Healthcare and Medicine Reference
In-Depth Information
iscussion 2
The SPL and forward head posture
The serratus anterior, as we noted above, is a complex muscle,
a broad combination of a quadrate and triangular muscle that
both stabilizes and controls the shoulder. Earlier in our phylo-
genetic history, the serratus was primarily responsible for cre-
ating a sling to support the rib cage within the uprights of the
scapulae (see Ch. 7 or DVD ref: Shoulder and Arm Lines,
3:22-5:07).
The lower slips of serratus definitely belong to the SPL, but
the middle slips form a connection with each other across the
bottom of the sternum, under the pectoralis major, at the level
of the 'bra line'. (See also Appendix 1 - this corresponds to
Schultz's chest band, p. 255) This creates a 'branch line' for
the SPL of interest where you see the ubiquitous forward head
posture.
If we follow this line from the midline just above the xiphoid
process, around the middle slips of the serratus to the middle
of the rhomboid and across to the splenius capitis on the oppo-
site side, we end up on the skull. To see or feel this for yourself
- and it is worthwhile to understand this pattern - take a six- to
eight-feet strip of fabric like a yoga belt or a length of gauze,
stand behind your model, place the middle of the strip above
the xiphoid and bring the two ends behind the model, crossing
them up between the shoulder blades to 'attach' them to the
skull by holding them there with your hands. (It is possible to do
this on yourself, but difficult to avoid getting tangled up.)
Now have the model jut their head forward of the rest of
the body. Feel the strip tighten and pull back on the sternum.
So many of those with forward head posture also have the
tight chest band, and this is a major avenue for the transmis-
sion of the strain. If you wish to see the chest band loosen its
hold on your model's breathing, get the head back up on top
of the body. That will ease this line and help restore the full
excursion of the chest in breathing.
Fig. 6.25 The pattern of the sling under the foot can be extended,
via the Spiral Line, to connect with the angle of pelvic tilt.
from the tibialis, creating a tendency (but not a certainty)
toward a fallen medial arch (B). Conversely, a posterior pelvic
tilt would tend to pull up on the tibialis and slacken the fibu-
laris, creating the tendency toward an inverted foot (A).
Take note of the further implication: a very tight SPL in
the back of the leg could overcome the front of the SPL and
produce both a posterior pelvis and an everted foot (Fig.
6.26A). When we view this pattern, we know that the back of
the lower SPL must have some significant shortening some-
where along these tracks. In the reverse pattern (B), an
inverted foot with an anterior tilt pelvis points to shortness
along the front of the lower SPL (tibialis anterior - anterior ITT),
though this pattern can also be linked to a short Deep Front
Line (see Ch. 9).
Discussion 3
The foot arches and pelvic tilt
It has long been recognized that the tibialis anterior and the
fibularis (peroneus) longus together form a 'stirrup' under the
arch system of the foot. The tibialis pulls up on a weak section
of the medial longitudinal arch, the fibularis tendon supports
the cuboid, the keystone of the lateral arch, and together they
help to prevent the proximal part of the transverse arch from
dropping (see Fig. 6.15).
Furthermore, there is a reciprocal relationship between the
two: a lax (or 'locked long') tibialis coupled with a contracted
(or 'locked short') fibularis will contribute to an everted (pro-
nated) foot, with the tendency toward a drop in the medial
arch (see Fig. 6.16). The opposite pattern, a shortened tibialis
and a strained fibularis, tends to create an inverted (supinated)
foot with an apparently high arch and the weight shifted later-
ally on the foot.
With our new view of the SPL, we can expand this concept
to include the entire leg: the tibialis connects to the rectus
femoris (SFL), the sartorius (SFL alternate route) and the ITT
and TFL (SPL). All of these connections go to the very front
of the hip bone: the ASIS or AIIS. The fibularis connects
through the long head of the biceps femoris to the ischial
tuberosity, or in other words to the very back of the hip bone
(Fig. 6.19).
Thus, the stirrup or 'sling' created by the tibialis and fibu-
laris extends up the leg to the pelvis and relates to pelvic
position (Fig. 6.25): an anterior pelvic tilt would bring the ASIS
closer to the foot, and thus remove upper tensional support
Discussion A
The lower Spiral Line and knee tracking
The SPL can affect knee tracking (the ability of the knee to
track straight forward and back in walking, keeping more or
less the same directional vector as the hip and ankle).
To assess knee tracking, you can watch your client walk
straight at you or straight away and see how the knees
travel during the different phases of gait. An alternative
assessment has your client stand in front of you with her feet
par2allel (meaning the 2nd metatarsals are parallel). Have her
bring both knees forward, with her feet on the floor and
while maintaining the upper body erect - neither sticking
her bum back behind her nor seriously tucking it under to
cause a backward lean in the rib cage - and see how the
two knees track (Fig. 6.27). If one or both knees are heading
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