In Chinese medicine, we use yin and yang as a useful method of pattern identification. Yin-Yang theory can also be applied to understanding the muscles, myofascia, and autonomic nervous system (ANS). In this post, I will discuss how yin-yang theory can be applied to understanding the musculoskeletal system, fascia, neck pain, and postural disorders.
As muscles both contract and lengthen, we can observe how the dual nature of yin-yang works in muscular activity and amongst opposing (antagonistic) muscles.
When chronic contraction occurs in a muscle group, by default the antagonists will become over-lengthened and weak. As a practical example of these yin-yang muscle dynamics, let’s apply it to a common disorder that frequently produces neck, shoulder, and upper back pain.
Forward Head Shift
Forward head shift, or anterior head shift, is common in today’s world as many of our contemporary work routines and daily activities result in a forward shift of the head and shoulders. This can cause diverse symptoms including neck pain, headaches, tension and pain in the shoulders and upper back, TMJ, chest pain, and dysfunction of various respiratory muscles.
This common pattern of forward head shift is often related to excessive desk work, screen time, and mobile phone use. Other work-related activities can also contribute to this, and any excessive activity that causes a person to lean their head and neck forward can be a contributing factor.
When anterior head shift occurs there are various muscles that can become excessively and chronically contracted. These include the suboccipital muscles, front flexors, SCM, medial scalenes, chest muscles, and the levator scapulae. The opposing muscles that become weak and long include the deep cervical flexors, erector spinae, and the shoulder blade retractors such as the middle trapezius and rhomboids.
With all those complex muscle groups I feel thankful that I’m an acupuncturist and know how to think in terms of the yin-yang theory and meridian-based patterns. These ways of thinking can greatly simplify understanding all the complex muscular imbalances that occur with forward head shift, and allow acupuncturists to find the most effective point groups to use.
A simple starting place to begin to unravel the muscular complexities of forward head shift is to recognize that when this pattern occurs, many of the muscles in the front of the head and neck will contract to pull the head forward. On the contrary, muscles in the back of the body get over-lengthened and will become weak with chronic imbalance. In this pattern, many patients feel pain in the muscles that are over lengthened and weak such as in the shoulder blade retractors and erector spinae (Tai Yang - SI - UB meridians).
The Simplicity and Beauty of Meridian-Based Approaches
In meridian-based approaches to syndrome differentiation, we want to identify what meridians/organs are symptomatic. If a client with a forward head shift has pain in the tai yang channels then we can use various meridians to address the pain in those meridians. However, for a client that has an anterior head shift and pain or symptoms in the chest, jaw, or respiratory system we will use different meridians and points. This is one of the strengths of using a meridian-based approach such as used in the Balance Method and Master Tung style treatments. These methods have a built-in way of working on meridians and myofascial lines that have yin-yang relationships.
Going back to the pattern of forward head shift we can see that some clients have a predominance of symptoms on the back lines, while others have symptoms on the front lines. My estimate is that 60 - 70% of patients have dominant symptoms in the back, 20 - 40% have symptoms in the front, and 15% have symptoms in both the front and back.
Once we identify the most predominant meridian-based patterns we can begin to determine what points will best address the client's overall pattern. For a patient with pain in the SI and UB meridians, or DBAL and SBL in myofascial terms, we can use points on these meridians: SI, UB, LU, LV, SP, KI, and HT. That’s a lot of meridians and points to choose from. Since I like to make things as simple and effective as possible, it's actually easier and more accurate to think in terms of myofascial lines rather than meridians.
For instance, pain in the upper back and between the scapula and spine is associated with the UB meridian. For this pattern, we may use points like UB 57 and local ashi points, small intestine points such as SI 3 and SI 7, kidney points, and even lung meridian points like LU 6, LU7, or the Three Scholars (33.13, 33.14, 33.15). After years of experience, I found that often these points worked, but that for a significant percentage of people, these points didn’t have any effect. To unravel this problem, let’s look at the myofascial anatomy.
Treating Upper Back Pain
In the upper back between the scapula and spine, we have a few muscles to consider. On the most superficial level we have the trapezius which is on the Superficial Back Arm Line (SBAL), and underneath this and on the DBAL are the rhomboids. Even more, pain in this location may be associated with the erector spinae which is on the SBL or UB meridian. Finally, we should also consider the intercostals which function as respiratory muscles and are associated with the lateral line and GB meridian.
When upper back pain is related to tension, over-lengthening, and weakness in the trapezius, erector spinae, scapularis, or rhomboids we will likely associate it with the UB and SI meridians. Using a meridian-based approach would warrant using the UB and SI meridians as well as the LU, HT, KI, SP, and LV meridians. Again, that's an awful lot of meridians and points to consider using.
If the pain is in the rhomboids or scapularis, good results can be achieved by using SI points on the DBAL such as a combination of two or three points including SI 3, SI 4, SI 7, or Master Tung points 22.08, 22.09, 33.10, and 33.11. If the pain is coming from the erector spinae, we may get the best results by using UB 57 and other UB points on the leg.
However, if the pain is related to problems in the trapezius the points on the SI and UB meridians may not produce any results, since the trapezius is on the SBAL. In this case, using points on the LI and TW meridians often gives the best outcomes.
I hope that the reader can begin to understand why it is so important for acupuncturists to be able to translate between meridians and myofascial lines. Doing so gives us more precise information about why some points work great for some patients but not for others, even when they have similar symptoms. Just as that ol' phrase goes: "same disease different treatment, different disease same treatment."
Translating between meridians and myofascial lines can also give us diagnostic information - whether the points work or not. If the points work then there is a good chance the muscular imbalance or pathology is on that myofascial line, if our first point group does not work, then we can look to other muscle groups and myofascial lines as being the source of the problem.
Additionally, when we consider opposing muscle groups like a tight SCM playing a role in posterior neck pain, we can gain insight into why stomach meridian points can also be effective for various kinds of back and shoulder pain. Similarly, GB meridian points can be effective when people suffer from rotations or tilts in their necks but this is a topic for another post. However, the same fundamental yin-yang and antagonistic muscle group dynamics apply when the lateral line or GB meridian is involved in the symptoms.
In summary, learning to identify forward head shifts and their related symptoms is a crucial task for acupuncturists. Simply identifying painful regions and meridians frequently does not give us enough insight into which points will give the best results. However, when we can translate between meridians and myofascial lines, and understand postural yin-yang myofascial dynamics, we can get better at both diagnosing and treating our clients.
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Kind regards,
Jim Spears M.S.
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