Hey everybody! Here comes the choo-choo! I’m talking anatomy trains; connected muscle systems that run up and down our bodies, also commonly called “kinetic chains” or “fascial lines.”
Have you ever gone into the chiropractor, PT, or for a sports massage, told the person your foot hurt, only to have them start working on your hip? Aha! The problem in your foot could be the squeaky caboose of a long line of problems in your body. It’s all connected.
As a massage therapist who works on many competitive runners, and as a competitive runner who has dealt with my fair share of injuries personally, I believe that all runners need to understand anatomy trains. Not only can it help with injury prevention and healing; it can also change the way you perceive your body in motion.
Often we think of injuries as isolated incidents: one runner may have a bum left knee and another may have a problematic right achilles. Some runners might even say they have a bad side. It’s easy to think that there is simply one weak spot on your body, but what you may not realize is that your problem area is likely the byproduct of several issues that run along one of your anatomy trains. The stubborn pain in your arch could be symptomatic of an imbalance in your hips, or the nagging hamstring tightness a result of your non-aligned pelvis.
Anatomy trains are made up of muscles, tendons, and other soft tissues, including fascia; a type of connective tissue that binds everything together. Tom Myers, the body worker that coined the term “anatomy trains” defines fascia as “the 3-D spider web of fibrous, gluey, and wet proteins that hold them (muscles, tendons, ligaments etc.) all together in their proper placement.” As my anatomy teacher in massage school used to say, “We’re all one piece of connective tissue.”
Looking at the lines of these trains, and the muscle and fascia that run along them, it’s easy to see how structural issues in one area of the body lead to pain in others. In fact, when I was learning about this in massage school I had an epiphany about an injury that had been plaguing my husband. His achilles, hamstring, and back issues, all on the right side were related and part of the same anatomy train!
Below I will outline a few of the anatomy trains and common injuries that I see most often in runners, trying to keep things from getting too technical and medical-jargony. I’ve also included pictures to highlight the muscles and fascia along each line and have tried to simplify as best as I can to relate it to running. An interactive human body muscle diagram that allows you to point and click on any muscle is here.
Superficial Back Line
The superficial back line includes the following muscles and fascia: the plantar fascia, toe flexors, achilles tendon, the gastrocnemius (one of the calf muscles), the hamstrings, lumbosacral fascia (spans the area of the low back), the erector muscles of the back, and the fascia of the scalp.
Injuries common along this line are plantar fasciitis, achilles tendonitis, hamstring tightness or tendonitis, and back tightness. Another common problem along the Superficial Back Line that many runners may not realize, which can contribute to pain in other areas of the body, is immobility in the big toe. This tightness can pull on the plantar fascia, which then leads to pulling on the achilles tendon, which then leads to achilles tendonitis: a chain reaction!
Superficial Front Line
The muscles that are part of this line are: the tibialis anterior (muscle on the front of the shin), the toe extensors, the quadricep muscles (vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris), the rectus abdominis, the sternalis (muscle along the sternum) and the sternocleidomastoid (a muscle of the neck).
General running related injuries associated with this anatomy train are tibial anterior tendonitis, quad tightness and patellar tendontis. A more specific example is a shortening in any one of the quadricep muscles, which then pulls on the knee cap causing it to painfully track incorrectly.
The muscles along this line tend to take a beating from extended downhill running. You may notice issues in this anatomy train after a race like the Boston Marathon or after doing a long run with a lot of downhills in it.
The muscles and fascia that fall along this line include peroneals (the muscles on the outside of the shin), tensor fascia lata (TFL, a small hip flexor muscle), gluteus maximus, the iliotibial band (ITB), obliques, intercostals (muscles between the ribs), SCM, and splenius capitus (muscle of the neck/head).
General running related injuries along this line include IT band syndrome, gluteus maximus and TFL tightness, and lateral hip bursitis. A more specific injury would be tightness in the TFL, which blends into the ITB at its upper aspect, causing adhesions or pulling on the ITB, which in turn pulls on the outer aspect of the knee cap and causes knee pain.
Additionally, if you have any sort of peroneal injury, like tendontitis at the insertion points on the feet, this can affect things all the way up to your hip because of the way your body compensates for the pain in the foot. This can cause issues along the IT band and into the lateral aspect of the hip (TFL and edge of gluteus maximus).
Muscles and fascia along this line include tibialis anterior, peroneus longus (muscle on the side of the shin), bicep femoris (outer hamstring muscle), TFL, the IT band, the obliques (ab muscles), and serratus anterior (muscle along the ribs that moves the shoulder blade and aids in moving the rib cage during breathing).
General examples of injuries along this line are tibialis anterior tendonitis, peroneal tendonitis, hamstring tightness or tendonitis, and TFL tightness. This line shows a connection between the hips and the arch of the feet. As it relates to running, flat feet or fallen arches may cause an anterior tilt of the pelvis (forward rotation), which can cause shortness in the hip flexors and a pulling on the hamstrings (i.e. bicep femoris, the lateral hamstring, mentioned above).
Another point to look at along this line is that it includes breathing muscles near the rib cage that fire when we inhale and exhale. If you have been breathing heavily, like during a race or very intense speed workout, these muscles will tighten and the shortening of the muscles pulls on the rib cage and may also impact the hips and their alignment. That of course can cause issues further down the chain, through the leg and into the foot. Even how we breathe can contribute to injuries!
Deep Front Line
Muscles and fascia along this line include tibialis posterior (the muscle on the inside of shin), toe flexors, adductor magnus (the biggest adductor muscle, on the inside of the thigh), iliacus, psoas (iliacus and psoas are the deep hip flexors), quadratus lumborum (QL), obturators (deep hip external rotators), pelvic floor muscles, and some smaller neck and head muscles (scalenes, hyoid muscles, masseter, and temporalis) as well. This line plays a major role in the stability and alignment of the core.
General running injuries along this line include tibialis posterior tendonitis, hip flexor strains, groin strains (adductor magnus muscle playing a role), and other hip injuries. A more specific example is if the QL, which attaches to the bottom of the rib cage and top of the hip bone (ilium), is shortened it will cause the hip to be pulled up into the body. This can cause a misalignment of the hips, one hip sitting higher than the other, which can in turn cause problems with the hip flexors and also cause a functional leg length discrepancy. This fascial line is greatly affected in women during and after pregnancy.
Functional Front Line
Muscles and fascia along this line include pectoralis major (big chest muscle), rectus abdominus, and adductor longus (another of the adductor muscles, on the inside of the thigh). This line can affect your running by shortening the pectoralis major through arm swing, impacting the abs and the groin (adductor magnus). For any of you runners out there who do regular baby jogger runs, this area may get overworked from the form you adapt while pushing the stroller during a run.
Functional Back Line
Muscles and fascia along this line include latissimus dorsi, gluteus maximus, vastus lateralis (outer quad muscle). Running can cause issues in this line in the gluteus maximus, which can then cause pulling on the lateral aspect of the thigh in the IT band or outside of the quad.
There are also deep and superficial back arm lines, which include muscles of the arms, shoulders, neck. These lines don’t impact running much, so I decided not to go into too much detail on them.
Linking the Lines to Running
As you can see, it’s almost always more than just one isolated area that plays into a localized injury. That bad achilles may stem from an immobile big toe joint, or tendinitis in the knee might be the product of tightness in the hip flexors, a chronically tight hamstring is stemming from a rotated pelvis, or groin pain may be coming from fallen arches.
The takeaway from all of this is that everything is connected. If you are dealing with an injury in one area, there are likely other areas of your body involved in that injury. My experience as both a massage therapist and a runner has shown me that when you discover weaknesses or imbalance along one of these lines, you need a two-fold approach.
First, massage and other manual therapies, like Graston, ART, or chiropractic manipulations can be great, but they will likely be a band-aid and not a cure. Especially if you’re plagued by a recurring injury or injuries along one of the anatomy trains above, seeing a professional like a physical therapist who can assess your gait and muscle function can be extremely helpful. They can identify the problem chain and give you exercises to help strengthen or retrain the muscles to fire properly.
Second, being mindful of your posture throughout the day is critical to combat weaknesses. Being aware of your posture while you sit at your computer, while you’re on your daily run, while you stand in line at the grocery store and, if you are a parent, while you are holding your child, can help to correct poor anatomical patterns we adopt while going about the activities of our daily living.
Do you have a derailed anatomy train?
*Thanks to my good friend, Ian Nurse, who took many of these photos used in this post and providing me with the material to highlight the fascial lines.