Tag Archives: Matt Callison – Brian Lau

Forward Head and Shoulder Posture Issues

A Problematic Postural Position: Forward Head and Forward Shoulder

 

So forward shoulder, um, it’s a, it’s a posture that it seems like it’s becoming more and more common with sitting in front of the computer a lot more than we used to, especially during this COVID time. Um, the propensity for this, for the weight of the head to go forward and the shoulders to go forward is really quite great. And the more that we sit in one position, we know that the muscles and the myofascial tissues are going to adapt to that position.

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.

The American Acupuncture Council for having us really appreciate that. I’m excited to get into this information. There’s a lot of great things with, uh, let’s go ahead and get into the first slide please.

Or the next slide. There we go. All right. Thank you. So forward shoulder, um, it’s a, it’s a posture that it seems like it’s becoming more and more common with sitting in front of the computer a lot more than we used to, especially during this COVID time. Um, the propensity for this, for the weight of the head to go forward and the shoulders to go forward is really quite great. And the more that we sit in one position, we know that the muscles and the myofascial tissues are going to adapt to that position. So it’s a lot easier to get into that forward head and for shoulder position. If we maintain that position for hours and hours throughout the day, now it’s usually predicated from what’s happening in the pelvis. So this is the reason why that, that we’re saying this is just one piece of the whole. So, I mean, you have to look at the whole body with this to help afford heading for shoulder, but we want to give you some nuggets that have helped us clinically quite a bit, um, to help alleviate some pain. Uh, Brian, do you want to, uh, say anything before we get in the next slide now? I think jump right into the next slide. All right.

All right. So the Ford had an imbalance in his posture, cannot counteract the forces of gravity, thereby increasing the stress on the muscle skeletal system and perpetuating the aging process. So you can see that red arrow that’d be the force of gravity as the head is going forward of the plum line. Let’s back up a little bit. The plumb line will be measured from the foot going up to the head. You want the plumb line to be in line with gallbladder 40 at the foot, the middle of the knee, the greater truck enter the middle of the hip joint. Then going up spleen 21 region into the chromium, the large intestine 15 region, and then the auditory meatus or the small attest in 19 region. So in this case, you can see that this patient’s head is forward by probably a good two and a half inches.

So for every inch for posture, there’s an increase of the weight by 10 pounds. Imagine what’s happening to the upper thoracic region and the lower cervical region and being elongated and polling quite a bit, trying to be able to maintain their proper positioning. But in this case, they’re really struggling because there’s so much weight pulling forward. This can increase the aging process significantly the longer that it ends up lasting. I mean, there’s a host of injuries that can occur from Ford head for shoulder. Brian, let’s go ahead and think about this. We’ve got thoracic outlet syndrome. You’ve got lower cervical spondylosis in the 40 plus age group. That’s increasing, um, nerve impingement. What else? Brian, with the sport headaches would be a big one. Yeah, that’s true. Brutal scapular nerve and traffic could be a big one there. Gosh, a chromatically vicular joint strain is something sternoclavicular joint strength is there, uh, with the pectoralis minor being a shortened position and the anterior scalings being in a shortened position. There’s your nerve entrapment sites for thoracic outlet syndrome. So, you know, with this for shoulder, it goes down the upper extremity chain, the head of the humerus. Sorry, go ahead.

Oh, go ahead. Yeah. The one worth mentioning also is the, uh, uh, when we’re going to be covering more in detail later is a lot of shoulder injuries, especially tendinopathies.

Yeah. So with this, we’re going to talk quite a bit about the functional anatomy of the Ford headed for shoulder, and then flip hats, put a different hat on blending, the two hats actually, and get into this new channels. So again, back to this Ford head and Ford shoulder, this is just one segment of what’s happening with the body. You’ve got humoral internal rotation, and then it’s going to affect the radio ulnar joint proximal, and also distal. So there’s a lot of things to be able to look at. So we’re just, again, just talking about one piece of the whole hair. Can we get to the next slide

While you’re doing that? Matt it’s worth mentioning that the head itself is 10 to 12 pounds. So an additional 10 pounds for every inch forward is pretty significant in terms of the amount of load that puts on the upper back and shoulder girdle and all that.

Yeah, absolutely. Absolutely. So Fort headed for shoulder is one component of something called upper cross syndrome, which Dr. Vladimir Yonda was the one that coined that term. Um, he noticed that a lot of patients in this particular posture, he would document the muscle imbalances that are, that are contributing and holding that posture as well. Now in the 1960s, this was a Latin Marianna in the 1960s, but also Dr. George Goodheart, who was another pioneer in posture and also muscle imbalances, both these guys actually in the 1960s. Talk a lot about the different types of Muslim balances, not only in the upper cross syndrome, but also in lower cross syndrome in the upper extremity and also the lower extremity. These two pioneers are, or actually the, um, major contributors to where we actually have a lot of manual muscle testing today. And manual muscle testing is becoming much more popular than it was in the 1960 seventies, or when I first became an acupuncturist in the 1990s, um, is becoming much more popular and these guys influenced that substantially.

So it was really quite interesting too, when you look at this paragraph here, that Dr. Vladimir Yonda, he thought of it as actually being more of the deficient muscle, the lengthened muscle that was perpetuating a lacrosse syndrome and the muscle bounces and Dr. George Goodheart was actually considering that be more of the shortened muscle is what’s causing the upper cross syndrome. So interesting glamor Yana thought it was more as the deficiency that, that made the excess and the Dr. Goodheart thinks it’s the excess that’s creating the deficiency, both work mean that these are both great pioneers, both actually work quite well. All right, so let’s go to the next slide. So your upper cross syndrome, uh, you’ve got with a Ford head and the Ford shoulder, if you look at the box on the upper left shorten overactive cervical extensor. So that means the upper extensors are really the biggest ones that are going to be shortened and active.

The suboccipital triangle, hence the reason for causing nerve entrapment of the lesser occipital nerve or the third occipital nerve, uh, developing trigger points when the suboccipital muscles causing muscle tension type headaches, um, a whole host of different injuries can, can occur in that area. And then below that you’ve got lengthened inhibit rom boys’ middle and lower trapezius. So those would be in a locked long position, a stretched out position, and you can see how the back shoe points of the heart and the lung here are going to be greatly affected the pericardium as well. So that’s going to be an elongated position, putting stress on those back shoe points. Then on the other side, you’ve got your shortened and overactive pectoral. So that pectoralis minor is going to be pulling excessively on the core court process, inhibiting the muscles on the other side, which are the wrong boys in the middle and the lower trapezius. Then you’ve got your LinkedIn inhibited, deep neck flexors, including the middle and anterior scaling. Hence the reason why you get thoracic outlet syndrome many times or many times, you see thoracic outlet syndrome with people with postures like this. Brian, do you want to say anything?

Yeah, sometimes the, um, the, the neck flexors, I would also include, uh, the longest call lion and longest capitus the deepest, deepest cervical flexors, which are, um, create neck flection, but they are, they’re a big stabilizer and we’ll get, this is a little foreshadowing, but, uh, from a Cindia channel perspective, those would be part of the kid decent new channel. So, um, kind of speaks a little bit to the kidney cheat and how that sort of loss of kidney cheese starts to cause that the, that depression and that, um, dropping of the head in the forwardness of the head.

Yeah. Good point. Yeah. Excellent.

Excellent. All right, let’s go to the next slide. So we’ve talked about this slide before.

This is some research that I did it starting in 2010, um, and presented it, I think in 2011 Pacific symposium, and also 2019, it’s looking at different types of posture and their relation to Zong, uh, uh, TCM patterns. So what I noticed is that with looking at, from the lateral view, certain postures would come in and they would have certain types of Azzam signs and symptoms. For example, the guy on the left, you’ve got spleen lung and kidney deficiency, and you can see how the lungs in this type of position in this position are having a difficult time expanding the diaphragm’s going to be constricted. I mentioned earlier that the tissues around the bladder, I’m sorry, the lung and the heart back shoe points will be elongated and struggling. Um, let’s see what else we’ve got compression caged is going to be affecting this and also the liver, and it is positioned the thoracolumbar fascia. The deep layers around the renal fascia will also be restricted inhibiting some of the kidneys, the kidney, but these people themselves will often come in with spleen, lung and kidney type of deficiencies. Brian, do you want to add anything to that?

Uh, no. I think you gave a good summary how it’s not just the muscle imbalance, but how it’s also affecting the internal organs and the space for the internal organs to do their proper function.

Hmm. So which ones out of, out of these spots,

Figures, Brian, which ones can you see have that forward head and forward shoulder type Fox?

Sure. Yeah. So the type one, the first one is the most obvious. And especially with the plumb line, as Matt was mentioning with the plumb line, going through GB 40, coming up through the greater trocanter, um, through the acromion, you can start seeing the shoulder going forward and you can really see the head going forward and the type one, the type two is there, but it’s a little, uh, um, maybe obvious it’s obvious if you look at it, but with the plumb line, there’s a little bit of a trick to it. And you notice how forward the greater trocanter is from the plum line. You know, this, uh, this patient and the type two. And for that matter of the type four posture have an anterior hip shift. So there’s, the hip is as moved forward and then their rib cage is starting to tilt back posterior.

So in some ways their, their head looks a little bit more aligned according to the plumb line and their shoulder looks a little bit more aligned according to the plumb line. But if you were to kind of imagine tilting the rib cage back into position, you know, to, to kind of line the rib cage up in, in a straight line, you would start to see with that, you know, uh, if you did that, how much the shoulder and that hadn’t been forward in relationship to the rib cage. So, um, there’s a definitely a big relationship between the pelvis and the head and shoulder position for those, those type two and type four ones in particular. But it’s, it’s a, if you adjusted, you definitely see the forward head in the forward shoulder, though. It’s a little different flavor from the type one. Yeah.

That’s interesting because if you do end up changing one segment of that, of that disparity, the compensation comes out somewhere it’s like Brian was saying, if you tilted that ribcage here for you brought those hips back to the plumb line, actually physically did that. You would see the compensation above and the forehead and for children. It’s great. Now an increase to type twos. You look at type four and you can see that the greatest rural Cantor is even farther forward, which is causing more of a poster tilt to the rib cage. And the shoulder is posterior to the plumb line, but it’s the same thing. If we brought those hips back, you would see a really far forward head and also afford shoulder. So somebody like this could be coming in with thoracic outlet syndrome or, or such, um, from the muscle imbalances within forehead and for shoulder in upper cross syndrome, the slide three and a type three and type five. I don’t see it as much, possibly type five. What do you think?

Yeah, they’re not as obvious. I mean, the head is forward on type three, but it’s really, that whole body is shooting forward. So it’s not, um, as much of the obvious head and shoulder forward. Yeah. Yeah. Okay.

Excellent. All right. So then, uh, what’s the next I Brian, you want to take?

Yeah, yeah. And Matt, uh, I will nevermind. Um, your audio is a little distorted. You might want to turn your phone off to have a little extra bandwidth, but I’ll be chatting here for a second and give you a moment anyways. So, um, we kind of alluded to this in the previous, uh, the previous slide where we have multiple examples of a forward head and forward shoulder, but I kind of used the term flavor, you know, that, that the farthest one on the left, the type one posture had us at quote unquote different flavor than the type two, which had that obvious posterior tilt to the rib cage and, um, had a different interaction of how things related to each other, but both, ultimately they both had a forward, um, shoulder and forward head. So if we wanted to kind of start assessing that variation from patient to patient, one way we can start to look at is the, um, is the position of the scapula, uh, and notice, uh, that it varies from patient to patient with this forward shoulder.

So a blanket term would be scapular protraction. Um, so scapular protraction, the shoulder blades are going wider and they’re usually tilting forward. Um, but when you start breaking down from patient to patient, you can start to see that there’s variation on tilts shifts and rotations. Um, so just to give a quick terminology, if the shoulder blade itself moves away from the spine, we might call that protraction. It’s an element of protraction, but we can be more specific and call it a lateral shift. You know, it’s shifted lateral retraction. It might shift medial and come closer to the spine. Um, if it tilts forward, we would call that an anterior tilt. So in that case, the top of the shoulder blade, the, um, SSI 12 region is facing forward. Um, it could also rotate around the rib cage. So we might call that a medial rotation cause the, the shoulder blade spacing more medial. So just, uh, based on where it’s moving, if it’s moving medial, moving lateral up down, et cetera, we can, uh, call based on shifts and tilts. So we’ll see an example of this on the next slide. So let’s go ahead and go to the next slide.

So this patient, we have, we could again call it a scapular protraction on the right side, but it’s different than some other people might manifest with scapular retraction. So if you look at the medial border and you were to kind of draw a line along that medial border, you’ll see that the medial border comes closer to the spine, uh, as it goes inferior on the right side in particular notice, the right side is what I’m talking about. So the whole scapula is in, we could call it downward rotation, but if we were to use this terminology of tilts and shifts, it’s a lateral tilt. The top of the, the scapulas facing lateral and the scapula is also moved a little bit away from the spine. So it’s a lateral shift. We’d have to look from the side, um, to see about if it’s tilting forward. It probably is. So it’s a likely anterior tilt, but that, uh, from this, this perspective is a little harder to see, but I think we will see that in the next, uh, slide. We’ll get another view for a different patient.

Hey Brian, can you go back? I’m sorry, can you go back to the last slide please? Um, just to keep in context, what we had with the previous slide. So this would also be immediate rotation of a scaffold, correct?

Medial rotation yet the immediate rotation. Uh, if it’s going around the rib cage, we can say that’s a lateral shift, cause it’s definitely moving away from the spine, but the scapula will start following the rib cage. So you could also describe that component of a medial rotation for sure, because you can kind of picture it the more it goes lateral. The more of the scapula is following the sort of, uh, border of the rib cage. It’s going to start turning and facing inward facing medial. So yeah, I would agree a lateral shift and a medial rotation.

So the anterior aspect of the scapulas is facing immediately. Okay, great. Yeah. Thanks Matt.

All right. So now to the next slide, and again, we could call this a younger, uh, gentlemen here, we could refer to this as a scapular protraction, but it’s a little different, a little different that, um, look than the previous patient. And really what you see is the strong anterior tilt. You can kind of notice that with the inferior border of the scapula, which is poking out in relationship to the top of the scapula. So it’s a, um, kind of highlights a little bit more of the shortening of the pectoralis minor muscle in the whole scapula tilting forward. We’d have to look at him from the back. He might have a little bit of a, um, a lateral shift to the scapula. I don’t recall from seeing previous images. Um, we don’t have it in this PowerPoint, but he didn’t this particular patient didn’t have a really obvious lateral shift. If I remember Matt, do you remember that

It was more of the superior shift in Andrew scapular tilt was more, but he did have scapular protraction on this right here.

Yeah. Yeah. But it’s manifesting a little bit more, is that, is that anterior tilt that anterior tilt component is, um, a little bit more prominent, but why is this important? What’s, what’s the importance of it. It starts to set a picture for which tissues are involved. And, um, if, if you look at it from which, which muscles in which structures are shortened, uh, and which ones are lengthened, it starts to also paint a picture, which send you a channels are involved. So, um, anything else on this one, Matt, before we, yeah,

Yeah, I think, um, for those people that don’t really know the muscles very well as if this is the pectoralis minor image, that’s on the right. So you can see if those fibers shorten their attachment sites, how it’s going to be pulling on that core court process, creating that anterior tilt now with an anterior tilt, the superior medial border of the scapula also raises up a little bit. So in that case, if you thought about what possible injury could be taking place here, the levator scapula, um, and that where it attaches to the superior medial border, as we know, has a lot of mild fascial adhesions in that tissue Guber is basically, I mean, it just feels so very, very rough and some people actually complain of pain in that region. So we could needle that section and that would give good relief for a little bit, but until we actually start working on that enter shift and the Petraeus minor shortening, we won’t be able to help out the elevator scapula and have it be pain-free

[inaudible] treating the effects, not the cause necessarily. Yeah. So we can go ahead and go to the next slide. So this is a little bit of a summary. So we have, uh, some, uh, scapular protraction that have more emphasis on that anterior tilt and that pec minor shortening. So we’ll give you a heads up that the pectoralis minor is part of the lung sinew channel. Um, also we have shortening in the upper fibers of the serratus anterior, also part of that lung sinew channel. And then that’s kind of counterbalanced, especially by the lower trapezius, also the middle trapezius and rhomboids, but we’ll, uh, kind of focus on the lower trapezius, which is there to stabilize against that sort of, um, pull from the pectoralis minor. That’s going to pull the scapula into an anterior tilt. The lower traps are there to sort of stabilize and hold the scapula in place and keep it from being pulled forward from the pectoralis minor.

So this is a very common muscle imbalance between these two, uh, internally and externally related channels, send new channels and muscles where the pectoralis minor gets overactive lock short into a shortened position, holds the scapula into an anterior tilt, uh, tends to pull it a little bit more into, uh, a lateral tilt. So kind of downwardly rotating the scapula, whereas the lower trapezius becomes inhibited and fails to counteract that. So we have an imbalance between these two related channels of the lung and the large intestine channel. So that’s important for local treatment, but of course, important for distal treatment also.

Yeah, that’s great. So the distal treatment, because the Petraeus monitor is going to be, fascially connected to all of the mild fascial tissue on that lung sinew channel all the way down to the wrist. We can use many acupuncture points or to change that mild fascial tension. So not just treating locally, but also adjacent and distal to signal the myofascial gene June, what we’re trying to do. So by treating the TCM, bialy internal and external relationships here, um, it’s just, it’s pretty amazing what can happen when you soften tissues so far away and signal while you’re trying to be able to do when our founding, our founding forefathers were just absolutely brilliant to be able to come up with such associations. And, and we’re just talking about it in a different way. This is great. We will be going over acupuncture points in a little bit.

Yeah. All right. So next slide. So then this particular, uh, example, now we have a little bit more of the emphasis on the lateral shift, you know, the movement of the scapula away from the spine. And, uh, with that, you’re going to see a little less, sometimes a little less of that anterior tilt. So it speaks a little bit more to a different set of tissues, the serratus, anterior, especially the middle and lower fibers of the straightest anterior and the rom points. So those become imbalanced. And in the system that we teach in sports medicine, acupuncture, this is part of the pericardium send new channel. The serratus anterior, um, is, is a big part of that, but the straightest anterior, it goes. And if you kind of notice in this illustration, it becomes a little bit faded because it’s going underneath the scapula. So it goes underneath, uh, it should say anterior to the scapula between the scapula and the rib cage.

And it attaches to the medial border of the scapula, right at the place that the rhomboids attach. So they really create one continuous, uh, myofascial sling. It’s almost like it seemed if you can kind of picture that, that sling that has like a seam along that medial word of the scapula. So it’s, it’s, it’s kind of anchored at that medial border of the scapula, but it’s a continuous sling. Um, and sometimes that’s referred to as the Rambo’s rate of sling, uh, for those who’ve paid attention to, uh, anatomy trains in the work of Tom Myers, he uses that terminology of thrombosis rate of slang. And we see that as a part of the pericardium sinew channel. So it’s a little bit more of that influence of that channel versus the lung and large intestine as a new channel and balance.

Yeah. [inaudible]

Of the scapula.

Oh, I’m sorry for, I’m sorry for interrupting Brian, go ahead and finish what you’re saying. No, that’s it. I finished. Okay. Here’s my audio better now? Yeah, much better. Okay, good. Uh, what was I saying? Yeah. On the cadaver, it’s fascinating to see the thrombosis rate is sling how the straightest anterior and the rom Boyd fibers just interdigitate. It is really one tissue, like so many other tissues in the body, but it’s keeping context of what we’re talking about now. It’s amazing to see how it’s just one line of Paul on that. Yeah. Fantastic. Oh, also something else now, even though we’re putting the pericardium channel or the pair of, even though we’re putting the serratus anterior into pericardium and also lung there’s a gray area with that in smack, we will often demonstrate that by needling the motor innervation points of the straightest, anterior, for example, ribs three through seven or so, you can even do four through six we’ll change a lung pulse.

So it is influencing the internal Oregon. For sure. If you have a patient that’s coming in that has asthma, common cold, a C D something like that, feel the pulse. If you would treat the motor entry points of this rate, anterior that pulse will definitely get better and change. So you are influencing what’s happening with those lungs. Just something to think about when you do have a patient like that. Yeah. It’s going to help the lungs to expand the rib cage, to expand by getting any kind of tension or lack of proprioception within us. Right. Of center. Sorry, Brian, go ahead. We’re going to say, yeah,

I was just, just commenting on what you’re saying that this radius anterior definitely when it’s, uh, restricted we’ll we’ll stop breathing well, we’ll prevent a really good solid fall inhale.

Yeah. Yeah. And it’s fun how fast it changes the pulse, you know, intuitively the body is all right. We can just keep going on this. We better get going. We only have one minute pink. Okay.

Yeah. So, so the, this was kind of painting a picture. You know, it’s a little bit of a simplification because things can be both, you know, you can have both that anterior tilt and the lateral shift, but, but generally when you look at patients one’s predominant or oftentimes at least one’s more predominant. And if we go back to those, uh, the, the, um, TCM patterns and postures, the type two person that we see kind of replicated here on the right with the posterior tilted ribcage. Again, if you were to tilt that rib cage back, you’d notice how much of an anterior tilt of the scapula we have here. You can see that from the illustration, she kind of resembles more of that, right. Illustration where the rib cage is tilting back. The pelvis is shifted forward. The scapula is almost straight up and down, but if we were to adjust the, um, the rib cage, you’d see in relationship to the rib cage in relationship to those tissues that are holding it in into a particular balance, that it’s a pretty strong anterior tilt of the scapula that tends to correspond much more with, uh, kidney deficient, postures, um, and kind of a lack of stability from, uh, the kidney channel sort of holding and stabilizing the body.

That’s a whole nother topic, but, um, but there’s this, there’s a strong correlation with this type of posture with various types of kidney deficiency that you saw from the five fosters that Matt was highlighting earlier. So there’s a relationship between the lung and the kidney channel and this type of posture you saw with the boy, even who had that little bit of a posterior tilt to the rib cage, very, uh, versus, uh, I’m ready to go on, unless you wanted to say something else about that, Matt.

Um, I think maybe just a little bit like another demonstration that we do in smack to see how the pelvis and his position is related to kidney cha. Um, we have, uh, people go ahead and stand up and partner up and feel each other’s, uh, kidney pulses on the right and left hand side. And the kidney pulse is going to be the weakest, the patient, or the practitioner will slowly go ahead and just do anterior poster, pelvic tilts, not enough to get the heart rate up. So it’s going to change that Paul’s, but just very slowly going to an anterior and posterior pelvic tilt, changing the fashion and the position of where the kidneys are. So then by doing that eight, 10, 12 times the kidney pulse actually starts to come up, which is pretty amazing. And it’s so significant. It happens almost every single time, but this demonstration, we, we do frequently in the smack program. And also, I think I did a civics symposium one time. It’s pretty amazing to be able to see that. So what’s the next slide.

So same idea with channel relationships, that more lateral shift of the scapula, um, oftentimes with a little bit of an upward rotation, um, but when you start seeing more of a lateral shift and that sort of rounding of the arms, uh, that often goes in corresponds with, uh, multiple things, but especially spleen channel deficiency. And you can see with this type one posture, as Matt mentioned, how that’s kind of compressing the spleen and, um, the organ itself is being compressed, but the posture and the tissues associated with that posture, um, the tissues associated that sinew channel are involved with the pericardium and spleen relationship. So, you know, you might consider distal points, multiple things, but something like splitting for pericardium six might be a component of the, um, the treatment protocol for this doesn’t have to be, but that’s something that comes to my mind. Whereas the previous one, you might consider something like lung seven, kidney six, or, you know, other other kidney and the lung channel points for the previous, uh, person versus a spleen and pericardium channel point for this one. So we’re going to talk more about points, but just kind of think that, you know, start, start making those connections now. And when we’ll get into that at some point in combinations,

This is great. All right. So with the pericardium and spleen, and also the kidney, the lung, the lung and large test in relationships, the straightest anterior with the pericardium and lung, these imbalances can create a numerous amount of injuries. And we’ve already talked about a few, let’s go to the next slide and see what actually happens to the children.

Yeah. So, um, as much as we can have a whole bunch of injuries that we could focus on, uh, we talked about muscle tension, headaches and spondylosis, and a whole, whole bunch of things. But, um, but we’re gonna kind of give an example related to the, um, the shoulder position, shoulder movement and, uh, tendinopathies. So Matt, do you want to talk about this one?

Sure. What scaffolding humor, rhythm,

The, the humorous,

And also the scab will have a rhythm as the person’s going into shoulder abduction. So when you have process of proper muscle balancing, then that scapula will go ahead into a rotation as the head of the humerus is coming up. Now, if there’s going to be imbalanced with that scapula, if the lung large intestine that roof or the chromium right here is going to not be as strong, it will end up actually coming down into a downward rotation, a budding the head of the humerus, that particular scenario is probably, you probably see that more times than not with shoulder problems is the inability for the, for the scapula to upwardly rotate and allow the head of the humorous to move freely within that joint. It’s the abutting of the head of the humerus against the chromium impinging, the superspinatus tendon, the capsule of bicipital long head tendon making insertional type of strains. Um, there’s, there’s so many different types of injuries that can occur with us. So balancing these muscles and the sinew channels is going to be really imperative, followed by some kind of exercise prescription, which, um, I believe it was last month or the month before that, that Brian and I have a podcast, right. That we talked about this.

Yeah. I said both. We talked about fab lab last two, two webinars, I believe. Hm, Hm. Yeah. You know, it’s interesting

Too, with this cause we don’t have there much time left is that we talked about mostly what’s happening with the scapula, but the head of the humerus with a forward shoulder position. In fact, you can just do this yourself. If you sit up and you have your shoulder go forward, your human starts to internally rotate. And that’s just the way that it starts to move, causing more muscle imbalance within the rotator cuff between the heart and the small intestine Jean chin. So it just keeps on going. We just don’t have enough time in this 30 minutes to be able to talk about that. So let’s go to the Brian D anything else go for the next slide? No, no, I think that’s good.

This is a severe case of shoulder impingement spinner, but you can see in this x-ray as the person going to the shoulder abduction, the rotator cuff muscles are not pulling that head of the humerus down into the joint. And it looks like the scapula stabilizers, the lung and larger tests and Jean, Jen, and also the pericardia are not lifting ASCAP properly into upper rotation. The greater tubercle that humorous is hitting the chromium and the fact that it looks like it’s been doing it for an awfully long time. Cause you can see it, the superior aspect of the humerus, like a rough mountain range edge there. I don’t know if you can see that I don’t have a cursor without I can be able to do this, but at the very top of that humorous in the black, you see a very rough edge and it looks like that’s probably from necrotic tissue or a lot of overused banging into their chromium. This person was in some pain for quite a long time. Let’s talk about some acupuncture points that we can use for forehead and for shoulder Brian. Yep. Sounds good. Next slide please.

All right, go ahead, Brian, go ahead. Well, the points are going to be based on the particular injury, obviously. So is it going to be periscapular pain? Is it going to be levator scapula insertional pain? Will it end up being super spine Natus tendinopathy or maybe bicipital tendinopathies. So depending on which injury is going to predicate, what local points that you have or the adjacent points we want to needle the Watteau G points bilaterally, that’s going to be level with the innervated tissue. So, um, kneeling a C4 through C6, which the C is not on there. My bad, sorry guys. So the Watchers Joshy points of C4 through C6 needling, the pectoralis minor motor point motor entry point, which would be best if you were actually shown how to be able to do that. So we don’t create a pneumothorax if you’ve never done it before. Um, the rhomboids, the middle and the lower trapezius motor entry points would be good to get that communication between the Petraeus minor and the trapezius. And of course the straightest, anterior ribs, three through seven, another muscle that would be best shown how to be able to do those motor entry points. Because if you obvious reasons, if you don’t actually need all that muscle and go to the intercostal space, you could cause some damage with that. So if you’re unfamiliar with anatomy very well, you don’t want to needle these motor entry points.

Yeah. I mean, it just, it’s not three through seven. Like all of them, you wouldn’t necessarily, wouldn’t be needling. Serratus. Anterior is read three, four, five. So you’re picking the more restricted one or two, uh, um, regions, you know, slips of this radius. Anterior, that’d be a lot of needling for, um, you know, for all, all of those, those lips. True.

But we are immediately two to three, sometimes four, depending on the case

And the persons that you want to cover, the distal points Bryant. Yeah. So, um, flexor carpi radialis motor point is a really, uh, excellent, um, uh, motor quieter motor entry point that will soften the pectoralis minor. So in combination is great, but if you’re not comfortable with needling, the pectoralis minor, it is, it is good to learn that in a classroom setting. Uh, just so you do it safely and don’t cause damage to people, but the flexor carpi radialis is a little bit easier of a tissue to, um, to work with if you haven’t been trained to do pec minor. So it’s going to have an effect on pec minor for sure. Uh, other points along the lung and large intestine channel would be, uh, indicated, uh, L I six would be the sheet cleft wine of the large intestine channel would be a really useful long seven would be an excellent point.

Brachioradialis is, uh, brachioradialis is kind of associated with both lung and large intestine, but, but it’s, um, but it’s definitely a, uh, large intestine channel point. That’s going to influence that portion of the channel. Um, protonate or Terry’s Motorpoint would be more for, um, pericardium sinew channel. So if it has more of that lateral shift and again, serratus, anterior is difficult to needle for some people, if they haven’t been trained for inner Terese would be a really excellent, uh, in, in addition or, or just a needle in that one as part of a comprehensive treatment would be good. And then P six, um, for obviously for the pericardium channel. Yeah.

It doesn’t have to be all of these points. You guys, it’s just, we’re just giving you some points to be able to choose from, um, the brachial radialis motor entry points. We could do large intestine, 11 that’s that could connect large intestine lung that’s the upper point. And then lung six, the sheet cleft point is also going to be a motor entry point for the brachioradialis. So points that you can be able to use to be able to communicate upper into the gene gin. Um, just to kick out a little bit more when you were talking about the flexor carpi radialis my mind went to that, um, cadaver dissection that we did on that last specimen. So thank you very much for this donor, continuing to help us learn quite a bit, um, how you showed the really strong connection between the biceps and the flexor carpi radialis and for that lungs in you. That was fantastic. It was great.

Um, the, um, sorry, I don’t have time to go into it, but the connection is the muscle itself attaches flexor carpi ulnaris, uh, flexor flexing carpi flexor carpi radialis attaches to the medial. Epicondyle definitely not on the lung channel distribution, but it has a fibrotic structure from the biceps called the last fibrosis. Sometimes it’s called the bite sip app and neurosis that links the flexor carpi ulnaris with the biceps, which is part of the lungs, then you channel. And then from there short head into the pectoralis minor, and it’s a really strong link. So we talked about how the rhombus rate is slinging on the rhomboids will, will interdigitate also here with the straightest anterior. When you look at the cadaver specimen, you’ll see the pectoralis minor come up to the court court process and just factually bind right with that bicep. Also the, uh, the biceps short head.

So it’s just one continuous tissue onto that coracoid process is fascinating to see the connections at the same layers anyway. So we’re kicking geeking out on that, um, which is crazy. So should we get into a video? You want to introduce the video Brian or the myofascial release, what we’re doing here? So this is a, uh, a pectoralis minor stretch. It’s pretty simple technique. You can do it with the person in a prone position and the video will walk you through it really good to do after treatment. I guess you could make an argument if you’re doing facedown treatment and then turning the person over and doing face up treatment that you might do it in the, uh, after you take the needles out, um, from the face down position and before you turn them over. But generally speaking, we teach these to do after treatment. So the video should run through everything. So we’ll go ahead and go into the next slide.

So this technique, it’s a passive stretch of the pectoralis minor. You’re going to use both hands, one hand, covering the scapula, especially covering the inferior angle of the scapula. The other hand reaches underneath and hooks around the coracoid process. So you have to have contact with the coracoid process and you’re falling to the inferior border of the coracoid process. So with the one hand pushing down, kind of in a direction following the lower trapezius, it’s almost like you want your hands to be the lower trapezius in terms of function, by pushing the scapula inferior angle down and lifting at the coracoid process to give a stretch to the pectoralis minor. When I say lifting, I’m not lifting straight up, that’s going to lock the scapula and kind of limit movement. But lifting is really more in some ways, following the angle of the lower trapezius and lifting headboard, cranial and slightly towards the ceiling, while you press the other hand down and you want to picture the fibers of the pectoralis minor are getting longer and you can hold for however long you feel is appropriate and changing angles slightly to get different fibers. Pec minor has a third, fourth, and fifth rib attachments. So different angles we’ll get different fibers of the pec minor.

So the video is longer than the technique needs to be just because it was showing the setup. It’s kind of a subtle technique. You don’t have the right line of Paul. You don’t get as much benefit from it. Yeah. And feels so good when that technique is applied. That technique is great at, in a combination of acupuncture, myofascial work, and then doing the stretch. It really helps with the four shoulder quiet, big buckets that Ford shoulder’s gonna go right back into place. If the person goes back to their desk and doesn’t do their exercises, do the opposite movement and a host of different movements that can be able to help open up that chest. Well, Brian, is there anything else that you want to say we’ve gone over our time again, thank you very much for hanging in there, guys. I hope this was useful for you, Brian. Anything else that you want to be able to say? Um, no. No. Uh, I think, uh, the technique is you’ll, you’ll see if you wanted to reference that in recordings, that is going to be at one of the techniques that we’re going to have in a class upcoming class. That’ll be a webinar in March. So we’ll have a lot of different techniques like that and kind of combining some myofascial release with acupuncture.

Awesome. Awesome. Cool. So I want to thank American Acupuncture Council again. Thank you, Brian. It’s always nice hanging out and doing these things with you. Next week, Sam Collins is coming in to be able to discuss the billing and coding for insurance. He’s always great for, uh, providing the latest updates, which is really important in these ever-changing times. Um, so thanks again, everybody really appreciate it. And, uh, we’ll see you again next month, right?

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil )

Follow us on
Instagram (https://www.instagram.com/acupuncturecouncil/),

LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/)

Periscope (https://www.pscp.tv/TopAcupuncture).

Twitter (https://twitter.com/TopAcupuncture)

If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

 

 

So as Matt said this time, we’re just doing the same thing, elevated ileum, but it’s its relationship to the shoulder girdle and then shoulder dysfunction and other upper extremity type problems. But we’ll give some more specific examples, but just keep in mind that there could be a whole ton of different, dysfunctions that could come from just one simple thing, like an elevated ilium.”

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 and happy new year. Thank you very much for attending. My name is Matt Callison.  Hi, thanks for attending. I’m Brian Lau.  We’re from ACU sport education and the sports medicine acupuncture certification program. Thank you to the American Acupuncture Council for having us. We have a sports acupuncture webinar. It’s always really fun to be able to do this once a month or every other month. This particular one, we’ve got more information for you. We have such a good time last month with Ian Armstrong, who’s the teacher of the postural assessment and corrective exercise class in the smack program. Brian and myself had a great time discussing elevated ilium and his contribution to medial knee pain had explored the different sinew channels and different acupuncture points and exercises that can be used to help to correct this. Then Brian, I was thinking that’d be great to be able to actually do something similar, looking at an elevated ilium and its contribution to a superior shift of the scapula or an elevated ilium and the injuries that that can cause. And some exercises that would be useful to apply after the acupuncturist acupuncture treatment. So, unfortunately though, Ian had some cut amendments, he wouldn’t be able to join us. So Brian and I are going to go ahead and take this over. Um, Brian, what do you think about us going to the intro slide? And if you have any words or so you want to share,

Uh, no, no, basically I guess just the small thing is that, um, elevated ilium could cause a whole ton of kind of, uh, potential pain patterns of low back pain, hip pain, a whole bunch of them. Last time we chose to see how it can relate to the lower extremities, especially the knee for medial knee pain. So it’s just an example, example to see how to start prescribing exercises, how to add them into the full, comprehensive treatment. So as Matt said this time, we’re just doing the same thing, elevated ileum, but it’s its relationship to the shoulder girdle and then shoulder dysfunction and other upper extremity type problems. But we’ll give some more specific examples, but just keep in mind that there could be a whole ton of different, uh, dysfunctions that could come from just one simple thing, like an elevated ilium. Hmm.

All right. Well, let’s go to the next slide. I think that’s a good segue for you. Want to go ahead and start with this one?

Yeah. So, uh, with this image, uh, again, we’re, we’re focusing in on a postural disparity, uh, we picked an elevated ilium cause it’s clinically relevant. It’s very common. You see it a lot in, uh, in clinic and you see both how it can relate. Like I said to, to local pain patterns, like low back pain, et cetera, but, but how it really becomes, you know, since so much weight transfers through the hip, it’s really one of the key structures, uh, that determined cemetery for a lot of the rest of the body. So if you can balance the pelvis that goes a long way in and of itself to balance the shoulder girdle, to balance the lower extremity knee position, foot position, et cetera. Uh, so it’s not the only thing. Um, but it’s a really a big thing. So we’ll look at its relationship to the shoulder girdle today and give some exercises review, uh, refer back to last times podcast where we looked at some exercises for the ilium itself.

Um, and then we’ll look at some exercises for shoulder girdle, but then how to combine those with acupuncture treatments. So in this image, you see this gentleman on the right there’s a elevated and you can kind of see the schematic, um, image. You can see that he has an elevated ilium on the left. So he follow, uh, you know, the line from the top of each, uh, iliac crest. You can see an elevated ilium on the left. We’ll look at some other ways you can measure it in the second, uh, then look at just for now the relationship that calm. And this is the most common way that it would present is that you’d have a balancing, you know, in the girdle of the shoulders, the shoulder girdle balance, where it’s going to start to compensate to that elevated ilium. And in this case, you see that elevated scapula on the right. And that’s probably the most common way that this would present. It could do it differently, but this is definitely the most common opposite elevated scapula or a superior shift. You might call that

Just want to emphasize as well that Brian was talking about balancing the elevated ilium or any kind of, uh, ileum type of partial disparities. I mean, the reason why it’s, you can see that it’s going to be the middle section of the skeleton. That’s going to affect what’s happening above and below in addition to housing, the dantien and the kidneys just above. So by balancing that aspect that helps, helps all kinds of different things they acupuncturist can be treating from pelvic floor dysfunction, lower jaw disharmony, OB GYN, middle job disharmony. So looking at balancing at the muscle skeletal systems, not just for orthopedic, it’s also for helping those on food. So that’s, that’s great. And this is what we emphasize in, in the smack program is trying to be able to get that elevated ilium or any kind of partial disparities and pelvis to go ahead and treat that first, which I’m sure a lot of practitioners will actually go for that as well. Yeah. Brian, before we go to the next slide. Okay.

Yeah, the we’re going to be zeroing in, in a second more on the shoulder and scapular position, but in this particular model, you can also really see the change in the position of the neck. And I’ll just give you a very simple way to see it. If you could picture that ilium elevated. I think I mirror image near my right hands up, but I’m trying to make it look like my left hand to kind of match this, this model, if, uh, the aliens elevated on the left, the person’s not going to stand in such a way that they’re, they’re leaning, you know, the leaning tower of PISA over on that side. And everything’s pointing, you know, uh, to the left, they’re going to find some place to compensate that someplace could be multiple places. It could be in the spine, which you see a little bit of in this model.

It can be in the shoulder girdle, it can be in the neck, they’re going to find some way to get their eye and their head and, um, ear position, you know, the equilibrium of the body a little bit more balanced. So if the shoulder girls are really fixed, maybe they’re going to find a way to do that all in the neck. Um, but the common one, the, the very frequent thing you see at least, um, that’s going to be part of this dynamic is the, uh, contralateral shoulder being higher and the, you know, compared to the hip, so left hip right shoulder, right hip left.

Great. As you can see the image on the right, the patient has an elevated ilium on the left and looks like there is elevation on the right as well. He does have a little lateral tilt to the right with the scapula quite. I mean, with the head that Brian was just talking about. So one of the muscles that we’re going to actually the only muscle that we’re talking about, primary muscle that we’re going to be talking about as well, the levator scapula. So can you see where the levator scapula attaches on the image on the left, the superior medial border of the scapula close to small tests in 13, and then it’s other attachment is going to be the transfers process of C1, C2, C3, C4. So the superior shift of the scapula, and you’ve got a shortening of that. Levator scapula, small tests and CGU channel that we’re going to get into a little bit more in this webinar, in a lock short position, it’s pulling the neck to the lateral side. So multitude of injuries can be occurring from this that we’re going to be getting into. All right. All right. Well then let’s go to the next slide. The quick review. This is what we talked about last month about measuring the ileum. Um, so you can see the middle image. There’s the hands are coming in on the side, on the lateral side, and the fingers are placed at a level line, right on top of that alien, it gives you an idea of where side is going to be elevated.

Well, I’m a person that, that doesn’t work for the camera position. So, well,

Go ahead, Brian. You can finish.

No, I just wanted to say that just for people to know that the, if you’re measuring that you’d be right behind the person that mats moved to the side to be able to see whatever his hands are. So just that heads up.

Yeah. True. And then functional anatomy from, um, OHS, overhead squat from the national Academy of sports medicine. Looking also at what happens with an elevated Dalian was usually an asymmetrical hip shift. And there’s a whole slew of sinew channel imbalances that occurs with this. And once we see this kind of posture where we’re automatically thinking of different acupuncture points that we can treat for locally adjacent and distant of the primary channels and the Sr channels, in addition to what this kind of Bosch is going to be doing to the organ.

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

All right. So here, you’ve got elevated scapula or also called a superior shift of the scapula, and it’s going to be associated with a lock short levator scapula that we discussed earlier, which you see here on this individual’s left side. This individual has an elevated ilium on the right often like Brian was saying it’s probably most of the times, but not all the time. There’s never an always is that the opposing side will have a superior shift of the scapula. Sometimes you’ll see a superior shift of the scapula on the same side of an elevated ilium, but what we’re going to be discussing here will still apply. All right? So this posture can lead to many different muscle and channel imbalances that we’re going to be discussing just a few of them. Um, some of the injuries that can happen with this will be rotator cuff tendinopathy, but Ron boy, minor constrain thoracic outlet syndrome. And there’s more Brian, do you want to say anything before we go to the next line?

Uh, well, I think we also have, uh, in the slide or is this the next one? Yeah, the downward downwardly rotated, uh, scapular position. And I think we have a little bit more on the next slide, so we can go over it a bit more there. Um, but uh, if you look at the scapula in this position, the left side, that I’ve looked at the glenoid cavity. So the, um, I have a little scapula here, so, uh, I think this look more like my, uh, left side of your looking through the rib cage at the front surface of the scapula, the glenoid fossa would go up. That would be upward rotation. This patient has more of a downward rotation of the scapula. And that’s pretty typical when the levator scapula shorten. We’ll talk about this again in the next slide, but, um, but that’ll play into some of the, um, discussions we have coming up in a few, few slides also. Okay. So next please.

All right, so this video’s not playing, maybe if you click on it, it’ll play.

I see. Okay.

So it’s not playing unfortunately. Well, that’s what happens with technology sometimes. So let’s just walk there.

I think it’s coming, isn’t it? Oh yeah. I can see them working on it. It looks good. There it goes.

Thank you. Okay. So one of the actions of the levator scapula as the name suggests it’s going to elevate the scapula. Now, what this is not showing is that you do have elevation in the scapular, but if you look at the origin, the assertion or the distal proximal attachments, it will also downwardly rotate that scaffold. If you will, Brian, can, you should have downward rotation again in your scapula.

Yeah. So tell me, Matt. And you can tell me if this is a case, this is the right scapula, but I think since we’re on, I think everything’s mirrored image. I’m trying to look at, make it look like the same. So does that look like the right side?

Yes. But can you do us a favor? Can you go ahead and keep it in front of you? Because it blends very well with the white background. Yeah. Okay. That looks really great, but you don’t have to raise it up a little bit, at least on mine now. Okay, good.

Yeah. So you’re seeing through my rib cage to the front surface of the scapula levator scapula would be attaching here to see one, two, three, and four transverse processes, a muscle of the small intestines in your channel, and it would lift or elevate the scapula. And at the same time it would soaps and please me or imaging, it’s hard. It would bring the side of the neck down to that side to its side, bend the head, but we’re talking mainly about the scapular position. So elevating the scapula. Okay.

That’s great. So let’s go to the next slide, please. I don’t think we’re going to talk a little bit more about the rotation. Okay.

[inaudible]

Yeah. And this one we’ll look at the downward rotation of the scapula

That’s there’s upward rotation downward. So when you see green about levator scapula, that’s when it’s shortening concentric contraction, it’s active and the Red’s going to be a lengthening contraction. So green is going to be upward, rotate downward rotation, and then you’ve got your upward rotation. So in a locked short levator scapula, you can see how it have a propensity to be stuck in a downward rotation, which will then when you’re raising the arm to shoulder abduction, like the scapula humeral rhythm, that images that’s on the right there, the greater tubercle, a big prominence on the humerus or the super spine EDIS and infraspinatus. And on the opposite side, the bicipital long head tendon can come up and hit that at chromium and cause a tendinopathy and impingement. There’s one more image. I think that will also be able to help with this. Um, can we go to the next slide?

Yeah, there we go.

Yeah. So then this would be when the levator scapula has been placing that scaffold into a downward rotation, as the arm goes into abduction, then the propensity for that greater tubercle to hit that a chromium is much, much higher leading to injuries that we were talking about. So all of this gives us actually protocols to be able to treat this, but for right now levator scapula is going to be a big one to do. Um, and we will talk about exercises here in a second. Brian, do you want to add anything to this?

Yeah. So, uh, the main thing we’re looking at those is very, I guess, biomechanical, we’re looking at particular muscles in this case, the levator scapula and how it’s going to elevate the scapula and how it’s going to tend to hold the scapula into that downer rotation of it’s shortened. It’s going to prevent the scapula from being able to follow the arm position, right. That would be normal movement to help keep that space between the acromion and the head of the humerus, uh, open. So it doesn’t pinch structures like the supraspinatus tendon, the bicep, uh, biceps tendon. So you’d want the scapula to be able to come upward and upward rotation as you’re going into AB duction. But if it’s kind of held too firmly in place by an overtight levator scapula and maybe some other structures, then it’s going to prevent that scapula from moving and then the arms going to bump into the chromium and, uh, that can lead to a lot of different pain patterns of the shoulder.

So that’s a very biomechanical view. That’s great, that’s great information and of itself, but then we have to remember that we have this whole, you know, really beautiful, intricate channel system. And, uh, the levator scapula, the muscle we’re kind of looking at in this case is a muscle of the small intestines and new channel. So we can needle it at the motor point, but we might include small intestine channel points to help contribute to a more thorough therapeutic outcome. We started with the elevated ilium, uh, and the quadratus lumborum is a big muscle that’s involved with the elevated ilium as are the AAD doctors, the thigh and hip add doctors. Those are muscles of the liver sinew channel. So we have this midday, midnight channel relationship that’s involved with, uh, maybe this local problem. We have a very, um, more comprehensive channel perspective that we can look at and start including points to directly affect the elevated Lam like the quadratus lumborum like add Dr. Longest liver channel points, maybe something like liver five, um, in combination with small intestine channel points and more local needling at the small intestine channel sinews. And then we can add other points in our acupuncture treatment based on the specific injury and other things we’re finding and you know, this person, blood deficient or inefficient or something like that. So this is starting to paint a more of a comprehensive picture that we’re looking at.

That’s something we find a lot in our own clinical practices, looking at the midday and midnight relationship between the liver on the small tests and channel, especially when there’s a shoulder abduction problems, such as what we’re seeing this slide, um, elevated ilium and shoulder abduction problems, pretty darn common. You’ll see that a lot in the clinic. Um, if you would, when you’re looking at the scapula, you guys, I take a look at that superior medial border of the scapula. That’s where the levator scap is going to be attaching where many people have that five Brodick tension in there that many of us will go ahead and needle right through that, um, that levator scapula, as we talked about before, it’s going to be attaching to the C1 through C4, transverse processes, attached to that. Then it goes down and it travels to the superior medial border.

Like I said, it blends in seamlessly with the super spy Natus muscle that’s located in the supraspinous fossa in this particular image. If you go disorder, large tests and 16 would be, then you’ve got large and tests and 15, just on the other side of the chromium, hopefully you guys are following along with this large test at 15 is where the super spine Natus tendon is going to be attaching. It’s usually about a quarter of an inch to an AF, probably five, eight, five eights of an inch wide blending into the capsule and attaching right onto the, um, a greater tubercle. Then from there, you’ve got your triceps part of the small test of senior channel, and then also going all the way down to flexor carpi on narrow switch. We talk a lot about the flexor carpi on there. Motor point is a magical, yeah, I’m going to use the word magical because it is empirical point that will soften the, um, a distal attachment, uh, levator scapula 99% of the time when you do actually get that flexor carpi on there’s motor point, right? It will soften that attachment side pretty dramatically. And this is something that we’ve been teaching in the program for probably about 10 years or so. It’s a really nice disappoint to use with levator scapula, shortening and pain at that proximal attachment. Brian, you wanna say anything else before we go on?

Oh, no, that’s good.

They were actually kind of moving right into, uh, exercises now. So the next slide, please.

So

Last month, these were some exercises or exercise, different levels of the, um, figure four crossover. That’s working quite a bit on the piriformis, this exercise. And a lot of the exercises that we use are based on [inaudible] work. Um, what we’ve done is we’ve actually looked at the different angles as far as the functional anatomy, the sinew channels, and we’ve modified his work, which actually happens quite a bit with people’s methods and techniques is that other people have good ideas about it. And then just kind of form it in a slightly different way. But we did want to give a shout out to Peter Garcia for his miraculous work and an exercise prescription, what he’s done over the years. Um, so again with this, this is what we’ve done for the elevated ilium one exercise, and that’s going to be discussed a lot further in last month’s podcast. And also we have a blog about it as well in the sports medicine, acupuncture.com website. Let’s go to the next side. We’ll talk about exercises where we can use for a levator scapula or a superior shifted the, um, this exercise for, um, elbow press is an exceptional exercise. Brian, do you want to start with that or do you want me to go?

Um, I can start and there’s a little bit of a, um, dialogues of you need to go back and look at it after the recording it’ll give a step-by-step, but the idea is you’re giving a little bit of a press of the elbows into the floor, but more importantly is you’re bringing this, the shoulder blades, the scapula together. So towards the midline in down. So, you know, in this case, levator scapula is going to tend to pull. It might be on one side, but pull that scapula up. So you’re D pressing using lower traps and using, uh, the, the rhomboids and middle traps to bring the shoulder blades together and down. So it’s the same time opening the chest and dropping the shoulder blades.

Hmm.

I don’t know if you got one dad, anything else about it, Matt?

Yeah, I was just looking at the image and how hands and Ian is enjoying it, and it’d be what the scapula is doing. And then 10% of it is going to actually be pressing into the floor. So this is a strong scapular stabilization exercise that works great after needling, um, or doing acupuncture to the levator scapula, pectoralis, minor, small tests and senior channel, um, a number of different points that we could use with this one. This is a simple exercise and kind of a triple star exercise that you can use even to advanced people, um, because it does require quite a bit of concentration to really get those scapulas to really form down and lock in. Then the next exercise is actually called just a second. Uh,

This is a short format, so we can’t go into too much, but, uh, if you go back at some point, if you want to look at the recording and look at the movements of the scapula, we were talking about levator scapula, but pec minor muscle of the lung sinew channel would be involved in a lot of these too, because it’s the antagonist agonist, antagonist relationship with levator scapula because it’s going to depress the scapula. So if it’s really short, maybe the levator scapula has to fight against it, but it also works with the levator scapula and downward rotation of the, of the scap. So I like this exercise in this case also because of that, um, opening and lengthening of the pec minor and kind of normalizing the tension of that, which is kind of a, not the direct channel we’re looking at, we’re looking at the small intestines in your channel, but how maybe the lungs and new channels coming in and relating to this picture, this exercise would be given after the acupuncture treatment. So maybe we’ve needled the pec minor on that side to make it more, um, accessible for the patient right away, you know, their body’s ready for the exercise kind of prime because we’ve reduced, um, tension in the pec minor and allow, or allowing them to more effortlessly do this exercise. Yeah. Cool.

And Brian, I’m sure we kind of rushed with this. There’s a lot of things that we really didn’t talk about. Like the lower trapezius being an antagonist to the levator scap elevation and depression and the literature, easiest being large attachments in your channel. So a size to be able to see that internal and externally related channels of the lung pectoralis, minor, lower trapezius, large intestine being called into Plex. What does that mean? Well, in our mind, if you would needle the motor points of each one of those, you’re already signaling those two mild fascial Sr channels. So therefore if you compliment that signal with more acupuncture points, adjacent and distal, it has to have an effect on those particular muscles. Cause it’s the signaling system that we use in acupuncture. Brian, you must anything about that? That’s good. All right. Cool. All right. So again, um, this elbow press is a great exercise to use as a preliminary exercise. So what about the next exercise please?

Yeah. Okay. This is one of our favorites. I would say triple star, maybe even quadruple started this. Um, this is an exercise that takes a lot of concentration and how we modified it a bit from how it was originally taught is we are increasing the, uh, or decreasing the thoracic flection. So we’re increasing thoracic extension. Let’s walk through that. So the first position the person’s going to have their knuckles on tide young, usually the middle finger there. They’re going to keep the wrist straight. The elbows are going to be out. As you can see, the knees are going to be at 90 degrees and hips are going to be at 90 degrees. We asked the person to go ahead and bring their elbows together toward the ceiling, keeping their fingers right at Thai Ong. All right. So by them doing that, you’ve got scapular protraction.

Then we ask the patient to begin the movement back down, bringing their elbows back down, leading with the rhomboids, leading with that medial border of the scapula and start to bring them together. All right. So you’ve got protraction and retraction. This exercise is really getting the agonist and the antagonist of those muscle groups working together. Now the emphasis, once the patient is able to do this success, now we actually increase it a little bit. We ask the patient to bring their elbows together when they’re going up to the ceiling, but above their nose. So what I’ll do is I’ll actually put my finger right above their nose and try to have the patient, bring their elbows up toward the nose, which is very, very difficult in order to do that. You really need quite a bit of thoracic extension, which is a wonderful thing to do when somebody has thoracic flection in those upper vertebrae, right?

For example, in upper cross syndrome and that head is forward. So this is a great exercise for that. It’s gonna, it’s gonna work the levator scapula quite a bit, a lot of the scapular stabilizers. And it’s, it’s definitely one of our favorites to use. This is also something that you may want to use with somebody who has upper jaw problems, for example, asthma or any kind of, of, uh, lung problems after COVID maybe C O P D, because how it’s working the front, move in the back shoe points and getting those muscles to be able to work in coordination. It’s going to work the channels as well and coordinate the channels.

Yeah. We had a question, uh, regarding this one, if somebody had a difficult timeline on the floor, so we cover stuff like this, a lot in the program where we have a multiple amounts of different exercises that can be done. That would be maybe a simpler exercise. If it’s somebody who has a difficult time of getting on the floor, cause maybe they’re not very conditioned. So I might go with a more simplistic exercise, but there is an actual variation of this, this, this exercise that that’s a little different, but it’s the same concept that can be done seated with a strap. It’s a little bit more isometric where you’re pushing out against the strap and lifting and doing some similar, similar, uh, focus. Um, but that would be, uh, adequate for somebody also, if, if that was, uh, you know, they were ready for that exercise, they could do the seated. Maybe they can’t get on the floor cause they have a shoulder injury and they, they can’t support himself. So you can definitely adapt this one to a seated position or you could just give them a more simple exercise.

Yeah. Cool. Good one. All right. So then what we talked about last time was using acupuncture as assessment, but also, um, using intradermal needles for increasing range of motion or decreasing the amount of pain during an exercise. For example, if somebody is having a hard time appropriate deceptively, trying to figure out how to do this exercise, or they may be limited in their range of motion, kind of stuck, or perhaps they’re feeling a little bit, um, slight pain or minimal pain with it, but it’s inhibiting them from doing the exercise. This is where intradermal needles on actual ordinary vessel points, but also you can use channel points to actual ordinary vessel points works pretty, pretty darn amazing. This is something that we teach in this program. And for those of you that have the sports medicine acupuncture textbook, let me think it’s in chapter four toward the end with, uh, exercise before treatment and exercise after treatment using intradermal needles. So it’s in that section chapter four. So what you’re about to see is a video of the smack program and the postural assessment and practice exercise. And there is a student there that’s having difficulty with actually doing this exercise. And so we’re applying intradermal needles based on what motion was the most painful or difficult. Okay. So let’s look at the next slide, the movie.

Now we know

That you can’t hear, let’s just read

[inaudible]. That is so awesome.

Yeah.

I still love her expressions so far. Um, yeah, so we can probably advance it to the next slide. We use a pine X needles from Sarah and, and you can get those from Lhasa OMS. Um, the point to a millimeters by 1.2 millimeter, um, that’s some of the best ones because it’s large enough to be able to create a sensation, but not large enough to be uncomfortable during movement. So those seem to be worked out pretty well with us. Yeah.

Uh, you can send them home with, uh, I mean, to keep them in for the patient for a few days to, while they’re performing the exercises to assist, you know, to keep that stimulation going. Yeah. Cool. Well, great. I think that’s,

Well, I mean, we could talk about this for hours, but no, I have, it’s regarded gone six minutes over that. So, um, thanks very much you guys, and I think we’re going to be scheduled again in February or March. Hopefully we’ll see you again then. Yeah.

And the next week, uh, Sam Collins is on, I’ll say I was going to be there. Awesome. Yeah,

I talk he’s, he’s hilarious. He’s really quite a sharp as a tack and he’s, he’s fun to listen to. So thank you very much. The American acupuncture council, Brian. You’re awesome as always. And thanks you guys. And hopefully we’ll be connecting again soon.

All right. Great. Thanks everyone. Goodbye.

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). Twitter (https://twitter.com/TopAcupuncture) If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

 

Exercise Prescription for the Acupuncturists – Callison, Lau, Armstrong

 

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Right.

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

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

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

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

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

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

So,

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

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

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

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

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

S

So should we maybe move on to the rotational?

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

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

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

Sure. Good idea,

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

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

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

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

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

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

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

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

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

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

Go for it again.

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

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

Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[inaudible].

 

Chondromalacia and Patellofemoral Syndrome: A Jingjin Perspective

 

 

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

Click here to download the transcript.

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

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

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

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

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

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

There we go.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Okay.

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

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

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

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

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

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

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

I brought you want to go over that short exercise?

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

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

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

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

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

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

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

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

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

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). Twitter (https://twitter.com/TopAcupuncture) If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

Brian Lau and Matt Callison

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

Click here to download the transcript.

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

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

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

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

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

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

So we have

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

Brian, next slide. And

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

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

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

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

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

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

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

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

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

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

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

I change in those related channels

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). Twitter (https://twitter.com/TopAcupuncture) If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.