Monday, September 7, 2015

Research Review from a Sinew Channel Perspective: The Anatomy of the Posterior Aspect of the Knee | The Journal of Bone & Joint Surgery

The Anatomy of the Posterior Aspect of the Knee | The Journal of Bone & Joint Surgery

The link above contains an abstract discussing anatomical research on the posterior knee. This research will be listed and discussed as a component in a class I will be teaching in San Diego, CA as part of the Sports Medicine Acupuncture Certification Program. This week will be class one and two for Module Four - The Lower Extremities, and the discussion will be part of my lectures based on the Anatomy of the Sinew Channels.

The research discusses the complexity of this structure and emphasizes eight fascial expansions off the main semimembranosus (one of the medial hamstring muscles) tendon (fig. 1). These include:

Fig. 1
  • A lateral expansion to the oblique popliteal ligament which is the largest posterior knee structure. This expansion had two attachments: 1) to the meniscofemoral portion of the posterolateral joint capsule and, 2) to the tibia, along the lateral border of the posterior cruciate ligament.
  • An anterior arm which connects to the medial collateral ligament;
  • A distal expansion which crosses over (posterior to) the popliteus.
A couple of things are important to note about this that can give some insight into the channel system, particularly the sinew channels. First off, it is useful to notice how fascially connected the semimembranosus is to the ligamentous and fibrocartilage structures of the knee. Fascial expansions connect to the MCL, PCL, and lateral meniscus (since the MCL attaches to the medial meniscus, this could be considered in addition). Considering that the Kidneys are associated with the knee, I feel this is a strong argument for the semimembranosus to be considered as part of the Kidney Sinew Channel.


Fig. 3:
Superficial
hamstrings
removed, illus.
KID SC
Fig. 2:
Superficial
hamstrings
intact, illus.
UB SC
Actually, I see the Kidney sinew channel comprising the semimembranosus and the 'fourth hamstring' which consists of the fascially connected biceps femoris short head and the middle fibers of the adductor magnus. This 'fourth hamstring' is discussed both by Dr. Janet Travell, MD in her book Myofascial Pain and Dysfunction: The Trigger Point Manual, and by Thomas Myers in his book Anatomy Train: Myofascial Meridians for Manual and Movement Therapists. This is depicted in fig. 3 to the right which is contrasted with the image containing the biceps femoris long head and semitendinosus in fig 2, to the left. The superficial hamstrings (semitendinosus and biceps femoris long head) both blend in with the sacrotuberous ligament which links these structures with the posterior ligaments of the sacroiliac joint. These more superficial hamstrings connecting to the posterior ligaments are logically ascribed to the Urinary Bladder sinew channel.

The semimembranosus and 'fourth hamstring' have more fascial connections to the pelvic floor which connects to the anterior ligaments of the sacroiliac joint and are ascribed, as discussed above, to the Kidney sinew channel. See my previous blog post on BL-58, the Luo-connecting point of the Urinary Bladder channel for more thoughts on these two sinew channels.


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