Tensegrity and Sinew Channel Relationships

I just submitted an article coauthored by Matt Callison to the Oriental Medical Newsletter, a publication of Pacific College of Natural Medicine. This article is the first of two parts and will discuss our research into the sinew channels (jingjin), secondary channels described in Chinese medicine. See Creating a Modern Model for the Assessment and Treatment of the Sinew Channels (Jingjin): Part 1 in the upcoming edition of the newsletter.

We have been exploring the sinew channels and building a more complete and comprehensive model of these using the original description in the Lingshu, but also fascial research, our own cadaver studies, and functional anatomy. With this information we have be building a model of these channels which is consistent with traditional channel theory while helping facilitate use of assessment based on orthopedic evaluation, postural assessment, and other functional tests. All of this information can be used then to build treatment protocol for these channels. We will be presenting this information at the Pacific Symposium in San Diego this Fall.

One of the concepts discussed in the article is tensegrity and this is used to help understand sinew channel relationships. Increasingly, many holistic health systems which work with posture (Rolfing/structural integration, osteopathy, chiropractic, etc.) use the principles of tensegrity when describing the human body and when describing how their inteventions improve alignment and reduce structural strain.

Tensegrity is a term coined by architect Buckminster Fuller and used in his design of the geodesic dome. Tensegrity is derived from tension integrity, and in tensegrity structures tension provides the integrity of the structures.

Fig. 1

Tensegrity structures, from the simple model in Fig. 1 to the human body, have several features. First of all, they have continuous tension and discontinuous compression. In Fig. 1, the continuous tension is created by the elastic bands, whereas in the body it is the myofascia. This myofascia consists of the muscles and the seamless fascia which connects one muscle to the surrounding muscles and the muscle to the bone via the tendons. The discontinuous compression consists of the wooden dowels in Fig. 1 and the bones in the body. These compression elements do not touch one another (there is a joint space in healthy joints), but are used by the tension elements to have something to pull on and create shape.

This is a simple concept, but for those who have studied anatomy and observed a model skeleton in a classroom, a perception can be created that the stacking of the bones is what determines the alignment of body. If a bone is out of place, then it needs to be reset and put back into place. The problem with this perception is that the skeleton is only standing because it is held up by a stand with a chain at the head. Without this and, more to the point, without the tension of the muscles and fascia pulling on the bones, this structure would fall to the ground. But, without the levers of the bones (or dowels in the Fig. 1), the myofascia would be a blob of useless muscle contraction.

So, the bones are not stacked one atop another like bricks are stacked in a wall, but, instead, float in a sea of tension comprised of the myofascia. What determines the shape of our structure, then, is the balanced, or possibly unbalanced, tension inherent in the myofascia. In a balanced structure, muscles pull on the bony framework; they have enough strength to perform their movement and supportive roles, but they are not overpowering other muscles (creating muscle imbalances) and their associated fascia is not too bound and restrictive.

Fig. 2

The sinew channels offer a way of assessing the tensional aspects of the body and how this tension produces or distorts shape. For instance, internally-externally (biao li) related sinew channels work together to create balance across major joint structures. In Fig. 2, the pull of the pectoralis minor (part of the Lung sinew channel and illustrated by the red arrow) coordinates with the pull of the middle and lower trapezius muscle (part of the Large Intestine sinew channel and illustrated by the blue arrow) to produce movements such as scapular protraction. Imbalances are frequently seen where the pectoralis minor (LU) is overactive and pulling excessively, whereas the middle and lower trapezius muscles (LI) are inhibited and failing to withstand the excessive pull of the pectoralis minor. This leads to a postural imbalance where the scapular position is held in protraction causing, among many other things, decrease in the volume of respiration. In addition to restriction in breathing, this imbalance can lead to many injuries (see the series of posts on Upper Cross Syndrome, a common postural imbalance resulting in scapular protraction and a head forward posture). Other sinew channel relationships exist, such as six divisions (liu jing bian zheng) and midday-midnight (zi wu liu zhu), that give insight into how the sinew channels interact to achieve overall balance in movement and position.

Fig. 4

Another feature of tensegrity structures is that they are very strong and come by this strength with little overall materials. They are strong because they disperse force that is put into them. If and when they do break, they often do so at a weak spot in the structure. For instance, if one of the elastic bands was already degraded or a slight cut was introduced and enough force was introduced, this area of damage would likely be where the structure would break. In our bodies, this is often in a region of a previous injury or damage from repetitive motion.



Clinically, these relationships can be used to build treatment protocols that balance overactive (excess) and inhibited (deficient) muscles, thereby balancing the sinew channels. Acupuncture to motor points and other ashi points, myofascial release, and corrective exercises are especially effective at treating the sinew channels. This approach is especially effective when combined with TCM to treat any Zangfu dysharmonies using acupuncture points (in combination with motor points), herbs and lifestyle recommendations.

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Head Forward Posture: Part 2 - Upper Cross Syndrome and the Sinew Channel

In the last post I discussed how a head-forward posture can, due to the additional load on the posterior cervical region, contribute to several injuries and orthopedic disorders. In this post, I will discuss a common relationship that a head-forward posture has with the shoulder girdle. The sinew channel relationship to this imbalance will also be discussed with the emphasis on the importance of assessing and treating this common pattern with acupuncture, tuina, and corrective exercises. In the next post, we will look at how this postural pattern relates to zangfu disharmony. Acupuncturists can greatly improve their results by recognizing and addressing this common postural imbalance when treating a wide range of conditions.

Upper cross syndrome describes a common postural pattern first discussed by Vladamir Janda, a Czech physician. Janda described this common upper body muscle imbalance as an X with one leg of the X consisting of a group of overactive (locked-short)* muscles and the other consisting of a group of inhibited (locked-long) muscles. This common pattern is seen with a head-forward posture and scapular protraction. 

*Note: locked-long and locked-short is terminology used by Thomas Myers and also employed by Sports Medicine Acupuncture. The tendency is for practitioners to think that inhibited muscles will feel soft and weak on palpation and that overactive muscles will feel ‘tight’. The reality is that there is often tension in both and they are both locked, one in a lengthened position, the other in a shortened. For practitioners of Chinese medicine, it might be helpful to consider the terms 'deficient' and 'excess.'

The muscles that contribute to this imbalance are listed below and grouped according to the overactive, locked-short leg of the X and the inhibited, locked-long leg of the X:

• Overactive: Pectoral muscles, posterior cervical extensors, levator scapula, upper trapezius
•  Inhibited: Lower and middle trapezius, anterior cervical flexors

Pectoralis minor, highlighted in red, pulls in and down in the front. Lower and middle trapezius (and rhomboids), highlighted in blue, pulls in and down in the back. When maintaining a balanced tone, this stabilizes and balances the shoulder girdle. The common muscle imbalance seen is for the pectoralis minor (red) to be overactive and the middle and lower traps (blue) to be inhibited.

The pectoralis minor is particularly important in its influence on scapular protraction as it has direct attachments to the scapula at the coracoid process. From the coracoid process, the pectoralis minor has an attachment to the 3^rd, 4^th, and 5^th ribs. The fibers attaching to the 3^rd rib have a relatively more horizontal fiber direction compared to the more vertical 5^th rib attachment. This line of pull creates a medial rotation of the scapula, while the 5^th rib attachment creates more of an anterior tilt. Scapular protraction often has components of both of these when the pectoralis minor is short.

The lower and middle trapezius, highlighted in blue, balancing
the pull of the pectoralis minor, highlighted in red. 

Balancing this line of pull is the lower and middle trapezius and the rhomboids. The lower trapezius balances the downward pull of the pectoralis minor while both the middle trapezius and rhomboids counter the movement of the scapula away from the midline. Both the lower and middle trapezius and the rhomboids have a tendency to become inhibited and fail to properly resist the pectoralis minor.

From A Manual of Acupuncture, by Peter Deadman. Notice
the connection of the LI sinew channel to the thoracic spine.

For acupuncturists, it can be very informative to review the pathway for the Large Intestine and Lung sinew channels. The Large Intestine sinew channel expands the influence of the primary channel as it attaches to the thoracic spine. I believe this to include a continuous sequence of muscles and fascial structures which start with the first dorsal interosseus muscle (accessible at LI-3 and LI-4) and continuing up the arm to connect, via the middle and lower trapezius, to the thoracic spine. The Lung sinew channel begins at the thenar muscles and continues up the arm to connect, via the pectoralis minor, to the ribs.

What this means is that the internally-externally related Lung and Large Intestine sinew channels work together to balance the shoulder girdle on the ribcage. When there is an imbalance between these two related channels, this is frequently seen with scapular protraction.

However, upper cross syndrome also describes cervical muscle imbalance. This includes the overactive cervical extensors on the posterior neck and the inhibited cervical flexors on the anterior neck. These can also be seen as an imbalance between internally-externally related sinew channels. The Urinary Bladder sinew channel includes the posterior cervical muscles, while the Kidney sinew channel includes the deep anterior cervical muscles such as the longus colli and longus capitis.

Even the pectoralis major can be seen to have a connection to the Urinary Bladder sinew channel. Through the thoracolumbar fascia, the Urinary Bladder sinew channel has a branch that I interpret as the latissimus dorsi. The latissimus dorsi attaches to the medial lip of the bicipital groove, in very close proximity to the attachment of the pectoralis major. However, classically the sinew channels are said to converge, and I believe the pectoralis major to be also part of the Heart sinew channel, so it is a region where the Urinary Bladder and Heart sinew channels converge.

BL-60 Kunlun, from A Manual of Acupuncture, by Peter Deadman

Also, there is a branch that attaches to the shoulder and connects with another area of convergence, the lower trapezius (this time converging with the LI sinew channel). In my view, both of these branches of the Urinary Bladder sinew channel (lats and lower traps) help explain how excessive pathological Yang can rise and contribute to tension manifesting in excess (overactivity) in the neck, shoulders and chest. It is helpful to review commentary about BL-60 Kunlun and understand that this point ‘Clears heat and lowers excess’. In addition it ‘pacifies wind and leads down excess’. This involves Liver disharmony with pathological Yang rising up the Urinary Bladder channel. This rising Yang often contributes to occipital headaches, neck pain, and shoulder pain. BL-60 Kunlun treats the manifestations of this rising Yang, often in combinations with SI-3 Houxi. Being a Jing-River point, it is an excellent point to relax the sinews, in this case associated with the Urinary Bladder sinew channel.

BL-60 Kunlun is a useful distal point to treat the rising Yang activity which contributes to the imbalance discussed with UCS, but in order to fully take patients out of this dysfunctional pattern, it is necessary to treat locally. Acupuncture to motor points of the affected muscles (both inhibited and overactive) is a great strategy to reset dysfunctional muscle spindles and balance the internally-externally related channels. In addition, tuina/myofascial release and corrective exercises help increase the therapeutic results.

UCS, therefore, offers fantastic insight into the coordinated balance between the sinew channels and common patterns of dysfunction that occur between internally-externally related channels. The Lung-Large Intestine sinew channels work together to balance the shoulder girdle, while the Urinary Bladder-Kidney sinew channels work together to balance the cervical spine.

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Head Forward Posture: Part 1

One of the most common postural disparities I see is a head-forward posture. In The Physiology of Joints, Volume III, French surgeon and anatomist Adalbert I. Kapandji states that for every inch the head goes forward it gains an additional ten pounds of weight in terms of strain on the posterior neck and upper back muscles. The average weight of the head is about 4.5-5 kg (10-11 pounds) and, in a balanced posture, it is supported evenly amid the muscles of the neck. With a head-forward posture, this balanced support is disrupted, and the posterior neck and upper back muscles then become increasingly more overloaded (and painful) with every additional degree of head-forward posture. With the head an inch forward (neutral is considered as consisting of the ear aligning over the acromion process which is the highest point of the shoulder) this means that the posterior neck and upper back muscles have to support about 20 pounds of weight all day. At 2 inches forward, this becomes about 30 pounds. With Americans spending more and more time behind the wheel, in front of computer screens, glued to cell phones and tablets, and performing other activities which lend themselves to this already common posture, it is not surprising that we frequently see so many problems attributed to this posture.

This is the first post of a three-part article about the implications of the head-forward posture. Part One (today’s post) discusses some common pain syndromes to which it contributes. Part Two will discuss the relationship of this imbalance to the shoulder girdle and will look at the sinew channel relationships. These two parts will be useful for patients and those suffering from the painful conditions described below; they will also be useful for acupuncturists who want to understand how improving posture can improve treatment results.

Part Three will explore the relationship of this imbalance to the zangfu (primary organ systems discussed in TCM). This will be largely for the benefit of practitioners of acupuncture, tuina and other modalities used in Traditional Chinese Medicine. 

The following are common complaints that involve a head-forward posture:

Generalized neck pain and shoulder pain caused from muscle overuse: As stated above, for every inch the head moves forward, it gains an additional 10 pounds of weight in terms of strain on the posterior neck and upper back muscles. What this means is that the muscles of the posterior cervical spine are working overtime, day in and day out, and for a prolonged time. It is just a matter of time before they start to cry out for some attention and that usually comes in the form of aches and pain. Specifically, the upper trapezius, levator scapula, and splenius cervicis are frequent muscular contributors to neck discomfort; they not only produce pain, but reduce range of motion and can contribute to stiffness, including stiffness which makes it difficult to turn the neck. Generally, restriction in the upper trapezius manifests in reduced range of motion and discomfort towards the end of the range of motion when looking in the opposite direction, while restriction in the levator scapula often causes pain when looking to the same direction. However, sometimes all three of these muscles can become spasmed, making it very difficult to turn the neck in any direction without considerable pain.

And it is not just the muscles which are involved with neck pain from a head-forward posture. The strain in the posterior neck from the additional load signals fibroblasts to produce more extracellular matrix to support this area. Fibroblasts are specialized cells that produce the building blocks of fibrous connective tissue, such as collagen fibers and a sticky, syrupy substance called proteoglycans (a protein-carbohydrate based molecular structure). Prolonged strain (such as years of bracing against the extra weight of having the head forward) stimulates production of this extra material which can be easily felt as dense, ropy, fibrous bands in the upper back and neck region. It is the body’s attempt to add more support to a region that has additional demands placed on it. Local massage, acupuncture, or other treatments applied directly to the painful tissue may temporarily help make this dense, stagnant tissue feel better, but the posture as a whole needs to be addressed if there is to be any hope of long-lasting relief.

Cervical facet joint referral patterns.
Image from: Osteoarthritis of the Spine:
The Facet Joints, Gellhorn, A.C. et al
Nature Reviews Rheumatology 9, April 2013

Facet joint syndrome: This involves a degeneration of the vertebral facet joints, which is usually secondary to degeneration of the intervertebral discs. Cervical disc degeneration is usually exaggerated whenever there is long term hypomobility (limited movement) of cervical spine. While the outer part of the intervertebral disc has a blood supply, the inner part does not and requires nutrition and fluids via diffusion from the outside. So, with any limited movement patterns that persist for a long time, the discs suffer. As one of my tai chi instructor states, “Motion is Lotion,” and this is definitely true for the spine. In addition to the discs, the synovial, freely moveable (at least they should be) joints of the spine can become degenerative and lead to pain, which can affect the neck but can also refer to the head and, even more commonly, between the shoulder blades. This is a commonly overlooked source of pain and patients with a head-forward posture are much more predisposed to it.

Facets joints are the synovial joints between adjacent vertebrae. They can become degenerative and painful with osteoarthritis of the spine. In a head forward posture, the upper cervical facets are often in a closed position while the lower facets are in an open unstable position. Both situations can aggravate the joints and lead to referred pain. This image is from Kapandji's Physiology of Joints.

Splenius capitis (close to GB-20) and splenius cervicis
(at extrapoint Bailao) TrP referral patterns.
Image from Travell and Simons' Myofascial Pain and
Dyfunction: A Trigger Point Manual.

Tension headaches: With cervical (neck) flexion and capital (head) extension, the posterior cervical muscles are in a shortened position, especially the muscles referred to as the suboccipitals. These four deep upper cervical muscles are very common causes of referred pain into the head, contributing to tension headaches. With the movement of the head forward, the eyes would be looking toward the ground if not for these muscles tightening to lift the head, placing the occiput into an extended position relative to the top of the cervical spine. Other muscles, such as the upper trapezius, splenius capitis, splenius cervicis, and sternocleidomastoid (SCM) are also negatively impacted and common contributors to tension headaches.

Nerve impingements and entrapments: Since disc health is affected by head-forward posture, it can play a role in spinal nerve impingement.  In addition, thoracic outlet syndrome (another type of entrapment of neural structures) is often seen with a head-forward posture. Both of these can radiate pain into the upper extremities and be causes of pain in the arms, elbows, forearms or hands.

Thoracic outlet syndrome involves an entrapment of the brachial plexus, which is the bundle of nerves that exit from the neck and travel to the arms. The brachial plexus can be entrapped as it travels between the anterior and middle scalene muscles (two anterior neck muscles which are shortened in a forward-head posture), between the clavicle and ribcage, and between the pectoralis minor muscle and the ribcage. The head-forward posture is often a contributing factor to all of these, especially as the entire shoulder girdle is involved (more on this in the next post).

Jaw tension: a head-forward posture places the mandible (lower jaw bone) in a position which stresses and tightens the muscles of the jaw. The position of the head places anterior neck muscles such as the suprahyoids and infrahyoids in an overstretched position. These muscles attach to the mandible and pull down on the lower jaw bone. The muscles of mastication (chewing), such as the masseter, reflexively tighten to hold the jaw close. They then develop trigger points which put pressure on the temporomandibular joint (TMJ).

Shoulder and other problems: Part 2 of this post will discuss the relationship of the balance of the cervical spine to the shoulder girdle. Because these are so intimately tied to each other, shoulder dysfunction such as supraspinatus tendinopathy, bicipital tenosynovitis, infraspinatus and subscapularis myostrain, and other conditions are often made worse by the strain of a head-forward posture. As we explore the sinew channel relationship described in Chinese medicine, this neck-shoulder girdle relationship will become even more apparent.

Image from Startle as a Paradigm 

for Malposture, by Pierce, F. et al 

Perceptual and Motor Skills, 1964

A)     Patient standing upright

B)      Door closes loudly and 

startles patient. Notice the 

shortening along the front 

of the body 

In addition to shoulder dysfunction, head-forward posture can contribute to other problems elsewhere in the body. This could become a very complex analysis, so I will not give a complete list. However, I will mention some interesting research that explored hamstring flexibility in relation to the suboccipital muscles (which extend the joint between the occiput and top of the cervical spine). This research measured hamstring flexibility and then split the subjects into two groups. Members of one group performed hamstring stretches; members of the other performed stretching to the suboccipital muscles. Surprisingly, the group that received stretching for the suboccipitals alone had a greater increase in hamstring flexibility (13%) than the group receiving hamstring stretches alone (9%). The reason likely has to do with the high concentration of muscle spindles present in the suboccipital muscles and, due to this, the fact that they have such a strong influence on tone throughout the musculature of the back, especially at the hip joint. Consider what happens when someone is startled, and the typical startle response observed. The firing of the suboccipitals might be reflexively tied to the firing of the hamstrings which assists in extending the hip joint. This, along with the shortening in the front of the body, would effectively protect the vulnerable organs.

For acupuncturists, it is worth reexamining the Urinary Bladder sinew channel and noting that it does bind to the occiput, and, therefore would include the suboccipital muscles. Looking for a head-forward posture and addressing shortened suboccipitals would be a worthwhile strategy, not only when treating local dysfunction, but with any strain pattern affecting the Urinary Bladder sinew channel. Addressing this pattern would help focus the selection of effective points to treat according to the principle of “selecting points above to treat below.”

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The Four Pillars of Traditional Chinese Medicine

While many of my posts are written for acupuncturists and manual therapists, the following is a description of the major treatments used in Traditional Chinese Medicine. It is written for patients.

Traditional Chinese Medicine (TCM) is a comprehensive medical system from China. While many people are aware of acupuncture, TCM actually incorporates four major avenues or treatment. These are known as “the four pillars” of TCM, and they are: acupuncture; Chinese herbal medicine and dietary therapy; Tuina, which incorporates medical massage and manipulation; and exercise and movement therapy. Your trained Doctor of Oriental Medicine will evaluate your case and prescribe one or several of these treatments depending on what is needed.

Acupuncture involves the use of very thin, single-use, sterilized needles inserted in various locations to regulate body processes. In the West, acupuncture is most often used for pain relief, for which it is very effective. But this is not the full scope of comprehensive acupuncture treatment; it is actually appropriate in a wide range of illnesses. Click here to see a complete list from the World Health Organization of the over 40 diseases acupuncture is listed to treat.

Chinese herbal medicine is based on a vast array of medicinal formulas, which are therapeutically balanced combinations of herbs used to treat patterns of medical disharmony. TCM looks for clinical signs and symptoms of these patterns and then prescribe specific herbal medicinal formulas to treat these patterns. TCM pattern differentiation and treatment with herbal medicinals can offer a safe and effective natural treatment for illness or can complement your treatment prescribed by your Western MD, in some cases possibly enabling your Western pharmaceutical prescription to be reduced, or helping deal with side effects. 

In addition to the prescription of herbal medicinals, dietary recommendations can also be used as part of the treatment. This can include general assistance with weight loss or maintenance, or specific food choices and preparations designed to help you manage an existing condition. 

Tuina is a Chinese system of clinical massage and joint mobilization. Tuina is derived from two words; tui meaning to “to push” and na meaning “to lift and squeeze”. Tuina uses light, moderate, or deep pressure to mobilize the body’s structures and joints and restore normal movement. It is primarily used for musculoskeletal conditions, but it can also be employed for other condition such as respiratory or digestive problems. Generally, tuina focuses on particular regions such as the neck, back, legs, etc., and resembles more clinical styles of Western deep tissue massage therapy. Click here to see a previous post about tuina.

Finally, Therapeutic Exercises are often prescribed in China to help treat illness and to maintain and improve health. In particular, tai chi (taiji) and qigong are therapeutic forms of exercise that improve flexibility, circulation and general wellbeing. 

When looking for a practitioner of Traditional Chinese Medicine, it is important to understand that many practitioners focus mostly on one or maybe two of these ‘pillars’ listed above, usually based on a practitioner’s specialization. Practitioners focusing on internal medicine might use herbs more extensively while those treating musculoskeletal pain might be inclined to use tuina more. In my clinical practice, I specialize in the treatment of sports injuries and orthopedic pain conditions. So, I primarily focus on acupuncture, tuina, and corrective exercises to facilitate rehabilitation from injury, and to correct muscle imbalances that contribute to pain conditions. When I prescribe herbal medicine, it is usually a formula (balanced combinations of herbs) to help with the particular pain or injury. Such herbal formulas may help with trauma; they may address how the body deals with inflammation, or they may regulate the nervous system to reduce overcontraction and tightness in the muscles. The herbs basically support the treatment, while the acupuncture, tuina and therapeutic exercise prescription specifically target the region of pain and return normal movement to the body. 

Another practitioner who specializes in internal medicine might rely much more on herbs, and their acupuncture treatment might be more supplemental. It is important for patients to know what to look for when seeking a practitioner, as not all have equal training and not all have experience that will make them effective in treating all medical problems.

Most TCM practitioners do use these four pillars, but there is no need to be dogmatic about using only techniques that originated in historical China. If a modern or Western-developed treatment protocol is appropriate and compatible with TCM principles, it can be integrated into a Four Pillars-based treatment plan. For instance, to reduce inflammation, I might prescribe a classical herbal formula, but I might also prescribe fish oil supplementation. Also, I frequently use manual massage techniques and mobilization of joints, but much of my training comes from Western bodywork systems such as myofascial release and structural integration (I am certified in both of these via the CORE Institute). On an even deeper level, my acupuncture treatments rely heavily on Western anatomy and Sports Medicine principles. These techniques are taught in AcuSport Seminar Series and the Sports Medicine Acupuncture Certification Program, on whose faculty I serve. My point is that as Chinese medicine becomes more global, it can include insight from many other viewpoints, especially Western medicine, but the heart of the medicine will continue to focus on these four basic pillars of treatment which are designed to return the body to a balanced state of health.

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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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Sports Medicine Acupuncture®

Since 2013, I have been on the faculty of the Sports Medicine Acupuncture Certification Program, teaching first on location in Manhattan, NYC and currently in San Diego, CA. It is a great honor and experience to teach with this program, as it is the most in-depth and extensive program of its kind in the country. I have the opportunity to work closely with probably the most knowledgeable person in the field of acupuncture and sports medicine, Matt Callison.

    

Sports Medicine Acupuncture® integrates Traditional Chinese Medicine principles with Western sports medicine. Practitioners are extensively trained in the following:

• Evaluation of injuries and orthopedic disorders to find the cause of pain and dysfunction. Based on these findings, treatment plans are then devised, which include acupuncture, myofascial release (a type of clinical deep tissue massage), and corrective exercises.
• Postural assessment to understand the global imbalances that can lead to, and/or prevent proper healing of, orthopedic disorders and sports injuries.
• Anatomy in great detail, including cadaver dissections. This allows for a comprehensive three-dimensional understanding of anatomy relevant to needle techniques, manual therapy techniques, and assessment of injuries.
• Relating the acupuncture channels discussed in Traditional Chinese Medicine to anatomical structures, especially continuous myofascial planes (myo-muscle, fascia-connective tissue).

Sports Medicine Acupuncture Certification is taught in four modules: 1) the spine; 2) head, neck and upper extremities; 3) low back and hip; and 4) lower extremities. Each module focuses on sports injuries, repetitive use injuries and orthopedic disorders in these regions. This program is designed to provide the most advanced training available in the assessment and treatment of these injuries. 

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