Fig.1: Modified from Atlas of Human Anatomy by Bernhard N. Tillmann |
All of these authors
list the peroneus (fibularis) longus and the peroneus brevis as part of the Gallbladder sinew
channel. However, I disagree with this assessment and think they are more
properly classed as a branch of the Urinary Bladder sinew channel. In this post I will give the obvious reasons why others include them as part
of the Gallbladder sinew channel, and then I will explain why I have
come to a different conclusion.
So, why do I disagree with all of these authors? To begin with, I will state that in my lectures in New York during the training for Sports Medicine Acupuncture in the 2013-2014 certification cycle, I included them with the Gallbladder sinew channel. This is despite the fact that the Gallbladder sinew channel is classically discussed as traveling anterior to the lateral malleolus while the peroneal muscles travel posterior to this structure. The peroneus longus does attach to the iliotibial band as discussed by Myers. Both the tensor fascia lata (TFL) and the gluteus maximus attach directly into the ITB, and the gluteus medius and minimus also link with it. These are all muscles that are associated with the Gallbladder sinew channel.
Fig. 2: Image modified from Deadman's A Manual of Acupuncture. |
Functionally, this
force transmission is important for sacroiliac joint balance, as it
links heel strike with sacroiliac balance. During dorsiflexion just
before heel strike, the peroneus longus pulls down on the fibular head which adds tension to
the biceps femoris and into the sacrotuberous ligament (which is a
structure that the biceps femoris is continuous with). This tension
through the sacrotuberous ligament then stabilizes the sacroiliac
joint in preparation for heel strike.
The biceps femoris
and the sacrotuberous ligament are part of the Urinary Bladder sinew
channel (Fig. 2). So, functionally and structurally the peroneus longus could
be considered as a branch of the Urinary Bladder sinew channel. And,
this matches nicely with the classical description of this channel.
The Urinary Bladder sinew channel does indeed have a lateral branch
which travels posterior to the lateral malleolus and fits the anatomy
of the peroneus longus.
How does this apply
clinically? First off, when treating the sinew channels many
practitioners treat off-channel ashi points such as trigger points
(TrPs) and motor points (MPs). Often this would include treating local
TrPs for pain. Knowing which sinew channel a muscle belongs to
informs which channel relationships exist and helps with distal (or away) point
selection.
For instance, peroneal tendinopathy is a condition seen with runners, especially when they increase mileage. Pain is usually seen in the region of BL-62, is worse with activity, and is often reproduced with plantar flexion and inversion of the ankle which stretches the peroneal tendon, though sometimes eversion causes pain as it engages the peroneals. This condition might be treated locally with acupuncture by threading the tendon around the BL-62 region. In addition, the peroneal MPs should be used (the peroneus longus MP is about 1 cun directly below the fibular head). In addition, excess tension observed in the biceps femoris, the erector spinae, or even the suboccipital muscles might be used to inform point selection. If a runner has excessive capital (head) extension there would be excessive shortness in the suboccipital muscles, BL-10 and/or GB-20 might be considered as useful points employing the principle of selecting points above to treat below.
Fig 3: By ms4denmark [CC BY-SA 2.0 (http://creativecommons.org/licenses/ by-sa/2.0)], via Wikimedia Commons |
Fig. 4 |
Brilliant !! But it thought you classified tfl as part of the Stomach sinew channel...
ReplyDeleteTFL is part of the GB sinew channel. The lingshu describes the Stomach sinew channel as linking with the shaoyang at this region, so I this muscle can be part of both channels. I think the easy way to differentiate it is to note that the TFL performs hip abduction along with the other GB sinew channel muscles, while it can also function with the ST sinew channel muscles as part of hip flexion. There are instances when the hip abductors are inhibited while the TFL is overactive along with the rectus femoris and other ST sinew channel muscles. In this case, ST channel points are probably the best bet along with local MPs of the necessary muscles.
Delete