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/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), 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: GB34 (Yanglingquan) is located on the outer aspect of the leg, just below the knee, in a depression anterior and inferior to the head of the fibula. It is easily palpable in most individuals, particularly when sitting or with the knee flexed.
Function: In Traditional Chinese Medicine (TCM), GB34 is known as the "Hui Meeting Point of the Sinews", making it a key point for treating musculoskeletal issues, especially those involving tendons and ligaments. It is commonly used to alleviate muscle tension, stiffness, and pain, particularly in the legs, knees, and hips. However, GB34’s influence extends beyond the lower body, and it is also beneficial for addressing shoulder pain and mobility issues. Since the shoulder relies heavily on the smooth function of tendons and ligaments, stimulating GB34 helps relieve conditions such as frozen shoulder or rotator cuff injuries by promoting the flow of Qi and blood, reducing inflammation, and improving overall joint function. While frequently applied for hip and lower leg conditions, GB34 is effective for treating tendonitis, bursitis, sciatica, and joint discomfort in other areas of the body, including the shoulder. Stimulating this point is believed to enhance circulation, relieve inflammation, and support muscle and joint recovery.
Contraindications:GB34 should be avoided in cases of local skin infections, open wounds, or significant inflammation near the knee. Caution is also advised when there are fractures, trauma, or recent surgery in the surrounding area, as direct stimulation may aggravate the condition.
SI10 (Naoshu):
Location: On the posterior aspect of the shoulder, in the depression inferior to the scapular spine, directly above the posterior axillary fold, when the arm is adducted (close to the body).
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, at the level of the fourth thoracic vertebra, and approximately one-third of the distance from the midpoint of the scapular spine to the inferior angle of the scapula.
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 anterior and inferior to the acromion, at the origin of the deltoid muscle.
Function in TCM: LI15 effectively treats 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 shoulder pain and stiffness, LI16 promotes smooth Qi flow and enhances joint flexibility, making it a key point for shoulder pain treatment.
LI11 (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.
Fascial Expansion Demonstration
In this video, Dr. Abelson, the Motion Specific Release (MSR) developer, demonstrates using fascial expansions to treat shoulder pain and 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
Utilizing fascial expansions in managing shoulder pain integrates contemporary insights into fascia, kinetic chain relationships, and core principles of traditional Chinese medicine. By focusing on how fascial planes intersect with acupuncture points like GB34, SI10, SI11, LI15, LI16, and LI11, this method offers a comprehensive approach to treating conditions such as rotator cuff injuries, shoulder impingement, frozen shoulder, AC joint complications, and shoulder instability. The combination of soft tissue manipulation, osseous procedures, and functional exercises enhances the effectiveness of the treatment, promoting both immediate relief and long-term health.
This holistic approach addresses the symptoms and tackles the underlying causes of shoulder pain, ensuring a balanced and effective recovery process. By merging modern fascial techniques with traditional acupuncture principles, patients can achieve optimal musculoskeletal health and overall well-being. We encourage you to explore these innovative treatments and experience the benefits of a truly integrated approach to shoulder pain management.
References
Schleip, R., & Jäger, H. (2012). "Fascia: The Tensional Network of the Human Body." Elsevier.
Myers, T. W. (2014). "Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists." Churchill Livingstone.
Stecco, C., Porzionato, A., Lancerotto, L., Stecco, A., Macchi, V., Day, J. A., ... & De Caro, R. (2008). Histological study of the deep fasciae of the limbs. Journal of Bodywork and Movement Therapies, 12(3), 225-230.
WHO (World Health Organization). (2008). "WHO Standard Acupuncture Point Locations in the Western Pacific Region." World Health Organization.
Chou, L. W., Hsieh, Y. L., Kao, M. J., & Hong, C. Z. (2001). Needling therapy for myofascial pain control. "Evidence-based Complementary and Alternative Medicine," 2011.
Tough, E. A., White, A. R., Cummings, T. M., Richards, S. H., & Campbell, J. L. (2009). Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomized controlled trials. "European Journal of Pain," 13(3), 3-10.
Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. "Anatomical Record," 269(6), 257-265.
Dorsher, P. T. (2009). Myofascial referred-pain data provide physiologic evidence of acupuncture meridians. "Journal of Pain," 10(7), 723-731.
Lewis, J. S. (2016). Rotator cuff tendinopathy: a model for the continuum of pathology and related management. "British Journal of Sports Medicine," 44(13), 918-923.
Simons, D. G., Travell, J. G., & Simons, L. S. (1999). "Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual." Lippincott Williams & Wilkins.
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DR. BRIAN ABELSON, DC. - The Author
Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.
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