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Anatomy Trains

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Laura Pempkowski

on 8 April 2015

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Transcript of Anatomy Trains

Anatomy rains
Myofascial Meridians for Manual & Movement Therapists
T
Based on the 3rd edition
book by Thomas W. Myers
Laura Pempkowski (almost) PT, DPT

1. ‘Tracks’ proceed in a consistent direction without interruption
Direction/straight lines
Depth/same plane
Intervening planes*

2. These tracks are tacked down at bony ‘stations’ or attachments

3. Tracks join and diverge in ‘switches’ and the occasional ‘roundhouse’*
Depends on physics and body position

4. ‘Expresses’ and ‘locals’
Expresses = multi-joint muscles
Locals = single-joint muscles
Poor/not ideal postures likely result from dysfunction in
the locals, which tend to be deeper


Tensegrity structure
Where to start?
What are Anatomy Trains?
What's the lingo?
Anatomy Train/Myofascial meridian:
interlinked series of these connected tracts of sinew and muscle

Myofascia:
any tissue (not plural or singular)

Myofascial continuity:
connection between two longitudinally adjacent and aligned structures within the structural webbing

Treatment structure:

1. Reopen tissue – increase flow, muscle function, connection with sensory-motor system (increase good)





How do you implement?
Anatomy Trains is a concept for looking at the body.

It is meant to be an adjunct way of thinking to institutionalized isolated muscle theory - where the muscular system works via approximation of its end points.

Anatomy Trains is based on looking at the myofascia (not singular or plural) as a ubiquitous structure - interrelating bones, muscles, ligaments, even organs.

Rooted in idea that the body is a tensegrity structure.
"Tensegrity" (tension integrity) by designer R. Buckminster Fuller

An architectural design of which structures maintain their integrity-wholeness or shape- due primarily to a balance of
woven tensile forces continual through the structure
as opposed to replying on continuous compressive forces like any common wall or column.

"Tensegrity describes a structural relationship principle in which
structural shape is guaranteed by the finitely closed, comprehensively continuous, tensional behaviors of the system, and not by the discontinuous and exclusively local compressional member behaviors.”
“It is possible that fully triangulated tensegrity structures may have been selected through evolution because of their structural efficiency – their high mechanical strength using a minimum of materials.”



Compression members
(bones) push outwards
against the tension
members that pull
inwards (muscles.)



Example: Herniated discs- used to be thought to be caused by continuous compression. Recent evidence shows that microstrains in the annulus from too much rotation as a cause, more often than direct traumatic compression.

Remote Loading
Example: With UCS, there are inhibited rhomboids and DNFs which need to be massaged/reperfused/awakened/worked
DNF chin tucks
Scap pinches/shrugs
Address tightness of pecs and locked length of upper traps
Manual, doorway, foam roller stretch
2. Ease the biomechanical pull that caused increases stress in the first place (decrease bad)

Similarly with LCS, there are inhibited abs and glutes
PPT
Glute squeeze
Address tightness of low back and hip flexors
Manual, RF and psoas kneeling, table stretches
Rules to Ride the Anatomy Trains:
Let's get going!
Superficial Back Line (SBL)
Superficial Front Line (SFL)
Lateral Line (LL)
Spiral Line (SL)
The Arm Lines

Superficial Front Arm Line (SFAL)

Deep Front Arm Line (DFAL)

Superficial Back Arm Line (SBAL)

Deep Back Arm Line (DBAL)
Back Functional Line (BFL)
Front Functional Line (FFL)
Ipsilateral Functional Line (IFL)
Deep Front Line
Postural function:
support upright extension in stance, prevent fetal flexion

Movement function:
create extension and hyperextension (except at knees)

Common postural compensation patterns:
Limited ankle DF
Knee hyperextension
Hamstring shortness (substitution for inadequadte deep ERs)
Anterior pelvic tilt
Sacral nutation
Lordosis
Extensor widening in thoracic flexion
Suboccipital limitation - upper cervical hyperextension
Anterior shift or rotation of occiput on atlas
Eye-spine movement disconnection

General movement treatment considerations









Prone on physioball - relaxation
Flexion “waves” by tightening belly and abs – encourage throughout whole body
Subocciptials - chin tucks/retraction and DNF. “Awareness Through Movement” lessons of Moshe Feldenkrais







2 pieces : toes-pelvis, pelvis-feet , but they FUNCTION as one

High proportion of fast twitch fibers – highly reactive to protect vital organs
Tends to shift down (where as SBL tends to shift up)

Postural function:
Balance the SBL
Provide tensile support to fight gravity
Maintain postural extension of the knee
Protect viscera

Movement function:
create flexion of trunk and hips, extension at knee, DF of foot

Common postural compensation patterns:
Limited ankle PF
Knee hyperextension
Anterior pelvic tilt
Anterior pelvic shift
Breathing restriction in anterior ribs (limited pump handle mechanism)
FHP





Anterior crural compartment
2 most common pattern problems:

1. Tendons gets stuck under retinaculum
– peritendinous sheaths adhere to fascia. Due to lack of full ROM

Treatment:

Pt
supine with heels off table. Active DF, PF with straight tracking
, guide heel and light fist on dorsum of foot. Continue to move up along the shin until you find an area of restriction, apply pressure and repeat DF/PF pass.

2. Forward leg lean
(ie knee is ant to ankle joint in resting posture) = tight calf/eccentrically loaded/locked long = anterior shin muscles move down/concentrically tight/locked short
Treatment:
Move the tissue of the anterior surface up again – push knuckles superior as pt DF, pause on PF.
Follow up with active DF/PF in new unrestricted range
Quads

More potential for issue because it’s a 2 joint muscle
Work tissue distal to prox as pt does this DF motion (proximal attachment is AIIS
not ASIS
)
Branch lines:
1. (Lateral) Tibialis anterior - ITT - ASIS
2. (Medial) Tibial tuberosity - Sartorius - ASIS

ASIS jump to pubis – same bone, therefore OK to derail for a moment
SFL portions are continuous in sagittal plan motions, but are disengaged during rotational motions

Switch @ 5th rib – depending on direction of motion/tension/strain
SFL
DFAL
Rectus Abdominis
Consider superficial fascia, muscle itself, deep fascia (transversalis)
Flat abs
= high tone muscle and superficial fascia
Bulging
= tight deep fascia
Iliac crest and obliques X
Frequent site of connective tissue accumulation,
and ‘cleaning’ these layers (external/internal obliques/TA) off the bone can be helpful in coaxing length from the LL
Zig zag: external oblique up/back, internal up/front
Anterior pelvic tilt: move tissues posteriorly
Posterior pelvic tilt: move tissues anteriorly
Neutral pelvis: either direction from midline OK

Ribs X
Zig zag: external intercostals up/back, internal up/front

Neck X
Back and up (SCM)
Front and up (splenius capitis)


Shoulder
Conceptual separation of shoulder form LL (LL is going according to the axial skeleton only)
Axial skeleton supports head,
therefore shoulder should have no role in working to support the head



General Movement Considerations
When assessing, if there is an imbalance present, check north/south for a compensatory imbalance on the opposite side (keeping eyes parallel with horizon)

Any lateral flexion stretches – without sagittal flexion or extension bias
Half moon
Triangle pose
Tandem stance with forward bend (stretches ITB of posterior leg)




Deep Lateral Line
Quadratus lumborum
Scalenes
Semispinalis capitis

Swimming and the stretch reflex
A decerebrated eel will still swim with a reciprocal wiggle due to the spinal stretch reflex of the intertransversarii muscles due to vibration sensors in the skin
During walking, potential energy to kinetic energy in zigzags of intercostals

Thought to be more involved with walking than we thought ( not just for ventilation!)

Emotions and postures
Show SFL = yes
Show SBL = no
Show LL = maybe
Participates in other lines (SBL, SFL, LL, DBAL), therefore dysfunction of SPL can affect the others
Rarely balanced/equal side to sid
e

Postural function:

Wrap the body in a double spiral that helps maintain balance across all planes
Connects foot arches and pelvic angle
Determine efficient knee tracking
Creates and compensates for twisting, rotation, lateral shifts (when imbalanced

Movement function:
create and mediate oblique spirals and rotations in the body, and, in eccentric and isometric contraction, to steady the trunk and leg to keep it from folding into rotation collapse

Common postural compensation patterns:
Ankle pronation/supination
Knee rotation
Pelvic rotation on feet
Rib pronation on pelvis
One shoulder lifted or anteriorly shifted
Head tilt, shift, or rotation

Zig-Zag made up of:
Deep myofascia (internals): Front and up (anterior and superior)
Superficial myofascia (externals): Back and up (posterior and superior)

Postural function:
Balance front and back
Bilaterally balance left and right
Stabilize trunk and legs in a coordinated manner to prevent buckling

Movement function:
create lateral bend (lateral trunk flexion, leg ABDuction, foot eversion), adjustable ‘brake’ for lateral and rotational movements of the trunk

Common postural compensation patterns:
Ankle pronation or supination
Limited ankle DF
Genu varus or valgus
ADDuction restriction/chronic ABDuctor contraction
Lumbar sidebend (unilateral contraction)
Lumbar compression (bilateral contraction)
Side shift of ribcage on pelvis
Shortening of depth between sternum and sacrum
Shoulder restriction due to over-involvement with head stability (especially with FHP)

"locked long"
SBL: Assessment and Treatment Tools
Forward bend and Plantar Fascia roll out
Anterior Shift WB

Drop vertical line down from inferior lateral malleolus
3:1 – 4:1 ratio in front:behind ankle joint line is normal
Measure line to 5th met head, and line to where heel leaves floor
> 5:1 indicates minimal support for the back of the body/tight/short SBL
Tight Erector spinae

Kyphosis/
promimenet SPs
-
work myofascia medially
to allow vertebrae to move forward
Lordosis/
deep SPs
-
work myofascia laterally
to allow vertebrae to move back
Subocciptials & Galea aponeurotica (scalp fascia)
Scalp trigger points (many meridians merge in the scalp, so fascicle orientation may be oblique, vertical, horizontal, etc.)
Circular fingertip pads to release fascia from skull

SFL: Assessment and Treatment Tools
Sternal area
Releasing sternal tightness: cephalad and/or lateral
Why not the hyoids?
Connect to the
posterior aspect
of sternal manubrium – therefore not on the same plan as the SFL (moreso DFL)

SCM
Counterintuitive in standing– flexion of the lower cervical spine, except for extension at the upper cervical spine - if chronically short/tight = FHP
Pt supine. Place open fist over SCM
(fingers positioned posteriorly) Apply pressure
(DO NOT PUSH INTO NECK). Rather, following fingers back “along the equator” without pressure on viscera to push fascia and SCM backwards. Pt assists by
rotating head away from your hand
(should hear hair on the table)
LL: Assessment and Treatment Tools
Iliotibial tract
Work
from lateral midline- spread fibers laterally
with knuckles or loose fists.
Or work vertical
. Use your ulna!

ABDuctors
Work in
radiating patterns away from greater troch towards iliac crest
Don’t forget to
release to facets of the greater troch itself!
SL: Assessment and Treatment Tools
Rhombo-serratus muscle
Typically rhomboids are locked long, & serratus locked short
Seen in body builders and kyphotic postures
Lower Spiral Line
Hip(ASIS) - arch - hip
Arches and stirrup
Pronated foot: tib anterior locked long, peroneus longus locked short
Supinated foot: peroneus longus locked long, tib ant locked short
The 4th hamstring (deep!)
Locals ( 1 joint muscle)
1. short head of biceps femoris – overactive in chronically flexed knees, or with laterally rotated tibia
2. adductor magnus – posteriorly tilted pelvis, limited hip flexion
General Movement Consideration
s







SL is most often tight in parts because it likely compensates for deeper rotatory issues, rather than be the primary cause of rotational postural impairments
So if you see a right twist with the SL, there is likely deeper left rotation postural issue
General movement treatment considerations









SBL/SFL imbalance
We too often see a concentrically shortened SFL/eccentrically locked long SBL (need to hold body in extension, but counteract flexion of a tight SFL) → tight feeling SBL.
Smart PT/PTA will free up SFL so the SBL can return to its proper job. Addressing only the SBL will not solve the problem alone!

SL dysfunction indicators
1. Shift or tilt in head position relative to ribcage

2. One shoulder more forward

3. Lateral ribcage shift relative to pelvis

4. Differences in direction of sternum and pubis
Goals
Balanced
Postural function:
Elbow strain's affect on mid-back pull, shoulder position, rib drag, neck posture, breathing function

Movement function:
manual activities for manipulating and exploring the environment.

Common postural compensation patterns can lead to:
Shoulder problems (pro/retraction, elevation
Scapular medial rotation & anterior tilt
Carpal tunnel syndrome
Elbow and shoulder impingement
Chronic muscular or trigger points
Lack of rib support (SPL, DFL dysfunction)

Pec minor
Clavipectoral fascia
Biceps
Radial periosteum
Radial collateral ligaments
Thenar muscles
Pec minor/clavipectoral fascia
Difficult to isolate
Functional shortness:
1. Restriction in upper rib movement/ inspiration (shoulders and ribs move together)
2. Trouble flexing arm and lifting shoulder for OH reach
3. Anteriorly tilted scapula
S
lide along ribs
, don't push on top

Biceps express - look at locals
Coracobrachialis (humeral ADD)
Brachialis (elbow flexion)
Supinator (forearm supination)
Traps
Deltoid
Lateral intermuscular septum
Extensor group
DFAL
SFAL
Pec major
Lats
Medial intermuscular septum
Flexor group
Carpal tunnel
Coordinates large arm motion/ flexion and ABD positioning AND fine motor control of grip
Which is actually tight: DFAL or SFAL?
Supine, arm off table ABD = SFAL on stretch

Now IR arm from shoulder (D1 extension) = DFAL on stretch
DBAL (rhomboid branch)
Rhomboids
Levator scap
RTC
Triceps
Ulnar periosteum
Ulnar collateral ligaments
Hypothenar muscles
Adjusts elbow angle (with DFAL)
Controls side to side motion of UB in quadruped
Provide stability from out of hand to back of shoulder
Active during UE Pilates reformer work
SBAL
Acts mostly to limit and contain the work of the SFAL
Controls ABD - overworked if rib cage or spine slumps out from under shoulder girdle
Which is actually tight: DBAL or SBAL?
Face client, hold his/her wrists, have him/her lean back from ankles

Palms up = SBAL on stretch

Thumbs down = DBAL on stretch


Use where patient feels tight as your guide
DBAL: trailing edge, feather tips
SBAL: hold out and lift wing
DFAL: leading edge
SFAL: power for flying
The Functional Lines
Postural function:
Less involved with maintaining posture than other lines
Approximate shoulder to opposite hip (in front and in back)

Movement function:
Provide increased leverage for more powerful and precision with motions

Common postural compensations:
Preference rotation usually associated with hand dominance or specific sport/activity where one shoulder is drawn to the opposite hip repetitively

Back Functional Line (BFL)

Front Functional Line (FFL)

Ipsilateral Functional Line (IFL)
General Movement Considerations
Engaging the Lines
Full body motions (pitching or kayaking) engage the line as a whole (wind up and release = stretch opposite lines BFL, FFL)

Timing, coordination, sequencing

Prone and supine alternating extremity co-flexion/extension
Palpate for simultaneous lift of contralateral extremities
Postural function:
Lift inner foot arch
Stabilize each segment of legs, including hip
Support the lumbar spine from the front
Surrounds and shapes abdominopelvic balloon
Stabilize the chest while allowing the expansion and relaxation of breathing
Balance the fragile neck and heavy head

Movement function:
No motion is isolated by the DFL, but its plays a role in assisting all other lines. Higher proportion of slow twitch fibers lends to its role in stability. (Proximal stability for distal mobility!) Difficult to identify DFL issues as dysfunction will also produce dysfunction in more superficial lines

Common postural compensations:
Chronic plantarflexion
High and fallen arch patterns/pronation and supination
Genu valgus and varus
Anterior pelvic tilt
Pelvic floor insufficiency
Lumbar malalignment
Breathing restriction
Flexed or hyerpextended cervicals
TMJD
Swallowing and language difficulties
General core collapse
Depression
General manual therapy considerations
Deep structures ares interlinked with neurovascular bundles - difficult to palpate. Coursework is advised
Lower leg: posterior compartment
DTM to posteriomedial edge of tibia
DTM to posterior septum behind peroneals, in front of soleus, have pt DF/PF
Good for treating high or fallen arches & bunions
Thigh
Work posterior adductor septum laterally to separate from hamstrings
Psoas
Upper- lumbar flexor
Lower- lumbar extensor
Consider 'locals' : pectineus, psoas minor/fascia band, iliacus, QL if you see lumbar lordosis/compressed lumbars/APT
Pelvic floor
Requires instruction and training

Longus capitis, longus colli, scalenes
SBL and (improper function of SCM in the SFL) can cause hyperextension of the cervical spine
Reawaken the deep neck flexors! Lift SCM forward, slide fingers medial and anterior to cervical TPs, as pt flattens neck onto table
Test time!
5 Step Analysis
* subjective observation*

1. Describe skeletal geometry

2. Assess soft tissue pattern

3. Synthesize an integrating story

4. Create strategy for short/long term plan

5. Evaluate and revise as needed
Subjective:
Strong, bright, positive, yet imperfect posture

1. Describe skeletal geometry
L head tilt, R shift (relative to neck)
R tilt shoulder girdle (note functional arm lengths)
General L spine curve
R pelvic rotation (relative to feet)
Genu varus
FHP
Anterior pelvic shift R>L

2. Assess soft tissue pattern
Pulled down upper SFL
Tight SBL shoulders -heels
Tight hamstrings, lumbar paraspinals
ABDucted LL (tight ABDs)
Upper LL: R lifted waist-cervicals, L dropped ear-waist
Short L upper body SL
Short R lower anterior SL
Short L lower posterior SL


Proximally tight DBAL & SBAL
DFL tight ankle-ischial ramus
R psoas short
L deep ERs tight

3. Synthesize an integrating story
Rotated pelvis
- due to internal rotation (ie. cervix?)
Tightened DFL lower body (causing varus)
Twisted torso to counterbalance

4. Strategize short/long term plan
SFL - chest, neck (to free ribs), shins ( to free knees)
Free tight SBL shoulders-heels
Lift R LL in upper quadrant
Free up L lateral abs and QL
R pectineus (APT and rotation)
Paraspinals and psoas to relax spinal twist

5. Evaluate and revise as needed
Subjective:
Ectomorph, but well muscled, light-hearted demeanor, balanced but not ideal

1. Describe skeletal geometry
Bow from heel-shoulder
FHP
(Head over pelvis/shoulders over heels)
Pelvis ant shift (relative to feet)
Pelvis ant tilt (relative to femur)
Rib cage posterior shift and tilted (relative to head and pelvis)
Medially rotated scapluae
R head tilt, L neck tilt
Shoulders tilted R
Rib cage and pelvis tilted L
WB L leg >R
R leg externally rotated
L rotation pelvis (relative to feet)
R rotation ribs (relative to pelvis)
L cervical rotation (to compensate eyes forward)

2. Assess soft tissue pattern
SFL pulled down full length
SBL pulled up heels-shoulder
Short ABD L>R
Tight R torso, L neck
Short R SL (R head tilt, L shoulder up)
Core rigidity




3. Synthesize an integrating story
Adult remains of what was probably was a "90# weakling" as a child
If the chest is lifted up and forward- this man will have better mobility and posture

4. Strategize short/long term plan
Lift whole SFL, especially chest & neck
SBL - suboccipitals
Lengthen ABDuctors
Lengthen L SL (to resolve rotation)
Tone up both SL to bring belly in and thoracic/shoulders forward
Open DFL inner ankle- anterior neck
Lengthen DFAL/pec minor and serratus
Lengthen DBAL rotator cuff (so rhomboids and traps can tone up to retract scaps)

5. Evaluate and revise as needed
Treatment Principles
1. Need
sufficient energy
available (nutrition, hormones, physical, etc.) to reach goals

2. Use available energy to seek increased functional and tissue
adaptability

3.
Change segmental relationships to gain increased
support

4. Seek
release
of underlying strain patterns

5.
Integrate
new pattern into everyday function and posture
Guidelines for Developing A Strategy
1. When palpating, start with affected/restricted/injured/painful area and move outward along the trains

2. Work on one part of a meridian can often have distant effects

3. Work the tissue of the meridian in the direction you want it to go

4. Work from the outside in, then inside out
Practitioner Body and Hand Use
Pay attention
to what your hands feel, listen to the tissue!
Layering
- Only go as far until the first layer that provides resistance
Pacing
- speed fore goes sensitivity, move at or below the rate of tissue melting
Body mechanics
- use your weight, leverage and time to effect tissue change
Movement
- tissue change is more effective when you can use client motion to your mechanical advantage
Pain
- patient's sensation accompanied by the 'motor intention to withdrawal' it means stop or slow down
Trajectory
- beginning, middle, and end (each stroke and each session) be mindful of your point
Complete body image

Skeletal alignment and support

Tensegrity/palintonicity

Length

Resilience

ROM

Reduced pain


Ability to hold and release somato-emotional change

Unity of intent with diffuse awareness

Reduced effort


Questions?
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