Pain-free near Gonzales Bay

Acupuncture in Action, for Back Pain: A Case For Adaptation & Pain

If you wonder what a Kiiko Matsumoto japanese-style acupuncture treatment given by Carmelle LeMaistre can be like, read on. Alix Jean also shares her insights, and a photo from Kat Ao because, hey that’s what collectives do.

Introduction: The problem to solve is not the pain itself.

CL: I recently gave an acupuncture treatment to a client who suffers from acute back pain. The pain started in his mid-back, wrapped around and down the back of his ribs. His doctor had diagnosed him with disc degeneration and osteoarthritis in the spine. After our chat, I left the room for him to change and get comfortable on the table. I was surprised to find that when I came back into the room, he lay face down, ready for needles in the back. Not what I instructed but makes sense, he’s in for back pain. We often think if something hurts, the pain is the problem to be fixed.

With Kiiko Matsumoto Style (KMS) acupuncture however, we don’t just seek to treat the discomfort; we look for the adaptation. The problem to solve is not the pain itself. Rather the goals are to understand how the pain is useful for the given situation, and to create a new situation where it is no longer “helpful” or needed.  I asked him to turn over so I could feel his abdomen, the starting diagnostic point for every treatment in KMS style. I hoped the abdomen could help lead me to the why.

Method: Diagnosing the Abdomen

CL: The abdomen showed me a hyper-vigilance in the autonomic nervous system–common with any pain. Oketsu sign was present (lower left abdomen) – likely from constipation caused by pain meds.

AJ: Oketsu is a KMS style term, in Chinese medicine loosely analogous to Liver Blood Stagnation. Correlated with a blockage of optimal blood flow, likely somewhere in the abdominal, pelvic or thoracic cavities, potentially related with a congestion in the rectal veins or hepatic portal vein (the main vein taking blood to the liver for processing) but can have full-body effects.

CL: Immune reflex was tight (lower right abdomen). There is a global pandemic after all.

AJ: In KMS, the Immune reflexes are related to the lymphatic system, where most of our immune cells live. It can be more gut-related, as 80% of lymphatic tissue is surrounding the gastrointestinal tract. Or it can be related with an “external invasion”, as in bacteria/mold/virus that the system is fighting off.

CL: And the anterior superior iliac spine (front of the hip) was painful , ipsilateral to the back pain. He has a history of lower lumbar spine injury and surgery, and resulting sciatica. So we knew the hips were already myofascially involved.

AJ: myo = muscle, fascia = connective tissue, therefore ‘myofascial’ means relating to the connective tissue surrounding muscle, and the muscles themselves. Fascia forms an interconnected web of tissue which not only keeps our body together, it holds patterns of movement and injury which interact with the ways we feel our bodies. Fascial tension is a key aspect of what changes with acupuncture treatments.

So Here We See the Pain is Very Helpful!

CL: His recent back issue comes from calcification in the spinal disc and inflamed arthritis in the mid-thoracic spine. My sense was that the mid-thoracic spine was taking a lot of compensation from the old lumbar injury. The spine could literally not hold itself up anymore. At least not without help. So the erector spinae muscle group, the spine stabilizers, took over to do its job. The erectors work hard, spasm and cause pain. After all, they’re doing a lot of work to keep him upright. We found the adaptation. Now if I took this adaptation away, treat the pain from spasming erectors – the weight of the body would fall back on the arthritic spine – so here we see the pain is very helpful!

This is where I make a case against intramuscular stimulation (IMS). To assume that all pain and muscle/fascia tension is something to be needled away for instant results in some way assumes that our body is not the intelligent sophisticatedly-evolved organism that it is.  The pain in the erectors was not the issue. The pain is the adaptation, the down-river effect, working around the original issue. Without treating the inflammation of the spine, the erectors might release temporarily while lying down. But as soon as tension was back in the system (from standing up and moving around for example) it would start to spasm again to protect the spine. I see this a lot with IMS–that the pain goes away quite quickly but is back the next day.

AJ: IMS aka “dry needling” is a common practice amongst physiotherapists and other health-care practitioners who use “acupuncture needles” to stimulate a twitch-and-release response in local areas of pain. It is generally much deeper, much more localized, induces more sensation, and does not adhere to the principles of Chinese/Japanese acupuncture within which Registered/Licensed Acupuncturists are trained.

Part of the Adaptation is Also Stress

CL: The other piece of the puzzle is that our muscles and fascia are neuroceptive – this means they can sense stress and safety and respond accordingly. Activated pain receptors send a high amount of cortisol into the system. This signifies a global stress response that it is not safe for muscles to relax and we should prepare to fight or flee, or commonly, freeze. So then, part of the adaptation is also stress. To needle big muscle groups directly with IMS doesn’t treat global stress in the nervous system. In fact, it can make these neuroceptive tissues feel even more threatened.

Which brings me to part of my treatment philosophy that is not always easy to hear:

  • Pain is usually a good thing. It’s a sign your body is trying to tell you something. Sometimes getting rid of your pain is not the best way to treat the whole body issue. Maybe this brings up bigger cultural issues around how we deal with discomfort, our constant strive for optimal productivity, the notion that a body in pain is something to be fixed and not listened to. Sometimes pain is very important, even necessary. In this case, the pain was essential to keep his spine upright without  further damage. His pain was wise.
  • Pain is always emotional. We can debate the chicken/egg here but the fact is that cortisol from stress increases inflammation which causes pain – pain causes more cortisol which signals stress – and the cycle goes on, no matter which came first. Culturally we are about as good at feeling our feelings as we are with the few days wait for that online purchase to arrive. I don’t want to gender things to much here but I do see a connection clinically with men of the older generations, who were raised to be stoic and who have chronic back pain. Just saying.
  • Healing is a process.  The best we can do in a session is create optimal conditions for the adaptation to not be needed anymore and trust that the body is the wisest one to guide the way to safety.

Conclusion: He came back the next week.

I did not feel like I could treat the pain. I could not in good faith release the spasms. Because I knew the spine was not ready to take the load. My sense was the body needed more time to find its way back to safety. But I could: help regulate the nervous system cortisol responses (through the kidney/adrenals), and bring down the inflammation on the arthritic discs with moxa. I treated the hip and rhomboid imbalances that were caused from the older lumbar spinal issue, to help restore some fascial integrity to stabilize the spine. We cleared the Oketsu reflex, hoping for a bowel movement and used Master Nagano’s old faithful Immune points.

AJ: Moxa – Short for moxibustion. A technique that uses heat over acupuncture points or the surface of the skin to promote blood flow to the area and reduce inflammation.

CL: Did it release the erectors? Not really. Did it help the pain? Kind of. And the rest: trust the body to do its thing.

He came back the next week. Several consecutive days with improved pain and weaning off the pain meds. The erectors were about seventy percent better and a new fascial pattern emerged. The nervous system was markedly improved on palpation. Most importantly there was a renewed sense of ease – maybe even some trust in the body’s unfolding process of adaptation.

Thoughts on Deepening our Relational Capacities in the Midst of Social Movements

To engage in social movements, activism or frontline work is to engage directly with the injustices of this world. To witness, participate, and to support each other during these painful times is a heroic act of nervous system disregulation. What we sacrifice and endure to be a part of justice moments needs to be held carefully and collectively. Restoring our capacity for relational connection — with ourselves and others — can be a potent resource for building resiliency in our movements for a more just world.

From a neurophysiology view, exposure to sensory information like injustice & harm doing, can shift our neuroception (nervous systems assessment of safety) out of social engagement and relational capacities (right brain, ventral vagal states), and into orienting and survival responses (left brain processing & dorsal vagal states). We may start to find that with our attunement and co-regulation abilities switched off (ability to connect and join nervous systems with others safely), that we start to feel isolated, feelings of fear arise, anger and anxiety increase, or the need to consume more media to try to rationalize our experience into safety. This can be further emphasized if you have a history of trauma or attachment wounds, as these neuro-pathways may already be deeply embedded, awakening our implicit experiences and bringing them to the surface.

With our survival instincts on guard, implicit memories awakened and relational capacity muted, we may be triggered more easily, move into anger before compassion with loved ones, or generally disconnected with the emotional states of people we encounter in our daily lives. This is normal and adaptive and a sign that your nervous system is trying to keep you safe the best way it knows how. But it is also for this reason, that we need to be mindful of the ways in which we participate in cultural somatics and the ability for us to perpetuate systemic oppression within interpersonal relationships or within our justice movements, in times of trauma and stress.

Some examples of what may shift you out of relational capacity may already be in your awareness and extend beyond your activism or frontline work: witnessing suffering, violence or injustice (directly & indirectly), experiencing personal harms, or structural oppressions like racism & sexism. Some experiences may be more subtlety embedding: increased external stimuli — loud noises, flashing lights, crowds. Media consumption like scrolling apps, news/tv, radio (as information floods the brain it shifts into left brain processes to file), basic needs not being met- food insecurity, financial stress, isolation, or being around others/in relationship with those who are dis-regulated.

Restoring our relational capacity should be at the forefront of our activism and justice movements because within that lies our individual and collective resiliency. Becoming relational — meaning in connection with others and our bodies — is simply a way to shift our brains orienting from survival to safety. The beautiful thing about this is that when we restore our nervous systems social engagement system, we are able to share and extend that felt sense of safety (ventral vagal state) with others (co-regulation) which impacts our relationships and communities, widening the window of tolerance all around us.

There are many ways to do this, and the resources you call on may change from situation to situation. Coming back to embodiment and relational states is a practice and should be approached with an openness and curiosity as to what is called for in the moment. You likely already have tools and practices through your innate wisdom, as we are all wired for connection. I like to think of these practices as two categories although both categories are overlapping and guide your nervous system to the same end .

  1. Relational practices — i.e. co-regulation & joining nervous systems with others to broaden your window of tolerance. These can be simple practices in your day to day interactions like being kind to others, making eye contact, smiling. Or more intentional practices like joined breathing exercises, physical touch and affection, hand holding, cuddling, joined pleasure & sex, eye gazing, dancing or movement with others, bodywork & acupuncture.

  2. Embodied practices: i.e.- Connecting us to our felt sense of safety in our bodies. Sometimes this can be harder for folks, especially if there is a history of trauma. If that feels true for you, start first with relational practices, to expand your window of tolerance in the presence of a trusted other. From there, try tapping into moments of your felt sense of safety while in connection. Embodied practices might include movement exploration or exercise, dance, stretching, mindful body scans, breathing exercises, bodywork, acupuncture, self touch & self pleasure.

Coming back to relational states can help us build resiliency, resist burn out, restore optimism and make community care more accessible. It can be centered in joy and celebration. It can feel like the antidote to the grief and uncertainty of working within justice movements. Over time, I hope it can become more central to our movement work.

https://medium.com/@carmellelemaistre/thoughts-on-deepening-our-relational-capacities-in-the-midst-of-social-movements-c31ee83ccde8

We Need Our Planet

Acupuncture in Action with Kat: Conflicts Inside and Out

A peek into an acupuncture treatment with Kat Ao.

Yesterday a young man booked his first acupuncture session, looking for relief for an aching upper back muscle. Over half way into the treatment, he mentions the point I just used, the eighth in the session, is the first that’s actually felt like a needle (the previous points didn’t bring on a needle-like sensation). This cued me to explain one of my favorite features of Japanese-style acupuncture: If the short-term goal is to help our bodies out of a stressed state that causes pain, then the process has to be just as stress-free. In other words, healing is a process.

Back to the treatment. I explained how tension on his right hip, abdomen, and left shoulder can contribute to that nagging upper back. To test that I used points that released these distal tensions. And that nagging spot also toned down. So some myofascial connections were there. I listen to his story and we agreed the persistence of the pain (seven years!) didn’t seem to line up with what started it. And so I offered a possible pathophysiological explanation that may line up with the myofascial tensions. This cued me to explain two more great things about J-style: 1) musculoskeletal anatomy interacts with internal functions. In short, everything’s connected. 2) The long-term goal is to help our bodies respond appropriately to our present contexts. In short, change happens.

The hour ends and he feels different, like the conflict between him and his back has shifted. Results can happen when we respect that: a) healing is a process, b) everything’s connected, and c) change happens. These principles are relevant beyond an acupuncture treatment, and it’s that integrity between how we live in our bodies and what’s in our external environment that can be so inspiring. I’m grateful for communities that live by these principles and stand up for our future. And hope that in our own way as acupuncturists and as receivers of acupuncture, we contribute to something better.

Resilience is Fertile: This is Your Liver on Acupuncture

We all want better habits, more flexibility, and perhaps broader perspectives. As it turns out, our bodies innately do this. Though sometimes it can be a struggle. Fortunately acupuncture can help us keep calm, and help our liver carry on.

Our Inner Resiliency

The liver is part of over 500 functions all over our bodies. For example, the liver helps process food, medications, and toxins. Allergic reactions and hormonal cycles depend on the liver. And to top things off, it regenerates itself. Regenerates. Itself.

Which is amazing, but what’s more is that the cells can change and even create structures that didn’t previously exist. From finding the energy to do things, to eliminating the unnecessary, to self-care, our liver can be a mentor for becoming our best selves.

Rebuilding tissues which our bodies need and that aren’t malignant requires the appropriate signals from our nervous system. As an example, research has found that the same versatile liver cells that can build a necessary bile duct can also spread cancer. The difference depends on the message. An ideal acupuncture treatment aids in making sure that the right signals are being sent. Clear messages need to go to not only your liver, but to all essential body systems like circulatory, immune and endocrine.

Our Inner Fertility

And so, acupuncture for fertility requires work on the entire nervous system. In a way, it’s about preparing the soil before planting a seed. Kiiko Matsumoto style acupuncture can help the sympathetic (flight or flight) and parasympathetic (rest and digest) functions of the nervous system be in perfect tandem. Because of this, its central diagnosis and treatment interventions rely on palpatory (touch-based) findings.

Furthermore Kiiko Sensei has developed effective treatment strategies for many common liver pathologies like systemic detoxification, to help the liver break down and excrete toxins. There are treatments for liver inflammation, which often shows up in mood and digestive complaints. And fatty liver treatments help with the absorption of fat, cholesterol and bile production.

So breathe a sigh of relief and book in a session. Let’s get ready for the rest of this busy summer season.

References

Izumi, Tomohito, et al. “Vagus-Macrophage-Hepatocyte Link Promotes Post-Injury Liver Regeneration and Whole-Body Survival through Hepatic FoxM1 Activation.” Nature News, Nature Publishing Group, 13 Dec. 2018, www.nature.com/articles/s41467-018-07747-0.

“Autonomic Regulation of Liver Regeneration After Partial Hepatectomy in Mice.” Journal of Surgical Research, Academic Press, 27 Mar. 2008, www.sciencedirect.com/science/article/pii/S0022480408001601.

“Cancer Most Frequently Spreads to the Liver; Here’s Why.” ScienceDaily, ScienceDaily, 6 Mar. 2019, www.sciencedaily.com/releases/2019/03/190306131418.htm.

“How Some Liver Cells Switch Identities to Build Missing Plumbing.” ScienceDaily, ScienceDaily, 2 May 2018, www.sciencedaily.com/releases/2018/05/180502132119.htm.

“Your Liver Is Essential to Your Life. The Canadian Liver Foundation.” Canadian Liver Foundation, www.liver.ca/your-liver/.

Post-traumatic stress disorder in our community

The clinical term is post-traumatic stress disorder (PTSD). And it’s a part of so many of us. I offer acupuncture temporarily at Lifemark Esquimalt. Working there I meet people that serve in the Canadian Forces. The stories their bodies share come to mind when I read this recent commentary by Romeo Dallaire on a recent tragedy,
“The brain is as vital to life as any organ in the human body. To treat an injury to the brain as less urgent, less in need of care and compassion than other, more obvious types of injury is misguided and ignorant. Our efforts to treat our veterans with PTSD must be comparable to our efforts to repair damaged hearts, provide timely kidney transplants, avoid amputations or restore eyesight.” Read more from Romeo Dallaire here.
And if you like research results, this from the Journal of Nervous and Mental Disease, and this from the American Public Health Association both show results of acupuncture’s efficacy in managing PTSD symptoms in veterans.To define PTSD there’s the criteria set by the Diagnostic and Statistical Manual of Mental Disorders. It’s a list of mostly psychological symptoms. Connecting these to physical symptoms and addressing both is where acupuncture and Chinese Medicine shines.