Utilizing the capabilities of fascial expansions to treat elbow pain represents a holistic approach that combines a modern understanding of fascia's role, kinetic chain relationships, and essential principles from acupuncture or traditional Chinese medicine. This exploration will focus on how fascial layers interconnect with specific acupuncture points, namely LI11, LI12, TH5, TH10, and GB 34. This method should be paired with soft tissue manipulation and osseous (bony) procedures, all supplemented by a series of functional exercises for enhanced effectiveness.
Article Index:
Fascia - A Dynamic Interconnected System
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Fascia is often defined as "one interconnected tensional network that adapts its fibre arrangement and density according to local tensional demands." When fascial tension is in good balance, the fascia distributes force throughout the body, allowing us to store and release energy for propulsion. When fascial tension is out-of-balance, hypertensive, or restricted, fascia can become the source of multiple dysfunctions.
Fascial Planes Affecting the Elbow
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Restrictions in fascial planes can be addressed using multiple techniques, such as acupuncture hands-on manipulation (soft tissue and skeletal procedures). Below are fascial planes that could greatly affect elbow function, specifically leading to nerve compression. Here are the primary regions that need to be considered: (Image from "Functional Atlas of the Human Fascial System", I highly recommend this textbook by Carla Stecco.
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Deep Fascia of the Arm: The brachial fascia, also known as the deep fascia of the arm, is a thick layer of white connective tissue that covers muscles. It is a component of a sheath that also contains the antebrachial fascia and resembles an evening glove. The brachial fascia divides the arm muscles into compartments by forming medial and lateral intermuscular septa and connecting to numerous muscle fasciae. Some muscle fibres are attached to these septa. Forces from the flexor carpi radialis muscle and biceps tendon cause tension lines in the fascia. Most triceps brachii fibres extend into the antebrachial fascia, making up the posterior elbow retinaculum.
Antebrachial Fascia:Â The antebrachial fascia, a thick, whitish connective tissue, covers forearm muscles and attaches to radial and ulnar styloids. The palmaris longus tendon pierces it and continues with hand fasciae. Flexor carpi radialis, and ulnaris muscles lie beneath it, while the wrist flexor and extensor retinacula reinforce it. The retinaculum connects to thenar and hypothenar muscle fibers.
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Acupuncture/Acupressure
In Traditional Chinese Medicine (TCM), acupuncture points, or acupoints, are specific locations on the body known for their therapeutic potential. These points are strategically situated along meridians or channels that guide the flow of energy, or "Qi" (pronounced "chi"), throughout the body. Acupressure, a related practice, involves manually stimulating these points to achieve similar therapeutic effects.
Stimulating acupuncture points in TCM is believed to restore equilibrium, regulate Qi circulation, alleviate pain, and promote healing. This ancient approach aims to maintain harmony and balance within the body's energy system.
Contemporary scientific research supports the physiological basis of these practices. Acupuncture points often coincide with regions dense in nerve endings, blood vessels, and lymphatic vessels, as well as areas with enhanced electrical conductivity. Stimulating these points may trigger physiological responses such as the release of endorphins, neurotransmitters, and other pain-relieving substances and may also influence blood flow regulation and immune responses.
Acupuncture/Pressure Techniques
In acupuncture, needles are not merely inserted into the skin; they are rotated and manipulated until the acupuncturist perceives a response in the tissue, often referred to as a "tug response." Similarly, acupressure involves more than just moving the tissue around the acupuncture point. It requires considering the exact location, surrounding anatomical structures, and direct fascial connections. The practitioner must palpate for any restrictions in the surrounding area that may be connected to the local acupuncture point being treated.
The acupuncture point is treated with various motions, including clockwise and counterclockwise rotations and fascial kneading of the soft tissue. This often involves rolling the tissue and moving it in multiple directions. While focusing on specific points, it is also essential to consider the fascial kinetic web and the larger kinetic chain that affects the entire body. This technique aims to activate the nervous system, modulate immune function, and release tension within the interconnected fascial network, ultimately alleviating discomfort through precise, targeted stimulation. Understanding the principles of tensegrity further highlights the interconnectedness and dynamic balance of the fascial system.
Specific Acupuncture Points
In Traditional Chinese Medicine (TCM), certain acupuncture points, including LI11, LI12, TH5, TH10, and GB34, are commonly used to alleviate elbow pain. These points are identified using the Chinese measurement unit "cun," which helps pinpoint precise locations on the body. One cun is roughly the width of the patient's thumb at the knuckle, 1.5 cun matches the combined width of the index and middle fingers, and 3 cun is equivalent to the width of the patient's four fingers placed together.
LI 11 (Quchi):
Anatomical location: The LI 11 acupuncture point (Quchi) is located at the outer end of the elbow crease, midway between the lateral epicondyle of the humerus and the end of the elbow crease when the elbow is flexed at 90 degrees.
MSK Function: Commonly used to relieve musculoskeletal pain, especially in the elbow, arm, and shoulder, and is effective in reducing inflammation and improving joint mobility. It is also used for treating conditions like tennis elbow and arthritis.
TCM Function: The TCM function of LI 11 for "clearing heat" can be understood in Western medical terms as reducing inflammation and modulating the immune response, making it effective for treating fevers and inflammatory conditions. "Cooling the blood" and "alleviating dampness" correspond to managing skin conditions like eczema and reducing swelling or fluid retention by improving circulation and reducing inflammation.
Contraindications: In Western terms, the contraindications for LI 11 involve caution in patients with chronic fatigue, low energy, or cold intolerance, as stimulating this point could worsen these symptoms. Overuse may lead to further energy depletion and exacerbate feelings of cold or weakness.
LI 12 (Zhouliao):
Anatomical location: The LI 12 acupuncture point (Zhouliao) is located on the lateral side of the upper arm, about one finger-width (1 cun) above LI 11, in the depression just anterior to the lateral epicondyle of the humerus. It is situated along the brachioradialis muscle.
MSK Function: LI 12 is used to relieve pain, stiffness, and tension in the elbow, arm, and shoulder, particularly in cases of tennis elbow or other lateral epicondyle issues.
TCM Function: In TCM, LI 12 is believed to activate the meridian, alleviate pain, and resolve stagnation, helping to promote the flow of qi and blood in the affected area. In Western medical terms, LI 12 is thought to enhance blood circulation and nerve function in the region, which can help reduce pain and inflammation.
Contraindication: This should be used cautiously in individuals who are very fatigued, weak, or have low energy levels, as stimulating this point might further drain their energy, potentially worsening symptoms like fatigue or weakness.
TH 5 (Triple Heater 5 - Waiguan)
Anatomical location: TH 5 is found on the dorsal (back) side of the forearm, approximately two cun above the wrist crease between the radius and ulna.
MSK Usage: TH 5 is used to alleviate pain and stiffness in the wrist, hand, and forearm. It's also applied in treating conditions such as tennis elbow, carpal tunnel syndrome, and general arm pain or weakness.
TCM Usage: Used to clear heat, release the exterior, and treat conditions like headaches, fevers, and ear disorders. In Western medical terms it is used to help reduce inflammation, boost immune response, and alleviate symptoms like headaches, fever, and ear disorders, potentially by improving circulation and reducing tension.
Contraindications: Avoiding needling patients with severe blood disorders, local skin infections, or those who are pregnant, as stimulating this point could potentially affect uterine contractions.ximal to the transverse wrist crease, between the radius and ulna
TH 10 (Tianjing):
Anatomical location: The TH10 acupuncture point (Tianjing) is located on the posterior aspect of the upper arm, in the depression about 1 cun (approximately one thumb's width) above the olecranon, when the elbow is flexed. It is situated near the triceps brachii muscle, between the tendons of the long and lateral heads.
MSK Function: TH10 relieves pain and tension in the elbow, upper arm, and shoulder, particularly in conditions like tennis elbow and triceps tendonitis.
TCM Function: This point is thought to reduce inflammation and alleviate symptoms of swelling or stiffness by improving lymphatic drainage and circulation in the arm.
Contraindications: Caution is advised when using TH10 in patients with significant weakness or chronic fatigue, as stimulation of this point might further decrease their energy levels.
GB 34 (Yanglingquan):
Location: GB34 (Yanglingquan) is positioned on the outer aspect of the leg, just below the knee, in a depression anterior and inferior to the head of the fibula. This makes it easily palpable in most individuals, particularly in a sitting or flexed knee position.
Function: In Traditional Chinese Medicine (TCM), GB34 is known as the "Hui Meeting Point of the Sinews", making it essential for treating musculoskeletal issues, particularly those affecting tendons and ligaments. It is commonly used to relieve muscle tension, stiffness, and pain, not just in the legs, knees, and hips, but also in other areas like the elbows. Although GB34 is frequently applied to hip pain, its influence extends to conditions like tendonitis, bursitis, sciatica, and joint discomfort in various regions of the body, including the elbow. By stimulating GB34, practitioners aim to improve Qi circulation (energy flow) and blood circulation, helping to reduce inflammation and enhance the function of affected joints and muscles.
In Western terms, GB34 is recognized for its ability to reduce muscle tension, improve mobility, and relieve pain. While it is particularly effective for the hip, knee, and lower leg, its action on tendons and ligaments also makes it valuable for elbow pain, such as in cases of tennis elbow or golfer's elbow. By improving circulation and reducing inflammation, GB34 can aid in the recovery of elbow tendonitis and other conditions affecting the elbow joint.
Contraindications: GB34 should be avoided in cases where there are local skin infections, open wounds, or significant inflammation near the knee. Caution is advised when there are fractures, trauma, or recent surgery in the surrounding area, as direct stimulation could aggravate the condition.
Fascial Expansion Demonstration
Using fascial expansions to treat elbow pain represents a holistic approach that combines a modern understanding of fascia's role, kinetic chain relationships, and essential principles from acupuncture or traditional Chinese medicine. This exploration will focus on how fascial layers interconnect with specific acupuncture points, namely LI11, LI12, TH5, TH10, and GB 34. In this video, Dr. Abelson, the Motion Specific Release (MSR) developer, demonstrates using fascial expansions to treat elbow pain.
Conclusion
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Harnessing the power of fascial expansions to treat elbow pain is a holistic approach that combines a modern understanding of fascia, kinetic chain relationships, and key principles from traditional Chinese medicine. Focusing on the interconnection between fascial layers and specific acupuncture points, this method offers a comprehensive treatment that pairs soft tissue manipulation with osseous procedures and functional exercises.
This approach addresses the immediate pain and promotes long-term health and functionality. Experience the benefits of this innovative and effective method for yourself, achieving optimal musculoskeletal health and enhanced overall well-being.
References
Bordoni, B., & Zanier, E. (2014). Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 7, 299-310. doi: 10.2147/JMDH.S66724
Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. The Anatomical Record, 269(6), 257-265. doi: 10.1002/ar.10185
Schleip, R., & Müller, D. G. (2013). Training principles for fascial connective tissues: Scientific foundation and suggested practical applications. Journal of Bodywork and Movement Therapies, 17(1), 103-115. doi: 10.1016/j.jbmt.2012.06.007
Stecco, C., & Hammer, W. I. (2018). Functional Atlas of the Human Fascial System. Elsevier Health Sciences.
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., ... & Linde, K. (2018). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. The Journal of Pain, 19(5), 455-474. doi: 10.1016/j.jpain.2017.11.005
Yang, M., Yang, J., Zuo, Z., Liao, X., Wen, Y., Fan, L., ... & Xia, J. (2016). The role of traditional Chinese medicine in the regulation of oxidative stress in treating coronary heart disease. Oxidative Medicine and Cellular Longevity, 2016. doi: 10.1155/2016/5691949
Yu, X., & Ding, G. (2012). Acupuncture mechanisms: Anesthesia, analgesia and protection on organ functions. World Journal of Traditional Chinese Medicine, 1(1), 59-66. doi: 10.15806/j.issn.2311-8571.2012.0013
Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications.
Maciocia, G. (2015). The Foundations of Chinese Medicine: A Comprehensive Text. Elsevier Health Sciences.
Kaptchuk, T. J. (2000). The Web That Has No Weaver: Understanding Chinese Medicine. McGraw-Hill Education.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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