Tag Archives: American Acupuncture Council

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Identify and Use the New ICD10 Updates

 

 

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

Click here to download the transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[inaudible].

 

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Growth, Hiring and Culture

 

 

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

Click here to download the transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[inaudible].

 

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Working with the Psoas Major and its Respective Sinew Channels

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Unfortunately.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[inaudible]

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

[inaudible]

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

 

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Segmental Acupuncture

 

 

Josh regularly, pursues high level trainings in cranial and visceral manipulation and has profound understanding of the interplay between the nervous system internal organs and musculoskeletal system.

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, my name is Poney Chiang from Toronto Canada. I teach continuing education courses from neuromeridian.net. Uh, welcome to this week’s live Facebook podcast show for the American Acupuncture Council. My guest for today is Josh Margolis. Joshua has been practicing manual medicine and bodywork since 1995 and acupuncture in Chinese herbal medicine since 2001 from 2005 to 2009. He was a faculty at the academy of Chinese culture and health sciences in Oakland. And yeah, I keep on change here to medicine in college in Berkeley, teaching anatomy, orthopedic acupuncture, advanced channel theory and pain management. Currently Joshua is on staff at the osteopathic college of Ontario and teaches in the doctoral program at several bay area acupuncture colleges. Additionally, he teaches segmental acupuncture and manual therapy of courses for acupuncturists throughout the United States. Josh regularly, pursues high level trainings in cranial and visceral manipulation and has profound understanding of the interplay between the nervous system internal organs and musculoskeletal system. In Joshua’s years of practice in the bay area, he has gained a diverse, loyal following comprise of professional musicians, dancers, yogis restauranteurs, athletes, and as well as children, the elderly and those with severe chronic illnesses, he has been practicing art from a Copia in Santa Rosa, California in 2011, as a pleasure for you to, for me to be able to have this chat with you today. Joshua welcome.

Thanks for having me here.

And, um, uh, are you joining us today from Santa Rosa right now?

Yeah, Santa Rosa, California. Yeah. It’s morning time here.

So I have been hearing really great, wonderful things about your courses. And I look forward to view a study with you in person, hopefully sooner rather than later. Um, so this is why I wanted to, um, use my spot for a guest today to steal all your secrets. I want to, I want to pick your brain and hear what is it that you do? What influences you like brings you? What makes you, you passionate about what you do? So let’s start by, um, telling us a little about, about yourself. I know I already give an in in-depth introduction, but you know, who, or what influenced you the most, would you say as far as, uh, practicing clinically speaking?

Well, I’ve always had my foot kind of into two worlds. Uh, I don’t that are not the domain. So, uh, and I used to feel like I put on two hats. Those are the two worlds being manual therapy and acupuncture, and I’ve always felt I had to kind of put two hats on and be like, okay, now it’s anatomy time and I’m going to do osteopathy. And now it’s acupuncture channel time and I’m going to do some kind of distill acupuncture, ear acupuncture. So, you know, I got pretty quick at, at, uh, switching my hats back and forth. Um, but of, you know, uh, thinking about how to integrate those things has been kind of an ongoing question for me. Uh, the, those two hats. So there’s been a couple key influences along the way. Um, Michael Kuchera who is, uh, an osteopath, I think he’s in, uh, Kirksville.

Uh, he wrote some great books on, uh, osteopathy for internal medicine, uh, disorders, and it really talks a lot about segmental organization and how you can, uh, exterminate you from external stimulus, uh, affect the internal processes. Um, and on a, another from the acupuncture side, uh, C Chan Gunn Chan Gunn, uh, really with the intramuscular stimulation and that concept of taking motor points and acupuncture or a trigger points and going back to the spine and treating the spine first and looking at that as maybe, uh, a more centrally mediated problem that, you know, partially maintained at the spinal cord level. Um, those two were really big in, uh, kind of my early, early career, uh, and continuing on. Um, there’s so many, there’s so many and Carol Levitt, uh, from the Czech Republic was a physician who really turned me on to, uh, functional, uh, musculoskeletal assessment and looking more beyond, you know, beyond what is sort of broken, but more how, how does movement happen and how can we coordinate movement?

And that has really influenced my acupuncture, uh, as well as manual work. And then, you know, researchers like you pony, to be honest, because, uh, you know, you’re taking that, looking at, uh, acupuncture, meridians and points through two lenses and, and really doing the research and the background work, um, and that, you know, that, that sort of legacy from Joseph Long and, and the others from the sort of Toronto medical acupuncture to unity, um, have been, uh, uh, a real influence to me. I was lucky enough to study with a medical acupuncturist, uh, early in my, in my career in that. So I’ve always been, uh, most of my professional life and very interested in that interplay and understanding, uh, kind of how, how things work, not just what works for what, right. I’m sure

For you, it’s the same as it is for me. The, the excitement is being able to find the similarities and find the anatomy and it, and it used to have medicine actually independently validate each other. There you find, uh, you know, oh, this is that same thing in the nature thing. And I say exactly about this anatomy, and then it just, uh, you know, you can have, I’m sure we can have a lot of decals and about all these, like, oh, how did these ancient people know like this anatomy, you know, um, so Russo, I’m glad that we, uh, like-minded because I know, um, you bring kind of the best of both worlds and that’s what I like to do also. Um, so tell me about, um, segmental acupuncture. Uh, I see that you’ve been teaching quite a bit of workshop about them. I know that’s probably a very in depth topic. Could you just, you know, give us with the coleslaw version of, uh, give us a sense of what is segmental acupuncture? How is it different from, um, you know, like, uh, a, a TCM approach, for example?

Yeah, that’s a great question. Um, I mean, the key thing is to understand that our tissues remember where they came from. So during embryologic development, you know, our, our tissues, uh, migrate off of, uh, you know, essentially a segmented worm type of, uh, uh, you know, our embryo is kind of a segmented worm and our tissues literally travel off that in different segments, but when they travel, they drag their nerve supply along with, um, so during that, during development and then on into, you know, birth and adult life, those connections stay, uh, PTEN the, you know, the segmental, the body doesn’t forget its segmental organization. Even if those tissues might’ve migrated quite far away from the original segment. And, you know, you have the, you know, the germ layers, dermatome, myotome, and sclera tome. And so now people are talking about the viscera Tom or the Interra tome for the internal organs, but essentially you have the skin, the muscles and the bone sensation.

Um, those, those might not overlap perfectly, you know, the muscles move in a different way than the dermatome moves and works in a little different way than the sclera tone. So, uh, we can access all these different layers and these different laborers can have their own ridiculously related pain too. You can have that sclerotomal pain, you know, with, uh, with, uh, someone who has a nerve, uh, nerve root injury that might be like this deep aching, hard to pinpoint just sort of pervasive pain, or you can have that more superficial dermatome pain burning, uh, you know, sharp, oh, kind of electric type sensation. So, you know, understanding that kind of, I find it’s very, very helpful. Um, another thing, uh, to, to understand key points regarding that, um, concept that the nerves have been dragged along is that, um, everything in, uh, in a segment influences everything else in a segment for good or for ill.

So that means that, uh, if you injure something in a segment, then it facilitates, it lowers the threshold for irritation, for other structures that share that same, uh, Embry logic, uh, source that seems segmental source. Um, so that, that’s a really key concept to understand, and that can help us develop, uh, distal type treatments are not always distillable. You might be treating appendicular really for, uh, for a trunk problem, or you might be treating actively for, uh, a peripheral problem, but, uh, that, uh, that those relationships has really stayed at stay active. And you can, you can, neuromodulate quite strongly, uh, using these inputs. So for example, like I, I’m very into, uh, periosteal pecking, uh, that’s real popular in the, in the, uh, British medical acupuncture world, uh, Felix man, and, uh, um, Cummings, uh, I think, uh, they, you know, that that approach is incredibly effective for modulating.

The whole segment. You can have a person who has, you know, a terrible rotator cuff injury, and then you heck the periosteum along the greater CA uh, treater tubercles or the humerus. Uh, and then, uh, you can change how the entire myotome behaves, uh, quite quickly, uh, very, very effective, very, very interesting. So, you know, the key being the non, uh, nociceptive inputs, uh, into the, into the segment, uh, will, uh, beneficially affect all the other structures. And, and also, you know, consequently, if there’s an injury that will negatively affect all the other structures that share that same sick mental intervention. So, you know, things like an injury to the sake of spring to the SSI joint, for example, could, can mimic sciatica, you know, [inaudible], uh, dermatome. So, you know, they might have a sclerotomal injury of the ligaments and the, and the, uh, periosteum and, uh, bone, but dogs are gonna feel the sensation, maybe along the S one S two dermatome, uh, you know, their heart disease coming down, the T1 T2 dermatomes, that’s more of a autonomic related segmental, uh, phenomenon or liver disease can show up sometimes in the C3 four, cause the capsule of the liver is innervated by the phrenic nerve.

So you can get liver disease. People can feel that right sided, neck and shoulder pain. These are just some very classical examples, but are relevant to, to assessment, uh, and understanding, uh, potential origins of things. Um, you know, I’m, I’m not going to go too long on this, but another concept that’s pretty awful here that overlays is the osteopathic consent concept of the facilitated segment, um, where, uh, through prolonged irritation or, uh, enough of an initial insult that the segment will itself will just become irritated and stay in an irritated state. And that, what that means is that the threshold for irritation for, to, to cause, uh, tissues to respond is becomes lower. Um, the, uh, reaction may be higher and, uh, you know, to the extent that even a non what should be a non painful stimulus might, might, uh, read as painful in, uh, to, to the body.

So these are all, uh, you know, assessable, uh, for us as, as acupuncturists doing physical medicine, doing physical assessments, we can see signs of all of this. So, you know, there’s something we call it, the red sign and osteopathy where you drag your fingers. Uh, so vigorously along the pair of spinal tissues, kind of along the Quato druggie points, um, you know, 2, 3, 4 times. And you’ll see at a segment that is, uh, more facilitated, more, uh, active, uh, irritated that you’ll have, uh, extended red response. Uh, you’ll see, pin will stay red, uh, you’ll find pseudo motor activity, uh, muscle shortening tenderness, uh, and perhaps, uh, Teebo like motion dysfunctions, uh, at these segments. And these are mostly autonomic signs and they’re probably autonomically. Uh, they seem to be autonomically mediated. So, uh, a lot of what we can do is then look back at a chart for, you know, sympathetic, uh, innervation in particular.

And, uh, you can learn a lot about what’s going on. Uh, there’s been some research that really shows that these pair of spinal signs show up before internal medicine, uh, disorders are, uh, measurable often that, you know, as the Oregon is inflamed and irritated, it’s sending back, uh, signals that it’s in trouble. And then that facilitates the segment. So, you know, we have, uh, so Maddow visceral and this row of somatic reflexes in the body, as well as some ADOT some ADOT and, uh, this were visceral reflexes, but from the acupuncture standpoint, a lot of what’s interesting are the interface between the Soma, our musculoskeletal system, our muscles joints, uh, cutaneous nerves, and internal body. And we’re starting to be able to map this, uh, pretty, pretty well. There’s been a, uh, osteopaths really researching this, uh, trying to validate, um, osteopathic, uh, uh, therapy theory and, um, uh, you know, things that people are noticing clinically, right?

We’ve been collecting clinical data for, you know, clinicians on our patients for a long time, but to start to understand that a little more with the science behind that. So they’ve been looking at that for, you know, 120 years now or something like that, but we can see these things in Chinese medicine, like the moon shoe points are very closely related to segmental innervation. Some of them are pretty precise and some of them are a little off like the small intestine and bladder points are more probably affecting the parasympathetics to the, to those organs rather than the FedEx small intestine much, but certainly the bladder and the uterus and so on using them like Bali out on the lower, the lower shoe points, the mood points are pretty, pretty, pretty well, uh, line up, uh, with very few exceptions, uh, segmentally, um, you know, things like spleen six, we can understand a little bit more about what we’re doing, and then there’s all these, you know, various techniques that have come out of, uh, mostly Western medical acupuncture, um, that are, are very helpful for us in the clinic. So that’s, uh, maybe a longer answer than you were looking for, but

No, that’s good. It’s important to lay the foundations. Right. Um, so the, the, the facilitation that you described does a work both as a lot of this, I be so sematic. Um, so that there’s some, if you have a chronic elbow issue that can lead to its corresponding segmental, glandular, or organ dysfunction, or like, you know, somebody who has a chronic organ issue when being more predisposed to certain types of joint or muscular movement disorders, um, that does that theory apply in both directions.

Yeah. That’s a great question. And yes, it does. Um, any, any irritant, you know, of enough, either severity like intensity or time will eventually have the potential to, uh, facilitate a segment. So when you go somato visceral, um, usually that’s, uh, like say you have like an upper back restriction, which could affect your, uh, cardiac function. There was like some cardiac chiropractors did a study and I’m sorry, I cannot find the study anymore. But I remember reading this study where they showed that there was a correlation between forward head posture and cardiac disease, for example, so tension in those upper, you know, 3, 4, 5, 6 thoracic vertebra and lack of movement, lack of nourishment seemed to affect cardiac function, have a interrelationship to cardiac. Um, and you can see it the other way. So, you know, someone has, uh, like heart disease. They’re going to potentially have more medial elbow pain because you’ve got that T1 T2 dermatome.

There’s going to be a, uh, there’ll be more easy. It’ll take less to injure that area. It won’t necessarily become like allogenic, except for in a more like severe case where you may have ongoing, uh, pain, like in head zones, for example, uh, and whatnot. But yeah, it’s, that’s important that concept that, uh, the somatic visceral, visceral sematic, it goes both ways. The work of, uh, uh, Akio Sato or Saito I, Japanese researcher, he wrote a great paper, like in 1997, that summarized kind of all that, all that stuff. Uh, and then, um, Myron Beale and Louisa burns are osteopathic researchers. Who’ve done a lot of work on the, on, on that, the sort of somatic and some out of visceral reflexes. There was a lot of literature on it actually. Um, but the Seto work is particular. It’s interesting because he was particularly looking at like, what happens if he massages little parts of like a rat and then looking at their autonomic nervous system and what was happening in like gastric motility, uh, bladder and those kinds of things. He, he did a lot of study on that. Him and his group did a lot of studies on that kind of thing. And I did the paper from 97 is sort of his retirement paper that covers all of his other videos. So the basic idea from the one,

Yeah. Uh, I wanna, I want to touch on what you talked about with the frame that phrenic nerve and its relationship to the capsule around the liver. Um, just as a reminder for everybody, because when I found out about that, that I was like, it was like a mind blowing emoji, like, uh, I, uh, when I thought about that, like, you know, the phrenic nerve innervates, the diaphragm, the diaphragm is in the TCM hypochondriacal region. And we also associate that liver she’s technician, right? So there’s a connection to the diaphragm and the FedEx nerve and the signs and symptoms there, but she’s stagnation. And now you have like actual anatomical basis to explain that the friend in there for some reason, get sensory information from the capsule and deliver. So the state of the tension, you know, Chinese person talks about like softening deliberate as a course of treatment.

The state of the tension of the liver through this capsule somehow is information that the phrenic nerve needs. And presumably that sensory input has there creates a reflexive, um, motor output to control the contraction of the, of the diaphragm. So it’s really, really beautiful that like, there is a connection between the liver and liver moving the cheese, you know, the, the, the, uh, the extradition we have in Chinese medicine. Yeah. So I, I, and now that’s related to like, you know, cervical radicular, apathy issues at the, you know, the upper cervical area and it’s associated with dermatomes and upper back. Um, it’s, uh, it’s just, you know, so exciting. Um, do you notice patterns like that? You know, like you can run a TCM and the patients, all of us all have like neck problems or something.

Yeah. Oh, certainly. I mean, certainly more like classical kind of distal acupuncture type techniques. You see all kinds of things that are sort of beyond the segmental thing and the, you know, like how did they figure out these interrelationships, like, you know, liver three improves blood flow at the brachial plexus. So yes, it works for neck problems. Right. But, you know, that’s a super segmental thing. Yeah. And the, and, you know, and you see the overlap with, as you mentioned with the liver, right. The C3 four, you know, you’ve got the super cool vicular nerves, you know, that’s a segmental relationship. So, you know, if the diaphragm or, uh, the liver at C3 four gets irritated, then there’s a potential to send hypersensitized C3 and four, which is, uh, you know, this whole, this whole region. So that kind of dive from attic or that, uh, trapezius pain that everybody sees often as related to, uh, some kind of liver congestion.

Okay. Interesting. So it’s all coming together. [inaudible] everyone has the richest, the nation, everybody has tight trapezius muscles. Right. So it can not be, um, I want you to discuss about German layers and, uh, do you use that, um, embryological concept and the way you select points or the way you assess a problem? How does that, how, how does that apply clinically?

Yeah, so, you know, the germ germ layers, dermatome, myotome, and sclerotomal, uh, just briefly those, those are the layers of, um, Misa term, he’s a normal development. So that’s what goes to make the dermatome goes to make the dermis. So the under deeper layers of the skin, uh, the myotome goes on to make the muscles that, and the sclerotomal goes on to make the, um, the, basically the spot, the spinal column and the ribs. Um, they, we do use the term sclerotomal a little more broadly in the adult, we know, refers to ligaments and bones, uh, and their innervation, but, uh, it’s so it’s used a little differently. The other two terms stayed pretty, pretty, uh, pretty, uh, uh, consistent. Um, but anyway, you know, one, one thing about using those different layers as these tissues migrate, you know, remember what I said earlier that the segment, uh, is continues to be interrelated and because tissues migrate it kind of different rates and different amounts, you may find that the dermatome and less Clariton don’t line up.

So someone may like have a broken phone, but you may be able to access the dermatome, uh, somewhere along the way. Um, or you may be able to access the myotome. You know, there’s a Hilton’s law, right? The, the, uh, that the, uh, basically muscles crossing a joint, uh, share fibers with the joint itself and with the, you know, overlying skin. So, uh, you can, you can access at any level to affect all the other levels. So, you know, that’s, that can be a really effective now, you know, thinking again, as general set mentally, you can go back to treat axially or peripherally for a problem. So if someone has a, I talked about shoulder problems earlier, right? So most shoulder, most of the shoulder, the glenohumeral joint is C5 C6, right? That covers pretty much the majority of the medial C4 on the, um, superficial bits and the skin.

But you could go back, uh, if someone had like a shoulder replacement surgery or frozen shoulder or whatnot, you could go back and look at the, uh, you could go back and look at like, see four or five and six at the neck, and you could treat the, uh, something I find is helpful is doing like a periosteal pecking on like C5, C6, uh, at the articular pillar can really neuromodulate the whole, that whole shoulder quite effectively. Uh, you could do that if you don’t do pecking and don’t have training in that are not interested in, you know, a stronger stimulation like that. You might just needle them all Tiffany in the neck, you know, do some deep repair of spinal noodling. Uh, you can run electrical stem, all those things are really effective for effecting, uh, sort of axial to peripheral. Um, you know, and then that goes both ways.

So if someone’s having C5, C6, right, C6 is kind of the, um, crisis point, uh, for the, uh, neck, right. Most mobile vertebra. And then it’s connected to C five or C seven, which already, which is one of the least mobile cervical vertebra. Um, and then T1, which of course has the ribs. So it’s more fixated. So there’s a sort of maximum movement, minimal movement right next to each other. And those time zones kinda ended up having problems. So you can, you could modulate C5 C6 on the, uh, C5. It like the greater tubercle of the humerus and C6 is more of the upper condoms or, uh, some parts of the posterior shaft of the humerus if you wanted to pack, but you could also look, okay, you can say C6, right, C6, you make a six, I don’t know if that’s coming out as a six, but, you know, in the old, uh, you could treat that dermatome only, you know, with like large intestine four or, you know, other other points that are related.

Um, so, you know, the germ layers, uh, I think are helpful, mark, conceptually, I haven’t found a way to go, like, you know, this is this and that, you know, like myotome is better for this, or dermatome is better for this, or sclerotomal, except for that, I would say sclerotomal stimulation is more effective for that really stubborn pain yeah. Pain that just won’t budge. And because there’s a lot of sympathetic innervation, uh, at the periosteum, uh, that kind of stimulation is really helpful if there’s like, uh, a, uh, some sort of autonomic piece and, you know, innovation is incredibly important. Um, and, uh, for everything including trigger points, right? You can feel a trigger point in if you know how you don’t even have to press the muscle. Cause there’s a pseudo-motor effect. There’s often a temperature difference. So, you know, every, almost every pain condition is going to have some change in the autonomics. And so if you, if you know how to look for that, that’s, that’s kind of a key to the assessment related to that, because your rotation at like a sclerotomal level, like a sprained ankle or a chronically sprained ankle is going to affect that whole segment. So you’re able to treat that, maybe that question.

Yeah. Um, just for our listeners, um, when Josh is talking about to a motor, you were talking about like, uh, the sweating, um, regulation of, uh, autonomic nervous system, right? Yeah. Yeah. So you’re able to is training, uh, palpate the, the, um, uh, the poor to the skin, um, in the vicinity of the trigger point and be able to diagnose, diagnose, uh, financial and point, even without having to push down to get that Asha tender feeling, just fine, touch alone, you’re going to start noticing some changes. Um, so this is, yeah, this is, this is really a very interesting, I, I, um, I, you know, everybody dermatomes in the mountains very well known third toast, you know, that started as the least well researched, but as, um, kind of the secret weapon in a way to be able to have that understanding, I would love to be able to combine those layers together and be able to treat, um, you know, cry problems from a different perspective.

That’s really, really interesting that you’ve had a lot of experience kind of seeing when to use which layer for which type of problem. Um, I also found it very interesting that like ligaments and, um, and, uh, and the attendants are, uh, part surely from the scotoma as well, because in Chinese medicine, they always talk about gene group, seniors and bone together as a binary. They don’t really separate those terms, um, you know, differently. So it’s interesting that those they share same, um, type of term, uh, German, um, innovations. Um, that’s finished up with the clinical Pearl. Um, uh, I heard that you have a lot of success in you. Um, I guess I’m very consistent results really inside a car. Is it possible for us to give, you know, give our viewers and listeners advice so that we can become more proficient in treating, um, such a debilitating problem as Sika?

Yeah, sure. Um, for a really acute sciatica, um, if there’s too much, uh, like muscle for boarding and spasm in the back or piriformis, uh, whether it’s, uh, radicular or a piriformis syndrome, these same approaches will, will be effective. Um, I often will use, uh, just the Bajan points, um, that, that when you get, uh, for really acute problems along the, and this is nothing new for Chinese medicine fans, um, really acute problems, the further away you are from the actual site often is more effective and like stimulating the cutaneous nerves, they’re the gene Wells or the, or the, the, uh, yang spraying points tends to be more effective for that really very hot acute pain. Um, I find you get a more complete, uh, regulation of the whole system. So I often will just for the first couple of visits at someone’s, you know, the people will get like brought in by their family member or, you know, couldn’t drive themselves to the clinic.

Um, those people I tend to use like often, uh, maybe kidney seven, especially if I can get a tibial nerve, you know, like, uh, if I can get a sensation down to the heel or to the toes when I, when I manually regulate it, those are usually my line of first, uh, first input, you know, maybe, uh, uh, like lingo.by something up there up higher, just to, you know, because sick mentally, uh, in terms of like gate control theory, if, if you, if you stimulate something at a higher level than the problem that does have an additive effect, it’s not as good as like treating the right segment, but, you know, your even 5% more is a lot for someone who can’t move, you know, so, so I do add some points that are higher up, um, but then for more chronic or, uh, pain, or if the muscle boarding’s not too severe, I often use, uh, Craig pins, which is, uh, is a, um, medical acupuncture technique where basically you needling along the bladder or the Pato judgy line make a central module encompassing the segments that are involved.

Uh, you can go higher, make it more like a profusion, include the autonomic levels, but you just do the sensory motor level. So say Attica is primarily S one S two. So you really need to focus on the sacrum. You might go up as high as T 12 a to L two, to cover those autonomics, but then we’re going to add, uh, local points as appropriate. So glute, max and piriformis, both of them, you know, primarily, uh, you’re getting like L five S one S two, uh, glute max. I think you get a little lower as well, but the, um, those are totally related to the Syns towed to dermatome problem that the person’s feeling pain they’re having. And then you can then add, uh, points like laying ho or, uh, which is like a posterior gallbladder 34 it’s sometimes called and, uh, and a bladder 40 to get the peroneal nerves and the, the, uh, tibial nerves as well.

So, you know, I, you don’t, you can be very flexible in terms of how you, how you do this, but each module goes at kind of a higher frequency usually. So, you know, it might be one to two Hertz, centrally, uh, two to four Hertz in the gluteus Maximus piriformis, and maybe, uh, like four to 15 or even higher, if you’re doing, um, sensory nerves, uh, down the leg way, sometimes bladder 60, or kidney three, you can, uh, kidney or kidney six, you can get more of the sensory fibers down there, uh, with a higher frequency, maybe as high as a hundred Hertz. Um, but I find that this works well.

I’m going to ask a question for the benefit of the listeners, because I know they’re going to want the specifics. So for the platform that you mentioned for the two sag example, um, would you be doing electrical stimulation there too? And what if so our frequency?

Yeah, the phone, if I tend to use, um, I tend to use a higher frequency. I can use like a hundred, sometimes 200 times even 500. Um, I, I do it either two ways, depending on kind of either position of the patient or their own squeamishness either. We’ll put it on like a high-frequency with like one to two Hertz. So it just goes back and forth so that they get,

Uh, connecting electricity between the web spaces. Is that how you’re doing it, um, for web spaces? So you’d be connecting needles together, or,

Yeah. So what I do is I take, I’m trying to get the camera oriented, uh, it’s backwards area area. So, you know, what I do is I get into all the web spaces and then I tend the needle. So I take all four [inaudible] and I put one clip on there. If I’m using, if I’m using the ITO, I might do that at, um, I might do that at like, with the black one, because the black leads a little stronger, stronger uneven, uh, stem, so that, because I’m in more sites, I might need a little stronger stimulation. And then I usually wire it up to like kidney kidneys, seven ish, but kidney seven is where I personally seem to get the tibial nerve, most distal, tibial, nerve, most reliable I’ll hook those like, like that. And I would generally use a high, um, if the, if the patient is able to crank it up themselves, get seven, there’s still a fair amount of motor.

So if I’m doing that, you know, you don’t want to at a high, at a hundred Hertz, they’re just like not comfortable. So if I’m doing sensory only, I might clip it like two buff on one param and just get one, you know, to the medial, to, and the lateral to do at a high, high frequency, or I’ll clip it at a lower frequency. And I include kidney seven as part of it. Um, and have that, even if they have a slight motor contraction, and then if I’m doing high, I give them the box and let them turn it up. And if I sometimes I’ll do a, my, I use pantheons mostly. And so they have the option to run like an alternating, like one to two Hertz or, and then like a hundred Hertz. So it goes back and forth. So they don’t accommodate to the, um, they don’t accommodate to the stimulation.

Um, again, just a little more detail because otherwise where they’re going to ask the questions. So you are doing the baffle on the effect of the size, same side as the sciatica, right? Or are you doing both sides? Counter lateral?

I often will do both sides. I mean, I immediately, you know, it’s enough to do the one side, but you get some Asian, you know, if you’re having more, any less to the segment, then that’s better for the you’re going to get a better outcome. So that’s where a lot of them like treating the left to do for the right and on up to the down, all that sort of Neijing, uh, links, shoe talk, uh, comes from, you know, really.

And the last question to summarize the protocol. How long do you use the electrical steam that you mentioned? High-frequency so in the order of a hundred Hertz, but how long do you do it for,

I do it for really hot static. I like to do a full 20 minutes. I really, I want to, I want to overwhelm that segment with non nociceptive input. I mean, to the extent that they can stand it. So if they’re able to turn it up themselves, that tends to actually work better because it could be accommodation and then they keep raising it and accommodation, and then I might run to hurt somewhere else in the body, one to two Hertz just to help with the beta endorphin release, but you know, like a large intestine for stomach 36, something, someone somewhere else, uh, you know, stomach 36 is great. It’s part of the peroneal nerve part of L L five. So that’s gonna relate to the sciatic symptoms. So, you know, you can, you can use your logic, whether TTM or from like a neuroanatomical standpoint.

That’s amazing. I can’t wait to try it tomorrow. And, um, so, um, unfortunately all the time we have her today, um, if we would like to step study more with you, is there, are there any resources or any contact that you have, um, for our listeners to the viewers?

Yeah. Um, on the east coast, uh, I’m working with the, uh, Dow collective and that’s a D a o-collective.com. That’s with, uh, Doty, uh, Chiang and pony and teach with them as well. So that’s exciting. Um, and, uh, the other place to find me is on Facebook. That’s where I keep most of my classes updated and that’s, um, uh, facebook.com/omt Lac. So that’s oh, as, and then, and then this is Mary T as in Tom, then Lac licensed acupuncturist, uh, OMT is osteopathic pathic manual therapy. So that’s my thing. And then the other way is to, you know, reach out to, yeah, I’m pretty fine to on the web and I can put you on my mailing list.

Yeah. Awesome. Thank you very much for sharing your experience and wisdom with us. Unfortunately, that’s all the time we have today. I’d like to thank all the, uh, other viewers and listeners for joining us, and don’t forget to join us next week. Uh, our guest for our hosts for next week is Matt Callison and Bri.an Lau. And, um, thank you once again and have a wonderful rest of the day.

 

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Are Vaccines Mandatory for Acupuncturists?

 

 

What’s happening, what’s mandatory, what’s mandatory. What’s not mandatory. What can I do? What do I have to do? And who can tell me to do it? So let’s go to the slides and let’s talk about what is mandatory and requirements for an acupuncture provider.

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 everyone. This is Sam Collins, your coding and billing expert for acupuncture and the American Acupuncture Council Network and information network, as well as the insurance company, of course, and welcome to another edition of, to the point and how to make sure your practice is doing well. This time, the topic is not going to be on coding and billing, not this week because obviously with a lot that’s going on very timely because we’re now getting close to October is what’s going to go on with vaccines. What’s happening, what’s mandatory, what’s mandatory. What’s not mandatory. What can I do? What do I have to do? And who can tell me to do it? So let’s go to the slides and let’s talk about what is mandatory and requirements for an acupuncture provider. As far as vaccines are concerned, do I have to get one and who can tell me to get one?

So you want to think about who can mandate, well, several things. There can be a mandate by the government, whether it be the federal, it could be the state, even local. You might have a city or a county. And then of course also private businesses may do so as well. So we have to remember, let’s look at, to see who is doing it, what they’re saying we have to do, and whether or not there’s going to be compliance for it. Because one of the things that’s occurring is a lot of people have gotten misinformation about who’s doing, or when they’re saying it, who they actually are including. So let’s start work first with this misinformation and misinterpretation. So you’ll see here in July 6th, the office of the alphas of legal council mandated that they said, no, we can do vaccine mandate. So there’s nothing constitutional.

We can say, oh, well I have a private citizen, right? And so forth. Well, we have a lot of rights, but do you have to wear a seatbelt? You know, do you have to wear a motorcycle helmet in some areas? So it’s that type of thing. So be careful if someone’s saying they can’t do it, they can, we have to look at, are they mandating it for us to do it? So let’s go here and let’s talk about federally, what’s happening for Medicare. So you’re going to see here at president Biden, you know, back a few weeks ago, made this big statement about Medicare, that Medicare is mandating it and they have to in federal and everyone was up in arms like, oh my God, is it going to have to be something we have to do? Well, they made a mandate that it said, yes, the key is, does that include acupuncturist?

Who does it include? And it’s often says facilities and people wonder what’s a facility. Well, facility generally is going to be a facility that provides services within it, such as a hospital, skilled nursing, that type, not generally individual provider offices. So with that said, what about the Medicare part under the federal? Does that apply well currently, of course. And I’m sure you’re well aware. Can an acupuncturist join Medicare? No. So that means absolutely not. Now a quick note, is there a bill right now to get acupuncture, to be part of Medicare? Yes. So make sure you’re supporting it. But as of now, there is no mandate for acupuncturists to even be in Medicare. So we want to be careful. That’s not part of it. There is a mandate that for Medicare facilities and providers, hospitals, that doesn’t include individual providers fee for service providers. So let’s just say you are working in a Medicare facility like within a hospital or a big clinic there you might be.

But for most of us, we’re working in private offices. So even if we were in Medicare, we wouldn’t have to, in fact, look here, it says a spokesperson directly. And this was just a week ago. This regulation does not directly apply to physician’s offices. If these are considered regulated under the provider specific Medicare health and safety regulatory provision, generally referred to as a condition of participation. In other words, in simplest terms as an individual provider, even if you were treating Medicare patients in a private office, you do not have to have a vaccination. So the federal rule actually does not apply to everyone. Now, if you are a medical doctor working in a hospital, yes. If you’re a nurse working in a hospital, if you’re an acupuncturist working in a hospital and there’s a few of you, that could be, but so long as you’re working in a private office, absolutely not.

So that being said, let’s talk about the conclusion of this and really what it means. Acupuncture providers can’t even join Medicare. So the, the mandate really doesn’t match. The only way it would, as I mentioned, would be if you were working inside one of those facilities. So again, from the federal level, nothing to worry about as far as a federal mandate for an acupuncture provider to do a vaccination or have a vaccination. And remember when they’re saying vaccinations, they’re also referring to also staff. So let’s talk about another federal plan. I’m sure many of you have heard or seen the VA made an announcement that they’re going to require vaccinations. And so here is on July 26th, they said the department of veterans affairs, making vaccines mandatory to all VA health personnel, including physicians, dentists, podiatrists, optometrists, and even went so far as to say anyone doing veteran administration through the VA choice program.

And so of course, everyone’s like, oh, what does this mean? Is this something that it’s going to be mandatory for me? And of course they had to make a clarification because everyone were all upset. Like, no, and you’ll see here. It says, and this is something the VA has posted. They are not requiring community providers, which is where acupuncturists fit. If you are working in your office as a community provider on a standard episode of care, where they refer a patient, there is no requirement for you, whether you belong to the Optum on the east coast or try west on the west coast. Now they do say they strongly recommend that you should have the vaccine, but there is no mandatory requirements. So both on the federal level of Medicare, the federal level of the VA, there is no requirement for vaccinations unless you’re working within a facility doing those services.

So by example, there are acupuncturist who work in the VA hospitals, or work in the big VA centers for those acupuncturist. If you work there, you will be vaccinated as every provider within that. Heck if you’re a janitor in those types of facilities, you are going to have to do, um, a vaccination. Well, let’s move the next step. What about state rules can states make that happen? So the first one I’ll point out here is for California. Now this is just an example of one for California. The department of health first came out and said they issued a mandatory vaccine for offices. And of course, everyone was like, what lost their mind going crazy? And I always will say, make sure that you understand the full rule read in detail. You’ll notice here. They made it mandatory. But however it says, we have exemptions which include acupuncture offices.

And in fact, this includes all types of facilities that are not covered under this order. So this means acupuncture offices. And of course all the rest of these meaning chiropractic as well as natural paths and almost every individual office occupational therapy, okay. Optometry offices, podiatry offices, physical therapy places. So in other words, it’s really, again, kind of going back to the facility areas, not the individual providers, again, facilities. So California does not have a mandatory facility for you even first days. If you work at a theme park, some people that if I’m a theme park nurse, I have to do it. So pretty much exempt except facility. So I will go back to kind of California followed the mandate of the federal government, which said facilities. However, we have to be careful. Some states are pushing it. So by example here, what about the state of New York?

Well, New York has made a mandate that says as of August 25th, their regulations include a broad vaccine mandate for New York health care facilities. So again, I want to use this term broadly and say facilities. And so here are the emergency regulations apply to each of the following types of categories in the state of New York, which is going to be general hospitals, nursing homes, okay. Diagnostic and treatment centers, including without limitation, community providers and birthing centers, again, big places. And then along with that certified home agencies and so forth, but I will highlight again, home health in person hospices, but this does not include acupuncture, adult care. So notice again, kind of the facilities area of this. That is where it applies. But while California New York don’t what about the state of Washington? Now, Washington is a bit different now you’re thinking, well, Sam, I’m not in one of those states.

What I’m going to implore you to do is make sure to check your state. There’s only a few that are, but definitely Washington is making an issue Washington as had a proclamation by the governor that on August that they’re requiring it. And within this, this means that you are mandatorily required to have vaccinations. And it has to be by October 18th. So this status includes again, acupuncture offices. It includes every employee providing healthcare. So it means everyone in your office, which means this is going to be difficult. Every one of us has to be within this. And it does mean acupuncture providers are included. So Washington’s going to be a bit tough. Now, are there exemptions you might be able to have absolutely. There can be exemptions, but it’s mostly religious exemption. So I would be careful, I would say, make sure, make sure that you verify within your state.

Cause I’m going to tell you for Washington right now, they’re pushing the issue. Now what’s going to be interesting is how are they going to enforce it? Are they going to require each licensee to send information? And they may, well, what if you don’t send it, could they suspend your license for a while? Possibly. So something I would look at well beyond the state of Washington there, again, as I mentioned, there’s exemptions, but I want to highlight Oregon is doing the same thing. Oregon is requiring it by October 18th, as well with no exemptions other than religious. So again, know your state. So if we go down just the west coast, Washington, Oregon, yes, California, no New York says no, at least for us, but you’ve got to be careful. So again, on a state level, if your state is enforcing it, please look at your licensing board, make sure, check with legal counsel to make sure am I in a position where I’m willing to fight back on this or do I just have to get the vaccination?

That’s gonna be a tough choice for some obviously, well, let’s move on to the next thing here. If the healthcare provider works in a healthcare setting, they must register request accommodations for the operator, which means, again, be careful of these exemptions. If your staff says that they can’t be there certainly could be healthcare concerns that do it. If they have a healthcare issue that doesn’t allow them, but be very careful. Am I really doing things that are vaccinated? It says if an individual does not qualify for an accommodation, they must get vaccinated. And notice it says, testing, not allow. There are some states that will say, Hey, no vaccine, but get tested. California is doing that. But of course that means for us, it doesn’t matter. Cause it’s not a requirement. But if you’re working in a facility, they would require this testing. So others are pushing back.

Well, what’s the next place. Okay. So we went from state and I get I’m an employee to look at your own state. What about local employers? Can they do it? According to legal side, a private company is allowed to mandate vaccines. You know, kind of private company mandate a lot of things, dress code, and otherwise in the United States, you’ll see here in the second box, mostly our employers and employees are at will. And this employment means you can be dismissed for anything, which could be, Hey, you relate to times this week, but if you won’t get vaccinated, so it becomes one of those ones. If local is doing it, meaning an employer, they could enforce it. Now could you try to bring a lawsuit? I’m sure you could. But in the, between of the lawsuit, would they allow you to continue working? Probably not. So I want you to be very conscientious of knowing within the rules of what is having to be done.

I’m not finding for us, that’s going to apply as much because you’re the employer. But let’s say you’re employed by someone. What if you work in an office where you’re with an MD or a chiropractor or anyone else and they mandate, Hey, we want you to have that. Well, I’ll give you an example. Take a look at this. Does Disneyland. If you work for Disney, can you have facial hair? Do you know up into 2000 at Disneyland, you could not have even a mustache. Even though Walt had a mustache, Disneyland wanted to be clean cut and no one could have facial hair. So that meant if you wanted to grow a beard, you can, you’re just not working for Disney. And so Walt had one, but up into 2000, you could have a very small trimmed mustache. Now the rule is you can have facial hair, it’s allowed, but notice what they say.

Employees are allowed to have beards as long as they’re kept shortened and trim. So what I’m bringing this up for is that always understand who has the right to do it as an individual. Do you have a right to say, I don’t want to do something. Sure. But that could mean you don’t have a right to like come into the business. For instance, could you say, I don’t want to wear clothes and go into a store or I don’t want to wear a shirt. Let’s not even go that far to just say no clothes at all. And we all know that no shoes, no shirt, no service. So the same thing applies. What I want to make sure is I hope most of you were on board with this, but I will tell you many of you have not. And I’m going to ask you, where are you getting your information?

This is the webpage of the American acupuncture council network. And I want you to see, I put it in red here talking about federal vaccine mandates do not include acupuncture offices. We’ve put in three times this. So if you haven’t already go to the American acupuncture council network page, go to the new section and sign up for our newsletter. Cause we keep you constantly updated as to what’s going on. And I want to just as a little tease, do you see that one I highlighted in blue? It says ICD 10 updates happen. October 1st include new new codes for back pain. How many of you were aware of that? So a week from Friday new codes for back pain, are you on top of that? The American acupuncture council, we’re here to be your resource, the network, especially seminars, our network service. If you don’t have a place to get this information correctly, you’re going to be lost.

Remember the internet is not your friend when it comes to this information because there’s just as much bad information come to the trusted resource, go to our site. If nothing else, at least get into the new section. Because if you don’t, we’re going to have some problems. Please make sure you’re always set to understand what’s new, what’s changed. And we’re always that resource. So be careful. Do I have to get a vaccine on a federal level? No VA level, no. Some states, yes. I gave just a few examples. So make sure, and of course, if you work for someone, it could be from them. If you need to know more information about that, we are the place to go. So what I’m going to say to all of you is thank you very much. If you want the resource go to our website, it’s just simple AC info network. We’re going to help you. We do continue education and much more than that. And for next week next, our host will be Poney Chiang. Remember the American Acupuncture Council is always your resource. And if you don’t have the right information, you’re likely not getting paid. And of course we want you to get paid. See you next time, everyone. Thanks for being with me.

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How to Setup Your Website to Attract New Patients

 

 

“So I have some very special guests that are joining me here today, and we’re gonna be talking about how to set up your website to attract new patients.”

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 folks, Jeffrey Grossman here. And thanks again for joining us with another installment of a live broadcast from the American Acupuncture Council, bringing you some great information, um, business building and marketing and coding and all these great things streaming to you live. So I have some very special guests that are joining me here today, and we’re gonna be talking about how to set up your website to attract new patients. And with me today, we are going to have, um, the, uh, the team from our sister company called Acu perfect websites. We’re gonna have Ben Thibert and Ken Moorhouse that will be joining us to answer some of those questions that have come in over the years around, you know, attracting patients to your website. So thank you, Ben. Thank you, Ken, for joining me here today.

Thanks Jeffrey. Thanks for every for having us. Thank you, AAC.

That’s awesome. Good, good. So, um, you know, a lot of practitioners are, you know, they just assume they can just put a website up there and just, you know, and just attract patients in these, uh, throngs of patients just started streaming into their door and that’s pretty much further from the truth. And so I kind of want to get some clarity, you know, that you guys can share based upon the fact that you work with hundreds of acupuncturists, you build a hundreds of websites every single month, you’re, you’re managing these services for them. And, um, you know, so you’ve, you’re, you’ve got your finger on the pulse literally. Um, and, um, you know, I think that it would be great to kind of share some of this insight into some of this information with, um, our members. So one of the first questions that I’ve heard over the past, and you probably, you guys probably hear about it too, because I think a lot of our clients come over from other companies to join our S um, so what are some important things that people miss when they’re doing their own website on services like Squarespace and Wix?

Yeah. So I think one of the most important things to think about when you’re building your website is content. Uh, content is what drives traffic to your website. So when you write content about TCAM and acupuncture and the different conditions that you treat people in your community will have access to that, if you set up your website correctly. So content is still king, uh, bill gates coined that term back in 1996, and he was talking about the future of the internet and sure enough content is still king on the internet. So it’s really important that you write good quality content on your website, and that can be blog posting. We’ll talk a little bit about, and you can also talk about landing pages as well. So in terms of blog posting, you want to write some content about TCM and acupuncture and how it can help conditions and be sure that when you’re writing your content, doesn’t have to be very long, 600 words will suffice, but you want to have a good quality post that talks about the condition, your location, how you help people in your community with those conditions and what modalities you may use.

So that’s a really good, good way to start attracting traction and getting people to visit your website. Uh, the other part of that is also landing pages are really important. Uh, Ben, did you want to talk a little bit about landing pages?

Yeah, just content in general. Um, one thing that we see is, you know, Google doesn’t rank sites based on how they look, it’s all based on what’s on the site and the content. So you could have a beautiful website, but if you don’t have the content on your homepage or your about page, that matches what people are searching for it, you’re not going to get ranked. You’re not going to get people to your website. Um, I mean, having a good looking website is, is important, but not in Google’s eyes. Um, so it’s important to have, you know, like on your homepage, for example, you want to make sure you list all the, um, services you provide. You want to list the main conditions that you treat. So when people are searching for acupuncture for back pain, you know, it’s going to come up. Um, it was one thing we see missed a lot is people will have, you know, maybe their mission statement or some, you know, quote that they like on the homepage, but they don’t have any information about what they do or what they offer, or even sometimes where they’re located, people miss that.

So you want to make sure you have all that stuff that Google is going to pick up and use to rank your site, uh, in your content, across all your pages, put your address. It was basic. It seems like it’s basic stuff, but it’s amazing how many people, it’s hard to find where they’re located or what their phone number is. If like dig through all their pages to find it. Um, that’s something that’s missed a lot. And, um, like as Kay mentioned, landing pages, that’s where you can get, get a little more detailed. So you can kind of use your homepage to list your general overview of what you do, what you offer. Um, but if there’s a specific service that you provide or a condition that you treat that you wanna really focus on and you can create a whole separate page for that, and that’s just called the landing page. So for example, if you focus on anxiety, you can have a whole landing page that talks about how acupuncture can help with anxiety, the different treatments that you offer, kind of your, your plan that you, when someone comes in to treat anxiety. But the important thing is to have a separate page that has all your good keywords in there that Google’s going to pick up and use to rank you for different, different conditions.

I think. Yeah, I think, I think that’s a big thing that people overlook is they just assume that they have a pretty looking website and that is just going to be the patient attraction tool for them, but having content with specific meta-tags and alt tags and title tags. I mean, that stuff that you know is what is, what, what you guys do. It’s what you guys focus on, which isn’t what a lot of practitioners do, um, in that way. But like when, when Google, when people like type in acupuncture, you know, back pain, Seattle, all of that information should be part of the content on some level, right?

Yep. Yeah. We could talk a little more about the meta-tags too. So it’s one thing that we see miss a lot is someone does their website on Squarespace or something, you know, even if they have great content on there on the page itself, um, we’ll see that their, their title tag for the page is just the word home or, you know, something really generic, but that the title tag is one of the most important meta-tags, that’s what Google uses to actually list your site in the listings. So each page use your title tag, and that’s what shows up when you search in Google, those are the title tags for each page. So you need to make sure that you have all your information in your title tag, that, you know, you have to keep it short. And I think it’s something like 60 characters. Um, but you want to have, you know, your business name and your city, and if your business name doesn’t include the word acupuncture, you want to make sure that you have, you know, have that in there as well. So you are targeting acupuncture in your city, in your title tags. That’s when we see missed a lot as the title tags aren’t set and it’s something has to go and manually do when you’re in Wix and Squarespace, you have to go and set those for each page.

To your point to Jeffery, all tags are sort of treated the same way as any time. If you have an image that you upload to your website, make sure you have a good description of that image, and also include some of that information. Some of the keywords that we’re talking about, your city, your location, and then a description of the image. And that really helps that with SEO and Google ranking, right?

I think a little bit into, I was gonna mention that that’s a big part of the, we’ll talk a little bit about ADA compliance too. And, um, accessibility and L tags are a big part of that, but go ahead, Jeffrey.

So, so as far as title tags, clarification on that, the title tag is the title of whatever content piece you’re putting out, whatever blog posts you’re putting out. Right.

It’s the title of that page? Um, yeah, so right. Yep. Okay.

And then, and then as far as pictures go, Ken, that’s a really good point because a lot of people just pick up pictures like, oh, me at the beach, right. Or whatever that is, or me doing moxa or me doing cupping, but like, it’s, you know, I mean, if someone puts up a picture of cupping, it should be like, Jeffrey’s acupuncture clinic, Seattle cupping. Right. That should be yeah.

Treating patient with capping or something similar to that effect. Yeah,

For sure. Yeah, because that all plays into like getting search when, when the search engine crawlers are out there, they’re like those search, not only the title tags, but the, the, the other alt tags in the photos, which is, I think I would, you know, I never knew that until I started, you know, you guys started jumping into the websites, informing us around that. So, um, cool. Um, and, um, so what is another question is like, what’s the best way for practitioners to reach more prospects in their community? Like how can they get out there and be more forward facing? So people when they are searching that they’re found?

Yeah. I think the number one thing that people miss as a practitioner is setting up their Google, my business account. Um, so if you go to google.com/business, uh, you can create a listing, uh, inside of Google and Google will, uh, rank your website better when you create that listing. And what it does is essentially it tells Google what you do, the services you offer, and also verifies that you’re actually a real business. And that’s really important to get a better ranking in search results. And also to, it allows you to appear on Google maps, which is really important because your patients will go to Google maps to try to seek you out. And part of Google maps includes reviews and reviews are really important. So if you think about going to a restaurant and a, you choose a five-star restaurant, uh, that, uh, that your peers have reviewed at five stars versus a one-star restaurant, you want to be part of that, that community that Google is putting in front of you. Um, and that’s through Google my business. So, uh, Google my business is really important, uh, way of getting in front of your community and making sure that you’re ranking well for some of the conditions and, uh, the modalities that we mentioned earlier

And Google my business it’s free. Right. There’s no cost to getting that set up.

Sure.

Right. Yeah. Yeah. There are a lot of third-parties that I’m sure a lot of people have gotten calls from, uh, you know, solicitors calling and saying, Hey, we’ll set up your Google business for you for, you know, X amount of dollars, hundreds of dollars. Uh, but it is free through Google if you do it yourself. Um, and a lot of times too, um, Google will, you know, use the yellow page listings to auto-generate your Google business listing. Um, but it’s, you know, usually lacking a lot of content. It’s just the basic. So you, even, if you have one up there, you want to make sure that you go to google.com/business and claim the listing. If it exists already, I go through the verification process and then you have full access to put all your information and make sure your hours are up to date. Um, you know, during COVID, you can, you can list your specific COVID changes that you have on your listing, um, and also have access to the reviews.

So you can interact with your views that come in. Um, that’s one thing that is important is, you know, you want to make sure that you’re encouraging your patients to leave reviews and then that you are going in there and actually responding to the reviews and interacting with them. And that shows Google that you’re, you know, not only have a lot of patients coming in, cause they leaving reviews for you, but you’re actually being proactive and using your listing and responding to both positive and negative reviews, hopefully all positive, but you can still go in and just say, thank you to people who leave reviews. Um, and that’s something that Google notice and, you know, if you’re really active with your listing, Google, you’ll start bumping up in the, in the ranks, especially if you’re in a competitive area where there’s, you know, dozens of, of competitors trying for that top, top, the top three spots on Google maps, those are the really important spot to get to because that’s where you show up kind of on the first page, when you search something that shows like just a couple map results, when you search, you know, you want to be great if you can get up in that top three spot.

So reviews will help a lot with that.

Yeah. Because these days, people don’t really scroll past the first page when they do a Google search. And you know, the first thing that shows up there are I think, paid ads and then sort of the map, you know, like the map listings and then, then other other generic rankings. Is that right?

Yeah. That’s one thing that, you know, a lot of people coming to us thinking that there’s a quick way to click one button to get to the first page of Google. And you know, it it’s a process, especially if you’re in a competitive area. Um, if you’re in a smaller town, you can see it as possible to get up to the first page within, you know, a month or so. But if you’re in a competitive market, it’s going to take time to build that, that ranking up and get to the first page or two. Um, but the, the easy, quick way to do get it to the first page is through the ads. And I mean, it definitely is a cost involved. Um, it can get expensive doing Google ads, especially in a, in a big market, but that’s really the only way to guarantee to get to the top spot immediately,

Right. By paying for the ads, hiring someone to run the hours they’re doing limit yourself. Right. And then around that, there’s so many different parameters that you’ve got to abide by in order to, you know, make sure you’re not stepping on their term terms of service or terms of use around that. Um, cool. Um, yeah. So Google, Google maps will help people get found. Google reviews are really important. Is there anything else that you can think of that is another good way for practitioners to, you know, have be found online?

Yeah, I think it just really is to summarize everything like Google my business is great and setting it up, but we have to also remember that Google loves fresh content, right? So if you’ve got a website that you’ve built and it looks great and it just goes dormant because you’re not adding fresh content to it related to the service that you provide, then most likely it will drop in organic ranking. So you’ve got the paid advertising, you’ve got the map and then you have the organic, you want to get into that organic space, the first page of Google. And that’s what takes time. So writing good quality blog posts about, um, your, your practice and the conditions you treat is really important. You got to keep feeding, Google that content, and the more you feed it, the higher you will rank compared to a site that doesn’t post anything. So that’s really what drives your ranking. Um, and then there’s some other, other, other factors that we talked about, like all tags and metatags, I want to,

Another thing I want to mention too is, um, you know, if you’re, especially, if you’re starting out and your site’s new and you’re starting at kind of from square one, you’re buried in the listings. Um, and it’s gonna be hard to get people organically to go onto your site. They’re not going to find you on the fifth page of Google. So one of the important things to do when you’re first starting out is to find other ways to get traffic to your site. So that’s through, you know, if you have a social media following, you know, you can start putting your blog posts onto social media. So people click through to your website. Um, if you have like a, you know, a newsletter list, sending out newsletters that link out to your website, um, even just first starting out, just sending your website to friends and family and have them visit because Google will see the traffic started picking up and that’ll say, oh, you know, people are getting to this website. This must be important enough to move up the rankings a bit. It must be relevant. Um, so that’s one thing that I think sometimes people miss, you know, if you build your website and it’s brand new and it’s sitting on the fifth page of Google, you know, you gotta find other ways people to get to the website first, before it can, you know, start moving up to the first page or so.

Cool. Um, okay. Um, another thing that I’ve heard in the past, and maybe you guys can shed some light on this is the fact that it’s important to have your website be mobile ready in order to, is that helpful for rankings at all or anything like that?

Oh, absolutely. Um, and it it’s something that it seems like it’s becoming more standard now. It is, it is the standard. So we see it less and less of people not having a mobile ready site, but we do still do see it. So, you know, having a mobile radio site super important, if people are searching for businesses, they’re doing it from their phone in 90% of the time. Um, so you want to make sure your website is mobile friendly because Google will tell if it’s not, and then they will lower your rank on mobile searches if you’re not mobile friendly, um, cause they want the sites that are easy to use to are the first ones that are popping up. So that’s super important to be mobile readily mobile ready. Um, you can search on Google and Google has its own mobile ready test. You can go and plug in your website and it’ll tell you if it’s coming back as mobile friendly or not.

Um, and then the other thing is, um, having SSL security is really important. That gives you that little lock icon in your browser that shows that you’re secure. Um, that’s pretty much standard at this point, it’s it? You know, it’s every host should have it an easy way for you to get that. Um, Google’s even say not secure if you, if you don’t have the SS SSL security on your site. And that just gives people peace of mind when they’re sending con your contact form through or messaging you. So yeah, mobile friendly and SSL are super important to have. And at this point, if you don’t have it, then you’re kind of behind the times.

Okay. Yeah. And you could tell, like, there’s a big difference between the way a website loads, that’s mobile friendly versus a website that is not mobile friendly. Cause I mean, some of the sites that, that, that you guys have worked on, literally like there’s a button, a big button, you just click to call, click to schedule, you know, click to send a message, right. I mean, let’s just seem super efficient.

Yeah, absolutely. It’s important to make it easy. And then one thing that we can also mention too, is, you know, having your website get found is one thing, but you want to make sure that it’s easy to use once people get there, you want to make sure that it’s easy. You want to have this really strong call to action. So when someone gets to your site, they know what to do next they know to contact you. They see a big contact us button. One thing you can do is, you know, go to your website and see how long it takes you to find the button, to see, to make an appointment or to call it. And if it takes more than two or three clicks, then you probably need to make it a little easier for people to find because people will give up quick and move on to the next thing. If it’s not easy to use or easy to find what they want.

Yeah. And it’s also important to put that call to action closer to the top of the page so that people don’t have to scroll down to get to it. And you want to make sure it’s front and center. And like Ben said, two or three clicks to get the, take the person down the path that you want them to go down is the, is the key. So go to your website and check it out and see how long it takes you to contact yourself. So

Right. Or what call to action you have like available on your site. It’s like, you know, you need to have a schedule. Now, call me now, download this free report now and all this stuff like right front and center. So if people don’t schedule with you right away, what’s the next action that they can then take to, you know, communicate or reach out to you or just stay in your loop.

And one thing, one thing you can do is, you know, contact, uh, you know, maybe, uh, an elderly relative or patient and have them go and test your site. Hey, is this, can you, can you find how to do this? Somebody who’s, doesn’t ha hasn’t been to your site. Maybe it’s kind of not super tech savvy and to see if it’s easy for them to, to navigate and navigate the site and get to what they want. Because if you, if you’re in there everyday working on it, it’s easy for you. Cause you know, everything is, but sometimes you kind of forget that other people don’t have the, the prior knowledge to know everything is like you do. So can I seeing some fresh eyes on your site and see if it’s easy to use? That’s important. Okay,

Cool. Cool. Okay. So, um, well I think that those are all the main questions that I have for you. Is there anything else that you guys would want to share?

Yeah, I think one thing that we, uh, we’re going to talk a little bit about just because it was a kind of, uh, came up this year as a ADA accessibility. Um, it’s one thing that, you know, beginning of the year, there were a lot of kind of reports of practitioners getting, getting sued for their website, not being accessible, um, mostly out of California. Um, so, you know, what’s one thing that we looked at a lot this year is, you know, making sure that our sites are, are as compliant as they can be. Um, you know, we got extra tools in there for, for accessibility, but just to talk about a few things, if you’re doing the site yourself to, to look for, um, the important thing with ADA accessibility is, you know, one of the, one of the most important things is making sure that your website is, is usable with just a keyboard without a mouse.

Um, and that’ll kind of mimic to what if people don’t have feel using like, you know, voice commands to use a website. You want to make sure that everything is accessible. So you can go, go and test your site and make sure that you can, you know, for example, navigate through your menu with just your tab key and your space bar, um, making sure you can get to pages, just using your keyboard. Uh, that’s an important thing to do. Um, you mentioned alt tags before in images. Um, if someone’s blind and using a screen reader to go through your website, you want to make sure that all the important images are, have the descriptive alt tag, um, behind them. So if you, someone can actually see the screen, it’ll describe what the image is. So, you know, patient receiving acupuncture or something on, on, uh, on the acupuncture picture. So that’s really important. That’s one of the thing that people get dinged. As you know, they’ll run through the website using a screen reader and to see if it’s broken or not. And that’s kind of as a red flag, if, if your site is not easy to use with a screen reader or a keyboard, um, anything else you wanted to add to that kin?

Yeah, I think the other part of that is screen readers is being aware of your heading tags. So your heading tags are basically the different sections of a page and Screenagers need to be able to determine what those sections are. So if you have a section about what is acupuncture and then some information, and then the next section is what about what is a moxibustion that kind of thing? Things a headings are important. Part of ADA accessibility, and like Ben said, active, perfect websites includes, um, the accessibility testing, making sure that your site is built correctly to meet some of the most of the requirements. And, uh, you know, it’s, we, we try to do our best to, to guide you along the way. If you want to make changes yourself, we give you the tips and tricks on how to make sure that when you’re uploading content or adding images, how to make your content ADA accessible so that you don’t get dinged by any, any of the ADA lawyer stuff that’s going on right now in California.

Cool. And one last thing,

I’m sorry, man. I was going to say Daniel, if anyone, you know, feel free to contact us, we’re happy to, you know, take a look at your website. We do have an evaluation available. Um, yeah. So feel free to reach out if you have any questions about this, we’re happy to go in more detail with you. Um, you know, actually look at your website.

Yeah. So there’s, so if you guys want a free website evaluation, um, there is a link right now, that’s up on the screen and, uh, I guess, uh, once you sit, once you go to that page, you submit your site and Ben or Ken or, or Ian, or reach out to you and, and take the next steps to evaluate your website. Um, and one thing that’s, I think really important to get across is the fact that a lot of times when you work with Wix or Squarespace, you’re actually, the practitioner is actually working on and building and updating and doing the website and upkeeping it and doing it all themselves. Whereas what you guys do like day in, day out, you guys are doing all that for the, our clients. Right, right, right.

He didn’t go to acupuncture school to become a web tech builder. You’re eight. So that’s what we’re here for. We take that off of your hands and it frees up more of your time so that you can treat more patients, you can attract more patients to, through our service, which is great. So that’s why we’re here. We’ve been building websites since 2011. So we’ve been going for 10 years now has been a great ride. So

It’s actually Ben’s baby, but don’t kill anyone, right? Yeah. Uh, so other than the evaluation is, is that the,

Yeah, just go to that school. I go to that site, um, you know, they’ll have our other links there for signing up for a free trial. If you want to try us out, uh, the free trial is really easy. You just give us your information, we’ll set up a new site for you. Even if you already have an existing one, we’ll set it up at a temporary address. You can kind of just see how it is, you know, click around, see how it works and you know, be ready to go. If you want to make the switch and make it all easy. We do all the tech stuff for you. Now. You don’t have to be knowledgeable in any of that. We’ll try to make it as easy as possible.

Yep. And one last thing. So you just mentioned switch. So a lot of people are scared to switch over because they think it’s a daunting, massively, huge thing to do so, but like that’s what you do. Like you literally do that, right?

Yeah. We do it in a way. So there’s no downtime. We’ll build your whole new site kind of at a temporary page, so you can see it, make sure you approve it. Everything, once everything’s in place, then it’s just a quick little switch at your domain name and everything goes live and there’s no downtime. So we walk you through all the steps that you need and do all the do as much as we can from our end to keep all the tech stuff out of your hands. So you can just get to work.

Sounds good. Well, thanks guys for, um, you know, joining me here today and sharing some insights and wisdom with, uh, the AAC and those that are watching here. Um, next week you can join, uh, Sam Collins is going to be here and he’s going to be, uh, talking about some great things, um, on, uh, billing and insurance. So comeback then other than that, thanks guys again for joining us. Thank you. The AAC for, uh, allowing me to bring, um, you know, some guests onboard to share some insight and some wisdom. So thanks everybody. Take care. Bye Ben. Bye Ken. Bye. Thanks Jeffrey.