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The Top 5 Reasons You Need A Social Media Strategy

 

 

I’m here on behalf of the AAC to provide you with some amazing content and information to help you grow your practice.

Click here to download the transcript.

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

Hi there and thank you for this opportunity to share some practice and marketing insights with you. For those of you that don’t know me, my name is Jeffrey Grossman, and I’m here on behalf of the AAC to provide you with some amazing content and information to help you grow your practice. I’m the founder and owner of acupuncturemedia works, Accudownloads and acupressure websites. And I started my practice in 98 and I had a lot of trials and tribulations and a lot of struggles. And I noticed that I had a problem in not knowing how to market my practice and how to properly communicate with my patients. And all I wanted to do was to treat people and I didn’t want to market or do any of that. Um, so the struggle was real. The struggle is real, and it took me down a path to start my companies, but that’s a longer story, best reserved for another time.

But what I want to do today is to share with you some insights and information about how to incorporate social media into your practice. But before I do that, I want to encourage and inspire you with the fact that you are an incredible resource. You’re natural healers. You know how to get people to feel balanced and healthy. We know how to, um, help people with safe, natural methods. And we change lives every single day and people need your help. They want your help. They need your services, but many people don’t even know that you exist. So I want to help change that. I want to help get you more people on your table. And that’s what these talks with the AAC are all about is to help you be seen, be heard and to ultimately bring people into your practice so that you can make more money and ultimately help more people.

So you are never alone. I want to remind you that, okay, I’m here for you. And at the end of today’s talk, or you feel like you need help getting set up or becoming focused, or if you just need a little motivation to move forward, please reach out. There are a lot of opportunities that, um, I can help you with in supporting your practice and you aren’t alone. I’ve been through this, I’ve worked with other practitioners who have been through this. So, um, use this talk as a resource, use me as a resource and just one or two simple changes, um, and aha moments from today’s talk can make all the difference for you. Okay? So let’s go ahead and get started. I want to talk with you about the top five reasons. You need a social media strategy and how to get started. Now, social media is an online marketing tool that allows you to communicate directly with your audience.

And there has never been a time in history when it’s this easy to connect with your patients. And today, every practice owner knows that it’s essential to have a strong social media presence and engage with your market online, excuse me, but few actually know how to do it effectively and get results. But the key difference between those who succeed and those who fail is simply planning. Okay? So practitioners that use social media successfully do so because they have a solid strategy in place and they take the time to plan this strategy with a big picture view, and then implement it in a systematic way. So your practice can absolutely benefit as well. And the time it takes to develop this strategy more than pays off, once you implement it and start getting closer to your practice goals. So today I would like to talk with you about five reasons, why you need a social media strategy and what you need to do to get started now first is that you have to maximize the effectiveness of your social media presence that allows you to attract the right kind of patient to your practice.

You then have to focus your energy and your time creating this strategy. So you can continue helping more people with your acupuncture treatments, right? So if you want to bring them in, you have to get in front of them consistently. All right? And then you have to know what type of content converts these prospects into paying patients. So you can make sure that your strategies actually working and that you’re reaching more of your marketing goals. And it’s important to find the, uh, the motivation to implement and post content every day. And I’ll show you how to make it a lot easier. And it’s going to be easier than you might think. And finally, you need to know what tools are important to measure your social media success. So you don’t waste your time and money on something. That’s not giving you a positive return. Okay?

Sound good. So many practitioners make the mistake of thinking that social media works like this. You log in, you check out your feed, you post some stuff, you interact with your commenters and you watch your grades gradually rise. Nice. Right? Sounds fair. But not quite. It doesn’t exactly work this way and it can, but it won’t be as effective as it can be. And here’s why if you don’t have a strategy and a plan, you won’t get any results from your social media activities. You may grow some followers by simply being there, interacting with them, but that won’t get you closer to achieving your practice goals. All your activities, including posting on Facebook or Twitter should help you get closer to your goals or it’s a waste of time. So developing a strategy first and foremost helps you link these activities with your goals. For example, if you’re using these platforms to nurture leads by sending them to your free report or your free evaluation, and just getting them to join your list, you’d post different content in a different way than you would, if your goal was to get them on your schedule directly, right?

So goals like raising brand awareness awareness, or building a base of loyal paying patients, motivating your prospects to schedule with you or stimulating more referrals or building your credibility for offers that you pitch all require you to do different things on social media. They all have different outcomes and need a different strategy and plan to get there. The first step is to identify your goals and what part of your activity will play into them. This is a key foundation of your strategy. Action steps would be to one, identify your current practice goals. Are you looking for referrals? Are you looking to double your new patients or simply increase your followers to identify what part of your social media activity plays into achieving these goals? Okay, so let’s move on to the next step. You are focused. If you develop a social media strategy, it streamlined your activities.

So you know, just what to do and you can focus on where you get the best results without the proper focus. You’re taking shots in the dark and hoping that people take the action that you want them to take. So with a strategy in place, your actions will lead them down a path to take a specific action that you want them to. For example, you may post a video and discover that it gets four times as much engagement as your text content. So this means that you need to work on your video into more video into your content mix and sharing a new video each week. So the time that you spend producing your videos will pay you back more than the text content. So one important part of any social media strategy is automation. Automation means letting a software program or app handle certain tasks and aspects of your activities.

They include things like social listening, chatbots, content, curation engagement, and also growing followers. So using software and apps to do these tasks, you, um, saves you time, saves you money, and it can really keep you focused on what you like doing. So an example of a program that you can use, like is like a scheduling software, uh, for your social media, like buffer or Hootsuite. So these are programs that can, you can post on a schedule, you set it up in advance, so you don’t have to do it manually. And it’s great sign time-saver and it it’s a task that you don’t need to do yourself each and every time. But there’s something that you need to consider with this, which is authenticity. So being authentic is the key to good social media marketing. So there are some tasks that you just can’t automate. You have to be there personally interacting with your audience.

So when you get crystal clear on your strategy, you’ve got a real plan for separating what you can and can’t be automated and using for the best results, action steps, number one, create a schedule and content strategy. So that each day, you know, what needs to be done when you sit down and log in, number two, look at social media automation tools such as buffer or promo Republic or hoot suite, and consider which ones might work best to suit your strategies. Okay. So now it’s time for reason, number three, creating content that converts ultimately will, uh, will determine your success with social media. And it’s this content that you, that needs to be engaging in. Interesting. It has to address the pressing questions and the pain points of your audience so that they will want to, like, it they’ll want to comment on it and they’ll want to share it.

So it should frame you as a helpful expert, who has a great deal of value to offer. And part of strategic planning will give you control over the content that you post. So you can decide on topics and formats and content type and create a mix and schedule so that you’re offering a variety of different types of media. And once you start posting, you’ll get feedback instantly to see which content works best. And then you can refine for even better results. And once you start, you need to maintain consistency and maintain a regular posting and marketing schedule. One way to do this is by using a service like tack you downloads, where you can find done for you, blog posts and graphics and newsletters and marketing tools at your fingertips. And it’s a great service to help support you in your strategy. If you don’t know what type of content already that you want to put forth.

Um, so what you’ll need to do is research and create a profile, uh, that will include the interests and of all of your patients, right? So that is part of engaging with your clients is to know what they want. Okay. And to know what type who your ideal patient is. And I teach this in my practice management class, and one of the exercises to map out who your ideal patient is, your avatar, who they are, what they read, what they eat, et cetera. And this becomes your intimate and, um, ideal prospect finder. So you could speak directly to them. And as part of this research, you’ll analyze your competitors and influencers and see what type of content performs best on, on their platforms. And you’ll choose some to follow and you’ll gain insights, following them to help you create your own unique content. So the result is that your content will have further reach, and we’ll be more laser focused when you have your ideal prospect in mind, as opposed to just trying to market to everybody.

You’re focused on who it is that you want to market and communicate to action steps, one identify topics, and the type of format and the content types that you want to share, and then create a posting calendar to get you started. Then this will, uh, you’ll refine this. Once you start implementing it, number two, create an outline of your ideal patient avatar and number three, perform a SWOT analysis on your competition. So you know, where, where they’re falling short, where you could step in. Okay. So this next reason is critical. And one of the best things about having a solid social media content plan is that you have somewhere to go, right? So it’s easy to get into a slump with social media where you’re not sure what to do each day, and you don’t see the results and your motivation starts to lag. But when you have a good strategy in place, you’ll know how to plan for each day.

And your to-do list of important tasks is ready to go. And this takes the work out of interacting with your audience. So you can just have fun and enjoy it. And it won’t feel like work at all, but just hanging out with your people at, you know, and that you love that you want to support in your community. And when you’re enjoying what you’re doing, this will translate to better content and more authenticity, which your audience will enjoy as well. So the best way to create daily task lists is to start big and work your way smaller and smaller. Start with the practice goals that you identify and how social media fits into each of those practice goals. And with that, and your content schedule, you can see the milestones that you have to reach into achieve in each day is a step towards each of those milestones.

You may also want to break up tasks and prioritize them. For example, first priority might be posting new content. Next priority might be replying to comments and re following people who started following you. So with leftover time, you might scroll your feed, looking for content ideas, or content to share, or spend time researching your audience. Excuse me, action steps. One, create a weekly plan for each day of social media activity and finish up each session with a list of things to do for next session to get you started. All right, so now I’ve covered most of the essential reasons why you need a social media strategy in order to get results. And the last thing we’re going to look at is how to measure the results of your strategy. So the question is, how do you know if you’re actually making progress toward your practice goals?

Right? Many practitioners don’t even have practice goals nor do they even know how their progress is moving forward. One of the most important advantages of social media strategies that you can set out a plan for monitoring the results of your actions using objective data, and you do this by setting key performance indicators that you can check regularly. For example, if you want to grow your followers, you can check how many times you’ve got new followers. You can set a goal for new followers each week. If you’re looking for more referrals, what will you do to track that? Okay, so this data will tell you whether your strategy is working and if it’s not working what you need to do to shift it and what you need to do in order to improve it, performance metrics can be tracked using analytic tools or a simple in-house spreadsheet.

And there’s programs that monitor these metrics for you, um, and, and set up and create a report for you, uh, that you could download and take a look at. So, um, your strategy also includes documenting your efforts in this’ll help you refine it and make your marketing for your social media more effective. So you can learn from your success. You can learn from your mistakes. You can learn from what worked and what didn’t work, so you can take, make your strategy better and more refined moving forward into the future. And an important factor in social media success is monitoring the improvement and the metrics of the documentation to help you do this action steps, take your practice goal and decide which metrics would help you determine whether you’re reaching it or not choose the metrics and put them into a timeframe or a spreadsheet. So you can measure and see the results regularly.

And look at these metrics, the tools, and choose which ones to use, start with a free ones or popular ones, and easy to use programs and upgrade with them as you needed. Okay. So I hope you that received some insights today. And if you’re ready to start implementing more practical steps to help you develop a comprehensive, manageable and motivating social media strategy, that delivers results reach out to me. I have a program that I’m launching over the next few weeks. So these are tips are just the starting point for you to help you focus, to get motivated for that. So if you’d like to learn more, um, I’d love to have you reach out to me. My email address is Jeffrey, J E F F R E y@acupuncturemediaworks.com and, uh, just shoot me an email. Let me know that you’re interested in learning more about social media marketing and how to implement strategies into your act, do acupuncture practice. So thank you again so much for the AAC for allowing me to come here yet again, to share some insights and marketing with you and next week, join us when Poney Chiang comes on board and share some insights and some inspirations with you. Take care, stay beautiful. Talk to you soon. Bye. Bye

 

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2 Keys to Attracting New Patients & MD Referrals

 

 

So I thought I would share, two principles, keys for attracting these patient referrals, and how to communicate with medical doctors for those referrals as well.

Click here to download the transcript.

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

I want to thank the AAC for inviting me back to host, um, to the point. And, uh, my name is Lorne Brown. I’m a doctor of traditional Chinese medicine. I have my practice in British Columbia, Canada. It’s called acrobatics wellness center. I’m also a CPA, a certified professional accountant in a past life. And I’ve written the book I’m missing the point, why acupuncturists fail, what they need to know to succeed. So I brought my clinical experience and my, um, my accounting business experience and share that with my colleagues. And I’m also the founder of healthy seminars and online platform for continued education and the chair of the integrated fertility symposium. So I love coming on here and sharing practice management tools. So you can be those prosperous healers where you’re supporting your patients. You’re experiencing abundance, you’re creating great health, and everybody’s happy for that. Um, my presentation today, and we’ll bring up that presentation now is called two keys to attracting new patients and MD referrals.

And so to build up a busy practice and to heal your communities, you need patients, they need to come and see you and want to see you. So I thought I would share, um, two principles, um, keys for attracting these patient referrals, um, and how to communicate with medical doctors for those referrals as well. So one of the keys here is being patient centric versus doctor centric in the business world. When I used to be an auditor and we’d do consulting, that would be customer centric versus company centric. And the key here is to be customer centric in our case, patient centric, creating that value for our patients being of service for our patients. And a lot of us have the right intention. We believe, we really believe that we care about our patients and we’re patient centric. Um, but I would suggest that on an unconscious level, often we are still being doctor centric.

It’s, we’re making a more about ourselves than we are about our patients. And an example of that would be our brochures and our websites. How many of us have beautiful pictures of people receiving acupuncture on our website, on our brochures make sense? We’re doing acupuncture, right? Or you think it would make sense. And it’s something that we love. Like we’re quite passionate. We love getting our acupuncture. Most of us who are practiced love, getting it and love, um, providing acupuncture. But do you ever think of what your patients see when they see your brochure? And what they see is this actually a large part of the population actually has a deep fear of needles. And so I would suggest unintentionally, a lot of us are being doctor or company centric and not customer patient centric. If we were them, we would think more about what our patient’s experiences are when they come to our website and see our brochures.

I will add that I’ve learned in my practice and I think we’re successful because we don’t really think or believe our patients are coming to us for acupuncture, what we realize. And it’s all based on your attitude and intention. We realize that our patients are coming to us for a solution. And if it happens to be requiring acupuncture needles, then, and they, and there’s research to support it, or we have case studies and competence to say that we can help them. Then they’re open to the acupuncture. If I say it’s taking Chinese herbs or receiving GWAS or cupping, um, or laser acupuncture or [inaudible] or cheek gong, they’re coming for a solution to a problem. And that’s what they’ve come to you. And it’s not necessarily that they want or need the acupuncture in their mind. They’re coming to you for a solution. And it just may happen.

That acupuncture is part of that solution. I just want to give you, so I said, I’m going to give you two key, key, um, steps for referrals. So the first one is being patient centered care and really putting yourself into your patient’s shoes, really trying to experience it from your patient’s perspective. An example in my practice at [inaudible] we’re famously known for fertility, we do a lot of reproductive health. And at the beginning, we used to have a baby pictures on our site and in our office. And we did a focus group and we learned that the patients hate seeing pictures of babies in the waiting room and on our website, we thought they would like it because it shows success and hope, right? Hey, look, look what we can do for you. But most of them say that they’re reminded of them not having a baby they’re failures.

Um, they are miscarriages that are unsuccessful ideas. And so coming into the waiting room, um, added stress and not, um, pleasure or peace to them. So again, getting into your patient’s mind and trying to understand what they want. So the focus here is B is to be patient care. And so we meant that patient centered care is about having that intention to care for your patients. However, the intention, the desire to care for your patients, or you even feeling a believe, you care for your patients is not enough. They actually need to know that you care. They have to experience it and believe it. And I’m going to suggest with you, um, I tip, can we go back to that earlier slide story? I, I that’s that too quickly. Um, I’m going to share with you, um, what I do, um, to show I care and I’m, I like to be known.

I want to be known for simple and powerful and effective tips and tools in my clinical practice and business pearls for you guys as well. So what I’m sharing with you is simple. So simple that it’s easy to be dismissed or ignored. It’s not complicated, but simple doesn’t need mean easy. Simple means anybody could do it, but it does require some discipline. And so I say here, what is easy to do is also easy not to do. And I’d like to send, check in emails or call my patients to see how they’re doing. And you can do this after our initial or after a special milestone. Um, I make a habit and using that word unconsciously, a habit of following up with my patients, um, around their pregnancy test date, um, for an IVF cycle. So I support a lot of women through their IVF.

Our clinic does not just me and we show, we go on site to the IVF clinic, the largest one here in Vancouver, BC, and provide both acupuncture, laser acupuncture on site. And I make a point to check in with them between their transfer date and the pregnancy test day, just to see how they’re doing, see if they have any questions, um, and then asking them to let me know an update when they know whether they’re pregnant or not. And so I encourage you to do that and it could be as simple as the following. I want to sh I want to give you, uh, some of the copy that you can do. It doesn’t need to be a long email. It can be tight. It could be subject line checking in, and then your copy could be hi. So-and-so I wanted to check in to see how you are doing period.

Please send me an update at your convenience and then your name and that’s it. Now the intention behind this is you want to know how they’re doing this is important because if you’re doing it, I believe intention carries some chew with it, some energy. So if you’re doing it because you want them to be your patient, I think on a subtle level, they may pick up on that. The good news is that when you do this, you create mind share. They remember you and likely often they’ll get back to you. Many of them will, and they’ll book more with you if they haven’t already. So there’s good news to doing this wherever your intention is to find out how they’re doing, because if the patient hasn’t rebooked, it could be because you resolve their issue. And so wouldn’t, you want to know that in document that in the file, you can even save the reply and they say that everything’s great.

You could ask them, um, to write a testimonial or Hey, if you know anybody else that struggling with what you struggle with, please send them. Cause as you can see, I love to treat that so simple like that. So your email is, and I’m going to show you some responses from patients that I sent this email to. I just wanted to check in to see how you’re doing. Please send me an update at your convenience. Sometimes they’ll tell you something that didn’t work. So you got to learn from their experience. So, and you may be able to correct that in that email or call them to make it right, but it’s just important to follow up with your patients. So, um, here’s an example of just two examples of what I received back from when I sent an email to patients. Now, I would say over 50% respond to my emails.

And, uh, often they’re, they’re quite nice emails, surprisingly, but good to get that feedback. And then there are those that just never respond. Um, so I sent an email checking in on this patient wanting to know, um, she had any questions and, um, I, and I asked if she could send me the results of her IVF cycle when she knows, um, she said, thank you Lauren, for the email, this is very kind of you to reach out. Remember I sit in their previous slide, they need to know you care, um, saying it or thinking it is not enough. And one way to let them know you care is by checking in via email. My blood work results came in today and it’s positive rate CG is 5 96. The nurse advised that is very good number to have at this stage. Let’s hope everything continues to go well from here.

So, you know, we’re having that relationship that trust, and this is good that she’s actually sharing this March. I appreciate your and Ryan support, Ryan and I both saw her through our clinic. Your clinic has been a tremendous part of my journey. Everyone has been so wonderful kind and professional. Thank you for providing this kind of support to women. I could follow up and say, thank you and remind you that we like to support you throughout the pregnancy. So now I can have that conversation with her. Um, so continue the acupuncture and advice about what we do during pregnancy. I could ask her if we can use her this, um, email, um, for our testimony, if it’s allowed in your, in your state or province to put it on the website. Here’s another example. I willing to respond it from her. Check-in you’re Lauren, your ears have been burning.

Your ears must have been burning because I was just talking about you and how incredibly skilled, supportive and genuinely caring you are. My hubby really enjoyed meeting you as well. And I know you really impressed him as well. So it’s showing you that we care based on their emails back. They’re showing you that little touch point, so simple to do, but again, what’s easy to do is also easy not to do. And you want to create this a habit, a lot of clinics. Um, I would recommend you doing this after the initial, if they have not rebooked. And even if they have within that week, just send in a check in email or any special milestone. It’s good to check in. And if you haven’t seen your patients for so many weeks or after two months, and you think there should be more care based on what you’re treating them for, then send in a, an email. Hi, just want to check in to see how you’re doing. Please send me an update at your convenience. So the next thing for referrals and for good medical care is, um, communicating with other health professionals. And I’m going to give examples of what we send to medical doctors. And you get a busy practice by getting referrals for word of mouth, through patients and also referrals from healthcare providers.

So the key here in anything in life to be successful, any enterprise, whether you’re a clinic, whether you’re selling widgets, whatever you’re doing is creating value for the person that’s buying your services or your products. And, um, in this case, think of, remember, we talked about patient centered care, think of the doctor as a customer of yours as well. You’re wanting them to refer to you, right? Um, so, um, think of them that way and want to create value for them because when you create value for other people, they tend to like you and want to work with you. So it’s important to find out their needs and how your relationship can benefit them. I know most of us are going to them saying, I want you to refer to me and that’s needy and that’s not creating value for them. That’s creating value for you.

And I would imagine those relationships don’t flourish or go anywhere because you started off with what can you do for me versus what can I do for you? So find out what you can do for them. I know in the Canada social system, doctors are quite busy. Um, medical doctors, um, tend not to like to treat the patients that have pharma allergy or list of symptoms. And so, you know, you can ask the doctors, what are the patients that you don’t like to see or take up a lot of your time. And so just start developing a relationship with them and finding out what kind of patients, um, you can help them with. Right? And when I say help them with in this case, um, you know, patients that, um, again, in Canada being social medicine, they don’t want to spend an hour with a patient.

They want to spend 10 minutes, maximum 15 minutes. So if a patient has a laundry list of, of, um, issues, they don’t like those. And so they would love to refer those off to people like me, where we spend an hour with them so they can see more patients. Um, I remember one doctor said, um, he doesn’t like patients that have a whole list of symptoms. And I said, well, I’m a holistic doctor. So I likes it. Patients, the whole list of symptoms. Sometimes a little humor will help as well. You want to create trust, um, and allow time to build this long-term relationship. So it is a marathon. It’s not a sprint. You don’t meet the practitioner or the medical doctor that day and then expect them to be a great referral source. It’s a relationship and over years, um, I’ve been in practice since 2000 over years, you start to develop relationships where these physicians become your champion, where they send a lot of patients to you. Um, and that could take time. But if you’re in practice today, think of yourself three years from now, what do you want? What kind of referrals do you want? And think of in three years, I want that relationship with that MD. So today start that relationship knowing that you’re going to date, you’re going to develop a relationship and over time it’s going to become a healthy relationship.

So I’m sending him a letter to the doctor. I find very beneficial and it’s good medical, um, um, medical care on your part as well. So, um, when you see a patient, send them a thank you letter for that referral. Now here’s a trick for you. Um, send them the thank you letter, even if they didn’t refer the patient to you. So when you do your initial, um, if you don’t collect it on the document, ask the patient who their primary care physician is. And so when you send a letter, um, say thank you for referring such a patient, you’re almost programming them like, oh yeah, I refer them. You know, but even if they haven’t and just let them know, you have this patient and mutual care, and I’ll share a letter that we sent to a doctor here in a moment. So I will give you a little template here that we use that you can now use.

So send them a, you know, what, they’ve come in for what your plan is, and that you’ll send them some progress report. So it’s good to send them kind of your initial findings and your treatment plan, send a revaluation, let them know, definitely refer back to the MD as well for their followup and confidently communicate with them. When you have questions or suggestions, don’t put them on a pedestal, but don’t have counterwill or make them your enemy and fight with them. Either your colleagues working mutually for this patient’s benefit. So own what you know, um, but also read the room and know who you’re talking to as well. And it’s really good medicine to have this integration. So here’s an example of a letter. I apologize, the presentation, put the bullet points there. You don’t need the bullet points, but I took out some names and some information just to preserve confidentiality, but here’s a letter to whom it may concern.

Um, Mr. X presented to our clinic AquaBounty wellness center on Wednesday, August 23rd for pain in his left knee, which he shared with related to osteoarthritis. I’m using a technique. Our clinic calls, laser acupuncture, which utilizes a class three B medical grade, low-level laser therapy in combination with electrical acupuncture. And skeeted, don’t inundate them with too much information, keep her letter short. And also it’s a good thing to remind you, at least in Canada, that when a medical doctor receives a correspondence regarding a patient, um, they’re technically supposed to put it in the file as well. So again, reminds them when they look at their file, who you are in your involvement. I give a brief education of what laser is. So education here, low-level laser therapy has been shown to relieve pain associated with main diseases and syndromes and cleaning, osteoarthritis. It implements red and infrared light to decrease pro-inflammatory cytokines promotes blood circulation and promotes tissue regeneration by increasing mitochondria ATP production through fighter, by my white fire till biomodulation.

And then I give them a two links to go to my website. If they’re really want to learn more, some doctors are going to want to know about this, and they’re going to look it up. I’ve had doctors call me after to go for lunch. Cause he wanted to know more about what we were doing. Cause they had a lot of patients that they have been trying to help with drugs, drugs, or surgery, and they still have not found relief. So they they’re looking for anything to help these patients. Um, my Mr. Patient, uh, so put your patient’s name, your Mr. Patient’s name. So whoever their name is, has received a treatment. So in this letter, just so you know, I was slow. I didn’t send it when they first came in, patient came in and I did not send the letter, but I sent it, you know, I said to the progress reports.

So sometimes you get behind. So I sent them this letter anyhow, um, after they’d been seen with seen by me for a couple of weeks, they received eight treatments, um, since August 23rd and has experienced noticeable improvement in pain reduction by his third session. So I’m showing the progress and how good this was after three treatments, they already have no pain. His current pain level is not existent. Even with strenuous activity. We have not noticed any significant reduction in swelling. So he was quite swollen, but we hadn’t seen much change in that over the past three weeks. And then I let him know. My plan is to continue to offer one or two weekly treatments until he has results from his schedule. X-ray October 2nd. Do you have any questions about our mutual care of this patient? Or if you want to communicate with me about any aspect of his care, please feel free to contact me in health. And then you give your email and name. If you’re sending it by mail, which I recommend, um, I’d say both mail and email, but put your business card in if you send it by mail.

So just remembering being successful as not doing extraordinary things, the, um, thinking about the patient centered care, sending them a check in email, writing a letter to your doctor at best, not extraordinary, right? But being successful is simply doing ordinary things extraordinary. Well, and so you want to make it as a habit and just think for the next three years, if every patient you saw, you sent in a check, an email and you sent a letter to their primary care physician, I’m just curious how many extra referrals you’ll get because the patients now know you care. And the doctors now know you exist.

Do keep in mind. It takes 20 years to become an overnight success. Really the point here is to manage your expectations and that this is a marathon, not a sprint I’m when I’ve coached my colleagues often, they’ll say I did what you said and it didn’t work. And just so you know, this response, I did what you said, didn’t work is one week after I told them what they could do. So if you’re telling me did work after a week, you’ve missed the message on building a relationship and it takes 20 years to be an overnight success. It’s a marathon, not a sprint and just create this habit and do this over time. And then after six months rafter, you’re telling me how it’s going, but definitely not after a week.

So keep this in mind. There’s two types of human suffering. This is by Jim Rowan, a nice quote. Um, look at the image on the left. You can see the fit gentleman inside this obese body drinking soda, water, it’s the pain of regret or the pain of discipline. So either way, there’s going to be some type of pain or effort. So the pain of regret or the pain of discipline. So I’m inviting you to go for the pain of discipline and write these emails. Um, I talk about what we just shared in my book as many other and many other, um, what I consider a key points in mindset and activities to help you build a successful practice. Remember as a practitioner acupuncture, you’re a business, whether you like it or not. Um, small businesses, acupuncturist are always at risk of failing because we’re small.

Just the nature of us being small businesses, lacking resources and money or people to do everything that needs to be done, puts us at risk of not succeeding and then add to it that many of us are in denial that we’re in business or don’t want to learn about business puts us even at greater risk. And so to be an effective healer, you need to have the union balance. You need to know your medicine. So constantly work on your clinical. And we do this well. We’re always putting our continued education forward and a priority. I know this from healthy seminars, seeing how many people are constantly learning. And then you have to also the other side, the young, you have to also give attention to the business side of it. And if you didn’t young or out of balance, you have disease or they separate and there’s death.

You go out of business. And so you can’t ignore the business out of your practice. And if you’re not in practice because your business is failing, unfortunately, then you’re not able to heal your community. And it’s important more than now than ever to have practitioners like you available to heal your community. So continue your healthy seminar studying on the medicine side. And I want to remind you just also study the business side so you can stay in business, have a busy practice, feel fulfilled, um, healing your communities. And if you’re interested in my book, um, there’s free shipping this month go to missing the point. book.com, make sure books in the URL. Otherwise it will go to a different website missing the point book.com. You can order a copy and have free shipping this month. And if you want to contact me, um, you can either go to healthy seminars.com.

That’s where we offer online continuing education. And I get a copy of those emails on my own, a little website called Lorne brown.com, where I interview people on conscious talks and I share, but conferences I may be involved in. So you can check me out there. There’s the website for my book, missing the missing the point book.com. And my clinic is AQI balanced.ca um, stay tuned to future AAC webinars with me. I’ll be interviewing more, um, colleagues over the, over the months and years. And I want to let you know that next week our colleague and our friend Jeffrey Grossman is going to be on to the point for this AAC webinar series. Thank you very much.

Callison-LauHD11032021 Thumb

The Stomach Sinew Channel and Low Back Pain

 

 

 We want to discuss the, uh, low back pain and the significance of the stomach channel. So let’s take a look at that first slide. Our discussion, very short discussion about this topic is going to be looking at the stomach sinew channel from above the knee and into the rib cage region and its influence on low back pain.

Click here to download the transcript.

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

Hello everyone. My name is Matt Callison. I’m here with my colleague Brian Lau and everyone. Uh, thank you to the American Acupuncture Council so much for having us. We want to discuss the, uh, low back pain and the significance of the stomach channel. So let’s take a look at that first slide. Our discussion, very short discussion about this topic is going to be looking at the stomach sinew channel from above the knee and into the rib cage region and its influence on low back pain. Um, the techniques that we’re going to be presenting here today is just something that you can routinely check for low back pain patients to see if the stomach Sr channel is a contributing factor to this person that’s coming in with chronic low back pain. It could actually even be acute low back pain to go ahead and check that as well.

So I think we should probably get going. We’ve got plenty of, of information here. Um, the first slide or this next slide that we’re going to be getting into is going to be specifically about the lateral Rapha. Now the lateral Rapha is a very significant tissue along the stomach sinew channel. That can be a contributor to low back pain. Let’s discuss this very strong fascial connection to the lateral Rafat. Um, you can see there on that lower left-hand corner of that. Call-out if you can circle that there for us. Yeah, there we go. It’s a continuation of tissue from the abdominals, the fascia from the abdominals and the thoracolumbar fascia. Uh, for those of you that know about the thoracolumbar fascia, it’s gained a lot of popularity over this last 20 years, significantly over the last decade about its importance functionally, but also in low back pain.

So the thoracolumbar fascia, it has got three layers. You have a posterior layer that covers the erector spinae. Okay. You’ve got a middle layer that’s underneath erector spinae and above the quadratus lumborum and then you have a deep layer that’s between the quadratus lumborum and the LDO. So as each one of these layers connect laterally, it becomes the lateral Rafa, the thoracolumbar fascia specifically between the poster and the middle layers. However, if you also look at cadavers, you’ll see that that poster layer also has some contributions to the lateral Rafa. It’s a communication link. It’s a segway between the abdominal fascia and the thoracolumbar fascia, and it sits right on top of the quadratus lumborum and we can be able to pal that palpate that for Osher point. So, uh, the reason why we’re talking about the latter fr right now, before we go into an overview, just such an important tissue for us to be able to consider and then farther into this presentation and we’ll get into the assessment and the treatment of it. So let’s go into the overview of the stomach channel and Brian, do you want,

Yeah, yeah, sure. So next slide. Yeah, we have, um, just a real quick introduction or re-introduction of the stomach sinew channel, if you haven’t, uh, looked at it recently. Um, the secondary channel that includes the myofascial planes, uh, of the stomach channel, there’s really two main branches. Uh, we have one that travels up the anterior lateral leg and thigh goes around the genitalia and spreads out into the abdomen. Then from there, it travels up the chest neck and face to the lower eyelid. So this is the main channel that you’re seeing in this image and this kind of, um, 3d model image here. Um, you can see primarily that main channel coming up, the midline of the thigh are a little bit, uh, lateral on the thigh. And then up into the abdominal layers up through the chest, up into the neck and up into the face, um, that kind of follows the, the primary channel for the most part.

Uh, the second channel is another branch of this that you don’t really see from this image, but we’ll have plenty of opportunities to see it in the next few slides. Um, this other branch is on the lateral kind of starts from the lateral knee, goes to the region of gallbladder 30. Sometimes it’s in that translations, they might say it and it connects the shower young. That might be another way that it’s worded, but it kind of becomes a little bit more lateral as a sort of a segue between it and the stomach channel from there. It runs to the 12th rib and ends at the spinal column. This is kind of adapted from a Vanguard translation at the link shoe, which is a particular source that I really like. Um, but, uh, all of the sources say relatively about the same thing when you look at translations. So let’s go through each of those branches a little bit more clearly and to the next line.

So if we wanted to start at the distal part, um, from the lower extremities, we can look at the stomach DJing, Jen, how it travels along the anterolateral leg and thigh. I think actually these two branches actually, uh, start in this, uh, leg region below the knee. And you can kind of look on this image for the tibialis. Anterior tibialis. Anterior is just lateral to the tibia. This is where really the primary channel of the stomach, the stomach primary channel runs along this area. Stomach 36 would be noodling directly into the tibialis, anterior and happens to be the motor point, uh, for tibialis anterior. So that’s an actual primary channel point. That’s going right through that region. From there, we could kind of follow that up, uh, lateral to the knee, into the rectus femoris, continuing to follow that stomach primary channel. But if you look at this image, we also have the extensor digitorum, longest muscles.

Um, you know, there’s several slips of those. The two, um, create a poll extension for toes two through five and especially toes two and three are part of the stomach channel. So this in some ways is sort of the beginning of that lateral branch. It’s kind of a, between the stomach primary channel and the gallbladder primary channel. It’s part of the stomach sinew channel. You have those toe two and three slips that kind of drive up toes four and five would be gallbladder send new channel, but we’re on the stomachs in your channel. That’s going to connect into the vastus lateralis and start to become that a secondary sort of a branch that more lateral branch.

All right. So let’s go back to the main branch main branch is going to run up the rectus from Morris. You can see the rectus for Morris, this image that kind of dark line on the thigh is the kind of the fascial separation between rectus Morris and vastus lateralis. So that’s in my opinion where the stomach channel runs, but that rectus for Morris that more medial muscle in that picture is going to be the sort of primary channel branch of the stomach sinew channel that then connects to the a, I S it actually connects to the a S I S or it’s fascia. And then it runs up through the inguinal ligament up the abdominal layers up the chest, et cetera, kind of following the primary channel of the stomach. Um, so in this case, what we want to focus on for today’s lecture is the abdominal fascia in particular, because we’re going to look at how that connects and wraps around to the, um, to the thoracolumbar fascia and the lateral Rafa in the stomach channel. It’s all the fascia that lives in is found on top anterior to the M rectus for Morris. I mean, excuse me to the rectus abdominis. So it’s all the fascial layers that are on top of, or superficial to the rectus abdominis. Um, part of those fascial layers in wrap around the body, following the fascia of the abdominals into the thoracolumbar fascia, into the lateral Rapha, and then connecting all the way to the spine. So next slide.

So the lateral branch on the other hand is going to be a little bit more lateral on the thigh. It’s covering the vastus lateralis, which is a pretty big muscle. That’s the fastest part, I guess, but the vastus lateralis actually covers really a lot of real estate on the lateral thigh, really going into attaching all the way to the back of the femur. Um, so it really covers the territory of both the stomach primary channel to some degree. And the, also the gallbladder, um, primary channel, the iliotibial band would be running down on top of this structure. Um, so it would be a kind of in a pretty big area, but this is the link through that lateral branch. If you follow that fastest ladder up, you can see where it communicates the chair’s fascia. It attaches to the same region as the anterior portion of gluteus medius and minimus, especially minimis. So, uh, just that, that hip joint region, you can see where those two muscles are communicating. Then from there, it’s going to continue into the thoracolumbar fascia meeting with a lateral Rafa about anything you want to add on these are,

Yeah, that tissue with Cal patient is pretty significant when somebody has a posterior tilt or an N tilt of the anonymous bone, versus when it’s a neutral pelvis, you can really tell the difference in palpation of that fibers of the anterior fibers of the minimus and the medias, like I said, with quite a change in inclination with that.

Yep. And it’s an often, we actually had a discussion on our, uh, Facebook group on sports act, a sports, um, acupuncture group. And, um, we were talking about how often this fastest ladder Alice is ropey and rigid and dense. And I think if you palpated the thigh quite a bit, you can probably notice that you do know, you do find a lot of patients that have a ton of tension in this area. Right. So let’s move on to the next slide. All right. So we have a few, uh, three, I think, cadaver images. So just the general warning. Um, this was in the beginning, we have the warning on the bottom of the screen. We’ve already had one small image, but these are a little bit closer, a little bit, um, more obvious they fill up the screen. They’re a more obvious cadaver images. So just be aware of your surroundings, you know, if you’re at a Starbucks and there’s people looking at your screen, maybe, you know, get it into a position where they can’t see it, it’s better not to view these in public, don’t share these images, um, you know, keep, uh, it’s it’s, we have to be very respectful to the donors and make sure that we don’t do anything inappropriate.

So this is an educational settings. So we have these images, but, um, but don’t share them with the general public or be mindful where you’re watching this ad. All right. So next, uh, next slide, let’s start looking at this connection. So there’s two lines on this, uh, cadaver drawn over this cadaver, and it’s just the dissection image. And then the top one, uh, which is the shorter of the two lines that’s showing the upper border of the glute Maximus and sports medicine acupuncture. We’ve referred to this as the gluteal app and erotic line. So that’s going to be more superficial than the glute medius and minimus, but I just wanted to show that demarcation, the bottom line is traveling up from the vastus lateralis. Then as it kind of makes a curve, you see it connecting into the glute medius and minimus, and then it follows right up into that, uh, lateral border of the erector spinae, which is that top portion of the line, um, that is kind of that whole trajectory of that lateral branch of the stomach, uh, send you a channel going all the way through the lateral Rapha and a moment we’ll actually see the erector spinae lifted, um, so that we can, um, get a clear view of the lateral Rafa.

One other thing to highlight from this image, you can get your bearings straight is if you go to the very top of that, um, that line, the longer line that’s, um, from there, if you go to the midline of the spine. Yep. Right in that region, we actually have the erector spinae cut. So everything above that, you’re seeing deep to the erector spinae. That’s going to allow us to lift up that little flap of the erector spinae to see the lateral Rafa a little closer. So let’s go to the next image then. And, um, this is just the lines removed, right? So see if you can find that same territory we just discussed kind of look at that trajectory of the sort of channel, like portion going from the thigh all the way up the glute medius and minimus up into the lateral Rafa. Okay.

And now let’s look at with the rector SPI and a lifted. So that would be on the next slide. So there is that little portion of the erector spinae lifted. Then you can see deep to that, to the next fascial layer and that boundary of the lateral RFA. That’s just that little, um, band that runs just lateral to the erector spinae. So again, you can follow that line down from the thigh, from the lateral thigh, going through glute medius and minimus into that lateral Rafa all part of the stomach sinew channel, that lateral branch of the stomachs, a new channel and a pretty juicy area when you’re working with a lot of chronic back problems. Right. That’s pretty sick.

Yeah. It’s pretty significant, uh, continuation from the lower extremity into that latter Rafa, you can see that line with the erector spinae lift up and the thickness of that ladder Raffa as well.

Interesting. Yeah, for sure. Yeah. Get that image in your mind though, because you’ll see some palpation coming up in a bit. Um, and this is where actually, can we go back to the previous image with the erector spinae down? Imagine you are pressing not on a cadaver specimen necessarily, but on a person, if you were pressing and you could kind of see through the skin and, um, and see that your, your pressure is going right to that lateral edge of the erector spinae diving, just deep to it, to that, uh, that boundary of the lateral rafting, that’s going to be where we’re going to be palpating. Um, so this is a, a lot of the types of things we tried to get across. Like these images come from our, um, uh, uh, anatomy, cadaver dissection lab that is on, uh, LASA right now. So these are part of, uh, you know, we have a bunch of videos and I’m really a little more thorough presentation on this, but even just looking at these images, you can kind of get an idea of, okay, if I were to press into that tissue and try to reach the next image, go to that, the next slide and reach that tissue that’s on that boundary, just deep to the erector spinae and know that, okay, that’s the lateral Rafay, I’m palpating for tension at that region.

And knowing that that’s part of the stomachs and new channels. So we have a lot of information right there that you want to take it and kind of go over that. It kind of kind of started the process a little bit, but I wanted to highlight it on the cadaver portion. So when we see it, we know what we’re looking at.

No, that’s great. This is going to be the cadaver dissections in module two anatomy, politician, palpation cadaver lab on Los OMS. But what you said, bright for the person to really understand where that lateral Rafa is, which is going to help significantly when they’re looking for Osher points in this tissue. And also when they’re palpating for, so the lateral Rapha attention test, which is going to be coming up here in just a couple minutes. So am I next? Yep. Okay. Let’s go to the next slide please. All right, here it is Latta Rafiq tension test. So you guys hear it for your notes. Um, you have this a step-by-step, you’re going to ask the patient to designate the pain level with palpation of this tissue on a scale of one to 10. Um, many people are gonna be thinking, well, you’re just palpating. The quadratus lumborum is actually the depth of the palpation.

That is significant here. When you look at the video that’s coming up next, you’ll show it it’ll show that Brian is palpating within the first quarter inch of the superficial tissue. Just touching that lateral Rapha that covers the quadratus lumborum. If we’re looking for the quadratus lumborum trigger points or motor entry point ratchet pop hitting more from deeper into that tissue. So there’s a difference in the palpation of it. A practitioner is going to attempt to decrease the tension and the pain of the lateral Raphi by using the following acupuncture, motor points, stomach 41 works great. 43 can be used on 36 being the motor point, as Brian said of the tibialis, anterior, the vastus lateralis motor points work really, really well for reducing the tension and the latter Rafiq. Um, same with the rectus abdominis points. We’re going to be covering that because there’s four different segments of the rectus abdominis motor points.

And it’s usually going to be the lower aspect that is going to be changing significantly, the tenderness of that lateral Rafa. So let’s look at this image here. You can see how Brian was talking about the, uh, channel going all the way up the vastus lateralis, going to the anterior fibers. I’m talking about the lateral image here of the patient. So you can see going up the vastus lateralis, going up the anterior fibers of the minimus, the media’s going across that iliac crest, which you just saw on the cadaver going right into that lateral Rafa right now from that tissue, the lateral Rapha is going to be following along on the poster and the anterior aspect of the abdominal wall, going to the rectus abdominis. So there’s your connection, your significant connection of the stomach Sr channel for low back pain into the latter Rafa.

And also the abdominal aspect is contribution to low back pain as well. There’s something that we’ve been talking about for a few years now, it’s called acupuncture as an assessment. Um, this is something where you can use a couple of acupuncture points just to be able to see if they will decrease the tension of a particular orthopedic examination. In this case, what you’re going to see in this next video is Brian’s going to be using a couple of points to reduce tension in the lateral Rapha. So let’s check out the ladder off a tension test and acupuncture as an assessment, let’s go to the, into the video

[inaudible].

So we’re looking at the lateral branch of the strong stomach send new channel. So the lateral branch of the stomachs and new channel from the thigh comes up through the vastus lateralis, connects with the gluteus medius and minimus, and then to the thoracolumbar fascia. So one of the key areas we look for in this lateral branch that connects them to the lumbar spine from the stomach channel is the lateral Rafa. The lateral Rapha is the meeting point is the fascial wall. That is the boundary between the iliacus Dallas’ lumborum the erector spinning and the quadratus lumborum. So those fascial planes come together in a seam at the lateral Rafa, and we’re going to go right into that lateral Rapha at a Rambo level of L three. Doesn’t have to be exact, but L three is a good landmark, and we’re going to start to palpation following the angle. So here’s the erector spinae falling off following the angle of the erector spinae down into that valley of the lateral Rapha. And we’re just looking for tension, but also palpatory pain to that. So we can ask the patient on a scale of one to 10, how that, what that pain level is with palpation. So what does that pain level there? Three by three? Yeah, it feels denser. Doesn’t feel, it feels like it’s healthy tissue. Most likely go to a different area. How about right there?

Three. All right. So can you stop bad? But if this was a big pain producer for the patient, then we would look at reducing that with distal points for this assessment and come back and how pain and see if that changes it. So primarily we’re going to be looking down with stomach channel and we can include things like vastus, lateralis, vastus, lateralis Motorpoint would be a good one to consider. We could look at, even though it’s on the gallbladder channel, the most, uh, pasture and edge of the vastus lateralis would be a possibility. So that would be in the region of gallbladder 31, and then we could follow it down also into the stomach channel, just by palpating. It feels like tip anterior has a certain amount of tension. So I’m going to use Tim anterior. I don’t know if it’ll change much based on the fact that you didn’t have a high pain aspect with the additional palpation, but let’s go ahead and work on it anyways. So we’ll use stomach 36, 1 of the motor points for tibial anterior.

Now we’ll come back to the area. So there’s two things I can look for what my palpation tells me. Does it feel like that tissue softened? And then what does the patient report in terms of pain, quality back at the same area and scale the one from one to 10? Yeah. And it feels softer to me. She says the one now, and from a three to a one, I’m having a hard time finding the exact location where I felt that tension before. Cause it feels like it’s been reduced. So other points to consider the distal stomach channel points down towards the feet, stomach 41 would be a possibility stomach, 40 stomach, 36, just based on palpation, felt like a good starting point for me. And then also looking at points along the thigh.

All right. So let’s just talk logistically about what we just saw here. So if you’re going to be treating the patient in a lateral recumbent position like that, using acupuncture’s assessments going to be really quite simple, um, you can also check the lateral Rafiq, the tension tests when the patient’s going to be standing, which is nice because you’ll be bearing and load bearing. So therefore the tissues are going to be a little bit different. Um, in that case you can check for Osher points while the person is standing. You could still go ahead and needle stomach 36, or you can use some distal points to, to see if that was start to change the tissue. You can also do the, do the lateral Rafa tension tests when the patient’s Lang prom. Now that makes it a little bit more difficult when you’re trying to be able to needle the vastus lateralis points, but we will have more access to the distal stomach channel points using stomach 45 stomach 44 stomach 43.

Those points are going to be a lot more accessible when the patient’s link prone and they will also change the tension within the lateral Rafa. And that way you can be able to plug in those points and then continue with your treatment. Um, this is going to be, um, just kneeling some Osher points within that lateral rafting. And you could see with Brian’s angle that he is angling it more toward the belly itself. Not necessarily parallel with the table, like how you would be needling the quadratus lumborum so pressing into that ladder, I Fe looking for Osher points and just tapping on that tissue. Remember that lateral Rapha is going to be a thin tissue on top of the quadratus lumborum and you might have two or three different Oscher points within that lateral Rafa. That’s going to span the region from the 12th rib all the way to the iliac crest. So let’s remember the depth of where that lateral Rafiq is. I’m trying to be able get disperse Oscher points within that region. Bride. You wanna add anything to that before we jump into the next slide?

Yeah, just that it’s um, I think I have that needle in about L three. Um, I do find that that region of L three and the lateral Rafa tends to be, um, pretty responsive and, um, you know, it’s a, it’s a good, I, I often find that is kind of the greatest tension, but for those who followed, uh, Luigi Stecco his work, um, you know, he has these really involved system where he talks about these different points, that parallel acupuncture points to some degree, but he calls them the centers of coordination. Um, and they’re like fascial unions between certain, certain regions of Paul on the muscle. Like this would probably be, I’d have to go back and look, but it’d probably be the, uh, include like the quadratus lumborum the erectors and coordinating movement between those. Um, but it’s in the fascia itself of the lateral Rafa. So this is one of his points, one of his centers of coordination, um, is that, that, uh, L three lateral Rapha mark. So kind of interesting. And I do find that that’s, I don’t know if this works super well, but I know a little bit of it, but I do find that that L three region is usually pretty predictable predictably. Um, more of the center of, of, of tension of that lateral or FFA. Sometimes when I need a lead, I have a slight inferior angle though. Like you said that 45, but, but slightly inferior.

Yeah. So predictable Osher point within that. [inaudible] so that’s great. That’s good. All right. Let’s see what the next slide is, please. All right, let’s go over the best slash motor entry points. There’s two primary for the vastus lateralis. One of them will be extra points, team food two, which is located just one to two soon, lateral from stomach 32, which would be food too. We know that stomach 32 is located six soon up from the lateral border of the superior lateral border of the patella. Uh, so following that up, make sure that you are going to be in the vastus lateralis, not in the rectus femoris. You’re going to slide over then one to two soon, um, into sheen futu, if you cross fiber, the vastus lateralis, it will often facilitate, uh, which would also be at the definition of a trigger point. Uh, if shin futu is going to be referring somewhere, then that would end up being also location of point.

Um, so this is going to be a branch off the femoral nerve going into that vastus lateralis extra point sheen food to a pretty powerful point. So it makes sure when you are kneeling it pretty slow and methodical needling, otherwise it can be a strong cheese sensation can come up really quite quickly. Now the upper fibers of the vastus lateralis, which oftentimes, um, can atrophy on many patients where it’s not really quite used, if they’re having some mechanical problems with the extension or knee flection, those upper fibers, if you divide stomach 31 and the superior border of the patella divided by thirds, it’s the meeting point between the middle and the upper thirds. Uh, you’ll definitely find an off SharePoint within that meeting point. That’s going to be another motor entry point from the femoral nerve going into those upper fibers. Um, the needle technique, that being that should actually be a little bit deeper than that, uh, should be more like, uh, 0.75 to 1.25 inches because the innervation is actually going to be more to the medial side from that femoral nerve.

So you have to go a little bit deeper into that mass lateral, so you guys would be able to make that correction. That would be great. All right. So let’s now I believe let’s go to the next slide, our rectus abdominis motor entry points here. You can see four needles on the left and four needles on the right. It’s an old bleak angle going into the rectus abdominis. The needle is starting at the spleen channel and then directing it toward the wrench channel going. Uh, th the objective here is to try to be able to get the needle to go to the poster aspect of the rectus abdominis. That’s where the innovation side is more on the poster aspect and not necessarily on the Antar aspect. We have to be very mindful to make sure that we know where the tip of the needle is going, and it’s not going past the rectus abdominis, therefore into the peritoneal cavity.

So be very, very mindful of where that needle is going, but your goal is to cross fiber, the rectus abdominis, and angle it. So it is going to be affecting more of that poster aspect. Um, there’s a great video. That’s going to be in the motor entry-point protocol. This will be in module two part of the online recordings that we have thankfully have finished. We’re coming really close to getting them all aligned. Um, it’s been over a year endeavor and what an adventure that has been I’m sure Brian can agree to that. Um, so those are available on Lassa OMS, um, the research for the rectus abdominis motor, point’s the largest diameter of these intercostal nerves. That’s going into the rectus abdominis or the ones that’s going to be located in the lower half. So that means number three, and number four, that’s on this particular slide.

So you want to locate stomach 23, which we know is going to be too soon above stomach, 25 and needle towards stomach three from the spleen channel, right? So the rectus sheets you’ll be connecting the spleen with the stomach then. So the needle is going to be going from the spleen channel toward the stomach channel, going into the motor entry point for that particular muscular segment of the rectus abdominis. I believe that particular one is innervated by the T 10 intercostal nerve. I could be wrong. It could be T 11. Um, again, but those, the research was showing that’s more of the larger diameter, um, um, uh, nerves coming across into that motor entry point. The next one to choose here would be also just below stomach 27, which we know is going to be located to super low stomach 25. That was nice about this too, is you look at it’s pretty much at the same level as the lateral Rafa as well.

So with low back pain, many times practitioners are not needling into the abdominals. And boy, you can really great get really good results by combining treatment on the back and also treatment on the front. So if you’re not treating the abdomen with low back pain and maybe your results haven’t been as good as you want to please make sure that you are going ahead and needling into these, these points, you’ll see that it actually will help significantly. And just as a side note also, um, I’ve had many patients have actually had constipation and I’ve used this needle technique and it works really quite well, more for the excess type of constipation, not necessarily for the blood deficiency type of constipation, but it’ll change Paris dialysis pretty well. All right, Brian, I think we’ve got a myofascial release technique that you’re going to be showing that’s really a great for spreading here. So do you want to introduce that?

Sure. Uh, so Matt mentioned getting better results by including the abdominal layers, especially if you’re doing these assessments and you find that, you know, somebody reports a seven out of a scale of 10 on the palpation of the lateral Rafa on a pain scale, and you need all the rectus abdominis, uh, as a, um, assessment or the vastus lateralis. And you find that when you go back and pal plate that maybe it’s gone down to a four or a three, so that’s telling you that that’s a component, you know, part of their low back pain. Maybe it’s not the primary source, maybe it is, but a component of their low back pain has to do with that tension in the thoracolumbar fascia. So sure if that, if that assessment showing improvement and why not put those needles back again as part of the comprehensive treatment and, or, and I say, and or maybe the person doesn’t have enough, cheetah include that many more noodles, or for whatever reason, maybe you don’t do the needles that you can do the myofascial, or maybe you do the acupuncture and the myofascial.

But speaking to this tension in the abdomen and possibly on the lateral quadriceps is going to be important for these patients. So this is a technique on the rectus of the dominance and it’s working, you know, the rectus abdominis has the six-pack six-pack muscle, it’s actually an APAC, but each of those little packs are there because there’s a tendonous transcription that separates one of the four segments of the rectus abdominis. Um, you know, so that, that’s what creates the six pack, but actually there’s a, uh, pack on each rib cage that doesn’t show up when people have really developed at abdominals. So it’s a, technically, it’s an APAC, but we’re going to be working in those tendonous transcriptions to free tension in the fascia. And this would not be uncommon to refer to the back, especially in the 20, uh, stomach 25 region. But let’s go ahead and look at the video for that.

So we’ll be working now with the rectus abdominis, but specifically the tendonous inscriptions of the rectus abdominis. This would be really relevant for when there’s pain at the thoracolumbar fascia, or especially at the lateral Rafa because those abdominal layers wrap around and become part of the thoracolumbar fascia and can add tension into the lateral Rafa. So in your assessment with the thoracolumbar fascia test, if you find that it reduces palpatory pain by doing acupuncture assessment at the rec fem, these would be techniques you could do after the needling. So we’re going to start at stomach 25. I’m going to use my fingers, pads and my fingers to sort of find that tenderness inscription, I’m going to sink perpendicular. Usually I find that a little bit inferior, like I’m kind of dropping in perpendicular and a little bit inferior helps to hook into that tendonous tissue, that fascial tissue, you don’t have a bone to push again. So I can’t just go straight in and resist against the bone. So I need to find a way to hook into that tissue. And this is a good, that little kind of curving motion seems to get a good hook, a good investment on that tissue. And then I’m spreading my fingers apart. So you can’t see it much. It’s a small movement, but it’s just like you’re unzipping a zipper hook in and spread.

Sometimes patients actually will feel this refer towards the back or even into the lumbar region.

You can work up to the next one, well, into the tenderness inscription sink in and spread

You can notice that as we’re working here, she’s starting to be able to take a little bit deeper of a breath, cause it’s freeing that tissue that can clamp down and resist the breath. And we’ll be at the cost of margin. I can continue to do spreading apart, or I can go up or down. If the person has a very hold in, compressed lower rib cage, I might want to bring the tissue out if they don’t have good tone in the abdominal muscles and it’s over flared, I might want to move the tissue up or I could just bread. And either way, I’m working along that costal margin,

Mindful that I don’t want to go all the way to the xiphoid. I’m just going up towards the xiphoid

One last pass. I can be at the attachment and again, spreading at that rectus abdominis attachment where the fascia starts to meet the pec major

And then I can work at the final attachment site at the pubic bone. I want to start above the pubic bone. So there’s the pubic bone I started above so that my pressure can get deep to where the rectus abdominis dives deep today, a posterior border of the pubic bone tendon, a tender area. Is that okay? And I can do a slight minuscule across fiber, or I can try to lift the pubic bone and decompress. This is another region that might refer into the lumbar region.

Right. So you don’t need to do all of those areas. You might pick and choose one or two regions. Stomach 25 is often very frequently involved. Costa margin’s frequently involved. All of it’s going to free the breathing take tension off the thoracolumbar fascia. And you can consider this technique when there’s a stomach, send you channel relationship to pain, such as facet, joint problems,

Especially a great technique to be able to use after kneeling, because it also takes pain away or soreness away from the needles as well. Um, there’s a lot more great Mahvash release techniques that we’re showing. And that’s from the assessment and treatment of the channel, send you module two, available a loss of OMS, um, really great techniques to be able to use right after the needling that can reinforce what you’re trying to accomplish with the acupuncture.

All right. It’s a slow treatment. Yeah. Yeah. It just, it’s kind of a slow, you know, you don’t want to rush through those treatments at the same time I was talking and I was teaching. So it seems like it would take a long time, but you can actually get through those, those, uh, even if you do all passes, all four passes, you can do that pretty much quicker than I was doing it there, you know, there was teaching and discussion and where and what I was doing and all that. So it seemed like it would be a long, long time spent, but not, not so much in practice.

Hi, Brian, it’s always a pleasure to be able to hang out with you and to be able to share knowledge. Thank you very much. Thanks very much at the American Acupuncture Council. Also next we’ve got, uh, Lorne Brown is going to be coming in and discussing some great things. I’m sure Lorne has been in the field for a long, long time and a great pioneer in himself. So check out Lorne next week. Thanks again to the American Acupuncture Council. Thank you very much. You guys for attending and we’ll see you again. All right. Yep. Bye-bye.

 

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Identify and Use the New ICD10 Updates

 

 

So every year when you hear the new codes is started, always remember it begins October 1st. So it’s important to note, am I making sure I have the codes that I’m using? Have there been any types of updates? So let’s move forward and talk about those.

Click here to download the transcript.

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

Welcome everyone. This is Sam Collins, the coding and billing expert for acupuncture and the American Acupuncture Council. Give you another episode of our show that keeps you up to date and what’s changing and moving forward. And as of course, I’m sure you’re aware. There has been an update to diagnosis codes. Keep in mind that diagnosis codes don’t update. At first of the year, they actually update October 1st of the year before. So every year when you hear the new codes is started, always remember it begins October 1st. So it’s important to note, am I making sure I have the codes that I’m using? Have there been any types of updates? So let’s move forward and talk about those. Let’s go to the slides. So here’s what we’re going to focus on. What are the 2022 updates, but I’m going to be pretty acupuncture centric. I want to make sure we’re focusing on the things that you code regularly because obviously each year that can be a lot of changes.

So keep in mind, October 1st is the date and it begins for this year with changes to back pain. So that’s really, what’s new, but it’s more than just back pain. And that’s what I want to kind of warn you about now. Probably not as maybe common, but the focus is we want to be certainly acupuncture centric. And as you well know, you’ve seen these updates year to year from 2017 to present every year there’s updates. And it’s confusing in a way, because often you go, well, if they’re changing 1,974 codes, do I need to know all those changes? And in fact, I would say, no, we want to know about the code you bill, the codes that are reimbursed and whether or not those have updates. So each year you’ll see these changes some years makes literally no difference. Other years can be a tremendous difference.

Beginning in 2021. Of course, there were some updates of course, that you had to work for a headache. Now you can think, okay, got headache codes update, but it was only to I’m sure you remember the [inaudible] in our 51 9. Good to note that those codes did update from our 51. And they are both reimbursable, whether you were billing like Aetna or Cigna, all the other payers. So those went right into the protocols of payment. And that to me is the focus. It’s not just knowing the changes, but what codes are payable. And I think that’s a confusing and often frustrating part for acupuncturist is not knowing what codes you get paid for. Well, for this year, there’s been updates where there’s 159 additions, 32 deletions, and you’re thinking, oh my God, what do I need to do? Well, let’s focus on what has changed for this year.

The one that’s very acupuncture specific of course is low back pain, low back pain is the most universally covered condition for acupuncture. In fact, I would say just about any insurance that covers acupuncture will cover for low back pain. So what does low back pain mean? The old code was M 54 5. Now that code is gone. Don’t use that code anymore. And the approximate synonyms for low back pain are all types. It could be acute chronic, whether it’s pregnancy related with radicular, apathy, mechanical, low back pain, you know, simple lumbago loin pain. Now the key here is that you’re just describing the pain. You’re not necessarily describing the causation. And I think that’s where often some acupuncturists get confused. Should it be better to decode like a sprain or a string? Well, potentially depends on the payer, the most ubiquitous and likely covered those to keep it simple, go with just back pain.

So what has been updated while there’s a new code? That’s M 54 50 that says low back pain unspecified. Now I want to keep in mind that this update began October 1st. So don’t be confused if you treated someone in September and you’re sending the claim. Now you’re going to use the old code. If you treated someone October 1st or later, you’re going to use the new code. So keep in mind that type of issue. But bear in mind, I’ve had a few people that go Sam I’ve built out in 54 50 and it came back as invalid. But I want you to bear to keep in mind that that was likely because of the clearing house. It wasn’t the carrier, but the clearinghouse often they’re just not updating their systems often enough. So what does low back pain unspecified really mean? Well, we’ll get into that. There’s another code and 54 51 for, for T progenic meaning related to the spine that looks promising, but we’re going to talk about that more specifics as to whether or not it’s going to fit for a typical acupuncturist.

And how about M 54 59? So here’s the update three new codes for back pain and 54 50 51 and 59. Now you may already be familiar with them, but let’s dig into what each of them mean, unspecified low back pain. And you think what does unspecified mean? It means that there’s a non-specific low back pain defined and not attributed to a specific pathology. Now often in many states, acupuncturists cannot make a quote unquote Western diagnosis or differential. So this might be your safest bet because you’re simply describing it hurts. You’re not differentiating. Why? So in other words, if there were something like pain in the low back related to a sprain or a strain or radicular apathy that potentially could be coded that way. And for like a Cigna insurance, they wouldn’t accept that, but Aetna would not. They’re going to take only the pain code. So it’s kind of knowing your carers, but this would be a good, easy code to indicate just low back pain.

And I would say this is the one that probably represents the change over from what M 54 5 was. I think this would be a safe bet or a safe bet to use, just to describe the plain symptom that you’re not differentiating it, but just that there’s a symptom of pain. Now you may be differentiated into, you know, B syndrome or cheese stagnation, but I’m talking about differentiating from a Western standpoint, like ridiculous apathy. Well, what about M 54 51? Now that’s specifying that there is specific pain from the vertebra or spine. Now I liked this because it seems like, oh goodness, I’m going to say it’s spine related, but let’s understand this really doesn’t, isn’t going to be used very much because the purpose of this code, which wasn’t well-publicized the purpose of it was to describe more specifically, what’s called vertebral endplate pain, which means actually a pathology of the bone that’s causing it.

So I would suggest this is not one you would use for like, oh, it’s something related to the spine, like a sprain strain. You would code that. So M 54 51. I’m not saying it’s not usable, but not very likely unless you have a differential of end plate pain in the vertebra of the low back. So not likely it’ll be a covered diagnosis, but make sure you have some specificity for it. The spine related conditions, such as sprain strain, radicular, apathy would not be appropriate for this. Cause simply code that. And again, I’m going to implore you. Here’s kind of the weirdness, Aetna wants only pain. However, Cigna will allow you to differentiate. So Cigna will accept back pain as well, but they allow you to differentiate to sprains and strains. So depending on the carrier, it may allow it for instance, Anthem would do the same.

Well, what about this other one? It says other low back pain. So we have unspecified and then others. So this is determined to be kind of non-specific low back pain is defined as low back pain, not attributable to a recognizable known pathology while you’re thinking, well, wait a minute. Isn’t that? What other or unspecified mean? Other means, I think you can kind of recognize that there’s some sort of causation, but just not one that you’re directly attributing it to again, pain, but not F not differentiating like spraying string. So the reality is it’s likely that you’re going to be coding M 54 50 or 59 as an acupuncture provider to replace the M 54 5. The key factor is making sure that you’re describing low back pain with the correct code. Keep in mind. They now require five characters. I know some of you are going to say, but standby have built in, has been rejected.

Remember that’s likely from the clearinghouse and potentially what you’ll need to do is just simply wait until they get an update to it. The problem here is that what about some of these plans that have a very short window to send claims? So check with your clearing house to figure out why they’re rejected because the carriers have certainly updated. What’s the best practice for this best practice. Use them 54, 50 or 59, simple 51 again, end play pain. I think gets a little bit, um, outside of probably scope. I’m not saying no, if it’s predetermined, you know, by example you could code are riotous, but it’s not going to be by you directly, but from, you know, their medical provider, they bring in the note. So again, best practice and 54 50 59, well everyone’s onto those codes, but are you aware that there was another code that updated headaches are also universally covered for acupuncture?

And there’s a new code specifically for what’s called a cervicogenic headache. Now cervicogenic means that it starts in the neck. So it’s a neck problem, but the pain is perceived in the head. So a little different from tension, but it’s usually involving some type of range of motion or other issue that’s directed into the neck. Now what’s the reason they’ve added this code is because they wanted to make it somewhat more specific, a cervicogenic headache before this code would have been coated with our 51 9. But now that there’s this specificity you could use code by example, our 51 9 would include things like, uh, I would say probably, uh, a headache where you’re saying it’s a sinus headache or some type of facial pain. Whereas this one is just a bit more specific. Would this be covered for acupuncture providers? Oh, absolutely. Again, you’ll see this one with Cigna.

I believe Aetna will adopt as well, but at this point I would hold off and stick with the R codes until we get a for sure on it. This is something that isn’t going to be a lot better to coach cervicogenic headache compared to say just a headache. Well, I will say it’s a slightly more specific and it might mean why you’re doing other things. Maybe it’s involving some neck pain. I mean, certainly you could have a headache which is playing neck pain, but again, I just liked that there’s some additional codes that you can kind of specify a bit more. I always will say medical necessity often as determined by the complexity of the condition you’re treating. So if we have simple back pain or simple headache, we’re not thinking very severe, not longterm, but in turn, if I said migraine or cervicogenic, there’s a little more severity and chronicity to that same would apply.

Let’s say you have low back pain where there’s radicular apathy. That’s certainly going to be more than simple pain, but again, it’s knowing your carriers, which carrier will and will not accept. And that’s, what’s important to know. That’s one of the reasons we do the service that American acupuncture council, the networking seminar. So make sure you stay on top of not only what the new codes are, but which ones are and are not payable. Well, what also updated now, this is when you’re going to go, well, sing them. This is, you know, I don’t cope, cough. It actually, I’ve not seen cough covered for any carrier though. I’ve seen some that do cover respiratory issues, not all, but some do well. This is a new code for cough, and I’m not sure, obviously that many of you were using these, but they did update them.

The codes now no longer are three characters. They now are four and in dictates the type of cough, but here’s why I’m bringing this up. Could this be a complication? Could this be what we call a comorbidity or adding to the complexity of the patient’s need for care? Let’s say a person has back pain, neck pain, and they’re coughing a lot. Could that irritate that so-called, Valsalva fecal pressure caused that pain to get irritated maybe. And I’m pointing out that these are things like let’s say a patient has a significant cough. Would that be something I want to document as part of their care, as part of their history and indicate anything that might increase the need for care, realize that even American specialty health and these types of carriers, when you’re requesting additional care, they’re not only wanting to know what’s going on with the patient in the sense of the primary reason for care, but all the other potential barriers to the patient responding well.

And that could be things of this nature. So always keep in mind, diagnosis is going to be the lifeblood of payment. It’s what we’re doing, but all plans have a specific code that they allow. Remember Aetna and Cigna are a bit different Evercore, a little bit different, a little bit more ubiquitous, but what about United? And now there’s a lot of similarities, but differences. So make sure you understand the codes that they are allowed. Make sure you’re using the code to the highest level of specificity, which means the new back pain codes have to add a digit, but most important, make sure it’s on their list. By example, if you were to code back pain to both Aetna and Cigna, those would be payable. But if you were to code a sprain of the lower back as 33, 5 XX, a Cigna would pay you, but Aetna would not.

So then how would I code back pain or sprain to Aetna? Well, you got it. If there’s pain well, will a sprain cause pain. Absolutely. So I simply just code the pain. So what’s allowed here is that Cigna, for instance, or Anthem allows a greater specificity in severity, but it still will be covered by sticking with the code. And that’s the part I want you to get. Don’t overcomplicate this, make sure the codes that you’re billing, which you’re probably eight to 10 on a regular basis are accurate. Correct. And up-to-date to make sure that your claims simply can be paid without the right code. We’re going to have a problem. So it’s easy to understand codes update every October 1st. Are there any other codes that have updated? Sure. But how often do you build Sjogren’s syndrome? Have you ever coded that? Probably not. They updated that code, but again, not one we would use regularly.

So I always will say, don’t be afraid to be a little acupuncture centric, just have the right code to note your claims get paid. And that’s really our role. The American acupuncture council is always here to be your help. Not only is it your malpractice carry, but also your support. Remember there are seminars and programs we do to make sure your claims get paid. Like if you’re saying, how do I get that list? Well, that’s where our network services do. And what I would ask all of you to do, take a moment to go to our Facebook page, to the American acupuncture council network, click on our Facebook page. There’s weekly updates on all types of issues, coding this week’s questions on how to do an ENM. And do you need a 25 where there’s also updates regarding vaccines and other types of issues. It’s always going to be a good source for you. So take a look. We always want to be here to help. That’s really our goal and mantra. Your success is our success. So I’m going to say thank you for being with me next week’s guest will be Dr. Taso-Lin Moy, and I’ll look forward to seeing you the next time. I hope to see it a seminar take care of everyone.

[inaudible].

 

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Growth, Hiring and Culture

 

 

Our topic today is growth hiring and culture setting your clinic apart. So everyone wants to work for you today. I’m very happy to announce that I got two other experts joining me in our expert panel today that we each will be sharing ideas on growth, hiring and culture fit.

Click here to download the transcript.

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

Hello. And I want to welcome you to the AAC To The Point my name’s Lorne Brown. I’m a doctor of traditional Chinese medicine. I’m a CPA, a chartered accountant, and I’m also the author of Missing the Point- Why Acupuncturists Fail and What They Need To Know To Succeed. Our topic today is growth hiring and culture setting your clinic apart. So everyone wants to work for you today. I’m very happy to announce that I got two other experts joining me in our expert panel today that we each will be sharing ideas on growth, hiring and culture fit. And we got Mark Sklar and Aimee Raupp. let me give a little bit of a brief introduction here. Each of ’em each of our presenters, our experts today. So mark, um, he’s known as a fertility expert, um, and he has over 18 years in clinical practice, helping couples get pregnant.

Um, he’s president of the American board orient to reproductive medicine and a founder clinical director of a very successful functional medicine, Chinese medicine practice in San Diego, where he sees several hundred patients a week. He’s developed a whole online platform where he does coaching and seeing patients also, um, around the world and his YouTube channel has well over a thousand subscribers already. So welcome our Sklar to our panel. We also have Aimee Raupp with us today. She’s known as a women’s health and wellness expert and just selling author. So published a couple of books, body belief, yes, you can get pregnant and chill out and get healthy. Um, she has been in private practice for over 16 years. She’s a licensed acupuncturist, herbalists in the New York area and she has two practices with several associates. I should mention. Mark also has several, several associates, which is why there are my expert panel today.

And Aimee has appeared on the view and has also been featured in goop glamour shape alert and the red book and has received endorsements from some people you may know, Deepak Chopra, Dr. Christine Northrup, um, Ariana Huffington and Gabby Bernstein, as well as she received endorsements from me and mark as well. I don’t know for there on this graph, so we can draw in a little bit of just an overview of growth hiring culture. So I’m going to bring up, uh, a presentation and then I’m going to have mark join us for a little bit on what he’s going to share on growth hiring culture. And then Aimee is going to take us home the anchor of our panel, and she’s going to talk a lot more about, um, cultural fit. Um, so let’s get this started and talk about growth, hiring and culture fit.

So really to have, um, a busy practice, it requires continuous referrals. And in this case, referrals come from having informed admin staff, um, from having, um, informed patients, which we create. And then, um, you being an, a formed TCM practitioner. If you stay to the end, um, we’ll share some key points and where we can go into more detail, cause I’m going to do a very superficial, but big overview for you guys today. Let’s focus on the really valuable front staff. So they’re your first, uh, contact for your patient. So they make your first impression. These are the people that are answering the phones and greeting your patients and exiting when, um, uh, saying goodbye when the exit and making sure if they need to be back in your clinic for that followup appointment. And so without this valuable front staff, um, this alone compare paralyze your practice, if they’re not the right person, because they are your first impression, your staff need to be able to instill the confidence in your patients, meaning they have to know, they have to be able to communicate to the patients that you, the practitioner are the right choice.

And so in my practice of Vancouver, acupoints wellness central, we have several associates been in practice role since two year, 2000. You can do the math there for awhile. We train our admin staff to be as knowledgeable as practitioners. So basically they become like practitioners. They can’t legally treat, and this allows them to become better advocates for the medicine and also, um, to be able to communicate well with the patients and ask for answer a lot of those questions. Um, it may be beneficial to treat your staff, your admin staff, and even their family members, because if they have a positive experience, um, then they’re going to become better advocates of your medicine as well. In the hiring process, often people say, do you have benefits? Do you offer medical benefits? And your answer actually can be, yes, I know the default always is no.

And I hear some of the reasoning, um, you know, we’re small practices. We don’t have that budget for, um, external or medical benefits, but you do actually offer medical benefits. It’s the medicine you practice. So if you’re doing, um, practicing as an acupuncturist or functional medicine practitioner, um, your staff actually be probably quite happy to receive a free acupuncture from you and a discount on, on supplements, um, and free or discounted testing services that you offer. And you may want to extend that to their family as well. So you do actually offer benefits and a lot of the people that take this admin position, the salary that it’s based on often, they can’t afford your services. So even more of a value added for them wanting to join your practice. My biggest mistake was, um, in this cultural fit ideas, I’ve heard some great admin staff, but I hired admin staff that had fear of needles.

It wasn’t a question I had asked. And so, um, it was only when a patient, um, would ask if you had, have you had acupuncture before, or they’re trying to communicate the acupuncture. You could see it in their face. That there’s fear. They didn’t want it. And so that is one of the, if you’re gonna take anything away today, when you’re hiring your front end staff, you should ask the following question. Have you ever had acupuncture before and watch their face? And they’d say yes. And it’s a very uncomfortable phase. They’re probably not going to be a good fit for you. And if they smile and tell you, they love it. That’s excellent. If they say they’ve never had acupuncture, the up question is, would you like to receive acupuncture? Do you have an interest and follow that instinctual facial response. I’m telling you that if they have a fear of needles, if they don’t want acupuncture, you don’t want them being your first impression, your front end staff take it from me. I learned this the hard way with integrity. They can’t tell patients that acupuncture is for them. So let’s talk about hiring for cultural fit. And first of all, let’s talk about the common pitfalls, um, for when you hire for cultural fit.

So some of the common pitfalls are hiring nice people. I’ve done this so often, right? Looking people. I think I get along with this person, this person seems nice, but they don’t have the skillset. So don’t do that. I’ve done that. Not very good for your front end. They do actually have to do the job besides you liking them, being a fit for your practice. They must have the skill. Um, you gotta be able to clearly set out the role and the requirements of the job. So this is your job as the leader, as the owner, the owner of the clinic, um, and another pitfall is, um, keeping them on board. Um, and they’re not the right fit. And so one of my colleagues used to say, you gotta be able to pull it off like a bandaid. If you have to let somebody go. So when you notice those red flags and those first few weeks of hiring somebody, don’t ignore them. And they think it’s better to pay attention to those red flags and let go of the people quickly. If they’re not the right fit, it’s much harder to do it later than it is at the beginning. Um, you know, not delegating properly, um, and, um, not giving them proper feedback. So that’s part of that training.

So we want to hire for the right cultural fit. Um, you know, we used to hire based on resume alone, um, and who we could afford, that was an epic fail. So you really want, um, the, uh, hire for the cultural fit and make sure you know, what your culture is. So I have on this slide, what my Acumatica’s culture culture is, and it’s clear to know what yours is, and then you’re looking for that fit that they share the vision, the values that you do, and having several touch points is key for this. And I have a link there to the community library@healthyseminars.com. Um, I have a much, uh, comprehensive talk on how to hire for culture fit and how to go through the process of hiring. So you can check more out there.

And then this just outlined some of the processes that I mentioned, that’s in that community library that I’m not going to go over here. And also myself, Marc and Aimee in our coaching and mentorship program that we offer for you guys, we go into crazy amount of detail and give you documents on how to do this as well in our rise, transform impact program. And again, these are some of the steps to pay attention to. Uh, and as I mentioned, this is the rise transform impact. So I’m just going to skip this because I want to just do a breath today. So that’s at healthy seminars.com for slash RTI, where myself, Marc and Aimee are going to be putting out some more of these free little clips for you to enjoy. And then there’s also much more that we do in our mentorship program. The real question you want to ask yourself then, because so many of my, um, the people that I’ve coached and talked to, um, they’re running their man, they’re doing their front staff job and really think of it this way.

This is really how you can clarify it. Did your school train you to treat patients or be a receptionist? What is your training and where does your passion lie? Is it in treating patients or doing admin tasks, even if you’re excellent at the men task, where’s your passion. And I think for the majority of you that invested time and money into Chinese medicine and functional medicine programs, I think your passion is in treating patients, not doing the men’s side. And I’ll share with you that if you have a good admin person, you can actually see more people help more people heal because less time answering phones, scheduling, collecting money means more time that you can be, um, taking care of your patients.

Let’s talk about our associates, be clear that this is not passive income. Um, you need to bring value to your associates, but it does add or increase your income generating potential. And it gives you some flexibility with time as well. Also know that you’re changing your job role, your, your leadership role, you’re going from being the practitioner to now managing people. And so if you don’t like managing people, um, then you want to hire and you want to have associates. You may need to hire an office manager to help manage your staff because there’s the entrepreneur, there’s the manager. And then there’s take technician. And we all love being the technician being that practitioner. But once you hire on staff and associates, you now have that managerial role and all that can take away from the entrepreneurial role, the vision of the growth of your clinic.

And so once you hire associates, you now have to manage people. So please know that your role is changing. Common question that Marc and Aimee and I get is, you know, I get staff. So how do I keep them from like leaving me and compete? Um, I will let you know that the non-compete agreement is hard to enforce. And there are other ways that we do in our mentorship program where you can set up systems. So they want to stay with you. And if they leave you, you won’t be resentful. Won’t be costly as well. So there are ways to do this that has integrity, that your associates feel great about. And you feel great about, um, there is, uh, a quote by Richard Branson that says the following train people well enough so they can leave, treat them well enough. So they don’t. And so a lot of this is about, um, how to train your staff.

So, um, they are great and they couldn’t leave you, but treat them really well. And this is what we go through more in our program. Um, so they don’t want to leave you. This is key, and we’ll also give you our non-compete, um, contracts. So all the things that we have put into our agreements and contracts. So the key here though, is to invest in your people. And there’s a meme going around saying, I’m the CEO and the CFO are having this conversation. What happens if we invest in our staff and our people, our associates, and they leave us. And the response from the CFO is, well, what happens if we don’t invest in our staff, we don’t train them and they stay in our company. And so you don’t want uneducated and untrained people in your company. Um, they will, they will bury you, um, in David Pink’s book dry, um, he talks about what motivates professionals and you are professionals, if you are practicing medicine, and this is that whole motto treat them well, may, will stay, but basically the factors that lead to a better performance and personal satisfaction out of the following, having autonomy.

So you want to have the sense that you, you are in control. You don’t want to feel controlled. So autonomy is important. So when you have associates, you don’t want to have your thumb on them, but it’s also not a free for all, but they got to have autonomy to be happy, to want to stay with you. Um, second one is mastery, um, to be able to reach for their potential to constantly have growth. Well, if you’re a practicing medicine, you never arrived that, you know, enough, as we know, there’s always opportunity to learn and grow in, uh, in your medicine. Um, so if you don’t have that mastery, like your drip looking envelopes, then that can become very boring. And it’s hard to stay in that job. But again, remembering that in Chinese medicine, that is not the case, having purpose, feeling like feeling what you do matters that has value.

Um, this is important. And then the last one is recognition. Um, your staff have to feel appreciated, have to feel valued. This is where I have failed early in my career. When I hired admin staff and I, our associates, I’m a self motivator. I’m doing all this great work for myself, investing myself, but I didn’t make time to talk or connect to my associates. And they felt not appreciated, not valued. So I did lose some associates in the early days and I adored them and I loved them and I did value them, but I didn’t communicate it to them. And so regular, um, connecting with your staff is key because if they don’t feel appreciated, this is another thing in the research that shows that people won’t leave. If they don’t feel valued or appreciated by you in his book, he shares that you can pay people fair market value, or even 10% below fair market value.

And if they have autonomy mastery, purpose, and recognition, they will stay the same thing as you pay them way over from market value. So the monies is better than they could ever imagine, but they don’t have autonomy mastery, purpose recognition. They’ll still leave you. So money’s the, uh, it’s not the driving force for people to stay. So, um, I do want to let you know that there’s a lot of talk about the renumeration. So what do I do? Is it a salary? Is that hourly? Um, do I pay, do they pay rent? How do we do this? Right. Um, how many rooms do we give them? So really these things come down to how you’re going to set up your clinic, because how you pay them, how many rooms they get is going to be based on a what’s your clinics, Val, um, um, goal and mission, meaning that acupoints minor all employees, because we’re a full on team.

Like we are a unit, that’s one of the things we have. So they’re all employees and how you do this really is what’s the value you’re creating. So there is no right way to do this, but there is a right way for your clinic and your vision, which myself and marketing, when you go into more detail in our programs. And so I will share with you that these are some of the ways that people do it. The key point here is what’s the value you’re bringing to your associates and what value they’re bringing to the clinic. And that’s how you determine the hourly, the salary, whether it’s commission rent, et cetera. So I’m going to bring on our experts. I just want to let you know that we do run a mentorship program, a coaching program, the three of us, um, is called rise, transform, and impact. And, um, if you want information on that or sign up for some more of our three little chats, um, then go to healthy seminars.com for slash RTI. I would like to bring on, um, mark now. And mark, I would like you to share a little bit about how we can do this, um, the growth and the hiring, the culture fit so we can grow our practices and people set ourselves apart. So people want to, um, want to work with us.

Absolutely. Well, first and foremost, thank you, Lorne, for, uh, inviting me to be part of this. And, um, you know, I think this is such an important topic for all of us as business owners, for the very fact that you mentioned in your slides, that, you know, we are not taught these things when we are in school, right. We’re taught to be clinicians and doctors. We’re not taught to be entrepreneurs or business owners. So if that’s the direction we want to go, then we need to take a step back and evaluate things a little bit differently. And in the first place that we need to start to evaluate and really consciously think about is growth. You know, where do we want our business to go? Where do you want to take your business? And, and when do you want it to get there? And so I think it’s easier to break this down into five-year chunks.

I mean, certainly if you want to look beyond that to have this really big, big goal, that’s fine. But I always like for all of you business owners to then say to yourself, where do I want my business to be in five years time? And this sets the stage for how those five years are going to go for you. So once you decide how you want the next five years to go, like what you’re trying to accomplish in those five years, maybe you want to have multiple clinics. Maybe you just want to grow your one clinic to have, uh, you know, 10 providers. Maybe you want to have an, uh, brick and mortar and you’ll have an online presence as well, whatever it is, that’s in your dreams, wherever you want to take your, your business, your little baby. I want you to set that intention consciously of where you want that to be in five years and growth doesn’t happen just by setting that intention.

Although that’s the first step it has to happen in baby steps, but we need to break down those baby steps based on that big goal. So we’re going to work backwards, right? So if, if in five years we want to, uh, have our brick and mortar and an online presence, then what do we need to accomplish in those five years to get there? And how does that need to be broken down? So then what you’re going to do is you’re going to set out for yourself to maximum of three goals annually that you’re trying to achieve. And the easiest way to do that is to say to yourself, okay, well, if I want to achieve that in five years, what do I need to do this year to take me closer to that five-year goal. Again, it, it, we all have our to-do lists and those to-do lists can be overwhelming and daunting.

But if we break down that to-do list into two or three annual goals, then that’s much more achievable. And then we’re going to take those two to three annual goals, and we’re going to break those down into quarterly. What do you need to do quarterly? And then what do you need to do monthly? And that’s how you’re going to make your weekly and daily to do list to accomplish all that. Now, if you can just accomplish one or two things on that checklist every day, if you can just check off one or two things every day on that checklist, you will be moving very quickly, although it might not feel that way, but you will be moving very quickly towards that bigger goal that you’re, that you had set for yourself. And that’s really how we’re going to achieve our overall growth for the business is setting that five-year goal, breaking that down into annual goals, and then breaking that down into bite sized chunks that you can accomplish on a daily and weekly basis.

And if you haven’t done this, I really want to encourage you all to go ahead and do this set aside with time, uh, this weekend to consciously make a choice for where you want to be in five years, and then start to break that down for yourselves. It feels really good to cross off those things on the list you feel accomplished, you feel like you’re moving closer to your goal and you get there much faster than you would think. But again, it happens with baby steps and those baby steps start to jump and start to look like big jumps and leaps, which is how I’ve been able to accomplish all the goals that I’ve had. And I know that Aimee and Lorne also do something similar, which is why I’m talking about that part of baby steps. And part of growth is also hiring. So, you know, when you’re, you’re in your clinics, you’re, you’re in your business, whether it’s virtual or brick and mortar, at some point, you’re going to come to a point where you need to hire staff.

And I know for many of us, our first goal is when do we get to hire that associate? That’s going to work under us. That’s going to, um, you know, start to work with, uh, patients who are coming to see you. Well, I would ask you all to, uh, to question that and maybe even put hiring associates on the back burner. I believe that we all do need to hire for growth and to achieve the goals that we have, but we need to start by hiring managers. And I think managers are going to allow you as an entrepreneur, as a business owner owner, and as a doctor to accomplish much more because as Lorne had mentioned, you know, we, we, weren’t trained to be receptionists and to run a practice. So shedding those things and giving yourself the ability to focus in on one treating and two, being an entrepreneur to have to think clearly to brainstorm and to create for your business are going to be the two most productive ways that you can take your business further and that you can grow.

So instead of hiring associates, first, I want you to hire two specific managers. One is an office manager who’s going to help you run the day to day running of the business, who can also serve as a front desk reception initially, who can also help you, uh, facilitate all the admin stuff while you are dealing with the clinical side of things. And then the other person that I want you to hire in terms of a manager is, uh, a social media manager or a marketing manager. Those are the two most important pieces and hires that you’re going to make because they’re going to free up your time. And it doesn’t mean that you lose control of these things, cause you’re still have your overall vision driving those. You’re still meeting with those managers to make sure that they’re on point and that they are facilitating your overall goal and vision, and that you’re still on the same page and that they’re running the business the way you want them to, but you are giving up the day-to-day management of the minutia and the detail of those tasks, which again, will free up a lot of your time and energy and resources, um, and get your mind thinking more about growth and clinic, which is where it should be versus running the day to day business.

If your mind stays on the day to day business, you’re going to have a really difficult time getting out of that and growing to where you want to be. And then part of any growth and hiring is culture. And I know that Aimee’s going to go into this a little bit more, but I have two points that I want to mention when it comes to culture. The first one is that anyone you hire to bring on has to believe in you. They have to believe in you as an individual. They have to believe in the medicine that you are providing. And they have to believe in the mission, the goal, the vision of where you want the business and the practice to go. So part of the questioning, um, that Lorne had discussed is going to be really valuable in hiring someone who believes in what you’re doing, where you want to go and how you’re trying to support, uh, patients.

And then the second part of hiring and growth is going to be trust that obviously you have to trust in them to facilitate what, what you’re trying to achieve, but they have to trust in you, right? They have to trust that you have their best intention at heart that, and they’ll have to, and they have to trust in you that you have your patient’s best intention at heart. And if those two things are, uh, are accomplished, then you can grow. You can achieve whatever it is that your heart desires, as long as you have the right path, the right support and the right culture in place to achieve that.

Thank you, mark. And, uh, two things I want to mention it, cause it comes up to me is that I can’t afford to hire an office manager. I will share with you that 13 years into practice. I burnt out and out of desperation. I decided to hire an office manager. And in my mind I was like, I’m going to make this much less this year because I’m paying an office manager. Now I didn’t choose to do it proactively, like is suggesting I was forced to do it because of my health. I burnt out guess what happened? So I hired this office manager, pay her salary, the clinic grew and paid her salary and was even more profitable because it freed up my energy to do what I do well, and she runs the clinic better than I could. So I did bring that in. If you’re saying, how am I going to do this?

I was prepared to make less. And sometimes it’s three steps backwards, 10 steps forward. I invite you not to have to burn out to find that out, to have to our office manager. I suggest you do it in advance, mark. Great points. Thank you very much. I’m looking for looking forward to continuing our work together and RTI you just a great communicator and you’ve shown it and I’m glad you’re teaching it. All right. Next up is I consider Aimee like a celebrity cause she’s been on all these cool TV shows and magazines. Um, um, and she’s our anchor today, Emmy. Um, Aimee, can you please talk a little bit about, um, cultural fit and, and fitting in? I know you have a lot to say on this.

Well, and I think what the point you just made about, um, you hired the office manager when you burnt out is, was my experience with hiring an associate? Um, I was, my practice was so busy and I was doing everything myself as we all do. And it was probably seen about 60 patients a week. I did have an assistant who was an acupuncture student. Um, but my, the same time my father had gotten diagnosed with a pretty aggressive cancer and was not doing well. And they were in California. I was in New York and I wanted to start getting there and spending more time, but I didn’t really have any backup. I didn’t have any help. And then, you know, a crisis happened, I actually had to get there and I was cornered into hiring an associate and it worked out she’s still with me, uh, 12 years later.

Uh, but it was, it’s an experience that I don’t think you want to put yourself in. You want to be set up to, um, hire and have your people aligned up. Who’s going to be there to support you. Who knows the team of the team, they, the brand’s mission and who can represent you. Right. I was really fortunate that who came in and literally saved me and saw my patients and basically helped me generate continuing to generate money so I could pay my rent and be with my family, um, worked out and she’s not just an acupuncture associated of mine for the last 12 years, but she’s also one of my lead fertility coaches at this point in my online business. And I think for all of us, it’s it is that I was never in that position where I felt like I could give things up.

I needed everything I was taking in. I thought bringing on an associate like similar to Lorne’s perspective with hiring, um, admin was gonna cut my income. And the interesting thing was, I think I missed 30% of my work days that year that I brought on my first associate and my income went up by 30%. And, and she also, I also provided enough income for her that she could quit her second job. And it was, it was a tremendous learning experience for me. And I was really, you know, tends to be how I do things is I can get thrown in. And then I kind of learn after the fact, but, um, from that experience and really every big growth point I’ve had moving forward from that point on was an understanding in what I like to call synergy, right? So my, my team synergy, my personal synergy, my business synergy.

And I think that is, you know, mark made some really good points about growth and the brand and the mission and trust, and that all has to be there in order for us to experience the kind of growth that we want and deserve. But it must also start with our own synergy with ourselves. So, and by that, I mean like, what is our alignment with ourselves? What is our alignment with our goals and our mission? And if you hate doing all the admin stuff or writing the blog posts or doing the social media, and then you’re also in the clinic, and then you also have to do the superbills and you, you know, you start to get very spread thin and you’re not aligned with the true purpose. And that alignment is what is key for the growth to happen the way you want it to.

And I think we can often get bogged down in kind of what mark was talking about as well of the day to day to do is, and we’re missing the bigger picture. So for me, as I’ve grown and you know, now I have the luxury of looking back and I didn’t always do everything in the correct order following the right steps. But what I tend to say, what was always true for me was, was the synergy in my alignment with my passion to help and to serve. And so for you to understand that if like coming home to that first, that, okay, is my alignment in check, is my synergy in check and similar to what Lorne learned and what I learned, how am I showing up for me? How am I showing up for my business? How am I protecting my business? How am I protecting my health?

And that is what constitutes, I mean, now I feel like I can step back and say that and see that from my own experience. Um, what constitutes a good leader too, is, is the leading by example piece. But you, you can’t do that if you’re not clear on what the vision is, what the values are, what the goals are, and you need your own checks and balances to come home to on, I think a weekly, even a daily basis, what is, what is my mission for today? What is my purpose for today? And what are the things that I need to do to grow my business? I know in the beginning for me, uh, you know, I had an assistant who was an acupuncture student, who is now my other associate. She’s been with me as well for over a decade. And, um, and then I was cornered into hiring an associate.

And then I had assistants over the years. And then as my other parts of my business grows, I started to write books. I started to have there wasn’t so much of an online presence, um, with my first book coming out. But as the years went on, then there was Facebook and there was social media and everybody was writing blogs. And I did not like all of that organization. And so I had to, again, I actually hired someone more of like a coach type situation, a business coach who helped me align and get clear what, you know, similar to what mark is saying, what, what is, what is the vision, um, where do I want to see my business in five years? What are the things I love to do? What are the things I hate to do? What are the things I need to take off my plate so that I can achieve these goals and these desires.

And it wasn’t until I was able to do that and prioritize that. And it was an expense, but it really helped streamline my business, move things forward. And I could start to put things into their containers. And that’s what really started to allow more growth for me. But it was, it was rooted in the synergy that I had with myself first, the alignment with my goals, my visions, and then now, as my team has grown, you know, I now have a chief of operations and she basically, as a Jack of all trades, she does social media. She helps with my newsletters. She does all the things that I don’t really love to do. I like to go on video and talk and be live. So I’ve gotten very clear about what I like and I like to be in the clinic. And I like to coach, I like to work with clients.

I like that one-on-one time. Right. Everybody is going to figure out what, what they like and what’s their special split space to be in, in their business. And then I think you, you think about hiring on support and another thing that is, uh, you know, mark and Lorne both touched upon is everyone who’s ever worked for me actually started as a patient HIPAA compliant or not. I don’t really know don’t really care cause it’s worked out for me. Um, and they believe in the medicine. They believe in me. They trust me, they get me, they understand my message. Whenever I’ve written a book and had a big book launch. If I had a PR campaign, a public relations campaign, I always made the head of a campaign, become a patient because no one could understand me unless they were a patient of mine. That’s really what I started to see.

And again, that comes back to the synergy cause they saw me in my element. And so, um, for you to think about that too, of like what lights me up, what is my alignment? And then how can I convey that? And that’s so much a part of what you’re conveying as you’re growing your business as you’re growing your brand. Um, and also as you’re hiring, because then once you start to have this team, um, and, and Lorne touched upon it too, is a, without your synergy and alignment, the business doesn’t have that strong center, right? And it’s, it’s impossible to grow if you are wishy-washy anywhere in that sense of alignment and synergy, it can always change and adjust. But what are the, what are the core principles of, of your business? And then also you need from there, these clearly defined goals and expectations of your team, whether they’re associates, whether it’s your front, front desk person, your acupuncture, assistant your head of social media, what, what are the pillars of the business?

What are the core mission statements? What is the synergy and the alignment, and are we all on the same page? Are we speaking the same voice? And I find that the, you know, critical number one way to get there is you have to own it yourself. You have to lead by example, you have to believe in the practice that you are doing. You need a team that also believes in that practice and believes in you and you need regular meetings with your team. This was something I greatly resisted. I never was in the corporate setting. I always, um, laughed at the idea of having a meeting about a meeting. It would just drive me insane. Like I was like, this is just the most inefficient use of time ever. And I don’t want to have meetings about meetings. Like I will never be that person.

And I’ve realized I need meetings about meetings because it’s actually what keeps my team together. And I had a recent situation where my virtual assistant she’s my admin. She basically runs everything from a virtual perspective with clinic and online. She couldn’t make our regular team calls because of a, pre-pub another commitment and her internship. And I started to see the team fall apart. There started to be miscommunications. There started to be just, there was the synergy was disappearing. And so I had to get her on the phone and we talked it through and I was like, well, we have to find a time because this there’s going to be a breakdown in the system. We’re a small team. We have to find time every single week that everybody is on a video call and we’re hearing each other’s voices. We’re making sure that we’re, we’re on the same page, that synergy, we have to come back home and remember, what is our mission?

What is, what is our purpose here? What are our goals? Right. We have our monthly goals. We have our quarterly goals from a financial perspective, from a business growth perspective and also from a service perspective. And so without that convening on a regular basis weekly, you’ll start to see things get broken up and your team will lose its it’s synergy. And without that synergy, it’s, it’s very challenging for the growth to reach the next level. So to me, it’s about, you have to come back home to you and your own personal synergy, getting very clear, similar to what mark said about your goals, your plan coming back home to that as often as you can. And then when you have your team, it’s the same thing. I have weekly meetings with each of my associates where we go over cases, we’re talking Chinese medicine constantly, even though we’re both, you know, we’re all seasoned practitioners at this point.

We’re just, what’s our goal. What’s our mission talking the same talk, feeling, you know, understanding the case in the same ways. Super important. I do that with my team as well with my chief of operations and my assistant. And so, and then we also have a broader group call once a month with everybody and again for synergy. And so we can all see and hear and understand each other, have compassion for each other, know that our goals are aligned and that’s what really helps support that growth in that culture. And, um, you know, I don’t, I, at this point haven’t had, um, people leave the team because they feel very heard. They feel very purposeful. They feel a part of something and they’re, they’re seeing the results. So to really think about that when, um, in your growth vision of how aligned are you and, um, what is, what is your synergy that you’re bringing to your mission to your business? And then as your team grows to that, you have constant check-ins around that synergy.

Thank you, Aimee. And I’ll share with you guys that on the RTI page, healthy seminars.com/rti, um, sign up because we’re going to be offering some three little short webinars like this, where we’re going to go into more detail about hiring associates and staff and other things about growing your practice, because we’re in this, uh, when we talk about our practices and growth, we’re in this because we want to help you, our communities, we do this because we love it. And, um, and that’s, that’s the focus and that’s why we want to grow because, uh, in life we can’t just stay still that stagnant. You’re either shrinking or expanding. And so let’s expand and help heal our communities again, Marc and Aimee, thank you very much, uh, for participating in having you as my experts and enjoy doing the coaching and mentorship with you guys. And again, I want to thank the AAC to the point, um, for inviting me to offer these, uh, practice management, uh, seminars and webinars, and, uh, check in for next week. Um, cause we have another special guest on the AAC To The Point. So tune in and listen to that webinar as well.

[inaudible].

 

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Working with the Psoas Major and its Respective Sinew Channels

 

 

This is  a particular muscle that a lot of people have interest in. It’s a very prominent structure. You could consider it part of the core of the body depending on how people define core.

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

Hello, welcome. And thanks for having us. Thanks to the American Acupuncture Council for welcoming us back. Uh, always great to do these webinars. Um, very frequently I do these with Matt Callison who had something to attend to today, so he wasn’t able to be here. Uh, we’ve kind of put this presentation together, uh, between the two of us, but in some ways, uh, sometimes one of us does a little bit more work on one particular one or the other. So this one, I actually did a little bit more of the setup with, so if he’s going to be out for a particular event, this one was probably as good as any, but it’s always nice to have them here and do this together. But anyways, um, that is why I’m doing this one by myself, but let’s go ahead and jump into the presentation. So what we’re going to be presenting on is the psoas major muscle.

This is, uh, a particular muscle that a lot of people have interest in. It’s a very prominent structure. Uh, you could consider it part of the core of the body depending on how people define core. Um, it can be one of the core structures. That definitely is a very core structure in terms of its stabilizing role on the spine. So we’ll go over all of this in the presentation, but it is such a central muscle that we decided to focus on it. Um, this particular timing, uh, we, we are focusing on it in this presentation because we’re getting ready to put together a, um, a little bit longer of a class, maybe like a three hour class, really much more of a deep dive into the, so as that that’ll probably be out for, um, available, uh, on a webinar for, uh, um, see use later in the, either the year, probably more likely, uh, closer to the new year in January.

So, uh, be on the lookout for that. It’ll be available on our webpage. It’ll be available through net of knowledge. Uh, so this is kind of the preparation for that. It’s a little shorter version of it. And we’re going to go into a little bit of depth in here and give you some ideas of how to work with this really important structure. So let’s go ahead and jump in. So first of all, let’s look at the anatomy. The, so as some ways has two heads on the axial spine there’s attachments, uh, on the vertebral bodies and actually right into the intervertebral discs of L four through T 12. So that tells you something right away that this is going to be involved in a lot of spinal problems in terms of its centrality and how it’s right up against those vertebral bodies with attachments right into the desks.

But that’s one of the heads L four through T 12, but then that one’s available in this image here. But if we were to kind of think, uh, posterior to this, if we were to kind of remove a vital little clicker and could remove the front surface of that. So as we’d see, it’s more posterior head, which is on the lesser trow canter, uh, excuse me, on the transverse processes of L five through T 12. Uh, so we have those two heads, which will be important in a, in a second, when we look at some of the neurology of this structure. Um, but for now just understanding that it really has attachments all the way up from L five to T 12, all the way on the lumbar spine, including lumbar discs for Debo bodies and that, um, the transverse processes, then it sort of descends down.

It crosses over the Elio pectineal Ridge, sort of over the junction between the pubic bone and the ilium, and then crosses and dives down towards the lesser trochanter of the femur. So that’s the territory we’re looking at in the grayed out sort of portion of this structure. We have the iliacus and as you see, and as many of you I’m sure know that the iliac is, has a common attachment on the lesser trow canter with the SOA. So sometimes people refer to as the iliopsoas, including that iliac Cassandra. So as I personally like separating those muscles, even though they have a common attachment on the femur, for reasons that we’ll get into a little bit later, both, uh, something we can see right now. And so as has actions on the spine where the ELA Acus doesn’t, but when we started looking at the channel sinews and some of those relationships, it’s nice to, in some ways have those muscles and separate mental compartments so that we can look at the sort of channel relationships to them. But yes, a lot of times people were referred to the iliopsoas because of that common attachment on the femur. Uh, so that’s the anatomy and that’s the territory that we’re looking at.

So one thing to know, right from the get go with the solo ads is it’s intimately related with the lumbar plexus. Uh, and, and particularly with the nerves that come from the lumbar plexus. So let’s look at this Netter image for a moment and kind of get our orientation straight. First of all, on the right side, we have the so as intact. So if you look at it by right side, I mean the illustrations, right. You know, the, the specimens right on the right side of the size is intact. And if you look at the left, so as not only is it cut as you get a little bit towards L five, you know, imagine you’re doing dissection and never was painting this image, I’m sure he was going by a dissection model. Um, so maybe they had already cut the so as, and, and so we can see the iliac is deep to that.

Um, but more than that on the left side, you can see that some of that more anterior head that attaches to the vertebral bodies and discs have also been cut away and we can see right into the body of the psoas and see that the lumbar plexus is actually situated right in top or right inside the, so as between those two heads between yeah, right there between those two heads of the, so as, uh, is the lumbar plexus and the nerves that come from the lumbar plexus, uh, and this particular study, uh, I’m quoting here, looked at the, um, dissections for 63 specimens and dissection and 61 of those, that was the case. So there’s variability like everything in human body, but in the majority, the vast majority of the cases that whole lumbar plexus is going to be situated inside the so ads. And then all the nerves that are coming from the lumbar plexus are going to penetrate through the solo ads.

So we can kind of look at that here. If we go back to the right side, we can look at the top most nerve that doesn’t actually penetrate through the, so as cause it’s not part of the lumbar plexus, that’s the subcostal nerve. It does share with the lumbar plexus, but then it wraps around the body, uh, innovate some of the abdominal muscles and the skin kind of, of the, the abdomen then below that we have the Iliad hypogastric and the ilioinguinal nerves, those do actually penetrate right through the psoas cause they’re coming from that lumbar plexus. So then they exit the, so as in those upper portion, uh, upper kind of proximal fibers of the, so as if we continue down from there, we have the lateral femoral cutaneous nerve. So it exits, so as a little bit more distal, a little bit more on the inferior portion of the fibers.

If we go a little bit, medial, you can see penetrating right through the psoas is a genital femoral nerve. And then if we go actually immediate to the, so as in that area, we’d have to kind of pick it out, but there’s the opterator nerve. So all of those have a relationship with the psoas in the sense that they’re all coming from the lumbar plexus, they all, you know, Pierce the, so as, uh, an exit, the, so as, um, and they have, you know, again, this intimate relationship with the psoas muscle. So we’ll get into that later in the importance of that. There’s a lot of importance just thinking about the anatomy. I’m sure you can think of many cases and pain patterns, trigger point referral patterns, how all of that is tied together and makes the, so as such a prominent structure and creating its own pain in the body, but also contributing to, um, various pain syndromes, like maybe back a lumbar junction syndrome, uh, involvement with clean Neal nerves, which are also coming from this lumbar plexus, but they’re on the posterior part, not visible from this image.

There’s a whole bunch of pain patterns. Um, a brief sidestep on this. This is not directly about the solo ads, but for those who are really into channel relationships, my interpretation of the dye, my, uh, is really these nerves that wrap around like those subcostal nerves, dealio hypogastric Leo and wean all lateral framework, cutaneous nerves, there’s nerves that are wrapping around from the back lumbar plaques, plexus and wrapping around the abdomen. I think that that speaks a little bit to the dynamite. I don’t know if I would say that the dynamite equals those nerves, but those nerves are part of the physiology of the dynamite because those nerves also innovate the abdominal muscles, like the transverse abdominis and the mobile leaks. Um, those nerves are influenced, as we know, by gallbladder 41, the oblique muscles are part of the gallbladder send you a channel. So I think somehow regulating tension through gallbladder 41 has an effect on those nerves that really wrap around following the trajectory of the diamond.

One other little thing about this it’s quite interesting is that the, you might have to go back and look this up if you haven’t looked at it for awhile, but the kidney divergent channel links intersects with the, my, uh, at L two, that’s just how it’s classically described intersects at the dynamite. And if you look at the trajectory of the opterator nerve, this other nerve of the lumbar plexus that opterator nerve goes right down and has sensory fibers right down to almost like the kidney 10 region. And that’s where the, um, kidney divergent channel takes off come kind of from that popliteal region comes up the thigh and then meets and intersects at the dynamite at L two region. So I think when we’re looking at the, my we’re looking somewhat at the physiology of the, uh, um, the lumbar plexus and the psoas is as kind of part of that relationship, but little bit more of a different subject, maybe in another day, we can hash that out a little bit more, but since we’re looking at this anatomy, it’s worth taking a moment to kind of, uh, compare and look at that kind of comparative anatomy between Western and Eastern.

All right. So some other, uh, ways that the, so as, um, interacts with the anatomy around it again, let’s get our orientation straight from this Netter image on the right of the specimen. The so as has been cut. So if you look closely, you’ll see the proximal fibers where it’s cut, and if you follow it down, you might even see the distal fibers. That’s kind of right over the [inaudible]. Yeah, they’re right there. So again, that’s so we can see what steep to that. We can see the quadratus lumborum. So the psoas and the quadratus lumborum have a pretty close relationship. The quadratus lumborum being a little bit more posterior takes off from the iliac crest and then goes up to the 12th rib. So there we have the quadratus, lumborum a really important muscle. We could do a class on the quadratus. Lumborum, it’s, it’s also really a, a quite a, um, important structure.

And maybe someday that’ll be a subject of one of these webinars. Um, I do want to highlight that anatomy because we have a dissection video coming up that is on the, so as, and that’s why I put it on here, but it does also cover the QL because if you look just distal to the quadratus, lumborum on the right. You can see how it shares fibers into the iliacus muscle, which isn’t that kind of pelvic bowl. And then that iliac is muscle. Like we looked at that common attachment on the lesser Cho canter, really farms, a continuous myofascial plane, all the way down to the ad doctors. You’ll see this in another image coming up and I’ll highlight it again. Um, but that in our interpretation and sports medicine, acupuncture is part of the liver send you a channel. You wouldn’t think of the quadratus lumborum as being part of the liver channel because in some ways we have to needle it from the back, but it’s not really a back muscle.

It’s a core, it’s a central muscle. It’s really a yin muscle on the inside of the body. Um, none of the medial thigh from the ad doctors, but then it blends in at the spinal attachments that we looked at and it really then becomes part of the kidney send new channel, which is interesting because not only is it part of the kidney send a channel, but we can see that the kidney organ is right up against that. So as, and in visceral osteopathy, they talk about how that, so as moves along the rails of the, so as you know, that if you kind of picture the psoas as being a rails of a train track, you know, that the kidney moves along the, so as the fascia is really intimately related with the, so as the renal fascia, and so as muscle, um, and by moves, what I mean is every time you take a breath that, so as moves about two centimeters down as the, as the diaphragm descends, it pushes the dominal contents, including the kidneys, all of the organs, liver, all of that.

But in this case, the kidney itself, it moves along. It kind of follows along that rail of the solo ads. So if you think about how many breaths you take every day, I don’t have the exact figure. This is something that when Matt was here, because he does know this Lennox, I heard him say it recently, but, um, but it’s quite a large amount of distance that, that kidney travels two centimeters isn’t that far, but two centimeters, every several seconds, all day that’s, that’s a lot of territory. So what happens now, if the renal fascia and the kid in the psoas, fascia are all adhered to each other and there’s limited capacity for that kidney to descend, well, then we’re going to have, you know, maybe restrictions in the psoas restrictions in the, in the hip flection. Uh, we’re going to have inability for the diaphragm to descend, you know, it’s going to cause some kind of obstruction, some kind of congestion that’s going to cause some health issues.

So when you’re working with the psoas, I think what I would take home from that relationship is when you’re working with the psoas, to some degree, you’re working with the kidney, if there’s more movement and more movement potential. And so as there’s more movement potential in the kidneys, and one of the ways that the kidneys become ill, and I don’t mean like kidney disease, um, in Western Sant standpoint, but in terms of lack of function is that they start to lose that mobility and motility of the Oregon kind of moving along the, um, the, so as, and then that can maybe descend a little bit. It can put pressure on those nerves we were looking at and it can cause their own symptomology. So being able to free up this region can really, um, both include improve function in the hip muscles. But, um, but also in the internal organs, the other thing that we can highlight, if you go back to the right side, we can see that proximal part of the, so as it’s cut, we can see how intimately related that is with the Dyer for him.

So that’s the cut portion yet right there. So in this nice, clean, better image where they take off all the fascia, you can see that it touches it, but in a real dissection with the fascia intact, you can see how integrated those fascial components are. And they become really one in the same, those sort of feed the crew of the diaphragm, the extensions and attachments of the diaphragm with the proximal. So as, so when you get people who are posterior tilt of the rib cage, maybe their pelvis slides forward and the rib cage tilts back. And it compresses that region of the diaphragm on the, so as that can have implications in breathing, I’m already thinking of kidney, not, um, grasping lung Chi is one way that I see it manifest. Um, so it’s gonna, it’s gonna decrease the ability of the diaphragm to descend, but it also can actually turn off the, so as, and cause problems with SOS its ability to stabilize the spine.

So when you start getting patients who maybe have back pain after starting to run, or they’re out dancing, moving in the back, pain comes on maybe five minutes as they start to tax their breathing. That’s one to start thinking of that relationship. And we have ways that we work on that in sports medicine, acupuncture. Unfortunately it won’t be in this webinar, but we’ll look at some ways that would affect it. Um, also, so kidney, so as QL, those are all and diaphragm. Those are all pretty intimately related. So let’s go into the next image, the next slide.

So here’s the, uh, image I put together for the send new channel relationships. So we’ve already talked about them. I don’t think I need to spend a whole ton of time saying it again, but, but we can see it from a different capacity now. So we have that medial thigh with the ad doctors, especially at Dr. Longest brevis and Peck tineas Priscilla’s could also be included in that these are part of the liver, send you a channel for those who know anatomy pretty well. The posterior muscle of this ad doctor group adductor Magnus attaches to a different portion on the back of the femur. It’s in a little bit different that, um, region that’s a little more posterior than this group that would be part of the kidney send new channel. So we’re looking at the thigh portion. We’re looking at the liver, send you a channel as it comes up to medial thigh, and you can see both the iliac is in the, so as the Eylea.

So as is part of that, liver send you a channel coming from distal, going up into the body. Uh, we talked about the iliacus and the QL. You can kind of find that in this image that it’s marked on the right [inaudible], that’s following that liver sinew channel all the way to the 12th rib. And then the, so as starts to attach more into the bodies of the vertebra blends in with the anterior longitudinal ligament, and it becomes part of the kidney sinew channels. So the SOA has this kind of a crossover. It takes off this delay from the liver sinew channel, and it ties into, um, the kidney send new channel. So which isn’t, well, we talk about it a couple different ways when you’re working with the distal ileus. So as for like grind strains, then more often than not there’s direct needle and you can do of course, but if you’re using disappoints, it’s going to be liver channel points that are going to have more of an effect on it.

Liver for liver five, those types of points are going to have a stronger effect on that liver. Five’s going to have a really strong effect on the quadratus lumborum through that, that QL iliacus relationship, but it would also have an effect on the distal Lilya. So as, so really when you’re talking about that distal portion, as it comes over the alien pectineal Ridge, and then God goes down to attached to the femur, you can kind of think of that as, as liver territory, liver sinew, channel territory, as it dives deep into the body. And we’re talking more about stabilization of the lumbar spine. We’re talking about how that stabilizes and moves and supports the lumbar spine. Then I’m going to put on my kidneys and new channel hat and think about its role more from the kidney sinew channel and how that’s going to affect it.

We will look in this webinar at a way of affecting that relationship when it’s not stabilizing the spine. And if the, um, so as this sort of testing week, um, but if I were going to use distal points, I might start thinking more kidney points, give me seven, the tone of vacation point on the kidney channel, uh, can sometimes wake up that ability for the SOS to support the lumbar spine. Uh, so if you’re thinking more body of the size, I guess you could say kidney, if you’re thinking more distal iliopsoas, you can think liver’s a new channel. I can say it a different way that if I’m thinking excess, I tend to see more of a relationship with the liver sinew channel, uh, excess meaning hypertonic restrictive. When I start seeing situations where it’s more about stability and support, then I see more of a relationship with the kidney channel kidney, send new channel a kidney channel points, distally.

So that’s a way of kind of making sense of its roles in terms of these two channels and it connects with all right. So actions of the SOS, the, so as does hip and trunk flection, hip flection, of course, we think about that with walking trunk flection. I want to come back to and a couple of slides. So just kind of put a little asterisk by that one that does lateral rotation of the hip, unless you see a source that says it does medial rotation of the hip. Um, lateral rotation is the bigger consensus, but I think gets rotation on the hip is negligible. I don’t really think about it so much personally, unless I’m doing a manual muscle test and you’ll see in the image coming up for that, that, um, there is a slight, uh, lateral rotation, but I don’t think it has a real large role in terms of lateral or medial rotation of the hip. Um, and sources say different things about it. So maybe it varies depending on the person’s position and how their body’s structure is hip flection, definitely trunk flection, definitely. Um, this third bullet point also definitely lateral flection of the spine and contralateral rotation. So if you can kind of picture that. So as contracting on one side, it’s gonna side them, that’s fine until a lateral flection to that side and rotated away.

Okay. So let’s think then about that. The, so as could be shortened, it could contract and shorten can contract and shorten and movement have flection and all that. But if it’s chronically hypertonic, it’s going to Paul on the lumbar spine it’s going to, and this is the consensus it’s going to pull it into more of a excessive lordotic curve. It doesn’t attach directly to the pelvis, but in the process of that spine being pulled into a lordotic curve and exaggerating that hyperextension of the spine, as it pulls the spine closer to the lesser trow canter, it’s going to pull the pelvis into an anterior tilt. So that top image is showing a neutral pelvis. Matt has a measurement at the ASI S and then I’m in the front and then a PSIS in the back. And there’s about a quarter inch. We’ve got about a finger width between that.

So that’s, uh, the, the measurement for a normal kind of a neutral pelvis. It’s about a quarter of an inch higher on the back, that’s normal. Um, but in the lower picture, you can see now that, uh, that quarter of an inch that is greater than a quarter of inch, that ASI S is situated, uh, much lower than what you see in the top image. So that’s what you had started seeing with bilateral shortness or unilateral if we’re just looking at it from one side, but let’s imagine that the, so that the pelvis bilaterally in that anterior tilt that same measurement and he’s doing on the right would look very similar on the left, this measurement, you know, it takes a little practice. You have to be right at the center of the PSIS. You have to find the upper border. You have to find the lower border, kind of find the lateral medial border and get right in the center of it.

And then the highest part also of the ASI S and that’s going to give you the measurement, cause you can kind of picture if I’m at the top border of the, um, uh, geez, it looks like I’m a mirror image here. I’m going to change my Android phone. See if, I don’t know if you guys are seeing the same thing I am. Um, if I’m, if I’m at the top border of the PSIS and the lower border of the ASI S it’s going to give me a false read, I need to be in a very consistent place. And that would be at the peak, you know, the central aspect of the PSIS and DSIS, um, and that’s gonna give me a sort of a more accurate measurement, but, um, that’s how you would measure it. But, you know, just looking at it, if you just look at that lower image, you can see that there’s a greater inclination forward, uh, anterior tilt of that bottom image.

So that was that way on both sides. And I would be thinking that the so as is in a locked short position, bilaterally polling, that’s fine into an excessive lordotic curve, taking the pelvis with it into an anterior tilt. Sometimes it looks like the person can’t fully stand up, picture them, seated, their hips flex. They go to stand up. And it’s like, as if they, that last few degrees of hip hip extension isn’t there, and they’re kind of held into hip flection and their spine tends to be a little bit more arch. This is the consensus with a shortening of the, so as at least bilaterally, uh, Tom Myers has an interesting perspective on it that I do kind of think there’s some merit to this, and he looks at the upper fibers versus the lower fibers. So when you remember back to those images were talking about the anatomy.

There is, it’s almost like six muscles, right from, from L five all the way to T 12. I did it as dissection at university of Tampa with a physician assistant group, um, where they’re there for the students, for the physician assistants. And I was helping lead this dice, the kind of group of dissections, and one of the specimens had really severe scoliosis in the spine and the lumbar spine almost became horizontal. And you could really see on that side, there’s six individual slips of the muscle as they were kind of widen that whole aspect of the psoas. And you’d see those each of those little slips going and attaching to the various side, um, attachment sites on the, on the spine. And with that spine orientation change to kind of widen the whole. So as, and, and almost gave that appearance of the six muscles.

So if you think of that, that way, those upper fibers, the ones that are accessible more laterally are the ones that go up higher, uh, on the, uh, on the, on the T 12 L one region, if those are shortened, like in that upper picture on the right, that might actually pull the spine more into a, uh, straighten kind of curve as if the person is on the floor doing trunk flection, like a curl, which the so as would be involved with, I would say that, that in that case, it’s more of the upper fibers, whereas the lower fibers in that bottom right image and kind of drawing, that’s really showing more of the lower fibers, pulling the spine into a hyperlordotic curve. I think this plays out quite a bit, especially when you get people whose pelvis has shifted forward and the rib cage has shifted back.

Sometimes those upper fibers are the more involved ones. So you can almost see the, so as, as being, uh, an antagonist of itself, you know, upper fibers versus lower fibers, this is not the norm, a normal view. This is not the consensus. This is an alternate view, but I kinda liked this view. And it kind of does give me some suggestions of how I work, especially with manual therapy, unilateral shortening, like we mentioned, is going to pull the spine into lateral flection to that side and contralateral rotation. When you’re looking at somebody, the umbilicus will look like it’s pointing away from the, the short. So as, so it’d be, that’s a, that’s a simple way of looking at it. You can kind of see the, uh, the umbilicus saying, you know, I’m pointing away from it that said the direction is pointing to would be more of the length.

And so as the, the direction is pointing away from would be the short. And so as there’s a lot of things that can involve that can affect the iliac. I mean, the umbilicus a position there could be scar tissue there. So I don’t take that too literally. That’s, um, it’s not an way, but you can sometimes come over the person and look down the spine and you can see that lumbar spine rotating one way or the other. So the side that’s more posterior is going to be the length and side. Um, in the side, that’s more anterior is going to be the shortened side. We’ll look at another way to, uh, to address this in a second.

All right. So we have a cadaver video coming up. I just want to remind people, who’ve seen some webinars where we have cadaver videos that these are, um, you know, it, shouldn’t be kind of viewed in public if you’re at Starbucks right now, and there’s somebody who can see your screen, maybe it’d be good to, to not watch this. Now, come back and watch it later. Just be mindful of your surroundings. This one, no faces are shown, but this one is pretty internal. And I think it could be disturbing for people who aren’t medical professionals of yourself. Do you find this stuff kind of disturbing, maybe don’t watch, but especially be mindful of your surroundings. Don’t take screenshots, don’t share these don’t record and share these videos. You know, we have to be really respectful for the donors. This is for medical professionals. Um, so just have that caveat when you’re watching it. And let’s go ahead and look at this. It’s going to show the, so as it’s going to show that QL and iliac is relationship and some movement.

So one last that aspect with the solo ads is we can look at the different fibers medial versus lateral, and how that relates to the lumbar spine. So if I look at these medial fibers, the medial fibers are going to be attaching to L five and L four and the lower portion, but the more lateral I go, the higher up the fibers become. So the fibers that are going up to T 12 L one upper portion are going to be the lateral fibers. And the ones that are going into the lower lumbar spine are going to be the medial fibers. So there’s some indications and some viewpoints on this that the medial fibers would be more involved with an anterior tilt and with lordosis, as they would be pulling the lumbar spine into a hyperlordosis hyperlordotic position, pulling the a L five L four L three lower portions into lordosis versus a posterior tilt where maybe the T 12 L one portion could be putting the, uh, lateral fibers and more upper fibers into a shortened position.

It’s not the common view, it’s just an alternate view, but interesting to think since the muscle is multiple slips, that this could be both involved in an anterior and posterior tilt, depending on which fibers you’re looking at, especially relevant for manual work, um, because we’re, we could highlight the different fibers. Last thing we can look at since we’ve talked about the quadratus lumborum is we get a good view of the quadratus. Lumborum now coming to the medial portion of the iliac crest and joining facially, at least the fascia has been taken off, but you can see the same fascial plane in through the iliacus. And then of course, down into the liver channel, as it travels and meets with the, uh, fascia of the abductors, as I go up from there, the diaphragm has been removed during the evisceration process, or at least disturbed, but we can appreciate that that same fascial plane then would blend into the cruise or the feed of the diaphragm from the upper fibers of the QL. And of course the so as itself would be a very, uh, integrated with the upper fibers of the diaphragm.

Actually, Alan, I think there was a, a little bit more of that video. I wonder if we can go back and slide forward a little bit, if we can’t do this, it’s no big deal instead of watching the whole thing. I don’t know if this can be a jumped up at the middle,

Unfortunately.

Okay. Yeah, no worries. No worries. Yeah, no worries. Okay. So let’s go to the next side that this one just shows some of the, like, kind of move the rib cage and you can see the, so as like side bending the spine, but I think we got a pretty good, pretty clear idea with that. Um, just by description. Uh, so this, uh, test here is, uh, lumbopelvic rhythm. This, we look more at for the urinary bladder, uh, channel relationships and new channel. It’s looking at the normal position where the lumbar spine moves in a one-to-one relationship with the nominate bone in the middle one. It’s showing that the innominate bone, um, is not moving so that you’re getting all, all movement in the lumbar spine, showing a restriction in the hamstrings, in the farthest, right. One, the nomina bone is moving, but the lumbar spine, not some more of that restriction in the urinary bladder sinew channel at the level of the lumbars.

Why am I showing it here? Because after we do this test, we can go to the next slide and we can have the person, uh, facing away from us and we can look at them from the back. And if you look at that image and I’ll let you look at it for a minute, um, from the back, can you see that one side is up higher? And by one side, I mean, the lumbar spine is up higher than the other side. So going back to that information of what the unilateral imbalance does at the, so as that Ray’s side is going to show us, show us the likely locked long inhibited. So as whereas the lock short, so as it’s going to be on this case, on the right side, which is pulling that accessibly into rotate rotation, or the left side is failing to support the spine, which is it, is this excess or deficient excess on the right deficient on the left, in relationship to each other, but on any given person, then we have to figure out, is this more about that excess more about the deficiency or both, but at least it’s telling us there’s an imbalance there.

So this lumbopelvic rhythm, great test for the urinary bladder, you a channel, but we can, uh, look at it from the back and get a window into the kidney sinew channel. So we have that left side showing that a relative length and position compared to the right side. And we can take that right into a manual muscle test manual muscle test of the psoas is having the hip and about 35 to 40 degrees. Fluxion that image is showing a little bit more than that. I think I put the wrong image in that. I noticed this just before we went live. Uh, this looks like the iliacus manual muscle test. So imagine that same position, but a little less hip flection. Yeah, yeah. About that angle of hip flection. So they look alike and I just grabbed the wrong one. But, um, so as manual muscle tests, everything else would be approximately the same, but it’s more of that 35 to 40 degrees of abduction flection, and then abduction to about 35 degrees driving UV 58 back towards the table.

So you’re taking them and slight AB duction, but really focusing on the extension and the so as it’s called onto to support that. So that is a manual muscle test of the so as you can do that immediately after the, um, seeing that, that sign, that, so as signed in the previous task store, you might do this on its own, but this is going to give you a window into how the so as is, are supporting the body. You have the person, you kind of give an initial load and as you over pressure, the, so as you’re seeing of that, so as fibers has enough cheese to lock on, we’ll talk about GB 27 in a second at top, probably we’ll close with, but you could also try even just putting a point in something like kidney seven and seeing if that wakes up, you might have to draw the needle back before you test and then retest and see if there’s a little bit more strength than the, so as kidney 27, we’ll definitely do it.

But, um, but you can also look for other points like kidney seven, kidney, three, kidney, six other channel points that might affect it. I’m not going to talk about 62 and [inaudible], that is a little bit longer of a discussion. Um, let’s go then to the next slide. So that goes into treatment. We have motor points that lie deep to UV 24 and UV 25. I’m not going to go in and into the needle technique for these because they involve a pretty deep needle technique that really takes some time to, to talk about, um, and we’ll allude to it, but it’s really something that needs to be spent a lot more time, uh, for safety reasons, but you can needle the, so as directly from the back, um, there’s these two motor points, they lied deep to a U B 24 and UV 25 physician is going into the next slide is through the back.

There’s a needle technique that kind of follows the edge of the, um, Leo Castelli’s lumborum muscle and goes along the lateral Rapha, right to the, the, so as, um, it’s safe if it’s done properly, but to go through all the details in such a quick, uh, class, like this would be a little bit irresponsible cause this one can cause damage. Cause it’s a fairly deep technique and there’s some, some complications, first thing going to reflect some spasm. You just have to be aware of some things before doing it. Um, this could be though useful for the excess side, particularly. So it is one of the, to consider learning at some point. Um, but the next one is going to affect the psoas actually quite well, especially for the, the locked long inhibited. So as, um, this is a technique that Matt, uh, came up with years, uh, years and years ago and as used and taught and a lot of people have used it quite successfully for a long time.

And this is using, uh, gallbladder 27. So with gallbladder 27, you’re angling it slightly lateral. And with like a slow sort of in and out, um, green turtle searching for the point, uh, noodle technique until you get either one of the following sensations, either wrapping back around the diamond, uh, wrapping down towards the liver channel towards the groin or following the stomach channel down the side of the leg, effecting either the lateral femoral cutaneous nerve down the stomach channel, the Elio hypergraph gastric nerve going towards the groin or the ilioinguinal nerve wrapping around. Um, maybe I think I have that back rail hypogastric wrapping around the DMI ilioinguinal wrapping to the groin, but it’s affecting one of those nerves from the lumbar plexus then, which is going to reflexively turn back the, so as on kind of stimulate that same neurology, cause it’s also in an innervated by that lumbar plexus and turn that so as back on, so it doesn’t have to be a strong sensation, but you need one of those three sensations and that will turn kind of calm down.

We’ll lock short. So as, but this technique really shines for the lock long inhibited size. Right. And I think I was wasn’t sure timing if we’d have time to show a manual technique, but, um, I think we have a little bit of time. It’s not real long, so let’s go ahead and go into that because I think this will bring it together. This is from a blog post. We just came out in October. Um, so it’s not sports medicine acupuncture. If you’re looking at this, um, webinar later on, um, it’s the October post. You don’t need to know that you can just find it, do a search warrant or find it, but it’s called working with SOS. Um, and it goes into this technique a little bit of setup, but then into this technique a little bit more in depth, uh, this technique is also on our YouTube channel, this video you’re about to see so you can access it there.

And if you wanted to review it later, um, or of course it’ll be in the recording for this class. So quick set up and then we’ll look at the video I’m working on both sides at the same time. It’s a very integrated technique. I’m going to do a movement that simulates walking. And then as simply I could say, I’m pinning down the cell ads and just letting that kind of free up each side, but really I can do more than that. I can kind of nudge, you know, maybe so as it’s really narrow and pulled medial, I can nudge it more wider. I can kind of work on those medial fibers and nudge it out a little bit. I can nudge the lighter side more, even more medial and kind of even that out that way. So, um, depending on which fibers are short, I can kind of affect it.

I can feel when I’m in there, that one, so is going to be much more medial and that’s going to be probably the last kind of short side and the way it kind of changes the orientation of that. So as the, um, other thing is when the person presses their foot move into, you’re going to see in a second and lifts the other foot, there’s sort of a down on the foot, they press, there’s sort of a downward movement and an upward movement on the foot they lift. And you can feel if those are even, and I can nudge it down or nudge it up. So I can kind of look for an even movement of the psoas. But what I’m really doing is using the SOA as its puppet strings to sort of mobilize and get an easement, even rotational movement in the lumbar spine and all the way through the pelvis. So simply I can just hold it down and kind of free, or I can influence movement. I can kind of mobilize in various directions. I kind of say this in the video, but I don’t think I go quite in as much detail. So let’s go and look at the video.

So we’re going to do it. So as technique, this one is going to be, um, working on both sides left and right at the same time, it’s very much of an integrative technique because we’re trying to sort of get an even tone between the two sides, but also an even movement. So let’s look at the movement aspect. First, the patient is going to slowly lift one foot up. At least they’re going to lift the weight up. They might not actually lift the foot off the table, but they’re going to start to bring the weight off that foot while they push the weight into the other foot. It’s like a walking motion. There you go. You don’t have to actually lift the foot up. It’s more about the pushing, but than it is about the, um, lifting foot. So they don’t have to literally lift it off the table.

There you go. Now decrease that movement by about 60, 50%. There you go. Yeah. So it’s a small movement. So she’s starting to do a movement. That’s very much like walking. So when I’m in working on the SOA, as at the time, I’ll be able to feel the movement that’s happening associated with the so as I’ll be able to feel the tone of the size, but also the rotation aspect that’s happening in the spine and through that area to the sacrum. So go ahead and relax. I’m going to find the ASI S going to start following the slope of the iliacus muscle, and we’ll be able to, to get down to the depth of the solo ads. So it’s like, you’re kind of going into a, um, a slope going medial, which will take you right to the iliopsoas. I can move a little bit, medial moving, any visceral or neurovascular tissue off to the side.

And now I feel like I’m at the depth of the size before she does the movement. I want her to lift and lift your left foot. Relax. I can just fine tune where I want my pressure and lift the left foot again. Here we go. Good. Now I’m right. The psoas on the left. And I go ahead and lift the right side, right side already feels like there’s a little bit more tone. Okay. So now I’m on the sides on either side. So start slowly doing that movement. It doesn’t have to be a big movement. It’s just about encouraging an alternating contraction with the as, and I can do two things. I can soften the right side, but I can also follow that rotation and help try to get an even movement to where it kind of sinks more easily on the left side, right side feels like it doesn’t want to go, but I can follow it into that movement And just wait for the tissue to sort of normalize and feel a little bit more similar between the two sides. There we go. Now it’s starting to move, starting to soften a little bit too. Okay. Definitely want to work respectfully with SOS because it’s very sensitive and you want to take your time and not bully through the tissue.

You might also, with this one, find that you work a little bit more on the medial aspect of the psoas and one side and the lateral aspect on the other, which I’m doing on the right side. I’m hooking into that medial aspect and helping bring it lateral.

[inaudible]

One more time. That’s good. Okay. Now I’m just going to hold and just have her just do that movement a little bit. I’m not going to do so much this time just to let the body function normalized a little bit. Okay.

[inaudible]

All right. So that is ed. Here are some references. If you want to go back and look at any of, of those, um, just from the presentation, but I think that is, uh, the presentation for today. If you wanted to look at that blog post, it goes into that last technique a little bit more in depth. Um, and like I said, hopefully by new year, we’ll have a three hour class, so we’ll be able to go through a little bit more of the needling and more, um, comprehensive. But I think hopefully this is something you can use right from the get-go. So, uh, Lorne Brown is going to be here next week. So tune in for that and thanks again to the American Acupuncture Council for having us and look forward to seeing you guys next time.