Lower back / Thigh / Hip / SIJ Flashcards
What is the Jing Jin of the lower back?
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)
What needs to be assessed in musculoskeletal conditions?
- 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
What structures are relevant to BL21-26?
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
What structures are relevant to BL28-BL30?
BL28 – 30 sacral iliac joint needle obliquely
What structure are relevant to BL31-34
BL31-34 sacral foramen (nerve)
What structures are relevant to GB25?
GB25 Quadratus Lumborum/12th Thoracic nerve
What structures are relevant to GB26 & LV13?
GB26 – Internal Oblique
LR13 – External Oblique
What structures are relevant to BL52?
BL52 – Psoas, when needled on the side towards the spin
What bladder distal points can be used for lower back pain?
BL39/40 & 55-67 all have indication of low back pain
What lung points can be used for lower back pain?
LU 5, LU5.5 and LU6 all have (BL Channel) lower back pain indications
What heart point can be used for LBP?
HT3 area (Kidney and GB Sinew Channels)
What are some distal points for LBP?
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
What is LBP due to?
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
What is a SMART treatment for LBP?
- 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)
How to treat acute LBP?
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
What is the SMART treatment for treating Cluneal nerves?
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)
What is a SMART treatment for Sciatica?
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),
What is SIJ pain?
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.
What distal point mirrors the SIJ?
This point is located distal and medial to the styloid process of the ulna between SI6 and TE4
What are the main branches of the lumbar plexus?
Illohypogastric
Illioinguinal
Genitofemoral
Lateral femoral cutaneous
Obturator
Femoral
What is the lumbar plexus?
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
What is the cause of LBP in TCM?
- Trauma, invasion of cold or damp, kidney yin or yang xu
What is the Western medicine cause of LBP?
- Myofasical trigger point
- Vertebral joint syndrome
- Degenerative joint disease
- Intervertebral disc syndromes
- Spondycolysis
What does the lower back include?
- Lumbar spine
- Sacrum
- Lumbo-sacral joint
- Sacroiliac joints
- The coccyx and associated soft tissues
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.
Where are sympathetic neurons that innervate the lungs?
Located at T1-T4, UB13
Where are sympathetic neurons that innervate the pericardium?
Located at T1-T5 UB14
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
What structure is GB25?
Quadratus lumborum & 12th thoracic nerve
What structure is GB26?
Internal oblique
What structure is LV13?
External oblique
What structure is the Stomach channel?
Rectus abdominus
What structure is YaoYan?
attachment to iliac crest / superior clonal nerves
What structure is BL52?
Psoas when needled on the side towards the spine
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
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
What is the erector spinae muscle group?
Spinalis
Longissimus
Ilicostalis
What orthopaedic testing can be done for lumbar disc injury?
Straight leg raise test
Slump test
Myotomal motor point tenderness
Valsalva manoeuvre
What are common pain referral patterns in lumbar disc injury?
Lateral and/or posterior thigh and leg along the dermatomes
What orthopaedic testing can be done for lumbar facet joint injury?
Stork standing test
Pelvic measurements
What are common pain referral patterns in lumbar facet joint injury?
Anterior or lateral hip, buttock and possible posterior thigh
What orthopaedic testing can be done for sacroiliac joint pain?
Posterior shear test
Gillets test
Sacroiliac rocking test
Pelvic measurements