The world, and anatomy, is a lot easier to understand when we talk about it in organized categories. But, sometimes, thinking outside the box is a much better approach. In this episode, Allison explores the identity crisis of the gluteus medius and how to ease the grip of confusion for this multifaceted middle muscle.
Allison’s column in Massage & Bodywork magazine:
“Buddha’s Six-Pack: Serratus and Intercostals, with a Diaphragm Chaser,” by Allison Denney, Massage & Bodywork magazine, May/June 2021, page 86, www.massageandbodyworkdigital.com/i/1358392-may-june-2021/88.
“The Muscle, the Beast, and a Cup of Tea: Conquering Sternocleidomastoid Fears,” by Allison Denney, Massage & Bodywork magazine, March/April 2021, page 80, www.massageandbodyworkdigital.com/i/1338685-march-april-2021/82.
This podcast sponsored by:
Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.
At Structural Elements, we view ourselves as Body Engineers. We evaluate the human body according to its structural integrity and establish proper balance between compression and tension elements. Through identifying patterns in the body, we are able to locate areas of compensation to treat the cause of the imbalance, not the site of pain. Our patients achieve lasting results as we reduce structural imbalances, improve connective tissue health, and reeducate movement patterns. Now, we have taken our education, operations, and communications infrastructure from our franchise company and made it available to the industry through (se) Connect.
(se) Connect is the only interdisciplinary knowledge sharing platform that exists in the wellness industry. Participants gain access to treatment tools, business tools, and the ability to connect with other professionals in a variety of modalities. Through our community, massage therapists, physical therapists, chiropractors, athletic trainers, acupuncturists, and others all learn to look at the body through the same lens, which allows for rich discussions on patient care and treatment options. Our training staff brings decades of experience in massage, manual therapy, acupuncture, chiropractic, and business, and we look forward to sharing that with you.
0:00:00.2 Speaker 1: With se Connect, you can learn a 15-minute comprehensive manual therapy treatment that will set you apart from other massage therapists. Se Connect is the only multi-disciplinary platform with practice tools, business tools, and a community of practitioners speaking the same language. Check it out at network.structuralelements.com.
0:00:27.0 Speaker 2: Anatomy Trains is happy to announce our return to the dissection lab in person. January 10th to the 14th, 2022 at the Laboratories of Anatomical Enlightenment in Boulder, Colorado. We are thrilled to be back in the lab with anatomy trained author Tom Myers, and master dissector Todd Garcia. Join students from around the world and from all types of manual movement and fitness professions to explore the real human form, not the images you get from books. This is an exclusive invitation, email email@example.com, if you'd like to join us in the lab.
0:01:08.8 Allison Denney: Hi, my name is Allison Denney, and this is The Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow. But the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peak at what's under the surface.
0:01:55.8 AD: There are two types of people in this world. Those who like Instagram and those who like Facebook. Or is it those who like Androids, and those who like Apple? Or is it coffee and tea? Or cats and dogs? Early bird and night owl? Sometimes I think there are so many categories that I forget which ones I fall into. And if I take one of those personality tests, I get entirely different results depending on the day, the week, the month, and of course, which planets are aligning. In other words, it's not always clear who I am. I'm not always sure what box I belong to. And I wouldn't want it any other way.
0:02:36.6 AD: For years, I wanted to figure out my category. It feels good to look at life like an organised shelf. It takes away the overwhelming confusion of self-definition or the definition of anyone else for that matter. Kind of like how looking at apartments to rent or houses to buy seems so appealing, not because I need a new place to live, but because everything always looks so clean and tidy in the pictures. Forever I wanted to live in any of those other houses, 'cause mine was a mess. The world seems to be easier when we talk about it in crisp, clean sections. I wanted to fit into one of those categories on that shelf.
0:03:16.5 AD: For a while in my youth, I was really selective about what shelf I wanted to live on. My young brain could only conceive of happiness existing in a choice few shelves. If I was in one or two of those, then I would be happy. As I grew and matured a bit, my one or two shelves grew to about three or four. I started to see why a certain category that I had snubbed my nose to in the past was actually upon further inspection, pretty cool, and I wouldn't have minded belonging there. And then with even more maturity, I kept adding shelves. Shelves that I not only would have been okay with belonging to, but that actually looked super appealing with my new woke sense of perspective.
0:03:58.5 AD: So much so, in fact, that the partitions between the shelves began to blur. The lines between the categories muddied. The overlaps of who fit where and what part of me was who became confusing. This was distressing as you can imagine, but then something magical happened. I started to see the world around me as green binary code and suddenly I could actually bend the reality of the matrix. No... I'm kidding... I'm not, Neo. But I did start to perceive how not categorising myself was actually something that might be beneficial. How living undefined could be freeing. And it was pretty cool. Not dodging bullets cool, but I gained a new sense of happiness and the inner peace that I bet even Neo would be jealous of.
0:04:47.4 AD: So when we look at human anatomy, how can we apply this mindset? Here is what I think. When we sit in our first Anatomy class in school, all we are taught is categories. First there are the levels of organisation... Cells, tissues, organs, etcetera. And then there are sub-categories of each of those... Long bones, cardiac tissue, afferent and efferent paths, etcetera. And then it gets even more assorted, sympathetic and parasympathetic, hyaline and elastic cartilage, etcetera.
0:05:20.3 AD: Granted, all of these neat packages really help the learning process. Being able to fit something in a box helps us to identify it and relate to it. For example, if we look at muscle tissue, the first thing we learn is that there are three types, striated, smooth and cardiac. The striated muscles, also known as skeletal muscles, are the ones that attach to bones. The smooth muscle, also known as involuntary muscles, are the ones that help your internal organs do stuff. And the cardiac muscle, also known as cardiac muscle is... Well, the heart. This really simplifies things. Nice, organised shelves. But do we think that the human body is really that simple? How can it be? This is the same human body that can freeze up and feel pain when the experts are insisting there's nothing wrong. And this is the same human body that can hike a mountain after being told it will never walk again. Also, this is the same human body that keeps unveiling its secrets and completely shifting how we understand the way we work all the time.
0:06:28.6 AD: Muscles, all of them in each category, very often straddle classification boundaries. The diaphragm, a striated muscle, can be thought of as both voluntary and involuntary. The stomach, a smooth muscle, can be held responsible for some diseases of the heart. And the heart well, it may not move our skeleton, but it certainly has moved us to do unthinkable and unimaginable things. Let's look for example at just one of those skeleton muscles. The gluteus medius. This is one of my favorite muscles. Known as the deltoid of the hip joint, this lateral hip muscle mimics the deltoid, in that it wraps around a ball and socket joint and pulls that joint into conflicting movements.
0:07:15.4 AD: If we look at the deltoid, it looks like a big upside down tear drop that has just been in a fight with a ninja and didn't fare so well. The glute medius is the same, just dropped down from the shoulder and applied to the hip. With many layers and a wide girth, this lateral hip muscle moves the hip joint into all but one of its possible actions. So the anterior fibers pull the hip into flexion and internal rotation, like if you were to sit in a chair and cross your legs. The posterior fibers pull the hip into extension and lateral rotation, like if you were to stand up and decide to walk like a duck. And the middle fibers, the ones in the middle, of course, pull the leg into abduction, like the beginning of a jumping jack that you were doing because sitting and then standing and then walking like a duck is indeed something to celebrate.
0:08:04.4 AD: The glute medius is one of the three glute muscles sandwiched between the maximus and the minimus. The maximus is the most well-known and is used to hogging the spotlight. The minimus is like the forgotten youngest sibling and who wants to make a loud noise every once in a while just to be heard. And the medius lies just in the middle, offering support to both its brethren and just doing its best to support the hip whenever it can. The origin of this noteworthy middle child lies on the gluteal surface of the ilium between the posterior and anterior gluteal lines just below the iliac crest. And can I just take a moment to talk about how nonsensical this is? I mean, it lies on the back part of the hip bone. And yes, the hip bone is divided into three sections. The ilium up on top, the ischium below and the pubis in the center, but the quote, unquote, "posterior and anterior gluteal lines" really throw an anatomist off. Both of those lines are on the back side or posterior aspect of the ilium.
0:09:10.3 AD: But because the ilium curves around to the front, like a big wing span about to hug you, the so-called anterior line is technically on the back part of the hip that wraps around to the front, kind of. It is so confusing, in fact, that if you search for the origin of the glute medius online, you will find many, many varying results. I found one site that just plainly stated the lateral hip as its origin, and I don't blame it. All you need to know here is that the glute medius is stuck to the back part of your hip bone that you can see if you were standing sideways. The back part of this muscle wraps around to the back and tucks under the glute max a bit. The front part wraps around to the front, a bit. The insertion, like I mentioned before, it's like a slashed up upside down tear drop. So all of these slashes or fibers, if you wanna get technical, converge down onto the femur at the big bump at the top, called the greater trochanter. Side note, I love this word because I love riding horses, and it always makes me think of cantering.
0:10:15.6 AD: The trick here is to understand that where a muscle latches itself onto the greater trochanter is going to dictate what that muscle does to the hip. If it grabs onto the front, it's going to pull the femur forward. If it grabs onto the back, it's going to pull the femur back. And if it grabs under the middle, it's going to pull the femur up and away from the other femur, pulling you into those jumping jacks, you're still doing because you love ducks so much. So we have this funny muscle that mimics the deltoid, is the middle child of three, and pulls the hip into so many different directions that it opposes itself. There is no doubt that this is a classic case of an identity crisis.
0:10:57.9 AD: So how do we handle a muscle who doesn't know who it is. The same way we handle anyone who is still trying to figure out who they are in this crazy world. Ease them into the idea that possibly not fitting into a box is a good thing and take it one day at a time. What techniques work then? I always like to start any glute medius work with my client on their side, affected hip up off the table. This gives me access to the entirety of the muscle while allowing space for my client to move his or her leg in whatever direction I need it to go.
0:11:32.6 AD: For the purposes of this verbal account of a hands-on demo, let's say we are working with the client's right hip. With their left leg extended straight and their right leg slightly bent towards their chest, place a bolster under their right knee, ensuring the neutrality of the joint itself. Just to be clear, if you leave the client's leg un-bolstered, the knee drops down to the table into a deduction. The one action the glute medius does not do, which would lengthen the middle and posterior fibers. We wanna start from a nice neutral position. Begin by locating the muscle itself, palpate the iliac crest and the greater trochanter. Drop in between those two points.
0:12:13.1 AD: And if you are in the lateral most aspect of the hip you are on the glute medius. Then start the work by slowly sinking in and working from posterior to anterior, and then again from anterior to posterior, across the belly of the muscle. The fibers happen to be running from superior to inferior, which means you are crossing perpendicularly over them. From this initial contact, you can begin to feel where the tension lies and check in with your client about anything they might be feeling as you work your way through the muscle. Once you have agreed on which aspect of the glute medius is creating a dysfunction, you can then decide what techniques might best apply.
0:12:54.0 AD: Maybe it's the posterior fibers and a pin and stretch would do the trick. Have your client extend their right leg, sink into the posterior fibers and then have them bring their knee to their chest, stretching out this aspect of the muscle. Or maybe the anterior fibers are tense and not letting go. Keeping the hip flexed and the anterior fibers softened, ask your client to gently kick their knee out straight, sink into the anterior fibers and have your client point their knee towards the floor, then up towards the ceiling, then back down towards the floor again.
0:13:30.1 AD: This engages the front of the glute medius while your pressure breaks up any stuck tissue around it. My favourite trick though, is based on what the glute medius does that is not written in our anatomy box... Holding that ball and socket joint in place. Most of us stand when we are standing around talking or waiting or just not wanting to sit with our weight shifted onto one leg and the other leg resting in a slack pose, not doing any of the work. That's all fine and good, except for the fact that we are taking all of our weight and giving it to one hip. And we do this pretty consistently over a long period of time, because habits are habits, you know.
0:14:11.8 AD: So the leg that is holding all of you up, that hip is working extra hard to remain stable. The glute medius located right there on the outside of that hip is struggling to hold that ball into that socket. And just like an elementary school teacher holding on to his patience, it's gonna get tired. And when it gets tired, it gets grumpy. Technically speaking, the glute medius is exhibiting an isometric contraction to steady the hip. And it is being held in a slightly elongated position to keep us balanced. And on top of it all it is not even fulfilling its purpose, the sitting or the standing or the duck walk or the jumping jacks.
0:14:54.0 AD: It is quite literally being thrown a curve ball when it already has this internal confusion of who it is. Talk about throwing salt on a wound. Try this... With your client, prone, sink into the affected glute medius and ask your client to completely let go of their glute max, their hamstrings, quads, kneecaps, calves and toes. Have them breathe into their low back, release their abdominals and let them feel the unwinding of a tension they didn't even know they had. The glute medius will start to understand how hard it has been working to fit in, and the grip of confusion will slowly begin to let go.
0:15:38.4 AD: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately into my brain via my eyeballs from a computer screen, drop me a line at firstname.lastname@example.org. That's R-E-B-E-L-M-T@abmp.com. I always wanna hear your questions, comments, suggestions or salutation. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on. Like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other Rebel Massage dabblings. I'm impressed you've made it all the way to the end, but because you have allow me to offer a glimpse into our next episode. Tune in next time as we ponder the bedeviled details of the trapezius muscle, the beauty of the nuchal ligament and the bravery of Michelangelo.
0:16:43.0 S1: Members are loving ABMP Five-Minute Muscles and ABMP Pocket Pathology, two quick reference web apps included with ABMP membership. ABMP Five-Minute Muscles delivers muscle-specific palpation and technique videos plus origins, insertions and actions for the 83 muscles most commonly addressed by body workers. ABMP Pocket Pathology created in conjunction with Ruth Werner, puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today. ABMP members log in at abmp.com and look for the links in the featured benefits section of your member home page. Not a member? Learn about these exciting member benefits at abmp.com/more.