We’re going to look at a club exercise today. It can be used for a patient exercise or maybe for your own practice, but particularly we’re going to look at shoulder girdle mobilization. And ribcage mobilization.

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’m Brian Lau and I’d like to thank American Acupuncture Council for having me back. We’re going to look at a club exercise today. It can be used for a patient exercise or maybe for your own practice, but particularly we’re going to look at shoulder girdle mobilization. And ribcage mobilization.

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So we’re going to be working with the Zhui Yin channels, the liver and pericardium channel. Why don’t we start by just a quick review of those channels, particularly the sinew channels. And then we can look a little bit at the anatomy and apply that to the exercise. So I’m going to put the presentation up and we’ll start looking at that information.

So this will be, again, a focus on the Zhui Yin channels. First of all, just quick review of the primary channels. We have on the left, we have the liver channel. Liver channel starts at the inner space between the first and second metatarsal, comes up the medial leg and thigh. This isn’t as much of what we’re going to be looking at today.

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Comes up into the groin and circles the genitals, and then this part will be a little more important as it traverses up the abdomen We’ll look at how it follows the line of the external obliques to liver 13, the motor entry point for the external obliques. So it’s a major innervation site for the external obliques.

It encircles the stomach when it comes internal. We’ll glance at that real briefly. The rest of the external channel goes to liver 14. Also in the external oblique muscle. And then the internal branch kind of connects in through the throat and the head. And we’ll leave that for another time.

Pericardium channel goes on the midline of the anterior part of the arm. Follows the median nerve. But then it comes up into the chest, also links to the side of the chest I guess you could say to the breast for women, but I would really consider it more in the soft tissue like the serratus anterior.

So with that in mind, let’s go to the Sinew channels. Sinew channels for the liver sinew channel really ends at the groin, but I extend it a little bit further. We’ll see this softer color one is really more of an internal portion that goes a little deep into the deeper musculature of the psoas, iliacus, and the quadratus lumborum.

But then they’re also, it also links with those external obliques, which is going to be a major component of rotation, which we’re looking at today. And it connects then with the paired pericardium channel, serratus anterior, also the lower costal fibers of the pec major and down into the arm. But we’ll notice as we look at a better anatomy picture that this, Serratus anterior branch is going to wrap around the back.

This is a way that I extend it and it’ll connect in the back with the rhomboids. It creates a sling with the rhomboids rhomboids in the serratus anterior. So let’s look at that anatomy. First of all, on the far left, we have that liver sinew channel ending at the groin, but it’s on that same myofascial plane.

As the iliacus and the psoas, iliacus then connects with the quadratus lumborum. Quadratus lumborum takes us to the twelfth rib, it’s between the ilium and the twelfth rib, and links with the diaphragm. We’ll see a lot of the movement we’re doing today is going to move the lower rib cage and mobilize that area of the diaphragm and the liver, which sits right under the diaphragm.

So we’ll note that anatomy there internally. But on the outside, we have the serratus anterior from the pericardium channel. interdigitates with the external oblique and creates a sling that wraps from one side all the way to the groin of the other side. If we follow the pericardium channel around, the serratus anterior goes under the scapula, attaches to the medial border of the scapula, but really it links fascially, seamlessly with the rhomboids.

When we do Dissection with the Sports Medicine Acupuncture Program, we look at this rhomboceretis sling. And sometimes you can take some time and actually tease those away from the bone and see that they’re continuous sling of tissue. That’ll link into this spleniosurfaces and capitis on the other side, so the opposite side neck.

So from one side of the neck, in this case, in the image, the left side. It’ll wrap around the right ribcage, link with the liver channel, continue along the right torso to the left groin. So it creates a sling around the body, very similar for those who know anatomy trains to the spiral line that Tom Myers talks about in his book.

If you’re not familiar with that, I wouldn’t worry too much about it. But it’s a very similar anatomy to that, though I take it a little bit slight alteration of how he organizes it. But the important thing to note today is it’s a spiral. It’s a spiral that facilitates rotation. And when we’re working with patients who have rotation type postural issues or discrepancies from the left and right, these channels would be largely involved.

The liver itself has a range of motion. It has a movement in the frontal plane follows if it stabilizes along this ligament, it’s called the triangular ligament, but if it stabilizes along a particular ligament that attaches to the diaphragm, The liver can move up and down more on the right side.

So it has a movement on the frontal plane. It has a movement in the transverse plane, and it has a movement in the sagittal plane. We’ll look at those, maybe I’ll demo those real quickly when we come out of the PowerPoint. Bottom line for now is if we’re going to mobilize this lower ribcage, we’re also going to be moving and massaging the liver and moving the diaphragm.

So diaphragm movement, liver movement, I guess spleen movement on the opposite side, but the liver is our thought for the day. And then the pericardium. Pericardium has attachments to the sternum, to the ribs, to the spine in the back. So we’re going to be moving the shoulder girdle. It’s going to pull on the thoracic spine, move the thoracic spine.

That’ll have some massaging. immobilization for the pericardium organ. So let’s look at that sort of on me. It’s easier to see it on a person than it is on the slides, but at least you have a view of the anatomy. So first of all, I have this club. I’m gonna grab this in a second. I’m just gonna put it down for now.

The liver itself, when we’re doing this movement, we want to be able to move that liver so it can move in the transverse plane, wrapping around with the ribcage, wrapping around with the ribcage, so we’ll notice that motion. We’re not going to have as much of this frontal plane motion.

That’s not going to be as big of a part of the exercise I’m doing today, but we might have a little bit of that sagittal plane motion. But primarily, we’re going to be looking at that transverse plane motion because as I swing the club, it’s going to pull the ribcage open. There’s also going to be a lot of movement in the shoulder girdle, thoracic spine, so that’s going to be moving the pericardium.

So that’s it. We’re going to use a club. It’s a really good way to work with this rotation. We’ll do a little bit of a progression. If you’re doing this yourself, you can start off with the first easier version and then progress up. If you’re working with patients who have shoulder issues, you just have to know when to give them the next level.

I’ll give some thoughts on that. A couple thoughts on the clubs themselves. I do have some variation of clubs here. I have some solid metal ones. 15 pounds, 10 pounds, and 5 pounds, even that little small one on the farthest away from me is a 5 pound, but it’s solid metal. So it looks very similar to this plastic one with metal filling, which is 2 pounds.

2 pounds is probably a really good place to start. These clubs are top heavy, purposely. So they can tip very easily and if people aren’t doing good motion they can wing their shoulder in a position that’s not particularly helpful. I have a three pound for the day’s demo. I usually use a five or a ten pound for these swings depending on what I’m trying to accomplish.

But start light, find the pathway, you don’t want to hurt yourself. So it’s better to start light. It’s a lot more, three pounds is a lot more than it seems when you’re swinging. that club around and throwing it. So if you have a good pathway, it’s an efficient movement, but you don’t want to start too high.

All right, so first progression. First progression, we’re not going to swing it overhead. We’re just going to go forward, back, forward, back. I want you to notice the ribcage. As I swing back, pulls the ribcage. open. I want to let it pull the ribcage open. So a couple things first, if you’re following along with this, I want to highlight something, is when I swing back, I’m turning my palm out.

So my hand, if it didn’t have the club, would be facing out. I don’t want to go back with my arm internally rotated. That’s going to put my shoulder in not a good position. Particularly if I had shoulder problems, that would be very aggravating. So as it goes along the midline, I want to turn out. In, out, in, out.

Let it pull the ribcage. Pelvis is stabilized. So I’m letting the movement move the shoulders. in the ribcage, massaging the liver, so back and forth, comfortable, just letting that movement mobilize the ribcage. If you’re

working with a patient with shoulder injury, maybe they do a smaller arc. You have to start small and then work towards that full range of motion. And one last hint before we look at the next portion is don’t let the pelvis kind of drag along. I have to stabilize so that I can move ribcage and shoulder girdle.

All right, next part. Overhead, I’m gonna place it just on the spine. I’m gonna let it touch my back for this first part. I’m gonna work with the shoulder mobility, shoulder girdle mobility. I want to let the club drop down like I’m trying to scratch my back low down. Lift the elbow, and make an arc, bring the elbow in, that pulls the shoulder blade around.

Lift the elbow, drop the club, bring the elbow back. Lift the elbow, drop the club, bring the elbow forward. Lift the elbow, drop the club, elbow back. So this works on the flexibility of the shoulder joint and the shoulder girdle.

Up, around, it’s okay at this phase to help yourself. I can push up, or the big range of motion issue people have is to pull the elbow in. Up, let the club drop, elbow out. Up, let the club drop, elbow in. I’m making an arc.

Patients, or if you’re new to this, sometimes when the elbow lifts, especially if the tricep flexibility isn’t there, the club lifts. But I don’t want to do that. I want to lift the elbow. drop the club. So again, you can help yourself with the other hand at this phase and just work, take your time to get that flexibility.

Next part, I’m going to lift the club away from the back and do the same thing, but the club moves. So you notice the club points to my same shoulder corner. The club points to the opposite shoulder. Same shoulder, opposite shoulder. It’s like it makes a pendulum type motion. It swings.

Once that gets comfortable, final phase, throw the club. Swings down, throw. I’m using my ribcage, shoulder.

Same thing, I don’t want the pelvis to go too wild, so I’m stable, letting the ribcage move.

Okay, that’s forward throws for back. I want to come over the same shoulder, I have to turn my torso to the opposite side, over the same shoulder, pendulum along the back, swing out.

Open the ribcage. Open the chest, open the ribcage.

All right, so we’ll do that again on the other side, but I want to highlight a couple things just from working with people on this a lot. That I give this to patients, maybe not the full movement or maybe portions of it. And I progressed them through the whole thing. I also do it in a Zoom Qigong class. I work with a lot of people that way.

We do it in Tai Chi class sometimes and we apply some Tai Chi drills to it. But working with a lot of people with this, there’s some common mistakes. The first one is the club can get horizontal and that kind of loses the trajectory. I don’t do that. When the club swings back, it points back up and then it’s like tucking.

a arrow into a quiver. It swings around in pendulums and out. And again, you see the clubs up and forward. So I don’t want to let the club get horizontal. I don’t want that top heavy portion to throw me around and then I lose control. It’s a very clean pathway. Point up, in, throw. Up, in, throw. Same thing as I go back.

Club points up, in, throw. You can see there’s a moment in time where my elbow’s down, tip of the club is up, and then it comes through.

All right, so we’ll go through those progressions on the other side. So first one, I’m gonna let the shoulder warm up and the ribcage start to mobilize. Palm turns in, palm turns out. In, Out ribcage moves. So maybe more of the spleen being massaged on me now, but it’s still that region of the liver channel in the sinews of the liver channel,

ribcage mobilization, diaphragm mobilizes,

and I’m ready for the next one. I’m going to take the club. Onto the back, elbow up, club drops down, elbow in, elbow up, club drops down, elbow out. I’m making an arc with my elbow. I can help myself if I want to work on the range of motion.

Take the club away from the back, pendulum. So it points towards the side I’m holding the club on, pull points towards the corner. of the opposite side, it makes a pendulum.

And then when I’m ready, I’m going to take that pendulum into a throw. In, throw. In, throw.

Other direction, turn, throw.

So let the whole torso open, pull back, chest opens. out, relax down. So it’s a full core movement.

Okay. Forward again, throw.

All right. So that gives the basics of it. I would start slow, start with getting control of the club and the swinging. Start with the range of motion before you start worrying too much about throwing, but I do want to show it once from the back. So you can see that. pendulum. Because that pendulum is what makes the club a little bit more weightless.

The idea is no matter how much weight you are, you’re controlling the weight, but you’re also using the momentum to throw. So let’s look at that pendulum from the back. I’m going to turn around. So we’ll go with the forward throws. I’ll go slow with this. So it tucks in. You can see that angle.

Swings around, and then through. Swings around, through.

So it’s a pendulum type motion as I pull my elbow to the corner.

Okay, when I go back, same thing. It’s gonna be in the opposite direction. Over the shoulder, pendulum around, throw.

Alright, YouTube channel that goes through it a little bit different, but same idea. That’s Jing Jin movement training, so if you want a little extra resources but you can also watch this video, I would recommend maybe practicing along with the video a few times. To get the angles, again, start with a lower weight, two pounds, one pound if you have a history of shoulder problems, before going up to something like five pounds, or even heavier once you get comfortable with it, ten pounds.

It can be a good way of doing strength training, but you don’t want to injure your shoulder, so you want to start slow and get the pathway. Who would be benefiting from this? Obviously people who want to increase the mobility of their shoulder girdle. So people who have shoulder problems, if they have a painful arc and it’s extremely painful to get the shoulder.

up. Maybe not quite appropriate for those patients, but they could start with using it to help swing and increase that range of motion at a lower capacity. And then as they get a little more comfortable, they can let that arc become a little bigger. But then I would definitely want to start with them once they’re ready here, getting that range of motion a little higher, dropping the club a little bit more before they start throwing weight around, because it is more.

Weight than you would think when it’s away from the body but also working with back pain, especially when there’s thoracolumbar junction type pain that might radiate down to the radi to the sacroiliac joint or the hip. This motion of the torso and that flexibility of the ribcage and diaphragm can be very helpful for that.

Internal problems, liver T stagnation or any TCM patterns that involve the liver, it would be a nice way to massage the liver and create a little more suppleness. And circulation, increase that circulation around the diaphragm and liver region. So it doesn’t have to be musculoskeletal problems, it could be digestive issues, a whole bunch of things where there’s a component of liver disharmonies.

So be creative with it, there’s a lot of things you can do with it, it’s an enjoyable exercise and it’s something patients can do on their own or if it’s something you’re doing for yourself, it’s something you can do on your own. Alright, I think that’ll wrap it up for today, so again, I would like to thank American Acupuncture Council.

Maybe we’ll do a follow up to this and look at some Tai Chi drills with the club, it’s a really great tool.

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So today we’re going to present on some therapeutic exercise, some qigong exercises for the wrist and elbow.

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’m Brian Lau. I’m with Sports Medicine Acupuncture, also with Jing Jin Movement Training. I want to thank American Acupuncture Council for having me again. So today we’re going to present on some therapeutic exercise, some qigong exercises for the wrist and elbow. Maybe a little more towards the wrist and for wrist dysfunction some mobilizations and just range of motion movements for the wrist, but it’ll also engage the elbow and we’ll look at the mechanics for both of those. So I have a presentation, we’ll go through a little bit of anatomy and then I’ll show some exercises. So let’s go to the slides and we will jump right in.

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All right, so first of all, the wrist joint is also called the radiocarpal joint. That is a condyloid joint. Condyloid joints, you can see it on the right on that image, it’s a modified ball and socket joint. This particular joint allows for flexion, extension, and it allows for, depending on your terminology, you might say radial deviation and ulnar deviation.

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You might call those abduction and adduction too, but basically those four movements. So flexion, extension, radial, and ulnar deviation. So there’s a decent amount of range of motion for the wrist joint. But then we can also look at pronation and supination that occurs at the distal and the proximal radial ulnar joint.

The exercises we’ll be doing will be employing those ranges of motion of flexion, extension, radial and ulnar deviation, and then of course pronation and supination, really pronation and supination are key to proper functioning of that joint. So here’s a little bit of an image that shows those.

I’m sure everyone’s familiar with these movements. But we have the normal ranges of motion. So for flexion and extension, normal range of motion is 80 to 90 degrees for flexion. 70 to 90 degrees for extension. So there’s some variability, but you want nearing 90 degrees. For ulnar and radial deviation, you have a little more range of motion for ulnar deviation.

We’ll look at the mechanics of why. So that’s about 30 to 35 degrees for ulnar deviation, a little smaller range of motion, 15 to 20 degrees for radial deviation. And again, we’ll look at the mechanics for that. And then for pronation and supination, we have about 90 degrees for both pronation and supination. Looking at the mechanics of the wrist, so the radiocarpal joint, there’s less space, your articulation is between the radius and the carpal bones. And there’s a little bit more space between the ulna and the carpal bones. And there’s a fairly complex structure. The triangular the triangular geez there’s a blank on the name triangular fibrocartilage complex, sorry about that is in this region.

It’s a collection of ligaments. There’s a meniscus and a disc. So there’s a lot of anatomy here that can get injured. That TFCC can become injured, there can be tears in the meniscus, and tears in the ligaments in this structure. But there is a little bit more space, and that greater space allows for greater movement and ulnar deviation. When we’re doing radial and ulnar deviation, I just wanted to highlight a couple things with the anatomy here, is that we can do a little manual work to help open up that range of motion. And in particular, we can come in between, to the ulna, between this fascial compartment that that contains the extensors of the wrist, particularly extensor carpi ulnaris.

We can move that away. and stretch that tissue as we’re doing the radial deviation to help stretch that tissue. We can also come in at that space pretty much along the large intestine channel here between the extensors of the wrist longus and brevis. So we can go in these fascial spaces and open those up while we’re performing the motion.

We’ll look at that when we come to the actual exercises. We’re going to look at a couple stretches for the wrist and then we’ll look at a couple more complex movements. So just so we have an idea with that, when we’re doing radial deviation, we can go into this space and kind of move this fascial compartment away from the bone, move the extensor carpi extensor carpi ulnaris away from the bone and create a little bit more space as we’re doing radial deviation and same thing applies.

When we’re doing ulnar deviation, I can come into the large intestine channel along the extensor and brevis brachioradialis, this mobile wad of three is what it’s called. These three muscles that are very mobile, I can get into that fascial space and open up the compartments while I do ulnar deviation.

So we’ll look at that in context in just a moment. We can also work on the lung channel on that same. Mobile WADA3, but on the volar side of the arm, the anterior portion of the forearm, and open up that fascial space. So the elbow itself is a hinge joint that’s going to allow for flexion and extension.

We’re primarily going to be looking at the wrist movement in this webinar, but but we will employ some movement in the elbow and it’s going to be that flexion and extension. But there is also that proximal radial ulnar joint does pronation and supination. It happens at both the proximal and the distal.

Radio ulnar joint. When we’re doing the pronation and supination, it helps link those motions. And it’s the case that when I do supination, I can increase that supination by going into elbow flexion. So supination, I can go a little farther with elbow flexion. And pronation, I can go a little farther when I do elbow extension.

So there’s a relationship between the movement of pronation and supination with elbow movement and we’ll look at that in just a moment. So for pronation and supination, we have multiple muscles that perform those. For pronation, we have pronator teres, we have pronator quadratus at the distal part of the forearm, and we also have both the extensor carpi radialis the, excuse me, the flexor carpi radialis and the brachioradialis.

Thanks. Both of those help maintain a certain amount of radial deviation when I’m doing pronation. So especially, some sources say brachioradialis more, some flexor carpi radialis, but they’re both involved. with pronation. For supination, I have the supinator, biceps brachii, and then the extensor pollicis longus of the thumb, so that helps pull the forearm into supination.

So a lot of muscles involved with those beyond just the pronators and supinators. So that’s the overview of anatomy. Let’s look at some of the exercises. Moved back just a little bit. We’ll start, I’m going to stay seated. We’ll start with some wrist mobilizations. So the first thing we have is we can work on extension.

So I’m going to bring my fingers together, index, ring finger, and the index finger. I’m going to put my middle finger on top. So Thumb and pinky together, holding something away from me, and elbow extension. I want to contract the flexors and stretch the extensors. So I want this to be somewhat active in the sense that I’m contracting the wrist flexors to be able to inhibit those extensors.

I’m giving a little over pressure to stretch those. That’s a nice stretch. If I want to increase that though, I can put my thumb inside and make a loose fist. Same thing, activate the flexors that’s going to stretch the extensors and a little extra overpressure to be able to really stretch that extensor compartment and do that a couple of times.

Exhale, contract the flexors, overpressure and stretch. Maybe do that three times.

And stretch. So to stretch the flexor to turn palm up into supination, straighten the elbow, and same thing, I want to engage the extensors to help inhibit those flexors. So I want this to be an active stretch. I want to pull my fingers back, pull the wrist back into extension, exhale, and a little over pressure, maybe for about two to three seconds.

Then again, open into extension, pull the fingers back, exhale, stretch, flexors. One more time. So again, I’m active, engaging those extensors to be able to stretch the flexors.

All right, so ulnar and radial deviation. So again, there’s less range of motion for radial deviation, a greater range of motion for ulnar deviation. That’s normal mechanics. But, I would say that many people get restricted on that radial deviation part, and everything sits and lives a little bit more into the ulnar deviation.

Think about typing on a keyboard, there’s a lot of things that we would do that would favor that ulnar deviation, and that can really compress and wear down that TFCC, that triangular fibrocartilage complex. on the ulnar side of the wrist, at the sand small intestine five region. So that would be a way I could go in with an acupuncture needle.

I can stimulate that area, increase blood flow at SI5. That’s a really good point for that. But then at some point I want to be able to stretch and open that side up. So I’m going to start with radial deviation. So I’m going to put my, I have my palms together. I’m going to put my little finger side out.

Stabilize the wrist. and pull into radial deviation. So this is where I can do a little bit of manual work if I want to help increase that. I can do it by just giving a little over pressure to go into radial deviation, but now I can go along the small intestine channel right up against the bone, pushing the extensor carpi ulnaris away from the bone, pulling down, and as I pull it’ll give a fascial drag on the periosteum of the bone on the extensor carpi ulnaris muscle.

So again, move down, push the extensor carpi ulnaris away, so I can lock me down into the bone, and then radial deviation to give a little stretch. So I can work down, eventually as I go farther towards the elbow, farther proximal, I’ll run into the anconeus muscle, right about there is where I’m starting to get into anconeus, but my goal is really at that extensor carpi ulnaris.

I can work more distal and work towards SI6. which is the border of that is the extensor carpi ulnaris right there on the bone and stretch. That’s a part of the triangular fibrocartilage complex is that extensor carpi ulnaris tendon. So it’s nice to be able to work on the tendon sheath and start to loosen that up.

Ulnar deviation. If I have a triangular fibrocartilage complex, Tear, that might be a painful motion. So I have to let pain be my guide for this, but for most people it’s gonna be fine. So I can stretch this way, but same thing I can now go at the along the ally channel, at the border of that mobile wat of three, and I’m going over the thumb muscles, the extensor lysis, brevis.

And Abductor pollicis longus. These are muscles that get injured with De Quervain syndrome. They can become very painful, especially when you go into ulnar deviation. Finkelstein’s test would be just that, where you put the thumb in and, oh, that hurts, that would be a positive for De Quervain’s.

So it’s useful to stretch this compartment out. I’m going to hold and same thing, pull down, ulnar deviation. So working over those thumb muscles. And then following along that border of the mobile WADA3 to be able to stretch, I’m going right up against the bone. So into that fascial space, up against the bone, pull towards the elbow, stretch.

So this is something you could do with patients. You could also show them this as a corrective exercise. I can go also along the lung channel, pull down, ulnar deviation to stretch.

Working to free that mobile WADA3, to free the borders. and help increase the range of motion into ulnar deviation. Okay, so last mobilization, we’re going to do pronation and supination. So this one, I want to have my arm by my side because I don’t want to be doing a lot of shoulder motion. So I’m going to use index finger, middle finger.

I’m going to stand up a little bit so you can see this one a bit better. Back up.

Index finger, middle finger, surround the thumb. I’m going to use my thenar eminence to block the wrist on the ulnar side, wrap around. So I’m going to pull with my fingers, push with my thenar eminence, and increase supination. I can use my extensor pollicis longus to pull back. That’s going to increase that supination.

Lift my little finger, that’ll increase supination, and overpressure. So Index finger, middle finger, either side of the thumb, thenar eminence against the wrist, overpressure. Pronation, palm down, thenar eminence on the radial side of the wrist, wrap the fingers around, and this is the one that I really want to be cautious, not because it’s going to cause injury, but I’m going to miss the stretch not to lift my elbow because that becomes a shoulder motion.

Not very challenging on the shoulder either. So I need to stabilize that elbow to the side and just do pronation. So same thing as I can bring my thumb down, little finger up, over pressure into pronation.

All right, same thing, two, three times to start to increase that. Again, don’t let the elbow come up because that takes the stretch away from pronation, brings it up into the shoulder and it’s not going to really do you much. I need to keep that elbow up against the side, pronation. Alright, so supination, pronation.

Alright, so let’s look now at a couple Qigong exercises. I’m going to back up just another step. Move this chair out of the way. So this is a common one that I use in Tai Chi and Qigong classes. Also on my own. It’s a very simple exercise. It’s actually built from standing meditation. In standing meditation, you might have a shoulder width stance, sitting a little bit, dropping the pelvis, letting the pelvis sink down, the head rises up, so there’s a little bit of stretch in the spine, and I’m slightly engaged in the center, round.

So there’s a round structure as if I’m holding a paper ball. My hands are open, fingers are spread out a little bit in the abduction. And the wrists and the fingers are aligned. So that would be a typical standing meditation posture. When I do this exercise, I want to use that standing meditation posture.

I want to have that little bit of a drop of the pelvis, a little bit of a elongation of the head. So do 20 towards the ceiling, a little bit of compression in the torso. And I have my shoulder blades coming around. And very round like I’m holding a paper ball. So that’s going to be the starting position, and from there I’m just going to rotate.

So I want to keep in mind how the thumb and other structures are keeping that wrist aligned. I don’t want to get too floppy with the wrists. A lot of people, when they do this, they start flopping, they lose the pronation and supination. I want to keep that alignment there. Almost as if I’m going around my middle finger or my index finger even better.

So just turn, I can go slow, or I can go fast. Once you get comfortable with it, you can speed it up a little bit. And I want to just let that motion move the body. So I’m pronation supination. This one you could do for about a minute or two. Just a nice warm up for the forearm. Starts really working the wrist and the elbow joint.

Next one is going to be built from that. Same posture with the body. Turn the top palm out, reach out, other hand comes in. I want

this one to move the ribcage, maybe a topic for another day, because there’s a lot of diaphragm motion, a lot of movement in the liver and the spleen. But we’re thinking about the elbow and the wrist, so I want to be able to fully pronate, turn the palm out, straighten the elbow.

Other hand supinates, comes in.

I can make this one slightly more round if I want, and reach,

letting the shoulder blade come around the ribcage.

Alright, last one. So this one I actually did in another webinar with American Acupuncture Council, it works on opening the chest up, but it also features that pronation and supination, so pronate, pull the chest open, straighten the elbow, reach out. Fully pronate,

chest rises, open,

open. Turn the forearms, line the hands up. Keep opening, hands are slightly in front of the elbows. Pull the shoulder blades together so this one starts really working on the chest quite a bit too. Fully press out, chest starts to compress, back

to neutral. Line everything up, fully open the chest,

and finish. So three exercises, all part of a standing meditation, Yi Quan type training. Their derivatives of that, first one’s just rotating the forearms, then the forearms rotate as I reach out, mobilizing the ribcage, but it also gives a nice stretch to the elbow. Stretch and challenge to the wrist joint, keeping good alignment to the wrist, and then opening the chest,

and involving the elbow, wrist, and shoulder girdle. Alright, so hope you find those useful. Those are great exercises to do for yourself. Especially after a long day of work, last one in particular, but great for patients. I use those quite frequently for patients for a whole host of issues. We were looking today at wrist and elbow, those would all be useful for those types of, many of those types of conditions, but that last one also very useful to open up the breathing, open up the shoulder girdle, so good for shoulder health.

Any of those motions, if there’s sharp pain or something discomfort, uncomfortable when patients are doing that, you have to let pain be the guide and modify it based on that. But they’re very adaptive, easy to work with, patients find them very useful. They’re pretty easy exercises too with a little bit of coaching.

So I’d recommend doing them yourself, get used to it, and then start working with those with patients. They’re really nice exercises. Thanks again to the American Acupuncture Council. Always fun to come and to present some of this information. I’ll see you all another time.

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And this is part two from a presentation I gave on the stomach channel. So we’ll compare the anatomy of the stomach channel with the spleen and kidney channel.

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Hi, I’m Brian Lau, I’m with AcuSport Education, also with Jingjin Movement Training. We’re going to be looking at the anatomy of the abdominal region of the spleen and kidney channel today. And this is part two from a presentation I gave on the stomach channel. So we’ll compare the anatomy of the stomach channel with the spleen and kidney channel.

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So just a little bit of a heads up I have multiple hats like many of us do. One of my main hats is I’m an anatomist. I lead dissection with AcuSport Education, but also with the University of Tampa. Physician Assistance Program. So I do a lot of exploration in human anatomy. So that’s the lens that we’re going to be looking at as we delve into these Fascial layers of the spleen and kidney channel.

But of course all of that gives a lot of clinical relevance So we’ll talk about it from a clinical perspective also. So let’s go ahead and go to the PowerPoint We’ll start looking at initially the spleen channel. So I have these, Additions to Netter’s Atlas of Human Anatomy. They don’t have the acupuncture points on this.

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Like I put these on manually. Netter is just one of the gold standards of anatomical illustrations, and it’s just such great illustrations that I thought I would add the adapt it by adding, in this case, the spleen channel. And as we know, the spleen channel is on the lateral edge of the rectus abdominis so useful information, but we can talk about the significance of that in just a second.

As we travel down to the lower portion of the spleen channel on the abdomen, we have spleen 12, spleen 13 at the inguinal ligament, spleen 12 also, but it’s on that lateral border of the femoral artery. So this will be our first window into understanding the depth in the fascial layer that makes up the spleen channel.

So keep that one in mind as we go to the next image. So what this next image is showing, also from Netter’s Atlas of Human Anatomy, is the arteries. There’s another image for the veins. They run together, but the vascular structures of the anterior abdominal wall. First of all, notice that this epigastric artery in the vein, like I said, runs together.

directly with it. That’s in a separate illustration for Netter, but that’s fine. You get the general idea that it’s running along here. That branches off of the femoral artery, or excuse me, the iliac artery in that region where it’s connecting with the femoral artery. So it’s branching off of that region of spleen 12.

And where does it go? It goes deep to the rectus abdominis, behind the rectus abdominis, And that’s the territory that it travels. In my mind, this is the Chiang Mai. This is the the vessel that you can palpate on the front. You can often feel a strong pulsation, especially if people don’t have good circulation in the aorta.

More blood shunts through this area. So it’s like a reservoir. It can open up or close up depending on the needs of the body. And it runs and follows the trajectory of the Chiang Mai. It branches into the thoracic artery and vein, which go to the breast, kind of one of the functions of the chong mai.

Sends out branches along the intercostal arteries and veins, and then eventually it branches into cervical arteries too that go up into the face. So That’s the territory that we’re looking at for the spleen channel. We’ll look at another image in a second on that. Also the chong mai follows the kidney channel points.

So again, we’re looking at a fascial layer that lives behind the rectus abdominis. And that’s going to be the deeper yin channel territory of the spleen and kidney channels. So here’s the kidney channel points. The kidney channel points are going to be on the medial edge of the rectus abdominis, pretty close to the linea alba, 0.

5 sun. And it’s going into the rectus abdominis muscle, but my target tissue is not at the rectus abdominis, but that posterior rectus sheath. So when we compare that to the spleen channel on the lateral edge of the rectus abdominis, same thing. It might be into the muscle, but posterior rectus sheath is going to be my target.

So this would be an easier image to look at if we can see a cross section to understand that layer. So here where we were last time, when we looked at the stomach channel is following these fascial layers of the external oblique, a little bit of the bifurcation of the internal oblique fascia going on top of the rectus abdominis.

The needle can get into that anterior rectus sheath, maybe potentially into the muscle. But that’s the territory, that’s the depth, that’s the region that I want to address when I’m treating it. Whereas, if I’m in the spleen channel, or the kidney channel, we’re looking at the internal oblique fascia, transverse abdominis fascia that goes posterior to the rectus abdominis.

So this posterior rectus sheath. So if I’m coming in at the spleen channel at that semi lunar line, I’m into this window of tissue that goes deep to the rectus abdominis. If I’m coming at the medial edge of the kidney channel, again, I want that needle to traverse down to that posterior rectus sheath. So I want to affect this layer here, multiple importances of that, but one very simple one is if I look at this bigger cross section, rectus abdominis.

Spine, erector spinae, quadratus lumborum. Is that fascia layer is continuous with the transverse abdominis and the internal obliques? And that’s going to continue to come into a seam at the thoracolumbar fascia as a structure called the lateral raphe. And that lateral raphe is going to separate into a deeper layer that goes between the quadratus lumborum and rector spinae, and a superficial layer that goes above the rector spinae.

So point is when I’m treating this deeper fascia layer, I’m speaking to, communicating with. The musculature like the quadratus lumborum and rector spinae. So there’s a lot of fossil communication between the front and the back through these abdominal fossil layers.

If I follow that posterior rectus sheath up first of all, let’s go back to the anterior rectus sheath. If I follow the anterior rectus sheath, part of the stomach channel, that’s going to go superficial to the ribcage. So I’m looking up at the diaphragm, there’s the xiphoid process, the stomach channel would go on the anterior surface of the ribcage.

If I’m following that posterior rectus sheath up, that’s going to blend in with the diaphragm. So it’s a different layer, only separated by, an inch and a half, two inches, pretty small distance. But but it makes a big difference internally if I’m going deep to the ribcage, and wrapping around to the back versus going superficial to the ribcage.

So this is my interpretation with the spleen sinew channel. It connects with that ribcage, excuse me, connects with the diaphragm, loops around and attaches to the spine through these attachments of the diaphragm called the cruciate the diaphragm. So when I’m treating this fascia layer, I’m going to have a much bigger impact on breathing much bigger impact on spinal health also.

Kidney channel, the kidney sinew channel doesn’t really travel through the abdomen, so I didn’t use that image, but there’s a lot of discussion with the kidney channel of how it loops into this region of related fascia. Especially with the lower rectus abdominis, it has a lot of connections into the pelvic floor, through the abdominal layers, into the multifidi.

This is the low connecting channel. It talks about that channel coming up that layer. We’re talking about posterior rectus sheath following the kidney channel to a point just below the, um, pericardium. The pericardium sits right on top of the diaphragm. So that’s exactly what it does. It comes to a point right to the, just below the pericardium, and then it loops around into the lumbar spine.

Like I said, a lot of anatomy, you don’t have to get in the weeds with it. But there’s much more of a connection with the diaphragm, much more connection with the pelvic floor, much more of a connection with the lumbar spine when we’re treating that posterior rectus sheath. That’s the take home. So let’s look at some pain patterns that are common when you’re treating the rectus abdominis.

We looked at this one with the stomach channel also because you could get trigger point formation in the belly of the muscle or at stomach 25 and this tendinous inscription between bundles of muscle. But very frequently. When there’s dysfunction here, it’s more on the edge of the muscle at that semilunar line, maybe a little bit of the obliques, maybe a little bit of the rectus abdominis fascia.

It’s like a triad between the muscle groups of the obliques, rectus abdominis, and that fascial seam where all of that fascia comes together. That can be a very prominent area for trigger point formation that can give a very gassy, distended feeling when you palpate it. Maybe that’s what patients are complaining about.

They often want to stretch that area sometimes that can refer all around to the back it can refer deep into the pelvis, it can feel like it’s internal in the pelvis. It’s a pretty broad distribution of pain that patients might either complain about or might be a component of their low back pain, for instance.

Or distention, bloating, et cetera. So along the spleen channel is the very frequent aspect of where these trigger points form. Anywhere from spleen 15 to about level of stomach 27 is pretty common. So you’re feeling at that semilunar line, feeling for fibrosity. I usually push a little into the edge of the rectus abdominis.

Another region where there’s common trigger point formation would be the medial edge. Now we’re at the kidney channel. So if I’m at that medial edge, it’s like I can scoop deep to the muscle and, I’m palpating slightly into the rectus abdominis, but I’m really feeling more for that posterior rectus sheath.

It’s like I’m going through that medial edge to get to the posterior rectus sheath. I can direct into the rectus abdominis itself, or I can direct into the linea alba along the REN channel. And same thing, a lot of pain, especially below the belly button umbilicus, maybe halfway between the pubis and the umbilicus is a common region.

It’s not going to always be exact. But along that kidney distribution is a very common area of trigger point formation for deep abdominal pain, especially abdominal pain that’s related to menstrual pain, dysmenorrhea. So for those patients who are having very difficult sensations during menstruation, this is a key area to look at.

You also have this paramedis muscle, which attaches to the linealba. That’s going to be at the lower kind of kidney 11 region that you’d have access to that. That can give a certain amount of pain in that abdominal area that can spread up to the umbilicus. The lower portions. We talked about this one of the stomach channel could be at the lateral edge along the stomach channel because this muscle narrows quite a bit as it gets to the pubic bone.

There’s not a whole lot of space on the muscle left here at the pubic bone, but really often it’s in that mid belly just off the linea alba. That’s where you frequently get this deep radiation bilaterally into the lumbar spine. And iliac crest region that can be its own pain pattern driving lumbar pain, but it might also be a component of things like lumbar facet pain.

Very important area to palpate, usually just above the pubic bone. Sometimes you even have to press the muscle into the pressing it into the pubic bone to elicit this sensation. But it’s a common area where there’s trigger point formation that could be a big component of lumbar pain that you wouldn’t necessarily think if you didn’t know the referral patterns.

Obviously you’d be palpating in the iliac crest, gluteal muscle, sacral area, lumbar spine. There might also be trigger point formation there because of its communication front to back. But don’t forget about this area. Alright, just a good netter image to see that. Spleen channel runs along the lateral edge, stomach channel runs in the middle, but as I get lower down, that line of the stomach channel really takes me to the lateral edge of the rectus abdominis.

If I move over a little bit to the kidney channel, that’s frequently where I’m going to find that trigger point formation right up against the pubic bone. Whoops.

I’m going to go back to this muscle. The other kidney channel points will take me through that medial edge so I can get to the rectus abdominis and feel into that posterior rectus sheath, spleen channel points. Again, I can through that lateral edge of the muscle at that union where it’s going to then dive deep underneath the rectus abdominis.

So any aspect that I’m needling through kidney and spleen, my tendency is to think into that posterior rectus sheath, which is slightly deeper than the muscle. So last time we looked at the motility of the stomach organ. This is looking at the kidney organ because movement in this area, if we can free the movement and control the abdominal movement we can get that flexion extension.

The kidney organ itself moves along the psoas. As I take a deep breath in, that drives the kidney down, it creates a certain amount of rotation in the kidney also, and the exhale and the diaphragm rises, the kidneys rise with it. There’s a movement from diaphragmatic breathing that if I can open that up by working on the the channels, increased breathing, that can be helpful, but it can also allow me to get a more more, efficient movement that can help mobilize the kidney organs, which is going to have good impact on the kidneys themselves, but also with lumbar pain and abdominal type situations that could be involved with the channels.

All right. So let’s look at a exercise that I do and I teach quite frequently. It’s called the spinal wave. I have a video for it. I can talk through some key points. This will be on the PowerPoint. Let me get to that slide. And this is on my YouTube channel, JingJinMovementTraining, if you want a reference, I also go into more verbal instruction on it.

But this one doesn’t have any narration, but I’ll narrate over it. Spinal wave is engaging the rectus abdominus. lengthening it. Engaging, ribcage comes closer to the pubic bone, so posterior tilt, neutral to anterior tilt, posterior tilt, anterior tilt. Same time, that ribcage drops, so this is a different variation where I bring that wave up to the whole spine.

And chest opens, but same spinal wave.

And this video shows variations with the arms and sending that energy out the arms, but whether you get that aspect of the patients, that initial one with the hands on is really the key starting position for patients, there’s a rotational version, et cetera. So you can build on it. Like I said, there’s this instruction is on my YouTube channel if you want to look at it a little bit closer.

All right, so maybe I have a few moments to go over that in my studio. I’m going to exit the PowerPoint and let’s back up and we’ll look at that real quickly.

All right, so let’s look at the spinal wave. I often, when I’m working with patients, I have them put a hand, and I do it myself this way too, put a hand on the lower rib cage and put a hand just below the umbilicus. So lower dantian. The hands aren’t doing anything. The hands are just helping me find that movement in the abdominals.

So the idea is I want to initiate that movement by pulling the pelvis up in the pubic bones. I’ll take me into a posterior tilt. Ribcage descends. Expand. Press. Expand. So I’m using the abdominals to drive spinal motion, drive kidney motion. Inhale, fill that area up. Exhale, compress starting from the pubic bone, rib cage follows.

Inhale, exhale. So you can also start this seated with patients, because very frequently patients are stiff with the spine, or yourself if you’re doing it for your own health. Sometimes they just want to do it with the knees, so they just move the knees or they move the hips or something like that.

But they have to engage the center. So pulling up the pubic bone, down the rib cage. Top hand shifts back, expand. Bottom hand shifts back, top hand shifts forward. Press, expand. Press, expand. So it takes control, takes practice, you’re engaging the front, expanding the front. You actually engage the transverse abdominis quite a bit, this one.

That’s why I like this one for the kidney and spleen channels as you’re starting to engage. Those deeper abdominal areas, exercising, massaging, increasing circulation between the front. Very nice. Thanks for checking this webinar out. Also, thank you to American Acupuncture Council, I always appreciate the opportunity to go over this information.

A lot of fun for me very exciting stuff in my mind hope you enjoyed it, and I will see you guys another time.

 

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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, 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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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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