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Forward Head and Shoulder Posture Issues

A Problematic Postural Position: Forward Head and Forward Shoulder


So forward shoulder, um, it’s a, it’s a posture that it seems like it’s becoming more and more common with sitting in front of the computer a lot more than we used to, especially during this COVID time. Um, the propensity for this, for the weight of the head to go forward and the shoulders to go forward is really quite great. And the more that we sit in one position, we know that the muscles and the myofascial tissues are going to adapt to that position.

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The American Acupuncture Council for having us really appreciate that. I’m excited to get into this information. There’s a lot of great things with, uh, let’s go ahead and get into the first slide please.

Or the next slide. There we go. All right. Thank you. So forward shoulder, um, it’s a, it’s a posture that it seems like it’s becoming more and more common with sitting in front of the computer a lot more than we used to, especially during this COVID time. Um, the propensity for this, for the weight of the head to go forward and the shoulders to go forward is really quite great. And the more that we sit in one position, we know that the muscles and the myofascial tissues are going to adapt to that position. So it’s a lot easier to get into that forward head and for shoulder position. If we maintain that position for hours and hours throughout the day, now it’s usually predicated from what’s happening in the pelvis. So this is the reason why that, that we’re saying this is just one piece of the whole. So, I mean, you have to look at the whole body with this to help afford heading for shoulder, but we want to give you some nuggets that have helped us clinically quite a bit, um, to help alleviate some pain. Uh, Brian, do you want to, uh, say anything before we get in the next slide now? I think jump right into the next slide. All right.

All right. So the Ford had an imbalance in his posture, cannot counteract the forces of gravity, thereby increasing the stress on the muscle skeletal system and perpetuating the aging process. So you can see that red arrow that’d be the force of gravity as the head is going forward of the plum line. Let’s back up a little bit. The plumb line will be measured from the foot going up to the head. You want the plumb line to be in line with gallbladder 40 at the foot, the middle of the knee, the greater truck enter the middle of the hip joint. Then going up spleen 21 region into the chromium, the large intestine 15 region, and then the auditory meatus or the small attest in 19 region. So in this case, you can see that this patient’s head is forward by probably a good two and a half inches.

So for every inch for posture, there’s an increase of the weight by 10 pounds. Imagine what’s happening to the upper thoracic region and the lower cervical region and being elongated and polling quite a bit, trying to be able to maintain their proper positioning. But in this case, they’re really struggling because there’s so much weight pulling forward. This can increase the aging process significantly the longer that it ends up lasting. I mean, there’s a host of injuries that can occur from Ford head for shoulder. Brian, let’s go ahead and think about this. We’ve got thoracic outlet syndrome. You’ve got lower cervical spondylosis in the 40 plus age group. That’s increasing, um, nerve impingement. What else? Brian, with the sport headaches would be a big one. Yeah, that’s true. Brutal scapular nerve and traffic could be a big one there. Gosh, a chromatically vicular joint strain is something sternoclavicular joint strength is there, uh, with the pectoralis minor being a shortened position and the anterior scalings being in a shortened position. There’s your nerve entrapment sites for thoracic outlet syndrome. So, you know, with this for shoulder, it goes down the upper extremity chain, the head of the humerus. Sorry, go ahead.

Oh, go ahead. Yeah. The one worth mentioning also is the, uh, uh, when we’re going to be covering more in detail later is a lot of shoulder injuries, especially tendinopathies.

Yeah. So with this, we’re going to talk quite a bit about the functional anatomy of the Ford headed for shoulder, and then flip hats, put a different hat on blending, the two hats actually, and get into this new channels. So again, back to this Ford head and Ford shoulder, this is just one segment of what’s happening with the body. You’ve got humoral internal rotation, and then it’s going to affect the radio ulnar joint proximal, and also distal. So there’s a lot of things to be able to look at. So we’re just, again, just talking about one piece of the whole hair. Can we get to the next slide

While you’re doing that? Matt it’s worth mentioning that the head itself is 10 to 12 pounds. So an additional 10 pounds for every inch forward is pretty significant in terms of the amount of load that puts on the upper back and shoulder girdle and all that.

Yeah, absolutely. Absolutely. So Fort headed for shoulder is one component of something called upper cross syndrome, which Dr. Vladimir Yonda was the one that coined that term. Um, he noticed that a lot of patients in this particular posture, he would document the muscle imbalances that are, that are contributing and holding that posture as well. Now in the 1960s, this was a Latin Marianna in the 1960s, but also Dr. George Goodheart, who was another pioneer in posture and also muscle imbalances, both these guys actually in the 1960s. Talk a lot about the different types of Muslim balances, not only in the upper cross syndrome, but also in lower cross syndrome in the upper extremity and also the lower extremity. These two pioneers are, or actually the, um, major contributors to where we actually have a lot of manual muscle testing today. And manual muscle testing is becoming much more popular than it was in the 1960 seventies, or when I first became an acupuncturist in the 1990s, um, is becoming much more popular and these guys influenced that substantially.

So it was really quite interesting too, when you look at this paragraph here, that Dr. Vladimir Yonda, he thought of it as actually being more of the deficient muscle, the lengthened muscle that was perpetuating a lacrosse syndrome and the muscle bounces and Dr. George Goodheart was actually considering that be more of the shortened muscle is what’s causing the upper cross syndrome. So interesting glamor Yana thought it was more as the deficiency that, that made the excess and the Dr. Goodheart thinks it’s the excess that’s creating the deficiency, both work mean that these are both great pioneers, both actually work quite well. All right, so let’s go to the next slide. So your upper cross syndrome, uh, you’ve got with a Ford head and the Ford shoulder, if you look at the box on the upper left shorten overactive cervical extensor. So that means the upper extensors are really the biggest ones that are going to be shortened and active.

The suboccipital triangle, hence the reason for causing nerve entrapment of the lesser occipital nerve or the third occipital nerve, uh, developing trigger points when the suboccipital muscles causing muscle tension type headaches, um, a whole host of different injuries can, can occur in that area. And then below that you’ve got lengthened inhibit rom boys’ middle and lower trapezius. So those would be in a locked long position, a stretched out position, and you can see how the back shoe points of the heart and the lung here are going to be greatly affected the pericardium as well. So that’s going to be an elongated position, putting stress on those back shoe points. Then on the other side, you’ve got your shortened and overactive pectoral. So that pectoralis minor is going to be pulling excessively on the core court process, inhibiting the muscles on the other side, which are the wrong boys in the middle and the lower trapezius. Then you’ve got your LinkedIn inhibited, deep neck flexors, including the middle and anterior scaling. Hence the reason why you get thoracic outlet syndrome many times or many times, you see thoracic outlet syndrome with people with postures like this. Brian, do you want to say anything?

Yeah, sometimes the, um, the, the neck flexors, I would also include, uh, the longest call lion and longest capitus the deepest, deepest cervical flexors, which are, um, create neck flection, but they are, they’re a big stabilizer and we’ll get, this is a little foreshadowing, but, uh, from a Cindia channel perspective, those would be part of the kid decent new channel. So, um, kind of speaks a little bit to the kidney cheat and how that sort of loss of kidney cheese starts to cause that the, that depression and that, um, dropping of the head in the forwardness of the head.

Yeah. Good point. Yeah. Excellent.

Excellent. All right, let’s go to the next slide. So we’ve talked about this slide before.

This is some research that I did it starting in 2010, um, and presented it, I think in 2011 Pacific symposium, and also 2019, it’s looking at different types of posture and their relation to Zong, uh, uh, TCM patterns. So what I noticed is that with looking at, from the lateral view, certain postures would come in and they would have certain types of Azzam signs and symptoms. For example, the guy on the left, you’ve got spleen lung and kidney deficiency, and you can see how the lungs in this type of position in this position are having a difficult time expanding the diaphragm’s going to be constricted. I mentioned earlier that the tissues around the bladder, I’m sorry, the lung and the heart back shoe points will be elongated and struggling. Um, let’s see what else we’ve got compression caged is going to be affecting this and also the liver, and it is positioned the thoracolumbar fascia. The deep layers around the renal fascia will also be restricted inhibiting some of the kidneys, the kidney, but these people themselves will often come in with spleen, lung and kidney type of deficiencies. Brian, do you want to add anything to that?

Uh, no. I think you gave a good summary how it’s not just the muscle imbalance, but how it’s also affecting the internal organs and the space for the internal organs to do their proper function.

Hmm. So which ones out of, out of these spots,

Figures, Brian, which ones can you see have that forward head and forward shoulder type Fox?

Sure. Yeah. So the type one, the first one is the most obvious. And especially with the plumb line, as Matt was mentioning with the plumb line, going through GB 40, coming up through the greater trocanter, um, through the acromion, you can start seeing the shoulder going forward and you can really see the head going forward and the type one, the type two is there, but it’s a little, uh, um, maybe obvious it’s obvious if you look at it, but with the plumb line, there’s a little bit of a trick to it. And you notice how forward the greater trocanter is from the plum line. You know, this, uh, this patient and the type two. And for that matter of the type four posture have an anterior hip shift. So there’s, the hip is as moved forward and then their rib cage is starting to tilt back posterior.

So in some ways their, their head looks a little bit more aligned according to the plumb line and their shoulder looks a little bit more aligned according to the plumb line. But if you were to kind of imagine tilting the rib cage back into position, you know, to, to kind of line the rib cage up in, in a straight line, you would start to see with that, you know, uh, if you did that, how much the shoulder and that hadn’t been forward in relationship to the rib cage. So, um, there’s a definitely a big relationship between the pelvis and the head and shoulder position for those, those type two and type four ones in particular. But it’s, it’s a, if you adjusted, you definitely see the forward head in the forward shoulder, though. It’s a little different flavor from the type one. Yeah.

That’s interesting because if you do end up changing one segment of that, of that disparity, the compensation comes out somewhere it’s like Brian was saying, if you tilted that ribcage here for you brought those hips back to the plumb line, actually physically did that. You would see the compensation above and the forehead and for children. It’s great. Now an increase to type twos. You look at type four and you can see that the greatest rural Cantor is even farther forward, which is causing more of a poster tilt to the rib cage. And the shoulder is posterior to the plumb line, but it’s the same thing. If we brought those hips back, you would see a really far forward head and also afford shoulder. So somebody like this could be coming in with thoracic outlet syndrome or, or such, um, from the muscle imbalances within forehead and for shoulder in upper cross syndrome, the slide three and a type three and type five. I don’t see it as much, possibly type five. What do you think?

Yeah, they’re not as obvious. I mean, the head is forward on type three, but it’s really, that whole body is shooting forward. So it’s not, um, as much of the obvious head and shoulder forward. Yeah. Yeah. Okay.

Excellent. All right. So then, uh, what’s the next I Brian, you want to take?

Yeah, yeah. And Matt, uh, I will nevermind. Um, your audio is a little distorted. You might want to turn your phone off to have a little extra bandwidth, but I’ll be chatting here for a second and give you a moment anyways. So, um, we kind of alluded to this in the previous, uh, the previous slide where we have multiple examples of a forward head and forward shoulder, but I kind of used the term flavor, you know, that, that the farthest one on the left, the type one posture had us at quote unquote different flavor than the type two, which had that obvious posterior tilt to the rib cage and, um, had a different interaction of how things related to each other, but both, ultimately they both had a forward, um, shoulder and forward head. So if we wanted to kind of start assessing that variation from patient to patient, one way we can start to look at is the, um, is the position of the scapula, uh, and notice, uh, that it varies from patient to patient with this forward shoulder.

So a blanket term would be scapular protraction. Um, so scapular protraction, the shoulder blades are going wider and they’re usually tilting forward. Um, but when you start breaking down from patient to patient, you can start to see that there’s variation on tilts shifts and rotations. Um, so just to give a quick terminology, if the shoulder blade itself moves away from the spine, we might call that protraction. It’s an element of protraction, but we can be more specific and call it a lateral shift. You know, it’s shifted lateral retraction. It might shift medial and come closer to the spine. Um, if it tilts forward, we would call that an anterior tilt. So in that case, the top of the shoulder blade, the, um, SSI 12 region is facing forward. Um, it could also rotate around the rib cage. So we might call that a medial rotation cause the, the shoulder blade spacing more medial. So just, uh, based on where it’s moving, if it’s moving medial, moving lateral up down, et cetera, we can, uh, call based on shifts and tilts. So we’ll see an example of this on the next slide. So let’s go ahead and go to the next slide.

So this patient, we have, we could again call it a scapular protraction on the right side, but it’s different than some other people might manifest with scapular retraction. So if you look at the medial border and you were to kind of draw a line along that medial border, you’ll see that the medial border comes closer to the spine, uh, as it goes inferior on the right side in particular notice, the right side is what I’m talking about. So the whole scapula is in, we could call it downward rotation, but if we were to use this terminology of tilts and shifts, it’s a lateral tilt. The top of the, the scapulas facing lateral and the scapula is also moved a little bit away from the spine. So it’s a lateral shift. We’d have to look from the side, um, to see about if it’s tilting forward. It probably is. So it’s a likely anterior tilt, but that, uh, from this, this perspective is a little harder to see, but I think we will see that in the next, uh, slide. We’ll get another view for a different patient.

Hey Brian, can you go back? I’m sorry, can you go back to the last slide please? Um, just to keep in context, what we had with the previous slide. So this would also be immediate rotation of a scaffold, correct?

Medial rotation yet the immediate rotation. Uh, if it’s going around the rib cage, we can say that’s a lateral shift, cause it’s definitely moving away from the spine, but the scapula will start following the rib cage. So you could also describe that component of a medial rotation for sure, because you can kind of picture it the more it goes lateral. The more of the scapula is following the sort of, uh, border of the rib cage. It’s going to start turning and facing inward facing medial. So yeah, I would agree a lateral shift and a medial rotation.

So the anterior aspect of the scapulas is facing immediately. Okay, great. Yeah. Thanks Matt.

All right. So now to the next slide, and again, we could call this a younger, uh, gentlemen here, we could refer to this as a scapular protraction, but it’s a little different, a little different that, um, look than the previous patient. And really what you see is the strong anterior tilt. You can kind of notice that with the inferior border of the scapula, which is poking out in relationship to the top of the scapula. So it’s a, um, kind of highlights a little bit more of the shortening of the pectoralis minor muscle in the whole scapula tilting forward. We’d have to look at him from the back. He might have a little bit of a, um, a lateral shift to the scapula. I don’t recall from seeing previous images. Um, we don’t have it in this PowerPoint, but he didn’t this particular patient didn’t have a really obvious lateral shift. If I remember Matt, do you remember that

It was more of the superior shift in Andrew scapular tilt was more, but he did have scapular protraction on this right here.

Yeah. Yeah. But it’s manifesting a little bit more, is that, is that anterior tilt that anterior tilt component is, um, a little bit more prominent, but why is this important? What’s, what’s the importance of it. It starts to set a picture for which tissues are involved. And, um, if, if you look at it from which, which muscles in which structures are shortened, uh, and which ones are lengthened, it starts to also paint a picture, which send you a channels are involved. So, um, anything else on this one, Matt, before we, yeah,

Yeah, I think, um, for those people that don’t really know the muscles very well as if this is the pectoralis minor image, that’s on the right. So you can see if those fibers shorten their attachment sites, how it’s going to be pulling on that core court process, creating that anterior tilt now with an anterior tilt, the superior medial border of the scapula also raises up a little bit. So in that case, if you thought about what possible injury could be taking place here, the levator scapula, um, and that where it attaches to the superior medial border, as we know, has a lot of mild fascial adhesions in that tissue Guber is basically, I mean, it just feels so very, very rough and some people actually complain of pain in that region. So we could needle that section and that would give good relief for a little bit, but until we actually start working on that enter shift and the Petraeus minor shortening, we won’t be able to help out the elevator scapula and have it be pain-free

[inaudible] treating the effects, not the cause necessarily. Yeah. So we can go ahead and go to the next slide. So this is a little bit of a summary. So we have, uh, some, uh, scapular protraction that have more emphasis on that anterior tilt and that pec minor shortening. So we’ll give you a heads up that the pectoralis minor is part of the lung sinew channel. Um, also we have shortening in the upper fibers of the serratus anterior, also part of that lung sinew channel. And then that’s kind of counterbalanced, especially by the lower trapezius, also the middle trapezius and rhomboids, but we’ll, uh, kind of focus on the lower trapezius, which is there to stabilize against that sort of, um, pull from the pectoralis minor. That’s going to pull the scapula into an anterior tilt. The lower traps are there to sort of stabilize and hold the scapula in place and keep it from being pulled forward from the pectoralis minor.

So this is a very common muscle imbalance between these two, uh, internally and externally related channels, send new channels and muscles where the pectoralis minor gets overactive lock short into a shortened position, holds the scapula into an anterior tilt, uh, tends to pull it a little bit more into, uh, a lateral tilt. So kind of downwardly rotating the scapula, whereas the lower trapezius becomes inhibited and fails to counteract that. So we have an imbalance between these two related channels of the lung and the large intestine channel. So that’s important for local treatment, but of course, important for distal treatment also.

Yeah, that’s great. So the distal treatment, because the Petraeus monitor is going to be, fascially connected to all of the mild fascial tissue on that lung sinew channel all the way down to the wrist. We can use many acupuncture points or to change that mild fascial tension. So not just treating locally, but also adjacent and distal to signal the myofascial gene June, what we’re trying to do. So by treating the TCM, bialy internal and external relationships here, um, it’s just, it’s pretty amazing what can happen when you soften tissues so far away and signal while you’re trying to be able to do when our founding, our founding forefathers were just absolutely brilliant to be able to come up with such associations. And, and we’re just talking about it in a different way. This is great. We will be going over acupuncture points in a little bit.

Yeah. All right. So next slide. So then this particular, uh, example, now we have a little bit more of the emphasis on the lateral shift, you know, the movement of the scapula away from the spine. And, uh, with that, you’re going to see a little less, sometimes a little less of that anterior tilt. So it speaks a little bit more to a different set of tissues, the serratus, anterior, especially the middle and lower fibers of the straightest anterior and the rom points. So those become imbalanced. And in the system that we teach in sports medicine, acupuncture, this is part of the pericardium send new channel. The serratus anterior, um, is, is a big part of that, but the straightest anterior, it goes. And if you kind of notice in this illustration, it becomes a little bit faded because it’s going underneath the scapula. So it goes underneath, uh, it should say anterior to the scapula between the scapula and the rib cage.

And it attaches to the medial border of the scapula, right at the place that the rhomboids attach. So they really create one continuous, uh, myofascial sling. It’s almost like it seemed if you can kind of picture that, that sling that has like a seam along that medial word of the scapula. So it’s, it’s, it’s kind of anchored at that medial border of the scapula, but it’s a continuous sling. Um, and sometimes that’s referred to as the Rambo’s rate of sling, uh, for those who’ve paid attention to, uh, anatomy trains in the work of Tom Myers, he uses that terminology of thrombosis rate of slang. And we see that as a part of the pericardium sinew channel. So it’s a little bit more of that influence of that channel versus the lung and large intestine as a new channel and balance.

Yeah. [inaudible]

Of the scapula.

Oh, I’m sorry for, I’m sorry for interrupting Brian, go ahead and finish what you’re saying. No, that’s it. I finished. Okay. Here’s my audio better now? Yeah, much better. Okay, good. Uh, what was I saying? Yeah. On the cadaver, it’s fascinating to see the thrombosis rate is sling how the straightest anterior and the rom Boyd fibers just interdigitate. It is really one tissue, like so many other tissues in the body, but it’s keeping context of what we’re talking about now. It’s amazing to see how it’s just one line of Paul on that. Yeah. Fantastic. Oh, also something else now, even though we’re putting the pericardium channel or the pair of, even though we’re putting the serratus anterior into pericardium and also lung there’s a gray area with that in smack, we will often demonstrate that by needling the motor innervation points of the straightest, anterior, for example, ribs three through seven or so, you can even do four through six we’ll change a lung pulse.

So it is influencing the internal Oregon. For sure. If you have a patient that’s coming in that has asthma, common cold, a C D something like that, feel the pulse. If you would treat the motor entry points of this rate, anterior that pulse will definitely get better and change. So you are influencing what’s happening with those lungs. Just something to think about when you do have a patient like that. Yeah. It’s going to help the lungs to expand the rib cage, to expand by getting any kind of tension or lack of proprioception within us. Right. Of center. Sorry, Brian, go ahead. We’re going to say, yeah,

I was just, just commenting on what you’re saying that this radius anterior definitely when it’s, uh, restricted we’ll we’ll stop breathing well, we’ll prevent a really good solid fall inhale.

Yeah. Yeah. And it’s fun how fast it changes the pulse, you know, intuitively the body is all right. We can just keep going on this. We better get going. We only have one minute pink. Okay.

Yeah. So, so the, this was kind of painting a picture. You know, it’s a little bit of a simplification because things can be both, you know, you can have both that anterior tilt and the lateral shift, but, but generally when you look at patients one’s predominant or oftentimes at least one’s more predominant. And if we go back to those, uh, the, the, um, TCM patterns and postures, the type two person that we see kind of replicated here on the right with the posterior tilted ribcage. Again, if you were to tilt that rib cage back, you’d notice how much of an anterior tilt of the scapula we have here. You can see that from the illustration, she kind of resembles more of that, right. Illustration where the rib cage is tilting back. The pelvis is shifted forward. The scapula is almost straight up and down, but if we were to adjust the, um, the rib cage, you’d see in relationship to the rib cage in relationship to those tissues that are holding it in into a particular balance, that it’s a pretty strong anterior tilt of the scapula that tends to correspond much more with, uh, kidney deficient, postures, um, and kind of a lack of stability from, uh, the kidney channel sort of holding and stabilizing the body.

That’s a whole nother topic, but, um, but there’s this, there’s a strong correlation with this type of posture with various types of kidney deficiency that you saw from the five fosters that Matt was highlighting earlier. So there’s a relationship between the lung and the kidney channel and this type of posture you saw with the boy, even who had that little bit of a posterior tilt to the rib cage, very, uh, versus, uh, I’m ready to go on, unless you wanted to say something else about that, Matt.

Um, I think maybe just a little bit like another demonstration that we do in smack to see how the pelvis and his position is related to kidney cha. Um, we have, uh, people go ahead and stand up and partner up and feel each other’s, uh, kidney pulses on the right and left hand side. And the kidney pulse is going to be the weakest, the patient, or the practitioner will slowly go ahead and just do anterior poster, pelvic tilts, not enough to get the heart rate up. So it’s going to change that Paul’s, but just very slowly going to an anterior and posterior pelvic tilt, changing the fashion and the position of where the kidneys are. So then by doing that eight, 10, 12 times the kidney pulse actually starts to come up, which is pretty amazing. And it’s so significant. It happens almost every single time, but this demonstration, we, we do frequently in the smack program. And also, I think I did a civics symposium one time. It’s pretty amazing to be able to see that. So what’s the next slide.

So same idea with channel relationships, that more lateral shift of the scapula, um, oftentimes with a little bit of an upward rotation, um, but when you start seeing more of a lateral shift and that sort of rounding of the arms, uh, that often goes in corresponds with, uh, multiple things, but especially spleen channel deficiency. And you can see with this type one posture, as Matt mentioned, how that’s kind of compressing the spleen and, um, the organ itself is being compressed, but the posture and the tissues associated with that posture, um, the tissues associated that sinew channel are involved with the pericardium and spleen relationship. So, you know, you might consider distal points, multiple things, but something like splitting for pericardium six might be a component of the, um, the treatment protocol for this doesn’t have to be, but that’s something that comes to my mind. Whereas the previous one, you might consider something like lung seven, kidney six, or, you know, other other kidney and the lung channel points for the previous, uh, person versus a spleen and pericardium channel point for this one. So we’re going to talk more about points, but just kind of think that, you know, start, start making those connections now. And when we’ll get into that at some point in combinations,

This is great. All right. So with the pericardium and spleen, and also the kidney, the lung, the lung and large test in relationships, the straightest anterior with the pericardium and lung, these imbalances can create a numerous amount of injuries. And we’ve already talked about a few, let’s go to the next slide and see what actually happens to the children.

Yeah. So, um, as much as we can have a whole bunch of injuries that we could focus on, uh, we talked about muscle tension, headaches and spondylosis, and a whole, whole bunch of things. But, um, but we’re gonna kind of give an example related to the, um, the shoulder position, shoulder movement and, uh, tendinopathies. So Matt, do you want to talk about this one?

Sure. What scaffolding humor, rhythm,

The, the humorous,

And also the scab will have a rhythm as the person’s going into shoulder abduction. So when you have process of proper muscle balancing, then that scapula will go ahead into a rotation as the head of the humerus is coming up. Now, if there’s going to be imbalanced with that scapula, if the lung large intestine that roof or the chromium right here is going to not be as strong, it will end up actually coming down into a downward rotation, a budding the head of the humerus, that particular scenario is probably, you probably see that more times than not with shoulder problems is the inability for the, for the scapula to upwardly rotate and allow the head of the humorous to move freely within that joint. It’s the abutting of the head of the humerus against the chromium impinging, the superspinatus tendon, the capsule of bicipital long head tendon making insertional type of strains. Um, there’s, there’s so many different types of injuries that can occur with us. So balancing these muscles and the sinew channels is going to be really imperative, followed by some kind of exercise prescription, which, um, I believe it was last month or the month before that, that Brian and I have a podcast, right. That we talked about this.

Yeah. I said both. We talked about fab lab last two, two webinars, I believe. Hm, Hm. Yeah. You know, it’s interesting

Too, with this cause we don’t have there much time left is that we talked about mostly what’s happening with the scapula, but the head of the humerus with a forward shoulder position. In fact, you can just do this yourself. If you sit up and you have your shoulder go forward, your human starts to internally rotate. And that’s just the way that it starts to move, causing more muscle imbalance within the rotator cuff between the heart and the small intestine Jean chin. So it just keeps on going. We just don’t have enough time in this 30 minutes to be able to talk about that. So let’s go to the Brian D anything else go for the next slide? No, no, I think that’s good.

This is a severe case of shoulder impingement spinner, but you can see in this x-ray as the person going to the shoulder abduction, the rotator cuff muscles are not pulling that head of the humerus down into the joint. And it looks like the scapula stabilizers, the lung and larger tests and Jean, Jen, and also the pericardia are not lifting ASCAP properly into upper rotation. The greater tubercle that humorous is hitting the chromium and the fact that it looks like it’s been doing it for an awfully long time. Cause you can see it, the superior aspect of the humerus, like a rough mountain range edge there. I don’t know if you can see that I don’t have a cursor without I can be able to do this, but at the very top of that humorous in the black, you see a very rough edge and it looks like that’s probably from necrotic tissue or a lot of overused banging into their chromium. This person was in some pain for quite a long time. Let’s talk about some acupuncture points that we can use for forehead and for shoulder Brian. Yep. Sounds good. Next slide please.

All right, go ahead, Brian, go ahead. Well, the points are going to be based on the particular injury, obviously. So is it going to be periscapular pain? Is it going to be levator scapula insertional pain? Will it end up being super spine Natus tendinopathy or maybe bicipital tendinopathies. So depending on which injury is going to predicate, what local points that you have or the adjacent points we want to needle the Watteau G points bilaterally, that’s going to be level with the innervated tissue. So, um, kneeling a C4 through C6, which the C is not on there. My bad, sorry guys. So the Watchers Joshy points of C4 through C6 needling, the pectoralis minor motor point motor entry point, which would be best if you were actually shown how to be able to do that. So we don’t create a pneumothorax if you’ve never done it before. Um, the rhomboids, the middle and the lower trapezius motor entry points would be good to get that communication between the Petraeus minor and the trapezius. And of course the straightest, anterior ribs, three through seven, another muscle that would be best shown how to be able to do those motor entry points. Because if you obvious reasons, if you don’t actually need all that muscle and go to the intercostal space, you could cause some damage with that. So if you’re unfamiliar with anatomy very well, you don’t want to needle these motor entry points.

Yeah. I mean, it just, it’s not three through seven. Like all of them, you wouldn’t necessarily, wouldn’t be needling. Serratus. Anterior is read three, four, five. So you’re picking the more restricted one or two, uh, um, regions, you know, slips of this radius. Anterior, that’d be a lot of needling for, um, you know, for all, all of those, those lips. True.

But we are immediately two to three, sometimes four, depending on the case

And the persons that you want to cover, the distal points Bryant. Yeah. So, um, flexor carpi radialis motor point is a really, uh, excellent, um, uh, motor quieter motor entry point that will soften the pectoralis minor. So in combination is great, but if you’re not comfortable with needling, the pectoralis minor, it is, it is good to learn that in a classroom setting. Uh, just so you do it safely and don’t cause damage to people, but the flexor carpi radialis is a little bit easier of a tissue to, um, to work with if you haven’t been trained to do pec minor. So it’s going to have an effect on pec minor for sure. Uh, other points along the lung and large intestine channel would be, uh, indicated, uh, L I six would be the sheet cleft wine of the large intestine channel would be a really useful long seven would be an excellent point.

Brachioradialis is, uh, brachioradialis is kind of associated with both lung and large intestine, but, but it’s, um, but it’s definitely a, uh, large intestine channel point. That’s going to influence that portion of the channel. Um, protonate or Terry’s Motorpoint would be more for, um, pericardium sinew channel. So if it has more of that lateral shift and again, serratus, anterior is difficult to needle for some people, if they haven’t been trained for inner Terese would be a really excellent, uh, in, in addition or, or just a needle in that one as part of a comprehensive treatment would be good. And then P six, um, for obviously for the pericardium channel. Yeah.

It doesn’t have to be all of these points. You guys, it’s just, we’re just giving you some points to be able to choose from, um, the brachial radialis motor entry points. We could do large intestine, 11 that’s that could connect large intestine lung that’s the upper point. And then lung six, the sheet cleft point is also going to be a motor entry point for the brachioradialis. So points that you can be able to use to be able to communicate upper into the gene gin. Um, just to kick out a little bit more when you were talking about the flexor carpi radialis my mind went to that, um, cadaver dissection that we did on that last specimen. So thank you very much for this donor, continuing to help us learn quite a bit, um, how you showed the really strong connection between the biceps and the flexor carpi radialis and for that lungs in you. That was fantastic. It was great.

Um, the, um, sorry, I don’t have time to go into it, but the connection is the muscle itself attaches flexor carpi ulnaris, uh, flexor flexing carpi flexor carpi radialis attaches to the medial. Epicondyle definitely not on the lung channel distribution, but it has a fibrotic structure from the biceps called the last fibrosis. Sometimes it’s called the bite sip app and neurosis that links the flexor carpi ulnaris with the biceps, which is part of the lungs, then you channel. And then from there short head into the pectoralis minor, and it’s a really strong link. So we talked about how the rhombus rate is slinging on the rhomboids will, will interdigitate also here with the straightest anterior. When you look at the cadaver specimen, you’ll see the pectoralis minor come up to the court court process and just factually bind right with that bicep. Also the, uh, the biceps short head.

So it’s just one continuous tissue onto that coracoid process is fascinating to see the connections at the same layers anyway. So we’re kicking geeking out on that, um, which is crazy. So should we get into a video? You want to introduce the video Brian or the myofascial release, what we’re doing here? So this is a, uh, a pectoralis minor stretch. It’s pretty simple technique. You can do it with the person in a prone position and the video will walk you through it really good to do after treatment. I guess you could make an argument if you’re doing facedown treatment and then turning the person over and doing face up treatment that you might do it in the, uh, after you take the needles out, um, from the face down position and before you turn them over. But generally speaking, we teach these to do after treatment. So the video should run through everything. So we’ll go ahead and go into the next slide.

So this technique, it’s a passive stretch of the pectoralis minor. You’re going to use both hands, one hand, covering the scapula, especially covering the inferior angle of the scapula. The other hand reaches underneath and hooks around the coracoid process. So you have to have contact with the coracoid process and you’re falling to the inferior border of the coracoid process. So with the one hand pushing down, kind of in a direction following the lower trapezius, it’s almost like you want your hands to be the lower trapezius in terms of function, by pushing the scapula inferior angle down and lifting at the coracoid process to give a stretch to the pectoralis minor. When I say lifting, I’m not lifting straight up, that’s going to lock the scapula and kind of limit movement. But lifting is really more in some ways, following the angle of the lower trapezius and lifting headboard, cranial and slightly towards the ceiling, while you press the other hand down and you want to picture the fibers of the pectoralis minor are getting longer and you can hold for however long you feel is appropriate and changing angles slightly to get different fibers. Pec minor has a third, fourth, and fifth rib attachments. So different angles we’ll get different fibers of the pec minor.

So the video is longer than the technique needs to be just because it was showing the setup. It’s kind of a subtle technique. You don’t have the right line of Paul. You don’t get as much benefit from it. Yeah. And feels so good when that technique is applied. That technique is great at, in a combination of acupuncture, myofascial work, and then doing the stretch. It really helps with the four shoulder quiet, big buckets that Ford shoulder’s gonna go right back into place. If the person goes back to their desk and doesn’t do their exercises, do the opposite movement and a host of different movements that can be able to help open up that chest. Well, Brian, is there anything else that you want to say we’ve gone over our time again, thank you very much for hanging in there, guys. I hope this was useful for you, Brian. Anything else that you want to be able to say? Um, no. No. Uh, I think, uh, the technique is you’ll, you’ll see if you wanted to reference that in recordings, that is going to be at one of the techniques that we’re going to have in a class upcoming class. That’ll be a webinar in March. So we’ll have a lot of different techniques like that and kind of combining some myofascial release with acupuncture.

Awesome. Awesome. Cool. So I want to thank American Acupuncture Council again. Thank you, Brian. It’s always nice hanging out and doing these things with you. Next week, Sam Collins is coming in to be able to discuss the billing and coding for insurance. He’s always great for, uh, providing the latest updates, which is really important in these ever-changing times. Um, so thanks again, everybody really appreciate it. And, uh, we’ll see you again next month, right?

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Acupuncturist Malpractice Insurance: Addressing Health Issues in children; Integration of Chinese Medicine to Western Medical Practice

In this post, we are sharing useful insights from a recent Live Event by Dr. Sam Collins of the American Acupuncture Council, with his guest, Dr. David Miller. Their discussion revolved specifically about addressing health issues in children of all ages and the things that acupuncturists can do in order gain more traction in the western medical practice.

Here’s the gist of that discussion:

Why communication is so important. Not all patients who come to your clinic are willing to undergo treatment if they are not familiar (if not fully aware) of the process and their benefits. However, with good communication skills, a practitioner can build reputation and patients begin to trust. It is imperative to send your message across to your patient and right communication is key – to develop a more personal relation with the patient, which makes them more open to new treatment even if the method veers away from conventions .

Why you should be familiar with state laws. Every state has its rules and regulations that are unique to them, which is why it is important that medical practitioners operating in a particular state should be familiar with laws in that area. This holds also true when it comes to acupuncture and the Chinese medicine in general. There are states that allow the integration of Chinese medicine into the western medical practice, but there are also states that impose steep regulations concerning this treatment approach. When you know the local laws, rules and regulations, the chances of your practice being hampered by possible conflict with the law become minimal.

Why go for an integrated, holistic approach in treating children. When making an assessment on children’s health (and eventually addressing the possible health issue), the approach should be holistic. They may complain about back pain, but you should also check the possible underlying issues. For instance, there might also a problem with digestive functions, respiratory issues (e.g. asthma), sleep issue, among others. Such approach is quite common in Chinese medicine, and as an acupuncturist, giving importance to this holistic approach yield positive result.

Why educating doctors about the Chinese medicine is helpful. The discussion also gave highlight on how important it is to educate doctors if you want to integrate acupuncture to western medicine. It put emphasis on the fact that some doctors has little to no knowledge about acupuncture; educating them opens a lot of opportunities, including the expansion of Chinese medicine to the western practice. And the plan of action to carry out process? You need to consider a number of things, including: sending a letter, giving them specific types of cases and their results, asking for a letter of consent (should their patients come to your clinic to seek alternative treatment).

Why establishing presence in the community is important for your practice. Again, the reason why there are still a lot of practitioners who are having a second thought to incorporate Chinese medicine to the western practice is simply the lack of awareness on its benefits. This is why an acupuncture practitioner should reach out to the community. This can help build trust and recognition as you will have an opportunity to introduce this approach to them – with proof of its effectiveness. You can do that using different techniques such as joining in state associations, volunteering, giving lectures – campaigning through grass roots education.

Here’s the link to the live event video:

And for your need of chiropractic malpractice insurance, contact ChiroSecure today at: (866) 802-4476

The AAC Pledges to Raise $300,00 for Acupuncture Research

The American Acupuncture Council has committed to fundraising $300,000 for the non-profit organization: Consortium for Oriental Medicine Research & Education (COMRE). With the support of the entire acupuncture community, and worldwide leaders alike, AAC will work tirelessly so that we can meet this goal which will directly serve for the betterment and enrichment of the acupuncture profession. COMRE was founded with the purpose and objective of advancing the development and promotion of alternative medicine in the United States. With greater awareness of the benefits and proven efficacy or oriental modalities, COMRE aims to bridge the divide and bring the art of healing to the attention of national healthcare providers and patients alike. To learn more about how you can support this worthy cause, visit us at Community Outreach.

Say Hello to AAC at PCOM

Stop by our booth and say hello to the friendly faces of the American Acupuncture Council at the upcoming Pacific Symposium in San Diego from October 28 to November 3, 2015. We will have some great giveaways and it is always a pleasure to meet new and existing clients and discuss the many exciting benefits of membership with the AAC.

The Pacific Symposium is hosted by Pacific College of Oriental Medicine. The annual Symposium is a great opportunity to network with fellow community healers while learning from innovators in the field. To learn more about the Symposium, or to register please visit:

HIPAA Compliance Audits on the Horizon

Recently the Office of Inspector General (OIG) for the Dept of Health and Human Services (HHS) did a study and found that the Office of Civil Rights (OCR), which has responsibility for HIPAA compliance, is not doing enough to ensure covered entities (CEs), including healthcare providers and insurers, are effectively following HIPAA requirements. They found that most activities were reactive, not proactive. The OCR agreed with report’s recommendations and that they need to do more oversight actvities.

Look for more HIPAA compliance audits and enforcement activities in the coming months as funding for these activities is provided to the OCR.

Have you gotten all your compliance requirements met? This includes: establishing your policies and procedures; implementing them within your practice; ensuring everyone has taken training; ensuring all your business associates have signed a BA Agreement and have security controls in place; and performing a risk assessment; just to name the major requirements.

Make plans in the near term to address all HIPAA compliance requirements.

NOTE: All the 50 State Attorneys General office are also ramping up to do their own HIPAA compliance audits and enforcement, in addition to the OCR’s activities.

See the full report at