Tag Archives: Acupuncture malpractice Insurance

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How to Setup Your Website to Attract New Patients

 

 

“So I have some very special guests that are joining me here today, and we’re gonna be talking about how to set up your website to attract new patients.”

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.

Hi folks, Jeffrey Grossman here. And thanks again for joining us with another installment of a live broadcast from the American Acupuncture Council, bringing you some great information, um, business building and marketing and coding and all these great things streaming to you live. So I have some very special guests that are joining me here today, and we’re gonna be talking about how to set up your website to attract new patients. And with me today, we are going to have, um, the, uh, the team from our sister company called Acu perfect websites. We’re gonna have Ben Thibert and Ken Moorhouse that will be joining us to answer some of those questions that have come in over the years around, you know, attracting patients to your website. So thank you, Ben. Thank you, Ken, for joining me here today.

Thanks Jeffrey. Thanks for every for having us. Thank you, AAC.

That’s awesome. Good, good. So, um, you know, a lot of practitioners are, you know, they just assume they can just put a website up there and just, you know, and just attract patients in these, uh, throngs of patients just started streaming into their door and that’s pretty much further from the truth. And so I kind of want to get some clarity, you know, that you guys can share based upon the fact that you work with hundreds of acupuncturists, you build a hundreds of websites every single month, you’re, you’re managing these services for them. And, um, you know, so you’ve, you’re, you’ve got your finger on the pulse literally. Um, and, um, you know, I think that it would be great to kind of share some of this insight into some of this information with, um, our members. So one of the first questions that I’ve heard over the past, and you probably, you guys probably hear about it too, because I think a lot of our clients come over from other companies to join our S um, so what are some important things that people miss when they’re doing their own website on services like Squarespace and Wix?

Yeah. So I think one of the most important things to think about when you’re building your website is content. Uh, content is what drives traffic to your website. So when you write content about TCAM and acupuncture and the different conditions that you treat people in your community will have access to that, if you set up your website correctly. So content is still king, uh, bill gates coined that term back in 1996, and he was talking about the future of the internet and sure enough content is still king on the internet. So it’s really important that you write good quality content on your website, and that can be blog posting. We’ll talk a little bit about, and you can also talk about landing pages as well. So in terms of blog posting, you want to write some content about TCM and acupuncture and how it can help conditions and be sure that when you’re writing your content, doesn’t have to be very long, 600 words will suffice, but you want to have a good quality post that talks about the condition, your location, how you help people in your community with those conditions and what modalities you may use.

So that’s a really good, good way to start attracting traction and getting people to visit your website. Uh, the other part of that is also landing pages are really important. Uh, Ben, did you want to talk a little bit about landing pages?

Yeah, just content in general. Um, one thing that we see is, you know, Google doesn’t rank sites based on how they look, it’s all based on what’s on the site and the content. So you could have a beautiful website, but if you don’t have the content on your homepage or your about page, that matches what people are searching for it, you’re not going to get ranked. You’re not going to get people to your website. Um, I mean, having a good looking website is, is important, but not in Google’s eyes. Um, so it’s important to have, you know, like on your homepage, for example, you want to make sure you list all the, um, services you provide. You want to list the main conditions that you treat. So when people are searching for acupuncture for back pain, you know, it’s going to come up. Um, it was one thing we see missed a lot is people will have, you know, maybe their mission statement or some, you know, quote that they like on the homepage, but they don’t have any information about what they do or what they offer, or even sometimes where they’re located, people miss that.

So you want to make sure you have all that stuff that Google is going to pick up and use to rank your site, uh, in your content, across all your pages, put your address. It was basic. It seems like it’s basic stuff, but it’s amazing how many people, it’s hard to find where they’re located or what their phone number is. If like dig through all their pages to find it. Um, that’s something that’s missed a lot. And, um, like as Kay mentioned, landing pages, that’s where you can get, get a little more detailed. So you can kind of use your homepage to list your general overview of what you do, what you offer. Um, but if there’s a specific service that you provide or a condition that you treat that you wanna really focus on and you can create a whole separate page for that, and that’s just called the landing page. So for example, if you focus on anxiety, you can have a whole landing page that talks about how acupuncture can help with anxiety, the different treatments that you offer, kind of your, your plan that you, when someone comes in to treat anxiety. But the important thing is to have a separate page that has all your good keywords in there that Google’s going to pick up and use to rank you for different, different conditions.

I think. Yeah, I think, I think that’s a big thing that people overlook is they just assume that they have a pretty looking website and that is just going to be the patient attraction tool for them, but having content with specific meta-tags and alt tags and title tags. I mean, that stuff that you know is what is, what, what you guys do. It’s what you guys focus on, which isn’t what a lot of practitioners do, um, in that way. But like when, when Google, when people like type in acupuncture, you know, back pain, Seattle, all of that information should be part of the content on some level, right?

Yep. Yeah. We could talk a little more about the meta-tags too. So it’s one thing that we see miss a lot is someone does their website on Squarespace or something, you know, even if they have great content on there on the page itself, um, we’ll see that their, their title tag for the page is just the word home or, you know, something really generic, but that the title tag is one of the most important meta-tags, that’s what Google uses to actually list your site in the listings. So each page use your title tag, and that’s what shows up when you search in Google, those are the title tags for each page. So you need to make sure that you have all your information in your title tag, that, you know, you have to keep it short. And I think it’s something like 60 characters. Um, but you want to have, you know, your business name and your city, and if your business name doesn’t include the word acupuncture, you want to make sure that you have, you know, have that in there as well. So you are targeting acupuncture in your city, in your title tags. That’s when we see missed a lot as the title tags aren’t set and it’s something has to go and manually do when you’re in Wix and Squarespace, you have to go and set those for each page.

To your point to Jeffery, all tags are sort of treated the same way as any time. If you have an image that you upload to your website, make sure you have a good description of that image, and also include some of that information. Some of the keywords that we’re talking about, your city, your location, and then a description of the image. And that really helps that with SEO and Google ranking, right?

I think a little bit into, I was gonna mention that that’s a big part of the, we’ll talk a little bit about ADA compliance too. And, um, accessibility and L tags are a big part of that, but go ahead, Jeffrey.

So, so as far as title tags, clarification on that, the title tag is the title of whatever content piece you’re putting out, whatever blog posts you’re putting out. Right.

It’s the title of that page? Um, yeah, so right. Yep. Okay.

And then, and then as far as pictures go, Ken, that’s a really good point because a lot of people just pick up pictures like, oh, me at the beach, right. Or whatever that is, or me doing moxa or me doing cupping, but like, it’s, you know, I mean, if someone puts up a picture of cupping, it should be like, Jeffrey’s acupuncture clinic, Seattle cupping. Right. That should be yeah.

Treating patient with capping or something similar to that effect. Yeah,

For sure. Yeah, because that all plays into like getting search when, when the search engine crawlers are out there, they’re like those search, not only the title tags, but the, the, the other alt tags in the photos, which is, I think I would, you know, I never knew that until I started, you know, you guys started jumping into the websites, informing us around that. So, um, cool. Um, and, um, so what is another question is like, what’s the best way for practitioners to reach more prospects in their community? Like how can they get out there and be more forward facing? So people when they are searching that they’re found?

Yeah. I think the number one thing that people miss as a practitioner is setting up their Google, my business account. Um, so if you go to google.com/business, uh, you can create a listing, uh, inside of Google and Google will, uh, rank your website better when you create that listing. And what it does is essentially it tells Google what you do, the services you offer, and also verifies that you’re actually a real business. And that’s really important to get a better ranking in search results. And also to, it allows you to appear on Google maps, which is really important because your patients will go to Google maps to try to seek you out. And part of Google maps includes reviews and reviews are really important. So if you think about going to a restaurant and a, you choose a five-star restaurant, uh, that, uh, that your peers have reviewed at five stars versus a one-star restaurant, you want to be part of that, that community that Google is putting in front of you. Um, and that’s through Google my business. So, uh, Google my business is really important, uh, way of getting in front of your community and making sure that you’re ranking well for some of the conditions and, uh, the modalities that we mentioned earlier

And Google my business it’s free. Right. There’s no cost to getting that set up.

Sure.

Right. Yeah. Yeah. There are a lot of third-parties that I’m sure a lot of people have gotten calls from, uh, you know, solicitors calling and saying, Hey, we’ll set up your Google business for you for, you know, X amount of dollars, hundreds of dollars. Uh, but it is free through Google if you do it yourself. Um, and a lot of times too, um, Google will, you know, use the yellow page listings to auto-generate your Google business listing. Um, but it’s, you know, usually lacking a lot of content. It’s just the basic. So you, even, if you have one up there, you want to make sure that you go to google.com/business and claim the listing. If it exists already, I go through the verification process and then you have full access to put all your information and make sure your hours are up to date. Um, you know, during COVID, you can, you can list your specific COVID changes that you have on your listing, um, and also have access to the reviews.

So you can interact with your views that come in. Um, that’s one thing that is important is, you know, you want to make sure that you’re encouraging your patients to leave reviews and then that you are going in there and actually responding to the reviews and interacting with them. And that shows Google that you’re, you know, not only have a lot of patients coming in, cause they leaving reviews for you, but you’re actually being proactive and using your listing and responding to both positive and negative reviews, hopefully all positive, but you can still go in and just say, thank you to people who leave reviews. Um, and that’s something that Google notice and, you know, if you’re really active with your listing, Google, you’ll start bumping up in the, in the ranks, especially if you’re in a competitive area where there’s, you know, dozens of, of competitors trying for that top, top, the top three spots on Google maps, those are the really important spot to get to because that’s where you show up kind of on the first page, when you search something that shows like just a couple map results, when you search, you know, you want to be great if you can get up in that top three spot.

So reviews will help a lot with that.

Yeah. Because these days, people don’t really scroll past the first page when they do a Google search. And you know, the first thing that shows up there are I think, paid ads and then sort of the map, you know, like the map listings and then, then other other generic rankings. Is that right?

Yeah. That’s one thing that, you know, a lot of people coming to us thinking that there’s a quick way to click one button to get to the first page of Google. And you know, it it’s a process, especially if you’re in a competitive area. Um, if you’re in a smaller town, you can see it as possible to get up to the first page within, you know, a month or so. But if you’re in a competitive market, it’s going to take time to build that, that ranking up and get to the first page or two. Um, but the, the easy, quick way to do get it to the first page is through the ads. And I mean, it definitely is a cost involved. Um, it can get expensive doing Google ads, especially in a, in a big market, but that’s really the only way to guarantee to get to the top spot immediately,

Right. By paying for the ads, hiring someone to run the hours they’re doing limit yourself. Right. And then around that, there’s so many different parameters that you’ve got to abide by in order to, you know, make sure you’re not stepping on their term terms of service or terms of use around that. Um, cool. Um, yeah. So Google, Google maps will help people get found. Google reviews are really important. Is there anything else that you can think of that is another good way for practitioners to, you know, have be found online?

Yeah, I think it just really is to summarize everything like Google my business is great and setting it up, but we have to also remember that Google loves fresh content, right? So if you’ve got a website that you’ve built and it looks great and it just goes dormant because you’re not adding fresh content to it related to the service that you provide, then most likely it will drop in organic ranking. So you’ve got the paid advertising, you’ve got the map and then you have the organic, you want to get into that organic space, the first page of Google. And that’s what takes time. So writing good quality blog posts about, um, your, your practice and the conditions you treat is really important. You got to keep feeding, Google that content, and the more you feed it, the higher you will rank compared to a site that doesn’t post anything. So that’s really what drives your ranking. Um, and then there’s some other, other, other factors that we talked about, like all tags and metatags, I want to,

Another thing I want to mention too is, um, you know, if you’re, especially, if you’re starting out and your site’s new and you’re starting at kind of from square one, you’re buried in the listings. Um, and it’s gonna be hard to get people organically to go onto your site. They’re not going to find you on the fifth page of Google. So one of the important things to do when you’re first starting out is to find other ways to get traffic to your site. So that’s through, you know, if you have a social media following, you know, you can start putting your blog posts onto social media. So people click through to your website. Um, if you have like a, you know, a newsletter list, sending out newsletters that link out to your website, um, even just first starting out, just sending your website to friends and family and have them visit because Google will see the traffic started picking up and that’ll say, oh, you know, people are getting to this website. This must be important enough to move up the rankings a bit. It must be relevant. Um, so that’s one thing that I think sometimes people miss, you know, if you build your website and it’s brand new and it’s sitting on the fifth page of Google, you know, you gotta find other ways people to get to the website first, before it can, you know, start moving up to the first page or so.

Cool. Um, okay. Um, another thing that I’ve heard in the past, and maybe you guys can shed some light on this is the fact that it’s important to have your website be mobile ready in order to, is that helpful for rankings at all or anything like that?

Oh, absolutely. Um, and it it’s something that it seems like it’s becoming more standard now. It is, it is the standard. So we see it less and less of people not having a mobile ready site, but we do still do see it. So, you know, having a mobile radio site super important, if people are searching for businesses, they’re doing it from their phone in 90% of the time. Um, so you want to make sure your website is mobile friendly because Google will tell if it’s not, and then they will lower your rank on mobile searches if you’re not mobile friendly, um, cause they want the sites that are easy to use to are the first ones that are popping up. So that’s super important to be mobile readily mobile ready. Um, you can search on Google and Google has its own mobile ready test. You can go and plug in your website and it’ll tell you if it’s coming back as mobile friendly or not.

Um, and then the other thing is, um, having SSL security is really important. That gives you that little lock icon in your browser that shows that you’re secure. Um, that’s pretty much standard at this point, it’s it? You know, it’s every host should have it an easy way for you to get that. Um, Google’s even say not secure if you, if you don’t have the SS SSL security on your site. And that just gives people peace of mind when they’re sending con your contact form through or messaging you. So yeah, mobile friendly and SSL are super important to have. And at this point, if you don’t have it, then you’re kind of behind the times.

Okay. Yeah. And you could tell, like, there’s a big difference between the way a website loads, that’s mobile friendly versus a website that is not mobile friendly. Cause I mean, some of the sites that, that, that you guys have worked on, literally like there’s a button, a big button, you just click to call, click to schedule, you know, click to send a message, right. I mean, let’s just seem super efficient.

Yeah, absolutely. It’s important to make it easy. And then one thing that we can also mention too, is, you know, having your website get found is one thing, but you want to make sure that it’s easy to use once people get there, you want to make sure that it’s easy. You want to have this really strong call to action. So when someone gets to your site, they know what to do next they know to contact you. They see a big contact us button. One thing you can do is, you know, go to your website and see how long it takes you to find the button, to see, to make an appointment or to call it. And if it takes more than two or three clicks, then you probably need to make it a little easier for people to find because people will give up quick and move on to the next thing. If it’s not easy to use or easy to find what they want.

Yeah. And it’s also important to put that call to action closer to the top of the page so that people don’t have to scroll down to get to it. And you want to make sure it’s front and center. And like Ben said, two or three clicks to get the, take the person down the path that you want them to go down is the, is the key. So go to your website and check it out and see how long it takes you to contact yourself. So

Right. Or what call to action you have like available on your site. It’s like, you know, you need to have a schedule. Now, call me now, download this free report now and all this stuff like right front and center. So if people don’t schedule with you right away, what’s the next action that they can then take to, you know, communicate or reach out to you or just stay in your loop.

And one thing, one thing you can do is, you know, contact, uh, you know, maybe, uh, an elderly relative or patient and have them go and test your site. Hey, is this, can you, can you find how to do this? Somebody who’s, doesn’t ha hasn’t been to your site. Maybe it’s kind of not super tech savvy and to see if it’s easy for them to, to navigate and navigate the site and get to what they want. Because if you, if you’re in there everyday working on it, it’s easy for you. Cause you know, everything is, but sometimes you kind of forget that other people don’t have the, the prior knowledge to know everything is like you do. So can I seeing some fresh eyes on your site and see if it’s easy to use? That’s important. Okay,

Cool. Cool. Okay. So, um, well I think that those are all the main questions that I have for you. Is there anything else that you guys would want to share?

Yeah, I think one thing that we, uh, we’re going to talk a little bit about just because it was a kind of, uh, came up this year as a ADA accessibility. Um, it’s one thing that, you know, beginning of the year, there were a lot of kind of reports of practitioners getting, getting sued for their website, not being accessible, um, mostly out of California. Um, so, you know, what’s one thing that we looked at a lot this year is, you know, making sure that our sites are, are as compliant as they can be. Um, you know, we got extra tools in there for, for accessibility, but just to talk about a few things, if you’re doing the site yourself to, to look for, um, the important thing with ADA accessibility is, you know, one of the, one of the most important things is making sure that your website is, is usable with just a keyboard without a mouse.

Um, and that’ll kind of mimic to what if people don’t have feel using like, you know, voice commands to use a website. You want to make sure that everything is accessible. So you can go, go and test your site and make sure that you can, you know, for example, navigate through your menu with just your tab key and your space bar, um, making sure you can get to pages, just using your keyboard. Uh, that’s an important thing to do. Um, you mentioned alt tags before in images. Um, if someone’s blind and using a screen reader to go through your website, you want to make sure that all the important images are, have the descriptive alt tag, um, behind them. So if you, someone can actually see the screen, it’ll describe what the image is. So, you know, patient receiving acupuncture or something on, on, uh, on the acupuncture picture. So that’s really important. That’s one of the thing that people get dinged. As you know, they’ll run through the website using a screen reader and to see if it’s broken or not. And that’s kind of as a red flag, if, if your site is not easy to use with a screen reader or a keyboard, um, anything else you wanted to add to that kin?

Yeah, I think the other part of that is screen readers is being aware of your heading tags. So your heading tags are basically the different sections of a page and Screenagers need to be able to determine what those sections are. So if you have a section about what is acupuncture and then some information, and then the next section is what about what is a moxibustion that kind of thing? Things a headings are important. Part of ADA accessibility, and like Ben said, active, perfect websites includes, um, the accessibility testing, making sure that your site is built correctly to meet some of the most of the requirements. And, uh, you know, it’s, we, we try to do our best to, to guide you along the way. If you want to make changes yourself, we give you the tips and tricks on how to make sure that when you’re uploading content or adding images, how to make your content ADA accessible so that you don’t get dinged by any, any of the ADA lawyer stuff that’s going on right now in California.

Cool. And one last thing,

I’m sorry, man. I was going to say Daniel, if anyone, you know, feel free to contact us, we’re happy to, you know, take a look at your website. We do have an evaluation available. Um, yeah. So feel free to reach out if you have any questions about this, we’re happy to go in more detail with you. Um, you know, actually look at your website.

Yeah. So there’s, so if you guys want a free website evaluation, um, there is a link right now, that’s up on the screen and, uh, I guess, uh, once you sit, once you go to that page, you submit your site and Ben or Ken or, or Ian, or reach out to you and, and take the next steps to evaluate your website. Um, and one thing that’s, I think really important to get across is the fact that a lot of times when you work with Wix or Squarespace, you’re actually, the practitioner is actually working on and building and updating and doing the website and upkeeping it and doing it all themselves. Whereas what you guys do like day in, day out, you guys are doing all that for the, our clients. Right, right, right.

He didn’t go to acupuncture school to become a web tech builder. You’re eight. So that’s what we’re here for. We take that off of your hands and it frees up more of your time so that you can treat more patients, you can attract more patients to, through our service, which is great. So that’s why we’re here. We’ve been building websites since 2011. So we’ve been going for 10 years now has been a great ride. So

It’s actually Ben’s baby, but don’t kill anyone, right? Yeah. Uh, so other than the evaluation is, is that the,

Yeah, just go to that school. I go to that site, um, you know, they’ll have our other links there for signing up for a free trial. If you want to try us out, uh, the free trial is really easy. You just give us your information, we’ll set up a new site for you. Even if you already have an existing one, we’ll set it up at a temporary address. You can kind of just see how it is, you know, click around, see how it works and you know, be ready to go. If you want to make the switch and make it all easy. We do all the tech stuff for you. Now. You don’t have to be knowledgeable in any of that. We’ll try to make it as easy as possible.

Yep. And one last thing. So you just mentioned switch. So a lot of people are scared to switch over because they think it’s a daunting, massively, huge thing to do so, but like that’s what you do. Like you literally do that, right?

Yeah. We do it in a way. So there’s no downtime. We’ll build your whole new site kind of at a temporary page, so you can see it, make sure you approve it. Everything, once everything’s in place, then it’s just a quick little switch at your domain name and everything goes live and there’s no downtime. So we walk you through all the steps that you need and do all the do as much as we can from our end to keep all the tech stuff out of your hands. So you can just get to work.

Sounds good. Well, thanks guys for, um, you know, joining me here today and sharing some insights and wisdom with, uh, the AAC and those that are watching here. Um, next week you can join, uh, Sam Collins is going to be here and he’s going to be, uh, talking about some great things, um, on, uh, billing and insurance. So comeback then other than that, thanks guys again for joining us. Thank you. The AAC for, uh, allowing me to bring, um, you know, some guests onboard to share some insight and some wisdom. So thanks everybody. Take care. Bye Ben. Bye Ken. Bye. Thanks Jeffrey.

 

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Staying Out of the Negative Gap Trap

 

 

So where the mind goes, the chief follows what you focus on, becomes a reality. So this is really about where you choose to put your intention.

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.

I want to thank the AAC for inviting me back, um, to their live stream, to the point my name’s Lorne Brown, um, a little background, I’m a CPA, a certified professional accountant. I’m a doctor of traditional Chinese medicine. I’m also a clinical hypnotherapists. I’m trained in psych K um, rapid tribes, transformational therapy, the Mercer of pure technique. And I’m the founder of healthy seminars.com offers continuing education, um, for acupuncturists as well as the founder of acrobatics wellness center. The first and I guess longest serving integrated fertility clinic in British Columbia, Canada. And I’m the author of this book missing the point. Why acupuncturists fail? Um, I want to, um, have a discussion with you about, um, ignoring or getting stain out of the negative gap trap. This trap is where, um, you lose your confidence. You feel frustrated, you feel depressed. And so, um, I promise you that for this lecture, um, I always like to set the intention. I hope to one day be remembered as the guy that keeps everything really simple, powerful, and effective. And I started his quote here is make everything as simple as possible, just not simpler. Um, and that idea, the risk of being too simple is that you may ignore it or dismiss it all together, but I will do my best to keep this simple, because I don’t like to do complicated, but yet powerful and effective.

So where the mind goes, the chief follows what you focus on, becomes a reality. So this is really about where you choose to put your intention. That is the key. And I like to use the idea of, um, the missing the tile syndrome, um, concept here. And so in missing the tile syndrome, the idea here is you have this beautiful, um, tapestry, this beautiful let’s think of our, our ceiling has been hand painted. There’s a million tiles and every tile has been beautifully hand painted. However, unfortunately in the corner of the ceiling, one tile has cracked and half of it has fallen. And because of that, the museum has closed the exhibit and notice it as worthless. And this is this idea that you have 999,000 beautiful tiles. But if you focus on that one damaged tile, then it becomes worthless to close the exhibit.

Um, I like to say when again, where the mind goes, achieve follows, what you focus on becomes your reality. So if you have nine good things happening and one bad and you focus on bad, then you suffer. Life is not great. Vice versa that if you have nine, not nine bad things happening and good, and you focus on that one, good, then life becomes great. And so it’s really about which Wolf you’re going to feed a, where are you going to put your attention? Where the mind goes? The chief follows what you focus on becomes reality. And I’m sure many of you who, who drive or purchased a vehicle in your life have probably had this experience that once you’ve decided on a vehicle that you like, all of a sudden, you see more of that make and model, and maybe even color of that vehicle, that car on the road.

It’s not that there’s any more of that car on the road. It’s just that that’s become your focus. And that’s what gets percolated up from your subconscious to your conscious mind. And you start to notice that you start to notice it more. These opportunities were always there. These vehicles were always there, but now that you’ve put a bit of focus there, you start to notice it more. And so this is how life happens. You start to experience, notice that, notice things more, this becomes the life you live, and this is why you could live in suffering and stress, or you can live in joy and gratitude keyword. There is, it’s a choice. Um, I really enjoyed a book called minding the gap and it was by, um, Dan Sullivan. He’s a coach and I really liked his metaphor. So I want to share my version of it, um, in this idea and how to stay out of this gap.

The gap is where you do not want to be. Um, he, he gives us idea that you set sail basically, and you untie your, your boat from land. And as you said, sail, you look out to the horizon. Now you gotta remember the horizon is a mental construct. There is no place where the sky and the ocean meet or in sky and land meat. It’s just a mental construct, but that’s where you set your target out. Um, those are those big audacious goals. That’s what you say, your target. When you leave the land on your sailboat and after 24 hours of sailing, you, you go down and retire at night. You have a nice sleeper below. When you wake up to your dismay, you notice that the horizon is just as far today as it was yesterday. And if you keep just focusing on horizon, then over a period of time, this can lead you to a lack of confidence, frustration, and depression.

So the antidote for this, the solution is to look backwards, to look behind you and notice how far you have come each day. And that’s the issue for a lot of driven people is they’re constantly focused on their long-term goals are focusing on that horizon, but they’re not stopping each day to do gratitude, to be grateful for what they have, where they have come. And so the gap is from the gap is the area from where you are today to where you want to be. That’s the gap. But what we have to remember is there’s also a position from where you are today and where you’ve come from, and this idea of, of practicing daily gratitude, where you look for things that you can be grateful for. It basically forces your mind, your brain to search for the last 24 hours of what has been going well for you.

And this is the antidote to staying out of the gap and enjoying life more. Uh, there’s this quote that if you cannot feel gratitude, then you cannot be happy. And so, so many of us still suffer, even though you have material possessions, I’m talking about the people that have, you know, if I, if I just have this, then I’ll be happy. Well, they have this, but yet they still don’t find the joy in their life. And the key quote here is if you cannot feel gratitude, then you cannot be happy. And I will say I was one of those people, very driven, um, that kept on achieving, but never finding that fulfillment. It was always short-lived. And I’ll talk more about that. And again, the key here is to state of gratitude and the solution is daily practice of gratitude. And let’s talk a little bit about how gratitude works as well from a scientific perspective.

Um, remember that this is your free will, gratitude is a choice. And it’s one of those things that I like as a mind hack. I like to do mine tax. And again, I’m always looking for these simple things. So what I’ll do is I’m just going to read a little bit, um, from some research here. Um, so again, on gratitude, um, many of us are always looking toward external factors. We’re always looking outside of ourselves to experience joy and happiness. When really it’s all related to internal work. This is a lot of the stuff around conscious work that many of you may have been exposed to. This is something science is just starting to grasp as well as shown by research out of UCLA mindfulness awareness research center. According to them, having an attitude of gratitude changes, the molecular structure of the brain keeps gray matter functioning.

It makes us healthier and happier when you feel happiness, the central nervous system is affected. So your whole autonomic nervous system changes, which many people say is the subconscious mind, the autonomic nervous system, you are more peaceful, less reactive and less resistant. Now that’s really a cool way I’ve taken care of your well-being. Now I suspect when you’re practicing gratitude, I suspect that you’re going into, um, alpha brainwaves. So when you’re in high tech high beta brainwaves, that’s that state of stress overwhelm anxiety you’re suffering at that time is that nice, um, state of detach relaxation. And when you’re an alpha brainwaves, basically you become resourced. And again, through research, what they’re noticing is that when we’re in this state of gratitude and in the state of alpha brainwaves, we now are able to access more of our mind that is normally not normally available to us in particular.

They say the research that we’re able to access more of that creative mind. And so when you’re in that stress response in high beta, you’re likely focusing on the problem. And when you go into gratitude, it has a shift in perception, and it takes you from focusing on the problem to now focusing on the solution. And that’s when, when you get into gratitude and alpha brainwaves, you now are in inspired thought, and that’s when one of these solutions inspired thoughts pops into your mind for what you can do. And you get really excited about I’m just going to read another little line here from some of the research. Um, scientists have discovered that feelings of gratitude can actually change your brain. So they’re measuring things and seeing the brain structure changes, synopsis that fire together wire together, and feeling gratitude can also be a great tool for overcoming depression and anxiety, more important now than ever.

Right? Furthermore scientists have discovered that the heart sends signals to the brain, your thoughts and feelings of gratitude create a physiological response in your body. So if you want to feel happy, practice joy and gratitude. If you want to feel happy, practice joining gratitude, it’s not going to be this relationship. Or when you make this so much money or you have this health, that’s going to make you happy. It is an internal experience. And remember, it’s not happiness. That brings us gratitude is gratitude. That brings us happiness. And so if you practice a daily, um, basically if you cannot feel gratitude, you cannot be happy. You can not feel happy. And so the idea of practicing gratitude daily is, um, you revisiting the past 24 hours and some people will find this a challenge by the way, but that’s okay. That’s just showing you that you’re not practiced at gratitude. And it’s taken a little bit of effort to get those wires to fire, right? Those synapses to fire. Last little piece from this research in short practicing gratitude seems to kick off a helpful self perpetuating cycle in your brain, perfect momentum, right? Counting your blessings now makes it easier to notice and count them later. And the more good you senior life, the happier, more successful your life becomes.

So in Shawn anchor’s book, he’s an author on the happiness advantage. He talks about a study where they take people that are basically, um, uh, you know, think of negative and positive. Um, people I’m losing the thought of the word. That’s not the word that he used in the book. Um, but it just, I just lost my head and normally it does it, but it, it, it will be okay still with the exercise that we’re going to do. So he has two groups of people, um, and one group, um, they’re, uh, both groups actually are asked to count how many images they see in the magazine and it’s timed. And this was a magazine made for the study. And what they notice is the, um, people that, um, I’m going to call it negative again, negative thinking, right? Things don’t go well for the victim thinking versus the people that are lucky enough, good things happen to them.

Um, the ones that were in the negative thinking group, they took longer to complete the exercise, then the positive mindset group. And that’s not the terms of use by the way, but it will work for what we’re doing. Now. What was interesting is they all had identical. So what’s the time difference. And in each magazine, there was an image and right under the first image, it said, um, if you’re reading this to finish this exercise, now go to the second to last page. And so on the second to last page, it said, show this line to the supervisor and collect $250. So these people would look at the picture, read this, flip it and hand it in. But there was a whole group of people that went picture, missed it, picture, picture, picture, and it took longer. This is that idea that I mentioned about seeing your make and model of the car on the road, where the mind goes, the chief follows what you focus on, becomes a reality.

There’s only so much information. The conscious mind can take five to seven bits of information. Your subconscious is a supercomputer. And so if you’re in that negative mindset, it’s only going to percolate up to you. That’s matching what you want. Like when you’re looking for that car, all of a sudden, you’re now noticing that car. So if you are of a positive mindset, that gratitude, you start to see more opportunities. They saw that line right away and were able to collect $250 by completing the exercise quickly where the other group were not able to read that line. They opportunities are always there. It’s there for everybody. So what’s the difference. The difference is what have you put your focus on? And gratitude is a way to start focusing on opportunity and what’s going well in your life. And when you do that, you start to notice more. And because you were experiencing that, it’s an inner experience. You’re enjoying life. And they’ve shown that it’s happy people that become successful. It’s not successful. People become happy, happy people become successful.

And there’s that quote, successful. People are happy, happy people are successful. We often think if I get this, then I’ll be happy. And that is not how it works. Pleasure is temporary success. That kind of success, material successes, pleasure is, is only temporary. And it puts you in a vulnerable state as well, because you’re always needing an external environment to be a certain way for you to feel a certain way. And in conscious work, this is about inner work and that you’re feeling good despite the external environment. So that’s a skill. Can you deny the five senses and what’s happening now, um, and bring up that feelings of joy and like attracts like, and this is how happy people do become successful. So happiness is more about the joy and striving for your potential than the actual end result. So enjoy the journey versus focusing on the destination idea.

So it really is less about the external world. I’m John anchor, again, the happiness advantage and before happiness, it was two books. Uh, one of the studies that he looked at is they looked at wanting to raise success rates and happy, uh, when you try to raise success rates. So in corporations that try to raise success rates. So profit margins, um, revenue, you know, on the material side, they saw happiness would flat line, but yet when they raised happiness inside these organizations, success would rise dramatically, educational and financial. And so again, happy people become successful in same thing for your organizations, happy organizations become successful.

So it’s a cause and effect. And we can take this from a Newtonian level to a quantum level. So on the Newtonian level cause and effect, we are using the external environment to make ourselves feel gratitude. So we’re looking at what has happened. So in that gap, minding the gap exercise, we’re looking behind us and in the last 24 hours, what can I be grateful for? Um, that’s cause and effect, and that’s on a Newtonian level and it’s very beneficial. And that’s where the research is has been done on the causing effect is kind of a quantum idea where you’re starting to feel gratitude in advance of what you desire and want before it’s actually manifested. And this is more beyond the scope of our discussion today. Um, but in that quantum level, you are now, um, using your imagination to create what you want in your life and you’re causing the effect.

And so, you know, um, to, you know, to, if you want to be healthy, then start to feel whole and complete, right? If you want to be happy, then start to feel joy and gratitude in advance of what you see physically, right? And so that’s causing the effect and that’s a quantum level idea that people talk of and that I love. And that’s more on a manifestation level. And today we’re really focusing on cause and effect where you’re looking at, what you can be grateful for, what I invite you to do now, while you’re listening to this, this is really simple. Um, but I would invite you to take a moment and write down three things that you’re grateful for. Oh, this was the part I, you know, it’s, I’m going to share this now. Cause I didn’t add this to the slide with the Shawn Achor lecture, um, research that he talks about, where they looked at those two groups of people where they looked at the magazine, this is very key.

So I’m glad I remembering this. Now it kinda ties it in together. So a quick, quick summary in that study, one group took much longer than the other because they missed it where it said, go to the supervisor and collect two 50. They miss that opportunity and just focused on the pictures. What they did is they took the pessimist. That was what it was pessimists and optimists. That’s how they kind of define the groups. So they took the pessimist group and they got them to write down for 21 days, three things that they can be grateful for three original things. And so every day they would write, not think, but write down three things that they be grateful for. And what they notice is not only did they see changes in the brain structure, so the brain wired differently, but these people started to feel more optimistic and start to notice more good things happening in their life that like attracts like, and so this is something that can be learned.

So wherever you’re at now, I would suggest, and I do this for my patients all the time. I suggest a gratitude practice. I’m going to actually tell you what I do is I recommend and a really nice book. So I buy more of the expensive books, too, a nice leather bound book. This one has like a strap to it. So if you can see that, so some people do a little hill Roy, but I do it on a nice binder because these are your gratitude, your, your joy, uh, books. So it’s, it’s precious. I’m giving it the respect, right? It’s precious. So it’s in a nice expensive book. And each day I write three original. Now the key to this is to take your time, write something you’re grateful for. What’s gone well in the last 24 hours or more. And write that down and allow yourself to feel the gratitude.

It’s the feeling that’s key. If you just write three things down, but you don’t bring up the feelings of gratitude. It won’t be very beneficial. That feeling is chemistry and the body feelings are chemistry, right? And so, and this has an effect on your electrical and hormonal nervous system, right? And so you want to bring up the feelings of gratitude. This is key. And if you have something that every time you think about it, it brings gratitude. You’re a welcome to write that down each day, but now you need four things because it has to be three original each day. So if you want to carry something forward or more than one thing forward, that is fine, but you need three original things. Now what happens if it’s difficult, then be grateful that it’s difficult because if it, if you were super great at it and you’re still suffering, um, that’s unfortunate, right?

Because what else can we do? And there’s lots of we can do if you’re finding it difficult, that is feedback that you don’t have that wiring for gratitude, because if it’s wired, it’s instant, it’s easy. Like you can just bang, bang, bang, and really feel it. Then, you know, it’s worried. Cause that subconscious is like a super fast super computer. So it would be easy and fast. If it’s not easy, then you are now building those synapses. Right? So time you think about it, you’re wiring your brain differently. Like we saw in that study that Shawn anchor quotes in his book, they noticed after 21 days that the brain changed and they felt more optimistic. They noticed more gratitude. They were experiencing more joy in their life. And so write three things down. I recommend an a, an, a book, the research didn’t do it based.

You do it in your head. They didn’t do it on your iPhone notepad, um, or on a sticky note. Um, I recommend a nice book and sometimes I sit back and I reread these things. I go back and I reread, um, what I put for gratitude. And I kind of have two practices, the Newtonian one where I look at what I’m grateful for in my life. And then the quantum level of cause and effect. I share to be grateful for things that have not manifested yet, but I believe we’re going to her. I’m convincing myself. They’re going to start to really imagine and dream that. And gratitude is powerful because gratitude is a form of receivership. When you are thankful when you were receiving something, um, or have received something you’re grateful, you’re thankful. So gratitude puts you in that, to that receiver, um, state.

Um, and that’s kind of basically what I want to share about how to stay out of the gap in today’s world, um, with the media and social media usually bombarding you with unfortunately negative thought patterns. Um, it’s really important for your mental health to develop practices like meditation and daily gratitude to really calm that nervous system, to take you from that high beta stress and anxiety and overwhelm into that alpha detach relaxation, right? To take you from that sympathetic fight or flight survival mode into parasympathetic, the rest and digest, um, system and your body will thank you for it. And these are just really simple mind hacks. So gratitude helps you stand in the gap by thinking about what has gone well in the last 24 hours is still healthy and okay to have to be looking into the horizon. It’s great to dream big.

Um, two things I would add to that, remember to keep looking where you’ve come from. That’s key. Otherwise it’s easy to fall into this gap of frustration and lack of confidence and depression and, um, causing effect, not only having the horizon, these big goals, but taking time to imagine, to meditate, to dream what it would be like if it was fulfilled now not thinking how you’re going to do that. I didn’t say that. Just thinking if it was happening now, what your dream is, if it actually has occurred, what would be different? How would you feel? How would you behave? How would you act? And you’re training your body, your autonomic nervous system, which I understand to believe is your subconscious system. Um, you’re training it and it now has that expectation. And then these opportunities start to show up in your life to help you materialize that in the physical plane here.

So thank you again for tuning in. Um, if you like these kind of topics and talks, I suggest you check out my book missing the point and, um, you can check out my website, um, Lorne brown.com. It has links to, um, where to get my book. It has links to my website that I found in healthy seminars where you can great, great con continued education for PDA and use. It also has, um, uh, a library there of our past 10 years of lectures and links to my clinic. So you can check all that out. And I want you to know the next week you want to tune into, to the point with AAC. Cause we got Jeffrey Grossman from acupuncture, media works, and he always has great business pearls to help you grow your practice. Thank you for listening. And I’d love to hear your feedback in the chat.

 

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PTSD – Post Traumatic Stress Disorder Tsao-Lin Moy

 

 

What is post-traumatic stress or post-traumatic stress syndrome? Like what does it look like from a Chinese medicine lens? Right. We’re going to cover what it is, what is pandemic fatigue recognizing and treating it in our patients and also recognizing it in ourselves.

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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.

No. Hello and welcome. And I’d like to thank the American Acupuncture Council for, uh, putting these talks on, on these platforms of Facebook, Twitter, YouTube, Instagram, and so many more. Um, my name is Tsao-Lin Moy. I am an acupuncturist and Chinese medicine practitioner with a brick and mortar practice in New York city union square. And so today we’re going to be talking about post-traumatic stress disorder, post-traumatic stress syndrome. And so we’ll go to the slides. Okay. What is post-traumatic stress or post-traumatic stress syndrome? Like what does it look like from a Chinese medicine lens? Right. We’re going to cover what it is, uh, what is pandemic fatigue recognizing and treating it in our patients and also recognizing it in ourselves. And then I’ll go over a few tips, uh, and, uh, treatment strategies that you can use with your patients and also to, for yourself. Right.

Um, so what is post-traumatic stress disorder? Well, it is defined as a psychiatric disorder. They can occur in people who’ve experienced or witnessed trauma events, such as natural disasters like Katrina or Sandy. Uh, what we’re seeing right now, a serious accident, a terrorist attack, war violence of physical violence, sexual violence. And this is based on, um, the American psychiatric associations definition. Right now we’re looking at seven to 8% of the us population, uh, will have, uh, post-traumatic stress at some point in their lives. Hey Cindy. Um, and 3.6% of us adults each year, um, are diagnosed with it. It’s a particular diagnosis, but we have to look at what happens before you get the diagnosis, right? Um, and, and then this case twice as many, it’s twice as high for women and also, you know, for teens. And we see a lot of that going on right now.

Um, this diagnosis requires exposure to an upsetting traumatic event. It’s often associated with something called combat fatigue, and a lot of veterans have this, and this is a statistic, 23% of veterans of Iraq and Afghanistan, um, are, have been diagnosed with PTSD or PTSS, uh, 30% of veterans from Vietnam. And this is something that is continuing to, to grow. And it’s something that’s really important that we start to address and can be addressed really well with acupuncture and Chinese medicine. And so here quick, there is an opportunity for us as Chinese medicine practitioners to really be of service. So what is this in the PTSD or PTSS is a form of Shen disturbance, right? And Shen is the idea of this dynamic interplay of the five mental and spiritual aspects of ourselves. These are housed in, we called the zone or the yin organs and are expressed in the form of our emotions.

Um, I’m not going to go over what the emotions are because I know all of you, um, have learned this in foundations, right? Um, but this is also sign when someone is experiencing something like post-traumatic stress, it’s a sign that the Shen is disturbed and is not going back into a state of balance. So there’s something that is preventing the natural inclination to move towards homeostasis. And this is through, this could be a physical experience or something emotional. Although I say everything we experience is in our body. So there is the we address what is the physical right? Um, so when the Shen is in order, the person’s ability to navigate the world with resilience and cultivate health and wellness is achieved. So it’s not to say that we don’t get upset and it’s not to say that we don’t get stressed and really stressed what’s happening is, is that the inability to self-regulate has been disrupted at a very deep level.

What we also are looking at is something called pandemic fatigue. And I put this in here because over time, us as practitioners and we see it with physicians, um, we are experiencing a situation in which we have to be vigilant all the time that we’re helping people. And we have all of these health issues that are really focused on staying healthy. And so what happens is, is we start to get really exhausted just from the situation. So as an acupuncturist, Chinese medicine practitioner, as practitioners, we’re also healers. So I want to put this forward. We’re not just, you know, mechanical and we work with energy medicine and the energy of others. So what’s really important is that we have to take care of ourselves. Um, and, uh, what we recommend to our patients is also that we need to really like look at, to do for ourselves. And oftentimes we forget, yeah.

Need to be the model. So what do we know for sure about, uh, PTSD and PTSS, all it’s kidney and heart liver and spleen. These are really, uh, two things that I’ve seen and witnessed. Um, there are many more, um, combinations, but with something like, uh, post-traumatic stress, stress plays such a major role. And it, by tapping into our adrenals, it affects the kidney cheat and the shock trauma affects the kidney essence affecting the brains. We look at the brain is an extension, the brain, uh, the spinal cord and the brain are really part of the kidney essence. And then in turn that brain and mind, you think the mind is housed in the heart, but also the extension goes through that physical the brain as well. So we look at the emotional disturbance, the chemical shifting, uh, PTSD and PTSS is not just a simple heart and a kidney heart disharmony, but it also involves a multitude of the symptoms.

So it really important when a and what I’m talking about is very specifically, we can recognize that the, the adrenals and the stress are, are really at the root of it, but then what’s happening. Is that the way it manifests starts to affect all different other parts of our body. And then we look constitutionally of the individual and also what their history is and then how that plays a role. And so though we may see all this in our patients, right? We can see like, oh, this person has this happening and that happening. We oftentimes are missing it in ourselves and we end up burning ourselves out.

So one of the things about PTSD and PTSS is that it changes our brain and body chemistry. So these changes result in the overstimulation, and this is Western stuff, the amygdala, which is that emotional survival response, the underactive aspect of the, which is the hippocampus, the hippocampus, uh, that what is an increases in stress hormones, and that affects our ability to move forward. So we often get these flashbacks, it affects the kind of memory aspect, and also in, um, it’s ineffective, we call the ineffective variability, which means that there are elevated stress hormones, and those interfere with self-regulation and we get the systemic decline. So we’re looking at, there’s an inability for the body to actually go into the parasympathetic, which is the rest and digest. And if we look at that from a Chinese medicine, we’re looking at the body needs to have the yin and the yang, right. And if we can’t go into the time of kind of cooling down and resting, then what happens is we’re always more young and more manic and we get this exhaustion.

So some of the symptoms of post-traumatic stress or post-traumatic stress syndrome are that these intrusive thoughts, worry, repeating thoughts. Uh, I look at distressing dreams that tells me a little bit more, that there’s like a liver thing, uh, flashbacks, um, you know, even feeling that, you know, they, people that they feel they’re reliving something, right. Uh, or in this case, what I look at, like I put in my notes communing with spirits, because you’re actually kind of involved in a situation that may be in the past and there isn’t really a person there, but you’re engaging, right. And this is really, you start to engage, let’s say the spirit world. Um, the other thing is avoidance avoiding reminders of an event, what to drawing from people or places and activities, um, avoid thinking about an event, not sharing feelings, right. And then there’s an aspect that I put in here too, is toxic positivity.

Um, or we, we also call it spiritual bypass is another term. And that is, is that everything’s great. Everything’s wonderful. Um, or towards others, we can be this way when they’re sharing their feelings, that we kind of tell them, oh, look on the bright side. Right. And, and this is, uh, also like something that we have to look at within ourselves that maybe we’re avoiding those difficult conversations and being able to get present. Right. And that’s something as a practitioner that, uh, kind of checking out is, is going to be also kind of a sign that we’re in this stress situation ourselves. Um, we look at alteration in cognition and mood, so negative thoughts and feelings, a lot of pessimism, um, you know, distorted beliefs, right. And also detaching from others, um, alteration in arousal and reactivity. So we start to look at reckless behavior, um, emotional outbursts, self-destructive behaviors, um, more vigilance, a lot of sleep problems.

And one of the things, uh, across the board, which I’ve noticed is that, um, people have had problems with sleep. Uh, so here is a little infographic of, you know, some of the things that people are experiencing, a lot of emotional, you know, outbursts, uh, frustration overwhelm, uh, just that feeling of, uh, not being able to deal with anything. And again, uh, what I do want to say is this is normal. We’re in, when you’re in a situation which is extreme in which we are in, in the way that we are now, there’s an aspect of self preservation and coping.

Now, sometimes this coping mechanism to the stress trauma is not necessarily beneficial over the long period, right? So the discomfort of trauma triggers our coping mechanisms from a state of fight or flight or freeze, right. In an effort to dull the pain to run away and to numb it. So examples of this are a lot of stress eating, a lot of junk food. So binging on junk food, like a lot of comfort food. Um, and this is something where with a, if somebody has this propensity, we’re looking at the day underlying, maybe have before, even a little stomach and spleen imbalance. Um, then we look at alcohol addiction, a lot of the addiction to medications now during the pandemic. And, uh, well, we’re still in it, uh, that in February, from February 15th to March 15th, 2020, there was like a 67% increase or 38, but I’m not to like look at the stats, um, in, uh, the prescription for anti-anxiety medication.

Right. And so that is a lot of these benzos do have addictive properties, but we, we, we need to cook to cope. There was also a study of an increase in alcohol use of new moms or women with children under the age of five. And so we start to look at, you know, how is somebody coping? And really this is a kind of medicine that, uh, you know, people are searching for. What do they know? Right. In other cases, there’s an increase in violence and angry outbursts. Now this, we look at liver gallbladder issues, right? Like any kind of, any kind of emotion that we’re unable to express is going to actually show up eventually in the form of some kind of stagnation, um, heat, inflammation, and anger, right. And also this is very normal, you know, we’re in situation, that’s very frustrating. The problem then becomes later on when we can’t get out of it.

And that becomes the pattern. Uh, the other thing is, is that if there is an underlying trauma that wasn’t resolved and that all also shows up a lot, when people come in for acupuncture and Chinese medicine, right, they they’ve tried other things and something is not working that there, the longer that they’ve had this experience, that the emotions and there’s much more going on then, um, that let’s say their initial accident, right. There’s more emotion that stuck with it. And then that is also hooking in and later on, that can show up. Uh, one of the, the activities also is extreme prepping, hoarding, food, toilet paper, um, exercising and dieting. Uh, we saw a lot of that. Uh, this is, uh, goes along lung and large intestine kind of controlling, right. Hoarding, controlling that metal energy, uh, another disassociation kind of checking out. And this is kind of like the Shen has gone to walk in and say, we want someone like, how are you doing?

Oh, I’m fine. Really in all this chaos, uh, it’s actually important that someone, you know, kind of acknowledges that things, you know, things are difficult and they’re getting through it. But the response that I’m fine is kind of really like, uh, I don’t know, uh, to me that says something like, Hmm, I don’t know, avoidance, uh, susceptibility to conspiracy theories like aliens and chip devices. So this is also a small intestine we’re looking at really, uh, inability to shift from what’s clear and unclear. Right? And that, that also ties into also fear. You know, when there’s a lot of fear of the unknown what’s going to happen is it’s going to trigger many different responses within, um, within ourselves and in our patients that then they can become very susceptible to things that, you know, something that they might’ve thought Ben seems to become a reality. And again, this is part of, um, not being so present, but actually, uh, going somewhere else, right. In terms of what, what is happening.

So do you know anybody that’s hoarding toilet paper? This was actually one of the responses that helped, uh, people to feel they’re in control that they’re actually doing something. So when someone starts hoarding or having certain kinds of behavior, it is a coping mechanism. It’s a, it’s a way for them to feel in control. And does this kind of like look at, uh, you know, what’s going on for that person. So they may, they may not say it, but, uh, this is like an indication that, you know, something may be gone, something else may be going on. Um, and so you’ll go, so why topic? Well, the topic is because if we don’t already have a form of this, post-traumatic stress, we’re on track to getting it because we’re living through very challenging and chaotic times much of which we have no control over. We’re witnessing a lot of death, uh, climate change, disasters, fires, flooding, and, um, the ravages of war and politics, having our lives up ended and having to pivot now.

And also what I want to say is the news cycles and social media, right? So much of the, the, the definition that was in one of the earlier slides about, you know, reliving, traumatic events, um, thoughts over and over again, that what’s happening is, is in our news cycles. We’re actually kind of seeing the same thing over and over and over again. So as an individual who might, who’s resilient, um, it’s hard to manage your thoughts when you keep getting exposed to social media. And so one of the things that I suggest, or the news, right, the news, the news likes to, um, be sensational in order to get the call it clickbait to get clicks. Uh, but what happens is, is that once you kind of see it, it’s very hard to unsee it and it taps into our other than conscious, right. And it kind of like works up, works us over.

And so really important is to clear the cookies on your electronic devices. So, and be careful of what you’re searching for, right? Because then all of a sudden you’re going to get a lot of that content. So the symptoms of, uh, PTSD PTSS Shen disturbance are a Shen disturbance and they reflect this disruption of the function of definitely the liver, you know, cause maintaining that free flow of Chi because when she and blood are in harmony, the mind is also at ease. And so this is also an indication of like where you want to look to when you can, you want to treat and help someone. Um, kidney essence is being drained. We know cause the brain, um, part of the brain is being affected. Um, there’s also that deficiency of heart blood, uh, people experiencing a lot of palpitations. Um, I, I highlighted or bolded insomnia because that is really like a big thing that, um, people are experiencing, um, both with a hyperactivity of heart fire on the mental restlessness.

Um, the, the issues are, if you’re not getting sleep and again, that’s that rest and digest, it is going to affect your information. And it’s also going to affect your mind. Right? Poor sleep is attributed to memory loss and long-term illness like dementia and Alzheimer’s. And if patients, one of the things that, uh, to look at, if your patients are not responding to treatment, uh, as you would say, Hmm, there’s something else going on. They’re not really healing. Then you have to really look at there’s something more and to look at the emotional component to being addressed.

So treatment strategies really need to address, uh, the stress cycle. Okay. So got a question about sleeping as a coping mechanism, right? Yes. Is like to get sleep, but you know, if there’s too much sleep, what can happen is that’s also like a kind of adrenal fatigue, right? Like all of a sudden, boom, somebody has been overstressed like with chronic fatigue or with fibromyalgia that they’re just, their energy is shocked, right? So adrenal, adrenal fatigue, or when your adrenals are shot, you’ll also like sleep a lot. But the key thing is, is that, are you getting a restful sleep, right? Because if you’re not waking up, uh, refreshed, then we also know you’re not getting those deeper levels of sleep. And that means you’re only get your cycles are off. Uh, and also like too long being asleep is also, you do build up a toxicity, right?

So over 10 hours of sleep is not better. There, there is that window of sleep. So sleeping is great. Uh, but also you want to get quality sleep, which means that your nervous system goes into that yin aspect. Right. Uh, so treatment strategies, well, I like the ear acupuncture and ear seeds, right? A lot of research in treating post-traumatic stress disorder, um, in, in, uh, is being used in the military. Right. And also used in addiction. And the beauty of either ear acupuncture or ear seeds is that they’re very simple. Right. And I like you put in some ears seeds and the patient can actually stimulate them, uh, points that I suggested, like Shen men, zero points sympathetic, then you can decide liver lung, like add a few other ones based on what you’re seeing in that patient. Right. Ear seeds are excellent because then later on they can, the patient can press them.

Uh, I’ve also used like the little, uh, the hand, uh, magnets, the Korean hand magnets, I guess they will. And on something like PC six, because not only does that help with anxiety and nausea, right. It’s easy for someone to access and, and to do right. So important that you’re going to give your patients some things that they can do on their own. Right. Because that is something that allows them to be in control. Right. And to be aware of that, they need to address their stress and you, and you give them resources. Moxibustion um, I actually prefer in these cases, moxa to needling, right. So if somebody is pretty startled and they’re, they’re overstimulated that you really want to cut there, there’ve been drained. You kind of want to add in something. And so a little bit of moxa, um, and less needling, right.

Cause then you’re piercing their, their defense. Right. And then that could be even like too much for somebody. So, uh, classic points like CB six CV, 12 stomach, 36 spleen six. So that’s more like central key, definitely. On the back, you would do 14, do 12, these help with the nervous system. And also that’s the meeting point of young, uh, do for right. The main men we’re looking at, uh, this is the gate of light, like on the gates of life, you know, when you’re stressed out or your, your, your kidney essence is draining, you really want to be able to route the person. So bladder, and then outside bladder point 52 more for spiritual, right. Or one more spirit point and then the six flowers. So you’re really like looking at helping that person consolidate their energy. Right. We don’t need to manipulate too much like, oh, they’ve, you know, this point for that, you just think about constitutionally helping them to get back into a place of balance, essential oils.

This is something also, they have essential oils have psychoactive properties. You can also miss that, have them massage them on certain points. I won’t get into. There’s like a whole, they’re all types of kinds of protocols. Um, but essential oils, uh, because they’re psychoactive, they go directly to the brain and can affect the chemistry. And that’s, this is a tool that can help your patients, um, when they’re feeling stressed or just to kind of have a, a, uh, you know, vapors or, um, a mist of it to really help them to, um, have a calm environment. They’re also great for children, right. Children experienced a lot of stress and often they can’t say it, they may act out right, and they’ll have tummy aches and, and, uh, other kinds of, of problems. Right. And they pick up our vibration, right. They’ve got their mirror neurons.

So if we’re stressed out, they’re going to pick it up. And then what I do recommend is something like Vetivar or bergamot. And this is, uh, in research, they, it shows that it has a similar effect as valuable in terms of calming, right. And also lavender is always like a natural, uh, uh, soothing and calming central oil. And you can get like lavender pillows and things like that. I think, uh, patients, they love, they love it, right? They love it. You can have little gifts, self massage. Uh, so in Asia for anyone who’s listening, if you’re Asian, it’s, it’s very common practice. Even as when I was a child, uh, to learn to kind of do massage techniques, especially on your parents’ back, you know, uh, little, little hands or walking on their, their back, uh, and, uh, you know, to learn how to do this.

And, and you do it in the home, uh, so you can teach your patients to massage their own feet, maybe stimulating kidney one, uh, they can also use one of those stimulation balls. You know, the kind of like helps to, uh, treat the entire body through the bottom of the foot, right. It’s also going to help with sleep. You can also massage a little bit of essential oil at the bottom of the feet. Um, I also, uh, like to teach my patients to press, you know, down the, the stomach channel, right. Stomach 36 all the way down. So there’s a stomach channel because that’s also the same idea is we want, you know, the, your central achie or nutritive cheek, um, your digestion, and that’s going to help to nourish the whole body. You’re you on cheat also liver three, nourishing your liver, helping with the smooth flow of, of cheap teas.

Um, there are so many teas out there. I suggest to my patients to kind of switch up caffeine, cause people want to be alert. Uh, stress can actually cause people to be really sleepy, right. Or to like really be overwhelmed, like dealing with, uh, a stressful situation. You actually burn a lot of energy and then have difficulty concentrating. Um, so, uh, offer having someone take tea, it has half the caffeine, but also, um, T is delivers a slow, an even amount of caffeine. And this is due to its chemical composition, which is actually great. I mean, there’s a lot of, there’s a history of the difference between, uh, coffee and tea and the idea in terms of the industrial revolution and being able to focus and be more productive. Right. Um, and that has to do with caffeine. Uh, what I have discovered is this is something that you can look up con a T uh, there are some over the counter and the health food stores. Uh, it is a very interesting herb. It’s a succulent from South Africa, natural serotonin uptake, inhibitor, meaning, uh, allows more serotonin to circulate. Um, so you feel better and, uh, stimulates the endocannabinoid system, uh, meaning immune. And then it’s also very empathic genetic. So you feel, you know, it’s at heart opening, you feel much better, and this is something that you can buy in the health food stores. And if you want, you can contact me and I can tell you different ones that I’ve looked at.

Okay. Another connecting with nature, what kind of mindfulness practice, um, and essential oils that you recommend, uh, bergamot, uh, the, uh, recommend vet D bear and Vermont, right? Those have the, if you look there’s research on those, uh, that, that shows that as the similar effect on the brain as taking Ballmer, right? So you smell it and you feel calmer, right. Um, so, uh, connecting with nature, having a mindfulness practice. So mindfulness practice, that’s a whole other, you know, it’s a very big topic, some kind of meditation or gratitude, uh, but also, you know, post-traumatic stress is very disruptive to the whole system at its deepest level. And so something there needs to be something great to feel that there’s something greater than right. Which is, which is that feeling with meditation, more connected to the world, right. Instead of, uh, uh, retracting or contracting.

Um, and one of the things is, is nature. So nature has a vibration, it sustains life, right? There’s a vibration of plants. There’s a vibration of the earth. And so things like gardening, or actually physically connecting barefoot to the earth or grass, or even sitting under a tree, what happens is, is our body is naturally going to go to synchronize with the vibration. And so we, and this gets back to us, right. Uh, when we are in a place of calm, we are so great for our patients. And I, and I know that they come and they say, wow, how are you? So calm? I always feel good when I come and see you. Right. And what it is is when you’re in a place of calm, you’re very stable. And then they have, it’s like, you’re like a beacon and a place of stability for them to feel like everything is going to be okay, which is why it’s very important that take care of yourself also.

And the other thing, um, before I conclude is I want to say that less is more so when dealing with, uh, post-traumatic stress, uh, less is more individuals are already overwhelmed and overstimulated, which is why I said like, okay, maybe some magnets, uh, that they can do on their own as well after being treated, uh, you know, to, to little things, simple shifts to ease them out of that cycle. Right. So they can feel that they could do a little thing that they’re in control of. They’re not given a ton of, of, uh, homework, because then that’s just like a whole other thing to deal with. And I think it’s really important that, uh, people can actually, uh, have these resources that you’re gonna teach them and show them. Of course, there are many more, uh, you can, uh, work with, uh, different kinds of recipes and foods to, to help them, you know, so something that’s simple, right.

And so that they can cultivate, uh, health and wellness and longevity and resilience for themselves. So this is the conclusion. Um, and let’s see, I hopefully I would like you to make sure that you join us next week, where we’re going to have Lorne Brown, uh, coming and, uh, he’ll be giving a wonderful talk. And again, I would like to thank the American acupuncture council for, uh, having these talks on. And I hope that, uh, they were interesting for you. I would love your comments and please, um, let me see, where would I please share the reference? Okay. Um, okay. There is going to be a transcript and a replay. Uh, so, uh, if, uh, or you can contact me and I can talk to you more about, you know, some of the essential, some essential oils, right. Um, that’s a whole other topic. All right. And, okay. So thank you. And I hope to see you next time.

 

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Communicating with Confidence

 

 

I think the first thing that I would say is that, my experience is that most people are not skeptics or, you know, this kind of, what I call these official pseudo skeptics. So people who spend a lot of energy trying to debunk things like acupuncture.

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Hello and welcome to another edition of To The Point. Very generously produced by the American Acupuncture Council today. I’m very excited. My guest is the well-known and beloved Mel Hopper, Koppelman, and Mel, for those that don’t know is the executive director of evidence-based acupuncture, an international nonprofit organization dedicated to improving public health through better information about acupuncture’s considerable evidence base. Uh, she completed her masters of science and acupuncture at the Northern college of acupuncture in New York in 2012, and has kind of taken the world of acupuncture by storm since then. Uh, she also has a second master’s of science in nutrition and functional medicine, uh, from the university of Western states in Portland, Oregon, she’s published numerous articles about acupuncture and she practices at her clinic Harbor, integrative health in Bristol, Rhode Island. Uh, so now, you know, so many of us know a little bit about acupuncture research, want to know more and also want to be able to communicate it to both the public and other medical professionals. Um, you know, what do you do when there’s a skeptic that says, oh, well, is the acupuncture just a theatrical, but they, the slave hour or something, you know, how do you retort these, you know, what kind of answer reply, and if you could give us some science to base it on so that we’re, we’re ready when that happens again.

Thank you. Thanks for that question. And thank you so much for having me on, um, I really appreciate it. And to the American Acupuncture Council. Um, yeah, so this is a great question. And one that comes up a lot. Um, I think the first thing that I would say is that, um, my experience is that most people are not skeptics or, you know, this kind of, um, what I call these official pseudo skeptics. Uh, so people who spend a lot of energy trying to debunk things like acupuncture. Um, and so most of the time people, um, that we might come across in different contexts may just be unaware, um, uh, that what of what acupuncture is or how it might help them. Um, and we can talk a little bit about some of the, um, scientific evidence that can help support that. If we’re talking to the public, mostly the public wants to know if we can help them.

Um, and that’s, that’s what I find. So, you know, I have this issue, will you be able to help me? And, and often they’re not going to need a, like a pub med reference bibliography in order to, to convince them, um, although sometimes that can be helpful if a patient or a client needs some support for communicating what they’re doing to other people. Um, that said, if we are speaking to medical professionals, and if we’re speaking in different contexts than having, um, referenced to the, uh, considerable evidence-based can be very useful. Um, and so the first thing that I’ve found, um, is that most, um, you know, depending on the context, most medical practitioners are simply unaware of how much evidence acupuncture has, um, which is a lot. Uh, so I think at last count, um, Cochrane had sequenced something like 14,000 studies, um, of acupuncture, which is more than for chiropractic more than for physiotherapy,

Right? Yeah. And somehow this, this is not out in the public or it hasn’t caught on somehow.

Right? I mean, things are definitely improving since I started, um, since I trained and then started communicating about it. But, you know, one thing that I really would love people to understand, and I was just having a chat about this with, um, Sandra Grassa who’s the, of [inaudible] working really hard at it. Yes. The global acupuncture community, um, really wonderful, um, intelligent guy. Um, and we were talking about how most people don’t realize that once the evidence is there and it’s strong and it’s repeated that doesn’t necessarily mean that it’s a treatment that’s going to be recommended in guidelines. And once the treatment is recommended in guidelines and acupuncture, um, one study found over 1200 recommendations for acupuncture in different guidelines. And, um, this was outside of China and Southeast Asia. So this was in north America, Australia, uh, you know, uh, Australia, New Zealand, Europe, you know, that, um, to my reading that may make acupuncture one of the most recommended treatments. Full-stop so it’s really, yeah.

Oh, I just wanted to interject that. Um, some people might not understand the context of the word guidelines that you’re how you’re using it. Can you explain what you mean by

That really great question. Um, so guidelines, um, will be produced by, it could be a government funded organization frequently, or let’s say a medically medical specialty group. And so there’s a group of experts who come together to review, um, all of the best quality evidence for a treatment for specific conditions to decide what they’re going to recommend. Um, so in the UK, there’s an organization, um, that’s abbreviated as nice. And so for the UK, this organization, nice will produce guidelines. Um, basically saying what doctors in the NHS should be offering, um, in, in other countries that works, it works differently. The United States, um, usually it’s a medical specialty groups will have different guidelines, also. Um, different government organizations will have guidelines. And so what most people don’t realize is that just because official guidelines recommend a treatment such as acupuncture doesn’t mean that, that it automatically gets implemented.

Um, so as an example, um, in the UK, the nice guidelines recommended acupuncture very strongly, um, for the prevention of chronic migraines. It was the second line recommendation, um, after trying a pharmaceutical and I never came across a doctor who was aware of that or who recommended it and patients weren’t aware of it either, even though it was within their constitution to be able to access it. And so, um, but on the, on the other hand, the guidelines had a weak recommendation for Botox, uh, by company called Alligan, which had much less evidence for its effectiveness applied to a lot fewer people, but how their GaN had actually taken the time to put together a hundred page document on how to implement the treatment in the UK. It trained up doctors. And so patients were very easily able to access Botox for migraines, um, on the NHS.

And so the difference there, wasn’t a matter of evidence because acupuncture had more and better evidence. It wasn’t a matter of the recommendations being there because the recommendations were stronger for acupuncture than for Botox. It was a matter that, um, I think many people, including the acupuncture profession, um, in various countries might assume that there’s an automatic, uh, once that recommendation is there, then people will have access and practice in the practitioners will know about it and they’ll be recommending it. And, you know, our doors will be flooded and that’s simply not the case. And so, um, you know, circling back to what you said before is that, you know, people, uh, you know, there is so much evidence for acupuncture and comparatively more evidence for acupuncture than other modalities that may have a stronger branding or people are more aware of, but we just, um, we need to do more perhaps to communicate it. So that’s in the consciousness of the public and the healthcare decision-makers

So public relations campaign.

Yeah. Well, this is it. Um, you know, yeah. Public relations campaign. And I know, um, you know, Matt Bauer at the acupuncture now foundation, he has thought a lot about that and about how to implement that and what the funding would look like for that. Um, the role that the evidence-based acupuncture, um, plays is by summarizing the evidence so that it’s available to be used by, let’s say, um, a public relations campaign, because what different organizations in different countries have found the hard one expensive way is that, um, reading and interpreting and communicating evidence about acupuncture is a really specialist skill. So you can spend, if you’re an organization, you can spend a lot of money on hiring really good PR people that doesn’t necessarily mean that they have the expertise to be able to get across some of the nuances, um, that involve, you know, what we do and how we’re studying.

Hm. So what do you think is the best way to go about this?

Well, yeah, no, I mean, that’s, that’s, that’s a nice question. Um, you know, I think one is first for us to have a better and maybe more accurate understanding of what the challenges are. So when I went to college, uh, for my MSC, um, I guess, you know, over a decade ago now, um, at that time, you know, most of the, the writing and information that was discussing acupuncture in terms of science was written by, by skeptics, by people who basically did not like the look of what we were doing, didn’t understand what we were doing. Um, and just, just thought it was stupid and wanted to tell people not to. And there wasn’t really any other kind of scientific or evidence-based perspective to counter it. So if you were, you know, kind of, uh, an educated, but not medical Joe public, and you wanted to know what the deal was, you really, you, you had either these, um, medical doctor skeptics saying that it’s a theatrical procedure, or you have acupuncture websites that talk about changing and yang, which people might not understand.

And so it might put you off a bit. Um, and so when I went to school, the message that I was getting from my, um, faculty was that there wasn’t much, it wasn’t much evidence for acupuncture because it wasn’t funded and because it was difficult to study, and I believe that they were just believing the skeptics. And when I started to kind of look, you know, look at what the skeptics were saying, and I was really, um, unimpressed with the strength of the arguments. I was like, kind of hoping that it would be like just some really good criticisms of what we did. And I found it was really weak and really not well thought out. Um, and then when I started doing a really basic literature review, I found like loads of studies and systematic reviews and tons of evidence. And so the first problem, um, to, to overcome was to help acupunctures know that what we do actually has a strong evidence base.

So that was, I understand the first problem. And then the second problem I would say is that, you know, research in all fields, especially in medicine is produced far faster than anyone can read it. And so, you know, within the profession, there is often still this kind of idea. Like we need more research that may be partially true. I’m not saying, I’m not saying we should stop doing research on acupuncture, but we, I think even more need people to, uh, to find, read, summarize, and communicate the research has already been done. So that’s the second problem is, is like kind of becoming aware of what’s there and getting out to the practitioners and to people who are working on policy and who were working with legislators at the state and national level. Um, and then the third thing, you know, is doing that. So you can get it into the guidelines and that is happening, right?

So, um, in the UK, the most recent, nice guidelines, um, for chronic pain that would publish in April, 2021, recommend acupuncture for any kind of chronic pain. It’s a very high recommendation. It’s incredible, it’s unprecedented. Um, it’s a really strong recommendation. It’s a really big deal because not only does that affect, uh, the, the population of the UK, if we can help the implementation. Um, but also other countries look to the nice guidelines to inform their policy. So, you know, getting into the guidelines. And then, um, I think the next that next piece is like us realizing that we need to do the implementation is not automatic at all at all. So in fact, you know, having, um, acupuncture rec recommended, uh, in Medicare guidelines here or in, um, the, uh, like joint commission, which is the organization in the United States that regulates all hospitals like over 20,000 hospitals, um, they have guidelines saying that non-pharmaceutical treatments must be offered as a first line of care to kind of prevent unnecessary opioid problems. Um, and they include acupuncture at the top of that list, but that does not then translate into automatically having an acupuncturist in every hospital at all. So we need, um, so, so my first thing is we need to do, uh, I think a good job of testing our assumptions of what the real problems are and making sure that we’re identifying the problems and then kind of solving them in a way that makes, um, the most, the most sense. Um, so that’s, that’s, uh, that’s how I would solve that.

Would it make sense instead of just trying to promote it to the public, these kinds of things, uh, to try to educate the doctors because through them, they w you know, they’ll be referring and then patients will become educated.

Yeah, that’s a, that’s a great question. Um, you know, I, I don’t know how much of the people who watch this are an international audience versus a US-based audience. Um, okay. Cause there’s, um, there are, you know, quite a few geographical considerations in terms of who’s paying for it. Um, so, you know, when, when, uh, the patients or clients themselves are able to make their own decisions, then you, um, you know, then you’re educating them and letting them know that you can help them solve their problems. Um, if we’re working through insurance, you know, and acupuncture is increasingly included on insurance plans, um, in the United States in different places. Um, but certainly I think the big thing, you know, I’ve had conversations with colleagues and one of their, you know, what questions they have about communicating with doctors about acupuncture, what a lot of them said was eating, getting them to care, uh, that it exists, like getting, getting them to show up to a meeting.

And so what that brings up to me is that we want to be really savvy about, like, thinking about what are the problems of the person or organization that we’re talking with that we can help solve. So, like, you know, doctors shouldn’t care that we’re, acupunctures just because we’re acupuncturists. Like what, why should they care? Well, let’s understand what their problems are and what they can. So, and what’s really beautiful about how acupuncture works and evidence-based for acupuncture. And I don’t think this is coincidental is that the evidence for acupuncture’s effectiveness is wrongest the conditions, the wishes, there are the least effective and safe options in conventional medicine.

Hmm. So we know that acupuncture works and there seems to be a resistance to the Western medicine based from adopting it. And it is often marginalized as alternative medicine. Can you speak about that?

Um, sure. I mean, that, that’s, uh, a, well, I mean, a couple of things like that, there’s different ways that we can look at what that means. Um, sometimes skeptics or critics will say something like there’s no like real medicine and alternative medicine, there’s just medicine that works and medicine that doesn’t work. And so, uh, from that perspective, I would say, well, you know, acupuncture is clearly medicine that works by the standards that are set forth for studying an intervention for a variety of conditions. And I do want to step back and say that if we’re talking about a treatment for a condition, it’s not, nothing is really, uh, ever framed in science that it either works or it doesn’t work. It’s really a question of, uh, what is the condition and what is the population and what is the intervention and compared to what oh, okay. So, uh, and there’s like a really, um, uh, big, uh, compared to what, um, thing that we need to bring to this discussion. On the other hand, um, in certain

Those kinds of comparative studies are, are, are important for validating acupuncture, uh, or to, uh, a prescription drug or another modality.

Yeah. So there’s, um, that’s a really good question. So for folks who are watching, you might not come across this before. Um, there’s a number of common ways that interventions are studied. And so most commonly, especially for pharmaceuticals, they’re studied, um, in a double-blind placebo controlled trial, where we’re trying to really control the environment in a very artificial way and remove all these different, um, variables. So we can study the medication and that’s standard for, um, for any treatment that doesn’t involve the practitioner doing anything and just handing over something to be taken. Uh, but it doesn’t, it’s not an appropriate design for any sort of, um, like kind of treatment that involves the practitioners. So for sample like surgery, you know, you can’t do a double blind placebo controlled trial and surgery. You can do sham controlled, which we can talk about, but, um, you can’t blind the surgeon, you can’t do sham controlled therapy, you can’t do sham control.

So anytime the practitioner is guiding the treatment, the practitioner, um, will, will know about it. So it’s just not the appropriate design for that type of Mo of modality. And then, um, on the other hand, you can compare a treatment such as acupuncture to what else is on offer. And really, you know, neither of those designs, I just mentioned, uh, placebo controlled versus kind of a real world, uh, effectiveness study. Neither one of these is right or wrong, good or bad. They just answered different questions. And the questions that patients have, and that clinicians have is I have a patient in front of me who has this problem, what are the options? And what’s the best option for this patient. So they’re comparing it to what else is on the table. So the study design that answers that question is what’s called a pragmatic study that measures acupuncture against, uh, the other things available. So that’s what that does sort of makes it makes sense.

So I first became aware of you on social media with your, um, work with Wikipedia. Can, you know, you had such brilliant responses to the pseudo skeptics, and I know it wasn’t just with Wikipedia. Can you tell people a little bit about that and you know, what you’ve done and where that situation is now?

Sure. Um, that’s a really good question. And it’s, it’s one, I know I’m glad that we’re bringing it up because this is one of the most common things that gets mentioned, uh, by acupuncturists and practitioners in any form is like, okay, well, Wikipedia is the, uh, encyclopedia that anyone can edit. And if you go look at the article on acupuncture, to be honest, I haven’t checked for a little while. Cause it, uh, it doesn’t change too much. Um, they don’t, they don’t have nice things to say about acupuncture at all. Um, and they don’t include, you know, the various Cochrane systematic reviews that show that acupuncture is more effective than sham or effective than usual care. They don’t include the guideline studies. They don’t include all these things. Um, and so, you know, what’s the deal. Why don’t, you know, why don’t we just end it?

Why don’t we do something with it to deal with their bias? You know? Yeah. So, um, you know, editing Wikipedia is something that, you know, I was part of a acupuncture research, um, group back. I was in the UK at London, south bank that meant, um, every so often. And it was a project that we identified, like, we need to do something about this. This is nuts. Um, but, um, you know, and, but various, uh, people, uh, very, um, very noble worthy people have tried and failed to edit that page. And so I decided to go on as an experiment just to see what the deal was. And so, um, this was actually quite a few, this was back in 2016. Um, and so I registered as an editor and I learned enough about the rules of the game to make sure that I didn’t break any rules so that there was been no grounds for, you know, there being any problem. Um, and acupuncture is one of the top 10 most contentious pages on with the piece.

What about COVID,

Um, possible, but it doesn’t have the history. So, um, you can even, you can kind of look back and see the number of edits. I mean, I can only imagine there’s thousands and thousands of pages of conversation. A lot of it not very civil about what’s on that page. Um, so it gets, so you’re not even allowed to come on as an editor and start editing. Um, you have to kind of earn your stripes, but you can participate in the discussion. So I entered, I joined that discussion. I was, uh, respectful. I did not break any rules and I simply provided a very standard references, Cochrane, systematic reviews, you know, talking about different things. Um, and within a week I had been banned as an editor forever. Um, yeah, they, they accused me of something called sock puppeting, which is when an editor is banned and then comes back under a new name.

So they were basically an, I kind of went and looked at the person that they were accusing me of being, and it was interesting. Um, I can assure you that I’m not her because her, uh, her only Wikipedia page that she ever wrote, it was on, uh, Korean pop. Um, that’s, that’s not me. I have like plausible deniability, like, um, that song came out years ago. I was like the last one to hear about it. So yeah, so we’re not the same person. Um, what we had in common is that we were, um, up on the research and was able to reference it in a, in a valid way. So we were basically just you report faithfully and accurately and fairly reporting the science. Um, and that’s why they thought I was hurt, which is a little bit sad. Um, more recently, Larry Sanger who’s one of the co-founders of Wikipedia, um, has spoken out on really, you know, when, when Wikipedia was initially founded, it was really, um, central part of it was, um, a neutrality policy so that that anybody could edit it and that it would reflect a plurality of views.

And, uh, he is pointed out how it very soon veered from that course. And now, you know, there’s like huge companies that really control that content. Um, in the case of the, of the acupuncture page, the individuals that I was, you know, being banned by, or being named cold by, or being criticized by, um, these were really early adopters of Wikipedia editing. So a certain personality and they, none of them have medical backgrounds and none of them have research backgrounds. Um, they’re mainly they have pharmaceutical backgrounds, um, in this case, I don’t think so. Um, I’ve never found evidence to support that. Um, but, um, but certainly they have a specific point of view that does not come from, um, a deep understanding of the subject matter. Um, and that they’ve been effective at kind of keeping us all out. Um, at one point, you know, we did, um, start a, uh, a kind of a petition and a movement to kind of call attention to the towel. Crazy. This is it’s, you know, acupuncture is recommended by governments all around the world and it’s included on health insurance. I mean, at this point, as I said, it’s really not alternative medicine in that way. Um, and we were not able, they just listed by their, their neutrality policy. So

It sounds like you tried to confuse them with the facts

I did. I w it was too easy. Um, so yeah, so, so for those, you know what I understand, I mean, the, um, unfortunately Wikipedia is the single most referenced website in the world for medical information by doctors, not just the public. And so, um, that’s just, you know, kind of, unfortunately, a sign of the times these days is that we do have these kinds of centralized nodes of information that don’t necessarily reflect. Um, you know, that can often reflect a certain point of view. That’s not necessarily, um, in line with public’s best interest or at least, you know, in the case of acupuncture, just being able to here’s some information about it and not just a, you know, kind of a one-sided view.

Yeah. Well, is there anything you want to lead us with, uh, you know, whether it’s the direction of things are going or, you know, a particular place to reference studies or whatever, whatever you’d like to, uh, think would be helpful?

Uh, yeah, no, that’s a great question. Um, a couple, a couple of things. One is, you know, I mentioned that sometimes acupunctures, um, can refer to as an alternative medicine in a way to discount it and to, um, to, um, to basically say that it doesn’t have an evidence, but on the other hand, sometimes it gets lumped in with all wonder if that’s a Larry singer Wikipedia call it. Um, so sometimes it gets lumped in into this like kind of alternative medicine bucket and it gets undifferentiated. So it’s like, oh, you know, alternative medicine, like natural medicine, you know, massage and hung me up at the acupuncture. And, and, and it gets kinda lumped into this undifferentiated bucket and the danger there can be, as you know, that there can be an increasing awareness of the, um, unintended side effects of pharmaceuticals and people trying to find alternatives.

But, um, there, you know, what we can do for people can be really diluted if we get lumped into that bucket, because acupuncture has an incredible amount of evidence. And so, and it, and it is also a system of medicine or, you know, it’s part and parcel of the system of medicine, um, and of itself. So that’s a little bit of a danger that we want to be aware of is that we want an increase. Um, I guess, um, we, we want to be available for people who want an alternative, but also understand that we’re not kind of just like a wishy washy touchy, feely, um, system, um, not, not to disparage any of those things, which, you know, I been training in and I go see, and they’re helpful as well. Um, so that’s, that’s one thing I would say, just to be kind of aware of that, that pitfall, you know, what we find with acupuncture is now that the evidence is so good, um, a lot of different professions want to use it.

And so, you know, we need to again be mindful of, um, you know, where our true challenges are and how we address those skillfully. Um, Ellen had a question about how to educate patients. And so this may be, um, is a kind of good thing to come back. It’s like the, you know, first is be really aware of your audience and who you’re speaking to and what your intention is and what their needs are. Um, so, you know, depending on where you’re located in the, um, like background of your patients, some may want research and evidence. Um, often I find that comes from a fear of seeming foolish, you know, not to kind of psychoanalyze anyone, but people would just want to know that there’s not enough that they enjoy it and that, or that they feel better. They want to know that there’s, that there’s evidence some, just find it interesting.

Um, and many, you know, really just want to, um, to know if you can help them. And I think Al asked the question before, yes. About researcher testimonials. And I think, um, you know, I’m, I’m not a marketing guru, but I think testimonials and, and, um, kind of pro social proof probably is the more influential, well, I mean, a good place to look at it from a political, I mean, that’s a good we’re testing it. And the pharmaceutical ads don’t tend to emphasize uh evidence-based to emphasize couples skipping around and smiling. So, um, that’s, I think they’ve done their research on what works. So that kind of told me that they’ve done their marketing research. Yeah. But wiling is more effective to get people to purchase then, um, then, then lots of systematic reviews

Because not all testimonials are real. I tend to trust the research more than I do testimonials.

Yeah. And that’s, I think, uh, my understanding there is that that’s why you see a move towards testimonials that are more difficult to fake. So if you can get a video testimonial from a patient, it’s kind of, you can tell that that’s not an actress or an actor, um, and we’re, or people using their real names, um, that, so that social proof is going to have more value. And I think that really just on a psychological unconscious level that does have more, um, you know, it’s almost like people need the, some people need the research in order for them to stay for the conversation or to be open to the conversation so that when they see the social proof, um, they’re, they’re, they’re, um, you know, which is different than a patient kind of coming across acupuncture. And then we just, you know, presenting tons of systematic reviews at them.

Um, I think what we know from a marketing research and psychology is that the social proof is probably gonna have more of an impact, but we want to, we want to just at the top, down in the bottom up, so the bottom up is you, um, influencing, uh, you know, people let it, I should say, letting people who we can, who might benefit from our services know that we’re there and that we can help them. But at the same time, we also want to make sure that if we have systems of healthcare that are being paid by different government institutions, that, that, that awareness is happening on that level as well.

Sure. Oh, is that a multi-faceted approach? Well, thank you so much. I really appreciate you coming on. Cause you know, it’s nice sunny summer day. So, um, you know, w we can talk again soon and go into some more specifics and thank you everybody for watching. And next week we have as a host Tsao-Lin Moy. So I hope you’ll tune in to see her. And again, thank you to the American Acupuncture Council and, um, Virginia Doran of luminous beauty.com this season. Thank you.

 

 

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97140 for the Acupuncture Provider – AAC Info Network

 

 

And I always like to have a little bit of time to talk about what codes are billable, how do we build them? What do we do correctly? I think that’s often a problem, by example, what actually is manual therapy?

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.

Okay. All right. I apologize for some technical difficulties, but welcome. This is Samuel Collins, your coding and billing expert for acupuncture, and specifically the American Acupuncture Council network, your go-to place for making sure you’re coding and billing are together. And quite frankly, your business sense. So if you’ve not checked us out, come to our site, but let’s focus in on what we want to talk about today. And I always like to have a little bit of time to talk about what codes are billable, how do we build them? What do we do correctly? I think that’s often a problem, by example, what actually is manual therapy? What does that mean? And how is it different? So let’s, let’s start here. Let’s talk about what manual therapy is. Well, part of dealing with CPT codes. I’m not sure if you’ve ever watched the show, the bachelor, and I’m a little embarrassed to say.

I have seen it not very much, but I, one time looked at the CPT codes and realize CPT codes are often simply like the bachelor. What I mean by that is you ever notice how kind of ambiguous sometimes they are. So think of it this way, the bachelor like CPT codes tends to be ambiguous, overlapping, and not clear to what their intent is. So think along these lines, when you look at these two codes and you’ll see here, I have them highlighted massage 9 7 1 2 4 and manual therapy, 9 7 1 4 0. How are those different? I mean, if you think of it, isn’t massage a manual therapy, isn’t it hands-on. And so that’s one of the issues we have to kind of deal with was where’s this differentiation.

So by example, take a look at these two pictures, the picture on the left picture, on the right, which of those actually would constitute bodywork. And what I mean by that is, is the one on the left massage, or is it manual therapy or is the one on the right? And there, I think is one of the issues I think we have to address for acupuncture providers is to really differentiate between the two as to what are we doing? Why are we doing it? If you will, where we’re doing it. And all those factors come into the coding and billing. Obviously body work is something that’s integrated into the acupuncture principles and traditional medicine for that matter. So let’s take a look. What is massage? Massage says, it’s a procedure that includes Effler Rouge, you know, circular motion, petrosal lifting and squeezing to potent stroking, percussion, even needing.

So again, kind of the standard massage things we all think of. And what’s the purpose of it? Well, muscle function to an extent, but if you think of it, probably relaxation, circulation, stiffness, uh, generically, it’s used to increase circulation and promote tissue relaxation. If you think about why do people get massages to relax that can help modulate pain a little bit. So, okay. So that’s the purpose of massage and that’s the style now, conversely, let’s talk about what is manual therapy? Well, let’s first look at the code manual therapy or the service manual therapy, 9 7 1 4 0. It says specifically in the CPT manual that says they are manual therapy techniques that include by example, mobilization manipulation, manual lymphatic drainage, manual traction, and it says one or more regions. Now that’s not a very big description when you think of it. So manual therapy techniques basically are hands-on services that go beyond standard.

Just simple massage, more, I would say deep tissue, if you will kind of to break up adhesions comparative to say just simple massage notice here, it includes things like manual trigger point therapy or myofascial release. Those would certainly be considered within that. Now let’s talk about it from a standpoint, how is it defined under the standards by the American physical therapy association? Since they’re the one that commonly used it let’s look at what they say. It says manual therapy techniques are skilled hand movements and skilled passive movements of joints and soft tissues that are intended to improve tissue extensibility. Now, I want you to notice here, the difference of that two massage massage said relaxation. This notice says tissue extensibility, and it says increased range of motion, induce relaxation. So there’s some overlap, modulating pain and reduced soft tissue, swelling, inflammation, or restrictions techniques may include manual lymphatic drainage, traction, you know, massage mobilization.

So you’re kind of going, well, wait a minute. They’re just kind of saying the same thing. So really how do I differentiate? What is manual therapy, comparatively? So types of manual therapy, well, manual traction. Is that something that acupuncturists might do? I think so joint mobilization. I want to be a little bit careful there because obviously you can’t do manipulation, but mobilization of movement certainly makes sense. And then there is of course myofascial release, and I think that’s the one we focus a little bit more on. So you notice here, a myofascial release says soft tissue mobilization. One or more regions may be medically necessary for the treatment of restricted motion and the soft tissues involved in the neck and extremities. So in other words, notice the emphasis towards manual therapy to be about tissue extensibility, that there’s restricted motion.

So manual therapy, what’s the difference? The difference is more about the goal of it. Obviously you put two hands on a person like those pictures I showed earlier, which is massage or manual therapy. It’s more about what you’re attempting to accomplish. So notice here, it says the goals of manual therapy are to treat restricted motion of soft tissues in the extremities, neck or otherwise, and restore soft tissue function or muscle function, meaning a restricted area. You’re breaking up the adhesions. So there’s normal movement movement without pain and increased extensibility. So you notice the keep emphasis here on extensibility. So how would you differentiate if you’re doing a hands-on simple squeezing, I would say certainly would fit massage, but if you’re doing it to break up literally adhesions in the muscles or restricted muscle that has now been shortened, that would be the myofascial release or if you will manual therapy.

So where do we fit that though with traditional medicine statements that include things like TuiNa or Washa? So TuiNa of course is literally the meaning of pension pool refers to a wide range of traditional medicine bodywork, but it’s considered probably the oldest. In fact, I would say everyone that’s doing massage is probably a form of this to an extent anyway. So with between a fit, as manual therapy or massage, well, I will say it could fit both because it depends on the level, the depth and what you’re trying to accomplish. So think along the lines of more, what is the goal of the therapy more than just because it’s hands-on, hands-on doesn’t necessarily mean it’s massage or manual therapy, but what you’re doing, but the why you’re doing it now, what about what shadow it says to scrape? That’s what it literally means. And it says a method in traditional or in traditional Chinese medicine, which includes the skin of the neck back.

And shoulders are limbs with dis lubricated and pressured or scraped with a round edge instrument. I think much like that. You’ve seen where people do these things called fascial abrasion techniques or breast in which I think often is just really a bastardization of Washoe to an extent. Now I’ve seen wash out, include a lot of things. So I want to be careful, I’m talking about that tissue scraping. Now, what would that purpose be? It’s done manually, even though it’s with the tool, it could be with your hand. Would that be more for a release than it would be for relaxation, obviously, an area that has an adhesion. You want to break apart that scar tissue that’s going to be more the myofascial release or the manual therapy. So what I’m trying to bring back here is that what you want to look at when you’re doing hands-on therapies to distinguish whether it’s massage simple or manual therapy is more about what is the outcome that you’re looking for?

What are you looking to change? So within that, I want you to think of purpose. What is the purpose of what I’m doing? That’s going to define it more in CPT. What they say is don’t choose a code that approximate, but what says exactly? So you might be doing a manual therapy. Let me use the term broadly, but yet it could be massage or it could be the more deep tissue work which equals the code for manual fare. Remember manual therapy was a code introduced in 1999 that replaced a lot of codes. It replaced traction, it replaced myofascial release. So it’s kind of a conglomerate code, but more meaning again for our purposes, kind of the deep tissue. So what I’d like you to think of is that when you’re appropriately coding for manual therapy, what is the purpose? If it is for tissue extensibility and range of motion, manual therapy after for simple muscle relaxation and pain modulation massage, okay.

Now beyond purpose, then I’ll go back to this picture, which of these is this massage or manual therapy? Obviously, as I mentioned, you can’t tell, but I will tell you the one on the right is the manual therapy picture. And the reason why is that one is being done to break up adhesions within the gastrocnemius and soleus in order to reduce restricted movement to the Achilles tendon. Whereas the one on the left, though, you could argue, what’s going to be, could be as deep that’s clueless, just relax the trapezius area in the shoulder region, if you will. So think of if I’m going to bill for manual therapy or provide manual therapy, just make sure you’re documenting the manual therapy. It’s hands-on but more about the purpose and the goal. So within that, what do you need to document? And this is really important part.

Obviously, if you’re billing for manual therapy, the big issue is that we have to show it. So documentation must be include that area. You’re doing the service also though, the or technique you’re using. And again, there could be a wide variety. Don’t be afraid of describing things like muscle, energy, PNF, things of that nature would fit certainly statements of myofascial release. What I want you to be careful of is don’t simply say I did manual therapy, identify what the styler technique was also indicate there, the start and stop times, or frankly, just the time. Remember this is a time service, much like is acupuncture. And so you do have to document time. Now you can document time. A couple of ways. You can just tell me how many minutes you spent, or you can do from into, if you say, Hey, I started at 10 and I ended at 10 20 of the 20 minutes either way, tell me how much time you spent because it’s time derivative.

And then along with that, the expected goals, and this is probably the more important factor to make sure you distinguish it from massage. I did myofascial release to the right shoulder to increase range of motion due to restrictions about the, you know, the clavicle area or the deltoid, something of that nature. Subscapularis you name it? Any of those would certainly be fit, but just tell me what the goal is. It’s more about the outcome then the service, could there be a mixture? What if you did some deep tissue work, but it also included a little bit of massage? Well, that certainly is fine. Just remember the bulk of the work would be the manual therapy. Therefore that would be the more appropriate code to bill. Now it is a 15 minute service and I’m sure you’re all aware. Does it require the full 15 minutes to bill for one unit just like acupuncture.

You do not have to spend a full 15 minutes face-to-face but at least eight minutes. So remember the eight minute rule does apply with this code as it would with massage for that matter. Now what it was billable here though. So here’s something I want to bring up about the eight minute rule. That’s often confusing. In fact, I did a program this weekend at the Florida state Oriental medical association. And one of the questions that came up was about timing. So I’m going to give you a little quiz here. Let’s see if you can pass. What is billable here? What if I do tend to 10 minutes, face-to-face doing acupuncture. You know, I insert some needles manual. And in addition to that, I do another 10 minutes of massage or manual therapy, either one don’t care. So I’ve spent 10 minutes on one, 10 minutes on it, the other, what can I, bill?

What will you bill for this visit? Can I bill for both codes? I’ll give you a moment to think about it, which is appropriate. Well, what is going to be appropriate? We have to do the eight minute rule. The time you spent with the patient, if you recall was 20 minutes total, remember 10 minutes in 10 minutes. Therefore, how many units is 10 minutes? We’ll look at this little chart and you’ll notice one unit is eight to 22 minutes. So if you only spent 20 minutes, can you bill for two units? And this is what’s important to remember, even though you’re doing two separate services, the time is cumulative. So if you’ve only seen, I spent 20 minutes, you cannot build both codes. Now you get to build one of them. Of course. And you always get to build the one that has a higher value, but you can’t build both.

So do make it important to always document time. Now, keep in mind. That’s because you spend 20 minutes. What if you actually spent, say 13 minutes on acupuncture and 10 minutes on the manual therapy would both be billable. Well, they would because you’ll notice two units is 23 minutes. So it becomes very imperative that you document the time properly in your file because frankly, that’s all someone’s ever going to look at. They’re not going to question so much the service as much as did you document it. What did you do? Where did you do it? And how much time did you spend?

So what about modifiers though? And this is a confusing area for acupuncturist because I’ve seen many of you say, Hey, do I need to have a modifier 59? When I bill this therapy? And the Frank answer is you do not. No modifier is typical on a claim for an acupuncturist when it comes to physical medicine codes for most plans. Now, bear in mind. Some people will think, oh, I have to put modifier 59. That is necessary for chiropractic providers, but it is not necessary for you. Chiropractors have to demonstrate a separate from manipulation, but not for acupuncture. So a 59 is not necessary on this code because it doesn’t have to be distinguished from something else. There’s no correlation of manual therapy to acupuncture. However, what but you want to make sure is is that though I don’t need to distinguish it from acupuncture. Are there some things we might have to do?

And this is something I want to make clear to not have anyone confused. We’ve done a program on this. You’ve been to a seminar with me. You’ve heard me talk about it as well. How about plans like United health care, Optum health, Anthem blue. Those companies require that when you build a physical medicine code, which includes manual therapy, you have to include modifier 59 or excuse me, modifier, GP, excuse me. So that true for all physical medicine codes. So if you’re billing a physical medicine code to United Optum Anthem, put a GP. Now notice, I didn’t say Aetna, I didn’t say Cigna. So don’t automatically add those in just because you’re billing, but to those carers only, but distinctively doesn’t acupuncturist need to put a 59 on manual therapy. You do not. There’s no need to distinguish it as a separate distinct service. So keep it simple, provide the manual therapy, why to reduce adhesions, increase range of motion.

If you’re doing it more for relaxation, likely massage bottom line is let’s make sure we’ve documented and build for it. Ultimately, if you’re providing a service, I want us to be reimbursed for it. I don’t think you should have a free clinic. No one has free clinics or at least at least no one. That’s trying to make a profit off of it. So I want you to keep in mind though. What about your state now? Of course, this is going across the whole United States. Now do most states have licensure for acupuncturists where they can do manual therapy or therapies? They do. By example, I’ll give one New Jersey has a very broad scope of practice, which clearly allows the service, but New York does not states like Florida do. And most states do so make sure you know, your state and what you’re allowed to do. But I will say generically, most states do allow adjunctive therapies and this can be within scope, but always check within your state to make sure am I practicing within my scope because some states do not.

So I don’t want to make this a blanket that everyone can do it because it may not be within your scope. Ultimately, what we want to be able to do is to make sure your practice can continue to thrive and enhance the care of your patients. I want you to do the services that are necessary for your patients to recover and get the best outcomes. Manual therapy certainly can be part of that. Let’s make sure we bill it right by documenting what we’re doing, where we’re doing it and the purpose. And of course time, ultimately we are your resource. If you’ve not taken a moment, come to our site, the American Acupuncture Council Network, AAC info network. We’ve got a new section there that is free to all of you. Don’t even have to be a member. We normally have a membership where I become part of your office.

I help you on a day-to-day basis with all types of issues, but we post a new section. So if you’ve not seen that, I would suggest take a look there. Cause we’ve got a lot of updated information on requirements for vaccines, whether it is or is not what’s going on with other issues regarding the ADA and other issues for acupuncture offices. So with that, I’m going to say thank you all very much. I’m glad to always spend time with you. Next week will be Virginia Doran and as always the American Acupuncture Council is always your resource as am I come and take a look, go to my Facebook page as well. And I welcome any questions from you. Thank you everyone. See you next time.

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Cluneal Nerve Entrapments: An Often Overlooked Cause of Low Back Pain

 

 

We’re discussing actually some case studies in low back pain and how routinely it is so important to check for cluneal nerve entrapments that could be contributing to the patient’s low back pain, or even mimicking it being 100% of the low back pain.

Click here to download the transcript.

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 thank you very much for coming to the American Acupuncture Council, our sports acupuncture webinar. We’d like to thank the American Acupuncture Council for sponsoring us with this. I’m here with my friend, colleague and partner in the sports medicine acupuncture certification program. Brian Lau.

Hi, nice to be here again,

Brian and I were discussing just the other day about the upcoming module two low back hip and groin webinar that we’re having in the anatomy pop patient cadaver lab. We’re discussing actually some case studies in low back pain and how routinely it is so important to check for cluneal nerve entrapments that could be contributing to the patient’s low back pain, or even mimicking it being 100% of the low back pain. For example, the superior cluneal nerve entrapment can mimic yarn syndrome pain at the iliac crest, or it could be maybe 30% or 40% of that con contribution to the pain. So something just to routinely check in your cases of low back pain to see if an attraction is contributing to part of it. So I think we could probably just start bouncing right into it. So, Brian, do you want to go ahead and take it away and we’ll just go to the next slide.

Yeah, sure. So, uh, we’ll go, um, pass the title slide here. So into the next slide, and we’re going to start by, um, just giving a quick overview of the clinical nerves. So you have three circles that you see there. Uh, we have the superior cluneal nerve, so that’s that upper circle, uh, that I’m going to cover quite a bit in just a moment. So just for now, yeah. There’s the highlight, uh, showing the superior cluneal nerves now there’s multiple ones. Um, and we’ll, we’ll talk about that in just a moment, but then below that, in that middle circle, we have the middle cluneal nerves. Uh, those mats going to go into a little bit more, we’re both going to discuss some, but, um, he’s going to take that primarily. We’re not going to be discussing the inferior cluneal nerves, that bottom circle, uh, in this particular webinar, just because, um, this one is a little bit more on causes of low back pain and fluid inferior cluneal nerves, or are important.

Maybe another day we’ll cover those, but we’ll focus more superior and middle. Uh, so these nerves are cutaneous. Nerves are sensory nerves. Um, they, uh, then that means they’re going to be primarily innervating the skin. So they’re traveling in the subcutaneous tissue and innovating the skin. Uh, so let’s go ahead and move on and we’ll go right into superior cluneal nerves. So the superior cluneal nerves, uh, come from, they stem from [inaudible] the dorsal ramus. They travel posterior, uh, as they get more inferior penetrate through fibrous tunnels within the thoracolumbar fascia, uh, then they branch over the iliac crest to become subcutaneous where they, uh, innovate the skin and the subcutaneous tissue. Uh, so these are a common site of entrapment. Uh, so this, uh, superior cluneal nerves can becoming trapped in the superficial layer of the thoracolumbar fascia and can contribute to low back and leg pain.

Uh, just the note is that’s a little bit of a shorthand. So when it says that they, they, uh, stem from L one through L three travel posterior, there’s a whole lot of territory, you know, they’re not traveling through empty space at that time period. They’re actually traveling through structures like the, so as they’re traveling sometimes through the quadratus lumborum, but usually between the psoas and the QL, they travel through the para spinal muscles. So there’s a lot of territory, uh, in that region that we might be able to come back to later on in the, in the webinar to differentiate between various types of injuries. Our focus though is going to be on that, uh, area where they Pierce the thoracolumbar fascia, just at the iliac crest region, and then drape over the iliac crest. So maybe more on the other, other areas later, but let’s go with the entrapment site that we’re talking about in this webinar. So that’s the superior cluneal nerves and their site of entrapment.

So in, in terms of, uh, entrapment, there’s a, these are all the superior cluneal nerves, but there’s a middle or medial. Uh, one of those though, you know, the one that’s most medial, uh, then there is a middle or intermediate and then a lateral, uh, superior cluneal nerve. So these are all superior cleaning, the nerves that we’re talking about now, but we’re looking at the multiple nerves. So the medial most the middle and the lateral one, and it’s usually the medial branch that is commonly affected, uh, in terms of, um, becoming and trapped. So they all can be contributors, but this, this medial branch is the one that we’re really, um, gonna focus on, uh, in terms of where it’s, it’s going to become trapped. So, uh, these traveled through a fibrous tunnel, uh, then they go over the iliac crest so they can get in trapped in that fibrous trunk tunnel of the thoracolumbar fascia, or they can get trapped between that and kind of adhering to the iliac crest. So there’s a lot of research out there. You can look into it if you want it to, to check more information about it, but this image really kind of highlights that fibrous tunnel that you can see that those medial branches of the superior cluneal nerves travel through. So it’s just a, just a sort of a fibrous tunnel through the thoracolumbar fascia. All right, so let’s move on next one.

So in a cadaver studies, the researchers found that this medial branch of the superior cluneal nerve was frequently adhered between the fibers tunnel and the thoracolumbar fascia and where the medial branch travels over the iliac crest located just lateral to the PSIS. So there’s a lot of studies on this. Um, why it’s studied in Western literature, uh, is twofold. Uh, they study it of course, because it’s an entrapment site and it can be a pain generator. It’s considered not super common of a pain generator, but it is a pain generator and it’s worth knowing about, uh, that’s one reason that it’s a study. The other reason that it’s studied is when they harvest bone from the iliac crest to use for, um, fusion for lumbar fusions, uh, they want to know, you know, it’s really important that they know where these, uh, cluneal nerves are, so that they don’t damage the cluneal nerves in the process of process of harvesting bone from the iliac crest.

So because of that, there’s a lot of really good research that that kind of gives an average of where these cluneal nerves exit, um, both, you know, the, the medial ones, the intermediate and the lateral ones. So they have it all charted out on various different cadaver studies, measured from the PSIS are measured from the midline. And if we look at this, um, medial branch of the superior cluneal nerve, it’s approximately in the region of Yan, you know, of course they’re measuring it from different criteria. They’re usually usually measuring in millimeters, but the measurement kind of comes to about that same measurement, uh, as Yan, which is three and a half sun from the lower border of L four, just over the iliac crest. So this being a common site of entrapment means that it’s also a contributing factor, or sometimes the factor for Yan syndrome, which is pain at this particular region.

Um, again, we can come back and differentiate this type of pain that’s caused from an entrapment of the superior cluneal nerve versus other things that are in this region. Like the Leo Castelli’s lumborum, which attaches to the iliac crest in that region, or deeper to that, the quadratus lumborum, which attaches to the iliac crest in that region. So being able to differentiate what’s the, the pain generator is important, but in that process of determining what’s the pain generator, we want to make sure that we take into consideration the, uh, the superior cluneal nerves. So those cause pain Ayanna, that pain might radiate down into the buttock region, and you could follow those nerves and see how they drape over the glute medius. And even over the glute Maximus. Matt, do you want to add anything to that kind of just jumped in and covering it, but

That was great. Yeah, that was really good. So, uh, just to reiterate the, the, on, we just published a, an article as well on the sports medicine acupuncture website, and it’s talking about the superior superior cluneal nerve entrapment at the extra point Yon, and also in the Yon region, just something to, for practitioners to consider that there is a cadaver dissection that we did. And we were able to find one of the superior cluneal nerves, which is a difficult dissection to tease out these cutaneous nerves. Um, it’s not just us, that it’s actually in some of the articles, um, that are in the references. Um, they talk about the difficulty of actually trying to tease them out and try to be able to dissect them, to see if they are entrapped or not. Um, Yon syndrome that we call it is also in Western science called iliac crest syndrome is basically the, um, the strain of the soft tissues within that area like Brian was talking about, could be the thoracolumbar fashion, the illiocostalis or the thoracolumbar fascia and the quadratus lumborum.

And this has been treated for thousands of years by acupuncturist, but yet the entrapment side also could be a contributing factor to that. So the patient is complaining of that low back pain. They may also talk about a mild parasthesia you’ll have to dig that out of them. Most people are not going to consider that as a chief complaint. Um, it’s just more of the low back pain in that Yon region. So the entrapment side is something definitely to assess which we’re going to be talking about. The very simple assessment coming up in just a little bit, Brian, should I jump into the next entrapment? Uh, yeah. Yeah.

There’s some other things that we can come back to later on. That’ll be more differentiation. Um, but, uh, just to highlight one real quickly, what you said about why these are so difficult to dissect is that they live in the, at least the process that we’re the part of them that we’re looking for, uh, in terms of where they drape over the iliac crest, those live in the adipose tissue, and you know, this dissection, I mean, this, uh, this image from Netter, they they’re so clear looking. It’s so easy to see, but in dissection and it all looks alike, it’s all the same color. These are little over a millimeter in diameter, so they’re super thin. And just finding them in that adipose can be very challenging and take time to look for. But, um, one highlight from the video that Matt referenced on the blog, um, that in the processing of this video, it’s funny how you listen to things over and over, and you never noticed something. I just noticed today, actually, when I was listening to it, that I say superficial cluneal nerve over and over again, instead of superior cluneal nerve. Um, so, uh, if you listened to that video, if you go to the blog post and you look at that, that dissection video, don’t be confused. It is superficial because we’re looking at it, look, our we’re highlighting and showing it where it would be in the adipose tissue. But I meant to say superior cluneal nerve and not superficial clinical.

Yeah, that’s good. Brian, I think, I think it’s important for people to understand that this is really quite superficial. So if we have the low back, you’ve got the skin, then you’ve got your layer of your subcutaneous tissue. Then it’s just underneath that. So people have been treating the superior and middle cluneal nerve entrapment for a long, long time with techniques with cupping. And guash on with acupuncture. All of those actually have a strong effect on this superficial tissue, which we’ll talk little bit more about Sue

And Matt. It sounds like your chickens are laying eggs in case people are wondering.

Yeah. They just, they, they, they love to interrupt these webinars. They do. All right. I was wondering if you could hear it. All right. So let’s go to the next slide. Thank you. All right. So the middle cluneal nerves, so let’s separate, let’s differentiate this from what Brian was just talking about. The superior cluneal nerves are further broken down to medial, intermediate and lateral. You can see those three nerves as the superior, right? That’s not circled in this particular image. So now, now we’re going to be talking about the middle cluneal nerves that are branches from the [inaudible] dorsal. Ramiah now like the superior cluneal nerves. They also exit through the thoracolumbar fascia. And then the cutaneous area for them to innovate is going to be the lower part of the PSIS medial, buttock and OXA also the coccsyx region. So a patient may be complaining of pain in that area. It could, it could be planning of pain in the SSI joint that at first glance, you’re thinking that it could be a sake really actually problem. Um, but then you further differentiate that possibly the middle cluneal nerves are part of this. And we’ll talk about that. And just a little bit, when we get into our assessment and treatment, let’s just break down the anatomy of it for, for us right now. So let’s go ahead and go to the next slide.

So anatomically here’s an image from Grey’s anatomy, the course of the middle cluneal nerve stems from the sacral nerve roots. So we talked about S one through S3, then it travels posteriorly either under or through the long posterior sacroiliac ligament. Now there’s a number of different references for you guys to be able to check out and through the different anatomy from human to human, the course of the medial cluneal nerve, um, does vary. So sometimes it’s going to be underneath this long posterior sacral ligament, and other times it goes through it. And other times it goes above it with patients that have had the medial cluneal nerve entrapment with the surgeons. What they’re, what they’re saying. And their research is that when the long posterior sacral ligament becomes two tense in certain conditions, it will entrap the medial corneal nerve as it exits from the [inaudible] underneath that ligament, or in some humans, it’ll actually go through that ligament.

So that would be the entrapment site in the ligamentous tissue. However, like we saw in the slide before we saw that, that medial cluneal nerve, as it exits deep in this ligament and then comes superficial cause it’s a cutaneous nerve and it goes through thoracolumbar fascia. So in one of the articles that are in the references, they actually talk about that as being one of the entrapment sites it’s strong and Divya in 1957, they actually talk about how difficult it was to go to find the medial corneal nerves, but they felt that the entrapment side was through that thoracolumbar fascia. And then with further research, I think a decade later is when they actually started seeing the possible trap this side of the long posterior sacral ligament. So there’s two and Travis’ sites for us to be able to consider with the middle cluneal nerves that can mimic or contribute to pain in the SIB joint region. So let’s remember that one.

Hey Matt, can I add something to this, uh, later on, uh, when we talk a little bit more about treatment, it’s worth that noticing the connection between the, um, long posterior sacral, uh, sacroiliac ligament and the sacred tuberous, like a mint, cause that’s all kind of one chain of, of continuous tissue. So the sacred tuberous ligament ligament goes from the issue of tuberosity on the kind of bottom of that image as starting right there and then travels up at an angle towards the sacrum. Um, so we might come back and mention that later. So just, this is a good image to see that. All right, thank you. Um, next slide,

We talked about the neuro travels through the superficial fibers and exits a slightly lateral to you be 32 and 34. So that would be our landmarks. So the entrapment site couldn’t be through that long posterior sacral ligament. That’ll be deep to that region and also through the thoracolumbar fascia as a possibility. All right. So in this very interesting study from, uh, Kono and atta, the middle cluneal nerve is associated with pain involving lower back and buttocks. It can mimic sake, really act joint pain. It creates sciatica likes sensations, which is really quite fascinating. Now, according to our research, the trapping of the middle cluneal nerves is underdiagnosed cause of low back and or lakes symptoms. And if you refer to this research, uh, what they found was in 13% of the cadavers that they dissected, they found that the, uh, middle, middle cluneal nerve was adhered and trapped underneath the long poster sacral ligament.

In fact, they teased out the middle corneal nerves in the middle colonial nerves. If we look at this pin had normal density on one side normal density on the other side, when the attract it was, it was really, really very, very thin. So that patient most likely had low back pain, which was an attribute from the middle cluneal nerve as fascinating. So 13% of the population. So think about how many people are coming into your office with low back pain, like said it’s a good routine thing to check for superior cranial, nerve entrapment, and middle cluneal nerve entrapment on this image. You’ll see, there’s an a, and then there’s a B. And what they did is they measured from the lower border of the PSIS and the posterior, um, the long posterior sacral ligament, which is a mouthful to say where approximately where that attracted is from the lower border of the PSIS. And on average, it was about one centimeter. It was about one centimeter, so that you can see why that entrapment would mimic sacroiliac joint pain because you’re right next door to the lower aspect of the sacroiliac joint. [inaudible]

All right. So Brian, we’ll go ahead and jump into this one together. I’ll start it off. So the Cardinal symptom of chronic low back pain with, or without legs symptoms, you guys, so this remember that it doesn’t always have to be a chief complaint of parasthesia, but it’s a good thing to ask if somebody talks about a little bit of numbness or tingling and they may not even be aware of it because it can be so subtle, um, into the butt off region or maybe down the leg. I’ve of course, if it’s going down the leg, we have to rule out a disc problem with the many different nerve tension test for sciatica. Um, common aggravating activities are going to be walking rising from sitting, standing flection and extension. So a lot of functional examinations are going to be important with this. Uh, patients often find that pushing above the iliac crest with their hand relieves symptoms of the superior cluneal entrapment. So that kind of body language you want to watch for, you can ask the person if they find that if they put pressure on their low back and they push down a little bit, if that helps, that would be a sign as a possible nerve entrapment.

Yeah. They’re kind of decompressing it themselves, right? Yeah,

Exactly, exactly. They’re decompressing and try to open up the, uh, Travis’ side. I mean, people can have this for years because it may be just low back pain of a two or a three, and then sometimes it gets really bad to a four or five. And how many people do you know that just don’t get treated with their low back pain thinking that it’s just an aging thing. So this is something for us to consider when that patient comes in. They’ve had it for chronic low back pain for years, definitely check for these nerve Travis’ sites. In addition to the other things that could be occurring, it could be sacroiliac joint problem. It could end up being a Yon syndrome where there’s a strain within that soft tissues. And we’ll talk about that a little bit more when we get into posture, which I think is in a few more slides, Brian, you want to take it from here?

Let me just, uh, dimension the, uh, leg pain aspects. And, and you can tell me if I’m correct on this map. And my understanding with that, first of all, the cluneal nerves, if you go back to those images, do travel through the gluteal region. Uh, they’re superficial at that point, but they’re traveling in the adipose to, in route to the skin, uh, over glute max glute medius, depending on which, uh, which ones we’re looking at. Um, but the leg symptoms, uh, from my understanding, I think is more of a sensitization and, and a common innervation for other nerves that are traveling peripheral nerves that are traveling down to the legs. So if it’s very, um, severe entrapment, then that can start to irritate the other, other structures in that same innovation zone and, and cause pain in the legs. That’s my understanding of it. Does that match, match your, your, um, understanding of that, the leg symptom, uh, component of it?

Yeah. Cause it makes sense. I mean, it shares the same sciatic nerve distribution of being L four down to S3. Yeah.

Yeah. And especially the middle cluneal nerves, which have a lot of, uh, innovation of the legs. Yeah. So, um, looking at, uh, uh, pelvic imbalances, if there’s an elevated ilium, uh, anterior tilt, uh, is, is often associated too with it because of the shortening that can happen in the thoracolumbar fascia with that, of course a posterior tilt is going to kind of overstretch that, um, that same structure. So it wouldn’t be unheard of to have a posterior tilt of the pelvis, but those are the things to really note and notice with, um, with, uh, uh, cluneal nerve entrapment, regardless if we’re talking about the superior or the middle colonial nerves, just because those, uh, postural imbalances and we’ll look at an image for this to kind of highlight it. Those are gonna put extra tension on, on the ligaments, the, the, uh, posterior, uh, sacred iliac ligament that we’re talking about, the long posterior sacral ligament, um, but also the thoracolumbar fascia and how that tension patterns are then going to relate to a propensity to entrap the nerve.

So when we get to an image on that, we can highlight some of those aspects. Uh, as we both mentioned, this could be the cause, you know, this could be what, uh, is the, the, the main pain generator for a patient. Um, it could be like number one, but you know, it also can be just a component of a series of things that are kind of coalescing in the same area, and that can cause pain. So it doesn’t have to be an all or none type of type of thing. Like Matt mentioned, I think 20 or 30% of it might be coming from the clinical nerve irritation and entrapment. So it’s worth checking for, uh, do you want to talk about assessment mat

With it? I think the next slide we can jump into and kind of get into a little bit more. Yeah, there we go.

Yeah. So here we have that image of somebody with an elevated ilium. So you can look at and see that the person has an elevation on the left. So sometimes we call it a left, elevated ilium. Sometimes we refer to that as a right tilt of the pelvis because the whole pelvic structure is tilting to the right. The top of it’s kind of pointing to the right, but the left side is high. And that’s the main thing to notice. So with that, there’s going to be a lot of shortening and things like the quadratus lumborum iliacus Talis lumborum, those are all, uh, kind of intimately associated with the thoracolumbar fascia. Um, so that’s gonna, uh, tend to, uh, correlate with more of a propensity for entrapment of the, um, cluneal nerves. I would tend to see it more often, see it on the side of the elevation, but again, just those changes are going to change the tension patterns on both sides. Really. So the fact that that, that the tension patterns are changed and disrupting the, uh, the, uh, uh, normal sort of, uh, even balance, uh, in the pelvic and low back region that, that elevation of the Lem could really be a big factor for, for people. Um, of course it’s not the only one.

Yeah. So at the takeaway with this, I believe is to make sure that you are addressing the pelvic imbalances, which will then help with the soft tissue imbalances that are in trapping the cluneal nerves, as well as causing a sick really act joint problems or Yon syndrome, or the other many other causes of low back pain, something of which that we spent a heck of a lot of time in module, two, trying to be able to teach people how to be able to balance these. Because when you think about it, you want to balance that dantien your center of gravity. And then by balancing that pelvic curdle that changes the balance above, and it changes the balance. Yeah.

Now this particular patient, uh, I can’t tell looking at them, especially from the back, uh, if there’s an anterior or posterior tilt, um, sometimes visually you can see that it’s a little easier to get in and palpate, uh, to, to, um, feel landmarks like the PSA. I S N a S I S and look, we have a particular protocol we teach to measure that that’s a little bit more accurate than just glancing. Same with pelvic rotation. That’s a somewhat of a visual assessment, but it’s all, it’s really more of a palpatory assessment, but this particular model, you can definitely see the elevation of the Lem. Cool.

All right. So then now the second to last bullet, did we cover? Yes. So, so the third to last bullet where it says cluneal nerve and trauma can be a contributing factor along with other causes of low back and leg pain. Absolutely. So when you’re diagnosing what is causing that person’s low back and leg pain simply, and this is the assessment. One of the assessments is simply taking your index finger or your middle finger, and just tap firmly, firmly, right over the area of Jalya where the superior cluneal nerves could be in tract. It’s like a tunnel sign. Alright, just tap very thoroughly all around that region, even onto the PSIS, where the traffic could happen, then move down level with you be 32 and you’d be 34, do the same type of tapping. What you’re looking for is the patient have any pain with that is a reproducing, the pain that they’re complaining about, is it reproducing any of the parasthesia that they know about, or maybe they don’t about it? Like if you’re, if you are tapping on there and it’s causing that, parasthesia consider that the nerves are entrapped and they are contributing to part of the clinical picture here. Brian was anything.

Yeah. Even before that, you might not have gotten to the point where you, you think about doing a tunnel sign there, but you’re just palpating. You’re kind of going through the process of figuring out where the cause of the low back pain is and trying to diagnose what the, what the condition is. And you go to palpate, maybe you think it’s an SSI joint, um, uh, it’s SSI, joint pain, and you go to palpate that PSIS region. And even with superficial pressure, you know, you barely, you’re definitely not pressing past the subcutaneous tissue into the deeper muscular structures, but when you start getting that superficial, uh, pain, that’s a little bit more pain than you’d expect at such a superficial level. That’s if I haven’t already been considering cluneal nerve entrapment, that’s a, that’s a point at which I’m definitely starting to think about it because it’s, uh, it’s, they’re, they’re cutaneous nerves. So you don’t have to press particularly hard to elicit pain if they’re irritated and then going from there to the tapping for a Tinel sign might be a consideration that’s, especially the case with the superior ones, you know, with the, the middle ones, the, the entrapment can be a little deeper if it’s at that, uh, ligaments. So that may or may not be quite the case, but if it’s irritated, uh, uh, at a periphery from that entrapment site, you still might get that elicit that, uh, very superficial pain.

All right. Should we go into a couple of needle techniques we could use? Yeah. So these are some images from the sports medicine acupuncture textbook on the left-hand side, you’ll see four arrows. Those are different vectors angles that we’ll use to palpate to affect the, um, iliac joint region. So the needle is going to actually be going into ligamentous tissue and the deep [inaudible], but let’s talk about the arrow that’s on the very bottom. Now that particular direction there, if you remember that direction is going to be very, very close to where the entrapment site of the middle cluneal nerve in the long post of your sacral ligament would be. So you could take your finger underneath that. PSIS approximately one centimeter go directly anterior, and then push upward toward that PSIS but deep angle it toward the sacroiliac joint. Now that’s really very, very tender and maybe even causes some parasthesia again.

Then you could be able to consider an entrapment site, and that would be a needle angle that we could choose. So going in with a three inch needle, or maybe a two-inch needle going into that Oscher point that we just diagnosed through palpation stimulating. Now, what you can do as well is to rotate the tissue around the needle. So turn the needle 180 degrees, 300 6720 degrees in one direction, as long as the patient’s. Okay. And then gently just pull up to loosen up that tissue with the idea, the intention of opening the area of the entrapment site. Of course, always to patient comfort. Uh, patients usually really liked that area because a deep, deep massage really doesn’t get to it, but that acupuncture needle can get to that region. So that’s one needle technique that you can use, but remember, that’s just one spot and this area is associated with the urinary bladder primary channel, and also the sinew channel.

So remember to link points that will address this region. So your adjacent and your distal points as well. Now you’ve got the images on the middle here on this slide and also in the lower right. That’s going to be looking at Yon. So the finger, you can see the middle fingers pointing right toward where that superior cluneal nerve can be entrapped. So that’s really quite tender. You can kneel that with your three inch needle. Um, the lower right-hand side is going to be kneeling in that level. And then as we discussed in the smack program, and this was Brian’s finding that this particular level is going to be more about the urinary bladder, send your channel, and if it would happen to be deeper, it’d be more about deliver channel Brian. You want to take it away? Uh,

Yeah. So this is another one that that needle technique by itself, uh, is great. And, um, I think what Matt was alluding to was if we’re at superficial, uh, pressing into Yon, we might, we’d be pressing into the iliacus Dallas, uh, muscle, which is also a potential, uh, site of pain in and of itself. But, uh, that could be putting excess tension into the thoracolumbar fascia. Um, and that would be more online with this new channel associated with the urinary bladder. So we might link it with, I don’t know, biceps, remoras, motor point, maybe beat channel points. We could try distal points and then go back and palpate that area and see if it reduces pain. If we go a little bit lateral sink in and go deep back to that same point. And we were at the quadratus lumborum attachment quadratus lumborum is on the myofascial plane that is continuous with the iliacus and into the abductors.

So it’s part of the liver send your channel. Uh, liver five would be my go-to point for that, but again, you can try different points and see if, uh, if that helps reduce pain at that site. Um, those, those are, those could potentially be vectors for the muscle pain, but those would also be associated with tension in that region. Um, when I, when I think that there’s, um, cluneal nerve entrapment, sometimes I do one vector like that, uh, just as being shown and I’ll do another vector above and trying to actually touch the iliac crest, kind of like two needles meeting at the same point and do it just what Matt mentioned with the middle Glendale nerve, where I’ll, I’ll, I’ll twist the needle to comfort to get the needle stuck purposely. You know, if you let it sit for awhile, it’ll, it’ll be able to come out, but you want to be able to get it a little bit, uh, wrapped around the tissue so that I can pull both of those needles in opposite directions. You know, one superior the other lateral to help decompress and open that area up. Maybe even a couple needles in, in that, uh, that region might be useful that way, but that would be by patient comfort. And you have to keep in communication with your patient.

Chinese needles are usually the best for that. Some of the, um, the Japanese or Korean Neil’s needles that are coded doesn’t wrap the tissue as well. So, um, our favorite needles for that is watchtowers. And you get the, watch us from LASA RMS. That’s good. Um, we’re about to show you. We’ll be,

Uh, Matt, since I let’s go back just for a second, since we’re mentioning, we both mentioned that, uh, usually you let the needle sit for 10 minutes or however long you’re going to have the treatment. They come right out after that time, but it’s always good to note which way you’re rotating the needle in case there is an issue and you have to D rotate it. Do you want to remember, oh, I did a clockwise. I needed to D rotate a counter-clockwise. So just, uh, to make a note of that is, is useful.

One more thing for me now is that after that needle technique, now this is not just an allopathic needle technique. This is going to be a needle technique for decompressing, that nerve entrapment in the region that you leave with that we’ll be communicating with all of the rest of the needles that you’re using during that treatment. So just to be clear, we’re not going in and doing the different needle techniques and then taking the needles out. That’s actually part of the treatment it’s going to be communicating with the channel systems. Just want to make sure that that was clear, uh, before we go to the next one. So we’re going to have two videos right now. These are some myofascial release techniques that are really very useful to use after the needle techniques. These techniques are going to be taught in the assessment of treatment of the channel sinews module two coming up in September. So these are just two of the, uh, mini techniques that we’re going to be teaching in that weekend class. Um, very useful for, uh, low back pain. And also in particular, these nerve entrapments. Brian, can we just go for it? Yeah, sure.

So this is a very simple technique just to spread and, and descend the tissue or the erector spinae as part of the urinary bladder sinew channel. A couple of considerations though, is as we’re spreading down the urinary bladder line, when we get to the iliac crest, we have a couple options. If the patient has an elevated ilium, may hike your Liam up. We might work a long, the iliac crest to be able to descend that tissue, but also to help, uh, push the helium down. In addition to that, a posterior tilt moving from medial to lateral will help sort of put the tissue back into a place. That’ll take them into an anterior tilt. So either posterior tilt or ilium elevation, I can take that tissue then to, from a medial to lateral position, they have an anterior tilt. I might gently come over the ilium, just being sure not to push into the bone and then descend down through the fascia over the sacrum. We’re going to find a good starting place somewhere around the inferior angle of the scapula. I want to be careful not to dig my elbow into the spine, but I’m going to be pretty close to the Lima, but the bulk of the pressure is going to be along the urinary bladder line sink in, and then slowly spreading downward [inaudible]

Patient movement. They can just gently take a nice deep breath and breathe in to the pressure

And exhale [inaudible].

And again, when I get closer to the OEM, that’s when I need to make a decision based on my assessment to either spread along the top of the iliac crest, going medial to lateral or in this case, I think I’m going to be careful not to dig my elbow into the bone. And I’m just going to continue downward to take the pelvis or influence the pelvis into a posterior tilt. Yeah. I can have the patients slowly talk to the pelvis under and relax one more time and track the glitch. Just try to slowly, just a little bit tuck under. Yeah, there you go. And that feels like a good place to exit.

Okay. It’s a very nice technique, especially after Neely needling in that area and helps reduce any kind of needle soreness. And then we have another one coming up, which is in particular really great for the sacrum and middle cluneal nerve. Brian, do I say anything before we jump into it? Nope. I

Think it’s about to start anyways. Or maybe that’s that play? Yeah, I think the video will describe it pretty well.

So it will be well working on the attachments of the glute Maximus, especially the sacral attachments and just that spreading and moving kind of softening the attachments along the sacrum. Very nice technique. Uh, we can adapt the technique to somebody who has a posterior and anterior tilt. This model. We have an anterior tilt, but I’m an exaggerate. The anterior tilt. You can imagine with that, that it’s going to be much more effective if I move that tissue away from the sacrum. Yes. But also downward to help encourage more. Posteriority tip the pelvis. Conversely, if somebody has posterior telecon tuck your pelvis under. Yeah. And in that case, you know, if you were working in that same direction, it’s going to encourage them more into a posterior tilt in the RDR. So it would make more sense to come from a different angle and help lift the tissue to help encourage more anteriority to the pelvis.

So we can adapt that general direction. But in both cases, you’re moving the tissue away from the sacrum, either away and down kind of lateral and down or lateral and up. So we’ll start with lateral and downward. I’m going to set a little bit out at the edge of the table. My side is towards her, so I can gently let my body sink into the tissue, using the elbow. Also a little bit of the proximal, although I’m going to go right to the sacral attachments, think perpendicular and then spread slightly lateral just to distract the tissue away from the sacrum, an inferior. I might have the patient gently and slowly tuck the pelvis under just the small movements, adequate good and relax, move slightly downward, get another area of the tissue sink in, talk under and move. That movement that you’re doing is going to help them talk the pelvis under relax [inaudible] and slowly, gently talk under

[inaudible].

So in some instances you might, especially with an anterior tilt, you might add to the technique I put in the patient into sort of a crawl position. And you can see in this position, that’s going to encourage even more of a posterior tilt of the pelvis. So I can do similar technique here. Again, similar technique with them in this position. And the position itself is going to encourage more of a posterior tilt

[inaudible]

And I might hold a little longer in this particular position.

[inaudible]

Okay. That was great. So with that crawl position, you could see that the long posterior sacral ligament will then be slackened because the attachment sites were brought together closer. The PSIS went into a posterior tilt and his Brian’s elbow was right there. Pretty much level with S two S3 S four region. So what a great technique for sacred iliac joint problems, as well as if you are suspecting any kind of, of middle cluneal nerve entrapment, Brian, anything you want to say before we do our conclusions?

No, I think, uh, I think we’re, we’re good. Um, just the fall assessment really to differentiate what’s causing the pain. Is this a contributor or is this really a sacred iliac joint problem or is this a facet joint problem? Um, thoracolumbar junction syndrome for me is one that’s really tricky to differentiate between just because of those nerves can also be involved in thoracolumbar junction syndrome, but they’re involved, uh, not as they exit the thoracolumbar fascia, but they’re involved, uh, in route to, to that region. So those are, those are a little trickier to differentiate, but looking at all, differentiation for all of those really ruled out which one is, or, you know, figure out which one is really the pain generator is important.

Yeah. A thorough differential diagnosis. Yeah. With through sports medicine assessment, and also through TCM, which is something that we do in sports medicine, acupuncture certification program. So you guys, if you like our education, please come join us at www.sportsmedicineacupuncture.com. You can also reach out to Patricia, which is, uh, through email AQI sport info@gmail.com. Um, I believe that’s going to be wrapping it up for us. You guys thank you so much for staying the extra time. I know that these are only supposed to be a half an hour, so thanks for the extra time and also come back next week. Cause we have Chen Yen coming in. Who’s going to be discussing a lot of great things. So, uh, Brian, it’s always a pleasure. Thank you so much. We want to thank the American Acupuncture Council for having us. Thanks for much you guys. And we’ll see you again soon. Yeah. Have a great day, everyone. All right. Bye