Exstore

Serratus Anterior: 4 inches inferior to mid axillary line. Grab and lift lats to expose serratus

External Rotator: Infraspinatus motor pt (between SI12 and lower border of scap)
Teres minor motor point (between SI 9 and SI 10)

Internal Rotator: Supine, subscap muscle (grab scap and needle lateral to the thumb away from lung)

Supraspinatus: SI 12 (needle towards fossa)

Ant Deltoid: Midway between anterior axillary fold & A/C joint

Mid Deltoid: 2 2.5 inches inferior and 0.5 - 1 inch anterior to SJ 14

Post Deltoid: 2 2.5 inches inferior and 05 - 1 inch posterior to SJ 14

Obliques: GB 26 (above Iliac crest in line with navel). Add transverse abdominis motor pt, 1 full inch
posterior (behind) GB 26.

Hip Flexors: GB 28 (0.5 inch anterior and inferior to depression of ASIS) Iliacus motor pt. Thread
towards iliacus .

TFL: GB 29 (midway between ASIS, or just above ASIS, and prominence of greater trochanter)

Glute Medius Anterior: tx prone, 3 - 4 inches superior and 1 inch posterior to head of greater
trochanter
Glute Medius Posterior: 1/3 of the way (medial) between PSIS (lateral to S2) and greater trochanter

Glute Minimus: halfway between greater trochanter and iliac crest

Glute Max (A Lombardi): 6 inches lateral to S4 and 1 inch inferior

Glute Max (M Callison): 0.5 to 1 cun inferior BL54 (3 cun lateral to S4)

Adductors: Liv 10,11,12

Additional Pts

Lateral Elbow Pain: Motor pt of brachialis (4 inches superior to Lu 5)

Elbow (anconeus) pain with extension: Motor pt of anconeus (1 inch distal and 1 inch lateral)

Upper arm or elbow pain with flexion: Motor pts long head of biceps (A. 4 inches distal to anterior
axillary fold. B. 5 inches distal and 1 inch medial)

Golfers Elbow (medial): Motor pt pronator teres (draw line moving distally and towards each other
from medial epicondyle and PC 3)

For elbow pain also stimulate area HTJJ T1 - T5

"perfusion treatment" is:
Normalizing sympathetic tone by stimulating the inferior cervical sympathetic chain (T1-T5) or lumbar
sympathetic chain (T10-L2). The inf cerv symp chain directly controls the blood vessels that feed
oxygenated blood to the head, neck, and entire upper extremity. The lumbar symp chain controls the
blood vessels that feeds oxygenated blood to the low back, pelvis and entire lower extremity. When
pain is present sympathetic tone is high which means blood vessels carrying oxygenated blood to the
periphery is narrowed. By doing this perfusion treatment: we decrease sympathetic tone so we
vasodialate these vessels allowing more oxygenated blood to be fed to these areas. So it is a treatment
that affects the entire system so naturally it would be effective for any ailment that affects the entire
system (diabetic neuropathy, CRPS, Fibromyalgia, CFS, chronic pain, inflammatory arthritis, etc).
The levels T1-T5 and T10-L2 are accessed along the HJJ points of the respective spinous processes. By
inputting at these levels we are modifying the sympathetic chain indirectly via the sinuvertebral nerve
which innervates the discs. Depth of insertion is about 1-1.5 cm. Usually stimulated at low freq 2-4 hz
with some exceptions.

John Steinke

Wrist Ankle Acupuncture for various painful conditions

Points for acute injuries with swelling

Shen men, Sympathetic, Subcortex

Five tiger points (master Tung). Also very useful for arthritis.

For Chronic Pain conditions

Shu stream points contralateral on same channel

Jing well point on affected channel if blood stagnation or acute strain
BL 67 for hamstring strain or BL sciatic pain

Acute Cramping

DU 26 (needle or acupressure with thumb nail)

Tendonitis (i.e. tennis elbow)

Kid gate (1 cun below SP9, find depression) and Kid 7. Moistens tendons.
GB 31

Points to prep for a marathon etc

GB31 and SP and ST point along same length

 Dr David Wells

To release the PSOAS you can needle the Subscap (Ht 1) as it is the homologus muscle

If one leg is longer than the other is usually related to SI joint being strained. The strained SI joint is
lower on the short leg and also rotated anteriorly to compensate.

The homologus pt for hip bursitis is LI 16 (ipsilateral)

The homologus pt for pectinius leg adductor is pec minor around Lu 2

Flax meal (ground flax seed) is associated with lowered risk of cardiovascular disease
and cancer of the colon, breast and prostate.

Supplement Lysine for herpetic neuralgia, cold sores (inflamed nerve root from herpes virus), shingles.
Herpes (chicken pox) can manifest as trigeminal neuralgia, sciatica, etc. Herpes virus feeds off of
arginine. Lysine, on the other hand, helps block herpes. Avoid nuts, chocholate, and corn. Favor high
protein food and beans. Lower intake of grains because they are high in arginine and low in lysine. For
lysine supplementation use 1 gram three times a day during a flare up of herpes virus which lives in the
nerve roots.

Modern diet is high in calcium and sodium, and low in magnesium and potassium.

Differential Diagnosis
Onset is acute - Consider sprain or strain, disc bulge/rupture, fracture (rare), infection (very rare),
Chronic
In an older person, consider arthritis.
In a younger person, consider postural stress.

Dif Dx Radiating Pain

Back pain radiates below the knee - Sciatica
Worse with flexion - disc
Worse with extension - stenosis
Worse only on getting out of chair - piriformis
Pain is down side of leg and/or groin and does not extend below knee Hip.

Red Flags
Fever with back pain - consider kidney infection, transverse myelitis, acute arthritis.
Recent unexplained weight loss consider cancer, drug use.
Difficulty with urination or defecation - consider cauda equina syndrome or infection.
Refer out

Common Diagnoses:
Lumbalgia or Facet Syndrome
Lumbar Sprain/Strain
Lumbar Disc Syndrome
Sacroiliac Sprain/Strain
Lumbar Stenosis
Piriformis entrapment syndrome
Lumbar disc treatment
Yao Tang during the acute phase - no local points
McKensie (cobra) exercises with traction
Lumbar HD formula
Water exercise, lying down some (first 2-3 days), and walking more after acute flare up. Less siting
and avoid bending forward.
Refer to neurosurgeon for consult

Treatment Lumbalgia
Needle UB 23-25, quadratus lumborum
trigger points, other local or syndrome related points as indicated.
Stretching exercises, walking more, sitting less.
1-4 visits in a two week period

Lumbar Stenosis
Range of motion makes sciatica worse on extension, better on flexion.
Kemps Test +
Stenosis is one condition that may require surgery as there is no way to dissolve the
overgrowth of bone obstructing the nerve.
The criteria for surgery is not pain but function.
Tests - Heel/Toe Walk, reflexes.
Preferred surgery is foraminotomy

Treatment Lumbar Stenosis

Needle UB23-27, quad lumborum TPs, GB 29, 30
Water exercise
2 visits per week for two weeks, then re-evaluate
Core Strengthening
Many problems are caused by weakness of the core muscles. Most conditions are helped by
strengthening the core.
Core muscles are the abdominals, lower back, which are supported by the butt, hamstrings and upper
back.
Core Strengthening
Anterior pelvic tilt is caused by weakness of the lower abdominals, glutes and hamstrings with overly
tight psoas and lumbar muscles (classic lumbalgia).
Exercises include plank, straight bridge, sit ups on a ball or with legs hanging off a bed, isometric
contraction of transverse abds,etc.
Abdominal Exercise
Contracting the abdominals without contracting the psoas is difficult. To do so, the thighs must be in
the same plane as the torso or the opposing muscles (hamstrings and gluteals) must be engaged.

Treatment Sacroiliac Sprain

Needle UB23-27, quad lumborum TPs, GB 29, 30. Check leg length.
Ice the joint 10 minutes TID
Walk, dont sit.
2 visits per week for two weeks, then 1 visit per week for two to four more weeks.
Treatment Lumbar Sprain
Needle quadratus lumborum trigger points, possibly Yao Tang Xue.
Do not needle lumbar bladder points in an acute back sprain (first week or two). You want the
erectors to remain tight in this case to push the disc forward. You want to keep the disc from
pressing backward on the nerve and radiating down the leg. Needle BL pts after acute phase.
Water exercises, walking more, sitting less.
2-3 visits per week for two weeks, then 1-2
visits per week for two more weeks.

Lumbalgia case study (red flag)

37 year old female presents with right lumbar pain of two weeks duration.
Insidious onset - no trauma. Sits for a living. She thinks the pain is due to stress,
which has been higher lately. The pain tends to get worse over the course of the
day and makes it difficult to sleep.
Palpation reveals tenderness along the right quadratus lumborum but also lateral to
that in the soft area of the waist. What do you do?
The answer to the question, What do you do? is that whenever you are in doubt, get more
information.
The next thing I did was get her temperature. Why? Possible kidney infection
Her temperature was 99.4
What could it be?
What more history is needed?
Further questioning revealed that she felt achy and tired, bloated in the lower abdomen, and though
she drank a lot of water, hardly urinated yesterday and today.
What to do now?
Lumbalgia case study
While questioning her to get information regarding her primary care physician, I
needled the QL trigger points, UB 65 (because it was tender), Sp9 and LI4. I got
her physician on the phone and asked if he preferred to see her or should I send her
straight to the ER
 NECK

Cervical disc bulge or rupture is common in cervical sprain injuries.

The Wright's Hyperabduction Test is to diagnose entrapment at the thoracic outlet.

Adson's Test is to diagnose entrapment at the cervical region.

Brachial Plexus Diagnosis:

Distinguish between Scalenes Anticus, Cervical
Disc and Thoracic Outlet Syndromes.
Use history and orthopedic testing.
Brachial Plexus Tests
Bakody's Sign Positive for Scalenes Ant.
Wright's hyperabduction test Positive for tight pectoralis minor muscle if symptoms and loss of pulse
occur as arm abducts.
Adson's test is positive if symptoms and loss of pulse occur as arm extends back and neck tilts away as
head rotates towards extended arm.
Shoulder Depression is a continuation of Adson's Test.

Cervical disc syndrome:

Cervical Disc Syndrome with Radiculopathy
Cervical Disc Syndrome with Myelopathy
M50.22 Cervical Disc Syndrome without Radiculopathy
M50.12 Cervical Disc Degeneration
All of the above apply to C4 though C7

Tests include:
Rust's Sign
Cervical Compression and Distraction
Bakody's Sign (Hand on head relieves pain)
Cervical disc bulge or rupture is common in cervical sprain injuries.
Use acupuncture to relieve pain, inflammation and some muscular tension.
Use Chiropractic or Tui Na to restore normal Position and ROM
Include traction with extension.
Goals restore normal range of motion and
eliminate radicular pain.
Orthopedic Tests
Active and Passive Cervical ROM. Vertigo or dizziness on rotation is Barre-Lieou Sign (vertebral
artery compression)
Reflexes and Dermatomes
Cervical compression Positive for disc lesion or stenosis if pain radiates into arm.
Cervical distraction Positive for disc lesion or stenosis if arm pain is relieved.