A Blue Poppy blog post by Bob Quinn
As I write this I have just left a unique class we offer at NUNM in Portland, OR: Advanced Palpation and Perception is what we call it. I co-teach it with another colleague, Michael McMahon. There is a basic idea we pursue in this class, and it is that manual therapy has an important role in the practice of acupuncture. We study the integration of Sotai, myofascial release, qigong tuina, teishin use, Trager rocking, and assorted acupuncture strategies. The result is that students enter their internship year well equipped to help patients with diverse physical medicine complaints.
I have met acupuncturists (many actually) who want to do only needle insertions and who are not open to including manual therapies in their treatments. It seems to be an idea that generates some push-back, and yet to me it seems so intuitively obvious that acupuncture and manual therapies are closely related. (I am aware that certain high-volume practice models prevent this sort of manual work, and I am glad that patients of limited means have access to these more affordable clinics.)
Perhaps this bias toward manual therapy on my part is due to my training in various Japanese therapies. In Japan there is a historical relationship between bodywork and acupuncture. The way in China that herbal and acupuncture thinking eventually cross-fertilized never happened in Japan. There it was bodywork that influenced acupuncture, and this, to me, seems a more natural marriage. Both are hands-on therapies after all.
Movement is another question. Many bodywork styles never involve patient movement, as we find in Sotai and some other styles, but this deserves some thought. Consider these quotes from Moshe Feldenkrais, one of the great pioneers in manual therapies (both in theory and practice) of the last 100 years:
“Movement is life and without movement life is unthinkable.”
I credit many people for my interest in movement, not just as a part of assessment, but also as an integral part of treatment itself. Chief among them would be my Sotai teachers—Stephen Brown, Peter Thompson, Jeffrey Dann—and among those I have had the most time with Jeffrey Dann, Ph.D. I wrote some months ago about the benefit of having a mentor, and Jeffrey has filled that role for me, and I deeply appreciate all the learning.
Jeffrey is one of the early pioneers of North American acupuncture and movement is a key feature of the style of treatment he has developed that he calls Koshi Balancing. From my Sotai and Koshi Balancing studies I have learned that patient movement is key in both diagnosis and treatment. In a future blog I’d like to describe why I think this Koshi Balancing system is so ingenious. (We have it on our to-do list here at Blue Poppy to film an online CE seminar on Koshi Balancing with Jeffrey, so that his ideas are more widely spread and appreciated.)
“Movement is life, life is a process. Improve the quality of the process and you improve the quality of life itself.”
Many of our patients come to us for help with physical medicine complaints. Typical would be back pain, knee pain, shoulder pain, but other possibilities show up regularly as well. Often, they have these problems due to movement, e.g., perhaps they work a job that involves repetitive motions. It strikes me as a strange in a certain sense that to treat a movement- generated problem we have the patients lie stock still on a table. I am aware of course that often we are able to help patients to varying degrees with this approach, but that is no argument for it being the only, or best, way to go.
We in AOM could take a tip from the ideas of Moshe Feldenkrais who would often have “patients” (he called them students, not patients) move slowly and gently under his watchful eye and with his hands on them. From this he was able to notice quite a lot that he could take action on in his lesson (he called them lessons, not treatments). For instance, we can watch closely as we ask a supine patient with low back pain to move her ASIS anteriorly toward the ceiling; in this example imagine your hands are resting gently on her ASIS. With trained eyes and soft hands we can perceive a lot, for instance, about what is going on in the “upstream” paraspinal muscles of this patient. The movement chain initiated by this ASIS movement might run into a blockage at some point up the back. The slower and more mindful the action, the more likely we are to notice (and the patient could notice as well) core issues that have led to the discomfort. We become informed where our needles might be placed, and we have a baseline measure to which we can later return to assess the effectiveness of our treatment.
I am not sure if the Portland acupuncture community is similar to what is going on around the rest of the US, but here many practitioners are actively working on ways to integrate various kinds of manual therapy with their acupuncture treatments. Probably most common among them are cranial-sacral work and shiatsu. I suspect we are not in fact unique and that this is a country-wide movement. I consider it healthy and look forward to many practitioners developing novel insights in the coming years from which we can all benefit.