pain also going down because the upper trapes is attaches to the clavicle. And when that joint is hyper Hoag and not stable the muscles around it, overcompensate and tug on the neck. Wow. One needle, one joint, huge regional effect. Couple of minutes worth of probing. Big difference.
Objectively verifiable that lasts sometimes indefinitely from a single treatment sometimes needs to be repeated a few times, but typically will last for months or years without any repetition. After an effective re stabilization. The other joint I’ll mention very quickly is the ankle similar, easy to treat, easy to.
With effects up and down the biomechanical chain from the hip to the foot improved by restabilizing a hyper mobile ankle joint.
Very fascinating. So it’s you have to, if you’re scaffolding, your foundation is compromised, then your muscles are not gonna properly. Improperly it’s different.
Are. Able to share us with us a inspiring clinical story that you’ve had recently, perhaps your practice or from teaching where it was something that, was very transformative. It made a difference. And wasn’t for this technique. Yeah. Yeah. I’ll mention a patient in her mid seventies that I’m actually currently treating , who a long time ago she was in her twenties.
So 50 years ago was an. Obese large person fell on her from, and sprained her superior tibio fibular joint, a small joint. That’s actually part of the calf, but where the superior part of the fibula articulates with the Tal Condi and also sprained her ankle. So she had a she fell sideways onto the ground with this person falling on Herra her superior tib joint, and her ankle.
And her. Couple of small midfoot joints as well, and has been in somewhat chronic pain ever since in her leg. And it’s affected her back and her neck, et cetera, 50 years ago. And and comes to me. And she happens to be medical professional herself has tried a number of different modalities, nothing really helped.
And I should say, this is why this technique is so important because there isn’t really any other technique that can restabilize a hyper mobile joint. You. Repair and replace it surgically, you can inject cortisone to reduce pain and inflammation, but actually changing the function structure without surgery.
This is really the only thing. Guha cupping manual therapy. Won’t do it. Distal kneeling. Won’t do it. So anyway, so I evaluate her calf and your ankle and go, wow. You’re on your superiority, fib joint and your lateral ankle ligaments. Small joint called the Calkino cuboid joint and the spring ligaments on the medial arch of the foot.
All of these are hyper mobile and stretched out from that single injury because they were never treated locally with this type of technique. About three or four minutes a couple of minutes per joint, again stands up off the table. It’s wow. My leg feels completely D.
And I recheck all the joints. Everything is stable. don’t see her for a month. She comes back in, everything’s still pretty good. The superior tib joint needed a little bit of tune up a little more kneeling, but I didn’t have to treat the ankle or the foot joints again. And then I see her, three or four weeks later and she’s can we work on something else?
Now? My life’s doing pretty good. I can. Yes. I love it when you get that oh, by the way, can you also treat this? And it’s yes. Got it. That’s that was super enlightening. I can’t wait to study with you. So if somebody like me wanted to study with you, where can we find out more information? Sure.
Thank you very much for asking and I’d be happy to work with anyone on this technique. My website is www dot a as in acupuncture, O as an Oriental medicine. And I know this is a been a standard term and I’m in the process of actually changing everything in my notes and eventually my website.
But right now it’s www.AOM, A as in acupuncture, O as in Oriental M as in medicine, professional, all is one word AOM, professional.com. And that’s where you can go for information about live webinars, distance learning classes, and returning to in-person teaching this summer, after a couple years off for the pandemic.
Excellent. Thank you. Once again, I’d just like to thank you for your time on behalf of the American Acupuncture, Acupuncture Council, and and to all our friendly viewers out there. If you have any feedback please comment. And and we would love to hear from you. Thank you very much.
All right. Thank you all for your time too.