Friday, June 7, 2019

Treatment of the Kidney Sinew Channel for Injuries Associated with the Urinary Bladder Sinew Channel

Fig. 1: This myofascial release technique on the posterior intermuscular septum of the thigh (the fascial septum between the adductor magnus and the medial hamstings) is taught in the Assessment and Treatment of the Channel Sinews class in Sports Medicine Acupuncture Certification. It is a technique that could be used to treat the Kidney channel as discussed in this post.

I authored this month's SMA (Sports Medicine Acupuncture®) blog post, which is on assessment and treatment of the channel sinews for posterior and medial knee pain. It focuses common injuries associated with the Urinary Bladder and Kidney channel sinews (jingjin), including upper gastrocnemius strain, hamstring tenosynovitis (both of these are associated with the UB jingjin), and MCL injury (associated with the KID jingjin). Check it out.

At the end of the post, I discuss how treatment of the channel associated with the injury does not always yield lasting results. Obviously, acupuncturists know this. We have many channel relationships that help guide our clinical decision making. Sometimes we treat the channel that is associated with an injury; sometimes we treat the internal-external pair; sometimes we treat based on six divisions; sometimes we use midday-midnight correspondences; and sometimes our decision-making can be even more complex. The channel system is very interdependent and it is not always as simple as treatment including local, adjacent, and distal points where all of these are on the same channel.

In the SMA blog post, I gave an example of treatment of upper gastrocnemius strain and/or hamstring tenosynovitis (UB jingjin) when there is a loss of integrity of specific ligaments associated with the KID jingjin. In these cases, the gastrocnemius and hamstrings will need to make up for the loss of stability in the knee due to the loss of integrity of the ligaments. To get lasting results in this case, one must address the Kidney channel. There are many ways that one can accomplish this and I don't want to get into treatment in this post. Regardless of whether you are using acupuncture, regenerative injection techniques, manual therapy, or other tools, communicating with the Kidney channel will keep the UB structures from having to overwork as they attempt to stabilize the knee.

Fig. 2

There is another example that didn't get explored in the SMA blog post for space reasons. It has to do with the relationship of the UB and the KID jingjin and their associated myofascial structures, the hamstrings and the adductor magnus. The hamstrings are associated with the UB jingjin and the KID jingjin. The two superficial hamstrings (the biceps femoris long head and the semitendinosus) are part of the UB jingjin while the semimembranosus is part of the KID jingjin (Fig. 2). 

Fig. 3: The semimembranosus removed on the right
to reveal the '4th hamstring'.
There is also a '4th hamstring' which is comprised of the biceps femoris short head and the adductor magnus (Fig. 3). The adductor magnus is not technically a hamstring, but the middle fibers are fascially connected with the biceps femoris short head and this pair can be considered as a 4th hamstring. This '4th hamstring' is discussed both by Tom Myers in his book Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists, and by Janet Travell in her book Myofascial Pain and Dysfunction: The Trigger Point Manual.

To recap, there are two pairs of hamstrings; a superficial pair (biceps femoris long head and semitendinosus; both associated with the UB jingjin), and a deep pair (semimembranosus and biceps short head/adductor magnus; both associated with the KID jingjin). The video below explores the anatomy of these two channels in the foot, ankle, leg and thigh.

Back to the topic of this post; how one channel can influence another and how an injury associated with one channel might require treatment to a related channel. The hamstrings get their blood supply from perforating arteries which branch off of the deep femoral artery (femoral artery profunda), which itself is a branch off of the femoral artery. The name 'perforating arteries' implies that they perforate something, which they do. They perforate the adductor magnus on their way to the hamstrings (Fig. 4). If the adductor magnus is short and tight, this could definitely restrict blood flow to the hamstrings. If you have a patient that comes in with chronic hamstring problems, maybe it is worth assessing and treating the adductor magnus. You will be assessing and treating the KID jingjin to help with any work you do with the UB jingjin. The image at the top of this post shows a myofascial release technique which frees obstructions in the posterior intermuscular septum of the thigh (between the adductor magnus and the medial hamstrings)

Fig 4: Gray's Anatomy illustration showing perforating arteries perforating the adductor magnus on their way to the hamstrings. Hamstrings are not shown in this illustration so that the arteries can be seen.

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