| MOTOR ACUPUNCTURE POINTS FOR NEURO MUSCULO SKELETAL DISORDERS & APPLICATION OF NEEDLING TECHNIQUES.BYProf. Dr A.R. SAMIULLAH and Dr SURENDRA HARISHCHANDRA PATILRPRESIDENT : National Institute of Alternative Medicine System (NIAMS)RCHAIRMAN : Federation of Acupuncture System of Therapy Board (FAST Board),Bangalore- INDIA. Muscle tissue is composed of cells that have the special ability to shorten or contract in order to produce movement of the body parts. The tissue is highly cellular and is well supplied with blood vessels. To accurately determine the location of the body’s musculoskeletal motor point I cross- referenced different sources used for electromyographic studies. To precisely locate the motor points defined as the site in the muscle having the lowest resistance to electrical conductivity, based on the electronic neuromuscular stimulator with an interrupted galvanic current and a standard probe of 8 mm in diameter. The reference area of each point was electrically stimulated until obtaining a muscle twitch with the least amount of current.The motor system is also called as somatic efferent nervous system. It is a set of central and peripheral structures (skeletal muscles and neural connections with muscle tissues) in the nervous system responsible for coordinating motor functions, i.e. movement. Motor Points: A motor point is a point on the skin at which electrical stimulation causes contraction of a muscle. The motor point, found in the central aspect of the muscle where the motor nerve enters the muscle, has the greatest influence on electrical activity and, as a result, the greatest impact on pain. Muscle Imbalance, Muscle Spindles and Yin and Yang Theory :Qi and Blood flow through the channels and collaterals nourishing the Yin and yang and moisten the muscles, bones and joints4.Just s harmony in nature depends on equilibrium between Yin and Yang, human movement depends on balance agonist and antagonist muscle groups in their role of supporting and moving the joints of the body. A muscle that shortens when contracting is an action of Yin. For example, the agonist in elbow flexion, Yang in nature, is the biceps as it shortens approximating the forearm toward the shoulder. On the opposite side of the arm, antagonist and Yin in nature, the triceps lengthens opposing the action of the biceps muscle. Balanced interaction maintains normal function and reflects a healthy balance of Yin and Yang.The spindle consists of a bundle of 3-10 muscle fibers called intrafusal fibers. These fibers are small in diameter and much shorter in length compared to the surrounding larger and more powerful skeletal muscle called extrafusal fibers. The muscle spindle is commonly found in lengths ranging from 2-4 mm. Motor Points: The motor point, the entrance of the motor nerve into the muscle, is defined as the most electrically excitable area containing the greatest concentration of nerve endings.Needling Techniques for Motor PointsIn acupuncture it is much easier to manipulate Yang in order to affect Yin. Applying this principle to needling opposing muscle pairs, it is much easier to relax a shortened muscle (Yang) by needling motor points than it is to strengthen an elongated muscle (Yin). To balance Yin and Yang and restore mu the practitioner must obtain a Qi sensation, (a dull, aching response) or fasciculation, (a local twitch response) when needling motor points. Shallow needling. The needle is inserting perpendicular or oblique just under the skin to touch the superficial fascial layer covering the underlying muscle tissue. This is a useful technique for needling sensitive patients with superficial muscle spasms. For example, in needling GB 21 (Jianjing) the needle enters only the fascial layer of the upper trapezius muscle to release the spasm. |
| Zygomaticus Major: Draws angle of mouth upward and outward as in smiling.Location: SI 18 oblique needle insertion directed toward the corner of the mouth 0.5 inch. Indications: Facial paralysis, twitching of eyelids, facial pain, toothache affecting upper set teeth, excessive wrinkling of skin around eyes and mouth. |
| Semispinalis Capitis:Semispinalis capitis facilitates in extension and laterally bends head to same side. Huatuojiaji PointsSpinal segments C2-T1. Perpendicular needle insertion 0.5-1.5 inches. Nerve: Cervical (dorsal rami)Anatomical position: UB 10 (Tianzhu) perpendicular needle insertion 0.5-1 inch. |
| Splenius Capitis:Spinal segments C3-C6.Anatomical position: Slightly inferior and lateral from Gb 20 (Fengchi). perpendicular needle insertion 1 inch. Indications: Headache, neck weakness, restricted range of motion in cervical flexion and rotation,emotional stress or constraint. Extra indication- also used for vision disturbance and equilibrium disorders. |
| Splenius Cervicis:Anatomical position: Extra point Bailao, 2 cun above and 1 cun lateral from Du 14 (Dazhui). Perpendicular needle insertion 1-1.5 inches toward the C5 or C6 vertebral body. |
| Sternocleidomastoid (SCM):Sternocleidomastoid is one of the largest and most superficial cervical muscles, which connect the sternum, clavicle, and mastoid process of the temporal bone and serve to turn and nod the neck. It flexes cervical spine, laterally flexes to the same side, rotates to the opposite’s side,and extends head (posterior fibers).Anatomical position: Between SI16 (Tianchung) and LI 18(Futu).Perpendicular needle insertion threaded from SI 16 (Tianxhung) toward LI 18 (Futu) 0.5 inch. |
| Rhomboid Major:Anatomical position: Level with the lower border of spinous process T4, 2.5 cun lateral, between UB 14 (Jueyinshu) and UB 43 (Gaohuangshu). Oblique needle insertion 0.5-1 inch. |
| Rhomboid Minor:Anatomical position: Level with the lower border of spinous process T2, 2 cun lateral, between UB (Fengman) and UB 41 (Fufen). Oblique needle insertion 0.5-1 inch. |
| Pectoralis Major:Pectoralis major facilitates in horizontal adduction and flexes of shoulder.Anatomical position: ST 14 (Kufang). Oblique needle insertion directed laterally 0.5-1 inch.Indications:Pectorailsmajor strain and tendinopathy, shoulder and arm pain, thoracic outlet syndrome, clavicular pain. |
| Pectoralis Minor:Anatomical position:Located approximately halfway between the ST 16 (Yingchuang) and SP 19 (Xiongxian) in the third intercostal spaces. Assess depth of the target tissue with finger palpation as this muscle is under the pectoralis major. Perpendicular needle insertion to the assessed depth of pectoralis minor motor point. Caution: To avoid penetrating pleural cavity, |
| Coracobrachialis:Spinal segments C6-C7. Perpendicular needle insertion 0.5-1.5 inches. Anatomical position: Extra point Chupi, 1 cun below Jianneiling. Jianneiling is located approximately halfway between the anterior axillary fold and LI 15 (Jianyu). Perpendicular needle insertion 1-1.5 inches. |
| Supinator: Supinates forearm:Spinal segments C5-C7. Perpendicular needle insertion 0.5-1.5 inches. Anatomical position: Two motor points:Approximately 1-1.5 cun distal from LU5 (Chize) and 0.5 cun toward the radial side. Perpendicular needle insertion 1 inch.With forearm pronated, this point is deep to LI 9 (Shanglian).Perpendicular needle insertion 1 inch. |
| Biceps Brachii (Long Head): Flexes Elbow, supinates forearm, stablilizes and depresses humeral head in glenoid fossa Anatomical position: Two motor points.LU 3 (Tianfu) or slightly to the ulnar side. Perpendicular needle insertion 0.5 inch.0.5 cun distal and slightly toward the ulnar side from LU 4 (Xiabai). Perpendicular needle insertion 0.5 inch. |
| Biceps Brachii (Short Head): Flexes Elbow, Supinates forearm:Anatomical position:1.0.5 cun medial to P 2 (Tianquan). Perpendicular needle insertion 0.5-1 inch. |
| Brachioradialis: Flexes ElbowAnatomical position: Two Motor points: LI 11 (Quchi) toward LU 5 (Chize).2. LU 6 (Kongzui) Perpendicular needle insertion 0.5 inch.Indications: Elbow and wrist pain, weakness with Elbow flexion when wrist is in neutral position. |
Flexor Digitorum Profundus: Flexes distal phalanges of 2nd- 5th fingers. Spinal segments C7-T1. Perpendicular Needle insertion 0.5-1.5 inches. Nerve: Median – Fingers 2 and 3. Ulnar – Fingers 4 and 5.Anatomical position: 5 cun distal from SI 8 (Xiaohal) on a line joining SI 8 (Xiaohal) and P 7 (Dialing). Perpendicular needle insertion 0.5-1 inch.Indications: pain with flexion of fingers, weakness of hand grip strength. |
| Flexor Digitorum Superficialis:Spinal segments C7-T1. Anatomical position: 0.5-1 cun ulnar side of P 4 (Ximen). Perpendicular needle insertion 0.5-1 inch.Indications: Flexor Digitorum Superficial strain and tendinopathy, pain with flexion of fingers, weakness of hand grip strength |
| Flexor Pollicis Longus: Flexes distal phalanx of thumbSpinal segments C7-T1. Anatomical position: 0.5 – 1 cun to the radial side from P 5 (Jianshi). Oblique needle insertion along the radial border 0.5-1 inchIndications: Flexor Pollicis Longus strain and tendinopathy, pain with thumb flexion. |
| Extensor Pollicis Longus: Extends IP Joint of Thumb Anatomical position: Halfway between SJ8 (Sanyangluo) and SJ 9 (Sidu). Perpendicular needle insertion 1 inch.Indications: Pain with extension of thumb |
| Opponens Pollicis: Abducts Flexes and Rotates ThumbSpinal segments C7-T1. Anatomical position: LU 10 (Yuji). Perpendicular needle insertion 0.5-0.75 Inch. Indications: Pain with thumb abduction,carpal tunnel syndrome |
| Dorsal Interossei: Abducts 2ND – 4TH FINGERSSpinal segments C7-T1. Anatomical position: Extra points shang baxie located on the back of the hand in the soft tissue Halfway between the metacarpal bones just proximal to the extra points Baxie and MCP joints. SJ 3 (Zhongzhu) and extra point (Luozhen) share the same location of the dorsal interossei motor points.Indications: Pain in the hand,pain in 2nd -5th MCP joints from arthritis or acute injury, numbness of hand and fingers |
| LUMBRICALS: FLEXES MCP Joints of 2nd -5th FingersSpinal Segments C7-T1. Nerve: Median – 1st and 2ndLumbricals. Ulnar – 3rd and 4th LumbricalsAnatomical position: The motor points are located on a line joining SI 3 (Houx) and LI 3 (Sanjian). The motor point for the first lumbrical muscles is 0.5 inch to the ulnar side of LI3 (Sanjian). The second lumbrical muscles motor point betweenthe second and third metacarpal bones level with first lumbrical muscles motor point.HT 8 (Shaofu) and P 8 muscles. Perpendicular needle insertion 0.5-1.5 inches. Benefits needle insertion of Baxie points between the metacarpal heads.Indications: Pain in the hand, pain in 2nd -5th MCP joints from arthritis or acute injury, numbness of hand and fingers |
| Multifidus: Extends spine, rotates spine to opposite side, stabilizes vertebraeSpinal Segments C1-C4 T1-T12, L1-L5. Perpendicular needle insertion 0.5-1.5 inches.Anatomical position: Huatuojiaji Points of associated vertebral level. Perpendicularneedle insertion 0.5-1.5 inches. Indications: Low back pain, vertebral or disc pathology, organ (zangfu) pathology of associated back Shu (beishu) points, |
| Longissimus Thoracis: Extends spine, laterally flexes spine to same sideSpinal Segments L1 – L5Anatomical position: Inner Urinary Bladder (Pang Guang) meridian points from UB 14 (Jueyinshu) through UB 22 (Sanjiaoshu). Oblique needle insertion 0.5-1 inches. Indications: Low back pain, Longissimus Thoracis spinalis thoracis spasm or strain. |
| Iliocostalis Lumborum: Extends spine, laterally flexes spine to same side, elevates pelvis.Spinal Segments T7 – T12. Anatomical position: Outer Urinary Bladder(Pang Guang) meridian points from UB 44 (shentang) through UB 52 (Zhishi). Oblique Indications: Low back pain, Iliocostalis Lumborum spasm or strain |
| Rectus Abdominis: Flex spine,Spinal Segments T7 – T12. Anatomical position: One motor points located oneach of the bilateral muscles segments on the stomach (Wei) meridian or slightly lateral. Level with REN 15 (Jiuwei). Transverse needle insertion2 -2.5 inches starting from edge of rectus abdominisIndications: Low back pain, constipation and rectus abdominis spasm or strain. |
| Piriformis: Externally Rotates HipAnatomical position: Halfway between UB 53 (Baohuang) and UB 54 (Zhibian). Perpendicular needle insertion 2 – 3 inches.Indications: Low back pain posterior hip pain with external or internal rotation, sciatica, greater trochanteric bursitis and piriforms spams or strain. |
| PSOAS: Flexes hip, Lumbar spine and externally rotates hip Anatomical position: The PSOAS motor point is deep to UB 24 (Qihaishu) approximately 2-3 inches depending |
| Tensor Fasciae latae: Flexes, Abducts and internally rotates HipSpinal Segments L4 – L5 and UB 31 (Shangliao). Anatomical position: Two Motor Points:GB 29 (Juliao). Perpendicular needle insertion 0.5-1 inch.1-1.5 cun directly inferior to GB 29 (Juliao). Perpendicular needle insertion 0.5-1 inch. Indications: knee pain particularly affecting the patella and lateral knee. |
| Biceps Femoris: Flexes and externally rotates knee, extends hip Anatomical position: short Head: 5 cun directly superior from UB 38 (fuxi). Perpendicular needle insertion 1-1.25 inches.Anatomical position: Long Head,Two Motor Points:1 cun lateral from UB 37 (yinmen). Perpendicular needle insertion 0.5-1 inch1-1.5 cun directly inferior and slightly lateral from UB 37 (yinmen). For further information:YouTube Channel: Prof.Samiullah-Fast Board |
Prof.Samiullah – Fast Board