Addendum to “Spinal Offsets and the Huatuojiaji Points: A Zangfu Perspective” Webinar with Lhasa OMS

Matt Callison and I were recent guests on a Lhasa OMS hosted webinar. We discussed Huatuojiaji points, vertebral mechanics, spinal offsets and their relationship to the Zangfu. This blog post will complement the information from the webinar and it contains information from the upcoming Module I webinar for SMAC where we go into considerably more detail on this subject. Click here to view the webinar.

Vertebral Mechanics — Addendum to Spinal Offsets and the Huatuojiaji Points: A Zangfu Perspective | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 1: A schematic showing a right spinal bend as seen from the posterior view

A spinal offset is essentially a spinal bend through a region of vertebrae. There is a concave and a convex side. We name the bend based on the direction the top of the bend faces. This would also be the side that contains the concave curve. So, the curve in Fig. 1 would be a right bend as the concave portion in on the right and the top of the curve faces to the right. In reference to postural assessment, we define a spinal offset as a sagittal plane deviation because it moves away from, or deviates from, the sagittal plane.

When prescribing exercises after treatment, we teach sagittal plane exercises for sagittal plane deviations. For spinal offsets, this would involve trunk flexion and trunk extension as this moves the spine in the sagittal plane. For this blog post, let’s briefly explore why trunk flexion and extension would assist in the reduction of spinal offsets. Keep in mind during this discussion that spinal mechanics are a bit complicated. This explanation is here for those who want to have a better understanding of the underlying mechanics. In clinic, you can always resort back to the simple formula of prescribing sagittal plane movements for sagittal plane deviations for ease and speed when working.

Vertebral Mechanics — Addendum to Spinal Offsets and the Huatuojiaji Points: A Zangfu Perspective | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 2: T9 is right side bent and left rotated on T10

During flexion, the vertebral facets open and during extension they close. When a vertebra rotates on the vertebra below, the facets close on the side it rotates away from. We describe the rotation based on which direction the front of the vertebral body faces. If T9 was right rotated on T10, the vertebral body of T9 would face to the right and the right transverse process would be more posterior. Another useful thing to know is that vertebral side-bending and rotation are coupled, which means these movements occur together. For the lumbar and thoracic spine, the normal movement is for side-bending and rotation to be couple to the opposite side. Again, if T9 was rotated to the right, it would side bend to the left (Fig. 2). You can feel this coupled nature if you place your hands on your back with one hand over the transverse processes on the left side of a vertebra and the other hand on the right side at the same level. If you side bend to the left, you will feel these segments rotate to the right.

Vertebral Mechanics — Addendum to Spinal Offsets and the Huatuojiaji Points: A Zangfu Perspective | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 3: The deep paraspinals are locked-short on the left, contributing to the left side bend and right rotation of T9 on T10.

During flexion, the vertebral facets open and during extension they close. When a vertebra rotates on the vertebra below, the facets close on the side it rotates away from. We describe the rotation based on which direction the front of the vertebral body faces. If T9 was right rotated on T10, the vertebral body of T9 would face to the right and the right transverse process would be more posterior. Another useful thing to know is that vertebral side-bending and rotation are coupled, which means these movements occur together. For the lumbar and thoracic spine, the normal movement is for side-bending and rotation to be couple to the opposite side. Again, if T9 was rotated to the right, it would side bend to the left (Fig. 2). You can feel this coupled nature if you place your hands on your back with one hand over the transverse processes on the left side of a vertebra and the other hand on the right side at the same level. If you side bend to the left, you will feel these segments rotate to the right.

Vertebral Mechanics — Addendum to Spinal Offsets and the Huatuojiaji Points: A Zangfu Perspective | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 4: Example of a spinal offset.

When there is a spinal offset, there will be a group of vertebrae that side bend and rotate as they move away from the midline. This will then change directions at the apex of the curve as the vertebrae move back to the midline. Again, there will be a change in direction as the vertebrae meet back at the midline. Let’s look at an example (Fig 4). In this patient, there is a prominent right bend in the spine from L3-T10. The vertebra from L3-L1 are left side bent and right rotated all the way to the apex of the curve which is at L1. Then, the vertebra from L1-T10 are right side bent and left rotated from the apex to the where the spine comes back to the midline at T10. All of the side bends and rotations will cause facets on one side to be more open and facets on the other side to be more closed. The regions of the apex and where the vertebra leave and return to the midline are particularly under stress and there is a change in direction and an increase likelihood of the facets to become fixated with one side stuck in a closed position and the other stuck open.

In the Sports Medicine Acupuncture Certification program, we teach a specific needle technique at the Huatuojiaji points for vertebral fixations which addresses the excess and deficiency found in the deep transversospinalis muscles. And, we teach a specific mobilization technique to return movement to the fixated facets. Finally, we have protocols for extraordinary vessel points to address the channel imbalances associated with fixations at each level. The combination of the distal extraordinary vessel points, Huatuojiaji point needling and combined with mobilization techniques are fantastic to address the levels where the vertebral facets are fixated.

Myofascial release techniques and corrective exercises can then be employed to align the spine and reduce the curvature at the spinal offsets. If we encourage movement in the sagittal plane, we are encouraging the facets to open in trunk flexion and close in extension. Since vertebrae that are rotated and side bent have an open and a closed facet, this balanced opening of the facets in flexion and closing of the facets in extension would move and decrease the rotation of the vertebral segments found in the spinal offset.

Let’s look at this in a very simple myofascial release technique which involves patient movement of flexion and extension of the spine. Note, it might not be appropriate for certain cases of radiculopathy and/or facet pain to employ patient movement involving trunk flexion and/or extension. Let pain be your guide and we can discuss more strategies in the upcoming classes for Module I.

About the author(s):

Brian Lau, AP, C.SMA is has been on the faculty of the Sports Medicine Acupuncture Certification since 2014, and also teaches foundation courses with AcuSport Education. Brian lives and practices in Tampa, FL where he owns and operates Ideal Balance: Center for Sports Medicine Acupuncture (www.ideal-balance.net). He blogs on anatomy and TCM at www.sinewchannels.com.