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SECTION 4 FASCIA: PART B

4.1: WHAT IS ANATOMY TRAINS©?

**THIS IS A LARGE SECTION, PLEASE TAKE YOUR TIME, UNDERSTANDING ANATOMY TRAINS CAN MAKE A HUGE DIFFERENCE

The founder of Anatomy Trains, Thomas Myers, puts it perfectly in his third edition of “Anatomy Trains” which is a book on the recommended reading list for those who want to know and learn more:

“Whatever else they may be doing individually, muscles also influence functionally integrated body-wide continuities within the fascial webbing. These sheets and lines follow the warp and weft of the body’s connective tissue fabric, forming traceable ‘meridians’ of myofascial. Stability, strain, tension, fixation, resilience, and… postural compensation, are all distributed via these lines…

Essentially, the Anatomy Trains map provides a ‘longitudinal anatomy’ – a sketch of the long tensile straps and slings within the musculature as a whole. It is a systematic point of view offered as a supplement (and in some instances as an alternative) to the standard analysis of muscular action.

This standard analysis could be termed the ‘isolated muscle theory’. Almost every text presents muscle function by isolating an individual muscle on the skeleton, divided from its connections above and below, shorn of its neurological and vascular connections, and divorced from the regionally adjacent structures… [Anatomy Trains] defines a muscle’s function solely by what happens in approximating the proximal and distal attachment points. The overwhelmingly accepted view is that muscles attach from bone to bone, and that their sole function is to approximate the two ends together, or to resist their being stretched apart. Occasionally the role of myofascial relative to its neighbours is detailed…

Once the particular patterns of these myofascial meridians are recognized and the connections grasped, they can easily be applied in assessment and treatment across a variety of therapeutic and educational approaches to movement.

Aesthetically, a grasp of the Anatomy Trains scheme will lead to a more three-dimensional feel for musculoskeletal anatomy and an appreciation of whole-body patterns distributing compensation in daily and performance functioning. Clinically, it leads to a directly applicable understanding of how painful problems in one area of the body can be linked to a totally ‘silent’ area removed from the problem…

Though some preliminary dissective evidence is presented… it is too early in the research process to claim an objective reality for these lines. More examination of the probable mechanisms of communication along the fascial meridians would be especially welcome. As of this writing, the Anatomy Trains concept is presented merely as a potentially useful alternative map, a systems view of the longitudinal connections in the parietal myofascia.”[i]

Therefore, Anatomy Trains helps the understanding of fascia by placing a functional perspective on it. Whilst it is still yet to be fully proven through research with Anatomy Trains being ‘ahead of the times’, Physical Therapists have found them to be very useful for both increasing understanding of a client’s situation whether it be injury/pain, medical condition/s, or developing performance, and advancing treatments to promote more beneficial results.

As there is still research needed to be conducted to support the Anatomy Trains perspective, there was debate whether to include this topic within this platforms material, with the decision to include it being based upon full disclosure. Respect for Anatomy Trains is constantly increasing, and whilst Physical Therapists may be more equipped to understand it in more depth, the general public should also be aware of what Physical Therapists are currently considering. What we know in Physical Therapy should not be restricted to Physical Therapists, and rather everyone should have an updated understanding of what is known within the industry – both what we have known for years, what has recently been discovered, and what is being considered. So here is Anatomy Trains…

PICTURE OF ANATOMY TRAINS MYOFASCIAL MERIDIANS

The above image shows an overview of these myofascial lines, but what are they called and what do they do? Noting this is a summary only, please refer to the book itself for further information.

NOTE: Trying to understand Anatomy Trains requires some creative thinking. Some people prefer to make the models advised by fascia researchers, as having a visual aid can help advance the insight. One interesting point to consider is patterns – look for the patterns within the body, noting these patterns are both objective and subjective, thus, whilst the patterns are generally the same (why humans resemble humans and not other animals), they can also differ between individuals in accordance with their nature and nurture, such as not everyone has 10 toes, 4 limbs, and a straight spine.

BASIC PATTERN:

The human body is made up of a head, torso and pelvic area which are all joined together by a spine consisting of 4 parts:

cervical, neck
thoracic, upper back
lumbar, lower back
sacral, pelvic area

The human body generally has 4 limbs to enable movement, these being 2 arms and 2 legs. All 4 limbs are connected to the body by ball and socket joint, followed by 1 long bone leading to a hinge joint (knees and elbows), followed by 2 bones (arm: radius and ulnar, leg: tibia and fibia), followed by a ellipsoid joint (wrist) and hinge (ankle) which is where the 2 bones of the lower limbs meet a plethora of bones in the feet and hands, and finally finishing with 5 digits for each limb, these being fingers and toes.

So there are patterns, you just have to look!

Anatomy Trains enables us to understand these patterns, and the various connections throughout the body – why and how you can have a trigger point in the roof of your mouth which can release your calf muscle/s, why you can have wide spread pain symptoms despite it starting in a localised area such as left shoulder and right knee, etc. It consists of 7 chains throughout the body, connecting us from head to toe….

[i] Myers “Anatomy Trains” book 3rd edition

4.2: SUMMARY OF ANATOMY TRAINS©

1. SUPERFICIAL BACK LINE (SBL) PICTURE

‘Connects and protects’ the back of the body in two pieces, these being from toes to knee and then knee to eyebrow. Its main purpose is to support the body in an upright position in the sagittal plane, thus preventing you from curling over into the foetal position. In more depth, with the exception of knee flexion (hence the split at the knee), the SBL supports extension and hyperextension, thus, mediating posture and movement by limiting forward flexion and maintaining any extreme backward extension (hyperextension).

Because the SBL provides fundamental postural support, it requires tissue that has stamina, to which the musculature within the SBL has adapted to contain a high proportion of slow-twitch fibres and the fascia is structured with “extra-heavy sheets and bands”. Examples of these sheets and bands include the Achilles Tendon, hamstrings, thorocolumbar fascia (fascia of the upper and lower back), the “cables” of the erector spinae group (muscles which help maintain spinal structure and balance), and the occipital ridge (where the base of the skull meets the top of the spine). The knee exception allows for knee flexion, to which the SBL assists knee tendons and ligaments to maintain structural and thus postural alignment involving the femur balancing on top of the tibia.

Commonplace postural compensations linked with the SBL include: restriction in ankle dorsiflexion, plantar fasciitis, calf tension, knee hyperextension, hamstring strain, anterior (forward) tilting pelvis, lordosis (curvature of the lower back), weakness in the upper back and neck, anterior movement or rotation of the occiput on the atlas (the bone at the top of the spine), and eye-spine movement disconnection.

As fascial connections are continuous meaning everything is somewhat connected, the SBL will be discussed further throughout this Anatomy Trains section as understanding one Anatomy Train without understanding its relationship with the other Anatomy Trains and the rest of the body, is pointless. Understanding how the various Anatomy Trains work together therefore is vital when trying to understand how the body works as a whole, not just in segments.

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PICTURE OF SBL ANATOMY TRAINS

2. THE SUPERFICIAL FRONT LINE (SFL) PICTURE

Connects the front surface of the body in two pieces, toes to pelvis, and pelvis to each side of the skull, and generally works as antagonist to the SBL such as the SBL supports flexion of the toes (dorsiflexion – moving toes closer to the shin), whereas the SFL supports extension of the toes (plantarflexion – moving toes away from the shin).

FOCUS: This opposing relationship at the toes also assists the lower leg to help prevent excessive movements which can cause injury. The plantar flexors (SFL) preventing the tibia and fibia (bones of the lower leg) from moving too far forward, and the dorsiflexors (SBL) prevent them from moving too far back. Weakness of such will cause further postural and biomechanical compensations, with the inner knee ligaments (ACL and PCL) being the first structures to feel such pressures.

The split at the pelvis allows for seated positions, yet when in standing, the SFL works “as one continuous line of integrated myofascia.”xxv As a whole, the SFL supports forward flexion of the torso and hips, knee extension, foot dorsiflexion.

As the body requires fast strong forward flexion movements such as sprinting, the muscles on the front of the body contain a high concentration of fast-twitch fibres to which the SFL supports. In essence, as the SFL contracts (shortens), the SBL must stretch and elongate and vice versa, thus, they work together to help create equilibrium through posture and biomechanics. Furthermore, an interesting concept is that professionals such as Wilbur Kelsick consider the neck as an aid for hip flexion which is notably visible in sprinters – each time they lift a leg to propel forward, the neck also moves forward to increase momentum, meaning in extreme cases, the neck assists neck flexion.

However, modern society has vastly changed and requires increased sitting whether it be a school desk, work desk, or driving, which shortens and increases pressure on the SFL portion above the pelvis, whilst elongating the SBL. Whilst this is generally okay for a short period of time, it can have detrimental impact when held for a long time and repeatedly. Consequently, as the head moves forward, so the ears are in front of the shoulders, the SFL is now having to absorb more weight from the head and is required to shorten, with the SBL elongating to compensate, becoming weaker at the base of the neck. The more this is held, the more the SFL and SBL are compelled to compensate in an attempt to maintain balance, with further compensations including kyphosis (arching of the upper spine), forward collapsed shoulders, and lordosis (arching of the lower back).

Therefore, the less physical work a person does in conjunction with more sitting and a lack of priority for posture, the body begins to adapt including breathing patterns which is discussed further in Section 5. Therefore, the more the body deviates away from optimal posture, the more the body compensates, with such imbalance related to injuries of the foot/ankle, shin/calf, quads/hamstrings, groin/glutes, abs/lower back, shoulders and chest with upper back, neck and head.

Overall, as few people are conscious about maintaining a good strong posture throughout the day, more and more people are experiencing postural deviations which is adapting how the MSK system works. This is increasing the amount of people who experience pain symptoms and musculoskeletal (MSK) injuries.

3. THE LATERAL LINE (LL) PICTURE

Runs along each side of the body although it begins close to the big toes where it moves outwards under foot, passing by the cuboid bone and then moving upwards to the outside knee and IT Band. It then encases the hip joint and iliac crest (upper ridge of pelvis), the rib cage where the front portion moves up the front of the neck along SCM and the back portion along Splenius Capitus where they both insert at the occiputs at the back of the head. Overall, the LL mediates forces between the SBL and SFL (as well as the arm line and spiral line which are explained below), whilst also offering postural stability along the outside of the body to ensure structural stability.

Movements which it directly aids with is any sideways movement or rotation and movements such as standing on one leg or a one-handed handstand, and indirectly by ensuring your body does not fall or collapse sideways in forward-backward movements. For those interested, examples of particular movements include sideways flexion of the torso, leg abduction, and foot eversion.

The LL is structured so that it can conduct its job efficiently and effectively, with the fascia widening as it moves upwards from the knee and hip so that by the time it reaches the top of the pelvis, it can encase the entire iliac crest. It then runs up the waist where it becomes wider once more to surround the rib cage from sternum to spine, offering increased thoracic protection. It then reaches the skull in two portions, following muscles along the front and back of the neck and whilst they share the same insertion, this is one of if not the most optimal way to stabilise each side of the neck when avoiding the shoulder.

TRY:

Stand up with both arms down by your sides and the palms of your hands facing your body. Now try sliding your right hand down towards your right ankle and see how far you get. Take a moment to relax and see if you can get any further. Then stand back up and repeat with left hand towards left ankle. Do you get further on one side than the other? Or were both sides as flexible as each other?

If you find you cannot reach one ankle as much as the other, thus, unable to flex as far to one side, the restriction comes from the opposite LL. Eg. Reduced torso flexion to the left is usually caused by restriction in the right LL.

To help put this into more context, with regard to postural compensation patterns, the most common associated with the LL are ankle pronation/supination, knee varus/valgus, side shift of the rib cage, shortening between sternum and sacrum, and shoulder restriction when the LL is excessively attempting to stabilise the head.

PICTURE OF SBL ANATOMY TRAINS

PICTURE OF SBL ANATOMY TRAINS

4. THE SPIRAL LINE (SPL) PICTURE

Via a helix structure, the SPL coils around the body in two parts in order to offer opposition to each other – what is a helix structure? Here is a PICTURE. Due to the structure, this one is a little more complicated, but also the most interesting, and therefore, some further description is required:

The Upper Track

The SPL attaches on either side of the head where the Occiputs meet the Temporal Bone, running down Splenius Capitus and then Splenius Cervicus where it joins the upper Spine (C6-T5).
As it reaches the spine, the SPL continues towards the opposite shoulder via the Rhomboids (both major and minor) noting this change of side is a continuous chain, thus the right side of the skull is directly attached to the left scapula and vice versa.
It then connects to the Infraspinatus and Subscapularis muscles of the Rotator Cuff, and Serratus Anterior (also an assisted breathing muscle) meaning the spine and scapula have a strong relationship, then continuing on by wrapping around ribs 5 to 9 as it reaches the sides of the rib cage.
As the SPL then moves towards the front of the body, it passes just below the solar plexus by coiling towards the navel (belly button) via the External Oblique and meeting the Linea Alba (central vertical line of the abdominals) noting both sides overlap here.
With no break in the chain despite overlapping, the SPL continues via the opposite internal oblique towards the ASIS (front aspect of the pelvis) where it meets increased pressure due to the various pulls from both above and below.

The Jump Rope

The SPL then connects to the TFL of the hip/pelvis and continuing down the IT Band towards the outside aspect of the upper tibia (lateral condyle of the tiba).
Abiding by the helix structure, rather than continuing down towards the outside ankle as the LL did, the SPL moves down via the Tibialis Anterior crossing the front of the tibia and passing the inside of the foot between the medial cuneiform and big toe.
Rather than ending there, the SPL then forms a stirrup, passing transversely across the bottom of the foot and attaching to the Peroneus Longus on the outside of the lower leg.
Moving upwards, the SPL then moves along the Bicep Femoris to which Tom Myers suggests the concept of the 4th Hamstring relating to reoccurring Hamstring injuries (please see recommended reading list and/or www.AnatomyTrains.com for more information). It then continues to Adductor Magnus where it reaches the pelvis at the Ischium and following the line already set by the SBL, it moves towards the Sacrotuberous Ligament.
From the Sacrotuberous Ligament, the SPL then moves across the sacral spine towards the sacral fascia on the opposite side. From here, it continues up the erector spinae muscles where it passes under The Upper Track at the Rhomboids and attaches at the Occiputs just behind where The Upper Track began.

As you can see, the SPL is somewhat complicated meaning its function is also complicated. On the whole, its prime function is to allow oblique spirals and rotations of the body and prevents rotational collapse of the body. However, due to its helix structure, it also “participates in creating, compensating for, and maintaining twists, rotations, and lateral shifts of the body.”xix

Due to the helix structure, the and its compensations can impact its linked Anatomy Trains which can deepen the roots for the deviated posture and biomechanics and vice versa which increases risk of injury and/or pain symptom. Such compensations can include a bilateral pelvic tilt, forward tilting shoulder, tilted to one side using a dominant leg, and weakness between opposing recessive hands and legs. Consequently, just because your body can absorb the deviated postures and biomechanics, it is not promoting longevity, and you only have one body.

5. THE ARM LINES (AL) PICTURE

Whilst this chain seems smaller and perhaps less important, due to modern society requiring the use of our arms in a seated position, from school and career desk work to driving, it is therefore just as important.

When seated and controlling movements with the arms, whether it be using a computer, pen or a steering wheel for example, this alone can create strain from the elbow to the mid back area. Lack of postural awareness can then increase this strain as the shoulders collapse forward meaning less scapula control to aid shoulder and thus arm movements. This compensation pattern can then spread around the body the longer it is held and/or if its repeated frequently. Peper et al. (2017)[i][ii][iii] found that posture impacts both mood and memory, Michalek (2014)[iv] finding the relevance regarding sitting postures in particular, linking the physical with the mental, making it vital for overall wellbeing… so your arms are just as important as everything else!

There are 4 Anatomy Trains related to the arm specifically, these being the:

FRONT OF THE ARM

Deep Front Arm Line (1): starts at the 3rd, 4th and 5th ribs passing the shoulder at the coracoid process and down the outside of the arm via the radius to the outer side of the thumb.
Superficial Front Arm Line (2): starts at the inner 3rd of the collar bone, costal cartilage (where ribs meet the sternum), lower ribs, lower back and upper spine/edge of the pelvis, and passes through the shoulder following the upper pectoralis fibers into the humerous leading into the arm following the inner aspect (medial portions), turning into the front of the forearm and where it travels into hand via the front of the wrist.

2 X

PICTURES OF ARM LINES

BACK OF THE ARM

Deep Back Arm Line (3): starts at the spine regarding the lower neck and upper back, moving down to the inner (medial) border of the shoulder blade (scapula), travelling back up to the shoulder where it passes via the head of the humerous (posterior portion), and then travels down the arm to the inner elbow (medial portion), and finally down the ulnar and into the wrist and hand where it travels down the outside of the little finger.
Superficial Back Arm Line (4): similar to the trapezius muscle, it starts at the spine from the occipital ridge where the neck meets the skull to the thoracic spine, travelling via the scapula to the outer (lateral) 3rd of the collar bone and acromioclavicular joint of the shoulder, continuing down the arm via the outside of the elbow and into the hand via the back of the wrist where it travels down the back of the fingers.

FOR MORE INFORMATION INCLUDING DETAILED PICTURES, PLEASE REFER TO THE BOOK LISTED IN THE RECOMMENDED READING LIST.

Consequently, these Anatomy Trains provide insight into how the shoulder works – the front of the shoulder being more connected to the thumb, and the back of the shoulder being more connected to the little finger. In greater depth, the Front Arm Lines are more associated with medial (forward) rotation of the shoulders, which can influence further rotation of the arm so the palm of the hand faces backwards, and are predominant when using the thumb. To support balance, the Bark Arm Lines do the opposite, they are more associated with lateral (backwards) rotation of the shoulders, influencing lateral rotation of the arm so the palms of the hands face forward, are predominant when using the little finger and offers stabilisation for the scapula.

Therefore, as the shoulders collapse forward, it causes the scapula to move upwards and outwards placing more pressure on the Deep and Superficial Front Arm Lines, shortening the associated muscles which weakens and lengthens the Deep and Superficial Back Arm Lines. Consequently, this will impact the torso with the upper chest and front of the neck absorbing excess pressure and the back of the torso dealing with pulls and strains as the shoulder blade becomes weaker. In context, the less focused a person becomes about posture in modern society, the more dysfunctional the Arm Lines become due to compensations, which can cause issues throughout out the body with the other Anatomy Trains also compensating.

People can forget that the scapula is a part of the shoulder despite being also named the shoulder blade, and considering the rotator cuff muscles attach the shoulder blade to the upper arm with the function to stabilise the shoulder joint through movement, the Back Arm Lines are vital. So again, just because your body can absorb the deviated postures and biomechanics, it is not promoting longevity, and you only have one body. Posture matters, so make it a priority!

[i] Peper, E., Lin, I. M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood. Biofeedback, 45(2), 36-41.

[ii] Peper, E., Booiman, A., Lin, I. M., & Harvey, R. (2016). Increase strength and mood with posture. Biofeedback, 44(2), 66-72.

[iii] Veenstra, L., Schneider, I. K., & Koole, S. L. (2017). Embodied mood regulation: the impact of body posture on mood recovery, negative thoughts, and mood-congruent recall. Cognition and Emotion, 31(7), 1361-1376.

[iv] Michalak, J., Mischnat, J., & Teismann, T. (2014). Sitting posture makes a difference—embodiment effects on depressive memory bias. Clinical Psychology & Psychotherapy, 21(6), 519-524.

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PICTURES OF EACH FUNCTIONAL LINE

6. THE FUNCTIONAL LINES PICTURE

As suggested by the name, this Anatomy Train is more concerned with function rather than posture, however, it can be impacted by other Anatomy Trains relating to posture such as the Spiral Line. There are 3 lines concerned with the Functional Lines:

The Back Functional Line (BFL): Sharing the same attachment to the arm as the Latissimus Dorsi (commonly known as the ‘lats’), it encapsulates the Latissimus Dorsi as it runs down the back, travelling towards the pelvis towards the sacral spine. Upon reaching the sacral spine, the BFL crosses to the glute on the opposite side close to the seat bone (Ischium/Sacrotuberal fibres). From here it travels down the upper leg passing under the Lateral Line where it reaches the Vastus Lateralis muscle of the Quadriceps group (‘Quads’) where it continues to the patella tendon and then the tibia, noting it can arguable reach the arch of the foot (medial longitudinal arch).
The Front Functional Line (FFL): Sharing the same attachment as the Pectoralis Major fibres on the upper arm (humerous), it follows the Pectoralis Major fibres down to the 5th and 6th ribs (noting Pectoralis Minor also connects to the 5th rib, thus linking with the Front Arm Lines). From here it continues down the Abdominals either side of the Linea Alba (linking with the External Oblique), until it reaches the pubic bone and pubic symphysis where it crosses to the opposite leg and follows the Adductor Longus and attaches to the back of the femur.
The Ipsilateral Functional Line (IFL): Sharing the same attachment site as the Latissimus Dorsi (alike the BFL above), it travels down the side of the body (not following the body of the Latissimus Dorsi muscle) where it connects to the lower 3 ribs and the same portion of the External Oblique as the Lateral Line. Continuing down the External Oblique, the IFL meets the pelvis (iliac crest), moving over the Anterior Superior Iliac Spine (ASIS – boney portion of the pelvis in front of the hip) and down the Sartorius muscle to the inner knee where it meets the tibia at the knee.

Overall, the Functional Lines aid movement or postures which require contralateral movement , examples include javelin, bowlers in cricket and baseball, shotput, tennis serve and backhand, and some swimming movements such as front crawl and back stroke, the Functional Lines help to stabilise and balance the body when using opposing arms and legs, and furthermore, produce more power in such movement. Regarding day-to-day life, the best example is walking where the Functional Lines help stabilise the body from shoulder to the opposite hip and knee.

7. THE DEEP FRONT LINE (DFL) PICTURE

Closely related to the Lateral Lines, Superficial Front and Back Lines, Spiral Lines and Functional Lines, the DFL focuses on deep integral support in both posture and movement. Due to this relationship with the other Anatomy Trains, it can not only directly impact them and augment compensatory patterns, but it can also provide further investment to compensatory patterns held in the other Anatomy Trains.

Starting at the plantar aspect of the toes and feet, it continues up the leg via the inner ankle to the deep tissue at the tibia and somewhat fibula, reaching the back of the knee at the popliteus and then moves inwards to meet the femur at the inner knee.

It then splits into two sections:

One portion moves up the Adductor Magnus and Minimus towards the ischial ramus (seat bone) where it then travels to the coccyx and up the front of the sacral spine where it meets the lumbar spine.
The other portion stays close to the inside of the femur although links with Adductor Brevis and Longus, and meets the top of the femur as it turns to form the hip bone, then passing through the pelvis linking with the Iliopsoas (Iliacus and Psoas group) and continues up to the lumbar spine to meet the first portion.

From the front of the lumbar spine, it splits into three sections:

One portion moves up the Anterior Longitudinal Ligament (attaches to the front of each vertebrae) until it meets the Basilar portion of the Occiputs.
A second portion moves up the spine to the diaphragm where it then moves forward linking with the Central Tendon and Parietal Pleura, and then continues up the front of the neck linking with Scalenes and Pharyngeal Raphe.

PICTURE OF SBL ANATOMY TRAINS

A third portion moves forward to the front of the diaphragm and up to the Xiphoid Process (bottom portion of the Sternum aka breastbone/plate) and continues up to the back of the Manibrium (top portion of the Sternum). From here, it passes close to the throat as it continues up the neck to the hyoid bone which provides integral support for the tongue, finishing at the front of the lower jaw (Mandible).

As the DFL can be found deep within the body, it is more associated with slow-twitch fibres which specialise in stamina/endurance. The DFL has specific functions such as supporting the main arch of the foot (medial longitudinal arch), stability throughout the leg including hip, supports the lumbar spine (lower back) from the front of the body, supports and helps shape the abdominal and pelvic area including gut, stabilizes the chest during breathing and lastly, provides integral support for the neck and head.

So now you’ve got a basic understanding of Anatomy Trains, here is a picture of all 7 Anatomy Trains together:

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