There is a noteworthy paper describing the needling of a single acupuncture point: Stomach 34 (also called Liangqiu).1
For those who haven’t studied acupuncture (or don’t remember the terminology) this point is located on the thigh, on a line drawn between the lateral border of the patella and the anterior inferior iliac spine, in a depression 2 centimeters (approximately .75 inches) proximal to the superior lateral border of the patella.2
In other words, it is in the vastus lateralis, the largest and most powerful portion of the quadriceps.
Key players to improve gait
One paper reports the muscle volume of the vastus lateralis (VL) as being approximately 675 cubic centimeters, followed by the vastus intermedius at 580 cubic centimeters, the vastus medialis 460 cubic centimeters, and the rectus femoris at 340 cubic centimeters.3 This shows the VL has about twice the volume of the rectus femoris.
It rises posteriorly from the femur along the linea aspera and circumnavigates the thigh in a counterclockwise fashion to attach laterally to the patellar tendon.4 Because this muscle makes up the bulk of the thigh, it stands to reason that needling the VL would affect the cortex more than would needling the vastus medialis, for example.
Studies of muscle fiber orientation suggest the vastus medialis oblique (VMO) force component is directed approximately 55 degrees medially and the VL force component is directed approximately 12 to 15 degrees laterally with respect to the longitudinal axis of the femoral shaft.5-8 This implies the fiber orientation of the VL gives it a mechanical advantage.
The muscle balance between the VMO and the VL, along with the periarticular soft-tissue structures acting on the patella, is considered a major component in the control of normal patellar alignment and function, with the VL often considered to be the dominant muscle, particularly in cases of patellofemoral dysfunction.9 The function of the VL is usually considered an extension of the knee and lateral rotation of the lower leg in open chain, and an extension of the thigh when the foot is in closed chain.
Another function and closed chain could be internal rotation of the thigh. It may take a while to grasp the concept, but if you stand on your right leg with your foot planted you can see how this could happen.10 This is often called “reverse engineering”, i.e., looking at muscular function from a closed rather than open chain function and working from the ground up.
A positive difference
In a paper describing needling this muscle, statistically significant improvements were seen in velocity, cadence, stride length, cycle time, step time, and single and double leg support after treatment.1 The effect was small, but positive.
After treatment, most parameters changed with the exception of “base of support,” which is an indicator of proprioception. Acupuncture seems to effect proprioception in a positive way, at least in the ankles and possibly on the cervical spine.11,12
These proprioceptive studies were conducted over a series of treatments, rather than just one, so perhaps if the participants in the knee study were treated a few more times, we would have seen a change. Imagine what could have happened if additional treatment modalities, such as exercise, proprioceptive work, and gait retraining were added.
In that study of elderly patients, acupuncture treatment had a positive influence on their gait. What a cost- effective alternative or addition to your rehabilitation services this could be.
Consider adding this modality to your current clinical toolbox, not only for older patients but for any who may have a gait abnormality.
Ivo Waerlop, DC, DABCN, practices in Dillon, Colorado, and teaches acupuncture, dry needling, and gait rehabilitation seminars in the U.S. and Canada. You can read more articles and learn about upcoming seminars on his blog at rehabchalktalk.com. He can be contacted at firstname.lastname@example.org.
1 Hauer K, Wendt I, Schwenk M, et al. Stimulation of acupoint ST-34 acutely improves gait performance in geriatric patients during rehabilitation: A randomized controlled trial. Arch Phys Med Rehabil. 2011;92(1):7-14. doi: 10.1016/j.apmr.2010.09.023.
2 Deadman P, Al-Khafaji M, Baker K. A Manual of Acupuncture (2nd Edition) (2007) Journal of Chinese Medicine. East Sussex, England.
3 Erskine RM, Jones DA, Maganaris CN, Degens
- In vivo specific tension of the human quadriceps muscle. European Journal of Applied Physiology. 2009;106(6), 827-838.
4 Battista C, Snow T. “Vastus laeralis.” Orthobullets. http://www.orthobullets.com/anatomy/10058/va stus-lateralis. Updated Dec. 2013. Accessed Sept. 2016.
5 Antich TJ, Brewster CE: Modification of quad- riceps femoris muscle exercises during knee rehabilitation. Phys Ther. 1986;66:1246-1251.
6 Karst GM, Jewett PD. Electromyographic analysis of exercises proposed for differential activation of medial and lateral quadriceps femoris muscle components. Phys Ther.
7 Lieb FJ, Perry J: Quadriceps function:an anatomical and mechanical study using amputated limbs. J Bone Joint Surg. 1968;50A(8):1535-1548.
8 Lieb FJ, Perry J: Quadriceps function:an electromyographic study under isometric conditions. J Bone Joint Surg. 1971;53:749-758. 9 Grabiner MD. (1993). Current Issues in Biomechanics (9th ed). Champaign, Ill: Human Kinetics Publishers.
9 Grabiner MD. (1993). Current Issues in Biomechanics (9th ed). Champaign, Ill: Human Kinetics Publishers.
10 Waerlop I. “Needling the Vastus Lateralis/Rectus Femoris and Vastus Intermedius.” The Gait Guys. https://tmblr.co/ZrRYjx24ecKUx. Published April 2016. Accessed Sept. 2016.
11 Tang WJ, Jiang CG, Chen LR, Pang Y, Li J, Huang Y. [Effects of acupuncture-moxibustion intervention on proprioception in athletes with lateral collateral ligament injury of ankle joint] .Zhen Ci Yan Jiu. 2013;38(4):314-8.
12 Heikkilä H, Johansson M, Wenngren BI. Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study. [ITAL]Man Ther.[/ITAL] 2000;5(3):151-7.