Ep 122 — Nature vs. Nurture, The Coracobrachialis: “The Rebel MT” with Allison Denney

0:00:00.2 Speaker 1: With SE Connect, you can learn a 15-minute comprehensive manual therapy treatment that will set you apart from other massage therapists. SE Connect is the only multi-disciplinary platform with practice tools, business tools, and a community of practitioners speaking the same language. Check it out at network.structuralelements.com.

0:00:25.6 Speaker 2: Anatomy Trains is happy to announce our return to the dissection lab in person, January 10th through the 14th, 2022 at the Laboratory of Anatomical Enlightenment in Boulder, Colorado. We are thrilled to be back in the lab with Anatomy Trains' author Tom Myers and master dissector, Todd Garcia, join students from around the world and from all types of manual, movement and fitness professions to explore the real human form, not the images you get from books. This is an exclusive invitation, e-mail at info@anatomytrains.com, if you'd like to join us in the lab.

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0:01:08.0 Allison Denney: Hi, my name is Allison Denney, and this is the Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow, but the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peek at what's under the surface.

0:01:55.5 AD: You know the debate, nature versus nurture. Are we born this way, or do we learn to be this way? There are good points in both camps, but because I like balance and I need a starting point for this podcast, we're gonna go with a little of both. Also, this is what research is claiming, we genetically inherit certain traits at birth, and as we grow up, we also learn particular aspects of how we behave, but instead of detailing one and then the other, I wanna investigate how these two sides of the debate actually intertwine and can offer some insights into how we look at anatomy, here is what I mean, there are leaders and there are followers, if you think about human history, my bet is that you could name at least 10 leaders who have commanded an audience, you may not agree with their ideas, but a leader is obvious when you see one, you might even be able to name a few in your local community, a teacher perhaps, or a business owner, even within your immediate friend group, I would wager that you couldn't think of a friend who tends to feel like the head honcho of your crew.

0:03:01.8 AD: Leaders are leaders because they lead. It's what they do. Then there are followers. Clearly, by nature, there are a lot more followers than there are leaders, could you imagine if the majority of humans were leaders, pretty sure the chaos we experience now would pale in comparison to what that might look like, most people are good with having someone else on stage, they may have strong opinions and perhaps they have a solid influence on some of the decisions made at the top, but for the most part, people sitting in the back seat are good with that driver being in control, it is arguably a lot easier there. There may be natural born leaders and there may be those who are very comfortable with someone else at the helm, but what happens when a follower decides that they want to be a leader? Or more to the point, they are thrown into the position of having to be one. Do they just become one? Is it as easy as taking a masterclass from some celebrity and learning the necessary skills?

0:04:04.1 AD: I would offer theories on what it would be like when a leader wants to become a follower, but that veers away from the point I'm trying to make here, plus the whole follower becoming a leader thing, I have a little experience with this one, not that I'm about to run for president, but I find myself sitting in a role as someone who other people in my field turn to for advice, and I also find myself often feeling very uncomfortable with it. It's not that I don't know what to say, or feel lost with what my answers might be, I feel uncomfortable because I was born a follower, and the mental shift I've had to make around accepting this role has been unbelievably insightful as to how what we think of ourselves runs deeper than we may be able to access, like into the cellular matrix deep, like maybe this is the nature part making its case, but it got me thinking, I am positive that our muscles feel exactly the same way.

0:05:02.0 AD: Say, they were born into a person who has behaved in a certain manner their whole lives, the soft tissue under the skin has settled into and are very comfortable with their roles. What happens then, when this person starts new habits or starts patterns that are not particularly balanced and healthy, and certain muscles begin to wither away while other muscles step in and have to take over, pain is usually the big red flag here, waving around, trying to get the brain's attention, but how do we handle this kind of imbalance, is it as easy as demanding that the muscles fall back in line, is it as easy as going to the gym and starting a new training regimen? I don't think so.

0:05:45.2 AD: I think we can get most of the way there with some basic strategies, but then there is this deep blockade, this wall that seems impenetrable, like that last little bit that would get you back to feeling normal, but will just never fully be realised. Sitting in a position of power when it's not in your nature is a very deeply philosophical pickle, not every person can be a natural born leader, and so similarly, not every muscle can be a prime mover. But it happens, whatever the reason may be, sometimes a synergist or helper muscle is thrown into the limelight and shouldered with great responsibilities. What do we do then? How can we as bodyworkers understand when this might be happening with a client, and how then can we best approach this quandary?

0:06:33.4 AD: I'll talk about techniques in a minute, first though, I wanna highlight a muscle that seems to fall into this debacle frequently, the coracobrachialis, located on the inside part of the upper arm, the coracobrachialis is named for its location and attachments, which always helps, Coraco indicates its connection to the coracoid process of the scapula, and brachialis refers to its general location in the arm. The word brachio is derived from the Greek brachion, meaning arm, and you see this play out not only in anatomy, like biceps brachii and the brachial plexus, but also in everyday terms like bracelet or embrace, so it originates up there at the coracoid process, that little protrusion of bone arising from the scapula and poking its way to the front of the shoulder, then drops down along the anterior and middle side of the upper arm and settles its insertion onto the medial surface of the mid humeral shaft, which just means it connects onto the middle part of the arm bone along the inside surface.

0:07:39.2 AD: This little guy enjoys the nickname of the armpit muscle, just medial and deep to the biceps brachii, the coracobrachialis is responsible in aiding the pectoralis major and the anterior deltoid with flexion of the arm. This is what your shoulder does when you reach out to shake somebody's hand or open a door or grab a steering wheel to drive a car, this just means that when we flex the shoulder, the pec major and the anterior deltoids are the prime movers or natural leaders, but there are other muscles that help, because it takes a village, you know, namely the coracobrachialis. In the soft tissue therapy world, this is known as a synergist or a natural helper, they are like the executive assistants who run around behind the scenes and keep the leader looking good. Shoulder flexing check, keeping my job today, the coracobrachialis is also tasked with helping the latissimus dorsi and the teres major pull the arm into a deduction or bringing the arm back down to your side.

0:08:42.0 AD: The funny thing about a deduction of the arm though, is that it is often not so much inaction as it is a position of tension, it is one of those things one might do if they find themselves aggravated by colleagues or irritated by crowds. It is protective and forceful and stems from the internal emotions that build walls, not just to keep the disturbances out, but also to keep the unpleasantries in, keep this in mind as we meander through techniques in a bit, but what happens when the pec major gets weak or the anterior deltoids lose their way, or the lats and the teres major never fully reach their potential? They were born into these leadership positions, but circumstances have knocked them down, perhaps they were born into a bookworm and never got exercised, maybe they were born into a person with scoliosis and activity was limited, or maybe they were born into somebody who was painfully shy and the posture that followed was sunken and small. What do you do with a muscle who, during the job interview agreed to help the prime movers stay on task and look good in the public eye, but now finds itself doing pretty much all of the work and is starting to question reality?

0:09:57.2 AD: The coracobrachialis is after all a synergist, a follower, it never wanted the limelight, it never wanted the responsibility, it was very happy hanging out in the shadows, here we stand though with a small spindly muscle sitting in a position of authority and questioning the meaning of life, it's doing a pretty good job, but deep down, it doesn't believe in itself, it feels the urge to sink into the shadows, it fights the exhaustion every day with a pep talk and a mantra, it needs help. What techniques work then? How we handle a muscle that is by nature a synergist and has found itself in the position of a prime mover is comparable to how we might handle a friend who is by nature a follower and has found themselves in a leadership role, a lot of support. With a client in a session, asking the right questions is the key to understanding the situation, the first and most important piece of information you can have is if this is a circumstance that can or cannot change, as in life itself, if you can change something that needs to change, figure out how to do it, if there are circumstances that cannot be changed, find acceptance and a new path.

0:11:17.1 AD: For example, has the pec major been injured to the point where it can no longer function normally, or have the lats never learned how to engage and your client is older and not willing to change. In these instances, the coracobrachialis needs all the help it can get. Awareness to where it is and what it does is your main goal, client supine, undrape the arm of the affected side, so if the right shoulder is feeling the issue undrape the right arm, palpate the coracoid process and follow the coracobrachialis down the medial aspect of the upper arm. Once you have located this slide immediately onto the pec major, standing to their side with your right hand on the pec major, have them lift their arm up off the table using your left hand as resistance, bring awareness to your client about where the pecs are, what they feel like when they are contracting and their relationship to the pain in their shoulder, repeat this process with the anterior deltoids, and then again with the biceps brachii, as you isolate each of these muscles and ask them to perform on the spot, you may notice that some are better than others at following directions, each of them has a slightly different agenda and ability to be self-aware, but all of them should be firing when asked.

0:12:36.8 AD: This isn't always the case though. Now, drop down into the coracobrachialis, use the same steps to isolate this muscle and have it contract, if your findings confirm your suspicions and it is indeed picking up the slack that the other big players have dropped, it's time to offer some support, like any tired muscle it's just looking for some relief, warm up the tissue, petrissage it, up and away from the humerus and pull it away from the surrounding layers, apply some detailed myofascial release, separating it out linearly from the biceps and vertically from the deltoids and the pec major. Give it a little room to move, air to breathe and new blood flow for nutrients.

0:13:18.8 AD: In a different scenario, it's possible that the situation can be overturned, for example, has your client been doing certain exercises improperly and contracting the wrong muscle tissue? Like an incorrect hand positioning for pushes or a shifted shoulder position for lat pulls. These little variations can call upon the wrong muscles, and the next thing you know, you've got a first mate in the captain's chair. In this instance, re-engaging the primary shoulder flexors offers the coracobrachialis a break, client supine, start with isolation of the coracobrachialis this time, with one hand drawing awareness to the muscle, use your other hand to create a resistance into shoulder flexion, playing around with the position of the client's arm will draw out contractions to the varying muscle fibres, so take your time and methodically create a contraction that highlights the coracobrachialis, pain with this action is just a positive indicator that you're on the right path.

0:14:20.4 AD: Once you have brought your client's awareness to how this muscle is wrongly being called into action, place one hand on each of the surrounding prime movers of shoulder flexion and ask your client to consciously utilise these to bring the arm up off the table. Once the connection from the brain to the right muscles is starting to click, employ a methodical repeating activation of each of them as you set the new neural pathways into play. I always contend that repetition is the key to education and here is a great example. Have your client repeat these contractions, hold your resistance, sink into the tissue that is contracted, continue to sink in once the muscle has relaxed, then rinse and repeat, asking a muscle to move when it is very used to not moving is like asking a person who is depressed to start thinking positively, it's not easy and it will take time.

0:15:15.6 AD: Remember that one of the jobs of the coracobrachialis involves holding the arm tight against the torso in an attempt to guard against the world, there are deep, deep psychological patterns at play here, and it will take time. It is hard to create new perceptions, but then one day after many attempts, it just happens naturally. So is it nature or is it nurture that dictates who we are and what we do? I think the better question is: How do we recognise each of them when they show up, and more importantly, how do we get them to communicate with each other, the answer, as is true for most of life, is to listen. 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, that's R-E-B-E-L-M-T@abmp.com.

0:16:22.0 AD: I always wanna hear your questions, comments, suggestions or salutation, 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 dabbling. I'm impressed you've made it all the way to the end, but because you have, allow me to offer a glimpse into our next episode.

0:16:50.8 AD: Tune in next time as we take a drive down the road called sciatica, there are a lot of forks in the road. And therefore, begs the question, how do we make a decision and ultimately, how do we apply ourselves?

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