High Leverage Points in the Neuro-Myofascial Net
by Robert Schleip
The following areas are usually bony landmarks where several important muscles attach and which are specially rich in mechanoreceptors. They are high leverage points to influence bigger structural patterns that reach way beyond the local area of this spot.
I have included the major lines of influence (i.e. the most direct myofascial connections) from each area.
- via gastrocs to back of knee and to thigh
- via soleus deep into calf
- 4 layers of fascia forward along sole.
2. Below med. & lat. malleoli
- many tendons wrap around here
- change of direction horizontal/vertical
- affects lower leg & feet.
Both places (1 & 2) are strong focal points to affect the lower leg all the way up to the knee as well as for the whole foot.
3. Medial side of knee
- Pes Anserinus:
Three long powerful ropes pulling in three different directions:
- sartorius to ASIS
- semitend. to tubs
- gracilis to pubes.
- Interlacing of semimembranosus & med. gastroc
4. Lateral side of knee
- fibular head:
- peroneals & crural fascia affecting whole lower leg incl. the foot position
- biceps fem. to midfemur and to ischial tubs (plus via sacrotub. lig. to Fascia thoracolumbalis)
- also down to foot: lat. gastroc. & plantaris
- popliteus to affect knee position (e.g. lat. sideshift of tibia in relation to femur)
- ITB to anterior, lateral & posterior pelvis
Both sides of the knee (3 & 4) provide powerful connections upwards to all sides of the pelvis as well as downwards to the foot.
5. Greater trochanter
- affects every aspect of pelvis! (Check out the anatomy for this yourself)
- via ITB to below knee
The greater trochanter can be seen as Grand Central Station in the fascial (train) network system. Almost every long fascial sling (or Intercity train) can be caught here.
6. Coccyx-Tubs-Ramus Line
This includes the sacrotuberous ligament (which used to be the tendon of the
biceps fem.) and sacrospinous ligament.
- Glut. max. attachment (on sacrotub.lig.)
- most powerful point to influence hamstrings
- pelvic floor
7. Multifidus triangle
The multifidus triangle has been defined as the area extending from L4 lateral to both iliac crests and then down to the lower third of the sacrum. Except for the muscular multifidus fibres it is mostly filled with white fascial insertion tissues. The thickest fascial place in the body!
- Roots of erector spinae, reaching all the way up to occiput
- deeper spinal musculature (spec. multifdus)
- iliosacral & iliolumbar ligamentous connections.
8. Trigonum Lumbale
Between the iliac crest, the dorsal margin of the obliquus abd. externus and the lateral margin of the latissimus there is often a small triangular window, called Trigonum Lumbale. It provides relatively easy access to:
- quadratus lumborum (check for three different fibre directions)
- affecting diagonal trains via obliquus abd. internus (extending up & forward)
- entry point to abdominal bag (Fascia transversalis bag) via transversus abdominis & iliacus.
The lumbodorsal junction includes here the lower end of the trapezius and of the semispinalis, so it covers T10 - L1/2.
- Superficial and deep layers of lumbodorsal fascia
- via latissimus & trapezius to shouldergirdle
- via erector spinae up to occiput
- via 12th rib to:
- quadratus lumborum
- psoas (indirectly)
- transversus abdominis (& abdominal bag)
- serratus posterior inferior.
10. Dorsal hinge(mid dorsal area around D4-7)
- influences shouldergirdle & arms via rhomboids & transverse trapezius
- upper ribcage via serratus posterior superior
- neck & head via trapezius (pars decendens) , splenius (cerv) & semispinalis (capitis).
- spinal extension (via erector spinae) as well as rotation (via deep spinal rotators which are most strongly developed in this area)
- costovertebral joints (here often most effective place to influence wholeribcage mobility). Also most efficient place to affect external intercostals (which are most focused around here).
11. Xiphoid area
- transversus thoracis
- rectus abdominis
12. Coracoid process
- Fascia clavipectoralis: thick fascia separating pect.min. & major, also enveloping subclavius & coracobrachialis.
- biceps brachii
13. Spina scapularis
- effect on cranium/neck as well as on scapula elevation via trapezius decendens & levator scapula
- on scapula retraction via trapezius transversus
- on arm retraction & abduction via deltoid
14. Lat.& med. epicondyle of humerus
Powerful places to affect the whole arm. Work on med. epicondyle tends to affect more the flexors, on the lateral epicondyle more the extensors of wrist & hand. It also affects the upper arm muscles via the lateral & medial septa and the attachments of triceps & brachialis on both septa.
15 Carpal tunnel area
- influences all plantar hand structures
- also all flexors in within lower arm
- radial attchements also go up to lat. epicondyle (e.g. brachioradialis)
16. Hyoid sling
- infrahyoids incl. omohyoid
- suprahyoids (floor of mouth)
- attachment of pretrachial fascia (which goes down behind clavicle to fascia clavipectoralis)
17. Nucheal lines
- Superior nucheal line: trapezius & sternocleidomastoid.
- Inferior nucheal line: suboccipitals, controlling A-O as well as C1-2 joints. These tiny muscles have richest desity of spindles on this planet. V.Janda: their function is primarily to be a sensory organ.
- in between: attachment of nucheal ligament (as extension of lumbodorsal fascia) and upper erector spinae portions (splenius, semispinalis, longissimus).
This area is probably the most powerful of all Magic Spots to affect superficial as well as innermost structures in the upper body.