Qi Dynamics and Directionality: In TCM, qi is not merely a static concept but a dynamic force that moves through the body's channels, and reflects, at least in part, the transmission of electrical impulses through the nervous system. Understanding how qi/electric charge moves through the body involves appreciating both the superficial and deep layers of tissue, as well as the directional flow influenced by the body's structural and functional anatomy.
Modern Myofascial Theory and Neuroscience: Modern myofascial theory, as detailed in works like Thomas W. Myers' Anatomy Trains and Carla Stecco's Functional Atlas of the Human Fascial System, emphasizes the interconnectedness of fascia and its role in movement, proprioception, and force transmission. Fascia is a continuous, three-dimensional web that supports and integrates the body's structure. This network is not passive but actively participates in maintaining balance and facilitating movement.
Integrating with TCM for Treating Spasticity: Spasticity, characterized by abnormal muscle tightness due to prolonged muscle contraction, can be addressed by understanding the interactions between qi and the fascial network. By targeting specific crossing points where multiple fascia layers intersect, TCM practitioners can influence both the superficial and deep tissues, enhancing the flow of qi and alleviating muscle tightness.
- Crossing Points: These are strategic locations where multiple myofascial lines intersect, such as the thoracolumbar fascia, which connects the upper and lower body. In TCM, points along the Du Mai (Governing Vessel) and Dai Mai (Belt Vessel) are particularly relevant for addressing these intersections.
- Layered Fascia Influence: Acupuncture and other manual therapies can be used to target these crossing points, facilitating the release of fascial restrictions and improving the flow of qi through both the superficial and deep layers. This is crucial for treating conditions like spasticity, where multiple muscle groups and fascia layers are involved.
Qi Movement and Needle Techniques
To harness the therapeutic potential of acupuncture, practitioners should consider the three-dimensional and directional characteristics of fascia and muscle groups:
- Vertical Needle Insertion: Promotes energy flow in the superficial back line (Tai Yang channels), supporting extension and upright posture.
- Oblique or Horizontal Needle Insertion: Targets the spiral line (Jue Yin channels), facilitating rotational movements and internal stability.
- Practitioner Presence: This style requires the practitioner’s presence, as the qi dynamic, particularly vagal tone, can only be influenced at the time of insertion or while manipulating tissue. This is done manually through the practitioner's awareness, by examining the visible return of vagal tone through the spastic regions and by restoring proper vagal tone through spastic regions through targeted acupuncture points that opent he refelxes. Presence is parasympathetic and cannot be set with a general healing intention, as students believe. We can only restore vagal tone in the present moment through direct manipulation.
Thankfully, this style is visible to the naked eye and objectively felt by both patients and practitioners, making it easier to cultivate the level of presence required. The goal is to promote these ideas through all forms of TCM, whether community, Zang fu, TJM, or orthopedic styles including scalp acupuncture to illustrate how understanding these techniques can leverage the style they already enjoy without contributing to more spasticity in the future.
This places TCM at the forefront of neuroscience that has not yet been added into the curriculum. Physical therapists, rather than neurologists, drive much of this understanding.
Challenges with Structural Integration, Dry Needling and Sympathetic Dominance
Structural integration, while offering a robust physiological model for understanding the fascia system and its role in coordinated movement, often involves painful massage styles, as many of you who have completed a Rolfing Series already know. The massage style "shreds" the muscle to force a change in the tissue without addressing sympathetic dominance. These techniques can lead to the body laying down more brittle, aggravating spasticity mediated by the brain and spinal cord.
Heavy or painful styles of needling, (and painful styles of deep tissue work, Rolfing), unknowingly exacerbate symptoms due to pain, which is a reflex that is never integrated. Involuntary pain reflexes lead to guarding and holding in the fascia. It re-triggers involuntary defense patterns, distorting the Qi dynamic (into the yang channels), compounding sympathetic dominance. This is especially critical in trauma cases where clients exhibit heightened needle or myofascial sensitivity. Pain is a vital life-saving defense that should be avoided to prevent re-triggering trauma in clients.
Many acupuncture practitioners and clinicians unknowingly exacerbate sympathetic dominance when performing trigger point or dry needling to address muscle tightness and rigidity. Resetting a motor point only provides a temporary solution because the underlying spasticity and/or reflex demonstration originates from more primitive regions of the brain and cervical spinal cord. Directly addressing the muscle site is ineffective until proper vagal tone is restored through flexion and contraction patterns in the body. Once vagal tone is restored in the fascia, the patient MUST do regular exercise, PT dance, walking, swimming or vestibular work to allow neuroplasticity to lay down new motor pathways.
A more nuanced understanding of the fight-flight response also suggests that electrical stimulation is often contraindicated in patterns of spasticity due to compounding sympathetic dominance. All exogenous electric current in body tissue is yang by nature. Spasticity, as a symptom of yang dominance, means that e-stim adds to the sympathetic derangement in the ANS rather than restoring a parasympathetic state to harness neuroplasticity
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