Tag Archives: Exercise

Exercise Prescription for the Acupuncturists – Callison, Lau, Armstrong

 

Hello, everyone. Happy holidays. Thank you very much for coming. Welcome to our December issue of the sports acupuncture webinar podcast. My name is Matt Callison. I’m Brian Lau. Thank you very much for coming you guys. And thank you for the American Acupuncture Council for inviting us here. We have a very special guest today. Ian Armstrong, who’s on faculty and the teacher of the postural assessment and corrective exercise class that we have in the sports medicine acupuncture certification program.

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

Thank you again for coming. Thanks for having me a bit, you know, watching you guys through these types of podcasts here for, for a few times, then I’m excited to join. Alright, awesome. Great. Can we go to that first slide there, please? And we’ll go ahead and do a little overview of what we’re going to be trying to accomplish in this very short 30 minutes or so a quick overview, and this is playing off of the blog article that Brian and I wrote on the sports medicine, acupuncture, webpage, um, exercise prescription for the acupuncturist in particular, it’s for, uh, when you have a patient with medial knee pain, a few different things to take a look at that can really end up helping quite a bit with, um, your patients.

And we’re talked about an elevated ilium and the muscle imbalances and the sinew channel imbalances that can end up causing the knee to move in. So we’re going to be speaking about that. Um, but also what can happen with, uh, PEs planus. So, um, let’s let’s, as a reminder, do something about this, uh, exercise prescriptions that we feel that the exercise prescription is a very important adjunctive therapy for an acupuncturist to use this. It’s just as important as prescribing herbs or dietary recommendations and exercise prescription is not only just for a postural imbalances and orthopedic rehab, but there are also many exercise prescriptions that are exercising muscles that stimulate the front move and the back shoe points, uh, as well as she cleft Lulu and, uh, Jean Wellpoint. So it’s important that we are exercising certain areas even for as food components, for example, like upper jaw, um, asthma, or even post COVID patients, how wonderful it will be to actually give them some exercises that gets their rip cage moving in such. And I know Brian has a few comments on this as well, so I’m gonna just hand it over to him.

Yeah, I think, uh, just the parallel that, uh, the, the space, you know, if you think about the whole chest and the abdominal cavity, you want a space in there for things to circulate well and move well. So if there’s a lot of collapse in the chest, well, that’s going to put a lot of pressure on the lungs and the diaphragm. If it’s, if it’s pushing inward, that’s going to put a lot of pressure on the liver. So to have really good, just circulation through the abdominal pelvic and through the thoracic cavity, um, corrective exercises, chigong, uh, Tai Chi, all of those types of movement exercises, which is a big part of the tradition of Chinese medicine, uh, is really essential both for like Matt said, orthopedic conditions, uh, especially, but for really any condition just to have proper circulation and proper movement throughout the whole system.

Great. So then let’s go to the next slide and Ian, do you want go ahead and start with this and walk us through?

Sure. So when we’re looking at, um, some contributions to, um, medial knee pain, there’s a couple of aspects that we’ve got to look at. Um, often the, the knee is really the joint that’s just caught in between two other joints that have a lot of range of motion that can have a lot of, uh, propensity for deviation, both standing or statically and through movement. So, um, in the pace program and smack, we look at both, uh, movement assessments and static assessments. Um, and with these two joints that I’m speaking of, I’m talking about the hip and, uh, later on as we’ll get to the, the ankle and foot. So in the first picture, we can see the gentlemen here, standing here with a plumb line down the center of the, of the body there. And you can see on his right side even a little bit more without having any palpatory confirmation, we can see that that right. Side’s got a little bit of elevation. You might be able to see even a little bit on that. Um, if you’re comparing the distance between the side of his body and each hand, you can see that there’s a little bit less on that right side. You can see a little bit of a fold on that right side. And you can almost tell that there’s a little bit of elevation of his, of his right ilium there.

Um, moving to the picture in the middle. We can see as a practitioner. It’s, it’s always good to confirm what we’re trying to see with palpation. You can see Matt’s got his hand over and on top of each iliac crest, and again, we’re his different patient. We can see that this, this person’s also got an elevated ilium on that right side. Um, and then we can confirm these, these, um, what will happen with these deviations are the imbalances of the myofascia the sinew channels and how it’s going to affect, um, the movement. So in this case, we, we like to use the, um, overhead squat. Uh, it’s it’s often used in the, in, in the national Academy of sports medicine or NASA. Um, it’s also a big movement screen. That’s that’s used in something called selective functional movement assessment that uses a lot of movement screens to try and help with pain and increased, uh, performance and function. You guys got anything to add to that?

Yeah, I do. For the, uh, actually two things for the middle picture. Uh, of course it’s a nice chance to see an elevated Valium again, but also, um, it really gives you a good picture of how to assess, uh, the elevated Lam. Now that math is kind of moving off to the side. So you can, you can’t see through Matt. So he’s moving off to the side, so you can see his hands, but if you were really assessing and there was no need to take a picture and he was right behind the person, the goal is to get your, your hands really at the top of the iliac crest, not just come in and feel bone, cause you might be in a slightly different place with each hand, but to kind of crawl up until you sink in just above the iliac crest sink into the area where it’s a little softer where there’s no bone under your knee, underneath your hands and come down on top of the iliac crest in the finger position really tells you if one hand is higher than the other. So that’s really the proper assessment, you know, a good way of assessing it.

Very true. I think it’s common to kind of miss that stat top of that iliac crest. It can hide from you. So sometimes I’ll even like to start at the rib cage and palpate down until I feel I’m in definite space. And then as you can see, as Matt’s using his hands, like, like, like, uh, levels that are really distinct, um, you know, landmarks of each of each height of each crest, um, and that’s really helpful to get, to get that clear distinct Mark and then just to get right at eye level with it when you’re assessing. Yeah,

You should be able to see it, but, but some it’s good to confirm with your hands. Cause sometimes maybe just a little bit of the adipose tissue sets on the structure and in a way that can confuse you or the pant line can confuse you or something like that. So, so the palpatory assessment is really, um, key. If I could add one more thing I’d like to see if Matt has anything to add to, and this is the last thing we’ll say about this because, um, the rest of it will be a little bit more on the biomechanics, but the person on the left of course has an elevated ilium. We could look, look at the musculature, the quadratus lumborum and stuff. We’ll talk about as we progress forward with, um, with the, the, uh, channel sinews that are involved. But if you kind of just think past the muscles for a little bit and think, well, his kidneys would be moving along the psoas muscle.

So what’s happening with the position of the kidney on the right or the liver. You know, the liver can have a range of motion that it does as you take a breath or as it slides in relationship to the stomach and the kidneys and all the organs, it can be complex, but you know, maybe that internally that that liver is stuck down to the kidney or to the intestines and isn’t able to sort of move freely. So he has to position himself in a way to sort of free and take pressure off that liver. And that’s what we were alluding to in terms of the internal design Fu can really be affected by posture and a lot of different ways,

Absolutely pelvic curdle, um, any kind of, of, of pelvic inflammatory diseases or any anything, actually, when you look at the dog food with an elevated alium, so let’s zero, uh, back into the medial knee pain with all orthopedic examinations, the practitioner will be thinking about what channels are affected in excess and deficiency. And therefore you can start figuring out what points do we be able to use. So this is a good segue then going into our next slide, going into our next slide. All right. Awesome bye. So here, it’s going to be taking a look, you’ll see a frontal plane muscles of the hip AB doctors and the hip Ady doctors along the gallbladder sinew channel, and also the liver send your channel. So when you have an elevated ilium, you can see that the hip AB doctors will be in a lengthened and relative deficient position on the side of the elevated ilium.

And then the add doctor muscles, the doctor muscles will be locked short and a relative excess. Why is this important to know, because it’s going to predicate your needle technique at the motor points of these particular muscles. So on the opposite side, you’ll see where the ileum is on a lower position that glute medius and minimus on the gallbladder channels in a lock short position, pulling that ilium downward. And then you have the add doctors are going to be in a deficient lock long position. Now these are only going to be in the frontal plane. Now these, these muscles themselves are going to be directly indicated with elevated ilium and as the person’s going into an overhead squat, what you’ll commonly see is that knee moving inward. Now there’s also other important muscle that we’re going to be talking about, uh, on the urinary bladder sinew channel. Ian, do you want to go from here?

Sure. Um, great explanation. I think from through the wonderful artwork on the left side, and then seeing the visual of me and an overhead squat on the right, you can see how the excess adductor, uh, is, can be pulling that knee moves need, uh, moving in, um, and the, the inability, uh, or the inhibition of the gallbladder sinew channel on the glute medius and minimus to properly support that, that knee and keep it stable. Um, however, there’s other things that we’ve got to tease out of this because it can, it’s not going to be the only culprit or it can be, um, other things obviously that, that, that they can cause that need to move in. Again, we mentioned the ankle, which will get and foot, which we’ll get to later, but also even looking at other kinds of muscles that are attaching to the hip.

And, um, th the issue, for instance, with the lateral hamstring group. Now we know that the lateral hamstring specifically the long head of the bicep is, uh, by articulate muscle, meaning it’s going to extend the hip and it’s also going to bend the knee. Therefore it’s going to cross that knee joint. So if you can think of it as the string on a bow and the leg being a bow, and how, if that string is tightening down, that leg is going to not have the ability to keep straight in. It’s going to start to collapse that knee to move inward. Um, so there’s other variations of this overhead squat that we would use to try and tease which one is being a culprit, and they could both be contributing to that needed to move in. Um, but we learned different variations of this overhead squat to, to try and tease that out, to see if that lateral hamstring group, um, is really contributing to the tightness and the not allowing that knee to keep straight and pulling that, that bow in. So that would be your, your urinary gallbladder, excuse me, in the urinary bladder SNU channel. Brian, you want to comment on that,

Uh, just to add to it, you know, that could, of course be in the same way that Ian described that could be the, the lateral head of the gastrocnemius also. And for that matter, Proteus longest that whole urinary bladder channel on that side. And again, just like we did in the sand, those both cross the knee, you know, gas rock coming from above hamstrings coming from below. So if you think of the whole channel from the hip to the foot, as Ian was saying, you know, you can see on the lateral side that bow, that, that line is short and creating a bowing of the knee versus the more medial hamstring and medial gastrocs. So it’d be relative excess on the, um, on the lateral side.

Right.

All right. So good, good, good. So just as a reminder for everybody, what we’re describing right now is zeroing in, on one partial dysfunction that can cause medial knee pain, that’s useful for the acupuncturist to assess now looking at the biceps, femoris that lateral hamstring being an excess position and what we already covered with the hip AB doctors and 80 doctors being excess and also deficient. So that’s going to be important. Now we also have to look at the constitution of the patient, right? So if we have our assessment, we do our tone, our pulse diagnosis. We figure out who is this patient with this medial knee pain, and perhaps maybe actually have the Ritchie stagnation or Libby inefficiency as well, where that Oregon is also contributing possibly to some of that medial knee pain, in addition to these partial dysfunction. So we would be developing our acupuncture treatment plan and protocol, which we don’t have time in this, in this particular podcast or webinar to, to go over.

Um, but after the acupuncture and a balanced acupuncture treatment, and then doing your myofascial release techniques or cupping or quash on Sasha, everything that we do as acupuncturist, you’re now priming body for exercise prescription. And this is really no different what our founding fathers have done before with acupuncture. And I’m sure teaching Tai-Chi exercises, movement patterns, and she’d gone. We’re just describing it in Western biomedical terms. So therefore, let’s go ahead and discuss, um, a, uh, really excellent exercise for lowering an elevated ilium after the acupuncture treatment, which would be in the next slide. And then this would be a nice little segue also for Brian. If you want to get ready for the demonstration, we’ve got a little treat for your products in his office, and he’s going to be demonstrating some of these exercises for us. So let’s introduce them first, the exercises, what you’re going to be saying.

So here on the slide on the left, you see, uh, Ian on a figure four wall. So his right hip is at 90 degrees and on his left ankle, you see that lateral malleolus over extra point. Hey Dean. So he’s going to be pressing the knee outward in order to work on the hip. The hip abductors are going to be contracting in the hip Ady doctors are going to be relaxing in this case. So you could see on the side of an elevated ilium, if you put the person into this particular position, the lox long deficient hip abductors on the elevated side are now contracting isometrically. Now this is after your acupuncture treatments. So they’re really in primed and ready for this. You have treated, you’ve treated the adductor muscle with the reducing needle technique. And now the adductors in this particular position are being reciprocally inhibited. So as complimenting the acupuncture treatment, now, if the person has lack of flexibility in this particular position, there’s a number of different sequences that we can do, which Ian, do you want to follow up with that? And, uh, just briefly just describe it and then we’ll go right into Brian so you can show it.

Sure. So, um, I mean, great description of me on the left there. Um, when we’re looking at these are other variations of what we would call figure four exercise. So you can see, um, someone else here on the right hand side, um, being able to, um, add a little bit more of a rotational type of movement to, um, again, as Matt was saying, uh, contract and, and stimulate the contraction of the gallbladder, sending channel with the AB doctors and getting that release and stretch of the adductors can, which will especially be profound and, and, and effective once the treatment has been completed. Um, I think, I imagine we’re pretty ready to move on and see, um, Brian here. Cause I’d love to talk about some of the nuances of these exercises and the keys to really making sure that they’re effective.

Yeah, that’s great. Let’s go to Brian. Awesome.

Great. So as you can see, Brian set up here, he’s got his hips flexed at 90 degrees. He’s got his knees flexed to 90 degrees. Um, it’s hard to tell from this angle, but we really want to make sure when someone is up against the wall like this, that their starting position is, is neutral with their feet. And by that, I mean, they’re not AB ducted. They’re not adducted, uh, with their feet and as Brian’s just demonstrating now, they’re all aligned North South or superior to inferior. So you don’t want to have that, that movement, um, of, of the misalignment of the feeds important to have those nice and aligned and together in line with the hips.

So,

Um, running with the two examples, meaning the, we saw on the first slide and then the second slide with the artwork of the, of the musculoskeletal system and the imbalances of the muscle groups. Let’s say that Brian had an elevated right side. Um, so it’s, it’s nice to you notice when you’re looking at the exercise in the photos before you saw that, obviously we’re, we’re addressing one side, it’s not a bilateral exercise, you’re addressing one side at a time. So when it comes to, um, giving this exercise to your patients, I think it’s nice to obviously have them do side both sides, but also it’s important to have them give a little bit more attention to that elevated side. We want to get more activation from that deficient gallbladder, uh, Cindy channel, the glute medius and minimus that are elongated and lengthen it inhibited by that elevated ilium.

So we’ll have him start with his right ankle. We’re going to have him go ahead and put his right ankle over his left knee, just like, so you can see that lateral malleolus even with heading. We want to make sure that his right foot is generally flush with the outside of the thigh. And it’s a good marker. So he’s not too far over, uh, and crossing beautiful. Um, and then he’s going to go ahead and extra, you know, abduct and externally rotate that hip and push down just like, so, and when we’re going through this exercise with the patient, we want to make sure that they’re not compensating at the hip and seeing that hip elevate. I know if it’s hard and humid, for those of you who are watching, you can kind of see what he’s doing through the mirror there and get an idea of how that compensation can often be had.

Um, with these postural exercises, you know, they don’t seem too difficult and, uh, and, and they aren’t. But the, the, the thing about them is, is when we have these deviations, uh, for a patient it’s often that they will, are used to moving their body to get out of the, the crux and the importance of, of the effectiveness of what that exercise is trying to do. So paying attention to these little deviations or wiggles and how they’ll try and get out of doing that, that the exercise properly is really important to pay close attention to.

Hey, Ian subgroups, I’m sorry for interrupting. You’re probably just about to say it, but I just want to make sure that we do cover some patients, right. As we know a difficult time getting that figure four, because of tightness in the hip, what would, what would you instruct to do

Beautiful Brian? Yeah, exactly. He just can’t get there, or maybe he can get there, but there’s so much deviation at the hip that hip starts to really tilt up, but that’s just, that’s no good, right? That’s not going to be effective. There’s no way that they can get out of that and get into proper alignment. So what we really need to do is decrease the, the angle of the leg. That’s not being stretched. So in this case, it would be Brian’s left leg. We’re going to go ahead and have him decrease that, that hip angle. So meaning that, that taking down that 90 degrees of hip flection, and really trying to make sure that we can give proper space for their, whatever their flexibility is to get that right aid, uh, ankle back over the left knee. So, and then being able to AB duct and externally rotate that hip, being able to stay, put that transverse plane, if you will, through that hip is not being, being deviated away from, and we’re getting a nice activation of those AB DRS, gallbladder, sinew channel, and that, that w you know, openness and the release of the, of the adductors and the liver sinew channel

S

So should we maybe move on to the rotational?

Sure. And then once the person can able to graduate from these particular exercises, and we’ll go into more, uh, an exercise that w that the person needs to have more flexibility for. So let’s, let’s take a look at that one.

Yep. So now, um, Brian’s in a position called a hook line position. You can see the soles of his feet are on the floor. Typically, I would say that I like to have about, um, 90 degrees of knee flection. So he’s a little bit more than that right now. That’s okay. That’s something that’s actually sort of customed to that patient. Again, you can decrease or increase that angle depending on how flexible they are. For instance, if the person is not so flexible, you can lengthen that, that, that, uh, there you go, just like that, just like that brand. So obviously you can see that that needs coming down. It will be easier for that patient to put that ankle over the knee. And then if they’re not getting enough stretch, you can increase that angle too. Right. You can go the other way. So going, you know, up just like Brian did allows that increase and maybe more stretch if that’s what they need depending on the patient.

Um, so once they found that, that right angle, you’re going to go ahead and take that right ankle over the left knee. Again, making sure that the ankle that left that left foot is flushed with the outside of the thigh. He’s going to go ahead and let that wrote that whole sole, that w that right foot to be on the floor. So he’s going to go ahead and rotate over. So that whole right leg outside of the leg, you know, that perennials, that it down all, that’s flush without side of the floor. He’s going to go ahead and dorsiflex and activate that right foot. So can see through the mirror, but he’s, he’s, he’s flexing that right foot. That’s all flush with the floor. We want to make sure we have Brian go to the other side so we can see that.

Sure. Good idea,

Please. He’s flexing that, uh, that right foot. Now that’s on the floor, the left sole the foot should be able to stay on the floor. So if that’s not being able to stay on the floor, then what we need to do is decrease the flection of the hip angle, just like we showed in the beginning. Uh, that means he’s probably too steep of an angle. It’s too much of a stretch. So it’s like the figure four wall. He’s going to go ahead and externally rotate an abduct AB duct, his, his left leg. And, uh, we haven’t really discussed that too much about the time. So you can hold for this for about 30 to 30 to 60 seconds. Um, I really also like to give a cue for the patient to really reach with the, in this case, it would just, this would be for Brian’s left knee.

So kind of reaching that towards the mirror, we’ll call it a quarter of a long gait, that area, um, um, and give more of a stretch, sometimes felt in the TFL sometimes even felt more in the quadratus lumborum, which is also on that liver sinew channel. So this one in regards to it’s difference with the figure four wall, I think sometimes people, uh, patients can feel more of the stretch moving in through that liver sinew channel up through that quadratus lumborum. You can also, if, if he’s comfortable with it, go ahead and rotate his head towards the leg that is, is being activated. So that left side for him, as you can see does that to the mirror. So I, that location can really feel all the way up through that necessary. Cause as, as we can see, we didn’t see in the artwork, um, uh, that, you know, the, the elevation of the ilium is also going to cause a shortened quadratus lumborum on the ipsilateral side.

This is excellent. Yeah. Um, we’re running short on time, so we’re going to have to cut that one. Um, Oh, this is also a it’s. All right. This is great. This is really good. Um, for step-by-step information on this exercise, we have that in the blog article on this sports medicine, acupuncture.com, it’s the September as the December blog article. So, um, let me discuss a little bit real quick. What we teach in the pace class, paces and acronym for the partial assessment of corrective exercise. Uh, we talk about intradermal needle using pine next needles on extra ordinary vessel points to be able to, uh, increase their range of motion and decrease pain. For example, if you had somebody that was in this figure four position, and they had some hip joint problems, or let’s say some, um, uh, discomfort in the hip abductors or so you could use a particular master and confluent points, uh, to help decrease this. So the patient can stay in that position and, um, perform these exercise successfully. So now what you’re about to see right now, a particular mastering fluid points. I’m not sure why there’s feedback happening right now, but anyways, um, let’s go to the next video. Please stop the CB right now.

This is from the pace class in a Chicago smack class, which you’re about to see

What’s your [inaudible] might have to do more and let’s see how [inaudible]. That’s pretty cool. Isn’t it? Let’s keep this rolling. This is really good. You guys, this was a really good one. You guys ready, guys? This is a really good one. And what the problem that she was having is just getting into this position. She was spending a lot of pain and the glute medius minimus. It was fatiguing. She wanted to actually get out of this position. So that movement is actually pretty complex. Isn’t it? It’s rotation. It’s extension hip AB duction. So we went ahead and did gallbladder 41, Sandra five on both sides. And she’s now able to do the exercises. Stay into this position is really quite an interesting face that she had is a lot of surprise. It was good. Okay. So if that one didn’t work, we would have used probably do my Yon chow or ran my child to be able to see what the extension and the happy option you guys good. Do it making sense. It was the points on the unaffected side that were most tender to the unaffected side were the most tender. All right. Good job guys. You’ve gone.

All right, let’s go to the next slide please.

All right. So what we’re using are the pioneers needles by Sarah and, um, the distributor for that is Los OMS. Los OMS is the sponsor for the sports medicine acupuncture certification program. That’s the size needle that we normally like to use people. Um, it will stimulate the receptors enough, the extramural vessel mastering called flow points enough. Um, and it’s usually painless for the patient when they’re doing exercises. So I know, I know that we’ve gone over time, everybody. I really apologize, but we only have like three or four more slides. So let’s go ahead and finish this up. Um, let’s go to the next slide please. And you want to take this over for the biceps femoris?

Sure. We’ve just got a couple examples here of some, um, some good bias, uh, bicep for Maura stretches again, understanding that with its biotech nature and how it crosses the knee joint, it can be a culprit for that knee moves in as well. So, you know, there’s a variety of different ways to address the bicep for Morris in terms of trying to get at a little bit more lengthened and, and, and not pull, have so much tension to pull that knee in or to move that knee. And so, um, you know, there’s a variety of other ones, but these are just a couple of examples, um, that you can do to try and, and solve that side of the knee moves in from the hip.

Yeah. We don’t have time to go into all the assessment for it, but there are ways in the overhead squat to change things to really tease out. Is this more coming from the, the UV, you know, biceps from Morris, uh, gastric, uh, area? Is it coming more from the liver gallbladder, uh, Sydney channel sort of aspects and it could be a combination of both. Yeah. Yep. Yep.

So let’s go to the next slide so we can see this. Yeah,

Go for it again.

So, um, as, as we, we mentioned, there’s, we’ve talked about some of the different things from different aspects from the hip that can cause that need to move in. Um, we can also be looking as we mentioned before at the foot, um, and how it can, you know, be a contributor to that knee moving in. So on the left side, we’re looking at, um, the, uh, has planets, um, and also sort of the foot abduction, uh, being part of that issue to move that knee, the knee moves in. And sometimes even if you don’t see, um, any, any Pez planets or, or, you know, from a standing posture or a foot abduction from the standing posture, when someone goes into an overhead squat, the, the tightness of that whole, um, lower urinary bladder, so new channel will come to light and you’ll see that foot abduct and even maybe start to collapse and overpronate um, so that would be, you know, restriction and tightness from the urinary bladder. So new channel, like your peroneal groups, your lateral gastrocs, some of the things that we mentioned that that could take that tightness and pull that knee in.

Yeah. A little change of subject, I guess, by the quick question popped up about the previous example of a San gel five. Uh, there was a question of is Sandra five or six Sandra at five and gallbladder 41. And typically in the corrective exercises, when there’s difficulty for various reasons, I would tend to help with more rotational aspects of rotational problems.

Yeah.

Um, the protocol for this isn’t in chapter four of the sports medicine acupuncture textbook, and this is something that we also teach a lot during each one of these, uh, pay series and the sports medicine acupuncture certification program. Going back to this slide, let’s take a look at the image on the right. Let’s just put our, our, our assessment and clinician hat back on when you’ve got that patient with medial knee pain and they go into an overhead squat and you see that knee moving inward, or possibly that foot then goes into abduction. That starts to move out. That’s really demonstrating a lot about the sinew channels that we discussed already, but let’s look at it. It looks slightly different way is that we saw that as you was mentioning earlier, that that doctor is going to be in a lock short position. It’s going to be access, pulling that knee inward, the biceps femoris being part of the urinary bladder sinew channel is also pulling, pulling that knee inward.

So therefore that also means that the medial hamstrings are going to be deficient now that entire UV myofascial Sr channel, even all the way down into the foot. All right. So that lateral musculature of the urinary bladder senior channel will be in an excess position, which I believe is information that we discussed in a Pez plan webinar that Brian and I discussed in a webinar a few months ago. So you can always go back and take a look at that one as well. There’ll be more information about needle techniques and session, how to get old, lift the arch with that. So you’ve got a whole treatment protocol locally, just to be able to treat this. And again, you’re always going to try to link this to the organs because nine times out of 10, there’s always going to be some kind of Oregon disharmony that the licensed acupuncturist can treat this traditionally is treat traditionally as well. In addition to this very Western biomedical way of looking at things, Anything else

That’s good just to highlight that Ian Ian’s demoing the overhead squat. And I dunno, even if you were just doing that for the picture, or if you have a tendency for the right knee to move in, but kind of what Matt was saying, if, Oh, go ahead.

I was going to say it’s probably both. Yeah. Yeah. I think probably I have more of a tendency of that foot to move out. And I think it was probably trying to demo that made many moves in, but yep.

So just to highlight, you know, through other assessments can tease out of, this

Is more of a balance between abductor and abductor and maybe this patient has signs of liver cheese stagnation, or liver blood deficiency. So you’re really putting all of it together. You know, this is, this becomes just another assessment that ties into the, uh, the full tongue polls questions, all of that.

Excellent. All right. So our next slide we’ll room going over is one quick exercise, which I think we actually taught in a previous webinar, but it’s such a great exercise for that, a foot abduction or a Pez planus piece. Um, so we’ve actually got two more slides, but let’s start with this one that we’re on right now. Uh, Ian, do you want to go ahead and take it over from here?

Sure. Um, we call this, uh, inchworm in the pace, uh, seminar series. You can also, I think you’re looking it up if it’s something that you want to learn about. Sometimes it’s also called a short foot exercise, but the first, uh, picture on the left-hand side, that’s the, that’s the beginning, uh, that’s the beginning photo or starting position. Um, you know, patient can be sitting, um, even if they’d like to, with their foot on the floor, um, standing cause just fine too. Um, and really making sure they’re getting all parts of the foot, that heel, maybe just under that big toe and part of that, uh, you know, right around UV 64, um, that part of that foot should also be planted on the floor and what they’re going to go ahead, as you can see in the second picture is that that big toe is starting to scrunch.

So what really you’re doing is you’re starting to get activation and we’ve talked a lot about the tightness or the restriction from the urinary bladder, so new channel causing that foot abduction. Well, we didn’t mention it when it’s talked about, I think in the previous, uh, seminar that Matt mentioned through, um, um, the American Acupuncture Council here is that the spleen and kidney sinew channels are ones that we’re trying to activate. And beginning of those channels, we have the abductor [inaudible] and the flexor health has previs. Um, so we’re really trying to activate the flexor hallucis brevis and the abductor, how has to try and get that activation and flection of the big toe in that medial arch. Uh, so they flex that toe forward and then they go ahead and lift and fall through. So it’s almost like your inch warming your foot, hence the name of the exercise. So you go ahead and scrunch that toe, kind of follow it up with the heel and then go ahead and lay that toe flat again and repeat maybe three, four times one way and then actually start to crunch and push it back as well. So you would go both directions.

Cool. You now Brian’s got a modification to the, Oh, sorry about that. Brian’s got a modification for this one. Uh, Brian’s got a modification for this, so let’s go to the next slide. Brian, let it go.

Yeah. So in this one, you, if, if you kind of see the ghost image on the top corner that his foot, uh, AB duction abduction, so you’re flattening as as much of the medial arch, as you can. You’re exaggerating that PEs planus and really collapsing that medial arch as much onto the floor as you can, to give yourself something to move out of. And then you’re sweeping the, the foot along the floor. It’s not as much a leg rotation is trying to use the foot muscles, the curve, the foot to make the foot like a going from a long position where the medial arch is flattened to the floor, the lifting and, and shortening that medial arch. So you’re like fully contracting that medial arch and the muscles that Ian mentioned abductor hallucis primarily. And this one, I think, and probably a little bit of flexor hallucis brevis and then you could repeat it, turn the foot back out, flatten the arch as much onto the floor as possible, and then make one big sweeping motion where you’re turning it in.

Yeah. Excellent. Well, gentlemen, this was, we gave a, a lot of information and just a super quick overview for those patients that are coming in with medial knee pain. Uh, please take a look at the hip for an elevated ilium. Please take a look at the foot for going into abduction, make sure that you are looking at the channels that are affected with this. As we described, make sure that you also are treating the patients constitution with this, because that does make tremendous changes and we’re not just treating locally. Uh, that’s going to inhibit us quite a bit. So let’s remember our roots in traditional Chinese medicine. And, uh, gosh, we went away. We went over. I’m sorry, everybody, but you know, this is what a good surprise. Yeah. Thank you so much for coming on. Really, really appreciate you very much. My pleasure. I’m

Very excited to join with you guys. I, I,

Yeah, it was awesome. Thank you. Yeah. Good, Brian. You as well. So it’s a pleasure speaking with you and we want to thank the American acupuncture council, um, for again, inviting us to be able to do this. Um, and also for next week, we’ve got Jeffrey Grossman coming in for the American acupuncture council. So make sure you, uh, tune into that as well. You guys thank you very much and we will see you in January happy new year. Happy holidays, everybody

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