Monday, September 26, 2016

The Psoas and the Liver Sinew Channel

I recently returned from Chicago for the start of Module 3 of Sports Medicine Acupuncture Certification (SMAC). The beginning of the module involves two classes, two days each. The first class was the Anatomy/Palpation/Cadaver Lab, taught by Matt Callison, David Vavrinchik, and myself. The second was Fascial Release for Myofascial Meridians, a class that I assist with and is taught by Simone Lindner. In October, I will return to assist with two classes for this module, the Assessment and Treatment of Low Back and Hip Injuries and Postural Assessment and Corrective Exercises (PACE) III, taught by Matt Callison and Ian Armstrong.

While teaching is an opportunity to share information with the class participants, it is also a chance for learning and investigation. In this past sequence, there were many chances for exploration, but one stood out for me.

This involved a 'cross pollination' of ideas from Matt and myself and from Simone. Simone is a longtime instructor with KMI (Kinesis Myofascial Integration), which is the school of structural integration started by Tom Myers, the author of Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. She is teaching a version of this program as a part of SMAC. But, since all of the participants are acupuncturists, we are able to look at relationships between the fascial release work that they teach for the myofascial meridians and acupuncture techniques that we teach to work with the sinew channels.

One such incidence involved working with the iliacus and psoas. Simone was in the part of the class where she was working with imbalance in these extremely important structures. After assessing and before actually performing the techniques, she palpated the iliacus and psoas. She would then perform the techniques and expect to feel the tissue change. But, we decided to try acupuncture first and then see if there was change in the tissue.

The main points we used were GB-27 and LIV-4. The psoas is a tricky structure to treat directly with an acupuncture needle. You can not reach it through the front without penetrating the peritoneum and there are risks involved with accessing it through the back. Matt Callison teaches a way to treat it with a particular needle technique at GB-27. The needle technique must propagate a sensation to one of three places to be effective in changing the holding pattern of the psoas.

Distal points for the psoas could include the Liver channel, as the psoas is on the Liver sinew channel. Or it could include Kidney points, as the psoas converges with the Kidney sinew channel at the spine. I recommended LIV-4, as the model had an anterior pelvic tilt on the side being worked on and a posterior pelvic tilt on the opposite side. In this type of situation, LIV-4 can be part of the treatment for the side with the anterior tilt. This is part of a protocol we teach in SMAC for an asymmetrical pelvis. I feel that LIV-4 addresses the shortened tissue along the sinew channel coming up the medial thigh and into the the iliacus and psoas.

After needling these points, obtaining the proper Deqi sensation, and with very little retention (we would have retained longer if time had allowed), we removed the needles and had Simone reassess. She was surprised by the degree of change that occurred in the tissue from this technique. After this, her technique required much less work. This is a very good argument for performing needling first and manual therapy second, as the acupuncture can do so much to open and prepare the tissue.