Hidden in the shadows, the serratus posterior superior and inferior are, what I like to call, our anatomical parentheses. Subtle, nuanced, and often ignored, finding where they are and what they feel like is crucial to the work we do. In this episode of The Rebel MT, I underscore pushing our awareness beyond what we’ve been taught and to see what anatomy is trying to tell us.
Rebel Massage Therapist: http://www.rebelmassage.com
Rebel Massage Therapist:
My name is Allison. And I am not your typical massage therapist. After 20 years of experience and thousands of clients, I have learned that massage therapy is SO MUCH more than a relaxing experience at a spa. I see soft tissue as more than merely a physical element but a deeply complex, neurologically driven part of who you are. I use this knowledge to work WITH you—not ON you—to create change that works. This is the basis of my approach. As a massage therapist, I have worked in almost every capacity, including massage clinics, physical therapy clinics, chiropractor offices, spas, private practice, and teaching. I have learned incredible techniques and strategies from each of my experiences. In my 20 years as a massage therapist, I have never stopped growing. I currently have a private practice based out of Long Beach, California, where I also teach continuing education classes and occasionally work on my kids. If they’re good.
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0:00:48.0 Speaker 2: The curious thing about muscles is that we don't see them as they are. We see them as we have studied them to be. We see them as red, oddly shaped bundles of fibers that are in control of what our bones do. We have studied them to be a category of tissues in our anatomy that allows for our movement. If we wanna stand up a collective group of muscles contracts and relaxes to change our position in space from mostly bent to mostly straight, and this is actually how they work, but there is so much more to them than meets the eye. If we look at the major muscle groups that we first begin to study in school, they exemplify a powerhouse of basic principles, like having an origin and insertion and an action. For example, the rhomboid muscles have an origin at the spinous processes of C7 to T5, and they have an insertion at the medial border of the scapula from just above where the spine of the scapula lives, down to the inferior angle and they have an action. The myosin and actin within the rhomboid muscles create a contraction and the rhomboids pull the insertion point back toward the spine, creating their primary action, retraction of the scapula.
0:01:53.9 Speaker 2: These basic principles allow our brains to relate to their location and function so that we can start to assimilate this new knowledge and apply it to the work we do. In other words, now we can talk about these red upper back, rectangular-shaped clumps in much clearer terms, and with that, we can begin to hone our craft. And this is awesome because when we have a serious knot in our own rhomboids, now we can totally understand it and we can really relate to our clients and help them move through their rhomboid issue because we have the same knot and have completely figured it out, but it's not that simple. It never is. Is it? The rhomboids actually live in and among a bunch of other muscles that are pushing and pulling on all of those bony parts, and who is to say what is really happening in the dark under all that skin? When we have a client who despite all the work we do in their rhomboids, doesn't seem to be getting relief, we get frustrated or dismayed or insecure. That stubborn knot just keeps rearing its ugly head.
0:02:53.4 S2: I could at this point get on a pedestal about how to build our confidence in our work, or how important it is to remember that releasing tension takes cooperation and self-care from the client in order for our work to actually stick, but I'm not. The soapbox I wanna stand on for this episode is that the ability to see things as they are and not what we want to see is a skill that takes a lot of practice, and the muscles I'm going to focus on today are not the rhomboids. They are the serratus posterior superior and it's upside down mirrored reflection, the serratus posterior inferior, muscles that don't necessarily adhere to those basic principles.
0:03:39.7 S2: Looking at a muscle chart and flipping it horizontally, if we highlight these two muscle sets, they make what I like to call the parentheses of muscle anatomy by definition, and for your grammatical review, a set of parentheses is a pair of round brackets used to mark off a digression or afterthought. In other words, parentheses hold a or phrase that is not completely necessary, but adds value to the sentence or idea being delivered, so maybe the serratus posterior superior or as I will refer to as the SPS from here forward, and the serratus posterior inferior, or as I will call the SPI from now on, are not containing a muscle group that are unnecessary, but that they themselves characterize the subtle yet integral idea that muscles can exist purely to add to the wonder under our skin. They are the underscore of how we breathe, the emphasis of how we stabilize and the highlighted attention to our back pain.
0:04:37.0 S2: Let's start with the SPS. Originating at the nuchal ligament and the spinous processes of C7 to T3 and reaching out laterally and down to create that serrated edge that inserts onto ribs 2 through 5, the SPSs main job is to elevate the rib cage during forced inhalation, which doesn't really fit into the formal action list we have come to know and love, flexion, extension, rotation, etcetera. But it is no small responsibility, and with great responsibility comes a lot of trigger points. As we look a little more deeply, we might notice that there are three things right off the bat that can go wrong. One, they possibly never get to live up to their full potential. We all know there are countless clients who are not the best at getting that full deep breath in. Two, they get stuck in positions for hours on end and often don't get the relief of elongating. They are not the easiest muscles to stretch. And three, they live in the shadow of the rhomboids and therefore often get ignored or overlooked.
0:05:39.5 S2: Moving down the back, the SPI is similar to its northern relative in that it harbors both a lot of responsibility and therefore a lot of tension, but as I pointed out before, it is flipped upside down, creating that parenthetical effect. Originating at the spinous processes of T11 to L2 and reaching out and up in that same serrated way and grabbing onto ribs 9 through 12, they actually do the same job as the SPS, but by pulling down instead of lifting up. So when we take that big deep breath in, the SPI anchors the lower ribs in place, allowing for the rest of the ribs to lift up and away. The better these muscles do their thing, the more we get that sweet sweet oxygen passing into our bloodstream. As you might have guessed though, they carry the same set of issues. One, that whole, never living up to their full potential thing, and seriously, this one's a big deal. Two, they get super stuck as the lower back typically has less mobility than the upper back. And three, these guys get eclipsed by the QL. Man, the QL gets all the attention.
0:06:46.6 S2: So these two muscles have it rough. They rarely contract, they hardly ever get stretched, and they pretty much never get seen. I would be irritated too, which leads us to the work. How exactly do we know when the SPS or the SPI is the problem? Like I mentioned earlier, the rhomboid and the QL take up a lot of emotional space, and there is a lot that can go sideways with those two main players. But when nothing seems to be working, or even if it is working but something seems amiss, finding the anatomical parentheses and giving them a little love, might just be the trick. Before you even get your client on the table, start with this. Have your clients stand in a doorway and face the side that doesn't have a door in it. You may wanna try this first so that you can feel it in your own body and possibly better describe what you are wanting your client to feel. Standing about arm distance from the panel of the doorway, have your client grab the edges with their fingertips at about chest level, then have them lean back so that they are falling towards a kind of seated position.
0:07:50.6 S2: Guide them to play around with bending and straightening their knees and bringing their chest closer and farther away from the floor. You can even suggest shifting the placement of their hands up or down on the door panel to get the effect you're shooting for. Then standing behind your client, place your fingers on their SPSs to give them a tactile point of reference and have them drop their chin and breathe deeply enough so that it brings those points closer to you and further up and away from the edge of the doorway. If you can see or palpate the inferior angles of their scapula moving out laterally and swinging upwards, you know they're starting to reveal that top set of parentheses. At this point, depending on their strength, flexibility and willingness, have them wiggle and squirm their torsos a bit so that the ribs are doing some accordion tricks, and so that the SPS can begin to catch a breath. Side note, if a doorway doesn't work, you can always their hands and be their stability, this just makes it hard to get that tactile communication to them, right when they need it most.
0:08:51.9 S2: The SPIs are a little trickier to shine the light on. For these, have your client stand with their feet about hip width apart and bend at the waist, allowing their chest to drop towards their thighs. With their knees bent, have them grab their hands behind their knees and begin to pull their back up. Trying to straighten the knees helps a bit, but not necessary. Allow for whatever they can do. Similar to before, place your fingers on their SPIs so that they can envision what they are supposed to be stretching and have them take a slow, deep breath into their lower ribs up towards the ceiling and into your fingers. All of this might just be enough. Teaching your client how to stretch a muscle that quite possibly has cobwebs on it is a win, but getting them on the table and getting some blood flow going is the icing on the cake. For clients who are not as flexible or able, have them lay prone on the table and play around with bolstering and arm placement as slight distinctions can make huge differences. Then, work with slow and considerable intention into and around these muscles. Now that your client has a keen awareness of their own anatomy, being able to vocalize when they feel you roll over a trigger point might come a bit easier.
0:10:02.0 S2: For clients with a little more capacity, get them in a side lying position and bolster under their head and between their knees. Have them keep both their hips and knees bent at 90 degree angles. Standing at the top of the side of the table, begin to work down the spine, moving your feet as you go, so you don't fall on your face and have them breathe while you find your way around the SP pair. The breathing is key. Having them sip in those last bits of air creates that crucial extra space, but for an extra bonus, if your client is a willing participant, as you work from rib 1 to rib 12, have them slowly transform into the fetal position, bringing their heads to their knees and their knees to their heads while rounding out the back. The head bolster can be tricky, so take it out of the equation if you proceed with this technique. Slide down the back again using whatever part of your hand, forearm, all-in-one tool that you choose, and offer relief to these hidden gems, where they finally get to breathe. This move can be incredibly helpful to get those parentheses to feel seen, heard and even taken care of. Some might even call it the decoration on the icing on the cake.
0:11:11.1 S2: The serratus posterior superior and inferior are parenthetical indeed, in the best sense of the word. Highlighting nuanced abilities of the breath we so desperately need, bringing value to the complex and critical structure that is our spine and emphasizing what really happens when we don't pay attention, our anatomy would not be the same without them. Mostly though, in teaching our clients about the secrets that lie under their own skin, we can understand more deeply, not only to see what we have been taught, but also to see anatomy for what it wants us to see.
0:11:51.9 S2: 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 email@example.com, that's R-E-B-E-L-M-T @ A-B-M-P.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.
0:12:39.3 Speaker 1: 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.