Utilizing fascial expansions in the management of shoulder pain presents an effective strategy that merges contemporary insights in fascia, kinetic chain relationships, and core principles of acupuncture or traditional Chinese medicine. In this article, we will delve into the integration of fascial planes with acupuncture points GB34, SI10, SI11, LI15, LI16, and LI11, emphasizing their potential to significantly enhance treatment outcomes for conditions such as rotator cuff injuries, shoulder impingement, frozen shoulder, AC joint complications, and shoulder instability. These treatments must be combined with an effective program of functional exercises for optimum results.
Article Index
Fascia
Fascia is often defined as "one interconnected tensional network that adapts its fiber arrangement and density according to local tensional demands." When fascial tension is in good balance, fascia distributes force throughout the body and allows us to store and release energy for propulsion. When fascial tension is out-of-balance, hypertensive, or restricted, fascia can become the source of various dysfunctions including shoulder pain.
Fascial Planes and Shoulder Pain
Restrictions in fascial planes can be addressed using multiple techniques, such as acupuncture hands on manipulation (soft tissue and skeletal procedures). Below are 9 fascial plane that could affect shoulder function. This does not mean that we would investigate each plane. What it does mean is that we would play consideration the history of previous injuries, muscle imbalances or postural stress that could affect these regions. Here the primary region 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)
Deltoid Fascia: The deltoid fascia adheres strongly to the muscle, connecting the deltoid's three sections (anterior, lateral, and posterior) and continuing with the brachial fascia. Proximally, it connects with the trapezius muscle fascia and partially adheres to the acromion, scapular spine, and clavicle.
Pectoral Fascia: The pectoral fascia, is linked to the pectoralis major muscle, it consists of two layers originating from the clavicle. It extends laterally, merging with deltoid and axillary fasciae, and forms the anterolateral thoracic fascia over the serratus anterior.
Subscapular Fascia: The subscapular fascia, a thin aponeurotic layer, is attached to the subscapular fossa and connected to the rhomboid fascia medially and glenohumeral joint laterally.
Axillary Fascia: The axillary fascia is a strong quadrilateral tissue, it links the brachial fascia laterally, serratus anterior fascia medially, pectoralis major fascia anteriorly, and latissimus dorsi fascia posteriorly.
Supraspinatus Fascia: The supraspinatus fascia is a strong fibrous layer enclosing the supraspinatus muscle. It connects with the levator scapulae fascia in the neck, clavipectoral fascia anteriorly, and rhomboid fascia medially. It partially adheres to and joins the infraspinatus fascia over the scapular spine.
Infraspinatus Fascia: The dense infraspinatus fascia covers the infraspinatus and teres minor muscles and attaches to the infraspinatus fossa, with some muscle fibers connecting to its deep surface. The deltoid, trapezius, and latissimus dorsi muscles partially cover this fascia,
Clavipectoral Fascia: The clavipectoral fascia, a tough connective layer, it originates from the clavicle, enclosing both the subclavius and pectoralis minor muscles. Laterally, it forms the axillary fascia's suspensory ligament, producing the armpit's "pit" when the arm is raised. It also partially covers the pectoralis minor muscle.
Superficial Layer of the Deep Fascia of the Back: The superficial deep fascia layer envelops muscles such as trapezius, latissimus dorsi, and gluteus maximus, incorporating the posterior thoracolumbar fascia. It adheres to muscles, connecting to the cranium, ligamentum nuchae, and vertebrae C7-L4. In the neck, it combines with deep cervical fascia, and at the shoulder, links to the scapula and acromion.
Intermediate Layer of the Deep Fascia of the Back: The intermediate deep back fascia layer includes rhomboids and serrati posterior muscles. The rhomboid fascia divides near the scapulae, with the superficial layer connecting to infraspinatus and supraspinatus fasciae, and the deep layer to serratus anterior fascia.
Acupuncture
Acupuncture points, also known as acupoints or simply points, are specific locations on the body that have been 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.
Modern research has revealed that acupuncture points often correspond to areas where there is a high density of nerve endings, blood vessels, and lymphatic vessels, as well as increased electrical conductivity. This suggests that the stimulation of acupuncture points may have physiological effects, such as the release of endorphins, neurotransmitters, and other pain-relieving substances, as well as the regulation of blood flow and the immune system.
Acupuncture Techniques
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.
Specific Acupuncture Points
In Traditional Chinese Medicine (TCM), acupuncture points GB34, SI10, SI11, LI15, LI16, and LI11 are frequently used to alleviate shoulder 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.
GB34 (Yanglingquan):
Location: On the lateral aspect of the lower leg, below the knee, in the depression anterior to the fibular head.
Function in TCM: Known for harmonizing the flow of Qi and blood, GB34 can indirectly aid shoulder pain by promoting overall balance and relieving tension in the body, including the shoulder area.
SI10 (Naoshu):
Location: On the posterior aspect of the shoulder, in the depression inferior to the scapular spine.
Function in TCM: SI10 is a key point for alleviating shoulder pain and stiffness. It promotes the smooth flow of Qi and blood in the shoulder region, making it essential for treating shoulder-related issues.
SI11 (Tianzong):
Location: In the center of the subscapular fossa, directly above the scapular spine.
Function in TCM: Utilized to relieve various shoulder conditions, SI11 enhances circulation and relaxes the muscles in the shoulder area, making it effective in treating shoulder pain and stiffness.
LI15 (Jianyu):
Location: On the lateral aspect of the upper arm, in the depression between the deltoid muscle fibers.
Function in TCM: LI15 is effective in treating shoulder pain, frozen shoulder, and enhancing joint mobility. It promotes the flow of Qi and blood, directly targeting shoulder discomfort.
LI16 (Jugu):
Location: At the upper end of the supraspinatus fossa, between the scapular spine and the clavicle.
Function in TCM: Vital for alleviating pain and stiffness in the shoulder, LI16 promotes smooth Qi flow and enhances joint flexibility, making it a key point for shoulder pain treatment.
LI11 (Quchi):
Location: On the lateral aspect of the elbow, in the depression at the midpoint of the lateral epicondyle line.
Function in TCM: Though primarily associated with elbow conditions, LI11 can contribute to shoulder pain relief by clearing inflammation and regulating the body's energy. Its role in supporting overall joint health makes it relevant for shoulder pain treatment as well.
Fascial Expansion Demonstration
In this video, Dr. Abelson, the Motion Specific Release (MSR) developer, demonstrates using fascial expansions to treat shoulder pain. He demonstrates how practitioners can combine this knowledge with Traditional Chinese Medicine (Acupuncture/Acupressure). By understanding the interconnected nature of fascial planes and their effect on jaw function, along with the specific acupuncture points and techniques used in TCM, practitioners can effectively alleviate pain and foster healing for patients dealing with neck pain.
Conclusion
The management of shoulder pain is an intricate endeavour requiring a multifaceted and innovative strategy. Integrating fascial expansions into the treatment not only bridges the time-honored principles of acupuncture or Traditional Chinese Medicine (TCM) with contemporary insights into fascia and kinetic chain relationships but also complements soft tissue and osseous hands-on modalities.
This comprehensive approach can be seamlessly woven into existing treatment methods, amplifying their effectiveness and achieving even better results for our patients.
Key Takeaways:
Fascial Understanding: The recognition of the interconnectedness of the various fascial planes, such as deltoid fascia, pectoral fascia, and infraspinatus fascia, provides a structured pathway to diagnose and treat shoulder dysfunction. The fine balance of fascial tension plays a crucial role in overall body function, with imbalance often leading to conditions like rotator cuff injuries and frozen shoulder.
Acupuncture Integration: By leveraging specific acupuncture points like GB34, SI10, and LI15, practitioners are able to alleviate shoulder pain by promoting the smooth flow of Qi and blood. Modern research corroborates these effects, indicating physiological responses such as endorphin release and blood flow regulation.
Holistic Approach: The combination of acupuncture techniques with an understanding of fascial planes offers a synergy that addresses the underlying causes of shoulder pain. This approach extends beyond symptomatic relief, emphasizing long-term health and stability through functional exercises.
Scientific & Traditional Confluence: The integration of TCM and the detailed knowledge of fascial planes represents a confluence of tradition and scientific research. It embodies a method that is both rooted in centuries-old wisdom and bolstered by contemporary biomechanical insights.
Patient-Centered Care: The consideration of individual history, muscle imbalances, or postural stress, along with a structured examination of the nine fascial planes affecting shoulder function, ensures a personalized and precise treatment plan.
In summary, the alignment of acupuncture techniques with a profound understanding of fascial expansions creates a complex, nuanced, and adaptable strategy for managing and alleviating shoulder pain. By integrating these concepts into soft tissue and osseous hands-on modalities, this approach harmonizes with numerous existing treatments used in musculoskeletal (MSK) conditions today and magnifies their effectiveness, offering even more robust solutions for our patients.
BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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