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.

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 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.

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 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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