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.

Welcome to qiological.

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

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

alliances conference in San Jose.

In addition to interviews and discussions with speakers of the

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

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

running a sports medicine practice.

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

of sports and orthopedic acupuncture.

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

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

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

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

Please enjoy these discussions and take what you learned here

and use it in your clinic.

Anthony Vondra mall.

Welcome to qiological.

Thank you very much.

Great to be here.

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

acupuncture alliances conference.

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

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

time here to have this conversation.

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

Orthopedic and sports acupuncture.

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

What, what set you down this path?

Sure.

That's a good question.

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

with a lot of neck pain and a concussion.

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

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

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

And what worked best actually was, was tight G.

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

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

herbs and Chinese medicine generally.

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

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

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

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

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

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

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

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

And the first.

Yeah.

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

I mean, you sound like an athlete.

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

I would, would have been athlete.

Um, but I enjoy using my physical body.

Sure.

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

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

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

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

trying out different activities.

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

And do they help?

Do they hurt?

Is yoga helpful?

Is Pilates harmful, et cetera, just experimenting and.

Learning from my own injuries.

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

Yeah.

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

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

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

you kind of make sense of the world.

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

yeah, certainly it does make sense.

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

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

their effects in my own body very much.

And that makes me very.

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

Exactly the opposite.

I feel acupuncture's effects.

Uh, I like how it feels.

Guash SHA cupping TuiNa exercise therapy fascinate me because I

feel their effects in my body.

And I want to share that with other

people.

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

what you're sensing and making.

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

able to feel it on the inside.

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

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

to be able to feel it yourself.

So that you've got

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

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

a sense of what's going on for you.

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

to have a needle go into that area.

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

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

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

um, yeah.

From your experience, how would you say orthopedic acupuncture?

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

learned in school accurate.

Oh, that's a good question too.

I don't know that it does.

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

I have not studied in China will be upfront about.

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

an accurate, complete representation of acupuncture and Chinese medicine.

The way has been practiced historically in China.

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

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

And then we twist it further because of our own inevitable

cultural lenses and biases.

In the west.

Um, but then I look at videos.

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

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

numbers in ways that would that.

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

horrified, shocked, wringing their hands.

It looks like surgery.

It looks like barbaric, et cetera, but.

Eastern medicine.

It's Eastern medicine is diverse.

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

from the subtleties of homeopathy to a radical orthopedic surgery.

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

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

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

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

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

Well,

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

sometime in acupuncture clinics.

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

Um, and sometimes it was.

Really different.

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

with that in the United States.

Yes.

So there is that.

Yeah.

Yes.

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

with more stimulation, is it.

Correct characterization.

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

the way acupuncture is generally taught in most schools in the

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

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

how acupuncturists in the far east would treat orthopedic injuries.

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

the subtle off body needle.

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

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

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

you know, right along the spine.

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

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

from what's taught in school?

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

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

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

It is integrative.

I do use the concepts and paradigms to Chinese medicine,

particularly for orthopedics.

The concept of longitudinal.

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

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

or tendon, no muscular meridians.

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

physical therapy is kind of rediscovering.

Variously called anatomy, trains or kinematic chains that is different

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

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

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

We're going to look at the knee joint.

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

from the hand to the shoulder.

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

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

the Western orthopedic and osteopathic.

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

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

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

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

I use distal kneeling.

I use here.

I use scalp.

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

works best for everyone all the time.

Oh man.

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

of the medicine we practice.

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

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

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

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

Diversity and uniqueness is the norm.

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

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

scrapbook of, of their life story.

And we have anatomic variations, congenital variations, acquired

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

best for all people all the time.

Right.

So you mentioned tendon Ole muscular meridians, and.

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

Talk about these quite a bit.

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

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

Yes, I would agree.

And, yeah.

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

I mean, some people like to bleed them.

My wife is crazy about using quash and.

Yeah.

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

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

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

tendon on muscular meridians.

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

anatomy, trains, and this sort of thing.

So I'd like to get your take on these

things.

So I think there's really two questions there.

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

Where do the.

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

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

the, the distributions, if you will.

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

clinical techniques do we apply.

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

Um, and what is what I have seen.

Uh, what I went through myself as an acupuncturist.

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

learn the primary ingredients.

We Westerners learned the primary meridians in school

focus exclusively on that.

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

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

two dimensional points on the surface and how that actually manipulates

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

I'm sorry.

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

Snarky or something.

I love

it.

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

mind to describe what we do.

Yeah.

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

We call it cheap, but yeah.

Yeah.

Pipes.

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

think there's a lot of translational questions

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

we want to spend a lot of time on.

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

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

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

Isn't a way to translate it correctly.

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

language the way they can in another line.

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

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

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

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

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

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

also the depth is very important.

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

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

muscle, the depths of, of structures.

And those three young meridians are all superficial.

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

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

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

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

of through the center of the limbs.

And this is all verifiable in a cadaver lab.

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

bones, and joints connect to each other.

Along these longitudinal tracks.

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

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

But as

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

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

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

that we unconsciously bring into our.

Our mistranslations of Chinese medicine that has no such divisions.

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

invisible energies that are somehow separate from physical reality.

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

Judeo-Christian view of the world.

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

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

having gone through our Neoplatonic and.

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

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

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

So yes, absolutely.

The, the, this.

The six divisions or six meridians.

However you want to translate it.

Our descriptions of tangible, physically verifiable structures that

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

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

outside forces to provide stability.

So there's a whole structural component.

To these six channels.

Absolutely.

I think there is.

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

who really look at and translate in comparison to the translators

of classics of internal medicine.

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

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

came out with a book a few years ago.

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

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

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

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

description of the nature of the gene.

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

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

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

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

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

We assign different muscles to different meridians, some of the

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

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

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

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

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

And, but we have our Achilles tendon.

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

the Greek mythology and stuff.

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

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

verifiable structures, not just theory.

Yeah.

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

30% at odds with each other on your ideas.

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

Yeah.

Something like that.

That's

pretty interesting.

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

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

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

love this phrase, spatial organization.

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

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

Yeah.

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

use that spatial organization.

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

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

So it was a referral from a physician.

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

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

So.

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

what was the problem in her medial foot?

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

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

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

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

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

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

ask myself why what's going on?

How did that happen?

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

Gin.

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

almost at the distal end of the chain.

So I want to look at her ankle joint.

I want to look at her knee joint.

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

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

No problem.

But her ankle joint was similarly loose and her hip.

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

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

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

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

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

So.

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

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

no needling locally or for that matter.

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

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

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

uh, Nyan Meridian in the foot.

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

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

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

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

So that's one example.

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

talking about ankle was loose.

Knee was.

Yeah.

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

tests do you use to get this?

Sure.

That's a good question.

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

just about joints along the pathway.

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

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

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

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

what I'm going to be teaching a lot.

This weekend is.

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

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

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

it through non anatomical directions.

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

That's a non anatomical motion.

That can happen.

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

joint gets sprained stretching out the anterior talofibular ligament.

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

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

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

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

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

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

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

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

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

you drive it to Maine from California.

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

is going to result in that wheel where.

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

loose and damaged, et cetera.

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

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

working over time and don't get to rest.

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

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

Developed tendonitis and myofascial pain and strains and inflammation

and degeneration and wear out.

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

is extremely important feeling.

What's the integrity of the ligaments.

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

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

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

Or is it loose and mushy like is being held.

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

gum, or maybe nothing at all.

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

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

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

it's called manual muscle testing.

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

nerve supply in order to contract.

So when we're testing strength or similar.

Tediously testing, muscle strength and nerve supply.

I'll use inspection.

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

same as the left leg, your right leg.

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

And so all of these pieces of information.

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

Where do I need to do guash Shaw?

Where do I need to do cupping?

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

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

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

guash Shaw a lot in their practice.

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

guash on my clinic a lot more with.

Frankly, stunning results.

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

shots.

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

myself about a number of years ago.

What

I'd like to hear that experience what happened.

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

Sure.

Yeah.

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

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

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

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

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

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

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

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

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

and slides past each other smoothly.

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

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

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

a muscle from contracting normally.

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

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

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

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

nutrients carries away waste products.

So is also very useful for that.

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

large areas very quickly and very safely.

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

Sure.

It can cause a bruise.

Only once have I broken skin accidentally?

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

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

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

Yeah.

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

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

back that would take forever.

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

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

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

Quite frankly.

Now that's not true of all areas.

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

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

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

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

And even an areas like generally I find the quadriceps.

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

really dig into and cover a lot of area.

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

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

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

Oh, that worked better for them.

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

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

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

that trigger point releases this person.

I can't find really anything physically verifiable.

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

scalp and ear acupuncture.

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

He always say right.

Tool for the right job, boys.

You

got it.

Yup.

Yeah.

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

Yes.

What kind of cups do you like to use?

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

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

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

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

off the cotton ball and the hummus.

Onto some other cotton balls that were there to catch blood

table paper went up in a blaze.

It was nearly a career ending disaster.

Oh yeah.

I am done with fire cupping.

I did not like, you know sure.

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

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

pump cuffs don't have that problem.

And it's easy to cover a large area.

Very fast.

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

either side of a patient's body.

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

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

precisely to their tolerance.

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

with, uh, 70% isopropyl rubbing alcohol.

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

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

No big deal.

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

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

physical therapist combination.

They call it myofascial decompression technique.

I call it active suction cupping.

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

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

Actively engage their own muscles with the cups.

They're overriding the sensation that they normally have that

tells them not to use that muscle.

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

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

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

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

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

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

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

I can put the cuffs on there.

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

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

and the blood flow and breaks.

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

patient goes, oh, I can actually move.

I can actually do this.

You pop the cuffs off almost invariably.

They feel much better, like right away.

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

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

I mentioned earlier that had never really responded well to

acupuncture to anything else.

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

This is basically gone.

Yeah.

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

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

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

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

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

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

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

and, and break up blood status?

Yes, it does.

I believe so.

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

in the physical therapy world right now.

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

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

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

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

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

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

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

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

and other fibers that have it's mostly.

That are crossing the muscle.

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

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

launch attitudinally and horizontally.

Are you familiar with this stuff called voodoo floss?

Uh, no, that's not.

That's not a familiar term to me.

Oh,

okay.

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

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

He actually lives in Taiwan.

He does some interesting bodywork stuff.

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

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

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

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

Uh, or a muscle area, but mostly joy.

And you wrap that stuff on there really tight.

It's like a tourniquet.

And then you have the person take their joint through

their usual range of movement.

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

force the muscle to break adhesions up.

Interesting.

Yeah.

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

you're doing it, I'm thinking.

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

Well, I could see that having a similar effect.

And now, now, now you got me curious.

Now I want to try it.

You can just go Google

it.

Okay.

Thank you.

I'll check it

out.

Yeah.

Check it out.

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

now.

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

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

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

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

matter, that didn't heal properly.

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

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

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

a joint that is loose and unstable.

You're getting pain inhibition preventing a full contraction.

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

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

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

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

pearls, uh, you know, our hussy points.

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

There's there would allow our body.

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

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

and the mobility of the body.

So when you are

working to stabilize the joints, I suspect you.

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

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

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

Yes, that's right.

Yeah.

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

I mentioned her.

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

comes out of our own personal experiences.

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

on, you know, lumbosacral pain.

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

doing some, uh, mobilization.

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

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

comfortable, took much less effort.

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

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

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

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

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

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

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

And a tool for treating anatomical structures.

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

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

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

If you know you're name.

Can you give us an example?

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

capitellar joint in the elbow.

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

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

pronation and supination of the elbow.

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

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

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

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

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

So I had a patient who.

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

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

a short that suddenly wrenched her elbow.

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

going numb from the elbow on down.

I was like, Ooh, this is not good.

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

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

as an orthopedist who basically.

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

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

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

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

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

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

And so she was getting this kind of transient compression

of the nerves and blood vessels.

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

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

I pull out my anatomy book.

And just look at the joint really carefully.

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

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

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

And then, and then find the.

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

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

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

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

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

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

Okay, good prognosis.

Those ligaments are not snapped through.

They're just stretched out.

And there's an immediate feedback response.

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

And you know, did you get it or not?

Did it restabilize or not?

Yup.

Re stabilized.

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

Wow.

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

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

It's painful, it's tight.

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

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

So looseness can bring its own troubles along with it.

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

That that makes a lot of sense.

And.

To correct that.

And it sounds like you can correct it pretty quickly by

needling into the ligament.

Now you've got to know your anatomy.

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

Yeah.

This is, this is how it looks.

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

are you feeling through the needle?

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

Sure.

That's an excellent question.

All of them.

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

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

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

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

integrity of the ligaments that span them.

I'm doing my passive joint and field testing.

That's really the key.

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

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

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

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

into a taut thick from rubber band.

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

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

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

It's kind of gummy.

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

You got it.

That is the essential insight.

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

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

joints stabilization techniques.

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

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

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

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

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

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

constantly work to keep that joint stable.

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

you know, get partial results.

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

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

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

When I started looking at the joint that those muscles or

tendons cross and going, oh, huh.

This joint is unstable.

We treat the joint.

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

Yeah.

That,

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

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

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

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

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

Yeah.

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

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

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

The, the muscles provide dynamic stability.

And sometimes it's very common.

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

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

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

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

blend into the front of the capsule.

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

All of these distinctions are linguistic and somewhat artificial

because this Chinese medicine tells us everything is interconnected and

interpenetrating and contiguous.

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

the joint if it's stretched out.

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

provide the dynamic stability and their contiguous relationship with,

uh, with a joint, uh, is treated.

Love

it.

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

Going back into my clinic and taking another walk.

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

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

backpacking analogy a little bit.

Okay.

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

Now I'm going to go off trail.

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

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

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

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

palpate, I'm going to test join.

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

And that just keeps everything fresh and exciting and alive.

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

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

walking the same trail back and forth.

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

I'd be looking for a different

job.

Me too.

Yeah.

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

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

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

look and see what's going on and listen.

Yeah.

Yeah.

You can also hear joint problems,

Hyrum see him.

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

just look at how people move.

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

to really learn that doesn't it.

Yeah, it does take practice and pulse and

tongue, everything takes practice and everything takes repetition.

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

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

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

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

and then treat their emotions.

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

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

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

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

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

elephant, trying to put it all together.

And

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

of the elephant with us here today.

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

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

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

with?

Um, yeah.

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

Have courage that you can apply needles very safely.

Yes.

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

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

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

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

If we know our anatomy.

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

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

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

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

online resources and books too, and stuff.

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

the way through you can practice.

Greater safety and greater results.

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

So

that sounds like good advice.

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