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, I am Brian Lau. I teach with sports Medicine Acupuncture, and with the Sports Medicine Acupuncture Certification program. I also teach with the three day cadaver dissection labs. And a little bit of the dissection is the impetus for why I’m gonna do the particular presentation I’m talking about today.
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First off, I wanna thank the American Acupuncture Council for having me. And we’ll go a little bit into the lung channel and the anatomy. We’ll look at some movement aspects of the channel also. So I just finished up two back-to-back five day dissections. I do this every year, the first two weeks of December with the University of Tampa with the Physician Assistance Program.
So I had a lot of opportunity to look internally with the body. We did a lot of external dissection, but we also did evisceration and we went into the abdominal and thoracic cavity. So that’s with physician assistants. I’m not really talking much about channels in there but I’m always thinking about the channels and I’m preparing for when we do dissection for acupuncturists how to communicate some of this anatomy to acupuncturists.
So that’ll filter in a little bit to this presentation today. And then we’ll go into some application with movement. So you can give some patient exercises that will engage the channel in this case, the lung channel fully. So let’s go ahead and go to the presentation and we’ll start jumping into the anatomy.
So let’s get a start. We’re just gonna go right into the internal pathway. So let me get the setup for this. So let’s imagine we’re in a prolonged, like a five day dissection lab. We’ll go briefly layer by layer. So what we have here, . is on the slide on the left is we have skin on at one portion.
We have some subcutaneous fat in this ne netter illustration, but primarily that’s been removed and we’re down to the level of the fascia above the rectus abdominis, the fascial, the rectus sheath, and the external obliques. So we can see the rectus abdominis underneath this rectus sheath. If I were to
Look at it from the back surface. That’s what we’re seeing in the right image. So in this case, we’re looking from the back through the body visceral cavities removed, and we’re seeing the peritoneal cavity from the back but the front surface of it. So here’s the rectus abdominis. You can see a window of it.
But what I wanted to highlight from this image, first of all, you have the falciform ligament, but another interesting structure is a remnant of the . This little ligament, which is the umbilical ligament, which is a remnant from embryological development. And this whole line here is very tied in with the linear alba, which is that thick Foss structure that separates the left and the right side of the rectus abdominus.
So a nice imprint of the Ren channel or the Ren mine. So we’ll come back to that a little bit now, but I just wanted to highlight that. Let’s go to the next slide. And here in this image we have the rectus sheath removed from the rectus abdominus. So this is what we would do in dissection is we would start to come underneath this rectus abdominus, just creating a little separation from the rectus abdominus and the tissue underneath.
And we would start lifting it up. And that’s what we have in this side right here. We have the rectus abdominus starting to be removed, and you can already get a imprint. You can see the peritoneal. Membrane, the serous membrane, and you can see some of the fascia under the rectus abdominus. The reason I’m going to this detail is when you do this dissection, sometimes it’s very adhered, and as you start removing and lifting the rectus abdominus from the pub pubic bone and lifting it off, it starts to tear the peritoneum because of all the adhesions there.
And why would that be so adhered? We have to get into the next layer, which would be the first layer in the visceral cavity in the abdominal cavity. And I’m gonna go right to that here. And this is what we would see as we open slice that very thin peritoneal membrane. We have the greater momentum and we have the stomach hanging off.
The stomach is that greater momentum. And if everything’s moving well on that person before they passed, then you can just easily kinda lift the undersurface of this greater momentum. Lift it up. And what underneath it is the transverse colon. So it’s very adhere, not adhered, excuse me. It’s very tied into, connected to that greater momentum.
So it’s connected to the stomach and it’s connected to the transverse colon. So that’s a lot of anatomy. But I wanted to highlight this anatomy ’cause it gives us a really a window into the internal pathway of the lung channel. When we look at the lung channel, . We’ll look at it now with different eyes, so we’ll look at that in just a moment.
But I do wanna highlight that on many people when we’re doing dissection on many specimens, there’s a ton of adhesions because one of the things this greater momentum does is it surrounds pathogens. So if you had, perforation, like an ulcer in the colon, it would surround that. And there’s a lot of lymphatic tissue in there.
There’s lymphoid. Cells that are gonna take care of those antigens. Or if there is some kind of entry of of some pathogen into the peritoneal cavity, that greater momentum can migrate around and surround those areas. So people who’ve had a history of peritonitis, it’s gonna be extremely adhered internally so they don’t lift as well, and you can imagine that they wouldn’t be able to move as well.
Also. So one more bit of anatomy and then we’ll look at the lung channel. Is the greater momentum hangs off the stomach. Let’s move up into the thoracic cavity. Oops. Wrong direction. And here is the continuation of the stomach, the esophagus, as it passes through the diaphragm, and as I go a little higher up, I get into the trachea and bronchi and those also are very connected with each other.
You could dissect them away, but it’ll take a lot of work. They almost are one unit. So now we have a lot of anatomy to go and look at that internal pathway of the lung channel. So let’s look at that. Here it is. So we see these, we study these internal pathways but it’s sometimes not always clear what the anatomy is when we learn ’em.
So we can now see that yes, we do have these bronchi break branching off the trachea. We could follow down the esophagus. We’ve learned when we learned the internal pathway that the internal lung path channel pathway connects to the stomach, it loops down and connects to the large intestine.
And that’s exactly what the greater momentum does. So what I’m proposing for this internal pathway is we have the trachea and bronchi, the esophagus, the stomach, the greater momentum linking with the large intestine at the transverse colon. So structures match. It matches the description of the internal pathway, but reminding ourselves again, that greater momentum has an immune function, that it has lymphoid cells in there, cells that migrate and take care of pathogens, also links with the actual function of the lungs because they do have a lot to do with wayI, wayI and the surface of the body.
This is at the surface of the internal . Abdominal cavity, but still taking some account of the immune response or the wayI response. So function and form, both match. I think it’s a really good a really good model for understanding the internal anatomy of that internal portion of the lung channel.
So let’s branch out now to the actual main channel. . But we’re gonna primarily talk about the sinus involved with it, because we’re gonna look at some movement aspects that, that we’re gonna, I’m gonna introduce that can help stretch and open and engage that outer channel, but also engage that inner inner branch of the channel.
So this is what I have as a model and what we teach in sports medicine, acupuncture. For the lung sinu channel, we have the pectoralis minor biceps, brachii, short head and long head. This bicipital a neurosis, which is an extension of that links in with the flexor carpi radialis, and then into the thenar muscles.
That’s the superficial branch. There’s also a deep branch of the sinu channel, which is the flexor lysis, longus, flexes. The big thumb, the brachialis, which lies deep to the biceps a little bit shorter. It doesn’t cross the shoulder joint, just crosses the elbow joint. And then that links up with the anterior deltoids and the clavicular head of the pectoralis major.
So we also have the scalings in there, especially the anterior scalings. I don’t have that listed in my list. But the, there’s that superficial branch all the way up into the thumb, to the pec miner and the deeper branch that lies underneath that. The main channel would follow the course, the little spaces between a lot of these mussel.
So these could be almost like the river banks. With all the river being the communication that happens in those fossils spaces. A lot of the organisms and such in the river. You could study a river, but you need to understand the river banks, the structures that make up that river, that form that river.
And that’s what the sinu channel’s kinda so for the rest of this webinar, I would like to look at a movement, a Qigong exercise that I give to patients. I also teach in Qigong classes. And this will exercise that external portion. It’ll engage those sinews, but I also wanna show how that’s gonna gently mobilize and move and massage the internal portion, the esophagus, the bronchi, the greater momentum, the stomach.
So I think if you wanna fully exercise the lung channel, it needs to have all of those components there. And this exercise does that nicely. There’s plenty of other good exercises, but I like this one particularly. sO this exercise I have on my YouTube channel, I did it a little bit differently when I filmed it originally.
I focused a little bit more on the stretching aspect. I’m gonna put up another video, same exercise, but I’m gonna do it the way I’m showing in this particular webinar. So that should be up soon. But either way you can check out the video on my YouTube channel if you wanna get a reminder of it.
Or this recording will be available afterwards too, if you wanna have a reminder for it. So if you used it yourself, great, you have some nice memory aids, but also if you give it to patients, it’ll be something you can refer back to. All right, so let’s set it up. So this is gonna be the exercise. It’s a very simple exercise.
Anything, anytime we engage these this lung channel, we wanna engage the sinus, of course, but we al engaging the sinus will open and close the chest, but we also wanna mobilize that internal pathway of the channel. We’ll look at that kind of point by pint. This is gonna be engaging the lung channel, but really when you’re engaging channels, you tend to do ’em in networks.
So this will be really the Y Ming and tie-in channels as a whole. So that’ll be the lung and spleen channel, the large intestine and the stomach channels. But the primary focus for this one is the lung channel. So we’ll come back and look at this video afterwards and highlight some features of it.
But let’s move on to the next slide.
So this is the starting position. This video will loop and you can see it as I’m talking about it. So I’m gonna start by bringing the hands up. I’m standing shoulder width stance. My arms are gonna cross in front of the body. The forearms are supinated, which means basically the palms are facing me.
Our palms are facing the chest. The hands are a little ways away from the body, so the shoulder blades are slightly pronated and the elbows are slightly lateral to the body. So that’s our starting position. I did mention in there that you’re standing at shoulder width. This exercise works perfectly well seated.
If you’re working with a patient or yourself and you have mobility issues and aren’t able to stand even somebody in a wheelchair. I, when I work with people seated, I have them slide forward sitting on their sit bones, sitting upright, so they’re away from the seat and, their sit bones basically serve as their feet then so that they’re able to have an upright posture in the same way that I have an upright posture in the standing version.
Okay, so I’m gonna start by opening the chest, which really means that I’m starting to retract the scapula. So the scapula are starting to pull together in the back. You might be able to see that in the mirror that I have behind me. That I’m starting to retract, bring the shoulder blades closer to the spine.
I’m opening the elbows while keeping them down. Pronating the forearms. So the pronation will start to stretch the biceps, and at the end of the opening, I’m gonna push the hands away from the body so the elbows will be extended. Also stretching the biceps. So generally . There’s a problem that I see when I give this exercise to people, and I wanna highlight what I wanna do before I highlight the problem.
You’ll notice as I’m doing this in the looped kind of version here, is that my hands start narrow or start medial to the elbows, but then they get ahead of the elbows. So that’s what I wanna do. I wanna keep the elbows down and I want the hands to go wide to the elbows. There’s a nice midpoint.
That you can notice where the hands line up right there, they line up with the elbows just on the side of the body. I’m gonna put my cursor over it. So right here. So there’s a point in time where the hands, elbows line up, the hands are facing out. This keeps my elbows from going wide. The point is a lot of people are internally rotated in the shoulder.
And if they keep their elbows wide, then the the arms stay and internal rotation. And I want my arms to externally rotate so that the whole structure opens up. So that’s a little landmark you can look for when you’re doing it yourself or when you’re giving it to patients, is that lining up right lateral to the body and then the hands continue out?
So this is the expansive phase. I’m starting to stretch the biceps. I’m opening the chest by retracting the shoulders in the back, which creates more space in my chest. Creates more volume in that whole thoracic cavity. So let’s look at the compressive phase of the movement. So once I’m fully open, I’m gonna start, you’ll see a little gentle contraction in the abdominals, which starts to compress the torso as I fully push out.
And that’ll take me into a further pronation of the forearms and a winding type motion in the forearm. So let’s look at that. So hands push, out turn. So you might be able to see a little better in the mirror is that the torso bows slightly. My abdomen bows my spine bows look at that a couple more times.
So this is where I can start to engage in the front and gently massage that greater momentum. There’s a little bit of shortening along the whole front line during the compressive phase, which then when I continue this movement and go into the expansive phase, I’m stretching, compressing, stretching, compressing.
So as I turn the forearms, then I’m gonna start to reach the arms back. So that’s the compressive phase of the movement, and then it returns back to the same position.
I leading with the fingertips.
So fingers come forward, I cross my hands, return my chest lifts, and that bow that was in the torso, un bow straightened. So I get a nice gentle stretching and mobilization of the inner part of the channel.
All right, I’m gonna go back a couple slides and I wanna look at the full exercise.
So hands come up, cross slightly away from the body, open the hands, expand the chest, push out slightly, compress hands back. Return back to the starting position.
Hands out, push, compress, hands back, return to the starting position.
All right,
so I’m gonna end the PowerPoint.
Yeah, very simple exercise. I would highly encourage you to practice it. Like I said, I’ll put up a video on my YouTube channel, but this video, I think it has the a little snippet of it so you can get the idea of it. But the goal is to open the chest, create more volume in the lungs, but then as I start to compress everything, bows.
Then I go back to the expansive phase, so there’s movement inside so that I can gently mobilize that greater momentum. I can gently mobilize the stomach, I can gently mobilize the trachea and the esophagus in combination with what I’m doing on the external portion of the lung channel. So the whole channel is active and the whole channel is engaged.
So I use this for a lot of different things. You could use it really for anything where you wanted to improve the health of the lung channel. So that could just be preventative, of course. Respiratory issues would be a key component. Of course, if you’re working with people with respiratory issues, you want ’em to have that full volume in the chest.
shOulder problems is one that I give this exercise to quite frequently. You have to make sure that there’s no pain with doing it. So one component is that turning internal rotation, once I’ve stretched out, is I want that to come as much from the body as opposed to all my arm where I’m cranking my shoulder forward.
That can create a lot of pain for people who have shoulder problems, so I have to be very gentle. I’m starting from the distal portion, winding my arm, compressing my torso slightly. So it should be very comfortable for people. There shouldn’t be any sharp pain with this exercise. But that’s one where I give this to is shoulder issues.
Neck issues of course, because that shoulder girdle health is very tied to neck neck pain. It’s really versatile exercise. It’s pretty simple. Patients can catch onto it very quickly. They tend to like it ’cause they’re sitting so much during the day if they work at a desk or driving, or so many instances where we’re compressed there.
So it feels really nice to be able to open and stretch the chest and stretch that whole fossil. Line throughout the arms, but also you get that nice gentle engagement in the inside. So give it a try see what you think of it. But you can always reference the video and highlight it.
And if I have a YouTube video up on it, you can give some questions and comments if you want further clarification. I think that concludes the information I wanted to give today. It’s short and sweet. I’m gonna put this information together into a longer class that I’ll put on net of knowledge that’ll be available through lasa and a couple other partners overseas.
But that should be coming out fairly soon. I’m gonna put a little self massage in there and some some other details for treatment, maybe some needling also. This was just an introduction. Got the ball rolling for that. I was very happy to. . To be able to introduce this to you, and again, thanks to American Acupuncture Council for having me on.
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So the topics we are going to cover today are facial motor points. Facial cupping and Gua Sha and derma rolling and protocols for treating specific conditions.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, my name’s Michelle Gellis. I am an acupuncture physician practicing in sunny Florida, and today I am going to do a presentation. This is part two of a two part. Presentation on an overview of treating neuromuscular facial conditions. I teach a two-day class on this subject, and I am going to be presenting some of the highlights for you today.
So if we can go to the first slide.
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So the topics we are going to cover today are facial motor points. Facial cupping and Gua Sha and derma rolling and protocols for treating specific conditions. In part one, I went through, Scalp, acupuncture and submuscular needling as some techniques that can be used to help with neuromuscular facial conditions such as Bell’s palsy, trigeminal neuralgia, TMJ, stroke, Ms.
Myasthenia Gravis, ptosis, and others. And today I’m going to touch on a couple of other techniques plus, um, some protocol specific conditions. So the first is facial motor points. And facial motor points. I’m sorry, motor points are, places in a muscle where if you needle them, it acts like a reset switch for the muscle.
So if the muscle is in spasm and it’s lost its ability to function properly, or if the muscle is overly tense or overly relaxed, if you needle into the motor point. It acts like a reset switch and it will bring the muscle back into normal functioning. And motor points are not trigger points or source spots.
And Chinese medicine, we call them Ashi points, but motor point is where the nerve bundle actually enters. Muscle. And fortunately for us, many motor points on the face are actually acupuncture points. So an example of a facial motor point are the. Facial motor points for the mentalis and the mentalis muscles are on either side of, uh, Ren 24.
And what they do are they help to elevate and protrude the up the lower lip like this, and they can also wrinkle the skin of the chin. Like that, and they are a half a soon lateral to Ren 24. And here in the picture you can see I put little diamonds to delineate where they are and where the muscle is.
And you would needle through the skin into the muscle, but not through the muscle itself.
Here is a very short video. I was teaching a cosmetic acupuncture class and in my cosmetic acupuncture class I was doing a demonstration and of cosmetic acupuncture, and my student mentioned that she had Bell’s Palsy many years previously. And as a result, she had lost some of the inability on one side of her face to purse her lips.
And if she, uh, she couldn’t whistle, if she brushed her teeth, uh, she would have trouble spitting ’cause she could only . Do this on one side, drinking through a straw was difficult, and so in addition to doing some of the cosmetic points I put in the motor point for the mentalis and this is what happened.
So you can see as soon as I put the needle in her chin started to twitch, and then once I stimulated it, the muscle really started to fire, which was very interesting. And she reported back to me that after that treatment, some of the issues that she had been having had resolved themselves. So motor points can be very beneficial when in with conditions wherein your patient, it has lost motor function of one of the muscles on the face.
And this is really apparent with the face because. On our face, the skin is directly connected to the muscles, which is why we can move the skin on our face without having to actually move a muscle. I’m sorry. We can move the skin on our face without having to move a joint or a ligament or tendon.
All we have to do is move the muscle and the skin moves.
aNother technique that can be used to help with neuromuscular facial conditions is utilizing facial cupping and guha. Now, facial cupping and guha has many similarities to the cupping and sha that you would use on the body, but you would use specialized tools that are designed for the face.
And you don’t wanna leave any marks on the face or neck when you are practicing. The facial cupping in Gua will bring blood and cheese circulation to the muscles, which will help with muscle movement. Brings qi and blood to the skin, which helps with . Cosmetic conditions and can also help if the fascia is very tight.
If there are fascial adhesions, it can help with that and . Any nerves that have become entrapped in facial tissue or within the fascia, it can help to release them. Facial cupping helps to move out stagnant lymph fluids, toxins. And if your patient has rosacea or any discoloration of the skin, facial cupping can be very beneficial for that.
And lastly, it helps to strengthen the vascular integrity of the face, increasing the blood flow, and helping with both neurological and muscular conditions of the face. So this is what fascia looks like and. Nerves will run through the fascia and they can become entrapped. Within the fascia. So using tiny facial cups and, uh, special oil that’s designed for cupping for the face, you can stimulate
The cup, the facial acupuncture points. You can glide the cups. You can stimulate the points again, and then you can use these xs symbolize a suctioning and releasing down the SCM under the clavicle into the lymphatic system. And this can really help, as I mentioned, with all of these different skin conditions.
And with facial guha, you’re actually taking specialized tools. These are jade, guha stones that are used to break up fas adhesions, stimulate acupuncture points and increase blood flow in the face. So here is a demo. This is a very abbreviated, demo a little facial cupping in Guha. I am a licensed board certified acupuncturist, and today I’m going to be demonstrating how to do facial cupping and guha.
The first step is to do a lymphatic drainage. Just ask your patient to turn the head to the side. And you’re going to start behind the ear and you’re going to work your way down and across underneath the clavicle times. I start right around Triple Energizer 17. Work my way down. right down the SCM. Now, it’s important when you’re doing this to not drag the cup down the neck or up the neck.
You’re gonna be using a suctioning and releasing until you get to the clavicle, and then you go right underneath the clavicle lung. Two area three movements that we’ll do. One is . A kind of a, like a dragging of the cup. So you would suction the cup and then move it and release it. Another one is a suction and release and just on a point.
And the other is would be like here where you’re dragging the cup. So sometimes you drag, sometimes you suction. And drag, and sometimes you just suction depending on where you’re working, like five and six, seven, and get right on up to stomach eight, just like this and up like that. guHa tools that I like to use are
Shaped like thickly, do both sides of the face at once. Whereas with the cupping, I just do the one side and then the other side, I just showed you the one side. With the gua, I do both sides of the face simultaneously, it feels better for the patient sides of the tool, and you’re really gonna sculpt the jawline, massaging acupuncture points along the way.
So stomach four. Stomach five and then coming along just like that. It’s a great way to help with the saggy gels. You can end with a little massage on small intestine 19 and work on the cheeks, and you can sculpt up this way and this way, and then get right into large intestine 20. And into stomach three, out to small intestine right here.
And bring the tools out, do gallbladder too. So essentially everything you’ve done with the cups, you are reinforcing with the guha tools and it can look like this and like this, and it feels really great. . foR your patients, it helps to break up any fa fascia that might be tense and really just those gels that might be sagging.
All the fat that falls down here, you can really move it back up.
I am. So again, this was just a little I am brief overview. I. I teach individual classes on cupping and guha, cosmetic, acupuncture, neuromuscular and all of these are brought together to help, to nourish the skin, the muscles, the nerves on the face. This is these are the tools that . I was using in my demo.
It’s a cupping and guha kit. It comes with glass cups and these jade guha tools. And there’s instructions, um, on the box and under the box. And there are also video instructions that come with it. And, you can learn about all of this@facialacupunctureclasses.com. Derma Rolling is another really wonderful tool.
So the nice thing about the cupping sets is these can be sold to your patients and you can teach your patients how to do self-care at home. In between. Treatments. So if they come to see you, if they can only come in to see you once a week, this is self-care for your patients. And some of my students have even put together little classes for their patients and their patients come and they learn how to use the tools in a group environment, which is fun for them.
But moving on to derma. Rolling. Derma rolling Is . A very effective tool for reeducating the connection between the skin and the muscles and the nervous system. If people have had long-term neuropathy, any sort of nerve damage. Sometimes you can, do some scalp acupuncture or work with the motor points, but this is another level of stimulating both the channels on the face so you can work right along the stomach channel, small intestine gallbladder, large intestine, any of the.
thE zong has meridians on the face. You can roll the roller to wake, not just the points up, but the entire channel. Plus, you’re stimulating the skin, which works in conjunction with the way the brain works. And these aren’t that much different than those . Barrel channel rollers that we might use on the body, but these have tiny needles and they are medical grade, so
These come in 0.5 millimeter or 1.0 millimeter in length, and they’re, you just roll them very gently on the skin. And I sell these to my patients so that they can self-treat at home once I teach them how to use it. And they all come with directions and video demos also. Okay, so Bell’s Palsy is a.
Probably the most common cause of facial paralysis that you will see in your treatment room. And it is typically a temporary condition and it is a result of a disruption of the function of the facial nerve, which is CN seven. And this prevents the messages from the brain. To the muscle, which causes muscle weakness and paralysis, and there can be a multitude of symptoms, uh, pain, neuropathy, muscle weakness.
Hearing loss taste sensations changing, um, changes in smell, vision, eyelids drooping, um, discomfort or pain in the jaw. And, uh, lots and lots of issues. And, but very much on a cosmetic level and typically. People will get this between age 15 and 60, but certainly I’ve seen patients as young as two and as old as 70, um, in my treatment space and the Western medical treatment is acyclovir.
Or an antiviral drug and then a steroid. And it is believed in western medicine that it is from a virus. And in Chinese medicine, we believe usually it is from a wind condition, wind, heat, usually, which affects the face. . the protocol for the exam is you would ask your patient to raise their eyebrows, close their eyes, tightly smile, puff out their cheeks.
If the orbicularis Aus has been affected, or the rosaro, if they try to puff out their cheeks when they close their lips, only one side will puff out and the other side arrow will come out. And smiling frowning. Show your lower teeth. Show your upper teeth. These are going to help you to isolate which muscles have been affected and then you would treat accordingly.
As I had mentioned wind, a wind condition, also blood stagnation or spleen sheet con deficiency. These are, uh, three different . Conditions from a TCM perspective that can, um, cause Bell’s Palsy. And for body treatments on everyone, I’m going to do LI four and stomach 36, and then I will treat the underlying.
dEficiency or stagnation or excess, whatever’s going on. And then I would do local. Points on the face, depending on what has been affected. aS I talked about last time, you can use scalp, acupuncture, ear chen, men, and point for the face. You can do motor points based on which muscles have been affected.
Facial cupping and Gu Shaw definitely to help bring energy into the muscles. Derma rolling . and you want to see the patient. I tell my students at least twice a week three times as ideal, but the more the better when you’re talking about treating a Bell’s Palsy patient. So this was a patient of mine and she had come in right after she was afflicted with Bell’s Palsy and I did an exam on her.
Closed her eyes. Okay. And as you can see, she could not close her right eye at all, and there is no movement in the right side of her face. And I actually misspoke. She had Bell’s Palsy for a while. She was past the point where the doctor said she would get any better and and so I treated her close for about six weeks and we were just starting to get some movement going.
Dry brow, close, dry. So you can see now she’s able to close her eye. nOt a lot of movement on the right side of her face yet the lower part, but she was able to close her lips a little bit. . It really requires patience and and time, but. iT’s just some information about my classes that I teach.
I do have an advanced certificate course, which is comprehensive. All of my classes carry CEUs. They’re all self-paced, recorded. And then you would, um, or can come for a two-day hands-on class. It’s included, but it is not required. And I do monthly live mentor sessions. That is the end of my presentation.
Here’s information about my social media. You wanna follow me on social, and I would like to say thank you to the American Acupuncture Council for this opportunity to present today. I. .
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi everyone. This is Sam Collins, your coding and billing expert for acupuncture, the American Acupuncture Council. And of course you, let’s make sure your claims are getting paid, and I don’t care whether you’re doing cash insurance or otherwise. We always wanna make sure you’re doing well, we have a vested interest in you.
Well, today I’m gonna spend some time talking about Valuation and management services or e and m codes or exam codes. And I’ve recently had a lot of offices with issues of Sam, my exams are being denied or they’re not paid and they’re giving me excuses that don’t appear. Right? So let’s talk about that a little bit.
Does a patient require an exam? Of course they do. Well, let’s get into that. Let’s go to the slides. Let’s talk about what’s going on and getting paid for your e and m services. How do I get paid for my exams? And I use the term exams because. Often people will say e and m, and then they say, office visit.
And I want you to keep in mind an office visit is anything that you do when a patient comes in, they’re visiting your office. So keep in mind, office visit from your standpoint should just be the visit overall. It depends on what you do. So by example, on days you do an exam. That would be an e and m service, and you may do treatment the same as well, so be careful.
The term offices, it will often get you confused. What I’m speaking about for exams of course, are evaluation management or e and m codes. If you’ve all learned, and you’ll notice we have two types. The new patient, the established patient, you know, two oh twos to 2 0 5 for new 2, 1, 1 to 2, 1 5 for establishing.
What are these for, for the indication when the patient required an examination by you. To determine their diagnosis, their need for care, and so forth. And so we’re broken down into four codes for new patients, five for established, and they’re pretty straightforward. They just indicate how much time or how much medical decision making did you spend doing an exam.
You should be familiar with that. That’s not the hard part. Where we run into problems often is, I’ll get off the saying, Sam, I billed for an exam code. And I didn’t get paid. The insurance said it’s not a covered benefit or it’s included in something else. So what is it that’s required to do or get paid for an exam?
Well, let’s think of it. An exam is something that’s absolute required. If an insurance says that you shouldn’t do an exam or it’s not within scope, I can’t believe that not to be true. I mean, obviously when a patient comes in, what’s the first thing you have to do? In order to know whether you can help them, you have to evaluate them.
It’s required to determine the condition and their need for care, what’s wrong with them. And then of course, I would argue it is a ethical and legal requirement. Can you imagine the liability if you said, Hey, I don’t care. What’s wrong with you? Just shut up and lie on the table and start needling in you and go, well, we’ll see what’s happening.
I don’t care what’s wrong. Well, of course not. It is an absolute requirement that you make some level of evaluation, determine the need and necessity for care. So I’m gonna say it is an absolute requirement to do an exam, however, where the confusion comes in is how do you bill for it and how do you document it?
Well, let’s realize the one thing that’s probably the most common issue for acupuncturists being denied for exams. Is the failure to understand that every time you bill an exam code an e and m code with treatment, you have to put a special modifier on it in order to determine and to demonstrate it is separate.
From the exam associated with the treatment. So notice here it talks about the acupuncture services or procedures includes an e and m assessment. So in simplest ways, think of it this way, if you saw someone for the very first time, you are clearly gonna ask them lots of information about who they are, what’s their symptoms, what’s going on, what makes it worse, what makes it better.
In other words, you’re gonna do a pretty detailed history. You’re likely gonna do some physical exam things. Maybe it’s tongue and pulse, maybe palpation, range of motion, you name it, the many things an acupuncturist might provide. And then based on that, you’re going to determine a diagnosis and then begin some treatment.
Well, those things actually are somewhat included in the acupuncture service, but here’s where we have to be unique. Realize the acupuncture service does include . A small exam. Now, the first visit, the one I just described, is clearly different, above and beyond. But let’s talk about that first visit is one thing, but what about when the patient comes the second time?
Maybe I come to you two days later and you say, Hey, Sam, how are you feeling? Is that a little better or worse than last time? How much time did the pain resolve for you? In other words, you’re gonna do a little short exam that includes a little history, maybe some findings such as, you know, uh, tongue and pulse again.
And then begin treatment. So there’s what we call a pre intra and post-service evaluation associated with treatment. So here is the number one reason most acupuncturists are denied for exams. You forgot to tell them this exam is above and beyond what I normally do as part of the visit. It’s a true examination and we have to put modifier 25.
So if you’ve been denied for an exam and you’re not familiar with 25, that’s probably the number one reason that modifier is necessary to indicate to the carrier that this examination was separate and distinct. Therefore payable, no modifier, no money. Now, why is that? Because you’ll see here, there is a pre-service associated with treatment.
When they come in the second time, you’re gonna do a little review of their record, a little record review, face-to-face time with them, do some evaluation things, get them set up for care, perform the care, and even after the care, you’re gonna evaluate, Hey, how are they doing? Give them some recommendations for at home.
And this is why it says specifically in the CPT Manual. It says what you see at the bottom here, it says, additional evaluation and management services may be reported separately if and only if the patient’s condition requires a significantly separate identifiable e and m service above and beyond the usual pre and post service work associated with care.
So in other words, we’re saying, no, no, no. This is not the one that we do day to day, but this is the one above and beyond. So to come full circle with that, when is that necessary? Well, clearly the first visit. There’s no doubt a first visit should be separately paid for an exam and we put a 25 ’cause that’s clearly above and beyond what you would do on a follow-up.
Now, when would it become necessary again? Now, some of you say, well, Sam, I do an exam every day. That’s exactly what we’re pointing out here. You do and we understand that, and a little bit of that is associated with the treatment. Keep in mind, that’s not only true for you as an acupuncturist, that’s true for medical doctors, chiropractors, physical therapists, anyone that’s doing this type of care.
Would have the same provision. So they have to put the modifiers as well to show that it’s separate. So we have to make sure it’s above and beyond. So it says here if and only if it requires a significant one. So the day-to-day one, you do for, you know, several visits after, not really, but when would it be appropriate?
Certainly every 30 days. Now why every 30 days? It’s the standard. It’s the one set up through Medicare that all insurances have adopted. So an exam on the very first visit. When every 30 days absolutely reasonable should be payable. Just remember, assuming there’s treatment, put a 25. Well, what if you say, what if I don’t put a 25?
You won’t get paid. Now, you don’t need a 25 on the day-to-day one, but on the one that’s exam, so the first visit. And then about every 30 days. Now, some of you say, I like to do it every six visits. No, it’s every 30 days. Whether you do 12 visits in 30 days or six, keep in mind it’s about 30 days. Now, there could be instances.
What if the patient says, Hey, last night I fell down and I hurt my back. Would that be appropriate to do a separate exam from what you were seeing them before? Let’s say it were headaches. Well, of course, because there’s something new or significant that’s above and beyond, so make sure it has to stand out.
In other words, make sure the exam clearly shows that this is not the routine exam, and that’s probably the number one reasons things get denied. So simply put, when you’re billing, put a 25, notice this example here. You’ll see 9 9 2 0 3, that mid-level exam. But because there’s acupuncture performed the same day.
We put the 25 modifier on it. The 25 modifier does not change the price. It’s still gonna be paid the same. It just indicates that it’s payable. There is no reduction in doing that. In fact, in many ways. I wonder maybe should that have been the second thing you’ve learned in acupuncture school? I mean, the first thing, of course, how wonderful the profession is, all the things you can do.
But can you imagine how many of you finished school? Never learn this one simple thing. And then of course you get out and you’re frustrated like, how come I don’t get paid for exams? Well, because you didn’t put the proper modifier. Now let’s keep in mind, I’ve had some offices though, that are saying, well, Sam, I know that I’ve been doing that and these insurances still won’t pay.
So what I’ve done here is I’ve taken a page. From the CPT book, I just took a picture of it. Put it up here, and here’s what it says. Notice it says, evaluation and management services may be reported in addition to acupuncture procedures when performed by physician or other healthcare professionals who may report them, which means you.
Now we move down a little bit here and we’ll get into this section here and it says it may be reported separately using modifier 25 so long as it’s above and beyond. So I wanna make sure if you ever get a carrier that’s saying . You shouldn’t be able to. I wanna point out the CPT manual clearly says it.
This is not unique to you. It says it the same for chiros, the same for medical doctors and so forth. So it is absolutely appropriate. However, there are some plans that come back and say, no, we’re still not gonna pay. So let’s talk about how to deal with if it’s denied, was it billed properly? Would be the number one thing.
Did I put modifier 25? That’s probably the simple one, but sometimes you’re gonna say to me, Sam. I did put the modifier 25. It still came back and it stated the exam was included in another service. What you’re gonna do is push back and say, excuse me, this was done on the first visitor every 30 days, and there was clearly a separate and distinct service, an exam that was above the routine day-to-day visit.
So you’re gonna push back on that and basically point out to them it was separate. That’s why we put the 25. But here’s the bigger problem sometimes. It’s because you have a contract. It’s why I will warn you. In fact, how many of you have worked with me directly? one-on-One to know whether or not it’s worth it to join some plans.
I’m not gonna say never, ever, but you wanna make some better choices. ’cause sometimes when you join these plans, you join ’em and think, great, I’m gonna get more patients. Do you know many of your contracts say we don’t cover exams? So the reason it may not be covered, it’s part of your PPO reduction.
It’s basically saying, we’re gonna send you a lot more patients, but we’re not gonna pay for the exam. You have to make it a business decision. Is that worth it to me to get less money, but maybe more patience in some instances? Maybe, but for me, mostly, probably not. So what if the issue is part of your contract?
Is there a way to dispute that? No. That’s the contract you signed up for. Now, maybe you might decide not to be part of it. This is why. Think of it. If you’re just a cash office, isn’t your first visit more expensive than a second visit? Think of that for a moment. Why is that? The first visit has an exam, but here’s the issue we’ve been running into, and I know a lot of you on the East Coast, I’ve done seminars there up and down the East Coast from New York, down to Florida, that the plan says an acupuncture provider is not paid or may not even do an exam.
We’re running into this into New York quite a bit, and my answer to that is, excuse me, you’re saying an acupuncturist cannot perform an exam. Would that not be against. The rules of just engagement of a patient. Can you imagine the liability if a doctor said, oh, I didn’t examine them. I don’t care what’s wrong with them, I just treated them well, how could you treat someone without evaluating what is wrong and knowing what to do?
So there’s a lot of pushback on that. If that’s what you’re running into, please get part of your state association. Join us in fighting to say, excuse me. Of course it is part of your scope. In fact, what I’ll tell you is look at your scope of practice. Does your scope of practice indicate an evaluation?
I’m gonna guarantee it does, at least at some level, so therefore should be payable, so be careful. I think what’s happening is some payers are finding, hey, acupuncturists will just go away if we tell them no, we’ll just pay for treatment. We don’t wanna pay for an exam. My goodness. No. If you’re doing an exam.
It’s necessary. Of course, that’s payable why it takes time. It takes effort to do it, so make sure that you’re always pushing back. However, please be sure if you are billing for an exam, and I don’t care whether it’s cash or insurance. By the way, is there clearly more information and more details that would show this visit had a distinctive exam?
Keep in mind if you’re billing for an exam, there needs to be an exam above and beyond, just kind of like acupuncture, and we’ll talk more about this coming up in the first of the year, but how are you documenting it? How to make sure you’re avoiding anyone coming back, saying the services weren’t properly described.
Not hard, but there’s things you have to do. Have you ever had help with that? Have you ever understood it? Maybe not. That’s what we do with the network. It’s not just about practice and making more money, but making sure we’re compliant. All those factors, I want to help you with that. That’s what we do with the network.
We do the education. Come to a seminar first of the year, you know what’s happening. There’s updates to these e and m codes. Nothing major but enough that you want to be aware of. To know which code to properly choose, and there’s some additional codes that are updating as well. We always want you to be in the know.
The American Acupuncture Council is your partner. I’m your partner. Your success is ours, and I wish you well. We’re always gonna be there as a resource. Take a look at our website, there’s our phone number, come to our seminars. We’re here to help everyone go out and do well, and I wish you a really good New Year and prosperous new year.
Thank you.
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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 everyone, my name is Dr. Shellie Goldstein. I’m here in Florida. Today’s lecture is called Fascia. So thank you so much to the American Acupuncture Council for allowing me to be here today and presenting this topic to you. So let’s go to the slides.
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One of the things that has become very obvious to me these days is the synergy of Eastern and western medicine. And I do firmly believe that integrating eastern and western medicine in today’s healthcare system is both multifaceted effort. It’s on both of our parts, Eastern and western practitioners.
It requires collaboration, education, research, and certainly cultural sensitivity. And when we are able to perform these responsibilities the potential is enormous for both patients, but also . For us as well for the patients. It provides a broader range of treatment options and more personalized care.
And then when we as eastern medicine practitioners begin to understand Western medical concepts we find that not only do the patients benefit, but we do as well because recognizing and understanding these parallels of each of those systems can . Absolutely lead to an enhanced professional collaboration and improved patient care, which is so important today because as Eastern medicine practitioners, this is our time.
This is our time to join Western medical practitioners in an integrative care modality to Bri be to improve the quality of healthcare and to bring forward. A much broader range of treatment options for both the patients and the practitioners as well. That is what brings me to this topic of fascia.
I am obsessed with fascia these days. Fascia is the glue that’s holding us all together. It’s the, from a modern anatomical and physiological. peRspective we see it both as fascia from a Western medical perspective, and in our world as Eastern medicine practitioners, we see it as the concept of Jji or the Sinu channels.
And when we talk about Jji, what we’re talking about is the network of pathways related to both . Muscles, tendons, and all of the other connective tissue that keeps us connected in the body. One is fascia. From a Western medical perspective, it’s a form of connective tissue. It contains collagen fibers, Alaskan fibers, and what we call ground substance.
And so ground substance is what keeps it all together, keeps it nice and moist. So you think about . Fascia is this tactile network of tissue that both surrounds every muscle organ, vessel bone and nerve fiber. But it also connects the horizontal planes from bone to the surface of the skin. So it surrounds and protects, but it also connects and it’s three dimensional.
As you can see of this image, it moves back and forth. It provides the structural integrity, the stability, and the flexibility of our body to move and be fluid in its movement. And it also allows us to move in a multi-directional and multi-dimensional plane so that we, our fluids are, our movements are nice and fluid.
One muscle doesn’t move and then mu another independently find the movement of another muscle so that there’s this schism of muscle contraction. But it’s that fluid movement that allows us to move through the different multi-dimensional planes upward, downward, inside outward, and then running through these planes.
Of fascia are nerves, and in that sense, not only do we have movement, but we have sensation. There are so many nerve endings or nerves that run through the fascial planes that it is almost as sensitive as touch on the surface of our skin. That’s how sensitive and acute our fascial system is. It is both affected by internal muscle activity and external, say, gravity and movement.
And so as these systems come into play, both our muscle contractions and the weight of external bearing systems, uh, it allows that transmission and that dispersion. Of that through the neck fascial network and then also through its visel properties. It helps to move us in one direction or another. So for example, if someone holds onto your arm and pulls, it’s not just your arm muscle that’s gonna pull, but your whole body is going move along with that.
With that pull or with that movement to compensate both movement in one direction and stabilize that movement in ano in another direction. And when we have our body moving in ni in a nice fluid system such as the fascial system, it actually helps to minimize the amount of energy that’s utilized throughout each singular or connected movement.
Fascia protects the integrity of the body and helps prevent or minimize local stress within a specific muscle joint or a bone. For example, if you have tightness in say, one area, it the ability for the fascial network to move and to break through that tightness allows the body to minimize that local stress.
Also to absorb that localized stress and move it through the body to release that, that tension or that stress. Think of it as the Terminator, right? Think of the Terminator Revisited. I. Think of what if the Terminator was just an individual subset of parts and there was this gap filler, this structure that was stayed in, in, in the, in those empty spaces and it just
Filled the space. That’s not what fascia is. Fascia is actually what we’ve been talking about. That ability for this entire elastic contractual signaling, whole body signaling network to move the body in a very fluid dynamic and structure so we can run faster, jump higher, and be more efficient in our movements.
There are multiple types of fascia. There’s superficial fascia. That’s what’s on the surface of our body, and it’s a very loose layer. It’s very wet, and it is made up of fat. Adipose tissue collagen and elastin fibers, and that ground substance or hyaluronic acid keeps that superficial fascia nice and loose and sticky so that its job is to actually attach the superficial and horizontal planes so that you get this smooth.
Flow between the different horizontal layers so that there’s no friction or tension. Its job is more to stabilize and connect these structures, whereas deeper fascia, I. Has much more fibrous and its job is to cover the different structures, bones, muscles, nerves, and vessels, and protect ’em. So it’s job is to actually absorb contraction.
There. If the body, say for example, if you start to fall, the fascia that surrounds the different muscles and tissues will contract right before you, you fall. In order to support the muscles and contain those muscles. So the difference being that the deeper fascia is protective, it’s contracting and it holds everything together, whereas the superficial is more of a connection, so it connects the different layers together.
aLso deep fascia has receptors that signal the sensation of pain, right? You land hard when you fall, and the body absorbs that shock. Feels that sensation sends it to the brain to signal the brain that something is occurring in that particular area, and then the brain can respond accordingly. And then deep deep into the pockets or the cavities of our body.
We have the visceral and the parietal fascia, and again, these are more loose, connective air, irregular tissue. That’s sub, that has that fat and that liquid hyaluronic acid in it and its job is to surround and protect the internal organs. The visceral fascia surrounds the organs and the AAL cavity, the lungs and the heart, whereas the parietal fascia lines the wall area of the pelvis.
Now what’s interesting and what’s most relevant for the conversation that we’re having today is the relationship between what we’re calling myofascial slings. So the myofascial slings are different planes that work together to create mobility and stability. So they are dense bands, as you can see, the superficial front sling, the superficial back sling, the lateral swing, the.
Spiral and the deep front swing. They’re bands that run from the back to the front of the body, shoulder to the contralateral hip, and their job is to play an int integral role in coordinating con control, coordination and control movement sequencing, and the integration or the kinetic movement that involves the transfer of force.
From the upper to the lower aspects of the body and extremities. So think of them as the slings that support and allow movement of the body. What’s interesting for us is these slings are ve are directly related to what we call our gene gen or sinu channels. These are not the Jing low. These are the sinu or muscle channels that are described separately from the jingo.
So the Jing gin channels incorporate the Sinu channels, the channel sinus, the muscle meridians, and the muscle conduits, or tender muscular meridians. They’re found in Theen. In Theen Chapter 43. It says that whey or defensive chi is formed from food or drink. It cannot travel within the vessels, but flows between the skin and the muscles.
It circulates through the chest and remains outside of the channels and vessels. Now Ma, Chicha then takes this information and combines it with the information that’s found in chapter 13 of the Ling Shoe. He says that the connective tissue of the limbs is either muscle or sinew in Chinese medicine.
Fascia in limbs, sinus, or muscles are both called gin. Therefore, muscle gin is the muscle channels inclusive of fascia, cartilage, tendon, and ligaments. And then he says that they’re discussed in chapter 13 of the Ling Shoe called Jin Gin Channel like muscles or muscles of the channels. And then in the link shoe in chapter 13.
The reference that he’s referring to is the statement that the pathology of sinus cause pain, tightness, and fla, acidity, and even impairs movement. So again, there’s this correlation of this band that we call Jji that is specific to movement and the coordination of muscle and tendon movement within the body.
And also founded by the research of Helen l Langevin at the University of Vermont. She suggests an overlap between fascia and the traditional Chinese medicine concept of channels or collaterals. Now she combines Jing Jin and Jing Lo. But ’cause what she’s saying is that she and her colleagues notice that the insertion and the attachments of the muscles and fascia create cleavages or lines that pull like the grain of in wood.
And then she says that the, there are many acupuncture points that lie directly over that area in these fascial cleavages, where the sheets of fascia diverge to separate, surround and support the muscle bundle, similar to the deeper fascia that we’ve been referring to. And then according to Langerman, the yang chi is said to flow in those spaces between the organs, the bones, and the flesh.
Now what’s fascinating is we, as our, and when we think of our Jji channels, we have CH 12 channels, six paired channels, the Ang Sinu, the Young M Sinu, the Young Chao tie in Cha Andan Sin Channels. If you look at the trajectory of those channels, they’re very similar to the fascial slings. So you can see them in, in this image is the similarities be between them.
But then if you look at this image, you can actually see the direct correlation between the specifics of the slings and the superficial lines of the sinu channels. So you see the superficial back and the urinary bladder channels are very similar. The frontline and the stomach channel are, have overlapping similarities.
And then the deep back arm line, the small is correlates with the small intestines in new channel and the hearts in new channel. The superficial back arm line corresponds with the. Triple burner sinu and the large intestine senu channel. And then if you look in the similarities between the lateral line and the gallbladder senu channel, they’re almost identical.
And then again, through the deep front line. We see overlapping correspondences between the liver sinu channel, the kidney sinu channel, the spleen sinu, and the spleen sinu channel. And then again, lastly, the deep front arm line corresponds to the lung sinu channel and the heart sinu channel. And the superficial front arm line is very similar to the pericardium Sinu channels.
So you can see that the planes of these channels very much o overlap with one another. So when we compare the similarities between Jing, Jin, and Fascia, we see that from a conceptual and anatomical and functional perspective, there are certain parallels between the Jji and Chinese medicine and Western medicine.
And that the myofascial system can be observed in their roles as connective tissue networks that support connect and influence body movement. And even though they’re described differently in our medical frameworks, they both recognize the importance of these pathways in maintaining health, um, both in terms of structural support.
In Chinese medicine, we see them in terms of our . Our support, movement and stability of the skeletal system we see in Chinese medicine, the concept of pain and dysfunction are attributed to our blockages or imbalances in the flow of Q and blood. And we know that from our Jing Jinen meridians, they’re thought to be responsible for the smooth circulation of vital energies.
And when there’s an obstruction in the sinew channels, it can lead to musculoskeletal problems, pain, and a decreased s ability to provide support to the body. And then we see the very similarities in Western medicine and western an anatomy. Same recognition of connective tissue that envelops impacts the muscles, the organs, the blood vessels, the nerves and other structures, and that same three dimensional network or support system throughout the body.
And similarly, I. When there are obstructions or disturbances in the myofascial slings in the fascial system, it leads to musculoskeletal problems, pain, and a decreased ability to provide structural support. We also see that similarity in the ability of the Jing gin and fass that. To movement and mechanical transmission.
So the gene gin acts as a conduit for smooth flow of chi and blood throughout the body and supporting that movement. Where is in western medicine, it’s the fascia that facilitates that smooth mood and colliding action. Between the adjacent structures we see there’s this interconnection. So we see in Chinese medicine, we understand that connection between everything, that continuous flow of chi and blood through the meridians and the vessels that are believed to nourish and support the organs and the tissues.
And we also understand that blockages or imbalances in this flow lead to health problems. And then we also correlate that interconnection integration by understanding the com, the emotional component of both pain, but also trauma into those jji affecting the specific organ system separately. Although the JJI does not necessarily refer to the organ systems, we know.
That there is an interconnection and integration in all the body parts with the deeper senses of emotion in our being. And then in Western medicine they think of this interconnection and integration more in terms of movement. But again, we all recognize the emotional component of it. . And then there’s the understanding of the parallel between gin and fascia in terms of pain and the perception of pain.
So we know from our functional MRI studies in that acupuncture’s ability to influence the brain’s activity in regions associated with pain perception, motor control and mood regulation. And we know . That acupuncture has been shown to activate the release of pain relieving endorphins. By modulating these pain perceptions we can, with acupuncture, we can reduce pain, improve mobility, and ease emotional related discomfort.
The same with in Western medicine, they may not use acupuncture, but there is that innate understanding that fascia contains sensory receptors, propria receptors, and neuro. No e receptors at which contribute to the somatic sensation appropriate adoption. In our Chinese medicine, we see pain in terms of B syndrome and we, and from our understanding of the gene gym, they’re not, although they’re not related to individual organs we do know that they.
Pain itself is what flows through the concept of pain or what we call B or painful obstruction syndrome. Pain, soreness, numbness of the muscles and tend tendons and joints. Rose runs through our Jing gym and we know that acupuncture improves and accelerates that flow of QE and blood within the Jing Gen to alleviate B syndrome, ands, restore proper function.
Now, although the a Jing Jin does not have acupuncture points, those acupuncture points lie along the Jing low. But we know that the Jing Jin and the Jing Low run in parallel. So we use the Jing low points. In order to affect the Jing, Jin Meridians and classical treatment strategies will include primarily we think of the Jing well points.
We also know that there are those four meeting points that are organized, the channels, and regardless of there being an arm, a leg or re or upper or lower uh, we know that CV three. Is for the three Li in channels small intestine. 18 for the three young channels. . Stomach eight or GB 13, depending upon the source for the three young channels of the arm and gallbladder 22 for the three yin channels of the arm.
And we also have realized that those anatomical locations of these specific points are similar to the histological nodes and convergent points of different myofascial planes. So there’s a another correlation there. In terms of treatment, we generally use the ASHI points, or those are the points when you palpate someone and they go, ah, , those are our Ashi points.
trIgger points. Those are those discreet local, hyper irritable spots along a band. So although the pain may be felt in a different area, it’s the, that one trigger point is the referral pain that accompanies this musculoskeletal discomfort. Or we use motor points. And motor points are the site where the motor nerve first pierces the muscle belly.
It’s also known as the MEP of the motor nerve point. And so those are those are the points that are very, a little bit larger in diameter. They carry a greater quantity of motor and sensory sensations and so those are great points for treatment as well. Other forms of treatment include cupping, are guhan.
So let me give you an example of what I’m talking about. Here’s a case study, and this is a hypothetical case study of a 47-year-old male patient presenting with a three-year history of plantar fascitis. He complains of excruciating sharp burning pain on the soles of his feet that would come and go.
The right foot was worse than the left and the right hamstringing. Lower back sous and medial head of the gastric Venus were very tight, and then that pain and upon palpation extended to the medial head of the area of the kidney. Now the patient said that he was not aware of any other physical or digestive disturbances, but upon palpation what we find is that, or are looking at his tongue and pulse, that his pulse was wiring and deep in the both proximal positions and tongue pale with red tips.
So what does that tell us? It tells us that although we are treating. The pain it through the jji. And in our situation, given this case study, this is the T Young Sinu channel or what we call the superficial backline from a Western medical perspective. But we also can tell that from his tongue and from his pulse that he has a little bit of underlying kidney deficiency.
So we’re gonna treat the stagnation in the bladder meridian of the TA Yang Sinu channel. That’s our primary treatment. We may support the kidney treat deficiency because as Chinese medicine practitioners, we’re always looking for that under root cause, but the primary treatment. Is the stagnation and the taang sinu channel.
The treatment is to resolve that stagnation in the bladder meridian of the taang channel and then all, and then to the secondarily, we’re gonna nourish kidney chii and chi and blood of the kidneys. So these are points that we might use that would support both the Tay Young Sinu channel treatment and then supporting the underlying kidney deficiency.
And from a Western perspective, what they were gonna do is a very similar thing. So Mo you see a lot of these points. Bladder 40, 60, 56, 57. 67, 37 all are along the bladder meridian, and then we are supporting . The underlying systems with kidney six, liver three, and spleen six. But as a western medical practitioner treating the back line, what I would do is use trigger points or different types of treatments to pressure with pressure to release the that medial gastric muscle so the patient gets treated, he comes back.
A week later are reporting that a significant reduction and there’s a significant reduction in his pain along the under sole area. But he still has some tight calves and a little bit of tightness in the right hip, which would make sense by looking at both the back sling and the CNU channel. So the next two treatments.
We’re going to incorporate the following points, gallbladder 29 34, and these are designed to release the tights around the hips. Again, we’re treating that sling or that’s sin new channel. And then after three treatments, his musculoskeletal problems significantly improved and he was able to mean. Remain pain-free by regular home care treatment.
And then if he were to go for physical therapy or western treatment, they would do a similar thing. They would treat, continue to treat that medial gastric ne emus area with including the antola lateral zone of the leg and the pelvis. So you see the similarity there. With us treating the channels and then in western medical treatments, the slings.
So there’s a lot of overlap here. And again, going back to the similarities of who we are, both from Eastern West and the importance of understanding. Both the Eastern and Western I do believe that we’re in the right time right now to be able to bring the eastern western medicine together and to make a huge difference and improve the health of our patients by offering a lot more opportunity and options.
So thank you so much for today’s presentation. Thank you to the American Acupuncture Council for allowing me to be here. It’s always a pleasure. And have a wonderful day and take care of those slings. All righty, take care. Bye. .
of Eastern and western medicine. And I do firmly believe that integrating eastern and western medicine in today’s healthcare system is both multifaceted effort. It’s on both of our parts, Eastern and western practitioners.
It requires collaboration, education, research, and certainly cultural sensitivity. And when we are able to perform these responsibilities the potential is enormous for both patients, but also . For us as well for the patients. It provides a broader range of treatment options and more personalized care.
And then when we as eastern medicine practitioners begin to understand Western medical concepts we find that not only do the patients benefit, but we do as well because recognizing and understanding these parallels of each of those systems can . Absolutely lead to an enhanced professional collaboration and improved patient care, which is so important today because as Eastern medicine practitioners, this is our time.
This is our time to join Western medical practitioners in an integrative care modality to Bri be to improve the quality of healthcare and to bring forward. A much broader range of treatment options for both the patients and the practitioners as well. That is what brings me to this topic of fascia.
I am obsessed with fascia these days. Fascia is the glue that’s holding us all together. It’s the, from a modern anatomical and physiological. peRspective we see it both as fascia from a Western medical perspective, and in our world as Eastern medicine practitioners, we see it as the concept of Jji or the Sinu channels.
And when we talk about Jji, what we’re talking about is the network of pathways related to both . Muscles, tendons, and all of the other connective tissue that keeps us connected in the body. One is fascia. From a Western medical perspective, it’s a form of connective tissue. It contains collagen fibers, Alaskan fibers, and what we call ground substance.
And so ground substance is what keeps it all together, keeps it nice and moist. So you think about . Fascia is this tactile network of tissue that both surrounds every muscle organ, vessel bone and nerve fiber. But it also connects the horizontal planes from bone to the surface of the skin. So it surrounds and protects, but it also connects and it’s three dimensional.
As you can see of this image, it moves back and forth. It provides the structural integrity, the stability, and the flexibility of our body to move and be fluid in its movement. And it also allows us to move in a multi-directional and multi-dimensional plane so that we, our fluids are, our movements are nice and fluid.
One muscle doesn’t move and then mu another independently find the movement of another muscle so that there’s this schism of muscle contraction. But it’s that fluid movement that allows us to move through the different multi-dimensional planes upward, downward, inside outward, and then running through these planes.
Of fascia are nerves, and in that sense, not only do we have movement, but we have sensation. There are so many nerve endings or nerves that run through the fascial planes that it is almost as sensitive as touch on the surface of our skin. That’s how sensitive and acute our fascial system is. It is both affected by internal muscle activity and external, say, gravity and movement.
And so as these systems come into play, both our muscle contractions and the weight of external bearing systems, uh, it allows that transmission and that dispersion. Of that through the neck fascial network and then also through its visel properties. It helps to move us in one direction or another. So for example, if someone holds onto your arm and pulls, it’s not just your arm muscle that’s gonna pull, but your whole body is going move along with that.
With that pull or with that movement to compensate both movement in one direction and stabilize that movement in ano in another direction. And when we have our body moving in ni in a nice fluid system such as the fascial system, it actually helps to minimize the amount of energy that’s utilized throughout each singular or connected movement.
Fascia protects the integrity of the body and helps prevent or minimize local stress within a specific muscle joint or a bone. For example, if you have tightness in say, one area, it the ability for the fascial network to move and to break through that tightness allows the body to minimize that local stress.
Also to absorb that localized stress and move it through the body to release that, that tension or that stress. Think of it as the Terminator, right? Think of the Terminator Revisited. I. Think of what if the Terminator was just an individual subset of parts and there was this gap filler, this structure that was stayed in, in, in the, in those empty spaces and it just
Filled the space. That’s not what fascia is. Fascia is actually what we’ve been talking about. That ability for this entire elastic contractual signaling, whole body signaling network to move the body in a very fluid dynamic and structure so we can run faster, jump higher, and be more efficient in our movements.
There are multiple types of fascia. There’s superficial fascia. That’s what’s on the surface of our body, and it’s a very loose layer. It’s very wet, and it is made up of fat. Adipose tissue collagen and elastin fibers, and that ground substance or hyaluronic acid keeps that superficial fascia nice and loose and sticky so that its job is to actually attach the superficial and horizontal planes so that you get this smooth.
Flow between the different horizontal layers so that there’s no friction or tension. Its job is more to stabilize and connect these structures, whereas deeper fascia, I. Has much more fibrous and its job is to cover the different structures, bones, muscles, nerves, and vessels, and protect ’em. So it’s job is to actually absorb contraction.
There. If the body, say for example, if you start to fall, the fascia that surrounds the different muscles and tissues will contract right before you, you fall. In order to support the muscles and contain those muscles. So the difference being that the deeper fascia is protective, it’s contracting and it holds everything together, whereas the superficial is more of a connection, so it connects the different layers together.
aLso deep fascia has receptors that signal the sensation of pain, right? You land hard when you fall, and the body absorbs that shock. Feels that sensation sends it to the brain to signal the brain that something is occurring in that particular area, and then the brain can respond accordingly. And then deep deep into the pockets or the cavities of our body.
We have the visceral and the parietal fascia, and again, these are more loose, connective air, irregular tissue. That’s sub, that has that fat and that liquid hyaluronic acid in it and its job is to surround and protect the internal organs. The visceral fascia surrounds the organs and the AAL cavity, the lungs and the heart, whereas the parietal fascia lines the wall area of the pelvis.
Now what’s interesting and what’s most relevant for the conversation that we’re having today is the relationship between what we’re calling myofascial slings. So the myofascial slings are different planes that work together to create mobility and stability. So they are dense bands, as you can see, the superficial front sling, the superficial back sling, the lateral swing, the.
Spiral and the deep front swing. They’re bands that run from the back to the front of the body, shoulder to the contralateral hip, and their job is to play an int integral role in coordinating con control, coordination and control movement sequencing, and the integration or the kinetic movement that involves the transfer of force.
From the upper to the lower aspects of the body and extremities. So think of them as the slings that support and allow movement of the body. What’s interesting for us is these slings are ve are directly related to what we call our gene gen or sinu channels. These are not the Jing low. These are the sinu or muscle channels that are described separately from the jingo.
So the Jing gin channels incorporate the Sinu channels, the channel sinus, the muscle meridians, and the muscle conduits, or tender muscular meridians. They’re found in Theen. In Theen Chapter 43. It says that whey or defensive chi is formed from food or drink. It cannot travel within the vessels, but flows between the skin and the muscles.
It circulates through the chest and remains outside of the channels and vessels. Now Ma, Chicha then takes this information and combines it with the information that’s found in chapter 13 of the Ling Shoe. He says that the connective tissue of the limbs is either muscle or sinew in Chinese medicine.
Fascia in limbs, sinus, or muscles are both called gin. Therefore, muscle gin is the muscle channels inclusive of fascia, cartilage, tendon, and ligaments. And then he says that they’re discussed in chapter 13 of the Ling Shoe called Jin Gin Channel like muscles or muscles of the channels. And then in the link shoe in chapter 13.
The reference that he’s referring to is the statement that the pathology of sinus cause pain, tightness, and fla, acidity, and even impairs movement. So again, there’s this correlation of this band that we call Jji that is specific to movement and the coordination of muscle and tendon movement within the body.
And also founded by the research of Helen l Langevin at the University of Vermont. She suggests an overlap between fascia and the traditional Chinese medicine concept of channels or collaterals. Now she combines Jing Jin and Jing Lo. But ’cause what she’s saying is that she and her colleagues notice that the insertion and the attachments of the muscles and fascia create cleavages or lines that pull like the grain of in wood.
And then she says that the, there are many acupuncture points that lie directly over that area in these fascial cleavages, where the sheets of fascia diverge to separate, surround and support the muscle bundle, similar to the deeper fascia that we’ve been referring to. And then according to Langerman, the yang chi is said to flow in those spaces between the organs, the bones, and the flesh.
Now what’s fascinating is we, as our, and when we think of our Jji channels, we have CH 12 channels, six paired channels, the Ang Sinu, the Young M Sinu, the Young Chao tie in Cha Andan Sin Channels. If you look at the trajectory of those channels, they’re very similar to the fascial slings. So you can see them in, in this image is the similarities be between them.
But then if you look at this image, you can actually see the direct correlation between the specifics of the slings and the superficial lines of the sinu channels. So you see the superficial back and the urinary bladder channels are very similar. The frontline and the stomach channel are, have overlapping similarities.
And then the deep back arm line, the small is correlates with the small intestines in new channel and the hearts in new channel. The superficial back arm line corresponds with the. Triple burner sinu and the large intestine senu channel. And then if you look in the similarities between the lateral line and the gallbladder senu channel, they’re almost identical.
And then again, through the deep front line. We see overlapping correspondences between the liver sinu channel, the kidney sinu channel, the spleen sinu, and the spleen sinu channel. And then again, lastly, the deep front arm line corresponds to the lung sinu channel and the heart sinu channel. And the superficial front arm line is very similar to the pericardium Sinu channels.
So you can see that the planes of these channels very much o overlap with one another. So when we compare the similarities between Jing, Jin, and Fascia, we see that from a conceptual and anatomical and functional perspective, there are certain parallels between the Jji and Chinese medicine and Western medicine.
And that the myofascial system can be observed in their roles as connective tissue networks that support connect and influence body movement. And even though they’re described differently in our medical frameworks, they both recognize the importance of these pathways in maintaining health, um, both in terms of structural support.
In Chinese medicine, we see them in terms of our . Our support, movement and stability of the skeletal system we see in Chinese medicine, the concept of pain and dysfunction are attributed to our blockages or imbalances in the flow of Q and blood. And we know that from our Jing Jinen meridians, they’re thought to be responsible for the smooth circulation of vital energies.
And when there’s an obstruction in the sinew channels, it can lead to musculoskeletal problems, pain, and a decreased s ability to provide support to the body. And then we see the very similarities in Western medicine and western an anatomy. Same recognition of connective tissue that envelops impacts the muscles, the organs, the blood vessels, the nerves and other structures, and that same three dimensional network or support system throughout the body.
And similarly, I. When there are obstructions or disturbances in the myofascial slings in the fascial system, it leads to musculoskeletal problems, pain, and a decreased ability to provide structural support. We also see that similarity in the ability of the Jing gin and fass that. To movement and mechanical transmission.
So the gene gin acts as a conduit for smooth flow of chi and blood throughout the body and supporting that movement. Where is in western medicine, it’s the fascia that facilitates that smooth mood and colliding action. Between the adjacent structures we see there’s this interconnection. So we see in Chinese medicine, we understand that connection between everything, that continuous flow of chi and blood through the meridians and the vessels that are believed to nourish and support the organs and the tissues.
And we also understand that blockages or imbalances in this flow lead to health problems. And then we also correlate that interconnection integration by understanding the com, the emotional component of both pain, but also trauma into those jji affecting the specific organ system separately. Although the JJI does not necessarily refer to the organ systems, we know.
That there is an interconnection and integration in all the body parts with the deeper senses of emotion in our being. And then in Western medicine they think of this interconnection and integration more in terms of movement. But again, we all recognize the emotional component of it. . And then there’s the understanding of the parallel between gin and fascia in terms of pain and the perception of pain.
So we know from our functional MRI studies in that acupuncture’s ability to influence the brain’s activity in regions associated with pain perception, motor control and mood regulation. And we know . That acupuncture has been shown to activate the release of pain relieving endorphins. By modulating these pain perceptions we can, with acupuncture, we can reduce pain, improve mobility, and ease emotional related discomfort.
The same with in Western medicine, they may not use acupuncture, but there is that innate understanding that fascia contains sensory receptors, propria receptors, and neuro. No e receptors at which contribute to the somatic sensation appropriate adoption. In our Chinese medicine, we see pain in terms of B syndrome and we, and from our understanding of the gene gym, they’re not, although they’re not related to individual organs we do know that they.
Pain itself is what flows through the concept of pain or what we call B or painful obstruction syndrome. Pain, soreness, numbness of the muscles and tend tendons and joints. Rose runs through our Jing gym and we know that acupuncture improves and accelerates that flow of QE and blood within the Jing Gen to alleviate B syndrome, ands, restore proper function.
Now, although the a Jing Jin does not have acupuncture points, those acupuncture points lie along the Jing low. But we know that the Jing Jin and the Jing Low run in parallel. So we use the Jing low points. In order to affect the Jing, Jin Meridians and classical treatment strategies will include primarily we think of the Jing well points.
We also know that there are those four meeting points that are organized, the channels, and regardless of there being an arm, a leg or re or upper or lower uh, we know that CV three. Is for the three Li in channels small intestine. 18 for the three young channels. . Stomach eight or GB 13, depending upon the source for the three young channels of the arm and gallbladder 22 for the three yin channels of the arm.
And we also have realized that those anatomical locations of these specific points are similar to the histological nodes and convergent points of different myofascial planes. So there’s a another correlation there. In terms of treatment, we generally use the ASHI points, or those are the points when you palpate someone and they go, ah, , those are our Ashi points.
trIgger points. Those are those discreet local, hyper irritable spots along a band. So although the pain may be felt in a different area, it’s the, that one trigger point is the referral pain that accompanies this musculoskeletal discomfort. Or we use motor points. And motor points are the site where the motor nerve first pierces the muscle belly.
It’s also known as the MEP of the motor nerve point. And so those are those are the points that are very, a little bit larger in diameter. They carry a greater quantity of motor and sensory sensations and so those are great points for treatment as well. Other forms of treatment include cupping, are guhan.
So let me give you an example of what I’m talking about. Here’s a case study, and this is a hypothetical case study of a 47-year-old male patient presenting with a three-year history of plantar fascitis. He complains of excruciating sharp burning pain on the soles of his feet that would come and go.
The right foot was worse than the left and the right hamstringing. Lower back sous and medial head of the gastric Venus were very tight, and then that pain and upon palpation extended to the medial head of the area of the kidney. Now the patient said that he was not aware of any other physical or digestive disturbances, but upon palpation what we find is that, or are looking at his tongue and pulse, that his pulse was wiring and deep in the both proximal positions and tongue pale with red tips.
So what does that tell us? It tells us that although we are treating. The pain it through the jji. And in our situation, given this case study, this is the T Young Sinu channel or what we call the superficial backline from a Western medical perspective. But we also can tell that from his tongue and from his pulse that he has a little bit of underlying kidney deficiency.
So we’re gonna treat the stagnation in the bladder meridian of the TA Yang Sinu channel. That’s our primary treatment. We may support the kidney treat deficiency because as Chinese medicine practitioners, we’re always looking for that under root cause, but the primary treatment. Is the stagnation and the taang sinu channel.
The treatment is to resolve that stagnation in the bladder meridian of the taang channel and then all, and then to the secondarily, we’re gonna nourish kidney chii and chi and blood of the kidneys. So these are points that we might use that would support both the Tay Young Sinu channel treatment and then supporting the underlying kidney deficiency.
And from a Western perspective, what they were gonna do is a very similar thing. So Mo you see a lot of these points. Bladder 40, 60, 56, 57. 67, 37 all are along the bladder meridian, and then we are supporting . The underlying systems with kidney six, liver three, and spleen six. But as a western medical practitioner treating the back line, what I would do is use trigger points or different types of treatments to pressure with pressure to release the that medial gastric muscle so the patient gets treated, he comes back.
A week later are reporting that a significant reduction and there’s a significant reduction in his pain along the under sole area. But he still has some tight calves and a little bit of tightness in the right hip, which would make sense by looking at both the back sling and the CNU channel. So the next two treatments.
We’re going to incorporate the following points, gallbladder 29 34, and these are designed to release the tights around the hips. Again, we’re treating that sling or that’s sin new channel. And then after three treatments, his musculoskeletal problems significantly improved and he was able to mean. Remain pain-free by regular home care treatment.
And then if he were to go for physical therapy or western treatment, they would do a similar thing. They would treat, continue to treat that medial gastric ne emus area with including the antola lateral zone of the leg and the pelvis. So you see the similarity there. With us treating the channels and then in western medical treatments, the slings.
So there’s a lot of overlap here. And again, going back to the similarities of who we are, both from Eastern West and the importance of understanding. Both the Eastern and Western I do believe that we’re in the right time right now to be able to bring the eastern western medicine together and to make a huge difference and improve the health of our patients by offering a lot more opportunity and options.
So thank you so much for today’s presentation. Thank you to the American Acupuncture Council for allowing me to be here. It’s always a pleasure. And have a wonderful day and take care of those slings. All righty, take care. Bye. .
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So today’s lecture topics are I’m going to define a neuromuscular facial condition. I’m going to talk a little bit about the theory behind a multifaceted approach, and then I will talk about submuscular needling and scalp acupuncture.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, my name’s Michelle Gillis. I am an acupuncture physician practicing in Florida, and today I am going to be speaking to you about treating neuromuscular facial conditions. This is part one of a part two presentation. First slide, please.
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So this is just a little bit about me. I am a former faculty member of the Maryland University of Integrative Health, and I am currently on the doctoral faculty at Yo Sound University, and I. I have been teaching facial acupuncture classes internationally since 2005. Here are some publications that I have completed in the Journal of Chinese Medicine.
So today’s lecture topics are I’m going to define a neuromuscular facial condition. I’m going to talk a little bit about the theory behind a multifaceted approach, and then I will talk about submuscular needling and scalp acupuncture.
So a neuromuscular facial condition is any group of disorders which can cause weakness or pain on one or both sides of your face, you might lose the ability to make facial expressions have . Pain, difficulty eating, drinking, speaking clearly. You can have ear pain, you can lose your sense of taste, smell, it can affect your eyes, your vision.
And you can also have the inability to sense heat or cold or be very sensitive to the heat or cold. What I have discovered over many years in practice is that using a multifaceted approach to treating these conditions, because some of them can be very difficult to treat, and using a multifaceted approach, can yield a more effective treatment than just using one of these modalities or the other.
Some examples of neuromuscular facial conditions is are Bell’s palsy, Ramsay Hunt syndrome, posis of the eyelids, and this can be one eyelid or both eyelids, synkinesis, which is when you’re trying to move one. Part of your face, but another part moves involuntarily. The side effects of a stroke TMJ Trigeminal Neuralgia multiple sclerosis, and there are many others I.
Part one and two of this presentation represents about an hour of what is usually a two-day class that I teach on treating neuromuscular facial conditions.
So the interesting thing about our face is that our face is the only part of our body where the skin is connected directly to the muscles, which is what gives the. Our ability to move the skin on our face without having to move any bones or ligaments or tendons. So here we have an example. We have skin, and then we have muscle.
And as you can see it, the skin is connected directly to the muscle and then down to the bone.
For example, here is a cross section of a part of the cheek, and you can see the skin and then the fat, and then the fascia and invested inside of this fascial layer is the muscle, and then there is deeper fascia and there is the facial nerve.
When treating the face, there are several things that’s, that are important and you wanna make sure you are increasing the blood flow to the area. I. Increasing the qi to the area and also if there’s any fossil adhesions that exist, that you can break these up because all of this can affect how the face moves and the sensations that we feel.
By using a technique called submuscular needling. In some instances it’s intramuscular needling, but submuscular needling can increase the flow of blood and QI to the area can help to break up any fascial adhesions. And if you are thinking in terms of . Cosmetic benefits. It can also stimulate collagen production to the area.
There are several muscles on the face, head and neck that are really conducive to this submuscular needling approach. And they are the auricular muscles, the temporalis muscle, the platysma, the masseter, the anterior digastric. The frontal, the proces, the corrugator, and the levator muscle. We are only gonna speak about a couple of those today.
And the using submuscular needling is part of this. Multifaceted approach. So in addition to Submuscular needling, we’re also going to talk today about scalp acupuncture, and then next time facial motor points, facial cupping and guha and derma rolling.
So here is another cross section of the face. And as you can see, the facial nerve is invested in this it’s called the SMA layer. It is the superficial muscular AERA system, and the nerve can become entrapped. And when that happens the signal that gets to the muscle, which in turn goes out to the skin, which moves the skin on our face, moves, the muscles in our face can become compromised.
So the first muscle I wanna talk about for Submuscular needling is the frontals and. The frontals muscle goes on either side of the eyebrows. There’s one head on one side of the eyebrow and one on the other. And what you would do is you would take, typically I do half inch needles and I would needle underneath the muscle.
And this is what it looks like here.
So when needling the frontals muscle, the way that you isolate the muscle is you ask your patient to raise their eyebrows. Go ahead and raise your eyebrows, okay? And then relax and you can find the border of the frontals muscle and the way that you needle. Is you’re going to go from the origin to the insertion.
So the origin is up here and the insertion is here.
And typically what I do is I will put in. Usually three needles
on the lateral edge, and I will put in two needles. On the medial side, and when you’re needling, what’s important is that the angle of the tube is the angle that the needle’s gonna go in. So if you go like this, it’s going to go too deep. If you go this is going to be too shallow, I use. My thumb or a finger to help to guide the needle.
So you wanna keep your fingers out of the way when you’re actually inserting. That way you can get to the correct depth right underneath the muscle. That’s the lateral side. Then you’re going to do the medial side, and usually two needles. Will suffice and I do the one side and then I do the other side and I’m using half inch needles.
You can use one inch needles depending on how big your patience forehead is.
The next muscle group. That I’m going to demonstrate for submuscular needling is the temporalis. So the frontalis is used to raise the eyebrows, and it’s also indirectly involved in raising the eyelids, the temporalis muscle, which is a large. Very thin, fan shaped muscle that’s on either side of the skull and it also goes in front of the ear.
It helps us with our chewing and it helps to, so it helps to elevate the jaw and it can be involved with conditions like TMJ. It can also cause head. Pain. If it is too tight, it can be involved in trigeminal neuralgia because nerves can become entrapped underneath the temporalis. I. And this is what this looks like.
So here’s the temporalis muscle, and what you would do is take needles and put them all around the outside of the temporalis. And I have a video for that as well.
So for the temporalis muscle. The idea is to find the outline of the muscle and it tends to be a very large muscle. It runs all the way from the back of the skull all the way around the front of the face. And you’re literally going to take the needles and you are just gonna work your way around.
The entire line of the muscle, and depending on how tolerant your patient is you can use, you can really thread like 20 of these into this area. I’m just doing a little demonstration here I want you guys to get an idea of what this looks like. And it doesn’t really matter which direction you’re going in.
What matters is that you’re getting, again, underneath the muscle and that you’re working your way all around the perimeter of the muscle in order to relax it. And they should have a nice little circle around. A muscle when you’re done, and this will really help to relax the temporalis muscle if they have TMJ.
Pretty much anything that affects the face. The temporalis muscle helps to pull the face up. I use this technique sometimes and facial rejuvenation when I teach my facial rejuvenation classes because the temporalis muscle can really lift up the face. I’m just gonna do one more again. I’m using serum one inch.
Needles. So that’s what that looks like.
So for the temper, the next. Technique that I use when I’m treating neuromuscular facial conditions is scalp acupuncture. Now, scalp acupuncture can be used and it is used traditionally to treat a multitude of. Conditions, everything from phantom pain to speech issues, to inability to move a body part.
But when I use and teach scalp acupuncture, it involves issues concerning the face. So when we when we would incorporate scalp acupuncture. We could use this in conjunction with submuscular needling or as a standalone technique, so any conditions that involve the face scalp, acupuncture can be very effective.
I. Especially when you’re dealing with a condition like trigeminal neuralgia where it’s very painful to needle directly onto someone’s face, you can use scalp acupuncture and this will treat the face without having to directly put needles in the person’s face. So here we have a cross section of the scalp.
We have the skin, we have the close connective tissue, and this is very heavily vascularized with lots of nerves. Then we have the aosis. Right below that is the loose connective tissue, and this is where you would want to insert the needle. Right below that is the perran and that is the skull. The good news is that when you’re trying to find the right depth to needle, if you just go down as deep as you can along the bone.
Then ’cause it, you, it is impossible to put an acupuncture needle through someone’s skull bone. You can needle right along the bone and if you get into the loose connective tissue, it will not be painful. If you go into the close connective tissue, you’re going through vessels and nerves, and it can be very painful.
So the thing that can be the most important thing to learn when you’re learning scalp acupuncture is how to measure. So the, you’re basically going to, these are not acupuncture points. These are areas of the. Scalp that affect different areas of the brain. And the way you measure is you’re going to get your horizontal and vertical planes, and then you will find the area of treatment based on that.
So the first landmark is from the glabella to the occipital protuberance, and the glabella is at the midpoint. Of you’re gonna get to the glabella is between the eyebrows and you’re gonna measure back to the occipital perturbance. And this will give you your line this way. And then you are going to find the midpoint, and that is the midpoint of the midline.
And if you go a half a centimeter. Behind the midpoint, that is where you’re going to be drawing a line. Right here. So you’re going to find the midpoint of the eyebrow and also go back to the occipital protuberance. And when you go back 0.5 centimeters, you’re gonna draw a line that intersects just like this, and you’re gonna break this up into three sections.
So the lower two fifths. Is this is where you would needle for concerns of the face? The upper extremities is the . Middle two fifths and then the upper one. Fifth is the lower extremities. So the lower extremities are the legs, the spine, the trunk, and the neck. And the upper extremities is just the arms and the hands.
And this bottom two fifths is the face. So this is the area that we would want to needle.
The technique for needling looks like this.
When you’re needling the scalp, it’s important to angle the needle properly so that it goes into the loose connective tissue. I like using a tube. You can freehand if you’d like, but I find that the tube helps me to guide the needle to the correct depth. I tap the needle in, remove the tube, and then I use my free hand to guide the needle
if the needle is improperly. Your patient should not feel any pain. So you’ll know that you’re into the loose connective tissue. If your patient doesn’t have any pain, when you needle, once the needle is in, you stimulate it gently for 30 seconds just like this. Or you can use electricity.
So that concludes our lecture today. So we covered Submuscular needling and we covered scalp acupuncture. Next time we are going to talk about facial motor points, facial cupping, GU Shaw, and derma rolling, and then some protocols for specific conditions. And I look forward to seeing you next time.
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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, and welcome to another episode of To The Point. I am Dr. Nell with American Acupuncture Council. Let’s go to the slides.
So today we’re gonna go over a topic that, again, every time I bring these to you guys, there seems to be a theme where many people are coming to me with these same questions. And so we’re gonna go over the idea of employment versus private practice. And so I don’t mean just employment as employment in a hospital.
We could talk about . Contract work synonymously. Really the idea we wanna dive into is the idea of growing your own business versus being a part of someone else’s business. And what are some of the pros and cons there? What are some of the considerations and things we need to go over? Why this is such an important topic to me is I have done all of these different variations of this.
I’ve done the cash practice, the insurance practice, I’ve done contract work worked in a medical facility, been part of a group practice, . There’s many different ways that you can build your career in this profession, in the clinical space, if maybe this’ll be a future one that we do. Talking about all the other different revenue streams you could potentially have, and ways that you could make impact or be employed in this industry beyond the clinical space.
But today we’re really going to hone into the clinical aspect of this. So with that, what are we thinking about today? What’s the considerations that we wanna have? We wanna talk about the risk reward ratio. . There’s nuances with that. If you’re on your own versus working for somebody else, same thing with costs.
The costs are gonna be drastically different. And even within those two different options, they’re gonna be different cost considerations, and then the benefits comparison, because of course, whatever decision we make, we always wanna be coming from. A really informed place and making decisions out of having substantial information rather than making a decision based on, oh, insurance feels complicated.
I don’t wanna deal with that. Or, I don’t know anything about owning my business, so I’m just not gonna do that. So we wanna look at what’s the benefit for us but also what are those risks, those costs, really the overall considerations that we need to have when making this informed decision. So let’s look at the risks and the rewards of both of these options.
Like I said, in that employment independent contractor piece . First and foremost, you wanna have malpractice insurance. Whether you’re working for yourself or you’re working for somebody else. You are gonna have the flexibility of how you manage risk when it comes to your own private practice.
You’re gonna have a lot of autonomy when it comes to deciding what is your environment going to look like? How am I going to control all these different variables around me? You’re not worried about, . Potentially other providers causing issues or sharing patients. If it’s you get to make the rules, right?
You also get to make decisions around what type of malpractice coverage you’re going to have. The limits. If you are working for somebody else, they are going to make a lot of these decisions. So that environment, if it’s a shared environment, you are not an autonomous entity there. I’ll give you an example.
When I first started my practice in Beverly Hills, I was sharing a medical space. So it was amazing for a new practitioner because I was in an environment with a neurologist, a chiropractor, massage therapy, Ayurvedic care nurse practitioners. Really loved that multidisciplinary approach. However, . We shared a waiting room.
We shared office staff, and even though we were all running our own businesses . When Covid happened, there were certain risks and, rules that were in place. And I got really concerned that, okay, what if these other providers aren’t following the rules? Could I get fined? Could I get in trouble?
And so there is an additional risk at having this multidisciplinary kind of space and not having that autonomy over your own space. Also, if you’re working for someone else let’s say you work at Modern Acupuncture. . They are going to determine what your limits of liability need to be. The the type of policy that you need to have.
They are going to have the setup of their physical space, right? So you are not going to have a lot of decision making power when you are working for somebody else. There are things you can do. Of course, you’re gonna be practicing clean needle technique. . You’re gonna make sure that you keep your risk as low as possible.
But at the same time, there’s only certain things that you can control when it is not your space. The rewards of that though, we’re gonna get into, and some of that has to do with the cost. So let’s look at that. It’s very interesting to me that, over 90% of acupuncturists are sole proprietors.
So running our own businesses going out on our own functioning as entrepreneurs. And yet, like 2% of our education is focused on business training and most small businesses fail within their first few years. . There is something really interesting about how that is set up and certain realities that we need to be aware of with that.
And cost is really one of those. So when you’re looking at the cost of starting your own business now, yes, we are in an industry that has pretty low overhead. We don’t need a lot of expensive equipment to get really dramatic results for patients. We need our needles, we need our basic tools. For CNT, we need a treatment table.
If you’re doing community acupuncture, you might not even need a table. You might need chairs. So there are ways to offset a lot of this cost. You can share space when you’re first practicing. You can rent a room, so you are operating as an autonomous entity, but you’re minimizing the cost of your initial investment in your practice and how that looks.
Obviously if you’re working for someone else, a lot of that might even be taken care of, that already low overhead could get even lower. So I had done an employment agreement with another acupuncturist when I was first starting, and I worked with him two days a week, but. He paid for all of the supplies.
He was, doing all of the insurance billing. He had a scheduling software that he was paying for. He had office staff, so all I was doing was showing up and treating. And so when we think about cost, we also wanna think about what does that mean? For what it’s potentially costing us as well, right?
So if you are operating in your own business, you get to determine what that fee schedule is. You get to determine what your take home from your business is going to be. Whereas if you’re working for someone else, you’ll see a lot of these jobs advertised online and sometimes it is nowhere near what you could make in private practice.
And that’s because. This entity that is employing you or contracting you is taking on not only a lot of that risk, but the cost as well. And so they have to offset that in some way. But I do really wanna talk about the benefits because this is going to look a little bit different depending on not only like what your risk tolerance is, what your interests are, what you genuinely want to spend your time doing.
So like I mentioned with private practice. You get to determine what your fee schedule is. Nobody is making that decision for you. You can do your own market research. You can say, I’m going to have a relationship based practice and I’m going to go out and make friends with other healthcare providers and make sure that I have a ton of referrals coming in and I keep my patients really happy.
You could have a FI high volume insurance practice where you are in network with a lot of companies that are essentially . Pre-qualifying people for you who are on those websites looking and saying, oh, hey, I’m interested in acupuncture. Where is there an acupuncturist in my area? So that flexibility and the autonomy that you will have in private practice is really your major benefit.
You get to make. All of the decisions that for some cannot feel like a benefit at all. Some people, and I would venture to say a lot of people in our industry did not get into this medicine to run a business. They are not interested in being entrepreneurs. That is not, top of mind. It’s that they wanna be incredibly cli, clinically competent, which most acupuncturists are who are licensed and they want to deliver incredible patient results.
And that’s what we like to do, right? The benefit of working for someone else, when you give up some of that autonomy, you get back a lot of that focus on being a clinician. So I loved at that point in my career, when I was first starting out for two days a week to be able to show up in an office and just treat and have a full schedule and never worry about recruiting patients or what the overhead was, or was my, business license renewed.
Did I pay my taxes, did I get my articles of incorporation in ? All of those things were taken off my plate as an employee as a contractor as well. Like I’m not worried about those things. I get to show up and do what I wanna do best. So when we are looking at . The benefit analysis here that is going to be highly individualized depending on who is looking at this.
I personally see so much benefit in running your own business and getting to determine what your marketing strategy’s gonna be. Who are those partners you’re going to bring in? . But a lot of people might not feel that way. I have a provider who works for me in my practice, and she is incredible.
She’s been licensed for 12 years and she, the entire time has only been interested in employment opportunities or contract work because she is very clear that she wants to spend every hour possible in her day. Focusing on patient care and treating patients, and she has absolutely no interest in running a business.
So looking at benefits that is highly individualized. There are certain things that you’re gonna say, oh hey that sounds really good to me. That will not sound good to somebody else. So just like our medicine is so highly personalized, this decision is as well. But I think the important things with this to remember are you have tons of flexibility.
. You get to decide if you want to only run your own business, if you want to work for someone else, if you wanna work with someone part-time. If you wanna have multiple locations, that is a really beautiful thing about not only the personalized aspect of care that we have, but the personalized aspect we can have with our clinical setup and the way we deliver that care.
It’s very important though to know your state laws. So for example in California it is very difficult to contract people. A lot of those laws were built around trying to protect independent contractors like Uber drivers that type of thing. And. The side effects of that have permeated into the healthcare delivery system.
And so you need to be knowledgeable about, okay, am I even allowed to have independent contractors? Am I allowed to be an independent contractor? If I’m an employee, who do I need to be employed by? Another California example you need to be employed by a professional corporation. So if you don’t, your employer doesn’t fall into that category.
They’re not supposed to be employing you as an acupuncturist in that state. So there is nuance there and workarounds for all that too. That’s where the flexibility comes in. That’s where talking to an attorney comes in. That’s where talking to me, letting me guide you and send you to the right people to help with this setup.
And the last thing I wanna end with is that. As a, not only a medical provider, but a provider of acupuncture and traditional medicine who is working in such a highly specialized area of healthcare. yoU are your business. So whether you are, presenting yourself and saying, Hey, like I have my private practice, but I also work here and I work here and I work here many times, we become the brand for our own entity.
People are drawn to you a lot of times, even more so than the medicine. People get very attached to their providers, and so while that provides a lot of . Flexibility. There’s also a ton of responsibility that goes along with that, and I think that’s, I wanna link that back to the risk management piece at the beginning that we really need to be mindful of.
Because even if we’re out there, we’re, posting on our own personal social media, we’re still representing ourselves and our business, whether we are employed or whether we are practicing independently. I love talking about these different options. I’ve been able to help a lot of providers navigate that landscape that’s my happy place.
So please feel free to reach out. We definitely have the risk management piece covered, and don’t forget to tune in next week for another episode of To The Point. Thanks for tuning in. .
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