Issue link: https://www.massageandbodyworkdigital.com/i/81195
5 to fingernails; and the DFAL is the leading edge from the pectoralis minor out to your thumb. The final and most problematic (from our point of view) line is the DBAL, the trailing edge of the wing from your levator and rhomboids through your rotator cuff on out through the triceps and point of the elbow to your little finger (Image 4, page 97). These lines are minutely detailed in Anatomy Trains (Elsevier, 2009), but here and now, this will have to suffice on the anatomy. In terms of function, the SBAL holds the arm aloft and fixes it in position and the SFAL directs the hand and fingers, while the two deep lines provide stability and refinement in aiming the hand at whatever we are working with. SHOULDER POSITIONING If you are working with a musician, jeweler, draftsman, or ping-pong player, the details of the forearms and hands are relevant, but here we will concentrate on the positioning of the shoulder. Even with that limit, we encounter sufficient complexity. The postural position of the shoulder rests largely with the scapula. With some exceptions, the clavicle and humerus have to follow the scapula's lead. The scapula itself is a roundhouse of muscular pulls all competing to dictate its position (Image 5). Please do not talk to me of a "scapulo-thoracic" joint— there is none. The scapula floats in a sea of elastic guy-wires that can be tense or relaxed, concentrically or eccentrically loaded, competing and restricting or ready to accommodate. Although I personally shrink from defining good versus bad for a scapular resting place (it depends on the shape of the back, the head, occupation, and a few other factors), many would argue that good positioning involves: • the vertebral border of the scapula lying vertically along a line above the angle of the ribs, and • the scapula hanging vertically when viewed from the side, with the proviso that the rib cage must also be vertical. In the all- too-common case of the rib cage being posteriorly tilted, then the scapula that is vertical to the gravity line would actually be anteriorly tilted relative to the rib cage (Images 6A and 6B). Common displacements include a very common (but often rib-cage centered) tilt of the shoulder girdle as a whole, or the scapula can be: • too wide or too narrow (laterally or medially shifted); • held up or too far down (superiorly or inferiorly shifted, though the latter is rare); • wider apart at the bottom than the top or (again, more rare) wider at the top than the bottom (laterally or medially tilted in our language, but upward or downward rotation in physiotherapy-speak); • held forward or pinned back (anteriorly or posteriorly shifted); or • anteriorly or (very rare) posteriorly tilted. The commonly used protraction and retraction are insufficiently exact to lead to coherent strategies for correcting shoulder position. The exact nature of the terms outlined above— tilt, shift, and rotation applied to each of the clavicle, scapula, and humerus— provides a shorter road to the most efficient treatment plan. Protraction may involve different levels of lateral shift, medial rotation, and anterior tilt, not to mention anterior, posterior, or superior shift relative to the rib cage. THE SCAPULAR X The scapula is a roundhouse in Anatomy Trains-speak, meaning that many muscles compete in setting its position. There are muscles going in nearly every direction from the triangle of the shoulder blade. Four of these, however, are key to setting its position. The scapula has many muscles attaching to it—and thus its position rests with the balance of these guy-wires: the rotator cuff, deltoid, teres major, triceps, biceps, and coracobrachialis attach it to the humerus; the serratus anterior and pectoralis minor attach it to the ribs; and trapezius, rhomboids, and levator scapulae attach it to the spine and head. We can safely ignore the omohyoid in terms of scapular position. 100 massage & bodywork march/april 2012