Class Notes 7

Quick quiz to demonstrate techniques.

Demonstration and practice of common manipulation techniques.

Passive movement of neck.

Passive movement of arms.

Passive movements of back, waist, spine.
All of these movements are indicated for low back, waist, spine problems.

It is best to perform back flexion movements when there is excessive LORDOSIS and tightness of the lower back, and weak abdominal muscles.  Back flexion should NOT be used in severe back pain, pain/tingling down leg, or bulging of discs.  #4 (Straight Leg Raise) is often used for diagnostic purposes of low back pain.

Back extension movements may be used for acute back pain, pain/tinglig down leg, or bulging discs, with caution.  Oftentimes these techniques are combined with focused deep-pressing on a problematic area or a significant point.

Twisting movements may also be used for acute back pain.  If the practitioner is able to palpate specific rotated sections of the spine, then pressure is applied to the side that "juts out", as the passive movement is applied.

Back flexion passive movements:
1) Jerk and drag to relax the waist.  (Patient supine)
a) Flex and press patient's knee toward chest (diseased side first).
b) Immediately drag down and pull.
c) Repeat on other side.
d) Can be done on both legs.

2) Deep-press bent legs to tug at the waist.  (Patient supine, healthy leg straight, diseased leg bent)
a) Hold diseased knee with one hand, grasp far side of table with other hand.
b) Gradually press knee into chest as far as it will go (using weight).
c) Repeat for healthy side.

3) Forward bend into sitting position.  (Patient starts off supine).
a) Stand at patient's feet.  Reach for patient's wrists, and grab with both hands (patient may also grab your wrists at the same time).
b) Pull toward you until patient is sitting upright.  Continue pulling until patient's upper body is facing down.  If you have an assistant, s/he may push on patient's back at the same time.

4) Straight leg raise.  (Patient is supine).
This is the traditional SLR technique.  It should be not be done past the point of discomfort.  It is often alternated with the pull-shake-rotate techniques.

Back Extension Passive Movements:
1) (Patient is prone).  Lower back extension, using the leg as the lever.
a) Deep-press problem area of back, waist or spine with one hand or knee.
b) Hold ankle of one leg with other hand and lift up or pull toward back to tug at the waist.  This can also be done with patient bending knees to touch the buttocks, and with practitioner lifting patient's leg at the knee.

2) (Patient is sitting).  Upper back extension, using the shoulders as the lever.
a) Deep-press problem area of back with one raised knee.
b) Hold both shoulders (hands over deltoids) and pull back moderately to expand chest and stretch back.

Back Twisting Passive Movements:
*Note: Twisting movements of the back can actually look very similar to Back Extension Passive Movements.  The difference is in the direction of the pull.  If the pull is straight back, then the technique is more oriented towards back flexion.  However, if the pull is oblique, or "on the angle," then the technique tends to be more oriented towards twisting.

1) (Patient is prone).  Upper back twist, using the shoulder as the lever.
a) Deep-press problem area of back with one hand.
b) Pull opposite shoulder with other hand (over deltoid) to twist spine and stretch shoulder as far back as possible.  Note that you are reaching across the table to the opposite shoulder to pull it.

*Variation: to work on rhomboids: (Patient is prone, with arm behind back in arm-bar position).  Either use a knife hand to slip in under the medial scapula, or use thumbs/fingers to press on rhomboids in region of medial scapula with one hand.  The other hand pulls opposite shoulder, as above.

2) (Patient is prone).  Lower back twist, using the leg as the lever.
a) Deep-press problem area of back/waist/hips with hand/elbow/etc.
b) Hold the front of the thigh of the opposite leg, and pull UP AND TOWARDS YOU.  Note that if you pull towards you, on the angle, this becomes more of a twist, and less of a simple back extension.

3) (Patient is side-lying).  Lower back twist, using the hip as the lever.
a) With the patient in side-lying position, and you standing at the patient's back, straighten the "lower" leg (the leg directly on the table), and bend the "upper" leg to an appropriate angle.  Note that the angle is important.  If you bend the "upper" leg so that the angle is more perpendicular to the body, then the twisting stretch is more extreme, involves the hips more, and tends to be more localized to the lower back.  If you bend the "upper" leg so that the angle is obtuse to the body, then the twisting stretch tends to be less extreme, involves the hips less, and tends to involve the entire back (and side of the body).
b) "Push" or press the hip forwards (away from you) while you "pull" the shoulder/arm back (towards you, or down towards the table surface).

*Note: a variation of this involves replacing the push forwards on the hip with a deep-press with hands/elbow on problem areas.

4) (Patient is side-lying).  Upper back twist, using the shoulder as the lever.
This is the opposite of #3, and is better for the upper back.

a) With the patient in side-lying position, and you standing at the patient's back, straighten the "upper" arm so that it is reaching for the upper corner of the table.  Straighten the "upper" leg so that it is hanging back behind the patient's body.
b) "Push" or press the shoulder forwards (away from you) while you "pull" the "upper" leg back.  Pull the upper leg back at the thigh or at the knee.

*Note: as for #3, you may replace the push forwards on the shoulder with a deep-press with hand on problem areas.

Passive Movements of Legs and Feet
We've already gone over many of the techniques for the legs and feet when we went over rectifying, pulling, rotation and shaking.

Keep in mind that rectifying, pulling, etc. can be applied to ALL joints of the legs and feet, not just the hips.  So the knees, ankles, and even each individual toe can be rectified, pulled, etc.

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HEAD AND FACE ROUTINE
Before we go into the actual description of the head and face routine, we need to familiarize ourselves with a few acupuncture points.  You will not need to use ALL of these points for every treatment, as each has somewhat specific indications.  ALTERNATIVELY, you may perform the routine by just following channel lines, without paying attention to specific points.  I will go over the channel method later.

Here are some important acupuncture points:

- DU 20 (sometimes written as GV or Governor Vessel 20): This point, for our purposes, lies at the vertex.  More specifically, it lies a bit behind the actual top of your head.  A shortcut for finding it is to draw a line up from the most posterior (back) part of the ear, up to the top of the head.

DU 20 or Baihui (100 Meetings) is where the energy of all meridians (directly or indirectly) meet.  This point is used to draw energy up, or sedate excess energy.  It can be used to calm the spirit, and treat headaches due to wind or heat.

- GB 20 Fengchi (Wind Pool): This point is located just below the occiput, between the origins of the trapezius and the sternocleidomastoid.  If you squeeze the back of your neck, you are, for the most part, feeling the borders of the trapezius muscle on your neck.  If you follow the trapezius up to the occiput, to the deep hole below it, you are on GB 20.

This point, as its name implies, is used to treat Wind (which involves all sorts of problems, from dizziness to headaches).  It is also an important point to treat eye disorders.

- Yintang (Hall of Impressions): This point is basically located at the third eye.  It is at the midpoint between the medial extremities of the eyebrows.  It is used to calm the shen, and to treat headaches, and nasal disorders.

- Du 26 (or GV 26: Man's Middle): This point is on the FRENULUM, that little valley between the nose and the upper lip.  It is about 2/3 of the way up (or 1/3 of the way down).  This point is a "balanced" resuscitation point, but in a larger sense, it unites the Yin and Yang energies of the body.

- Du 27 (or GV 27): This point is on the upper lip.  Used primarily for local lip issues.

- Ren 24 (CV 24 Chengjiang, Container of Fluids): This point is in the mentolabial groove, that dent between your chin and the lower lip.  Used for mouth disorders, including problems with salivation.

- UB 1 Jingming (Bright Eyes): This point is located just (0.1 cun) medial and superior to the inner canthus of your eyes (the inner corner of your eyes).  It is used, as the name implies, for eye disorders.

- LI 20 Yingxiang (Welcome Fragrance): This point is located at the top of the nasolabial grooves (the crevice that joins your nostrils to the edge of your lips).  It is technically about halfway up the ala nasi.  This point, as the name implies, is used for nasal disorders.

- St 4 Dicang (Earth Granary): located a little off the corner of the lips, at the bottom of the nasolabial groove.    Used, in conjunction with the next two points, for mouth disorders (deviations of the lips, Bell's palsy, etc.).

- St 7 Xiaguan (Below the Joint): feel the cheek bones (maxilla).  Now feel the hollow under the cheekbones.  Follow the underside of the cheekbones back towards the ear, until you stop because you hit bone (the condyloid process of the mandible).  This is St 7.

- St 6 Jiache (Jawbone): Have the patient clench their teeth.  The jaw muscles (near the angle of the mandible) should bulge up.  This point, St 6, is on the belly of those muscles (the masseters), about a finger's-breadth anterior to the angle of the mandible.

- Taiyang (Greater Yang): This point is located on the temple area.  Find the lateral extremity of the eyebrow (SJ 23) and the outer canthus of the eye.  Now take the midpoint of those two points, and slide your finger very slightly back into a depression.  This is Taiyang.  It is used for migraine headaches.

- SI 19 (Tinggong, Palace of Hearing): This point is level with the prominence of the tragus, which is the flap of cartilage that "lids" the ear.  It is used for hearing disorders.

- SJ 17 (Yifeng, Wind Screen): This point is located in a deep depression behind the ear lobe.  It too is used for ear disorders.

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HEAD AND FACE ROUTINE
(Patient is sitting)
1) Stroke and caress the head to benefit the brain.

a) Stroke head front to back from hairline to hairline; start slow to fast, rubbing the scalp repeatedly.  Rub left side first, then right side, and then middle.

b) Interlace fingers and rub both GB 20 with thenar eminences joined together.

c) Clutch and grasp large handfuls of hair (don't PULL!!! BE GENTLE!).

d) Pound Du 20 with open fists lightly.

2) Open Passes and dredge Apertures

a) Divide the forehead by rubbing outwards with both thumbs from Yintang to lateral hairlines.

b) Pinch the browline between index finger and thumb of both hands, from Yintang out to the end of the eyebrows several times.

c) Nip and knead (30 small circles) the following points: Yintang, Du 26, Du 27, Ren 24 (Generally, for activating and balancing Yin and Yang); UB 1 (for eyes); LI 20 (for nose); St 4, 7, 6 (for jaw problems; you can use your thumb, index finger, and middle finger to hit all three points at once); Taiyang (for migraine headaches); SI 19 and SJ 17 (for ear problems).

d) Lift and pull both ears from behind several times.

ALTERNATIVELY, you may treat the head and face in supine position, using the chart provided.

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Homework: Please practice the routine for the Head and Face, so that you can demonstrate it next week.