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Low Back Pain Treatment Protocols – Including DU 1 (Changqiang)



The point is DU 1. And in my opinion, it’s really quite underutilized. I’ve been doing a lot of research on it just because of the amazing results that you can get when you use DU 1 in combination with other points.

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Hello everyone. Thank you so much for coming to this American Acupuncture Council webinar. My name is Matt Callison. My esteemed colleague, Brian Lau, could not be able to make it. He’s teaching right now. There is a scheduling conflict, so I will be with you before this next 25, 30 minutes or so, discussing a topic that I thought was really quite important.

It’s something that we discuss in the Sports Medicine acupuncture certification program. In the pelvic floor aspect, module two. The point is DU 1. And in my opinion, it’s really quite underutilized. I’ve been doing a lot of research on it just because of the amazing results that you can get when you use DU 1 in combination with other points.

This is also gonna be something that I’ll be discussing in the symposium that we’re. Pacific sports and acupuncture or orthopedic acupuncture symposium coming up in San Diego, March 30th through April 3rd. It’s it’s a big mile fascial point. It makes huge, massive mile fascial changes and it’s a point that I highly encourage for people to to go back and use again.

Many people think about D DU 1 is. Rectal problems or prostatitis or hemorrhoids or something like that. But I highly encourage for people to think about using this point for low back problems, especially chronic low back problems. In the SMACK program, it’s really quite common that people will have low back pains since it’s such a common injury.

I’ll call one of the students up to the front. We’ll talk about their low back pain. It could be a Yon syndrome. It could be sac iliac joint pain. It could be anything that’s affecting their low back and all needle. DU 1, take the needle out and then reassess. They may walk around a little bit and it is often using the 90 percentile.

Reduced substantially. Now of course it’s gonna end up, that pain’s gonna end up coming back just because we’ve only treated one point for about 30 seconds. But the reason why I do that is to show the group that DU 1 is a substantial point to use and it makes Big maas changes an excellent point to use with other acupuncture points for low back pain.

So with that, why don’t we go ahead and get started then Let’s get into the, this first slide here. Again, I’m encouraging using D one into low back treatment pain protocols because of its massive ability to make big changes into the my fascia. All right, so to start with this, we’re gonna talk about the FAS continuum.

This is gonna be some text that’s coming from this article, and you’ll see the reference there at the very bottom, through a scientific review and a comparison of anatomy text. A factual continuum exists between the abdominal. The pelvis being the pelvic floor as well and lumbar wall and such knowledge can improve the understanding of referred pain pathophysiology.

Now, research has shown that deep fascial layers are well innovated and capable of transmitting mechanical forces from a distance. This is outstanding work from Helene Langin in 2002, and she continues to. To publish incredible articles on the efficacy of acupuncture. So what she’s saying is that with mechanical stimulation, like an acupuncture needle, there can be a transmitting of mechanical forces, a signaling along these mile fascial planes for some distance, just like what our founding fathers 2000 years ago knew about manipulating chi and having it actually travel along the channels and the collateral.

This concept of fascial anatomical continuity may have important clinical implications for the treatment of pelvic pain or even lumbar injuries. I thought that was really quite significant. Later in the article, it states lower back symptoms, might find their origin in explanation from pelvic floor disorders.

This new concept could improve the treatment of chronic pain and could lead to an important enhancement of current anatomical knowledge and therapies. They’re being really pretty safe by saying the word could there, from my clinical experience, is definitely a very important thing to be able to treat the pelvic floor, including DU 1 with low back injuries because of the fascial continuum.

In addition to the communication between. Pelvic floor, the abdomen, the multifidi, and the respiratory diaphragm. More in that is just a tick. Let’s go ahead and take a look at some more work of Helene Lango bins

now because the structure. And composition of fascial connective tissue is responsible, is responsive to mechanical stimuli. We propose that acupuncture plays a key role in mechanical transduction signaling, and that’s what acupuncture is. It’s a signaling system, mechanical transduction signaling, and the integration of several physiological functions.

The mechanical stimulation of connective tissue generated by the acupuncture needle manipulation could transmit a mechanical signal to sensory nerves, and as we well. . It absolutely does. Acupuncture needle stimulation that results in the spreading of collagenous matrix deformation and cell activation.

Along fascial connected tissue planes may mediate acupuncture effects remote from the acupuncture needle site, so spreading of collagenous matrix deformation. That’s basically needle technique, inserting the needle and lifting and thrusting being one. And how that can propagate a signal along mile fascial planes as we know them now, what our founding fathers talk about as the channels and the collaterals.

So Helene Lang’s work is pretty outstanding with all of this. So what we’re looking at right now is that we have a connection of the mild fascia and also of the pelvis of the abdomen of the low back, and also respiratory diap. Could we actually go one slide back please. I wanna show you something.

All right, so in this image, and I know the text in there is really quite unclear. That’s actually from the article itself. So it was unclear in the article. And like I said, the reference is right there. I don’t have the ability to point, I don’t have a pointer here, so if you guys could follow me along here, that would be great.

On the right hand side, you can see the abdomen and it’s a greenish turquoise lettering. Around the abdomen. So that’s gonna be scarpa’s fascia. Scarpa’s fascia is gonna be part of the abdomen. Now that green line goes all the way underneath in toward red one and DU 1 area. Now you can see, DU 1 that’ll end up being the A.

So if you take a look at the. A reddish looking text. More on the left hand side, you’ll see the letters acl. ACL is the acronym for Oxid ligament, which is the tissue that we’re gonna be discussing here in just a little bit. That is at DU 1. So you can see here with this representation is that each one of these fascial layers, from the pelvis to the admin to the back and going all the way up to the respiratory diaphragm, communicate with one another.

And this is the important thing is to take away from this is looking at as an acupuncturist, what points can we use for low back pain? It’s just not putting needles into the low back. What else did that? What other tissues does that low back actually communicate? Pelvic floor, abdomen, respiratory diaphragm.

So getting that entire core structure to communicate with one another, using mechanical stimuli of acupuncture along myofascial planes and mechanical transduction signaling. In other words, balancing chi and blood, moving through the channels in order to be able to decrease. All right. Let’s go ahead and skip a couple slides here and we can see where it says core stability, communication in the channels, please.

All right, good. All right, so this is something that I, a slide that I took out of the module two pelvic floor discussion, and I think it’s really quite important just to help to reinforce the communication between the pelvic floor and the other structure. Studies show coordinate a strategy in which all abdominal muscles, pelvic floor and the respiratory diaphragm are cod in order to control the Indo pressure and fascial tension.

They work together. There’s communication with all of these. They work together. Research shows that he, so that should be the stimulation of efferent nerves to the pelvic floor muscles when the pelvic floor muscles were activated. Created a reflex of co contract. The respiratory diaphragm and also the transverse a dominus showing a coordinated communication between these structures.

So again, with transverse a dominus, often being very weak in cases of low back pain, how important it is to be able to treat pelvic floor, the low back, the abdomen, as well as the diaphragm. And many times acupuncturists are like, for example, treating the Watto GI points, you’re gonna be stimulating the multifidi and the multifidi interdigitates itself.

With a trans or subo, we could be treating the diaphragm through U B 17. And in the smack program we talk about stomach 20 as being influential point for the diaphragm, especially on the right hand side. Then also in the pelvic floor, there’s many different points that we can use to affect pelvic floor muscles.

And in this particular presentation, I’m gonna emphasize. Treating DU 1 because it is a core point, a foundational point for the dui, and it does affect many of the mild fascists that we’re discussing. So let’s go to the next slide, and let’s get right into the aox ligament, which is the tissue of the aox ligament.

Tissue of DU 1. So next slide, please.

Oops, I think we went too far. Sorry about that. Can you go. . Yeah. Thank you. So the anaco ligament is also referred to as the postnatal septum. You’ll see that in some of the research page papers. Anaco Rafe, which actually has its own definition, and also the anaco body. So you’ll see all those different terms.

Speaking about the Anaco, Now the acl, that’s what we’re gonna refer to from now on. The ACL, can be described as a myo, fibrous, thick connective tissue located in the midline of the body, in the floor of the pelvis, right?

The ACL connects as a RA tissue with bilateral slings of the levator anti. So a RA tissue is going to be where you have a communication. You have a tissue on one side, tissue on the other side, connected by this tenderness, connective tissue, or also a ra. For example, the later RA in the low back, right next to the quads, lium.

That will then be like the Segway tissue, a RA tissue that connects into the. In this particular case, it’s looking at the aox ligament where D one is as a RA tissue where the bilateral slings, the lava anti, in particular the IOC Oxid, the pubic al and the pub erectile muscles go in and interdigitate right into that aox ligament.

Where DU 1 is located. In addition, the Coxs muscle also has fibers that interdigitate with the acl, which is really quite important. The ous muscle is something that we need in this MAP program all the time for Sacred I problems. So the combination of using DU 1 with the Coxs helps to reinforce that treat.

So on this image here, if you can see on the right hand side, you see the letters acl. That’ll be the aox ligament. So you see the C there. That’s gonna end up being your Coxy. Right next to the CO is the cm. That’s gonna be your Coxid GS muscle. That muscle. The pelvic floor is going in and attaching underneath the coic and it’s going interdigitate itself with the acl, right?

So then you have to the left, almost in the middle of this image is the la so that would be your Lior a I. So those fibers right there are going to be your cubic coxin chill, your pubs, and your ICOs, like I said, which interdigitate with the acl. Where DU 1 is located? All right. Let’s go to the next slide, please.

The anaco ligament has two distinct layers to it, which is something that you can actually try to think about when you’re needling into it. That helps with the depth aspect. So the Anaco Li with these two distinct layers that connect to various faial layers, including the posterior layer of the thac lumbar fascia.

Very important because the thac lumbar fascia is often where pain will be generated around the Yon region and also P gun region. So the anoxic ligament can connect with this poster layer thera, lumbar fascia, as well as internally to the endo pelvic fascia that’s gonna surround the pelvic bowl and the regional organs.

Now this endo pelvic fascia has links to the transverse Alice fascia, which is part of the transverse A. It’s all connected, and this is what my point. So number one, the superficial fibers span this, again, we’re talking about the two different layers here. So the most superficial one, superficial fibers span originating from the fibers of the external anal sphincter or the EASs, right?

So we know about that, and running upwards to the coex is going to be your superficial acl. So when you’re. Palpating this, you’re gonna be feeling that superficial ACL with a deeper palpation. You’ll be pressing into the second layer, which we’re gonna be getting into in just a second. So this superficial layer joins the fashion ligamentous attachments on the poster aspect of the coic and sacrum.

So you can think about that when you have a sacred iliac joint problem, because it’s gonna be continuous. This fascia continuous from the superficial layer going toward the sac iliac joint. And as we talked about earlier, by stimulating with mechanical transduction stimuli or needle technique, very light needle technique, cuz it’s gonna be DU 1, it will still be communicating with other aspects of that fascia.

The superficial ACL joins the SAC tubs ligament, which is gonna be another G wire for the sacrum. Excellent for sac problems. And it continues into the glut maximus, which is a major stabilizer for the low back and posterior layer OFAC lumbar fascia. Extremely important. So let’s now go to the other slide, please.

Let’s talk about the second one. This is now the deeper layer. So the second layer is a deep fiber fibrous band. It’s gonna be, it’s gonna be thicker than the superficial layer originates from the anterior periostin of the cos, right? So the anterior aspect of the coic superficial one is going more.

Superficial aspect of the coic, which then can go ahead and spread. Let’s see if I can do this a little bit better here. So then can go ahead and spread along the ligamentous tissue, the glute maximus, and into the thal lumbar fascia. Let’s go back the D one now, the deeper. Part of the anaco ligament is attaching to the underside of the coy right here, the pre sacral fascia, and that pre sacl fascia directly links into the endo pelvic fascia.

So let’s look at this slide here and we’ll talk about a more.

All right, so then this layer is referred to as the deep acl. The deep ACL directly connects to the endo pelvic fascia and the bilateral slings of the La Vader Antiox. Yep. Like I said, the pelvic floor is gonna be interdigitating with that antiox ligament. This deeper layer is gonna be communicating with the fascia that surrounds the pelvic bowl, holds the organs in place, the endo pelvic fas.

DU 1 is a remarkable point in its ability to communicate with lots of different tissues. All right, let’s go to the next slide if we could. Let’s talk about the function of this ligament. Now in this histological study, the anaco ligament was found to be abundant in smooth muscle and elastin fibers. So what does that mean to us?

When an acupuncture needles going into D one, you’re now tapping into the autonomic nervous system because of the smooth muscle and because it has alast in fibers, we wanna make sure that those elast in fibers are going to actually be up to par, that they’re gonna have still their recoil. Much of the skin in our face has elastin, and with age, obviously it starts to droop.

If we can be able to stimulate these elastin fibers and then provide exercises, for example, keel exercises to help to restore the 10 saity of the anoxic ligament, that’s gonna go a long way in the successful results with low back pain. In addition to lower J is harmonies. So during activity, the anaco ligament will involuntary, shorten and tighten.

It adapts to the. And is responsible for absorbing and transmitting forces generated during movement, and that’s gonna be within that pelvic floor. It also functions to support the pelvic viscera and when the lader anti contracts. The ACL that should be ACL pulls the vagina and rectum forward to maintain urinary and fecal continents.

Weakness of the lava or anti causes sagging of the anticoag ligament, which therefore decreases the A cell support of the pellet floor, which is gonna be very important. This sagging increases the probability of urinary continents and constitutes a predisposition to pelvic organ prolapse. I was at a. A gathering of people, and this was in new.

And we were talking about some different things that people had. And this woman said that she just had a childbirth gave birth to a child, and it was about a year and a half ago, and she said she was still getting some urinary continents with that and, I didn’t have any needles. There was not any acupuncturists where she lives, so I just asked her to go ahead and stimulate, DU 1 numerous times per day when she could in privacy.

And she emailed me back a week later and she said how remarkable it was that her urinary continents completely changed and she’s much better. Just, that’s just with acupoint pressure at DU 1. So again, it’s a very incredible point. Its integrity, D one’s. Integrity is vital and defecation and maintains continence and sexual function.

The antiox ligament is clinical significance as it contributes to maintaining the integrity of the pelvic floor muscles as a dynamic anchor for stabilization. Okay.

All right, so let’s get into the actual location of D one. In the acupuncture books, it’s, there’s two different places that I have seen it located. One location is just underneath the tip of the coex. That’s where some people will put it. I think the better place to put it, and this is where actually you’ll see more of this description is halfway between the tip of the coic and also the anus.

Are the indications, common acupuncture, books, diarrhea, bloody stools, hemorroids, so like rectal problems or lower jaw. Problems. Prolapse of the rectum? Absolutely, because antiox ligament will also be prolapsed. Constipation is a possibility there. Prostitis, and this was interesting. Not all books will have pain in the lower back but some books do, which is quite interesting.

Also you can use this to help with the she in manic disorders. Traditional actions as we know it’s gonna regulate the dui. It’s also gonna regulate the Remi resolves the damp heat that would be part of the diarrhea and such, and it calms the mind. It is an anchoring point, as we know it’s a low connecting point of the dui.

And for traditional acupuncturist, low connecting points, we know helps to open up the channel, right? So when there is pain in the channel, we use the low connecting point and that helps to open up the channel. Decreases pain. It’s also the crossing point, of course, do my with Remi. So it helps to be able to regulate the yin the master of the yin and the master of the young.

There’s a crossing point for the kidney, which makes sense because the kidney is part of that pelvic floor, influential of the pelvic floor. It’s also a crossing point of the gallbladder, which is I found real interesting. And there are some fascial correlations between the pelvic floor and the tensor fascia.

Lata. So think about it when somebody is coming in with L five dermatome sciatic pain, and you do a straight leg graze and you do see that it’s actually gonna be coming from the low back and it’s traversing down the dermatome of the L five, which would be your gallbladder channel. This would be an excellent point to use in addition to your wato Jaji points of L four, L five, tensor, fa, gallbladder 31, gallbladder 34.

Again, DU 1, would be like an opening point, an anchoring point, a signaling point for the rest of these points, DU 1 is an anchorings, a great. DU 1’s a starting point of the dui, obviously, as we know. And so we know that starting points are very powerful, where the kidney y energy emanates outward extending itself along the dui.

So since the DUI controls the Y of the body as we know this point, as the name applies, promotes the body strength and vigor. All right, so personally I like to use acupuncture to DU 1 when they’re in a prone position, and I know many people were taught to use in a sideline position that can work as well. What’s unfortunate about the sideline position? Is that you’re gonna be limited to what points you can include with it because the person’s gonna be in the later recumbent position, whereas the person’s gonna be prone.

It lifts the pelvis up using pelvic blocks. If you’re familiar with using pelvic blocks, it works extremely well. Helps to take away pelvic fascia tension just by reducing the anterior and the posterior pelvic tilts. If you don’t have that, then just a pillow underneath the pelvis will help Substantial.

This is gonna be something that you also wanna talk to your patient about, that this is a point that you want a needle. I find that if you ask the patient to palpate it themselves, they start to understand where you’re gonna be going with that. You can use some information if you like, from this seminar to help to build your case, why you want to go ahead and treat.

DU 1 for this person’s chronic low back pain. It’s always a good idea to have this conversation before you actually start needling them just in case they need to use the restroom and prepare themselves or the area for cleanliness. Okay. So then we wanna locate and treat in the prone position.

Using pelvic blocks is always a really good idea. What I’d like to do is to use this as one of the first points. So I’ll crossfire the aox ligament. I’ll go ahead and locate the coex, and then find the axid ligament I’ll crossfire so I can feel left and right sides right. And then go ahead and press directly right into the anoxic chill ligament and feel for the most tension.

Now the most tension usually is gonna be going superior toward the head, or you can angle it ever so slightly underneath toward the cosics. Now, some people go this way. Some people will go up into this way to get really get that pre sacral fascia and I think that can work. When I’ve done that, I’ve caught, I’ve caused sharp pain more than twice, so that’s something you may wanna consider with that.

I think we’re actually starting to miss too, maybe some of the depth of the two layers of the anaco ligament. So going in toward the head or slightly upward, I find actually makes the best mile fascial change. With this. All right, so perpen needle insertion, three quarters of an inch to an inch and a half is gonna be totally fine, and the reason why is because going from the skin, then you’ve got subcutaneous tissue and that’s gonna be your superficial and your deep fascia, which is highly innovated in that region.

Once you get past that, then you’ll start to feel the actual layer of that, of the acl. From there, go ahead and insert into the ACL into. Thickest most tender spot. Okay, so cautions advised, do not needle past the acl, or an anterior direction to the close proximity of the rectum. This is something that you have to be going way too fast.

For doing that. So you wanna make sure that your palpation tells you where the ACL is and what’s the depth of it going. An inch or an inch and a quarter is totally fine with most people. Not a problem whatsoever.

All right, so let’s look at DU 1 point combinations with this. These are just suggestions, you guys, because of its potential to communicate with many pertinent structures affecting the low back. D ones an excellent point to combine with other low back drawing thigh and abdominal acupuncture points.

So the following’s gonna be some point combinations to choose from. The pharmist motor point is gonna be excellent to use. Usually that usually will have that bilateral for sac iliac joint problems. It’s part of the poster support for the pelvic floor. So DU 1 with the pure performance is useful.

DU 1 with the cos because those fibers do communicate with one another. That can be extremely useful as well. Personally, I don’t use preforms and cos at the same time. It’s just a little bit. Too much for the patient. It just depends on what we’re actually trying to treat. Extra point yon, which we’re treating quite often with low back pain that comes in quite a bit with a iliac crest syndrome or Yon syndrome.

That pain that’s right on top of that iliac crest. Using DU 1 with yon because there’s a direct communication between the superficial layer. Of the antiox ligament and the posterior layer of the thac Colombar fascia where Yon lives. The SAC tubs ligament, again being a G wire for the sacrum. Useful in SAC iliac joint pain.

That also connects with D one, so DU 1 and the sac tubs. Ligament is a nice combination as well. Dew one with go bladder 29 can also be useful. You can still need a Goler 29 in the prone position with blocks on. It’ll just be more of an oblique. Type of angle. And of course when you turn the person over and you’ve already treated DU 1 in the same treatment, you can treat rec ado the transverse ado also the obliques because they help to also signal with DU 1.

So it’s a really nice combination. Is DU 1 as your founding point in addition to the rest of the points, cuz they all communi. All right, so this was a very quick webinar. This hopefully enlightens you a little bit and excites you to be able to use DU 1 and to communicate with your patients why you want to be able to use DU 1.

There are some references, I believe on the next slide. That you’re welcome to go ahead and collect there. This is just something that I’m happy to go ahead and do. There’s a lot more elaboration with needling. DU 1 and practice that’s gonna end up being in the SMACK program, but also, like I was saying, it’s gonna be part of my lecture on March 31st, 2023.

In the So as symposium that lecture is gonna end up being big points that move mild fascia that cha makes mild fascial changes and DU 1 is definitely within that category. Thanks, you guys really appreciate your time. I hope this was really useful for you. And I wanted to thank the American Acupuncture Council for having me.

This was really great and I believe that’s it for now. We’ll see you next time. Thanks everybody.