Orthopedic acupuncture english

Orthopedic Acupuncture

:easing pain

easilyCaitlin Donovan October 2013

Lao tsu – Tao Te Ching

• Men are born soft and supple;• Dead, they are stiff and hard.• Plants are tender and pliant;• Dead, they are brittle and dry.

• Thus whoever is stiff and inflexible• Is a disciple of death.

• Whoever is soft and yielding• Is a disciple of life.

Orthopedic acupuncture vs. tcm• Done often by

physical therapists and known as ‚dry needling’

• Based on ‚cause and effect’ theory

• Treats the symptom at hand

• Done by trained acupuncturists

• Based on whole patient

• Treats underlying disorders

Anatomy of a muscle

• Origin• Insertion• Belly

• Innervation• Myofibrils

Anatomy of a muscle

Myofibrils

Trigger points

Trigger Point

Muscle Spasm

• A trigger point is the contraction of a few sarcomeres in the muscle, creating feelings under the skin like: knots, ropes, etc.

• A spasm is the contraction of the entire muscle, rendering it useless for a period of time.

Motor Point

• Zone of innervation• Generally found in mid-muscle

• Often Ah Shi• When needled, relaxes the whole

muscle

MOTOR POINT - SUPRASPINATUS

Needling motor points

• Cross Fiber technique• ‚green turtle searching for the point’

• 1,2,3 method• Look for: Muscle twitch, De Qi

„When the strength of the disease has subsided, the needle will be loose; if the

diseasehas not yet subsided the needle will be as if rooted... Atthis time the needle should not be withdrawn; if it is, the disease will return”

-- Ode of the Golden Needle

Balancing muscle groups

• Muscles that have a high degree of trigger points, tend to be slightly shortened.

• Thus, the antagonist muscle is automatically lengthened.

• Using motor points, we look to lengthen shortened muscles.

• Shortening lengthened muscles should be done through various exercises with the help of a physical therapist.

Agonist / Antagonist Muscle Groups

• pectorals/latissimus dorsi (pecs and lats)• trapezius/deltoids (traps and delts)• abdominals/spinal erectors (abs and lower-back)• quadriceps/hamstrings (quads and hams)• Anterior tibialis / Gastrocnemius• biceps/triceps• forearm flexors/extensors

Crossed Syndrome• Structural vs. Functional Approach to muscle pain• Electromyographic testing• Patterns of Imbalance are predictable

o Upper Crossed Syndrome o Lower Crossed Syndrome

• Flexors prone to tightness• Extensors prone to weakness• Muscle Dysfunction Joint Dysfunction Muscle

Dysfunction

Upper Crossed Syndrome

Tendino Muscular meridians (TMM)

• „The twelve muscle regions, the conduits which distribute the qi and blood of the 12 main meridians to nourish the muscles, possess the function of connecting all the bones and joints of the body and maintaining the normal range of motion”

- Chinese Acupuncture and Moxibustion

Tan Balance MethodOpposite Clock System

GB HT

LV SI

LU UB

LI KI

ST PC

SJ SP

Head / Jaw

Sternocleidomastoid• Origin: Mastoid Process• Insertion: Sternum, Clavicle• Innervation:

o Motor: Accessoryo Sensory: C2, C3

• Accessory Nerve: Cranial Nerve XIo Supplies SCM and upper trapezius

• Action:o Acting alone, tilts head to its own side and

rotates it so the face is turned towards the opposite side

SCM

LUOJING

Upper Trapezius• Origin: External occipital protuberance, Nuchal

Ligament• Insertion: lateral third of the clavicle• Innervation:

o Motor: Accessory Nerve, C3o Sensory: C3, C4

• Action: Rotation, retraction, elevation and depression of the scapula

External Occipital Protuberance

Nuchal Ligament

Upper Trapezius

Splenius Capitis• Origin: Nuchal ligament and Spinous Processes

C7-T3• Insertion: Mastoid process of temporal and

occipital bone• Innervation: Spinal Nerves C3, C4• Actions: Extend, rotate and laterally flex the

head

Splenius Capitis

Masseter

• Origin: Zygomatic Arch, Maxilla• Insertion: Coronoid Process, Ramus of the

mandible• Innervation: Mandibular nerve• Action: Closing of the mouth and protraction

Masseter

Point Combinations• SCM – Motor Point + LI 4, St45, Lu 7

o Relaxes the muscles, clears heat

• Upper Trapezius – GB21, GB 20, UB 10o Alleviates pain, disperses stagnation, expels windo BE SURE TO COVER THE NECK AFTER TREATMENT!!

• Splenius Capitis – Motor point, LV3, LI 4o Relaxes the Sinews, moves qi

• General -- SI 3, UB60, UB62o Opens the Du, removes obstructions in the UB mai

• General – SJ 8, GB 39, GB34o Relaxes the sinews and ligaments,clears the vessels and relaxes the

neck

Practice

LuojingMotor Point: Upper Trap

Motor Point: Splenius CapitisGB 21

Motor Point: Masseter

Levator Scapulae

• Origin: Transverse Processes of C1-C4• Insertion: Superior medial border of the scapula• Innervation: C3, C4, C5• Action: Elevates Scapula

Levator Scapulae

Levator Scapulae

Dijia

Scalenes (Anterior, Posterior,Middle)

• Origin: Transverse Processes of C2 – C7• Insertion: First two ribs• Innervation: C3-C6• Actions: Elevation of the first and second ribs

Scalenes

Scalenes• Motor Point for Middle / Posterior Scalenes –Dijia

o Middle – angle the needle towards the laryngeal prominence

o Posterior – angle the needle ina slight inferior directrion towards the transverse processes

• Motor Point for Anterior Scaleneso Jingbi – Locate a tender area 1.5 cun up from the

medial 1/3 clavicle, at the posterior margin of the SCM. With pressure, pain or numbness should be felt in the arm! Needle perpendicular until slight numbness is felt down the arm. CAUTION: you are close to the jugular vein and the apex of the lung!

Cervical Myotomes• C1 and C2 (the first two cervical nerves) control

the head.• C3 and C4 help control the diaphragm • C5 controls upper body muscles • C6 controls the wrist extensors and also provides

some innervation to the biceps.• C7 controls the Triceps • C8 controls the hands.

Cervical Dermatomes

Basic Ortho TestCervical Quadrant Sign:

o Patient Position: Seatedo Slight compression of the cervical vertebraeo + test = referred or reproduction of pain

Shoulder Abduction Test:o Patient Positioin: Seatedo Patient places handontop of head and restso + test= reduction or elimination of symptoms

Brachial Plexus

Practice

• Dijia – 3 directions• Jingbi

• Cervical Quadrant Sign• Shoulder Abduction Test• Palpation of LU1/LU2 area

Hua To Jia JiCervical 1-7 --- Neck RegionCervical 1-4 --- Head RegionCervical 4-7 --- Upper LimbCervical 3 – Thoracic 9 --- Chest Wall and Thoracic

CavityThoracic 5 – Lumbar 5 --- Abdominal CavityThoracic 11 – Lumbar 5 --- Lumbar / SacralLumbar 1 – Sacral 4 --- Pelvic CavityLumbar 2 – Lumbar 5 --- Lower Limbs

Facilitated Segments

• Osteopathic / Chiropractic view of Huatojiaji• Lack of ROM / Pain / Discomfort / Shortened

muscles over a section of vertebrae can be used as a diagnostic measure or a preventative measure of disease process

• i.e., Men with Cardiac issues tend to have lack of ROM in T2-T4

Mu and ShuLung Lu 1 UB 13

Large Intestine St 25 UB 25

Gall Blasdder GB 24 UB 19

Kidney GB 25 UB23

Spleen Lv 13 UB 20

Liver Lv 14 UB18

Bladder Ren 3 UB 28

Small Intestine Ren 4 UB 27

San Jiao Ren 5 UB 22

Stomach Ren12 UB 21

Heart Ren 14 UB 15

Pericardium Ren 17 UB 14

Practice

• Evaluate Jiaji• Note Fascilitated Segments

• Evaluate Mu• Evaluate Shu

• Needle 3 jiaji points

Shoulder

Shoulder Girdle

• Three Bones• Two Joints

• Five Major Muscles1. Rhomboids2. Trapezius

3. Levator Scapulae4. Serratus Anterior5. Pectoralis Minor

Rhomboids (Minor;Major)

• Origin: Nuchal Ligaments, Spinous Processes C7-T5

• Insertion: Medial Border of the Scapula• Innervation: Dorsal Scapular Nerve• Action: Pulls scapula medially, rotates scapula,

holds scapula to thorax wall

Rhomboids

Middle / Lower Trapezius

• O: T4-T12 Spinous Processes

• I: Aponeurosis to the scapular spine

• In: Accessory +C3,4• Action: Rotation,

retraction, elevation and depression of the scapula

• O: C7 – T3 Spinous Processes

• I: Medial acromian, Scapular Spine

• In: Accessory + C3,4• Action: Rotation,

retraction, elevation and depression of the scapula

Middle / Lower Trapezius

Trapezius

Serratus Anterior

• Origin: Outer surface of 8 or 9th rib• Insertion: Costal Aspect of medial margin of the

scapula• Innervation: Long Thoracic Nerve• Action: Protracts and stabilizes scapula, assists in

upward rotation

Serratus Anterior

Serratus Anterior

GB 23SP 21Ah Shi

Pectoralis Minor

• Origin: 3rd to 5th ribs• Insertion: Medial border and superior surface of

the coracoid process of the scapula• Innervation: Medial Pectoral Nerve• Action: Stabilizes scapula by drawing it against

the thoracic wall

Pec Major and Minor

Pectoralis Minor

Practice

• Motor Points:• Rhomboids

• Middle / Lower Trapezius• Serratus Anterior• Pectoralis Minor

Rotator Cuff

• Supraspinatus• Infraspinatus• Teres Minor• Subscapularis

Rotator Cuff

Supraspinatus

• Origin: Supraspinous fossa of the scapula• Insertion: Superior / Middle facet of greater

tuberosity on the humerus• Innervation: C5 (Suprascapular Nerve)• Action: Abducts the arm

Supraspinatus

Infraspinatus

• Origin: Infraspinous Fossa• Insertion: Posterior facet of the greater tuberosity• Innervation: C5, C6• Action: Externally Rotates the arm

Infraspinatus

Infraspinatus (2)

Teres Minor• Origin: Middle half of the lateral border of the

scapula• Insertion: Inferior facet of the greater tuberosity• Innervation: C5 (Axillary Nerve)• Action: External Rotation

Teres Minor

Teres MinorJian - Huo

Subscapularis

• Origin: subscapular fossa• Insertion: Lesser tuberosity or humeral neck• Innervation: C5, C6 (Upper and Lower

Subscapular Nerve)• Action: INTERNALLY rotates the humerus

Subscapularis

Practice

• Supraspinatus• Infraspinatus (2)• Teres Minor

• Subscapularis (2)• SI 12 – GB 21

Electro Acupuncture

• Principle Points Only• Flows to negative

• NEVER CROSS THE BODY!!!• Tonifying vs. Reducing

• Chronic Pain, Neuralgia, Anesthesia, Spasm, Paralysis, Water Retention• 10 – 20 minutes

Practice

• Abdomen points• Leg points

• Motor Points / Upper body• Analgesia points

Common Problems

• Cervical LIgament Sprain• Degenerative Joint / Disc Disease

• Supraspinatus Tendinitis• Impingement Syndrome

• Bicipital Tendinitis

Cervical Ligament Sprain

• Cause: Car accident, contact sports injury• Problem: Sprain of ligaments in the cervical

spine, Straining ofthe neck musculature from hyperextension / hyperflexion

• Treatment: Initial Stage- Ice ligaments / Heat muscles (48 hours)

• Acupuncture: Jiaji T4-T6• UB 40, Sp 10, LI 11, LI 4, Lv 3• SJ 5, GB 39, GB 34• UB 10, GB 20, GB 21• SI 3, SI 11, UB 60, UB 62

Degenerative Disc Disease

• Cause: age, hypomobility of the vertebrae• Problem: shortening of the paraspinal muscles,

narrowing of intervertebral space, increased pressure on nerve roots, calcifications.

• Acupuncture:• Jiaji of affected region• Xinshi, Xiaxinshi, Dijia, Levator Scapulae Motor

Point• LI 15, LI 11, LI 5 • SSJ 14, SJ10, SJ 4• SI 10, SI 8 SI 5

Supraspinatus Tendinitis

• Cause: Overuse of the shoulder• Problem: Inflammation of the Supraspinatus

Tendon, muscle imbalance, fatigue, weakness in the rotator cuff.

• Acupuncture:• Motor Points of the shoulder girdle• Subscapularis needling – with arm at min 90° angle• Supraspinatus: LI 16 AC Joint• SI 3, SI 10, SI 11, SI 12, GB 21, SJ 14• ST 14, ST 15, LI 16, Jianneiling, Dai Jian Zhen, LI 11,• LI 4 / SJ 10, SJ 4

Impingement Syndrome

• Cause: Repetitive overhead activities• Problem: Head of the humerus cannot move freely,

muscle imbalance, external rotator weakness• Acupuncture:• Motor Points of the shoulder girdle• Subscapularis needling – with arm at 90degree

angle• Supraspinatus: LI 16 AC Joint• SI 3, SI 10, SI 11, SI 12, GB 21, SJ 14• ST 14, ST 15, LI 16, Jianneiling, Dai Jian Zhen, LI 11,

LI 4 / SJ 10, SJ 4

Bicipital Tendinitis• Cause: Overhead repetitive motions• Problem: Inflammation of the long head of the

biceps where the tendon passes through the bicipital groove

• Acupuncture:• Jianneiling, Dai Jian Zhen, Tai jian, Chu Pi, Jian

Jian• SI 3, SI 10, SI 11, SI 12, GB 21, SJ 14• KD27, ST14, ST 15, LI 16, LI 11, LI 4,SJ 4

Thank You!

Orthopedic acupuncture english

Health & Medicine

Transcript of Orthopedic acupuncture english