Artwork for podcast Qiological Podcast
032.3 Sinew Channels & Joint Stability • Anthony Von der Muhll
Episode 3219th May 2018 • Qiological Podcast • Michael Max
00:00:00 00:57:46

Shownotes

In this episode we discuss anatomy, orthopedic assessment,  the treatment of joints, sinew pathways, and ligaments.  Our guest takes a deep look, both literally and figuratively  at the anatomy and clinical use of the jing-jin, the “sinew” or “myofascial” pathways. Especially as they relate to joint stability or dysfunction.  

Listen in for a conversation around the clinical power of the sinew channels and why brushing up on your anatomy will help you get better clinical results and improve your confidence with deep needling.

Transcripts

Michael Max:

Welcome to qiological.

Michael Max:

Mini-series dedicated to sports and orthopedic acupuncture for the next

Michael Max:

few days, I'll be bringing you several podcasts a day from the sports acupuncture

Michael Max:

alliances conference in San Jose.

Michael Max:

In addition to interviews and discussions with speakers of the

Michael Max:

conference, you'll also be hearing from participants and you'll have

Michael Max:

a special front row seat at a round table conversation around the issues,

Michael Max:

running a sports medicine practice.

Michael Max:

The sports acupuncture Alliance was created to promote the study and practice

Michael Max:

of sports and orthopedic acupuncture.

Michael Max:

I'm delighted that they were willing to partner with qiological to bring

Michael Max:

you this mini series so that those of you who are not able to attend

Michael Max:

the conference could learn from the speakers as well as the participants,

Michael Max:

and to get a taste of what it's like to be here at this special event.

Michael Max:

Please enjoy these discussions and take what you learned here

Michael Max:

and use it in your clinic.

Michael Max:

Anthony Vondra mall.

Michael Max:

Welcome to qiological.

Anthony Von Der Muhl:

Thank you very much.

Anthony Von Der Muhl:

Great to be here.

Michael Max:

Um, yeah, this is really been fun here at the sports

Michael Max:

acupuncture alliances conference.

Michael Max:

And I'm so delighted to have an opportunity to speak with, with the

Michael Max:

different speakers and delighted that we could find a little bit of

Michael Max:

time here to have this conversation.

Michael Max:

I'd like to start with how you found your way into doing.

Michael Max:

Orthopedic and sports acupuncture.

Michael Max:

Is this a longterm interest of yours or was there some sort of inciting incident?

Michael Max:

What, what set you down this path?

Anthony Von Der Muhl:

Sure.

Anthony Von Der Muhl:

That's a good question.

Anthony Von Der Muhl:

Um, my own injuries, uh, when I was 24, I had a bad bike accident that left me

Anthony Von Der Muhl:

with a lot of neck pain and a concussion.

Anthony Von Der Muhl:

And then later that same year, a soccer injury where I tore up the

Anthony Von Der Muhl:

muscles in the inside of my leg affected my gait and my spine.

Anthony Von Der Muhl:

And conventional physical therapy didn't really seem to help me very much.

Anthony Von Der Muhl:

And what worked best actually was, was tight G.

Anthony Von Der Muhl:

And that really piqued my interest in, and I was living in San Francisco at the time.

Anthony Von Der Muhl:

So it was very easy to branch out from there and to acupuncture and Chinese

Anthony Von Der Muhl:

herbs and Chinese medicine generally.

Anthony Von Der Muhl:

And so I, I was kind of on the fence.

Anthony Von Der Muhl:

I, I was interested in physical therapy, even though it hadn't worked well for me

Anthony Von Der Muhl:

personally, but when I really had to make a decision, wanted to make a decision

Anthony Von Der Muhl:

about going into a career that would last for me, Chinese medicine seemed

Anthony Von Der Muhl:

like a much bigger field with a much broader scope and had worked better me.

Anthony Von Der Muhl:

So that was the logical choice for me, but I always maintained an interest

Anthony Von Der Muhl:

and a focus on orthopedics and sports, centuries and neuromuscular skeletal pain.

Anthony Von Der Muhl:

Cause that's how I found my way to it.

Anthony Von Der Muhl:

And the first.

Michael Max:

Yeah.

Michael Max:

And it sounds like you had a long-term interest just in how the body works.

Michael Max:

I mean, you sound like an athlete.

Anthony Von Der Muhl:

Um, I want to be athlete, let's put it that way where

Anthony Von Der Muhl:

I would, would have been athlete.

Anthony Von Der Muhl:

Um, but I enjoy using my physical body.

Anthony Von Der Muhl:

Sure.

Anthony Von Der Muhl:

And, uh, and I've been more of a, a dabbler in everything from rock climbing

Anthony Von Der Muhl:

and backpacking to racquetball and, and, uh, not great at anything, but enjoy.

Anthony Von Der Muhl:

Surfing, you know, what used to be called rollerblading inline skating.

Anthony Von Der Muhl:

So that's, I think that's, that's a lot of how I've learned is from

Anthony Von Der Muhl:

trying out different activities.

Anthony Von Der Muhl:

Tigie Bagua, martial arts, and finding out and feeling what do they do to my body?

Anthony Von Der Muhl:

And do they help?

Anthony Von Der Muhl:

Do they hurt?

Anthony Von Der Muhl:

Is yoga helpful?

Anthony Von Der Muhl:

Is Pilates harmful, et cetera, just experimenting and.

Anthony Von Der Muhl:

Learning from my own injuries.

Anthony Von Der Muhl:

And really, I feel like that's the best way of all to learn.

Michael Max:

Yeah.

Michael Max:

Well, it also sounds, you know, some of us are very visual, some are

Michael Max:

auditory and some are really, some of us are really kind of static and

Michael Max:

it, it sounds to me like you might be one of these kinesthetic characters,

Michael Max:

you kind of make sense of the world.

Michael Max:

Uh, through your body, is that, would that be an accurate way of,

Anthony Von Der Muhl:

yeah, certainly it does make sense.

Anthony Von Der Muhl:

And I'm not much of a learner herbs have never really done that much for me, which

Anthony Von Der Muhl:

is a puzzle and a frustration to some of my colleagues, but I can't really feel

Anthony Von Der Muhl:

their effects in my own body very much.

Anthony Von Der Muhl:

And that makes me very.

Anthony Von Der Muhl:

Unsure and hesitant when prescribing them to patients and physical modalities.

Anthony Von Der Muhl:

Exactly the opposite.

Anthony Von Der Muhl:

I feel acupuncture's effects.

Anthony Von Der Muhl:

Uh, I like how it feels.

Anthony Von Der Muhl:

Guash SHA cupping TuiNa exercise therapy fascinate me because I

Anthony Von Der Muhl:

feel their effects in my body.

Anthony Von Der Muhl:

And I want to share that with other

Michael Max:

people.

Michael Max:

That's great, you know, to be able to have a way of sensing and knowing

Michael Max:

what you're sensing and making.

Michael Max:

You know, being able to see what works, what doesn't being

Michael Max:

able to feel it on the inside.

Michael Max:

I suspect that's well, I know it's important.

Michael Max:

Um, you know, in my practice to, you know, have, have, uh,

Michael Max:

to be able to feel it yourself.

Michael Max:

So that you've got

Anthony Von Der Muhl:

a sense of what to pay and it makes it much easier

Anthony Von Der Muhl:

for me to look the patient in the eye and say to them, honestly, I have

Anthony Von Der Muhl:

a sense of what's going on for you.

Anthony Von Der Muhl:

I, and I I've been there myself where I feel that I know what it feels like

Anthony Von Der Muhl:

to have a needle go into that area.

Anthony Von Der Muhl:

I know what it feels like to have a pain in that joint and that, uh,

Anthony Von Der Muhl:

Increases trust on the part of the patient and an empathy, I think is very

Anthony Von Der Muhl:

helpful for the therapeutic Alliance, if you will, and improves outcomes,

Michael Max:

um, yeah.

Michael Max:

From your experience, how would you say orthopedic acupuncture?

Michael Max:

Differs from, I'm just going to say regular what we

Michael Max:

learned in school accurate.

Anthony Von Der Muhl:

Oh, that's a good question too.

Anthony Von Der Muhl:

I don't know that it does.

Anthony Von Der Muhl:

I think there's my own sense is now I have not been to China.

Anthony Von Der Muhl:

I have not studied in China will be upfront about.

Anthony Von Der Muhl:

But I wonder whether what we get taught in schools in America is really

Anthony Von Der Muhl:

an accurate, complete representation of acupuncture and Chinese medicine.

Anthony Von Der Muhl:

The way has been practiced historically in China.

Anthony Von Der Muhl:

I think there's a lot of indications that it's not, that we get kind

Anthony Von Der Muhl:

of a distilled reader's digest, compressed and distorted version.

Anthony Von Der Muhl:

And then we twist it further because of our own inevitable

Anthony Von Der Muhl:

cultural lenses and biases.

Anthony Von Der Muhl:

In the west.

Anthony Von Der Muhl:

Um, but then I look at videos.

Anthony Von Der Muhl:

I mean, YouTube is now a great resource and I see acupuncturists in

Anthony Von Der Muhl:

the far east using enormous needles, going deeply into the body in large

Anthony Von Der Muhl:

numbers in ways that would that.

Anthony Von Der Muhl:

And then I see the comments on Facebook from Western practitioners are

Anthony Von Der Muhl:

horrified, shocked, wringing their hands.

Anthony Von Der Muhl:

It looks like surgery.

Anthony Von Der Muhl:

It looks like barbaric, et cetera, but.

Anthony Von Der Muhl:

Eastern medicine.

Anthony Von Der Muhl:

It's Eastern medicine is diverse.

Anthony Von Der Muhl:

Uh, just as Western medicine is diverse and we've got everything

Anthony Von Der Muhl:

from the subtleties of homeopathy to a radical orthopedic surgery.

Anthony Von Der Muhl:

It's all Western medicine, same thing in the east.

Anthony Von Der Muhl:

So I have good reason to believe based on historical sources.

Anthony Von Der Muhl:

From teachers that I've studied with, who have spent a lot of time in China,

Anthony Von Der Muhl:

that some of the kinds of kneeling techniques that are now taught in the

Anthony Von Der Muhl:

west as orthopedic acupuncture also have roots or parallels in the far east.

Anthony Von Der Muhl:

Well,

Michael Max:

I know I've spent a little time in Asia and

Michael Max:

sometime in acupuncture clinics.

Michael Max:

And I know that what I saw sometimes it was very similar to what we do.

Michael Max:

Um, and sometimes it was.

Michael Max:

Really different.

Michael Max:

And my basic takeaway was, I don't think I can get away

Michael Max:

with that in the United States.

Michael Max:

Yes.

Michael Max:

So there is that.

Michael Max:

Yeah.

Michael Max:

Yes.

Michael Max:

So it sounds like you're doing a lot more deep needling and maybe

Michael Max:

with more stimulation, is it.

Michael Max:

Correct characterization.

Anthony Von Der Muhl:

I think that's, I think that's, uh, compared to

Anthony Von Der Muhl:

the way acupuncture is generally taught in most schools in the

Anthony Von Der Muhl:

west, I'd say yes, but I don't.

Anthony Von Der Muhl:

But like I said, I don't know that it's actually any different from

Anthony Von Der Muhl:

how acupuncturists in the far east would treat orthopedic injuries.

Anthony Von Der Muhl:

And again, you've got, we've got everything from

Anthony Von Der Muhl:

the subtle off body needle.

Anthony Von Der Muhl:

Japanese practitioners to the deep kneeling with needles, the size of,

Anthony Von Der Muhl:

you know, knitting needles, or even I've seen things that look like

Anthony Von Der Muhl:

a golf club going into somebody's back from a Korean practitioner,

Anthony Von Der Muhl:

you know, right along the spine.

Anthony Von Der Muhl:

And so I think that's, I'm not sure I really answered your question though.

Anthony Von Der Muhl:

I think your question was how is what acupuncture, orthopedics different

Anthony Von Der Muhl:

from what's taught in school?

Anthony Von Der Muhl:

I can't speak generally to acupuncture orthopedics, but I can, I can talk a

Anthony Von Der Muhl:

little bit about what I do and what I've learned to learn to do from teachers.

Anthony Von Der Muhl:

So yes, that's exactly what we're looking for.

Anthony Von Der Muhl:

It is integrative.

Anthony Von Der Muhl:

I do use the concepts and paradigms to Chinese medicine,

Anthony Von Der Muhl:

particularly for orthopedics.

Anthony Von Der Muhl:

The concept of longitudinal.

Anthony Von Der Muhl:

Tracks or chains or continuity's of myofascial tissues that we translate as

Anthony Von Der Muhl:

a senior Meridian, so that the DJing gen the senior meridians or the myofascial

Anthony Von Der Muhl:

or tendon, no muscular meridians.

Anthony Von Der Muhl:

I was a very extremely useful concept, which Western medicine is now a Western

Anthony Von Der Muhl:

physical therapy is kind of rediscovering.

Anthony Von Der Muhl:

Variously called anatomy, trains or kinematic chains that is different

Anthony Von Der Muhl:

from the way orthopedics was practiced in the west, you know, 30, 40 years

Anthony Von Der Muhl:

ago where it was very kind of cross sectional, you know, horizontal.

Anthony Von Der Muhl:

We're just going to look at the elbow joint.

Anthony Von Der Muhl:

We're going to look at the knee joint.

Anthony Von Der Muhl:

How they're part of a continuity from the foot to the low back to

Anthony Von Der Muhl:

from the hand to the shoulder.

Anthony Von Der Muhl:

So that longitudinal Meridian, if you will, approach is, is very useful.

Anthony Von Der Muhl:

And I use it all the time, but I've also learned a tremendous amount from the, the,

Anthony Von Der Muhl:

the Western orthopedic and osteopathic.

Anthony Von Der Muhl:

Uh, ways of looking at the body and particularly my topic that

Anthony Von Der Muhl:

I'm, that I think is less commonly taught in the west is kneeling

Anthony Von Der Muhl:

into joints and ligaments and joint capsules, intra articular structures.

Anthony Von Der Muhl:

And I also do trigger point needling, myofascial, needling.

Anthony Von Der Muhl:

I use distal kneeling.

Anthony Von Der Muhl:

I use here.

Anthony Von Der Muhl:

I use scalp.

Anthony Von Der Muhl:

I've never, I should say I've never found one particular approach that

Anthony Von Der Muhl:

works best for everyone all the time.

Michael Max:

Oh man.

Michael Max:

That's, you know, that is the beauty and the frustration

Michael Max:

of the medicine we practice.

Anthony Von Der Muhl:

And if every medical modality, I mean, if, you know,

Anthony Von Der Muhl:

if you, if you hear a surgeon who's or a doctor say, this is the one best

Anthony Von Der Muhl:

treatment for everyone all the time, run and run and hang on to your wallet.

Anthony Von Der Muhl:

Um, because that's not how human beings are put together.

Anthony Von Der Muhl:

Diversity and uniqueness is the norm.

Anthony Von Der Muhl:

And the anatomy books are composite, you know, sort of middle of the

Anthony Von Der Muhl:

bell curve approximations, but every human being, every body is a

Anthony Von Der Muhl:

scrapbook of, of their life story.

Anthony Von Der Muhl:

And we have anatomic variations, congenital variations, acquired

Anthony Von Der Muhl:

variations, and it's, it's impossible for any one approach to work

Anthony Von Der Muhl:

best for all people all the time.

Anthony Von Der Muhl:

Right.

Michael Max:

So you mentioned tendon Ole muscular meridians, and.

Michael Max:

I've heard other people that do orthopedic and sports acupuncture.

Michael Max:

Talk about these quite a bit.

Michael Max:

And, and the people that I know that do the trauma medicine, the hit medicine,

Michael Max:

all that, these seem to be really important meridians to pay attention to.

Anthony Von Der Muhl:

Yes, I would agree.

Anthony Von Der Muhl:

And, yeah.

Michael Max:

And, and so I'm wondering how you like to work with them.

Michael Max:

I mean, some people like to bleed them.

Michael Max:

My wife is crazy about using quash and.

Michael Max:

Yeah.

Michael Max:

I mean, I I've watched her do amazing things with squash off, you know,

Michael Max:

like, like a jelly jar and you know, some oil and it's incredible.

Michael Max:

So I'm curious to know how you like to work with the

Michael Max:

tendon on muscular meridians.

Michael Max:

And in, like you said, th these days Western medicine is looking at these as

Michael Max:

anatomy, trains, and this sort of thing.

Michael Max:

So I'd like to get your take on these

Anthony Von Der Muhl:

things.

Anthony Von Der Muhl:

So I think there's really two questions there.

Anthony Von Der Muhl:

And one is, you know, what, uh, is the, the sort of.

Anthony Von Der Muhl:

Where do the.

Anthony Von Der Muhl:

The gene gin, tell us to look in the body to find sources of pain or disability.

Anthony Von Der Muhl:

And they tell us to look longitudinally, you know, along the,

Anthony Von Der Muhl:

the, the distributions, if you will.

Anthony Von Der Muhl:

And then the second question which I'll get to in a moment is what

Anthony Von Der Muhl:

clinical techniques do we apply.

Anthony Von Der Muhl:

Um, but the first question is a very important question.

Anthony Von Der Muhl:

Um, and what is what I have seen.

Anthony Von Der Muhl:

Uh, what I went through myself as an acupuncturist.

Anthony Von Der Muhl:

And what I've seen happen in the profession is that people

Anthony Von Der Muhl:

learn the primary ingredients.

Anthony Von Der Muhl:

We Westerners learned the primary meridians in school

Anthony Von Der Muhl:

focus exclusively on that.

Anthony Von Der Muhl:

It's mistaught I, in my opinion, as sort of a pipe system with a

Anthony Von Der Muhl:

circulating goo that we manipulate through putting needles into, into, into

Anthony Von Der Muhl:

two dimensional points on the surface and how that actually manipulates

Anthony Von Der Muhl:

the glue, that's flowing through the pipes, it's kind of mysterious.

Anthony Von Der Muhl:

I'm sorry.

Anthony Von Der Muhl:

I'm I'm, I'm being a little bit, um, what's the word?

Anthony Von Der Muhl:

Snarky or something.

Anthony Von Der Muhl:

I love

Michael Max:

it.

Michael Max:

We, we sometimes have a very unsatisfying way to the Western

Michael Max:

mind to describe what we do.

Michael Max:

Yeah.

Michael Max:

So we often think about channels and GU I mean, we've got a fancy name.

Michael Max:

We call it cheap, but yeah.

Michael Max:

Yeah.

Michael Max:

Pipes.

Michael Max:

Um, I'm with you, my friend, I

Anthony Von Der Muhl:

think there's a lot of translational questions

Anthony Von Der Muhl:

and linguistic questions that is probably outside of the scope of what

Anthony Von Der Muhl:

we want to spend a lot of time on.

Anthony Von Der Muhl:

But so I just throw it out as a question as to an, and, you know, God

Anthony Von Der Muhl:

knows on Facebook, people get into huge battles with each other over

Anthony Von Der Muhl:

correct translations of words like gee, and let's just acknowledge there.

Anthony Von Der Muhl:

Isn't a way to translate it correctly.

Anthony Von Der Muhl:

Chinese and English are some things that just can't be expressed, uh, in one

Anthony Von Der Muhl:

language the way they can in another line.

Anthony Von Der Muhl:

So rather than, than argue over a correct translation of G what I find

Anthony Von Der Muhl:

most useful again, is the concept of spatial organization and where to look

Anthony Von Der Muhl:

in the body to find potential sources of pain and disability and the longitudinal

Anthony Von Der Muhl:

orientation, the meridians, and the way that their, that the S uh, Ancient

Anthony Von Der Muhl:

classical Chinese medicine tells us to look at, at essentially six of them,

Anthony Von Der Muhl:

not 12, the young Ming, the Taiyang and the shaoyang, et cetera, as, and

Anthony Von Der Muhl:

also the depth is very important.

Anthony Von Der Muhl:

And that's often we think of the deaths in terms of penetration of, uh, external

Anthony Von Der Muhl:

evils, but they also tell us about the devs, the fascia, the depths of

Anthony Von Der Muhl:

muscle, the depths of, of structures.

Anthony Von Der Muhl:

And those three young meridians are all superficial.

Anthony Von Der Muhl:

The young man on the front, shaoyang on the side, Taiyang in the back.

Anthony Von Der Muhl:

And then when we go to the yin meridians, they're all internal and

Anthony Von Der Muhl:

central with a deepest, other than the ShaoYin Meridian being really an

Anthony Von Der Muhl:

axial or central Meridian, you know, right up the, the spine, but also kind

Anthony Von Der Muhl:

of through the center of the limbs.

Anthony Von Der Muhl:

And this is all verifiable in a cadaver lab.

Anthony Von Der Muhl:

You can go into the anatomy lab and look at how these muscles, tendons,

Anthony Von Der Muhl:

bones, and joints connect to each other.

Anthony Von Der Muhl:

Along these longitudinal tracks.

Michael Max:

So you're thinking of the six layers, the, the O gene as being

Michael Max:

literally deeper or more superficial in the body, not as a concept.

Michael Max:

But as

Anthony Von Der Muhl:

an actuality, as an actuality, and I think that's one

Anthony Von Der Muhl:

of the, um, at, at, at, at the bottom of it, I think we have this Neoplatonic

Anthony Von Der Muhl:

split in the west between, you know, mind and body or spirit and matter

Anthony Von Der Muhl:

that we unconsciously bring into our.

Anthony Von Der Muhl:

Our mistranslations of Chinese medicine that has no such divisions.

Anthony Von Der Muhl:

So we get that there's these sort of theoretical meridians and, uh,

Anthony Von Der Muhl:

invisible energies that are somehow separate from physical reality.

Anthony Von Der Muhl:

That's uh, that is, uh, uh, Neoplatonic and also

Anthony Von Der Muhl:

Judeo-Christian view of the world.

Anthony Von Der Muhl:

The Chinese view is it's all integrated, it's all interpenetrative.

Anthony Von Der Muhl:

Um, which I think is actually much closer to modern quantum physics and

Anthony Von Der Muhl:

having gone through our Neoplatonic and.

Anthony Von Der Muhl:

Judaeo-Christian and Newtonian phases in the west, our flagship science

Anthony Von Der Muhl:

of physics is actually coming full circle to a, a much more integrated

Anthony Von Der Muhl:

understanding of reality that matches the original Chinese vision much better.

Anthony Von Der Muhl:

So yes, absolutely.

Anthony Von Der Muhl:

The, the, this.

Anthony Von Der Muhl:

The six divisions or six meridians.

Anthony Von Der Muhl:

However you want to translate it.

Anthony Von Der Muhl:

Our descriptions of tangible, physically verifiable structures that

Anthony Von Der Muhl:

you can put your hands on and you can also observe how they transmit

Anthony Von Der Muhl:

forces along longitudinal pathways to make the body move or to resist

Anthony Von Der Muhl:

outside forces to provide stability.

Michael Max:

So there's a whole structural component.

Michael Max:

To these six channels.

Anthony Von Der Muhl:

Absolutely.

Anthony Von Der Muhl:

I think there is.

Anthony Von Der Muhl:

And certainly, you know, translators, uh, there's not that many people

Anthony Von Der Muhl:

who really look at and translate in comparison to the translators

Anthony Von Der Muhl:

of classics of internal medicine.

Anthony Von Der Muhl:

I'm only aware of one book David legacies that really focuses on

Anthony Von Der Muhl:

specifically on the Jing Jin Australian practitioner and translator, uh,

Anthony Von Der Muhl:

came out with a book a few years ago.

Anthony Von Der Muhl:

Believe the title is the gin gin, and his last name is spelled L E.

Anthony Von Der Muhl:

Double G E for those of you who want to look it up, Donald Kendall and his work,

Anthony Von Der Muhl:

the Dao Chinese medicine has a chapter devoted to the, to the, uh, DJing Jenna.

Anthony Von Der Muhl:

Well, both of them agree is that if you, you look at the nature brings

Anthony Von Der Muhl:

description of the nature of the gene.

Anthony Von Der Muhl:

Jen, it's very, it's very.

Anthony Von Der Muhl:

In comparison to the descriptions that the DJing law, the primary meridians, it

Anthony Von Der Muhl:

seems three almost, but it's very clear that they're describing specific muscles.

Anthony Von Der Muhl:

Now it's hard to translate some of them and figure out exactly what they mean.

Anthony Von Der Muhl:

So Donald Kendall schema is different from legacies, which is different from mine.

Anthony Von Der Muhl:

We assign different muscles to different meridians, some of the

Anthony Von Der Muhl:

time, maybe 20 or 30% of the time, we're at odds with each other.

Anthony Von Der Muhl:

And we can go into that more detail if you want.

Anthony Von Der Muhl:

But what we all agree upon is that there were actually describing things like the

Anthony Von Der Muhl:

biceps, the triceps, the hamstrings, the, what we call the hamstrings in the west.

Anthony Von Der Muhl:

And I don't remember the Chinese term, but you know, it might be the fish belly.

Anthony Von Der Muhl:

And, but we have our Achilles tendon.

Anthony Von Der Muhl:

You have to know who Achilles was in order to understand that and

Anthony Von Der Muhl:

the Greek mythology and stuff.

Anthony Von Der Muhl:

So the poetic language of Chinese classical Chinese leaves open a lot

Anthony Von Der Muhl:

of room for misinterpretation, but they're very clearly describing physical

Anthony Von Der Muhl:

verifiable structures, not just theory.

Anthony Von Der Muhl:

Yeah.

Michael Max:

You just mentioned that you and leggy and Donald Kendall are 20 to

Michael Max:

30% at odds with each other on your ideas.

Michael Max:

You know, 20, 30% at odds means you're agreeing 70 to 80% of the time.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

Something like that.

Anthony Von Der Muhl:

That's

Michael Max:

pretty interesting.

Michael Max:

So for, for the folks that are listening here to our conversation, let's go a

Michael Max:

little bit into how you access these, uh, And work with them and that in

Michael Max:

using them, you, you were talking about this longitudinal look and, and you, I

Michael Max:

love this phrase, spatial organization.

Michael Max:

Tell us a bit about how you use spatial organization to understand

Michael Max:

what someone's problem might be, and then what you would do with.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

So to complete the, or to go a little more into the, how I would

Anthony Von Der Muhl:

use that spatial organization.

Anthony Von Der Muhl:

And then what I would do is for example, I'm the head of patient, uh, referred to

Anthony Von Der Muhl:

me recently for, uh, she's an athlete, a runner had a medial foot arch pain.

Anthony Von Der Muhl:

So it was a referral from a physician.

Anthony Von Der Muhl:

And that's the diagnosis was just simply, you know, I can't remember

Anthony Von Der Muhl:

what the code was, but something about medial foot arch pain.

Anthony Von Der Muhl:

So.

Anthony Von Der Muhl:

The concept of the DJing gin was very useful for me in not only finding locally,

Anthony Von Der Muhl:

what was the problem in her medial foot?

Anthony Von Der Muhl:

Archer first metatarsal, uh, was very loose and, uh, the

Anthony Von Der Muhl:

ligaments that connect it to the midfoot bones were stretched out.

Anthony Von Der Muhl:

So she was getting a whole lot of play every time she landed on her forefoot

Anthony Von Der Muhl:

during her, or, you know, pushed off from her forefoot during her running.

Anthony Von Der Muhl:

I didn't see whether she was a heel runner or a toe runner.

Anthony Von Der Muhl:

Uh, either way that joint was loose and unstable, but then I have to

Anthony Von Der Muhl:

ask myself why what's going on?

Anthony Von Der Muhl:

How did that happen?

Anthony Von Der Muhl:

She didn't have any history of traumatic injury with the gin.

Anthony Von Der Muhl:

Gin.

Anthony Von Der Muhl:

Tell me to do is to look further along that chain in her case, it was

Anthony Von Der Muhl:

almost at the distal end of the chain.

Anthony Von Der Muhl:

So I want to look at her ankle joint.

Anthony Von Der Muhl:

I want to look at her knee joint.

Anthony Von Der Muhl:

I want to go all the way up to her hip joint and her, her gluteal musculature.

Anthony Von Der Muhl:

And along the way, I found her knee joint with stable.

Anthony Von Der Muhl:

No problem.

Anthony Von Der Muhl:

But her ankle joint was similarly loose and her hip.

Anthony Von Der Muhl:

I had a tendency to sub blocks anteriorly and her external rotators were tight too.

Anthony Von Der Muhl:

You know, I don't, you know, it's chicken and egg doesn't really matter

Anthony Von Der Muhl:

to me, which came first, but she had an overall pattern of rotating her leg

Anthony Von Der Muhl:

externally, uh, her hip joint subluxing anteriorly and her, her medial ankle

Anthony Von Der Muhl:

joint ligaments, the deltoid ligament also being loose and stretched out.

Anthony Von Der Muhl:

So.

Anthony Von Der Muhl:

Treating all the way along that pathway in general is going to, in my experience,

Anthony Von Der Muhl:

work a whole lot better than just simply focusing on the foot itself by

Anthony Von Der Muhl:

no needling locally or for that matter.

Anthony Von Der Muhl:

If you're a fan of distal techniques and you go medial foot arch, well, I'm

Anthony Von Der Muhl:

going to use, you know, a balanced method or a master dong points or something.

Anthony Von Der Muhl:

And look on the opposite hand and treat, you know, treat the,

Anthony Von Der Muhl:

uh, Nyan Meridian in the foot.

Anthony Von Der Muhl:

I'm going to go to the tie in radio on the hand.

Anthony Von Der Muhl:

Works to, to provide short-term pain relief, but to provide a structural

Anthony Von Der Muhl:

change that alter through gate biomechanics, I need to look along

Anthony Von Der Muhl:

the biomechanical pathway and that's very well described by the gin gin.

Anthony Von Der Muhl:

So that's one example.

Michael Max:

What kind of tests do you use to assess you were just

Michael Max:

talking about ankle was loose.

Michael Max:

Knee was.

Michael Max:

Yeah.

Michael Max:

In terms of location of the hip joint, how do you, what kind of

Michael Max:

tests do you use to get this?

Anthony Von Der Muhl:

Sure.

Anthony Von Der Muhl:

That's a good question.

Anthony Von Der Muhl:

Um, well the, in that particular example I gave you, I was talking

Anthony Von Der Muhl:

just about joints along the pathway.

Anthony Von Der Muhl:

So what I use is what I learned from a physical therapist and actually

Anthony Von Der Muhl:

from another acupuncturist, Alon Marcus, uh, who is now retired, but

Anthony Von Der Muhl:

it was, you know, an encyclopedia of acupuncture, orthopedics and orthopedics

Anthony Von Der Muhl:

generally called joint plate testing where you essentially, and that's

Anthony Von Der Muhl:

what I'm going to be teaching a lot.

Anthony Von Der Muhl:

This weekend is.

Anthony Von Der Muhl:

Grasping one bone firmly with a hand and then grasping the other bone or other

Anthony Von Der Muhl:

structure on the other end of that joint and moving it through both anatomical

Anthony Von Der Muhl:

planes, the way the joint is supposed to move, but also sometimes testing

Anthony Von Der Muhl:

it through non anatomical directions.

Anthony Von Der Muhl:

For example, the foot is not supposed to slide forward on your tibia and fibula.

Anthony Von Der Muhl:

That's a non anatomical motion.

Anthony Von Der Muhl:

That can happen.

Anthony Von Der Muhl:

However, it's not, it's not voluntary under our control, but at the ankle

Anthony Von Der Muhl:

joint gets sprained stretching out the anterior talofibular ligament.

Anthony Von Der Muhl:

That's supposed to hold the foot, you know, on the, the tibia.

Anthony Von Der Muhl:

Fibula, actually, this particular ligament is, goes from the tails to the fibula.

Anthony Von Der Muhl:

If that ligament gets stretched out, suddenly the whole foot can slide,

Anthony Von Der Muhl:

you know, maybe only a, you know, an eighth of an inch, a few millimeters

Anthony Von Der Muhl:

forward on the fibula, but that's enough to disrupt biomechanics.

Anthony Von Der Muhl:

Maybe not walking across the room, but you go for a 10 K run.

Anthony Von Der Muhl:

That's going to affect how muscles are used up and down the example of like,

Anthony Von Der Muhl:

you know, you bang your wheel into, to occur, parking it, you know, in a hurry.

Anthony Von Der Muhl:

And then you drive across town, no big deal, but you take that same car and

Anthony Von Der Muhl:

you drive it to Maine from California.

Anthony Von Der Muhl:

By the time you cross the country, that little imbalance in the wheel alignment

Anthony Von Der Muhl:

is going to result in that wheel where.

Anthony Von Der Muhl:

Unevenly and the tire wearing out on the CV joint, getting

Anthony Von Der Muhl:

loose and damaged, et cetera.

Anthony Von Der Muhl:

So that's what happens to these seemingly small trivial injuries where the little

Anthony Von Der Muhl:

bit of extra joint play than all the muscles that cross that joint are now

Anthony Von Der Muhl:

working over time and don't get to rest.

Anthony Von Der Muhl:

And they're normal, you know, contraction, relaxation cycles,

Anthony Von Der Muhl:

because they're having to make up for the, the laxity of the joint.

Anthony Von Der Muhl:

Developed tendonitis and myofascial pain and strains and inflammation

Anthony Von Der Muhl:

and degeneration and wear out.

Anthony Von Der Muhl:

And so checking the joints, uh, using that joint play testing technique

Anthony Von Der Muhl:

is extremely important feeling.

Anthony Von Der Muhl:

What's the integrity of the ligaments.

Anthony Von Der Muhl:

Is there too much plays or what's the end feel?

Anthony Von Der Muhl:

Is it, is it a normal infield, which is kind of a, from elastic rebound, uh,

Anthony Von Der Muhl:

like it's being held in place by a very thick taut, rubber band in general.

Anthony Von Der Muhl:

Or is it loose and mushy like is being held.

Anthony Von Der Muhl:

It's been placed by stretched out silly putty or old chewing

Anthony Von Der Muhl:

gum, or maybe nothing at all.

Anthony Von Der Muhl:

Maybe the ligament snapped clean through and you have kind of an empty end field.

Anthony Von Der Muhl:

That's a business, not a good situation, but I also use manual muscle testing on.

Anthony Von Der Muhl:

Which is helpful for testing the strength and function of the it's actually called

Anthony Von Der Muhl:

it's called manual muscle testing.

Anthony Von Der Muhl:

There's really manual strength testing because the muscle has to have an intact

Anthony Von Der Muhl:

nerve supply in order to contract.

Anthony Von Der Muhl:

So when we're testing strength or similar.

Anthony Von Der Muhl:

Tediously testing, muscle strength and nerve supply.

Anthony Von Der Muhl:

I'll use inspection.

Anthony Von Der Muhl:

I watch how this patient walks, you know, as is her leg and you know his right leg,

Anthony Von Der Muhl:

same as the left leg, your right leg.

Anthony Von Der Muhl:

No, her right leg is rotated a little externally during her gait.

Anthony Von Der Muhl:

And so all of these pieces of information.

Anthony Von Der Muhl:

And they're just clues to put together to figure out where do I need to needle?

Anthony Von Der Muhl:

Where do I need to do guash Shaw?

Anthony Von Der Muhl:

Where do I need to do cupping?

Anthony Von Der Muhl:

What exercises do I need to prescribe or Unprescribed for her,

Michael Max:

we've mentioned, guash shot a couple of times in this conversation.

Michael Max:

Um, and I recently did an interview with a couple of women who use

Michael Max:

guash Shaw a lot in their practice.

Michael Max:

In fact, after doing that interview, I've started using

Michael Max:

guash on my clinic a lot more with.

Michael Max:

Frankly, stunning results.

Michael Max:

I I'm shocked at the amount of time that I practice acupuncture, not use flu

Anthony Von Der Muhl:

shots.

Anthony Von Der Muhl:

I had a, I had a similar, uh, I had a similar conversion experience

Anthony Von Der Muhl:

myself about a number of years ago.

Anthony Von Der Muhl:

What

Michael Max:

I'd like to hear that experience what happened.

Michael Max:

And then I want to hear about how you're using wash out to help your patients.

Anthony Von Der Muhl:

Sure.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

Quasha is an extremely useful and I think underused modality in the way.

Anthony Von Der Muhl:

But what I find in general it's most useful for is breaking up adhesions and

Anthony Von Der Muhl:

restrictions in muscles that have suffered a strain that has not healed completely.

Anthony Von Der Muhl:

And also some structures like the it band or thoracolumbar fascia that,

Anthony Von Der Muhl:

that, uh, you know, Too tight or damaged and stuff we'll develop, basically.

Anthony Von Der Muhl:

What is scar tissue, not keloid scars that you see on the surface of the

Anthony Von Der Muhl:

skin, but, uh, areas where the tissue organization is disrupted and has

Anthony Von Der Muhl:

grown back in a disorganized fashion instead of the nice, neat parallel

Anthony Von Der Muhl:

bands of fibers, uh, Born with where everything is elastic and has recoil

Anthony Von Der Muhl:

and slides past each other smoothly.

Anthony Von Der Muhl:

So, gosh, I was very useful at breaking up those tangles of collagen and

Anthony Von Der Muhl:

elastin fibers and what we might call a phlegm and blood Stacy's knotted

Anthony Von Der Muhl:

together, glycoproteins that are kind of gumming up the works and preventing

Anthony Von Der Muhl:

a muscle from contracting normally.

Anthony Von Der Muhl:

Uh, and it, it radically increases blood flow through the area.

Anthony Von Der Muhl:

And of course, one of the great insights early on of, or, you know, from the

Anthony Von Der Muhl:

beginning, Uh, Chinese medicine is that blood is essential for tissue

Anthony Von Der Muhl:

healing and that increasing perfusion through an area brings an oxygen and

Anthony Von Der Muhl:

nutrients carries away waste products.

Anthony Von Der Muhl:

So is also very useful for that.

Anthony Von Der Muhl:

So that's mostly what I use it on is, and I also like it because you can cover very

Anthony Von Der Muhl:

large areas very quickly and very safely.

Anthony Von Der Muhl:

It can be uncomfortable to the patient if I overdo it.

Anthony Von Der Muhl:

Sure.

Anthony Von Der Muhl:

It can cause a bruise.

Anthony Von Der Muhl:

Only once have I broken skin accidentally?

Anthony Von Der Muhl:

And that was on myself because I like how it feels so much, you know, put something

Anthony Von Der Muhl:

on Netflix and sit there and wash out my own it banned and then look down.

Anthony Von Der Muhl:

I was like, oops, kind of overdid it there.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

But I don't do that with patients, but it's very safe.

Anthony Von Der Muhl:

And for example, you know, the, the, the large muscles of the

Anthony Von Der Muhl:

back that would take forever.

Anthony Von Der Muhl:

To find all the trigger points and needle them with, you know, pay palpation of

Anthony Von Der Muhl:

Osher points and, you know, trigger point release techniques and so on.

Anthony Von Der Muhl:

I can just get it all in a few minutes with a guash spoon and do a better job.

Anthony Von Der Muhl:

Quite frankly.

Anthony Von Der Muhl:

Now that's not true of all areas.

Anthony Von Der Muhl:

I mean, again, as I was saying earlier, right.

Anthony Von Der Muhl:

I feel the same way when I go backpacking or, you know, for any

Anthony Von Der Muhl:

other activity it's really important to have the right gear and the

Anthony Von Der Muhl:

right tools to deal with a specific problem with a patient before you.

Anthony Von Der Muhl:

And even an areas like generally I find the quadriceps.

Anthony Von Der Muhl:

Work is great for great territory for guash Shaw, large muscles that you can

Anthony Von Der Muhl:

really dig into and cover a lot of area.

Anthony Von Der Muhl:

But for some people it's just too painful or it just doesn't work as well.

Anthony Von Der Muhl:

So they're own like, okay, well let's get the cups and put them on

Anthony Von Der Muhl:

and have them flex and extend their knee with the cuffs on their quad.

Anthony Von Der Muhl:

Oh, that worked better for them.

Anthony Von Der Muhl:

You know, I'm going to, that person has one specific trigger point.

Anthony Von Der Muhl:

That's really hanging everything up and just, isn't going away with Quasha.

Anthony Von Der Muhl:

I'm going to dig in there with a needle and get that muscle to Twitch until

Anthony Von Der Muhl:

that trigger point releases this person.

Anthony Von Der Muhl:

I can't find really anything physically verifiable.

Anthony Von Der Muhl:

They're a good candidate for decel, acupuncture, and

Anthony Von Der Muhl:

scalp and ear acupuncture.

Michael Max:

I'm uh, I'm thinking about my shop teacher in the eighth grade.

Michael Max:

He always say right.

Michael Max:

Tool for the right job, boys.

Michael Max:

You

Anthony Von Der Muhl:

got it.

Anthony Von Der Muhl:

Yup.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

And I find that I find that myself all the time.

Anthony Von Der Muhl:

Yes.

Michael Max:

What kind of cups do you like to use?

Anthony Von Der Muhl:

I use the vacuum pump cups for a couple of reasons.

Anthony Von Der Muhl:

When I was an intern school, I had a glass cup pop off a patient full

Anthony Von Der Muhl:

of blood fall on the floor and shatter when doing fire cupping.

Anthony Von Der Muhl:

I last time I fire cups, I, uh, a piece of burning cotton ball fell

Anthony Von Der Muhl:

off the cotton ball and the hummus.

Anthony Von Der Muhl:

Onto some other cotton balls that were there to catch blood

Anthony Von Der Muhl:

table paper went up in a blaze.

Anthony Von Der Muhl:

It was nearly a career ending disaster.

Anthony Von Der Muhl:

Oh yeah.

Anthony Von Der Muhl:

I am done with fire cupping.

Anthony Von Der Muhl:

I did not like, you know sure.

Anthony Von Der Muhl:

You know, you can be, you can get it right.

Anthony Von Der Muhl:

99.9, 9% of the time, all it takes is one accident and, and you're done so vacuum

Anthony Von Der Muhl:

pump cuffs don't have that problem.

Anthony Von Der Muhl:

And it's easy to cover a large area.

Anthony Von Der Muhl:

Very fast.

Anthony Von Der Muhl:

I can, I can put a whole row of cuffs up the pair of spinals on

Anthony Von Der Muhl:

either side of a patient's body.

Anthony Von Der Muhl:

Uh, I'm on either side of a patient's spine in, you know, in a minute.

Anthony Von Der Muhl:

And I can also calibrate the degree of suction, much more

Anthony Von Der Muhl:

precisely to their tolerance.

Anthony Von Der Muhl:

I can pump it up a lot stronger than it's generally possible to do with,

Anthony Von Der Muhl:

with, uh, 70% isopropyl rubbing alcohol.

Anthony Von Der Muhl:

And here's the real kicker is that the patient can then move

Anthony Von Der Muhl:

their own body with the cuffs in place and have the cuffs pop off.

Anthony Von Der Muhl:

No big deal.

Anthony Von Der Muhl:

I just put them back on, but that's a, that's a technique that I actually

Anthony Von Der Muhl:

learned from my physical therapist who learned it from an acupuncture,

Anthony Von Der Muhl:

physical therapist combination.

Anthony Von Der Muhl:

They call it myofascial decompression technique.

Anthony Von Der Muhl:

I call it active suction cupping.

Anthony Von Der Muhl:

I don't think there's anything different, how I do it than what.

Anthony Von Der Muhl:

But it's essentially, it's a, the genius of it is that by getting the patient to.

Anthony Von Der Muhl:

Actively engage their own muscles with the cups.

Anthony Von Der Muhl:

They're overriding the sensation that they normally have that

Anthony Von Der Muhl:

tells them not to use that muscle.

Anthony Von Der Muhl:

Now we're not talking about a Kiva muscle is torn or, you know, the first 72 hours.

Anthony Von Der Muhl:

No, this is way too, you know, Too disruptive.

Anthony Von Der Muhl:

The technique I'm talking about, where the patient is getting basically

Anthony Von Der Muhl:

false information from their nervous system, telling him not to use a

Anthony Von Der Muhl:

muscle that actually needs to be used and needs to be stretched out.

Anthony Von Der Muhl:

It needs to be worked, needs to have blood pumped through it in order to recover.

Anthony Von Der Muhl:

And that's where the cuffs at this active cupping technique is very useful.

Anthony Von Der Muhl:

I can put the cuffs on there.

Anthony Von Der Muhl:

The patient can flex and extend their spine, rotate, twist their spine

Anthony Von Der Muhl:

around and, and it increases the, both the, uh, the stretch effect

Anthony Von Der Muhl:

and the blood flow and breaks.

Anthony Von Der Muhl:

Pain inhibition and fear in an avoidance inhibition of using those muscles, the

Anthony Von Der Muhl:

patient goes, oh, I can actually move.

Anthony Von Der Muhl:

I can actually do this.

Anthony Von Der Muhl:

You pop the cuffs off almost invariably.

Anthony Von Der Muhl:

They feel much better, like right away.

Anthony Von Der Muhl:

And you know, the first time of physical therapist did it to me.

Anthony Von Der Muhl:

And I had 20 years of back pain ever since soccer injury.

Anthony Von Der Muhl:

I mentioned earlier that had never really responded well to

Anthony Von Der Muhl:

acupuncture to anything else.

Anthony Von Der Muhl:

You know, guash Shaw gave me some temporary relief, this like six sessions.

Anthony Von Der Muhl:

This is basically gone.

Michael Max:

Yeah.

Michael Max:

So with this active cupping, it's not like a distal thing.

Michael Max:

You're putting the cups right on the area that's having trouble.

Michael Max:

And while those cups are on, you're having them move and stretch and

Michael Max:

rotate and, and, and use that muscle is, is part of what's happening here.

Michael Max:

That you've got the suction you're decompressing, the tissue, which is.

Michael Max:

But at the same time, you're, you're adding movement in, does this give,

Michael Max:

does this like supercharge the ability to break up adhesions and,

Michael Max:

and, and break up blood status?

Anthony Von Der Muhl:

Yes, it does.

Anthony Von Der Muhl:

I believe so.

Anthony Von Der Muhl:

And others it's an analog and analogous technique is something that's very popular

Anthony Von Der Muhl:

in the physical therapy world right now.

Anthony Von Der Muhl:

And massage therapy, world active release technique, you know, where you fix a

Anthony Von Der Muhl:

trigger point with your thumb or, you know, your elders, and then you have the.

Anthony Von Der Muhl:

Contract and relax the muscle while you're putting pressure in there.

Anthony Von Der Muhl:

So that's just more effective than simply just putting the pressure in or

Anthony Von Der Muhl:

simply having the patient just use the muscle because you're, you're much more

Anthony Von Der Muhl:

radically breaking up the kind of, um, pathologic cross-linking of, of, um,

Anthony Von Der Muhl:

tendon on muscular fibers that develops after an injury where in addition to the

Anthony Von Der Muhl:

normal parallel organization of fibers, you've got all these elastin and collagen

Anthony Von Der Muhl:

and other fibers that have it's mostly.

Anthony Von Der Muhl:

That are crossing the muscle.

Anthony Von Der Muhl:

And by using the muscle while grinding through those fibers, it's very

Anthony Von Der Muhl:

uncomfortable, but it breaks them up because it pulls on them in both

Anthony Von Der Muhl:

launch attitudinally and horizontally.

Michael Max:

Are you familiar with this stuff called voodoo floss?

Anthony Von Der Muhl:

Uh, no, that's not.

Anthony Von Der Muhl:

That's not a familiar term to me.

Anthony Von Der Muhl:

Oh,

Michael Max:

okay.

Michael Max:

It's something that a friend of mine turned me on to.

Michael Max:

He's a, he's a bodyworker plot he's guy, yet.

Michael Max:

He actually lives in Taiwan.

Michael Max:

He does some interesting bodywork stuff.

Michael Max:

It's this, uh, it's called voodoo floss, which is a great name.

Michael Max:

And it's basically like taking the tire of an inner tube and like slicing it open.

Michael Max:

So you've got a big man of this elastic material and you're putting on the joint.

Michael Max:

I mean, this wouldn't be good for lower back, but you put it on a joint or mostly.

Michael Max:

Uh, or a muscle area, but mostly joy.

Michael Max:

And you wrap that stuff on there really tight.

Michael Max:

It's like a tourniquet.

Michael Max:

And then you have the person take their joint through

Michael Max:

their usual range of movement.

Michael Max:

And because it's got all this compression from the outside, it seems to really

Michael Max:

force the muscle to break adhesions up.

Michael Max:

Interesting.

Michael Max:

Yeah.

Michael Max:

I mean, when I hear you talk about this cupping, the way that

Michael Max:

you're doing it, I'm thinking.

Michael Max:

Uh, this sounds a little bit like that voodoo floss stuff.

Anthony Von Der Muhl:

Well, I could see that having a similar effect.

Anthony Von Der Muhl:

And now, now, now you got me curious.

Anthony Von Der Muhl:

Now I want to try it.

Michael Max:

You can just go Google

Anthony Von Der Muhl:

it.

Anthony Von Der Muhl:

Okay.

Anthony Von Der Muhl:

Thank you.

Anthony Von Der Muhl:

I'll check it

Michael Max:

out.

Michael Max:

Yeah.

Michael Max:

Check it out.

Michael Max:

I'd like to, uh, I'd like to get your opinion on

Anthony Von Der Muhl:

now.

Anthony Von Der Muhl:

What, what w what it made also is what, what is the topic for the

Anthony Von Der Muhl:

class that I'm going to teach at the conference is using needles.

Anthony Von Der Muhl:

Into joints to stabilize them, to tighten up the ligaments that

Anthony Von Der Muhl:

have become lax or stretched out after a sprain or surgery for that

Anthony Von Der Muhl:

matter, that didn't heal properly.

Anthony Von Der Muhl:

And with that joint, more stable, the muscles that cross it will heal better

Anthony Von Der Muhl:

will function better because they're not, they're getting to contract with

Anthony Von Der Muhl:

more force and then relax more completely then happens with muscles that cross

Anthony Von Der Muhl:

a joint that is loose and unstable.

Anthony Von Der Muhl:

You're getting pain inhibition preventing a full contraction.

Anthony Von Der Muhl:

And yet the muscle also never gets to relax completely because it's always got

Anthony Von Der Muhl:

to stay somewhat turned on to compensate for the, the instability of the joint.

Anthony Von Der Muhl:

So what the what's I think it has in common with the voodoo floss that you're

Anthony Von Der Muhl:

talking about is the and Chinese medicine tells us to write the joints, the nine

Anthony Von Der Muhl:

pearls, uh, you know, our hussy points.

Anthony Von Der Muhl:

You know, the joints are all these confluence of really important structures.

Anthony Von Der Muhl:

There's there would allow our body.

Anthony Von Der Muhl:

To move through space and treating the joints is very important for

Anthony Von Der Muhl:

the functioning of the muscles that cross it and, and for the stability

Anthony Von Der Muhl:

and the mobility of the body.

Anthony Von Der Muhl:

So when you are

Michael Max:

working to stabilize the joints, I suspect you.

Michael Max:

Using your particular diagnostics found the joint's a bit loose.

Michael Max:

It sounds like you would go up or down that particular longitudinal train of

Michael Max:

what's connected, but it sounds like you're also going deeply into the joints.

Anthony Von Der Muhl:

Yes, that's right.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

And that's something that I learned from Alan Marcus.

Anthony Von Der Muhl:

I mentioned her.

Anthony Von Der Muhl:

And what he really did for me was, well, again, a lot of our, our inspiration

Anthony Von Der Muhl:

comes out of our own personal experiences.

Anthony Von Der Muhl:

I was taking a class from him, uh, and we got to the section

Anthony Von Der Muhl:

on, you know, lumbosacral pain.

Anthony Von Der Muhl:

And he used me as a demonstration model needle into my, after

Anthony Von Der Muhl:

doing some, uh, mobilization.

Anthony Von Der Muhl:

And when I stood up on the table, I felt like a different person.

Anthony Von Der Muhl:

I mean, everything from head to toe was lined up in a way that felt much more

Anthony Von Der Muhl:

comfortable, took much less effort.

Anthony Von Der Muhl:

My posture was better, everything I was like, and it lasted for.

Anthony Von Der Muhl:

I don't remember exactly a week or so before it began to fade, but you know,

Anthony Von Der Muhl:

that's pretty good for one or two needles to produce that profound effect that,

Anthony Von Der Muhl:

and clearly with, you know, with some repetition, it had a more lasting effect.

Anthony Von Der Muhl:

What came out of that for me, was, uh, returned to studying anatomy books.

Anthony Von Der Muhl:

And that's what he really did for me as a teacher is kind of kick open the

Anthony Von Der Muhl:

door and say, go, go study your anatomy again and learn to use your needle as a.

Anthony Von Der Muhl:

And a tool for treating anatomical structures.

Anthony Von Der Muhl:

And so I just started spending a lot of time looking at skeleton models,

Anthony Von Der Muhl:

looking at my netters on my lunch breaks and studying other resources

Anthony Von Der Muhl:

of anatomy to really understand all the things you can do with a needle.

Anthony Von Der Muhl:

If you know you're name.

Anthony Von Der Muhl:

Can you give us an example?

Anthony Von Der Muhl:

Well, yeah, so no one ever taught me how to needle the radio

Anthony Von Der Muhl:

capitellar joint in the elbow.

Anthony Von Der Muhl:

That's the joint that, you know, that joins the radius of the humerus.

Anthony Von Der Muhl:

It's this kind of curious, uh, circular joint that allows the, the, uh, for

Anthony Von Der Muhl:

pronation and supination of the elbow.

Anthony Von Der Muhl:

Having been taught by all on this technique of testing the joints,

Anthony Von Der Muhl:

integrity through passive, you know, joint, uh, joint play testing.

Anthony Von Der Muhl:

And then if you find a plane in which it is loose and the ligaments has

Anthony Von Der Muhl:

got too much motion and the L the end feel is kind of soft and mushy

Anthony Von Der Muhl:

rather than from a needling into those ligaments to tighten it back up.

Anthony Von Der Muhl:

So I had a patient who.

Anthony Von Der Muhl:

She had kind of a F she's actually a student of mine had a freak injury where

Anthony Von Der Muhl:

she was reaching into her washing machine and there was Archer dryer and there was

Anthony Von Der Muhl:

a short that suddenly wrenched her elbow.

Anthony Von Der Muhl:

And, you know, she came into my clinic the next day and her arm was

Anthony Von Der Muhl:

going numb from the elbow on down.

Anthony Von Der Muhl:

I was like, Ooh, this is not good.

Anthony Von Der Muhl:

This, this could be a serious, you know, limb threatening injury where,

Anthony Von Der Muhl:

you know, nerve and blood supply are, are getting damaged, refer to

Anthony Von Der Muhl:

as an orthopedist who basically.

Anthony Von Der Muhl:

And here's a slang come back in a month.

Anthony Von Der Muhl:

If it's not better, that was a disappointing referral.

Anthony Von Der Muhl:

Didn't come the way out the way I wanted.

Anthony Von Der Muhl:

Cause I was afraid she would need surgery, but in some like, okay,

Anthony Von Der Muhl:

well let's do what we can here and on miss stress testing and found her

Anthony Von Der Muhl:

radiocapitellar joint was really loose and had gotten wrenched out of place.

Anthony Von Der Muhl:

And so she was getting this kind of transient compression

Anthony Von Der Muhl:

of the nerves and blood vessels.

Anthony Von Der Muhl:

So I'm like, we can need to stabilize this joint right away.

Anthony Von Der Muhl:

If the orthopedist not going to do it, I'm going to do my best here.

Anthony Von Der Muhl:

I pull out my anatomy book.

Anthony Von Der Muhl:

And just look at the joint really carefully.

Anthony Von Der Muhl:

And this is not a commonly spraying joint is probably one of the most

Anthony Von Der Muhl:

stable joints in the body, but so I'd never done it before, but I'm

Anthony Von Der Muhl:

like, let's look at the anatomy, see where those ligaments should be.

Anthony Von Der Muhl:

And then, and then find the.

Anthony Von Der Muhl:

And then, you know, without going into too much detail about the technique, which

Anthony Von Der Muhl:

is hard to describe in audio, basically going through lung five, large intestine,

Anthony Von Der Muhl:

11, having to reposition the arm a couple of times to account for the pronation

Anthony Von Der Muhl:

supination I was able to needle into those ligaments really deeply and it aids.

Anthony Von Der Muhl:

And it was uncomfortable for her, but we could test it immediately afterwards.

Anthony Von Der Muhl:

It's like, oh, it's really stabilized.

Anthony Von Der Muhl:

Okay, good prognosis.

Anthony Von Der Muhl:

Those ligaments are not snapped through.

Anthony Von Der Muhl:

They're just stretched out.

Anthony Von Der Muhl:

And there's an immediate feedback response.

Anthony Von Der Muhl:

You can test it, take the needle out, instantly tested again.

Anthony Von Der Muhl:

And you know, did you get it or not?

Anthony Von Der Muhl:

Did it restabilize or not?

Anthony Von Der Muhl:

Yup.

Anthony Von Der Muhl:

Re stabilized.

Anthony Von Der Muhl:

She comes in a couple of days later, the numbness is almost gone.

Michael Max:

Wow.

Michael Max:

So there's a couple of things that come to mind for me.

Michael Max:

The first is so often people come in, they complain of something being tight, right?

Michael Max:

It's painful, it's tight.

Michael Max:

So often we're looking to deal with things that are tight, but you know,

Michael Max:

Chinese medicine, we could have excess, we could have deficiency, right.

Michael Max:

So looseness can bring its own troubles along with it.

Michael Max:

That, I mean, for me, that's that that's a real take home.

Michael Max:

That that makes a lot of sense.

Michael Max:

And.

Michael Max:

To correct that.

Michael Max:

And it sounds like you can correct it pretty quickly by

Michael Max:

needling into the ligament.

Michael Max:

Now you've got to know your anatomy.

Michael Max:

Are you going with, with, you know, you've got an image in your mind.

Michael Max:

Yeah.

Michael Max:

This is, this is how it looks.

Michael Max:

Are you palpating, like with one hand to see what you're feeling,

Michael Max:

are you feeling through the needle?

Michael Max:

How do you know that you're getting that ligaments?

Anthony Von Der Muhl:

Sure.

Anthony Von Der Muhl:

That's an excellent question.

Anthony Von Der Muhl:

All of them.

Anthony Von Der Muhl:

Uh, basically I've simultaneously got my anatomy book there.

Anthony Von Der Muhl:

I'm checking that I'm feeling with feeling for the joint line, with my fingers.

Anthony Von Der Muhl:

And that's a, that's a skill, but with a little practice, just like feeling a

Anthony Von Der Muhl:

pulse, you'll get very sensitive, that feeling joint lines and feeling the

Anthony Von Der Muhl:

integrity of the ligaments that span them.

Anthony Von Der Muhl:

I'm doing my passive joint and field testing.

Anthony Von Der Muhl:

That's really the key.

Anthony Von Der Muhl:

And then I'm also feeling with the tip of the.

Anthony Von Der Muhl:

And with again, with just like pulse taking or with any other needle

Anthony Von Der Muhl:

technique with practice and repetition, you get to feel the difference at the

Anthony Von Der Muhl:

end of the needle between a healthy ligament, which is like needling

Anthony Von Der Muhl:

into a taut thick from rubber band.

Anthony Von Der Muhl:

And needling Intuit to generated or stretched out ligament, which feels

Anthony Von Der Muhl:

like you're kneeling into old glue or chewing gum kind of sticky, but it's

Anthony Von Der Muhl:

also kind of soft and mushy and it doesn't have the firmness and elasticity.

Anthony Von Der Muhl:

It's kind of gummy.

Anthony Von Der Muhl:

So all of the above, but I want to go back to you.

Anthony Von Der Muhl:

You got it.

Anthony Von Der Muhl:

That is the essential insight.

Anthony Von Der Muhl:

And that is I think, missing, uh, often missing from.

Anthony Von Der Muhl:

Both in the world of physical therapy, cause they don't really have any

Anthony Von Der Muhl:

joints stabilization techniques.

Anthony Von Der Muhl:

And from acupuncture, orthopedics is this is what Chinese medicine tells us young.

Anthony Von Der Muhl:

The muscles are young, the ligaments and joint castles are yin.

Anthony Von Der Muhl:

If you only treat one aspect of that and you have an incomplete treatment,

Anthony Von Der Muhl:

if you treat both and you recognize the deficiency in the ligaments, a

Anthony Von Der Muhl:

structure, the deficiency in this, in the stability creates a compensatory.

Anthony Von Der Muhl:

Access and hypertonicity, and the muscles that cross that joint that have to

Anthony Von Der Muhl:

constantly work to keep that joint stable.

Anthony Von Der Muhl:

And so you can treat the excess all the time and not really,

Anthony Von Der Muhl:

you know, get partial results.

Anthony Von Der Muhl:

And, but a lot of times it will just kind of keep coming back and

Anthony Von Der Muhl:

all of my treatments started being much more effective, whether it's

Anthony Von Der Muhl:

rotator, cuff tendonitis, or Achilles tendonitis or quad strain or something.

Anthony Von Der Muhl:

When I started looking at the joint that those muscles or

Anthony Von Der Muhl:

tendons cross and going, oh, huh.

Anthony Von Der Muhl:

This joint is unstable.

Anthony Von Der Muhl:

We treat the joint.

Anthony Von Der Muhl:

Then all of my muscular treatments work much better and have lasting results.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

That,

Michael Max:

you know, as we're having this conversation, I'm thinking, well,

Michael Max:

that makes sense, because you can work all day, you know, and you can work many

Michael Max:

days in a row if you want on what let's just call it the, the branch aspect.

Michael Max:

But, but if you're not getting down to the root.

Michael Max:

It's it's hard to correct the branch.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

And then to keep that my, my own discussion of this balanced, I want

Anthony Von Der Muhl:

to say that the muscles that cross the joint are also very important.

Anthony Von Der Muhl:

And so I'm not saying, oh, all you gotta do is treat the joint because.

Anthony Von Der Muhl:

The, the muscles provide dynamic stability.

Anthony Von Der Muhl:

And sometimes it's very common.

Anthony Von Der Muhl:

For example, in the shoulder joint, the ligaments and the anterior shoulder

Anthony Von Der Muhl:

can get stretched out and lose, not because of a traumatic shoulder

Anthony Von Der Muhl:

dislocation, but simply because of poor postural and biomechanical falls.

Anthony Von Der Muhl:

And then the rotator cuff starts to degrade well, the rotator cuff tendons

Anthony Von Der Muhl:

blend into the front of the capsule.

Anthony Von Der Muhl:

And that's what cadaver labs really teach me is that.

Anthony Von Der Muhl:

All of these distinctions are linguistic and somewhat artificial

Anthony Von Der Muhl:

because this Chinese medicine tells us everything is interconnected and

Anthony Von Der Muhl:

interpenetrating and contiguous.

Anthony Von Der Muhl:

So if I'm going to treat a shoulder rotator cuff problem, I need to treat

Anthony Von Der Muhl:

the joint if it's stretched out.

Anthony Von Der Muhl:

But I also need to treat those rotator cuff muscles and tendons so that they

Anthony Von Der Muhl:

provide the dynamic stability and their contiguous relationship with,

Anthony Von Der Muhl:

uh, with a joint, uh, is treated.

Anthony Von Der Muhl:

Love

Michael Max:

it.

Michael Max:

It's it's got me thinking about all kinds of ways.

Michael Max:

Going back into my clinic and taking another walk.

Michael Max:

Anthony Von Der Muhl: That's the fun of it.

Michael Max:

You know, for me, it's sort of like, um, you know, again, to use the

Michael Max:

backpacking analogy a little bit.

Michael Max:

Okay.

Michael Max:

Um, I've hiked this trail using this map many times.

Michael Max:

Now I'm going to go off trail.

Michael Max:

I'm going to, you know, I'm going to set, I'm going to.

Michael Max:

Go cross-country and I'm just going to feel what my feet find and look

Michael Max:

around with my eyes, see, and, and use the map in a whole different way.

Michael Max:

Instead of just telling me where the trail is, I'm going to

Michael Max:

palpate, I'm going to test join.

Michael Max:

So I'm going to look around and pull out my anatomy book all over again.

Michael Max:

And that just keeps everything fresh and exciting and alive.

Michael Max:

And, and, uh, to me, it's just a much more exciting way to practice than

Michael Max:

simply going through protocols over and over again, which is kind of like

Michael Max:

walking the same trail back and forth.

Michael Max:

If I had to do protocols day in and day out.

Michael Max:

I'd be looking for a different

Michael Max:

job.

Anthony Von Der Muhl:

Me too.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

It would've gotten boring, you know, within the first year or two out of school

Anthony Von Der Muhl:

and an unsatisfying, because the results are only partial and incomplete a lot

Anthony Von Der Muhl:

of the time, if you just sort of stick to a protocol and, and don't feel and

Anthony Von Der Muhl:

look and see what's going on and listen.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

Yeah.

Anthony Von Der Muhl:

You can also hear joint problems,

Michael Max:

Hyrum see him.

Michael Max:

I mean, I liked what you were saying earlier that you

Michael Max:

just look at how people move.

Michael Max:

And let that also speak to you, I guess that takes some practice

Michael Max:

to really learn that doesn't it.

Anthony Von Der Muhl:

Yeah, it does take practice and pulse and

Anthony Von Der Muhl:

tongue, everything takes practice and everything takes repetition.

Anthony Von Der Muhl:

And, uh, and you know, this approach isn't for everyone.

Anthony Von Der Muhl:

And some people are just, you know, learn through difference.

Anthony Von Der Muhl:

You know, as you said, some people are, you know, visual or auditory

Anthony Von Der Muhl:

learners and they'll listen to the patient's voice and how they talk

Anthony Von Der Muhl:

and then treat their emotions.

Anthony Von Der Muhl:

And that's, that's also important for orthopedics and biomechanics,

Anthony Von Der Muhl:

because a lot of this stuff does have emotional dimensions to it.

Anthony Von Der Muhl:

Patient has poor posture because they're depressed and they slump and slouch.

Anthony Von Der Muhl:

Or they're tight because they're angry and, you know, and et cetera.

Anthony Von Der Muhl:

But, um, you know, we're all blind men feeling different parts of the

Anthony Von Der Muhl:

elephant, trying to put it all together.

Anthony Von Der Muhl:

And

Michael Max:

yeah, well, I, I appreciate you taking some time to share your portion

Michael Max:

of the elephant with us here today.

Michael Max:

Anthony Von Der Muhl: You're very, very welcome.

Michael Max:

Well, I think we need to get back to the conference here.

Michael Max:

Anthony, are there any final thoughts that you'd like to leave the listeners

Anthony Von Der Muhl:

with?

Anthony Von Der Muhl:

Um, yeah.

Anthony Von Der Muhl:

You know what, just don't be scared of a needle.

Anthony Von Der Muhl:

Have courage that you can apply needles very safely.

Anthony Von Der Muhl:

Yes.

Anthony Von Der Muhl:

You need to know where major neurovascular bundles are and sports medicine.

Anthony Von Der Muhl:

We're rarely treating over the abdomen, you know, but we need to know where our

Anthony Von Der Muhl:

internal organs are, but we can needle much deeper, much more strongly and

Anthony Von Der Muhl:

use much thicker needles very safely and do a lot of good and help patients.

Anthony Von Der Muhl:

If we know our anatomy.

Anthony Von Der Muhl:

And knowing our anatomy spending time and cadaver labs with, I prefer 3d and

Anthony Von Der Muhl:

palpable, you know, take a class from a body worker who teaches surface anatomy.

Anthony Von Der Muhl:

There's some great instructors in the bodywork field about really identifying

Anthony Von Der Muhl:

your muscles and your joints and your ligaments, you know, and then there's the

Anthony Von Der Muhl:

online resources and books too, and stuff.

Anthony Von Der Muhl:

But the more, you know, your anatomy, not just on the surface, but all

Anthony Von Der Muhl:

the way through you can practice.

Anthony Von Der Muhl:

Greater safety and greater results.

Anthony Von Der Muhl:

And, and I find it much more fun and exciting and alive and satisfying.

Anthony Von Der Muhl:

So

Michael Max:

that sounds like good advice.

Michael Max:

It's always good to know more about the stuff that we need to know about.

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