Acupuncture of the Thoracolumbar Fascia: An In Vivo Ultrasonic Demonstration

The first edition of the Fascia Anatomy Summer School, organized by McGill University’s Department of Anatomy and Cell Biology in Montreal, was held from July 17th to 21st, 2023. The aim of this study week was to present the latest research on the anatomy and function of fascias, and attendant therapeutic perspectives. The seminar’s organizers: Gabriel Venne, D.O., M. Sc., Ph. D, Assistant Professor and Director of the Division of Anatomical Sciences at McGill, and Carla Stecco, M. D., Department of Neuroscience, University of Padua in Italy, led the anatomic dissection labs.

The panel of researchers responsible for presenting the theoretical part was made up of surgeons, anatomists, biologists, and engineers. Our student group comprised doctors, osteopaths, acupuncturists, physiotherapists, and movement professionals. In sum, the program addressed different perspectives on the study of fascias: dissection, research, embryology, species evolution, ultrasonography, histology, biomechanics, and practical workshops.

Thanks to its various needle techniques, acupuncture has a direct mechanical impact on superficial and deep fascia.

During this study week, our team of acupuncturists had the incredible opportunity to conduct an ultrasonic-assisted puncture of the thoracolumbar fascia. The reaction of the researchers present at this demonstration was extremely promising: thanks to its various needle techniques, acupuncture has a direct mechanical impact on superficial and deep fascia. This demonstration represents a first decisive step in fascia acupuncture research, and heralds new working hypotheses with promising therapeutic applications.

Fascias in 2023: An Overview

Fascia research has experienced a real boom over the past five years. Currently, focus is on clarifying nomenclature and establishing histological, anatomical, and functional differentiations between the various fascial layers. The aim: to enable targeted and tailored therapeutic interventions [1]. The fascial system ensures structural support, the distribution of the pressure load, and, as its primary therapeutic principle, interface mobility through gliding and the preservation of viscoelasticity.

This connective tissue network is organized across multiple strata and grouped into three main layers: superficial, deep, and visceral. Each layer has a specific composition and function, and distinct properties [2].

Therapeutic Precision

There is a virtually one-to-one correspondence between the therapeutic approaches to the fascia and to acupuncture.

It is noteworthy that the concept of fascial continuity is evidenced by the fascial planes, which ensure the communication and coordination of their various components. In addition, these fascial planes bring together different soft tissues (muscles, tendons, ligaments, aponeurosis, etc.) enabling their coordination and the distribution of mechanical loads and proprioceptive information. It is a system capable of non-linear mechanical adaptation, operating in a decentralized way, with a certain memory plasticity and whose main therapeutic orientation aims for the elimination of restriction, gliding, and free circulation.

Other approaches, such as distal or peripheral treatment, are growing in importance. These perspectives in treatment help determine the origin of biomechanical disfunctions and evaluate pathological compensatory mechanisms.

Fascia Planes and Meridians

If stagnation is the principal disfunction targeted by these types of therapeutic strategies, they are not dissimilar to those concerning acupuncture treatment; the meridian system enables a mapping of the myofascial system and organization of peripheric and distal force vectors. [3].

Indeed, there is a near-perfect correspondence between the therapeutic approaches to fascia and acupuncture [4]. It is likely that this correspondence is based in the fact that the network of acupuncture points and meridians can be considered a representation of the network formed by interstitial connective tissue [5].

Accordingly, the meridians’ anatomical reality is found in the fascial plans. Their stimulation brings about a tissue activity called “Qi” capable of acting on all physiological aspects, whose effects appear to propagate down to the cellular level through a phenomenon called mecanotransduction [6].

A model combining connective tissue plasticity and peripheral sensory modulation in response to the sustained stretching of tissue that results from acupuncture needle manipulation.

As the ultrasonic acupuncture procedure demonstrated during this study week, not only does acupuncture appear to interact directly with the superficial and deep fascias, but, through its various techniques, it can influence their configuration and comportment. This mechanism of action is based on connective tissue plasticity and the peripheral sensory modulation in response to the sustained tissue stretching resulting from the manipulation of the acupuncture needle [7].

The Map is Not the Territory

Thanks to its biomechanical and physiological system of organization, acupuncture’s theoretic framework could prove of key importance in the understanding of the organization and functioning of fascias [8].

Could it be that the meridian system permits us to push further our understanding of the organization of the various components of the fascial system? Is there a real anatomical correspondence to be found beyond the “energy lines”?

Current fascia research endeavors to understand the structural organization and mechanisms underlying their interfaces. If the fascia network of the body is indeed the physical substrate of the meridians, there are important clinical and research implications [9]. Now more than ever it is important to recognize that acupuncture’s meridian system is not simply a map without material correspondence, but rather a rich and complex anatomical repertoire and classification system for deciphering the territories of the human body.

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References

[1] Schleip, R., G. Hedley and C.A. Yucesoy. “Fascial nomenclature: Update on related consensus process.” Clin Anat. 2019 Oct;32(7):929-933. doi: 10.1002/ca.23423. Epub 2019 Jun 27. PMID: 31183880; PMCID: PMC6852276.

[2] Stecco, Carla. Functional Atlas of the Human Fascial System. Elsevier Canada, 2015.

[3] Dorsher, Peter T. “Myofascial meridians as anatomical evidence of acupuncture channels.” Medical Acupuncture, 21, 2009: 91-97.

[4] Oschman, James L. “Fascia as a body-wide communication system.” In: Findley T, Schleip R, Huijing P, Chaitow L, eds. Fascia: The Tensional Network of the Human Body. Elsevier Canada; 2012: 103-110.

[5] Langevin, Helene M. and Jason A Yandow. “Relationship of acupuncture points and meridians to connective tissue planes.” The Anatomical Record, 269, 2002: n. pag.

[6] Finando, S. and D. Finando. “Qi, acupuncture, and the fascia: a reconsideration of the fundamental principles of acupuncture.” The Journal of Alternative and Complementary Medicine, 2012 Sep;18(9):880-6. doi: 10.1089/acm.2011.0599. Epub 2012 Aug 8. PMID: 22874011.

[7] Langevin, Helene M. “Acupuncture, connective tissue, and peripheral sensory modulation.” Crit Rev Eukaryot Gene Expr, 2014;24(3):249-53. doi: 10.1615/critreveukaryotgeneexpr.2014008284. PMID: 25072149.

[8] Marcelli, Stefano. “Gross Anatomy and Acupuncture: A Comparative Approach to Reappraise the Meridian System.” Medical Acupuncture, 25, 2013: 5-22.

[9] Yu Bai, Jun Wang, Jin-peng Wu, Jing-xing Dai, Ou Sha, David Tai Wai Yew, Lin Yuan,and Qiu-ni Liang. “Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body.” Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2011, Article ID 260510, 6 pages doi:10.1155/2011/260510