Tag Archives: Matt Callison – Brian Lau

Exercise Prescription for the Acupuncturists – Callison, Lau, Armstrong

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Right.

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

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

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

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

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

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

So,

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

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

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

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

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

S

So should we maybe move on to the rotational?

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

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

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

Sure. Good idea,

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

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

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

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

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

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

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

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

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

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

Go for it again.

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

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

Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[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.

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Brian Lau and Matt Callison

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

Click here to download the transcript.

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

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

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

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

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

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

So we have

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

Brian, next slide. And

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

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

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

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

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

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

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

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

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

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

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

I change in those related channels

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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