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Chapter 5 Connective Tissue 65
FIGURE 5-19 Lifting and rolling the calf tissues.
r The therapist is standing at the side of the table next to
the client’s calf.
1. Fascial Lift and Roll Technique. Lift and roll the skin
and muscles of the calf, the gastrocnemius and the
soleus, moving in horizontal strips (Fig. 5-19).
2. Myofascial Spreading of the Calf. Placing the heels of
the hands on the midline of the calf, spread laterally.
Variation—Use the fingertips to spread each side of
the calf separately, from the midline laterally (Fig. 5-20).
3.
Myofascial Mobilization of the Calf. Using your
fingers, roll the muscles against the underlying
muscles and bones. Work to release any areas that feel
adhered.
4. Flex the Knee, Bringing the Leg Perpendicular to the
Table. Dorsiflex the foot, and hold the stretch.
FIGURE 5-20 Myofascial spreading of the calf.
◗ ANTERIOR THIGH
Position
r The client is lying supine.
r The therapist is standing at the side of the table next to
the client’s knee.
1. Fascial Lift and Roll Technique. Place your hands in
the skin rolling position on the thigh, parallel to the
muscle fibers. Lift and roll the tissues of the thigh
(Fig. 5-21). Move from the knee to the hip, and work
in horizontal strips, covering the entire thigh.
2.
Myofascial Spreading of the Thigh. Place the hands
around the thigh, with the heels of the hand meeting
FIGURE 5-21 Lifting and rolling the
myofascial tissue of the anterior thigh.
66 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
David Rini
FIGURE 5-22 Myofascial mobilization of
the anterior thigh.
at the midline. Applying pressure with the base of the
palm, slowly slide the hands apart, spreading the tissues
of the thigh. Begin the stroke at the knee. Repeat the
spreading action in horizontal strips to the hip.
3.
Myofascial Mobilization of the Thigh. Using the fingers
of both hands, roll the muscles of the thigh over the
bone until they slide freely (Fig. 5-22).
◗ MEDIAL THIGH
Position
r The client is positioned supine, with the leg to be worked
on bent at the knee and turned out, or in side posture,
with the top leg flexed 90° and the bottom leg straight.
The underneath leg is the one to be massaged.
r The therapist is standing at the side of the table next to
the client’s knee.
1. Myofascial Spreading of the Medial Thigh. Place the
sides of the thumbs next to each other on the midline
of the medial thigh. Slowly spread the thumbs apart,
stretching the myofascia (Fig. 5-23). Begin the stroke
at the knee. Working in horizontal strips, continue to
the groin.
2. Myofascial Mobilization of the Medial Thigh. Using
your finger pads, roll the muscles against the bones,
helping them to slide freely.
FIGURE 5-23 Myofascial spreading of the medial thigh.
Chapter 5 Connective Tissue 67
FIGURE 5-24 Lifting and rolling the tissues of the
lateral thigh.
◗ LATERAL THIGH
Position
r
The client is placed in side posture. The upper leg is
flexed, with a bolster under the knee. This is the leg that
will be massaged.
DAR
The therapist is standing on the front side of the table and
r
is facing the thigh of the client’s top leg.
1. Fascial Lift and Roll Technique. Place the hands in the
skin rolling position along the lateral thigh, parallel to the
muscle fibers. Lift and roll the muscles (Fig. 5-24). Start
at the knee, and continue, in horizontal strips, to the hip.
2.
Myofascial Spreading of the Lateral Thigh. Place the
heels of the hands against the midline of the lateral thigh.
Slowly spread the hands apart (Fig. 5-25). Begin the first
stroke at the knee. Repeat, in horizontal strips, to the hip.
Variation—Spread each half of the thigh individually.
Place the hands parallel along the midline of the thigh.
Using the fingertips, spread from the midline outward.
Work in horizontal strips, and continue to the hip. Repeat
on the other side.
3.
Myofascial Mobilization of the Hip. Standing behind the
client, place the forearm across the hip area. Slowly roll the
muscles in a back and forward motion (Fig. 5-26). Place
the forearm farther back into the gluteal area, and repeat.
◗ POSTERIOR THIGH
Position
FIGURE 5-25 Myofascial spreading of the lateral thigh.
r The client is lying prone.
r The therapist is standing at the side of the table next to
the client’s thigh.
68 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
DavidRini
FIGURE 5-26 Myofascial mobilization
of the hip.
1. Fascial Lift and Roll Technique. Lift and roll the skin
and muscles, working parallel to the fibers. Begin the
stroke slightly above the knee joint. Move in horizontal
strips to the hip.
2.
Myofascial Spreading of the Posterior Thigh. Use either
the heels of the hands or the knuckles. Place your hands
on the midline of the thigh, just above the knee. Slowly
and evenly spread the hands apart. Move in horizontal
strips, from the knee to the hip.
Variation—Stand at the side of the table, and face
the client’s thigh. Place the fingertips of both hands on
the midline of the thigh. Allow the fingers to sink into the
tissues until mild resistance is felt. As the tissues soften,
let the fingers slowly slide in a medial direction. Walk
around to the other side of the table, and repeat the
stroke on the posterior thigh in the opposite direction.
1. Myofascial Mobilization of the Posterior Thigh. Using
the fingers, roll the muscles of the thigh over each
other and against the femur. Work to free the individual
muscles from adhering.
◗ POSTERIOR HIP
Position
r The client is lying prone.
r The therapist is standing at the side of the table next to
the client’s pelvis.
Fascial Lift and Roll Technique. Lift and roll the gluteal
1.
muscles in a superior direction (Fig. 5-27).
2.
Myofascial Spreading of the Posterior Thigh. Using your
knuckles or the heels of the hands, spread the tissues
from the sacrum to the trochanter (Fig. 5-28).
3. Myofascial Mobilization of the Posterior Thigh. Using
your fingers, roll the muscles to re-establish individual
action (Fig. 5-29).
◗ ABDOMEN
Position
r The client is lying supine, with a bolster under the knees.
r
The therapist is standing at the side of the table and is
facing the client’s abdomen.
1.
Fascial Lift and Roll Technique. Reach across the client’s
body, and grasp the skin at the waistline between your
thumb and fingers. Roll the skin, moving slowly toward
the midline (Fig. 5-30). When you encounter tightness
or resistance, slowly lift the skin away from the underlying muscle, and hold until a softening is felt. Cover
the entire side of the abdomen thoroughly, working in
horizontal strips from the side of the trunk to the midline.
Chapter 5 Connective Tissue 69
FIGURE 5-27 Lifting and rolling the gluteal tissues.
FIGURE 5-28 Myofascial spreading of
the gluteal area.
70 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
David Rini
FIGURE 5-29 Myofascial mobilization of the
gluteal tissues.
FIGURE 5-30 Lifting and rolling the
abdominal tissue.
Walk around to the other side of the table, and repeat
the procedure on the other half of the client’s abdomen.
2.
Myofascial Stretch of the Abdomen. Place the right palm
on the abdomen, over the navel area. Place your left
palm on top of your right hand. Begin to make a slow,
clockwise, spiraling motion, moving the skin over the
underlying tissues (Fig. 5-31). Do not glide over the
skin. Gradually increase the size of the spiral, stretching
the skin and fascia to their maximum degree.
3. Abdominal Stretch of the Abdomen. With the client’s
knees flexed, have him or her stretch both arms overhead
and reach fully. Encourage the client to take a deep
breath, lifting the chest and pulling the abdomen in
while continuing to stretch the arms overhead until a
stretch is felt in the abdominal muscles (Fig. 5-32). A
useful image to aid this stretch is to tell the client to
imagine the navel touching the front of the spine as
he or she reaches.
DAR
Chapter 5 Connective Tissue 71
FIGURE 5-31 Myofascial stretching of
the abdomen using the palms of the
hands.
FIGURE 5-32 Abdominal stretch.
72 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
David Rini
FIGURE 5-33 Longitudinal neck release.
◗ NECK
Position
r The client is lying supine on the table.
r The therapist is sitting at the head of the table.
1. Longitudinal Neck Release. Place the fingers of both
hands under the occipital ridge. Allow the fingers to
sink into the tissues until a slight resistance is felt.
Move the tissues of the neck with short up-and-down
strokes but without sliding over the skin (Fig. 5-33). Move
the fingers down a couple of inches to the next section
of the neck, about an inch below the first section, and
repeat the up-and-down stroke. Continue with this pattern
to the base of the neck.
Return to the occiput, and place the fingers farther
away from the midline than on the first pass. Repeat the
sequence down the neck.
Lateral Neck Release. Place the fingers lengthwise, from
2.
underneath, on either side of the spinous processes of
the neck. Let the fingers sink into the tissues. Slowly
spread them laterally, away from the spine (Fig. 5-34).
Slide farther down the neck, and repeat. Continue,
spreading in horizontal strips, to the base of the neck.
3.
Horizontal Neck Release. Turn the client’s head slightly
to the side. Using your fingers, sink in along the anterior border of the sternocleidomastoid muscle. Slowly
glide the fingers in a posterior direction as far as you
can reach (Fig. 5-35). Repeat, in horizontal strips,
throughout the length of the neck.
FIGURE 5-34 Lateral neck release.
DAR
DAR
FIGURE 5-35 Horizontal neck release, with the working hand
moving posteriorly.
4.
Laterally Flex the Client’s Neck. Place your fingers
into the front portion of the trapezius muscle on the
flexed side, slightly behind the clavicle. Gradually sink
in until mild resistance is felt, and perform the short
up-and-down movements with your fingers.
5. Repeat moves 1 through 4 on the other side.
REVIEW QUESTIONS
Level 1
Receive and Respond
1. What is the best description of fascia?
a.
A loose, highly innervated, slightly contractile sheath
of tissue that connects the skin to underlying tissues
b.
An interconnected network of connective tissue layers
that wraps, supports, separates, and infiltrates tissues
throughout the body
c.
A tough, dense membrane that surrounds muscles
and muscle groups
d.
An umbrella term for all tissues in the body composed
primarily of protein fibers, liquid medium, and invested
with few living cells
2. Which statement is most accurate?
a. Fascia, muscles, and muscle sheaths are inextricably
interwoven, and cannot be separated into discrete
structures
b.
Fascia is now considered to be a subtype of connective tissue with its own innervation and separate
embryologic roots
c.
Fascia is now considered to be an outgrowth of muscle
and is no longer discussed as a separate tissue type
d. Fascia and muscles have been seen to work together
to adapt to weight-bearing stress; this means all fascia
is contractile material
3. What are the three main constituents of fascia?
a. Tendons, ligaments, cartilage
b.
Hyaluronic acid, mucopolysaccharides, thixotropic gel
c. Collagen, elastin, reticular fibers
d. Protein fibers, liquid matrix, fibroblasts
4. What is an adhesion?
a.
A complication of scar tissue from trauma or overuse
b. A site of linkage between adjacent collagen fibers
c. An area where chronic muscle tightness has caused
the muscle sheaths to stick together
d. An area where collagen has overgrown and become
sticky
5. Fascia is most heavily invested with what type of sensory
neuron?
a. Thermoreceptors
b. Mechanoreceptors
c. Nociceptors
d. Proprioceptors
Chapter 5 Connective Tissue 73
Level 2
Apply Concepts
1. Collagen has good tensile strength, but poor elasticity.
What does this mean?
a. Fibers resist stretching and have excellent rebound
capacity
b.
Fibers can withstand stress, but they do not rebound well
c. Fibers are good for wrapping and shock absorption,
but not for pulling or stretching
d. Fibers can rebound well, but they tear easily
2. Fascia is sometimes referred to as a three-dimensional
web. How might this concept be applied to a client with
persistent knee pain?
a. His knee pain is a result of dura mater restrictions
within the central nervous system
b. His knee pain will lead to back and hip problems if
it is not addressed quickly
c. His knee pain might be a sign of a history of trauma
relating to running away from something frightening
d.
His knee pain may be related to distant fascial restrictions that lead to movement inefficiencies
3.
Most of the connective tissue routines described in
Chapter 5 follow which sequence?
a.
Fascial lift and roll; joint mobilization; myofascial
mobilization
b. Myofascial spreading; fascial lift and roll; myofascial
mobilization
c.
Myofascial mobilization; fascial lift and roll; joint
mobilization
d.
Joint mobilization; fascial lift and roll; myofascial release
4.
A fascial lift and roll technique is intended to address....
a. periosteum.
b. muscle sheaths.
c. superficial fascia.
d. epimysium.
5.
Myofascial spreading on an extremity is typically done...
a. from proximal to distal.
b. from lateral to medial.
c. from medial to lateral.
d. from inferior to superior.
Level 3
Problem Solving: Discussion Points
1.
Read Box 5-1 “Fascial ‘Release’: What Does the Science
Say?” Working with a partner, explain what “fascial release”
means to you. What has been your experience of this
phenomenon? What is an appropriate way to describe it?
2. Working with a partner, practice the stroke, “myofascial
spreading of the plantar surface of the foot.” How much
pressure do you need to reach the sense of mild resistance?
What changes as your fingers move laterally? Analyze
these sensations and try to describe them to your partner.
74 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
4.
REFERENCES
1.
Schleip R. Fascial plasticity—a new neurobiological explanation. J Bodyw
Mov Ther. 2003;7(1):11–19.
2.
Schleip R. Fascial mechanoreceptors and their potential role in deep tissue
manipulation. Excerpted from Schleip R 2003: Fascial plasticity—a new
neurobiological explanation. J Bodyw Mov Ther. 2003;7(1):11–19 and
7(2):104–116. http://www.fasciaresearch.com/images/PDF/Innervation
Excerpt.pdf
3.
Oschman JL. Excerpts from publications by James L. Oschman, Ph.D. Readings on the
scientific basis of bodywork and movement therapies. http://www.somatics.de/artikel/
for-professionals/2-article/24-excerpts-from-publications-by-james-l-oschman-ph-d
Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent
peritoneal adhesions in a rat model. J Bodyw Mov Ther. 2012;16(1):76–82.
5.
McKay E. Assessing the effectiveness of massage therapy for bilateral
cleft lip reconstruction scars. Int J Ther Massage Bodyw. 2014; 7(2):3–9.
6. Wilk I, Kurpas D, Mroczek B, etal. Application of tensegrity massage
to relieve complications after mastectomy—Case Report. Rehabil Nurs
J. 2015;40(5):294–304.
7. Cho YS, Jeon JH, Hong A, et al. The effect of burn rehabilitation on
massage therapy on hypertrophic scar after burn: a random trial. Burns.
2014;40(8):1513–1520.