Acupuncture for Neck Pain
There are many acupuncture points for neck pain yet choosing the right ones can be challenging. Popular points like GB 20 and GB 21 can be effective but are invasive. Points like small intestine 3 (SI 3) and UB 62 are also indicated for neck conditions, but as a pair they are usually insufficient on their own. Luo Zhen (Ex - UE - 8 / 22.03) is very effective for acute conditions but responds best when also used with triple warmer 3 (TW 3 / 22.06).
Then there are the Master Tung points like the Three Weights (77.05, 77.06, 77.07), the 7 Tigers (77.26), 22.03, 22.06 and points on the palm 22.01 & 22.02.
With so many points to choose from, how do you determine which ones will give the best results? What form of pattern identification do you use to choose the points? What do you do if your first point groups don't work?
Understanding the anatomy of the myofascial lines can help every acupuncturist get better and more efficient at treating neck disorders.
Myofascial lines or chains are similar to the meridians.
The image shows what are known as the Back Arm Lines. The section on the left mirrors the small intestine meridian and is known as the Deep Back Arm Line (DBAL). The right side covers the area of the large intestine and triple warmer meridians in the arms, and is known as the Superficial Back Arm Line (SBAL). Notice that the points TW 3, TW 5, Luo Zhen, and LI 4 are all a part of the SBAL, while SI 3, SI 10, SI 11, SI 12, and SI 13 are all on the DBAL.
This is important for acupuncturist to understand as the myofascial lines provide a basis for the meridians. With knowledge of the fascial lines acupuncturists can improve their point selections and get better clinical results.
The Urinary Bladder Meridian and the Superficial Back line
The Superficial Back Line (SBL) from Anatomy Trains by Tom Myers, Elsevier Publishing.
This image is of the Superficial Back Line (SBL) and includes the achilles tendon, calf muscles, hamstrings, paraspinals, neck muscles, and occipital fascia. The muscles and connective tissues on the SBL form a functional and structurally related myofascial line - the SBL.
The myofascial lines help us to understand many dynamics that happen with acupuncture. For instance, distal needling is often more effective than local needling for many conditions of the spine. This is why points like SI 3, SJ 3, Luo Zhen, UB 60, UB 62, and 77.01 - 77.04 are highly regarded for conditions of the neck and back.
Remember the old adage about using the opposite end of the meridian to treat the symptomatic side?
We find this concept and treatment method used in many different styles of acupuncture including TCM, 5 Elements, Korean Hand Therapy, Master Tung style and the Balance Method. Similarly, the most distal points are used to treat the sensory organs, and digestive disorders are treated with points like stomach 36, spleen 9, liver 3, large intestine 4, and other points on the limbs. Non-local or distal needling is used throughout acupuncture and traditionally relates to the internal - external relationships between the organs and meridians.
The effects of non-local or distal needling can be better understood by adopting a myofasical line model.
Myofascial Lines & Muscle Levels
Let's take another look at the image of the arm lines and consider two primary levels of muscles.
The SBAL includes the forearm flexors, deltoid muscles, and trapezius. When we needle points like Luo Zhen, TW 3 and TW 5, it will have a direct effect on the SBAL. This is why TW 3 and TW 5 is good for pain at GB 20 and GB 21.
On the DBAL we find the small intestine meridian and SI 3, which is the confluent point for the DU meridian and spinal column. As the DBAL includes the levator scapulae and rhomboids, we can begin to understand how points on the SI meridian can influence the deeper levels of muscles connecting to the neck and spine.
DBAL
SBAL
As neck, back, and spinal disorders are some of the most common conditions that acupuncturists treat, it is essential to understand how the myofascial lines connect to the meridians and acupuncture points.
Acupuncture Points for Neck Pain
Using a meridian systems approach to treating neck pain we would first identify what meridian is affected. The most common areas of neck pain include UB 10, UB 11, UB 12, GB 20, GB 21, SJ 15, SI 13, SI 14, SI 15, and in the Hua Tuo Jia Ji points.
In the meridian connections the UB and SI meridians are related and called the tai yang meridians. Similarly, the GB and SJ channels connect to form the shao yang meridians. To utilize the meridian systems we can use SI points to treat pain in the urinary bladder channel, and triple warmer points to treat the gallbladder meridian.
A good system one connection to treat pain at GB 20 and GB 21 is to use Luo Zhen, SJ 3, and SJ 5 on the opposite side from the pain. Using san jiao points to treat the gallbladder meridian is referred to as the system one connection in the Balance Method.
The Shao Yang Connection & Contra-lateral Needling
Notice how in the image GB 20 and GB 21 are on the trapezius and part of the Superficial Back Arm Line (SBAL). The points SJ 5, SJ 3, and Luo Zhen are also on the SBAL and indicated for neck pain.
Why needle the opposite side?
When using system one connections it is usually best to needle the opposite side; however, in some cases you will find that needing the same side is effective too.
Researchers have found that contra-lateral needling on the opposite side releases pain relieving substances in the spinal column. These same substances are released if needling occurs on the same or opposite side. There are also biomechanical and myofascial explanations for why contra-lateral needling is often best.
Pain in the Rhomboids, Levator Scapulae, or at SI 13
In traditional systems pain in the scapula or along the SI meridian can be treated with points like SI 3, SI 4, SI 5, SI 6, SI 7, and local points like SI 11, SI 12, or SI 13.
If you are still needling local points like SI 13, SI 12, and SI 11 you can replace these with distal points like SI 3, SI 7, or the Master Tung points on the small intestine meridian including 22.08, 22.09, 33.10, 33.11, and 33.12.
The key to using distal points is to use 2 or 3 in close proximity.
In the case of pain in the scapula or rhomboids use points on the SI meridian along the ridge of the ulna. I usually use two or three needles located 3 cun, 6 cun and 7 cun above the wrist crease. The first two correspond to Master Tung's points 33.10 and 33.11. These should be needled on the same side as the pain.
For pain in the neck, levator scapulae, SI 13, or in the cervical HTJJ points, use SI 3 with another point 1.5 cun proximal to small intestine three.
What about using UB meridian points for pain in the neck or in the SI channel?
Since the UB and SI channels are both tai yang meridians so we can use urinary bladder points to treat pain in the scapula and along the SI meridian. Points in the region from UB 58 - UB 60 (7 Tigers) are especially effective for pain in the scapula and also treat pain at GB 21.
What is the Tai Yang Relationship?
The UB and SI meridians are both located in the posterior regions of the body. The SI channel runs through the posterior section of the arms, upper back, and neck. Similarly, the UB meridian transverses through the occiput, posterior neck, paraspinals, hamstrings and calf muscles.
Anatomically, and from a myofascial perspective, these meridians meet at the attachments of the levator scapulae and rhomboids to the spine.
While many of acupunctures effects work through the nervous system, many of its benefits can not be solely explained by nerve responses. Needling can also help structural issues with alignment and works on the myofascial system in numerous ways. Research by Helene Langevin M.D. has shown that twirling needles causes fascia to stretch as well as changes in structural proteins.
Another factor operating on biomechanical and structural levels has to do with the way we hold tension in our bodies. Our muscles hold tension in trigger points and when they are overworked or strained. When muscles hold tension they can transmit that tension through the myofascial lines. This also relates to the way in which referred pain will follow the meridians and myofascial lines.
Acupuncture helps to remove tension from our bodies, and non-local needling can reduce stress and strain at distant regions. The mechanisms of this follow the meridians and myofascial lines.