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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Does research support the effectiveness of acupuncture for treating low back pain?
A study published in the Annals of Internal Medicine assessed acupuncture’s effectiveness for treating low back pain.
33 randomized, controlled trials met inclusion criteria and were sub-grouped according to acute or chronic pain, style of acupuncture, and type of control group used.
For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment, and no additional treatment.
This study’s findings concluded acupuncture effectively relieves chronic low back pain.
However, no evidence suggests that acupuncture is more effective than other active therapies.
Remember the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.
There is a reason acupuncturists have trusted AAC with their business for 50 years.
Not an American Acupuncture Council member? Get a Quick Quote and find out how much you will save! Click here!
The top three cybersecurity threats. As outlined in the health industry, meaning you, your acupuncture practice and cybersecurity.
Click here to download the transcript.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, everybody. Good morning, good afternoon, whatever it may be for you. This is Perry Barnhill with the Fearless Acupuncturist, and in the background that you don’t see Dr. Julie McLaughlin. We want to give a big thanks to the American Acupuncture Council for bringing you this presentation on the top three cybersecurity threats that you need to be aware of in the context of your practice and hipaa.
Start slideshow please. I am gonna give big thanks to the a, a C for bringing this to you. All right, here we go. Let’s talk about the top three. There’s many tops, but we’re gonna start with the top three. Okay. The top three cybersecurity threats. As outlined in the health industry, meaning you, your acupuncture practice and AC cybersecurity.
Oh, so why do we teach hipaa? We understand what it’s like to have a practice. We understand what it’s like to take care of patients, and we also understand what it’s like to not really know for sure what it is we should know in regards to compliance and in regards to hipaa. So we’re here to teach you this and we’re gonna start going through some of these top three cybersecurity threats.
Again, myself and Julie we’re both he healthcare practitioners, as you can see, and also both have certifications in compliance. Alrighty. So let’s talk about some things, buzzwords, as I would say that you hear probably quite frequently, but don’t really think about in the context of your practice and in hipaa, social engineering.
So what does social engineering mean? Let’s go through this. Social engineering is a form of psychological manipulation that tricks users into making. Security mistakes and giving away sensitive information. It relies on human error. So it relies on things like our staff that may make a mistake and click the wrong link.
What we’ll talk about, and also mistakes that we as the providers may make as well. So in uses humans to make mistakes and instead of specifically using the software or actually your system to make a mistake, it tricks us by exploiting. Our human emotions. So let’s get into some of those things.
One, this is something that you really need to sit down, talk about, train with your staff such that they don’t get themselves in trouble with clicking on the wrong link. Now, what are some things you need to pay attention to? This is what they call phishing. If you’ve ever heard the word phishing, it’s not like catching a fish in the water, but these crooks are out there phishing for us to make mistakes and trick our brains into clicking something we shouldn’t click.
So if for example, number one here, if you don’t recognize the sender in an email, for example, do not click it. Okay? If you’re not expecting an attachment or an email. You may not wanna be clicking it. ’cause if you click it, you might get yourselves in a whole lot of hot water. What about this one?
Does the from address match the message? When you get an email, look at these things closely. You’d be surprised. But the little things here, these little tips, could prevent you from having the compromise of protected health information, which in turn could potentially get you some fines and penalties with HIPAA if you’re not doing the things you’re supposed to be doing.
All right, and number four. What about this one? You get emails that sort of create or invoke a sense of urgency. Double check it. Maybe it’s not a legitimate email. What about the, not recognizing the destination URL or the website, is it a secure website? These are things where I, it professionals help out a ton, but simple little tips like this training our staff and us being aware of them can help prevent massive compromises and breaches of PHI.
Number eight is this email asking for your logging credentials. Seriously, be very cautious. Certainly if you’re not aware that something’s coming across, if anybody asks for your logging information, it’s probably better idea just not to do it unless you’re a hundred percent for sure. Number nine, bad grammar or bad spelling.
I know you’ve seen this. Have you seen emails come across The spelling? Looks a little weird, a little funky. It’s not correct. The grammar doesn’t sound particularly correct as well. Don’t click on it. Just don’t click on it. What about this one? Number 10 is the greeting or signature generic or lack contact info.
Anything that looks funny with emails that are coming across, just don’t click on ’em. ’cause if you do and they’re contaminated and they’re corrupted it’s a lot of energy and it takes a lot of time to make sure that. Compromises of PHI didn’t happen. And you didn’t get hacked. Which kind of brings me to the next one here.
Ransomware. We’ve heard of ransomware. What is ransomware? Ransomware is a threat, to us and to our devices. And what makes this form of malware so unique is the word ransom. Basically, ransom extorts us, these hackers. They’ll steal our information, our protected health information, like our patient’s information, the patient’s files, and they’ll tell us, Hey.
We have this, we’re gonna keep it. You can’t even access it until you pay us X amount of money, and it sometimes is thousands and thousands of dollars. Now I wanna say this, don’t ever pay them until you speak with an IT professional or you speak with someone who you’re very confident, that’s very aware of all of this ransom, this malware don’t do anything until you contact someone, a professional regarding these things.
Okay? So here’s some threat quick tips to be aware of, kinda like we talked about in the phishing side of things. Most ransomware, they’re sent in phishing emails. So you get these funny looking emails, you click on ’em, and guess what? Now they got your information or your patient’s information, and they can hold it ransom.
So don’t click on those things, stay alert when any email prompts you to enter your credentials. If you notice, a lot of these tips are very similar. To the phishing tips. First they gotta get you, and then when they get you, they can hold you for ransom or hold that information for ransom.
So be cautious, before you click any links in any emails that you have, make sure those senders are legitimate and as a proactive measure, check to see whether the computer and network to what you’re connected to have proper intrusion protection systems and software in place. I can’t overemphasize this unless you really need to make sure your computers are secure.
Now that we’ve talked about ransomware, kinda like we talked about phishing and gave you some tips, let’s talk about some tips regarding RAN regarding ransomware and how you can prevent yourselves from getting hacked and having to pay some of these ransom demands. Okay, most ransomware, guess what?
They’re sent in phishing and email campaigns. So be careful if you open up any attachment that may look weird. Funny spelling, grammar, just like we talked about earlier. ’cause once they get that, they can hold your protected health information for ransom. Number two, stay an alert when any email prompts you to enter your credentials.
I know we said this earlier, but it’s really important because these fishers, these scammers, they will check on these things. They will ask for these things and once they have them. They’re into your system and they have your passwords. Be cautious. Before clicking any links looking at the senders and checking the URLs.
Very important. Share all of this information with your staff. ’cause your staff, you may think that, okay, this ain’t gonna happen, but it might if you don’t train your staff on the things they shouldn’t be clicking on and what they need to be aware of as a proactive measure. Check your computer, and make sure the network to which you’re connected have proper intrusion systems and software in place.
It’s so important that you have IT professionals. Help and protect your computer systems. And due to the severity and time sensitivity of ransomware attacks, if you think this is happening, or if you think it happened, or if it’s in the process of happening or something weird is going on with your computer.
Make sure you seek out your IT professionals, because if they get it, it’s a big process of trying to get it back. And then guess what? Now we gotta deal with hipaa. Now we have to deal with the OCR and potential report. And then guess what? We might even have to send notifications to patients. Something we just don’t wanna have to do if it’s not necessary.
So here’s some other things. Preventing loss or theft of equipment or data. Things like taking your laptops or your data in your car. So physical loss of equipment, these things can happen. Or even data access to that you work with daily has to be carefully protected. Alright, so let’s talk about some tips here.
Never leave your laptop or your iPad unattended at work or in transit. Yeah, in transit. What do I mean by that? Like I said, in your vehicles. There are providers that have left their laptops wide open, sitting on the front seat, even sitting on the dash, and they get stolen. It’s not something we want to happen.
Password policies and updating the passwords. These are all things that need to be in your manual. They’re all things that we have to do. They have to be part of your procedures and your policies. If you don’t have these things in play, guess what? You’re not HIPAA compliant and maybe subject to some fines or some penalties.
We don’t want that. It’s not necessary. Don’t share your password with anyone. I know a lot of us, we don’t do these things, but sometimes we do. Staff shouldn’t be, sharing their password with the staff person next to ’em. They need to have unique passwords again. If this is part of your policies and your procedures, USB drives, be very careful if anybody brings in, like a patient, A USB drive.
’cause they want you to look at their files or their imaging. It could be corrupted. So I would avoid. Even going down that road with them, you have to encrypt sensitive data. Of course if you lose anything, number seven here, lose any equipment or if you have any at all suspicious activity on your systems, you have to get on top of this early, seek out the IT people, get ’em to stop it so it doesn’t go any further.
Alerting officials again promptly if something seems suspicious. And keeping your emergency context close by this is so important. I can’t even overemphasize how important this is for you to be aware, but also anybody in your office really needs to be on top of these things. So what are some next steps?
A lot of people say, Hey, I don’t know if I’m compliant or not. Go through a HIPAA download checklist. You can download this right here for your office. You can scan the QR code here, go through and look at these questions. And sometimes they’re not always as a simple yes or no, do you have policies and procedures to protect patient information? A lot of us do. So you could say, oh, I got that one. But do you have. Legitimately written down policies and procedures, what’s the policy? What is it? And the procedure is how do we do it, or how do we implement it?
You have to have all of these in play for everything HIPAA related, even passwords, updating passwords, making sure passwords are strong. All right. A lot of times if you’d ever, if you ever want to, a lot of people like to schedule a demo. They wanna see what our program looks like. So you can do that, you can schedule a demo by going to this go dot fearless provider.com/demo.
You can scan the QR code. We are more than happy to go over it with you. You can look at our program from the inside. A lot of times people just wanna get started. So go to www.fearlessacupuncturist.com. Or you can contact myself at Dr. perry@betterhipaablueprint.com. I’m more than happy to answer any questions that you may have.
So in the meantime, everybody have an amazing day, and thank you so much for joining us here. Take care.
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, my name’s Michelle Gellis, and I would like to thank the American Acupuncture Council for giving me this opportunity to speak to you today about microneedling for hair loss. Go to the first slide.
A little bit about me. I am an acupuncture physician. I am the author of this book called Treating the Face. It is a comprehensive guide. Wait this way and back a little bit. Okay. It is a hardcover 500 page full color book with over 350 images in it, on treating the face and. There’s an entire chapter in this book on micro needling, so you might wanna check that out.
And I teach cosmetic and facial acupuncture classes internationally, and I am currently on faculty at Yoan University in Los Angeles, California. So what is microneedling? Microneedling creates micro channels in the skin, and these micro channels will trigger cellular repair and regeneration. It helps to stimulate collagen and elastin and growth factors in the skin, improves the blood flow to the skin, and therefore nutrient delivery.
It enhances the absorption of any topical products that are put on the skin. And. Therefore it is used for skin rejuvenation, for things like wrinkles, scars, pigmentation issues, and what we’re gonna talk about today, hair growth. This is what a micro natal pen looks like. This particular one is made by AccuLift and you can see the website on the slide there, acif skincare.com.
And these have a dial here, and this determines. How deep the little needles on this cartridge will go into the skin. And this little window here it determines the speed, how fast those needles are going in and out of the skin. And this is what the needle cartridges look like. These are the 16 pin or 16 needle cartridges that would be used for microneedling the scalp.
And I did wanna talk to you a little bit today about hair loss, different types of hair loss. There are a lot of different reasons why we lose our hair. And this quick 10 minute lecture I’m giving you today is part a much longer one hour CEU lecture that I give. Which goes into all of this in much more depth.
So this is an overview, but some of the more common types of hair loss are androgenetic. Alopecia, which is commonly referred to as male pattern or female pattern baldness or hair loss. Intelligent effluvium, which is typically from stress or illness if your hair falls out. Alopecia areata, which is an autoimmune disease, scarring up.
Alopecia, which is an irrevocable follicle loss. There are other hair shaft abnormalities. Enogen Effluvium, which is a rapid hair loss resulting from some sort of a medical treatment like radiation or chemo. Tinia capita, which is ringworm in the scalp. And hypo psychosis, which is just naturally sparse hair or reduced hair growth.
Now micro noodling is good for some of these and not for others, but I just wanted for to purposes of today. I just wanted to give you an overview on some of the different types of hair loss within the TCM framework, hair loss. Can mean reduced follicles, whereas hair thinning is the reduced shaft, the caliber of the hair shaft, and we have several patterns that we look for.
So chi and blood deficiency, damp heat, liver, kidney deficiency. These are all different patterns that can show up with hair loss, just microneedling. I’m sorry for hair loss that microneedling can be effective for. So you want to address the root with body points and then do some local scalp therapy with the microneedling.
So you do your acupuncture body points, and then you would do the microneedling locally and. Blood heat generating wind pattern might show up as itching, headache, red tongue, and the treatment. Would be to clear the heat, extinguish the wind chi and blood deficiency frequently, or post illness or postpartum.
And your patient may have fatigue, palor, weak pulse, thin hair. And the treatment would be to tonify the cheek, nourish the blood for damp heat. This is often diet related. They might have a greasy scalp, loose roots, itching, red tongue, so you wanna clear the heat, resolve the dampness. And for a liver and kidney deficiency, this can happen in middle aged individuals.
They might have dull or graying hair, so microneedling can actually help the hair to not be as gray as well. They might have sore back knees, dizziness. Red tongue thin coat. Thin rapid pulse. So you wanna nourish the liver and the kidney. And of course, within Chinese medicine, mental and emotional factors can play a role in hair loss.
So stress, grief and worry can cause hair loss. So how does microneedling support the hair growth? Microneedling, as I said, stimulates the collagen production. Also, when you create these little micro injuries, it triggers cytokine and regenerative cycling in the skin. And this can help with the hair regrowth.
It enhances blood circulation. It, as I mentioned, improves the absorption. And trans epidermal delivery, how any topicals that you would put on your scalp, whether it’s a medical topical, like something like Minoxidil or some sort of a peptide or a growth serum, it can thicken the existing hair. And enhance the overall scalp health, making a more more, better, more fertile place for the hair to grow.
And it can activate some if the person has a hair follicle, it can activate the dormant follicles promoting new growth. It also releases growth factors and in my longer lecture, I get into what all of these different growth factors are, and these can help with all of the above concerns. So within Chinese medicine, the way we think of it is microneedling promotes qi blood.
And collagen renewal and stimulating the scalp works with microcirculation for the follicle vitality.
So again, activating stem cells, enhancing the microcirculation and creating collagen production can help to thicken the hair and enhance the overall scalp health. The equipment that you need is a professional microneedling pen. Especially if you’re working in your office, you don’t want to get a commercially available pen.
You want to get a professional microneedle pen because the speed. Will be calibrated properly. The pen itself should have anti backflow technology. The needle should come in single use cartridges and then serums that are appropriate for hair growth. Things that. Contain growth factors or peptides.
Botanicals, and you will prep the scalp with witch hazel or alcohol to cleanse it. You’re going to need gloves. You’re going to section the hair. And you could put topical anesthetic on and then put on a disposable, like a shower cap for 15 minutes. You can even use blue light if you have a blue light device.
So you want, the basic treatment flow is you meet with your patient. You’re going to prescreen them for any contraindications and go through a treatment plan. Typically, you’re going to see them once every two weeks or so, and. You’re going to cleanse the skin, apply numbing cream. Then that has to come off and you would section the hair, whatever hair is there, and you’re going to apply serum.
You’re gonna set the depth on the pen, depending on where in the scalp. And other factors, it’s either gonna be 0.25 to 1.0 millimeter, and then you’ll either do a linear or a stamping motion. You could use red light afterwards to help to increase the blood flow, and then you would set up aftercare with the patient, tell them what needs to be done, and then you could see them again in two to four weeks.
Typically improvement is seen within eight to 12 weeks. And that usually looks like enhanced density and reduced shedding. And you want to make sure that. You are following clean needle techniques. You’re going to use gloves. Your hands are gonna be clean. You would have a clean field set up. You definitely want to use single use cartridges, and they’re put into the sharps afterwards and you want to record the.
Of the needle, how many passes you did, if you used an LED light, how much time and what the response was. And then of course, document with before and after photos. So here are a couple of before and after photos from patients over about 12 weeks. And as you can see the density. Was quite significant density change in this patient’s hair.
And the first one was taken. If you’re wondering why the hair color was different this was taken. In the beginning of the autumn after the summer, and then this was taken 12 weeks later and after some haircuts, all of the blonde had grown out after a few months. And this is another before and after, again, significant changes in this bald area.
So if you want to learn more on my website, facial acupuncture classes.com, you can get a copy of my ebook on microneedling. And I also offer several different classes on microneedling for anti-aging acne. Hair loss. And I also teach live hands-on classes around the country and around the world.
But the online classes do have live they have demos and they’re all approved for continuing education. So you can visit facial acupuncture classes.com. And if you wanna learn more about the products, go to Alife Skincare. Com.
Is acupuncture effective in reducing postoperative complications in fracture patients?
Bone fracture is a common orthopedic condition that affects millions of people worldwide.
Patients with fractures often have a risk of developing complications, including pain, inflammation, infection, delayed healing, thrombosis, and organ failure.
A study evaluated individuals hospitalized for their first fracture surgery.
Patients who received three or more acupuncture treatments within one week were compared to those who received none and found a significantly higher survival probability in the acupuncture group.
The study concluded acupuncture appeared to have the potential to reduce postoperative complications in bone fracture patients.
Further large-scale studies are needed to provide stronger evidence.
Remember the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.
There is a reason acupuncturists have trusted AAC with their business for 50 years.
Not an American Acupuncture Council member? Get a Quick Quote and find out how much you will save! Click here!
So today we’re gonna look at some manual techniques that supplement your acupuncture treatment for shoulder injuries, particularly for something like supraspinatus tendinopathy that would be particularly indicated for that, but really a wide range of shoulder injuries.
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, welcome to another American Acupuncture Council webinar. My name is Brian Lau. I’m an instructor with the Sports Medicine Acupuncture Certification Program. I also have a YouTube channel and movement based program called Jing J Movement Training, where we look at channel send you relationships to movements.
So today we’re gonna look at some manual techniques that supplement your acupuncture treatment for shoulder injuries, particularly for something like supraspinatus tendinopathy that would be particularly indicated for that, but really a wide range of shoulder injuries. We’re gonna look at some manual techniques that can supplement your acupuncture treatment.
So let’s look at a bone model real quick. Get a an idea of what we’re looking at. Oops, we’re Alan, we’re starting with maybe we should start over.
So let’s look at a bone model first and we’ll get an idea of what our goals are for the treatment. Then we’ll look at some anatomy slides and then we can look at the actual manual techniques. So I have a scapula, so this is looking at it from the front. This is the right scapula. So we’d be looking through the rib cage.
On the front surface, on the ventral surface of the right scapula spine of the scapula’s on the back. So there’s the back view, but we’re looking at the front view. Here’s the coracoid process for reference. I’m gonna put the ERUs in here. So many times with shoulder injuries, especially with patients, as they start getting older, we have a situation where the head of the humerus rides up in the joint and usually a little bit forward.
So it doesn’t get seeded, it doesn’t set in the joint really well, and it rises up. The big problem with that is, as you can see, is when that humerus rises up, the humerus, especially the greater tubercle, tends to bump into the acromion and pinch anything that’s coming underneath there, like the supraspinatus tendon.
So it tends to ride up and a little bit forward. We’re gonna do several techniques on some of the rotator cuff muscles to help mobilize the head of the humerus back into the joint. And create a situation that allows for better healing. So that’s gonna be our goals. We’ll look at that on the the techniques, but let’s look at a little bit more anatomy first.
So we’ll go to the slides.
So this netter image we have from above. We have the rotator cuff muscles. So the trap trapezius, upper trapezius has taken off. We have a couple other images. We’re looking again at the back surface the posterior surface of the scapula and shoulder girdle, and then we’re looking at the anterior surface.
Pretty much what we just saw a second ago. We’re looking at the anterior surface of the shoulder girdle and the rotator cuff musculature. Let’s start with the upper portion. So we have the supraspinatus, and the supraspinous fossa. SI 12 would be going right into the belly of that muscle into a motor entry point of that muscle for reference.
That muscle then continues lateral. We would have LI 16 getting close to the myo tendonous junction. The supraspinatus is going underneath the acromion to attach to the greater tubercle right there. So this is a common area where it’d get impinged in shoulder impingement syndrome. We can start getting a tendonitis or tendinopathy.
Of that supraspinatus tendon very easily because of instability there can’t really see the in infraspinatus and Terry’s minor super well from this perspective, but we can see ’em wrapping around and going to the greater tubercle also. And then from the front we have the subscapularis on the subscapular fossa going to the lesser tubercle.
So from the back surface there’s a better view. We still have supraspinatus, but a better view of the infraspinatus. Looking at the fiber direction, going up and out. Terry’s minor, we’re not gonna look as much as at Terry’s minor in these techniques, but it’ll cover it somewhat. And then subscapularis from the front also going up and out in its fiber direction.
So just a image with some points in, for some reference, we have SI 12 in the supraspinatus. We have SI 13 in the superspinatus. I 16. All of these are very protected. As long as your measurement’s good, very protect is protected by the subscapular fossa, that needle can go straight down and it’s gonna be protected by bone as long as I’m not way forward and diving the needle down through the trapezius higher, farther forward than the supraspinous fossa that could cause a pneumothorax with deep needling there.
If I’m measured correctly and I’m, relatively close to the spine of the scapula, very safe points. Sometimes people even thread from Ally 16 underneath the acromion towards Ally 15. So it’s an interesting aspect is that we have ally channel points more at the tendon aspect. We have si 12, si 13 much more related to the belly of the muscle.
You can go back and review and recall that the Ally channel intersects. The small intestine channel at SI 12, and you can see that there is quite a relationship there. From the back we have SI 11, 10 and nine, wrapping around the Terrys minor. So you can see the SI channel really relates quite a bit to the the rotator cuff musculature.
And then from a, from the front, we have heart one, an opposing muscle group in the sense that it does similar. Activity that it stabilizes the head of the humerus, but it does internal rotation versus these si channel muscles which do external rotation. So the heart Sinu channel has a slight different capacity in its in its actions, but there’s heart one would go deep into that.
Subscapularis, we can see it almost better from this top image where we would be going through the axilla. The arm wouldn’t be going through the anterior deltoids like this. So the arm would be up, it’d be going into the axilla parallel with the rib cage deep needling into heart. One would access the subscapularis a good technique to really learn in class if you’ve never done it because there is a pneumothorax thorax risk if it’s not done properly.
But we’ll look at a manual technique, which is great practice for this needling technique. And it’s actually a very effective technique in and of its own. So one last image. So this is gonna be our basic goal is we’re gonna. Sink down into the supraspinous fossa for the supraspinatus, and we’re going to slowly spread posterior to anterior.
We’ll do several passes covering the length of the muscle. My goal is gonna be to reduce tension, in the supraspinatus, but particularly that sinking down. I wanna notice that muscle attaches to the greater tubercle. So I want to do the technique in such a way that’s gonna drop descend the head of the humerus.
Same thing with the infraspinatus. I’m gonna sink in and slowly spread cross fiber through the infraspinatus muscle and using that muscle as a lever. I wanna pull down the head of the humerus. So we’re gonna be using the myofascia to move the humerus down so the slow spreading over infraspinatus, slow spreading over supraspinatus.
We’ll have that goal. Descending the head of the humerus. We can almost think about these as ification techniques because these muscles tend to get inhibited and they don’t properly seat the head of the humerus into the joint, into the glenoid cavity. And then the final technique we’ll look at will be face up, will be coming deep in the heart, one pinning the tissue, and as the patient does movement, there’ll be an influence down also to help descend the head of the humerus.
But this will be more of a pin and stretch technique, and it’ll be more of a sedating technique. So very frequently we have a situation where this muscle is in excess, this muscle is overactive, the bully. And it tends to create a little internal rotation, pulls the joint forward, but collectively those rotator cuff muscles are failing to seat the head of the humerus into the joint.
And that sets the situation up for the. Bone to rise up and pinch that supraspinatus tendon. This is something we work with quite a bit in our upper extremity class in sports medicine, acupuncture. So this is something we go through quite extensively in our upper extremity class, in sports medicine, acupuncture.
We go through a lot of the dynamics of this, but we’ll get a flavor of this through the videos that are coming up. So let’s go ahead and watch the first video on supraspinatus and we’ll come back and review some of what I just said with the infraspinatus to set up that next video. Look at some rotator cuff techniques.
First of all, just a little bit of cocoa butter. You can see on my finger, not a whole lot. I’m not even gonna put it on patient, just get it on my hands. So just a little bit of lubrication, but I want it to be mostly grab on the connective tissue. So more shearing type techniques. So not too much lubrication.
For the first one on supraspinatus, I’m gonna have the arm up on the table. There’s the spine of the scapula. I’m gonna move this technique. I’m not gonna use my finger like this. I’ll show the full technique in a second, but I’m gonna move the trap slightly out of the way so I can sink down into the supra spinous fossa.
And my target will be on the supraspinatus, but I wanna see the head of the humerus drop down. So this is primarily a technique to drop the head of the humerus down in the glenoid cavity. Using the supraspinatus as a lever. So I’m gonna come at the head of the table, hands on the spine of the scapula, move the traps out of the way, sink down into the spine.
Supraspinous, fossa, and descend the head of the humerus.
Pushed down. I wanna see that head of the humerus drop down. My thumbs are in contact with the supinate and I’m just gently spreading over it.
Spine of the scapula. The head of the humerus push down
spine of the scapula decent. The head of the humerus push down
and I’m just covering the range of it. So right at SI 12, slightly medial to SI 12. Going closer to SI 13. Moving lateral to the region of Ally 16, and I’m just covering as much of the s spine as fossa as I can my last pass.
Alright, so infraspinatus, just the review, I’m gonna be spreading, sinking in kind of at the spine of the scapula. I’m gonna be spreading down and out going across the fibers, but with that emphasis on pulling downward to help descend the head of the humerus. So it’ll be a down and out slow spread myofascial release type technique through the infraspinatus.
Let’s go ahead and look at that technique. So for infraspinatus, I wanna bring the arm off the table. About 90 degrees, unless the patient has some pain. With that, you can make it a smaller angle, but my preference is to be 90 degrees. I’m gonna come back to the head of the table infraspinatus. The fibers are going up and out, so towards the greater tubercle.
So up and out, I’m gonna do a pass across the fibers of it. Again, it’s like I wanna pull through that muscle to drop the head of the humerus down. This one I often use a knuckle, maybe two knuckles. I turn my ulnar side away. That way my bones are lined up. I can start at that spine of the scapula, sink down into the tissue, move the tissue down and out, and I’m gonna start to slowly spread through the infraspinatus.
So just a slow stroke, waiting for the tissue to soften, not trying to rush through the tissue,
getting small fasciculations along the way. And there we go. So same thing, I’m gonna go slightly medial or lateral. I went medial in this case, sink down into the tissue to the depth of tension and shear down and out.
I’m just covering the infraspinatus, so I’m at the lats now. I’m gonna stop there.
Move slightly lateral down and out.
So one more pass. I can add patient movement with this. So the infraspinatus is an external rotator. I can have them do slight external rotation. Then slight internal rotation as if they’re bringing the arm back onto the table. So just the comfort just to get a little movement as they’re doing it. Go and relax there for a moment.
So I’m gonna sink in first, drop into the tissue, and go ahead and do that slight motion now. External rotation, I’m just holding that barrier. That’s good right there. Internal rotation, go back the other way, and this way it’s gonna start to stretch through that tissue. That might be a little more challenging for the patient.
External rotation, so the hand comes up and hand back.
Good. Do one more. Pass there. Hand up. And then hand back. As he starts going that way, I’m gonna really spread through the tissue.
And there we go. That’s good. Alright, so last video and last technique we’ll look at will be for the subscapularis. Again, this is a really good technique if you’ve never done deep needling into heart, one, not only can you get a lot of results and improvement with patient’s conditions by doing this technique.
Maybe that’s all you ever do, but it also does set up the palpation and the sort of kinesthetic awareness of doing a deep needling technique there. So we’ll look at a manual technique for the subscapularis. I’ll hold off on the needling technique because I think this is best left for classroom in person instruction.
If you’ve not needle the subscapularis deep in the heart, one. It’s a safe technique. If you’re taught properly, you’re pretty close to the rib cage, you’re following parallel to the rib cage and you’re going straight down into the subscapular fossa. So if you don’t have the palpation down, the needle could advance into the between the ribs and into the pleura and causing pneumothorax.
So it’s definitely a technique to learn in person with guidance if you’ve never done it before. This manual technique, however, will be very useful to get the palpation down. And the manual technique is extremely effective in and of itself. So I’m gonna do, just like I would do with the needle technique, I’m gonna reach under the scapula, move the scapula out just a little bit.
It doesn’t move it out much, but it gives you a little bit of extra space. I have the lats peck, I have this little triangle right in there. I’m just gonna come in. A couple tricks with this is I don’t want to grab too much skin. ’cause as I advance down, you can feel how that’s pulling skin and it stops me from going too far down, doesn’t feel great on his end, and then it stops me from doing the technique.
So I need to get the skin out of the way. By that I mean I need to lift it a little bit, move my fingers around, kinda get to where I’m gonna go advance down into that subscapular fossa without pulling a lot of excess skin. So I’m gonna now angle straight down. I can feel the ribs on my fingernail side, and I’m gonna angle straight down into that subscapular fossa cross fiber feeling for bands of that subscapularis muscle.
It’s almost like I’m going to si 11 on the front of the scapula, so this would be deep in the heart one. So once I’m there. One of the things I can do is I can have the patient move their elbow down following the angle of the arm. So they’re making their arm long. That might be enough, but but if they can, then I’m gonna have them start to bring their arm up, keeping the elbow out.
There you go. Keeping that elbow out, bringing the fists slowly over the chest, reaching the elbow out. I really wanna. Push the subscapularis down while they reach the elbow out. Decompress the shoulder joint so as much as they can bring you in by bringing the arm up, the better. So they’re gonna get the hand up.
And now external rotation.
To about there, and then if they can bring the fist down towards the table.
There we go. All right. So JT has pretty good range of motion, so that makes it look a certain way that is not necessarily achievable for somebody who, has limited range of motion and this technique would be too much for ’em. So sometimes you can’t even get the arm up to 90 degrees.
It’s okay to back it off a little bit. I don’t wanna put them in an unstable position. I definitely don’t want that humorous. Can you kinda shrug your shoulders as I do this? I don’t want, yeah, I don’t want that arm to shrug up as I bring their arm to 90 degrees. I’m working at counter purposes, so I need that head of the humerus down.
Maybe I can only get ’em up a certain amount. I can definitely get them to reach the elbow out and decompress, pull the head of the humerus down as I’m pushing the subscapularis medial and freeing the subscapularis. That would be enough for some people. Maybe they can lift their arm up a little bit, so you just have to work with where they are.
But the starting position would be to get into the muscles. Okay, if I do this again, so to get down into the muscle. Feel that subscapularis, I’m cross fiber in it right now. Get on that band. I wanna almost bend that band and just gently reach the arm out, decompressing the head of the humerus.
They could also go into external rotation here, but I like them to be able to bring me in by going into horizontal a deduction to bring me more into the muscle. Maybe that’s as far as they could go. JT can go farther, but I’m just saying maybe a patient you’re working with that’s their end point.
No problem. I can work there, have them reach free. Maybe next week we’ll come back and see if we can go a little farther.
Alright. Very good. Thank you for taking the time to watch those. You can see those techniques take a little bit of time, but not particularly much. A lot of that was me explaining and setting up the techniques. You could easily do this if you had the face down portion. You could take the needles out, do these techniques, spending a couple minutes going through the superspinatus and the infraspinatus to help descend that head of the humerus.
It wakes up the muscles. It helps give them proprioceptive awareness so that they can more appropriately pull down. Head of the ERUs and seat, the head of the humerus in the joint. If you do a second round of treatment and you do whatever on the front, maybe even including the needling for subscapularis, you could follow up with this technique on subscapularis.
Or maybe you don’t do the needling on subscap. This is a really great manual technique to cover that that range of the muscle. Something to consider. My last thought on this is point combinations. Is if there is this excess in subscap and more inhibition sort of deficiency in the small intestine channel muscles.
Infraspinatus, supraspinatus, te minor. A combination I use quite frequently is the source point on the SI channel SI four and the low connecting point on the heart channel heart five. So a source low connecting combination. Feel free to comment. I’d love to hear some other point combinations you guys do that might, you find, give good results and good responses for these types of conditions, or if you use that that low source point combination. Tell me if if you feel like that’s been a useful point, combination for you. Always nice to learn from each other, so I’ll be checking out the comments and maybe we can have a little bit of a conversation about that.
Thanks again for taking the time out and watching this, and thanks to American Acupuncture Council for having me. So it’s always great to be able to do these webinars and I appreciate the opportunity. Hope to see you guys next time.