Anatomy Made Simple: Inner Muscles vs Outer Muscles

Let me start right off by saying that I’m not one to call attention to myself, or to toot my own horn. In fact, I've been known to not even tell my co-workers that it’s my birthday. This should give you an idea of how difficult it is for me to write about one of the best kept secrets in professional sports.

Being injured all of the time is not normal. If you're an athlete, it doesn't necessarily mean you will be frequently injured or in pain. Yes, sports do increase your odds of getting hurt, but they don't guarantee it. In fact, I played basketball and baseball throughout my life and I remember less than a handful of injuries. Of course some of that was simply luck of the draw, but now (as a physical therapist) I realize there's so much more to it.

As a physical therapist, testing has been ingrained in me since PT school. I learned that the initial evaluation process should involve testing of specific parts of the body, such as the joints, muscles, and nerves. The results of these tests would then play a role in guiding my treatments. Basically it gave me a starting point.

In this podcast episode, Dr. Scott Curtis from the Princeton Spine and Joint Center interviewed me about suspension based physical therapy. We discussed the Redcord suspension system that I use on all of my clients. It comes from Norway and consists of ropes, slings and bungee cords. I enjoyed explaining how we use Redcord to deliver the neuromuscular activation (NEURAC) treatment approach...

When I was in high school, I read the book A Tale of Two Cities by Charles Dickens. I can’t help but compare that story to my journey as a physical therapist. When I looked over my old cliff notes in preparation for writing today’s blog, Dickens came right out the gate in his first paragraph with the theme of duality...

The evidence for treating musculoskeletal pain has remained consistent over the years. It supports two basic aspects of physical therapy: to move your joints and to understand pain science. So why, early on in my career, was it so hard for me to successfully treat patients in pain? I guess moving without pain is harder than you might think. Just ask the old me that didn’t have access to a “zero-gravity” suspension exercise system.

In my previous blog post I explained the science behind musculoskeletal pain and how Redcord is my secret weapon to overcome it. Today, I’m going to discuss one of the most important aspects of suspension based physical therapy: creating a "zero-gravity" environment so that you can move your joints through pain-free ranges of motion.

I wanted to share something that happened to me while recently evaluating someone for physical therapy. A mother of two elementary school children comes in with complaints of right hip pain and a long history of hammer toes on both feet. Neither of these issues are urgent or in an acute stage. She just wants to prevent them from getting any worse.

I would like to discuss something that takes suspension based physical therapy to the next level. It’s called the Redcord Stimula. Developed by physiotherapists in Norway, the Stimula is a vibrating mechanical unit that attaches to the suspension ropes in order to provide extra vibration that manual “perturbation” simply cannot match.

I wrote this song while sitting in front of my fireplace listening to Bing Crosby’s Twelve Days of Christmas. I recommend getting inspired by listening to Bing’s version first so you can sync my version to his. Happy holidays from the Activcore family to yours.

If you know me, you know that I love to simplify things especially when it comes to physical therapy. That’s why I love Redcord. It is a simple yet effective tool. Now don’t get me wrong, it looks intimidating with all of those ropes, slings and bungee cords. But once you learn how to use the equipment and understand the testing and clinical reasoning process (known as Redcord NEURAC), it makes treating people so much easier.

In my last blog post I talked about how to simplify explaining anatomy to clients by way of the myofascial system. Before we dig into each myofascial chain, I would like to discuss another simple concept that has also dramatically improved the way I treat and educate my clients.‍ The concept of inner muscles versus outer muscles was introduced by Anders Bergmark in 1989.

In my last two blogs, I explained how our muscles (and hence our bones and joints) are connected to each other through a series of myofascial chains. I also explained how we have inner muscles that stabilize our joints versus outer muscles that move our joints. ‍In the spirit of keeping things simple with regards to explaining the myofascial chains, I am going to break them down from the front of the body, back of the body, and sides of the body.

In this blog series, I am breaking down the myofascial chains (chains of muscles that work together to perform movements) into the ones in the front of the body, back of the body, and sides of the body. I highlighted the Deep Front Line in my last post. Today I'm going to talk about the second of three myofascial chains located in the front of the body: the Front Functional Line.

I am always inspired after teaching any course, and this past weekend was no different. We recently hired 5 new Doctors of Physical Therapy at Activcore and it is my job to teach them how to do suspension based physical therapy. I also mentor them on a one-on-one basis to speed up their learning curve. As one of the first physical therapists in the United States to use this "zero gravity" system, I have countless success (and not so successful) stories to tell.

To be honest, when I talk about the myofascial chains located on the front of the body, I seem to mostly refer to the Deep Front Line and the Front Functional Line. That's because I often find "weak links" along these chains upon testing them, especially in the hip adductors or inner thigh muscles.‍The Superficial Front Line is more of an afterthought, if everything else tests normal.

Instant gratification is all around us every single day. We get our news immediately from our phones. Our meals come prepared and ready to heat up and eat in several minutes. And we get anything we want from Amazon with literally the click of a button. Our world is moving so fast compared to years ago. So why would recovering from a lower back injury be any different?

I come from a baseball family and more specifically a family of baseball pitchers. My grandfather pitched for the Braves and the Yankees in the 1930’s and 40’s. He stood a lengthy 6 foot 7 inches tall soaking wet. My dad was a 6 foot 5 inch lefty pitcher from Portland, Maine who played one season with the Kansas City A’s. I was a pitcher in high school but an injury to my elbow ended my career before it even began.

There is strong evidence to support suspension based physical therapy for shoulder rehabilitation and performance. So it’s perplexing why it has taken so long to become the gold standard of care. This type of treatment intervention is common in Norway, where it originated. But here in the United States it barely exists. I guess one reason for this is that the profession of physical therapy began in this Nordic region of the world in the early 1800s. Therefore they have about a hundred more years of clinical experience than we do.

I felt inspired to write this blog after re-watching a 2011 TED Talk by Lorimer Moseley on the topic of pain. I have seen this episode multiple times and it always makes me laugh. He knows how to tell a good story that merges science with comedy. He actually makes learning (about pain) fun!

For over 15 years, I've been teaching suspension based PT to physical therapists across the country. I have seen all different types of clinics incorporate the Redcord suspension system into their daily practice. During these classes, many pelvic floor physical therapists have exclaimed how great suspension exercise is for postpartum moms. I would hear this over and over again. But I didn't know exactly why.

Posture has always been a hot topic of conversation in the physical therapy world. When I mention that I’m a PT, people often ask about their posture and what exercises will make it better. To be honest, this is a loaded question. There’s no one simple answer. If you asked 10 physical therapists, you’d probably get 10 different answers.