Sunday, April 10, 2016

Acupuncture Treatment for the Spiral Line

A common treatment we utilize in Sports Medicine Acupuncture® when there is strain along a sinew channel involves the classical needle technique of multiple needles along a line (pai ci). This treatment can help release bound fascia and restore length and range of motion along this line. This post will discuss an acupuncture treatment for shortening along the upper portion of the spiral line (SPL) discussed in Anatomy Trains; it is a useful protocol for posterior neck pain (often unilateral) when there are shifts and rotations seen between the pelvis, ribcage, and neck.

The SPL is a myofascial structure that winds around the body. Posturally, it can be be associated with rotational distortions and shifts of major body structures. Often times, it is involved with more superficial counter rotations to deeper core rotational patterns, such as those caused by having one psoas shorter than the other.

First, a word about what the SPL is and how it relates to the sinew channels. The SPL is a myofascial meridian discussed in Thomas Myers' book Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. There are strong parallels between the sinew channels discussed in Chinese medicine and the Anatomy Trains (myofasical meridians) discussed by Myers. I have used this book, along with other sources, as one of my references as I determine which myofascial (muscles and fascia) structures belong in which channel. This sinew channel information is then taught in the Sports Medicine Acupuncture Certification program (which, for this certification cycle, is in Chicago).

While there are points in common, there are also key differences between which structures make up the sinew channels and which are discussed in Anatomy Trains. The spiral line, however, is not similar to any one sinew channel, and can be seen as a unique structure. Actually, it involves the interaction of multiple sinew channels, primarily the Urinary Bladder, Gall Bladder, and Stomach sinew channels.

The upper SPL travels from the ASIS of one ilium, crosses to the opposite ribcage, wraps around to the posterior torso and travels under the scapula, and crosses back around to the other side at the spine (on the same side as it started) to connect to the neck. For instance, if we started at the left ASIS, it would incorporate the left internal oblique muscle, the right external oblique to the right serratus anterior, and right rhomboids (see the last post on the rhombo-serratus sling), then crossing over to the left splenius cervicis and splenius capitis to attach at the left transverse processes of C1-C3 and head. There would be a parallel structure on the opposite side of the body starting at the right ASIS and ending on the right C1-C3 transverse processes.

When there is shortness in one SPL, the ASIS will be closer to the contralateral lower ribcage. This will be seen with a ribcage that is shifted left or right in relation to the pelvis (shifted towards the ASIS of the short SPL) and/or rotated in relation to the pelvis (rotated toward the ASIS of the short SPL). This will be caused by shortness in the fascial sling of one internal oblique and the contralateral external oblique and serratus anterior. In addition, the head will then be shifted in the opposite direction in relation to the ribcage and/or there will be lateral flexion of the cervical spine. This will be caused by shortness in the remaining portion of the sling, which includes the serratus anterior and rhomboids (rhombo-serratus sling) and the contralateral splenius cervicis and capitis. Assessment of this involves a visual observation of the patient's posture.

Once it is determined which side is short, the following acupuncture protocol can then be added to the treatment. This protocol will release the bound fascia and restore length to the shortened SPL. This shortened side will frequently correlate to the side of the neck pain that a patient comes in complaining about, and can include trigger points in the shortened splenius cervicis, trigger points in the levator scapula (which will also often be in a shortened position), facet joint pain on the side of the shortened splenius cervicis (and the side of lateral flexion compressing the cervical facets on that side, and many other cervical complaints.

The protocol includes the following points:
  • GB-26 (the motor point of the internal obliques) and the contralateral LIV-13 (the motor point of the external obliques).
  • Serratus anterior MP on the same side as LIV-13.
  • Rhomboid major and minor motor points on the same side as LIV-13.
  • Huatuojiaji points associated with attachments of the splenius cervicis and rhomboids (usually T2-T3 are reactive).
  • Bailao (the motor point of splenius cervicis) and splenius capitis motor point (close to GB-20), both on the same sides as GB-26.
This entire protocol can be performed with the patient prone as GB-26 and LIV-13 can both be reached with the patient in a prone position. Adding distal points creates a more balanced treatment. These can vary based on other findings, but a typical protocol is included in the figure to the right and these points are highlighted in red. This includes:

  • BL-62 and contralateral SI-3 (SI-3 on the side of cervical pain). This combination addresses the Yang Qiao and its paired Du mai. The Yang Qiao involves the coordinated interaction between the Urinary Bladder, Gallbladder and Stomach sinew channels.
  • GB-41 and contralateral SJ-5 (SJ-5 on the side of the short rhombo-serratus sling). GB-41 and SJ-5 address rotational aspects of the pattern.
  • LIV-5, Adductor longus motor point, Quadratus lumborum motor point (on the side of the elevated ilium). This combination addresses the deeper underlying core imbalance. This shortness in the Liver sinew channel on one side will often cause deeper rotations which will result in counter-rotations mediated by the SPL.