Our show for today is because I became very interested in Yamato’s new Scalp Acupuncture, and I heard great things about it.

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.

Welcome to this week’s American Acupuncture Facebook Live podcast show. I’m your host, Poney Chiang of neuro-meridian.net. I’m joining you today from Toronto, Canada, and today my guest is David Bomzon. And David is a Chinese therapist and lecturer who specialized in acupuncture in neurological rehabilitation, and is considered to be the leading authority on rehabilitation acupuncture in.

David graduated from the East West College of Classical Chinese based in Tel Aviv, Israel in 2006, and is a former student of Dr. Toshi Kasu Yamamoto, the discoverer of Yamamoto new scalp acupuncture. David. Together with Avi Amir, established the NEMA Center in 2007, which is the largest community clinic in Israel for integrated Chinese medicine, which combines classic Chinese medicine.

Yamamoto New Scalp Acupuncture with Western Medicine. He also established a unique support center at the NEMA Center, which provides continued professional enrichment as well as professional guidance to new graduates and experienced practitioners in the field of complimentary medicine. David is a lead acupuncture in the rehabilitation department in the Benig Zion Medical Center in Haifa.

And David is involved in clinical. Which is investigating the benefit of Y essay in neurological rehabilitation in 2020. Together with Avi David published the book entitled Clinical Handbook of Yamamotos New Scalp Acupuncture. Throughout his career as a therapist, lectures and mentor Deborah has published, has pushed for the integral combination of acupuncture, Chinese medicine, and scalp acupuncture.

And the reason why I’ve invited, To our show for today is because I became very interested in Yamato’s new Scalp Acupuncture, and I heard great things about it. So David, welcome. Thank you for sharing your time with us today and and how are you doing in are you in high far right now?

No. Hello Pony. Thank you for inviting me. I’m I live, I’m not far from my home. I live in the Galilee. I’m 45 minutes commute from. . Okay, great. Can you tell us about Dr. Yamamoto how did he research and discover this form of acupuncture? Dr. Yamamoto is an amazing amazing European amazing person.

I learned a lot from him. He actually started at he special. He didn’t come from the field of acupuncture, and he started actually on the field of anesthesia Anology. He studied anology. He finished in Japan. But in his travels, he traveled to the United States, and then he was in Germany for a couple of years.

Years. But then he, after a few years abroad, he came back to his hometown nana, where he opened the practice and clinic for. Pain management and basically with one of the patients there, he found himself stumbling onto the world of acupuncture. Due to, he says it was an accident, the kind of an accident that he had of a patient that when his patient had a lower back pain with disc and when he looked for an sensitive area to inject the neuro block, he was injecting Lido.

He gave her injection, but he only injected the cell line to the patient. And the next day when the patient came back, he was pretty sure he would be sued for medical malpractice. Cause he only realized in the evening of that day that he never injected any medicine Okay. And act. And actually she came to thank him and say that the pain was gone and she feels amazing.

And that was his first kind of encounter with Acupunc. and then he started studying for himself acupuncture. He was very much influenced by the idea of microsystems. He learned nasal acupuncture or Rico acupuncture, suzu, which is the hand the Korean acupuncture of the hand. And when in 1970, he, when they first published about the GI style scalp acupuncture came out, he went and he studi.

And he started using it in his clinic. He said it took him a while to really specialize and get the results he was looking for with the GL style. And then he basically, if we familiar with the G style, you have the motor and the sensory lines of the area of the ELOs area. And when a patient came to this clinic that was suffering actually from a shoulder pain, like a frozen shoulder.

And actually he had his head when he was looking for the points, he had his hand roundabout here on the patient. And this area is very tender for that patient. And when he pressed down on it, sudden the patient felt some release of in his shoulder and there was more mobility in the shoulder with yours.

That’ll become yamamotos, first point he ever discovered. And then Yamamoto is very curious. Very imaginative and always looking for the, because of the influence by this mirror reflection and the microsystems, he started searching for more points on the area of the scalp for treating different areas in different parts of the body.

And he actually started connecting the dots between the Chinese scalp, acupuncture or even D 24, which is a point that affects the mind. Okay, so D 24, we know it affects the mind. And he said, okay, if I have the mind here and the head, then slowly, if I go down, On my hairline, I’m gonna discover more and more points.

And then he goes to the area of the shoulder, which was the area of C, and slowly discovered 5, 7, 8 points. From that, the whole system developed to about today there’s comprises of about 60 points, I think, which is divided into different somatotypes and microsystems in a large microsystem system.

So that’s how we discover. Okay. You might, you mentioned Somato. Is that one of the underlying principles of wine essay or is it possible to generalize? You mentioned Microsystem any my understanding is that they, there’s actually several microsystems in this system there, several Somato Topes.

Can you comment about just introduce the US to sort the jet the broad strokes of the system. So we have, it’s, Yamamoto always mentions that his system is more of a microsystem. Which is divided into little groups of somato tops, which the first group is like the basic points, which is very as you can see, points that affect the body, like the physical structure of how western medicine sees the human body.

The next group is like brain points, so you can affect, the idea is to affect the brain in some. Some manner, but those brain points do not like that. You don’t match the neuroanatomy of the areas of the bone or the anatomy of the brain. Okay? So that’s the second group. And then you have what’s called the ipson points, which is another group of points, which actually is here is the connection to the organs and the channels.

And then you have cranial nerve points, which is actually a mixture of the Ipsy lung points with the brain points from my. All these just little microsystems that developed with the yours that not necessarily, some of them are on the scalp. He has like a microsystem on the, around the Mals area of the foot, but on the cervical of, sorry, on the spinal cord.

He also has a Soto top, the chest area. But the idea is always looking for different areas to affect different parts of the body. And you really see it in his practice that he’s always trying, Be very open minded and if something doesn’t work, he’s always gonna look for something else. And this is why.

Kept on discovering more and more points. . Okay. What type of patient would you say best benefit from Y nsa? First of all, I forgot to mention that Yamamoto style acupuncture is based on palpation based acupuncture. You have also spread out throughout the body diagnostic areas that tell you which group of points, which points to needle and which areas to needle.

Forgot to mention that. But the patients that benefit from Yamamoto scalp acupuncture, also from clinical research at the Doctor Yamamotos done, and also from research that I’ve been doing in my practice. Mainly, first of all, pain patient. It’s very good instrument for managing pain management. So it’s fantastic for that.

And this is what it was developed for. But also I found, and also Dr. Alo for different types of neurological disorders. It could be stroke, Parkinson’s, like I work also in a Parkinson clinic in the rehabilitation center. We found it very useful. It’s a special point for Parkinson. There’s also multiple sclerosis, any orthopedic car accident or nerve damage to the spinal cord.

So it’s very diverse in treating neurological problems and pain. And in rehabilitation, the advantage is that once you needle little scalp, you can do, the patient is mobile to do his activity or his practice. So actually you’re getting like one plus one is worth two, is two and a half, three.

So that’s the advantages of it. So let me just backtrack a little bit. So it seems like one of the things that’s different is that it’s very how patient informed. And and I’m I’m very pleasantly surprised to hear that Dr. Ya Moto has anesthesiology background and has studied gel style of Chinese scale acupuncture.

I have found that in my encounter with western medical practitioners that have interest in a acupuncture, a lot of times they come from I’m more likely to see anesthesiologists and neurologists. Being more open-minded towards acupuncture because they work the nervous system. They understand pain from a neurological perspective.

And so I’m pleasantly, happy to hear Dr. Yamamoto brings the neurological understanding and perhaps that’s why the system works so well for neurological conditions now. Is it possible for us to give you, give us a little bit more understanding as to. The young public acupuncture might is different than gel style or any other form of c acupuncture that that you’ve encountered?

I know there’s not, there’s probably some similarities. Just for the interest of the listeners who may be interested in learning to teach Yamamoto style, maybe they already learned J style and jazz style. Why should I yet learn another? If you can comment on that.

I’m also familiar with the juice style and GI style. I also use it in the hospital. But I found that one of, one of the things that first of all he always mentions that his system is more of a microsystem. And it’s less like based on the he or the anatomy of certain areas of the brain. If you go words like GI style, if you look, if you go deeper research into GI style even you, I think I watched the video of yours pony that you spoke about, let’s say the core line which has with the pre motor area of the brain.

Yeah. So it’s actually based on the neuro anatomy in general. The. J takes it also to the understanding of a Chinese diagnosis, which is important. And Yamato, if you look at the areas of the points there, like not much of the points in the zones match the neuroanatomy of the brain. , or if maybe if we dig research and found more discoveries about the brain, we’ll see that there is some type of batching of that idea.

So that’s the first difference. The second. The second difference is, so also the needle inside is not usually contralateral or lateral. Usually it’s the side that is chosen is according to the diagnostic zones that are, or in the abdomen or in the neck or in the elbow area. That tells you which side, which points need to be needle.

So that’s also a big difference between the Yamamoto and the Chinese scalp acupuncture method. And also the needle in technique is very different if in the scalp acupuncture, you have to have a thread in motion and then you gotta basically manipulate the needles could be dwelling or even pumping.

Yamamotos style is more acupuncture points. So actually you just, you need all the points perpendicular. , it’s not necessary to stimulate the points. And I once asked the Yamamoto, you need to needle the point, the stimulate the points. No, it’s not necessary to manipulate the points. Cause any movement of the mimics is actually moving the fascia below that the needle in that is actually causing the stimulation that you need.

So that’s one of the, another great big difference between it. So you could say, in some cases for us, whoever starts out, it’s more friendly for the patient until you become very specialized with the Chinese. So that’s very useful for us to know. A lot of the scalp acupuncture systems in particular the Chinese ones require you to have your own TCM or Western biomedical diagnosis.

Sounds like Yamamoto style has its own system of diagnosis. And and I actually. To, like hearing that the kneeling does not require a lot of stimulation and a lot of threading because that generally is a bit more uncomfortable. And if you work with children, let’s say if you work with cerebral policy or autistic children you wanna do it fast.

And just, put the needles in so that there’s less fuss and better cooperation with children. So I can see how the YAMA model style might actually be more practical in, in, depending on the type of patient demographic that you’re working with. Would you be able to give us a a clinical story or something that, you was maybe memorable in your experience applying Yamamoto maybe early on when you started doing this for the first time or in your rehabilitative work right now?

Something that like, really even for me, I practice a long time, but I still get like amazed and find acupuncture miraculous every day. Inspires me, please share with us something of that nature with Yama style that you felt you really changed some patients lives. So the story goes back I’ve been practicing acupuncture from 2007, so three years in Yamamoto from 2009.

And when I started out in my early time years of Yaba motto, I was actually called to come to a house, call on a patient who had a stroke. We’d speaking about five years after the stroke, and he had aphasia, motor aphasia. , and he’s around 80 at that time. And actually what they wanted me to try and treat, they heard that scalp acupuncture is very useful for aphasia and if I could come and try and help him.

So I decided I went to help him. Now, one of the things that the patient. He also had some paralysis of his shoulder, of his upper extremity of, I think it was the, if I remember correct, it was the right side. So if he was standing, his hand was like down here. He could’ve moved more than this of his hand.

So I came to I came to do the treatment and I’d done my diagnosis, I needle. Actually three points. One was like what’s correlated with the cerebrum and the cerebellum points according to, because of the diagnosis. And another point the area of actually the cervical spine. Cause you have the diagnosis.

And I think immediately after about the three needles, I said, okay, let’s see if you can speak. A lot of times the speech takes a long time to impair or improve. So I wasn’t basing myself on the speech. Just move your hand a bit. And he took his hand right up to his mouth and he just bursted out crying, right?

And this was, and I was like trying to keep my cool and say, oh, it works. But I was totally amazed. Like I was blown away, said Wow. And and that was a story with this patient that we just con and. Speaking five years after a stroke that he’s never moved, his hand moved more than maybe two, two to three inches.

Right? And now takes it up to his hand so he could even now attach a prop for him to eat now. , he saw as a mace, like that result. Wonderful. I’ve always like to ask them, my guests to share a couple of clinical pearls or techniques. I know it’s a very complex in depth system, but just to get, our viewers interested, inspired to maybe take up proper training in Yama style someday.

Some give us a couple of tricks that we can apply maybe. This AF today or tomorrow so that we can see and appreciate and admire the power of Yamamoto staff acupuncture. Okay, great. I’ll be thrilled to do so what some of the points, if you don’t wanna use diagnosis, you can use very much symptomatically and they amazing points and they have an amazing result.

The first point is actually what’s called the D point. Is located on the interior hairline. Okay. If you can show me the image. Okay. The first image, Alan sorry. One minute. Something’s knocking loud at the door. I wanna stop them a second. Sorry about this. And he’s saying it’s

And ready. Sorry about this. We’re meant to finish. My son’s calling me. So if you can see the D point here in black, it’s on anterior hairline. It’s very, and it’s about a centimeter above the zygomatic bone, okay? And it’s very powerful point for treating lower back pain or any problem of the lower extremities as well.

So it’s a very good and useful point that you can use in your clinic already. So this is how it easy, you can see the bone structure there. If we go to the next image, Allen you can see this is how it is with the ha of the hairline. So you can see it’s right on the hairline, it’s on the interior hairline and about a centimeter above the zygomatic bone.

And what you wanna do here is look for a very sensitive point and then needle that sensitive point. Okay? So that’s how much, how deep insert. Not not more than not more than a soon. So you’re looking between half a soon about insertion. Okay. Okay. But you can even help, you can even palpate it and push pressure on it and ask the patient to move around.

And if it’s better or the back, you just needle that point. It’s another way you can locate it. So that’s first point. And no simulation, just, and do you retain for, is it in and out or do you retain for some time? 30 minutes minimum. Okay. You can leave it fall per longer. The next point is actually what’s the a point, which is right here just on the line of the bladder channel, bladder three around bladder three area.

If you can see the image here in blue. Which on the line of the bladder three area, which is, let’s say the hairline, that’s gonna be the area of cervical. Cervical three. Four. And if you go about one centimeter up, you’re actually going up towards the head. So the superior part is about the head. And as you go down with that line, you’re going down from cervical one down to cervical eight, which is about a centimeter out of the hair.

And also you look for the most sensitive point on that line and you needle it. And if you need a couple of points, you can needle a couple of points, and that’s very useful for any cervical pain. Okay. Do you how they bilaterally? Just see which side is the most tender. Because we are not using the diagnosis here and we basically using it according to the symptoms, so you need a lot on the side that you have symptom.

For example, if it’s on the left side, you’re gonna need all these points on the left or on the right side. The same with the D point. Okay? And so they’re very useful and I hope you have great success for them and found yourself in charge and enchanted by this wonderful method and this wonderful human being.

Yeah, it sounds like it’s very practical and very easy to apply. And then so I’m gonna look forward to to trying out today. Unfortunately that’s all the time we have. Can you tell us some information about where we can find out more information about you? Do you have a website or social media?

So this is my website ww doma ac.com. So you can found a lot of information there. Also on healthy seminars, I have a online course, so you can go there. You can follow me on Facebook, YouTube, just print my name. And if you take my, I have a a Facebook page, which is actually just the pnima-ac ac and that you’ll get to my Facebook page as.

Excellent. Thank you so much for generously sharing your time with us and being so kind with your, sharing your knowledge and and I look forward to studying Yamamoto style with you in the near future. Hope so soon. So an honor to meet you in person pony, online person, . Yeah. Finally, after so many years, I’ve been following.

The the admiration is mutual. Thank you very much. Okay. Enjoy and what connects soon. Yeah. Thank you. Have a good evening.

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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.

As our viewers can see the title of our talk today is Prolo acupuncture, and I’m guessing that stem from prolotherapy, but I’m not sure what that is. So you can tell us what that is.

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.

Hi, welcome to this week’s Facebook podcast show for the American Acupuncture Council. My name is Poney Chiang from neuro-meridian.net. I’m talking to you from Toronto Canada today. My guest is Dr. Anthony Von der Muhll who is joining us today from Al Cerrito, California. Anthony Von der Muhll graduated from the five branch university of TCM, 2002, and founded as Santa Cruz, acupuncture, orthopedic and sports medicine connect in three.

He now practices at the sports acupuncture connected in Berkeley, California. Anthony’s one of very few acupuncture in the United States with extensive experience serving as an expert witness for the California acupuncture board and civil mal. Practice litigations. He emphasizes the highest in safety.

Ethics is sustainability in his classes. He’s the founder of AOM Professional. Has taught certification acupuncture, orthopedics since 2015, he has served as a clinical supervisor at masters in doctoral levels for close to 20 years. And he has taught acupuncture, orthopedics and pain management programs at the doctoral level for.

Numerous, very highly prestigious academic institutions across the United States. I’ve invited Anthony to join us today for interview because he has a lot of experience with the, with orthopedics, but he does something that very few people talk about, which is using acupuncture to increase joint stabilization and increase joint mobilization.

So it is my honor. To have you here today, Anthony, my honor to be here. Thank you very much for the invitation let’s get started. As our viewers can see the title of our talk today is Prolo acupuncture, and I’m guessing that stem from prolotherapy, but I’m not sure what that is. So you can tell us what that is.

And how is pro acupuncture differs when. Yes. Yeah. Great question. Yeah. This name, Prolo acupuncture is basically what I call it. There, isn’t a a defined name for this technique in some classical text, but the technique has its correlates in ancient Chinese medicine. As best we can tell, or at least I can tell from reading descriptions of kneeling techniques, but I happened to learn it through a rather different route, which was another acupuncturist.

Who had studied extensively with I think primarily osteopathic physicians. The acupuncturists I learned from was Alan Marcus, who is now retired who specialized in orthopedics and what he learned from studying with some osteopaths and sports medicine physicians is the technique of probing lax, ligaments, and joint capsule.

To bring about tightening and re stabilization of the joint. And the same technique can also be used to remobilize a joint that is lost range of motions, say through adhesive capitis or joint contractual osteo. Although those are more difficult to treat than a joint that is simply lax in a, in, one or more planes.

And so the derivation of the name again is, proliferative therapy is the term is used by physicians who use this technique. Typically they’re injecting an irritant solution of some sort like Dex or salt water, or sometimes they have cocktail like MSM or Conroy and sulfate and they’re.

But a lot of the effect is actually from just simply the needle itself is the mechanical and various neuromuscular reflexes that occur from. Needling into particular tissue. And so it can be done with a dry needle, an acupuncture needle, a filoform needle, or sometimes occasionally a seven star needle.

Interesting. Are there any indications, counter indications for this type of technique? Yeah. Good question. So the indication is very simple, but it’s not intuitive. The indication is simply a joint that has an abnormality either hypomobility or hyper-mobility in one or more planes, not pain.

And so that I’m emphasizing that at underlining that because we are so wired by our training and education to to think about only pain and to respond to patient’s complaints about pain. But pain is a complex multifactorial phenomenon and there’s all kinds of ways to treat pain. But this is a technique that is very specific to restoring the function and the integrity of joints, which in my clinical experience.

And there’s a lot of, other clinical experience and evidence to support this, that joint hyper mobility or hypo mobility. Can be at the root of a lot of chronic pain and disability. So in some sense, it’s an indirect method, but the benefit of focusing on the joint rather than on pain is that you’re improving structure and function.

You’re not just providing temporary relief for addressing psychosocial factors that contribute to pain, which are important, but. Pain tends to come back until you improve structure and function in certainly in my experience. And so that’s why I gravitated to this technique is that it seemed to have a longer lasting effect on not just symptom relief, but actually bringing somebody back to their full functional capacity in everyday life work, et cetera.

That’s very interesting. Yeah. I I never thought about, stability or instability. Independently from pain. And it’s definitely making me very curious about the your method and your instruction. I’m curious about you mentioned seven star and needles.

So we can use this with our existing toolbox. There’s no special, copyrighted trademark products. I have to buy to, to take these courses. Okay. That’s very cool. Having said that, are there certain tools that you find work better for this. Sure. Sure. That’s a great question. So the one thing that’s a little different from what many of us are, were used to or experienced at say the master’s level training is that in general for probing deep into larger joints, we often used need to use larger gauge needles than some of you might be comfortable with.

And certainly I was comfortable with initially. And I’m talking, for example, a very large joint, like the knee joint, where we can do a lot of good in restabilizing a stretched out sprained anterior crucial ligament. I may use a 24 gauge needle. That’s much thicker than the 32 34 36 that are common in in more superficial acupuncture.

Using, classical locations. But the thickness and the stiffness of the needle are important because I don’t want that needle to bend or worst of all break off inside a joint. And I actually have better control and ability to direct the needle that might sound like it would be much more painful.

And actually repeatedly from both patients and my fellow practitioners to whom I’ve taught this technique, the response is surprisingly, it actually does. It feels different. It’s more like a blunt probe and a little less sharp and pokey than a very thin gauge needle. So it’s not necessarily any more painful.

It’s just different. So what type of a gauge are we talking? That’s at one end of it is a, a very large joint, like the hip or the knee on a large patient. I may need, I may reach for a 24 gauge needle, but more typically I’m using, a 30 gauge needle, a 28 gauge needle on small joints, like the fingers, a 32 or even a 34 will work.

Okay. But a deeper, larger joint needs a stiff. Thicker gauge needle to be both safe and effective in my experience is is the technique completely manual or is there like electrical stimulation in conjunction or depending? Sure. Good question. The answer is no, it doesn’t depend on anything else.

Besides the mechanical probing with your hands electrical stimulation can be useful for a patient who does have a lot of pain at the site of the joint hypermobility or hypermobility, but the essential technique. Itself is one of the reasons I began using it is that it works very fast. Under a minute worth of probing with a needle, and then you can take it out and you’ve accomplished your entire treatment effect.

You don’t need to retain the needle. On a very a joint that is badly sprained with, multiple planes that are hyper mobile. I might spend, four or five minutes, probing around till I get the joint stability I’m looking for. But again, once this is a. There is a, an immediate response that I’m looking for.

I can probe for a minute or so, withdraw the needle and recheck the joint through a manual technique called joint play testing, or end field testing. And I get immediate feedback. It’s oh, it’s either more stable or it’s not, if it’s not, I. Probably just didn’t quite get the angle. Right? Didn’t get the needle into the right location.

I can go back in probe around a little more, but with a little bit of experience, you get very fast and accurate at knowing exactly where to go with the needle and getting that re stabilization, take the needle out. You can move on to the next joint, or you can do something completely different. You can, do GU hour cupping or herbs or, treat a different condition like their I or whatever.

So I do retain the needle though on a patient who is experiencing either a lot of post needling discomfort or is just in severe pain and then I’ll hook up the electrical stem and that will provide some additional, that’ll provide the pain relief, but it doesn’t really, it’s not necessary for the effect on restabilizing or Reil the.

To help our viewers visualize, can you describe a little bit of what you’re doing with your hands? Certain change, intensity you’re feeling for, are pecking, are you going through resistance because most people have not learned this technique and we’re not asking you to teach us, but give us some idea.

What is the technical feel or the sensation that you expect the patients to feel while you’re operating this method? Sure. That’s a great question. So the technique there are basically two methods of physical exam that, that. Guide me to where the needle needs to go. The easiest one that comes, that is you need the least training for essentially is simply palpating the joint for tenderness.

And typically it’s the joint line, the crack or crevice in between two bones that span by ligaments and joint capsule. That’s where the palpation is most instructive. And for example the medial knee, extremely commonly sprained, the medial tryout of MC ACL and medial meniscus palpating along the tibio Foral joint line to find where is it most tender in its medial aspect tells me exactly where I need to go.

And then I will take that needle and I’m often asked a question, what’s the right angle is the angle that you need to get into the tender area. That in occasionally you have to be careful about bypassing a major artery, the hip joint, for example, we have to avoid the femoral artery.

So there’s some safety considerations there, but most joints, most of the time, it’s simply finding the tender aspect of the joint line and inserting directly into it. The second method that allows you to verify whether or not your technique has been effective is what I mentioned earlier. The joint play testing, and probably the best way I can do this actually is the, I’m just.

It’s basically a two handed technique, but I can grab a needle here and give you an idea of how I would do this. For example, say on my own, say I, sprained my thumb. And I wanna restabilize an inter financial joint there. And so I will, and it’s perfectly safe to do this on an uninjured joint, by the way.

So if for some reason, your history and physical exam guide you to a joint that doesn’t need this, you’re not gonna do any harm as long as you follow basic safety procedures of clean needle technique. And like I say, occasionally avoiding a major artery that’s in the area. So I’m gonna take my uninjured thumb here and I’ll show you how this would work.

I can palpate along the joint line, say, oh, ouch. And what I’m really looking for is a patient. I actually watch the patient’s face while I’m doing this. Cause what I’m looking for is reflexive unconscious, involuntary grimacing or wincing, not just them telling me verbally it’s tender, but I want, I’m looking for something like this.

I press in the joint line and they go, oh, Wow. Yeah, that’s it. That’s where it’s really sore. And then this is counterintuitive. I know, but remember, I’m not treating pain here. I’m treating structure and function. I’m gonna go right into that tender area. Will it be sore? Yes, actually. That’s how I know that I’ve got the needle where it needs to go.

Is that the patient says, oh, you’ve got it. You’ve produced my typical symptoms. That’s the bulls. And then I know I’m in an injured ligament because uninjured ligaments in joint capsules, oddly enough, won’t really hurt that much. You’ll feel a little poke as the needle goes through the skin, maybe a little pressure, a little mild achiness, but nothing beyond that.

But when the patient goes, ah, that’s it, that’s the pain I’ve been feeling. I know that the needle is where it needs to be. And then I can probe around a little bit pecking, but it’s not hard pecking, it’s more probing. And then. Like I say, typically within a minute, I can just take the needle out, recheck that joint and it’s rest stabilized.

I see. No, that’s very helpful. Thank you very much. Do you find that there are certain joints that you tend to apply your technique more often than others? Like the, for example, in other words, like other which joints in your clinical practice, do you find the most? Unstable and most able and or, or most hyper mobile.

Yeah. Great question. So the I’ll just mention three joints that really were where I first started using this or that really got my attention. I was introduced to this technique by being a demonstration patient for Alon Marcus. Some gosh. 1520 years ago where he, I was having a lot of chronic low back pain at the time.

And he needle into my posterior SAC, IC ligaments along the SAC IC joint line. And, within a couple minutes of probing around the needle, he took it out. I stood up off the table and I was like, Wow. I have never felt an acupuncture treatment like this. Not only was the pain down in my back, but my entire posture from head to toe felt completely realigned in a way that was more comfortable.

And required less energy and essentially to stay standing and that lasted for a good week or so, and then slowly dissipated. Like all of our acupuncture treatments, it does need to be repeated sometimes, but I was so I, I had felt completely different that I was like, wow, I wanna learn something about this, but the two joints where I’ve actually probably used it the most commonly that where I saw the biggest difference in.

Patient’s clinical outcomes was, number one is the acromioclavicular joint that small little crack in between the clavicle and the AROM which is very superficial, easy to find, easy to needle into safe to needle into as long as you don’t needle immediately towards the lungs. And I began to, I was having a lot of trouble with, chronic rotator.

Shoulder, pain and dysfunction and so on. And I was like, oh, that’s right. There’s that technique that Alan showed me, let me try that on the AC joint. And right away, I started getting, instead of 60%, improvement, et cetera, Mo almost invariably, most of my patients. I found through joint play testing had a loose AC joint that they weren’t even aware of.

It was not painful or symptomatic, but needling into it. Suddenly we got stability of that joint full range of motion in the shoulder. Very often, sometimes there was still some range of motion deficits coming from the GLE humeral joint, but improvements in range, muscle strength. Verified through manual strength testing very frequently, fully restored or greatly improved.

And interestingly neck pain also going down because the upper trapes is attaches to the clavicle. And when that joint is hyper Hoag and not stable the muscles around it, overcompensate and tug on the neck. Wow. One needle, one joint, huge regional effect. Couple of minutes worth of probing. Big difference.

Objectively verifiable that lasts sometimes indefinitely from a single treatment sometimes needs to be repeated a few times, but typically will last for months or years without any repetition. After an effective re stabilization. The other joint I’ll mention very quickly is the ankle similar, easy to treat, easy to.

With effects up and down the biomechanical chain from the hip to the foot improved by restabilizing a hyper mobile ankle joint.

Very fascinating. So it’s you have to, if you’re scaffolding, your foundation is compromised, then your muscles are not gonna properly. Improperly it’s different.

Are. Able to share us with us a inspiring clinical story that you’ve had recently, perhaps your practice or from teaching where it was something that, was very transformative. It made a difference. And wasn’t for this technique. Yeah. Yeah. I’ll mention a patient in her mid seventies that I’m actually currently treating , who a long time ago she was in her twenties.

So 50 years ago was an. Obese large person fell on her from, and sprained her superior tibio fibular joint, a small joint. That’s actually part of the calf, but where the superior part of the fibula articulates with the Tal Condi and also sprained her ankle. So she had a she fell sideways onto the ground with this person falling on Herra her superior tib joint, and her ankle.

And her. Couple of small midfoot joints as well, and has been in somewhat chronic pain ever since in her leg. And it’s affected her back and her neck, et cetera, 50 years ago. And and comes to me. And she happens to be medical professional herself has tried a number of different modalities, nothing really helped.

And I should say, this is why this technique is so important because there isn’t really any other technique that can restabilize a hyper mobile joint. You. Repair and replace it surgically, you can inject cortisone to reduce pain and inflammation, but actually changing the function structure without surgery.

This is really the only thing. Guha cupping manual therapy. Won’t do it. Distal kneeling. Won’t do it. So anyway, so I evaluate her calf and your ankle and go, wow. You’re on your superiority, fib joint and your lateral ankle ligaments. Small joint called the Calkino cuboid joint and the spring ligaments on the medial arch of the foot.

All of these are hyper mobile and stretched out from that single injury because they were never treated locally with this type of technique. About three or four minutes a couple of minutes per joint, again stands up off the table. It’s wow. My leg feels completely D.

And I recheck all the joints. Everything is stable. don’t see her for a month. She comes back in, everything’s still pretty good. The superior tib joint needed a little bit of tune up a little more kneeling, but I didn’t have to treat the ankle or the foot joints again. And then I see her, three or four weeks later and she’s can we work on something else?

Now? My life’s doing pretty good. I can. Yes. I love it when you get that oh, by the way, can you also treat this? And it’s yes. Got it. That’s that was super enlightening. I can’t wait to study with you. So if somebody like me wanted to study with you, where can we find out more information? Sure.

Thank you very much for asking and I’d be happy to work with anyone on this technique. My website is www dot a as in acupuncture, O as an Oriental medicine. And I know this is a been a standard term and I’m in the process of actually changing everything in my notes and eventually my website.

But right now it’s www.AOM, A as in acupuncture, O as in Oriental M as in medicine, professional, all is one word AOM, professional.com. And that’s where you can go for information about live webinars, distance learning classes, and returning to in-person teaching this summer, after a couple years off for the pandemic.

Excellent. Thank you. Once again, I’d just like to thank you for your time on behalf of the American Acupuncture, Acupuncture Council, and and to all our friendly viewers out there. If you have any feedback please comment. And and we would love to hear from you. Thank you very much.

All right. Thank you all for your time too.

So in general, I think the physical examination is essential to all of us, no matter what style of acupuncture we practice, especially if you’re treating any kind of pain or injuries.

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

Hi. Good afternoon. My name is Poney Chiang from neuro-meridian.net. I’m joining you today from Toronto Canada. Uh, welcome to this week’s show for the American Acupuncture Council. Uh, my guest for today is Jamie Chavez. Jaime Chavez has been a licensed acupuncturist in California since 2002, and he received his master’s in traditional Chinese medicine and 5, 4, 5 branches and has participated in internships in Beijing, China. He specialized in the treatment of a work-related injuries. He is currently the head acupuncturist in a prominent bay area. Workers’ compensation connects and works alongside medical doctors, physiotherapists and orthopedic surgeons. Jamie is passionate about the art of physical examination and integrates multidisciplinary approach in the assessment treatment of MSK pathologies. Jamie has been an instructor in several bay area acupuncture schools at both the master’s and doctoral level. It was during this time that he discovered his passion for teaching.

Jamie has had the honor of introducing acupuncture to medical residents who periodically shouted him for clinical rounds. He has been a guest lecture for Stanford physician assistant program, and it has been actively teaching physical examination skills to acupuncturist in hospital settings. Jamie continues to find joy in spreading the word about the effectiveness of acupuncture. Also, you may, in case you haven’t know, um, you don’t know, and you should, you, Jamie is also the admin and founder of the Dow, uh, Facebook group, which is discussion acupuncture, orthopedics. So it having waiting to interview, uh, Jamie for a long time. Now he’s a busy guy, our schedules just never coincided. So I’m very, very, very excited to finally be able to make that happen. And, um, and very much looking forward to this, uh, this interview. Thank you so much for joining us. Jamie,

Thank you for having me. It’s a pleasure. Yeah.

So you are, um, the, um, the very passionate about physical examination and, uh, I know, you know, a lot of people don’t do that. And so for those of us that probably need a bit of, um, motivation or, um, what is it that you can tell us in terms of what makes physical examination so important to clinical practice?

So in general, I think the physical examination is essential to all of us, no matter what style of acupuncture we practice, especially if you’re treating any kind of pain or injuries. Um, it’s a way of holding yourself accountable so that you can prove or disprove your own thinking about what you are, you know, thinking is going wrong with patient. So someone comes in with the chief complaint and you gather the data and you think something’s going on, but you have to hold yourself accountable. You have to keep yourself in check and try to, um, eliminate your own bias and, uh, basically try to get better at gaining clinical experience because we’re all researchers in the clinic. And so this is our way to do research. So we want to find things that are reproducible, repeatable, and physical examinations, that bridge, you know, for me.

That’s great. Um, I have heard you talk about, um, uh, I’ve heard that you really enjoy teaching through acronyms and mnemonics and, uh, you know, it was just, we learned by association. So it’s good to have something to kind of associate things with, um, when it comes to, um, physical examinations, is there any, uh, not mnemonics that you think would be helpful for us to, to become more comprehensive in our, um, uh, intakes or in our assessments?

Yes, there’s a ton of them out there. I mean, I’ve, I’ve gathered and tried all these different ones over the years. Um, but none of them really, uh, crossed over and applied directly to an acupuncturist. So, you know, there was, there was missing pieces or the order was not right. So I came up with a mnemonic, um, a horse, uh, H O R S E. And I’ve been sticking with that one ever since. And, um, I can explain a little bit about what each of those letters means. Um, the H is the history of the patient. So that’s, you know, their past history, which is the things they fill out on the initial intake form, but then there’s the present history, which is, you know, regarding their chief complaint, what brought the patient into the clinic to be seen today, let’s get all the data regarding that specific topic.

And then, uh, the, oh, is the, uh, observation. So what do you see from the patient? And that’s now we’re getting into the physical exam skills. So what do you see when you look at the patient? And that usually begins the moment you lays up, you know, they eyes on them when they’re in the waiting room, when you walk them back to the treatment room and then, you know, there’s other, you know, key pieces that you’re going to look for, depending on what they’re coming in to be treated for. But observations really important. I’m very passionate about observation because it’s so fast and you can see so much if you know what you’re looking at. And a lot of times we see things, we just don’t know how to interpret it. So that’s something I’ve been really passionate about over the last couple of years and just really diving deep into it, just diagnosing by looking, um, the are for horses, range of motion, which is essential.

It’s one of the most important things that anybody can start using right away, because it’s so fast and you get so much data from the patient. There’s different types of range of motion. So there’s active range of motion. There’s passive range of motion. There’s resisted range of motion, resisted range of motion could be like your manual muscle tests, right? It’s all in that frame. You know, passive range of motion could be your muscle length tests. You know, there’s many different ways to look at that. And then the S is the special tests. Um, so that’s the orthopedic tests. Some people call those provocative tests because you’re trying to basically tease out where the problem’s coming from. And then the E is explored by palpation. You know, hands-on diagnosing by touching. So each of those, you know, contributes to the horse acronym, and that is the order of operation for me.

So we talked to the patient first, and then when it comes to physical exam, we look at them, we have them go through a movement assessment and that could be active, passive, or resisted, or all of them at the same time, you know, check each one individually and you would want to do it in that order. So active range of motion is first because you want to see how willing the patient is to even move right away. You’re already, you know, gauging where they’re at when you want to do other tests down the road, and then you would do passive next. And then you would do resisted last because resistive could be provocative. It could cause pain in a patient. You always save painful tests for last, because if you cause your patient discomfort, you know, they may say, okay, I don’t want to do this anymore.

Right? Like, let’s stop the exam here. So you’d, and if they’re, if you provoke their pain, you know, it also skews your results for everything else you check, because now that, you know, they feel a little discomfort. Now, everything you check is you don’t know how valid it is. And then for us, you know, we’re acupuncturist. So what are we going to do before we stick a needle? Now we’re going to palpate. So why not do that last? Um, and that in itself, how patient is provocative, it causes pain and patients. So definitely we want to save that towards the end and then go right into our needle. Hm.

Okay. I like that. It’s like from the, from the, uh, assessment, the palpation diagnostics, and it goes transition smoothly into the actual needling component. So it’s, it’s very seamless. Um, I’ve heard of, you mentioned something called the ABCs before. Is that also a type of, uh, assessment or is that something different?

That’s another acronym. So like, you’re mentioning, I love, I love mnemonics and acronyms. Right? Um, what, what you see a lot of, and, you know, I, you know, with social media and things, you kind of get a sense for how well people are able to extract data from their patient. Um, but the ancient horse is the history. And I have an entire course just on how to do, you know, a history. You know, we could talk about that all day, but to keep it really simple, there’s key components that you have to get from your patient when they come in. And there’s tons of acronyms for this. But the one that sticks with me the most is just knowing your alphabet. Cause who doesn’t know their alphabet. Right. That’s like the basics. So it’s, but this part of the alphabet is old. P Q R S T.

If you can remember OPQ Q R S T, you can get all the data very quickly from your patient. So for example, like if you like pony, if you’re on my patient and let’s say you shoulder pain, I would ask you the O, which is, you know, when did this happen? The onset, the O is for onset. When did this happen? And how often do you feel this complaint? Is it 24 hours a day? Or does it come and go if it comes and goes, how long does it hang around before you know, those kinds of things? So that’s the O the P is palliative and provocative palliative means, you know, uh, soothing to the pallet. So something that makes you feel better. So pony, what makes your shoulder feel better? What makes it feel worse? The other part of the P is provocative. Like these are essential questions, because if you tell me it feels worse at night when you’re sleeping, I already know there’s something wrong with your sleeping position.

That needs to be correct. You know, those kinds of things. Can you tell me he feels good, then obviously you’re going to feel good when you leave. When I use infrared heat, moxa, hot pack, you know, we already know what it’s going to help. Um, so the next thing is the quality and the quantity. So, um, you know, the quality of your pain tells us a lot. Is it sharp, dull, achy, burning, throbbing, et cetera. You know, the nature of pain gives us some clues. And then we can go to the quantity, which is like zero to 10. How is your pain right now in this moment that you’re talking to me, you know? And then how is it at its worst in the last 24 hours? How is it at its best then the last 24 hours? So that’s how we could use that pain scale a little more accurately.

And then the RSM LPQ. So O P Q R the R is radiate. Does it radiate anywhere? Is your, is your discomfort localized or does it go to a different area of your body? And this is important not to lead the patient. So if someone comes in with sciatica, I don’t say, does the, does the pain radiate from your back down to the bottom of your foot? Like you wouldn’t ask, you wouldn’t lead the patient, you gotta leave the questions open. Like, does your pink go anywhere else? If so, where and how often, you know, and then T is time, is your symptoms worse during a certain time of the day, morning, afternoon, or night? If you say you keep waking up in pain, I know something’s going on with your sleeping position, or maybe you have some arthritic changes, you know, and they get better as you warm up.

So it already gives you a lot of clues, but what you see as a lot of people don’t gather that data when they present case studies and things, and in the subjective information is key. Like you already have a clue, like a very good clue of what the problem is before you ever laid hands on the patient. If you do that old PQRST. And now when you get into the rest, the physical exam, you’re again, just trying to prove or disprove your hypothesis. So if I tell you, Hey, pony, I think you have a rotator cuff tear, and this is the reason why you have these symptoms, but then you have these data points and, you know, it’s like proving a case to yourself, holding yourself accountable versus like, well, I just heard that pain there means you could have this, you know, like, or I, when I press here at Hertz, like that’s not enough data we need to, we need to be more, um, we need to, to raise the bar on our level of a practice, you know?

That’s great. Yeah. Um, I definitely think that if you, if one does a very good history, um, oftentimes, you know, with some, with enough clinical experience, you already have you already kind of starting to find out in New York, you almost, you’re just doing one or two orthopedic tests to confirm, you know? Um, so, uh, a good history taking can actually, in a way, it seems like time-consuming, people might not want to do it, but it’s actually the opposite. I think that if you did a good history taking, you end up having to hone in faster and you’re going to be, uh, maybe it’d be more, more efficient in your practice. Actually. It’s not, it’s actually the, counter-intuitive not the other way around. Um, um, like for example, um, uh, I like the accountability discussion, you know? Um, because here’s the thing, obviously, as a practitioner, we, we, we always, we sometimes deal with practitioner at patients that are more difficult to say, oh, the pain is still there.

The pain is still there. Yeah. But it’s like 10% of what it used to be. Right. So, you know, it’s, you can’t make a yes or no. You have to, you know, many ways the quantitative or qualify it. Right. It does not refer. So this is how, you know, as meditation is working, but also sometimes the patient needs help knowing that too, because to them it’s like yes or no. Right. And yeah, and now the weird thing is that, um, the opposite can happen. Sometimes they can not be getting better, but they have so much trust in you. They say, say they are better, you know, that happens too. So, so these tests go both ways. It actually helps you, you know, if is actually better than not even though the patient might say it’s better, but it actually may not be. Right. So that’s

A good point.

Yeah. I know. So like,

They don’t want to hurt your feelings. They want to say, oh yeah, you’re doing a good job, you know,

But, uh, but you know, some sometimes, you know, I mean, of course there’s the, the, this, the report is the placebo effect. You know, the attention being heard, you know, uh, you know, maybe we just, I keep putting in needles, we help them to sleep in their, you know, their stress level is better. So indirectly things have gone better, but right. But you know, maybe the range of motion didn’t get better, that sort of things. But, you know, it is, if you didn’t take the time to do these assessments, then you’d be, you know, you’re not really truly helping the patient. Right. So I, I, I’m such a big fan of, um, of, um, these, um, more objective measures and does, so I hope I have a chance to, uh, to take one of your classes in near future.

Thank you. Yeah. Likewise. Yeah. There’s, I mean, the, the objective things is amazing. Cause it’s really the whole story. Like if you just, if you don’t go, if you don’t do that, you’re missing half the story. It’s like going to the movies and walking out halfway through, you’d never even found out what the ending was. You know, like by doing these things, like you said, you hold yourself accountable, you can see the, you know, the full presentation and something that I’ve been really like, just kind of blown away is that the more you do this, you start to understand your patient, the person in front of you better, you understand how they hurt themselves. And then you, you know, as you treat them and they start to get better, you’re able to have a better picture on Tet, you know, how to teach them how to prevent themselves from getting hurt.

Again, you know, it’s like the back pain I’ve been seeing so much ridiculous at the, in the last few months, I think from all the people working at home, sitting too much and things, but it’s always like, you know, their sleeping position, their sitting position or their standing position, how they stoop and twist and things. And then if you can identify the activities for them and show them how to move a little better, it’s like, wow, these patients that have had pain for 11 months over a year, nothing’s helping them after a couple of visits, all of a sudden they just shift, you know, it’s like, wow, okay. Those are the patients that are listening to your advice, you know, and then, you know, your acupuncture treatment and or whatever treatment you’re doing is going to hold better. It’s going to have a better, uh, um, lasting effect because they don’t just go home and immediately do the thing that w was causing their injury to begin with.

You know, so those are, it’s just, it’s so it’s so vital. And before I forget too, one of the things that I think is really important as clinical experience. So I know we always talk about, you know, okay. People like to talk about how many patients they’ve seen, but I look at it as like, how many pushups can you do? You can probably do a hundred really lousy pushups, but could you do like 10 really good ones? And I think that’s the same with treating patients. Can you treat 10 patients really good? And if you can, I think your clinical experience is going to be so much more profound than treating a hundred or a thousand patients very quickly without getting all that data, getting that feedback and seeing what your, you know, your input, what your needles are actually doing. So the more you go deeper, you know, you get a richer, more fulfilling experience that, you know, it’s going to help other people more down the road, you know,

[inaudible], you know, I actually, I find, um, um, you know, a lot of times the patients that come to our practice, um, have gone through the conventional healthcare system, which is not known for spending time with their patients. Right. So how do you know you remember how many times patients say to you? Oh, you know, you, they, they say that, oh, you know, more than my neurologist or, you know, more than my surgeon. It’s not that we know more than them. It’s just that we actually take the time to ask questions and do the assessments. So, but, but for whatever it’s worth that time, that the demonstration of your knowledge and doing the testing, listen carefully, it’s actually building rapport and confidence. So they’re already ready to be needled and treat it right by you. Right. You know, that’s a, that’s a big part of, um, the efficacy. I think that, you know, yeah. Like, you know, you explain what’s going on. Why is the referring for example, right. And this is why I’m going to show you here, even though you, your, your pain is there, but I’m going to need a, you hear that, that you lay out in race, a logical progression, and th they put them put some at and comfortable with you. Right. And I think that goes a long way to, you know, that rapport building is huge.

Yeah. I think that’s it.

Yeah. And, and I think that’s one, um, value of a good history or assessment taking that is, you know, it’s not just a, you know, a left brain diagnostic thing is actually can become a right brain emotional and relationship building kind of thing.

Absolutely. I had a, um, a patient yesterday and she was telling me that she went to another acupuncturist and she had a bad treatment. And then I saw I’m naturally gathering data all the time. So I said, well, what defines a bad treatment to you? You know, I want to know, cause I don’t want to repeat those mistakes. And so, you know, basically she went in for back pain, the patient, the practitioner said, so what’s going on? You have back pain. Okay. Let’s have you lay on your stomach needles in needles out after she gets off the table. Okay. Have a nice day. Never once anything else. And I don’t, I don’t want to, I’m not saying that that’s bad. I mean, I’ve treated, been shaded by amazing practitioners that that can do that. But what I’m saying for us, you know, for the majority of people, you know, taking the time to actually figure out what’s going on with the person and letting them know that you, you know, what you’re doing is profound versus the shotgun approach where I just do protocols or recipes for every person.

And then you depend on that. So when it works great, you’re the hero. You feel so good about the experience, but when it doesn’t work, you have no idea what to do next, you know? And then it goes back to what you’re saying, like, you know, that, that rapport, but what I see as it comes down to trust, like your patients need to trust you. And if you know what you’re talking about, and you can explain it to the patient on their level, you can see that trust right away. I mean, I had a new patient yesterday. I didn’t even put needles in yet and he’s already trying to refer me people. I haven’t even treated him yet. It’s because he had four different complaints and we were able to like, okay, here’s, what’s at this. And he’s like, Hey, you know, you know where my problem’s coming from. He’s like, you know, can I send people to you? And I haven’t even treated him yet, you know? But the trust, the trust is already there.

So the take home message is that do good assessment through good history and it’ll lead to more referrals,

More trust. And not only tomorrow,

That’s talk about common mistakes that we make in our, in our, um, clinical examination, history, taking process. Uh, you know, as an instructor, you, um, must see this a lot. Can you help give us some ideas of what are some things that we can do better? Where some common examination mistakes. I thought you mentioned, for example, don’t say, does your pain start from here? Refer there. I don’t don’t coach them. That’s one. Right? Anything else that you can, you can let us know? Yeah.

Yeah. For sure. There’s a ton, obviously, you know, I’m making mistakes all the time and learn from them. But I say the number one mistake is to assume anything. Um, so if you start assuming things, you know, you don’t leave room for air and there, and as you, you know, get experience in this profession, you become very aware that nothing is always right. So you always see people say, oh, that treatment works like a charm. That treatment works every time that no, it doesn’t, you know, like there’s no, there’s no perfect of anything. So I wouldn’t jump on the thing and say, you have a rotator cuff tear based, you know, I’m certain of this for me. I like to say, well, these things suggest the possibility that this might be going on, but I could be wrong. And, but we’re going to treat it like that.

And we’re going to keep reassessing as we go. And if what we’re doing is working great, let’s keep doing it. If it’s not working, we’re probably missing something. Leave the door open for mistakes, because you’re going to make mistakes every single day. And if you’re at this level where you don’t make mistakes and you, you feel like everything works like a charm, um, you have to check yourself, you have to hold yourself accountable and get back to this understanding that, you know, there is no two people that are exactly the same. And you could be very wrong about this person in front of you. I mean, I had a person with supposedly a rotator cuff tear who had cancer in his shoulder. And it took, it took the doctors a while to figure out that there was a tumor in there, you know, but if I, I learned a valuable lesson from that experience, because if I was in private practice, he was getting better with acupuncture.

He was a swimming teacher and he was getting his range of motion, was getting better. He was getting stronger, less pain. He was doing good. Unfortunately, there was cancer in there and I did not, there was no way I would have known it. I would have thought that, Hey, okay, you’re doing good discharge you. So, I mean, never, never assume anything in this business. Um, so that’s a big mistake. I think another big mistake is to, uh, jump on a bandwagon. So you learn a couple of assessments tools, and you think that’s all there is you need to continue to go deeper. You know, it’s not one thing, you know, if you do manual muscle testing, for example, that’s a great tool, but that’s not your entire picture of that horse acronym. That’s a one little sliver and you need to incorporate as many of those pieces as you can, to develop an educational guests that support your hypothesis.

So if you only have one little sliver of information and you go, okay, you, your problem is this because you know, this muscle is weak or whatever you are missing, the bigger picture, you know? So I would say, you know, keep learning like never, never, you know, get satisfied. You got to go deep. And if you want to try to get better at something, what I found helpful for me is just pick a body part. So like, for example, I keep saying shoulder, cause it’s on my mind. But you know, if you go to the say, I want to learn shoulders, you can learn shoulders really easily. I mean, the technology is in your hand, the anatomy is in your, in your phone, just take some notes, right. But then what you need to do is just, you know, fill in the blanks of that horse.

So what kind of questions should I ask someone who has a shoulder problem? There are some specific questions that can help guide your, if you’ve got pain at nighttime, that’s a very common symptom of rotator cuff tears. When, you know, wakes you up from your sleep. It doesn’t mean you have a rotator cuff tear if you wake up from sleep. But it’s just one more data point or one more clue. You know, if you, you know, what do you see when you look at a patient who has a rotator cuff issue, what is their range of motion going to be like actively passively resisted? And then what special tests can help differentiate two competing diagnosis? So maybe there’s like, I think it’s this or this. Well, there’s going to be some tests that can be used that differentiate that. And then when it comes to palpation, that’s our, that’s our expertise.

But just know what’s underneath your finger. You got to get in there and know how to differentiate. If I pop a [inaudible] with the arm, you know, resting on some, like my hands on my belly and I press on July 15, I’m touching the supraspinatus tendon. But if my hand is out to the side on the table with my Palm to the ceiling and our press, I 15, I’m more likely pressing the biceps tendon now. So it’s just like little subtle things like that. Can, you know, they’re so basic, but when you apply them, it seems like it’s advanced, but it’s really not. Um, so those, those are some common things off the top of my head, but there are a lot of things that we do wrong and there’s still a lot of things that I do wrong, but I think maybe the, the worst thing you could do is stop learning, you know, keep being motivated because we’re helping people.

And we’re in this profession that is bridging this gap between surgery and everybody else that’s not helping these patients like we are on the frontline and acupuncture is that effective. It blows my mind every day, but we have to have a way to test how effective it is to get that experience that I was talking about that helps us to be better. And then share that information freely, freely with your colleagues. So everybody’s better. I think that is one of the best things we can do as a profession. And I hope we can get there.

Certainly I think if, um, we all up our own game by becoming better at doing assessments, it would transform the prestige and the, you know, the, uh, the reputation of our, our profession for sure. Right? Like, uh, the it’s, um, now I will run out of time, but I, I, I have to pick your brain. Okay. Um, I want you, can you share like a clinical Pearl with us? I always like to do this, something that you pay, perhaps you really good at treating, you know, you’re talking about shoulders today, anything about shoulders or something like that, that, uh, you know, some, some assessment or diagnostic advice you can give us so that we can maybe try it out, or maybe it’s something that we’re not, not thinking in that way and give us a different thinking cap to help us look at the body or assess, um, the patient, any advice for our fellow listeners and viewers today.

Sure. Um, my lead-in will be that, you know, there are, there is this like, you know, movement where people are saying, you know, special tests, orthopedic tests are not good. Those people unfortunately have not done the research. And it’s much easier to say it’s not good then to dive deep and learn it because it takes a long time to really understand all these things. And I know because I’ve been going through it. But one thing that I’ve been doing in the last year is digging in and picking apart all the research and starting to pick out, you know, tests that have been proven time after time to be effective and how effective those tests are like, uh, you know, changing your post-test probability of someone having a problem. So no orthopedic tests are not bad. Yes, they’re great. But you have to understand how to utilize them.

So a really simple clinical Pearl for shoulders is if somebody tries to raise their arm over their head, but they can’t. And they ended up shrugging their shoulder into their ear. Based on the research, they are 15% more likely to, if they, if they can do this without shrinking their shoulder, they’re 15% less likely I should say, to not have a rotator cuff problem. So people who can raise their arm easily and freely, you know, that’s, they could still have a rotator cuff issue because people are asymptomatic and so forth. But when you see somebody shrug their shoulder into their ear to try to raise their arm, what that tells you right away, is there something wrong with their shoulder? It doesn’t tell you what it is, but it’s what they’ve narrowed it down to. It’s either the rotator cuff it’s frozen shoulder, or they have arthritis in the joint so that there is a sh there’s a high probability that somebody has a shoulder issue.

If they put their shoulder in their ear to try to raise their arm over their head and they can raise it all the way. And then as a side note, let’s say, you’re that person that can raise your arm easily, but you can’t bring it down very easily. Like you have to bend your elbow to, to shorten the moment arm so that it’s not as heavy. You end up bending the arm or you support it to bring it down. That starts showing you like, okay, this person is more likely to have a rotator cuff issue. And that sign alone changes the post-test probability by 15%. So what does that mean? Wow, that’s a lot of information, but what they’ve shown is the number one risk factor for rotator cuff injuries is age. And if you’re 60 years old, you’re 25% more likely to have a rotator cuff tear.

If you come in saying my shoulder hurts. So 25% of those people have rotator cuff tears. If that person has a hard time lowering their arm, now you add to that 25%, an extra 15, and you go, oh, this person is 40% likely to have a rotator cuff tear going on. Just with that information alone. I didn’t even ask them any questions and they do it at intake. I didn’t do the other tests. Just those two pieces of information alone. He’s 40% more likely to have a rotator cuff tear. He’s 60 years old and he can’t lower his arm without bending his elbow and supporting it. So these tests, when you use them like that, they can give you some good clues to support your hypothesis.

Thank you so much. I would love that because a lot of times people look at things like under, you know, on the way up or, or, uh, doing the activation part, but they don’t look at the entire process. There’s another 50% of it is when they put themselves back into neutral position. And that, that part you mentioned where they with shortening their arm. Like if you just turn around to do your charting, you would miss that complete, right? Yeah. That’s exactly right. Yeah. So I really, I really, really watched the entire process. You know, I really read a lot, so I thank you very much. I’d love, I learned so much from you in this short amount of time that we have for today. Where can the rest of us go? If we want to find out more information about your courses, do you have any contact information, you know, website, social media, uh, work. When you go to, if you want to study more with you in the future,

Um, you can check out the Facebook group discussions on acupuncture, orthopedics, uh, Dao, D a O is the acronym to make it easy to remember. Cause I love that. There you go. So, and then I have my website it’s www.orthopedic-acupuncture.org, orthopedic-acupuncture.org.

Thank you so much, Jamie. It’s been a pleasure. It’s been an honor to finally meet you virtually face-to-face. Thank you very much. They are that. Yeah. Thank you for most of our fellow viewers. And don’t forget to join us next week, where we’re going to have my fellow host, Virginia Doran. Uh, gimme another excellent show.

Josh regularly, pursues high level trainings in cranial and visceral manipulation and has profound understanding of the interplay between the nervous system internal organs and musculoskeletal system.

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

Hi, my name is Poney Chiang from Toronto Canada. I teach continuing education courses from neuromeridian.net. Uh, welcome to this week’s live Facebook podcast show for the American Acupuncture Council. My guest for today is Josh Margolis. Joshua has been practicing manual medicine and bodywork since 1995 and acupuncture in Chinese herbal medicine since 2001 from 2005 to 2009. He was a faculty at the academy of Chinese culture and health sciences in Oakland. And yeah, I keep on change here to medicine in college in Berkeley, teaching anatomy, orthopedic acupuncture, advanced channel theory and pain management. Currently Joshua is on staff at the osteopathic college of Ontario and teaches in the doctoral program at several bay area acupuncture colleges. Additionally, he teaches segmental acupuncture and manual therapy of courses for acupuncturists throughout the United States. Josh regularly, pursues high level trainings in cranial and visceral manipulation and has profound understanding of the interplay between the nervous system internal organs and musculoskeletal system. In Joshua’s years of practice in the bay area, he has gained a diverse, loyal following comprise of professional musicians, dancers, yogis restauranteurs, athletes, and as well as children, the elderly and those with severe chronic illnesses, he has been practicing art from a Copia in Santa Rosa, California in 2011, as a pleasure for you to, for me to be able to have this chat with you today. Joshua welcome.

Thanks for having me here.

And, um, uh, are you joining us today from Santa Rosa right now?

Yeah, Santa Rosa, California. Yeah. It’s morning time here.

So I have been hearing really great, wonderful things about your courses. And I look forward to view a study with you in person, hopefully sooner rather than later. Um, so this is why I wanted to, um, use my spot for a guest today to steal all your secrets. I want to, I want to pick your brain and hear what is it that you do? What influences you like brings you? What makes you, you passionate about what you do? So let’s start by, um, telling us a little about, about yourself. I know I already give an in in-depth introduction, but you know, who, or what influenced you the most, would you say as far as, uh, practicing clinically speaking?

Well, I’ve always had my foot kind of into two worlds. Uh, I don’t that are not the domain. So, uh, and I used to feel like I put on two hats. Those are the two worlds being manual therapy and acupuncture, and I’ve always felt I had to kind of put two hats on and be like, okay, now it’s anatomy time and I’m going to do osteopathy. And now it’s acupuncture channel time and I’m going to do some kind of distill acupuncture, ear acupuncture. So, you know, I got pretty quick at, at, uh, switching my hats back and forth. Um, but of, you know, uh, thinking about how to integrate those things has been kind of an ongoing question for me. Uh, the, those two hats. So there’s been a couple key influences along the way. Um, Michael Kuchera who is, uh, an osteopath, I think he’s in, uh, Kirksville.

Uh, he wrote some great books on, uh, osteopathy for internal medicine, uh, disorders, and it really talks a lot about segmental organization and how you can, uh, exterminate you from external stimulus, uh, affect the internal processes. Um, and on a, another from the acupuncture side, uh, C Chan Gunn Chan Gunn, uh, really with the intramuscular stimulation and that concept of taking motor points and acupuncture or a trigger points and going back to the spine and treating the spine first and looking at that as maybe, uh, a more centrally mediated problem that, you know, partially maintained at the spinal cord level. Um, those two were really big in, uh, kind of my early, early career, uh, and continuing on. Um, there’s so many, there’s so many and Carol Levitt, uh, from the Czech Republic was a physician who really turned me on to, uh, functional, uh, musculoskeletal assessment and looking more beyond, you know, beyond what is sort of broken, but more how, how does movement happen and how can we coordinate movement?

And that has really influenced my acupuncture, uh, as well as manual work. And then, you know, researchers like you pony, to be honest, because, uh, you know, you’re taking that, looking at, uh, acupuncture, meridians and points through two lenses and, and really doing the research and the background work, um, and that, you know, that, that sort of legacy from Joseph Long and, and the others from the sort of Toronto medical acupuncture to unity, um, have been, uh, uh, a real influence to me. I was lucky enough to study with a medical acupuncturist, uh, early in my, in my career in that. So I’ve always been, uh, most of my professional life and very interested in that interplay and understanding, uh, kind of how, how things work, not just what works for what, right. I’m sure

For you, it’s the same as it is for me. The, the excitement is being able to find the similarities and find the anatomy and it, and it used to have medicine actually independently validate each other. There you find, uh, you know, oh, this is that same thing in the nature thing. And I say exactly about this anatomy, and then it just, uh, you know, you can have, I’m sure we can have a lot of decals and about all these, like, oh, how did these ancient people know like this anatomy, you know, um, so Russo, I’m glad that we, uh, like-minded because I know, um, you bring kind of the best of both worlds and that’s what I like to do also. Um, so tell me about, um, segmental acupuncture. Uh, I see that you’ve been teaching quite a bit of workshop about them. I know that’s probably a very in depth topic. Could you just, you know, give us with the coleslaw version of, uh, give us a sense of what is segmental acupuncture? How is it different from, um, you know, like, uh, a, a TCM approach, for example?

Yeah, that’s a great question. Um, I mean, the key thing is to understand that our tissues remember where they came from. So during embryologic development, you know, our, our tissues, uh, migrate off of, uh, you know, essentially a segmented worm type of, uh, uh, you know, our embryo is kind of a segmented worm and our tissues literally travel off that in different segments, but when they travel, they drag their nerve supply along with, um, so during that, during development and then on into, you know, birth and adult life, those connections stay, uh, PTEN the, you know, the segmental, the body doesn’t forget its segmental organization. Even if those tissues might’ve migrated quite far away from the original segment. And, you know, you have the, you know, the germ layers, dermatome, myotome, and sclera tome. And so now people are talking about the viscera Tom or the Interra tome for the internal organs, but essentially you have the skin, the muscles and the bone sensation.

Um, those, those might not overlap perfectly, you know, the muscles move in a different way than the dermatome moves and works in a little different way than the sclera tone. So, uh, we can access all these different layers and these different laborers can have their own ridiculously related pain too. You can have that sclerotomal pain, you know, with, uh, with, uh, someone who has a nerve, uh, nerve root injury that might be like this deep aching, hard to pinpoint just sort of pervasive pain, or you can have that more superficial dermatome pain burning, uh, you know, sharp, oh, kind of electric type sensation. So, you know, understanding that kind of, I find it’s very, very helpful. Um, another thing, uh, to, to understand key points regarding that, um, concept that the nerves have been dragged along is that, um, everything in, uh, in a segment influences everything else in a segment for good or for ill.

So that means that, uh, if you injure something in a segment, then it facilitates, it lowers the threshold for irritation, for other structures that share that same, uh, Embry logic, uh, source that seems segmental source. Um, so that, that’s a really key concept to understand, and that can help us develop, uh, distal type treatments are not always distillable. You might be treating appendicular really for, uh, for a trunk problem, or you might be treating actively for, uh, a peripheral problem, but, uh, that, uh, that those relationships has really stayed at stay active. And you can, you can, neuromodulate quite strongly, uh, using these inputs. So for example, like I, I’m very into, uh, periosteal pecking, uh, that’s real popular in the, in the, uh, British medical acupuncture world, uh, Felix man, and, uh, um, Cummings, uh, I think, uh, they, you know, that that approach is incredibly effective for modulating.

The whole segment. You can have a person who has, you know, a terrible rotator cuff injury, and then you heck the periosteum along the greater CA uh, treater tubercles or the humerus. Uh, and then, uh, you can change how the entire myotome behaves, uh, quite quickly, uh, very, very effective, very, very interesting. So, you know, the key being the non, uh, nociceptive inputs, uh, into the, into the segment, uh, will, uh, beneficially affect all the other structures. And, and also, you know, consequently, if there’s an injury that will negatively affect all the other structures that share that same sick mental intervention. So, you know, things like an injury to the sake of spring to the SSI joint, for example, could, can mimic sciatica, you know, [inaudible], uh, dermatome. So, you know, they might have a sclerotomal injury of the ligaments and the, and the, uh, periosteum and, uh, bone, but dogs are gonna feel the sensation, maybe along the S one S two dermatome, uh, you know, their heart disease coming down, the T1 T2 dermatomes, that’s more of a autonomic related segmental, uh, phenomenon or liver disease can show up sometimes in the C3 four, cause the capsule of the liver is innervated by the phrenic nerve.

So you can get liver disease. People can feel that right sided, neck and shoulder pain. These are just some very classical examples, but are relevant to, to assessment, uh, and understanding, uh, potential origins of things. Um, you know, I’m, I’m not going to go too long on this, but another concept that’s pretty awful here that overlays is the osteopathic consent concept of the facilitated segment, um, where, uh, through prolonged irritation or, uh, enough of an initial insult that the segment will itself will just become irritated and stay in an irritated state. And that, what that means is that the threshold for irritation for, to, to cause, uh, tissues to respond is becomes lower. Um, the, uh, reaction may be higher and, uh, you know, to the extent that even a non what should be a non painful stimulus might, might, uh, read as painful in, uh, to, to the body.

So these are all, uh, you know, assessable, uh, for us as, as acupuncturists doing physical medicine, doing physical assessments, we can see signs of all of this. So, you know, there’s something we call it, the red sign and osteopathy where you drag your fingers. Uh, so vigorously along the pair of spinal tissues, kind of along the Quato druggie points, um, you know, 2, 3, 4 times. And you’ll see at a segment that is, uh, more facilitated, more, uh, active, uh, irritated that you’ll have, uh, extended red response. Uh, you’ll see, pin will stay red, uh, you’ll find pseudo motor activity, uh, muscle shortening tenderness, uh, and perhaps, uh, Teebo like motion dysfunctions, uh, at these segments. And these are mostly autonomic signs and they’re probably autonomically. Uh, they seem to be autonomically mediated. So, uh, a lot of what we can do is then look back at a chart for, you know, sympathetic, uh, innervation in particular.

And, uh, you can learn a lot about what’s going on. Uh, there’s been some research that really shows that these pair of spinal signs show up before internal medicine, uh, disorders are, uh, measurable often that, you know, as the Oregon is inflamed and irritated, it’s sending back, uh, signals that it’s in trouble. And then that facilitates the segment. So, you know, we have, uh, so Maddow visceral and this row of somatic reflexes in the body, as well as some ADOT some ADOT and, uh, this were visceral reflexes, but from the acupuncture standpoint, a lot of what’s interesting are the interface between the Soma, our musculoskeletal system, our muscles joints, uh, cutaneous nerves, and internal body. And we’re starting to be able to map this, uh, pretty, pretty well. There’s been a, uh, osteopaths really researching this, uh, trying to validate, um, osteopathic, uh, uh, therapy theory and, um, uh, you know, things that people are noticing clinically, right?

We’ve been collecting clinical data for, you know, clinicians on our patients for a long time, but to start to understand that a little more with the science behind that. So they’ve been looking at that for, you know, 120 years now or something like that, but we can see these things in Chinese medicine, like the moon shoe points are very closely related to segmental innervation. Some of them are pretty precise and some of them are a little off like the small intestine and bladder points are more probably affecting the parasympathetics to the, to those organs rather than the FedEx small intestine much, but certainly the bladder and the uterus and so on using them like Bali out on the lower, the lower shoe points, the mood points are pretty, pretty, pretty well, uh, line up, uh, with very few exceptions, uh, segmentally, um, you know, things like spleen six, we can understand a little bit more about what we’re doing, and then there’s all these, you know, various techniques that have come out of, uh, mostly Western medical acupuncture, um, that are, are very helpful for us in the clinic. So that’s, uh, maybe a longer answer than you were looking for, but

No, that’s good. It’s important to lay the foundations. Right. Um, so the, the, the facilitation that you described does a work both as a lot of this, I be so sematic. Um, so that there’s some, if you have a chronic elbow issue that can lead to its corresponding segmental, glandular, or organ dysfunction, or like, you know, somebody who has a chronic organ issue when being more predisposed to certain types of joint or muscular movement disorders, um, that does that theory apply in both directions.

Yeah. That’s a great question. And yes, it does. Um, any, any irritant, you know, of enough, either severity like intensity or time will eventually have the potential to, uh, facilitate a segment. So when you go somato visceral, um, usually that’s, uh, like say you have like an upper back restriction, which could affect your, uh, cardiac function. There was like some cardiac chiropractors did a study and I’m sorry, I cannot find the study anymore. But I remember reading this study where they showed that there was a correlation between forward head posture and cardiac disease, for example, so tension in those upper, you know, 3, 4, 5, 6 thoracic vertebra and lack of movement, lack of nourishment seemed to affect cardiac function, have a interrelationship to cardiac. Um, and you can see it the other way. So, you know, someone has, uh, like heart disease. They’re going to potentially have more medial elbow pain because you’ve got that T1 T2 dermatome.

There’s going to be a, uh, there’ll be more easy. It’ll take less to injure that area. It won’t necessarily become like allogenic, except for in a more like severe case where you may have ongoing, uh, pain, like in head zones, for example, uh, and whatnot. But yeah, it’s, that’s important that concept that, uh, the somatic visceral, visceral sematic, it goes both ways. The work of, uh, uh, Akio Sato or Saito I, Japanese researcher, he wrote a great paper, like in 1997, that summarized kind of all that, all that stuff. Uh, and then, um, Myron Beale and Louisa burns are osteopathic researchers. Who’ve done a lot of work on the, on, on that, the sort of somatic and some out of visceral reflexes. There was a lot of literature on it actually. Um, but the Seto work is particular. It’s interesting because he was particularly looking at like, what happens if he massages little parts of like a rat and then looking at their autonomic nervous system and what was happening in like gastric motility, uh, bladder and those kinds of things. He, he did a lot of study on that. Him and his group did a lot of studies on that kind of thing. And I did the paper from 97 is sort of his retirement paper that covers all of his other videos. So the basic idea from the one,

Yeah. Uh, I wanna, I want to touch on what you talked about with the frame that phrenic nerve and its relationship to the capsule around the liver. Um, just as a reminder for everybody, because when I found out about that, that I was like, it was like a mind blowing emoji, like, uh, I, uh, when I thought about that, like, you know, the phrenic nerve innervates, the diaphragm, the diaphragm is in the TCM hypochondriacal region. And we also associate that liver she’s technician, right? So there’s a connection to the diaphragm and the FedEx nerve and the signs and symptoms there, but she’s stagnation. And now you have like actual anatomical basis to explain that the friend in there for some reason, get sensory information from the capsule and deliver. So the state of the tension, you know, Chinese person talks about like softening deliberate as a course of treatment.

The state of the tension of the liver through this capsule somehow is information that the phrenic nerve needs. And presumably that sensory input has there creates a reflexive, um, motor output to control the contraction of the, of the diaphragm. So it’s really, really beautiful that like, there is a connection between the liver and liver moving the cheese, you know, the, the, the, uh, the extradition we have in Chinese medicine. Yeah. So I, I, and now that’s related to like, you know, cervical radicular, apathy issues at the, you know, the upper cervical area and it’s associated with dermatomes and upper back. Um, it’s, uh, it’s just, you know, so exciting. Um, do you notice patterns like that? You know, like you can run a TCM and the patients, all of us all have like neck problems or something.

Yeah. Oh, certainly. I mean, certainly more like classical kind of distal acupuncture type techniques. You see all kinds of things that are sort of beyond the segmental thing and the, you know, like how did they figure out these interrelationships, like, you know, liver three improves blood flow at the brachial plexus. So yes, it works for neck problems. Right. But, you know, that’s a super segmental thing. Yeah. And the, and, you know, and you see the overlap with, as you mentioned with the liver, right. The C3 four, you know, you’ve got the super cool vicular nerves, you know, that’s a segmental relationship. So, you know, if the diaphragm or, uh, the liver at C3 four gets irritated, then there’s a potential to send hypersensitized C3 and four, which is, uh, you know, this whole, this whole region. So that kind of dive from attic or that, uh, trapezius pain that everybody sees often as related to, uh, some kind of liver congestion.

Okay. Interesting. So it’s all coming together. [inaudible] everyone has the richest, the nation, everybody has tight trapezius muscles. Right. So it can not be, um, I want you to discuss about German layers and, uh, do you use that, um, embryological concept and the way you select points or the way you assess a problem? How does that, how, how does that apply clinically?

Yeah, so, you know, the germ germ layers, dermatome, myotome, and sclerotomal, uh, just briefly those, those are the layers of, um, Misa term, he’s a normal development. So that’s what goes to make the dermatome goes to make the dermis. So the under deeper layers of the skin, uh, the myotome goes on to make the muscles that, and the sclerotomal goes on to make the, um, the, basically the spot, the spinal column and the ribs. Um, they, we do use the term sclerotomal a little more broadly in the adult, we know, refers to ligaments and bones, uh, and their innervation, but, uh, it’s so it’s used a little differently. The other two terms stayed pretty, pretty, uh, pretty, uh, uh, consistent. Um, but anyway, you know, one, one thing about using those different layers as these tissues migrate, you know, remember what I said earlier that the segment, uh, is continues to be interrelated and because tissues migrate it kind of different rates and different amounts, you may find that the dermatome and less Clariton don’t line up.

So someone may like have a broken phone, but you may be able to access the dermatome, uh, somewhere along the way. Um, or you may be able to access the myotome. You know, there’s a Hilton’s law, right? The, the, uh, that the, uh, basically muscles crossing a joint, uh, share fibers with the joint itself and with the, you know, overlying skin. So, uh, you can, you can access at any level to affect all the other levels. So, you know, that’s, that can be a really effective now, you know, thinking again, as general set mentally, you can go back to treat axially or peripherally for a problem. So if someone has a, I talked about shoulder problems earlier, right? So most shoulder, most of the shoulder, the glenohumeral joint is C5 C6, right? That covers pretty much the majority of the medial C4 on the, um, superficial bits and the skin.

But you could go back, uh, if someone had like a shoulder replacement surgery or frozen shoulder or whatnot, you could go back and look at the, uh, you could go back and look at like, see four or five and six at the neck, and you could treat the, uh, something I find is helpful is doing like a periosteal pecking on like C5, C6, uh, at the articular pillar can really neuromodulate the whole, that whole shoulder quite effectively. Uh, you could do that if you don’t do pecking and don’t have training in that are not interested in, you know, a stronger stimulation like that. You might just needle them all Tiffany in the neck, you know, do some deep repair of spinal noodling. Uh, you can run electrical stem, all those things are really effective for effecting, uh, sort of axial to peripheral. Um, you know, and then that goes both ways.

So if someone’s having C5, C6, right, C6 is kind of the, um, crisis point, uh, for the, uh, neck, right. Most mobile vertebra. And then it’s connected to C five or C seven, which already, which is one of the least mobile cervical vertebra. Um, and then T1, which of course has the ribs. So it’s more fixated. So there’s a sort of maximum movement, minimal movement right next to each other. And those time zones kinda ended up having problems. So you can, you could modulate C5 C6 on the, uh, C5. It like the greater tubercle of the humerus and C6 is more of the upper condoms or, uh, some parts of the posterior shaft of the humerus if you wanted to pack, but you could also look, okay, you can say C6, right, C6, you make a six, I don’t know if that’s coming out as a six, but, you know, in the old, uh, you could treat that dermatome only, you know, with like large intestine four or, you know, other other points that are related.

Um, so, you know, the germ layers, uh, I think are helpful, mark, conceptually, I haven’t found a way to go, like, you know, this is this and that, you know, like myotome is better for this, or dermatome is better for this, or sclerotomal, except for that, I would say sclerotomal stimulation is more effective for that really stubborn pain yeah. Pain that just won’t budge. And because there’s a lot of sympathetic innervation, uh, at the periosteum, uh, that kind of stimulation is really helpful if there’s like, uh, a, uh, some sort of autonomic piece and, you know, innovation is incredibly important. Um, and, uh, for everything including trigger points, right? You can feel a trigger point in if you know how you don’t even have to press the muscle. Cause there’s a pseudo-motor effect. There’s often a temperature difference. So, you know, every, almost every pain condition is going to have some change in the autonomics. And so if you, if you know how to look for that, that’s, that’s kind of a key to the assessment related to that, because your rotation at like a sclerotomal level, like a sprained ankle or a chronically sprained ankle is going to affect that whole segment. So you’re able to treat that, maybe that question.

Yeah. Um, just for our listeners, um, when Josh is talking about to a motor, you were talking about like, uh, the sweating, um, regulation of, uh, autonomic nervous system, right? Yeah. Yeah. So you’re able to is training, uh, palpate the, the, um, uh, the poor to the skin, um, in the vicinity of the trigger point and be able to diagnose, diagnose, uh, financial and point, even without having to push down to get that Asha tender feeling, just fine, touch alone, you’re going to start noticing some changes. Um, so this is, yeah, this is, this is really a very interesting, I, I, um, I, you know, everybody dermatomes in the mountains very well known third toast, you know, that started as the least well researched, but as, um, kind of the secret weapon in a way to be able to have that understanding, I would love to be able to combine those layers together and be able to treat, um, you know, cry problems from a different perspective.

That’s really, really interesting that you’ve had a lot of experience kind of seeing when to use which layer for which type of problem. Um, I also found it very interesting that like ligaments and, um, and, uh, and the attendants are, uh, part surely from the scotoma as well, because in Chinese medicine, they always talk about gene group, seniors and bone together as a binary. They don’t really separate those terms, um, you know, differently. So it’s interesting that those they share same, um, type of term, uh, German, um, innovations. Um, that’s finished up with the clinical Pearl. Um, uh, I heard that you have a lot of success in you. Um, I guess I’m very consistent results really inside a car. Is it possible for us to give, you know, give our viewers and listeners advice so that we can become more proficient in treating, um, such a debilitating problem as Sika?

Yeah, sure. Um, for a really acute sciatica, um, if there’s too much, uh, like muscle for boarding and spasm in the back or piriformis, uh, whether it’s, uh, radicular or a piriformis syndrome, these same approaches will, will be effective. Um, I often will use, uh, just the Bajan points, um, that, that when you get, uh, for really acute problems along the, and this is nothing new for Chinese medicine fans, um, really acute problems, the further away you are from the actual site often is more effective and like stimulating the cutaneous nerves, they’re the gene Wells or the, or the, the, uh, yang spraying points tends to be more effective for that really very hot acute pain. Um, I find you get a more complete, uh, regulation of the whole system. So I often will just for the first couple of visits at someone’s, you know, the people will get like brought in by their family member or, you know, couldn’t drive themselves to the clinic.

Um, those people I tend to use like often, uh, maybe kidney seven, especially if I can get a tibial nerve, you know, like, uh, if I can get a sensation down to the heel or to the toes when I, when I manually regulate it, those are usually my line of first, uh, first input, you know, maybe, uh, uh, like lingo.by something up there up higher, just to, you know, because sick mentally, uh, in terms of like gate control theory, if, if you, if you stimulate something at a higher level than the problem that does have an additive effect, it’s not as good as like treating the right segment, but, you know, your even 5% more is a lot for someone who can’t move, you know, so, so I do add some points that are higher up, um, but then for more chronic or, uh, pain, or if the muscle boarding’s not too severe, I often use, uh, Craig pins, which is, uh, is a, um, medical acupuncture technique where basically you needling along the bladder or the Pato judgy line make a central module encompassing the segments that are involved.

Uh, you can go higher, make it more like a profusion, include the autonomic levels, but you just do the sensory motor level. So say Attica is primarily S one S two. So you really need to focus on the sacrum. You might go up as high as T 12 a to L two, to cover those autonomics, but then we’re going to add, uh, local points as appropriate. So glute, max and piriformis, both of them, you know, primarily, uh, you’re getting like L five S one S two, uh, glute max. I think you get a little lower as well, but the, um, those are totally related to the Syns towed to dermatome problem that the person’s feeling pain they’re having. And then you can then add, uh, points like laying ho or, uh, which is like a posterior gallbladder 34 it’s sometimes called and, uh, and a bladder 40 to get the peroneal nerves and the, the, uh, tibial nerves as well.

So, you know, I, you don’t, you can be very flexible in terms of how you, how you do this, but each module goes at kind of a higher frequency usually. So, you know, it might be one to two Hertz, centrally, uh, two to four Hertz in the gluteus Maximus piriformis, and maybe, uh, like four to 15 or even higher, if you’re doing, um, sensory nerves, uh, down the leg way, sometimes bladder 60, or kidney three, you can, uh, kidney or kidney six, you can get more of the sensory fibers down there, uh, with a higher frequency, maybe as high as a hundred Hertz. Um, but I find that this works well.

I’m going to ask a question for the benefit of the listeners, because I know they’re going to want the specifics. So for the platform that you mentioned for the two sag example, um, would you be doing electrical stimulation there too? And what if so our frequency?

Yeah, the phone, if I tend to use, um, I tend to use a higher frequency. I can use like a hundred, sometimes 200 times even 500. Um, I, I do it either two ways, depending on kind of either position of the patient or their own squeamishness either. We’ll put it on like a high-frequency with like one to two Hertz. So it just goes back and forth so that they get,

Uh, connecting electricity between the web spaces. Is that how you’re doing it, um, for web spaces? So you’d be connecting needles together, or,

Yeah. So what I do is I take, I’m trying to get the camera oriented, uh, it’s backwards area area. So, you know, what I do is I get into all the web spaces and then I tend the needle. So I take all four [inaudible] and I put one clip on there. If I’m using, if I’m using the ITO, I might do that at, um, I might do that at like, with the black one, because the black leads a little stronger, stronger uneven, uh, stem, so that, because I’m in more sites, I might need a little stronger stimulation. And then I usually wire it up to like kidney kidneys, seven ish, but kidney seven is where I personally seem to get the tibial nerve, most distal, tibial, nerve, most reliable I’ll hook those like, like that. And I would generally use a high, um, if the, if the patient is able to crank it up themselves, get seven, there’s still a fair amount of motor.

So if I’m doing that, you know, you don’t want to at a high, at a hundred Hertz, they’re just like not comfortable. So if I’m doing sensory only, I might clip it like two buff on one param and just get one, you know, to the medial, to, and the lateral to do at a high, high frequency, or I’ll clip it at a lower frequency. And I include kidney seven as part of it. Um, and have that, even if they have a slight motor contraction, and then if I’m doing high, I give them the box and let them turn it up. And if I sometimes I’ll do a, my, I use pantheons mostly. And so they have the option to run like an alternating, like one to two Hertz or, and then like a hundred Hertz. So it goes back and forth. So they don’t accommodate to the, um, they don’t accommodate to the stimulation.

Um, again, just a little more detail because otherwise where they’re going to ask the questions. So you are doing the baffle on the effect of the size, same side as the sciatica, right? Or are you doing both sides? Counter lateral?

I often will do both sides. I mean, I immediately, you know, it’s enough to do the one side, but you get some Asian, you know, if you’re having more, any less to the segment, then that’s better for the you’re going to get a better outcome. So that’s where a lot of them like treating the left to do for the right and on up to the down, all that sort of Neijing, uh, links, shoe talk, uh, comes from, you know, really.

And the last question to summarize the protocol. How long do you use the electrical steam that you mentioned? High-frequency so in the order of a hundred Hertz, but how long do you do it for,

I do it for really hot static. I like to do a full 20 minutes. I really, I want to, I want to overwhelm that segment with non nociceptive input. I mean, to the extent that they can stand it. So if they’re able to turn it up themselves, that tends to actually work better because it could be accommodation and then they keep raising it and accommodation, and then I might run to hurt somewhere else in the body, one to two Hertz just to help with the beta endorphin release, but you know, like a large intestine for stomach 36, something, someone somewhere else, uh, you know, stomach 36 is great. It’s part of the peroneal nerve part of L L five. So that’s gonna relate to the sciatic symptoms. So, you know, you can, you can use your logic, whether TTM or from like a neuroanatomical standpoint.

That’s amazing. I can’t wait to try it tomorrow. And, um, so, um, unfortunately all the time we have her today, um, if we would like to step study more with you, is there, are there any resources or any contact that you have, um, for our listeners to the viewers?

Yeah. Um, on the east coast, uh, I’m working with the, uh, Dow collective and that’s a D a o-collective.com. That’s with, uh, Doty, uh, Chiang and pony and teach with them as well. So that’s exciting. Um, and, uh, the other place to find me is on Facebook. That’s where I keep most of my classes updated and that’s, um, uh, facebook.com/omt Lac. So that’s oh, as, and then, and then this is Mary T as in Tom, then Lac licensed acupuncturist, uh, OMT is osteopathic pathic manual therapy. So that’s my thing. And then the other way is to, you know, reach out to, yeah, I’m pretty fine to on the web and I can put you on my mailing list.

Yeah. Awesome. Thank you very much for sharing your experience and wisdom with us. Unfortunately, that’s all the time we have today. I’d like to thank all the, uh, other viewers and listeners for joining us, and don’t forget to join us next week. Uh, our guest for our hosts for next week is Matt Callison and Bri.an Lau. And, um, thank you once again and have a wonderful rest of the day.