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 am Brian Lau. I teach with sports Medicine Acupuncture, and with the Sports Medicine Acupuncture Certification program. I also teach with the three day cadaver dissection labs. And a little bit of the dissection is the impetus for why I’m gonna do the particular presentation I’m talking about today.

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First off, I wanna thank the American Acupuncture Council for having me. And we’ll go a little bit into the lung channel and the anatomy. We’ll look at some movement aspects of the channel also. So I just finished up two back-to-back five day dissections. I do this every year, the first two weeks of December with the University of Tampa with the Physician Assistance Program.

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So I had a lot of opportunity to look internally with the body. We did a lot of external dissection, but we also did evisceration and we went into the abdominal and thoracic cavity. So that’s with physician assistants. I’m not really talking much about channels in there but I’m always thinking about the channels and I’m preparing for when we do dissection for acupuncturists how to communicate some of this anatomy to acupuncturists.

So that’ll filter in a little bit to this presentation today. And then we’ll go into some application with movement. So you can give some patient exercises that will engage the channel in this case, the lung channel fully. So let’s go ahead and go to the presentation and we’ll start jumping into the anatomy.

So let’s get a start. We’re just gonna go right into the internal pathway. So let me get the setup for this. So let’s imagine we’re in a prolonged, like a five day dissection lab. We’ll go briefly layer by layer. So what we have here, . is on the slide on the left is we have skin on at one portion.

We have some subcutaneous fat in this ne netter illustration, but primarily that’s been removed and we’re down to the level of the fascia above the rectus abdominis, the fascial, the rectus sheath, and the external obliques. So we can see the rectus abdominis underneath this rectus sheath. If I were to

Look at it from the back surface. That’s what we’re seeing in the right image. So in this case, we’re looking from the back through the body visceral cavities removed, and we’re seeing the peritoneal cavity from the back but the front surface of it. So here’s the rectus abdominis. You can see a window of it.

But what I wanted to highlight from this image, first of all, you have the falciform ligament, but another interesting structure is a remnant of the . This little ligament, which is the umbilical ligament, which is a remnant from embryological development. And this whole line here is very tied in with the linear alba, which is that thick Foss structure that separates the left and the right side of the rectus abdominus.

So a nice imprint of the Ren channel or the Ren mine. So we’ll come back to that a little bit now, but I just wanted to highlight that. Let’s go to the next slide. And here in this image we have the rectus sheath removed from the rectus abdominus. So this is what we would do in dissection is we would start to come underneath this rectus abdominus, just creating a little separation from the rectus abdominus and the tissue underneath.

And we would start lifting it up. And that’s what we have in this side right here. We have the rectus abdominus starting to be removed, and you can already get a imprint. You can see the peritoneal. Membrane, the serous membrane, and you can see some of the fascia under the rectus abdominus. The reason I’m going to this detail is when you do this dissection, sometimes it’s very adhered, and as you start removing and lifting the rectus abdominus from the pub pubic bone and lifting it off, it starts to tear the peritoneum because of all the adhesions there.

And why would that be so adhered? We have to get into the next layer, which would be the first layer in the visceral cavity in the abdominal cavity. And I’m gonna go right to that here. And this is what we would see as we open slice that very thin peritoneal membrane. We have the greater momentum and we have the stomach hanging off.

The stomach is that greater momentum. And if everything’s moving well on that person before they passed, then you can just easily kinda lift the undersurface of this greater momentum. Lift it up. And what underneath it is the transverse colon. So it’s very adhere, not adhered, excuse me. It’s very tied into, connected to that greater momentum.

So it’s connected to the stomach and it’s connected to the transverse colon. So that’s a lot of anatomy. But I wanted to highlight this anatomy ’cause it gives us a really a window into the internal pathway of the lung channel. When we look at the lung channel, . We’ll look at it now with different eyes, so we’ll look at that in just a moment.

But I do wanna highlight that on many people when we’re doing dissection on many specimens, there’s a ton of adhesions because one of the things this greater momentum does is it surrounds pathogens. So if you had, perforation, like an ulcer in the colon, it would surround that. And there’s a lot of lymphatic tissue in there.

There’s lymphoid. Cells that are gonna take care of those antigens. Or if there is some kind of entry of of some pathogen into the peritoneal cavity, that greater momentum can migrate around and surround those areas. So people who’ve had a history of peritonitis, it’s gonna be extremely adhered internally so they don’t lift as well, and you can imagine that they wouldn’t be able to move as well.

Also. So one more bit of anatomy and then we’ll look at the lung channel. Is the greater momentum hangs off the stomach. Let’s move up into the thoracic cavity. Oops. Wrong direction. And here is the continuation of the stomach, the esophagus, as it passes through the diaphragm, and as I go a little higher up, I get into the trachea and bronchi and those also are very connected with each other.

You could dissect them away, but it’ll take a lot of work. They almost are one unit. So now we have a lot of anatomy to go and look at that internal pathway of the lung channel. So let’s look at that. Here it is. So we see these, we study these internal pathways but it’s sometimes not always clear what the anatomy is when we learn ’em.

So we can now see that yes, we do have these bronchi break branching off the trachea. We could follow down the esophagus. We’ve learned when we learned the internal pathway that the internal lung path channel pathway connects to the stomach, it loops down and connects to the large intestine.

And that’s exactly what the greater momentum does. So what I’m proposing for this internal pathway is we have the trachea and bronchi, the esophagus, the stomach, the greater momentum linking with the large intestine at the transverse colon. So structures match. It matches the description of the internal pathway, but reminding ourselves again, that greater momentum has an immune function, that it has lymphoid cells in there, cells that migrate and take care of pathogens, also links with the actual function of the lungs because they do have a lot to do with wayI, wayI and the surface of the body.

This is at the surface of the internal . Abdominal cavity, but still taking some account of the immune response or the wayI response. So function and form, both match. I think it’s a really good a really good model for understanding the internal anatomy of that internal portion of the lung channel.

So let’s branch out now to the actual main channel. . But we’re gonna primarily talk about the sinus involved with it, because we’re gonna look at some movement aspects that, that we’re gonna, I’m gonna introduce that can help stretch and open and engage that outer channel, but also engage that inner inner branch of the channel.

So this is what I have as a model and what we teach in sports medicine, acupuncture. For the lung sinu channel, we have the pectoralis minor biceps, brachii, short head and long head. This bicipital a neurosis, which is an extension of that links in with the flexor carpi radialis, and then into the thenar muscles.

That’s the superficial branch. There’s also a deep branch of the sinu channel, which is the flexor lysis, longus, flexes. The big thumb, the brachialis, which lies deep to the biceps a little bit shorter. It doesn’t cross the shoulder joint, just crosses the elbow joint. And then that links up with the anterior deltoids and the clavicular head of the pectoralis major.

So we also have the scalings in there, especially the anterior scalings. I don’t have that listed in my list. But the, there’s that superficial branch all the way up into the thumb, to the pec miner and the deeper branch that lies underneath that. The main channel would follow the course, the little spaces between a lot of these mussel.

So these could be almost like the river banks. With all the river being the communication that happens in those fossils spaces. A lot of the organisms and such in the river. You could study a river, but you need to understand the river banks, the structures that make up that river, that form that river.

And that’s what the sinu channel’s kinda so for the rest of this webinar, I would like to look at a movement, a Qigong exercise that I give to patients. I also teach in Qigong classes. And this will exercise that external portion. It’ll engage those sinews, but I also wanna show how that’s gonna gently mobilize and move and massage the internal portion, the esophagus, the bronchi, the greater momentum, the stomach.

So I think if you wanna fully exercise the lung channel, it needs to have all of those components there. And this exercise does that nicely. There’s plenty of other good exercises, but I like this one particularly. sO this exercise I have on my YouTube channel, I did it a little bit differently when I filmed it originally.

I focused a little bit more on the stretching aspect. I’m gonna put up another video, same exercise, but I’m gonna do it the way I’m showing in this particular webinar. So that should be up soon. But either way you can check out the video on my YouTube channel if you wanna get a reminder of it.

Or this recording will be available afterwards too, if you wanna have a reminder for it. So if you used it yourself, great, you have some nice memory aids, but also if you give it to patients, it’ll be something you can refer back to. All right, so let’s set it up. So this is gonna be the exercise. It’s a very simple exercise.

Anything, anytime we engage these this lung channel, we wanna engage the sinus, of course, but we al engaging the sinus will open and close the chest, but we also wanna mobilize that internal pathway of the channel. We’ll look at that kind of point by pint. This is gonna be engaging the lung channel, but really when you’re engaging channels, you tend to do ’em in networks.

So this will be really the Y Ming and tie-in channels as a whole. So that’ll be the lung and spleen channel, the large intestine and the stomach channels. But the primary focus for this one is the lung channel. So we’ll come back and look at this video afterwards and highlight some features of it.

But let’s move on to the next slide.

So this is the starting position. This video will loop and you can see it as I’m talking about it. So I’m gonna start by bringing the hands up. I’m standing shoulder width stance. My arms are gonna cross in front of the body. The forearms are supinated, which means basically the palms are facing me.

Our palms are facing the chest. The hands are a little ways away from the body, so the shoulder blades are slightly pronated and the elbows are slightly lateral to the body. So that’s our starting position. I did mention in there that you’re standing at shoulder width. This exercise works perfectly well seated.

If you’re working with a patient or yourself and you have mobility issues and aren’t able to stand even somebody in a wheelchair. I, when I work with people seated, I have them slide forward sitting on their sit bones, sitting upright, so they’re away from the seat and, their sit bones basically serve as their feet then so that they’re able to have an upright posture in the same way that I have an upright posture in the standing version.

Okay, so I’m gonna start by opening the chest, which really means that I’m starting to retract the scapula. So the scapula are starting to pull together in the back. You might be able to see that in the mirror that I have behind me. That I’m starting to retract, bring the shoulder blades closer to the spine.

I’m opening the elbows while keeping them down. Pronating the forearms. So the pronation will start to stretch the biceps, and at the end of the opening, I’m gonna push the hands away from the body so the elbows will be extended. Also stretching the biceps. So generally . There’s a problem that I see when I give this exercise to people, and I wanna highlight what I wanna do before I highlight the problem.

You’ll notice as I’m doing this in the looped kind of version here, is that my hands start narrow or start medial to the elbows, but then they get ahead of the elbows. So that’s what I wanna do. I wanna keep the elbows down and I want the hands to go wide to the elbows. There’s a nice midpoint.

That you can notice where the hands line up right there, they line up with the elbows just on the side of the body. I’m gonna put my cursor over it. So right here. So there’s a point in time where the hands, elbows line up, the hands are facing out. This keeps my elbows from going wide. The point is a lot of people are internally rotated in the shoulder.

And if they keep their elbows wide, then the the arms stay and internal rotation. And I want my arms to externally rotate so that the whole structure opens up. So that’s a little landmark you can look for when you’re doing it yourself or when you’re giving it to patients, is that lining up right lateral to the body and then the hands continue out?

So this is the expansive phase. I’m starting to stretch the biceps. I’m opening the chest by retracting the shoulders in the back, which creates more space in my chest. Creates more volume in that whole thoracic cavity. So let’s look at the compressive phase of the movement. So once I’m fully open, I’m gonna start, you’ll see a little gentle contraction in the abdominals, which starts to compress the torso as I fully push out.

And that’ll take me into a further pronation of the forearms and a winding type motion in the forearm. So let’s look at that. So hands push, out turn. So you might be able to see a little better in the mirror is that the torso bows slightly. My abdomen bows my spine bows look at that a couple more times.

So this is where I can start to engage in the front and gently massage that greater momentum. There’s a little bit of shortening along the whole front line during the compressive phase, which then when I continue this movement and go into the expansive phase, I’m stretching, compressing, stretching, compressing.

So as I turn the forearms, then I’m gonna start to reach the arms back. So that’s the compressive phase of the movement, and then it returns back to the same position.

I leading with the fingertips.

So fingers come forward, I cross my hands, return my chest lifts, and that bow that was in the torso, un bow straightened. So I get a nice gentle stretching and mobilization of the inner part of the channel.

All right, I’m gonna go back a couple slides and I wanna look at the full exercise.

So hands come up, cross slightly away from the body, open the hands, expand the chest, push out slightly, compress hands back. Return back to the starting position.

Hands out, push, compress, hands back, return to the starting position.

All right,

so I’m gonna end the PowerPoint.

Yeah, very simple exercise. I would highly encourage you to practice it. Like I said, I’ll put up a video on my YouTube channel, but this video, I think it has the a little snippet of it so you can get the idea of it. But the goal is to open the chest, create more volume in the lungs, but then as I start to compress everything, bows.

Then I go back to the expansive phase, so there’s movement inside so that I can gently mobilize that greater momentum. I can gently mobilize the stomach, I can gently mobilize the trachea and the esophagus in combination with what I’m doing on the external portion of the lung channel. So the whole channel is active and the whole channel is engaged.

So I use this for a lot of different things. You could use it really for anything where you wanted to improve the health of the lung channel. So that could just be preventative, of course. Respiratory issues would be a key component. Of course, if you’re working with people with respiratory issues, you want ’em to have that full volume in the chest.

shOulder problems is one that I give this exercise to quite frequently. You have to make sure that there’s no pain with doing it. So one component is that turning internal rotation, once I’ve stretched out, is I want that to come as much from the body as opposed to all my arm where I’m cranking my shoulder forward.

That can create a lot of pain for people who have shoulder problems, so I have to be very gentle. I’m starting from the distal portion, winding my arm, compressing my torso slightly. So it should be very comfortable for people. There shouldn’t be any sharp pain with this exercise. But that’s one where I give this to is shoulder issues.

Neck issues of course, because that shoulder girdle health is very tied to neck neck pain. It’s really versatile exercise. It’s pretty simple. Patients can catch onto it very quickly. They tend to like it ’cause they’re sitting so much during the day if they work at a desk or driving, or so many instances where we’re compressed there.

So it feels really nice to be able to open and stretch the chest and stretch that whole fossil. Line throughout the arms, but also you get that nice gentle engagement in the inside. So give it a try see what you think of it. But you can always reference the video and highlight it.

And if I have a YouTube video up on it, you can give some questions and comments if you want further clarification. I think that concludes the information I wanted to give today. It’s short and sweet. I’m gonna put this information together into a longer class that I’ll put on net of knowledge that’ll be available through lasa and a couple other partners overseas.

But that should be coming out fairly soon. I’m gonna put a little self massage in there and some some other details for treatment, maybe some needling also. This was just an introduction. Got the ball rolling for that. I was very happy to. . To be able to introduce this to you, and again, thanks to American Acupuncture Council for having me on.

 

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Today we’re gonna be presenting on some shoulder mobility. We’re gonna look right away from at a shoulder mobility drip drill with weighted clubs.

Click here to download the transcript.

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

Hello I’m Brian Lau. I, first of all, I’d like to thank American Acupuncture Council for having me back. Today we’re gonna be presenting on some shoulder mobility. We’re gonna look right away from at a shoulder mobility drip drill with weighted clubs. So that’s why I’m standing here. We’re gonna go over some movement aspects with that.

These would be something you can do yourself, which are really great mobilization exercises to keep your own shoulders healthy. But also you could prescribe these to patients. We’ll look at some caveats for when you can do that, when you might not want to do that. It might be a little too much depending on the stage of shoulder injury.

This would also have implications for neck injuries. We can go over some of that in context. Let’s go over that right from the start. But let’s look at some movement aspects first. So I have a little bit of a bone model here. So this would be my left scapula. and left humerus. So I’m gonna put it in front of me.

Obviously this would be behind the ribcage, but just to give a little bit of context. So we’re gonna be looking at this shoulder mobility drill that’s gonna work on the glenohumeral joint, of course. So we have good movement in that, but we’re also challenging the strength so that we can do movement with stability and the joints not moving around excessively.

But with any shoulder movement, we wanna look at this sort of dance between the shoulder joint. and the shoulder girdle. For instance, you can look up something called the scapula humeral rhythm. So with that’s specifically in reference to abduction. As the body goes into abduction, as the arm goes into abduction, you wanna have this following of the scapula.

So it goes into upward rotation. The scapula’s not moving real well. It’s very possible, probable that the joint will hit the head of the humerus up against the acromion, and that can pinch and compress and impinge on the superspinatus tendon, biceps tendon. A lot of tendon type impingement problems can come from that.

So it’s a nice dance. You can look at it up online. You can find the exact ratio of movement of how they relate to each other. But it’s not just abduction. When the body does internal rotation in the shoulder joint, the scapula likes to follow into protraction. So it gives a little bit of room, a little bit of movement.

So that the joint doesn’t get compressed in the front of the joint. Same thing with external rotation. Sometimes it likes to combine itself with retraction of the scapula. Maybe even a little bit of a downward pull on the scapula. So there’s a nice dance of movement between the scapula on the ribcage glenohumeral joint.

I could add to that. the sternoclavicular joint so that this whole complex is moving in this nice unified movement. It’s not just the shoulder girdle though. When I’m doing any type of movement like overhead, my ribcage is gonna open and expand and move. So there’s a combined movement that happens in the ribcage all the way down to the diaphragm so that a lot of these movements take this whole range of motion of the upper body, thoracic spine ribcage.

Shoulder blade, sternoclavicular, joint glenohumeral joint, and a combined activity that’s organized and controlled, or at least we want it to be organized and controlled. There’s a lot of neurology that helps link that. The phrenic nerve going down to the diaphragm has a lot of relationships to the shoulder joint.

In the shoulder capsule, but also the rotator cuff muscles. If I go on the right side, there’s a little branch of the fren phrenic nerve called the nicco abdominal nerve that goes right into the liver into the capsule of the liver. So any liver mobility problems are also gonna potentially show up as especially right shoulder problems.

So that’s a lot to think about. We’re going to. Not necessarily try to dwell on all of those. As we’re doing the movement, we’re gonna look at one key aspect and allow all of those other things to happen. So I’m gonna put this down for a second and grab another tool.

So we’re gonna have a weighted club. If you don’t have a club, that’s fine. I’ll show you what you can do without one. It’s actually nice to start without a club. This is a five pound club. One or two pounds is really nice to start with. Or we can just have our thumb out. , my arm has a certain amount of weight in it, so this is fine.

All the movements we can do to get used to these movements, we can get we can do without a club or you can have a wooden spoon or something if you wanna have a little bit of something that gives you an idea of where you are in space. That’s one nice thing of the club. But the actual weight is useful too.

So if you were to do this on an ongoing basis, maybe start with a two pound weight, three pound weight, and you can go up from there. We’ll look at some options. So we’re gonna be holding the club at the base. I’m gonna have my arm out at 90 degrees in elbow flexion. I’m gonna start at about level with the opposite shoulder, so I’m in a little bit of internal rotation.

My chest can be relaxed. Again, if you don’t have a club, you can just stick your thumb up and that’ll give you an idea of the direction that you have. So the first thing I wanna do is just warm up the joint. We’re gonna build a movement here, piece by piece. So I’m gonna go into external and pull the shoulder blade back.

So I should get my arm lined up to the side, my elbow’s level with my hand. Chest is open. Then back into internal rotation. I can let my chest fold just a little bit. So right from the get-go, the driving force is the shoulder blade. I wanna pull my shoulder blade open, or I should say pull it back towards the spine to open the front.

Then I wanna let the shoulder blade come into protraction, my chest relaxes retraction, pull the shoulder blade towards the spine, open the chest. So right from the start, we’re working on the hearts in you channel as I go into internal rotation and the small intestines in you channel. As I go into external rotation and pull the shoulder blade, it’s fine.

So nice exercise for the in you channels. Alright, so this is stage one, but we’re going add a swing to this. So instead of me just turning my arm out, I’m gonna let the weight drop and find that position again. Let the weight drop swing. So it’s a swing and a catch. Down, turn the arm, open the chest, catch down, turn the arm, close the chest.

Catch. So swing you can go slow or you can start speeding it up if you feel comfortable with it. So we’re building a movement. This is a movement called Mills. Okay, next thing, swing. Catch now I’m gonna go overhead. I want my shoulder blade to be the driving force, so I want my shoulder blade to go into upward rotation, hand behind the neck, down, catch up,

down, up. I wanna keep a stable base down. Okay, now we’ll change one more time. Up

turn, throw, catch, swing, catch, cast it, overhead, turn, throw catch. So that’s the movement. It’s like a throwing motion like you’re throwing a baseball, but again, driven by the shoulder blade. Pull the shoulder blade back to open the chest. Upwardly rotate to point your scapula up towards the sky, protract and down.

Very nice. We can go the other way now. So over the shoulder, same shoulder. Pull the shoulder blade, open down, swing catch. Cast open, throw, swing, catch, cast open. Throw one more time. Swing and catch. Cast open. Pull the shoulder, blade back, throw. All right. Real quick, we’ll do it on the other side. Then we’ll look at some various options, when to do this, how to do it with patients or for yourself if you’re having shoulder issues.

So let’s go quickly through it again. Internal external rotation, external pull the shoulder blade open, chest opens, line the elbow up with the hand. So I don’t want my elbow facing back. I want it under level with the hand, chest in,

open the chest. Okay, we can do that with a swing. Let the weight drop up. Drop up 90 degrees. Drop up again, we’ll go overhead now. So up. Hide the hand behind the neck. Throw catch up. Throw catch. Okay, one more change up. I wanna turn my body in front of the other shoulder, swing, catch, cast, throw, swing, catch, cast, throw either direction over same shoulder.

Pull the shoulder blade open to pull the chest open down

over the shoulder. Retract the scapula, pull the chest open down.

So great movement to strengthen the shoulder blade the shoulder joint to strengthen and move the shoulder blade and to coordinate that activity with the chest and ribcage. This would be not a good idea to start with the five pound of somebody who’s having shoulder pain. Maybe that’s where it’s really nice to start with just the weight of the arm.

Maybe they have a painful arc. Oh, that’s causing a lot of sharp pain just to do that. They’re not stable. They don’t have strength to support that shoulder shoulder joint. They don’t have the strength for that shoulder blade to roll up and upward rotation so that they have a comfortable, nice movement and oh, it hurts to do that.

It’s probably not a good exercise for them. You need to build them up to that. You need to give them a simpler exercise, a floor exercise. We’ll look at some acupuncture techniques. There’s a lot that has to happen before they can comfortably do this. Once they can comfortably go up, maybe starting with no weight, one pound, two pounds would be a good idea.

Keep it small. Once they get coordinated movement then, and they’re feeling comfortable with that. Five pound,

five pounds pretty good. They get a little more comfortable, then they can go up more weight. So adding weight will create a little bit more challenge. So this is 10 pounds. So if I’m doing the same movement with this 10 pound weight, then that requires more force, obviously, but it’s not just the weight.

So 10 pounds

and 10 pounds. Now this 10 pounds weighs a lot more than the other 10 pounds because of where that weight is sitting farther away from my hand. And the torque that creates. when I’m going ahead, I don’t wanna swing it cuz my camera’s pretty close here, . But when I’m going ahead and if I were to swing that through, that’s gonna require a lot more strength on my part to be able to balance and manipulate this weight that’s farther from my hand if I were to move down even to the handle.

Even just holding that and stabilizing it is a lot more difficult because, oh, any little movement here, I have to do a lot more stability to support that. Since it’s so much farther away from my hand. So those are ways you can increase and build on this exercise. But you don’t wanna start with a shoulder.

A patient with shoulder pain, painful arc with that mace. You may not even be able to start with the weight of their own arm. You have to build them up to it. So just some ideas, some things you can work with go through step by step, maybe starting. with that, just internal external rotation, if that’s not excessively painful, just to be able to balance that weight in external rotation is gonna start to strengthen and stabilize that joint.

So that would be a good starting place. Then you can build until they get the full sort of movement of throwing. So that’s what I wanted to start off with was the mobilization. So we can start thinking about feeling, coordinating that activity of the shoulder blades with the movement of the glenohumeral joint and how that relates to the chest and all of the whole, really the whole body.

So what if they have limited range of motion? Let’s go over some potential techniques. We’re gonna focus mostly on the pectoralis major, cuz the pectoralis major has to lengthen to be able to get my arm back. It has to lengthen to be able to get my arm back in both positions, different fibers. But Peck major is gonna be one of the key structures that’s gonna limit mobility.

If this peck major’s held in a shortened position, I can only go so far. So I want to be able to have full range of motion, full elong full ability to elongate in that pack. Major in all different planes. So we’ll focus on that. I’ll tell you from the get-go, Sarus anterior would be another big one.

Another day we’ll just focus on P Major for today. So I’m gonna switch to PowerPoint and let’s go over a little bit of information, a little bit of the anatomy, and we can look at some techniques for acupuncture and manual therapy. So let’s get the slides up. I’m gonna come a little closer.

All right. All right. So here’s some netter images. If we look at the left image first, let’s look at the bottom left. We have Peck major. So Peck major’s a really intriguing muscle. It has the clavicular head that’s going up and attaching to the medial third of the clavicle. It has the sternal head attaching to the sternum.

Then as we go down a little bit, we see costal fibers attaching to the costal cartilage and that bottommost slip that you see attaching into the abdominal fascia. Is the abdominal head. So we have really four heads depending on how it’s divided. Some books look at it as three heads, but clavicular, sternal, costal and abdominal heads are the way I look at it.

So interesting thing about that is they play out with the yin channels of the arm. The clavicular head is part of the sinu channel, sternal head, part of the heart, Sinu channel Costal, and an abdominal head, part of the pericardium Sinu channel. Those fibers have to organize themselves with the muscles of the back, such as the rhomboids.

So we’re looking at the sternal fibers and we were going into that external rotation movement with the arm down. Peck major has to elongate, rhomboids pulls the shoulder blade back towards the spine. So it’s a balance between the hearts in you channel and the small intestines in you channel. , we start from internal rotation, Peck major’s in a shortened position as it goes into external rotation.

Infraspinatus, Terry’s minor part of the small intestine sy channeler firing while the peck major is lengthening. So they have this yin young relationship of one letting go, one shortening. So we don’t have time to go through all the channel relationships for each of them, but that’s one to start with.

We’ll look a few at a few of them though as we go into the PowerPoint. So lung sinu, channel clavicular, head of the Peck majors, part of that Peck miner’s, really the key muscle that’s also involved with this shoulder mobility exercise we were doing. Peck miner is gonna have a tendency to pull that shoulder forward into an anterior tilt when it’s shortened.

If you remembered from that exercise we were doing, we had a pretty neutral. Position the scapula is moving a lot, but we didn’t have this jutted out forward shoulder at any point when we were doing it. If that’s in a shortened position like that, we need to do a technique acupuncture’s great to be able to release the peck miner.

We can also use points along the channel, even muscles along the channel, like the flexor carpi. Radialis is a really great muscle to release the peck miner, so needling the motor point. If you’ve studied with sports medicine, acupuncture, we teach the motor point for flexor carpi radialis. Fantastic distal point, even though it’s not an official lung channel point, it’s kind of part of the lung inu channel.

So really a fantastic point to release Peck miner. But Peck miner needling is something to learn too with the caveat of being safe with it because it is close to the PLE cavity. That Peck miner is gonna have to be balanced by the large intestines Inu channel, lower traps, which is supporting it.

Those have that yin yang balance. Also upper fibers of Sarus anterior part of the long Sinu channel. Those are those upper two slips. They have a different fiber direction than the rest of the sarus anterior, and they have different action. Again, we can come back to Sarus anterior maybe another day. So here’s the movement of the lung sinu channel.

It’s gonna tend to pull that scapula, like that top arrow, which is pulling the scapula down into an anterior tilt, countered by the large intestines Sinu channel, which stabilizes the scapula against that force of the peck miner. So if you go back and review large intestine Sinu channel, you’ll see that it goes down into the thoracic spine.

It follows those lower trap fibers. So nice combination to work with. Har Sinu channel was the one we alluded to just before. The Har Sinu channel includes pretty much the Peck major, I think of the whole Peck major, but really the sternal head in particular is the big one for Hart Sinu channel.

This would be very important for that movement that we were doing, the mills that we were doing with the weighted clubs. We can also notice that the subscapularis is in there. Subscapularis is another big one, a really great muscle to learn how to needle. But it’s not something for a webinar.

That one’s much better for classroom setting because you’re going. Deep into heart. One with really a three inch needle, you have to be very mindful of where the ribcage is, so you can advance the needle towards subscapularis, but not towards the ribcage. So plenty of space if you do it properly. But too much room for error on a webinar.

So classroom setting. Another day we will look at some needling for tech major, though. So this relationship for the scapula is, again, we have protraction As the scapula pulls around, the ribcage moves away from the spine. P major is one of the big muscles that’s gonna contribute to that. And then that’s countered by the rhomboids, which are multiple channels.

But in this case, they’re acting along with other muscles as part of the small intestine sy you channel. But all of that’s happening with internal rotation, pag, external rotation, infraspinatus, Terry’s minor, also subscapularis, part of the small intestines in new channel. So those have to coordinate their activity as one shortens.

The other one has to let go as the, then it changes phases, and the other one shortens. They have to alternate. Elongate contract. Elongate contract. So very much of a yin yang relationship with those two. Peck major is usually the one that’s overactive, and we’ll be looking at a technique for that. Finally, the Pericardium Sinu channel.

Pericardium Sinu channel has a really interesting trajectory. . It involves the sarus anterior, also these lower fibers of the Peck major, all of those come down and blend in with this abdominal fascia. So it creates like a almost like a fascial belt around the ribcage that can get too tight. So we need to loosen up that belt.

Nice thing about that exercise we were doing is we had that in. an out aspect with the chest. So we’re starting to exercise and soften that sort of what can be a too tight of a belt around the ribcage for a lot of people. So the interesting thing about this one though is it wraps around the ribcage, which it’s discussed classically, but I take it a little beyond what you might think and into this Rambos sling.

So the sarus anterior attaches to the medial border of the scapula, and it links seamlessly with the sarus anterior. So much so that in recent dissection, and I’ve done this a few times, you can tease the fibers of the rhomboids and sarus anterior off the scapula and kind of layer, soft, slow approach and then bring the scapula away and you just have this seamless.

Sling of tissue that you don’t see really a break. All is where the scapula attached to it. But you have the sarus, anterior rhomboids is one continuous structure. You can pull the scapula off. It’s not something that if you were to take the scap off, you’d have to sew those back together.

They’re already united. They’re already part of a sling. That actually then combines over to the contralateral side and blends in with the SIA services and capitus. So this shoulder movement that we’re doing can have good implications for neck pain for a lot of reasons, but one of which is that those snia services and capitus muscles become problematic for a lot of neck pain patterns.

So we can needle splenius services, we can needle splenius capitus of their pain producers, but to be able to integrate them with the scapular movement so that there’s this nice sling expansion contraction on either side is a really great way to keep those changes. So this exercise we’re looking at, fantastic for shoulder problems, but neck problems, especially with plem and surfaces pain patterns, right?

So movement pattern with those and things you can look at. Somewhat protraction and retraction, but also that upward and downward rotation of the scapula. PS radius anterior in particular upwardly, rotates the scapula. So if you go back to this movement we were doing, there’s a lot of times where the scap is doing this circular movement of rotating up around ProTrac, protraction, rotating back down, rotating up.

Retraction rotating down. So that rotational aspect of the scapula is a very key movement of the pericardium sinu channel, moderated by the lower fibers of the peck, major sarus anterior, and then the rhomboids and also the upper part of the traps. So I put this pericardium Sinu channel in here, but again, this is an ebb and flow between Pericardium Sinu channel, San Joo channel.

So lots of scapular movement, lots of things to think about with just a small exercise. You’re really working all three of those in you channels. But I think the big one is pericardium and San Joo channel. That’s the one that’s the most prominent with the exercise we looked at. Got to twist my arm to say that cuz the other ones are.

All right, so tech major is what we’re focusing on for treatment. So you’re teaching this exercise to somebody or you’re doing it yourself. And oh, it’s hard to really get that arm back. It’s hard to pull that shoulder back and have this nice open chest because of that Peck major holding everything. So it’s like this too tight of a grip on the shoulder blade, and I can’t get that movement.

Or when I’m back here, I can’t get my arm back because that Peck major is pulling. So any of those positions that are difficult to get. Open in the chest. Peck major is gonna be a key player in that, and it’s one that we can look at on the webinar. There’s some concerns. We have to be careful. We have to know where the ribcage is.

There’s some cautions. I put this in the video and this is a video that’s up on my YouTube channel. You can reference later, or you can reference it directly from this webinar, which will be recorded. But it’s safe enough. I think we can look at it. In a webinar setting, I go through step by step.

This is a way to needle the Peck major for those who have taken sports medicine, acupuncture classes. Matt teaches it a little bit differently, which I think is great and maybe good for a class setting. I felt a little more comfortable with this one for a webinar setting because we’re holding the tissue up away from the ribcage.

So it’s it’s one that I use. I like it. Just for the reason that I like the technique, but it’s also, I think, a really useful one to have on the YouTube channel. And have on the webinar because I mitigates the risks by lifting the tissue away. So let’s look at it.

Okay.

We’re gonna look at palpation for to bands within the pectoralis major muscle, and we’ll look at a way of needling this muscle safely. First, let’s identify the fiber direction for the various portions of this muscle. The CLA head runs from the medial of the clavicle to the specifically the lateral lip of the, okay.

The sternal head runs from the sternum to the universe.

And the coastal and abdominal heads run from the coastal cartilage and the abdominal fascia, and then travel up to the s.

The arm down the clavicular fibers run superficial to the sternal fibers.

Which runs superficial to the coastal and abdominal fibers. The layered arrangement changes when the arm is overhead. The different layers unwrap and then wrap again as the arm is brought down. Palpating for top bands and the muscle can be helpful to gauge tension. Here I am palpating the clavicular head.

In assessing pretension, I can also push from inferior to superior or superior to inferior to feel which offers the most resistant.

And I can advance the needle across the fibers in that direction.

I have to take care that I place the needle in the same angle as the palpation and not change the angle deeper towards the.

Now I am palpating sternal head, starting from the sternum, and noting a local twitch with palpation.

This layer has a notable, palpable band, an easy way to needle the factor. Major is to grasp and lift the tissue away from the underlying rib cage

while grasping. You should feel the plane, the rib cage makes.

You then find the top band and place your two fingers around it.

Place the guide tube at an angle that allows the needle to penetrate the band and then advance the needle into the P major. Direct it toward your thumb into the needle, parallel to the rootage.

You can redirect the needle, but keep the needle parallel to the ribcage until you get the needle response.

The needle is always directed parallel to the ribcage, and you should never aim the needle towards the ribcage. The needle is parallel to the ribcage directed slowly towards the thumb and not downward towards the feral cap.

You should not perform this technique if you do not have an adequate sense of where the ribcage is the plaintiff makes, or where the needle tip is in relationship to your thumb. The advancing needle can be felt by the thumb, but you need to be sensitive to this. You should not perform this technique on women with breast implants.

Otherwise, working with women is essentially the same. Palpation will be the same, but you’ll not be palpating through breast tissue. You still have access to muscle around the breast tissue. Let’s go over this technique again on a female model, . So when I’m palpating, I want to feel for the clavicular fibers.

I can press into fibers going up. and that inferior to superior direction, or I can palpate into them from a superior to inferior direction. Feeling for resistance doesn’t feel particularly top. So I’m not gonna needle those fibers. I can palpate close to the stern looking for top bands.

Of one right there through that sternal fiber. Sometimes you’ll even see a local twitch response as you palpate through that. Interestingly, I can see a little bit of that local Twitch response respond up through the s SCM muscles. Those pec fibers do link with the scm, but I just feel able to top in there.

If I were to follow that’s gonna take me into that sternal portion of the muscle and. That’ll help me find and differentiate where there’s spot in the muscle for men. You have a little bit more territory you can palpate for women this sternal edge is a really useful area cause you can palpate feel without having even the ship.

The other area where you can palpate where it’s probably easiest to needle is that the excellent. So I have access to the bulk of the muscle through here. This is where knowing those fiber orientations can be very helpful. So I can come and feel for hotness within the muscle. Noticeable damage fibers.

And this is the easiest way to needle it. If you wanna be very cautious. I wouldn’t do this needle technique, breast implants cause you could puncture the breast implant, but faring that it’s not a problem. So I can grasp the muscle this way, heal the tension within the muscle hold. To guide you between my fingers, I’m gonna angle towards my thumb.

I can feel the edge of the top end, and maybe looking for trigger points you might need get a switch response with palpation, and I can hold and then advance the needle towards my thumb. I need to be really comfortable with the idea of kneeling towards my numb feeling that needle advance towards my thumb, bring it out, but it’s very safe situation there.

Do some general looking thrusting, different needle angles to listener response to tech nature.

All right, so I have a minute long myofascial release. This was longer technique, but this was YouTube short. This is on the Sports Medicine acupuncture YouTube channel. So you can reference it there. Again, it’ll be in the recording. This will be the last thing we have for today. And you can see a follow up technique to the needling.

Myofascial release for the HE major will take place with either the patient having their arm down by the side, especially useful for the clavicular head attachments, or having the arm up above the head and external rotation. Much better for the sternal and the costal fibers. And what you’re gonna have the patient do is start to turn their torso, start turning towards your same side.

So you wanna have the fibers shorten so that you can get in, get a good investment, get a good grab of the tissue, and relax there. Then have them turn away from the shoulder so they’re keeping the shoulder on the table. And trying a little slower, one slower turn the torso away, and they’re having to learn how to relax that als nature while you’re spreading through it.

All right. Very nice. Feel free to check these videos out. Like I said, those, the references along with this recording will be on the on my channel. It’ll be in multiple places, but it’ll be on my YouTube channel. The QR code is there, but also the webpage along with sports medicine, acupuncture had that myofascial release technique.

So I think I can take off the slides. And just to give a quick idea with that myofascial technique, in that exercise we were doing, we were moving the shoulder away from the ribcage. to get more space and buy that the front of the rib cage, I should say. So that ability for Peck major to move kinda like I’m throwing a ball, I have to be able to expand and move that shoulder away.

The myofascial technique, we did it slightly different, is we compressed and moved the rib, moved the sternum closer to the humerus and had the patient relax the shoulder on the table while they moved the sternum away from the arm. So same thing. The just different reference point is they were learning how to relax the Peck major so that they could turn the sternum away from the arm.

And in the exercise they were. Moving the arm away from the sternum. So same idea, just a different focus. Both of those are gonna require the peck major to lengthen. Both of those are gonna open the heart a little bit, or at least the heart channel, heart send you channel. Great exercise. If you have any questions feel free to comment on the webinar.

I’ll be checking those and maybe it’s something you can add to your routine, definitely with patience, but even yourself. I think that mobility exercise is a really fantastic exercise. So thanks again for American Acupuncture Council for having me. Dr. Martha Lucas will be here next week, so check check out next week and I will see you guys again another time.

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