Body Lines

8/20/2019 Body Lines

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In our continuing series on visual assessment via

the Anatomy Trains lines, let us now explore BodyReading

the shoulders and arms. The shoulders involve not

one, but six myofascial meridians. Our highly mobile

shoulders move and shift position in a wide variety of

ways relative to the ribs and neck, contributing to strain

and pain patterns that include everything from headachesto compensations in the low back and even the legs.

With such complexity before us, we simplify hereby 1) highlighting the uniqueness of the human armarchitecture, 2) briey outlining the lines involved,and 3) giving some indications of how the shoulder canefciently rest, move, and respond to the breath.

Our shoulders have a complicated history. In most four-leggedcreatures, the foreleg bears more weight than the hind leg. Theribs and spine rest into a myofascial sling made primarily outof the serratus anterior muscle (Image 1A). In a well-trained

horse or a thin fellow doing a pushup, the saw-toothed slips of serratusare readily visible. Since we rearedup on our hind legs some 4 million years ago, we f reed the shoulder fromits job of being the primary supportthat holds the torso up off the earth.

If the anthropologists andcomparative anatomists have it right,our line of ancestry went through atime of swinging through the trees, which developed the prehensilecapability of our hands, and involvedthe shoulder moving and rotatinglaterally to support the entire weightof the body—but this time in tension,from hanging, not bracing (Image 1B). When we came down out of the treesand onto the seashore, the arms werefreed to swim, pick up sticks and stones,curl around our beloved children,

steady the plow, and tap on computerkeys.Our human shoulder is no longer

the major structural column (except forthose doing handstands or headstands).For us, the shoulder is supported by thestructural column—a yoke that halfhangs off the neck and half rests onthe top of the ribs. When you includethe weight of the attendant muscles,the shoulder girdle is remarkablyheavy, and can easily load the neck andspine signicantly, and detrimentallyif it is out of balance (Image 1C).

While the arm and leg are similarin construction—a ball and socket joint, then one bone, then a hinge joint,then two bones, then three, four, andve bones in a similar arrangement—the shoulder and arm denitely leantoward mobility, while the leg andhip are designed more for stability(Image 2). Put simply: to keep up

The Arm LinesBy Thomas Myers

The shoulder is the main support for the body weight in compression for most quadrupeds (A ) andthe main support in tension for arboreal apes (B ). In a standing human (C ) this is all reversed:it is the turn of the heavy shoulder assembly to be supported by the ribs and spine.

BODYREADING THE MERIDIANS | @WORK | ESSENTIAL SKILLS | MYOFASCIAL TECHNIQUES

technique

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with the arm and hand’s many talents,the shoulder has to slide all over theplace, making it more vulnerable toboth injury and misalignment.

THE ARM LINES The complexity of the myofascialstructures along the arm is mind-boggling. The arms have to controlthe nest instrument the world hasever known—the human hand—atone end, and are anchored into thehead, neck, upper spine, ribs, low back,hip, sacrum, and even arguably the

The arm and leg are similarly designed in a1, 2, 3, 4, 5 arrangement of bones, and themuscles are easily comparable as well. Thearm tilts this design toward extra mobility,while the leg tends toward greater stability.

femurs at their other end. Let us makesome sense of this by organizing the“myofascialature” (I made that up,don’t repeat it to anyone with a degree)into a series of connected lines.

To qualify, these lines must 1)start at the axial skeleton and go allthe way to the ngers, and 2) involveconjoined fascial bers running in afairly straight direction. Using thoserules, one can divide the arm’s softtissues into four of these lines.

We name the Arm Lines forhow they are arranged in the armpit(Image 3). The pectoralis major ispart of the Supercial Front Arm Line(SFAL) (Image 4A). The pectoralisminor and subclavius, and the fasciathat surrounds them, are part of theDeep Front Arm Line (DFAL). In theback, the t rapezius and deltoid form the

beginning of the Supercial Back ArmLine (SBAL) (Image 4B). Beneath theseare the rhomboids and levator scapulaeleading to the rotator cuff of the DeepBack Arm Line (DBAL). These linesterminate in the four corners of thehand—the palm, thumb, back of thehand, and little nger respectively.

Because the intricate anatomy isbeyond the scope of a short article, youcan follow the individual structuresin each line by following the chartsin Image 4. For simplicity, you canbest visualize the four Arm Linesas the four aspects of a bird’s wing.Lean forward and stick your armsout like a kid playing airplane: theSFAL is the bottom of your wingfrom pectorals to palm; the SBAL isthe top of your wing from trapezius

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The Arm Lines are named for how theypresent at the armpit level—two infront of the axillary space, two behind.

SuperficialBack ArmLine

Deep Back Arm Line

SuperficialFront ArmLine

Deep Front Ar m Line

The four Arm Lines go from the axialskeleton to the four corners of the hand.

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to ngernails; and the DFAL is the leading edge from thepectoralis minor out to your thumb. The nal and mostproblematic (from our point of view) line is the DBAL, thetrailing edge of the wing from your levator and rhomboidsthrough your rotator cuff on out through the triceps andpoint of the elbow to your little nger ( Image 4, page 97).

These lines are minutely detailed in AnatomyTrains (Elsevier, 2009), but here and now, this willhave to sufce on the anatomy. In terms of function,the SBAL holds the arm aloft and xes it in positionand the SFAL directs the hand and ngers, while thetwo deep lines provide stability and renement inaiming the hand at whatever we are working with.

SHOULDER POSITIONINGIf you are working with a musician, jeweler, draftsman,or ping-pong player, the details of the forearms andhands are relevant, but here we will concentrate on thepositioning of the shoulder. Even with that limit, weencounter sufcient complexity. The postural positionof the shoulder rests largely with the scapula. With someexceptions, the clavicle and humerus have to follow thescapula’s lead. The scapula itself is a roundhouse of muscularpulls all competing to dictate its position (Image 5).

Please do not talk to me of a “scapulo-thoracic” joint—there is none. The scapula oats in a sea of elastic guy-wiresthat can be tense or relaxed, concentrically or eccentricallyloaded, competing and restricting or ready to accommodate. Although I personally shrink from dening good versusbad for a scapular resting place (it depends on the shape ofthe back, the head, occupation, and a few other factors),many would argue that good positioning involves:• the vertebral border of the scapula lying vertically

along a line above the angle of the ribs, and• the scapula hanging vertically when viewed from the side, with

the proviso that the rib cage must also be vertical. In the all-too-common case of the rib cage being posteriorly tilted, thenthe scapula that is vertical to the gravity line would actuallybe anteriorly tilted relative to the rib cage (Images 6A and 6B).

Common displacements include a very common(but often rib-cage centered) tilt of the shouldergirdle as a whole, or the scapula can be:• too wide or too narrow (laterally or medially shifted);• held up or too far down (superiorly or inferiorly

shifted, though the latter is rare);

• wider apart at the bottom than thetop or (again, more rare) wider atthe top than the bottom (laterallyor medially tilted in our language,but upward or downward rotationin physiotherapy-speak);

• held forward or pinned back(anteriorly or posteriorly shifted); or

• anteriorly or (very rare)

posteriorly tilted. The commonly used protractionand retraction are insufciently exactto lead to coherent strategies forcorrecting shoulder position. The exactnature of the terms outlined above—tilt, shif t, and rotation applied to eachof the clavicle, scapula, and humerus—provides a shorter road to the mostefcient treatment plan. Protractionmay involve different levels of lateralshift, medial rotation, and anterior tilt,not to mention anterior, posterior, orsuperior shift relative to the rib cage.

THE SCAPULAR X The scapula is a roundhouse in Anatomy Trains-speak, meaning thatmany muscles compete in setting itsposition. There are muscles going innearly every direction from the triangleof the shoulder blade. Four of these,however, are key to sett ing its position.

The scapula has manymuscles attachingto it—and thus itsposition rests withthe balance of theseguy-wires: the rotatorcuff, deltoid, teresmajor, triceps, biceps,and coracobrachialisattach it to thehumerus; the serratusanterior and pectoralisminor attach it to theribs; and trapezius,rhomboids, and levatorscapulae attach it tothe spine and head.We can safely ignorethe omohyoid in termsof scapular position.

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BODYREADING THE MERIDIANS

relationship between the lower trap andthe pectoralis minor, which can pullthe scapula up and over the rib cageinto anterior tilt or medial rotation.

You will have a difcult timending people where the lower trap hasovercome the pectoralis minor to pullthe scapula too far down and in, but you wil l not have to go far to nd those where the scapula is crawling up over oraround the rib cage to the front. Medialrotation or anterior tilt of the scapulaoften lies with a short pectoralis minor(or restriction in the clavipectoralfascia in which it is imbedded). Variousstretching and manual therapy methodscan reach and lengthen these short

tissues, and are commonly neededfor proper shoulder girdle balance. Whichever way we achieve an

even tonal balance among these fourand the other muscles that pull on thescapula, the reward will be an easyand mobile shoulder movement.

The scapula relatesprimarily to the rib

cage in terms ofBodyReading. Thescapula can appearvertical relative tothe gravity line (A),but still be anteriorlytilted relative to theribs. Straighten theribs, and then you willsee the anterior tiltof the scapula (B).

One leg of this X is the oppositionalforces between the rhomboid musclesand the serratus anterior—theformer pulling up and in (assistedby levator) while the latter pullsdown and out (Image 7A). When theserratus overcomes the rhomboids—is hypertrophic or concentricallyloaded—the scapula will rest toolaterally on the back (this happensfrequently in kyphotic patterns). When the rhomboids dominate—andthis happens frequently in at-backpatterns—the scapulae rest too closeto the vertebral spinous processes, andtoo medially for optimum function.

The other leg of the X is a little

less straightforward, but just aspowerful (Images 7B and 7C). Theonly muscle that pulls down and inon the scapula is the lower part ofthe trapezius. To oppose this force, amuscle would have to be pulling up andout on the shoulder, which is clearlyimpossible—that would be a muscleout beyond your ear. But wrap thatstrap over the front of the body, and you can see the reciprocal antagonistic

Four musclescompete to setthe primaryscapularposturalposition: therhomboidsand serratusanterior formone leg ofan X, whilethe lowertrapezius and

the pectoralisminor have anantagonisticrelationshipalong the otherleg of the X.

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THE CLAVICLE The clavicle holds our shoulder out away from themidline, and is thus fairly well anchored to the topof the sternum medially and must follow the scapulalaterally. There is a small disc in the sternoclavicular joint, which tells us this joint must glide a litt le, whichis a necessary movement for good shoulder function.

When you ask a client to open his arms wide (as ifabout to enfold a grandchild) and you see the scapulae risein back, the cause is often not a too-tight levator scapulae

or trapezius, but a sternoclavicular joint that cannot glidelaterally, causing this compensation in the back. When yousee this pattern, release the subclavius under the medial thirdof the clavicle. When this heavily-fascial muscle relents,the clavicle can glide, and proper arm carriage returns.

THE SHOULDER IN BREATHING An easy but tel ling assessment for the shoulders isto watch their response to the breath. Watch rst with the client’s normal tidal breath, but if that is toosmall to produce any shoulder movement, have himincrease the depth of the breath gradually until you seesome movement response in the shoulder girdle.

Generally, you will see one of three patterns:• The shoulder girdle moves straight up with the in-

breath and back down on the exhale. In this case, lookto the muscles that hold the shoulder to the ribs—serratus anterior and pectoralis minor principally.

• The shoulder girdle hardly moves, even with a deeperbreath. In this case, the shoulder is hanging off theneck and head, and you should look to the trapezius andlevator scapulae that hold the shoulder girdle from above.Interestingly, release of the scalenes, which are not normallylisted as shoulder muscles, but do attach fascially to thearms, can often bring good results for this pattern.

• The shoulder girdle moves up and out on the inhale; downand in on the exhale. This, in my opinion, is the Goldilocksmovement—just right. The shoulder is loose enough toride and glide on the rib cage in response to the breath.

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THE RELAXED ARMFrom the hand up, one can readmore or less exion in the ngers(everybody exes a little), ulnar or(rarely) radial deviation at the wrist,chronic pronation or supination of theforearm, or excessive exion at theelbow—come to class for these details.

For space reasons, the last issue we will deal with for the arms is where the

humerus lies in terms of medial andlateral rotation. Various measures havebeen proposed for where neutral liesfor the humerus. Ida Rolf urged us togo for a balance where the olecranon ofthe elbow pointed laterally, but I havenever been able to make sense of this,either anatomically or functionally.Some yoga teachers have suggestedthat the elbow should point straightback behind us, and I have never beenable to make sense of that measureeither. The conclusion I have come tois that there is a broad range of neutralin humeral rotation. It is, after all, themost moveable joint in our body.

The humeral position that makesthe difference is not relative to thetorso, but relative to the scapula,and that in turn depends on thebalance of tension in the rotatorcuff—the SITS muscles. Thesubscapularis is a medial rotator;the supraspinatus, infraspinatus,and teres minor al l contribute to

lateral rotation—or more often,stabilizing during medial rotation.For an easy way to BodyRead

where the humerus lies, put theindex nger of one hand along thetop of the spine of the scapula with your ngertip near the acromion,and another nger to bisect theolecranon. A 90-degree angle between


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The Functional Linesextend the arms tothe opposite legs,across the midlineof the body, formingtwo large Xs—oneon the front crossingat the pubic bone,and one on theback crossing at thesacrolumbar junction.

these two l ines is about right—if the angle is tooacute, the humerus is laterally rotated; if too obtuse,it is medially rotated in the glenohumeral joint.

THE FUNCTIONAL LINESFinally, we should mention the other two lines thatextend the arms down to the contralateral legs—theFront and Back Functional Lines (Image 8). When youthrow a rock or a spear, or bat a ball, the force generatedby the arm is multiplied by the additional lever arm ofthe trunk pivoting on the opposite leg. The FunctionalLines transmit these forces across the midline of thebody in two large Xs—one across the front, and oneacross the back. These conjoined muscle linkages—thelower edge of the pectoralis major to the line betweenthe rectus abdominis and external oblique across thepubic symphysis to the adductor longus in front, thelatissimus to the thoraco-lumbar fascia to the lowergluteus maximus in back—team up to reciprocallyimpart more momentum and speed to the hand.

Interestingly, despite the fact that we are all“handed” and thus use one set of these lines more thanthe other, my 30 years of observation tells me thatthese lines rarely govern posture, perhaps because they

are used reciprocally with every step. Whatever thereason, when you see one shoulder closer to the oppositehip, it is usually the Spiral Line that is the culprit(January/February 2012, BodyReading the Meridians,page 94), not these innocent Functional Lines.

The arms are highly complicated bits of machinery, very handy accoutrements to our body’s repertoire,and amenable to the poetry of bird’s wings andnonverbal haiku. We have covered only a few majorassessments, but we hope they are of use to you.Next issue will be the last in this series as we takeon BodyReading of the last of the Anatomy Trainslines, the core of the Deep Front Line.


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Thomas Myers is the author of Anatomy Trains (Elsevier, 2009)and Fascial Release for Structural Balance (Nor th Atlantic, 2010).Myers studied with Ida Rolf and has practiced integrative bodyworkfor more than 35 years. He directs Kinesis, which offers more than100 professional certications and continuing education seminars per

year wor ldwide. For more information, v isit w ww.anatomy trains.com.

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