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Communicating with Confidence

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

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

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

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

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

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

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

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

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

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

So public relations campaign.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What about COVID,

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

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

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

It sounds like you tried to confuse them with the facts

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

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

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

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

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

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

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

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

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

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

97140 for the Acupuncture Provider – AAC Info Network

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Click here to download the transcript.

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

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

Hi, nice to be here again,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And exhale [inaudible].

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

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

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

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

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

[inaudible].

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

[inaudible]

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

[inaudible]

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

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

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

TCM Infertility, Pain and Overall Wellness Geek-Out Session

However, the focus really is going to be on clinical and why it’s important to just keep learning and how neuroanatomy can advance your practice.

Click here to download the transcript.

Again, thanks to the AAC, um, for inviting me to be part of their, uh, To The Point show. And my name is Lorne Brown. I’m a CPA, a charter accountant. I’m also a doctor of traditional Chinese medicine in Vancouver, BC, Canada, and I’m also trained in laser therapy and, uh, I run healthy seminars and today we’re going to have a special guest. Um, my colleague and friend Poney Chiang, um, Poney is an acupuncturist as well. Um, he’s a neuro Meridian and neuro anatomy expert. And so he’s been teaching on healthy seminars so we can understand the neuroanatomy and neuroscience of acupuncture, both the classical and mainstream. And we had a geek-out session. So Poney and I had a Geekout session a couple of weeks ago, and we decided to share this with you, and I’m going to tie this into practice management. However, the focus really is going to be on clinical and why it’s important to just keep learning and how neuroanatomy can advance your practice.

And so again, I want to thank Poney for joining me today. Um, and there he is great to have you here and we’re going to, we’re going to geek out again. What I want to share with you is low-level laser therapy for fertility, and I’m going to give you a very short version story, but this has been my focus. I think I’m one of their early adopters outside of Japan using laser for fertility. And I do combine it with acupuncture. Um, and the reason, um, I started doing this was I came across a paper, um, where a medical doctor, Dr sure. Out of Japan, um, he, he he’s a pain specialist and he would treat people for pain. And he had this technique, which is later, um, been dubbed the Oshiro technique or the proximal priority technique. And he did a lot of work around the neck area.

And, um, he would always treat this first, before he treated the local area where there was pain. And in the story, the true story that happened here is he was treating a woman who was 55 years of age with menopause for back pain. And so he would do this proximal treatment. Um, the purpose is to create blood flow everywhere because if you increase blood flow everywhere, it would go to the toe and you’d go to the back and this would help with the healing. And so he did this technique with her and lo and behold, not only did he resolve her vaccine, but her cycle returned, uh, she wasn’t happy about that. And he thought it was a, one-off go see your OB GYN, cause it could be something serious. Well, within the calendar year, he was treated another woman in menopause for back pain.

Her period came back. So what they decided to do in his, at the hospital is they did a very small pilot of about 74 women that were translating to English as severe infertility average age, 39, several years of infertility, um, many cycles of art assisted reproductive techniques. And about 23% of them became pregnant. And over 60% had a live birth rate. And this is from a very poor prognosis group. And then they expanded that study to 701 women and 23% got pregnant, 50% got it, had a live birth. And his thinking was the reason these women had an improvement in their fertility is when doing this technique around the neck. Um, it created a parasympathetic response, which they were able to measure using thermal photography and other lab tests. Um, it would increase blood flow everywhere, including blood flow to the ovaries and more blood and circulation to the ovaries, better follicular Genesis, and lo and behold.

This was the reasoning why they thought the improve the fertility in these women. So I had been working on my protocol and I’ve spoken to practitioners around the world that are experts in laser therapy and treating fertility. Some that are treating the endometriosis and they’re doing stuff around the neck. They’re doing stuff locally on the abdomen. There’s doing stuff on the sacrum as do I. And I wanted to know why for a couple of reasons, one is it’s important to communicate to the patients how this will benefit them. And also the, the, uh, IVF doctors I work with. They want to understand this from a Western perspective, it’s, they’re not going to learn Chinese medicine. And so it’s important for them to understand that from a Western perspective, here’s the small little practice management tip and then pointing is going to come in and I got some questions for him and we’re going to geek out.

The practice management to appear is because I became well known as an early adopter for laser, for fertility. And because I invested in these machines, just so you know, um, I have several machines machines, each one’s, um, about $25,000 or more. Um, and I invested in these and women before COVID, uh, were flying to my clinic to be treated by this. So it wasn’t something I was expecting, or it would happen, but because I separated or separate myself from the pack, in a sense, I was doing something different. I was doing acupuncture for fertility, but I was bringing in laser for fertility. And I was able to explain from a Western perspective, how this can benefit and become familiar with the papers and share this, this attracted both, um, Western doctors and the public to seek my clinic for these treatments. So here’s the Geeko part because it’s important to know you can’t just buy laser, start doing this.

You want to understand how to use it so you can keep using it better and patients have questions. And so we have doctors, you got to explain it. So if pony can come back on here, pony, I got some questions for you. They talk about this parasympathetic response and, um, for acupuncture. So I’m going share with you. They talk about the anatomical features, but what they did is they did points in the nuclear, the also pity area. So do 15 bladder, 10 gallbladder, 20 area. They did stuff to, to reach the vertebral artery. So gel 17, um, they did the carotid stomach nine, 10, and they wanted to hit a feature called this Dalai ganglia, stomach 11. And can you explain to us in pony, how is this? Cause this is something we could use on all of our patients. If it’s going to bring chief flow everywhere, um, specifically also for fertility, can you explain then why these points stomach 11, 9, 10 do 15. How is this going to engage a parasympathetic response and increased blood flow everywhere, including the reproductive system?

Sure. Uh, if we can have the slides, please would make it easier for us to explain. So when you’re doing points, um, on the occipital area, um, or looking at points at gallbladder 20 blurred, 10 points in this area are actually where, as you know, the cervical portion of the trapezius muscle goes there, you might not know about cervicogenic headache. Ty traps can give you headaches, right? But the attribute this muscle is interesting is that as the muscle innovated by a cranial nerve 11 spinal accessory nerve. And so when you put a needle in trapezius muscle, including points that Goldberg 20 bladder, 10, even Goldberg 21, um, you are stimulating the spinal accessory nerve. We used to think that spinal accessory nerve is truly a motor nerve, but now we know that it’s actually sensory and motor. So what that means is that as an African bring information back to the brainstem, back to the nucleus of this cranial nerve 11, and what’s interesting is that quite another 11th nucleus is right adjacent to the cranial nerve 10 nucleus, which is a Vegas nerve.

So it is known that there’s new Peters have interactions with each other. So this is why simply needing points that GABA are $20 21. Anything that is supplied by the spinal accessory nerve will have effect from the cranial 11 nerve nucleus to the or 10 biggest nucleus. And as you know, Vegas, 90% of the body’s parasympathetic response. So we can easily explain how points in the back of the neck can achieve this increase in parasympathetic state and therefore more profusion to all the glands and organs of the body. Now ask for points in the front. Um, uh, while you’re looking at here in the dissection picture, uh, it’s got the throw in the south big is all removed and D these long, um, cell tissues that the, um, the probes are supporting or raising, it’s called a, it’s called a cervical sympathetic ganglion. So, um, uh, if you look at the diagram on the, on the bottom, you’ll see there’s actually three cervical sympathetic ganglia superior, cervical, middle cervical, and thoracic also know as the Stella, as an a star.

So, interesting thing is that every single one is Ganga are actually an acupuncture point. That’s already been passed down to it by ancient acupuncture or ancient acupuncture anonymous. And when we stimulate these points, if we can look at the Sutton, the next slide, please, there are correspondence like given to us in terms of the point. And the exact ganglion does involve without going into way too much detail. Okay. But you should want to gangs are actually supplied nerves to the heart, the cardiac. So they each one of these gangs individually and collectively supply the cardiac nerve that controls the contraction. So if you are modulating this, you are improving cardiac output. Therefore it’s an increased blood flow to everywhere in the body. So this is likely how the Ashira protocol was able to, to, you know, inadvertently increased fertility, you know, even though the focus in our neck, but because it’s affecting the civic center Ganga, which is known to control the, the, um, the heart rate, it’s increasing cardiac output, which gives you blood everywhere, including reproductive organs.

Brilliant. And thank you for that. And this is, so this is why I think, because it’s on the parasympathetic, I think of cheapo like liver cheese stagnation would become tight and constricted and that’s authentic. And when you’re in parasympathetic that she’s flowing freely, which is probably why most of the research, the women 38 and under seem to be benefiting most from laser fertility, because they’re the cheese stagnation type. And once you get into the 38, plus we’re probably getting more into the kidney in, in young deficiency. And, um, maybe we’re not able to, um, with the laser therapy do enough for them. And so this is my working theory. I think a lot of the women we’re seeing that we’re helping have a form of stagnation in Stacy’s. The laser therapy has other benefits, too. It helps regulate inflammation. Doesn’t Al not only just increased blood flow and it does help improve the mitochondria functions.

So there’s all these benefits back to our neuroanatomy. So myself included, a lot of people started wanting to put the lasers closer to the ovaries, but in the laser world, um, red and infrared light, it’s really difficult to get that kind of light to the ovaries in the Oshiro group. They did the neck and they also did a point near when 12, they didn’t say why I was thinking, they’re trying to hit the ovarian artery because it kind of comes off the aortic arch near there. But you’re telling me from a neuro anatomy perspective, there’s a different level. And, um, can you tell me why there might’ve been benefit from then doing the, the red 12? Is there any reflex points or anything happening in the abdomen that we’d want to target and before you go, they’re pointing. I just want to share that where we’re at today is we want to do the approximal points.

We want to get the blood flow. We want to hit some lymph nodes that are feeding the abdominal area. And I want to talk about the lotto gene, a lot of non Chinese medicine, trained, um, laser therapists, um, always treat the nerve roots coming out that are innovating the area they want to effect. So this is kind of what I want to cover with you today from a neuro anatomy, neuro Murray and acupuncture specialty, what are we doing from a Chinese medicine and Western perspective? So is there any benefit doing something locally that’s going to help, um, with the ovarian function and uterine receptivity, keeping in mind when we talk about the needle or the laser, the laser is not going to reach therapeutic level. It’s unlikely. It’s going to reach the ovaries and you’re not going to put a needle in the ovaries, right? You don’t want to do that. So, so what is happening here? What are we doing when we do these lower abdominal points that can be impacting the reproductive system, or were they just having happy thoughts? And there is no real benefit from the run 12

Area. Uh, if we can have this slide with the sympathetic and parasympathetic, uh, innovations of the spine. Um, so while we get that ready, let me just explain that. Um, in Chinese medicine, we’re talking about ying and yang, visual, Oregon in Western medicine to have a similar and how we try to achieve healthy balance in Western medicine has similar notion of homeostasis where you’re trying to balance the parasympathetic and sympathetic nervous system. Yes, that’s the mind. And so it’s, to me, they’re very analogous concepts in Eastern medicine, and we’re trying to balance any, obviously Oregon in Western medicine, we’re trying to achieve sympathetic comparison, like balancing short and, and, and the other student is that each organ has both sympathetic and Paris, the next innovation. And they both do their job to encourage ensure optimal function of each Oregon. So if I can draw your attention to the left side of this diagram, what you’re seeing here is the spinal cord. And those little dots are horizontal lines that are coming out from the blue dots. And the blue lines represent parts of the sympathetic chain, which is, as you may recall from square thoracic or lumbar. So it’s [inaudible].

And so when you look at where those nerves go to, they go to various types of, of, uh, uh, plexus in gangland then, which then subsequently control the blood flow to various organs. So, um, as you know, a lot of the, the, um, uh, fertility related points, um, um, uh, they took on shirt for on the actual point, um, stomach 29, which was supposed to mean gray line is returning the period, right? So these points are located in the lower pelvic area. So where, um, so how can we account for this based on this, um, understanding of the sympathetic person and never system, if I can draw your attention. And if we really hone in to the very, very bottom blue nerve on the left side, it’s called a lumbar spine secondary. And, and, uh, so if you have a laser there, right there, perfect.

And you can see that, uh, from there there’s one more pink, red color that comes out, it’s called a hypogastric plexus, right? And then if you look at the very, very bottom word in the gray box, it says reproductive organs. So that means that if we can trace the report organs, blood flow to the hypogastric plexus, which by tracing one level up to the lumbar spine CIC nerve, and then back to level L one L two. So if we look at the points that are in that area, it’s going to share in stomach 29th. And, and it’s only Tanya that if you look at the indication though, I have to do with, with fertility, with men seas, with reproduction. So we can explain that because those points in that area are exactly Lyn 12 region of the, of the, of the dermatome. So by, by putting nerves there, we are having what’s called reflexive effect.

The needle stimulate T 12 L one nerves, which travels back to the spine. Does these nerves wrap around from the spine around to the interior as aspect of the body, does the Afrin sensation and back to the spine and reaches is corresponding T 12 L one segment. Now each second, each second response has sensory motor, as well as sympathetic, um, uh, types of innovation. So we call this reflex effect. Once the Afrin reaches a segment, it was sent information to the corresponding autonomic levels, which in this case are digs, precise, autonomic levels of the, of the body that controls the, uh, cemetery output or the blood flow to these reproductive organs. So it is by, it seems that we’re affecting and locally, we are, we are in tenders that were needing over the ovaries for example, but the information is going back to the spine and then the spine, um, passes it through the sympathy, Oregon, which then sends it back into the Oregon. It’s effecting it’s instantaneous, but it has undergone a complete full stroke. It, but it happens so fast that it’s, it seems as if there’s an immediate effect. And

So, um, when you’re the, whether this spinal segment segments that are innervating the ovaries and cause, um, I’ve heard also in some of the literature I looked at, they were talking about like T nine T 10 and T 11 innovate, the old reason, S one S two more for the uterus. When you mentioned stomach 29 and Z gong, you’re saying that’s more like T 12 L one. And we, when we did get go, you did say there’s like a Christmas tree effect. So when you’re needing below, you’re still getting a lot of these or lasering. You’re getting those above, but can you just clarify what you’re seeing there? What’s from this diagram, what’s innovating the old reason what’s innovating the uterus from the spinal second.

Okay. So if you were to, to, uh, look at the Y to Jaggi points or the, uh, the back shoe points along the spine, um, re recall what we were about the sympathetic chain is [inaudible] right. So all two of bring us to 2023 level and our be 20, 22 levels. I say bladder 2023 level is two. And then bladder 22 is our one. So, um, now we’re talking about what’s called the dorsal Ramiah of the spinal nerve, as opposed to the veterinary. And I, when we were talking about needing the pelvic area, those are the parts of the spine of that came forward. They call the interior Mr. Ventura, but there are ones that go back to integrate the muscles around the spine. And those fellow doors are in mind. So if you needle L one L two, which happens to be bladder bladder 22, 20 23, and these are the points that we would use anyway, because there can use reproduction in Chinese medicine, right? Actually, probably that you need to read it by KMS, but if you need, at that level, you are still at L one and L two. So the same simplest reflux applies. It’s just that now it’s happening through the posterior branch as opposed to the ventral branch, but at the same permission will ultimately go back to the same segment, L one L two and then cross into the sympathetic, uh, aspect of the, of our body. So

Again, beautiful Chinese medicine that we have, the front middle and the back shoes. If somebody is facing, we can treat anterior, we can do the Z gong and stomach 28 are still make 29 points and have that reproductive effect at the point say, or if we’re treating them face down, we can do the back Shu point, like we know for a kidney for reproduction. Um, and again, same segments so we can dress it, both sides. So the Chinese medicine approach understood this 2000 years ago. And now with neuroanatomy, we can explain why you can do it face up or face down, and you’re still having that effect. Am I, if I’m understanding

You correctly? Absolutely. And there’s this one tiny, tiny bit I can add to that is that we’ve been talking a lot about what’s going on to lifestyle as a slide today. Let’s take a look at the right side of the slide, which is a parasympathetic. So it, um, ultimately when we need all yes. If, if we can just focus on the sacrum area on the, on the bottom where the black two black lines coming out. Yeah. Or that area right there. So oftentimes I get asked, um, you know, if you’re stimulating a SIM and say, isn’t it that gonna reduce blood flow and, um, and, uh, uh, we only want to stimulate the parasympathetic that that is correct. But what we do know from a lot of studies in acupuncture is that, um, uh, the ultimate net gain effect that acupuncture is parasympathetic. It, even though it’s limit points are supposed to more sympathetic is a very short transient effect.

It’s almost like the body knows that, oh, I’m feeling more sympathetic. Now I can activate my own homeostatic mechanism to go towards parasympathetic. So the end result will always be parasympathetic. So you can think of it as using the young, to treat a year in Chinese medicine kind of concept. Okay. Obviously they are obviously see within each other. So inseparable concepts. Now let’s take a look about a, the Paris Stemmet idea. We would need a formula that directly. So those are your, your, your, um, your secret for MRR points, but our 31 32 33. So if you look at the bottom, uh, of the right side of the, this fixture, um, you’ll, you’ll see that these, um, these nerves also supply the reproductive organs, right? You see that there’s college coming up from there, from the black lines on there, right? It’s not just a red lines on the left.

That would mean that we put our origin as well. So just, if you want to be super finicky, theoretically speaking, or anatomically speaking, it’s only as two and three and onwards would have the effect. So that means [inaudible] or bladder 31 is not as important here. So if you have the ability to palpate the real for a minute and try to put the needle into that for, to affect those points, you want to target as to it onwards. So if we can have the very first slide, we can jump to the very beginning, we get it, we get a sort of inside out view. There it is. The inside our view of what happens in the sacred and the inside. And you see all those nerves and all the blood vessels over there, they actually communicate with each other. So when you put a needle into [inaudible], we are increasing the parasympathetic control of the pelvic organs and blood flow directly.

Now you may look at this and realize that, oh, this is kind of like the Sonic nerve, right? These nerves become the side nerve NSI. And it goes all the way down to the back of the thigh, into the lower leg, even down to the foot area. And what’s the point that’s most commonly associated gynecology in all the Chinese medicine, spleen six, right? As many as six lies exactly on the site, Agner trajectory. So even though you may not be needing the second directly by noodling spinning six, you are liking kneeling in the sacrum indirectly. What’s the message comes back to you because the sciatic nerve is, um, as, um, uh, alpha syn two segments. So crosses these these segments so that you will have a direct impact on the blood flow to of the, of the pelvic organs, reproductive organs, your genital organs, and so on and so forth.

So these things that we learned from, from traditional indications that passed down, there’s absolutely no reason to doubt they do what they say they do. It’s just that we don’t have the understanding to catch up with these information. But, but, uh, another thing is that if you understand this new anatomy, then you can actually create more points. So points like, can you four, can you, five are all derivatives the Stagner and, and, and you can see why they will also potentially be very effective for treating fertility issues and you can create your own protocol. So once you understand the new UNM, I remember

When we had our offline geek-out session, you’re sharing how spleen six, the nerves, a little bit deeper, but easier to reach it, like kidney three or kidney six, because of this reflex point. That’s what you’re talking about now.

Yes. So the, the, the, the part that say that reaches that immediate aspect, the ankle is called the posterior tibial nerve. So if you go through Spain stage, they actually got to pass through a muscle called the Fetzer digitorum muscle, you know, to get to the dinner. But if you go a little more distant with when the nerve becomes more superficial about, at the level of CUNY 3, 4, 5, 6, those points you can think of it as, like, can you say X four or more for year and aspect, right. Can you three for CI aspect, those points are still derivatives of the sagging there. So the message was still go back to the, to the S two S level two to improve circulation of that pelvic pelvic organs. So there’s no re ne no reason why you can, it cannot add another level of TCM on top of that heel. How do you decide within Spain six or seven spins three? You know, they are all Threadless. I never anatomic issue at work, but, you know, six might have more yin indications or is three might have other indications, you know, or you want to use a more of a, a low point. Like, can you afford, for example, so you can, how they’re actually not mutually exclusive. You can actually refine it further with, with a TCM lens on top of it.

And this is why, um, I like studying with pony and why I recommend pony. Um, I remember one of your course on healthy seminars, you’re talking about these nerve roots and having this discussion about the sympathetic and parasympathetic and how you mentioned you’re reaching the sympathetic, but it has this parasympathetic effect, because I think you were mentioning, there’s like three that were coming out from the dorsal root. Um, you reached the more superficial one, but when you reach that superficial one, they’re like their siblings, they’re all affected. And therefore you’re getting that parasympathetic as well. That’s right. And so, um, tying this together then, um, I just want to share with you that, uh, the Chinese medicine aspect of it, it just blows my mind still how brilliant it is because we’re choosing points based on a different paradigm. However, in modern times with this incredible technology, it is explaining it is validating these points.

And I know some of my colleagues are purists and they don’t want to know anything about the west. And I like to know as much as I can about both. Um, because as you’ve shared, it can help direct your treatment in choosing your points. And what’s really valuable in clinical practice is my patients and the doctors. I work with the medical doctors. Um, they’re not going to understand the back Shu point for the kidney, but they want to understand how this nerve root is going to innovate the old reason. If I do this, we know there’s a parasympathetic response, which brings more blood flow there or activates this organ. That’s important to them. And so this is why I highly recommend the integrative approach. It does not mean forget about what you’ve learned and forget it, what acupuncture. It really is going deep into the classical and going deep into neuroanatomy, but with a trained acupuncturist, like pony Chung, because you pay tribute to both medicines, you don’t dismiss one or the other, and you’re constantly the two which helps with clinic, you know, myself.

Um, I’ve invested, it’s almost embarrassing. I was looking, I have over $260,000 in lasers in my clinic now we’re, we have many practitioners, so patients want it. So we need to have these lasers. And I don’t know how many thousands of hours I’ve invested so I can keep, um, modifying how I do it. So I can be individualized and improve our, our approach. And as you can see, I’m talking to people like pony. We did this conversation, a version of this offline. And then I just said, you know what? This was so fantastic for me. I want to share this with everybody. And so this is why we came on and did a mini version of what we did already, because I think this is really beneficial. And so my message here is not to be scared of other things like laser therapy. It’s incredible how it’s transforming my practice.

I use both the acupuncture and the laser in my practice for fertility. Um, and so that’s been valuable. It’s made patients, um, want to, um, come to my practice for these treatments. And I keep learning and talking to people like pony, um, cause it gives you the confidence and the key is to be able to communicate why you’re doing what you’re doing. And so I’m not suggesting that you just violate her and start to do it. Um, just like you wouldn’t want somebody just to do a weekend acupuncture course and start doing acupuncture on people. You do want to under, you want to get good quality lasers and you really want to understand what you’re doing so you can play with your protocol. I have to give another big, thank you to pony again, for the cadaver work you’ve been doing. And just the deep dive you’re doing in neuro Meridian acupuncture. Um, and, and bringing this to the masses again, you can study with pony on healthy seminars.com, um, and a big thank you to the American acupuncture council for inviting me to host this show. I want to let you know that your speaker next week will be Poney, Poney Chiang also hosts a show on the AAC. So tune into the ACC and you can listen to Poney Chiang and hear what he’s going to talk about on his show. Uh, thank you all very much and Poney, Thank You. Have PTT anytime. All right, till next time

How To Clarify Your Message So Your Practice Can Survive & Thrive

I want to help you get more people on your treatment table. And that’s what these talks are all about. To help you be seen, to help you be heard and to ultimately bring people into your practice so that you can make more money, change more lives, help more people, and kind of create the life and grow into the dreams that you imagined for yourself.

Click here to download the transcript.

Hi folks, Jeffrey Grossman here. 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 the founder and owner of Acupuncture MediaWorks, Accu downloads, and Accurate, Perfect Websites. And I started my practice in 1998 and I had a lot of these trials and tribulations and so many struggles that I basically had no marketing savvy that I had to start from scratch like many of you listening today. And I noticed that I had a problem in knowing how to market my practice and properly communicate to my patients because all I wanted to do was to treat them and not to market to them. But this struggle took me down the path to create the companies that I run today. And it’s, it’s a longer story and best preserved for another time.

So what I want to remind you is, is, is that we as acupuncturists, you, as an acupuncturist are an incredible resource. You’re a natural healer. You now, how to help people get and feel balanced and healthy. You know how to help people get well using safe and natural methods and you change lives every single day. The thing is, people want your help. They’re looking for your help. They need your services, but unfortunately many people don’t even know that we exist and we’re gonna help you change that. Oh, I want to help you get more people on your treatment table. And that’s what these talks are all about. To help you be seen, to help you be heard and to ultimately bring people into your practice so that you can make more money, change more lives, help more people, and kind of create the life and grow into the dreams that you imagined for yourself.

So I also want to remind you is that you’re never alone, that I’m here for you. I’ve been where you are and I’ve struggled. I have one of the same issues and concerns. And if at the end of today’s talk that you feel like you need more help getting set up or becoming focused. Or if you just need a little motivation to move forward, please please reach out to me. The, there are so many opportunities than ever for you to help more people, but you have to understand what people are looking for now and how you can best present that to them. And because of that, because I feel like I want to support you in your practice growth on what you to have the latest updates, the latest research. So I created a detailed report for what is working now and recommendations on how you can make it work for your practice to get more people in your treatment table.

It’s a 15 page resource that you will find invaluable. And I’ll share that with you at the end of today’s talk. So you could use, today’s talk. You can use this ebook resource that I want to share with you, um, to help you grow your practice. And just one or two of these changes that you walk away from, from today’s talk and tap into from what we’re going to be sharing with you today, or from this ebook can make all the difference for you. Okay? So let’s go ahead and get started. I want to talk with you today about the three part framework to clarify your message so that your practice can not only survive but thrive. And today I want to talk with you about two marketing concepts that everyone on this call should consider adopting into their practice. And what I’ll be sharing with you today will separate you from your competition and allow you to deliver a more clarity and focus messaging to the community that you serve.

So you may have heard of Donald Miller. He is a profound author and influencer in the business world and his teachings and ideas. They’re not new. He’s simply been able to articulate them and simplify them for the marketing newbie to understand and connect with the concepts that I want to share with you are from his book. Marketing made simple and also from his other book called developing your StoryBrand. And I want to talk with you briefly on how to tap into the idea of creating your story brand and how to craft your one liner. And I’m going to break these down for you, tell you what they are, how to create them for your own practice and share a couple of examples with you. So first, let me talk with you about the importance of StoryBrand today. We live in a fast paced, overly automated, digitally driven society and expressing our humanity and cultivating connection is becoming a new premium.

These days. We’re surrounded with convenience and instant gratification. Making personalized human connections are increasingly scarce and they’re coveted these days. And with this kind of environment, your practice can no longer to appear to be human lists or a faceless entity. And in order to survive these days, you need to connect and bridge that human gap with prospects, engaging on a deeper level than before. And this is where your StoryBrand comes in. StoryBrand is the cohesive narrative that weaves together the facts and the emotions that your brand or AKA your practice evokes. And this is where you give your prospects, the reasons they should choose you, your services over your competition. Story. Branding is no longer a nice to have. It is a need to have and what will ultimately maximize your practices, visibility its profit and its impact. So treat this, treat your story brand as a compass for your marketing strategies.

So I want to briefly review the seven step framework of creating your story brand. Okay? And it’s more detailed. It is book for you to get it if you want to. So the first part is the customer is the hero a K a your patient. So you need to identify and be clear about who you are attempting to help targeting everyone is like targeting no one. So you act, you need to strictly define who you are helping. This is where I feel a lot of my clients fall short when it comes to identifying their perfect ideal patient. Step number two is that a problem exists, external internal conflicts that a patient may have. And there’s a reason that your customers choose you over the next practitioner is because of the external problems that you solve or frustrating them in some way. And if you can identify that frustration, put it into words and offer to resolve it.

Something special happens. And this is the first step to helping, which is clarifying the problem, your hero, AKA, your patient is facing step three, meets a guide, which is you. You’re the practitioner. The customers are looking for help, AKA a guide to help them through, to solve. The problem is that they’re faced with and the guide, which is you offers advice or wisdom or experience. And you share with them what they, what, what, what they would have done differently. Had the, how, how, how do you known better at the time? And you offer positive way, excuse me, a positive way forward to overcome their problems. Step number four, there’s a plan which is a treatment plan or home care recommendations. So customers are going to trust a guide practitioner who has a plan. So make sure that you make the hero note that you have suggested that you know why you’re suggesting the path that you’re suggesting to them.

So what steps do they need to take to schedule with you? What steps do they need to take to enjoy maximum benefits from your care? So spell out those steps. And this is usually mapped out during your report of findings and step five, there are calls to action. So coming in for care and following care recommendations, customers are challenged now to take action and nothing is going to happen unless they act on a plan. So a guide will motivate them or motivate the hero to take action. And having Claire clear calls to action means customers. They’re not confused about what actions they need to take to do the work with you. Step six, help them avoid failure, right? And this is when patients aren’t achieving their healthcare goals. So everyone is trying to avoid a tragic ending. So knowing what could happen if no action is taken is required to motivate the hero, to act on a plan that you’ve collaboratively set up with them.

And step seven seven, which is, it ends in success, which means you’re solving their internal and external problems and helping them achieve their healthcare goals. This principle shows people how your services can positively influence their lives. People are drawn to transformation. And when they hear about and see about transformation in others, they want it for themselves. And the more you, you featured their transformative journey with your customers that have ever have experienced that the faster your practice will grow, the more referrals you’ll regret. So that’s basically the seven step framework that you should go through in order to create a story brand for your practice. And I’ll tell you how to use them in your marketing shortly. So now let’s get, um, get into the next step, which is the importance of creating your one-liner. And this is another area that Donald Miller suggested all businesses.

And in our cases, our practices have dialed in a one. Liner is a concise statement that clearly explains your offer. And it gives you a simple, clear, and memorable way to tell potential customers what you do and how, what you do, benefits them. And it outlines the problem that you help your customers solve in a simple, relevant, and repeatable way. And this is composed of three parts, the problem, your solution, and their reward. And it’s incredibly easy to create, but it can take some time to refine. And here’s how to begin the process of creating your winning one-liner part. One is to identify the problem and in this step, identify your customer, right? And the major problem that you help them eliminate, where is their life painful or uncomfortable, and what do they want to change? What’s not working for them. What keeps them up at night and you can get specific, but keep it concise.

And when someone asks you, what you do, your habit is probably to give them a direct, not very compelling answer. For example, if you’re in the house cleaning business, then the normal way that you’d likely answer this is by saying I clean people’s houses. Or if you’re really could, you might say I clean people’s houses so they don’t have to. And when you answer in the normal way, you’re cutting out the part of the equation where you have the most opportunity to connect with people. And that’s exactly what the problem section of your one-liner does. In other words, if you start with the solution, I E that I clean houses, then you have nowhere to go in the conversation, which is why it’s vitally important to start with the problem instead, because the problem opens up a story loop in your conversation. So instead of answering with I clean people’s houses, you start with this kind of response.

Instead, most people pay cleaning their houses. It’s a completely waste of their time and it robs them of their weekends every single week. And when you begin your answer with the problem, instead of a success response, you’re drawing the other person into a more, uh, into more than just a conversation. What you’re doing is you’re actually inviting them into a story. And since you’ve only provided one part of the story, which is AKA are the problem that you start mentioning, you’ve opened up what they call a story loop in copywriting lingo, and their brain wants to know, and it needs to know the rest, right? So once you tell them that most people cleaning their house. So they’ll immediately think to themselves, that’s totally right. I pay cleaning my house every single week, and now they’re waiting for the rest, right? And no, you know, you’re not being sleazy or salesy when you approach the conversation.

In this matter, you’re simply engaging people in a story and using a more effective approach to marketing and sales. And here’s an example of the problem that you may be familiar with. And I’ll be sharing the rest of this. This is a gamble as they go on in the next few steps. But for now, the problem in this example is people are tired of taking pills. Okay? So just keep that in mind. I’ll get back to that in a second. So now for part two, so the first part is identifying the problem. Second part is coming up and bleeding what your solution is. So now that you’ve opened up the story loop by starting your answer with the problem, it’s time to begin to close it, but not entirely. The solution is where you get to begin telling them what you do. So going back to the housekeeping example, you could continue by saying, so I have an entire team of professional cleaners who clean your house and make your home look like a million bucks.

Again, you don’t just say I clean houses, you spice things up a little bit. You had some, some juicy little details and you include emotional elements, right? And you leave people thinking, wow, that sounds incredible. How do I get my hands on that? So if there is something unique about what you do or what your practice provides or what services that you provide, especially, especially if you’re in a crowded market, the solution section is also where you can include those details. In that case, you don’t just say I clean houses is dead. You tell them. So I have an entire team of professional cleaners who clean your house using state-of-the-art vacuums and all organic cleansers. Okay. You started the conversation, whether it’s taking place in person or on your website, you’ve started this conversation with a problem and you’ve opened up the story loop and you started bringing people in and interested into what you’re saying.

Okay. And the solution is where you solve that problem. And so how do you write the solution section of your one-liner? Well, writing the solution section sounds pretty simple because it can often be the easiest portion of right. And that doesn’t mean you don’t still work at it and write it down. You should come up with like three or four variations before you land on the winner. So here’s part of my familiar example. So the problem was, people are tired of taking pills. That’s the problem. They’re tired of taking pills. Your solution would be. So we offer traditional Chinese medical treatments and state of the art therapies for the relief of chronic pain. That’s the solution you offer now on to putting all this together in part three, which is the reward to this point in the conversation, again, whether it’s in person or in your marketing materials, you’ve introduced a problem that potential customers are facing, and you presented your solution that you have to offer, right?

So now it’s time to aim high and hit a home run. And the reward section of your one-liner is where you get to brag a little bit. And this is where you get to tell people what your life, I’m sorry, what their life will look like after they’ve used your services. And this is where you share the transformation that can occur in their life. As a result of working with you again, that housekeeping example, people don’t want their houses cleaned, and they don’t just want it to look like a million bucks. They want their weekend back. They don’t just want to spend that time cleaning. And the reward section is where you remind them that that’s exactly what you provide. How do you write the reward section in one of, in your one-liner? Well, you want to focus on how your product makes a customer’s life better based on the transformation that you identified already.

And again, you likely won’t man, nail it on the first, try instead, write out four or five or more options or different variations and see which one that you liked best. So remember at this point in your one-liner, you need to make sure that each section is telling a consistent story and that they all flow well together. And to put my familiar examples together, here’s what your one liner should sound like. The problem people are tired of taking pills, your solution. So we offer traditional Chinese medical treatments and state-of-the-art therapies for the relief of chronic pain and their reward is we help people have less pain, more movement and a better life. How awesome is that? One liner, people are tired of taking pills. So we offer a traditional Chinese medical treatment as there are therapies for the relief of chronic pain, and we help people have less pain, more movement and a better life done.

Okay. So to recap, what’s the pain point you want your customer, your customer wants to resolve. Okay. What’s your unique solution to that pain point? And how does your customer’s life look after their pain is resolved? Well, now that you’ve made your one-liner it’s time to share it with the world and I suggest doing it the following way first practice it. Okay. Ask some brutally honest friends or strangers at a coffee shop to listen to your one-liner and tell you if it is clear, what you do and how you help second memorize it, and like actually memorize it. Right? And if you have a team, have them memorize it to other part, put it on your website. This statement should be the first chunk of copy that people see when they hit your website. And don’t forget, make sure that you use it. So next time someone asks you what you do, give them your one-liner and see what happens and add it to all of your marketing materials, your business cards, email signature, LinkedIn, Instagram, Facebook, Google, Twitter, okay, just put it out there in the world.

This is transformative. And if you dial it in will set you apart from your competition. Here’s a couple of examples I want to share with you too many people struggle with pain and injuries. We provide effective treatment that allows you to perform well in life sport and work without pills, surgery, and high costs. We offer unique and individualized evaluations and treat injuries with prenup, cupping, and acupuncture so that at our, so our practice members can go out when their next race and feel great. So now you can clearly communicate what your practice offers and why people should buy from you in one simple sentence. So now the great thing is that this is the one-liner that you’re going to repeat thousands of time to every single patient until they can repeat it as clearly as you can. And this is the single line that your front desk is going to be using.

And it’s also what you’re gonna be telling your accountant as also what your spouse will repeat and your kids will repeat, and you’ll even put it on t-shirts or even hats. And, and if you can create a clear and concise message for your practice members, they will reward you with sending friends, family, and everybody else to you. Okay? So I hope that you receive some answers and inspiration and insight for what you needed today. And I want to encourage you to reevaluate your plans, right? What are you going to be doing over the next 30 and 60 and 90 days in your practice? Do you want to put together a one-liner? So, hi, I’d love to help you and give you a fresh perspective. If you need help. I love to start a chat with you and I offer a free 15 minute mentoring and discovery calls.

What you could do is shoot me an email at Jeffrey, J E F F R E Y at acupuncture, immediate works.com. And I’ll get back to you as soon as possible in the subject line, say, I saw you at the AAC. So again, Jeffrey, J E F F R E Y at acupuncture, mediaworks.com. And I’ll get back to you as soon as possible. And remember that you are an incredible resource. You change lives day in and day out. You know, all about this amazing natural life, changing ways to support a person, um, to be healthy and to be strong and to be immune strengthened. So people are looking for you and they want your help and they need your help. So how are you going to show up? So if you’re looking for help, I encourage you to reach out to me, shoot me an email then for those of you that are sticking around here is the URL for the free resource that I put together, which is called resetting your practice for 20, 21.

How to get more patients on your table, you can go ahead to, uh, grab this URL at Accu media, a C U M E D I a dot U S slash reset, 2021. So Accu media.us/reset 2021. You can download that ebook and reach out. Let me know, be well, stay strong, continue to change lives. One person, one needle at a time, you are awesome and the world needs you. And again, reach out if you need some more support next week, Lauren Brown is going to be joining us on the AAC network here. So be there, take care, stay beautiful. Talk to you guys too.

Motor Points and Trigger Points: A Compare and Contrast Discussion

We want to talk about the compare and contrast of what is a motor point, what is a trigger point, which is a very, very common question and also how to use them clinically.

Click here to download the transcript.

Hello everyone. Thank you very much for attending our Sports Acupuncture Webinars sponsored by the American Acupuncture Council. My name is Matt Callison. I’m here with my colleague and good friend,

Brian Lau. So

Last month we had Josh Lerner as a guest. I was not able to make it last month, but Brian and Josh talked about trigger points quite a bit, and the pathophysiology and also different clinical uses. We wanted to this month to discuss and build upon last months, a narrative. We want to talk about the compare and contrast of what is a motor point, what is a trigger point, which is a very, very common question and also how to use them clinically. So before we actually start going into, let me talk about Josh a little bit here on the reason why we have him is he’s like Brian, who is, uh, not only just an excellent clinician, but a true academic. So that’s a pretty rare combination to have, uh, Josh graduated from the north west Institute of acupuncture and Oriental medicine in 2001. And he’s currently on faculty of the Seattle Institute of east Asian medicine, or he’s teaching orthopedic medicine trigger point theory, muscle-skeletal amp and also points and channels. Now he’s studied with Tom Bizzio and Frank Butler for quite a while. Starting in 2006, he also started taking trigger point release, uh, acupuncture trigger point release in 2007, and started dry needling classes in 2016, which he has become certified in dry needling in 2019. Now being an overachiever that Josh is, he also took the smack program at the same time and graduated from the sports medicine acupuncture certification program in 2017. So Josh is welcome. Thank you very much for coming Josh and help us out with this podcast webinar. Really appreciate it.

Thanks for having so you appreciate being asked back for this.

Yeah, absolutely. Well fun. All right. So we only have 30 minutes, so let’s jump right into what is the motor point? Well, you didn’t get into the trigger point, then start talking a little bit about case studies and how to be able to use them. Uh, first things first, the motor point when I first started studying them, this would be before I was an acupuncturist when I was going in and, uh, physical education and athletic training school at San Diego state university. I graduated from SDSU in 1986. Now in the training room, we were taught to use one inch by one inch or two inch by two inch could be even four inch by four inch electrical pads to place them over the central aspect of the muscle in order to influence the muscle belly or the motor point region. Now, it was common to be able to use these pads on agonist and antagonist muscles, for example, hamstrings and quadriceps, or even on hamstrings and then to a distal tendon or a proximal tendon in order to influence the electrical energy of that particular muscle.

Now, when I became an acupuncturist graduating from Pacific college Oriental medicine, which is now called Pacific college of health sciences, graduated from Pacific college in 1992, always was curious about the motor point and wondered as an acupuncturist. What would it be like to take a highly conductive electrical material, a stainless steel needle, and put it into this region as defined as having the lowest resistance to electrical conductivity. So therefore we, you have a region that has the lowest resistance to electrical electrical conductivity. That means that there is a enormous amount of cheap potential to manipulate. Now, of course, an acupuncture needle is much thinner than a one by one or a two by two pad. So therefore I started my journey and researching motor points. Where are they located at that time? Nobody was really talking about motor points, trigger points was the big thing.

Um, it was still under a lot of influence of Janet Chevelles and Dr. Simon’s enormous work and trigger point theory and their books as well. Um, and at that time, I, like I was saying, motor points really weren’t discussed very much. They were mentioned in the Shanghai text of acupuncture, which is an interesting read with that. And then going online and trying to find who was actually doing acupuncture on motor points, um, was Dr. Chan Gunn. Now he was up in Canada and he was also researching on motor points, but she’s got some incredible research if you guys wanted to go and check that out on Google scholar, um, being more of the dry dealer, um, he was really staying quite a bit away from traditional Chinese medicine and taking it more toward the dry needling aspect of it. And so we’ll finish that story at another time.

So what I found was taking acupuncture to the Motorpoint region was changing range of motion, changing muscle strength, decreasing pain. And this was really very, very exciting. Um, but trying to find where those motor points are at that time was very difficult because there really weren’t that many maps available. It was more of a line drawing with just like a black dot on it. So gathering a number of different research articles. I think it was in the forties or fifties, and today it’s well over 300 research articles that I have on motor points in their locations. But back then, there wasn’t very much so collecting that information and then also electrocuting a triathlete friend of mine with the surface surface electrode, trying to find exactly where these motor points are. Then I would map them and then locate them according to bony landmarks and acupuncture points for the acupuncturist.

Now this was way back in the early 1990s. And that was when the motor point manual came out, which I even have a copy of that anymore, but also the motor point chart came out and I’ll since then, it’s also has been updated the motor point chart. And this just came out in 2019. The original came out in the year 2000. Also some of the work that I was doing back then in the year 2000, I actually collected a whole lot of notes and started writing quite a bit and then published this treatment of orthopedic disorders manual, which came out, like I said, in the year 2000 or actually 1998, it came out and it’s been used at all three Pacific college campuses since then now in 2007, then my research came out and published the motor point index in 2007. So long story short, my work has been out there for a long, long time and has actually influenced quite a few people over the years.

Um, this has a lot of accountability and a lot of responsibility to it because even as today, Motorpoint locations have changed a little bit. The definition of the motor point has changed. Um, motor points. Now over these last 15 years are talked a lot about you’ll see research articles all over the place. It has infiltrated our field pulled a lot from the work that I have created, but then also what other people are also doing with motor points. So it’s, it’s something that is needing some discussion about what is a trigger point and what is a motor point. Now, the definition of the motor point in the 1940s, fifties, and sixties was basically an umbrella term for where the motor nerve inserts into the muscle belly and where the motor nerve inserts at the intramuscular junction, the neuromuscular junction. So both of those locations, which can actually be far away from one another in a muscle was the umbrella term called motor point.

Now recently, I would say within the last five to seven years, you start to see articles talking about motor entry points. And this is actually a better way of describing where my work has actually been taken is I’ve been looking for the motor point where it goes actually into the muscle belly itself. And the reason why is because it has the largest diameter of the motor nerve, then going into that motor point and has the lowest resistance to electrical conductivity, I’m taking that acupuncture needle and inserting it into that spot is where we can actually change quite a few things within that muscle, not only within the muscle itself, but also how the central nervous system views what’s happening within that muscle.

So the interesting, interesting thing about this is with motor points, like I said, that’s more of an umbrella term for what’s now being clearly defined as a motor entry point or where the motor nerve inserts into the neuromuscular junction would be the intermuscular motor point. So again, as the motor nerve comes in and inserts into the muscle itself has the largest diameter that goes into the motor into the muscle. Then it usually will bifurcate and go into a proximal part of the tissue. And also the distal part of the tissue sometimes close within an inch sometimes far away, six to eight inches, depending on the length of the muscle. So these collateral branches from the motor nerve travel within the muscle tissue and then insert into the actual muscle itself back can be called the intramuscular motor point. So we have motor entry points. We have intermuscular motor points, VM umbrella term would be motor points.

So I hopefully that actually helps. Um, you don’t really see motor entry point too much discussed in our field, but I’m sure it will start to spread over this next five or 10 years. Just, just because that gives us a little bit more clear definition of what exactly we’re trying to be able to treat. Now, the motor entry point is where the green triangles are on the sports medicine, acupuncture textbook, and also on the motor point chart, that’s where the motor entry point is located. Okay. So then now the intramuscular motor points themselves, um, those can actually be turning into trigger points with Josh and Brian and I are going to go ahead and discuss that in just a little bit or a trigger point can also develop, uh, at the location of the motor entry point. So from here, why don’t we now start to compare and contrast with the trigger point? Josh, do you want to take it away or Brian, do you want to add anything?

Yeah, I’ll, uh, I’ll step in here. And so Matt and I have had lots and Brian, Matt and Brian, and I have all had lots of discussions about, um, comparing and contrasting, um, trigger point phenomenon with motor points. And so there are a few different, um, dimensions within which we can kind of talk about these both contrasting differences and comparing areas that are similar. So one of the things to keep in mind, especially once we start talking a little bit more clinically, is that as helpful as it is to really talk about the, the differences between ideas about motor points versus trigger points to a large degree, especially clinically there’s a huge amount of overlap. And it’s a, if you really like Venn diagrams, there’s like a big circle about trigger point phenomenon and a big circle about Motorpoint phenomenon. There’s a huge gray area of overlap between the two of them.

So I’m going to try and keep that in mind as I’m discussing this, but it might sound at times like I’m being a little bit arbitrarily black and white about differences between them when that’s really not the case. So, um, one of the, one of the areas of contrast is that the motor points are basically a, a normal physiological phenomenon. Everybody has motor points. It’s just how the body works. Whereas trigger points are very specifically a pathological phenomenon. I’m not going to talk too much about the details about trigger point physiology, Brian and I spent an hour actually last time talking about a lot of that stuff. And so if you want to brush up on that, you can kind of go watch the previous podcast that Brian and I did. I think there are also going to be some links to some other discussions that Brian and I and a few others have had about trigger point stuff.

So you can refer back to that. Um, so that’s the first contrast is just normal physiology versus a pathological condition, right? Trigger points. Are they form due to some kind of muscle damage, right there, a small contracture in a muscle fiber that is the response to either like an excessive eccentric load or, uh, a low level contraction that goes on a long time and kind of wears out the fiber. Uh, another, another type of contrast between them is that motor points in a lot of ways are more like acupuncture points in that not only everybody has them, but the, the locations tend to be somewhat predictable, even though there can be quite a bit of variety of from person to person, whereas trigger points can really form just about anywhere in a muscle. So when you’re looking to treat trigger points, you really have to palpate the entire length of a muscle.

Whereas when you are treating motor points, um, you’re generally starting from a somewhat relatively defined position. Like it’s, uh, say, you know, in the middle, like the middle part of a muscle, or like in the case of say the rectus femoris, one of the common motor points is going to be halfway between like stomach 31 and hunting, right. You still have to palpate locally and the actual location you’re going to be looking for like a kind of an usher point. It might be, you know, one up to sooner, so away from that point, but you’re starting roughly from [inaudible].

Um, another, another area of contrast, uh, that I think will probably open up interesting discussion because Matt and I have talked about this quite a bit is how you use them clinically and what muscles you choose to treat, whether if you’re thinking about a trigger point versus a, um, a motor point. And so I’ll just kind of talk just very briefly about my take on this and then maybe, uh, Brian and Matt, if you guys want to pop in and, uh, contradict what I’m saying. Awesome, nice and heated, spicy debate going. So motor points in my practice, I tend to use very, uh, very kind of more generally to really overall improve the functioning of the muscle and to treat in the sense of the little skeletal homeostasis, what I’m really focusing a lot on biomechanical issues, where there’s a joint dysfunction in gallons of muscle pull across a joint, or are treating, uh, a muscle in one area of the body.

And I want to treat the entire senior channel. I might need other muscles more display or more proximally in that CGU channel. I’m 10 years motor points is in those locations, more commonly, um, and for trigger points, I tend to overall use the more specifically to treat the referral patterns when there’s pain or some other like parasthesia, that might be part of the referral, but even having said that there’s a huge amount of overlap between them. And so I also very commonly will use trigger points to treat more general biomechanical issues and old very often also use motor points to treat painful conditions. Um, and there’s a more subtle distinction to be made. And how I diagnose personally between the use of those two things. Um, it has to do with the fact that when you have pain, sometimes the pain is coming from a motor point, but you can have pain due to a muscle dysfunction that isn’t sorry, a trigger point.

Um, you can have pain from muscle dysfunction that is not from a trigger point pain, but just you can have pain because the muscle itself isn’t firing correctly, which can send signals to the central nervous system, kind of a warning signal. That just something isn’t right. We’re going to just give you some pain. So you stop using the muscle. Um, so you can have cases of pain that are in a muscle that are not to the trigger point, but they can be helped a lot by motor points. Um, so there are just kind of muddied the whole discussion a little bit with that. So I I’ll, uh, let’s open this up, Matt, Brian, uh, what do you guys want to talk about in terms of that?

Uh, Brian, I’ve got a few things to say, but why don’t you go ahead and start? Uh,

Well, I just say something simple and that’s, uh, you, both of you guys painted an ice clear picture of, uh, a difference between a motor point in a, in a trigger point. But if you look at a lot of the discussion and sometimes even the research out there, it’s not always so clear cut as, as Josh kind of alluded to it, the Venn diagram of how they overlap in terms of, um, comparisons, but even in terms of discussion like Matt was mentioning, sometimes they use the term motor entry points, sometimes motor point to encompass all of that. It’s not always very, um, consistent sometimes there’s discussions of trigger points that talk about, like, I saw several research articles that talked about an anatomical basis for trigger points. And they were basically looking at the motor entry point as the site of where trigger points tend to form.

Um, so the it’s not so clear how we’re going to try to discuss it from a, um, you know, compare and contrast and as if they’re different, but there’s a lot of overlap out there. So if you’ve looked into this at all, sometimes it’s easy to get confused because it’s confusing cause there’s a lot of different, different people saying different things about it that aren’t always consistent. Um, and I know this isn’t the case with the newer edition at Trevell and Simon’s book, but, um, in the previous additions, you know, they had Xs on sort of the frequent location of where a trigger points tend to form. And there was numbers, you know, like trigger point number one, upper traps trigger point number two, and in a different regions and different kinds of common sites. Now, of course, within that common site, you’d have to palpate and find the exact location.

Um, uh, and it’s going to be very variable, but there were sort of go-to sites, so to speak. And, um, if you look at those go-to sites, you’ll see that those go-to sites tend to be at the motor point, the motor, uh, close to the motor entry point location, um, where the muscle is getting the innovation. So, uh, the reality is that motor points are at the location of where common trigger points form, and both of them share one similar thing in their description and their language is that a motor point is the highest concentration of motor in plates. It’s a motor in plates or the cite on muscles that are, uh, have receptors for acetylcholine. So a motor point is the highest concentration of motor end points, a boater, um, in plates. I think that’s more of the classical definition of, of a motor points. Now with motor entry points, that’s more about the entry side of the nerve, but the classic definition going a little farther back as the highest concentration of motor in plates and trigger point in the language is often described as forming at the site of the highest concentration of motor in plates. So there’s a lot of parallel and there’s a lot of overlap and it’s not always clear to differentiate one from the other, my turn.

All right. Thanks Brian. Um, Josh Brian, that was awesome. That was good. Uh, in, in my mind, the motor implants are going to be where the intramuscular motor points are a little kid at, um, where the motor nerve enters into the muscle. There can be collateral branches that go into the motor end plates, but not always. So let’s now take this information and see if we can be able to bring it into some kind of clinical sense, for example, let’s I remember before we get into clinical sense, let’s remember that motor points also can be used as empirical points that will take pain away from a distance site. And that pain from a distance site has nothing to do with the trigger point referrals. Like for example, a flexor carpi ulnaris motor entry point is pre magnificent and taking pain away from the levator scapula attachment.

And that lateral posterior side of the neck or the piriformis motor entry point takes pain away from a urinary bladder 10 region. So there’s a number of different ways of looking at the motor entry point. And also what the trigger point is. Let’s say that tomorrow a patient comes in with sciatica, you use slump tests, you use straight leg, raise tests, a neural tension test, and they’re negative. So it doesn’t seem like it’s true sciatica. So what could be causing the sciatica like sensations? There’s a number of things that can, for example, a Fossette joint can cause referral pain, a sick really act joint can cause referral pain trigger points can cause the sciatica like referral pain. So let’s say that with this patient that you’ve done slump test and straight leg raise, and you’ve ruled out sacred iliacs joint dysfunction or Fossette joint dysfunction.

And you’re palpating along the iliac crest where the gluten minimis attaches and you find with palpation, it reproduces that patient’s sciatica likes sensations. This is just in the hypothetical example. So you’re looking at the glute minimus at its attachment side, or maybe the muscular tenant is junction site that you’re palpating around that area. And it’s a way from the motor point, which would be the muscle belly halfway between the superior border of the greater show canter and the iliac crest. That point definitely needs to be treated because it was causing this person sciatica or sciatic, like sensation definitely needs to be treated and TCM. We look at it as being either as an access or deficient, is it cold? Is it damp? And we are treated according to how we know how to get rid of and resolve damp or treat cold, reduce access, reinforce the deficiency.

It’s all going to be predicated on your palpation. Now, from my experience, if we treated the motor points of the gluteus minimus, first that trigger point that was located two or three inches away would be difficult to find it’s not going to be reproducing that same type of parasthesia. So from my experience, I would like to treat the trigger point. First, what I’ll do clinically is treat the trigger point first because that’s what’s causing it. And they’re like what Josh was talking about before let’s treat the motor entry point, cause that’s going to be then communicating quite a bit, the central nervous system about where that muscle is in space. You guys want to comment on that? Yeah. So

I think, um, another really great aspect to think about motor points is that in that particular case that you’re talking about, the motor points are also going to be incredibly useful to then treat the other muscles that might be involved in why that glute minimus develop trigger points in the first place. Right? So there may be, uh, there may be some, you know, if there’s like a pelvic imbalance where you have to look at the balance between the, the hip, uh, AB doctors like the glute medius and minimus plus with the add doctors plus with like the QL, um, that there may be this larger muscle imbalance issue between keeping the pelvis level in the, in the frontal plane, right? So it could be that treating the motor points of the adductor longus and brevis the quadratus lumborum and even using the motor points more in a TCM sense of looking at excess and deficiency to try and balance.

A lot of that is going to be a really important part of the treatment to keep that one gluteus minimus that’s causing referral pattern to keep that from developing further trigger points, right? Cause the trigger points could just be the end result, like the last symptom of a dysfunction that has been going on from these other areas, right. Um, where you might need to treat motor points, uh, down in the, in the cap for any of the motor points for the muscles that control the foot of the ankle. Cause maybe the glute minimus is developing trigger points because of its being overloaded because of an ankle dysfunction. Right? So I think that’s another aspect to the balance between looking at trigger points versus motor points that can be really helpful clinically. Awesome. Brian, anything you wanna say?

Yeah, I would just add into that some distal channel points do it. Now we have a pretty comprehensive picture. You know, we, we use this one a lot with the glute medius and minimus minimus in this case. Cause it’s clearly on the gallbladder sinew channel ma uh, Josh mentioned the quadratus lumborum and the add doctors, which we on time to go into it now, but the QL is, uh, part of the liver send you a channel as the ad doctors are. So you could also include points, um, to affect the relationship between those channels like sourced and low combination gallbladder, 40 liver five would be a really good combination that we use quite easily in the program. So you do, maybe we have this one point, that’s creating a referral, but it’s linked, uh, functionally with other muscular structures. So glute minimus in this case, linked with quadratus, lumborum add doctors in terms of how they’re in dysfunction together. So we can use motor points and trigger points and combinations of those muscles along with distal channel points. And that’s a to create a good local distal and point combination from a TCM standpoint.

Oh, awesome. Yeah, that’s good. Let’s go farther into that. So remember you guys, Osher points have been treated for thousands of years. So trigger points and tender motor points have been observed and treated with traditional techniques. And in some of the discussions that Josh and Brian have had is that when a trigger point is located in a different location than the motor entry point, it’s really common to find a tight palpable band linking the two. So for example, from the motor entry point, if you cross fibered toward the trigger point, many times you’ll actually find that type palpable ban linking the two, which maybe is why punk’s a needle technique was developed, which is really quite common in myofascial acupuncture by kneeling three or four needles in a row within that tight palpable bag. One of the needles would be at the motor entry point.

One of the needles are two of the needles might be the trigger point. So you’re covering those bases. And then as Brian was talking about linking that particular channel with points that will open up the channels in the collateral Xi, cleft Lubo points and such, and let’s also remember this patient, what’s their internal balance. What’s happening with them? How well can they handle inflammation because it’s on the gallbladder channel. Well, how is their liver and gallbladder functioning in their life? Could the liver and the gallbladder be contributing to part of this clinical picture? Always something for us to be able to consider is people are not just coming in as meat suits. We treat the entire patient. Great discussion. You guys.

Yeah. Another really interesting aspect to, uh, bringing TCM theory into this is also looking at, uh, general, like we get into TCM basic constitutions, right? There’s I very often find an element of spleen Xi deficiency with certain types of people who tend to develop a lot of trigger points because of the, the spleen’s ability to supply energy to muscles. Right? Cause the trigger point formation is in a sense of problem with energy supply to the muscle after it gets damaged, right? There’s a, there’s a very strong case to be made for looking at the importance of blood status and using herb formulas to treat a lot of blood status. Um, I think I mentioned maybe in a previous discussion that Brian and I had, I’m a big fan of the drew Yutang family of formulas for treating various types of musculoskeletal pain for that, uh, for that purpose. So I think that that’s, that could be a whole other podcast. We could talk about like a TC woman also talking about like postural distortions and TCM constitutional diagnoses, and then talking about muscular relationships between postural distortions and TCM stuffs. That could be a whole other thing we can get. Right, right.

That would be hours and hours and hours or people would just go to the smack program. Right. Well, this has been a great conversation, you guys, and I think there’s a lot of clarity that was added to this. Um, we are right approaching that 30 minute mark right now. Is there any closing comments that you guys want to be able to say?

Uh, I’ll just say, well first, um, Matt and Brian, thanks again for inviting me to do this. I really appreciate it. And uh, I just want to put it out there for everybody listening that the, the, the smack program, the sports medicine acupuncture program was one of the real turning points in my career. It kind of brought together, even though I’ve done a lot of work with trigger points and some orthopedic stuff before then, um, it really brought together, uh, so many different elements of what I was trying to get at when I was doing, um, orthopedic work with my patients that it’s probably saved me 15 or 20 years of studying on my own, trying to do a lot of this together. So I just wanted to say, thank you, Matt and Brian for, uh, giving people this opportunity. Great.

Well, thanks for that, Josh really appreciate that. And that’s good. Um, yeah, it’s always welcome. And no, Josh, you didn’t bug me with your questions during the smack program where you sat down as a no, no, you just have very inquisitive mind. And the thing is, is that kind of dialogue is so welcome to because other people are stimulated by that kind of conversation. So it’s always welcomed. So thank you, Josh, for that also for more, let me finish this one real quick, Brian, for more information about Josh in the comments section, there’s, uh, three different links that, um, he’s talking about trigger points for anybody who’s interested in a motor point chart or motor point book. There’s also, there’s going to be links for that as well. Go for what Brian.

Yeah. On the topic of, uh, messages coming up, there was a question which we could go into a lot of detail and we don’t have time, but it was about osteoarthritis of the hip. Um, and I just want to quickly say that the same discussion we were just having about balancing the pelvis, um, by using motor points, uh, in terms of like, if there’s a, uh, elevated Lem, QL, glute medius, and minimus, and the combination of motor points, plus distal points, that’ll help balance the hip joint would be really a great idea for osteoarthritis, but you could also look at, uh, what trigger point referrals are referring to that region of pain. The hip joint itself can refer pain and can be, can be the pain source. Sure. But since we’re talking about trigger points and motor points, looking at the trigger points that are part of that referral, uh, it could be that the trigger point is causing 20, 30, 40, 50, 60% of that pain. Um, so also treating the, the, uh, looking for trigger points in those, um, regions that could be referring to that area would be a, it would be a good idea to start with

Joshua say something, I’ve got something to add.

Um, uh, the only thing I would add to that is if you’re not used to looking up trigger point referral patterns, it not is going to not just be the muscles locally to the hip, right? One of the muscles that might recreate something like osteoarthritis of the hip could be like the lung just amiss muscles up around the thoracolumbar junction around T 12, right. That can refer pain down to the truck hacker. So there’s a lot that has that a lot of, um, resources out there to allow you to look up for pain in one particular area of the body, what is the list of different muscles that can all refer to that area? And it’s really helpful looking, you can find those online it’s in Trevell um, uh, yeah, very useful resource.

Um, just to add some clarity with this one, cause I don’t know what kind of diagnostics were made with the osteoarthritis. So the patient may actually have confirmed osteoarthritis, but now these comments that we’re making is that, um, there also could be, uh, pain contributors, which would be trigger points. So as we know, uh, trigger points can also live not only in muscle tissue that we’ve been addressing over these last couple of hours is also can live in joint capsules, tendons, ligaments. So needling the joint capsule itself may also help in this particular case as well.

All right. Anything else, gentlemen? I think we, uh, we covered most of the stuff we wanted to cover.

All right. Well thank you very much. Really, really appreciate it. And so stay tuned for next week, come in, check in, check out Jeffrey Grossman for next week. And Brian is, was nice hanging out with you, Josh. Thank you so much. Really, really appreciate it. Thanks you guys. Bye now. Bye-bye