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Alright so let's get into the muscles
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now, and I want you guys to try to think
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through this process. I know the answers are on the board, I'm not taking them
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away from you, but let's try to think through this. So the first muscle up
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there is your serratus anterior, yeah, your serratus anterior if i remember
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correctly
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inserts into the vertebral or medial border of your scapula, which is which
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side? Which side of my scapula is my vertebral or medial border? Touch it,
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palpate it, this side right the inside. Now it courses underneath my scapula
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wraps around and it originates on the top eight ribs, you guys cool with that.
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You guys know this muscle, you guys ever seen bodybuilders and they do this thing,
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they're like dude I'm so huge my lats got teeth. You guys know what I'm talking
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about. No you have no idea. You guys know what I'm talking about those little
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little teeth that come out right here, that's not your lat that's your serratus
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anterior poking out, in fact the name serratus comes from what, it looks like a
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serrated knife right, it's that shape. Well if it attaches from ribs to scapula
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what joint is it going to move, not my shoulder, my scapula right. We kind of
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said that these two joints, we say we can kind of combine them, and we call it
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movement of the scapulae right. So we're talking about the scapula. So that's the
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joint, what are my joint actions for my scapula, let's make a little word bank.
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Protraction, retraction, who are we missing? Good.
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So we know that the serratus anterior is going to move my scapula, and these are
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my scapular joint actions. Now we just have to figure out which joint actions
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my serratus anterior is going to cause. Well is my serratus anterior
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going to move my ribs? Probably not much. Ribs don't like to move all that much.
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It's definitely going to pull my scapula then towards my origin, which is going to
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look like what? What is this muscle going to do when it contracts? Right so is it
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going to do this? Show me, if you can't tell me show me. So what joint action is
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that? Protraction, right protraction. Now the other joint action the serratus
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anterior does is a little complicated too, well it's not complicated it's just
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not as easy to visualize. So what ends up happening is, if, what would happen to my
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scapula if my seratus anterior pulled the bottom of my scapula in this
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direction? What joint action would I have?
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Upward rotation.
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That's it, we're done with serratus anterior. Was that terrible? Yep that was
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terrible, okay on to the next muscle. Should we do PEC minor, sure why not, why
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not do the PEC minor. So my PEC minor
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originates from ribs three four and five, and inserts into my coracoid process. So
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it's a muscle on the front here right. So
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draw the front of my scapula, my little coracoid process here. Put some ribs in
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little PEC minor.
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You guys want to feel your PEC minor. I'm going to show you how to palpate your
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PEC minor, which direction are those fibers? More or less vertical right. Which
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way does your PEC major run across? So your PEC major is on top of your PEC
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minor, so we need to feel through your PEC major. So what you're going to do is
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you're going to kind of relax your PEC major. On the outside of your PEC major
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here you're going to strum this way, and what you'll start to feel if you kind of
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dig in there, is you'll start to feel like some vertical guitar strings that
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you can kind of strum over, that are probably pretty tender. Some
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of you guys a little tender? These guys tend to get pretty tight, yeah, no. Is
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anybody having a problem feeling their PEC minor? I can come over and help you
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palpate. I don't have a problem with this. Who can't feel their PEC
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minor, everybody's going to feel their PEC minor. Alright so your PEC minor is right,
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right and those fibers right there. So you guys are probably just not pressing
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hard enough, or your pressing too far over, those guys right there, those guys
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right there. Everybody everybody I touch just like oh god yes these muscles have a
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tendency to get tight, sore. Everybody got it, you got it? Press deep, it's right here.
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Alright so what do these fibers do? What do these this muscle do? What joint
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actions? Well what joint does it cross?
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What joint? Not shoulder joint, shoulder would be the combination of my humerus
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and my scapula, this goes from ribcage to scapula, which means who is it going to
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remove? Scapula alright. So what joint actions do you think this muscle can do?
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Protraction it's on the front, that's a good guess.
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What else? Depression right, yeah it has that vertical arrangement, it's going to
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want to kind of pull this way, right. If it pulls on the outside corner that way,
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what happens? And a little downward rotation, nice job. That's PEC minor. Yes
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ma'am great question. So traditionally origins and insertions have been based
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on, origin is the more stable of the two attachments of the muscle, but that
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doesn't always work out. You will see some textbooks where it's written
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proximal and distal attachment right. Generally origins are more proximal,
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that's not always the case. Let me tell you how much I care about which one's
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the origin and which ones the insertion.
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Initially guys you don't even have to memorize the origins and insertions. If
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you can memorize the bones and visualize roughly where they're at on the bone,
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you're in good shape. Later origins and insertions will mean a lot more to you
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as you get more into like pathology and problems that happen, and injuries that
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happen, then you have to start understanding origins and insertions a
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little bit better right. Now your big thing today, what bone does it attach to?
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What joint does It move? What direction is it going to move that joint in? That's
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it right, slowly but surely. You can add origins and insertions later, and
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honestly whether you flip them it doesn't matter. I mix up origins and
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insertions all the time. As far as which ones which, guess how much it affects my
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practice, oh my god did you see what he did he touched the insertion and he
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thought it was the origin, haven't been fired yet for that one. You're okay, all
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right. Trapezius, you guys know where your traps
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are? Do you know why your trapezius is called your trapezius? It's shaped like a
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trapezoid. What's the trapezoid shape,
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it's a kite shape right. You guys know that? So you guys are doing good in
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kinesiology and you did great in geometry, is what you're telling me, um. So
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yeah trapezoid is a kite shaped, and that's how your traps are shaped. That's
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a trapezoid, there's a lopsided trapezoid, let's change this chest a little bit.
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Everybody's cool with that all right let's, the funny thing about the trap is
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it's actually kind of like three muscles.
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Too big, that's not going to work all right. Head, spine everybody's good with that?
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All right now let's draw the trap. So we have upper trap that goes from the
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acromion process and spine of the scapula to external occipital
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protuberance. down your ligamentus nuchi, which is looking at in your spine,
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and into maybe the top thoracic vertebrae. Then you have more middle
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trapezius, it connects to kind of this midsection of the spine in your scapula,
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and then some more of those middle thoracic vertebrae. You guys still cool?
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Maybe this one actually comes off more like this, and then you have your lower
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trapezius which goes from spine of scapula all the way down to t12. So you
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got upper, middle and lower.
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So the trapezius goes from spine to scapula. What's it going to move? Your
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scapula for the most part. All right now let's start with the upper, that's that's
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this fiber direction right here. What joint actions do you think the upper
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trap is going to cause? Maybe some elevation, you guys think that's a good
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that's a good call, that's a good call. So we got a little bit elevation, what else?
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Yeah pulls on this outside edge here right, so if it pulls up on the outside
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edge isn't my scapula going to want to do that? Yeah so it'll contribute to some
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upward rotation. What is the middle one's going to do? These guys. Which one? A
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muscle can't do two opposing joint actions. Yeah if it contracts it's
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going to retract.
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What about my lower traps, what are they going to do? Depression, that's good call.
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I think they'll pull this way.
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What else, and that picture started out looking so clean and now it's beginning
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to look like a mess, sorry about that. Start over.
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Just do one scapular again,
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and the purple marker is dying all right. So I had my upper guys pulling this way,
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i have my middles pulling this wa,y and my lowers pull in this way. So my lower
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will do depression, what else will it do?
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Whew we have, we have a debate going? I heard one upward rotation and one
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downward rotation, which one is it going to do mmm. You guys remember my pinwheel
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analogy? You guys want to change your answer, can you guys see this, if I pull
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down on this inside corner what happens to my glenoid fossa, it goes up right. Did
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you guys see that if I pull down here, this goes up. Upper trap pulls from the
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outside, which is why it also goes up.
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Does that make sense? Cool you guys are cruising through the scapulae muscles,
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cruising. Levator scapulae with a name like levator scapula, what do you think
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is a joint action this muscle might contribute to? Elevation, thank you thank
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you. Sometimes we get to give me in the PT or in the anatomy world, you got to take
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them when they come alright. So let's do levator scapulae.
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Levator scapula, what joint are we moving again? Yeah i'm going to guess with
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levator scapulae is the name, we're also going to be moving the scapula. Given
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that it has an origin on the superior angle of the scapula, and then an
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insertion into the transverse processes of C1 through 4. Alright so up on
00:18:0400:18:09
the top of the cervical spine, it kind of looks like this. What joint actions do we
00:18:0900:18:22
got? Elevation, but you're not done. So i agree with you its elevation, it will
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definitely do some of this. but if it pulls on this corner what happens to
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this? Yeah it's a downward rotator. So by pulling up on this corne,r that causes
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this guy to go down that way. So it makes sense? Cool.
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You guys ready for rhomboids.
00:19:0600:19:15
Rhomboids there's a major and a minor, but for we can think about them as one
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muscle for the most part. They go from C7 to T5 alright, C7 to T5 on the spine to
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the medial border of the scapula. Why are they why are they called rhomboids,
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because they're shaped like a rhombus.
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Alright if they go from spine to scapula what are they probably going to
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move? Scapula, based on the direction of their fibers what joint action is it going
00:19:5300:20:07
to be good at? I like that, what joint action is that? Retraction. So you have a
00:20:0700:20:18
muscle its shape like this, yeah it's going to pull this way, anybody want to
00:20:1800:20:21
take a guess on what rotation it does?
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Everybody's cooled down word, but you guys got that pretty quick huh. So yeah
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you can kind of see how in this direction it would pull a scapula here
00:20:3900:20:47
right, or another way to look at it is if I upwardly rotated my scapula what would
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happen to my rhomboids? They get stretched out right, which means when
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they contract they pull me back down into downward rotation. Does that make
00:20:5700:21:06
sense? Alright you guys are killing it, killing it. So I think we're ready for
00:21:0600:21:17
our first graph, go to page 11. So I'm going to make you kind of flip stuff, all
00:21:1700:21:20
the answers you need we've already gone over, but I'm just kind of flipping how
00:21:2000:21:26
you look at this. So what I want you to do is how many boxes do you guys got? One
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two three four five six seven eight so they can, in that graph I
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included anterior and posterior tipping as the last two boxes, you can skip those
00:21:3700:21:44
if you want. I want one joint action per box for the six joint actions we have up
00:21:4400:21:51
here. You're then going to tell me what plane each one of those joint actions is,
00:21:5100:21:59
what muscles are responsible for each joint action, and a sample exercise for
00:21:5900:22:04
each joint action, you guys good with this? I'll give you a big hint on the
00:22:0400:22:11
muscles, there's at least two muscles per joint action. In fact for most of the
00:22:1100:22:15
joint actions there's only two muscles. There is a couple where a third muscle
00:22:1500:22:23
could be added. You guys got, how much time you need, five minutes. You guys can
00:22:2300:22:29
confer with each other, and then we'll throw it up on the board.
00:22:3400:22:39
Alright so what are my joint actions guys?
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So I got protraction, retraction, what else? Upward rotation, downward rotation,
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elevation and depression. What plane is protraction in? Transverse. What plane is
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retraction in then? Transverse. Upward and downward rotation? Frontal.
00:23:4600:23:56
What about elevation and depression? Frontal.
00:24:0000:24:05
Alright we already knew that from earlier today. So now let's add the the
00:24:0500:24:12
muscles to this. Who will protract the scapula? Serratus anterior is actually
00:24:1200:24:22
your primary protractor so you guys can put a star by that one. Who else?
00:24:2300:24:27
Pectoralis minor.
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Who wants to pick an exercise, what's an exercise that includes protraction? Maybe
00:24:4700:24:53
not pull ups. Bench, bench, anything anything, we in fact we could generalize
00:24:5300:25:01
a little bit and just call it pushing. Anytime you push something you want to
00:25:0100:25:06
protract your scapula. What about retraction ,what are the muscles that
00:25:0600:25:21
retracts? Middle trapezius and rhomboids.
00:25:2300:25:35
What's an exercise that would include retraction? Reverse fly sure. If
00:25:3500:25:45
pushing includes protraction, what probably includes retraction? Pulling.
00:25:4600:26:00
Upward rotators? Serratus anterior, thank you big important one. This is one of the
00:26:0000:26:06
ones that has three muscles, upper and lower traps.
00:26:1200:26:24
What's an example of an exercise with upward rotation? Lateral raise sure.
00:26:3100:26:38
Downward rotation? Pectoralis minor
00:26:4400:27:14
and levator scapula and rhomboids, nice job. What's an exercise? Pull up sure.
00:27:2000:27:29
Elevation, who's going to elevate? Upper trap and levator scapulae.
00:27:4100:27:48
Exercise? Shrugs.
00:27:5500:28:06
Depressors? PEC minor and lower trap.
00:28:1200:28:22
Exercise, that one's a tough one right, we don't really do a lot of exercises with
00:28:2200:28:36
just depression. No dip would pull you into depression. maybe the top of a dip
00:28:3600:28:41
right like if you really try to push through the top, I could see that top of
00:28:4100:28:46
a dip. There's a physical therapy thing,
00:28:4600:28:50
something called a functional pushup.
00:28:5200:29:03
I'll show you guys what this is so people for example who have lost some of
00:29:0300:29:07
their lower extremity function right, they don't, they're not able to use their
00:29:0700:29:13
legs real well, and you got to teach them how to get around to bed, and if you can
00:29:1300:29:19
get them sitting how could I have them scoot side to side on a bed with limited
00:29:1900:29:22
lower body function?
00:29:2600:29:35
Right so that's scapular depression right and then they shift over. Cool
00:29:3500:29:38
little movement pattern. Alright so you guys could write that down as an example.
00:29:3800:29:43
How'd you guys do on that graph? At the very least you have a nice little
00:29:4300:29:46
study guide for the scapular muscles right, and that's all the scapular
00:29:4600:29:53
muscles, that's it from us, you guys nailed it.