TYPE M3 (FIGURE 6.7) Quick Tips

1. When lying down and relaxed on your bed, try to wiggle your toes smoothly and gently spread them apart without involving your ankles and knees. If you have difficulty with gentle move-ment and struggle to move quickly, then you fall into type M3.

2. Again, in a lying-down position, relax your entire body and try to move your ankles very slowly in all directions, in a 360° circular motion. If this motion is difficult for you, you can be classi-fied as type M3.

3. Bend your ankles toward your legs and stretch them. You may experience areas of tightness on your legs.

4. Check the bottoms and sides of your feet between your toes; are there any points of concern?

5. Have you recently experienced any pain, stiffness, or numbness in your big toe, without any other medical issues, such as diabetes? Does one or both of your feet have a bunion, a bump on the side of the big toe? It will appear as your big toe leans in toward the second toe, rather than pointing straight ahead.

6. Do you have heel pain accompanied by spider veins and a tendency to easily bruise on your legs? Palpate each side of your ankle; if your inner ankle feels swollen, follow along the tibia with light pressure. Do you feel pain or dis-comfort? Are your veins prominent? If you have a leg massage, you will prob-ably feel tightness and tension.

7. Does your job consist of standing for long periods, or do you walk on a hard floor such as marble, tile, and stone throughout the day?

Related Condition

• Weakened pelvic floor: After child-birth, incorrect exercise, trauma

• Overactive bladder syndrome

• Constipation: Idiopathic or sphincter contraction

• Inner knee pain and swelling

• Whole-body pain: Fibromyalgia

• Lower back pain

• Heel and toe pain

• Occiput headache

• Gynecological issues, male fertility issues

• Lower abdominal scar from surgery

• Surgery on lower extremities and spent much time recovering

• Tightened gluteus muscles and leg muscles

• Swollen legs, especially inner thigh

• Balance problem

• Lower body obesity

• Swollen legs due to an internal organ disorder

Clinical Syndrome

Most type M3 syndromes demonstrate abnormal conditions on the lower extremi-ties, such as swelling or local obesity, muscle tightness, and foot and toe prob-lems. Patients may visit clinics in order to treat various symptoms, such as knee pain, hip pain, sprained ankle, foot pain, lower abdominal cramps, frequent urination, idiopathic constipation, and weight loss.

Even with different symptoms and signs, I found similar patterns during observa-tion and palpaobserva-tion. On the contrary, some-times the knee pain or leg pain is the same in terms of symptom, but the etiologies or body structures differ from each other. For example, both type M2 and type M3 exhibit

FIGURE 6.7 Type M3.

leg and foot discomfort and signs distin-guishing the patterns. However, if the entire body structure is observed, we can find dif-ferences in character.

The leg structure of type M3 is different from that of type M2, which is closer to a valgus type. The key distinction is that a knock-knee can absorb the shock and flat feet can avoid further movement for type M2. Type M3’s leg structure shows the opposite conditions. First, leg muscles are lengthened and weak, especially the gas-trocnemius and soleus (back side of muscle connected with the Achilles tendon) mus-cles, and feel shrunken when palpated. The side and front leg muscles—the tibialis ante-rior, extensor digitorum longus, and exten-sor hallucis longus (extension for toes)—are lengthened and difficult to distinguish, which means the toes are misaligned and have limited motion. This causes the out-side leg to tighten, and development of a hyperextended knee causes the patient to stand on the outside of the foot.

Usually the joint takes on the role as a shock absorber while we are in motion. If the knee is hyperextended and ankle inversion is present, which is caused by the foot supina-tion in type M3, then each mosupina-tional shock goes directly to the pelvic area and spine.

Clinical experience tells us that these conditions result from the tightness of hip muscles and the lower back pressing for-ward, which sets the hips and spine out of alignment. Comparing type M2 and type M3 lordosis cases, the lower back of type M3 patients does not necessarily present as an anterior pelvic tilt, which reduces the shock directly exerted on the spine. The anterior pelvic tilt is the body’s natural way of maintaining flexibility, protecting the spine, and making more room for tension absorption, as in lordosis during pregnancy.

Instead of lordosis symptoms, kyphosis (hunched upper back) and scoliosis (side-ways curvature of spine) are accompanied by type M3 disorders. In severe cases, a flat-back posture can be presented in con-junction with other symptoms. A typical flat-back posture is a forward-leaning head, long neck shape (cervical spine extended), straight chest and back, posterior tilted pel-vis, extended hip and knees, and ankle joint inversion.

The appearance of someone in a flat-back posture is sometimes also apparent. It is rather common in people who tend to per-form many sit-up-type exercises, boxers, and those who have poor core and back sta-bility. They tend to be very alert and have quick responses and high endurance. Most patients incline more to the fight and flight mode, rather than the relax and rest mode.

The type M3 group has internal symp-toms related to gynecologic issues, urinary and bowel syndromes, and circulatory prob-lems, such as insufficiency of venous return.

Unlike other groups, type M3 patients do not complain of pain in its initial stage;

however, over an extended period, the pain may become intense and unbearable.

It is important to record the medical his-tory, which may consist of trauma, injury, or any surgery, to assess the treatment plan for type M3. Type M3 symptoms are presented on the entire body if in the chronic stage, and outer appearances are not as prominent as they are in types M1 and M2.

Lower extremities support your balance, side by side, front, and back, constantly moving and adjusting motion to maintain the correct position for your upper body.

These endeavors are influenced by any biomechanical changes or stresses on the pelvic region, which is the center of infor-mation between the legs and spine. Feet,

ankles, knees, lower abdominal area, groin area, and thoracic and lumbar spine prob-lems can lead to movement compensations, which can change the normal function of the pelvis and legs. Over time, these changes result in abnormal hip joint structures.

Type M3 displays conditions similar to those of a pear-shaped body. The hip and pelvic upper thigh areas look larger than other parts of the body. Especially, the area between the legs bulges with extra fatty tis-sue and cellulite. If the congestion or obe-sity symptoms are severe, the outer shape is similar to that of an anterior pelvic tilt, X-shaped legs, and even a flat-footed shape.

However, if you palpate the legs and pelvis area, the internal muscles and vein condi-tions will exhibit symptoms associated with type M3. Types S, M2, and M3 can present simultaneously, and so do their symptoms.

In such cases, the treatment will be pro-cessed externally from the outer shell and move inward, toward the internal organs.

Understanding the Mechanism

Type M3 is related to the vertically aligned pathway along the feet to the cervical spine, following the circulatory system (Figure 6.8). Whereas type M1 involves the hori-zontal arm and shoulder rotation, leading the breathing muscles, type M2 lengthens and is strengthened with a circular accor-dion-shaped cylinder in the outer shell of the body.

The pelvis is the center of the body, link-ing the spine and the legs. The information received from the bottom of the body is gathered at the pelvis and transferred to the brain. Orders are received from the brain at the pelvis and are enacted by the lower extremities. If the pelvis is weak and has a problem, the entire body can be affected.

For example, a misplaced and weak pel-vic diaphragm results in pain and tension, which will affect breathing and freedom of movement.

Body Balance

During an ordinary stance, the pelvis is tipped slightly forward, controls the whole-body equilibrium, and maintains an upright posture. When the balance is disturbed by either an external or internal force, the body immediately reacts in order to move the trunk and extremities and so find a stable center. A stable center is changeable, depending on the motion and action.

Balancing, in essence, means the constant communication of each side and the nego-tiating of the center of power between the two sides. The body has three major control mechanisms for body balance and posture:

one is control over the whole-body equi-librium to maintain an upright posture,

FIGURE 6.8

Type M3 mechanism.

another is control over lumbopelvic orien-tation to maintain spinal posture, and the last is control at the intervertebral level to maintain vertebral body alignment.

When picking up a heavy object from the ground with your arms, the internal force between the trunk and lower extremities is reactive. If a bus or train stops suddenly, your extremities will grab a secure object or readjust your standing position in order to resist the forward moving force and so regain balance. Since every movement demands control of equilibrium, trunk and spinal flexibility and stability are necessary.

The center base for the two vertical equilib-rium lines (one on the right side of the leg toward the spine, the other on the left side of the leg toward the spine) is the pelvis.

Muscle Sequential Connection and Function for Type M3

The erector spinae muscle provides resis-tance and assists in the control of bending forward at the waist level. As it is named, an erect position from bending is carried out by the erector spinae extensors. The erector spinae muscle consists of three columns of muscle, the iliocostalis, longissimus, and spinalis, each running parallel on the outer sides of the vertebra and extending from the lower back of the skull all the way down to the pelvis.

The erector spinae muscle has many antagonist and synergist muscle groups as the muscles cover almost the entire back area, connecting the neck, ribs, and pelvis.

The antagonists at the neck are the neck flexors, such as the sternocleidomastoid, the longus coli, and the longus capitis. The rec-tus abdominis and the abdominal oblique muscles are the antagonists for trunk action. While straightening the spine, the

synergists are the hip extensors (gluteus maximus muscles) and the hamstring mus-cles. The erector spinae muscle triggers pain over your entire back and may even send pain to your upper leg and lower abdominal region.

The hamstrings are located on the back of the thighs. They are composed of three muscles. On the inside of the thighs are the semimembranosus and semitendinosus.

On the outside are the biceps femoris. The hamstrings originate from the lower pelvic bone, and they connect with the pelvis, the femur, and the lower leg. If you bend your knee into a sitting position, the hamstring contracts.

When you sit on a chair, you can move your ankle in a motion similar to that of pressing the brake pedal in your car. Your back leg muscles engage in this motion. The back leg muscles are the gastrocnemius and soleus muscles. Both the gastrocnemius and the soleus run the entire length of the lower leg, connecting behind the knee and at the heel.

The gastrocnemius muscles have two branches at the top behind the knee and connect medially and laterally with the thighbone, the femur. During walking, the gastrocnemius muscle is flexed and creates the bending action for smooth movement of the upper legs. If you wear high heels or flip-flops, the knee bending motion will be decreased.

Both the gastrocnemius muscle and the soleus join onto the Achilles tendon, which is one of most important parts for balanc-ing in an upright posture. The ankle, the approximately six-inch circular lower leg compartment, can affect your static body posture, motion, walking, and balancing because the area includes almost 10 ten-dons, many ligaments, nerves, and blood

vessels communicating with the central nervous system through the vibration of tendons, venous return, and skeletomuscu-lar imbalance.

In TCM and Asian culture, the feet and lower legs have been treated as the symbol of a healthy life and longevity. If you keep your feet warm and clean, your important tendons will not become stiff and rigid, and blood circulation will be encouraged.

Type M3 focuses on the lower extremity–

pelvis–spine loop mechanisms. The caus-ative factors that occur at the root of the loop can result in symptoms. For example, an individual had to have knee surgery due to an accident, and one leg became weaker than the other because of a long recov-ery period. The individual only used one leg, and as a result, the body compensated for this irregularity. The lumbar muscles became contracted in the inactive leg. This caused postural problems with a poor walk-ing gait. The poor walkwalk-ing gait generated leg joint pain and foot pain that was felt in the spine.

As another example, a patient had a myo-mectomy for uterine fibroids several years ago and subsequently had another surgery for endometriosis. Since then, she felt skin tightness on the one side, mostly due to scarring on the skin area, and she tried to avoid bending the area, so she stretched her spine as much as possible. Later, she had severe pain in the occipital area and ankle, which continued until her lower pelvic area was treated.

Type M3 and Blood Circulation

An important characteristic in type M3 is the relationship between the muscles and the blood vessel pump. The legs have several skeletal pumps for circulation to assist the

venous return, which is toward the right atrium after pushing venous blood up with muscular contraction. If there is limited muscle contraction in the lower extremi-ties, blood can pool in the lower legs. This causes a decrease in the venous return and cardiac output.

Especially ankle movements such as plantar flexion and dorsi flexion (heel and toe position) are triggers to move the gas-trocnemius muscle, passing the central vein between the two areas of the muscle.

But a poor range of motion in an ankle occurs in conditions where muscles are already lengthened or weakened, by wear-ing uncomfortable shoes such as high heels, and swollen ankles. Furthermore, long peri-ods of standing and sitting may also result in insufficient venous return.

A chronic insufficient venous return results in edema, swelling, and skin changes.

In this case, one-third of the lower leg may display spider veins, discoloration, ulcers, and thinning skin. Toe movement will be limited, and sometimes the toe shape is deformed.

Ankle and toe movement are closely related because the muscles of toe extensors work together when the ankle is extended and the muscles of the toe flexors work with the ankle flexors. However, the toe extensor and flexor muscles move freely while the ankle muscles rest.

This means that if the ankle muscles do not have a full range of motion, toe motions are restricted. Toe pain or deformity influ-ences the position of the ankles and knees, which will affect the walking gait and the entire body.

One-third of leg components are mostly tendons, which tend to be poor blood supply areas. A lack of blood supply will not allow rapid eradication of swollen symptoms. The

daily care of ankles and feet is the best way to prevent type M3 symptoms.

Pain

Type M3 patients do not usually complain of pain symptoms during the initial stages.

When they do notice the pain, the incident that led to the problem is usually long forgot-ten if not related to an accident or trauma.

The pain is not localized, and it is easy to pinpoint the origin. It does not involve inflammation or muscle contractions.

Type M3 patients usually experience pain in the occiput area and complain of shoulder pain, upper back pain, lower back pain, pelvic pain, leg pain, medial and lat-eral knee pain, and ankle pain. Their pain is quite intense and affects their daily life.

Sometimes spastic pain and muscle spasms bother them at night and cause sleep inter-ference, which can cause depression.

Type M3 pain characteristics are as fol-lows: Before the pain began, patients were very active, athletic, and maintained a busy schedule, enjoying sports and danc-ing. Mild discomforts such as constipa-tion, foot pain, and shoulder pain did not bother their activities. The common pain trigger is time off from daily activities.

For example, a sprained ankle may have triggered entire body pain after spend-ing several days off. Or a stressful project was completed and time was taken off for a vacation. Or emotional trauma caused by a breakup or separation resulted in physical pain after suffering the emotional pain. While going through a difficult time, type M3 patients typically lose weight and severe pain begins.

In my clinical experience, the physical patterns are found and the pain spot is usu-ally showed by stretched muscle fibers and

a “dried-out” body fluids area. This is not treated with trigger point needling. The muscles alongside the spine are very tight and the spine cannot move freely. At the same time, the inner legs and thigh areas are very sensitive to pressure. When areas of pain are stimulated or palpated, the real pain spot will react.

For example, one of my patients com-plained of upper neck pain, but her neck and arms did not have any points of con-cern. While I palpated her neck, the left side of her hip muscles twitched. I went on to record her history and understand her con-dition. She had been severely traumatized by second surgery complications, and 15 years previously, she suffered several pelvic organ issues. She had been so busy taking care of children that she did not have much time to focus on her own health care. The pelvic pain affected her walking and stand-ing posture. Her spine transformed to a flat-back shape. She had chronic indigestion and constipation. She reported never feel-ing real relaxation.

The root cause of the pain that she expe-rienced was chronic sacral tension stress from lower extremity movement. Her lower abdominal tension and discomfort were

The root cause of the pain that she expe-rienced was chronic sacral tension stress from lower extremity movement. Her lower abdominal tension and discomfort were