Healthcare and Medicine Reference
In-Depth Information
to keep the heel from moving downward. Have your
client dorsiflex; the heel will press down against your
restraining hand, and the client's femur will be pressed
into his hip. Have him dorsiflex again, adding just a
minimal lifting/flexing of the knee. This time, your
hand acts as an anchor (you can add the suggestion,
'Imagine the back of your heel is glued to the table while
you flex your ankle'), and the knee and the hip will flex
as the ankle 'pumps' the knee up.
Watch the hip. If the client's ASIS moves toward the
knee (lumbar hyperextension) as the knee rises, have
him be as passive as possible in the hip. The hip should
remain neutral or even fall back as the foot is dorsiflexed
and the knee flexes. If the hip is actively flexing, work
with the client's movement until it is minimally disturb-
ing to the knee and hip, and most of the work is taking
place at the ankle.
Place whatever applicator you wish to use just above
the patella (feel free to use everything from fingertips to
elbows depending on the body type and muscular devel-
opment of the client). Work slowly cephalad up the
rectus femoris, while the client repeats the dorsiflexing
movement, keeping the heel 'glued' to the table. Pay
particular attention to the receptor-rich area between the
patella and the belly of the muscle. You can follow it,
especially in those with an anterior pelvis, all the way to
the AIIS (remember to track the muscle into its attach-
ment, deeper and lower than the ASIS). Your goal is to
free the two-joint rectus from its monarticular knee exten-
sors below; the client's movement will help you accom-
plish this (DVD ref: Superficial Front Line, 25:44-33:12).
Fig. 4.12 The penumbra of the
SFL could be said to include the
entire quadriceps group, but a
stricter interpretation sticks with
the rectus femoris part of this
group, passing up onto the
anterior inferior iliac spine.
The three vastii of the quadriceps all grab onto various
parts of the femoral shaft, but the fourth head, the rectus
femoris, continues bravely upward, carrying the SFL
to the pelvis (Fig. 4.12). Although the rectus occupies
the anterior surface of the thigh, its proximal attachment
is not so superficial. Its upper end dives beneath
the tensor fasciae latae and the sartorius to attach to the
anterior inferior iliac spine (AIIS), a little bit below
and medial to the anterior superior iliac spine (ASIS).
There is a small but important head of the rectus
that wraps around the top of the hip joint. Palpation and
experience with dissection reveals that in some undeter-
mined percentage of the population there is an addi-
tional fascial attachment of this muscle to the ASIS.
Branch lines
Returning to the upper part of the shin, there are alter-
native routes or switches here (Fig. 4.13). Instead of
going straight up with rectus femoris, we could choose
to follow the anterior edge of the iliotibial tract (ITT)
from the tibialis anterior muscle (as we will in Ch. 6 with
the Spiral Line), which would carry us laterally up the
thigh to the ASIS. This could be seen to mechanically
link to the internal oblique.
On the medial side of the knee, we could follow the
sartorius from its distal attachment on the periosteum
of the tibia around the medial thigh, again arriving at
the ASIS, though this time the 'follow through' north of
the ASIS would be the external oblique (see the new
Ipsilateral Functional Line in Ch. 8). These various
branch lines of pull coming off the 'roundhouse' of the
ASIS would allow us to travel in various ways up the
abdomen to the ribs (Fig. 4.14). While these trains are
obviously in use in daily movement, we are choosing to
emphasize, in this chapter, the direct and vertical link
up the front of the body.
The quadriceps
The strictest interpretation of the SFL would include
only the rectus femoris, not the entire quadriceps, but
for the freedom of this line, we must ensure that the
rectus, being a two-joint muscle, is free to do its job at
both hip and knee. Repetitive motion patterns, espe-
cially in athletics, can result in the rectus being stuck
down to the underlying vastii.
The following technique requires a careful set-up of
client movement. What we are after here is the client's
use of his ankle movement to flex the knee and the hip.
Your client lies supine with his heels on the table. Place
a finger or hand against the bottom of the client's heel,
Derailment
At the upper station of the rectus femoris, our Anatomy
Train seems to come to a halt. No muscle or fascial
structure takes off from here in a generally superior
direction; the abdominal obliques take off at angles (Fig.
102
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