Ep 81 - Rectus Abdominus: The Quilted Belly Protector, The Rebel MT, with Allison Denney

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0:01:24.4 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.

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0:02:10.3 AD: For this first episode, I would like to dive into a general overview of how the body works. No, I'm not gonna lecture on the levels of organisation of cells and tissues, and then add links to power points that might trigger a little PTSD from when you were in school. Instead, I'm going to become a bit vulnerable and talk about one of the biggest struggles I've had since I was a kid. And again, no, I'm not going to make this podcast a self-indulgent opportunity to vocalise my inner strife while ruminating in the sound of my own voice. What I am going to do though is compare notes on how we think to how we perform. There are unbelievable similarities between the deep thoughts we process and the profound workings of our anatomy. Not just in the physiological correlations of self-care and happiness, even that I tend to question sometimes, 'cause when depression hits, depression hits, if you know what I mean.

0:03:01.2 AD: My comparisons lie more in the philosophies of human tissue, the psychology of muscles, the attitude of connective tissue. The "family dynamics" that flare up from squeezing these not yet fully evolved mentalities into a tiny space held in place by your skin. Here is what I mean. All of my life I've been told that I should listen to my gut. "What does your gut tell you?" my mom would ask when I couldn't decide what instrument to play in middle school. "What do you feel in your gut?" my teacher would ask when I couldn't figure out how to write down a thought. What should I wear today, my brain would taunt me knowing I couldn't make a decision to save my life. These questions made it seem like everyone else knew what their guts were talking about and I was the only one without a direct line to my viscera. Asking me what I wanted for dinner would sometimes throw me over the edge, not because I was sick of deciding what to eat, but because the simple question thrusted me into a deep debate about whether or not I should choose something good for me, so that everyone admired me for being healthy or smart, or if I should choose something I really wanted, because my taste buds were screaming for a burger and fries and a milkshake.

0:04:16.4 AD: Over the years I have found some peace between these parts of who I am. Ultimately, I think we all have many sides to us. This makes the whole listening to your gut idea seem less intimidating. Your gut doesn't have all the answers, after all, there are a heap of parts that make up the whole of you, and they all deserve a fair trial. What I wanna emphasise here is that our muscle tissue operates in largely the same manner. For the sake of this podcast, I'm focusing on skeletal muscle tissue, you know the ones that attach to bone, and we call out by name. Although the idea that this is also true for smooth and cardiac muscle tissue is deliciously tempting to examine, but that's for another episode. Let's say, for example, that your rectus abdominis suffers from the same conflict. It is being told by everyone, its family members, the transverse abdominis and obliques, its neighbours, the glutes and the psoas, and its unseen God/deity/universal presence, the brain, that it should do some sit-ups. And it really wants to be respected in the core community, but at the same time, it hurts every single time the sit-ups happen. So no, it doesn't really wanna pull the front of the rib cage to the front of the pelvis today, thank you very much.

0:05:30.6 AD: Also, at the same frustrating time, the diaphragm is advising it to do the exact opposite, not to contract, but to relax. Because how is the diaphragm supposed to pull air all the way into the lungs when the rectus abdominis is sore and grumpy? Belly breathing has not been a favourable fad for the six-pack. You can see how this would create a bit of an insecurity issue. The question becomes, how do we handle an insecurity when it comes to psychology? What is the most effective way to talk to a child or a partner who is deeply unsettled? How do you manage your own needs when what you actually want is not quite what you should want? Whatever your answer is, this then is how we approach the insecurities of your rectus abdominis. Here are the details.

0:06:21.9 AD: The stats we learned in massage school are specific. The rectus abdominis is one of four abdominal muscles. It originates on the pubic symphysis and the pubic crest, meaning, it starts in the front of the pelvic bone, and it inserts on the cartilage of the fifth, sixth, and seventh ribs, which means it shoots up and latches on to the lower part of the front of the rib cage. It also hangs on to the xiphoid process, which is a thin pointy tail at the base of the sternum. This funny little bony landmark seems to serve as a solid grasp for this muscle the same way a rock climber looks for that perfect ledge to ensure its security. The other noteworthy detail is that these insertions are also shared by the ever-demanding diaphragm, which as I mentioned before, has a very clear agenda. Do you think signals ever get crossed here? My bet would be, yes.

0:07:14.2 AD: The rectus abdominis is also a superficial muscle, which means it is closer to the surface than its brethren. It has two sides which are separated vertically by a line of connective tissue called the linea alba, and it has multiple bellies that are separated horizontally by similar connective tissue lines called the tendinous intersections. All of these lines are like stitches in a quilt that give it its six-pack appearance you can see from the outside on someone who doesn't have an indecisive rectus abdominis. These bellies are then held into place by the abdominal aponeurosis. This, by the way, is one of my favourite words, apo coming from Greek origins, meaning away or to change into, and neurosis also Greek, meaning sinew, which is the part of a structure that binds it together or to something else.

0:08:03.5 AD: We've got a couple of these in our body, but here in the front of the torso, this flat sheet of connective tissue is aptly named the abdominal aponeurosis. The rectus abdominis has a cavity of organs and viscera as a backdrop. This means that there is no hard surface that is going to push back if you press too hard into this muscle in the same way that the femur might push back as you sink into the hamstrings, or that the scapula might stand firm as you drop into the infraspinatus. So, direct from compression and friction are out of the picture as far as techniques go. It does though have a pretty serious job, it's a postural muscle, a core muscle, and a protector of the aforementioned guts and viscera. So it may be vulnerable, but it is also quite capable of some serious rigidity.

0:08:51.2 AD: Lastly, it's responsible for forward flexion of the vertebral column and the tilting of the pelvis posteriorly. In other words, bringing your nose to your knees and your knees to your nose. Maybe the contrast between where it is and what it is responsible for is a lot of pressure for this little guy to handle. I don't know, something to think about. What techniques work then? This is where listening comes in. Let's say we are detecting some hesitation, the client complains of inconsistencies and random cramps. Maybe it needs a little coaxing, a little passive assisted movement to get it going, from a supine position have your client bend their knees and place their feet on the table. Slide your hands behind their knees and guide them towards their chest as the client works internally to do the same. Or let's say we think there might be some pretty serious underlying tension, perhaps a good night sleep will do the trick. Nice relaxing effleurage strokes to ensure it gets that deep REM sleep that is so important to healing.

0:09:51.1 AD: Again, with the client supine bolstered under the knees to encourage that total relaxation, use a broad flat palm or finger pads to sooth these fibers from their anxieties. Following a clockwise general direction will remind the large intestine lingering in the background that you come in peace. Or maybe we suspect that it is overworked and exhausted. It may just need to vent, like we all do with a good night out with your friends after a long week. Resistance-infused contraction with homework and a specific regimen will do the trick to get the steam out. Similar to how a workout might feel when frustrations are high, the engagement of the client's energy here can help direct the tension and focus the approach. This can be done in a multitude of fashions and can be utilised as a PNF, an AET, or simple active stretching. Client supine, knees bent, feet on the table, apply a little resistance and see if they can bring their knees to their chest, or arms crossed over their body, apply a little resistance and see if they can bring their shoulders to their knees.

0:10:55.2 AD: Client's side lying, targeting one side at a time, standing on the posterior side, lift the top leg, hold at the knee and ask them to bring that leg up to their belly while you pull back in the opposite direction. With all of these interactions, once the client has let go of trying to resist what you were pushing against, the rectus abdominis has led off a little heat and can now relax into chill mode. Then if you want, you can revisit the REM sleep trick mentioned before. There are oh so many approaches for this quilted belly protector, if you can truly understand what it is asking for, you can create a sweet combination of techniques, approaches, and tactics that will cater to that particular muscle on that particular visit. Knowing what each muscle needs is not a blanket statement that we can dole out to all clients. Listening to a client, listening to a muscle, listening to all the variables that lead up to that visit on that day, this is the key.

0:11:52.7 AD: So, how does the body work? I have no idea, but I do know that I have learned a lot about myself from listening to my gut, to my muscles, to my joints, to my heart. They are all wanting to be heard, your job as a massage therapist is to listen to it all. 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. I always wanna hear your questions, comments, suggestions, or salutations. 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 dabblings.

0:13:06.3 AD: 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. Tune in next time as we explore the journey of how we start so squishy as babies, to what makes us tough as adults and the necessary survival tactic the plantar fascia has adapted along the way.

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