GB-21 (neck / shoulder tension, rebellious Qi)

Jian Jing (Shoulder Well) is a place many people tend to store their stress. Every day, people come into my office and complain about neck and “shoulder tension.” They really mean the trapezius and levator scapula muscles, not the shoulder joint. I’ve been saying for years that we need a better name for this part of the body, but “noulder” isn’t catching on (for obvious reasons!).

Referred pain and trigger points for the trapezius.

Referred pain and trigger points for the trapezius.

The trapezius is a big muscle, and it does a lot. Carrying heavy loads (especially unbalanced ones – so carry a small purse and use both straps of your backback!), working with your arms up (I’m talking to you, hair stylists!), or just general hunchiness over a computer… all are common causes of tension. The traps refer pain over the head to the eyebrow area, so shoulder tension can give you a severe frontal headache.

GB-21 also descends energy, so it’s good for rebellious rising Qi causing headaches, dizziness, heartburn, or vomiting.

GB-21 for relieving neck and shoulder tension.


Find GB-21 at the top of the upper thoracic area (aka “noulder”), halfway between the shoulder joint and the spine. Press firmly for 10-15 seconds with a healing intention. NOTE: Do not use GB-21 on pregnant women.

Also – look into some better ways to release your stress!

Ergonomic & Repetitive Stress Injuries

Good ergonomic posture at your desk is important. Even more important - take frequent breaks to walk and stretch.

Good ergonomic posture at your desk is important. Even more important – take frequent breaks to walk and stretch.

Repetitive stress injuries happen when you perform the same movement over and over for an extended period of time. Ergonomic problems are when your position or movement is counter to what your body does naturally. Common examples include carpal tunnel syndrome from using a computer, or a swimmer’s bad shoulder. Sitting itself can cause problems if you do it too much. To avoid injury:

1) Break up the repetitive nature of your motions. Get up and do a lap around the office (or house) every hour or so. Change your routine: Instead of typing on Tuesdays and filing on Wednesdays, do a little of each both days, so you aren’t making the same precise movements for hours. Can you switch to the other side or hand? Even small changes can make a difference. For example, my knitting friends who have trouble will opt for a different size needle (which affects hand position and motion) or even type of project. The more variety the better.

2) Double check your ergonomic situation. It may be helpful to get someone to take a picture of you while you’re working so you can see your own posture. If you use the phone, try a headset. Sitting at your computer, you should be looking straight ahead at the top third of the screen. If you are looking up or down, adjust either your seat height or the monitor. Your elbows should be resting at 90 degrees, and your wrists should be straight. Having them bent down or cocked back for the keyboard increases strain. Your knees should be at hip height or just above. If your chair is too tall, use a footrest. If you have a penny-pinching boss, you should know that OSHA can send out an ergonomic expert (free!) to suggest cheap/free fixes in your office.

When playing sports or working out, consult a coach or professional trainer to be sure you’re using good form. Learn the anatomy relating to your activity. In addition to preventing injury, your performance will improve! I used to be a bodybuilder and certified trainer, so feel free to ask me if you have any questions.

3) Stop as soon as symptoms start. Give your body a chance to heal. Ice and anti-inflammatory drugs like ibuprofen may be helpful here, as will an anti-inflammatory diet. Likewise, get care early. A new problem is always easier to chase away than an entrenched one. Myofascial release will free up adhesions. Osteopathic medical massage can retrain your tight muscles, and acupuncture will reduce inflammation.  Rest. Stretch gently, and do any physical therapy exercises your healthcare professional recommends. Try to avoid that activity for a while.

Frequently re-examine your routine and ergonomics to identify any areas that need improvement. By nipping problems in the bud, you can prevent a long-term aggravation.

The Shoulder

Front view of the bones of the shoulder joint.

We can do amazing things with our arms. Lift them overhead, cross our chests, even link our hands at our spines. In fact, the shoulder is the most mobile joint in our bodies, thanks to its “ball and socket” configuration. See how the head of the humerus (upper arm bone) fits into the scapula (that triangular bone in your upper back) like a baseball into a glove? It can spin on the smooth, round surface to provide a spectacular range of motion.

The posterior (back) view of the shoulder.

Just as with national politics, there’s a trade-off between freedom and stability. The complexity of this joint makes it prone to a variety of injuries. Cartilage lines the articulating joint surfaces to create a smooth track for movement. If torn, it takes a long time to heal and may require surgery. There’s the bursa, a fluid-filled sac that provides cushioning. Inflammation here, called bursitis, can be very painful. Rest, ice, anti-inflammatory drugs, and acupuncture are the best treatments (of course an anti-inflammatory diet will help, too). The well-known rotator cuff is actually a set of four deep muscles that stabilize the joint and work to rotate the humerus. Three (supraspinatus, infraspinatus, and teres minor) can be seen in the drawing of the back view of the shoulder. The fourth, subscapularis, attaches to the front of the scapula and goes to the front of the humerus and the joint capsule. If torn, they will require rest and then specialized exercises to repair.

Overtop the rotator cuff is a layer of larger muscles, such as the latissimus dorsi & teres major (back), and the pectoralis muscles (front), and the deltoid (that roundy bit at the corner). These are your heavy duty movers. Ironically, since the lats and pecs both attach to the front of the humerus, unbalanced exercising can lead to an internally rotated (palms towards the back) shoulder, or “ape” posture. This is a great example of the importance of an intelligent, balanced workout plan. Then of course there are all the muscles that continue down the arm to control the elbow, including the triceps and biceps.*

If any of these muscles are dysfunctional, the bursa is irritated, or the cartilage is torn, you can have shoulder pain and loss of range of motion. Connective tissue can adhere, and scar tissue builds up over time. In extreme cases, you can develop Frozen Shoulder, which is exactly what it sounds like. It just won’t move. There are other causes of shoulder pain, too, ranging from nerves being pinched at the neck to gallbladder disease, but these musculoskeletal problems are the most common.
Acupuncture can reduce inflammation, increase bloodflow, relax tight muscles, and speed healing. I can also perform Osteopathic medical massage to break up scar tissue, release myofascial adhesions, and retrain the neurological system. This allows chronically tight muscles to return to normal. In most cases, therapeutic exercise is important for complete healing.

*Please note that I’m simplifying the anatomy quite a bit  for the purposes of this article. If you’re interested in all the marvelous details of our bodies, I highly recommend Netter’s Atlas.

LI-4 (headache, arm or facial pain, infection, hot flashes)

LI-4: Hegu. This point is astonishingly useful for a wide variety of complaints, but don’t use it if your patient is pregnant!

Large Intestine 4 is the acupoint most well-known by the general public. I first had it taught to me by a riding instructor when I was a kid living in rural Virginia. The name for this point is Hegu, “Joining Valley,” which is a reference to its anatomical location on the back of your hand, in that fleshy area between the thumb and forefinger. Feel around – it’ll be tender if you need it – but the easiest way to find it is to squeeze your thumb against your hand. The highest point of the muscle is where you want to press. Use firm, gentle pressure for 10-20 seconds with a healing intention. Try both sides.

Hegu, or Joining Valley, is a tremendously useful point. It moves stagnation, so you can use it to clear pain and stiffness anywhere in the upper body. Hegu will be particularly effective along the LI channel, which runs from the nail of the forefinger, along the forearm to the lateral (outside) elbow, up the arm and across the shoulder, eventually crossing the upper lip to end at the opposite side of the nose. Shoulder and elbow pain, carpal tunnel, and (of course) headaches are common uses. It’s specifically the Ruler of the Face, so it’s doubly powerful for frontal headaches, eye pain, sinus blockage, and tooth pain. It also releases heat and is part of a point combination for fighting viral or bacterial infections. If  you are prone to hot flashes, this point could be your new best friend. Also use LI-11, pictured here, to clear heat.

And by the way… the leading cause of headache is dehydration. Drink a glass of water!

WARNING: Because Hegu is a moving point, DO NOT use it if you are pregnant or bleeding. It can induce a miscarriage or increase blood loss. On the other hand, if you are overdue and want to evict your baby, this is a great way to do so, along with some other points (assuming everyone is healthy and it’s not a complicated pregnancy!). It will usually increase menstrual flow if the patient is having her period. If you have a severe headache paired with sudden loss of motor control or speech, get to a hospital immediately. DO NOT use LI-4 until you are sure you are not having a hemorrhagic stroke (bleeding inside the brain). This goes for head injuries, too!