Sunday, August 21, 2016

The Gluteus Maximus and Converging Sinew Channels

Fig. 1: Image from Functional Atlas of the Human
Fascial System by Carla Stecco
This image (Fig. 1)  is from the excellent book, Functional Atlas of the Human Fascial System, by Carla Stecco. In Manhattan two years ago, during the Sports Medicine Acupuncture Certification (SMAC) program, Matt Callison and I were preparing a fresh tissue cadaver specimen for the Anatomy/Palpation/Cadaver lab for Module 3, which addresses the lower back and hip. In this specimen, we observed an interesting fascial expansion which extended from the deep fibers of the gluteus maximus and connected to the hamstrings and sacrotuberous ligament (STL). This was in the region of BL-36. We saw this as confirmation that the gluteus maximus was part of the Urinary Bladder sinew channel.

Fig. 2: Image from
A Manual of Acupuncture
by Peter Deadman
Maybe this seems like an obvious sinew channel in which to place this muscle, but consider that the gluteus maximus also attaches to the iliotibial band (ITB) which is on the lateral leg. Also, this muscle matches the topography described in the Lingshu, which mentions that the Gallbladder sinew channel has a branch that attaches to the sacrum (Fig. 2 and 3). Both of these vectors of pull are discussed in Stecco's book and seen in Fig. 1. The black line (ITB - gluteus maximus - sacrum) describes the GB sinew channel. The red line (hamstrings - gluteus maximus - STL - thoracolumbar fascia and erector spinae) describes the BL sinew channel. So, the gluteus maximus is an example of where two sinew channels converge. Like the primary channels, this kind of convergence is something that occurs with some regularity.

Fig. 3: Image from
An Atlas of Human
Anatomy for
Students and
Physicians by
Carl Toldt
A few clinically useful things can be taken from this:

1) The gluteus maximus MP can be added to treatments that affect the GB sinew channel. These include trochanteric bursitis, iliotibial band friction syndrome, and asymmetrical pelvic tilts (contributing to a host of potential problems). Treatment can include GB distal points.

2) The gluteus maximus MP can be added to treatments that affect the BL sinew channel. These include hamstring and gluteus maximus strain, hamstring tendinopathy, coccydynia, sacroiliac joint problems, and erector spinae strain. Treatment can include BL distal points. 

3) The gluteus maximus MP has an empirical use, which is that it reduces tension in the upper cervical muscles. This is an example of treating below to affect above on the same channel. 

4) The gluteus maximus MP can be considered as a distal point when treating restriction and pain in the pectoralis muscle. The pectoralis major is on the Heart sinew channel, so this can be considered a midday-midnight (GB-HE) treatment. And, there is a branch of the BL sinew channel which also travels through the pectoralis major via the  thoracolumbar fascia - latissimus dorsi - pectoralis major - SCM branch seen in Fig 4. It is not imperative that you know which channel relationship you are affecting, and this topic can be taken up another time. 

5) Lastly, the gluteus maximus becomes bilaterally weak when there are upper cervical vertebral fixations. This is harder to explain easily; I can refer you to an article I wrote that was in the Illinois Association of Acupuncture and Oriental Medicine Newsletter (The Illinois Acupuncturist) and will be in the upcoming Florida State Oriental Medical Association newsletter. This is also posted on my blog and you can click here to see it. 

Basically, I see this problem as an interaction of the Urinary Bladder sinew channel and the Spleen and Stomach sinew channels, and an example of Earth overacting on Water. These sinew channels have an agonist/antagonist relationship. The Stomach and Spleen sinew channels become bound, which restricts the anterior portion of the diaphragm and the deep anterior myofascia (abdominals below, transversus thoracic and hyoids above). This causes tension in key regions of the spine and can lead to vertebral fixations. Certain muscles on the BL sinew channel then become bilaterally weak (the gluteus maximus in the case of upper cervical fixations). In Sports Medicine Acupuncture, we treat upper cervical fixations by using vertebral mobilization techniques for the affected vertebrae, needling SP-4/P-6 (which affects the deep holding pattern) and needling the MP of the gluteus maximus. 

Fig. 4: Image from A Manual of Acupuncture by Peter Deadman

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  1. Hi Brian! Interesting article. On the final point you made about upper cervical fixation and weak glutes, I would be cautious in attributing causation to something that is more likely a correlation. Many people through repetitive motion, sitting excessively and lack of exercise have muscle atrophy and simultaneous stiffening in areas that get little mobility. In my experience it is less an earth over water than it is poor posture and poor physical training.
    In terms of treatment, that may be the same regardless of how the patient got there.
    Keep up the great work!

    1. Thanks for the comment, Caroline! I would agree with the correlation, as inhibition of the glutes could come from other sources. By bilateral weakness of the gluteus maximus, I am specifically referring to manual muscle testing. Gluteus maximus will be bilaterally weak when testing with MMT when there are upper cervical fixations. And, they will then test strong when the fixation is corrected. MMTs are interesting in that they are not really testing how strong or weak a muscle is, but, instead, are testing its ability to adapt to change. The body is positioned to line the muscle for maximum influence and the patient is asked to resist eccentric loading of the muscle. The initial force is not much and then it is loaded more. A muscle that lacks adequate Qi (for lack of a quicker way of explaining) will not be able to adapt to the change (the actin/myosin cross bridging will not lock on effectively). So, a bodybuilder with very strong, powerful and developed muscles might fail a MMT and a couch potato with weak and flabby muscles might pass.

      This is primarily Matt Callison's work based on other works (Goodheart, for instance). I was explaining the relationship via the sinew channels of this phenomenon of upper cervical fixations inhibiting gluteus maximus.

  2. Oh, I understand what you are talking about (I think), in that the weakness is referring to how well they do the MMT rather than the actual muscle tone of the muscle in question. I have experienced that type of muscle testing with a chiropractor friend of mine. It's interesting to think about the phenomenon of spinal adjustments influencing the sinews in terms of chinese medicine. According to Ling Shu chapter 13, the deepest layers of spinal connective tissue are attributed to foot shaoyin and that the inability to straighten up or bend forward are signs of pathology in that terrain. But there isn't a clear theoretical line from treating cervical spine and the glutes; perhaps the internal-external relationship between shaoyin and taiyang? I have done a fair amount of research on the sinew meridians and am happy to see some good discussion of them!

    1. Yes, that's it. It is about the muscles ability to adapt and 'lock on'. This inability to lock on can still destabilize the muscle during activity. I am soon going to put together a video on something called the pelvo-ocular reflex which explains another of these relationships (C1-Occiput fixations and bilateral psoas weakness with MMT). This one is easier to explain via Yin and Yang Qiao and it can be felt with a willing partner (what the video will be on).

      In reference to the Lingshu, I think the 'deepest layer of the spinal connective tissue' is the anterior longitudinal ligament. This is continuous with the pelvic floor below and the longus colli and pharyngeal muscles above.

      The spinal fixation work is something we teach in Sports Medicine Acupuncture Certification. Follow the link above to the article I have in the newsletter and you can get an idea of this approach. Certain regions of the spine, when fixations occur, cause certain muscles to become bilaterally weak. Matt was influenced by this work, which came from a stream of chiropractic. In addition to mobilization techniques, he started experimenting with specific huatuo techniques and EV point combinations. This added to the efficacy of the treatment. So SP4-P6 can be included to the treatment (along with specific huatuo and mob techniques) for upper cervical fixation, but also thoracic fixations. When I started teaching with SMAC, I looked at the sinew channel relationships and noticed that tension in sinew channels could affect the spine in certain regions (SP sinew channel can lock the thoracic and upper cervical spine). And the muscles that become inhibited are for these cases are all muscles that have attachments to the thoracolumbar fascia and are part of the branches of the BL sinew channel. If you read the article, let me know your thoughts.

      Thanks for the comments, Caroline. It is nice to chat about this. I think there is a lot of room for development within the sinew channels.