Fig 1: Typical posture often seen with Liver Qi Stagnation. Image courtesy Matt Callison, L.Ac. |
Dysfunction is observed when the Liver sinew channel (which is more posterior than the Spleen sinew previously discussed) is short and the ribcage is closer to the pelvis in the back than in the front, compressing the posterior diaphragm. This compression prevents the diaphragm from being able to descend effectively; patients often must rely more on the accessory breathing muscles, such as the scalenes, which often become tight and restricted. These patients often exhibit chest or paradoxical breathing. Many of them have the typical Liver Qi Stagnation posture seen in Fig. 1. This posture presents with a very straight, rigid spine and an anterior tilt to the pelvis. The chest is often held up in a military-style posture and the patient looks as if they are unable to exhale fully. This posture, along with several others, were presented and discussed by Matt Callison, L.Ac. at the Pacific Symposium in 2011, where he presented research which correlated Zangfu disharmony as described in Traditional Chinese Medicine with common postural patterns. (This was discussed in a previous post.)
Figure 2: Palpation of the QL at Yaoyan. Image courtesy of Matt Callison, L.Ac. from his soon to be released book Sports Medicine Acupuncture. |
Another frequent pain condition which is seen with this posture is thoracic outlet syndrome (TOS) which involves an entrapment of the brachial plexus either between the anterior and middle scalenes, between the clavicle and ribcage, or between the pectoralis minor and the ribcage. In this posture, the scalenes and pectoralis minor are short and holding the ribcage too rigidly up (creating a very wooden spine). I associate these muscles with the Lung sinew channel, but see this as a way that excessive Liver energy can affect the channels associated with the Lung. These patients often have a paradoxical breathing pattern where they pull the abdomen in during the inhale and lift the chest. This uses accessory breathing muscles and they should be elevating the upper ribs, but with the restricted movement in the diaphragm, they have to work overtime; thus they become tight and rigid and can then compress neural structures.
Fig. 4: Anterior pelvic tilt. |
In addition to acupuncture to distal points, direct needling of motor points to muscles such as the QL, scalenes, pectoralis minor, and other related structures can help improve alignment. Also tuina is indicated. I utilize myofascial release extensively in my practice and it can be very helpful in releasing tight fascia and allowing the body to find a more healthful balance. In Sports Medicine Acupuncture and in the KMI training, Simone Lindner teaches a very useful myofascial release technique to the lateral raphe (a fascial structure which then separates to becomes the anterior and posterior layer of the thoracolumbar fascia). This structure is at the edge of the QL; the technique involves working with a seated patient and, using this fascial structure as leverage, lifting their ribcage out and away from their pelvis in the back. Also addressing the front of the diaphragm is useful as it is pulled up. Accessing this fascia under the costal margin and bringing it down will free the breath and soften the Liver channel.
Other sinew channels have a strong relationship to the diaphragm, either directly or indirectly, and can be explored at another time. Most notably, the Pericardium sinew channel influences it via its relationship with the serratus anterior, another muscle which can act as a clamp and restrict proper expansion of the thorax. Needling SP-21 or other points which correlate with motor points of this muscle will increase the Lung pulse, for instance. The Lung sinew channel relates to the pectoralis minor and the scalenes (both discussed in this post) and has a strong relationship to the diaphragm in that these muscles are accessory breathing muscles and, when restricted, can greatly limit breathing. The Yang sinew channels also include many structures such as the abdominals and pectoral muscles that can limit expansion of the breath. Therefore, the diaphragm, with its relationship to effortless and healthful breathing, is one of those pivotal structures for vibrant health.
Note: Tom Myers has an interesting discussion on this fascial plane which I am categorizing as part of the Liver sinew channel. His post can be found here; however, it is not written from a TCM or Chinese medicine prospective.
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