Tag Archives: Acupuncture malpractice Insurance

Callison-LauHD06012021 Thumb

Clinically Relevant Trigger Points

 

 

So we’re going to talk, uh, about some relevant trigger points. There’s a lot of relevant trigger points, but we tried to narrow it down to ones that are probably the most frequently seen in practice, especially ones that are good to with, for practitioners who maybe don’t use a lot of trigger points or wanting to get into working with trigger points.

Click here to download the transcript.

Click here to download the slides.

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

Welcome everybody. I’m here with Josh Lerner and I’ll introduce him in just a moment, but I just wanted to give a little heads up. Matt Callison and myself. Uh, co-present uh, frequently on this webinar that the American Acupuncture Council is kind enough to welcome us to. And I, Matt couldn’t make this particular, uh, uh, date and we’re here with Josh Lerner, but the reason I’m mentioning that is the subject matter we’re talking about actually has roots in some conversations we’ve had with Josh over the past couple of years, uh, specifically looking at the difference between motor points and trigger points, difference, comparison, uh, overlap, you know, uh, just a, it’s a, it’s a really great topic and that was going to be our webinar. But, um, the dates didn’t work for Matt. And, uh, we’re going to have this as part one where we’re talking a little bit more specifically about trigger points and then looking at part two on July 7th, Josh will be back with us and we’ll kind of get a little bit more into that difference between difference and again, comparison between trigger points and motor points. So thanks for joining us today, Josh.

Thank you, Brian. I appreciate being invited to do this. It’s always a plan involved with doing that.

Yeah, yeah. It’s great to have you here. So Josh, uh, Josh is up in the Seattle area and the Pacific Northwest has been practicing for 20 years. Um, and teaching at the Seattle Institute of east Asian medicine for 11 years. Uh, is that correct?

Yep, that’s it. Yeah.

And you focus on a lot of things, but uh, particularly in specifically relevant to this, uh, webinar with, uh, orthopedics TuiNa and corrective exercises.

Yeah. That’s a main part of my practice. So I incorporate a lot of the sports medicine, acupuncture protocols, as well as stuff, uh, dealing with trigger points, uh, corrective exercise, you know, movement assessment and lots of manual therapy with, uh, including things like 29.

Yeah. And Josh is also a graduate of the sports medicine acupuncture program. And like myself has a pretty long history in martial art practice, which I think is what gets a lot of us into this work initially, which is interesting. Yeah. Yeah. So there’s definitely, we would like to chat for a bit, but there’s a lot of material to present, so maybe we will go ahead and jump right into the, uh, the presentation and Josh, let me know if there’s anything you want to add before we, uh, go into that. Ready to go. We’re good. All right. So we’re going to talk, uh, about some relevant trigger points. There’s a lot of relevant trigger points, but we tried to narrow it down to ones that are probably the most frequently seen in practice, especially ones that are good to with, for practitioners who maybe don’t use a lot of trigger points or wanting to get into working with trigger points.

Um, this will be a, a chance to kind of go into those specifically though for a short webinar. We’re not going to really get into a lot of needle technique, which takes a little bit more set up. We’re going to try to put it into the context, more of, um, assessment recognizing and when, when to look for these and when to, um, utilize them and maybe even some disappointed channel theory with it. So let’s go to the next slide and we’ll jump right into that. So I’m strictly speaking, uh, myofascial trigger points, uh, or just oftentimes referred to as trigger points are a concept that’s developed in Western neuromuscular medicine. Uh, so there’s a history of it. Um, we’ll probably mostly be talking about the, the work of Dr. Janet Reval and David Simons or David Simmons. Uh, but there’s a history that goes way back, many people involved with it. I guess you could say a history that kind of parallels some, some discussions that happened in Chinese medicine, but it’s a, it’s a Western history. However, if you look closely and you, and you’re versed in both traditions, you will definitely see a lot of overlap. So we’re going to discuss the overlap, but just keep in mind that that overlap is

Not strict

Trigger point in the, you know, if you get travails books, she’s not going to be talking about the large intestine channel. Um, but there’s a lot overlap if you look for it. And just a as one quick example, looking at this picture on the right, we have two pictures actually on the left-hand side of that image, there is a supraspinatus trigger point referral patterns. Superspinatus access in the region of SSI 12 though, it’s attachment at ally 15, my tendonous junction around ally 16. And then you see the referral going down the large intestine, a little bit, the lung channel, but primarily the large intestine channel. So this muscle superspinatus as part of the small intestines sinew channel. However, there’s a link with the large intestine channel. So on the right, many of us are familiar with this Deadman image and you’re looking at that large intestine channel, um, where you see some of that trigger point referral pattern.

But it’s interesting to note that from ally 15 and to ally 16, where you would have access to the superspinatus, the channel then links, uh, intersects at SSI 12. So even the description of the large intestine channel starts showing some relationships to this, uh, um, superspinatus muscle and how there’s a relationship between both the referral pattern and the channel itself. We could talk the whole webinar about relationships between this, this type of thing between the channels and the trigger point referrals. But unfortunately, that’s not the topic though. Fortunately, we had some really great things to say, uh, uh, in addition to that, but Josh, anything you wanted to, uh, add or any thoughts that you have on, on this? I know we talk about this a lot.

Yeah. I’m not a whole lot, but just as a general idea, it’s something that people can really do is if you’re interested in this kind of thing, look at referral patterns and Trevell or other resources, but look not only at the main pathways of channels, but also delve into a lot of the law channels. Um, some of the other less commonly really known, uh, although everyone knows the law channels, but, um, the ones, your, a lot of the connections you’re not normally going to think of very often, you’ll see more connection with the trigger point referral patterns there than if you’re just looking at the main channel pathways. So in some ways you can kind of use this as an opportunity to go back and delve into traditional channel theory and kind of get into some details and start uncovering some connections you might not otherwise have thought about.

Yeah, and to me, it seems kind of obvious that the channel system in Chinese medicine has a pretty long history, a long tradition, many things that added to the development of the channels. But I think a simple one is that people were probably needling areas and node and noting and, uh, seeing the common referral and saying, oh, there’s something about needling at that SSI 12 region that kind of refers, um, down a particular pathway. And that was, you know, that, that, I’m sure I had a big part of the development of the channel system. And in addition to other things

I absolutely, yeah. Alright.

I think we can jump into the next slide. So just to give a definition, a myofascial trigger points are a hyper irritable spot in skeletal muscle that is associated with a hyper-sensitive palpable nodule and a top band. We’re going to break this down and talk a little bit more about it in a second. Uh, the spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena. This is the definition in a travail and Simmons book, the trigger-point manual, which is a great resource, a two volume, uh, resource. And you can see some of that play out in the image on the left, which is showing the sternal head of the, uh, um, SCM muscle sternocleidomastoid and the referral to the sort of frontal region occipital region Vertex of the head a little bit into the face when you’re looking at these referral patterns.

Something to take in, uh, into consideration is the darker, the red doesn’t necessarily indicate more pain when there’s referral. It’s more about frequency. You know, that that there’s going to be, uh, the greater frequency of that sort of frontal region for the sternal head occipital region. And these spillover regions are going to be a little less common, but still, still common. Uh, but the intensity of that pain might be, uh, for patient a might be greatest at the Vertex of the head. I would say it tends to be greater at those, those, um, more common sites, but, but that’s what it’s showing is more frequency of referral, uh, with the spillover being less frequent. And Josh, do you want us to actually break down a little bit of this definition? I think,

Uh, well just because one of the things that I teach at, uh, the Seattle Institute of east Asian medicine is a specific class on trigger point theory. And I find that emphasizing really understanding each of the individual words in that, um, in that definition can be really helpful. So, uh, I like the way that I define it, I kind of, you know, the words are shifted around a little bit, but it’s essentially the same definition, but it is first it’s, we’re talking about ones in skeletal muscle. They’re also their trigger point phenomenon that can occur in other tissues, aside from skeletal muscle, a muscle like in periosteum and joint capsules, things like that. But for the majority of what we’re going to be talking about is occurring in skeletal muscle. Um, it is, they occur in a taut band in the skeletal muscle. So whenever you’re looking at trigger points, you’re always going to be trying to palpate for a particular palpable taught band.

Then you will look along in that top band for the, the nodule. Usually it’s some type of thickening or a slightly harder section of that top band, and then you apply some type of manual pressure to it. And you’re looking to see if you can find the most hypersensitive spot in that nodule in that top band. And just understanding that definition itself can help you clinically when you’re trying to start learning this material. And you’re actually going to start looking for trigger points. If you keep all of that in mind, um, it will help with how you’re palpating, um, especially as acupuncturists, we tend not to palpate as deeply for, and as strongly for kind of big gross structures like taut bands and muscles. We tend to be much better palpating for more subtle things like pulses, um, chief lo in channels, whether or not, you know, kind of the spaces between things, the way that a lot of people find acupuncture points instead of big, you know, really obvious structures, uh, which it sounds kind of counterintuitive that that would be harder for acupuncturists to do. But, um, you know, Brian, you have this experience as well. And, uh, Matt and I have talked about this, how acupuncturists it’s, when they’re learning this material, whether it’s looking at motor points or trigger points, there’s always an adjustment period. We have to kind of shift gears perceptually to actually be able to palpate correctly for taught math and muscles compared to focusing on real kind of more subtle things like fascial planes and acupuncture points, things like that. And

You have to know the anatomy quite well, which is something that some acupunctures know really well. But, um, often we hear how that is something that could be a little bit under Todd in school. And I think as a profession, we really need to bring that level of anatomical understanding of

Absolutely.

All right. Well, why don’t we move on to the next slide then? So, uh, just so you have some understanding of some classification of trigger points is they do have classifications, um, a trigger point can be an active versus a latent trigger point. The image here is showing the upper trapezius and the referral pattern active generally would be a little bit larger, probably more contractile tissue, but that’s not the main gist of the definition. It’s really about that. The patient is actively coming in with that complaint. You know, maybe they’re talking about in this case, a cervicogenic type or tension type headaches that are traveling up the neck and, oh, it really hurts, you know, at the temple. So they’re actively feeling that that referral pattern, whereas latent trigger points as any of us have probably noticed we’re in they’re palpating and tissue sometimes. And oh, I didn’t realize I was insensitive.

You know, somebody says that they feel maybe some referral, uh, so it’s late and it’s kind of hidden, you know, maybe it’s a little extra, uh, challenge on a tissue, you know, carrying groceries a little too far, you know, suitcase in the airport or something. Um, and that latent trigger point can start to become an active trigger point. But at this point, Leighton would be that you’re not feeling it until you manually put pressure on it and kind of, kind of, um, highlight it through that pressure. So active trigger points would be, you know, people coming in with that complaint late in you’re kind of finding in the process, a key trigger points, satellite trigger points, I think is a really important thing because, uh, the difference is, is key trigger points. In this case, using the image of the, um, the, the upper trapezius.

You can look at that referral and see that, that cervical region traveling along the gallbladder channel, if we were looking at it from a TCM lens into the temp temporality. So the temporal region, well, you can form satellite trigger points along that pain pattern. It’s like that irritating noxious signal, um, will start to cause satellite trigger points along that referral pattern. So upper traps are, are often a key trigger point that can refer into the head and into the temporal region causing secondary satellite trigger points into the temple region. And it might be that the person coming in is complaining about that pain at the temple. And we go, and maybe a point like Thai Yong or the, um, uh, trigger points, or maybe even the motor point of temporality we use, and that will help. But until we sort of get it at that source, it’s going to be much more likely to come back and be short-lived help, uh, unless we can kind of find those key, uh, trigger points.

So that’s very similar to the channel theory, you know, um, in terms of, uh, us looking at that sort of more of a comprehensive view of, of the, uh, the channel in this case, um, and the muscle within that channel. And then the last classification is central trigger points versus attachment. The previous image of the superspinatus, uh, showed the central trigger points around the SSI 12 region and frequently there’ll be attachment trigger points added this attachment, like an ally 15, let’s say. Um, and generally speaking, the central trigger points have a little bit more, uh, emphasis and trigger point thought, uh, in the sense that if you take care of the trigger at the central region belly of the muscle, then oftentimes the attachment months resolve, or at least, uh, um, it’s more likely to resolve. And maybe, maybe those are the secondary ones that you look at, anything with that Josh,

Uh, yeah, just a little bit about active versus latent because clinically this is one of the areas where people often can run into problems when they really start getting into act, uh, treating trigger points. Um, like, like Brian said, it’s the act of trigger points that actually bring them into the clinic, right? They’re coming in with, um, say pain in the front of their shoulder from like an infraspinatus or a superspinatus trigger point, or maybe trading down the arm and you palpitate. And then you may palpate up around the upper trapezius and find trigger points in the upper trapezius. And even if you palpate them, it may refer up into their head. Um, and you may get distracted because you found this latent trigger point that may have nothing to do directly with the patient’s symptom. Um, but you can actually find latent, trigger points all over your body.

Um, they’re much more numerous than active trigger points. Uh, you, I don’t want to alarm anyone who’s watching this right now, but as you’re sitting there or standing, or hopefully not driving, watching this podcast, uh, your body is riddled with Leighton trigger points. They’re all over there throughout your entire body, but they normally don’t cause problems, but they’re often very easy to find. And so it can be, um, a little bit of a stumbling block because once you get good at palpating trigger points and finding them, you can kind of find them in almost any muscle, not any muscle, but large number of muscles, if you look hard enough. And so that’s where we’ll talk a little bit later about differential diagnosis and how important clinical reasoning is in addition to just palpatory skills. Um, because I, and I’m sure Brian’s done this and anyone else who’s worked with trigger points.

You can spend a lot of, uh, needless energy and time treating muscles that may actually not be helping with their problems. So that’s just one other thing. And also some of the treatments can be, uh, can involve some discomfort for the patient depending on the type of treatment that you’re doing. And so sometimes you’re needlessly causing the patient some soreness afterwards, if you’re doing something like dry needling or mashing on a trigger point manually for a long period of time, when maybe you didn’t need you because the real problem was elsewhere. So that’s just another act, uh, another aspect to active versus latent. That’s helpful to understand clinically.

Yeah, that’s a great point, Josh. I’m glad you brought that up. I see similar things with needling to where, uh, there’s a response, a sensation achieve response. And, um, sometimes that’s not the target tissue that you’ve reached, but instantly, you know, people who are new to this type of work, it’s like, okay, oh, they felt it. I’m going to stop. Now, if it’s painful, you don’t need to keep on barreling through it. But the point is that sometimes that initial sensation you get might be not at the level and the depth that your target is. And it’s not that that shouldn’t be taken note of, but maybe, you know, you’re, you’re wanting to be a little bit different target tissue. That’s going to have a different sensation. And I see that whether it’s trigger points, motor points, tendon periosteum, whatever the target is, is that the target is one thing. Um, and the sensation that you get might be felt at a different region, um, that isn’t your target yet,

Which further strengthens the importance of really understanding the anatomy in three dimensions. If you actually know what it is that you’re, you’re effecting.

Yeah, absolutely. All right. So I think we can get into the next slide and then Josh and myself, we’re kind of bouncing back and forth, but he was going to take it in just a moment from here. So, one thing to consider with that with trigger points is that they’re often, like if you look at travails book, she talks about functional units, um, and this would be a grouping, usually agonist and antagonist muscles. It’s a little broader than just this, but that’s the basic simple definition, um, that they often also share us a spinal reflex. Again, that’s the simple definition, but if you look at our functional units, they often go a little bit beyond just that, but it’s groupings of structures that relate to each other that are functionally working together and often become dysfunctional together. So if there’s a, a pain generator and say the upper trapezius, well maybe also the superspinatus deltoids, maybe even the SCM, those are all kind of, um, uh, dysfunctional together.

And those can, uh, you know, be sort of creating a, uh, problem, uh, in, in terms of how they relate to each other. So needling the, the source of the pain is useful, but also working, um, kind of normalizing the relationship between that functional unit can really give much longer AskPat lasting results. This is something we teach in sports medicine, acupuncture, not necessarily from the trigger point lens, so to speak, but, um, you know, Matt Callison and in his book, um, uh, has, uh, has something called the Watteau arc and something that’s taught in module one. We have module one coming up, um, soon. And, uh, uh, the end of the month, uh, that’ll be on net of knowledge, a webinar for it, and then it’ll be live or accessible after that. But it kind of parallels this idea of a functional unit where you’re working with these groupings of related muscles, but then the Watteau arch, we’re also adding the lotto Jaci points to affect the deep paraspinal muscles for that level.

That’s, innervating those muscles really relevant in a lot of sports injuries, also extremely relevant for patients with spondylosis, where there may be having a reduced neural output to those regions of muscles, like the supraspinatus and infraspinatus, um, that that reduced output and the neural output might not be leading to, um, radicular pain. It might be, you know, preclinical, um, you know, before that radicular level, but that reduced neural output can cause dysfunction in muscles that those muscles then have muscle imbalances that can lead to dysfunction. So including those Watteau Jaci points of that segment can be really useful. We usually do a sets of three. So like say for the rotator cuff muscle, maybe we’re doing C4, C5 and C6 at the lotto judgy points. So that’s a great addition to working with these because you’re also working then with the do channel to some extent, and looking at that relationship between that and the channels, we also get a lot into send you channels in our program. And, um, uh, the way we look at sinew channels and define the sinew channels kind of relates to this functional unit idea too.

So,

Yeah, and I saw, uh, candy justice just asked a question about perpendicular versus, uh, threading needling. I, um, I, I really want to answer that question. It’s a great question. I think given how long we’ve already been talking over just the first few slides, I don’t know if we’re going to get to it. I’ll just say really briefly that the, there are a few answers to that question. One of them is just practical. Some muscles are easier to needle perpendicular versus more, um, threading either with the muscle fibers or sometimes cross fiber. Sometimes it’s a safety issue. If you’re needling some of the muscles over the thorax, for instance, um, you’re going to often be needling more, uh, in a kind of a threading or like a transverse, um, just to avoid going into the pleural space. It’s going to have to do also partly with, uh, in some cases, whether or not you’re going to actually needle with retention versus doing more like a dry needling. So try this, not a very full and, uh, probably satisfying answer, but, um, for the, uh, so we can kind of get on with the rest of the lecture. And I dunno, think we’ll really have time during the lecture to answer any more questions, keep asking them maybe in the, in the conversation after this is posted and like on the Facebook page, whenever we can get to them. But I just wanted to recognize that question and address the aspect of it.

Right. So the next slide.

Okay. All right. So, um, understanding the pathophysiology of trigger points, meaning both the physiology and pathology of them can also be really helpful when you’re thinking clinically. So first just understanding what a trigger point actually is. And for the next few slides, when we talk about physiology, I’m going to try really, really hard to be brief, but this is such a really, really cool and interesting topic that Brian and I, as we were talking, we could probably spend an entire hour long, an hour and a half a lecture just on these first few slides. So I’m going to try and edit myself as much as I can here. So what is a trigger point? A trigger point is essentially a series of small, very localized contractions within a muscle fiber. It is not what is called an electrogenic contraction of the whole muscle. So if you remember back to your anatomy and physiology classes, which all of you took either as part of before acupuncture school, and you remember muscle physiology, normally what happens with a muscle contraction is there’s a signal from the central nervous system sent down along a motor nerve, it’s an electrochemical signal.

And then it reaches the end of the motor nerve to the little, the terminal button. The, uh, the nerve ending then releases a neurotransmitter acetylcholine in the case of neuromuscular junctions, which diffuses across the cleft, comes into contact with the surface of the muscle fiber. Depolarizes the surface of the muscle fiber. And then it causes all the actin and myosin to kind of ratchet past each other and you get a contraction. And that normally happens when you have a nerve signal sent down that happens to an entire motor unit within a muscle. Um, and then the end, it happens to all the motor units in a muscle. What happens with trigger points is because of damage to the muscle. Some of those motor end plates, meaning the areas where the motor nerve is touching and contacting the muscle. Uh, there is a type of dysfunction that has to do with, uh, based on the most recent research I’m aware of, um, an excess spontaneous leakage in a sense of acetylcholine across the claps.

So basically neurotransmitter is spontaneously diffusing towards the muscle fiber to a greater degree than normal. It is actually a normal process. It just starts to happen more commonly in damaged motor end plates. And this causes a small amount of localized depolarization in the muscle fibers. And so you end up getting small little pockets of, of contractile units of the sarcomeres within the muscle that are contracting. So this is happening independent of an actual signal from the central nervous system. So once these little pockets of contraction form, they essentially are kept, they keep occurring because of some feedback loops essentially within the muscle itself, independent of continued input from the motor aspect of the nervous system. Um, and if you look at another interesting thing clinically, that can be helpful to realize with trigger points is if you look at the picture on the right. So we have here a drawing that was actually taken from an actual slide that comes from Trevell.

Um, the top shows a whole muscle with the talk band in it, and then the kind of thick and nodule the middle of the belly, which is the trigger point region. And then if you zoom in and look at the lower portion, you can see each of these muscle fibers kind of running across the picture there, they all have these little vertical lines, which are the individual sarcomeres, right? In, in between each vertical line, there is the contractile unit and the thickened kind of darker areas are where the trigger point contraction is occurring. And you can see that those vertical lines closer together, right? So the, as the sarcomeres contract, they go this way. But also that means that as anything else, if you squeeze it in one direction, it’s going to get thicker in the other direction. And so that thickening of all those sarcomeres with those contractions is what causes the thickened, not in the muscle, but if you look on either side of those knots, right, you’ve got like this, not in the middle, but then you can see the rest of the fiber on either side that the distance between the lines is a lot greater.

So those sarcomeres, uh, that are not part of the little contracture are actually being stretched and usually being overstretched, meaning that the actin and myosin fibers are actually often stretched past each other, which means that not only do you have a knot in this muscle, that is so that part of the muscle is partly pre contracted, which means it’s going to lose strength and a bunch of other motor dysfunctions that’ll happen with the presence of trigger points, but it’s also going to lose strength because some of those fibers are overstretched to the point where they can no longer mechanically produce the same amount of force when they contract. So it’s not just referred pain, that’s going to be the issue with trigger points, but also a disruption of the muscle’s ability to fire normally, and to relax normally, and their whole sorts of other, um, re uh, neurological reflexes that are involved in this. So we can get into some other time, but that’s, uh, something that can be really helpful to realize clinically that it’s not just referred pain out. There is this kind of actual physical dysfunction in the muscle that has other implications. Um, so let’s anything to add to that, Brian?

No, I think that was great. Cool.

So let’s move to the next slide. So when you have this contraction in the muscle, one of the things that happens is there’s this interference with the local blood flow. So as with any type of excess tension in soft tissue like that, it’s going to put pressure on blood vessels and on the lymph system. And so you end up within the actual, not the trigger point itself, a decrease in blood flow, meaning, uh, not just decrease in the nutrients in blood, getting to it, but also a decrease in oxygen. So you end up with local scheming and hypoxia. Interestingly, there’s actually a, essentially a retrograde blood flow outside the trigger point. So as the blood’s trying to get in the knot is keeping blood from getting into that portion of the muscle. So you have the buildup and actually a higher oxygen saturation outside the trigger point with a lower oxygen saturation inside the trigger point.

When you have a lower oxygen concentration, this leads to a drop in the pH in that area of the body. So the area inside the trigger point then becomes much more acidic. And that stimulates the release of a lot of other chemicals that are often pro-inflammatory or allergenic, meaning pain producing. So it releases all sorts of prostoglandin serotonin substance P brainy, canine, um, uh, CGRP bunch of, uh, interleukins, some ones in particular. And so all you get this kind of soup of biochemical signals that are producing some localized inflammation and also stimulating nociceptive nerve fibers. So remember nociceptive nerve fibers, which are often called pain fibers, actually, they’re not, they don’t send pain signals. They send signals of actual or impending tissue damage, right? The pain is something that’s processed and occurs in the, in the brain central nervous system. But what happens with trigger points then is you have this biochemical soup of concentrated, essentially pain producing substances in the area.

When the signal through the nociceptive nerve fibers becomes prolonged enough and strong enough, you know, over a long enough period of time, those signals go up to the spinal cord. And there are actual changes that occur in the spinal cord that are called central sensitization. So that there’s essentially a decrease in the threshold necessary for a lot of those signals, no susceptive or, you know, pain and signals to get to the brain. So there’s an increased chance that any given, uh, no susceptive signal is going to make it up to the brain. Normally our nervous system in a sense is designed to weed out anything below a certain threshold, just so that we’re not flooded with too much information than we can deal with in our central nervous system. Um, but with trigger points and any other kind of chronic pain, the threshold for that information to get up starts to get lowered.

Plus the nervous system in the, in the spinal cord itself starts to wake up old and disused connections between different spinal levels, essentially spinal segmental levels, and actually can form new ones. So it’s a signal say going into the C5 dermatomal myotomal level at the spine, say there’s a trigger point, like an infraspinatus, um, what will happen if that happens over a long enough period of time and is intense enough, is that the signal essentially spills over into adjacent spinal segments, very commonly or more commonly inferior. So the there’s some, maybe some connections that spill over superiorly to like C4, but very commonly will go down. So maybe C6 and C7, those spinal levels are now going to be getting input, no susceptive input or damage or pain input. And what happens for reasons that people aren’t quite sure of is that by the time all those signals get up to the brain, the brain is really interpreting those spillover signals more than the signal coming from the area itself.

It’s really common when you have a trigger point in a muscle with a few exceptions that the area where trigger point is itself, you don’t have any symptoms there it’s pretty far away from the area where the trigger point is, um, especially with some of the muscles like in the hips and the shoulders out into the periphery. So the, the signal of pain that you’re experiencing is actually coming maybe from like the C6 or even the C7 level. And that’s what we call referred pain. So that’s why you can have a, not these trigger points in a muscle, but have the experience of discomfort or pain or numbness or parasthesia happening in what seems like a really distal, uh, area far away. Cool. Anything else for that, Brian?

No, that was great. Great explanation.

Cool. Okay. And so let’s move on to the next slide. All right. So a few other things to think about with trigger points that will also really help you as a practitioner, um, from getting to myopic. Um, so trigger points are a possibility and our component of pain and dysfunction, that’s, uh, an understatement. Um, really some of the research suggests that up to 80% of the cases of pain might involve some type of trigger point phenomenon with any kind of pain. So having said that once you get into trigger point stuff, it can be so effective and it can be so kind of interesting that you can forget to do a differential diagnosis for a lot of the other really important, uh, generators of pain and dysfunction. It might be, you also have to consider joint dysfunctions, other soft tissue, you know, looking at ligaments, you have to look at whether or not someone has other systemic problems that can be contributing to their problem, right?

Nutritional deficiencies, especially things like vitamin D I think iron deficiencies, metabolic disorders. Um, so hypoglycemia and diabetes can be two really big ones that can have caused someone to have a propensity, to, to, um, generate trigger points and also to have more kind of higher levels of pain. Um, basically anything that affects the energy supply to the muscles can be a condition that can lead someone to more easily develop trigger points. If you’re a TCM practitioner, it’s also really important to put these findings into your assessment. And so personally, what I found is when I’m dealing with trigger points and thinking in TCM terms, um, going back to the idea that there is this limitation of blood flow in the area, treating trigger points locally, in one sense, as a form of blood is can be very helpful. And I’m a huge fan of the [inaudible] family of formulas.

I tend to use [inaudible] [inaudible] few herbalists out there a lot or variations of those. Um, but also systemically looking at things like spleen sheet efficiency, especially in terms of how it affects muscle function can be really helpful. So even if you decide to get into this, you’re into this now, and you’re getting really myopic about trigger point stuff, always keep in mind all of the systemic stuff, and don’t give up your as an acupuncturist or as an herbalist and the TCM practitioner. Um, uh, although you probably go through phases where that happens to a greater or lesser degree, I know I did for awhile, but always keep the rest of that in mind. Uh, anything else there, Brian?

Nah, this is just something that Josh and myself have talked about a lot, is that when people just, like you said, start working with something like trigger points, it’s easy to sort of start to, to just see everything as a trigger point and, and kind of throw everything else out the window. Um, and sometimes we learn something new and that’s just the way it goes for a little while, but, but yeah, bringing that full comprehensive, uh, aspect of our medicine back into play is really essential. So, uh, yeah, so let’s kind of go into the next step. So I think we’ve covered a lot of information already in terms of, uh, pain and quality of pain with, uh, trigger points. I think this, uh, next couple of slides, we’ve pretty much covered in the context of the previous slides. So, um, if you’re going back and watching this it’s on the screen, you can reference it, but I think we’ve already really covered an aspect of this. So why don’t we move on even Ms. Josh, is there something you wanted to say about that? Let’s move

On, not on this one, the one after, see what’s the slide right after this one? Uh, yeah, just the fact, just the importance of, um, basically when you’re diagnosing trigger points that you’re looking for them, the aspects you have to take into consideration first or the history of the patient, because often they’re good. There’s going to be some type of traumatic injury or overuse problem or chronic postural disorder. So his, the patient’s history is one thing. Um, the importance of palpation is another thing that you have to actually get into the muscle palpate and look for those sore spots, um, uh, history of palpation and, uh, and assessing, um, you know, movement dysfunction kind of looking at actually doing some, either manual muscle testing, range of motion testing, things like that. Um, but that’s, yeah, we can actually, if you want to kind of just move into the individual muscles, that’s probably a good idea. This is, as we predicted, we’re kind of taking a long time to get from the really cool stuff that we have to be nerds about.

Know we were talking, we can almost do have done a long time just on this, these first parts, but yeah, let’s, let’s move forward. So diagnosis, um, uh, uh, trigger points as Josh was mentioning was really largely based on palpation. Of course, you have to rule out other components of pain and they’re not one or the other, but maybe there’s a facet causing a particular pain. And, um, you have to roll out all of those things. We’re going to focus more on the trigger point aspect, which is going to come down to palpation. And Josh, you wanna kind of go into a little bit of the, the criteria for that.

Uh, yeah. So the, the, the three most important things to understand with trigger points are these things here listed on manual palpation. So first, if you suspect a muscle has trigger points in it that they’re causing problems. And again, actually one of the other things we forgot to mention with diagnosis, the other third thing that I was trying to think of history palpation, but also understanding the referral patterns and a lots of resources online for looking at referral patterns. It’s best. If you look in Trevell or even the most recent version of it, um, by body part. So often you can find lists of if there’s pain in the front of the shoulder, there’s a list of muscles that are the most common muscles that refer to that area. Um, so understanding that, so that, that helps kind of narrow your, your clinical focus down a little bit, but then basically what you’re gonna do is palpate the muscle.

And look for first, the top band, look, you’re looking for these, those stringy or Roby bands in the muscle. And then once you find that, then you’re pressing directly into those top bands moving along the top band, really the entire length of the muscle, the trigger points will often tend to form in certain areas in certain muscles for a number of reasons, more commonly than others, but really you need to check the entire length of the muscle if you can. And then along that tender along that top band, one of those spots is going to be one or two are going to usually be the most exquisitely tender to the touch. Um, often there would be a slight thickening or hardening of the band in that particular location. And if you’re lucky, not lucky, I mean, probably about 60 to 70% of the time, at least, um, if you’re in the right spot, the spot that you press is not only going to be very sore to the touch, but it’s also going to refer pain elsewhere and ideally reproduce the symptom that the patient is coming in for.

So, because someone’s coming in for migraines, you feel the upper trapezius, you squeeze it. Not only is it sore in the upper trapezius, but it actually recreates their symptoms with things like migraines. You have to be careful not to cause it in the clinic cause that’s a whole other topic. But for, um, a lot of patients that recognition of, oh, this practitioner is, uh, knows exactly what’s going on with me, cause they can touch me this other place. And all of a sudden my symptom is occurring. I now trust this practitioner. Um, and maybe they’ve been to two doctors and an osteopath and a chiropractor and two other acupuncturists and massage therapists. And no one has thought to look at that. And you’re the, maybe the first one who’s doing that. So that’s a really common experience, both that I’ve had and I’m sure Brian’s had, and even all the students at the school that I teach, they get that in school of having a patient in the student clinic, tell them you’re the first person that I feel like has actually gotten to where my problem is. So,

Um, yeah, after this, we have a video also this, the video shows a local Twitch response with palpation. Some muscles don’t have a tendency to do this. Some do, and it’s not an essential quality of, um, diagnosing trigger points. But when you do find with palpation this local Twitch response, that it, it’s usually a good sign that you’re at the right spot, especially if they’re feeling that recreation of the symptoms. And I kind of helps you a zoom in on the region where that trigger point formation is. So let’s just look at a quick video that shows for the SCM, you’ll see this. And then for the peroneus longest [inaudible]. So you’ll see this both with the sternal head and the clavicular and especially the Clifford Cuellar head

[inaudible].

So if you look down at the clavicle area with the curricular edge, you’ll see that clavicular head starting to fire just with the cross fiber strumming of the muscle [inaudible] Peroneus longus and apprentice, as long as you don’t see the muscles as much, but look at the foot going into aversion. So when that muscle is under a lot of, uh, uh, strain from metric or point formation just trumping the, the muscle will cause that muscle to fire. So just some things to look for when you’re, when you’re doing assessment. I think we can go to the next slide and, uh, sports medicine,

Muscles, maybe. Yeah, yeah.

I think that’s a good idea. Thanks Josh. Uh, so upper trapezius is one of the most common, uh, acupuncture is very familiar with this one because, uh, uh, oftentimes around the, the region of, uh, gallbladder 21, there’ll be trigger points. Uh, there can be other areas they call bladder 21 happens to be a motor point. We’ll talk about that difference in July, but, uh, this is a extremely common one that comes into practice, especially relevant for tension, muscle, tension, headaches, referring up the back of the neck and then wrapping around usually the gallbladder channel distribution to the temple occasionally to the chin, as you can see kind of the angle of the mandible. Um, most of us, uh, have needled a, this, uh, muscle just cause noodling gallbladder 21. Um, but again, with Josh was mentioning, mentioning with the trigger point palpation, you’re looking not just at one particular region, you have to look through the whole length of the muscle, but that gallbladder 21 or a little bit more medial where the upper trapezius starts to turn the corner are common sites where you start to see those pain generation, um, for trigger points of the upper traps.

And from a channel perspective, a gallbladder channel would be obvious it’s part of the gallbladder sinew channel, but it’s also part of the large intestines and you channel as it comes up the arm into the, uh, the deltoids up into that leading edge of the, of the upper traps. Um, so large intestines and Joel, to some extent, urinary bladder, if you look at the urinary bladder, send you a channel, you’ll see that it, um, has a lateral branch and it covers a whole wide range even coming into the front of the body. But in my interpretation, I see that as including the lower trapezius, upper trapezius, really the whole trapezius muscle, um, and then wrapping around to the SCM muscle. So, uh, the distal points that you can consider with this are along those channels. And one that I find is extremely helpful when people have pain and restriction rotating to the opposite side, as that upper trapezius starts to fire and becomes painful, it can limit motion, gallbladder 39 is my go-to for it, but not actually strict gallbladder 39. I actually do more of an anterior gallbladder 39, particularly at the peroneus Tertius muscle, which would be anterior to the fibula. That’s the one that I find really changes the upper trapezius. And of course I do needle the Udall locally with that too, but that peroneus Tertius motor point, which is kind of an anterior gallbladder 39, uh, is, is really a key one for me.

Yeah. Uh, another, um, distal treatment that I find works really well for this. Uh, if you do Richard tan balanced method stuff, we’re just interested in some of the other more esoteric channel connections, looking at midday, midnight relationships, um, in thinking of this as a primarily gallbladder channel issue, then often looking for Asher points along the heart channel, heart and gallbladder being across the clock from each other and the Chinese clock. Um, if you find a lot, a line of tender points on the forearm and the heart channel, very often needling, those can help quite a bit with upper trapezius stuff because of that heart gallbladder, the David and I relationship. Yeah.

And I think both Josh and myself are in agreement that local needling is also important and we’re not downplaying that, but just for the webinar where we’re not working with people live, we thought we’d focus a little bit more on the symptoms and the distal aspects. The combination is strongest and local distal. Linda Jason is really strongest. Right. Next slide. Uh, so just some things to look for, and then I’ll cue you into the traps. The symptoms that we mentioned are obviously important, but this sort of, um, upward sloping of the clavicle and where it’s kind of making like a V if it’s tense on both sides, uh, shortened on both sides, but that upward sloping and kind of backwards sloping of the clavicle is something that I noticed and kind of start tuning in with, uh, um, over-correct activity in the upper trapezius, particularly also limited range of motion, uh, um, with turning or lateral flection are keys for, um, kind of finding a restriction in the upper trapezius.

Definitely. I think we can go on to the next one. All right. So the SCM can have a similar referral pattern in some ways to the trapezius. Um, and there are actual neurological reasons for that in one sense, the, both the operatory pier or the trapezius and the STM are both innervated by the 11th cranial nerve in addition from like C3 area. And so, uh, they actually start out embryologically as one muscle, the trapezius and the SCM both. And then as you grow as a, as an infant, as child, as your collarbone lengthens, those muscle fibers separate, um, torn. Now there’s actually a gap between the two, but the, the two share a lot of interesting kind of symptomatology and function. Uh, so in terms of symptomatology, you can see in the picture, the SCM in terms of pain or other types of parasthesia causes mostly symptoms in the side of the head, occasionally one SCM will cause symptoms on the opposite side of the head.

Um, but usually it’s centered somewhere around the side of the face, the ear, occasionally the Vertex, um, the occiput, the interesting thing about the STM in particular, and this is one of the few muscles in the body that has this happen is that trigger points can often cause a lot of symptoms that are trigger points, at least in this muscle. It can cause a lot of symptoms that often don’t seem related to muscle function. So muscle symptoms that often seem like they’re more autonomic nervous system phenomenon in terms of the SCM that can include a wide variety of dysfunctions or symptoms of the sense organs. So you can have blurry vision, uh, seeing things like, uh, uh, other, other types of visual disturbances problems with hearing so ringing in the ears. So tinnitus is a common one feeling of pressure in the ears as feeling like fluid in the ears that isn’t from an actual physiological cause.

And it can cause stuffy nose. It can cause excessive, runny nose can cause excessive lacrimation. Um, it can cause dizziness, sometimes some types of vestibular disorders often have a component of SCM or other neck muscle dysfunction. And so it’s also very helpful when you have an understanding of, of what some of the possibilities are for, um, trigger points symptomatology with this muscle, just start recognizing that with some patients. So for instance, for me, commonly, it’s a patient who comes in with maybe sinus or allergy symptoms and they don’t seem to be seasonal or related to anything particular, just kind of there all the time, very commonly, even just palpating the FCM, all of a sudden will cause one of their nostrils to open. And so sometimes treating the SCM for things that can look like allergy symptoms or like hay fever, if it’s seems disconnected from changes in like pollen levels can be something good to look for.

Um, thinking of this, uh, I very commonly end up treating distal points along the stomach channel for this. Um, and also interestingly, the UBI channel, this is not something that if you’re, if you’re only looking at regular channel pathways, you’re going to normally think of, but if you look again at the sinew channel pathways, the UV channel is one of those ones that has pathways that go far away from where the standard kind of channel normally goes. So there’s a, an aspect of the urinary bladder sinew channel that falls up the lat comes across into the Peck and up the neck. And this comes from an aging, just Brian and Matt have actually mapped it onto particular muscles. And so sometimes treating the SCM as a urinary bladder, senior channel muscle can be really helpful. You’ll be 60. I use UV 63 a lot with that sometimes if it happens to be tender or something, or you’ll be 57 or 58. Um, so that’s another fun aspect to that. Uh,

As in young energy, you know, coming up the UV channel. And I, I find when it is, you be an often that has dysfunction associated also with the upper traps, the lower traps, you know, when those are all kind of activating together as that sort of, you know, tension building up the body is where I really see that UV connection.

Absolutely. All right, let’s do the next slide. Um, I I’ll just briefly talk about this before, because we’re not, cause this can muscle can be a little bit harder to examine. Um, partly for safety reasons, because you’re talking about a muscle that is, fascially bundled up with a carotid artery and a lot of other kind of neurovascular structures right near there. Um, most of the time when I treat this, although I do needle it with retention, the way that, um, you will learn in the sports medicine program where essentially needling from stomach nine back towards like small intestine 16 or that area, um, or doing, uh, dry needling, which is a little bit more, requires a little bit more care because your piston and kind of moving the needle in and out, but really learning how to manually release this muscle first, um, and getting really comfortable with the palpation, grabbing the muscle, separating it from the neck and being able to isolate the fibers while you’re pressing on them. Getting very comfortable with that before you start needling, it is a really good idea. Um, anything else kind of in general to say about palpating and treating that muscle that you want to add? Brian,

And then I think I agree with that, uh, um, manual work. If you’ve not used a needle in this muscle, get in, Hey, you’ll get a lot of benefit from, uh, doing the manual work. It’s it’s, um, it’s one that, uh, does well with manual work, but it gets your hands acclimated to that ability to sort of pull the muscle away and feel the, the, how far, how deep that muscle goes and where it is in relationship to other structures. So that’s very important.

Yeah. And I’ll, I’ll say that when I teach this material at school out here in Seattle, uh, the first thing that I have students do for the first year of their education before they do any needling of any of these is they learn manual releases for all of these muscles, because they’re especially as an acupuncturist, if you don’t get a lot of chance to practice specifically palpating muscles, like we’ve talked about, um, it can be very difficult to just start needling them. And so I want to make sure that like my students in particular have of experience with manual palpation and treating the muscles just with their hands first cause then growing into the needling is actually relatively easy.

We’ll say something interesting about the SCM is a two headed muscle, S S C M Sterno and uh, clavicular heads, both attaching to the mastoid process. Um, the channel relationships as the sternal head tends to be more associated with the stomach channel and the [inaudible] had more associated with the sand gel channel. So if you go back and look at the club, vicular had distribution in particular, you’ll see that it does refer deep in the year. And that’s often what people, when you’re working with, it’s like, oh, I feel that in my ear. And that’s the one that has more of a tendency to cause things like, uh, postural vertigo. And, and, um, the point is, is if you look at that clavicular head in particular and then go think about points like San Jo three or sand JAL five, and the relationship of the sand Dow channel to the year, it’s again, one of those areas where you can start to see a little parallel between channel theory and trigger point theory.

Yeah, definitely. Right. Next slide. Yeah. Why don’t we

Get to, I think we’re there. We have Josh and myself knew we had a lot of information and weren’t sure we’re going to get through it all. I don’t want to downplay levator scapula. It’s such an awesome muscle to be familiar with. Um, but let’s go pass this one to, uh, pass this and we’re going to go, I think, to infraspinatus Josh, why don’t you take infraspinatus?

All right. So this is along mean all these muscles. This is going to be true, but the infraspinatus along with like the upper trap and the, um, SCM are ones that if you just build your practice around treating like just this muscle, you would still be incredibly busy and have lots of very, very happy patients. Um, so this is one of the most common areas for trigger points that need to be treated for almost any kind of shoulder joint dysfunction, but also, uh, very commonly for pain in just pain in general in the front of the shoulder, but also down the arm, even all the way down to the thumb fingers of the hand. So the, the most common location for the referral for this one is deep pain in the front of the shoulder. And this can often feel like mean patients will often describe it as like a toothpick kind of sensation around like the large intestine, 15 area.

Um, very commonly they’re going to come in and be told they have bicipital tenor synovitis or bicipital tendonitis because the pain often occurs right over the biceps tendon as it’s going through the, the bicipital groove. Um, this is really a small intestine sinew channel muscle, even though the most common referral pattern is down, essentially the large intestine and partly the lung channel and the best way to treat this distally is usually through small intestine channel points. So a small for can be helpful. Um, most of the time I’m using essentially small intestine three and a half, which is the motor point for the abductor digiti [inaudible], um, kind of right between it’s like the large intestine, four of the small intestine channel, essentially kind of right in the middle of that, of the metacarpal, uh, bone there, where the muscle is. Um, but again, this is one of those muscles that if you get good at palpating, it, uh, for any kind of shoulder problem, this can be really helpful to treat.

And not just because of the referral pattern, another very common issue with any kind of shoulder problem is the biomechanical dysfunction that happens. Even if just someone has mild pain, they start kind of using the shoulder a little bit differently. The, uh, the strain of, of even just raising your arm or whether it’s something like playing tennis or reaching up for a can of tomato sauce in your pantry or something like that. When you have pain from any cause for the shoulder, it starts altering the biomechanics of the scapula. Often the scapula doesn’t move as well, and the rotator cuff muscles, and have to do extra work to kind of stabilize the head of the humerus and to kind of make sure you have the as much arm elevation as you need. So usually the first thing that happens is the rotator cuff muscles of which the infraspinatus is one start developing trigger points or other dysfunction. And so regulating the relationships among all the rotator cuff muscles, which usually involves infraspinatus and also subscap, which we’ll get into in a different discussion, um, can be incredibly helpful, um, for just a wide variety of not just referred pain issues, but also any kind of glenohumeral, biomechanical issue.

Anything to add to that, Brian. Yeah, I see an X on there that I think is an artifact. I might’ve put an X on SSI 11 because that’s such a common area of trigger point formation, even that could be anywhere in the muscle and moving that image around. I think there’s a little artifact there. So don’t go looking for a trigger point in the infraspinatus off of the scapula. That’s an extra price on the top the top. Right.

Okay. Well, you understand that, that be more than that. All right. Uh, next slide. Uh, oh yeah, yeah. As soon as some examination infraspinatus, so often anything that’s going to stretch the infraspinatus, it’s an external rotator. So usually end range of internal rotation or not even end-range of it’s really severe. So reaching behind your back, like to get a wallet out of your pocket, unstrapping a bra, but also having the muscle contract fully can also often cause a pain. So external rotation often that’s going to be like brushing your hair right. Going up into this motion was causing contractually external rotators. Um, so that’s a general rule of thumb with points is that the pain can be brought on either by fully stretching the muscle or by contracting the muscle. So it’s another thing you have to really start to understand work doing this kind of work is what muscle functions are and for any given motion in one part of the body or when joint, which muscles are contracting, which muscles are stretching. So understanding agonist, antagonist relationships, um, can be really helpful in diagnosis, as well as treatment planning in terms of figuring out what spinal levels you want to add to help kind of, uh, normalize muscle function,

Right. Then you can go to the next one. Yeah. And I think we’ll just go through these quick, cause I know, uh, uh, we’ve gone a little past the time that we were hoping for a work around and talk all day, but I know some of you guys probably need to get back to work. Um, so quadratus lumborum is such an important structure. And the referral that you can see is, is kind of generally at that iliac crest region down towards the greater trocanter, uh, deep into the glute area, it’s such an important structure to learn how to needle, especially in a class setting, um, for, uh, uh, to be able to, uh, work on directly, uh, just because it’s so indicated and so many, uh, types of back pain conditions, uh, the work we do in sports medicine acupuncture would probably surprise a lot of people.

If you haven’t heard this already as a, we see this as part of the liver send new channel. Now the liver sinew channel ends at the groin, but if we were to follow that myofascial plane up from the ad doctors going right in that iliac fossa, um, its continuous myofascial plane into the iliac as muscle that would continue right into the quadratus lumborum. So even though you have to get to it through the back, um, it’s really a very deep core structure on the plane of the myofascial, send you a channel of deliver, uh, channel liver network and liver five. And sometimes even adding liver five with liver three as a combo is just a really magical combination for, um, reducing pain in the, um, quadratus lumborum again, a local needle is so important there, but uh, oftentimes just from palpatory pain, liver five and, and um, adding liver three, we’ll reduce it by 50% you go back and palpate afterwards you’ll find that that the pain is reduced by 50% just with those points. And they often, especially liver five becomes very reactive, very tender, very easy to find when the quadrant is some farms under a lot of pressure, a lot of stress.

Yeah. And I would just add, if you treat low back pain, get to know the QL, it’s a, it’s one of the most important muscles along with like the, so as to treat for any kind of low back dysfunction yeah.

Then attaches above into the 12th rib leads right into the diaphragm. So it’s kind of starts to get getting you into that visceral core of the body. Um, so elevated ilium, the next slide is showing, uh, that’s just measuring the helium from the side. We’ve talked about that a lot, various other, um, myself and various other webinars. Um, it’s on our sports medicine, acupuncture, uh, blogs, you’ll see blogs on Anjana syndrome and stuff like that. And it’ll go into that in a little bit more depth if you want to reference those. So let’s look then at the glute medius and minimus, we’ll skip this one, so right. And to medias, why don’t you finish these up Josh? We could probably even look at them as a pair.

Yeah. So this is another one of those long with the QL and the other ones. This is one of the really important points to treat, um, this in the minimus, uh, really for low back pain in addition to hip dysfunctions. So in Trevell often she talks about the referral pattern for the glute medius, which is the larger, more superficial lateral hip muscle primarily. Um, Ady ducts the hip. Uh, the referral pattern generally tends to be somewhere around the sacrum and the iliac crest and a little bit around the gluteal area itself. And then if you go to the next slide that the minimis, which is deeper, kind of underneath the, uh, the glute medius kind of closer to the ilium, um, slightly smaller in scope that the minimus tends to refer down the leg and can really mimic sciatica or any other kind of an L five radiculopathy in practice.

I’ve found that it seems like the glute medias can also refer down the leg like this. Um, I’ve had, I’ve had treated some patients where I know I’m treating the glute medius cause I’m nowhere near deep enough or I’m like right at the iliac crest and they still get the referred pain down the leg. So basically the, really the significance of this muscle or this pair of muscles to me is really this particular referral pattern. And aside from, um, the biomechanical aspects of it as an add doctor, one of the, it’s the really important muscle for stabilizing the pelvis. Every time you walk and take a step, right? If you understand a little bit about orthopedic medicine, you know, the Trendelenburg sign, have someone pick up one foot and look to see if like, if they’re standing on their right foot, if the, if the left side of their pelvis drops, when they stand, they kind of like sag a little bit that’s culture and Ellenberg sign, it’s a sign of dysfunction and, and not a lack of firing of the gluteus medius and minimus.

Uh, and that has repercussions for postural and movement function throughout the rest of the body, along with the QL and muscles in the neck. Um, but aside from those structural issues, the pain referral pattern for this, if you learn to recognize it and then to treat it by treating these muscles up around between like gallbladder 29 and gallbladder 30 in that area, uh, this can mean potentially even have some patients, you know, keep them from getting unnecessary surgeries. I’ve had patients who have been told they had, they needed like a spinal fusion, things like that because they have pain radiating down the leg. We treat the glute medius and minimus and their pain goes away. Right? Cause it’s really, really common for trigger points in muscles for number of reasons that I can have an entire lecture on that. Even in Western medicine circles, they get ignored.

And for some of the muscles like this, where the implications of not realizing that it’s a muscular issue are the implications when there’s something like getting a surgery to fix the problem, uh, that can become a really big issue. That can be very important to the patient. So learning to recognize these, uh, you will, if you start treating this type of thing, have the experience of having, uh, the patient, um, realize they maybe don’t need this very invasive surgery that is that they’re planning to have. Um, just because they’ve been told by one person like an orthopedic surgeon that you need to have like a spinal fusion. So that’s one of the, this was one of the really important muscles that I find for that issue in particular. Right?

Yeah. And it’s also becomes dysfunctional with, uh, frequently with the quadratus lumborum. So even needling, sometimes QL will refer down the leg because of that stimulation from QL into its referrals zone at the glute medius minimus region, and then stimulate, you know, it’s almost like a transfer through that. So, um, but, but those are very, um, very often in dysfunction together. And lo and behold, we have a liver and gallbladder relationship then. So a consideration yeah. Consideration of liver five, uh, and gallbladder 40 source point to help, uh, kind of build energy. And the gallbladder’s a new channel for these muscles that tend to be inhibited and pain generators when there’s inhibition, not always, but that’s the tendency and, uh, liver five to help with that more overactive, uh, add doctors. But we talk more about the quadratus lumborum so QL and add doctors on the liver test and new channels. So something to consider with that really a great combination. All right. Well, I think that, uh, thanks for bearing with us already. We took a little time with that, but, um, it was a pleasure working with Josh and tune in next week for, uh, Jeffrey Grossman’s, uh, presentation. Uh, and thanks again for everybody for coming. Thank you, Josh.

 

 

AACTTPMaimon05262021HDThumb

Anxiety Is Not Fear – Yair Maimon

 

 

…the lecture today will be on, uh, I think a very relevant topic about anxiety, and there is a lot of misconception that links, anxiety and fear, and in Chinese medicine, and we’ll say fear, we’ll link it with the kidney in the essence of the kidney

Click here to download the transcript.

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

Hello everybody. And welcome. I would like first of all, to thank the American Acupuncture Council for, uh, putting up this lecture and, uh, arranging everything around it. So thank you very much. Uh, the lecture today will be on, uh, I think a very relevant topic about anxiety, and there is a lot of misconception that links, anxiety and fear, and in Chinese medicine, and we’ll say fear, we’ll link it with the kidney in the essence of the kidney, but as you will see, anxiety is actually in some cases may be related to kidneys, but in most cases it is not. So I will start with some slides now, so we’ll follow my lecture. Um, so the lecture, as I say, it will be also based on the clinical and clinical experience, because I always like to teach from the clinic from the clinic and from the thing, the most important information we gather from patients.

And we see actually the effectiveness of our daily acupuncture when we are in the clinic. Next slide, the prevalence of anxiety is actually quite wide. I mean, according to the American psychiatric association, they’ll say 10% of people are affected by anxiety disorder, but really 30%. And I think more will experience it in the life. If you ask me now, after Corolla should be updated thing, then the numbers are much higher and it’s twice often women than men. And it makes sense. I think women just, the more sensitive in men are better in maybe negating or not allowing their emotions to out in America. They’ll say it’s about 40 million people suffering from anxiety disorders and it’s the most common mental illness. So, so it’s a kind of major issue. Next slide please.

And, uh, if you look at the, the way it is described, so anxiety refers to anticipation of future concerns. So there is some concern about something bad that will happen. Actually it can be many things is when you unfold the case in the clinic, it can be a very vague thing, or it can be very real in sometimes very surprising and it may create this avoidance behavior. So people will not do something like they’re afraid to drive the car because there is some fear related to losing control in the car or that something will happen in the car. I have very strange cases like people will drive in the car, but not in bridges or not to pass tracks. Usually it relates to something that we will see later on as a, as a kind of trauma-based things. It, but fear is very different. Fear is in emotional response to some real threat, immediate threat it’s more associated in, in Western medicine was the flight and fright reaction that the body chooses. The sympathetic SIM system becomes very active and it’s either fight or try to escape from danger. Next slide.

So when we look at the pathology, we see the things, it is not the same as fear. And, uh, this one is real and this one is a bit unreal and it’s always something, you anticipate something in the future. And when we look at the symptoms, you will see, it’s not really kidney symptoms that you see in the clinic, which if anxiety will be fear, it’s much more the palpitations, the chest pain, chest oppression. I think almost 50% of people who got come to emergency room with like a threatened heart attack, or they think they have heart attack. It’s actually panic disorder or anxiety disorders. So it’s a very common that all the symptoms more relate to the fire into the heart next line. So you see it’s not the kidneys and, uh, if we can look for the next line. So, um, one of the things that anxiety very much refers to is this kind of, uh, um, being rooted in some trauma, in some memory and, uh, this memory that’s the interesting part can be a root of the memory can be known, can relate to a certain situation, but even more interesting.

It can be unknown next time when it is known, it’s very well, I won’t say easier to treat, but like we use different strategy and, uh, it can be, you know, death, it can be an accident. It can be any event, you know, events in the army like, uh, uh, PTSD. Then usually I, I feel that it’s good to combine acupuncture with some other strategy, with some other kind of behavior modifications like a behavior, psychology, MDR, be a feedback. So when you can pinpoint to is some very specific event, like if somebody got stuck in an elevator for a long time, now he’s afraid to go through an elevator is and anxiety and panic attacks about it. Then maybe, you know, it can be, the acupuncture will be amazing and creating a change, but maybe we’ll need another intervention. It’s more interesting when we go to the unknown area, when there is no real reference, uh, to the, the beginning of this anxiety attack.

And then also it can be prenatal or postnatal next slide. And this differentiation of postnatal and prenatal is, is also important in the clinic. I find it many times the postnatal, uh, if the root is already in the postnatal life, we’ll see more of this heart symptoms, palpitations, arrhythmias, chest oppression, different things around the heart. And even people will be concerned that they have something wrong with the heart. When it’s a prenatal, obviously there is no memory and it will relate to some issue maybe that starts very already at the pregnancy time and maybe even earlier, but I mean, it, some things are running in the family. I can good example if the mother, especially the mother, because the mother and the fetus are very connected through their PO. If the mother has anxiety, she can pass it to the child. Obviously, if there was some traumatic event to the mother and I’ve had many cases that I’ve seen that I can route to, sometimes during pregnancy, like the mother went through an accident or the mother, I know different cases where the mother wanted to do an abortion and then regret it.

So in a way it was traumatic to the child. So then there’ll be a certain anxiety and uncertainty issues around death. And that’s whenever there’ll be, I know a patient of mine, if there’d be some death in the movie, you will go into this anxiety attack. So the prenatal roots are very interesting to watch. And then the symptoms also may shift. You will see more like to do also with breathing difficulty, waking up with difficult breathing, being afraid. There’ll be not enough oxygen, uh, eh, even claustrophobia, strange dreams, fear of losing control. You’ll see a lot of different, weird symptoms, which are initiating the anxiety or coming with the anxiety next slide. So it will be very different, uh, when the root is known or unknown. And also to me, the treatment will be different. And I’ll, I’ll talk a little bit about treatment also of unknown roots.

Exactly. I think it can be really, uh, kind of, uh, beginning of, or the root of many symptoms in the clinic. And this is also symptoms you will find when you look at what symptoms anxiety can provoke. So it can be neurological, digestive, respiratory cardiac, muscular. So you have patients actually coming to you with a chronic fatigue syndrome is fibromyalgia was different abdominal, the disturbances, but actually it is anxiety. And you may treat for a long time, the physical symptoms with very little success. And till you change the strategy and the focus of treatment on the anxiety and the root of the anxiety, and then suddenly all the symptoms will disappear. All will get better. Next slide. So this is very common to me to kind of shift my attention from a physical cause to something which is deeper to a real root of disease, which is deeper.

Let’s go through a simple, not simple like case from the clinic. And then I can explain, um, it’s a patient 29 years old is quite a quiet person. Uh, first I introduced him a little bit, like what I see in the clinic. Um, he kind of, kind of rude himself is very shy and, uh, but it can be also engaging. I mean, if you talk with him, he will look at you. So pat is timid, shy, quiet. He will not initiate a discussion. And when you look in his eyes and maybe you can also see through this, there is something a bit lost and a bit sad and a bit lacking there. Next slide. So, uh, this is like, what do you see in the clinic and how the anxiety manifested in him? Uh, any, when you say since the day I remember myself, I have anxiety and anxiety attacks.

I was very shy as a child and almost not seen in this is something also interesting, like this feeling of not being seen by friends. Although he, he, you know, it looks good is very active, but he always, this has stayed. You know, one of the deepest thing that I can say about myself, I always feel alone. Even that he’s surrounded with people, uh, he has this feeling of being alone and he’s when he is with people, easily feels offended and gets insulted, especially in the group, you know, things that maybe people don’t like him or say something about him and he will immediately withdrawn next slide. So this is like very shy and inward person. And if I asked him about the sentence for the anxiety, he says, I have this tension in the upper part of the abdomen around rent 15 and a, and it says like, when I get this kind of anxiety attack or anxiety feeling, I feel everything is going up to the head very often lately I will have insomnia, especially during time that there is more anxiety and this tendency for short breasts let’s time.

So, uh, you can see that there’s like many symptoms and his, his life is very much kind of the quality of life is extremely reduced. My oldest feelings. So I asked him also what makes him better? That’s a very key question to ask people. And a lot of time we’ll give you actually an insight of, um, both the root of the disease, but also for the path of healing. It’s a very simple question. Uh, but sometimes actually the most important. So he says when I feel loved, which was a very surprising, you know, because it was very honest and, uh, you know, titled as patients, you almost feel like you want to hug him suddenly, you know, cause it’s like bringing this honest pain, but also this there’s something about him and not being seen in any meaning law, which is also very much calling for lab to, to ask.

It’s almost the path of the diagnosis. And he says, when I have a new relationship with when he is in relationship with somebody that he loves and feels connected to enclose, there’s less anxiety and then asked him what it is related to. And I find questions that are one of the most important part in really understanding a case, the answers to two good questions, a good, they can be very simple, are extremely revealing. So he says it’s connected to a fear very kind of deep and morphic theory says the feel of being alone, the kind of feeling of being alone gain related to some kind of, you know, it’s not a fear from something, but it has this kind of being alone and this kind of being lost in this being alone as a key, a feature in his internal life, next slide. So you can see that, that he’s very, um, Inwood person, but in the same times is seeking and yawning for, for, for this love and connection.

And I say, when did it start this kind of fear in itself, it started at a very early age. So probably the root is prenatal, as you will see later, asked him if he in yet other fears, he says, don’t not really fierce, but difficulty in relationship, difficulty in start relationship in intimacy. And, um, it says it doesn’t stay long in relationship and he doesn’t understand why, like you said, only feel close, even if the relationship are good for him. So again, it’s a kind of already hinting as towards something deeper, which is the root of the anxiety, next slide. So, uh, the pals and the tank, so the pulse was on the heart and pericardium, uh, some will call it kidney and very deep and weak. So basically I put it. There’s no fire. The fire pulse is very weak. There’s no fire there.

The tongue is normal. Next slide. So you can see that the gain, another issue, uh, we’ll go now to the diagnosis. Next slide. So the diagnosis in general, there is a weakness and it’s important to see access or weaknesses, always the beginning of diagnosis. And there’s a weak fire, weak meekness, 12 fire, some weakness in the kidney. And I put it as a general tendency feeling of not protected because the treatment will reflect the diagnosis, the treatments we want to bring back this ability to feel more protected, next slide. And, um, so again, and when we look at the diagnosis, so you can see this shyness, this ministerial fire pericarp fire, which very much relates to relationship is very weak and very weak Shan and eyes. And if that is kind of a bit lost as Shen is a bit weak, next slide. So you seek instance deficiency overall of firing and weakness.

Uh, since it’s a day, he remembers itself is a prenatal and this feeling of not seeing again, this points to this week fire. So we want to strengthen tonify this fire in a very deep way into treated this prenatal root of this weakness. And as this easily feel offended, it’s another part of CARICOM and it’s a drain. So it’s a pericardial lever. A lot of time can relate to is next time, next time. So, uh, also the symptoms, you know, very much the divergent channel and divergent channels are a lot of times keen treating anxiety as the divergent channel of the pericarp relates to this area and goes up to the head. So it explains this kind of feeling that he has an insomnia shortness of breath, again, relates to the pericardia, this tightness in the chest and this lack of Dwayne stagnation, next slide. So, um, and again is relates to love relationship. So, um, I it’s very clear like where the case is going to end if this weakness of pedicab, but also relate to the gene level next line.

So this, um, prenatal root is one of the key routes that we want to address here. And we want, that’s where I find it, that the kind of usual acupuncture and send the straight forward, doesn’t bring this deep transformation effect unless we go to some kind of a different usage of acupuncture and next slide. So, um, and the pulse on the tongue, again, re reflect the same thing. So next slide, and we can finalize the diagnosis that there’s this fire, especially pericardial, uh, weakness, and some DJing and kidney essence weakness. Next slide. So the treatment I, I, I used for him was sometimes pericardium, which I will not discussing in this lecture, but it’s the fire of the pericarp very interesting point. And I’ll lose it just on its own, just to one point treatment. And one point needling sometimes create very dramatic effect. And then it was very cut one and do 11, which I want to discuss next time.

Um, this is a picture of the DOMA. It’s part of a project that I’m doing with two colleagues, bottles, Kaminski from Poland, then Rania ya’ll from Israel and took together with the painter from Poland and Matina Yankee. And so we kind of paint and portray them Perigon in a various more special way, but basically in this project, looking deeper into the effect of, by the effect of points and the mechanism and the names of points. So do 11 Shen doubts, look at the name, they do it the way of the Shen, the Dow of the Shan, next slide. So here you can see the picture, uh, from our, uh, book, which will be hopefully ready in a year. You’re already working seven years on itself. I’m still optimistic, but it takes long. We already went through all the points twice and we’ll need more time to finalize it all.

So first of all, this point is located on the level of their heart. And you can see here this, this kind of this pathway, this path of the Shen next slide and the path of the Shen is this path, uh, that, uh, the, the road, which the emperor used to travel in the, to the Imperial too. So it means it’s like to go to this ancestral energy. And when we talk about prenatal, uh, effects, we’re talking about really, uh, ancestral or, or things that are passing in the lineage. And I find in the clinic that many strange symptoms can be related to lineage to, to the parents and to the whole lineage. And then that’s why the patient cannot understand the root, or why has this symptoms? So this point is a very special name. Next slide. This Shen down this way to the clear way of the Dow.

And this is the way the emperor used to go to this ancestral through tubes and all the, the points by two on the upper chest and upper back, uh, relate to this dynamic of the gene, going up to the heart to be transformed into shape, to this deep transformation of water and fire. So if you look at the location of the point, it’s on the level of his bladder, 15, which relates to the heart and bladder 44 also, which relates to the heart. So the location also explain us the dynamic of this deep changes of the heart. Next slide.

So we can use this points to establish this back communication with self, the established, a communication with your own downs, your own inner path, which is special for you, you know, which is special for the patient, which is dependent very much on his individuality he’s authenticity, which I can say, like the background noise of sometimes ancestral noise, different traumas are just taking the person of his own path of his own authentic feeling and path. And when person is connected to this place, then the Shen comes out and then nothing really can disturb you. And this point can be used for anxiety distinction for, uh, for flight and next slide for timidity, and also for shortness of breath. The other point, which is interesting is card one, just use it today. Actually in yesterday, it’s called celestial pool and you see this beautiful drawing that we are a painting.

It’s a drawing of this pericarp channel. And this point is on the pericarp. You can see it’s quite high, it’s on the mountain. So it’s on the chest area, you know, just by the nipple next slide. And the name celestial pool is very special. Next slide it’s to do with this place of, uh, the pre heaven and post heaven meeting, meaning of, of really the root of life, which is heavenly. At this point, there is internal trajectory which are connected to rent 17. So it’s also very good to a lot of chest oppressions and, but even eye disorders. I mean, it’s part of the windows of heaven and windows of heaven are very much related to, um, the divergent meridians, which are balanced deep balancing our emotional life, that the Virgin Meridian, the extremely important in treating emotions and especially deep rooted emotional problems and emotional conflict, it’s also meeting point was liver and gallbladder. So when you see things more related, uh, on the, on the drain level, this point again, has another treated actually was this point, the person who is a glacier who has difficulty of swallowing, uh, next slide.

So, uh, as I said, its name is very special. Heavenly pawn is a place of, of this connection. This is this ascend, early pond is, you know, in all the places and all the classic life are starting from water from this essential poem, which everything is timing for next line. So just to kind of finish up this short lecture. So in his case, it is it, is it fear? No, it is more this weakness of this weakness of fire, this deep deed for love and being in and feeling loved and feeling protected, which is, that’s why the CARICOM is sometimes translated as the heart protector. So there is this weakness of also wood and water, which is not supporting the fire, but the fire is the core in his case next line. And using this kind of points really create a transformation. If you’re interested to hear more about kind of how to use transformation points, I put a whole series actually, during COVID about the different, eh, anxiety disorders. I call it creating the cloud series because it’s to do with anxiety and depression and other, uh, more emotional rooted and understanding better the emotions. And now we can treat them with acupuncture next line.

So as a final note, you know, I it’s, I, I call it by the way, clearing the cloud, because sometimes when you use this, especially windows of heaven point, it’s like you open the window. It’s like the, the image is like, you know, suddenly there is light in the room, or if you walk during the day and there is clouds and suddenly they’re clear and the sky is open. So the whole internal feeling is changing. And to me, the most magical part of acupuncture is this ability to transform, to touch heaven in the patient. And to me, having in the patient is, is a very real thing. It’s the real deep inspiration of being connected to something which is greater than, than you. It’s difficult to put it in words, but it’s a very known feeling when you feel in a place when your heart is at peace, when you feel connected, it’s then it’s when you’re alleviating suffering and clearing this clouds and allowing this real deep healing and change. So next time. So, um, I hope it was helpful for you. And, uh, thank you all for joining, joining in, and thanks again, the American Acupuncture Council for providing this show. Be healthy, feel well. And from Shanta Shan, thank you so much and all the best.

 

YENAACTTPHD05192021 Thumb

How to Get Past the Gatekeepers for MD Referrals – Chen Yen

 

 

You like the idea of attracting more patients through medical doctor referrals, but you’re not really sure how to get past the gatekeepers,

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.

You like the idea of attracting more patients through medical doctor referrals, but you’re not really sure how to get past the gatekeepers. So this is Chen Yen your six and seven figure practice make-over mentor at introvertedvisionary.com and welcome to my show today on AAC live. So, uh, you might have been thinking about getting referrals from medical doctors, but, um, let’s talk about, well, how do you actually connect with them? Because some of the most common challenges that I hear are having trouble getting past the gatekeepers, or, you know, how do you approach them so that they actually do take you seriously? And then what if they’re saying things to you? Like the, you’re not a part of my insurance network and, or they might seem skeptical. And the truth is that as far as I’m days go, it is true. Not every medical doctor will refer, but did you know that medical doctors have thousands of patients in their practices and many would be actually happy to tell their patients about you, if they knew about you and how you can help their patients.

So, um, as we get into this, I w I want to share, uh, uh, let me just, let me just think about this, what I want to share. Okay. So, so then is it worth it to you to develop that relationship with, with a medical doctor? And it just, you just only need, like, you don’t need a ton of medical doctors referring. You just, you know, a handful of medical doctors who are your biggest champions. And remember, they don’t always have to be medical doctors either. They could also be other kinds of conventional medicine practitioners or holistic health practitioners too. So whether it be nurse practitioners or nurses or PAs, I have clients who are nurse practitioners also, and they say, Hey, don’t forget about us. It’s actually easier to get in with us then, then medical doctors as well. And then you could also look at like making connections with other holistic health practitioners, for example, chiropractors and naturopathic doctors, too, to mutually collaborate on helping you’re working as a team or to collaborate more on, on getting better outcomes for your patients.

So specifically, let me give you three hot tips related to connecting with MDs. And, uh, this comes from my experience of having worked in different settings in the hospital setting as a pharmacist, as in the outpatient setting. Also, I’ve been in the insides of the FDA and at Merck, and having seen what actually gets medical doctors to refer and what doesn’t and giving you the shortcut to that. So, and by the way, I, I have, um, okay. So as far as, uh, the, the, the, the, uh, the tips that I was going to share with you, so the number one tip of connecting and getting in with MDs is to actually go around the gatekeepers, because if you’re just facing the gatekeepers, what are they doing there? They’re there to screen you out. One of the most common mistakes is, is I actually also sending things like letters, but what happens to, to a letter, just think about the kinds of mail you get in your office.

And you, you look at one and you really don’t know, uh, you don’t really recognize it. What do you do? Right? It’s like, and this is what the gatekeeper might be doing like, right. So, so then, um, how, how do you actually, I approached them, get them going around the gatekeepers one hot tip is to, to actually, I message the doctor on a platform like LinkedIn. So this is a, an Avenue that our clients right now are getting really good results from. And we had a client of ours. Who’s been doing this, and then he’s been getting zoom meetings with the medical doctor. He also, um, offers up to, to meet in person too, but isn’t it nice to have that opportunity where you don’t have to leave your, your, um, house, you don’t have to leave your clinic. And then you could just do a zoom with a medical doctor and start to, to help them be more aware of how you can help their patients.

So that is one hot tip, and then you just need to know what exactly to be messaging them. And then I went to do, if they don’t, don’t actually, um, get back to you, right? So, but that’s, that’s one thing that’s working really well for, for, um, our clients. And then the, um, the second hot tip is, um, and these are tips that I’m teaching you from the doctor referral success roadmap in the, uh, in our consistent patients, make-over, uh, mentorship for introverts. And so it’s to actually go, go through your existing patients, see this is instead of sending letters instead of calling the office. And then they’re like, who are you? Um, some of the most low hanging fruit is, is think about the, the patients you’ve, you’ve had good results with and, or who have been very appreciative of your care. And how can you actually, um, ask, they’re even ask the patients more about the, their primary care doctor, if they have one or other kinds of practitioners they see, and then, then you can ask them, um, do you, do you like them?

Right? Cause it’s also important to, to get a sense of what that practitioner is like, you’re the people who, who will likely refer most to you. And also the people you’ll enjoy working with the most are ones who are most with you value wise. So you need, it’s not just about reaching out to any kind of provider. It’s also helpful to be discerning too, about who you develop these relationships with. And then, so then how do you go about this? So once you, after you have, have, uh, have a better sense of whether he wants to connect with that, that doctor or not, then you could always suggest that the patient bring it up to, to the medical doctor about how they’ve been coming to your practice and essentially putting a word in for you. Right. Just saying, tell your, your doctor, how, how it’s been for you coming here.

And I would love to, um, connect with your doctor because, uh, I would love to too, I’m developing my network of referrals and in the area and wanted to connect with, you know, would like to talk to them and understand their, their practice philosophy better as there might be the ne uh, opportunity for mutual referrals or, uh, when, when the need arises. So, so that is something that you could bring up to your patient. And then what happens when I’m after that? How do you actually approach the, the doctor, uh, when you, you know, doctor’s office and Dr. So we actually have a template for this that I want to make sure you have, because that we could just, just, uh, use it right away already to help you with, with getting into the next step of this. And, um, you can go to, I’ll give you the website link.

So it’s at introverted visionary.com forward slash get M D referrals. So it’s introverted, visionary.com forward slash get M D referrals. And there you can download a template, um, that will be instantly, and you could use that to help you with what, what do you actually, uh, how do you go about, you know, what do you say to that doctor once you actually have that opportunity to connect with, with that doctor so that you start getting referrals, you’re more likely to start getting referrals sooner rather than later. So the third hot tip of what you can do to go around the gatekeepers instead of just, just, you know, talking to the gatekeepers and then them screening you out is, uh, to, uh, educate the doctors through, uh, and a talk or a webinar where you’re in front of the providers. So why is this it’s because many times when, when, um, you might not be getting referrals, it’s because of, of one, three reasons, and let’s have a look at the slides here.

So let’s hop into the second slide here. So, so, you know, and, and also in terms of the, Oh, and go ahead and go to the second slide. So this is, this first one is just that most people often quit, right? When they’re looking at getting referrals from doctors, they’re just like, well, they try a little bit, and then they quit. And they’re like, well, this thing doesn’t work. Whereas it might be that it’s just because you haven’t, uh, haven’t had a system in place that works to have it happen because we have clients. Imagine if you actually had three providers sending you one or two referrals a week, what would that do for your practice? It’ll get filled up pretty quickly. Right? So, so in order to increase the number of referrals, for example, if, uh, whether you’re not getting any or whether you’re already getting some, let’s look at the three reasons why you may not be getting referrals as much right now, one.

And then, and then we’ll talk about why, you know, the, the webinar also doing your talk and then how you know, that kind of thing, um, can help speed, speed up this referral referral thing happening. So one reason why they may not be referring or not referring as much yet is because there’s not trust in you as the practitioner. So this, this is also in you personally, you know, that, that personal connection with you just think about it, the people that you might connect with the most, or the people you might refer to the most, you like them, like chances are, there’s some, you know, they either like them for who they are personally, uh, or they, they, they’re just really great with their patients, right. But there’s still some kind of a personal connection. Otherwise you could, you could choose to refer to someone else also.

So, uh, so their connection with you as a person can also play, play a role. The second reason why you may not be getting as many referrals as you could be, or any at all yet is they might be, they might not trust in your modality. Now, when we talk about modality, I don’t just mean that they think acupuncture can help it. It’s also beyond that, it’s like, what do they actually understand the scope of what acupuncture can help with? Or do they just think that it’s just used for musculoskeletal pain and that’s about it, right? So to what extent do they actually under skid stand the scope of how you can really help their patients? Also, they need to know and understand if it’s safe and effective. If it’s not safe, they’re not going to refer. Even if they think it’s going to be effective, but if they’re kind of scared about safety or, or, um, or like, if you’re, you know, if you’re you offer Chinese herbs and then they’re all concerned about drug interaction, then they won’t be referring.

So how can you help, help them feel safer? And also there are many of them are concerned about lawsuits these days. And so that’s a, um, an of consideration whenever they, they, um, they refer, they don’t want to get in trouble for referring to someone who ends up screwing up on their patients because they can, that’s not a good thing, is it? So, so then how are you communicating your, um, the safety and efficacy of your approach? The third reason why you may not be getting as many referrals as you could be get is because they’re not necessarily, you’re not necessarily top of mind awareness for them. So they’re busy and they might be going about their day with so much happening. Seeing patients day in and day out, are they having nurses have get their attention vendors are trying to get their attention. Drug reps are stopping by people.

They’re getting calls and requests all the time throughout the day. They’re really busy. And so what we want, and if you’re not top of mind awareness for them, they’re not gonna refer. So because today they might have thought about you. And then two days later, they already forgot about you. This is why drug companies think about this. Why do drug companies spend so much money sending drug reps to eye, to doctor’s offices? They know they have statistics to back it up that every single time when a drug rep goes and educates the doctor more, there’s this spike in prescribing, I’ve seen this because I’ve been in the inside of a pharmaceutical industry company, right? So this is the sort of thing that, that I, if you are able to get to the point where, where when doctors are, are seeing patients during the day, and I think thinking anything, meaning I remember I should refer to this person, that’s when you will be getting more referrals from medical doctors.

And so, um, uh, and so thank you for showing the slides for my help with this. Like the, so then, um, the, as far as an Ellen, if you could switch back to me, that’d be great. So as far as the, the, um, in, in terms of what can you do is to actually educate, um, the doctors further, right? Remember we talked about the, the, even if they realize that, uh, or understanding, Oh, acupuncture can help with pain, but if, if there are certain scenarios where they’re not as, as, um, well, an understanding about related to whether it’s safe, or if it makes sense for this particular situation that can think, then they’re not going to refer for that situation. So one way, how are you going to actually, um, help the doctors understand better? So one great way is to educate them. And, and then, uh, but then how do you educate them when, when they’re really busy seeing patients all times.

So if you’re able to have the, have the doctor hop on a zoom, or if you’re, if you want to stop by, and then, then also be sharing a couple of key things, you know, then, uh, or if you’re speaking in front of a more for like at a conference or something, um, where there are providers there, for example, we had a client of ours who spoke to a room full of 50, um, medical doctors and other kinds of conventional medicine practitioners. So she got 10 patients herself, as far as those doctors coming in to see her. And then she got referrals. In addition to that, now some of you might be thinking well, but I don’t know about speaking in front of such a large audience. I feel a little intimidated for one and another. I just don’t want to be speaking at a large audience.

Don’t worry. You don’t actually have to, you could literally just be talking to one, one, a medical doctor, one person’s not feeling more comfortable. So, um, yeah, but for those of you who want leverage, cause imagine if you, you actually just, I, again, you know, you do one, one webinar or one talk and then you’re, you’re done for a long time. The doctors are referring, you’re getting three patients a week. You’re getting five patients a week consistently for a while. Then you don’t actually have to be doing marketing for a long time. This is one of the few approaches where, where, um, you can literally be putting it in place once and you could be getting referrals three months from now, six months from now, even a year longer from now, and not have to be constantly marketing other approaches. Typically you need to be constantly marketing.

Would you agree? And that can get exhausting. You would just like to be focusing on helping your patients and treating patients. So, so then you just need to have a system that brings in doctor referrals quickly and consistently as well. That works. And so, as far as I promise to also share with you the what to do, uh, when the doctor is not in your insurance network too, so, um, or the ones that you seem to my top, it might seem skeptical. So, so as far as the, the, the w if there, you’re not a part of their insurance network, it’s just a matter of two things. One is what if instead you reached out more to medical doctors who had cash based practices, or who had concierge based medical practices, because there are medical doctors like that out there, and they would be there.

Patients already used to that kind of a culture of pink cash. And so that’s one possibility. Second possibility is, um, just because a patient has insurance doesn’t always mean that they won’t pay cash for it, for example, um, there, I mean, I can think of two instances, have you ever, uh, perhaps maybe you have insurance, right. But have you ever paid out of pocket ever happily? So if you have, then, then that’s an example of, of someone, even though they would much, but would you also rather prefer to, to, um, have your insurance? We accept that. Of course, most people, if they are paying for insurance, they want insurance to be accepted, but you still in the end still also paid out of pocket. Right? Why that it’s because you really saw the value. And, and so the second possibility is that, you know, again, we can’t really judge people for, um, whether they will pay or not.

For example, I actually had a client who, who, um, who told, who suggested her patient, this patient actually got on a train one hour each way to go see her. And she said to her one day, she’s like, well, why don’t you see someone closer to you? You know? Um, and she’s like, and this person was on Medicaid. Right. And I, because also my client was going to be moving to another location. And it might’ve been a little bit further away from this person. So, but she said, well, why don’t, why don’t you just, just let me, let me refer you to a different provider who be closer to you. And she said, no, I save up my money every month to come and see you. And it just really hit her. And it really hit me too. Right. And as it should hit all of you that it’s, who are we to judge, whether someone can afford it or not, or choose to save up their money to come and see you, even if indication is, are maybe they, they quote unquote can afford it.

Right. Um, and so, so it’s not fair for us as practitioners who judged that it’s fair for us as practitioners to, to let people know about their options. So if, if a medical doctor actually says that to you while you’re not in our insurance network, and you’re say that’s true. And, um, I believe, you know, one of the most powerful, one of the most helpful things for patient is for them to know their options. And then you could tell that story that I just shared with you, you could say, you know, for example, there a practitioner who, who actually had a patient who, who had Medicaid and, uh, and she said, you know, so you could just tell that exact same story to this metal, whoever medical doctor you’re talking to, who might be concerned, you’re not in their insurance network. So if you’re finding this helpful, go ahead and, and like this, or typing the chat, uh, what’s been one valuable tip so far.

And if you want the script that I promised you in terms of a, an exact, um, script that you can use to help you approach, uh, medical doctors for whom you have mutual patients with so that you can get the ball rolling more, to be getting more referrals from medical doctors, then you can go to introverted visionary.com forward slash get M D referrals. And then you just need to know, see one of the most common mistakes. A lot of acupuncturists end up making with this when wanting referrals from medical doctors is, um, not really having a strategy. It’s just like, Oh, let me, let me go ahead and reach out to these doctors. And, Oh, I had a good conversation. Oh, they should start referring now because they said they would let me know if they had any, anyone who could refer you, but, but, um, how’s that worked for you before it, and if you haven’t tried it before, let me just share with you this, that typically, that doesn’t work very well.

So you need to have, do you actually have a strategy that works? Do you actually have systems in place or even certain things that are automated that support getting doctor frills? And these are the things that our clients come to us for in our consistent patients make over mentorship for, for introverts, um, as well. So you’re welcome to go to our website at introvertedvisionary.com. And if you’re, if you’re tired of being at a plateau and, uh, would like to be busier consistently with patients, or if you’re already busy and would like to be able to free up your time and, um, be able to still help more people without having to, to feel so burnt out, then, uh, feel free to reach out to us as we help our clients. We’ve helped our clients. We’ve ushered our clients into six figures and seven figures the introverted way. So stay tuned next week for a year. Yair Maimon, uh, who will be your host for AAC show next week, till next time

 

 

Lorne-Brown-AAC005122021Thumb

How Baseball Can Teach Acupuncturists How to Succeed

 

 

…in baseball, um, a batter gets up and he asked to swing, right, swing, batter, batter, batter, swing. Right? And I think in life in general, um, we can stand up at the plate and some people can make it look so simple. Some people will see, um, and we see that they have success and we’re seeing their home runs.

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 American Acupuncture Council again for having me host, um, to the point and, um, our unusually hosting on practice management, success ideas with integrity, for an acupuncturist, a brief introduction of who I am. My name’s Lorne Brown. I’m a doctor of traditional Chinese medicine. Um, I have a clinic in Vancouver, BC, Canada, [inaudible] wellness center. Most of the founder of healthy seminars. It used to be known way back when as Pro D seminars now known as Healthy Seminars. Um, and I’m also the chair of the Integrated Fertility Symposium and the author of this book Missing the  Point, Why Acupuncturists Fail and What They Need to Know to Succeed. And I’m also a CPA, a certified professional accountant. Um, the topic today that I wanted to share with you is, um, how baseball can teach acupuncturists, how to succeed. And I was thinking about it in my own personal experience.

Um, and in, in baseball, um, a batter gets up and he asked to swing, right, swing, batter, batter, batter, swing. Right? And I think in life in general, um, we can stand up at the plate and some people can make it look so simple. Some people will see, um, and we see that they have success and we’re seeing their home runs. And I often get accused of that. Myself. Some of my peers, colleagues say, life is simple for you. Like things always work out for you. And what I am aware of is that they don’t know about all the misses, all the strike outside of that. My, I do swing a lot. Um, and just like in baseball, like, uh, like, uh, a player from the, the, uh, in history, a record maker, babe Ruth, um, he’s famous for his home runs. Um, but what people don’t realize is people like babe Ruth, Hank, Aaron, all these home run giants also struck out a lot.

Um, but we tend to remember their home runs. And if you don’t swing and you don’t risk missing, then you don’t get that home run. And when you’re at bat or in life, when you have an idea, the thing that can interfere with it is our fear. And the other thing that some of my friends and colleagues say is, you’re lucky Lauren, because you got all this courage. You can just go, go do these things. You don’t, you’re not afraid. And I realized that, um, maybe I make things and other people who are having success may make things look simple. Um, but it’s not always as easy as that. And so I kind of wanted to share with you this baseball analogy and to share with you kind of my epiphany and what happened to me and, uh, and that anybody can do this and start to live and manifest the dreams and desires they have.

So the first thing is, many of you have heard that courage is not the absence of fear. And so when you’re standing at, you know, back to our baseball analogy, you’re standing up at bat, I’m ready to swing. Um, there can be a lot of fear there. You know, you could be afraid to swing cause you don’t want to strike, Oh, you don’t wanna miss the ball and look silly. You got all these fans, you got your teammates, you got, um, um, the coaches there. So sometimes fear can cause us to freeze, um, or avoid swinging the bat. And so in life, it’s the fear that prevents us from moving forward with something that we really want to do. That’s in our heart desire, a fear of failure out of fear of ridicule, out of fear that it may upset others. And then they won’t like us.

And so I want to share with you that, um, all people, myself included have fear, and the difference is just like you, we went our pants, but we move forward and continue to do the activities just with wet pants. And so it’s important to know that it’s not, if there’s not no such thing as absence of fear here, there is the fear, and this is what brings up the courage. It’s if you don’t have the fear, there is no curse. So there’s gotta be this curve, something that comes up from you and from my Chinese medicine colleagues here, we understand that Azure and, and the Chinese Shen system, how this is part of your will your courage. So there’s things that you can do probably early in acupuncture to support that I’m going to talk mostly about mindset and some of my real life experiences.

And so I didn’t pithany I had is when I first did my first integrated fertility symposium. So we did it for five years in person. And, um, and then our first year, um, doing it online was in 2021. And so to share with you what happened to me back in 2015 when I had my first, um, epiphany on courage is not the absence of fear. And then this formula to move through the fear, to develop the courage, to move through, to have your heart’s desires be manifested was as follows. So in 2015, I was asked to put on a conference in Vancouver, it was going to be related to fertility. My, uh, my friend who has passed since then, Ray Rubio, wanting to, um, a conference for his AB or I’m exam. You wanted to host the exam outside of the United States. He kind of wanted a destination experience and he wanted to have a conference built around it.

And so we had this discussion in the, and I was running healthy seminars, known as pro Decembers back then. And the idea was, I’ll build a conference and they’ll host an exam on one of the days, but we’ll build a conference around that. And it would be now you got to think of the, um, of what was happening in that time was 2015. Um, online was becoming popular and a lot of conferences in the States were struggling. They didn’t have a lot of, and so the idea of taking a conference, um, with the focus for the American acupuncturist and putting it in another country and then making the theme on infertility. So rather than attracting as many people as you can with multiple, um, topics, we just had fertility as our topic was a risky venture, right? Lots of reason for fear and doubt. And what ended up happening is, um, at one point, Ray said, how are things looking, um, in the planning process?

And I said, look, let me get back to you. I’m going to run some numbers. And so this is about, um, nine months, 10 months before the date that he wanted us to do it in Vancouver. I said, yes, we would do it. And then I finally looked at my numbers and wow, the way I wanted to do it, cause I wanted to do it. What I would call, right. I wanted to do it well. I wanted to do it different. The first time we did the numbers, um, and my wife works with, um, healthy seminars. Um, the budget was crazy. It was too risky. So risky that if it didn’t work, we would probably have to sell her home downsides. It was too risky, the way I wanted to do it. So she said, what are you gonna say to Ray? Ray’s my good friend.

I said, I’m going to tell him I’m not gonna do this. This is too risky. So I call up Ray and I said, Ray, look, I looked at the numbers and I gotta tell ya, I can’t do the ifs in Vancouver, um, is just too risky. And his response was, Hey, we already told people we were, we were doing this. Um, and we already have our board who, who purchased plane tickets to come to Vancouver, that date, you need to do this. And I wanted to be a man of my word. So I took a deep breath, a lot of fear, but the curse started to come up and I said, we’re doing it. I agreed. And when I got off the phone later that day, my wife asked me how to re handle it. And I said, interesting, you should ask, um, we’re doing the conference.

And she said, you gotta be crazy. You said, we’re going to have to sell our home and downsize. Um, and I responded, I only said that if it didn’t work, it’s not like nobody will show up. Now here’s the epiphany. Once I decided we’re doing this, I committed. We call the hotel where we wanted to do it. The, it wasn’t actually a hotel, but a hotel for the guest and then the location to have the conference. And we put our deposit down. Now I’ve made a commitment. Now the courage. So basically, first of all, you have some fear and this fear creates courage. You need the courage. I was afraid I was going to fail, have to sell my home, but I’ve committed. I now know I’m doing this. So the first key in this process to manifestation and moving through fear is yes, you got to bring up the courage, right?

You got to be able to will willingly swing knowing that you may strike out. So you got to go for the ball. And then this courage leads to commitment. The commitment was, I had the courage to put a deposit down on the hotel, put a deposit down on a location and start to learn and figure out how I’m going to put this conference, um, on the ground. So the first thing is the commitment is key. You gotta have a date. You got to sign some papers, signs, and contracts with speakers. Now you’re committed. You’re in this. There is no retreat. There is no, I’m not going to do this. Like I tried to do with Ray on the phone. Cause I wasn’t really committed. Then I said, yes, I’ll do it. It was more of a want desire. But now I’m at the bat with a whole bunch of fans in the stands.

And I, and I pitchers ready to throw a ball at me and people are waiting on me to swing, to hit that ball. So commitments, the first step, once you really commit it’s public, you told people you’re doing this. You start to accept registration, you’re paying vendors and suppliers. So you can run something in this case. Right? So the commitment, so then sort of the commitment creates the courage. I said it backwards, by the way, it’s you have the fear you decide to do it. That’s the commitment. The first thing, the commitment creates the courage because now that I’m doing this, I can’t retreat. So now I have to find the courage. And then what I found as I learned about putting on a big conference and refining out a company and finding out about food and all the things we want to do, the pricing we learned, like it was a, um, a lot of energy, a lot of work and fun and stress by the way.

But that developed capability by learning and actually figuring out how to do this. And by the way, the fear comes about, because I actually did not have the confidence or the capability when I said yes to doing this conference. Remember I hadn’t done a big conference before. So there’s where the fear is. I had no confidence. I had no skills that I was aware of to do this. So I made the commitment first and I had enough time from commitment day. Yes, I’m doing this too. When I had an execute to develop those capabilities, those skills, those know how. And so I made the commitment, that commitment creates courage. That courage creates capability. Cause I learned how to do this. And then the conference actually sold out. It was amazing. I would say that I go to conferences all the time, if we want to my favorite conferences.

And uh, I heard great feedback and we sold out five years in a row after that. And so that first capability, once I knew how to do it, and we saw at work gave me confidence. When I finally swaying at the ball there hit the home run that gives you more confidence to swing at the pitch. The next time it comes now, actually I’m in a another, um, process, but now I’ve done this so many times. Um, I have fear make the commitment. The commitment creates the courage. The courage creates the capability because you figure out how to do it. And then the capability creates the confidence and the confidence gives you more ideas to do more commitment. And the process is just a continuation. It’s kind of like the shin coups cycle, right? Each one creates the other and then it’s just repeats. And so in 2021 ish, we decided to run our ifs online.

Now I had no knee or desire to do my conference online because we run healthy seminars. We already run online content. There was no need to put content online. We already do it. We were doing it all through 2020 and 21 during that time period for those that remember COVID and isolation and shutdowns, but we had a different dream and idea. We wanted to inspire the public to seek out, um, acupuncturist for integrated reproductive care. And back in the day when Fowchee was, um, talking about we’re going to follow the science when he was talking about the COVID virus and Trump had just said, um, drink bleach or sit out in the sun to kill the virus. And Fowchee says, no, we’re going to follow science. I heard this was my interpretation. I heard Fowchee say, when we’re going to follow the science is that science is synonymous with pharmaceutical research.

And it was just the, the impression I got. And I saw this as something that could be negatively impact, um, uh, non-pharmaceutical therapies and research. Um, and there’d be a bias for that. And so I got this inspiration to create a conference, but my intention actually was for this was to have public education as part of it. So I got all the speakers to create public educational lectures. Um, 10, 20 minute short lectures that the participants at the ifs could share with the public to then inspire them, to seek them out for integrative care. And the way envision is the speaker does a professional talk for the CU and PDAs and us, the acupuncturist get excited and we can do this in our clinic, but we may not be able to articulate it like that speaker. Um, and so having that speaker share why the public can benefit from what we do, um, may support us.

These are assets that we could share on our websites and our social media. And a lot of the speakers are both MD and TCM trained, not weekend acupuncture, train. I mean, they’ve done MD training and they’ve done the full TCM training like you. And so we have a good four or five of our speakers that are actually IVF doctors. So MD, OB GYN, IVs specialists, and TCM acupuncture, herbalist trained. And they sh so th th them giving these public education videos adds the credibility, um, to the information to sharing, and then people would seek us out for integrative care. So that was the idea behind why I want to do the ifs online. And, um, we had a whole different format. It wasn’t over a weekend like everybody was doing it’s over two months. Um, uh, as I said, we had, we wanted people to share these educational videos.

We created chat. We did all, we did it very different. We did something that hasn’t been done as of, as of yet, at that time online for digital conferences, we made it two months. We had a lot of forums and chat features so we can interact. The sponsors had to create educational content, a lot of new stuff. And so it was another one of those experiences. I don’t have anybody to copy to follow from right. To learn from and what happens if they don’t like it? Um, what happens if it doesn’t work? And I had a focus on my intention, my, the reason doing it. So the reason I really wanted to do this was to have public education videos and get them in the hands of my peers and have them share this on their website and social media to educate, inspire the public, to seek us out for integrative care.

So that became my focus. That was my desire. And we started to build this website. Um, so I started selling tickets May 1st. It was going to open up in 2021. That was the idea here. And, um, we started selling tickets before the website was built. Luckily, we got everything else done by the end of February of that year. But to let you know, I had started selling tickets. I, people were committing to this online conference and we even have the website built yet. And I worked with my tech team. They thought it was at one point, they told me in early of April, that that date, uh, May 1st was impossible. And I said, well, I’m glad you agree with me. That May 1st is not the right date. Cause I wanted to actually April 25th. And so they work longer hours. I work longer hours and we figured it out.

So we went from, we had fear and we could, there was a lot of uncertainty. There’s a lot of unknown. And then from fear, we made a commitment. We’re doing this. And I contracted speakers are recorded. Their public talks and their professional talks. And we started building a website, but we at least started selling tickets. And that commitment, I mean, that was a serious commitment. Gave us, creates the, um, the courage. So now we had to do this. Then we got the capability because the site function and it worked, and then you get the confidence. So this is that swing batter, swing. Now I’ll share with you in that conference. We, you know, we had similar registration, like we would in person, but we learned so many things. So many things that we thought would happen did not, but this is all part of learning process.

There is no failure. There’s just learning. And you create something, you go up to the bat and you get ready to swing. You prepare. Um, but at the end you there’s that uncertain. You don’t know. So I will summarize that. You want to focus on the end result. Why are you doing this? And if you’re doing it, that could be one of your reasons money. But I find that as one of the least motivational ones, if it’s, and yes, money can be part of it, always, you know, for me, we have all these goals that we want to do and then can it, can it be profitable, right? But we have hierarchy. And money’s usually at the lower end of other goals we have, um, when we do our projects. So a few other things that I wanted to share with this idea that nice guys finish last.

I want to share with you that nice guys and gals can finish first. And then this idea that you have to be a bull in a China shop, you have to be a mean-spirited person. You have to be ruthless to be successful. So is a myth why they may be interpreted as, um, not very nice people. These people that are successful is that they’re more interested in achieving their goals, their visions than they are on popular opinion. And so you may not understand what they’re doing, but they have a dream, a desire, and nothing’s going to stop them from that. And so if you don’t agree and you express your disagreement and you think your argument is so good, that when they hear it, they should drop their desires and dreams and change course. And they don’t, you are interpreting them as not nice and mean-spirited, but they’re just so focused on their goal that whether you like them or not is not important enough.

I will share from my experience and talking to other people that have made great dents in the universe that are influencers that are considered successful. They want people to like them. It hurts when people are angry and don’t like them. They just care much more about what they’re trying to achieve than they do about other people’s opinions. And that’s why they end up being successful because so many people have these great ideas and they start with them and then people come in and try and give you their doubt, their fare fears, and many of us then stop overdoing an example in our profession, when community acupuncture, um, started to, um, come out, uh, many, many moons ago, there was a opposition by a lot of people saying it’s not good, Chinese medicine acupuncture. You can’t go do a good diagnosis in a short period of time, blow whatever the reasons were.

And the people of community acupuncture had a dream to get acupuncture to the masses at a, at a, at a lower rate. And whether you liked it or not was not enough for them to stop. But a lot of people did not like the founders of this movement, but they had a dream, a desire, and your opinion to them was not enough for them to stop. And so that comes down to the last point is ignore the naysayers because people are going to have their ideas, their fears, and they’re going to try and create doubt. When I wanted to do the ifs conference again, what was the naysayers or doubts? Hey, you’re crazy to do this in Vancouver and American conference in Vancouver, Canada, the conferences in the States aren’t well attended. How do you expect people to get on planes or get passports and come to you?

Right? Hey, we can’t fill our conferences and we have multiple topics and yours is just on reproductive health. This isn’t gonna work. And so, um, those are the naysayers. So to be successful when you get up at the bat, swing batter, batter, batter, swing, batter, batter, batter. I want to remind you or summarize a few things. One is, um, ignore the naysayers, ignore the people, yelling at you in the stands, ignore them to stay focused on the prize. Know what you want, get clear on what you want and focus on that. And then remember if you feel fear and you feel uncomfortable, that is considered normal. Um, um, we don’t like to feel uncomfortable and fear is uncomfortable. If you can commit to something because you have a dream and then you commit to doing it, you say it publicly, you, you, you put your deposits down.

That commitment creates the courage. And so until you commit, if you haven’t officially committed, it’s very easy to withdraw. And step back, once you commit that creates the courage and the once you have the courage and you know, you have a, a deadline, a date that courage allows you to seek out counsel, take courses, ask for help, hire consultants, hire special skill people to build the product or service that you want. And then when you get that capability, those skillset that gives you confidence. And then that confidence becomes a vicious cycle and you find something new to commit to. And when you, when you do this from the baseball analogy, when you’re ignoring the naysayers and you’re focused on what you want, you’re focused on, you see the home run. All of a sudden that courage comes up because you’ve committed your ad bag. You decided to go up to the bat.

And for whatever reason, sometimes it seems like that ball gets a little bigger or maybe even slows down a bit for like the baby Bruce. And they hit a lot of home runs every time they swing, even when they missed in their mind, they thought they were hitting that ball over the fence. And so that is the process. So I hope this was of interest to you. Uh, one more little, let you know, if you’re interested in my book, let me know, missing a book. I have stories like this and other ideas that I consider simple, powerful, and effective for growing your practice with integrity. I want to let you know that next week Chen Yen will be on, um, To The Point. And if you have questions for me, feel free to post those in the chat. And, um, if you’re looking for connecting with me on any other way, there’s my website athealthyseminars.com. I wish you success and take best care.

Callison-LauHD05052021 Thumb

Tibial Stress Syndromes (Shin Splints) – Callison/Lau

 

 

“…we’re from ACU Sport Education and the Sports Medicine Acupuncture Certification Program. Um, we’re going to talk today about tibial stress syndrome.”

Click here to download the transcript.

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

Hello everyone. Welcome to our sports acupuncture webinar. My name is Matt Callison. I am Brian Lau. We want to thank the American Acupuncture Council for sponsoring our, our sport, our sports acupuncture webinar here. Uh, we’re from ACU Sport Education and the Sports Medicine Acupuncture Certification Program. Um, we’re going to talk today about tibial stress syndrome. So let’s go to the first slide please.

So since spring has sprung and we’re quickly approaching summer, we’ll start to see patients that are coming in with a tibial stress syndrome or the layman term for this being shin splints. Uh, people are trying to be able to get in shape. And so this is a common, very common overuse injury. So, uh, Brian, we’re chatting just last week. We, uh, we just published our module three lower extremity online recordings through net of knowledge. And we were talking about what we could actually grab from that since it’s so fresh in our minds and tibial stress syndrome was, was the first thing that we thought about. And so this is actually a, uh, it’s a fun topic because it is something that most of us most acupuncturist to see clinically. And there are some techniques that we have found work extremely well for this. So, uh, before we jump into the first slide there, Brian, do you want to say anything or do you want to go right into medial stress syndrome?

Uh, I’ll say something simple and that is, uh, this particular topic is one that I’ve dealt with, uh, not for a long time, but when I was in high school, I was a wrestler and we used to do a lot of drills on a hard floor running drills and these wrestling shoes that had zero support. Um, they’re not, you know, they’re designed to be on a mat, right? Not on, uh, not for running shoes, but sometimes being young and stupid. We were lazy and just wore the same shoes as we went out and did running drills and exercises and sass. I remember at the high school, this was, uh, something that I didn’t have horribly, or it stopped me that it was quite painful. So I know this one personally, uh, fortunately I haven’t dealt with it for, uh, most of my adult life

Mm

Midnight. And then that I’m ready to roll. All right. So should we go to the next slide and Brian, you want to take it away?

Sure.

As Matt mentioned, that student’s lens is kind of the layman term, uh, for medial and anterior tibial stress syndrome, I’m going to start the discussion talking about medial tibial stress syndrome. So that’ll affect the, the sort of medial side of the tibia, and we’ll look at the anatomy and kind of mechanism of injury for that. Um, and then, uh, I think Matt will take it, uh, from anterior

Tibial stress syndrome, but collectively people refer to these as shin splints. Um, it’s an overuse injury inflammatory condition that involves micro tears and either the myofascial origin. So the tibialis anterior that would be for the anterior tibial stress syndrome or the tibialis posterior for the medial tibial stress syndrome. Uh, those muscles are along the shaft of the tibia. So let’s, uh, go to the next slide and we’ll jump into medial tibial stress syndrome. So immediate tibial stress syndrome, uh, the pain and tenderness is found on the medial really at the posterior medial aspect of the tibia, you know, on the sort of the yin channel side of the leg. Um, so on the medial portion of the tibia, just really on that most posterior aspect. So that would be along the liver channel. Um, and we’ll talk a little bit about the channels on this slide, but, um, it’ll be usually the pain is, is level with the area between spleen eight and spleen six.

That can be a little less than that. It can go beyond those boundaries, but that’s the typical region that it covers. Uh, so that’s the area that people will tend to have pain that they’ll, um, they’ll be complaining about, um, in terms of channels. When we get later in the presentation, we’re going to be looking at a myofascial release technique. We’re gonna be looking at an acupuncture, of course, but then we’ll also look at the myofascia release technique. And in that, uh, particular associated technique, it will be in reference to the spleen, send you a channel. So this injury and the pain is a long that distribution of the liver channel, but the channels, aren’t just a line along the body. You know, they’re not only on the surface, so to speak, you know, we’re taking a needle or we’re penetrating the skin and where that needle goes can be, they’re either more deep or superficial.

So if we were just to glance at this image from mats, a text, a sports medicine acupuncture, um, and look at the arrows, the arrows are pointing to the tibialis posterior muscle, which is what attaches to the posterior surface of the tibia. And that’s, what’s going to pull excessively, or when it does pull excessively on the tibia and you create little micro tears there, that’s going to be what contributes to the medial tibial stress syndrome. But if we look at where those arrowheads sit, not what they’re pointing to, they’re pointing to tibialis posterior, but where do they sit? There’d be another muscle there. Um, that’s not shown in this illustration because it’s, it’s highlighting the relevant anatomy of the tibialis posterior, but that muscle that’s just medial to the tibial. The tibialis posterior would be the flexor digitorum longest. And then if we go lateral on the other side and the lateral side of tibialis posterior, it would have flexor hallucis longest.

But if we come back to that medial side where those arrow had CIT, uh, that would be flexor digitorum longest, that’s actually part of, as we define it in sports medicine, acupuncture, part of liver sinew channel, whereas the tibialis posterior a little bit more anterior, um, and a little bit more in the middle part of the tibia, you know, lateral to the flexor digitorum longest is the tibialis posterior as part of the spleen sinew channel. So depending on the depth that the needle is reaching, uh, we’ll also determine really which at least from a sinew channel perspective, what, uh, uh, channels being, uh, affected. Uh, so we’ll look at, at that aspect as we’re doing the myofascial release technique and we’ll discuss it, um, also, uh, in terms of the channels when we get to the acupuncture portion, but just a heads up, and I’ll re refresh that when we get back to the myofascial release techniques, but this one’s talking about the anatomy and that’s the tibialis posterior, that’s what the arrows are pointing to note that the tibialis posterior comes down, the leg becomes a little bit more medial around spleen six, and then look at how it attaches onto the foot and how much of a support mechanism it creates on the arch of the foot.

It’s really the Keystone muscle for that. Uh, at least from an extrinsic, from the muscles that are in the leg for creating arts apart in the foot. Uh, so I kind of think about the aspect of how the spleen can lift and this a spleen sinew channel muscle is really a prime lifter of the medial arch. And I, I see that as one of the spleen functions to have lifting, you know, in this case of the foot. So if we can go onto the next slide

[inaudible]

So a medial tibial stress syndrome, like we said, involves the tibialis posterior muscle commonly occurs, uh, occurs in individuals who are moderately to severely over pronated. Um, because of that line, Nepal, that we were just looking at how much that, um, tibialis posterior influences the lifting of the arch, when you’re going to the weight bearing and the foot hits the ground, there’s a normal pronation, you know, the foot, the arch is going to drop and that tibialis posterior is going to be elongated, but there’s normal. And then there’s, overpronation where it’s just like a flat tire. And that Tim posterior, it gets pulled really excessively long, probably a little bit in a more of a charring standpoint. So it doesn’t have that normal elongation where there’s a little tone there and it kind of checks, it keeps that, that, um, pronation and check, it keeps it from going too far out of the boundaries in this case, it just flattens.

So if you were to look at these images here and just glance at the runners, if we can see from the waist down, uh, notice which one of those, you know, they’re not all hitting, they’re not all in the, in the weight-bearing part of the gate, but some of them are which ones do you notice, or which one do you notice that really highlights that collapse of the medial arch? I’ll give you a second just to glance at that, but you can look at the front person, you know, th the, the weights falling to the medial arch that’s normal probation, but if you look at the person just behind him, right in the middle of the shot, um, it looks like I can’t tell what the number is 71 possibly, uh, with delusional shorts on yeah. Blue shorts. Um, you can see how much farther that person’s going into pronation and imagine that dropping of the medial arch and how accessibly that would be pulling on the tibialis posterior. Um, so people with foot overpronation is going to be a really key thing that you’re going to notice. That’s going to affect things like a medial tibial stress syndrome. Um, it’s very common with runners that accounts for approximately 13 to 17% of all running related injuries. So it’s a pretty big one. You’ll see it as the prime complaint, or at least a secondary complaint in your practice. Um, you know, frequently, if you haven’t already anything you wanted to add to this format.

Yeah. Brian, I just want to reiterate what you’re talking about with the spleen function being, lifting the tibialis posterior, or this is something that we talked about in December webinars through the American acupuncture council. It will be spoken about it has planets and the number of different injuries that can actually occur from that. And we actually spent a bit of time asking practitioners to look for, um, any time of earth signs and symptoms, spleen and stomach that may be actually contributing to some of the musculoskeletal pain, because with any muscle skeletal injury, there’s always going to be some kind of [inaudible] component, either that the organ and the channel has directly effected that or that the organ systems are deficient and not controlling inflammation very well. So there’s always some kind of [inaudible] component for the TCM practitioner to take a look at that. So that was the December, uh, webinars, something that you, you guys may want to check out on PEs planus, uh, Brian talk right now, but the tibialis post here. But if we look at that person with the blue shorts as well with the tibialis anterior, that will also end up being elongated with overpronation. So we’ll talk about the tibialis anterior, just a little bit, Brian, back to you.

Yeah. Yeah. And just the foreshadow that that’s going to be the stomach Cindia channel. So now we’re talking about spleen stomach and, and often how those correlate again, from a Zong Fu perspective, how frequently those, those two organs are so integrated, you know, that compared to other internal, external parents, those two are just like really functioned quite often together. And their disharmonies are often associated, um, both from a musculoskeletal, but even from his own food perspective. So I’m curious Matt, about the, the, um, long food perspective. I feel, you know, doing Chicano practice Tai Chi can be really any physical activity. If you take time to strengthen the arch in my mind, I feel like, and I see this to some extent play out though. It’s a little hard to, to test for, but, um, but I feel like you’re strengthening this lean channel. Sure. You know, at least the component that’s related to the foot, but I feel like that’s, that’s strengthening and calling on extra blood flow to that area, more communication with the nervous that that starts to be, you know, at least a component of, of strengthening tone to find the spleen. So even from his own food perspective, that, that, um, improvement of health for the floods can also have a, um, uh, regulatory effect on the whole system.

Yeah. And that’s through any channel, right? I mean, if you have a, um, excess gallbladder or excess excess liver and deficiency in gallbladder by exercising, the hip AB doctors and 80 doctors, it does help to balance that particular aspect. In fact, you can, you can feel the pulse prior to the exercises and feel maybe a sharp edge to a pulse. Some people would call that a winery recalls and then have the person do hip AB duction, 80, the options, and it softens the pulse. And that’s just one example. We could also talk about subscapularis and Terry’s minor, you know, again, but, but Brian’s point here is that how important it is to be able to prescribe exercises to your patient. And these are more webinars, isn’t it actually, how important is to prescribe exercises to be able to compliment your acupuncture treatment based on your differential diagnosis for TCM differential diagnosis? Sorry, Brian,

That’s good. Yeah, I think we’re ready to jump ahead. Next slide. All right. So some differentiation, because there’s more than one thing, uh, you know, fortunately, or unfortunately, fortunately, because it makes us put our detective hats on and makes life more interesting. Uh, there’s more than one thing that can cause pain in this region. Um, so if anytime, somebody comes in with pain and we just like, ah, medial tibial stress syndrome, uh, we’ll get it sometimes. And we’ll miss it other times because sometimes it’s not medial tibial stress syndrome and a common very, very close. I mean, you know, within probably less than an inch, uh, of, uh, uh, posterior to this where there’s going to be pain would be a solely a strain. So just off, you know, not up against the bone, but just off the, uh, the bone just posterior, um, there’s going to be a, uh, painful when there’s a solely a strain cause the soleus is a pretty wide muscle and it covers a lot more territory, both medial and lateral than the gastrocnemius.

So this would be, again, this is, uh, channels are a little odd in the, in the leg compared to the rest of the body because it’s along the spleen channel, but the soleus, again, as we have it defined and, and a sports medicine acupuncture would be part of the kidneys in new channel, but we’re on, you know, in this case, the pain that often is going to be apparent is really pretty close to that. Um, kind of most medial edge of the solely, as you know, this only has covers that whole posterior portion of the leg. So it’s a big muscle. And, uh, the bulk of that solely is really, it would be the kidney sinew channel, but the distribution of the pain is going to be really along more of this spleen channel, just posterior to the, um, often again in that region of spleen eight, but that through spleen seven, it’s probably not going to go down as low as spleen six. Um, so something to be aware of, you know, if you’re palpating to help confirm the pain and not so painful right up against the bone, but you back off, uh, what would you say Matt, about half an inch, an inch at the most? Yeah, yeah.

A quarter of an inch sometimes.

Yeah. And then that’s where, Oh, you know, that’s where the pain is. That’s you, you have your fingers right on it. That starts indicating more of a soleus, uh, uh, strain. And, um, it’s pretty close, pretty close in terms of their description of where it’s going to be. So something to look for, uh, uh, that can help differentiate the pain and that’s going to be a different channel correspondence. It’s going to be different, uh, uh, treatment. We’re going to stay with medial tibial stress syndrome for today, but it’s good to differentiate. Can I add something to that, right? Absolutely. Please. Yeah.

So we can use, this is something that we’ve talked about in the past before where we talk about it quite a bit actually is, um, acupuncture as an assessment. This would be when you’re in your assessment. Uh, part of the, um, treat of the clinic, uh, patient visits are for the patient visit and you’re trying to figure out, okay, this is a solely extreme, it seems like it’s going to be more painful. And it’s bound up in that mild fascial tissue about a quarter of an inch away from the bone. Um, we’re saying that it’s more of the kidney, mild fascial gene, Jen, but it’s also the spleen primary channel. Okay. So where’s the stagnation. Is it in the primary channel or is it in the soleus, mild fascial tissue? Um, in the kidney, what we could do is maybe needle kidney three, we can needle maybe kidney four as part of the assessment, and then go back to that soleus and feel if it’s quite a bit softer, is there less pain without patient to the patient?

If not, maybe we could needle spleen three and spleen four and see if that moves cheat within this plain channel and go back and out pate. That solely is, um, from my experience, it’s usually going to end up being kidney three, kidney four, and sometimes even kidney five that starts to take pain away from that solely us. But it’s nice to be able to at least put your detective hat on as Brian was saying and figure out actually, where is that stagnation? Is it more in the spleen primary channel or is it in the kidney gene, Jen?

Yeah, maybe we could just throw in an ashy point, uh, or if you’re a little more, have a little more finesse, maybe a motor point if you know the location for the soleus motor point and you’re going to get resolved, but you’re going to increase those results. If you link it with the channel and it start building a comprehensive picture and Madden this image, you can actually kind of see it. You know, we, we highlight this in our cadaver, um, classes, uh, uh, we look at it on a, on a cadaver specimen and you can really see that. Um, but this even just in the image here, you can see it quite well because if you follow the soleus through the Achilles tendon and look at its attachment on the Achilles tendon, um, I can tell you that the solely as partial portion has a much stronger connection into the medial side of the calcaneum attendant onto the calcaneus.

But then, uh, in this particular model, you can see how that links through the fascia of the calcaneus and right into the abductor hallucis, which we dropped straight down from, uh, could be six. There’s a pretty prominent abductor hallucis muscle. That’s, that’s visible, um, here. So, you know, that whole chain is, is really, uh, um, all part of the same myofascial plane of tissue. And, and as Matt was saying, like, give me five, such a strong point. Other other kidney points might be the ones that are really, um, indicated kidney two is the motor point for the abductor hallucis. So there was a lot of pronation that might be willing to consider too. Yeah. A lot of good choices for this, but that’s kind of deviating from the topic of the, of the day. So anything else,

Because we go in a lot more detail on that module three in the anatomy cadaver lab, and talking about that with different slides such and how I’m really how important that is, and trying to be able to balance out that calcaneus with any kind of, of ankle injuries or these technology and such are going to keep moving and we’re going to take all day. Yeah.

Uh, so the second differentiation to, to consider is a tibial stress fracture. It’s it’s, um, often as a gradual onset, it’s a progression of tibial stress syndrome. So, um, uh, the, the, um, when the tibia is excessively pulling and you’re getting these micro tears, especially if the person’s really powering through it and controlling it with then sets is, uh, um, is that a common dynamic, um, to kind of deal with the pain and they keep on working with it that can progress into a tibial stress syndrome where there’s a lot of, uh, starting with a lot of extra osteoblast, the plastic cellular activity, um, that can sometimes show up on a x-ray, uh, frequently can show up on an x-ray. And, um, you can kind of see that little cloudy area where the arrows are pointing to, and that can progress into a tibial stress fracture.

So with that, there’s going to be a really exquisite tenderness at a point specific region on the tibia. So if it’s not responding to treatment there, that that area is, um, exquisitely tender, where you’re palpating, um, even sometimes a very light pressure. This is something to consider and getting some imaging would be the way to go. And I think the next slide shows a little bit more on this map, but if you want to add anything here before we move on, maybe after the next slide. Yeah. Okay. So the next slide. Yep. So that doesn’t always show up on the x-ray because some of that osteoblastic activity is maybe a relatively new, and it hasn’t reached the level where it’s going to show up on an x-ray. So you can’t really rule it out with a negative x-ray MRI will show a little bit more. Um, but, uh, it, again, it’s really, I, I, we, I see it as if it’s not responding and there’s that, you know, points specific exquisite tenderness, that’s the indications that I’d be looking for, uh, that you would want to consider this to be real, uh, stress fracture method. You are going to add something. I think, uh, the GDV, but I think is another good one. Yeah, go ahead. Yep.

Both of these x-rays were from a patients of mine. Um, and when you are suspecting an osteopath increase osteoblastic activity, or even as it progresses into even a cortical stress fracture, um, like Brian was saying, it is exquisitely tender as you’re palpating along the tibia, and you find that spot, there’ll be a fluid within the tissue. We call that chia DEMA. Um, and it just the gentlest of pressure for the patient. It hurts quite a bit. Um, so just know this is trying to go and get some imaging. If it doesn’t show up on an x-ray, then you want to request a bone scan or even an MRI, but a bone scan is usually the gold standard for that kind of thing. If it’s not going to show up on an x-ray, you want to catch that you want to be the acupuncturist that catches this. Um, and, and because this will come into an acupuncturist office, if you are treating musculoskeletal injuries, uh, it’s just something to be able to make sure that you’re aware of anything else be. Nope. All right.

Okay. So now we’re going into a anterior tibial stress syndrome. So this is going to be affecting the tibialis anterior, which is responsible for 80% of dorsi flection. And it’s an incredibly strong decelerator for plantar flection. So you can see this runner, who’s running down an incline, he’s got heel strike. And so his foot is going into plantar flection. So that tibialis anterior is slowing down the ankle and the foot. So it’s, ecentric CLI lengthening. It’s a contraction. So therefore with overused, just like the tibialis posterior, it can have micro tearing some of the fascial attachments or the muscle fibers microscopically can start to tear away a little bit from that bone thing causing pain. Now the pain just like tibials poster syndrome is going to be on the bone. So you want to palpate medial to the stomach channel on the aspect of where the tibialis anterior attaches to the tibia bone.

That area will be tender if it’s going to end up being a shin splints of involving the tibialis anterior. So let’s go to the next slide and you’ll see the common areas to pop it for. This is usually around stomach 37, generally speaking. I don’t think I’ve ever seen it go all the way up to stomach 36 reasons. It’s usually more toward the muscle belly of it. Um, uh, stomach 37 and even just below stomach 39. So again, I just want to reiterate, it’s not on the stomach channel. That’s a different injury. That would be a tibialis anterior strain. So if you palpated on the stomach channel and you feel a fast cycle of tissue, that’s really quite hardened and that’s causing more pain than when you palpate on the edge of the bone where the tibialis anterior, it comes close to, right? So then therefore it’s going to be more of a tibialis, anterior strain.

Why is it important? It’s going to be different needle techniques, same channel that you’re working with, same channel correspondences that you can work with. But yet if it’s the tibialis anterior strain, we’re going to be needling the motor points. Um, and not necessarily the, um, the technique that we’re going to be showing you for shin splints. Now there’s something that we should all be aware of. And maybe you already know about this, but if not, make sure that if the person is talk is, is complaining about anterior pain when running it gets worse during activity, and then starts to go away. When you look at the front of the leg, that anterior, there may be a certain shine to the tissue, let’s go to the next slide.

It could be chronic exertional compartment syndrome. Now this is a pretty serious condition that often requires surgery. Um, I’ve seen this quite a few times at UCS D the treatments that we applied helped with the person, but as soon as they actually started going back into activity, it came right back. Surgery is in my mind, the better way of going with this, uh, chronic exertional compartment syndrome is usually occurring with people that are increasing their training or they’re changing their running terrain. Something of that nature could also usually be brand new shoes, but they’re starting to develop shin splints, anterior shin splints, but yet the pain is going to be more in the tibialis. Anterior is going to be a long, the bone. It’s going to be a accompany, usually with a burning or an aching or a pressure sensation. And a big note here, it’s often bilateral 70 to 80% of the time you’ll have this as bilateral.

So remember that one, that’s a key. All right. And then also with this burning aching and pressure and possible numbness as well, is that it usually will start to go away 30 minutes, 15 minutes or 30 minutes after they actually stopped their activity. What happens is that the muscle tissue starts to hypertrophy from the increased training or from changing the random terrain and at a very rapid rate. And so the fascia tightens quite a bit, and with that increased pressure within that answer your compartment. And now this kind of chronic exertional compartment syndrome can happen to any compartment of the lower leg, but it’s most common in the anterior compartment. So this is why I can kind of mimic this tibialis anterior stress syndrome or the shins anterior shin splints. Is that the, so like I was saying is that muscle will start to hypertrophy.

You’ll get the fascia starting to type, it starts to compress. You’ll have a decrease of the venous return. So therefore there’ll be increase of the interstitial fluid. That’s going to put pressure on the neurovascular structures. Um, it starts to get a lot of compression within that region. Again, you’re going to start pressing against the anterior tibial nerve and the deep peroneal nerve, um, getting the signs and symptoms of burning aching pressure numbness. If you do have a patient with that, you want to refer them out, continue to treat them because you’re going to, you can still help them, but refer them out for further diagnostics with this. Now it can be a very serious condition if you’re going to be decreasing the amount of blood to the area, uh, let’s go to the next slide. This is something that I think is really quite viable valuables to feel the dorsal Punal pulse, which is right next to stomach 42, right?

So this is going to be a collateral branch off of the anterior tibial artery. So if you go just lateral to the extensor, hallucis longus tendon, and just medial to the extensor, digitorum, longus tendon, you want to feel for that pulse, right? So it’s pretty common. Make sure you compare sides, even if you feel the pulse on the same side of the possible exertional syndrome, if it is decreased compared to the opposite side, we think of that as being a symptom, right? So as a pop, sorry, as a possible sign here. So, um, feel the dorsal pudo pulse in these kinds of cases, it’s going to be pretty valuable information for you. All right. So what else do we have? Let’s go next.

Can I say something real quickly about that? Matt is, um, some people, some folks are aware of both of these, uh, situation, uh, conditions, but, um, uh, maybe not. So it’s worth mentioning, you know, compartment syndrome, uh, for those who might be aware of like more of an, uh, traumatic compartment syndrome, where you have something call on your legs, some kind of a weight or something like that, you know, an earthquakes and stuff like that. You’ll see these with people. That’s a much more trauma-based, uh, uh, condition where you get that swelling and that can be an emergency, a really severe emergency condition. Um, this is like that it has the same components in that it’s, it’s, um, it’s, uh, restricting and putting pressure on those neurovascular bundles, but it’s not from, you know, impact like a trauma, like something falling on the leg or something like that. But a lot of people are aware of, of compartment syndrome, and this is notice the difference of chronic exertional compartment syndrome. So just that,

Well, there won’t be blood vessel rupturing or bruising with case. Cool. All right. Thanks, Pete. All right. So let’s, um, start to get into the treatment techniques with this. Um, at UCS, I started an externship for Pacific college of Oriental medicine, which is now called Pacific college of health sciences. Um, this was, gosh, I’ve been doing this for 20 years now and it still is ongoing. So we take the interns from Pacific college and we treat the UCF athletes and, uh, shin splints is extremely common, um, there, so we have plenty of experience, uh, to, to practice a number of different techniques to see what works and what actually doesn’t work. And so, um, I developed the study and it’s, again, it was just a very small study. It was only a three week study. We only had 45 people in the pool. Um, there was three groups in the study.

One was an acupuncture, only study. One was a sports medicine only group. And then there was also a group that was a combination between acupuncture and sports medicine. Now, the protocols for sports medicine was ice stretching and strengthening, and also ultrasound. They were using actually both ultrasound and ice in this case, depending on the patient. So they were doing it using those four things. Then the sports medicine group, um, with the acupuncture sports medicine, we applied the techniques that were about to go over the accuracy techniques in addition to the sports medicine protocols. And then we also had the acupuncture group of suggest acupuncture in that sense. Um, so what we found was that at the end of the three weeks, Oh, there’s one important note is that almost each one of these athletes were taking a lot of assets and they’re taking it, um, during and before, and also after the events, because they really need to be able to compete or they’re going to lose their position on that team.

So, um, and says was, was gobbled down like candy. And so one of the questions that we had with this particular study was that they could go ahead and decrease the amount of end sets if they wanted to voluntary voluntarily. So, um, this was something that we found in the study that, that in the acupuncture group, people were actually not taking the sets and just coming in twice a week for the acupuncture, which was not statistically significant in the other two groups. Uh, so in this article, uh, printed in the journal, Chinese medicine, 2002, so way back when, um, it does show that the acupuncture group was actually far superior and the other two groups, um, really didn’t match up very well as far as getting results. Now, again, this was only a three week study. There was only 45 participants in this. If we made it an eight or a 10 week study, I would think that the other two groups would actually start coming up. But I think there was actually enough evidence to show that these needle techniques that we’re about to get into, um, actually work pretty darn well. Um, and this is something that, um, I continue to use and have been teaching in the SPAC program Ford smack program for a good 20 years now. And, um, so we’re getting a lot of good results with it. So let’s take a look at the next slide.

All right. So the key with this with medial tibial stress syndrome is to palpate where the top of the pain is on the tibia. And then also where’s the lower range, the lower end on the tibia. So you’re going to start your needling at the top, just above the painful area. And you’re going to thread a number of different needles could be eight, could be 12. It could be more depending on how long the area of pain is. So each needle will

Actually,

And we’ll go in and the other one we’ll actually go right on top of it. So there’ll be continuous needles all along that edge. Now it’s going to be shallow needling, right? And that’s going to be very important. You don’t want to go deep when we did go deep. It actually aggravated the condition. So it’s a transverse needle technique, no more than 15 degrees, right? You want to thread that needle right along the edge of the tip yet, as if it is scraping the tibia, you don’t want it to go too much into the soft tissue. You want it in the crevice, just off of the edge and on that edge of that bone, right along that liver channel, just like on liver five, how we try to be able to scrape the bone fat, think about that with these particular needles, uh, you don’t want the needle at 30 degrees.

You wanted at 15 degrees, 10 to 15 degrees, and then thread that. So they overlap all the way down to low the area of pain. Now match this needle technique with your constitutional treatment. You can also go ahead and treat other points with this. For example, we were talking, um, spleen points because the tibialis posterior is associated with the spleen gene, Jen. So we want to treat spleen points in this case, of course, we want to probably treat stomach 36 for the patient, which is also nice. Cause that’s the motor point, one of the motor points for the tibialis anterior. So to reiterate this needle technique is not the only thing that we do, but this is a successful needle technique for helping to decrease pain. When you are helping to treat this patient now for the anterior tibial stress syndrome, which is the next slide.

It’s the same type of needle technique is the exact same idea. And, but you’re threading in different areas, obviously. So it’s right on the edge of that tibia and medial to the tibialis anterior in this case. So again, this is going to be something that you want to go ahead and treat the person constitutionally with it. And also you want to apply the myofascial techniques that we’re going to be getting into just next, I believe. Um, one important note, if the patient does have foot overpronation that this, these needle techniques will help decrease the pain, but the foot overpronation will need to be corrected or helped. And one way or another through exercises treatment, maybe, maybe the foot is prone is so much that you actually need to be able to get inserts. And that’s something that we actually talked about in that webinar in December. So the foot overpronation does need to be addressed for long-term clinical success. Brian was saying, um, no, I think it’s good. All right. You want to get into the mob passionate techniques? Yeah, sure.

So, um, I guess we go to the next slide. So we have, uh, one, one slide and a video for, um, demand terrier. And for tip posterior, we’ll start with tip posterior. Uh, we have videos for these because as Matt mentioned, um, we pick the subjects that we’ve recently presented on it, and it’s now live on the Neta knowledge, uh, for some of our classes, for the sports medicine acupuncture program. Um, and we recorded, uh, some acupuncture, more distal points for treatment of things in the assessment and treatment of the sinew channel class. But we have a lot of myofascial release techniques in those classes. So we have videos for them, for presenting at the webinars, um, uh, just cause we had better camera angles. We can, we can plan it a little bit better. Unfortunately, we don’t have videos for the acupuncture part cause we we’re, we’re reserving those classes for live classes, just so there’s more oversight.

Um, especially certain techniques require a little bit more oversight where there might be. Um, it might cause damage if people aren’t doing them correctly, we’ve, we’ve reserved those for post COVID, um, to do a in-person. Um, but some of the other classes, we were able to do a online webinar form during this time of COVID. So unfortunately that videos for them, it’s not to say that these are more important than the acupuncture. It just happens that we have videos for them. So let’s use them. Um, so this one, uh, we’re going to be working just sinking deep, uh, behind the tibia. And the goal is to kind of move the tissue posterior to soften those connections of the tibialis posterior, uh, from the tibia, uh, with the caveat that if there’s extreme discomfort for this, you have to use less pressure or maybe start using this technique as the, um, a few sessions in, as the acupuncture starts improving the condition.

So if the person is retreating from you on the table, either soften the pressure or uh, hold this one in reserve for down the road, but it’s usually, uh, able, you’re usually able to do it. It’s a slow technique you’re giving the time, uh, the tissue time to sort of soften and melt a little bit and connected tissue to sort of, um, become a little bit more soluble to go from that more gelatinous, hard state to a more soluble state. So it’s, it’s often applicable, but, um, you might have to modify pressure, especially on this medial surface that could be quite tender. So you’re going be sinking, a soft fingers sink in, take your time. And then slowly moving the tissue posterior as the person does a range of motion with the foot, if it’s too much of a range of motion that can push you out. So, so it has to be a small plantar flection, dorsal flection, very slowly. You’ll see that on the video. So let’s go ahead and look at the video and it’ll highlight that

This is a compliment to the tibialis, anterior myofascial release the technique. Again, it could be one that’s done along with that one, or it can be done separately. There’s various clinical reasons why you might do one or the other. Um, but the same idea exists is I want to move the tissue from the deep posterior compartment from lower down around spleen six in particular, it’ll be over tibialis posterior. I want to move that tissue away from the tibia. And I want to angle my direction down into that deep posterior compartment, multiple muscles there. But my goal is thinking about influencing the tibialis posterior and moving that most anterior most muscle away from the bone and giving more space along the spleen channel and spleen send you a channel. So I’m going to enter in just posterior to the tibia. Spleen six would be a really good starting point to consider.

So we’ll go in the region of spleen six, angling posterior, I’m going to have the patient’s door selection and plantar flection. This one, especially as I get higher up, it might be a smaller if I can get away with a little bit more, well, that might get to the point where it feels like his musculature is pushing you out out of that little Valley, which has all minimize the movement. Reposition slightly superior, six strays towards the table, and then ankle dorsiflexion thinkers. It could be the flat of the failings, same thing. As I dropped behind the tibia, I sink down towards the table and a slide traction, posterior, they’re going to do it ankle doors to flection. That’s almost pushing me out, but I’m going to do it to see if I can open up that tissue a little bit and relax, good up singing down traction, posterior slightly, just enough to give a drag on the tissue call for movement. Could you even consider using the flat on my elbow, but I’d have to be very mindful of depth because this tissue can be very sensitive.

One more

Sink down, traction, posterior call for movement. That’s enough right there. Yep. Too much. And we’ll push you out. So you might have to minimize the movement. Let’s do one final pass. Might be a little bit more on the solely as two, but that’s okay. It’s still opening up that same space behind the tibia. All right. An excellent technique for tibialis posterior syndrome. As the other technique on the stomach channel would be for tibialis anterior syndrome. It’s excellent to open up the ankle dorsi, flection and working on any condition that would be affecting the foot, uh, especially PEs planus. And we can look at a modified technique for past planters specifically.

I think we can probably move on, uh, to the next slide. Uh, that one I think was most relevant for tibialis posterior stress syndrome. Um, and I know we have not unlimited time. So, uh, this is a similar technique and we’re on the stomach. I send you a channel on the tibialis, anterior, very similar idea. I’m going to sink into the tissue. There’s a little bit more meat of the tissue to sink into. We have such a narrow space for tip posterior. You’re buying the tibia to get to that deep posterior compartment, but the anterior compartment we’re really having a little bit more direct access to. And another difference with this one is the tin posterior. I’m just kind of angling and stretching away, but I’m not gliding through the tissue so much because then I would just be gliding through the soleus. So it’s, it’s more of a traction. Whereas this one I’m going to actually glide through the tip anterior, but at the same goal to help soften those connections to the tibia. So let’s go ahead and look at this one.

We’re looking at a specific myofascial release technique for the tibialis anterior muscle and especially cases and especially useful in cases where it feels like the tibialis anterior. Is it here to the tibia and another condition where you might feel a little bit of a loss of a ballet dance, rigid, tibialis, anterior, and glued and stuck to the tibia. So we’re going to come in with a fist loose fist. My knuckles are going to be right up against the tibia and not driving into the tibia tibial crest, but right up against the tibia as close as I can get to it, I’m going to angle directly down. I’m going to go planning through the muscle, but I don’t want to think about it as a round technique where it pulls the leg into external rotation. I want to think that I’m going straight down to the table and it’ll actually squeeze the leg, push it a little bit into medial rotation, or at least it will influence it towards medial direction.

So again, this way around the leg will pull it into lateral rotation this way, straight down into the table, we’ll push it into medial rotation. So I’m going to contact sync perpendicular into the tissue, ask the patient to do some divorce, deflection toe extension plantar, flection to reflection. Sometimes it’s a little bit faster of a technique, but this tissue feels very stuck here. So I’m going to take my time and let it soften and melt and back out. It’s not uncommon to see some little tracks where your fingers, where it’s a little finger tracks. I can move down a fist length. I can sing stray towards the table, ask for movement and falling at that flood into dorsiflexion and plantar reflection. Again, even if I take my hand away, it actually pushes the leg more into medial rotation because my intention is just straight down. One more pass. You don’t want to go too far down because it can get a little nervy at about mid leg is good. It’s a one Margo plantar flection, and I’m going to do one more pass on the coming back up. You don’t have to do it this way every time, but this tissue felt particularly congested, uh, ankle, Doris deflection, total extension, and then down.

All right, that’s great. So, um, just to reiterate on some of the first technique for the medial side, if the patient is experiencing what you are thinking of osteoblastic activity, where there’s a dime-sized spot that is exquisitely tender, you can perform the technique above and below. It just let pain be your guide. I mean, these techniques are actually very, very useful after the acupuncture technique, um, to help free up that area and increase the circulation. Uh, Brian, anything you want to say before we jump into the exercise now, I think, uh, we’re ready for that. So with the exercise, this is ankle rotation. This is coming from our postural assessment and corrective exercise class in module three. This is a go-to exercise for shin splints. This is something that’s always going to be in. The protocol will be the only exercise. It all depends on the patient’s posture.

Like for example, if they do have food, overpronation, there’ll be a number of different exercises that we teach to be able to, um, use with that. But this would be one exercise we would throw into that protocol because it does exercise all of this in new channels, the yin and the yang sinew new channels with the lower leg. Um, this is an exercise that actually requires quite a bit of concentration. Those because people start to kind of have it, their mind is wandering or the dog comes and licks the patient’s face because they’re on the floor. You know, you have to really concentrate with this exercise. Now in this photo, what you’re seeing is the model, bring the hip into 90 degrees of hip flection, and then supporting that leg so that the tib and the fib are going to pair be parallel with the table.

I’m parallel with the floor. Then you go into ankle dorsi, flection from ankle dorsi flection. You’re going to ask the person to make a full range of motion as if you’re drawing. And Oh, you do that 10 or 15 times in one direction. And then you do 10 or 15 times in the opposite direction. Now to work the opposite side, you’ll notice that the model has Dorsey flection. So this is going to be an exercise that you want to work on both sides. You know, the person’s going to be having shin splints on one side exercise, both sides because there is going to be a crossover neurologically and also with the channels. So this is a really great exercise to really, um, before running and also after running helps really loosen up that lower leg quite a bit, um, before the run. And it helps to, uh, loosen up the leg quite a bit after the run as well. Brian, anything you want to add to that? Yeah.

Yeah. You know, when they’re doing the exercise, I know this is my hand. So you just have to use a little imagination here, but if the person has e-version and they’re already, you know, you can look at the, the video, uh, the webinar we did on PEs planus, we go into it a little bit more than I have time here, but if there are any version of their ankle and foot position is such that it’s going to encourage that, that turning out, um, whether they’re pointing the foot down in the planet reflection or up into door selection, and they have a much harder time going up and in or down and in, which is going to engage, tip anterior and tip posterior. Um, when they do this, they sometimes cheat a little bit, or they’re like a little, uh, a little iffy on the both, uh, down and in and up and end portion of it. But they’re very strong on the up and out, down and out portion of it. You really have to coach them to make sure they’re there fully getting that foot turned in, in both directions, whether they’re going clockwise or counterclockwise. So don’t let them just kind of like, you know, bully it into one direction. It kind of like, eh, not quite there at the other direction, you have to give them a little bit of incentive or kind of bring that to their attention

At least. Yeah. That’s a good point watching your patient, perform the exercise before they go home and do it. And a lot of concentration each time, making sure they’re going into the complete range of motion. If the mind starts to wander, it’s going to be really easy just to kind of flap it around a little bit, which is not really doing very much. It’s not really exercising this. Um, this is also called shin burners. And after doing it 10 or 15 times yourself, you’ll understand why it’s also called shin burners. It’s a difficult exercise. It’s a fantastic exercise, especially for shin splints. Anything else there, Brian? No, I think we are good. All right. So here’s some contact information. You guys, um, uh, thank you so much for attending. It looks like we really went over time with this. And so for you guys that hung out the whole time, thank you very much. Uh, we wanted to thank the American Acupuncture Council again for having us with this sports acupuncture webinar. Um, Brian, it’s always a pleasure hanging out with you and we should say, Oh yes, next week, make sure that you are back for Lorne Brown. He’s going to be discussing some topics, whatever Lorne is going to be talking about. It’s always excellent. He’s got that unique ability to be an amazing clinician and a real, quite an academic as well. So, um, Lauren is a great guy and somebody to be able to listen to.

All right. Thanks. You guys very much. Appreciate it. Yeah. Thank you.

 

GWRHDDoran04282021 Thumb

Continuing Education Issues in the World of Covid

 

 

…the Kongress is so well organized and so fun, you know, I think, Oh, they’re just going to be listening to lectures all day, but there are, but there’s great teachers from around the world. And there’s also wonderful social events…

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, I’m Virginia Duran. And this week’s host for another edition of, to the point, very generously, really produced by the American Acupuncture Council. And, uh, today we’re going to be talking about issues around continuing education in this new COVID world and where we might be going in the future and the pros and cons of online learning and issues that are specific to our field when it comes to continuing education. And so I thought who would have more experience with this then? Julia Stier, uh, Julia is the Kongress chair, woman of the international TCM Congress in Rosenberg, Germany, uh, which has been running for 52 years. And I think of it as the, the largest and most prestigious acupuncture conference in the world or in the Western world. I should say. I don’t, I’m not sure what’s done in the East, but, um, she’s very, very capable and has had to pivot last year, uh, in, in, in a couple of weeks time to putting everything online. And so she’s been dealing with these larger issues around the new continuing education sphere. And so I would like to introduce you to Julia and, um, have her tell us about, uh, how we might, um, proceed and solve some of these. So, Julia, thank you so much for taking time to be here. Cause I know you have another Congress coming up in a few weeks and uh, time is already precious.

So thank you. Can you tell us how

You, how you got into the field?

Um, yeah. Yeah. Oh, well, um, my mother is from Taiwan, I’m half Taiwanese. So, um, in my family or no family, the some Chinese doctors already. And so, um, I sort of grew up with Chinese medicine and it was normal and, um, at all plays and, um, when I was, um, um, a young girl at 17 or 18, I, um, had some, um, chronical condition that came up and up again and I had to take a lot of antibiotics and then I went to see a Chinese doctor and she treated me a couple of times and it sort of, it never occurred again. So, um, I was completely convinced and I, um, started learning, um, uh, Chinese medicine. Um, a couple of years later I have, um, studied, um, medicine also. And, um, also I have been working in, um, um, I’ve been, uh, an event manager, um, lots of years. So, um, when this position at the Congress, um, was free, um, I, it sort of everything came together. Everything just fell into place. And so, um, it was, um, sort of, it was supposed to be, I guess, especially well

Having, you know, knowledge of both worlds, uh, you know, some people don’t have the organizational skills to do something like this, but the, the Kongress is so well organized and so fun, you know, I think, Oh, they’re just going to be listening to lectures all day, but there are, but there’s great teachers from around the world. And there’s also wonderful social events where you’re dancing with your, your heroes or your DCM heroes thing. It’s it’s um, it’s and it’s so well balanced with you have things on nutrition, she gung and tie cheese sessions, uh, herbs, a little, you know, there’s some Western, uh, style acupuncture. There’s classical, there’s Japanese, Korean. I don’t know about Taiwanese, but we should have it if we don’t, you don’t, there’s just, it’s so well balanced to really reflect all the aspects of the medicine that I’m, uh, you know, I feel so fortunate to have, uh, presented there a few times and to just even attend. Um, so we do want to know though how you’ve managed to bridge this gap, uh, or, you know, uh, pivot on, you know, how you’ve been doing it and how you have to do it now and love to hear your thoughts about what it might be like in the future. Yeah.

Oh, well, um, last year it was, um, sort of a surprise in Europe. Um, racial, um, became real, um, in, in March I think. And, um, we had the first, um, lockdown light in Germany from middle of March and the Congress was only two months later. So, um, we really didn’t have a lot of time to think, um, or to make plans. So, um, we just decided to take everything online, um, because we thought this was the only possibility something could happen and, you know, tickets were sold already. Everything was booked, everything was planned. And so, um, yeah, we just went straight ahead. We found, um, a partner in net of knowledge. Um, they are a Canadian company, they have this educational platform already and they program, they set us up, um, um, well, um, a site in there on their educational platform. And so, uh, we could start from there and actually most of our speakers, um, were really, really, um, brave too.

They just, and then said, yeah, let’s go. And we try. And, um, some courses, of course, some lectures, um, some workshops, especially the practical clinical workshops. We couldn’t take online. Um, like the palpation based work. It was, we couldn’t really think of any way at that time. And, um, but most of my questions is how do you, how do you accommodate the, these challenges with the, uh, clinical style workshop? Yeah, well, um, what really worked out well is, um, we had, for example, we had, um, this, uh, Japanese speaker, um, he is, um, in his practice in, um, in Japan and he had, we had two lays with them and the translator, um, with him in the translator and, um, he had patients coming in and, um, so, um, all participants, they could watch online. Um, it was all live. Um, they could watch online.

Um, they had a view directly in the practice. Um, the speaker, um, he quit, um, talk to them directly and he could, you know, treat the patient and, um, do the theoretical part before. And then, um, we could just, um, what should him, how he handles things and he could tell, you know, he could demonstrate a lot on the patients and participants always had the possibility to ask questions. And so it was a really interactive, um, way of teaching. Um, although it was only online. Um, but, um, it was not, it was not only, you know, sitting in front of the screen and watching for seven hours a day and not really being able to do something other than just listening. Um, but you could, uh, really actively taking parts, um, and the demonstration of learning. So, um, that was really good. Um, and also, uh, there was this, um, speaker from Italy and she had, um, trainer, baby, um, uh, workshop. So the participants, um, the babies, um, enter the class and, um, they could, um, turn on the cameras. And so, um, the speaker could, uh, you know, uh, the extra, she could watch them the treat their babies and, um, still comment on how they, how they were treating and how they were, you know, doing what they were taught to. So, um, this was, this was really, um, this was really good way of bridging this gap for us.

Yeah. I think it’s very clever your solution. Yeah. One question I had was, uh, how do you manage, um, intellectual property issues? Because it seems to be a kind of epidemic in the field, at least in the U S and, uh, but I shouldn’t say cause every country I teach in within six months, somebody’s teaching my stuff. So it’s not unique to the U S it may be worse here, but, um, it, it, it’s hard with something where a lot of what we’re teaching is in the public domain, but, you know, material or, uh, you know, with an online platform, how do you protect it with this protector on that issue?

Yeah, well, of course, um, we have, uh, um, w we have them, well, we have not, everybody can just come in, you have to, we have only the participants who could, who get the code, um, uh, to get into the workshops. And, uh, we have people actually watching closely and controlling that, not nobody’s in there who doesn’t belong there. And, um, so it’s, it’s, um, similar to, to a live event really. Um, and there’s these controls. And then of course we mock all the, all the slides, all the slides are being marked from the speakers. Um, Mark does theirs and then, um, well in the end, um, it’s really like an, a live course. You also, you will also always have participants there who take photos or, um, make audios or, um, or video recordings. And, um, we have an eye on that and, uh, of course there are certain rules which people have to follow.

And, um, actually of course, um, some of our speakers put their handouts up, uh, upload the handouts before. So participants can, you know, prepare and Donald before, but some of us, because I’m also, uh, you know, fear that the slides or the material, um, will be taken. So, um, they only provide the material to the participants who leave their email address, and maybe they, um, send out the slides after the, um, after the lecture backs. Um, there will always be a small gap. You can’t close at the end. You can’t really well, um, be a hundred percent safe. Um, but we, and what we can all do is, um, have an eye on everything that is going on. And so, um, in Germany that is not, that’s not re re a lot if someone teaches us what, um, uh, material that is known from somewhere else that has been already taught by somewhere else by somebody else, or is really somebody else’s method that they involved. Um, somebody will see it as somebody will always realize.

Yeah, yeah, no, I’m always so impressed how you have such wonderful teachers and, you know, from all over the world, I mean, from Japan and China and Korea and Australia, North America, all over Europe, and probably some places I’m missing, how, how do you there’s, so there’s so much talent, but how do you choose? Um, and, you know, do you have, you have themes, I think yearly themes for the Congress that have a certain topic you want to promote then, then, um, and then you have, you know, people teaching other things too, but it must be a tough decision.

Oh, yes, yes. Oh, there’s so many really good teachers out there. And of course we have, um, we have a lot teachers who, uh, were already, um, um, part of the Congress many, many times, and you know, who we can really rely on and who always, who we, who we know will be sort of a Garand to, you know, um, to, to do a really, really good lecture that is entertaining and still, you know, really well, they have a lot to say. And, um, and then, um, I’m reading a lot of journalists and I’m visiting other congresses. And then of course, I always have an open ear to suggestions such as sun shins. So, um, many people, um, keep, um, send in their proposals and many people have some, you know, some teachers that they propose to us that they say what you might like, and then there’s, um, there’s also a thing of online learning.

Um, there’s this, um, a lot of material on YouTube and other channels, um, nowadays, so I can get a better impression of, um, what the speaker has already been doing. Um, it’s, um, it’s not, um, it’s not taught to find new speakers that are really a lot new challenges. Um, it’s just, yeah, but it’s hard to decide because we only have, you know, we have like, uh, sometimes some years we have 60 speakers, which is a lot, but, um, there are a lot more who we, who couldn’t speak. So yes, it’s a tough to show

Or, and, and with, you know, uh, if you’re, um, also providing the videos afterwards where people who couldn’t attend or people who just, you know, want to, you know, get it all, then you don’t have to worry about like missing, you know, your favorite speaker cause they were at the same time. So there, there are some advantages to the online viewing of the class.

Yes, yes, yes they are. I mean, nothing can, you know, there’s, uh, that the personal it’s it’s missing, of course I’m the person I’m meeting and the dancing, the, you know, social, but, um, what really is a plus a big plus is that you, you buy a day ticket and you don’t only get to see one workshop. Um, you can, and this is something that actually a lot, a lot of people did last year. You can, during the day you can jump between the lectures and you know, what, you don’t have to stay in one lecture all day. And, um, uh, we upload the recordings of the days, um, for a couple of months afterwards. And so, and until the 1st of September, September of this year, you have time. Um, what if you booked? So, um, at 10 days we will get the chance to see 10 courses, 10 lectures, instead of one.

Can you tell us, um, a little bit about the theme and some of the speakers this year and how they can help people can find out more information about it?

Oh yes. Do you find, um, the whole program on a TCM hyphen Congress for the key dot and D E is also an English language, of course. And, um, uh, the thing, well, this year it’s, um, expressions of the metal element. Can you see this? Yeah, very appropriate because of the metal element and it’s about a physical and mental manifestations of skin and respiratory diseases. Um, we have, um, a lot about topic, but also really, um, on, on any other topic you can imagine. And, um, we have learned a lot from last year things that worked really well and we left out things that maybe didn’t work out so well. And, um, all for example, this year we have, um, a live cooking class. So, um, there’s in the handout and there’s a sort of a stopping list and you can go and, um, do your groceries before. And then, um, on the day, um, you can, you can be actually cooking with our teacher. She does this. And then, um, and this is also something we couldn’t do live in an, in an actual kitchen because you can’t put hundred cooks into a kitchen, especially

Okay.

When everybody can do this from their homes and they’re connected.

Well, that’s a great idea. Yeah. Yeah. We’ll miss some of the interacting with your colleagues from all over the world, but you know, that’ll come in the future. And of course it’s really about the, uh, the content of the Kongress. So, um, is there anything else you wanted to say before we close? Yeah.

Um, because you mentioned the, like the interaction we have, um, we have some social gathering, um, um, also online, like, um, um, the fantastic finale, for example, it’s always on, it’s a concert on Saturday nights, um, which is, um, done mostly by us because, and, uh, we did that last year and we have that this year too. Um, it was really nice, you know, it’s, it’s sort of, uh, the same feeling

Yeah. Whoever wants to can turn on the cameras. And we had a long, long chat after the concert and it was hot woman, really, it was nice to see everyone and, you know, at least that for a while. So, um, yes, everyone who was interested can just check out the program and be sure, um, it will, there will be a social interaction to not only, you know, learning on a high level, but also, um, meeting each other in some way.

So everything, but the 2:00 AM drinking with your teachers. We try, maybe that goes lunch. Okay. Well, thank you so much for, uh, being part of the show and we’re so grateful and next week for those that can tune in, we have Matt Callison and Brian Lau as hosts. So, um, really, uh, again,

This is Virginia Duran of luminous beauty.com signing off and thanks to the American Acupuncture Council again, see you soon.