Wednesday, 30 November 2016

Slings and Chains

There's been a lot of talk over the last few years about fascia. We've had symposia about it and there seems to be some interesting research taking place. We no longer see it as just a layer of tissue but as something more significant than that. It seems quite logical when you think about it that this cling-film like material that is wrapped around muscles and bones and that blends together to form something of a network throughout the body, should actually be playing a role in the complex systems of movement and posture.

Now, I'm no expert, so I'll leave the technical stuff to someone else, but as a therapist I'm fascinated by the relationships that exist through this fascial net, as I am about the non-isolated relationships between muscles. When we learn our basic anatomy it's usually done muscle by muscle as if they work in isolation. But we soon realise that this is not the case. Very quickly we discover agonist and antagonist as one relationship, then we begin to learn about co-contraction, eccentric and concentric contractions, synergists and stabilisers. Next we might start to think about movement patterns. Not just getting up from a seated position or taking a walk but about what happens when we kick a ball or hit a tennis serve.

These patterns are a series of complex interactions as muscles contract to produce movement at a joint or to stabilise a joint during movement. Suddenly our origins, insertions and actions of isolated muscles simply won't do the job of informing our understanding of these patterns.

Of course, from a therapy point-of-view, it's only when these patterns breakdown and cause an injury or a limitation that we tend to get involved. It's then that we start the detective work of trying to figure out what's going on and what we might be able to do to help fix it. I've never bought into the slightly "mystical" approach that I've seen some therapist apply. Personally I prefer to think a little more logically and dare one say scientifically about what I'm doing. For me there's nothing mysterious about a pain in the shoulder starting from the ankle on the opposite side when you understand a little more about how muscles interact and how fascia responds. It makes logical sense.

This is where myofascial slings are helpful as are muscle chains. Muscle chains got mentioned to me the other day and I'd not heard the term before, so I decided to do a quick bit of research. There's a lot more to be read, but at it's most basic a muscle chain simply traces the relationship between muscles and they cross joints or share attachment site. For example, think about the relationship between tibialis anterior and latissimus dorsi on the opposite side. TA shares and attachment site with peroneus longus, which in turn shares a site with bicep femoris. Follow this hamstring muscle and you'll find a connection with GMax via the sacrotuberous ligament. GMax and LD share an attachment via the thoracolumbar fascia. You could trace gastroc in a similar way. In fact, when a client comes to me complaining of tight hamstrings, I often check gastroc first with a simple test. Usually, even if the hamstrings are tight, there's tightness in the calf too. Where the client first feels this in a forward bend can be a clue as to where the primary problem might lie.

So, if you're just starting out in therapy remember to think about muscles in relationships and in movement patterns and not just in isolation, and maybe try to find a subtle way to get your gym bunny clients to understand that too!

Friday, 19 February 2016

The new muscle on the block

So, last year as I recall we were told about a new ligament in the knee and now we find out there's a new muscle in the quadriceps! They've given it the name tensor VI, or TVI. It lies between VL and VI and apparently the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella.

According to the abstract I read (you can find it here) this new extensor was found in all the lower limbs investigated. What caught my eye was the insertion on the medial aspect of the patella. Thinking out loud I wondered whether further research would point to the influence this newly discovered extensor might have on patella tracking. I don't know, and it would obviously depend on how that medial attachment relates to the patella tension and the quadriceps in general. That's something for the clinicians and sports science folk to play with!

It is quite amazing that with all the anatomy studies that have been done that we're still finding new stuff, but I guess we're more complex that we probably imagine.

Thursday, 14 January 2016

Tennis Anatomy

I decided to read this book for two reasons. I'm both a therapist and a tennis player, so the book appealed to both aspects of my thinking. The book has value to both, but maybe not as much for the therapist as for the player.

As a therapist, the value of the book lies in the detailed analysis of which muscles are at work in the full range of tennis shots. Knowing where to focus your attention when working with any sports person can be a challenge, and of course it differ from sport to sport. As well as tennis players I get to treat a range of sports people from runners to rugby players.

The books provides a general introduction to how a tennis player moves and how they adapt to different surfaces and also how different styles of playing influence the way muscles are used. There's also a useful section at the end of the book on movement patterns that could be used to provide the basis for rehabilitation exercises, and a chapter covering common tennis injuries and stretches. The chapters in-between look at specific areas of the body (shoulders, wrists, core, etc). Chapter 8 is focussed on rotational strengthening.

Each chapter looks at the anatomy of the area, how it is used in tennis and then offers a series of exercises related to strengthening that area.

The reface makes the aim of the book very clear:
This book is written for serious competitive and recreational tennis players... In this book, we highlight the different muscles groups involved in each of the strokes and show you how to best train those specific muscle groups as part of a comprehensive approach to tennis-specific training.
The book certainly delivers on that level! From a therapy perspective, the book's value lies in increasing one's understanding of the mechanics of tennis. How you apply that knowledge is up to you!

My verdict: Not really a therapy book, but a useful read if you're dealing with racket sports.