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.

Tuesday, 27 December 2022

Acupuncture helps relieving chemotherapy-induced peripheral neuropathy

Neuropathic pain related to chemotherapy (chemotherapy-induced peripheral neuropathy [CIPN]) is a common problem in cancer treatment. The symptoms of CIPN include tingling, burning or pricking sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. ), sensitive to noxious stimulation, pain and decreased physical activity. Some patients also experience motor symptoms, such as dropping items, splaying fingers, and inability to complete normal daily activities.

Acupuncture, which has drawn researchers’ attention in recent years, is widely accepted for its noninvasiveness and safety has been widely used in diabetes-related neuropathy and carpal tunnel syndrome as well as CIPN.

A recent study analysed the effects of acupuncture from 6 high quality randomized control trials with 386 cancer patients. They found that acupuncture led to significant improvements in pain score, acupuncture can effectively relieve CIPN pain and functional limitation.

References
Tsai-Ju Chien, et al Integr Cancer Ther. 2019; 18: 1534735419886662.

Monday, 26 December 2022

Acupuncture is effective for ulcerative colitis

The colon is the large intestine (bowel) and the rectum is the end of the bowel where stools are stored. Ulcerative colitis is a chronic condition where the colon and rectum become inflamed and small ulcers can develop on the colon's lining and can bleed and produce pus. The main symptoms of ulcerative colitis are: recurring diarrhoea with or without blood, mucus or pus, abdominal pain, urgency and frequency of needing to empty the bowels, especially after meals. Other common nonspecific symptoms include extreme tiredness (fatigue), loss of appetite and weight loss. The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is.

Acupuncture has traditionally been used in the treatment of inflammatory bowel disease in China and is increasingly applied in Western countries. This is a study investigated the effect of acupuncture in the treatment of ulcerative colitis. 29 patients with mild to moderately active UC (mean age 37.8 +/- 12.0 years) were recruited. They received treatments of 10 sessions over a period of 5 weeks and followed-up for 16 weeks. The results suggested that acupuncture seem to offer an additional therapeutic benefit in patients with mild to moderately active UC.

References

Stefanie Joos Scand J Gastroenterol. 2006 Sep;41(9):1056-63.

Sunday, 25 December 2022

When you have toothache, do you ever think of using acupuncture to release it?

Acupuncture for orofacial pain

Orofacial pain or facial pain described as an ache in the front part of the head (including the oral cavity) is a common presentation in primary care. Nearly a quarter of patients in a British primary care study (2504 adult patients) reported orofacial pain. Orofacial pain is most commonly caused by the disease of the teeth. Dental caries and periodontal diseases, musculoskeletal and neuropathological diseases are the most common cause of orofacial pain. Patients with orofacial pain had elevated anxiety values and correlation between elevated anxiety and intensity of pain. The management of the pain is challenging. Medication and complementary methods were applied.

Acupuncture releases orofacial pain effectively. This is recognised by dentists. UCLA School of Dentistry is offering a unique, evidence-based program to train dentists in the basics of acupuncture and Traditional Chinese Medicine (TCM) theory. By combining TCM principles with Western allopathic Medicine modalities, participants will feel comfortable diagnosing and understanding the pathophysiology of both acute and chronic oral pain conditions from an integrative East-West perspective. Moreover, graduates will learn basic acupuncture treatments that can be safely delivered to patients.

A study evaluated 557 patients with orofacial pain based for their pain management and found that the most common form of therapy is Michigan stabilization splint: for disc displacement of temporomandibular joint (TMJ) in 38.9% of patients and in combination with physiotherapy in 18.7% of patients; for osteoarthritis of TMJ in 28.4% and in combination with physiotherapy in 26.4% of patients. The treatment with anticonvulsant drugs for trigeminal neuralgia predominates in 54.3% of patients, which is combined with acupuncture in 25.7% of patients and only acupuncture in 17.1% of patients.

Acupuncture can help with dental pain

Acute dental pain is the main reason for seeking dental services. Have you tried acupuncture for reduce your dental pain? There is a study aimed to evaluate the use of acupuncture in reducing the intensity of acute dental pain in pre-dental care in patients waiting for emergency dental care, and was conducted at the After-Hours Emergency Dental Clinic of Piracicaba Dental School, and at the Emergency Center Dental Specialties I in Piracicaba, São Paulo, Brazil. 120 patients participated the study. The Visual Analog Scale (VAS) was used to measure pain intensity. All patients underwent one session of acupuncture. Reduction in pain was observed in all120 patients. The results of this study indicate that acupuncture analgesia could be a technical adjunct to pain control in patients with acute dental pain, contributing to the restoration of health with social benefit. It is worth trying acupuncture for your dental pain.

Acupuncture helps to recover from dental surgery

Surgical removal of the impacted or semi-impacted third molars is a routine procedure performed by oral and maxillofacial surgeons. The edema and limitation of mouth opening can be triggered by the inflammatory process initiated by surgical trauma. Usually its presence contributes to the increase of pain because there is an increase of tissue tension. Acupuncture therapy helps the maintenance of immune function and restores homeostasis, promotes muscle relaxation, therefore it is selected as an adjunctive treatment for this surgery in a research. The aim is that acupuncture treatment can minimize the symptoms of these occurrences. The result has shown that acupuncture was effective in reducing postoperative residual edema and intraoperative bleeding.

References

https://www.bmj.com/content/361/bmj.k1517

https://www.dentistry.ucla.edu/learning/acupuncture-integrative-oral-medicine

Badel T et al Acta Clin Croat. 2019 Jun;58(Suppl 1):82-89. doi: 10.20471/acc.2019.58.s1.12.

Grillo CM J Acupunct Meridian Stud. 2014 Apr;7(2):65-70. doi: 10.1016/j.jams.2013.03.005. Epub 2013 Apr 11.

Gil MLB et al J Acupunct Meridian Stud. 2020 Mar 20. pii: S2005-2901(20)30078-9. doi: 10.1016/j.jams.2020.03.063. [Epub ahead of print]

Saturday, 24 December 2022

Having blepharitis, tried acupuncture?

The eyelids which cover the eyes and protect them from debris and injury have lashes with short, curved hair follicles on the edge of the lids. These follicles contain oil glands. These oil glands can sometimes become clogged or irritated, even inflamed causing blepharitis. Blepharitis is inflammation of the eyelids. Blepharitis usually affects both eyes along the edges of the eyelids.

Blepharitis is often a chronic condition that's difficult to treat. Blepharitis can be uncomfortable and unsightly. But it usually doesn't cause permanent damage to your eyesight, and it's not contagious.

Symptoms of blepharitis include: watery eyes, red eyes, burning or stinging sensation in the eyes, itchy eyelids, red, swollen, inflamed eyelids, flaking skin around the eyes, crusted eyelashes, oily eyelids, a feeling that something is in or on the eyes, sensitivity to light, crusted eyelashes, etc. Risk factors to have blepharitis include: having eyelash mites or lice, bacterial infection, medication side effects, a malfunctioning oil gland. There are two types of blepharitis: 1) anterior eye inflammation occurs on the outside of your eye where your eyelashes are located. Dandruff on your eyebrows and allergic reactions in your eyes can cause anterior eyelid inflammation. 2) posterior eyelid inflammation occurs on the inner edge of eyelids closest to your eye. A malfunctioning oil gland behind your eyelash follicles usually causes this form of inflammation.

If you have difficulty to get rid of blepharitis, try acupuncture to help.

A case report of acupuncture on chronic blepharitis. A woman aged 61-year-old had a chronic blepharitis on her right upper eyelid for one and half years. The eyelid was red and swollen. It felt stinging. She had three acupuncture treatments. After one treatment the redness and swellings were much better and after three treatment, the blepharitis was completely gone and the eyelid was clear of inflammation.

Friday, 23 December 2022

Why the rib cage is painful? can acupuncture help?

Rib pain and muscle cramps around the rib cage


Rib cage known as thoracic cage is formed by vertebral column, ribs and sternum. It encloses the heart, big blood vessels and lungs and protects them from damage. There are 24 ribs in human. Rib cage is attached by muscles of the neck, thorax, abdomen and back and covered by the fascia and the skin.

Rib cage pain can happen. The pain can be sharp, dull or achy. It can be caused by heart and lung conditions, fracture of ribs and other bone conditions. If you have rib cage pain, you need to see doctor to find out the underlying causes. Rib cage fascia inflammation and muscle spasm are a common cause of rib cage pain.

Muscles attached rib cage

Intercostal muscles are the muscles between ribs. They move rib cage and play an important role in breathing. Other muscle attached the ribs include that the serratus anterior muscle is a broad, curved muscle located on the side of the chest; the pectoralis minor muscle is the smaller of the two sets of muscles that connect the bones of the chest to the shoulder and upper arm; the external abdominal obliques have their origins along the lateral ribs 5 through 12 and internal abdominal obliques.

The sternum or the breastbone, is a long, narrow flat bone at the front of the rib cage. The muscles attached the sternum include the sternocleidomastoid, pectoralis major, sternohyoid, and sternothyroid muscles. The xiphoid process is the lower end of the sternum provides an important attachment point for the tendons of the diaphragm, rectus abdominis, and transverse abdominis muscles.

Acupuncture can help rib cage pain and rib cage muscle spasm.

Thursday, 22 December 2022

What is uterine receptivity? Improve uterine receptivity with acupuncture.

Acupuncture improves uterine receptivity and helps implantation

When an egg is fertilised by a sperm, an embryo is formed and developing. At the same time, there are also changes in the uterus to prepare the arrival of the embryo. When an embryo arrives at the uterus, it will implant into uterine wall. A successful implantation depends on the synchronous development of both the endometrium and embryo. Uterine inner lining gets thicker, uterine smooth muscles are relaxed after ovulation. There is also communication between the uterine cells and the embryo to get the best time of implantation. Delayed implantation time will lead to implantation failure or miscarriage. During the development of uterine inner lining uterine blood circulation is the key factor to get ready for implantation. After embryo implanted, the embryo initially takes nutrients and oxygen from maternal blood circulation system and removes the waste via maternal blood circulation system. Good uterine blood circulation is essential for early stage of embryo development. To improve uterine blood circulation, acupuncture is the best candidate. Since a decade ago, acupuncture was suggested that it increases uterine blood flow. This will help embryo implantation and embryo development in the uterus.

Acupuncture improves uterine receptivity

If an egg is fertilised, it will be transported to the uterus and it will be implanted into uterine endometrium. Within the uterus, the foetus develops during pregnancy. Endometrium is the inner lining of uterus. It goes cyclic changes responding to ovarian hormone oestrogen and progesterone levels and sheds off each month with new endometrial lining replaced, if the egg is not fertilised. If pregnancy occurs, the endometrium will retain. After ovulation, the uterine endometrium becomes thicker to prepare for embryo implantation. If endometrium is not thick enough (less than 6 cm), implantation does not occur. If the thickness of endometrium is greater than 12 cm, there were three times more chances to get pregnant. To get embryo implanted, there must be a receptive uterus. Ovarian hormones oestrogen and progesterone are involved in regulating uterine receptivity. Uterine smooth muscles tend to contract especially at low progesterone level. Increased progesterone level makes uterus more relaxed. The thickness of endometrium and contractility of uterine smooth muscles are the key factors for the uterus becomes receptive.

Age and uterine receptivity

Women’s fertility is declining with advanced age which is attributed to declining of egg quality. A significant low success rate in IVF is an example. Success rate could be 48.8% for women younger than 30 years old while in comparison to 13.6% in women with 42 years old. Embryo implantation rates also decline in a linear fashion, from 29% in women younger than 34 years to approximately 5% at age 42. Apart from egg quality what other factors contribute to this change? This could be because of poor uterine receptivity in women with advanced age. This was suggested that in the case of egg donation, there was also low pregnancy rate in women with increased age.

Conditions of the uterus that affect uterine receptivity

Luteal phase deficiency (LPD) is a condition in which there is either no enough progesterone production or poor endometrial response. This is a major cause of infertility and recurrent pregnancy loss. In luteal phase defect, there is no enough progesterone produced which shows either low progesterone or too much fluctuation of progesterone levels. Or the uterine endometrium does not respond well to the progesterone stimulation because of lack of progesterone receptors or lack of cell surface adhesive proteins. There is poor endometrial development or delayed endometrial development, as a consequence, uterine receptivity is poor and the embryo loses its chance to implant.

Endometriosis

Uterine endometrial tissues grow outside of uterus. Women with endometriosis were found to have decreased fertility. Poor egg development and poor egg quality, impaired fertilization lower the embryo ability to implant. Also failing to respond to progesterone well makes their uterine endometrium less receptive.

Hydrosalpinx

Hydrosalpinx is distally blocked, dilated, fluid-filled fallopian tube caused by infectious diseases. Women with haydrosalpinx have difficulty to get pregnant. Tube blockage is not the only factor that is contributed to the cause. Women with hydrosalpinx have lower implantation, pregnancy and delivery rates and a higher incidence of spontaneous miscarriage after IVF–embryo transfer compared with women with tubal infertility of other causes. The inflammation of the tubes could spread to the uterus and make inflammatory environment in the uterus.

Uterine fibroids

Uterine fibroids are the most common uterine benign tumours in women of reproductive age. They can distort the uterine cavity or obstruct the fallopian tubes or cervical canal affecting women’s fertility. They may also change uterine receptivity and cause infertility.

Endometrial polyp

Endometrial polyps are benign, localized overgrowths of endometrium. It may affect infertility by mechanically disrupting the transport of sperm and embryo and making endometrium not responding to progesterone.

Polycystic ovarian syndrome (PCOS)

PCOS is a common endocrinological disorder in women of reproductive age. Infertility associated with PCOS is mainly because there is no ovulation or less frequent ovulation. When ovulation was introduced by drugs in women with PCOS, implantation rates are lower than fertile controls and early pregnancy loss rates are increased which suggested that implantation failure is also contributing to the causes. The hormone imbalance in women with PCOS makes the endometrium less receptive.

Endometritis

Chronic endometritis causes prolonger inflammation in endometrium and affects endometrial receptivity which is associated with infertility and implantation failure.

Acupuncture can help uterine receptivity by regulating hormone balance, increasing uterine blood flow, improving uterine lining and relaxing the uterine smooth muscles. Whether you like to get pregnant naturally or via IVF, acupuncture can help your uterine receptivity to increase your chance to get pregnant and stay in pregnancy.

Wednesday, 21 December 2022

Look after your overall health with facial acupuncture

Stress is the body's reaction to harmful situations. The symptoms of stress vary from person to person. The symptoms include emotional, physical and behaviour. Emotional symptoms include feeling agitated, frustrated, easily getting crossed, easily losing control, having difficulty relaxing and calming down, feeling anxious, depressed etc. Physical symptoms include low energy, feeling tired, headache, aching or pain in the body, muscles tension, dizziness, insomnia, digestive problems, frequent illness, loss of libido, shaking, clenching jaw, cold hands, and feet etc. Behaviour symptoms include always worrying, lack of concentration, poor memory, feeling slow, being pessimistic, unable to stop eating or eating less. Anxiety is that you feel fearful and tense. You may also have some physical symptoms, such as, increased heartbeat, feeling sick, shaking, short of breath, chest pain, headache etc. Most people feel anxious from time to time. It is normal in stressful situation. However, if anxiety persists or there is no obvious reason to be anxious, it becomes abnormal.

The frontal lobe is located at the front of the brain just underneath frontal bone. It controls important cognitive skills, such as emotional expression, personality, problem solving, memory, language, communication skill, judgment, and sexual behaviours. It makes up about one third of the brain and is the largest lobe of the brain. It also controls muscles movement and speech. The frontal lobe enables us to respond to any changes accordingly. Acute stress can impair the function of the frontal lobe that required complex and flexible thinking by increasing both dopamine and noradrenaline release. Chronic stress induces the structural changes. chronic stress weakens the structures that provide negative feedback on the stress response and strengthens the structures that promote the stress response. Stress and anxiety are related to this part of the brain that is not functioning well. The stress and anxiety of frontal lobe is reflexed at the forehead tension.

Connection between mind and body has been discovered for centuries. In ancient time, it was believed that emotions were linked to disease and patients were advised to visit spas or seaside resorts when they were ill. Today it is widely accepted that there is a powerful mind-body connection through which emotional, mental, social, spiritual, and behavioural factors can directly affect our health. There is common sense ‘too much stress makes you sick' which means that there is a links between stress and health.

Facial acupuncture is an effective way to release stress, anxiety and relax mind and the body.

Tuesday, 20 December 2022

Chewing muscles on the face and jaw pain and tightness.

The temporalis muscles

The temporalis muscle (temporal muscle) is a broad fan shaped muscle on each side of the head covering much of the temporal bone. It is not facial expression muscle, but one of the mastication muscles (chewing muscles). It is attached to the mandible (jaw) and to the skull’s temporal bone, or temporal fossa. It is one of the muscles involved in jaw movement (lift the jaw and retract the jaw) and is the most powerful chewing muscle of the temporomandibular joint. You can see and feel the muscle contracting while the jaw is clenching and unclenching. The muscle is innervated by a branch of trigeminal nerve.

The masseter muscles

One of the strongest chewing muscles is masseter muscle. It consists of two heads: superficial head starts from the maxillary process of the zygomatic bone and the anterior two thirds of the inferior border of the zygomatic arch and inserts into the angle of the mandible and inferior half of the lateral surface of the ramus of the mandible; the deep head starts from the posterior third of the lower border and from the whole of the medial surface of the zygomatic arch and inserts into the upper half of the ramus of the mandible. This muscle involves jaw movement.

Monday, 19 December 2022

What are facial expression muscles? How do they wrinkle the face?

Muscles on the forehead

The frontalis muscle (frontal belly) is the muscle on the forehead. It is a thin, quadrilateral form. There is a pair of them. There are no bony attachments. The medial fibers are going downwards and connected with the muscle fibers below including the Procerus; the corrugator and the orbicularis oculi. They attach to the skin of eyebrow. Its lateral fibers also mix with the latter muscle over the zygomatic process of the frontal bone. The muscle fibers move up and join the galea aponeurotica (tough fiber layer on the head). The frontalis muscles lift eyebrows when looking up and wrinkle the forehead horizontally by pulling the scalp back. The muscle is innervated by facial nerve. The antagonist muscle is orbicularis oculi muscle.

Procerus muscles and corrugators

The procerus muscle arises from the nasal bone and inserts into the skin over the lower part of the forehead between the two eyebrows. Its fibers blend in with those of the frontalis muscles. Its contraction pulls the skin between the eyebrows downwards producing horizontal wrinkles between the eyes over the bridge of the nose.

The corrugators supercilli muscle is a small muscle at the medial end of the eyebrow. It originates from the medial end of the superciliary arch and its fibers pass upward and laterally and end at the deep surface of the skin above the middle of the orbital arch. It is beneath the frontalis muscle and above the orbicularis oculi muscle. Contracting of this muscle draws the eyebrow downward and medially creating the deep vertical wrinkles between the eyebrows. It is known as frowning muscle.

Muscles surrounding the eyes

The orbicularis oculi muscle is the ring like muscle surrounding the eye. It originates from the nasal part of the bone and goes all the way laterally surrounding the border of the orbit forming a broad and thin layer. It spread over the eyelids, temple and down to the cheek. The orbital orbicularis is the orbital portion of the muscle. It forms a complete circle without interruption. The upper part blends in with the frontalis and corrugators muscles.  Palpebral orbicularis is the palpebral portion of the muscles responsible for the involuntary eye blink. Contraction of this muscle causes the eye to close or blink. The orbital portion can be consciously controlled. Contraction of the muscle also causes the wrinkles at the out corner of the eye which are known as crow feet. For example, as under the sun, the skin of the forehead, temple, and cheek is drawn toward the medial angle of the orbit, and the eyelids are firmly closed. The skin is folded especially radiating from the lateral angle of the eyelids. The antagonist of this muscle is the levator palpebrae superioris muscle.

Muscles in the cheek

There are four muscles on the cheek: They are lying in the cheek from middle to lateral, from cheek bone to the upper lip: They are the levator labii superioris alaeque nasi, the levator labii superioris muscle, the zygomaticus minor, the zygomaticus major. They form the nasolabial groove, from the side of the nose to the upper lip. This line is deepened in expressions of sadness. These muscles draw the angle of the mouth upward and backward in smiling. These muscles’s contraction creates tension on the cheek, deep nasolabial groove, gummy smile and wrinkles the cheek.

Levator anguli oris is a deep facial expression muscle on the cheek. It originates from the canine fossa of maxilla, inferior to the infraorbital foramen. It elevates the angle of the mouth and deepens the nasolabial lines and facilitates smiling.

There are two muscles on the cheek by the mouth.

The risorius muscle arises in the fascia over the parotid gland and, passing horizontally forward, inserts onto the skin at the angle of the mouth. It is a narrow bundle of fibers, broadest at its origin lying superficial to the platysma. It is known as the ‘smiling muscle’ as its contraction draws the angle of the mouth outward and produces a smile.

The buccinator muscle is a thin quadrilateral facial muscle by the mouth. It originates from maxilla and mandible bones and fibrous band behind the third molar. It is the main muscle of the cheek, that provides it with structure and tightness. The muscle goes towards and inserts to the angle of the mouth. It contributes to smiling and chewing.

Muscles on the nose

Nasalis is a paired muscle that covers the dorsum of the nose. It originates from the maxilla crawls upwards on the back of the nose and ends there and blends in each other from the opposite side at the back of the nose. This muscle dilates the nostrils, depresses the nostril wings and wrinkles the nasal skin.

Muscles surrounding the mouth

There are a few groups of muscles around the mouth.

The orbicularis oris muscle is the muscle encircling the mouth and it lies between the skin and the mucous membranes of the lips. The orbicularis oris muscle is a complex of muscles in the lips that encloses the mouth. It consists of four independent quadrants that connects each other which gives it a look of circular. It blended in with other expression muscles on the face. When it contracts, it closes the mouth and puckers the lips creating vertical wrinkles around the mouth.

Muscles below the mouth draw the corner of the mouth down.

The depressor anguli oris is a muscle that originates from the mandible and inserts on angles of the mouth to depress the angle of the mouth.

The depressor labii inferioris muscle is a muscle of the face that draws the lower lip down and slightly laterally. 

The mentalis muscle elevates and protrudes the lower lip and wrinkles the skin of the chin.

The platysma muscle is a broad sheet of muscle originated from the the fascia covering the upper parts of the pectoralis major and deltoid going upwards to lower cheek and blend in with the muscle around the mouth. It draws the lower lip and corner of the mouth outward and downward.

Muscles lift up the upper lip. Muscles in the cheek involves in lifting upper lip. These muscles include the levator labii superioris alaeque nasi, the levator labii superioris muscle, the zygomaticus minor, the zygomaticus major and Levator anguli oris. They originate from cheek bone and all end in upper lip.

The risorius muscle and the buccinator muscle pull corner of the mouth outwards.

Platysma Muscles

The Platysma muscle is thin like a flat sheet situated within the subcutaneous tissue of the neck. It originates from the fascia that covers the clavicle, the acromial region and the superior portions of the pectoralis major and deltoid muscles. It arises across the neck up to the lower face. It inserts onto the lower border of the mandible or the skin of the lower lip and attaches to the skin and subcutaneous tissue of the perioral region, and to the muscles surrounding the mouth. The platysma blends with the depressor anguli oris and depressor labi inferioris muscles and reinforces their actions. It also contributes to the formation of the orbicularis oris complex and the formation of the modiolus.

 

Saturday, 17 December 2022

Having painful leg? acupuncture can help.

The leg is the section of the lower limb extending from the knee to the ankle. There two bones the tibia or shinbone together with the smaller fibula bone. Muscles in the legs move the ankle, foot and toes. There are three muscles at superficial layer: the calf muscles, including the gastrocnemius and soleus are the muscles at the back of the leg and plantaris. Achilles tendon is attached to the calcaneus bone in the heel. There are four muscles in the deep compartment of the posterior leg: the popliteus, tibialis posterior, flexor hallucis longus and flexor digitorum longus. These muscles contract to flex the foot — such as when standing on the tiptoes — and flex the toes. They also stabilize the ankle joint and foot and to maintain the body’s balance. There are four muscles in the anterior compartment of the leg; tibialis anterior, extensor digitorum longus, extensor hallucis longus and fibularis tertius. They invert the foot at the ankle joint and extend the toes. There are two muscles in the lateral compartment of the leg; the fibularis longus and brevis. They turn the sole of the foot outwards.

Most common leg pain results from wear and tear, overuse, or injuries in joints or bones or in muscles, ligaments, tendons or other soft tissues. Some types of leg pain can be caused by problems in the lower spine where the nerve to the leg originates and then travels to the legs, such as slipped disk, sciatica.

Leg pain can be mild that comes and goes, or severe that makes it difficult to sleep and walk. The pain is often described as aching, throbbing or burning and it can be accompanied by numbness, tingling and muscle weakness. For leg pain treatments, finding the cause is important and treatments depend on the causes.

Shin pain
Shin pain is pain on the front of the lower leg between the knee and the ankle. It can hurt directly over the shinbone all the way or over the muscles that are on the inner or outer side of the tibia. It can be a dull aching, or sharp and severe pain. It can be one or both shin with large area across whole length of the shin bone. This pain is usually caused by overuse from irritation of the muscles or other tissues in the leg. The cause is not clear, but it is suggested that running and repetitive weight bearing on the legs leads to inflammation of the soft tissue around the shin bone.

Leg muscle cramps are common, and it usually occurs in the calf muscles. It can also happen in any other leg muscles. When it happens, the muscles in the leg suddenly become tight and painful which will last seconds to minutes. After the cramping has passed, pain and tenderness in the leg can stay for some time.

Acupuncture is amazingly effective for leg pain. For example, a 35-year-old woman had pain in front of leg along the shin bone for two years. She had 8 sessions of weekly acupuncture treatment. After 6 weeks, the pain completely disappeared.


Friday, 16 December 2022

Abdominal muscles, abdominal pain and acupuncture

Chronic abdominal pain

Fortunately, in most of cases the chronic abdominal pain is not caused by severe illness, but it can be depressing if the abdomen is always painful. There are many problems that can cause abdominal pain.

Smooth muscle is in the walls of hollow internal organs, such as the arteries, intestines, bladder in the abdomen. When they contract, the organ is squeezed. Most of the abdominal pain is visceral pain which is pain arising from the internal organs. Visceral pain is triggered by smooth muscle distension or contraction, stretching of the capsule surrounding an organ, ischaemia and necrosis, or irritation by chemicals produced during inflammatory processes. If stomach or intestine wall becomes spasm, this may result in pain. So do kidneys, gallbladders and other internal organs. When the uterine smooth muscle becomes spasm, menstrual cramps occur. It is often deep, dull or dragging and is typically diffuse and poorly localised. It can be associated with nauseas, vomiting, and changes in heart rate or blood pressure. It can also evoke strong emotional responses. There can be a referred pain which is pain experienced at a site distant from source of the pain. It is due to the convergence of different afferents on to the same neurones in the spinal cord.

The abdominal wall muscles are skeletal muscles extending from the superior border of the pelvis to the inferior border of the ribcage. There are four pairs of muscles: transverse and rectus abdominis and the internal and external obliques.

Abdominal muscles and chronic abdominal pain

The rectus abdominis muscles

The rectus abdominis muscles are a pair of long flat muscles lie vertically along the middle line of abdomen. Each muscle is divided by narrow bands of tendon into four muscular bodies. It originates from the edge of the pubis bone and the pubic symphysis in the pelvis and ends at the inferior edges of the costal cartilages of the fifth through seventh ribs and at the lowest point of the sternum. The rectus sheath is a covering connective tissue surrounding the rectus abdominis muscles where the internal and external oblique muscles attach. The thick mass of white fibrous connective tissue is in the midline of the abdomen and joins the two rectus abdominis together. The important function of rectus abdominis muscles is to flex the spine when they contract. Contraction of the abdomen results in increased pressure within the abdominopelvic cavity and is useful to push substances out of the body during exhalation, defecation, and urination. It helps delivering a baby. If there are trigger points present in these muscles, you could feel the pain at the abdomen, lower and mid back region. The symptoms include pain at the low abdomen, period pain, stomach cramping, heart burn chest pain, indigestion, nauseas, vomiting bloating, genital pain, bladder problem, low and mid back pain etc.

Transverse abdominis muscle

Transverse abdominis muscle is the deepest muscle on the front and side abdominal wall. It lies between the rib cage and pelvic bone. It starts from the back thoracolumbar fascia, from the top inner surface of the lower six ribs, from the bottom front of the upper edge of the pelvic bone and inguinal ligament and it ends at the front abdominal midline. It is a very important core muscle in compressing the abdomen, providing thoracic and pelvic stability and supporting abdominal visera. It maintains good posture and helps to deliver a baby for pregnant women. Trigger points in transverse abdominis could contribute to the abdominal pain and low back pain.

External and internal oblique muscles

The external abdominal oblique muscles are a pair of muscles that lie on the lateral and anterior sides of the abdominal wall. They are broad, thin and on the top layer of the abdominal muscles. They start from ribs 5-12 and end at the midline of the abdomen, pubis and iliac crest of the hip bones. Contraction of this muscle makes lateral bend and rotation of the spine, flexes the spine and pulls the chest downwards and compress the abdominal cavity.

The internal abdominal oblique muscles lie on the lateral and anterior sides of the abdominal wall just underneath the external abdominal oblique muscles and above the transverse abdominal muscle. It bends the spine forward and bring the shoulder of the side forward and it also bend the spine sideway and rotates it. It compresses abdominal contents and assists digestive process and breathing. If trigger points are present in these muscles, the pain can be felt in following area, in the side, the waist area, the groin area, the low abdomen, across the upper back below shoulder blades, across the low back just above hips, stomach pain, testicle pain, pelvis pain bladder pain.

Chronic abdominal pain may be present for weeks to months, or even years. Bloating is a common symptom accompanied with chronic abdominal pain. Most people have experienced this symptom, when the abdomen is stretched, puffy and uncomfortable. The common cause is constipation which is caused by too little fluids and fibers and lack of exercises. Food allergy and intolerance can be caused excess wind production causing bloating. Inflammation in abdomen such as irritable bowel syndrome can lead to bloating. Pain conditions such as low back pain, hip pain, abdominal pain can accompany bloating because of alteration of the nerve activities. Acupuncture can help reduce bloating and some chronic abdominal pain such as indigestion, inflammatory bowel diseases or muscular pain, benign ovarian cysts, pain with frequent urination, and muscular pain from the abdominal muscles.

Urologists use acupuncture to treat bladder pain.

 

Thursday, 15 December 2022

Which acupuncture points used for your slipped disk?

A slipped disc is a condition in which the disc in the spine is torn and the central part inside comes out. It causes chronic back pain. The pain often begins in the lower back and over time it spreads to other parts of the body. Sometime there is no symptom. This is because the slipped part of the disc is small which will not affect nerves or spinal cord. If sciatic nerve is affected the pain could travel from the low back, through the buttocks and down the legs to the feet as stated above.

Acupuncture does not make slipped the disk go back but acupuncture treatment can help to release the pain and other symptoms. Which acupuncture points are most used to treat slipped discs? A study analysed data from recent 10 years. They found 49 main acupuncture points from 173 studies. there were 10 most common used acupoints on Bladder Meridian [Geshu (BL 17), Xiaochangshu (BL 27), Shenshu (BL 23), Dachangshu (BL 25), Pangguangshu (BL 28), Guanyuanshu (BL 26), Weizbong (BL 40), Zhibian (BL 54), Chengshan (BL 57), Kunlun (BL 60)], 2 on Gallbladder Meridian [Huantiao (GB 30), Yanglingquan (GB 34)], 2 on Governor Vessel [Yaoyangguan (GV 3), Shuigou (GV 26)], 2 on Stomach Meridian [Zusanli (ST 36), Juliao (ST 3)], 2 on Spleen Meridian [Sanyinjiao (SP 6), Xuehai (SP 10)], and the rest were extra points (Huatuo Jiaji) and Ashi points. The selected acupoints were most located on the lumbosacral region, leg and fewer located on the face, back and local part.
Which points do your acupuncturist used? 

Wednesday, 14 December 2022

What is connection between water and the skin?

The skin contains 64% water. Water makes the skin elastic and smooth. Water is constantly lost from the body through sweat, urine and breath. Without regular top-up water, the body became dehydrated. The skin is vulnerable to dehydration, due to such as large area exposure to outside of the world. Dehydration causes skin wrinkles and is also related to dry, scaly skin and irritant dermatitis. Dehydrated skin loses its glow and looks dry, dull, saggy and flaking. Drink plenty of water to prevent the skin from dehydration. Exposure to cold, wind and low humidity makes the skin dehydrated; this is due to water loss and poor circulation from the skin. Excessive alcohol can make skin dehydrated. Avoiding harsh environment and keeping healthy life style can protect the skin from dehydration. Drinking plenty of water is essential to keep the skin hydrated.

Tuesday, 13 December 2022

Which acupuncture points are used for your back pain?

Why acupuncture is effective for low back pain?

There are several mechanisms that explained the effectiveness of acupuncture on pain relief. Acupuncture stimulates nerve endings located in muscles and other tissues leading to production of endorphins and other neurohormonal factors. Acupuncture reduces inflammation by releasing vascular and immunomodulatory factors. Acupuncture increases local blood circulation and improves muscle stiffness, joint mobility and swelling.

Standardization of acupuncture points for low back pain

Acupuncture treatment for specific patients with chronic low back pain vary widely across practitioners. If you go and see a few different acupuncturists, you would get acupuncture at different points. There are no standardized acupuncture points for any conditions. A study has shown that twenty diagnoses and 65 acupoints were used at least once; and only one point UB23 was used for every patient by most acupuncturists. In China standardization of acupuncture points was encouraged to achieve best outcome of the treatment. There was a study compared the efficacy of standardized acupuncture and individualised acupuncture points. In this study up to 15 sessions of acupuncture treatments were offered. 78 patients were in the standard acupuncture group and 72 patients were in the individual acupuncture group. Both acupuncture interventions were applied by the same medical doctor specialized in western general medicine (25 years of clinical practice) and trained in Chinese medicine with 20 years' experience in treating low back pain with acupuncture. The result has shown that the average pain severity after 8 weeks and 26 weeks did not differ significantly between both groups. This study has shown the possibility of standardization of acupuncture treatment for chronic back pain patients. However in real world, there is no standardized acupuncture points for back pain. If you see different acupuncturist, you have got different acupuncture points and different effects. Which acupuncture points do your acupuncturist used? 

Acupuncture points are frequently used in lower back pain

There are over 400 acupuncture points in human body according to Chinese medicine theory. The selection of appropriate acupuncture points is the first step to obtain therapeutic effects. Lee SH et al analysed acupuncture points from 53 studies using modern techniques to extract most commonly used acupuncture points. There were 33 most frequently used acupoints for lower back pain (LBP). The most frequently used acupoints in the treatment of low-back pain were BL23 (51%), BL25 (43%), BL24 (32%), BL40 (32%), BL60 (32%), GB30 (32%), BL26 (28%), BL32 (28%), and GB34 (21%). All local acupoints for LBP are on the Bladder and the Governing vessel especially at the low back position of these meridians. Most of the distant acupoints are on the Bladder and Gallbladder meridians. The acupoints include seven acupoints (BL23, BL24, BL25, BL26, and BL32 as local points and BL40 and BL60 as distal points) on the bladder meridian and two acupoints (GB30 as a local point and GB34 as a distal point) on the gallbladder meridian.

Monday, 12 December 2022

Which muscles are involved in knee pain and leg pain?

Three sets of muscles in the upper leg all attached to the knee joint. As mentioned above, pectineus, satorius and quadriceps are in anterior group; hamstring muscles are in posterior group; adductor magnus, adductor longus and adductor brevis and gracilis are in medial group. Tensor fasciae continuing with iliotibial tract are in the lateral side. Inflamed iliotibial band is one common cause of pain on the outer side of the knee.

Two sets of muscles in the lower leg are also attached to the knee joint: extensors at the front and flexors at the back. The soleus muscle together with the its superficial muscle gastrocnemius are known as calf of the leg. Calf muscle is at the back of the leg which originates from the distal end of the femur through the calcaneal (Achilles) tendon and ends to the calcaneus of the heel. It flexes the knee.

Sunday, 11 December 2022

Thoracolumbar fascia and back pain

Thoracolumbar fascia and back pain

The thoracolumbar fascia or lumbodorsal fascia or thoracodorsal fascia is a deep fascia at the back of the posterior thoracic and abdominal region. It goes up and is continuous as nuchal fascia on the back of the neck. It wraps around deep muscles at the back. It is made up of three layers: anterior, middle and posterior. The anterior layer is the thinnest and the posterior layer is the thickest. Psoas major muscle lies in the front of the anterior layer; Quadraus lumborum muscle is between the anterior and middle layers; the erector spinae muscles and transversospinales muscles are between the middle and posterior layers; Latissimus dorsi and serratus posterior inferior muscles lie at the back of the posterior layer.

Thoracolumbar fascia injury or overuse can cause inflammation of the fascia leading to pain and tightness at low back, shoulder and hip, difficulty of breathing, difficulty of walking, muscle weakness etc.

Acupuncture can release the facia effectively to release back pain. 

Saturday, 10 December 2022

Neck pain, fascia and nuchal ligaments in the neck.

Fascia and nuchal ligaments in the neck

Surrounding muscles, blood vessels and nerves, there is a layer of fibrous tissue called fascia. In the neck, there are a few layers of fascia that support the structure of the neck. Some of the fascia blends in the ligament at the midline of the neck. This ligament is the nuchal ligament in the neck.

Nuchal ligament attaches the bottom of the skull and extends all the way along midline of the neck down to the last cervical spinous process (from the seventh cervical vertebrae, the lowest cervical vertebrae on the neck). It limits the flexion of the neck and provides sites for attachment of some muscles including trapezius, splenius capitis, rhomboid minor and serratus posterior superior and cervical spinalis. Ossification, fibrosis and inflammation of the ligament result in neck stiffness and pain.
Neck pain, tried acupuncture? 

Friday, 9 December 2022

Which muscles in the thigh is involved in thigh pain?

Thigh is the area between the hip and the knee. There are a few groups of muscles in the thigh. Anterior group include pectineus, satorius and quadriceps (rectus femoris, vastus medialis, vastus intermedius and vastus lateralis. Posterior group includes hamstring muscles (semimembranosus, semitendinosus and biceps femoris. Medial group include adductor magnus, adductor longus and adductor brevis and gracilis. The lateral is tensor fasciae which continues with iliotibial tract. The iliotibial tract, also known as the iliotibial band, is a thick strip of connective tissue connecting several muscles in the lateral thigh. It arises at its proximal end from the tendons of the tensor fasciae latae and gluteus maximus muscles and then travels along the lateral side of the thigh and across the knee joint, inserting on the lateral epicondyle of the tibia.

Thursday, 8 December 2022

Quadriceps femoris related thigh and knee pain, acupuncture can help

The quadriceps femoris also known as the quadriceps extensor, quadriceps or quads is agreat extensor muscle of the knee and it is a four headed muscle on the front of the thigh or four separate portions of the muscles. They all have their own names. All four parts of the quadriceps muscle join together forming one tendon which extends to the patellar lligament on the knee.

Rectus femoris is in the middle of the thigh, covering most of the other three quadriceps muscles. The rectus femoris muscle starts as two or three heads from pelvic bone. The straight head attaches to the anterior inferior iliac spine, and the reflected head attaches to the superior rim of the acetabulum and capsule of the hip. Sometimes there is a recurrent head that arises from the anterosuperior angle of the femur’s greater trochanter. All the heads join, and the belly of the muscle then runs down the anterior thigh to attach by a broad aponeurosis to the base of the patella.

The rectus femoris muscle not only extends the knee but also flexes the hip. If the thigh is fixed, contraction of this muscle helps to tilt the pelvis forward. Trigger points of this muscle can be present on front of the hip joint and knee joint. If trigger points are present in this muscle, one can feel thigh pain and tightness and deep aching in the knee.

The other three lie deep to rectus femoris and originate from the body of the thigh bone, femur.

Vastus laterlis is on the outside of the thigh; trigger points of the muscle can be found on the outside of the thigh. vastus medialis is on the inside of the thigh; trigger points of this muscle can be found at the inside of the thigh. Vastus intermedius is in the middle, underneath the rectus femoris.

Acupuncture can help release trigger points of these muscles and reduce thigh and knee pain.

Wednesday, 7 December 2022

What is pelvic bone?

The hip bone or pelvic bone is a large flat bone connected with sacrum and coccyx of the lower spine. Two hip bones join each other at front midline and join together with sacrum and coccyx at the low back forming pelvis surrounding the pelvic cavity which accommodates bladder, reproductive system and bowels.

The hip bone is formed by three parts: illium, ischium and pubis.

The ilium is the highest and largest part of the hipbone consists of the body and wing.

The ischium is the lowest part of the hip bone and made up of three parts–the body, the superior ramus and the inferior ramus.

The pubis is at the anterior of the hip bone. It is divided into the body, superior ramus and inferior ramus.

The hip bone has a few groups of muscles attached as follows

The abdominal muscles include the abdominal external oblique muscle (attaches to the iliac crest) , the abdominal internal oblique muscle (ataches to the pectin pubis) and the transverses abdominis muscle (ataches to the pubic crest and the pectin pubis),

The back muscles include the multifidus muscle (attaches to the medial surface of the posterior superior iliac spine, the posterior sacroiliac ligaments and part of the sacrum)

The gluteal muscles include three gluteal muscles: gluteal maxmus muscle, gluteal medium muscle and gluteal mininus muscle. They all arise from the outer surface of the hip bone and

The lateral rotator group of muscles include piriformis muscle, superior gemellos muscle, obturator internus muscle , inferior gemellos muscle and obturator externus muscle.

Adductor group of muscles include adductor brevis, adductor longus, adductor magnus, adductor minimus, pectineus, gracilis and obturator externus.

Hamstrings include long head biceps femoris, semitendinous and semimembranosus

Two muscles at the anterior of the thigh rectus femoris muscle and sarturius muscle

One shoulder muscle--- the latissimus dorsi muscle (attaches to the iliac crest ).

They serve the origin of many muscles which involved in lower limbs movement. The body anchors the origin for the superioe gemellus muscle; the ischial tuberosity known as sitting bone anchors the origin for the inferior gemellos muscle and hamstrings; the superior ramus is a partial origin for the internal obturator and external obturator muscles; the inferior ramus anchors the origin for the adductor magnus muscle and the gracilis muscle.

Neck pain, stiff neck and poor posture, Tried acupuncture?

Neck pain and a stiff neck

The levator scapula muscle located at the back and side of the neck connecting the neck with the shoulder is most affected. These muscles can be strained by everyday activities: for example, sleep in an awkward position, use a computer for a prolonged period, have a bad posture or have some sports injury such as swimming sudden fall, hold a phone between the neck and shoulder etc. Anxiety and stress can cause tension in the neck muscles leading to neck pain. Tight muscles are often chronic. Tight muscles block blood circulation of the body and muscles don’t get enough nutrition and become weak and easily get further damage. Because of blocked energy supply, you will feel tired all the time. Poor posture is a common cause of tight neck and shoulders. This causes overuse some groups of muscles and causes micro injury to the muscles which become tight to protect themselves from further injury. Furthermore the tight neck will make poor posture worse. It becomes a viscous circle.

Tuesday, 6 December 2022

Which muscles are involved in hip pain? Release hip pain with acupuncture.

The muscles of the hip joint are the muscles involved in movement and pain in the hip. There are four main groups of them.

Gluteal group

The gluteal muscles include the gluteus maximus, gluteus medius, gluteus minimus as mentioned above.

Tensor fasciae latae originates from the anterior part of the outer lip of pelvic bone and inserted about the junction of the middle and upper thirds of the thigh.

Adductor group

This group include five muscles: the adductor brevis, adductor longus, adductor magnus, pectineus and gracilis. They all originate on the pubis and insert on the medial, posterior surface of the femur, with the exception of the gracilis which inserts just below the medial condyle of the tibia. When they contract they move the thigh inwards.

Iliopsoas group

The iliacus and psoas major are the two muscles that belong to illiopsoas group. The pain and trigger points related to iliopsoas is at the hip, the low back and upper thigh. Walking and standing upright can be painful, if there are trigger point present in these muscles.

Lateral rotator group

This group comprises six muscles including the externus and internus obturators, the piriformis, the superior and inferior gemelli and guadratus femoris. These six muscles originate at the lower part of pelvic bone and insert on the top of the thigh bone.

Acupuncture can help reduce hip in most of the cases. For example, A woman aged 37 had left hip pain for 10 years. The pain was always there, sometimes it got worse, and sometimes it got better but it never went. It was a dull aching and throbbing pain. Walking made the pain worse. After 8 weekly acupuncture treatments the pain has completely gone. With one-year follow-up, the pain didn’t come back.

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.

Why can you feel the pain?

Pain receptors

Pain is a signal that is transmitted from the injured part of the body to the brain. Most illness causes pain; therefore the pain signal cannot be ignored. Noxious stimuli elicit tissue damage and activated pain receptors. Activation of pain receptors initiates the process that pain is experienced. Pain receptors are free nerve endings presented in the skin, muscles, joints, bone and viscera. They are sensory receptors that sense and detect tissue damage and then transmit the signal through nerves to the brain. There are three types of pain receptors. First type is skin pain receptors which are in the skin. They can sense pinching, cutting, stretching, temperature, chemicals and other mechanical. If the stimulation is prolonged, these receptors are sensitized and respond more widely. Second type is joint receptors in the joint capsules and ligaments. Third type is visceral pain receptors located in internal organs. Silent pain receptors or sleep pain receptors are these receptors that are normally not responding to noxious mechanical stimulation, however they can become responding to mechanical stimulation (They are awakened and no longer sleep any more) during inflammation and after tissue injury. This is because continuous stimulation from the damaged tissue reduces the threshold of these receptors and causes them to be responding again.

Pain receptors respond as soon as the tissues are damaged regardless the causes. Damaged tissues release substances from lysed cells and newly synthesized inflammatory substances at the site of injury such as globulin and protein kinase, arachidonic acid, histamine, nerve growth factors, substance P, potassium, 5HT and acetylcholine, lactic acid etc. Release of these substances reduces the threshold of the pain receptors and this is so called sensitization. If the receptors are sensitised, low level stimulation which was harmless in origin and did not cause any response before tissue damage can activate the pain receptors causing pain sensation. The response is rapid within 15-30 seconds after injury. The redness appears around the injury site caused by vasodilation and this inflammatory response becomes maximal after 5-10 minutes. Lowered pain threshold is seen in the area.

Recent research has shown that acupuncture is effective to release pain for chronic prostatitis

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