Ep 112 – The Devil is in the Details, The Trapezius: “The Rebel MT” with Allison Denney

0:00:00.0 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.

0:00:25.8 Speaker 2: Anatomy Trains is happy to announce our return to the dissection lab in person, January 10th to the 14th, 2022 at the laboratory of Anatomical Enlightenment in Boulder, Colorado. We are thrilled to be back in the lab with Anatomy Trains' 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 info@anatomytrains.com, if you'd like to join us in the lab.

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0:01:08.9 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.

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0:01:55.4 AD: It's not that anyone is better at doing something than anyone else, it's more that some people have figured out some tricks to get them ahead of the game. Sure there are those who have natural talents and serious commitment coupled with natural talent is usually the one-two punch that launches a person into the ether. But most of us are pretty good at a couple of things, or kind of good at a lot of things, and finding that key to success feels clouded by confusion. This is not a failure only happens to those who quit lecture. This is an exploration of how being detailed and then digging for more details and then extracting details about those details can be the thing that separates you from the pack. This is about how taking your time to be in the moment will never let you down.

0:02:44.8 AD: This is about how you as a massage therapist, your client, with the heavy tension of life and a muscle with its many parts, fibers and moving elements can reap the benefits of an intricate approach. They say the devil is in the details. It's an expression that has come to symbolize how annoying getting through the particulars of a matter can be. Interestingly enough, the original phrase is, God is in the details, which was meant to mean that whatever one does should be done thoroughly bringing one closer to God. I should point out, this is also something I have spent my entire life avoiding. I was the kid in school that would do the absolute minimum to get away with a passing grade. This was my approach at my first job as a waitress, where I wanted the least busy sections, so I could be the first to go home at the end of a shift. And when I first lived in my own apartment, laundry was on a strictly as needed basis, bare minimum.

0:03:43.5 AD: The recognition that doing anything slightly above and beyond might be something I should consider only came to me later in life when I began to see that there were beautiful things in the world, and I started to feel curious about how anyone could produce them. My first experience with this was in an art class I took in college, it wasn't a photo of a famous painting introduced to me in a lecture as you might think. It was the experience of sitting next to a particularly talented classmate who seemed to be able to paint really beautiful pieces of art. I got to see her work from beginning to final product and learn something very important, she took her time and paid attention to the details. My poor mother, she spent her whole life trying to teach me about the life lessons art can reveal, and here it took some random college student to open my eyes.

0:04:34.5 AD: What I did learn, though, from the wisdom of my art historian mother, is that when we look at any great work of art, there is always a captivating story behind it. Take for example, Michelangelo's David, a sculpture of a man who took down a giant with a sling, this massive marble marvel stands 17 feet tall and took the artist over two years to complete. But the curious tale of how he brought David to life is more fascinating than the art itself. An anonymous stream, the detail of David stance, proportions, blood vessels and muscular and bony structure are what make us stop and stare. Up until this point, dissecting a cadaver to explore what was under the skin was prohibited by law.

0:05:18.3 AD: It had been done by other greats, including Leonardo da Vinci, but it was not a class taught at a local college. Access to corpses was hard to come by. Michelangelo though was young and innovative, he proposed to deal with a local church offering a crafted wood crucifix that was to be placed above their altar, Michelangelo in turn was given access to certain rooms where he could dissect the cadavers to study anatomy. From there figuring out how to sculpt the human form came from a deeper, more educated perspective. I'm not suggesting that we all go cadaver diving or break the law or make deals with churches to get a better idea of how to do bodywork, but I'm suggesting that thinking outside of the box and taking that extra step to gain a new approach is the devil or the God worth detailing.

0:06:11.1 AD: Let's take a closer look at the trapezius muscle, better known as the traps, this particular muscle group has a lot more to it than most people think. Before going to massage school, I like many others thought the traps were the big grip of muscle in the undefined shoulder neck-ish region, I affectionately like to call the sheck. They were the thing I wanted to grab on myself if I felt like my neck was tight or I had a headache. And they were the thing I wanted to grab on someone else when attempting to massage a friend, before having any clue what I was really doing. They are though, as you probably already know, much more than the meat of the sheck that makes the rock look like a threatened cobra. Spending most of the way down the spine, the origin reads like a highly technical instruction manual. The insertion meanwhile shoots out to the shoulder at a neat and tidy point that is a lot easier to navigate. Which means if you think about it, we are looking at a sideways hand-held paper fan, and similar to the fan, there are long sections of it that give the traps the ability to do a multitude of actions.

0:07:14.5 AD: But unlike the fan, it is capable of so much more than just opening and closing. Let's dissect that instruction manual for a moment. The list of bony landmarks is impressive, starting with the external occipital protuberance of the skull, the traps extend down from there to grab onto the medial portion of the superior nuchal line of the occiput, the ligamentum nuchae, and then the spinous processes of each vertebra from C7-T12. No wonder we all just think of the traps as being up there in the sheck. This is way too overwhelming to comprehend, but in simpler terms, what we are really talking about is the bump on the back of your head at the base of your skull, the band of connective tissue down the back of your neck, that is really only there to help muscles like the traps attach on to something. More on this in a minute, because side note, there are so many muscles clamouring for something to hold on to back there, and then each of the bumps on the spine that stick out posteriorly, all the way down to where the rib stop.

0:08:16.1 AD: Let's pause on that ligamentum nuchae for a moment. For some reason, anatomers have clung on to the Latin version of this piece of human tissue. In plain English, it's named the nuchal ligament, and in even plainer English, it's a ligament, or a tendon, pending on how you look at it. So when we think about a ligament, we know it to be a piece of connective tissue that attaches bone to bone. And ligaments are almost always named for the bones they are connecting, like, how the acromioclavicular ligament attaches the acromion process to the clavicle. But what is a nuchae or a nuchal, or whatever you wanna call it? Nuchal is defined as pertaining to the nape of the neck, or the spinal cord. Coming from Latin roots, circa 1400, nucha refers to the spinal cord.

0:09:04.3 AD: This ligament doesn't really attach to the spinal cord, it attaches to the skull and the bumps on the spine that are in the neck and protrude out most posteriorly. So, it's a ligament because it attaches all these bones to each other, but it is also a tendon because it serves as an attachment point for muscles that are having a hard time squeezing their way down to the spine, kind of like all the gadgets we are trying to plug in to an average outlet. There are so many muscles back there that are needing to attach onto something. So the body in all its awesomeness created this extra extension, kind of like a biological surge protector, so that no one back there needs to worry, hence the nuchal ligament. Cool, right?

0:09:47.7 AD: Okay, onto the insertion. With a sigh of relief, the traps come out and insert onto the clavicle and the scapula. More specifically, they hit the spine of the scapula, that part of the scapula that looks like a little shelf for your doll's tea set. The chromium process, the end of the shelf that sticks out at the top of the shoulder and the lateral third of the clavicle. So the part of your collar bone that is reaching out to meet that shelf extension. These are much easier to comprehend and fun fact, these are the exact same attachment sites as the origin of the deltoid muscle. Who says siblings can't share? What the traps do is a whole other discussion. Because they are so broad, we think about them in three parts, kind of like a day has three parts, the morning, midday, and the evening.

0:10:37.5 AD: First there are the upper traps, or the morning part of the day. This, as you may remember from a couple of hours ago, is when we get up and get out of bed. So, to follow the analogy, the traps lift up the shoulder, tilt the head to the side, look up and around and make us wonder what the day holds. Then there are the middle traps represented here by the middle part of the day, where we push and pull our way through the daily grind. [0:11:01.8] ____ of clients, the responding to emails, the dishes, the dishes, the middle trap stabilize us and keep us focused and on task. And last, there are the lower traps. These bring us back down in the evening, forcing our shoulders to drop away from our ears and let go of the last bits of the day we might be holding on to.

0:11:25.3 AD: For most of us, they may have forgotten how to do this, but in an ideal world, they are doing their part and keeping their balance. So yes, there are indeed a lot of details in this vast expanse of a muscle, but if we see them for what they are, understand them for what they do, and approach them with the detail of a renaissance artist, there is so much work we can do here. What techniques work then? One of the trickiest parts about working with the traps is figuring out how to separate them from the surrounding muscles that very commonly make a lot of noise. The answer here lies in the ability to hear the sound of the traps among the cacophony of all the other tissues. Let's say for example, that the upper traps are waking up your client with an emphatic headache. Client supine, create a positional release to allow the ease of grabbing the superficial traps away from the underlying structures. For example, to focus on the right side, passively, laterally tilt the head to the side, so that the right ear is closer to the right shoulder. Then do the same with the right shoulder, passively pull it up, positioning it closer to the ear.

0:12:35.3 AD: Now you have a beautifully softened right upper trap, grab at the surface and allow the ease of the position to dictate the ease of your work. The muscle will catch on to all this ease and quiet down a bit. Or let's say that the mid-traps are wreaking havoc on your client's ability to perform all those daily tasks we so lovingly refer to as the grind. The push and pull, the back and forth, the strain to maintain the pace of all the things can settle in and make themselves at home right here. But take heed, the middle traps pull the scapula back into retraction while the often confused rhomboids lift the scapula up into elevation. Well, this is a handy piece of knowledge, with your client prone, sink into the mid-back region where these two muscles are often found competing for attention. Have your client lift their shoulders up off the table, asking them to make their shoulder blades "Kiss" is a great way to bring this action to life.

0:13:35.1 AD: Here, you can feel the mid-traps contract. Hang out here while your client holds the contraction, once they relax, stay right there and sink in a little bit deeper. This active engagement technique is quite good at separating out who does what under the mask of all that skin. The mid-traps will feel heard, or maybe like I mentioned before, your client's lower traps have forgotten how to play their part in pulling the scapula down at the end of the day. They have grown weak and tired from trying and have all, but given up the fight against the upper traps and the levator scapula. A PNF here pulls them back into the picture and opens up channels of communication with the brain. With your client prone, slide and hold their arm off the table so that it's close to their head, near the face cradle. As you pull their arm towards you, have them pull their shoulder down against your resistance towards their hip.

0:14:31.5 AD: Again, it's not that the lower traps need to engage every night to actively pull the shoulders down out of the ears, but if we wake up some neural pathways, they won't just fade away into the finale of the musical that is your client's back. The last and final detail to consider is, if your client is having an issue with any one part of this massive muscle, don't ignore the other two. The traps may have their divisions, but that doesn't mean they can't get along. With a devilish detailed approach to all three of these works of anatomical art, the masterpiece of a pain-free life is right there at your fingertips. 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 eye balls from a computer screen, drop me a line at rebelmt@abmp.com. That's R-E-B-E-L-M-T@abmp.com.

0:15:35.1 AD: I always wanna hear your questions, comments, suggestions or salutations. 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.

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0:16:03.9 AD: Tune in next time as we investigate why the pride of the pectoralis major is both a good and a bad thing, and how we as body workers can use this knowledge to our advantage.

0:16:18.9 S1: Members are loving ABMP Five-Minute Muscles and ABMP Pocket Pathology to 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 bodyworkers. 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 login 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.