This blog post will look at the influence of the myofascial plane of the Lung sinew channel (jingjin) on the position of the scapula and, therefore, its involvement with injuries associated with postural disparities of the scapula. One key muscle of the Lung sinew channel that influences the position of the scapula is the pectoralis minor, because of its attachment to the coracoid process of the scapula. However, we are also going to look at the portion of the channel distal to this in the arm itself.
The goal of this post is to expand the clinician’s understanding of how shortening and loss of elasticity in the entire Lung channel sinew can contribute to injuries of the shoulder and neck, and then to introduce to the clinician a self-administered set of myofascial release techniques to return length and elasticity to the sinew channel. These techniques will be extremely useful while working with patients remotely, but can be adapted to working with a patient in clinic, and best results will be obtained after a complete acupuncture treatment.
The simple reason that the Lung sinew channel affects scapular position is that the biceps brachii short head and the pectoralis minor both attach to the coracoid process of the scapula. Since the Lung sinew channel of the arm forms a continuous myofascial plane from the thumb to this attachment on the scapula, shortening and loss of elasticity anywhere in this myofascial plane will transmit to the scapula (Fig. 1). The myofascia that makes up the Lung sinew channel (Fig. 2) includes the following:
- Thenar muscles
- Flexor pollicis longus
- Flexor carpi radialis
- Lacertus fibrosis (bicipital aponeurosis)
- Biceps brachii
- Anterior deltoids
It is worth noting also that this channel’s Yang counterpart, the Large Intestine sinew channel, includes the muscles that stabilize the scapula and resist the pull from the muscles of the Lung sinew channel (Fig 3). Specifically, this includes:
- Middle and lower trapezius
Imagine placing an elastic band over this myofascial plane of the Lung sinew channel from the thumb to the coracoid process. Now, imagine that this elastic band was too short. This would pull the thumb closer to the scapula. This could be observed in postural assessment (Fig. 1). First, the elbow would likely be flexed. Next, since the biceps also supinate the forearm, the forearm would be somewhat supinated. Finally, and most importantly, the downward pull on the coracoid process would contribute to an anterior tilt of the scapula.
Next, imagine that you had this shortened and stiff elastic band in place while you were reaching for something such as a dish on a shelf. Under normal circumstances, scapular stabilizing muscles such as the lower trapezius (LI sinew channel) would secure the scapula in place while the elastic plane of the Lung sinew channel elongated (primarily observed as the elbow extends and the forearm pronates). But, with this shortened and stiffened elastic band, these motions could not happen and the scapula would get pulled excessively. Put another way, the movement of the arm would not be able to occur without pulling the scapula along with it (Fig. 4).
There are a couple of key places that we can intervene to return elasticity to this stiffened structure and allow for differentiated movement (the arm reaching without pulling the scapula). As acupuncturists, we would not be surprised that these would be acupuncture points, but they are also fascial regions where the fascial pull of multiple muscles in the channel converges and communicates (Stecco, 2004). LU 1, LU 5, and LU 7 will be the entry points for these myofascial release techniques, and the person performing them will move and stretch the fascia distally away from the scapula. This will follow the direction of the Lung channel.
The step-by-step directions are below for each point. I recommend trying this out on yourself several times before teaching it to a patient. Also, there is a video that shows a demonstration of these steps below.
- LU 7-LU 10: This technique will return elasticity to the distal portion of the Lung sinew channel, help differentiate the LU from the LI sinew channels, open the wrist joint and free the thumb (a binding region of the LU sinew channel) from the forearm. With your fingertips or knuckles, sink into LU 7. Mobilize the fascia from LU 7 towards LU 10 while lengthening the arm by extending the elbow, pronating the forearm, and slightly extending and deviating the wrist to the ulnar side, all while opening the hand. The goal is to not lock any of the joints, but to feel the arm getting longer while stabilizing the scapula.
- LU 5-LU 6: This technique will return elasticity to the mid-portion of the Lung sinew channel, free the humerus from the forearm, open the elbow joint (a binding region of the LU sinew channel), and reduce fascial adhesions and increase gliding between the biceps brachii, brachialis, brachioradialis, flexor pollicis longus, and flexor carpi radialis. With the tips of your finger or knuckles, sink into LU 5. The same movement will be performed as above, but with emphasis on fully extending the elbow joint. The fascia will be mobilized from LU 5 through LU 6. LU 6 is both the xi-cleft point of the Lung channel, but also a motor point of the brachioradialis muscle (Callison, 2019).
- LU 1: This technique will help soften the attachments on the coracoid process to free the scapula from the chest and arm, and will help with proprioception when engaging the muscles of the Large Intestine channel to help stabilize the scapula. Use the fingers to push on the inferior border of the coracoid process. The direction of the push should be superior and lateral (to encourage the scapula out of an anterior tilt and protraction) while the patient uses the muscles of the Large Intestine sinew channel (lower and middle trapezius, rhomboids) to pull the scapula towards the spine and downward.
There are many injuries associated with scapular protraction. Due to the fact that scapular and head position are so intimately related, that list would include not just shoulder injuries, but common neck injuries. These techniques could also be useful for injuries of the wrist (such as De quervain’s tenosynovitis) or injuries of the elbow. The important thing is to prescribe this self-myofascial release technique to patients when you observe scapular protraction and when you observe inability of the arm to move forward in the sagittal plane without pulling the scapula along for the ride. It would be indicated to follow this self-myofascial release technique with a corrective exercise to strengthen the scapular stabilizers. An exercise such as elbow press would be very helpful, and the patient will have a much easier time performing this exercise correctly after freeing the myofascial tissues of the Lung sinew channel.
Callison, M. (2019). Sports Medicine Acupuncture: An Integrated Approach Combining Sports Medicine and Traditional Chinese Medicine.
Stecco, L. (2004). Fascial manipulation for muscoloskeletal pain. Piccin-Nuova Libraria.