PARAVERTEBRAL POINTS New keys on your vertebral keyboard

It is well known that the vertebral keyboard, via the sympathetic trunk, has a major influence on organ function.

This is a two-way segmental relationship: a vertebral articular fixation can affect an organ (somatovisceral reflex) and, conversely, a visceral dysfunction can be reflected at the corresponding spinal level (viscerosomatic reflex).

In a segmental framework, these correlations form a complex network. Each node can communicate with any other: dermatome, myotome, sclerotome, viscérotome. It is classically described, according to Head[1], that a disorder of the gallbladder may be associated with muscular manifestations in the shoulder.

But this can also involve the skin (dermatome) or bony structures (sclerotome) corresponding to the same segmental level.[2]

[1]In the 1890s, the neurologist Sir Henry Head identified certain skin zones that develop sensitivity (allodynia) during visceral pathology (Head’s zones). He also highlighted the existence of specific points within these zones, which he called “maximum points.”

[2]Wancura-Kampik, I. (2012). Segmental anatomy: The key to mastering acupuncture, neural therapy, and manual therapy (1st ed.). Elsevier Urban & Fischer.

Original illustration by Head showing the zones and the “maximum” points

This segmental conception gives certain key points of the spine a dual interest, both diagnostic and therapeutic.

We propose here an osteopathic approach based on the correspondences of segmental anatomy[1], which are also found in acupuncture as the Back Shu points (Bei Shu Xue)[2]. These paravertebral points provide specific access to the visceral system. They play an essential role in the treatment of chronic diseases. Some authors even go so far as to assert that a chronic illness cannot be treated without resorting to the Back Shu points.[3]

[1]Wancura-Kampik, I. (2017). Segment-Akupunktur: Der wissenschaftliche Hintergrund der chinesischen Akupunktur (1st ed.). Kiener Verlag.

[2]Cabioglu, M. T., & Arslan, G. (2008). Neurophysiologic basis of Back-Shu and Huatuo-Jiaji points. The American Journal of Chinese Medicine, 36(3), 473–479.

[3]O’Connor and Bensky, 1988, cited by Cabioglu and Arslan, American Journal of Chinese Medicine, vol. 36, no. 3, 2008, p. 474.

In osteopathic practice, the convincing — sometimes spectacular — clinical results obtained by working on these paravertebral points should encourage us to integrate them systematically into the examination and treatment of the spine.

It is also worth noting, among the proposed correspondences between vertebrae and organs, the relationship established from the work of Irvin Korr, synthesized by Bath and Owens[1].

[1]Bath, M., & Owens, J. (2023). Physiology, viscerosomatic reflexes. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559218/

Location

In acupuncture, three vertical lines running along the back are described:

    . 1 spinal line, median (Governing Vessel),

    . 1 paravertebral line on each side, about 3 cm (2 finger breadths) from the midline, where the Back Shu points are located (first chain of the Bladder meridian).

   . 1 costal line on each side, running along the medial border of the scapula, about 6 cm from the midline (second chain of the Bladder meridian); its points — positioned horizontally across from certain Shu points — have specific functions[1].

[1]Cojan, P. (2017, October 14). Points of the lateral branch of the Bladder meridian [Communication], AFERA Congress, France. In LMO practice, this is the line we follow when testing the posterior thorax with contact at the costal angle.

Illustrating, from outside to inside:

The costal line (lateral chain of the Bladder meridian).

The paravertebral line (medial chain of the Bladder meridian), with the Shu points shown in yellow.

The spinal line (Governing Vessel).[1]

[1]https://lesouffledumenhir.blogspot.com/2020/06/les-points-bei-shu-xue-bei-shu-xue-shu.html

The Back Shu points are all positioned symmetrically, on the right and left, along the paravertebral line.

The paravertebral Shu points

Properties

The ideogram “Shu” 输 means “to transport, to convey.”

In the concept of acupuncture, they conduct the Qi (energy) toward the viscera, giving direct access to the organ.

According to some authors[1], they enable the transmission of our “original energy” (Yuan Qi) in communication with the points of the Governing Vessel, and a specific distribution for each. They therefore act as sites of defensive-energy accumulation over the more fragile zones of our constitution.

From a more osteopathic point of view, these paravertebral points are in anatomical relationship with the posterior ramus of the spinal nerves, which carries motor, vasomotor, and sensory information to and from the skin and the deep muscles of the back.

For this reason, they are also in relationship with the vertebral sympathetic chain[2].

[1]Montakab, H. (2012). Acupuncture point and channel energetics: Bridging the gap. Kiener Verlag.

[2]The axons of sympathetic ganglionic neurons leave the ganglia as gray communicating rami that join the rami of the spinal nerves. The spinal nerves provide sympathetic innervation to the trunk wall and contribute to the formation of the splanchnic nerves for the innervation of the abdominopelvic viscera.

Shu point and posterior branch of the spinal nerve

Each Shu point corresponds to a specific organ or function[1].

For example, the T3–T4 paravertebral point (BL 13) corresponds to the Lung organ.

According to our experience, these points are also found when an Extraordinary Vessel requires treatment[2].

In this case, the same T3–T4 Lung paravertebral point should be related to the Conception Vessel (whose opening point is LU 7).

[1]To learn about the different indications of the Back Shu points, it is useful to refer to an acupuncture atlas. The action of a point is not limited to the corresponding organ alone.

[2]See LMO blog articles: Osteopathic regulation of the major body systems via the Extraordinary Vessels.

Correspondance vertèbres-organes des points Shu

Officially, in acupuncture, there are only 12 pairs of Shu points.

From a clinical standpoint, this designation “Shu point” (access point) would undoubtedly deserve to be extended to other vertebral levels, assigning to each a particular tropism.

For example, the C7–T1 paravertebral point (BL 11) could be considered a Shu point for the musculoskeletal system, and the T7–T8 paravertebral point (BL 17) as the equivalent of a Shu point for the diaphragm.

The correspondences proposed in acupuncture are not merely conceptual; they match segmental anatomy precisely.

These references are clinically very useful and applicable in osteopathy.

In practice, osteopaths do not need to know the nomenclature and names of the points as codified in acupuncture. It is enough to know to which vertebral level (using the tip of the spinous process as a landmark) and with which organ the point is related.

For example: T5–Heart, T9–Liver, L2–Kidney, etc.

Diagnostic Function

A Shu point that is tender to palpation serves as an alarm bell pointing to a vertebral and/or visceral dysfunction.

In our experience, if the point is sensitive to pressure but not fixed (no fascial or muscular tension, nor any vertebral articular blockage), this indicates a visceral dysfunction. In this specific case, the Shu point serves as a diagnostic aid (an alarm point) but should not be treated, as long as it is not fixed.

This distinction between an active point (fixed) and a reactive point (sensitive) is important. In acupuncture or reflexology, for many authors, tenderness of the point prescribes treatment. However, in our view, tenderness of the point simply highlights a vertebral or visceral dysfunction. An osteopath should only treat a structure if it truly presents a tissue fixation or blockage.

Therapeutic Function

These are essential points which, when they need to be treated, allow the corresponding organ to be tonified. They prove very useful in osteopathic practice, especially with fatigued patients and chronic conditions.

There are many reasons that explain the depth of action of these points, such as the embryology of the posterior trunk musculature’s development, which shows the superposition of several layers with multiple segmental levels. For example, at point BL 13 (the Lung Shu point), the acupuncture needle — or the osteopath’s finger — contacts and then crosses, from superficial to deep, the dermatome (T3), then a first myotome (C4 and the accessory nerve[1] for the trapezius), a second myotome (C5–C6 for the rhomboids), then a third myotome (T3–T4 for the serratus posterior superior). A single point thus triggers an “extended” segmental activation from C4 to T4, including a cranial nerve.

Below T9, the Back Shu points lie on the thoracolumbar fascia, which serves as a key relay for the posterior spiral myofascial chains, connecting, for instance, the latissimus dorsi and the gluteus maximus[2].

[1]Cranial nerve XI, formerly known as the spinal accessory nerve.

[2]Willard F.H., Vleeming A., Schuenke M.D., Danneels L., Schleip R. (2012). The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of Anatomy, 221, pp. 507–536.

 The Vertebral Examination

We propose 2 different tests at each vertebral level[1].

The tests are carried out using pressure-circumduction to assess the suppleness/elasticity of the tissues[2].

A global test on the median spinal line (midline), in contact with the spinous process, to individually evaluate each vertebral segment[3].

If the finger detects resistance to pressure-circumduction (positive test), this normally indicates a vertebral blockage.

A specific test on the paravertebral line, about 3 cm from the midline, testing the paravertebral muscles.

The contact point is located in the vertebral groove, in a small depression between the multifidus and the erector spinae muscles.

[1]In parallel, we also add a 3rd test for the ribs using the points of the second chain of the Bladder meridian (costal line).

[2]This is indeed an osteopathic test to assess the degree of tissue resistance at the point, and not an “energetic test” in the sense understood by Chinese medicine (to assess emptiness or fullness, cold or heat, etc.). https://lmosteo.com/diagnostic-et-traitement-de-la-lesion-osteopathique-selon-lapproche-du-lmo

[3]Tests described in our article “The vertebral segment lesion, a new osteopathic approach.” https://lmosteo.com/la-l%C3%A9sion-du-segment-vert%C3%A9bral

Paravertebral contact point between multifidus (MF) and erector spinae (ES)

A resistance to pressure-circumduction perceived under the finger (positive test) indicates a muscular tension that can be of vertebral or visceral origin.

In the absence of any vertebral fixation (negative spinous process test), a positive paravertebral test naturally directs us toward a visceral dysfunction. This visceral dysfunction will need to be verified through the osteopathic tests of the organ involved[1].

[1]One may also optionally add a pressure test on the corresponding anterior segmental point (Mu point in acupuncture).

Tension test of the paravertebral points

Hierarchical Diagnosis

This is an essential step to properly differentiate secondary points from the dominant points that are to be treated as a priority.

It should be noted that pressure sensitivity of a point is not a reliable selection criterion, as the most painful point is not necessarily the dominant one.

To objectively compare the points with one another, we use the technique of the inhibitory balance test.

The principle of the inhibitory balance test is simple: when the practitioner simultaneously contacts 2 fixed points, it is felt that, under his fingers, the tension of one point releases while the other point resists and remains blocked. This is an inhibitory reflex, of neurological nature, which reveals the more active point. The inhibited point will be considered secondary, whereas the one for which the tension persists will be considered the dominant point.

When there are several points to compare, simply keep the dominant point found and put it in balance with another point. Then, depending on the number of points identified, balance the new dominant points with a remaining one.

Since in practice we rarely have more than 3 or 4 blocked points, this inhibitory balance procedure is quite fast.

Where the acupuncturist would place a needle, we propose to treat the point using the recoil technique.

Recoil is a gentle structural correction technique: applying tension against the tissue barrier (the blockage), delivering a directed impulse against the resistance, and quickly withdrawing the hands to allow the induced vibration to take effect[1].

Recoil has a dual effect here:

A mechanical effect, by releasing the articular and muscular structures.

A neurological effect, by stimulating the point and activating the corresponding organ.

The recoil has many advantages: simplicity and speed of execution, precision of adjustment, applicability to all patients (from infants to the elderly), immediate effectiveness, and no contraindications.

Even though the focus is on muscle, the adjustment also involves the entire fascial environment of the point and the corresponding spinal nerve.

It is necessary to carefully set the direction of the adjustment, whose impulse will always be directed against the resistance. Analytical tests in distal/proximal traction and in clockwise/counterclockwise rotation tell us exactly in which direction to treat the point.

The effect of the treatment can also be enhanced by using the patient’s breathing.

Recoil performed during the inspiratory phase will reinforce the sympathetic system, whereas, when performed during the expiratory phase, it will calm the sympathetic system.

Do not hesitate to perform several successive recoils, if necessary, in order to fully release the tissue fixation and “open” the point[2]. One may even use the tip of the finger, at the edge of the nail, much like an acupuncture needle.

[1]Demonstration videos of the recoil technique are available in English on the LMO YouTube channel: https://www.youtube.com/channel/UCQCZW0vXUPSFciJ8d5bhHOQ

[2]“Open” here means to free the space between the multifidus and erector spinae muscles. Unlike in acupuncture, the goal is not to tonify or disperse a point, but simply to normalize a tissue, muscular, and neural tension.

An 80-year-old patient has been consulting us regularly, 3 to 4 times a year, for chronic low back and neck pain. Osteopathic treatment clearly improves her pain, but she has retained a dry, recurrent cough for more than two years.

During one session, to complete the general treatment, we added the right T3–T4 paravertebral point (the Lung Shu point), which remained discreetly fixed. Much to the patient’s surprise, the cough disappeared completely and lastingly, from the very next day!

A telling clinical case which, although it proves nothing in itself, clearly illustrates the importance of these paravertebral points in osteopathy, as in acupuncture.

It also underscores the value of considering points of resistance — even discreet ones — within a symptomatic approach, using the somatovisceral reading grid proposed here.

Eric Prat, Ostéopath D.O., LMO

Dr René Descartes, Internal Medicine Physician and Acupuncturist

English translation proofread by Chantal Fillon, Osteopath D.O.