The Superficial Back Arm Line is one of several Fascial Lines proposed by Thomas Myers (SOURCE-1). This line is predominately active duirng arm motions behind the torso or elevation in the frontal plane ( GH Joint - Abduction ) and serves as the antagonist to the Superficial Front Arm Line (SOURCE-1). The Superficial Back Arm Line is one of four Arm Lines . This line is almost identical to its Myofascial Chains equivalent, the Lateral Arm Chain , a congruency not seen with other Fascial Lines or Myofascial Chains .
The following lists bony and muscular landmarks that are integrated into the Superficial Back Arm Line from most proximal to distal (SOURCE-1):
External Occipital Protuberance
Superior Nuchal Line
Spinous Process of Thoracic Spine
Spine
Acromion
Lateral 1/3rd of Clavicle
Deltoid Tubercle
Lateral Epicondyle
Dorsal surface of Fingers
Wrist Extensors:
As scientific understanding of Fascia l structures is still in its infancy, the sophisticated and interrelated Fascial Lines discussed by Thomas Myers are yet to gain full support of the literature. With this said, there is growing evidence of myofascial continuities that reflect some of the relations described by Fascial Lines :
Trapezius to Deltoid - while the scale of this continuity and its appropriate nomenclature are contended, its presence is less ambiguous. TheDeltotrapezial Fasciaextends from the distal portion of the Upper Trapezius courses over the Acromioclavicular Joint to blend with the acromial portion of the proximal Deltoid (SOURCE-3). A more extensive description of this continuity, theDeltotrapezial Aponeurosis, consists of a convergence of the Perimysium of the Trapezius and Deltoid , fibres from the Acromioclavicular Joint Capsule and the Periosteum of the Clavicle and Acromion to form a complex fascial structure (SOURCE-3)
Deltoid to Lateral Intermuscular Septum - the deep Fascia of the Deltoid is continuous with the deep Fascia of the upper arm, known as theBrachial Fascia(SOURCE-2). Through the Brachial Fascia, the Fascia over the lateral portion of the Deltoid is continuous with the Lateral Intermuscular Septum (SOURCE-2)
Lateral Intermuscular Septum to Wrist Extensors - the Lateral Intermuscular Septum courses the lateral Humerus and adheres to the Supracondylar Ridge of the Lateral Epicondyle of Humerus (SOURCE-2). The Brachial Fascia gives rise to the Intermuscular Septums and at its distal end is continuous with the deep Fascia of the forearm, theAntebrachial Fascia(SOURCE-2). The Antebrachial Fascia serves to compartmentalise Muscles of the forearm, subjugating the Common Extensor Tendon and its derived Wrist - Extension muscles primarily to the superficial and deep layers of the posterior compartment, forming a continuity (SOURCE-2)
The following observations may be indicative of Superficial Back Arm Line dysfunction:
Resting Posture
Flexed Thorax - Ribs / Spine in excessively flexed/ hunched posture ( Thoracic Spine Kyphosis )
Elevated Shoulder Girdle
Excessive (but slight) GH Joint - External Rotation or Wrist - Extension
Movement
GH Joint - Flexion + Backwards Lean - akin to the other Arm Lines the relative tone between the Superficial and Deep Front Arm Lines may be determined. Patient flexes their straight arms which are stabilised at The Hands by the practitioner and leans back onto their heels. With full Elbow - Supination / GH Joint - External Rotation the superficial line is emphasised, while the addition of Elbow - Pronation / GH Joint - Internal Rotation emphasises the deep line (SOURCE-1). The sites of greatest perceived stretch suggests restriction (SOURCE-1)
Excessive Scapulothoracic Joint - Elevation
Symptoms of Pain may be greater with all involved joints locked rather than bent as the fascial line is pulled taut
Determining the direction and extent of Fascia l restriction can be done with a light pressure over a desired segement and applying a superficial glide. The region and direction of greater soft-tissue resistance would suggest fascial restriction.
Treatment for Superficial Back Arm Line dysfunction emphasises restoring Fascia l mobility, movements at The Shoulder Girdle such as those that involve GH Joint - Abduction or arm motion behind the torso and Wrist - Extension . In some instances the release of a single structure contained within the Superficial Back Arm Line forms an effective treatment, while in others the entire Fascia l line may require attention.
The folowing stretching techniques may be beneficial for dysfunction of the Superficial Back Arm Line:
Door Frame Neck Stretch - self-guided neck stretch with several variations
Genie Stretch - rudimentary horizontal adduction stretch
Cervical - Lateral Flexion - lengthens Upper Trapezius
Add GH Joint - Adduction (either Horizontal Adduction across body or Adduction behind body) - lengthens Deltoid and Lateral Intermuscular Septum
Add Wrist - Flexion and/or Elbow - Pronation - lengthens Extensors
Myofascial Release of the following structures through Massage or self-guided means may be of benefit to those with Superficial Back Arm Line dysfunction, with specific techniques often discussed on their respective pages:
Practitioner-Guided
Upper Trapezius - this segment may be released through several methods
Superficial Glide - may be applied from as high as the Occipital attachment and directed along the line of its fibres towards the Acromion. Contralateral Cervical - Lateral Flexion may be added to elongate the fibres under pressure
Transverse Frictions - more targeted presure may be applied to segments of the muscle that appear particularly restricted. Often with restriction of the Superficial Back Arm Line, there is an almost horizontal line of fibres above the Spine of Scapula and below superficial muscle belly of the upper fibres that is notably more tonic than the surrounding fibres
Deltoid - with patient supine or side-lying, a stripping pressure is applied with broad contact (forearm or heel of hand) following the orientation of its fibres and in the direction of restriction, typically inferiorly. Horizontal GH Joint - Adduction may be added to elongate the muscle under pressure
Deltotrapezial Fascia - transverse frictions may be applied at the union of these fascial structures over the Spine and Acromion of Scapula
Common Extensor Tendon - the shared origin of the Wrist - Extension muscles may be treated at the Lateral Epicondyle of Humerus with sustained compression, transverse frictions or a “pin and stretch” with the addition of Wrist - Flexion / Elbow - Pronation
Wrist Extensors - superficial glides may be applied with a forearm, broad Thumb pad or knuckles in the direction of restriction, typically towards The Wrist
Self-Guided
The following Strength techniques can be used for the Superficial Back Arm Line:
Band Pull-Apart - basic isotonic exercise for Scapular Retractors
Prone Cobra - isometric exercise that emphasises Middle and Lower Trapezius
Bird-Dog - bodyweight isotonic exercise that emphasises Posterior Sling / Core
Face Pulls - bilateral isotonic horizontal pull exercise that emphasises GH Joint - External Rotation
Inverted Rows - rudimentary isotonic horizontal pull exercise that utilises bodyweight
Side Raises - isotonic GH Joint - Abduction exercise with many variations
Bottoms-Up Kettlebell Walk - isometric push/ stability exercise with or without perturbation
Seated Row - rudimentary weighted isotonic horizontal pull movement
Upright Row - weighted isotonic vertical pull exercise that emphasises Upper Trapezius and Deltoid
One Arm Row - unilateral DB version of Seated Row
Overhead Press - isotonic vertical push exercise with large overhead range
DB Shoulder Press - unilaterally loaded overhead press variation
Bent Over Row - weighted isotonic horizontal pull exercise that emphasises entire posterior chain
Lu Raises - large GH Joint - Abduction range with no Humerus rotation to promote Scapulothoracic Joint - Upward Rotation
Shrug - weighted isotonic exercise that emphasises Scapulothoracic Joint - Elevation
Farmers Carry - upperbody/ Core isometric exercise with perturbation of walking
Push Press - wholebody, explosive variation of the Overhead Press
DB Hang Clean - unilateral clean progression, often performed explosively
Kneeling Landmine Press - wholebody, explosive vertical pressing exercise with large overhead range
Split Stance Landmine Press - crossbody, standing variation of the Kneeling Landmine Press
Suitcase Carry - unilateral farmers carry which emphasises crossbody functional patterns
DB Snatch - unilateral isotonic, explosive shoulder exercise with large overhead range
DB Snatch to Step-Up - wholebody DB Snatch variation that emphasises diagonal functional patterns
Bird-Dog Row - One Arm Row variation that emphasises Posterior Sling
Myers, T. W. (2009). Anatomy trains: Myofascial meridians for manual and movement therapists (2nd ed.). Elsevier.
Standring, S. (Ed.). (2016). Gray’s anatomy: The anatomical basis of clinical practice (41st ed.). Elsevier.
Czerwonatis, S., Dehghani, F., Steinke, H., Hepp, P., & Bechmann, I. (2020). Nameless in anatomy, but famous among surgeons: The so called “deltotrapezoid fascia.” Annals of Anatomy - Anatomischer Anzeiger, 231, 151488. https://doi.org/10.1016/j.aanat.2020.151488