Ep 345 - The Infinite Loop of the Obliques: “The Rebel MT” with Allison Denney

0:00:00.0 Speaker 1: As hands-on health professionals, we want more than labeled charts of muscles, nerves, and bones. We crave anatomy education that informs our touch. AnatomySCAPES, innovative online trainings are bringing vibrant, visual, real anatomy understanding to therapists worldwide with the Anatomy Lovers E-Box. Each month, you'll receive an image packed research loaded mini-course, really visual, really relevant real anatomy education for hands-on professionals. And they are yours to keep, so you can watch them again and again. ABMP members save 20%. Go to anatomyscapes.com/abmp and become an Anatomy Lovers E-Box subscriber today. 

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0:01:33.0 Speaker 2: A Celtic Knot is not just a pretty design on a ring or a pendant on a necklace. It is a pattern of a loop or multiple loops that have no start or end symbolizing the interconnectedness of life. There are many different versions of Celtic knots denoting the various aspects of our lives, like love, friendship, or happiness. But the overarching meaning is the continuousness of one curve lending itself to the next that represents the infinite path of our lives and our relationships. Whether or not this is something you believe in or want to explore more is not the point of this episode. It is however, a concept rooted so deeply in our humanness that it shows up over and over and over again in our anatomy and physiology. The concept that parts of who we are operate in a cycle that is constantly seeking balance is probably not new to most of you. 

0:02:30.8 S2: This is what homeostasis is. We see this best exemplified in our endocrine and nervous systems. For example, when I get depressed and bury myself in a bucket of ice cream, my endocrine system recognizes the overdose of sugar releases insulin to help regulate the amount of sugar in my bloodstream and keeps me in operating mode so I don't actually glitch from too much chocolate. Conversely, when I feel guilt around the amount of sugar I have consumed and starve myself for the next couple of weeks, my endocrine system kicks in again and releases glucagon to pull some of that storage sugar out and inject it back into my bloodstream so I don't glitch from too much guilt. This is actually called a negative feedback loop, and if you look this up online, you will probably find some images that look like the infinity symbol with arrows guiding your eyes around each side of a continuous loop describing what happens when you over or under anything. 

0:03:22.9 S2: Of course it is not as simple as that. It never is, but you get the idea. We are infinitely seeking balance and the imagery of looping too far in one direction and then too far in the other direction keeps bringing us back to the center. Side note, I do not recommend the ice cream and guilt seesaw as a regular practice, but sometimes finding our limits keeps us human. The looping can go beyond just two directions though, and there is a Celtic knot for that. It is called the Celtic Love Knot, and it is represented by a double infinity symbol. I suggest looking one up, but to give you some imagery, it looks like two pretzels that have been connected, one right side up and one upside down, except staying in the Celtic theme, it is one continuous line looping in and out and around and back again. In truth, it is supposed to illustrate two hearts woven together, hence the name, but I see pretzels. This particular weave exemplifies as I mentioned earlier, that our inner workings are not that simple. The arcs and curves are many, winding in and around each other so much so that it can make one dizzy. But the Celtic love knot is the perfect representation of one particular muscle or muscle group that is the focus of today's episode, the internal and external obliques. 

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0:04:45.5 S2: The word oblique actually has roots in old French, meaning slanting, sloping, sideways, crooked or not straight. And this is fitting. Each of the four obliques, one internal and one external on each side of your abdomen are found sloping or slanting in their own way. They are of the elite handful of muscles that rotate the torso. Yes, they both take part in flexing and laterally flexing the spine, but their role in rotation and relationship to each other is what I wanna highlight most. These beautiful layered fan like structures sit atop one another and act antagonistically to each other, with one pulling in one direction and the other twisting in the other direction. It is their opposition that most people commonly notice first, but if we look a little closer, we begin to observe that their lines don't really have a beginning or an end. They dive under and over each other like a pair of dolphins playing in a wave. 

0:05:38.7 S2: Their non-linear movement is a work of engineering genius and might I add an exquisite piece of humanness. It is the pairing of these two muscles that epitomizes the Celtic Love Knot. The entwining of the obliques and their interactive relationship with each other creates a push and pull dynamic that on the surface seems linear, but if we look a little closer, the unending loop that they create around the entirety of our core draws out the pattern that one might mistake for a couple of hearts or pretzels, depending on your take on things. Okay, so let's start superficially. The external obliques are exactly that external meaning closer to the skin. So these are the ones you'll see on the side of a motivated buff human with six pack abs. The external obliques originate on the external surfaces of the fifth through 12th ribs actually dovetailing with the serratus anterior. 

0:06:34.4 S2: They then reach forward and down to insert onto the anterior iliac crest, so the top of the side and front of the hip. Their tendons then merge into the abdominal aponeurosis and sort of seal themselves at the linea alba, that line down the center of the six pack. More on this in a bit. Diving a little deeper, the internal obliques can't be seen on said buff human, they are more well internal. And while the external obliques start higher up and back and then reach forward and down, the internal obliques start lower down and back and reach forward and then up. PS: And by the way, the obliques share this crisscross pattern with the internal and external intercostals. I likened these to the Ship of Theseus a few episodes back and will include a link to that episode in the show notes. So originating all the way back at the thoracolumbar aponeurosis, the internal obliques reach forward along the iliac crest and grab onto the inguinal ligament at the front of the hip. 

0:07:33.2 S2: Then they reach up to insert onto the internal surfaces of ribs 10 through 12, the abdominal aponeurosis and eventually the linea alba, but not really eventually, because that implies that they end there, which they don't. This is where looking at charts and muscle maps does this no justice, the connective tissue that connects both the internal and external obliques to their insertion structures. Don't just grab a bone and call it a day. Where these tendons meet at the abdomen, they wind their way into the connective tissue that in sheaths or envelops the rectus abdominis and then becomes the linea alba at the center, similar to the external obliques, these tissues sort of seal themselves at this point, but that doesn't mean they stop there. Connective tissue connects and keeps connecting everywhere, all over the body. So where one connective tissue structure like a ligament, or in this case a tendon looks to end at a bone or a seam, it really doesn't. It continues on to the next tissue, because its job is to connect. 

0:08:41.8 S2: And while it might be easy to conclude that the tendons of the external obliques on your right side bleed into the tendons of the external obliques on your left side, the actions of these muscles dictate something different. As I mentioned before, all four of these muscles play a role in both flexion and lateral flexion of the spine. But their ability to twist us is where things get interesting. In physiology speak, the external obliques act contralaterally, whereas the internal obliques act ipsilaterally. What that means is that if your right external obliques contract, they will rotate the torso to the left or contralaterally or to the opposite side and vice versa. If your left external obliques contract, they will twist your torso to the right, while if your right internal obliques contract, they will rotate your torso to the right or ipsilaterally or to the same side and vice versa again, when your left internal obliques fire, they will twist your torso to the left. 

0:09:41.0 S2: But what all of that really means is that if the external obliques on the right side are firing to rotate the torso to the left, the internal obliques on the left side are chiming in. And conversely, if the internal obliques on the right side are working to rotate the torso to the right, then the external obliques on the left side are pitching in too. So if these antagonistic muscles are actually teaming up with their opposing counterparts to make stuff happen, it is not hard to envision a thread of connection that loops one into the other. Diving over and under each other creating, one might say, an infinite loop, there is a thread around the lower torso that involves the external obliques on the right side, slides through the linea alba at the center of the abdomen, ropes into the internal obliques on the left side, meanders through the thoracolumbar fascia in the back, and then reconnects at the external obliques on the right side. 

0:10:43.4 S2: And conversely, the opposing loop involves the external obliques on the left side, passing through the linea alba, connecting into the internal obliques on the right side, weaving through the thoracolumbar fascia and reconnecting with the external obliques on the left side. They glide over and under each other, and although they move independently, they really don't. Their total relationship is intricate, layered and completely intertwined. One might think the Celts were onto something, issues or dysfunction with the obliques can often present as low back pain. Try this. When focusing on the obliques, begin your session with your client supine, knees bolstered and arms slightly abducted away from the body. Standing at one side of the table, use one hand on the ribs closest to you, and reach across with your other hand to hold the opposite ribs. Gently begin to move the ribs left and right, creating a rocking motion for the client. 

0:11:42.6 S2: Then bring your hands to the lateral aspects of their hips and do the same. You've just created passive movement into the attachments of the obliques and perhaps even some awareness for your client. Next, face the side of the table. And for discussion purposes, if you are at their right side, pull their left arm across their body toward you, holding their shoulder and lifting it up off the table towards you, rotating their spine. With your thighs anchored into the table and practicing good body mechanics, keep their shoulder lifted, as you use your right hand to manipulate the... As you use your right hand to manipulate the thoracolumbar tissues. Play around with pulling up with your right hand while you lessen the hold with your left hand and let their shoulder drop to the table and then pulling their shoulder up while you relax the work into their low back. 

0:12:32.5 S2: This passive rotation combined with the attention to the thick connective tissues in the posterior torso is a good beginning point to noticing how their obliques are doing, for both you and your client. Switch sides and repeat this process. Check in with your client, and keep in mind the infinite loop of tissues you are manipulating. Honor them individually, but do not disregard their grasp on the entire torso and consequently their connecting anatomy. Understanding where the obliques are and what they do is only a fraction of the picture. Staying focused on one without their relationship to the other will most likely lead you astray and probably into frustration. The obliques, all of them, are much like the inner workings of our lives and our relationships. They're nuanced and complex and where you might think one ends, it is just the beginning. 

0:13:27.3 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 eyeballs from a computer screen, drop me a line at rebelmt@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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