Tag Archives: Matt Callison – Brian Lau

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Treating Patients Who Work at a Desk



So we’ll be looking at movement, corrective exercises and some other things to be able to recognize patterns in patients when you’re looking at it from a channel perspective.

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

Hi, thanks for coming today. My name is Brian Lau and sometimes I present with these AAC webinars with Matt Callison, but he wasn’t able to make it today. And I’ll be presenting solo, but this is something I’m gonna be presenting a little bit more of an expanded view on at the Pacific Sports and Orthopedic Acupuncture Symposium.

Which if you’re watching this live is coming up in spring, but you might be seeing this. , it’ll be an ongoing event, so maybe check it out another time. So this is a little sample of that and I’m gonna be expanding on it quite a bit at that symposium. So what I’m gonna be looking at today is specifically treating patients who work at a desk.

But this is really looking at more movement oriented aspects of the channels, looking at the movement from a channel perspective. So while sitting if we’re in a static position is not really moving, but it is moving cause we’re holding the position. So we’ll be looking at movement, corrective exercises and some other things to be able to recognize patterns in patients when you’re looking at it from a channel perspective.

So we have this nice image in the beginning title slide. And I took this from the internet and I liked it cuz it says bad posture and I guess it’s not great posture. That could definitely cause strain. We’ll talk about this a little bit more in a second, but I generally don’t think anything is a bad posture.

There’s positions that have a use and that particular position of somebody was crouching over and had to look up. It’s a fine position, but if we’re gonna hold that for a prolonged period of time, it becomes problematic. and it can definitely lead to pain. So I don’t really like to think about good posture or bad posture.

I like to think of movement potential and the ability to move in and out of a particular position and to move in and out of that position with ease. So that’s a little bit more of the take. We’ll be looking at and we’ll go through some specifics on that. So let’s jump right in. So first of all, prolonged sitting puts a strain on the body, especially if the patient sits with poor posture.

Yes, I just said that maybe nothing’s could be totally bad posture, but if they’re sitting in a position that’s collapsed, that’s putting pressure on the organs, that’s putting pressure on the joints for a prolonged period of time, that’s gonna lead to problems. , and this is the frequent position the patients will sit in, is they’ll have their back and shoulders rounded.

So you could say scapular protraction would be there and their heads are forward. The myo fascia of the back is not engaged and it’s locked long. So things like the lower T trapezius, the erector spinna in certain regions, those are all gonna be in a long position and they’re failing to bring the body back into extension.

And then the other key point is that the core is not gonna be. We’ll be looking at that from a movement perspective here in a second, but that’s gonna be the general thing that you’re seeing with people. They get tired, they’re there at the desk for a long time. Things start to sag and slouch.

When they do that for prolonged period of time, that can lead to many injuries that obviously all of us see in our clinical practices. So these will be things like muscle tension, headaches, you can see especially. Younger kid in the bottom picture, a great picture that’s not staged.

That was a camera that was on, on particular people. And these were just live action shots that they got. You can see how much capital extension that younger kid has and how much tension that’s gonna put on things like the suboccipitals. And the cervical muscles that can refer into the head and create very much of a tension type headache pattern.

So tension headaches are gonna be a massive one that’s going to be pretty prevalent with office workers. Thoracic outlet syndrome is the scaling shorten and the peck minor shorten that’s gonna look, have a potential for entrapment sites for the brachial plexus. And then they’re gonna have symptoms down into the arms.

Rotator cuff tendonopathies. It’s putting the shoulder in a bad position and especially with activity that’s gonna tend to put more strain and wear and tear on the shoulder. Peri scapular pain, both the cervical fast sets muscles like lava or scapula. Other things can refer into that peri scapular region.

So that’s gonna be a common complaint and all of that’s gonna put a lot of undue stress on the cervical joints and lead to premature or increase the chances of degeneration. For generative disc disease and that can lead to a whole host of other problems. So it’s a massive problem. Many of our patients are office workers.

They sit for prolonged periods of time on the desk. So it’s really important to be able to have a good working knowledge to be able to help them come out of those patterns. And we’ll look at some acupuncture ideas, but I wanna start with looking at it a little bit more from a movement standpoint, because I think this is something that we can.

Really increase our effectiveness if we can give them some movement reeducation. So just a little bit of something I’ve been working on, especially starting just a little bit before covid and then all of a sudden I had a little bit more time when I had my practice closed for a little bit then have it closed too long.

But that sort of allowed me to really start getting into my own training. and as I was getting into a lot more movement training, I have a pretty extensive background with Qigong and Tai Chi and some martial arts. But I started doing a lot of body weight calisthenics and just something I was really interested in.

When I was younger, I used to be a wrestler and wrestlers have a lot of similar training where we use a lot of body weight type, climbing rope. pull-ups and a lot of other body weight type stuff. You’re obviously, if you’re wrestling, you’re using a lot of other people’s body weight as you’re doing competition.

It’s something I was really interested in when I was younger and I of started coming back into it in my, I guess this is just before my fifties and really enjoyed it. But since I’m an anatomist and since I’m looking at the channels a lot, especially the channel sy and thinking. Movement quite a bit.

As I’m doing all these exercises, I’m going over my head what channel am I working with? How is this organizing between channels? It’s just something that’s really taken a hold with me and I’ve been really looking a lot more at developing a system for understanding movement through the perspective of the channels and use.

And generally, most of the movement that we’re gonna be looking at is gonna fall under one of three categories, and these will be. The Y and Shao yin channels, so movements that are organized around those. That’s primarily what we’re gonna be looking at today. So we’ll come back and talk about that one.

But that’s gonna be primarily extension type movements and we’ll add to it a little bit in a second. Shao y and Joy Yin. So the Shao y and joy Yin channels. So these will be actually one of two things that are co-related, either side bending type motions or snowball. So when we’re walking and moving, we’re stabilizing from our sides and preventing excess movement.

So that would be part of it. Or just literally like side bending type motions and also rotational type move movements. Maybe another webinar we can go into a little more detail of how those are co-related through the joints to this pelvic joints. But for now we’ll just keep it simple side bending and rotation.

and then Ming based patterns, much more flexion oriented type positions. We can look at the movements from the channels and design very health giving type, Chiang, movements that are organized through the channel. Syk, these movements can open fossil planes, mobilize joints, and mobilize and massage the organs.

So looking at the movement of the organs and the movement potential of the organ. Those channels actually take the organs into a movement. Briefly going back to Shain SHA Yin, the liver itself has a rotational type movement where it rotates around the the su inferior venava. So the, any type of rotational movement’s.

Also mobilizing the liver side. Bending the liver has a side bending type motion where it kind of moves and side bends. So any side bending type of movement will also mobilize and move the. So understanding the channel syk and their movement actually gives a little window into understanding how to self mobilize the organs through movement, which is really a lot of what Chiang and those types of exercise systems are about.

But we can just look at it a little bit more with a modern lens. So let’s go today into the ta, young Shein pattern. So this would be urinary bladder, small intestine. I know you everyone knows this, or at least if you’re an acupuncturist, So urinary bladder, small intestine, kidney and heart. We’ll be focusing a little bit more on the urinary bladder, kidney portion, but these movement patterns engage the back and the core lines.

So those are gonna be a big part of it. The general movements involve hip and spine extensions, so they’re things that lift us and bring us upright into the world. So extension. Would be the big part of it. Spine and hip extension, scapular depression. So they help pull the scapulas down.

Again, this aspect of lifting us up into the world. So very open and upright and present in the world. We’re gonna have external rotation, especially the small intestine sy channel. An extension, so shoulder external rotation, extension, elbow extension. all of this with a very stable core because as you’re going into extension, it’s easy If those muscles in the back are in the urinary bladder channel and small intestine channel are too overactive in some respects, they can over overextend us.

So we need the stability of things like the transverse dominance to keep us stable. So there’s a nice relationship between how the back and the front work, especially via the kidney and the urinary bladder channel. , both of them, to give us a sort of extension, this nice expanded spine and nice upright posture that’s really prevalent in much of, much activity we do.

And sometimes becomes less prevalent when we’re sitting and starting to fall and collapse a little bit. So these would be active sitting and just to keep us upright and keep us in a really good decompressed position of the spine. So the movements are gonna include things like stacking the spine and pelvis, stabilization of the shoulder girdle and engagement of the core.

So I have a little video here that you could use this for an exercise for office workers. It’s not the main one I’m gonna be showing for today, but just to highlight some of these features. It’s a front lever progression. So a front lever would be if I were holding onto the bar and making myself completely.

Horizontal with the ground, something I’m not able to do, working towards it, maybe in the year next year, come back and we’ll see how I’m doing on that. But it’s a very difficult exercise it takes a lot of strength in the back, a lot of strength in the core. But this would be an easier way to do it.

You can see being at a much less angle where I’m more upright, still at an angle. I have to extend the back to be able to get upright. I have to externally rotate the shoulders. I have to pull down with the lats and I have to stabilize with the core. And I think you can see all of that a little bit better with the actual movement.

So I’m gonna play the video. This is a pretty short video about a minute. The very first thing I’m gonna do is relax the arms so they become passive shoulders go into protraction. I become rounded in the back. Then I’m gonna start to let that relax all the way down the back. I’m not sticking my behind out.

I’m just letting the spine stretch and drop until I’m underneath the band passively hanging. And when I’m ready, I’m gonna start to push up, haul into the band, gauge the lats gauge, the lower trapezius gauge, the core return to that straight line.

All right. So that’s a very nice exercise cuz it massages the spine and basically going into a lengthened. In the urinary bladder, small intestine channels. And then the standup portion is where I start to engage those structures. So I engage ’em from a position where they’re already lengthened.

And, a pretty decent full length position and then engage ’em from that position to come back to an upright posture. So I sometimes use that as a nice warmup exercise and just to inform and give information to the channels before doing something that might be more strenuous.

If I’m doing, trying to do the front lever, working with that and putting more strain in the body, I like to have a a good warmup to where I start to inform the body of what muscles are activating and how is the. Organizing those movement between the channels. You don’t have to think about it so heady, but just how does a body organizing that movement before I go into something that’s a little bit more difficult.

But that is a really nice exercise by itself for for people who are in offices. If you have a setup for something like that, it can be really nice. But I’ll show so one that’s maybe a little bit more accessible in the. . So let’s briefly go over some channel information. So as all of us know, the urinary bladder channel moves down, starts at the brow and travels down to the foot.

But how about the Sinu Channel? So the Sinu Channel, we of already saw it a little bit with this previous video. The Sinu channel tends to pull downward. to create an upright posture. I really like this image on the right, which is from a outer print book from an anatomist John Hall Grundy, who Tom Myers, if you’ve ever studied with him, really likes this book quite a bit and uses some of his images.

I, I think his images are great. They’re very thoughtful. He gives just these dissection images. Sometimes this one’s more of schematic. That kind of shows the body from a different perspective. That helps us understand something about the body. And this one’s kind of showing that aspect of those erector spina, almost like a pulley.

And what they’re doing is they’re pulling to bring us upright. Yeah, maybe they can get too tight in areas and over pole, but they’re just like this, those hands on the ropes or just of lifting us up. They’re lifting us up from the back. They’ll lift the front upwards. So the downward pole in the.

lifts us upwards in the front. Very good representation of the urinary bladder sinu channel. So we would have that capacity at things like the lower trapezius. See if I can get my cursor on here. So lower trapezius is gonna pull down on the scapula to help lift and open the chest. The erector spin A is gonna pull on the spine to help us come out of flexion and into extension.

GLUT Maximus is going to help us prevent us from going too much into an anterior tilt to the pelvis. So it’s gonna drop the pelvis down and keep the pelvis in a good neutral position. So when it gets weak and inhibited, sometimes people will then go into more of an anterior tilt to the pelvis and put strain on the back so it helps stabilize the back, stabilize the SI joint muscles like the lateral portion.

of the leg here, this lateral branch of the UB channel on the bottom left which I interpret as the Proteus longest and brevis, those help. Or if they get too short, let me say it. That way, if they get too short and lift excessively, they’ll help, they’ll collapse the foot into the medial arch. So we have a technique that we show, and we have this on our YouTube channel where we pull those down, descend help.

Propri receptors understand they don’t need to be so excessively lifted. They can drop down to help take away that dropping into the medial arch. And then we’ll combine it with a lifting technique on the medial arch at things like kidney two, which is the abductor hallucis motor point. So I was gonna put that into my presentation.

I wasn’t sure if I’d have time, but that is on our channel. I decided not to put it. Not relevant necessarily to office workers specifically, but just to understand that downward aspect of the channel and how the channel in pathology sometimes can excessively lift. So the kidney channel moves up and stabilizes.

So when we start looking at the channel sinus, we have structures like in front of the spine. The so as major. The anterior longitudinal ligament, a big stabilization of the the spine in the front of the spine, and then this portion at the neck up at the top of the spine there on the image on the right would be the longest coli and longest capitus.

Those are very important for stabilization of the neck, so when those get weak and inhibited the neck tends to jut out. So they have a certain amount of ability to keep the neck in a nice upright stacked.

The kidney channel also. Not, if you look at the description in the ling shoe of the SY channel, it’s pretty vague. You have to really start looking a lot at cadaver dissection and some research, fossil research. You have to bring a lot of things together, I think, to get a good understanding of what structures could be potentially part of this INU channel.

It’s a work I’ve been doing for about the past 10 years. But it would be hard to find a description from the Ling shoe that talks about things like the transverse of Dominus as part of the kidney sinew channel. But if you look at the channel system as a whole, the low connecting point does talk about the core in a way.

because this channel, this low connecting channel, travels up the abdomen following the kidney channel. Question I have is what depth? I think it’s at the depth of the transverse abdominus that goes to a point just below the pericardium. If the transverse abdominus is part of those structures, it’s gonna blend in with the diaphragm pretty seamlessly.

And then the heart sits right on top of the diaphragm. So that would technically go to a point just below the pericardium. And then those the multifidi connects also with the pelvic floor, but also I’m sorry, the transverse of dominus connects with the pelvic floor, but also the multifidi, these deep lumbar muscles that are stabilizing muscles of the spine.

So I think the kidney low channel is really giving some kind of description, maybe not of the muscles, but of the ability for those muscles. to stabilize a big part of the kidney channel to stabilize the lumbar region to support. And I think their description, their trajectory hints at these core stabilizing structures of the transverse, a dominus, the pelvic floor, the diaphragm, and the lumbar multifidi.

in sports medicine, acupuncture, we take those core structures and put ’em in the Sinu channel just for ease. So the kidney sinu channel would include those core stabilizers of the spine, the SOAs, which is other, and also a core stabilizing muscle, at least the portion, the stabilizing, the , the deeper fibers and the more superior fibers of the soaz, which are really stabilizing the spine are part of the kidney channel.

A little bit of a aspect of the ql. Also, all of these stabilizers of the spine really speak to the kidney channel and its lumbar and spinal stabilization role. But then also, like I said, up in the neck we have those longest coal, iron capitus. So very much about standard. So collectively the urinary bladder in the kidney sinew channel are looking at balancing the spine in a very easy way, or at least a simple way of looking at the spine.

is to look at the curves of the spine. Cause it’s tricky when you start doing postural assessment. Is that right? Is that normal? So one thing you can look at is there a balance between these curves of the spine? And what these curves are is things like the cervical lordosis that’s in that picture is referred to as a secondary curve, meaning that it’s not there at birth.

As we, start looking up into the world and put strain in the body, we start developing that secondary curve in the cervical. primary curve in the thoracic spine that’s there at birth, we have just an a c curve, so they call that a primary curve. And then same thing as we’re crawling and moving and eventually stand up and walking, we start developing a secondary curve at the lumbar spine.

So looking at that kind of curve of the spine can help us understand if the, there’s a good balance between the urinary bladder and kidney channel because we want a really good balance between those curve. We don’t want all thoracic curve or we don’t want an excessive cervical lordosis or an excessive lumbar lordosis or maybe a flattening of the lumbar lordosis.

Some people naturally have less curvy of the spine. Some people have naturally more curvy of the spine, so you can start looking and seeing is there a balance between those secondary and primary curves. Back to Tom Myers, his work, I’ve studied a little bit. , he also extrapolates that out to the posterior knee, which isn’t a spinal curve, but that’s a normal, there should be a little bend, a little gentle lordosis and if you wanna call it that in that posterior portion of the knee.

But as you look at people, sometimes their knee becomes hyperextended and say, so they’ve lost that curve relationship or even the arches of the feet. So you can take that idea of that balance of the curves all the way down the. Into the knees, into the feet and the arches. So we want just a nice, even ebb and flow in those curves of the spine.

So I think you can agree looking at those images of the desk sitters that were dropped, , their balance was lost. They have a, capital extension, a strong curve up at that upper part of the cervical spine. But everything is, the whole spine is in curved. They’ve lost a little bit of the lumbar curve.

There’s not a really good balance between those positions. So let’s look at an exercise and we’ll talk acupuncture. And we’ll also look at a myofascial release technique. Let’s look at an exercise that is a little bit more accessible. Cause people can do it in a chair. This is something you can work with them.

on. This is gonna be a seated exercise. It’s modified from a Chiang pattern eight pieces of brocade for those who know it. This is the second move. It’s two hands, hold up the heavens and it stacks the spine. That’s gonna be the first thing it does, but then it’s also gonna start moving in the frontal plane.

So a side bending movement. The reason of that is because, Office workers, everything is moving forward or back. Maybe the neck shutting backwards or forwards. Maybe the thoracic spine is sinking back, but everything’s moving away from that frontal plane. The head maybe moves away from the frontal plane, the back moves away from the frontal plane.

Everything is in. That front and back position, maybe those people exercise, maybe they don’t. But frequently when people exercise, everything’s in that front and back position. Like running much of weight lifting, everything’s flexion, extension, flexion extension. So most people, especially office workers, aren’t doing enough movement in the frontal plane, like side bending motion.

So this exercise is gonna stack the spine, get a good balance in the spine, get a good stability in the. Engaging those back muscles and then it’s gonna start going into a side bending motion to help bring in a different movement potential that they’re not probably, or let’s just say they’re more than likely underutilizing.

And that can really give a little tensional support from the side and help that elevation and lift coming up the body. So I’m gonna go ahead and play that video.

Many of my patients sit for prolonged periods of time in this position, the head is forward, the back muscles are under slack, and the core is not engaged. Prolonged times are spent with major parts of the spine move forward or back. Let’s look at a simple Qigong exercise that can be a mini break from sitting and help alleviate some of these issues.

This Chigong pattern is one of the eight movements in a system called the Eight Pieces of Bou. This is a great chigong exercise for office workers since it highlights an engagement of the back and core while performing a side to side movement. These are movements which are frequently absent and sitting, especially if the posture suffers.

The exercise can be performed standing or seated. Here we see it standing, but we will look more detailed at the seated version since it can be easily adapted to a work environment.

Start by sitting upright on the sit phones or the issue two Verocity. Roll off the back of the zip bones and round the back, then roll back onto the zip bones, engage the back and core, and grow back to an upright position. Again, roll off the back of the sit bones and round the back. Roll back onto the sit bones.

Engage the back and core. Grow to an upright position. Repeat the same movement, but this time, rotate the arms and turn the palms up.

Turn the palms down as you grow back to upright.

Now let’s look at the full movement roll down. Like before, interlace the fingers as you grow and expand. Start to turn the palms towards the sky. Get the elbows lined up with the side of the body. Reach upward and maintain an open chest.

End to the side, allowing the opposite side ribcage to open and the spine to curb. Keep both sip bones on the seat. Return to the midline and then repeat and stretch to the opposite side.

Return to the midline stretch up. Then let everything relax down while bowing the spine. As the hands passed, the solar plexus row opened the chest gauge the back and horn. The entire movement can be repeated several times. At least three times would make a great little mini break and help bring back length and ease while sitting.

All right, so that’s on my YouTube channel. It’s Jing Jin Movement Training, if you wanted to check that out. It goes through a practice run of it if you wanted to do it with the video. So that it gives you a chance to practice that. I think there’s three three repetitions of that. If you were to work with that on a pa with a patient the whole movement’s great because of that side bending aspect.

Again, that’s a movement that they don’t often do and everything that they are doing is forward and backward generally. So it’s nice to have some tensional support. Put into the body from the side to help give tension, good tension to give, like stabilization, kinda like an old-fashioned boy scout pup tent.

You want a nice balanced pole in all of those wires that are giving the tent nice shape. So it’s nice to have that little pole from the side. But if you didn’t have the time, or maybe a patient wasn’t super aware starting with that, rolling off the sit bones and letting the spine. and rolling back on the sit bones and letting the spine stack is a really great educational tool for the patient because my general view, again, is that there’s not a good or bad position for the body.

If I were to roll off the sit bones and curve and I were reading a book and I had a book in my lap, that’s not a bad position. I have a nice, I wouldn’t wanna be there all day, but it’s a nice curve through the spine. It’s a balanced curve. And if I roll back up on my sit bones and stack everyth I think that’s a good position. Again, I wouldn’t wanna necessarily sit in that all day. I wanna get up and move around a little bit. Where I think people run into the most trouble is when the spine is not working in a balanced position. Maybe they’ve rolled off the set bones, they’ve collapsed the chest, but then they arch the head up.

So part of the spine is inflection, and then another part of this spine is making up all that difference and. and that position is where people I think tend to get in into more trouble. It’s fine for a momentary movement, but when you’re holding that position, it’s not a particularly comfortable position.

Puts a lot of strain on the neck and the shoulder girdle and can lead to injuries. So I like that aspect of rolling up onto the sit bone so they can get that support under them from the pelvis. And finding that position of stacking the chest, bringing the head back, lining everything. , but you don’t want ’em to go too far, you don’t want ’em to roll off the front of the hip bones and hyperextend either.

So it’s just finding that balanced tone from the pelvis, torso, shoulder, girdle head, everything is comfortable, balanced, and it’s a much more injury-free position. Doing that, I think is a better strategy than trying to dictate to somebody how to sit and pull the shoulders back and everything becomes very stiff.

Finding that relationship of how the pelvis stacks on the chair and everything else stacks above it is a really great tool. Acupuncture can be very useful for obviously for a lot of these injuries. So if we’re looking at acupuncture, we have to spec specify really what they’re coming in for. So a lot of the local base injuries are gonna be more specific treatments for those.

I’m not gonna get into that cuz there’s a whole host of them. Learning how to treat and recognize those particular injuries can be very useful in guiding that. But just some general guidelines for distal points. If people are in that position for a long period of time and they’re not engaging the back, those back muscles tend to get inhibited and they have a hard time finding those muscles that help depress the scapula externally, rotate the shoulder girdle, stack the spine.

So UV 64 SI four is really a wonderful combination, both of them being source points to help. Channel T to help inform the channels and give a little bit of energy to the channels to help them find those find those muscles and engage those muscles more effectively. So UB 64, SI four are really a great great treatment.

UB 60 SI three. Obviously a lot of people use that combination of their acupuncturist. UV 60 as many people know is really working on that excess young that rises up the channel. So there’s people who have their ears up against their, their shoulders up against their ears, and everything tenses.

And that channel rises excessively that, especially if it’s much more of a tension stress high-end type thing is a really great point to help descend that chi down the channel. S I three obviously used for a lot of neck pain. So those are great great combinations for those people who have a lot of excess rising of the back of the body.

And leading to things like tension headache tension headaches, kidney four, low connecting point of the kidney channel can really help engage the core structures if they have a very weak and inhibited core like transverse, abdominous, pelvic floor, that kind of stuff. And then working with local motor points for things like the rhomboids upper and middle trapezius and the chest muscles to help balance the front and the back can be a great strategy.

So last thing we’re gonna look at today is the am myofascial technique that’ll help stack the spine and Descend. The channel in the back descend the urinary bladder channel. So this is a technique we teach at sports medicine, acupuncture program. And we have, I have this one up on my YouTube channel, Jin Movement training.

There’s a similar table technique to this on the sports medicine, acupuncture, YouTube channel.

Let’s look at a myofascial technique where we spread down the urinary bladder. Jin, especially concentrating on the erector speed. A muscle room. We will have the patient roll forward vertebra by vertebra.

While they are actively flexing the spine, we will spread through the tissue to soften and lengthen any areas where the erector being a or bunched. So you can do this with both hands simultaneously or one hand at a time. Both hands is nice, but sometimes it’s good to guide the patient by working on one side while you’re assisting them.

It depends on their ability to do this. First thing they’re gonna do is make sure they’re solid in their feet. They can even give a little small push back into their feet so that they can support against your pressure.

Now let the head go and she’s just pulling me through the erector. Speeding. So I’m lengthening, I’m looking for balanced movement. Okay, let the left shoulder go that. You can just go straight down. So with women, you’re gonna have to readjust around the bra straps there. You gonna stop for a moment so when they stop, you’re gonna sink back in and then have them go deflection as you spread through the erector.


all relax

and hold. Stop for a moment.

Sink back in and then have them continue down in deflection the whole time being supported in the feet. Let the left shoulder go a bit. There you go. Good. And now continue to drop and you’re spreading through the erector. Speeding now into the lumbar.

All right. Now you can help them as a stack. So behind settles first, a little bit more weight here. There you go. A little bit more.

A lot of people wanna come up instantly with the head. I’m gonna do this incorrectly for a second. A lot of people wanna come up here first, but we want them to stack first and get the support stack chest. and they’re in a neutral position.

Great. So that’s a bench work technique that’s very common in structural integration. It’s the type of work I did before an acupuncturist. Rolfing is a type of structural integration. We do a ton of bench work. I really like it cuz the patients are actively engaged and they’re they’re able to informed the body, by that movement of stacking, in this case, stacking the spine.

If you do go to the YouTube, my YouTube channel at the Jing Jin Movement Training and watch that particular video, I’ll give you something to look for. She had a hard time stacking her lumbar spine. and I of wish I would’ve pointed it out on the video. I of noticed it when I was demonstrating the technique that I didn’t wanna take the time there.

But as I, as she goes to stack the body, she has a very difficult time coming outta flexion with a lumbar spine and then misses it and comes up above it. And she has a tendency to have like a lot of people who are very athletic She has a pretty notable anterior tilt to the pelvis, so maybe a little more time spreading through that lumbar region.

A little bit more time stacking would’ve been indicated. But I was just doing it as a demo. But anyway, something to sharpen your eyes. You can look and see, cuz what we wanna see is that each vertebral level moves apart one by one, and then each one then stacks from the bottom. That’s kind of part of that training of the UB Jing gin to get that stacking and get that upright posture so that then people can feel comfortable in their seated position.

So thank you to American Acupuncture Council for for having me for this webinar has been very nice presenting on some of these ideas. These are, like I said, things that we teach within the sports medicine acupuncture program, especially in. One of the classes that I helped co-develop the class that’s looking at assessment and treatment for the channel sy use.

So check that out. If you get a chance, you can also, like I said, check out those YouTube channels and hope to see you guys again. So thanks. Thanks again to American Acupuncture Council.


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Low Back Pain Treatment Protocols – Including DU 1 (Changqiang)



The point is DU 1. And in my opinion, it’s really quite underutilized. I’ve been doing a lot of research on it just because of the amazing results that you can get when you use DU 1 in combination with other points.

Click here to download the transcript.

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

Hello everyone. Thank you so much for coming to this American Acupuncture Council webinar. My name is Matt Callison. My esteemed colleague, Brian Lau, could not be able to make it. He’s teaching right now. There is a scheduling conflict, so I will be with you before this next 25, 30 minutes or so, discussing a topic that I thought was really quite important.

It’s something that we discuss in the Sports Medicine acupuncture certification program. In the pelvic floor aspect, module two. The point is DU 1. And in my opinion, it’s really quite underutilized. I’ve been doing a lot of research on it just because of the amazing results that you can get when you use DU 1 in combination with other points.

This is also gonna be something that I’ll be discussing in the symposium that we’re. Pacific sports and acupuncture or orthopedic acupuncture symposium coming up in San Diego, March 30th through April 3rd. It’s it’s a big mile fascial point. It makes huge, massive mile fascial changes and it’s a point that I highly encourage for people to to go back and use again.

Many people think about D DU 1 is. Rectal problems or prostatitis or hemorrhoids or something like that. But I highly encourage for people to think about using this point for low back problems, especially chronic low back problems. In the SMACK program, it’s really quite common that people will have low back pains since it’s such a common injury.

I’ll call one of the students up to the front. We’ll talk about their low back pain. It could be a Yon syndrome. It could be sac iliac joint pain. It could be anything that’s affecting their low back and all needle. DU 1, take the needle out and then reassess. They may walk around a little bit and it is often using the 90 percentile.

Reduced substantially. Now of course it’s gonna end up, that pain’s gonna end up coming back just because we’ve only treated one point for about 30 seconds. But the reason why I do that is to show the group that DU 1 is a substantial point to use and it makes Big maas changes an excellent point to use with other acupuncture points for low back pain.

So with that, why don’t we go ahead and get started then Let’s get into the, this first slide here. Again, I’m encouraging using D one into low back treatment pain protocols because of its massive ability to make big changes into the my fascia. All right, so to start with this, we’re gonna talk about the FAS continuum.

This is gonna be some text that’s coming from this article, and you’ll see the reference there at the very bottom, through a scientific review and a comparison of anatomy text. A factual continuum exists between the abdominal. The pelvis being the pelvic floor as well and lumbar wall and such knowledge can improve the understanding of referred pain pathophysiology.

Now, research has shown that deep fascial layers are well innovated and capable of transmitting mechanical forces from a distance. This is outstanding work from Helene Langin in 2002, and she continues to. To publish incredible articles on the efficacy of acupuncture. So what she’s saying is that with mechanical stimulation, like an acupuncture needle, there can be a transmitting of mechanical forces, a signaling along these mile fascial planes for some distance, just like what our founding fathers 2000 years ago knew about manipulating chi and having it actually travel along the channels and the collateral.

This concept of fascial anatomical continuity may have important clinical implications for the treatment of pelvic pain or even lumbar injuries. I thought that was really quite significant. Later in the article, it states lower back symptoms, might find their origin in explanation from pelvic floor disorders.

This new concept could improve the treatment of chronic pain and could lead to an important enhancement of current anatomical knowledge and therapies. They’re being really pretty safe by saying the word could there, from my clinical experience, is definitely a very important thing to be able to treat the pelvic floor, including DU 1 with low back injuries because of the fascial continuum.

In addition to the communication between. Pelvic floor, the abdomen, the multifidi, and the respiratory diaphragm. More in that is just a tick. Let’s go ahead and take a look at some more work of Helene Lango bins

now because the structure. And composition of fascial connective tissue is responsible, is responsive to mechanical stimuli. We propose that acupuncture plays a key role in mechanical transduction signaling, and that’s what acupuncture is. It’s a signaling system, mechanical transduction signaling, and the integration of several physiological functions.

The mechanical stimulation of connective tissue generated by the acupuncture needle manipulation could transmit a mechanical signal to sensory nerves, and as we well. . It absolutely does. Acupuncture needle stimulation that results in the spreading of collagenous matrix deformation and cell activation.

Along fascial connected tissue planes may mediate acupuncture effects remote from the acupuncture needle site, so spreading of collagenous matrix deformation. That’s basically needle technique, inserting the needle and lifting and thrusting being one. And how that can propagate a signal along mile fascial planes as we know them now, what our founding fathers talk about as the channels and the collaterals.

So Helene Lang’s work is pretty outstanding with all of this. So what we’re looking at right now is that we have a connection of the mild fascia and also of the pelvis of the abdomen of the low back, and also respiratory diap. Could we actually go one slide back please. I wanna show you something.

All right, so in this image, and I know the text in there is really quite unclear. That’s actually from the article itself. So it was unclear in the article. And like I said, the reference is right there. I don’t have the ability to point, I don’t have a pointer here, so if you guys could follow me along here, that would be great.

On the right hand side, you can see the abdomen and it’s a greenish turquoise lettering. Around the abdomen. So that’s gonna be scarpa’s fascia. Scarpa’s fascia is gonna be part of the abdomen. Now that green line goes all the way underneath in toward red one and DU 1 area. Now you can see, DU 1 that’ll end up being the A.

So if you take a look at the. A reddish looking text. More on the left hand side, you’ll see the letters acl. ACL is the acronym for Oxid ligament, which is the tissue that we’re gonna be discussing here in just a little bit. That is at DU 1. So you can see here with this representation is that each one of these fascial layers, from the pelvis to the admin to the back and going all the way up to the respiratory diaphragm, communicate with one another.

And this is the important thing is to take away from this is looking at as an acupuncturist, what points can we use for low back pain? It’s just not putting needles into the low back. What else did that? What other tissues does that low back actually communicate? Pelvic floor, abdomen, respiratory diaphragm.

So getting that entire core structure to communicate with one another, using mechanical stimuli of acupuncture along myofascial planes and mechanical transduction signaling. In other words, balancing chi and blood, moving through the channels in order to be able to decrease. All right. Let’s go ahead and skip a couple slides here and we can see where it says core stability, communication in the channels, please.

All right, good. All right, so this is something that I, a slide that I took out of the module two pelvic floor discussion, and I think it’s really quite important just to help to reinforce the communication between the pelvic floor and the other structure. Studies show coordinate a strategy in which all abdominal muscles, pelvic floor and the respiratory diaphragm are cod in order to control the Indo pressure and fascial tension.

They work together. There’s communication with all of these. They work together. Research shows that he, so that should be the stimulation of efferent nerves to the pelvic floor muscles when the pelvic floor muscles were activated. Created a reflex of co contract. The respiratory diaphragm and also the transverse a dominus showing a coordinated communication between these structures.

So again, with transverse a dominus, often being very weak in cases of low back pain, how important it is to be able to treat pelvic floor, the low back, the abdomen, as well as the diaphragm. And many times acupuncturists are like, for example, treating the Watto GI points, you’re gonna be stimulating the multifidi and the multifidi interdigitates itself.

With a trans or subo, we could be treating the diaphragm through U B 17. And in the smack program we talk about stomach 20 as being influential point for the diaphragm, especially on the right hand side. Then also in the pelvic floor, there’s many different points that we can use to affect pelvic floor muscles.

And in this particular presentation, I’m gonna emphasize. Treating DU 1 because it is a core point, a foundational point for the dui, and it does affect many of the mild fascists that we’re discussing. So let’s go to the next slide, and let’s get right into the aox ligament, which is the tissue of the aox ligament.

Tissue of DU 1. So next slide, please.

Oops, I think we went too far. Sorry about that. Can you go. . Yeah. Thank you. So the anaco ligament is also referred to as the postnatal septum. You’ll see that in some of the research page papers. Anaco Rafe, which actually has its own definition, and also the anaco body. So you’ll see all those different terms.

Speaking about the Anaco, Now the acl, that’s what we’re gonna refer to from now on. The ACL, can be described as a myo, fibrous, thick connective tissue located in the midline of the body, in the floor of the pelvis, right?

The ACL connects as a RA tissue with bilateral slings of the levator anti. So a RA tissue is going to be where you have a communication. You have a tissue on one side, tissue on the other side, connected by this tenderness, connective tissue, or also a ra. For example, the later RA in the low back, right next to the quads, lium.

That will then be like the Segway tissue, a RA tissue that connects into the. In this particular case, it’s looking at the aox ligament where D one is as a RA tissue where the bilateral slings, the lava anti, in particular the IOC Oxid, the pubic al and the pub erectile muscles go in and interdigitate right into that aox ligament.

Where DU 1 is located. In addition, the Coxs muscle also has fibers that interdigitate with the acl, which is really quite important. The ous muscle is something that we need in this MAP program all the time for Sacred I problems. So the combination of using DU 1 with the Coxs helps to reinforce that treat.

So on this image here, if you can see on the right hand side, you see the letters acl. That’ll be the aox ligament. So you see the C there. That’s gonna end up being your Coxy. Right next to the CO is the cm. That’s gonna be your Coxid GS muscle. That muscle. The pelvic floor is going in and attaching underneath the coic and it’s going interdigitate itself with the acl, right?

So then you have to the left, almost in the middle of this image is the la so that would be your Lior a I. So those fibers right there are going to be your cubic coxin chill, your pubs, and your ICOs, like I said, which interdigitate with the acl. Where DU 1 is located? All right. Let’s go to the next slide, please.

The anaco ligament has two distinct layers to it, which is something that you can actually try to think about when you’re needling into it. That helps with the depth aspect. So the Anaco Li with these two distinct layers that connect to various faial layers, including the posterior layer of the thac lumbar fascia.

Very important because the thac lumbar fascia is often where pain will be generated around the Yon region and also P gun region. So the anoxic ligament can connect with this poster layer thera, lumbar fascia, as well as internally to the endo pelvic fascia that’s gonna surround the pelvic bowl and the regional organs.

Now this endo pelvic fascia has links to the transverse Alice fascia, which is part of the transverse A. It’s all connected, and this is what my point. So number one, the superficial fibers span this, again, we’re talking about the two different layers here. So the most superficial one, superficial fibers span originating from the fibers of the external anal sphincter or the EASs, right?

So we know about that, and running upwards to the coex is going to be your superficial acl. So when you’re. Palpating this, you’re gonna be feeling that superficial ACL with a deeper palpation. You’ll be pressing into the second layer, which we’re gonna be getting into in just a second. So this superficial layer joins the fashion ligamentous attachments on the poster aspect of the coic and sacrum.

So you can think about that when you have a sacred iliac joint problem, because it’s gonna be continuous. This fascia continuous from the superficial layer going toward the sac iliac joint. And as we talked about earlier, by stimulating with mechanical transduction stimuli or needle technique, very light needle technique, cuz it’s gonna be DU 1, it will still be communicating with other aspects of that fascia.

The superficial ACL joins the SAC tubs ligament, which is gonna be another G wire for the sacrum. Excellent for sac problems. And it continues into the glut maximus, which is a major stabilizer for the low back and posterior layer OFAC lumbar fascia. Extremely important. So let’s now go to the other slide, please.

Let’s talk about the second one. This is now the deeper layer. So the second layer is a deep fiber fibrous band. It’s gonna be, it’s gonna be thicker than the superficial layer originates from the anterior periostin of the cos, right? So the anterior aspect of the coic superficial one is going more.

Superficial aspect of the coic, which then can go ahead and spread. Let’s see if I can do this a little bit better here. So then can go ahead and spread along the ligamentous tissue, the glute maximus, and into the thal lumbar fascia. Let’s go back the D one now, the deeper. Part of the anaco ligament is attaching to the underside of the coy right here, the pre sacral fascia, and that pre sacl fascia directly links into the endo pelvic fascia.

So let’s look at this slide here and we’ll talk about a more.

All right, so then this layer is referred to as the deep acl. The deep ACL directly connects to the endo pelvic fascia and the bilateral slings of the La Vader Antiox. Yep. Like I said, the pelvic floor is gonna be interdigitating with that antiox ligament. This deeper layer is gonna be communicating with the fascia that surrounds the pelvic bowl, holds the organs in place, the endo pelvic fas.

DU 1 is a remarkable point in its ability to communicate with lots of different tissues. All right, let’s go to the next slide if we could. Let’s talk about the function of this ligament. Now in this histological study, the anaco ligament was found to be abundant in smooth muscle and elastin fibers. So what does that mean to us?

When an acupuncture needles going into D one, you’re now tapping into the autonomic nervous system because of the smooth muscle and because it has alast in fibers, we wanna make sure that those elast in fibers are going to actually be up to par, that they’re gonna have still their recoil. Much of the skin in our face has elastin, and with age, obviously it starts to droop.

If we can be able to stimulate these elastin fibers and then provide exercises, for example, keel exercises to help to restore the 10 saity of the anoxic ligament, that’s gonna go a long way in the successful results with low back pain. In addition to lower J is harmonies. So during activity, the anaco ligament will involuntary, shorten and tighten.

It adapts to the. And is responsible for absorbing and transmitting forces generated during movement, and that’s gonna be within that pelvic floor. It also functions to support the pelvic viscera and when the lader anti contracts. The ACL that should be ACL pulls the vagina and rectum forward to maintain urinary and fecal continents.

Weakness of the lava or anti causes sagging of the anticoag ligament, which therefore decreases the A cell support of the pellet floor, which is gonna be very important. This sagging increases the probability of urinary continents and constitutes a predisposition to pelvic organ prolapse. I was at a. A gathering of people, and this was in new.

And we were talking about some different things that people had. And this woman said that she just had a childbirth gave birth to a child, and it was about a year and a half ago, and she said she was still getting some urinary continents with that and, I didn’t have any needles. There was not any acupuncturists where she lives, so I just asked her to go ahead and stimulate, DU 1 numerous times per day when she could in privacy.

And she emailed me back a week later and she said how remarkable it was that her urinary continents completely changed and she’s much better. Just, that’s just with acupoint pressure at DU 1. So again, it’s a very incredible point. Its integrity, D one’s. Integrity is vital and defecation and maintains continence and sexual function.

The antiox ligament is clinical significance as it contributes to maintaining the integrity of the pelvic floor muscles as a dynamic anchor for stabilization. Okay.

All right, so let’s get into the actual location of D one. In the acupuncture books, it’s, there’s two different places that I have seen it located. One location is just underneath the tip of the coex. That’s where some people will put it. I think the better place to put it, and this is where actually you’ll see more of this description is halfway between the tip of the coic and also the anus.

Are the indications, common acupuncture, books, diarrhea, bloody stools, hemorroids, so like rectal problems or lower jaw. Problems. Prolapse of the rectum? Absolutely, because antiox ligament will also be prolapsed. Constipation is a possibility there. Prostitis, and this was interesting. Not all books will have pain in the lower back but some books do, which is quite interesting.

Also you can use this to help with the she in manic disorders. Traditional actions as we know it’s gonna regulate the dui. It’s also gonna regulate the Remi resolves the damp heat that would be part of the diarrhea and such, and it calms the mind. It is an anchoring point, as we know it’s a low connecting point of the dui.

And for traditional acupuncturist, low connecting points, we know helps to open up the channel, right? So when there is pain in the channel, we use the low connecting point and that helps to open up the channel. Decreases pain. It’s also the crossing point, of course, do my with Remi. So it helps to be able to regulate the yin the master of the yin and the master of the young.

There’s a crossing point for the kidney, which makes sense because the kidney is part of that pelvic floor, influential of the pelvic floor. It’s also a crossing point of the gallbladder, which is I found real interesting. And there are some fascial correlations between the pelvic floor and the tensor fascia.

Lata. So think about it when somebody is coming in with L five dermatome sciatic pain, and you do a straight leg graze and you do see that it’s actually gonna be coming from the low back and it’s traversing down the dermatome of the L five, which would be your gallbladder channel. This would be an excellent point to use in addition to your wato Jaji points of L four, L five, tensor, fa, gallbladder 31, gallbladder 34.

Again, DU 1, would be like an opening point, an anchoring point, a signaling point for the rest of these points, DU 1 is an anchorings, a great. DU 1’s a starting point of the dui, obviously, as we know. And so we know that starting points are very powerful, where the kidney y energy emanates outward extending itself along the dui.

So since the DUI controls the Y of the body as we know this point, as the name applies, promotes the body strength and vigor. All right, so personally I like to use acupuncture to DU 1 when they’re in a prone position, and I know many people were taught to use in a sideline position that can work as well. What’s unfortunate about the sideline position? Is that you’re gonna be limited to what points you can include with it because the person’s gonna be in the later recumbent position, whereas the person’s gonna be prone.

It lifts the pelvis up using pelvic blocks. If you’re familiar with using pelvic blocks, it works extremely well. Helps to take away pelvic fascia tension just by reducing the anterior and the posterior pelvic tilts. If you don’t have that, then just a pillow underneath the pelvis will help Substantial.

This is gonna be something that you also wanna talk to your patient about, that this is a point that you want a needle. I find that if you ask the patient to palpate it themselves, they start to understand where you’re gonna be going with that. You can use some information if you like, from this seminar to help to build your case, why you want to go ahead and treat.

DU 1 for this person’s chronic low back pain. It’s always a good idea to have this conversation before you actually start needling them just in case they need to use the restroom and prepare themselves or the area for cleanliness. Okay. So then we wanna locate and treat in the prone position.

Using pelvic blocks is always a really good idea. What I’d like to do is to use this as one of the first points. So I’ll crossfire the aox ligament. I’ll go ahead and locate the coex, and then find the axid ligament I’ll crossfire so I can feel left and right sides right. And then go ahead and press directly right into the anoxic chill ligament and feel for the most tension.

Now the most tension usually is gonna be going superior toward the head, or you can angle it ever so slightly underneath toward the cosics. Now, some people go this way. Some people will go up into this way to get really get that pre sacral fascia and I think that can work. When I’ve done that, I’ve caught, I’ve caused sharp pain more than twice, so that’s something you may wanna consider with that.

I think we’re actually starting to miss too, maybe some of the depth of the two layers of the anaco ligament. So going in toward the head or slightly upward, I find actually makes the best mile fascial change. With this. All right, so perpen needle insertion, three quarters of an inch to an inch and a half is gonna be totally fine, and the reason why is because going from the skin, then you’ve got subcutaneous tissue and that’s gonna be your superficial and your deep fascia, which is highly innovated in that region.

Once you get past that, then you’ll start to feel the actual layer of that, of the acl. From there, go ahead and insert into the ACL into. Thickest most tender spot. Okay, so cautions advised, do not needle past the acl, or an anterior direction to the close proximity of the rectum. This is something that you have to be going way too fast.

For doing that. So you wanna make sure that your palpation tells you where the ACL is and what’s the depth of it going. An inch or an inch and a quarter is totally fine with most people. Not a problem whatsoever.

All right, so let’s look at DU 1 point combinations with this. These are just suggestions, you guys, because of its potential to communicate with many pertinent structures affecting the low back. D ones an excellent point to combine with other low back drawing thigh and abdominal acupuncture points.

So the following’s gonna be some point combinations to choose from. The pharmist motor point is gonna be excellent to use. Usually that usually will have that bilateral for sac iliac joint problems. It’s part of the poster support for the pelvic floor. So DU 1 with the pure performance is useful.

DU 1 with the cos because those fibers do communicate with one another. That can be extremely useful as well. Personally, I don’t use preforms and cos at the same time. It’s just a little bit. Too much for the patient. It just depends on what we’re actually trying to treat. Extra point yon, which we’re treating quite often with low back pain that comes in quite a bit with a iliac crest syndrome or Yon syndrome.

That pain that’s right on top of that iliac crest. Using DU 1 with yon because there’s a direct communication between the superficial layer. Of the antiox ligament and the posterior layer of the thac Colombar fascia where Yon lives. The SAC tubs ligament, again being a G wire for the sacrum. Useful in SAC iliac joint pain.

That also connects with D one, so DU 1 and the sac tubs. Ligament is a nice combination as well. Dew one with go bladder 29 can also be useful. You can still need a Goler 29 in the prone position with blocks on. It’ll just be more of an oblique. Type of angle. And of course when you turn the person over and you’ve already treated DU 1 in the same treatment, you can treat rec ado the transverse ado also the obliques because they help to also signal with DU 1.

So it’s a really nice combination. Is DU 1 as your founding point in addition to the rest of the points, cuz they all communi. All right, so this was a very quick webinar. This hopefully enlightens you a little bit and excites you to be able to use DU 1 and to communicate with your patients why you want to be able to use DU 1.

There are some references, I believe on the next slide. That you’re welcome to go ahead and collect there. This is just something that I’m happy to go ahead and do. There’s a lot more elaboration with needling. DU 1 and practice that’s gonna end up being in the SMACK program, but also, like I was saying, it’s gonna be part of my lecture on March 31st, 2023.

In the So as symposium that lecture is gonna end up being big points that move mild fascia that cha makes mild fascial changes and DU 1 is definitely within that category. Thanks, you guys really appreciate your time. I hope this was really useful for you. And I wanted to thank the American Acupuncture Council for having me.

This was really great and I believe that’s it for now. We’ll see you next time. Thanks everybody.


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Treatment Considerations for Myofascial Trigger Points



So we’re gonna be discussing some treatment considerations for myofascial trigger points, how to incorporate them into the treatment, a little bit of comparison between those and motor points.

Click here to download the transcript.

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

Hello. Thanks for joining us everyone. And thanks to American Acupuncture Council for having us back. I say us, but Matt Callison is not joining us today. So it’s just me and our guest, Joe Bickle, Joseph Bickle, and I’ll introduce him in a second. Sorry, Matt’s not here. He had a little incident with food poisoning, so he will feel better soon, hopefully.

But didn’t really feel up to being in on the webinar today. So we’re gonna be discussing some treatment considerations for myofascial trigger points, how to incorporate ’em into the treatment, a little bit of comparison between those and motor points. So it’ll be a really nice discussion that Joe and myself have.

So let me introduce Joseph Bickle. He is graduate of the SMAC program, Sports Medicine Acupuncture certification. So he’s a C.SMA. He also took classes as I did in Myo pain which goes through some various trigger point protocols. I haven’t taken all the classes. Joe did take all the classes, so he certified through Myop pain.

So we’ll have a little common language we can discuss and maybe talk a little bit about that training also. Joe, do you wanna give any background of how you, we can get more into specifics in a bit, but how you incorporate or what you do and where you work and Yeah. So I work primarily in two different locations in Minneapolis, St.

Paul area. I work as part of an outpatient program attached to the Allina Health and Abbott Northwestern. And then I also do supervise at the local school Northwestern Health Sciences, their human performance center, where we focus primarily on treating athletic conditions. Obviously treating there.

But my patient population tends to be more of the chronic pain and or chronic orthopedic conditions throug

h the Allina Health System. Great. All right. So we’ll jump right into the discussion. We’ll start with a PowerPoint. We’re not gonna have a PowerPoint for the whole whole webinar. But we wanted to start with just a little brief discussion on A comparison of motor points and trigger points.

These are not such a black and white, easy comparison to make cuz there’s a lot of crossover. And on top of that, there’s a lot of discrepancy on how people describe a lot of these things. So they’re not even always clear delineations between the two. But just since a lot of people use motor points, a lot of people use trigger points, some people use both.

It’s nice to of get a little. Into the the different slash similarity comparison. So let’s go to the first slide. Gimme just a second.

All right. There we go. Sorry about that. So we’ll start, like I said, this comparison, but then once we get through the. The PowerPoint, we’ll start talking about some key kind of areas referral patterns, a little bit about how to assess for trigger points, including them into the treatment. And then one of the main things we wanna talk about today is is dosage.

So how much stimulation do you give? Are you looking for a ation, the duration of treatment? So I know I’ve had a problem and I talked to Joe about this. Sometimes I’ve overtreated people and they come back and, Oh, they were so sore, And it’s little soreness is one thing but you can definitely overtreat.

So being able to judge how much that person can tolerate is really important. And I know all of us know that from Chinese medicine, but looking at it from this little more my myofascial stimulation is really an important topic. Let’s go into this. Joe, if you have anything to add, we’ll just talk about it, but we’ll just get through these like early slides to start off with.

Anything to add to that now or we’ll get, I guess we’ll probably getting into it as we go. Yeah, I just guess would just like to emphasize that it really, it can get a little confusing motor points versus trigger points. And so for anyone listening who has feel that way, you’re in good company.

Yeah. Excellent. So what is a, let’s start with a motor point. I’m gonna use the term motor entry point. So motor points are described not consistently inco inconsistent descriptions of. A lot of the more precise language is using motor entry points, cuz this specifically tells you it’s where the motor nerve enters or penetrates the muscle.

So what you’re seeing in this image here is a picture of the flexor carpials. So what’s being held there with the gloved hand is the ulnar nerve, which is traversing down the for. But then you see that little collateral branch that the hemostats are pointing to. That, that collateral branch is going entering right into the flexor carpials.

That’s gonna be about a third. If you drew a line from heart from s si eight to heart seven, and made that line divided in thirds, that’s gonna be the proximal and middle third junction. Thereabouts. It’s slight variability on pe, person to person, but it’s pretty consistent. It’s a pretty consistent location.

So that’s gonna be the motor entry point, and we’ll talk about other terminology here in a second. So not really all always agreed upon, but that’s the definition that I like and that I wanna use and that we tend to use in the sports medicine and acupuncture program. Whoops, let’s get. All right, so once the motor nerve enters the muscle though, then it bifurcates and sends branches out, usually approximately in distally, and those branches terminate somewhere in the muscle and some languages some descriptions.

If you look at research, we’ll talk about those as being intramuscular motor points, so areas where the motor nerve after it bifurcates and travels for. Depending on the muscle and the person and all that, it’s gonna D terminate at that intramuscular motor point. So that’s a motor point also. But that would be an intramuscular motor point versus the motor entry point.

So in this image, if you can look somewhere in the center, this is the hamstrings. Somewhere in the center you’ll see me P. That’s the motor entry point. That’s where the sciatic nerve sends off. A branch enters the muscle, penetrates in the muscle. Then dlp, plp, I forget what those stand for.

Proximal and dis. But basically they’re talking about the termination place within the those branches that go distally and proximally and then terminate at the intramuscular motor point. So that’s something that we can talk about and maybe from there, make a comparison to trigger points. And Joe, I don’t know if you wanna jump in here and add any thoughts to this.

Yeah, I think that’s, that sums it up pretty well as far as the main differences that I’ve seen and that I work with where the motor point is, motor entry point tends to be a lot more predictable. Like you were saying, how you’re mapping out the flexi, carpal nas whereas the end plates can be a little bit less predictable and therefore more palpation based.

But otherwise I would agree. So would you say, and this is the way I see it trigger point. When we define a trigger point here in a second, trigger points can exist anywhere in the muscle. So this is showing the biceps for Morris Longhead motor entry points somewhere in the center. The muscle, it’s pretty close to UV 37, just lateral to UV 37.

There’s another one too, the couple different motor entry points, but this is the main one. And then those junctions that send out intra muscularity and terminate at where it says PLP and dlp. Those would be the area where there’s motor in plates where there’s receptors for acetylcholine.

That’s the neuromuscular junction. You can describe it in structure. You describe it in function. That’s where the discrepancy between neuromuscular junction and motor in plates comes in. But in trigger point language, they mention that trigger points tend to form at the highest concentration of motor implants.

So in my mind, that would be at these intramuscular motor points, even though they don’t have these mapped. I don’t know how variability, how much variability it is. Maybe someday there’ll be all these maps that say, Oh, okay, here’s where the distal intramuscular motor point is of the biceps, or more.

I doubt it. It’s probably much more variable than that. But this would be the relationship in my mind is there’s the motor entry point where the muscle, where the motor nerve enters the muscle and then the intramuscular motor points that terminate somewhere that’s probably less predictable in each.

And those would be sites where the trigger points tend to form. They could also form really at the motor entry point. It could form anywhere in the muscle, but those are gonna be the key areas. Yeah, I would definitely agree. It definitely seems like there is some predictability to those, to the end plates.

, but I don’t, obviously I’m, I would assume things like activity, how athletic the person is, their movement patterns would have an impact on those locations. So Yes. Yeah, I would. It is interesting that you mentioned predictability cuz for those who used trigger points and have looked at Janet Trevell and David Simon’s book Myofascial Pain and Dysfunction Trigger Point Manual.

In her early additions, up until just recently into the recent edition, she had Xs not because they were definitive locations for trigger points, she made it clear that they could exist anywhere in the muscle, but she had Xs just clinically being a very skilled palpate and c. Of areas where you tend to find trigger points, it tends to form here in the muscle.

The kind of go-to areas that that wasn’t trying to imply that they would always be there, but they were go-to based on clinical experience and just seeing a whole ton of patients. In the recent addition of that, they took those x’s out, which I don’t know, I could see an argument for it.

Cause you have to palpate all through the muscle and. But I kinda like the X’s. I don’t know. . How do you feel about that, Joe? I see two sides to that argument. I actually like them not there because it does force the practitioner to palpate , as opposed to one, I think one thing acupuncture specifically can fall into a trap on is they’re used to that precise location.

Tell me the measurements and then I can find. And they can lose that ability to palpate exactly what they’re feeling for. Yeah, for sure. And that’s, I think the reason, not for acupuncturists per se, but that’s the reason they weren’t taken out. Yeah. But yeah, as I understand that is why yeah.

If you do work with trigger points a lot that you will find that they tend to be not, I wouldn’t say predictable. Yeah. It tends to be go-to areas. You tend to find some consistency. But, that’s the trap. You’re right. Is. Can then start to force yourself to think, there should be a trigger point here cuz the pain referral or whatever.

And you don’t palpate carefully and end up missing something that if you were to be more open minded, open, open possibility about it, I think you would just not get Huang up on trying to force it into that location. Yeah. All right, so then motor entry points, intramuscular motor points.

Trigger point is a hyper irritable spot in skeletal muscles associated with hypersensitive, palpable nodules and a taught band. So when you’re palpating for a trigger point, we can talk about what that refers to. The spot is painful on compression and can give rise to characteristic referral, pain referred tenderness, motor dysfunction, and autonomic phenomena.

So that’s the definition from Trave and Simon’s book. And it’s a mouthful in and of. . But that tells you that there’s a hypersensitive, palpable nodule there. So whereas a motor point is, or especially motor entry point is an anatomical thing, you have that, whether there’s dysfunction in the muscle or no dysfunction.

It’s there. It’s, it might be slightly there, variable from person to person, but it’s in a relatively consistent location that the muscle’s in dysfunction, the motor point’s there. If the muscle’s healthy, the motor point’s there. It’s just part of your anatomy. Whereas trigger points are talking more specifically about dysfunction, they could form at a motor entry point.

They could form at the intramuscular motor points, They could form somewhere else in the muscle, probably most likely at the intramuscular motor points. But they’re they’re a sign of dysfunction where there’s hyper irritability and there’s characteristic referral patterns and other phenomena that you see with it.

Good. Joe, I’m gonna move on unless you wanna add something to that. No, I think that summed it up pretty well. All right, so we’ll come back to this we’ll take the PowerPoint away for now. We’re gonna come back to this when we use an example later and discuss the Quadra Lium. But just glancing at it for now, you can see these characteristic referral patterns that are mapped out when you’re looking at these referral patterns.

You. If you don’t know the mapping, there’s something that you wanna know about ’em is that dark red doesn’t indicate more intensity of pain. The dark red indicates more of the Tendency of where those muscles refer to. And this one is from an old edition. It has the X’s in there. Modern ones don’t have the newer edition doesn’t have that X, but don’t worry about that so much.

But that characteristic darker red area is where you’re gonna more commonly see that referral. And then there’s the spillover, speckly red that could be just as severe pain at those spillover areas, but they’re less frequent, less frequently gonna be experienced there. So that’s what the mapping is.

So let’s bring the PowerPoint away and we can come back to that in a. All right, so exit this out so I can see Joe. There we go. Good. So we talked a little bit about that difference between motor points and trigger points. So let’s look at how you would incorporate, if you’re using motor points, how you would incorporate trigger points in or even if you’re not using trigger points.

How would you incorporate, what would you be doing? What would lead you to think trigger points and how would you make that a part of your treatment? Sure. Just looking at the mapping that Traves done, I think. L thinking about it from someone who is new to orthopedics or new, certainly new to trigger points.

I think that’s your first go to is based on patient symptom presentation. And then that’s gonna narrow it down. So if we’re looking at the QL as an example, it’s lighting up parts of the hip, parts of the si. There are gonna be multiple muscles that do but it does give you a way of zooming in relatively quickly to Alright, I’m gonna start thinking about glutes.

I’m gonna start thinking about ql. And then you can also, if you’re more orthopedically inclined, you can start thinking about. The spine and other things as well. So that’s a good first step. I think a good second step would be reading some of the traves information. She gives a lot of more specific symptom presentation and as well as other ways to incorporate.

So talking about the relationship between glued trigger points and their effect on QL as well. And. Another good way of starting would be active and passive ranges of motion. I know when I first started of getting into this, that was a very nice, like just memorize how the body can move and then have a patient see what they can and cannot do and incorporate that into a pre and post exam.

And then lastly, I’d. What I’ve been talking about before, help patient, the more you can get a feel for the tissue, it’s gonna lead you in a direction. . Yeah. This is the trick with those who use motor points. The trick cuz there is crossover cuz in sports medicine, acupuncture in the certification program we tend to use more discussion of motor points and we use a lot of the same thing, range of motion.

Looking at muscle inhibition, that could be something. I know trave talks about muscles becoming inhibited when there’s trigger point formation in there, so there’s definitely a lot of crossover. Yeah, in the sense that, if somebody has limited range of motion in the upper trapezus, for instance, so I go with the motor point, or do I go with the trigger point?

What’s my. What’s what’s going to be the thing that leads me to one or the other. And they can be the same thing cuz the trigger point might form at the motor entry point location. But let’s assume it’s a little off the motor entry point location. Which one do I use? So what’s your way of differentiating those, even though there is so much crossover?

What’s your way of differentiating those usage? Sure. I guess I tend to look at it and especially this is gonna. Feed off of my smack background, but motor points tend to, or I use them more so for global aspects of treatment. So looking at the posture, like if we’re talking about bet trapezius, upper cross syndrome, know, I’m definitely gonna be thinking more motor entry point.

Whereas if the patient’s coming in for. That temporal rams horn headache I’m gonna be specifically thinking, All right, I need to feel the upper trapezius, find some trigger points in that region or not advanced that, that are almost recreating those symptoms. That’s a good bet.

If you’re finding a 10 point that’s saying, Oh, wow, yeah, that, that goes right to where my, I typically have a headache. , That’s why I’ll tend to lean in on treating the trigger point specifically over the motor point. Yeah, I gotcha. Let me say it. Tell me this is because I, this is what I heard, and this is how I think about it too.

But let’s use back to the Upper cross syndrome patients coming in with headache neck pain, maybe cervical type headaches, tension headaches that are coming up the cervical spine, and then radiating along the gallbladder channel to the temple. So knowing the trigger point referrals, upper traps would be one of the key structures that I’d wanna look at for that.

However, they have upper curl syndrome. So once I’ve diagnosed and assessed that, that posture and I can see that posture’s part of that pain pattern, I could choose motor points such as the OIDs, lower traps to help re return some. Awareness to that area so that the person’s able to engage them, especially if I give ’em some exercises afterwards to help engage that.

I might include Peck minor as a way to let that peck minor soften. It’s not what’s causing the pain, it’s not the direct cause of the pain, but it’s part of that that postural symptomology and then the upper trap sugar point to speak almost directly to that pain referral. Yeah. Yeah, I definitely consider it like trigger points to be like the branch treatment of to use a Chinese medicine term, the branch treatment of kind of assessing those like postural and mobility issues where the trigger point itself is a symptom of what, what’s going on underneath.

But it still needs to be treated, and Thank you. So you’re incorporating, I need. This trigger point, this exact one part of the region of that muscle. But I also need to balance that with motor entry points to create a more global effect. , I know. And leading up to this webinar on Facebook there was a question about needling motor points.

Will that release the trigger point or will that have a clinical effect on the trigger point? So should there be, and I think this is gonna be very opinionated by the way, but should there. If you find that trigger point in the upper traps, should I needle the motor point, assuming the trigger points at a different location?

Should I needle the motor point to release that trigger point in the upper traps or should I go right to the trigger point? Sure. Any thoughts on that? I think this would actually this would lead into our conversation about dosage because needling into that trigger point is gonna have a certain level of sens.

Versus needling into the motor point. . And to me that becomes a question about who’s sitting in front of me. I think there are times where I would say needling the trigger point is exactly what you need to do. And there are other times where I don’t think that’s a great idea. I think just balancing the treat, focusing more so on the bilateral trigger point or bilateral motor points, and then postural issues might be a better approach depending on who’s sitting in front of you. Yeah. Gotcha. It’s interesting the idea of trigger points. I’m gonna make a comparison to something. I do, I’m in Florida, so I can do injection and I use.

Modified like buffer, D five W 5% dextrose and sterile water, which could be great for trigger points. I use it for trigger points. It’s also used for ural injection. So when you’re working with cutaneous nerves, so a lot of pain syndromes, you can palpate these cutaneous nerves and do very superficial injection.

And using the D five W to desensitize some of the nerves because the idea is that when nerves are absent when there’s glucose, oxygen deprivation, when there’s pressure on the nerves, they, they’re not getting oxygen. They’re not getting glucose. Dextro is about the same thing. You can desensitize them with this dextrose solution, bathing that area and this Dex solution.

And the person who who really spearheaded a lot of this work is MD and New Zealand. And he uses it really comprehensively for a lot of different things, even like sciatica. And it’s like you’re desensitizing that most distal portion. Of the nerve. It reminds me a little bit of distal points in acupuncture, even though they’re, these aren’t, know, it might be around the knee or wherever the pain presentation is, but it’s almost like desensitizing that end of the nerve kind of, refers back to that neurologically back to the main unit.

I of feel like trigger points are a little bit like that too, versus motor points is sometimes you wanna use the motor point, which is gonna affect all the branche. Distal from that, all the intramuscular motor points. But I wonder if it has like a little dispersed effect. It’s effect is dispersed among all of those, which is very regulatory versus sometimes you need to zoom in right at that most distal branch that’s irritated.

Yeah, exactly. And I to play off of that, I don’t think there’s anything wrong with saying, All right, let’s try the, let’s try the motor entry point. , and then reassessing the trigger point and saying, Howard, how’s that feeling? Now that I’ve done. I think that’s a good thought process to be going.

Yeah. Gotcha. On that topic, and you already started getting into dosage, I think we should probably go into that. Could you define dosage again, cuz it’s a term I hear in acupuncture world, often when people hear dosage they think medicine, which is medicine.

Medicine can. Yeah, it can be a little tricky. I’ve broadened my definition quite a lot in the last year. So I considered anything that’s, Going into the treatment. I think the way it gets talked about and has been researched the most is number of, treatments within proximity one another.

So number of treatments per week but needle retention time, we talk about it in school, like the 23 some minutes and talking about cheese cycling. You can of get locked into that and stop thinking about it, but there’s definitely a difference between needling. Leaving a needle in for a minute, to five minutes, to 15 to 35 those are all gonna have a different effect on particular patients.

The amount of needles and then the amount of stimulation like we’re with, talking about trigger points, the local twitch response doing some type of manual technique on the needle. Eim, I think these all have a level of stimulation, a level of dosage. And they all do slightly different things. As an example, there are times where.

What you want to do is to get multiple local twitches versus another patient who’s gonna have a really bad reaction to that. And maybe Easton was a better way to go. But then even then you can of start building off of that. Or what are the accessory techniques you’re doing? What effect is that gonna have on your treatment and how often you need to be treating and how much needling you do.

If you’re doing a ton of mild fascial work, like we learn, like we learn in smack, how much needling do you really. I know going through the program we’d spend you’re spending like five minutes doing a tech a mile fascial release technique, and then you’d have you or Matt just being like, I just remind everybody you’ve already done the needling at this point, so you don’t have to do all that.

A ton of mild fascial work. And that’s an just an example of moderating the dosage and then what you’re giving ’em, what you’re giving them. As far as herbs or homework assignments I know there’s some interesting research that talks about using exercise to minimize that post-treatment soreness.

I certainly think if you’re incorporating that, you need to be thinking, how much work can I do with the needle versus how much work am I gonna have the patient do when they’re at. And yeah, I just think those are all different examples of what you could term dosage. Yeah. I also add a thought to that is that upper cross syndrome would be an example of this.

Somebody can’t tolerate a lot of needle stimulation. That’s a lot of needles to do. The rom boy major rom boy, minor, middle traps, lower traps, tech minor. Especially if you’re doing this bilateral. There’s a lot that goes. So I start to think distal points sometimes too. And think which channels are those, if those muscles are part of a sinia channel and maybe I can affect differently, maybe not as direct, but maybe I can affect those lower traps with the urinary bladder channel, a distal point that I might be using anyways. And I can have that have some regulatory effect.

I think its effect is gonna be a little bit more dispersed and its effect is gonna be stronger if that distal points there. Plus the local point. But, the person can’t tolerate, I can still of build energy in the channel to help that, relate to the lower traps in that case without having to needle ’em directly.

If I do need to minimize, or maybe to release the Peck minor, I’m gonna use a lung channel point that’s gonna have a little less less , impact. It’s not gonna be as strong of a needle sensation as going into the Peck minor with a, with a. Yeah. And I agree. You can have two, you can have one patient and then 30 minutes a nut later, another patient, same condition.

If we’re doing upper cross, you’re doing the upper trapezius trigger point and you’re gonna make it worse. Or someone else, you, if you do the upper cross, trigger point, you’re gonna make ’em way better. . And it’s just, I think the trick is learning how and when to do that. I do think there are some tales, but ultimately just building your clinical experience around how you’re, how patients are gonna respond to that.

But yeah, it’s a thing I love about Chinese medicine is that gives us, it gives us those options. If I can’t treat the trigger point directly, I can use lung seven. Yeah. It’s funny, I think when I’ve overtreated people, it comes down to this one thing. And I’m gonna use a phrase that I heard this in context from another educator used to teach with sports medicine, acupuncture Patrick Cunningham.

He discussion, he reminded it was, this was an online discussion, but it reminded folks about a saying they have in chiropractic, which is being addicted to the audible. So that case is trying to adjust and get that pop, and sometimes the joints move, but you’re like, I’m looking for that audible.

I feel like face situations are that, and this was his point, the fasiculations are that in the acupuncture world especially more sports acupuncture based world is getting addicted to that big muscle twitch. And sometimes that you put the needle in and boom, it’s right there. But other times not and, maybe you over overstimulate looking for that big muscle twitch because that’s what’s driving, that’s what you judge as being what’s important for the treatment.

Maybe their body’s telling you something different. I dunno. So when I have over, when dosage has been wrong, it’s for me, that’s what it’s been. Yeah. I’m guilty of that too. Certainly. Who doesn’t love just getting that like nice big pop of the muscle? Yeah. What was I gonna say based off of that?

Oh shoot. Escape me. But you said something that reminded me of that, but Yeah. I think. Certainly knowing when and how much and knowing that, I also like to say it’s like it’s not the worst thing in the world to over treat somebody. As long as you’re communicating with them like, Hey, I’m gonna do this thing, you’re probably gonna be sore one to two days.

Anything over that. I consider to be too strong. I’ve definitely had patients be like, Oh yeah, I think we did a little too much and then it’s, and then we move on. We know to treat, do a little less stem. But the point, I need to close with this cuz we’re running a little short on time, but the ations I do think is where it’s spending a minute or so on and I’ll mention my thoughts on it.

I don’t think there’s an answer to if you need a ion or not. I feel like the ion is, I. . But I think oftentimes we miss these very small background, quiet fasiculations, which is maybe what that person’s body needs. And I have some ways that I sometimes, like I, for Summit 36, if I’m using that for the tibialis anterior or just any tib anterior or motor motor point or trigger point, I’ll go down distally to about the liver four area and just go a little lateral, which would be right on the tibialis anterior tend.

Yeah. Sometimes you need all that region of oft anterior and you can clearly see and feel of ion, but sometimes you can’t. But you can fairly clearly feel like a little pull on the tendon and it’s I might have missed that on the needle and kept on looking for a ion. . And I think for some people that their body is that was the therapeutic outcome and I got it and I missed it if I don’t have a way of assessing it.

So sometimes I think when we talk about fasiculations, we’re not talking. , the spectrum of that muscle ion that can happen, that can be from almost imperceptible to you can physically see it. Yeah, sometimes we talk about fasiculations as it being that part of the spectrum is the parts you can physically see or right there you see it.

Yeah. Yeah. No, I think it’s important to understand that. Even the research is gonna tell you. Oh, like getting a twitch, it does have a response. It has a local response, has a global response. But searching for it can actually recreate a lot of the, in nociceptive increase the presentation of a lot of the nociceptive chemicals that you’re actually trying to get rid of.

Yes, getting the twitch can matter to a degree. , but it’s very easy to overdo if you go hunting for it. And I do think, like you’re saying, like trying to look further, like further distally or approximately along the muscle, looking for those small littler twitches is probably a smarter way to go.

Yeah. And also I think when it’s like that and it’s assuming you’re in the right location, sometimes you take the needle out, Repa. Oh yeah. I think I was just a little off. And you put it in, you get it right away, but sometimes you’re right on the right spot. And then sometimes you just have to use good needle technique instead of just banging away at the muscle.

You just coax Yeah. Little English on it. Yeah. . So I think that’s that’s been the change for me in treatment is not just assuming. I didn’t get the twitch because I’m in the wrong location and just keep on wailing away at it. But just to see that as the body needs a little bit more a little more mechanical stimulation, quiet stimulation in that area and let it come to the needle.

In those cases where it’s probably more of a deficiency case, know, Cause the excess portions you put the needle in and know, it’s, Yeah. It’s there. Yep. Yeah, I would agree. All right. Joe’s gonna be presenting at the 2023 specific sports in an orthopedic acupuncture symposium.

Maybe you’ll get a little more into some of this at the symposium. I know the dosage thing is a really interesting thing, and you’ve talked a lot about various research that, that discusses this, and I think that’s useful to hear it from that perspective. Hopefully more on that topic later.

Yes, that is the point. Oh, we were gonna talk about ql, but I think we’re probably a little short on time, so maybe we’ll leave it at that. We got a lot of good information discussed in this. All right. So thank you, Joe. Thanks for being the guest. Sorry Matt couldn’t join us. Thanks again to the American Acupuncture Council for having us.

It’s always great to, to be available for these webinar. And I didn’t get who is here next week, but I think it’s usually put up on the screen, so there we go. Awesome. So hopefully you guys can join next week and thanks again and see you guys another time. Thank you, Joe. All right. Yeah, Thanks Brian.


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Sacroiliac Joint Pain: Considerations for Acupuncture Treatment



So let’s go ahead and get that. Pearls these nuggets these wonderful protocols to be able to use for sacred iliac, joint pain and dysfunction.

Click here to download the transcript.

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

Hello, everyone. Thank you very much for attending our lecture on the sacred iliac joint. My name is Matt Callison. I’m here with my colleague, Brian Lau. Hi, thank you very much to the American acupuncture council for having. Brian. And I were talking about the upcoming module two low back hip and groin for this sports medicine acupuncture certification program.

That’s in September. And we’re thinking about different ideas of what we could be able to present. Because sacred iliac joint pain that would be presented at September and November is so prevalent with many people with different lifestyles. And we thought it would be a good idea to share with you some of our experiences.

As experiences at different points and different things that we can be able to use for releasing sacroiliac joint pain and dysfunction. What we’re doing is actually just going to be providing you in this short period of time, just a slice of the pie of things that can be used to help to reduce pain and the sacred early, actually, there is quite a few more things that you have to take a look at, but that would end up taking quite a few days to be able to go through all of that.

So let’s go ahead and get that. Pearls these nuggets these wonderful protocols to be able to use for sacred iliac, joint pain and dysfunction. So the next slide there, if we could. Go to is it’s such a crazy common injury for people and it can be able to come and go can actually really be recalcitrant for a number of different people as well is sacred iliac, joint pain, and the sacroiliac joint and the tissue surrounding that is usually the innocent bystander.

If from the different postural and muscle imbalances that are causing a total. Our torsion, a strain within the post here, sacred iliac ligaments, and also the that are just over that sacred iliac joint. So the sacroiliac joint does have a very small amount of motion, but again, it’s the innocent bystander from different pelvic imbalances and muscle.

And with those muscle imbalances come channel imbalances. And with that then comes challenge bounces within the associated channels. So this is something for us to be able to take a look at as an acupuncturist. Let’s go ahead and present some real gems here that we can be able to instantly take pain away from the sacroiliac joint and not just needling local.

So the next slide, please.

This is a bit of an overview, so we could use the innovations of L four L five at the Wachovia, Josh G points as well as you be 31 and 32. You be 33 would also be a choice. That’s just easier to find. You’d be 31 at 32 Bali out points. So this would be where we could actually affect the. We’ll also talk about points along the internal pathway of the call bladder that can be used as its own separate treatment protocol as well.

And of course, local needling in the sacred iliac joint region. And the reason why I say not into the sacroiliac joint is because it’s very difficult to get an acupuncture needle into that small little crevice of the sacred iliac joint. It’s something that I think as professionals, we should never say.

To anyone that were actually neatly into that joint, we would actually need some kind of digital imaging in order to guide us to go in there. So it’s just important that we have our language straight, especially if we’re going to be discussing to medical doctors or chiropractors or physical therapists, we’re stimulating the tissue around the Secor iliac joint, helping to decrease pain.

Then after that, we’ll get into some important motor points and also some tissues like the sacred tuberous ligament that are associated with the urinary bladder and kidney. So let’s go ahead and start right off. I think the next slide, please. This is a repaid. This is some, these are some points that you can use consider when you are needling locally underneath that PSIS for the sacred iliac joint pain is the innervation site to that joint.

So walk to a jig points at L four L five needle, those bilaterally as usually for the past. For needling, those points also, you be 31 and 32. I don’t really need all those bilaterals, but you could normally I would be needling just the side of the effected SSI joint. So you’d be 31 and 32 good combinations with local needling that you can use that in addition to, let’s go to the next slide point combination here of gallbladder 29, which is. Motorpoint or the superior motor point for the tensor fascia Lata. You can also use gallbladder 30, or I prefer the piriformis motor entry point. And I’ll discuss why in just a second. That would be with your SIJ needle technique and then also do one.

So why are we using this point combination? Let’s take a look at the internal pathway. So that image on the right, this is from Royston Lowe’s book of secondary or ordinary. I think it’s called secondary to. Printed in the 1980s, you can see from gallbladder 29, Brian, I don’t know if you’re have a cursor, if you could be able to point that out.

So gallbladder 29 on the hip there, we can see from that primary branch 29 will then go to gallbladder 30. That’s as we know into the buttock region, there’s an internal pathway that goes from gallbladder 29 down deep across the PSIS and communicate. Seemingly with the steak really act joint and its tissues, because the next point is that it communicates with, as you be 31 30, 2 33 and 34, the Bali alpha points, then that internal pathway goes down to two one, which is really quite interesting when we look at the pelvic floor.

So we’ll have a quick discussion on that, which is a very quick from that do one. Then the internal pathway arises and goes back up to the surface at gallbladder 30. This is the reason why we could use gallbladder 29, where the internal pathway begins before it goes to the sacroiliac joint. We could also use do one would be a good choice because of the ligament that had a cost to Jill ligament is the seam of the left and right pelvic floor.

So it has a lot of communication within that region. We could also use gallbladder 30 there because that’s where the internal pathway comes up and arises at gallbladder 30 personally, I prefer to use the piriformis motor entry point in this case, the reason why is because of its influence within that region has a really strong stabilizing effect for the sacrum itself.

When I’m using gallbladder 38, I’m actually thinking about trying to stimulate that sciatic nerve when there is true. SIADH. So I’m using that for a little different purpose or also with ease and gallbladder 30, just on a side note, it’s an excellent point for tonifying chia. Something to be able to mock up, you can use that with 36.

So back to the sacroiliac joint pain, gobbler 29, where the internal pathway exits from gallbladder 30 is where it comes from the deep, after going to the Bali Al points and the secretary iliac joint region to do one resurfaces at gallbladder 30. So you could use that point or the piriformis motor entry point.

That’s a nice combination. And you would tie in those needs. Those local needles around that area with gallbladder 41 is sad. Job five being the master income fluent points for the diamond mine young way has a strong effect on the civic really act joint that we demonstrate quite a bit with Gillette’s test in the smack pro.

All right. So that’s a standalone. However, you could use that with the L four and L five watch OCI points, or you’d be one and you to help tie in that internal pathway and also the innovation. It’s a solid treatment. So let’s go into, I think the next one, Brian is going to take over and start talking about the urinary bladder and kidney.

Yeah. So this would just be a, something to consider an add into the treatment. If we just get an overview of the urinary bladder and kidneys and new channels, translation for the sinew channels. We have a partial list on the left for the urinary bladder. So a new channel and a partial list on the right for the kidney sinew channel.

I say partial, cause it’s only taking us up to the lumbar spine. These channels would continue. But I’m just glancing at that image. We can notice a couple things. First of all, the urinary bladder sinew channel is going to go posterior region through the glute max hamstring tendons. We’ll talk about a couple other structures, but they’re going to form and unite at the posterior.

Part of the sacrum with the posterior sacred iliac ligaments. So that’s something right there. So it’s going to have an influence on the sacred iliac joint. Through the posterior second is really act ligaments, the kidneys, send new channels, going to dive deeper, anterior to the sacrum, to form the ligaments on the anterior portion of the sacred.

So those channels run fairly close to each other, running up the leg and thigh, and then diverged at the pelvis. Kidney channel can be sending a channel going into the pelvic floor, anterior to the sacrum urinary bladder, posterior to the sacrum. And they’re going to have quite an influence on the balance of the sacrum.

So we’re not going to necessarily have to treat every structure listed in. But we’ll highlight a few specific ones and we can look right now and notice on the left, we have the sacred tuberous ligament as part of the urinary bladder sinew new channel. This is the ligament that goes from the issue of tuberosity to the sacrum, a major structure that supports the sacrum.

So if I’m bending forward, that’s going to prevent my sacrum from basically popping out of the joint. It’s a very supportive structure on the sacrum, the piriformis part of the urinary bladder send you to. Blue max, which would be important. We’re not going to talk about it as much today, but we’ll highlight that line from the hamstrings, especially the biceps for Morris into the sacred tuberous ligament, and influenced also by the piriformis.

And then one last structure on the urinary bladder is one that would not be super obvious for a lot of people is Fronius long in the prone in general, the peroneal group, it’s very lateral. It looks like it’s on the gallbladder channel. It’s a lateral branch of the urinary bladder sinew channel. I’m going to put my cursor on it and run up through here.

The gallbladder channel would run just anterior to this. So this is a lateral bland branch of the. Urinary bladder channel. It’s going to go up to the fibular head and then link very strongly with the biceps for Morris. And then up through there and to the sacred tuberous ligament and the posterior sake really act ligaments.

That’s a key structure that we’re going to be working on that whole line in this. And we’ll talk about that in this presentation. And then the kidney send new channel. Just isolate one structure and that’s part of the pelvic floor, which has a big influence on the sacred iliac joint. That’s the issue of Cox.

So let’s move forward and look at those. Brian, yeah. Can you go back to that slide? I just want to offer one thing. I remember something that you and I have taught in the past when we’re talking about acupuncture as an assessment. So when the patient is laying prone and you can palpate underneath that PSIS and they have a certain amount of pain when you’re palpating in that region.

It’s usually the peroneus long as sometimes it’s the biceps for Morris, but it’s also the protein as long as it’s a real go-to muscle to go ahead and treat that motor entry point and see if that’ll decrease. The SSI joint pain usually does by a good 50%. So remember that combination, the Proteus longest the biceps femoris, and of course, going into this particular tuberculous.

But the peroneus longus is one point that can really take a lot of pain away from the sacred iliac joint, which is wonderful to be able to do so you can see patients have a lot of confidence. You as a practitioner, when you use one needle and you decrease their pain substantially. Thanks, Brian.

Yeah, sure. Yeah. This would functionally would really help support the SSI joint during gait, cause as you’re walking in heel strike, those muscles would start firing and help help. Whole mechanism that supports and pulls down and blocks, maybe that’s the right term, but supports stabilizes.

That’s sort. I was looking for help stabilize the sacred iliac joint, especially in running and walking type activities. So it’s really tied into the balance of the sacroiliac joint closure of the joint. That’s awesome. That’s great. Performance and sacred tubers ligaments are are ones that we’ll look at a lot.

And this slide This is a complex topic. When we get into the movement of the sacroiliac joint, I’m not going to go into super detail with it. Cause you have to, if you’re interested, you can look up nutation and counter nutation. It’s a long process to describe it and it can get very bogged down in the mechanics.

But simply speaking as you’re walking and running, you have one leg going forward and one leg going back in the innominate bones follow that there’s going to be a rotary rotation type motion in the denominator. You can picture the leg that’s swinging back is going to influence one that side. Let’s say, it’s my right leg.

That’s swinging back. This is going to influence that right side into an anterior tilt the pelvis. Whereas the leg that moves forward the forward leg is going to influence the innominate bone on that side of a D my left side in this case is going to go into a posterior tilt. And then as the gait changes in the leg switch, that’s going to go back the other way.

There’s going to be this kind of rotational type aspect through the innominate bone. That’s going back and forth. And even just from the get-go, you’ll notice with people that there is going to be a cemeteries in that. And maybe one side, it goes really easily. And the other side, not so well. So that’s going to set up the potential for things like say curly act, joint pain.

The sacrum has a particular movement in that rotation that is helped and supported by the guy wires of the parapharmacy and sacred or tumors. That’s going to prevent the sacrum from just being locked to that innominate bone movement. And it’s going to create this nutation and counter nutation motion this swaying and nodding of the sacrum.

And that’s what kind of creates the sacred joint movement. It’s a very small movement, but it’s an important movement. So we’re there to help support and guide the sacrum and its movement within that rotary movement of walking and. So it’s very important in the balance and stability and movement of the sacroiliac joint.

Because these are such key structures that holding onto the sacrum and supporting the sacrum and guiding the sacrum, it makes sense to make those part of the treatment. Paraform MIS via treating via the pair of farmers, motor entry point and the sacred tuberous ligament are very key structures that you can just include in treatment for Sacre iliac joint pain, but.

Ways you can use assessment to help determine when they’re going to be most effective manual muscle test postural findings. There’s a test for the sacred tuberous ligament that we use that we help feel for when it’s over bound and preventing and locking the movement. So those can help guide it, but they’re really key structures for this whole dynamic.

So let’s talk about piriformis motor point. This is from from Matt’s book the motor point, you actually having both the sports medicine acupuncture book, but also the Motorpoint index for the location. That point is halfway between you’d be 53 and you’d be 54. That’s how it’s described in the motor point index.

But easier to teach when we’re teaching this motor point for location is to find the PSIS. Let me get the cursor there. Find the borders of the PSIS lower border, upper border medial lateral get right in the middle of the PSIS. That’s going to be one of your points. Next point is going to be where’d my cursor go.

There we go. It’s a little hard to move on this due to, we know we’re due to his and draw a line between middle Brian. Yeah. Do we have a video for this next? It might be easier just to watch that video because the cursor is having a harder. Okay. Yeah, we can do that. Yeah. It’s hard to control the cursor cause it’s a kind of a small window, so yeah.

And it just describes it in the video. So let’s just go for that. Okay. We’ll do so I think it’s the next slide. Yeah,

we’re looking at the lateral side of the hip and identify the piriformis and loader entry. So first let’s go ahead and feel for due to then also for PSI. So we’ll take three fingers. I feel for that PSIS superior Porter, inferior border medial Porter, lateral border. And I just arrived for the middle of that.

PSIS I feel duty. Yeah, from the middle of the PSIS to do too, we’re going to divide that in half. So there’s a line drawn from the middle of the PSIS to due to being the hiatus of the sacrum. Divide that in half on that line. Okay. So then now this point, the halfway point, you’re now going to go perpendicular to the line until you feel the edge of the sacrum from the edge of the sacrum.

We’re now going to follow that line, just continue. One more SU identifying the PSIS inferior border fingers, medial border superior border, and lateral border go right into the middle. Take the other hand to the sacral Cox show injunction, which would be due to the hiatus of the sacred and the PSIS the highest of sacrum.

Divide that in half. There’s going to be a line here. So divide that. From that line now drop perpendicular line paid out till you feel the edge of the sacrum from the edge of the sacrum. Just one more soon out and you’ll then locate the piriformis. Motorpoint approximately one sort away from the lateral border around the sacred.

This was soon.

Next slide. Alright, so you guys, the continuation of that video actually does show the needle going in, but it’s just it’s a perpendicular needle with a three-inch, going into the depth about two inches. For those people that have studied with us before, that this is also the piriformis motor point is an empirical motor point that softens the urinary bladder 10 region.

So it’s really quite useful with a cervicogenic headaches when needling for sacred iliac, joint pain, and dysfunction. So always a good idea to needle bilaterally the period before. When you’re using manual muscle testing, it’s very common to have one piriformis be weak, and then the other one would actually be strong or a locked short position.

So it’s always good idea to be able to needle both piriformis. Brian, you wanna just keep going on the secretary of this ligament or do you want to keep take over.

All right. So in combination, as Brian was talking about earlier is the guy wires for the sacrum would be your sacred tuberous ligament. And also by that a performance, we just covered now with the sacred tuberous ligaments, a very prominent, dense tissue, easy to find just off of do to. So if you divided due to, and the issue of tuberosity in half and did a cross fibers for your cross fibering, where that ligament is, it’s a very.

Ligaments about the size of your pinky. Very dense. However, it does have some flexibility. So when you find some Oscher points within that region, you can see it. The red arrow that’s on the left is going to perpendicular with the sacred tuberous ligament. That’s how you want to palpate it. That’s how you want to needle it.

Usually in the middle sections where you’re going to find some Osher points I’m using an inch and half. You might need three and she knows depending on the size of the person’s bum but it shouldn’t happen to two or two and she will usually go right in that area. Needling that bilateral late is usually a good idea with sacred iliac joint pain as well.

Now there’s going to be another muscle, the next slide part of the pelvic floor being the issue of Cox and GS muscle, the issue of Cox GS Brian, let’s see if we can get the cursor. I know it’s really channel. To do that, that right-hand side, that issue is going to be located under the sacred tuberous ligament.

So you can see the cutaway on the right hand side of the image. And the cutaways, you can see the sacred tuberous ligament and also the sacred spinus ligament and where the pointer is right now is the underlying issue of Cox a G as part of that pelvic floor. So the same way that you would needle the sacred tuberous ligament going right into that dense ligament, if you took a three inch needle and threaded that up underneath the sacred tuberous ligament scraping, basically the.

Of it. The needle would probably be brushing against the sacred spinus ligament as well. The next tissue is going to be an issue of Cox and GS. This is a game changer for sake, really act joint pain. And there’s a number of different reasons why we need them in this muscle as well for the lower ciao complaints.

But for right now, let’s just keep on the sacred iliac joint. You can consider the issue of Cox, of GS as part of the pelvic floor and also Guidewire to help to stabilize. So needling the district Cox, a gas is very safe. However you can see that caution is advised on the left-hand side there. This technique really should be needled by experienced practitioners with excellent knowledge of anatomy.

You need to have really good command of your needle technique and know where the point of the needle is going at all times with this. Inadvertently go too far internal, you could affect internal organs. And that would not be a good idea whatsoever because of the risk of infection. This is a wonderful point to be able to use for just for experienced practitioners only.

All right. What do we have next? We’ve got now the local needling, right? The local needling for the sacroiliac joint pain in the secure sacroiliac joint region has been around for decades. There’s different ways of going about needling it, the way that we teach it in the smack program is to get the upper two thirds of that sacred iliac joint, where mostly where the pain is and divide that into four quarters.

From that PSIS the medial border. You move out just medial, just about once someone may be three quarters of a stone in order to take a finger to press underneath the PSIS, which is the roof of the sacroiliac joint. So that finger is going to go just underneath that. PSIS toward the secretary iliac joint, and you’ll divide that into four different vectors or four different angles.

So it always good to ask the patient does vector. How does that feel? That better be as you move down a little bit, how does that feel? Vector? See, it should move down just a little bit more. How does that feel? And of course, vector D and they’ll tell you let’s see, they’re going to be, what’s common.

It’s usually a and C could be B and D. So whatever those are you go ahead and take your inch and half needle and start threading that underneath the PSIS in the direction of the CIC. Really? Actually, there’s a great local. Technique to be able to use in combination with the other points that we have used, or at least some selection of different points that we’ve have talked about.

Great to be able to combine these needle techniques. After all the needles have been pulled out with the following myofascial release technique. This is something that we teach in our sinew channel myofascial techniques, class. This is also another game-changer to help, to reduce the tension within the tissues of the sacred early actuate and also the glute Maximus.

Brian, do you want to take it away? Now? We have a video for this one. It’s a pretty simple technique. I’ll let the video show it, but it’s, I’m working on the boundaries, the borders and attachment sites at the sacrum. It’s an easy technique just as loosen that a lateral border of the sacrum and help free the sacroiliac joint.

And you can modify it based on somebody in a posterior tilt or an anterior tilt. You can basically. Bring the leg up and you’ll see this in the video. It can like a crawl position to help bring that more anterior tilted pelvis into a posterior tilt and influence it out of that position pretty well.

Or you can move in the other direction for somebody in a posterior tilt to influence that and take it more into an anterior position. We’ll see that in the video.

so we’ll be working on the attachment. So the glute Maximus, especially the sacral attachments and just the spreading and moving softening the attachments along this. Very nice technique. We can adapt the technique to somebody who has a posterior and anterior tilt. This model. We have an anterior tilt, but I’m an exaggerate.

The anterior tilt. You can imagine with that, that it’s going to be much more effective if I move that tissue away from the sacrum. Yes. But also downward and help encourage more posterior. Or they took the pelvis. Conversely, if somebody has posterior tilt your pelvis under. And in that case, if you were working in that same direction, it’s going to encourage them more into a posterior tilt than the RDR.

So it would make more sense to come from a different angle and help lift the tissue to help encourage more anteriority to the pelvis. So we can adapt that general direction, but in both cases are moving the tissue away from the sacrum, either away and down lateral and down or lateral enough. So we’ll start with.

Lateral and downward, is that a little bit at the edge of the table? My side is towards her, so I can gently let my body sink in for them tissue using the elbow. Also a little bit of the proximal hole. Now I go right to the sacral attachments, think perpendicular and then spreads slightly lateral just to distract the tissue away from the sacrum and inferior.

I might have the. Gently and slowly tuck the pelvis under just the small movements, adequate

relax, slightly downward, another area of the tissue and under move, that movement that you’re doing, you can help them talk, but all of us under.

They generally talk under


I’m from instances you might, especially with an anterior tilt, you might add to the technique I put in the patient into sort of a crawl position. And you can see in this position, that’s going to encourage even more of a posterior tilt the pelvis so it can do similar technique. You’re comfortable.

Cellular technique with them in this position. And the position itself is going to encourage more of a posterior tilt

and I might hold a little longer in this particular position.

All right.

We have a QR code here for the new program that just started. We’ve the sports medicine acupuncture has been going on. This is jeez, what cycle is this mat now? 13, 14, but this is a updated version of it where we’ve added significantly to the. So for more information you can access the QR code.

That class has just started. I just actually returned from San Diego two days ago. So I’m still on California time. But that was for not for this, but the class just started this past month for module one module two will be in. You can start at any time, low back hip and pelvis. It’s a really pocket one.

It’s great. Yeah. It’s starting in September.

And Matt, why don’t you talk about this? Sure. Yes. So we are crazy enough to be able to put on a symposium because the field needs it. So ACA sport education we’ve gotten together, we’ve decided that the field really needs to be able to have a sports orthopedic acupuncture type of supposedly. So it’s something that should be happening hopefully every single year.

We’ve got a great speakers. This is going to be coming up in March 30th, April 1st in 2023. I’m here in San Diego. If you want any information there, just go to sew as education.com. So app as is the acronym for the title of the simple. The civic sports and orthopedic acupuncture symposium or so, so as education.com the next slide, I’m not going to get into all these introductions.

You guys can go ahead and check that out. Check that out. That’s also going to be on. So as education.com, theme is going to be mild fascial assessment and treatment. We’ve got some great people here. I can’t wait for this symposium. This is going to be a lot of fun. We also have recordings through loss of OMS.

That’s going to be available. Under the online CE use 75% of the smack program is going to be online, is online. And Brian and I are also working on an acupuncture anatomy series. You see there on the upper left. So as major and quadrant slump, And then if you want, if you like the way our education is, then you know, this get connected, we’ve got Facebook, we’ve got YouTube, our sports acupuncture Facebook page is really quite popular.

That’s a great one. To be able to ask some questions, you get a lot of knowledgeable people that are trying their best to be able to give their experiences with it. It’s a good Facebook feed as for sure. Brian, is there anything you want to add to that? Nope. I think. Okay, so next week, Sam Collins for me here.

Oh, that’s right next week. Sam’s going to be here. That’s awesome. Thank you so much to the American acupuncture council for having us, it’s really wonderful. Brian, it’s always a pleasure to be able to be hanging out with you and talking about medicine. It’s great. Thanks very much. So then we’ll see you next time.

Thanks everybody right. Bye. Bye.


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Occiput-C1 Fixations and Imbalances in the Channels



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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.

Hello everyone. Thank you very much for coming to our presentation. Thank you very much to the American Acupuncture Council for having us. My name is Matt Callison. I’m here with my dear friend and colleague Brian Lau. Thanks for having us. Brian. And I were talking the other day and we were discussing our topic for this particular presentation.

We’ve got the module one presentation coming up for the smack program and it has a lot to do with the T-bar fixations and sacral fixation. How they can contribute to patient’s pain. And this particular one with the occiput and the Atlas is a very important one for acupuncturist to know.

So we wanted to be able to shed some light on this particular fixation and how it can contribute to a number of different injuries. So with without further ado, we’ve got quite a bit to get through. So why don’t we go to the next slide there?

All right. So in the certification program, sports medicine, acupuncture certification program in module one, we look at the role that fatigue and sacral fixations play in the patient’s complaints, including musculoskeletal conditions, but also food. When there’s a table fixations in the thoracic region in this particular presentation.

As I mentioned before, we’re going to introduce the occiput and see one fixation. That’s going to be taking place at the Atlanta occipital. Now this fixation could cause many patient complaints, such as cervicogenic, headaches, muddled, or cloudy thinking neck pain. And, for that matter also it can contribute to job pain, low back pain, and a very interesting so as strain because of the association that this fixation has with bilateral.

So as is that we’re going to touch upon here and just a little bit. So why don’t we get started about what is of the tibial fixation with the next slide? So if a fixation complex is going to be the compression and torquing of one vertebra on top of the other and the locking of the vertebrae together, creating creates a hype boat, mobile, it just fixate those two vertebraes or even three vertebraes that lock together.

Have a lack of mobility within that segment of the spine, which is going to be further restricted with Maya. And also ligamentous adaptations, holding that fixation in place. Now the Fossette choice can be locked into a compression into rotation. It can be tilted to the left and right sides in the sports medicine acupuncture program.

We also discuss how the thoracic vertebrae can be stuck in flat. And also into extension. So if you can take a look here is as if the vertebrae, when it has a compression and torquing, it just locks one on top of the other. And it may not actually look like it’s out of alignment. Many times the vertebraes actually feel like they’re in place, but they end up.

Moving very well. They get stuck with one another that causes a barren motion within the region. And the more chronic that fixation is going to be in place, it starts to then affect the spinal nerves itself. So acupuncture, manual techniques work extremely well to be able to open up these fixations and get more energy to the Zong Fu and also the innervated tissue.

So skeletal system. So what’s on, then let’s go right into that Oxford C1 here. All right. So we’re going to focus on this particular fixation. We’re going to call it the joint from now on just cause it’s a lot easier than saying atlanto occipital joint from the entire presentation. So the skull or the head, it sits right on the superior articular Fossette via the occipital condyles.

Brian, would you be able to show. Where those condos are on the skull and the image on the right. You can see those blue images there that’s on that skull. So then those particular articular areas are going to then fit right into the articulate areas of the Atlas. And you can see there in the cost services, superior articular surface of the lateral mass.

So it’s really quite interesting. The headsets, basically balancing on this very small area on that Atlas. So let’s go to the next slide then.

Now this joint is a small range of motion. That’s going to be approximately 10 to 15 degrees of flection and extension. So that’s going to be the movement of basically nodding. Yes. So it’s the very small movement of 10 to 15 degrees of flection and extension of nodding. Yes. Which is a difference between.

Full cervical flection and full cervical extension. It’s just that small little movement of nodding. Yes. Now some research researchers are going to agree that there’s also a little bit of movement in lateral flection or a lateral tilt of the occiput on the Atlas. And we’re going to discuss that a little bit there too.

When you start to, when we get into the assessment. Now the suboccipital muscles that are located deep to gallbladder 20, and also the semispinalis capitis muscle, especially the superior fibers. They’re going to be primarily responsible for this action. So those are going to be two muscles that we’re going to be definitely treating and linking that with their senior channels.

Let’s go to the next slide. I want to discuss a little bit about how the angle of post. So on the left, you see an image of the four suboccipital muscles that surround Cobb that are 20. So you can see the angle or the line of pull of the suboccipital muscles. They’re going to go ahead and. Tilt the cap or tilt the occiput into extension now on the right, you can see those upper fibers of the semispinalis capitas.

Those will also be tilting the cap or the occiput into extension. So let’s go through that language again. You’ve got cervical extension. But then with that small little movement in the AAO joint, it is capital extension or a little bit of a tilt. If you take your fingers and put them rod over gallbladder 20 on yourself.

And once you’re there, just look to the ceiling, you’re going to have a small little movement of capital extension. So what you’re feeling then is these upper fibers starting to contract. And holding that area in place. So therefore, if you have a posture, let’s go to the next slide there. Brian, we could, if you have a posture where the person’s going to be stuck in capital extension, for example, this image on the far right.

Where the head is basically stuck in the end range of yes or capital extension. Many of our patients who have cervicogenic headaches are clouded thinking low back pain, neck pain, have this particular posture, which on the upper right, that had, is stuck in capital extension. So therefore the AOJ.

Is locked has, and then the soft tissue around that AOL joint actually starts to become adhered and locking that position. But you also have people that we have the end range of. Yes. So you can see on the lower right. That person is going to be more into a flection of that capital. Now that can also be a fixation of the joint and also have muscle and soft tissue balances as well.

So let’s talk about those soft tissue balances, because we’re going to be looking at that for treating with acupuncture. Now, all the tipo fixations, including the fixation of this AOL. It’s going to happen, have the mild fascia imbalances between left and right sides of this, especially apparent with the suboccipital and the semispinalis spinoffs muscles.

So often there’s going to be a lock short muscles, which we can be able to label and treat as an excess on one side of the joint, which is really holding on locking that joint. And then on the opposite side, there’ll be locked long muscles, which we can categorize. As deficient and they’re inhibited their weekend, which is going to predicate needle technique that we’re going to be talking about here in just a little bit.

And that’d be on the opposite side of the choice. Now, this image on the right, this is going to be of the thoracic spine. So you can see there’s going to be locked short Xs on one side and lengthened and deficient on the. For this particular conversation, we’re going to be looking at the upper fibers of the semispinalis capitas and also the suboccipital muscles that we can treat with and also specific needle technique for gallbladder 21 side will be excess and the other side will be deficient.

And this is something that you can often feel just with palpation. And we’ve got a video of this. We can be able to show you here in just a little. So not only are these a local needles that we’re going to be using the extra earn near vessels of small intestine three, and you’ll be 60 to work exception.

To build a help with releasing that occiput and Atlas fixation as well, there’s going to be other muscles that we honestly want to look at and associated channels that we want to look at. That could be actually fixing. The a O joint. And I think we can hand it right over to Brian. So you can get into that.

Brian, are you ready?

Okay I don’t know, Matt, did you mention that inclusion of ? Yeah. At the very end, the extra investors can do my job. Yeah. So we’ll come back to that in a second. Looking at the primary channels associated with it. We have really a combination between the urinary bladder and the small intestine that channel sinew channels.

We’ll go with this new channels. Just to get a quick overview, we’re not going to go through the whole channel for this lecture, but I have it listed here in terms of the myofascial structures that are part of the UV new channel. It’s primarily what you’d expect, running up the posterior part of the body, following the urinary bladder.

But let’s take note of these little branches that sometimes we forget about, if we don’t look at this, the new channels that branch from the primary channel going up and down the back and then wrap around the front and then wrap up to the shoulder. So we’ll get this anatomy in a second, but we can just briefly see this Leticia, this door sigh wrapping around to the PEX and then linking for this lecture.

What’s really important is the Sternocleido mask. And then we have another branch that comes off of this region also and links with the upper trapezius. So that’s one thing. And then the last thing to look at is this binding region that we’ve already discussed at this suboccipital region. So let’s start with the suboccipitals Matt’s already talked about them.

This image is nice because we have a slightly different angle and we can get an appreciation, not only for. The rectus capitis posterior major and minor and the angle they take, but how sharp of an angle. Then we miss out on, when we look at those images that are going straight from the back, we lose track of how much of angle these oblique capitus muscles have.

So that’s nice to see from a slightly different. But collectively, these are going to have a really big influence over the balance of the suboccipital joint and seeing the angle, these muscles take, you can see how imbalances between one side and the next might not just have that extension aspect that Matt’s talking about, but also that ability to sorta have the head not sit on quite straight.

Really key muscles to suboccipitals for the balance of the, of this Atlanta occipital. But also really the balance of the whole urinary bladder send channel. And the tone of that whole urinary bladder send you a channel included also would be the cervical extensors semispinalis capitas.

But then if we go to the the branches that were discussed off the urinary bladder channel, oh, we have the lats into the pecs and then creating a myofascial plane with the sternocleidomastoid is an interesting muscle it’s part of multiple sinew channels. Definitely part of the stomach.

But it has this linkage with the urinary bladder channel. And I’ll give you one indication where you might’ve seen something related to this is when you’ve learned about points and learned about urinary bladder 60. That, that is a common point for headaches. But the description, if you go back and just read the commentary saying Deadman, the description of that often talks about young rising, excess, young, rising up the.

Urinary bladder channel. And the way I interpret that is that tension that rises up to back when people have a lot of St Liberty’s stagnation, a lot of rising liver, young, rising, but it often rises up that urinary bladder channel and everything tenses up, SCM, upper traps, the cervical muscles, the back muscles.

It’s that raising of the shoulders that happens in that scrunching of the neck that happens. So it’s a very typical stress response and these muscles are very involved with. But they’re also because of their mechanical attachments at the mastoid process for the SCM and then the upper traps going all the way up to the EOP, they can also contribute to that capital extension and that discrepancy from left to right.

So their accessory muscles, their muscles, we can also consider as part of a treatment when we’re working with fixations at this region and things that are associated with that. Cervicogenic, headache, cervicogenic. Okay, quickly going through the small intestine, send your channel. We have multiple structures.

We’re not going to get into them all today, but levator scapula is a big one. And that binding region that happens at the upper cervical region, look at an anatomy image of that. Levator scapula actually attaches to C1 through C4 transfers processes. So it has an influence on much of that upper cervical spine, but especially that C1 transverse process.

Be a big contributor to that tilting of the head from side to side, some of the discrepancy in terms of how that’s going to balance, not just a position from a capital extension, but that maybe shortening and raising the shoulders or on one side. And that discrepancy from side to side. So levator scapula is another one that can be a player in this and can be And accessory muscle treating the suboccipitals important.

We’re going to be looking at a technique at gallbladder 20 and semispinalis capitas. Did you be 10, but don’t forget about levator. Scapulae it’s a good one to consider in this whole list. So collectively these two channels are going to meet and have a binding region at that upper cervical spine Atlanta occipital joint region, the suboccipital region.

And collectively are going to be a part of that whole balance of the AAO joint. So here’s a nice image showing that upper fibers of the levator scapula meeting at the transfers per process, and then sharing, communicating mechanical information with the oblique capitus superior and inferior muscles, which are two of the muscles of the suboccipital.

Triangle two of the suboccipital muscles. So they can really work together in terms of balancing, but also become dysfunctional together. All right.

Kind of piety to look at some images. Okay. Yeah, Brian. So let’s get into these and talk about these. I think this is a nice segue into that discussion of the upper trapezius and levator scap as well. So the image on the left, you can see that she’s got a bit of a lateral tilt of her head onto the AOL joint.

You can see how that left ear is slightly lower than right. And this is something also that you see with patients, let’s say, for example, that you’re sitting on a stool and the patient’s sitting on the table right in front of you. Have you ever noticed that it looks like their head’s just not quite on straight.

So there has slightly, just slightly tilted. This is something that you would see on the left and I’ll guarantee you 99 out of a hundred. If you go back and you palpated the gallbladder 20 and the bladder 10. Once I will feel very access and the other side will feel very deficient. Hence something that we’re going to discuss here next is that person will also have bilateral.

So as weakness. So we’ll talk about that here on the next slide, but for right now that image on the left, you can see that they’ve got a little bit that lateral tilt, same thing with the image on the right, this gentleman. You can see his tilt on the right to the levator scapula is going to be in a locked, short position on that right-hand side.

And he most likely has an Oxford C1 fixation as well. So these people could have cervicogenic headaches or any of those aforementioned signs and symptoms that we had. Brian, do you want to talk about the capital extension there on the remaining two? Yeah, I would agree that, the big structures to consider on these ones that Matt talked about would be the suboccipital muscles are so influential on the tone, but it seems to me without having any other information on these patients, you know what they’re coming in with, et cetera, it seems to me like levator scapula would be indicated for those.

Whereas these pictures on the right, I might change my tune if I saw them from the back, but at least from the view, from the side and the success of capitalization, The suboccipitals are going to be involved with that, but I would also be looking at the SCM for both of these these patients.

And it could, it’s going to be the case at one side, it’s going to be shorter and that’s going to contribute to that tilting of the head not being quite on straight. So it would be an accessory muscle to consider along with the suboccipitals and semispinalis capitas, especially if they’re coming in with headaches and it seemed like the SCM was a component of that.

Maybe referring into the frontal region or deep into the occiput STM would likely be involved with that. Maybe even upper traps, all upper traps are in a position where they’re pulled forward. So we’ll be including in this discussion, after looking at some local needle technique, we’ll be including a myofascial technique that you can refer back to those two, right images when we’re talking about that myofascial technique.

And that would be the type of patient that, that the technique we’re going to show with. Yeah, that’s a good point. I would suspect the image on the far left that her left upper fibers of the SCM would also be really quite locked short. The same with the gentlemen on the money. I would think that his SCM on the right.

Yeah, that’s great. Holding this fixation in place. Now you guys, we are zeroing in on the AAO joint for those people that might be looking at the posture on the left images there. Yeah, of course, the elevated ilium and the side bands at the spine and such all of that would have to be addressed.

Which we do in the different modules in the smack program. But right now we’re just zeroing in. Joy joint, how important it is to observe and treat it for different types of signs and symptoms and pain patterns. All right. So the next slide is one is an assessment from applied kinesiology.

So this is George Goodheart’s work, but I’m not exactly sure if it came from him or maybe John PHY in touch for health. I’m not exactly sure which one, but yet with an occiput Atlas fixation at the joint, it will create bilateral. So as weakness. So therefore, if somebody has this muscle that’s in hidden.

And therefore they’re going out and doing extra curricular activity, hiking, doing something above and beyond. You could see how that muscle would be struggling and eventually could actually strengthen. So when somebody has a hip flexor strain, it’s affecting that. So as it’s always a good idea to go up and look at the joint now, since the so as is not going to be stabilizing that lumbar spine as well, being inhibited from a fixation at that AOA joint, it can also create low back.

This is a really great assessment looking at the so as, and then once you correct the AOL joint with acupuncture, and also we’re going to be showing you a little bit of a manual technique that you can use, and also a mild fascia release technique on the upper trapezius that’s affected. You would then go back and check the so as for strength and if it is not bilateral, so as weakness anymore.

So then therefore you’ve done your job with some patients. It might be, then you need lateral weakness, meaning it’s just one. So as that’s weak, that means that the AAO joint is still corrected. Remember with the fixation it’s bilateral. If bilateral weakness turns into unilateral weakness, it then becomes more of a segmental problem or just a localized problem, which we could go ahead and treat the Watteau GS of the high T 12 down to about as well as GB 27 on that particular side in order to be able to turn that.

So as right back on. Cool. All right. So what do we got next here? I will say one quick thing about that. It seems odd, right? The, so as in the occiput C1, there’s not a direct innovation. It’s not like the so has, is getting its innovation from C1. But if you wanted to just look up something called the ocular pelvic reflex it talks about the relationship between the eyes, which have a strong relationship with the suboccipital muscles in terms of turning the head and following eye movement and the pelvic position and really the lower spine position.

So it’s probably a regional. Component that’s communicating between eye movement and stabilization of the spine. And maybe that gets turned off when there’s an occupancy one fixation theory, but it’s really more clinical observation than it is a direct anatomy thing. But that’s what I think it works according to those principles, but that’s something that you teach and demonstrate in the senior channel class.

And it’s really quite interesting. So as fire, when the eyes left or right with that. So that relationship, thanks for bringing that, Brian. That’s good. That’s where it’s like, if there’s somebody seated and you press into the abdomen and you can touch the, so as you often feel that firing slightly, when people look up to the coroner, which suboccipitals will start the fire and you can feel that tone change, like I got my eyes closed and be like, okay, you’re moved.

You moved sometimes you don’t feel it. Maybe those people, you don’t feel it as well. Or you only feel that. Sometimes it’s quite prominent sometimes not so prominent. Maybe the people it’s not really prominent on are the ones with the occiput C1, fixation but you can definitely feel this how, as I’m communicating with that small little eye movement, that’s happening in this small head movement that occurs from that.

All right. Cool. Next.

All right. So when you’re feeling the gallbladder 20 suboccipital region and bladder 10 left versus right. When someone does have an AOL fixation, one side definitely feels more pliable, more deficient. The other side is harder tissue. It’s more dense tissue. It’s usually a bit more painful to palpate.

So with the excess side, what you could do is to go ahead and palpate gallbladder 20, but in three different directions. So from gallbladder 20, if you angle it toward the contralateral gallbladder one, you’re going to be affecting the rectus. Capitis posterior minor and major. If you take your finger from gallbladder 20 and you angle it toward the ipsilateral gall bladder, one is going to be affecting the oblique capita superior.

And then from gallbladder 20, if you angle toward rent 24, you’re putting pressure into the Oakley capitus inferior. So whichever one is actually the most tender or Maven creates a headache is the angle that you want to actually needle from gallbladder 20. If you need a one to 1.1, five inches in any of these directions, it’s going to be totally.

It’s, it is safe to be able to do that. The only one that you want to make sure that you’re definitely kneeling toward the ipsilateral gallbladder. One from gallbladder 22 effectively. Capita superior is one inch to one to 1.5 inches. That’s not an inch and a half. It’s one-to-one. Five suggestible over an inch.

Needling that direction will be very safe. If you do go towards maybe the ear, maybe you’re going too fast. You’re going to be very close to the table, ardor in it’s unprotected region. So we want to make sure that we’re not angling towards or also the ear in that particular case. And then bladder 10, if we can go to the next slide there, which I think it just continues to discuss as go to the next slide.

Yeah, I try to maybe it’s try it again. It’s just stop. Okay. Nope. Here we go. All right. So there we go. So then bladder 10 is going to be the key point for the semispinalis capitas. Now, as we know the way that we were taught as bladder 10 is going to be level with do 15 and gallbladder 20 is level with do 16.

For the last this, so this particular image is from the motor point index that was published and 2000, the year 2000 news I believe was published. And so the information has changed. We have found the actual motor entry point for the semispinalis capitas, the upper fibers at least to be level with deuce 16.

So that means that we’re putting bladder. Level with gallbladder 20 and frankly from my own clinical experience, I think Brian can agree with this as well. Is that treating the upper or the modified bladder 10 level with do 16 and also level with cobbler 20, you get a lot more cheese sensation than you do.

When it’s level with the do 15, but don’t believe me, try that yourself. You guys make sure that you’re needling one soon perpendicular to the table or to the floor going in level with popular 20 and do 16 compared to level with do 15. I think you’ll find, you’ll get a lot more cheese sensation at that particular point.

So the next side is actually showing another view. Semispinalis capitas. You can see how it’s just 20. We’ve modified this and we’re putting it level with gallbladder 20. Everybody got a lot more cheat that way. All right. So the video you’re about to see is going to be needling bladder 10, one inch perpendicular to the floor on one side will be the excess side.

And then on the other side, we’ll end up. Gallbladder 20. So it’s not necessarily going into the three different directions. We’re just needle gallbladder 20 on this particular time, which you can do. But a good idea on the excess side is to palpate those three directions affect that suboccipital triangle.

I think you’ll get better success rate for releasing the AAO joint. This particular video, the audio didn’t turn out very well. So I’m going to go ahead and narrate this as it goes. So Brian, whenever you’re ready, I’m ready.

all right. So we’re going to be looking at, there’s do 16 right there. This is going to be for your a oh, joint fixation do 16. So I’m going to go ahead and palpate on the right-hand side and that feels. Really quite dense there at bladder 10, which we know is going to be about 1.3 soon lateral, that’s going to be the upper trapezius that I’m working my finger through to get to the deeper layer, which is sound mispronounced.

Moving lateral going into gallbladder 20 and feeling the density of gallbladder 20. Now going over to the left-hand side, bladder, 10 more pliable, softer tissue, easier to get in gallbladder 20 more pliable, soft tissue. So there’ll be excess on the right perpendicular to the table of floor going in at bladder.

One inch, you could even go in 1.2, five inches here. I do recommend a deeper needle technique at this particular point to get into that semispinalis capitas and a gallbladder 20 on the right. We’re going to needle just toward the tip of the nose in this case at gallbladder 20. But this would be the area that we could go ahead and pop it to three different directions for the suboccipital triangle in this particular video.

no, on the left-hand side, we want to reinforce this. So this is going to be a shallow needle technique going right into that upper trapezius going in just about a quarter of an inch. No more than a half an inch in that area. A very light CISA station compared to the opposite side, and then a gallbladder 20, the same thing going toward the tip of the nose.

Very light needle sensation here. More of a reinforcing needle technique from clinical experience going in and really wailing on these areas are getting a lot of cheat on areas that are deficient will actually make the person a little bit worse.

So deeper on the right-hand side, more of a reducing needle technique, more superficial on the left hand side, more of a reinforcing needle technique.

This is a video is on our YouTube channel. By the way, I know sometimes streaming the, you can get a little choppy, but if you want it to go back and look at it again, that’s on our channel sports medicine, acute.

All right. This was a really great muscle energy technique for the Suboxone suboccipital triangle muscles. I believe it was developed from Phillip Greenman in the 1940s. He’s a very famous osteopath that has quite a few different books out. It’s a great technique to build. Right after the needling and after the mile fascia work as well you can even use this type of a myofascial technique.

When there isn’t an a O fixation, it just helps to really relax the patient quite a bit. So this is a step-by-step you can see there’s these different slides. That’ll be in your notes here or in this recording here that you guys can be able to check out. It’s basically gently pulling the person’s head into tracks.

And they’re going to look back at you to help to stimulate those suboccipital muscles. And then once they relax, you’re then going to go ahead and just eat a long gait, the head and traction a little bit further. So it is a muscle energy technique where they contract against you. You prevent any kind of movement for about the count of six.

They relax, and then you pull the head chest. Farther. So you’re helping to realign the occiput onto the Atlas. This again, it’s just a, it’s a fantastic mobilization technique.

Here’s the other rest of the instructions. So like Matt said, if you go back and access this recording and you’ll have this, we also have this, I believe in module. Is it module one? Senior channel class or is that going to be module four? It might be module four senior channel class we actually have. Oh yeah.

On a, not a knowledge. Yeah, that’s correct. It’s module four. Okay. All right. So one more technique. And this one will highlight that branch of the urinary bladder send new channel, that’s connecting with the upper traps and the SCM many ways it’s working with the foster. Of that that, that surrounds both the upper traps and the SCM, which are embryologically one muscle, but splits.

So they really have the same fascial compartment, same fascial bag. And this is just taking the fascia and bringing it back. This video has a lot of different steps. We’re going to not watch the whole thing. We’re going to watch just a portion of it. That’s relevant to this discussion. So I’m gonna kinda go a little ways into the video.

Let’s see, that might not be able to, yeah, there we go. Okay.

And same thing. I’m going to be narrating this just for sound aspects. So we’re going to use it as a loose fist and that loose Fest is going to place right on the upper trapezius on that border of the upper trapezius. So we want to put a lot of pressure so much. It’s just enough to get a hook into the two.

And then we’re going to bring the tissue down towards the table back, really bringing the tissue back while the patient rotates their head to the opposite side. It’s like when I learned this technique, I think we use the description of a velvet glove, which kind of is a nice way to think about it.

Do you want a soft pressure? Doesn’t mean it’s not deep. It’s just not pushing into the tissue deep. The next step we can follow up that same fascial compartment up through the. But I’m highlighting is I don’t want to go in front of the SCM with my fist. I want it to be on the SCM. I don’t want to go in front of that border.

Same thing I put in just enough pressure to get ahold of the fascia. If PHP patients are hyperextended like that, I want to use that pull down towards the table to help straighten and elongate the back of the neck. I might even have them bring the chin and a little. And then they rotate while I’m bringing that whole fascial layer back to the almost to the spine as processes as far back as I can reach it while they’re rotating.

So it’s not a lot of pressure into the neck. It’s more about hooking that superficial layer of the cervical fascia and bringing it back. And then I can have them do it again with another pass. When I’m showing there is when they turn, I want them to rotate on an axis and not bend the head to the side.

It’s almost like they have an access or a pole going through the spine that stays straight. So it’s just a very, they should almost feel their hair scraping along the table as they do it. And I’m bringing that whole superficial cervical fascia. So it’s a nice technique to help decompress the back of the neck and elongate that fascia that’s associated with many things, but the occiput C1 area for this lecture let’s create.

So Brian, we’ve got the proverbial hook coming to pull us off the stage right now. We have. Let’s get through this within the next 30 seconds or so. So the new Nepro is forced Mestinon department certification program starting in San Diego here in July. There is the QR code. We’re happy to answer any questions that you guys may have.

And then also in March, end of March of next year, we have a, so as events, the Pacific sports and orthopedic or acupuncture symposium, that is the acronym. So as. And this is going to be based on myofascial pain. We’ve got incredible speakers that are coming, including Dr. Antonio Stecco Dr. Roberta Pratt Rebecca Pratt, our Nielsen, Brian Lau.

I will be there and Bensky, we’ve got a whole, a great list of people that are coming to present. There’s the QR code for? We’ve got a lot of online recordings as well, that we can be able to further your continuing education. That’s going to be through Lhasa OMS here in the United States, Eastern currency in Canada.

And there’s also distributors international for that. You can also follow us. We’ve got YouTube and Facebook and Instagram and Brian, you want to give a shout out for your movement therapy? We’ve been putting together a lot of description of movement associated with the channel sinews. So it’s a not evaluate calisthenics and Qigong Tai Chi, various things, but it’s not about what the exercises are.

It’s really looking at it more from a channel perspective, how you train those channels, wake up those channels and incorporate like really efficient movement, but those channels, and then you can start strengthening. So Jim gen channel sinews movement training a QR code, or you can just do a search for Jim gen movement training, all the other stuff.

We mentioned the sports medicine acupuncture. If you go on YouTube and you don’t have to code with you, just do a search for sports medicine, acupuncture for any of those are fantastic. That’s it. Yeah. Hopefully this was a useful for you. There was some pearls for you guys to be able to crab and help out some patients.

Cause that really is the bottom line. We want to be able to help other people. If you have any questions whatsoever, please reach out to us. We’re happy to be able to answer those questions. Next week. Cholon Moya, who’s going to be coming. I was really happy to be able to hear that she’s actually going to be presenting chose a fantastic speaker and an incredible practitioner.

She’s one of Kiko, Kiku Matsumoto is top students. She took the sports medicine, acupuncture certification. Twice and she’s blending the two things together and she’s just a ball to listen to. She is just a walking dictionary, amazing Tsao-Lin Moy for next week. Thank you very much, everybody. Thank you so much for the American Acupuncture Council.

Happiness. Brian’s always great to hang out with you, buddy, and we’ll see you again soon.


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A Proprioceptive Acupuncture Technique at Extrapoint Chonggu



Click here to download the transcript.

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

Hello, everyone. Thank you very much for attending our American Acupuncture Council webinar presentation. My name is Matt Callison. I am here with my esteem colleague, Brian Lau. I thank you. That. We’ve got a really fun topic today. It’s a proprioception at Extra Point Chonggu. Brian, can we go ahead and go to that first hetero slide?

Let’s get this slide.

So we’re going to be discussing is a needle technique for Extra Point, Chonggu, which is actually just one portion of a treatment for a upper cross syndrome posture. The upper cross syndrome posture, which we’re going to be elaborating here in just a little bit can lead to a multitude of different injuries.

And today is very short presentation. We’re gonna be. We’re going to be lecturing about how to actually needle this particular point and stimulate these lower cervical area that usually has a proprioceptive deficiency from this particular posture of a Ford, had an upper cross syndrome. So let’s go ahead and I think jump right into upper cross syndrome so we can discuss that.

So this term upper cross syndrome was coined by Vladimir Yonda close to 40 years ago. He is an osteopath in specializing in rehabilitative medicine, and he coined this term basically from looking at his patients that have a very unique type of posture that we actually see in our practice. And you as well, commonly, I would say every single.

It is looking at a forward head posture of a plumb line, increased thoracic kyphosis. So you can see that upper back really starting to curve without forward head. That’s going to lead to a number of different postural imbalances and agonist antagonist. So Bladimir, Yonda when he saw this, he actually coined this term is looking at it as a cross.

So you can see that the pectorals in purple here, the pectorals are going to be in a locked short position. Pulling on that humerus, making the humerus internally, rotate, collapsing the chest. Now going through that, you can see the next purple would be the neck extensors. Now those neck extensors are locked short, but they’re actually with through evolution, looking at portions of these neck, extension extensors are going to be locked short, and some of them will actually be locked long.

The longer part let’s say the lower cervical aspect of. That posture you’ll see that the neck extensors would be more in a lengthened position because of the forward head. Then the upper cervical region, the neck extensors actually be in a shortened position. So a little bit more on that with the next slide and just a little.

So that’s the purple aspect. Those are your locked short muscles. Now you’re locked long muscles will be, if you can see where the increase thoracic kyphosis would be your rhomboids, your middle trapezius, your lower trapezius, those muscles be very weak, allowing scapular, protraction, as well as that increased thoracic kyphosis.

Now, if we look on the Antar aspect of the body, you see the neck flexors. So it’s the deep neck flexors in particular that are going to be. Locked long or inhibited posture. If we look at the sternocleidomastoid, which will also be a neck flexor, that’d be more in a locked short position. So you have your general upper cross syndrome, but there’s also going to be just some variabilities within those muscle groups that will be locked long and locked.

So the point, the takeaway here is to look at as today’s presentation is that lower cervical region will be usually proprioceptive deficient in that forward head posture. It’s a lengthened area. So we’re going to use an acupuncture needle to try to reestablish some of that proprioception combined with an exercise to bring that forward, head back to neutral position.

Let’s look at a couple of models here. Let’s go to the next slide. There’ll be. So zeroing in on this upper cross syndrome or a common posture that lengthens the lower cervical region. So you can see how the head is really quite forward, but then it’s going to compress the tissues of the upper cervical region.

So if you could take two fingers and just put them right there at gallbladder 20, and once you have that, just simply start to look toward the ceiling. You might tilt the head back just a little bit. That’s called Qapital extension. So that’s different than cervical extension. Cervical extension is when you have all of the cervicals moving capital extension.

When you had your fingers there, gallbladder 20, you might have flipped those muscles. Just move just a little bit. When you’re looking up, that’s going to be looking at the upper neck extensors, especially the suboccipital triangle. And when those muscles get really quite taut that can lead to a number of different types of headaches, nerve and syndrome.

So the third occipital nerve, the greater occipital nerve, the suboccipital. Lots of different injuries that can occur from this particular posture. So you can see what the, both these models, if they got increased thoracic kyphosis, the head goes forward as a compensation for that forward head. The person’s just going to tilt their heads slightly upwards so they can see the horizon.

And that’s going to cause that capital extension and a number of different injuries. Now Brian’s going to go ahead and show a video that he did of himself to explain this a little bit more. Brian, do you want to take that away?

Yeah, sure. Videos just showing the relationship between the shoulder girdle movement, the scapular movement and the.

So there’s a ton of sinew channels that act on the position of the scapula and the movement of the scapula, not a ton, but there’s several. And we can go through them, but really, I just wanted to highlight in this video, how the spinal movement links with those scapular movements and the tie into what we’re seeing in these images here, before we go into the video, these models, as you see, have increased thoracic.

So their spine in that thoracic region and the upper, or excuse me, lower cervical region. The spine is stuck in flection. So we’re going to look at the relationship between the flection and extension components of the spine and how that relates to the scapular movement. Pretty short video. It’s an Instagram video.

It’s going to be on our Instagram channel or Instagram page. So it’s a minute long Instagram. Doesn’t give you a lot of time for these things, but it’s very brief. So let’s give it a look at. Okay there. We’re going to look at the relationship of the spine to the shoulder blade movement using this resistance band.

So as I go from protraction retraction, that movement likes to occur. As the spine comes out of flection, the cervical spine starts drying back and pact traction. That the spine will want to go into election retract. Buying comes out of flection, cervical spine throughout the back. Many people have a forward head posture.

So the spinal movements not coordinating with the entire movement of the body that sets them up for injury in the cervical spine angle, her girdle potential job problems, headaches. So they need to learn how to get rod, that surgical site back to encourage the entire.

all right. I’m gonna go back here for a second, a fun thing about filming things is you notice aspects that you wouldn’t notice otherwise. I had my mic here on the shirt. So when my head goes forward, of course, I go a little ways away from the. But I was acutely aware of how different my voice was and I was strained.

My voice became when I went into that forward head posture. So that was quite interesting, but yeah, just also noticing the the difference tension in the extensor suboccipital reason and how that sets you up for a whole host of different potential problems. But with that video you might notice the scapular movement and how much activity there, there occurs in the rhomboids lower trap.

It was mentioning those structures that are pulling the scapula back and retraction. So that can get us thinking about ways of treating this beyond just the technique we’re going to be highlighting. And I think Matt’s going to get into that on the next slide here. Okay. Okay. Thanks, Brian. That was good.

So just as an overview, what we’re looking at is just a portion of that upper cross syndrome, the increase thoracic kyphosis, which are going to, it’s going to have a lock long and weakened and. Rhomboids middle trapezius, lower trapezius. The head is going to be forward, which is going to be a lengthening of those lower cervical vertebra.

Then you have a shortening of the upper cervical tissues. So in this image, the head is neutral. Now, if we look at, if we can be able to take that head and just move it forward, we can start to see a little bit more of how. Lower cervical vertebrae going forward and how it would be great if there was a way for us to actually pull that lower segment of the cervical vertebra and all of the tissues that are highly appropriate, receptive your deep paraspinal muscles, your supraspinous ligament, your interspinous ligament, and encourage that to be able to come back while the person’s.

He is trying to strengthen the rhomboids, the lower trapezius, the middle trapezius, and add proprioception add sheet to that particular part of the. So I would say probably about 15 years ago. So I started playing around with this needle technique with the exercise and the combination is pretty profound.

And this is the reason why we wanted to share that with you today. Again, the takeaway here is this is one portion of the needle techniques or the points that we’d be using and the exercises that we’ll be using for upper cross syndrome. And Ford had an increased thoracic hypothesis, but it is a Pearl.

This is a big point. This is a great technique to be able to use. So it’s underneath the C6 vertebra. You’re inserting the needle through the skin, through the superficial fascia, the adipose tissue, and then the first tissue of resistance that you’ll feel would be the supraspinous ligament. Now, once you go through that, supraspinous ligament than the.

Long and wide interspinous ligament is going to be the next issue of resistance that you’ll feel with that acupuncture needle on most people, it’d be probably about, just about a one inch needle insertion, which is completely safe. You’re very far away from the spinal cord. Some patients when they’re laying on the table prone, it’s difficult to get to that C6 area because maybe they have a lot of tissue in the area or are just increase extension for some patients.

Some practitioners like to lower the head. To be able to open up that neck personally, as a patient. I don’t care for that very much. Having my head drop down a little bit. Doesn’t feel very good to me. Usually what I’ll do for patients is just to put a pillow underneath the chest and that’ll open up the neck.

So as a practitioner, just take your finger or two fingers and start feeling underneath that C6 vertebra separating the tissue so you can get an idea. On how to be able to put that needle up underneath the spinus process of C6 and get through those a formation, a four mentioned tissues. Once you get into that interspinous ligament, which is about, like I said, about an inch deep propagate Xi, and it may take a while actually for that patient to get to you because of the lack of appropriate.

Now, remember this is also going to be combined with other points for example, the wrong point motor point, the middle trapezius rotor point, the lower trapezius motor point you could use GB 20. There’s a number of different points that we can use depending on the patient’s case. So once you’re able to get an established Che at Extra Point Chonggu, then what we’ll do.

We’ll wrap the tissue around the needle by twisting the needle in one direction until the needle starts to get stuck. Once it’s stuck, then we’re gently going to start to pull that tissue back posterior where alongs. So we want that tissue to go back it’s lengthened because of the forward head position.

We want that tissue to go back at the same time as the. Doing an exercise, the prone and neck protraction exercise. So let’s go to the next slide there. Be

all right. So as that person is elongating that lower aspect of the cervical spine, bringing him back into extension, you’re pulling up with the needle so they can start to get an understanding of raising that lower cervical part of their body up toward the. They’re going to slowly just start to tuck their chin a little bit.

So that starts to get rid of some of that capital extension. And they set up this exercise by lowering and squeezing the scapulas together. Then engaging the middle trapezius, the rhomboids and the lower trapezius. So this is an exercise that you would do after all of the needles have been taken out with the exception of Extra Point, Chonggu.

Brian, is there anything that you wanted to add to that before we jump right into the video to show them. Yeah, you’ll you’ll see this a little bit on the video coming up that the tendency for the people who really need this technique in particular, the tendency, when people start to lift their chest by engaging the rhomboids middle lower traps they’re really tied into the idea, not even consciously, but just their body’s kind of stuck in it in a particular position to where they want to arch their neck.

And exaggerate the neck position that we’re trying to get them out of. It’s just something that’s very difficult for people who really need this technique. It’s difficult for them to find that movement where they both retract the scapula and bring the, draw the cervical spine back and lengthen that posterior portion of the cervical spine, especially the upper cervicals.

And now of course, the technique is designed to help with that, to help give them a signal and encourage them. But you have to look at the. And make sure that they’re not going further into capital extension, like trying to lift a lift up and going further into capital extension. So you have to coach them.

Now, the good news is the technique helps give a little cue and coach them at the same time, but sometimes verbally coaching is necessary. And you’ll see an example of that coming up. Yeah, that’s a really good point. A lot of people will go into that capital extension just because they’re used to doing that.

So thanks for saying that, Brian, by coaching the person, just to tuck their chin a little bit, that helps with it. Now, this technique also is useful. If you didn’t want to needle it by just pinching the tissue of Chong GU and lifting that. But it’s not as successful in my own opinion as actually using a stainless steel needle, going into the interspinous ligament propagating sheet.

To me, that’s the changing proprioception far better than just actually just lifting up that skin. Cool. All right. So let’s, and again, you’re in the blue channel, right? With the needle you’re in the do channel, you’re in the ligamentous tissue and you have a lot more sway on it. So you’re ready for the video.


super supplies.

Squeeze caplets together, race together and relax everything. So bring these guys to be a backbone because you put this together

for me and agree this.

all right. That video is up on our YouTube channel by the way. So if I noticed the birds are a little aggressive, they’re mad in your background, they’re making some noise and it might not have heard anything. This sounds a little put out by that, but we do have that up on our YouTube channel. If you wanted to check that out sports medicine acupuncture, and you can do that.

Oh, sorry, Brian, are you finished? Can I go? Okay. This was a recording that we just did in New Jersey to finish the 2019 2022 smack program. It was three years because of the smack of sorry for him because of the COVID. So we just finished this. This was a module for neck, shoulder, and upper extremity. This is one of the techniques that we’re using now.

Remember, we’re also going to be needling the other points as well, and that helps with proprioception. So the person gets an idea on how to be able to lower and squeeze the scapulas together. So that’s great. That’s, this is a really wonderful technique to be able to use. We’re going to be teaching this class again here in San Diego and that’s coming up in June four days and that will be wrapping up completely of the 2022.

So also what we’re going to be teaching with this is a wonderful myofascial technique that Brian has introduced into the program that works extremely well for that particular posture and opens up the tissue. Great mile fast, mild fascial technique to use after all the needling. Brian do want to take it away.

Yeah, sure. So this is a seated technique. It’s a interactive between you and the patient. So first and foremost, you want the patients sitting in a position that is going to help facilitate change in the body. So you don’t want to just slouching though. I am starting a little slouch. So if you look at the picture, there’s three images, the one in the left most image once you have the person stacked on their sit bones, you’re going to take your Louis kind of knuckles.

I usually use just the flat kind of inner phalanx of two fingers. And you’re going to place that approximately I’m not being really exact on any location, really, whatever real estate you can get in that upper cervical spine. And you want to allow the patient to drop their chest and go into the Capitol extension.

Why am I doing that? I’m doing that so that the tissue shortens and I can get a good investment of the tissue. I can hook, I can engage the fascia. I can sink into the fascia and then you’re coaching the patient to start a lift. The sternum, descend the scapula by engaging the rhomboids lower. And drawing the cervical spine back.

So they’re a long gating, the the posterior part of the cervical region, especially those lower cervical structures that we’re trying to to engage. So they’re doing that while you’re descending and gliding through the tissue. So again, just initial setup, they drop the, they exaggerate the posture, so you can get a hook on the tissue.

And then as you’re drawing that tissue down, And elongating, they’re doing the movement, bringing the cervical spine back and opening the chest. So you’ll see that in the technique, these just give you the kind of rundown and the instructions for that. But let’s look at the video.

this technique is a combination between the manual work that you’re doing and also the movement of the patient. So you want to coach them with the movement, first of all, so have them drop the chest. And serve a call extension. So that’s going to be the starting position, starting them with bad posture.

And then they lift the chest and the length and the posterior cervical spine. So they start an extension with the chest dropped and then lift the sternum, like in the back of the neck, the chin comes in. Many times patients will have a difficult time doing that. When they go to lift the sternum, the loss of go more into extensions and some patients you have to coach them to the movement of this technique is really a big part of it to starting them.

And this position is it let’s come back to neutral. I’m going to gently place my fingers up towards the occiput. Just any area of the cervical spine that I have access to. I’m going to take them into the starting point. That will shorten the tissue. It allow me to get a purchase of the tissue and now it’s a pin and they start to come out of that and I’m stretching the tissue in the posterior cervical spine associated with urinary bladder.


and another pass maybe slightly lateral or slightly medial is again, place your fingers on the deck. Take them into the starting position. That allows me to get a hook last meeting the hold of the tissue, because it’s in a short position now, as I bring the tissue to known where they come out of that position, lifting the sternum, bringing the chin, like the need of the posterior part of the neck.

And I can take it all the way down through the upper part of the thoracic spine.

all right. So this is a supine version. I guess time to the seated extensor technique. So in this one, we had the patients who I’m limited the ability for them to be as involved in it, by dropping the chest, by lifting the head. So it takes away a little bit of the re-education aspect, but at the same time, there are next, a little bit more relaxed or they’re in a more neutral position that way.

I can still take them into capital extension with them in capital extension. I can sink into the tissue pretty close to the occiput. And as I bring the tissue down and start spreading downward, I can bring their neck back into a neutral position. So it’s a little more passive on the patient’s arm and the seated.

so it might be appropriate if there was currently neck pain, that they were having a harder time in the seated position, or if you just don’t have time to put them into a seated position or to use the time of their place,

the two movements. With the hand where you’re bringing them in to flection

lengthening the posterior part of the neck. The other one with the other hand, simultaneous where you’re spreading downward descending, the aging.

So a question about how many times, or how long would you do this technique? It’s a short technique, two passes, three passes. You don’t need to do it really more than three passes. If I were to doing multiple passes, I would probably move slightly lateral or slightly medial and cover the same region but tissue that’s slightly medial to the first pass or silent lateral to the first.

These are short techniques. There are supplement to the acupuncture. They don’t need to be something you spend a lot of time with something else, especially with the seated technique that might not be apparent is when I was following the person, as they went into a kind of exaggerated drop chest capital, a extension I’m not cramped.

I’m not digging my hand in as deep as I can. I’m really just following it’s more of a pivot point is you’re guiding them and following you’re not trying to force them into that position. So I’m not using a lot of pressure. By doing that, I get a hook on the tissue and the pressure really comes from when they start coming out of that position.

So you don’t need to use a whole, a strong ton of pressure with it. It’s a pretty gentle. There’s four, so they’ll feel it, but it’s not anything that you’re driving them in or trying to sorta mobilize the spine by doing it. So it’s more just following, Hey, Brian. I also saw that same question about the needle techniques.

So I think I’ll go ahead and address that as well. Do you want to go to the next slide? Just so people can see that information?

There we go. It’s just has our information that you do, but general, we have a lot of these videos up there. We also post them on our Instagram account and Facebook page. So all sports medicine acupuncture. If you searched for that, you’ll find it. And then our webpages there. So to address the question about how often are you using the Chung goo lifting technique?

Until the patient actually has a really good command of the movement of going into prone, neck retraction. Once they have that, then you can go ahead and stop now. So we addressed this needling technique as basically for that forward head, but you can also use. This 0.4 disc problems, cervical disc problems.

Also, if there’s going to be tenderness to just in that local area, there’s an Oscher point. You can also just go ahead and needle that without actually the lifting technique is for when you see that forward head posture. But again, this point could be used for a number of different types of local injuries.

Brian, is there anything else that you want to add before we had. Just as the bounce off what you said. Yeah. It’s used when they’re, when they have that forward head posture. It might also be used when you say use that neck extension exercise that we highlighted and the person’s really struggling and they can’t figure out how to coordinate that movement to bring that portion of the spine back.

It’s very difficult. And actually I was teaching, I teach some online Teagan classes that was covering this today because there are people that do that very thing when they go to open the chest. Arched the neck up and you try to coach them and they have a very difficult time finding that region.

So it’s appropriate aseptic technique. It gives that a pointer to this tissue bring this back, without using words, they can feel that the noodle kind of pulling that region is oh, that’s what you’re asking me to do. You’re asking me to bring that back. It’s just, it becomes very clear.

It’s like a spotlight on that region. So yeah. Just use it, use the technique, but you might use it when you’re seeing people struggle with particular instruction that.

The guys that wraps it all up. If you have any questions whatsoever for Brian or myself, or you’re interested in the program or any of our classes and information, there’s our contact information that was there in those notes. Thank you so much for attending. Really appreciate it. I remember next week also, Sam Collins is going to end up being here.

I thank you again for the American Acupuncture council. And we’ll see again next, next month. Yes. Thanks everyone. Thanks everybody.