Brian Lau and Matt Callison

Palpation in Assessment and Treatment

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Hello, I’m Brian Lau. Welcome. I’m here today with Matt Callison. We’re both with AcuSport Education. Also here today with Chad Bong. Many of you know Chad Bong. He’s one of the founding members of the Sports Acupuncture Alliance. There’s been three summits so far. Chad, you can let us know about the state of any upcoming ones. We’re in the midst of COVID-19 pandemic, so I believe that’s on hold. But we’ll have a chance to chat about that.

Chad’s also the host of PinPoint Performance Podcast. Just had a recent edition out with Jamie Chavez. I was interviewed for that. That’ll be coming out in a little bit. I think Matt’s been a past guest of that also. Whitfield Reaves, a bunch of other really great educators have been a guests of that podcast. Chad, do you want to say anything about the upcoming summits or possibilities of that?

I don’t know. We’re a little nervous about trying to get a hundred people in a room in our current state.

Yeah, sure.

So I don’t know. We have a lot of decisions to make with that. So as things start to get clear, maybe as a vaccine comes out, then we’ll be able to set it down the line. But it’s a big project. I was very thankful we didn’t have one set for this spring because-

Yeah, timing is not good for your live.

… I couldn’t have imagined having canceled something like that. So I’m glad that that worked out in our favor, but I’m a little nervous about setting one up right now. So we’ll see what the future holds there. But we’ll definitely keep with the podcast. We have a fair amount of them recorded-

Great.

… so we’ll be able to be turning some of them out every two weeks.

Awesome.

Yeah. So, Chad, just a little bit of background. Chad, you have a Master’s in Exercise Science.

Correct.

Also a massage therapist, studied massage therapy. A graduate of Southwest Acupuncture College. You’ve taught at a number of schools, Southwest, you’re currently at the WON Institute, and you’ve taught at Tri-State College of Acupuncture.

Yes.

Then in addition to that, of course you teach a lot of continuing education classes. So many folks who are listening might have attended some of those-

Possibly.

… or highly recommended to attend at some point in the future when we’re back doing live stuff.

Yeah, I definitely prefer the live stuff because I like the hands-on stuff, like what we’re talking about today, the palpation stuff. I don’t know how you teach that over the internet. Although I have to teach that over the internet because The WON is on 100% online classes right now.

Yeah, sure.

In the next couple of weeks here, I have to start teaching, three, four-hour classes on palpation.

Yeah. We’re going to be doing some online stuff with palpation, too.

It’s going to be tough.

It’s tough, but it challenges you in a different way. It brings out some sides that puts the spotlight on and makes you observe a little bit more. I mean it’s good to be positive about it. But I agree. Ideally, there’s no substitution for palpation live.

Yeah. I can’t put my hand on their hand and help them feel what they’re trying to feel. Once you teach this stuff for long enough, you can place your hand on top of somebody else’s finger and feel what they’re feeling through their fingers.

Sure.

So you can be like, “Not that thing right there, that thing right there.” You just can’t do that over the internet. So at least I haven’t figured that out yet.

Hey, Brian. I was looking at our list for the introduction for Chad, and it looks like there’s one line here. So Chad’s also a licensed acupuncturist and he’s completed Whit Reaves’ apprenticeship program. You also co-authored a book with Whit, right?

I helped with his book.

Yeah. So maybe that’s a good segue to go into your article from coracobrachialis that you just spoke about with Lhasa. I think it was last week or two weeks ago. Do you want to segue right into that, Chad?

Sure, we can move into that. So I did a coracobrachialis. We’re trying to put out some information for people during the COVID thing here. So I tried to pick something that I think just gets missed sometimes, I think, that other acupuncturists send me patients for that, for whatever reason, they haven’t figured out or haven’t gotten.

So that’s where we got into the coracobrachialis. It’s an interesting one as far as the palpation stuff because it’s an important muscle to be able to palpate not only the tissue of the muscle, because it’s not super easy to palpate the coracobrachialis versus the short head of the biceps without some practice. Then you also have to really know where that whole neurovascular bundle is that’s sitting right underneath it.

So when you do go in there, the needle, you’re not whacking away on that. Although I know some acupuncturists who purposely hit things like that, but I’m not one of them.

So I think it’s important to really be able to feel the difference between tissues. A pulse would be a real easy one to feel there. Then feel the septum in between the short head of the biceps and the coracobrachialis.

Then we’ll find bony landmarks, the coracoid process, and having some way to think through that, and then be able to see where the muscle ends and where the muscle begins and being able to continue that line down so you can feel the tissue all the way I think is important. So I think that’s pretty good into this whole idea of palpation.

Yeah. The discussion of that, what you were pointing out, is something that I note quite a bit working with acupuncturists, and I think this makes sense. We learn points and we learn an anatomy of points, whether that’s specific muscular anatomy or just bone landmarks and palpation and feel for indentation.

So I think acupuncture is often, understandably so, thinking points and they lose sometimes sight of that real estate of the muscle attaches from here and travels through this region of the arm or whatever structure you’re palpating, and thinking of it as a space and a region and relationship from this muscle to another muscle where the neurovascular bundle is all of those things together. It’s easy to lose sight of when you’re used to feeling for individual points. So I know what-

I agree. If I think back to acupuncture school, it was just like you learn all of this stuff, but it’s just this one point and this is another point and another point. It’s not all of the tissue in between and what all that tissue feels like and the depths of the tissue and the three-dimensionality of the body, being able to think about the body in more than just the surface area. You can get to the same spot inside the body from different angles, different points.

Yeah, sure.

Going back to the coracobrachialis, wouldn’t you guys agree that sometimes coracobrachialis strains seems like it’s a bicipital tenosynovitis. It’s easy to go to a bicipital tenosynovitis when, in reality, it’s actually a coracobrachialis strain.

So that’s where palpation comes in. It’s so important to understand what you’re feeling. Is it really the bicipital tendon and you cross-fiber that? If that doesn’t really cause the pain, then go deeper into the coracobrachialis, especially after some resistance, so you can feel it pop up. So palpation is everything in assessment. It’s what builds a treatment protocol, right?

I find it very important. I bring in the whole massage therapy world to it. Although my concept on palpation and feeling and tissue has evolved quite a bit from what I would have just called myself a massage therapist versus after going through acupuncture school and spending all of that time working with Whit and just getting much more specific and precise with what I’m doing palpation-wise. Whereas in the beginning of massage school, it’s just sliding strokes.

Yeah, sure.

You don’t get quite so precise. But, over time, I think if you keep practicing, you get super precise.

Yeah, yeah. Whit’s very big into palpation, thank goodness, because palpation is a missing link in our training in school, that’s for sure. So with palpation, I mean, isn’t it a lifetime skill also? I mean we should continue to learn all the time, especially the more that you actually consciously know about anatomy. The more that you can actually see anatomy and know what the underlying structures are, then you can start to actually see it in their palpation. So it seems to me that it’s just a lifetime skill development.

Yeah. I think like most things, the deeper you go into it, the bigger the hole is. So you can just keep learning more and more. I sat down and wrote some notes about things that I wanted to talk about during this thing, and building your anatomy base to understand where all of those tissues are. Then, on top of that, building the palpation base.

Both of those are endless processes, things that you could go on learning for the rest of your life, the details of anatomy. I think my anatomy is pretty good, but I know there’s people out there who know their anatomy better. I think I could spend a lot more time with cadavers and ultrasound and things like that and try to develop my feel and the view of this tissue even better. So I think there’s always room for learning.

Sure.

Then palpation, I have students in the beginning, when I first started with them, do the thing where you put a one-inch piece of thread underneath sheets of paper and then they palpate it. People, when they begin, maybe can feel that under 15, 20, maybe a really good person might get 40 in the beginning. But if you keep practicing, you can get up near a hundred sheets of paper with that little piece of thread under there and you’ll be able to find it.

So just developing that sense so that when you feel something different in the tissue, you can start to feel the actual differences in texture, which is really what I’m looking for is changes in texture in the tissue that I’m trying to feel to be able to tell that there’s something different going on in that specific spot.

Wouldn’t you say that then you could also quantify to excess, deficient, damp, hot, cold, which would then set up your needle technique and also your application of acupuncture and moxibustion, right? So if it feels real excess, we’re going to be feeling it with palpation and then needling it as a reducing method. So palpation is … It’s so incredibly deep. Hey, Chad. I think you and I have been bogarting this, and we haven’t been letting Brian speak.

Oh, no, I’m good. [crosstalk 00:11:37].

You’ve just to jump in, Brian.

Yeah, yeah, yeah.

It’s a first come first serve show here.

Yeah. I do want to segue a little off of Chad giving tips because I had a few thoughts for this podcast of giving maybe some tips. We don’t have a ton of time to go into that, but we can talk about some guidelines or tips since that is an area within the acupuncture profession that could be improved on. You already gave a tip basically, was increasing sensitivity by having some method that you can start to add sheets of paper and feel through those sheets of paper to where you have greater and greater depth that you’re feeling through.

Yeah. If you want to talk about how, I think somebody could get better and better at palpation. First, I think you have to have a basis in anatomy, right?

Yeah, sure.

I think we all have. We’ve all been thinking about anatomy a lot. I think you need to learn that base so you can understand what tissues you’re trying to feel. Then I think you should build on that with learn what all the functions are, learn where the major neurovascular bundles are going through things, and maybe learn the functions of those muscles by practicing your manual muscle test, so that you can see what those muscles are actually doing.

Then you’re building multiple brain connections where you’re not just trying to memorize, “Oh, the biceps does elbow flexion,” you’re actually doing the elbow flexion or you’re having somebody else do the elbow flexion while you resist them.

So I think building your anatomy base, and thinking of it from small to big. Don’t just like, “I’ve got to learn all of the anatomy.”

Yeah, sure.

Just put pieces on top of pieces, layer it. But then once you have the … And I think you should do some range of motion stuff in there so you can see how people move. Then start feeling things. Really, the more different types of bodies, the more different tissue you feel, the better idea you’re going to have on what this tissue should feel like and what is different about the tissue?

Watch the students going through the three semesters of palpation stuff with me, and in the beginning, they can tell their auto-muscle and that’s about it. By the end, they’re like, “Is it that thing or is it that thing?” which is cool to watch the progression with them. Is that what you’re looking for?

Yeah. Well, I mean I have one. We were mentioning the coracobrachialis when you mentioned that doing a contraction to bring that muscle up. A tip that I often teach when I’m talking with students about a little bit more certainty for what they’re palpating is, yes, you can get the muscle to come up by a certain action, but you can be a little bit more precise on what action you use.

Coracobrachialis is a great example because it does really two major actions, but one of them, shoulder flexion. Well, it’s also right next to the bicep. So if you put your finger and span down and get on what you think is the coracobrachialis and have the person do shoulder flexion, it’s not going to tell you a whole lot because it’s going to contract, the biceps are going to contract. And what am I feeling? I don’t know. But if you recall that it also does adduction, [adeduction 00:00:14:46], adeduction is a much better-

Horizontal.

Horizontal adeduction. But also just straight adduction. That’s going to-

It tends to position your arms in, I guess, but-

Yeah, but that’s going to bring it up a little bit more different. It’s going to differentiate it a little bit more from the biceps just based on the action that it’s doing.

Yeah, a mechanism of injury, like, for example, you see usually this injury with people doing too many pushups or bench press or something like that. What else refers to the anterior shoulder, though? Doesn’t the lower motorpoint, which is also the same location of a trigger point of infraspinatus? [crosstalk 00:15:19].

It definitely refers to the front of the shoulder. The story I told at the beginning of the coracobrachialis thing, that’s what I thought it was. I pushed on her infraspinatus, I felt around back there, and I found a spot that just referred right to the front of her shoulder. So I was like, “Well, there we go. This is our thing.” She was a backstroke swimmer. So I was like I’ll treat her. Infraspinatus is the main concept muscle-wise, and this’ll get better pretty quickly, and it didn’t.

Don’t you hate that?

It doesn’t happen that often, but, well, it does.

Did they get somewhat better?

I learned something, though, right? I learned something by having her not get better. She didn’t get better basically.

At all. At all. Okay.

A couple of times actually. So I did some work on the infraspinatus and I did some work on the biceps and the deltoid, and I just wasn’t getting anywhere. Then, finally, I was like, well, I’m going to try the coracobrachialis. Once I needled the coracobrachialis, the next time she was 90% better when she came in. Then she was back to swimming. She’d missed swimming for years, basically, as far as competitive swimming.

How do you needle the coracobrachialis? We teach it as needling the motor innervation [ju pi 00:00:16:36], which is one tsun below [jan ayling 00:16:39]. How do you needle it?

So I’ll come pretty close to there. I’ll find it off of the coracoid process and then palpate out, making sure I’m on the right line by … People can see me, right?

Mm-hmm (affirmative).

Making sure I’m on the right line by coming and finding it in here, and then palpating all the way up here and then needling going out and down. But not super deep. You just want to get through whatever you happen to be under there, either the anterior delt or a little bit of the pec major. But, again, all of that neurovascular bundle there is sitting behind the coracobrachialis there. So you’ve got to be a little bit careful.

So I’ll needle it there, but you can also get into it inside the arm here, which is what I talked about when I did the coracobrachialis presentation. But here you really have to know your palpation, right?

Yeah, sure.

You have to be able to separate … I don’t know if you can see my screen right now, but if you do a light flex, you can see that septum in there. If you flex it a ton, it’ll just go away and it’ll just feel like the bicep.

But you can get this little space right here, but then you have to know right behind it. In this position, inferior to it is that whole neurovascular bundle. You can feel the brachial artery right there. So you’ve got to make sure you don’t hit that thing.

But this would be by palpation in here to see if I can find a spot that’s really interesting. Then I’d usually get two needles into it. You don’t have to needle deep. That muscle is basically right at the surface, so you don’t have to go crazy, again because you want to be careful of all the neuro stuff back there.

Then I would just get two needles into that tissue, some light e-stims just until either the patient feels it or you see a little tiny bit of a twitch. Then if you have needles in up here and needles here, you might see these needles moving and these needles moving, if you have a light twitch going on.

Brian, how do you like to palpate it?

Well, I use the motorpoint ju pi quite a bit. But like Chad mentioned, I sometimes do look for trigger points, or ashi points, a little bit more inferior. I don’t discuss that as much with people just because it takes a lot of set up in terms of students. It takes a lot of set up, and there is a little bit more risk. You have to be a little more mindful of the palpation.

But, yeah, I do sometimes needle it in that more inferior aspect. I do find that that’s a pretty common area of congestion. I also do a lot of manual work in that area. I probably more frequently do manual work at that part of the muscle than I do needling it and separating the coracobrachialis.

This is where it comes really having the palpation skills there because you can separate it from the septum. It can create a lot of congestion in that septum between the biceps and the triceps and being able to open that septum up.

Something else that we do when we teach … Chad, you probably know that we use a lot of models with sinew channels. The coracobrachialis is on the pericardium sinew channel, palpating it and then going and needling either a point like [piece X 00:19:44] or something. But in that case, I’d probably go with another muscle on the pericardium sinew channel like the pronator teres, maybe pronator quadratus, and see, when you go back and return to palpation, if that diminishes. Usually it’ll be about by 50% that you can diminish some of the sensitivity to palpation from a distal point. It doesn’t mean you won’t needle it locally, but-

So I’m glad you brought that up because David Legge, in his book, he basically puts it on the lung channel.

Yeah, that’s great.

And I was like I don’t necessarily agree with that. So I’m glad I got somebody else on my corner here [crosstalk 00:20:20] pericardium.

Yes.

It’s all opinion, of course, right?

Yeah, I mean you’re trying to decipher some pretty ancient language that’s been translated.

It’s in a different myofascial bag than the lungs, the lung channels. Yeah, it’s different.

Yeah, I agree.

Yeah, we have the biceps on the lung channel and then how that relates down the arm, the pericardium on the … I mean coracobrachialis on the pericardium channel. I think we have a video where we do on a cadaver specimen, where we have a needle in the … I don’t think this is up on our YouTube channel, but the needle in the coracobrachialis motorpoint and pronator teres motorpoint.

I forget now which one we turned and wrapped, but more aggressive than you do on a person. This isn’t a technique demonstration, but turning the needle to where it really, really grabbed a hold of the tissue. Obviously it’s a cadaver specimen, so there’s no sensation.

But you really want to get the needle stuck and then pull and see if it transmits force. I think it was from coracobrachialis down to pronator teres. You pull on coracobrachialis and you’ll see that [crosstalk 00:21:26].

You saw them both move.

Yeah.

That’s pretty cool.

Yeah.

Now we needled it the way that we needle it in SMAC, which is supposed to meet at the bicipital tendon, going in at an angle distal into that area, into the innervation site, which is common area for strain in that region. It seems like going from what Chad was showing, going from the medial intermuscular septum, in between the bicipital septum, going that way. It seems like we’re just going to the same spot, but at two different angles.

Like I said, it’s a 3D thing. We’re working from three dimensions. So you wanted tips. I think a great tip is for people who … The first time you’re trying to work on a muscle or find a muscle is to break open the Motorpoint Index book and be like, okay, ju pi is right here. So I know that I’m all on that muscle if I go to this point, or at least I’m really close to it depending on some other person’s anatomy. But I’m right on this muscle. So you could find that spot.

Even if you’re not a motorpoint needling person, or if you are, but at least it gets you on the muscle so you can start in a spot that’s in a good spot, and then you can palpate from there. It’d be a good way to find, say, like a popliteal muscle or coracobrachialis or something like that. Just use the Motorpoint Index wording and description of the location to find the actual point on the muscle, I think, is a great way to go about it.

Well, gosh, since we’re talking about that, you might as well go ahead and get the Sports Medicine Acupuncture Textbook because the images have not just individual, but it’s grouped together. So you can see the motorpoints all together. Thanks for that, Chad. That was a nice segue, buddy.

No problem. Anytime.

Yeah, and I think it’s important to see it in relationships too, because it’s good when you’re learning anatomy to see that isolated muscle on a skeletal structure and get a clear picture of where it attaches to and where it lives, but then to be able to see it in relationship to the other structures … Because that’s going to be more like when you’re actually going to palpate because you have to differentiate between blood vessels and other muscles and just the whole picture.

Yeah. I think it just helps people who don’t have quite the palpation background to find a certain spot, but then we also know like, okay, that’s a relatively safe spot to put a needle essentially, is into where the motorpoint is marked out. So you have both a point that’s relatively safe to put a needle in and it gets you on the muscle. So I think it’s a good way to learn where each of these muscles are and where there’s points you could access them as you go about learning this stuff.

Now I want to bring one thing up, is that, remember, our founding fathers really didn’t know the anatomy so well. There is some literature that does show they had … They were doing dissections, for sure. But the anatomy knowledge is not like how it is today.

So not knowing the underlying anatomy then gives the practitioner so much of a feel of what’s happening in the skin over the muscle itself. How well can you move the skin of an acupuncture point or a motorpoint or a lesion or something? How well does that skin move over that muscle or adhere to it because of the skin ligaments and the subcutaneous tissue onto the fascia profunda?

So there’s so many different things that can be developed just by not knowing the anatomy, but by going by what’s happening within the skin. I think that’s how we started, right?

Sure.

Then with dissection then came more anatomy and such, because we’re feeling for excess and deficiency, and I already talked about all of that. But I think that was really quite traditionally was how it began.

I’m sure it was just, again, layers on top of layers of learning over a long time for our [inaudible 00:25:23].

Matt, I just saw a question come in about the name of the book you mentioned.

Oh, great. Awesome. Thank you. It’s called Sports Medicine Acupuncture. If you go to SMAtextbook.com, SMAtextbook.com, there’s information about it. Thank you very much for that.

Yeah, and I guess we can mention Whitfield Reaves’ book. Chad, you had some interaction with that book also, if you wanted to mention that, because another great resource for acupuncturists who are transitioning into a more orthopedic or sports model.

Yeah, the Acupuncture Handbook of Sports Injuries and Pain. Yeah, it’s a great concise book about 25 really common injuries that people … If you’re going to work in sports injuries kind of world, those are the injuries, the 25 of the most common injuries, you’re going to see. So it lays out a really simple way of going about treating those injuries. I’m not a very good [crosstalk 00:26:29].

Yeah, more and more resources are out there now for sports and orthopedic-based acupuncture, which is great. I think there’s more on the horizon, too. So it seems like it’s a really growing field right now.

Yeah, the amount of people who are into this and posting things that they’re trying has grown exponentially since we started.

Hey, guys, there’s only about four minutes left. Is there anything that you want to wrap up with or any other questions that we can be able to take?

I think-

I can give one quick … We’re on some tips. This is an easy tip and it won’t take long. But when we’re palpating muscles, also being able to effectively palpate bone is quite important. What I frequently see when I’m teaching palpation is people tend to go in very quick and jab you when they’re palpating for bone. Just a general tip is when you’re doing it to use a flatter surface.

If you’re using your fingertips and you’re trying to palpate the coracoid process, you can’t really tell if you’re on the head of the humerus, if you’re on the coracoid process. You’re on maybe attachments that can feel hard if you go in too quick.

Whereas if you come in and match the shape of the bone, it has like a little hook. So if you can get your finger around that little hook and get more surface on the bone, and also wait a little bit of time and let that density of the bone … As the tissue softens around your hand, that density of the bone really comes to your hand more. It’s a really good strategy for palpating bone.

Then once you’re on that, you can do a little back and forth movement to get a little more clarity to it. But bone palpation, I find for a lot of people who are not really taught outpatient well, they’re too quick, too quick on the point of their finger. So just imagine how much information … You can’t really bring in as much information on a point as you can on a flatter surface.

Yes, I would-

[crosstalk 00:28:26]. Go ahead, Chad.

I would carry that into muscle as well.

Sure.

I mean, if you go in there really quick, the people are just going to tense up. They’re going to have constant pain, especially if you’re working on bigger muscles, if you use a bigger surface, like I’ll use a fist or an arm or something like that. Then I’ll just find something I’m interested in and just keep working into a smaller thing so then I eventually get down to my finger or something.

But you can feel a lot of very interesting things that you might miss with just a finger with a wider surface on, say, a bigger muscle. So don’t forget to do that. And work your way in. So you can put a lot of pressure on a human being if you work your way in there slow. If you go in fast, they’re just going to jump off your table.

Yes, I agree. Something that I’ve said for a long, long time is if you use a number of different anchors, following up with what you just said, Chad, but specifically your pericardium nine, because, in my mind, what works for me is that allows intuition to come up. It seems like I get a lot of messages when I feel with my pericardium nine finger. Maybe that’s just [Mattism 00:29:29], but I believe that’s actually fairly true for a lot of people.

Yeah. I have people practice with all their fingers, like figure out what finger works for you.

It works better than the elbow, that’s for sure.

I don’t know, man. You can train an elbow pretty well.

Yeah, I agree.

That’s true.

I agree.

That’s true.

I agree.

My elbow sensation 20 years ago was nothing. I could tell I was on a human body. But, no, man, I can feel a ton of stuff. It’s just because I’ve used them a lot to find things. That doesn’t mean I’m using them to cause an immense amount of pressure on somebody. But on big areas, a forearm shaft, a shaft of your ulna, you can find a lot of stuff with it.

Yeah.

Hey, I know we don’t have a ton of time, but there are a couple of reoccurring questions refining palpation, and two that I’ve seen come up quite a bit is palpation on people who are obese, because it can create a little bit more challenge. I mean I’ve worked with plenty of obese people that had just great muscle tone, very easy to palpate, and some very thin people who had very … Very difficult to palpate. But, generally, generally, it’s much more difficult to palpate people who have extra weight. Any tips or thoughts on that?

Matt?

Sure. Move it to the side as much as you can, knead it as much as you can, and also put the patient into a position to allow gravity to move the subcutaneous fat out of the way. For example, if you want to go to the lateral side of the body or into the obliques or something like that, instead of having them being supine, have them roll to the side so you can have that tissue with gravity move out of the way. Different tips like that is fine, but it takes a while. It will start to melt, but it takes time to do that.

Yeah. I think there’s different levels of connective tissue inside adipose tissue, too. So I think there’s a difference in how some of these things are going to feel. Some of it’s pretty easy to move through, some of it’s more difficult to move through.

Retinacular cutis.

Yeah.

Again, it’s practice. That’s why I say you need to try on a lot of bodies. You can’t just practice on one person because, yeah, you’ll get good at palpating that person, but you need to practice on all shapes and sizes of people to really get good at this skill.

Yeah. Having done a lot of dissection, you get to see, with people who are obese, how much subcutaneous fat there is, but also how much internal visceral fat there can be. Even when you’re seeing what you’re doing, sometimes differentiating structures on a cadaver specimen can be very difficult with people who are obese.

These are all great tips, but at some level you just have to do your best and understand that it’s inherently more challenging. That’s why sometimes people who are more obese, sometimes they don’t do certain surgical procedures because it’s … I mean this is when you’re in there seeing things. It’s hard to differentiate.

Now imagine you can’t see anything and you’re going in with your hand trying to differentiate the structures. It’s harder. You just have to understand that it’s harder. But [crosstalk 00:32:38].

But it can be [inaudible 00:32:38] a lot of stuff.

Sure. But you have to also understand that, at some capacity, with some people that you just have to do your best and feel your best and trust that you’re on the right structure. If you are in a risky area, maybe choose not to do those certain points that you can’t safely differentiate where you’re at and needle safely.

Definitely.

Yeah. Now the palpation is followed by needling. Then the needling density also helps, wouldn’t you say?

Yeah.

So then if you’re palpating … Are we still on the obese, I guess?

Yeah.

I mean this is a whole another podcast or webinar.

Sure.

Yeah, it is. [crosstalk 00:33:17].

You’re talking about density of tissue when you’re dealing with a needle. That’s a whole … Like we could talk about another half an hour, probably an hour, about just how a tissue feels and how you need to learn that when you’re practicing your needle. What does it feel like to go through fat? What does it feel like to go through fascia? What does it feel like to go through muscle, both healthy muscle and not healthy muscle? You talked about like you could diagnose somebody off of palpation with excess, deficient, whatever. You could do the same thing with a needle.

Absolutely. Absolutely. That would be fun to do. That’d be a fun discussion to have.

Yeah.

I’m ready.

Well-

You guys, it’s 10:33. So another question or … Yeah.

It doesn’t matter to me.

We’ll also be looking at questions on Facebook and can answer those via written responses. But I think we’re probably about ready to wrap up.

All right. Some closing comments. Chad, I just want to say thank you very much for doing this with us. That was really, really fun. It’s always great to get your insight on this. Also, so, Brian, it’s great always being with you as well.

Yeah, of course.

Let’s make sure that next week that you stay tuned to this because you’ve got Yair Maimon that’s coming in. If you have not had an opportunity to be able to listen to him, he is a brilliant speaker, a real bright light. He’s an excellent person to tune in with. He’s got all kinds of different insights with acupuncture and traditional Chinese medicine. So I hope you enjoy that. Brian, anything else that we need to say, thanking American Acupuncture Council?

Yeah, thanks to American Acupuncture Council, of course. We’ll be back then in a few weeks down the road for some more discussion of orthopedic and sports acupuncture.

Yeah, this is a topic that Brian and I hit on the podcast that we did. So if you’re interested in this, stay tuned for when we release Brian’s podcast, because Brian gets into his thought process on this a little bit more in the podcast.

Awesome.

I agree.

That’s great. When is that podcast, Chad?

I don’t know.

Okay.

We have a pretty big queue of podcasts right now.

Yeah, yeah, yeah. The one with Jamie Chavez, there was a little discussion on palpation, too. It wasn’t the centerpiece of the whole thing. It covered a lot of topics, but there’s a little bit in that also.

Josh, our goal is we get into it a little bit more, because he’s more of a bodyworker. You, we got into it quite a bit because you’re more of a bodyworker, too. So those are probably the two biggest ones we talked about palpation stuff.

Got you, okay.

Josh is … I don’t know when we’re going to release that either, but it’s coming to PinPoint.

Okay. Yeah, I was about to say I hadn’t heard his yet, but that’s why.

Yeah.

All right.

Thanks, guys.

All right, thanks very much, and we’ll see you next time.

See you.

Okay, bye bye.

Bye bye.

We done, Brian?

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