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Treatment Considerations for Myofascial Trigger Points



So we’re gonna be discussing some treatment considerations for myofascial trigger points, how to incorporate them into the treatment, a little bit of comparison between those and motor points.

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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. Thanks for joining us everyone. And thanks to American Acupuncture Council for having us back. I say us, but Matt Callison is not joining us today. So it’s just me and our guest, Joe Bickle, Joseph Bickle, and I’ll introduce him in a second. Sorry, Matt’s not here. He had a little incident with food poisoning, so he will feel better soon, hopefully.

But didn’t really feel up to being in on the webinar today. So we’re gonna be discussing some treatment considerations for myofascial trigger points, how to incorporate ’em into the treatment, a little bit of comparison between those and motor points. So it’ll be a really nice discussion that Joe and myself have.

So let me introduce Joseph Bickle. He is graduate of the SMAC program, Sports Medicine Acupuncture certification. So he’s a C.SMA. He also took classes as I did in Myo pain which goes through some various trigger point protocols. I haven’t taken all the classes. Joe did take all the classes, so he certified through Myop pain.

So we’ll have a little common language we can discuss and maybe talk a little bit about that training also. Joe, do you wanna give any background of how you, we can get more into specifics in a bit, but how you incorporate or what you do and where you work and Yeah. So I work primarily in two different locations in Minneapolis, St.

Paul area. I work as part of an outpatient program attached to the Allina Health and Abbott Northwestern. And then I also do supervise at the local school Northwestern Health Sciences, their human performance center, where we focus primarily on treating athletic conditions. Obviously treating there.

But my patient population tends to be more of the chronic pain and or chronic orthopedic conditions throug

h the Allina Health System. Great. All right. So we’ll jump right into the discussion. We’ll start with a PowerPoint. We’re not gonna have a PowerPoint for the whole whole webinar. But we wanted to start with just a little brief discussion on A comparison of motor points and trigger points.

These are not such a black and white, easy comparison to make cuz there’s a lot of crossover. And on top of that, there’s a lot of discrepancy on how people describe a lot of these things. So they’re not even always clear delineations between the two. But just since a lot of people use motor points, a lot of people use trigger points, some people use both.

It’s nice to of get a little. Into the the different slash similarity comparison. So let’s go to the first slide. Gimme just a second.

All right. There we go. Sorry about that. So we’ll start, like I said, this comparison, but then once we get through the. The PowerPoint, we’ll start talking about some key kind of areas referral patterns, a little bit about how to assess for trigger points, including them into the treatment. And then one of the main things we wanna talk about today is is dosage.

So how much stimulation do you give? Are you looking for a ation, the duration of treatment? So I know I’ve had a problem and I talked to Joe about this. Sometimes I’ve overtreated people and they come back and, Oh, they were so sore, And it’s little soreness is one thing but you can definitely overtreat.

So being able to judge how much that person can tolerate is really important. And I know all of us know that from Chinese medicine, but looking at it from this little more my myofascial stimulation is really an important topic. Let’s go into this. Joe, if you have anything to add, we’ll just talk about it, but we’ll just get through these like early slides to start off with.

Anything to add to that now or we’ll get, I guess we’ll probably getting into it as we go. Yeah, I just guess would just like to emphasize that it really, it can get a little confusing motor points versus trigger points. And so for anyone listening who has feel that way, you’re in good company.

Yeah. Excellent. So what is a, let’s start with a motor point. I’m gonna use the term motor entry point. So motor points are described not consistently inco inconsistent descriptions of. A lot of the more precise language is using motor entry points, cuz this specifically tells you it’s where the motor nerve enters or penetrates the muscle.

So what you’re seeing in this image here is a picture of the flexor carpials. So what’s being held there with the gloved hand is the ulnar nerve, which is traversing down the for. But then you see that little collateral branch that the hemostats are pointing to. That, that collateral branch is going entering right into the flexor carpials.

That’s gonna be about a third. If you drew a line from heart from s si eight to heart seven, and made that line divided in thirds, that’s gonna be the proximal and middle third junction. Thereabouts. It’s slight variability on pe, person to person, but it’s pretty consistent. It’s a pretty consistent location.

So that’s gonna be the motor entry point, and we’ll talk about other terminology here in a second. So not really all always agreed upon, but that’s the definition that I like and that I wanna use and that we tend to use in the sports medicine and acupuncture program. Whoops, let’s get. All right, so once the motor nerve enters the muscle though, then it bifurcates and sends branches out, usually approximately in distally, and those branches terminate somewhere in the muscle and some languages some descriptions.

If you look at research, we’ll talk about those as being intramuscular motor points, so areas where the motor nerve after it bifurcates and travels for. Depending on the muscle and the person and all that, it’s gonna D terminate at that intramuscular motor point. So that’s a motor point also. But that would be an intramuscular motor point versus the motor entry point.

So in this image, if you can look somewhere in the center, this is the hamstrings. Somewhere in the center you’ll see me P. That’s the motor entry point. That’s where the sciatic nerve sends off. A branch enters the muscle, penetrates in the muscle. Then dlp, plp, I forget what those stand for.

Proximal and dis. But basically they’re talking about the termination place within the those branches that go distally and proximally and then terminate at the intramuscular motor point. So that’s something that we can talk about and maybe from there, make a comparison to trigger points. And Joe, I don’t know if you wanna jump in here and add any thoughts to this.

Yeah, I think that’s, that sums it up pretty well as far as the main differences that I’ve seen and that I work with where the motor point is, motor entry point tends to be a lot more predictable. Like you were saying, how you’re mapping out the flexi, carpal nas whereas the end plates can be a little bit less predictable and therefore more palpation based.

But otherwise I would agree. So would you say, and this is the way I see it trigger point. When we define a trigger point here in a second, trigger points can exist anywhere in the muscle. So this is showing the biceps for Morris Longhead motor entry points somewhere in the center. The muscle, it’s pretty close to UV 37, just lateral to UV 37.

There’s another one too, the couple different motor entry points, but this is the main one. And then those junctions that send out intra muscularity and terminate at where it says PLP and dlp. Those would be the area where there’s motor in plates where there’s receptors for acetylcholine.

That’s the neuromuscular junction. You can describe it in structure. You describe it in function. That’s where the discrepancy between neuromuscular junction and motor in plates comes in. But in trigger point language, they mention that trigger points tend to form at the highest concentration of motor implants.

So in my mind, that would be at these intramuscular motor points, even though they don’t have these mapped. I don’t know how variability, how much variability it is. Maybe someday there’ll be all these maps that say, Oh, okay, here’s where the distal intramuscular motor point is of the biceps, or more.

I doubt it. It’s probably much more variable than that. But this would be the relationship in my mind is there’s the motor entry point where the muscle, where the motor nerve enters the muscle and then the intramuscular motor points that terminate somewhere that’s probably less predictable in each.

And those would be sites where the trigger points tend to form. They could also form really at the motor entry point. It could form anywhere in the muscle, but those are gonna be the key areas. Yeah, I would definitely agree. It definitely seems like there is some predictability to those, to the end plates.

, but I don’t, obviously I’m, I would assume things like activity, how athletic the person is, their movement patterns would have an impact on those locations. So Yes. Yeah, I would. It is interesting that you mentioned predictability cuz for those who used trigger points and have looked at Janet Trevell and David Simon’s book Myofascial Pain and Dysfunction Trigger Point Manual.

In her early additions, up until just recently into the recent edition, she had Xs not because they were definitive locations for trigger points, she made it clear that they could exist anywhere in the muscle, but she had Xs just clinically being a very skilled palpate and c. Of areas where you tend to find trigger points, it tends to form here in the muscle.

The kind of go-to areas that that wasn’t trying to imply that they would always be there, but they were go-to based on clinical experience and just seeing a whole ton of patients. In the recent addition of that, they took those x’s out, which I don’t know, I could see an argument for it.

Cause you have to palpate all through the muscle and. But I kinda like the X’s. I don’t know. . How do you feel about that, Joe? I see two sides to that argument. I actually like them not there because it does force the practitioner to palpate , as opposed to one, I think one thing acupuncture specifically can fall into a trap on is they’re used to that precise location.

Tell me the measurements and then I can find. And they can lose that ability to palpate exactly what they’re feeling for. Yeah, for sure. And that’s, I think the reason, not for acupuncturists per se, but that’s the reason they weren’t taken out. Yeah. But yeah, as I understand that is why yeah.

If you do work with trigger points a lot that you will find that they tend to be not, I wouldn’t say predictable. Yeah. It tends to be go-to areas. You tend to find some consistency. But, that’s the trap. You’re right. Is. Can then start to force yourself to think, there should be a trigger point here cuz the pain referral or whatever.

And you don’t palpate carefully and end up missing something that if you were to be more open minded, open, open possibility about it, I think you would just not get Huang up on trying to force it into that location. Yeah. All right, so then motor entry points, intramuscular motor points.

Trigger point is a hyper irritable spot in skeletal muscles associated with hypersensitive, palpable nodules and a taught band. So when you’re palpating for a trigger point, we can talk about what that refers to. The spot is painful on compression and can give rise to characteristic referral, pain referred tenderness, motor dysfunction, and autonomic phenomena.

So that’s the definition from Trave and Simon’s book. And it’s a mouthful in and of. . But that tells you that there’s a hypersensitive, palpable nodule there. So whereas a motor point is, or especially motor entry point is an anatomical thing, you have that, whether there’s dysfunction in the muscle or no dysfunction.

It’s there. It’s, it might be slightly there, variable from person to person, but it’s in a relatively consistent location that the muscle’s in dysfunction, the motor point’s there. If the muscle’s healthy, the motor point’s there. It’s just part of your anatomy. Whereas trigger points are talking more specifically about dysfunction, they could form at a motor entry point.

They could form at the intramuscular motor points, They could form somewhere else in the muscle, probably most likely at the intramuscular motor points. But they’re they’re a sign of dysfunction where there’s hyper irritability and there’s characteristic referral patterns and other phenomena that you see with it.

Good. Joe, I’m gonna move on unless you wanna add something to that. No, I think that summed it up pretty well. All right, so we’ll come back to this we’ll take the PowerPoint away for now. We’re gonna come back to this when we use an example later and discuss the Quadra Lium. But just glancing at it for now, you can see these characteristic referral patterns that are mapped out when you’re looking at these referral patterns.

You. If you don’t know the mapping, there’s something that you wanna know about ’em is that dark red doesn’t indicate more intensity of pain. The dark red indicates more of the Tendency of where those muscles refer to. And this one is from an old edition. It has the X’s in there. Modern ones don’t have the newer edition doesn’t have that X, but don’t worry about that so much.

But that characteristic darker red area is where you’re gonna more commonly see that referral. And then there’s the spillover, speckly red that could be just as severe pain at those spillover areas, but they’re less frequent, less frequently gonna be experienced there. So that’s what the mapping is.

So let’s bring the PowerPoint away and we can come back to that in a. All right, so exit this out so I can see Joe. There we go. Good. So we talked a little bit about that difference between motor points and trigger points. So let’s look at how you would incorporate, if you’re using motor points, how you would incorporate trigger points in or even if you’re not using trigger points.

How would you incorporate, what would you be doing? What would lead you to think trigger points and how would you make that a part of your treatment? Sure. Just looking at the mapping that Traves done, I think. L thinking about it from someone who is new to orthopedics or new, certainly new to trigger points.

I think that’s your first go to is based on patient symptom presentation. And then that’s gonna narrow it down. So if we’re looking at the QL as an example, it’s lighting up parts of the hip, parts of the si. There are gonna be multiple muscles that do but it does give you a way of zooming in relatively quickly to Alright, I’m gonna start thinking about glutes.

I’m gonna start thinking about ql. And then you can also, if you’re more orthopedically inclined, you can start thinking about. The spine and other things as well. So that’s a good first step. I think a good second step would be reading some of the traves information. She gives a lot of more specific symptom presentation and as well as other ways to incorporate.

So talking about the relationship between glued trigger points and their effect on QL as well. And. Another good way of starting would be active and passive ranges of motion. I know when I first started of getting into this, that was a very nice, like just memorize how the body can move and then have a patient see what they can and cannot do and incorporate that into a pre and post exam.

And then lastly, I’d. What I’ve been talking about before, help patient, the more you can get a feel for the tissue, it’s gonna lead you in a direction. . Yeah. This is the trick with those who use motor points. The trick cuz there is crossover cuz in sports medicine, acupuncture in the certification program we tend to use more discussion of motor points and we use a lot of the same thing, range of motion.

Looking at muscle inhibition, that could be something. I know trave talks about muscles becoming inhibited when there’s trigger point formation in there, so there’s definitely a lot of crossover. Yeah, in the sense that, if somebody has limited range of motion in the upper trapezus, for instance, so I go with the motor point, or do I go with the trigger point?

What’s my. What’s what’s going to be the thing that leads me to one or the other. And they can be the same thing cuz the trigger point might form at the motor entry point location. But let’s assume it’s a little off the motor entry point location. Which one do I use? So what’s your way of differentiating those, even though there is so much crossover?

What’s your way of differentiating those usage? Sure. I guess I tend to look at it and especially this is gonna. Feed off of my smack background, but motor points tend to, or I use them more so for global aspects of treatment. So looking at the posture, like if we’re talking about bet trapezius, upper cross syndrome, know, I’m definitely gonna be thinking more motor entry point.

Whereas if the patient’s coming in for. That temporal rams horn headache I’m gonna be specifically thinking, All right, I need to feel the upper trapezius, find some trigger points in that region or not advanced that, that are almost recreating those symptoms. That’s a good bet.

If you’re finding a 10 point that’s saying, Oh, wow, yeah, that, that goes right to where my, I typically have a headache. , That’s why I’ll tend to lean in on treating the trigger point specifically over the motor point. Yeah, I gotcha. Let me say it. Tell me this is because I, this is what I heard, and this is how I think about it too.

But let’s use back to the Upper cross syndrome patients coming in with headache neck pain, maybe cervical type headaches, tension headaches that are coming up the cervical spine, and then radiating along the gallbladder channel to the temple. So knowing the trigger point referrals, upper traps would be one of the key structures that I’d wanna look at for that.

However, they have upper curl syndrome. So once I’ve diagnosed and assessed that, that posture and I can see that posture’s part of that pain pattern, I could choose motor points such as the OIDs, lower traps to help re return some. Awareness to that area so that the person’s able to engage them, especially if I give ’em some exercises afterwards to help engage that.

I might include Peck minor as a way to let that peck minor soften. It’s not what’s causing the pain, it’s not the direct cause of the pain, but it’s part of that that postural symptomology and then the upper trap sugar point to speak almost directly to that pain referral. Yeah. Yeah, I definitely consider it like trigger points to be like the branch treatment of to use a Chinese medicine term, the branch treatment of kind of assessing those like postural and mobility issues where the trigger point itself is a symptom of what, what’s going on underneath.

But it still needs to be treated, and Thank you. So you’re incorporating, I need. This trigger point, this exact one part of the region of that muscle. But I also need to balance that with motor entry points to create a more global effect. , I know. And leading up to this webinar on Facebook there was a question about needling motor points.

Will that release the trigger point or will that have a clinical effect on the trigger point? So should there be, and I think this is gonna be very opinionated by the way, but should there. If you find that trigger point in the upper traps, should I needle the motor point, assuming the trigger points at a different location?

Should I needle the motor point to release that trigger point in the upper traps or should I go right to the trigger point? Sure. Any thoughts on that? I think this would actually this would lead into our conversation about dosage because needling into that trigger point is gonna have a certain level of sens.

Versus needling into the motor point. . And to me that becomes a question about who’s sitting in front of me. I think there are times where I would say needling the trigger point is exactly what you need to do. And there are other times where I don’t think that’s a great idea. I think just balancing the treat, focusing more so on the bilateral trigger point or bilateral motor points, and then postural issues might be a better approach depending on who’s sitting in front of you. Yeah. Gotcha. It’s interesting the idea of trigger points. I’m gonna make a comparison to something. I do, I’m in Florida, so I can do injection and I use.

Modified like buffer, D five W 5% dextrose and sterile water, which could be great for trigger points. I use it for trigger points. It’s also used for ural injection. So when you’re working with cutaneous nerves, so a lot of pain syndromes, you can palpate these cutaneous nerves and do very superficial injection.

And using the D five W to desensitize some of the nerves because the idea is that when nerves are absent when there’s glucose, oxygen deprivation, when there’s pressure on the nerves, they, they’re not getting oxygen. They’re not getting glucose. Dextro is about the same thing. You can desensitize them with this dextrose solution, bathing that area and this Dex solution.

And the person who who really spearheaded a lot of this work is MD and New Zealand. And he uses it really comprehensively for a lot of different things, even like sciatica. And it’s like you’re desensitizing that most distal portion. Of the nerve. It reminds me a little bit of distal points in acupuncture, even though they’re, these aren’t, know, it might be around the knee or wherever the pain presentation is, but it’s almost like desensitizing that end of the nerve kind of, refers back to that neurologically back to the main unit.

I of feel like trigger points are a little bit like that too, versus motor points is sometimes you wanna use the motor point, which is gonna affect all the branche. Distal from that, all the intramuscular motor points. But I wonder if it has like a little dispersed effect. It’s effect is dispersed among all of those, which is very regulatory versus sometimes you need to zoom in right at that most distal branch that’s irritated.

Yeah, exactly. And I to play off of that, I don’t think there’s anything wrong with saying, All right, let’s try the, let’s try the motor entry point. , and then reassessing the trigger point and saying, Howard, how’s that feeling? Now that I’ve done. I think that’s a good thought process to be going.

Yeah. Gotcha. On that topic, and you already started getting into dosage, I think we should probably go into that. Could you define dosage again, cuz it’s a term I hear in acupuncture world, often when people hear dosage they think medicine, which is medicine.

Medicine can. Yeah, it can be a little tricky. I’ve broadened my definition quite a lot in the last year. So I considered anything that’s, Going into the treatment. I think the way it gets talked about and has been researched the most is number of, treatments within proximity one another.

So number of treatments per week but needle retention time, we talk about it in school, like the 23 some minutes and talking about cheese cycling. You can of get locked into that and stop thinking about it, but there’s definitely a difference between needling. Leaving a needle in for a minute, to five minutes, to 15 to 35 those are all gonna have a different effect on particular patients.

The amount of needles and then the amount of stimulation like we’re with, talking about trigger points, the local twitch response doing some type of manual technique on the needle. Eim, I think these all have a level of stimulation, a level of dosage. And they all do slightly different things. As an example, there are times where.

What you want to do is to get multiple local twitches versus another patient who’s gonna have a really bad reaction to that. And maybe Easton was a better way to go. But then even then you can of start building off of that. Or what are the accessory techniques you’re doing? What effect is that gonna have on your treatment and how often you need to be treating and how much needling you do.

If you’re doing a ton of mild fascial work, like we learn, like we learn in smack, how much needling do you really. I know going through the program we’d spend you’re spending like five minutes doing a tech a mile fascial release technique, and then you’d have you or Matt just being like, I just remind everybody you’ve already done the needling at this point, so you don’t have to do all that.

A ton of mild fascial work. And that’s an just an example of moderating the dosage and then what you’re giving ’em, what you’re giving them. As far as herbs or homework assignments I know there’s some interesting research that talks about using exercise to minimize that post-treatment soreness.

I certainly think if you’re incorporating that, you need to be thinking, how much work can I do with the needle versus how much work am I gonna have the patient do when they’re at. And yeah, I just think those are all different examples of what you could term dosage. Yeah. I also add a thought to that is that upper cross syndrome would be an example of this.

Somebody can’t tolerate a lot of needle stimulation. That’s a lot of needles to do. The rom boy major rom boy, minor, middle traps, lower traps, tech minor. Especially if you’re doing this bilateral. There’s a lot that goes. So I start to think distal points sometimes too. And think which channels are those, if those muscles are part of a sinia channel and maybe I can affect differently, maybe not as direct, but maybe I can affect those lower traps with the urinary bladder channel, a distal point that I might be using anyways. And I can have that have some regulatory effect.

I think its effect is gonna be a little bit more dispersed and its effect is gonna be stronger if that distal points there. Plus the local point. But, the person can’t tolerate, I can still of build energy in the channel to help that, relate to the lower traps in that case without having to needle ’em directly.

If I do need to minimize, or maybe to release the Peck minor, I’m gonna use a lung channel point that’s gonna have a little less less , impact. It’s not gonna be as strong of a needle sensation as going into the Peck minor with a, with a. Yeah. And I agree. You can have two, you can have one patient and then 30 minutes a nut later, another patient, same condition.

If we’re doing upper cross, you’re doing the upper trapezius trigger point and you’re gonna make it worse. Or someone else, you, if you do the upper cross, trigger point, you’re gonna make ’em way better. . And it’s just, I think the trick is learning how and when to do that. I do think there are some tales, but ultimately just building your clinical experience around how you’re, how patients are gonna respond to that.

But yeah, it’s a thing I love about Chinese medicine is that gives us, it gives us those options. If I can’t treat the trigger point directly, I can use lung seven. Yeah. It’s funny, I think when I’ve overtreated people, it comes down to this one thing. And I’m gonna use a phrase that I heard this in context from another educator used to teach with sports medicine, acupuncture Patrick Cunningham.

He discussion, he reminded it was, this was an online discussion, but it reminded folks about a saying they have in chiropractic, which is being addicted to the audible. So that case is trying to adjust and get that pop, and sometimes the joints move, but you’re like, I’m looking for that audible.

I feel like face situations are that, and this was his point, the fasiculations are that in the acupuncture world especially more sports acupuncture based world is getting addicted to that big muscle twitch. And sometimes that you put the needle in and boom, it’s right there. But other times not and, maybe you over overstimulate looking for that big muscle twitch because that’s what’s driving, that’s what you judge as being what’s important for the treatment.

Maybe their body’s telling you something different. I dunno. So when I have over, when dosage has been wrong, it’s for me, that’s what it’s been. Yeah. I’m guilty of that too. Certainly. Who doesn’t love just getting that like nice big pop of the muscle? Yeah. What was I gonna say based off of that?

Oh shoot. Escape me. But you said something that reminded me of that, but Yeah. I think. Certainly knowing when and how much and knowing that, I also like to say it’s like it’s not the worst thing in the world to over treat somebody. As long as you’re communicating with them like, Hey, I’m gonna do this thing, you’re probably gonna be sore one to two days.

Anything over that. I consider to be too strong. I’ve definitely had patients be like, Oh yeah, I think we did a little too much and then it’s, and then we move on. We know to treat, do a little less stem. But the point, I need to close with this cuz we’re running a little short on time, but the ations I do think is where it’s spending a minute or so on and I’ll mention my thoughts on it.

I don’t think there’s an answer to if you need a ion or not. I feel like the ion is, I. . But I think oftentimes we miss these very small background, quiet fasiculations, which is maybe what that person’s body needs. And I have some ways that I sometimes, like I, for Summit 36, if I’m using that for the tibialis anterior or just any tib anterior or motor motor point or trigger point, I’ll go down distally to about the liver four area and just go a little lateral, which would be right on the tibialis anterior tend.

Yeah. Sometimes you need all that region of oft anterior and you can clearly see and feel of ion, but sometimes you can’t. But you can fairly clearly feel like a little pull on the tendon and it’s I might have missed that on the needle and kept on looking for a ion. . And I think for some people that their body is that was the therapeutic outcome and I got it and I missed it if I don’t have a way of assessing it.

So sometimes I think when we talk about fasiculations, we’re not talking. , the spectrum of that muscle ion that can happen, that can be from almost imperceptible to you can physically see it. Yeah, sometimes we talk about fasiculations as it being that part of the spectrum is the parts you can physically see or right there you see it.

Yeah. Yeah. No, I think it’s important to understand that. Even the research is gonna tell you. Oh, like getting a twitch, it does have a response. It has a local response, has a global response. But searching for it can actually recreate a lot of the, in nociceptive increase the presentation of a lot of the nociceptive chemicals that you’re actually trying to get rid of.

Yes, getting the twitch can matter to a degree. , but it’s very easy to overdo if you go hunting for it. And I do think, like you’re saying, like trying to look further, like further distally or approximately along the muscle, looking for those small littler twitches is probably a smarter way to go.

Yeah. And also I think when it’s like that and it’s assuming you’re in the right location, sometimes you take the needle out, Repa. Oh yeah. I think I was just a little off. And you put it in, you get it right away, but sometimes you’re right on the right spot. And then sometimes you just have to use good needle technique instead of just banging away at the muscle.

You just coax Yeah. Little English on it. Yeah. . So I think that’s that’s been the change for me in treatment is not just assuming. I didn’t get the twitch because I’m in the wrong location and just keep on wailing away at it. But just to see that as the body needs a little bit more a little more mechanical stimulation, quiet stimulation in that area and let it come to the needle.

In those cases where it’s probably more of a deficiency case, know, Cause the excess portions you put the needle in and know, it’s, Yeah. It’s there. Yep. Yeah, I would agree. All right. Joe’s gonna be presenting at the 2023 specific sports in an orthopedic acupuncture symposium.

Maybe you’ll get a little more into some of this at the symposium. I know the dosage thing is a really interesting thing, and you’ve talked a lot about various research that, that discusses this, and I think that’s useful to hear it from that perspective. Hopefully more on that topic later.

Yes, that is the point. Oh, we were gonna talk about ql, but I think we’re probably a little short on time, so maybe we’ll leave it at that. We got a lot of good information discussed in this. All right. So thank you, Joe. Thanks for being the guest. Sorry Matt couldn’t join us. Thanks again to the American Acupuncture Council for having us.

It’s always great to, to be available for these webinar. And I didn’t get who is here next week, but I think it’s usually put up on the screen, so there we go. Awesome. So hopefully you guys can join next week and thanks again and see you guys another time. Thank you, Joe. All right. Yeah, Thanks Brian.