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Fascial Expansion: MSR Jaw Pain Protocol

Updated: Feb 28


Fascial expansions describe a network of fascial planes connecting various anatomical structures like the jaw and knee. This connective tissue, primarily collagen-based, encompasses muscles, bones, and organs, offering structural support and enabling biomechanical communication [7]. These planes adapt to mechanical forces, changing density and fiber layouts. Such adaptability ensures efficient force distribution vital for biomechanics and energy release during movement [6][23]. Recognizing this interconnectivity aids in understanding musculoskeletal conditions, where imbalances in one area can affect another. Therapies targeting the fascial system, including manual methods and acupuncture, effectively address these issues by restoring balance [24].


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Fascial Expansions and TCM


Addressing temporomandibular joint disorders (TMJ/TMD) by leveraging fascial expansions provides a well-rounded method that brings together the latest fascial research[1], the understanding of kinetic chain connections[2], and the time-tested principles of acupuncture or traditional Chinese medicine[3]. In this article, we'll explore how fascial layers interact with acupuncture points ST6, ST7, ST8, SI8, LI4, and GB20[4][5]. To achieve the best outcomes, it's important to combine this approach with both soft tissue and osseous techniques[6], as well as incorporating a routine of functional exercises[7].


Jaw-Related Fascial Planes


Addressing restrictions in fascial planes is possible through various techniques, such as acupuncture and hands-on manipulation (soft tissue and skeletal procedures)[3][6]. The fascial planes outlined below play a significant role in jaw function, making it essential to consider these primary regions: (Image from "Functional Atlas of the Human Fascial System", I highly recommend this text by Carla Stecco. Click on Image for link)


  1. Epicranial Fascia: This fascinating fascia connects the occipitalis and frontalis muscles, seamlessly extending to the temporal fascia that wraps around the temporalis muscle[10]. As you move forward, the epicranial fascia transforms into Tenon's fascia[11].

  2. Tenon's Fascia: Acting as a protective sheath, Tenon's fascia surrounds the levator muscle of the upper eyelid[11]. Interestingly, the rear third of Tenon's fascia combines with the orbital fat, ultimately connecting to the optic nerve's protective covering[12].

  3. Pterygoid Fascia: Encompassing the medial and lateral pterygoid muscles, the pterygoid fascia attaches to the temporomandibular joint (TMJ) capsule[13]. A part of the upper head of the lateral pterygoid muscle directly inserts into the anteromedial region of the articular disc[14]. Consequently, the lateral pterygoid muscle and its associated fascia can have a direct effect on the articular disc's position during TMJ movement[13].


Image: Stecco, Carla; Stecco, Carla. Functional Atlas of the Human Fascial System (p. 109). Elsevier Health Sciences. Kindle Edition. I highly recommend this atlas, just click the link or the above image.


 

Acupressure

Acupuncture points, also known as acupoints or simply points, are specific locations on the body identified in Traditional Chinese Medicine (TCM) to possess therapeutic effects when stimulated[16]. These points are located along meridians or channels, believed to be pathways of energy flow called "Qi" (pronounced "chi") throughout the body[15]. According to TCM, stimulating acupuncture points can help restore balance, regulate the flow of Qi, alleviate pain, and promote healing in the body[16].


Recent research has shown that acupuncture points often correspond to areas with a high density of nerve endings, blood vessels, and lymphatic vessels, as well as increased electrical conductivity[17]. This suggests that the stimulation of acupuncture points may have physiological effects, such as the release of endorphins, neurotransmitters, and other pain-relieving substances[18], as well as the regulation of blood flow and the immune system[6].


When it comes to acupuncture techniques, needles are not merely inserted; they are rotated and pulled back and forth until the acupuncturist perceives a response in the tissue (sometimes referred to as a tug response)[3].


Acupressure

Acupressure follows a similar approach: stimulating a region to activate the nervous system and release tension within a fascial network of interconnected tissue[20].


 

Specific Acupuncture Points


In Traditional Chinese Medicine (TCM), acupuncture points ST6, ST7, ST8, SI8, LI4, and GB20 are commonly used to alleviate pain associated with temporomandibular joint disorders[21].


Note: We employ the same point when utilizing acupressure instead of acupuncture. The choice of technique depends on your professional scope of practice. It's crucial to remember that we're not only working on the acupuncture point but also releasing the surrounding fascia.


The location of these points is often described using the Chinese term "cun," a unit of measurement employed in acupuncture for locating points on the body[4]. One cun is approximately equal to the width of the patient's thumb at the knuckle[4]:




ST 6 (Jiache):

  • Location: At the prominence of the masseter muscle, one finger-width anterior and superior to the angle of the mandible.

  • Indications: Facial paralysis, trigeminal neuralgia, toothache, and temporomandibular joint disorders.





ST 7 (Xiaguan):

  • Location: Anterior to the ear, in the depression between the zygomatic arch and the mandibular notch.

  • Indications: Facial paralysis, temporomandibular joint disorders, toothache, and tinnitus.



SI 8 (Xiaohai):

  • Location: On the medial aspect of the elbow, in the depression between the olecranon process of the ulna and the medial epicondyle of the humerus.

  • Indications: Elbow pain, upper limb disorders, and conditions affecting the scapular and shoulder regions.




LI 4 (Hegu):

  • Location: Dorsal aspect of the hand, between the first and second metacarpal bones, approximately at the midpoint of the second metacarpal bone.

  • Indications: Headaches, toothaches, facial pain, neck pain, and various conditions related to the face and head.



GB 20 (Fengchi):

  • Location: On the posterior aspect of the neck, below the occipital bone, in the depression between the upper portion of the sternocleidomastoid and trapezius muscles.

  • Indications: Headaches, migraines, neck pain, dizziness, and conditions affecting the eyes and ears.




 

Fascial Expansion Demonstration

In this video, Dr. Abelson discusses the fascial planes that directly impact jaw function. He then 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 TMJ/TMD.


 

Conclusion


In conclusion, merging fascial research and Traditional Chinese Medicine principles within the Motion Specific Release treatment system creates a holistic approach for tackling temporomandibular joint disorders (TMJ/TMD). By grasping the interconnected nature of fascial planes and their influence on jaw function, as well as the specific acupuncture points and techniques used in TCM, practitioners can effectively ease pain and encourage healing for patients struggling with TMJ/TMD. Moreover, blending this knowledge with soft tissue and osseous techniques, accompanied by a routine of functional exercises, can enhance treatment outcomes. As our comprehension of fascia and its connection with acupuncture points keeps growing, we can look forward to further progress in the field, paving the way for more effective and tailored treatment strategies for a range of musculoskeletal conditions.


 

DR. 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.

 


Revolutionize Your Practice with Motion Specific Release (MSR)!


MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.


Attend our courses to equip yourself with innovative soft-tissue and osseous techniques that seamlessly integrate into your clinical practice and empower your patients by relieving their pain and restoring function. Our curriculum marries medical science with creative therapeutic approaches and provides a comprehensive understanding of musculoskeletal diagnosis and treatment methods.


Our system offers a blend of orthopedic and neurological assessments, myofascial interventions, osseous manipulations, acupressure techniques, kinetic chain explorations, and functional exercise plans.


With MSR, your practice will flourish, achieve remarkable clinical outcomes, and see patient referrals skyrocket. Step into the future of treatment with MSR courses and membership!

 

References


  1. Bordoni, B., & Varacallo, M. A. (2018). Myofascial pain syndrome (MPS). In StatPearls [Internet]. StatPearls Publishing.

  2. Kumka, M., & Bonar, J. (2012). Fascia: A morphological description and classification system based on a literature review. Journal of Can Chiropr Assoc, 56(3), 179-191.

  3. Chen, H., Xie, Y. Y., Zou, Y. H., Yang, B., & Luo, D. (2016). Acupoint Selection for the Treatment of Temporomandibular Disorders: A Systematic Review. Journal of Traditional Chinese Medicine, 36(3), 261-269.

  4. Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications.

  5. Cuccia, A. M., & Caradonna, C. (2010). The relationship between the stomatognathic system and body posture. Clinical and Experimental Rheumatology, 28(1), 2-8.

  6. Stecco, C., Hammer, W., Vleeming, A., De Caro, R., & Rijn, R. M. V. (2013). Functional atlas of the human fascial system. Elsevier Health Sciences.

  7. 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.

  8. Stecco, C., & Schleip, R. (2016). A fascia and the fascial system. Journal of Bodywork and Movement Therapies, 20(1), 139-140.

  9. Bordoni, B., & Zanier, E. (2015). Skin, fascias, and scars: symptoms and systemic connections. Journal of Multidisciplinary Healthcare, 8, 11-24.

  10. Willard, F. H., Vleeming, A., Schuenke, M. D., Danneels, L., & Schleip, R. (2012). The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of Anatomy, 221(6), 507-536.

  11. Lim, R., & Morrison, J. G. (1998). Tenon's capsule: a scanning electron microscope study of the fascial planes around the rectus muscles. Australian and New Zealand Journal of Ophthalmology, 26(1), 29-35.

  12. Meyer, D. R., Linberg, J. V., Wobig, J. L., & McCormick, S. A. (1991). Anatomy of the orbital septum and associated eyelid connective tissues. Ophthalmic Plastic & Reconstructive Surgery, 7(2), 104-113.

  13. Loukas, M., Tubbs, R. S., & Wartmann, C. T. (2009). Anatomical observations of the pterygoid muscles in relation to the pterygoid venous plexus. Folia Morphologica, 68(4), 227-231.

  14. Herring, S. W. (1993). Functional morphology of mammalian mastication. American Zoologist, 33(3), 289-299.

  15. Kaptchuk, T. J. (2000). The web that has no weaver: understanding Chinese medicine. Contemporary Books.

  16. 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.

  17. Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. The Anatomical Record, 269(6), 257-265.

  18. Han, J. S. (2003). Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences, 26(1), 17-22.

  19. McDonald, J. L., & Janz, S. J. (2017). The acupuncture evidence project: a comparative literature review. Australian Acupuncture and Chinese Medicine Association Ltd.

  20. Holey, L. A., & Cook, E. (2003). Evidence-based therapeutic massage: A practical guide for therapists. Elsevier Health Sciences.

  21. Fricton, J. R. (2006). Myofascial pain: Mechanisms to management. Oral and Maxillofacial Surgery Clinics, 18(3), 329-345.

  22. Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications.

  23. Huijing, P. A. (2009). Epimuscular myofascial force transmission: A historical review and implications for new research. International Society of Biomechanics Muybridge Award Lecture, 31(1), 9-21.

  24. Wilke, J., Schleip, R., Klingler, W., & Stecco, C. (2017). The lumbodorsal fascia as a potential source of low back pain: a narrative review. BioMed Research International, 2017.


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