You are currently browsing the tag archive for the ‘“Acupuncture”’ tag.

When it comes to trigger point needling in the shoulder one of the major muscles we have to address is subscapularis. It plays a unique role as the only rotator cuff muscle to perform internal rotation. It is also notoriously uncomfortable to access. In my days as a massage therapist, I found it was in a similar class to the psoas in the fact that even in seemingly healthy muscle, it is very sensitive. When it comes to needling, it takes significant skill to safely needle. Please see this video for how I like to needle subscapularis!

sub scap needling

In our advanced shoulder course, we teach how to treat subscapularis and the first aspect we discuss is risk to reward. The risk of needling any trigger point should not exceed the reward of it being released. With confident palpation, accurate needling skills and proper training, the risk of needling subscapularis decreases and the reward increases. If these skills are not present, the risks can include pneumothorax, nerve damage or artery puncture. If someone is untrained or uncomfortable with needling subscapularis, we encourage using manual therapy to treat the local trigger points. If you are interested in some of our favourite manual therapy techniques, check out last week’s blog!

Palpation

In my opinion the most important tool to confidently needling subscapularis is

Palpating subscapularis

Palpate where subscap is believed to be and resist internal rotation

manual muscle testing. As mentioned above, the subscapularis performs internal rotation. When palpating what is believed to be suscapularis, resisting internal rotation can help confidently identify the muscle. I like to ask the patient to push their wrist to belly button as a cue (check this out in my video). Another tip is to identify other easy to find landmarks such as intercostals, latissimus dorsi, and the lateral border of the scapula. Once the lateral border of the scapula is located it is simple to find the way to the subscapular fossa. If you know all your surroundings structures, it becomes much easier to find any muscle you attempting to palpate.

Trigger points

As shown in the picture below, the trigger points in subscapularis refer to the posterior shoulder and arm as well as the anterior and posterior wrist. Under palpation is often easy to illicit a clear referral pattern.

Subscap trp

When to treat

Deciding when to treat subscapularis is not always as straightforward as other trigger points acupuncturists treat. With a muscle like the upper trapezius, a trigger point can be palpated and safely released on a patient. In the case of subscapularis, many factors can get in the way. Frozen shoulder is a great example. It can be a major relieving factor to needle these trigger points for decreased range of motion, but the patient needs to have the range of motion to allow access. Manual therapy can help achieve access to this area. The axilla is also a common area for patient’s to be ticklish. This is usually easily overcome by the use of a glove and quick firm pressure. I would say comfortable patient placement with safe access is an absolute must. For me, I prefer to needle subscapularis in supine position with the patient in abduction as seen in the video.

Some common indications for needling the subscapularis can be:

  • Frozen shoulder
  • Decreased internal rotation
  • Posterior shoulder pain
  • Difficulty with putting a bra on (don’t forget Lats and Teres Major!)

Homecare for subscapularis

Homecare for subscapularis is dependent on movement and orthopedic assessment. Sometimes internal rotation with a resistance band is appropriate, but often there is more to it then that. For example, in the case of SICK Scapula, focusing on corrective exercises for the tipping of the scapula and it’s accompanying dyskinesis may prove more useful then direct strengthening to the subscapularis. Some of the most basic shoulder exercises I like can be found in the Trigger Point Acupuncture facebook group or in this video. Another great tool that can be incorporated is kinesiotape. To see an easy and effective taping method, check this video out! Just because we are using homecare to treat other muscles doesn’t mean that Subscapularis won’t be indicated for needling. It is simply that we have to treat the whole pattern, versus just a single muscle….however, that is nothing new to an acupuncturist, we always treat the pattern!

If you enjoyed this post please subscribe! And remember the above is for educational purposes only. Online reading and videos are not a substitute for in person training by a qualified professional. The author is not responsible for your actions should you use anything in the above article.

 

 

One of the most under-utilized techniques in the acupuncturist’s tool belt is manual therapy (Tui Na). This modality can be an extremely effective tool to decrease pain and increase range of motion immediately for a patient. Manual therapy is a modality every acupuncture practitioner spent a fair amount of time learning in school. Of course, like any other technique learned, it takes practice and clinical use to stay consistent with.

Often, we do not think there is time in a treatment for manual therapy, so this video shows how you can spend just a few minutes to get fast results. A few minutes before or after treatment can make a world of difference in patient outcome. Remember patients want the fastest results they can get!

When to use manual therapy

                Every practitioner will have their preference. I used to always perform manual therapy before needling, but have shifted into using the techniques more post treatment. The major exception to this is the needle sensitive patient or acute muscle spasm (i.e. torticollis). Using manual therapy before needling can decrease the discomfort of needling for a needle sensitive patient.IMG-0355 The reasoning is simple; manual therapy to MTrP will decrease the active response of the trigger point. If a patient is hypersensitive to needling, 30 seconds of manual therapy to oversensitive trigger points makes all the difference in the world.  After treatment it can quickly make a difference in pain and range of motion on top of what acupuncture had already achieved. This manual therapy can really be the icing on the cake of a great treatment.

Get immediate relief of symptoms

When performing manual therapy post treatment, it is pivotal that it provides immediate relief and increase ROM. When utilized on top of acupuncture it can accelerate the treatment effect. As discussed in this short video a combination of passive flexion and active flexion with compression on a MTrP can help to decrease the pain quickly. If the patient is sensitive to pressure passive flexion performed correctly should decrease pain in the point by approximately 60%. Hold pressure in the decreased pain state at least 30 seconds and up to 2 minutes then retest and the pain point should be less sensitive. This technique is often called positional release or strain counter-strain. If the patient is less sensitive to deeper techniques applying pressure through flexion of the muscle can create a quick decrease in trigger points. A combination of the two can be beneficial and quickly attained.

For quickly increasing ROM I add PNF (Proprioceptive Neuromuscular Facilitation) or Muscle Energy techniques along with the above techniques. My personal favourite version of these is a method of Contract-Relax technique which works through reciprocal inhibition. For example, when a patient has decreased lateral flexion in the cervical spine they are placed in passive flexion. Once a range where the muscle restricts movement is attained the patient restricts lateral flexion in the opposing direction for several seconds. After a few seconds the patient relaxes and passive range of motion increases. The results are instant and are phenomenal for increasing range of motion.

Create a well-rounded treatment

As acupuncturists we often fall into the trap of thinking our needles are a hammer and every problem is a nail. We have a complete scope of practice to treat a variety of conditions and should use the tools in our tool bag as efficiently as possible and to the best of our ability. When treating pain combining just a few minutes of manual techniques can be an excellent way to create a well-rounded approach to the patient’s symptoms. Please comment with your favourite manual therapy techniques to use on patients!

Information in the above contains statements related to the below:
Bron, Carel et al. “Treatment of Myofascial Trigger Points in Patients with Chronic Shoulder Pain: A Randomized, Controlled Trial.” BMC Medicine 9 (2011): 8. PMC. Web. 29 Mar. 2018.
https://www.jiscs.com/Article.aspx?a=11
Hindle, Kayla B. et al. “Proprioceptive Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and Muscular Function.” Journal of Human Kinetics 31 (2012): 105–113. PMC. Web. 13 Apr. 2018.

 

 

When we teach our courses one of the most common questions is about intensity of needling. Specifically, how much mechanical irritation is needed to relieve a trigger point. This is, of course, a loaded question. There is a great deal of research that is done to try to answer this. Research will also examine whether or not a twitch response is necessary for pain relief. However, in practice the amount of twitch response varies quite a bit not only from patient to patient, but often from location of the body.

The upper trapezius is an very common area to illicit a large twitch response multiple times. Depending on the severity of the patient’s pain level and their comfort Upper Trap Needlingwith trigger point needling, the amount of stimulation can greatly differ. If the patient is coming in after an MVA for example, less may very well be more. If the patient is a high-level athlete they may do better with a higher level of stimulation. This can only be assessed after building a relationship with the patient.

So how much stimulation should I use?

If it is the first time a patient is receiving trigger point acupuncture, I highly recommend starting with low to moderate levels of stimulation. It is very easy to increase the treatment intensity the second visit, but it is impossible to take back treatment intensity after the fact. Proper communication the patient can really help determine the treatment intensity. This does differ from the TCM tonification/sedation methods. We always have patients report back on how they felt afterwards and there are two questions that are key:

1.How long were you sore?

2.How long did you have a decrease in pain?

How long were you sore?

                Soreness is common after trigger point needling. Soreness is not pain! The soreness associated with trigger point needling should be likened to that of post work out. If a patient notes an increase in pain or lasting pain, then decreasing mechanical stimulation or utilizing more superficial fascial needling may be indicated. Manual therapy can also greatly help patients that have an increase in pain from needling.

How long did you have a decrease in pain?

                This question serves two purposes, and one of those is to see if an increase in stimulation is indicated. If the patient noted little to no soreness and only a brief or no relief, increasing stimulation can be indicated. This question can also can indicate treatment frequency for the patient. It is very common to have trigger point needling patients come in for shorter intervals at the beginning such as twice a week for two to four weeks depending on condition or whether or not they are seeking care with other providers.

One of the other major concepts to get across to patients is that less can be more. While we are going for a twitch response we don’t want the patient to be in pain. More often than not, a twitch response isn’t particularly painful, it is just a new sensation. If the patient is associating pain with a particular trigger point being needled it shouldn’t necessarily be a grin and bare it situation. That is why communication is key. In my opinion, communication during the needling process of trigger points is more interactive than that of needling acupuncture points with therapeutic properties. If we can communicate goals of needling with the patient, then needling intensity can be better attained creating more positive treatment outcomes.

If you are an athlete of any kind then you have probably been inundated with suggestions on what supplements will get you to become the best athlete you can. From claims of magical pills to drinks containing vitamins (that you will never absorb), the market is full of options. A very large portion of them are unnecessary and essentially junk. In fact, one of the first things I like to do with my athlete patients is have them bring in supplements to the clinic. In doing so, we can go over all of the ingredients and figure out what is working for them and what they should add into their regimen. While everybody is different here are  a few items that should grace the cabinet of every athlete whether professional, amateur, or weekend warrior.

Weight lifters often treat this like it is a precious as gold, which to the body it can be.

1)      Protein Powder- Weight lifters often treat this like it is a precious as gold, which to the body it can be. Protein isn’t just for people trying to bulk up. Whenever we perform athletic activities we are breaking down muscle to some degree. Protein is what helps build that muscle back up. From a nutritional standpoint, protein is also great to have before a work out to assure adequate nourishment. The question is what kind of protein powder is best.

  • Whey Protein Isolate- Definitely one of the most popular. Whey is a milk based protein and is considered a complete protein (contains all the necessary amino acids). The thing to watch for is what other junk have they put with it and is if it is truly a Whey protein isolate. Quick tip to avoid junk: always read “extra ingredients” and look at the carb/protein/fat content. You don’t want a protein packed with carbs or fats. The only aspect where whey protein fails is that it is obviously not a vegan product and not so friendly to those that are lactose intolerant. Also, milk is very mucous producing so congestion/phlegm may be an undesirable side effect.
  • Pea Protein- An excellent option for those sensitive to dairy or concerned about welfare of animals. Pea protein is considered a hypoallergenic, vegan protein that is easily digested. The con of Pea Protein is that a Vegan athlete would need to consider integrating other sources of protein as well to assure an adequate balance of amino acids is achieved.
  • Hemp/Soy/Rice- Other powdered proteins include Hemp, Soy, and Rice. The most common complaint I hear about hemp is the flavor and that it is more limited at stores than Soy, Pea, or Whey. Soy protein is an acceptable option in moderation, although it is becoming a very common food allergy for people because it is quietly added in many of our foods. Also, finding an organic source may be more difficult and most Soy is not GMO free. Rice protein is a great option and is also easily digestible.

Whenever looking for a protein powder, stay away from ones that add sugar.

2) Daily Multiple- If you are an athlete you are using up more nutrients than an average person and you need to replenish these. Choosing a daily vitamin can be tricky. Check out our previous blog article about choosing a proper daily vitamin here.

3) Ca+Mg- Calcium and Magnesium in combination is an excellent step in recovery. While it is important for an athlete to consider products that will improve athletic ability, the ability to recover is just as important. Calcium and magnesium need each other in the body, so it is great to take them together. Ca+Mg taken in small doses at night can act like an all natural muscle relaxer due to the magnesium content.

4) Fish Oil- Continuing along the lines of recovery, fish oil is anti-inflammatory. Like all supplements, all fish oils are not created equal. There are also many ‘types’ of fish oil, depending on the content and ratios of the ingredients. One fish oil recommended for an athlete would be different than one recommended for cognitive health or during maternity. For pain, choose a high grade, pure triglyceride form fish oil with high grade eicosapentaenoic acid (EPA) over a high level of DHA (docosahexaenoic acid). Ratios of EPA and DHA can important in tailoring the treatment for different conditions. The benefit of supplementing with Fish oil over just eating fish is twofold. Often, people cannot eat enough fish to attain a therapeutic dose and there is also concern of mercury content, especially if certain fish are eaten. The downside of fish oil is obvious; it is not for the vegan athlete. Vegans often utilize flax seed instead, but this provides ALA (Alpha-lionlenic Acid) which may not provide the same therapeutic effect.  As a vegan athlete it is difficult to attain the benefits of EPA directly leaving ALA as main option. Other considerations before starting a fish oil would be to consider current medications and avoid with some medical procedures. As with everything in this article, it is best to discuss individual needs with a medical professional before starting supplementation.

5) Chinese Herbs- This is a very broad statement. Chinese herbal medicine has an apothecary of hundreds of herbs. Almost always, herbs are combined together rather than used alone because TCM (Traditional Chinese Medicine) is all about balance. It would be necessary to see an East Asian Medicine Practitioner to find out what herbs would be best for each athlete. For an example however, one commonly used formula for athletes is Yu Peng Feng San Wan. Because training can be very draining and tax the immune system, supplementing short term with this formula can be very beneficial to help burn out or prevent what is called a “Wind Invasion” in TCM. While this is only one example, there are many other uses for a patient to take Chinese herbs such as pain, digestive upset, or even fatigue.

For athletes, considering any or all of these products is a great idea. Whether a weekend warrior or a serious competitor, every athlete deserves to get the best performance they can.  If you enjoyed this information please subscribe to our blog and for more great tips follow us on Facebook!

*The preceding is not intended to diagnose or treat and is for informational purposes only.

February is American Heart Health month and it is a great month to focus on becoming aware of heart health. Heart disease is the leading cause of death in the United States and has been for years. The best way to prevent heart disease is applying early detection methods and treating them accordingly. I would challenge everyone to make it a priority in the month of February to consider the following methods for detecting heart disease and taking the appropriate steps to identifying your heart health.

  1. Blood Pressure– Considered a basic vital test, blood pressure identifies the amount of pressure pushing against the walls of vessels as it circulates through the body. Testing blood pressure is a quick and simple procedure that everyone should take advantage of knowing. A healthy blood pressure is important as it relates to how hard your heart is working. While it is expected to work harder during exercise (which is healthy) it should remain at a rate of 120/80 or less at rest. For American Heart Month our office is offering complimentary blood pressure screenings!
  2. Pulse– Another basic vital sign, measuring a pulse is a simple procedure that literally takes a minute! By feeling the inside of the wrist on the thumb side you can palpate the radial pulse. By simply counting how many beats you feel for 1 minute (or multiply it by 2 after 30 seconds) you can assess your pulse. A resting pulse for a normal adult can range between 60-100, and is another indicator of how hard you heart is working. If the pulse is consistently high or low it is something to discuss with a doctor. There are many other aspects to a pulse to consider but as a baseline the number of beats per minute is “vital” to know. If you are interested in the many other aspects of the pulse, ask your local acupuncturist!
  3. Total Cholesterol– Cholesterol is an important part of building healthy cells and is found within the blood stream. A normal amount is great! However an increased amount of cholesterol can increase the risk of heart disease. High cholesterol, unlike the previous two markers, does not have any associated symptoms when it is present. The only way to accurately assess cholesterol is through a blood lipid panel. This is a simple test and depending on the patient’s age and previous test results is recommended at different intervals. One standard acceptance is that a total cholesterol over 200 should be addressed. Do you know your current cholesterol level?
  4. Other blood tests– Cholesterol is a common test taken that most people are at least familiar with. In fac,t it is so well known that there is constant conflicting opinions on what aspects are important and how best to treat it among many health care practitioners. There are also other blood tests that work to assess cardiac health that should be considered during American Heart Month. Another example of a  blood test that can be used to consider cardiac risks are CRP and Homocysteine.  A C-Reactive Protein test isn’t a specific heart test. It is actually a test to measure inflammatory markers in the body. Elevated levels simply tell us there is inflammation…somewhere. That being said when taken into consideration with other factors (age, health history, lifestyle habits, family history). CRP isn’t done as commonly as Cholesterol screening however it can help with a better overall picture. There are also other blood tests such as homocysteine and fibrinogen that can be utilized to assess cardiovascular risks. It is important to discuss what tests are best suited to discover your heart health!
Image

Blood Pressure is one of the easiest and vital signs to help assess the health of the heart.

This is the first blog in an upcoming series for American Heart Month. Please be sure to subscribe or check back for more useful heart related information throughout the month. Comments and suggestions are always welcome!

5 Quick tips for shopping healthier:

1. Shop the perimeter of the store- If you avoid the middle aisles you are more likely to be purchasing fresh foods like fruits and vegetables, rather than frozen meals or sugary cereals and snacks.

2. Read the label- There is a great deal of important information that can be attained on a label. To keep it easy avoid added sugars and ingredients you can’t pronounce.

3. Eat a variety- In order to get a balanced amount of nutrients it is important to eat different meals. This concept is also important to avoid acquiring food allergies. Eating the same thing everyday is not only boring but, also not the best choice for eating healthy. Remember, make your plate colorful.

4. Switch to tea- If you are drinking a “cup of joe” every day try switching to green tea, as it has a higher antioxidant content and less caffeine. There are also many other great ways to get off coffee like “Teeccino”. Your insides will appreciate it.

5. Going Organic- While this is obvious, you don’t need to go all out everytime you see the big “O”. Store brands organic is still organic. Also foods such as Bananas, Watermelons, and Avocados that have thicker outer shells are a topic of debate. If you can’t buy all organic stick to purchasing the “dirty dozen”  organic to avoid strong amounts of pesticides. These consist of strawberries, apples, grapes, potatoes, peaches, nectarines, cherries, raspberries, bell peppers, celery, broccoli, blueberries and spinach.

Want more free health tips? Subscribe to this blog 🙂 Comments welcome!

This information is not intended to treat or diagnose any disease. It is solely the opinion of the author and should be interpreted as such.

Enter your email address to follow this blog and receive notifications of new posts by email.

Hours & Info

425-556-0484
M-F 10am-5pm
Saturdays by appointment only

There was an error retrieving images from Instagram. An attempt will be remade in a few minutes.