Tag Archives: Sports Acupuncture

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Acupuncture Malpractice Insurance – Lung Channel Anatomy and Function

 

 

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, I am Brian Lau. I teach with sports Medicine Acupuncture, and with the Sports Medicine Acupuncture Certification program. I also teach with the three day cadaver dissection labs. And a little bit of the dissection is the impetus for why I’m gonna do the particular presentation I’m talking about today.

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First off, I wanna thank the American Acupuncture Council for having me. And we’ll go a little bit into the lung channel and the anatomy. We’ll look at some movement aspects of the channel also. So I just finished up two back-to-back five day dissections. I do this every year, the first two weeks of December with the University of Tampa with the Physician Assistance Program.

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So I had a lot of opportunity to look internally with the body. We did a lot of external dissection, but we also did evisceration and we went into the abdominal and thoracic cavity. So that’s with physician assistants. I’m not really talking much about channels in there but I’m always thinking about the channels and I’m preparing for when we do dissection for acupuncturists how to communicate some of this anatomy to acupuncturists.

So that’ll filter in a little bit to this presentation today. And then we’ll go into some application with movement. So you can give some patient exercises that will engage the channel in this case, the lung channel fully. So let’s go ahead and go to the presentation and we’ll start jumping into the anatomy.

So let’s get a start. We’re just gonna go right into the internal pathway. So let me get the setup for this. So let’s imagine we’re in a prolonged, like a five day dissection lab. We’ll go briefly layer by layer. So what we have here, . is on the slide on the left is we have skin on at one portion.

We have some subcutaneous fat in this ne netter illustration, but primarily that’s been removed and we’re down to the level of the fascia above the rectus abdominis, the fascial, the rectus sheath, and the external obliques. So we can see the rectus abdominis underneath this rectus sheath. If I were to

Look at it from the back surface. That’s what we’re seeing in the right image. So in this case, we’re looking from the back through the body visceral cavities removed, and we’re seeing the peritoneal cavity from the back but the front surface of it. So here’s the rectus abdominis. You can see a window of it.

But what I wanted to highlight from this image, first of all, you have the falciform ligament, but another interesting structure is a remnant of the . This little ligament, which is the umbilical ligament, which is a remnant from embryological development. And this whole line here is very tied in with the linear alba, which is that thick Foss structure that separates the left and the right side of the rectus abdominus.

So a nice imprint of the Ren channel or the Ren mine. So we’ll come back to that a little bit now, but I just wanted to highlight that. Let’s go to the next slide. And here in this image we have the rectus sheath removed from the rectus abdominus. So this is what we would do in dissection is we would start to come underneath this rectus abdominus, just creating a little separation from the rectus abdominus and the tissue underneath.

And we would start lifting it up. And that’s what we have in this side right here. We have the rectus abdominus starting to be removed, and you can already get a imprint. You can see the peritoneal. Membrane, the serous membrane, and you can see some of the fascia under the rectus abdominus. The reason I’m going to this detail is when you do this dissection, sometimes it’s very adhered, and as you start removing and lifting the rectus abdominus from the pub pubic bone and lifting it off, it starts to tear the peritoneum because of all the adhesions there.

And why would that be so adhered? We have to get into the next layer, which would be the first layer in the visceral cavity in the abdominal cavity. And I’m gonna go right to that here. And this is what we would see as we open slice that very thin peritoneal membrane. We have the greater momentum and we have the stomach hanging off.

The stomach is that greater momentum. And if everything’s moving well on that person before they passed, then you can just easily kinda lift the undersurface of this greater momentum. Lift it up. And what underneath it is the transverse colon. So it’s very adhere, not adhered, excuse me. It’s very tied into, connected to that greater momentum.

So it’s connected to the stomach and it’s connected to the transverse colon. So that’s a lot of anatomy. But I wanted to highlight this anatomy ’cause it gives us a really a window into the internal pathway of the lung channel. When we look at the lung channel, . We’ll look at it now with different eyes, so we’ll look at that in just a moment.

But I do wanna highlight that on many people when we’re doing dissection on many specimens, there’s a ton of adhesions because one of the things this greater momentum does is it surrounds pathogens. So if you had, perforation, like an ulcer in the colon, it would surround that. And there’s a lot of lymphatic tissue in there.

There’s lymphoid. Cells that are gonna take care of those antigens. Or if there is some kind of entry of of some pathogen into the peritoneal cavity, that greater momentum can migrate around and surround those areas. So people who’ve had a history of peritonitis, it’s gonna be extremely adhered internally so they don’t lift as well, and you can imagine that they wouldn’t be able to move as well.

Also. So one more bit of anatomy and then we’ll look at the lung channel. Is the greater momentum hangs off the stomach. Let’s move up into the thoracic cavity. Oops. Wrong direction. And here is the continuation of the stomach, the esophagus, as it passes through the diaphragm, and as I go a little higher up, I get into the trachea and bronchi and those also are very connected with each other.

You could dissect them away, but it’ll take a lot of work. They almost are one unit. So now we have a lot of anatomy to go and look at that internal pathway of the lung channel. So let’s look at that. Here it is. So we see these, we study these internal pathways but it’s sometimes not always clear what the anatomy is when we learn ’em.

So we can now see that yes, we do have these bronchi break branching off the trachea. We could follow down the esophagus. We’ve learned when we learned the internal pathway that the internal lung path channel pathway connects to the stomach, it loops down and connects to the large intestine.

And that’s exactly what the greater momentum does. So what I’m proposing for this internal pathway is we have the trachea and bronchi, the esophagus, the stomach, the greater momentum linking with the large intestine at the transverse colon. So structures match. It matches the description of the internal pathway, but reminding ourselves again, that greater momentum has an immune function, that it has lymphoid cells in there, cells that migrate and take care of pathogens, also links with the actual function of the lungs because they do have a lot to do with wayI, wayI and the surface of the body.

This is at the surface of the internal . Abdominal cavity, but still taking some account of the immune response or the wayI response. So function and form, both match. I think it’s a really good a really good model for understanding the internal anatomy of that internal portion of the lung channel.

So let’s branch out now to the actual main channel. . But we’re gonna primarily talk about the sinus involved with it, because we’re gonna look at some movement aspects that, that we’re gonna, I’m gonna introduce that can help stretch and open and engage that outer channel, but also engage that inner inner branch of the channel.

So this is what I have as a model and what we teach in sports medicine, acupuncture. For the lung sinu channel, we have the pectoralis minor biceps, brachii, short head and long head. This bicipital a neurosis, which is an extension of that links in with the flexor carpi radialis, and then into the thenar muscles.

That’s the superficial branch. There’s also a deep branch of the sinu channel, which is the flexor lysis, longus, flexes. The big thumb, the brachialis, which lies deep to the biceps a little bit shorter. It doesn’t cross the shoulder joint, just crosses the elbow joint. And then that links up with the anterior deltoids and the clavicular head of the pectoralis major.

So we also have the scalings in there, especially the anterior scalings. I don’t have that listed in my list. But the, there’s that superficial branch all the way up into the thumb, to the pec miner and the deeper branch that lies underneath that. The main channel would follow the course, the little spaces between a lot of these mussel.

So these could be almost like the river banks. With all the river being the communication that happens in those fossils spaces. A lot of the organisms and such in the river. You could study a river, but you need to understand the river banks, the structures that make up that river, that form that river.

And that’s what the sinu channel’s kinda so for the rest of this webinar, I would like to look at a movement, a Qigong exercise that I give to patients. I also teach in Qigong classes. And this will exercise that external portion. It’ll engage those sinews, but I also wanna show how that’s gonna gently mobilize and move and massage the internal portion, the esophagus, the bronchi, the greater momentum, the stomach.

So I think if you wanna fully exercise the lung channel, it needs to have all of those components there. And this exercise does that nicely. There’s plenty of other good exercises, but I like this one particularly. sO this exercise I have on my YouTube channel, I did it a little bit differently when I filmed it originally.

I focused a little bit more on the stretching aspect. I’m gonna put up another video, same exercise, but I’m gonna do it the way I’m showing in this particular webinar. So that should be up soon. But either way you can check out the video on my YouTube channel if you wanna get a reminder of it.

Or this recording will be available afterwards too, if you wanna have a reminder for it. So if you used it yourself, great, you have some nice memory aids, but also if you give it to patients, it’ll be something you can refer back to. All right, so let’s set it up. So this is gonna be the exercise. It’s a very simple exercise.

Anything, anytime we engage these this lung channel, we wanna engage the sinus, of course, but we al engaging the sinus will open and close the chest, but we also wanna mobilize that internal pathway of the channel. We’ll look at that kind of point by pint. This is gonna be engaging the lung channel, but really when you’re engaging channels, you tend to do ’em in networks.

So this will be really the Y Ming and tie-in channels as a whole. So that’ll be the lung and spleen channel, the large intestine and the stomach channels. But the primary focus for this one is the lung channel. So we’ll come back and look at this video afterwards and highlight some features of it.

But let’s move on to the next slide.

So this is the starting position. This video will loop and you can see it as I’m talking about it. So I’m gonna start by bringing the hands up. I’m standing shoulder width stance. My arms are gonna cross in front of the body. The forearms are supinated, which means basically the palms are facing me.

Our palms are facing the chest. The hands are a little ways away from the body, so the shoulder blades are slightly pronated and the elbows are slightly lateral to the body. So that’s our starting position. I did mention in there that you’re standing at shoulder width. This exercise works perfectly well seated.

If you’re working with a patient or yourself and you have mobility issues and aren’t able to stand even somebody in a wheelchair. I, when I work with people seated, I have them slide forward sitting on their sit bones, sitting upright, so they’re away from the seat and, their sit bones basically serve as their feet then so that they’re able to have an upright posture in the same way that I have an upright posture in the standing version.

Okay, so I’m gonna start by opening the chest, which really means that I’m starting to retract the scapula. So the scapula are starting to pull together in the back. You might be able to see that in the mirror that I have behind me. That I’m starting to retract, bring the shoulder blades closer to the spine.

I’m opening the elbows while keeping them down. Pronating the forearms. So the pronation will start to stretch the biceps, and at the end of the opening, I’m gonna push the hands away from the body so the elbows will be extended. Also stretching the biceps. So generally . There’s a problem that I see when I give this exercise to people, and I wanna highlight what I wanna do before I highlight the problem.

You’ll notice as I’m doing this in the looped kind of version here, is that my hands start narrow or start medial to the elbows, but then they get ahead of the elbows. So that’s what I wanna do. I wanna keep the elbows down and I want the hands to go wide to the elbows. There’s a nice midpoint.

That you can notice where the hands line up right there, they line up with the elbows just on the side of the body. I’m gonna put my cursor over it. So right here. So there’s a point in time where the hands, elbows line up, the hands are facing out. This keeps my elbows from going wide. The point is a lot of people are internally rotated in the shoulder.

And if they keep their elbows wide, then the the arms stay and internal rotation. And I want my arms to externally rotate so that the whole structure opens up. So that’s a little landmark you can look for when you’re doing it yourself or when you’re giving it to patients, is that lining up right lateral to the body and then the hands continue out?

So this is the expansive phase. I’m starting to stretch the biceps. I’m opening the chest by retracting the shoulders in the back, which creates more space in my chest. Creates more volume in that whole thoracic cavity. So let’s look at the compressive phase of the movement. So once I’m fully open, I’m gonna start, you’ll see a little gentle contraction in the abdominals, which starts to compress the torso as I fully push out.

And that’ll take me into a further pronation of the forearms and a winding type motion in the forearm. So let’s look at that. So hands push, out turn. So you might be able to see a little better in the mirror is that the torso bows slightly. My abdomen bows my spine bows look at that a couple more times.

So this is where I can start to engage in the front and gently massage that greater momentum. There’s a little bit of shortening along the whole front line during the compressive phase, which then when I continue this movement and go into the expansive phase, I’m stretching, compressing, stretching, compressing.

So as I turn the forearms, then I’m gonna start to reach the arms back. So that’s the compressive phase of the movement, and then it returns back to the same position.

I leading with the fingertips.

So fingers come forward, I cross my hands, return my chest lifts, and that bow that was in the torso, un bow straightened. So I get a nice gentle stretching and mobilization of the inner part of the channel.

All right, I’m gonna go back a couple slides and I wanna look at the full exercise.

So hands come up, cross slightly away from the body, open the hands, expand the chest, push out slightly, compress hands back. Return back to the starting position.

Hands out, push, compress, hands back, return to the starting position.

All right,

so I’m gonna end the PowerPoint.

Yeah, very simple exercise. I would highly encourage you to practice it. Like I said, I’ll put up a video on my YouTube channel, but this video, I think it has the a little snippet of it so you can get the idea of it. But the goal is to open the chest, create more volume in the lungs, but then as I start to compress everything, bows.

Then I go back to the expansive phase, so there’s movement inside so that I can gently mobilize that greater momentum. I can gently mobilize the stomach, I can gently mobilize the trachea and the esophagus in combination with what I’m doing on the external portion of the lung channel. So the whole channel is active and the whole channel is engaged.

So I use this for a lot of different things. You could use it really for anything where you wanted to improve the health of the lung channel. So that could just be preventative, of course. Respiratory issues would be a key component. Of course, if you’re working with people with respiratory issues, you want ’em to have that full volume in the chest.

shOulder problems is one that I give this exercise to quite frequently. You have to make sure that there’s no pain with doing it. So one component is that turning internal rotation, once I’ve stretched out, is I want that to come as much from the body as opposed to all my arm where I’m cranking my shoulder forward.

That can create a lot of pain for people who have shoulder problems, so I have to be very gentle. I’m starting from the distal portion, winding my arm, compressing my torso slightly. So it should be very comfortable for people. There shouldn’t be any sharp pain with this exercise. But that’s one where I give this to is shoulder issues.

Neck issues of course, because that shoulder girdle health is very tied to neck neck pain. It’s really versatile exercise. It’s pretty simple. Patients can catch onto it very quickly. They tend to like it ’cause they’re sitting so much during the day if they work at a desk or driving, or so many instances where we’re compressed there.

So it feels really nice to be able to open and stretch the chest and stretch that whole fossil. Line throughout the arms, but also you get that nice gentle engagement in the inside. So give it a try see what you think of it. But you can always reference the video and highlight it.

And if I have a YouTube video up on it, you can give some questions and comments if you want further clarification. I think that concludes the information I wanted to give today. It’s short and sweet. I’m gonna put this information together into a longer class that I’ll put on net of knowledge that’ll be available through lasa and a couple other partners overseas.

But that should be coming out fairly soon. I’m gonna put a little self massage in there and some some other details for treatment, maybe some needling also. This was just an introduction. Got the ball rolling for that. I was very happy to. . To be able to introduce this to you, and again, thanks to American Acupuncture Council for having me on.

 

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Improving Shoulder Mobility – Brian Lau

 

 

Today we’re gonna be presenting on some shoulder mobility. We’re gonna look right away from at a shoulder mobility drip drill with weighted clubs.

Click here to download the transcript.

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

Hello I’m Brian Lau. I, first of all, I’d like to thank American Acupuncture Council for having me back. Today we’re gonna be presenting on some shoulder mobility. We’re gonna look right away from at a shoulder mobility drip drill with weighted clubs. So that’s why I’m standing here. We’re gonna go over some movement aspects with that.

These would be something you can do yourself, which are really great mobilization exercises to keep your own shoulders healthy. But also you could prescribe these to patients. We’ll look at some caveats for when you can do that, when you might not want to do that. It might be a little too much depending on the stage of shoulder injury.

This would also have implications for neck injuries. We can go over some of that in context. Let’s go over that right from the start. But let’s look at some movement aspects first. So I have a little bit of a bone model here. So this would be my left scapula. and left humerus. So I’m gonna put it in front of me.

Obviously this would be behind the ribcage, but just to give a little bit of context. So we’re gonna be looking at this shoulder mobility drill that’s gonna work on the glenohumeral joint, of course. So we have good movement in that, but we’re also challenging the strength so that we can do movement with stability and the joints not moving around excessively.

But with any shoulder movement, we wanna look at this sort of dance between the shoulder joint. and the shoulder girdle. For instance, you can look up something called the scapula humeral rhythm. So with that’s specifically in reference to abduction. As the body goes into abduction, as the arm goes into abduction, you wanna have this following of the scapula.

So it goes into upward rotation. The scapula’s not moving real well. It’s very possible, probable that the joint will hit the head of the humerus up against the acromion, and that can pinch and compress and impinge on the superspinatus tendon, biceps tendon. A lot of tendon type impingement problems can come from that.

So it’s a nice dance. You can look at it up online. You can find the exact ratio of movement of how they relate to each other. But it’s not just abduction. When the body does internal rotation in the shoulder joint, the scapula likes to follow into protraction. So it gives a little bit of room, a little bit of movement.

So that the joint doesn’t get compressed in the front of the joint. Same thing with external rotation. Sometimes it likes to combine itself with retraction of the scapula. Maybe even a little bit of a downward pull on the scapula. So there’s a nice dance of movement between the scapula on the ribcage glenohumeral joint.

I could add to that. the sternoclavicular joint so that this whole complex is moving in this nice unified movement. It’s not just the shoulder girdle though. When I’m doing any type of movement like overhead, my ribcage is gonna open and expand and move. So there’s a combined movement that happens in the ribcage all the way down to the diaphragm so that a lot of these movements take this whole range of motion of the upper body, thoracic spine ribcage.

Shoulder blade, sternoclavicular, joint glenohumeral joint, and a combined activity that’s organized and controlled, or at least we want it to be organized and controlled. There’s a lot of neurology that helps link that. The phrenic nerve going down to the diaphragm has a lot of relationships to the shoulder joint.

In the shoulder capsule, but also the rotator cuff muscles. If I go on the right side, there’s a little branch of the fren phrenic nerve called the nicco abdominal nerve that goes right into the liver into the capsule of the liver. So any liver mobility problems are also gonna potentially show up as especially right shoulder problems.

So that’s a lot to think about. We’re going to. Not necessarily try to dwell on all of those. As we’re doing the movement, we’re gonna look at one key aspect and allow all of those other things to happen. So I’m gonna put this down for a second and grab another tool.

So we’re gonna have a weighted club. If you don’t have a club, that’s fine. I’ll show you what you can do without one. It’s actually nice to start without a club. This is a five pound club. One or two pounds is really nice to start with. Or we can just have our thumb out. , my arm has a certain amount of weight in it, so this is fine.

All the movements we can do to get used to these movements, we can get we can do without a club or you can have a wooden spoon or something if you wanna have a little bit of something that gives you an idea of where you are in space. That’s one nice thing of the club. But the actual weight is useful too.

So if you were to do this on an ongoing basis, maybe start with a two pound weight, three pound weight, and you can go up from there. We’ll look at some options. So we’re gonna be holding the club at the base. I’m gonna have my arm out at 90 degrees in elbow flexion. I’m gonna start at about level with the opposite shoulder, so I’m in a little bit of internal rotation.

My chest can be relaxed. Again, if you don’t have a club, you can just stick your thumb up and that’ll give you an idea of the direction that you have. So the first thing I wanna do is just warm up the joint. We’re gonna build a movement here, piece by piece. So I’m gonna go into external and pull the shoulder blade back.

So I should get my arm lined up to the side, my elbow’s level with my hand. Chest is open. Then back into internal rotation. I can let my chest fold just a little bit. So right from the get-go, the driving force is the shoulder blade. I wanna pull my shoulder blade open, or I should say pull it back towards the spine to open the front.

Then I wanna let the shoulder blade come into protraction, my chest relaxes retraction, pull the shoulder blade towards the spine, open the chest. So right from the start, we’re working on the hearts in you channel as I go into internal rotation and the small intestines in you channel. As I go into external rotation and pull the shoulder blade, it’s fine.

So nice exercise for the in you channels. Alright, so this is stage one, but we’re going add a swing to this. So instead of me just turning my arm out, I’m gonna let the weight drop and find that position again. Let the weight drop swing. So it’s a swing and a catch. Down, turn the arm, open the chest, catch down, turn the arm, close the chest.

Catch. So swing you can go slow or you can start speeding it up if you feel comfortable with it. So we’re building a movement. This is a movement called Mills. Okay, next thing, swing. Catch now I’m gonna go overhead. I want my shoulder blade to be the driving force, so I want my shoulder blade to go into upward rotation, hand behind the neck, down, catch up,

down, up. I wanna keep a stable base down. Okay, now we’ll change one more time. Up

turn, throw, catch, swing, catch, cast it, overhead, turn, throw catch. So that’s the movement. It’s like a throwing motion like you’re throwing a baseball, but again, driven by the shoulder blade. Pull the shoulder blade back to open the chest. Upwardly rotate to point your scapula up towards the sky, protract and down.

Very nice. We can go the other way now. So over the shoulder, same shoulder. Pull the shoulder blade, open down, swing catch. Cast open, throw, swing, catch, cast open. Throw one more time. Swing and catch. Cast open. Pull the shoulder, blade back, throw. All right. Real quick, we’ll do it on the other side. Then we’ll look at some various options, when to do this, how to do it with patients or for yourself if you’re having shoulder issues.

So let’s go quickly through it again. Internal external rotation, external pull the shoulder blade open, chest opens, line the elbow up with the hand. So I don’t want my elbow facing back. I want it under level with the hand, chest in,

open the chest. Okay, we can do that with a swing. Let the weight drop up. Drop up 90 degrees. Drop up again, we’ll go overhead now. So up. Hide the hand behind the neck. Throw catch up. Throw catch. Okay, one more change up. I wanna turn my body in front of the other shoulder, swing, catch, cast, throw, swing, catch, cast, throw either direction over same shoulder.

Pull the shoulder blade open to pull the chest open down

over the shoulder. Retract the scapula, pull the chest open down.

So great movement to strengthen the shoulder blade the shoulder joint to strengthen and move the shoulder blade and to coordinate that activity with the chest and ribcage. This would be not a good idea to start with the five pound of somebody who’s having shoulder pain. Maybe that’s where it’s really nice to start with just the weight of the arm.

Maybe they have a painful arc. Oh, that’s causing a lot of sharp pain just to do that. They’re not stable. They don’t have strength to support that shoulder shoulder joint. They don’t have the strength for that shoulder blade to roll up and upward rotation so that they have a comfortable, nice movement and oh, it hurts to do that.

It’s probably not a good exercise for them. You need to build them up to that. You need to give them a simpler exercise, a floor exercise. We’ll look at some acupuncture techniques. There’s a lot that has to happen before they can comfortably do this. Once they can comfortably go up, maybe starting with no weight, one pound, two pounds would be a good idea.

Keep it small. Once they get coordinated movement then, and they’re feeling comfortable with that. Five pound,

five pounds pretty good. They get a little more comfortable, then they can go up more weight. So adding weight will create a little bit more challenge. So this is 10 pounds. So if I’m doing the same movement with this 10 pound weight, then that requires more force, obviously, but it’s not just the weight.

So 10 pounds

and 10 pounds. Now this 10 pounds weighs a lot more than the other 10 pounds because of where that weight is sitting farther away from my hand. And the torque that creates. when I’m going ahead, I don’t wanna swing it cuz my camera’s pretty close here, . But when I’m going ahead and if I were to swing that through, that’s gonna require a lot more strength on my part to be able to balance and manipulate this weight that’s farther from my hand if I were to move down even to the handle.

Even just holding that and stabilizing it is a lot more difficult because, oh, any little movement here, I have to do a lot more stability to support that. Since it’s so much farther away from my hand. So those are ways you can increase and build on this exercise. But you don’t wanna start with a shoulder.

A patient with shoulder pain, painful arc with that mace. You may not even be able to start with the weight of their own arm. You have to build them up to it. So just some ideas, some things you can work with go through step by step, maybe starting. with that, just internal external rotation, if that’s not excessively painful, just to be able to balance that weight in external rotation is gonna start to strengthen and stabilize that joint.

So that would be a good starting place. Then you can build until they get the full sort of movement of throwing. So that’s what I wanted to start off with was the mobilization. So we can start thinking about feeling, coordinating that activity of the shoulder blades with the movement of the glenohumeral joint and how that relates to the chest and all of the whole, really the whole body.

So what if they have limited range of motion? Let’s go over some potential techniques. We’re gonna focus mostly on the pectoralis major, cuz the pectoralis major has to lengthen to be able to get my arm back. It has to lengthen to be able to get my arm back in both positions, different fibers. But Peck major is gonna be one of the key structures that’s gonna limit mobility.

If this peck major’s held in a shortened position, I can only go so far. So I want to be able to have full range of motion, full elong full ability to elongate in that pack. Major in all different planes. So we’ll focus on that. I’ll tell you from the get-go, Sarus anterior would be another big one.

Another day we’ll just focus on P Major for today. So I’m gonna switch to PowerPoint and let’s go over a little bit of information, a little bit of the anatomy, and we can look at some techniques for acupuncture and manual therapy. So let’s get the slides up. I’m gonna come a little closer.

All right. All right. So here’s some netter images. If we look at the left image first, let’s look at the bottom left. We have Peck major. So Peck major’s a really intriguing muscle. It has the clavicular head that’s going up and attaching to the medial third of the clavicle. It has the sternal head attaching to the sternum.

Then as we go down a little bit, we see costal fibers attaching to the costal cartilage and that bottommost slip that you see attaching into the abdominal fascia. Is the abdominal head. So we have really four heads depending on how it’s divided. Some books look at it as three heads, but clavicular, sternal, costal and abdominal heads are the way I look at it.

So interesting thing about that is they play out with the yin channels of the arm. The clavicular head is part of the sinu channel, sternal head, part of the heart, Sinu channel Costal, and an abdominal head, part of the pericardium Sinu channel. Those fibers have to organize themselves with the muscles of the back, such as the rhomboids.

So we’re looking at the sternal fibers and we were going into that external rotation movement with the arm down. Peck major has to elongate, rhomboids pulls the shoulder blade back towards the spine. So it’s a balance between the hearts in you channel and the small intestines in you channel. , we start from internal rotation, Peck major’s in a shortened position as it goes into external rotation.

Infraspinatus, Terry’s minor part of the small intestine sy channeler firing while the peck major is lengthening. So they have this yin young relationship of one letting go, one shortening. So we don’t have time to go through all the channel relationships for each of them, but that’s one to start with.

We’ll look a few at a few of them though as we go into the PowerPoint. So lung sinu, channel clavicular, head of the Peck majors, part of that Peck miner’s, really the key muscle that’s also involved with this shoulder mobility exercise we were doing. Peck miner is gonna have a tendency to pull that shoulder forward into an anterior tilt when it’s shortened.

If you remembered from that exercise we were doing, we had a pretty neutral. Position the scapula is moving a lot, but we didn’t have this jutted out forward shoulder at any point when we were doing it. If that’s in a shortened position like that, we need to do a technique acupuncture’s great to be able to release the peck miner.

We can also use points along the channel, even muscles along the channel, like the flexor carpi. Radialis is a really great muscle to release the peck miner, so needling the motor point. If you’ve studied with sports medicine, acupuncture, we teach the motor point for flexor carpi radialis. Fantastic distal point, even though it’s not an official lung channel point, it’s kind of part of the lung inu channel.

So really a fantastic point to release Peck miner. But Peck miner needling is something to learn too with the caveat of being safe with it because it is close to the PLE cavity. That Peck miner is gonna have to be balanced by the large intestines Inu channel, lower traps, which is supporting it.

Those have that yin yang balance. Also upper fibers of Sarus anterior part of the long Sinu channel. Those are those upper two slips. They have a different fiber direction than the rest of the sarus anterior, and they have different action. Again, we can come back to Sarus anterior maybe another day. So here’s the movement of the lung sinu channel.

It’s gonna tend to pull that scapula, like that top arrow, which is pulling the scapula down into an anterior tilt, countered by the large intestines Sinu channel, which stabilizes the scapula against that force of the peck miner. So if you go back and review large intestine Sinu channel, you’ll see that it goes down into the thoracic spine.

It follows those lower trap fibers. So nice combination to work with. Har Sinu channel was the one we alluded to just before. The Har Sinu channel includes pretty much the Peck major, I think of the whole Peck major, but really the sternal head in particular is the big one for Hart Sinu channel.

This would be very important for that movement that we were doing, the mills that we were doing with the weighted clubs. We can also notice that the subscapularis is in there. Subscapularis is another big one, a really great muscle to learn how to needle. But it’s not something for a webinar.

That one’s much better for classroom setting because you’re going. Deep into heart. One with really a three inch needle, you have to be very mindful of where the ribcage is, so you can advance the needle towards subscapularis, but not towards the ribcage. So plenty of space if you do it properly. But too much room for error on a webinar.

So classroom setting. Another day we will look at some needling for tech major, though. So this relationship for the scapula is, again, we have protraction As the scapula pulls around, the ribcage moves away from the spine. P major is one of the big muscles that’s gonna contribute to that. And then that’s countered by the rhomboids, which are multiple channels.

But in this case, they’re acting along with other muscles as part of the small intestine sy you channel. But all of that’s happening with internal rotation, pag, external rotation, infraspinatus, Terry’s minor, also subscapularis, part of the small intestines in new channel. So those have to coordinate their activity as one shortens.

The other one has to let go as the, then it changes phases, and the other one shortens. They have to alternate. Elongate contract. Elongate contract. So very much of a yin yang relationship with those two. Peck major is usually the one that’s overactive, and we’ll be looking at a technique for that. Finally, the Pericardium Sinu channel.

Pericardium Sinu channel has a really interesting trajectory. . It involves the sarus anterior, also these lower fibers of the Peck major, all of those come down and blend in with this abdominal fascia. So it creates like a almost like a fascial belt around the ribcage that can get too tight. So we need to loosen up that belt.

Nice thing about that exercise we were doing is we had that in. an out aspect with the chest. So we’re starting to exercise and soften that sort of what can be a too tight of a belt around the ribcage for a lot of people. So the interesting thing about this one though is it wraps around the ribcage, which it’s discussed classically, but I take it a little beyond what you might think and into this Rambos sling.

So the sarus anterior attaches to the medial border of the scapula, and it links seamlessly with the sarus anterior. So much so that in recent dissection, and I’ve done this a few times, you can tease the fibers of the rhomboids and sarus anterior off the scapula and kind of layer, soft, slow approach and then bring the scapula away and you just have this seamless.

Sling of tissue that you don’t see really a break. All is where the scapula attached to it. But you have the sarus, anterior rhomboids is one continuous structure. You can pull the scapula off. It’s not something that if you were to take the scap off, you’d have to sew those back together.

They’re already united. They’re already part of a sling. That actually then combines over to the contralateral side and blends in with the SIA services and capitus. So this shoulder movement that we’re doing can have good implications for neck pain for a lot of reasons, but one of which is that those snia services and capitus muscles become problematic for a lot of neck pain patterns.

So we can needle splenius services, we can needle splenius capitus of their pain producers, but to be able to integrate them with the scapular movement so that there’s this nice sling expansion contraction on either side is a really great way to keep those changes. So this exercise we’re looking at, fantastic for shoulder problems, but neck problems, especially with plem and surfaces pain patterns, right?

So movement pattern with those and things you can look at. Somewhat protraction and retraction, but also that upward and downward rotation of the scapula. PS radius anterior in particular upwardly, rotates the scapula. So if you go back to this movement we were doing, there’s a lot of times where the scap is doing this circular movement of rotating up around ProTrac, protraction, rotating back down, rotating up.

Retraction rotating down. So that rotational aspect of the scapula is a very key movement of the pericardium sinu channel, moderated by the lower fibers of the peck, major sarus anterior, and then the rhomboids and also the upper part of the traps. So I put this pericardium Sinu channel in here, but again, this is an ebb and flow between Pericardium Sinu channel, San Joo channel.

So lots of scapular movement, lots of things to think about with just a small exercise. You’re really working all three of those in you channels. But I think the big one is pericardium and San Joo channel. That’s the one that’s the most prominent with the exercise we looked at. Got to twist my arm to say that cuz the other ones are.

All right, so tech major is what we’re focusing on for treatment. So you’re teaching this exercise to somebody or you’re doing it yourself. And oh, it’s hard to really get that arm back. It’s hard to pull that shoulder back and have this nice open chest because of that Peck major holding everything. So it’s like this too tight of a grip on the shoulder blade, and I can’t get that movement.

Or when I’m back here, I can’t get my arm back because that Peck major is pulling. So any of those positions that are difficult to get. Open in the chest. Peck major is gonna be a key player in that, and it’s one that we can look at on the webinar. There’s some concerns. We have to be careful. We have to know where the ribcage is.

There’s some cautions. I put this in the video and this is a video that’s up on my YouTube channel. You can reference later, or you can reference it directly from this webinar, which will be recorded. But it’s safe enough. I think we can look at it. In a webinar setting, I go through step by step.

This is a way to needle the Peck major for those who have taken sports medicine, acupuncture classes. Matt teaches it a little bit differently, which I think is great and maybe good for a class setting. I felt a little more comfortable with this one for a webinar setting because we’re holding the tissue up away from the ribcage.

So it’s it’s one that I use. I like it. Just for the reason that I like the technique, but it’s also, I think, a really useful one to have on the YouTube channel. And have on the webinar because I mitigates the risks by lifting the tissue away. So let’s look at it.

Okay.

We’re gonna look at palpation for to bands within the pectoralis major muscle, and we’ll look at a way of needling this muscle safely. First, let’s identify the fiber direction for the various portions of this muscle. The CLA head runs from the medial of the clavicle to the specifically the lateral lip of the, okay.

The sternal head runs from the sternum to the universe.

And the coastal and abdominal heads run from the coastal cartilage and the abdominal fascia, and then travel up to the s.

The arm down the clavicular fibers run superficial to the sternal fibers.

Which runs superficial to the coastal and abdominal fibers. The layered arrangement changes when the arm is overhead. The different layers unwrap and then wrap again as the arm is brought down. Palpating for top bands and the muscle can be helpful to gauge tension. Here I am palpating the clavicular head.

In assessing pretension, I can also push from inferior to superior or superior to inferior to feel which offers the most resistant.

And I can advance the needle across the fibers in that direction.

I have to take care that I place the needle in the same angle as the palpation and not change the angle deeper towards the.

Now I am palpating sternal head, starting from the sternum, and noting a local twitch with palpation.

This layer has a notable, palpable band, an easy way to needle the factor. Major is to grasp and lift the tissue away from the underlying rib cage

while grasping. You should feel the plane, the rib cage makes.

You then find the top band and place your two fingers around it.

Place the guide tube at an angle that allows the needle to penetrate the band and then advance the needle into the P major. Direct it toward your thumb into the needle, parallel to the rootage.

You can redirect the needle, but keep the needle parallel to the ribcage until you get the needle response.

The needle is always directed parallel to the ribcage, and you should never aim the needle towards the ribcage. The needle is parallel to the ribcage directed slowly towards the thumb and not downward towards the feral cap.

You should not perform this technique if you do not have an adequate sense of where the ribcage is the plaintiff makes, or where the needle tip is in relationship to your thumb. The advancing needle can be felt by the thumb, but you need to be sensitive to this. You should not perform this technique on women with breast implants.

Otherwise, working with women is essentially the same. Palpation will be the same, but you’ll not be palpating through breast tissue. You still have access to muscle around the breast tissue. Let’s go over this technique again on a female model, . So when I’m palpating, I want to feel for the clavicular fibers.

I can press into fibers going up. and that inferior to superior direction, or I can palpate into them from a superior to inferior direction. Feeling for resistance doesn’t feel particularly top. So I’m not gonna needle those fibers. I can palpate close to the stern looking for top bands.

Of one right there through that sternal fiber. Sometimes you’ll even see a local twitch response as you palpate through that. Interestingly, I can see a little bit of that local Twitch response respond up through the s SCM muscles. Those pec fibers do link with the scm, but I just feel able to top in there.

If I were to follow that’s gonna take me into that sternal portion of the muscle and. That’ll help me find and differentiate where there’s spot in the muscle for men. You have a little bit more territory you can palpate for women this sternal edge is a really useful area cause you can palpate feel without having even the ship.

The other area where you can palpate where it’s probably easiest to needle is that the excellent. So I have access to the bulk of the muscle through here. This is where knowing those fiber orientations can be very helpful. So I can come and feel for hotness within the muscle. Noticeable damage fibers.

And this is the easiest way to needle it. If you wanna be very cautious. I wouldn’t do this needle technique, breast implants cause you could puncture the breast implant, but faring that it’s not a problem. So I can grasp the muscle this way, heal the tension within the muscle hold. To guide you between my fingers, I’m gonna angle towards my thumb.

I can feel the edge of the top end, and maybe looking for trigger points you might need get a switch response with palpation, and I can hold and then advance the needle towards my thumb. I need to be really comfortable with the idea of kneeling towards my numb feeling that needle advance towards my thumb, bring it out, but it’s very safe situation there.

Do some general looking thrusting, different needle angles to listener response to tech nature.

All right, so I have a minute long myofascial release. This was longer technique, but this was YouTube short. This is on the Sports Medicine acupuncture YouTube channel. So you can reference it there. Again, it’ll be in the recording. This will be the last thing we have for today. And you can see a follow up technique to the needling.

Myofascial release for the HE major will take place with either the patient having their arm down by the side, especially useful for the clavicular head attachments, or having the arm up above the head and external rotation. Much better for the sternal and the costal fibers. And what you’re gonna have the patient do is start to turn their torso, start turning towards your same side.

So you wanna have the fibers shorten so that you can get in, get a good investment, get a good grab of the tissue, and relax there. Then have them turn away from the shoulder so they’re keeping the shoulder on the table. And trying a little slower, one slower turn the torso away, and they’re having to learn how to relax that als nature while you’re spreading through it.

All right. Very nice. Feel free to check these videos out. Like I said, those, the references along with this recording will be on the on my channel. It’ll be in multiple places, but it’ll be on my YouTube channel. The QR code is there, but also the webpage along with sports medicine, acupuncture had that myofascial release technique.

So I think I can take off the slides. And just to give a quick idea with that myofascial technique, in that exercise we were doing, we were moving the shoulder away from the ribcage. to get more space and buy that the front of the rib cage, I should say. So that ability for Peck major to move kinda like I’m throwing a ball, I have to be able to expand and move that shoulder away.

The myofascial technique, we did it slightly different, is we compressed and moved the rib, moved the sternum closer to the humerus and had the patient relax the shoulder on the table while they moved the sternum away from the arm. So same thing. The just different reference point is they were learning how to relax the Peck major so that they could turn the sternum away from the arm.

And in the exercise they were. Moving the arm away from the sternum. So same idea, just a different focus. Both of those are gonna require the peck major to lengthen. Both of those are gonna open the heart a little bit, or at least the heart channel, heart send you channel. Great exercise. If you have any questions feel free to comment on the webinar.

I’ll be checking those and maybe it’s something you can add to your routine, definitely with patience, but even yourself. I think that mobility exercise is a really fantastic exercise. So thanks again for American Acupuncture Council for having me. Dr. Martha Lucas will be here next week, so check check out next week and I will see you guys again another time.

 

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Treating Patients Who Work at a Desk

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Turn the palms down as you grow back to upright.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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and hold. Stop for a moment.

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

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

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

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

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

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

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

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

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

 

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

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tissue of DU 1. So next slide, please.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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Treatment Considerations for Myofascial Trigger Points

 

 

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

Click here to download the transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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Occiput-C1 Fixations and Imbalances in the Channels

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Brian, are you ready?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All right. Cool. Next.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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