Muscles of the upper trunk- origins, insertions, actions and antagonists.

As I said in my last post, if you want to work with the body (especially sports massage or Reciprocal Inhibition) you need to know the antagonist muscles, as well as the origins, insertions and actions of them. This is because in a classic example of poor posture you will see this.
So if you see tight muscles in one area, you can look at the antagonistic muscles to see why they may actually be over extended and loose, instead of the origin of the problem! You may just be stuck in a compensation pattern. No one is going to want to put their shoulders back if their muscles in their pecs have atrophied and are so tight that it is uncomfortable. So stretching or puffing your chest out may actually be what you need to help the muscles in your shoulders and back! If you have this common issue, and want a cheap fix, laying on a rolled up towel, or a foam roller between your shoulder blades (or scapula) may help this issue correct itself without massage, allowing gravity to do it's work for you.

So let's get into the muscles, and their antagonists. (This will be long, but fear not, you only need to get a general idea of these and their locations, most health professionals will not memorize all of this stuff. . .It is a great resource to keep in your files though. Which is the only reason I have made it!)

Erector Spinae Group

Action:

• Unilaterally: Laterally flex vertebral column to the same side
• Bilaterally: Extend the vertebral column

Origin: Common tendon that attaches to the posterior surface of sacrum, iliac crest, spinous processes of the lumbar and last two thoracic vertebrae

Insertion: Various attachments at the posterior ribs, spinous and transverse processes of thoracic and cervical vertebrae and mastoid process of temporal bone

       Antagonist: rectus abdominis muscle

Spinalis

Action: Laterally: Flex the head and neck to the same side. Bilaterally: Extend the vertebral column.

Origin:

• Spinous processes of the upper lumbar and lower thoracic vertebrae
• Ligamentum nuchae, spinous process of C-7

Insertion:

• Spinous processes of upper thoracic
• Spinous processes of cervicals, except C-1

       Antagonist: Rectus abdominis muscle

Longissiums

Action: Laterally: Flex the head and neck to the same side. Bilaterally: Extend the vertebral column.

Origin: Common tendon, transverse processes of upper five thoracic vertebrae

Insertion:

• Lower nine ribs and transverse processes of thoracic vertebrae
• Transverse processes of cervical vertebrae
• Mastoid process of temporal bone

       Antagonist: Rectus abdominis muscle

Iliocostalis

Action: Unilaterally: laterally flex the vertebral column to the same side. Bilaterally: Extend the vertebral column.

Origin: common tendon, posterior surface of ribs 1-12

Insertion:

• Transverse processes of lumbar vertebrae 1-3 and posterior surface of ribs 6-12
• Posterior surface of ribs 1-6
• Transverse processes of lower cervicals

       Antagonist: Rectus abdominis muscle

Transversospinalis Group

Multifidi and Rotatores

Action:

• Unilaterally: Rotate the vertebral column to the opposite side
• Bilaterally: Extend the vertebrae

Origin:

• Multifidi: Sacrum and transverse processes of lumbar through cervical vertebrae
• Rotatores: Transverse processes of lumbar through cervical vertebrae

Insertion: Spinous processes of lumbar vertebrae through second cervical vertebrae

• Multifidi span two to four vertebrae
• Rotatores span one to two vertebrae

Semispinalis Capitus

Action: Extend the vertebral column and head

Origin: Transverse processes of C-4 to T-5

Insertion: Between the superior and inferior nuchal lines of the occiput

       Antagonist: Sternocleidomastoid, Longus colli and capitis, Scalenus anterior, medius, and posterior

Splenius Capitis and Cervicis

Action:

• Unilaterally: Rotate the head and neck to the same side, laterally flex the head and neck to the same side
• Bilaterally: Extend the head and neck

Origin:

• Capitis: Inferior one-half of ligamentum nuchae and spinous processes of C-7 to T-4
• Cervicis: Spinous processes of T-3 to T-6

Insertion:

• Capitis: Mastoid process and lateral portion of superior nuchal line
• Cervicis: Transverse processes of C-1 to C-3

Antagonist: (Both) Sternocleidomastoid; Longus colli and capitis; Scalenus anterior, medius, and posterior. 

(When you think of the area of the neck people would chop to decapitate you, think of the two capitis's)

Quadratus Lumborum

Action:

• Unilaterally:

1. Laterally tilt the pelvis
2. Laterally flex the vertebral column to the same side
3. Assist to extend the vertebral column

• Bilaterally: Fix the last rib during forced inhalation and exhalation

Origin: Posterior iliac crest

Insertion: Last rib and transverse processes of first through fourth lumbar vertebrae

       Antagonist: Rectus abdominis, Internal oblique, External oblique

Abdominals

Rectus Abdominis

Action: Flex the vertebral column and tilt pelvis posteriorly

Origin: Pubic crest, pubic symphysis

Insertion: Cartilage of fifth, sixth, and seventh ribs and xiphoid process

       Antagonist: Erector spinae, Quadratus Lumborum

External Oblique

Action:

• Unilaterally: Laterally flex vertebral column to the same side, Rotate vertebral column to the opposite side
• Bilaterally: Flex the vertebral column, Compress abdominal contents

Origin: External surfaces of fifth to twelth ribs

Insertion: Anterior part of the iliac crest, abdominal aponeurosis to linea alba

       Antagonist: Erector spinae, Quadratus Lumborum

Internal Oblique

Action:

• Unilaterally: Laterally flex vertebral column to the same side, Rotate vertebral column to the same side
• Bilaterally: Flex the vertebral column, Compress abdominal contents

Origin: Lateral inguinal ligament, iliac crest and thoracolumbar fascia

Insertion: Internal surface of lower three ribs, abdominal aponeurosis to linea alba

       Antagonist: Erector spinae, Quadratus Lumborum

Transverse Abdominis

Action: Compress abdominal contents

Origin: Lateral inguinal ligament, iliac crest, thoracolumbar fascia and internal surface of lower six ribs

Insertion: Abdominal aponeurosis to linea alba

       Antagonist:  erector spinae

Diaphragm

Action: Draw down the central tendon of the diaphragm, Increase the volume of the thoracic cavity during inhalation

Origin:

• Costal attachment: Inner surface of lower six ribs
• Lumbar attachment: Upper two or three lumbar vertebrae
• Sternal attachment: Inner part of xiphoid process

Insertion: Central tendon

Intercostals

External and Internal Intercostals

Action:

• External: Draw the ribs superiorly to assist with inhalation
• Internal: Draw the ribs inferiorly to assist with exhalation

Origin: Inferior border of the rib above

Insertion: Superior border of the rib below

       Antagonist: External intercostal muscles

Serratus Posterior Superior

Action: Elevate the ribs during inhalation

Origin: Spinous processes of C-7 to T-3

Insertion: Posterior surface of second through fifth ribs

Antagonist: Serratus posterior superior, Transversus abdominis

Serratus Posterior Inferior

Action: Depress the ribs during exhalation

Origin: Spinous processes of T-12 to L-3

Insertion: Posterior surface of ninth through twelfth ribs

       Antagonist: Serratus posterior superior, Levatores costarum brevis and longi

Intertransversarii

Action:

• Unilaterally: Laterally flex the vertebral column to the same side
• Bilaterally: Extend the vertebral column

Origin and Insertion:

• Cervical: Spanning the transverse processes of vertevrae C-2 to C-7
• Lumbar: Spanning the transverse processes of vertebrae L-1 to L-5

Interspinalis

Action: Extend the vertebral column

Origin and Insertion:

• Cervical: Spanning the spinous processes of C-2 to T-3
• Lumbar: Spanning the spinous processes of T-12 to L-5

Subclavius (or under the clavicle)
Origin=the first rib right at the junction with the costal cartilage.
Insertion=the groove for the subclavius muscle, called the subclavian groove

Action=depresses the clavicle inferiorly and anteriorly

Antagonist=sternocleidomastoid or SCM muscle

Rhomboid major
 origin= spinous process of upper thoracic vertebrae
 insertion= vertebral border of scapula
 action = rotates and retracts scapula

While retracting-Antagonists: Serratus Anterior, Pectoralis Minor
While rotating-Antagonists: Trapezius (upper fibers), Trapezius (lower fibers), Serratus anterior (lower fibers)


Rhomboid minor
Origin= spinous process of lower cervical and upper thoracic vertebrae
 Insertion= vertebral border of scapula action= rotates and retracts scapula
Antagonist= Trapezius






Levetor scapulae
Origin= transverse processes of cervical vertebrae
 Insertion= vertebral border of scapula
 Action= elevates scapula,
Antagonist=serratus anterior and the lower fibers of the trapezius

Pectoralis minor
Origin= anterior surface of upper-middle ribs

Insertion= coracoid process of scapula
Action= depresses, protracts, and rotates scapula
Antagonist=rhomboid muscles


Pectoralis major
 Origin= clavicle, sternum, and costal cartilages of upper ribs
 Insertion= greater tubercle of humerus
 Action= flexes, adducts, and medially rotates arm

Antagonist to sterno section= romboid and trapezius muscles
antagonist to the rest are supraspinatus and deltoid muscles

Supraspinatus
 Origin= supraspinous fossa of scapula
 Insertion= greater tubercle of humerus
Action= abducts arm (part of Rotator cuff)
Antagonist=Pectoralis major lower fibers, latissimus dorsi, teres major

Infraspinatus
 Origin= infraspinous fossa of scapula
 Insertion= greater tubercle of humerus
Action= laterally rotates arm (part of rotator cuff)
Antagonist=subscapularisteres Major, lats, pec major, anterior deltoid

     Teres major
 Origin= inferior angle of scapula

 Insertion= lesser tubercle of humerus
 Action= adducts, extends and medially rotates arm
 Antagonist=deltoid, infraspinatus, and teres minor.





Teres minor
 Origin= On the dorsal surface of the middle half of the lateral border of the scapula.
Insertion=The lowest of the three facets of the greater tubercle of the humerus
Action=Externally rotates the arm
Antagonist= Deltoid


Subscapularis
Origin=Subscapular fossa of the scapula.
Insertion=Lesser tubercle of humerus.
Action=medial rotation of the arm at the shoulder joint
Antagonist= infraspinatus.

Trapezius

Action: 

Upper Fibers: elevate and upwardly rotate scapula. Extends neck.

Middle Fibers: Adducts scapula

Lower Fibers: to depress and help upper fibers upwardly rotate scapula

Origin: 
Upper part: External occipital proturberance, medial third of the superior nuchal line, the ligamentum nuchae, and the spinous process of C7

Medial Part: Spinous processes of T1 to T5.

Lower Part: Spinous processes of T6 to T12

Insertion: 
Upper Part: Lateral third of the clavicle and the medial aspect of the acromion process of the scapula

Middle Part: Medial edge of the superior surface of the acromion process of the scapula and the superior edge of the scapular spine.

Lower Part: Tubercles of the apex of the scapular spine.

And that's all folks! (For now at least. . .)

More about joints, and what you need to know.

My last post dealt with movement terms and joints that did the movement.
Some important joints to know are the:

Glenohumeral Joint – joins the Scapula and the humerus

Acromioclavicular Joint – Joint the Acromion and the Clavicle

Sternoclavicular Joint – Joins the Clavicle and the Sternum

Scapulothoracic Joint – The Scapula glides across the Thorax

There are numerous types of joints though. These include the:

Fibrous, Cartilaginous and Synovial joints.
The ones surrounded with synovial fluid, that go pop when the fluid gets displaced are called (surprise) Synovial joints.

There are 6 types of Synovial Joints:

 Condyloid, Hinge, Pivot, Saddle, Ball & Socket and Gliding joints. I remember them with the acronym 

CH(i)PS B(a)G

There are 3 types of fibrous joints:

Suture, Syndesmosis, Gomphosis
(There are a lot of S's there, so sorry, but I can't think of a brilliant memory hook for the other joint types.)

There are 2 types of cartilaginous joints:

Symphysis-the fixed or nearly fixed union of bones, as that of the two halves of the lower jaw or of the pubic bones.
Synchondrosis-a type of cartilaginous joint in which the cartilage is usually converted into bone before adult life. The connecting medium is hyaline cartilage.

So yes, if you haven' figured it out, cartilage or cartilaginous joints are made up of different types of cartilage as well. 

I get ahead of myself though, as we have not discussed what cartilage actually is?

Cartilage is- Connective tissue which allows tissue to bear mechanical stress. It is more widespread in the infant skeleton, being replaced by bone during growth.

There are three types of cartilage.

1. Hyline cartilage-The most abundant type, found as supportive tissues in the nose, ears, trachea, larynx, and smaller respiratory tubes.
2. Elastic cartilage- It has the firmness and resiliency of hyaline cartilage as well as flexibility and elasticity. It is found in jointless organs that frequently encounter bending or folding. In the adult human, elastic cartilage is found in the pinna of the ear, the external auditory canal and Eustachian tubes as well as the epiglottis and cuneiform cartilage of the larynx.
3. Fibrocartilage- is the tough, very strong tissue found predominantly in the intervertebral disks and at the insertions of ligaments and tendons.
   
   
   That stuff was a bonus; I love studying this stuff! I mean, isn't it cool to be able to say as you stroke the ears "Does this feel nice to your Hyline and Elastic cartilage?" Or maybe you don't like big fancy words like I do. . .Words are very important though, especially words for the body, as they help us know ourselves. And as a wise man once said:

So here are some terms that help you know your body.
Fossa= Large shallow depression in a bone. (There is also a cute mammal called a fossa FYI.)

Tuberosity= Large, often rounded, rough projections or grooves.

Spinous process is a bony projection off the posterior (back) of each vertebra.

Bursae=fluid filled sacs that serve as a cushion between tendon and bones.

Bursitis= Inflammation of the fluid filled sacs that serve as a cushion between tendon and bones.

("Itis" is always in reference to inflammation, but there is another term for inflammation: monoarticur

The opposite is polyarticular, which means noninflammatory.)

These sacs, like our tendons and ligaments are very important, especially around the joints. The Bursae are often neglected as root causes for radiating pain I have read. The 2 most common hip injuries are iliopsoas tendinitis and iliopsoas bursitis. Iliopsoas injuries are poorly recognized as a cause of hip and groin pain. It is located in the groin and higher, but it can be a cause of low back pain, because of how it effects the muscles on the other side of the body. 

The largest muscle in the body, called the gluteus maximus muscle as well as most of the hamstrings are antagonists (fight against) to the iliopsoas. When one is tight, the other is consequently strained. . . and that strain effects the entire back as it pulls it down! No amount of work on those strained legs will help your back pain without first dealing with the iliopsoas, or "psoas" for short. 

"Iliopsoas Syndrome" refers to a stretched, torn or completely ruptured iliopsoas muscle or tendon, which is frequently experienced along with or causes iliopsoas bursitis. In the case of the latter, the damaged tendon rubs on the bursa sac, causing it to become inflamed. Massage, chiropractic, acupuncture, ice, exercises and physical therapy are good natural helps for Iliopsoas Bursitis, or bursitis of all sorts! Although sometimes more aggressive techniques like therapeutic ultrasound, electrical stimulation, aspiration or surgery are needed. More on this here, and here.

So this was just one example of how the knowledge of antagonist muscles are a key to learning how the body works, and compensates for pain due to just one tight muscle.

In the next post I will deal with not just the typical origin, insertion and action of muscles, but antagonist muscles to them as well.

Anatomy terms for movements of the body, and the joints that facilitate them.

 Terms for movement of the body can help us both explain our actions and those we want others to do as part of the massage. They also help us not sound so foolish to an educated client or therapist. (Plus, whether or not someone knows the terms, you could always impress them and talk over their heads, which is kind of fun if you ask me. :)

Besides all that, we have to know them for the test in order to be a massage therapist, so check them out!



To flex a muscle, which is flexion, you will be shortening the angle of the joint, as you do with flexing your bicep. When everything is flexed, your body is in the fetal position. 

Extension is the opposite of that, and opening up the joint. 

To abduct an arm, which is abduction, you take it away from the body, or anatomical position, which all positions start from. This is like you abduct a child by taking it away from it's parents. To adduct, or the action of adduction, is to add to the body. 

Knowing that medial is speaking of the middle of the body, as I previously posted, it makes sense that medial rotation is rotating towards the mid-line. Which the opposite of is lateral rotation. 

Circumduction is any joint that allows a full circle. The root is often a dead giveaway as to the meaning of the word if you notice.


Speaking of a circle, to rotate something like an arm we call one direction supination and the other pronation. 

To remember them I think of a bowl of soup in my hand for supination, and pouring it out when I pronate it.

Then we have inversion and eversion.

If you get these basics, you are off to a great start in knowing the body movement terms!

How do these movements happen though? Joints! 

There are numerous types of joints, and you need to know them.

There are:
A. Plane joints
B. Hinge joints
C. Pivot joints
D. Condyloid joits
E. Saddle joints
F. Ball and socket joints

I personally find them a bit confusing, as they are pictured in numerous ways. For instance here,

                                  and here.

So good luck with differentiating them, but know the list anyhow. And with that, you will know the basics of the movements of the body, and the joints that facilitate them.

A 25 minute relaxing massage routine

         
To start off a professional massage you should first prepare your room and yourself. (You do this before you even walk in the room with the client.)

 Presuming the lights are dim, music is on, cream or oil is there and the sheets are changed. . . first you will want to wash or sanitize your hands.

Then make sure your mindset is right; it's all about the client. We don't chat about ourselves, and in fact don't chat at all if they prefer silence. You should ask about their preference to talk or not at the "intake" time before they undress. (This is the time where you discuss anything they have written on their paperwork.)

Then coming from the top of them, as they are lying down in a prone position, we place our well lubricated hands on the clients back.

Now (or before) we center and ground ourselves.

The idea that bodyworkers and therapists need to protect themselves from invisible energies is not a conventional idea. In the Western medical model, it may even be considered nonsense. Yet instructors in schools throughout the United States are teaching students the importance of taking time to protect themselves, before and after engaging with clients.

While the practices may vary from school to school, students and practitioners all express the importance of centering or grounding and of reinforcing the boundary of the energy field that surrounds us. When this is not done, practitioners report feeling new identical pains to the client's pains, drained, upset, or not themselves.

 Centering is a way of owning and protecting yourself and your energy or space. Grounding means that you are solidly anchored and connected in the present.
I liked this quote:
"There are many ways to ground yourself before a treatment. You could focus on your breathing, stilling your mind from all those chattering thoughts. As you wash your hands, focus on being tranquil, compassionate, non-judgemental; visualize negativity being washed down the drain. Stand quietly and feel your whole body, from your head right down to your feet; or imagine that your feet are growing roots right down into the earth. If you’re not a visual person, imagine stillness inside yourself."

"During a treatment, ground yourself by being focused on what you’re doing with this client in the present moment. The more you talk to the client, telling your own stories, the more your mind wanders. On the other hand, you may be mentally running through what should be on your grocery list, or silently reviewing what you did right or wrong with the previous client. Before you know it, you’ve detached from your palpation senses and your treatment is less effective."

In another case, the client may be unburdening himself of some past or present experience that he needs to talk about that resonates with you, reminding you of your own experiences and “ungrounding” you. Instead of letting the information or image get stuck in your mind or body, imagine that you are like a screen door, letting everything pass through."
Source

So after a minute or so of hands on centering/grounding,
 the place we start is with. . .

Effleurage This is for the purpose of smoothing on the cream/lotion/oil, relaxation and/or just to get the client use to your touch. Working with the layers of muscles it is also most comfortable to start easy, especially with people who have never had a massage before, as deep tissue massage with too much pressure may actually do some damage if the superficial layers aren't first dealt with, or so I've been told. (Like this picture below.)



Going down the spine and around to the sides, following through to the neck and repeating, we do this for about 4 minutes before going on with the effleurage to one side.

Going to a side, stroke the side closest to you from the hip area to up around the shoulder and down the arm with straight wrists. One hand following the other and one turned with the body more as you lean into the move.

Do this for about 3 minutes.

Then we progress to  Petrissage or "the act of kneading."

Picture playing around with bread. There are plenty of different strokes with petrissage, but with the exception of wringing, they all get the skin lifted in lumps. Never pinch!

Wringing

Do a variety of petrissage strokes for about 5 minutes. 

While retaining contact, move to the head again and resume the effleurage from the neck to spine and back again for a few strokes while you transition to the other side. A nice touch here is adding a long stretch around the bottom of the spine or to the side, like this.

Repeat the side hand effleurage followed by the hand head facing up the spine, as you lean into the body and spread more cream/oil. Do this again for about 3 minutes.


Then move on to the petrissage strokes of choice for 5 minutes on the other side.

Then onto the legs.

Through the folded over sheet, underwear or naked, use your fists on the gluts or bum, like you are a cat pawing away in delight. Go slowly and deeply, as there are many layers to get through there. (Be mindful of leaning with your abs and not using your shoulders.)
















Then starting at the calf on the same leg, use long effleurage strokes (continuing up the thigh) to spread cream/oil before moving onto the petrissage of the whole leg.



 End the leg with a fist in the gluts and the other hand stretching the leg down by the calf. 

Then repeat on the other leg. Take only 5 minutes doing this on both legs combined.

And that is your typical 30 minute massage, including changing and intake.

And don't forget to always encourage your clients to drink after a massage to avoid symptoms of detoxing.