One of the things I love most about anatomy is that you can never know it all. Even if you have memorized all the muscle locations and attachments on paper, every person’s body is unique and will present tissues differently. Plus, hearing anatomy from a new perspective always provides fresh insight. Because we were in a PT school, it was also interesting to hear Dr. Beth’s perspective on ideas I have discussed with other YTU instructors.
We discussed the nervous system in greater detail than I have since college. It was good to review what I learned at the university in a relevant way. One of the things Dr. Beth mentioned was that the point of the muscle that presents with a knot tends to be the same site where the nerves enter the muscle (the neuromuscular junction). This can be one cause of the tenderness when you roll or massage over a knot. The sensation may be a combination of feedback from the tight tissue, the nerve being stimulated, or both. She then said that it might be more beneficial to move away from the knot and work on surrounding tissues that were also tight.
This reminded me of a concept my teacher, Jill Miller, has said: “Think globally, not locally”. Just because the pain is presenting in a specific spot does not mean that the site is the source of the pain. When we think globally, and take the entire person’s body into perspective, many times we can find other potential sources of the pain. Instead of worrying just about the specific pain at that spot and numbing it, why not look globally for the source of the pain and solve the problem permanently?
I was again reminded of this concept when looking at the lower limb of one of the forms. The body had a large bunion on the left foot and the left knee presented with more joint wear and damage then the right knee. In fact, the medial epicondyle of the femur (inside edge of the knee) was totally worn away and jagged, instead of smooth like the lateral (outside) edge. You can only imagine the pain it must have been for this person to walk.
It was incredibly interesting to see the global affect of what I initially thought was a postural habit. A bunion is not a lone ranger, and tends to come along with other permanent bony changes. It ended up that this woman had only four toes on her left foot! This could potentially explain why a bunion would form (if she was turning her left foot out because it did not provide as much support as the 5-toed right foot), and the excessive wear on the medial (inside) compartment of her knee. If this woman were alive, dealing with a bunion through surgery or other corrective measures would only be working with a tiny piece of the problem and completely ignoring the structural and postural issues that caused the bone spur in the first place. Besides, I will never know if the missing toe is the cause of the issue, as we can only make up stories based on what we find in cadavers.
So, the next time you go to roll on a gristly knot, instead of torturing yourself on the hot spot, roll in the surrounding neighborhood. It may be just the release your tissues were kneading.