The title of today’s presentation is cosmetic facial acupuncture. What’s working and lurking below the surface, and I am a cosmetic facial acupuncturist.
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.
Thank you for the American Acupuncture Council for inviting me here today. It’s really an honor and a pleasure to be here and thanks to all of you who are here and watching and listening and participating.
I appreciate you being here and I hope that you enjoy this presentation today. So I am from Florida. And happy to be here. So let’s go. We’re going to start the PowerPoint presentation. The title of today’s presentation is cosmetic facial acupuncture. What’s work w lurking below the surface, and I am a cosmetic facial acupuncturist.
So I’m going to help you to see what’s lurking below the surface. Here we go. So cosmetic acupuncture. It’s really a form of my rung. It’s an ancient, traditional form of healing based on the concept of beautiful appearance. And in China, we’re in, when we talk about beautiful appearance, we’re not talking about just the inside, but we’re talking about acupuncture and herbal medicine.
That was notably used by the ancient Chinese emphasis and anchors to keep their concubines looking beautiful and healthy. And it was practiced in Asia for centuries as part of a holistic regime to both enhance beauty and to delay the visible signs of aging. And it was also designed to promote systemic health and overall wellbeing.
Today, cosmetic facial acupuncture is one of the most popular specialties among acupuncturists in this country. And I was part of a 2014 NCC AOM acupuncture, facial rejuvenation needs assessments. And in that survey, we asked a number of questions, reaching out to all of the members of the NTC AOM organization.
And based on the feedback that we received, we found out that 62% of the patients of these acupuncturist, patients inquired about acupuncture for appearances. That’s a lot of people. And when I asked myself the question both for the, from the perspective of the patients, but also from me as a clinician’s perspective, why do people come for cosmetic facial acupuncture?
They come for prevention. They come for a desire for a natural alternative. That’s more congruent with their belief systems because times have changed now. And I find that my patients are much more interested in something that’s a holistic or natural alternative, as opposed to say surgery or some invasive procedure.
But also this I thought was particularly interesting and it has to do with the patient’s conflict about aging. What happens when someone begins to age? What happens on the inside? And what I’ve realized is that as we age, we start to change both in relationship to ourselves and in relationship to.
Ourselves when we’re dealing with others. So for example, in our twenties and thirties, what are the primary goals or what are the primary objectives or things that are important to people in their twenties and thirties? They’re interested in their social life. They’re interested in their careers.
They’re seeking partners their lifestyle, their homeless. At that age, there aren’t a lot of visible or physical changes. So it’s not really in the forefront of their perspective about themselves or the things that they’re concerned about. As we begin to age and move into the gen Z generations or decades of our forties and fifties, we start to shift our priorities, start to shift our relationship to ourselves and to other begins to share.
We are a little more invested in our career. Our partner may be starting a family or having a family. We have friends, and this is when we first start to see those visible and physical changes. And then as we move into our later years, sixties and up, this is when those visible changes are very visible and much more.
We’re much more affected by them. And this is when we start feeling our relationship about aging and re-examining ourselves and re-examining our life. Good looking at well, what have we accomplished? What haven’t we accomplished? Am I happy with myself? Am I do I feel like I’ve given enough or received enough in my life and all of these questions bring up what we call either a life crisis, or a big change in our life.
And it’s somewhere between this fifties and sixties. And it’s well-documented, we know it as say our life transition. It’s a period of questioning. Our identity may be challenging. Our self-confidence this typically occurs from about 45 to 65 years. It lasts about one to two years and clinically it’s described as a psychological unraveling brought about by events that highlight.
Our person’s growing age, inevitable mortality and perceived life, a Cod accomplishments. It’s when we start thinking, okay, I might be on the other half of my life, I may have lived. Longer than I have left to live. And it really, I don’t know for those of you who have gone through that are in it now it’s quite can be quite traumatic.
And it often spurs this desire to make drastic changes in our, in their current lifestyle or in our current lifestyle. And a lot of that comes from the urge to recapture our youth or to hold onto what we perceive as our. And for some people, this is exciting. It’s an opportunity to really look at themselves to really self evaluate, to see our insight, look at our insights, maybe a self-exploration and reassessing and reappraising, and there’s an enthusiasm behind it and it challenge and it’s a very exciting.
Part of our life, let’s say that’s not always true for others. For others. It can be a time of confusion. Emptiness. Meaninglessness or restlessness, maybe we’re not happy with what we’re thinking. Maybe we’re not happy with ourselves. Maybe there are some things that we feel like we have not accomplished or places where we felt like we felt short, fell short in our lives and it’s disturbing.
But then there are others and this is really sad, it’s so challenging and it’s so fraught with turmoil that it can lead to depression. It can lead to anxiety. It can lead to disillusionment self-doubt self-loathing. And a lot of these people have a kind of a shallow or not a strong sense of themselves or not as strong.
Since of their confidence. And so when, and they’ll rely on the superficial aspects of themselves, their looks their social life to actually validate who they are as a person. And when those things that you’re look start to Duane or not be up to what we thought we should look like what’s left.
There’s not much left. And it’s actually very upsetting and very difficult for ourselves and for our patients. And particularly in our Western culture, we are a very youth driven culture. And when we are faced with. No longer looking like the youthful person that we think we should be. It throws us into turmoil.
And from a clinical perspective, we know that although our patients are seeking treatment for appearance enhancement, they’re coming in for their wrinkles, there’s their skin or whatnot. We know that it’s not just that superficial make-over that they’re looking for, but there’s this deeper, emotional and spiritual healing that needs to be attended.
And this is the beauty of our medicine as acupunctures. And particularly as a cosmetic facial acupuncture, as big as acupuncturist, because our treatments are both physical. They treat the psycho emotional and they treat the spiritual component, especially when we’re looking at it from the principles of Chinese med.
And when I say according to the principles of Chinese medicine, what am I talking about? I’m talking about the balance of yin and young cheap blood fluids, the meridians organs and all of the systems that are involved. So for example, when we look at the pair organ systems and all of their attributes, From the perspective of the heart, the small intestines, the pericardium, and the San chow.
We know that as a system, they rule the blood vessels well in our world as cosmetic facial acupuncturist, we’re looking at complexion, we’re looking at fine lines, broken capillaries, rosacea, that type of. From the spleen and the stomach, we know that system oversees the muscles and the muscle, the health and integrity of muscles.
That’s the same for facial acupuncturists. We’re looking at the facial muscles and the integrity or the attenuation of the facial muscles every time. We know from our Chinese medicine, that the lungs in the large intestine oversee one skin or the concept of skin and in our world, what we’re looking at is skin quality, texture, poor size acne, rosacea.
That. And then we also know from our Chinese medicine knowledge that the kidneys and the bladder oversee the bones and aging, the entire concept of aging. And so a lot of conditions that are involved, premature aging bone fragility, bone resorption on the face. We’re looking at the kidneys and the bladder.
And then this is the kind of the one that’s a little bit different, but we know that the gallbladder and the liver oversee. Ligaments and tendons will in our world. What we’re thinking of is not so much ligaments, intendance, but the smooth flow of cheer, the way that the muscles contract relax.
And when that smooth flow gets loss, what we begin to see is the skin on top of the muscles of the face, begin to crease and fold, and that begins the development of bringing. From a psycho-emotional perspective, we’re looking at the five elements. We’re looking at the fire earth, metal water wood perspective.
And we know that fire has to do with one’s ability to socialize their healthy socialization whether they over socialize under socialized, that balance that occurs in the fire element. The. Is about how we digest our thoughts. It’s about our ideas and it’s about self-esteem from a metal perspective, we’re looking at lungs grief, the way that we breathe in, breathe out, letting go the ability to let go of the old and bring in the new and the inability to do bringing grief, resentment, or regret. From the water perspective or the kidneys again, we’re looking at acceptance and fear. How are we aging? Are we okay with aging? What do we anticipate? Can we accept it? Is it fearful? Is it so fearful that we actually get paralyzed and depressed? That type of. And the wood element being delivered and the anger, it’s about the inability to actually make those changes, leading to frustration, bitterness, resentment, lack of hope, change remorse, all of the emotions that go with the frustration or the inability to actually let go and change.
So as practitioners, we are balancing both the physical and the imminent. And what’s interesting for a facial acupuncturist is our ability to correlate those facial features with the systems of the water wood, fire earth, and metal are the five elements and the organ systems. And we can actually see on the face, those changes that occur both on the physical and the emotional perception.
So let’s look at wrinkles. If you look at the different aspects of the face, starting with the upper forehead, that’s ruled by the kidneys around the eyes and the lower portion of the forehead is the liver. The lungs really ruled the cheek area. The spleen, stomach and digestion around the mouth in between the eyebrows.
The kidneys are the ears as well as the upper forehead and the lower aspect of the chin. And when there is an emotional disharmony within those organ systems, it can show up as wrinkles. It can show. And changes in skin coloring. It can show up in terms of say dyschromia or pitting in this tissue.
And so as facial acupunctures, we actually learn how to look at the face, diagnose the face, both from a physical and an emotional perspective. And then there’s also an emotional map. This is from Lotus Institute, Lillian. And she has actually outlined the direct emotions that occur within those features, whether it be wrinkles, skin pitting, flattening changes in color of the skin.
Is the skin a little white or pale meaning frozen or is it red? Meaning there are signs of. Yeah, when we treat, we definitely need to treat all of the emotions. We need to treat the emotional component as well as the physical. And when we are looking at those underlying pattern disharmony, we see that the wrinkles that the skin color.
So that the flattening or trajectory of the face those are just the symptoms. What we’re really looking for are those underlying pattern that as harmony and that we differentiate with our signs and symptoms through our poults and our tongue. And then we treat the superficial or the root. Which is the the wrinkles as the symptoms.
So for example, we’re going to look at ours signs and symptoms, tongue called that type of thing. And we’re going to discover whether it’s liver cheese, stagnation, frustration, repressed, anger, and we’re going to treat that with body points and then the branch, the wrinkles that show up, particularly if we’re looking at, say the liver around the forehead we’re going to treat those with these.
So here’s an example. This is a patient of mine and he was a 44 year old male. He was looking for acupuncture treatment to enhance his facial appearance. And his chief concern was what we’re calling disfat satisfaction with the forehead and glabellar area, the glabella areas that crease in between the forehead.
Sometimes it’s a single crease. Sometimes it’s a multiple crease you can see in this patient. That’s a very deep crease on one side. And then a smaller crease rate by the inner campus of the eye on the other side. So even though this patient had bilateral headaches, he had a history of carpal tunnel syndrome.
He had asymptomatic mitral valve prolapse and periodic lumbar pain. Those were erotic. But he wanted treating was this creasing between his forehead. So we spent a lot of time talking about it. We spent time talking about the physical component of it, the underlying patterns of disharmony. And then we reached into the emotions, the frustration and anger for him about aging, because the peer pressure for him to look youthful was hi the standard was so high in his world that he just couldn’t get past it. He did not like himself. He was so frustrated, anger, angry about it. So we had to trust both of them. And we did we came well. I came up with a liver cheap pattern with blood stagnation and congestion in the gall Meridian validated by the tongue and pulse.
The treatment plan was to harmonize. And then we decided we were going to do this for 10 weekly treatments and then reevaluate. So I chose some points. I showed somebody points to reflect the treatment that I was doing face points to actually subsidize the underlying pattern disharmony. And then I did some of your points.
I always use your points. I think they’re really. Okay. And so this is the before and after this is what happened after country meets. And as you can see, there’s a significant difference for those of you who do practice facial acupuncture, some of these changes may be more obvious to you, but even for someone who doesn’t.
Visible difference. The first change that you see as the softening in the creasing between the glabellar region, but look at his whole face, look at his entire demeanor. Can you see? And the before picture. In the heel Muslims angry, his face has pulled in his jaws. Clenching his face is very tight. And then in the after 10 treatments, you can see his face is so much more relaxed.
He’s more comfortable with himself physically and also emotionally as well. So this is just one example of many ways that we are treating, not just the. Superficial, because if I had just treated deliberately stagnation, if I had not addressed what was going on underneath, I may have seen a difference.
I don’t think it would have been the significant and it certainly wouldn’t have been within the timeframe that needed that we were given. I gave ourselves. But again, just to reiterate and validate the significance of not just treating the surface, but really treating the physical, the emotional, the spiritual, and using that with our pattern underlying patterns as harming.
Using surface points to treat the face and pulling the whole thing together. So it, again, not just one one aspect of it, but particularly in facial acupuncture, because when you think about the face and when you think about the orifice as the face, your eyes, your ears, your nose, your mouth, we are the face picks up everything.
It’s the first line of defense. And we know that we hold all of our emotions and our muscles and the fascia and tissue and the face is the first place that we hold everything. And one of the last places that we’ll re let go, because in order to make big changes, you have to actually resolve the emotions that go with it.
You have to resolve the underlying trapped trauma that’s in there. And so this is actually makes it extraordinarily rewarding for them. As a facial acupuncturist, because when I can make a change, not just a visible change and their surface, but when I can actually affect them on an emotional and a psychodynamic level, I feel like I’ve done a really good job.
Just to say, for those of you who are interested in learning. This program is that I teach is part of the Pacific college of health sciences. It’s called the facial applications for cosmetic enhancement or the face program. And you, it’s wonderful because we’re not just bringing in me, but we’re bringing in all the known leaders of today’s world.
Their classes are start once a year in January and there’s information for our, you, for those of you who are interested. I can also follow me on Instagram or if you want more information, I can certainly give you more through my website. But just want to say that this has been such an amazing and rewarding profession for me because I really feel like I’ve helped people to not just look better and feel better physically, but to actually.
Age in a way that they are comfortable and more productive, both in terms of who they are for themselves, but also just to make a small difference in who they are in relationship to the world too. So thank you very much. And I appreciate. Being here. And then also before I entertain questions, I want to say that there’s another pro wonderful presentation.
So stay tuned next week for a Sharon Weizenbaum who will be presenting as well. And I have to just say that the quality of presentations through the American Acupuncture Council is really it’s dependence. And thanks again for having me here today, Alan. I appreciate.
Are there any questions from anybody?
I actually had a question about the gentleman whose face you worked on. Was he literally a happier person as a result or that didn’t really make him any happier in the long run. Thank you for asking that. Not only was he a happier person, but the the stress that he was feeling and the trauma around.
Feeling like he was getting judged by his peers dissipated. And in other words, he didn’t care as much. What other people thought about him, which is pretty amazing. Yeah. Last question then we’ll wrap up. Because I’m really was curious about, do people become addicted to the treatment in other words? Oh, wow.
This was great. And now, people become addicted to facial surgeries when they’re doing surgeries or body surgeries that just keep wanting to change and change. Is that something that you find in working with people? I it’s, yes. It’s different. I, and I know exactly what you mean. When people are addicted to facial surgeries the addiction.
Is that is wanting to look better and better, but it doesn’t change. What’s on, under what’s going on underneath, which is a self dissatisfaction. And that’s what the addiction is. The addiction is based on needing to. Look better because they’re not satisfied or happy or content within a, with this, what people get addicted to as a they look better.
But they feel better about themselves. And it’s the feeling better that becomes the addiction similar to say meditating, you feel like you’re a better person in a few meditate. There’s something that happens to you and you, your relationship to yourself within the world becomes a more peaceful place to live.
It’s the same with this type of acupuncture, a you look better, but also more importantly, you become at peace with yourself. And when you are at peace with yourself, not only you’re you a better person for yourself, but you’re a better person for others.
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.
Billing expert for acupuncture and the American Acupuncture Council network, as well as the American Acupuncture Council Malpractice Insurance. With another time to get with you to update you on what’s going on, what’s changing to make sure your practice is thriving. Remember the American Acupuncture Council was always your partner.
If you have a question and need an answer, trust me, we’re there for you. So what are we going to talk about? Medicare. So let’s go to the slot. So I want to talk about Medicare because there’s so many things that are confusing or misunderstood or misrepresented that I think are going about. And I’m getting so many calls and requests for this, whether it’s people on my network or coming to seminars, what is going on with Medicare?
What does it really cover? And what is the. Differences between Medicare part, B and C who pays me. So I want to make sure there’s a clear understanding. Regular Medicare part B is what you see on the left side here, that standard Medicare card, but you’re going to know a lot of people have something else called Medicare advantage.
And so we want to kind of talk a little bit about that to make sure there’s a really clear understanding of what’s going on because of course you are being in a. With people requesting information or saying, I heard it’s covered. Take a look at some of these ads. The upper left is from a RP where they put out, Hey, Medicare will cover acupuncture for back pain out or regular med take care of patients sees these types of things and thinks, well, I want to get the care because notice even blue cross blue shield has an ad for it.
In addition, here’s another one, indicating a zero acupuncture for 24 visits. And this was a commercial where they literally show acupuncture on the commercial. Realize acupuncture has become a commodity. For these plans because it’s their way of enticing people to get their plan. Ooh, join ours because there’s a benefit.
Now the confusion of course, is what are the differences between this part a and part B and really what is Medicare? Well, who are the Medicare patients? Will Medicare patients, is it going to be people 65? Obviously, at least as long as you’ve paid into Medicare, I think for 10 years you will automatically get Medicare benefits when 65.
But remember Medicare is not just for people over 65. There could be some people who are younger that have a permanent disability and as a consequence are entitled to Medicare. So don’t be surprised when a Medicare patient is younger, but it also could be people with end stage renal disease, probably not ones that we would see, but certainly the.
Now what’s going on with Medicare is understanding the types of Medicare. Now we have standard Medicare part a, which is the one everyone gets it’s hospitalization when you go to the hospital. But the one we’re speaking of is very typical as well. And it’s Medicare part B I’ll call that traditional Medicare.
So this is the original Medicare benefit that covers going to the hostel. Going to a doctor’s office and having a drug benefit. Now, the good news is these people can use it. Anyone within the system, does it matter? The state and Medicare pays its portion and the patient pays 20% of it. So not bad, a good, nice coverage for people who are over 65, for those that don’t remember prior to the implementation of Medicare, many people who are older would literally go bankrupt with any illness.
So this has been something that’s been quite the good, safe. Bottom line though, is what’s going on for acupuncture? That’s what we’re concerned about. So you notice I have it in red here and it says acupuncture is covered, but it says for chronic low back pain, only under direct supervision of a medical provider.
So all of a sudden, well, yeah, But it’s only covered when done under medical supervision. So that makes it somewhat limited. The low back pain of course is limitations for it as well. But nonetheless, the supervision makes it hard. And part of that reason is acupuncturists have not yet become Medicare providers.
We need to get a bill, which we already have one going. That’s going to make acupuncture providers under the social security, social security. To be part of Medicare. So until we get that, we’re going to be stuck with this type of issue of needing the supervision or, or referral, if you will, from a medical provider, that bill is being moved and hopefully we’ll see something in the next couple of years, but this is kind of the cart before the horse.
If you think that Medicare was really going to first do a study of how good acupuncture could be to see if it was working or not, the evidence was so overwhelming, they decided to cover it. The problem. The cart before the horses while they’re covering it. But because acupuncture’s can’t join, Medicare is still had to have some tangential way of getting in, which means under the medical provider, meaning for traditional Medicare part B, it still has to be billed by a provider within Medicare.
And that’s limited to basically medical providers, so that one’s a little more complicated or a little more difficult, but nonetheless, still the late. Let’s talk about though. Also what a lot of you are experiencing and misunderstanding is there’s this second type of Medicare that’s often referred to as a Medicare advantage plan, or also known as a Medicare parts seen.
I know of those letters can be confusing, but I like to think of it as a Medicare advantage plan. What a Medicare advantage plan is a way for a Medicare patient to literally chip trade their Medicare benefits to this point. And then this plan takes over for the benefits and it’s under companies like United healthcare, Aetna, Cigna, all these ones offer them and they have to offer all the same benefits as regular Medicare.
Sometimes it’s actually even cheaper. Which to me is interesting. When you think of it, how is it that we can manage Medicare patients for like 500, 600 a month in premium yet when we buy premiums for someone that’s younger, it’s thousands of dollars. Well, that’s because it’s insurance companies making sure.
Bottom line though, is that these plans have to cover exactly as Medicare does. So in other words, they have to cover the low back pain, just like Medicare to however many of these fines. And you’ll see this in a second. The last bullet offer extra benefits like acupuncture, and these can be built directly by an acupuncturist to the plan without being part of quote unquote.
Now, some of these plans may require you enroll, and I frankly will have no problem with enrolling because it only gets you into the one and gives you access. These can be pretty darn good, but let’s understand the. Traditional Medicare part B regular. Again, acupuncture is a benefit now, but chronic low back pain only, and up to 20 visits a year or so, not bad.
What it says though, is that the there’s 12 visits within 90 days. And assuming the patient improves another eight, the difficulty for us is that an acupuncturist can perform. But it must be supervised by a medical provider. And this could be an M D a D O a PA, an NP or a CNS. And so these are all medical providers that are enrolled in Medicare.
So in other words, you’re working kind of for this person, if you will, it’s not a referral, but something you’re working with because it has to be built by. So to take a look at it, this under this national coverage determination, you’ll see here. It says the most recent is that it will cover for chronic low back pain.
And that is defined as back pain. That’s more than 12 weeks. Now that doesn’t mean like, oh, I’ve had it exactly 12 weeks, but think of how many Medicare patients talk about all my. I’ve had back pain on and off for the last 10 years. Well, by definition, that’s certainly going to be chronic. It certainly can’t be associated with other inflammatory diseases like infections or metastatic cancer, but traditional, as most people get back, pain realized 85 million people a day habit.
That kind of makes sense. It will be covered. Now here’s something interesting. Obviously you’re all aware that back pain codes updated and part of the complications in dealing with this when they update. Medicare published what codes they were going to allow, even though M 54 50 is one of the codes new for back pain under the Medicare guides.
What they indicated is that it’s only going to be M 54 51 for routine progenic or other specified in 54 59. So make sure if you’re billing Medicare, part of the reason if you’re getting denials is you have to update to one of these two codes and bear in mind. There are some payers that have been delaying until April 1st, for some reason, but.
Those are the codes. If it’s back pain, notice the code, doesn’t say, uh, chronic. It’s just the idea. And that’s why M 54 59 is the more likely now it pays up to 12, but notice it says an additional eight sessions will be covered for patients demonstrating improvement. I think that’s fairly straightforward.
Most patients, in fact, getting acupuncture with back pain, almost always improve, obviously. And it’s just as long as that’s there they’ll allow additional eight meeting up to. Now the complication here is this is not a yearly benefit in the way you might think, meaning it starts over in January. It’s a rolling year.
So by example, it says if the first services performed on March 25th, The next service beginning of the new year, can’t be until March 1st of the following year. So they do it as a rolling month. So it’s literally 20 visits with any within any 12 month period, not January to January, but it could be from March to March and so forth.
Now the complications here is that physicians can furnish it. Of course, medical doctor certainly could physician assistance, but they also have to have some additional licensure for accurate. Bottom line is you’ll notice here. It says auxiliary personnel can do it so long as you have a master’s or a doctoral degree for acupuncture, which is going to be all of you.
And therefore you can provide it. Now here’s the problem you’re providing it, but it says here, auxiliary personnel, furnishing acupuncture must also be under the appropriate level of supervision. Now, a lot of people have misinterpreted appropriate level. It’s thinking, oh, it’s just based on a referral.
And they come in the office, unfortunately, not that simple under this rule, that’s under these two regulations I have, here are 4, 10, 26 and 27. You have to be present in the same office. So it means you gotta be in the office with this medical provider when the service is delivered, they bill for it.
But yeah. This can’t be a simple referral, but in the office, this means either you’re in their office working, or maybe they come to your office, realize that a lot of nurse practitioners, CNS and others are traveling. Maybe they come to your office one or two days a week. This might be helpful, but this is certainly a benefit for someone working in a larger medical clinic.
In fact, this might be an opportunity for someone that goes into a medical practice that does geriatric medicine to deal with low back pain and pain management. So certainly something to think of it. But bottom line. You’re going to be working for this medical provider. Now keep in mind, working for them could be under two ways.
It could be as an independent contractor. It also could be as an employee. So either way it is certainly possible. But again, you can see the limitations here. It has to be done directly under supervise. Now you may wonder, well, what does Medicare pay? So what I’ve done is I’ve just put up a few areas of Medicare payments and you all notice this increased about 10% this year.
So a nice little jump for us, of course, that also helps for the VA as well, but notice in all areas, whether I’m using California, Illinois, Florida, Texas, you’ll notice the first set is generally around $40 or higher, maybe up to 45, the additional sets in the 30 range. So I’m just going to round up. 44 first set 30 for additional sets, which means approximately a hundred plus per visit because generally you’re going to do three sets and I’m not saying always, but generally that’s what Medicare loss, that means a hundred dollars a visit that certainly can be pretty good.
We’ll talk more about that, that money part of it towards the end, but I think this is something viable. If you’re getting a hundred percent. This certainly makes a lot of sense. Now it’ll make the most sense when we can directly. Cause now if you’re working with someone, obviously that a hundred dollars per visit has to be split between two.
So therefore it may not be quite that you’re getting that full amount, but again, this is not. So again about 41st set, 30 for additional sets. Now you’ll notice if you’re doing an electroacupuncture it’s more like 50 and 40. So now we’re looking at probably about 130. If you’re doing a electroacupuncture, by the way, these fees also will apply to VA, but also the.
To Medicare advantage, which I’ll demonstrate in just a second, but here’s what you’ve probably all been noticing. The Medicare advantage is an area that I certainly would say you should be looking into. Medicare may have some limits because of the way we can access the patient Medicare managers. Aren’t that complicated.
Here’s what I took literally off of my television, where they are using acupuncture to advertise this plan. And I’ve seen this over and over notice here. Zero copay. In other words, a patient comes in and they pay nothing. Now with these types of plans, you’re generally going to have to be in network and, or be a deemed provider, which I’ll explain in a moment.
But bottom line is these are going to pay approximately the same and in many instances more, which is not bad. So when a patient has a Medicare advantage plan, this is what you’ll see. They won’t have that traditional Medicare card, but one like this and you’ll notice it literally will say. Medicare advantage right on the card or Medicare part C.
So that’s how you’ll know. Be careful though, the person will still have their old Medicare card. So always ask them, let me have all of your Medicare and all of your insurance cards so you can verify. Cause once they have this plan, they no longer actually have traditional Medicare. They have this plan they’ve traded for it.
And to give you the numbers, there’s about 63 million people with Medicare. That’s a lot. And about half of them now have Medicare advantage plans simply because the benefits with them are often a little bit better, less out of pocket. And yet what’s interesting. How has it, can Medicare advantage plans offer so much?
Yeah, it’s from a plan that Medicare is paying them 600 a month. And again, I go back to, it shows how much insurance companies profit off of others, if they could take the sickest people. So here’s an actual card for a Medicare advantage plan. And this is one that was sent to me. A member of the network was saying, Hey Sam, what does it mean in this Medicare advantage of place?
The Medicare limiting charges, and often that’s misunderstood because acupuncturist aren’t part of Medicare. So you’ve never heard the term limiting charge. Medicare has fees that are called par non-par. The limiting charge is literally 15% higher than the regular rate. So you remember those fees, I just showed you add 15% to that.
So let’s talk now, probably with these closer to $50 for first set. So I want to make sure when you’re billing these Medicare advantage plans, don’t build what you think they’re going to cover bill your normal fee, bill, your 60 or 70. If they allow 50, they’ll pay it. But if you bill thinking, they’re only going to pay you 42.
And you go 42. Well, sure. They’re going to pay you 42, but what if they would’ve been paying you 50? So always bill your regular rate, just know that you cannot collect the difference. And this is what brings up this term deemed provider. Many times when you get into these plans, you may have to join, but often you’ve done.
All you have to do is accept the patient. But when you do accept the patient, it’s like you become in network on a claim by claim basis. In other words, we call it deemed D E M Dean to provider. And what this refers to is this, when you take the patient, then you have to accept what the plan allows. For your billing.
So in other words, if there’s a zero copay, the patient has a zero co-pay except the plant, or if there’s a small copay. Now these benefits actually are pretty darn good. As you can tell what the limiting charge add 15% to what I just said, and you can go, wow, wait a minute. Now, Sam, are you meaning $115 just for acupuncture?
Yeah, that’s exactly what I mean. Now these advantage plans are pretty good and advantage plan has to do exactly the same. As regular Medicare. So it has to cover just like it does here. What is covered the chronic back pain. But most of these plans you’ll notice here. It says acupuncture routine. You can find a net that you can find a network care provider, you know, searching for the acupuncture benefits, online directory.
So what are they looking for? This routine acupuncture. What is routine acupuncture? Routine acupuncture means they cover for pain management, no need for a referral or anything. Notice regular Medicare says they may require a referral or working directly. So I had someone last week contact me and say, Hey Sam, I heard they’re going to implement a referral.
No, no, no, no. For regular Medicare. Cause you have to be under super. But for these plans, you don’t require referrals for routine acupuncture, which means basically pain management, the same you’ll build any United health care plan to illustrate that. Take a look at how they cover it. This is the Medicare advantage plan for acupuncture.
Notice it actually covers dry needling. If you choose to do that, now I’m going to suspect, do acupuncture because that’s what you are. It pays. In addition, you can’t combine dry needling with acupuncture anyway, but notice what they cover here. It’s noting routine acupuncture codes, not a complete list. So what I want to highlight Medicare advantage plans, cover acupuncture, but also covered.
Exams and therapies, because notice it’s not a complete list. It lists the ENM codes and acupuncture codes, and then notice therapies, electric stem, infrared ultrasound exercise. It could include massage and manual therapy always think of what is within your scope. And they will. I have some offices doing some very aggressive care with this.
And while I think it’s a lot for one visit, I have one office that bills well close to $400 per visit. And he literally gets paid almost all of it under this type of plan. Now these are patients that a lot of pain and a lot of things going on, but again, pretty good. So a Medicare advantage plan is something I would probably say I’d want to be part of, because look at the access that they have, the key.
Do people know that you’re willing to take these plans? Are they aware of it? Have you joined any of them? Because to me there’s no downside. If you join a Medicare advantage plan, is there any cost? No. If you join a Medicare advantage plan, does that mean you have to join the regular plans with them?
Generally not. You can join just for Medicare advantage, which means the only downside is you join and you don’t get a patient, but assuming you get one or two more people are looking for a thing of how many people have pain over age 65. I mean, that’s almost a given for many, let’s learn to manage that so that they can start to do it without medication.
So I want to make sure you always are up to date. The American Acupuncture Council Network is always updating information. If you’re not familiar with our website, please go to our website. It’s AAC info network, nothing insurance, but info network. And you’ll notice here we put out newsletters. And one of the things we just put out Aetna is.
Acupuncture to all of their commercial plans now. So that’s a really good benefit, but how would you be aware of it without going to our new section? We want to make sure you’re always up to date. So anytime something’s changing, we’re the resource. Just go to our new section. There’s no cost for it. Just go to the new section and click on it.
Take a look once a week, sign up for our email alert and you’ll get that as well. We also posted out on our social media, in addition though, notice here about how to deal with financial agreements. Remember we did the no surprise, not that long ago. So we’re going to be a resource. Allow me to be part of your practice.
We have a hotline service where you can call me, email me, fax me on any type of information you need questions with. We’re here to help you get paid. We have a vested interest. We want your success. I do because I really want to, before I retire, making sure acupuncture is fully integrated into Medicare.
So take a look at our hotline and we’re always going to be a resource with you. The American Acupuncture Council Network, go to our site. Give us a call. We’re here. I’m going to say, thank you everyone very much. We’re going to have a special Friday show and the guests, the guest hosts will be Shelly Goldstein.
And I’m gonna say to all of you be well, take care of yourself. Remember you’re important, but it’s more important to be good. Thanks everyone.
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, again, thank the American Acupuncture Council for inviting me to continue hosting my show on their series to the point my name’s Dr. Lorne Brown and I’m the founder of healthy seminars. And I have run my practice in Vancouver, BC, and I’m the author of. Missing The Point why acupuncturists fail and what they need to know to succeed.
Our topic today is being laser focused on patient results. And I’m very excited. I’m going to give a thorough introduction to our guest today, which is Dr. Steve Liu. And we’re going to talk about being laser focused on patient results. And you’ve probably heard me talk about this before, where I say to her.
Thriving fulfilling practice where you’re helping people and you have abundance in your life as well. Yin and yang have to be in right relationship. And that yin and yang is your clinical results or clinical skills. And then there’s the practice management, your business skills, and many, I’m a charter account and I’m a CPA and I’m a doctor of Chinese medicine.
And it’s important to have those in balance if they separate or they’re out of balance and you have no practice management skills, even though. Skilled practitioner in the world, you may have no patients, so you’re not really helping that many people. So my goal is for you to develop that practice skill.
So with integrity, you’re helping your patients. So you experience abundance and you help heal your community. When we talk about being laser focused for patient results, it’s a pun, but we’re actually going to talk about low level laser therapy and how this can not only. Help with your clinical results.
And that’s why I’ve asked Dr. Steve Liu to come on with us. But also I’m going to share a little bit about this, the practice management of, by adding that special added value in your clinic practice, that you’ll become more attractive to your patients. So let’s introduce Dr. Steve Liu. He’s become, he’s not only a colleague, but he’s.
A friend of mine over the short period of time that I’ve gotten to know him. He is a licensed acupuncturist from from Arizona. He used to be an electrical and laser engineer in the Silicon valley. So he’s been fantastic for me to talk to when I want to ask about the different lasers out there and how they work, because he’s got that background and he’s combined low-level laser therapy, which the scientific community calls photobiomodulation and what we call laser acupuncture.
In his acupuncture practice. So he’s integrating the two and it’s been doing that since 2000. So he’s had quite a few years since the year, 2000 of combining those. So he’s the perfect guest to have on our show. You should know that he is a member of the north American association for photobiomodulation therapy since 2001.
And he was it’s presidents from the years, 2008 to 2010. So that’s quite a feed as well for an acupuncture. To be ahead of that north American laser association. He also served as the president of the Arizona society of Oriental medicine and acupuncture as well. And he’s also served as a board member of the international society for medical laser application.
So you’re starting to see. Steve is very involved in the communities and sits on boards because of his skillset and his knowledge. And he founded in 2006, the American society for laser acupuncture as lat and in his practice. He treats many conditions. He’s going to talk about some of the neuropathy chronic.
Alzheimer’s disease and Parkinson’s disease as well. So let’s bring Steve on and I’ve got some questions for Steve. I want to let our audience know right away. Steve, these are the questions I’m going to ask you. So for all those of you, why do you want to pay attention? I’m going to ask Steve why laser acupuncture and regular acupuncture, why he sees it as a perfect.
I’m going to ask him what he’s using it for in his practice. Why are people attracted to his practice and what is giving him better clinical results since he’s doing the combination. And then we’ll talk a little bit about as lad as well. So Steve, welcome to the point. I’m so glad to see you again.
My good friend let’s dive into this why laser acupuncture and photobiomodulation also knows a lot of laser therapy. Why do you think this is a perfect marriage for us acupuncture?
Thank you Lauren. Thank you. Thank you again for the wonderful introduction. And my name is Steve Liu. I’m a laser acupuncturist.
That’s what I call myself now. I think there’s a three folds Y acupuncture and TCM will form a Perfect marriage. And number one we see a lot of older patients. And I always tell my older patients that we are not 20 years old anymore, including myself. So our healing ways slow. So we, as as an acupuncturist, we always try to convince patients that how to help heal faster, but then they are older and laser can leave.
Help speed up that healing along with acupuncture treatment and number two, or, some patients may be afraid of needles. So they are needle phobic and kids, especially, and younger people or even older people. So you can use a laser acupuncture in place of of the needles.
And number three, I think is the most important part is the. When you see chronic pain, which is what we see all the time, it’s very challenging as and because these are patients that came from, I call them medical rejects because they’re being rejected by the medical professionals, whether it’s medical doctors or chiropractors.
And because the techniques they tried and they don’t work for these patients, then they come to us as a last resort. And how are we going to heal these chronic. And laser is the one acupunctured get the healing started. We know that we can do that. And then once we got healing going, we need the laser to help speed up.
And I think that’s the best part of that in this matter.
Yeah, I think I’ve heard you call it. It’s the great normalizer. And so you’re finding that using the laser with your acupuncture, you’re helping these older chronic patients bodies behave more like they’re younger or an acute stage. So you’re getting those results.
Yes. I love that term normalize it. That’s why I use that too, because when you have a older patients and how do you get this healing going? Just like a young people and whether they are 60, 70, 80, 90 years. So I have a, my oldest patient now is 95 year old with chronic back pain. And she’s walking around with pain, without pain.
How I can do it because I normalize that. And with acupuncture using laser. So I love that word, Laurence, the normalizer the laser to normalize,
What are the conditions that you predominantly see in your practice? And I know there’s many out, like I predominately see gynecology, fertility, PCs, endometriosis, and I’m using my acupuncture laser.
You’re doing a lot of other conditions outside of the fertility. Can you share where your clinical experiences. The laser acupuncture along with acupuncture.
Yes. I love to talk about that because later I always tell patients that. Photobiomodulation works on cellular levels and what are not cells in our body is everything right?
So we, this laser work on muscles and tendons and soft tissue. That’s what I really like to work on because as I see a lot of these cases in my clinic, but they also work on the nerve tissues and which is very challenging for us like a neuropathy. And I wrote an article for the acupuncture today a few months ago that.
To me, it’s a, one of the best technique we can have is combined, combining acupuncture, like often and toes around the toes. But at the same time, use the light right around the toes and balls of feet, because that’s where the nerve has become dysfunctional. So this is why the nerves also offer quite very well.
Laser works on the Mito con. So for instance, Parkinson disease, sometime the scientists called the mitochondrial dysfunction in the brain, even though it could be the substantial Niagara without the they’re not producing enough dopamine, but what if you shine the light in the brain? And there’s a tons of study for that.
So why don’t you combine the. That body acupuncture, scalp acupuncture with light over the scope. And it’s wonderful combination that you can have. So this is why there’s an unlimited, sky’s the limit. Really? The sky’s the limit. When you combine in photobiomodulation laser therapy. With acupuncture.
So this is why anything you can think about you can use laser. So I don’t have any pain case that without laser, it’s always as a part of the electricity on the needles. And I always have laser around the needles and I always have a heat over the needles. So I called it the whole enchilada.
So this is why it’s a wonderful results. And that’s why we can get referrals from your clients. And from the top.
Sorry, I just want to summarize that you’ve been using it in your practice to help slow down the progression of Alzheimer’s and Parkinson’s disease. And you were sharing a little bit about the mechanism.
It, it’s outside the scope of our interview today to go into detail, but there’s photobiomodulation that you’re using in your practice. So you’re using it as laser therapy. Then you’re doing laser acupuncture, laser on the points, and then you’re doing needle acupuncture. So that’s what you’re doing.
And the mechanism of photobiomodulation the laser therapy. You talked to the mitochondria, the battery, the cells. And so if those batteries of the cells are repairing, they can divide better. So there’s that healing response and what we see with Alzheimer’s and Parkinson’s regulates inflammation. Chronic systemic inflammation is becoming the cause of so many diseases.
So if it can help with that, Reduction in pain and then all these other disease processes, scar tissue, and adhesions. So if we think of all of those injuries with scars, and then you talked about the nerves, even nerve regeneration, and then blood flow increases blood flow to the area. So that’s why, we’ve talked, you said is the perfect marriage, right?
And then the needle-phobic patients, this just opens up your practice to everybody now because there’s probably. Close to 50% of the people that would want to see you as an acupuncture, see, to get relief, but they can’t come through your doors because their fear of needles is so bad. And so by doing non needle acupuncture, you now open your door to other people.
I often hear from our colleagues, that are doing the needle, that all, how can laser acupuncture work or is there a research that it works? You and I both have access to the needle and the laser, and we love using both. And we. The laser. So that’s why I like hearing from you because you’re not biased because you have both, you’re trained in both and you can use both and you are choosing use both, but can you share, is there research, what’s your, what are you aware of about the research on laser acupuncture, having an effect on the body similar, or if there’s any difference from needle accurate?
When I thank you again, Lauren, you’re such a good summarize a thank you. And my, when I first heard about laser acupuncture with my from my mentor, Dr. Margaret Naser in Boston, and that she published first study on the. With the laser acupuncture, you can look it up. And and she was so excited when that first heard about her and got to know her, and then she got so excited.
And then call me up since this is the first time in may journal American medical association journal that actually published a study that contained word. Acupuncture and laser acupuncture. So that was the first thing. That first time I was just blown away with what laser and laser acupuncture can do for something like a carpal tunnel, as you can see, involve a median nerve.
So what happens in front of this? I began researching more and more. There’s a study that I run into a study. They use a regular laser acupuncture, shine, the laser lights on the acupuncture point in the year to help quit smoking. And I love to see more studies and I would love to do someday in the future that I can do on the quit smoking.
I do acupuncture, quit smoking myself. But when I come to like a pain, like a lower back pain and a soft tissue injury pain, and I really have to combine acupuncture in the. And the laser member lasers there to help lower the inflammation. We don’t stop inflammation. Inflammation is a part of a healing.
That’s how acupuncture help. Okay. So when we put needles into the tissues, guess what we produce some low level inflammation, and that’s why we need. But lasers is there to help speed up that, that mechanism Becca kickstarted by the acupuncture. But when patients really have a problem with needles, for instance, you can use laser acupuncture in place of the knee points.
So you can use a red lasers on the distal points like. All these points on the fingers and the palms and the risks. And then you can use an infrared lasers on the body, like a stomach 36 and spleen six. And so on screen 10. And deeper because you want to target the third nerves underneath that acupuncture point.
So this is why we can combine laser and acupuncture or laser acupuncture by itself. So this all can come to. In the therapy
and not all lasers are created equal. And so the wavelength matters. So the color of the light’s going to matter about how it’s going to affect the cell, the tissue, and how deep it’s going to go.
The power of the laser is going to affect. The dosage of photons at the target tissue. So that’s important because how much time you need to keep the laser on the body. And so some of the lasers are, can be a large investment for acupuncturists. And this is why I love talking to you because I know Steve that you’ve built lasers because you remember everybody Steve’s a doctor or Chinese medicine, and he’s also a electrical and laser engineers.
He can look at a system. He actually helps some of the manufacturers improve on their systems. Cause he’s got that skillset. I wanted to ask you a little bit that first of all, not all lasers are created equal. So some lasers, although there are a couple hundred dollars, they’re no different than using a PowerPoint light.
You’re not going to get any therapeutic value really on it. So still. You have to invest. It seems to get a good laser. Personally, I want to share this story and then just talk about how you have found that, how this is helped your practice grow by having the lasers. And th the story I want to share with you is my first laser I invested in.
Was about $6,500. And I used it for onsite for IVF clinics, laser acupuncture because the clinic had shown that it increased implantation rates by 15%. So that was a big investment and that’s what I use it for, but I wanted to get the results, help my patients. And it made our patients more attractive to our clinic as well, because we were offering this and then I wanted to help with egg quality, and that required a different laser system and help with endometriosis and polycystic ovarian syndrome and and engaging the relaxation.
There’s lots of things we can do with the. And so that system costs me $20,000. Now I got to share something with you that I was not expecting, but I understand why it ha it helped. Because when you create value, the marketplace, your patients will seek you out. They will. They will see you over other people.
They’ll actually people get on planes, pre COVID to are to go to our clinic, to be treated with our laser for fertility and PCRs. They’ll drive an hour in my city to come to our clinic, even though there’s many acupuncturists in their area, because they want somebody, a clinic that has the experience, the knowledge and the good quality lasers to get them results.
So here’s the quick story. And then I’m curious to hear what your experience has been I have when I introduce the laser for fertility in our clinic, several of the patients that I was treating, and let’s just say they were being charged $95 back then for acupuncture only. And I would recommend twice a week and many of them would say they couldn’t afford twice a week.
So they’d come once a week. Or some of them said I can’t afford. And they did not have. When I introduced the laser, we increased the price of having acupuncture with the laser. And so we increased the price to say one for $140. So actually it was 130 back then. So 95 for acupuncture only, or 1 35 for both.
And what we know, and it was three times a week because we were following a group that had done, had seen an improvement pregnancy rates when they did the laser fertility approach three times. In the follicular phase. And so we replicated that and that’s what we educated our patients, these patients that said they could not afford $95 once a.
Or even twice a week, it started coming in three times a week. So what I learned from that is it wasn’t that they couldn’t afford it was that they didn’t see the value in what I was doing in acupuncture, how I educated them to spend $95 a week or $95 twice a week. They just didn’t see the value there.
But when I shared how laser fertility has the potential to improve egg, quality and pregnancy rates, whether you’re trying to concede that. Or an IVF and share some of the research. They then were willing to pay 1 33 times. To get the results. So it was never always about the affordability. It was. Is there enough value to pay that much money?
So I wasn’t expecting that, but that’s what the laser has done in my practice. It has made me, it has separated me from other clinics that are just doing acupuncture because many of the patients are learning about this, get an educated, and they actually want the photo by modeling. With their acupuncture.
What was your experience? Have you found that by what you’re doing and you have a fast program, which you can introduce as well because you’re getting the results in using laser. Has that also a major practice, even that much more busier before you compare to before you added the laser?
Yes. I always say results resolved.
And as an acupuncturist and. Pretty much all the time is the last resort, a practitioner that patients see and see you, you want to produce results. And to me, laser is the is probably the only way that when it’s combined with acupuncture really get the result. And because you heal, you.
And I know sometimes it’s hard to say the word cure, but then it’s how it works. And so yes, this is a value added because you can do, you can charge you $150 for acupuncture, but if you does not if you do not produce the results, it’s still worthless. But if you add it in this so in my practice, I combined a laser and acupuncture was when fee I don’t have an additional fee for laser.
I consider as a value added so that when I produce results, They are, they’re going to see effect within a few treatments and guess what? And then when they were completely here, And they are going to refer all their friends and relatives and neighbors. And then the thought is, begin to hear about you name and they began to refer their clients to you.
So guess what? You can love busier practice. That’s how I see it. And that’s why it’s a laser is a result driven. And and I absolutely agree with you that Lauren is. I don’t think it’s really the money. It’s a, it’s the result when the patients see the result and they say they will pay for it.
Yeah. Definitely want to get, they want to get the results and adding the laser helps give you that result. And they also is the education like, so when the understand for whatever reason I just, it’s an observation. They understand photobiomodulation, it’s more modern, it’s more sciency. And when you can see the mechanisms, they understand that and they’re willing to give it a go or give it a try where acupuncture is old and they’re questioning it.
I’m not saying it doesn’t work. I use both. So it does work. And I have found that it’s. It’s something that has been attracted to patients. And I always say in my book, and when we talk at the beginning, we want to help them with integrity. So when you charge, because again, when you’re making investments in $20,000 lasers and you only have so many there’s value there.
So if you choose to charge more. You’re doing it with integrity because Ava invested in more equipment, but your patients don’t care about that. They don’t care about your debt or how much it costs you. They care about what kind of value they’re going to get when they pay you. And so I’ve made that investment and then patients are willing to endure.
In me because I have the tools to help them get the results. I know in your practice, you have a program called fast for chronic pain, and you go off and we’ll help people under 10 treatments get incredible relief, chronic pain, and so that makes you busy, but that fat program requires laser and it does.
Correct?
Absolutely. It’s the key F a S T I came up with this idea is how to heal and again, a lot of the time you can cure these a chronic soft tissue problem, like tennis elbow, conference elbows, and people come in and say, I bought these for three months. I have these for three years.
Why? Because all the cortisones, no, the anti-inflammatories and all this, they literally stopped the healing. But the needle is there to help kickstart a healing. But how do you get this healing going in the better rate, quicker rate that could useful rate? When Joel, like when you were in 20 years old laser lasers there to help speed it up.
And so laser is really the key and to help. And so I can literally tell my patients that with intent treatments, you will be. Done. And then the pain’s all gone, all completed relief. So this is why, and I’m I’m very proud of this this program FST and you can look it up and I intend to bring it up in my conference with Aslan, which is American society for.
Lola laser acupuncture therapy asset work. And we’ve intend to have a conference in this later this year and that bring this fancy program certification program out. And I’m working on that pretty much every day, try to figure out how to get this program together and in module of structure and Lauren and I are trying to figure out how to put this one together.
Yeah, looking forward to that. And so that’s, website’s important. So if you’re looking for more information about laser acupuncture and photobiomodulation, that’s the term that’s replacing low-level laser therapy is photobiomodulation and laser acupuncture, check out the athlet website. Cause you’ll see more information available there.
And this is something. Again, I’m going to put the practice management twist on it is when something is a value and people want it. Then other people start to offer it just like acupuncture. It’s not just train acupuncturist that offer the acupuncture nurses. Do it, doctors do it, physios, do it.
Chiropractors do it. I know in our profession. Acupuncture’s don’t like it, then other people are doing acupuncture, but when something is effective, other people get it into their scope with photobiomodulation laser acupuncture, massage therapy are doing it. Chiropractors are doing our physios. They’re doing it.
So it’s out there. It’s really big in Europe, but more so in Australia, less so in north America and in Canada, in the us. But it’s great. It’s gaining a momentum so quickly right now. And so this is. Learn about this because. It’s going to be something that if your colleague has it or the physio has it, and if the physio can do acupuncture and laser, and you only do acupuncture as a public member, you’re going to go to somebody that can do both.
Steve said, one fee for both. Somebody’s going to go see him versus somebody on the same street that can only do acupuncture. So this is my invitation that. If you don’t give this some attention, there’s a possibility that you’re going to miss out and other modalities, other professions are going to have incorporated this.
So I think it’s important that acupuncturists incorporate, especially the laser acupuncture part. And as Steve said, at the beginning, it is a credible marriage. Practitioners that I talked to that are using photobiomodulation with their acupuncture. Never turned back. They love it. And again, I, my whole focus is on gynecology, fertility using the laser acupuncture with my needles.
Steve, I want to thank you again for joining me today. Can you tell us a little bit about asthma? That’s what we’ll finish off here. But just tell us a little bit. The asthma organization that you’ve created and just what’s available for acupuncturist on that website. Yes.
Thank you. Lauren athlet against Stanford American society for laser acupuncture therapy.
I came up with this idea back in 2006 and I reserved the domain name as lab. Beautiful. And it’s nice and short, and I need to have this name reserved obviously long time ago, but I haven’t had a really chance to really get him going until last year. And then this is really the year 2022.
We’re going to learn. I help bring this to the community. This is a, you can look it up and there’s a mission statement. I really want to use this as a community for Acupac. We are the acupuncture. We cannot own laser acupuncture, not any other like chiropractors was physio in massage therapists.
We are going to have it. And in order to, for us to integrate this tool into our practice, you guys need to, of course be educated. And I love to be the educator and also teach you how to sell. Lasers devices and what is technology and what is led and what’s the different between laser and the LEDs and what are all these companies they’re making all these devices, then what’s the protocol for all of these providers and so on.
So this is a community I like to have, and that’s always all for us, the acupuncturist. And then, so we can. Successfully integrate that into our practice and make like a Lauren. I know Lori is a very passionate to make us a good businessman as well. And it’s important. It’s Ian in not only need to have a good skills, but we gotta be a good businessman.
You notice this. Thank you gotta
have. You gotta have those business skills. So it’s not so many people give it a negative connotation. And we’re talking about, you just got to know how to run a practice. You got to know how to charge for things so you can keep your doors open so you can keep treating your community.
It’s just really simple. It’s matte and you can do it with integrity. And so that’s where we talk about the laser therapy today and laser acupuncture. So as lab we’ll have a conference or as a conference, it was information. Unhealthy seminars.com. We have continuing education courses available for laser therapy.
On our community library, we have many interviews with experts and researchers on laser acupuncture, Dr. Steve Liu being one and is going to be offered many more. So do check out healthy seminars.com for the photobiomodulation laser acupuncture courses. All right. You’ve been listening to. To the point with AAC and tune in next week when Sam Collins comes in and joins us on the AAC to report to the point show.
I want to thank you, Dr. Steve Leo, and I want to thank you guys for tuning in today.
We’re going to talk in the next 30 minutes about treating children with anxiety and it’s definitely a growing issue that I see more and more in my office especially lately and since the pandemic.
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, my name is Moshe Heller and I’ve been practicing and teaching Chinese medicine for the past. 28 years. And I wanted to first think the American Acupuncture Council for organizing the show and giving me an opportunity to speak about this really important subject matter treating children with anxiety.
If you can start the slide. We’re going to talk in the next 30 minutes about treating children with anxiety and it’s definitely a growing issue that I see more and more in my office especially lately and since the pandemic. And I think the pandemic definitely has a strong influence on children’s.
Tendency to be anxious. And and we can see this very clearly in even in the CDC report from March through October, the PR the proportion of mental health related emergency department visits increased 24% in children aged five to 11, and 31% among teenagers age 12 to 17 compared to 2019.
So there’s a huge increase. And but I wanted to present how we can really help with with Chinese medicine, with our medicine. Very Much. So I wanted to I’m going to start by just going over a case study that will present some of the common issues that I see in my office. So I want to talk about Sally, which is not a, it’s a not her real name is a 17 year old female that.
Came to see me in the office. And she was brought in by her. She gave me with her mother. And then as you walked in the room, I noticed that her, she had a really pale complexion and. With that her eyes were very bright. Although she didn’t, we didn’t, she didn’t have a direct gaze.
At the beginning there was a lot of shyness. Her body was very thin, but looked very tense and her main complaints were having anxiety. Digestive disorders like indigestion. She felt a lot of gas and bloating and very uncomfortable with her in her digestive system. As he said, she came with her mother and she was at first very shy.
And her mother would actually answer her questions, but after a while she opened up and we even I asked the mother to wait outside. So we had some time together to talk about her issues. So she reported that the anxiety really started a little over a year ago and that was about a year into the pandemic and she thought it was related to the changes due to the pandemic.
The pandemic created a lot of change in children’s lifestyle. The way that they had to learn and that caused of course, a lot of stress and therefore anxiety. In the past three months though, her symptoms became much more severe. And they included things like. Difficulty falling asleep, palpitations nightmares difficulty focusing on schoolwork and being easily distracted racing thoughts and then loss of appetite.
And then also a tingling and loss of sensation in the fingers, fingertips and toes which is a very typical of some of the panic disorder. And and also had some diarrhea like on and off diarrhea and a pasty feeling in their mouth and nausea, frequent nausea. So that’s, these are all the symptoms.
She reported. So she also experienced on the background, some seasonal allergies. So she had that tendency to have some damn port phlegm frequent headaches. Mostly occipital and frontal and tension in the neck and shoulders was very, as a co, she experienced that frequently. She also complained of having a weak digestive system even before meaning.
She would be very gassy and experiencing soft stools and diarrhea frequently. She craved sugar and was taking an iron supplement because of low iron count in. Her misses were regular. They came every 28 to 30 days. But there was a lot of heavy bleeding and it lasted four to five days and had some low back pain prior to the arrival of the bleeding and her pulse was really thin and tight.
And the tongue very swollen and puffy, and there were teeth marks and a thick white coat on the all over the tongue. But the tip was a very rare. So I diagnosed her with having a spleen and heart by acuity which is a common pattern that I see in in, in adolescents. And the blood acuity and liver G w also having some blood vacuity and liver cheek constraint with a slight damp accumulation or pretend to have some Dem.
So I chose to include points like heart seven rent, 17 rent, 12 rent, six stomach, 25, stomach 36 and spleen six. So I would choose anywhere between four, four to six points. And you do that by laterally and would see her once a week. So we talked about changing her diet, eliminating Dan producing foods, meaning that reducing her dairy cheese intake and simple carbs white flour products and and.
And adding, eating more foods that strengthened spleen, QI and blood things like beets and yams and butternut squash to include it in her guide. So that there’ll be some nourishment as well as maintaining a warm dive, meeting, eating more soups and And cooked foods rather than raw food.
So we could see here that there’s a, that I arranged all the symptomology and how each with each of the which each of the patterns the loss of appetite and the gas Ines and the sugar cravings and weak digestion and tendency for soft stools, all indicated a spleen. Vacuity the.
Back by acuity was manifested with the palpitations, the nightmares, the difficulty focusing on schoolwork and being easily distracted. And the blood vacuity with difficulty falling asleep which is something I differentiate, Difficulty falling asleep as more of a blood vacuity, as opposed to falling asleep easily and waking up at in the middle of the night, which is a more of a yin vacuity.
Then the heavy menses may also contribute to the blood vacuity. So we are seeing these heavy menses. It may also indicate. The Liberty constraint and we see with the the frequent headaches she will also the tense look, the tense neck and shoulder, and this kind of tendency to be easily stressed.
And this combination of having Liberty stagnation with blood vacuity which points towards the liver blood vacuity would explain this kind of tendency to have loss and tingling sensation in the toes. And. And the seasonal allergies, of course may lead may point to a bit of a lung deficiency, as well as maybe some tendency to have dampness, as we say.
And also the tendency to have nausea and this kind of pasty feeling in the mouth all point towards dampness. I think I skipped the. Okay. So I actually prescribed a F herbal formula and I prescribed a formula called calm plus, this is a formula that I’ve I created in my herbal company called motion herbs.
And then I have a link down at the end of the slideshow to our website motion or. Dot com. And this complex is a combination of herbs that move liver cheese com the heart and and strengthen the blood and yen and therefore, I used that I like to use this formula for anxiety and it’s really fit very well into this picture.
And after 10 days of this formula she reported feeling much calmer. She did not have any anxiety episodes in the last few days and she felt much better and sleep pattern was also. Much better. And she was able to do schoolwork with less effort. So she showed marked in poor improvement with taking this formula.
After three months of this formula, most of her symptoms were resolved and including her digestive issues, and we decided to stop taking the formula. So after three months of this formula, she reported that the. Our symptoms has, we’re almost, we’re completely resolved. So I wanted to to go over I’m actually just going to skim quickly about the definition of anxiety in biomedicine, in the sense that we want.
Understand how, when people say that they ha they’re anxious, what does that mean? Usually anxiety falls under what we call generalized anxiety disorder. And we can you can read this hopefully this th. PowerPoint would be available for you to go back. And there are under this the anxiety section, we also see panic disorders as part of that, as well as things that are associated with D with with anxiety is phobias and specific D different specific phobias included in.
And also social anxiety disorders and separation anxiety disorders, and post-traumatic stress disorder is a very common diagnosis nowadays. And very important that we understand that when somebody complains of having anxiety, it could be related to post-traumatic PTA.
In terms of Chinese medicine. On the other hand, it’s interesting that anxiety is not really a classical category that is used in classical Chinese medicine, but it’s more modern term. And since we see palpitations. As being one of the very common symptoms with anxiety, it is a lot of times included in it.
So fear and palpitation Gingy or panics robbing that’s Chang Chong or junk chow, which is agitation. It’s this kind of feeling of being overwhelmed.
I’m sorry. I think. Okay. But in children, that is really a we have to remember a few things that are very important. I think when we’re treating children with anxiety, because children have unique characteristics that make them more prone to having anxiety. First of all there’s this famous saying that says that all children disease are caused by fear, fright and indigestion, and that starts from an early age.
Most of the pathologies that we see in children stem from having some kind of a fright or fear or being anxious, and then also in combination with
These are the two important aspects. So we also have to remember that it is the characteristics of children to be excess in wood and fire and deficient in earth, metal, and water. So that means that this kind of excess in wood and fire will create a higher. Tendency to be very anxious and very stressed or they would pick up stress more easily.
Whereas the metal where’s the earth being deficient is causing a spleen vacuity which was. Although we think a lot of times as as a spleen vacuum being not necessarily associating with anxiety in reality, I see that a lot of times this kind of earth vacuity is the cause for anxiety because of its relationship with the heart in particular.
It also is important to see that in each developmental stage is each age. We see different pathologies common pathologies. And I wanted to put point out that this. From seven to puberty is the age where we are becoming more aware of our emotions and being challenged, especially by society too.
Control those emotions and in that period of time that is very very time where we need to pay attention because children can easily develop anxiousness around different issues. Because of that. Necessity to be in, in control or have this transformation where suddenly they have to be in control of their emotions.
So a very, as we say, a very livery time, and that is it at that period of time. So we have to remember the children are susceptible to emotional stress, and I’m talking about little kids two years old, a year old, a few months old, four or less, or even later, even the stress doesn’t necessarily need to come from.
Themselves, but rather from the environments of the pickup stress and what’s happening from their mother or from their caregiver or from their family or their surrounding. And I always believe that children are this, like this emotional antenna. So they pick up whatever is in the environment and it affects their their own.
So in that case I always remember that when children come in with anxiety, I always check in with the caregiver in, from this idea of treating the child, treating the mother to treat the child. So especially with anxiety, that is very important to, to consider.
I in the R coursing gene chin pediatrics we tend to we also teach this whole idea that there is this kind of spiral of development, and we revisit different issues at each period of time. And I, we really believe that this developmental Mandela will tell you how to approach children at different ages, according to where they are in this cycle of growth.
And so we see here that each cycle of growth is related to to an element and that and since it is controlled by a certain element, it has the same kind of nature that we would expect from that element in in, in, in that period of time. So attention. Alienation and anxiety are a modern pandemic.
We see that very quick, very commonly. And we see that because I think we are giving children too little, too late of these things and things like too little connection, too little exercise, too little darkness, too little quiet. To the BOR being bored. So children don’t know or don’t want to be bored.
And I think that’s actually an important aspect of growth growing up, but we also give them too much, too fast too much food additives and an energy rich, nutrient poor diet too much pollution too much artificial light and screen time. All these things create an excess of young, whereas not enough of a balance.
And so it and so the so that it creates this kind of. Imbalance of having too much of the fire and the T then scatters and therefore eventually will cause or is it gives a tendency to form a anxious. So there are, I wanted to also point out that there are two there are a few common patterns of illness that I see very frequently that you can pick it, pick up and they, a lot of times.
We’ll be we’ll cause development in, or be part of it. It will be that the child will be anxious. So the first one has to do with it, what we call an accumulation disorder and we see that frequently in younger children. Although, I think we can see a lot of times the remanence of that later on in age, but it’s one of the advantages of treating children, treating pediatrics is that you can catch these things very early on and really prevent.
Years of suffering later on emotional suffering or physical suffering. If you catch that on, when a child is young and that they have a lot of red cheek and a lot of irritability and insomnia, but also have this kind of indigestion or difficulty digesting foods and you might suspect an accumulation disorder in, and by the way, accumulation disorder is something, a term that was coined by Julian, Scott which he has great ideas and I found it to be very true ineffective, but we go very deeply into assessing and diagnosing accumulation disorders in children.
In our course at pediatrics. And that this accumulation disorder also points to this kind of very important triangle or three aspects that we that are connected and interrelated. And that is the new Europe, neuro gastro immune triad. Or a trial. So there’s a relationship between our nervous system through the Vegas nerve that affects our gastrointestinal.
Function. And that affects our immune function. And there is feedback in both directions that that we need to understand that it’s all connected. So when we have an issue with our nervous system, like having anxiety, we definitely need to be in tune with what’s going with the gastro immune function.
Accumulation disorder disorders are a gastric dis disturbance that we need to look at. And we’ll talk about the immune aspect in a second. So I just put in some main points that we use for treatment seafaring is the main points when the child is young up to probably two years of age later on, we might use more body.
For a treating that, that accumulation. Hyperactive spleen sheet deficiency is another diagnosis that we commonly see. This is a child that has all the signs of spleen vacuity, but behaviorly is really having a lot intends to be very anxious, has a lot of sleep disturbances little. Asleep difficulty falling asleep enjoying being the center of attention and w and wants to be very manipulative all these symptoms and usually the child looks very thin and and weak, but the energy is bursting.
So hyperactive splintery deficiency. Another pattern that we commonly diagnosed. And or see frequently especially associated with anxiety later on in life. The interesting thing is that when we have when we have hyperactive spleen Xi deficiency, our treatment is based on strengthening the spleen and not necessarily calming all that excess.
It will come from this. The seemingly a false excess comes from a deficiency and we need to strengthen rather than disperse. There’s another pattern that we usually see, which is called hyperactive kidney cheat deficiency. This this also will have a lot of spleen Xi deficiency, signs and symptoms, but they’ll have very specific other symptoms like dark pools around the eyes.
The page would be a very thin but long a face would be really pale, bright. Wow. And be very fearful and anxious in this case, the fear is very strong and having a lot of anxiety about different things. Being very hypersensitive and also has a lot of issues around sleep and takes very long to go get into bed.
These are very difficult children to treat because they are so afraid from any thing that is done to them, that they can become very hysterical. In any case? The important thing is that the treatment is again mostly use points that strengthen both kidney and spleen and not necessarily any dispersing treatment.
And the last one, which is the other arm of the tr triple the triangle which is the immune part is the lingering pathogenic factor. And I think this is a very important thing to remember because when we look at pathogenic factors that enter into the body, Child as young as they become, they can become lingering.
And there’s a lot of signs and symptoms that will, you will help you diagnose them. And once they are lingering, they can affect our emotional gr the level of the, our nervous system. And therefore, Can cause anxiety later on or tendency to be very anxious. We’re running out of time.
So I’m going to run through the rest of the slides the treatment for the lingering pathogenic factor as we have this really. Amazing. Treatment protocol, which is bylaw. You be 13, 18 and 20. And I use a combination of shout child tongue or some kind of variation of shout child, your tongue to treat that lingering pathogenic factor aspect of the patient.
So in pediatrics I just wanted to point out we have different treatment modalities. We’ll out, tend to use a lot of TuiNa shown Ishan technique is an amazing technique, which we teach again at the Jim Shang pediatrics course. I think that it’s an amazing technique that we can apply to children and get very good results without inserting needles.
And that the gates, the fear factor, especially for anxious kids. And I also use another. Technique, which is cutaneous electricity stimulation, meaning using electrical stimulation to stimulate certain points as opposed to using needles, all that is taught in our course. We also connect we use magnets and we use, we teach how to use them for Paid for pediatric patients.
And they’re an amazing tool that you can actually send patients with it and shows the show them how to massage it and and participate in the treatment. And it creates great results. So I’ve concluded some of the points that I use for anxiety, as well as common patterns in terms of using both both points and herbs.
And I’m actually running out of time. So I will end with this With thank you for being here and listening. And if you want to hear more, there’s many avenues to to hear more and learn more about treating children and and with anxiety or treating children in general through either My herbal company, which is called motion herbs which I have sometimes free webinars on, on, through that venue, I’m going to be treating teaching a course through global branches, which is called the first cycle of life and focusing on the first years, 7, 7, 8 years of children.
So you can Look at the global branches, look it up online and you can register on that their page. And through our Jing Shen pediatrics sent course, which will be distributed through net of knowledge and loss, OMS which, and you can pick it up. So I want to thank the ACA again for this wonderful opportunity to speak.
It’s been a pleasure and I want to remind you that next Wednesday log on here, Sam Collins. Thank you very much.
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 and welcome. My name is Tsao-Lin Moy, and I’m the founder of Integrative Healing Arts in Union square in New York city. And I would like to thank the American Acupuncture Council for putting these lives on for your entertainment and also for educating you about acupuncture and Chinese medicine.
Please and comment for today we’re going to be talking about adrenal exhaustion and burnout and the amygdala hijacking, which has a slightly different and okay. So let’s go to the slides.
Okay. There we go. All right. So today we’re going to be talking about adrenal exhaustion, burnout, and the amygdala hijacking and what strategies that we can be using with acupuncture and Chinese medicine. So here we go.
All right. So what we’ve got here is what adrenal exhaustion. And in Chinese medicine, we call that the kidney yin and yang deficiency, where the beginning young is out of balance. And what we see is elevated cortisol. We’ve got low melatonin, a lot more physical conditions, such as fatigue irritability problems with sleeping.
So we start to see the day and night shifting. It’s very common that your patients may be on some kind of prescription medication. There is a lot of tiredness and Schedule is irregular, right? So they may be taking anti-anxiety medication sleep aids, antidepressants. All right. So this we see is very common.
Most of our patients that come in have something going on with their kidney energy and given the situation that we’re in right now with the news and everything happening around the world that for sure. This is going to be coming into your practice. And we’ll go to the next slide and look at what are going to be strategies for this level.
And we’re looking at so strategy here is really regulating the yin and the Yom the nervous system, because this is where we’re starting to see that it’s out of balance. A big component is going to be sleep right for regulating the circadian rhythm. We can address it with diet, right? Making sure that our patients are drinking enough water staying away from alcohol getting some exercise.
Very important is going to be detoxing from social media because that actually gets people really upset. And to clear those cookies as I call them that type that tend to follow another what we’re looking at for your patients is acupuncture for sure, because we know that it’s. The brain chemistry and the neuropeptides that actually allow the body to go into that deep, relaxed state herbal medicine.
Some of it, yes. Definitely supplements. If you. The basic we call the formulas such as the shadow side, the free and easy wander or something like way P tongue, where there’s going to be a lot more worry. So this is going to be, for someone who is relatively healthy that they’re just going, that they’re out of balance, right?
So we’re like, Like the exhaustion, it’s a little bit different from the Western, what we call exhaustion, where they may be given anti some kind of steroids. But here we have an opportunity for the person to shift back into balance and go into some more state of relative balance. We call it and as a practitioner, We also do social support therapy.
We talk with our patients about how to balance their life really important. A lot of times when people are very stressed out, it’s very difficult for them to do something like meditation. And what I have found in my practice is really offering them breath work. And that could be the 4, 7, 8 breath work.
There is also Wim Hoff, which is has been. Become very popular. There are lots of videos of how to do it, and if somebody is feeling stressed out, all they need to do is to shift their breathing. The other thing too is to really look at taking time in nature. And at this moment when you’re working with your patients that are in this particular kind of imbalance, they actually are pretty open to listening to suggestions.
The time in order to stabilize, I would give it three to five months really consistently coming in for treatment and then also to create and cultivate different habits where they can manage their stress and become aware of it and actually be much more proactive in it. So the next slide.
Now burnout is what we look at is a whole other level of kidney depletion, right? Compared to adrenal exhaustion, which is a little bit more of the physical is such, we’re looking at more of the emotional, and here we’re seeing that this is this more inward and racing thoughts, but also the trouble of blue sleeping.
So I’ve underlined sleeping because that is a huge problem. And this is going to be really a key for addressing something with your patients, like where can you start? So when someone comes in with so many symptoms, it’s very important to keep your treatments. Another thing that we see with burnout is that there’s more depression going inward.
Even self-medicating the people may be on a lot of medication. The essence is being drained. And then we also see with the physical manifestations, we start to see things like chronic fatigue, fibromyalgia auto-immune really like depletion, and really. Feeling defeated. And so here is we’ll go to the next slide, like how we’re gonna let’s change to this next.
Okay. So as I mentioned, oh, we want to go back one, let’s go back one. We can very similar to adrenal exhaustion. The idea is you want to. Rescue them in a way, strengthen the mind body connection and their ability to really connect with their body. So this is a place where, we would use acupuncture and for all of you that are live.
I would be very interested to find out like, what acupuncture points would you choose? Because right now this person is really so depleted. What kind of points would you use? And the thing with the more exhausted that a patient is, and this can also happen from a recovery, from an illness that, you know, they.
You might want to do a lot for them, but in fact, the less is more. And the areas to really focus on are going to be the really deep and restorative sleep, because that is where their nervous system is going to be able to do a reset. If they can do a practice like meditation or yoga just to get their chair moving and to build up their energy formulas would be for someone.
Adrenal exhaustion. You want to support the kidneys and also the stomach and spleen, a very classic, maybe the blue Jong ichi Tong, really to help them to nourish. And again my recommendation is. To for them to add in something like breath, work and breath work is we can see it. If you’re exercising that you actually do get really good oxygen saturation, which will help with deeper sleep.
But for someone who’s really exhausted, you really don’t want them to. To, I wanna say encourage them to go back to a, in a adrenal field way of living where they’re running marathons all the time, or getting up and trying to do too much. And in fact, the more serious let’s say or the condition, what we’re looking at with the adrenals, you really want to offer them something very simple because they can’t really take any, anything more.
Okay, so we’ll go to the next slide. My little clicker is not working here. So here is an example of breathwork. So breathing, we’re doing more than just regulating the nervous system. You’re also reducing the cortisol levels. And this is really important when we’ve got something going on with our adrenals and our kidney energy.
And again, when we breathe in, we’re actually looking at that lung and kidney relation. And here studies have shown that this higher level of oxygen actually encourages deeper and restorative sleep, which is known as a slow wave sleep. And why is that important? Because people with extreme adrenal exhaustion and burnout have, will tend to maybe sleep a lot, but not get the restoration there.
So all right, we’ll go to the next.
So here is a don’t know what happened to the top of it, but here’s, I wanted to show a picture of what somebody looks like when they’re really terrified. And this is actually a kid who is on a rollercoaster. And what is happening is the wa eyes are wide open. The heart rate is increasing.
They start to breathe, very shallowly, dry mouth sweating. And then what we look at is the tightening of the extensors. And this is really the do check. So in all that stress you see with animals when they get stressed out that the back of their neck tenses up. And so we see a lot of our patients come in with neck and shoulder, tight neck and shoulder TMJ.
And that is, innervated by the cranial nerves. So we’re looking at this connection with stress levels and then how it manifests in the body. So we’ll go to the next slide. So what are we looking at? We’re looking at the kidney and heart being out of balance. We’re also looking at the liver and spleen out of balance. And so this is this water, fire relationship. The water really would, your kidney energy really helps with your heart energy, that connection. And when you’re, it’s out of balance, we’re looking at too much fire, right?
Not enough of the balance of water for two cool things. We’re also looking at the wood and earth relationship out of harmony. So what happens is we end up with things like emotional turmoil the worry of the spleen, the fear of the kidney actually cause the heart and the psyche to like escape.
And then we have the. The liver, which is the wood and responsible for the smooth flow starts to control. Everything goes out of balance. And we realized like, Hey, what’s happening? The liver energy is trying to control everything. And so what we see is a lot more of that literary and. And at this point, I invite a lot of comments.
What do you think, what kind of points might you use when you see this? What’s, what is when you start to see this happening and I’m sure it is in your practice what point prescriptions might you use? So I’m very interested for your opinion, please come right. Or we’ll go to the next slide.
All right. So here the five elements chart, or we see the liver’s role is the smooth flow of cheap emotions and blood and interesting studies recently show that the liver does have a regulatory function with the central nervous system. And there are fibers, both sympathetic and parasympathetic fibers.
That are linking to from the liver, going to the brain. Very interesting that right now we’re looking at, Hey, the liver does have access to, the brain chemistry. One of the things in Chinese medicine, as we know that the liver stores the blood while we’re at rest. And what that actually means is it actually helps to filter it.
And then when needed the blood the clean blood actually goes out to the. When that’s not happening, such as when stress hormones are increased they actually increase enzymes in the liver and cause inflammation and toxicity. And so we see this with women that are, pre-menstrual a lot of that those emote, the strong emotions come from inflammation of the cytokines, which is like right before the bleed aspect of the cycle.
We’ll go to the new.
So what happens when we’re under prolonged stress and I’m putting in fear what happens is that the brain starts to remodel and we get a lot more systemic change. And this is as we’re going to be moving into, what is the definition of an amygdala hijacking or a takeover? The amygdala is a almond shaped a part of your Olympic system or your reptilian brain.
It’s about emotional survival. It filters all of your senses. And the more that it’s triggered, it actually grows larger. And then what we see is an underactive hippocampus, which has to do with a lot of memory starts to shrink. And so what this does is that it. Causes the individual to not be able to regulate themselves, it interferes with self-regulation and we see things like a systemic decline. So some of the symptoms are also the memory problems, a lot of distortions of paranoia, things like conspiracy, more angry and manic behavior. And this is, these are. Behaviors. We also see with patients that have early onset with dementia and something like Parkinson’s right.
And also we look at there’s an increase in this amygdala activity in patients that have bipolar, especially during their manic episodes. So we’re looking at here’s this connection, the more exciting. A person gets and more this fear, the swinging, the extremes that we’re looking at, the amygdala is involved in it and causes can cause a lot of turmoil.
So we’ll go to the next.
So the amygdala is this almond shaped structure in the brain, and it’s involved with processing the emotions. So going back to where the five elements are. When the amygdala is triggered and hijacks the person we call the, or the brain that those emotions are distorted. And so there are the two structures that are, there are part of each one of the brain, and they’re located near the base. And what we see is when the. Amygdala hijack brain parts, brain, no longer function. It actually just shuts it down, but without the ability or the use, and this is in the frontal lobe, which is like decision-making a person is unable to think clearly and they have confusion.
And they’re not in control of their responses and we actually need, we see a lot of it. We see a lot of it that’s been happening in the news where people are having outbursts and screaming, and everyone says this person was like a really nice person. I don’t understand. But what happens is they got triggered.
We’ll go to the next.
So the amygdala engagement, the more that it’s engaged, the more difficult it is for someone to think clearly. And self-regulate so when you get the amygdala hijacks, a control of a person’s ability to respond Nat rationally. It’s tapping into fear oriented perceptions and views, most things as a threat.
So this is where we’re looking at. It’s a real serious Shen disturbance because the liver is out of control, right? So the more things are out of control seem out of control. The more that the liver energy starts flaring up and Causes the the mind or the shin of the heart to leave in the, and that’s like a disturbance.
The response usually tends to be aggressive and can be very violent. So we look at episodes where someone may have anger management issues or sudden outbursts and blow ups. So what’s the next.
So here is a picture of someone who is like the earlier picture that I had there, where there was a little boy who was actually showing fear where you could actually, that was that momentary fear where what happens is the eyes are opening up and the heart is racing and here is actually a picture of somebody.
Who is actually in this state where they’re acting extremely irrational. So when some parts of the brain are revved up, others are shutting down and this, like the fear can actually cause the areas of the brain to the. Have judgment to just not be there. And so it’s very difficult for the make a good decision.
So here is actually a picture of what has been known to be as a Karen. She is this woman who just lost it and then it is actually terrifying some people in their own car. And I’m sure she’s a very nice lady. However, she went off and this is when you actually see this irrational behavior.
So we’ll go to the next excellent.
So how can we rescue this? I checked the medulla. Technically when the amygdala is engaged, it takes about six seconds or like the chemicals to recede. So this is, so that we don’t live in this state for a long period of time, whatever the problem is, if it’s triggered over and over, we start to see that it grows up there.
And then what happens? We get this perpetual behavior that continues to be reinforced. So if you have a patient that’s coming in, because they’re, they, they’re having a lot of problems that what’s important is to help them become aware of what’s happening in their body so they can take steps to prevent it.
And really important is going to be. Addressing the liver. And even though this is what we considered a Shen disturbance we may want to give all kinds of calming Formulas, but the problem is that the liver is gone wild. And until that can actually be stabilized, that we start with the end of just treating some of the symptoms.
So it has to be at least two or three pronged where Getting rid of the inflammation that is literally in the liver and we’re coming up upon spring. So this is a really, we may start to see more of this energy coming up because of the season. And what you can do is have your patients start drinking things like nettle tea, dandelion, and burdock, really to help clear that out.
The other is to do some breathing and breath. So this is going to help to reduce the cortisol levels. It’s going to also help address their. Acupuncture. Definitely. The thing is if they are really in a heightened state that actually you could trigger something with them, with acupuncture very interested in, which possible treatment strategies.
Could be aggressive energy treatments might be the thing is if you start needling on the back surface, that’s the sympathetic area. So you actually might have. Actually stimulate something more with the do channel being in excess, you might want to think about treating Ren the fund, the front more funds to bring energy more towards the part of the body.
With herbal formulas again probably less is more definitely there issues when people have. These outbursts that are related to low things like low vitamin D vitamin C. So you might recommend some of the supplements if you are unaware of what supplements there are a suggest or how they work to do a little bit of research on it.
Sunshine, we need a lot of sunlight that actually is going to help also with the liver, right? The liver process is D No processed foods. We know that causes a lot of inflammation. We want to avoid alcohol and a lot of other stimulants. So let’s go to the next slide. Comments. All right, here we go.
Stress negatively impacts our body, mind, and spirit, and really long-term stress affects the body’s ability to regulate itself and actually makes changes to the brain and these negatively affect cognition and are also connected with mental disorders. And including dementia and previously I talked about PTSD.
So in the case, Also in the case of something like PTSD, we really look at how the brain chemistry is altered. We see this, this is one of the challenges is that it’s not as easy as when someone just has an adrenal exhaustion to actually go back. And balance themselves that we are actually dealing with someone who their brain is functioning a little bit differently.
However it is possible to help them to to heal right. To heal. Just as a quick, PTSD is more of a site that is considered a psychiatric disorder. And it’s related to someone having an experience or a trauma that then they will relive over and over again. So they have that flashback and that becomes a barrier for them to use.
I would love to hear some comments. I’m sorry if my the presentation got off to a Rocky start we had a little bit of an adrenal surge when we didn’t know whether the The computer was going to work or the mic. And I’d like to thank the American Acupuncture Council. And for next week we have Lorne Brown that is going to be joining the American Acupuncture Council.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hello, everyone. Thank you so much for coming to our discussion on the quadratus lumborum structure, function and treatment. My name is Matt Callison. I’m here with Brian Lau and we’re here to shortly discuss this. Amazing muscle that we use quite a bit in acupuncture. That’s also very popular in massage therapy, as well as functional medicine.
It’s a muscle that has been discussed for four decades as being a primary pain generator. But with the advancements within mile faster research and also with biomechanics and functional medicine, the quadratus lumborum is actually evolving into a muscle that is different than from when I first learned about it in sports medicine in 19, late 1986.
Early 1980s, actually. So it has evolved quite a bit with its actual functionality. So Brian and I here to be able to discuss a little bit about this muscle give some quick assessment and some quick treatment techniques with us. And Brian, is there anything that you want to go for as an overview before we jump right into
slide two now I think we can jump on in the presentation up.
Yep. All right.
All right. So the quadratus lumborum is a complex muscle with a various fiber directions. Okay, this is, what’s so interesting about this muscle is that it’s just not one pancake of a muscle. That’s going to elevate the ilium or lower the the 12th rib, which is the way that I was actually taught in the early 1980s, late 1980s is that it was an elevator of the ilium, which we’d really don’t see that very much at all anymore.
What we’ll be discussing is looking at these different fiber arrangements and how this muscle is seen more of a, like a cross-link between. At other muscles acting on the spine or the ileum. So it’s really quite interesting that its role as more of a, synergist or an assistant to a lot of other muscles in different movement patterns.
So we’re going to start to talk about that here in just a little bit. Let’s look and see where it is actually oriented. You can see that the muscles part of the post, your abdominal wall, looking at this cross section of as directly connected to the transverse of dominant. So Brian, can you get the cursor in there?
And maybe we can see that the quadratus lumborum has a direct line along that core line, right into the transverse of dominance. Now that’s via the lateral Rafa tissue. And because it’s got such a strong connection to the transverse abdominis, that is the quadratus lumborum. If there are dysfunctions or increased tensions or lack of.
Tension actually in the transverse of dominance in the Antar aspect, it will directly affect the quadratus lumborum and the poster aspect, and also vice versa. Common commonly you’ll see this with certain fascial distortions as well. Let’s get into the latter Rafa just a little bit more here and the next slide.
So let’s look at the quadratus lumborum and how it’s sandwiched between the anterior and middle layer of the thoracolumbar fat. As we know, the thoracolumbar fascia has three different layers. It has an anterior later layer. It has a middle layer and it has a
post to your person
noticing you’re actually doing a really dumb job plus, cause that’s not easy to do right now.
All right. So we’ve got the quadratus lumborum and the three layers of thoracolumbar fascia. Increased tension, lack of tension to the quadratus. Lumborum how it’s going to affect the transverse abdominis, how it’s also going to affect all layers of the thoracolumbar. So that poster layer, the thoracolumbar fascia is what we commonly see in the anatomy artwork or anatomy charts, where you can see on the backside, the white tissue, that’s connecting the store side down to the glute Maximus bilaterally.
So that would be your post to your thoracolumbar fascia. And we just need to remember that there are two other layers and the quadratus lumborum is sandwiched between those two layer. Very important. And let’s see what’s next.
All right. So looking now from an anterior view, you can see that post to your abdominal wall. You see the quadratus lumborum from there. And also the psoas. The psoas is something that Brian and I spoke about for, gosh, it was a three hour conversation on the structure, a tree, a function and treatment.
Which was great. It was a lot of fun because there were so many things to discuss on the psoas. And that was in January or was that Brian? He did that.
Yeah, we it was early, earlier in January, maybe mid January. I think it’s a loss of now recorded the week we had the live class still online live class in January 10th.
It sounds like. I think it seems about right.
That was the first of the acupuncture anatomy series that Brian and I. Intending to do quite a few videos. Within this realm or the folder of acupuncture anatomy. And this is the second one actually, but it’s coming up soon. So what this presentation today is actually going to be able to give you a couple of pearls that you can be able to really use with the quadratus lumborum and some knowledge about some possibly new knowledge about it.
And then if you wanted to actually go a little bit deeper with it, we’re going to talk for about two hours or just over two hours. I’m just the quadratus lumborum and it’s connection. And it’s connections. Like I was saying before the quieter, some borrowers is seeing more of a crossroad now, like an assistant or a synergist to a lot of other functional movements.
So it’s a lot of fun. It’s a lot of fun to be able to discover that and how it can actually be able to change a needle technique and also treatment protocols or extra points that you can be able to use in addition to the quadratus lumborum so not just local, but also adjacent and dystonia. So looking here at the view, you can see the quadratus lumborum there, that Brian has his cursor on I’m gracefully placed.
I might add. And where are the quadratus lumborum inserts? You can see how it has a direct connection to the diaphragm there at the RQ at ligament. So that would be the lateral arcuate ligament. Okay. Going over the, so ads would be your medial, Q it ligaments. So they act as like a sleeve where it is part of the function of the diaphragm, which is an important thing to remember when you are treating low back.
So then also take a look inferior where that quadratus lumborum attaches to the iliac crest. It interdigitates, it becomes as one with the Illy axis. And it’s really quite fascinating to see on a cadaver because the fibers do actually come together. So if we were to tease away the fibers underneath the iliacus and the quadratus lumborum with a scalpel, just riding along the periosteum, you could lift that up and it would just become one to.
And all the way to the diaphragm, if you continued up that way.
Yeah. True. True. All right. So Brian, I think, are you
taking it away now? Yep, I believe so. Okay. All right. So this is a from research with six cadaver specimens, really looking at the physical arrangement of the quadratus. Lumborum not keep in mind.
This is six specimens. So it’s not a hundred or 200 or 300 spins. But at least it gives a, it starts to give an idea of the complex arrangement of the quadratus lumborum. And when looking at these specimens in this research, there’s three layers to the quadratus. Lumborum, we’re looking at the back through the the, posterior part of the body right now.
So we’re looking at the posterior layer, but then there’d be a middle layer and there’d be an anterior layer. So there’s really three layers to this complex muscle of the quadriceps. And this particular research then compared the six specimens and looked at the various fascicle arrangement. And this is something we might expand upon when we do the the longer two hour class.
But just to give a quick overview of this now there’s first of all, there’s a lot of variability from specimen to specimen, variability, and size or place. Really number of assets, musicals all those types of things. But generally there was mostly at least half of the physicals acted on the 12th rib and there were Leo costal fast tickles.
So that’s what outlined in green from ilium to the 12th rib, there was Leo lumbar facet. That’s what in that more yellow line from the alien to the lumbar spine. Actually, there were some Elliot thoracic basketballs that went all the way up to the body of the 12th thoracic vertebra, but by and large, these are the bulk of the, vascular disease.
Leo costal, Emilia lumbar. The middle layer is the one that has the lumbo costal from the transverse processes to the 12th. You can’t see those from this image, but that would be sandwiched in that middle lane here. So do you have to memorize all of these different farcical arrangements? Not necessarily but, to understand the role or at least to understand the complexity of this muscle, it’s important to remember that there are these various layers, some going from alien to rib, some going from ilium to the lumbar spine, some going from lumbar spine to the 12th rib.
So very complex. And it’s a classical arrangement in size. And. So because of this complexity, the muscle fiber and physical orientation of the QL, it’s difficult really to identify the actions when you’re looking at the quadratus lumborum and this line of pulse the one thing, if it went from ilium to 12 three, that was just like a straight shot from the ilium to the 12th.
Speculate much more easily of what these this role would be because it would be acting from the hip to the rib. And it would be a little more of a straight shot, but because of the fact that there’s these various forces, various vectors acting on it, there’s a lot of uncertainty on the role, the action of the quadratus lumborum.
So let’s go over the general actions. Notice that all of these, at least the first two bullet points on the actions have an asterisk. So let’s talk about the asterick first. So these actions are really placed under question right now by researchers because of just what we said because of this complex arrangement.
So it seems that maybe the quadratus lumborum has not so much to do with a particular action. Let’s say lateral flection of the trunk Obliques are in a much better mechanical advantage to do lateral flection of the trunk, but the quadratus lumborum is there to help out with the, to assist with that, to be a helping aid at same time, it can stabilize the spine.
So there’s a lot of stabilization roles of it probably in potentially. And that’s what the research seems to show extension some sources say extension. It doesn’t really have a good leverage to do extension, but it has leveraged to help with extension help with directors. You can see a lot of different rotational aspects based on the fiber direction.
So really what it seems is that like, when Matt mentioned is really more of this cross link where it’s helping in assisting more functional units of, structures that are moving together. But the traditional roles of the quadratus lumborum is that there’s a unilateral contraction or when there’s a unilateral contraction that does lateral flection of the vertebral column of the lumbar spine.
And whereas the opposite side then would be stabilizing. So we were looking at this right QL that could laterally flex the the lumbar spine. So it’d be come. The lumbar spine would become concave to that side. Bilateral contraction is where it’s usually talked about as a extension, but it seems like it’s pretty minimal and extension and more about assisting if it doesn’t mean.
And then it does seem to have a role in assisting with inspiration because of it’s a poll on the 12th rib as the diaphragm contracts, it would want to lift the 12th rib. So the QL is under there to stabilize the 12th rib and, aid in countering the, diaphragm’s pole. So this would be important, but things like speech anything where you’re getting up there and really projecting your voice in particular, you can picture that QLD in there to assist with that.
So complex muscle.
Yeah. So those, oh, Hey Brian, can I add something to that? Sure, absolutely. So the first two bullets, you guys with those asterix. That research. They actually did some EMG studies on that and they had the patients go, or the models go into extension of the lumbar spine as well as lateral flection into a number of the D into the muscles that actually act on the spine.
And what they found was that the erector spinae was actually like 90% involved in the extension of the lumbar spine. Whereas the quadratus lumborum only 10%, which truly is very interesting. And they basically had the same results with the unilateral contraction. The quadratus lumborum as well. How is wasn’t really actually a primary mover.
It’s just, again, it’s like more of a cross-link across road, a synergist and assistant a stabilizer. So it’s really quite fascinating with that. And I think
we were discussing this recently about myself and I feel like working on the muscle, which is jumping ahead and I don’t want to get into too much on that now, but if the lumbar spine isn’t hyperextension.
To me. I’d never really think that I really want to lengthen the QL so much because it does have, it seems like it has a minimal role in extension, but to be able to get that free gliding of the QL and the erector speed and to be able to decompress the tissue. So you can almost try to lift the tissue out from, being buried deep into the lumbar spine.
To me, that’s how I think about it more. And its role of extension is more postural and less dynamic.
Yeah, the QL being more of a posture muscle, like for example, in single lady, single leg weight bearing in order to have the stability of the lumbar spine than the lateral sling comes into play. So you’ve got the glute medius and minimus and the tensor fascia Lata on one side, and then you’ve got the quadratus lumborum on the opposite.
With that sling, being able to keep the balance in the frontal plane when somebody is standing on one leg and how important that actually is, this is something that we’re going to discuss quite a bit further in the law. And discussion of the quadratus lumborum is coming up in a couple of months. It’s important gives you a lot of great treatment protocols and ideas about what senior channels to be able to treat locally, adjacent and distal as well as mild work and addition exercises to prescribe as well.
That’s going to be very important with that frontal plane. Cool boy, we talked about that slide for a long time.
Okay. A you’re on stuff. Yeah. The quadratus lumborum has a, relationship in terms of at least the topography of it with the lumbar plexus, but it’s really a little bit more complex than just that. So first of all, just a review of the lumbar plexus. This is coming from the ventral Rami of L one through L four, but if you look at this top image the subcostal nerve, the T 12 intercostal nerve, which is called the subcostal.
Share some fibers down into L one. So really the subcostal nerve five contributes to the lumbar plexus. Why are we focusing on the lumbar plexus, these specially, this upper portion, the subcostal nerve, the Elio hypogastric nerve which I don’t know. I can see this on the screen, but subcostal nerve would be right under that 12th rib.
Then the next one to come out would be the ilial hypogastric and then the ilioinguinal. Those travel right on that anterior surface of the quadratus. Lumborum okay. Interesting. But th those are also the primary innovation sources, which especially the subcostal nerve, which is map it’s going to get into in just a moment.
But something to bear in mind as we get a little farther in the lecturer, we’ll come back to this and talk about it is if we follow these these nerves that wrap around the posterior part of the abdominal wall and start to become anti. Because they have cutaneous sensory branches that create sensation that, that supplied the skin and then the sensory aspect for the posterior lateral gluteal region.
I think that says thigh, but that’s really say the gluteal region. Posterial lateral gluteal region. The greater trocanter region, the suprapubic region and the proximal medial thigh. So hold that thought, we’ll remind you about it. But just keep that in mind that, the nerves that are kind of part of the innovation of the quadratus lumborum that have us a structural relationship into, in terms of where they are have the sensory distributions to the lateral.
Greater trocanter grind and I’m up in the superpubic region. So we’ll come back and look at that and how that applies in just a bit. Anything you wanted to add to this map before jumping into the,
no, it was a good setup for what’s to come
fix some interest on it. All
right. So we’re staying within the motor nerve innervation. So this isn’t some research that I gathered. It’s really quite interesting. I found this to be true is that varying research articles and textbooks. There’s not agreement on which nerves actually innovate the quadratus lumborum, but the most important one will end up being the subcostal mainly with the research that’s below because of its large Dianne.
It’s measurement of being so large diameter, therefore you’re going to have more neurons and motor neurons it within that motor nerve, that’s going to be entering the quadratus lumborum and then it also discussed the ill hypogastric nerves that were also innervating the quadratus lumborum. But with those nerves, actually having less contribution to it.
So there are, what we know of is three primary. Motor entry points with the biggest one or the go-to one in my mind will be the one that the subcostal nerve is actually going to be intervening. So let’s go to the next slide because it does show some research on here and you can see, so here a you’ve got the T 11 intercostal nerve, and then you’ve got the subcostal nerve will be B.
You can see that it’s has a larger scale. And innovations to that. Now what they did is actually they opened up that subcostal nerve so that you can actually start to be able to see the different branches then see, is going to be your
So see what ended up being, I believe part of the hill in Greenville and possibly part of the ilial hypogastric so you can see how that subcostal nerve in B is going pretty close to. Brian, can you show on the far upper left corner that the iliac crest, the ilium there? Yeah. There you go. So you can see how that subcostal nerve is going toward the muscle valley of the quadratus lumborum.
So we’ll discuss the subcostal innervation coming up in the treatment section. All right, Brian.
All right. Some of the work we teach quite a bit and work with in the, sports medicine acupuncture program is the Sydney channels. So we’ve really been working for probably 10 years now coming up on 10 years now on really building a comprehensive model for the channel, send news DJing, gen 10 new channels, whatever translation you’re using for the.
And really highlighting the specific anatomical structures that are associated with each channel sinew, how they relate functionally to seeing things like their external internal relationships. In this case, the gallbladder send you a channel or other, correspondences to have they function together.
But for today, just looking straight at the myofascial plane that makes up the liver Sindu channel is quite interesting. Cause this one. A little diverges a little bit from the classical description. The classical description has the liver sinew channel terminating or ending at their groin at the genitals, I think specifically is what it says.
But if you look at the the myofascial plane and it has a much more interesting relationship in that, Line that’s coming up from the foot through the medial thigh, up through the ad doctors doctor longest brevis pectineus Priscilla’s adductor. Magnus is a different one. That’s more in the kidney sinew channel, but this more anterior line of the abductors longest brevis and tineas, that would be then very continuous with that fascial plane all the way up into the iliac.
And as Matt mentioned where the iliac has shares fascial fibers, interdigitates in with the quadratus lumborum. And then up into the tall throne, that would be the liver send you a channel. So if you follow that plane deep into the pelvic structure for the LA axis, it would come out into the QL.
And I know a lot of people might be thinking QL, it’s a back muscle. It seems like that would be urinary bladder maybe, or maybe even. Send you a channel, but if you think about it as being less of a back muscle, which it really isn’t, but more of an abdominal muscle it’s in the abdominal wall, it’s it’s much more of a yin much muscle, much more of a core stabilizing deep structure.
And it starts to make more sense, especially then when you look at that, continuous fascial plane through the abductor line, up into the iliac is QL and The would be a part of that also, especially the distal fibers. , it’s a little more complex than, we can get into today, but we covered this quite a bit in our so as a three hour class and different sort of relationships with the cell ads, but that this, the portion in particular would be part of deliver, send new channel also.
Yeah, Brian was sold me on this one was. Okay. When you gave me a call and you said, Hey, try this liver five points. And I, my practice on every person that day, I palpated their quieter to some warm and then needled liver five. And it was remarkable how well liver five, we will point at the liver channel, soften the quadratus lumborum on not couple, but every single.
And in particular, what we’ve been teaching this for Yon syndrome or the deep layer, which we’re going to actually be talking about just a little bit that y’all, don’t send him, but he was pretty magnificent to be able to feel how liver five and in combination of liver three. And I think I might be jumping ahead with information time.
Yeah, it is. It’s remarkable how well that does work. So I think we’re going into assessment now.
Yep. That is the case. So when I go ahead, no, go ahead.
Okay. So with elevated ilium, this is one thing that we can be able to look for, that we know that the quadratus lumborum, the myofilaments, the actin, and the mind.
Are going to be in a locked short position. It’s not because it’s pulling on the alien pulling upward, but it’s because the glute medius and the amendments have weakened on are allowing that ilium to actually rise up the opposite side. Glute medius and minimus are then shortened and pulling that side down the opposite side.
So it’s it’s the opportunity for this muscle then to become shortened. Now, commonly what we’ll see with this as well is a lateral tilt of the rib cage on the same side, which want to go to the next slide.
All right. So when you get that elevated ilium, what the body wants to do is to compensate. They start to lean to the same size, so it can start to balance itself. So that would be another sign that we can address. I’m looking from the post, your review, an elevated alium always go ahead and measure it with your fingers as well.
Just to confirm your visual findings and then look at the lateral tilt of the rib cage. Usually with the love handles, so to speak, you’ll see a difference between. And left sides and more of an accumulation of tissue when there’s an elevated ilium and a lateral tilt of the rib cage. So in that case, you’ve got the this 12th rib is now going to be actually coming down.
And which means shortening of pretty much all of the fibers of the quadratus from quadratus lumborum I would think making people. Tender to palpation and also Yon tender to palpation, as well as the motor entry point. Let’s go to the next slide. Brian, you want to chime
in on this? Yeah. And this particular image.
It looks like really more just lateral tilt without so much of a elevated ilium, a little tricky to tell. We’d have to almost get in there and get our fingers on. And make sure that what we’re seeing on the exterior surface matches, but just glancing at it. I don’t see a whole lot of elevation of the helium this particular person, but more about the lateral tilt more about that 12th rib being pulled, down.
So you don’t always have to see an elevated ilium with it, but frequently you’ll see these two go together, elevated ilium and lateral tilts with routine. This particular person is a massage therapist. So she leans a lot with her right arm in terms of using a pressure with her right arm quite a bit.
So you can see how that would have a propensity to shorten that right side.
Oh, do you want to say before we move on Matt, that these distal point recommendations are just go-tos that are frequently. Helpful for this condition. There’s ways we apply these in our program and really make determinations of which points to use, but you can just try them out and experiment with them in terms of the part of the full, comprehensive treatment.
In addition to the local points, which we’re going to be getting into, this is just a portion of the treatment, right? This isn’t like a whole treatment is treat the QL out the door. You go in the person. And it might temporarily help, but but you need to be much more comprehensive to get lasting results and, looking again at the fact that the QL across links.
So we need to treat multiple structures and look at his role of communicating between multiple, structures instead of just QL, maybe put a little electrical stem on it, out the door next patient comes in.
Yeah. Yeah. I forgot because we grabbed these slides from the senior channel class, which we have.
So the acupuncture distill those points we’re using as acupuncture is in assessment. We’ve discussed this a few times before, basically trying to be able to change an orthopedic exam and manual muscle test a certain particular posture by using different acupuncture points that will change that myofascial sin, U2.
Before and after and using acupuncture and assessment, it’s just basically seeing, can you make a change in that body using these acupuncture points? And once you can see it and retest it, then you pull those needles out. But you remember to be able to plug those needles back in during the comprehensive treatment of acupuncture, because you saw how it actually makes a difference.
And I think that’s where that’s where this is coming from. Good. I’m glad you explained
that Brian. Yeah. Maybe this is not a great time. I think there was some, a question on the QL and the diaphragm. I see some references to it, but I don’t see the actual question. So we’ll catch that at the end.
If if that hasn’t been answered already,
there it is. We do believe the QL Motorpoint help with help in effect with the diaphragm. Yeah, I would say that I, used the QL personally and I’ll see what Matt has to say. But personally, when I’m working with respiratory issues, I don’t even want to say respiratory issues cause that’s a broader category.
Restricted breathing when breathing seems like it’s a component of the back pain, maybe the person is more of a chest breather and that deep diaphragmatic breath is, and it isn’t filling the low back and massaging the, spinal joints and expanding. And that elastic aspect of the inhale, exhale, expanding the lumbar spine and expanding the soft tissue structures in that lower part.
I definitely go to QL as part of the treatment. It’s
absolutely also the, so as cause we teach we’d be able to see if the low back pain is actually could be. Weakening or an inhibited. So as it’s been constricted in the diaphragm, there’s a manual muscle test that you can use with that. Yeah, for sure.
So add also GB 20 stabbing, you’ll be 17 UV 23 for the kidneys. So as, and also quadratus lumborum I think would be a good idea.
I’ll say one other thing about it then maybe move on unless you have anything else to add. And Matt to it as is, I also think about what’s at the other side of the rib cage. So you have the QL attachment to the total.
And then you have the scalings attaching to the first two ribs. And I find that, especially with people who are more of these chest breathers, who are overusing the scalings is that relationship can be very important as it is speaking to scaling. Especially the anterior scaling is a little hard to needle unless you’ve had specific training on it, but at least some some myofascial work or some, softening manual work to help free some of that excess tension in the scalings.
And. Speaking to the tension at the QL, you’re working on both sides of the ribcage. That can be really useful.
All right, this is great. But how far should we go on this? We’ll start talking about forward head posture and
we got to get going. I can never get. All right. So yes, let’s now talk about needling. These points. And the upper left image, you can see pop patient, the extra point P guns. We know that P guns going to be located at 3.5, some lateral food lower court spot. The process of hell one. Really what I’m going for in this particular case is that the corner pocket I call it, it’s where the Elliot cost Alice also the quadratus.
Lumborum where they attach to that 12th rib. Just palpating along the 12th rib from the lateral aspect up into that corner, you can see a bit of a crease there. So the needle then would be inserted the same direction as my middle. And making sure that it’s not going to go anterior to the 12th rib. So it’s a really good idea to palpate that 12th rib and the topography of that all three, because you don’t want it to go and tear that could cause a pneumothorax.
So you don’t want to insert that and go Antar to the 12th rib caution is advised. Then you can look at the motor point, which is going to be approximately halfway between P gun and Yon. It’s not on every. The directions for finding this motor point, or it’s gonna be just lateral to you be 52 on some people you could find that just slightly more superior from the midpoint being between extra point Pentagon and Yon.
So that’s one aspect that you can get it, or you go slightly higher. If you get, if you can find you be 52, that’s going to put you in the ballpark of that subcostal innervation. So insert the needle, make sure it’s going to end up being parallel to the T. With the quadratus lumborum, I’m sure all of us have gone ahead and needle that quite a bit.
Being an educator and seeing a lot of people that are needing needling, the quadratus lumborum palpation is everything here, and you need to be able to make sure you are actually on that QL and on the deeper. I see a lot of students actually needling the ilial cost Dallas, which is going to get results.
Absolutely. But it’s not dealing the quadratus lumborum so it’s going to be different intent there. And we have in the upper right-hand corner, we have Jaan. This is going to be the deep layer of yang, which would be the quadri Islam. Attachment on that lateral aspect of the pelvis. And it’s amazing how far the lab, the quadratus lumborum actually attaches to the pelvis.
So this particular needle technique is, not going to be on the edge of it, but it is going to be going through the quadratus lumborum in across fiber direction. So you’re influenced in influencing quite a bit of appropriate sectors there, the golgi, tendon, organs, and such Brian, anything to add, or you want to jump to the next.
I know let’s go ahead. And I think the next one just shows some images of the the needling placement.
All right. So we just described that pretty well. I think you guys can be able to that in the images, these images are from the sports medicine, acupuncture, textbook, and now.
Yeah. So we’ve already discussed the liver five.
So when I was talking about the lumbar plexus and there’s nerves that wrap around some of which intervates the QL, the subcostal ilial hypogastric Leland. We know Matt, do you know if it’s the, I was here, it’s the L and L to a anterior division, anterior. For for QL or at least I’ve seen you indicate that, is that branches off the Leo hypogastric Amelia.
We know. Cause I know those are one L region or are they like before the lumbar plexus ranches off?
I didn’t understand your question because it is the illegal hypogastric Ilian wino. And I do agree that it’s the ventral Rami. That’s how it’s talked about, but what is, okay. What was the question?
My question is sometimes I’m just seeing reference to L one and L two and I wasn’t sure if it was before.
If it was the, ventral Ray mine, Aramco Ramey, before they get to the lumbar plexus. And there’s like a motor nerve that branches off before intermingling with the lumbar plexus, or is it post lumbar plexus? gastric then it’s, definitely post lumbar plexus. I don’t know. It’s gonna be one more thing for us to be able to go research.
Anyways, those have an intimate relationship with the QL and it is intriguing. The re pain referral, the trigger point referrals. Many folks here are probably work with trigger points, or maybe use them as, a part of the assessment. I use them. That’s not the air, the only thing that can refer and cause pain.
But I think it’s a a useful thing to look for. Especially QL is so frequently involved with a lot of low back pain patterns. And when you look at the the QL referral pattern pretty much goes to where those sensory divisions of the nerves. To the lateral posterial lateral gluteal region to the greater trocanter region, wrapping around to the suprapubic region and then wrapping around to the groin.
There’s also some divisions that go really more posterior deep into the gluteal SSI joint or into the, kind of deep buttock region. But to me that. It doesn’t really talk about it this way and literature, when you talk about trigger points. But to me, that sort of emphasizes that segment has become irritated.
The QL has maybe the QLC irritating factor. Maybe the QL is part of the irritation of that segment, but the sensory division of that complex, so to speak has, been irritated. Maybe that’s, open to debate. And I haven’t seen it quite some depth that way and discussion of trigger point sensitization, but it would make sense to me because there’s such a neurologically intimate relationship between those nerves and the quadratus lumborum.
But to me that also speaks to the the possibility or at least a possible mechanism of how liver five it’s so effective for the QL is that. Working with that collateral circulation being the the low connecting point, it’s working with that collateral circulation that is referring pain, both to the gallbladder channel distribution and the liver channel distribution.
It’s has a referral that’s between these two internally externally related channels. And it’s interesting that it’s the low connecting point that would have. It’s such a, strong relationship in terms of removing pain from the quadratus lumborum and helping with that pain referrals, sensitization.
And then this is something that I’ve been working with in that I started adding liver three, and that seems to really increase the effectiveness on liver five by itself is quite effective, but liver three, yet the low point on that channel is just even a stronger treatment. So this is a really great disciplined.
Combination that you can use in combination with the local noodling. Let me just covered for that side where the TQL is really a pain generator. Yeah. For something like that.
It’s interesting to see the image, the trigger point image that’s on top there on the upper. You can see where the X’s are at Yan and pagan and that reasonable.
These points have been needled for thousands of years or have been known to be a referring type of point a trigger. And then the points lower. Let’s see the deep ones. Is that around you be 23 regions, that upper one. Cause the other one looks like it’s close to almost. Yeah. So
This, is what first of all, let me give a quick statement that this is the old edition of travails book, because I think that, I think it’s the third edition, the newest.
Addition, they’ve taken out these exes because trigger points can inform anywhere in the muscle. I kinda like the, I kinda the Xs, but it’s around for Lark. Chevelles passed, on now. So the decision was made after the fact that I guess they’re basing it on ongoing research and such, but they made the decision on the third one, which is I understand the decision to take out the Xs.
So I think the X’s aren’t. That this is where the trigger point is going to be in this referral, but it’s just tendencies. It’s if there’s a tendency for that upper, especially more lateral fibers to have this that’s marked one to have this referral, which I find is pretty commonly the case that it refers pain that’s, where that trigger points.
So it lives in more of that lateral edge of Yon tends to have more of that number two district. Then, if you go deeper, you advance the needle deeper. And your question, Matt, I wonder the same thing. Are you actually hitting those medial fibers of the QL? Are you starting to get into attachments of the multi-fit eye?
Cause they blend so much together. We’ve seen that a lot on cadaver specimens, but those are the ones that tend to refer deeper down. And I wonder that same aspect. QL or if it’s the relationship of the QL to the , which are on the same layer that I think that
Be really interesting the next time that we get an opportunity to dissect this, Brian is to follow the subcostal nerve into the motor entry point.
And then if we have time to do this would be great is to see if, and then do intramuscular dissection and just follow where it starts to buy for Kate. Is that smaller, small branch traveling intramuscular going to. Yeah, Yon and P going to be fascinating to see if we could follow it up there. Got you. In our system.
We’re really geeky. That’s why, by the way, that’s why I liked the Xs. Cause I think that’s what the X is. That tendency is probably more intramuscular sort of international
sites. Dr. Trevell is probably rolling in her grave because if they’re going to take those exits, I don’t know.
All right. An interesting that channel discussion, but it’s a really effective treatment.
Pate QL. We’ll give it a try. Yeah. Before you actually needle QL, especially Yon seems to be really highly effective. This way is palpated to get a pain scale from your patient. Let’s say, oh that’s, a seven. When you really get on that, that really gets to the source of the pain needle liver five liver three, and then go back and palpated and see what happens.
And I think you’ll find that if you get a really good cheap response to those disappoints, that in and of itself reduces pain by 50% or more. And then the rest you’re getting the the, local needs. It’s a really big part of the full treatment.
It’s good.
All right. We teach a lot of myofascial release techniques in the program especially like targeted ones that really supplement the treatment. And this is a a myofascial release technique for the quadratus. Lumborum especially getting to that lateral edge. If you try to reach the QL through the erector spinae, good luck.
That’s a really. Layer, especially in the lumbar region of tissues. So it’s maybe you can touch it. But you’re going to have minimal influence on it with your fingers. It’s you can needle in there, but it’s hard to determine the depth, cause you don’t know exactly where you are when you’re just going perpendicular.
That’s why the needle technique matchup is going more from lateral to medial, almost the same way my finger is there, but he was showing it with the person in a prone position. So this will be very much like the the needle technique as well. Anterior to the , I’m pretty much at Yon rubbed up right against the iliac crest.
You can angle your finger. Once you get a really deep contact there and engage the tissue, you can angle that pressure up towards the 12th rib and have the person reach their leg down to bring the hip down. So their thigh, you can’t see it fully in this image, but their thigh is in line with their.
So as they reached their foot, say, let the towards the back wall or something straight in line with the torso downward, that’ll start to pull the hip down while you’re spreading and moving that tissue towards the 12th room. So you’re elongating one direction is there, their forest is going the other direction.
And you can take that up to the tall throne. Then you could change directions because of those different fiber orientations. You can change the orientation then down towards the iliac crest and have them reach their. Upward to pull the rib cage up. So you’re decompressing the tissue away from the 12th rent on, and then bring the tissue down towards the Lem.
Is there having a force in the opposite direction, really effective technique after a needle lane and it can help return that tissue to a really good resting length.
Yeah. There’s a lot of good techniques in that class. Yeah. A lot of good ones to use. Same thing with my techniques and same thing with needle techniques is there’s a lot of good exercise techniques as well, trying to be able to accomplish on reinforce your treatment.
I’m thinking about it still as excess and deficiency is when you have a locked short muscle, it will act like it’s excess, but it will be an underlying deficiency when you have a lock long-term. It acts as a deficiency. So it’s a good idea to once you reestablish the channels and the CIM blood and the axle plasmic flow, and we discuss in the actual muscles and the channels themselves.
It’s a great idea to go ahead and strengthen the. It’s long muscles and then try to be able to stretch those lock short muscles. This is one particular stretch is one of our favorites as well. That’s a patient favorite as well. The figure for spinal rotation, where you have the ability to eat long gate, the quadratus lumborum, you can see on the lower photo that she has crossed over that figure for a position.
So her right foot is on the floor and the lateral aspect of her leg, and also thigh is going to be on the floor. So for her to be able to bring her right knee into hip AB duction that helps to lock down and pull down that ilium that could be elevated and causing a shortening of the quadratus.
Lumborum so great exercise to be able to use, like I said, it’s a patient favorite. It helps to release the quadratus lumborum as well as to activate that glute medius, which is going to end up being part of that lateral sling that we briefly talked about. And we’ll talk about it quite a bit more. Yeah. A two hour lecture coming up in just a couple of months on the quadratus.
Lumborum Brian, I think that’s it, man. We went way over time. I hope that. Okay. We have references as well. You guys, we also have something in the notes that you can buy. You guys can go ahead and take a look. We have a number of different recordings. About 75% of our smack program is now. And also on loss at OMS, which is great.
Also the psoas class, the three-hour class that Brian and I did just this last January, that’s available as well as part of the acupuncture anatomy series. LASA OMS also carries a sports medicine, acupuncture textbook, which is the next slide. And so I think we’re probably good to go.
Brian, anything else that you want to be able to quick?
This has classes is great on a Lhasa and it’s much more comprehensive because we have more. But there was no, we did do a, C a. So as if you want to get a little taste for that class that wasn’t, I knew you remembered November. So if you go on a C’s page, you can search back for the the, so as webinars we did there also, so that’s a give you a sort of a sample of that, class, and then you can see it through AAC’s page,
which we always appreciate them having us on and, a
thank you to both an Acupuncture Council. Yeah, absolutely big, huge. Thank you for having us and supporting us. Thank you so much for that, Brian. That was a good call to be able to bring that back in. So that’s good. Anything else, Brian? Ah, Lauren Brown.
Yes. He’s going to be here next week. Make sure you check him out. He’s. A big professional in our field, a wonderful academic and an amazing practitioner. So check him out. He always has really interesting things to be able to say, thank you very much. American Acupuncture Council Brian, always nice hanging out with you.
I’ll talk to you again soon. All right. Bye everybody.
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