I just finished day 1 of a 5 day dissection course led by Todd Garcia. I am working alongside many of my sports medicine acupuncture® colleagues. I will post some discoveries from the class soon. This type of experience is such a fantastic way to see and explore the channels of Chinese medicine!
Monday, February 26, 2018
Thursday, February 15, 2018
KID 10 (yingu) and the Posterior Knee
KID 10 (yingu) is a very interesting point in relationship to the knee and knee injury and pain. It contains some fascinating anatomy that might not be apparent on first glance.
Peter Deadman, in A
Manual of Acupuncture, describes
the location thus: “At the medial end of the popliteal crease,
between the semitendinosus and semimebranosus tendons.” Claudia
Focks, author of Atlas of Acupuncture,
has a similar description: “At the medial end of the popliteal
crease, between the tendons of the semimembranosus and semitendinosus
muscles, on the level of the knee joint space.”
I find these descriptions a bit confusing, as they don't completely
match what we find in palpation. In
a way, it
might be more accurate to say that KID 10 is between the
semimembranosus and
another part of the semimembranosus. If
you press into the space between the semitendinosus and the
semimebranosus tendon, you
might be able to feel a very
thin, but palpable band. This
band will definitely contract
when the knee is flexed, verifying that it is a hamstring.
What
hamstring muscle is between the semimembranosus and semitendinosus
tendon, you might ask? Look
at most anatomy books and you won't find one. The answer is that this band is a fibrous
expansion of the semimembranosus
tendon which blends into the oblique popliteal ligament (a major
structure of the posterior joint capsule). I think KID 10 is between
the main body of the semimembranosus and this lateral expansion. If
you advance into this space, you will affect
the fascia of the fibrous expansions of the semimembranosus.
Press
slowly and gently into this space and you will frequently elicit a referral deep into the knee joint and
into the medial tibia. Needling into this would contact this
proprioceptive rich fascia which blends with the posterior capsule of
the knee. These expansions also have connections to the medial meniscus and the
medial collateral ligament (see 'anterior arm' in the image to the left).
If
you press or needle lateral to this expansion, in other words, between
it and the semitendinosus, you miss this fascia altogether.
This
is a somewhat challenging area to palpate. When palpating, stay very
close to the lateral border of the main tendon of the semimembranosus
and you will slide between it and this fascial expansion. Having the knee flexed helps with palpation.
In addition to KID 10, and when presented with medial knee pain and/or problems with the posterior knee capsule, you might consider treating the motor points of two muscles of the Kidney sinew channel: semimembranosus and popliteus. As can be seen in the image above, these muscles are very connected to this important fascia that stabilizes and supports the posterior and medial knee. Obviously, there is a lot more assessment that would be required to build a treatment plan, but these suggestions would frequently be applicable for MCL injury, medial meniscus injury, weakness of the posterior joint capsule, and medial knee pain referred from semimembranosus.
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