200 FASCIAL AND MEMBRANE TECHNIQUE ● restrictions of the sternoclavicular joint in Figure 8.1 General listening in the standing position. connection with changes of tone in the subclavicular layers Contact With the flat hand on the cap of the skull. Action The therapist places one hand on the cap ● changes to the tensile force between the dura of the skull and asks the patient to close his or her mater and the components of the body eyes; the therapist’s hand is completely relaxed connected to it and does not exert any active pressure. The thera- pist’s attention is now directed at whether the ten- ● changes to the various tissue layers of the sile force acting under this hand is emitting in a suboccipital triangle particular direction. Here, it is important for the therapist’s attention to be entirely centered on the ● changes to the mobility of the cranial sutures, interior of the palm and not on the tactile contact particularly in the base of the skull of the fingers. If this technique is applied correctly, the patient will be able to tell whether a connec- ● changes to the membranous connection between tion has been created between the therapist’s test- the maxilla and the skull bones located above it ing hand and the primary problem zone. ● changes in the region of the mandibular joint. General listening in the sitting position (according to Barral) This is not a complete list; it only names the aspects that, as a rule, are at the center of the prob- Patient Sitting. lem. In light of the variety of possible deformations and restrictions of motion, it is recommended to Therapist Standing behind the patient. keep the examination very general at the beginning so as to be able to localize the changes of form and motion restrictions that have the greatest signifi- cance in whiplash. The general listening and local listening processes originally developed by Pierre Barral are particularly suitable in this case. Both techniques have been accepted for the most part as an important component of osteopathic culture and are also applied outside the osteopathic field. The advantage of this type of examination lies in the fact that the body is touched so carefully that the risk of additional irritation has been eliminated to a large extent. Any oversensitivity of the patient that may manifest is respected and shock-induced reactions can be avoided without a problem. If the therapist is acquainted with Barral’s thermal diagnosis, this process should be used to examine the test findings. Because this diagnostic procedure does not use any manual contact, it is particularly suitable for situa- tions in which acute injuries are present. The tem- perature differentials that can be detected in thermal diagnosis can usually be perceived without a prob- lem. Precise categorization regarding individual anatomical structures requires extraordinary sensi- tivity and the most precise, detailed anatomical knowledge (Barral 1996). General listening in the standing position (according to Barral) Patient Standing with the legs slightly apart. Therapist Standing behind the patient.
TREATMENT OF THE FASCIAL AND MEMBRANE SYSTEM AFTER WHIPLASH 201 Action The therapist makes sure to have good contact with the floor and to be sitting neither in a slouched position nor overly erect. Using the palms of the hands and the forearm, the therapist accepts the weight of the patient’s arms and now pays attention to whether and in which direction a pull impulse can be felt on one side. This pull impulse is a sign of the side on which we will find the restriction. In performing the general listening technique, there is the risk that the therapist will project processes from his or her own organism onto the patient’s body by way of the tactile senses. This can be best prevented by the therapist being in an equilibrium of the autonomic nervous system. In other words, the therapist should not be in an overactive state or in a greatly relaxed state. The watchword for “listening” is “quiet attention.” Figure 8.2 General listening in the sitting position. Skeptics may note that examinations of this type are actually very vague and should not be Contact With the palm of the hand on the cap of taken seriously by science in comparison with the the skull. “objectivity” of the examination of joints in the musculoskeletal system. We can respond to these Action The therapist’s hand is used in the same skeptics by saying that, when we examine a joint, manner as in the technique described above. we touch the bone itself only in the rarest of cases Because the region of the lower extremities is and the bones that are easier to touch are part of a excluded from the observational field of the test by model that, while it arises from a certain reason- the sitting position, the test result found in the able, schematized viewpoint, is in no way more standing position may be made more precise. It is “real” than the tensile forces that are tangible in advisable to supplement this test with the follow- the myofascial system. In order to understand the ing test for the region of the chest cavity and the meaning and capacity of the “listening” process, shoulders. we must merely compare it with other sensory perceptions. The musician’s skilled ear registers General listening in the sitting position from the sound of each individual instrument of the the anterior side (according to Barral) orchestra and, with the inner ear, can even hear the true tone of transposed instruments from a score, Patient Sitting. which would be difficult or even incomprehensi- ble for musical laypersons. I think that general lis- Therapist Sitting in front of the patient. tening is a sort of tactile hearing. The therapist’s hand registers and localizes the course of the Contact With both forearms under the patient’s movement curves in the interior of the patient’s slightly raised forearms. organism in the same manner in which the musi- cian registers the course of the rhythm and melody of individual instruments.
202 FASCIAL AND MEMBRANE TECHNIQUE Figure 8.3 General listening in the sitting position from the anterior side. Alternative test to Barral’s general listening the pelvis. The therapist first feels whether a resist- ance to the shear force manifests inside the leg, for Patient In the dorsal position, legs extended with example at the level of the knee or at the transition the ankles reaching just over the edge of the treat- to the pelvis. This is a sign of an injury or restriction ment table. on the side in question. It is possible to avoid the resistance and continue with the test if the therapist Therapist Sitting at the foot. slightly reduces the shear force and then succes- sively intensifies it again as if to slowly turn up the Contact With both hands from the posterior direc- dimmer on a light switch. Thus, the therapist is tion in the lower third of the calves. gradually able to transmit the shear force into the interior of the pelvic and abdominal cavities and the Action Both of the therapist’s feet are in good con- area can be localized in which resistance is occur- tact with the floor and the therapist’s posture is nei- ring. In this area as well, we first reduce the shear ther slouched nor overly erect. The object is for the force somewhat as soon as we encounter resistance therapist’s posture to be contributed by the organ and then gently intensify it again and transmit it column and the autonomic musculature while the through the diaphragm into the interior of the chest exterior musculature of the ribcage and pectoral gir- cavity. As a rule, as soon as we are pushing against dle are relaxed. The weight of the therapist’s fore- the diaphragm, we must wait for a moment because arms is rested on the treatment table and the the force we are applying is initially transmitted by therapist’s hands hold both calves. The primary way of the arch of the diaphragm into the preverte- weight of the legs is resting on the therapist’s palms bral space of the central tendon. while the therapist’s fingers are relaxed and slightly bent. The therapist now closes his or her eyes in In the most favorable case, we will be able to order to aid visualization. The therapist imagines continue the shear test into the region of the neck that the two calves are scales resting in his or her and cranium. This test is primarily suitable for hands. The therapist then adjusts the touch of these localizing severe restrictions in the region of the scales so that it has precisely the same quality on ligamentous connections of the organs by sensing both sides. This means that the therapist’s hand has resistance to the subtle push. This technique pro- been adapted on each side to the existing shape of vides little information on restrictions of movement the right or left calf. Now the therapist gradually located very close to the middle central axis of the exerts a subtle but very steady shear force along the body such as restriction in the joint of the tailbone or inner longitudinal axis of the legs in the direction of
TREATMENT OF THE FASCIAL AND MEMBRANE SYSTEM AFTER WHIPLASH 203 Figure 8.4 Alternative test to Barral’s general listening. sacrum or the large longitudinal components such process that is very difficult to understand ration- as the esophagus and trachea. ally. I can only refer to its performance and signifi- cance in practice (Prat 1999). Variation of general listening in the dorsal position This test can deliver misleading results if unilateral tension patterns are present in the Patient In the dorsal position, legs extended. suboccipital region of at the base of the skull. In such a case, it is necessary to differentiate Therapist Sitting at the head. precisely between the local restrictions of the atlanto-occipital connection and the forces Contact With the bent front phalanges of the acting from a greater distance. index, middle, and ring fingers of both hands in the tissue just below the base of the skull. Treatment of whiplash Action The therapist first moves the fingertips In cases of whiplash, it is advisable to wait a few slightly in the vertical direction in order to intensify days or even a few weeks before the first manual the contact with the suboccipital tissue. Then the treatment. The reason for waiting lies in the fact therapist uses all involved fingertips to pull gently that a drastic development of symptoms frequently longitudinally through the whole body. In so doing, does not occur until days or weeks after an acci- the therapist precisely observes whether this pull is dent. Especially if the patient has a tendency toward met with stronger resistance on the left side or right psychological reactions, it is advisable to wait for side. On this side, the therapist now precisely dif- the first high point of the pain symptoms. If the ferentiates which finger is able to feel the resistance therapist treats the patient immediately after the most clearly. We speculate that the localization of accident during a relatively pain-free period of time the resistance with the ring finger, which is applied and the symptoms do not develop in their full scope in the medial plane, is a sign of fixations in the until after this treatment, the patient will be under region of the dura; resistance in the region of the the impression that these problems were made middle finger is a sign of fixations in the region of the organ system; and resistance in the region of the index finger is a sign of fixations in the region of the parietal system. This test procedure is naturally a
204 FASCIAL AND MEMBRANE TECHNIQUE Figure 8.5 General listening in the dorsal position. worse by the therapy. This will necessarily lead to treatment normalizes the dynamics between the development of inner resistance and can con- ergotropic and trophotropic activation. In other siderably complicate the course of treatment. It is words, the treatment should first give only mini- also significant that the accident represents a dras- mal stimuli so that, after every agitation of the sys- tic physical development and the possibility that tem, the corresponding relaxation is allowed to the patient may initially experience any physical emerge. The first touches are crucial. treatment on the subconscious level as a continua- tion of this physical effect cannot entirely be ruled In practice, we see again and again that, if the out. For this reason as well, treatment techniques lower extremity is carefully treated, a calming of the should be selected with the greatest care and it is state of agitation occurs. If changes have occurred in essential to treat only the problems that can be this region, it is advisable to begin treatment there, clearly diagnosed. Too little is better than too much! for example, with a careful correction of restrictions of movement in the region of the ankle or metatar- In selecting the treatment technique, we should sus. The method that I showed in the section on remain strictly within the framework of the injuries special joint techniques (see Chapter 6, Special and restrictions of movement found in general lis- techniques for treating the joints of the foot) is suit- tening and attempt to reconstruct which portion able for this purpose. was already present before the accident and which injuries and restrictions of movement can actually The usually comprehensive fixation of the dura be attributed to the accident. It is helpful to use the mater and its tensile effects should be treated in most gentle techniques possible, avoiding strong connection with the large anterior longitudinal pull effects and abrupt applications of force. ligament of the spine. Techniques applied to the sacrum should be used first, and then the treatment The patient is frequently still in a state of shock should be continued in the region of the cranium. even weeks after the accident. This means that the autonomic nervous system is subliminally in a The essential subsequent step is the treatment constant state of ergotropic agitation. In addition of the elements inside the visceral cavities, i.e. the to the purely physical causes, this is the reason for treatment of changes to ligamentous and mesen- the sleeplessness that we sometimes observe. teric layers of organs. For this reason, the therapist must select the qual- ity of the touch in such a way that the manner of The mobility of any of the organs may have been affected by the force of the accident. For the first treatment steps in the visceral region, it is crucial
TREATMENT OF THE FASCIAL AND MEMBRANE SYSTEM AFTER WHIPLASH 205 to evaluate the transitions between the visceral for the time being. Direct joint manipulation could cavities. Because of the transition between cavities have drastic negative consequences from which it having different hydrostatic pressure, these transi- takes the patient a long time to recover. tions are particularly at risk because the existing pressure differential may have been increased many In cases of whiplash, there is frequently a strong times over by the force of the impact. By gliding on emotionalization of which the patient is usually not their serosal layer and through the overstretching aware. This emotionalization should be respected of ligamentous connections, entire organ groups for the purpose of a positive course of treatment. can be spatially displaced. This displacement causes On the physical level, it is expressed in tonal chains the segments of the body to appear displaced rela- of the musculature and an individual bodily pos- tive to one another on the exterior as well. In such ture. We should avoid applying so-called myofas- a situation, corrective attempts applied to the pari- cial release stretching to the large fascial layers of etal system have little effect. the system. Rather, the patient should at first have the opportunity to assume the body positions that We should give particular attention to the organs correspond to the interior expression. Only after located directly below the diaphragm and the retro- the dominant inner fixations have been released peritoneal organs or sections of organs, particu- will we move the large exterior sheath layers in the larly the kidneys. If the victim in an accident was direction of the normal pattern. wearing a seat belt, the transition between the chest cavity and the lower cervical region should To give an example, if the organism appears to be precisely examined, particularly in the anterior be slouched, this may be attributable to a restric- region. The deep laminae of the neck are frequently tion of movement in the kidneys. In such a case, an affected, as well as the ligamentous suspension of alignment by treating the myofascial layers at the the pleural cupula that connects the central cervi- surface would only cause additional discrepancies cal spine to the uppermost section of the endotho- between the interior structure and the exteriorly racic fascia and thus to the pleural cupula itself. visible static of the body. In comparison, a treatment strategy that first makes contact with the entire sys- In whiplash, massive impactions can occur at tem by way of the lower extremity and then releases the sutures of the bones of the skull. However, we a few restrictions in the interior of the visceral and should bear in mind that the classic, very subtle craniosacral system and only then addresses the craniosacral application in treatment of whiplash autonomic musculature of the back and ribcage is has its limits. As much as we should allow our associated with far fewer risks. actions in this region to be guided by caution, it is a reality that severe changes may have been caused Treatment of altered tensile effects of the in the craniosacral region by the accident, requir- dura mater by mobilizing the second segment ing a very decisive intervention, otherwise our work of the sacrum in the craniosacral system would produce only a deep relaxation. The relatively drastic techniques of If the dura mater is under abnormal tension, the Barral and Croibier, which are primarily directed sacrum as a whole appears limited in its at the inner elasticity of the bones of the skull, and movement. The second segment, to which the associated techniques for treating the membranous dura is attached, also appears to be harder than connections between the maxilla and skull have the rest of the bone. particularly proven themselves in practice (Barral and Croibier 1999: 184–90, 266–7). Patient In the dorsal position, both legs extended. Although these changes that typically occur in Therapist Standing to the side at the level of the whiplash particularly manifest in the area of the thighs. neck, extreme restraint is advisable in this section of the body. This is the region where the patient Contact Supporting the sacrum from the poste- feels the symptoms particularly intensely. If there rior direction with a flat palm while the other hand are restrictions of motion between cervical verte- brae, it is advisable to avoid direct manipulation
206 FASCIAL AND MEMBRANE TECHNIQUE supports the lower lumbar spine, also from the At the contact point on the sacrum, the therapist posterior direction. The hand position is subse- now exerts a pull in the direction of the tailbone quently switched so as to produce direct contact without altering the existing tilt of the pelvis or the on the sacrum with the fingertips of both hands. bend of the lumbar region. In other words, the ther- apist pulls the sacrum in such a way that the pull Action The therapist first takes the sacrum in one acts inward in the vertebral canal and the state of hand so as to adapt it to the posterior arch of the the dura mater can be evaluated. In the case of bone. At the same time, the other hand is supporting changes to the tension pattern, the counterpull will the lower lumbar spine from the posterior direction, manifest at the second segment of the sacrum. The but avoids exerting pressure on the spine itself. therapist now positions the tips of the fingers and Figure 8.6 Treatment of altered tensile effects of the dura mater by mobilizing the second segment of the sacrum. Figure 8.7 Position of the hand on the sacrum.
TREATMENT OF THE FASCIAL AND MEMBRANE SYSTEM AFTER WHIPLASH 207 thumbs around the second segment of the sacrum Contact With the palms of both hands in and so that several contact points are produced on the above the region of the twelfth rib from the poste- bone. The therapist ensures that the sacrum as a rior side, parallel to the course of the ribs. whole is resting on these contact points without changing its position. The therapist now modifies Action The therapist registers the breathing move- the touch reaching through the subcutaneous ment and compares the right and left sides. On the layer and lumbar fascia as though to compress the side where less spatial excursion of the diaphragm periosteum more strongly against the bone, avoid- can be felt, the therapist successively compresses ing any sliding of the surface of the sacrum, and the posterior chest cavity. During this, it is important intensifies the contact as if to push through the that the patient continue to breathe so that several sheath of the periosteum into the bone. While breathing cycles occur during compression. The maintaining this very peculiar type of contact, the therapist now begins to use the palm to compress therapist feels whether a “melting reaction” is the lower chest cavity on the other side. The thera- present at the connection points between the tissue pist maintains the compression of both halves of and the bone. As a rule, this is a minimal move- the thorax and pushes the side that feels freer some- ment that the therapist should follow in all direc- what more strongly toward the central line while tions until the rigidity at the second segment of the following the direction of the costal arch. This will sacrum begins to be released. Subsequently, reas- cause the inner pressure to increase even more on suming the original position of the hands on the the side of the restriction. The therapist now uses sacrum and lumbar region is recommended so as this increase in pressure to release the costal arch to examine the result of the treatment. and guide it into a greater expansion in the lateral and posterior directions. The therapist’s hands are Treatment of the shock pattern in the now returned to their initial position in order to region of the diaphragm compare the spatial excursion of both halves of the diaphragm yet again. If the desired effect is not Patient In the dorsal position, legs extended. felt, I recommend waiting a few minutes and then performing the technique again with a slightly dif- Therapist Standing to the side at the level of the ferent direction of pressure. thighs. Figure 8.8 Treatment of the shock pattern in the region of the diaphragm.
208 FASCIAL AND MEMBRANE TECHNIQUE The variety of layers touching one another at superficial fascial layer of the trapezius muscle. In the transition between the chest and contrast to the muscle fibers, the fibers of the right abdominal cavities does not always make it and left fascia form one unit. The therapist uses the easy to definitively determine where exactly other hand to maintain gentle contact with the ori- our treatment is having its effect. It is certain gin of the nuchal ligament. If the head and neck that this technique affects spasm-like patterns want to give way in rotation and lateral flexion, of the diaphragm itself. However, it also affects the therapist supports these movements to their the connective tissue connection between the endpoint and allows this twisting to remain in the organs of the upper abdomen and the supported position. At the same time, the thera- diaphragm, and it certainly also has an effect pist reaches toward the contact points of the fascial on the distribution of the serosal layer in the tissue in the upper region of the back, taking care narrow gaps between organs. In performing not to glide on the contact points, but rather to this technique, it is crucial that the therapist apply increased pressure through the deep fascia compress the intermediate layers of the chest in the direction of the interior of the body, as if the wall from the posterior direction so subtly that fingertips were wandering through the patient’s it is possible to observe the reaction of the body in the direction of the ceiling. As soon as the inner components surrounded by these supporting hand in the region of the back of the intermediate layers. Based on this observation, head is able to sense that the head wants to return the therapist will be able to treat the relatively to the central line, the therapist follows this move- tough fascial and membrane structure of the ment. It is crucial that the intensive pressure in the ribcage at the same time as the connective region of the upper chest cavity remain until the tissue sheaths and ligamentous suspensions of movement back to the central line has been com- the organs they surround. The procedure pleted. described by John Upledger (Upledger and Vredevoogd 1983: 46–9) is a suitable Treatment of the transition between the alternative or supplement to the treatment upper cervical spine and the head described above. Patient In the dorsal position, legs extended. Treatment of the transition between the upper chest cavity and lower cervical Therapist Sitting at the head. region Contact One hand holds the occiput, while the Patient In the dorsal position, legs extended. thumb and fingers of the other hand support the space between the second cervical vertebra and Therapist Sitting at the head. the base of the skull on both sides next to the vertebrae. Contact With the thumbs and fingertips on both sides of the costal joint connections at the level of Action In this technique, we apply the technique the fourth thoracic vertebra; the other hand sup- described for the upper chest cavity and lower cer- ports the occiput. vical region (see above) to the very small area of the atlanto-occipital transition. Here as well, it is Action The therapist slightly raises the occiput crucial that the hand placed farther in the inferior without exerting a pull on the cervical spine. Using direction, i.e. on the neck, be fixed while the hand the fingers of the other hand, the therapist sup- placed farther in the superior direction on the ports the upper portion of the thoracic region from occiput follow the movement tendencies and thus the posterior direction. At this point, the therapist allow the head to turn or tilt into the position dic- produces an intensive contact with the relatively tated by the dominant tension conditions. The hand supporting the occiput therefore follows in “listening” while the tip of the thumb and finger- tips of the other hand hold the myofascial bed of
TREATMENT OF THE FASCIAL AND MEMBRANE SYSTEM AFTER WHIPLASH 209 the upper cervical spine. This holding position If this technique is applied precisely, we will be remains unchanged until a change in tone is able to influence the muscular and ligamentous discernible and the head moves back to the central microstructures of the suboccipital triangle as line. well as the large longitudinal layers such as the dura and the large anterior longitudinal The tendency of the head to change its position ligament of the spine at the same time. Because can still be sensed after the first treatment. The both of these longitudinal layers are connected therapist should then support the rotation and lat- to the sacrum, I recommend reexamining the eral flexion movement a second time, and some- sacrum, in particular the second segment of the times a third and fourth time. In so doing, the sacrum, and treating it with the technique therapist is able to modify the contact in the region described above, if necessary. of the cervical spine in such a way that different layers of the fascial bed of the upper cervical spine Figure 8.9 Treatment of the are reached each time. transition between the upper chest cavity and lower cervical region. Figure 8.10 Position of the hands, clarified on the skeleton.
210 FASCIAL AND MEMBRANE TECHNIQUE Figure 8.11 Treatment of the transition between the upper cervical spine and the head.
211 Chapter 9 Treatment after pregnancy and birth CHAPTER CONTENTS Pregnancy and the birth of a child cause long-term Summarizing aspects 215 changes to a woman’s entire myofascial system. The increase in volume of the pelvic cavity produces a drastic shear effect in the cranial direction and on the organs located below the diaphragm. At the same time, the pressure increases in the inferior direction and in the lateral direction on both sides. Owing to hormonal influences, the tensile force of the ligaments decreases during advanced preg- nancy, which is an essential condition for a problem- free birth. However, because the tensile force of the ligaments is still reduced months after birth, lasting changes can develop in the joint system. Changes occur in the fascial layers of the lower extremities as well. In order to counteract the weight of the child, the tone of the musculature on the pos- terior side of the legs must increase, usually first in the lower legs. The gastrocnemius and soleus mus- cles are particularly affected. Because the increase in muscle tone is effective over a period of months, the fascial sheath layers of the affected muscles react with corresponding reinforcement and orientation of their fibers. This process also causes aftereffects that are significant for months after birth. The change in position by the organs in the pelvic and abdominal cavities during pregnancy is only possible because the peritoneum changes as well; its surface increases by far more than its reg- ular area of 2 m2. This process also has conse- quences that reach far beyond the pregnancy. Only some of the excess peritoneal layers are able to degenerate on their own after birth.
212 FASCIAL AND MEMBRANE TECHNIQUE It is characteristic of the process of change that the distal end of the gastrocnemius muscle, the occurs during pregnancy that precisely localized second hand supports the lower leg from the ante- detailed fixations as well as large-area layers of the rior direction in the region of the tibialis anterior. parietal system are influenced. In the case of first pregnancies, it is entirely possible that the increased Action The therapist supports one knee on the effects of force inside the abdominal and pelvic cav- lower end of the treatment table and the therapist’s ities may release fixations. Pregnancy is, after all, a thigh supports the toes and transverse arch of the natural process and this process has a great positive foot. The patient’s knee is slightly bent. Using potential for the correction of the inner structure of the surface of the middle phalanges of one hand, the myofascial system. It is precisely for this reason the therapist first applies pressure to the superficial that it is necessary to proceed in a very targeted layer of the crural fascia in order to then apply pres- manner with corrective treatment impulses after sure at a very oblique angle almost parallel to the birth. The woman’s organism has completed a far- skin to the superficial and middle layers of the gas- reaching conversion process and many tissue layers trocnemius and soleus muscles. The other hand are in a rather hypotonic state. Therefore, the thera- supports the lower leg from the anterior direction pist’s job is merely to treat a few restrictions of with firm contact on the anterior portion of the fas- motion as carefully as possible and otherwise influ- ciae. While the contact is maintained in the anterior ence the overall form of the organism with globally region without any sliding, the therapist exerts a applied techniques in such a way that the natural stretching push in the posterior section, sliding at regeneration process can occur without a problem. the contact point very slowly and only a few cen- timeters. The therapist then asks the patient to push Treatment of shortened myofascial layers in the knee gently into the treatment table and stretch the region of the lower leg the heel somewhat. It is crucial that the sliding on the posterior side of the thigh be conducted very Patient Prone, both legs extended, arms resting to slowly and the intensity of the contact be main- the side of the torso. tained during the entire sequence of movements. Therapist Standing at the feet. This technique should then be applied analo- gously to the other leg. We have to pay close atten- Contact With the middle phalanges of one hand tion to the differences between sides and modify at the transition between the Achilles tendon and the angle of application and intensity of pressure correspondingly. Figure 9.1 Treatment of shortened myofascial layers in the region of the lower leg.
TREATMENT AFTER PREGNANCY AND BIRTH 213 Treatment of the myofascial tension patterns the adductor magnus and semitendinosus mus- of the thigh cles as well as on the other leg. It may be necessary to modify this technique in relation to existing ten- Patient Prone, both legs extended, arms resting sion conditions. to the side of the torso. The technique described for the lower leg and Therapist Standing at the level of the knees. thigh can be applied in a modified form to any longitudinal muscles of the posterior side of Contact One hand supports the thigh from the the leg. For the efficacy of this technique, it is anterior direction while the other hand reaches necessary to create an intensive contact with between the biceps femoris and semitendinosus the fasciae and to ensure that the pressure muscle from the posterior direction above the knee. actually reaches the fascial layer between the muscle bellies. Any tugging, gliding motion on Action The therapist supports the thigh with one the skin must be avoided. In addition to this hand in such a way as to produce a flat contact with technique, which is applied to a large area, the the anterior layer of the fascia lata parallel to the techniques described in the chapter on the outside shape. The therapist holds the entire leg so lower extremity can be used as well (see that approximately horizontal hinge axes manifest section 4.5, Lower extremity). at the ankle, knee, and hip joint. With the other hand, the therapist reaches parallel to the orienta- Treatment of the fascia of the transversus tion of the muscle fibers between the muscle bellies abdominis and the spatial relationship between of the long head of the biceps femoris and the semi- intraperitoneal and retroperitoneal components tendinosus muscle. The therapist uses his or her body weight to allow the touch to first sink through Patient Sitting upright on a stool with the knee the superficial layer and then make contact between joints at a lower level than the hip joints. the fascial sheaths of the two muscle bellies. The therapist selects the direction of pressure in such a Therapist Kneeling in front of the patient. way that the tissue is not crushed against the bone located below it. With intensive contact, the thera- Contact With the palms completely relaxed on both pist gradually moves in the proximal direction sides of the abdominal wall just below the navel. toward the ischial tuberosity. This technique is then applied in an analogous manner for the fascial boundary layers between Figure 9.2 Treatment of the myofascial tension patterns of the thigh.
214 FASCIAL AND MEMBRANE TECHNIQUE Action First, the therapist asks the patient to make abdominis and its fascia. Only then do we good contact between both feet and the floor. Then intensify the quality of the touch far enough the therapist asks the patient to completely relax the that the contact encroaches on the peritoneum abdominal wall and allow the pelvis to tilt slightly on both sides. Finally, we allow the touch to act in the anterior direction around the axis of the hips farther in the dorsal direction through the so that the pelvic segment moves toward the thera- peritoneal cavity until we have the impression pist’s palms. The patient should keep the sternum in that we have arrived at the posterior layer of a superior–anterior position, but still remain com- the peritoneum. In an ideal case, while the pletely relaxed on the anterior side of the body. patient’s pelvic cavity is leaning against our hands, we reach the retroperitoneal cavity just The therapist then modifies the contact with below the kidneys. At this moment, it is both hands as if to carefully support the contents worthwhile to change the quality of the touch of the pelvis while it tilts forward, and then lifts it again in the sense of a very subtle “listening.” minimally in the cranial direction and gradually We may be able to notice a shear effect guides it somewhat farther inward in the direction manifesting on one side in the inferior of the middle central line of the torso. Seen from direction. We follow this effect minimally in the the outside, it appears as if the therapist were try- inferior direction and then intensify the ing to push the organs from both sides toward the impulse gently in the cranial direction. front of the spine. If this technique is correctly applied, a gradual correction of the spatial relationships occurs between the fascial layers of the abdominal wall, the ante- rior layer of the peritoneum, and the posterior layer of the peritoneum relative to the renal fascia. The effects of this technique occur gradually. In the weeks after the birth, it acts on the exterior myofascial structure of the pelvic and abdominal cavities and the mobility of the organs. Ultimately, its objective is to move the spread-out parts of the enlarged peritoneum more strongly together and thus allow an improved alignment of the organs of the torso. This technique consists of active and passive Figure 9.3 Treatment of the fascia of the transversus components, which must be taken into account abdominis and the spatial relationship between if the technique is to be performed successfully. intraperitoneal and retroperitoneal components. The tilt of the pelvis in the anterior direction corresponds to the active part; we move our hands only minimally in the dorsal direction. This has an effect on the patient’s body as if we were raising the entire contents of the pelvis slightly in the cranial direction. However, this procedure has a passive component as well: in “listening,” during the lifting process, we note any resistances that may occur in the tissue. We feel our way layer by layer, first through the muscular fascial structure of the exterior abdominal wall until we reach the transversus
TREATMENT AFTER PREGNANCY AND BIRTH 215 Summarizing aspects but rather on and in the fasciae of the myofascial system. Schematically conducted training of the Because the movement of the diaphragm is gener- abdominal muscles may cause the increased area of ally limited during pregnancy, lasting changes may the peritoneum that is still present to be extended also occur to joints in the upper body that are further, or ligaments connected to organs to be dependent on the movement of the diaphragm. In overextended. It is advisable to perform exercises such cases, before applying the techniques in the for strengthening the muscles only once the liga- lower extremities and the pelvic and abdominal mentous and membranous layers of the abdominal cavities, I recommend ensuring that no articular and pelvic cavities have regained their normal restrictions are present in the region of the thorax. state, which will happen three months after deliv- The costovertebral joints and the sternoclavicular ery at the earliest. However, there are limitations to joints require particular attention in these situa- strength training of some muscle groups even then, tions (see sections 4.1 and 5.1). if the coordination of overlapping muscle pulls is not taken into account. In the gymnastics of regeneration, we must keep in mind that the large changes during preg- nancy do not manifest on the actual musculature,
217 Concluding remarks For psychologists who have had little education in tissue and can be read there. Thus, a shape devel- anatomy, there is sometimes the danger of over- ops that is more than a collection of discrete looking the fact that the physical side of a person anatomical parts. In the treatment of the fasciae and has its own dynamics. Therefore, overinterpreta- membranes, the therapist communicates with this tions of physical expression may occur in psy- shape. Anatomical knowledge is helpful, but it chotherapy. On the other hand, a therapist following serves more as topographical orientation than as a manual approach has the far greater risk of the actual therapeutic technique. blindly believing in the laws of matter. However, a bent back is not only a pronounced kyphosis of the A great virtuoso of the violin once said, “The best thoracic spine; it is also an expression of a bent technique is the kind that you don’t even notice.” person. I think that what he meant was that efficient The spatial form of the fascial and membrane technique is applied inconspicuously and is never network can be read like the story of a person given an end in itself. It is in this spirit that Fascial and shape. Recurring motion sequences, the preferred Membrane Technique addresses the organism as a orientation and perception, as well as the prevailing structure of form. It is applied to the physical struc- basic emotional pattern, leave their marks on the ture in order to reach the psychological unity of the person.
219 Bibliography Abehsera A. (2000) Craniosacrale Osteopathie: Ein wichtiger Breul R. (2002) Die Blätter der Fascia renalis. Osteopathische Baustein der Osteopathie. Osteopathische Medizin, 1. Medizin, 2. Abehsera A. (2002) Craniosacrale Osteopathie unter der Croibier A. (2005) Diagnostic Ostéopathic Général. Elsevier: Paris. Lupe—Teil II. Osteopathische Medizin, 4. Friedlin M. (2003) Annäherungen an den Faszienbegriff— Barral J-P. (1993) Manipulations Uro-Genitales. Éditions de Eine semantische Untersuchung. Osteopathische Medizin, 1. Verlaque: Aix-en-Provence. Flury H and Harder W. (1988) The tilt of the pelvis. Notes on Barral J-P. (1996) Manual Thermal Diagnosis. Eastland Press: Structural Integration, Zurich, 1. Seattle, WA. Godard H. (2003) Verbesserung der sensorischen Dynamik. Barral J-P. (2002) Lehrbuch der viszeralen Osteopathie. Vol. 2. In Schwind P (ed.) Alles im Lot. Eine Einführung in die Urban & Fischer: Jena. Rolfingmethode. Droemer-Knaur: Munich. Heine H. (1997) Lehrbuch der biologischen Medizin. Barral J-P and Croibier A. (1999) Trauma. An Osteopathic Grundregulation und extrazellulare Matrix. Grundlagen und Approach. Eastland Press: Seattle, WA. Systematik. 2nd edn. Thieme: Stuttgart. Horwitz G. (1981) Pneumatic and tensile structures. The Barral J-P and Croibier A. (2005) Manipulation peripherer work of Frei Otto. Bulletin of Structural Integration, 7 (2). Nerven. Osteopathische Diagnostile und Therapie. Elsevier: Ingber D. (1998) Architekturen des Lebens. Spektrum der München. Wissenschaft, 3. Jones LH. (1981) Strain and Counterstrain. American Barral J-P and Mercier P. (1988) Visceral Manipulation. Academy of Osteopathy: Newark, NJ. Eastland Press: Seattle, WA. Kleinau A. (n.d.) Lang- und mittelfristige Ergebnisse nach Operationen wegen eines Karpaltunnelsyndroms. Barral J-P and Mercier P. (2002) Lehrbuch der viszeralen Unpublished manuscript and research report. Osteopathie. Vol. 1. Urban & Fischer: Jena. A second Köpf-Maier PS. (2000) Wolf Heideggers Atlas der Anatomie des edition in translation of Barral and Mercier (1988), above. Menschen, 5th edn. 2 vols. Karger: Basel. von Lanz T and Wachsmuth W. (1972) Praktische Anatomie. Barral J-P, Mathieu P and Mercier P. (1993) Die Ein Lehr- und Hilfsbuch der anatomischen Grundlagen Untersuchung der Wirbelsäule. In Handbuch für die ärztlichen Handelns. 1 vol. Part 4. Springer: Heidelberg. Osteopathie. The International Academy of Osteopathy: Lanz U. (1967) Anatomical variations of the median nerve in Gent. the carpal tunnel. Journal of Hand Surgery, 147. Liem T. (1998) Kraniosakrale Osteopathie. Ein praktisches Benninghoff A. (1994) Anatomie. Vol. 1, 15th edn. Urban & Lehrbuch. Thieme: Stuttgart. Schwarzenberg, Munich. Liem T. (2000) Praxis der kraniosakralen Osteopathie. Thieme: Stuttgart. Benninghoff A. (1934) Über die Anordnung und die Megele E. (1991) Diagnostische Tests beim Bedeutung der Bindgewebssysteme im Gefüge der Karpaltunnelsyndrom. Der Nervenarzt, 62. Muskulatur. Verhandlungen der Anatomischen Gesellschaft, 42. Meert GF. (2003) Das Becken aus osteopathischer Sicht. Funktionelle Zusammenhänge nach dem Tensegrity-Modell. van den Berg F. (ed.) (1999) Angewandte Physiologie. Vol. 1: Urban & Fischer: Munich. Das Bindegewebe des Bewegungsapparates verstehen und beeinflussen. Thieme: Stuttgart. Bienfait M. (1982) Les Fascias. Societé d’édition Medicale “Le Pousse”: Bordeaux. Boebel R. (1957) Über die Beziehungen des M. iliopsoas mittels seiner Faszie zu den Gefäßen der Fossa iliopectinea. Zeitschrift für Anatomische Entwicklungsgeschichte, 120.
220 BIBLIOGRAPHY Maitland J. (2001) Spinal Manipulation Made Simple. A Manual of Schleip R. (2003) Faszien und Nervensystem. Osteopathische Soft Tissue Techniques. North Atlantic Books: Berkeley, CA. Medizin, vol. 1. Myers T. (2001) Anatomy Trains. Myofascial Meridians for Schleip R, Klinger W and Lehmann-Horn F. (2005) Active Manual and Movement Therapists. Churchill Livingston: fascial contractility: Fascia is able to actively contract and Edinburgh. relax in a smooth muscle like manner and thereby influence biomechanical behavior. Acta Physiologica, 186 Morton DJ. (1952) Human Locomotion and Bodyform. A Study (Suppl. 1). of Gravity and Man. The Williams & Williams Company: Baltimore, MD. Schulz L and Feitis R. (1996) The Endless Web. Fascial Anatomy and Physical Reality. North Atlantic Books: Müller H. (1990) Morphologische Grundlagen der Berkeley, CA. Kiefergelenksfunktion und deren Störungen und Konsequenzen für Diagnostik und Therapie. Professorial Schwind P. (2003) Alles im Lot. Eine Einführung in die dissertation, Ludwig-Maximillians-Universität, Munich. Rolfingmethode. Droemer-Knaur: Munich. Mumenthaler M. (1962) Über Lähmungen peripherer Schwind P. (2001) Die manuelle Behandlung des Nerven im Extremitätenbereich. Deutsche Medizinische Karpaltunnelsyndroms—Faszien- und Membrantechnik. Wochenschrift, 38. Osteopathische Medizin, 3. Mumenthaler M. (1964) Die Therapie des Schwind P. (2002) Faszientechnik für Behandlung des Carpaltunnelsyndroms. Deutsche Medizinische Kiefergelenks. Osteopathische Medizin, 1. Wochenschrift, 51. Sobotta J. (2001) Atlas der Anatomie des Menschen, 21st edn. Mumenthaler M and Schlack H. (eds.) (1982) Läsionen 2 vols. Ed. R Putz and R Pabst. Urban & Fischer: Munich. peripherer Nerven. 4th edn. Thieme: Stuttgart. Staubesand J and Li Y. (1996) Zum Feinbau der Fascia cruris Oschman JL. (2000) Energy Medicine. The Scientific Basis. unter Berücksichtigung epi- und intrafaszialer Nerven. Churchill Livingstone: London. Manuelle Medizin, Springer: Berlin, 34 (5). Pernkopf E. (1987) Atlas der topographischen und angewandten Sutherland WG. (1990) Teachings in the Science of Osteopathy. Anatomie des Menschen, 2nd edn. Ed. H Fermer. Urban u. Ed. A Wales. Rudra Press: Portland, OR. Schwarzenberg: Munich. Tittel K. (1978) Beschreibende und funktionelle Anatomie des Paoletti S. (2001) Faszien. Anatomie—Strukturen—Techniken— Menschen. 8th edn. Gustav Fischer: Stuttgart. Spezielle Osteopathie. Urban & Fischer: Munich. Upledger JE and Vredevoogd JD. (1983) Craniosacral Therapy. Prat D. (1993) Le cadre osteo-musculaire de la sphere uro- Eastland Press: Seattle, WA. genitale. In Prat D et al. Nouvelles Techniques urogenitales. Éditions de Verlaque: Aix-en-Provence. Varela FJ and Frank S. (1987) The organ of form: toward a theory of biological shape. Journal of Social and Biological Prat D. (1999) Manual diagnostics. Lecture at the Structures, 10. interdisciplinary symposium by the Munich Group, Villa Degiani, Friuli. Waldeyer A and Mayet A. (1993) Anatomie des Menschen, 16th edn. 2 vols. De Gruyter: Berlin. Rauber A and Kopsch F. (1987) Anatomie des Menschen. Lehrbuch und Atlas. Ed. H Leonhardt, B Tillmann, Wilhelm K. (1987) Kompressionssyndrome des Nervus G Töndury and K Zilles. Thieme: Stuttgart. ulnaris und Nervus medianus im Handbereich, Orthopäde, 16. Rolf IP. (1993) Rolfing im Überblick. Junfermann: Paderborn. Rolf IP. (1997) Rolfing—Strukturelle Integration. Wandel und Zumhasch R and Hinz C. (1999) Das Karpaltunnelsyndrom. Anatomie, Ätiologie, Diagnostik und präoperative und Gleichgewicht der Körperstruktur. Ed. and rev. P Schwind. postoperative Behandlungsmöglichkeiten. Part I: Ergotherapie & 2nd edn. Irisiana: Munich. Rehabilitation, 5.
221 Index Note: page numbers in italics refer to figures and tables. A annular ligament 99 autonomic nervous system 11 antebrachial fascia 95 ergotropic agitation after whiplash abdominal cavity 204 myofascial structure after giving carpal tunnel syndrome 103 birth 214 treatment according to Ida Rolf 98 axis 140 pregnancy 211 antebrachial interosseus membrane 96 membrane connections 142–144 shear force test 202 anticipatory movement activity 36 thoracic cavity transition 33–34, arms B 35, 41 connection to shoulder joint 84 examination 41–42, 43 back, upper, myofascial structure to fascial network treatment thoracic cavity 55–56 abdominal muscles, strengthening 215 104 abdominis muscle band structures extensor musculature 93, 94, 97 bone connections 28 oblique 49, 50 fascial anatomy 94–96 organ 29 transverse 137 flexor musculature 93, 94, 97 form 93 Barral, Jean-Pierre fascia treatment 213–214 intermuscular septa 94 general listening acceleration force 198 in the sitting position 200–201 acetabular fossa, connective tissue treatment 97 in the standing position 200 membrane anatomy 94–96 liver mobility treatment 169–170 cushion treatment 131–132 periosteum 97 liver motility 171 acromioclavicular joint 104 superficial fascia treatment organ movement 168–169 adaptation process 32 restriction 167–168, 169 adductor magnus muscle 113, 115–116 96–97 peripheral nerve treatment 133 upper, transition to forearm 105 subclavius muscle treatment 89–90 fascia 116, 213 see also carpal tunnel; forearm; supplementary test 85–87 agitation, ergotrophic/trophotropic technique for lumbar intervertebral hand disk protrusions 147–149 204 articular disk 182, 183 thermal diagnosis 200 alveolar nerve 189 atlanto-occipital junction 66, 72 alveolar processes 190–191 biceps brachii aponeurosis 98 anatomy 1–2 compression 161 biceps femoris muscle 70, 109 ankle joint 109 restrictions 203 scoliosis treatment 80 fascial treatment 112–113 calcaneus intraosseus tension treatment 140–142, 195 myofascial tension patterns 69 treatment 166 see also occiput bicipital aponeurosis 95 atlanto-occipital membrane 22, 23, 141 bicipital tendon 99 hinge joint axis technique 119–122 contact 27 birth, treatment after 211–215 hip arthrosis compensatory atlas 140 membrane connections 142–144 changes 127 attentiveness, differentiated 14 movement restriction correction 204
222 INDEX bladder calf 117 realignment 27 fixation 177 capitate bone 103 stretch 6 ligaments 145 carpal bones 101 communication by therapists 13, 14–15 movement restriction 132 carpal ligament, transverse 102 connective tissue 1–2, 5, 6 vesical sphincter dysfunction 154 carpal tunnel 85 balance shift in elements 32 continuity 6 body stocking 23–24, 25 anatomical conditions 102–103 elasticity 198 bones, band structure connections 28 median nerve treatment below 108 functions 2, 6 bow legs 120, 122, 123 stretching effect 105–107 malleability 9–11 brachial fascia 94 carpal tunnel syndrome 101–109 material properties 6–7 brachial intermuscular septum, medial examination 103 mobilization techniques 2 treatment 103–109 overextension 10–11 97 carpi radialis, extensor 98 plasticity 7, 198 brachial plexus 77, 84–85, 105 carpi ulnaris, flexor 98, 102 properties 7 cartilage, embryonic development 9 contact, therapeutic 15, 16 tunica layer 81 cervical fasciae 38, 181–182 subtle 28 brachialis muscle 94 cervical spine coracoacromial ligament 91 brachioradialis muscle 98 cranium transition treatment 65–67 coracobrachialis fascia 81 breathing curvature treatment 65 coracobrachialis muscle 94 head transition 208–209, 210 coracoid process 82 anticipatory movement activity 36 hyperextension 75 costal joints, movement restriction 86 diaphragm treatment techniques intervertebral disk protrusions costovertebral joints 215 craniosacral membrane, tension 58–64 149–151 form development 32–35 retromedial 151–152 relationships in scoliosis 77 globally applied spinal techniques lower, motion restrictions 139–140 craniosacral osteopathy 23 mobility 67 craniosacral pulse model 180 64–76 spinal processes 75 craniosacral system 179–180 mechanisms of upper chest cavity tensile forces 35 thoracic spine transition 93 contact 29 40 treatment 65–67 global 23, 24 mobilization of layers 37 upper chest cavity transition 208 organ movement 39, 40, 168 see also neck/neck region movement restrictions 180 passive 33, 38 cervicocranial transition 189 tension patterns 180 pattern 64–76 cervix, uterine whiplash treatment 205 pelvis tilt 36 ligament movement restriction 153 craniosacral therapy 167 respiratory area fascial network ligamentous connection to sacrum techniques 79 cranium treatment 46–57 144 breathing motion transmission 46, 47 torso segment spatial relationships chest cavity see thoracic cavity cervical spine transition treatment clavicle 90, 92 35–37 65–67 breathing motion 32 rib connection 85 mandible connection 180 tension reduction 184–185 mobility 185 examination 40–42, 43, 45–46 see also sternoclavicular joint oral implant complications 190 limitations 38 clavipectoral fascia 81, 91 sagittal suture region treatment lower pelvic region evaluation coccyx 153–154 anatomy 154–155 185, 186 45–46, 46 anterior fixation 156–157 shear test 202 retroperitoneal area evaluation 46, crural fascia 117, 118 treatment 160–161 deep layer treatment 125–126 47 connection to sacrum 154 superficial layer treatment segmented erection of body 37 lateral fixation 157, 158–159, 160 shear effect 46 mobilization 161 122–123, 124 tension patterns 37 myofascial tension pattern 155 cuboid bone, joint with calcaneus 165 transmission to cranium 46, 47 pull effect on lowest segment of cuneiform bones 164 breathing space, anatomy of sacrum 155–156 D fasciae/membranes 37–40 collagen fibers 5 deep fascia, fingertip direct C compression 27 application 18 deformation 198 calcaneofibular ligament 163 embryonic development 9 deformation process 5, 7 calcaneonavicular ligament 162, 164 extensibility 198 deltoid muscle 94 calcaneotibial ligament 163 organization 27 calcaneus intraosseus tension treatment 165–166 joint with cuboid bone 165 joint with talus 163–164
INDEX 223 diagnosis 15 exhalation 33, 38 strain 94 diaphragm 32, 33 extracellular matrix 6 upper arm transition 105 fracture, healed 24–25 cupulas 78, 79–80 F relationship with liver 61–62 G relationship with stomach 62 fascia, definition 5 simultaneous treatment 59–61 fascia infraspinata 82 galea aponeurotica 140, 184, 186 tension 138 gastrocnemius muscle 211 treatment 87–88, 89, 91–92 gemellus muscle, superior 128, 129, excursion space 177 fascia lata 111 altered 78 131 anterior/posterior layers genu valgum 120, 122–123 forces 40 116–117 genu varum 120, 122, 123 function 36 Gibsonís fascia 9–10 movement restrictions 33–34 subgluteal horizontal part 113–114, glenoid fossa 91 115, 128–129 Glissonís capsule 169 pregnancy 215 global contact, craniosacral system 23, position 40 treatment techniques 112–117 serosa 39 fascia supraspinata, treatment 91–92 24 shear force 39 fascial system 1 gluteal fascia 111 gluteal muscles 130 test 202 functions 2, 3 gluteus maximus muscle 155 shock pattern treatment 207–208 mechanoreceptors 11 gracilis muscle 112, 115 spatial relationships with lung and plasticity 11 ground substance 7 fascial treatment 2 Guyon’s canal 85, 106, 108 pleura 60 fascial tubes, thigh 112, 115 treatment techniques 58–64 femoral head ligament 131–132 H femoral nerve 133 lower boundary 59 fibers, adaptation 32 hamate bone 103 relationship with liver, stomach fibula 117 hamulus 102 head 125 and pleura 63–64 talus joint 163 hand upper boundary 58 fingers extension movement 93 Douglas space 110 bent 20 fasciae 96 dura mater 23, 24, 153 direct application 20–21 flexor side, treatment of fasciae altered tensile effect treatment first phalanges 20–21 101, 101 independence 17–18 forearm transition 94–95 205–207 index 20 independence 17–18 fixations 203, 204 indirect application 20, 24–26 indirect application 24–25 second phalanges 20 strain 94 E use 16–17 see also fingers; palm fingertips, direct application to deep elastic bridges 7 hand–contact technique 15–27 elastic fibers 5, 6–7, 198 fascia 18 head fist application 20–21 deformability 198 foot transition from upper cervical elastin 6–7, 198 spine 208–209, 210 anatomy 117–119 nuchal ligament 67 arch 162 see also cranium; skull resting length 198 fascial layer 118 hinge joint axis technique 119–122 return force threshold value 10–11 form 109–111 hip joint elbow joint 85 joints 162–166 flexor muscles 98 ligaments 162 adductor muscle fascia 127 oblique cord 99 mobilization techniques 162–163 arthrosis 109, 126–135 shear pressure 106 foramen magnum 185 embryonic development 9 dura attachment 153 rehabilitation for surgical emotionalization, whiplash 205 forearm intervention 126 endothoracic fascia 6, 9, 35 extensor muscles 96, 98 neck fascia connection 181 fascia 95–96, 97–98 capsule 128 thickness 54 flexion movement 93 fascial anatomy 127–128 whiplash treatment 205 flexor muscles 96, 98 membrane anatomy 127–128 envelope, organ 28 hand transition 94–95 rotator muscle group 127, epicondyle interosseus membrane treatment lateral 94 129–132 medial 94, 98 99–100 surgical intervention 126, 127 epimysium 111 treatment techniques 128–133 erector muscles, tone imbalance 78 ergotropic agitation 204
224 INDEX humerus, elastic compression 104 J treatment of relationship with hydrostatic chambers 8 stomach, diaphragm and joints pleura 63–64 I function 9 hinge joint axis technique 119–122 triangular ligament 178 iliac fossa, periosteum 128 lordosis iliococcygeal muscle 155 K iliolumbar ligaments 68, 139 lumbar spine 67–68, 68, 110, iliopsoas muscle fascia 128 kidneys 144–145 iliosacral joints fixation 177 mobility treatment 174–175 spinal curve 65 inferior section mobilization movement 39 lumbar fascia 6, 67 144–146 restriction 132, 153, 205 lumbar spine sinking motion 36 treatment 143–144, 145 whiplash treatment 205 curvature 109–110 iliotibial tract 112 flat back treatment 68–69, 69 knee joint 109 hyperlordosis 67–68, 68 deep layer treatment 113–114 function 111 intervertebral disk protrusions ilium hinge joint axis technique 119–122 loads 120 146–147 alae 68, 70 retromedial region according to outflare 70–72 knock-knees 120, 122–123 impulses kyphosis, thoracic spine 73–74, 75 Barral 147–149 minimally corrective 29 lordosis 67–68, 68, 144–145 slow-acting 28 L indirect techniques, band structures reduction 110 latissimus dorsi muscle 82, 83 motion restriction treatment 28 fascial boundary with serratus infants anterior 40 137–138 fascial investment 87–88 sacrum transition 70, 80, 93 idiopathic scoliosis 77 scoliosis treatment 79 leg decompression technique infraspinatus muscle 82 form 109–111 138–139 inhalation hinge joint axis treatment liver movement 61 techniques 119–126 kinked 147, 148 spine curvature 32–33 lower treatment 195 intercostal membranes 38 anatomy 117–119 tension pattern 68 dorsal 20 interosseus membrane 24–25, thoracic region transition 93 indirect treatment 19, 20 117, 123, 125 lungs mobilization 42 shortened myofascial layers 212 altered spatial excursion 78 treatment 46–48, 48 segmental organization 3 mobility 174 intercostal muscles 33, 38 shear force resistance 202 motility treatment 172–174 fascial layer activation 42 tension patterns 109 spatial relationships with pleura intercostal region 38 upper, myofascial complex 109 interosseus membranes 28 see also hip joint; thigh and diaphragm 60 antebrachial 95 carpal tunnel syndrome 103 levator ani muscle 155 M forearm 99–100 levator scapulae muscle 83, 104 lower leg 24–25, 117, 123, 125 lingual nerve 189 malleolus, lateral 123, 125 interpleural space treatment 54, 55 listening 28, 29, 48 mandible 193 interstitial receptors 11 liver intervertebral disk protrusions correction of reduced/absent diaphragm right cupula protrusion 188–189 146–153 relationship treatment 61–62 intracranial membrane system 180 cranium connection 180 expir fixation 172 temporalis muscle insertion 187 oral implants 193 inspir fixation 170–172 mandibular cavity 195 intracranial pressure 180 motility treatment 170–172 mandibular joint 180 ischiadicus 2 movement during inhalation 61 active movement 182–183 ischial rami 109 movement restriction 86, 93 biomechanics 183–184 diagnostics 182–183 myofascial tension patterns treatment 169–170 dysfunction 180 128–129, 129 sheath layer stricture 170 movement 183–184 neck region fasciae 181 ischial tuberosity 70, 128 opening function 187 coccyx relationship 157, 160 passive movement 182–183 treatment 184–189 ischialgia 111 manual treatment 13–14 side-effects 23, 24 three-dimensional 23–24
INDEX 225 masseter muscle 183, 184 chronically hyperextended 75, 76 ligamentous connection restrictions masticatory muscles 182 fascia 39 202 maxilla 191–192 layers 181–182 ligamentous structures 28 anatomy 193 mandibular joint 181 ligamentous suspensions 208 implants 189–190 intervertebral disk protrusions mobility 33, 40, 42, 168–177 membranous connections with 149–151 after whiplash 204–205 skull 205 retromedial 151–152 limitation 35, 42, 54, 63–64, 93, motion restriction 194–195 myofascial layers 151 spatial relationship with base of shear test 202 132 spatial relationship with maxilla mobilization 42 skull and neck 187–188, 195 motility 168–169 maxillary sinus 192, 193 and skull base 187–188, pelvic 132 mechanoreceptors 11 195 serosal layer distribution 208 median nerve 102 thoracic cavity transition 35, 41, treatment after whiplash 204–205 44–45 osteopathy 3 anatomical variations 108 whiplash treatment 205 craniosacral 23 direct influence below carpal see also atlanto-occipital junction; overcompensation process, atlanto-occipital membrane; tunnel 107–108 atlas; axis; cervical spine; intervention 28 passage in elbow joint 105–107 occiput radices 105, 106 nerves P tissue bed treatment 104–105 function 101 membranes 2 organ movement relationship to palatine bone anatomy 190–192 definition 6 form 178 palm functions 2, 3 nervi nervorum 101 treatment 2 nervous system direct application 19 metatarsus activity during manual therapy 11 independence 17–18 calcaneus intraosseus tension see also autonomic nervous system listening 48 neurocranium 194 two-dimensional application 22, 22 treatment 166 nuchal fascia 39 use 16–17 movement restriction correction nuchal ligament 67, 67, 181–182 palmar aponeurosis 96, 100 connection to occiput 75, 188 palmar muscle, long 102 204 whiplash treatment 208 parietal system mobility 33 fixations 203 mobilization techniques 2 O pregnancy 212 motility 33 pectineal fascia 127 movement patterns 36 oblique abdominal muscle 80 pectoral fascia 81–83 Müller H 182–183 external 84 pectoral girdle muscle fibers 6 adaptation to forces 93 myofascial bridge, thoracic cavity 38 obliquus capitis muscles 141 examination 84–87 myofascial skeleton 8 obturator internus muscle 128 form 80–81 myofascial units, subcostal 20 obturator nerve 133 periarthritis 87 myofascial unity 6 occiput 66, 144 thoracic cavity connection myofascia/myofascial layers membrane connections 142–144 treatment 56–57 contraindications to treatment in nuchal ligament connection 75 treatment techniques 87–93 whiplash 205 support 27 pectoralis major 81 whiplash treatment 208 pectoralis minor 81 embryonic development 9 see also atlanto-occipital junction fascia treatment 87–88, 89 overly tense 28 oral implants 189–190, 192–193 pelvic cavity pregnancy 212–213, 215 organs ligament connections 144, 145 shortened in lower leg 212 abdominal 39 membrane connections 144, 145 slack 28 myofascial structure after giving during inhalation 33 N mobilization techniques 40 birth 214 connective tissue sheaths 208 pregnancy 211 nasal cavity 194–195 diaphragm influence 177 shear force test 202 nasal–pharyngeal space 181 embryonic development 78 pelvic organs, movement restriction natural table 27 envelope 28 navicular bone 162 fixation 53, 177, 203 132 fluid dynamics 28 pelvic region, lower, breathing talus joint 164–165 neck/neck region movement evaluation 45–46, 46 chronically contracted myofascial layers 75–77
226 INDEX pelvis 110 psychoemotional context, tension leg hinge joint treatment band structures 28 patterns 27 techniques 119 coccyx role 154 connective tissue cavities 176 pterygoid muscle superficial fascial layer of arm hip arthrosis compensatory lateral 188, 189 treatment 96–97 changes 127 medial 183, 189 ligamentous connections 73 Ruffini’s endings 11 ligaments 109 pterygotemporomandibular myofascial complex 109 aponeurosis 182, 189 S rotation 147 shear force 199 pubic bone 177 sacral bone motion effect 74 pubococcygeal muscle 155 dural path 23, 24 tension relationships 110 puborectal muscle 155 movement 46 tilting 36, 67, 109, 145–146 angle 147 Q sacrococcygeal joint 153–157, 158–159, posterior 69–71, 109 160–161, 162 tuberosities 70 quadratus muscle, pronator 107 ulna application to large ligaments fascial layer treatment 161, 162 25–26, 27 R mobilization 160, 161 motion restriction 154 perception, preferred patterns 36 radial nerve 97, 98 sacrococcygeal ligament 71 perineural tunicae 3 radial tuberosity 99 sacrococcygeal synchondrosis 154 peritoneal cavity, stabilization 175–177 radiology for scoliosis 77 sacroiliac ligament 6 peritoneum radius 95, 99 interosseus 71 receipt, touch component 14 tension 145–146 anterior layer 214 rectum, ligaments 145 sacrospinal ligament 160 parietal, sliding behavior 42 rectus abdominis fascia, upper section sacrotuberous ligament 26, 70, 109 posterior layer 214 sacrum 68, 71 pregnancy 211 treatment 48–49 coccyx visceral, sliding behavior 42 rectus capitis posterior minor muscle pharyngobasilar fascia 181 connection 155 phrenic nerve 178 141 pull effect on lowest segment physical devices 13–14 Renaut’s bodies 101 pisiform bone 102 repetitive stress/strain syndrome 95 155–156 plantar aponeurosis 118 respiratory area, fascial network role 154 plantar ligament, long 162, 164 iliosacral joint mobilization 144 pleura treatment 46–57 lumbar spine transition 70, 80, 93 adhesion treatment in upper respiratory space maintenance 81 decompression technique retinaculum, flexor of wrist 101, 102, thoracic cavity 52, 53 138–139 parietal 173 103 kinked 147, 148 treatment 107–108 treatment 195 sliding behavior 42 retinaculum, lower limb 118 mobility 144 spatial relationships with lung and retroperitoneal area, breathing motion movement restriction 202–203 second segment mobilization diaphragm 60 evaluation 47 treatment of relationship with liver, retroperitoneal cavity 214 205–207 whiplash treatment 205–207, 209 stomach and diaphragm peritoneal cavity stabilization see also iliosacral joints 63–64 175–177 sagittal suture region treatment of visceral, sliding behavior 42 pleural cupula 9, 35, 185 retroperitoneal space 39 cranium 185, 186 mobility 45 ribcage 34 scalene fascia 10, 54, 77, 185 suspending connections 54 whiplash treatment 205 clavicle connection 85 treatment of posterior section 50–51 posture 37 compression 42, 44 scalene muscles 32, 40, 76, 152 patterns 36 exterior limits 38 postvertebral tension 36 fascial structure treatment 208 activity 184 pregnancy, treatment after 211–215 membrane structure treatment 208 flexion 140 prevertebral erection 36 shoulder joint connection 81, 84 scaphoid bone 102, 103 prostate, ligament movement ribs scapula 82, 92, 104 restriction 153 breathing motion 32, 33 scapulohumeral fascia 82–83 psoas muscle 39, 138 compression 56 Schneider’s membrane 192 kidney mobility treatment 174–175 upper vertebral joints 104 scoliosis vertebral joints 136–137 etiology 78 Rolf, Ida 3 idiopathic in infancy 77 antebrachial fascia treatment 98 myofascial treatment 77–80 treatment 79–80
INDEX 227 semimembranosus muscle 70 hyperextension 65 tensegrity model 7–9, 10 coccyx relationship 154 thoracolumbar fascia 38–39 tension patterns fascial treatment 112–113, 115 see also cervical spine; lumbar psychoemotional context 27 semitendinosus muscle 70 spine; thoracic spine therapeutic interventions 9–10 coccyx relationship 154 spleen 35 tensional forces, transmission 7 fascial treatment 112–113, 213 spondylolisthesis 148 teres major muscle 82, 87 sternoclavicular joint 84, 104 teres minor muscle 82, 87 septae, deep 28 therapeutic contact 14 serous fluid 39–40 connection treatment 50, 51, 137 therapists serratus anterior muscle 80, 83 ligamentary tensions 90 communication 13, 14–15 pregnancy 215 hand–contact technique 15–27 activity 89–90 sternocleidomastoid muscle 76 internal equilibrium 14 external oblique connection area 84 fascia 112 presence 14–15 fascial boundary 50 sternum, treatment 52–53 thermal diagnosis of Barral 200 Still, Andrew Taylor 167 thigh with latissimus dorsi 40 stimulus provision 15 fascial anatomy 111–112 treatment 49 stomach fascial tubes 111, 115 movement coordination 84 diaphragm left cupula relationship form 109–111 shear force myofascial tension paths 69–70, 71 assessment 202 treatment 63 diaphragm 39 dysfunction 86 treatment in pregnancy 213 elbow joint 106 incomplete spatial curve 78 thoracic cavity pelvis 74, 199 position 78 subclavius muscle 89 pyloric section 62 abdominal cavity transition 33–34, shoulder joint 80 treatment of relationship with liver, 35, 41 arm connection 84 fascial network treatment 104 diaphragm and pleura 63–64 examination 41–42, 43 capsule 82 stress patterns 7 contact 23–24, 25 decelerated recoil effect 104 subclavius fascia 81 deep membrane layers 24, 25 mobility 81, 92–93 diaphragm movement restrictions movement function 83 treatment 88–90 periarthritis 86 subclavius muscle 85–86 34 ribcage connection 81, 84 dynamic space 39 stability 81 Barral’s treatment 89–90 fascial system evaluation 44 see also pectoral girdle shear force 89 form stabilization 34 shoulder test tension lateral, myofascial complex Barral’s 85–87 dorsal position 85 fascial 90 treatment 56, 57 sinus lift technique, minimally- patterns 90 myofascial bridge 38 reduction 184–185 neck cavity transition 41, 44–45 invasive 189, 192–193 subcostal musculature, myofascial neck region connection 35 skull pectoral girdle connection layers 20 membranous connections with subdeltoid fascia 82–83 treatment 56–57 maxilla 205 suboccipital triangle 209 shear force test 202 subperitoneal cavity, peritoneal cavity spatial relationships 33 sutures in whiplash injury 205 superficial fascia 38 skull base 140 stabilization 175–177 subscapularis muscle 82 treatment 46–48 spatial relationship with maxilla supraspinatus muscle 82 support of interior form 27 and neck 187–188, 195 Sutherland, William Garner 167, surface fascia 24, 25 transition to lower cervical region unilateral tension patterns 203 179–180 sliding layers 7, 8 flexion–extension model 23 208 small tissue units 22–23 upper soleus muscle 211 T spinal cord 153 breathing mechanisms 40 spinal techniques, globally applied for tactile orientation 36 myofascial structure to upper talocalcaneal ligament 163 breathing patterns 64–76 talus 162 back 55–56 spine 34 pleural adhesion treatment joint with calcaneus 163–164 anterior longitudinal ligament 204, joint with navicular bone 164–165 52, 53 209 temporalis fascia 182, 186–187 thoracic expansion 9–10 temporalis muscle 183–184 thoracic spine bending 39 fascial layer treatment 186–187 curvature insertion on mandible 187 cervical spine transition 93 treatment 65–67 during inhalation 32–33 organ fixation 177 costal vertebral joint treatment 136–137
228 INDEX thoracic spine (contd) transverse fasciculi 95 visceral techniques 167–178 curvature 136 trapezium bone 102 whiplash 204 treatment 65 trapezius muscle 76, 83, 91, 92, 188 flat back treatment 72–73 viscerocranium 194 intervertebral disk protrusions fascial layer 208 mechanical trauma 195 152–153 treatment kyphosis 73–74, 75 visual orientation 36 lower cervical spine motion directive 15 restriction 140 goals 2 W lumbar spine transition 93 non-directive 15 scoliosis 80 triceps brachii muscle 94 whiplash 10–11, 197–209, 210 vertebral joint motion restrictions triceps surae 117 accident circumstances 199 135–136 trophotropic agitation 204 alternative test 202–203 wedging 136 turgor effect, organ 28 complex 199 delay in treatment 203–204 thoracic wall U emotionalization 205 intermediate layers 38 examination 198–203 layers 43 ulna 95, 98, 99 force direction 199 application to large ligaments of general listening thoracis muscle, transverse 33, 40, 137 pelvis 25–26 in the dorsal position 203 treatment 52–53 in the sitting position 200–201 ulnar nerve 103, 105, 106 in the standing position 200 thoracocervical transition 56 damage 108 irritation 199 treatment 54–55, 184–185 mechanics 197–198 urogenital tract organs 132 prelesional state 198 thoracolumbar fascia 24, 25, 38–39 uterovaginal septum 110 problem zones 199–200 stretching 68 uterus progression 34 shear force assessment 202 thumbs ligaments 145 treatment 185, 203–209, 210 independence 17–18 mobility of neck 144 use 16–17 posterior tilt 110 tibia 117, 125 V talus joint 163 vertebral joints tibial muscle, posterior 164 costal 136–137 tibiofibular ligament 123 movement restriction 86 tissue compression, healed fracture thoracic spine 135–136 treatment techniques 135–146 24–25 torso vesical sphincter dysfunction 153 spatial relationships 35–37 visceral cavities 39 touch 14 transmission, touch component 14
Search
Read the Text Version
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
- 31
- 32
- 33
- 34
- 35
- 36
- 37
- 38
- 39
- 40
- 41
- 42
- 43
- 44
- 45
- 46
- 47
- 48
- 49
- 50
- 51
- 52
- 53
- 54
- 55
- 56
- 57
- 58
- 59
- 60
- 61
- 62
- 63
- 64
- 65
- 66
- 67
- 68
- 69
- 70
- 71
- 72
- 73
- 74
- 75
- 76
- 77
- 78
- 79
- 80
- 81
- 82
- 83
- 84
- 85
- 86
- 87
- 88
- 89
- 90
- 91
- 92
- 93
- 94
- 95
- 96
- 97
- 98
- 99
- 100
- 101
- 102
- 103
- 104
- 105
- 106
- 107
- 108
- 109
- 110
- 111
- 112
- 113
- 114
- 115
- 116
- 117
- 118
- 119
- 120
- 121
- 122
- 123
- 124
- 125
- 126
- 127
- 128
- 129
- 130
- 131
- 132
- 133
- 134
- 135
- 136
- 137
- 138
- 139
- 140
- 141
- 142
- 143
- 144
- 145
- 146
- 147
- 148
- 149
- 150
- 151
- 152
- 153
- 154
- 155
- 156
- 157
- 158
- 159
- 160
- 161
- 162
- 163
- 164
- 165
- 166
- 167
- 168
- 169
- 170
- 171
- 172
- 173
- 174
- 175
- 176
- 177
- 178
- 179
- 180
- 181
- 182
- 183
- 184
- 185
- 186
- 187
- 188
- 189
- 190
- 191
- 192
- 193
- 194
- 195
- 196
- 197
- 198
- 199
- 200
- 201
- 202
- 203
- 204
- 205
- 206
- 207
- 208
- 209
- 210
- 211
- 212
- 213
- 214
- 215
- 216
- 217
- 218
- 219
- 220
- 221
- 222
- 223
- 224
- 225
- 226
- 227