Today we’re gonna look at a little bit of the anatomy of the bladder sinew channel, and specifically in relationship to bladder 60, like a sphere of influence of bladder 60.

Click here to download the transcript.

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

Hi, I’m Brian Lau. I’m with Accu Sport Education sports medicine acupuncture program. And I always appreciate coming in with the American Acupuncture Council, so thanks for having me. Today we’re gonna look at a little bit of the anatomy of the bladder sinew channel, and specifically in relationship to bladder 60, like a sphere of influence of bladder 60.

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So we’ll look at using that point of course, but then applying it or at least syncing it, linking it with other points in the sinews. So something that would be along what you would think of as the bladder channel, but then we’ll draw out the full sinew channel course and look at how it relates to some of the other structures off the primary channel, but more along the sinew channel.

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Let’s start with that. We’ll go to the slide and we’ll start looking at the first bit of information. So this is a image of bladder 60. So it’s just showing, of course everyone knows the location of bladder 60 between the lateral malleolus and the Achilles tendon halfway. But just a summary of some of its actions.

It clears heat and lowers yang, so particularly when there’s tension rising up the bladder channel, and you think of stress and being at work and everything, shoulder’s rising and the whole back line rising. Pacifies wind and leads down excess. That’s pretty similar to the first action in some ways in terms of how it plays out in this situation.

It activa- activates the entire bladder channel and alleviates pain. A lot of pain indications for this point. Relaxes the sinews and strengthens the lumbar spine, and then it promotes labor. So just a quick note while we’re on this image is you can note the course of the sural nerve. So this point would be in a location that would stimulate the sural nerve.

The sural nerve is branches off of both the tibial branch of the sciatic nerve and the common fibular branch. They come back together, but then it travels down, pretty much down the midline along the bladder channel shifts over to the lateral side. So when you, when needle bladder 58, you’d be stimulating that and then down along the course of the bladder channel.

So this would be stimulating that. It’s nice to know the target tissue and some expectations of where that qi sensation would go. Because this is a cutaneous nerve, it would supply sensation down the foot, so you could expect to see some traveling sensation along the bladder channel from that But if we look at the bladder sinew channel, that k- helps us draw out some of those actions and indications.

This illustration is showing sort of two levels, or two layers of the bladder sinew channel. When we do dissection in the program, we do a three-day dissection. This would be on day two, where we start to, to look at the posterior aspect of the body. And if I were to remove skin and adipose, that’s what we would do in a dissection process, the very first structures we get to would be what we see in this box here on the back, which would be the latissimus dorsi, trapezius.

Those are gonna be the most superficial structures. Glute max. And that’s our superficial bladder sinew channel. It’s a lot of what we see as these branches in Deadman’s illustration coming off of the main channel. So it highlights these lateral branches that wrap around to the front of the body.

We’ll come back and look at the front in just a second. But if I were to remove this layer reflect back that layer, then I would get to what would be along the main course of the channel, erector spinae, sacrotuberous ligament, hamstrings, et cetera. A lot of these link at the thoracolumbar fascia.

It’s multilayered, so that’s our linking point between the superficial and deep layer. This will be the subject of the day. If I were to continue from a dissection standpoint, the next layer past the deep bladder channel layer would be the kidney channel sinew channel layer. So that would be our sort of progression, but we’ll stop at the bladder channel today.

So back to the branches. This is where I think a lot of the influence of Bladder 60 is not so much on the main channel, a little bit for sure, but primarily on these branches. So the latissimus dorsi, trapezius, which branch off of the thoracolumbar fascia, the glute max, which branches off of the thoracolumbar fascia.

But if I were to look at the latissimus dorsi, that comes to the front of the arm to the bicipital groove and kind of shares fascia

with the pectoralis major. So it links into the front of the chest and then follows up the SCM. The platysma would also be part of this and into the facial muscles. I don’t have that in the illustration, but you can see this link of the latissimus dorsi, pectoralis major, sternocleidomastoid.

So some areas in the front of the body, which a lot of us don’t really think about with the bladder channel. But with the bladder sinew channel, there is some linkages into the front of the body So here’s another illustration that shows that from the side, labels it. But we have the a lot of, not all of them, but many of the indications of Bladder 60.

So let’s think of those indications from the perspective of this these lateral branches. So clears heat, lowers yang, pacifies wind, and leads down excess. That would include things like headaches. Headaches are a big one for Bladder 60. Visual dizziness bursting eye pain in the upper teeth. A lot of these would correlate with headaches, with Bladder 10 area, so into the semispinalis capitis.

But if we were to broaden out, especially the SCM, the sternocleidomastoid would contribute to things like visual dizziness. It can be a component when there’s trigger points in that. It can be a component of positional vertigo. Of course, headaches. Headaches are a big one. We’ll look at the referral pattern for this in a second.

But headaches it can create a lot of referral into the face area and link with facial issues, both pain and other conditions, even things like Bell’s palsy to some extent. So it can contribute to or at least link with facial pain particularly. Pain in the upper teeth, it can refer into that area also.

So SCM is one of our big links for that. Upper trapezius too. We’ll look at some referral patterns for the upper trapezius. The kind of goal that I want to highlight is that trigger points are becoming increasingly more considered with in medicine in general, but particularly in the acupuncture world.

And many of us, I teach trigger point classes trigger point needling classes within Acusport education. And I just see it with when I teach, when other people teach, is that there’s a tendency to shift away from our TCM when we start looking at more medic- more Western medical language and thought processes and stuff.

So I always like to remind back into the channel system and link with distal points and not lose sight of the channel theory when you start doing more orthopedic or or Western sort of type approaches. And trigger points is somewhere in between. A lot of the language nowadays is Western, but of course, it parallels a lot of what we learn in Chinese medicine.

So not like a complete divergence or anything. So that’s the goal is I want to consider when I’m needling local points like in the sternocleidomastoid trigger points, I might link it with Bladder 60 in particular instances So another indication, relaxes the sinews, strengthens the lumbar spine, activates the channel and alleviates pain.

Stiff neck, goes hand in hand with what we were looking at, but trapezius can be a big component of that also. Contraction of the shoulder and back. Upper trapezius is gonna be one of our big links for that. Fullness of the chest, we can note that the pectoralis major is part of that lateral branch, so that can definitely create a lot of pain and sensations in the chest area.

Heart pain that radiates to the back, and then the other one would be sacral pain and coccyx pain, which is a big one. So we’ll look at the glute maximus. Last indic- action, I should say, but there’s some indications there of course too, is that promotes labor. And I’ll just highlight and not really focus on it much past this, but if I can create some stimulation in this region of the chest, pectoralis major, that’s gonna have an influence on the breast, and oxytocin, which would contribute to promoting labor.

So putting out oxytocin would be, if there’s stimulation in that breast area, that’s… Even if it’s distally, that’s going to have the body put down, put out oxytocin, and that’s gonna start the labor process when the person’s close to it. So just a consideration there so here’s the sternocleidomastoid trigger point referral patterns.

I highlighted some key points around the SCM. Though if you’re needling trigger points, sometimes with palpation, you might be a little off these points, but these are good starting places to consider with the SCM. And just to note that the SCM has a referral into the frontal area, a…

in the eye and cheek area. I’m not sure if I’d be thinking of bladder 60 for this referral. I might be thinking more stomach channel point, stomach 41. Maybe a different day we’ll look at stomach 41 and how it links. Into the ear, I might be thinking San Jiao 3. So the SCM’s a complicated muscle.

There’s multiple channel relationships to it. But what I do wanna highlight is that kinda occipital region. So when there’s that occipital pain and palpating the SCM starts to bring that referral, and it’s “Oh, yeah, that, that feels like my headache,” that would be my consideration particularly for bladder 60.

So when I go to needle, I can just palpate and needle according to what I’m palpating. But I would say San Jiao 16 is a really common point that I use, particularly from the back end of it. So I would thread not perpendicular, but I would thread that needle through the back fibers of the SCM. A little bit more superficial, I might get the sternal head.

If I go a little deeper, I’ll get the clavicular head. So depending on how close to the surface you wanna be, into the muscle at least, but how close to the surface of the muscle versus deeper in the muscle will get different fibers, so you can change the angle of that. That’s a very common approach I do.

Gallbladder 12 would be up at the attachment. 20 would… You can angle it into the SCM or the traps or just straight in. SI 16, I don’t needle that region as much but it’s sometimes reactive there. Stomach nine, I would, again, angle into the muscle. Stomach nine’s a really useful location. Lower fibers, even something like stomach 11, but I don’t find those areas become as reactive.

I do wanna highlight the external jugular vein. So the external jugular vein, which wouldn’t be a big deal if you hit it, it’d just cause a bruise. We don’t wanna cause a bruise. It’s better not to hit it, better to know and look for it. But it’s not, overly gonna be damaging to the person. It’s more cosmetic at that point.

People don’t want a big bruise on their neck. But at the same time, if we can avoid it, better to avoid it. But you can note that it starts and runs behind the SCM. It crosses superficial to the SCM, and then it goes anterior to the SCM. So I particularly like San Jiao 16 in that area ’cause it’s behind the external jugular vein, and I have pretty good access to the muscle without worrying too much about the external jugular vein.

Stomach nine, also on the anterior surface, very good. So those are common areas of insertion. But, you might modify the location. You don’t have to be strict with the location of any of these when there’s SCM strain, it’s nice to note how much fascial communication there is with the pectoralis major.

Clavicular head in particular for the clavicular head of the SCM, clavicular head of the pec majors lung one would be a consideration. But really just trigger points along the whole pectoralis major can help reduce tension into the SCM, especially if people are desk workers and they’re spending a lot of time closing the chest, driving, desk, pretty much a lot of what we do on a day-to-day basis.

People tend to get overactive in that pectoralis major. Even the lats, serratus major, those would be considerations to contribute. If I were linking bladder 60 with the SCM, maybe some points in the pectoralis major lats, these would be starting to build a little bit more of a comprehensive treatment So trapezius is another big one.

Trapezius is multiple channel relationships also. We have gallbladder 21, gallbladder channel, gallbladder 39 is really useful to reduce tension in the upper trapezius. San Jiao points have an effect on it. There’s a lot of channels that converge at the trapezius, but the bladder channel, especially that sinew channel coming up the body is one of those, one of those channels.

And again, I can think it kinda correlates to that pulling up tension in the back when we have stress, and we’re busy and, we wanna have that area descend down and drop. We don’t want that excess to rise. So those would be a consideration for bladder 60 if that seems to be the correlation.

But again, that occipital referral. So this is showing the lower trapezius trigger points and some other, like mid-fiber trigger points and the referral into the occipital region. So a very common often missed area with headaches. When I am assessing for this, I might kinda spread even just with a finger spread, oops, spread through the lower trapezius kind of in the direction that my cursor’s going, from a downward lateral direction cross fiber, and sometimes you’ll even see little local twitch responses.

This is a pretty superficial insertion. You have to kinda thread right into the muscle. So if you’re not used to needling the trapezius in this this region, you do have to know that it’s a fairly thin region. There’s not a whole lot of tissue, especially for people who are thinner. There’s not a lot of adipose in this area, so and the muscles are fairly thin in this area, so there’s not a whole lot of space before you get to the rib cage.

So there is a little bit of pneumothorax risk if you don’t know how to needle this area properly. But I usually thread through a feeling with my finger. I can feel the fibers, and I’m gonna advance the needle through those fibers, an oblique, almost transverse angle. Too transverse, and you’re just going through the skin, but it’s still a relatively oblique transverse.

But even San Jiao 15, gallbladder 21, these are all points you could consider linking. Bladder 10 would be more… And it’d go through the upper traps, but it’d be more in the semispinalis capitis. That would be, of course, a really useful local point for that occipital head pain. But yeah, the lower trap’s one that is frequently missed.

So this is a composite of some of the pain patterns from the trapezius in general, and I would be thinking more of that kind of coming up the bladder channel occipital referral for bladder 60 more than I would for the kinda classic gallbladder channel distribution. I would kinda think gallbladder 39 for that among other choices that I might go with that one.

That would be my pain referral that I would be looking at. So that occipital pain would be the big one. And again, you could link it with other muscles, pec major, lats, other things like that And then the final one we’ll discuss for today is glute max because this is a big component of many sacral pain and coccyx pain type patterns, and that would be the influence of bladder 60.

So this shows from Travell’s book some of the referral, along the sacrum, especially that attachment site. Sacral type pain, coccyx pain. So the Xs, these… I think the current editions of her book doesn’t include these Xs, ’cause there could be trigger points anywhere in the muscle. I kinda like the Xs that showed her clinical experience of where, this region when there’s trigger points, how it would tend to refer there.

But I think the modern editions, they take away the Xs ’cause these trigger points can refer anywhere in the muscle along these distributions. But I still think there’s some value in the Xs personally. And they correlate to certain regions of acupuncture points, bladder 35, especially for that coccyx pain.

36, anywhere along that line, actually, there can be trigger points in those lower fibers. That can be a big component of coccyx pain. But any of these points could influence coccyx pain or b- sacral pain. Bladder 54 would be in the main region of one of the motor entry points, as w- as with gallbladder 30.

And the black l- circle here represents more just kind of attachment trigger points. I, I don’t off the top of my head know of any point there, but I didn’t look that closely with it. But I just think of it as an common area of attachment trigger points. So yeah, just a quick run-through of the the channel.

But particularly the influence, sphere of influence of bladder 60. And I think the idea is linking it with those local points and adjacent points. Pec major, SCM, trapezius, lower trapezius fibers if there’s occipital pain, glute max with the sacral and coccyx type pain. Those would be really good starting places.

Learning more myofascial trigger point techniques can be great, but then we wanna bring it back into our channel system. All right. So I think that is, wraps it up for today. So we’ll look at some maybe next time, some more anatomy, go through some of the channel related anatomy.

I think it’s a really good way to review channels and think about them a little differently if you didn’t have this type of approach when you were learning the medicine. So again, I always appreciate and thank American Acupuncture Council for having me, and I will see you next time.

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So today we’re gonna look at some manual techniques that supplement your acupuncture treatment for shoulder injuries, particularly for something like supraspinatus tendinopathy that would be particularly indicated for that, but really a wide range of shoulder injuries.

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

Hi, welcome to another American Acupuncture Council webinar. My name is Brian Lau. I’m an instructor with the Sports Medicine Acupuncture Certification Program. I also have a YouTube channel and movement based program called Jing J Movement Training, where we look at channel send you relationships to movements.

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So today we’re gonna look at some manual techniques that supplement your acupuncture treatment for shoulder injuries, particularly for something like supraspinatus tendinopathy that would be particularly indicated for that, but really a wide range of shoulder injuries. We’re gonna look at some manual techniques that can supplement your acupuncture treatment.

So let’s look at a bone model real quick. Get a an idea of what we’re looking at. Oops, we’re Alan, we’re starting with maybe we should start over.

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So let’s look at a bone model first and we’ll get an idea of what our goals are for the treatment. Then we’ll look at some anatomy slides and then we can look at the actual manual techniques. So I have a scapula, so this is looking at it from the front. This is the right scapula. So we’d be looking through the rib cage.

On the front surface, on the ventral surface of the right scapula spine of the scapula’s on the back. So there’s the back view, but we’re looking at the front view. Here’s the coracoid process for reference. I’m gonna put the ERUs in here. So many times with shoulder injuries, especially with patients, as they start getting older, we have a situation where the head of the humerus rides up in the joint and usually a little bit forward.

So it doesn’t get seeded, it doesn’t set in the joint really well, and it rises up. The big problem with that is, as you can see, is when that humerus rises up, the humerus, especially the greater tubercle, tends to bump into the acromion and pinch anything that’s coming underneath there, like the supraspinatus tendon.

So it tends to ride up and a little bit forward. We’re gonna do several techniques on some of the rotator cuff muscles to help mobilize the head of the humerus back into the joint. And create a situation that allows for better healing. So that’s gonna be our goals. We’ll look at that on the the techniques, but let’s look at a little bit more anatomy first.

So we’ll go to the slides.

So this netter image we have from above. We have the rotator cuff muscles. So the trap trapezius, upper trapezius has taken off. We have a couple other images. We’re looking again at the back surface the posterior surface of the scapula and shoulder girdle, and then we’re looking at the anterior surface.

Pretty much what we just saw a second ago. We’re looking at the anterior surface of the shoulder girdle and the rotator cuff musculature. Let’s start with the upper portion. So we have the supraspinatus, and the supraspinous fossa. SI 12 would be going right into the belly of that muscle into a motor entry point of that muscle for reference.

That muscle then continues lateral. We would have LI 16 getting close to the myo tendonous junction. The supraspinatus is going underneath the acromion to attach to the greater tubercle right there. So this is a common area where it’d get impinged in shoulder impingement syndrome. We can start getting a tendonitis or tendinopathy.

Of that supraspinatus tendon very easily because of instability there can’t really see the in infraspinatus and Terry’s minor super well from this perspective, but we can see ’em wrapping around and going to the greater tubercle also. And then from the front we have the subscapularis on the subscapular fossa going to the lesser tubercle.

So from the back surface there’s a better view. We still have supraspinatus, but a better view of the infraspinatus. Looking at the fiber direction, going up and out. Terry’s minor, we’re not gonna look as much as at Terry’s minor in these techniques, but it’ll cover it somewhat. And then subscapularis from the front also going up and out in its fiber direction.

So just a image with some points in, for some reference, we have SI 12 in the supraspinatus. We have SI 13 in the superspinatus. I 16. All of these are very protected. As long as your measurement’s good, very protect is protected by the subscapular fossa, that needle can go straight down and it’s gonna be protected by bone as long as I’m not way forward and diving the needle down through the trapezius higher, farther forward than the supraspinous fossa that could cause a pneumothorax with deep needling there.

If I’m measured correctly and I’m, relatively close to the spine of the scapula, very safe points. Sometimes people even thread from Ally 16 underneath the acromion towards Ally 15. So it’s an interesting aspect is that we have ally channel points more at the tendon aspect. We have si 12, si 13 much more related to the belly of the muscle.

You can go back and review and recall that the Ally channel intersects. The small intestine channel at SI 12, and you can see that there is quite a relationship there. From the back we have SI 11, 10 and nine, wrapping around the Terrys minor. So you can see the SI channel really relates quite a bit to the the rotator cuff musculature.

And then from a, from the front, we have heart one, an opposing muscle group in the sense that it does similar. Activity that it stabilizes the head of the humerus, but it does internal rotation versus these si channel muscles which do external rotation. So the heart Sinu channel has a slight different capacity in its in its actions, but there’s heart one would go deep into that.

Subscapularis, we can see it almost better from this top image where we would be going through the axilla. The arm wouldn’t be going through the anterior deltoids like this. So the arm would be up, it’d be going into the axilla parallel with the rib cage deep needling into heart. One would access the subscapularis a good technique to really learn in class if you’ve never done it because there is a pneumothorax thorax risk if it’s not done properly.

But we’ll look at a manual technique, which is great practice for this needling technique. And it’s actually a very effective technique in and of its own. So one last image. So this is gonna be our basic goal is we’re gonna. Sink down into the supraspinous fossa for the supraspinatus, and we’re going to slowly spread posterior to anterior.

We’ll do several passes covering the length of the muscle. My goal is gonna be to reduce tension, in the supraspinatus, but particularly that sinking down. I wanna notice that muscle attaches to the greater tubercle. So I want to do the technique in such a way that’s gonna drop descend the head of the humerus.

Same thing with the infraspinatus. I’m gonna sink in and slowly spread cross fiber through the infraspinatus muscle and using that muscle as a lever. I wanna pull down the head of the humerus. So we’re gonna be using the myofascia to move the humerus down so the slow spreading over infraspinatus, slow spreading over supraspinatus.

We’ll have that goal. Descending the head of the humerus. We can almost think about these as ification techniques because these muscles tend to get inhibited and they don’t properly seat the head of the humerus into the joint, into the glenoid cavity. And then the final technique we’ll look at will be face up, will be coming deep in the heart, one pinning the tissue, and as the patient does movement, there’ll be an influence down also to help descend the head of the humerus.

But this will be more of a pin and stretch technique, and it’ll be more of a sedating technique. So very frequently we have a situation where this muscle is in excess, this muscle is overactive, the bully. And it tends to create a little internal rotation, pulls the joint forward, but collectively those rotator cuff muscles are failing to seat the head of the humerus into the joint.

And that sets the situation up for the. Bone to rise up and pinch that supraspinatus tendon. This is something we work with quite a bit in our upper extremity class in sports medicine, acupuncture. So this is something we go through quite extensively in our upper extremity class, in sports medicine, acupuncture.

We go through a lot of the dynamics of this, but we’ll get a flavor of this through the videos that are coming up. So let’s go ahead and watch the first video on supraspinatus and we’ll come back and review some of what I just said with the infraspinatus to set up that next video. Look at some rotator cuff techniques.

First of all, just a little bit of cocoa butter. You can see on my finger, not a whole lot. I’m not even gonna put it on patient, just get it on my hands. So just a little bit of lubrication, but I want it to be mostly grab on the connective tissue. So more shearing type techniques. So not too much lubrication.

For the first one on supraspinatus, I’m gonna have the arm up on the table. There’s the spine of the scapula. I’m gonna move this technique. I’m not gonna use my finger like this. I’ll show the full technique in a second, but I’m gonna move the trap slightly out of the way so I can sink down into the supra spinous fossa.

And my target will be on the supraspinatus, but I wanna see the head of the humerus drop down. So this is primarily a technique to drop the head of the humerus down in the glenoid cavity. Using the supraspinatus as a lever. So I’m gonna come at the head of the table, hands on the spine of the scapula, move the traps out of the way, sink down into the spine.

Supraspinous, fossa, and descend the head of the humerus.

Pushed down. I wanna see that head of the humerus drop down. My thumbs are in contact with the supinate and I’m just gently spreading over it.

Spine of the scapula. The head of the humerus push down

spine of the scapula decent. The head of the humerus push down

and I’m just covering the range of it. So right at SI 12, slightly medial to SI 12. Going closer to SI 13. Moving lateral to the region of Ally 16, and I’m just covering as much of the s spine as fossa as I can my last pass.

Alright, so infraspinatus, just the review, I’m gonna be spreading, sinking in kind of at the spine of the scapula. I’m gonna be spreading down and out going across the fibers, but with that emphasis on pulling downward to help descend the head of the humerus. So it’ll be a down and out slow spread myofascial release type technique through the infraspinatus.

Let’s go ahead and look at that technique. So for infraspinatus, I wanna bring the arm off the table. About 90 degrees, unless the patient has some pain. With that, you can make it a smaller angle, but my preference is to be 90 degrees. I’m gonna come back to the head of the table infraspinatus. The fibers are going up and out, so towards the greater tubercle.

So up and out, I’m gonna do a pass across the fibers of it. Again, it’s like I wanna pull through that muscle to drop the head of the humerus down. This one I often use a knuckle, maybe two knuckles. I turn my ulnar side away. That way my bones are lined up. I can start at that spine of the scapula, sink down into the tissue, move the tissue down and out, and I’m gonna start to slowly spread through the infraspinatus.

So just a slow stroke, waiting for the tissue to soften, not trying to rush through the tissue,

getting small fasciculations along the way. And there we go. So same thing, I’m gonna go slightly medial or lateral. I went medial in this case, sink down into the tissue to the depth of tension and shear down and out.

I’m just covering the infraspinatus, so I’m at the lats now. I’m gonna stop there.

Move slightly lateral down and out.

So one more pass. I can add patient movement with this. So the infraspinatus is an external rotator. I can have them do slight external rotation. Then slight internal rotation as if they’re bringing the arm back onto the table. So just the comfort just to get a little movement as they’re doing it. Go and relax there for a moment.

So I’m gonna sink in first, drop into the tissue, and go ahead and do that slight motion now. External rotation, I’m just holding that barrier. That’s good right there. Internal rotation, go back the other way, and this way it’s gonna start to stretch through that tissue. That might be a little more challenging for the patient.

External rotation, so the hand comes up and hand back.

Good. Do one more. Pass there. Hand up. And then hand back. As he starts going that way, I’m gonna really spread through the tissue.

And there we go. That’s good. Alright, so last video and last technique we’ll look at will be for the subscapularis. Again, this is a really good technique if you’ve never done deep needling into heart, one, not only can you get a lot of results and improvement with patient’s conditions by doing this technique.

Maybe that’s all you ever do, but it also does set up the palpation and the sort of kinesthetic awareness of doing a deep needling technique there. So we’ll look at a manual technique for the subscapularis. I’ll hold off on the needling technique because I think this is best left for classroom in person instruction.

If you’ve not needle the subscapularis deep in the heart, one. It’s a safe technique. If you’re taught properly, you’re pretty close to the rib cage, you’re following parallel to the rib cage and you’re going straight down into the subscapular fossa. So if you don’t have the palpation down, the needle could advance into the between the ribs and into the pleura and causing pneumothorax.

So it’s definitely a technique to learn in person with guidance if you’ve never done it before. This manual technique, however, will be very useful to get the palpation down. And the manual technique is extremely effective in and of itself. So I’m gonna do, just like I would do with the needle technique, I’m gonna reach under the scapula, move the scapula out just a little bit.

It doesn’t move it out much, but it gives you a little bit of extra space. I have the lats peck, I have this little triangle right in there. I’m just gonna come in. A couple tricks with this is I don’t want to grab too much skin. ’cause as I advance down, you can feel how that’s pulling skin and it stops me from going too far down, doesn’t feel great on his end, and then it stops me from doing the technique.

So I need to get the skin out of the way. By that I mean I need to lift it a little bit, move my fingers around, kinda get to where I’m gonna go advance down into that subscapular fossa without pulling a lot of excess skin. So I’m gonna now angle straight down. I can feel the ribs on my fingernail side, and I’m gonna angle straight down into that subscapular fossa cross fiber feeling for bands of that subscapularis muscle.

It’s almost like I’m going to si 11 on the front of the scapula, so this would be deep in the heart one. So once I’m there. One of the things I can do is I can have the patient move their elbow down following the angle of the arm. So they’re making their arm long. That might be enough, but but if they can, then I’m gonna have them start to bring their arm up, keeping the elbow out.

There you go. Keeping that elbow out, bringing the fists slowly over the chest, reaching the elbow out. I really wanna. Push the subscapularis down while they reach the elbow out. Decompress the shoulder joint so as much as they can bring you in by bringing the arm up, the better. So they’re gonna get the hand up.

And now external rotation.

To about there, and then if they can bring the fist down towards the table.

There we go. All right. So JT has pretty good range of motion, so that makes it look a certain way that is not necessarily achievable for somebody who, has limited range of motion and this technique would be too much for ’em. So sometimes you can’t even get the arm up to 90 degrees.

It’s okay to back it off a little bit. I don’t wanna put them in an unstable position. I definitely don’t want that humorous. Can you kinda shrug your shoulders as I do this? I don’t want, yeah, I don’t want that arm to shrug up as I bring their arm to 90 degrees. I’m working at counter purposes, so I need that head of the humerus down.

Maybe I can only get ’em up a certain amount. I can definitely get them to reach the elbow out and decompress, pull the head of the humerus down as I’m pushing the subscapularis medial and freeing the subscapularis. That would be enough for some people. Maybe they can lift their arm up a little bit, so you just have to work with where they are.

But the starting position would be to get into the muscles. Okay, if I do this again, so to get down into the muscle. Feel that subscapularis, I’m cross fiber in it right now. Get on that band. I wanna almost bend that band and just gently reach the arm out, decompressing the head of the humerus.

They could also go into external rotation here, but I like them to be able to bring me in by going into horizontal a deduction to bring me more into the muscle. Maybe that’s as far as they could go. JT can go farther, but I’m just saying maybe a patient you’re working with that’s their end point.

No problem. I can work there, have them reach free. Maybe next week we’ll come back and see if we can go a little farther.

Alright. Very good. Thank you for taking the time to watch those. You can see those techniques take a little bit of time, but not particularly much. A lot of that was me explaining and setting up the techniques. You could easily do this if you had the face down portion. You could take the needles out, do these techniques, spending a couple minutes going through the superspinatus and the infraspinatus to help descend that head of the humerus.

It wakes up the muscles. It helps give them proprioceptive awareness so that they can more appropriately pull down. Head of the ERUs and seat, the head of the humerus in the joint. If you do a second round of treatment and you do whatever on the front, maybe even including the needling for subscapularis, you could follow up with this technique on subscapularis.

Or maybe you don’t do the needling on subscap. This is a really great manual technique to cover that that range of the muscle. Something to consider. My last thought on this is point combinations. Is if there is this excess in subscap and more inhibition sort of deficiency in the small intestine channel muscles.

Infraspinatus, supraspinatus, te minor. A combination I use quite frequently is the source point on the SI channel SI four and the low connecting point on the heart channel heart five. So a source low connecting combination. Feel free to comment. I’d love to hear some other point combinations you guys do that might, you find, give good results and good responses for these types of conditions, or if you use that that low source point combination. Tell me if if you feel like that’s been a useful point, combination for you. Always nice to learn from each other, so I’ll be checking out the comments and maybe we can have a little bit of a conversation about that.

Thanks again for taking the time out and watching this, and thanks to American Acupuncture Council for having me. So it’s always great to be able to do these webinars and I appreciate the opportunity. Hope to see you guys next time.

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One of the things we were doing is evisceration and kind of exploring those internal branches of the channel. So this is gonna be a very anatomical perspective of that internal branch of the kidney channel. We’ll go over the anatomy.

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Hello, thanks for joining and thanks to the American Acupuncture Council for having me again. My name’s Brian Lau and I teach with the Sports Medicine Acupuncture Certification Program. I also have a YouTube channel, Jingjin Movement Training, where I go over a lot of channel oriented approaches to movement, especially for the Jing J or channel Send You Perspective.

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So check out my YouTube channel if you get a chance. You’ll see some very similar ideas that I’m gonna be presenting today. So what we’re gonna be looking at today is we’re gonna dive into the internal branch, or at least a portion of the internal branch of the kidney channel. In sports medicine, acupuncture.

We have some three day cadaver dissection classes, and I just finished one. I. One of the things we were doing is evisceration and kind of exploring those internal branches of the channel. So this is gonna be a very anatomical perspective of that internal branch of the kidney channel. We’ll go over the anatomy.

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We’re gonna look at some netter slides. We’re not gonna look at cadaver images, but they’re drawn from, or they’re illustrated from cadaver dissection. Very good illustration, so we should get a somewhat of a clear idea. What those internal branches look like. There’s really no substitute to doing it in person though, but this will be pretty good.

We’ll get a little bit of a window into that internal branch of the kidney channel and then we’re gonna look at a very simple movement exercise that will kinda stretch, move some of those fossil planes engage that internal branch of the kidney channel. This is something you can do for your own cultivation and development.

It’s also a very easy exercise to give to patients. So I’ll give some thoughts on prescribing it to patients. So a lot to look at, but it’ll be a fairly easy and straightforward exercise that we can we can extrapolate from that to be able to put movement into that portion of the channel to really be specific in our thought process for the movement through that plane.

So let’s start with looking at the channels. We’ll go to the presentation. And start right away from one that you’re very common and familiar with is this Deadman image from a manual of acupuncture. We know the kidney channel, so you know, the kidney channel coming up, the medial portion posterior or medial portion of the thigh up into the abdomen.

I would say at the level of the transverse abdominis when you’re needling, that, that would be deep to the rectus abdominis and getting the deepest abdominal layer. Then it goes up into the chest and terminates, but. We’re gonna look at this internal branch, especially in the abdomen area. So let’s zoom into this area that goes from the urinary bladder and to the kidneys.

Many people think this follows the ureters that makes sense, but we’re gonna be looking at a whole fascial plane. First off, let me say from this Deadman illustration that from an illustrative standpoint, he draws or not whoever the illustrator is, they draw this much bigger. The kidneys are very large and it looks like this.

Whole internal branch is very anterior, but that’s not particularly it’s useful for the illustration to see the structures, but it’s not very informative of where this actually lives. It would be just posterior to the midline. So if you think about this internal core, this portion of the internal branch is gonna be on the back portion of the core.

And by core I don’t mean core musculature, I’m talking about the central. The the peritoneal cavity, this is in the back. This is retroperitoneal, so it’s closer to the front of the spine, closer to the back, but it’s pretty center back center. So keep that in mind from this illustration. When you come back and use this as a guide, understand that this is not forward as we’re seeing in the illustration.

So let’s look at some netter images and get a little clarity. So first thing, this is the anterior, the ventral portion of the peritoneal cavity. This isn’t the target we’re looking for today. I just wanna walk you in. This would be pretty much the approach we do when we do eviscera evisceration, where we’re taking the ventral cavity.

We’re taking the contents of the peritoneal cavity out of the body, putting them on a table to study. They’re still connected through their peritoneal connections. They’re still all, it’s all one piece. It’s still organized. You just have to put it on a table and you can study it out of the table instead of trying to look in the ventral cavity.

But when we first start, everything’s intact. So we’ve, reflected back the abdominal muscles. We’ve cut open the peritoneum. This would be the first thing and what is the stomach. You might see a little portion of the liver, but it’s a little more buried under the ribcage, the stomach, and the greater omentum hanging off of the stomach.

It’s not the subject of this of this presentation, but I can note that this, in my opinion is what’s being described by the internal branch of the lung channel because this greater momentum hangs off the stomach much like it’s described as connecting with the stomach. It hangs off the stomach if you lift the greater momentum up, which you can do very easily unless there’s been a lot of peritonitis and scar tissue.

You’ll see that the transverse colon is attached intimately right to the back surface of that greater momentum. And when you look back at the lung channel, it comes off the stomach and links with a large intestine. I think they’re not describing a channel per se, but a plane they’re describing anatomy with this particular internal branch.

We could go more into that another day, but just to highlight the start of what we’re looking at, because once we have that ventral cavity open. We’re gonna start to come in and gently cut away the abdominal contents from the parietal peritoneum from the peritoneal wall. So that’s gonna be our first access.

And over time it’s gonna maybe look something like this. I’ll tell you when we do evisceration, we’re cutting the intestines out also. But we’re gonna come around the intestines and go behind them to the posterior abdominal wall and eventually. You’re gonna see the strong connection of the small intestines to the root of the mesentery that goes basically from the jejunum all the way to the ileum.

So I put this slide in here just to highlight how stronger bound the abdominal contents are to the back of the abdominal wall compared to the front of the abdominal wall. But it also gives us a window in how we would do the evisceration would be coming around the intestines. Maybe this image doesn’t quite show that as well as this image.

This image is showing a cross section so I can see where I might bring that scalpel around the intestines and cut it away from the abdominal wall. I’m gonna follow in front of the kidneys and in front of the perren fat, which is generally much thicker than what in this in this image.

I’m gonna come around the inferior vena cava. Generally, when we do evisceration, we go behind the pancreas. The pancreas, at least a majority of it is retroperitoneal. So you could go in front of the pancreas. We usually go behind the pancreas, take the spleen out, and take the whole abdominal contents out.

So you know, you have one person lifting up. Pulling everything to the right while there’s gentle cutting, maybe move, pull to the left. Gentle cutting. Eventually we bring the whole abdominal contents up, bring the liver away from the diaphragm, clamp the bowels, cut those so we can eventually lift everything and remove the abdominal contents.

And once that happens, this is what something like this. This is a pretty good illustration that doesn’t quite. Look like it would be in, in a a real body. It’s simplified a little bit to make it a little bit easier for, for study for med students and such. But we’ll see that the intestines were removed.

Some things were kept in this case, the pancreas was kept in this netter image. Like I said, I usually go behind the pancreas and bring that out. The kidneys are left in though there’s a lot of perren fat around them. You don’t actually see the kidneys until you remove that fat. The adrenal glands are left in.

A lot of the vasculature is left in so we can study. In dissection, we can study this posterior retroperitoneal space, which is basically what we’re looking at. Especially if the peritoneum was cut off in this illustration, it’s left on. So imagine this film of the peritoneum off, the pancreas out.

That’s what we really end up with, is that retroperitoneal space. And this, in my opinion, is that internal branch of the kidney channel. It could follow the ureters. There’s the ureter. To the kidney from the urinary bladder. So urinary bladder to kidney. So the ureters are in there, but I don’t think of it as necessarily like a line or a space.

I think of it as a plane. I think they’re talking about this retroperitoneal space. And when you’re doing this dissection, it’s amazing how loosely held all of this is. You’re using a scalpel, but sometimes you can just tease it apart with your hands. You have gloved hands of course, but you can tease it apart with the hands and break up.

Some of those little cross links that are connecting the peritoneum to the retroperitoneal space. It’s very loosely held. Now. It’s a large space, so collectively there’s some integrity there, but individual spots of that are pretty loosely held, or at least we want ’em to be fairly loosely held. We want a little bit of movement in that plane.

And this is what I wanna explore with the exercises I’m gonna show is not to think of the movement exclusively as musculoskeletal movement. Yes, the muscles are gonna be active. Yes, the spine’s gonna be moving. But can we sense, can we bring our attention and our awareness to that space that’s in front of the spine and let that sort of elongate and come back up and move.

Can there be some movement there to increase circulation in this internal branch of the kidney channel? So what is in this retroperitoneal space? We have the kidneys. That’s gonna be a big part. The SOAs, you can see a little shadow of the SOAs. Right in here. It’s covered by a lot of the fascia in this retroperitoneal space.

So to view the SOAs, you’d have to remove that fascia, but you can see the outline of it there. The kidneys are intimately tied to the SOAs. So the SOAs would be a big part of it. The ureters going down to the bladder. A lot of the blood vessels. So if we can get movement in this plane what’s gonna happen with the aorta and the inferior vena cavas, those can create a little bit of a stretching and elongation to help for their suppleness because that’s very important that they have a certain amount of suppleness in those vascular structures.

There’s lymph nodes, pancreas is in there, but I’m not sure if that’s relevant for the internal kidney. Channel as much as it is, maybe other aspects. But the pancreas would be in that retroperitoneal space. A lot of nerves coming through there. The perren fat that covers the kidneys, but there’s a lot of other fat back here that has a lot of implications for health.

It’s a very metabolic tissue. So there’s some hormone production from that. I don’t know if movement would help that, but I think that just getting circulation and free movement in that area can’t hurt. I think it has a lot of implications for health, not in an area that’s been explored much in terms of how we understand movement, but I think there could be a lot of implications for improved health, and maybe that’s one of the mechanisms of Qigong and those types of practices is to introduce movement into these internal cavities of the body.

And this one, the kidney channel in particular. All right, so just some, quick sample of some distortion of those. Internal branch of the kidney channels. I could have picked a whole lot of other types of images. But overweight is people who are obese a big portion because that abdominal wall is less tightly held in the front than it is in the back.

So oftentimes that extra weight pulls everything forward. And you can picture how compressed that internal branch of the kidney channel that retroperitoneal space was. How. Close that area is, and how little movement is gonna occur in that retroperitoneal space. Not somebody who’s heavy, but this is not an uncommon posture.

It’s a kidney deficient posture where the pelvis moves forward. We look at this in sports medicine, acupuncture. See a lot of correlations with various types of kidney deficiency, kidney in deficiency. Commonly with this, you see this with older people. This person’s not particularly older, but you see it a lot with elderly too, where the body starts collapsing, where the pelvis shifts anterior and the rib cage collapses down onto the pelvis.

And again, you can imagine that region of that retroperitoneal space. Just posterior to the midline, how compressed that area is, how compressed that area is, and how potentially little movement there is. So we wanna introduce movement, build core strength for this person, which is also involved with the kidney network, but also to start to introduce movement into that retroperitoneal space.

So that’s the last slide. Why don’t we look at the movement. It’s very much a squatting exercise. It’s a Qigong exercise, a type of spinal wave. Very simply, it’s a squat, but I’m focusing on getting an expansion and compression throughout the spine, particularly in the space we’re talking about.

You’ll still be an arm motion, it could be interpreted as a macrocosmic orbit. You know that circulation up and down the spine is the microcosmic orbit. That’ll be inherent in this movement, but then that expresses out into the arms. So you’ll see that there’s an arm component. I wanna start though, on parallel bars and just show this dropping.

You can see it a little bit better when I’m off the ground. You can see the pelvis in that area drop a little bit more than you’ll see in the squatting exercise. That’s not the exercise I’m showing. That’s just for demonstration. So we’ll show a static hold on parallel bars so I can let the pelvis drop and you can visualize that area elongating and softly, gently stretching a little bit.

Then I’ll show it in the squat activity. So let’s move to that position and we’ll look at the exercise today and keep in mind that that kidney channel internal branch. So I wanna start off with an exercise that’ll let you see what I was talking about in the slides with the anatomy.

This isn’t the exercise I wanna show, but it’s a little bit more visible. The next exercise is a little bit more subtle. So this is gonna show just that ability for the lower pelvis to drop and that internal branch of the kidney channel just elongate and stretch and have a little bit of movement and just coming up.

Into a hold on the parallel bars. I wanna initially pull the pelvis up, so I’m engaging my core to pull them, pull the pelvis towards the shoulders, and then let everything relax. So just letting gravity take the pelvis down. So it’s that initial drop sinking of the pelvis. Elongation of the pelvis and the spine, especially the lumbar spine, but that internal branch of the kidney channel will stretch.

So one more time just to see that I’m gonna do this while I’m sitting in just a moment. I just wanna let gravity take the pelvis down so I can get that stretch on the internal branch of the kidney channel. All right. I’m gonna move these.

Move that out the way. Do you want me to move it all the way outta the way, Alan? I guess it’s fine. Fine there. As long as it’s a little more.

So let’s look at the full exercise. So maybe I’ll start with a little bit of a spinal wave motion to warm the spine up. I’ll show this from the side in a moment. I’m just getting things moving. This will start to engage that internal branch of the kidney channel, but a little bit more of the musculature of the front and back is engaged.

I’m just warming up. So just a little bit of spinal wave activity. Let me show that from the side. So if you’re working on these exercises and following along with this, I just wanna initiate that from the pelvis tuck. The pelvis under chest comes down, so rectus abdominis is engaged back, muscles are engaged, front muscles are engaged.

I’m creating a circulation up and down the spine.

Exhale, if I wanna bring my breathing into it. Inhale, exhale, and inhale. I could do other variations of that to get the chest involved, but I’m gonna go into the main exercise now, so I’ll show it first from the side. I wanna get about a pelvic width stance outside of my pelvis could fit on the inside of my feet.

And elongate the spine, chest relaxes, and here’s that part. Whereas on the parallel bars, I want to drop the pelvis down. A little less visible, but it has a feeling of that elongation that you got on the parallel bars. So chest softens, pelvis sinks. Drop the pelvis down. Gauge that internal branch of the kidney channel by letting it just relax and stretch.

Sink. Let it go. I’ll do a few more from the side, and then we’ll look at it from the front.

All right, so chest softens, everything comes slightly in. I have a very slight hollow shape to the spine. Then the next part is I wanna let the pelvis sink. Let the pelvis sink. Let the pelvis sink. Everything’s getting longer inside. Eventually the whole body’s gonna start coming down, but there’s a moment where my pelvis is moving away from my head as I push up, everything’s coming together as I fully stand up, everything’s spreading apart.

Chest is coming higher than the pelvis. Chest sinks down towards the pelvis. Pelvis sits away. Pelvis comes up, chest expands away, chest softens down, pelvis sits away. So I return length to the body. There’s like a compression, a lengthening. I don’t wanna go down all compressed. I don’t wanna lean forward.

I wanna let everything drop, stretch, elongate, relax, soften inside, and just let it go. Okay, so a couple times from the front. So again, the setup is hips can fit between my two feet. So about the inside of my feet are about as wide as my hips. I’m going to open the chest, press up, relax the chest, sit down,

press up, get taller, soften the chest, sit the pelvis away.

Sink down, push up.

And up.

All right, that shows the main exercise, very subtle, quiet exercise. You can show it for patients quite easily. Easy to work with, easy to work with for yourself. But a couple highlights is that you can watch out for is sometimes people don’t have enough strength on the adductors, or excuse me, the abductors, so when they go down, the knees collapse in.

So that might be something to work with. Of course flexibility in the spine. You don’t want ’em to be like you saw from the side, very rigid or sticking their behind out. A lot of that can be strength and flexibility. So I’m gonna take just a quick step forward and note that I might use something to hold onto.

Especially if I’m giving this to patients and they’re new, I have a TRX in my room, so TRX might even be better if there’s a slight angle where they’re holding onto. But even just kitchen sink, parallel bars, a door, something like that, just so they can go down in a controlled manner, let the pelvis sink down and just having something to hold onto can make it a little easier so they can concentrate on not letting the knees pull in.

They keep the shape open, they can. Work on just letting everything soften and just having that extra little support can be very helpful for ’em pushing up. The other thing is they don’t have to go super low, right? If it starts getting distorted, going farther than that, maybe that’s where they stop for now, push up, et cetera, so they build the leg strength, build the flexibility.

Build the relaxation to let the spine go and holding on is a perfectly acceptable way to do it.

So simple exercise, but it offers a ton for patients and even just for your own self practice. All right, so I hope you found that informative. It’s one exercise. I particularly like that exercise and I use it a lot in my own practice, and I do show variations of that to patients. But I think the bigger thing is to start thinking about therapeutic functional type movement patterns and considering that visceral component.

How does that move the inside? How does that move and engage these internal branches of our channel network? It gives you a different perspective on movement instead of just thinking about the muscles that are involved. And I think there’s a ton of implications for health and development and wellness from that.

So play with the ideas. You can use this exercise for this particular internal branch, but it’s not tied to one exercise. It’s a. It’s a thought process that, a change in paradigm, a paradigm shift for movement. So give it a thought, put it into your own practice and see see how it goes.

So thanks again to the American Acupuncture Council. I always appreciate having the opportunity to come on and present. Hope you found this informative. Again, if you wanted some more information, you could look at my YouTube channel, Jingjin Movement Training. I cover a lot of these types of exercises, and again, from a channel perspective but there will be other times we’ll be here with the American Acupuncture Council.

We’ll look at some other ideas with it at that time. So thanks again.

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We’re going to look at a club exercise today. It can be used for a patient exercise or maybe for your own practice, but particularly we’re going to look at shoulder girdle mobilization. And ribcage mobilization.

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

Hi, I’m Brian Lau and I’d like to thank American Acupuncture Council for having me back. We’re going to look at a club exercise today. It can be used for a patient exercise or maybe for your own practice, but particularly we’re going to look at shoulder girdle mobilization. And ribcage mobilization.

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So we’re going to be working with the Zhui Yin channels, the liver and pericardium channel. Why don’t we start by just a quick review of those channels, particularly the sinew channels. And then we can look a little bit at the anatomy and apply that to the exercise. So I’m going to put the presentation up and we’ll start looking at that information.

So this will be, again, a focus on the Zhui Yin channels. First of all, just quick review of the primary channels. We have on the left, we have the liver channel. Liver channel starts at the inner space between the first and second metatarsal, comes up the medial leg and thigh. This isn’t as much of what we’re going to be looking at today.

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Comes up into the groin and circles the genitals, and then this part will be a little more important as it traverses up the abdomen We’ll look at how it follows the line of the external obliques to liver 13, the motor entry point for the external obliques. So it’s a major innervation site for the external obliques.

It encircles the stomach when it comes internal. We’ll glance at that real briefly. The rest of the external channel goes to liver 14. Also in the external oblique muscle. And then the internal branch kind of connects in through the throat and the head. And we’ll leave that for another time.

Pericardium channel goes on the midline of the anterior part of the arm. Follows the median nerve. But then it comes up into the chest, also links to the side of the chest I guess you could say to the breast for women, but I would really consider it more in the soft tissue like the serratus anterior.

So with that in mind, let’s go to the Sinew channels. Sinew channels for the liver sinew channel really ends at the groin, but I extend it a little bit further. We’ll see this softer color one is really more of an internal portion that goes a little deep into the deeper musculature of the psoas, iliacus, and the quadratus lumborum.

But then they’re also, it also links with those external obliques, which is going to be a major component of rotation, which we’re looking at today. And it connects then with the paired pericardium channel, serratus anterior, also the lower costal fibers of the pec major and down into the arm. But we’ll notice as we look at a better anatomy picture that this, Serratus anterior branch is going to wrap around the back.

This is a way that I extend it and it’ll connect in the back with the rhomboids. It creates a sling with the rhomboids rhomboids in the serratus anterior. So let’s look at that anatomy. First of all, on the far left, we have that liver sinew channel ending at the groin, but it’s on that same myofascial plane.

As the iliacus and the psoas, iliacus then connects with the quadratus lumborum. Quadratus lumborum takes us to the twelfth rib, it’s between the ilium and the twelfth rib, and links with the diaphragm. We’ll see a lot of the movement we’re doing today is going to move the lower rib cage and mobilize that area of the diaphragm and the liver, which sits right under the diaphragm.

So we’ll note that anatomy there internally. But on the outside, we have the serratus anterior from the pericardium channel. interdigitates with the external oblique and creates a sling that wraps from one side all the way to the groin of the other side. If we follow the pericardium channel around, the serratus anterior goes under the scapula, attaches to the medial border of the scapula, but really it links fascially, seamlessly with the rhomboids.

When we do Dissection with the Sports Medicine Acupuncture Program, we look at this rhomboceretis sling. And sometimes you can take some time and actually tease those away from the bone and see that they’re continuous sling of tissue. That’ll link into this spleniosurfaces and capitis on the other side, so the opposite side neck.

So from one side of the neck, in this case, in the image, the left side. It’ll wrap around the right ribcage, link with the liver channel, continue along the right torso to the left groin. So it creates a sling around the body, very similar for those who know anatomy trains to the spiral line that Tom Myers talks about in his book.

If you’re not familiar with that, I wouldn’t worry too much about it. But it’s a very similar anatomy to that, though I take it a little bit slight alteration of how he organizes it. But the important thing to note today is it’s a spiral. It’s a spiral that facilitates rotation. And when we’re working with patients who have rotation type postural issues or discrepancies from the left and right, these channels would be largely involved.

The liver itself has a range of motion. It has a movement in the frontal plane follows if it stabilizes along this ligament, it’s called the triangular ligament, but if it stabilizes along a particular ligament that attaches to the diaphragm, The liver can move up and down more on the right side.

So it has a movement on the frontal plane. It has a movement in the transverse plane, and it has a movement in the sagittal plane. We’ll look at those, maybe I’ll demo those real quickly when we come out of the PowerPoint. Bottom line for now is if we’re going to mobilize this lower ribcage, we’re also going to be moving and massaging the liver and moving the diaphragm.

So diaphragm movement, liver movement, I guess spleen movement on the opposite side, but the liver is our thought for the day. And then the pericardium. Pericardium has attachments to the sternum, to the ribs, to the spine in the back. So we’re going to be moving the shoulder girdle. It’s going to pull on the thoracic spine, move the thoracic spine.

That’ll have some massaging. immobilization for the pericardium organ. So let’s look at that sort of on me. It’s easier to see it on a person than it is on the slides, but at least you have a view of the anatomy. So first of all, I have this club. I’m gonna grab this in a second. I’m just gonna put it down for now.

The liver itself, when we’re doing this movement, we want to be able to move that liver so it can move in the transverse plane, wrapping around with the ribcage, wrapping around with the ribcage, so we’ll notice that motion. We’re not going to have as much of this frontal plane motion.

That’s not going to be as big of a part of the exercise I’m doing today, but we might have a little bit of that sagittal plane motion. But primarily, we’re going to be looking at that transverse plane motion because as I swing the club, it’s going to pull the ribcage open. There’s also going to be a lot of movement in the shoulder girdle, thoracic spine, so that’s going to be moving the pericardium.

So that’s it. We’re going to use a club. It’s a really good way to work with this rotation. We’ll do a little bit of a progression. If you’re doing this yourself, you can start off with the first easier version and then progress up. If you’re working with patients who have shoulder issues, you just have to know when to give them the next level.

I’ll give some thoughts on that. A couple thoughts on the clubs themselves. I do have some variation of clubs here. I have some solid metal ones. 15 pounds, 10 pounds, and 5 pounds, even that little small one on the farthest away from me is a 5 pound, but it’s solid metal. So it looks very similar to this plastic one with metal filling, which is 2 pounds.

2 pounds is probably a really good place to start. These clubs are top heavy, purposely. So they can tip very easily and if people aren’t doing good motion they can wing their shoulder in a position that’s not particularly helpful. I have a three pound for the day’s demo. I usually use a five or a ten pound for these swings depending on what I’m trying to accomplish.

But start light, find the pathway, you don’t want to hurt yourself. So it’s better to start light. It’s a lot more, three pounds is a lot more than it seems when you’re swinging. that club around and throwing it. So if you have a good pathway, it’s an efficient movement, but you don’t want to start too high.

All right, so first progression. First progression, we’re not going to swing it overhead. We’re just going to go forward, back, forward, back. I want you to notice the ribcage. As I swing back, pulls the ribcage. open. I want to let it pull the ribcage open. So a couple things first, if you’re following along with this, I want to highlight something, is when I swing back, I’m turning my palm out.

So my hand, if it didn’t have the club, would be facing out. I don’t want to go back with my arm internally rotated. That’s going to put my shoulder in not a good position. Particularly if I had shoulder problems, that would be very aggravating. So as it goes along the midline, I want to turn out. In, out, in, out.

Let it pull the ribcage. Pelvis is stabilized. So I’m letting the movement move the shoulders. in the ribcage, massaging the liver, so back and forth, comfortable, just letting that movement mobilize the ribcage. If you’re

working with a patient with shoulder injury, maybe they do a smaller arc. You have to start small and then work towards that full range of motion. And one last hint before we look at the next portion is don’t let the pelvis kind of drag along. I have to stabilize so that I can move ribcage and shoulder girdle.

All right, next part. Overhead, I’m gonna place it just on the spine. I’m gonna let it touch my back for this first part. I’m gonna work with the shoulder mobility, shoulder girdle mobility. I want to let the club drop down like I’m trying to scratch my back low down. Lift the elbow, and make an arc, bring the elbow in, that pulls the shoulder blade around.

Lift the elbow, drop the club, bring the elbow back. Lift the elbow, drop the club, bring the elbow forward. Lift the elbow, drop the club, elbow back. So this works on the flexibility of the shoulder joint and the shoulder girdle.

Up, around, it’s okay at this phase to help yourself. I can push up, or the big range of motion issue people have is to pull the elbow in. Up, let the club drop, elbow out. Up, let the club drop, elbow in. I’m making an arc.

Patients, or if you’re new to this, sometimes when the elbow lifts, especially if the tricep flexibility isn’t there, the club lifts. But I don’t want to do that. I want to lift the elbow. drop the club. So again, you can help yourself with the other hand at this phase and just work, take your time to get that flexibility.

Next part, I’m going to lift the club away from the back and do the same thing, but the club moves. So you notice the club points to my same shoulder corner. The club points to the opposite shoulder. Same shoulder, opposite shoulder. It’s like it makes a pendulum type motion. It swings.

Once that gets comfortable, final phase, throw the club. Swings down, throw. I’m using my ribcage, shoulder.

Same thing, I don’t want the pelvis to go too wild, so I’m stable, letting the ribcage move.

Okay, that’s forward throws for back. I want to come over the same shoulder, I have to turn my torso to the opposite side, over the same shoulder, pendulum along the back, swing out.

Open the ribcage. Open the chest, open the ribcage.

All right, so we’ll do that again on the other side, but I want to highlight a couple things just from working with people on this a lot. That I give this to patients, maybe not the full movement or maybe portions of it. And I progressed them through the whole thing. I also do it in a Zoom Qigong class. I work with a lot of people that way.

We do it in Tai Chi class sometimes and we apply some Tai Chi drills to it. But working with a lot of people with this, there’s some common mistakes. The first one is the club can get horizontal and that kind of loses the trajectory. I don’t do that. When the club swings back, it points back up and then it’s like tucking.

a arrow into a quiver. It swings around in pendulums and out. And again, you see the clubs up and forward. So I don’t want to let the club get horizontal. I don’t want that top heavy portion to throw me around and then I lose control. It’s a very clean pathway. Point up, in, throw. Up, in, throw. Same thing as I go back.

Club points up, in, throw. You can see there’s a moment in time where my elbow’s down, tip of the club is up, and then it comes through.

All right, so we’ll go through those progressions on the other side. So first one, I’m gonna let the shoulder warm up and the ribcage start to mobilize. Palm turns in, palm turns out. In, Out ribcage moves. So maybe more of the spleen being massaged on me now, but it’s still that region of the liver channel in the sinews of the liver channel,

ribcage mobilization, diaphragm mobilizes,

and I’m ready for the next one. I’m going to take the club. Onto the back, elbow up, club drops down, elbow in, elbow up, club drops down, elbow out. I’m making an arc with my elbow. I can help myself if I want to work on the range of motion.

Take the club away from the back, pendulum. So it points towards the side I’m holding the club on, pull points towards the corner. of the opposite side, it makes a pendulum.

And then when I’m ready, I’m going to take that pendulum into a throw. In, throw. In, throw.

Other direction, turn, throw.

So let the whole torso open, pull back, chest opens. out, relax down. So it’s a full core movement.

Okay. Forward again, throw.

All right. So that gives the basics of it. I would start slow, start with getting control of the club and the swinging. Start with the range of motion before you start worrying too much about throwing, but I do want to show it once from the back. So you can see that. pendulum. Because that pendulum is what makes the club a little bit more weightless.

The idea is no matter how much weight you are, you’re controlling the weight, but you’re also using the momentum to throw. So let’s look at that pendulum from the back. I’m going to turn around. So we’ll go with the forward throws. I’ll go slow with this. So it tucks in. You can see that angle.

Swings around, and then through. Swings around, through.

So it’s a pendulum type motion as I pull my elbow to the corner.

Okay, when I go back, same thing. It’s gonna be in the opposite direction. Over the shoulder, pendulum around, throw.

Alright, YouTube channel that goes through it a little bit different, but same idea. That’s Jing Jin movement training, so if you want a little extra resources but you can also watch this video, I would recommend maybe practicing along with the video a few times. To get the angles, again, start with a lower weight, two pounds, one pound if you have a history of shoulder problems, before going up to something like five pounds, or even heavier once you get comfortable with it, ten pounds.

It can be a good way of doing strength training, but you don’t want to injure your shoulder, so you want to start slow and get the pathway. Who would be benefiting from this? Obviously people who want to increase the mobility of their shoulder girdle. So people who have shoulder problems, if they have a painful arc and it’s extremely painful to get the shoulder.

up. Maybe not quite appropriate for those patients, but they could start with using it to help swing and increase that range of motion at a lower capacity. And then as they get a little more comfortable, they can let that arc become a little bigger. But then I would definitely want to start with them once they’re ready here, getting that range of motion a little higher, dropping the club a little bit more before they start throwing weight around, because it is more.

Weight than you would think when it’s away from the body but also working with back pain, especially when there’s thoracolumbar junction type pain that might radiate down to the radi to the sacroiliac joint or the hip. This motion of the torso and that flexibility of the ribcage and diaphragm can be very helpful for that.

Internal problems, liver T stagnation or any TCM patterns that involve the liver, it would be a nice way to massage the liver and create a little more suppleness. And circulation, increase that circulation around the diaphragm and liver region. So it doesn’t have to be musculoskeletal problems, it could be digestive issues, a whole bunch of things where there’s a component of liver disharmonies.

So be creative with it, there’s a lot of things you can do with it, it’s an enjoyable exercise and it’s something patients can do on their own or if it’s something you’re doing for yourself, it’s something you can do on your own. Alright, I think that’ll wrap it up for today, so again, I would like to thank American Acupuncture Council.

Maybe we’ll do a follow up to this and look at some Tai Chi drills with the club, it’s a really great tool.

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So today we’re going to present on some therapeutic exercise, some qigong exercises for the wrist and elbow.

Click here to download the transcript.

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

Hi, I’m Brian Lau. I’m with Sports Medicine Acupuncture, also with Jing Jin Movement Training. I want to thank American Acupuncture Council for having me again. So today we’re going to present on some therapeutic exercise, some qigong exercises for the wrist and elbow. Maybe a little more towards the wrist and for wrist dysfunction some mobilizations and just range of motion movements for the wrist, but it’ll also engage the elbow and we’ll look at the mechanics for both of those. So I have a presentation, we’ll go through a little bit of anatomy and then I’ll show some exercises. So let’s go to the slides and we will jump right in.

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All right, so first of all, the wrist joint is also called the radiocarpal joint. That is a condyloid joint. Condyloid joints, you can see it on the right on that image, it’s a modified ball and socket joint. This particular joint allows for flexion, extension, and it allows for, depending on your terminology, you might say radial deviation and ulnar deviation.

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You might call those abduction and adduction too, but basically those four movements. So flexion, extension, radial, and ulnar deviation. So there’s a decent amount of range of motion for the wrist joint. But then we can also look at pronation and supination that occurs at the distal and the proximal radial ulnar joint.

The exercises we’ll be doing will be employing those ranges of motion of flexion, extension, radial and ulnar deviation, and then of course pronation and supination, really pronation and supination are key to proper functioning of that joint. So here’s a little bit of an image that shows those.

I’m sure everyone’s familiar with these movements. But we have the normal ranges of motion. So for flexion and extension, normal range of motion is 80 to 90 degrees for flexion. 70 to 90 degrees for extension. So there’s some variability, but you want nearing 90 degrees. For ulnar and radial deviation, you have a little more range of motion for ulnar deviation.

We’ll look at the mechanics of why. So that’s about 30 to 35 degrees for ulnar deviation, a little smaller range of motion, 15 to 20 degrees for radial deviation. And again, we’ll look at the mechanics for that. And then for pronation and supination, we have about 90 degrees for both pronation and supination. Looking at the mechanics of the wrist, so the radiocarpal joint, there’s less space, your articulation is between the radius and the carpal bones. And there’s a little bit more space between the ulna and the carpal bones. And there’s a fairly complex structure. The triangular the triangular geez there’s a blank on the name triangular fibrocartilage complex, sorry about that is in this region.

It’s a collection of ligaments. There’s a meniscus and a disc. So there’s a lot of anatomy here that can get injured. That TFCC can become injured, there can be tears in the meniscus, and tears in the ligaments in this structure. But there is a little bit more space, and that greater space allows for greater movement and ulnar deviation. When we’re doing radial and ulnar deviation, I just wanted to highlight a couple things with the anatomy here, is that we can do a little manual work to help open up that range of motion. And in particular, we can come in between, to the ulna, between this fascial compartment that that contains the extensors of the wrist, particularly extensor carpi ulnaris.

We can move that away. and stretch that tissue as we’re doing the radial deviation to help stretch that tissue. We can also come in at that space pretty much along the large intestine channel here between the extensors of the wrist longus and brevis. So we can go in these fascial spaces and open those up while we’re performing the motion.

We’ll look at that when we come to the actual exercises. We’re going to look at a couple stretches for the wrist and then we’ll look at a couple more complex movements. So just so we have an idea with that, when we’re doing radial deviation, we can go into this space and kind of move this fascial compartment away from the bone, move the extensor carpi extensor carpi ulnaris away from the bone and create a little bit more space as we’re doing radial deviation and same thing applies.

When we’re doing ulnar deviation, I can come into the large intestine channel along the extensor and brevis brachioradialis, this mobile wad of three is what it’s called. These three muscles that are very mobile, I can get into that fascial space and open up the compartments while I do ulnar deviation.

So we’ll look at that in context in just a moment. We can also work on the lung channel on that same. Mobile WADA3, but on the volar side of the arm, the anterior portion of the forearm, and open up that fascial space. So the elbow itself is a hinge joint that’s going to allow for flexion and extension.

We’re primarily going to be looking at the wrist movement in this webinar, but but we will employ some movement in the elbow and it’s going to be that flexion and extension. But there is also that proximal radial ulnar joint does pronation and supination. It happens at both the proximal and the distal.

Radio ulnar joint. When we’re doing the pronation and supination, it helps link those motions. And it’s the case that when I do supination, I can increase that supination by going into elbow flexion. So supination, I can go a little farther with elbow flexion. And pronation, I can go a little farther when I do elbow extension.

So there’s a relationship between the movement of pronation and supination with elbow movement and we’ll look at that in just a moment. So for pronation and supination, we have multiple muscles that perform those. For pronation, we have pronator teres, we have pronator quadratus at the distal part of the forearm, and we also have both the extensor carpi radialis the, excuse me, the flexor carpi radialis and the brachioradialis.

Thanks. Both of those help maintain a certain amount of radial deviation when I’m doing pronation. So especially, some sources say brachioradialis more, some flexor carpi radialis, but they’re both involved. with pronation. For supination, I have the supinator, biceps brachii, and then the extensor pollicis longus of the thumb, so that helps pull the forearm into supination.

So a lot of muscles involved with those beyond just the pronators and supinators. So that’s the overview of anatomy. Let’s look at some of the exercises. Moved back just a little bit. We’ll start, I’m going to stay seated. We’ll start with some wrist mobilizations. So the first thing we have is we can work on extension.

So I’m going to bring my fingers together, index, ring finger, and the index finger. I’m going to put my middle finger on top. So Thumb and pinky together, holding something away from me, and elbow extension. I want to contract the flexors and stretch the extensors. So I want this to be somewhat active in the sense that I’m contracting the wrist flexors to be able to inhibit those extensors.

I’m giving a little over pressure to stretch those. That’s a nice stretch. If I want to increase that though, I can put my thumb inside and make a loose fist. Same thing, activate the flexors that’s going to stretch the extensors and a little extra overpressure to be able to really stretch that extensor compartment and do that a couple of times.

Exhale, contract the flexors, overpressure and stretch. Maybe do that three times.

And stretch. So to stretch the flexor to turn palm up into supination, straighten the elbow, and same thing, I want to engage the extensors to help inhibit those flexors. So I want this to be an active stretch. I want to pull my fingers back, pull the wrist back into extension, exhale, and a little over pressure, maybe for about two to three seconds.

Then again, open into extension, pull the fingers back, exhale, stretch, flexors. One more time. So again, I’m active, engaging those extensors to be able to stretch the flexors.

All right, so ulnar and radial deviation. So again, there’s less range of motion for radial deviation, a greater range of motion for ulnar deviation. That’s normal mechanics. But, I would say that many people get restricted on that radial deviation part, and everything sits and lives a little bit more into the ulnar deviation.

Think about typing on a keyboard, there’s a lot of things that we would do that would favor that ulnar deviation, and that can really compress and wear down that TFCC, that triangular fibrocartilage complex. on the ulnar side of the wrist, at the sand small intestine five region. So that would be a way I could go in with an acupuncture needle.

I can stimulate that area, increase blood flow at SI5. That’s a really good point for that. But then at some point I want to be able to stretch and open that side up. So I’m going to start with radial deviation. So I’m going to put my, I have my palms together. I’m going to put my little finger side out.

Stabilize the wrist. and pull into radial deviation. So this is where I can do a little bit of manual work if I want to help increase that. I can do it by just giving a little over pressure to go into radial deviation, but now I can go along the small intestine channel right up against the bone, pushing the extensor carpi ulnaris away from the bone, pulling down, and as I pull it’ll give a fascial drag on the periosteum of the bone on the extensor carpi ulnaris muscle.

So again, move down, push the extensor carpi ulnaris away, so I can lock me down into the bone, and then radial deviation to give a little stretch. So I can work down, eventually as I go farther towards the elbow, farther proximal, I’ll run into the anconeus muscle, right about there is where I’m starting to get into anconeus, but my goal is really at that extensor carpi ulnaris.

I can work more distal and work towards SI6. which is the border of that is the extensor carpi ulnaris right there on the bone and stretch. That’s a part of the triangular fibrocartilage complex is that extensor carpi ulnaris tendon. So it’s nice to be able to work on the tendon sheath and start to loosen that up.

Ulnar deviation. If I have a triangular fibrocartilage complex, Tear, that might be a painful motion. So I have to let pain be my guide for this, but for most people it’s gonna be fine. So I can stretch this way, but same thing I can now go at the along the ally channel, at the border of that mobile wat of three, and I’m going over the thumb muscles, the extensor lysis, brevis.

And Abductor pollicis longus. These are muscles that get injured with De Quervain syndrome. They can become very painful, especially when you go into ulnar deviation. Finkelstein’s test would be just that, where you put the thumb in and, oh, that hurts, that would be a positive for De Quervain’s.

So it’s useful to stretch this compartment out. I’m going to hold and same thing, pull down, ulnar deviation. So working over those thumb muscles. And then following along that border of the mobile WADA3 to be able to stretch, I’m going right up against the bone. So into that fascial space, up against the bone, pull towards the elbow, stretch.

So this is something you could do with patients. You could also show them this as a corrective exercise. I can go also along the lung channel, pull down, ulnar deviation to stretch.

Working to free that mobile WADA3, to free the borders. and help increase the range of motion into ulnar deviation. Okay, so last mobilization, we’re going to do pronation and supination. So this one, I want to have my arm by my side because I don’t want to be doing a lot of shoulder motion. So I’m going to use index finger, middle finger.

I’m going to stand up a little bit so you can see this one a bit better. Back up.

Index finger, middle finger, surround the thumb. I’m going to use my thenar eminence to block the wrist on the ulnar side, wrap around. So I’m going to pull with my fingers, push with my thenar eminence, and increase supination. I can use my extensor pollicis longus to pull back. That’s going to increase that supination.

Lift my little finger, that’ll increase supination, and overpressure. So Index finger, middle finger, either side of the thumb, thenar eminence against the wrist, overpressure. Pronation, palm down, thenar eminence on the radial side of the wrist, wrap the fingers around, and this is the one that I really want to be cautious, not because it’s going to cause injury, but I’m going to miss the stretch not to lift my elbow because that becomes a shoulder motion.

Not very challenging on the shoulder either. So I need to stabilize that elbow to the side and just do pronation. So same thing as I can bring my thumb down, little finger up, over pressure into pronation.

All right, same thing, two, three times to start to increase that. Again, don’t let the elbow come up because that takes the stretch away from pronation, brings it up into the shoulder and it’s not going to really do you much. I need to keep that elbow up against the side, pronation. Alright, so supination, pronation.

Alright, so let’s look now at a couple Qigong exercises. I’m going to back up just another step. Move this chair out of the way. So this is a common one that I use in Tai Chi and Qigong classes. Also on my own. It’s a very simple exercise. It’s actually built from standing meditation. In standing meditation, you might have a shoulder width stance, sitting a little bit, dropping the pelvis, letting the pelvis sink down, the head rises up, so there’s a little bit of stretch in the spine, and I’m slightly engaged in the center, round.

So there’s a round structure as if I’m holding a paper ball. My hands are open, fingers are spread out a little bit in the abduction. And the wrists and the fingers are aligned. So that would be a typical standing meditation posture. When I do this exercise, I want to use that standing meditation posture.

I want to have that little bit of a drop of the pelvis, a little bit of a elongation of the head. So do 20 towards the ceiling, a little bit of compression in the torso. And I have my shoulder blades coming around. And very round like I’m holding a paper ball. So that’s going to be the starting position, and from there I’m just going to rotate.

So I want to keep in mind how the thumb and other structures are keeping that wrist aligned. I don’t want to get too floppy with the wrists. A lot of people, when they do this, they start flopping, they lose the pronation and supination. I want to keep that alignment there. Almost as if I’m going around my middle finger or my index finger even better.

So just turn, I can go slow, or I can go fast. Once you get comfortable with it, you can speed it up a little bit. And I want to just let that motion move the body. So I’m pronation supination. This one you could do for about a minute or two. Just a nice warm up for the forearm. Starts really working the wrist and the elbow joint.

Next one is going to be built from that. Same posture with the body. Turn the top palm out, reach out, other hand comes in. I want

this one to move the ribcage, maybe a topic for another day, because there’s a lot of diaphragm motion, a lot of movement in the liver and the spleen. But we’re thinking about the elbow and the wrist, so I want to be able to fully pronate, turn the palm out, straighten the elbow.

Other hand supinates, comes in.

I can make this one slightly more round if I want, and reach,

letting the shoulder blade come around the ribcage.

Alright, last one. So this one I actually did in another webinar with American Acupuncture Council, it works on opening the chest up, but it also features that pronation and supination, so pronate, pull the chest open, straighten the elbow, reach out. Fully pronate,

chest rises, open,

open. Turn the forearms, line the hands up. Keep opening, hands are slightly in front of the elbows. Pull the shoulder blades together so this one starts really working on the chest quite a bit too. Fully press out, chest starts to compress, back

to neutral. Line everything up, fully open the chest,

and finish. So three exercises, all part of a standing meditation, Yi Quan type training. Their derivatives of that, first one’s just rotating the forearms, then the forearms rotate as I reach out, mobilizing the ribcage, but it also gives a nice stretch to the elbow. Stretch and challenge to the wrist joint, keeping good alignment to the wrist, and then opening the chest,

and involving the elbow, wrist, and shoulder girdle. Alright, so hope you find those useful. Those are great exercises to do for yourself. Especially after a long day of work, last one in particular, but great for patients. I use those quite frequently for patients for a whole host of issues. We were looking today at wrist and elbow, those would all be useful for those types of, many of those types of conditions, but that last one also very useful to open up the breathing, open up the shoulder girdle, so good for shoulder health.

Any of those motions, if there’s sharp pain or something discomfort, uncomfortable when patients are doing that, you have to let pain be the guide and modify it based on that. But they’re very adaptive, easy to work with, patients find them very useful. They’re pretty easy exercises too with a little bit of coaching.

So I’d recommend doing them yourself, get used to it, and then start working with those with patients. They’re really nice exercises. Thanks again to the American Acupuncture Council. Always fun to come and to present some of this information. I’ll see you all another time.

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And this is part two from a presentation I gave on the stomach channel. So we’ll compare the anatomy of the stomach channel with the spleen and kidney channel.

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

Hi, I’m Brian Lau, I’m with AcuSport Education, also with Jingjin Movement Training. We’re going to be looking at the anatomy of the abdominal region of the spleen and kidney channel today. And this is part two from a presentation I gave on the stomach channel. So we’ll compare the anatomy of the stomach channel with the spleen and kidney channel.

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So just a little bit of a heads up I have multiple hats like many of us do. One of my main hats is I’m an anatomist. I lead dissection with AcuSport Education, but also with the University of Tampa. Physician Assistance Program. So I do a lot of exploration in human anatomy. So that’s the lens that we’re going to be looking at as we delve into these Fascial layers of the spleen and kidney channel.

But of course all of that gives a lot of clinical relevance So we’ll talk about it from a clinical perspective also. So let’s go ahead and go to the PowerPoint We’ll start looking at initially the spleen channel. So I have these, Additions to Netter’s Atlas of Human Anatomy. They don’t have the acupuncture points on this.

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Like I put these on manually. Netter is just one of the gold standards of anatomical illustrations, and it’s just such great illustrations that I thought I would add the adapt it by adding, in this case, the spleen channel. And as we know, the spleen channel is on the lateral edge of the rectus abdominis so useful information, but we can talk about the significance of that in just a second.

As we travel down to the lower portion of the spleen channel on the abdomen, we have spleen 12, spleen 13 at the inguinal ligament, spleen 12 also, but it’s on that lateral border of the femoral artery. So this will be our first window into understanding the depth in the fascial layer that makes up the spleen channel.

So keep that one in mind as we go to the next image. So what this next image is showing, also from Netter’s Atlas of Human Anatomy, is the arteries. There’s another image for the veins. They run together, but the vascular structures of the anterior abdominal wall. First of all, notice that this epigastric artery in the vein, like I said, runs together.

directly with it. That’s in a separate illustration for Netter, but that’s fine. You get the general idea that it’s running along here. That branches off of the femoral artery, or excuse me, the iliac artery in that region where it’s connecting with the femoral artery. So it’s branching off of that region of spleen 12.

And where does it go? It goes deep to the rectus abdominis, behind the rectus abdominis, And that’s the territory that it travels. In my mind, this is the Chiang Mai. This is the the vessel that you can palpate on the front. You can often feel a strong pulsation, especially if people don’t have good circulation in the aorta.

More blood shunts through this area. So it’s like a reservoir. It can open up or close up depending on the needs of the body. And it runs and follows the trajectory of the Chiang Mai. It branches into the thoracic artery and vein, which go to the breast, kind of one of the functions of the chong mai.

Sends out branches along the intercostal arteries and veins, and then eventually it branches into cervical arteries too that go up into the face. So That’s the territory that we’re looking at for the spleen channel. We’ll look at another image in a second on that. Also the chong mai follows the kidney channel points.

So again, we’re looking at a fascial layer that lives behind the rectus abdominis. And that’s going to be the deeper yin channel territory of the spleen and kidney channels. So here’s the kidney channel points. The kidney channel points are going to be on the medial edge of the rectus abdominis, pretty close to the linea alba, 0.

5 sun. And it’s going into the rectus abdominis muscle, but my target tissue is not at the rectus abdominis, but that posterior rectus sheath. So when we compare that to the spleen channel on the lateral edge of the rectus abdominis, same thing. It might be into the muscle, but posterior rectus sheath is going to be my target.

So this would be an easier image to look at if we can see a cross section to understand that layer. So here where we were last time, when we looked at the stomach channel is following these fascial layers of the external oblique, a little bit of the bifurcation of the internal oblique fascia going on top of the rectus abdominis.

The needle can get into that anterior rectus sheath, maybe potentially into the muscle. But that’s the territory, that’s the depth, that’s the region that I want to address when I’m treating it. Whereas, if I’m in the spleen channel, or the kidney channel, we’re looking at the internal oblique fascia, transverse abdominis fascia that goes posterior to the rectus abdominis.

So this posterior rectus sheath. So if I’m coming in at the spleen channel at that semi lunar line, I’m into this window of tissue that goes deep to the rectus abdominis. If I’m coming at the medial edge of the kidney channel, again, I want that needle to traverse down to that posterior rectus sheath. So I want to affect this layer here, multiple importances of that, but one very simple one is if I look at this bigger cross section, rectus abdominis.

Spine, erector spinae, quadratus lumborum. Is that fascia layer is continuous with the transverse abdominis and the internal obliques? And that’s going to continue to come into a seam at the thoracolumbar fascia as a structure called the lateral raphe. And that lateral raphe is going to separate into a deeper layer that goes between the quadratus lumborum and rector spinae, and a superficial layer that goes above the rector spinae.

So point is when I’m treating this deeper fascia layer, I’m speaking to, communicating with. The musculature like the quadratus lumborum and rector spinae. So there’s a lot of fossil communication between the front and the back through these abdominal fossil layers.

If I follow that posterior rectus sheath up first of all, let’s go back to the anterior rectus sheath. If I follow the anterior rectus sheath, part of the stomach channel, that’s going to go superficial to the ribcage. So I’m looking up at the diaphragm, there’s the xiphoid process, the stomach channel would go on the anterior surface of the ribcage.

If I’m following that posterior rectus sheath up, that’s going to blend in with the diaphragm. So it’s a different layer, only separated by, an inch and a half, two inches, pretty small distance. But but it makes a big difference internally if I’m going deep to the ribcage, and wrapping around to the back versus going superficial to the ribcage.

So this is my interpretation with the spleen sinew channel. It connects with that ribcage, excuse me, connects with the diaphragm, loops around and attaches to the spine through these attachments of the diaphragm called the cruciate the diaphragm. So when I’m treating this fascia layer, I’m going to have a much bigger impact on breathing much bigger impact on spinal health also.

Kidney channel, the kidney sinew channel doesn’t really travel through the abdomen, so I didn’t use that image, but there’s a lot of discussion with the kidney channel of how it loops into this region of related fascia. Especially with the lower rectus abdominis, it has a lot of connections into the pelvic floor, through the abdominal layers, into the multifidi.

This is the low connecting channel. It talks about that channel coming up that layer. We’re talking about posterior rectus sheath following the kidney channel to a point just below the, um, pericardium. The pericardium sits right on top of the diaphragm. So that’s exactly what it does. It comes to a point right to the, just below the pericardium, and then it loops around into the lumbar spine.

Like I said, a lot of anatomy, you don’t have to get in the weeds with it. But there’s much more of a connection with the diaphragm, much more connection with the pelvic floor, much more of a connection with the lumbar spine when we’re treating that posterior rectus sheath. That’s the take home. So let’s look at some pain patterns that are common when you’re treating the rectus abdominis.

We looked at this one with the stomach channel also because you could get trigger point formation in the belly of the muscle or at stomach 25 and this tendinous inscription between bundles of muscle. But very frequently. When there’s dysfunction here, it’s more on the edge of the muscle at that semilunar line, maybe a little bit of the obliques, maybe a little bit of the rectus abdominis fascia.

It’s like a triad between the muscle groups of the obliques, rectus abdominis, and that fascial seam where all of that fascia comes together. That can be a very prominent area for trigger point formation that can give a very gassy, distended feeling when you palpate it. Maybe that’s what patients are complaining about.

They often want to stretch that area sometimes that can refer all around to the back it can refer deep into the pelvis, it can feel like it’s internal in the pelvis. It’s a pretty broad distribution of pain that patients might either complain about or might be a component of their low back pain, for instance.

Or distention, bloating, et cetera. So along the spleen channel is the very frequent aspect of where these trigger points form. Anywhere from spleen 15 to about level of stomach 27 is pretty common. So you’re feeling at that semilunar line, feeling for fibrosity. I usually push a little into the edge of the rectus abdominis.

Another region where there’s common trigger point formation would be the medial edge. Now we’re at the kidney channel. So if I’m at that medial edge, it’s like I can scoop deep to the muscle and, I’m palpating slightly into the rectus abdominis, but I’m really feeling more for that posterior rectus sheath.

It’s like I’m going through that medial edge to get to the posterior rectus sheath. I can direct into the rectus abdominis itself, or I can direct into the linea alba along the REN channel. And same thing, a lot of pain, especially below the belly button umbilicus, maybe halfway between the pubis and the umbilicus is a common region.

It’s not going to always be exact. But along that kidney distribution is a very common area of trigger point formation for deep abdominal pain, especially abdominal pain that’s related to menstrual pain, dysmenorrhea. So for those patients who are having very difficult sensations during menstruation, this is a key area to look at.

You also have this paramedis muscle, which attaches to the linealba. That’s going to be at the lower kind of kidney 11 region that you’d have access to that. That can give a certain amount of pain in that abdominal area that can spread up to the umbilicus. The lower portions. We talked about this one of the stomach channel could be at the lateral edge along the stomach channel because this muscle narrows quite a bit as it gets to the pubic bone.

There’s not a whole lot of space on the muscle left here at the pubic bone, but really often it’s in that mid belly just off the linea alba. That’s where you frequently get this deep radiation bilaterally into the lumbar spine. And iliac crest region that can be its own pain pattern driving lumbar pain, but it might also be a component of things like lumbar facet pain.

Very important area to palpate, usually just above the pubic bone. Sometimes you even have to press the muscle into the pressing it into the pubic bone to elicit this sensation. But it’s a common area where there’s trigger point formation that could be a big component of lumbar pain that you wouldn’t necessarily think if you didn’t know the referral patterns.

Obviously you’d be palpating in the iliac crest, gluteal muscle, sacral area, lumbar spine. There might also be trigger point formation there because of its communication front to back. But don’t forget about this area. Alright, just a good netter image to see that. Spleen channel runs along the lateral edge, stomach channel runs in the middle, but as I get lower down, that line of the stomach channel really takes me to the lateral edge of the rectus abdominis.

If I move over a little bit to the kidney channel, that’s frequently where I’m going to find that trigger point formation right up against the pubic bone. Whoops.

I’m going to go back to this muscle. The other kidney channel points will take me through that medial edge so I can get to the rectus abdominis and feel into that posterior rectus sheath, spleen channel points. Again, I can through that lateral edge of the muscle at that union where it’s going to then dive deep underneath the rectus abdominis.

So any aspect that I’m needling through kidney and spleen, my tendency is to think into that posterior rectus sheath, which is slightly deeper than the muscle. So last time we looked at the motility of the stomach organ. This is looking at the kidney organ because movement in this area, if we can free the movement and control the abdominal movement we can get that flexion extension.

The kidney organ itself moves along the psoas. As I take a deep breath in, that drives the kidney down, it creates a certain amount of rotation in the kidney also, and the exhale and the diaphragm rises, the kidneys rise with it. There’s a movement from diaphragmatic breathing that if I can open that up by working on the the channels, increased breathing, that can be helpful, but it can also allow me to get a more more, efficient movement that can help mobilize the kidney organs, which is going to have good impact on the kidneys themselves, but also with lumbar pain and abdominal type situations that could be involved with the channels.

All right. So let’s look at a exercise that I do and I teach quite frequently. It’s called the spinal wave. I have a video for it. I can talk through some key points. This will be on the PowerPoint. Let me get to that slide. And this is on my YouTube channel, JingJinMovementTraining, if you want a reference, I also go into more verbal instruction on it.

But this one doesn’t have any narration, but I’ll narrate over it. Spinal wave is engaging the rectus abdominus. lengthening it. Engaging, ribcage comes closer to the pubic bone, so posterior tilt, neutral to anterior tilt, posterior tilt, anterior tilt. Same time, that ribcage drops, so this is a different variation where I bring that wave up to the whole spine.

And chest opens, but same spinal wave.

And this video shows variations with the arms and sending that energy out the arms, but whether you get that aspect of the patients, that initial one with the hands on is really the key starting position for patients, there’s a rotational version, et cetera. So you can build on it. Like I said, there’s this instruction is on my YouTube channel if you want to look at it a little bit closer.

All right, so maybe I have a few moments to go over that in my studio. I’m going to exit the PowerPoint and let’s back up and we’ll look at that real quickly.

All right, so let’s look at the spinal wave. I often, when I’m working with patients, I have them put a hand, and I do it myself this way too, put a hand on the lower rib cage and put a hand just below the umbilicus. So lower dantian. The hands aren’t doing anything. The hands are just helping me find that movement in the abdominals.

So the idea is I want to initiate that movement by pulling the pelvis up in the pubic bones. I’ll take me into a posterior tilt. Ribcage descends. Expand. Press. Expand. So I’m using the abdominals to drive spinal motion, drive kidney motion. Inhale, fill that area up. Exhale, compress starting from the pubic bone, rib cage follows.

Inhale, exhale. So you can also start this seated with patients, because very frequently patients are stiff with the spine, or yourself if you’re doing it for your own health. Sometimes they just want to do it with the knees, so they just move the knees or they move the hips or something like that.

But they have to engage the center. So pulling up the pubic bone, down the rib cage. Top hand shifts back, expand. Bottom hand shifts back, top hand shifts forward. Press, expand. Press, expand. So it takes control, takes practice, you’re engaging the front, expanding the front. You actually engage the transverse abdominis quite a bit, this one.

That’s why I like this one for the kidney and spleen channels as you’re starting to engage. Those deeper abdominal areas, exercising, massaging, increasing circulation between the front. Very nice. Thanks for checking this webinar out. Also, thank you to American Acupuncture Council, I always appreciate the opportunity to go over this information.

A lot of fun for me very exciting stuff in my mind hope you enjoyed it, and I will see you guys another time.

 

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