New patients often ask me about the process of Acupuncture.  

• How much acupuncture treatment is it going to take for me to feel better?  
• What is a standard course of acupuncture treatment?  
• What results can I expect from acupuncture treatment?
  

The easiest way to answer these questions is to relate Acupuncture treatment to a roller coaster ride (minus the vomiting if roller coasters aren't your thing - but acupuncture can help that too!).

Did you ever notice that the biggest hill of a rollercoaster is always somewhere in the beginning of the ride?  This is so the cars can develop enough momentum from the first hill to propel them through the rest of the course.  Getting to the top of that first hill, however, takes some work.  

The full weight of the cars must be towed up the hill from a standing start before they can be released at the top.  In fact, if the ride contains a really gigantic summit, sometimes you are pulled up a smaller hill first, and then the momentum from that smaller hill is used to help you crest the next larger hill.

The early stages of your acupuncture treatment are like the first hill of a rollercoaster. Just as it takes energy to get a heavy train of cars moving from a standstill, breaking a pattern of chronic meridian imbalances requires a large initial output of energy.

Before we can even think about getting you up the first hill, we need to break your current physical pattern and get you to the start.  Just like reversing a roller coaster, this requires three initial steps:

1. stopping the negative momentum
2. reversing the negative movement and bringing your body back to neutral 
3. starting the process of climbing up the hill
   

Each treatment draws you a little closer to the goal, but initially the body will want to pull back to its previous momentum or posture.  This is where the work comes in.

The early progress can be slow going. In addition, unlike the controlled environment of a roller coaster track, life’s stresses will tend to perpetuate negative patterns "adding weight to your car," to continue our metaphor, and thereby act to pull you back down the hill. Through consistency and regularity of treatment, however, these obstacles can be overcome. 

Imagine how inefficient it would be if the coaster were to come to a complete stop at the base of each new hill.  All momentum would be lost and the hard climb would have to be repeated over and over again.  This is exactly what happens with inconsistent treatments.  Healing builds upon itself, and breaks in care lead to a slower response.


So how much treatment does it really take?  In China a standard course of treatment is 10 treatment in 10 days and then you reassess.  Here in the US we find that virtually impossible and largely unnecessary.  In my practice I see the average patient once a week for 6 treatments for an initial course and then we reassess.  The longer you have been suffering the longer it can take to see lasting results, however, so a course of 12 treatments is generally expected and as mentioned, consistency is key to success.

The best advice I can give, therefore, is to be patient early on in your care and give your treatments time to do their work.  Not only must imbalances be addressed, but the body needs time to repair and regenerate from the inside out.  

Just as a little tiny roller coaster hill would never propel the cars through their entire run, one or two treatments will not reverse the effects of chronic imbalances.  Use momentum as your ally and then sit back and enjoy the healthy ride! 

This is one of my favorite quotes from Thich Nhat Hanh, a Vietnamese Buddhist Monk and author of many volumes on applying Buddhist philosophies to life.  It also illuminates one of the key features of acupuncture that I think people who haven't experienced it often don't think about - that one of the most important parts of an acupuncture treatment is just resting on the table and letting the needles do their work.

Its rare that we take time out to just "be" and dwell in the present moment like the little mantra above suggests.  Acupuncture treatment forces us to take that time, because for the 20 minutes you are on the table there is nothing you can do but breathe deep and be present.

Breathing deep and being present can calm the autonomic nervous system - like the woman in this Wall Street Journal video mentions - and acupuncture enhances that effect to calm the heart rate and respiration as well as your stress and anxiety.  This makes acupuncture an excellent tool for stress relief.

So if you're looking for a good de-stresser before the holidays, think about getting in for treatment sooner rather than later and even if you can't make it in for treatment, I hope you like the quote above and think about using it as a meditation mantra the next time you get a few quiet moments to just be!

This is a short excerpt from Dr. Oz demonstrating a simple acupuncture and moxabustion treatment for back pain.  Back pain is the MOST common complaint that people seek acupuncture for and I promise you that any acupuncturist worth their salt is proficient at treating it!

The thing I like best about this video and why I posted it today, is because they do a brief consult with an MD and a Chiropractor before demonstrating the acupuncture treatment, so you get to hear together and compare the methods and recommendations of the MD, the Chiropractor and the Licensed Acupuncturist for treatment.

The MD option? Differential diagnosis (what type of pain is it? spasm, muscular, disc, bone, nerve, etc.), imaging, followed by physical therapy and or cortisone shots, pain medication, possible surgery.

The Chiropractic option?  Chiropractic adjustment, perhaps soft tissue (massage) work, and supplements

The Acupuncture option? Acupuncture + heat therapy (moxa in this case, though heat therapy isn't always recommended) for 30 minutes, possibly chinese bodywork therapy (massage) in addition.

Indeed, back pain is something I see week in and week out in my clinic.  I always use a combination of acupuncture and bodywork therapies to treat back pain, including cupping, gua sha and Tuina (chinese therapeutic massage) and sometimes heat therapy in the form of a TDP heat lamp depending on the case.

I usually recommend a course of 6 weekly treatments to start and then we reassess to see if further treatment is indicated or necessary.  Some people are better in 2 or 4 while others require 12 or more - it depends on the severity and acute or chronic nature of the pain, in addition to lifestyle, work and repetitive use factors.  All of these things are assessed repeatedly along the course of treatment to ensure that we are making the most progress possible at every stage, and that we are working towards a pain free state!

As someone who has suffered from back pain myself due to injury I know how debilitating it can be and I am well familiar with both the energetic and muscular structures of the back, hips and abdomen that interplay to create and sometimes sustain back pain without intervention.

If you're interested in booking or learning more, please go to my online schedule and book an appointment or free consult today!

~Rebecca

For those of you that don't know what Diastasis is you're lucky, and probably represent a majority.  If you DO know what Diastasis is I am happy to report a viable, successful and research proven approach to recovery that I can now say I have experience with myself!  Its called the Tupler Technique and I'll tell you a little bit about it and the acupuncture and supplements I am combining it with to aid in recovery.  Before I get to that, however, let me explain what diastasis is and why I am dealing with it.

Diastasis is separation of the abdominal muscles, the Rectus Abdominis specifically.  It happens most commonly in women post partum though it can happen to anyone male or female for a variety of reasons.

The linea alba (as in the picture at left) is the connective tissue that holds the rectus abdominis together and everyone has a gap of about 1 finger width between those muscles.  If you lay down and lift your head off the bed/floor with your fingers on your midline you will feel your rectus abdominis lift on either side of your finger and you can measure that gap yourself.

If you have more than two finger-widths between your muscles at any given point from the ribcage down to the pubic bone, you've got a diastisis or a larger than normal gap that may need repair.  Very large diastasis' can be healed surgically, but it is always recommended to start with a rehab program before you pursue a surgical option.

I developed a small diastasis during my first pregnancy, and having a C-Section delivery after 36 hours of labor only made it worse.  Luckily for me, it was small and healed on its own with little to no intervention on my part.

Fast forward two years later to another labor and deliver (successful VBAC, woohoo!) leading to another diastasis.  While recovering from a vaginal birth is much easier and quite preferable to C-Section recovery, I had a 2 year old son at home who was 35 pounds and wasn't going to stand for not being carried around by mama.  I did my best with posture and position, but I lifted my son daily and often and he was FAR beyond the 10 lb weight limit my midwife attempted to impose on my postpartum.

With a belly still stretched from pregnancy, this gave my abdomen no chance to heal and the result was a diastasis almost 5 finger widths across at my belly button a year later that was not going to heal on its own.  

So here is a picture of my diastasis belly before I started the Tupler Technique program:

(Yes, I'm in my pajamas, wasn't really thinking about sharing the photos when I took the picture…) 

As you can see, the top of my belly button kind of protrudes a little bit.  I used to have a true "innie" before, and above my belly button is this strange pouch that I assure you I didn't used to have.  This is me comfortably back to pre-pregnancy weight, fyi.  The crazy thing is that when I would tense my stomach muscles or try to suck them in, I would still have that strange upper belly bulge.  After I ate it would stick out even more like my stomach was physically protruding, and I was experiencing some regular back pain from the abdominal weakness.  Not fun, folks, not fun.

I waited until the weather got a little colder here in Portland because the Tupler Technique involves exercises, movement modifications (sitting, standing correctly etc) and wearing a specialized splint (read "girdle") to physically hold the separated halves of the muscle closer together so the connective tissue in between has a chance to shorten up without being overstretched again and again.  The splint is thick and heavy and warm and I knew I couldn't wear it in the summer months.

Okay, so now I am 3 weeks into the process and here is what my abdomen looks like:

I haven't weighed myself but I think I have gained some weight - the program involves NO EXERCISE aside from brisk walking until you get farther along so you don't risk stretching your tenderly healing connective tissue, and since I live on spinning and aerobics this is affecting me quickly.  Still, I know the wait will be worth the reward and that I can lose what little I might gain in a few more weeks with focused effort.

You can see the splint marks there on my abdomen, but I am very impressed with the results thus far and feel very confident that my tummy will go back to its previous diastasis-free state once I am done.  I've already  had to order a second splint in the smaller size this week because my abdomen has come together so much that the arms of the splint wrap all the way around to my back, where they used to wrap only to my hips just a few weeks ago.  To make it to 6 weeks and beyond I will therefore need a smaller one.

I know my success is also due to the added alternative medicine steps I am taking to give my  body the best chance possible to heal.

The full Tupler program is actually 18 weeks if you stick with it religiously.  It takes a minimum of 6 weeks for your transverse abdominis muscle (your internal muscular girdle if you will) to strengthen enough to start supporting you appropriately and for the connective tissue to heal enough to hold well, so depending on the severity of your diastasis you  may be able to shorten the term of the splinting, but it is recommended to go a full 18 weeks if you want the best results from the program.

Three weeks in and 9-15 to go depending on my perseverance, and here is what I am doing to heal my diastasis on all fronts:

• Tupler Technique Program including Splinting, Transverse Abdominus Exercise and Movement Modification
• Acupuncture focused on strengthening the Dai Mai specifically
• Chinese Herbs appropriate to my energetic pattern and attuned to blood building and tendon nourishing
• Western nutritional supplementation including

1. Multivitamin
2. Fish Oil
3. Green Food Supplement
4. Standard Process Ligaplex - ligament rehabilitation formula
5. B vitamins, high in B12

The Tupler Technique program also called "Lose Your Mummy Tummy" can be ordered on Julie Tupler's website - she is the RN who developed and did the research to prove its effectiveness.  

If you have a severe diastasis it is highly recommended to work with a certified professional to get sized right for your splint and have help with the exercises.  You can find a list of licensed therapists on Julie's website.  Here in the Portland area, the "Tummy Team" is the best known group who specialize in diastasis though I don't know that they are actually Tupler certified.

I freely admit that I ordered the kit and have been pursuing it on my own.  My body awareness is fair and I have a physical therapist husband at home to assist me, so I feel confident in my ability to follow the directions of the program without going to the Tummy Team myself. 

Next, on my program above is Acupuncture focused on the Dai Mai along with Chinese Herbs appropriate to my pattern, and I'll tell you a little more about that.

According to TCM theory, connective tissue weakness is related to blood deficiency and weak Liver function.  Indeed, Blood and Yin are deeply depleted in pregnancy and birth due to the needs of the fetus and the challenge and vigor of labor.  I always recommend women eat chinese herbal soup or congee post partum to help rebuild their Qi and Blood post partum in addition to getting regular Acupuncture.

For Diastasis specifically, it is important to focus Acupuncture treatment not only on the Liver and Spleen to help tonify and build blood to strengthen the connective tissue, but also on the Dai Mai a.k.a. the Belt or Girdle channel (as seen at left).

This is an extraordinary meridian that encircles the waist exactly where the worst of a diastasis is found, and the presence of a diastasis means a weakening or disruption of proper Qi flow in this meridian.  Like the Transverse Abdominus muscle - the only muscle that encircles the waist, the Dai Mai is the only channel that travels horizontally across the body instead of vertically.  This means it has a very difficult job to do and it must do this job alone - just like the transverse abdomens!

Chinese Medicine is also hallmarked by what is called "syndrome differentiation" which translates as individual treatment for individual needs.  I have an energetic baseline of Spleen and Heart Qi deficiency with Dampness so I am taking herbal tonics specific to this pattern and I believe treating my constitution this way is further helping me to recover and rebuild well.

The western nutritional supplements I am taking are a basic protocol I recommend for everyone - multi vitamin and fish oil/EFA in particular, B vitamins, green food - with the Ligaplex which is a whole food supplement specifically for ligament and connective tissue rebuilding and repair.  Standard Process supplements are very tried a true - a company from the 1920's with a strong track record of success.  I have taken the Ligaplex before for heart palpitations related to leaky (weak connective tissue) heart valves and found it helpful.  Indeed, my regular heart palpitations related to a congenital murmur have actually decreased over the past 3 weeks as well.

The result so far is what you see in the pictures above - at only 3 weeks in my abdomen is drastically changed, and my back pain is also gone.  How much the back pain is gone because I am effectively wearing a brace 24/7 and how much it is gone due to strengthening is yet to be seen, but I can tell that my transverse abdominus is noticeably stronger, so I am hopeful that the weak-ab related back pain is going to go away as well as my "mummy tummy" as part of this process.

I hope I will make the full 18 weeks of splint-wearing but I am not sure.  It already feels tedious to wear it and dress around it, and my abdomen is healing rapidly, so my goal at this point is to make it to 12 weeks and then reassess.  Even if I don't wear the splint 24/7 anymore I will definitely continue with the increasing transverse abdominus exercises for the full 18 weeks.

Julie Tupler has a saying that "every belly should be checked" and as I move ahead with this process, I think she is right.  Even if you don't have a diastasis, learning to do these kinds of transverse abdominus exercises and learning to engage that muscle consciously during all strenuous activity is very valuable - I can already tell that my back is much safer for learning to use my abdomen this way.  I feel very confident recommending her program and I will definitely be educating more of my pregnant and postpartum patients about it as time goes on, because even a mild diastasis deserves care and attention.  After all, all mom's want to be able to lift and carry their children safely without compromising their backs and essentially, that is what this program will allow you to do - for as long as your children let you pick up and cuddle them!

As I continue with this journey I will post about it more, and if you have any questions or know someone who might have a diastasis or is struggling to heal a diastasis, please send them my way.  I would be overjoyed to help other people heal from this uncomfortable weakness and learn how to "lose their mummy tummies!"

Until next time,
~Rebecca