Healthcare and Medicine Reference
In-Depth Information
default, the top of the peroneus longus in-between
(lateral compartment, LL).
While the tendon of the lateral hamstring is the most
prominent structure attaching to the head of the fibula,
the LL continues by way of the anterior ligament of the
head of the fibula (Fig. 5.8A). This fascial link can be felt
coming into tension just anterior and superior to the
head of the fibula when the leg is actively abducted
while lying on the side, or supine, when the leg is medi-
ally rotated and the foot is lifted from the ground (Fig.
5.8B). It forms a clearly palpable connection between the
head of the fibula running slightly anterior toward the
lateral tibial condyle and on into the ITT.
The ITT, the next fascial element of the LL, is clearly
palpable on the lateral aspect of the thigh at or
just above the femoral condyle, as a strong superficial
band. Follow it upward to feel it widen and thin out
along the thigh superficial to the muscular feel of the
vastus lateralis, which can be contracted by extending
the knee.
Above the level of the greater trochanter, the LL
includes more muscular elements: the tensor fasciae
latae can be easily felt by placing your fingers just under
the lateral lip of the ASIS, and then medially rotating the
hip (turning the knee in) (Fig. 5.9). The upper fibers of
the gluteus can be similarly felt by placing your fingers
under the lateral aspect of the PSIS and then laterally
rotating and abducting the hip.
Between these two, the strong central part of the
ITT can usually be felt passing up to the middle of
the iliac crest, with the gluteus medius muscle lining
it on the inside. This muscle can be clearly felt in
abduction.
To feel the parts of the abdominal obliques involved
in the LL, pinch the waist along the lateral aspect (Fig.
5.11). Providing that muscle can be felt, the more super-
ficial external oblique will have a 'grain' that runs down
and forward toward the hip. A deeper pinch contacts
the internal oblique whose 'grain' runs the other way:
down and back from the ribs to the hip. Performing
small trunk rotations is helpful in differentiating
these two layers. Both muscles are closer to vertical
out here on the side than they are in the anterior abdom-
inal region, but the differences in direction can still be
clearly felt.
The external intercostals can be felt between the ribs,
especially just superior to the attachments of these
abdominals, before the ribs are covered over by various
layers of shoulder musculature. The internal intercostals
are difficult to feel through the externals, but can be felt
by implication in forced expiration or in rotation of the
rib cage to the same side as the palpation.
The three layers of myofasciae in the neck are all
accessible to palpation. The SCM, clearly palpable on
the surface, has already been covered in our discussion
of the SFL (Fig. 5.12). The splenius capitis is most
easily palpated by putting your hands on your client's
head so that the palpating fingers are just under and
slightly posterior to the mastoid processes, but with
your hand arranged so that your thumbs can offer some
resistance to head rotation (DVD ref: Lateral Line, 58:00-
59:05). Have your client rotate his head, and you will
feel the splenius contract on the same side he is turning
toward, just under the superficial (and usually quite
thin) trapezius muscle. You can also do this palpation
on yourself.
The deepest layers of neck myofasciae involved in
the LL require precision and confidence to palpate. To
find the anterior scalene, have your client lie supine,
and gently lift the SCM forward with the fingernail side
of your fingers, and press in gently with your fingertips
to feel the solidity of the motor cylinder (the scalenes
and the other muscles surrounding the cervical
vertebrae) (Fig. 5.16). The most lateral of these muscles
is the middle scalene (DVD ref: Lateral Line, 1:00:25-
1:01:47). Slide the pads of your fingers along the front
of the motor cylinder, not pressing into it, not shying
away from it, with your ring finger just above the
collar bone. (The client will feel pain or tingling in his
fingers or a drawing pain in the scapula if you are
pressing on the brachial plexus; if so, move.) The half-
inch band under your fingertips is the anterior scalene.
Have the client breathe deeply; the anterior scalene
should engage during, and for many especially at the
top
of,
the
inhalation
(DVD
ref:
Lateral
Line,
The other end of this line, the obliquus capitis supe-
rior, can be felt by bringing your hands around to cup
the occiput in your palms, so that your fingers are
free and under the back of the neck. Curl your fingers
under the occiput and insinuate your fingertips
under the occipital shelf, mindful that you must feel
through the trapezius and the underlying semispinalis
muscles. Come to rest with fingertips under the occiput,
with three fingertips in a row, preferably the ring,
middle, and index fingers, with the ring fingers
almost touching at the midline, and the index fingers
medial to where the occiput starts to curve around
toward the mastoid process. Sizes of hands and skulls
vary, but for most the six fingertips will be comfortably
together on either side of the midline. The occipital
attachment of the obliquus capitis is just under your
index finger, and can be tractioned by pinning the index
finger and pulling posteriorly and superiorly with a
gentle hand.
The other end of the 'Deep Lateral Line', the quadra-
tus lumborum (QL), can be palpated in the side-lying
client by hooking one's fingertips over the superior edge
of the iliac crest near the ASIS and walking the fingers
back toward the PSIS. At or behind the midline, you will
encounter the leading edge of the QL fascia, often very
tough, which leads the fingers away from the crest
toward the lateral end of the 12th rib - a clear indication
that you have accurately found the QL. This will not
work if your fingers are walking back in the top or
outside of the iliac crest; because of the depth of the QL,
your fingertips must be on the inner rim of the iliac crest
to reach this fascial layer.
To work the QL toward greater length and respon-
siveness, work along this outer edge, freeing it from the
iliac crest toward the 12th rib (DVD ref: Lateral Line,
52:58-57:09).
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