Healthcare and Medicine Reference
In-Depth Information
The rules of the game
Although the myofascial meridians are intended as a
practical aid to working clinicians, finding an 'Anatomy
Train' is most easily described as a game within this
railway metaphor. There are a few simple rules, designed
to direct our attention, among the galaxy of possible
myofascial connections, toward those with common
clinical significance. Since the myofascial continuities
described here are not exhaustive by any means, the
reader can use the rules given below to construct addi-
tional trains not explored in the body of this topic.
In summary: to be active, myofascial meridians must
proceed in a consistent direction and depth, via fascial
or mechanical connections (through a bone). It is also
clinically useful to note where the fascial trains attach,
divide, or display alternative routes (Fig. 2.1).
From time to time, we will find places where we have
to bend or break these rules. These breaks in the rules
are given the name 'derailments', and the reasons for
persisting in spite of the break are given.
A. Direction
As an example, the pectoralis minor and the coracobra-
chialis are clearly connected fascially at the coracoid
process (Fig. 2.2A, and see Ch. 7). This, however, cannot
function as a myofascial continuity when the arm is
relaxed by one's side, because there is a radical change
of direction between the two myofascial structures. (We
will abandon this awkward term in favor of the less
awkward 'muscles' if the reader will kindly remember
that muscles are mere ground beef without their sur-
rounding, investing, and attaching fasciae.) When the
arm is aloft, flexed as in a tennis serve or when hanging
from a chinning bar or a branch like the simian in Figure
2.2B, these two line up with each other and do act in a
chain that connects the ribs to the elbow (and beyond in
both directions - the Deep Front Arm Line to the Super-
ficial Front Line or Functional Line).
The usefulness of the theory comes with the realiza-
tion that problems with the tennis serve or the chin-up
may show up in the function of either of these two
muscles or at their connecting point, and yet have their
source in structures farther up or down the tracks.
Knowing the trains allows the practitioner to make rea-
soned but holistic decisions in treatment strategy,
regardless of the method employed.
On the other hand, fascial structures themselves can
in certain cases carry a pulling force around corners. The
peroneus brevis takes a sharp curve around the lateral
malleolus, but no one would doubt that the myofascial
continuity of action is maintained (Fig. 2.3). Such pulleys,
when the fascia makes use of them, are certainly permit-
ted by our rules.
1. Tracks proceed in a consistent
direction without interruption
To look for an Anatomy Train, we look for 'tracks' made
from myofascial or connective tissue units (which are
human distinctions, not divine, evolutionary, or even
anatomically discrete entities). These structures must
show a continuity of fascial fibers, so that like a real train
track, these lines of pull or line of transmission through
the myofascia must go fairly straight or change direc-
tions only gradually. Some myofascial connections are
only pulled straight in a certain position or by specific
activities.
Likewise, since the body's fascia is arranged in
planes, jumping from one depth to another among
the planes amounts to jumping the tracks. Radical
changes of direction or depth are thus not allowed
(unless it can be demonstrated that the fascia itself actu-
ally acts across such a change), nor are 'jumps' across
joints or through sheets of fibers that run counter to the
tracks. Any of these would nullify the ability of the
tensile fascia to transmit strain from one link of the chain
to the next.
B. Depth
Like abrupt changes of direction, abrupt changes of
depth are also frowned upon. For example, when we
look at the torso from the front, the logical connection in
terms of direction from the rectus abdominis and the
sternal fascia up the front of the ribs would clearly be the
infrahyoid muscles running up the front of the throat
(Fig. 2.4A). The error of making this 'train' becomes clear
when we realize that the infrahyoid muscles attach to the
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