Anatomy of the thoracopelvic region

Although this is not an anatomy text, it is important to review the anatomy of the thoracopelvic region to understand the complaints that clients express. The foundation of this area is composed of the vertebral spine, rib cage, pelvis, sacrum, and coccyx (Figure 8-1). It is structurally held together by a complex network of ligaments, fascia, tendons, and muscles. Multiple moving parts and the shape of this area make it more prone to injury, especially repetitive-movement disorders. Poor posture and incorrect body mechanics lead to trauma, repetitive injuries, stress disorders, and muscular pain.

Figure 8-1 Axial skeleton.

(From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)

The musculature of the back can be classified into three levels of depth: superficial, deep, and deepest. This is a key understanding to successful deep tissue massage. Not all the smaller, intricate muscles of the thorax are listed because they are beyond the scope of this text; however, the focus of the massage therapist is on the following layers of muscles.

The deepest layer consists of the postural muscles, which many therapists strive to address. These consist of the suboccipitals, transversospinalis group (multifidi, rotators, and semispinalis), and intercostalis muscles (Figure 8-2).

Figure 8-2 Deepest layer.

(From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)

The deep layer consists of the splenius (capitis, cervicis), levator scapulae, erector spinae group (iliocostalis, longissimus, spinalis), serratus posterior (superior and inferior). This is the area where most therapists spend their time working (Figure 8-3).

Figure 8-3 Deep layer.

(Right side) (From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)

The superficial layer consists of the trapezius, rhomboids, latissimus dorsi, and serratus anterior (Figure 8-4).

Figure 8-4 Superficial layer.

(Left side) (From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)

Visualizing the back of the body in context to the muscular layers helps the therapist understand the three-dimensional complex of the body. Identifying which muscles need to be addressed dictates the appropriate layer to focus on. The layer being addressed dictates the depth, pressure, and speed of the technique. Understanding this process helps identify the approach and technique that is best suited for the muscle.

Postural distortions

Some of the causes of back discomfort can be directly related to postural distortions of some form. Postural distortions were discussed briefly in Chapter 2 about the assessment of the client. As discussed, hyperlordosis, hyperkyphosis, and scoliosis are distortions of concern. However, that chapter did not discuss how those distortions are created. Many therapists have been trained to think of these misalignments in the form of a linear positioning of the spine.

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