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Musculoskeletal Illustrations

Years ago, I started creating my own illustrations. I wanted my manuals to display illustrations that struck a balance between simple and clear. After studying other illustrators’ work, I began to see the advantages and disadvantages of different styles (realistic, line drawings, photos, etc.). However, I also found that even very respected illustrators like Frank Netter of the Color Atlas of Human Anatomy or B.D. Cummings from Myofascial Pain and Dysfunction, The Trigger Point Manual, had errors. Somehow, the errors in those revered texts both discouraged and encouraged me.

The Basic Idea

HOI - supraspinatus

Origin, Insertion

As I worked, I realized that trigger points could be activated and de-activated by manipulating nerve endings in joints. More than that, the specific way that the joint was displaced determined which trigger points were activated in the muscles that crossed that joint. Applying this understanding, I made great progress in addressing clients’ issues—even those who had already seen many other practitioners without success.

So, I started illustrating musculoskeletal anatomy in a way that focused on the local joints of those muscles. I put them on a slide show in my treatment room. I would glance up from my work and have epiphanies about the anatomical relationships. Even those I had worked with for years.

Supraspinatus is a simple example.  Note that in this illustration,

  • The bone where it originates (scapula) is blue.
  • The bone where it inserts (humerus) is green.
  • The glenohumeral joint is the local joint.

HOI - scalenus posticus

Trapped Bones

The posterior scalene is a little more involved.

  • It originates on C4-C6.
  • It inserts on the second rib
  • C7-T2  are trapped between the bones of origin & insertion
  • The intervertebral joints from C4-T2 and the costovertebral joint of T2 are local joints.

It is interesting that the scalene is difficult to release with lasting effect without releasing the displaced rib at C2, which proprioceptively governs the scalene trigger points.

This simple color coding of bones makes it easy for the bodyworker to comprehend how to release trigger points through local joint work. The implications of what to do and treatment sequence become clearer by understanding which bones and joints are trapped between the origin and the insertion point.  This creates easier treatment, muscles that relax and contract more completely, and, thus, longer-lasting results.

In this case, it is interesting to see how many muscles wedge the lower cervicals between their origin and insertion. It made my checklist for faster, longer-lasting treatment more effective.

iliocostalis cervicis - string diagram

String Diagrams

Here’s another example: a string diagram of iliocostalis cervicis. This illustration says a lot about the contribution to pain between the shoulder blades and in the base of the neck.

By the way, because of the attachment of ribs on the sternum, other ribs could be considered in the joints between the origin and insertion. Unless they are the only joints between origin and insertion (like levator scapula), I don’t highlight those tertiary joints created by the rib cage. I don’t find them to be relative in joint work for that muscle, and they can make the illustration very confusing.

Revealing Common Structural Problems

Looking for what may be compressing the base of the neck? This illustration of semispinalis cervicis is very interesting and not often considered as other muscles come more immediately to mind because of their positioning to the pain pattern.

I’ve chosen a simpler, less organic style and focused less on more subtle fascial attachments. In this way, I can highlight the relationships of muscles and joints.

Relationships in Layers

Translucent illustrations show how one muscle fits and works in relationship to others. This illustration shows how gluteus medius, gluteus minimus, and gluteus maximus all share a vector of pull that pushes the foot posterolateral.

Synergists Working Together

This illustration shows the layers of extrinsic chest muscles that depress the pectoral girdle. This illustration is seldom seen but very helpful for the therapist, who wants to understand what may need to be worked when shoulders are slumped.

I also love this view of the axial skeleton.

I’m always working on new views and perspectives that help bodyworkers. Your comments or suggestions are appreciated.

[email protected].

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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.

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