Fig 2: The deep posterior
compartment, including the
tibialis posterior. The
soleus has been removed to
reveal the deeper structures
|
Fig. 1: Soleus muscle. The more superficial gastrocnemius muscle has been removed. |
When teaching the Spleen sinew channel, I include the tibialis posterior muscle as
part of a series of myofascially linked structures connecting the medial arch to the knee and thigh. Tibialis posterior is the middle muscle of the deep posterior compartment. The placement of the muscles behind the tibia from medial to lateral is as follows: flexor digitorum longus - tibialis posterior - flexor hallucis longus. Therefore, if you were to insinuate your fingers under the tibia in the region of SP-7 or SP-8, you would encounter the flexor digitorum. If you were able to continue, you would contact the tibialis posterior and then the flexor hallucis longus. Inferior to this, the tibialis posterior then crosses under (anterior to) the flexor digitorum longus and, by the time it passes behind the medial malleolus, it is the most anterior of the deep posterior compartment muscles (recall the mnemonic 'Tom, Dick and Harry' to remember the order of the tendons at the medial malleolus).
Fig 3: Deep posterior compartment tendons as they pass posterior to the medial malleolus. These are (in order) tib posterior, flexor digitorum longus, flexor hallucis longus |
Therefore, SP-6 is at an anatomical location where there is a literal crossing of the three yin sinew channels. This accounts for the usefulness of SP-6 as a distal point for knee pain. This is especially the case when the knee pain has a component of disruption of the musculature of the Spleen sinew channel and can include conditions such as chondromalacia patella, patellofemoral syndrome, and pes anserine tendinopathy.
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