Head Shoulders Knees and Toes: Kids songs and muscular relationships

Do you remember the song “Head, Shoulders, Knees, and Toes?” I happen to live with a four year old who loves all things bone, so these songs are very much a part of my consciousness.  I always find it remarkably funny how much these “body” songs are connected to the work that I do.   “Head, Shoulders, Knees, and Toes” is clearly a song about the first scan in a postural assessment.  First, I see if the head is even between the shoulders, I look to see if one shoulder is higher than the other, I see if the knee caps are pointing straight forward, I check where the toes are pointing, and then I look back at the knees to see if they line up with the toes.  There you have it: head shoulders knees and toes, knees and toes! Throw in some pelvis alignment and we’ve got ourselves a kid’s song!  Of course there’s more to it, but that’s where I start.  These bony landmarks are a great way to assess the relationships within the musculoskeletal system, which brings me to this week’s installment of “how do you remember all that?” Last week I talked about the Latin names of muscles as pneumonic devices that actually make it easy to remember them, this week I’ll talk about remembering muscular relationships because in actuality there would be no “Head, Shoulders, Knees and Toes” without the relationship between fascia, muscles, and bone.  I’ll finish with a story about a client who benefited directly from knowledge of these relationships.

The following memory tricks are based on the work of Tom Myers who developed Anatomy Trains as a way of analyzing muscle relationships in function.   When you are remembering relationships, muscular names are not necessary to achieve great function.  Tom Myers would go so far as to say that perseverating on the actions of individual muscles might even impede healthy function.  In real life no muscle acts alone, so isolating individual muscles does not create functional strength.  In general when I think of muscle groups I think Back, Front, Side, Inside and Spirals…These of course correlate to Tom Myers’ Superficial Front Line, Superficial Back Line, Lateral Line, Deep Front Line, and Spiral Line (along with his arm line and functional lines) The lovely thing about Tom Myers’ work is that while the theory can explain incredibly complex ideas with great detail and accuracy, it’s simplicity can also be broken down for anyone to understand and use for greater movement efficiency.

When I think of the Back of the Body (Superficial Back Line), I think of the bottom of the foot, the back of the lower leg, the back of the thigh, the back of the hips, the spine, the back of the neck and the skull wrapped around to the forehead.  These body parts work together to propel the body forward, hold the body upright, and bend the body backwards.     

When I think of the Front of the Body (Superficial Front Line), I think of the top of the toes, the front of the shins, the front of the thighs, the belly, the chest, the front of the neck, and the face.  These body parts curl the body into a ball, help us bend forward, and pull our body forward through space.

When I think of the Side of the Body (Lateral Line), I think of the bump on the side of the ankle (lateral malleolus), the side of the lower leg, the side of the thighs, the side of the hip, the waist, the side of the ribcage, and the side of the neck.  These muscular relationships help us bend to the side, and transfer weight so that we can lift one foot while walking.

When I think of the Inside of the Body (Deep Front Line), I think of the deep fascia in the foot, behind the bones of the lower leg, the inner thighs, the inside of the pelvis, right along the front of the spine, and believe it or not the tongue.  These muscular relationships are our center or our core.  They move the legs, stabilize the pelvis, and hold us up from the inside (think of a tent pole).

When I think of Spirals in the Body, I imagine a rubber band or string that connects the right ear to the left shoulder blade, then it wraps around the left side of the ribcage, and runs across the abdomen to the right hip.  Then this rubber band continues down the right inner thigh, moves around the front of the right lower leg, wraps around the bottom of the foot from the inside of the ankle to the outside of the ankle. Our imaginary rubber band continues to move up the side of the lower leg, and then up the back of the thigh.  Phew…I like to think of these Spiral relationships as the balancers in the body.  Imagine this scenario: If imbalances on the inside of the body cause the ribcage to rotate to the right, then the spirals in the body can adjust the head neck and shoulders so that anyone with this spinal rotation doesn’t have to spend his or her life walking around in a circle (yay for homeostasis).     

Now of course these descriptions are quite simplified. Basically I reduced Anatomy Trains into five paragraphs, which in many ways is a travesty to the depth of information in this fabulous book.  But if you’ll forgive me, I want to explain how I used the simplicity of this in depth theory with a client recently.  This person returned to The Pilates Studio after a time away, and as she was communicating the “status” of her body, she talked about a shoulder that was causing pain.  After some conversation, we both determined that probably there was some sort of impingement in the shoulder, and I certainly had a few movement recipes in mind for her shoulder.  Then she said something that gave me pause.  She talked about feeling tightness over her entire body.  She has some scoliotic rotations in the spine, which we had worked with in the past, but the stiffness she spoke of was not something I had heard from her before.  This led me to a different strategy with her, even though I knew what I wanted to do for her shoulder I decided to postpone shoulder specific exercises for a few sessions.  

First we worked with the relationship of the back of the body to the front of the body. We bent forward and backward, we released tight spots and strengthened weak spots.  We played with flexion and extension of the spine.  We worked to make the bottom of the feet malleable, and we played with flexion and extension of the ankle and the hip.  Then we began working with the side of the body and the inside of the body.  We flexed the spine from side to side.  We strengthened the side of the hips. We lengthened the muscles that run in front of the spine. And finally we played with spirals.  I used the very simplified information as a structure to choose Pilates exercises, and my only goal was to relieve the feeling of stiffness.  The funny side effect was that well, her shoulder started feeling better before I ever addressed it directly.  It wasn’t perfect, but the range of motion improved, and the pain decreased.  By the time we started working with shoulder motion directly, we were working with a shoulder that was not as acute as the beginning of her sessions.

Now one of my pet peeves is using an anecdotal story (like the one I just told) and then spouting causal relationships as if the anecdote of one person’s movement experience proves anything.    I could list so many other things that could have contributed to this client’s decrease in shoulder pain.  There was no “control” in our work together, we were simply two people problem solving and moving together.  We allowed ourselves to be creative, and now I have another anecdote that I can add to the plethora of anecdotes that have shaped my practice over the years. 

Well then what do I know? I do know that working with muscular relationships rather than isolating individual muscles will create a powerful movement experience for any person.  I also know that if you watch a baby rolling around on the floor, you will see that we are born with this innate knowledge that somehow disappears.  I also know that “Head Shoulders Knees and Toes” has been running through my head since I started writing this post, and I hope that I have not passed that onto you.  But beyond that I am simply a mover that is teaching other people to move, and if you’re still wondering how I remember all that…Just think about all of the connections in your world that allow you to remember all that you do, and well that’s how I remember all that.

Katrina Hawley C.M.A, R.S.M.E

Co-director of The Pilates Studio