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Acupuncture Therapies 1 > Lower back / Thigh / Hip / SIJ > Flashcards

Lower back / Thigh / Hip / SIJ Flashcards

1
Q

What is the Jing Jin of the lower back?

A

Jing Jing of the lower back
Bladder Channel: (Superficial layers)
Gall Bladder Channel (Side stabilisers of hip)
Stomach Channel (Rectus abdominus and Psoas)
Kidney Channel – (deeper layers including multifidus and Quadratus Lumborum and other stabilisers)

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2
Q

What needs to be assessed in musculoskeletal conditions?

A
  • Palpation – channels/ points, channel sinews site of complaint etc.
  • Lower Body Assessments & upper body assessments
  • Range of Motion (ROM testing)
  • Manual Muscle Testing (MMT Strength of muscles for stability)
  • Specific Orthopaedic testing
  • Specific i.e. if the problem is present, treat it. If not, you do not need to include the points/treatment
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3
Q

What structures are relevant to BL21-26?

A

Bladder points 21-26 relevant segmental posterior rami. I.e. BL21 11th thoracic nerve and BL26 posterior rami of 5th lumbar nerve. Also, these are segmental motor points of the longissimus muscles

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4
Q

What structures are relevant to BL28-BL30?

A

BL28 – 30 sacral iliac joint needle obliquely

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5
Q

What structure are relevant to BL31-34

A

BL31-34 sacral foramen (nerve)

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6
Q

What structures are relevant to GB25?

A

GB25 Quadratus Lumborum/12th Thoracic nerve

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7
Q

What structures are relevant to GB26 & LV13?

A

GB26 – Internal Oblique
LR13 – External Oblique

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8
Q

What structures are relevant to BL52?

A

BL52 – Psoas, when needled on the side towards the spin

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9
Q

What bladder distal points can be used for lower back pain?

A

BL39/40 & 55-67 all have indication of low back pain

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10
Q

What lung points can be used for lower back pain?

A

LU 5, LU5.5 and LU6 all have (BL Channel) lower back pain indications

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11
Q

What heart point can be used for LBP?

A

HT3 area (Kidney and GB Sinew Channels)

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12
Q

What are some distal points for LBP?

A

SI3 Master Point of GV
GV26 acute LBP especially difficulty with flexion/extension
KI3 – Derivative of Sciatic nerve useful to treat KI/BL sinew channel
GB34/ST 36 Derivative of Sciatic nerve (Common peroneal and deep peroneal), especially for sciatic pain
LR3 – Distal derivative of the deep peroneal nerve, purely sensory here
SIJ point distal to the styloid process of the ulna between SI6 and TE4 - Needle towards
HT Channel

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13
Q

What is LBP due to?

A

Most back pain is due to soft tissue and muscular tension.
Erector Spinae and hamstrings (BL sinew Channel) are tight.
Psoas (SP Sinew Channel)
Abdominal muscles (ST sinew Channel) and the Gluteal muscles (G. Max Bladder, G Med & G. Min GB sinew Channel) are weak
The Quadratus Lumborum (GB Sinew Channel) acute spasm,
Other muscles, Latissimus dorsi refers to
the back

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14
Q

What is a SMART treatment for LBP?

A
  • Sensory: Distal Myofascia/ Superficial back line/ Bladder channel sinew (BL 10, BL 11, BL57, BL58), Sural Nerve (BL60), Tibial Nerve (BL40)
  • Motor: N/A (overalps with HJJ)
  • Autonomic: Auricular Lumbar/ muscle relaxation/ Shen Men/ Point Zero
  • Radiculopathy: HJJ (T10-S1) depending on level
  • Trigger/Ashi: Longissimus, Illiocostalis (BL 11-21); Quadratus Lumborum (BL 51), Psoas (BL 52), Latissimus (BL 45-49, GB22)
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15
Q

How to treat acute LBP?

A

In acute lower back spasm go distal, points such as BL40
You need the abdominal muscles to help activate the core to help relieve the spasm
LR13 (external Obliques) GB26, plus 1 cun behind (internal obliques) with low-frequency 2Hz electro for up to 5-6 minutes

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16
Q

What is the SMART treatment for treating Cluneal nerves?

A

Sensory: Dai Mai Master/Couple (GB41/SJ5)
Motor: Not applicable-
Superior Cluneal Nerve: Yao Yen (Transverse needle with 100Hz e-stim) *Lateral Femoral Cutaneous Nerve: GB-27
* -llihypogastric & Ilioinguinal Nerve (T12-L1): KI-25, KI-12-14, CV-3/4. * -Genital Femoral Nerve: GB-28 & ST-30
Autonomic: BL23, GV4 (sympathetic switch) Radiculopathy: HTJJ T11-L2
Trigger/Ashi: Quadratus Lumborum (Pigen)

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17
Q

What is a SMART treatment for Sciatica?

A

Sensory: Tibial Nerve (KI3); Sural Nerve (BL 60, BL 62); Sciatic (ST35)
* Motor: Tibial Nerve (BL40); Common Peroneal (GB39); Sciatic (GB30);
Posterior Femoral Cutaneous (UB 36-37)
* Autonomic: GV26, Auricular Sciatic point (sensory) Auricular Sciatic point (motor)
* Radiculopathy: HTJJ L4-S2 (electroacupuncture)
* Trigger/Ashi: Longissimus, Illicostalis (UB 11-21); QL (BL52), Psoas
(UB24), Latissimus (UB45-49, GB22),

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18
Q

What is SIJ pain?

A

Sacroiliac Joint (SIJ) Pain usually a result of the dysfunction of the movement, either fixated or loss of motion.
Often from acute injury or repetitive use and muscle imbalances
The patient often feels pain medial to PSIS, gluteal region and anterior groin. Some may even report a disjointed feeling in their hip.

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19
Q

What distal point mirrors the SIJ?

A

This point is located distal and medial to the styloid process of the ulna between SI6 and TE4

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20
Q

What are the main branches of the lumbar plexus?

A

Illohypogastric
Illioinguinal
Genitofemoral
Lateral femoral cutaneous
Obturator
Femoral

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21
Q

What is the lumbar plexus?

A

The lumbar plexus is a web of nerves. It is formed from the 1st four lumbar nerves and subcostal T12 nerve
The plexus passes through the Psoas major and front of the hip joint supplying parts of the abdomen and anterior part of the thigh.
Provides sensory and motor input

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22
Q

What is the cause of LBP in TCM?

A
  • Trauma, invasion of cold or damp, kidney yin or yang xu
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23
Q

What is the Western medicine cause of LBP?

A
  • Myofasical trigger point
  • Vertebral joint syndrome
  • Degenerative joint disease
  • Intervertebral disc syndromes
  • Spondycolysis
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24
Q

What does the lower back include?

A
  • Lumbar spine
  • Sacrum
  • Lumbo-sacral joint
  • Sacroiliac joints
  • The coccyx and associated soft tissues
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25
What are the HJJ points?
Extra points distributed on each side of the spine, there are 48 points in total. They are located 0.5 - 1 can lateral to the lower boarder of the spinous process of each cervical, thoracic and lumbar vertebrae. They are found on the same paraspinal branch as the medial branch of the dorsal primary nerve.
26
Where are sympathetic neurons that innervate the lungs?
Located at T1-T4, UB13
27
Where are sympathetic neurons that innervate the pericardium?
Located at T1-T5 UB14
28
What is the Jin Jing of the lower back?
Bladder - superficial layers GB - side stabilisers of the hip ST - rectus abdominus + psoas KD - multifidus and QL
29
What structure is GB25?
Quadratus lumborum & 12th thoracic nerve
30
What structure is GB26?
Internal oblique
31
What structure is LV13?
External oblique
32
What structure is the Stomach channel?
Rectus abdominus
33
What structure is YaoYan?
attachment to iliac crest / superior clonal nerves
34
What structure is BL52?
Psoas when needled on the side towards the spine
35
What distal points can be used on the lower back?
In acute pain: Xi cleft points Microcirculation: Lou connecting points Jing well points: to affect the sinew channel Shu stream points: joint problems BL39/40 BL55-67 are indicated for lower back pain Yaotong xue: acute lower back problems SI3: master point of GV GV26 acute LBP (difficulty with flexion and extension) KI3: derivative of the sciatic nerve, useful to treat KI/BL sinew channel GB34/ST36 derivative of the sciatic nerve, sciatic pain LR3: distal derivative of the deep perineal nerve
36
What is most. back pain due to?
- Soft tissue or muscular tension - Erector spine + hamstrings are tight - Abdominal muscles and glute muscles - QL can go into acute spasm
37
What is the erector spinae muscle group?
Spinalis Longissimus Ilicostalis
38
What orthopaedic testing can be done for lumbar disc injury?
Straight leg raise test Slump test Myotomal motor point tenderness Valsalva manoeuvre
39
What are common pain referral patterns in lumbar disc injury?
Lateral and/or posterior thigh and leg along the dermatomes
40
What orthopaedic testing can be done for lumbar facet joint injury?
Stork standing test Pelvic measurements
41
What are common pain referral patterns in lumbar facet joint injury?
Anterior or lateral hip, buttock and possible posterior thigh
42
What orthopaedic testing can be done for sacroiliac joint pain?
Posterior shear test Gillets test Sacroiliac rocking test Pelvic measurements
43
What are the common pain referral patterns in sacroiliac joint pain?
Buttock region, hamstring region, groin region and possibly the leg
44
What is the SMART treatment for treating sciatica?
S: Tibial nerve (KI3), Sural nerve (BL60, BL62), Sciatic (ST35) M: Tibial nerve (BL40), Common perineal (GB39), Sciatic (GB30), Posterior femoral cutaneous (UB36-UB37) A: GV26, Aricular sciatic point (sensory) R: HJJ L4-S2 EA T: Longissimus, Illicostalis (UB11-21), QL (BL52), PSOAS (UB24), LATS (UB45-49, GB22)
45
What is Sacroiliac pain?
SIJ pain results from dysfunction of the movement, either fixated or loss of motion Often from acute injury or repetitive use Pain medial to PSIS, Gluteal region & Anterior groin
46
What is the SLR test?
Used to assess for the presence of nerve root involvement/disc injury parenthesis of the lower leg Patient is supine, hip is medially rotated and adducted knee extended Flexes the hip until the patient complains of pain/paresthesia or tightness in the back or back of leg
47
What is the Jing Jin of the hip, buttock and groin?
Bladder Channel: G. Max and Hamstrings (deep external rotators) Gall Bladder Channel G. Medius, G. Min, TFL Stomach Channel (Quadriceps) Kidney/LR/SP Groin adductors (common Attachment site) Spleen Psoas muscle
48
What is Legge's Jing Jin distribution?
BL: hamstrings, sacro-tuberous ligament to sacrum to paraspinal muscles GB: iliotibial bland, gluteus maximus, TFL, gluteus medias, minimus, deep lateral rotators to QL ST: rectus femoris and sartorius to abdominals SP: Adductor longus, pectinous, iliopsoas to diaphragm LR: Adductor brevis KD: Adductor Magnus, gracilis to pelvic floor muscles
49
What are callison's point combinations for treating postural problems?
Unilateral anterior pelvic tilt: ipsilateral (same side) LR4 & GB39.5 Unilateral posterior pelvic tilt: ipsilateral (same side) GB41 + TE5 Bilateral anterior pelvic tilt: GB39.5 on side with greatest anterior tilt, GB41 and TE5 on side with lesser anterior pelvic tilt Bilateral posterior pelvic tilt: GB41 and TE5 on side with greater posterior pelvic tilt, LR4 and GB39.5 on the side with the least amount of posterior pelvic tilt Pelvic rotation: GB41, TE5 & GB26 on same side as the forward rotation Elevated ilium: LR4 and GB39.5 on the same side of the anterior pelvic tilt. GB41 and TE5 on the same side of the posterior pelvic tilt.
50
What is BL53?
Superior Gluteal Nerve (Nerve to G Min, Ged and TFL)
51
What is BL54?
Inferior Gluteal Nerve (Nerve to G. Max)
52
What is GB30?
Sciatic Nerve, Piriformis
53
What is BL36?
Inferior Cluneal Nerve (superficial) Sciatic nerve (deep)
54
What is GB29?
Tensa Fascia Lata (TFL)
55
What is the extra point HuanZhong?
sciatic Nerve/ Obturator internus muscle
56
What is SP12 & SP13?
SP12 – femoral Nerve SP13 – Iliacus
57
What is LR9, LR10, LR11 & LR12?
LR9 – Sciatic nerve in Adductor Hiatus LR10 – Anterior Branch of Obturator nerve; Adductor Longus LR11 – Obturator Nerve (anterior/posterior branches; inguinal branch of ilioinguinal nerve), Adductor Brevis LR12 – Pectineus Muscle
58
What is the special point for the glute medius/ glute minimus?
Jian Kua Main action: turns on gluteus medius and minimus if weak. Indications: Lower back pain, hip pain, ITB syndrome, hip bursitis. If due to weakness. Location: On lateral line, midway between the iliac crest and the greater trochanter. Approximately 2 cun posterior to GB 29.
59
What are distal points for the hip / buttock and groin?
Distal Points on affected channels such as Xi Cleft points (acute pain), Luo Connecting points microcirculation. Jing Well Points affecting the entire Sinew channel, Shu Stream points joint problems. BL37 – Hamstring muscles are usually tight in these problems KI7 – Psoas muscle San Cha points (Wolverine Claws) (3 in total san cha yi, san cha er, san cha san) Xinmen 33.12 groin/hip/coccyx & sciatica pain GV19/GV20 Coccyx pain GB41 psoas pain Balance Deltoid/Infraspinatus muscle = glute max muscle. Supraspinatus = Piriformis, SI14 = Sacroiliac Joint Balance Pectoralis Major for Leg adductors (adductor longus, Magnus, brevis, LR5 groin area
60
What are tests for trochanteric bursitis?
Conduct Modified Ober’s test here Conduct FABER Conduct FAIR Test
61
What muscular imbalances lead to trochanteric bursitis?
TFL, Gluteus medius, Gluteus Minimus Gluteus Maximus locally, this condition responds well to surrounding the dragon needling and also local moxibustion
62
What is Legges treatment for trochanteric bursitis?
Principle points: ▪ GB 29 & GB 30 (local points) ▪ GB 40 (distal point, Yuan-Source Point and dispersing action) ▪ BL 62 (Opening point of Yang-Qiao) ▪ SP 6 (resolve damp, invigorate Qi) Supplement points: ▪ GB 27 or GB 28 (radiating pain); SP 3 & ST 36 (with dampness); BL 30 (with Cold); GB 43 & ST 44 (with heat)
63
What is piriformis syndrome ?
* Results from tension or tightness in the piriformis muscle * Can mimic sciatic-like syndromes where paesthesia can be felt up and down the leg and lower back * Primarily they complain of buttock pain
64
What test can be conducted for piriformis syndrome?
* FAIR test can be conducted
65
What is a differential diagnosis for sciatica?
* Piriformis syndrome
66
What is a smart treatment for piriformis syndrome?
SMART treatment for piriformis * Sensory: Cutaneous branch of superficial peroneal nerve (GB37), Deep peroneal nerve (LR3) * Motor: Ventral Rami of Sacral Nerve S1-S2 (BL 31, BL 32) * Autonomic: Sacral plexus (SP6), Auricular Sciatic Nerve. * Radiculopathy: Sciatic Branch (HTJJ L5, S1-S2) Overlap w Motor * Trigger/Ashi: Gluteus Minimus (Extra: Jian Kua), Piriformis (GB30), * Additional Points/ Treatment Tips: * Medial hamstring issues refer to the hip * Lateral hamstring issues refer to the knee * * DDX: Semitendinosus, semimembranous, iliocostalis lumborum and longissimus thoracis trigger points, which can refer to the buttocks.
67
What is the balance method for the supraspinatus?
Balance ideas for the piriformis * Anatomical position of the supraspinatus is quite useful to mirror the piriformis muscle * Needling the opposite SI12, LI16 and getting the person to move the hip / piriformis * Can also needle the infraspinatus and teres minor if tender (all these structures reflect the gluteal muscles)
68
What is Groin pain / abductor strains?
* Groin strains / adductor strains refer to strains of the adductor longus, adductor brevis, adductor magnus, pectineus and gracilis * Usually from a sports injury * Patient complains of frontal hip pain in the medial aspect of the groin and/or running down the leg * Groin muscles are SP/LR and Kidney channels
69
What is the Master Tung point for the groin?
Master Tung point 33.12 (Heart gate) * Located 1.5 distal to SI8. * Used on the opposite side to treat hip/groin pain, sacral pain, medial leg and thigh pain * Indicated for inflammation of the hip joint and/or degermation of the hip joint
70
What muscles are involved in knee flexion?
Hamstring group, popliteus, sartorius, gracilis, upper fibers of the gastrocnemius
71
What muscles are involved in knee extension?
Quadriceps group
72
What muscles are involved in tibial internal rotation?
Semimembranosus, semitendinosus, sartorius, gracilis, popliteus
73
What muscles are involved in tibial external rotation?
Biceps femoris short head
74
What is ST31?
Rectus Femoris Motor point
75
What is ST32?
Intermediate (Anterior) Femoral Cutaneous Nerve Rectus Femoris, Deeper Vastus Intermedius motor point
76
What is ST33?
Vastus Lateralis Motor Point
77
What is ST34?
Vastus Lateralis Motor point
78
What is SP10?
Vastus Medialis Motor point
79
What is Baichong wo?
Vastus Medialis Motor point
80
What is SP11?
Medial Femoral Cutaneous Nerve/ Sartorius muscle
81
What is BL36?
Inferior Cluneal Nerve (Gluteal Branch of PFCN); Sciatic Nerve (deep) hamstring attachment
82
What is BL38?
Biceps Femoris Short Head
83
What is GB31?
ITB / Biceps femoris long head
84
What is GB32?
Sciatic nerve
85
What is GB33?
Common Peroneal (Lateral approach); Inferior Lateral Articular Nerve
86
What is SP9?
Popliteus deep needling
87
What is BL56?
Tibialis Posterior
88
What is BL57?
Musculotendinous junction of Achilles & Gastrocnemius
89
What is BL58?
Lateral Sural Cutaneous Nerve
90
What are some distal points for the thigh / calf?
Distal Points on affected channels such as Xi Cleft points (acute pain), Luo Connecting points microcirculation. Jing Well Points affecting the entire Sinew channel HJJ Segments L3-L5/ BL31 (posterior thigh/calf) HJJ Segments (L2-L4 Anterior Compartments) Muscle mirroring calf muscles to arm flexors Muscle mirroring upper arm to upper thigh
91
What is DVT?
Deep vein thrombosis Serious life-threatening condition A thrombus (blood clot) that forms in the deep veins of the leg. Refer for medical diagnosis and treatment
92
What is DVT symptoms?
The symptoms of a deep vein thrombosis (DVT) may include; Pain and tenderness in the leg worse with walking, better with rest Pain on extending the foot with knee extended Swelling of the lower leg, ankle and foot Engorgement of surface veins Skin that is red and warm No history of trauma
93
What is acute compartment syndrome?
Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment In acute cases bleeding from trauma or intense overuse produces an increase in pressure – Required immediate surgery intervention to relieve the pressure In chronic cases, training has increased the muscle bulk faster than the facial sheath has been able to accommodate it, Fascia not expanding quickly enough This pressure can cause pain, inhibit circulation, compress nerves leading to nerve damage and muscle weakness.
94
What are some special tests for the thigh / calf?
Depending on strain area test the following: Bent knee Stretch test for proximal hamstrings 90-90 SLR Test Ely’s Test (Rectus Femoris) Thomas Test or Modified Thomas tests Plantar and dorsiflexion of the foot for the gastrocnemius and soleus
95
Why is heat and Moxa more effective in treating muscular strains?
It increases the blood flow whereas RICE delays healing, healing requires inflammation to work
96
What is the prognosis for strains?
Minor muscle strains recovery 1-3 weeks Larger tears 4-8 weeks Rupture of the muscle - surgery 6+ months or longer recovery
97
What is shin splints?
Tenoperiostitis Medial tibial stress syndrome (MTSS) is the most prevalent form of shin splints and can affect a broad range of individuals. This condition is an irritation of the fascial attachment of the soleus on the periosteum of the middle to distal third of the tibia
98
What are the symptoms of shin splints?
Pain, palpable tenderness and possibly swelling Recurring dull ache Over-pronation - excessive inward rolling that causes tibial twisting and overstretching of the lower extremity muscles Restricted dorsifelexion of the ankle and tight calf muscles Undertaking high-impact exercises on hard, noncompliant surfaces (ex: running on asphalt or concrete)
99
What is Legges ideas for treating shin splints?
Tendino-Muscular level Bleed ST 45; Ahshi points on opposite side Channel level ST 43 affected side & LI 3 opposite side (Shu-Stream combination) ST 41 (jing-river point); ST 44 (Ying-spring point); GB 34 (influential point of tendons) Local & Distal & Adjacent ST 36 + Ahshi points going down the ST channel as far as ST 39 SP 4; KI 2 (adjacent points) Distal points depending on what channel the problem is on, SP 5, GB 39, GB 34 could be added to the base prescription
100
What is a SMART treatment for shin splints? Anterior?
* Sensory: Deep Peroneal Nerve (LR3) * Motor: Common Peroneal Nerve Lateral Approach (GB33), LingHou. * Autonomic: KI-7, T10-L2 * Radiculopathy: Lower Extremity L4-S3 (HTJJ L4-S3) * Trigger/Ashi: Tibialis Anterior (ST 36, ST 37, ST 38) * Additional Points/ Treatment Tips: * Periosteal needling for local repair and heat application
101
What is a SMART treatment for shin splints? Posterior?
Sensory: Medial Plantar Nerve (SP1, LR1) Motor: Tibial Nerve (BL40, SP9) Autonomic: : KI-7, T10-L2 Radiculopathy: Lower Extremity L4-S3 (HTJJ L4-S3) Trigger/Ashi: Soleus (SP8), Tibialis Posterior (BL56, SP6 Deep) * Additional Points/ Treatment Tips: * Periosteal needling for local repair and heat application
102
What is YaoYan used for and what is its significance anatomically?
This point is located on the superior edge of the iliac crest where the lateral aspects of the iliocostalis lumborum and quadratus lumborum muscles attach. The Yaoyan region is defined as extending from L4-L5 transverse processes medially to extra point Yaoyan laterally Used to treat lower back pain
103
What is differential diagnosis for YaoYan syndrome?
Yaoyan syndrome is defined as a soft tissue strain in the yaoyan region of the low back A differential diagnosis could be nerve entrapment of the superior cluneal nerve.
104
How do the superior cluneal nerves contribute to LBP?
The SCN can become entrapped in the superficial layer of the thoracolumbar fascia (TLF) and is a recognized contributor to low back pain
105
What are the HJJ?
- Distributed each side of the spine, 48 points in total 0.5-1cun lateral to the lower boarder of the spinal processes of each cervical, thoracic and lumbar vertebrae - Found on the same paraspinal branch as the medial branch of the dorsal primary nerve
106
What does the lateral branch of the dorsal primary nerve do?
- Innervates the erector spinae musculature which are found at points of the inner and outer UB channels

Acupuncture Therapies 1 (11 decks)

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