DOCSLIB.ORG

Posture and Voice

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Posture and Voice Care of the Professional Voice ASSOCIATE EDITOR: Robert T. Sataloff, MD, DMA Posture and Voice John S. Rubin Lesley Mathieson Ed Blake The necessity for proper posture The larynx is suspended from the pendicularly oriented shoulder gir- has been recognized by singing teach- base of the skull, not by direct bony dle; vertically over the hip joints and ers for centuries. However it has taken attachment, but by a series of mus- the pelvis; and vertically over the for- the medical community (and the gen- cles and ligaments. It could, in one ward facing feet. A plumb line through eral public) longer to recognize its sense, be considered to be in the cen- the coronal plane formed by the ears value. ter of a constant battleground between would pass directly over the plane of Recently, the importance of pos- the deep extensor and flexor groups of the shoulders and hip joints. The eye ture to well being has become popu- muscles of the neck and upper back. plane is horizontal, the rib cage is neu- larized through the works of authors Additionally, it even could be tral. The spine "rests in the pelvis such as Alexander, 1 Pilates,2 Felden- viewed as a victim in this struggle due much as a person sits in a rocking krais,3 and others. Physiotherapy and to its location in the front of the neck, chair. "s It has four curves. The sacral osteopathy have become integral to its dense muscular attachments to the and thoracic curves are concave ven- the field of sports medicine, and to tissues in front of the cervical spine, trally, the lumbar and cervical curves rehabilitation of musculoskeletal and its connections to the trachea. are convex. injuries. Only very recently, however, Furthermore every time that we swal- In our society, however, this ideal has consideration of such sciences low, the larynx is forced to move up state of affairs rarely happens. Many been applied to voice research and and down in the neck. The strong of us spend most of our time, both at rehabilitation. The authors believe muscles that connect the larynx to work and leisure, in a seated position that it is helpful for singers to be famil- the bottom of the tongue bring it in front of various consoles or screens. iar with the latest concepts and per- upwards when we swallow. The rib- We tend to sit slouched, with our legs spectives on posture from the medical bon-like (strap) muscles connecting it crossed, pelvis tilted, stomachs com- and alternative medical literature. to the sternum (chest-plate) are the pressed and lower back stretched. It major muscles bringing it downwards. is not surprising that chronic lower Rolf has described the ideal state back pain is a problem of enormous journal of singing, January/February 2004 of posture as "equipoise" in which magnitude in our society. Volume 60, No. 3, pp. 271-275 .4 Copyright 2004 the individual stands upright The We shall now look at the muscles National Association of'Feachers of Singing head is held vertically over the per- in the neck around the spine, and try JANUARY/FEBRUARY 2004 271 John S. Rubin, Lesley Mathieson, and Ed Blake to understand how they might affect a b the larynx. The posterior extensors of the back, the "erector spinae," support and span the spine. The major action of the erector spinae is to maintain the C upright position of the body. When standing at rest, the center of gravity lies just in front of the second sacral vertebra. Body movement, however, frequently carries the center of grav- ity forward. This mass of muscle is ED then required to restore the upright position (Figure 1). The muscles attached to the skull produce extension, lateral flexion, and —h C Figure 2. Suboccipital muscles a. Semispinalis Capitis: b. Rectus Capitis Posterior Minor; c. Occiput; d. Obliquus Capitus Superior; e. Obliquus Capitis Inferior; f. Rectus Capitus Posterior Major; g. Atlas; h. Axis R. Ger, P. Abrahams, and T R. Olson. Essential C!inicalAna.tomy, 2nd ed. (New York: Parthenon h Publishing Group; 1996). rotation of the head .6 One group, the We shall look at all these muscles suboccipital muscles (the muscles now from a different perspective. attached to the occiput), permits accu- Muscular involvement of the cervi- rate positioning of the head and thus cal spine can be categorized into sta- lets us see in 3-D. These muscles bility and mobility activities. Stability extend and rotate the skull (Figure 2). muscles control the head and neck in They are countered by the deep a neutral position, thereby minimiz- muscles of the anterior neck that twist ing the various pressures (loads) the head on the neck and flex the neck placed on the cervical spine when we (bend it forward), including the move around. The longus colli is the ru scalenes and prevertebral muscles. primary anterior muscular stabilizer These muscles attach from the cer- of the cervical spine. This is impor- Figure 1. Deep neck muscles: Erector vical spine down to the upper two tant, as becomes clear below. spinae and Transversus Spinalis ribs (the scalenes), to the upper tho- Mobility muscles are the prime a. Occiput; b. Semispinalis Capitis; c. Atlas; racic spines (longus colli), or up to movers of the head, neck, and shoul- d. Semispinalis Cervicis; e. C 7; f. Semi- the skull base (longus capitis).79 der girdle. They serve also to provide spinalis Thoracis; g. Longissimus Capitis; In addition four more superficial a stability mechanism in the event of h. Iliocostalis Cervicis; i. Iliocostalis muscles, the sternocleidomastoid, 1ev- reduced muscular support from the Thoracis;j. Iliocostalis Lumborum; k. Longissimus Cervicis; 1. T 12; m. ator scapulae, trapezius, and the sple- longus coll. Examples of mobility mus- Longissimus Thoracis; n. Pelvis nius, bind the neck to the shoulder cles include the stemocleidomastoid, girdle. When the neck has a muscular trapezius, and levator scapulae. Adapted from R. Ger, P. Abrahams, and T. R. Olson. Essential Clinical Anatomy, 2nd ed. (New problem, they can also become impor- It must be pointed out that this is York: Parthenon Publishing Group; 1996). tant in neck movement (Figure 3))0 simplistic. Among other factors, the 272 JOURNAL OF SINGING Care of the Professional Voice on a raked (canted) stage, will more bone. in particular, we postulate that likely than not cause the performer one of these muscles, the stylohyoid to lean his or her head up, or, in more muscle that connects the hyoid to the anatomic terms, put the upper and base of the skull, shortens (Figure 3). mid cervical spine in a substantial In so doing, in its resting position, it degree of extension. Alternatively, in causes the larynx to rise up in the nonsingers, shorter individuals have neck, thereby changing the shape of a tendency to tilt their heads upwards the vocal tract, altering resonance and when in the presence of taller indi- pitch.' viduals. Taller individuals have a ten- We also believe that a higher posi- d dency to stoop, with one postural tion of the larynx in the neck reduces element including leaning forward the efficiency of the voice as we reach and extending the head on the neck. for higher notes and can ultimately The problem here is as follows: this cause a reduction in the upper part forward position of the head results in of the pitch range (how high we can increasing pressures on the joints sing). What we believe happens (this Figure 3. Superficial neck muscles, lat- between the vertebrae, especially if it is anecdotal, and not yet proven) is eral view becomes a habit, which it often does. that a muscular imbalance occurs a. Stylohyoid; h. Posterior Belly of It can also cause pressure (compres- between the muscles that raise and Digastric; c. Sternocleidomastoid; d. sion) on these (facet) joints. This also lower the larynx, particularly the sty- Trapezius; e. Hyoid; f. Oniohyoid; g. causes long standing changes in some lohyoid and sternohyoid. The short- Clavicle; h. Anterior Belly of Digastric of these supporting muscles. In par- ening of the stylohyoid thereby resists ticular, the erector spinae muscles in upper and forward movement of the stiffness of the upper thoracic spine in the back go into chronic contraction hyoid bone and thyroid cartilage dur- itself can have an influence on cervi- and become overly powerful. In the ing singing. This, in turn, alters vocal cal spine motion. If it is stiff going front there are changes in the resting fold length and tension, leading to into extension, this then can require length of the longus colli. This puts potential loss of the singer's top range, increased movement from the cervi- the longus colli at a significant in addition to the presence of breathy cal spine to achieve a functional range mechanical disadvantage. Because it phonation. of extension. Over time, this increased is the main anterior stabilizer of the Others believe that shortening load has potential to cause hypermo- cervical spine, this is probably along- (chronic contraction) of the cricothy- bility of certain segments of the cer- term problem.12 roid muscle also may occur) 4 This vical spine versus their proximal and The tug of war changes in favor of could be postulated to occur in re- distal segments. other muscles. The sternocleido- sponse to the laryngeal elevation Furthermore, as the cervical spine mastoid, levator scapulae, and upper described above, or even to the for- often has inappropriate muscular sta- trapezius are relative "winners" and ward position of the larynx due to the bility, as discussed above, there is a pull the upper cervical spine into even cervical spine being held extended.
Load more

Recommended publications
  • Identification of the External Branch of the Superior Laryngeal Nerve During Thyroidectomy
    ORIGINAL ARTICLE Identification of the External Branch of the Superior Laryngeal Nerve During Thyroidectomy Nitin A. Pagedar, MD; Jeremy L. Freeman, MD, FRCSC Objectives: To determine the feasibility of identifica- sition according to Cernea classification and correlation tion of the external branch of the superior laryngeal nerve with patient and gland characteristics. (EBSLN) during routine thyroidectomy and to describe the EBSLN position according to the Cernea classifica- Results: Three of 178 EBSLNs (1.7%) could not be iden- tion system. tified using the routine technique. The EBSLN was found in the highest-risk position (Cernea type 2b, crossing the Design: Prospective case series. superior vascular pedicle below the upper border of the gland) in 48.3% of cases, and in the lowest-risk position Setting: Academic tertiary care center. (Cernea type 1, crossing more than 1 cm above the up- per border) in 7.3%. Specimens larger in weight and in Patients: One hundred twelve consecutive patients un- dimension were correlated with type 2b nerves. dergoing hemithyroidectomy or total thyroidectomy by the senior author between August 15 and December 31, Conclusions: The EBSLN can be routinely identified dur- 2007. ing thyroidectomy. Moreover, many EBSLNs are in po- sition to be at high risk of injury during ligation of the Interventions: None. superior vascular pedicle. Main Outcome Measure: Proportion of EBSLNs iden- tified. Secondary outcome measures included EBSLN po- Arch Otolaryngol Head Neck Surg. 2009;135(4):360-362 TUDIES HAVE SHOWN THAT SUB- identified than in cases in which no search jective voice disturbance after was performed. thyroidectomy is very com- Anatomic studies have sought to delin- mon,1,2 even without injury to eate the course of the nerve near the supe- the recurrent laryngeal nerves.
    [Show full text]
  • Superior Laryngeal Nerve Identification and Preservation in Thyroidectomy
    ORIGINAL ARTICLE Superior Laryngeal Nerve Identification and Preservation in Thyroidectomy Michael Friedman, MD; Phillip LoSavio, BS; Hani Ibrahim, MD Background: Injury to the external branch of the su- recorded and compared on an annual basis for both be- perior laryngeal nerve (EBSLN) can result in detrimen- nign and malignant disease. Overall results were also com- tal voice changes, the severity of which varies according pared with those found in previous series identified to the voice demands of the patient. Variations in its ana- through a 50-year literature review. tomic patterns and in the rates of identification re- ported in the literature have discouraged thyroid sur- Results: The 3 anatomic variations of the distal aspect geons from routine exploration and identification of this of the EBSLN as it enters the cricothyroid were encoun- nerve. Inconsistent with the surgical principle of pres- tered and are described. The total identification rate over ervation of critical structures through identification, mod- the 20-year period was 900 (85.1%) of 1057 nerves. Op- ern-day thyroidectomy surgeons still avoid the EBSLN erations performed for benign disease were associated rather than identifying and preserving it. with higher identification rates (599 [86.1%] of 696) as opposed to those performed for malignant disease Objectives: To describe the anatomic variations of the (301 [83.4%] of 361). Operations performed in recent EBSLN, particularly at the junction of the inferior con- years have a higher identification rate (over 90%). strictor and cricothyroid muscles; to propose a system- atic approach to identification and preservation of this Conclusions: Understanding the 3 anatomic variations nerve; and to define the identification rate of this nerve of the distal portion of the EBSLN and its relation to the during thyroidectomy.
    [Show full text]
  • Larynx Anatomy
    LARYNX ANATOMY Elena Rizzo Riera R1 ORL HUSE INTRODUCTION v Odd and median organ v Infrahyoid region v Phonation, swallowing and breathing v Triangular pyramid v Postero- superior base àpharynx and hyoid bone v Bottom point àupper orifice of the trachea INTRODUCTION C4-C6 Tongue – trachea In women it is somewhat higher than in men. Male Female Length 44mm 36mm Transverse diameter 43mm 41mm Anteroposterior diameter 36mm 26mm SKELETAL STRUCTURE Framework: 11 cartilages linked by joints and fibroelastic structures 3 odd-and median cartilages: the thyroid, cricoid and epiglottis cartilages. 4 pair cartilages: corniculate cartilages of Santorini, the cuneiform cartilages of Wrisberg, the posterior sesamoid cartilages and arytenoid cartilages. Intrinsic and extrinsic muscles THYROID CARTILAGE Shield shaped cartilage Right and left vertical laminaà laryngeal prominence (Adam’s apple) M:90º F: 120º Children: intrathyroid cartilage THYROID CARTILAGE Outer surface à oblique line Inner surface Superior border à superior thyroid notch Inferior border à inferior thyroid notch Superior horns à lateral thyrohyoid ligaments Inferior horns à cricothyroid articulation THYROID CARTILAGE The oblique line gives attachement to the following muscles: ¡ Thyrohyoid muscle ¡ Sternothyroid muscle ¡ Inferior constrictor muscle Ligaments attached to the thyroid cartilage ¡ Thyroepiglottic lig ¡ Vestibular lig ¡ Vocal lig CRICOID CARTILAGE Complete signet ring Anterior arch and posterior lamina Ridge and depressions Cricothyroid articulation
    [Show full text]
  • The Role of Strap Muscles in Phonation Laryngeal Model in Vivo
    Journal of Voice Vol. 11, No. 1, pp. 23-32 © 1997 Lippincott-Raven Publishers, Philadelphia The Role of Strap Muscles in Phonation In Vivo Canine Laryngeal Model Ki Hwan Hong, *Ming Ye, *Young Mo Kim, *Kevin F. Kevorkian, and *Gerald S. Berke Department of Otolaryngology, Chonbuk National University, Medical School, Chonbuk, Korea; and *Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, California, U.S.A. Summary: In spite of the presumed importance of the strap muscles on laryn- geal valving and speech production, there is little research concerning the physiological role and the functional differences among the strap muscles. Generally, the strap muscles have been shown to cause a decrease in the fundamental frequency (Fo) of phonation during contraction. In this study, an in vivo canine laryngeal model was used to show the effects of strap muscles on the laryngeal function by measuring the F o, subglottic pressure, vocal in- tensity, vocal fold length, cricothyroid distance, and vertical laryngeal move- ment. Results demonstrated that the contraction of sternohyoid and sternothy- roid muscles corresponded to a rise in subglottic pressure, shortened cricothy- roid distance, lengthened vocal fold, and raised F o and vocal intensity. The thyrohyoid muscle corresponded to lowered subglottic pressure, widened cricothyroid distance, shortened vocal fold, and lowered F 0 and vocal inten- sity. We postulate that the mechanism of altering F o and other variables after stimulation of the strap muscles is due to the effects of laryngotracheal pulling, upward or downward, and laryngotracheal forward bending, by the external forces during strap muscle contraction.
    [Show full text]
  • 6. the Pharynx the Pharynx, Which Forms the Upper Part of the Digestive Tract, Consists of Three Parts: the Nasopharynx, the Oropharynx and the Laryngopharynx
    6. The Pharynx The pharynx, which forms the upper part of the digestive tract, consists of three parts: the nasopharynx, the oropharynx and the laryngopharynx. The principle object of this dissection is to observe the pharyngeal constrictors that form the back wall of the vocal tract. Because the cadaver is lying face down, we will consider these muscles from the back. Figure 6.1 shows their location. stylopharyngeus suuperior phayngeal constrictor mandible medial hyoid bone phayngeal constrictor inferior phayngeal constrictor Figure 6.1. Posterior view of the muscles of the pharynx. Each of the three pharyngeal constrictors has a left and right part that interdigitate (join in fingerlike branches) in the midline, forming a raphe, or union. This raphe forms the back wall of the pharynx. The superior pharyngeal constrictor is largely in the nasopharynx. It has several origins (some texts regard it as more than one muscle) one of which is the medial pterygoid plate. It assists in the constriction of the nasopharynx, but has little role in speech production other than helping form a site against which the velum may be pulled when forming a velic closure. The medial pharyngeal constrictor, which originates on the greater horn of the hyoid bone, also has little function in speech. To some extent it can be considered as an elevator of the hyoid bone, but its most important role for speech is simply as the back wall of the vocal tract. The inferior pharyngeal constrictor also performs this function, but plays a more important role constricting the pharynx in the formation of pharyngeal consonants.
    [Show full text]
  • Vocal Cord Paralysis
    Vocal Cord Paralysis What Is Vocal Fold (cord) Paresis And Paralysis? Vocal fold (or cord) paresis and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles). Paralysis is the total interruption of nerve impulse resulting in no movement of the muscle; Paresis is the partial interruption of nerve impulse resulting in weak or abnormal motion of laryngeal muscle(s). Vocal fold paresis/paralysis can happen at any age – from birth to advanced age, in males and females alike, from a variety of causes. The effect on patients may vary greatly depending on the patient’s use of his or her voice: A mild vocal fold paresis can be the end to a singer's career, but have only a marginal effect on a computer programmer's career. What Nerves Are Involved In Vocal Fold Paresis/Paralysis? Vocal fold movements are a result of the coordinated contraction of various muscles. These muscles are controlled by the brain through a specific set of nerves. The nerves that receive these signals are the: Superior laryngeal nerve (SLN), which carries signals to the cricothyroid muscle, located between the cricoid and thyroid cartilages. Since the cricothyroid muscle adjusts the tension of the vocal fold for high notes during singing, SLN paresis and paralysis result in abnormalities in voice pitch and the inability to sing with smooth change to each higher note. Sometimes, patients with SLN paresis/paralysis may have a normal speaking voice but an abnormal singing voice. The recurrent laryngeal nerve (RLN) carries signals to different voice box muscles responsible for opening vocal folds (as in breathing, coughing), closing vocal folds for vocal fold vibration during voice use, and closing vocal folds during swallowing.
    [Show full text]
  • Parts of the Body 1) Head – Caput, Capitus 2) Skull- Cranium Cephalic- Toward the Skull Caudal- Toward the Tail Rostral- Toward the Nose 3) Collum (Pl
    BIO 3330 Advanced Human Cadaver Anatomy Instructor: Dr. Jeff Simpson Department of Biology Metropolitan State College of Denver 1 PARTS OF THE BODY 1) HEAD – CAPUT, CAPITUS 2) SKULL- CRANIUM CEPHALIC- TOWARD THE SKULL CAUDAL- TOWARD THE TAIL ROSTRAL- TOWARD THE NOSE 3) COLLUM (PL. COLLI), CERVIX 4) TRUNK- THORAX, CHEST 5) ABDOMEN- AREA BETWEEN THE DIAPHRAGM AND THE HIP BONES 6) PELVIS- AREA BETWEEN OS COXAS EXTREMITIES -UPPER 1) SHOULDER GIRDLE - SCAPULA, CLAVICLE 2) BRACHIUM - ARM 3) ANTEBRACHIUM -FOREARM 4) CUBITAL FOSSA 6) METACARPALS 7) PHALANGES 2 Lower Extremities Pelvis Os Coxae (2) Inominant Bones Sacrum Coccyx Terms of Position and Direction Anatomical Position Body Erect, head, eyes and toes facing forward. Limbs at side, palms facing forward Anterior-ventral Posterior-dorsal Superficial Deep Internal/external Vertical & horizontal- refer to the body in the standing position Lateral/ medial Superior/inferior Ipsilateral Contralateral Planes of the Body Median-cuts the body into left and right halves Sagittal- parallel to median Frontal (Coronal)- divides the body into front and back halves 3 Horizontal(transverse)- cuts the body into upper and lower portions Positions of the Body Proximal Distal Limbs Radial Ulnar Tibial Fibular Foot Dorsum Plantar Hallicus HAND Dorsum- back of hand Palmar (volar)- palm side Pollicus Index finger Middle finger Ring finger Pinky finger TERMS OF MOVEMENT 1) FLEXION: DECREASE ANGLE BETWEEN TWO BONES OF A JOINT 2) EXTENSION: INCREASE ANGLE BETWEEN TWO BONES OF A JOINT 3) ADDUCTION: TOWARDS MIDLINE
    [Show full text]
  • Cervical Spine and Cervicothoracic Junction Alexander R
    46 Cervical Spine and Cervicothoracic Junction Alexander R. Riccio, Tyler J. Kenning, John W. German SUMMARY OF KEY POINTS the approximate cervical spinal levels for the purposes of the skin incision. These include the hyoid bone (C3), thyroid • Understanding the anatomy of the cervical spine and cartilage (C4-5), cricoid cartilage (C6), and carotid tubercle neck is of the utmost importance for the surgeon (C6). These landmarks, however, may not be universally reli- operating in this region. able because, depending on a patient’s body habitus, they may be difficult to palpate reliably; moreover, the relationships are • The anatomy of this region can be classified from only an estimate and variability exists. superficial to deep and further analyzed by system, The most prominent structure of the upper dorsal surface including muscle, bone, nerves, vasculature, and soft of the nuchal region is the inion, or occipital protuberance. tissue. This may be palpated in the midline and is a part of the • Regarding the nerves in the neck, more focused occipital bone. The spinous processes of the cervical vertebrae consideration is taken for surgical purposes when may then be followed caudally to the vertebral prominence, discussing the laryngeal nerve as a result of the variably corresponding to the spinous process of C6, C7 (most potential morbidity associated with iatrogenic injury common), or T1. to this nerve. The prominent surface structure of the ventral neck is the • The vertebral artery is discussed in specific detail as laryngeal prominence, which is produced by the underlying well due to its clinical importance and proximity to thyroid cartilage.
    [Show full text]
  • The Structure and Movement of Clarinet Playing D.M.A
    The Structure and Movement of Clarinet Playing D.M.A. DOCUMENT Presented in Partial Fulfilment of the Requirements for the Degree Doctor of Musical Arts in the Graduate School of The Ohio State University By Sheri Lynn Rolf, M.D. Graduate Program in Music The Ohio State University 2018 D.M.A. Document Committee: Dr. Caroline A. Hartig, Chair Dr. David Hedgecoth Professor Katherine Borst Jones Dr. Scott McCoy Copyrighted by Sheri Lynn Rolf, M.D. 2018 Abstract The clarinet is a complex instrument that blends wood, metal, and air to create some of the world’s most beautiful sounds. Its most intricate component, however, is the human who is playing it. While the clarinet has 24 tone holes and 17 or 18 keys, the human body has 205 bones, around 700 muscles, and nearly 45 miles of nerves. A seemingly endless number of exercises and etudes are available to improve technique, but almost no one comments on how to best use the body in order to utilize these studies to maximum effect while preventing injury. The purpose of this study is to elucidate the interactions of the clarinet with the body of the person playing it. Emphasis will be placed upon the musculoskeletal system, recognizing that playing the clarinet is an activity that ultimately involves the entire body. Aspects of the skeletal system as they relate to playing the clarinet will be described, beginning with the axial skeleton. The extremities and their musculoskeletal relationships to the clarinet will then be discussed. The muscles responsible for the fine coordinated movements required for successful performance on the clarinet will be described.
    [Show full text]
  • Shifteh Retropharyngeal Danger and Paraspinal Spaces ASHNR 2016
    Acknowledgment • Illustrations Courtesy Amirsys, Inc. Retropharyngeal, Danger, and Paraspinal Spaces Keivan Shifteh, M.D. Professor of Clinical Radiology Director of Head & Neck Imaging Program Director, Neuroradiology Fellowship Montefiore Medical Center Albert Einstein College of Medicine Bronx, New York Retropharyngeal, Danger, and Retropharyngeal Space (RPS) Paraspinal Spaces • It is a potential space traversing supra- & infrahyoid neck. • Although diseases affecting these spaces are relatively uncommon, they can result in significant morbidity. • Because of the deep location of these spaces within the neck, lesions arising from these locations are often inaccessible to clinical examination but they are readily demonstrated on CT and MRI. • Therefore, cross-sectional imaging plays an important role in the evaluation of these spaces. Retropharyngeal Space (RPS) Retropharyngeal Space (RPS) • It is seen as a thin line of fat between the pharyngeal • It is bounded anteriorly by the MLDCF (buccopharyngeal constrictor muscles anteriorly and the prevertebral fascia), posteriorly by the DLDCF (prevertebral fascia), and muscles posteriorly. laterally by sagittaly oriented slips of DLDCF (cloison sagittale). Alar fascia (AF) Retropharyngeal Space • Coronally oriented slip of DLDCF (alar fascia) extends from • The anterior compartment is true or proper RPS and the the medial border of the carotid space on either side and posterior compartment is danger space. divides the RPS into 2 compartments: Scali F et al. Annal Otol Rhinol Laryngol. 2015 May 19. Retropharyngeal Space Danger Space (DS) • The true RPS extends from the clivus inferiorly to a variable • The danger space extends further inferiorly into the posterior level between the T1 and T6 vertebrae where the alar fascia mediastinum just above the diaphragm.
    [Show full text]
  • The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 1
    Open Access Review Article DOI: 10.7759/cureus.7794 The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 1 Bruno Bordoni 1 1. Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA Corresponding author: Bruno Bordoni, [email protected] Abstract Working on the diaphragm muscle and the connected diaphragms is part of the respiratory-circulatory osteopathic model. The breath allows the free movement of body fluids and according to the concept of this model, the patient's health is preserved thanks to the cleaning of the tissues by means of the movement of the fluids (blood, lymph). The respiratory muscle has several systemic connections and multiple functions. The founder of osteopathic medicine emphasized the importance of the thoracic diaphragm and body health. The five diaphragms (tentorium cerebelli, tongue, thoracic outlet, thoracic diaphragm and pelvic floor) represent an important tool for the osteopath to evaluate and find a treatment strategy with the ultimate goal of patient well-being. The two articles highlight the most up-to-date scientific information on the myofascial continuum for the first time. Knowledge of myofascial connections is the basis for understanding the importance of the five diaphragms in osteopathic medicine. In this first part, the article reviews the systemic myofascial posterolateral relationships of the respiratory diaphragm; in the second I will deal with the myofascial anterolateral myofascial connections. Categories: Medical Education, Anatomy, Osteopathic Medicine Keywords: diaphragm, osteopathic, fascia, myofascial, fascintegrity, physiotherapy Introduction And Background Osteopathic manual medicine (OMM) was founded by Dr AT Still in the late nineteenth century in America [1]. OMM provides five models for the clinical approach to the patient, which act as an anatomy physiological framework and, at the same time, can be a starting point for the best healing strategy [1].
    [Show full text]
  • Bilateral Variation of the Suboccipital Region Musculature
    S Journal of O p s e s n Acce Anatomy and Physiological Studies CASE REPORT Bilateral Variation of the Suboccipital Region Musculature AR Dickerson*, CL Fisher PhD Center for Anatomical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, USA Abstract Dissection of the posterior cervical and suboccipital regions of an embalmed 81-year-old male cadaver revealed bilateral variations in the muscular anatomy, including two accessory muscles lying deep to the semispinalis capitis on each side, as well as a bilateral doubling of the rectus capitis posterior major muscle. These two sets of anatomical variations have little to no previous documentation in the literature. The accessory muscle bands were observed to have unique relationships with the greater occipital nerve on each side. This case report describes the findings in detail and examines their precedent in the literature. The suboccipital region has been implicated in the etiology of cervicogenic pain, headaches, and occipital neuralgia. Variations in the muscular anatomy have the potential to create structural interactions with vascular and neurologic structures in the area. Anatomic variations like those reported here should be considered in the diagnosis and treatment of pain and other conditions of the suboccipital region. Keywords: Anatomic Variation, Suboccipital, Accessory Muscle, Greater Occipital Nerve, Rectus capitis posterior major muscle Background leading us to believe that we had encountered accessory muscles that had been previously unreported. The muscles This case report describes variation of the musculature in the were delicate and located in a region often removed to expose suboccipital region observed during dissection of an embalmed the suboccipital region just beneath, so we postulate that the 81-year-old male cadaver.
    [Show full text]