Healthcare and Medicine Reference
In-Depth Information
To continue down from here, place your fingers under
the edge of the anterior iliac crest, then abduct and
medially rotate the hip joint (Fig. 6.11). The tensor fasciae
latae (TFL) muscle will pop your fingers out. From here,
the iliotibial tract (ITT) can be felt, dimly at the top
of the thigh but more distinctly as you pass down toward
the knee. With the hip abducted and the foot off the
ground, the connection from the ITT across the knee
joint to the tibialis anterior can be clearly felt (Figs 6.12
and 6.13).
Follow the tibialis anterior down the front of the shin
next to the tibia and find its strong tendon emerging
from under the retinacula on the medial side of the front
of the ankle. Strongly dorsiflex and invert the foot to feel
the tendon as far down as you can toward its station
between the 1st metatarsal and 1st cuneiform (Fig.
6.14).
The fibularis longus starts just on the other side of
this attachment, with a fascial continuity through the
fascia of the joint capsule, but this is very difficult to feel,
except by implication, owing to the overlying myofascia
and fascial padding on the bottom of the foot (Fig. 6.15).
The fibularis longus tendon passes under the foot deep
to almost everything else, running through a canal in
the cuboid (again very difficult to feel) and emerging to
our fingers just under the lateral malleolus of the ankle
(Fig. 6.17). Two tendons will be palpable here, but the
fibularis brevis tendon (which is part of the LL but not
the SPL) will be superior to our fibularis longus tendon
and clearly headed for, and attached to, the 5th metatar-
sal base.
The fibularis longus myofascia passes up the outside
of the leg to the fibular head, where there is a clear, pal-
pable, and easily dissected connection to the lateral
hamstring, the biceps femoris. Follow the hamstring
tendon up the outside back of the leg to arrive at the
ischial tuberosity. From here the SPL connection passes
onto the sacrotuberous ligament, the sacral fascia, and
the erector spinae. (Palpation of these structures is dis-
cussed in connection with the Superficial Back Line in
Ch. 3, pp 91 and 92, so we will not repeat it here.)
Discussion 1
Fig. 6.22 Spinal twist poses such as the Triangle pose or Seated
Twist are custom-made to stretch the upper portion of the Spiral
Line on one side, while engaging it on the other.
The upper Spiral Line and postural rotations
of the trunk
Because of the mechanical rather than direct connection
across the pelvis at the ASIS, and the roundhouse of vectors
that affect the ASIS position, the upper and lower portions of
the SPL frequently, although not always, work separately; in
any case they are most easily discussed separately. The two
parts remain linked, of course, and can work in concert, but
are also capable of singing different tunes.
The upper portion of the SPL, from the occiput around the
contralateral shoulder girdle to the ASIS (Fig. 6.7), is in a
perfect position to mediate rotations in the upper body (Fig.
6.23). 'Mediate' because clinical experience suggests that the
Spiral Line is only sometimes the cause of such postural rota-
tions or twists, but is often involved in compensating for
deeper spinal twists which may come from any of a number
of structural or functional sources (see also Ch. 9 on the Deep
Front Line).
rhomboids continue on into the serratus anterior. Most
of that large sheet of muscle, however, is invisible under
the scapula. In thin individuals, the lower four or five
slips (which are the part under discussion here) can be
seen outside the edge of the latissimus when the model
contracts the muscle (e.g. in a push-up) (Fig. 6.8).
The link from the anterior part of the lower serratus
onto the external oblique, across the linea alba into the
internal oblique on the opposite side, is well known and
can be easily palpated or observed, as in Figure 6.9. This
brings us to the connection of the internal oblique onto
the anterior iliac crest and ASIS.
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