Fascial expansions form a dynamic network connecting structures from the jaw to the feet, which is crucial for structural support and biomechanical communication. These collagen-rich tissues adapt to mechanical forces, altering their density and fibre arrangements to ensure efficient force distribution and energy release during movement.
Understanding this interconnectivity helps explain how imbalances in one area can impact another. We combine Fascial Manipulation with Acupuncture or Acupressure to treat Temporomandibular Disorders (TMD). This integrated approach effectively restores balance and addresses musculoskeletal issues, leveraging the fascial network's adaptability to enhance overall function and relieve pain.
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Fascial Expansions and TCM
Addressing temporomandibular joint disorders (jaw pain) through fascial expansions offers a comprehensive approach that integrates the latest fascial research, kinetic chain connections, and traditional Chinese medicine principles, such as acupuncture. This article will delve into how fascial layers interact with key acupuncture points like ST6, ST7, ST8, SI8, LI4, and GB20. Combining this method with soft tissue and osseous techniques, along with a routine of functional exercises, ensures optimal outcomes by addressing both structural and functional aspects of TMD treatment.
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)
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].
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].
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.
Acupuncture/Acupressure
& Jaw Pain
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, and 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 ST6, ST7, ST8, SI8, LI4, and GB20 are commonly used to alleviate pain associated with temporomandibular joint disorders [21].
Both acupuncture and acupressure stimulate the nervous system to release tension within the fascial network, promoting healing and pain relief. Western medicine recognizes these techniques' effectiveness, as they often align with areas dense in nerve endings, blood vessels, and lymphatic vessels. This convergence highlights the interconnectedness of TCM and Western medicine in understanding and utilizing the body's natural responses for therapeutic purposes.
ST 6 (Jiache):
Location: At the prominence of the masseter muscle, one finger-width anterior and superior to the angle of the mandible.
Indications: ST 6 (Jiache) benefits TMD by relieving jaw pain, reducing muscle tension, improving blood circulation, modulating nerve activity, and balancing Qi. In Western medical terms, balancing Qi refers to promoting optimal physiological function and homeostasis in the body.
Contraindications: T 6 (Jiache) is contraindicated in cases of severe infection or acute inflammation in the area, such as an abscess or cellulitis.
ST 7 (Xiaguan):
Location: Anterior to the ear, in the depression between the zygomatic arch, in the depression anterior to the condyloid process of the mandible.
Indications: Facial paralysis, temporomandibular joint disorders, toothache, and tinnitus. ST 7 (Xiaguan) benefits TMD by alleviating jaw pain, reducing muscle tension, improving joint mobility, and enhancing blood circulation in the temporomandibular region.
Contraindications: ST 7 (Xiaguan) is contraindicated in cases where there is an acute infection or severe inflammation in the area, such as with acute tooth abscesses or severe temporomandibular joint (TMJ) disorders.
SI 8 (Xiaohai):
Location: On the medial aspect of the elbow, in the depression between the ulna's olecranon process and the humerus's medial epicondyle.
Indications: Elbow pain, upper limb disorders, and conditions affecting the scapular and shoulder regions. From a TCM perspective, SI 8 promotes circulation and reduces inflammation, thus easing jaw pain.
Contraindications: SI 8 (Xiaohai) should be used with caution in patients with fragile or compromised elbow joints and those with a history of severe elbow injuries or conditions such as bursitis or severe arthritis.
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: LI 4 (Hegu) is an effective acupuncture point for treating TMD by relieving pain, reducing inflammation, decreasing stress and muscle tension, improving circulation, and balancing Qi. LI 4, also known as Hegu, is a crucial acupressure point in traditional Chinese medicine and is classified as a Yuan-Source point of the Large Intestine Meridian. This means it plays a vital role in balancing the body's primary qi (energy) and is often used to treat conditions related to the internal organs. Renowned for its ability to alleviate pain and inflammation, promote relaxation, and enhance overall well-being.
Contraindications: LI 4 (Hegu) is contraindicated during pregnancy because it can induce uterine contractions and potentially cause premature labor. It should also be used cautiously or avoided in patients with conditions that contraindicate stimulation or manipulation of this acupoint.
GB 20 (Fengchi):
Location: GB 20, also known as Fengchi, is a significant acupuncture point located in the depression between the upper portion of the sternocleidomastoid muscle and the trapezius muscle, just below the occipital bone.
MSK: GB 20 is known for its ability to relieve muscle tension and stress, which can alleviate the strain on the TMJ and reduce associated pain.
TCM: In traditional Chinese medicine, GB 20 is also used to treat conditions such as dizziness, insomnia, common colds, and hypertension by promoting the circulation of Qi and blood, and clearing wind and heat from the body.
Contraindications: GB 20 should be used with caution in individuals with severe cervical spine issues or fractures, and deep needling should be avoided to prevent injury to the spinal cord or brainstem.
Fascial Expansion Demonstration
Fascial Expansion: MSR Jaw Pain Protocol
Dr. Abelson discusses the fascial planes directly impacting jaw function in this video. He then demonstrates how practitioners combine this knowledge with Traditional Chinese Medicine (Acupuncture/Acupressure).
Conclusion
Fascial expansions form a dynamic network that connects structures from the top of your head to the bottom of your feet, providing crucial support and enabling biomechanical communication. This collagen-rich tissue adapts to mechanical forces, ensuring efficient force distribution and energy release during movement. Fascinatingly, fascia has ten times more neurological receptors than muscles, making it a vital component in force transmission and sensory communication. Understanding this interconnectivity reveals how imbalances in one area can affect others.
Using fascial manipulation with a deep understanding of the fascial kinetic web and acupuncture points can achieve remarkable results. This integrated approach allows for targeted treatments that address the fascia's mechanical and neurological aspects. By stimulating specific acupuncture points, such as those for TMD, we can influence the entire fascial network, promoting relaxation, reducing tension, and enhancing healing. Combining these methods with soft tissue and osseous techniques and incorporating functional exercises ensures comprehensive treatment of TMD. Embracing such holistic strategies alleviates discomfort and enhances overall function, supporting a better quality of life and well-being.
References
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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.
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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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