Thursday, September 3, 2015

Article Review: Understanding the IT band | Harvard Gazette

Link: Understanding the IT band | Harvard Gazette

Fig. 1, From Netter's
Atlas of Anatomy
Linked above is an article that summarizes some interesting research about the elastic qualities of the iliotibial band (IT band or ITB). This fascial structure connects the lateral hip with the lateral knee. The gluteus maximus attaches directly into the IT band, as does the tensor fascia lata (TFL) muscle. This structure can be involved with many pain patterns, including IT band friction syndrome, about which I posted recently. This post will explore the content of the Harvard Gazette article through the perspective of the Stomach and Gallbladder sinew channels.

Fig. 2, From Netter's
Atlas of Anatomy
The research shows that the IT band stores and releases elastic energy during walking or running, which makes these activities more efficient. Running, in particular, was shown to take advantage of this elastic recoil. The 'recycled energy' gained from elastic recoil is due to the fact that the IT band connects to the front of the pelvis through the TFL attachment (ASIS and anterior iliac crest) and the back of the pelvis through the gluteus maximus (primarily the sacral attachments and PSIS) (fig. 1). During extension, the anterior line of ITB through the TFL to the front of the pelvis is stretched, and the energy being released propels the limb forward. The posterior line of the ITB through the gluteus maximus to the posterior pelvis is then stretched as the limb is flexed, thus building tension and storing energy to assist with extension. A pretty remarkable system of energy storage and conservation is therefore created and used!

For acupuncturists, especially Sports Medicine Acupuncturists like me, there is an opportunity to examine this dynamic with respect to the sinew channels. I believe this involves the Gallbladder sinew channel and the Stomach sinew channel (or at least a branch of the Stomach sinew channel).

Fig 3: Gallbladder Sinew Channel
from A Manual of Acupuncture, by
Peter Deadman
Gallbladder Sinew Channel: This involves the attachments of the extensor digitorum longus into the ITB, which, in my clinical experience, communicates primarily with the gluteus maximus attachment (fig. 2 and 3). One might also consider the peroneus longus, but I feel this is more properly assigned to a branch of the Urinary Bladder sinew channel which connects into the biceps femoris and affects sacroiliac joint balance during gait. But that is beyond the scope of this discussion (see fig. 5).

Fig 4: Stomach Sinew Channel
from A Manual of Acupuncture
Stomach Sinew Channel: This involves the attachment of the tibialis anterior into the ITB which, in my clinical experience, communicates primarily with the TFL. Note that the ST sinew channel does involve the tibialis anterior and anterior crural fascia attaching into the quadriceps (mainly rectus femoris and vastus lateralis). But I believe the ITB-TFL connection to be a branch of the ST sinew channel (fig. 2 and 4), as depicted in Deadman's A Manual of Acupuncture and described in the Ling Shu: "A branch goes along the leg bone and joins the Leg Shaoyang..." (translation from Jingjin, by David Legge).

Fig. 5: Urinary Bladder sinew
channel From A Manual of Acupuncture.
Note the side branch on the leg, which I 
interpret as the peroneus longus; 
this connects to the biceps femoris 
and is not part of this discussion.

So, proper balance and efficiency in walking and running is partially achieved through the relationship of the Stomach sinew channel and the Gallbladder sinew channel. This gives new insight into Zusanli ST-36 (Leg Three Miles) which is one of two motor points of the tibialis anterior. The TFL is very often overactive, as seen in Ober's test. Could needling the motor point of the tibialis anterior at ST-36 allow for better range of motion through this tibialis anterior-ITB-TFL connection, allowing for better extension and creating more stored energy? It sounds like classical thought was on to something in stating "that stimulating Zusanli ST-36 would enable a person to walk a further three li, even when exhausted." (from A Manual of Acupuncture).

I encourage you to check out the original article; there is a great animation to visualize the elastic recoil I mentioned.

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  1. now that I'm aware of your work I'm very pleased to be working through your blog posts. This one seems to conjecture that needling ST-36 could balance the ST and GB jingjin and relieve a tight TFL. Has your subsequent clinical work confirmed this?

    1. Thanks for the comment! In my opinion St 36 would have a greater effect on the vastus lateralis. St 40 is frequently even better as it has an effect more on the toe extensors which communicate more laterally along the St jingjin into the vastus lateralis. This would effect the IT band since the anatomy is so integrated between the ITB and VL. GB channel points would have more of an effect on the ITB directly and also the structures that attach into it such as the glute max and the TFL. I use both channels to treat.