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Fig. 4.20 Vesalius, in an early precursor of the myofascial meridians theory,
shows the rectus abdominis fascia going up the rib cage nearly to the
collarbone. Why? (Reproduced with permission from Saunders JB, O'Malley
C. Dover Publications; 1973.)
Fig. 4.21 Our attempt to
reproduce what Vesalius indicates
as a connection from the rectus on
up the chest yielded a
disappointing lacework, at least on
the part lateral to the sternum over
the chondral portion of the ribs.
Given the palpable layer of tissue
that can be felt in this area, future
dissections using fresh-tissue
cadavers for comparison will
include investigation of the pectoral
fascia itself.
shows a 'switch' here, a choice point, where strain or
tension could follow either line, depending on the cir-
cumstances of movement, posture, and the necessity of
It is interesting to note that Vesalius shows the rectus
fascia proceeding under the pectoralis major almost
all the way to the clavicle (Fig. 4.20). Modern anatomists
think he may have been making a deliberate reference
to canine anatomy, but perhaps he was reflecting
the fascial reality of his time. Could it be that the pre-
dominant activities at that period - chopping and agri-
cultural work in general; in other words, active flexion
movements - resulted in the laying down of increased
sagittally oriented fascia traversing the front of the
Our attempts to make a similar dissection have
fallen short of Vesalius's picture (Fig. 4.21). On the basis
of only a few attempts at dissection, we have been able
to follow the fascia up the sternum, but not any wider
on the cartilaginous 'breastplate' to either side of the
sternum, where our results could best be described as
The sternalis is an anomalous, capricious and surface
muscle, though it is often expressed fascially even when
it is not expressed muscularly. Whether or not the ster-
nalis muscle or fascia can be detected, the SFL continues
up from the rectus by means of fascial layers, which are
readily palpable, over the sternum, the sternochondral
joints, and the costal cartilages, up to the origin of the
sternocleidomastoid. We suspect that stronger forces are
transmitted mechanically through the sternum, as well
as fascially via these layers and the pectoral fasciae as
The sternal area
Above the costal arch, the rectus may be lifted head-
ward from the front with extending fingertips or the
heel of the hand. Although the rectus formally stops at
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