The Commanding Middle pressure point (B 54), also known as Urinary Bladder 54 or Bladder 54, is located at the midpoint of the back of the knee crease. In Traditional Chinese Medicine (TCM), this point is recognized for its capacity to treat lower-back disorders, leg stiffness, and sciatica by influencing the flow of energy along the Bladder meridian. It is commonly used for both acute and chronic musculoskeletal issues in the lower body.
Summary Table
| Attribute | Details |
|---|---|
| Pressure Point Name | B 54 – Commanding Middle |
| Body Area | Knee |
| Exact Location | Center of back of knee crease |
| Common Uses | Relieves knee pain, back stiffness, sciatica |
| Stimulation Technique | Press fingertips into crease and rock legs back/forth for 1 min |
| Contraindications | Avoid with active varicose veins, swelling, or recent surgery |
Clinical Significance & Associated Conditions
The Commanding Middle pressure point is widely indicated in cases of:
- Lumbar tension and chronic low-back pain
- Sciatic nerve discomfort, especially radiating pain down the leg
- Posterior knee tightness, including hamstring stiffness
- Knee joint pain or arthritis, particularly affecting flexion and extension
- Poor circulation or stagnation in the legs due to inactivity or compression
In clinical use, this point targets conditions rooted in tension along the Bladder channel and spinal musculature.
Location
B 54 is located in the popliteal fossa—the soft, shallow depression at the back of the knee.
To locate:
- Sit or lie with the knee slightly bent
- Identify the midpoint between the tendons on either side of the back of the knee crease
- Gently press inward into the hollow space; the point lies directly at the center
This position makes it especially responsive to motion-based stimulation techniques.
How to Stimulate It
To activate the Commanding Middle pressure point:
- Technique: Place your fingertips into the center of the back of the knee
- Motion: While seated or lying down, gently rock your legs side to side for 1 minute
- Depth: Apply moderate, steady pressure without compressing too deeply into the nerves
- Frequency: Use daily or as needed during periods of lower-body tension or stiffness
- Alternative: Acupressure tools or rolling devices can be placed under the knees for hands-free application
Pairing this with slow breathing enhances parasympathetic engagement and muscular release.
Benefits and Common Uses
B 54 is commonly used to:
- Relieve lower-back pain, especially when bending or walking
- Ease sciatica, particularly when pain originates from the lumbar or sacral area
- Improve mobility in the knees and legs
- Release stiffness in the hamstrings and calves
- Support pelvic alignment through energetic flow along the Urinary Bladder meridian
In TCM, B 54 is regarded as a command point for the lumbar region, governing Qi and blood flow to the spine and lower extremities.
Physiological Functions & Mechanisms
B 54 lies over:
- The tibial nerve, popliteal artery and vein
- Beneath semimembranosus and semitendinosus tendons medially
- Adjacent to the origin of the gastrocnemius muscle
Stimulation can:
- Relieve muscular strain through reflexive release of the posterior chain
- Improve venous return and lymphatic drainage from the lower limbs
- Reduce nerve compression symptoms, such as tingling or numbness in sciatica
- Activate deep fascial release contributing to improved range of motion
Practitioner Insight
In my experience, this point is especially helpful during long travel days or after extended periods of standing. It provides immediate relief to the lower back and legs and is a go-to for people managing sciatic discomfort without aggravating the spine directly.
Safety & Contraindications
Do not apply strong pressure to B 54 in the following cases:
- Varicose veins or blood clots in the popliteal area
- Knee surgery recovery or active inflammation
- Sharp pain or numbness that worsens with pressure
Avoid direct stimulation if there is swelling, bruising, or restricted circulation. See the full acupressure safety guide for additional guidance.
As always, listen to your body and stop if discomfort arises.
Related Points & Techniques
B 54 is often used alongside:
- B 23 – Sea of Vitality to support spinal strength and lower-back relief
- K 3 – Bigger Stream to anchor energy in the ankles and kidneys
- GB 30 – Jumping Circle for sciatica and hip tension
Complementary techniques:
- Hamstring stretches following stimulation
- Heat therapy across the lumbar spine
- Pelvic rocking or supine bridges to support mobility after release
Scientific Perspective
Evidence-based studies support use of posterior knee acupressure points for:
- Reducing chronic lower-back pain intensity and improving lumbar flexibility
- Enhancing neuromuscular coordination in patients with sciatica
- Increasing peripheral circulation and reducing venous stasis in immobile populations
One trial noted that targeting B 54 reduced pain levels by over 30% in participants with non-specific lower-back pain (PubMed).