Tag Archives: Matt Callison – Brian Lau

Chondromalacia and Patellofemoral Syndrome: A Jingjin Perspective

 

 

Hello, everyone. Welcome to the American Acupuncture Council podcast. My name is Matt Callison. I’m with my colleague and dear friend, Brian Lau. Hello, welcome. We’re here to talk about Chondromalacia and Patellofemoral Syndrome. A Jingjin Perspective, because this is only 30 minutes. We’re not going to have a lot of time to be extremely thorough, but hopefully the, what we’re going to be talking about in this short presentation will hope to provide content that can be used to enhance the practitioners current treatments for these conditions, and also possibly excite the practitioner to learn more.

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.

So why don’t we jump right into the information I want to introduce you to Brian is going to get started with, uh, with, uh, a video that we’ve been working very hard on, right? Yeah. Well, first of all, as you can see, there’s a warning screen up. Uh, this video coming up is from a recent dissection. Uh, Matt and I did a

As preparation for the Sports Medicine Acupuncture certification, uh, module three, uh, anatomy, palpation and cadaver lab is the first two days of module three. When we do the program, we usually, well, we always prepare the cadaver specimen beforehand as part of that whole two day experience. Students come in and they’re able to, um, work with the cadaver during the cadaver lab portion of that class. And then that evening we stay after prepare the cadaver for the next day, a different view, different depth, maybe from prone to supine. They come in they’re there. They’re able to see that, uh, prepared specimen the second day as part of the experience for the two day lab. So now with COVID, we’re having a transition to some of the classes being online and webinar-based based. We have an upcoming one in October. So this is one of the videos that we produced for the anatomy palpation cadaver lab coming up in October.

Uh, the experience is a little bit different in some ways I think it’s potentially better because the students get a chance to see some of the dissection, some of the process that we’re doing, but at the same time, they’re not there for the experience live, but there’s, there’s pluses and minuses. So this is a video from the upcoming class. We’re not going to be able to play the entire video, but, um, it’ll supplement the discussion of what we’re doing today, which is on Chondromalacia and Patellofemoral Syndrome. I’m going to go in and play the first part of the video. So there’s a little bit of a, uh, animation to set the stage about how the patella tracks. So you’ll see that coming up in just a moment.

Let me see. Sorry. I didn’t have the video started. It should start in just a second. Now, here it goes. So what’s, you’re seeing there’s patella is not on the bone is set up with a supine position and this is going to highlight the trochlear groove. That’s where the patella tracks, the patella should come in and just a moment, and you’ll see how it sits over this patellar groove of the femur. So the patella tracks during flection and extension along that patellar or trochlear groove, and that’s partly held in place, or at least, um, that movement is, is controlled by the guy wires of the spleen and the stomachs and new channels. And if there’s balance in those channels, well then of course, that’s going to allow the patella to track along that trochlear groove. So a common situation very frequently in clinic when people are having problems with patellar tracking, leading to pain, is the stomach send new channel, especially the lateral quadriceps, the vastus lateralis pulls accessibly and the spleen send you a channel is weak and not doing quite the, the amount of work

Or the load that’s necessary. So what happens is then the spleen fails to lift the patella. Paul’s lateral. We’ll talk more about that as we go through the presentation, I’m going to go back to that place. Let me get back to that moment. And now we’ll see that on the cadaver specimen.

There we go.

This video is showing the quadriceps three of the quadriceps. We’ll be showing the vastest intermediate in a separate video for this video. You see the rectus femoris muscle, the rectus femoris attaches to the patella blends in all the way down to the tibial tuberosity. You’ve got the vastus lateralis attaches to the lateral lip of the femur, attaches to the lateral aspect of the femur blends in with the fibers of the rectus femoris and attaches to the tibial tuberosity. Then you have the vastus medialis, here’s the longitudinal fibers of the vastus medialis and the vastus medialis has oblique fibers. As it comes down, attaches to the medial aspect of the patella blends in with the other quadriceps to attach to the two tuberosity. As we learned in the previous lectures, you have the spleen channel affecting the vastus medialis. You have the stomach channel affecting the vastus lateralis.

We need to have an even pool between these two muscles so that the patella can evenly run evenly, go through the entire trochlear groove, a common imbalance between these muscles between these channels will pull the patella lateral and superior causing condor, Malaysia and patellofemoral syndrome. In other videos, you’ll see lateral retina curriculum needling for that also surround the dragon needle technique around the patella that can help with that condition. The rectus femoris you can see as a bipartite muscle. That means it has a linear Alba. So this Linea Alba runs down the center of the patella with all right, little summary of what we’re looking at, Matt. Yeah. I just want to say something really quick. I’m not quite sure we’re having technical difficulties because on my view, it looks really, really blurred that videos is crystal clear with the resolution that we normally have that was really blurry.

Um, Brian, are you seeing the same thing as a blur on your end to look fine on my end, but it might be that I’m looking at the screen that it’s playing on. Well, maybe it’s my glasses. Let me take a look. Sorry about that. You guys, um, patellofemoral syndrome will frequently present with a lateral glide and or lateral tilting of the patella. This is what we were discussing, how the stomach send you channel that vastus lateralis pulling up on that lateral aspect of the patella and the spleen channel weekends is unable to guide that of the patella. So it starts to tilt as you can see to the lateral side. So this malposition can lead to increased pain and also deterioration of the patellar cartilage, which would be also another name for chondromalacia patella and what’s next or Brian.

So the patellar tracking injuries causing pain can lead to positive valuations, such as with using Clark’s sign. Clark sign is a very good test. It’s a test that causes pain. So you have to make sure that you’re doing it very gently. What you’re doing is you’re forcing the patella actually into that trochlear groove. And if there’s chondral Malaysia, if there’s that sand underneath that patella, then you can only imagine for those people that don’t have it, what that’s going to feel like when you’re actually trying to get that patella to grind against the bone. And that’s what Clark’s sign is. So it’s, it’s a very good test, but you have to use a lot of sensitivity with it, cause it can really hurt the patient quite a bit of that gross feeling. Yeah, it is. Yeah, it is. It’s your purpose, Brian. My take on Eli’s test toss test, uh, Eli’s test and Thomas test will utilize test specifically.

Uh, the, the patient is prone and you’re bringing their heel to their behind and you’re seeing Morris is able to fully lengthen. And if it’s shortened, then what it does is as they get into the extreme of me, flection that shortened rec fem starts to Paul acceptance excessively on the phenomena bone and it drives the nominate bone up. So it’s really simply a test to see if the rec fem is able to folly lengthen. If it’s not, then that indicates an overactive and block short rec fem part of the stomach’s in your channel. And that would be really good information that that would lead you to, um, wanting to reduce tension along the rec fem and along the stomachs and new channel Thomas test test for multiple things. Um, in this context for this lecture, it’s another test that will test for a quadricep length.

So it’s a, it gives you another way of looking at if the quadriceps is a group or overactive, uh, it does also test for so as shortness Elio. So as shortness, another channel send you another lecture, uh, potentially, um, Sartorious shortening part of the spleen sinew channel also kind of less related to the patellar tracking in this case, but it does test for other things, but in our context for today, it’s really about the quadriceps. So these are two excellent tests to test for overactivity in the quadriceps. Eli’s more specifically on the rec fem, um, places suit by patients. So I’ll take this next bullet. Um, as we know, when the leg is extended, it’s easy for the practitioner to move the patella cause it’s mobile. So in this particular test, if we go into knee flection of about 20 or 30 degrees, that adds a little bit of tension that Battelle announced a little bit tighter into that trickle your groove.

Now we can push on the patella from side to side motion. This is a kinder, gentler test and Clark sign. So you may want to use this one test first to see if that’s positive, then you won’t have to use Clark sign. Um, this, this test is actually really reliable, at least for me, uh, next assess the tightness of ladder retina and live in the knee. So place the suit by a patient in a straight leg position with a quadriceps, relax, the practitioner lifts the lateral edge of the patella away from the lateral, from Macondo, a tightness or inability to raise the lateral edge. Approximately 15 degrees indicates a tight lateral retina macula, but of course, you’re going to compare it to that, to the opposite side. So you’re going to palpate the patella and get your thumbs to start working up underneath that lateral edge of the patella, soften the tissue a little bit, take maybe 20, 30 seconds to do it, and then lift that patella. If that patella on that lateral side, doesn’t lift more than 15 degrees. That’s a positive side for that, that stomach send you channel tightening down that lateral retina macula just is a, usually a cold stagnation in that region pulling down on that area. So this is the reason why we have a needle technique going into that region, which also is a moxibustion is also applicable with that. Brian want to say anything or move to the next slide?

I’ll just add a little quick something. Uh, so these are all of course Western orthopedic tests, but since we’re looking at it from the perspective of the sinew channels, all of these to some extent are channel tests also. So, um, this test testing for the lateral retina curriculum in the video coming up, you’ll see how that lateral retina baculum is part of and continuous with the deep fascia of the thigh and how the stomach’s in new channel polling excessively through, especially the vastus lateralis can add extra tension into that lateral reticulum. So it’s part of a continuous chain from the thigh into the knee. So when you’re testing that you’re testing the stomach, as Matt mentioned, you’re testing the stomach’s in your channel. So you’re getting a little bit of a window into the stomach GI. So depending on what other signs and symptoms you found from your evaluation in this case, your TCM evaluation, you can put that information, uh, along with what you’re finding with this more palpation and the assessment of the knee. You know, maybe the person has acid reflux or some other, you know, rebellious stomach GI signs. And you’re feeling that excessive tightness on the vastus lateralis you’re lifting the Batalla, the Batalla doesn’t pull and doesn’t move away from that lateral surface. So well, so it’s pulled lateral. So that would all start to paint a picture both from a local orthopedic standpoint, but also from the whole body holistic approach from TCM. Good to put them two together.

Yeah, totally agree that that’s the lesson. I think we learned in first year of acupuncture school, how the meridians, the channels are connected to the organs and when you’re really looking for that, you can find that you’re absolutely right. Brian, a lot of that with the gallbladder channel as well. Sure. Cool. All right, well let’s keep moving. All right. So this is the needle technique using two, three inch needles going through the retina baculum, um, this is a needle technique that you want to make sure that it travels just underneath the subcutaneous fascia, the subcutaneous adipose layer, and just scraping along that lateral [inaudible] for many patients, if you start to angle oblique with this needle technique, it’s going to hurt very bad. So this is a needle technique that you want to practice on somebody that can handle needle stimulation. Don’t try this on a patient for the first time.

If you practice this needle technique, first, if you go too deep, it’s going to cause a lot of pain. If you, if you have that needle ride between the superficial fascia and the deep fascia, just underneath the adipose and before the muscle layer and the retina and that joint capsule just slide it right along that practice. At first two needle side by side work really well and moxibustion, or electricity can work that blue.is stomach 36. So what you’re doing is you’re aiming those needles towards, so at 36, yeah. And the, uh, the two needles. Now you might’ve said this, but I didn’t hear it myself. Uh, those are three inch needles that are better, um, shown there. And you’ll see that actually in the next cadaver video. So right now you can kind of look through the skin and picture it, but pretty soon you want to have the picture and you’ll be able to see it a little bit more clearly in terms of what the target tissue is.

Right. I don’t know if you wanted to mention anything or maybe it’s just simply saying that that surgical techniques are to, to release this lateral retina macula, which is kind of an extreme version, but this is the same tissue that, uh, the needles are working with the soften and release that ladder. [inaudible] in a way that doesn’t, uh, what’s better to not have to go under the knife if you can. So this is a, uh, a really an excellent technique that would, um, kind of parallel, I guess, some of the more aggressive surgical techniques. And it’d be part of a comprehensive picture of the other needles being used in this whole treatment and myofascial work and exercises and stretching. And even guash is, it’s a tissue that is pliable. You can get it to stretch. Um, it just takes some time to be able to do it, but absolutely you can get really good results with this and the myofascial techniques and yet everything else that we do.

Alright, so surround the dragon needle technique. We’re going to be seeing this in the video, coming up on a cadaver specimen, usually seven needles. You’re just going around the patella itself. Your goal is trying to get underneath that Battelle. It’s a way of getting the retina macular tissue, that tissue all around that patella to actually communicate and loosen up as much as possible, but you can use Eastham on those needles, or you can also use moxa with it. These needles will be in addition to other spleen and stomach CGU channel dysfunction. And of course we’re treating the foot and the hip, anytime that there’s a deep problem buts that’s for a conversation for another day. Yeah, yeah. Those are one and a half inch needles. So you’re not trying to drive the needle as far as you can, under the Batalla. You’re just trying to get, uh, get the needle in the space between the patella and that the trochlear groove basically to also, you know, work on some of that fixed pain side of, of where there’s a degeneration of that, the patella cartilage, right? So we are ready to look back at the cadaver image. I’m going to cue it up to the point that we’ll take it from there. So we’ll see those needle techniques on a cadaver prepared cadaver specimen. So that’ll give us a little better view, especially the red Nakheel and you’ll be able to directly see that tissue. So again, if you’re sensitive to cadaver images, then maybe you look away for this portion. But, um, I think it’s, uh, all of us being medical professionals, it should be fine.

So let me queue it up. Give me just a moment. There we go. The lateral and medial retina baculum of the knee are part of the stomach and spleen sinew channels. Respectively here, we see an acupuncture needle inserted into the lateral retina curriculum. We teach a technique and assessment and treatment to address this target tissue. This is a surround the dragon needle technique for the patella uses for condor Malaysia, patella, we’ll be using seven needles going around the patella. The first two needles will be on the lateral side would be the first one. The second one will be on the medial side, located halfway between the superior pole and the inferior pole. The goal is to get the needle underneath the patella, as far as possible.

Each one of these needles is directed toward the underside of the patella. This needle technique is performed when the leg is, has knee extension, not a pillow underneath it all, but knee extension flat on the table, you can also apply electrical stimulation on this, or you can also do direct from ox or right onto the patella. Brian, can you freeze that for a second? Here? We can get a better before the MFR. Yeah, yeah, that’s good. Is it on the, uh, surround the dragon? Uh, I’ll get it back there. Alright. Okay guys. Um, so let me just discuss this. So the needles that you have going from, uh, the two inferior needles, I think you probably have already figured that out one is going into the medial. She on the other one is going into the lateral Sheehan or stomach 35, the needles that are on the medial and lateral side, those are inserted halfway between the superior border and the inferior border of the patella, lifting that patella up to the side and inserting the needle under you do that on medial lateral sides. The remaining three needles, two of them will be on the superior medial border. I’m sorry. One will be on the superior medial border and the other one will be on a superior lateral border. Again, the intention to go underneath the patella, the last needle at extra point, Hadeen going underneath or going through the tendon and underneath the patella there. Hopefully that was helpful.

All right. So we’ll play then and look at the myofascial techniques that can be used afterwards. These are working also directly with retina curriculum.

Okay.

Oops. Sorry about that. Hold that back. Ah, why is that? There it goes.

Alright. So we’re going to be seeing now manufacturer release technique, moving there

Better look at these fibers tissue structures with stabilize the patella, the hands are mobilizing the retina macula on each side to show their influence on the position of the patella.

So you can see how that lateral superior allowed a border. The patella is now straighter.

Now with the superficial fascia removed, we can see how these tissues connect to the deep fascia of the thigh and the respect of channels in use.

Can you see doing this myofascia release technique after you’ve done the needling because the needling is changing the tissue density and the force changing the perception, and then you physically use your fingers to move that tissue re encourage them.

Marshall will give a better view of the underlying muscles of these channels and use and their relationship to patellar balance. All right. I shot, right? Yeah. So you got to also see two different depths with the superficial fascia removed. You get a little better view of how continuous that retina macular tissue is on the medial and lateral side with the deep fascia and how the pole from the stomach and spleen channel would also, um, have something to do with, in terms of too much Paul, on the stomach’s in your channel with Paul excessively on that lateral retina baculum so reducing at the, especially the motor point of the vastus lateralis would be helpful along the stomach’s in your channel. And then if there was weakness and an inability at sort of a lessening of Paul on the spleen side, then you could use this, the vastus medialis motor point to help bring cheetah, bring a little bit of tone to that, uh, vastus medialis to compliment the treatment. So those two are working in coordination with each other when they’re imbalanced.

I brought you want to go over that short exercise?

Uh, I think, go ahead, Matt. Matt, why don’t you take that one?

All right. So here we have the, uh, just, uh, you can use a small foam roll or you can use a towel. That’s gonna be rolled up about four inches or so sometimes five or six. And it just depends on the density of that towel. Go ahead and put it underneath the knee. You want to have the patient go ahead and place their fingers over spleen 10 or extra point by Chong, low two or three fingers would be great. You have the person seated just like this and then have them focus on contracting the vastus medialis oblique fibers when they are, when they’re trying to press their knee into the pillow or into the towel. So with knee injuries and patellofemoral syndrome and lots of different knee injuries, the vastus lateralis is going to fire before the vastest media out. So bleak and that’s backward.

Let me say that again. The vastus lateralis will fire before the vastest media, so bleak and in the muscle firing sequence that’s backward. So again, it really supports that stomach gene gen Xs, spleen T deficiency here. So let’s have that have that patient do this exercise after you’ve just treated the stomach and spleen gene gin, and also did your myofascia release. And you’re giving this one exercise just that small protocol can help a lot of patients about all, obviously it depends on how the severity of the injury, but this is really giving you a good little package to be able to start working with these kinds of conditions. Again, emphasize that the patient is getting that bass as media. So bleak fibers to fire before the vastus lateralis, when they’re going into knee extension, right?

Yeah. Just for those who maybe haven’t looked at the anatomy as closely, the vastus medialis, the medial quadriceps, that kind of tear shaped muscle on the medial side of the thigh, um, is a muscle, but the, a VMO, the vastus medialis oblique are the fibers that start as there as the more inferior fibers that, that take more of an oblique direction as they sort of angle towards the patella. So when you get higher up in the muscle, the fibers are a little bit more straight up and down a little bit more longitudinal, but the lower fibers then start to angle and they’re more oblique. So that’s what the, the abbreviation BMO vastus medialis oblique is same muscle, just the oblique fibers.

Well, Brian, I think that’s our last slide on this conversation, but, um, is there anything else that you want to cover as a closing for this Brian?

Uh, no, no. I can look through some of the, uh, chats. I know there’ll be some questions. I just, again, like distress, I’ve already said it. Matt said it, but, um, you know, a lot of folks who haven’t had a lot of orthopedic, uh, experience as they start to transition more into orthopedic work, uh, for TCM practitioners, it’s very easy to sorta see it as sort of a different world. You know what I mean? It’s, it’s, uh, all of a sudden Western orthopedic tasks, we’re doing Clark sign, we’re doing, uh, Eli’s, we’re doing,

We’re talking about patellar tracking. We’re talking about a lot of very Western type concepts, but the goal, one of, one of our goals, at least in sports medicine acupuncture, is to really bridge those two, those two worlds. So when you’re looking at the, especially this Indian channel relationship, it all is very specific work that we were showing more local work, but it’s part of the big picture. Again, looking at the song, food, looking at the, if we had more time, we could talk about how the hip and the foot position relate to it. And there’s other channel relationships that’ll go with that that are better part of the big picture. So, um, it’s really just taking information you have and applying it in a, in a slightly different context, but don’t lose sight of the information you do have, cause it’s such a powerful medicine to really put together with this more orthopedic approach.

Yeah. Excuse me. I agree. So for the TCM practitioner, all of those different syndromes that have knee pain as a sign and a symptom, that’s something to look at kidney cheat efficiency, kidney inefficiency, liver, cheese stagnation, especially with peasants Ryan problems and medial, knee pain, all of those things apply. So we treat the patient with our TCM diagnosis and then we add this sports medicine on top of it. Yeah. And we’ve been doing this for a while now, so we’re getting pretty good at it. So hopefully you guys can be able to come check out our webinars. We want to thank the American Acupuncture. Do you have something else to add Matt real quick? Okay. I’ll think those guys afterwards, um, the, the surround the patellar needle technique, Matt showed the two, uh, Sean points. Um, so that’s a little bit more of a angling under the patella.

If you go to the YouTube channel for sports medicine acupuncture, there’s also a video that has the knee and much more flection and showing more of a needling more towards the [inaudible] direction to, to access the, um, uh, anterior cruciate ligament or a different direction to access the medial and lateral meniscus. So the reason I’m bringing that up, it’s not really part of this class, but just understand that these same point different needle directions are gonna specifically target different target tissues. So it might help, uh, start to bring it a little bit more into a full picture. If you wanted to check out it’s another cadaver video that you can see on our, uh, uh, YouTube channel. Yeah. And that will also be in our webinar coming up in October. Okay. Now, now you can think, yeah, we want to thank the American acupuncture council very much for having us in this sports acupuncture podcast. You guys thank you for listening. We appreciate you very, very much. Um, next week we have Laura or the American acupuncture council has Lauren Brown coming in to discuss things. So that’s going to be fantastic if you have not heard Lorne Brown speak, um, you should check it out. Lorne is a very incredible practitioner and an academic as well. It’s a really nice blend. Thanks very much. You guys. Thanks, Brian. Really appreciate you. Thank you. See everybody.

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Brian Lau and Matt Callison

Foot Over-Pronation and the Spleen and Kidney Channels – Brian Lau and Matt Callison

Click here to download the transcript.

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.

Welcome. Thanks for attending today. So we are recording, uh, prerecording, this video, uh, I’m visiting Matt in San Diego. We’re doing some, uh, dissection and we’re doing some, uh, techniques and putting them on video for some future classes that we’re working on. So this will be prerecorded and, uh, hopefully it’ll be an enjoyable experience for everybody. Good morning, everybody. So Brian and I presenting today, a brief clinical discussion on foot overpronation and the spleen and kidney channels. This topic is in depth in a 30 minute webinars highlighting only a portion of the content. However, we felt that the information in this presentation is providing the viewer some ideas that can be integrated into your own clinical practice. And we’re going to start this presentation with three primary, uh, with three primary biomechanical components of foot pronation that also leads to foot overpronation. So, Brian, do you want to talk about the video?

Yeah, sure. So, uh, put this video together and it uses a flexible foot model. You’ll see the video in just a moment, uh, just a little bit of, um, information on the video when I’m demonstrating and I’m pushing this foot down on a hard surface so that it takes the foot into pronation so that we can look at the components of pro nation, but I really flattened that foot down to the surface to, to highlight those particular movements in real life. And there’s a disclaimer that says this in real life, this would really be more like foot over pro nation, but it helps that helps visualize those particular movements. And that’s why it’s really flattened. And you’ll see what I’m talking about in just a second. Yeah. So just so you know that it’s not going to be on your end, this video, the first five seconds there pauses just a little bit after that, it Rose really quite smooth. So here we go, Normal footprint nation occurs.

And the longest pause that we’ve had in walking and running during the impact and weight bearing phase of gait, the foot falls into pro nation. This movement helps absorb shock and builds elastic, tension and structures such as the plantar fascia, which much like a trampoline will create an elastic recoil. During the next phase of gait, normal pro nation involves a combination of foot abduction emotion in the transverse plane. E-version at the subtalar joint emotion in the frontal plane, an ankle dorsiflexion, a movement in the sagittal plane during ankle dorsiflexion. There is also a medial rotation of the tibia during these movements, the spleen and kidney channel send use become lengthened. They also help control the motion and prevent the foot from over pronating. So proper tone in these channels send use necessary for support.

All right, so the video, it can, it’s very biomechanical. It’s an important thing to understand when you’re a sports acupuncturist, then you’re working with athletes or you’re working really with anybody who has injuries that have a component of foot overpronation that’s influencing the condition. But, uh, so I would argue just understanding the biomechanics is important, but even from a channel perspective, understanding the different components of the biomechanics is important because it tells us a little something about the channel sinews, and it tells us a little something about the position of those channels and the influence and relationship of one channel to the next. So this slide is going over a little bit of that and talking about an over pronated foot, really what you saw in the video as much of a collapse as we saw on that foot arch. Um, and with that overpronation number of things happen that caused really a downward collapse in the yin channels.

We saw that on the video with the spleen and kidney channel in particular, um, where those channels are kind of collapsed and dropped down and an excess excessive upward polling from the young related channels, like the urinary bladder channel in particular. So we see this in the image that she collapses downward on the inside and the, she has pulled upwards on the young side. This can lead to a number of injuries of the foot in particular plantar fasciitis, or plant our past Geosys. It can influence things like shin splints because of the collapse and the excessive polling of the muscles that attach onto the tibia. It can be a component of medial knee pain because of the internal rotation that occurs in the tibia. And really that can transfer all the way up into the hip and back and neck and upwards. You know, I mean, it really has a global influence on the body when the foot over collapses like that.

So we have

Another image here. That’s showing this in a little bit more detail on the inside and yellow, we have the spleen and stomach cheek collapsing downward, both of those that the, um, yellow on the inside of the tibia re referencing the tip posterior is a really major influence of a particular muscle that holds up the arch. That if that muscle is weak at the spleen, she is weak in particular, there’s going to be a tendency for that muscle to be weak and not lift and hold up the arch in the proper way to, by anterior on the stomach side, it is also a big part of that, cause it crosses over and attaches to the medial arch. Both of those will really help lift the medial arch. And then you have the upward Pauline from the urinary bladder channel send you, especially through the protea, as long as the brevis, which we’ll look at

Brian, next slide. And

This is looking at it from the back. So if you look at the right side of the foot image, you can see that the calcaneum tilt. This is part of the aversion that we saw in the video, the calcaneus tilts medial, the top of it kind of falls medial, and you can see a bowing of the Achilles tendon. So we can see a dropping of the kidney sinew channel and a lifting of the urinary bladder in particular, the soleus part of the kidneys. So new channel has more fibers that attach to the medial part of the calcaneus. Whereas the gastrocnemius, the more superficial muscle, we can see that on the left, where it’s kind of splayed back, um, and kind of off to the side, the gastrocnemius attaches on the lateral side, they both form the Achilles tendon, but if you tease those fibers away, the gas track would attach to the lateral portion solely based on the medial portion, the medial portion is going to be dropped and pulled access to be long in relationship to the lateral portion.

So another influence of the channel send news, right? And this next slide, I’m sorry, go ahead, Matt. I think the next one’s going to be the navicular drop. Yes. So let’s go back. The image on the right, you can see as Brian was discussing the imbalances of the sinew channels, this particular view poster is called helping sign that we’re going to be discussing here in just a second. There’s another way of actually looking at this as well, because the tibialis posterior spleen sinew channel attaches to the navicular bone using the navicular drop test is really quite efficient and looking at the lengthening of that tendon and the spleen channel. So when the person is a non weight bearing position, which is the top image you can measure to see how high the navicular bone is that blue.is that kidney, to which we know, can you choose located just underneath inferior border of the navicular bone? The bottom image is going to be a full weight bearing position. So you can see that blue dot has dropped significantly indicating that the bones being dropped as well as the tibialis. Most tutor attended spleen sinew

Channel becoming lengthened. The medial arch is collapsing. So here we’ve got being signed. The calcaneum e-version. So the calcaneus is tilting into an every position. You’ve got a bowing of the Achilles tendon. As, as we discussed before, this can lead to a number of different injuries, tarsal tunnel syndrome, Achilles tendinopathy, et cetera. So looking at this helping sign is an indication for foot overpronation. Now there’s a lot of people in the population that are walking around like this, and they don’t have any pain whatsoever, but with overuse, eventually pain will come just because it’s such a mechanical problem. In addition to the spleen kitty channels, being lengthened. And as we’ll discuss in just a little while or momentarily, the effect that the actual organs have play into this as well.

So with this particular one, you can see this test foot abduction, or it’s also a foot flare sign. You can look at this from an anterior view, or you can look at it from a posterior view. In the anterior view, you can see how that kidney sinew channel is long. And it’s dropped going from kidney for kidney five, kidney six. You can see how kidney two has dropped is a foot flare sign, so that foot’s going into abduction, lengthening that kidney send you. So the, the tissues involved in the kidney sinew are, are lengthened, and they don’t have very much integrity here at all. They’re not supporting the arch. Whereas on the other side, the bow, the are they internal extra relationship to the kidney, urinary bladder sinew channel is in a shortened position. So we’re going to talk a bit more about how to be able to treat that.

Is there anything that you want to say that before we go to the next line? Yeah. You know, that the lines that are representing the medial and lateral side, of course, the kidney and UV, um, it’s the channel, but it’s also the channel send news, which, uh, the, on the inside of the foot as the abductor hallucis. So it really does, uh, um, kind of go along the medial side to the big toe like that. And, you know, for that matter, the primary channels also over length and like that, but, uh, but in particular, this is showing the channel send use, and then the abductor digit, I minimize for the urinary bladder channel, which attaches to the minimize the little toe. So it’s also, um, uh, you know, follows that UV channel. So in a moment, we’ll show you some needle techniques and myofascia work for these two muscles in particular.

All right. So then the intrinsic foot muscles are out of balance of the abductor. Hallucis is Brian just to discuss on the kidney channel is locked long and it fails to support the medial arch and the abductor digital Mattamy is going to be locked short. Uh, Brian, do you want to take it away? And we’ll comment on both of these, these slides. So this, uh, again, very, uh, that in and of itself is going to increase people’s ability to work with, uh, uh, with flat with flatfoot, with Pez playing this and put over pro nation and many injuries that might come from that. But, uh, bringing that back into a holistic view, that’s in Chinese medicine, we can start to look at some relationships of something called acquired. Flatfoot something that develops later in life, usually in the 40 plus age group, especially more common with women.

Um, and there’s usually relationships. This is a very Western discuss discussion, but we’re going to bring it back into the Chinese medicine discussion here in a second, but this, uh, usually is involved with a number of types of injury. I mean, uh, uh, illnesses such as hypertension, diabetes, obesity. Um, so there’s a correlation with those types of illnesses and acquired flatfoot where people start having a loss of integrity and the tip posterior muscle and a collapse of the foot. Yeah. So the unusual or prolonged stress that’s going to attack spleen cheat and kidney cheat, faulty, biomechanics, ligament laxity in particular, that’s going to be kidney churchy as well, and the normal aging process. And as we know, uh, kidney cheese on the decline, the older that we get. So let’s move on to the next slide. Go ahead and be, uh, well, uh, just, um, some, uh, information from research, actually, Matt one to take this one.

Yeah. So posterior tibial tendon dysfunction is the most common cause of adult acquired foot. So basically we’re just kind of backing this up with acquired flat foot deformity, Beals States that poster tibial tendon insufficiency. Remember that’s what attaches to the vicular bone. That drops is the most common cause of acquired adult flat foot deformity. The exact etiology of this disorder is still unknown, but for a TCM practitioner, I think it really gives a lot of credit to looking at kidney chia and spleen to you when you’re treating somebody with PEs planus, because they’re coming in with an injury.

So what we did is we looked at two different references, the clinical handbook of internal medicine by McLean, and also the treatment of modern Western medical diseases with Chinese medicine by flaws and Phillips who now, um, we just jotted these down here. You can see in the bulleted points, hypertension, yes. Liver, young rising you’ve got phlegm fire. Well, the spleen and the kidney is going to be associated with phlegm liver and kidney yin deficiency. Absolutely. You’ll see that also with hypertension. So when somebody has hypertension and flat feet, we’re looking at the kidney channel there, there’s also the pattern of Chong and Wren dysregulation, which is interesting because you see the master points of Chong being explained for, and then red being right being lung seven, kidney six, blood Stacey, this is something else with hypertension and then obesity. What these two authors with these are talking about stomach key with food stagnation will stomach, stomach being tibialis, anterior, which can be in a lengthened position in PEs, planus, phlegm, dampness.

You’ve got your spleen there. You’ve got spleen deficiency being cheat efficiency, as well as Yong deficiency. I’m allowing that collapse of the medial arts. So the strength of the organ itself being reflected within that channel primary channel and gene, Jen, I’m not giving enough cheesy to be able to support that medial arch at obesity. You’ve got liver and kidney inefficiency as well, as well as CHAM blood basis, then diabetes, there’s your stomach heat systemic channels and paying the fact that diabetes, spleen and stomach cheat efficiency. There’s your tibialis, posterior spleen tibialis, anterior not getting enough to within the channel because of the organs overall chain blood deficiency flam, again, being spleen. Liver is fleeing disharmony with heat. There’s your spleen channel again? Kidney, heart, and liver yin deficiency. There’s your kidney channel, kidney and heart yang deficiency, kidney channel again, and kidney in acuity. So there’s a lot of support with the spleen of the kidney channels here. Um, Brian brought up a really good point about this. If we were able to do some kind of, of, um, research with it. Brian, do you want me to describe your idea that you and I were talking about yesterday?

Yeah. So, you know, in the acquired flat foot discussion from Western circles, they just basically say that there’s correlation with hypertension, there’s correlation with obesity and diabetes. What would it be? Very curious and, and, uh, I think it’d be great to, to study it w it would take some time and resources. Of course, let’s say you took hypertension and you took all the people with hypertension who had acquired flatfoot, it’d be curious to see how many of those people had, if you differentiate them into patterns from a Chinese medicine standpoint, how many of those people had really more correlation with the spleen and kidney patterns? Um, based on the fact that those are going to have it,

I change in those related channels

And that my hypothesis, my guess would be that, that if you found the people with hypertension who have acquired, flatfoot, you’d have more phlegm fire more,

And kidney yin deficiency, maybe not so much liver young. Right.

Who knows, I’d be curious to find it, but that would be my guess. Yeah.

The takeaway from this, everybody is that, and this is something that we teach a lot in our education and our school is that when you’re looking at musculoskeletal, it’s never just musculoskeletal. There’s always some kind of zone food component, and we are TCM practitioners. So always look at that [inaudible] component, being able to supplement the musculoskeletal treatment, it should be held together. So this is something that a sheet for you guys to be able to take a look at. This is going to be just for the local muscles themselves, that you can be able to treat in addition to the person’s constitutional points and zone food. So, um, the peroneus longus and the peroneus brevis, these are going to be locked short. They’re going to be accessed. These muscles are going to be real, uh, primary in treating this. So you want to reduce the access so that the deficiency starts to come up. So we’ll address the deficiency as well. But since we don’t have a heck of a lot of time on this webinar, we are going to be showing you the peroneus longest and the prone peroneus brevis needle technique. We’ll also going to be showing you the abductor hallucis and flexor hallucis brevis needle technique as well. Um, there’s also an image I believe of the abductor digital me that you can be able to use. So, Brian, anything you want to say before?

Yeah. I’m sure there’s people watching this who are going Fronius longest and breakfast. That’s on the gallbladder channel. Uh, this is interpretation, but go back and open up Deadman or any book that has image of the channel send news. Of course, they just show topography. They’re not showing him in particular muscles, but you’ll see that the urinary bladder send you channel has a lateral branch that could be interpreted. We interpret it as pretty, as long as in brevis those muscles have a much stronger fascial connection to the hamstrings. I’m in link with the urinary bladder channel. Whereas we put the gallbladder, send new channel more with the extensor digitorum longest, which is just in front of the fibula. And really, if you look at it from primary channels, you’d see the gallbladder 34 and many of the gallbladder points along the lower part of the channel would actually go right into extensor digitorum longest. So yeah, go back and check out those images and you’ll see there’s a lateral branch. And that’s what we’re interpreting is plenty as long as some brevis

In addition, Brian and I actually, we proved this relationship on a cadaver specimen and it’s on our YouTube video channels, sports medicine, acupuncture, where we put a needle into the Proteus longest motor point. We put a needle into gallbladder 34, and then we put a needle into the biceps for more the hamstring motor point. We pulled on the biceps for Morris motor point. You could see where the force tension was going, and it was moving the Proteus longest needle substantially, but not gallbladder 34. So this is a really linking that urinary bladder sinew channel that’s on the YouTube channel sports medicine acupuncture. If you guys want to check that out, let’s go into the video showing the peroneus longest. And the peroneus brevis, I’m going to set this up a little bit. So you can see is that we have one needle in the peroneus longest motor point, which is located just two stone below the head of the fibula. And then we have a needle in the peroneus brevis that’s angled upward. So we’re wrapping the twist, the needle. We wrapped the fibers around the brevis and we’re pulling down so that you’ll see the needle moving on the Proteus longest because we want that. She took me moving downward in PEs planus with every step, as we talked about earlier in this, that she is moving upward on that lateral side, being the young side, we want to pull it down. So here we go.

Peroneus longest motor points too soon down from the head of the fibula peroneus brevis motor points. One soon above gallbladder, 35, this needle technique for the perennials that are in a shortened position from foot overpronation. We want to try to be able to pull the muscle fibers downward in order to be able to change the cheesy within the channel change, the appropriate perception. When I wrapped the fibers around the peroneus brevis and I start to pull down, you can see the movement in the peroneus longest motor point. So I’m going to maintain the traction. You can see how that needle is moving. So therefore the muscles, the fascia, all the proprioception here is starting to change and I’ll hold this. So the muscle can get used to being in its new position.

Alright, so that needle technique is in combination with something that we talked about earlier, lifting up the medial arch. So this is a needle technique that you can apply to everyone, but it is very useful to apply to those people that can handle the strong cheese sensation I’m using a thinner needle is also useful, but you, in my experience, you need to have this as a Chinese needle. Um, some of the needles that are coded, um, will not allow the fibers to wrap around that. So, um, it’s a good idea to be able to have our Chinese, you know, I’ll watch, those are my favorite to use in this particular case. But again, you can use a thinner gauge needle, but two muscles are the abductor hallucis in the flexor. Hallucis brevis that we’re needling here. The motor points of each muscle found on the kidney and the spleen sr channels are needle to lift the collapsed tissue at increased proprioception. So you’re needling there underneath kidney too. And then also you’re needling halfway between spleen three and spleen for going into the muscles themselves, twisting the needle to patient tolerance, and then gently just lifting that arch so that you are starting to change the proprioception with that. Then you would leave those needles in place. In addition to all the rest of the needles that we have in that formula, treating adjacent points, distal points, and also constitutional zone crew. Yeah. I might add something to that. As Matt mentioned, you’re leaving those needles in, uh, so usually

If they’re in for 10 minutes and you go to bring the needle out, no problem that comes out, the tissues relaxed, you know, it might be the case that the needle wouldn’t come out right away. That’s the point is you’re trying to lift that tissue, but it usually will come out, no problem, but do pay attention to which direction do you turn the needle on case? Uh, it really doesn’t happen with me this way, but in case of where to get stuck, you’d want to unwind it. And the other directions of your going clockwise, you know, make a note of that. And if you, if the person can’t tolerate this type of treatment, it’s not too bad that you’re, you know, you’re going slow and gentle and to patient tolerance, but needling, the motor points would still be useful on their own. But it’s going to give a little bit more bang for the buck by doing this lifting technique.

Yeah. Sure. All right. So here’s the needle technique. That’s kind of based on the same idea. Brian, do you want to go ahead and discuss that?

Yeah. The image I’m just kind of glancing at this now and noticing that the little black line for UV 63 and UV 64 is a, is a, um, just a pointer. The needles are a copper kind of colored. So, uh, take note where you can see my thumbs holding onto those needles. So same idea. Uh, the needles are put into UV 64 and UV 63 64 is the motor point for the abductor digit I minimize, which has a strong connection to the lateral band of the plantar fascia. So you’d be 62 would be into that lateral plantar fascial band. And then the needles are twisted gently. And until they catch the tissue until they catch the fascia and then pulled away from each other to help widen that, uh, lateral portion of the, uh, urinary bladder send you a channel, the part they get shortened as the foot goes into abduction. And that whole side of that lateral plantar fascia become shortened. You’re widening that lateral band of the plantar fascia. So it reduces, you know, reducing technique.

Yeah. So this technique followed by a really good, mild fascia technique. They were going to show you an image here in just a second is really quite good doing this technique and then the mild fascia. So Brian would take away some of the myofascial work.

Yeah. So myofascial work is really going to be, um, following the same principles. So a, this, you can see the two knuckles on the urinary, excuse me, on the peroneus longus. And brevis going down that, uh, lateral band of the urinary bladder send you a channel. It’s kind of widening that lateral band, but each time you’re, tractioning this issue down and then widening kind of like making little Chevron type, uh, positions and move down a little bit, bring the tissue down, widen, go down next step. So the whole time you’re, you are widening that, that portion of the lateral compartment, which is containing the, the peroneus longus and brevis, but you’re bringing that tissue down. That’s the key takeaway from this as you’re helping, uh, encourage the fascia and muscle and all the appropriate sectors downward in the same way you were with the needle technique.

Yeah. Starting top pending at the bottom. Yeah. Good. That lateral band would be pulling the foot into, um, into IE versions that you’re helping correct that by, by dropping it very useful after the needle technique and see what the next myofascial release, Oh, it’s an exercise. Right? So inchworm exercise, this is a very useful exercise for helping to restore some of the integrity in that medial arch. Um, it’s warm. You can actually Google that if you wanted to, and you can get this step by step, you can see with the foot on the left. Um, this is I think, prions foot. So he doesn’t have a Pez plaintiffs on there, but if it was a flat foot, um, you can see as what he’s doing in the middle of the images, he’s bringing the first metatarsal and the big toe up toward the calcaneum as the calc Aeneas stays in place.

So he’s increasing the integrity of that medial arch. Then he puts his way on the forefoot and he brings the cow Kanyes back, which will flatten the foot again. And then he repeats the exercise. This is an exercise that you could probably find step by step. I would think on Google, this is also something that we teach in its entirety. I think though, a usually in Google, it’s not going to be under insure. Um, it’s uh, and cause usually people don’t walk it back like this and it’d be called a, uh, short foot exercise, but we modified that. Okay. Yeah. So the short foot exercise is going to be a little simpler than this one. So, and that would be probably, you know, you can find videos of that, uh, curls probably to take it away on this one. Yeah. This one that is, if you look at the, the, the kind of ghost image on the top little corner portion, that is your, you are taking the foot and you’re dropping the medial arts, you’re taking the foot into abduction and just, you know, basically collapsing your weight into the medial arch.

And then you’re starting from a position, I guess, a dysfunction and then you’re curling the foot and lifting the medial arch. Um, so this one would also strengthen those, um, intrinsic muscles of the foot along the, the kidney and spleen channel. But it would also be calling on things like the tip posterior, because it starts to take the foot into a position that, that, uh, engages the tip posterior. So this is, uh, training, both the intrinsic and extrinsic flip muscles. Yeah. Good. Yeah. So the ghost image is the, before the, not the fall images the after, and it’s not a ghost image because it’s so white, it’s actually because the right funnel doesn’t move on. Okay. There’s a references, right? So you guys thank you very much for attending this. We want to thank the American acupuncture council for having us. This has been really a lot of fun. We hope that with this very complicated and in depth topic, we just took some portions of it actually. And hopefully we gave you some useful insights or clinical pearls that you can be able use to be able to help other

People to help your patients. Uh, Brian, thanks very much, Matt. I do want to highlight that there is also on the YouTube channels, sports, medicine, acupuncture, uh, full needle treatment, uh, that shows both before and after for changes in the foot that was done in one of our classes that covers this whole whole protocol, basically without the myofascial and corrective exercises, but just the needle abortion. Yeah. Good point. Okay. Well thanks very much. Appreciate it. Yeah. Thank you. Alright. Take care everybody.

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