Hyung Suk Choi, LAc

Thank you all audiences for quality discussions and responses.

@Thory Tessem
I would like to thank you first. You are the first one who laughed with my joke; 'Shake not stir(shaken not stirred)'. I did it a hundred times without any responses.

@Robert Wison
GeundongChim: When to apply strengthening or stretching.
It depends on your palpating. You need to see if the patient's muscle is tightened or weakened. In many cases, the muscles are both tightened and weakened. It may be not intuitive but think about psoas. When you sit to a long time, psoas get tightened and weakened.
The following is the common indication for strengthening with GeundongChim
• Chronic / recovery stage of a long period of pain
• Motor weakness by central/peripheral nerve injury
The following is the common indication for stretching with GeundongChim
• Myofascial pain syndrome, Fibromyalgia
• Any condition with Shortened muscles
• Muscle spasm, strain
• Postural problems eg. Upper back pain
• Limited ROM problem - eg. Frozen shoulder

@Meera Agarwal
Thank you for clarifying, I should have mentioned that clearly. These methods are for common chronic ankle pain; high ankle sprain and sinus tarsi syndrome, for acute ankle pain, I prefer collateral acupuncture and immobilization. Ironically immobilization is one of the most common treatments in KA.

@Ann Brameire
That is a very good and sharp question. You cannot passively contract the muscle. But, you can passively shorten the patient's muscle by flexing the joint. The mechanism behind Thompson test is 'pulling Achilles tendon by shortening the gastrocnemius muscle with gripping the muscle belly'. When you grip the belly (lifting and shortening of gastrocnemius), Achilles tendon is pulled toward muscle. If the tendon is completely torn, this pulling cannot transit to ankle plantar flexion. The most of tendon integrity test like drop arm test, Jobe test, Cozen test, etc. all involve muscle contraction to provoke tendon injury. Thomson test is a variation of muscle contraction which connected to injured tendon.

@ Vicki Chung
The heating needle is the ancient method used from NeiJing, and it was popular in the late Chosun dynasty in Korea. Though heating time varies from literature, usually color change is the indication.

@Robert Wilson
Thank for bringing this issue, both tendons are treated. Inserting right beside tendons.

Video 5
@Noreen
3 times visit a week preferably, and change into 1-2 visit a week in accordance with improvement.

@Terry
Treatment setup is based on literature. In actual clinic, they used to get better than this expected plan.

@Ana
Intercristal line. The intercristal line (also known as Jacobys’s Line or Tuffier’s Line) is a horizontal line drawn across the highest points of both the iliac crests.

@Elizabeth
Thank you for the link.

@Gail
the highest points of both the iliac crests

@Li-ren
3-5 cm, mostly in the clinic.

@Nancy
They are below L4 or L5 considering visually inspected PSIS. But, it was a demo, and actually I use 6-8 set of needles on lumbar area.

@Gail
Yes, that broad stretch includes all gluteus muscle and pyriformis too.

Video No.6
@Margaret
These were used for demo.
0.3*50 mm (around hip)
0.2*30 mm (back)
0.16*15 mm (neck)
0.4*40 mm (for shoulder and back, psoas in the first video)

@Terry
Psoas is located deep under both side transverse process of lumbar. So location of multifidu and erector spina is the same location. It is hard to approach from posterior to anterior in prone position.

@Dalia
Correct. Moving pelvis with distal point, and also w/ intervertebral needle.

@Thory
Thanks for nice summary; Structure affects function, and function affects structure.
Yes, there have been many traditional acupuncture with movement method in TCM history.

@Tricia
For average build less than 4cm depth. In case you apply sitting crouched posture, make it 1cm shorter. Needle right between vertebarae will be sucked 1 cm more with standing up.

@Suk fun
Yes, those are common points selection(expelling wind) for cervical disc herniation too.

@Noreen
In this protocol for acute low back pain, both sides are applied with distal acupuncture. eg.both LI4, LI11

@Tricia
Right in the middle, the purpose of this intervertebral needling is increasing blood circulation around the disc, endplate, and ligament. For jiaji line 45 degree slant insertion is used in KA.

@Mikhail
That is very important question. In KA, you should estimate the depth first beforehand insertion. Estimate the distance between 'pressed down erector spinae and QL' and vertebra, insertion depth should be little (3-4cm) less than midline. So, it varies a lot depending on body build. If you insert the needle on psoas, you can feel the different texture at the end of needle.

Thank you all! I am following up with the questions I could not answer at the class. This is for the lecture; "Maximize Recovery of Musculoskeletal Pain with Kinetic Acupuncture, Part I"

Video 4
@Elizabeth
Thank you for loving this!

@Kailie
I did not show the teres minor insertion, but that is commonly treated muscle too. First locate GH joint and insert the needle right beneath it. Grabbing(isolating) teres minor and latissimus dorsi before insertion is the common way of insertion.

@Anaya
Right, with some extreme body build it is very hard to apply the method. Same goes with tuina or other manipulations.
Thank you for mentioning that non-meridan acupuncture(eg.dry-needling) have been used from ancient times and always have been part of TCM.

@Gami
I just applied the needle on opposite site for recording convenience.

@Thory
감사합니다~~~

@Daniela
Actually I use E-stim a lot for both local and distant. But, frozen shoulder modality only includes distant E-stim. I wanted to introduce standard procedure.

@Kaille
Yes, and no. Insertion method including Chicken foot insertion is one of the topic of next class.

Video 5
@Noreen
3 times visit a week preferably, and change into 1-2 visit a week in accordance with improvement.

@Terry
Treatment setup is based on literature. In actual clinic, they used to get better than this expected plan.

@Ana
Intercristal line. The intercristal line (also known as Jacobys’s Line or Tuffier’s Line) is a horizontal line drawn across the highest points of both the iliac crests.

@Elizabeth
Thank you for the link.

@Gail
the highest points of both the iliac crests

@Li-ren
3-5 cm, mostly in the clinic.

@Nancy
They are below L4 or L5 considering visually inspected PSIS. But, it was a demo, and actually I use 6-8 set of needles on lumbar area.

@Gail
Yes, that broad stretch includes all gluteus muscle and pyriformis too.

Thank you all! I am following up with the questions I could not answer at the class. This is for the lecture; "Maximize Recovery of Musculoskeletal Pain with Kinetic Acupuncture, Part I"

Video No.1
@Robert
Using inversion table with acupuncture is one of the common method in Kinetic acupuncture. I have one in my office too.

@Thomas, Laura, Brianna
Thank you!

Video No.2
ATX : acupuncture treatment. Sorry for not clarifying abbreviation.

@Debra
Pressing beforehand needling is common method. Force should be adjusted based on patient's condition. For instance, hard pressure should not be done for points around acute injury(excessive in TCM). But, I found out that some of my students press to subtle to locate the point exactly and to reduce the needle pain. This will be the topic in next class too.

@Katarina
Yes, e-stim on healthy side.

@Siahrei
Yes, my many friend and I also approach from the armpit with shoulder abduction position, when I palpate tightness.

@Laura
Maybe perpendicular is not right description. Following the inner surface of scapular slightly toward scapular, away from thorax, eventually hitting the scapular.

Video No.3
@Gail
Does ROM last after treatment? Yes, it does, as long as patient follow ROM exercise at home. If patient disuse arm, they lose ROM again.

@Delia
Needle insertion for subacromial space located at bursa, needle insertion is supposed to be without resistance. MD uses this place for injection too for shoulder pain.

@Johanna
Gwandongchim(Needle on joint with movement) is usually remained with oscillation and traction, and removed for flexion and extension of shoulder.

@Kailie
Distant needling is applied based on severity. If patient complains pain with movement, that is the time to apply ST38 and ST40, and E-stim, sequentially. Usually LI5 and LI11 from the start.

@Anaya
This modality is for frozen shoulder. Acute rotator cuff tear can be contraindication of this method. If the tear is chronic with absolute limited ROM(even with passive force), this method can be very useful.

@Gami
Geundongchim with stretching is used for Tennis elbow which will be the topic of next class.

@Li-ren
That is very insightful. Actually in Korea, vibration devices have been tried for these techniques, and I am researching too.

Total 5 times of treatment, she visited twice a week. The reason of fast recovery was because it has been 2 years already. It was thawing stage.

Thank you for your patience

Geundongchim is a major Kinetic Acupuncture maneuver treating muscle tightening, trigger points, and weakness. Isometric contraction and stretching are combined with 'FenCi(分刺)'. FenCi in NeiJing refers to the direct insertion into the muscles for treating bi syndrome.

Gwandongchim is an acupuncture technique combining GuanCi (关刺) with the various joint movements. GuanCi in NeiJing refers to the insertion of acupuncture into the joint cavity and surrounding tissues like tendons and ligaments. Combining joint movements consist of oscillation, traction, rolling, and sliding.

'OS' stands for 'onset', I am sorry for confusing with abbreviation

@Kay, about needle size
It depends on location and purposes. For regular movement 0.2 diameter is commonly used. My most used needle diameters are 0.2 & 0.4mm. O.4mm is finer compared to dry-needle. Thanks.

@Karen and Michele
Thanks for interest!
https://youtu.be/nDcRWw8b738
This video is explaining about patello-femoral insertion and patella movement (sliding and rolling) There are so many other detailed Kineticacupunncture techniques I did not explain here. Today we only took care of basic formula to mix.

@Christopher about distal point
I should have been clearer about this. Yes, you can use any style of acupuncture for this. Because it is not the area of Kinetic acupuncture, I did not spare time for explanation about this regular needling. REGULAR acupuncture you have been already doing can be applied. Therefore I can say Kineticacupuncture is not substituting regular acupuncture. It is just another weapon, especially for chronic musculoskeletal problems.

@Kasra about needling point of Gwandong chim
Yes, needle location of Gwandong chim is basically joint cavity where the injured(target) tissue is located. For example of wrist, in case of TFCC ulnar side cavity is the location, and in case of De Quervain's disease, radial side is. But, practically in case of De Quervain's disease, Geundong Chim is more importand because it is not the problem with inside of joint.

@Carlos, ilhwa, Evan, Yang, Wong and Jeanice
Thank you for your interest. you are the best! Yes, I will do it again with a lot more demonstrations of actual techniques.

@Elizabeth, about needle bending
A: Basically needle should NOT be bent or move. That is the reason why we apply isometric contraction or eccentric contraction as a basic movement. I demonstrated how not to bend needles on myself, at the 15-20 min, isometric slide. In case of Gwandongchim with joint play, needle do not move either, because needle is located at empty space like femoro-tibial space. But, some techniques involve movement of needle like giving feedback or detaching technique.

@Dr.Song, about the fake golf ball.
A. Thank you for question for clarity Dr.Song and thanks for the answer Dr.Gaeor. It is made of dense foam. Here is the my education video about that practice.
https://www.youtube.com/watch?v=2fzaLkxOjRg
I made that one for my students, because I could not find any insertion technique explanation on the text. It happened to be only in Korean, I think you can understand.
Recommended needle is 0.2mm diameter, and 30mm length, because it is easier to get straightness.

Thank you all the audience. This is Dr.Choi. I am sorry I could not answer the questions at the live webinar, so I would like to answer questions here. I wish it will help you to understand Kineticacupuncture.