Muscolino
Muscolino
Muscolino
reversing anatomy:
from muscles to myofascial meridians
As massage therapy continues to carve out its rightful force of muscle. Given that function follows from struc-
niche in the world of integrative health, the responsibil- ture, structural anatomy is usually studied first so that
ity to better know anatomy and physiology increases. physiologic functioning can then be understood.
Successful clinical orthopedic work cannot be accom-
plished with the application of memorized treatment THE CUTTING UP OF ANATOMY
technique routines. Rather, it requires critical think- However, learning anatomy is usually a daunting task
ing that is only possible with a true understanding of for students and therapists because it’s basically a nam-
the principles of anatomy and physiology of the human ing game, with thousands—if not tens of thousands—of
body. Understanding these principles enables us to ap- names to learn. We cut the body up into smaller and
ply them to the specific circumstances of the client who smaller pieces, which are each named, usually with Lat-
is on the table, allowing for competent assessment and in root words. In fact, the term anatomy itself comes
treatment. from the Latin-based roots tome and ana, which literal-
ly mean cut up. This is appropriate because it perfectly
ANATOMY AND PHYSIOLOGY describes the origins of anatomy training, where a ca-
Anatomy is the study of the structure of the body, and daver was cut up into pieces and the pieces were named.
physiology is the study of the body’s functioning. These This method of anatomy training still exists today,
www.amtamassage.org/mtj
are not the same things, but they are certainly related. and for all its faults, is likely necessary. After all, it’s im-
It’s the anatomic structure that determines the physi- possible to present the entire human body to a student
ologic functioning of the body. Two musculoskeletal ex- or therapist, and simply say “Here it is. Know it.” To
amples: 1) It is the rigid structure of a bone allows it to make this study feasible, we need to divide the body into
function as a lever, and 2) It is the presence of parallel smaller chunks of content so that they are more easily
actin and myosin filaments with cross-bridges between learned by the student.
them in muscle tissue that allows for the sliding of one The inherent risk involved with our approach to
filament along the other, creating the functional pulling anatomy is that the more we divide up the body, the
89
body mechanics
more likely we are to lose sight of the bigger picture, Taking a step back and presenting a somewhat larger
where individual structures are interwoven to function picture of musculature before studying the minutiae of
together. In a sense, we risk ending up with thousands individual muscles can be helpful.
of jigsaw puzzle pieces, each one learned and committed Muscles can be organized into structural groups at a
to memory, without a good understanding of the picture joint: these groups are located anteriorly, posteriorly,
they form. laterally, etc. When examining these structural groups,
This is certainly true when learning the muscular sys- we can also relate them to their functions. For example,
tem. Learning muscles usually involves just that: learn- all muscles that cross the glenohumeral joint anteriorly
ing each individual muscle one at a time, separate from with a vertical component to their fiber direction can
the others. If our instructor and textbook do not present flex the arm at the glenohumeral joint. Therefore, the
the bigger picture of muscular structure within the body, structural group of anterior muscles (with a vertical ori-
however, we will have learned the names of many pretty entation) is the functional group of flexors. Similarly, all
jigsaw pieces without having learned how they fit togeth- posterior muscles oriented in this manner can extend
er. True understanding of kinesiology (human motion) the arm at the glenohumeral joint.
requires more than memorizing lists of individual mus- This reasoning can also be used for laterally oriented
cles; it requires a level of understanding that can only abductors and medially oriented adductors. Regarding
come from seeing the bigger picture of muscle structure rotations, all muscles that wrap horizontally around the
and function. From this understanding, the application glenohumeral joint on the anterior side can medially
to competent clinical orthopedic work follows. rotate the arm at the glenohumeral joint, and muscles
that wrap horizontally on the posterior side can laterally
STRUCTURAL AND FUNCTIONAL MUSCLE GROUPS rotate the arm at the glenohumeral joint.
The solution involves proper framing of the content. Pointing out these structural groups not only facili-
Figure 1. Fibrous fascia forms one Figure 2. The tendon (or aponeurosis) of a muscle is actually the coalescing of all the
continuous web that traverses and endomysia, perimysia, and the epimysium.
connects the entire body.
CREDIT : Illustrated by Giovanni Rimasti
Muscle fibers
Endomysia
Epimysium
Bone
Muscle
belly
summer 2011
Fascicles
Tendon
Perimysium
90 mtj/massage therapy journal
CREDIT: Paoletti,
S: The Fasciae:
Anatomy, Dysfunction
and Treatment,
Seattle, 2006,
Eastland Press
tates our anatomic approach of learning the individual stop here. Just when we think that we see the big pic-
muscles by giving us a framework for their organization, ture, there is often an even larger picture to appreciate.
it also immediately points out the anatomic/physiologic This even bigger picture involves placing muscles into
relationship between structural groups and functional the fascial webbing that traverses the entire body (FIG-
groups, making critical and creative thinking possible. URE 1). Looking at the muscular system in this man-
ner requires us to look at patterns of muscle groupings
“REVERSING ANATOMY” that extend beyond the local joint(s) where, we learned,
With the big picture of functional groups at each indi- each of the muscle has its actions. To best understand
vidual joint presented first, we can now learn each indi- how muscles fit into the fascial web of the body, we need
vidual muscle. When that’s done, the next critical step is to look at the body from the perspective of fibrous fas-
reversing anatomy. cial connective tissue.
If anatomy is defined as breaking things apart, then The term fascia literally means bandage. Like a ban-
reversing anatomy is integrative—the process of putting dage, fibrous fascia creates a web that wraps around
the pieces back together. Now is the time to reassemble structures of the body, providing a continuum that con-
all the muscles that have been learned back into the big nects these structures to the rest of the body. The fascial
picture of the entire muscular system. This process is web truly forms the structural framework that unites
especially instructive now that we know and appreciate the entire human body.
each individual jigsaw piece. Looking at the body from this fascial perspective, we
It’s now possible to see the larger picture of all the can see that fascia provides the framework for all oth-
functional groups of mover muscles throughout the er tissues to form. If bone cells (osteocytes) lay down
body, as well as the interrelationship between the func- bone matrix within a fascial sleeve, a bone is formed
tional groups, such as whether they are mover/antago- within fascial periosteum. If nerve cells (neurons) are
nist pairs or mover/stabilizer pairs, for example. This formed within fascial sleeving, the brain and spinal cord
level of knowledge is truly important when looking to are formed within meninges, and peripheral nerves are
understand and assess postural and movement patterns formed within sleeves of endoneurium, perineurium,
in the human body. and epineurium.
A B
Tendon of
Tendon of muscle A
muscle A
Continuous
fibers
Tendon of
www.amtamassage.org/mtj
muscle B Tendon of
Bone Bone muscle B
Figure 3A. The classic understanding of a muscle attachment is that all the tendinous fibers end at the bony attachment, and are
discrete from adjacent musculature. B, In reality, most tendinous attachments of muscles have some fibers that are continuous
91
CREDIT : Figure 3a Illustrated by Jeannie Robertson. Figure 3b from Muscolino JE: Kinesiology, The Skeletal System and Muscle Function, 2ed. St.
Louis, Elsevier / Illustrated by Jeannie Robertson
body mechanics
endomysium, perimysium and epimysium sleeves, mus- Hence, structurally, a myofascial meridian can be
cles are formed. In fact, our usual division of a muscle defined as a linear series of muscles/myofascial units
and its tendon (or aponeurosis) is a virtual myth. The interconnected within the fascial webbing of the body
tendon of a muscle is actually the coalescing of all the (FIGURE 4). Because each myofascial unit functions to
endomysia, perimysia and the epimysium at the ends of create pulling force (the essence of muscle function is
the muscle. These fascial structures wrap around every that muscles create pulling forces), a myofascial merid-
individual muscle fiber, every muscle bundle (fascicle) ian acts to transfer the pulling force of one muscle to
and the entire muscle itself. In other words, the fascial the other muscles of the meridian. Further, if a muscle
tissue that creates the tendon/aponeurosis is integral to is stretched, the pulling force of this stretch can also be
and pervades the entire muscle belly. In fact, a better transmitted through the meridian.
term than muscle for this structure would be myofascial Therefore, a myofascial meridian is effectively a line
unit, because it describes the nature of the structure as that transmits tension (pulling) forces throughout the
having muscular and fascial components that are inex- body. This tension transfers sequentially from one myo-
tricably bound into one indivisible unit (FIGURE 2). fascial unit of the meridian to the next. Like the concept
MYOFASCIAL MERIDIANS
But looking at muscles as myofascial units still misses
the bigger picture of the myofascial system, because
even these myofascial units are not truly independent
units. Rather, they are linked to other myofascial units
in the form of myofascial meridians. The classic repre-
sentation of muscles is that they have discrete attach-
ment points on bones. By this model, each of the mus-
cles is independent of one another (FIGURE 3a).
However, this is rarely the case. Far more often, even
though some of the fascial tendinous fibers of the mus-
cle do attach into and end at the attachment bone, other
fascial tendinous fibers go beyond the bony attachment
site and are continuous with the fascial tendinous fibers
of the adjacent muscle (FIGURE 3b). In this manner,
these muscles/myofascial units are linked to each other.
Examining the fascial connections between muscles
allows us to discern specific lines of linkage that travel
throughout the body. These lines are called myofascial
meridians. Each myofascial meridian is a somewhat dis-
crete aspect of the fascial web that travels and connects
far reaches of the body.
summer 2011
TISSUE.”
meridian.
Hamstrings
www.amtamassage.org/mtj
1 Through the painstaking, creative, and innovative work by Tom Myers, twelve major myofascial meridians (also called anatomy
trains), have been mapped in the body. For a full treatise on myofascial meridians, see Anatomy Trains, 2ed., 2009, by Tom Myers.
Published by Churchill Livingston of Elsevier. Also of tremendous value when examining the concepts of myofascial continuity is the
93