wk11 - upper limb protocol Flashcards
What are the effects of the Upper Limb Protocol?
· Regulatory protocol for neck & upper limb
· Normalizes movement at the neck, shoulder, elbow, wrist, and fingers
· Relaxes & realigns soft tissue
· Uses traction & foulage to enable joint mobility
· Facilitates qi & blood flow to and through the upper limb
· Affects all meridians on the upper limb
What are the clinical applications / indications for the Upper Limb Protocol?
· Scapular pain · Neck pain · Upper back pain · Bursitis · Rotator cuff tear / tendonitis · Frozen shoulder · Bicepital tendonitis · Tennis / Golfer's elbow · Arthritic elbow / shoulder / wrist / hands / fingers · Carpal tunnel syndrom · Wrist / forearm pain · Trigger finger · De Quervain's tendonitis
What are the 14 steps of the Upper Limb Protocol?
1) Press / Round Rub SI 11
2) Pluck lats & pecs
3) Grasp & Pull anterior deltoid
4) Grasp & Pull posterior deltoid
5) Roll shoulder: superior, anterior, posterior
6) Grasp / Pinch / Knead biceps & triceps
7) Dig / Press brachialis
8) Pinch / Grasp / Knead forearm
9) Wipe Yin side & Yang side of forearm to wrist
10) Sinew Divide Yang side of forearm
11) Round Rub thenar & hypothenar
12) Dig LI 4
13) Traction / Foulage / Knead (3x) and Nip (1x) the fingers
14) Foulage the arm
What is the benefit of step 1: Press / Round Rub SI 11?
Energizes & moves qi through the shoulder & upper limb
What is the benefit of step 2: Pluck lats & pecs?
· Relaxes tension & spasm in lats & pecs
· Relieves stagnation
· Moves qi & blood
What is the benefit of steps 3 & 4: Grasp & Pull anterior deltoid & posterior deltoid?
· Relax tension & spasm in deltoid
· Moves qi & blood
What is the benefit of step 5: Roll shoulder (superior, anterior, posterior)?
· Moves qi & blood through the shoulder
· Relaxes spasms & breaks adhesions
· Frees movement of the shoulder joint
What is the benefit of step 6: Grasp / Pinch / Knead biceps & triceps?
Moves qi & blood through the meridians of the upper arm (LI, LU, SJ, SI)
What is the benefit of step 7: Dig / Press brachialis?
· Relax tension in the brachialis
· Facilitate normal extension at the elbow
What is the benefit of step 8: Pinch / Grasp / Knead forearm?
· Relax tension & spasm in the flexor, extensor, and other muscles of the forearm
· Moves qi & blood through the Yin & Yang channels of the forearm
What is the benefit of step 9: Wipe Yin side & Yang side of forearm to wrist?
· Moves qi & blood through the superficial layers of the forearm
· Moves Wei Qi
· Relaxes tightness & spasm
What is the benefit of step 10: Sinew Divide Yang side of forearm?
· Strongly courses qi through the Yang channels of the forearm
· Releases tension in the interosseous membrane & extensor muscles
What is the benefit of step 11: Round Rub thenar & hypothenar?
Relaxes tightness & spasm in the hand
What is the benefit of step 12: Dig LI 4?
· Courses qi in the hand & the limb
· Relieves pain
What is the benefit of step 13: Traction / Foulage / Knead (3x) and Nip (1x) the fingers?
· Relieve tension & free the joints of the fingers
· Flash energy through the channels of the upper limb
What is the benefit of step 14: Foulage the arm?
· Frees up the joints of the upper limb
· Unblocks stagnation & moves qi through the upper limb
How do you perform step 1: Press / Round Rub SI 11?
· Stand at patient’s side
· Supporting hand on front of shoulder
· Press thumb perpendicularly into SI 11
What is the location for SI 11 (aka “Limb Gate point”)?
in a depression on the scapula 1/3 down on a line drawn from the midpoint of the scapular spine & the inferior angle
How do you perform step 2: Pluck lats & pecs?
· Lift patient’s arm in neutral position ~45 degrees off center (patient’s arm should be relaxed)
· Pluck lats with your thumb on posterior axilla
· Pluck pecs with your thumb on anterior axilla
How do you perform steps 3 & 4: Grasp & Pull anterior deltoid & posterior deltoid?
· Stand slightly behind patient to grasp & pull anterior deltoid
· Stand slightly in front of them to grasp & pull posterior deltoid
· No need to move hands; keep pulling at same spot using both hands
How do you perform step 5: Roll shoulder (superior, anterior, posterior)?
· Lift patient’s arm in neutral position ~45 degrees off center
· Apply light traction while rolling over pecs, deltoid, and shoulder joint
· Rotate pt’s arm externally to expose pec minor
· Rotate pt’s arm internally to expose teres muscles
How do you perform step 6: Grasp / Pinch / Knead biceps & triceps?
· Lift patient’s arm to a neutral position
· Grasp / Pinch / Knead with your thumb on Yang side of arm
· On the biceps, pinching is safer bc of HT channel (don’t dig finger tips under medial border of biceps)
How do you perform step 7: Dig / Press brachialis?
· Find the depression just lateral to the biceps brachii tendon
· Dig / Press with towards humerus
How do you perform step 8: Pinch / Grasp / Knead forearm?
· Hold onto patient’s wrist/hand, start near elbow and move down to wrist
· Pinch / Grasp / Kneed flexors, extensors, and brachioradialis muscles
How do you perform step 9: Wipe Yin side & Yang side of forearm to wrist?
· You can be seated for step 9 onward
· With thenar and thumbs together, wipe outward
How do you perform step 10: Sinew Divide Yang side of forearm?
· Start near elbow and move down to wrist
· Feel for depression between muscles
· With thumbs back to back, press deeply and rotate outward slightly (thumbs stay back to back throughout, and hold Yin side of forearm with other eight fingers)
How do you perform step 11: Round Rub thenar & hypothenar?
Round Rub thenar & hypothenar using your thumb
How do you perform step 12: Dig LI 4?
Two techniques:
1) Place your thumb on Yang side of webbing and your index finger on Yin side of webbing, then press the two fingers towards each other
2) With the patient’s thumb & index finger close together, hold their entire hand from the Yang side and press down with your thumb
What is the location for LI 4?
in the web between the index finger & thumb, closer to the 2nd metacarpal bone (technically at the midpoint of the 2nd metacarpal)
How do you perform step 13: Traction / Foulage / Knead (3x) and Nip (1x) the fingers?
· Place your stabilizing hand over the metacarpals
· Hold each finger between your thumb & index finger, and traction / foulage / knead on the same pass
· Nip nips of fingers using the middle phalanges of your 2nd & 3rd fingers
How do you perform step 14: Foulage the arm?
· Have the patient’s arm hanging slack (they may need to side bend)
· Make sure patient’s arm won’t knock against side of chair
