Ep 296 - The Paradox of the Intercostals: “The Rebel MT” with Allison Denney

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0:01:30.8 S1: There is an age old philosophical paradox pulled from Greek mythology called The Ship of Theseus or Theseus' Paradox that raises some very interesting questions. If you don't know it, it goes like this. According to legend, Theseus was a young prince of Athens who was raised elsewhere, not knowing his status. Upon coming of age, he learned of his true identity and in an attempt to reclaim his heir to the throne, he returned to Athens, to find that King Minos was in charge. As these stories go, King Minos was paying a debt, which for some odd reason involved seven girls and seven boys being sentenced to a labyrinth that contained a half-man half-bull beast called the Minotaur. Of course, Theseus volunteered as tribute to enter the labyrinth with the kids, defeated the Minotaur and rescued the children from certain death. They then escaped onto a ship to the Greek island of Delos. Every year, the Athenians commemorated this legend by taking the ship on a pilgrimage to Delos to honor the story of Theseus. There's so much buried in this tale, the least of which is how fun it is to rattle off the names of Greek Gods and places, but the heart of this tale is not the idea of a mythical creature that is half-man half-bull. The real dirt is the paradox that arises from what happens after the defeat of the bad guy and the rescue of the children.

0:02:47.8 S1: The annual voyage to Delos took a toll on the ship of Theseus. The planks of the ship rotted over time as ships made of wood do, requiring the eventual replacement of each plank until ultimately every single plank had been swapped out for a new one. After a time the ship was constructed of completely different wood. So the question remains, if every single part of the ship of Theseus was not the original, was it still the ship of Theseus? Which begs the follow-up query, if matter remains the same and defines an identity, then what if matter changes, what then happens to identity? This ethical dilemma has perplexed humans for generations. It has shown up repeatedly through time, including the adage of George Washington's axe, which has had both the handle and the blade replaced, and in a more modern telling, like in the finale of Marvel's WandaVision, when the original version of Vision comes face-to-face with a newer copy of Vision, one asks the other if he is familiar with The Ship of Theseus' thought experiment.

0:03:54.1 S1: It is quite the question. There are those who stand on the side of the quandary arguing that a whole is more than the sum of its parts and identity exists beyond matter, and then there are those who defend the idea that the parts are what define the identity. So the answer, if there is one, is still lost in the Cosmos somewhere. Point being, how do we find the answer to this ancient question and how the heck does this relate to anatomy? Allow me to dive in.

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0:04:26.8 S1: Whether or not you know the tales of Greek mythology, you are most likely familiar with the idea that the human body replaces itself every seven years by the lifespan and regeneration of cells. You can see how this question of parts and identity really gets thrown for a loop when you combine this with Theseus' Paradox. Well, let me first calm any potential anxiety and tell you that it is not so simple as that. Well, it is true that the average age of all cells in the body is about 7-10 years. Individual cells can have a life span and anywhere from three days like the cells and your colon to 70 years like the cells in your muscles and fat. And even if you are worried, if you will have an identity crisis when you hit 70, your DNA has your back. What the ancient Greeks and honored philosophers didn't quite understand yet, was that the DNA that gives life to each new cell and the trillions of cells that are bubbling in your body is the same DNA from birth to death.

0:05:23.9 S1: This may help ease the frauded plight of who am I really. But I still love the question. So much so, that I wanna take another spin on it, only this time instead of looking at the life of a cell and the idea that our parts are in constant flux, I wanna focus on the planks, the planks that are used to build a ship create a beautiful visual of arched and angled repeating patterns necessary for stability, holding inside what needs to stay safe. The planks of Theseus' ship, lean into the push and pull of a tireless ocean, very much like if I may be so bold, the intercostal muscles of our torso. Stay with me here. You may be familiar with the intercostals as the muscles between the ribs, and with good reason, very simply put, inter means in between and costal means relating to the ribs. You may also know them less formally as the meat that comes on a rack of ribs and pairs well with a big potato. Either way, when you look at these muscles, you can see a pattern, rib, muscle, rib, muscle, rib, muscle, repeat until you have a full rib cage similar to, shall we say, a plank of wood, some sealant, a plank of wood, some sealant. You get the idea. These pairings of muscle and rib or wood and sealant merge together to form a structure that protects the very delicate insides.

0:06:43.1 S1: For the ship of Theseus, it was the children escaping from a monster. For the human body, it is our vitally important heart and lungs. In both scenarios, their construction is key to their ability to bend and move under force and pressure. Side note, the internal frame of a wooden boat is actually called the ribs and the planks are called the skin, but the frame and the planks in reality are built to intersect each other, not live parallel to each other. But hello, I'm betting, I'm not the only one seeing the symbology here. Back to the intercostals. To make things a little more complicated because it's what humans do, there are two sets of intercostal muscles, internal and external. And I'll give you one guess as to which one lives where. They are in actuality, very difficult to discern when it comes to palpation and bodywork, but their job is to find them more than their relationships to each other. They both play a role in respiration, where the external intercostals are responsible for inhalation, the internal intercostals are responsible for exhalation.

0:07:47.9 S1: I know. It would be much easier to remember if internal was associated with inhalation and external was associated with exhalation. Some would even describe this as paradoxical anatomy, like Greek mythology likes to make you think. But here is a thought that might help. The two sets of muscles have general and similar sets of origins and insertions being the rib above and the rib below, but their fibers are oblique, meaning at an angle, and they're layered at a right angle to each other, the external fibers are oriented downward and forward while the internal fibers are oriented upward and backward. And while they are thin and difficult to discern from each other in palpation, know this, the external intercostals reach downward and pull the ribs up and back during inhalation. Picture a can-can dancer who lifts her skirt to kick high in the air and the internal intercostals reach upward and pull the ribs down during exhalation. Picture a soccer player pulling off their jersey after scoring a goal. All of them, as we take a deep breath, work together to nurture and protect that which is inside.

0:08:55.0 S1: So in the same way that the planks of a ship become weakened with age and with the forces of the ocean, the intercostals and all tissue for that matter, tire with the pressures of life. And although we have done amazing things with prosthetics and bionics, we have not quite figured out how yet to replace old muscle with new ones. In the meantime, there's massage therapy. When it comes to working with the intercostal muscles, it's important to note that they are mostly buried under other muscles that are on and around the ribcage. Getting to them involves a lot more nuance than it takes to roll an elbow over a hamstring, turns out they lie most superficially just anterior and medial to the lats and inferior to the pec major. In other words, if you grasp the corniced edge of your ribs as they arc down and away from the bottom point of your sternum, and then slide out on to the ribs, or more technically speaking, the convergence of the costal cartilages 6 through 10, this is the most access you will have to these muscles.

0:09:53.5 S1: This doesn't mean you can't affect them from working through the lats on the side or through the lower traps in the back, but deeper muscles involve deeper work, and sometimes that's not easy. Start where you can get to know them well, and once you've got a strong sense of how they feel with your client, influencing the more lateral and posterior intercostal fibers that hide under the depths will start to feel less confusing. As always, I wanna push the idea of working on muscles with your client in different positions, because variety is not only the spice of life, but it is also the key ingredient to detailed bodywork. But for the intercostals, I recommend starting with your client side lying. This gives your client the ability to move their arm around and even twist their torso a bit, and it gives you the ability to feel ribs expand, collapse and slide around.

0:10:43.1 S1: Start by palpating the ribs, slide your finger tips in between them and don't do anything. Instead, ask your client to do the following, First, have them raise their arm up so that it's next to their ear and relax into gravity. This initial movement should open up each intercostal space and allow you to feel the intercostal muscles with more detail, then have them take a deep breath in and then of course out. Because the intercostal are muscles of respiration, you should be able to feel the shift that happens with their call to action.

0:11:15.4 S1: It is very subtle though. Don't get frustrated if you only feel the ribs moving but nothing in the muscle tissue. Just remember that they are lifting the ribs up and then pulling them down, so what you should feel here is more of a tension and less of the big contraction you might be used to with other muscles. From here, stay anchored into the intercostals and have your client play around with the movement of their arm, have them extend their arm up to the wall, nearest the face cradle, have them bring their arm in front of them, keeping their elbow extended, and then swing their arm back, allowing their torso to rotate, and then have them lift their arm toward the ceiling and reach up as if they were trying to touch it. Obviously, these are all shoulder movements, but the shoulder doesn't act in isolation, the rib cage will move with it, and the combined efforts of the intercostals to allow movement and stabilize at the same time is an engineering feat.

0:12:07.6 S1: From here, the work is your own. Remember that these are thin muscles with a lot of connected tissue, keeping them connected to the ribs and to each other, so use techniques that cater to these types of tissues, a little friction, a little myofascial release, and a lot of finesse. Most importantly, remember what these planks are keeping safe from the outside world. Asking your client to breathe consciously as you work acknowledges the precious cargo inside. It is all well and good to take care of things from the outside, but if your clients aren't working internally as well, we are only reaching half of the whole picture.

0:12:43.2 S1: So maybe the intercostals aren't exactly parallel to the planks of wood on the ship of Theseus, and maybe the original planks would have lasted longer with a regular massage using the right wood oils. But maybe the question of parts and identity is the wrong question. Perhaps the better question is one of beliefs and truth. Perhaps the deeper truth or the DNA of the ship of Theseus is in the original creation of the ship, and the hopes and dreams that went into its construction. Perhaps the truth of the things we build, a ship, a house, a career, lies less in the parts and more in the belief of the thing. It is our beliefs after all that can survive the worst storms.

0:13:28.3 S1: 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 rebelmt@abmp.com, that's R-E-B-E-L M-T at abmp.com. 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.

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