The Acupuncture Outsider Podcast

It's important to know the progression of muscle fiber dysfunction to better understand how to treat and how long it may take to correct the problem.   The analysis of current research provides substantial evidence supporting the progression of muscle fiber dysfunction as a significant contributor to musculoskeletal pain, aligning with the hypothesized sequence: sustained muscle tone leading to long-term muscle fiber shortening, which subsequently culminates in painful myofascial trigger points. The initial phase of this progression is rooted in the transition from normal physiological muscle tone to a state of pathological hypertonia or chronic muscle overload. Sustained low-level muscle contractions, even at submaximal levels, are shown to generate sufficient intramuscular pressure to compromise local capillary blood flow. This circulatory impairment leads to localized ischemia and hypoxia within the muscle fibers, precipitating a critical "energy crisis" due to insufficient ATP production. This energy deficit is pivotal for the subsequent development of muscle fiber shortening. ATP is indispensable not only for muscle contraction but also for the crucial process of muscle relaxation, specifically for the detachment of myosin heads from actin and the re-uptake of calcium ions. When ATP is depleted, these relaxation mechanisms fail, resulting in sarcomeres becoming locked in a state of sustained, pathological hypercontraction. This localized shortening at the sarcomere level forms the palpable "taut band" that is a hallmark of myofascial trigger points. Over extended periods, such sustained pathological shortening can also contribute to broader structural changes like muscle contractures, involving fibrosis and a permanent reduction in muscle length. The culmination of this progression is the development of painful trigger points. The sustained sarcomere hypercontraction, driven by the energy crisis and calcium dysregulation, creates a severely acidic local environment. This acidic milieu, coupled with tissue injury from prolonged ischemia, triggers the release and accumulation of various neuroactive and inflammatory mediators. These substances directly stimulate and sensitize muscle nociceptors, manifesting as the exquisite tenderness and characteristic referred pain associated with active myofascial trigger points. Furthermore, the pathophysiology of myofascial trigger points is characterized by a complex, self-perpetuating vicious cycle. The energy crisis and subsequent acidic environment inhibit acetylcholinesterase, leading to prolonged acetylcholine effects and further sustained muscle contraction. Concurrently, mediators like calcitonin gene-related peptide (CGRP) not only potentiate muscle contraction but also directly activate nociceptors. This intricate feedback loop ensures the chronicity of the condition, as the consequences of muscle shortening directly exacerbate the initial problem of sustained contraction and pain. This comprehensive understanding of the progression from sustained muscle tone to muscle shortening and painful trigger points has significant implications for both clinical practice and future research in musculoskeletal pain. For clinicians, it underscores the importance of early identification and intervention for chronic muscle tension and overuse, aiming to disrupt the energy crisis cycle before fixed structural changes or chronic pain states become entrenched. Therapeutic strategies should not only target pain relief but also address the underlying metabolic and biomechanical dysfunctions, including restoring proper muscle length, improving local circulation, and resolving the energy deficit. For researchers, the identified roles of specific molecules like CGRP and the intricate feedback loops within the "energy crisis" model present promising avenues for developing novel diagnostic markers and targeted pharmacological or rehabilitative interventions that can effectively break the self-perpetuating cycle of myofascial pain.   Online Courses: https://richardhazel.podia.com    

I almost never hear discussion about this muscle for midback pain.    My two cents about this muscle and how to assess and treat it.    Online Courses: https://richardhazel.podia.com    

I'm walking you through how I assessed and treated a complex case of cluneal, sciatic and possibly pudendal nerve symptoms. As well as managing the patient's anxiety when symptoms flare.    Online Courses: https://richardhazel.podia.com    

Have you seen neuropathy and chronic myalgia that patients believe happened after taking Cipro?  I've seen it several times.  This might be one of those cases. Best sleep he's had in 20 years after the first treatment of what looked like Sural Nerve Entrapment. I'm covering the Sural Nerve Entrapment in Sydney at the end of March.   https://chinesemedicineeducation.com/product/motor-point-acupuncture-trigger-point-needling-nerve-entrapments/   Online Courses on Podia: https://richardhazel.podia.com For the month of March (my birthday month) I'm giving discounts. 20% off any courses and bundles with the code MARCH20 50% off the Motor Point Location Video Course with the code BIRTHDAY50  

I had an interesting case this week of NTOS and he also had tinnitus that improved from the treatment.   Online Courses: https://richardhazel.podia.com   IG: @richhazel  

The book Crooked by Cathryn Jackobson Ramin is a must-read book for anyone who works with back pain patients or is considering a back surgery for low back pain.   I talk about research the author mentioned and some other research that will blow your mind.   Crooked is available on Audible if you prefer an audio book.  https://www.cathrynjakobsonramin.com/   The Value of Magnetic Resonance Imaging of The Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects   The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting': results from an RCT and blinded trials   Online Courses: https://richardhazel.podia.com  

Anterior shoulder pain on shoulder flexion Anterior shoulder pain on planting a ski pole Pseudo Frozen Shoulder Restricted Shoulder Flexion All cases I saw this week. Pec Major and Lats for the win! (Some dry needling was necessary)   Online Courses and Mentorship Group on Podia: https://richardhazel.podia.com    

Is it frozen shoulder or an impingement? Can we fix a frozen shoulder with acupuncture? Here are my 2 cents.    Thank you, to Feedspot for selecting The Acupuncture Outsider for the Top 15 Acupuncture Podcasts on the Planet.   https://podcast.feedspot.com/acupuncture_podcasts/   Online Courses for Functional Acupuncture:  https://richardhazel.podia.com    

Double Crush Syndrome is mostly seen in the medical field as something rare that happens to people in an earthquake when a building collapses on them.   In the world of successfully treating peripheral neuropathies with Functional Acupuncture it's helpful to take a less restrictive definition of Double Crush.     Online Courses: https://richardhazel.podia.com My website: https://www.richhazel.com  

Why I'm calling my style of acupuncture Functional Acupuncture.   Janda famously said that there are 2 schools of thought in musculoskeletal medicine. Stuctural and Functional. Most are still using the Structural approach (and our patients are paying the price - literally)   Online Courses: https://richardhazel.podia.com  

The functional approach to knee pain will look for movement dysfunction and attempt to correct it.    Others might blame arthritis, the patient's weight, L4-5 issues...   I'm going to look at joint pain as an issue of how the joint moves.   Online Courses: https://richardhazel.podia.com  

Very interesting case this week. And a second case of crippling pain where all the doctors threw their hands up and said, "there's nothing we can do."     Online Courses: https://richardhazel.podia.com BlackFriday Discount good until Dec 31 BLACKFRIDAY20 for 20% off All Courses and Bundles  

I recently treated my own suboccipital muscles and am now realizing how important it is to treat them on people with neck pain and restricted range of motion. These are now in my arsenal for quality of life / mobility treatments.  Online courses  BLACKFRIDAY20 for 20% off all courses and bundles. https://richardhazel.podia.com  

Sounds strange but I don't treat pain.  I see patients for pain every day, but I'm not trying to treat their pain. There's more to it than that.   Online Courses: BLACKFRIDAY20 Discount Code for 20% Off all Courses and Bundles until December 31. https://richardhazel.podia.com  

Interesting case on a college athlete. How I assessed and treated this issue.   Come to the 3rd European Orthopaedic and Sports Acupuncture Congress in Barcelona: Space will be limited to 40 people.  https://integrative-acu-seminars.com/3rd-european-orthopaedic-and-sports-acupuncture-congress/   Online Courses: https://richardhazel.podia.com    

Treating Seniors is a skill you need to learn and there are no books or courses to take. Treating Pro Athletes gets you some prestige but the true test of your assessment and treatment skills as an acupuncturist (as well as your people skills) will be in treating an older population with sub-optimal health statuses.      Online Courses: https://richardhazel.podia.com OCTOBER10 until the end of the month for 10% off everything.  

My First Inferior Cluneal Nerve Entrapment Case! And an update on my ACNES patient.       online courses: https://richardhazel.podia.com OCTOBER10 for 10% off everything until the end of October.  

"Most (musculoskeletal) issues start at the Pelvis" - Vladimir Janda         Online Courses: https://richardhazel.podia.com OCTOBER10 for 10% off Everything Until the End of October.

The unfortunate gap in understanding pain is the musculoskeletal system and the nervous system's response to overuse, pain and injury.     Online Courses: https://richardhazel.podia.com OCTOBER10 discount code for 10% off everything on the site until the end of October    

Some tough pain cases are getting better (fast)!   Here is the link to Podia. My new course just went live.   https://richardhazel.podia.com    

I saw a new patient this week with posterior knee pain and his leg would internally rotate when he had been playing golf for a while.       Online Courses: https://richardhazel.podia.com  

It's not easy to treat a pain that the patient only feels at times when they are not in the clinic with you. You have to go on their memory of where it hurts and what they are doing at that time. On palpation there was no pain to reproduce. Length testing and muscle testing showed nothing.  I had to rely on Dr. Travell to figure it out.       Online Courses: https://richardhazel.podia.com  

Just a review of how I usually treat a leg length discrepancy and some of my tough cases. Foot neuropathies, Cauda Equina Syndrome, Migraines     Online Courses: https://richardhazel.podia.com  

If you're sticking needles into the site of pain you're waving the flag of surrender. If you know the cause of the pain, you should be getting good/great results in your first treatment and have it resolved or greatly improved very quickly soon after, in most cases. If you are sticking needles into things where they hurt, you're likely missing the real cause of the problem.  Yes, I'm going to piss people off. But Janda and Lewit were right. "He who treats the site of pain is often lost"!     Online courses: https://richardhazel.podia.com    

I recently saw a discussion about treating the psoas with acupuncture techniques like fascial pecking on the abdomen, treating the segment, addressing other issues like the abdominals and core, distal points.   What should we do and why?    All of the above are good, but there are times when the motor point is essential. Here's my take.   Online Courses: https://richardhazel.podia.com  

More gold from Dr. Trescot's book.  There are many ways to entrap the radial nerve. The ones we can address with acupuncture can respond very quickly.    Here's Dr. Trescot's Book on Amazon. (The Springer site has it for about $100 more than Amazon) https://a.co/d/2QN64U4   My online courses are here: https://richardhazel.podia.com    

Something I was teaching in Amsterdam recently. Easy to miss, but easy to treat.   As I mentioned, you can learn more about Dr. Jenny Nieters' Courses here: https://alamedaacupuncture.com/learn-sports-acupuncture-with-jenny-nieters/   My courses are here: https://richardhazel.podia.com    

This is my favorite way to find hip dysfunction for people who have hip pain or for athletes who want to avoid injury and have better sports performance.       My online courses are here: https://richardhazel.podia.com

Just got back from Amsterdam. We had a great Congress. I'm discussing what you missed and then some details I wanted to mention about the Gluteus Minimus that you won't hear most of the time.     https://richardhazel.podia.com    

Most likely your doctor looks at your pain as a structural issue. i.e. Joint inflammation needs an anti-inflammatory.  Unless you need a surgical intervention, Janda would have seen your pain as a functional problem. Your sensorimotor system is having problems.  This is why I'm 100% in the Janda camp and why it gets such great, lasting results.         If you are an acupuncturist and are wanting to learn motor points, come to Amsterdam in June: https://integrative-acu-seminars.com/2nd-european-orthopaedic-and-sports-acupuncture-congress/  

There are some new devices for Restless Leg Syndrome that use electric stimulation to stimulate the afferent nerves of the low leg.   What's the connection to the Superficial Peroneal Nerve and Restless Leg? I'm not sure, but I'm willing to start treating patients with this in mind.   Also, some updates on tough nerve entrapment cases.   If you are an acupuncturist and are wanting to learn motor points, come to Amsterdam in June: https://integrative-acu-seminars.com/2nd-european-orthopaedic-and-sports-acupuncture-congress/   My online courses are here: https://richardhazel.podia.com    

Recognizing symptoms of peripheral nerve entrapment is critical for chronic pain patients who have gotten no relief from the usual standard of care and diagnostic exams.    When you know the symptoms, you can rule in or out a peripheral nerve entrapment and then palpate the typical entrapment zones to confirm you are on the right track.    If you are an acupuncturist and are wanting to learn motor points, come to Amsterdam in June: https://integrative-acu-seminars.com/2nd-european-orthopaedic-and-sports-acupuncture-congress/   My online courses are here: https://richardhazel.podia.com    

People often ask questions about how to use electric stimulation of an acupuncture needle in the motor point of a muscle. They want to know why and how and for how long.  I attempt to give some answers based on what I have seen. There are so many opinions about it that I thought it would be best to give you the basic explanation that has worked well for me. If you're happy with your results, that's what you should do.  I leave it to others to dispute the minutiae of frequencies and points and length of treatment.  If you are an acupuncturist and are wanting to learn motor points, come to Amsterdam in June: https://integrative-acu-seminars.com/2nd-european-orthopaedic-and-sports-acupuncture-congress/   My online courses are here: https://richardhazel.podia.com    

Some updates about Amsterdam and the recordings on Podia and the Mentorship Membership on Podia.   Here's the registration link for Amsterdam in June: https://integrative-acu-seminars.com/2nd-european-orthopaedic-and-sports-acupuncture-congress/   Here's the Podia link: https://richardhazel.podia.com   This episode is about a recent patient with SIJ pain and it was due to the psoas being tight.     

Coracobrachialis issues that are often missed for pain and mobility and cutaneous nerve symptoms.   Here's the Amsterdam Link: https://integrative-acu-seminars.com/2nd-european-orthopaedic-and-sports-acupuncture-congress/   Podia Online Courses Here:  https://richardhazel.podia.com    

I had a rough week trying to sleep with terrible neck pain that was giving me a right-sided headache almost like a migraine.     https://chinesemedicineeducation.com/event/motor-point-acupuncture-mastery-using-jandas-crossed-syndromes-as-a-roadmap-to-success-plus-advanced-treatments-for-nerve-entrapment-syndrome/   https://integrative-acu-seminars.com/2nd-european-orthopaedic-and-sports-acupuncture-congress/   For the month of March 2024 everything on Podia is 20% off with the discount code MARCH20 at checkout. You can use it as many times as you want. https://richardhazel.podia.com    

Know the signs of issues with these intrinsic foot muscles. They will help with plantar fasciitis and other foot pain.   Also, here are the live seminar links I mentioned:   https://chinesemedicineeducation.com/event/motor-point-acupuncture-mastery-using-jandas-crossed-syndromes-as-a-roadmap-to-success-plus-advanced-treatments-for-nerve-entrapment-syndrome/   https://integrative-acu-seminars.com/2nd-european-orthopaedic-and-sports-acupuncture-congress/   For the month of March 2024 everything on Podia is 20% off with the discount code MARCH20 at checkout. You can use it as many times as you want. https://richardhazel.podia.com    

Sometimes that low leg pain and numbness is an entrapment of the superficial peroneal nerve. It's not always an L5-S1 radiculopathy.  Pain on plantar flexion and inversion can be a sign of superficial peroneal nerve entrapment. https://linktr.ee/richhazel   Everything on Podia is 20% off until the end of March. Use the discount code MARCH20 as many times as you want until March 31. 

Everyone who uses motor points and trigger points in their acupuncture treatments owes their thanks to these MDs.   https://richardhazel.podia.com    

Why should we care about the Upper and Lower Crossed Patterns? How does it help to know the difference between a tonic and a phasic muscle?         https://richardhazel.podia.com https://www.richhazel.com  

Some people say that posture has no connection to pain. I disagree.    Happy New Year!!      https://richardhazel.podia.com

Dr. Vladimir Janda and Karel Lewit were pioneers of musculoskeletal medicine who have given us a roadmap to understand assessment and treatment of pain.   Assessment and Treatment of Muscle Imbalance: The Janda Approach https://a.co/d/0JCe9vt     https://richardhazel.podia.com    

I'm really happy to see a daily migraine patient cancelling appointments because they have gone a month without a migraine! I've updated how I treat migraines. It's always a work in progress. I have to learn from clinical experience and doctors like Dr. Andrea Trescott so I'm sharing what I have learned so far in hopes it will help others.   https://RichardHazel.podia.com  

I see patients in their 70s 80s and 90s that I don't run through a range of manual muscle testing for their pain. This is how I prefer to assess and treat. And it works very well.     https://richardhazel.podia.com    

Two interesting cases this week to share.   Here's my website link for the Seminar in Italy: https://richhazel.com/live-seminars/   https://richardhazel.podia.com    

There are some key considerations that have helped me with foot numbness, tingling, hot/cold sensations.   Online Courses and Mentorship Community https://richardhazel.podia.com    

Isn't it likely that osteoarthritis is due to unaddressed muscle imbalances? It seems to be the case clinically. This is a case from this past week of an 87 year old woman with constant knee pain that has her now in a wheelchair.    

I think that learning a subject from the source material, research, science has been the key to getting excellent results for me. I think when you learn a "system" from someone, you are limited by their system, especially if they don't share their source material so that you can keep learning.     https://richardhazel.podia.com    

Gua Sha is soft tissue manipulation but all not all soft tissue manipulation is Gua Sha.   There is a difference and here's what it is.   https://richardhazel.podia.com  

A patient with a diagnosis of Plantar Fasciitis will have different symptoms from the last one you saw with the same diagnosis and different from the next as well.   We need to think about foot biomechanics, nerves, the plantar aponeurosis and we need to know specifically where the patient is having pain.   https://richardhazel.podia.com    

Entrapment of the superior cluneal nerve can be a source of chronic low back pain, especially after lumbar disc surgery.  It can be a source of psuedo-sciatica as well.   https://kangfu.eu/european-orthopaedic-and-sports-acupuncture-congress/   https://richardhazel.podia.com