Lower Leg

Question 1

List the 3 taught lower leg points and describe their location

Answer 1

Lower leg points

1. BL57

On the posterior midline of the leg, at the apex of the inverted “V” of the musculotendinous junction of the gastrocnemius muscle and Achilles tendon, approximately 8 cun below the popliteal crease. Contract and relax the gastrocnemius to locate.

2. SP6

3 cun superior to the most prominent point of the medial malleolus, posterior to the tibia and anterior to the Achilles tendon and soleus muscle.

3. ST36

On the leg, 3 cun below the knee joint line with the knee in extension or 3 cun below the lower margin of the patella when the knee is flexed, 1cun lateral to the crest of the tibia.

Question 2

BL57 location and needling technique

• Location
• Insertion
• Depth

Answer 2

BL57 location and needling technique

Location

On the posterior midline of the leg, at the apex of the inverted “V” of the musculotendinous junction of the gastrocnemius muscle and Achilles tendon, approximately 8 cun below the popliteal crease. Contract and relax the gastrocnemius to locate.

Insertion

perpendicular to the skin, posterior to anterior

Depth

0.5-1.5 cun

Question 3

Describe relevant BL57 anatomy

• Muscles (1)
• Nerves (1; deeper - 1)
• Vessels (3)

Answer 3

BL57 anatomy

Muscles

1. gastrocnemius

Nerves

1. sural nerve S1 in the skin
   * Deeper*
2. tibial nerve L4-S3

Vessels

1. small saphenous vein
2. & 3. posterior tibial artery and vein

Question 4

List 7 neuroanatomical indications for BL57

Answer 4

BL57 indications

1. sciatic pain
2. low back/buttock pain
3. spasticity in the posterior leg muscles
4. myofascial strain/sprain of hamstrings, gastrocnemius and soleus
5. Achilles tendonitis
6. plantar fasciitis
7. muscle cramp

Question 5

SP6 location and needling technique

• Location
• Insertion
• Depth

Answer 5

SP6 location and needling technique

Location

3 cun superior to the most prominent point of the medial malleolus, posterior to the tibia and anterior to the Achilles tendon and soleus muscle.

Insertion

medial to lateral (perpendicular to the skin), posterior to the tibia. Avoid needling the tendons of flexor digitorum and tibialis posterior by having patient plantar & dorsiflex the foot to locate the tendons

Depth

1-1.5 cun

Question 6

List relevant SP6 anatomy

• Muscles (4)
• Nerves (1; deeper - 1)
• Vessels (3)

Answer 6

SP6 anatomy

Muscles

1. tibialis posterior
2. flexor digitorum longus
3. plantaris
4. soleus

Nerves

1. saphenous nerve L3-4 in the skin
   * Deeper*
2. tibial nerve L4-S3

Vessels

1. & 2. posterior tibial artery and vein
2. great saphenous vein

Question 7

List 3 neuroanatomical indications for SP6

Answer 7

SP6 indications

Nb Parasympathetic switch

1. Pain and inflammation of the medial aspect of the leg
2. Problems with tibialis posterior or flexor digitorum longus: shin splint syndrome
3. Immune point for rheumatoid arthritis

Question 8

ST36 location and needling technique

• Location
• Insertion
• Depth

Answer 8

ST36 location and needling technique

Location

On the leg, 3 cun below the knee joint line with the knee in extension or 3 cun below the lower margin of the patella when the knee is flexed, 1cun lateral to the crest of the tibia.

Insertion

anterior to posterior, aiming between the tibia and the fibula towards the interosseus space, on a horizontal plane

Depth

1-1.5 cun

Question 9

List relevant ST36 anatomy

• Muscles (2)
• Nerves (1; deeper - 1)
• Vessels (2)

Answer 9

ST36 anatomy

Muscles

1. tibialis anterior
2. extensor digitorum longus

Nerves

1. lateral sural nerve L4-S1 in the skin
   * Deeper*
2. deep peroneal nerve L4-S2

Vessels

1. & 2. anterior tibial artery and vein

Question 10

List 8 neuroanatomical indications for ST36

Answer 10

ST36 indications

1. Pain anywhere in the lower extremity
2. Autonomic dysfunction anywhere in the body
3. Chronic Regional Pain Syndrome (CRPS)
4. Disorders of the anterior aspect of the leg e.g. anterior compartment syndrome
5. Rheumatoid arthritis immune point
6. Hemiplegia, motor dysfunction of the leg
7. Energy promotion
8. Mood modulation helps with depression