Healthcare and Medicine Reference
In-Depth Information
A
A
B
Fig. 7.35 The relative tilt of the scapula must be measured against
the rib cage. If the rib cage is posteriorly tilted (a common postural
pattern in the Western world), the scapula may appear vertical to
the floor but in fact be anteriorly tilted relative to the rib cage,
involving a short pectoralis minor. Both (A) and (B) show an
anteriorly tilted scapula relative to the rib cage; both need length in
the pectoralis minor.
Fig. 7.34 The other leg of
the scapular 'X' consists of
a mechanical connection
through the scapula
between the lower part of
the trapezius in the back
and the pectoralis minor in
the front.
B
ability in the shoulder, lower arm, and hand requires a number
of crossover 'switches' that muddle the neat precision of the
Arm Lines, but provide additional possibilities for mobility and
stability in movement (DVD ref: Shoulders and Arm Lines,
15:18-15:38).
The two heads of the biceps brachii gives us an instance
of a crossover link between lines. So far, we have enunciated
only the connection of the short head from the coracoid
process to the radial tendon, which suited our purposes for
the DFAL. The long head, however, passes through the inter-
tubercular groove and onto the top of the glenum of the
scapula, thus joining mechanically with the supraspinatus of
the rotator cuff and on into the levator scapulae - or, in our
language, connecting the DFAL to the DBAL (Fig. 7.36).
In addition to the two heads that give it its name, the biceps
also has two 'feet', and this other foot provides another cross-
over. Aside from the radial tendon, the distal end of the biceps
sports the odd bicipital aponeurosis weaving itself into the
flexor group, thus linking the DFAL with the SFAL (Fig. 7.37).
This structure, along with the oblique cord between the ulna
and the radius, allows us to carry weight in the arms almost
entirely through myofascial connection between the scapula
and the fingers, without putting undue strain on the delicate
elbow and radio-ulnar joints.
To expand this weight-carrying function, as it is yet another
example of a crossover, when we carry an object like a suit-
case by our sides, the weight is primarily carried by the fingers
curled and held by the flexors of the SFAL (reinforced by the
thumb gripped with the DFAL). This tensile weight is not
carried to the medial epicondyle and on up the rest of the
SFAL, however; it is intercepted by the bicipital aponeurosis
and transferred to the biceps muscle, thus diverting strain
from the vulnerable elbow and crossing over into the DFAL.
At the top of the short head of the biceps, the tension is
transferred superiorly at the coracoid process to the coraco-
clavicular ligament and thus to the clavicle, where it is picked
up by the clavicular portion of the trapezius (and thus trans-
ferred to the SBAL), which carries the tension to the occiput
- a frequent site of headaches in those who venture out car-
rying a heavy object on one side (Fig. 7.38 and
Shoulders and Arm Lines, 15:39-16:05). (The need to coun-
terbalance this pull on the other side can also lead to strain
and pain in the opposite side of the neck or low back as well,
especially for the unpracticed. Experienced carriers of asym-
metrical loads, like mailmen, will have distributed the load,
more or less successfully, over the whole structure.)
Releasing the upper structures of the DFAL is thus part of
a strategy of relieving forward head posture or hyperextended
upper cervicals, especially in those accustomed to carrying
significant loads.
The distal attachment of the deltoid is right up against the
brachialis muscle. If we take this switch instead of the stan-
dard SBAL deltoid-lateral intermuscular septum connection,
we have a link between the SBAL and the DFAL (Fig. 7.39).
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