The Three Layer of Integrative Orthopedic Acupuncture

What is Integrative Orthopedic Acupuncture?

I consider myself very fortunate to be doing the work I do. It provides a great combination of intriguing puzzles and positive impact. It also cultivates what I consider to be a useful perspective on the world and an increased capacity to understand complex situations. One of the ways I think it does this is that it forces me to consider a patient’s single problem as it manifests through different planes of influence. Specifically, we evaluate problems to find the pattern of dysfunction threading through their person on three different levels:

• The physical - a mechanical understanding of where their pain is coming from.
• The energetic - an understanding of how their symptoms may be a superficial expression of a deeper process taking place in their body, involving the internal organs.
• The mental/emotional/spiritual level - to what extent are their symptoms a physical manifestation of a deeper discomfort or dissatisfaction they aren’t able to are aren’t willing to consciously acknowledge?

I’ll briefly walk through a new patient evaluation and how these three levels can show up simultaneously in the same set of symptoms for a patient. This patient, Nancy (not her real name) came to my office seeking assistance with chronic muscle tension, aching pain and fatigue. Nancy was a woman in her 40s, an office worker, spending long hours at a desk at work and giving entirely too much of herself to her family as she simultaneously manages the home, does all the cooking and cleaning, and works a full time job. At work she’s an emotional dumping ground for her coworkers, providing a supportive ear for them. At home she’s still providing emotional support to those around her and worrying over them all day but failing to support her own emotional nourishment. She’s understandably tired, and her emotional and relationship habits are manifesting in her health at deeper levels. She finds herself craving unhealthy foods, seeking emotional nourishment through food when she feels emptied by her life. Her poor diet impacts her digestion, resulting in poor absorption, the accumulation of inflammation and poor production of energy. The heaviness we feel when we fail to eat properly Chinese Medicine recognizes as “dampness”. The transformation and elimination of that dampness is what a healthy functioning digestive energetic accomplishes. In the absence of healthy strong digestive energy “dampness” accumulates resulting in a sensation of heaviness, fatigue and lack of motivation.

We’ll look closer at each of these levels in her and how they interact and influence each other.


Orthopedic: The Physical Level

Her most severe pain was on the outside of her thighs and across her low back, but she also experiences dull, aching pain through her shoulders, arms, neck, and upper back.

Nancy works at a desk for the majority of her working hours, and her extended sitting has altered the correct orientation of her pelvis, shortening of the muscles on the front of the hips and thighs. In turn the glutes and the IT Band are stretched to their limit as the back of the pelvis has tilted upwards. The pain down the sides of her legs feels like tension in the IT Band to her and she is drawn to stretching the glutes and IT band area, but in fact they are tight because they are already stretched to their limit. Stretching these predictably gives her temporary relief as she frees up more room in them, but of course the pain returns because this is the opposite of what is actually needed. In treatment different approaches were applied to the front aspect vs the back aspect of her legs and hips. On the front the muscles (Psoas and Rectus Femoris (the main Quad Muscle)) were locked into a shortened position and needed to shift to a longer, more relaxed state. This was accomplished through acupuncture and a specific needling technique for releasing the muscles. Needles were inserted into the motor points (locations where the nerves enter the muscle) and stimulated gently until they elicited a small twitch. Like a computer reseting to the factory settings after a shut-down, the twitch normalizes the tension in the muscles. Massage to lengthen these muscles was also applied and rehabilitation exercises and stretches targeting the psoas and quads were prescribed. In contrast, the back of the legs and hips were too relaxed. The muscles needed to be strengthened, or more specifically they needed to be “woken up”. Typically, it isn’t an issue with the muscle being too weak, but more that the muscle gets lazy and simply doesn’t fire when it should. These muscles are needled more gently and electrical stimulation is applied at a low level to cause small, repeated, and involuntary contractions in the muscle. These contractions remind the muscle to fire and lower the threshold needed to elicit muscular contractions in these muscles in the future. It’s analogous to taping someone on the shoulder and reminding them to stand up straight; it’s a gentle reminder for the body to do more of what it was designed to do. She was also prescribed exercises for these muscles, including short 1 minute posture correction exercises to be repeated throughout her work day to ensure that the long hours at her desk don’t continue to alter her proper alignment.

Energetic

Nancy’s internal medicine picture is one of poor energy production and increased systemic inflammation stemming from the digestive system. (In this article I’m trying to use language that can be easy understood by our readers, but in fact, in the course of treatment these are concepts that are far better understood and much more thoroughly explained with the language of Chinese Medicine. In her case she’s experiencing what Chinese Medicine would call Spleen Qi Deficiency failing to generate Qi and Blood, with the accumulation of dampness and Damp Bi Obstruction.) In order to resolve that dynamic we included acupuncture points to wake up the digestive system, resolve and transform dampness and reduce the inflammation. She was presenting with the signs of lymphatic congestion as well which is a common manifestation of inflammation stemming from digestion. Points addressing this and helping to circulate the lymph were added and lymphatic self massage was added to her exercise prescription. I also prescribed a custom granule formulation of Chinese Herbs using the formula Shen Ling Bai Zhu San. This formula, originally designed in the 11th century, resolves the dampness that has accumulated as a result of poor digestion, resets the digestive energy and with additional herbs added, helps to resolve swelling in the joints and muscles to reduce the pain she’s experiencing. In the first few weeks of treatment she also took part in a comprehensive nutritional consultation where we went through her current diet, time and lifestyle constraints. Then we reviewed education on proper food choices for her based on her energetic picture, troubleshot her schedule and timing difficulties around food to find some practical solutions for her, established a new shopping list, and sent her out with a new food list and set of recipes. Without addressing the real life obstacles to diet change (time, routines, cooking ability and flavor) making dietary change can be very difficult.

Emotional/Spiritual

Chinese Medicine has a powerful system of understanding personalities and how they are expressions of, and interact with, our bodies as a whole called the Five Element system. The Five Elements are a set of five phases of transformation that occur throughout nature. All phenomena can be categorized as belonging to one primary phase of this system. In her case, she operates from and in turn manifests imbalances within the Earth element. It’s common that our strongest element is also the source of our illnesses. Earth embodies the nurturing energy of fertile soil beneath our feet, the archetypal character of a mother, and the late summer seasonal energy. It’s an energy that absorbs, easily wraps you up in a hug, that feels non-threatening and supportive. Earth energy people are lovely and certainly do a lot of good for the world, but when they express this energy in an unbalanced way, excessively and without sufficient boundaries they erode their own energy. Imagine how poorly managed soil erodes away, without sufficient structure and boundaries our love for others can look more like enabling or self-destructive. Earth element people tend to present with patterns of disfunction characterized by dampness and a deficiency of energy. The Five Elements interact with one another in a complex dynamic. A deep explanation isn’t necessary to understand her case. So briefly, the Five Elements are Earth, Metal, Water, Wood, and Fire. Earth encompasses the digestive organs, the emotion of worry and nurturance, the season of late summer and the tissue of muscles. As seen above, when it is out of balance dampness accumulates. Wood encompasses the Liver and Gall Bladder organs, the emotions of anger and courage, the season of spring, and the tissue of tendons. Just like the roots of plants holding the soil together and preventing erosion, increasing the activity of the wood energetic in a patient helps to hold healthy boundaries within their Earth expression. Her imbalance can be seen as either an excess in the Earth element or a deficiency of the wood element failing to properly restrain and hold the Earth element. Ideally each of the elements is able to manifest sufficiently to maintain a balanced and healthy psyche and the capacity to meet each situation with an appropriate and healthy response. In her case, specific acupuncture points along the Earth and Wood meridians were used to balance those energies, inviting the Wood dynamic to play a bigger role in restraining her Earth energy.
Often simply discussing the Five Elements with patients is helpful in itself, as having a language to build a framework around your interaction with the world makes it possible to initiate changes that you otherwise wouldn’t be able to envision. Indeed, giving her an understanding of the the Five Elements and her place within it made it easier for her to express and manifest more Wood energy with clearer boundaries and a better preservation of her personal energy. In her case there are events in her history, upbringing and family dynamic that established or solidified the imbalances she manifests. Fortunately, uncovering and addressing the historical reasons for the imbalance isn’t necessary to make significant changes in the imbalance that they created. In fact finding a healthier balance in the here and now creates a more solid foundation to then go back and dismantle the damage that their history created.

Nancy’s Response to Treatment

Nancy is a great example of how ripples move through our entire system when we consider the whole person. Her primary complaint was regarding her joint pains which resolved relatively quickly. With a combination of treatments twice weekly and prescribed exercises her pains resolved to the point that she was able to manage her discomfort on her own with regular exercises over the course of 3 weeks. But the deeper work was also important, and successfully addressing her voiced complaints would not have been possible without working on the other aspects she was presenting with. Following through on exercise prescriptions and dietary change are daunting already, doing that when you’re encumbered by a general sensation of heaviness and fatigue are nearly impossible. Freeing up her energy was crucial in being able to more her to the next step. Over the course of several weeks Nancy’s pulses shifted. The “slippery” sensation, characteristic of excessive “dampness”, was improved and the positions of her pulses that reflect the wood and earth aspects of the Five Elements became more balanced. She also began establishing routines where she set aside restoration time for herself which she defended with healthy boundaries. Her demeanor shifted as she held herself straighter both physically and metaphorically. She seemed to have a more solid frame underneath her. She still returns from time to time, weekend activities might give cause her pain to return or she’ll come in for occasional tune-ups. But her experience of her life, her power over it, are significantly improved.