Healthcare and Medicine Reference
In-Depth Information
but can be felt on the back of the heel bone. Put your
fingers on the heel bone while you flex and extend the
toes to feel the effect on the fascia around the heel (Fig.
3.12, p. 78). The Achilles tendon is easily felt and famil-
iar to most, but follow it up the calf as it widens and
thins. If your model is standing on the balls of her feet,
the lower edges of the gastrocnemii heads are easily
palpable where they attach to this aponeurosis. Relax
the ankle, and the large soleus is easily felt deep to this
fascial sheet.
The next station, the heads of the gastrocnemii, lies
between the strong tendons of the hamstrings behind
and above the knee at the back of the femoral condyles
(Fig. 3.18, p. 81). The hamstrings reach down with their
tendons below the knee: the two semis (semimembra-
nosus and semitendinosus) to the medial part of the
tibia, the singular biceps femoris to the fibular head on
the lateral part of the lower leg. Follow the hamstrings
up to the posterior aspect of the ischial tuberosity (Fig.
3.21, p. 83).
If you reach under the medial edge of the gluteus
maximus just above the tuberosity, you can find the
almost bone-like sacrotuberous ligament - the shortest,
most dense track of this line. Reach in along its medial
side, following it up to the lower, outer edge of the
sacrum (Fig. 3.22, p. 85).
From this station of the sacrum, between the two
posterior superior iliac spines, the erector spinae and the
underlying transversospinalis traverse the entire spinal
column in a long track up to the occipital ridge. The
innermost of the erector spinae, the spinalis muscle, less
than a half inch wide in most cases, can be felt right up
against the spinous processes, most easily at the mid-
thoracic, 'bra line', level (Fig. 3.23, p. 85).
The middle of the erector spinae group, the longissi-
mus, is easily felt as a series of strong cables just lateral
to the spinalis. The most lateral of the muscles, the ilio-
costalis, can be felt between the cables of the longissimus
and the angle of the ribs. The slips of this muscle often
feel like the raised ridges of corduroy as you strum them
horizontally at this level. Any of these muscles can then
be traced up or down from where you locate them.
At the top of the neck, the semispinalis muscle is
easily palpable under the trapezius (especially when
your model pushes the head back against resistance) as
two vertical cables narrowing down from the occiput.
From the station at the occipital ridge, the epicranial
fascia, or galea aponeurotica, runs up over the occipital
bone (containing, in most people, slips of the occipitalis
muscle), over the top of the head and down the forehead
(enveloping the frontalis muscle) to attach to its final
station, the brow ridge (Fig. 3.30, p. 89).
ditional anatomical thinking recognizes the thoracic and
sacrococcygeal curves of the spine, which are concave to the
front of the body, as primary curves, that is, curves that still
reflect the flexed position of fetal development.
During late pregnancy and in the first year of life, the sec-
ondary curves form in sections within the baby's primary
flexion curve. Activating the neck muscles (to lift the head) and
later the lower back muscles (to sit and crawl) changes the
shape of the intervertebral discs to reverse the convexity of
the cervical and lumbar curves respectively (see Figs 10.28-
10.34, p. 219-20). In the standing posture, however, we can
expand our view of the spinal undulation to the whole body,
seeing the cranial curve as a primary curve, the cervical as
secondary, the thoracic as primary, the lumbar as secondary,
and the sacrococcygeal as primary.
Extending this point of view down the legs, the slight flex
of the knees can be seen as secondary, the curve of the heel
as primary, and the arch of the foot as secondary, and the ball
of the foot as primary. The knee 'curve' forms in the process
of learning to stand, and the final secondary curve to form,
the foot arches, takes final shape as the child strengthens the
deep calf muscles in walking.
While these curves are not all developmentally equivalent,
this concept is quite practical, and admits wide application in
the field of manual and movement therapy. All the primary
curves are more or less maintained by the shape of the sur-
rounding bones. The cranium is interlocked to itself, the tho-
racic curve is maintained by the ribs and sternum complex, the
sacrococcygeal curve by the hip bones and pelvic ligaments,
and the heel by the shape of the foot bones (Fig. 3.34).
All the secondary curves, however, are more dependent on
the balance of muscles, first to create and then to maintain
their position: thus the cervicals and lumbars, being the free-
standing sections of the spine, depend more heavily on the
guy-wires of the surrounding myofascia for their stability and
positioning. The bones and ligaments leave the knee free to
run from full flexion to hyperextension; muscle balance deter-
mines where the knees habitually rest. The arches of the foot
are likewise pulled into final position as the child stands and
walks, and their maintenance depends as much on the suc-
cessful balance of soft tissues in the leg and foot as on any
actual arch in the bones. (The muscles that reach down from
the calf to pull up on the various arches will turn up later as
the lower ends of other major train lines - see Chs 5, 6, and
9 on the Lateral, Spiral, and Deep Front Lines.)
In functional posture and movement, all of these secondary
curves are also related to each other. Lack of balance in one
often asserts a compensatory pattern into other nearby sec-
ondary curves. The illustrated relation between the knees and
lower back is readily seen in day-to-day observation (Fig.
3.35). Proper balance among all the primary and secondary
curves, accompanied by an evenness of tone in the SBL
tissues, can be seen as a balanced unfolding into 'maturity'
from the embryonic fetal curve. Postural flexion or hyperexten-
sion patterns can be related to areas where full maturation
was not complete. Chronic flexion of the hips is often occa-
sioned by the failure of the hips to fully extend as the child
grows; this lack of extension will require indicative, 'readable'
compensation in the SBL. A person who is completely 'evolved'
(in its literal sense of 'unfolded') displays a 'tensegrity' balance
of the body's alternating sagittal waves.
The SBL links the posterior aspect of all these curves
together, from top to bottom. The general tenet of the myo-
fascial meridians approach is that strain travels up or down
along these lines. Thus, problems in any of these curves may
create strain up or down the line. The converse also works:
stubborn pain problems may best be served by extending our
assessment and treatment to other parts of the line, often
quite distant from the site of pain. this topic is an extended
plea to create time and space in which to consider such an
Discussion 1
The SBL and the waves of the spine
The SBL provides a functional link across the waves that
constitute the primary and secondary curves of the spine and
legs. In the plantigrade human posture, the body arranges
itself in an alternating series of counterbalancing curves. Tra-
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