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Motor Points and Trigger Points: A Compare and Contrast Discussion

 

 

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.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello 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

 

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Social Media Trends 2021 for Acupuncturists – Chen Yen

 

 

What do I need to do on social media to actually get new patients you been posting? And you’re wondering how come I’m not necessarily getting that many likes or interests and definitely not getting as many new patients from it as I would like.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Do you have a key?

Do you ever wonder, well, do you ever hear, Oh, I need to be on social media, but I ever wonder, what do I need to do on social media to actually get new patients you been posting? And you’re wondering how come I’m not necessarily getting that many likes or interests and definitely not getting as many new patients from it as I would like. So welcome to my show today on the social media trends this year for acupuncturists that you can learn from so that you can, can see where to spend your time and energy and where not to focus your time and energy. So that way you can focus on, on actually helping patients instead of worrying about where to find them. And I am Chen Yen six and seven figure practice make-over mentor@introvertedvisionary.com. So let me share with you a few of the top trends to pay attention to right now.

So you can decide whether to take advantage of them and whether it makes sense for you. So, one thing is that the attention span of people are, is starting to get shorter and shorter, shorter. I remember seeing a statistic. I was like, how, how the attention span is shorter than a goldfish. Can you imagine that? So things like, um, stories that can interest people are more likely to get attention, for example, um, are you doing Facebook stories or Instagram stories or Snapchats and things like that? So that’s one thing too, to consider the, um, second thing in terms of trend wise is that it’s harder to actually get, um, interest and new patients through organic traffic. And why is this? Because a lot of the popular social media platforms like Facebook and Instagram, and even YouTube is starting to get more this way, but in terms of how do they actually generate revenue it’s through people paying for ads.

So for example, Facebook, back in the day, did you know that back in the day when Facebook was newer, you could pretty much have a business page on there. And pretty much everybody who would like your business page would see your posts, but guess what percentage nowadays actually might see your posts organically? I seen studies as low as it’s like 3.5% of people who actually like your page might actually see your posts. So what does that mean for you? You might spend time posting and then you’re wondering how come, uh, very few people seem to be liking or sharing. Right. Have you noticed that before? And then, um, Instagram is, is a better platform typically right now for organic traffic compared to however guess who bought Instagram, Facebook. So just like how they’ve done with Facebook, it’s typically going to be, I mean, it’s, it’s likely to be where once they get enough interest, then it’s going to turn into even more and more of a pay to play platform.

So, um, there’s also in terms of what can you do to actually get interest on, on social media, if you aren’t planning on paying for ads or even if you are paying for ads, how can you make it more effective? So, um, one thing is to actually incorporate this one hack, which is for example, on Facebook, did you know, like this one hack I’m about to share with you can actually get you 10 times up to 10 times more views from your organic posts than if you just posted a text post, what is it it’s to do a Facebook live? And why is this? Because? So Mark Zuckerberg had come out years ago saying that he wanted to see Facebook take over YouTube for video and video is one of the most, the fastest growing social media platform right now, in terms of sorry, the fastest growing platform among all kinds of platforms and overall online.

Did you know that Cisco said that by, uh, they did a study on this, you know, 82, they were expecting 80. Let’s see it was 80, 82% of all internet traffic by 2021 was expected to be video and a Facebook, uh, high-level executive came out. This, this is a few years back saying, saying that video would be like number one, you know, the main way people would consume content. And, and, um, and then also in, in 2022, um, let, let me just look at this. So 82% of the global and, Oh, sorry, uh, a growing popularity of video internet, did you know that internet users spend six hours and 48 minutes per week watching videos online? This was in 2019, according to limelight. And so what does this mean? See, because how can, uh, especially with what’s happened this past year, more people are interested in being online, but what does that also mean? It means that there’s more noise and more, more people trying to get your attention online if you were just posting.

So how long does it actually take for people to actually get to, to know and trust you? Well, it usually takes more than just posting a few text posts, because how much can you actually know of someone just by, by seeing a few texts posts? Right. So, so then just speed up that trust. And, and there, I remember seeing some studies out about this too. I think it was put out as actually brought up by Forbes that more people are, are feeling like they need to have more trust before they are interested in working with anyone. Right. And so, um, nowadays than, than ever before. So this is something that is super important. And if you want to build that connection, um, it faster then being able to educate, because one of the reasons why people are coming to you is because you are, um, they are not educated about how you can help.

They don’t understand acupuncture, they don’t understand Chinese medicine, you might get excited about it, but people don’t really understand. So if they don’t understand, they’re not going to come in and how can you educate them to understand and be able to speed up that process much faster than just, you know, posting on texts on social media. And so, so video is a great way of doing that, whether it is on Facebook lives, uh, whether it is on, for example, you too, or you could put a video on your website to help explain your services so that people, um, understand it faster as well, and, and see being an acupuncturist and seeing your patients and them and your patients, potential patients deciding whether or not to work with you is it’s such a personal relationship with, with you as the, the acupuncturist. And so not only do people feel like they need to understand that it can work, they also need to understand.

I mean, they also need to feel that sense of connection and resonance with you and your energy. So, so then in terms of, of video, let me just give you a couple of quick tips related to this and, um, let me share with you because what if you actually get nervous and, uh, you don’t really like the idea of, of being in front of people, you know, with a camera kind of staring at you. So I’m gonna share with you a couple strategies that can help you overall. Um, and then I’m also gonna share with you strategies that you could do, even if you don’t want to be on video. And even if you feel like I don’t, I don’t think that’s for me. Uh, Jen, I’ll share with you a different strategy where you could just create one thing and use it over and over and over again, to bring in new patients.

So a couple of quick tips, when, when you do things on video, is this, what if you get nervous? So I, um, I used to feel this super performance anxiety when I, when I would be on, on camera or just speak at all when I was little, my dad, um, I grew up in a family, very strict research scientists. My dad was PhD. Um, first-generation immigrants from Taiwan, super strict, you know, when other kids would be, uh, like, um, Sunday morning, this is when I was around eight years old. When we would get the Sunday paper, I used to always feel a little jealous of other kids. Why? Because I imagined that they would, they would open up the paper or they get to, got to check out the comic strips. And what, what happened to me? I had my, my dad had me do current event talks every Sunday and I dreaded it.

I was terrible at it. And I cried all the time because he was very strict. Like he was, he doesn’t speak like my stylist. He’s very analytical and he critiques and stuff to the point where, where I just felt really inadequate. And because of that, I felt so much performance anxiety whenever, whenever I would speak. And I vowed to myself, I will never speak when I, when I grow up in terms of being in front of a girl or even being on camera. Right. And so, so then, but why did I end up deciding to, to actually speak is because I, um, I love teaching when I was little, I would get these kids. My idea of fun was getting the kids in the neighborhood around and then sitting around me and then I would go get my, get these worksheets from my third grade teacher.

And then I would get, I would have these kids, um, you know, do worksheets and everything. That was my idea of fide back then. It still is for me right now. So in any case, um, it was that desire to educate and teach people that led me to learn how to do this, but I will say that, uh, and the reason I bring this up is that if I can do that go from, from being extremely, having this performance anxiety to where, because I literally, uh, I would get so nervous when I first started speaking, uh, what I grew up that I didn’t, I would say something and then I didn’t know what I was talking about. I felt so, like I was sweating inside and my face turn really red and that I literally didn’t make any sense. It was that embarrassed.

I felt like such a fool. Right? So, um, the reason I bring this up is that if I can do it from the place of feeling like a complete fool and I winded a height under a rug, but then now getting to a place where I’m getting invited to speak nationally and more comfortable with it. I can say that if I can do it, then you could totally do it. And one thing, what’s one hot tip that you could use anywhere you go. If you’re, whether you’re at, you’re being asked to share about your practice and you feel really anxious about, um, whether it’s on video and you’re all of a sudden doing a video, or you’re doing some kind of, uh, talking kind of experience is this, you can just stick your tongue out.

So stick your tongue out,

Like the lion’s breath, right. In, in yoga. And, and that could just totally, totally put you in the present moment. So the heart racing starts coming down and your, your, the thoughts in your head about how you don’t know what you’re talking about comes down, and then you end up being more in a complete present moment. So that’s one hot tip. And I second hot tips. So let’s talk a little bit about, uh, a couple of the, um, Oh, the second hot tip is called the action. So, um, this is something that will help you, regardless of what social media platform you use, regardless of whether you do a text post, or if you do a, um, actually do more of a video, right. And, and by the way, a side tip for you, if you’re just doing a text posts, is that doing stories?

Oh, actually. Okay. I, I lost my train of thought for a moment, but we it’s just a reminder for you that remember doing, if you do a text posts doing like Instagram stories or Facebook stories is, will work better because it shows up, for example, Facebook will show up more on the top and people are more interested in hearing about stories as well. So, um, now, as it comes to call the action, one of the biggest mistakes, a lot of practitioners make is not actually give any kind of call to action that, um, that really leads people to, to book with you, or really leads people to take that next step, whatever that next step might be. And so that’s where you might be posting all these pretty close and, and inspirational messages and, uh, and things, and you, and then you’re, you’re still posting you’re, you’re like, hi, I’m here.

And how come nobody’s nobody’s reaching out? Or, or you might just say, Oh, call, call my clinic. And that’s about it. Right. So is there anything that you could vary that with because sometimes people, um, might not feel quite like they’re ready quite yet that way, or maybe they just want a different way of, of actually connecting with you. So, um, one thing that, that, that, that makes it easy and feels like it’s more comfortable. So for example, one hot seat for you is that you can actually, um, for example, if it’s on, on Facebook or if it’s on Instagram, you’ll, you’ll tweak this just a little bit, but it might be PME to get this assessment done so we can find out dot, dot dot, or you could say PME, if you’re dealing with similar health issues, we could discuss your situation, whether it makes sense for you to get it checked out.

Right? So notice that actually helps people think, Oh, maybe I need you to do something about this health issue or, or, or maybe I need to get, get it checked out. So it’s, it’s more of a, kind of, of a call to action that will actually interest people in, in booking with you. And then, um, if you want, if you don’t want people to PMU, you could ask them to click on a link to schedule an appointment, but how can you actually say that, right? In terms of, of whether it’s in a text post, or whether you’re saying it, um, video wise or verbally. So click on this link and book an appointment where we will do a such and such, and I’ve set aside a few spots for you to be able to get in with me week if you’re watching right now. So why is this really effective?

Because notice it gives a little more of a sense of an urgency, because if people feel like they could just do it anytime they might not do it right now, but if you’re actually letting them know that, you know, you’ve set aside spots this week for them, then if they’re watching right now and then to actually take action on that link, then it there’ll be more likely to, to actually do it. And I actually decided to make it easier for you, because these are just, just a couple of sample scripts from our template. That is the number one thing to supercharge, getting new patients from any social media platform, whether it’s a text post or whether it is a, um, a video kind of a post. So you can click on the link below that will be popping in, in the chat for you to actually access it.

And I’ll just give it to you also right now. So it’s introverted visionary.com forward slash C T a Scripps. So introverted, visionary.com forward slash C T a scripts. And then you can click on the link below in the chat and then, um, go there and download. You’re going to get the template in your inbox right away. Um, so go there right now, also, you know, by the way, for those of you who might feel like you’re, you’re in a place where you’re at your, if you’re feeling like you’re being, you’re frustrated with not getting as many new patients as you would like, or, and you just know you’re capable of so much more because you’ve had a dip in your income and also in your practice in terms of patient flow and feel free to also at that link, you’ll have an opportunity to book in for a free double my practice strategy session as well, to see what actually might be the most effective way to grow your practice faster this year, and actually have some help with it to grow, grow faster.

So in terms of, um, another hot tip that I wanted to give you about, about how can you be B uh, reaching where people would actually getting new patients on social media more effectively, for example, through, through video. And then I’m going to wrap up by sharing one hot seat that you can use if you decide, Oh, I don’t know about, you know, having to show up for social media all the time and creating all this content, right? Like I’m gonna share, share with you a hack where you could just create one thing and have it, use it, use it over and over again, to bring in new patients into the practice that our clients are using to do, which, um, when, when you tackle it, it’s like, it’s like it can end up even being on autopilot, which is pretty cool. So in terms of, um, the second, I mean, the, the tip other tip I was going to share with you about, about being more successful on video is that, um, let’s talk about a couple of the pros and cons of some of the platforms.

For example, a Facebook live is nice because you could literally just go live when you, when you feel like it. And, um, and then in terms of, or if you feel like it, right. And the, the thing about, about live, like I mentioned earlier, is that it, it gets sent out to, to up to 10 times more people than if you were to do a text post. Right. But the, um, the disadvantage of it is that if there’s not as much interest in that Facebook live early on in terms of, of for example, right, when you go live and in that timeframe, or at least earlier on within a day or two, then you might not get as much traction with your video, right? So that is a drawback with, with Facebook lives. Um, now in terms of, uh, length of a video, if you do do Facebook lives, it’s great to do over 10 minutes.

And some people say, well, why that long? Why? Because, because people are, um, sometimes they are, they’re coming onto Facebook at different times, but if you just do a video for like 30 seconds, then pretty much it didn’t give, give different people enough time to even hop on at all. And it’s already over. So for Facebook live to get more traction, ideally over 10 minutes is really good. Now another platform that you can use, and actually we’ve had, uh, we’ve had clients who just create one Facebook live, do it really well, and then run ads to it and bring new patients in the door. Right? So you just need to know what to say. That actually brings a new patients, and then you don’t only have to create what you don’t have to create a lot. Um, the other, um, ask the other possibility in terms of, of social media platform, um, for doing video to actually bring in new patients is YouTube.

So why is YouTube really great as a, to consider? So YouTube is people are actually going there to search for answers. They’re not just kind of surfing and then, Oh, they happen to see your Facebook live, right? They they’re actually looking for answers to their problems. So, and more people are actually starting to watch more and more YouTube videos. Um, just think about yourself. Do you ever watch YouTube videos too? Well, even if you don’t other people do as well. So, um, and the nice part about YouTube is that it’s like, it’s essentially a search engine. And, and then did you notice that if you, if you type things into Google, YouTube videos actually end up coming up, but not other kinds of videos come up as, as readily. I mean, Facebook lives do come up also. I’ve seen it, but it’s, but what do you, what do they tend to prefer as putting on top, like the first page?

Usually for people it’s usually YouTube videos. So what are some hot tips about YouTube videos? If you wonder, well, what am I going to actually say, say on YouTube questions and answers like frequently asked kinds of questions are good kinds of questions to, to put up on YouTube. And then, um, the big, and then another hot tip is you could do a video. That’s more about, you know, uh, how to, uh, how to find a good acupuncture, how to find a good acupuncturist, or you could, you could mention how to find a good, um, where to find a good acupuncturist and then put your city and state where you’re located in, because then, then that can also help with the search algorithms to actually help people find you locally. So those are a couple of, of hot tips in terms of length of a video for, for YouTube. Is that it also, it tends to build over time. Like if you, it tends to work better, if there’s a cumulative effect of your videos, if you do more videos versus just like a couple of them, right? Like if you, if you do videos at least once a week, um, over the course of a year, I promise you that you’re going to start getting more organic traffic. It’s definitely more of a long game than a short game. Right.

So Facebook live, it could be more of a short game if you do it well and do it early and do it, just do just one, like do one really well. And then do, you know, run, run ads to it. So now let’s wrap up with what, what is, what can you actually do if you’re feeling like, Oh my gosh, that’s just so not me where I feel like I have to create content all the time. It’s like, I don’t want to feel like I have to create, create new content all the time. I don’t have time for that. I just want to see patients. Um, so what can you do? This is what our clients actually doing. That’s, shortcutting all, this is actually creating just one webinar that converts and then doing it over and over and over again in front of different audiences.

So you could either do it in front of other audiences, or you could even get it automated and then have it bring patients in with just one webinar that, that works great, because then you don’t have to come up with new topic or content or anything like that. You literally just have to create one, that’s it, not 10, not 20, not spend time on social media all the time when you don’t have time, but literally just one webinar that converts. And what does that mean by one webinar that converts, it means that because there’s a difference between just educating people on, on what you have to offer, versus being able to also inspire new patients to come from it. It’s a very different skillset. How can you do both? How can you not only educate, but also inspire new patients come from it. So that’s something that I’m covering in an upcoming free training that I’m doing.

So, um, feel free to, if you have an interest in it, feel free to just type in the chat about it, and then that you’re interested and then I’ll, um, make sure to, to reply to you and send you the link to register for that. So, um, it’s really excited for you and about shortcutting things so that you aren’t feeling like you have to spend all the time on social media when you either don’t already have time for it. Or you’re like me more of introvert where, you know, it’s not like we always want to be displaying or our public lives. I mean, despite this way, everything about our private lives all the time, every single day, like 5 million posted a week or something, you know, in terms of like, Oh, I need to post like twice a day or three times a day, it just feels exhausting.

Right? So let’s simplify things have just few things like, or just even one, like I mentioned, right. Work well for you. So you can focus on seeing patients and doing what you enjoy the most. So with that, I look forward to, uh, Oh, and if you want the templates for the, um, free scripts that can help you with getting more new patients from social media, any social media platform. And the best part is that you can actually use these templates, like literally copy and paste. You can use this in all kinds of situations, even if you’re never on social media, whether it’s on your website, that you actually have an in a way to, to lead interested people into booking an appointment with you. Like what, what could you say that would get them more interested rather than, Oh yeah, just call it car office.

Right? Uh, or if you’re talking to people in, um, you can incorporate some of these things as well. So, so it’s, it’s going to be useful for you across the board and, and you don’t even have to be on social media, or if you want to be on social media, then it’s certainly going to help you instead of feeling like you’re just spending all this time posting. So, but nothing much else is happening for, from it. So go ahead and, and go, go to the link. And then I look forward to look forward to, to, um, you getting the downloads to help you right now, and then also getting you insight into, um, your practice and certainly happy to see if and how we can help you grow faster this year. So, um, yeah. Let’s have your practice take off this year.

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Mystery of Kidney 1

The Mystery of Kidney 1 Yair Maimon

We know in Chinese medicine, we are actually stepping in this footsteps of giants who had a deep understanding of how matter and energy changes into each other, how water and fire transform next. And so this is from matter and next to energy. So this is really the footsteps we are following. 

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

I would like to thank the American Acupuncture Council, putting up this teaching. And, um, soon we will start with going deeper into understanding the mystery of, uh, one very interesting point kidney One. So let’s start the teaching.

So let’s start the teaching.

Well, as, you know, Kidney One is the only point that touches the ground. And next,

Next slide, please,

It is located on the very bottom of the foot. It has by the way, few locations, but this is the one that we use very often. Next slide.

We know in Chinese medicine, we are actually stepping in this footsteps of giants who had a deep understanding of how matter and energy changes into each other, how water and fire transform next. And so this is from matter and next to energy. So this is really the footsteps we are following. Next slide, please.

Can we look at men? Men stands between heaven and earth and then atomical position in Chinese medicine is with both hands out, you know, the anatomical position in West, in Western medicine, it’s with the heads down and that’s indicates the position of men pointing out to heaven and connecting heaven and earth. And in the slides, you can clearly see how the young, they have an energy goes down and how the energy goes up. And this goes through men, and this is also the movements of the meridians. The meridians starts from below and they go up and the young Marie didn’t start from above and go down the next slide. And with the same dynamic of, in any Ang interchanges, we can understand why all the in Meridian that starting with the work point, because that other dynamic from what to fire and why the young meridians are starting with metal, because they’re the dynamic of fire to water next slide.

And

This is a beautiful picture, uh, with my two colleagues about [inaudible]. We are working on this project of actually painting the acupuncture meridians. And this is the painting of the kidney, the whole kidney Meridian, which starts at the kidney one that you will see soon and ends up in the chest with the last kidney points. Next slide. This is the picture of a kidney one. And in kidney one, you see actually here, two birds, one bird is pointing downward, and one bird is pointing upward. And this is very much the dynamic in this kidney. One that brings the yang energy from a bow

Down,

But also brings the yin energy

Back up next.

Oh, you will be able to see the tree because there is this in the painting. We have a tree next. It’s the, well, it’s a DJing Wellpoint, and this is a very strong dynamic of a gene. Well point, the changing of the energy of in an yang next, you will see this,

Um,

Which is pointing down, bringing the energy down and next,

This is

There is the young energy going up at this point. So this is a very strong and, and amazing dynamic on this, uh, acupuncture point next.

Okay.

The name of the point is young Chang and young is bubbling or it’s kind of opening also for flowers. So it’s, so you have this very strong dynamic of energy entering the body. And when you stand with your soul, your feet on the ground, you can actually feel this energy coming up from the ground, but it’s a very special one. The Tron talks about like a spring and it’s to do with the water and with some special water gushing out at this place. Next, Every point has many names and this point also has many names. Um, one of them is in GU in GU called the invalid the deep Valley

Next.

And when we, and I choose this too, to talk a little bit about the name of this, uh, the secondary name of this pointing will because it’s very strongly indicates that this point is genius on the Meridian. It’s the most heated point. It’s a point when you look at somebody, you don’t see it by the way, there is two hidden points. One is on the kidney and the other one is the heart art one. This is the two points you can never see there, but it’s also to do with this hidden route of energy of the kidney. And this is the place where things are starting and initiating. And it’s almost, what’s one of the interesting point actually, to treat fear and deep seated treat, because fear is well, is hidden inside and gushes out and fills you when you are full with fear and will later I’ll give an example of how you use this point with people was fear and anxiety, even panic attack next.

Okay.

The nature of this point is it’s an entry point of the kidney Meridian. It’s a gene, well it’s wood point and it’s the lowest point of the body and it’s to do with the gene. So you see all this pointing to a very strong dynamic of the kidney. And the next time You mentioned before, and it’s very special about it’s one of the only points that has this Juul action. One that it takes a strong access from the head. I just treated somebody with very high blood pressure kidney one immediately reduced his blood pressure, especially if he’d because in his case it was for kidney deficiency and it helps on the other hand to revive consciousness, it brings the young app and revive consciousness, and it helps to calm this period and also rescue the young when needed next slide. This was a good example to show what happens when it’s like when the kid is tapping into the water. So one, we have the dynamic of going down and then the water are coming up. So this kind of a nice reminder of young energy going down while the ene energy responding and going up next slide,

One of the

Paul and one of the, to me, it’s, it’s more than, than the action of the point that this point touches the ground. And this touch this, uh, sole of the foot touching the ground represent on one hand the EAN, but also the beginning of transformation of the cause they, it starts from this point goes up to the Mo to the body, and this is the most place to root yourself. You know, when you walk in the ground, when, and sometimes people went down rooted and just say, take off your shoes. The best is if you’re a next to a beach, you know, you stand in the sand, but also if you are out there in the forest or in your garden, and you put your feet on the ground, you feel that you can root yourself endlessly into the ground through this point. So it has this very strong rooting ability, but also the connection to the ground is like in electricity, we have one place which is connecting to the ground. It allows this access from the head to be discharged naturally to the ground. Unfortunately, we work with shoes and we are full with our head with activity. So this, this charging a notion doesn’t happen. And it means our head stays full with the noise. And the ability of this points to calm is not utilized, unfortunately, because we don’t walk barefoot and we don’t spend time, you know, just being in touch with the ground next time, next slide.

So being

The lowest point in the body, but also being the would point, what point means there is a strong dynamic there, the word for spring, for the strong dynamic of this point for moving the water is very important. That’s why a lot of time we’ll see very strong effect of this point, almost immediate because of this word nature. So this powerful effect of this point is to do with the strong gang movement on the very, in a Meridian of the kidney. This is where the energy move from the bladder to the key liter is a strong change of energies. That’s why it can treat also extreme condition like epilepsy, Vertex, headaches, especially in off sometimes Vertex side effects can be hypertension next time. So one of the incidents is collaborative, young loss of consciousness, the best way to treat loss of consciousness. It’s treat kidney one on the feet and then heart nine. So you balance the fire and water. The two gene dwell points that are very strong in the dynamic of yang and bringing back consciousness next. And it helps to reduce the access of young suffer, red face waiting in the upper parts, strong feeling in the face next.

And one of its deep abilities is to balance the key and the heart. So it’s used very often for agitation, insomnia, but really hard difficulties in falling asleep, but also fears and anxiety, and very important point for menopause. Next line.

Uh, I want to spend a few minutes on this harmony of kidney and heart because they are very commonly seen in the clinic and sometimes they don’t respond. And until you create this strong dynamic of water and fire and for agitation for insomnia, but it’s also used even for memory problem, um, tendency to fear, a lot of time around menopause, women will complain and all this, uh, symptoms and because the water and fire are getting out of balance, especially if there is a preexisting condition of inefficiency. That’s why I put here the tongue of a patient, uh, with the treated with menopause, hot flashes, night sweats, insomnia, and very strong anxiety attacks all related in coming around the menopause time. And kidney one was the one that really resolved the case. Next slide.

And also since it’s a wood point on the kidney and the water is the mother of wood, it’s very good in, um, balancing the liver and kidney. So for uprising of livery angle, liver fire. So especially when you see the strong vision is visual dizziness. My, my last patient in the clinic had the strong spell out of very strong dizziness and, um, and actually changes in vision in the light days. And also kidney one was just immediately after she said, Oh, what did you do? I feel grounded. My dizziness went. So just today, I have to thank this point and his strong ability to help this balance. Next There’s a nice story about Quato and who was treating the general weight. I too had a very strong headache and was, was mine was confused. And yet this very strong visual dizziness, probably some kind of a migraine and headache. And, uh, Watteau was puncturing kidney one and immediately got cured, but also maybe he had the high blood pressure. So again, this was a nice story from already the second century, you know, saying how this point was used dramatically in this case, by the famous WATO physician. Next

Another nice case from the clinic. It’s a patient that I’ve been treating for a while. Uh, he has a fear of water. He has a lot of memories from early childhood of being beaten by his father, but also with great anxiety and fear from, from this beating in, from the father, when he came, he has lower back pain feeling of cold. This general called this as some dizziness. Sometimes you wake up at night to urinate many times, sometimes twice, and he’s quite young. It shouldn’t be, it has a sexual problem is performance anxiety. So you see all many different aspects related to fear and to unstable water and kidney energy. Next, This is his picture and you can see the eyes, you know, you can really see the fear there. You can really assess it. Yeah, I do a lot of diagnosis from observation says you come to the room and go, what’s going on with his kidneys. What’s going on with this fear next. So on him, I treated kidney one and kidney 23. And the reason I use kidney 23, because all the upper Kimmy chest point are very good for deep seated fears from early childhood, from, uh, things that are happening already in the natal or even prenatal life. So, uh, I feel be interested. I’m teaching a lot about this point and especially about 10 points, next slide.

And now they’re good example is a female she’s 42, and I’m saying 42, just married with two. And she felt extremely exhausted when she came to me for the last three years. And this exhaustion is actually got deteriorated in the last year. So when she came, she was most of the time spending in bed. It wasn’t like a depression. It was a real physical exhaustion. She would hardly call go out in, in bed. I even to do simple things before this, she was very functional. She was executive in high-tech and she said she has difficulty concentration insomnia, lower back pain, strong, lower back pain, uh, periods were very delayed. And, um, last year she had infertility and, uh, now she has this all the time. Also dislike fears coming out, even from doing little tasks and difficult. And let’s say she’s 44 because she’s in this time of changes of the kidney Meridian every seven years,

Six

Feature from the clinic side, just from the, you know, I needed a kidney one and I’m bringing this patient because after this one treatment, she, she was like, totally better. You know, she came out of bed and she started to get better from, from this point on, would I obviously treated her more and, uh, in this case is, are so inspiring in South teaching for the effect of the point. So this is, to me, it was always a good example of the, the strength and the, um, ability of this true point to create a dynamic change in, in patients a case.

It looks like we use this

Point also in Chicago. You know, there’s two like main points. One is on the kidney. One again, when you in the simple exercise, simple Chicong exercise, which I recommend for everybody is sustained. Obviously, if you can stand without shoes on the ground, it’s even better. And you root yourself, you inhale and exhale through this point to root yourself, to root the lower that here, Dan can the lower abdomen, and it helps the body to absorb this yin energy. And after a while you feel stronger and firmer, so pericardium and kidney one, or the two, this access and entry points of energy, which are used a lot in Chicano.

Next slide.

This point with boxer, it’s actually one of this, uh, almost homeopathy likes cures likes. It says to subdue the liver young and reduce excess in the head to warm up this point.

Next one

Calming effect of this point is just touching it. It works amazingly in children really dramatically. So you can just touch this point. And then you’ve seen that children are kids that they cannot fall asleep. They’re overactive. So even just touching this point, you can even tell them to breathe to this point, but also in the clinic. If we can just touch for a minute, you see how people immediately relax and come down for insomnia, especially before bedtime. Uh, if you can do it to children, to others, it helps to kind of relax and bring down in the root Dene. So it helps to fall asleep. And now they’re good exercises just to put before sleep, to put the legs. And before this to massage a little bit, this point in hot water, you can even put salt in the water. Again, it helps to discharge the success of energy from the head down to the leg and into the water and helps to relax before sleep next line.

Uh, there is another interesting, uh, um, recorded, uh, teaching, which I did with my colleague, Ron Yale, that we are reading together, writing together this book about kidney one, where we are just discussing this point. So you can also enter and watch it for free if you’re interested, but everything in life is about the jink and Chen. And this exchange, when we see gene is water and Shen fire, and this changes of fire to water and water to fire. This is where we started of method, changing to energy and energy into matter. This is the essence of life on earth. So that’s why this point being on this very edge of this essence of yin is so dramatic and so important and can be used utilized in the clinic in so many ways. Next slide. Again, I would like to thank the American Acupuncture Council for allowing this teaching and thank you all for watching it. I wishing you the best of health. And especially in this time, the best of spirit and happiness, all the very best from me or my mom. Thank you very much.

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Year of the Ox Thumbnail

The Year of the OX 2021 – Tsao-Lin E. Moy

 

I want to thank the American Acupuncture Council for having me as their host. My name is Tsao-Lin Moy. I am a licensed acupuncturist and herbalist. I practice in New York city and I am the founder of integrative healing arts, uh, where I’m located in union square. Um, today I’m going to be talking about the Zodiac, uh, as we are going to be entering into the year of the ox and what we can do with that energy to help us be healthy and have an abundant practice. So, um, I’m going to go to a slide presentation, um, to give you some visuals. So this year is the year of the ox and the, it will be starting on February 12th and it will be through January 30th, 2022. And we have been in, uh, for 2020 has been very challenging for a lot of people, I think for the whole world.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

And so it’s important to also look at that with Chinese medicine. The Zodiac is actually a part of, one of the branches of Chinese medicine. It’s the esoteric, um, aspect of Chinese medicine. Now, um, there are 12 Zodiacs, right? And so here we are, uh, the, the year of the arts. So if you’re born in this a year, it’s going to be the metal ox, right? Because there’s also the aspect of the five elements. And as practitioners, we also, we understand the five elements as a cycle, right? A generative cycle, or it could be a control.

So

With the 12 Zodiacs, we have the, the elements, earth, metal, water wood in fire. And these ODS, the Zodiacs are based on a lunar calendar. So each lunar year, we have also, uh, an elemental cycle. Uh, the 12 year cycle actually follows the Jupiter’s orbit around the sun. And that takes about 12 years for 2021. The Zodiac is the ox, and that is connected to the element of the earth. And as we know, earth, energy is very nurturing. It is yin and the time is more of a winter, but winter has potential, right? And the, uh, the element though for this year is going to be metal. So people born in 2021, the year of the ox are called a metal ox or a golden ox. And the earth element, you know, is part of the nature of the ox. So that aspect always be, will be present.

Um, but metal is going to be influencing it. Um, the animals Zodiac or the animal influence will also depend on the date that you were born. So if you were conceived in February, all the babies being conceived, uh, coming up soon, they will be, uh, conceived in the energy of the ox and when they will be born, they’ll be have more of those, uh, ox attributes. Um, what’s important to know is that we all hold these energies within us and, uh, relate and interact with these influences under the principles of yin and yang. And this is about dynamic balance. Uh, metal, uh, attributes are considered to be from there’s some rigidity, also persistence strength and determination. The metal person can be controlling, ambitious, and forceful and set in their ways as metal is strong. But also if you look at the idea they cut to the chase, they don’t, uh, play around. Right. Um, here we go. And as you can see, here are these two beautiful,

So

Is, uh, a earth element and is really the art, uh, is down to earth. Their nature is hard working. Um, they have integrity, they’re reliable. Uh, someone who was born under the ox is honest in nature. They’re dependable, they’re strong, very determined. Um, and you can say they’re incorruptible and sometimes they can be inflexible, right? They’re very strong minded, strong, um, oxen, constitutionally, if you are born in that year are physically strong and have robust health. Uh, the Zodiac is related to agriculture and cultivation. So this is going to be a very important theme. When we talk about business and health, uh, doing the hard work to plow the fields and sow the seeds for the future growth and abundance, um, ox have great patients and a much longer view of what’s going to be to come. So who do we know that is born in the year of the off

Broccoli

Mama? Uh, so if you wanna look at, uh, a person as we call a celebrity or someone who is a leader who carefully plans, et cetera, et cetera, uh, Barack Obama is, uh, is an example of that kind of energy, really steady, um, determined and, and not dissuaded from making things happen.

Um, as an aside, our, our new president and vice-president, uh, uh, Joe Biden is a water horse, and Kamala Harris is a wood dragon, right? So we have a great, we’ve got the wood energy, I’ve got the water energy water feeds the wood. So we’re going to look at how the president, the new president is also supporting of, uh, women and in particular, the vice-president really to be a mentor. And also the idea of, you know, how he is nourishing and, and you can see that in his, his energy, right? He’s very, he’s like the grandfather. Um, so I won’t get into politics. Uh, but, uh, what I want to say is like, with this energy coming up, how are we going to use this energy of the Zodiac to bring abundance and prosperity this year? So one of the things is having great patients and a desire to make progress.

So this is really OX energy. Um, ox will have a definite plan and with detail steps to which they apply their strong faith and physical strength. Um, so if you imagine the lines that they plow in the field, uh, is really like slow and steady, uh, and really looking to cultivate for the future. So your health is also important. So this is about being robust. If you want to cultivate robust health, I mean, you want to cultivate more robust health. Otherwise you can get burnt out with overwork, right? And we’ve seen this last year, a lot of scurrying around, you know, trying to be resourceful. That’s the energy of the rat resourceful. Um, but you know, now we’re in a, we’re going to be coming into a space where we really need to look at, we need to get to work. Uh, ox can achieve their goals by consistent persistence, right?

And this means don’t give up. Um, I know that 2020 has been very challenging. Many people have kind of, you know, some people have decided to not practice or their, uh, you know, their, their business has been in flux, a lot of people. So this is really where we need to get back to work. Um, ox are not much influenced by others or the environment, but persist in doing things according to their ideals and capability. Um, so you have to be mindful that you don’t get stuck or mired in your own ways. So this can also be an, if you become too stubborn or you think that this is the way it is, that is what we consider a kind of a mind set, um, versus what we need is a mind shift. So in this case for this year, no shortcuts or quick fixes or magic bullets, it’s really, you know, constant considering, uh, consistent work and planning.

So really looking at, um, looking ahead that there is going to be growth. Uh, we have to plant those seeds, right? We’re in this place now where we’re moving out of, uh, this pandemic energy. Um, the other topic is it’s time to get more visible with acupuncture and Chinese medicine. Now, this is kind of a pep talk, you know, for all of you practitioners out there. Um, we have thousands of years of evidential knowledge on how to help people. Right now, we are still in a pandemic. COVID has hit the globe, right? People in the media are looking for natural solutions to heal. A lot of people are suspicious of vaccines. A lot of people are suspicious of antibiotics and pharmaceuticals. It would just come off of a lot of that, uh, you know, funny stuff going on with pharmaceuticals, acupuncture, and Chinese medicine, offer benefits for people to heal and get healthy.

You need to cite research. Um, acupuncture can relieve inflammation, naturally boost the immune system. There are Harvard and NIH studies that actually prove this. And so this is where we’re at a point that there isn’t really anything out there that’s going to help the long haulers in terms of drugs and other therapies. What is really clear is that acupuncture and Chinese medicine, because of the model that it is to help people heal better, to take charge of their health, that we are actually holding this information. It’s really important to get out there. And so, um, what I’m gonna kind of challenge you all is to really look at how you can plant those seeds of information. You want to seed the information. Um, so the people will become aware that there are solutions. I mean, maybe they already are solution aware. They are aware that they have a problem.

That’s not getting fixed, um, by conventional methods, right? And so this is an area where you can shine and where you can offer real help. Uh, with thousands of years of evidence, right? Asia had over 240 some odd, uh, epidemics over the last couple thousand years. And so the, the information that we can provide for people to heal themselves is very important, right? And I hope you recognize that you have a lot of knowledge that can help a lot of people, right? What you do, you want to love what you do and do what you love. Um, I don’t know if anybody has went into, uh, acupuncture and Chinese medicine thinking that they were, you know, their, their first, uh, focus was going to be making millions of dollars, right? You have a servant’s heart. And what’s really important is you also have the knowledge that can really help people, right? And so I want to remind you all that, you have this, you went through the schooling, you went through the training, you are a, uh, you’re practitioners, you’re professionals. You’re not commodities, right. You’re healers.

So this year is also about rebuilding your practice, right? Again, this is this ox energy. We’ve all had to pivot in some form, you know, hands-on, uh, practices. There is no substitute. There really isn’t a substitute. You can’t do virtual acupuncture, right? Um, the, the, uh, relationship between the patient and the practitioner is what makes the difference. It’s the alchemy that pulls it together. We are the guides, they are the Explorer, right? We’re the facilitators. People need us. So this year is going to be about rebuilding, maybe shifting your focus of your practice. And in, in the previous slide, I kind of outlined a few areas to really focus on where people are struggling, loss of smell, and taste, sleep, anxiety, digestive disorders, all of those and pain, a lot of pain. And, uh, there’s a lot of research that shows that acupuncture and Chinese medicine is very effective.

So what we’re looking at is, you know, we want to have our feet on the ground with the earth energy, right? This is nurturing. It’s the time to practice what we preach, right? With yin and yang balance and resilience. We have to model, right? Remember that you have thousands of years of evidential knowledge to help people heal. There’s no substitute for hands-on treatments, right? Everyone might say they do Wausau or cupping or dry needling. But the reality is, is that the knowledge that we hold is what really makes it effective and helps people to heal. So the situation has been, the people are scared and you have those solutions that can help them. What is nearest and dearest, and that is their health. So I want to thank everyone who showed up to listen to this lie. Um, I want to thank the American acupuncture council for having me. And I also

Want to let you know to please join us next week when our host will be, yeah. Mammo, thank you for listening and, uh, have a great new year.

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). Twitter (https://twitter.com/TopAcupuncture) If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

 

E & M Code Evaluation 2021

2021 Evaluation and Management Coding Update


“So I want to give a little bit of an introduction today as to what’s occurring to at least give you a feeling for it. Certainly this is not going to be what I can fully give you at a full seminar and a, through a consultation, but at least to give you some updates enough to be able to get in, to handle what has changed. So E&M codes, evaluation, and management, or if you will, exam codes are being updated for 2021. So I’m sure you’re all familiar with what a hat we have had of course, in the past, which of course were the standard E&M codes.”

Click here for a copy of the transcript.

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.

Hey, welcome everyone. Happy new year.

Glad to have you with me. Thank you to the American Acupuncture Council for giving an opportunity for us to share with you information, putting in billing and really making your practice for the new year. So happy new year to everyone. And of course, year of the ox. And I also will tell you, it’s going to be the year of time. I’m Sam Collins, the coding and billing expert for acupuncture. In fact, you probably see multiple articles from you and acupuncture today and other publications, as well as I’m on the United healthcare committee for coding and reimbursement sitting for acupuncture’s behalf, as well as who for ICD 11. So I have a very vested interest, of course, in your practice, in the thriving of what you do. Well, of course, this year, like all years, there’s always something new and updating, and I’m sure some of you have already noticed there’s been some changes that have happened with E&M (evaluation and management) codes.

Make sure you check out our 30 day trial s we can prove to you how simple it is to get you paid.  Click here!

So I want to give a little bit of an introduction today as to what’s occurring to at least give you a feeling for it. Certainly this is not going to be what I can fully give you at a full seminar and a, through a consultation, but at least to give you some updates enough to be able to get in, to handle what has changed. So E&M (evaluation and management) codes, evaluation, and management, or if you will, exam codes are being updated for 2021. So I’m sure you’re all familiar with what a hat we have had of course, in the past, which of course were the standard E&M (evaluation and management) codes. Now, when I say E&M (evaluation and management) always remember that means evaluation and management. So that means evaluation the exam management, the, you know, dealing with the patient, discussing with them. And I’m sure you’re all pretty familiar with these codes in the sense of we have new patient codes. And of course we have established patient codes. What, what these codes are, for course are simply for exams. These codes are no longer going to be there. At least described this way. What they’re doing is trying to make this a lot easier to deal with. So obviously you’ll see these codes. And I think the one thing we all picked up on that was always, there was things like this. You’ll notice here. It says physicians typically spend 10 minutes. Well,

I’m sure you’re all aware that never was the reason

For the code. It was not something based on what’s typical, but what was considered an average and more about what you did on the exam. Now, a quick note, what is not changing is the definition of a new patient or established patient. A new patient of course, is going to remain the same. That’s someone brand new or office or someone you’ve never seen before. Okay. Meaning I’ve never seen them, but it could also be a patient you haven’t seen for three years. So do recall the three year rule when it comes to a new patient, even if it’s a past patient, but they’ve not been to you within three years or more, you may build a new patient again. So that’s the new patient code that’s not changed and established patients not changing either. That’s any exam of a patient that’s existing. Existing means anyone you’ve seen within three years.

So it could even be a new injury, but it also obviously would be a re-exams. So what’s changing. So I kind of chose this Bob Dylan kind of theme times, they are a changing and this is really a dramatic shift and what’s changing. So the bottom line is the codes are changing, but I want everyone to be aware if you attended a seminar with us, the American acupuncture council that I’ve taught, I’ve actually been teaching these changes since 2019. So hope you have a little bit of information if you’ve been there, but let’s keep this in mind. I’m sure most of you are aware. The old way of coding was pretty complicated. There were a lot of guidelines that you can see here. The 1997 documentation guidelines was 50 pages long. And in this guideline, you’ll see all of these things where you had. If you see on the left side here, all these organ systems that you had to have, and then of course it was the number of bullets of what things did you do?

Did you do a range of motion? Did you do palpation? Did you do tongue? And these bullets added up, so you had to have kind of a scoring. So familiarly, if you were billing a nine, nine, two Oh three, you had to do at least two or more organ systems in 12 bullets, which for most people was like, I don’t understand what you’re talking about, or it becomes complicated on the way that acupuncture is, do it. And I’m sure if you’ve been to our seminars again, you’ve seen this guideline as well. That talks about for each code. So notice each code nine, nine two Oh one to two, one two says problem-focused expanded, but you’ll notice it talks about the number of bullets. This is what was complicated. And frankly, this is the reason they’re making a fairly big change with this. The reason why is finally CPT, I think did something to less complicate.

And I won’t say CPT is necessarily trying to complicate, but they’re trying to make it accurate. Well, what they realize they needed to do something with these codes because they really weren’t working for the way doctors examined patients and particularly acupuncturists. And the whole point of this change is to increase time with your patient. Not doing a lot of other works, like doing certain bullets, just to meet the guidelines. It should improve the payment accuracy as well, because it allows you to truly pill a code that’s accurate for what you do, because I’m sure some of you as an acupuncturist are pretty frustrated that often you might spend 30 to 45 minutes with the patient, but yet the exam based on the old guidelines, it might only come out to a two Oh two and you’re thinking, Oh my goodness, I spent 45 minutes. So this update is really reflecting that.

And so what’s happened is these new codes now indicate a focus on time. Oh, let me go back here. And so you’ll notice here. The first thing you’ll notice is nine, nine two Oh one has been eliminated. So you’re never going to use nine, nine two zero one. Again, what we have now for new patients is nine nine two zero two through nine nine two zero nine, excuse me, nine nine two one five. So two zero one has been eliminated. So some people are like, Oh, this is going to be a problem. So take a look here. You’ll notice. Now this code says it’s an office or other outpatient visits. So notice it doesn’t necessarily say exam though. That’s part of it. And it says for the evaluation and management of a new patient, which requires medically appropriate history and examination and a straightforward medical decision-making.

Now you may look at that go, well, what does straight mean? Well, it means it’s fairly minimal, but here’s the best part. Take a look at this. And this is really something excellent for acupuncturists. It says here, when using time for code selection, 15, 29 minutes of total time spent on the date of the encounter. So in other words, the big change for this year is time now becomes a focus that you can use should choose the appropriate code. So if you Ben 15 to 29 minutes, the code would be nine 92. Well, too, if you spend you’ll notice here 30 to 44 minutes, it will be a two Oh three. If you spend 45 to 59 minutes, a 200, and then if you’re going, obviously plus an hour to up to an hour and 14 minutes, it would be a two Oh five. So now what you can do as a provider, start to log the amount of time you’ve taken with the patient.

Cause understand that the time you spend with a patient, not always as doing exam things or palpation, right? If you will, but taking the history gathering. In fact, here’s the really cool part about this. Notice this statement here, it says of total time spent on the date of the encounter. So no longer is it just face to face time. It’s now going to be the entire time. So by example, I bet many of you have a patient fill out a relatively detailed history form. And of course, once they fill that out, you’re going to spend maybe five or 10 minutes reviewing it before you even go in the room with the patient, because you want to see what they said that week and ask more points, questions. Here’s the important part of that. You now you can take the time you did reviewing that before seeing the patient, this is before or after seeing the patient so long as it’s in the same day, it doesn’t have to be face-to-face.

So now I want you to start thinking not only is time important when you document acupuncture, as we’re all aware, but it now also becomes important when doing evaluation. So it’s going to be important if you will to think of it. This is the year of time. I know it’s the year of the ox, but it’s the year of time you’re going to time acupuncture. But now I want you to start to tell me how much time you spent doing any of the activities that are running [inaudible] to your acupuncture visit or exam it could be, or the patient or after if you’re having to review or, you know, probably, uh, consult with another doctor potentially. So you’ll notice all of them have a time value. Now that’s different. So this is a completely new description. That old description is now gone. Now, the other thing that did update a little bit, they did obviously indicate time.

But one thing to note nine, nine two, one, one you’ll notice here does not have a time value. And that’s because that’s considered a value for a non doctor seeing the patient like a staff person, which wouldn’t happen in a Kairos or excuse me, an Accu setting, but maybe in a medical setting, they might have a staff taken a blood pressure. So think of it this way. You’re going to code a nine nine two one one. You’re always going to code. According to time, notice on a re exam of a patient 10 to 19 minutes. Now as a two, one to 20 to 29 minutes is a two, one three. So where I think things are going to be a lot easier for acupuncture. Now, just going to document the time now I will say, let’s be a little careful. If you tell me you spend an hour with every patient, no matter what they have, that’s going to be problematic because now it’s not an issue of what you’re seeing.

It’s a style, but assuming you do more or less, depending on severity, this all makes a lot of sense. And so now you’re simply going to pick the code that’s appropriate. I do believe you’re going to see a lot more potentially two Oh threes and twos, zero fours, based on that timing of that first visit. However, I do think on the re-exams we might be more in the 200 threes and two, one twos, not the two, one fours. It goes on re-exams will you spend more than 30 minutes on the re-exams? I won’t say that is this typical, but not saying not here’s the important part document the time. So here’s, what’s changed the old really based everything on the complexity. And you had to have history of physical exam, medical decision making, and it had to all fit within these guidelines. Well, the new one no longer requires a specific history or exam.

Now that doesn’t mean there isn’t an importance to a history and exam. It just means that’s not going to be the absolute basis for the codes. They’re going to allow you to use the time that you spend with the patient. If you will counseling them to an extent, in addition, they will still allow medical decision making. That’s what MDM stands for here, medical decision-making. So this is where I’m sure some of you have seen this. You can go to a medical doctor and maybe you’re with him or her all of 10 minutes, but they Ville bill a very high value code and you think, Oh my God, how could they build such a code for 10 minutes? Because the medical decision-making being life or death or something that with a great risk of morbidity, mortality may be higher. So there’s still going to be a component of that.

But I think this really helps complementary providers like acupuncturist, better code according to the amount of time and things you need to do with the patient. So to kind of give a synopsis, you’ll notice nine, nine, two Oh two to two Oh five. You’ll notice the total minutes here, but then notice it says medically appropriate. So do keep in mind. If someone comes in with a simple shoulder pain, I doubt that’s ever going to reach a high level, even if you spent an hour. Cause what about that would be high in the sense of risk of morbidity mortality, but what if they have multiple areas? What if there’s low back pain and it’s rated into the stomach? Those all certainly could make a difference. In addition, notice now on the right side as well, it says medically appropriate for the established patients. But notice again, just the time and what it says a straight forward, think of straightforward is something you can almost see it without really even evaluating just based on the patient telling you, but the more complex, the more things we have to do deal with.

So I do want to make an emphasis here. History for an exam is no longer the reason for the code. It could be medical decision-making or time you should do an appropriate history and exam for the patient’s condition. Obviously, would you want to do a full history of a patient with a simple shoulder problem? Probably not. I mean, we don’t need as many of those factors as we did in the past just to qualify, but it would be appropriate necessarily based on the history of the patient. Tell you, so it says here healthcare providers should not interpret this change to mean that the documentation efficient exam is not necessary. A complete medical record of services is rent. Rendered is important for many reasons, such as providing information for quality initiatives, but also making sure that there’s an appropriate amount of information to make the diagnosis that we’re getting.

So although a specific level of history exam will not be a factor for 2021. You still need it for accuracy. Just be careful. Let’s not conflate everything to an hour. So my only concern would be, let’s not put ourselves in a position that if your style indicates an hour, I’m not against that, but that’s not an issue where the necessity based on severity is there. So I know this was a quick and easy to show you the new codes that they’re time-based. But I want to say to all of you, the American acupuncture council is here to help you. And I will say, give us a chance to help you. We have seminars, we have a program called the network where I can become part of your office, what I’d like all of you to do. If you have a moment, take your phone, open up your camera and that little QR code in the left side.

If you click on that, you’re going to get a free 30 days to make me part of your office. Give me a chance to make sure your claims can get paid and help you with these codes. Even better realize we do seminars, but network members get a chance to deal with me one-on-one so that we can go through, well, how do I do this, Sam? What do I need to document? What level to make sure that you’re fully compliant. So if you click there, it gives you a three free 30 days to our service. I would say, give me a chance to send me a couple of bad claims. Send me a couple of claims you weren’t paid on. I will guarantee will always make you more money. And after 30 days, you’re going to happily say, I want to stay part of your program.

As I said, this was going to be quick and easy. And it just to give you an idea, but please take a look for those of you that have our Accu code. Remember, these are all published there as well. So the new codes now are going to be more time to base with an elimination of nine nine two zero one. And of course, no time with nine nine two one one. So document your time. I’m going to say thank you to all of you. And I hope that you get a chance to try the 30 day trial, get ahold of me. Let’s get moving forward. Let’s make 20, 21 the best year ever. Your patients need you. I want to be part of that service with you. So I’m going to say thank you to all of you and I’ll see you next time. This is Sam Collins, the coding and billing expert for the American Acupuncture Council wishing you all the best .

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So as Matt said this time, we’re just doing the same thing, elevated ileum, but it’s its relationship to the shoulder girdle and then shoulder dysfunction and other upper extremity type problems. But we’ll give some more specific examples, but just keep in mind that there could be a whole ton of different, dysfunctions that could come from just one simple thing, like an elevated ilium.”

Click here to download the transcript.

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 and happy new year. Thank you very much for attending. My name is Matt Callison.  Hi, thanks for attending. I’m Brian Lau.  We’re from ACU sport education and the sports medicine acupuncture certification program. Thank you to the American Acupuncture Council for having us. We have a sports acupuncture webinar. It’s always really fun to be able to do this once a month or every other month. This particular one, we’ve got more information for you. We have such a good time last month with Ian Armstrong, who’s the teacher of the postural assessment and corrective exercise class in the smack program. Brian and myself had a great time discussing elevated ilium and his contribution to medial knee pain had explored the different sinew channels and different acupuncture points and exercises that can be used to help to correct this. Then Brian, I was thinking that’d be great to be able to actually do something similar, looking at an elevated ilium and its contribution to a superior shift of the scapula or an elevated ilium and the injuries that that can cause. And some exercises that would be useful to apply after the acupuncturist acupuncture treatment. So, unfortunately though, Ian had some cut amendments, he wouldn’t be able to join us. So Brian and I are going to go ahead and take this over. Um, Brian, what do you think about us going to the intro slide? And if you have any words or so you want to share,

Uh, no, no, basically I guess just the small thing is that, um, elevated ilium could cause a whole ton of kind of, uh, potential pain patterns of low back pain, hip pain, a whole bunch of them. Last time we chose to see how it can relate to the lower extremities, especially the knee for medial knee pain. So it’s just an example, example to see how to start prescribing exercises, how to add them into the full, comprehensive treatment. So as Matt said this time, we’re just doing the same thing, elevated ileum, but it’s its relationship to the shoulder girdle and then shoulder dysfunction and other upper extremity type problems. But we’ll give some more specific examples, but just keep in mind that there could be a whole ton of different, uh, dysfunctions that could come from just one simple thing, like an elevated ilium. Hmm.

All right. Well, let’s go to the next slide. I think that’s a good segue for you. Want to go ahead and start with this one?

Yeah. So, uh, with this image, uh, again, we’re, we’re focusing in on a postural disparity, uh, we picked an elevated ilium cause it’s clinically relevant. It’s very common. You see it a lot in, uh, in clinic and you see both how it can relate. Like I said to, to local pain patterns, like low back pain, et cetera, but, but how it really becomes, you know, since so much weight transfers through the hip, it’s really one of the key structures, uh, that determined cemetery for a lot of the rest of the body. So if you can balance the pelvis that goes a long way in and of itself to balance the shoulder girdle, to balance the lower extremity knee position, foot position, et cetera. Uh, so it’s not the only thing. Um, but it’s a really a big thing. So we’ll look at its relationship to the shoulder girdle today and give some exercises review, uh, refer back to last times podcast where we looked at some exercises for the ilium itself.

Um, and then we’ll look at some exercises for shoulder girdle, but then how to combine those with acupuncture treatments. So in this image, you see this gentleman on the right there’s a elevated and you can kind of see the schematic, um, image. You can see that he has an elevated ilium on the left. So he follow, uh, you know, the line from the top of each, uh, iliac crest. You can see an elevated ilium on the left. We’ll look at some other ways you can measure it in the second, uh, then look at just for now the relationship that calm. And this is the most common way that it would present is that you’d have a balancing, you know, in the girdle of the shoulders, the shoulder girdle balance, where it’s going to start to compensate to that elevated ilium. And in this case, you see that elevated scapula on the right. And that’s probably the most common way that this would present. It could do it differently, but this is definitely the most common opposite elevated scapula or a superior shift. You might call that

Just want to emphasize as well that Brian was talking about balancing the elevated ilium or any kind of, uh, ileum type of partial disparities. I mean, the reason why it’s, you can see that it’s going to be the middle section of the skeleton. That’s going to affect what’s happening above and below in addition to housing, the dantien and the kidneys just above. So by balancing that aspect that helps, helps all kinds of different things they acupuncturist can be treating from pelvic floor dysfunction, lower jaw disharmony, OB GYN, middle job disharmony. So looking at balancing at the muscle skeletal systems, not just for orthopedic, it’s also for helping those on food. So that’s, that’s great. And this is what we emphasize in, in the smack program is trying to be able to get that elevated ilium or any kind of partial disparities and pelvis to go ahead and treat that first, which I’m sure a lot of practitioners will actually go for that as well. Yeah. Brian, before we go to the next slide. Okay.

Yeah, the we’re going to be zeroing in, in a second more on the shoulder and scapular position, but in this particular model, you can also really see the change in the position of the neck. And I’ll just give you a very simple way to see it. If you could picture that ilium elevated. I think I mirror image near my right hands up, but I’m trying to make it look like my left hand to kind of match this, this model, if, uh, the aliens elevated on the left, the person’s not going to stand in such a way that they’re, they’re leaning, you know, the leaning tower of PISA over on that side. And everything’s pointing, you know, uh, to the left, they’re going to find some place to compensate that someplace could be multiple places. It could be in the spine, which you see a little bit of in this model.

It can be in the shoulder girdle, it can be in the neck, they’re going to find some way to get their eye and their head and, um, ear position, you know, the equilibrium of the body a little bit more balanced. So if the shoulder girls are really fixed, maybe they’re going to find a way to do that all in the neck. Um, but the common one, the, the very frequent thing you see at least, um, that’s going to be part of this dynamic is the, uh, contralateral shoulder being higher and the, you know, compared to the hip, so left hip right shoulder, right hip left.

Great. As you can see the image on the right, the patient has an elevated ilium on the left and looks like there is elevation on the right as well. He does have a little lateral tilt to the right with the scapula quite. I mean, with the head that Brian was just talking about. So one of the muscles that we’re going to actually the only muscle that we’re talking about, primary muscle that we’re going to be talking about as well, the levator scapula. So can you see where the levator scapula attaches on the image on the left, the superior medial border of the scapula close to small tests in 13, and then it’s other attachment is going to be the transfers process of C1, C2, C3, C4. So the superior shift of the scapula, and you’ve got a shortening of that. Levator scapula, small tests and CGU channel that we’re going to get into a little bit more in this webinar, in a lock short position, it’s pulling the neck to the lateral side. So multitude of injuries can be occurring from this that we’re going to be getting into. All right. All right. Well then let’s go to the next slide. The quick review. This is what we talked about last month about measuring the ileum. Um, so you can see the middle image. There’s the hands are coming in on the side, on the lateral side, and the fingers are placed at a level line, right on top of that alien, it gives you an idea of where side is going to be elevated.

Well, I’m a person that, that doesn’t work for the camera position. So, well,

Go ahead, Brian. You can finish.

No, I just wanted to say that just for people to know that the, if you’re measuring that you’d be right behind the person that mats moved to the side to be able to see whatever his hands are. So just that heads up.

Yeah. True. And then functional anatomy from, um, OHS, overhead squat from the national Academy of sports medicine. Looking also at what happens with an elevated Dalian was usually an asymmetrical hip shift. And there’s a whole slew of sinew channel imbalances that occurs with this. And once we see this kind of posture where we’re automatically thinking of different acupuncture points that we can treat for locally adjacent and distant of the primary channels and the Sr channels, in addition to what this kind of Bosch is going to be doing to the organ.

All right, well, let’s go to the next slide please.

All right. So here, you’ve got elevated scapula or also called a superior shift of the scapula, and it’s going to be associated with a lock short levator scapula that we discussed earlier, which you see here on this individual’s left side. This individual has an elevated ilium on the right often like Brian was saying it’s probably most of the times, but not all the time. There’s never an always is that the opposing side will have a superior shift of the scapula. Sometimes you’ll see a superior shift of the scapula on the same side of an elevated ilium, but what we’re going to be discussing here will still apply. All right? So this posture can lead to many different muscle and channel imbalances that we’re going to be discussing just a few of them. Um, some of the injuries that can happen with this will be rotator cuff tendinopathy, but Ron boy, minor constrain thoracic outlet syndrome. And there’s more Brian, do you want to say anything before we go to the next line?

Uh, well, I think we also have, uh, in the slide or is this the next one? Yeah, the downward downwardly rotated, uh, scapular position. And I think we have a little bit more on the next slide, so we can go over it a bit more there. Um, but uh, if you look at the scapula in this position, the left side, that I’ve looked at the glenoid cavity. So the, um, I have a little scapula here, so, uh, I think this look more like my, uh, left side of your looking through the rib cage at the front surface of the scapula, the glenoid fossa would go up. That would be upward rotation. This patient has more of a downward rotation of the scapula. And that’s pretty typical when the levator scapula shorten. We’ll talk about this again in the next slide, but, um, but that’ll play into some of the, um, discussions we have coming up in a few, few slides also. Okay. So next please.

All right, so this video’s not playing, maybe if you click on it, it’ll play.

I see. Okay.

So it’s not playing unfortunately. Well, that’s what happens with technology sometimes. So let’s just walk there.

I think it’s coming, isn’t it? Oh yeah. I can see them working on it. It looks good. There it goes.

Thank you. Okay. So one of the actions of the levator scapula as the name suggests it’s going to elevate the scapula. Now, what this is not showing is that you do have elevation in the scapular, but if you look at the origin, the assertion or the distal proximal attachments, it will also downwardly rotate that scaffold. If you will, Brian, can, you should have downward rotation again in your scapula.

Yeah. So tell me, Matt. And you can tell me if this is a case, this is the right scapula, but I think since we’re on, I think everything’s mirrored image. I’m trying to look at, make it look like the same. So does that look like the right side?

Yes. But can you do us a favor? Can you go ahead and keep it in front of you? Because it blends very well with the white background. Yeah. Okay. That looks really great, but you don’t have to raise it up a little bit, at least on mine now. Okay, good.

Yeah. So you’re seeing through my rib cage to the front surface of the scapula levator scapula would be attaching here to see one, two, three, and four transverse processes, a muscle of the small intestines in your channel, and it would lift or elevate the scapula. And at the same time it would soaps and please me or imaging, it’s hard. It would bring the side of the neck down to that side to its side, bend the head, but we’re talking mainly about the scapular position. So elevating the scapula. Okay.

That’s great. So let’s go to the next slide, please. I don’t think we’re going to talk a little bit more about the rotation. Okay.

[inaudible]

Yeah. And this one we’ll look at the downward rotation of the scapula

That’s there’s upward rotation downward. So when you see green about levator scapula, that’s when it’s shortening concentric contraction, it’s active and the Red’s going to be a lengthening contraction. So green is going to be upward, rotate downward rotation, and then you’ve got your upward rotation. So in a locked short levator scapula, you can see how it have a propensity to be stuck in a downward rotation, which will then when you’re raising the arm to shoulder abduction, like the scapula humeral rhythm, that images that’s on the right there, the greater tubercle, a big prominence on the humerus or the super spine EDIS and infraspinatus. And on the opposite side, the bicipital long head tendon can come up and hit that at chromium and cause a tendinopathy and impingement. There’s one more image. I think that will also be able to help with this. Um, can we go to the next slide?

Yeah, there we go.

Yeah. So then this would be when the levator scapula has been placing that scaffold into a downward rotation, as the arm goes into abduction, then the propensity for that greater tubercle to hit that a chromium is much, much higher leading to injuries that we were talking about. So all of this gives us actually protocols to be able to treat this, but for right now levator scapula is going to be a big one to do. Um, and we will talk about exercises here in a second. Brian, do you want to add anything to this?

Yeah. So, uh, the main thing we’re looking at those is very, I guess, biomechanical, we’re looking at particular muscles in this case, the levator scapula and how it’s going to elevate the scapula and how it’s going to tend to hold the scapula into that downer rotation of it’s shortened. It’s going to prevent the scapula from being able to follow the arm position, right. That would be normal movement to help keep that space between the acromion and the head of the humerus, uh, open. So it doesn’t pinch structures like the supraspinatus tendon, the bicep, uh, biceps tendon. So you’d want the scapula to be able to come upward and upward rotation as you’re going into AB duction. But if it’s kind of held too firmly in place by an overtight levator scapula and maybe some other structures, then it’s going to prevent that scapula from moving and then the arms going to bump into the chromium and, uh, that can lead to a lot of different pain patterns of the shoulder.

So that’s a very biomechanical view. That’s great, that’s great information and of itself, but then we have to remember that we have this whole, you know, really beautiful, intricate channel system. And, uh, the levator scapula, the muscle we’re kind of looking at in this case is a muscle of the small intestines and new channel. So we can needle it at the motor point, but we might include small intestine channel points to help contribute to a more thorough therapeutic outcome. We started with the elevated ilium, uh, and the quadratus lumborum is a big muscle that’s involved with the elevated ilium as are the AAD doctors, the thigh and hip add doctors. Those are muscles of the liver sinew channel. So we have this midday, midnight channel relationship that’s involved with, uh, maybe this local problem. We have a very, um, more comprehensive channel perspective that we can look at and start including points to directly affect the elevated Lam like the quadratus lumborum like add Dr. Longest liver channel points, maybe something like liver five, um, in combination with small intestine channel points and more local needling at the small intestine channel sinews. And then we can add other points in our acupuncture treatment based on the specific injury and other things we’re finding and you know, this person, blood deficient or inefficient or something like that. So this is starting to paint a more of a comprehensive picture that we’re looking at.

That’s something we find a lot in our own clinical practices, looking at the midday and midnight relationship between the liver on the small tests and channel, especially when there’s a shoulder abduction problems, such as what we’re seeing this slide, um, elevated ilium and shoulder abduction problems, pretty darn common. You’ll see that a lot in the clinic. Um, if you would, when you’re looking at the scapula, you guys, I take a look at that superior medial border of the scapula. That’s where the levator scap is going to be attaching where many people have that five Brodick tension in there that many of us will go ahead and needle right through that, um, that levator scapula, as we talked about before, it’s going to be attaching to the C1 through C4, transverse processes, attached to that. Then it goes down and it travels to the superior medial border.

Like I said, it blends in seamlessly with the super spy Natus muscle that’s located in the supraspinous fossa in this particular image. If you go disorder, large tests and 16 would be, then you’ve got large and tests and 15, just on the other side of the chromium, hopefully you guys are following along with this large test at 15 is where the super spine Natus tendon is going to be attaching. It’s usually about a quarter of an inch to an AF, probably five, eight, five eights of an inch wide blending into the capsule and attaching right onto the, um, a greater tubercle. Then from there, you’ve got your triceps part of the small test of senior channel, and then also going all the way down to flexor carpi on narrow switch. We talk a lot about the flexor carpi on there. Motor point is a magical, yeah, I’m going to use the word magical because it is empirical point that will soften the, um, a distal attachment, uh, levator scapula 99% of the time when you do actually get that flexor carpi on there’s motor point, right? It will soften that attachment side pretty dramatically. And this is something that we’ve been teaching in the program for probably about 10 years or so. It’s a really nice disappoint to use with levator scapula, shortening and pain at that proximal attachment. Brian, you wanna say anything else before we go on?

Oh, no, that’s good.

They were actually kind of moving right into, uh, exercises now. So the next slide, please.

So

Last month, these were some exercises or exercise, different levels of the, um, figure four crossover. That’s working quite a bit on the piriformis, this exercise. And a lot of the exercises that we use are based on [inaudible] work. Um, what we’ve done is we’ve actually looked at the different angles as far as the functional anatomy, the sinew channels, and we’ve modified his work, which actually happens quite a bit with people’s methods and techniques is that other people have good ideas about it. And then just kind of form it in a slightly different way. But we did want to give a shout out to Peter Garcia for his miraculous work and an exercise prescription, what he’s done over the years. Um, so again with this, this is what we’ve done for the elevated ilium one exercise, and that’s going to be discussed a lot further in last month’s podcast. And also we have a blog about it as well in the sports medicine, acupuncture.com website. Let’s go to the next side. We’ll talk about exercises where we can use for a levator scapula or a superior shifted the, um, this exercise for, um, elbow press is an exceptional exercise. Brian, do you want to start with that or do you want me to go?

Um, I can start and there’s a little bit of a, um, dialogues of you need to go back and look at it after the recording it’ll give a step-by-step, but the idea is you’re giving a little bit of a press of the elbows into the floor, but more importantly is you’re bringing this, the shoulder blades, the scapula together. So towards the midline in down. So, you know, in this case, levator scapula is going to tend to pull. It might be on one side, but pull that scapula up. So you’re D pressing using lower traps and using, uh, the, the rhomboids and middle traps to bring the shoulder blades together and down. So it’s the same time opening the chest and dropping the shoulder blades.

Hmm.

I don’t know if you got one dad, anything else about it, Matt?

Yeah, I was just looking at the image and how hands and Ian is enjoying it, and it’d be what the scapula is doing. And then 10% of it is going to actually be pressing into the floor. So this is a strong scapular stabilization exercise that works great after needling, um, or doing acupuncture to the levator scapula, pectoralis, minor, small tests and senior channel, um, a number of different points that we could use with this one. This is a simple exercise and kind of a triple star exercise that you can use even to advanced people, um, because it does require quite a bit of concentration to really get those scapulas to really form down and lock in. Then the next exercise is actually called just a second. Uh,

This is a short format, so we can’t go into too much, but, uh, if you go back at some point, if you want to look at the recording and look at the movements of the scapula, we were talking about levator scapula, but pec minor muscle of the lung sinew channel would be involved in a lot of these too, because it’s the antagonist agonist, antagonist relationship with levator scapula because it’s going to depress the scapula. So if it’s really short, maybe the levator scapula has to fight against it, but it also works with the levator scapula and downward rotation of the, of the scap. So I like this exercise in this case also because of that, um, opening and lengthening of the pec minor and kind of normalizing the tension of that, which is kind of a, not the direct channel we’re looking at, we’re looking at the small intestines in your channel, but how maybe the lungs and new channels coming in and relating to this picture, this exercise would be given after the acupuncture treatment. So maybe we’ve needled the pec minor on that side to make it more, um, accessible for the patient right away, you know, their body’s ready for the exercise kind of prime because we’ve reduced, um, tension in the pec minor and allow, or allowing them to more effortlessly do this exercise. Yeah. Cool.

And Brian, I’m sure we kind of rushed with this. There’s a lot of things that we really didn’t talk about. Like the lower trapezius being an antagonist to the levator scap elevation and depression and the literature, easiest being large attachments in your channel. So a size to be able to see that internal and externally related channels of the lung pectoralis, minor, lower trapezius, large intestine being called into Plex. What does that mean? Well, in our mind, if you would needle the motor points of each one of those, you’re already signaling those two mild fascial Sr channels. So therefore if you compliment that signal with more acupuncture points, adjacent and distal, it has to have an effect on those particular muscles. Cause it’s the signaling system that we use in acupuncture. Brian, you must anything about that? That’s good. All right. Cool. All right. So again, um, this elbow press is a great exercise to use as a preliminary exercise. So what about the next exercise please?

Yeah. Okay. This is one of our favorites. I would say triple star, maybe even quadruple started this. Um, this is an exercise that takes a lot of concentration and how we modified it a bit from how it was originally taught is we are increasing the, uh, or decreasing the thoracic flection. So we’re increasing thoracic extension. Let’s walk through that. So the first position the person’s going to have their knuckles on tide young, usually the middle finger there. They’re going to keep the wrist straight. The elbows are going to be out. As you can see, the knees are going to be at 90 degrees and hips are going to be at 90 degrees. We asked the person to go ahead and bring their elbows together toward the ceiling, keeping their fingers right at Thai Ong. All right. So by them doing that, you’ve got scapular protraction.

Then we ask the patient to begin the movement back down, bringing their elbows back down, leading with the rhomboids, leading with that medial border of the scapula and start to bring them together. All right. So you’ve got protraction and retraction. This exercise is really getting the agonist and the antagonist of those muscle groups working together. Now the emphasis, once the patient is able to do this success, now we actually increase it a little bit. We ask the patient to bring their elbows together when they’re going up to the ceiling, but above their nose. So what I’ll do is I’ll actually put my finger right above their nose and try to have the patient, bring their elbows up toward the nose, which is very, very difficult in order to do that. You really need quite a bit of thoracic extension, which is a wonderful thing to do when somebody has thoracic flection in those upper vertebrae, right?

For example, in upper cross syndrome and that head is forward. So this is a great exercise for that. It’s gonna, it’s gonna work the levator scapula quite a bit, a lot of the scapular stabilizers. And it’s, it’s definitely one of our favorites to use. This is also something that you may want to use with somebody who has upper jaw problems, for example, asthma or any kind of, of, uh, lung problems after COVID maybe C O P D, because how it’s working the front, move in the back shoe points and getting those muscles to be able to work in coordination. It’s going to work the channels as well and coordinate the channels.

Yeah. We had a question, uh, regarding this one, if somebody had a difficult timeline on the floor, so we cover stuff like this, a lot in the program where we have a multiple amounts of different exercises that can be done. That would be maybe a simpler exercise. If it’s somebody who has a difficult time of getting on the floor, cause maybe they’re not very conditioned. So I might go with a more simplistic exercise, but there is an actual variation of this, this, this exercise that that’s a little different, but it’s the same concept that can be done seated with a strap. It’s a little bit more isometric where you’re pushing out against the strap and lifting and doing some similar, similar, uh, focus. Um, but that would be, uh, adequate for somebody also, if, if that was, uh, you know, they were ready for that exercise, they could do the seated. Maybe they can’t get on the floor cause they have a shoulder injury and they, they can’t support himself. So you can definitely adapt this one to a seated position or you could just give them a more simple exercise.

Yeah. Cool. Good one. All right. So then what we talked about last time was using acupuncture as assessment, but also, um, using intradermal needles for increasing range of motion or decreasing the amount of pain during an exercise. For example, if somebody is having a hard time appropriate deceptively, trying to figure out how to do this exercise, or they may be limited in their range of motion, kind of stuck, or perhaps they’re feeling a little bit, um, slight pain or minimal pain with it, but it’s inhibiting them from doing the exercise. This is where intradermal needles on actual ordinary vessel points, but also you can use channel points to actual ordinary vessel points works pretty, pretty darn amazing. This is something that we teach in this program. And for those of you that have the sports medicine acupuncture textbook, let me think it’s in chapter four toward the end with, uh, exercise before treatment and exercise after treatment using intradermal needles. So it’s in that section chapter four. So what you’re about to see is a video of the smack program and the postural assessment and practice exercise. And there is a student there that’s having difficulty with actually doing this exercise. And so we’re applying intradermal needles based on what motion was the most painful or difficult. Okay. So let’s look at the next slide, the movie.

Now we know

That you can’t hear, let’s just read

[inaudible]. That is so awesome.

Yeah.

I still love her expressions so far. Um, yeah, so we can probably advance it to the next slide. We use a pine X needles from Sarah and, and you can get those from Lhasa OMS. Um, the point to a millimeters by 1.2 millimeter, um, that’s some of the best ones because it’s large enough to be able to create a sensation, but not large enough to be uncomfortable during movement. So those seem to be worked out pretty well with us. Yeah.

Uh, you can send them home with, uh, I mean, to keep them in for the patient for a few days to, while they’re performing the exercises to assist, you know, to keep that stimulation going. Yeah. Cool. Well, great. I think that’s,

Well, I mean, we could talk about this for hours, but no, I have, it’s regarded gone six minutes over that. So, um, thanks very much you guys, and I think we’re going to be scheduled again in February or March. Hopefully we’ll see you again then. Yeah.

And the next week, uh, Sam Collins is on, I’ll say I was going to be there. Awesome. Yeah,

I talk he’s, he’s hilarious. He’s really quite a sharp as a tack and he’s, he’s fun to listen to. So thank you very much. The American acupuncture council, Brian. You’re awesome as always. And thanks you guys. And hopefully we’ll be connecting again soon.

All right. Great. Thanks everyone. Goodbye.

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