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Fascial Expansions: Knee Pain Relief

Updated: Apr 1


Fascial Expansion

Utilizing the capabilities of fascial expansions to treat knee pain represents a holistic approach that combines a modern understanding of fascia's role, kinetic chain relationships, and essential principles from acupuncture or traditional Chinese medicine. This exploration will focus on how fascial layers interconnect with specific acupuncture points, namely ST34, Sp10, ST36, Liv8, and ST44. This method should be paired with soft tissue manipulation and osseous (bony) procedures, all supplemented by a planned series of functional exercises for enhanced effectiveness.


Article Index:


 

Fascia A Dynamic Interconnected System


Fascia, the intricate connective tissue, is described as a "unified tensional network that modifies its fiber alignment and density in response to localized tensional needs." This adaptation enables the fascia to play a critical role in our body's balance and functionality.


When the fascia's tension is well-balanced, it is a force distributor, storing energy and discharging it to aid propulsion. However, when this delicate balance is disturbed, leading to excessive, unbalanced, or constrained tension in the fascia, it can cause various dysfunctions.


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Fascial Planes Influencing the Knee

The knee's function and stability are intricately tied to several fascial planes. These plane restrictions can be skillfully managed through various techniques, including acupuncture and hands-on manipulation, encompassing soft tissue and skeletal procedures. Here's a breakdown of the key regions to consider:


  1. Gluteal Fascia: For those suffering from iliotibial band syndrome (ITBS) or lateral knee pain, clinicians should pay close attention to the gluteus maximus and tensor fasciae latae muscles. Encased by the gluteal fascia, these muscles, along with the iliotibial tract, are vital in delivering lateral stability to the knee joint.

  2. Fascia Lata & Iliotibial Tract (ITT): The ITT not only provides lateral knee stabilization but also functions as a distal tendon insertion for the tensor fasciae latae and gluteus maximus muscles. Attaching to the lateral condyle of the tibia constitutes the anterior knee retinaculum, stabilizing the knee in extension and partial flexion, an aspect fundamental to walking and running.

  3. Crural Fascia: Enveloping the leg muscles, the crural fascia links with the fascia lata and the foot's deep fasciae. It adheres to various bony structures and is strengthened by myofascial expansions and tendons. Its connection to muscles like the tibialis anterior and extensor digitorum longus, as well as the knee's medial collateral ligament and capsule, makes it vital. Around the ankle, retinacula fibers reinforce it. Thinner on the posterior side, it is perforated by the small saphenous vein in the popliteal region, and it also creates anterior and posterior peroneal septa, defining the leg's lateral compartment.


 

Knee Acupuncture

Acupuncture/Acupressure


Acupuncture points, also known as acupoints or simply points, are specific locations on the body that have been identified in Traditional Chinese Medicine (TCM) as having therapeutic effects when stimulated. These points are found along meridians or channels, which are believed to be pathways of energy flow called "Qi" (pronounced "chi") throughout the body.


According to TCM, stimulating acupuncture points can help restore balance, regulate the flow of Qi, alleviate pain, and promote healing in the body.


Modern research has revealed that acupuncture points often correspond to areas where there is a high density of nerve endings, blood vessels, and lymphatic vessels, as well as increased electrical conductivity. This suggests that the stimulation of acupuncture points may have physiological effects, such as the release of endorphins, neurotransmitters, and other pain-relieving substances, as well as the regulation of blood flow and the immune system.


Acupuncture Techniques


When acupuncturists treat a patient, acupuncture needles are not just inserted; they are rotated and pulled back and forth until the acupuncturist feels a response in the tissue (sometimes called a tug response). When performing acupressure, we do the same thing: stimulate a region to activate the nervous system and release tension in a fascial network of interconnected tissue.


Specific Acupuncture Points


In Traditional Chinese Medicine (TCM), acupuncture points acupuncture points ST34, Sp10, ST36, Liv8, and ST44 are frequently used to alleviate the knee pain. These points are typically identified using the Chinese measurement unit "cun," employed in acupuncture to pinpoint locations on the body. One cun is approximately the width of the patient's thumb at the knuckle, 1.5 cun matches the combined width of the index and middle fingers, and 3 cun is equivalent to the width of the patient's four fingers when placed together.


ST34 (Liangqiu)

ST34 (Liangqiu):

  • Located: 2 cun above the patella on the anterior aspect of the thigh, in the depression lateral to the patellar ligament

  • Benefits: Alleviates knee pain, reduces swelling



SP10 (Xuehai)

SP10 (Xuehai):

  • Located: 2 cun above the medial edge of the patella, on the bulge of the medial portion of the quadriceps femoris muscle

  • Benefits: Regulates blood circulation, relieves pain



ST36 (Zusanli):

ST36 (Zusanli):

  • Located: 3 cun below the knee joint, one finger width lateral to the anterior crest of the tibia, in the tibialis anterior muscle

  • Benefits: Boosts energy, supports digestion, strengthens the immune system, alleviates pain and inflammation


LIV8 (Ququan)

LIV8 (Ququan)

  • Located: On the medial aspect of the knee, in the depression at the medial end of the popliteal crease, between the posterior border of the medial condyle of the tibia and the semitendinosus and semimembranosus muscles

  • Benefits: Nourishes liver and kidney yin, relieves knee and leg pain




ST44 (Neiting)

ST44 (Neiting):

  • Located: On the dorsum of the foot, between the 2nd and 3rd toes, proximal to the web margin in the depression

  • Benefits: Clears heat, reduces inflammation






Fascial Expansion Demonstration

Utilizing fascial expansions in Knee pain management presents an effective strategy that merges contemporary insights in the fascia, kinetic chain relationships, and core principles of acupuncture or traditional Chinese medicine. In this video, Dr. Abelson, the Motion Specific Release (MSR) developer, demonstrates using fascial expansions to treat knee Pain.


 

Conclusion


The exploration of utilizing fascial expansions and acupuncture to treat knee pain unveils an integrative approach that harmonizes modern insights into fascia's role, kinetic chain relationships, and principles from traditional Chinese medicine. Key fascial planes, including the Gluteal Fascia, Fascia Lata, and Crural Fascia, are intricately linked to knee function and stability. The treatment strategy emphasizes the interconnected relationship between specific acupuncture points like ST34, Sp10, ST36, Liv8, and ST44, along with soft tissue manipulation, osseous procedures, and functional exercises, underscoring the importance of an integrated therapeutic approach.


In summary, this exploration connects the complex landscape of fascia, acupuncture, biomechanics, and physiology, offering a holistic perspective on knee pain treatment. This approach encourages clinicians to embrace a nuanced and effective method of managing knee pain by uniting traditional wisdom with modern scientific insights. It presents a promising pathway towards better patient outcomes and represents a step forward in the interdisciplinary field of holistic healthcare.


 

DR. BRIAN ABELSON, DC. - The Author


Photo of Dr. Brian Abelson

Dr. Abelson's approach to musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he integrates the latest research with a compassionate understanding of each patient's unique needs. As the Motion Specific Release (MSR) Treatment Systems developer, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.



 


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References


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  2. Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. The Anatomical Record, 269(6), 257-265. doi: 10.1002/ar.10185

  3. Schleip, R., & Müller, D. G. (2013). Training principles for fascial connective tissues: Scientific foundation and suggested practical applications. Journal of Bodywork and Movement Therapies, 17(1), 103-115. doi: 10.1016/j.jbmt.2012.06.007

  4. Stecco, C., & Hammer, W. I. (2018). Functional Atlas of the Human Fascial System. Elsevier Health Sciences.

  5. Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., ... & Linde, K. (2018). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. The Journal of Pain, 19(5), 455-474. doi: 10.1016/j.jpain.2017.11.005

  6. Yang, M., Yang, J., Zuo, Z., Liao, X., Wen, Y., Fan, L., ... & Xia, J. (2016). The role of traditional Chinese medicine in the regulation of oxidative stress in treating coronary heart disease. Oxidative Medicine and Cellular Longevity, 2016. doi: 10.1155/2016/5691949

  7. Yu, X., & Ding, G. (2012). Acupuncture mechanisms: Anesthesia, analgesia and protection on organ functions. World Journal of Traditional Chinese Medicine, 1(1), 59-66. doi: 10.15806/j.issn.2311-8571.2012.0013

  8. Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications.

  9. Maciocia, G. (2015). The Foundations of Chinese Medicine: A Comprehensive Text. Elsevier Health Sciences.

  10. Kaptchuk, T. J. (2000). The Web That Has No Weaver: Understanding Chinese Medicine. McGraw-Hill Education.


 
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