Ep 271 – Cool Muscles with Dr. Joe Muscolino

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0:01:06.0 Durren Buford: I'm Darren Buford.

0:01:07.0 KC: And I'm Kristen Coverly.

0:01:08.2 DB: And welcome to The ABMP Podcast, a podcast where we speak with a massage and bodywork profession. Our guest today is Dr. Joe Muscolino. Dr. Muscolino has been a manual and movement therapy educator for more than 30 years. He is the author of The Muscular System Manual and Kinesiology. He teaches continuing education workshops around the world and he has created Learn Muscles Continuing Education, a video streaming subscription service for manual and movement professionals. And he has created Muscle Anatomy Master Class, the most comprehensive and detailed muscle anatomy online class in the world. Visit learnmuscles.com for more information. We're so excited to speak with Joe today, Dr. Joe today, because of the September, October 2022 issue of massage and bodywork magazine, with his article, Cool Muscles Confessions of Anatomy Geek. You can find a nine of the cool muscles in the September, October 2022 print issue of Massage and Bodywork magazine and 11 additional cool muscles in the digital version, available online at massageandbodyworkdigital.com. Hello, Joe and Hello Kristin.

0:02:15.1 Dr. Joe Muscolino: Hi there Kristin, hi there Darren. How are you folks?

0:02:18.5 KC: We're great, and we're so excited to welcome you back to the ABMP Podcast. As Darren said, we're really focusing on your article in the September, October 2022 issue of Massage and Bodywork magazine about cool muscles. Joe, as the title of your article suggests, you are a self-professed anatomy geek, which we love, of course, because we are too. Tell us, when did your passion for anatomy first begin?

0:02:45.2 DM: Oh goodness, I think it developed over time. I knew I wanted to be a soft tissue manual therapist, I'm a chiropractor but very soft tissue oriented. I knew that back in high school, and then I got my bio degree and then I went to chiropractic school. But in the beginning, I think learning anatomy was something I had to do, and then I started teaching at a massage school one year out of chiropractic college. And again, when I was teaching it, I think I was teaching it because it was for the board exams, and I gradually came to understand that if you didn't understand anatomy structure, then you couldn't really understand physiology function, and if you didn't understand that, you couldn't understand pathophysiology, pathomechanics, pathofunction. And if you couldn't understand that, you couldn't figure out how to do... Assess for treatment. So I came to realize that anatomy structure is the fundamental basis, the foundation for everything that we do, and if we can't critically think from the anatomy, we can't creatively apply our skill sets. So, I think that took a number of years of really teaching and working with my patients.

0:03:58.7 DB: So Joe, you and I speak often, because you are a frequent author and contributor to massage and body work magazine, and we're always working back and forth on ideas. So, I'm curious, when you pitched the idea originally that came into Massage and Bodywork magazine, on the cool muscles article, what inspired you to create this?

0:04:16.1 DM: First, I have to say, when I was first pitching it, I really didn't know how it would be received because I thought it was just so kitschy, just so geeky, just saying cool muscles, that's when you came back and you immediately liked it, I was like, "Oh wow, this is so great", and I just geeked out doing the article, and that's why I think I thought of the subtitle, Confessions Of An Anatomy Geek. There are just some muscles that are so fascinating to me. I've been teaching muscles so long, I teach cadaver labs too for muscles and fascia, Let's begin by, if anyone reads the first paragraph of the article, they'll see that I first set this in the context that muscles are located within their kinematic chains for force production and within myofascial meridian chains for the continuities, but that we can still take a step back and look at any individual muscle for its own specific structure and function. And when we do that, I look at some muscles and they just have a personality to me. Maybe you'll ask about it later, but for example, the plantaris muscle, is this little muscle that I say has so much pluck. Its like its belly is three inches long, and then it has a long ribbony tendon that's like 12 to 16 inches long, and I always think in that story, The Little Engine that Could...

0:05:43.6 DM: That it just keeps going. I think I can, I think I can. I think I can. And when I teach it in cadaver labs, I show it and I say, "It's way up here, starting at the distal end of the femur, and it is determined to make it to the calcaneus."

[laughter]

0:05:57.8 DM: And by God it does. And it just has personality. And then I thought of all the other muscles that have some personality or some distinctive feature about them, whether it's structural or functional, and I just started making a list of one after the other, and I came out with... I was going to 10, but I couldn't stop at 10. So I said I'll do 15, then I said if I do 15, I'm leaving these out.

[laughter]

0:06:24.5 DM: And I finally settled on 20, but even then, I probably felt a bit unsettled about who I was leaving out.

0:06:31.4 KC: Okay, so let's talk about some of these muscles that made the list, and side note listeners, this was a really fun read. I was... I also was geeking out with you, Dr. Muscolino, as I was reading the article.

0:06:43.9 KC: So fascinating. And in addition to the muscles that are familiar, like the piriformis, psoas major, and teres major, there are others on the list that may be less well known, like the quadratus plantae and the coccygeus. So there's really deep, interesting information in the article, I can't wait for you to read it and tell us about it. Let's start talking about some of the muscles that are on the list specifically. So there's actually a pair of muscles on the list that are cool because of their relationship to each other, the flexor digitorum superficialis and the flexor digitorum profundus. Dr. Joe, tell us more about how their relationship makes them cool and how they made the list.

0:07:25.9 DM: This is one of the most elegant... Simple yet elegant formations in human anatomy that exists, and it just puts me in awe of how there might be a problem and the solution can be so easy and yet so incredible. And that is that we have two, what are called, long finger flexors, flexor digitorum flexes digits two to five: Index, middle, ring, little fingers, superficialis and profundus, one's more superficial, one is deeper, more profound, it's more profundus. And when you look at them, the superficialis ends on the middle phalanges of fingers two to five, but the profundus has to get to the distal phalanges. But the profundus is deeper. So when the superficialis ends on the middle phalanges of those four fingers, it blocks the way, it blocks the path for profundus to get to the distal, the more distal phalanx of each of those fingers.

0:08:30.4 DM: So it's so simple, the superficialis simply splits to go to the medial lateral sides of the distal... Of the middle phalanx, excuse me. The middle phalanx of that finger so that the profundus can just slip right between the medial and lateral slips to go to the distal phalanx. And that same basic contextual architecture is in the lower extremity, but that's with flexor digitorum brevis and flexor digitorum longus, the two similar muscles that have to have different names, you can't say deep and superficial there. And one's shorter and one's much longer, so brevis, the longest, works well, it's the same thing, in the foot, the flexor digitorum brevis ends at the middle phalanges and the flexor digitorum profundus ends at the distal phalanges, so you have that same split.

0:09:32.6 DM: And just to make a comparison too, I talked about a moment ago, plantaris, if you looked at the upper extremity, a muscle that's similar to plantaris would be the palmaris longus, which has a relatively short belly and then a long distal tendon, relatively. So it's always fascinating for me to not just look at a specific muscle, but also when it's in an extremity, to look at the cognit, the homologous muscle in the other extremity: Upper-lower, lower-upper.

0:10:08.5 DB: Dr. Joe, the adductor magnus got on the list because it's the body's most under-appreciated muscle, how does it earn that status?

0:10:17.5 DM: So, of course, it's not as if that has been sanctioned by some official organisation.

[laughter]

0:10:25.6 KC: That's Muscolino sanction, everyone. Yes?

[laughter]

0:10:29.9 DM: Yeah, that is right. I did step forward to say that when I was re-reading the article last night for the podcast this morning, I was saying, "Should I put adductor magnus as the most, should I have done that or should I have gone to teres major?" And that's like a 50-50 for me. But I think I'll go with adductor magnus. So, adductor magnus, first of all, is an incredible muscle, and it's so under-appreciated, to begin with, because from a superficial... I mean from an anterior view and from a posterior view, it's deep to other muscles. The adductor magnus is deep to the adductors longus and brevis, and gracilis to some degree from the anterior view.

0:11:11.0 DM: So if you're looking at an anterior view, you don't really see it, and if you look at a posterior view, it's deep to the medial hamstring, so you don't really see it. And a lot of people, unfortunately, don't look at medial views and lateral views. Or they don't look at deeper views. So you have to appreciate this muscle by either looking at a medial view, or better yet, looking at a deeper anterior view and a deeper posterior view. So right off the bat, it's kind of off the radar just by where it's located. And I liked once... I think it was Tom Myers once said that the adductor magnus is a shelf that the other adductors sit on anteriorly and the medial hamstring sit on posteriorly. And I have to say, Tom is always great at being creative with how he describes things, so that shelf visualization I think is wonderful.

0:12:06.8 DM: Then we look at it and say, "Well, when you look at it, it has a twist in its fibers, and there are two other muscles in the human body that have a twist in their fibers: Levator scapulae and latissimus dorsi. And when you look at why might a muscle have a twist: Well, the alternative is all the fibers are parallel, and if they're all parallel, they all have the same line of pull, some diagonal, oblique direction to them likely. But when you have a twist, lower fibers on one bone end up higher on the other, and higher fibers on one bone end up lower on the other. And although we can't really ascribe an intent for this, because I think evolution is really random selection of...

0:12:54.5 DM: Random mutations that are selected, natural selection. You can still say, "Well, what does it end up meaning in the end?" And what it means in the end is some of the fibers are more horizontal and some are more vertical. So you have a different line of pull for some of the fibers than other fibers. Or better to speak about some motor units compared to other motor units. And that gives the muscle a variety of function. And adductor magnus is one of the three muscles in the human body that has a twist in it. So even right there, that's fabulous. Come on, Chubby Checker, lets do the twist.

[laughter]

0:13:31.6 DM: Back in 1963 or '64 or something. And then beyond that, it's one of these transitional muscles. So if you were to take the hip joint, an adductor magnus is a muscle of the hip joint, you can look at the muscles in front and say, "Well, we have the hip flexors in front, we have the extensors in back, we have the adductors on the medial inside, we have the abductors, A-B ductors, on the lateral outside, but there's transitional muscles. So for example, going across the hip flexors in front, you get to pectineus. It's technically an adductor, but it's also a flexor. And it's innervated by the femoral nerve, which is for the flexor anterior compartment. But it is part of the adductor medial compartment. Well, if we keep going around, adductor magnus is the transitional one from the medial compartment to the posterior compartment. And it actually has two heads. An anterior head and a posterior head. And the anterior head is innervated by the obturator nerve of the medial compartment. But the posterior head is innervated by the sciatic nerve of the posterior extensive compartment. Extensor compartment. And in fact, the posterior head goes to the ischial tuberosity and there's an anal retentive kind of thing, folks.

0:14:55.9 DM: It's not ischial, it's ischial. You can look in all four major medical dictionaries, it's ischial tuberosity, ischium bone etcetera. So the posterior head of the adductor magnus goes to the ischial tuberosity. It is innervated by the sciatic nerve, it crosses the hip joint posteriorly, check, check, check, that makes it sound like a hamstring. And in fact, it is dubbed... It is named, as a nickname, the fourth hamstring. And even though that can be ascribed to the entire adductor magnus, it really fits for the posterior head. So there's just all these features about adductor magnus that are just so amazing, so wonderful, so distinctive.

0:15:45.6 KC: Let's take a short break to hear a word from our sponsors.

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0:16:26.3 KC: Hey life-long learners. Did you know that Elements Massage Studios are hiring? And at the top of their list, is curious massage therapists, like you. Elements Massage Studios are all about improving the lives of everyone they touch. For them, that includes giving you training in new skills, a supportive team and chances to grow a client list. If this sounds like it could be your new home, let them know we sent you by going to elementsmassage.com/abmp. That's elementsmassage.com/abmp.

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0:17:00.9 KC: Let's get back to our conversation.

0:17:02.7 KC: One of the muscles that gets cool status on the list is because of its unique anatomical function and path, and that's the Sartorius. Tell us more about that.

0:17:13.1 DM: Yeah, the Sartorius... Well, first of all, Sartorius is always one of these trivia question muscles, because it's like, "What's the longest muscle in the human body? What's the smallest muscle? What's the biggest?" Etcetera. Sartorius is the longest muscle in the human body, so there's one distinctive feature about it. Another distinctive feature would be that I love muscle names because muscle names are 99.9% reliable to tell you something about that muscle so that you don't have to memorize that something about the muscle. And Sartorius has a really cool name because it comes from the Latin word for tailor, someone who works with clothing. And Sartor, if we look at English, you can usually find a cognate term in English. So if someone has great Sartorial skill, it means they are a very good dresser, because tailors make clothing, they're good with choosing clothing. So if you say, "Well, why is it called the tailor muscle?" Well, before they were sewing machines, a tailor would sit kind of cross-legged. And to cross one leg over the other in the typical style, let's say I'm going to cross my right leg over my left low extremity, I want my right ankle on my distal anterior left thigh.

0:18:33.0 DM: So if you look at the positioning you need to achieve that cross-legged positioning, what you have to do is from anatomic position, you flex A-B duct laterally, externally rotate the thigh hip joint, and then flex the leg, lower leg at the knee joint. And those are the four major joint actions that one would learn first about the sartorius. You don't even have to memorize the actions in that regard, all you need to do is say, "I need to achieve this cross-legged position. What do I need to do it from the anatomic position?" Sagittal plane flexion, frontal plane abduction, transverse plane lateral rotation, by the hip and then flexion of the leg at the knee. And I'm in that position. So I would always tell my students, just know that it means tailor, cross-legged and you'll get there. And so that's another fascinating thing. But what's even more fascinating than that is the fact that the muscle starts on the anterior superior iliac spine, the ASIS. So, it's the anterior. And in fact, it's anterior and lateral. It makes its way distally, going more and more, medial and posterior, it crosses the knee joint posteriorly, and then comes back around the anterior again to attach onto the proximal anterior tibia at the Pes Anserine tendon attachment. So it's anterior, posterior, anterior. And that's very unusual.

0:20:09.5 KC: And of course, whenever we bring up something like this, the natural next question. I had a professor who once said any one answer usually brings you to another question and you keep going deeper and deeper until... As he would say, he was a philosophy professor, the final question is, "Who are we? Why are we here and what is God?" So, Sartorius, I'm sure could lead us there, but we could go back in evolution. And what the reasoning for this is, is if you look at quadrupeds, four-legged animals like cats and dogs, they are pre-flexed in their lower extremities. And if you look at the Sartorius, or even the Gracilis in them, it is a straight line muscle. But when we straightened out our joints, the fascia holding the sartorius and gracilis in place kept the muscle in anterior, posterior, anterior positioning, and now the muscle is no longer straight, it kind of bends around the knee and comes back again. So that, to me, is just incredibly fascinating. And something I don't even mention in the article, but you could say, is, whenever you're learning muscle attachments on... You're learning them on bones, classic bone attachments, it's always nice when you can put things in groupings. So, if someone says ASIS to me, I think Sartorius, but I think TFL, Tensor Fascia Latae.

0:21:38.8 KC: If someone says Pes Anserine tendon, I think Sartorius, I think Gracilis, and I think semitendinosus. If someone says coracoid process of the scapula, then I'm going to think Coracobrachialis Pec minor and short head of biceps brachii. I put them in groupings instead of each one being separate. And I'll leave one more critical thinking, geeky thing about this. When I said, you can figure out the joint actions of Sartorius by knowing its tailor, really, you figure out all joint actions of all muscles by simply looking at the line of pull relative to the joint, which means where the line of pull crosses relative to the access through the joint, assuming it's axial motion we're looking at, and you shouldn't even have to have a gimmick for Sartorius tailor muscle, you should never memorize any joint action of any muscle, any motion pattern of any muscle, you can figure out the joint actions, the oblique plane motion pattern based on the line of pull.

0:22:43.1 DB: So Dr. Joe, you mentioned with regard to learning strategies. For the listeners who are inspired to deepen their muscle knowledge but feel a little bit overwhelmed, can you share your advice for how they can do that effectively? Where should they start?

0:22:57.4 DM: When I started teaching 36 years ago at a massage school, I started teaching the way the syllabus was set up from before me, which was one muscle at a time. And I started to find that, that was really too myopic. It didn't look at big picture first. So I gradually transitioned my teaching style and my writing style in my textbooks and in my videos, when I have the content in written or video format, to instead say, "Let's start with some general guidelines here." So if we're looking at the hip joint, any muscle that crosses the hip joint with any vertical-ness to its direction of fibers has to flex the thigh at the hip joint. It will bring the anterior surface of the femur of the thigh, toward the anterior surface of the pelvis. Any muscle that crosses the hip joint posteriorly with any verticalness to it must extend the thigh at the hip joint. Any muscle on the outside, lateral side, must A-B duct, any on the inside must A-D duct, adduct. And then when you look at rotations in the transverse plane, you look at how they wrap around. If they wrap from medial to lateral, as they go from pelvic bone to femur or whatever way we would look at it.

0:24:25.9 DM: Piriformis, for example, is a lateral rotator because it goes from medial to lateral on the posterior side. And when we're visual, which we cannot be as easily in a podcast, I literally just place my hand from my pelvic bone to my femur with the heel of my hand on, let's say, the ASIS and the fingers being wrapped to the lateral side. And I say, "This is TFL." And if you pull the fingers toward the heel of the hand, the lateral surface of the thigh toward the ASIS, you'll pull into medial internal rotation. And you put a hand in the back side for Piriformis, and you pull and you show a side rotation. You look at line of pull and you look at functional groups. Anterior line, posterior line, lateral line, medial line, and then rotations.

0:25:12.3 DM: And I'll leave it at something else here too. I read a quote the other day that I really loved, and they said, "The hardest thing about life is not learning. It's unlearning." So to me, I think very often what happens is a lot of people, or whatever it would be, individuals, teachers, when they teach... Textbooks, when they teach, they teach without giving the critical thinking guidelines. Instead, what they do is they just present. And they don't give the understanding of why we're doing what we're doing and then people memorize things sometimes, unfortunately. And then when they have to go to the critical thinking, they have to unlearn what they thought they were doing to now re-contextualize everything in this critical thinking picture. And I bring this up now because...

0:26:04.6 DM: When I teach from the outset, something like muscles of the hip joint, I say, Well, look, instead of the distal attachment being pulled or the proximal attachment for a hip flexor muscle, for example, there are 12 hip flexors in front, you could pick Psoas Major as one of them, or iliacus or TFL, or adductor longus, pectineus, etcetera. Instead of pulling the anterior surface of the thigh toward the anterior surface of the pelvic bone, you could pull the anterior surface of the pelvic bone down toward the anterior surface of the thigh, the femur, and that's the reverse action. That's origin toward insertion.

0:26:43.8 DM: That is what's called closed chain. There is a kinematic chain of elements: Pelvis, thigh, leg, foot. And the distal segment, the foot, is fixed on the ground, and therefore it can't move, so the proximal element moves instead. So the pelvis moves toward the femur, if we're looking at bones here. And actually, in the low extremity, when you're in Gait cycle, 60% of the time, you are closed chain, which means 60% of the time, it's gonna be origin moving toward insertion, which is the reason why I don't like origin insertion terminology. I probably get that pet peeve of mine in every one of our podcasts, right, Kristen? Right, Darren? So I like to say just proximal attachment, distal attachment. But my point is, all hip flexors are anterior tilters of the pelvis. All hip extensors are posterior tilters. All hip abductors for the thigh are depressors, lateral tilters of the pelvis, and all of the ones on the inside, adductors, are elevators in the same side, pelvis, and all lateral rotators of the thigh, femur at the hip joint are contralateral rotators of the pelvis, and all medial rotators are lateral rotators of the pelvis. The point is, I introduce closed chain right from the outset, so the student or the therapist immediately gets the big picture idea that a muscle is simply a pulling machine, and it can pull bone A to bone B or bone B to bone A.

0:28:19.2 DM: It never chooses one or the other, it's just whichever has less resistance to moving will do the moving. And what will those movements be? Just look at the line of pull relative to the joint that it's crossing. And it is the simplest way to look at things. And it's so uncomplicated, and it gives you the flexibility to open up toward all of the functioning of the body later. So you asked me, Darren, about how I teach. That's how I teach muscle function.

0:28:50.4 DB: I wanna thank our guest today, Dr. Joe Muscolino. To find out more information about Joe and the good work he's doing, visit learnmuscles.com. Thanks, Joe, and thanks, Kristen.

0:28:58.8 DM: Thank you very much, Kristen. Thank you, Darren, it's always a pleasure to be here.

0:29:04.7 KC: Dr. Joe, thank you for being an anatomy geek and for sharing your passion today and bringing some of these muscles to life. I hope everyone listening goes to Massage and Body Work, September, October 2022 issue to read the full article. You will love doing deep dives into each of the 20 muscles. So fun.

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