We want to talk about the compare and contrast of what is a motor point, what is a trigger point, which is a very, very common question and also how to use them clinically.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hello everyone. Thank you very much for attending our Sports Acupuncture Webinars sponsored by the American Acupuncture Council. My name is Matt Callison. I’m here with my colleague and good friend,
Brian Lau. So
Last month we had Josh Lerner as a guest. I was not able to make it last month, but Brian and Josh talked about trigger points quite a bit, and the pathophysiology and also different clinical uses. We wanted to this month to discuss and build upon last months, a narrative. We want to talk about the compare and contrast of what is a motor point, what is a trigger point, which is a very, very common question and also how to use them clinically. So before we actually start going into, let me talk about Josh a little bit here on the reason why we have him is he’s like Brian, who is, uh, not only just an excellent clinician, but a true academic. So that’s a pretty rare combination to have, uh, Josh graduated from the north west Institute of acupuncture and Oriental medicine in 2001. And he’s currently on faculty of the Seattle Institute of east Asian medicine, or he’s teaching orthopedic medicine trigger point theory, muscle-skeletal amp and also points and channels. Now he’s studied with Tom Bizzio and Frank Butler for quite a while. Starting in 2006, he also started taking trigger point release, uh, acupuncture trigger point release in 2007, and started dry needling classes in 2016, which he has become certified in dry needling in 2019. Now being an overachiever that Josh is, he also took the smack program at the same time and graduated from the sports medicine acupuncture certification program in 2017. So Josh is welcome. Thank you very much for coming Josh and help us out with this podcast webinar. Really appreciate it.
Thanks for having so you appreciate being asked back for this.
Yeah, absolutely. Well fun. All right. So we only have 30 minutes, so let’s jump right into what is the motor point? Well, you didn’t get into the trigger point, then start talking a little bit about case studies and how to be able to use them. Uh, first things first, the motor point when I first started studying them, this would be before I was an acupuncturist when I was going in and, uh, physical education and athletic training school at San Diego state university. I graduated from SDSU in 1986. Now in the training room, we were taught to use one inch by one inch or two inch by two inch could be even four inch by four inch electrical pads to place them over the central aspect of the muscle in order to influence the muscle belly or the motor point region. Now, it was common to be able to use these pads on agonist and antagonist muscles, for example, hamstrings and quadriceps, or even on hamstrings and then to a distal tendon or a proximal tendon in order to influence the electrical energy of that particular muscle.
Now, when I became an acupuncturist graduating from Pacific college Oriental medicine, which is now called Pacific college of health sciences, graduated from Pacific college in 1992, always was curious about the motor point and wondered as an acupuncturist. What would it be like to take a highly conductive electrical material, a stainless steel needle, and put it into this region as defined as having the lowest resistance to electrical conductivity. So therefore we, you have a region that has the lowest resistance to electrical electrical conductivity. That means that there is a enormous amount of cheap potential to manipulate. Now, of course, an acupuncture needle is much thinner than a one by one or a two by two pad. So therefore I started my journey and researching motor points. Where are they located at that time? Nobody was really talking about motor points, trigger points was the big thing.
Um, it was still under a lot of influence of Janet Chevelles and Dr. Simon’s enormous work and trigger point theory and their books as well. Um, and at that time, I, like I was saying, motor points really weren’t discussed very much. They were mentioned in the Shanghai text of acupuncture, which is an interesting read with that. And then going online and trying to find who was actually doing acupuncture on motor points, um, was Dr. Chan Gunn. Now he was up in Canada and he was also researching on motor points, but she’s got some incredible research if you guys wanted to go and check that out on Google scholar, um, being more of the dry dealer, um, he was really staying quite a bit away from traditional Chinese medicine and taking it more toward the dry needling aspect of it. And so we’ll finish that story at another time.
So what I found was taking acupuncture to the Motorpoint region was changing range of motion, changing muscle strength, decreasing pain. And this was really very, very exciting. Um, but trying to find where those motor points are at that time was very difficult because there really weren’t that many maps available. It was more of a line drawing with just like a black dot on it. So gathering a number of different research articles. I think it was in the forties or fifties, and today it’s well over 300 research articles that I have on motor points in their locations. But back then, there wasn’t very much so collecting that information and then also electrocuting a triathlete friend of mine with the surface surface electrode, trying to find exactly where these motor points are. Then I would map them and then locate them according to bony landmarks and acupuncture points for the acupuncturist.
Now this was way back in the early 1990s. And that was when the motor point manual came out, which I even have a copy of that anymore, but also the motor point chart came out and I’ll since then, it’s also has been updated the motor point chart. And this just came out in 2019. The original came out in the year 2000. Also some of the work that I was doing back then in the year 2000, I actually collected a whole lot of notes and started writing quite a bit and then published this treatment of orthopedic disorders manual, which came out, like I said, in the year 2000 or actually 1998, it came out and it’s been used at all three Pacific college campuses since then now in 2007, then my research came out and published the motor point index in 2007. So long story short, my work has been out there for a long, long time and has actually influenced quite a few people over the years.
Um, this has a lot of accountability and a lot of responsibility to it because even as today, Motorpoint locations have changed a little bit. The definition of the motor point has changed. Um, motor points. Now over these last 15 years are talked a lot about you’ll see research articles all over the place. It has infiltrated our field pulled a lot from the work that I have created, but then also what other people are also doing with motor points. So it’s, it’s something that is needing some discussion about what is a trigger point and what is a motor point. Now, the definition of the motor point in the 1940s, fifties, and sixties was basically an umbrella term for where the motor nerve inserts into the muscle belly and where the motor nerve inserts at the intramuscular junction, the neuromuscular junction. So both of those locations, which can actually be far away from one another in a muscle was the umbrella term called motor point.
Now recently, I would say within the last five to seven years, you start to see articles talking about motor entry points. And this is actually a better way of describing where my work has actually been taken is I’ve been looking for the motor point where it goes actually into the muscle belly itself. And the reason why is because it has the largest diameter of the motor nerve, then going into that motor point and has the lowest resistance to electrical conductivity, I’m taking that acupuncture needle and inserting it into that spot is where we can actually change quite a few things within that muscle, not only within the muscle itself, but also how the central nervous system views what’s happening within that muscle.
So the interesting, interesting thing about this is with motor points, like I said, that’s more of an umbrella term for what’s now being clearly defined as a motor entry point or where the motor nerve inserts into the neuromuscular junction would be the intermuscular motor point. So again, as the motor nerve comes in and inserts into the muscle itself has the largest diameter that goes into the motor into the muscle. Then it usually will bifurcate and go into a proximal part of the tissue. And also the distal part of the tissue sometimes close within an inch sometimes far away, six to eight inches, depending on the length of the muscle. So these collateral branches from the motor nerve travel within the muscle tissue and then insert into the actual muscle itself back can be called the intramuscular motor point. So we have motor entry points. We have intermuscular motor points, VM umbrella term would be motor points.
So I hopefully that actually helps. Um, you don’t really see motor entry point too much discussed in our field, but I’m sure it will start to spread over this next five or 10 years. Just, just because that gives us a little bit more clear definition of what exactly we’re trying to be able to treat. Now, the motor entry point is where the green triangles are on the sports medicine, acupuncture textbook, and also on the motor point chart, that’s where the motor entry point is located. Okay. So then now the intramuscular motor points themselves, um, those can actually be turning into trigger points with Josh and Brian and I are going to go ahead and discuss that in just a little bit or a trigger point can also develop, uh, at the location of the motor entry point. So from here, why don’t we now start to compare and contrast with the trigger point? Josh, do you want to take it away or Brian, do you want to add anything?
Yeah, I’ll, uh, I’ll step in here. And so Matt and I have had lots and Brian, Matt and Brian, and I have all had lots of discussions about, um, comparing and contrasting, um, trigger point phenomenon with motor points. And so there are a few different, um, dimensions within which we can kind of talk about these both contrasting differences and comparing areas that are similar. So one of the things to keep in mind, especially once we start talking a little bit more clinically, is that as helpful as it is to really talk about the, the differences between ideas about motor points versus trigger points to a large degree, especially clinically there’s a huge amount of overlap. And it’s a, if you really like Venn diagrams, there’s like a big circle about trigger point phenomenon and a big circle about Motorpoint phenomenon. There’s a huge gray area of overlap between the two of them.
So I’m going to try and keep that in mind as I’m discussing this, but it might sound at times like I’m being a little bit arbitrarily black and white about differences between them when that’s really not the case. So, um, one of the, one of the areas of contrast is that the motor points are basically a, a normal physiological phenomenon. Everybody has motor points. It’s just how the body works. Whereas trigger points are very specifically a pathological phenomenon. I’m not going to talk too much about the details about trigger point physiology, Brian and I spent an hour actually last time talking about a lot of that stuff. And so if you want to brush up on that, you can kind of go watch the previous podcast that Brian and I did. I think there are also going to be some links to some other discussions that Brian and I and a few others have had about trigger point stuff.
So you can refer back to that. Um, so that’s the first contrast is just normal physiology versus a pathological condition, right? Trigger points. Are they form due to some kind of muscle damage, right there, a small contracture in a muscle fiber that is the response to either like an excessive eccentric load or, uh, a low level contraction that goes on a long time and kind of wears out the fiber. Uh, another, another type of contrast between them is that motor points in a lot of ways are more like acupuncture points in that not only everybody has them, but the, the locations tend to be somewhat predictable, even though there can be quite a bit of variety of from person to person, whereas trigger points can really form just about anywhere in a muscle. So when you’re looking to treat trigger points, you really have to palpate the entire length of a muscle.
Whereas when you are treating motor points, um, you’re generally starting from a somewhat relatively defined position. Like it’s, uh, say, you know, in the middle, like the middle part of a muscle, or like in the case of say the rectus femoris, one of the common motor points is going to be halfway between like stomach 31 and hunting, right. You still have to palpate locally and the actual location you’re going to be looking for like a kind of an usher point. It might be, you know, one up to sooner, so away from that point, but you’re starting roughly from [inaudible].
Um, another, another area of contrast, uh, that I think will probably open up interesting discussion because Matt and I have talked about this quite a bit is how you use them clinically and what muscles you choose to treat, whether if you’re thinking about a trigger point versus a, um, a motor point. And so I’ll just kind of talk just very briefly about my take on this and then maybe, uh, Brian and Matt, if you guys want to pop in and, uh, contradict what I’m saying. Awesome, nice and heated, spicy debate going. So motor points in my practice, I tend to use very, uh, very kind of more generally to really overall improve the functioning of the muscle and to treat in the sense of the little skeletal homeostasis, what I’m really focusing a lot on biomechanical issues, where there’s a joint dysfunction in gallons of muscle pull across a joint, or are treating, uh, a muscle in one area of the body.
And I want to treat the entire senior channel. I might need other muscles more display or more proximally in that CGU channel. I’m 10 years motor points is in those locations, more commonly, um, and for trigger points, I tend to overall use the more specifically to treat the referral patterns when there’s pain or some other like parasthesia, that might be part of the referral, but even having said that there’s a huge amount of overlap between them. And so I also very commonly will use trigger points to treat more general biomechanical issues and old very often also use motor points to treat painful conditions. Um, and there’s a more subtle distinction to be made. And how I diagnose personally between the use of those two things. Um, it has to do with the fact that when you have pain, sometimes the pain is coming from a motor point, but you can have pain due to a muscle dysfunction that isn’t sorry, a trigger point.
Um, you can have pain from muscle dysfunction that is not from a trigger point pain, but just you can have pain because the muscle itself isn’t firing correctly, which can send signals to the central nervous system, kind of a warning signal. That just something isn’t right. We’re going to just give you some pain. So you stop using the muscle. Um, so you can have cases of pain that are in a muscle that are not to the trigger point, but they can be helped a lot by motor points. Um, so there are just kind of muddied the whole discussion a little bit with that. So I I’ll, uh, let’s open this up, Matt, Brian, uh, what do you guys want to talk about in terms of that?
Uh, Brian, I’ve got a few things to say, but why don’t you go ahead and start? Uh,
Well, I just say something simple and that’s, uh, you, both of you guys painted an ice clear picture of, uh, a difference between a motor point in a, in a trigger point. But if you look at a lot of the discussion and sometimes even the research out there, it’s not always so clear cut as, as Josh kind of alluded to it, the Venn diagram of how they overlap in terms of, um, comparisons, but even in terms of discussion like Matt was mentioning, sometimes they use the term motor entry points, sometimes motor point to encompass all of that. It’s not always very, um, consistent sometimes there’s discussions of trigger points that talk about, like, I saw several research articles that talked about an anatomical basis for trigger points. And they were basically looking at the motor entry point as the site of where trigger points tend to form.
Um, so the it’s not so clear how we’re going to try to discuss it from a, um, you know, compare and contrast and as if they’re different, but there’s a lot of overlap out there. So if you’ve looked into this at all, sometimes it’s easy to get confused because it’s confusing cause there’s a lot of different, different people saying different things about it that aren’t always consistent. Um, and I know this isn’t the case with the newer edition at Trevell and Simon’s book, but, um, in the previous additions, you know, they had Xs on sort of the frequent location of where a trigger points tend to form. And there was numbers, you know, like trigger point number one, upper traps trigger point number two, and in a different regions and different kinds of common sites. Now, of course, within that common site, you’d have to palpate and find the exact location.
Um, uh, and it’s going to be very variable, but there were sort of go-to sites, so to speak. And, um, if you look at those go-to sites, you’ll see that those go-to sites tend to be at the motor point, the motor, uh, close to the motor entry point location, um, where the muscle is getting the innovation. So, uh, the reality is that motor points are at the location of where common trigger points form, and both of them share one similar thing in their description and their language is that a motor point is the highest concentration of motor in plates. It’s a motor in plates or the cite on muscles that are, uh, have receptors for acetylcholine. So a motor point is the highest concentration of motor end points, a boater, um, in plates. I think that’s more of the classical definition of, of a motor points. Now with motor entry points, that’s more about the entry side of the nerve, but the classic definition going a little farther back as the highest concentration of motor in plates and trigger point in the language is often described as forming at the site of the highest concentration of motor in plates. So there’s a lot of parallel and there’s a lot of overlap and it’s not always clear to differentiate one from the other, my turn.
All right. Thanks Brian. Um, Josh Brian, that was awesome. That was good. Uh, in, in my mind, the motor implants are going to be where the intramuscular motor points are a little kid at, um, where the motor nerve enters into the muscle. There can be collateral branches that go into the motor end plates, but not always. So let’s now take this information and see if we can be able to bring it into some kind of clinical sense, for example, let’s I remember before we get into clinical sense, let’s remember that motor points also can be used as empirical points that will take pain away from a distance site. And that pain from a distance site has nothing to do with the trigger point referrals. Like for example, a flexor carpi ulnaris motor entry point is pre magnificent and taking pain away from the levator scapula attachment.
And that lateral posterior side of the neck or the piriformis motor entry point takes pain away from a urinary bladder 10 region. So there’s a number of different ways of looking at the motor entry point. And also what the trigger point is. Let’s say that tomorrow a patient comes in with sciatica, you use slump tests, you use straight leg, raise tests, a neural tension test, and they’re negative. So it doesn’t seem like it’s true sciatica. So what could be causing the sciatica like sensations? There’s a number of things that can, for example, a Fossette joint can cause referral pain, a sick really act joint can cause referral pain trigger points can cause the sciatica like referral pain. So let’s say that with this patient that you’ve done slump test and straight leg raise, and you’ve ruled out sacred iliacs joint dysfunction or Fossette joint dysfunction.
And you’re palpating along the iliac crest where the gluten minimis attaches and you find with palpation, it reproduces that patient’s sciatica likes sensations. This is just in the hypothetical example. So you’re looking at the glute minimus at its attachment side, or maybe the muscular tenant is junction site that you’re palpating around that area. And it’s a way from the motor point, which would be the muscle belly halfway between the superior border of the greater show canter and the iliac crest. That point definitely needs to be treated because it was causing this person sciatica or sciatic, like sensation definitely needs to be treated and TCM. We look at it as being either as an access or deficient, is it cold? Is it damp? And we are treated according to how we know how to get rid of and resolve damp or treat cold, reduce access, reinforce the deficiency.
It’s all going to be predicated on your palpation. Now, from my experience, if we treated the motor points of the gluteus minimus, first that trigger point that was located two or three inches away would be difficult to find it’s not going to be reproducing that same type of parasthesia. So from my experience, I would like to treat the trigger point. First, what I’ll do clinically is treat the trigger point first because that’s what’s causing it. And they’re like what Josh was talking about before let’s treat the motor entry point, cause that’s going to be then communicating quite a bit, the central nervous system about where that muscle is in space. You guys want to comment on that? Yeah. So
I think, um, another really great aspect to think about motor points is that in that particular case that you’re talking about, the motor points are also going to be incredibly useful to then treat the other muscles that might be involved in why that glute minimus develop trigger points in the first place. Right? So there may be, uh, there may be some, you know, if there’s like a pelvic imbalance where you have to look at the balance between the, the hip, uh, AB doctors like the glute medius and minimus plus with the add doctors plus with like the QL, um, that there may be this larger muscle imbalance issue between keeping the pelvis level in the, in the frontal plane, right? So it could be that treating the motor points of the adductor longus and brevis the quadratus lumborum and even using the motor points more in a TCM sense of looking at excess and deficiency to try and balance.
A lot of that is going to be a really important part of the treatment to keep that one gluteus minimus that’s causing referral pattern to keep that from developing further trigger points, right? Cause the trigger points could just be the end result, like the last symptom of a dysfunction that has been going on from these other areas, right. Um, where you might need to treat motor points, uh, down in the, in the cap for any of the motor points for the muscles that control the foot of the ankle. Cause maybe the glute minimus is developing trigger points because of its being overloaded because of an ankle dysfunction. Right? So I think that’s another aspect to the balance between looking at trigger points versus motor points that can be really helpful clinically. Awesome. Brian, anything you wanna say?
Yeah, I would just add into that some distal channel points do it. Now we have a pretty comprehensive picture. You know, we, we use this one a lot with the glute medius and minimus minimus in this case. Cause it’s clearly on the gallbladder sinew channel ma uh, Josh mentioned the quadratus lumborum and the add doctors, which we on time to go into it now, but the QL is, uh, part of the liver send you a channel as the ad doctors are. So you could also include points, um, to affect the relationship between those channels like sourced and low combination gallbladder, 40 liver five would be a really good combination that we use quite easily in the program. So you do, maybe we have this one point, that’s creating a referral, but it’s linked, uh, functionally with other muscular structures. So glute minimus in this case, linked with quadratus, lumborum add doctors in terms of how they’re in dysfunction together. So we can use motor points and trigger points and combinations of those muscles along with distal channel points. And that’s a to create a good local distal and point combination from a TCM standpoint.
Oh, awesome. Yeah, that’s good. Let’s go farther into that. So remember you guys, Osher points have been treated for thousands of years. So trigger points and tender motor points have been observed and treated with traditional techniques. And in some of the discussions that Josh and Brian have had is that when a trigger point is located in a different location than the motor entry point, it’s really common to find a tight palpable band linking the two. So for example, from the motor entry point, if you cross fibered toward the trigger point, many times you’ll actually find that type palpable ban linking the two, which maybe is why punk’s a needle technique was developed, which is really quite common in myofascial acupuncture by kneeling three or four needles in a row within that tight palpable bag. One of the needles would be at the motor entry point.
One of the needles are two of the needles might be the trigger point. So you’re covering those bases. And then as Brian was talking about linking that particular channel with points that will open up the channels in the collateral Xi, cleft Lubo points and such, and let’s also remember this patient, what’s their internal balance. What’s happening with them? How well can they handle inflammation because it’s on the gallbladder channel. Well, how is their liver and gallbladder functioning in their life? Could the liver and the gallbladder be contributing to part of this clinical picture? Always something for us to be able to consider is people are not just coming in as meat suits. We treat the entire patient. Great discussion. You guys.
Yeah. Another really interesting aspect to, uh, bringing TCM theory into this is also looking at, uh, general, like we get into TCM basic constitutions, right? There’s I very often find an element of spleen Xi deficiency with certain types of people who tend to develop a lot of trigger points because of the, the spleen’s ability to supply energy to muscles. Right? Cause the trigger point formation is in a sense of problem with energy supply to the muscle after it gets damaged, right? There’s a, there’s a very strong case to be made for looking at the importance of blood status and using herb formulas to treat a lot of blood status. Um, I think I mentioned maybe in a previous discussion that Brian and I had, I’m a big fan of the drew Yutang family of formulas for treating various types of musculoskeletal pain for that, uh, for that purpose. So I think that that’s, that could be a whole other podcast. We could talk about like a TC woman also talking about like postural distortions and TCM constitutional diagnoses, and then talking about muscular relationships between postural distortions and TCM stuffs. That could be a whole other thing we can get. Right, right.
That would be hours and hours and hours or people would just go to the smack program. Right. Well, this has been a great conversation, you guys, and I think there’s a lot of clarity that was added to this. Um, we are right approaching that 30 minute mark right now. Is there any closing comments that you guys want to be able to say?
Uh, I’ll just say, well first, um, Matt and Brian, thanks again for inviting me to do this. I really appreciate it. And uh, I just want to put it out there for everybody listening that the, the, the smack program, the sports medicine acupuncture program was one of the real turning points in my career. It kind of brought together, even though I’ve done a lot of work with trigger points and some orthopedic stuff before then, um, it really brought together, uh, so many different elements of what I was trying to get at when I was doing, um, orthopedic work with my patients that it’s probably saved me 15 or 20 years of studying on my own, trying to do a lot of this together. So I just wanted to say, thank you, Matt and Brian for, uh, giving people this opportunity. Great.
Well, thanks for that, Josh really appreciate that. And that’s good. Um, yeah, it’s always welcome. And no, Josh, you didn’t bug me with your questions during the smack program where you sat down as a no, no, you just have very inquisitive mind. And the thing is, is that kind of dialogue is so welcome to because other people are stimulated by that kind of conversation. So it’s always welcomed. So thank you, Josh, for that also for more, let me finish this one real quick, Brian, for more information about Josh in the comments section, there’s, uh, three different links that, um, he’s talking about trigger points for anybody who’s interested in a motor point chart or motor point book. There’s also, there’s going to be links for that as well. Go for what Brian.
Yeah. On the topic of, uh, messages coming up, there was a question which we could go into a lot of detail and we don’t have time, but it was about osteoarthritis of the hip. Um, and I just want to quickly say that the same discussion we were just having about balancing the pelvis, um, by using motor points, uh, in terms of like, if there’s a, uh, elevated Lem, QL, glute medius, and minimus, and the combination of motor points, plus distal points, that’ll help balance the hip joint would be really a great idea for osteoarthritis, but you could also look at, uh, what trigger point referrals are referring to that region of pain. The hip joint itself can refer pain and can be, can be the pain source. Sure. But since we’re talking about trigger points and motor points, looking at the trigger points that are part of that referral, uh, it could be that the trigger point is causing 20, 30, 40, 50, 60% of that pain. Um, so also treating the, the, uh, looking for trigger points in those, um, regions that could be referring to that area would be a, it would be a good idea to start with
Joshua say something, I’ve got something to add.
Um, uh, the only thing I would add to that is if you’re not used to looking up trigger point referral patterns, it not is going to not just be the muscles locally to the hip, right? One of the muscles that might recreate something like osteoarthritis of the hip could be like the lung just amiss muscles up around the thoracolumbar junction around T 12, right. That can refer pain down to the truck hacker. So there’s a lot that has that a lot of, um, resources out there to allow you to look up for pain in one particular area of the body, what is the list of different muscles that can all refer to that area? And it’s really helpful looking, you can find those online it’s in Trevell um, uh, yeah, very useful resource.
Um, just to add some clarity with this one, cause I don’t know what kind of diagnostics were made with the osteoarthritis. So the patient may actually have confirmed osteoarthritis, but now these comments that we’re making is that, um, there also could be, uh, pain contributors, which would be trigger points. So as we know, uh, trigger points can also live not only in muscle tissue that we’ve been addressing over these last couple of hours is also can live in joint capsules, tendons, ligaments. So needling the joint capsule itself may also help in this particular case as well.
All right. Anything else, gentlemen? I think we, uh, we covered most of the stuff we wanted to cover.
All right. Well thank you very much. Really, really appreciate it. And so stay tuned for next week, come in, check in, check out Jeffrey Grossman for next week. And Brian is, was nice hanging out with you, Josh. Thank you so much. Really, really appreciate it. Thanks you guys. Bye now. Bye-bye
Today I will lecture about immunity or different aspects of immunity as you know, immunity or immune system is actually a Western term. So we need to do a lot of translational medicine to understand it from the Chinese medicine perspective.
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 everybody. This is Dr. Yair Maimon from yairmaimon.com. Uh, first of all, I would like to thank the American Acupuncture Council, put up this, uh, show in lecture. And, um, today I will lecture about immunity or different aspects of immunity as you know, immunity or immune system is actually a Western term. So we need to do a lot of translational medicine to understand it from the Chinese medicine perspective. It’s one of the most complex system in the body, and it encompasses, um, the root of many diseases we know from what immune to other. And obviously now during the pandemic, we know that the immune system plays a big part, both in, in protecting, but also a big part in the side effects of the COVID in recovery. Uh, so we’ll touch on few aspects of immunity and, um, later I’ll give kind of a small overview of the translation from Chinese medicine to Western medicine and immunity. So let’s start with some slides, please.
Okay. As the slides are coming up, um, uh, I would like to mention that it’s more, I’ll talk in this lecture about like few layers of immunity. One of them is to do with compromised immunity, like in cancer patients. And then the other one will, uh, I would like to discuss more the type of immune and immune response when the immune system is weak from both from how can we treat it from a horrible perspective and how can we treat it from acupuncture? I was very lucky to, um, do also research herbal research, uh, which proved the effect of acupuncture on immunity and especially on deep immunity or innate immunity, which is our, uh, um, the type of immunity that protects us also from viruses and protects us from, uh, all the different aspects of, uh, not acquire the immunity, which is the learning part of immunity.
So, as I say here, I’ll start with this general idea and move. And, um, also in the classics already, um, in so-and chapter 72, they mentioned if sanctuary and sanctuary is a kind of concept of all the upright chain, the body. So if Zen chief, the chief of the body remains strong shakuhachi, which is a general term for invasion of pathogens to the body cannot invade the body. Then she must be weak when invasion of Shechem take place. So already 2000 years ago, they were very aware that there is, let’s say constant war or a constant struggle between two aspects. And it’s important to understand that because when we treat, we are looking at this struggle on one hand, we want to strengthen immunity. On the other hand, if there is a pathogens we want to weaken the pathogen and there’s different ways to talk about immunity in Chinese medicine, and one of them, which I would like to start with, and I’ll try to evolve as, as we go on is to look at three different aspects of immunity Cenci and Shen is an important part of immunity Shen is our connection to self.
And let’s say even our emotional life and spiritual life. So when one is balanced, the immune system is better when one is not balanced emotionally or in the Xena life, then the immune system will go low, we’ll go low and weak. And we have a lot of examples for this, for myriad part of disease, uh, that can come up when the emotion and the spiritual part of the person are disconnected. Then we have the way cheese, white cheese, the very common way to discuss immunity in Chinese medicine. But it’s very superficial. It’s the kind of immediate fight from external threats. And then we have the gene chain, which is like the deepest part of immunity. And really immunity comes from the steepest part of gene chia or interaction all the time of our constitution and our gene with, with life. So, and, and when we go, we have look at the immunity also from a different perspective and I’m proposing different way of how we translate here.
Again, I’m taking this model that we discussed before and enlarging it. So if we look at way cheaper in Chinese medicine, we’ll look at the lung, we’ll look at the way pathogens are invading. The lung is the upper inner organ. Yeah, that is all the time connected with the external. So external pathogens will enter the lung the same as we have now with COVID. And then we can treat the, uh, external pathogens with different, um, method. By the way, also, by treating with 10 Damascus, meridians was divergent Meridian. A lot of the complications of COVID can be explained by the Virgin Meridian. Uh, and then we have [inaudible] and it’s more related to the kidney and it deals with more with internal pathogen. And then sometimes we need to resolve and look at extra meridians, and then we have [inaudible], which causes more collects to the heart and it relates to traumas.
And then we have different special points that can help the person to unlock trauma and deals better with trauma in Western medicine, we also differentiate between adaptive and innate immunity. Most of the lecture now will be on this innate immunity and also most of the, our herbal research. So we are kind of focusing on this aspect. When we look at the class practical example of a weakening of gene as a result, there is a weakened immune system, and you can see in one sentence, I’m talking Western medicine and Chinese medicine, Jenkins, Chinese medicine chemotherapy, which has given to cancer patient for example, is Western medicine. So that’s a classic example of chemotherapy will weaken immune system. And we can explain it from a Chinese point of view. So, um, you feel looking at this, the side effects, for example of chemotherapy, we’re looking at weakening of bone marrow and which causes reduce white and red blood cells.
That’s why I said medicine, Chinese medicine is weak Miro. We have general compromise the immunity and we have lots of hair and no Chili’s medicine Herod belongs to the kidney and to the gene, we have reduced in cognitive and memory functioning, more related to the gene, uh, reduced fertility, eh, aging people will age sometimes very fast when they’re exposed to chemotherapy and deep fatigue. So all this stuff I kind of explained in Chinese medicine, the weakening, this very deep substance, which is called gene. And that means also that when we applied therapy, we’ll use points or herbs to treat the, uh, this aspect of gene. I’ll give a simple example. Well, Herb’s like, uh, the best example is maybe to look at Wrenchen again, very special gene saying very special, a herb, which tonifies the gene and the UNG. So we have the normal [inaudible] that works mainly on the cheese.
We have the prepared, the red, eh, hungry tension. So it most tonifies the young, if there is more young and coldness, we have Xi and Chen, which is like the American ginseng. Um, tonifies the UN and also the superior engine St. Which is not exactly gene thing. See what ya, that actually strengthening the, not just the immune system, but also its ability to cope in stress and difficult times. So all of this herbs are very adaptogenic and this is actually the key strengths for herbal medicine in immunity. It helps to balance the immunity. If it’s overactive, it reduces it. If it’s underactive it, tonifies it. And this is the strength of, uh, looking at Chinese medicine. We hardly ever use single herbs in Chinese medicine. So we use formulas and the classic formula for immunities, you being [inaudible], um, Jane screen made of three herbs, one, she buys you think thing.
It’s amazing classical formula for general general tonifying of immunity. And obviously with the inspiration of this [inaudible] formula, we, we change it. I changed it to one formula, uh, which I’ve researched for many years in Altria, which is the result of research of just one research of almost five years when we tested this formula on different individual, both healthy and eh, cancer patients and immunities suppressed patient. So this is the LCS, eh, one or two in our research on tonics are called now. And then I did another research on the formula, which are let’s discuss here, which also affects immunity, they’ll say is 1 0 1 or protectable. So this formulas have been studied deeply. This is one of our, uh, um, published research on the effect of the botanical compounds, the LCS one-to-one and innate immunity. And I specifically mentioned the native immunity because this is the part of the immune system that both responds immediately to threads like viruses, but also has a very strong component of, uh, checking the body all the way, surveilling the body and killing cancer cells.
So this is the importance of this research. If you see, one of the conclusions was this, this research, uh, works, um, on the net immunity, but we also tested it with different types of chemotherapy and others just to see also that there is no drug in herb interaction. And that’s one of the key components of my work. And I had a very extensive, a biological lab where we can test things on different levels, not just test them on the, uh, immune system, but also see interactions with different drugs and see how different patients they’re responding to it. So this is how we ran the research. We take usually blood, uh, from, uh, patients and, uh, but also from, uh, volunteers, we isolate if you see in blue, the neutral fields from their blood. So we isolate the active, one of the active components of innate immunity.
And then in the next Quare, you can see that we are examining the neutrophil activity. So what we’re actually doing is looking at activity. When you have a normal blood tests, you just have quantity. How many you have, we are looking at how active it is after we are adding the LCS. Uh, one or two, the tonics are to the protectable, to the, uh, cells. So this is a example of, um, uh, in like four patients you can see in blue is their bladder that control Blab. And when we are adding the formula, it’s sometimes active three or four times more, both in healthy patients and in sick patients. So you can see the, how the neutrophil activity has been elevated in Chinese medicine. We also see tonifies cheese. So people are less tired, which is the classical effect of chemotherapy. So like you produce study, but I also think this formula just to sometimes when I’m fatigued I to, to tonify because it tonifies deeply, uh, the chair of the body and not a thing that we are checking, not just the neutrophil activity, but also the activity of natural killer cells.
This is the subtype of the, uh, white blood cells. And this actually are the cells that are both, uh, very active in killing viruses, but also killing cancer cells. So having a strong natural killer cell activity is something which is important to maintain health in all the levels. So here also, you see the difference between the control, uh, the component of the formula are quite interesting. There is three, um, mushrooms. It takes quite a lot of time to make the formula, to establish it, to concentrate. It, it’s always a process of testing it and testing on in, in the lab testing in different ways. And if you look at the three mushrooms put together, they also, uh, have a significant effect on immunity. In other studies, they improve the ability to cope with tress. They activate, um, and their, their active ingredient also being found and being isolated.
So on some of the mushrooms, we can really follow the active ingredient. And a lot of time is the polysaccharide like a big sugar component, which are very good in activating immunity and also balancing immunity, the other herd like a stragglers attracted. And lygus true. Also demonstrate a lot of immunomodulation function and they’re good for fatigue for mental function and stabilizing blood sugar level and even enhancing liver and kidney function. So if formula overhaul is, we know has allistic effect not much wider than just on the immunity, and this is the beauty of it. So when we are designing formula, we are looking at something that works on three different levels of immunity or Nietzsche, which is it’s actually designed Fuji that protects the Sandpoint. And [inaudible], so we’re looking at this different Herb’s and their component and how they work, not just on allowing the body to fight better with external pathogens, but also keep a better immunity inside.
And, um, I would like to know we’ll demonstrate it in a case so you can see how it is applied. A practically, as I say, I see a lot of patients in different stages and, um, this is, uh, a cancer patient. I am patient of mine. She’s 62 she’s after a lung cancer, that the main part of a treatment was removal of her left lung. She didn’t have any further treatment, just the removal of the lung, where the tumor, uh, was found. And she came immediately after the operation. So she was extremely lacking of energy. You can even see a she’s extremely vivid person. I knew her also, I used to see her in the past before she had the lung cancer. So series very active, but suddenly she was white. As we know what happened when you have achieved the efficiency. If you look in their eyes and I put the eyes, she was very depressed and detached and very sad, deeply sad.
I mean, her husband brought her in and, and really like, bang me know, do something for her. She, she really like, you know, she came before the operation. She was herself enough to shoot that. Like she lost it. You know, he feels like she’s, he’s losing her. I’ll not just on a physically, but mostly on this emotional product. So the points that I did was a combination of stomach 36 and large intestine, 10 to lead points since suddenly on the Lange and the lead point on the hand, which you combine it together as strongly tonifying the, and the chief, but again, on a deeper level, because they’re on the young meat and kidney nine, which will, tonify more the gene part of, uh, the, um, the immunity, especially working on the, on the sheet cliff points and the way my suite works deeply on terrifying immunity.
And on the back, this is one of the key points, bladder 42, the poo hall, the door of DePaul, uh, which will both work on her, Shen on the sadness. It’s quite amazing point it’s on the level of bladder, a 13.4, the lung, because it has few function. One, it treats severe immunity of the lung. It works on DePaul, the spiritual or deeper aspect of the land that is when you’re detached from it, there is deep sadness, but it also helps to reduce heat from the lungs. So it’s one of the key points to treat patients with COVID because it will achieve this dual thing that we want. In one hand, it will come this heat in the lung, which is part of the cytokine storm or excessive inflammatory reaction of immunity, but will also strengthen the land that has been weakened by the COVID.
Then by fighting the disease. And I gave her this botanical LCS one or two, the tonics are. So, by the way, if you want to read all the research, you can look away. We have just a research plant website, it’s for data formula with, for both the LCS. One, one that comes with just some pure research website and you have access to the research and also all the herds. So if you are interested, you can always read there more and, uh, to look at this, a prescription for this patient. So you can see again, I’m trying to, I have this kind of whole picture of the face. So for like, for the Shan part to do bladder 40 to DePaul who the tour of DePaul, so it will address not just the physical part, but also the shell is spirit part. This detachment is deep depression that she felt after the operation and then treating the way and the itchy by combining points on the young mean the stomach and large intestine combination and kidney nine, working on the gene.
So you’re seeing Chinese medicine. We kind of very much go from theory to practice and gave her the LCS one or two in the same times, again, to work on the way change, changing. So we are kind of having a complete, um, cover of, of immunity. And that’s the beauty of acupuncture to me that we can think in three dimension and, and treat them three dimension. And the results were amazing. I mean, a week later she was like a different person, you know, it’s like this patient tell you, wow, it’s a magic. So this is a, I think a good example of how it works. And, um, I did, there’s a lot in explaining, uh, especially during the coffin in explaining immunity. And, uh, I put it into one large teaching package it’s called to serve and protect where it has different components. So it doesn’t just look on the, uh, it looks on the foundation of immune system, like focuses also on allergies, inflammation, the way the body responds to external pathogen.
Then it goes deep into in Nathan adaptive immunity and talks about how the immune system works. And how can we it, and also talking about what we look like also deeply in this, uh, or started to look deeply in this teaching about, uh, internal causes and deeper aspects of immunity. And one of the interesting thing from a Western point of view, and it helps us to understand Chinese medicine actually goes deeper into it is when we talk about auto-immunity we talking about distinguishing self from non-self and in Chinese medicine, it has a lot of meanings. So if you will, wherever interested to look at it any further, you can look at the TCM academy website and are able to look at some of these lectures. I think they can kind of give you a wider range of appreciation of how immunity can be treated, especially with acupuncture, because it’s a vast subject.
And to me, one of the key in the clinic, so this is serving protect actually like the idea, cause immunity is a bit like, you know, it has all this aspects of having, uh, when you look in guarding, you know, society, so you have the placements, that’s how he took this name from, and then you have the, um, soldiers on the borders and you have the intelligence, et cetera, et cetera, all of them working to keep society safe and the same works in immunity. So, um, I think this kind of, uh, gives you some insight and some ideas of how we treat them to treat the immunity in Chinese medicine. So, uh, again, I would like to thank the American acupuncture council and, uh, thank you very much for watching wishing you the best of health and healing your ear. So all the very best, and you can watch also next week on the, on this channel and Matt Callison and, uh, Brian Lau talking about, uh, uh, the treatment of sports medicine. So you get another aspect of Chinese medicine and the scope of this medicine and how it treats the variety of problems. And, uh, so I hope now you’ll get more insights about immunity and then hope it was inspired and helpful. So thank you very much again for watching. Thank you.
“I believe that knowledge is power and we’re all trying to be have our patients and society become educated consumers. So as much as we can share knowledge, as much as we can share what we know with each other, the better.”
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.
Hi, I’m Virginia Doran of luminousbeauty.com. And I want to welcome you to another edition of the point to the point. A show, very generously produced by the American Acupuncture Council today. I’m extra delighted to have as my guest, Dr. Mark Grossman. Uh, when I met Mark in 1992, we were both going to acupuncture school in, uh, New York and Connecticut. Uh, but Mark is very unusual in that he holds the licenses in both acupuncture and is a doctor of optometry and, uh, to fulfill his dream of practicing holistic and integrative eyecare, he’s fully trained in acupuncture. Uh, even though he, he didn’t need to be to, uh, to be practicing. Um, and he’s also trained in nutrition and visual vision therapy, and he saw this significant void in holistic eye care, um, and not only, you know, filled in to practice that way himself, but he trains practitioners internationally online and in-person, and, uh, he’s published many books.
Um, the four ones that, um, are probably most notable and, and, uh, appropriate for this audience is Nash, natural eye care, a comprehensive manual for practitioners of Oriental medicine, where he goes into both, um, acupuncture and herbal prescriptions. And then he has a book, natural eye care, your guide to healthy vision. They sound similar or different book. It’s an 800 page texts, and it covers about every eye condition from both the Western and Eastern perspective, plus nutrition and supplements, herbs, clinical tips. It’s really a must have for every practitioners library. He’s also written a book, very interesting book, very unusual, greater vision, a comprehensive program for physical, emotional, and spiritual clarity. Uh, another thing that he teaches about and the international bestseller magic eyes beyond 3d your vision. Um, so you can find more information about his books. Trainings has specifically done products, but also about many, many different eye conditions.
His website is full of information. He’s very generous with his knowledge as he shares it to people and that’s natural eye care.com. So after that, um, uh, I, I asked you to, to, um, you know, speak on this because I think it’s so necessary and there’s not much draining or, um, awareness of this in our field. And also, um, I think that, uh, you know, if you could give some examples of like, say glaucoma, for instance, you know, a common condition that, uh, to give an idea how you work, the in-depth, uh, approach, you have to things. So thank you so much for being out. Cause I know you were in the middle of her work day. Uh, so, you know, if you can tell us how you got into this, that’d be very briefly. And then, uh, you know, what you want to impart.
Oh, thank you so much, Virginia. And I’m very, very grateful to you, Dr. Alan Weinstein. Who’s a master of putting this out the American acupuncture council, because I believe that knowledge is power and we’re all trying to be have our patients and society become educated consumers. So as much as we can share knowledge, as much as we can share what we know with each other, the better. And it’s very interesting. I was meditating this morning and I was saying, oh, I think I know what I have to start with saying, and you said it beautifully. How did I get into this acupuncturist? Usually have a drive. It’s like, oh my God, this is my calling. This is my calling of what I want to do in life. And my story was, I was already an eye doctor for, uh, 16 years had just finished paying off my student loans.
And then I went to a friend’s house. And in the middle of her living room was one of the first books in the Western hemisphere, an acupuncture called the web that has no Weaver. And I felt that I could remember it. Like it was yesterday. The book looked at me, I looked at the book. I said, I can’t believe I got to go to acupuncture school. Now I thought I had a way out because acupuncture wasn’t licensed in New York state yet. And as you know, as one of my, uh, classmates, we had to go to school in Connecticut first. So we went to school in Connecticut for a year. And then we spent the next two to three years in new York’s New York city. So I said, well, I guess I got to go. I don’t know why I’m going. Uh, I just know I have the calling and we’re going to talk about the call and we can talk about those moments in our life that we get those signals of what we need to do and how our vision, how not only our outer vision, but our inner vision affects how we are in life and how it affects eye conditions.
And we are in an epidemic. That’s an epidemic in society right now. Do you know that over 90% of young adults from 14 years and younger in China and Japan are near-sighted, if you don’t consider 90% epidemic, then the thing is, you know, and with the advent of computers and being online. So we need to take care of our eyes. And as we know in Chinese medicine, if you can go to the first slide Allen, we know that all the meridians go to the eyes, all the meridians go through the heart. So when we are working with people with high conditions, acupuncture, Chinese medicine, I believe is an integral part of the integrative medicine team that needs to be to help these conditions. I, um, about a month or two ago, I lectured at the east west integrative medicine department that UCLA that’s been going on for over 25 years.
Oh my God. And we did an international conference, which I was part of the panel on Chinese medicine and vision. So the need is there, there were some amazing acupuncturist, like one of my colleagues and co-teachers Dr. Andy Rosenfarb who specializes in vision and Chinese medicine. So what I want to really put out today is how important and how Chinese medicine can be part of that team and myself. And I’ve been practicing for over 40 years as an optometrist. And what are we up to now, Virginia 26, 28 years, 26 years as an acupuncturist. And I didn’t even know when I was in a, I doctor school, optometry school. And I would say, excuse me, why did they get a cataract in the left eye and not the right eye? And they go, you mean, you want to know why I said, yeah, I’d like to know why.
And Ted Kaptchuk said it beautifully. He said in Western medicine, in which I was trained, we look had, how does X cause Y but in Chinese medicine, what do we look at? What is the relationship between X and X and Y? And I believe that all disease dis ease in the body mind has to do with relationships, relationships, to our environment, to the trees, to the oceans, to our, uh, families, to our friends. And what are, what is the goal of every acupuncture or Chinese medicine treatment, balance and harmony. And when we have balance and harmony and Chinese medicine speaks about it beautifully, we have no stuck energy. And I believe in my experience that almost all eye conditions, uh, due to stagnant energy. So let’s go to the next slide. Allen integrative medicine envision, we need an integrative approach. You know, I lectured at the integrative healthcare symposium and there were acupuncturists in the audience, functional medicine doctors, natural paths. Yes. I always tell people who I see, I’m just a little part of your team. We want to do integrative medicine. Next slide.
Can I interrupt a second? I went recently to an eye doctor to, you know, just have a checkup and tests. And I don’t think I’ve actually ever done that as an adult. And, um, you know, they dilated my eyes for something. They put some other drops in. I mean, for three weeks, I could barely see, and, and my eyes didn’t adjust back, you know, the dilation, but they were cloudy from the second. They put the first drops in and, um, you know, all they could suggest was a drug. And they said, oh yeah, it’s not, it’s not, it’s no problems with it. But I looked up the side effects of the drugs. It was every organ, every organ. And it was going to change. It could change the color of your skin, your eyes, but they thought, oh, no, this is totally benign. So there’s such a need for what you do, you know?
And for some and others to know about it, really, we all should be trained in this specialty because it’s, you know, what’s going on is kind of barbaric really anyway, sorry to interrupt, but you’re never interrupted. And yet at the same time, I talked to you about it and you were like, oh, we have, you know, we have technology and ways to do it, that you don’t have to be dilated. Oh, there’s different versions of these different medications without the preservatives. That cause a lot of the effects side of it, you know, why don’t other doctors know this?
So as somebody in both professions with both hats on I, doctors are really, really nice people. They really try hard. But as we know with most Western medicine, we have limited things in our toolkit. We have medication, we have surgery and that’s it. We are looking at the eye as an isolated organ. I had a patient I’m going to see later at my last patient today because he was told she has eyelid cancer, but I started talking to her. And what are the lids related to in Chinese medicine, the stomach and the spleen. Is she having problems with her microbiome? Is she having issues? Is she seeing a functional medicine doctor? Yes. But the eye doctor said, oh, you’ve got bumps on your eyelid. You know, it’s maybe it’s eye cancer, but I’m just saying, we need to look at the relationships. And remember when I just said before, um, well, why did you get a cataract in your left eye before the right Chinese medicine in most people?
Right. I father I male, I yang. I left, I feminine yen receptive. So when I really look in, I mean into why somebody develops macular degeneration, glaucoma cataracts, and why they may get an in one eye versus the others, I’m going to talk to them. What’s going on in their relationships with their father, with their husband. I mean, I’ve got stories, I’ve got stories, you know, after 40 years. So let’s keep going because this is just a preview because I really want acupuncture is to, to, to get the power that they have for this kinds of treatments. My website, natural eye care started about 20 years ago. My business partner in that is, uh, Michael Edson. And Michael is an acupuncturist also. So we refer to acupuncturist all the time because it’s both are bent. Uh, you see a pho a phone number there, (845) 255-8222.
The direct number for Michael, which is the new number on our website is 8 4 5 4 7 5 4 1 5 8. But you can go to the website and Michael loves talking to acupuncturists and we are there as a service to help you work with your patients. Next slide, Allen. These are some of my books beyond 3d magic eyes. Those of you who are old enough know about these 3d pictures that you relax your eyes and then a hidden picture comes out. Uh, it was published. We, uh, they sold over 30 million of those books. I wrote two of them. I’m the medical consultant to them. Uh, I got there, but after they sold the 30 million, so I didn’t really profit from it. Um, but those magic eye pictures, uh, one of the tools I use not only to help people’s eyesight, but to help reduce liver stagnation through the eyes, the greater vision book was written because I do believe in the Mati body, mind and spirit of all eye conditions, natural eye care that I wrote with about twenty-five years ago, which was the book before it’s time with a good friend of mine, Dr. Glenn sweat out is in Hawaii. Um, and then we can go to the next slide where we expanded on it to that 800 page, 2000 peer review references book, uh, on natural eyecare. And that book is also available on Amazon and then on Kendall. And we also divided it into about five or six smaller books because that’s a very heavy book, but it is, it is. I have had the 10 different doctors help me with it. So it is, uh, a really good resource. Um, next down, next slide.
So let’s talk just a little bit. The only thing worse than being blind is to have sight, but no vision. Where does vision happen? It happens in the mind. That was a quote from Helen Keller. Next slide, Dalai Lama, in order to carry a positive action, we must develop here a positive vision. One of the real keys in Chinese medicine is the person has to have it in their belief system that the, this kind of thing can help. You know, we’re not there to convince people. We want people to feel positive and if they can conceive, if they believe it, they can conceive it. Next slide. This is, uh, something which my magic eye books are based on vision is the art of seeing what is invisible to others. You know, we need to see the bigger picture and what does Chinese medicine do? It sees the bigger picture next, and this is how I sign all my emails.
And I’m going to give you all my personal email, um, today, because you’ll see if you have any questions that come up, because the question is not what you look at, but what you really really see next slide. Okay. And here we go. No, no, that’s good. We got to go to Shakespeare. The eyes are the windows to your soul. We know about that. People, the Shen the spirit, the pilot light our eyes tell us how much our spirit is connected with our soul. And I believe that through the eyes we can help people, uh, go through their soul’s journey next and Benjamin Franklin, an ounce of prevention is worth a pound of cure. So nutritionally Chinese medicine wise, if we can get people on good visual hygiene, the dentists talk about dental hygiene, plus your teeth, brush your teeth, brush your teeth, but we’re on computers. Yeah, because 11 hours a day on digital devices, we need to do visual hygiene. We need to take care of our bodies and our mind next.
And this is the integrative medicine approach, which is, I think the Chinese medicine approach imagine a oriented towards healing rather than disease, where physicians believe in the natural killing capacity of human beings and emphasize prevention above treatment in such a world, doctors and patients would be partners towards the same ends. And that’s why the minimum I’ll see patients or clients is I say, I want you to come in after we’ve worked for awhile, once a season, as the seasons change, as you are going to be relating to your environment different than, uh, we need to do a tune-up. So on all my clients, I say the minimum I’m going to see you is once we get everything balanced and in harmony is once a season. Next slide. So these are some of the allied complementary practitioners I might refer to for different eye conditions. Um, and acupuncturist is right there.
And even though it’s, it’s not on top, let me tell you, uh, my partners in my practice, my PA one partner is a chiropractor and the other partners, and as an acupuncturist. So, uh, acupuncture and chiropractic are some of the biggest referrals that I make in my, um, uh, integrative team approach, along with natural paths and functional medicine practitioners. But at different times, I may use any of these different complimentary practitioners. Next, this is the office I rent space in. This is the outside next slide. The reason I’m showing this is the waiting room before COVID where now we have people six feet apart. Next next one, contact lenses next, because contact lenses from an acupuncture standpoint, what they do is they put people who are very near-sighted. They create a larger retinal image size. So actually just switching people from an eye as an eye doctor from glasses to contact lenses may open up a whole way of Le less liver tree stagnation.
These are some of the, this is some of the high end technology that’s available today because, and I can help you as acupuncturists, uh, read the reports on this and, uh, talk to you about the findings on some of these tests, in terms of Chinese medicine. These are pictures underneath the retina. They take pictures underneath the macula, underneath the optic nerve. They take a 3d picture of the eye. And as, um, Virginia said some many times we don’t have to even dilate the eyes. Do you know, as we said, the eye Embrya logically physiologically and neurologically, what is it? It’s brain tissue. If you continue to mind, you can change your eyes. We all know about the neuroplasticity of the brain. Therefore we have neuroplasticity of the eye and you know, that you can diagnose, uh, Alzheimer’s disease early through retinal photos. Yes. This thing is out there. So the technology today in the eye will give good insight to people’s eyesight. Next slide. Okay, let’s go to slide 23. [inaudible].
So, as I said, the hi is brain tissue. Do you know that there are studies that in multiple personality disorders, they all had different prescriptions. Oh, very interesting. Mind, body spirit, next slide and trigger points. Uh, both me and Virginia. We had the pleasure and the utter gratitude that we were able to learn from. Uh, one of the, the pioneer of trigger points, Janet Trevell who wrote these two giant giant books, even bigger than my book on trigger points. And when I learned that it’s the neck, the shoulder, the upper trapezius, going to the sternocleidomastoid up to the suboccipitals that many vision problems come from, because why not that that happened? Because people have poor posture when they’re on devices and things tension. Exactly. Next slide Allen, the spleen is surveys is the neck muscle. So when we’re doing trigger point therapy, we can help with pain in the eyes.
We can help with glaucoma, which, um, I’ll talk about very briefly after, but I really wanted you to know that trigger points, uh, whether you do it through deep tissue or you do it through acupuncture could be very, very helpful in, uh, treating, uh, eye problems. Next slide again, the SCM, a biggie player, especially with musicians, especially like violin and Viola players. Ah, because those people I’ve got studies on how that affects a stigmatism. So yeah, the eye and the body and posture are very related. Next slide. The psoas muscle. If you have a tight psoas muscle, sometimes it relates to a vertical imbalance between the two eyes. So again, we have to look at the whole body next.
Okay. That’s it for the slides on. Thank you. So I’ve got about six minutes. I’m going to give you an overview of glaucoma because glaucoma is so we can do so many things because glaucoma is a disease, this ease of the optic nerve. But the only thing that I doctors having a toolkit of glaucoma is medication with lots of side effects and surgery, and they even have people. And then what they say is, oh, oh, we just have to lower the pressure. But look at that. Here’s the, here’s the optic nerve. Yes. According to physics, if you lower the pressure in the eye pressure hitting the optic nerve, that’ll be helpful because the higher the pressure, the more it could possibly break down the optic nerve, normal pressure and glucometers between 10 and 22. But wouldn’t it make sense to also build up the ocular blood flow to the optic nerve?
Wouldn’t it make sense to work on neurodegenerative neuro uh, uh, neurodegeneration? I mean, that’s what, uh, the eye research is showing. We want to have, um, things that are helpful for the nerves. So nutrition very helpful for that alpha-lipoic acid N-acetylcysteine, um, sublingual, vitamin B12, the B vitamins. So nutrition, very helpful acupuncture super-duper for, uh, helping with ocular blood flow and circulation because circulation, that’s why studies show that as little as aerobic exercise, four times a week can help with, uh, lowering the pressure. But what is one of the, some of the main things in Chinese medicine? You know, we all say liver, liver, liver, nice, but in Chinese medicine and glaucoma liver is a big player because it’s the stagnant liver cheat that can add to, to, uh, CA um, Livia, hyperactive, liver, young, that can cause a high eye pressure. So I’m always trying to bring the pressure down, bring it down.
I want to deal things with the earth element. I may have them stand in dirt, rub a, a ball on kidney. One, bring the energy down. So liver three, liver aids for blood, uh, gallbladder 20 to release the tension in the occipital. Uh suboccipitals so liver kidney very, very important. Especially sometimes the pattern is a kidney yin and Liberty in deficiency. So there’s basically, this is where it gets a little tricky. There’s like six different kinds of glaucoma. Some glaucoma is due to more due to inflammation, such as pseudoexfoliation glaucoma. Some glaucoma has normal tension, normal eye pressure, but has what we call large cupping in the optic nerve. And therefore, you know, we can lower the pressure, but it’s more about getting more blood flow to the optic nerve and, uh, helping the nerves. And then there’s the eye, the glaucoma that has high eye pressure.
But again, the tool dry doctors is just lower the pressure. So we can see very easily how Chinese medicine can have an effect. And going back to the muddy bind spirit stress, oh my God, they have studies that show that stress can increase the eye pressure. So even in the regular literature on Western medicine, so we want to relax. That’s why my favorite formula that I created with my, uh, acupuncture partner, Jason Elias, and we called revision. And what is it based on B Florim and Pini combination. Why, because what is that called relaxed wander? And I added some bilberry and some Ginko, and I added a little Licey and chrysanthemum to bring energy to the eyes. So we really want to do Western Chinese herbs coleus and air vinegar. That’s very good to lower eye pressure. So I really, what I really want to share with you and hope you get a, and if you want to learn more, I am totally available.
My personal email is D R Grossman 20 twenty@gmail.com. I really want to let you know that the ability for Chinese medicine to help with chronic eye conditions and basically all eye conditions, is there that Nick, that place that you, if you really into it, that you want to add to your practice is there. And you will, you will have patients. My friend and colleague, Andy Rosenfarb is busy, busy, busy, and he trains, uh, acupuncturists in a special kind of acupuncture called micro acupuncture. So again, thank you so much for your attention and your time. And hopefully listening to this, uh, again, knowledge is power, and I hope that you become part of an integrative medicine team to help people in the world keep their precious gift of sight. Thank you so much.
Thank you so much, mark. And thanks again to the American acupuncture council, um, Virginia Doran signing off from luminousbeauty.com and yeah, Yair Maimon is next week. So, so he’s always got something interesting. I hope you’ll check that out too. All right. Goodbye. Bye.
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.
Well, good day, everyone. This is Sam Collins, your coding and billing expert for acupuncture, the American Acupuncture Council and the American acupuncture council network. Welcome you to another program. We’re going to give you always some updates on coding, billing, documentation, things to help enhance your practice. Remember, our goal is the American Acupuncture Council is to always enhance you. We’re symbiotic. We obviously offer malpractice insurance, which I’m sure many of you have, but we also offer our network service, which gives you some up-to-date information. And this is partly what we do here is to make sure that your practice does well. So let’s get to the point. Let’s start to understand what’s happening in currently going on with modifiers. Let’s go to the slides. If they’re not up. Those modifiers that we run into often are very confusing for many acupuncturists. And there’s been some recent changes that you may not be aware of, that you probably have gotten some denials.
So let’s talk today about what is necessary for modifiers on an acupuncture claim. What do we really need? And believe me, I think there’s a lot of misinformation, unfortunately, and does not get you paid without the right information. So what are modifiers? What modifiers of course are referred to as what we say, a level one modifier and it’s to supplement information about the claim itself. There are usually two digits or two characters in line, and they tell us something specific about the service. By example, modifier 25 to indicate it’s a separate, distinct service things of that nature. So the modifier is there to tell us something more about it. In many ways, the lack of a modifier will cause a denial. In fact, I bet many of you didn’t learn about using a modifier 25 until you got up in practice and you were like, why do I never get paid for an exam is because we’re not using the right modifier.
Remember a modifier does not alter payment. It just indicates a specific specificity about the code so that it can be paid. And so where do modifiers go? This is a portion of a course of a 1500 claim form. You’d put the data service and notice here. There’s a section that says modifier and notice there’s four spaces, 1, 2, 3, 4. So is it possible that you might have to use more than one modifier? It certainly could be. It would be unusual in an acupuncture setting, but possible just bear in mind that you can always add up to four now, what is the most common modifier for acupuncturists? And this is the one I will say. Every acupuncture is going to use at some point and it’s modifier 25. And what modifier 25 indicates it says modifier 25 is defined as a significant separately, identifiable evaluation management service by the same physician or other healthcare, other qualified healthcare professional on the same date of service of another procedure.
So all that gobbly goop means that the modifier is required when you’re doing an ENM evaluation management or exam code the same day as acupuncture or any treatment to indicate that the exam was separate or above and beyond what we note as the pre and post service evaluation. So by example, when you see someone on a first visit, you’ve never seen them before. It is clear, you’re going to do a significant examination. You can’t just say, Hey, I don’t care. What’s wrong with you. Put them on a table and hit them with needles. But what you’re going to do is take their history, do a full evaluation. So that is clearly an exam above and beyond normally what you do. So that’s why on a first visit, when you build an exam, you always will put a 25 modifier. However, let me make a clarification.
Some acupuncturists have the misinformation that they’re going to do an evaluation management or an office visit on every single visit. And that is actually incorrect. And here’s why the acupuncture code includes a pre-service and post-service evaluation. So by example, I just noted the first visit. The first visit. Clearly you have the history of the injury. When did it happen? What did you do? All those things, but on a follow-up visit, yes, you are going to do a small evaluation. What are you going to do on a follow-up visit? Like if I were your patient on the second visit, you would say, Hey Sam, how are you feeling today? Is that better? Last time when you left, the pain was much less. So in other words, it’s going to do a review of the chief complaint that is called the pre-service. So the reason you can’t bill an exam every day is because the acupuncture code or actually any treatment code includes a small evaluation.
So the reason you’re putting a 25 modifier on the first exam is your notification to the insurance that this exam is above and beyond the exam associated with treatment beyond the normal day to day, how are you feeling better, worse tongue pulse and so forth. So again, an exam can’t be done every day, but there is an evaluation every day. That’s part of it. So for billing purposes, take a look how it goes. The modifier goes right next to the code and the mid-level exam, 9 9 2 0 3 and a 25. If you forget to put the 25, it is an automatic denial, just a hundred percent will not be paid. The 25 is there to indicate that it’s a separate and distinct service and payable. Doesn’t alter the price, but does indicate that it is a payable exam because it’s above and beyond the one you do day to day.
Now this, I will say every acupuncturist does no question, the first visit. And re-exams probably about every 30 days. Be careful do not build one each and every visit and also be mindful. Some carriers that you belong to, and that can include some of the blues as well as, um, some of the, uh, uh, United health care policies. Depending if you have a membership through like Ash, they may pay only one exam a year. So it’s not an issue that you didn’t use the right code or modifier check your contract. But assuming non contracted one should be paid. One done so long as you include the 25. Now you’ll notice I did put here a new patient exam, but it could be an established patient 9 9 2 1 3. So that again, most common one. Now here’s one you may not be familiar with, obviously, regardless of that, COVID seems to be tailing off.
Might there still be a use for telemedicine visits for an acupuncturist, particularly for a patient on their first visit. Maybe they don’t have the time to come in for an hour visit. So maybe you do the first half of the visit telemedicine meaning the non-treatment part. So how do you identify telemedicine? Well, there’s a unique modifier for telemedicine. It’s modifier 95. Now you’ll notice I have it right next to an ENM code because a telemedicine visit is an evaluation it’s counseling. So you would use an ENM code, but to identify it as telemedicine put a 95. Now, remember telemedicine does mean audio, video and live. It cannot be recorded as not a phone call. It must be live interactive, audio video. Now the one of a unique difference for this one is not just the modifier. You’ll notice. The place of service says zero to the zero to places.
Service indicates also a telemedicine setting. So it not only needs the 95 modifier, but the zero two, if it’s a telemedicine visit, now remember telemedicine. Obviously we can’t treat, but could there be places where there’s counseling for a patient where they can’t come in or let’s face it? What if they can’t come in timely or don’t have the time to spend an hour an hour and a half, which may be the history, might it be more convenient? Would it make more sense to maybe do a telemedicine, at least that part, and then follow up with a half hour visit where you actually do treatment. So a viable one they’re 25 on exams with treatment, but telemedicine 95. Now there’s another modifier. And this is the one I’m sure many of you have missed out on it’s modifier GP. I’m sure if you’ve billed the VA, you’re aware of it.
But what this modifier is called is called an always therapy modifier. It’s what’s called a HICPAC modifier, HCPCS healthcare, common procedure coding system. And it’s a letter one, and it’s always therapy because every time you build a therapy to some payers, they need to identify who’s providing it, meaning a therapy provider. So for acupuncture purposes, you’re going to use modifier GP. Now you’re going to think, well, GP indicates physical therapy. That’s true, but that’s within your scope. So you’re going to put a GP, not a geo or a GM, just understand geo means services by an occupational therapist, G N by a speech therapist. So for our purposes under scope of practice, it would be a GP. Now, what does this add on to literally every physical medicine rehabilitation code? So when you think of what is that, that’s going to be every therapy code, right?
We all the way from hot packs all the way through the unlisted service. So common services, massage, gosh, manual therapy, infrared heat exercise. In fact, what I will say is any therapy code that begins with the nine seven, not including acupuncture will require the GP and who requires it well United healthcare as of April last year, that includes Optum health. It also includes anyone going to the VA, which you’re probably already aware of, but here’s the newest beginning April 1st of this year. And I’m sure you’ve noticed it on a lot of claims going to Anthem. And this includes blue cross blue shield of Michigan notice blue cross of California. Now let me be clarified here for anyone from California in California, blue cross and blue shield are separate companies. So it includes blue cross in California, but not blue shield. So do be aware of that nuance and most other states they’re combined.
And that includes all of these states, including Indiana, Kentucky, Missouri, New Jersey, New York, Ohio, Vermont, and Wisconsin. And I think others as well. So check your EOB is if it comes back and it says this service is missing a modifier and it’s a therapy, chances are it’s the GP. Now that means all physical medicine codes. The question you may have though, is any other payers? Well, Medicare is one of them, but remember Medicare, we’re not billing directly, but technically if you’re looking for a denial for Medicare, you would put that on there, but again, not common. And so how does the code look like? Well, take a look here. You’ll notice I did an exam, same thing, but notice 9 7 0 2 6 GP. The GP does not change the price. It’s just a requirement for payment. So you may think, well, Hey Sam, can I add the GP to every client?
Why not just add it to everything? Well, that could be partially problematic. And I wouldn’t blanket it because there are carriers that may not recognize it and may deny it. So for now, I’m going to say Anthem policies, United healthcare and their affiliates and the VA a hundred percent. And if you ever get a dial back that says this claim for physical medicine services or physical therapy is missing a modifier, it’s likely a GP, but again, don’t Blake. It, it, because here’s what I’ve also found. If you put a modifier on something, they’re assuming you’re trying to tell them something unique and chances are, they may deny it. So for now stick with just those payers, if you’re wondering, well, how would I know this? One of the things you can do, the American acupuncture council is your partner and our website for our education division.
The network has a new section go to AAC info network, click on the new section, and you’ll see all these updates. It’s one of the ways we try to keep you up to date. So if you’ve never gone to the network website, please take a look, AAC info, network.com, click on news. And in fact, just sign up for our email subscription. And what we’ll do is send you once something has changed, because here’s the difficult part I come to you probably once a month or every other month, but what happens in between us, something has changed. So it’s our way of updating. So again, GP on all physical medicine codes, and we want to give you a portal where you can start to use it. Now here’s an area that I think is often very confusing and a lot of acupuncturists have bad information. They will say, Sam, do I need to use modifier 59?
Well, what does a 59? It says a distinct procedural service. And it says under certain circumstances, it may be necessary to indicate that a procedure service was distinct or independent from other services, not including an ENM. So a lot of acupuncturists have made this assumption that, oh, I put that on my second set. You absolutely do not. A second set is already distinct. There’s also another other modifier. That’s common. It’s more or less the same. And it says a separate structure. And it’s excess. Now I’m bringing this up to make sure you understand what these modifiers are and why you wouldn’t use them, because you do not have to indicate that the acupuncture is to a separate area. We don’t have that type of rule or protocol where I think this comes from is people not understanding chiropractic claims. And part of the unfortunate thing is often people who teach you are not teaching you specific things about acupuncture, but that’s something that may be related to what a physical therapist does or what a chiropractor does.
So let’s talk about specifically a chiropractic claim versus an acupuncture claim. Chiropractors have to use modifier 59 when they’re using massage or manual therapy. And it’s because the rule is a chiropractor is not separately reimbursed for massage or manual therapy. If it’s done in the same area as manipulation, hence why that modifier is there to show, oh, it’s distinct. It’s a separate area. Now this edit doesn’t apply to acupuncture. There’s nothing about acupuncture and manual therapy that will require a 59. So if you’re putting a 59 with it, there’s no absolute necessity for it. In fact, it may cause the claim to be denied. So as a general rule, the modifiers you’re going to use as an acupuncturist are going to be 25 on exam codes in GP. For those, those companies that I mentioned now, would you ever use a 59 will never for acupuncture, but I’ll give a scenario.
Some of you, you may be doing a little bit more of a rehab style with a patient. Maybe they have back pain and you’re doing some exercises and therapeutic activities. Particularly this could apply with a VA patient. If you were combining exercise 9 7 1 1 0 with therapeutic activities and 9, 7, 5, 3 0, you would put a 59 or one or the other codes to distinguish them as separate. And the reason why is those two services are very, very similar in fact, to be the exact same thing, but the outcome being different. So you want to distinguish that part of the service was, you know, exercise and part was a therapeutic activity. So that would be about the only place I would ever see the use of 59. So don’t get caught up that, oh, I have to use it. Trust me, it’s innocuous information and just incorrect. So again, 25 in GP, but not a 59.
And the reason I’m bringing up news, I’ve done a program with you before where I talked about Cigna at American specialty health, I’m going to let you know no, this doesn’t apply to California, Oregon, Washington, but to other states, if you’ve not seen it, they’ve delayed the change to September and they’ve upped the ante to 89, a visit from 55. So that’s a nice change. You should have received some information on it, but if you have not, how do you find out go to AAC info, network.com, click on the news tab. And you’ll see, I’ve written an article piece on that. Our job at the American Acupuncture Council, keeping you up to date, keeping you paid keeping to make sure your practice survives. So if you’ve not been to our site, this is the site. Notice here, the new section, click on that. You’re right in.
But let’s talk about what are you doing to really make your office do well. Have you ever thought of where do I get my answers? Who do I get them from? Hire an expert. We offer a service called the network where for a small fee per year, you get complete access to me where I become part of your staff. You can ask me questions on coding, billing, documentation, medical necessity. Hey, Sam, a claim got denied. Get to a place where we’re making sure your claims getting paid. Here’s what I guarantee you. Join our network. I’ll get your money back within a month because all I have to do is answer one or two questions and it’s always related to money. You’ve gotten paid back and it’s going to be triple fold because guess who gets notified? First people who are in the network, we send out an email chain to everyone.
That’s a network member when something’s changing. Anytime there’s an update. You’re notified first. So let’s help you get your claims paid, go to our site. Here’s a QR code you can go to, but simply go to our site. AACinfonetwork.com. We’re here to help as always the American Acupuncture Council is your policy holder or your policy holders, but we’re also your advocates. Now next week’s program will be Virginia Doran. I look forward to seeing you all next time. Take a look at the site. Let’s get you paid and best wishes to everyone. Thank you very much.
And today I want to shed some light on a few simple ways that you could be doing that building your practice was something that many of us were not taught in acupuncture school, but seldom did we receive the foundations of building a successful practice and keep patients coming in.
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.
Hi there. Jeffrey Grossman here. Thank you. The American Acupuncture Council. Once again, for this opportunity to share some business and marketing insights with you, I’m really glad to be here today. Today’s a special day for me. June is a special month for me and things are changing. COVID is in the rear view mirror. People are getting outdoors life.
Wow. I have no idea what that was.
Um, so, um, life is assembling back to normalcy. And so what does this mean to you? Well, people are looking for your help. People will need to understand the value that you offer. Um, that is well beyond just treating painful conditions. Most patients, most prospects, most strangers really understand that acupuncture is helpful for pain, but as you and I know acupuncture goes well beyond just treating painful conditions. And today I want to shed some light on a few simple ways that you could be doing that building your practice was something that many of us were not taught in acupuncture school, but seldom did we receive the foundations of building a successful practice and keep patients coming in. You’ve got all the know-how, you’re an amazing pulse diagnostician and herbalist, a Needler, or cupper all of those things make you amazing with the medicine. But many of us don’t have the tools that are needed to consistently attract new patients and to systematically keep them in the care and keep yourself in top of mind awareness.
So all of that won’t be much help if you don’t have some of this information limiting sharing with you today. And that’s why I’m excited to be hosting this web class about the only three things that you should be doing online. Uh, so I want to share a few simple ideas that can help you get more patients on your treatment table. Keep you in top of mind awareness with your existing patient base and help you get found more easily online. So welcome for those of you that don’t know me. My name is Jeffrey Grossman. I’m the founder of acupunctureMediaWorks and acupuncture websites, and Accu downloads. And I started my practice back in 1998 and I had tons of trials and tribulations and struggles in my practice. And basically I was scared and broke back in the day because I had no business acumen and I was not savvy at all in any form of marketing.
And I had to start from scratch and I continue to, you know, struggle for many, many years of my practice, but I noticed that I had a problem. And the part of the problem was I wasn’t really figuring out how to properly communicate with my patients and how to consistently show up in their inbox or on their social media feed. Um, so the struggle took me down a path to start my companies. Um, so I can, you know, so I needed to create those marketing materials for myself. And then therefore I now have them available for practitioners. So that’s a longer story. And maybe we’ll talk about that at some other time, but I want to remind you that you are an incredible resource. You’re an amazing resource to change lives every single day. And I want to help you become more noticed. I want to help your community to be able to find you more, to tap into your skill set.
So you could help change lives. One needle, one person at a time. But unfortunately, a lot of people don’t even know we exist, right? They let alone knowing the vast conditions that we can treat, but I want to help you change that. I want to help you get more people on your table. And I want to talk about how to help you be seen and be heard and to ultimately bring people into your practice so you can make more money and to help more people. So at the end of today’s talk, if you feel like you need some help getting set up or becoming focused, or if you just need a little motivation or some clarity, feel free to reach out to me, I’ll have my I’ll let you know, my email address is, or you could ping me here on the social media channels.
I’m here to help give you a fresh perspective. And there are more opportunities now than ever to help people and help them understand what it is that you can do for them. So, um, I put together a 15 page resource that I think that you’ll find invaluable. And again, I’ll share the link for you today at the end of today’s talk, and you could use this, uh, this resource and this talk today to help reset your practice. And just one thing from today’s talk or form that from that resource ebook that I put together for you, one or two simple changes that you make can make the difference in your practice moving forward. Okay? So, but what I wanted to do is I wanted to really talk today about simplifying, um, today’s talk and reviewing what I think the only three things are that you should be consistently doing online.
And consistency is key here. Having a plan is key here and actually initiating your plan is the real key here. So time is scarce and chances are that you don’t know what to do next, right? So I’m going to make it easy and let’s start here. The first thing is to become find-able okay. So your website is the hub of all of your marketing opportunities, but simply having a website is no longer enough. All your competitors are vying for the same new patients on the internet. They have websites too, right? So let me ask you this. When was the last time you did a Google search and clicked over to the second or third pages that appeared in the search, right? My guess is not too often. And your patients are no different. And for your website to be found by someone searching for an acupuncturist, your site must appear on the first page of search results, right?
So optimally, it should really appear in one of the top three positions and these places, um, received the lion’s share of traffic and clicks and, um, you know, and, and all of this leads to what new patients, new prospects, people coming in and checking you out, which means your website must be seen as reliable and authoritative and trusted by Google and optimized to perform better in the search engines, then your other neighborhood acupuncturist, because Google and other search engines, aren’t willing to risk their reputation on, you know, a website that isn’t, uh, SEO properly, or it might not be up to par based upon some of their requirements. So what do I mean by that? There’s two things. First, your practice website must be optimized for search terms and new patients. You know, that that new patients would be using to fight an acupuncturist. And second, the design, the navigation and the user experience must invite visitors to stick around and to explore your site because you only have a few seconds to attract attention and to get people to take the next steps.
And because everything that you do and everything, everyone that you meet, all of the marketing, that materials that you’ve put out there, all do what, right? They point back to your website, anytime anyone mentions you and your practice, what’s going to happen. They’re going to go check you out on your website. And even your social media channels, your website is the hub that people visit before they step a literal foot inside your door. And all of this, um, this, this hub is all of your marketing activities is the first place people go to search for you. So it’s where your first impression it’s where your, your prospects make their first impressions. Okay. So what are the only three things that you should be doing online? Well, glad you asked. Okay. So I know there’s so many other things that you could be doing to market and to grow your practice and to get your website SEO, and to use meta-tags and title tags and the right search terms and all that.
But I want to talk about three things that I’m pretty confident that you should be doing consistently in your practice, which are generating leads, communicating with your current patients and creating and distributing great and shareable content. And I didn’t say mediocre content. I said, great and shareable. And there’s a difference. And let me talk about that. Briefly, many of you are not doing this, and many of you don’t even know that this is a thing, right? So generating traffic to your acupuncture website and converting those visitors into new patients is a f’ing and it separates successful practices from struggling ones, right? So what is traffic generation? And simply put it’s in marketing lead generation is the initiation of customer interest or inquiry into the products and the services that you offer and leads could be created for the purpose, such as building an email list or, um, an E newsletter list or in our case to get more patients on your treatment table and lead generations, the process of attracting and converting strangers and prospects into paying patients that ultimately pay, stay and refer.
So here’s a few types of traffic generation techniques that you should be doing. And hopefully you are doing these. And if you aren’t doing any of these that I’m going to reviewing here on this list, I implore you to figure out how you can get that done, whether or not you’re going to hire it out, whether or not you’re going to learn how to do it, whether or not you’re going to, you know, check out YouTube and search some videos to make it happen for yourself. But you should be doing at least three or five of these, if not all of these types of chap, traffic generation techniques. So Facebook ads, right? No brainer. You can easily target locally in your community and your zip code. Google. My business should be absolutely 100% set up for your practice website and online and Facebook reviews. These are important.
How many times have you checked out the reviews of a restaurant or even another practitioner before you chose to make them, you know, the food of choice or your practitioner also lead generation through community relationship, building and connecting out, um, into different resource groups and to work with other organizations and other, other meetup groups that are out there. Professional networking is a great way to generate leads into your practice. Social media, obviously that is a powerful way to generate leads into your practice and your website, and make sure that on your website, you’ve got specific calls to action. You’ve got benefit focused, lead magnets, your you’ve got your scheduling set up. You’ve got online classes that lead to generation, and you’ve got condition specific self-care classes and videos. All of those things that I just mentioned are about generating traffic from the internet and the outside world into your practice.
So everything that you do is meant to stimulate curiosity and move people along that path to becoming a new patient, right? The good news is that you’re driving traffic all the time, right? You just may not be intentional about it and getting the conversions that you’d like, which is AKA transforming a stranger or a prospect into a new patient that is a conversion. So here are a couple of questions that you should ask yourself. What am I consistently doing to stay in top of mind awareness with my patients? How can I improve my website ranking and appear in one of the top three spots is my site Google ready? Are my reviews going to be enough to drive interest when people hit your site? Is there a clear marketing message? What’s the journey a prospect goes through when they hit my site, what do you want your prospects to do?
What are their next steps? Can they schedule, can they download something? Can they grab, uh, can you grab their email? Um, and from giving away something cool, like a free report. And do you have relevant content that speaks to your customer’s specific problems? And this is huge. A lot of times we put out content, but we don’t have a clear marketing message or even a clear idea of who our actual real patient is. So we’re putting out information that might not pertain to them. So that’s important that to have relevant content that speaks to your customer’s specific problems. So the goal with generating leads is to always have a stream of new prospects flowing into your practice, whether it’s scheduling a visit, giving you a call, downloading your benefit focus report, or even walking in your door, right, new prospects, they are the lifeblood of every practice.
And if you’re not consistently working on lead generation, you’re probably going to be fighting an uphill battle. All right. So the next thing you need to be doing is communicating with your current patients on a routine and regular basis. Okay. Routine and regular basis. That means you need to have systems set up in a rhythmic way that you are doing it regularly for your patients, right. You can’t just throw out some social media and, you know, one month and six months later come back and do it. You’ve got to have a system and a plan in place. Okay. So let’s talk about this. It’s great to have your website, you know, that’s working fantastic that your site is generating leads for you. And I hope that you have at least some of the things I just mentioned a second ago. Um, now the question is how are you communicating to your strangers and your prospects and your patients, right?
So your new prospects, your active patients and your inactive patients, how do you keep the communication channels open? Okay. How often are you getting in front of your patient base and sharing pertinent and timely information? How often are you adding and updating a blog post? How often do you send off an email or a newsletter or a simple postcard to nurture your existing patients? How often are you sharing new and relevant research with them and how many videos do you post on a regular basis? So all of this is extremely important in order to keep your patient base engaged and involved so that they don’t fall out of care so quickly. And the truth is that technology makes it so easy for you to do all of this, right? There’s even software and companies that do it all for you. So I’m going to talk briefly about some ideas, some of you, which, you know, you may know about these already.
So for blog posts, there’s no shortage of topics, right? You can talk about seasonal topics, dietary suggestions for healing or particular ailment, acupressure for coming conditions, tight chief or back health. There’s so much opportunity for you as an acupuncturist to write about and for emails. Well, for starters, you should have a new patient welcome series and existing patient nurture campaign, and a few emails that go out to remind patients of their appointments. And even a few emails that go out to get your inactive patients back in at minimum, those are the four different email campaigns you should have in place. If you don’t, you really need to evaluate that for research content. Well, what’s the latest research that you came across about acupuncture. Are there any new studies that you, that if you shared with your patients that they would say, wow, I had no idea that acupuncture was so good for that problem.
Okay. So that’s just a couple ideas again, we could spend a long time just talking about that specifically, but now the question is how often do you post, how often should you be communicating with your patients? Uh, well, the answer may not be what you want to hear and the answer is often. Okay. So I’d say that the rule of thumb for a patient communications should be at minimum one time a week for an email three times a week for social media, like Facebook and Instagram, two to four new posts added to your website each month and maybe one or two newsletters going out on a monthly basis. Okay. And for those of you that are adventurous, and I know that some of you are adventurous out there. Um, video content is extremely important. Okay. And here’s why Google, Google, Google, right? And of course, expert authority, positioning video gives you a boost in rankings and it allows more people to see your website, which means more people will take action and take you up on your offers or download your benefit, focus, lead magnet, or even schedule with you.
And also videos are going well, great way to position you as an expert. Okay. So that’s a brief lowdown about communicating with your patients. And now the final step is creating and distributing your great content to practice members, to build trust and rapport. And it’s that simple find a time in your schedule to consistently share your content. A rule of thumb is that I teach my students is that you should set aside at least two to four hours a week minimum for your marketing content distribution activities. And one of the cool things that many people don’t think about is that you can repurpose your content, right? So you create a video, you have it transcribed, and then it can be used as an email or a newsletter or a blog post. When you create a newsletter, you can use that on your website, on your social media pages and send it as an email.
This is repurposing your content, create it once and then disseminate it through other channels. And it’s important to get your priorities straight and to use your time wisely here. Um, I know that one, I say that many of your thinking, um, that I’m referring to treating patients, but no I’m talking about your marketing and communication strategies. So take this seriously. You can be the best practitioner, the most adept herbalists and precision pulse taker. But all of that means nothing. If you don’t have a steady flow of new leads, that continually community, that, that, that continually come in. So you, that you continually communicate with, um, with you class a content, so hope that this was a timely reminder, and I hope that you received some answers and inspiration and insight for what you needed today. And I want to encourage you to reevaluate your plans and to take and make actual strategies, right?
So if you want a fresh perspective, if you need help, you can reach out with me. We can set up a free, no cost, 15 minute mentoring and discovery call. If you’re interested in that, just shoot me an email at Jeffrey, J E F F R E Y at acupuncture, media works.com and I’ll get back to you as soon as possible. So Jeffrey, J E F F R E Y at acupuncture, media works.com and I’ll get back to, so remember, you’re an incredible resource. You change lives day in and day out, and you know, all about natural healing. You all know all about life-changing ways to support a person’s health and wellbeing. People are looking for you. COVID is getting in the rear view mirror and they want your help. They need your help. So how are you going to show up in the next 30, 60, and 90 days to change the lives of people that are around you?
So if you’re looking for this hope, if you’re looking for encouragement, if you’re looking for strategies, please do not hesitate to reach out. Shoot me an email. Also, thanks for sticking around. And the URL for downloading that ebook that he mentioned is Accu media, a C U N E D I a dot U S slash reset 2021. And you’ll be able to grab that 15 page report. And again, that’s Accu media, ACU, N E D I a slash reset 2021 and get that report. So be well, stay strong, continue to change lives. One person, one needle at a time next week, feel free to join us here. The AAC we’ll be having Sam Collins coming on board. You’re awesome. And the world needs you. So reach out if you need some support, if you need some love, if you need some help, I’m here for you. Take care, stay beautiful. Talk to you soon. Bye. Bye.
So we’re going to talk, uh, about some relevant trigger points. There’s a lot of relevant trigger points, but we tried to narrow it down to ones that are probably the most frequently seen in practice, especially ones that are good to with, for practitioners who maybe don’t use a lot of trigger points or wanting to get into working with trigger points.
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.
Welcome everybody. I’m here with Josh Lerner and I’ll introduce him in just a moment, but I just wanted to give a little heads up. Matt Callison and myself. Uh, co-present uh, frequently on this webinar that the American Acupuncture Council is kind enough to welcome us to. And I, Matt couldn’t make this particular, uh, uh, date and we’re here with Josh Lerner, but the reason I’m mentioning that is the subject matter we’re talking about actually has roots in some conversations we’ve had with Josh over the past couple of years, uh, specifically looking at the difference between motor points and trigger points, difference, comparison, uh, overlap, you know, uh, just a, it’s a, it’s a really great topic and that was going to be our webinar. But, um, the dates didn’t work for Matt. And, uh, we’re going to have this as part one where we’re talking a little bit more specifically about trigger points and then looking at part two on July 7th, Josh will be back with us and we’ll kind of get a little bit more into that difference between difference and again, comparison between trigger points and motor points. So thanks for joining us today, Josh.
Thank you, Brian. I appreciate being invited to do this. It’s always a plan involved with doing that.
Yeah, yeah. It’s great to have you here. So Josh, uh, Josh is up in the Seattle area and the Pacific Northwest has been practicing for 20 years. Um, and teaching at the Seattle Institute of east Asian medicine for 11 years. Uh, is that correct?
Yep, that’s it. Yeah.
And you focus on a lot of things, but uh, particularly in specifically relevant to this, uh, webinar with, uh, orthopedics TuiNa and corrective exercises.
Yeah. That’s a main part of my practice. So I incorporate a lot of the sports medicine, acupuncture protocols, as well as stuff, uh, dealing with trigger points, uh, corrective exercise, you know, movement assessment and lots of manual therapy with, uh, including things like 29.
Yeah. And Josh is also a graduate of the sports medicine acupuncture program. And like myself has a pretty long history in martial art practice, which I think is what gets a lot of us into this work initially, which is interesting. Yeah. Yeah. So there’s definitely, we would like to chat for a bit, but there’s a lot of material to present, so maybe we will go ahead and jump right into the, uh, the presentation and Josh, let me know if there’s anything you want to add before we, uh, go into that. Ready to go. We’re good. All right. So we’re going to talk, uh, about some relevant trigger points. There’s a lot of relevant trigger points, but we tried to narrow it down to ones that are probably the most frequently seen in practice, especially ones that are good to with, for practitioners who maybe don’t use a lot of trigger points or wanting to get into working with trigger points.
Um, this will be a, a chance to kind of go into those specifically though for a short webinar. We’re not going to really get into a lot of needle technique, which takes a little bit more set up. We’re going to try to put it into the context, more of, um, assessment recognizing and when, when to look for these and when to, um, utilize them and maybe even some disappointed channel theory with it. So let’s go to the next slide and we’ll jump right into that. So I’m strictly speaking, uh, myofascial trigger points, uh, or just oftentimes referred to as trigger points are a concept that’s developed in Western neuromuscular medicine. Uh, so there’s a history of it. Um, we’ll probably mostly be talking about the, the work of Dr. Janet Reval and David Simons or David Simmons. Uh, but there’s a history that goes way back, many people involved with it. I guess you could say a history that kind of parallels some, some discussions that happened in Chinese medicine, but it’s a, it’s a Western history. However, if you look closely and you, and you’re versed in both traditions, you will definitely see a lot of overlap. So we’re going to discuss the overlap, but just keep in mind that that overlap is
Not strict
Trigger point in the, you know, if you get travails books, she’s not going to be talking about the large intestine channel. Um, but there’s a lot overlap if you look for it. And just a as one quick example, looking at this picture on the right, we have two pictures actually on the left-hand side of that image, there is a supraspinatus trigger point referral patterns. Superspinatus access in the region of SSI 12 though, it’s attachment at ally 15, my tendonous junction around ally 16. And then you see the referral going down the large intestine, a little bit, the lung channel, but primarily the large intestine channel. So this muscle superspinatus as part of the small intestines sinew channel. However, there’s a link with the large intestine channel. So on the right, many of us are familiar with this Deadman image and you’re looking at that large intestine channel, um, where you see some of that trigger point referral pattern.
But it’s interesting to note that from ally 15 and to ally 16, where you would have access to the superspinatus, the channel then links, uh, intersects at SSI 12. So even the description of the large intestine channel starts showing some relationships to this, uh, um, superspinatus muscle and how there’s a relationship between both the referral pattern and the channel itself. We could talk the whole webinar about relationships between this, this type of thing between the channels and the trigger point referrals. But unfortunately, that’s not the topic though. Fortunately, we had some really great things to say, uh, uh, in addition to that, but Josh, anything you wanted to, uh, add or any thoughts that you have on, on this? I know we talk about this a lot.
Yeah. I’m not a whole lot, but just as a general idea, it’s something that people can really do is if you’re interested in this kind of thing, look at referral patterns and Trevell or other resources, but look not only at the main pathways of channels, but also delve into a lot of the law channels. Um, some of the other less commonly really known, uh, although everyone knows the law channels, but, um, the ones, your, a lot of the connections you’re not normally going to think of very often, you’ll see more connection with the trigger point referral patterns there than if you’re just looking at the main channel pathways. So in some ways you can kind of use this as an opportunity to go back and delve into traditional channel theory and kind of get into some details and start uncovering some connections you might not otherwise have thought about.
Yeah, and to me, it seems kind of obvious that the channel system in Chinese medicine has a pretty long history, a long tradition, many things that added to the development of the channels. But I think a simple one is that people were probably needling areas and node and noting and, uh, seeing the common referral and saying, oh, there’s something about needling at that SSI 12 region that kind of refers, um, down a particular pathway. And that was, you know, that, that, I’m sure I had a big part of the development of the channel system. And in addition to other things
I absolutely, yeah. Alright.
I think we can jump into the next slide. So just to give a definition, a myofascial trigger points are a hyper irritable spot in skeletal muscle that is associated with a hyper-sensitive palpable nodule and a top band. We’re going to break this down and talk a little bit more about it in a second. Uh, the spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena. This is the definition in a travail and Simmons book, the trigger-point manual, which is a great resource, a two volume, uh, resource. And you can see some of that play out in the image on the left, which is showing the sternal head of the, uh, um, SCM muscle sternocleidomastoid and the referral to the sort of frontal region occipital region Vertex of the head a little bit into the face when you’re looking at these referral patterns.
Something to take in, uh, into consideration is the darker, the red doesn’t necessarily indicate more pain when there’s referral. It’s more about frequency. You know, that that there’s going to be, uh, the greater frequency of that sort of frontal region for the sternal head occipital region. And these spillover regions are going to be a little less common, but still, still common. Uh, but the intensity of that pain might be, uh, for patient a might be greatest at the Vertex of the head. I would say it tends to be greater at those, those, um, more common sites, but, but that’s what it’s showing is more frequency of referral, uh, with the spillover being less frequent. And Josh, do you want us to actually break down a little bit of this definition? I think,
Uh, well just because one of the things that I teach at, uh, the Seattle Institute of east Asian medicine is a specific class on trigger point theory. And I find that emphasizing really understanding each of the individual words in that, um, in that definition can be really helpful. So, uh, I like the way that I define it, I kind of, you know, the words are shifted around a little bit, but it’s essentially the same definition, but it is first it’s, we’re talking about ones in skeletal muscle. They’re also their trigger point phenomenon that can occur in other tissues, aside from skeletal muscle, a muscle like in periosteum and joint capsules, things like that. But for the majority of what we’re going to be talking about is occurring in skeletal muscle. Um, it is, they occur in a taut band in the skeletal muscle. So whenever you’re looking at trigger points, you’re always going to be trying to palpate for a particular palpable taught band.
Then you will look along in that top band for the, the nodule. Usually it’s some type of thickening or a slightly harder section of that top band, and then you apply some type of manual pressure to it. And you’re looking to see if you can find the most hypersensitive spot in that nodule in that top band. And just understanding that definition itself can help you clinically when you’re trying to start learning this material. And you’re actually going to start looking for trigger points. If you keep all of that in mind, um, it will help with how you’re palpating, um, especially as acupuncturists, we tend not to palpate as deeply for, and as strongly for kind of big gross structures like taut bands and muscles. We tend to be much better palpating for more subtle things like pulses, um, chief lo in channels, whether or not, you know, kind of the spaces between things, the way that a lot of people find acupuncture points instead of big, you know, really obvious structures, uh, which it sounds kind of counterintuitive that that would be harder for acupuncturists to do. But, um, you know, Brian, you have this experience as well. And, uh, Matt and I have talked about this, how acupuncturists it’s, when they’re learning this material, whether it’s looking at motor points or trigger points, there’s always an adjustment period. We have to kind of shift gears perceptually to actually be able to palpate correctly for taught math and muscles compared to focusing on real kind of more subtle things like fascial planes and acupuncture points, things like that. And
You have to know the anatomy quite well, which is something that some acupunctures know really well. But, um, often we hear how that is something that could be a little bit under Todd in school. And I think as a profession, we really need to bring that level of anatomical understanding of
Absolutely.
All right. Well, why don’t we move on to the next slide then? So, uh, just so you have some understanding of some classification of trigger points is they do have classifications, um, a trigger point can be an active versus a latent trigger point. The image here is showing the upper trapezius and the referral pattern active generally would be a little bit larger, probably more contractile tissue, but that’s not the main gist of the definition. It’s really about that. The patient is actively coming in with that complaint. You know, maybe they’re talking about in this case, a cervicogenic type or tension type headaches that are traveling up the neck and, oh, it really hurts, you know, at the temple. So they’re actively feeling that that referral pattern, whereas latent trigger points as any of us have probably noticed we’re in they’re palpating and tissue sometimes. And oh, I didn’t realize I was insensitive.
You know, somebody says that they feel maybe some referral, uh, so it’s late and it’s kind of hidden, you know, maybe it’s a little extra, uh, challenge on a tissue, you know, carrying groceries a little too far, you know, suitcase in the airport or something. Um, and that latent trigger point can start to become an active trigger point. But at this point, Leighton would be that you’re not feeling it until you manually put pressure on it and kind of, kind of, um, highlight it through that pressure. So active trigger points would be, you know, people coming in with that complaint late in you’re kind of finding in the process, a key trigger points, satellite trigger points, I think is a really important thing because, uh, the difference is, is key trigger points. In this case, using the image of the, um, the, the upper trapezius.
You can look at that referral and see that, that cervical region traveling along the gallbladder channel, if we were looking at it from a TCM lens into the temp temporality. So the temporal region, well, you can form satellite trigger points along that pain pattern. It’s like that irritating noxious signal, um, will start to cause satellite trigger points along that referral pattern. So upper traps are, are often a key trigger point that can refer into the head and into the temporal region causing secondary satellite trigger points into the temple region. And it might be that the person coming in is complaining about that pain at the temple. And we go, and maybe a point like Thai Yong or the, um, uh, trigger points, or maybe even the motor point of temporality we use, and that will help. But until we sort of get it at that source, it’s going to be much more likely to come back and be short-lived help, uh, unless we can kind of find those key, uh, trigger points.
So that’s very similar to the channel theory, you know, um, in terms of, uh, us looking at that sort of more of a comprehensive view of, of the, uh, the channel in this case, um, and the muscle within that channel. And then the last classification is central trigger points versus attachment. The previous image of the superspinatus, uh, showed the central trigger points around the SSI 12 region and frequently there’ll be attachment trigger points added this attachment, like an ally 15, let’s say. Um, and generally speaking, the central trigger points have a little bit more, uh, emphasis and trigger point thought, uh, in the sense that if you take care of the trigger at the central region belly of the muscle, then oftentimes the attachment months resolve, or at least, uh, um, it’s more likely to resolve. And maybe, maybe those are the secondary ones that you look at, anything with that Josh,
Uh, yeah, just a little bit about active versus latent because clinically this is one of the areas where people often can run into problems when they really start getting into act, uh, treating trigger points. Um, like, like Brian said, it’s the act of trigger points that actually bring them into the clinic, right? They’re coming in with, um, say pain in the front of their shoulder from like an infraspinatus or a superspinatus trigger point, or maybe trading down the arm and you palpitate. And then you may palpate up around the upper trapezius and find trigger points in the upper trapezius. And even if you palpate them, it may refer up into their head. Um, and you may get distracted because you found this latent trigger point that may have nothing to do directly with the patient’s symptom. Um, but you can actually find latent, trigger points all over your body.
Um, they’re much more numerous than active trigger points. Uh, you, I don’t want to alarm anyone who’s watching this right now, but as you’re sitting there or standing, or hopefully not driving, watching this podcast, uh, your body is riddled with Leighton trigger points. They’re all over there throughout your entire body, but they normally don’t cause problems, but they’re often very easy to find. And so it can be, um, a little bit of a stumbling block because once you get good at palpating trigger points and finding them, you can kind of find them in almost any muscle, not any muscle, but large number of muscles, if you look hard enough. And so that’s where we’ll talk a little bit later about differential diagnosis and how important clinical reasoning is in addition to just palpatory skills. Um, because I, and I’m sure Brian’s done this and anyone else who’s worked with trigger points.
You can spend a lot of, uh, needless energy and time treating muscles that may actually not be helping with their problems. So that’s just one other thing. And also some of the treatments can be, uh, can involve some discomfort for the patient depending on the type of treatment that you’re doing. And so sometimes you’re needlessly causing the patient some soreness afterwards, if you’re doing something like dry needling or mashing on a trigger point manually for a long period of time, when maybe you didn’t need you because the real problem was elsewhere. So that’s just another act, uh, another aspect to active versus latent. That’s helpful to understand clinically.
Yeah, that’s a great point, Josh. I’m glad you brought that up. I see similar things with needling to where, uh, there’s a response, a sensation achieve response. And, um, sometimes that’s not the target tissue that you’ve reached, but instantly, you know, people who are new to this type of work, it’s like, okay, oh, they felt it. I’m going to stop. Now, if it’s painful, you don’t need to keep on barreling through it. But the point is that sometimes that initial sensation you get might be not at the level and the depth that your target is. And it’s not that that shouldn’t be taken note of, but maybe, you know, you’re, you’re wanting to be a little bit different target tissue. That’s going to have a different sensation. And I see that whether it’s trigger points, motor points, tendon periosteum, whatever the target is, is that the target is one thing. Um, and the sensation that you get might be felt at a different region, um, that isn’t your target yet,
Which further strengthens the importance of really understanding the anatomy in three dimensions. If you actually know what it is that you’re, you’re effecting.
Yeah, absolutely. All right. So I think we can get into the next slide and then Josh and myself, we’re kind of bouncing back and forth, but he was going to take it in just a moment from here. So, one thing to consider with that with trigger points is that they’re often, like if you look at travails book, she talks about functional units, um, and this would be a grouping, usually agonist and antagonist muscles. It’s a little broader than just this, but that’s the basic simple definition, um, that they often also share us a spinal reflex. Again, that’s the simple definition, but if you look at our functional units, they often go a little bit beyond just that, but it’s groupings of structures that relate to each other that are functionally working together and often become dysfunctional together. So if there’s a, a pain generator and say the upper trapezius, well maybe also the superspinatus deltoids, maybe even the SCM, those are all kind of, um, uh, dysfunctional together.
And those can, uh, you know, be sort of creating a, uh, problem, uh, in, in terms of how they relate to each other. So needling the, the source of the pain is useful, but also working, um, kind of normalizing the relationship between that functional unit can really give much longer AskPat lasting results. This is something we teach in sports medicine, acupuncture, not necessarily from the trigger point lens, so to speak, but, um, you know, Matt Callison and in his book, um, uh, has, uh, has something called the Watteau arc and something that’s taught in module one. We have module one coming up, um, soon. And, uh, uh, the end of the month, uh, that’ll be on net of knowledge, a webinar for it, and then it’ll be live or accessible after that. But it kind of parallels this idea of a functional unit where you’re working with these groupings of related muscles, but then the Watteau arch, we’re also adding the lotto Jaci points to affect the deep paraspinal muscles for that level.
That’s, innervating those muscles really relevant in a lot of sports injuries, also extremely relevant for patients with spondylosis, where there may be having a reduced neural output to those regions of muscles, like the supraspinatus and infraspinatus, um, that that reduced output and the neural output might not be leading to, um, radicular pain. It might be, you know, preclinical, um, you know, before that radicular level, but that reduced neural output can cause dysfunction in muscles that those muscles then have muscle imbalances that can lead to dysfunction. So including those Watteau Jaci points of that segment can be really useful. We usually do a sets of three. So like say for the rotator cuff muscle, maybe we’re doing C4, C5 and C6 at the lotto judgy points. So that’s a great addition to working with these because you’re also working then with the do channel to some extent, and looking at that relationship between that and the channels, we also get a lot into send you channels in our program. And, um, uh, the way we look at sinew channels and define the sinew channels kind of relates to this functional unit idea too.
So,
Yeah, and I saw, uh, candy justice just asked a question about perpendicular versus, uh, threading needling. I, um, I, I really want to answer that question. It’s a great question. I think given how long we’ve already been talking over just the first few slides, I don’t know if we’re going to get to it. I’ll just say really briefly that the, there are a few answers to that question. One of them is just practical. Some muscles are easier to needle perpendicular versus more, um, threading either with the muscle fibers or sometimes cross fiber. Sometimes it’s a safety issue. If you’re needling some of the muscles over the thorax, for instance, um, you’re going to often be needling more, uh, in a kind of a threading or like a transverse, um, just to avoid going into the pleural space. It’s going to have to do also partly with, uh, in some cases, whether or not you’re going to actually needle with retention versus doing more like a dry needling. So try this, not a very full and, uh, probably satisfying answer, but, um, for the, uh, so we can kind of get on with the rest of the lecture. And I dunno, think we’ll really have time during the lecture to answer any more questions, keep asking them maybe in the, in the conversation after this is posted and like on the Facebook page, whenever we can get to them. But I just wanted to recognize that question and address the aspect of it.
Right. So the next slide.
Okay. All right. So, um, understanding the pathophysiology of trigger points, meaning both the physiology and pathology of them can also be really helpful when you’re thinking clinically. So first just understanding what a trigger point actually is. And for the next few slides, when we talk about physiology, I’m going to try really, really hard to be brief, but this is such a really, really cool and interesting topic that Brian and I, as we were talking, we could probably spend an entire hour long, an hour and a half a lecture just on these first few slides. So I’m going to try and edit myself as much as I can here. So what is a trigger point? A trigger point is essentially a series of small, very localized contractions within a muscle fiber. It is not what is called an electrogenic contraction of the whole muscle. So if you remember back to your anatomy and physiology classes, which all of you took either as part of before acupuncture school, and you remember muscle physiology, normally what happens with a muscle contraction is there’s a signal from the central nervous system sent down along a motor nerve, it’s an electrochemical signal.
And then it reaches the end of the motor nerve to the little, the terminal button. The, uh, the nerve ending then releases a neurotransmitter acetylcholine in the case of neuromuscular junctions, which diffuses across the cleft, comes into contact with the surface of the muscle fiber. Depolarizes the surface of the muscle fiber. And then it causes all the actin and myosin to kind of ratchet past each other and you get a contraction. And that normally happens when you have a nerve signal sent down that happens to an entire motor unit within a muscle. Um, and then the end, it happens to all the motor units in a muscle. What happens with trigger points is because of damage to the muscle. Some of those motor end plates, meaning the areas where the motor nerve is touching and contacting the muscle. Uh, there is a type of dysfunction that has to do with, uh, based on the most recent research I’m aware of, um, an excess spontaneous leakage in a sense of acetylcholine across the claps.
So basically neurotransmitter is spontaneously diffusing towards the muscle fiber to a greater degree than normal. It is actually a normal process. It just starts to happen more commonly in damaged motor end plates. And this causes a small amount of localized depolarization in the muscle fibers. And so you end up getting small little pockets of, of contractile units of the sarcomeres within the muscle that are contracting. So this is happening independent of an actual signal from the central nervous system. So once these little pockets of contraction form, they essentially are kept, they keep occurring because of some feedback loops essentially within the muscle itself, independent of continued input from the motor aspect of the nervous system. Um, and if you look at another interesting thing clinically, that can be helpful to realize with trigger points is if you look at the picture on the right. So we have here a drawing that was actually taken from an actual slide that comes from Trevell.
Um, the top shows a whole muscle with the talk band in it, and then the kind of thick and nodule the middle of the belly, which is the trigger point region. And then if you zoom in and look at the lower portion, you can see each of these muscle fibers kind of running across the picture there, they all have these little vertical lines, which are the individual sarcomeres, right? In, in between each vertical line, there is the contractile unit and the thickened kind of darker areas are where the trigger point contraction is occurring. And you can see that those vertical lines closer together, right? So the, as the sarcomeres contract, they go this way. But also that means that as anything else, if you squeeze it in one direction, it’s going to get thicker in the other direction. And so that thickening of all those sarcomeres with those contractions is what causes the thickened, not in the muscle, but if you look on either side of those knots, right, you’ve got like this, not in the middle, but then you can see the rest of the fiber on either side that the distance between the lines is a lot greater.
So those sarcomeres, uh, that are not part of the little contracture are actually being stretched and usually being overstretched, meaning that the actin and myosin fibers are actually often stretched past each other, which means that not only do you have a knot in this muscle, that is so that part of the muscle is partly pre contracted, which means it’s going to lose strength and a bunch of other motor dysfunctions that’ll happen with the presence of trigger points, but it’s also going to lose strength because some of those fibers are overstretched to the point where they can no longer mechanically produce the same amount of force when they contract. So it’s not just referred pain, that’s going to be the issue with trigger points, but also a disruption of the muscle’s ability to fire normally, and to relax normally, and their whole sorts of other, um, re uh, neurological reflexes that are involved in this. So we can get into some other time, but that’s, uh, something that can be really helpful to realize clinically that it’s not just referred pain out. There is this kind of actual physical dysfunction in the muscle that has other implications. Um, so let’s anything to add to that, Brian?
No, I think that was great. Cool.
So let’s move to the next slide. So when you have this contraction in the muscle, one of the things that happens is there’s this interference with the local blood flow. So as with any type of excess tension in soft tissue like that, it’s going to put pressure on blood vessels and on the lymph system. And so you end up within the actual, not the trigger point itself, a decrease in blood flow, meaning, uh, not just decrease in the nutrients in blood, getting to it, but also a decrease in oxygen. So you end up with local scheming and hypoxia. Interestingly, there’s actually a, essentially a retrograde blood flow outside the trigger point. So as the blood’s trying to get in the knot is keeping blood from getting into that portion of the muscle. So you have the buildup and actually a higher oxygen saturation outside the trigger point with a lower oxygen saturation inside the trigger point.
When you have a lower oxygen concentration, this leads to a drop in the pH in that area of the body. So the area inside the trigger point then becomes much more acidic. And that stimulates the release of a lot of other chemicals that are often pro-inflammatory or allergenic, meaning pain producing. So it releases all sorts of prostoglandin serotonin substance P brainy, canine, um, uh, CGRP bunch of, uh, interleukins, some ones in particular. And so all you get this kind of soup of biochemical signals that are producing some localized inflammation and also stimulating nociceptive nerve fibers. So remember nociceptive nerve fibers, which are often called pain fibers, actually, they’re not, they don’t send pain signals. They send signals of actual or impending tissue damage, right? The pain is something that’s processed and occurs in the, in the brain central nervous system. But what happens with trigger points then is you have this biochemical soup of concentrated, essentially pain producing substances in the area.
When the signal through the nociceptive nerve fibers becomes prolonged enough and strong enough, you know, over a long enough period of time, those signals go up to the spinal cord. And there are actual changes that occur in the spinal cord that are called central sensitization. So that there’s essentially a decrease in the threshold necessary for a lot of those signals, no susceptive or, you know, pain and signals to get to the brain. So there’s an increased chance that any given, uh, no susceptive signal is going to make it up to the brain. Normally our nervous system in a sense is designed to weed out anything below a certain threshold, just so that we’re not flooded with too much information than we can deal with in our central nervous system. Um, but with trigger points and any other kind of chronic pain, the threshold for that information to get up starts to get lowered.
Plus the nervous system in the, in the spinal cord itself starts to wake up old and disused connections between different spinal levels, essentially spinal segmental levels, and actually can form new ones. So it’s a signal say going into the C5 dermatomal myotomal level at the spine, say there’s a trigger point, like an infraspinatus, um, what will happen if that happens over a long enough period of time and is intense enough, is that the signal essentially spills over into adjacent spinal segments, very commonly or more commonly inferior. So the there’s some, maybe some connections that spill over superiorly to like C4, but very commonly will go down. So maybe C6 and C7, those spinal levels are now going to be getting input, no susceptive input or damage or pain input. And what happens for reasons that people aren’t quite sure of is that by the time all those signals get up to the brain, the brain is really interpreting those spillover signals more than the signal coming from the area itself.
It’s really common when you have a trigger point in a muscle with a few exceptions that the area where trigger point is itself, you don’t have any symptoms there it’s pretty far away from the area where the trigger point is, um, especially with some of the muscles like in the hips and the shoulders out into the periphery. So the, the signal of pain that you’re experiencing is actually coming maybe from like the C6 or even the C7 level. And that’s what we call referred pain. So that’s why you can have a, not these trigger points in a muscle, but have the experience of discomfort or pain or numbness or parasthesia happening in what seems like a really distal, uh, area far away. Cool. Anything else for that, Brian?
No, that was great. Great explanation.
Cool. Okay. And so let’s move on to the next slide. All right. So a few other things to think about with trigger points that will also really help you as a practitioner, um, from getting to myopic. Um, so trigger points are a possibility and our component of pain and dysfunction, that’s, uh, an understatement. Um, really some of the research suggests that up to 80% of the cases of pain might involve some type of trigger point phenomenon with any kind of pain. So having said that once you get into trigger point stuff, it can be so effective and it can be so kind of interesting that you can forget to do a differential diagnosis for a lot of the other really important, uh, generators of pain and dysfunction. It might be, you also have to consider joint dysfunctions, other soft tissue, you know, looking at ligaments, you have to look at whether or not someone has other systemic problems that can be contributing to their problem, right?
Nutritional deficiencies, especially things like vitamin D I think iron deficiencies, metabolic disorders. Um, so hypoglycemia and diabetes can be two really big ones that can have caused someone to have a propensity, to, to, um, generate trigger points and also to have more kind of higher levels of pain. Um, basically anything that affects the energy supply to the muscles can be a condition that can lead someone to more easily develop trigger points. If you’re a TCM practitioner, it’s also really important to put these findings into your assessment. And so personally, what I found is when I’m dealing with trigger points and thinking in TCM terms, um, going back to the idea that there is this limitation of blood flow in the area, treating trigger points locally, in one sense, as a form of blood is can be very helpful. And I’m a huge fan of the [inaudible] family of formulas.
I tend to use [inaudible] [inaudible] few herbalists out there a lot or variations of those. Um, but also systemically looking at things like spleen sheet efficiency, especially in terms of how it affects muscle function can be really helpful. So even if you decide to get into this, you’re into this now, and you’re getting really myopic about trigger point stuff, always keep in mind all of the systemic stuff, and don’t give up your as an acupuncturist or as an herbalist and the TCM practitioner. Um, uh, although you probably go through phases where that happens to a greater or lesser degree, I know I did for awhile, but always keep the rest of that in mind. Uh, anything else there, Brian?
Nah, this is just something that Josh and myself have talked about a lot, is that when people just, like you said, start working with something like trigger points, it’s easy to sort of start to, to just see everything as a trigger point and, and kind of throw everything else out the window. Um, and sometimes we learn something new and that’s just the way it goes for a little while, but, but yeah, bringing that full comprehensive, uh, aspect of our medicine back into play is really essential. So, uh, yeah, so let’s kind of go into the next step. So I think we’ve covered a lot of information already in terms of, uh, pain and quality of pain with, uh, trigger points. I think this, uh, next couple of slides, we’ve pretty much covered in the context of the previous slides. So, um, if you’re going back and watching this it’s on the screen, you can reference it, but I think we’ve already really covered an aspect of this. So why don’t we move on even Ms. Josh, is there something you wanted to say about that? Let’s move
On, not on this one, the one after, see what’s the slide right after this one? Uh, yeah, just the fact, just the importance of, um, basically when you’re diagnosing trigger points that you’re looking for them, the aspects you have to take into consideration first or the history of the patient, because often they’re good. There’s going to be some type of traumatic injury or overuse problem or chronic postural disorder. So his, the patient’s history is one thing. Um, the importance of palpation is another thing that you have to actually get into the muscle palpate and look for those sore spots, um, uh, history of palpation and, uh, and assessing, um, you know, movement dysfunction kind of looking at actually doing some, either manual muscle testing, range of motion testing, things like that. Um, but that’s, yeah, we can actually, if you want to kind of just move into the individual muscles, that’s probably a good idea. This is, as we predicted, we’re kind of taking a long time to get from the really cool stuff that we have to be nerds about.
Know we were talking, we can almost do have done a long time just on this, these first parts, but yeah, let’s, let’s move forward. So diagnosis, um, uh, uh, trigger points as Josh was mentioning was really largely based on palpation. Of course, you have to rule out other components of pain and they’re not one or the other, but maybe there’s a facet causing a particular pain. And, um, you have to roll out all of those things. We’re going to focus more on the trigger point aspect, which is going to come down to palpation. And Josh, you wanna kind of go into a little bit of the, the criteria for that.
Uh, yeah. So the, the, the three most important things to understand with trigger points are these things here listed on manual palpation. So first, if you suspect a muscle has trigger points in it that they’re causing problems. And again, actually one of the other things we forgot to mention with diagnosis, the other third thing that I was trying to think of history palpation, but also understanding the referral patterns and a lots of resources online for looking at referral patterns. It’s best. If you look in Trevell or even the most recent version of it, um, by body part. So often you can find lists of if there’s pain in the front of the shoulder, there’s a list of muscles that are the most common muscles that refer to that area. Um, so understanding that, so that, that helps kind of narrow your, your clinical focus down a little bit, but then basically what you’re gonna do is palpate the muscle.
And look for first, the top band, look, you’re looking for these, those stringy or Roby bands in the muscle. And then once you find that, then you’re pressing directly into those top bands moving along the top band, really the entire length of the muscle, the trigger points will often tend to form in certain areas in certain muscles for a number of reasons, more commonly than others, but really you need to check the entire length of the muscle if you can. And then along that tender along that top band, one of those spots is going to be one or two are going to usually be the most exquisitely tender to the touch. Um, often there would be a slight thickening or hardening of the band in that particular location. And if you’re lucky, not lucky, I mean, probably about 60 to 70% of the time, at least, um, if you’re in the right spot, the spot that you press is not only going to be very sore to the touch, but it’s also going to refer pain elsewhere and ideally reproduce the symptom that the patient is coming in for.
So, because someone’s coming in for migraines, you feel the upper trapezius, you squeeze it. Not only is it sore in the upper trapezius, but it actually recreates their symptoms with things like migraines. You have to be careful not to cause it in the clinic cause that’s a whole other topic. But for, um, a lot of patients that recognition of, oh, this practitioner is, uh, knows exactly what’s going on with me, cause they can touch me this other place. And all of a sudden my symptom is occurring. I now trust this practitioner. Um, and maybe they’ve been to two doctors and an osteopath and a chiropractor and two other acupuncturists and massage therapists. And no one has thought to look at that. And you’re the, maybe the first one who’s doing that. So that’s a really common experience, both that I’ve had and I’m sure Brian’s had, and even all the students at the school that I teach, they get that in school of having a patient in the student clinic, tell them you’re the first person that I feel like has actually gotten to where my problem is. So,
Um, yeah, after this, we have a video also this, the video shows a local Twitch response with palpation. Some muscles don’t have a tendency to do this. Some do, and it’s not an essential quality of, um, diagnosing trigger points. But when you do find with palpation this local Twitch response, that it, it’s usually a good sign that you’re at the right spot, especially if they’re feeling that recreation of the symptoms. And I kind of helps you a zoom in on the region where that trigger point formation is. So let’s just look at a quick video that shows for the SCM, you’ll see this. And then for the peroneus longest [inaudible]. So you’ll see this both with the sternal head and the clavicular and especially the Clifford Cuellar head
[inaudible].
So if you look down at the clavicle area with the curricular edge, you’ll see that clavicular head starting to fire just with the cross fiber strumming of the muscle [inaudible] Peroneus longus and apprentice, as long as you don’t see the muscles as much, but look at the foot going into aversion. So when that muscle is under a lot of, uh, uh, strain from metric or point formation just trumping the, the muscle will cause that muscle to fire. So just some things to look for when you’re, when you’re doing assessment. I think we can go to the next slide and, uh, sports medicine,
Muscles, maybe. Yeah, yeah.
I think that’s a good idea. Thanks Josh. Uh, so upper trapezius is one of the most common, uh, acupuncture is very familiar with this one because, uh, uh, oftentimes around the, the region of, uh, gallbladder 21, there’ll be trigger points. Uh, there can be other areas they call bladder 21 happens to be a motor point. We’ll talk about that difference in July, but, uh, this is a extremely common one that comes into practice, especially relevant for tension, muscle, tension, headaches, referring up the back of the neck and then wrapping around usually the gallbladder channel distribution to the temple occasionally to the chin, as you can see kind of the angle of the mandible. Um, most of us, uh, have needled a, this, uh, muscle just cause noodling gallbladder 21. Um, but again, with Josh was mentioning, mentioning with the trigger point palpation, you’re looking not just at one particular region, you have to look through the whole length of the muscle, but that gallbladder 21 or a little bit more medial where the upper trapezius starts to turn the corner are common sites where you start to see those pain generation, um, for trigger points of the upper traps.
And from a channel perspective, a gallbladder channel would be obvious it’s part of the gallbladder sinew channel, but it’s also part of the large intestines and you channel as it comes up the arm into the, uh, the deltoids up into that leading edge of the, of the upper traps. Um, so large intestines and Joel, to some extent, urinary bladder, if you look at the urinary bladder, send you a channel, you’ll see that it, um, has a lateral branch and it covers a whole wide range even coming into the front of the body. But in my interpretation, I see that as including the lower trapezius, upper trapezius, really the whole trapezius muscle, um, and then wrapping around to the SCM muscle. So, uh, the distal points that you can consider with this are along those channels. And one that I find is extremely helpful when people have pain and restriction rotating to the opposite side, as that upper trapezius starts to fire and becomes painful, it can limit motion, gallbladder 39 is my go-to for it, but not actually strict gallbladder 39. I actually do more of an anterior gallbladder 39, particularly at the peroneus Tertius muscle, which would be anterior to the fibula. That’s the one that I find really changes the upper trapezius. And of course I do needle the Udall locally with that too, but that peroneus Tertius motor point, which is kind of an anterior gallbladder 39, uh, is, is really a key one for me.
Yeah. Uh, another, um, distal treatment that I find works really well for this. Uh, if you do Richard tan balanced method stuff, we’re just interested in some of the other more esoteric channel connections, looking at midday, midnight relationships, um, in thinking of this as a primarily gallbladder channel issue, then often looking for Asher points along the heart channel, heart and gallbladder being across the clock from each other and the Chinese clock. Um, if you find a lot, a line of tender points on the forearm and the heart channel, very often needling, those can help quite a bit with upper trapezius stuff because of that heart gallbladder, the David and I relationship. Yeah.
And I think both Josh and myself are in agreement that local needling is also important and we’re not downplaying that, but just for the webinar where we’re not working with people live, we thought we’d focus a little bit more on the symptoms and the distal aspects. The combination is strongest and local distal. Linda Jason is really strongest. Right. Next slide. Uh, so just some things to look for, and then I’ll cue you into the traps. The symptoms that we mentioned are obviously important, but this sort of, um, upward sloping of the clavicle and where it’s kind of making like a V if it’s tense on both sides, uh, shortened on both sides, but that upward sloping and kind of backwards sloping of the clavicle is something that I noticed and kind of start tuning in with, uh, um, over-correct activity in the upper trapezius, particularly also limited range of motion, uh, um, with turning or lateral flection are keys for, um, kind of finding a restriction in the upper trapezius.
Definitely. I think we can go on to the next one. All right. So the SCM can have a similar referral pattern in some ways to the trapezius. Um, and there are actual neurological reasons for that in one sense, the, both the operatory pier or the trapezius and the STM are both innervated by the 11th cranial nerve in addition from like C3 area. And so, uh, they actually start out embryologically as one muscle, the trapezius and the SCM both. And then as you grow as a, as an infant, as child, as your collarbone lengthens, those muscle fibers separate, um, torn. Now there’s actually a gap between the two, but the, the two share a lot of interesting kind of symptomatology and function. Uh, so in terms of symptomatology, you can see in the picture, the SCM in terms of pain or other types of parasthesia causes mostly symptoms in the side of the head, occasionally one SCM will cause symptoms on the opposite side of the head.
Um, but usually it’s centered somewhere around the side of the face, the ear, occasionally the Vertex, um, the occiput, the interesting thing about the STM in particular, and this is one of the few muscles in the body that has this happen is that trigger points can often cause a lot of symptoms that are trigger points, at least in this muscle. It can cause a lot of symptoms that often don’t seem related to muscle function. So muscle symptoms that often seem like they’re more autonomic nervous system phenomenon in terms of the SCM that can include a wide variety of dysfunctions or symptoms of the sense organs. So you can have blurry vision, uh, seeing things like, uh, uh, other, other types of visual disturbances problems with hearing so ringing in the ears. So tinnitus is a common one feeling of pressure in the ears as feeling like fluid in the ears that isn’t from an actual physiological cause.
And it can cause stuffy nose. It can cause excessive, runny nose can cause excessive lacrimation. Um, it can cause dizziness, sometimes some types of vestibular disorders often have a component of SCM or other neck muscle dysfunction. And so it’s also very helpful when you have an understanding of, of what some of the possibilities are for, um, trigger points symptomatology with this muscle, just start recognizing that with some patients. So for instance, for me, commonly, it’s a patient who comes in with maybe sinus or allergy symptoms and they don’t seem to be seasonal or related to anything particular, just kind of there all the time, very commonly, even just palpating the FCM, all of a sudden will cause one of their nostrils to open. And so sometimes treating the SCM for things that can look like allergy symptoms or like hay fever, if it’s seems disconnected from changes in like pollen levels can be something good to look for.
Um, thinking of this, uh, I very commonly end up treating distal points along the stomach channel for this. Um, and also interestingly, the UBI channel, this is not something that if you’re, if you’re only looking at regular channel pathways, you’re going to normally think of, but if you look again at the sinew channel pathways, the UV channel is one of those ones that has pathways that go far away from where the standard kind of channel normally goes. So there’s a, an aspect of the urinary bladder sinew channel that falls up the lat comes across into the Peck and up the neck. And this comes from an aging, just Brian and Matt have actually mapped it onto particular muscles. And so sometimes treating the SCM as a urinary bladder, senior channel muscle can be really helpful. You’ll be 60. I use UV 63 a lot with that sometimes if it happens to be tender or something, or you’ll be 57 or 58. Um, so that’s another fun aspect to that. Uh,
As in young energy, you know, coming up the UV channel. And I, I find when it is, you be an often that has dysfunction associated also with the upper traps, the lower traps, you know, when those are all kind of activating together as that sort of, you know, tension building up the body is where I really see that UV connection.
Absolutely. All right, let’s do the next slide. Um, I I’ll just briefly talk about this before, because we’re not, cause this can muscle can be a little bit harder to examine. Um, partly for safety reasons, because you’re talking about a muscle that is, fascially bundled up with a carotid artery and a lot of other kind of neurovascular structures right near there. Um, most of the time when I treat this, although I do needle it with retention, the way that, um, you will learn in the sports medicine program where essentially needling from stomach nine back towards like small intestine 16 or that area, um, or doing, uh, dry needling, which is a little bit more, requires a little bit more care because your piston and kind of moving the needle in and out, but really learning how to manually release this muscle first, um, and getting really comfortable with the palpation, grabbing the muscle, separating it from the neck and being able to isolate the fibers while you’re pressing on them. Getting very comfortable with that before you start needling, it is a really good idea. Um, anything else kind of in general to say about palpating and treating that muscle that you want to add? Brian,
And then I think I agree with that, uh, um, manual work. If you’ve not used a needle in this muscle, get in, Hey, you’ll get a lot of benefit from, uh, doing the manual work. It’s it’s, um, it’s one that, uh, does well with manual work, but it gets your hands acclimated to that ability to sort of pull the muscle away and feel the, the, how far, how deep that muscle goes and where it is in relationship to other structures. So that’s very important.
Yeah. And I’ll, I’ll say that when I teach this material at school out here in Seattle, uh, the first thing that I have students do for the first year of their education before they do any needling of any of these is they learn manual releases for all of these muscles, because they’re especially as an acupuncturist, if you don’t get a lot of chance to practice specifically palpating muscles, like we’ve talked about, um, it can be very difficult to just start needling them. And so I want to make sure that like my students in particular have of experience with manual palpation and treating the muscles just with their hands first cause then growing into the needling is actually relatively easy.
We’ll say something interesting about the SCM is a two headed muscle, S S C M Sterno and uh, clavicular heads, both attaching to the mastoid process. Um, the channel relationships as the sternal head tends to be more associated with the stomach channel and the [inaudible] had more associated with the sand gel channel. So if you go back and look at the club, vicular had distribution in particular, you’ll see that it does refer deep in the year. And that’s often what people, when you’re working with, it’s like, oh, I feel that in my ear. And that’s the one that has more of a tendency to cause things like, uh, postural vertigo. And, and, um, the point is, is if you look at that clavicular head in particular and then go think about points like San Jo three or sand JAL five, and the relationship of the sand Dow channel to the year, it’s again, one of those areas where you can start to see a little parallel between channel theory and trigger point theory.
Yeah, definitely. Right. Next slide. Yeah. Why don’t we
Get to, I think we’re there. We have Josh and myself knew we had a lot of information and weren’t sure we’re going to get through it all. I don’t want to downplay levator scapula. It’s such an awesome muscle to be familiar with. Um, but let’s go pass this one to, uh, pass this and we’re going to go, I think, to infraspinatus Josh, why don’t you take infraspinatus?
All right. So this is along mean all these muscles. This is going to be true, but the infraspinatus along with like the upper trap and the, um, SCM are ones that if you just build your practice around treating like just this muscle, you would still be incredibly busy and have lots of very, very happy patients. Um, so this is one of the most common areas for trigger points that need to be treated for almost any kind of shoulder joint dysfunction, but also, uh, very commonly for pain in just pain in general in the front of the shoulder, but also down the arm, even all the way down to the thumb fingers of the hand. So the, the most common location for the referral for this one is deep pain in the front of the shoulder. And this can often feel like mean patients will often describe it as like a toothpick kind of sensation around like the large intestine, 15 area.
Um, very commonly they’re going to come in and be told they have bicipital tenor synovitis or bicipital tendonitis because the pain often occurs right over the biceps tendon as it’s going through the, the bicipital groove. Um, this is really a small intestine sinew channel muscle, even though the most common referral pattern is down, essentially the large intestine and partly the lung channel and the best way to treat this distally is usually through small intestine channel points. So a small for can be helpful. Um, most of the time I’m using essentially small intestine three and a half, which is the motor point for the abductor digiti [inaudible], um, kind of right between it’s like the large intestine, four of the small intestine channel, essentially kind of right in the middle of that, of the metacarpal, uh, bone there, where the muscle is. Um, but again, this is one of those muscles that if you get good at palpating, it, uh, for any kind of shoulder problem, this can be really helpful to treat.
And not just because of the referral pattern, another very common issue with any kind of shoulder problem is the biomechanical dysfunction that happens. Even if just someone has mild pain, they start kind of using the shoulder a little bit differently. The, uh, the strain of, of even just raising your arm or whether it’s something like playing tennis or reaching up for a can of tomato sauce in your pantry or something like that. When you have pain from any cause for the shoulder, it starts altering the biomechanics of the scapula. Often the scapula doesn’t move as well, and the rotator cuff muscles, and have to do extra work to kind of stabilize the head of the humerus and to kind of make sure you have the as much arm elevation as you need. So usually the first thing that happens is the rotator cuff muscles of which the infraspinatus is one start developing trigger points or other dysfunction. And so regulating the relationships among all the rotator cuff muscles, which usually involves infraspinatus and also subscap, which we’ll get into in a different discussion, um, can be incredibly helpful, um, for just a wide variety of not just referred pain issues, but also any kind of glenohumeral, biomechanical issue.
Anything to add to that, Brian. Yeah, I see an X on there that I think is an artifact. I might’ve put an X on SSI 11 because that’s such a common area of trigger point formation, even that could be anywhere in the muscle and moving that image around. I think there’s a little artifact there. So don’t go looking for a trigger point in the infraspinatus off of the scapula. That’s an extra price on the top the top. Right.
Okay. Well, you understand that, that be more than that. All right. Uh, next slide. Uh, oh yeah, yeah. As soon as some examination infraspinatus, so often anything that’s going to stretch the infraspinatus, it’s an external rotator. So usually end range of internal rotation or not even end-range of it’s really severe. So reaching behind your back, like to get a wallet out of your pocket, unstrapping a bra, but also having the muscle contract fully can also often cause a pain. So external rotation often that’s going to be like brushing your hair right. Going up into this motion was causing contractually external rotators. Um, so that’s a general rule of thumb with points is that the pain can be brought on either by fully stretching the muscle or by contracting the muscle. So it’s another thing you have to really start to understand work doing this kind of work is what muscle functions are and for any given motion in one part of the body or when joint, which muscles are contracting, which muscles are stretching. So understanding agonist, antagonist relationships, um, can be really helpful in diagnosis, as well as treatment planning in terms of figuring out what spinal levels you want to add to help kind of, uh, normalize muscle function,
Right. Then you can go to the next one. Yeah. And I think we’ll just go through these quick, cause I know, uh, uh, we’ve gone a little past the time that we were hoping for a work around and talk all day, but I know some of you guys probably need to get back to work. Um, so quadratus lumborum is such an important structure. And the referral that you can see is, is kind of generally at that iliac crest region down towards the greater trocanter, uh, deep into the glute area, it’s such an important structure to learn how to needle, especially in a class setting, um, for, uh, uh, to be able to, uh, work on directly, uh, just because it’s so indicated and so many, uh, types of back pain conditions, uh, the work we do in sports medicine acupuncture would probably surprise a lot of people.
If you haven’t heard this already as a, we see this as part of the liver send new channel. Now the liver sinew channel ends at the groin, but if we were to follow that myofascial plane up from the ad doctors going right in that iliac fossa, um, its continuous myofascial plane into the iliac as muscle that would continue right into the quadratus lumborum. So even though you have to get to it through the back, um, it’s really a very deep core structure on the plane of the myofascial, send you a channel of deliver, uh, channel liver network and liver five. And sometimes even adding liver five with liver three as a combo is just a really magical combination for, um, reducing pain in the, um, quadratus lumborum again, a local needle is so important there, but uh, oftentimes just from palpatory pain, liver five and, and um, adding liver three, we’ll reduce it by 50% you go back and palpate afterwards you’ll find that that the pain is reduced by 50% just with those points. And they often, especially liver five becomes very reactive, very tender, very easy to find when the quadrant is some farms under a lot of pressure, a lot of stress.
Yeah. And I would just add, if you treat low back pain, get to know the QL, it’s a, it’s one of the most important muscles along with like the, so as to treat for any kind of low back dysfunction yeah.
Then attaches above into the 12th rib leads right into the diaphragm. So it’s kind of starts to get getting you into that visceral core of the body. Um, so elevated ilium, the next slide is showing, uh, that’s just measuring the helium from the side. We’ve talked about that a lot, various other, um, myself and various other webinars. Um, it’s on our sports medicine, acupuncture, uh, blogs, you’ll see blogs on Anjana syndrome and stuff like that. And it’ll go into that in a little bit more depth if you want to reference those. So let’s look then at the glute medius and minimus, we’ll skip this one, so right. And to medias, why don’t you finish these up Josh? We could probably even look at them as a pair.
Yeah. So this is another one of those long with the QL and the other ones. This is one of the really important points to treat, um, this in the minimus, uh, really for low back pain in addition to hip dysfunctions. So in Trevell often she talks about the referral pattern for the glute medius, which is the larger, more superficial lateral hip muscle primarily. Um, Ady ducts the hip. Uh, the referral pattern generally tends to be somewhere around the sacrum and the iliac crest and a little bit around the gluteal area itself. And then if you go to the next slide that the minimis, which is deeper, kind of underneath the, uh, the glute medius kind of closer to the ilium, um, slightly smaller in scope that the minimus tends to refer down the leg and can really mimic sciatica or any other kind of an L five radiculopathy in practice.
I’ve found that it seems like the glute medias can also refer down the leg like this. Um, I’ve had, I’ve had treated some patients where I know I’m treating the glute medius cause I’m nowhere near deep enough or I’m like right at the iliac crest and they still get the referred pain down the leg. So basically the, really the significance of this muscle or this pair of muscles to me is really this particular referral pattern. And aside from, um, the biomechanical aspects of it as an add doctor, one of the, it’s the really important muscle for stabilizing the pelvis. Every time you walk and take a step, right? If you understand a little bit about orthopedic medicine, you know, the Trendelenburg sign, have someone pick up one foot and look to see if like, if they’re standing on their right foot, if the, if the left side of their pelvis drops, when they stand, they kind of like sag a little bit that’s culture and Ellenberg sign, it’s a sign of dysfunction and, and not a lack of firing of the gluteus medius and minimus.
Uh, and that has repercussions for postural and movement function throughout the rest of the body, along with the QL and muscles in the neck. Um, but aside from those structural issues, the pain referral pattern for this, if you learn to recognize it and then to treat it by treating these muscles up around between like gallbladder 29 and gallbladder 30 in that area, uh, this can mean potentially even have some patients, you know, keep them from getting unnecessary surgeries. I’ve had patients who have been told they had, they needed like a spinal fusion, things like that because they have pain radiating down the leg. We treat the glute medius and minimus and their pain goes away. Right? Cause it’s really, really common for trigger points in muscles for number of reasons that I can have an entire lecture on that. Even in Western medicine circles, they get ignored.
And for some of the muscles like this, where the implications of not realizing that it’s a muscular issue are the implications when there’s something like getting a surgery to fix the problem, uh, that can become a really big issue. That can be very important to the patient. So learning to recognize these, uh, you will, if you start treating this type of thing, have the experience of having, uh, the patient, um, realize they maybe don’t need this very invasive surgery that is that they’re planning to have. Um, just because they’ve been told by one person like an orthopedic surgeon that you need to have like a spinal fusion. So that’s one of the, this was one of the really important muscles that I find for that issue in particular. Right?
Yeah. And it’s also becomes dysfunctional with, uh, frequently with the quadratus lumborum. So even needling, sometimes QL will refer down the leg because of that stimulation from QL into its referrals zone at the glute medius minimus region, and then stimulate, you know, it’s almost like a transfer through that. So, um, but, but those are very, um, very often in dysfunction together. And lo and behold, we have a liver and gallbladder relationship then. So a consideration yeah. Consideration of liver five, uh, and gallbladder 40 source point to help, uh, kind of build energy. And the gallbladder’s a new channel for these muscles that tend to be inhibited and pain generators when there’s inhibition, not always, but that’s the tendency and, uh, liver five to help with that more overactive, uh, add doctors. But we talk more about the quadratus lumborum so QL and add doctors on the liver test and new channels. So something to consider with that really a great combination. All right. Well, I think that, uh, thanks for bearing with us already. We took a little time with that, but, um, it was a pleasure working with Josh and tune in next week for, uh, Jeffrey Grossman’s, uh, presentation. Uh, and thanks again for everybody for coming. Thank you, Josh.
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