Imagine having a massage and feeling relaxed and renewed, standing taller and straighter, and walking pain-free. To create this type of experience for clients, massage and bodywork practitioners need to understand and promote balanced movement in the body through the study of kinesiology, the science of human movement. 

This article’s approach to kinesiology is therapeutic because applications are made to improve the overall posture and movement of client and practitioner alike. Because the leading cause of disability in working adults is musculoskeletal pain that limits normal movement, and a primary reason that people seek therapeutic massage and bodywork is for pain relief, it is imperative that we understand kinesiology in order to help our clients restore normal, pain-free movement.¹ 

A study of kinesiology requires learning the names, functions, and locations of all the muscles and joints. Although the mere thought of learning all these facts can be daunting, the process can also be fun, interesting, and even exciting when the body becomes the learning laboratory. You are encouraged to approach therapeutic kinesiology by actually experiencing what integrated joint and muscle functions feel like in your own body. Not only will your body reap the benefits of your newfound knowledge, learning will be easier if your cognitive study is reinforced with body experiences.

Dimensional Balance and Structural Integrity

Every massage stroke we do has direction, so each stroke provides us with an opportunity to move the client’s body toward improved alignment and dimensional balance. When the body has dimensional balance, it has symmetry and proportion in its height, width, and depth. Each segment of the body aligns above and is supported by the segment below it (Image 1A). As simple a move as bringing the legs directly under the body (kneecap under hip socket) puts the femur into the natural medial rotation that occurs in extension. When we apply massage strokes in a direction that improves alignment, if the client pays attention, she will receive a passive education about optimal skeletal alignment.

Chronically contracted muscles associated with faulty postures pull and shorten certain areas of the body, tipping body segments off center (Image 1B). This results in a distortion of the dimensional balance of the body, reducing its overall structural integrity. By contrast, when the joints are optimally aligned, the muscles have a normal length, the body has dimensional balance, and the body posture is in a state of structural integrity. The term structural integration was originally coined by Ida Rolf to name the somatic therapy she developed that is now known as Rolfing.² 

Kinetic Chains

Movement is rarely isolated in one muscle or joint. Instead, basic and familiar movement patterns of the human body occur along chains of action, passing from one joint to the next in a predictable sequence. This is defined as a kinetic chain—a combination of successive joints linked by a series of muscles along a movement pathway. A number of kinetic chains have been identified from different kinesiological viewpoints: 

• An articular chain views the series of connected joints along a movement pathway.

• A muscular chain views the group of muscles that function together to produce a common action, such as the extensor chain or the flexor chain.

• A neurological chain views the neurological links of muscles that contract in an ordered sequence during developmental movement patterns, reflexive movements such as a flexor withdrawal reaction, and postural stabilization functions.

Kinetic chains are often described by the actions they produce. For example, the extensor chain of muscles runs along the back of the body from the head to the bottom of the feet (Image 2). It also crosses to the front of the body above the knee at the quadriceps, which are knee extensors. We see the power of the extensor chain in actions such as the graceful arc of the body in a swan dive. By contrast, the flexor chain is what curls the trunk and limbs during a cannonball dive. The flexor chain of muscles runs along the front of the body from the jaw and neck down through the abdominals and front of the legs to the toes. 

It is important to understand the relationship between kinetic chains, muscular balance, and muscular dysfunction. An efficient, coordinated movement reflects muscular balance—the relative equality of muscle length and strength between opposing muscles along kinetic chains.³

Tightness or weakness in one muscle along the kinetic chain reduces the efficiency of movement in the entire chain. Musculoskeletal pain can occur in an area of the body far from the movement dysfunction that is causing the pain. Vladimir Janda, a Czech neurologist, describes this process of muscular imbalance as a “chain reaction.” He explains how muscular pain can occur in a different location than the muscular imbalances causing the overall functional movement pathology. Unless the overall muscular imbalance is addressed in treatment, localized muscular pain can be temporarily relieved with massage or bodywork, yet persist because of the faulty movement pattern.

In order to better illustrate the principles of therapeutic kinesiology, we will now examine the relationship between kinetic chains, muscular balance, and muscular dysfunction as it pertains to the spine. Take advantage of the partner practice exercises as both a practitioner and client to better enhance your understanding of these concepts.

Spinal Movement

In the articular chain of joints along the spine, each vertebral segment can move within a small range of motion. The total range of spinal motion reflects the sum of movement in many vertebral segments. Ideally, each segment contributes its share to the overall motion of the spine. However, when chronic muscular tensions and joint dysfunctions glue groups of vertebrae together, they will move in blocks. This increases stress on the mobile segments, which are forced to move under increased load.

To make a general assessment of spinal flexibility, begin by observing a partner’s spine in positions of flexion and hyperextension. 

• At end range of spinal flexion, the lumbar and cervical curves flatten and the thoracic curve increases (Image 3A). 

• At end range of spinal hyperextension, the lumbar and cervical curves increase and the thoracic curve flattens (Image 3B).

Muscles of the Spine: Erector Spinae 

The muscles of the spine are of particular importance given that one of the primary reasons that people receive massage is to alleviate back pain. The type of back pain that practitioners can treat the most effectively comes from muscular dysfunction associated with poor posture. 

Deep to the outer layer of spinal muscles and posterior to the spine lies another large group of spinal extensors called the erector spinae (ES) muscles. The large, ropy fascicles (muscle slips) of this complex group of muscles cascade along the back from the occiput to the sacrum. Each individual fascicle spans 6–8 vertebral segments. 

The ES group is made up of three sections that run parallel to each other—the spinalis, longissimus, and iliocostalis (Image 4). Each of these sections has three or four subsections named after the part of the spine they cross: the lumborum (lumbar), thoracis (thoracic), cervicis (cervical), and capitis (cranial). Each subsection is innervated by the spinal nerves at that respective segment.

The spinalis lies closest to the spine. The vertical fascicles of the thin spinalis cervicis arise from and attach to the spinous processes of the cervical vertebra in a curved configuration like rings on a target. The vertical fascicles of the spinalis thoracis are functionally more significant. They arise from the spinous processes of the midthoracic vertebrae and attach to the spinous processes of the lower thoracic and upper lumbar vertebrae.  

The longissimus runs along the spine lateral to the spinalis. Its nearly vertical fascicles arise from a thick, broad tendon that descends the length of its medial muscle along the lumbar spine and attaches to the sacrum and iliac crest. The longissimus lumborum ascends along the lower back and attaches to the lower ribs. The longissimus thoracis follows the same upward path to insertion sites on the middle and upper ribs. The longissimus cervicis runs from the upper ribs to the lower cervical transverse process. Finally, the longissimus capitis arises from the transverse process of the thoracic vertebra and attaches on the mastoid process. 

The iliocostalis is the most lateral portion of the ES. It also arises from a thick, broad tendon, which is lateral to the longissimus tendon and attaches to the sacrum and iliac crest. The iliocostalis lumborum inserts on the lower six ribs, the iliocostalis thoracis inserts on the upper six ribs, and the iliocostalis cervicis inserts on the transverse processes of the lower cervical vertebrae. 

Postural Muscles Along the Spine

Many of the primary stabilizers lie close to the joints, particularly along the spine (Image 5). For this reason, they are often referred to as “core” muscles. A kinetic chain of core postural muscles in the pelvis—the transversus abdominis, multifidus, diaphragm, and perineum—form a closed loop that provides a foundation for stability in the entire body.

The transversospinalis lies medial and deep to the ES from the occiput to the sacrum. It consists of three muscles: the rotatores, multifidi, and semispinalis capitis. The diagonal fascicles of the multifidi run along the spine in a herringbone pattern. Each fascicle runs diagonally from the transverse process of one vertebra to the spinous process of a vertebra that is three or four segments higher. The multifidi fascicles originate on the posterior sacroiliac ligaments, the posterior superior iliac spine, and the transverse processes of L5 to C2, and insert on the spinous processes of L5 to C2. 

The lumbar multifidus is an important postural muscle. When contracted, its fibers fill the lamina groove and elongate the lumbar spine, stabilizing the curve in a maximally lengthened position. In an optimal firing sequence of spinal hyperextension, the multifidi contracts before the erector spinae.  

Benefits of Core Training

A person doesn’t have to be injured to begin training the core muscles as postural stabilizers. Core exercise programs that focus on developing the core muscles to improve form have become popular. Many of these programs focus on teaching people to contract the postural muscles in order to maintain a neutral spine while strengthening the larger, more extrinsic muscle groups. 

Core training can also be integrated into bodywork with neuromuscular patterning, a method of practicing a specific movement pattern in order to reorganize and improve general muscle and joint function. To integrate neuromuscular patterning into hands-on sessions, a practitioner might ask a client to lengthen a shortened part of the spine while that practitioner applies myofascial stretching to the area. The client’s active movement not only enhances the stretch, it develops the client’s body-based skills and organizes more efficient neuromuscular pathways, which in turn improves the structural integrity of the entire body. 

Facilitating balanced movement in the body should be a primary goal of every massage session. Understanding how muscles function together and affect one another will allow you to work with clients to create the results they are looking for, and the best way to grasp this connection is to feel it under your hands, as well as in your own muscles. 

Notes

1. S. Mense, D. Simons, and J. Russell, Muscle Pain: Understanding Its Nature, Diagnosis, and Treatment (Baltimore: Lippincott Williams & Wilkins, 2001).

2. I. Rolf, Rolfing: The Structural Integration of Human Structures (New York: Harper & Row, 1977).

3. P. Page, C. Frank, and R. Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach (Champaign, Illinois: Human Kinetics, 2010).

  Mary Ann Foster is the author of the newly released textbook Therapeutic Kinesiology: Musculoskeletal Systems, Palpation, and Body Mechanics (Pearson Publishing, 2013). She can be contacted at mafoster@somatic-patterning.com.