Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Monday, 5 December 2022

What is cluster headaches?

Cluster headaches

Cluster headaches are uncommon but very severe headaches. The pain always strikes one side of the head typically located in or around one eye and is very severe burning or sharp pain. The affected area may become red and swollen, the eyelid may droop, and the nasal passage on the affected side may become stuffy and runny. The attack starts abruptly and lasts for 30 to 60 minutes. This type of headaches tends to come in clusters, with one to eight headaches a day during a period of weeks, months or a couple of years. In between clusters, there may be no headache symptoms, and this headache-free period can last months to years. Acupuncture again is effective to reduce cluster headaches.

Which muscles are involved in low back pain?

The Gluteal muscles

The gluteal muscles are a group of three muscles making up the buttocks: the glutes maximus, gluteus medius and the gluteus minimus. They originate from the back of the pelvic bone ilium and sacrum and end on the thigh (femur).

The largest and the most superficial of the three gluteal muscles is the gluteus maximus. It makes up a large portion of the shape and appearance of the hips. The functions of the muscles are extension, abduction, external and internal rotation of the hip joint.

Gluteus maximus starts from the posterior gluteal line of the inner upper ilium crest, the posterior surface of the lower part of the sacrum and the side of the coccyx, aponeurosis of the erector spinae, sacrotuberous ligament and the fascia covering the gluteus medius. The gluteal maximus go downward and lateralward and insert into iliotibial band and glutealtuberosity. It extends and laterally rotates the hip and extends the trunk. Gluteus maximus injury is a common source of the low back pain. Trigger points are often presents at the originated fibers. The pain can radiate to the thigh, knee, leg and even foot like sciatic pain.

Erector spinae muscles

The erector spinae muscles are a group of muscle and tendons lying along the side of the spine. They arise from the anterior surface of the tendon attached to the medial crest of the sacrum, spinous processes of the lumbar and last two thoracic vertebrae, the supraspinous ligament, the innerpart of the iliac crest and the lateral crest of the sacrum. They extend up through lumbar, thoracic and cervical regions. This group of muscle include iliocostalis, longissimus and spinalis. The erector spinae make the back straight and rotate the back from side to side. Injury, strain chronic inflammation to these muscles may cause back spasm, pain and stiffness.

Others

The quadratus lumborum is a deep muscle at the back that runs from the last ribs and transverse processes of lumbar vertebrae to the top of the pelvis. It is quadrilateral in shape and forms posterior abdominal wall. When one side of the muscle contract, it flexes the spine laterally; when both side of the muscles contract, it extends the spine; it helps expiration and inhalation; and when it contracts on one side, it elevates pelvic bone. If trigger points are present in this muscle, it is a common source of low back pain. This is often caused by overuse, poor posture, stress, strain and tension from twisting, bending or lifting improperly etc.

The psoas major muscles are the deep muscles by the sides of the spinal column. They go downwards to the pelvic bone and end at lesser trochanter of the femur. Illacus muscles start from the interior side of the pelvic bone. The psoas major and the illacus muscles join together and form the iliopsoas. These muscles connect the core and lower limbs and they flex the hip joint, bend the spine forward and laterally and raise the spine from supine position. The pain and trigger points related to iliopsoas is at the low back and upper thigh. Walking and standing upright can be painful, if there are trigger point present in these muscles.

Sunday, 4 December 2022

Skin absorption, What is it? Why it is important?

The skin is a barrier of the body. Its out layer is responsible for keeping water in the body and keeping other harmful chemicals and pathogens out, making skin a natural barrier to infection. However, it does allow some chemicals to pass through and enter the body. This is so called skin absorption which refers to transporting chemicals from the outer surface of the skin into the skin or even into other part of the body when skin exposed to chemicals or cosmetic products. Absorption of substances through the skin depends on duration of contact, concentration and solubility of the substance as well as physical condition of the skin itself. When applying skin products, it is important that the product is not toxic. If it is toxic, it is not only harmful to the skin, but also it can get into the body causing harm to the whole body.

Which neck muscles get involved in neck-shoulder pain?

Muscles at the neck

The neck is the centre of muscle network of the upper body. The cervical spine and the muscles and ligaments are at the back of the neck. The cervical spine is made up of seven vertebraes between which is a disc. Spinal cord is within the spine and protected by the spine. Nerves come out from the cervical spine and innervated the neck and arms.

There are many muscles connect the neck to the head, shoulders and the back.

Trapezius muscle

Trapezius is a large triangular muscle superficially located at the neck and upper back. It connects the neck to the head and shoulders and upper back and middle back. Apart from trapezius there are many muscles connecting the neck to the head and shoulders.

Muscles connect the neck to the head. As mentioned above some muscles connect the neck to the head contributing to the head and neck movement. They are Semispinalis captisis which is deep to the trapezius muscle is originated from the four to seven cervical vertebraes and the upper seven thoracic vertibraes. Beneath this muscle there are five other muscles including rectus capitis posterior minor,rectus capitis posterior major, rectus capitis anterior, rectus capitis lateralis, obliquus capitis superior. Splenius capitis and Longissimus capitis are originated from lower cervical spine and upper thoracic spine and attach to the head.

Muscles connect the neck to the shoulder blades and the back

Levator scapulae muscle

Levator scapulae muscle is the muscle located at the back and side of the neck. It originates at the transverse process of the first to fourth cervical vertebrae and inserts at the superior corner of the scapula. It rotates and flexes the cervical spine laterally, when one shoulder is fixed. It flexes and extends the cervical spine, if both the shoulders are fixed. It lifts up the shoulder when the spine is fixed. This muscle pain presents a stiff and painful neck. The pain is characterised at the one side of the neck and the upper shoulder and it may go down to the shoulder blade and between shoulder blades. The pain limits the movement of the head.

The rhomboid muscles

The rhomboid muscles include the rhomboid muscle major and the rhomboid muscle minor. They connect the shoulder blades to the vertebras (C7-T5) to adduct the arm and pull the shoulder blades towards to the spine. Cooperating with levator scapulae muscle they lift up the medial border and downwards rotate the shoulder blades. The rhomboid muscle major also holds the shoulder blades onto the ribcage.

The serratus posterior superior

Deep to the rhomboid muscles is the serratus posterior superior. This muscle originates at the C7-T3 vertebras and attaches at the second to the fifth ribs under the shoulder blade. It elevates the ribs to aid diaphragm for deep breath.

The splenius cervicis are originated from T3-T6 and inserted to the C1-C3 transverse process. The cervical part of the illiocostalis muscle ends at the cervical transverse processes.

The semispinalis cervicis are originated from the transverse processes of C4-T10 and attach to the spinous processes of C2-C4. They extend, rotate the head and spine.

In the neck there are also some intrinsic muscles such as multifidus, minor deep intrinsic muscles, rotators between and process of the vertebras to stabilise the vertebral column.

Saturday, 3 December 2022

Which muscles are involved in upper back pain?

Trapezius muscle

Trapezius is a superficial broad triangular muscle at neck and upper back, one of the largest superficial muscles at the upper back. It attaches to the base of the skull and extends down to the neck, the upper back until mid back; laterally it inserts to the shoulder blades. There are three functional regions to the muscle: the Upper, middle, and lower trapezius, and each region has its own function: upper region moves the shoulder blades and support the arms; the middle region retracts the shoulder blades and the lower region rotates and depresses the shoulder blades.

Rhomboid major and minor muscles

Below Levator scapulae muscle are Rhoboids including rhomboids minor and rhomboids major.

Rhomboid minor and Rhomboids major are muscles on the back connecting the shoulder blade with the spinal column. Rhomboids major is just below the rhomboid minor. They are deeper to the trapezius starting from spinal column C7 to T5 and inserting to the medial border of the shoulder blade. They keep the shoulder blade pressed against the back and retracted the shoulder blade toward the spinal column. The innervation to these two muscles is from C4-C6 nerve root on the neck.

Trigger points present in trapezius and/or Rhomboids are a common cause of upper back pain.

The serratus posterior superior

Deep to the rhomboid muscles is the serratus posterior superior as mentioned above.

Acupuncture needles are inserted in trapezius trigger points are an efficient way to release upper back pain.

Friday, 2 December 2022

Shoulder pain and rotator cuff disorders

Rotator cuff disorders

Rotator cuff disorder is another common cause for shoulder pain.

The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm to the shoulder blade as mentioned above. The rotator cuff tendons provide stability to the shoulder; the muscles allow the shoulder to rotate. The rotator cuff keeps the joint in the correct position, allowing it to move in a controlled way. Rotator cuff disorders occur when these tendons and muscles get irritated or damaged. The disorders include inflammation of the tendons or bursa, impingement (a tendon is squeezed and rubs against bone), calcium building up and tears of the tendons. The most common causes are 1) normal wear and tear. Rotator cuff is damaged due to years of using the shoulder and changes in the rotator cuff, for instance thinning and wearing of the tendons and reduced blood supply. 2) overuse. Activities involved in using rotator cuff a lot such as tennis, swimming or painting or using over a prolonged period can stress or injure the rotator cuff. 3) rotator cuff injury. Too much over head lifting or throwing sports etc can injure rotator cuff.

The symptoms include pain and weakness in the shoulder and it is worse during the activities when the arm is above shoulder level – for example, when brushing the hair; when the arm is moving away from the body; pain is in the front and side of the shoulder.
Acupuncture is very effective to release shoulder pain. 

Thursday, 1 December 2022

Which muscles are related shoulder pain?

Muscles surrounding the shoulder joint

Trapezius muscle

Trapezius muscle attaches to the base of the skull and extends down until mid back and laterally it inserts to the shoulder blades. It is involved in the shoulder blades movement

Pain caused by middle and lower part of the trapezius can present burning pain or aching on the top of the shoulder. Also pain caused by the lower part of the muscle can present upper shoulder pain; pain at the back of the shoulder blade which could radiate to the inside of the arm to the ring and little fingers.

Latissimus dorsi

Latissimus dorsi is the largest flat muscle in the back.

It originates from the inferior thoracic and lumbar vertebrae, sacrum, iliac crest, and the four most inferior ribs, runs laterally up through the back, inferior part of shoulder blades and inserts to the upper front of the humerus. This muscle plays a role in shoulder joint movement such as adducting the arms, extending the shoulders and rotating shoulder joints medially. Tight latissimus dorsi and the trigger points in the muscles could be one of the causes of shoulder pain, forearm pain, pain between shoulder blades, shoulder blades and pain in front of shoulder.

There are seven muscles that connect the upper arm to the shoulder blades.

Rotator cuff

Rotator cuff is a group of four muscles including supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle. They connect the scapula to the head to the humerus (arm) , stabilize shoulder joint and contribute to shoulder joint movement including abduction, internal rotation, and external rotation of the shoulder. Rotator cuff problem such as injury or overuse of these muscles can cause shoulder pain which is characterised as pain around the shoulder and reduced shoulder joint movement.

Teres major muscle

Teres major muscle also connects shoulder blades to the upper arms starting from lower angle of the shoulder blade and ending at the upper arm in the front of the shoulder. The teres major muscle is involved in adducting the arm, stabilising the humeral head, extending the shoulder and rotating it inwardly. The teres major trigger points cause pain at the back of the shoulder which can radiate to the front and side of the shoulder and down the backside of the arm.

Deltoid muscles

The deltoid muscle forms the rounded contour of the shoulder and is the big muscle on the shoulder. It has three parts; the front, middle and back. The front part is involved in flexing the shoulder and internally rotating the arm. The middle part is involved in shoulder abduction. The back part is involved in extending the shoulder and externally rotating the arm.

Coracobrachialis muscle

This is the smallest muscle that connects upper arm to the shoulder blade. It plays a part in adduction, flexion, and inward rotation of the arm. It also helps stabilise humeral head within the joint.

Muscles connected chest and shoulder

Pectoralis major and minor muscles

The pectoralis major muscle and the pectoralis minor muscle are the muscles located at the chest They are overlapped.

The pectoralis muscle originated from inner half of the clavicular bone, sternum as well as the cartilage of the sixth or seventh rib and the aponeurosis of the abdominal muscle. The muscle goes laterally and inserts to the upper arm. It adducts the arm and rotates the shoulder inwardly, pull down the shoulder joint and elevated the arm to the front. Pectoralis minor originates from 3-5 ribs and it runs upward and laterally and inserts to the surface of the coracoids process of the scapula. It pulls the shoulder blade downward, forward and inward towards the ribs, stabilizes the shoulder. The trigger point of the muscle contributes to the pain in front of the shoulder that could radiate to the chest, upper arms and all the way down to the inner side of the forearm.

What is cluster headaches?

Cluster headaches Cluster headaches are uncommon but very severe headaches. The pain always strikes one side of the head typically located i...