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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Turn the palms down as you grow back to upright.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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and hold. Stop for a moment.

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

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

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

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

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

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

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

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

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

 

 

 

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

Click here to download the transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tissue of DU 1. So next slide, please.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

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

Click here to download the transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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