Harnessing the power of fascial expansions to alleviate wrist and hand pain offers an effective and innovative approach. This method provides a multifaceted treatment strategy by integrating modern insights into fascia's role within the kinetic chain and drawing on essential principles from acupuncture and traditional Chinese medicine.
This journey will explore the intricate connections between fascial layers and specific acupuncture points such as PC7, LU9, TH4, TH5, LI4, LI5, and SI4. This holistic approach promises enhanced effectiveness when combined with soft tissue manipulation, precise osseous procedures, and a structured series of functional exercises.
Article Index:
Fascia
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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.
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Fascial Planes Affecting the Wrist and Hand
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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 wrist and hand function. Here are the primary regions that need to be considered: (Image from "Functional Atlas of the Human Fascial System", I highly recommend this text by Carla Stecco. Click on Image for link)
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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 the thenar and hypothenar muscle fibres.
Deep Fasciae of the Palm:Â When the palmar aponeurosis contracts, the five-part palmar fascial complex of the hand is activated. The deep palmar fascia, supported by the deep transverse metacarpal ligament, is between the lumbricalis and interossei muscles and is the source of the palmaris brevis muscle. The first dorsal interosseous muscle's fascia is connected to the adductor fascia by the third metacarpal bone.
Dorsal Fascia of the Hand: Two deep fasciae run along the dorsum of the hand. All extensor tendons are covered by the superficial lamina, which continues distally with the dorsal fascia of the fingers and proximally with the extensor carpi retinaculum. Each metacarpal bone's periosteum and the deep lamina, located above the interossei dorsalis muscles, are fused together. Despite being tiny, these two fasciae have aponeurotic characteristics. Adhesions between the superficial lamina and the intertendinous connections guarantee a strong functional association between the superficial lamina and the extensor tendons.
Deep Fascia of the Fingers: There's no superficial fascia in fingers; skin is anchored to deep fascia by fibrous elements for flexible hand movement without shifting skin. The retinacula around finger joints reinforce the deep fascia, integrating with extrinsic and intrinsic musculotendinous structures in a three-dimensional fibrous skeleton and assisting hand mechanics.
Acupuncture
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Acupuncture points, also known as acupoints or simply points, are specific locations on the body identified in Traditional Chinese Medicine (TCM) as having therapeutic effects when stimulated. These points are found along meridians or channels, which are believed to be pathways of energy flow called "Qi" (pronounced "chi") throughout the body. According to TCM, stimulating acupuncture points can help restore balance, regulate the flow of Qi, alleviate pain, and promote healing in the body.
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Modern research has revealed that acupuncture points often correspond to areas with a high density of nerve endings, blood vessels, and lymphatic vessels and increased electrical conductivity. This suggests that stimulating acupuncture points may have physiological effects, such as the release of endorphins, neurotransmitters, and other pain-relieving substances and the regulation of blood flow and the immune system.
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Acupuncture Techniques
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When acupuncturists treat a patient, acupuncture needles are not just inserted; they are rotated and pulled back and forth until the acupuncturist feels a response in the tissue (sometimes called a tug response). When performing acupressure, we do the same thing: stimulate a region to activate the nervous system and release tension in a fascial network of interconnected tissue.
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Specific Acupuncture Points
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In Traditional Chinese Medicine (TCM), acupuncture points PC7, Lu9, TH5, TH4, TH5, LI5 and SI4 are frequently used to alleviate wrist and hand pain. These points are typically identified using the Chinese measurement unit "cun," employed in acupuncture to pinpoint locations on the body. One cun is approximately 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 when placed together.
PC7 (Pericardium 7)
Anatomical location: center of the wrist (middle of the transverse crease, palmer crease), between the tendons of palmaris longus and flexor carpi radialis.
MSK Usage: PC7 effectively treats pain and dysfunction in the wrist and hand, particularly in cases like carpal tunnel syndrome, tendonitis, or arthritis.
TCM Usage: Promoting relaxation and reducing stress-related symptoms, potentially influencing the autonomic nervous system. T%reating conditions associated with systemic inflammation or infections.
Contraindications: While not strictly contraindicated, care should be taken when using PC7 during pregnancy, especially in the first trimester, due to its strong effects on calming the mind and moving Qi. Moving Qi" in Western medical terms refers to enhancing circulation, improving energy flow, and facilitating the body's natural healing processes.
Lu9 (Lung 9)
Anatomical location: At the radial end of the transverse crease of the wrist, in the depression on the lateral side of the radial artery.
TCM Usage: It is used to tonify the Lung Qi and Yin, harmonize the blood circulation, and promote overall respiratory health. In Western medical terms, this means enhancing respiratory function and maintaining moisture in the lung tissues, improving and regulating cardiovascular health and blood flow.
MSK Usage: Wrist pain, carpal tunnel syndrome, tendinitis, or general stiffness in the hand, wrist, and forearm.
Contraindications: Because the radial artery is close to the site, careful needling technique is essential. The needle should be inserted at a shallow angle to avoid hitting the artery.
TH5 (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.
TH4 (Triple Heater 4)
Anatomical location: Located on the dorsal aspect of the wrist, in the depression between the tendons of the extensor digitorum communis and extensor digiti minimi muscles.
Measurement: 1 cun proximal to the dorsal wrist crease
MSK Usage: TH 4 is commonly applied to relieve wrist pain, stiffness, and carpal tunnel syndrome, and to improve joint mobility in the wrist and hand.
TCM Usage: TH 4 (Yangchi) is used to tonify the Qi, regulate the Triple Heater (San Jiao), and address issues like fatigue, dry mouth, and disorders of the wrist and hands. In Western medical terms, this means TH 4 (Yangchi) is believed to help boost overall energy levels, improve fluid balance, and treat conditions like fatigue and dry mouth.
Contraindications: Avoid areas with skin infections, wounds, or severe inflammation. Caution is advised for patients with blood clotting disorders, on anticoagulants, or during pregnancy.
LI5 (Large Intestine 5)
Anatomical location: Radial side of the wrist, between Extensor Pollicis Longus and Brevis tendons.
Measurement: 1 cun proximal to the radial wrist crease
Usage: The LI 5 acupuncture point is primarily used in musculoskeletal treatment to relieve pain, swelling, and stiffness in the wrist and hand, particularly for conditions like tendinitis, carpal tunnel syndrome, and arthritis.
Contraindications: Avoid needling in local skin infections, open wounds, or fractures near the wrist to prevent the worsening of these conditions.
SI4 (Small Intestine 4)
Anatomical location: Ulnar side of the hand, in the depression between the base of the 5th metacarpal bone and the triquetral bone.
Usage: The SI 4 acupuncture point is used in musculoskeletal treatment primarily to relieve pain, stiffness, and inflammation in the wrist, hand, neck, shoulder, and arm and to reduce swelling in conditions associated with heat in the Small Intestine meridian. Heat in the Small Intestine meridian" refers to inflammation or hyperactivity in the tissues and systems associated with the meridian, manifesting as symptoms like pain, swelling, and redness in corresponding anatomical regions.
Contraindications: There are no major contraindications for using the SI 4 acupuncture point, but care should be taken when needling in patients with local skin infections, open wounds, or severe sensitivity in the area to avoid aggravating these conditions.
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Fascial Expansion Demonstration
Fascial Expansion: MSR Wrist & Hand Protocol
Utilizing the capabilities of fascial expansions to treat wrist and hand 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 PC7, LU9, TH4, TH5, LI4, LI5, and SI4.
Conclusion
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In conclusion, integrating fascial expansions with acupuncture and traditional Chinese medicine principles offers a promising holistic approach to treating wrist and hand pain. This method leverages modern understandings of the kinetic chain and fascial networks and taps into the therapeutic potential of specific acupuncture points. By addressing fascial restrictions and enhancing tissue mobility through soft tissue manipulation, precise osseous procedures, and functional exercises, this comprehensive strategy aims to restore balance and improve overall functionality in the wrist and hand.
The synergy between fascial manipulation and acupuncture/acupressure provides a multifaceted treatment that can significantly benefit patients suffering from musculoskeletal pain. This approach underscores the importance of viewing the body as an interconnected system, where addressing one part can lead to improvements in another.
References
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Abelson, B. J., & Abelson, K. T. (2010, June 1). Release Your Kinetic Chain with Exercises for the Jaw to Shoulder.
Abelson, B. J., & Abelson, K. T. (2010, June 1). Release Your Kinetic Chain with Exercises for the Shoulder to Hand.
Abelson, B., Abelson, K., & Mylonas, E. (2018, February). A Practitioners Guide to Motion Specific Release, Functional, Successful, Easy to Implement Techniques for Musculoskeletal Injuries (1st edition). Rowan Tree Books.
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
Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications.
Kaptchuk, T. J. (2000). The Web That Has No Weaver: Understanding Chinese Medicine. McGraw-Hill Education.
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
Maciocia, G. (2015). The Foundations of Chinese Medicine: A Comprehensive Text. Elsevier Health Sciences.
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
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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 with a success rate of over 90%, 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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