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By: Dr. Brian Lau, AP, DOM, C. SMA

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Monday, December 21, 2015

The Diaphragm and the Liver Sinew Channel, Part 2

In the last post we outlined the basic anatomy associated with the Liver sinew channel. If you have
not yet read it, you might want to start with that post. In this post, we will discuss a common
postural dysfunction associated with the Liver sinew channel, and we will look at common
orthopedic conditions associated with this. Finally, we will discuss some treatment options. Keep
in mind that many of these treatments are best learned in a class setting and that much of the
discussion here will be alluding to these techniques. Others will be relatively straight forward and
easily adaptable in your practice, however.
Dysfunction is observed when the Liver sinew channel (which is more posterior than the Spleen
sinew previously discussed) is short and the ribcage is closer to the pelvis in the back than in the
front, compressing the posterior diaphragm. This compression prevents the diaphragm from
being able to descend effectively; patients often must rely more on the accessory breathing
muscles, such as the scalenes, which often become tight and restricted. These patients often
exhibit chest or paradoxical breathing. Many of them have the typical Liver Qi Stagnation posture
seen in Fig. 1. This posture presents with a very straight, rigid spine and an anterior tilt to the
pelvis. The chest is often held up in a military-style posture and the patient looks as if they are
unable to exhale fully. This posture, along with several others, were presented and discussed by
Matt Callison, L.Ac. at the Pacific Symposium in 2011, where he presented research which
correlated Zangfu disharmony as described in Traditional Chinese Medicine with common
postural patterns. (This was discussed in a previous post.)

Fig 1: Typical posture often seen with

Liver Qi Stagnation. Image courtesy
Matt Callison, L.Ac.
Many of these patients present with Yaoyan syndrome (often referred to as Iliac
Crest Syndrome in Western circles). This presents with pain at Yaoyan. Yaoyan is
level with the lower border of L4 and, depending on whether you palpate slightly
more medial or lateral, will be more reactive at either the iliocostalis (the most
lateral muscle of the erector spinae group) or the quadratus lumborum (QL)
attachment at the iliac crest. When there is pain with palpation of the QL, I
frequently find LIV-5 to be very sensitive to palpation, also. Needling LIV-5 and
obtaining Daqi often reduces the pain at the QL with palpation by about 50%.

Another frequent pain condition which is seen with this posture is thoracic outlet
syndrome (TOS) which involves an entrapment of the brachial plexus either
between the anterior and middle scalenes, between the clavicle and ribcage, or
between the pectoralis minor and the ribcage. In this posture, the scalenes and
pectoralis minor are short and holding the ribcage too rigidly up (creating a very
wooden spine). I associate these muscles with the Lung sinew channel, but see
this as a way that excessive Liver energy can affect the channels associated with

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 the Lung. These patients often have a paradoxical breathing pattern where they
pull the abdomen in during the inhale and lift the chest. This uses accessory
breathing muscles and they should be elevating the upper ribs, but with the
restricted movement in the diaphragm, they have to work overtime; thus they
become tight and rigid and can then compress neural structures.

Figure 2: Palpation of the QL at Yaoyan. Image courtesy

of Matt Callison, L.Ac. from his soon to be released book
Sports Medicine Acupuncture.

Fig. 3: Brachial plexus entrapment on the left side 1) between the ribcage and clavicle, 2) between the anterior and middle scalene, and 3) under the pectoralis minor.
I include the scalenes and pec. minor in the Lung sinew channel. They are listed here as Liver Qi Stagnation and the posture shown above is a common contributor of
TOS.

Since an anterior tilt of the pelvis is involved with the posture in Fig. 1, it is important
to address this when treating many pain patterns, especially if they are chronic. In
the Sports Medicine Acupuncture Certification program run by AcuSport Seminar
Series, we teach a particular needle technique at LIV-4 (paired with GB 39.5) as
treatment for an anterior pelvic tilt. This is used on the most anterior side and could
be part of the treatment of many back conditions such as radiculopathy, facet
syndrome, and SI joint dysfunction; it can also be used with treatments for TOS and
other problems. This point combination and needle technique was developed by
Matt Callison through his understanding of channel theory and then refined with trial
and error. I interpret LIV-4 as softening the psoas and helping relax and lengthen this
muscle, which is such a strong contributor to an anterior pelvic tilt. It is mentioned
here to highlight the relationship of the Liver sinew channel to the psoas major,
which is heavily involved with an anterior tilt of the pelvis.

Fig. 4: Anterior pelvic tilt.

In addition to acupuncture to distal points, direct needling of motor points to muscles

such as the QL, scalenes, pectoralis minor, and other related structures can help improve
alignment. Also tuina is indicated. I utilize myofascial release extensively in my practice
and it can be very helpful in releasing tight fascia and allowing the body to find a more
healthful balance. In Sports Medicine Acupuncture and in the KMI training, Simone
Lindner teaches a very useful myofascial release technique to the lateral raphe (a fascial
structure which then separates to becomes the anterior and posterior layer of the
thoracolumbar fascia). This structure is at the edge of the QL; the technique involves
working with a seated patient and, using this fascial structure as leverage, lifting their
ribcage out and away from their pelvis in the back. Also addressing the front of the
diaphragm is useful as it is pulled up. Accessing this fascia under the costal margin and
bringing it down will free the breath and soften the Liver channel.
Other sinew channels have a strong relationship to the diaphragm, either directly or
indirectly, and can be explored at another time. Most notably, the Pericardium sinew
channel influences it via its relationship with the serratus anterior, another muscle which
can act as a clamp and restrict proper expansion of the thorax. Needling SP-21 or other
points which correlate with motor points of this muscle will increase the Lung pulse, for
instance. The Lung sinew channel relates to the pectoralis minor and the scalenes (both
discussed in this post) and has a strong relationship to the diaphragm in that these
muscles are accessory breathing muscles and, when restricted, can greatly limit breathing.
The Yang sinew channels also include many structures such as the abdominals and
pectoral muscles that can limit expansion of the breath. Therefore, the diaphragm, with its
relationship to effortless and healthful breathing, is one of those pivotal structures for
vibrant health.
Note: Tom Myers has an interesting discussion on this fascial plane which I am categorizing as part of the Liver sinew channel. His post can
be found here; however, it is not written from a TCM or Chinese medicine prospective.

Recommend this on Google

Labels: Anatomy of the Sinew Channels, Diaphragm, Diaphragm and TCM, Liver Sinew Channel, Paradoxical Breathing, Psoas,

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 Quadratus Lumborum, Yaoyan

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