Tag Archives: American Acupuncture Council

MENOPAUSE – The Treatment of Hot Flashes in Women

And today I’ll talk on a very unique topic of menopause, on hot flashes, but in a very, I can say, different way, or I would like to highlight different points of how we treat and the potential of treatment of acupuncture.

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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 everybody. I’m Dr. Yair Maimon, and I would like, first of all to thank the American Acupuncture Council for putting up this presentation. And today I’ll talk on a very unique topic on of menopause, on hot flashes, but in a very, I can say, different way, or I would like to highlight different points of how we treat and the potential of treatment of acupuncture.

For menopause and especially for hot blood, hot flashes. So let’s put up the slides first. Menopause. It’s to do with transformation. Al always, it’s a time of changes for women. It’s a transformation. And when we talk in Chinese medicine of transformation, it’s always something to do within any yang.

It’s always rooted in this constant transformation of matter into energy and energy into matter. Or we’ll talk about transformation of. And let’s look a little bit about the uniqueness of the way in Chinese medicine, the uru, the womb is understood. If you look at chapter 47 and chapter 33 the simple questions, you’ll see that the UREs is connected on one side with the bowel Ma, with UREs vessel to the heart, and on the other side with the bowel duress channel to the kidneys.

So immediately the UREs is between two very specific organs, the heart and the kidneys. And as the heart and the kidneys will present the water and. Or again, if we go deeper, we can say Matter and energy. And the UREs is a place of creation and of birth between fire and water, or between earth and heaven.

And fire and heart are connected to the she to the spirit, and the kidneys are connected to the jing and the meaning of these two phenomenas, the meeting of Ian Yang are creating. New life, a new possibility of life. So Duru in this way is perceived in a very deep way of connecting heaven, an earth of connecting the heart and the kidneys, and It’s very much related to the earth in Chinese medicine, but also to this two organs which are heart and kidney.

And it means also when we are utilizing acupuncture points, and especially later when we look at some research on hot flashes. So there’ll be some points related to the heart. Like heart seven, the low point of the heart, peric heart seven. And if you look at the kidneys blood at 23, that tonifies the kidney, Kidney three, which is the again, the source points, the un point of the kidney.

So we see all this un points of the. Perricone heart and kidneys and splint six, which is more related to the earth where all the in channels are crossing, and again, has a very closed link to the lower jaw and to dure. So this actually took this points. It’s very common pins, but they’re also been used in research, which I would like later to present, but.

This is another way to show the logic of Chinese medicine, of connecting the fire and the water, the heart and the kidney, and enhancing the, and reducing also side effects of menopausal changes. So menopause, it’s always this movement of transformation of in and young. And we know the cycling woman of every seven years of the cycle in around 49 is the menopause time.

By the way, the premenopause starts much earlier. So many symptoms can be much earlier than the menopause itself. In this lecture, I’m not going to talk on the, about the natural kind of menopausal symptoms and occurrence of symptoms, but more on menopausal symptoms and especially hot flashes which are occurring due to anti hormonal medicine.

Anti hormonal medicine is given. To women who had cancer, and especially cancer, which is sensitive. There is receptors on the cancer cells themselves, which are sensitive to estrogen. And then the treatment is anti-estrogen treatment, especially in different cancers, either gynecological cancer in very common breast.

So endocrine therapy in western medicine applies this anti hormonal medicine, and because the tumors that are hormone related, the, if there is more presence of hormones in the body, there is more tumor growth. So this is the very common, as a saying, breast cancer and in several gynecological cancer.

There’s two major ways of an of endocrine treatment. One is to block the receptors on the cells themself to estrogen. The other one is to stop the production of estrogen. This is a very common treatments like tamoxifen. If you see on the cells, there’s the receptors for estrogen. And the tamoxifen mimic or has affinity in binds to the surface of the cell and therefore the estrogen cannot bind to it and therefore start the growth of especially mutated cancer cells.

So this is the kind of competition idea. It binds to the receptors in the cells, so the oxen and the other one is aromatase inhibitors. The estrogens in order to become estrogen, they’re going through different pathway of changes. One of them is the aromats and when DITs is inhibit, then there’s no production of estrogen.

There’s different ways to block the production of estrogen. This is the very common one with aromatase inhibitor. The bottom line is very similar, is producing in women who are taking anti hormonal medicine. Many side effects of menopause due to this medicines. There’s many common side effects for women who are receiving endocrine therapy.

I, I s. Put here the most common one, like fatigue, hot flashes is a big one. Mood swing, insomnia, sometimes even disturbance in concentration and depression. And there is a whole list of symptoms of menopausal symptoms, which are reduced by the endocrine therapy. This medicines are taken for long time, five years, sometimes for 10.

And many women stop almost 30% are stopping. Sometimes the treatment, even though it can be very useful for them because of the side effects, but acupuncture, Has been shown and there is evidence that it’s extremely effective treatment to reduce side effects, especially hot flashes and joint pain.

In this presentation, I want to talk a little bit about the evidence that we have for acupuncture, reducing the hot flashes, but also enhancing general better wellbeing in this woman. One of the early studies, but still I think one of the very Inspiring studies was head to head study. Women breast cancer women are taking anti hormonal medicine.

Were divided into group two groups. One was receiving acupuncture and the other one was receiving venlafaxine, which is like s nri. It’s really, it’s a light antidepressant drug, but it has also the it reduces also hot flashes, so it’s commonly used also for hot flash. And they measured the outcome.

They gave a certain 12 weeks of treatment. Then the treatment stops both the. Hormonal. They, I had avela vaccine, so both the medicine and the acupuncture was stopped after 12 weeks. After three months, the women didn’t receive any other treatment, and then they looked at the outcome even one year later.

And the acupuncture group did extremely well and the. Obviously you’ll see the Venlo vaccine. As you stop the, as the women stop the medicine the effect was quite immediately reduced and hot flashes were back. You’re welcome to read the full study. I’m just giving some highlights.

So as the results, you can see that both group exhibits significant decrease in hot flashes, depressive symptoms, and other quality of life symptoms. But in the acupuncture group it was the same for the acupuncture in the Vela vaccine. But by two weeks after stopping the treatments, the Vela vaccine group had significant increase in hot flashes where the hot flashes in the acupuncture group remained very low.

So this is very important because we are showing the effect of acupuncture. As a, something that enhances the ability of the body to, to bring itself back to balance. So we are really talking about the quality of the healing qualities of acupuncture which is lacking when you treat sometimes symptomatically, like in this.

And also in the Vela vaccine, it’s also very commonly known as Vix had many adverse effects. There was those in dry mouse dizziness and anxiety with acupuncture group. The opposite. There was no negative effect, but actually there was some additional benefit, even increasing sex drive in some women. And most of them reported improvement in their energy, clarity of thoughts and sense of wellbeing.

So the acupuncture group, No side effects is opposite. Had other benefits comparing to the group that took the vela vaccine? So in conclusion to this research, the acupuncture appears to be equivalent drug to therapy in this patients. But it is safe, effective, it’s a durable for vaso matter.

Vasomotor is this hotline, flashes and secondary for long term is also. Long term use of estrogen and anti hermon estrogen use. The points that they used in this research were quite interesting. So the main points you can see, and I mentioned them before, was bladder 23, kidney three in spleen six. So strengthening the kidney and in enhanced also the all the in channels and the spleen.

And this is the point that. All of the practitioner news, and then there were secondary points that can be a according to TM diagnosis. So the practitioners had some kind of freedom to choose which points are the most beneficial for the patient so they could do a diagnosis, Chinese medicine diagnosis and be more.

Exact on what’s going on with the patient. So if it was more heat and young, they couldn’t do 14 or do 20 with The 14 especially can reduce a lot of heat and especially if the heat goes up to the upper parts of the body. If those cheat deficiency like fatigue, stomach 36, ran six, lung nine, and if there was more disturbances at night Dreams, sleep disturbances goldbar 20 and leave it.

Or more agitation. By the way, many menopausal symptoms are to do with more blood stagnation agitation and if it was more to address the she than per card seven and heart seven. And this is the points we discussed before, and it was for 12 weeks. So four weeks, it was twice a week, and then another eight weeks, once a week treatment.

So the total treatment was for 16 weeks. And I would like to present another research, a larger research with 190 women and they received 10 acupuncture treatment session. And again, both of this research was published in the Journal of Clinical Oncology. It’s a very reputable journal. So it’s in science, it’s not just what you publish, but where you publish it.

So publishing in such a journal has a lot of or additional weight to it. And especially if if you want to present a acupuncture evidence to oncologists or to the medical team, it’s good to quote high reputable journals such as the Journal of Clinical. So this also had a 10 acupuncture session.

So this group was doing as you will see, the choice of diagnosis and points was a bit more diverse than the first research. And this. Quite a few research on that topic I’m just presenting to, and they also followed up for three months and six months post-treatment visits. In both cases, we see its, and this uniqueness that it’s not just the treatment itself, but also when the treatment stops, we can still.

Even half a year and a year later, the effects of treatment. Cause many patients usually ask me, how long, do I need to come for acupuncture? Is it like a life thing? So I say, no. If you’ll come for a series of treatments, then the benefit. Should last long to me actually for many years. Because if the acupuncture was accurate in the diagnosis was good, it has an effect, which is a long term effect.

So again, here, the conclusion that acupuncture is effective integrity intervention which the quality of life and hot flashes for these women they use the much more elaborated. And actually, that’s what I love about this research. A real TCM diagnosis and Chinese medicine is a medicine we don’t just use points per condition, but we are trying to do a deeper diagnosis, understand better.

And different women will have hot flashes depending also on their The condition they came with. So if they came with more in deficiency, there’ll be more the hot flashes on and the quality of life impairment, your de deficiency. So there was a set of points, and here they actually looked at the percentage of the diagnosis.

16% of the women was diagnosed with kidney deficiency. I just highlighted the kidney points like 6, 3, 7, and 10 that they could choose. But obviously also you see here heart six, which is very good for heart and kidney in deficiency if it’s kidney in and young deficiency. Or kidney, liver in deficiency with some young rising then again will be different points.

So there’ll be still the kidney six, Percu seven as a kind. Major points to balance the kidney and percu of fire and water. But we’ll see here additional points like liver three and gold bladder 20 and maybe combination of liver three and large intestine four will to move the stagnation and enhance better levy and liver.

Two to reduce heat from the liver. So you see the point combination here is a different, Oh, sorry. Has a different dynamic including lung seven and kidney six, which is the opening the remi, the channel in front of the body, which is responsible for all the in. And then if it’s kidney and heart disharmony particularly, then you will see this group of points.

There’ll be more kidney points from kidney six to kidney two. Kidney two is one of the interesting points that can take back the heat into the kidneys and enhance the kidneys. So it’s not just reduces heat, but also enhances the kidney young. And additional point we’ll see per card six, hard six, the hard six that we discuss for the in of the heart.

And Percu six with each additional ability also to be the main point of the, in way my balancing all the in. In the body and enhancing the heart womb kind of balance. So also hormonally there will be much more enhancement in, in, in using this points. And additionally in this group, many other points that are to do with enhancing kidney and also relaxing points like on the du mind, CV 15, because the heart is so much involved.

And as you can see, there’s 10% in. Of patients in this group were 36%. So you see most of the patients were of kidney and liver in deficiency, so they were more coming from this group from Flame Studies, Flame of Chita. There were still, it’s very different diagnosis. You’ll see that we’ll have some other points like Stomach 40, splint 10.

So more looking at this dynamic of a phlegm and cheese stagnation additionally to kidney and hard points. And blood stuff is, interestingly enough, there was none in this group, but still in clinic in the when we look at the symptoms, sometimes the symptom. Is also very common and seen commonly.

When we I would like to say that one of my passions is to teach the treatments of cancer patients and especially to treat oncology, acupuncture. And we do a very extensive course at the TCM Academy, and the idea is to teach and give. Tools, but also the skills and the competencies to treat cancer patients and especially cancer patients who are having side effects.

And we combine the three pillars of Western medicine, Chinese medicine, and research and evidence base. Cause when we combine this three pillars, I think then there is a. Clearer understanding both of the sys, the symptom, the ability to communicate with the patients, and the also the medical team that is working with the patients.

And in cancer, it is extremely effective. Extremely effective, but extremely important to understand both the Western medicine and the Chinese medicine differentiation, which. Very relevant to cancer patients. So if you want to know more, you can check up at the TCM Academy website. And this is this extensive oncology acupuncture program which covers, There’s also in the website Ava free stuff, but covers also other ideas like pain, nausea, vomiting, fatigue, and other components which are has so much.

To treat cancer patient and to treat the side effects. So I hope you learned something about the treatment of hot flashes, evidence based behind it. And with this slide I want to wish you all the best of health and from Chantel. She thank you very much for listening and being with us, and again, I would like to thank the American Acupuncture Council for putting this up.

So all the best and thank you so much.

How to Transition to a Cash-Based Practice

thinking about transitioning to a cash based practice so that you could just focus on helping your patient instead of figuring out what codes and how to jump through hoops, and then you’re in the right place.

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If you are tired of dealing with the hassle of insurance, the paperwork, the, it’s taking too long to get reimbursed, sometimes even insurance companies saying that you have to jump through these hoops and even taking your reimbursement back. and you’ve been thinking about transitioning to a cash based practice so that you could just focus on helping your patient instead of figuring out what codes and how to jump through hoops, and then you’re in the right place.

But how this is Chen and your six and seven figure practice makeover mentor@introvertedvisionary.com and your host for the AAC show today. And today we’re gonna talk about. Just from having a lot of experience with helping our acupuncturists and other holistic health practitioner clients transition from an insurance based practice to cash-based practice, I’m gonna share with you some pearls of what has helped our clients with that transition well, so that you can apply if you’re thinking about transitioning to cash based practice or already planning on doing so.

So the, there a couple things in terms of. Certainly. Let’s first talk about some benefits of cash based practice, and then let’s also have a look at some of the biggest challenges to transitioning and what to do about it. So some of the benefits are that you don’t end up having this waiting period.

You could get paid right away. Also, you don’t have to have either yourself spend time on this admin stuff or having to hire a biller or someone to chase after claims and different things like that. No more cat and mouse kind of game, right? so many benefits of, or being able to, to transition, but what are some of the.

The challenges to to transitioning that I often see, So one of the things that I hear is that but if they’re used to paying for insurance, then once I transition to cash, then they’re not going to be staying or that I want to still be affordable. And by the way, in terms of if your patients are used to paying for insurance and you’re afraid that they’re, they won’t end up continuing to work with you.

I’m going to share with you a couple of practical tips that will help you with this. But the most important thing is if you have a way of attracting new patients in the door, even if you some patient. Don’t end up staying with you, you will still have a patient flow of of new patients willing to pay cash if you know what you’re doing.

And then as far as the concern about, I want to still be affordable. So I think it’s very important for you to be in alignment with your own practice philosophy and if there are still reasons where you really want to accept insurance and keep doing that, but there’s still. But some of the shortfalls of that is you may need to see a higher volume of patients in order to be sustainable in your practice.

Or you need to hire or things out like billing or have higher expenses related to that or your time insanity, right? So there’s a trade off with that. So it’s just a matter of you choosing what’s most in alignment for you and then. If you’re not liking it, explore other options like transitioning to cash’s practice.

But some of the other things that I hear are, But what about the economy? So even during the start of the pandemic and when people were freaking out and being concerned about how, I’m not working right now and not making money, things like that. In, in terms of potential patients in that situation, even during the start of the.

When potential patients might have been in that situation or there was just this fear about things there were still acupuncturists who were doing just fine with cash based practices. In fact, some of our clients who are, were completely cash based, were doing great during even the start of the pandemic, during the pandemic and even, and also now as well too.

There’s always a, at any economy, there are people who have the ability to pay cash there. Are there gonna be people who may not be able to afford it? That might be true, but there are always, in any economy, even if there’s a recession, there’s always people. Who are able to and willing to and open to paying cash and interested in seeing you in your cash based practice.

It’s just a matter of being clear about the who you would really like to be helping. So let me share with you three tips to transitioning to a cash-based practice. And I feel like the very first one, Is very key. When I, when you hear me say it, you’re gonna think, Oh yeah, I know that.

And then you might think, Oh, I’ll just skip a scope, but what about the next one? And and yet I feel like this one that I’m about to share with you is one of the reasons why a lot of acupuncturists don’t do it is just mainly because of this main reason. And is the distinction between those who don’t do it and who do it.

What’s the distinction? is being really confident in your abilities as an acupuncturist and in that you’re totally worth, people paying you even if it were cash based practice. So when you are able to show up from that place of confidence and that sense of where you are really the expert. and a both in the knowingness that you’re an expert and in that you are good with your clinical skills, then it’ll make it an easier transition to you having a cash based practice if you’re still feeling like you’re.

Not that good clinically or you are, You have a lot of fear coming up around this then in terms of how to transition, then maybe it’s not time to do it yet. You really owning that energetically is going to be the key to everything else I’m gonna share with you beyond this as well. . And then the second thing is and also I was gonna mention related to the first thing, cuz otherwise how come there are acupuncturists and other holistic practitioners we’ve helped who’ve come straight out of school, they’re totally fresh grads and they start off with a cash based practice.

In fact I have a, an acupuncturist client who just did that in the last two months and she is at 12 patients a week, and she could be seeing more actually. But she does go and goes to where they, the her patients are. So she’s more limited with being able to travel and that kind of thing.

That’s her preference right now. But There, otherwise she has the capacity to see more, and she has a hundred percent cash based practice straight outta the school. People are totally happy to pay it. So why is it that, that some fresh grads can do that, but then some acupuncturists are have been in practice for 20 years and are still afraid that if they were to transition to a cash based practice and then people won’t, will stop coming.

So that’s why this confidence factor and you really owning that your expertise makes a big difference. So then the second thing is to carve out your differentiating factor and what is your differentiating factor? What’s your specialty? By the way, specialty doesn’t mean that you always have to focus on.

One particular kind of health issue or anything like that. It’s just really looking at what differentiates you and how can you help people see that you are the one to go to, whether it’s in your community, whether it’s for a particular kind of a health issue that you’re the go-to person to go to, whether it’s for a certain kind of patient experience too.

So have you ever thought about that? What is your differentiating factor? Of your practice that makes your practice the experience of a patient coming through your clinic different than the experience of other people going to other acupuncturists. And if the reason for that is it’s either unique or it’s very, Like it’s something that people really want then, and you also are able to communicate that in such a way that people feel like, Oh, I just have to go see her, or I have to go see him.

Then you it’ll make it a lot easier for you to transition into cash base practice. And they’re not just comparing you like, Oh wait, but my insurance covers this. They’re feeling like I just need to see you. And so this could. Also there, there could be, as I mentioned, it could either be that you become, decide to really carve out like this, I’m the go-to acupuncturist for particular health issues.

Or it could be the patient experience whether it’s like you can always get seen within x number of hours. Maybe that’s your differentiating factor, right? That maybe it could be that they don’t have to travel, that you go to them. Maybe it could be that you are the, you’re just the go-to acupuncturist within this kind of, this vicinity in, in, in the area.

So it could also be how you showcase your credibility factor. So one of our clients who has a cash based practice, Whenever someone would call at her front desk and then they weren’t really sure if they cuz yeah, they weren’t really sure if they wanted to book with her. One of the things that her receptionist says before they hang up the phone is, go check out all our five star reviews on Google.

So that’s an example of where a contributing factor to your credibility factor. So how clearly are you showcasing your credibility in whether ways like reviews or in how you describe your clinic and how it’s different or in how you’d describe your story and journey and your expertise. Those are all aspects that make up your credibility factor.

That’s really important to help you with transition more seamlessly. And then the third key to transitioning to a cash based practice smoothly is having a way of explaining to people in such a way that, that they they like they’re totally willing to pay cash, right? So where you are able to be prepared with what to say.

To and the right visuals that support it too. So when we work with our clients and get a few key visuals in place and then make the transition, the patients, the existing patients also are able to. Not only like verbally hear it from you or experience from you about how you’re like the person they wanna still keep seeing, but also what’s happening in terms of what do they see on your walls?

What do they see in what you give to them that makes them just see this clinic, or see you as an acupuncturist as this is the place I still need to go to because. , there’s nobody else who does it like this, right? So do you have visuals in place that really differentiate your practice?

And I found that when we get these in place with, in working with our clients, it makes a huge difference in transitioning to cash based practice. Now, the fourth thing, a bonus tip here is. , you can also consider offering other kinds of products or services too that can help support cash flow in the practice as well.

So these could be either additional streams of income related to supplements, herbs, or there could be products that you feel like are beneficial for your patients or even just a lay public. It could be ancillary services, whether it’s, for example, an acupuncturist client of ours is doing point injection therapy and she end.

Making additional income stream by adding that on top of the acupuncture treatments. We have clients also offering other types of anular services that are in alignment with the rest of their practice, whether it might be microneedling or it might be having other practitioners in the clinic like are doing, fertility clinic and offering our Vigo massage.

And then there are also. Opportunities for, even things that don’t require your time. For example, maybe they’re, you feel like foot baths or sauna is great. Ionic fit foot baths or saunas or, that kind of thing that you end up having at the clinic, which can also help support your patients and cash flow.

And that can also. Be helpful as you’re transitioning to cash based practice, although for most of our clients in that timeframe of transitioning focusing on one main thing, which is about. Being able to have good communication with your existing patients so that it’s a seamless transition and that most of your patients do end up staying with you is the most important thing to focus on.

And then also with bring in new patients that are willing to pay cash and this is what it is. So some of, sometimes acupuncturists tell me they’re like But I’m still a little afraid that if I go all cash then I’m just not gonna have enough patience because that’s just how it was.

And how I, I used to track people through insurance companies. And so part of it in looking at this is by thinking about this, it’s like radio weights. If you are sending certain radio signals at at a frequency, let’s say it’s like 89.5, right? Is what you’ve been sending radio waves at for insurance, then you’re gonna keep attracting the insurance patients because of what you’re doing.

But if we just tune your frequency to 94. Nine . And then your, all your communication, all your messaging, all your radio waves are all about that, whether it’s in what you say, what people see also in your marketing and your communications with, then you’re attracting a different kind.

Of patient who is at that different wavelength. And so that’s what we need to get in place. And then you will be able to feel really comfortable with transitioning to cash based practice. And it doesn’t have to be hard, It doesn’t have to feel like you, you just, you keep putting it off until you get so.

Frustrated by having to deal with the headaches of insurance or having to stay late. For example, I know an acupuncturist who has a busy insurance based practice, he stays late every day to do charting and then and billing related stuff. His family’s not really seeing him like he has kids, and his wife is when are you gonna come home Earlier?

Because you’re missing your kids growing up, right? So you know, you don’t need to wait till it hits that point, because once it hits that point, you’re already burnt out. And then wanting to transition is just not as good of a place to be. So why not be able to plan ahead and then. Especially at the start of the year, it’s oh, is this a really good time to actually transition?

It is one of the moments of start of the new year. So new things on new practice, new you, new energy, right? In terms of, or evolution and reinvention. So if you are in a place where you would like help with transitioning to cash based practice, or if you would just like free six and seven figure practice makeover tips that can help support the growth of your practice so that you could grow with less stress and have a practice that you’re proud of, then go to introverted visionary.com, then go to introverted visionary.com and look around or book a free chat with us and happy to help you further.

Till next time.

Treating Facial Wrinkles with Intradermal Needling

And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started.

Click here to download the transcript.

Hi, my name is Dr. Shelly Goldstein. Welcome to the American Acupuncture Council. Thank you so much for having me here today. And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started. We think of wrinkles on our face and we think of them as just wrinkles.

But in fact, there are many, types of wrinkles on the face, and they come from many different sources. We can get wrinkles from. Bone changes and over time, all of these changes occur on many different levels. So from the deepest level bone, as we age, bone resource, or starts to break down, bone is the underlying structure of our face.

And so when the bone starts to break down, so do the overlaying structures, including the skin or the surface, which is where the wrinkles. We can get wrinkles from muscle changes over time. We say muscles attenuate, which means they, they get stiff and stagnant and then they create different peaks and values increases in the face.

We can get wrinkles from fat changes. Over time, fat starts to break down and move primarily into the nasal labial fold, or that fold between the edge of the nose and the corner of the mouth and accentuates different types of wrinkling. And then of course, all of those wrinkles show up on the skin. So on top of the wrinkles that occur from the skin level.

Are those deeper wrinkles? So today we’re gonna focus on the wrinkles that we see that appear on the skin from skin changes. The skin is part of the Anta system. The anta system consists of that fat layer, the subcutaneous of the hypodermis. And then on top of that is, Dermal layer, which is the true health of the skin.

Skin cells start at the bottom of the dermis, make their way up to the epidermis, above the dermis, and then they float to the top and they come off. So the true health of the skin and the visible health of the skin reside in the epidermis and the dermal layer, and that is the layer that we’re going to talk about when we talk about intradermal needling.

Intradermal needling is one of many different types of needlings that occur when you go get an injection or a hypodermic shot if they go into the muscle. It’s called intramuscular need. If it’s at the slide slightly into the, that subcutaneous level that’s called subcutaneous needling, intravenous, lev needling goes right into the bloodstream, and then there is the intradermal needling, which goes between the.

Into the dermal layer. So we see on needling too deep is that it misses that middle dermis layer. If you needle too shallow, it stays too superficial at the epidermal level into, if it’s inserted properly, it goes into the dermis and you can actually see it creates a little swelling at the surface.

And that’s how you know if you are into the intradermal needling because you can actually see the surface of the skin popping. Why, intradermal needling into the dermal layer? What’s going on? Basically, and in a nutshell, we’re working in the connective tissue portion of the dermal layer. There are two types of connective tissue in the dermal layer of the tissue.

There’s the papillary layer. Which is that loose mesh work that we can see on the right, and this primarily provides the nutrients to the skin, and then there’s the rec particular level below, which is much thicker, and it provides the density of the tissue or density of that layer, the structure of that layer.

When we think about connective tissue, what are we talking about? The primary components that make up connective tissue are collagen. Collagen is the support system. It’s like the mattress that you lie on. It’s the firm structure that has enough balance in it to allow you to lie comfortably. But it also.

Has enough resilience and tension so that you have support. That’s collagen. It’s the mattress of the germal layer of the tissue and the mattress of connective tissue. In addition to connective tissue and collagen, we have elastic fibers. And as you can see in this slide, it’s a very thin vertical.

Structure and that’s gonna allow the snap or the ability for that dermal or the connective tissue to bounce back. So you lie on the mattress, it sinks in, you get up, it pops back up, and that’s due to the elastin fiber within the connect. Tissue and then also in the connective tissue. We have fibroblast cells.

And fibroblast cells are what stimulate the production of collagen, and then we, It’s all embedded in this aqueous solution of hyaluronic acid. And hyaluronic acid provides the moisture and the ability for cells to float around and receive the nutrients that they need to grow healthy. It’s also what keeps our skin nice and hydrated and moist.

Now as we age, what happens? We age, we start to lose the ability for the cells to mo migrate from the base of the germal layer up through the epidermis, and they lose their vitality. We start to lose the integrity of the collagen and the elastin in those layers. They begin to get disorganized or not line up properly.

We start to lose the VAs, the blood vessels that iva that area and nourish the, area as well. When all of this happens, we start to lose that plumpness, the plumpness of the. The connective tissue and the dermal layer itself. When it starts to, when we lose the integrity of that it starts to dry out, we start losing hyaluronic acid in within that area.

And then we start to see not only as it dries out, but that dermal layer in that epidermal layer start to thin and separate. Creates more dryness. And then as we lose that suppleness of disorganization of collagen, an elastin, we start to see pitting. And you can actually see in this image, you can see the surface of the skin starting to pit.

Sometimes we call that wrinkle. Sometimes we call it skin pitting. For our purposes, There are multiple types of wrinkles. There are fine lines are primarily due. They’re not wrinkles. They’re due to the loss of hyaluronic acid in the tissue or dehydration. And the key is to just drink more water.

We are apply more hyaluronic acid or hydration to the surface of your skin. For our purposes, we are going to look today at shallow wrinkles. Shallow wrinkles, you’ll see in a moment are very superficial wrinkles. When the collagen starts to move up and down, or the elastin starts to snap back we, lose the creases.

So the creases come when we’re activating our muscles or textures of the skin, and then they relax as they, as the shallow wrinkles become more sedentary, they move into deep wrinkle. And this is when we are actually start to see changes in the architecture and integrity of collagen in the skin tissue and, also lattin so it becomes more visible when the faces at Russ and then static wrinkles are are a different type of wrinkle.

They’re actually. Deep wrinkles that have been around for a while. And in this situation actually starts to create damage into the tissue via the loss of elasticity within an elastin within that skin tissue. And then again, this too is visible at when the faces rest. And then we have dynamic wrinkles.

And these have more to do with muscle as opposed to skin create, although they may. Static wrinkles and deep wrinkles and cello wrinkles. When you treat dynamic wrinkles, you actually have to treat the muscle as opposed to the skin. So here’s an example. Here’s shallow wrinkles are on the left. And as you can see in this image, the person on the left or the figure on the left is probably in her thirties.

The middle is probably in there, her fifties and sixties. And then the on the right is, older. Most shallow wrinkles occur earlier in. And as you can see, say particularly in this image starting at the nasal labial full dot full between the edge of the nose and the corner of the Mac, you start to see the creasing there.

You’ll start to see it in between the eyebrows, Ella creasing, and possibly across the forehead. As they move into deeper wrinkles, you can start to see the changes of the architectural changes in the face. You can start to see a deeper creasing between the eyebrows, the nasal labial, fo maybe around the mouth, starting to see a change in the mental crease, which is between.

The chin and the lower lips and the marionette lines, which are between the corner of the mouth and the jaw area. And then as they move into more static wrinkles, they create a number of changes in the architecture of the face. And you can see the visible difference here. In fact, it’s just a progression from left to right and most of it has to do with age and lifestyle.

And diet. What’s interesting about needling at different layers of the tissue, particularly at the epidermal level and the germal level, is the references to it that we’ve seen in the classics, notably the ling shoe over time. In the classics, they talk about numerous, there are numerous discussions about needling guidelines specific to the layers of the face, the skin, the flesh.

The channels around the muscles, and then at the layer of the bone. So there are constant references throughout time about different ways and the importance of kneeling at all of those different levels. Also in the Ling shoe, in chapter one, it says The skin, the flesh, the muscles, the tendons and the meridians occupy different places in the body and that different diseases respond to different methods of treatment.

In chapter seven, it talks about the illnesses. If illness is superficial and needling is deep, it will penetrate and injure the good flesh. If illness is deep and needling is superficial, results will not be obtained. So again, there’s the references to the changes, the importance of needling at different different layers, and then the results that can be obtained when properly kneeling into those different levels.

Intradermal needles is superficial needling, obviously, and it’s sim very similar to Japanese needling technique. We know in Japanese needling technique that the insertion is superficial, that the manipulation, if there is any manipulation occurs at the surface of the skin. We’re not needling for Dutch.

And the needle gauges. The needles themselves are different. They’re very thin, and the length varies, say between a very short needle and say a 30 millimeter, which is like an inch long. When we are needling for the purpose of intradermal needling, what’s going on? There are multiple theories as to why this works.

One that’s the most popular and actually the foundation of say Derma rolling or microneedling, is the fact that when you insert a needle into the surface of the skin, it actually creates a little wound. Wound healing results. When you put something in or you damage the surface of the skin fibroblasts, circle that area and immediately start to stimulate the production of collagen and elastin within that tissue to actually heal the wound from the inside.

This was what we called a wound healing cascade, and which case again? We insert the needle, it creates a micro damage into the surface of the skin or under the surface of the skin. Fibroblasts come in, they stimulate the production of collagen. Collagen starts to line up, as well as elastin into the dermal layer of the skin.

And you can actually see in this image, In the first image, you see where the damage was created, and then you start to see the abundance of fibroblasts building collagen and elastin at the dermal and epidermal layer to start to thicken and to heal this microtrauma. Another theory is in doing so, what we’re doing is actually enhancing not just the collagen, but also the elasticity as well.

So we’re building collagen, building elastin under the skin, stimulated by the trauma that was created by inserting a needle into the surface of the skin. And there’s also something else that’s going on, and that’s called Paso Electric. Collagen is the primary component in connective tissue, which we just learned, and it also is capable of transmitting electrical signals throughout the bottom.

So it has an electric energy, call it, she call it electro Paso. Call it whatever you want, but it creates a vibration or an electricity. that then signals throughout surrounding area. And it’s both mechanical. So inserting in the needle stimulates this Paso electricity. It creates both the mechanical and electrical properties that vibrate out into the surface and connect with other systems.

So when. Insert the needle as a form of an external influence. The electrical current in that tissue created by the collagen radiates out into neighboring structure. It’s a, it’s somewhat the foundation of acupuncture in our culture is creating some type of an energetic that then spreads, not just stays at the center where we’re need.

It begins to spread out throughout surrounding tissue. And in our world, the meridians that, that connected these points. So we need and put the needle in. Intradermal needling, it stimulates that wound healing cascade. It excites that collagen Paso electricity. And it also releases fascial tension, which is the tension that is created by holding that tissue in this stagnant place now for so long.

The slide in this presentation or in this PowerPoint is histological slide. So they take pieces of skin or where there are wrinkles, they put ’em on the slide and, they put them they put a little piece of glass on top of it and they slide it under a microscope and, then you actually get an, a larger image or a magnified image of what’s going on.

So here we see a wrinkle. And it looks like a little divot like this. This is another slide. The wrinkle is actually very, shallow. This would be considered a shallow wrinkle. This is very minor or more minimal wrinkle, moving into a deeper wrinkle. Here’s a deeper wrinkle. You can see it’s not just a, dip or, but more of a plummet, a little deep area.

So that’s a different kind of wrinkle. So as you can see, we’re going to see all different types of wrinkles, and we’re gonna needle them differently as well, depending upon the. The, wrinkle itself. So we can’t really look at a magnifying glass in our practice. We’re not gonna take a slide and put it under my magnifying glass.

So you have to start to train your eye to see what does a wrinkle look like? Is it very shallow? Does it look a little bit deeper? Does it look like it’s petted? And then we’re going to decide how to needle it, and we’re gonna decide which type of needles to. Most of the intradermal needles today are either the straight intradermal needles, the Japanese one, or the press tax.

And they’re good. They don’t give you a lot of flexibility if you, they’re very tiny. You have to use a pair of tweezers if you’re using an intradermal needle and just slide it in. And you get a very short distance of, being able of insertion the press tax. There’s only one way to needle it and it’s down.

So that is somewhat limiting. EUS is a new serum needle and I think it’s a really good needle, and it’s ones that I choose to use. They’re stainless steel needles. They’re triple polished. They’re similar to serum needles. They’re high. The, quality of them is great. They come in a bolt pack of four.

They’re really easy to use and they’re a little bit longer. Some, they range between they’re all about seven millimeters, but then the thickness of them is varies. Different sizes. So depending upon the type of needle you choose you can affect different types of wrinkles. All of them work. It’s just a matter of personal preference.

So I’m gonna show you these slides. So this is a shallow wrinkle, which means it’s going to show up and then disappear. So when the model lifts her eyebrows and cringes her forehead, then you’re gonna start to see them. And I’ve actually had her do this in this image. And so we’re gonna look at these needles.

It’s pretty good. It’s a little blurry, but basically she doesn’t have a lot of wrinkles. And the wrinkles that she does have moose. One way to find out whether it’s a shallow wrinkle list, actually, to have your patient lift their eyebrows, drop them further eyebrows, and see what stays, and see what goes away.

So in this situation, what I’m gonna do is I’m actually gonna spread. The tissue and needle very shallowly into the needle. So in this situation, when you’re spreading the needle it’s a very shallow insertion at the upper level of the dermal level. You open the wrinkle, slide the needle into the surface, and you can line them up because most of these are fairly long needles.

So this is a good technique to use if you’re doing, if you’re treating a very shallow. Let’s see. This is more of a deeper ecstatic wrinkle, and this is the nasal labial fold right here. It’s the different, it’s from the corner of the nose to the sock corner of the mouth. A lot of it has to do with tissue that has fat that has moved down, or gravity muscle attenuation.

Has some effect in it. But in this situation, you’re gonna actually treat the wrinkle itself. Now, it’s hard to spread this because it’s a deeper wrinkle and it’s static. You can see it, it will stay there whether the person is smiling or frowning or either or making any other muscle expression. So rather than trying to spread this, wrinkle, what you’re gonna do is you’re gonna actually grab.

Like this and pinch, and then slide the needle into the crease. So let’s take a look at this. So I’m pinching, it, and slide. Okay. I’ll show you. This is a closer version of it. This is a, and it’s a little bit blurry, but I think you get the image. You’re gonna pinch and slide. Okay. It takes little practice.

It’s almost as if you want to take that area, start further out, pinch it, and let’s do this one more time so that you can see it. You’re pinching, you’re starting f pretty far out. In order to pop it, pop the tissue up so that the only thing that you can actually see is the wrinkle. Perfect. Let’s keep going.

Okay. Now, we’re gonna talk about deep wrinkles for a moment. On top of the changes of the architecture that occur within the derma layer, when A wrinkle has been around for a long time, it starts to affect the tissue around it very similar to that of a. Scar tissue is composed of the same collagen protein as healthy skin tissue similar to this, but because of the trauma or because of the static nature of the wrinkle, the tissue around it starts to change.

So similar to a scar where during tissue healing, the collagen cells group together. Like this and bunch up. This is sometimes what a deep wrinkle looks like. We’re gonna look at one in a minute. The way to treat this is not to slide the needle in because that’s not gonna really break up the tissue is and not to pop it and go into.

Base, but actually to go into the wall of the tissue to start to break up the fibrous tissue that is starting to develop, to create this, that stagnant nature, that depth of, the wrinkle itself. So here we go. Take a look. This is, if you look at the, let’s look up here. This is what we’re gonna treat.

This where the red arrow is. But if you look at, and it’s right here on the large image. Now look at this wrinkle. This wrinkle starts at the, in the lip. It starts at the base of the bottom lip and actually projects all the way down, but right. This is the depth of the wrinkle. This is probably where it started, began to spread.

So here’s where the damage is. Here’s where potential scar damage is, what we’re calling scar damage, but it’s really not a scar. It’s basically tissue that has been in one position for a very, long time. So in order to affect this, we actually need to break this, tissue up and around it. So we’re gonna take.

And I’m gonna needle into the wall. You can either needle from the outside in or you can needle from the inside out, but the object is to actually get into the wall of that wrinkle as opposed to the base of the wrinkle itself.

So just as a recap, we have fine lines. Fine lines are basically due to creases in the skin surface caused by dehydration. And the way to treat it is to enhance water consumption or to apply it or both. We have shallow wrinkles, which have to do with creases that are just beginning, and they change so they’re not stagnant.

Over time, you spread the wrinkles and needle into the crease. We have deep wrinkles where the crease is caused by the beginning of. In a lack of integrity of collagen and elastin in the tissue itself, and they stma, they’re starting to show up and stay there, stay at the face, or stay visible when the face is at rest.

And then we have static wrinkles. And these result from a loss of elasticity, tissue damage, we see that build up or the change in the architecture of collagen elastin around those needle wrinkles. And the treatment is to, the intradermal, kneeling treatment is to needle into the crease of the wall. And then we have dynamic wrinkles, often known as ride tides.

And these develop from repeated facial movements, in which case we need to treat the muscle as well as the. So thank you for today’s presentation. If you have any other questions or want to know more about facial acupuncture or cosmetic facial acupuncture you can visit me@hamptonsacupuncture.com, my website.

You can email me@infohamptonsacupuncture.com or follow me on Instagram at Shellie underscore Goldstein. So thank you again everyone. Thank you, the American Acupuncture Council. It’s always a pleasure to be with you and next week stay tuned for Chen Yen she’s very exciting and a wonderful lecture. I’m sure you’ll enjoy her presentation as well.

Treatment Considerations for Myofascial Trigger Points

So we’re gonna be discussing some treatment considerations for myofascial trigger points, how to incorporate them into the treatment, a little bit of comparison between those and motor points.

Click here to download the transcript.

Hello. Thanks for joining us everyone. And thanks to American Acupuncture Council for having us back. I say us, but Matt Callison is not joining us today. So it’s just me and our guest, Joe Bickle, Joseph Bickle, and I’ll introduce him in a second. Sorry, Matt’s not here. He had a little incident with food poisoning, so he will feel better soon, hopefully.

But didn’t really feel up to being in on the webinar today. So we’re gonna be discussing some treatment considerations for myofascial trigger points, how to incorporate ’em into the treatment, a little bit of comparison between those and motor points. So it’ll be a really nice discussion that Joe and myself have.

So let me introduce Joseph Bickle. He is graduate of the SMAC program, Sports Medicine Acupuncture certification. So he’s a C.SMA. He also took classes as I did in Myo pain which goes through some various trigger point protocols. I haven’t taken all the classes. Joe did take all the classes, so he certified through Myop pain.

So we’ll have a little common language we can discuss and maybe talk a little bit about that training also. Joe, do you wanna give any background of how you, we can get more into specifics in a bit, but how you incorporate or what you do and where you work and Yeah. So I work primarily in two different locations in Minneapolis, St.

Paul area. I work as part of an outpatient program attached to the Allina Health and Abbott Northwestern. And then I also do supervise at the local school Northwestern Health Sciences, their human performance center, where we focus primarily on treating athletic conditions. Obviously treating there.

But my patient population tends to be more of the chronic pain and or chronic orthopedic conditions throug

h the Allina Health System. Great. All right. So we’ll jump right into the discussion. We’ll start with a PowerPoint. We’re not gonna have a PowerPoint for the whole whole webinar. But we wanted to start with just a little brief discussion on A comparison of motor points and trigger points.

These are not such a black and white, easy comparison to make cuz there’s a lot of crossover. And on top of that, there’s a lot of discrepancy on how people describe a lot of these things. So they’re not even always clear delineations between the two. But just since a lot of people use motor points, a lot of people use trigger points, some people use both.

It’s nice to of get a little. Into the the different slash similarity comparison. So let’s go to the first slide. Gimme just a second.

All right. There we go. Sorry about that. So we’ll start, like I said, this comparison, but then once we get through the. The PowerPoint, we’ll start talking about some key kind of areas referral patterns, a little bit about how to assess for trigger points, including them into the treatment. And then one of the main things we wanna talk about today is is dosage.

So how much stimulation do you give? Are you looking for a ation, the duration of treatment? So I know I’ve had a problem and I talked to Joe about this. Sometimes I’ve overtreated people and they come back and, Oh, they were so sore, And it’s little soreness is one thing but you can definitely overtreat.

So being able to judge how much that person can tolerate is really important. And I know all of us know that from Chinese medicine, but looking at it from this little more my myofascial stimulation is really an important topic. Let’s go into this. Joe, if you have anything to add, we’ll just talk about it, but we’ll just get through these like early slides to start off with.

Anything to add to that now or we’ll get, I guess we’ll probably getting into it as we go. Yeah, I just guess would just like to emphasize that it really, it can get a little confusing motor points versus trigger points. And so for anyone listening who has feel that way, you’re in good company.

Yeah. Excellent. So what is a, let’s start with a motor point. I’m gonna use the term motor entry point. So motor points are described not consistently inco inconsistent descriptions of. A lot of the more precise language is using motor entry points, cuz this specifically tells you it’s where the motor nerve enters or penetrates the muscle.

So what you’re seeing in this image here is a picture of the flexor carpials. So what’s being held there with the gloved hand is the ulnar nerve, which is traversing down the for. But then you see that little collateral branch that the hemostats are pointing to. That, that collateral branch is going entering right into the flexor carpials.

That’s gonna be about a third. If you drew a line from heart from s si eight to heart seven, and made that line divided in thirds, that’s gonna be the proximal and middle third junction. Thereabouts. It’s slight variability on pe, person to person, but it’s pretty consistent. It’s a pretty consistent location.

So that’s gonna be the motor entry point, and we’ll talk about other terminology here in a second. So not really all always agreed upon, but that’s the definition that I like and that I wanna use and that we tend to use in the sports medicine and acupuncture program. Whoops, let’s get. All right, so once the motor nerve enters the muscle though, then it bifurcates and sends branches out, usually approximately in distally, and those branches terminate somewhere in the muscle and some languages some descriptions.

If you look at research, we’ll talk about those as being intramuscular motor points, so areas where the motor nerve after it bifurcates and travels for. Depending on the muscle and the person and all that, it’s gonna D terminate at that intramuscular motor point. So that’s a motor point also. But that would be an intramuscular motor point versus the motor entry point.

So in this image, if you can look somewhere in the center, this is the hamstrings. Somewhere in the center you’ll see me P. That’s the motor entry point. That’s where the sciatic nerve sends off. A branch enters the muscle, penetrates in the muscle. Then dlp, plp, I forget what those stand for.

Proximal and dis. But basically they’re talking about the termination place within the those branches that go distally and proximally and then terminate at the intramuscular motor point. So that’s something that we can talk about and maybe from there, make a comparison to trigger points. And Joe, I don’t know if you wanna jump in here and add any thoughts to this.

Yeah, I think that’s, that sums it up pretty well as far as the main differences that I’ve seen and that I work with where the motor point is, motor entry point tends to be a lot more predictable. Like you were saying, how you’re mapping out the flexi, carpal nas whereas the end plates can be a little bit less predictable and therefore more palpation based.

But otherwise I would agree. So would you say, and this is the way I see it trigger point. When we define a trigger point here in a second, trigger points can exist anywhere in the muscle. So this is showing the biceps for Morris Longhead motor entry points somewhere in the center. The muscle, it’s pretty close to UV 37, just lateral to UV 37.

There’s another one too, the couple different motor entry points, but this is the main one. And then those junctions that send out intra muscularity and terminate at where it says PLP and dlp. Those would be the area where there’s motor in plates where there’s receptors for acetylcholine.

That’s the neuromuscular junction. You can describe it in structure. You describe it in function. That’s where the discrepancy between neuromuscular junction and motor in plates comes in. But in trigger point language, they mention that trigger points tend to form at the highest concentration of motor implants.

So in my mind, that would be at these intramuscular motor points, even though they don’t have these mapped. I don’t know how variability, how much variability it is. Maybe someday there’ll be all these maps that say, Oh, okay, here’s where the distal intramuscular motor point is of the biceps, or more.

I doubt it. It’s probably much more variable than that. But this would be the relationship in my mind is there’s the motor entry point where the muscle, where the motor nerve enters the muscle and then the intramuscular motor points that terminate somewhere that’s probably less predictable in each.

And those would be sites where the trigger points tend to form. They could also form really at the motor entry point. It could form anywhere in the muscle, but those are gonna be the key areas. Yeah, I would definitely agree. It definitely seems like there is some predictability to those, to the end plates.

, but I don’t, obviously I’m, I would assume things like activity, how athletic the person is, their movement patterns would have an impact on those locations. So Yes. Yeah, I would. It is interesting that you mentioned predictability cuz for those who used trigger points and have looked at Janet Trevell and David Simon’s book Myofascial Pain and Dysfunction Trigger Point Manual.

In her early additions, up until just recently into the recent edition, she had Xs not because they were definitive locations for trigger points, she made it clear that they could exist anywhere in the muscle, but she had Xs just clinically being a very skilled palpate and c. Of areas where you tend to find trigger points, it tends to form here in the muscle.

The kind of go-to areas that that wasn’t trying to imply that they would always be there, but they were go-to based on clinical experience and just seeing a whole ton of patients. In the recent addition of that, they took those x’s out, which I don’t know, I could see an argument for it.

Cause you have to palpate all through the muscle and. But I kinda like the X’s. I don’t know. . How do you feel about that, Joe? I see two sides to that argument. I actually like them not there because it does force the practitioner to palpate , as opposed to one, I think one thing acupuncture specifically can fall into a trap on is they’re used to that precise location.

Tell me the measurements and then I can find. And they can lose that ability to palpate exactly what they’re feeling for. Yeah, for sure. And that’s, I think the reason, not for acupuncturists per se, but that’s the reason they weren’t taken out. Yeah. But yeah, as I understand that is why yeah.

If you do work with trigger points a lot that you will find that they tend to be not, I wouldn’t say predictable. Yeah. It tends to be go-to areas. You tend to find some consistency. But, that’s the trap. You’re right. Is. Can then start to force yourself to think, there should be a trigger point here cuz the pain referral or whatever.

And you don’t palpate carefully and end up missing something that if you were to be more open minded, open, open possibility about it, I think you would just not get Huang up on trying to force it into that location. Yeah. All right, so then motor entry points, intramuscular motor points.

Trigger point is a hyper irritable spot in skeletal muscles associated with hypersensitive, palpable nodules and a taught band. So when you’re palpating for a trigger point, we can talk about what that refers to. The spot is painful on compression and can give rise to characteristic referral, pain referred tenderness, motor dysfunction, and autonomic phenomena.

So that’s the definition from Trave and Simon’s book. And it’s a mouthful in and of. . But that tells you that there’s a hypersensitive, palpable nodule there. So whereas a motor point is, or especially motor entry point is an anatomical thing, you have that, whether there’s dysfunction in the muscle or no dysfunction.

It’s there. It’s, it might be slightly there, variable from person to person, but it’s in a relatively consistent location that the muscle’s in dysfunction, the motor point’s there. If the muscle’s healthy, the motor point’s there. It’s just part of your anatomy. Whereas trigger points are talking more specifically about dysfunction, they could form at a motor entry point.

They could form at the intramuscular motor points, They could form somewhere else in the muscle, probably most likely at the intramuscular motor points. But they’re they’re a sign of dysfunction where there’s hyper irritability and there’s characteristic referral patterns and other phenomena that you see with it.

Good. Joe, I’m gonna move on unless you wanna add something to that. No, I think that summed it up pretty well. All right, so we’ll come back to this we’ll take the PowerPoint away for now. We’re gonna come back to this when we use an example later and discuss the Quadra Lium. But just glancing at it for now, you can see these characteristic referral patterns that are mapped out when you’re looking at these referral patterns.

You. If you don’t know the mapping, there’s something that you wanna know about ’em is that dark red doesn’t indicate more intensity of pain. The dark red indicates more of the Tendency of where those muscles refer to. And this one is from an old edition. It has the X’s in there. Modern ones don’t have the newer edition doesn’t have that X, but don’t worry about that so much.

But that characteristic darker red area is where you’re gonna more commonly see that referral. And then there’s the spillover, speckly red that could be just as severe pain at those spillover areas, but they’re less frequent, less frequently gonna be experienced there. So that’s what the mapping is.

So let’s bring the PowerPoint away and we can come back to that in a. All right, so exit this out so I can see Joe. There we go. Good. So we talked a little bit about that difference between motor points and trigger points. So let’s look at how you would incorporate, if you’re using motor points, how you would incorporate trigger points in or even if you’re not using trigger points.

How would you incorporate, what would you be doing? What would lead you to think trigger points and how would you make that a part of your treatment? Sure. Just looking at the mapping that Traves done, I think. L thinking about it from someone who is new to orthopedics or new, certainly new to trigger points.

I think that’s your first go to is based on patient symptom presentation. And then that’s gonna narrow it down. So if we’re looking at the QL as an example, it’s lighting up parts of the hip, parts of the si. There are gonna be multiple muscles that do but it does give you a way of zooming in relatively quickly to Alright, I’m gonna start thinking about glutes.

I’m gonna start thinking about ql. And then you can also, if you’re more orthopedically inclined, you can start thinking about. The spine and other things as well. So that’s a good first step. I think a good second step would be reading some of the traves information. She gives a lot of more specific symptom presentation and as well as other ways to incorporate.

So talking about the relationship between glued trigger points and their effect on QL as well. And. Another good way of starting would be active and passive ranges of motion. I know when I first started of getting into this, that was a very nice, like just memorize how the body can move and then have a patient see what they can and cannot do and incorporate that into a pre and post exam.

And then lastly, I’d. What I’ve been talking about before, help patient, the more you can get a feel for the tissue, it’s gonna lead you in a direction. . Yeah. This is the trick with those who use motor points. The trick cuz there is crossover cuz in sports medicine, acupuncture in the certification program we tend to use more discussion of motor points and we use a lot of the same thing, range of motion.

Looking at muscle inhibition, that could be something. I know trave talks about muscles becoming inhibited when there’s trigger point formation in there, so there’s definitely a lot of crossover. Yeah, in the sense that, if somebody has limited range of motion in the upper trapezus, for instance, so I go with the motor point, or do I go with the trigger point?

What’s my. What’s what’s going to be the thing that leads me to one or the other. And they can be the same thing cuz the trigger point might form at the motor entry point location. But let’s assume it’s a little off the motor entry point location. Which one do I use? So what’s your way of differentiating those, even though there is so much crossover?

What’s your way of differentiating those usage? Sure. I guess I tend to look at it and especially this is gonna. Feed off of my smack background, but motor points tend to, or I use them more so for global aspects of treatment. So looking at the posture, like if we’re talking about bet trapezius, upper cross syndrome, know, I’m definitely gonna be thinking more motor entry point.

Whereas if the patient’s coming in for. That temporal rams horn headache I’m gonna be specifically thinking, All right, I need to feel the upper trapezius, find some trigger points in that region or not advanced that, that are almost recreating those symptoms. That’s a good bet.

If you’re finding a 10 point that’s saying, Oh, wow, yeah, that, that goes right to where my, I typically have a headache. , That’s why I’ll tend to lean in on treating the trigger point specifically over the motor point. Yeah, I gotcha. Let me say it. Tell me this is because I, this is what I heard, and this is how I think about it too.

But let’s use back to the Upper cross syndrome patients coming in with headache neck pain, maybe cervical type headaches, tension headaches that are coming up the cervical spine, and then radiating along the gallbladder channel to the temple. So knowing the trigger point referrals, upper traps would be one of the key structures that I’d wanna look at for that.

However, they have upper curl syndrome. So once I’ve diagnosed and assessed that, that posture and I can see that posture’s part of that pain pattern, I could choose motor points such as the OIDs, lower traps to help re return some. Awareness to that area so that the person’s able to engage them, especially if I give ’em some exercises afterwards to help engage that.

I might include Peck minor as a way to let that peck minor soften. It’s not what’s causing the pain, it’s not the direct cause of the pain, but it’s part of that that postural symptomology and then the upper trap sugar point to speak almost directly to that pain referral. Yeah. Yeah, I definitely consider it like trigger points to be like the branch treatment of to use a Chinese medicine term, the branch treatment of kind of assessing those like postural and mobility issues where the trigger point itself is a symptom of what, what’s going on underneath.

But it still needs to be treated, and Thank you. So you’re incorporating, I need. This trigger point, this exact one part of the region of that muscle. But I also need to balance that with motor entry points to create a more global effect. , I know. And leading up to this webinar on Facebook there was a question about needling motor points.

Will that release the trigger point or will that have a clinical effect on the trigger point? So should there be, and I think this is gonna be very opinionated by the way, but should there. If you find that trigger point in the upper traps, should I needle the motor point, assuming the trigger points at a different location?

Should I needle the motor point to release that trigger point in the upper traps or should I go right to the trigger point? Sure. Any thoughts on that? I think this would actually this would lead into our conversation about dosage because needling into that trigger point is gonna have a certain level of sens.

Versus needling into the motor point. . And to me that becomes a question about who’s sitting in front of me. I think there are times where I would say needling the trigger point is exactly what you need to do. And there are other times where I don’t think that’s a great idea. I think just balancing the treat, focusing more so on the bilateral trigger point or bilateral motor points, and then postural issues might be a better approach depending on who’s sitting in front of you. Yeah. Gotcha. It’s interesting the idea of trigger points. I’m gonna make a comparison to something. I do, I’m in Florida, so I can do injection and I use.

Modified like buffer, D five W 5% dextrose and sterile water, which could be great for trigger points. I use it for trigger points. It’s also used for ural injection. So when you’re working with cutaneous nerves, so a lot of pain syndromes, you can palpate these cutaneous nerves and do very superficial injection.

And using the D five W to desensitize some of the nerves because the idea is that when nerves are absent when there’s glucose, oxygen deprivation, when there’s pressure on the nerves, they, they’re not getting oxygen. They’re not getting glucose. Dextro is about the same thing. You can desensitize them with this dextrose solution, bathing that area and this Dex solution.

And the person who who really spearheaded a lot of this work is MD and New Zealand. And he uses it really comprehensively for a lot of different things, even like sciatica. And it’s like you’re desensitizing that most distal portion. Of the nerve. It reminds me a little bit of distal points in acupuncture, even though they’re, these aren’t, know, it might be around the knee or wherever the pain presentation is, but it’s almost like desensitizing that end of the nerve kind of, refers back to that neurologically back to the main unit.

I of feel like trigger points are a little bit like that too, versus motor points is sometimes you wanna use the motor point, which is gonna affect all the branche. Distal from that, all the intramuscular motor points. But I wonder if it has like a little dispersed effect. It’s effect is dispersed among all of those, which is very regulatory versus sometimes you need to zoom in right at that most distal branch that’s irritated.

Yeah, exactly. And I to play off of that, I don’t think there’s anything wrong with saying, All right, let’s try the, let’s try the motor entry point. , and then reassessing the trigger point and saying, Howard, how’s that feeling? Now that I’ve done. I think that’s a good thought process to be going.

Yeah. Gotcha. On that topic, and you already started getting into dosage, I think we should probably go into that. Could you define dosage again, cuz it’s a term I hear in acupuncture world, often when people hear dosage they think medicine, which is medicine.

Medicine can. Yeah, it can be a little tricky. I’ve broadened my definition quite a lot in the last year. So I considered anything that’s, Going into the treatment. I think the way it gets talked about and has been researched the most is number of, treatments within proximity one another.

So number of treatments per week but needle retention time, we talk about it in school, like the 23 some minutes and talking about cheese cycling. You can of get locked into that and stop thinking about it, but there’s definitely a difference between needling. Leaving a needle in for a minute, to five minutes, to 15 to 35 those are all gonna have a different effect on particular patients.

The amount of needles and then the amount of stimulation like we’re with, talking about trigger points, the local twitch response doing some type of manual technique on the needle. Eim, I think these all have a level of stimulation, a level of dosage. And they all do slightly different things. As an example, there are times where.

What you want to do is to get multiple local twitches versus another patient who’s gonna have a really bad reaction to that. And maybe Easton was a better way to go. But then even then you can of start building off of that. Or what are the accessory techniques you’re doing? What effect is that gonna have on your treatment and how often you need to be treating and how much needling you do.

If you’re doing a ton of mild fascial work, like we learn, like we learn in smack, how much needling do you really. I know going through the program we’d spend you’re spending like five minutes doing a tech a mile fascial release technique, and then you’d have you or Matt just being like, I just remind everybody you’ve already done the needling at this point, so you don’t have to do all that.

A ton of mild fascial work. And that’s an just an example of moderating the dosage and then what you’re giving ’em, what you’re giving them. As far as herbs or homework assignments I know there’s some interesting research that talks about using exercise to minimize that post-treatment soreness.

I certainly think if you’re incorporating that, you need to be thinking, how much work can I do with the needle versus how much work am I gonna have the patient do when they’re at. And yeah, I just think those are all different examples of what you could term dosage. Yeah. I also add a thought to that is that upper cross syndrome would be an example of this.

Somebody can’t tolerate a lot of needle stimulation. That’s a lot of needles to do. The rom boy major rom boy, minor, middle traps, lower traps, tech minor. Especially if you’re doing this bilateral. There’s a lot that goes. So I start to think distal points sometimes too. And think which channels are those, if those muscles are part of a sinia channel and maybe I can affect differently, maybe not as direct, but maybe I can affect those lower traps with the urinary bladder channel, a distal point that I might be using anyways. And I can have that have some regulatory effect.

I think its effect is gonna be a little bit more dispersed and its effect is gonna be stronger if that distal points there. Plus the local point. But, the person can’t tolerate, I can still of build energy in the channel to help that, relate to the lower traps in that case without having to needle ’em directly.

If I do need to minimize, or maybe to release the Peck minor, I’m gonna use a lung channel point that’s gonna have a little less less , impact. It’s not gonna be as strong of a needle sensation as going into the Peck minor with a, with a. Yeah. And I agree. You can have two, you can have one patient and then 30 minutes a nut later, another patient, same condition.

If we’re doing upper cross, you’re doing the upper trapezius trigger point and you’re gonna make it worse. Or someone else, you, if you do the upper cross, trigger point, you’re gonna make ’em way better. . And it’s just, I think the trick is learning how and when to do that. I do think there are some tales, but ultimately just building your clinical experience around how you’re, how patients are gonna respond to that.

But yeah, it’s a thing I love about Chinese medicine is that gives us, it gives us those options. If I can’t treat the trigger point directly, I can use lung seven. Yeah. It’s funny, I think when I’ve overtreated people, it comes down to this one thing. And I’m gonna use a phrase that I heard this in context from another educator used to teach with sports medicine, acupuncture Patrick Cunningham.

He discussion, he reminded it was, this was an online discussion, but it reminded folks about a saying they have in chiropractic, which is being addicted to the audible. So that case is trying to adjust and get that pop, and sometimes the joints move, but you’re like, I’m looking for that audible.

I feel like face situations are that, and this was his point, the fasiculations are that in the acupuncture world especially more sports acupuncture based world is getting addicted to that big muscle twitch. And sometimes that you put the needle in and boom, it’s right there. But other times not and, maybe you over overstimulate looking for that big muscle twitch because that’s what’s driving, that’s what you judge as being what’s important for the treatment.

Maybe their body’s telling you something different. I dunno. So when I have over, when dosage has been wrong, it’s for me, that’s what it’s been. Yeah. I’m guilty of that too. Certainly. Who doesn’t love just getting that like nice big pop of the muscle? Yeah. What was I gonna say based off of that?

Oh shoot. Escape me. But you said something that reminded me of that, but Yeah. I think. Certainly knowing when and how much and knowing that, I also like to say it’s like it’s not the worst thing in the world to over treat somebody. As long as you’re communicating with them like, Hey, I’m gonna do this thing, you’re probably gonna be sore one to two days.

Anything over that. I consider to be too strong. I’ve definitely had patients be like, Oh yeah, I think we did a little too much and then it’s, and then we move on. We know to treat, do a little less stem. But the point, I need to close with this cuz we’re running a little short on time, but the ations I do think is where it’s spending a minute or so on and I’ll mention my thoughts on it.

I don’t think there’s an answer to if you need a ion or not. I feel like the ion is, I. . But I think oftentimes we miss these very small background, quiet fasiculations, which is maybe what that person’s body needs. And I have some ways that I sometimes, like I, for Summit 36, if I’m using that for the tibialis anterior or just any tib anterior or motor motor point or trigger point, I’ll go down distally to about the liver four area and just go a little lateral, which would be right on the tibialis anterior tend.

Yeah. Sometimes you need all that region of oft anterior and you can clearly see and feel of ion, but sometimes you can’t. But you can fairly clearly feel like a little pull on the tendon and it’s I might have missed that on the needle and kept on looking for a ion. . And I think for some people that their body is that was the therapeutic outcome and I got it and I missed it if I don’t have a way of assessing it.

So sometimes I think when we talk about fasiculations, we’re not talking. , the spectrum of that muscle ion that can happen, that can be from almost imperceptible to you can physically see it. Yeah, sometimes we talk about fasiculations as it being that part of the spectrum is the parts you can physically see or right there you see it.

Yeah. Yeah. No, I think it’s important to understand that. Even the research is gonna tell you. Oh, like getting a twitch, it does have a response. It has a local response, has a global response. But searching for it can actually recreate a lot of the, in nociceptive increase the presentation of a lot of the nociceptive chemicals that you’re actually trying to get rid of.

Yes, getting the twitch can matter to a degree. , but it’s very easy to overdo if you go hunting for it. And I do think, like you’re saying, like trying to look further, like further distally or approximately along the muscle, looking for those small littler twitches is probably a smarter way to go.

Yeah. And also I think when it’s like that and it’s assuming you’re in the right location, sometimes you take the needle out, Repa. Oh yeah. I think I was just a little off. And you put it in, you get it right away, but sometimes you’re right on the right spot. And then sometimes you just have to use good needle technique instead of just banging away at the muscle.

You just coax Yeah. Little English on it. Yeah. . So I think that’s that’s been the change for me in treatment is not just assuming. I didn’t get the twitch because I’m in the wrong location and just keep on wailing away at it. But just to see that as the body needs a little bit more a little more mechanical stimulation, quiet stimulation in that area and let it come to the needle.

In those cases where it’s probably more of a deficiency case, know, Cause the excess portions you put the needle in and know, it’s, Yeah. It’s there. Yep. Yeah, I would agree. All right. Joe’s gonna be presenting at the 2023 specific sports in an orthopedic acupuncture symposium.

Maybe you’ll get a little more into some of this at the symposium. I know the dosage thing is a really interesting thing, and you’ve talked a lot about various research that, that discusses this, and I think that’s useful to hear it from that perspective. Hopefully more on that topic later.

Yes, that is the point. Oh, we were gonna talk about ql, but I think we’re probably a little short on time, so maybe we’ll leave it at that. We got a lot of good information discussed in this. All right. So thank you, Joe. Thanks for being the guest. Sorry Matt couldn’t join us. Thanks again to the American Acupuncture Council for having us.

It’s always great to, to be available for these webinar. And I didn’t get who is here next week, but I think it’s usually put up on the screen, so there we go. Awesome. So hopefully you guys can join next week and thanks again and see you guys another time. Thank you, Joe. All right. Yeah, Thanks Brian.

Facial Fascia: Appearance and Function

And I am going to talk to you today about facial fascia and what it is and how it can affect your facial acupuncture treatments and how it can affect your patient’s appear.

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Hi, my name’s Michelle Gillis. I am an acupuncture physician and I teach facial and cosmetic acupuncture classes internationally. And I am going to talk to you today about facial fascia and what it is and how it can affect your facial acupuncture treatments and how it can affect your patient’s appear.

So I wanna thank the American Acupuncture Council for this opportunity, and I need to see the first slide.

So what is facial fascia? That is going to be the first thing we talk about today, and after that we will discuss how it affects your facial appearance. and the movement of your face. So it’s not just about cosmetic, but also how your face functions, and then some treatment modalities, things we can do in order to affect the function of the face by treating the fascia.

So facial fascia is composed of two layers, and the first is the superficial facial fascia, and that is On the outer layer, and that is, it’s right underneath your skin and it helps to support your face and hold everything up, and it’s responsible for giving you a youthful appearance and. It also can carry a lot of tension in it and restrict circulation to the face so things can get trapped, whether it’s lymphatic fluid or blood.

And even some of the superficial nerves. Then we have the deep fascia layer, and that kind of forms a girdle and it is called the mass layer, the superficial muscular epi neurotic system. So the superficial layer itself. Has the superficial fascia itself has two layers. It has the outer layer, which is this kind of fatty layer, and then we have the mass layer, which is right here and.

That is what allows us to make facial expressions. It takes the nerve impulses from deep and sends them out to the muscle, which then translates out to our skin.

So the superficial. Fasha layer is what is responsible for our facial expressions. And the deep fascia layer, which includes the fascia of the temporalis because the temporalis is connected to the face the parotid fascia, which goes down into the neck. The periosteum, which works around the part of the skull that connects to the face.

and the septum, the area around the orbit or the eye area. And this is where the deep fascia exists on the face. So here’s a. Pictorial representation of a piece of bone and a muscle and the skin. And the reason why this is important is because our face is the only part of our body where the skin is connected.

To the skin layer is connected to the bone through muscle, which is why you can move the skin on your face without having to move. Any part of your face so you don’t have to move joint in order to move the skin on your face, everywhere else on your body, if you wanna move the skin, one of your body parts has to move.

The skin can’t move Separate from the the body part.

So one of the things that can happen is, so here’s the bone and here’s the fat and the muscle and the skin. And what can happen is, so as the muscle contracts, the skin gets pulled towards the bone and we can get. Kind of wrinkling of the skin, right? If you smile, if you raise your eyebrows, if you pull your eyebrows together, if you purse your lips right, you can purse your lips without having to move any bone at all.

Just by moving the muscle, the ais ORs, and what can happen is, We can get these fossil adhesions, which are like scar tissue. They can happen as we age. They can happen through injury, they can happen through overuse or underuse. And it’s this very fibrous collagen fibers. It’s like if you think about, if you have like a chicken.

And you pull the chicken away from the bone. There’s that layer. It almost looks like really a strong cobwebs, and those fibers can. Trap nerves and blood and other things. And they can cause these adhesions where it can prevent the full expression on our face of different facial expressions, the full movement and.

Like if an individual perhaps had a stroke and things, or Bell’s palsy and things don’t move for a long time, then you have to physically get this area moving because of these muscle adhesions that can form. So here’s the bone. Here’s a piece of bone, and here’s the fascia, and here is a nerve, which as you could see, could get trapped in the fascia and it could prevent the signaling so the muscle won’t even.

The signal that it needs to move because the nerve is trapped or it can reduce. The ability of the muscle to move well, and it can also restrict blood flow. You can see there’s veins that could also get trapped. So here’s a picture of someone with Bell’s Palsy. They’re making a facial expression with the right side of their face, but the left side of their face isn’t moving.

At all, and part of this is due to nerve damage, but it can also be from entrapment

and wrinkles. When we think of wrinkles, we think of something that happens as we age, and in many cases it can be from sun damage, it can be from just the skin getting older, but also if you habitually make an expression and the skin is attached to the fascia. If that fascia is restricted at all, then you can end up with these deep wrinkles.

We see it a lot in people’s far heads and even sometimes around the eyes with crow’s feet or the lips. And also with jowling. , and I’m gonna talk about a couple of ways that we can help with this, but sometimes wrinkles and sagging are reversible just by doing things to the fascia layer. So here we have an example of forehead wrinkles.

Perhaps this person made the expression where they raised their eyebrows a lot. Also, this is when I said jowling. This is what is referred to as a jowl, and it can happen through the aging process. Things loosen and they become a fixed into a new position. Sometimes it’s from excess weight on the face, sometimes it’s from habitually frowning.

And When I was young, my mother used to say to me, Don’t make that face. It’s going to stay that way. And there was actually a lot of truth to that. A lot of our facial expressions get etched on our face over time.

So what are some of the treatment modalities that we can use in order to affect this fascia? On the face. One very effective treatment is facial cupping. Now, facial cupping is something it’s a skill that you would need to learn. It’s not like cupping on the back. You don’t want to try to use your glass cups and cup the face the way you would’ve back, or a neck or a shoulder or a.

Facial cupping uses small cups. and they look like this. And you would use these small cups and oil and you would glide these cups across the skin. You don’t park the cups and you do it in such a way that encourages lymphatic drainage. And works with the anatomy of the face. And this is a cupping set that is made by Oculus Skincare.

And so there’s a slightly larger cup and a smaller cup for different types of wrinkles and. Rubber part is very easy to squeeze so you can squeeze and move and release and squeeze and move and release, and really keep that chi and energy going. Facial Guha is also another technique that we can use.

And here are some facial guha tools. You can see that they are these are made out of Jade and they’re specially shaped to work around the gel. The cheeks to work along the temporalis and underneath the chin, across the clavicle. Lots of places where we can get these adhesions and by. This kind of physical movement of doing the cupping and then the guha afterwards.

You help to keep the lymphatic system of the face moving, the blood and the chi moving, and also to really get in there and break up those fas adhesions, especially with the guha tool on the forehead. You can spread the wrinkles and you can really get in there and break up a lot of that tension and that tight fascia.

So this is a picture of me just doing some gua along the jaw, jawline, sculpting the face, helping to lift everything up.

And the next technique that we can use, which is very beneficial for submuscular needle, for treating facial fascia is submuscular needling. and this is a technique where you would work on different areas of the face. And I teach a whole class just on submuscular needling, and it involves taking your needles and getting.

Underneath the muscle. So you’re really getting underneath these memetic muscles. I’ve lost my mouse. Where’d they go? You get underneath the memetic muscles. And you’re going to needle right through and down. And this can help get into the superficial fascia and then into some of the deeper fascia depending on which part of the face you’re working on.

And you would insert a few needles. Underneath the muscle, depending on what part of the face you’re working on. So I have a quick video that I’ll show in a moment, but you can use this to work. Underneath the mace here, you can use this to work along the attachment points for the pla. You can work into and underneath the anterior digastric.

You can work underneath the corrugator muscles. You can work underneath the frontals muscle. Pretty much any muscle were on the face where you have access to the margins of the muscle you can get underneath there. And this can really effectively break up some of those fossil adhesions, which is really quite wonderful.

And let’s see. I don’t know if you’ll be able to hear this, but you can see it and I can talk through it.

In needling, the frontalis 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, so this is the frontals muscle 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 you find the borders up here in the insertion is here. And typically what I do is I will put in usually three needles, and then you get right underneath the muscle lateral on either side 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 gonna go too deep. If you go like this, it’s 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 lateral side. Then you’re going to do the medial side, and usually two needles. Suffice. And I do the one side and then I do the other side and I’m using half inch noodles. You can use one inch noodles depending on how big your patient forehead is, so you just get all the way down underneath the muscle.

And isolate the muscle and needle right underneath it, and this, you would just leave the needles in for anywhere from 15 minutes to a half an hour. And this is especially helpful. Let’s say your patient has Bell’s Palsy or some sort of facial paralysis. You can do it on both sides. You can do it on one side, wherever the muscles are affected.

This is just a list of some of the classes that I teach facial and cosmetic acupuncture, facial cupping. A lot of what we talked about today is from my treating neuromuscular facial neuromuscular facial conditions class. I do some self care for acupuncturists safety ethics, microneedling. And a lot of the techniques that we use for cosmetic acupuncture can also be beneficial for treating neuromuscular facial conditions like osis.

Or if someone’s had a stroke, TMJ and vice versa. A lot of times when you’re working with a neuromuscular facial condition that your patient might have, it also helps to benefit the Movement of their face and therefore their skin will look healthier and more vibrant. So I think that’s everything.

I wanted to thank the American Acupuncture Council again, and next week we have Matt Callison and Brian Lao, and I hope to see you again next.

Best Practices for Structuring a Virtual Visit

So there are two types of virtual visits…

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Would you like to have a virtual practice but you’re not sure how to structure your visits? Or you currently already have a virtual practice, if would like, is to flow better and help your ideal patients or clients get the best outcomes possible. Welcome, this is Chen Yen, your six and seven figure practice makeover mentor at introvertedvisionary.com. So there are two types of virtual visit. Number one is that you might be treating them in more of a practitioner patient kind of a relationship.

And then so they are considered your patient and maybe you have seen them in person before. And then you’re just having the virtual side of the connecting, going done virtual. And then and then some of you may be completely telehealth, and of course you need to check with the loss of your state and profession about that and how it’s kosher or not.

And then the second possibility of virtual visit is that you are type of virtual visit is that you are coaching them on more and educating them on mindset and health kind of education. So there is no. Provider patient kind of relationship here, it’s strictly on educating, it’s strictly on teaching and perhaps coaching.

And those are the two types of virtual visits that, that I see are most common. And so what, how can you structure the flow of these visits? So the first hot tip is to. At the beginning of a visit set a strong intention for for the visit and what to expect. So certainly some of the PR principles that if you’ve had a brick and mortar practice apply if it’s virtual, but sometimes because you’re not used to what a virtual flow would look like, then you’re wondering how best to.

Communicate it and communication becomes, and setting expectations and inspiring becomes even more important because that dimension of being with you in person isn’t there. So the. First is setting the intention of the visit and letting them know what to expect today. So that way your patient or client feels really grounded in what to expect instead of just starting off in a visit and talking about things.

One important thing is to set the intention and expectations for today, and then at the end of the visit summarize what’s been covered. Many times in a treatment, in person what has happened, they can experience it and feel it. And and maybe sometimes you, for you don’t always think to summarize what you did to today.

But it’s even more important if it’s in a virtual relationship to, to summarize what happened, acknowledge the progress that’s been made, and then ask them. So this is really key. So this is something that, this next thing I’m about to share is something that is often overlooked because as a clinician, it’s easy.

Just bring up what you saw was had shifted for them or what to ex, what to expect perhaps next time and that kind of thing. But even before then, if you’re able to ask them to share what stood out for them and then solidify your next step recommendations, then it helps the, your.

Patient or client be able to verbalize that and settle into another level of owning that and feeling that from the visit instead of you just bring up what, what stood out for you about that session for them and the Also using powerful questions throughout your visit. So this is a second hot tip.

What, how do you structure the visit? So I shared with you this overarching idea of structuring and what to say at different moments in time, beginning and then at the end of your visit. But then what are some powerful kinds of things to ask or say during your visit? Consider asking questions that might be powerful questions, for example, saying things like, what will having that do for you?

What’s important to you about that? So these are kinds of questions that can help your patient or client. Reflect on things more especially if a virtual visit may not be as quite experiential as in person in the way that you have imagined, in the way that you’re used to in person. So certainly a virtual visit doesn’t mean that, that people don’t have an experiential shift.

It’s just that the shift typically is a little bit different than an in person experience. Another kind of a phrase would be saying, Oh, something like this. Imagine if X, Y, Z. So when you are sparking belief changes, how can you weave in words that paint a picture of that for them? One of the things about virtual visit many times in terms of the practitioner’s role and how it shifts compared to a brick and mortar in person role is that there’s likely even more within a virtual visit where you are able to like that the.

Part of the value is sparking belief change or inhabit kind of change. And so what you can, whatever you could say to inspire to also hold them accountable for those shifts can really make a difference for a patient or client. Cuz how many of you have ever thought, especially if you don’t have a virtual practice, ci, you’ve thought.

What can I actually do in a virtual visit that people would find beneficial? Cause I just, I, I need to see them in person. There’s, I don’t see that I can really give much value in a virtual visit. And sometimes we don’t think about how some, the most significant shifts that a patient or client can make has to do with the lifestyle changes that they’re making in between your visits and.

So it, but sometimes those are the hardest things for a patient or client. So how can you help them ha have better outcomes Because they’re actually motivated, inspired, and they are sticking with the lifestyle changes that you are recommending for them. And Also the, Have you ever had a, discussing the, at the begin, also at the Beginning of each visit, like at the next visit, always discuss the commitment.

So what was the previous commitment that your patient or client made? What and verbalize that. So last time we discussed you X, Y, Z. And then talk about the progress with that commitment. And this accountability piece might seem so trivial but still crucial because have you ever had that experience or maybe either you had a coach before, like in sports or something or a teacher in school where you had to be accountable to whether it was just even turning homework in.

Then did you notice you, you then worked on the homework and turned it in. Whereas if you didn’t have homework to turn and you probably wouldn’t turn it in, or if you have had a coach you were responding to, or a coach, sports coach who made you do 10 pushups every morning then you did do those pushups.

Whereas if you, and maybe someone watching you right, doing the pushups, then you were more likely to do it. Same thing with your patients or clients when you can hold them accountable. There’s huge value to that. That way your patients or clients are held accountable even if they didn’t feel like it.

Final couple hot tips is are this, so remember that. Because I think one of the things about a virtual practice and virtual visit situation is especially at first feeling like, Oh, I’m not sure if I’m really giving enough value here because I’m so used to treating and then they’re feeling the treatments being having shifted.

And and so is this feeling. We need to give in, in, in each visit. So we need to educate them about as much as possible because we’ve got this time allotted. So we need to put everything in that visit as much as possible. And guess what happens? Patient or client gets into information overload and feels so overwhelmed.

And then sometimes then they don’t end up rebooking or, have this that ever happened to you before where you if you’ve had a virtual Practice, you’ve noticed that, oh, maybe I said too much in that visit. , right? And so remember that information overload is not helpful. It’s actually the right balance of, because it can overwhelm people and people can tend to only absorb so much each time, even though we wanna give so much each time.

And so it’s helpful to, it’s an art and a skill. To be conveying what is important to convey in that container and enough to help them move forward with an important shift. So when shifting from a model of treating people to helping people online and perhaps missing the treat treating component, remember that the value of the visit is not just in fixing people.

So think about what are the most significant things that will spark lasting transformation and focus on that in, in your visits. If you are in a place where you already have a virtual practice or thinking about getting it, shifting into more of a virtual practice, either hybrid brick and mortar and virtual practice model, or maybe even a hundred percent virtual so that you have that flexibility to travel anywhere or work from home and not have to.

Be tied down to renting office space and being tied to having staff and that kind of thing as much, then I, but you’re not really sure how to go about it. You’re welcome to, to check out our website and reach out to us at introvertedvisionary.com. So introverted visionary.com and till next time.