The Endless Web: Fascial Anatomy and Physical Reality

The Endless Web Fascial Anatomy and Physical Reality

R. Louis Schultz, Ph.D. and Rosemary Feitis, D.O. Illustrations by Diana Salles Photographs by Ronald Thompson

North Atlantic Books Berkeley, California

Copyright © 1 9 9 6 by R. Louis Schultz and Rosemary Feitis. All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording or otherwise—without the written permission of the publisher. For information contact North Atlantic Books. Published by North Atlantic Books P.O. Box 1 2 3 2 7 Berkeley, California 9 4 7 1 2 Cover drawing of a child by Diana Salles Cover ard book design by Andrea DuFlon Printed in Canada The Endless Web is sponsored by the Society for the Study of Native Arts and Sciences, a nonprofit educational corporation whose goals are to develop an educational and crosscultural perspective linking various scientific, social, and artistic fields; to nurture a holistic view of arts, sciences, humanities, and healing; and to publish and distribute literature on the relationship of mind, body, and nature. ISBN 13: 9 7 8 - 1 - 5 5 6 4 3 - 2 2 8 - 6 Library of Congress Cataloging-in-Publication Data Schultz, R. Louis (Richard Louis), 1 9 2 7 The endless web : fascial anatomy and physical reality / by R. Louis Schultz and Rosemary Feitis; illustrations by Diana Salles ; photographs by Ronald Thompson, p. cm.

North Atlantic Books are available through most bookstores. For further information, visit our website at www.northatlanticbooks.com or call 8 0 0 733-3000.

Includes bibliographical references and index. ISBN 1 - 5 5 6 4 3 - 2 2 8 - 3 (paper) 1. Manipulation (Therapeutics) 2. Fascia (Anatomy). 3. Rolfing. I. Feitis, Rosemary. II. Title. [DNLM: 1. Fascia. 2. Manipulation, Orthopedic. 3. Human Body. 4. Holistic Health. WE 5 0 0 S387e 1996] RD736.M25S38 1 9 9 6 615.8'2—dc20 DNLM/DLC for Library of Congress

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Contents Introduction Part I

E a r l y D e v e l o p m e n t Pre- a n d P o s t - B i r t h 1

E m b r y o l o g y : I n t r o d u c t i o n to C o n n e c t i v e Tissue

3

2

Early E m b r y o l o g i c a l D e v e l o p m e n t

6

3

Factors in the G r o w t h of t h e E m b r y o

11

4

D e v e l o p m e n t of M e s o d e r m a l Tissues

13

5

E m b r y o n i c L i m i t a t i o n s a n d Early Structural Organization

Part I I

7

T h e Effect of t h e Birth Process

8

21

Developmental Transitions in the N e w b o r n and Young Child

23

Myofascial Structures: T h e Spine as an E x a m p l e of "Living A n a t o m y "

27

M o v e m e n t and Gravity

34

10

Body Contour

40

11

E m o t i o n s a n d t h e Fascial W e b : B o d y Awareness and Response Patterns

46

9

Body Retinaculae (Bands/Straps) 12

T h e C h e s t B a n d : Implications for M o v e m e n t and Behavior

13

Part I V

15

C o n n e c t i v e Tissue B o d y 6

Part III

vii

53

T h e Inguinal Band and the Structure and Function of the Vertebral C o l u m n in Relation to t h e Bands

61

14

T h e Eye B a n d a n d C h i n B a n d

68

15

The Collar Band, Umbilical Band, and Groin Band

73

Anatomy and Function 16

Proprioception: Internal Body Awareness

83

17

Upper Body

85

18

Axial Skeleton

93

19

Pelvis a n d U p p e r Legs

98

20

T h e System of Horizontal a n d Vertical Myofascial Structures

106

 

v i       T H E  E N D L E S S  W E B  

21

Reciprocity of Movement

109 

22

Joints

114 

  Part V              Practical Application  23

Doing Bodywork Based on the Connective  Tissue Concept

119 

Evaluation

119 

First Intervention

120 

How to Go Deeper

123 

How to Touch

124 

How to Make It Last

126 

Illustration Index

127 

Subject Index

129 

About the Authors

131 

Introduction T h e m u s c l e - b o n e c o n c e p t p r e s e n t e d i n s t a n d a r d a n a t o m i c a l d e s c r i p t i o n gives a p u r e l y m e c h a n i c a l m o d e l o f m o v e m e n t . I t s e p a r a t e s m o v e m e n t i n t o discrete f u n c t i o n s , failing to give a picture of t h e seamless i n t e g r a t i o n seen in a living body. W h e n o n e part m o v e s , t h e b o d y as a w h o l e responds. Functionally, t h e o n l y t i s s u e t h a t c a n m e d i a t e s u c h r e s p o n s i v e n e s s i s t h e c o n n e c t i v e tissue. T h i s is t h e heart of t h e c o n c e p t t h a t we are p r o p o s i n g in this b o o k . Including an u n d e r s t a n d i n g of fascia/connective tissue in t h e evaluation of m o v e m e n t gives a n m o r e accurate picture o f t h e p h y s i c a l reality o f t h e b o d y . T h e c o n n e c t i v e tissue c o n c e p t w e discuss a c c o u n t s for m u c h o f t h e success o f R o l f i n g . T h i s i s a c o n c e p t t h a t w a s o r i g i n a l a n d u n i q u e w i t h Dr. R o l f a t t h e t i m e she was developing her m e t h o d of working with bodies. She started in t h e late 1 9 3 0 s . A t t h a t t i m e a n d u p i n t o t h e 1 9 5 0 s , received w i s d o m stated t h a t soft tissue c o u l d n o t h o l d a c h a n g e . M y o f a s c i a per se was n o t e v e n c o n sidered as a d e t e r m i n a n t of structure. B o n e - s e t t i n g (osteopathy, c h i r o p r a c t i c ) was t h e o n l y t r e a t m e n t for structure t h a t was t h e n considered effective. Today, m a n y f o r m s of b o d y w o r k i n c l u d e a soft tissue t e c h n i q u e . T h i s i s o n e o f t h e t w o i d e a s a b o u t b o d y w o r k t h a t Dr. R o l f e s t a b l i s h e d t h r o u g h her work. Her o t h e r seminal idea has to do with t h e c o n c e p t of g r a v i t y a s i t a c t s o n t h e p h y s i c a l b o d y — t h e stress l i n e s t h r o u g h t h e b o d y t h a t ideally establish a n d reinforce physical structure. This, t o o , is implem e n t e d t h r o u g h t h e c o n n e c t i v e tissue c o m p o n e n t . I n fact, t h e centrality o f c o n n e c t i v e tissue t o Rolfing a n d our a t t e m p t t o u n d e r s t a n d c o n n e c t i v e tissue has b e e n t h e impetus for this b o o k . T h e way bodies c h a n g e during Rolfing is n o t satisfactorily explained by any of the usual descriptions of physical m a k e u p . Traditional a n a t o m i c a l attitudes a b o u t c o n n e c t i v e tissue do n o t give us a living picture of t h e d y n a m i c s i n v o l v e d i n t h e c h a n g e s w e see i n o u r w o r k . W h a t h a s i n t e r e s t e d us is t h e body's apparently great capacity for structural c h a n g e at a n y age. W e are c o n f r o n t e d d a i l y w i t h v e r y w i d e d e v i a t i o n s f r o m s t a n d a r d a n a t o m i c a l description in people w h o function perfectly well. People look very different e v e n t h o u g h t h e y are m a d e o f t h e s a m e c o m p o n e n t p a r t s . W e h a v e c o m e t o the working hypothesis that this variability is a function of certain properties o f t h e c o n n e c t i v e t i s s u e b e s t i l l u s t r a t e d b y its d e v e l o p m e n t f r o m e m b r y o n i c m e s o d e r m i n t o m a t u r e tissue. Our ideas a n d c o n c e p t s h a v e c o m e directly out of our experience as Rolfers—a c o m b i n e d total of m o r e t h a n forty-five years. P e o p l e t e n d t o a p p r o v e a n d d i s a p p r o v e o f t h e i r b o d i e s p i e c e m e a l . It's r a r e f o r t h e m t o l o o k a t t h e m s e l v e s a n d s a y t h e y ' r e all b a d o r all g o o d . R a t h e r , it's " M y b e l l y sticks o u t , " " I ' v e a l w a y s h a d k n o c k k n e e s , " " M y l e f t f o o t i s b i g g e r t h a n m y right f o o t . " O n t h o s e o c c a s i o n s w h e n t h e y are feeling g o o d a b o u t t h e m s e l v e s , t h e y l i k e t h e s h a p e o f t h e i r h e a d o r t h e set o f t h e i r s h o u l d e r s . W o m e n s a y t h e y l o o k g o o d i n t h o s e s h o e s , w h i l e m e n say, " T h a t c u t o f jacket brings out t h e best in my shoulders."

viii

THE

ENDLESS

WEB

N o t o n l y d o t h e y see t h e m s e l v e s t h i s way, t h e y a l s o h a v e t h e s a m e i m p r e s s i o n o f o t h e r s . F o r m a n y , c e r t a i n p a r t s o f t h e b o d y are m o r e a t t r a c t i v e : " I ' m a l e g m a n , " o r " I like m e n w i t h b i g s h o u l d e r s . " I n o u r n a t i o n a l c u l t u r e , i t s e e m s t o b e a c c e p t e d t h a t o n e ' s business, e c o n o m i c , social, a n d sexual succ e s s e s a r e less i f o n e i s f a t . A m a n fears t h a t i f h i s p e l v i s m o v e s w h e n w a l k i n g , r u n n i n g , o r o t h e r k i n d s o f m o v e m e n t , t h e w h o l e w o r l d will q u e s t i o n h i s s e x u a l p r e f e r e n c e s . A w o m a n ' s b r o a d s h o u l d e r s a r e t a k e n a s a s i g n o f aggression and masculinity. M o s t of i n n e r - b o d y awareness is also piecemeal, a n d generally negative: " I h a v e a n upset s t o m a c h , " " M y k n e e h u r t s , " " M y n e c k i s stiff," " M y n o s e i s stuffed." M o r e t h a n likely this is a carry-over f r o m t h e Puritan n o t i o n that it is u n s e e m l y to speak well of oneself. W h e n I brag, I am c o n c e i t e d , w h i c h is b a d . T h i s g e t s i n t e r n a l i z e d s o t h a t w h e n I feel g o o d a b o u t m y s e l f , g o o d a b o u t my body, I e n d up feeling guilty. E v e n w h e n t h e a i m i s t o i m p r o v e t h e p h y s i c a l self, t h e f o c u s i s o n o n e t h i n g a t a t i m e . A m a n w i l l d o p u s h - u p s a n d lift w e i g h t s t o b r o a d e n h i s s h o u l d e r s ; a w o m a n w i l l d o l e g lifts t o s l i m d o w n h e r legs a n d h i p s . Yet t h o s e h i p s o r t h o s e s h o u l d e r s a r e a n e x p r e s s i o n o f e v e r y t h i n g else i n t h a t b o d y . T h e y ' r e t h e r e s u l t n o t o n l y o f its s t r u c t u r e , b u t a l s o a n d r e c i p r o c a l l y of h o w e v e r y t h i n g else in t h a t b o d y is used. This kind of connectedness is easy to understand in impact injuries. W h e n I s t u b m y t o e , t h e i n j u r y r e s o n a t e s t h r o u g h m y w h o l e b o d y , all t h e way to my head, whether I notice it or not. The pain in the toe makes me n o t w a n t t o s t a n d o n it, a n d m y w h o l e b o d y s h i f t s i n o r d e r t o a v o i d f e e l i n g w e i g h t o n t h e p a i n f u l p a r t . I w a l k l i g h t l y o n t h e side t h a t h u r t s , m o r e h e a v ily o n t h e side t h a t d o e s n ' t . I f I ' m n o t a w a r e o f d o i n g t h i s , m y t e n d e n c y i s t o k e e p t h e s h i f t i n w e i g h t t o o n e side l o n g a f t e r t h e t o e i s n o l o n g e r p a i n f u l . T h e p a i n f u l side h a s c o n t r a c t e d a w a y f r o m t h e s o u r c e o f p a i n a n d i s s h o r t e n e d . This is especially true if t h e toe was b r o k e n , a n d t h e pain has persisted for a l o n g t i m e . T h e c o m p e n s a t i o n (shortening a n d deviation) b e c o m e s a p e r m a n e n t part of structure. A n e v e n m o r e o b v i o u s e x a m p l e i s a b r o k e n a r m o r leg. E v e n a f t e r t h e cast is r e m o v e d , there is t h e physical habit of allowing for t h e weight a n d bulkiness of t h e cast, as well as t h e fear of o n c e again freely using t h e part that was b r o k e n . People t e n d to carry an arm that was o n c e broken half b e n t , as t h o u g h it w e r e still in a s l i n g or a c a s t . T h e s e are straightforward responses to straightforward injuries. Our bodies t e n d t o r e c o r d o u r r e s p o n s e s t o t h e e v e n t s i n o u r life like a c a l c u l a t o r w i t h a m e m o r y . In our living tissue, t h e record b e c o m e s fixed w i t h c o n s t a n t replaying. Like an orchestra, e a c h part relates to t h e o t h e r segments. In an orchestra w h o s e m e m b e r s h a v e m a n y y e a r s o f e x p e r i e n c e p l a y i n g t o g e t h e r , i f o n e s e c t i o n g o e s o f f k e y o r p l a y s o f f t e m p o , t h e rest o f t h e o r c h e s t r a a t t e m p t s t o compensate and blend in. I n t h e h u m a n b o d y , c o m p e n s a t i o n i s life s u p p o r t i v e . I f I w e r e t o g i v e in c o m p l e t e l y to a b r o k e n leg or a w h i p l a s h e d n e c k , I w o u l d be in bed. I

INTRODUCTION

wouldn't be able to function. T h e body's t e n d e n c y is to go toward as m u c h balance in a n y given m o m e n t as it c a n find, giving us m a x i m u m operational support for t h a t m o m e n t . T h e p r o b l e m occurs w h e n w e keep t h e c o m p e n s a t i o n after t h e i n j u r y h a s h e a l e d . O n e o f t h e m o s t c o m m o n e x a m p l e s o f this is the t e n d e n c y to keep birth trauma as a part of one's physical m a k e u p . W h a t has fascinated us as Rolfers in our w o r k w i t h clients a n d in our experiences of our o w n bodies is the m e c h a n i s m of this record. How a n d w h e r e d o w e k e e p t h i s m e m o r y o f o l d i n j u r y ? Ida R o l f ' s a n s w e r w a s t o e x a m ine a system of the b o d y that has b e e n neglected, b o t h by scientists and by medically oriented practitioners: t h e c o n n e c t i v e tissue or m y o f a s c i a . To use t h e orchestra analogy, t h e c o n n e c t i v e tissue is t h e score on w h i c h t h e n o t e s are w r i t t e n ; b o n e , m u s c l e , a n d o r g a n s y s t e m s a r e t h e i n s t r u m e n t s . T h e c o n nective tissue is t h e record; it is an i n f o r m a t i o n b a n k for t h e body. Visualize a n e t curtain or a h a m m o c k . W h e n a h o o k pulls on o n e part of that web, the resulting distortion influences every part of t h e system to s o m e d e g r e e . A s w e l o o k a t c o n n e c t i v e t i s s u e , its h i g h l y s t r u c t u r e d d i r e c t i o n a l o r i e n t a t i o n is suggestive of this k i n d of i n f o r m a t i o n system. By tracing c o n n e c t i v e tissue's o r i g i n , f u n c t i o n , a n d a p p e a r a n c e i n t h e b o d y , t h i s b o o k s h o w s h o w myofascia creates an informational w h o l e of t h e living organism. It is t h e u n i f y i n g factor i n t h e m o v e m e n t system w e call t h e body. T h i c k e n i n g , snagging, or h o l d i n g in a n y part of t h e c o n n e c t i v e tissue w e b results in a g e n e r a l h e a v i n e s s o f m o v e m e n t . W h a t a t first i s a w a y t o p r o t e c t a p a r t o f t h e b o d y (particularly a part t h a t hurts) e v e n t u a l l y results in a loss of fluidity throughout the entire body. P e r h a p s t h e b e s t i m a g e o f f l u i d i t y i s a t i g e r o n its w a y t h r o u g h t h e f o r e s t , n o t m a k i n g a s o u n d a s i t m o v e s a c r o s s l e a v e s a n d t w i g s a n d p a s t b u s h e s . Its " k n e e b o n e i s c o n n e c t e d t o its . . . a r m b o n e " w i t h o u t r e s t r i c t i o n , a l l o w i n g a s p r i n g - l i k e a c t i o n a m o n g all p a r t s o f its b o d y . O u r d r e a m i s t o h a v e all o f u s m o v i n g surefootedly t h r o u g h our f o r e s t s — b e t h e y o f w o o d , o f steel a n d c o n crete, or of h u m a n i t y .

ix

PART

ONE

Early Development Pre- and Post-Birth

ONE

Embryology

Introduction to Connective Tissue T h e b a s i s f o r all b o d y f o r m i s e m b r y o l o g y . I n

A b o n e c a n b e r e m o d e l e d t h r o u g h o u t life

understanding embryology, we understand

a s t h e r e l a t i v e stresses o n i t c h a n g e . T h i s i s

h o w the adult structure c a m e to be. Embryol-

h o w braces work on the jaw (now being used

ogy doesn't stop at birth; we have that p o t e n -

f o r all a g e s ) : c o n s t a n t p r e s s u r e c r e a t e s s o m e

tial f o r c h a n g e all a l o n g . I n a s e n s e , w e a r e

change in the b o n e formation and, thereby,

embryos throughout our lifetime. T h e aging

in the c o n t o u r of t h e upper a n d lower jaw-

process is also a part of t h e e m b r y o l o g i c a l

b o n e s . Research has b e e n published w h i c h

process. D e a t h is a n o r m a l part of develop-

describes t h e results of c h a n g i n g a n d increas-

m e n t . D e g e n e r a t i o n is a n o r m a l part of t h e

ing t h e pressure on o n e e n d of a b o n e . T h e

life c y c l e o f t i s s u e , w h i c h g r o w s a n d d i e s f r o m

b u m p s o n b o n e s are p l a c e s w h e r e m u s c l e t e n -

t h e early m o n t h s o f prenatal life.

d o n s a t t a c h . T h e b u m p s are t h e r e f o r e regions

To the embryologist, the term " e m b r y o "

of localized rapid g r o w t h of b o n e as a result of

i s a p p l i e d t o d e v e l o p m e n t t h r o u g h t h e first

prolonged tension on that spot. If tension is

t r i m e s t e r o f p r e g n a n c y . L a t e r s t a g e s are

applied to a different area, t h e n e w area is

t e r m e d "fetal d e v e l o p m e n t . " We are generaliz-

stimulated to create an increased a m o u n t of

ing the term, using embryological in a m u c h

b o n e , a n o t h e r b u m p . W h a t t h e n appears t o

broader sense, as a time w h e n things develop

h a p p e n i s t h a t o n t h e o t h e r side o f t h e b o n e

a n d d i f f e r e n t i a t e . All t i s s u e g o e s t h r o u g h t h i s

there is s o m e localized resorption of b o n e ,

state, b o n e s as well as soft tissue. In general,

resulting in an i n d e n t a t i o n . It seems that a

t h i s stage m a r k s t h e o r i g i n o f p o t e n t i a l

certain v o l u m e of b o n e is needed in the body;

organs. Undifferentiated cells develop i n t o

its c o n f i g u r a t i o n a d a p t s t o c h a n g i n g stresses

p o t e n t i a l liver, p o t e n t i a l b o n e , p o t e n t i a l s k i n .

over time. This m e a n s that if we hold our-

T h e b o d y is always at p o t e n t i a l — t o c h a n g e ,

selves i n a b e n t p o s i t i o n , b o n e u l t i m a t e l y

a n d for n e w t h i n g s t o d e v e l o p .

a c c o m m o d a t e s its s h a p e t o t h a t p o s i t i o n .

Birth is a c h a n g e in e n v i r o n m e n t , o n e of m a n y t h a t occurs t h r o u g h o u t life. W e k n o w

U n d e r p r o l o n g e d stress t h e b o n e c a n g e t a different configuration, a slightly different

t h a t cells t u r n o v e r w i t h i n o r g a n s — t h a t is,

curving. T h e s e c h a n g e s are slight, b u t if t h e y

t h e y live, d i e , r e g e n e r a t e . T h i s i s t r u e o f

were plotted over time they would neverthe-

every organ except the brain, a n d even that

less p r o b a b l y b e m e a s u r a b l e . W e all see p e o p l e

is b e g i n n i n g to be questioned. E a c h cell has

b e c o m e m o r e b e n t with age. T h e b o n e has

a finite lifetime, n o r m a l l y considered seven

c h a n g e d its c o n f i g u r a t i o n . I t d o e s n ' t h a p p e n

years. W i t h i n seven years, every cell in an

i n o n e m o n t h o r six; i t takes place over m a n y

o r g a n dies a n d i s r e p l a c e d . T h e o r e t i c a l l y t h a t

years.

m e a n s t h e r e i s a p o t e n t i a l i n t h e s e cells t o

C o n n e c t i v e tissue literally c o n n e c t s a n d

regenerate in a different direction. This m a y

supports. It forms t h e structure of t h e body.

b e w h a t h a p p e n s i n a g i n g . I n o u r v i e w , all

This is a new concept. We tend to think of

c h a n g e i s t h e first s t e p i n n e w p o s s i b i l i t i e s .

structure in terms of muscle a n d b o n e . But in

This is what we m e a n by developmental

fact, structure is t h e result of t h e o r g a n i z a t i o n

anatomy.

o f m u s c l e a n d b o n e . C o n n e c t i v e tissue, i n

4

THE

ENDLESS

WEB

response to m o v e m e n t , is the organizing

C o n n e c t i v e tissue supports t h e organ,

factor. M u s c l e tissue is e n f o l d e d w i t h i n t h e

nerve, and vascular systems. It makes up

fascia; t h e c o m b i n a t i o n is called myofascia.

a high proportion of body mass, reaching

Movement is the outcome of embedded mus-

t h r o u g h all b o d y e l e m e n t s like a s u p p o r t i v e

cle tissue a c t i o n o n t h e surrounding c o n n e c -

n e t or spider w e b . This is a g o o d i m a g e

t i v e t i s s u e . (Fig. 1-1). S t r u c t u r e is t h u s t h e

because it is organized but irregular—the

result o f m o v e m e n t , t h e characteristic m u s c l e

fibers o f a s p i d e r w e b are a l s o n o t i n a c o m -

a c t i o n on t h e c o n n e c t i v e tissue b e d as a

pletely regular p a t t e r n . A spider w e b d e p e n d s

w h o l e . C o n n e c t i v e tissue (myofascia) defines

o n its s u p p o r t — t w i g s o r t h e w i n d o w l e d g e it's

t h e b o d y c o n t o u r a n d is t h e organ of structure

s p u n a r o u n d — f o r its s h a p e . S i m i l a r l y , m y o f a s -

a n d m o v e m e n t (as I d a R o l f c a l l e d it) i n t h e

cia is adaptive.

body.

M o s t of t h e forces acting on a b o d y are f r o m t h e o u t s i d e . B u t f o r c e s a l s o arise f r o m inside, in the interconnections within the b o d y . I n t e r c o n n e c t i o n s are m a i n t a i n e d w i t h m o v e m e n t or inhibited with lack of m o v e m e n t . M a n y people m o v e o n l y a part of their

Epimysium

b a c k s w h e n t h e y walk, for e x a m p l e . As a r e s u l t , c o n n e c t i v e t i s s u e i n t h e b a c k l o s e s its e l a s t i c , s p i d e r w e b q u a l i t y a n d i s m u c h less adaptable or movable. Perpetuating this

Perimysium'

i m m o b i l i t y , c o n n e c t i v e tissue t h i c k e n s a n d hardens. T h e r e is research s h o w i n g t h a t pressure or t e n s i o n o r f r i c t i o n a p p l i e d i n o n e area o f t h e

Endomysiunr

e m b r y o r e s u l t s i n i n c r e a s e d s e c r e t i o n o f fibers b y t h e c o n n e c t i v e t i s s u e cells a t t h e s t i m u l a t e d p l a c e . T h e s e fibers t e n d t o a r r a n g e t h e m selves a l o n g t h e line of t h e pull or friction or

Figure 1-1 This cross section of the arm shows the way in which muscle tissue is embedded within its connective tissue wrapping.

t e n s i o n . T h e c o n n e c t i v e tissue t h e n c h a n g e s from a lacelike elasticity to s o m e t h i n g m o r e d e n s e . If a fly g e t s c a u g h t in a s p i d e r w e b , there's a snag, a t i g h t e n i n g of t h e w e b in

EMBRYOLOGY

that area. Everything is pulled toward t h a t s n a g , p a r t i c u l a r l y a s t h e fly m o v e s a r o u n d . Similarly, i f t h e r e ' s a s n a g i n t h e m y o f a s c i a l w e b , i t t e n d s t o g r a b — c o n n e c t i v e t i s s u e fibers concentrate there.

•

W e h a v e said t h a t e v e r y t h i n g i n t h e b o d y is supported by c o n n e c t i v e tissue. W i t h i n

B

t h a t tissue i s a r i c h n e t w o r k o f c a p i l l a r y b e d s . W h e n an area is compressed, t h e b l o o d supp l y t o t h a t area i s a l s o c o m p r e s s e d a n d t h u s impeded. This t h e n affects t h e physical state of the intercellular matrix, with far-reaching results o n p a r t i c u l a r stages o f d e v e l o p m e n t . C o n n e c t i v e tissue is alive in t h e sense t h a t it responds to stimulus. It has certain physical laws t h a t i t lives b y . T h e r e a r e c h e m i c a l l a w s a s well, b u t t h e p h y s i c a l o n e s a r e m o r e r e a d i l y a p p a r e n t . A g i v e n s i t u a t i o n a l w a y s g i v e s rise to a specific reaction. C o n n e c t i v e tissue cells

C

D

(fibroblasts) b u i l d a n d s e c r e t e f i b e r s . U n d e r a certain kind of stimulus, s u c h as pressure, this process can be speeded up. This is n o t unusual; it is t h e n o r m a l way for a t e n d o n or ligament to grow and take shape before birth. As t h e e m b r y o gets bigger, t h e b o n e s get bigger. I n g r o w i n g , t h e b o n e p u s h e s o u t , c r e a t i n g a directional pressure in t h e c o n n e c t i v e tissue bed between t h e two growing heads (ends) of t h e b o n e (Fig. 1-2). T h i s i s t h e n o r m a l f o r m a tion of ligaments and (where there is muscle tissue) o f t e n d o n s . T h e d i r e c t i o n o f t h e ligam e n t or t e n d o n is determined by t h e directional pull. T h e pattern of m u s c l e a n d t e n d o n a n d l i g a m e n t i s e s t a b l i s h e d v e r y early, i n t h e first c o u p l e o f m o n t h s o f g e s t a t i o n . I n t h e later m o n t h s , s t r u c t u r e s b e c o m e m o r e e l a b o r a t e , m o r e set, a n d larger.

Figure 1-2 This schematic shows an idealized sequence of normal development of tendon from early gestation to just before the baby is born. The process continues throughout life. (A) Early undifferentiated connective tissue near early newly differentiated bone. (B) The growth of the bone exerts a directional pull within the connective tissue bed. (C) Beginning of a more recognizable tendon shape; note that potential muscle tissue is developing within the tendonous bed. (D) Fully formed tendon with muscle developing along the line of connective tissue tension between the two bones.

5

TWO

Early Embryological Development

It's a b i g j u m p f r o m t h e first g e r m c e l l t o t h e

Extraembryonic, mesoderm

f o r m a t i o n o f g e r m l a y e r s t h a t a r e t h e first r e c o g n i z a b l e f o r m o f t h e e m b r y o . T h e r e are t h r e e g e r m layers:

Embryonic,, disc

• t h e e c t o d e r m g i v e s rise t o t h e b r a i n a n d

Amnion

Ectoderm Endoderm*

nervous system a n d t h e superficial epi-

Primitive yolk sac

dermis (skin) • t h e e n d o d e r m g i v e s rise t o t h e d i g e s t i v e system a n d t h e digestive glands • t h e m e s o d e r m g i v e s rise t o m u s c l e , b o n e ,

Second week of pregnancy

blood, the urogenital system, and connective tissue in general

Head

By about the end of the second week of pregnancy, t h e cell has b e c o m e a disk t h a t is s u r r o u n d e d b y c a v i t i e s filled w i t h f l u i d . T h e e m b r y o grows b y t h e m u l t i p l i c a t i o n o f cells, w h i c h organize i n t o layers at a b o u t t h e seco n d week. T h e disk has a t o p layer (ectoderm)

Amnion-

a n d a b o t t o m layer ( e n d o d e r m ) . Direction in the e m b r y o is established at the beginning of a b o u t t h e t h i r d w e e k (Fig. 2-1), w h e n a n a r e a o f m o r e rapid cell f o r m a t i o n develops i n o n e p a r t o f t h e disk. At the beginning of the third week, the

Tail

Primitive streak

Ectoderm Endoderm-

Primitive^ yolk sac

e m b r y o i s a b o u t t h e size o f t h e t i p o f a p e n c i l p o i n t . T h e area of greater proliferation is

Early third week of pregnancy

approximately a quarter of the total surface area. It rapidly c o n d e n s e s i n t o a line w h i c h is called t h e p r i m i t i v e streak. T h i s is t h e tail e n d of the embryo; it eventually becomes the anal

Nolochord

region. W h e n t h e primitive streak is estab-

Primitive -"streak

lished, t h e m i d d l e layer ( m e s o d e r m ) begins to develop. T h e process of growth in the embryo Figure 2-1 A three-dimensional view of the embryo at the beginning of the third week of pregnancy, showing the initial differentiation of ectoderm and endoderm and the first indication of directionality, as well as the notochord, which marks the location of the future spine.

Mesoderm

Ectodernr Endodemv

Late third week of pregnancy

EMBRYOLOGY

7

n o w b e c o m e s twofold: cell m u l t i p l i c a t i o n b y division o f existing cells, a n d t h e g e n e r a t i o n o f n e w cells f r o m t h e primitive streak. T h e e m b r y o at this stage is r o u g h l y oval and b e c o m i n g m o r e elongated as it grows. Having established top and b o t t o m (ectoderm a n d e n d o d e r m ) as well as a tail (primitive streak) a n d t h e r e f o r e a h e a d f o r o u r e m b r y o , w e c a n n o w k n o w w h i c h a r e its r i g h t a n d l e f t sides. C e l l s p r o l i f e r a t i n g f r o m t h e p r i m i t i v e streak are e n l a r g i n g a n d e l o n g a t i n g t h e disk. Cells i m m e d i a t e l y in front of t h e source (the p r i m i t i v e s t r e a k ) d e v e l o p i n t o t h e rest o f t h e body. Logically, we w o u l d e x p e c t t h a t either everything is established at the same time in t h e e m b r y o and grows bigger and m o r e c o m p l e x ; or, s i n c e e v e r y t h i n g g r o w s f r o m t h e p r i m i t i v e s t r e a k ( t a i l ) , t h i s e n d d e v e l o p s first (initially tail, t h e n t h e pelvis, t h e n chest, neck, a n d finally t h e head). In fact, neither is the case. Nature doesn't share our sense of logic. T h e primitive streak r e m a i n s primitive (undifferentiated). T h e n e w cells created f r o m the primitive streak b e c o m e t h e h e a d a n d t h e n t h e rest o f t h e b o d y f r o m t h e t o p d o w n . T h e head is gradually pushed away from t h e s o u r c e a s t h e rest o f t h e b o d y g r o w s b e t w e e n . T h e top e n d is pushed farther a n d farther away from the source. M u l t i p l i c a t i o n o f cells i s t a k i n g p l a c e throughout the embryo, not only at the source, a l t h o u g h t h e greatest generation is there. The embryo is growing geometrically: lengthwise, sideways, a n d internally. T h e s h a p e c h a n g e s f r o m a disk i n t o a r o u n d , body-like s h a p e . T h e circular disk was like a slab of "silly p u t t y " t h a t got pulled l e n g t h Figure 2-2 This cross section sequence illustrates stages of development during the third and early fourth week of gestation, showing the changes from early germ layer pattern to recognizable structures.

8

THE

ENDLESS

WEB

wise. As longitudinal pressure increases, t h e

t h e oldest part of t h e digestive system is t h e

edges b e g i n to curve inward, closing to f o r m

m o u t h . T h e b a c k o f t h e m o u t h i s older t h a n

a m o r e t u b u l a r s h a p e (Figs. 2-2, 2-3). T h e

t h e esophagus, the s t o m a c h is older t h a n the

o u t s i d e ( w h i c h w a s t h e t o p o f t h e disk) i s t h e

small intestine, and so forth. T h e sigmoid

ectoderm. T h e inside (originally t h e b o t t o m

c o l o n just in front of t h e anus is the " n e w e s t "

o f t h e disk) i s t h e e n d o d e r m . T h e m e s o d e r m

part of t h e body. At birth, t h e m o s t differentiated part of t h e

is t h e filling b e t w e e n t h e s e t w o layers. T h e p r i m i t i v e s t r e a k i s t h e first " s t r u c t u r e "

e m b r y o i s t h e h e a d . T h e least differentiated

differentiated from the general mass of the

(the least m a t u r e ) is t h e pelvis. Differentiation

primitive e m b r y o . It later b e c o m e s the anal

o c c u r s w h e n cells h a v e b e e n i n o n e l o c a t i o n

region, so t h a t we m a y say t h a t this r e g i o n is

long enough to have multiplied and elabo-

t h e " o l d e s t " part o f t h e body. After t h e anus,

rated. T h e primitive local structures mature. E n d o d e r m a l cells m u l t i p l y a n d d i f f e r e n t i a t e i n t o specifically e n d o d e r m a l structures; ecto-

Primitive streak

Ectoderm-

d e r m a l cells i n t o t h e v a r i o u s e c t o d e r m a l struct u r e s , a n d s o f o r t h . E v e n t u a l l y , cells b e c o m e

Endoderm^

s p e c i f i c — a m u s c l e c e l l , a liver c e l l , a b r a i n

Notochord'"

cell. Tail

A t t h e e a r l i e s t stages o f e m b r y o n i c d e v e l o p m e n t , a c e l l in a g i v e n p o s i t i o n h a s a n u m b e r of potentialities. A cell s o m e w h e r e in t h e h e a d , for e x a m p l e , w h e n it divides i n t o two, m a y b e d i v i d i n g i n t o t h e l e f t a n d r i g h t sides of t h e head. W h e n these in turn divide, t h e y m a y b e c o m e structures in front a n d back. As

Heart, primordium

cells c o n t i n u e t o d i v i d e , t h e y split t h e i r potentiality, b e c o m i n g more and more focused toward a purpose. E a c h c e l l c r e a t e s its o w n s p e c i f i c e n v i r o n m e n t w i t h i n t h e g e n e r a l m a t r i x . T h e r e are structural a n d c h e m i c a l changes within the cell as it zeros in on b e c o m i n g o n e t h i n g , o n e o r g a n . T h e s u r r o u n d i n g cells m a k e u p t h e

Heade fold

e n v i r o n m e n t o f t h a t o r g a n , c o n t r i b u t i n g t o its s t r u c t u r e , its s h a p e . I f t h e c e n t r a l c e l l i s p u t i n

Heart, primordium'

a n o t h e r part of t h e b o d y early e n o u g h , it c a n Tail -•fold

b e c o m e a d i f f e r e n t o r g a n . Yet a t s o m e p o i n t i n t i m e , its e n v i r o n m e n t h a s s h a p e d i t suffic i e n t l y t h a t i t c a n b e c o m e o n l y itself.

Figure 2-3 This mid-sagittal (lengthwise) sequence shows the folding of the body during the third week of gestation. The same structures are present as in Figure 2-2.

F o r e x a m p l e , p o t e n t i a l liver at first is j u s t a l i t t l e t u b e w h o s e cells are s e p a r a t i n g f r o m t h e rest o f t h e g u t . A s l o n g a s t h e s e cells stay i n s i d e t h e t u b e , t h i s e n v i r o n m e n t will d e t e r m i n e t h a t t h e y b e c o m e liver. I f o n e c o u l d

EMBRYOLOGY

dissect a w a y o n e o f t h o s e cells a n d p u t i t i n a

integrity of the growing vertebral c o l u m n .

nearby e n v i r o n m e n t , it could b e c o m e a pan-

T h e resulting c o m p l e x i t y o f pulls a l o n g a n d

creas. As described in m a n y standard e m b r y -

b e t w e e n t h e d e v e l o p i n g b o n e s results i n t h e

ology texts, it has b e e n s h o w n that potential

differentiated ligaments that c o n n e c t the

pancreas does n o t differentiate into mature

bones

(Fig.

9

2-4).

p a n c r e a s cells u n l e s s it is in a s p e c i f i c m e s o -

In a d d i t i o n to a grid-like support f r o m

dermal e n v i r o n m e n t (potential fascia). Rela-

b o n e , t e n d o n , a n d l i g a m e n t , t h e b o d y gets a

t i o n s h i p to t h e surrounding fascial tissue is

"packing material" support from connective

i m p o r t a n t ; i t m a y b e t h e s p e c i f i c e n e r g y field

t i s s u e . Fat is a p a r t of t h i s m a t e r i a l . It is

that makes t h e difference for this tissue.

a n o t h e r kind of c o n n e c t i v e tissue. D e p e n d i n g

About the end of the fourth week, the

o n its d e n s i t y , i t a c t s t o c u s h i o n , p r o t e c t , a n d

embryo has developed primitive arms and

pad the b o d y or to provide support a n d spac-

legs as w e l l as a p r i m i t i v e b r a i n , p r i m i t i v e

i n g w h e r e it's m o r e d e n s e . I n a d i p o s e (fat)

spinal c o l u m n , a n d t h e b e g i n n i n g s of verte-

tissue, cells enlarge by a c c u m u l a t i n g droplets

brae to protect t h e central nervous system.

o f i n t r a c e l l u l a r fat; fibers a n d m a t r i x a r e

I t i s n o w s h a p e d like a t u b e a n d i s g e t t i n g

p u s h e d aside by t h e engorged cells. This tissue

bigger, p a r t i c u l a r l y a t t h e h e a d e n d . Its s h a p e

is i m p o r t a n t in t h e spatial a r r a n g e m e n t of

i s t h e result b o t h o f s e l f - p r o l i f e r a t i o n a n d o f

structures. Fat is o n e of t h e body's ways of

t h e s p a c e r e s t r i c t i o n s a s d e t e r m i n e d b y its

i m m o b i l i z i n g or wedging an area.

outside e n v i r o n m e n t . A r o u n d all o f t h e s e p r i m i t i v e s t r u c t u r e s p r i m i t i v e cells are p r o l i f e r a t i n g i n t o " f i l l e r . " T h i s filler i s m e s o d e r m a l t i s s u e — p r i m i t i v e fascia m a d e u p o f c e l l s , fibers, a n d i n t e r c e l l ular m a t r i x . Its t e x t u r e i s like glass w o o l o r a n g e l hair, t h e k i n d o f s t r i n g y , fluffy s t u f f

A

t h a t sticks t o y o u r f i n g e r s . T h e m a t r i x i s s t i c k y

B

a n d s o m e w h a t like J e l l - O i n t e x t u r e . I n m o s t p l a c e s i n t h e b o d y , i t stays s o f t u n t i l b i r t h . In o t h e r places, pressures a n d t e n s i o n s , b o t h internal and external, cause it to respond by getting hard and directional—ligaments and t e n d o n s begin to form. Hardness a n d direct i o n o f fiber are t h e n o r m a l f a c t o r s c r e a t i n g structure in c o n n e c t i v e tissue. I n t h e places w h e r e b o n e will f o r m , t h e soft m a t r i x b e c o m e s m o r e rigid, e s t a b l i s h i n g a directional pull. This internal tension, together with external pressures f r o m t h e c o n f i n i n g walls of t h e uterus, stimulates cells

C

D

locally to increase p r o d u c t i o n of fibers. An e x a m p l e is p r e v e r t e b r a l c a r t i l a g e . As it g r o w s , its p u s h i n t o t h e c o n n e c t i v e t i s s u e b e d c r e a t e s a stress l i n e , o r g a n i z i n g a n d m a i n t a i n i n g t h e

Figure 2-4 Tendon/ligament formation.

1 0       T H E  E N D L E S S W E B  

As the head fold grows, the endoderm layer (inner 

considerable amount of fat. This fat is an important part of 

lining) grows within the ectoderm (outer lining). 

the environment of the large intestine, particularly of that 

Mesenchyme (the primitive mesoderm or middle layer) fills 

part which runs across the abdomen, connecting to the 

the space between them. As the head fold begins, the back 

backbone in the area of the lowest attachments of the 

of the mouth begins to take shape out of the endoderm. As 

diaphragm. Thus the inner organs and their ʺpacking 

folding continues, more and more endoderm is brought 

materialʺ affect overall body ease and mobility. Emptying 

into an internal lining, forming esophagus, stomach, and 

the digestive tract, for example, can have a dramatic effect 

eventually the curvature of the stomach, the coiling of the 

on posture. If the transverse colon is filled with fecal 

small intestine, and so forth.  Fully developed endodermal tissue is held in position 

material, it is necessarily restricted in mobility. This  compresses the back part of the diaphragm and related 

inside the body by a thin, filmy layer of connective tissue. It 

spinal junctions. For the most part, however, healthy 

is like a spider web that holds structures in place, like thin 

endodermal tissue can and does adapt freely to other body 

guy wires. Endoderm structures do influence the 

structures. 

conformation (shape and relationship) of bony structure. 

Cells start out with the potential to become anything. 

The large intestine, for example, is almost literally glued to 

Gradually they become more specialized, developing into 

the back part of the abdominal cavity, where it forms a 

specific parts of the embryo as it grows. 

heavy fascial connection that includes a   

THREE

Factors in the Growth of the Embryo

This overview of early embryological develop-

E c t o d e r m a n d e n d o d e r m structures are f u n c -

m e n t has b e e n necessarily sketchy a n d gen-

tionally b o t h m o r e discrete a n d m o r e stable

eral. H o w e v e r , it p r o v i d e s a f r a m e w o r k f o r

i n f o r m . Yet c o n n e c t i v e t i s s u e b e c o m e s

discussion of embryological concepts as t h e y

increasingly important, establishing the

predispose a n d influence t h e shape a n d char-

arrangement of structures as t h e e m b r y o

acteristic m o v e m e n t of t h e individual.

g r o w s i n size. T h e r e h a v e b e e n f e w t i s s u e

D e s c r i p t i v e e m b r y o l o g y tells o n l y p a r t o f t h e

studies of late p r e g n a n c y t h a t detail w h a t

story. It is a h i s t o r y of g e n e r a l p a t t e r n s of

goes on u n d e r n e a t h t h e skin of t h e develop-

growth. Minor variations in this developmen-

ing infant. It is reasonable to suppose that the

tal p a t t e r n a l l o w p r e d i c t i o n o f t h e i n d i v i d u a l ' s

great spurts in g r o w t h t h a t take place toward

future structure a n d behavior.

t h e e n d o f p r e g n a n c y are t h e result o f a n

T h e r e are s h i f t s i n t h e i m p o r t a n c e o f o n e

increase in t h e v o l u m e of c o n n e c t i v e tissue.

factor over a n o t h e r as t h e e m b r y o grows. At

T h e b o d y grows organically, solving prob-

o n e p o i n t , t h e size l i m i t a t i o n s o f t h e w o m b

l e m s a n d m e e t i n g n e e d s a s t h e y arise, rather

may be the most important. At another time,

t h a n b e i n g set u p a c c o r d i n g t o a p r e d e t e r -

internal growth and differentiation m a y

m i n e d p l a n . G e n e t i c p r e d e t e r m i n a t i o n sets

take precedence. As described in Section 1,

t h e stage; v a r i a t i o n s are a k i n d of p r o b l e m

a c h a n g e i n t h e d i r e c t i o n a l stress i n t h e m e s -

solving. N o t w o o f u s are t h e s a m e . N o t w o

e n c h y m e m o d i f i e s t h e o r g a n i z a t i o n o f sur-

sides o f t h e b o d y a r e t h e s a m e . T h e s e v a r i a -

r o u n d i n g tissue. Every g r o w t h stage t h u s

tions relate to differences in e n v i r o n m e n t ,

creates n e w d e m a n d s a n d challenges i n t h e

both internal and external, of the kind we

internal environment of the embryo. In gen-

have b e e n describing. As b o d y structures

eral, t h e r e s p o n s e is a g r e a t e r d e g r e e of s p e -

develop, they change the internal environ-

cialization of function.

m e n t o f t h e i m m e d i a t e area, creating c h a n g e s

The external environment becomes

a t t h e a n a t o m i c a l level. T h e r e are m a n y slight

increasingly i m p o r t a n t as t h e e m b r y o gets

differences in t h e rate of d e v e l o p m e n t inside

larger. W i t h i n t h e w o m b , t h e r e m a y b e s o m e

t h e e m b r y o . T h e o r c h e s t r a t i o n o f t h e s e vari-

insufficiency of t h e p l a c e n t a (there are chil-

ables makes up t h e physical c o m p o n e n t s of

d r e n w h o are b o r n w i t h m a l n u t r i t i o n ) . I f t h e

individuality. This is true long before birth,

m o t h e r ' s diet is i n a d e q u a t e , t h e e m b r y o will

even before the embryo is recognizably

be affected. If t h e m o t h e r takes m e d i c a t i o n or

human.

drugs, t h i s will h a v e a g r e a t e r or lesser i n f l u e n c e d e p e n d i n g o n t h e d r u g , t h e s t a g e o f ges-

O n e factor in this kind of problem solving is t h a t cells h a v e a m u c h wider ability to

tation, and dosage and/or frequency. If she is

respond to changing environment than is

constipated during m u c h of the pregnancy,

generally believed. M e s o d e r m is a p r i m e

this exerts pressure on t h e uterus.

e x a m p l e . It h a s types of n o n s p e c i f i c cells t h a t

As t h e e m b r y o develops, in terms of struc-

a p p a r e n t l y g i v e rise t o d i f f e r e n t k i n d s o f s p e -

tural organization, c o n n e c t i v e tissue is t h e

cialized cells as n e e d e d . T h e s e cells are p r e s e n t

least s p e c i f i c o f t h e d e v e l o p i n g t i s s u e s . M e s o -

in the embryo, the child, and in the mature

derm remains relatively a m o r p h o u s .

adult. We have termed this the " e m b r y o n i c

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area as a w h o l e . If this h a p p e n s at o n e time schedule, it creates o n e kind of structure. If it h a p p e n s later, it c r e a t e s a s l i g h t l y d i f f e r e n t s t r u c t u r e . E v e n a m a t t e r o f h o u r s i s signific a n t . This is t h e reason that drug effects c a n be so devastating at o n e e m b r y o n i c stage a n d less so at a n o t h e r . T h a l i d o m i d e is a r e c e n t i l l u s t r a t i o n . I f i t w a s t a k e n early, w h e n a r m s a n d legs w e r e j u s t b e g i n n i n g t o d e v e l o p , t h e r e w o u l d b e n o a r m s o r legs a t all. I f t a k e n later, o n l y fingers or forearms m i g h t be affected. T h e e m b r y o d e v e l o p s i n all its p a r t s b o t h Figure 3-1 The way the baby lies within the uterus determines the ultimate pattern of the spine.

on a general timetable (the genetic contribut i o n ) a n d o n its o w n i n d i v i d u a l t i m e t a b l e . This c a n be a little lagging or a little a h e a d of t h e average pattern. D e v e l o p m e n t takes place

p o t e n t i a l of m e s o d e r m . " Reticular cells a n d

in spurts. By t h e e n d of t h e s e c o n d or third

l y m p h o c y t e s are e x a m p l e s of this type of cell.

m o n t h o f p r e g n a n c y , all t h e e l e m e n t s are i n

Reticular cells in c o n n e c t i v e tissue very proba-

place. From t h e n o n , growth is a matter of

b l y a c t a s s o u r c e c e l l s , g i v i n g rise t o s p e c i a l -

b e c o m i n g bigger, m o r e coiled, o r m o r e c o m -

ized c e l l s o n d e m a n d . L y m p h o c y t e s i n b l o o d

p l e x . After t h e t h i r d m o n t h o f p r e g n a n c y ,

a n d l y m p h o i d tissue a c c u m u l a t e n e a r a n area

t h e e m b r y o has dealt w i t h t h e problem of

o f i n f e c t i o n , w h e r e i t s e e m s t h a t t h e y are a b l e

b e c o m i n g w h a t it is—an identifiable creature

to assume multiple functions as needed in the

of h u m a n type. From t h e n on, it is dealing

healing process, even m e t a m o r p h o s i n g into

with a different problem, n a m e l y the develop-

p h a g o c y t i c ( r e s t r u c t u r i n g cells) o r b e c o m i n g a

m e n t i n t o a b i g g e r , m o r e d i f f e r e n t i a t e d sys-

source of additional c o n n e c t i v e tissue cells. Such m o r p h o l o g i c a l (shape a n d structure) responses t o e n v i r o n m e n t are t h e e x t r e m e . Yet all c e l l s c h a n g e t h e i r r a t e o f g r o w t h i n

t e m . Increasingly, external e n v i r o n m e n t b e c o m e s a m a j o r factor. Also at this p o i n t , individual variations b e c o m e increasingly apparent. The embryo

response to environmental stimulus. Even

shows individual body shape and conforma-

in t h e adult, if a k i d n e y is r e m o v e d , w i t h i n

t i o n . T h e w a y t h e b a b y lies i n t h e u t e r u s

a short time the remaining kidney doubles in

determines t h e ultimate pattern of the spine

size t o c o m p e n s a t e . C e l l s f o r t h i s r e g e n e r a t i o n

(Fig. 3-1). W h e t h e r t h e h e a d i s t o t h e r i g h t o r

c o m e from within the b o d y As the kidney

t o t h e l e f t o r b e t w e e n t h e t w o legs, h o w t h e

g r o w s , i t c o n t i n u e s t o f u n c t i o n a s a k i d n e y . Its

arms are curled a r o u n d — a l l t h e s e are impor-

cellular processes are fully l o a d e d — e v e n over-

tant factors in t h e final shape. As it grows, t h e

loaded—yet it can make this compensation.

e m b r y o (and t h e infant a n d adult) expands in

T h e coordination of t i m i n g is a m a j o r factor in embryonic development, meshing

size b u t r e t a i n s t h e e a r l y p a t t e r n o f r o t a t i o n . Internal e n v i r o n m e n t is primary at the

internal and external environmental

cellular level, m o r e influential w h e n t h e

d e m a n d s . For e x a m p l e , as a few cells b u d

e m b r y o is very y o u n g . As t h e fetus b e c o m e s a

off the e n d o d e r m tube to begin to form the

child and t h e n an adult, external environ-

liver, t h i s c h a n g e s t h e e n v i r o n m e n t o f t h e

m e n t takes on an increasingly significant role.

FOUR

Development of Mesodermal Tissues

W e n e e d t o digress f o r a m o m e n t t o d i s c u s s

study of tissues), t h e fascial wrapping of

t h e d e v e l o p m e n t o f t h o s e m e s o d e r m a l tissues

m a t u r e m u s c l e is n o t a true w r a p p i n g . It is

t h a t will b e c o m e t h e b o n e s , l i g a m e n t s , t e n -

better described as an area of greater c o n -

dons, muscle, and myofascial elements of

c e n t r a t i o n of c o n n e c t i v e tissue. T h e r e is no

c o n n e c t i v e tissue. T h e s e are t h e structural

b e g i n n i n g o r e n d t o t h e s e s t r u c t u r e s . Liga-

c o m p o n e n t s of mesoderm; they share a char-

m e n t s a n d t e n d o n s d o n o t really a t t a c h t o

acteristic pattern of growth.

b o n e — t h e y are c o n t i n u o u s w i t h t h e p e r i o s -

It is usually assumed t h a t c o n n e c t i v e tissue

t e u m (a fibrous covering of t h e b o n e ) , w h i c h

(fascia) c o n d e n s e s a r o u n d a m u s c l e b e c a u s e

in turn is continuous with the next tendon

e x i s t i n g m u s c l e t i s s u e n e e d s a w r a p p e r . It is

or l i g a m e n t .

(Fig.

4-2).

our belief that t h e direction of t h e c o n n e c t i v e

Anatomists tend to describe the b o d y in

tissue ( t e n d o n o r l i g a m e n t ) i s e s t a b l i s h e d first.

t e r m s o f its d i s s e c t i b l e p a r t s . A l i v i n g b o d y i s

P o t e n t i a l m u s c l e tissue c a u g h t w i t h i n t h i s

a c o n t i n u o u s w h o l e . T h i s is especially true of

directional pull differentiates i n t o m a t u r e

its c o n n e c t i v e t i s s u e c o m p o n e n t s . T h e e r r o r

muscle oriented along the line of pull. Muscle

arises w h e n w e t h i n k o f f a s c i a a s a t u b u l a r

itself i s s p o n g y , a b l e t o e x p a n d a n d c o n t r a c t a n d s o e x e r t p r e s s u r e a n d f r i c t i o n o n its surr o u n d i n g fascial bed. M u s c l e tissue is similar i n c o n s i s t e n c y t o taffy. C o n n e c t i v e t i s s u e gives i t s h a p e , d i r e c t i o n , a n d o r g a n i z a t i o n , m u c h a s t h e c a n d y w r a p p e r s h a p e s t h e taffy. Because it is c o n t i n u o u s t h r o u g h o u t the body,

B

c o n n e c t i v e tissue g e n e r a l i z e s l o c a l m u s c l e a c t i o n . For e x a m p l e , a s t h e b i c e p s m o v e , t h e whole arm moves, including the shoulder and neck. T h i s i n t e r a c t i o n d e v e l o p s early, i n t h e first or second m o n t h of pregnancy. Muscle tissue is caught in the middle of the connective tissue d i r e c t i o n a l l y w h i l e i t i s still p r i m i t i v e . T h e c l u m p of primitive m u s c l e cells elongates t h r o u g h directional pressure. At this stage t h e g r o u p o f p r i m i t i v e m u s c l e cells c h a n g e s i n t o differentiated m u s c l e cells. Further g r o w t h i n c r e a s e s m u s c l e size b y c e l l r e p r o d u c t i o n . This development m a y be stimulated by the physical tension present in the connective tissue, o r i t m a y b e s t i m u l a t e d b y t h e a s s o c i a t e d e n e r g y field (Fig. 4-1). In terms of histology (the microscopic

c

D

Figure 4-1 This schematic shows an idealized sequence of normal development of tendon/ligament from early gestation to just before the baby is born. The process continues throughout life.

14

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b o n e ) p u s h e s o u t i n t o t h e c o n n e c t i v e tissue b e d , d i r e c t i o n a l stress l i n e s a r e e s t a b l i s h e d . These have one character along the bone and

Periosteum^

another between the bones. The connective

Tendon'

t i s s u e c o m p o n e n t w i t h i n t h e s e stress l i n e s i s s t i m u l a t e d t o i n c r e a s e fiber p r o d u c t i o n , a n d

Fascia>-

Brachialis-

Intramuscular -connective tissue fibers

t h e s e fibers are a r r a n g e d a l o n g stress l i n e s . This reinforces t h e directional pull within t h e c o n n e c t i v e t i s s u e b e d , s t i m u l a t i n g m o r e fiber production.

Tendon*

Traditional a n a t o m y describes the average soft tissue structures of t h e body. We h a v e f o u n d a v a r i e t y o f a t y p i c a l c o n n e c t i v e tissue b a n d s a n d c o m p r e s s i o n s t h a t are i l l u s t r a t e d i n no a n a t o m y text. We have interpreted these

Figure 4-2 Upper arm (brachialis muscle), showing the connective tissue continuity. Periosteum -> tendon -> myofascia -> tendon -> periosteum.

as an individual response to idiosyncratic patterns. These patterns can include habitual gestures or posture, c o m p e n s a t i o n to injuries, i n d i v i d u a l rates o f g r o w t h , a n d e n v i r o n m e n tal stresses o f all k i n d s . T h i s k i n d o f i n d i v i d u a l

covering a r o u n d m u s c l e tissue. It is m o r e

response is apparent as early as t h e third

a c c u r a t e t o say t h a t t e n d o n goes t h r o u g h

m o n t h o f intrauterine life.

m u s c l e t h a n t h a t t h e m u s c l e lies w i t h i n t h e tendon. Keep in m i n d that in t h e embryological

A r o u n d t h e s i x t h m o n t h o f p r e g n a n c y , size l i m i t a t i o n s in t h e uterus b e c o m e a factor. T h e m o r e stringent this limitation, t h e greater t h e

s t a g e o f d e v e l o p m e n t , all o f t h e s e s t r u c t u r e s

likelihood of adaptation. In m a n y infants, for

are p o t e n t i a l . W h a t starts a s p o t e n t i a l t e n d o n

e x a m p l e , t h e c o n n e c t i v e tissue o n t h e o u t s i d e

or ligament has potential muscle developing w i t h i n it. T h e c o n n e c t i v e t i s s u e a r o u n d t h e p o t e n t i a l m u s c l e l o s e s its t e n d o n o u s c h a r a c t e r a n d b e c o m e s fascia (bedding). T h e ends of t h e original b a n d of fibers remain as the tendon o u s a t t a c h m e n t s . W h e r e t h e c o n n e c t i v e tissue b a n d s e x t e n d across a b r o a d area of t h e body, s u c h as t h e b a c k , t h e y are called a p o -

Figure 4-3 The folding of the fullterm baby in the uterus creates normal fascial tensions, resulting in localized thickenings of connective tissue.

neuroses. T h i s is a wider, flatter e q u i v a l e n t of t e n d o n as it connects to the broader muscles. We h a v e isolated a particular part of m e s o -

o f t h e leg b e c o m e s t h i c k e n e d . T h e legs are held folded within t h e uterus so that tension

dermal differentiation—that of tendons and

is created between the knee cap and the hip.

ligaments a n d associated muscle within the

W h e r e there is this kind of pressure, the stim-

c o n n e c t i v e tissue bed as a w h o l e . W h a t do we

ulation causes a heavier c o n c e n t r a t i o n of

m e a n b y differentiation? W h a t really h a p p e n s

fibers, f o r m i n g a t h i c k e n e d s h e e t o f f a s c i a .

w h e n c o n n e c t i v e tissue structures get organ-

This is n o t a response to internal need, but

ized? As cartilage ( w h i c h will be replaced by

a r e s p o n s e to o u t s i d e p r e s s u r e (Fig. 4-3).

FIVE

Embryonic Limitations and Early Structural Organization

As t h e fetus grows, e n v i r o n m e n t a l pressures

w h e r e it is called t h e ilio-tibial tract. T h e ante-

begin to d o m i n a t e . At six m o n t h s , t h e fetus

r i o r s u p e r i o r s p i n e a c t s like a h o o k s u s p e n d i n g

is really b e i n g pressed by t h e l i m i t a t i o n s of

a p i e c e o f f a b r i c . T h e m u s c l e s o f t h e t h i g h lie

space. This is particularly true if t h e m o t h e r ' s

w i t h i n t h e folds.

posture or structure supports t h e p r e g n a n c y w i t h difficulty. T h e c h i l d m o v e s a r o u n d q u i t e

A n o t h e r pull is d o w n to t h e pubic b o n e f r o m t h e rib region. T h e m u s c l e m o s t directly

a bit, so that it does have s o m e o n g o i n g

influenced is t h e rectus a b d o m i n i s , t h e "sit-

choice. Especially toward t h e eighth m o n t h

u p " m u s c l e o n t h e f r o n t o f t h e a b d o m e n . Its

of pregnancy, however, this m o v e m e n t tends

ease a n d l e n g t h s e e m to relate to t h e degree

to be restricted to t h e limbs because there is

o f c u r l a s t h e c h i l d lies i n t h e u t e r u s .

so little space. T h e child's position in the uterus is thus

N o w h e r e are t h e s e pulls in i s o l a t i o n . T h e r e are a l w a y s c r o s s - t e n s i o n s a m o n g t h e m . W e

i m p o r t a n t i n its s t r u c t u r a l d e v e l o p m e n t a n d

have described a line of force d o w n to the

alignment. W h e t h e r the head is to t h e right

pubic b o n e and o n e up to t h e anterior supe-

o r t o t h e left o f t h e k n e e s , w h e r e t h e a r m s

rior s p i n e . I n a d d i t i o n , t h e r e i s a t o r s i o n

are i n r e l a t i o n s h i p t o t h e s p i n e — t h e s e f a c t o r s

between these two b o n y protuberances.

establish t h e individual pattern of t h e verte-

T h e soft tissue organizes as a s h e e t across

bral c o l u m n . W e assume t h a t t h e p o s i t i o n o f

t h i s area, w h i c h i s t h e groin. W i t h i n t h e s h e e t

the head on the neck is determined by these

t h e r e are specific areas of c o n c e n t r a t i o n of

s p i n a l r o t a t i o n s (Fig. 5-1). It w a s I d a Rolf's

c o n n e c t i v e tissue fibers. T h e m o s t a p p a r e n t is

assumption that this relationship is estab-

the inguinal ligament, a rope-like b a n d from

l i s h e d a s e a r l y a s t h e first w e e k o f p r e g n a n c y .

t h e anterior superior spine to t h e pubic b o n e .

S u c h p r i m a r y r o t a t i o n s are a u g m e n t e d a n d

W h e n this is t o o h e a v y a n d short, it restricts

compensated by intrauterine limitations during late pregnancy. Other places in t h e b o d y m a y s h o w idiosyncratic changes in structure, changes away from simple efficiency. W h a t , t h e n , is simple efficiency? It m a y be visualized in terms of the concept of an embryonic, undifferentiated c o n n e c t i v e tissue b e d in w h i c h t h e r e are directional pulls. As t h e b o n e s grow i n t o this bed, their protuberances act as hooks, prov i d i n g f o c a l p o i n t s o f s o f t t i s s u e t e n s i o n (Fig. 5-2). For i n s t a n c e , t h e a n t e r i o r s u p e r i o r s p i n e of the ilium (the top front corner of the hip b o n e ) " s n a g s " t h e b r o a d fascial sheet t h a t c o m e s u p t h e leg f r o m t h e k n e e . T h i s c r e a t e s c o n v e r g i n g folds at t h a t p o i n t . T h e sheet of fascia also t h i c k e n s o n t h e side o f t h e t h i g h ,

Figure 5-1 The rotations in the fetus continue into the structure of the adult.

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m o v e m e n t ; w h e n it is insufficiently establ i s h e d , t h e g r o i n sags. T h e l u m b o - d o r s a l f a s c i a , w h i c h lies i n a A.S.I.S.

Rectus abdominis m.

Inguinal ligament

h e a v y v e r t i c a l b a n d o n t h e b a c k , i s a s o f t tissue structure that is established by t h e h o o k ing effect at t h e spinal flexures, those places where t h e degree of b e n d i n g in the spine is greater. T h e f e t a l s p i n e d o e s n o t d e s c r i b e a s m o o t h c o n t i n u o u s " C " c u r v e ; i t i s a segm e n t e d curve. These segmental junctions

Ilio-tibial tract

a r e e s t a b l i s h e d b e f o r e t h e b o n e s start t o f o r m . .Sartorius m.

These junctions probably determine regional variations in t h e shape of the vertebrae. T h e f e t a l c u r v e i t s e l f i s n o t a r e s p o n s e t o restriction from the w o m b ; there seems to be gene t i c d e t e r m i n a t i o n f o r t h a t c u r v e t h a t i s later reinforced a n d redirected by the muscular

Rectus femoris m.

pressure of t h e u t e r i n e walls as t h e child grows. B y t h e t i m e t h e f e t u s i s full t e r m a n d r e a d y t o b e b o r n , i t i s a b a l a n c e d n e t w o r k o f soft tissue pulls reflecting t h e i n t e r a c t i o n b e t w e e n its g e n e t i c b l u e p r i n t a n d i n t r a u t e r i n e stresses.

Figure 5-2 Arrows pointing in one direction indicate the major tensions that are unidirectional. Note the tensions on the inguinal ligament are bidirectional between the ASIS (anterior superior iliac spine) and the pubic bone (not labeled).

W h e n t h e c h i l d i s b o r n , i t h a s t o start w o r k ing—literally—to counteract some of the habits t h a t a r e a l r e a d y e s t a b l i s h e d i n its b o d y . Its spinal curve and a kind of crouched position o f legs a n d a r m s m u s t b e o p e n e d a n d l e n g t h ened

(Fig.

5-3).

EMBRYONIC

LIMITATIONS

AND

EARLY

At birth, the head nods forward and the

STRUCTURAL

17

ORGANIZATION

leg. T h i s s t r u c t u r e i s f u n c t i o n a l i n t h e

hip turns under. A h u m a n being in t h e w o m b

w o m b a n d as the child crawls. But as t h e

is b o r n in a natural s t o o p . He straightens for

b o d y b e g i n s to stand, t h e s h o r t n e s s is felt as

m a n y r e a s o n s : f o r c o m f o r t , t o m i m i c , f o r effi-

a restriction that inhibits secure upright bal-

ciency of movement, to explore. As these new

a n c e . Gradually, as d e m a n d for stable m o v e -

physical habits are established, t h e y i n d u c e

m e n t i n c r e a s e s , t h i s t i s s u e m u s t l e n g t h e n . Or,

additional cross-stresses w i t h i n t h e c o n n e c -

as is m o r e usual, t h e growing child finds c o m -

t i v e tissue n e t w o r k . P r e v i o u s l y e s t a b l i s h e d

p e n s a t i o n s a r o u n d t h e s h o r t n e s s t o s e r v e its

stresses d i s s i p a t e f r o m l a c k o f u s e , t h e y m a y

needs. T h e lumbar spine (lower back) m a y

be modified, or t h e y m a y remain as a sub-

c o m e t o o far f o r w a r d , o r t h e legs m a y b e

structure w i t h i n t h e body.

pulled up and into the body.

T h e knee-up position in t h e fetus makes

T h e r e are n u m e r o u s e x a m p l e s o f s u c h

an almost direct line of restriction across t h e

restrictions in fascial sheets a n d c o n n e c t i o n s

pelvis b e t w e e n t h e lower b a c k a n d t h e inside

as the child develops in the w o m b . This m a y

o f t h e t h i g h . T h i s stress l i n e i s c o n t i n u o u s

be t h e origin of so-called spontaneous curva-

with t h e fascial t h i c k e n i n g o n t h e small o f t h e

tures. Children w h o have s h o w n n o prior

back. T h e c o m b i n a t i o n is a compressed, lean-

structural problems can suddenly develop a

ing " S " curve between the lower back and t h e

curvature (scoliosis) just before puberty. T h i s i s n o t a rare o c c u r r e n c e . I t i s p o s s i b l e t h a t t h e

Figure 5-3 The myofascial structures elongate and change relationship as the baby moves from fetal curve (A), to creeping (B), to crawling (C), and on to the first steps (D).

A

B

pattern of the curve m a y have been established in t h e soft tissue relationships of t h e spine early o n . T h e d e m a n d s f r o m growing body weight and increasing control of movem e n t then bring out the inherent weakness.

C

D

PART

TWO

Connective Tissue Body

SIX

The Effect of the Birth Process The term "birth trauma" has considerable

instituted deliveries of t h e b a b y u n d e r water.

emotional impact. From a physiological point

First e f f o r t s t o c l e a n o f f t h e b a b y w e r e d o n e

o f view, t h e a c t u a l p a s s a g e n e e d n o t b e s t r u c -

in the water and no suctioning of airway was

t u r a l l y d a m a g i n g . T h e r e m i g h t b e s o m e diffi-

deemed necessary. M o r e traditional birthing

c u l t y b e c a u s e o f t h e size o f t h e h e a d a n d

n o w includes vigorous toweling and drying

shoulders, yet this should be transitory. A

t h e b a b y as well as suctioning to clear t h e

prolonged period of labor m a y be a source of

airway. Birthing t e c h n i q u e s of t h e first half

tension, but even twenty-four or forty-eight

of this century included holding the baby

hours should not under ordinary conditions

inverted by t h e feet until t h e first cry was

make that m u c h difference to structure.

h e a r d to be sure t h e airway was clear.

Birth is an extraordinary condition. T h e

W h a t happens to the diaphragm and the

infant is e x p e r i e n c i n g a total c h a n g e in envi-

ribs w i t h b r e a t h i n g i n t h e d i f f e r e n t k i n d s o f

r o n m e n t . It has no established ways of deal-

birthing? Intrauterine breathing m o v e m e n t s

i n g w i t h all t h i s n e w n e s s . A t b i r t h , t h e b a b y

have to be shallow because the a b d o m e n and

is a wide-open system. N e w stimuli, because

u p p e r ribs a r e s h a r p l y c o m p r e s s e d i n t h e f e t a l

t h e y are n e w , are m a g n i f i e d i n t h e i r i m p o r t

p o s i t i o n . O n l y t h e l o w e r ribs ( a n d p o s s i b l y

b o t h physically a n d e m o t i o n a l l y . It is a truism

the diaphragm) can be involved. The first

in psychology that what we learn under panic

b r e a t h a f t e r b i r t h starts t h e p r o c e s s o f p u s h i n g

c o n d i t i o n s is w i t h us for life. T r a u m a t i c sen-

t h e fluid o u t o f t h e lungs. B r e a t h i n g h a s actu-

sory attack, such as b e i n g held upside d o w n

ally started before b i r t h , a n d s o m e a m n i o t i c

under bright lights, c a n i n d u c e structural c o n -

fluid n e e d s t o b e e x p e l l e d . T h a t w a s t h e r a t i o -

tractions or sensory shutdown that m a y never

nale for t h e shock. T h e spanking a n d h o l d i n g

go away. T h i s is a c u l t u r a l r a t h e r t h a n a p h y s i -

the n e w b o r n upside d o w n were used to

ological part of the birth process.

ensure that the lungs were cleared.

Birth is the beginning of n e w e n v i r o n m e n -

As adults, we t e n d to be either chest

tal i n f l u e n c e s o n s t r u c t u r e , o n e s a r i s i n g o u t o f

breathers or abdominal breathers. Does the

c o g n i t i v e i m p a c t . T h e r e a r e b a s i c a l l y t w o dif-

first breath of the n e o n a t e initiate t h e pat-

ferent kinds of m a l f u n c t i o n in t h e b o d y —

tern? In abdominal breathing, the diaphragm

t h o s e c a u s e d b y t r a u m a t i c ( e x t e r n a l ) stress

moves up and down and the increased vol-

a n d t h o s e t h a t result f r o m d e v e l o p m e n t a l

u m e o f air i s a c c o m m o d a t e d i n t h e a b d o m e n .

( i n t e r n a l ) stress. W e t e n d t o a c c e p t t h e l a t t e r

In chest breathing, t h e d i a p h r a g m also m o v e s

because "that's just t h e way t h e world is" or

up and down, but not as much. Abdominal

"that's just t h e way m y b o d y is." W e h a v e n o

b r e a t h i n g quiets t h e b o d y a n d draws t h e

comparisons. We can never know h o w we

focus of energy lower in t h e body, a pattern

w o u l d feel w i t h o u t t h a t stress.

well suited to m e d i t a t i o n . Chest b r e a t h i n g

Breathing is one of the major new things that happens with birth. It would be inter-

draws t h e focus of e n e r g y u p w a r d i n t o a m o r e a c t i v e p a t t e r n . ( I n o u r v i e w , t h e d e s i r a b l e rest-

e s t i n g t o c o m p a r e a L e B o y e r f i l m o f t h e first

ing state is a b a l a n c e b e t w e e n t h e t w o — s e e

minutes of infant delivery with a film of m o r e

Fig.

traditional births. T h e French obstetrician

6-1.)

As t h e support of uterine constriction is

22

THE

ENDLESS

WEB

very thin. Both light a n d sound can and do c o m e through. There m a y even be an intrau t e r i n e n e e d for t h e i n f a n t t o w i t h d r a w b y contracting. T o u c h is t h e earliest sense response, establ i s h e d a t a b o u t o n e m o n t h o f g e s t a t i o n . Tactile s t i m u l a t i o n c h a n g e s radically at birth. In t h e u t e r u s , t h e r e i s fluid c o v e r i n g t h e c h i l d i n addition to the uterine musculature. At birth, t h i s a m n i o t i c fluid i s n o l o n g e r t h e r e . A t b i r t h t h e r e are s u d d e n i n t r u s i o n s o f f o r e i g n t e x t u r e s s u c h as sheets, rubber-gloved fingers, suctioning devices, a n d rectal t h e r m o m e t e r s . T h e w h o l e skin is an organ of t o u c h . T h e laying on of gentle hands at birth is something we Figure 6-1 In a balanced combination of chest and abdominal breathing, the abdomen lengthens (vertical arrow) and the rib c a g e widens (horizontal arrow). The inhale is shown in Figure ( 2 ) ; we have exaggerated the drawing for greater visual i m p a c t — this is what it feels like but the visible effect is less than this illustration suggests.

all k n o w t o b e i m p o r t a n t . I t i s g o o d t o see i t so beautifully represented in LeBoyer's* film of birthing. W i t h the work of the second generation of progressive ideas in b i r t h i n g / gentle ways of s t i m u l a t i n g sensory a w a k e n i n g h a v e b e e n f o u n d — f o r e x a m p l e , b l o w i n g air on the chest or using the mother's voice in a low m o n o t o n e to stimulate breathing.

lost at birth, t h e r e are n e w pressures f r o m

T h e c h a n g e in the quality of sensory

b l a n k e t s , s h e e t s , d i a p e r s . D i a p e r s are t h e m o s t

response to the new environment is the

insistent pressure, but even sheets a n d blan-

first c h a l l e n g e t h e b a b y f a c e s . H o w t h i s

kets probably create m o r e pressure t h a n we

c h a n g e is h a n d l e d has a marked effect on

suspect. It was o n c e c o m m o n to pin d o w n

identity. Structurally, a defense response

i n f a n t s h e e t s . Lately, i n s t e a d o f p u t t i n g t h e

is expressed as tissue c o n t r a c t i o n a n d with-

child under a blanket, he or she is put into

drawal. A shock to the system, taking the

o n e or m o r e sleepers a n d has a little m o r e

i n f a n t d i r e c t l y i n t o d e f e n s e , m a y start a w a y

freedom of movement.

of being. Often, it seems as t h o u g h a baby's

T h e child was exposed to light and sound

first c r i e s are r e a l l y a n g r y o r f e a r f u l . T h e c o n -

in t h e w o m b , but these were muffled. At

n e c t i v e t i s s u e r e s p o n s e t o t h a t first e m o t i o n

birth, sensory input is increased in intensity.

c a n last t h r o u g h l i f e .

Probably it b e c o m e s a traumatic factor o n l y if it is s u d d e n a n d / o r h i g h l y i n t r u s i v e . A f e t u s is subjected to m o r e sound t h a n we suspect. W h e n t h e uterine wall is fully e x t e n d e d , it is

*See Frederick LeBoyer, Birth Without Violence (New York: Knopf, 1 9 7 5 ) . f S e e Michel Odent, Birth Reborn (New York: Pantheon, 1984).

SEVEN

Developmental Transitions in the Newborn and Young Child

Development is not complete at birth. Birth

i s l a r g e l y c a r t i l a g e , w i t h s m a l l disks o f b o n e

marks a transition toward a greater a n d ulti-

(Fig. 7-1). B e c a u s e t h e h i p c a r t i l a g e is m a l -

m a t e l y m o r e refined use o f m o v e m e n t . T h e

l e a b l e , h o w a c h i l d h a b i t u a l l y lies i n t h e c r i b

c o n n e c t i v e tissue i s t h e s y s t e m b y w h i c h w e

has great effect on this lower structure. If he

m e d i a t e m o v e m e n t , yet structurally, t h e least

o r s h e lies o n t h e b a c k o r f r o n t , t h e legs t e n d

complete system is t h e c o n n e c t i v e tissue.

to be splayed out because of limited pelvic

Increased d e m a n d for m o v e m e n t furthers

ossification as well as lack of soft tissue t o n e

maturation of t h e c o n n e c t i v e tissue. As we

t o p u l l t h e legs t o g e t h e r .

use a part, it b e c o m e s m o r e capable, m o r e

At birth, the m o s t developed pelvic mus-

skilled. I n t u r n , a s w e b e c o m e m o r e s k i l l e d ,

culature is in the back. T h e gluteus m a x i m u s

we explore a wider range of m o v e m e n t .

muscle is very well developed. T h e erector

Feedback systems can operate to increase

spinae (long m u s c l e s of t h e b a c k ) are strong,

the range of m o v e m e n t , or t h e circuit c a n get

w h i l e t h e b e l l y w a l l i s less s o . T h o s e m u s c l e s

s h u n t e d a n d g o i n t o a d o w n w a r d spiral. F e e d -

t h a t t e n d t o pull t h e leg t o w a r d t h e m i d d l e

b a c k s y s t e m s a r e c h a r a c t e r i s t i c o f all l i v i n g

( a d d u c t o r s ) a r e e v e n less s t r o n g . S w a d d l i n g ,

organisms.

the practice of binding a n e w b o r n closely

T h e r e is very little i n f o r m a t i o n available about muscle, c o n n e c t i v e tissue, a n d o r g a n

i n c l o t h , w r a p s t h e legs s o t h a t t h e y a r e h e l d close together. It m a y be that isometric m o v e ments of the infant within this wrapping

Figure 7-1 At birth, centers of ossification are more fully developed in the upper body than in the lower. This is especially noticeable in the space between the bony ossifications in the pelvis and legs when compared to the shoulders and ribs.

stimulate balance in the hip joint. D e v e l o p m e n t a l r a t e s a n d p a t t e r n s set u p t h e stresses; l e a r n i n g t o u s e t h e b o d y r e i n forces t h e process. T h e m a j o r i t y of children, w h e n t h e y start t o s t a n d u p i n t h e i r c r i b s , p u l l themselves up with their arms and shoulders. T h e y are u s i n g t h e i r stronger parts to h o i s t themselves up on the cartilaginous, rubbery legs a n d p e l v i s . O b s e r v e a s m a l l c h i l d w h o has just discovered h o w to stand. T h e child spends the day going up and down, pulling u p w i t h h i s a r m s , g e t t i n g r u b b e r y o n h i s legs,

d e v e l o p m e n t l a t e i n t h e f e t a l c y c l e . After t h e

falling down, c o m i n g up, getting rubbery,

first t h r e e m o n t h s o f p r e g n a n c y , m o r e e m b r y -

and so forth. He is visibly exploring the bal-

ology texts concentrate on t h e growth of

a n c e possibilities in his pelvis. If t h e h i p j o i n t

external form. T h e sequence in which the

has r e a c h e d t h e stage w h e r e t h e tissues are

head develops a h e a d o f t h e tail a n d t h e b a c k

m a t u r e e n o u g h t o s u s t a i n t h i s e x e r c i s e , all i s

a h e a d o f t h e b e l l y i s m a i n t a i n e d , a s far a s w e

well. But children (and parents) are o f t e n t o o

c a n tell, a f t e r b i r t h .

eager. O v e r u s e o r u s e o f a j o i n t b e f o r e i t i s

In the newborn, the bones of the head and

adequately developed can physically change

c h e s t are r e l a t i v e l y w e l l d e v e l o p e d . T h e p e l v i s

t h e s h a p e o f t h e j o i n t i t s e l f (Fig. 7-2). O r t h e

24

THE

ENDLESS

WEB

course, m o v e m e n t c a n n o t "flow t h r o u g h " to t h e b o n e s . Range of m o v e m e n t is restricted. Maturity in a j o i n t is t h e exploration of t h e

Cartilage

full r a n g e o f p o s s i b i l i t i e s w h i l e still r e t a i n i n g Synovial membrane

Cleft -

Joint cavity Joint capsule

Perichondrium Mesenchyme

stable m o v e m e n t . J o i n t s b e c o m e mature with use. This

Articular cartilage

process accelerates after birth with kicking,

Periosteum

rocking, looking around, a n d so forth. It is important to remember that a child doesn't

Immature

Mature

Figure 7-2 The essential difference in the comparison of mature and immature joints is that the immature " b o n e " is still cartilage. Thus the immature joint is more pliable and, unfortunately, is more deformable by misuse.

start w i t h w a l k i n g . I f t h e c h i l d d o e s n ' t c r a w l before it walks, it is likely to h a v e m o t o r u n c o o r d i n a t i o n for life. T h e child m a y also h a v e a brain i n c o o r d i n a t i o n , m a n i f e s t i n g as disabilities in t h i n k i n g , reading, seeing, a n d learning. In crawling, an infant works with the c o n n e c t i o n o f t h e fascial s h e e t s b e t w e e n t h e

m i s u s e m a y b e less d r a s t i c — s i m p l y a h a b i t u a l way of moving. We define a myofascial structure as i m m a ture w h e n it is insufficiently developed to m e e t t h e d e m a n d for m o v e m e n t . A n y j o i n t c a n b e i m m a t u r e e i t h e r s t r u c t u r a l l y o r i n its pattern of use. T h e heel is an excellent e x a m ple of this. W i t h o u t a well-developed heel, t h e f o o t w o u l d be m o r e like a l o n g e x t e n s i o n of t h e leg. A m a t u r e h e e l a c t s as a f u l c r u m t h r o u g h w h i c h t h e f o o t a n d leg relate t o e a c h

Immature (4 yrs)

other. Babies don't have this kind of heel u n t i l t h e y b e g i n t o w a l k (Fig. 7-3). T h e b o n e a n d tissue e l e m e n t s are present, b u t t h e soft tissue h a s n ' t b e e n s h a p e d b y use. W h e n t h e c h i l d starts to walk, it usually stands on t h e

•Tibia

balls of t h e feet. It has to because t h e heel c a n ' t reach t h e floor; t h e muscles c o n n e c t i n g

Talus

u p t h e leg a r e n o t y e t e x t e n d e d a n d t h e t w o •Calcaneous

h e e l b o n e s a r e still w e d g e d u p i n t o t h e a n k l e joint b e t w e e n t h e tibia a n d fibula. Eventually, t h e b o n e s are w o r k e d free a n d t h e m a t u r e

Mature

h e e l rests f i r m l y o n t h e g r o u n d . Adequate flexibility at t h e joints is t h e anatomical definition of maturity. W h e r e t h e r e is i m m a t u r i t y in a j o i n t , it is c h i e f l y a quality of t h e soft tissue p o r t i o n of t h e joint. W h e n it is inelastic, contracted, or pulled off

Figure 7-3 The black outlines in the immature foot represent cartilage that will eventually be replaced by bone. Note the difference in the shape of the talus as it is molded by ossification and use. Concurrently note the change in the position of the calcaneus.

DEVELOPMENTAL

TRANSITIONS

IN

outside of the knee and the h i p a n d on up i n t o t h e b a c k (Fig. 7-4). C r a w l i n g r e d i r e c t s

THE

NEWBORN

AND

YOUNG

CHILD

25

stability in position is harder to keep. An e l d e r l y p e r s o n w i t h a s e v e r e s c o l i o s i s is

t h e f l e x u r e s o f t h e fetal p o s i t i o n . I t i s n e c e s -

at the other end of the spectrum of malleabil-

sary f o r t h e c h i l d a c t i v e l y t o u s e t h i s p o s i t i o n

ity of cartilaginous tissue. T h e r e are m i n e r a l

before going on to the elongations of t h e

d e p o s i t s i n t h e disks b e t w e e n t h e v e r t e b r a e ,

body required in walking. Crawling seems

w h i c h t h e n b e c o m e m o r e o r less r i g i d . D i s k s

to establish the lower back (lumbar) curve.

consist of fibrocartilage, w h i c h is dense a n d

It r e i n f o r c e s a s i m u l t a n e o u s p a t t e r n of r i g h t

fibrous. Functionally it is similar to b o n e ;

angles at b o t h the hip a n d the knee. Crawling

histologically it is an i n t e r m e d i a t e stage b e -

develops t h e use of t h e pelvis, b r i n g i n g it

t w e e n cartilage a n d b o n e tissue. Fibrocartilage

t o w a r d t h e level o f m a t u r i t y o f t h e s h o u l d e r s

itself c o m p r i s e s a s p e c t r u m of d e n s i t y — i t c a n

a n d belly. A c r a w l i n g c h i l d p r a c t i c e s s y n c h r o -

b e rigid like b o n e o r r u b b e r y l i k e c a r t i l a g e .

n i z i n g t h e a r m s a n d legs, a s w e l l a s r i g h t a n d

T h e difference between o n e kind of connec-

left sides.

tive tissue a n d a n o t h e r is in t h e a m o u n t a n d

A t b i r t h , t h e pelvis a n d legs are p r i m a r i l y

o r g a n i z a t i o n o f t h e fibers a n d i n t h e d e n s i t y

cartilage. Proportionately, t h e arms h a v e m o r e

of the intercellular matrix. W i t h i n limits, any

b o n e , t h e r e i s a fair a m o u n t o f b o n e i n t h e

o f these tissues m a y m o v e i n t h e direction o f

ribs, a n d t h e u p p e r v e r t e b r a e h a v e m o r e b o n e

increased rigidity or at a n o t h e r t i m e , reverse

than the ones down toward the lumbar

t o t h e d i r e c t i o n o f g r e a t e r fluidity. T h i s c a n

r e g i o n a n d t h e s a c r u m . T h e full r e p l a c e m e n t

h a p p e n at a n y age.

of cartilage by b o n e in t h e skeleton is n o t

Reversibility of tissue density is an i n s t a n c e

c o m p l e t e until t h e age of t w e n t y to t w e n t y -

of the embryological nature of connective

five. W h e n t h e r e i s still c a r t i l a g e i n t h e v e r -

tissue in t h e adult. I m p a c t e d areas, such as

t e b r a l c o l u m n , i t m a y b e e a s i e r t o c h a n g e its

b e t w e e n t h e shoulder blades or across t h e t o p

c o n f o r m a t i o n b e c a u s e o f its g r e a t e r m a l l e a -

o f t h e p e l v i s , c a n f e e l like t e n d o n s . L i k e t e n -

bility. A t t h e s a m e t i m e , i t m a y b e t h a t a n y

d o n s o r l i g a m e n t s , t h e y are t h e f u n c t i o n a l r e s p o n s e t o n e e d . W e all h a v e w a y s o f s h o r i n g

Figure 7-4 (A) before birth; (B) creeping; (C) crawling; (D) standing.

A

B

o u r s e l v e s u p a g a i n s t t h e stresses o f w e i g h t a n d constriction. We create short "ropes" and

C

D

26

THE

ENDLESS

WEB

folds across a j o i n t or wide cross b a n d s to

structure of the n e w b o r n into a c o m p e t e n t ,

stabilize an u n b a l a n c e d shoulder or hip.

independent child.

The problems begin when we attempt to

T h e r e a r e a l s o less o b v i o u s d e m a n d s —

work against rather t h a n with gravity as we

s u b t l e e x p e c t a t i o n s t h a t start v e r y y o u n g . W e

m o v e . W h e n a c h i l d first starts t o w a l k , s h e

e x p e c t d i f f e r e n t t h i n g s f r o m a b a b y girl t h a n

gets up a n d a i m s toward a table or s o m e o t h e r

f r o m a b a b y boy, for e x a m p l e . S o m e of this

s u p p o r t . S h e s o r t o f falls f o r w a r d , a n d h e r legs

m a y e v e n start b e f o r e b i r t h ; i n s o m a n y c a s e s ,

m o v e under her to keep her upright. If she

the child is talked about as " h e . " Infants and

l e a n s b a c k a t all, s h e sits. S h e s o o n l e a r n s t o

c h i l d r e n are n a t u r a l p e r f o r m e r s a n d t h e y get a

prefer falling on her b o t t o m to falling forward

great deal of r e i n f o r c e m e n t to act, to m i m i c .

on h e r face. T h e result is t h a t s h e starts to

( " I s n ' t t h a t c u t e ; j u s t like h i s f a t h e r . " ) A n o t h e r

b a l a n c e o n t h e b a c k o f her legs. I f this p a t t e r n

way of saying the same thing is that children

persists i n t h e a d u l t , t h e r e w i l l b e t r o u b l e .

are natural seekers of a t t e n t i o n a n d approval.

W h e n a child is held with his arms up, he

A w o m a n w h o h a d a l o t o f i n j u r i e s t o o n e leg

b r i n g s h i s legs f o r w a r d to w a l k (Fig 7-5). As

said, " M y m o t h e r used to tell me t h a t w h e n I

h i s legs m o v e o u t i n f r o n t , h e f e e l s t h a t h e i s

was a b o u t three years old I followed my father

f a l l i n g b a c k w a r d a n d starts c o m p e n s a t i n g : t h e

around in the garden a n d imitated his limp."

lower back c o m e s forward, the shoulders go

Perhaps n o t surprisingly, this was t h e s a m e

back, and the head comes forward to balance.

leg s h e r e p e a t e d l y i n j u r e d .

A further c o m p l i c a t i o n is t h a t b u l k y diapers

As a b a b y l e a r n s to u s e its b o d y , it h a s

f o r c e t h e legs a p a r t . I t i s i n t e r e s t i n g t o see

m a n y o p t i o n s . A s i t g r o w s older, t h i s w i d e -

h o w m a n y adults walk with this kind of c o n -

o p e n range of possibilities narrows in favor

f i g u r a t i o n — h e a d f o r w a r d a n d legs s p l a y e d . After birth, t h e activities of b r e a t h i n g ,

of greater precision of m o v e m e n t . Premature use, inappropriate i m i t a t i o n , or a too-early

t u r n i n g over, sitting u p , grabbing things,

d e m a n d for precision c a n skew t h e j o i n t out

l o o k i n g for things, crawling, a n d walking are

of true, creating restriction, lack of precision,

the primary stimuli to convert the immature

and eventually, pain.

Figure 7-5

EIGHT

Myofascial Structures

The Spine as an Example of "Living Anatomy" The "organ" that transmits m o v e m e n t in the

c o n n e c t i v e tissue. It is a heavier c o n d e n s a t i o n

body, that makes a structural w h o l e of us, is

o f fibers a t t h e s u r f a c e o f m u s c l e . M y o f a s c i a

t h e mesodermal tissue—the c o n n e c t i v e tissue.

also exists as layers b e t w e e n m u s c l e s , relating

These hard a n d soft tissues t o g e t h e r m a k e u p

t h e m o r e superficial surface muscles to t h o s e

w h a t Ida R o l f c a l l e d t h e " o r g a n o f s t r u c t u r e . "

deeper in t h e b o d y as well as c o n n e c t i n g

C o n n e c t i v e tissue v a r i e s i n t e r m s o f t h e p h y s i -

adjacent muscles into groups. We consider

c a l n a t u r e o f its i n t e r c e l l u l a r m a t r i x a n d i n

fascia to be a c o n t i n u o u s system, e x t e n d i n g

t h e n u m b e r a n d d e n s i t y o f its f i b e r s . I n

throughout the b o d y between the deepest

descriptive terms, this m e a n s t h a t s o m e is

b o n e level ( p e r i o s t e u m - t e n d o n - l i g a m e n t )

h a r d e r o r softer, s o m e i s m o r e e l a s t i c o r m o r e

(Fig. 8-1) a n d t h e l a y e r j u s t u n d e r t h e s k i n

rigid. C o n n e c t i v e t i s s u e i s c o n t i n u o u s

( t h e s u p e r f i c i a l f a s c i a ) . It is a l a y e r i n g of s h e e t s

throughout the body from toe to head. Bone,

of fibrous tissue t h a t flows t h r o u g h t h e body,

for e x a m p l e , is a c o n c e n t r a t i o n of h a r d inter-

eddying around b o n y protuberances that

cellular m a t r i x w i t h i n a c o n n e c t i v e tissue b e d .

c o m p r e s s a n d r e d i r e c t its flow. I t i s t h e p a c k -

Histologically, therefore, b o n e is c o n t i n u o u s

ing material of the body; it makes up our

with t h e total b e d of c o n n e c t i v e tissue.

contours and holds us in place.

Myofascia, t o o , is a specialized type of

M u s c l e lies w i t h i n f a s c i a l s h e a t h s . I n a d d i t i o n , f a s c i a l fibers i n t e r p e n e t r a t e t h e m u s c l e , w r a p p i n g a r o u n d smaller m u s c l e fiber groups (Fig. 8-2). M u s c l e fibers e x p a n d a n d c o n t r a c t , exerting internal pressure on this myofascial

Periosteum*

tissue. Acting like a guy rope, t h e fibrous

Tendon^

Fasciar-

Brachialis-

Intramuscular -•connective tissue fibers

Epimysium

Tendorw

Perimysium'

Endomysium.

Figure 8-1 Brachialis muscle in upper arm showing continuity of connective tissue: periosteum and tendon with fascia. Ligaments similarly bridge the periosteum of one bone to the periosteum of the other bone in a joint.

1

Figure 8-2 Cross section of the upper arm showing the fascial sheaths (labeled) surrounding muscle fibers (dots) and muscle groupings.

28

T H E

E N D L E S S

W E B

Coracoclavicular ligament & Subclavius m.

fascial s h e a t h t h e n transmits t h e m o v e m e n t to the periosteum of the b o n e with which it is c o n t i n u o u s . In adults as well as in t h e e m b r y o and neonate, where the myofascial covering

Coracoid process Coracobrachialis m.

h a s b e c o m e t o u g h e n e d (as i t d o e s t h r o u g h habitual tension or holding), it condenses .Pectoralis minor m.

to encase the muscle in such a way that there i s less c a p a c i t y t o l e n g t h e n a n d t o m o v e . As we h a v e said, t h e m y o f a s c i a l b e d of t h e

Biceps m. (short head)

adult, as well as of t h e e m b r y o , responds to habitual t e n s i o n with a localized increase of f i b r o b l a s t s a n d i n c r e a s e d s e c r e t i o n o f fiber in t h e direction of pull. This creates a t o u g h e n v e l o p e t h a t e n c a s e s t h e m u s c l e , r e d u c i n g its c a p a c i t y t o l e n g t h e n o r m o v e freely. T h e f o c u s of Rolfing is this t o u g h e n e d myofascia, and i t c a n b e f e l t t o r e g a i n its n a t u r a l e l a s t i c i t y a s Rolfing proceeds. We therefore have reason to believe that this toughening of the myofascial s h e a t h is reversible. Fascial s h e a t h s get " s n a g g e d " o n b o n y h o o k s . An e x a m p l e is t h e coracoid process, a b o n y projection on t h e inside of the shoulder b l a d e just a b o v e t h e armpit. Fascia e x t e n d s as a continuous sheet from the hand, arm, and c h e s t all t h e w a y u p t o t h e n e c k a n d h e a d . T h e c o r a c o i d p r o c e s s r e a c h e s i n t o t h a t fascial c o n t i n u u m , m o d i f y i n g its f l o w (Fig. 8-3). S i m i l a r l y , t h e t a i l b o n e ( c o c c y x ) a c t s like a h o o k , i n t e r r u p t i n g t h e c o n t i n u i t y o f fascial tissue f r o m t h e outside i n t o t h e inside of t h e pelvis. H o o k s are o n e w a y t h a t b o n e a n d m y o f a s c i a interact to redirect, stabilize, or m a g n i f y m o v e m e n t p o t e n t i a l . T h e s e are t h e r e f o r e areas o r s t r u c t u r e s t h a t w i t h i m proper use m a y b e c o m e foci of i n h i b i t i o n of movement. Hooks are f r e q u e n t l y points o f a t t a c h m e n t

Figure 8-3 A look at the surface of the shoulder demonstrates the continuity of the fascial sheath (photo). The underlying fascial pulls graphically illustrate the complex dynamics focused on the coracoid process (drawing).

f o r m y o f a s c i a l s t r u c t u r e s . For e x a m p l e , t h e coracoid process is the point of a t t a c h m e n t of muscles from t h e arms to t h e shoulder. On the other hand, the tailbone is only mini m a l l y a p o i n t of a t t a c h m e n t for t h e muscles f r o m t h e l e g t o t h e t r u n k . Yet t h e t a i l b o n e ' s

MYOFASCIAL

STRUCTURES

29

e f f e c t o n leg m o v e m e n t b e c o m e s a p p a r e n t i f it has been displaced in a n y w a y — m o v e d to t h e r i g h t o r t h e left, t o o d e e p o r t o o c l o s e t o the surface—then there is interference with t h e easy s w i n g o f t h e leg. I n j u r i e s t o t h e c o c c y x are c o m m o n i n c h i l d h o o d , a n d e a s i l y i g n o r e d . T h e y are d i f f i c u l t t o t r e a t — i t i s i m p o s s i b l e to p u t a c a s t on a t a i l b o n e . B o n e projects i n t o t h e c o n n e c t i v e tissue bed with broad surfaces as well as w i t h h o o k s . The upper rim of the hip bones, the edge of t h e l o w e r ribs, a n d t h e s h i n b o n e s a r e e x a m ples. T h e s e , t o o , s e r v e a s a r e a s o f a t t a c h m e n t for myofascial units. In general, t h e s e b r o a d e r surfaces a r e c o n n e c t e d w i t h m o r e s u p e r f i c i a l

Figure 8-4 Dowager's hump.

s o f t tissue o r g a n i z a t i o n . S m a l l e r p o i n t s o f a t t a c h m e n t usually serve to redirect deeperlying tissue. There is a f u n c t i o n a l reasonableness to t h e c o m b i n a t i o n of myofascial sheets and b o n y

arm moves, that movement should continue wavelike through the neck a n d i n t o the head. Yet t h e r e i s f r e q u e n t l y a b l o c k i n g o f t h e m o v e -

p o i n t s o f r e f e r e n c e . T h e g r o w i n g b o n e sets u p

m e n t . For e x a m p l e , a t t h e j u n c t i o n o f t h e

stresses ( d i r e c t i o n a l pulls) i n t h e c o n n e c t i v e

neck with the chest vertebrae, there is often

tissue i n u t e r o . W h e n t h e s e a r e f r o m a s i n g l e

a c h r o n i c h o l d i n g p a t t e r n t h a t i n l a t e r life i n

p o i n t (for e x a m p l e , t h e w a y t h e h a m s t r i n g s

w o m e n is c a l l e d a d o w a g e r ' s h u m p (Fig. 8-4).

a t t a c h to t h e ischial tuberosities), t h e result tends to be a grouping of rope-like structures.

Since the spine is the focus of so m a n y m o v e m e n t difficulties, w e will g o i n t o s o m e

W h e n t h e p u l l s are f r o m a b r o a d a r e a (for

d e t a i l a b o u t its s t r u c t u r e a s a n e x a m p l e o f

example, the transverse muscles covering

w h a t w e c a l l " l i v i n g a n a t o m y . " All o f t h e

t h e a b d o m e n ) , t h e r e s u l t i s m o r e like a b r o a d

spinal c o l u m n ' s 1 8 6 j o i n t s are i n v o l v e d i n

sheet.

every m o v e m e n t of t h e body. This is espe-

" P o i n t of a t t a c h m e n t " designates t h e sup-

cially well d e m o n s t r a t e d in b r e a t h i n g , w h i c h

posed e n d p o i n t of m o v e m e n t for a muscle or

is n o t generally t h o u g h t of as a " m o v e m e n t . "

group of muscles. It is i m p o r t a n t to r e m e m b e r

T h e r e are t h r e e or four articulations b e t w e e n

t h a t f a s c i a c o n t i n u e s p a s t t h i s p o i n t o f refer-

e a c h vertebra. I n t h e c h e s t region, t h e r e are

ence. Points of a t t a c h m e n t c h a n g e the quality

three articulations of each of the twelve t h o -

of movement. They change the strength of

r a c i c v e r t e b r a e w i t h its a s s o c i a t e d r i b . T h e r e

t h e gesture a n d absorb s o m e of t h e energy of

are f u n c t i o n a l a r t i c u l a t i o n s b e t w e e n t h e c e n -

a m o v e m e n t b e f o r e t r a n s m i t t i n g i t t o t h e rest

tral b o d i e s o f t h e v e r t e b r a e a s t h e y r e l a t e t o

of the body.

t h e disks b e t w e e n t h e m ( t h e s e a r e n o t u s u a l l y

Ideally, m o v e m e n t f r o m a g e s t u r e t r a v e l s

considered true joints, but t h e y do f u n c t i o n

t h r o u g h t h e a r m o r leg o r h e a d t o w a r d t h e

as joints). Holding patterns can and do occur

spine. M o v e m e n t transmits as a wave d o w n

b e t w e e n a n y o n e o r (usually) m o r e o f t h e s e

the spine as well as across t h e spine a n d i n t o

articulations, restricting m o v e m e n t through-

t h e o t h e r side o f t h e b o d y . T h u s , w h e n t h e

o u t t h e s p i n a l c o l u m n (Fig. 8-5).

30

THE

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WEB

We i n c l u d e b o n e , fascia, a n d m u s c l e in our d e f i n i t i o n of a s p i n a l c o l u m n (Fig. 8-6). I n d i Costal facet of transverse process

Inferior costal articular facet

vidual vertebrae m u s t b o t h separate vertically and rotate with every body m o v e m e n t . The spinal c o l u m n as a w h o l e integrates rotation w i t h l e n g t h e n i n g a n d s h o r t e n i n g t o allow for

Superior costal

diagonal m o v e m e n t s . These types of m o v e -

articular facet

m e n t s are c o m b i n e d to give t h e spring-like action of the spine that is characteristic of v i r t u a l l y all m o v e m e n t i n a t r u l y m o b i l e s p i n e . In d i s s e c t i o n , a spiral p a t t e r n is v i s i b l e in t h e c o n n e c t i v e tissue a r o u n d t h e spine. M o v e m e n t between individual vertebrae is p r o p a g a t e d t h r o u g h this spirally arranged c o n n e c t i v e tissue i n t o t h e spine as a w h o l e . Figure 8-5 In the thorax, the articulations of the ribs with the vertebrae add another level of complexity to spinal mechanics.

T h e spinal c o l u m n is constantly moving in response to breathing, heartbeat, blood c i r c u l a t i o n , c r a n i a l r h y t h m , e t c . For e x a m p l e , w h e n we i n h a l e , t h e r e is a t e n d e n c y for t h e c o l u m n to l e n g t h e n ; spinal curves decrease in a n g l e . W h e n w e e x h a l e , t h e b o d y settles b a c k i n t o its n o r m a l c u r v e s (Fig. 8-7). N e i t h e r t h e spine n o r t h e c o n n e c t i v e tissue t h a t wraps t h e vertebrae a n d their associated muscles is ever

Anterior longitudinal ligament

„ Interspinous ligament

1

"at rest." As m o v e m e n t b e c o m e s more active, conn e c t i v e tissue wraps m o r e tightly a r o u n d t h e

Intervertebral, disc

-Ligamentum flavum

Vertebral body (centrum)

s p i n e . T h e p a t t e r n o f c o n n e c t i v e tissue t h e n goes f r o m a primarily vertical at-ease position

.Spinous process

Posterior 'longitudinal ligament

Transverse, process

Ventral

Dorsal -

Figure 8-6 Lumbar vertebrae with associated ligaments illustrating the complexity of fiber direction.

Figure 8-7 Inhale (B) and exhale (C).

MYOFASCIAL

STRUCTURES

31

to a spiraling, narrower wrapping a r o u n d t h e

protein solutions is their response to changes

vertebrae and muscles. T h e action of t h e mus-

i n t e m p e r a t u r e — t h e y w i l l b e f l u i d (sol) i n

cle fibers i s r a c h e t - l i k e , u n i d i r e c t i o n a l , a n d

w a r m e r t e m p e r a t u r e s , t h i c k (gel) i n c o l d e r

m o d u l a r (all o r n o t h i n g ) . T h e a c t i o n o f c o n -

temperatures. This type of solution is called

n e c t i v e tissue i s b a s e d o n e l a s t i c r e c o i l , w h i c h

a c o l l o i d ; g e l a t i n , f o r e x a m p l e , is a c o l l o i d .

i s less rigidly p a t t e r n e d . R e c o i l c a n b e p a r t i a l ,

W h e n an area of t h e b o d y is n o t stimulated

it is m u l t i d i r e c t i o n a l , a n d it is p r o p a g a t e d in

by movement, the underlying chronic muscu-

waves. As t h e c o n n e c t i v e tissue wraps m o r e

lar t e n s i o n ( h o l d i n g p a t t e r n ) c u t s o f f c a p i l l a r y

c l o s e l y t o t h e s p i n e , its e l a s t i c r e c o i l p r o p e r -

circulation to t h e area. Blood circulation

ties b e c o m e a n i n c r e a s i n g l y larger p r o p o r t i o n

n o r m a l l y provides h e a t as well as nutrients

o f t h e m o v e m e n t . T h a t is, t h e m o r e f o r c e

and waste removal. As capillary circulation

b e h i n d t h e m o v e m e n t , t h e greater t h e in-

decreases, t h e colloid m a t r i x c h a n g e s state

v o l v e m e n t of t h e c o n n e c t i v e tissue. Gesture

f r o m sol t o g e l , a n d its c o n s i s t e n c y b e c o m e s

t h e n b e c o m e s b o t h faster a n d m o r e integrated

m o r e glue-like, trapping c o n n e c t i v e tissue

(smoother). T h e c o n t r a c t i o n o f m u s c l e fiber i m p e l s t h e

fibers i n t o a n o n - m o v i n g m a t t e d m a s s . A s w e h a v e d e s c r i b e d , fibers p r o l i f e r a t e w h e r e v e r

c o n n e c t i v e tissue to wrap itself m o r e closely

t h e r e i s t i s s u e stress. T h e r e s u l t i n g m a s s o f

around muscle and vertebrae, paradoxically

t h i c k e n e d m a t r i x a n d increased fiber m a s s

causing the spine to elongate. As the muscle

can be palpated as an unmoving, painful

fiber r e l a x e s , t h e c o n n e c t i v e t i s s u e r e c o i l s ,

thickening.

maintaining and spreading m o v e m e n t

This kind of buildup can be reversed by t h e

through the spine and out into the body.

intervention of manipulative or movement

It is this wavelike propagation of m o v e m e n t

techniques. T h e i m m e d i a t e effect is to modify

through the b o d y as a w h o l e that supports

the physical nature of the matrix. T h e ensu-

continuity of m o v e m e n t and creates m o v e -

i n g g r e a t e r f l u i d i t y o f m a t r i x g i v e s rise t o a

m e n t t h a t i s s m o o t h r a t h e r t h a n jerky.

changed m o v e m e n t pattern and eventually

T h e elastic recoil of t h e c o n n e c t i v e tissue

to a c h a n g e in fiber d e n s i t y a n d d i r e c t i o n .

arises f r o m t h e a r r a n g e m e n t o f fibers w i t h i n

M a n i p u l a t i o n appears to be a faster m e t h o d

t h e c o n n e c t i v e t i s s u e m a t r i x . C o l l a g e n fibers

of c h a n g e ; intelligent exercise and/or stretch-

t h e m s e l v e s are n o t elastic, but t h e y are coiled

ing also has t h e desired effect. In either case,

a n d t h e i r i n t e r w e a v i n g a l l o w s f o r e l a s t i c dis-

an improved positioning with respect to t h e

p l a c e m e n t a n d r e t u r n . W h e n t h e s e fibers a r e

gravity line is essential to a c h a n g e in fiber

densely matted or not aligned in the direction

density.

o f m o v e m e n t , t h e i r e l a s t i c p o t e n t i a l i s dis-

T h e c o n n e c t i v e tissue m a t r i x is an i m p o r -

persed. This is t h e case w h e r e there is t h i c k e n -

t a n t factor in tissue resilience. W h e r e t h e

ing and b u n c h i n g of c o n n e c t i v e tissue. This

matrix is t h e primary factor in a h o l d i n g pat-

can be palpated a n d is sensed as restriction

tern, it c a n be palpated as a glassy m a s s . T h i s

and/or pain.

is o n e of t h e m o s t t r o u b l e s o m e types of tissue

T h e physical state of t h e m a t r i x also plays

restriction. It is generally close to t h e b o n e

a role in t h e ability of t h e c o n n e c t i v e tissue

a n d is usually difficult to influence toward

t o respond t o m o v e m e n t . C o n n e c t i v e tissue

renewed movement. Some c o m m o n examples

fibers d o n o t e x i s t i n a v a c u u m . T h e y a r e

are areas u n d e r t h e s h o u l d e r b l a d e o r k n o t s

e m b e d d e d in a m a t r i x t h a t itself is h i g h l y

j u s t a l o n g t h e s p i n a l v e r t e b r a e (at t h e s p i n o u s

organized. This intercellular m a t r i x is a pro-

processes). T h e s e are places t h a t are o f t e n very

tein solution. O n e of the chief properties of

sore as well as tight. O t h e r sore places, closer

32

THE

ENDLESS

WEB

t o t h e b o d y s u r f a c e , t e n d t o b e w h e r e large

c o n n e c t i v e t i s s u e serves t h i s f u n c t i o n . M u s -

m u s c l e masses cross e a c h o t h e r or attach to

cles, in this m o d e l , provide t h e source a n d

bone

direction of m o v e m e n t energy. Muscles exe-

(Fig.

8-8).

We describe the c o n c e p t of joints in more d e t a i l l a t e r (see S e c t i o n 2 2 ) , b u t i t s h o u l d b e

cute movement. In t h e classically taught picture of t h e

mentioned now that between each of the

body, b o n e s are t h e supporting structures.

m a n y a r t i c u l a t i o n s o f t h e s p i n a l c o l u m n (as

However, b o n e s do n o t t o u c h . It is thus

well as in a n y j o i n t of t h e b o d y ) t h e r e is fluid

impossible for t h e m to support t h e b o d y the

that is similar in c o m p o s i t i o n to t h e intercel-

w a y a t a b l e is s u p p o r t e d by its legs. S u p p o r t

lular m a t r i x . As b o n e s articulate, t h e y are n o t

in a m o v i n g structure is very different f r o m

in direct c o n t a c t with e a c h other. T h e y have

s u p p o r t in a s t a t i c s t r u c t u r e , s u c h as a h o u s e .

fluid b e t w e e n t h e m . B o n e s " f l o a t " i n r e l a t i o n -

S u p p o r t i n a m o v i n g s t r u c t u r e arises f r o m t h e

ship to e a c h other. As t h e c o n n e c t i v e tissue

organization and arrangement of the connec-

compresses around the spinal c o l u m n , the

tive tissues. W h e n we speak of a m o v e m e n t

fluid c a p s u l e s b e c o m e l o n g e r a n d t h i n n e r ,

b e i n g supported, we are describing t h e a c t i o n

p u s h i n g t h e v e r t e b r a e f a r t h e r a p a r t (Fig. 8-9).

o f o p p o s i n g a n d b a l a n c e d tissue g r o u p s . T h e

T h e spinal c o l u m n is l e n g t h e n e d by a c o m b i -

r e c i p r o c a l , b a l a n c e d p l a n e s o f c o n n e c t i v e tis-

nation of the narrower coiling of the connec-

sue s u p p o r t b o t h m u s c l e a n d b o n e b y t h e i r

tive tissue a n d t h e pressure of t h e c o m p r e s s e d

elastic capability.

fluid b e t w e e n b o n e s .

A s i n t h e s p i n e , all j o i n t s s h o u l d l e n g t h e n

This is a n e w picture of physical structure.

w i t h m o v e m e n t a s t h e c o n n e c t i v e tissue

Here t h e c o n n e c t i v e tissue is t h e supportive

w r a p s a n d s u p p o r t s t h e j o i n t c a p s u l e . For

aspect of t h e structure. B o n e s are spacers,

this t o h a p p e n , t h e c o n n e c t i v e tissue m u s t b e

serving to position a n d relate different

r e s i l i e n t . T h i s r e s i l i e n c e i s felt a s e a s e ; i n p h y s -

areas o f t h e c o n n e c t i v e tissue. B o n e s are n o t

iological terms, it is described as t o n e . An

t h e supporting structures of t h e body; t h e

increase in c o n n e c t i v e tissue resilience is o n e of t h e goals of w a r m u p before exercise. T h e concept of physical support of movem e n t is simplified if we t h i n k in terms of the

E Levator 'scapulae m.

c o n n e c t i v e tissue b e d rather t h a n in terms of

;

Trapezius m.

/Supraspinatus m.

A-

B D

C .Latissimus dorsi m.

F

Figure 8-8 These fascial dumpings are the common "sore places" that we complain about. (A) The trapezius as it crosses the tip of the shoulder (acromion). (B) The trapezius as it crosses the scapula below the scapular spine. (C) The interaction of the levator scapulae and the supraspinatus at the upper medial point of the scapula (often especially intractable). (D) The interaction between the trapezius and latissimus dorsi at about the lumbo-dorsal hinge. (E) The attachment of the levator scapulae to the base of the occiput. (F) The pad created by the latissimus dorsi at the lumbosacral junction.

MYOFASCIAL

m u s c l e m o v e m e n t . Physical a c t i o n alters t h e

STRUCTURES

33

resilient, either generally or locally, h o l d i n g

shape of t h e c o n n e c t i v e tissue b e d t h r o u g h -

patterns b e c o m e habitual. There is a c o n c o m i -

out t h e structure, creating greater c h a n g e

t a n t loss o f range o f m o v e m e n t a n d o f energy.

where m o v e m e n t originates and rippling into

M a n y p h y s i c a l t h e r a p i e s a d d r e s s t h i s loss o f

more attenuated change farther away from

ability. T h e Rolfing i n t e r v e n t i o n is t h e o n e we

t h e origin of m o v e m e n t . B o n e s are spacers,

k n o w b e s t . B y w o r k i n g t o e n h a n c e t h e resili-

like t h e m e m b e r s o f a g e o d e s i c d o m e . A s i m -

e n c e of t h e c o n n e c t i v e tissue bed, Rolfing

plified m o d e l i s a t e n t , w h e r e t h e t e n t p o l e i s

reeducates the b o d y toward an improved

held upright by the balanced tension between

relationship to the gravity line.

r o p e s o n b o t h sides.

B o t h Rolfing a n d m a s s a g e m i g h t b e classi-

W e t e n d t o have a n easier t i m e e n v i s i o n i n g

fied a s d i r e c t i n t e r v e n t i o n t e c h n i q u e s . S h i -

support from below from a base such as t h e

atsu, acupuncture, a n d reflexology act by

e a r t h or a c h a i r . S u p p o r t in a l i v i n g , m o v i n g

releasing energy t h r o u g h t h e c o n n e c t i v e tis-

b o d y c o m e s f r o m above as well as f r o m below.

sue. O t h e r therapies work t h r o u g h retraining

T h e h e a d a n d t h e fingertips are as m u c h a

m o v e m e n t , e i t h e r p a s s i v e l y (Trager m e t h o d )

part o f t h e s u p p o r t s t r u c t u r e a s are t h e t o e s .

or actively, or by a c o m b i n a t i o n of active a n d

Adequate length in the neck and adequate

passive (Rolfing M o v e m e n t work, Alexander

lift i n t h e h e a d a r e e s s e n t i a l t o t h e m o v e m e n t

work, Feldenkrais Functional Integration).

integrity of t h e b o d y as a w h o l e .

Exercise that is properly d o n e also t o n e s a n d

W h e n t h e c o n n e c t i v e tissue b e d is n o t

l e n g t h e n s c o n n e c t i v e tissue. S o m e forms of exercise, s u c h as yoga, t'ai chi, a n d swim-

Figure 8-9 The figure to the right shows the lengthening that occurs with spinal movement as connective tissue more closely wraps the joint. Notice that the connective tissue fibers change direction, becoming more vertical as the spinal column elongates. Lumbar vertebrae

Anterior longitudinal' ligament

Interspinous ligament

Intervertebral, disc'

tigamentum flavum

Vertebral body* (centrum)

^Spinous process Posterior •longitudinal ligament

Transverse, process

Ventral

Dorsal-

m i n g , are b y design activators o f c o n n e c t i v e tissue t o n e . Poorly d o n e exercise a n d exercising w h e n exhausted, however, have an opposite e f f e c t o n c o n n e c t i v e t i s s u e , c a u s i n g i t t o harden and contract.

NINE

Movement and Gravity

W h e n a n y part o f t h e b o d y m o v e s , t h e entire

the joints of the bones going from heel

b o d y responds. We always m o v e f r o m a base

to toes, there is also w i d e n i n g b e t w e e n t h e

o f s u p p o r t . Ideally, w h e n w e sit, m o v e m e n t

b o n e s o f t h e f o o t t h a t are side b y s i d e . T h i s

is initiated f r o m t h e part of t h e pelvis t h a t is

c u s h i o n i n g o f m o v e m e n t acts b o t h t o protect

resting o n t h e chair. W h e n m o v i n g forward,

t h e structure a n d t o provide spring for t h e

t h e pelvis rocks forward, t h e pubic b o n e drops

n e x t step. T h e spring action c o m e s from

slightly toward t h e sitting surface, a n d t h e

the lengthening provided as the connective

t a i l b o n e is e l e v a t e d o f f t h a t s u r f a c e (Fig 9-1).

t i s s u e w r a p s a n d e x t e n d s t h e j o i n t s . T h e leg

T h e m o v e m e n t is like a spring. It starts at t h e

becomes longer with m o v e m e n t . This is the

pelvis a n d is quickly t r a n s m i t t e d t h r o u g h t h e

result of l e a n i n g forward f r o m t h e base of

b o d y u p t o t h e h e a d a n d d o w n t o t h e feet.

support, allowing t h e leg to c o m e forward

T h i s falling-forward m o t i o n takes o n l y sec-

b y l e n g t h e n i n g a t all o f its j o i n t s .

o n d s ; i t i s t h e first p a r t o f a n y f o r w a r d m o v e -

T h e hip j o i n t l e n g t h e n s as well as widens

m e n t . A s f o r w a r d m o t i o n starts, t h e p e l v i s

w i t h m o v e m e n t . C o n n e c t i v e tissue wraps t h e

widens, h o w e v e r slightly. T h e r e is an increase

i n t e r f a c e b e t w e e n t h e h e a d o f t h e leg b o n e

in t h e space across t h e sacroiliac j u n c t i o n

(femur) and the hip socket (acetabulum), so

and a widening at the pubic b o n e (pubic

that t h e h e a d of t h e femur drops slightly out

s y m p h y s i s ) . As a result, t h e h i p b o n e s (gene-

o f t h e s o c k e t a n d d o w n w a r d . T h i s frees t h e

rally c o n s i d e r e d relatively i m m o v a b l e ) also

pelvis for t w o of t h e three m o v e m e n t s charac-

widen.

teristic of walking: rocking forward a n d back

In walking, we push off from the ground

a n d f r o m side t o s i d e . ( T h e t h i r d m o v e m e n t i s

u s i n g t h e j o i n t s i n t h e f o o t (Fig. 9-2). T h i s

swiveling, w h i c h results f r o m t h e f r e e d o m of

i n i t i a t e s m o v e m e n t i n t h e first s p l i t - s e c o n d ;

m o v e m e n t between sacrum and ilium).

m o v e m e n t is t h e n transmitted to the ankle.

A base of support is an u n m o v i n g surface

Above t h e ankle, t h e shin b o n e c o m e s for-

or structure f r o m w h i c h m o v e m e n t is initi-

w a r d w h i l e t h e h e e l b o n e slides b a c k w a r d ,

a t e d . Ideally, all p a r t s o f t h e b o d y are free t o

thereby increasing the horizontal space in the

respond to m o v e m e n t . But this is seldom

foot as well as t h e vertical space b e t w e e n foot

fully realized. M o r e often, in walking we con-

and ankle. O n c e again, this is m o v e m e n t by

tract s o m e part rather t h a n fully l e n g t h e n i n g .

lengthening. As the shin b o n e c o m e s forward,

T h e leg m a y b e pulled u p against t h e h i p

t h e r e m a i n d e r of t h e b o d y is propelled for-

joint; t h e hip m a y b e i m m o b i l i z e d a n d used

ward. Ideally, t h e resulting m o v e m e n t is

a s a n i n t e r n a l b a s e o f s u p p o r t . A s t h e leg i s

literally a falling forward of t h e w h o l e b o d y

pulled up, t h e hip joint is compressed, short-

—unless s o m e part of the b o d y is held back.

ened. T h e pattern of compression is trans-

In walking, and particularly in running,

mitted through the body. The most extreme

there is a great i m p a c t on t h e foot. T h e spaces

exaggeration of this kind of walking is the

between the bones of the foot widen and

goose step.

lengthen as the foot comes in contact with

J o g g i n g a n d r u n n i n g are a m a t t e r o f l e a n -

the ground; they narrow and arch as the foot

ing farther forward t h a n w h e n walking; you

lifts u p . N o t o n l y i s t h e r e l i n e a r e x t e n s i o n i n

adjust your speed in walking or running by

MOVEMENT

h o w far y o u l e a n f o r w a r d . T h i s i s t h e h a r d e s t

AND

GRAVITY

35

M a n y people have a t e n d e n c y to carry their

t h i n g f o r u s t o d o ; w e t e n d t o resist l e t t i n g

h e a d s as t h o u g h t h e y were i n d e p e n d e n t struc-

everything go forward. We bring t h e shoul-

tures. A m o r e workable image is to consider

ders b a c k , t h e ass b a c k , a n d / o r h a n g o n t o o u r

t h e skull a s a g r e a t b i g v e r t e b r a s i t t i n g o n t o p

s p i n e i n s o m e way, i n o r d e r t o h a v e a f e e l i n g

of t h e spine. This allows us to visualize h o w

of control. A c o m m o n exaggeration of this is

t h e h e a d c a n m o v e " i n l i n e " w i t h t h e rest o f

holding the body tensely upright as we walk

the spine. W h e n the m o v e m e n t of the spine

o r r u n , w i t h t h e r e s u l t t h a t t h e legs a r e i n

is like a s p r i n g , t h e h e a d is its last s e g m e n t .

front of t h e torso. T h e b o d y is t h e n literally

M o v e m e n t reverberates t h r o u g h the spine

leaning backward.

a n d is released t h r o u g h m o v e m e n t of t h e

In m o v i n g with length, as m o v e m e n t is

head. Holding anywhere in t h e structure

initiated, the joints open (lengthen) spon-

reflects m o s t strongly at t h e ends of t h e

t a n e o u s l y a n d s e q u e n t i a l l y . First t h e a n k l e

body—between the ankle and heel and

opens. As it reaches the proper limit, the knee

between the head and neck. Holding can

joint opens, and so on. Insofar as the joints

also originate at t h e t o p e n d . Almost uni-

are free t o o p e n , t h e m o v e m e n t o f w a l k i n g

versally, w h e n w e t h i n k o f s o m e t h i n g o r

ripples all t h e w a y t h r o u g h t h e b o d y t o t h e

c o n c e n t r a t e i n a n y way, w e h o l d our h e a d s

head.

rigidly. T h i s h o l d i n g t r a v e l s d o w n t h r o u g h t h e s p i n e a n d i n t o t h e legs, r e s u l t i n g i n a n audibly heavier tread. W h e n t h i n k i n g (which is most of the time), we c o m e down heavily on our heels. In day-to-day living, we d o n ' t t h i n k about m o v e m e n t in anatomical terms. A m o r e accessible c o n c e p t has to do with controlled/ allowed m o v e m e n t . H o l d i n g t h e h e a d rigidly on t h e n e c k is c o n t r o l . This kind of rigidity is

Figure 9-1 Rising

a l m o s t always a response to u n c o n s c i o u s fear: w e a r e a f r a i d o u r h e a d w i l l fall o f f , w e a r e afraid t h a t we will be so jarred t h a t our h e a d will be seriously disturbed, we're a l m o s t afraid our brains will get rattled. W h e n w e w a n t t o focus on something, most of us automatically f e e l a s t h o u g h w e h a v e t o h o l d still. W e a r e afraid we will lose t h e i m a g e . T h i s h a p p e n s w h e n we are visualizing i n t e r n a l l y ( l o o k i n g at t h e pictures inside our head) as well as w h e n we are seeing externally. It is a m i s u s e of our abilities, yet it is very c o m m o n . T h e other end of this c o n t i n u u m is allowed movement. We can be confident that as we walk our brains will n o t b e rattled. W e c a n

Figure 9-2 Walking.

b e s u r e t h a t w e c a n see t h e w o r l d i n m o v i n g p i c t u r e s . W e all are a b l e t o see a n d u n d e r s t a n d

36

THE

ENDLESS

WEB

movies even though they show a new frame

t h e leg a n d c o n t r o l r o t a t i o n b e t w e e n t h e

twenty-four times a second. We don't have

two bones as the foot moves. T h e density

t o h o l d e a c h f r a m e still i n o r d e r t o see it. W e

a n d a r r a n g e m e n t o f t h e fibers a s w e l l a s t h e

don't need to control every aspect of our

physical nature of t h e intercellular matrix

m o v e m e n t ; w e n e e d t o let ourselves m o v e

m u s t b e d i f f e r e n t , t o g i v e t h e n e c e s s a r y dif-

a n d a b s o r b a n d let g o . T h e idea that structure determines f u n c t i o n i s a n o l d o n e . Ida R o l f g a v e e x p a n d e d m e a n -

ference in compressor ability (resistance to compression). We exist in gravity—we have weight and

ing t o t h e reverse c o n c e p t — t h a t f u n c t i o n

w e rest o n t h e s u r f a c e o f t h e E a r t h . I n g e n e r a l ,

determines structure. Using the connective

a body's o n l y g o o d c h o i c e with respect to

tissue m o d e l , we c a n elaborate h o w parts of

g r a v i t y i s v e r t i c a l i t y . T h e c o n c e p t is, h o w e v e r ,

t h e b o d y t h a t are a n a l o g o u s structurally (arms

merely a useful abstraction. Because t h e body

a n d legs) a r e f u n c t i o n a l l y d i f f e r e n t . T h e differ-

is c o n s t a n t l y m o v i n g , there is rarely static

e n c e lies i n t h e w a y t h e l i m b s a t t a c h t o t h e

verticality.

trunk, reflecting a difference in n e e d a n d use.

Bodies also d o n ' t m o v e straight forward.

I n t h e leg, a t t a c h m e n t s a r e p r i m a r i l y f o r l i n -

E v e r y g e s t u r e i s o n a d i a g o n a l , a n d t h e s e diag-

ear tracking. T h e r e is t h e n e e d for t h e leg to

o n a l s are b a l a n c e d . It is this b a l a n c e a m o n g

go forward a n d b a c k a n d for t h e joints of t h e

c r o s s - m o v e m e n t s t h a t c r e a t e s f u n c t i o n a l ver-

leg t o m o v e w i t h o u t excess r o t a t i o n . I n t h e

t i c a l i t y i n t h e m o v i n g b o d y . For e x a m p l e , i n

arm and shoulder, t h e primary need is for

walking, o n e leg a n d h i p c o m e forward t o -

r o t a t i o n a s w e l l a s f o r m o b i l i t y i n all t h e

gether with the opposite shoulder and arm

joints. T h i s is a very different kind of

w h i l e t h e o t h e r leg a n d h i p w i t h t h e o p p o s i t e

lengthening.

arm and shoulder balance backward. There is

T h e o r g a n i z a t i o n o f t h e c o n n e c t i v e tissue

always this kind of reciprocal m o v e m e n t tak-

i n t h e legs t h e r e f o r e n e e d s t o b e d i f f e r e n t

ing place a r o u n d t h e central axis of t h e body.

f r o m t h a t o f t h e a r m . I n t h e leg, i t i s s t r u c -

Turning the b o d y is initiated from the base

tured for stability; in t h e a r m , it is m o r e elas-

of support which, in walking, is mediated

tic for flexibility. T h e shoulder blade a n d

t h r o u g h t h e feet. T h e r e must therefore be

c o l l a r b o n e ideally float freely in t h e c o n n e c -

e n o u g h elasticity of action at t h e ankle joint

t i v e t i s s u e , w h i l e t h e h i p b o n e a n d leg are

and between the foot b o n e s to allow not only

m o r e closely knit. In m a n y m o v e m e n t s , the

for b e n d i n g at t h e j o i n t but also for rotation

a r m a c t s i n r e s p o n s e t o t h e rest o f t h e b o d y

so as to m o v e quickly and smoothly from

w h i l e t h e legs i n i t i a t e m o v e m e n t . T h e t ' a i

o n e side t o t h e other.

c h i c o n c e p t i s t h a t t h e a r m s f l o w like r i b b o n s

W i t h s o m e c a u t i o n , w e use t h e a m b i g u o u s

after m o v e m e n t has b e e n initiated in t h e

word " c o r e " for t h e body's central axis. It is

legs a n d p e l v i s .

a n o t h e r u s e f u l a b s t r a c t i o n ; t h e r e i s n o struc-

We believe that there is a difference in t h e

tural correlate for this core. T h e b a l a n c e d

c o m p o s i t i o n of t h e c o n n e c t i v e tissue in t h e

diagonals of the limbs function best in c o m -

legs a n d t h e a r m s , p a r t i c u l a r l y i n s t r u c t u r e s

b i n a t i o n w i t h t h e free spring a c t i o n o f t h e

like t h e i n t e r o s s e o u s m e m b r a n e s o f t h e f o r e -

core. We have discussed the spring action of

a r m a n d l o w e r leg. I n t h e a r m , t h e i n t e r o s -

the spine. T h e concept of a core includes both

seous m e m b r a n e needs to be elastic so that

spine (with head, sacrum, and coccyx) and

the b o n e s can rotate with the multidirectional

t h e viscera. There is reason to believe that the

u s e o f t h e h a n d . I n t h e l o w e r leg, t h e i n t e r -

c o n n e c t i v e tissue of t h e organs is also a part

osseous m e m b r a n e must be denser to support

of movement. This can be demonstrated in

MOVEMENT

AND

GRAVITY

37

dissection a n d is visible in behavior. T h e viscera themselves, t h e n , also h a v e a spring action that helps to organize m o v e m e n t in t h e b o d y as a w h o l e . T h e literal c e n t r a l a x i s o f t h e b o d y t r a v e l s through t h e viscera, n o t t h r o u g h t h e spine (Fig. 9-3). A s t o m a c h a c h e , a h e a r t s p a s m , hemorrhoids, a s t h m a — a l l deflect t h e b o d y from verticality as m u c h as or m o r e t h a n a m u s c l e s p a s m or a r o t a t e d v e r t e b r a . F u n c t i o n a l l y , t h e n , t h e v i s c e r a are i n c l u d e d i n t h e c o r e s t r u c t u r e a n d are a d e t e r m i n a n t o f verticality. Even w h e n the primary m o v e m e n t is straight forward, such as walking across an u n i m p e d e d floor, t h e j o i n t s o f s u p p o r t i n t h e b o d y still n e e d t o b e f r e e t o r o t a t e s l i g h t l y . T h e clearest e x a m p l e of this (and t h e largest rotation in walking in a straight line) is in t h e connection between the sacrum (the base of t h e spine) and t h e two b o n e s o f t h e hip. T h e sacrum remains relatively stable as t h e two hip bones rock with each m o v e m e n t of the leg. T h e m o v e m e n t i s a l m o s t like a figure eight, absorbing a n d a c c o m m o d a t i n g t h e swivel a c t i o n a s o n e leg a n d t h e n t h e n e x t

Figure 9-3 Central axis of the body.

r e a c h e s t h e floor. ( T h i n k o f M a r i l y n M o n r o e o n h e r w a y a c r o s s t h e floor. T h i s i s a n e x a g -

b e c o m e s f u n c t i o n a l l y lighter. T h e muscles o f

geration, b u t it is graphic.)

the back of the neck and the shoulders can

W h e n w e a r e s t a n d i n g m o r e o r less still, i f w e are i n a l i g n m e n t , o u r w e i g h t i s c o m f o r t -

t h e n start t o r e l a x . T h e c o n c e p t of gravity is particularly

a b l e a n d w e n e e d less e f f o r t t o k e e p o u r s e l v e s

appropriate to a m o v i n g body. The b o d y

u p r i g h t . I n s t a n d i n g still, t h e c o n c e p t o f

i n m o t i o n i s still a l i g n e d — t h e h e a d i s i n l i n e

weight is a g o o d w a y of analyzing structure.

w i t h t h e shoulders, t h e shoulders are i n line

T h e classic e x a m p l e h a s t o d o w i t h t h e posi-

with the a b d o m e n , the a b d o m e n is in line

t i o n o f t h e h e a d . I f t h e h e a d i s t o o far f o r w a r d

w i t h t h e pelvis, t h e pelvis is in line w i t h t h e

— t h a t is, i f t h e c h i n o r f o r e h e a d i s l e a d i n g t h e

k n e e s — n o m a t t e r h o w far o r i n w h a t d i r e c -

rest o f t h e b o d y — t h e n i t i s n o t s u p p o r t e d b y

tion the body leans. T h e exception is the o n e

the neck. It is cantilevered. Since the head

leg t h a t i s forward t o p r e v e n t t h e b o d y f r o m

weighs somewhere between ten and fifteen

falling. W h e n t h e leaning b o d y is in align-

p o u n d s , w e m u s t t h e n use t h e large m u s c l e s

m e n t , this forward foot is directly under the

in t h e back of t h e shoulders a n d n e c k literally

h e a d (Fig. 9-4). T h e s u p p o r t f o r t h e h e a d i s

to hold o n t o our heads. As soon as the head

t h e forward foot. Gravity t h e n acts t h r o u g h

is m o v e d b a c k i n t o a p o s i t i o n w h e r e it is

the b o d y in the w h o l e space that it occupies,

centered on and supported by the neck, it

a broad base b e t w e e n t h e t w o feet.

38

THE

ENDLESS

WEB

placement of the organs is asymmetrical. Further, it seems possible that differences in brain function engender asymmetrical movem e n t preferences resulting in structural asymm e t r y . T h e s e n o r m a l d i f f e r e n c e s are s l i g h t a n d , ideally, i t i s p o s s i b l e t o v i s u a l i z e h o r i zontal lines through the body. T h e r e is a further m e a s u r e of proper alignm e n t . This is the relationship of the deep to t h e m o r e superficial structures, t h e b a l a n c e b e t w e e n surface tissue a n d tissue t h a t is close to t h e b o n e . This is visible in t h e surface Figure 9-4 Walking.

contour. W h e r e there is excessive knotting or flabbiness, there is this kind of surface-todeep tissue i m b a l a n c e .

In l o o k i n g at t h e c o n n e c t i v e tissue arrange-

W h e n i n n e r a n d o u t e r s t r u c t u r e s are i n

m e n t in dissections of h u m a n bodies, we

b a l a n c e , t h e tissue h a s w h a t we call proper

n o t e d t h a t there was s e l d o m a linear (vertical

t o n e , m u c h t h e way a violin string that is

or horizontal) arrangement of connective

i n p e r f e c t t e n s i o n h a s p e r f e c t p i t c h . All t h e

t i s s u e fibers o n t h e s u r f a c e o r d e e p w i t h i n

w o r d s w e u s e t o d e s c r i b e t i s s u e t o n e are s u b -

the body. T h e fibers tended to run diagonally

j e c t i v e — t h e y have to do w i t h personal experi-

across t h e b o d y . For i n s t a n c e , we saw a h e a v y

e n c e r a t h e r t h a n o b j e c t i v e s t a n d a r d s . Yet g o o d

c o n c e n t r a t i o n o f f i b e r s g o i n g f r o m o n e side

t o n e is s o m e t h i n g we all r e c o g n i z e . It is a

o f t h e c h e s t a c r o s s t o t h e o p p o s i t e side o f

springiness to t h e t o u c h and suppleness in

the a b d o m e n and down to the opposite hip.

movement.

Fascial crisscrosses seen in dissection s e e m to

Vertical integrity a n d g o o d t o n e are our

relate to t h e n o r m a l rotations in a m o v i n g

measures of a properly aligned body. W h a t

body. W h e n crisscrosses h a v e h e a v y c o n c e n -

g e t s i n t h e w a y o f t h i s i d e a l s t r u c t u r e ? For Ida

t r a t i o n s of fat a n d gristle, this is t h e excessive

Rolf, t h e b a l a n c e o f t h e p e l v i s w a s p a r a m o u n t .

response of a b o d y that is n o t in alignment.

S h e f e l t t h a t e v e r y s e s s i o n i n R o l f i n g h a s a s its

M a n y of these padded oblique angles can be

ultimate goal the creation of better balance in

s e e n o n t h e s u r f a c e o f t h e b o d y . T h e y are u s u -

t h e pelvis. This has to do with t h e relations of

a l l y f o l d s , f r e q u e n t l y f o l d s t h a t p e o p l e refer t o

the hip b o n e (ilium), the sacrum, and the

a s fat t h a t t h e y c a n ' t g e t rid o f . B u t t h e y a r e

lower back (lumbar) vertebrae. These relations

actually heavier b a n d s of c o n n e c t i v e tissue,

are n o t s i m p l e . T r o u b l e — p a i n , awkwardness,

usually a response to a b n o r m a l rotation of

stiffness, heaviness—is a product of misalign-

the b o d y in m o v e m e n t . In an aligned body,

m e n t (rotation) of any one of these elements

o b l i q u e fascial structures are n o t r a n d o m .

with respect to another. In the pelvic region,

T h e y are n e c e s s a r y for n o r m a l m o v e m e n t .

t h e h i p b o n e c a n b e r o t a t e d i n its r e l a t i o n t o

T h e o b l i q u e s o n t h e f r o n t o f t h e b o d y are

t h e s a c r u m o r t h e leg b o n e . T h e sacrum c a n

in balance with those on the back.

be rotated with respect to the lumbar spine

Seen from the front, a well-aligned person

or the tailbone or the hip bone. There may be

s h o u l d a p p r o a c h s y m m e t r y , b u t w e are n e v e r

further rotations between individual lumbar

entirely s y m m e t r i c a l . For o n e t h i n g , t h e

vertebrae.

MOVEMENT

W h e n w e speak o f t h e rotation o f b o n e s

AND

GRAVITY

f r o n t or b a c k , s c o l i o s i s is a s i d e w a y s S - s h a p e d

w i t h r e s p e c t t o e a c h o t h e r , w e are t a l k i n g

b e n d in the spine, w h i c h should be m o r e or

about the " h o m e " position of the b o n e . This

less s t r a i g h t i n t h i s v i e w .

is the position that the b o n e returns to w h e n

39

Scoliosis a n d lordosis are clinical t e r m s

i t i s a t rest. I n m o v e m e n t t e r m s , t h e r e s t r i c -

that identify spinal exaggerations. In using

t i o n w o u l d b e n o t i c e a b l e a s a loss o f r a n g e o f

t h e terms, we speak as t h o u g h t h e i m b a l a n c e

m o v e m e n t . All o f t h e s e i m b a l a n c e s b e t w e e n

were solely or m o s t l y c o n f i n e d to t h e spine.

b o n e s are m a i n t a i n e d b y t h e s o f t t i s s u e — m u s -

But a scoliosis is manifestly an i m b a l a n c e of

cle, l i g a m e n t , c o n n e c t i v e tissue. T h e d i s c o m -

t h e b o d y a s a w h o l e . A r m s , legs, h e a d , p e l v i s ,

f o r t w e feel arises f r o m o u r a w a r e n e s s o f s o f t

a n d rib c a g e are all p a r t o f t h e a b e r r a t i o n . W e

tissue t e n s i o n r a t h e r t h a n b o n e i m b a l a n c e .

c a n ' t e v e n say t h a t t h e spine is w h a t is h o l d -

Rotation is a c o m b i n a t i o n of tilting a n d

ing the body in the scoliotic posture. Our

swiveling of b o d y parts, creating i m b a l a n c e s

e x p e r i e n c e as Rolfers is t h a t w h e n we release

in the vertical a n d horizontal planes. Here we

t h e t i s s u e o f a r m s o r legs o r r i b c a g e , t h e s p i n e

e n c o u n t e r an interesting difficulty in translat-

starts t o u n w i n d . C o n v e r s e l y , t h e s p i n e w i l l

ing f r o m t h e visual to t h e verbal. Seen in pro-

n o t u n w i n d u n t i l e x t e r n a l structures are given

file, e x c e s s i v e p e l v i c tilt t h r o w s o f f t h e v e r t i c a l

greater range of m o v e m e n t . So we prefer to

l i n e . S e e n f r o m t h e f r o n t (or t h e b a c k ) , a p e l -

speak of curvatures of t h e b o d y as a w h o l e

v i c tilt t h r o w s o f f t h e h o r i z o n t a l l i n e a c r o s s

rather t h a n curvatures of the spine.

t h e body. Images are t w o - d i m e n s i o n a l ; t h e

T h e r e are o t h e r f a c t o r s i n v o l v e d i n i d e a l

body is three-dimensional. The combination

structural vertical a n d horizontal a l i g n m e n t .

of vertical a n d horizontal tilting in t h e b o d y

F o r e x a m p l e , if a p e r s o n w i t h a f a i r l y b r o a d

is w h a t we c a l l r o t a t i o n , a spiral t w i s t .

pelvis stands w i t h his feet t o o close together,

There is a welter of t e r m i n o l o g y used to

he's obviously n o t going to be in easy bal-

describe t h e various types of rotation of t h e

a n c e . He'll have to t i g h t e n s o m e part of his

p e l v i s / s a c r u m / l u m b a r spine area. T h e y are

body to keep himself upright—grabbing with

precise as diagnostic tools, but u n f o r t u n a t e l y

t h e toes, locking his knees, tightening t h e

t h e y t e n d to confuse t h e situation for m o s t

buttocks, and/or contracting the shoulders.

of us. Diagnosis attempts to identify t h e m o s t

If his feet are slightly farther apart, t h e y c a n

p r o m i n e n t aspect of a problem. We a n d our

b a l a n c e t h e b r o a d p e l v i s . T h e t w o legs a r e

d o c t o r s say, "I h a v e a l o r d o s i s ( s c o l i o s i s ,

f u n c t i o n a l l y a unit, a base for e v e r y t h i n g

kyphosis)." But these terms tend to lock the

above t h e m . Adequate width and depth of

b o d y i n t o a static picture. W h a t we n o t i c e so

t h e body, as well as free range of m o t i o n ,

o f t e n is t h a t rotations are n o t static, t h e y d o n ' t

are all a p a r t o f e v a l u a t i o n o f s t r u c t u r e .

stay p u t . For e x a m p l e , t h e d a n c e r w i t h t o o

The h u m a n body is obviously an enclosed

c o n c a v e a l u m b a r curve in standing will o f t e n

system. We exist w i t h i n t h e circumference of

show an exaggerated c o n v e x curve in sitting.

our skin a n d fascia. T h e h e a d is t h e opposite

W h a t are t h e s e t e c h n i c a l t e r m s , a n d h o w do t h e y relate to our c o n c e p t of b o d y align-

e n d of a t e n s i o n line f r o m t h e feet. Proper length and extension within that circumfer-

m e n t ? Seen f r o m t h e side, lordosis is an exag-

e n c e allows for adequate t o n e t h r o u g h o u t .

geration of the n o r m a l curves of the spine.

This leads us b a c k to t h e circular c o n c e p t

(There seems to be no medical t e r m i n o l o g y

that we have talked about in reference to

f o r a b a c k t h a t i s t o o flat, e v e n t h o u g h t h i s

other aspects of balance. Cause a n d effect

can create a lot of mischief.) Seen f r o m t h e

in the body b e c o m e interrelated.

TEN

Body Contour

W h e n we look at the contour of the whole

A p h o t o g r a p h of a b o d y s h o w s s h a d o w s

b o d y , w e c a n see i t a s a m a p o f t h e u n d e r l y i n g

a n d h i g h l i g h t s t h a t c a n be seen as hills a n d

structures as t h e y affect t h e c o n n e c t i v e tissue

v a l l e y s (Fig. 10-1). T h e r e are areas w h e r e t h e

bed. Muscles expand and contract in response

t i s s u e b u l g e s a n d areas w h e r e i t a p p e a r s t o b e

t o d e m a n d . Habits lay d o w n pads, s o m e t i m e s

h e l d d e e p . H i g h l i g h t s (hills) c o r r e s p o n d t o

c o n t a i n i n g fatty accumulations. T h e position

t h i c k e n e d pads of tissue b e t w e e n skin and

o f b o n e s w i t h i n m u s c l e a n d c o n n e c t i v e tissue

b o n e ( a n d / o r m u s c l e ) . T h e s e p a d s are o f t e n

controls the direction of m o v e m e n t . Volition,

m a d e up of fatty tissue in association with

habit, a n d self-image shape the connective

f i b r o u s c o n n e c t i v e t i s s u e . T h e s h a d o w s (val-

tissue, w h i c h in t u r n supports a n d restricts

leys) a p p e a r t o b e a r e a s w h e r e s k i n a l m o s t

the activity of muscle, b o n e , and other func-

sticks to b o n e ( a n d / o r m u s c l e ) . W h a t is creat-

tions such as circulation, breathing, and

ing these adhesions seems to be a compacted

digestion. T h e result is a person's s h a p e .

b e d o f c o l l a g e n fibers m i x e d w i t h i n t e r c e l l u l a r

The contour of the body is based on connective tissue. As it interacts with b o n e s a n d

m a t r i x i n its gel s t a t e . B o t h o f t h e s e modifiers o f c o n t o u r reflect

m u s c l e s , t h e s e soft tissues are t h e p r i m a r y

t h e w a y t h e b o d y i s u s e d . H e a v y fat a n d c o n -

determinant of body shape. This is in contrast

n e c t i v e t i s s u e p a d s are v i s i b l e i n areas t h a t

t o t h e u s u a l artist's c o n c e p t i o n o f m u s c l e

h a v e b e e n u n d e r t e n s i o n for a lifetime. T w o

anatomy as determining the outline of the

p a d s t h a t are p r e s e n t i n a l m o s t all b o d i e s are a

body. Body shape is therefore affected by the

v e r y h e a v y t h i c k e n i n g a t t h e b a s e o f t h e skull

holding patterns that we have described.

a n d a heavy pad at t h e base of the spine, over

Figure 10-1 Body contour tells us a lot about the condition of the underlying connective tissue and its potential for movement. Here are photographs of three very different body types. Intuitively we have expectations of how these bodies will move.

t h e t o p o f t h e b u t t o c k s (Fig. 10-2). M u s c l e s a r e o v e r u s e d i n t h e s e t w o a r e a s . T h e large, b r o a d m u s c l e a t t h e b a s e o f t h e skull (trapezius) i s i n c o n s t a n t p a r t i a l c o n t r a c t i o n t o s u p port a forward head. T h e upper margin of the gluteus m a x i m u s habitually contracts to hold

BODY

CONTOUR

41

t h e p e l v i s rigid. C h r o n i c t e n s i o n h a s r e s u l t e d in a h e a v y pad on t h e b o d y surface. I n d e n t a t i o n s are likewise visible in areas that have b e e n u n d e r t e n s i o n for a lifetime. T h e b o n e appears to be right at t h e i n d e n t e d surface, just u n d e r t h e skin. Actually, t h e b o n e lies u n d e r several layers o f t o u g h e n e d c o n n e c t i v e tissue. T h e skin sticks to t h e leathe r y (or glassy) c o n n e c t i v e t i s s u e . O n t h e o t h e r h a n d , where t h e c o n n e c t i v e tissue layer over b o n e is in good t o n e , t h e skin c a n m o v e freely over b o n e a n d tissue. We never actually t o u c h b o n e in palpating t h e body. There is always a c o n n e c t i v e tissue l a y e r o f g r e a t e r o r lesser c o m p l e x i t y b e n e a t h t h e skin. C o n t o u r is idiosyncratic e v e n at birth. In a detailed dissection on t w o stillborn infants, there was a considerable difference in m u s c l e development. In one, the musculature of the b o d y was relatively undeveloped, while in t h e o t h e r t h e pattern was well defined a n d visible

Fat& "connective tissue pad

Figure 10-3 This is a photograph of a dissection of a stillborn baby at term. The heavy pad of fat over the gluteal region was a thick mass of connective tissue containing fat. Note the similar padding across the shoulders and up into the neck. d o w n to t h e tiniest muscle. However, t h e patterns of c o n n e c t i v e tissue padding in t h e t w o

.Trapezius m.

b a b i e s w e r e i n m a n y w a y s s i m i l a r (Fig. 10-3). In b o t h , there was a heavy pad of fibrous c o n nective tissue across t h e upper posterior bor-

Erector spinae m. Fat& -.connective tissue pad .Gluteus maximus m.

der o f t h e large h i p b o n e s , crossing over a n d tying the hip bones to the sacrum. There were also pads of fatty c o n n e c t i v e tissue b e t w e e n t h e legs ( b e t w e e n t h e r e g i o n o f t h e a n u s a n d t h e genitals). These pads were thick, s o m e w h a t like a diaper b e n e a t h t h e skin. T h e presence of this padding at birth would indicate t h a t it is a n o r m a l part of b o d y c o n t o u r . It is only w h e n it is overdeveloped and thickened t h a t it b e c o m e s a p r o b l e m . We tend to think that heavy muscle is good

Figure 10-2 Fat and connective tissue pads.

a n d that the more a muscle is developed, the better off we are. Overdeveloped m u s c l e s l o o k

42

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impressive, b u t t h e y t e n d t o reduce free range

a n d therefore c a n n o t m o v e straight forward

of m o v e m e n t . This is because the pumped

a n d b a c k w a r d (Fig.

muscle is contracted, resulting in compression

ing is c o m b i n e d with stretching and body

a n d s h o r t e n i n g at t h e joints. For b a l a n c e , a

a w a r e n e s s (e.g. y o g a ) , i t i s s o m e t i m e s p o s s i b l e

heavy muscle needs another equally heavy

to maintain adequate freedom of movement

m u s c l e t o o f f s e t its c o n t r a c t i v e n e s s . W h e r e

in the joints along with development of the

there has b e e n m o r e persistent effort at m u s -

muscle mass.

c l e b u i l d i n g o n o n e side o f t h e j o i n t t h a n t h e other, t h e j o i n t torques (twists).

10-4). W h e r e b o d y b u i l d -

A reasonable a m o u n t of bodybuilding is a good thing, creating t o n e and strength.

A bodybuilder w h o conscientiously works

T o o m u c h of a g o o d t h i n g in this case causes

o n all o f t h e m u s c l e s c a n a c h i e v e a b a l a n c e o f

restriction and exacerbates preexisting habit-

tightness around individual joints. This bal-

ual distortions. Excessive d e m a n d on a b o d y

a n c e is based on partial c o n t r a c t i o n ; it will be

part always brings out whatever c o m p e n s a -

functional as long as t h e program of exercise

t i o n s or restrictions already exist in t h e part.

is m a i n t a i n e d . But w h e n such a person walks,

This is true for p u m p i n g iron, working out

he or she ends up with a kind of waddle. T h e

on m a c h i n e s , r u n n i n g or jogging, or ballet.

leg i s n o t able t o l e n g t h e n o u t o f t h e j o i n t

Unless there is modification of t h e exercise to a c c o m m o d a t e individual idiosyncrasies, there will e v e n t u a l l y b e p r o b l e m s . I n a d d i t i o n , c h a l l e n g i n g w o r k o u t s are generally associated

Proportionately small head

w i t h exercising past t h e p o i n t of efficiency.

Short neck

This is where most of the mischief occurs. It is virtually impossible n o t to create chronic Arms pulled into shoulders

a n d / o r acute injury w h e n repeatedly exercisi n g i n a n e x h a u s t e d s t a t e . O u r a d v i c e i s t o let pleasure be your guide. How m a n y people

Shortened torso

have you seen smiling while running? Arms go wide

T h e c o n c e p t s o f c o n t o u r a n d posture overl a p a n d b l e n d i n t o e a c h o t h e r . B o t h are t h e result of habitual h o l d i n g patterns. Posture is apparent in t h e static p h o t o g r a p h as overall

Legs pulled into pelvis Legs go wide

b o d y balance or imbalance. From t h e front, w e see i m b a l a n c e w h e n o n e s h o u l d e r i s higher t h a n the other, o n e arm longer than t h e o t h e r , o n e side o f t h e h i p c a n t e d u p w a r d , o n e knee tending more in or out. From the side, w e h a v e already m e n t i o n e d t h e deviations f r o m vertical such as the head forward, shoulders up or r o u n d e d , chest depressed, pelvis tipped forward or tucked back. O n e of t h e great d e t e r m i n a n t s of posture

Figure 10-4 The muscle development of this body looks impressive, but that muscle bulk is a major impediment to freedom of movement.

i n t h e b o d y i s t h e p s o a s m u s c l e . Its c o n n e c t i v e t i s s u e r a m i f i c a t i o n s are e s p e c i a l l y i m p o r tant. T h e psoas myofascia is interwoven with t h e fascia o f t h e muscles o n t h e inside o f t h e

BODY

CONTOUR

43

pelvis a s w e l l a s w i t h t h e d i a p h r a g m f a s c i a .

pelvic b ri m, chronically flexes t h e b o d y at

I n t h e g r o i n a r e a , j u s t t o t h e side o f t h e p u b i c

t h e level of t h e groin, so t h a t it p r e v e n t s truly

b o n e , the direction of t h e psoas changes. This

erect posture."*

allows it to act as a k i n d of pulley. T h e psoas

T h e preferences o f t h e psoas are n o t obvi-

tendon attaches to the femur at the top of the

o u s a t b i r t h . T h e y start t o s h o w w h e n t h e legs

inner thigh and is thus c o m m o n l y bound up

adjust to bearing weight, as t h e child crawls

w i t h t h e fascia o f t h e l o n g e r m u s c l e s g o i n g

a n d starts t o s t a n d u p . Nevertheless, m u s c u l a r

d o w n t h e leg.

imbalances do exist in t h e n e o n a t e . As we

W h e n the psoas is habitually contracted,

h a v e said, c h i l d r e n a r e b o r n w i t h m o r e d e v e l -

all k i n d s o f p o s t u r a l a n d f u n c t i o n a l d i f f i c u l -

oped muscle in back t h a n in front. At about a

ties c a n arise. T h e p s o a s c a n b e t o o s h o r t , t o o

year old, in order to walk, t h e child has s o m e -

wide, t o o narrow, t o o flaccid. Moreover, e v e n

h o w to solve the p r o b l e m i n h e r e n t in this

t h o u g h centrally located in the body, it is

muscular a n d c o n n e c t i v e tissue i m b a l a n c e .

a b i l a t e r a l m u s c l e . T h e t w o sides a r e r a r e l y

O n e fairly c o m m o n s o l u t i o n i s t o o v e r u s e t h e

s y m m e t r i c a l i n t o n e , p l a c e m e n t , a n d size. A

psoas, pulling the lumbar vertebrae forward.

physically asymmetrical psoas t h e n leads to

This is the origin of the typical big-bellied

l u m b a r r o t a t i o n s a n d p e l v i c tilts (Fig. 10-5).

baby look.

A c c o r d i n g t o Ida Rolf, t h e p s o a s i s o n e o f

I m m a t u r e b o d y patterns f r e q u e n t l y persist

the most significant muscles of the body. It maintains body structure a n d b o d y relations h i p s (Fig.

10-6A and 6B). T h e p s o a s o r i g i -

*Ida P. Rolf, Rolftng: The Integration of Human Structures (New York: Harper & Row, 1 9 7 7 ) , p. 1 1 0 .

nates along t h e upper l u m b a r spine; for part o f its l e n g t h i t r u n s a l o n g t h e f r o n t s u r f a c e o f

Lateral pelvic tilt

t h e l u m b a r v e r t e b r a e . Its o r i g i n i s i n c l o s e proximity to the two tabs of the diaphragm called t h e crura; t h r o u g h these n e i g h b o r s , t h e psoas c a n involve t h e respiratory pattern. It diagonally traverses t h e cavity of t h e pelvis, a n d i n s e r t s b y a t e n d o n s h a r e d w i t h t h e iliac u s ( t h e i l i o p s o a s t e n d o n ) i n t o t h e lesser t r o c h a n t e r of t h e femur. T h e iliacus lines t h e i l i u m , t h e large b o n e o f t h e p e l v i c b a s i n . S t r u c t u r a l l y , t h e p s o a s is a b r i d g e b e t w e e n

Psoas ' longer lax Psoas shortened;, pulls pelvis up

u p p e r b o d y a n d legs. "If a b o d y is n o r m a l , t h e psoas should e l o n g a t e d u r i n g f l e x i o n a n d fall b a c k t o w a r d the spine. This prevertebral support ensures l e n g t h i n t h e l u m b a r s p i n e a s a w h o l e , irrespective of general b o d y position. W i t h t h e psoas f u n c t i o n i n g in this n o r m a l pattern, lengthening with every m o v e m e n t of flexion, t h e l u m b a r v e r t e b r a e c a n n o t slip i n t o t h e compression and misalignment that is the beginning of t h e bad lower back. A deteriorated psoas, glued d o w n as it crosses t h e

Figure 10-5 A physically asymmetrical psoas leads to lumbar rotations and pelvic tilts.

44

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the psychological pattern tends to change as t h e physical structure is able to evolve. On t h e other h a n d , physical culture experts a t t e m p t to m o d i f y structural patterns by building up muscle mass. A familiar example are all t h o s e e x e r c i s e s d e s i g n e d t o " t i g h t e n t h e t u m m y . " It is our c o n t e n t i o n that it is n o t effective to shorten t h e belly muscles to m a t c h the tight back muscles. We believe that n o a m o u n t o f s i t - u p s will i m p r o v e a s t r u c t u r e w h o s e k e y is a c o m p u l s i v e l y t i l t e d p e l v i s . Moreover, no physical p r o b l e m exists in isolation, so we c a n n o t ameliorate structure by f o c u s i n g o n o n e s y m p t o m . For e x a m p l e , t h e r e are t w o typical h o l d i n g patterns reinforcing a b e l l y t h a t sticks o u t . O n e i s a d e p r e s s i o n o f t h e rib a r c h ( c o s t a l a r c h ) . T h e o t h e r i s a n i m m o b i l i t y at the groin (inguinal) region. T h e s e start t o d e v e l o p i n t h e s m a l l c h i l d . T h e y t o o a r e e x a c e r b a t e d a s t h e c h i l d starts t o w a l k . B o t h of these patterns would be reinforced r a t h e r t h a n c o r r e c t e d w i t h i m p r o p e r sit-ups. A n o t h e r e x a m p l e of a c o m m o n postural Figure 10-6A This masterly drawing by John Lodge has been taken from Ida Rolf's book on Rolfing. It shows the iliopsoas and its associated muscles.

set i s f o c u s e d a t t h e b a s e o f t h e n e c k ( s e v e n t h c e r v i c a l v e r t e b r a ) . A t its e x t r e m e , t h e h e a d i s p u s h e d v e r y far f o r w a r d . T h e s h o u l d e r b l a d e s are so h i g h t h a t it a l m o s t looks as t h o u g h t h e y are p u s h i n g t h e h e a d forward, cantilev-

into adulthood. T h e y intensify to pervade the

ering it out over t h e chest. A variation of this

b o d y a n d t h e personality o f t h e adult. Start-

pattern is often seen in older w o m e n and

ing with the work of W i l h e l m Reich,* there

m e n . T h e " d o w a g e r ' s h u m p " i s t h e result o f

has b e e n t h e t e n d e n c y t o classify characteris-

creating an excessive pad at the base of the

tic b o d y postures in clinical terms. Reich clas-

neck.

sifications were hysteric, psychotic, schizoid.

Like t h e folds of a curtain, w h e n t h e h e a d

T h e basis for these types is considered to be

is forward, everything in t h e b o d y appears to

b o d y a r m o r i n g , w h i c h is w h a t we call h o l d i n g

h a n g from the base of the neck. There is no

patterns. Psychological treatment of character

way this posture can be corrected by simply

a r m o r i n g is designed to release these patterns.

"holding your head u p . " It is too hard to hold

We prefer n o t to classify physical habits in

y o u r h e a d up; y o u will stop t h e effort as s o o n

psychological terms. Our assumption is that

as your attention is deflected from bettering your posture. To get t h e n e c k straight, you

*See W i i l h e l m Reich, Character Analysis (New York: N o o n d a y Press, 1 9 9 0 ) , p. 7 2 .

m u s t exert c o n s t a n t effort to pull against d e p r e s s e d ribs a n d c o l l a r b o n e . Y o u m u s t p u s h

BODY

CONTOUR

45

against h u n c h e d or rounded shoulder blades. E v e n a s s u m i n g y o u c o u l d d o all t h a t , t h e r e are f u r t h e r h o l d i n g p a t t e r n s all t h e w a y d o w n to t h e feet. Rolfers h a v e b e e n t a l k i n g a b o u t t h e way people use their structures inefficiently, squandering their energies and working against themselves. H o w can an efficient b o d y b e d e s c r i b e d ? Rolfers like t o t a l k i n t e r m s o f vertical and horizontal planes. T h e y evaluate the body in terms of the logic of m e c h a n i c s and draw lines t h r o u g h t h e b o d y in t h e mind's eye. T h e total b o d y tissue—bone, muscle, and especially c o n n e c t i v e t i s s u e — acts together to create t h e structure t h a t gives t h e s e i m a g i n a r y l i n e s . T h e s e l i n e s are m o r e a p p a r e n t i n a b o d y t h a t i s still, b u t b o d y workers learn to evaluate t h e u n d e r l y i n g structure of a m o v i n g body. T h e goal, t h e n , is n o t so m u c h to achieve perfect vertical a n d horizontal structure lines in a body. Rather it is to free t h e soft tissues so that t h e b o d y c a n m o v e freely b y b a l a n c i n g t h r o u g h planes t h a t are h o r i z o n t a l a n d vertical. Our goal is to h a v e j o i n t s m o v e as t h o u g h they were in line.

Figure 10-6B A chronically short psoas will have its greatest impact on the groin, forcing the pelvis down in front. There is a concurrent loosening of the normal t o n e of the rectus abdominis. One very common result is lordosis and a pot belly.

ELEVEN

Emotions and the Fascial Web

Body Awareness and Response Patterns As children, we are taught almost everything

t h o s e early fears. I n W i l l i a m J a m e s ' f a m o u s

w e d o i n life, a n d y e t i t i s t a k e n f o r g r a n t e d

d i c t u m , "I d o n ' t r u n b e c a u s e I am afraid;

t h a t w e k n o w h o w t o u s e o u r b o d i e s . It's

I am a f r a i d b e c a u s e I r u n . "

assumed that we n e e d to learn h o w to use

M o v e m e n t patterns express personality

our brains, but presumably using our bodies

p a t t e r n s a s w e l l a s v i c e v e r s a . Fear m a n i f e s t s

i s d o i n g w h a t c o m e s naturally. N o o n e gives

as a g e n e r a l c h a r a c t e r i s t i c in all a s p e c t s of

us i n f o r m a t i o n on h o w to create balance or

t h e individual's identity—in body, e m o t i o n ,

change physical problems.

e n e r g y , m i n d . T h e t r u e n a t u r e o f fear (lack

W h e n a c h i l d starts to walk, it is no l o n g e r

of t r u s t ) is t h a t it is a s i g n a l to p a y a t t e n t i o n .

an o b j e c t to be carried a r o u n d (however lov-

Yet we h a b i t u a l l y m i s i n t e r p r e t it as a s i g n a l to

ingly). It is b e c o m i n g independent in the

fight or flight. Even in t h e case of a b o d y part

w o r l d , t a k i n g c h a r g e o f its o w n l i f e . J u s t t h e

t h a t h u r t s w h e n i t i s m o v e d , fear i s m o r e

f a c t t h a t t h e b a b y i s u p o n t w o legs i n s t e a d o f

a p p r o p r i a t e l y a s i g n a l f o r c a u t i o n . It s h o u l d

d o w n o n all f o u r s s e e m s m i r a c l e e n o u g h . I t

not cause us automatically to tighten that

w o u l d b e g i l d i n g t h e lily t o t r y t o i n s t i l l f o r m ,

a r e a . T h e m o r e w e t i g h t e n it, t h e m o r e i t will

even t h o u g h this would be the best time to

hurt. This "natural" reaction has an outcome

s h o w a c h i l d h o w t o u s e its l e g s .

t h a t i s t h e r e v e r s e o f o u r i n t e n t i o n . T h e fear

I m a g i n e , f o r a m o m e n t , a b a b y ' s first s t e p s .

o f b e i n g u n s t e a d y p r e c i p i t a t e s all sorts o f

T h e r e i s u n s t e a d i n e s s i n t h e f e e t a n d legs,

unconscious modifications—locked neck,

accompanied by attempts at balancing with

g r a b b e d t o e s , s u c k e d - i n ass, h e l d s h o u l d e r s ,

t h e a r m s . W h e n t h e b a b y w a s c r a w l i n g o n all

c l e n c h e d j a w s . T h e s e a r e all i n r e s p o n s e

fours, security lay in keeping t h e back steady

t o o u r fear o f b e i n g u n a b l e t o c o n t r o l o u r

and pushing off with the hands and knees.

m o v e m e n t or are d o n e to avoid ridicule or

W h e n there is unsteadiness in walking, the

embarrassment.

baby again attempts to control with arms

Integrated m o v e m e n t centers around the

a n d k n e e s a n d b y h o l d i n g t h e s p i n e rigid.

c o n c e p t of l e a n i n g forward so that gravity

W h e n adults h o l d a child to help it walk,

r a t h e r t h a n e f f o r t i n i t i a t e s a c t i o n . For m a n y

they generally hold under the armpits or by

p e o p l e , t h e s u g g e s t i o n t o l e a n o r fall f o r w a r d ,

the hands. This again reinforces the pattern

instead of creating a relaxation response,

of c o n t r o l l e d shoulders to stabilize walking.

starts a p r o c e s s o f t i g h t e n i n g i n t h e b o d y .

T h i s persists as t h e h o l d i n g p a t t e r n of t h e

T h e result is a g r a b b i n g p o i n t (or several).

adult

This holding is unnecessary. The whole body

(Fig.

11-1).

M o s t h o l d i n g p a t t e r n s are related t o e m o -

c a n b e i n a fluid s t a t e a t all t i m e s . T h e r e a s o n

t i o n a l fear, l a c k o f t r u s t . R e a s o n a b l e c a u t i o n

s o m e o n e d o e s n ' t a l l o w h i m s e l f t o " f a l l " for-

and attempts at control by the infant as it

w a r d i n t o m o v e m e n t i s t h a t h e d o e s n ' t trust

learns to walk can be retained as m o v e m e n t

his structure.

patterns in t h e adult. T h e adult is n o t afraid

O f t e n t h i s l a c k o f t r u s t starts w i t h a r a t i o n a l

of losing b a l a n c e a n d falling, but as t h e adult

fear. W h e n w e a r e s m a l l a n d l e a r n i n g t o w a l k

walks, h e / s h e u n c o n s c i o u s l y restimulates

t o o early, w e c a n ' t l e n g t h e n t h e j o i n t s t o t h e

EMOTIONS

AND

THE

FASCIAL

WEB

point where leaning forward is comfortable.

Ideally, a n y p h y s i c a l s e n s a t i o n c a n b e

T h e c h i l d f i n d s s o m e w a y t o p u l l its b a l a n c e

experienced through the body the way a

b a c k . Later, i n t h e a d u l t , t h e s a m e k i n d o f

s h i v e r g o e s f r o m t h e f e e t all t h e w a y t o t h e

r e a c t i o n persists. T h i s i s p a r t i c u l a r l y e v i d e n t

crown of t h e head. Holding t h e breath is a

47

in sports. In skiing, for e x a m p l e , it is essential

w a y o f s t o p p i n g t h a t p h y s i c a l flow. P e r h a p s

to lean forward. There is m o r e control in the

we do this because we don't want to experi-

tips o f t h e skis, m o r e lift i n t u r n i n g , a n d less

ence the sensation or the emotion (emotions

c h a n c e o f falling d o w n o n steep o r b u m p y

are physically e x p e r i e n c e d ) . W h e n we are in a

slopes. T h e r e is also m o r e m o b i l i t y because of

state of fear or c a u t i o n , we usually try to stop

a greater c o n t r o l in t h e knees. M o s t b e g i n n i n g

things so we can think about them, explain

o r i n t e r m e d i a t e skiers, h o w e v e r , d o n o t l e a n

t h e m , get ourselves c o m f o r t a b l e . This t o o is

f o r w a r d . W h e n t h e y fall, t h e y g e n e r a l l y fall

w h e n we stop our breath; we have difficulty

b a c k w a r d . T h e y sit d o w n . T h i s i s t h e r e a c t i o n

maintaining our r h y t h m of breathing and

we taught ourselves in c h i l d h o o d . T h e after-

thinking at the same time.

the-fact e x p l a n a t i o n is t h a t we are afraid to

As we h a v e said, r e s p o n s e p a t t e r n s t h a t are

fall f o r w a r d b e c a u s e w e ' r e a f r a i d w e m i g h t h i t

repetitive a n d u n c o n s c i o u s tend to b e c o m e

our heads. Not true. We're m u c h m o r e likely

c h r o n i c . In t h e case of t h e breath, w h a t we

t o fall f o r w a r d o n t o h a n d s a n d k n e e s .

see is a p a r t i a l h o l d i n g . M a n y p e o p l e h a v e a

We're not taught to walk as children, and we're n o t taught to breathe. T h e m o s t c o m -

stored reservoir of air in t h e lower part of t h e chest; t h e lower ribs m o v e very little or n o t at

m o n tendency of anyone frightened is to

all. As a r e s u l t , t h e r e is a t e n d e n c y to b a r r e l or

hold his or her breath. An e x a m p l e is j u m p -

r o u n d o u t in t h e lower chest. A s e c o n d area

ing i n t o cold water. W i t h t h e initial s h o c k

w h e r e there is little breath activity is in t h e

of t h e cold, our t e n d e n c y is to gasp, to draw

u p p e r t i p o f t h e l u n g s . T h e ribs j u s t u n d e r t h e

the breath into the lungs and to hold it there.

collar b o n e s a n d h i g h u p inside t h e a r m p i t are

The whole body tightens and is unable to

u n e x p l o r e d t e r r i t o r y — m o s t o f u s d o n o t feel

adjust to t h e coldness of t h e water. Letting

o r m o v e t h e s e t o p m o s t ribs. T h e tips o f t h e

t h e breath out allows t h e b o d y to relax; t h e

lungs extend up to this region, so we should

w a t e r n o l o n g e r feels a s c o l d . S i m i l a r l y , w h e n

b e able t o m o v e t h e s e ribs freely w i t h every

we experience physical pain, gasping and

breath. Being restricted at t h e t o p a n d t h e

h o l d i n g t h e b r e a t h are c o m m o n , b u t t h e y

b o t t o m o f t h e rib c a g e , w e r a r e l y e x p e r i e n c e

o n l y serve t o r e t a i n p a i n .

a full b r e a t h .

Figure 11-1

48

THE

ENDLESS

WEB

O n e w a y t o e s t a b l i s h a full b r e a t h i s t o

Evaluating bodies, we tend to focus on

concentrate on the exhale. As you come to

the physical things that have gone w r o n g —

t h e e n d o f y o u r u s u a l e x h a l e , a l l o w m o r e air

illnesses, accidents, ways we got pushed out

to leave t h e lungs. This does n o t m e a n push-

of s h a p e . T h i s is a h a b i t , a p o i n t of view, an

i n g t h e air o u t w i t h t h e a b d o m e n , b u t r a t h e r

attitude that is shared by most people. In

allowing t h e rib cage to relax, especially t h e

general, we tend to take notice only w h e n

t o p m o s t a n d lowest ribs. Put y o u r h a n d s o n

we're hurt. I k n o w about my ankle because

y o u r l o w e r ribs j u s t a b o v e t h e a b d o m e n . Feel

t h a t little twinge r e m i n d s me t h a t I n e e d to

t h e m o v e m e n t o f t h e s e ribs a s y o u b r e a t h e ,

b e c a r e f u l o f it. I t h i n k a b o u t m y s h o u l d e r

concentrating on the exhale. The exhale

because it catches every time I m o v e my arm

b e c o m e s t h e active part of t h e breathing

in a c e r t a i n w a y .

cycle; the inhale occurs spontaneously. Holding t h e breath is a pattern m o s t of us use to ward off u n w a n t e d feelings. To s o m e

Pain is o n e way the body c o m m u n i c a t e s to us. We h a v e o t h e r kinds of physical awaren e s s , b u t t h e y t o o are u s u a l l y n e g a t i v e — w e

e x t e n t , w e are t a u g h t t o h i d e e m o t i o n . For

h a v e p o r t i o n s o f o u r b o d i e s t h a t w e d o n ' t like.

example, exasperated parents sometimes do

This is a different kind of c o m m u n i c a t i o n .

almost anything to stop their children from

O n e is a direct message in terms of pain or

crying. T h e crying m a y b e reasonable. For o n e

sensation; t h e other is an emotional message,

t h i n g , i t i s a v e r y g o o d w a y o f l e t t i n g all t h e

a judgment.

air o u t o f t h e l u n g s , a n d i t i s a l s o a w a y o f

W h e n s o m e t h i n g h u r t s , w e first c h e c k t o

letting a physical problem work through the

be sure t h a t n o t h i n g is injured or b r o k e n . If

b o d y . W h e n a c h i l d h a s t o s t o p its c r y i n g , i t

there is no injury, we try to put t h e pain out

must tighten or cringe—tense up. Another

o f m i n d . I n a way, t h i s i s life s u p p o r t i v e . I f m y

c o m m o n message to children is to stop that

a n k l e h u r t s a n d t h a t ' s all I t h i n k a b o u t , I ' m

feeling, stop t h a t activity, stop t h a t noise.

n o t going to get m u c h d o n e . But there is a

W h e n a child must stop doing something,

problem. If I shut off sensation in my ankle

a r r e s t its m o m e n t u m , its o n l y r e c o u r s e i s

so I d o n ' t feel p a i n , I shut out o t h e r sensa-

t o h o l d s o m e p a r t o f its b o d y — i t s b r e a t h o r

tions f r o m my ankle as well. N o w I h a v e a

b a c k or jaw. T h i s is t h e m o m e n t (in a c h i l d

body image that doesn't include my ankle,

or adult) w h e n t h e e m o t i o n gets stored in

perhaps doesn't include my hip, and so forth.

t h e c o n n e c t i v e tissue.

My sense of vitality is diminished. T h e same

Usually we don't k n o w that we're holding our breath, any more than we know when we m a k e other habitual gestures. They're u n c o n -

kind of process occurs w i t h respect to e m o tional pain. People h u n c h their shoulders or hold t h e m

s c i o u s , a n d as J u n g says in h i s Collected Works,

back in response to being told not to slump.

" T h e u n c o n s c i o u s is really u n c o n s c i o u s . "

This kind of holding pattern puts the body

T h e s e responses are so h a b i t u a l t h a t t h e y ' r e

i n t o a p o s i t i o n t h a t is strained, t h a t is n o t

p a r t o f o u r s e l f - i m a g e , p a r t o f w h a t is. W e

i n h e r e n t i n its o r i g i n a l p h y s i c a l d e s i g n . I t

don't learn t h e m the same way we learn to

results in a similar kind of d e a d e n i n g of

read or to c o o k or to do algebra. We learn

awareness. People are rarely aware of t h e

by c o p y i n g our peers, our siblings, our elders.

strain in their posture. Over t i m e , t h e strain

Patterns that we have absorbed unconsciously

b e g i n s t o t e l l . A s w e a g e , w e feel all sorts o f

are harder t o c h a n g e . T h e y are m o r e i n g r a i n e d

aches and creaks.

i n our c h a r a c t e r s t h a n t h o s e t h a t are a b s o r b e d knowingly, by conscious learning.

T h e n there is the chronic pain. Constant low-level back pain is c o m m o n . This is often

EMOTIONS

t h e result o f a p r e c e p t t a u g h t t o t h e v e r y

AND

THE

FASCIAL

WEB

49

as a w h o l e . It simply gets stuck at our weak

y o u n g t h a t l i t t l e b o y s ( a n d girls) d o n ' t w i g g l e

link; this stoppage is the sensation of pain.

t h e i r rear e n d s . E v e n w h e n t h e h o l d i n g p a t -

T h e cause, t h e initial event, is often unre-

tern has originated in t h e child, t h e awareness

l a t e d . For e x a m p l e , i f y o u b r e a k a l e g o r s p r a i n

o f r e s t r i c t i o n a n d p a i n c a n start a t a n y a g e .

a n a n k l e , c o m p e n s a t i o n sets i n a t t h e h i p a n d

T h e s e r e s t r i c t i o n s arise f r o m g e n e r a l a t t i t u d e s

b a c k t o f a v o r t h a t leg. A n y f u t u r e p a i n o r

in t h e culture. T h e r e are also individual kinds

p r o b l e m i n t h e leg, u n r e l a t e d t o t h e o r i g i n a l

of contraction and holding.

accident, reinforces t h e initial c o m p e n s a t o r y

(A personal note from o n e author: " O n c e , for e x a m p l e , w h e n I was w a l k i n g up o n e of

habit. In time it is impossible to determine w h i c h is cause a n d w h i c h is effect. It is m o r e

t h e s t e e p streets i n S a n F r a n c i s c o , m y k n e e

accurate to describe physical problems in

started to twinge. S o o n t h e pain was so severe

t e r m s o f a r e a s o f a c u t e o r less a c u t e s e n s a t i o n .

t h a t I felt I w o u l d n ' t b e a b l e t o r e a c h t h e n e x t

Physical a n d e m o t i o n a l awareness are c o n -

street corner. N o r c o u l d I find a c o n v e n i e n t

n e c t e d . W e feel e m o t i o n s physically. I m a g i n e ,

p l a c e t o sit d o w n . A n d t h e n I s u d d e n l y real-

for e x a m p l e , t h e characteristic shiver t h a t is

ized t h a t i n t h e t e n s i o n o f t h e c l i m b a n d t r y -

fear. A v a r i a t i o n o f t h i s i s t h e d e l i g h t e d t h r i l l

i n g to get w h e r e I w a s g o i n g in a h u r r y , I h a d

of terror in a h o r r o r m o v i e or on a roller

b e e n h o l d i n g m y j a w c l a m p e d . W h e n I let m y

coaster. It is probably true that t h e physical

jaw relax, t h e k n e e pain w e n t away a n d I was

manifestation of e m o t i o n is a secondary p h e -

a b l e t o get u p t h e h i l l . " A m o v e m e n t c o n n e c -

n o m e n o n , a response to the actual e m o t i o n .

tion between jaw and knee seems obscure, but

And yet this response, this expression of the

there it was. It is an e x a m p l e of t h e c o m m o n

e m o t i o n a l impulse, is part a n d parcel of the

phenomenon of how movement at one end

e m o t i o n itself. H u m a n b e i n g s s e e m t o b e

of the body constrains the other end, even

feedback systems. There is an initial germ of

though the rationale behind the c o n n e c t i o n

awareness. It is expressed intellectually, e m o -

is n o t clear at t h e m o m e n t . )

t i o n a l l y , p h y s i c a l l y , o r all t h r e e , a n d t h i s t h e n

T h e sensation of pain is a signal t h a t s o m e thing is going on that isn't right. T h e m o r e we're unaware of our bodies, t h e m o r e we n e e d a g u i d e t o let u s k n o w h o w a n d w h e r e

feeds b a c k i n t o t h e system t o b e e n h a n c e d , muted, redirected, etc. The physical response to e m o t i o n is t h r o u g h t h e soft tissue. T h e fascia is t h e e m o -

t h i n g s n e e d t o get b a c k t o t r u e . U n f o r t u n a t e -

tional body. That's a metaphysical concept;

ly, w e u s u a l l y t h i n k o f p a i n a s t h e c a u s e o f t h e

w e c o u l d c a l l i t m e t a - a n a t o m y . Ideally, f e e l -

problem. T h e n t h e "logical" response is to try

i n g s a r e felt i n t h e t o t a l b o d y — e m o t i o n s

t o get rid o f t h e p a i n . T h e a r e a t h a t h u r t s i s

travel t h r o u g h t h e fascial w e b . W e t h e n in-

not necessarily t h e cause of t h e pain; t h e

terpret t h e physiological sensation as anger,

body as a w h o l e is out of balance and o n e

affection, love, interest, a n d so forth.

place is taking t h e brunt of t h e strain. M o s t

Proprioception is t h e ability to sense

of us h a v e a w e a k l i n k , a p l a c e t h a t t w i n g e s ,

one's own physical being. Emotion and

aches, or contracts whenever we experience

energy also have a physical c o m p o n e n t t h a t

stress. A l m o s t a n y e m o t i o n a l o r p h y s i c a l

w e are i n c l u d i n g i n t h i s t e r m . I t i s t h i s p h y s -

t r a u m a will g i v e rise t o p a i n i n t h i s stress site,

ical p r o p r i o c e p t i o n t h a t w e i n h i b i t w h e n

even t h o u g h t h e t r a u m a is n o t to t h a t area.

e m o t i o n or e n e r g y or structural e v e n t s are

We react as systems to a n y situation. A

inconvenient. O n e such type of inhibition

blow, an e m o t i o n a l upset, whatever trouble

is transferring awareness from o n e modality

we get i n t o reverberates t h r o u g h t h e o r g a n i s m

t o a n o t h e r . For e x a m p l e , p e o p l e w h o d o n o t

50

THE

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WEB

wish to recognize that they have an e m o -

are h u n c h e d a f t e r a b a d fall. B o t h h a v e b e -

tional pain frequently transform it into phys-

c o m e a part of t h e structure a n d part of t h e

ical pain, as in a t e n s i o n h e a d a c h e . Our goal is to clarify t h a t w h i c h is physical

physical m a k e u p of the body. Conversely, it is hard n o t to experience a m i x t u r e of

and to allow that w h i c h is emotional to be

depression and anxiety w h e n a bad back

seen as s u c h . It is always easier to deal w i t h

o r a c h r o n i c h e a d a c h e flares u p .

a s i t u a t i o n i n its o w n m o d a l i t y . P h y s i c a l p a i n ,

Physical and e m o t i o n a l sensations overlap

for e x a m p l e , is w h a t y o u feel w h e n y o u break

and influence each other. It is important to

your arm. It is n o t appropriate to try to deal

distinguish t h e m in terms of a choice of ther-

with a broken arm in terms of your resent-

apy. I n t h e e x a m p l e o f t h e b r o k e n a r m , t h e r e

m e n t at the person w h o pushed you.

is a lingering fear ( e m o t i o n ) t h a t t h e a r m is

On the other hand, the reason your neck

fragile. In physical fact, t h e h e a l e d break has

can't straighten and lengthen m a y be because

m a d e t h e a r m s t r o n g e r ; all t h a t r e m a i n s i s

of the shock of being continually bullied in

t o let g o o f t h e e m o t i o n a n d m o v e t h e a r m

c h i l d h o o d . Physical w o r k will o n l y partially

freely.

open that problem unless there is recognition that there m a y be an e m o t i o n a l origin. W h e n w e c a n see e m o t i o n a l s i t u a t i o n s clearly, w e

We have shown h o w a body functions and s o m e o f t h e h i s t o r y o f it's g r o w t h . W e h a v e

are t h e n in a p o s i t i o n to m o v e t h r o u g h a n d

" f l e s h e d o u t " t h e c o n c e p t o f a c o n n e c t i v e tis-

away from t h e m .

sue b o d y a n d given images a n d descriptions

W h a t makes the pain seem physical is that

of h o w this concept c a m e into being and how

it does include a structural c o m p o n e n t . An

it works itself o u t in an actual physical body.

e m o t i o n a l l y held part of t h e b o d y b e c o m e s

I n t h e n e x t s e c t i o n , w e use t h a t i n f o r m e d

rigid a f t e r b e i n g h e l d t i g h t l y o v e r y e a r s .

perception to look at and analyze body

S h o u l d e r s t h a t are h u n c h e d f r o m fear are

contour.

difficult to distinguish f r o m shoulders t h a t

PART

THREE

Body Retinaculae (Bands/Straps)

TWELVE

The Chest Band Implications for Movement and Behavior I n o r d e r t o feel a l i v e a n d c o m f o r t a b l e , w e

soft tissue structures. T h e c o n t o u r patterns

n e e d free flow, w h e t h e r we c a l l it a free f l o w

w e d i s c u s s i n t h i s s e c t i o n a r e a series o f s e v e n

of energy or of m o v e m e n t . This freedom is

such bands. As we describe these individually,

visible physically in b o d y c o n t o u r : it is possi-

we talk m o r e about w h a t t h e y i m p l y about

ble to infer f r o m s o m e o n e ' s shape t h e state

b o t h m o v e m e n t and behavior.

of his or her energy a n d ease of m o v e m e n t . The most obvious aspect of the body is

Straps represent a f u n c t i o n a l c o n n e c t i n g structure t h r o u g h t h e b o d y w h e r e t h e r e are

proportion. An example is the balance

no traditional anatomical connections from

between the top and b o t t o m halves of the

f r o n t to b a c k . We describe t h e straps as b e i n g

body. We o f t e n say t h a t a m a n ' s h e a d is t o o

just u n d e r t h e skin because t h a t is w h e r e we

small for his shoulders, t h a t a w o m a n ' s h i p s

see t h e m . A s t h e b o d y m o v e s , t h e y s e e m ,

are t o o w i d e , t h a t a kid's legs a r e t o o s k i n n y .

h o w e v e r , t o g o all t h e w a y t h r o u g h a s w e l l

A s e n s e of p r o p o r t i o n is a m a t t e r of a e s t h e t i c

as a r o u n d t h e surface. T h e y m a y be visualized

judgment; standards vary from o n e culture

as planes through the body.

to another. Aesthetic proportion is o n e way of inter-

T h e s e straps o n t h e s u r f a c e o f t h e b o d y a r e similar in function to t h e armor of an arma-

preting body contour. A silhouette outline

dillo. T h e s e g m e n t a t i o n of the armor holds

shows t h e hills a n d valleys o f t h e body. T h e

e a c h p a r t rigid w i t h r e s p e c t t o its n e i g h b o r i n g

h i l l s refer t o b u l g e s a n d t h e v a l l e y s t o t i g h t

section while nevertheless permitting some

places where surface tissue appears stuck to

m o v e m e n t . Similarly, i n t h e h u m a n body, t h e

underlying tissue. Theoretically, an ideal b o d y

straps preserve e x t e r n a l structure, p r e v e n t i n g

h a s a m o r e o r less s m o o t h c o n t o u r . W h e n

too deep an infolding as the body bends. To

m u s c l e s are n o t b e i n g u s e d , t h e y s h o u l d b e

s o m e degree, this is probably an effective way

able to relax a n d thus create no m a r k e d

o f s h o r i n g o u r s e l v e s u p . I t i s a p a t t e r n w e see

bulging. Muscles contract and thicken as

i n all h u m a n b e i n g s .

t h e y are u s e d ; a s t h e y r e l a x , t h e a r e a f l a t t e n s .

S t r a p s s e e m t o arise i n m u c h t h e s a m e w a y

I n a n area t h a t d o e s n o t f l a t t e n , t h e r e a r e

as tendons and ligaments, which they appear

often a c c u m u l a t i o n s of c o n n e c t i v e tissue a n d

to resemble in structure. T h e telltale sign of

fat t h a t h a v e b e c o m e c e m e n t e d i n t o p l a c e

t h e p r e s e n c e of a s t r a p is a f l a t t e n i n g or d e -

over t h e muscle tissue.

pression running horizontally through the

Besides i n d i v i d u a l v a r i a t i o n s i n c o n t o u r , t h e r e are a l s o p a t t e r n s t h a t are m o r e o r less

b o d y surface. It m a y be c o n t i n u o u s or interrupted—like a dotted line. W h a t defines these

c o m m o n t o all b o d i e s . T h e s e p a t t e r n s a p p e a r

as restrictive b a n d s is their inflexibility; t h e y

a s s t r a p s — b a n d s t h a t w e see r u n n i n g h o r i z o n -

break t h e flow of m o v e m e n t .

tally a r o u n d t h e body, a l m o s t like retaining

T h e m o s t obvious strap, evident i n a l m o s t

b e l t s h o l d i n g in t h e s o f t t i s s u e (Figs. 12-1 &

e v e r y o n e , is a h o r i z o n t a l depression in m i d -

12-2). T h e s e a r e r e l a t i v e l y i n d e p e n d e n t o f t h e

chest, just b e l o w the nipples. Seen f r o m t h e

m u s c l e a n a t o m y o f t h e body. T h e y are u n e x -

front, this is located at the junction of the

pected a n d u n e x p l a i n e d , b u t t h e y are visible

upper insertion of t h e rectus a b d o m i n i s

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Figure 12-1 Body Retinaculae: The Seven Body Bands of the Torso 1. The lowest band in the torso (pubic band) extends from the pubic bone in front across the groin (which is thereby shortened), around the hip bones (the greater trochanter of the femur), and across the buttocks, ending at the junction of the sacrum and coccyx. 2. The band across the lower abdomen (inguinal band) is frequently more prominent in men. It connects the two bony projections of the pelvic bones in front (the anterior superior spines of the ilia). It usually dips slightly downward in front, like an inverted arch, resembling an internal jock strap or chastity belt. Its lower margin tends to include the inguinal ligament, connecting the band downward to the region of the pubic bone. This band extends laterally along the upper margin of the large wings of the pelvic bones (ilia), ending at the lumbosacral junction.

along the lower border of the pectoralis major, across the mid-lateral chest, and down the lateral margin of the latissimus dorsi where it begins to run parallel to the scapula toward the arm. The strap appears to tie the lower tip of the scapula to the back ribs and ends at the dorsal hinge of the spine. When this strap is pronounced, there is not only a depressed midchest, but an inability to expand the ribs sideways in breathing. 5. The fifth strap at the shoulders (collar band) involves the clavicle and is part of the tissue gluing the clavicle to the first and second ribs in front. It can be felt as a pad of tissue just below and deep to the collar bone (clavicle). It extends laterally to the tip of the shoulder, with some fibers fanning down into the armpit. The strap continues toward the back on the inside and outside of the upper border of the shoulder blade (scapula), and ends at the junction of cervical and thoracic vertebrae.

3. The third band crosses the abdomen (belly/umbilical band) and is perhaps the most variable in location. It may cross at the umbilicus (sometimes creating a crease in the abdominal wall extending out on either side of the umbilicus), or it may lie midway between the umbilicus and the midcostal arch (tying t o g e t h e r the two sides of the costal arch). In either case, it will extend laterally to form an arch across the abdomen to the lower ribs on each side—particularly to the free tip of the eleventh rib. It travels backward along the lower ribs, ending at the junction of the thoracic and lumbar vertebrae.

6. The area below the chin (chin band) is an area of concentration of fibers and padding which includes the hyoid bone and the base of the jaw, passing just below the ear, and ending where the base of the skull joins the first cervical vertebra (atlas). 7. The top band (eye band) is the most difficult to visualize. It originates on the bridge of the nose, travels across the eye sockets and above the ears, and ends at the back of the skull just above the occipital crest (the bump at the back of the skull).

4. The fourth band is in the area just below the nipples (chest band) and is visually the most apparent. It is usually a non-moving depressed area on the chest; the skin seems glued down onto the ribs and muscle. Laterally, it extends

Reprinted from Rolf Lines, The Journal of the Rolf Institute, 1 9 9 5 , with permission. NOTE: For the body retinaculae, we have used the terms " b a n d " and "strap" interchangeably.

muscle and the lower insertion of the pecto-

of the chest, hinging between the fifth and

ralis m a j o r m u s c l e (Fig. 12-3). T h e b a n d is

s i x t h (or s i x t h a n d s e v e n t h ) t h o r a c i c v e r t e -

slightly higher as it m o v e s around to t h e back

b r a e . T h i s d i v i s i o n o f t h e rib c a g e i n t o t w o

b e c a u s e t h e ribs c h a r a c t e r i s t i c a l l y a r e a n g l e d

parts was apparent in our dissections. T h e

downward in front. The back extension of

a n g l e o f t h e ribs c h a n g e d v i s i b l y a n d rela-

this strap seems to be t h e dorsal h i n g e , a

t i v e l y a b r u p t l y ; t h e q u a l i t y o f t h e t i s s u e dif-

functional division of the chest (thorax). T h e

fered as well.

dorsal h i n g e is visible as a c h a n g e in m o v e m e n t pattern between upper and lower halves

I n f r o n t , t h e s t r a p starts a b o u t a n i n c h a b o v e t h e l o w e r t i p o f t h e s t e r n u m . T h i s also

THE

A

Figure 12-2 Body Straps: (A) side view; (B) front view

CHEST

BAND

B

t i s s u e o v e r t h e s t e r n u m a n d ribs, i t i s e a s i e r t o see w h e r e t h e c o n n e c t i v e t i s s u e h a s b e c o m e glued to t h e b o n y surface.

d e f i n e s t h e c o n n e c t i o n f r o m o n e side o f t h e

55

T h e b a n d a t its d e e p e s t l e v e l i n v o l v e s

body to the other. We tend to ignore this

t h e u n d e r l y i n g ribs a n d t h e intercostal m u s -

right-to-left relationship across t h e s t e r n u m ,

c l e s , r e s t r i c t i n g full e x p a n s i o n o f t h i s p a r t o f

yet it is an i m p o r t a n t o n e , reinforcing a n d

t h e rib c a g e i n b r e a t h i n g . S u p e r f i c i a l l y , t h e

often c e m e n t i n g side-to-side variations in

m u s c l e s t h a t are visibly i n h i b i t e d in t h e i r

m o v e m e n t . Because there is little m u s c l e

m o v e m e n t are t h e rectus a b d o m i n i s a n d t h e

56

THE

ENDLESS

WEB

pectoralis major. T h e rectus a b d o m i n i s spans f r o m t h e p u b i c b o n e t o t h e m i d d l e ribs o f t h e c h e s t . I t c r o s s e s t h e l o w e r m a r g i n o f t h e rib c a g e ( c o s t a l a r c h ) a n d o f t e n a d h e r e s t o it. In fact, there is a heavy t h i c k e n i n g on t h e underside of the rectus a b d o m i n i s at the costal arch, giving the appearance that the m u s c l e e x t e n d s o n l y f r o m t h e b o t t o m part o f t h e rib c a g e t o t h e p u b i c b o n e . By anatomical design, relaxation of the r e c t u s a b d o m i n i s a l l o w s t h e f r o n t o f t h e rib c a g e t o lift. T h e a b d o m e n t h e n l e n g t h e n s f r o m t h e p u b i c b o n e t o t h e ribs. T h e r e c t u s a b d o m i n i s also provides vertical stability to counterbalance the action of the long muscles of t h e back. W h e n it is h e l d tightly, there is a shortening between the mid-chest and the p u b i c b o n e . T h e result is a folding in of t h e A

a b d o m i n a l region a n d a depression at the l o w e r m a r g i n o f t h e rib c a g e . T h i s i s t r u e w h e t h e r t h e h o l d i n g is caused by a postural h o l d i n g (sit-ups or a s u c k e d - i n b e l l y ) or a structural h o l d i n g (stuck c o n n e c t i v e tissue). Immediately contiguous with the upper a t t a c h m e n t of t h e rectus a b d o m i n i s is the lower margin of the pectoralis major muscle. T h i s a t t a c h e s a t t h e m i d d l e ribs, n e a r t h e stern u m , traveling f r o m there t o t h e upper part of the arm b o n e (humerus). W h a t we have, t h e n , a t t h i s s u p e r f i c i a l s o f t t i s s u e level o f t h e body, is a vertical pull f r o m t h e mid-ribs d o w n w a r d a n d a diagonal pull f r o m t h e m i d ribs u p w a r d . T h e o v e r l a p o f t h e s e t w o pulls i s at t h e s t e r n u m a n d includes t h e lower a n d m i d d l e p a r t o f t h e rib c a g e . Ideally, e a c h o f

B Figure 12-3 Mid-chest strap: (A) front view; (B) side view. The arrows denote the major lines of force of the muscles involved in the movement between pelvis and arms. Ideally, movement flows through the muscles in sequence. This flow is interrupted by the mid-chest strap. Its location is defined by the major lines of force of the muscles.

t h e s e t w o m u s c l e s i s s h e a t h e d i n its f l e x i b l e e n v e l o p e of c o n n e c t i v e tissue, allowing it t o s h i f t a s t h e b o d y m o v e s f r o m side t o side, walks, etc. T h e m u s c l e tissue of t h e rectus a b d o m i n i s a n d t h e pectoralis m a j o r is separate, b u t their c o n n e c t i v e tissue forms a continuous, segmented web, allowing the m o v e m e n t o f o n e m u s c l e t o b e reflected i n t o the other.

THE

CHEST

BAND

57

T h e s u p e r f i c i a l m u s c l e a n d c o n n e c t i v e tissue p a t t e r n h e r e m a y be i m a g e d as a Y w i t h a broad double base. M o v e m e n t is transmitted vertically a n d diagonally across t h e chest. W h e r e there is habitual restriction, t h e effect on m o v e m e n t is progressive. W h e r e c o n n e c tive tissue i s o r i g i n a l l y o n l y l i g h t l y h e l d down, bodily activity t h e n tends to drag t h e margins of the two adjacent muscles closer together, causing t h e c o n n e c t i v e tissue to thicken. A s t h e strap c o n t i n u e s a r o u n d t h e s i d e , going toward t h e back, it crosses t h e upper margin of t h e latissimus dorsi, a broad m u s c l e a r i s i n g f r o m all t h e s p i n e s o f t h e v e r t e b r a e from about T6 to the sacrum. Above, it narrows i n t o a t e n d o n t h a t r u n s a l o n g t h e l a t e r a l outside margin of t h e shoulder blade (scapula). It ends in an a t t a c h m e n t to t h e a r m bone (humerus). The attachments of the pectoralis m a j o r a n d t h e latissimus dorsi o n t h e a r m are a d j a c e n t . T h e y c o u n t e r b a l a n c e e a c h other and determine the openness of the armpit. The Y form on the front of the body (rectus a b d o m i n i s a n d pectoralis m a j o r m u s cles) is t h u s b a l a n c e d by a V f o r m ( l a t i s s i m u s dorsi m u s c l e ) on t h e b a c k (Fig.

12-4).

T h e h o r i z o n t a l c o m p r e s s i o n t h a t w e are calling a strap crosses f r o m m i d - s t e r n u m a r o u n d to t h e side, overlapping t h e space where the pectoralis m a j o r and the latissimus dorsi m u s c l e s a p p r o a c h e a c h o t h e r . T h e s e m u s c l e s s h o u l d b e free t o slip v e r t i c a l l y w i t h r e s p e c t t o e a c h o t h e r , l e a v i n g t h e a r m full range o f m o v e m e n t . W h e n t h e y are c a u g h t up in a restriction, t h e a r m p i t is c o m p r e s s e d . T h e strap h e r e i s v e r y m u c h like t h e b o d i c e o f a dress w i t h a n E m p i r e w a i s t l i n e . A n o t h e r image that comes to m i n d is the scaffolding of the b o t t o m edge of a brassiere. T h e strap restricts lateral rib m o v e m e n t a s w e l l a s

Figure 12-4 The " Y " of the front and the "V" of the back.

m o v e m e n t t o raise t h e a r m s . F r o m t h e lateral m a r g i n o f t h e p e c t o r a l i s

t h e ribs a n d t h e m u s c l e s o f t h e b a c k , a n d

m a j o r , t h e strap t h e n c r o s s e s t h e l o w e r t i p o f

ends approximately at t h e dorsal h i n g e . W h e n

the scapula. It c o n t i n u e s across t h e b a c k of

t h e strap is h e a v y a n d tight, it inhibits t h e

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m o v e m e n t o f t h e s c a p u l a . Ideally, t h e s c a p u l a

stress a t t h e d o r s a l h i n g e . P u d g y a d o l e s c e n t

is suspended a n d c a n " f l o a t " freely over t h e

boys also c a n be uptight about nipples and

ribs a s t h e a r m m o v e s . F o r e x a m p l e , w h e n

breast tissue, a n d t h e y h u n c h over for t h e

you reach the arm forward and up, the

s a m e reason. An aberrant pattern takes h o l d

scapula drops. As the reach continues, the

i n t h e b o d y w h e r e t h e r e i s t h e desire t o h o l d

scapula t h e n floats upward. W h e n there is a

d o w n , c o n t r o l , hide. C o n t r o l is really t h e

restriction by a band, neither the downward

m o s t descriptive term here.

nor the upward m o v e m e n t of the scapula is possible without exertion and the recruitment of e x t r a n e o u s m u s c l e (Fig.

12-5).

As t h e strap runs f r o m front to back, it

T h e r e are a limited n u m b e r of ways to effect control in the body. W h i l e emotional rationales underlying a n y given structure vary, t h e p h y s i c a l h o l d i n g falls i n t o p a t t e r n s .

crosses over a n u m b e r of additional deeper

T h e s e p a t t e r n s a r e w h a t w e see a s s t r a p s . I n

muscles as well as t h e superficial o n e s we

m i d - c h e s t , t h e strap m a y b e caused b y a n

h a v e described. T h e c o n n e c t i v e tissue asso-

accident, by a desire to hide t h e breasts, by

c i a t e d w i t h all o f t h e s e h a s d i r e c t i o n a l p u l l s

a desire n o t to b r e a t h e , by t h e n e e d n o t to

that modify the horizontal quality of the

l o o k d i f f e r e n t f r o m e v e r y b o d y else, o r b y res-

s t r a p . T h i s i s p a r t i c u l a r l y t r u e a t t h e sides.

p i r a t o r y d i s e a s e . All t h e s e d i f f e r e n t c a u s e s

T h e r e are pulls u p i n t o t h e armpit, d o w n

manifest in t h e b o d y as a similar pattern.

toward t h e lower lateral m a r g i n of t h e rib

T h e c h e s t s t r a p ties i n w i t h t h e f a m i l i a r

cage, a n d t o w a r d t h e pelvis. T h e result is a

g e s t u r e o f h o l d i n g t h e a r m s t o t h e side t o

t o r q u i n g t h a t p u l l s t h e s t r a p a w a y f r o m its

guard t h e armpits. Armpits are sensitive a n d

main path around the chest.

t h e p r o t e c t i v e g e s t u r e i s s i m i l a r i n all i n d i v i d -

This, then, is the physical description of

uals. As t h e strap b e c o m e s tighter a n d m o r e

t h e mid-chest strap—the nipple binder. We

f i r m l y e s t a b l i s h e d , d i f f e r e n t parts o f t h e b o d y

h a v e c o v e r e d its p a t h i n s o m e a n a t o m i c a l

get drawn in. T h e pressure of hiding t h e

detail t o s h o w t h e m u s c l e a n d c o n n e c t i v e

a r m p i t s r e i n f o r c e s t h e t i g h t n e s s o f t h e strap

tissue p a t h w a y s by w h i c h it influences t h e

a n d i n h i b i t s t h e l a t e r a l (side) e x p a n s i o n o f

body. T h i s b r o a d effect is probably a reason

t h e w h o l e t o p o f t h e rib c a g e .

t h a t b r e a t h i n g d y s f u n c t i o n s are so widespread and influence every aspect of the body. H o w d o straps c o m e i n t o b e i n g ? T h e

F o r e x a m p l e , i n b a b y p i c t u r e s a t less t h a n a year old, o n e child's shoulders were very narrow and high, obscuring the neck. The

reasons are generally m u l t i p l e a n d c u m u l a -

a r m s w e r e c l o s e l y p u l l e d i n t o t h e sides o f t h e

t i v e . First, r e s t r i c t i o n s t e n d t o set i n a s w e g o

body, protecting t h e armpits. As this child got

through the challenges of growing up. They

to be about eight or nine, he went through

a r e like s e e d s i n a p e a r l . S o m e t i m e w e s u c c e s s -

a period of b e i n g a "sulky c h i l d . " This gave

fully incorporate t h e m with m i n i m a l c o n n e c -

impetus to the h u n c h e d - u p physical pattern.

tive tissue disturbance. O t h e r times we grow

As an adult, his chest seemed too narrow in

successive c o n n e c t i v e tissue layers to c u s h i o n

p r o p o r t i o n t o t h e rest o f h i s b o d y . T h e e f f e c t

a n d protect ourselves from t h e irritation. T h e

of b o d y w o r k was dramatic: his chest got four

seed m a y be physical or e m o t i o n a l in origin.

c o a t sizes bigger. T h e b o d y w o r k d i d n ' t give

We h a v e described several scenarios of physi-

h i m t h e n e w chest; it merely allowed h i m

cal origin.

to use w h a t was there.

A s s o m e girls first b e g i n t o d e v e l o p b r e a s t s ,

A m o r e e m o t i o n a l l y based way of express-

they try to hide t h e m . T h e y cave in at t h e

ing what we m e a n is that the blueprint of the

sternum a n d h u n c h their shoulders, creating

s t r u c t u r a l p a t t e r n starts i n t h e b a b y , b e c o m e s

T H E

C H E S T

B A N D

59

Figure 12-5 This array of shoulder movements provides comparison of three very different body types. The positions of the scapulae have been outlined. Notice the great differences in muscle recruitment at the elbow, neck, and along the spine.

60

T H E

E N D L E S S

W E B

established as the character type, and t h e n

a n d t h e o t h e r s f o l l o w . D e c i d i n g w h i c h i s first

i s e m b e d d e d a s a n a t t i t u d e i n t h e a d u l t . It's

cause is difficult a n d usually n o t necessary.

n o t s o m u c h t h a t t h e c o n t r a c t i o n s start i n

T h e b o d y has certain places where it can most

a n y o n e place a n d t h e n spread outward. T h e

e a s i l y c o n t r o l its o w n m o v e m e n t . T h e s e c r e a t e

pattern as a w h o l e is sketched in a n d t h e n

c h a r a c t e r i s t i c p a t t e r n s o f i n h i b i t i o n regardless

becomes reinforced and more pronounced

of cause.

w i t h age a n d use. J u d g i n g f r o m t h e t w o babies

T h e straps are n o t e x a c t l y t h e s a m e i n all

t h a t we dissected, t h e p a t t e r n is laid d o w n in

individuals. There is s o m e variation in place-

utero. As early as in t h e n e w b o r n , we have the

m e n t a n d shape. T h e strap is t h e structure as

b e g i n n i n g s o f f i b r o u s c o n c e n t r a t i o n s . Later,

a w h o l e . Individual variations pull it d o w n in

if aberrant t e n s i o n s are m a i n t a i n e d , these

o n e place, tighten it in another. T h e attach-

b e c o m e like a b r o a d t e n d o n . T h e s t r u c t u r e

m e n t s o f t h e strap, t h e differences i n e m p h a -

s o m e t i m e s looks like t e n d o n in dissection;

sis, m a y b e t h e d i f f e r e n c e b e t w e e n s o m e o n e

it certainly feels like t e n d o n u n d e r t h e skin.

w h o is barrel-chested and s o m e o n e w h o is

But i n " n o r m a l " a n a t o m y n o t e n d o n s are

very n a r r o w f r o n t - t o - b a c k a n d wide side-to-

described in that location.

s i d e . W e e m p h a s i z e a g a i n t h a t t h e strap i s

T h e restrictions inhibit our evolution to an " u p r i g h t s t a n c e . " Shoulders get raised as

n o t a s t r u c t u r e p e r s e . It is a l o c a l c h a n g e in the balance between fiber and matrix

t h e chest sinks d o w n a n d t h e head c o m e s

organization within the total connective

f o r w a r d . O r t h e h e a d m a y c o m e f o r w a r d first,

tissue bed.

THIRTEEN

The Inguinal Band and the Structure and Function of the Vertebral Column in Relation to the Bands A

A n o t h e r visually o b v i o u s strap is w h a t m i g h t be called t h e chastity belt or i n g u i n a l strap w h e n s e e n f r o m t h e f r o n t (Fig. 13-1). It is a connection between the top front b o n y p r o t u b e r a n c e s o f t h e h i p b o n e ( t h e ASIS o r anterior superior spines of t h e ilia). This c o n n e c t i o n i s like a h a l f - m o o n s h a p e , c u r v i n g

Rectus abdominus m.

Costal arch/

downward from these protuberances. The rectus a b d o m i n i s m u s c l e inserts o n t h e p u b i c

.Inguinal 'band

b o n e so t h a t t h e strap crosses t h e lower part of this muscle. T h e strap b r o a d e n s across t h e lower a b d o m e n . In m a n y people it includes

Inguinal ligament " 1

Pubic tbone

n o t o n l y f a s c i a l fibers b u t fat d e p o s i t s a s w e l l . These c a n e x t e n d deep i n t o t h e pelvis, filling the pelvic bowl. T h i s k i n d o f fat i s a t y p e o f c o n n e c t i v e tissue. Its cells h a v e b e c o m e e n g o r g e d w i t h a n a c c u m u l a t i o n of fat droplets. T h e r e is very little i n t e r c e l l u l a r m a t r i x i n t h i s k i n d o f t i s s u e . T h e fibers are c r o w d e d i n b e t w e e n t h e c e l l s . Because of this lack of intercellular matrix,

B

t h e fat tissue h a s b e c o m e i n f l e x i b l e . I t i s therefore an effective inhibitor of energy and movement. T h e strap across t h e groin is particularly apparent in people w h o perform constant r e p e t i t i v e e x e r c i s e s s u c h a s sit-ups a n d l e g lifts. G y m n a s t s , f o r e x a m p l e , t e n d t o h a v e an almost horizontal line across t h e groin, f o r m i n g a shelflike ridge in t h e lower a b d o m e n . T h i s c a n b e felt a s a t o u g h m a r g i n halfway between the belly button and the pubic bone. The a b d o m e n immediately above t h e ridge i s n o t i c e a b l y m o r e p l i a b l e , less rigid to the touch. O n e o f o u r f r e q u e n t l a m e n t s is, " N o m a t t e r

A.S.I.S. Sacral pad'

, Inguinal band i Inguinal ligament -.Pubic bone

h o w m u c h I d i e t , I n e v e r s e e m t o g e t rid o f m y b e l l y ; i t still sticks o u t . " T h e b u l g e , h o w ever, h a s n o t h i n g t o d o w i t h a n e e d t o d i e t .

Figure 13-1 Inguinal band: Front and side views.

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T h e inguinal strap c o n t i n u e s a r o u n d t h e sides o f t h e h i p s . I t s e e m s t o c r o s s just b e l o w t h e u p p e r e d g e o f t h e h i p b o n e (crest o f t h e ilium). This creates a t e n s i o n across the b o n e a n d pulls t h e c o n n e c t i v e tissue i n t o folds. T h e s e folds c o m e i n t o b e i n g m u c h t h e way pulling on a c o r n e r of a sheet creates deep pleats in t h e fabric. Similarly, pulls across t h e b a c k o f t h e u p p e r p e l v i s a n d t h e s a c r u m give rise t o t e n d o n - l i k e s t r u c t u r e s a c r o s s t h e l o w e r b a c k . T h e s e c a n feel l i t e r a l l y like s m a l l r o p e s or cables under t h e skin. In s o m e individuals, i t a l m o s t feels a s t h o u g h t h e s e r o p e s h a v e k n o t s i n t h e m . T h e y f o r m a stressed c o n n e c tion across t h e upper margin of the sacrum a n d t h e l o w e r l u m b a r v e r t e b r a e , t y i n g left a n d r i g h t sides t o g e t h e r . M o s t "lower back p a i n " appears to c o m e from this region. These ropes tying together t h e t h r e e b o n e s ( s a c r u m a n d t w o ilia), i n h i b i t sacroiliac m o v e m e n t . This i m m o b i l i t y across Figure 13-2

Figure 13-3

t h e sacrum is t h e m a j o r contributor to lower b a c k s y n d r o m e . C h i l d r e n typically s h o w a lot

It is t h e b o d y ' s w a y of e s c a p i n g t h e restric-

of m o v e m e n t across t h e sacrum. This m o v e -

tions resulting from tightness above (chest

m e n t o f t e n d i s a p p e a r s i n l a t e r life, p r o b a b l y

strap) a n d t i g h t n e s s b e l o w (groin strap). Or

i n t h e t e e n s . W e all s e e m t o w a n t / n e e d t o

t h e tightness m a y b i n d at mid-belly; we talk

control pelvic m o v e m e n t .

a b o u t a strap there in Section 15. In general, t h e r e are t w o a b e r r a n t a b d o m i -

T h e i n g u i n a l b a n d b l e n d s i n t o t h e fascial and/or fatty pad normally present on the

nal patterns, each with variations. O n e is the

s a c r u m . W h e n this is t o o thick, it adds to t h e

individual whose lower belly is held in; his

i m m o b i l i t y of t h e area. T h e b a n d thereby is

back t h e n b e c o m e s taut and his upper belly

continued down to the tailbone (coccyx). In

b u l g e s (Fig. 13-2). T h e o t h e r p a t t e r n i s t h e

d e s i g n , it r e s e m b l e s a j o c k s t r a p or d a n c e r ' s

person w h o t i g h t e n s t h e area b e t w e e n t h e

belt. T h e b o t t o m part e x t e n d s d o w n b e t w e e n

l o w e r m a r g i n o f t h e rib c a g e a n d t h e b e l l y

t h e legs t o t h e V - s h a p e d b o n y b a s e o f t h e

b u t t o n . Here, t h e upper a b d o m e n b e c o m e s

p e l v i s . H e r e i t b l e n d s w i t h t h e fat a n d f i b r o u s

tight a n d t h e area b e l o w t h e belly b u t t o n

tissue t h a t is t h e n o r m a l filling of t h e space

p r o t r u d e s (Fig. 13-3). W h i c h e v e r p a r t is b e i n g

b e t w e e n t h e legs ( b e t w e e n t h e c o c c y x , p e l v i c

held, t h e o t h e r m u s t of necessity stick out;

rami, and pubic bone). W h e n the V of the

t h e tissue has to go someplace. N o t o n l y t h e

rami is compressed and too narrow, particu-

soft tissue b u t also b r e a t h needs space. People

l a r l y i n m e n , t h i s t i s s u e c a n feel like c e m e n t

breathe predominantly in the upper or lower

a n d i t o f t e n b e c o m e s a filler t h r o u g h t h e

a b d o m e n . In either case, t h e h o l d i n g inter-

w h o l e b a s i n o f t h e p e l v i s . T h u s straps are n o t

feres w i t h t h e f r e e f l o w o f b r e a t h , e n e r g y , a n d

o n l y surface p h e n o m e n a b u t traverse t h e

movement.

body space.

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T h e f r o n t o f t h i s b a n d i s e a s y t o see a n d feel a n d i s m u c h t h e s a m e i n all p e o p l e , a l t h o u g h it varies in degree of t e n s i o n . In back, in addition to t h e surface ropes t h a t run parallel a c r o s s t h e u p p e r m a r g i n o f t h e p e l v i s , t h e r e i s o f t e n a d e e p e r set o f t e n s i o n s n e a r t h e t o p a n d side o f t h e s a c r u m . T h i s i s a s s o c i a t e d with t h e fascia o f t h e gluteal m u s c l e s a n d runs f r o m t h e surface to deep in t h e pelvis, d o w n t o t h e b o n e . M a n y m e n are t o o n a r r o w at t h e base of t h e pelvis, b e t w e e n t h e legs. T h i s results i n a n a b d o m e n t h a t i s p r o p o r t i o n ally t o o w i d e i n f r o n t . T h e h i p b o n e l o o k s a s t h o u g h it wings out. This again adds to a wide abdominal contour. In m e n , t h e c o n n e c t i o n across t h e front of

Fascia of -erector spinae jlumbo-dorsal fascia) .Sacroiliac junction Fascia of -•gluteus maximus m.

t h e g r o i n s e e m s like a b a n d t r y i n g t o h o l d t h e lower a b d o m e n together. In w o m e n , t h e s a m e kind of narrowness is m o r e c o m m o n in back,

Jlio-tibial tract

across t h e sacrum. I n b o t h cases, t h e t e n s i o n on t h e outside of t h e pelvis produces a corresponding tension on t h e inside. There is a c o m p l e t e set o f m u s c l e s o n t h e i n s i d e o f t h e pelvis a s w e l l a s o n t h e o u t s i d e . T h e c o n n e c t i v e tissue o f t h e o u t s i d e m u s c l e s ( s u r f a c e ) relates t h e m o v e m e n t o f t h e lower b a c k r e g i o n t o t h e o u t s i d e ( l a t e r a l side) o f t h e leg

(Fig.

13-4).

T h e c o n n e c t i v e tissue o f t h e psoas e x t e n d s from the inside lower back to t h e inside (me-

Figure 13-4 The connective tissue of the surface muscles relates the movement of the lower back region to the outside (lateral side) of the leg.

dial side) o f t h e t h i g h a t t h e lesser t r o c h a n t e r (Fig. 13-5). T h e t w o f a s c i a l p l a n e s ( s u r f a c e

of t h e ilium w i n g out in front. T h e iliacus

and deep) b a l a n c e e a c h other. Tightness in

then tightens and is too short to function

o n e will b e reflected i n t h e o t h e r w i t h every

with ease. T h e b r i m of t h e pelvis is pulled

m o v e m e n t of t h e leg or pelvis.

forward and d o w n toward the pubic b o n e .

In walking, the most p r o m i n e n t l y involved

W h e n t h e iliacus is very short, t h e inside of

muscle structure f r o m inside t h e pelvis is t h e

t h e leg i s h e l d t o o tightly i n t o t h e h i p socket.

i l i o p s o a s a n d its a s s o c i a t e d f a s c i a . W e w i l l

T h e r e s u l t o f all t h i s i s a t e n s i o n a r o u n d t h e

discuss t h e p s o a s m u s c l e i n S e c t i o n 1 9 . T h e

p u b i c b o n e . A b a n d of strain (inguinal strap)

iliacus, t h e o t h e r part o f t h e iliopsoas c o m -

across t h e lowest part of t h e a b d o m e n

plex, lines t h e inside of t h e b o w l of t h e pelvis.

attempts to balance that internal shortness,

It diagonally crosses t h e p u b i c b o n e a n d

often resulting in a heavy fatty c o n n e c t i v e

a t t a c h e s o n t h e i n n e r p a r t o f t h e leg a t t h e

tissue b a n d o n top o f t h e p u b i c b o n e .

lesser t r o c h a n t e r . W h e n t h e p e l v i s i s b o u n d

In m e n , b o t h sexual f u n c t i o n and feelings

tightly in back, t h e anterior superior spines

a b o u t castration are c o n n e c t e d t o t h i s b a n d .

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Restriction in the groin and pubic region o f t e n serves t o b l o c k o r d a m p e n s e x u a l e n j o y m e n t . It's a l m o s t a s t h o u g h t h e p e n i s i s h u n g through the band, so that the tightness of the b a n d c a n b l o c k t h e o r g a s m i c w a v e t o t h e rest of t h e body. This limits sexual e n j o y m e n t to t h e penis. A n o t h e r e l e m e n t in sexual blocking is m e n ' s castration worries. These seem to be centered n o t around the scrotum, but at a m o r e lateral region of t h e groin where, before birth, t h e testes leave t h e protection of t h e b o d y . T h e y d e s c e n d b e t w e e n t h e t h i n layers o f t h e lower a b d o m i n a l wall d o w n i n t o t h e s c r o t u m b y w a y o f t h e i n g u i n a l c a n a l (Fig. 13-6). T h e inguinal canal is t h e target of a variety of problems, particularly in m e n . Inguinal hernias s e e m to be t h e result of excessive strain a n d postural h o l d i n g on an area that is vulnerable and unprotected. We have found that lessening the tightness of the groin b a n d Figure 13-5 This drawing from Dr. Ida Rolf's book on Rolfing illustrates the psoas and iliacus muscles on the inside of the pelvis. The connective tissue of these inside muscles of the pelvis connects the inner abdomen and inside lower back to the inside (medial side) of the thigh.

reduces t h e severity of t h e hernia or elimin a t e s it. T h e g r o i n a r e a i s t i g h t i n m o s t m e n , w h o o f t e n h a v e a " d o n ' t t o u c h " signal there such as ticklishness. For b o t h m e n a n d w o m e n , t h e b a n d often shows up in the breathing pattern; abdominal m o v e m e n t f r o m t h e b r e a t h g o e s a s far d o w n a s t h e b a n d i n g , n o t all t h e w a y d o w n t o t h e p u b i c b o n e . I n w o m e n , t h e strap i s m o r e c o m m o n l y focused deeper in t h e lower a b d o m e n , shelving u n d e r n e a t h t h e ovaries a n d func-

inguinal canal (pathway of spermatic cord)

Pathway of -"testes' d e s c e n t b e f o r e birth

tionally separating t h e ovaries from t h e geni t a l s . T h i s is a l a r g e f a c t o r in p r e m e n s t r u a l s y n d r o m e a n d the reason PMS so often does

Inguinal l i g a m e n t H (inferior j u n c t i o n of internal a n d external abdominal obliques) i

n o t yield to medication. T h e banding tends to be deep a n d shelflike, so that a c c o m m o d a t i o n of the necessary changes in posture caused by pregnancy is inhibited. In pregnancy, the w e i g h t o f t h e b a b y rests d o w n i n t o t h i s shelf, c a u s i n g i t t o b e c o m e t h i c k e r a n d less r e s i l i e n t . After b i r t h , t h e t h i c k e n e d b a n d r e m a i n s . T h e p e l v i c s t r a p w i d e n s i n b a c k , o f t e n ris-

Figure 13-6 Inguinal band and descent of testes.

ing as h i g h as t h e twelfth rib, where it m e s h e s w i t h t h e fascia o f t h e m u s c l e s a l o n g t h e spine.

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A s w e h a v e said, t h e b a n d a t m i d - c h e s t b l e n d s with t h e fascia of t h e dorsal h i n g e in t h e

(1) Junction at lambda/ sphenoid

region of t h e sixth dorsal vertebra. Clearly, therefore, t h e structural i n h i b i t i o n created by the bands influences spinal integration a n d

(2) Occipital-cervical

m o v e m e n t . In turn, restriction of m o v e m e n t at the junctions of the vertebral c o l u m n

- ( 3 ) Cervico-dorsal

increases t h e tightness of t h e bands. Interfere n c e in spinal f u n c t i o n leads to characteristic changes in posture and physical behavior. We

(7) Dorsal hinge

t h e r e f o r e digress t o d e s c r i b e s o m e a s p e c t s o f the structure and f u n c t i o n of t h e vertebral column in relationship to the bands. T h e muscles a n d fascia t h a t r u n longitudinally f r o m t h e n e c k to t h e s a c r u m are a c o m -

(4)Lumbo-dorsal

plex interweaving of layers. T h e y stabilize t h e variety of m o v e m e n t s of t h e different b o n y vertebrae that m a k e up the spinal c o l u m n . A l t h o u g h t h e vertebrae are similar in s h a p e ,

. ( 5 ) Lumbo-sacral

t h e y are d i f f e r e n t i n d e t a i l s o f d e s i g n a n d size. These differences imply differences in range

•(6)Sacro-coccygeal

and direction of m o v e m e n t . In general, the b a n d s relate to j u n c t i o n s of t h e spinal colu m n , places where t h e vertebrae c h a n g e shape. T h e s e j u n c t i o n s are b e t w e e n t h e h e a d

Figure 13-7 Junctions of the spine.

and neck (occipito-cervical), between the neck and chest (cervico-dorsal), between chest

On the inside of t h e body, just in front

and lower back (lumbo-dorsal), b e t w e e n lower

o f t h e s p i n e , lies t h e a u t o n o m i c n e r v o u s sys-

back and sacrum (lumbo-sacral), and between

t e m (ANS). T h i s runs l o n g i t u d i n a l l y f r o m t h e

the sacrum and tailbone (sacro-coccygeal).

b a s e o f t h e s p i n e u p i n t o t h e h e a d . A l o n g its

T h e d o r s a l h i n g e i s Ida Rolf's a d d i t i o n t o t h i s

l e n g t h t h e r e are a n u m b e r o f s p i n a l p l e x i .

list

T h e s e are i n t e r r u p t i o n s i n t h e flow o f i n f o m a -

(Fig.

13-7).

T h e change in vertebral shape at t h e dor-

t i o n a l o n g t h e system. T h e y serve m u c h t h e

sal h i n g e i s m o r e s u b t l e ; t h e c h a n g e i n m o v e -

same function as a busy t e l e p h o n e e x c h a n g e ;

m e n t pattern is m o s t visible in a living, m o v -

t h e y are places w h e r e n e u r a l messages c a n get

ing body. T h e reason for this a p p a r e n t l y is

t r a n s m i t t e d in diverse directions. G e n e r a l l y

that the change in function and morphology

s p e a k i n g , t h e ANS n e r v e p l e x i a r e l o c a t e d n e a r

here entails t h e soft tissue a n d o u t l y i n g b o n e s

t h e spinal j u n c t i o n s t h a t we listed a b o v e . It is

as well as t h e vertebrae t h e m s e l v e s . T h i s is

interesting to n o t e that these places of m a x i -

s o m e w h a t true everywhere along t h e spine,

m u m m o v e m e n t o f t h e spine are associated

of course, but it is m o r e i m p o r t a n t in t h e

w i t h c e n t e r s o f m o s t c o m p l e x ANS a c t i v i t y .

upper chest. T h e additional stabilizing influ-

W h e n t h e r e is ease of m o v e m e n t at t h e s e

e n c e f r o m t h e s h o u l d e r b l a d e a n d its s o f t tis-

junctions there can be stimulation of the

sue c o n n e c t i o n s t o t h e s e v e r t e b r a e m o d i f i e s

nervous impulses that control metabolic

their m o v e m e n t .

activity.

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As the embryo is enfolded in the w o m b , its b a c k d e s c r i b e s a C c u r v e (Fig. 13-8). As we h a v e said, t h i s is n o t a s m o o t h c u r v e ; it is a series o f b e n d s i n t h e b a c k . T h e s e b e n d s are l o c a t e d a t w h a t will b e c o m e t h e s p i n a l j u n c tures. T h e e m b r y o n i c C curve o p e n s after birth as t h e child explores a n d learns to stretch a n d l e n g t h e n . Ultimately, there is a c h a n g e in t h e direction of s o m e of t h e angles, creating t h e snake-like f o r m of an adult upright spinal c o l u m n . A

B

C

Figure 13-8 The embryonic C curve (A) straightens as the infant begins to walk (B) and later assumes the normal adult curves (C).

A

B

Figure 13-9 Developmental movement sequences: (A) intrauterine folding; (B) contralateral creeping; (C) crawling; (D) standing.

Bonnie Bainbridge Cohen's Developmental M o v e m e n t Sequences* graphically *See B o n n i e Bainbridge C o h e n , Sensing, Feeling, and Action: The Experiential Anatomy of Body-Mind Centering (Northampton, Massachusetts: Contact Editions, 1 9 9 3 ) .

C

D

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demonstrate h o w these flexures interact w i t h m o v e m e n t . As she describes t h e sequence, in

- (1) J u n c t i o n at

t h e first d a y s a f t e r b i r t h t h e n e w b o r n e x t e n d s

lambda / sphenoid

its h e a d . S o o n i t raises t h e h e a d , t h e n p u s h e s

(2) Occipital-cervical

o f f w i t h its h a n d s . Full m o b i l i t y i n c r e a s e s with homolateral m o v e m e n t s — f i s h l i k e swing-

-(3) Cervico-dorsal

i n g f r o m side t o side. T h e n c o n t r a l a t e r a l creeping a n d rocking prepare t h e b o d y for crawling

(Fig.

13-9). (7) Dorsal hinge

These m o v e m e n t s correspond to t h e activat i o n of b o t h t h e spinal flexures a n d t h e assoc i a t e d ANS p l e x i : (1) j u n c t i o n a t t h e s p h e n o i d (see S e c t i o n 1 4 o n t h e e y e b a n d , b e l o w ) ; (2) j u n c t i o n b e t w e e n h e a d a n d n e c k ; (3) j u n c t i o n

(4)Lumbo-dorsal

b e t w e e n n e c k a n d c h e s t ; (4) j u n c t i o n b e t w e e n c h e s t a n d l o w e r b a c k ; (5) j u n c t i o n b e t w e e n l o w e r b a c k a n d s a c r u m ; (6) j u n c t i o n b e t w e e n

(5)Lumbo-sacral

s a c r u m a n d c o c c y x ; (7) j u n c t i o n a t d o r s a l h i n g e (Fig.

13-10). C o h e n h a s n o t e d t h a t -(6)Sacro-coccygeal

w h e n a part of this s e q u e n c e is o m i t t e d in childhood, there can be dysfunction, and that this dysfunction is correctable even in the adult as t h e missing m o v e m e n t pattern is

Figure 1 3 - 1 0 Spinal junctions.

practiced. There is often resistance to activati n g s o m e o r all o f t h e s e s p i n a l j u n c t i o n s . T h e

they compress the b o d y at spinal junctions.

r e a s o n s r e l a t e t o m a n y life t r a u m a s . O n e o f

T h e straps c r e a t e a s y s t e m o f t r a n s v e r s e r e i n -

t h e m o s t j o l t i n g c a n c o m e very early i n life.

forcing structures w h e r e w e d o n ' t w a n t t o (or

D a n g l i n g a n e w b o r n b y its f e e t a t b i r t h s h o c k s

can't) trust t h e u n d u l a t i o n s of an upright

t h e safety of t h e curve w i t h a l m o s t a s n a p p i n g

spine. Their t e n d e n c y is to pull us forward

m o v e m e n t . T h e resulting position as t h e child

and d o w n in front. Kinesthetically, this is

hangs head back and spine locked in a back-

sensed as resistance to the feeling of openness

ward curve causes an acute w r e n c h i n g a n d

that comes with being upright. It isn't that

ripping of fragile fascial c o n n e c t i o n s . T h i s

t h e s p i n e ( a n d t h e b o d y ) c o n t r a c t s ; it's t h a t

is very similar in effect to a w h i p l a s h i n j u r y

it refused to o p e n u p . E m o t i o n a l l y , we feel

in an auto accident.

t h a t s a f e t y lies i n t h e c u r l e d - i n - o n - o n e s e l f

M o s t people u n c o n s c i o u s l y try to retain

p o s i t i o n . It's r e a l l y a r e m e m b e r e d safety. T r u e

s o m e part of their fetal curve. T h e b o d y

a d u l t s t a b i l i t y a n d s a f e t y lie i n b e i n g u p r i g h t ,

straps are a w a y o f f o s t e r i n g t h i s b e c a u s e

flexible, a n d resilient.

FOURTEEN

The Eye Band and Chin Band T h e r e are t w o straps t h a t restrict m o v e m e n t o f t h e h e a d — a c h i n strap a t t a c h e d at t h e j u n c t i o n b e t w e e n t h e atlas a n d t h e o c c i p u t a n d a n o t h e r strap t h a t seems to go right across t h e e y e s like a m a s k . B e c a u s e o f t h e t e n s i o n t h a t these straps spread t h r o u g h t h e h e a d , m o s t o f u s a r e n ' t a b l e t o s e n s e t h e b a l a n c e o f t h e cran i u m a s a w h o l e . H a b i t u a l t e n s i o n i n t h e surf a c e t i s s u e o f t h e skull c h a n g e s t h e r e l a t i o n s o f t h e b o n e s . T h e b o n e s i n v o l v e d are n o t o n l y t h e larger e x t e r n a l b o n e s o f t h e cranial vault a n d jaw, b u t a l s o a c o m p l e x a r r a n g e m e n t o f delicate b o n e s centering a r o u n d t h e eyes a n d b a c k t h r o u g h t h e skull a t e y e l e v e l . T h e s t r a p like t e n s i o n f r o m t h e surface generalizes to t h e s e b o n e s . T h e areas indirectly affected include the brain stem, the limbic system, and the pituitary a n d pineal glands.

Figure 14-1 Eye strap.

T h e e y e s t r a p lies r o u g h l y a c r o s s t h e e y e s a n d a b o v e t h e ears (Fig. 14-1). I n t h e b a c k , i t is at about the main junction of bones of the skull. Starting at t h e f r o n t m i d l i n e , this b a n d crosses t h e muscles o n t h e bridge o f t h e nose, the circular muscles ringing t h e eye sockets, t h e u p p e r m u s c l e s t h a t let y o u w i g g l e y o u r

Frontal

e a r s , a n d t h e t e m p o r a l i s m u s c l e a n d its f a s c i a a t t a c h i n g t o t h e jaw.

Lacrimal

T h e eye socket is c o m p o s e d of a fusion of a n u m b e r o f b o n e s (Fig. 14-2). T h e u p p e r p o r -

Sphenoid Zygomatic

tion is the frontal b o n e , w h i c h continues on as t h e m a j o r b o n e of t h e forehead. Medially, t h e r e are lacrimal a n d e t h m o i d b o n e s , w h i c h

Ethmoid

also f o r m t h e upper medial part of t h e nasal

Maxillary

cavity. T h e lower part of t h e orbit is a c o n t i n u a t i o n of t h e maxilla (upper jaw). Laterally there is the zygomatic bone, which continues a s a b o n y a r c h t o w a r d t h e ear. P o s t e r i o r l y ( t h e

Mandible

back of the orbit) there is the sphenoid b o n e , w h i c h also forms part of a shelf below t h e b r a i n . T h e s e b o n e s are tied t o g e t h e r b y sutures t h a t a n a t o m i s t s consider to be

Figure 14-2 Bones of the eye socket.

THE

Anterior fontanelle Posterior fontanelle

EYE

BAND

AND

CHIN

69

BAND

tiny increments of movement, they nevertheless s i g n i f i c a n t l y a f f e c t f a c i a l e x p r e s s i v e n e s s a s well as t h e free use of t h e senses—sight, hearing, smell, taste.

Anterolateral fontanelle

Tension across t h e orbit of t h e eye c a n result in a n a r r o w i n g of t h e entire facial r e g i o n . T h e b o n e s o f t h e o r b i t are s q u e e z e d together. There is chronic tension in the eye

Posterolateral fontanelle

s o c k e t a n d o n t h e e y e b a l l itself. G o o d v i s i o n relies o n m i n u t e m u s c u l a r a d a p t a t i o n s f o r

Figure 14-3 Fontanelles are locations of non-fusion between bones in the fetal and infant skull. The dotted line embryologically is the site of the first flexure of the body.

n e a r a n d far v i s i o n . A s w e s a i d , c o n n e c t i v e tissue is t i g h t e n e d — l o s e s a d a p t a b i l i t y — w h e n its a s s o c i a t e d b o n e s are c o m p r e s s e d . Prolonged immobility and compression in the socket distort t h e shape a n d adaptability o f t h e e y e b a l l itself. T h i s m a y a c c o u n t f o r a n u m b e r o f c o m m o n visual problems. W h e n , t h r o u g h h a b i t u a l t e n s i o n s , t h e eyes are fixed

Frontal

Ethmoid -Sphenoid

i n o n e attitude, t h e free range o f e m o t i o n a l expression is also d i m i n i s h e d . This t o p m o s t b a n d relates t o t h e suture c a l l e d l a m b d a (at t h e p o s t e r i o r f o n t a n e l l e ) . T h i s is n o t as o b v i o u s l y a spinal flexure as are t h e vertebral flexures. In e m b r y o l o g i c a l terms,

'Temporal

it is t h e fusion of t h e apical (topmost) b o n e s . I n f a c t , e m b r y o l o g i c a l l y t h i s i s t h e site o f t h e first f l e x u r e of t h e b o d y (Fig. •Parietal Occipital

14-3).

We have talked about the sphenoid b o n e in relationship to t h e eye socket. T h e sphen o i d c a n also be considered t h e h u b of t h e b o n y skull w h e n s e e n f r o m a b o v e (Fig.

14-4).

I t i s s h a p e d like a b u t t e r f l y w h o s e w i n g s r e a c h Figure 14-4 Notice the juncture between the sphenoid and occipital bones at the base of the skull. This interface is the focus of most cranial manipulation.

t o t h e s u r f a c e o f t h e h e a d i n t h e flat a r e a j u s t l a t e r a l t o t h e e y e s . B e c a u s e o f its l o c a t i o n , t h e s p h e n o i d c a n get locked in place as a result of tensions from t h e surface. W h e n t h e eye b a n d tightens, the sphenoid can't move. Converse-

immovable joints. William Sutherland,* the originator of cranial osteopathy, realized t h a t slight inter-

ly, w h a t h a p p e n s o n t h e i n s i d e o f t h e h e a d i s reflected on t h e surface. O n t h e c o v e r o f The Protean Body b y D o n

osseous m o v e m e n t s , w h i c h he termed the

J o h n s o n / there is a drawing of the sphenoid

b r e a t h i n g o f t h e skull, a r e n e c e s s a r y f o r t h e

f l o a t i n g i n t h e air. S e e n like t h i s , i n i s o l a t i o n

h e a d t o f u n c t i o n . A l t h o u g h t h e s e are v e r y

f r o m t h e rest o f t h e b o n e s o f t h e c r a n i u m , i t

*See William G. Sutherland, The Cranial Bowl (Meridian, Idaho: The Cranial Academy, 1 9 4 8 ) .

t S e e D o n J o h n s o n , The Protean Body (New York: Harper & Row, 1 9 7 7 ) .

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r e s p o n d freely, t h e o t h e r e n d p o i n t i s a l s o restricted, inhibited, or immobilized. T h e strap just under a n d including t h e c h i n (Fig. 14-5) is r e l a t e d to t h e j u n c t u r e of t h e h e a d w i t h t h e first t w o v e r t e b r a e o f t h e n e c k . This is the juncture of the occiput with the a t l a s a n d a x i s . I t i s v e r y m u c h like t h e k i n d o f c h i n strap advertised in t h e b a c k pages of an o l d - t i m e f a s h i o n m a g a z i n e , d e s i g n e d t o lift sagging or double chins. It surrounds and binds d o w n a floating b o n e on the front of the neck called the hyoid. This U-shaped b o n e defines the angle between the chin and the throat. The hyoid anchors many of the so-called strap m u s c l e s of t h e throat. It is t h e keystone of the bridge b e t w e e n breastbone ( s t e r n u m ) a n d t h e a n g l e o f t h e jaw. Like a n y o t h e r place o f m u s c l e a t t a c h m e n t , t h e h y o i d is a focus of tissue buildup w h e n Figure 14-5 Chin and collar straps.

there is habitual t e n s i o n . It is tugged downw a r d w h e n t h e s t r a p m u s c l e s o f t h e t h r o a t are o v e r l y t e n s e (Fig. 14-5). T h i s is s e e n as a d o u -

is easily m i s t a k e n for t h e b o n y pelvis. This similarity is m o r e t h a n visual. In fluid b o d y m o v e m e n t , s p h e n o i d a n d pelvis m o v e i n

ble c h i n . The band continues from the hyoid and u n d e r t h e c h i n i n a n upward p a t h across t h e

concert and reciprocally If one doesn't move,

a n g l e o f t h e jaw. I t f r e q u e n t l y f o r m s a p a d o n

t h e o t h e r i s i n h i b i t e d i n its m o v e m e n t , a s h a s

t h e a n g l e o f t h e jaw, j u s t b e l o w t h e ear. W h e n

been demonstrated in Sutherland's cranial

t h e b a n d is particularly tight, an increasingly

osteopathic work. A further relationship

d e n s e a n d d e e p p a d o f tissue v i r t u a l l y i m m o -

b e t w e e n s p h e n o i d a n d t h e b o n y p e l v i s lies

b i l i z e s t h e a n g l e o f t h e jaw. T h e j a w i s b o t h a

i n t h e fact t h a t t h e y b o t h h o u s e i m p o r t a n t

sliding a n d a hinged joint. W h e n the jaw is

e n d o c r i n e g l a n d s . T h e p i t u i t a r y g l a n d lies i n

strapped back, t h e sliding m o t i o n is limited

an indentation at the center of the sphenoid.

a n d m a y d i s a p p e a r . As we see it, t h i s is a

The gonads develop within the protection of

m a j o r factor underlying temporo-mandibular

t h e b o n y pelvis.

joint (TMJ) problems.

Cranial osteopaths have m a d e the obser-

The continuation of the band thickens

vation that the sphenoid rocks. There is s o m e

around the mastoid process b e h i n d and below

controversy about whether this m o v e m e n t is

t h e e a r a n d g o e s o n t o restrict t h e j u n c t i o n

t h e result of an i n h e r e n t b o d y r h y t h m or a

b e t w e e n t h e occiput, atlas, a n d axis. W h e n

response to the r h y t h m of the breathing. In

this h a p p e n s , n o d d i n g b e c o m e s a n effort a n d

either case, the m o v e m e n t is observable and

the head's gliding response to walking is

palpable. We have seen this rocking reflected

bound down.

b e t w e e n pelvis a n d s p h e n o i d . W h e n o n e o f the endpoints of this flow can no longer

T h e a c t u a l j u n c t i o n o f t h e skull w i t h t h e t o p t w o v e r t e b r a e i s c o v e r e d b y a h e a v y fascial p a d

I II I

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about an inch thick. This is o n e example

this generalizes tension into t h e back of t h e

where a natural p a d d i n g in t h e b o d y c a n serve

tongue. We don't think of the tongue being

a s p a r t o f a s u r f a c e b a n d s u c h a s w e are d e s c r i b -

tense, but it can be. Moreover, the condition

i n g . T h e d i f f i c u l t y arises w h e n t h e t e n s i o n i s

of the esophagus and trachea is under the

excessive a n d b e c o m e s a tight surface strap.

influence of these tensions. Voice students,

Extreme tension at the back of the head

for e x a m p l e , learn to release these t e n s i o n s

p u s h e s t h e skull b o n e s t o o far f o r w a r d o v e r

a n d c o n t r o l t h e s e tissues w i t h m i n u t e

the neck bones, giving the appearance of a

awareness.

v e r y flat b a c k o f t h e h e a d . A s t h e b a n d c o n tracts a n d distorts t h e p o s i t i o n o f t h e h y o i d ,

Figure 14-6 Upper body bands.

Visualization of the upper body bands on p h o t o g r a p h s i s s h o w n i n Figure 1 4 - 6 .

FIFTEEN

The Collar Band, Umbilical Band, and Groin Band Like t h e c h i n s t r a p , t h e n e x t s t r a p — t h e c o l l a r

a c r o m i o n just in front of t h e shoulder joint.

strap (Fig.

T h i s is t r a d i t i o n a l l y d e s i g n a t e d as a s l i g h t l y

15-1)—is of g r e a t i m p o r t a n c e to

singers, w h e t h e r o p e r a o r s h o w e r s i n g e r s . I t

movable joint, w h i c h can be a misleading

involves primarily t h e base of the throat, t h e

c o n c e p t . For e x a m p l e , in a w h e e l w i t h ball

upper tip of t h e lungs, a n d t h e upper m a r g i n

bearings, t h e ball bearings m o v e o n l y slightly.

of t h e shoulders. W h e n this strap is very

But if o n e is stuck, t h e larger m o v e m e n t of

t i g h t , its m o s t s t r i k i n g f e a t u r e is a t i g h t n e s s

t h e wheel stops or eccentrically grinds d o w n

underneath the Adam's apple where the two

its c o m p o n e n t s .

clavicles (collarbones) m e e t t h e s t e r n u m

T h e strap c o n t i n u e s t o w a r d t h e b a c k a l o n g

(breastbone). T h e m o s t c o m m o n result i s

the inner and outer margin of the scapula. It

compression around the base of the neck.

ends b y spreading o u t over t h e area o f t h e

T h e c o l l a r b o n e s are t i g h t l y g l u e d d o w n t o

dowager's h u m p — f r o m t h e upper medial tip

t h e u p p e r ribs i n f r o n t a n d t i g h t l y h e l d t o t h e

of the scapula to the cervicothoracic j u n c t i o n .

upper margins of t h e shoulder blades (scapu-

T h i s s t r a p a t t h e b a s e o f t h e t h r o a t , like t h e

lae) i n t h e b a c k . D e e p h o l l o w s a t t h e b a s e o f

o t h e r straps, c a n be c o m p a r e d to a p i e c e of

t h e n e c k , just b e h i n d t h e c o l l a r b o n e s , are

c l o t h in w h i c h part of t h e weaving is very

evidence of t e n s i o n w h e n this strap h a s

tight a n d part of it is very loose. T h e tightest

b e c o m e too tight.

area b i n d s t h e clavicle a n d t h e u p p e r part of

In front, t h e strap seems to e n c l o s e t h e

t h e s c a p u l a . T h e l o o s e r e x t e n s i o n s b r o a d e n its

w h o l e length of t h e c o l l a r b o n e as well as t h e

influence out i n t o the upper part of t h e arm,

two u p p e r m o s t ribs. It includes a small m u s c l e

pulling the arm in closer to the b o d y and

called the subclavius. This c o n n e c t s the m i d dle s e c t i o n o f e a c h c o l l a r b o n e t o t h e first a n d s e c o n d ribs a n d c o n t i n u e s a s l i g a m e n t s t o t h e sternum and coracoid process, medially a n d laterally, r e s p e c t i v e l y . T h i s s m a l l m u s c l e i s active in respiration w h e n t h e c o l l a r b o n e m o v e s i n relation t o t h e ribs. W h e n t h e fas-

Fascia of _ scalene m Hyoid bone Collar strap

.Fascia of strap m.

cial c o v e r i n g o f t h e m u s c l e i s t h i c k e n e d , t h e

• Clavicle

subclavius is i m m o b i l i z e d b e t w e e n t h e t w o bones. T h e collar strap c o n t i n u e s a l o n g t h e clavicle t o t h e t i p o f t h e s h o u l d e r b l a d e ( a c r o m i o n ) . T h i s p r o j e c t s like a b o n y s h e l f o v e r

Coracoid process

Acromion Scapula

the t o p m o s t part of t h e arm b o n e (humerus). W h e n there is a heavy pad on top of the acromion, any m o v e m e n t is inhibited b e t w e e n clavicle a n d scapula a n d acts as a brake o n t h e lateral (sideways) m o v e m e n t of the arm. T h e clavicle articulates with t h e

Figure 15-1 The collar strap.

•Sternum

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r o t a t i n g i t s l i g h t l y o u t o f its s o c k e t . O t h e r

h o r i z o n t a l direction a n d in t h e vertical cross-

fibers e x t e n d i n t o t h e a r m p i t , c l o s i n g t h e

b a n d i n g s . W h e n b o t h pulls are unusually

a r m p i t a n d c o m p r e s s i n g t h e upper ribs. T h e s e

s t r o n g , t h e w h o l e area b e c o m e s a t h i c k e n e d

c o n c e n t r a t i o n s o f fibers w e c a l l s t r a p s n o t

mass of tissue.

o n l y c i r c l e t h e b o d y o n its s u r f a c e b u t h a v e

This k i n d of i n t e r a c t i o n also occurs

a third dimension going deep inside, crossing

b e t w e e n t h e c h i n strap a n d t h e collar strap,

t h e b o d y like a shelf. In t h e collar strap, t h e

and it strongly influences the front of the

shelf c a n be seen on t h e surface of t h e body.

throat. Four muscles ( c o m m o n l y termed the

It crosses over t h e o f t e n - h o l l o w spot in t h e

strap muscles) a t t a c h t h e h y o i d b o n e t o t h e

base of the neck containing the scalene mus-

u p p e r t i p o f t h e b r e a s t b o n e . T h e larger ster-

c l e s (Fig. 15-1). T h e u n d e r s i d e o f t h e s c a l e n e s

n o c l e i d o m a s t o i d overlies these a n d provides

c a n a n d o f t e n does h a v e a fascial c o n n e c t i o n

a direct vertical c o n n e c t i o n between t h e

to t h e upper tip of t h e lungs. Very few of us

t w o s t r a p s . C h r o n i c t e n s i o n i n t h e fascia

are aware t h a t lungs e x t e n d so h i g h up in t h e

surrounding these muscles brings the front

body, a n d a m i n i s c u l e n u m b e r of us m a k e use

p a r t o f t h e t w o straps c l o s e r t o g e t h e r , a s c a n

of this upper tip of our respiratory capacity.

be seen in people w h o "lead with their

Two characteristic m o v e m e n t patterns reinforce t h e tightness of this strap—compressing

chins." T e n s i o n i n t h i s area a f f e c t s s p e e c h a s

the armpits and h u n c h i n g the shoulders.

well as m o r e c o m p l e x vocalizations such as

Armpit c o m p r e s s i o n is a k i n d of guarding,

singing or playing a wind instrument. Any

protecting the body because of ticklishness,

stressful s i t u a t i o n c a n s e r v e t o t i g h t e n t h e

habitual anxiety, protecting t h e breasts, etc.

t h r o a t a r e a . W h e n a n g r y , o n e ' s v o i c e m a y rise

Shoulders pulled up c a n also be a response

o r w o r d s m a y n o t c o m e o u t . I n grief w e g e t

to perpetual anxiety, or it can be carrying the

" a l l c h o k e d u p . " T h i s i s a t least p a r t o f t h e

weight of the world on your shoulders. Mind-

m e c h a n i s m t h a t u n d e r l i e s fear o f p u b l i c

set v e r y q u i c k l y b e c o m e s b o d y s e t . B o t h r e s u l t

speaking.

i n l a c k o f m o b i l i t y i n t h e u p p e r ribs a n d a kind of breathless feeling. Like t h e o t h e r s , t h e collar strap is present

T h e c h e s t s t r a p (see S e c t i o n 1 2 ) i n t e r a c t s w i t h t h e c o l l a r s t r a p v i a t h e c o n n e c t i v e tissue of t h e pectoralis m a j o r ; this c a n cause a verti-

i n all b o d i e s t o o n e d e g r e e o r a n o t h e r . S o m e -

cal c o m p r e s s i o n on t h e upper chest. Reduced

times it is visible as a light b a n d i n g on t h e

r a n g e o f m o t i o n i n t h e s h o u l d e r ( c o l l a r strap)

s u r f a c e . S o m e t i m e s i t i s less v i s i b l e b u t c a n b e

correlates with lack of m o v e m e n t in the up-

felt as a very tight b a n d a l m o s t at b o n e level.

per ribs a n d shortness of breath. Tightness

Very d e e p h o l l o w s in t h e body, areas t h a t are

f r o m b o t h o f t h e s e straps i n t o t h e a r m p i t

ticklish or painful to t h e touch, and marked

inhibits freedom of m o v e m e n t of the arm

c h a n g e s i n c o l o r a r e all i n d i c a t i o n s o f c h a n g e

at t h e shoulder joint f r o m above and below.

in c o n n e c t i v e tissue fluidity a n d b o d y flexibility. Functionally, t h e straps overlap. For e x a m ple, t h e eye strap a n d t h e c h i n strap pull o n

T h e strap associated with t h e u m b i l i c u s (Fig. 15-2) i n t h e f r o n t a n d t h e l u m b o - d o r s a l hinge in the back tends to make the body

e a c h o t h e r i n t h e r e g i o n j u s t b e h i n d t h e ear.

look as t h o u g h it were divided into an upper

Both act on t h e m o v e m e n t of t h e jaw a n d

a n d a l o w e r h a l f . It is v a r i a b l e in its p o s i t i o n

t h e tipping of t h e head. W h e r e strong vertical

r e l a t i v e t o t h e u m b i l i c u s . I t c a n r u n just u n d e r

m u s c u l a r a n d fascial pulls cross t h e b a n d s , t h e

t h e s m a l l c a r t i l a g e a t t h e b o t t o m o f t h e ster-

s t r a p t h e n b e c o m e s l o c a l l y d e n s e r b o t h i n its

n u m (the x i p h o i d process), a few i n c h e s

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BAND,

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BAND

75

above the umbilicus. It m a y run directly across t h e u m b i l i c u s , f o r m i n g a deep i n d e n tation e x t e n d i n g o u t to either side. Or it m a y e x t e n d across t h e a b d o m e n an i n c h or so b e l o w t h e u m b i l i c u s (Fig.

15-3).

T h e b a n d c o n t i n u e s t o w a r d t h e sides, i n m o s t cases a little b e l o w t h e arch of t h e ribs. It seems to run b o t h inside a n d outside t h e ribs, g e n e r a l l y p u l l i n g t h e free e n d s o f t h o s e ribs d e e p i n s i d e t h e b o d y . I n d o i n g s o , i t m a y

11th&12th, ribs

compress t h e a c t i o n of t h e lateral part of t h e

•Umbilicus •Umbilical strap

d i a p h r a g m . T h e strap c o n t i n u e s t o t h e b a c k by way of t h e twelfth rib i n t o t h e l u m b o dorsal j u n c t i o n , o f t e n i m m o b i l i z i n g t h e free tips o f t h e t e n t h a n d e l e v e n t h r i b s . T h e r e i s s o m e s e m b l a n c e of this strap in e v e r y o n e . At t h e sides, i t i s a c o m p o n e n t o f t h e v e r y c o m m o n t e n s i o n c e n t e r e d o n t h e free m a r g i n s o f t h e l o w e r r i b s . T h e t i p o f t h e e l e v e n t h rib i s pulled deep into the b o d y in m o s t people.

Figure 15-2 Note that the area of the eleventh and twelfth ribs is the lumbo-dorsal junction.

Ideally, t h e e l e v e n t h rib lies j u s t b e l o w a t h i n sheath of muscle and skin and establishes the width of the lower chest in t h e back. H o w deeply it is pulled into t h e b o d y seems to influence t h e position of t h e strap (and vice v e r s a ) . I t i s p o s s i b l e f o r t h e t w e l f t h rib t o b e deflected d o w n almost to t h e rim of t h e p e l v i s . S i m i l a r l y , t h e e l e v e n t h rib c a n b e pulled d o w n toward t h e pad o n t h e crest of the hip bone. T h e free r i b s — t e n t h , e l e v e n t h , a n d t w e l f t h —are attached to the diaphragm and establish its w i d t h a n d r a n g e o f m o v e m e n t . T h e u m b i l ical s t r a p i s t h u s c l o s e l y a s s o c i a t e d w i t h t h e

Costal arch

Umbilicus

Umbilical ^trap (variable locations)

d i a p h r a g m o n t h e side. T h e r e s u l t o f t i g h t n e s s in t h e strap is a d i a p h r a g m t h a t is f u n c t i o n ally a n d s t r u c t u r a l l y t o o n a r r o w a n d c o n s e quently overworked. Breathing capacity is more labored and the diaphragm begins to a c t like a r e t a i n i n g s h e l f a c r o s s t h e b o d y . A n e x t r e m e version of this is k n o w n as a pigeon breast. T h e pubic or groin strap is t h e lowest strap i n t h e a b d o m e n (Fig. 15-4). I t m a y b e s e e n o n

Figure 15-3 The location of the umbilical strap is variable

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the front of the body in the dense pad of c o n n e c t i v e tissue on t h e surface of t h e pubic b o n e . It c o n t i n u e s sideways a r o u n d t h e body, crossing the groin. A diagonal heavy ligament (the inguinal ligament) connects the anterior superior spines o f t h e h i p b o n e t o t h e lateral points of the pubic b o n e . This is crossed by t h e h o r i z o n t a l p u l l o f t h e p u b i c b a n d . After i t crosses t h e inguinal ligament, t h e b a n d c o n t i n u e s l a t e r a l l y o v e r t h e g r e a t e r t r o c h a n t e r (at the top of the thigh bone), mixing with the b u i l d u p o f fat a n d f i b r o u s t i s s u e s o o f t e n f o u n d o v e r t h a t p r o t u b e r a n c e . T o t h e rear, it runs deep to the lower border of the gluteus m a x i m u s (Fig.

15-5), e n d i n g a t t h e j u n c t i o n

of the sacrum with the tailbone (coccyx). Posteriorly, it c o n t r i b u t e s to (and s o m e t i m e s forms) t h e gluteal fold. It blends into t h e

Figure 15-4 Groin strap, anterior view (also showing inguinal strap and ligament).

heavy pad f o u n d on t h e ischial tuberosities (sitting b o n e s ) . S t r o n g cross-pulls are associated w i t h this b a n d . In the center front, there is a vertical c o n n e c t i o n b e t w e e n t h e rib c a g e a n d t h e pubic crest associated w i t h t h e rectus abdom i n i s a n d its c o n n e c t i v e t i s s u e (Fig. 15-6). This vertical retaining b a n d for t h e front of t h e b o d y is very c o m m o n l y h y p e r t o n e d (overstrong). T h i s relates to o u r cultural preference f o r a flat b e l l y a n d t o o u r t e n d e n c y t o o v e r e x ercise. T h e act of habitually sucking in t h e belly itself s h o r t e n s t h e front of t h e body. O n e i t h e r side o f t h e p u b i c b o n e , crosspulls o n t h e b a n d t e n d t o b e s o m e w h a t o b l i q u e . O n e arises f r o m t h e l o w e r m a r g i n

Figure 15-5 Groin strap, posterior view.

of the oblique muscles of the abdomen as t h e y c o m e d o w n t o f o r m t h e i n g u i n a l liga-

as a V-shaped t h i c k e n i n g on t h e inside of

m e n t . As t h e strap crosses t h e greater

t h e legs, a l o n g t h e p u b i c r a m u s . T h e strap

t r o c h a n t e r o f t h e f e m u r , t h e r e are p u l l s f r o m

i s s p l i t — p a r t o f i t g o e s b e t w e e n t h e legs a n d

b e l o w , c o m i n g f r o m t h e leg, a n d f r o m a b o v e ,

part goes a r o u n d t h e legs.

c o m i n g f r o m t h e crest o f t h e hip b o n e .

T h e p u b i c strap is a c o m p l e x weaving in

As was t h e case in t h e collar strap, s o m e

a n d out of t h e b o n y structure at the base of

o f t h e fibers o f t h e p u b i c b a n d run d e e p t o

t h e a b d o m e n . T w o internal cross-structures

t h e h i p j o i n t r a t h e r t h a n a c r o s s its o u t e r sur-

are l o c a t e d h e r e — t h e pelvic a n d urogenital

f a c e , a l t e r i n g t h e w a y t h e f e m u r tits i n t o t h e

diaphragms. The internal extension of the

h i p socket. In addition, parts of t h e strap exist

p u b i c strap is c o n t i n u o u s w i t h t h e c o n n e c t i v e

THE

COLLAR

BAND,

UMBILICAL

BAND,

AND

GROIN

BAND

77

tissue of b o t h of t h e s e . In turn, these diap h r a g m s are p e n e t r a t e d by, a n d c o n t i n u o u s with, the musculature of the rectum, urethra, and vagina

(Fig.

15-7).

The location of the tailbone is important because it is o n e e n d of support for t h e h a m m o c k c a l l e d t h e p e l v i c f l o o r . I t i s a l s o , a t its connection with the sacrum, the endpoint of t h e p u b i c strap. Unfortunately, t h e t a i l b o n e is one of the most vulnerable and accidentprone locations in t h e body. Children repeate d l y fall b a c k w a r d o n t o t h e i r t a i l b o n e s . I n l a t e r life, a c c i d e n t s i n v o l v i n g b i c y c l e s , r o l l e r skates, a n d m a n y t e a m sports s e e m s o m e h o w t o f o c u s o n t h e t a i l b o n e a n d its a p t i t u d e f o r getting j a m m e d . In general, we don't consider t h i s d a m a g e — n o b o n e i s b r o k e n , i t i s n ' t serious. But this can be o n e of the longest lasting kinds of imbalance in the body. A w r e n c h e d Figure 15-6 Groin strap with rectus abdominis.

tailbone has no support to pull it b a c k i n t o position; no o n e has ever seen a plaster cast on a tailbone. Most doctors, bodyworkers, a n d sports trainers d o n ' t t h i n k t h e c o c c y x is very i m p o r t a n t . To us, seen a n a t o m i c a l l y , it is r e m i n i s c e n t of t h e tip of an arrow. T h e Vshaped sacrum is t h e arrowhead, a n d t h e vert e b r a l c o l u m n i s t h e s h a f t . T h e c o c c y x , like t h e arrow tip, guides t h e direction of m o v e ment; the spine compensates by flexion, extension, and rotation. W h e n the pubic strap t i g h t e n s d o w n , it reduces flexibility, c e m e n t i n g t h e c o c c y x i n t o a fixed attitude. T h e pelvic a n d p u b i c straps h a v e very h e a v y vertical i n t e r c o n n e c t i o n s in front a n d back. In front this is partly the c o n t i n u a t i o n of t h e lower rectus a b d o m i n i s fascia as it traverses t h e a p r o n o f t h e pelvic strap t o w a r d t h e pubic strap. It has sideways ramifications that thicken the inguinal ligament. In the back, t h e t w o straps are c o n n e c t e d by a h e a v y pad on b o t h the inside and the outside of the sacroiliac j u n c t i o n . This configuration, with the connections in front and back, and the

Figure 15-7 The pelvic and urogenital diaphragms.

straps b e t w e e n , gives a m o d i f i e d " j o c k s t r a p " or "chastity belt" under t h e skin.

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Figure 15-8

BODY

Figure 1 5 - 9

RETINACULAE

(B A N D S / S T R A P S)

79

PART

FOUR

Anatomy and Function

SIXTEEN

Proprioception

Internal Body Awareness M o v e m e n t can be evaluated from the outside

o k a y t o zip y o u r fly a n d b r a g a b o u t t h a t . It's

by a trained observer. It is evaluated f r o m t h e

okay as a teenager to be athletic and to show

inside by proprioception. This is t h e internal

o f f y o u r p h y s i c a l p r o w e s s . It's n o t o k a y t o

physical sensation of position in three-dimen-

swank your hips or push out your breasts.

sional space. Most of us c a n sense our bodies

W h e n w e g i v e u p t h e f r e e d o m t o feel o u r

to s o m e degree. W h e n we t u n e in, however, it

bodies in this way, it is n o t a f r e e d o m easily

is surprising h o w m a n y parts of our bodies we

regained. T h e teenager w h o chooses n o t to

d o n ' t f e e l . For e x a m p l e , m o s t p e o p l e w a l k

feel m o v e m e n t i n h i s o r h e r h i p s m a y f i n d a s

around with one shoulder higher than the

an adult t h a t t h e r e is a loss of sexual feeling.

other, o n e eyebrow higher t h a n t h e other, etc.

Pelvic m o v e m e n t , sexual identity, a n d t h e

Yet w e are rarely a w a r e o f t h i s . W e a r e s t a r t l e d

like a r e l o a d e d a r e a s o f a w a r e n e s s . E v e n i f w e

w h e n s o m e o n e points it out, and usually find

turn to s o m e t h i n g neutral, such as throwing a

it difficult to sense e v e n t h e n . W i t h s o m e

ball, p r o p r i o c e p t i o n o f t h e m o v e m e n t will b e

effort, w e m a y feel o u r f e e t , b u t f i n d i t i m p o s -

defined by body image, m o v e m e n t image,

sible t o s e n s e o u r a n k l e s . W e m a y b e a b l e t o

accidents, and physical structure.

r e a c h o u r l o w e r legs, b u t s o m e h o w c a n ' t g e t a sense of our i n n e r thighs. T h e older w e get, t h e m o r e w e t e n d t o limit

Proprioception is the summation of our physical history into the m o m e n t of present a c t i v i t y . As I t h r o w a b a l l , I m a y f e e l my w r i s t

our body sense to w h a t hurts. Children often

s n a p p i n g a s t h e b a l l i s r e l e a s e d b u t h a v e less

seem to have a pleasurable sense of their b o d -

awareness of h o w my elbow extends. I m a y

ies. T h r o u g h t r a i n i n g , a c c i d e n t s , a n d u n w e l -

feel m y a r m a s I t h r o w , b u t n o t h o w m y a r m

c o m e sensations, adults learn n o t to take

c o n n e c t s to my back or h o w my back is sup-

pleasure in their bodies. Everything f r o m

p o r t e d t h r o u g h m y pelvis a n d legs. I n t h e

cultural taboos t o u n w a n t e d e m o t i o n s a n d

Midwest, t h e t e r m for this kind of w h o l e b o d y

painful memories (physical a n d e m o t i o n a l )

e n g a g e m e n t is " b o d y English." Every physical

t e a c h a d u l t s t o b e less a w a r e o f t h e i r b o d i e s . Proprioception is the conscious part of

act reverberates t h r o u g h t h e w h o l e body, a n d t h i s c a n b e c o n s c i o u s l y felt. P r o p r i o c e p t i o n ,

body awareness. There is also an u n c o n s c i o u s

then, is sensing the mechanics of m o v e m e n t .

aspect of t h e body, and it is here that cultural

W h e r e there is a gap in proprioception, there

b o d y i m a g e s are t h e m o s t p r o f o u n d l y i n f l u e n -

is a habitual i n h i b i t i o n of m o v e m e n t . This is

t i a l . V i c t o r i a n i d e a s o f " n i c e n e s s " still e x i s t i n

a n c h o r e d i n t h e f l e s h b y loss o f e l a s t i c i t y i n

t h e m o d e r n g u i s e o f o k a y - n e s s . It's o k a y t o

t h e c o n n e c t i v e t i s s u e , a r e d u c t i o n i n its a b i l i t y

feel m y s h o u l d e r s ; it's less o k a y t o feel m y

t o s t r e t c h a n d t h e n r e t u r n t o its o r i g i n a l

b r e a s t s , a l t h o u g h it's m o r e o k a y t o feel m y

shape. Releasing these contractions in the

breasts w h e n I'm a l o n e t h a n w h e n I ' m i n

c o n n e c t i v e tissues is a m a t t e r of physical or

public, and this is again different from breast

mental awareness.

s e l f - e x a m i n a t i o n . Little c h i l d r e n are t a u g h t

T h e straps i n h i b i t p h y s i c a l r e s p o n s i v e n e s s

t h a t it's o k a y , e v e n w o n d e r f u l , t o t i e y o u r

a n d proprioception. An i m a g e of h o w a strap

s h o e l a c e s a n d b r a g a b o u t it. It's m u c h less

w o u l d feel p r o p r i o c e p t i v e l y i s a w o m a n i n t h e

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early part of this c e n t u r y wearing a corset.

m u c h smaller t h a n t h e actual physical struc-

S h e h a s little o r n o articulation o f m o v e m e n t

ture. We usually feel our arms to be shorter

between the top and b o t t o m halves of her

t h a n t h e i r l e n g t h , o r o u r legs, p a r t i c u l a r l y t h e

b o d y . A s s h e w a l k s , u n d u l a t i o n f r o m h e r legs

t h i g h b o n e s , as shorter t h a n t h e y are. Possibly

t h r o u g h her waist i n t o h e r chest a n d shoul-

this reflects p s y c h o l o g i c a l a s s u m p t i o n s about

ders i s i n h i b i t e d . W h e n w e d o n o t f e e l m o v e -

o u r c a p a c i t y . T h e r e is a l s o a p h y s i c a l result

m e n t in t h e waist or at t h e t o p of t h e pelvis,

o f this kind o f attitude. W h e n I'm n o t aware

a similar structure under t h e skin occurs.

o f t h e full s p a c e i n m y h e a d , t h e skull b o n e s

C o n n e c t i v e tissue c a n h a r d e n t o t h e p o i n t

c o m p r e s s . This shows as a narrowness at t h e

w h e r e i t a c t s like a c o r s e t . W e t e n d n o t t o f e e l

temples, creating a head that is too long and

this as a restriction. If we did, it w o u l d be

too deep.

irritating. Instead, w e simply feel t h e c o m -

O n e indicator of the difference between

forting familiarity of n o t being able to m o v e

reality a n d internal image is t h e sense of un-

our waists. It is n o t always possible to release

familiarity w h e n we're faced by a three-way

structures like this b y physical m e a n s a l o n e .

mirror. We m a y be a c c u s t o m e d to our frontal

A Rolfer c a n set t h e stage for t h e release, b u t

i m a g e , b u t feel surprise a t o u r p r o f i l e a n d

u n t i l t h e individual is ready to feel m o v e m e n t

e v e n m o r e a t o u r s h a p e i n b a c k . It's w o r t h

t h r o u g h t h e area, t h e o n l y t h i n g a Rolfer c a n

n o t i n g h e r e , t o o , t h a t w e are a " d o i n g " s o c i -

do is allow the person to b e c o m e m o r e pre-

ety, o r i e n t e d t o w a r d w h a t i s i n f r o n t o f u s . A s

cisely aware of t h e area of h o l d i n g . T h e let-

w e see o u r s e l v e s i n a m i r r o r , i t i s c o m m o n t o

ting go is done by the client.

m a k e automatic adjustments to "look better."

P r o p r i o c e p t i o n is filtered t h r o u g h percep-

We are apt to a s s u m e a " b e t t e r " posture, pull

t u a l s t y l e . T h e r e a r e p e o p l e w h o are p r e d o m i -

our shoulders back, stand up "straighter."

n a n t l y visual a n d t h o s e w h o are auditory.

W e are r a r e l y a t rest i n f r o n t o f a m i r r o r .

V i s u a l i z e r s t e n d t o see a n d k n o w a b o u t t h e i r

Static proprioception b e c o m e s more c o m -

external physical image. Auditory types c o m -

p l e x i n m o v e m e n t . Normally, w e are i n m o v e -

pare what t h e y perceive physically to verbal

ment, and in m o v e m e n t the limitations of a

d e s c r i p t i o n s a n d are m o r e o f t e n aware o f

structure b e c o m e m u c h m o r e apparent. Struc-

internal structure and imbalances.

t u r a l a b e r r a t i o n s a n d p r e f e r e n c e s are f u n d a -

O f t e n p e o p l e a r e u n w i l l i n g t o o c c u p y all

m e n t a l l y a m a t t e r o f h o l d i n g s o m e p a r t rigid.

of their potential space. T h e y don't use their

W h e n the body moves, it must move around

full c h e s t , t h e full p o t e n t i a l o f t h e i r rib c a g e ,

t h e h e l d place. W h e n t h e h i p i s restricted, for

o r a full p e l v i s . U n c o n s c i o u s l y , t h e y s h o r t e n

e x a m p l e , effort has to be e x p e n d e d to hold it

the body, develop curvatures of the spine,

rigid w h i l e w a l k i n g . M o v e m e n t s s u c h a s w a l k -

p u l l t h e legs i n t o t h e h i p , s h o r t e n t h e n e c k .

ing d o w n t h e street or up steps, or eating at a

W o m e n often have thin arms; there m a y be

t a b l e all s h o w c h a r a c t e r i s t i c b o d y h a b i t s .

an unwillingness to demonstrate the potential

P r o p o r t i o n a n d b a l a n c e are t h e keys t o

or power that is available in arms and shoul-

m o v e m e n t . Anomalies in physical proportion

d e r s . M e n o f t e n h a v e t h i n legs, p e r h a p s a

or balance, whether seen from the outside or

t i g h t e n i n g o f t h e legs i n r e s p o n s e t o a t i g h t -

s e n s e d i n t e r n a l l y , are s i g n s o f t h e c o n n e c t i v e

e n i n g of t h e pelvis.

tissue pattern u n d e r t h e skin, reflecting t h e

W h e n p e o p l e b e c o m e aware o f these gaps

c o n n e c t i v e t i s s u e s t r u c t u r e w e h a v e b e e n talk-

in proprioception and the accompanying

i n g a b o u t — t h e surface b o d y straps, vertical

h a b i t u a l attitudes, t h e y are surprised. A l m o s t

holdings, diaphragms, a n d shelves through

invariably, people sense their h e a d as being

the body.

SEVENTEEN

Upper Body

T h e r e are m a n y ways t o analyze h u m a n struc-

t h e ribs i n f r o n t t o c o m e u p w a r d . F o r e a c h

ture. Osteopaths, orthopedists, physiatrists,

person, t h e initial c h a n g e is different. But for

a n d c h i r o p r a c t o r s see p e o p l e i n t e r m s o f b o n e

o n e of these habits to be modified, the other

p l a c e m e n t — h o w s t r a i g h t t h e s p i n e is, h o w

two m u s t c h a n g e as well.

well t h e a l i g n m e n t s t a c k s u p f r o m h e e l t o ear.

The position of the head, upper chest, and

General medical practitioners generally evalu-

s h o u l d e r s i s n o t s e p a r a t e f r o m t h e rest o f t h e

ate h e a l t h in terms of t h e soft t i s s u e s — m u s -

b o d y . W h e n t h e u p p e r ribs a r e c o m p r e s s e d ,

cles, b l o o d a n d n e r v e s u p p l y , i n t e r n a l o r g a n s .

v e r y o f t e n t h e l o w e r ribs a r e o v e r e x p a n d e d .

W e are p r o p o s i n g a n o t h e r perspective—evalu-

The extreme of this is the pear-shaped body,

a t i o n o f t h e c o n n e c t i v e tissue b e d o f t h e b o d y .

i n w h i c h t h e l o w e r r i b s flare o u t w a r d w h i l e

This includes the conformation of muscle and

t h e u p p e r ribs are so c o m p r e s s e d t h a t t h e

b o n e but is not limited to these.

shoulders are d r a w n t o g e t h e r a n d narrow.

T h e straps w e h a v e d e s c r i b e d g i v e a s e n s e

It is t h e soft tissue c o n f i g u r a t i o n s t h a t give

of h o w c o n n e c t i v e tissue c a n create structures

rise t o t h e s e s i l h o u e t t e s . A m o r e d e t a i l e d a n a t -

that overlap and interconnect. T h e direction

o m y of the chest and upper back is needed to

of t h e c o n n e c t i v e tissue is n o t d e t e r m i n e d by

flesh o u t o u r p o i n t . T h e c o n n e c t i v e tissue

any one muscle or muscle group. Our purpose

c o n f o r m s to t h e muscle. In fact, it would be

is to give an image of p h y s i o g n o m y t h a t is

m o r e a c c u r a t e t o s a y t h a t t h e c o n n e c t i v e tis-

m o r e inclusive, m o r e directly related to t h e

sue guides t h e m u s c l e pathways. F u r t h e r m o r e ,

experience of structure a n d to m o v e m e n t . In order to discuss structure, we analyze t h e

it is c o n v e n i e n t to say t h a t m u s c l e a t t a c h e s to b o n e , b u t this is n o t strictly true. T h e c o n n e c -

b o d y r o u g h l y i n t e r m s o f its u p p e r a n d l o w e r

tive tissue e x t e n s i o n s a r o u n d m u s c l e s (ten-

halves. T h e easiest w a y t o b e g i n talking a b o u t

dons, aponeuroses) continue on as the

the upper body is to look at the position of

c o n n e c t i v e tissue covering of b o n e (perios-

t h e ribs. I n m o s t p e o p l e , t h e ribs a n g l e t o o

t e u m ) . B o n e a n d m u s c l e lie e m b e d d e d w i t h i n

s h a r p l y d o w n w a r d i n f r o n t . I d e a l l y t h e ribs

t h e c o n n e c t i v e tissue w e b .

would hang more horizontally, although normally there is always s o m e slight angle. The typical b o d y configuration that a c c o m -

In the front of the chest, the major muscle of t h e outer layer is t h e pectoralis major, t h e " p e c s " that muscle builders attempt to

p a n i e s d e p r e s s i o n o f t h e u p p e r ribs i n c l u d e s a

d e v e l o p (Fig. 17-1). It is a l a r g e f a n - s h a p e d

sunken and flattened upper chest, elevated

muscle covering the majority of the upper

shoulders, a n d a head thrust forward. These

c h e s t , e x t e n d i n g f r o m t h e m i d d l e ribs u p

t h r e e g o t o g e t h e r . I f t h e u p p e r ribs w e r e raised

a l o n g t h e side o f t h e b r e a s t b o n e a n d t h e m i d -

in front, the shoulders would automatically

dle half of t h e c o l l a r b o n e . T h e fan converges

drop and the head c o m e back to a m o r e

across the shoulder in front, a n d ends by

upright position. Likewise, if t h e focus is on

attaching to the humerus an inch or two

bringing the head back, it is necessary to

below the shoulder joint.

allow m o r e space for t h e b r e a t h t o c o m e u p

In the back, there is t h e trapezius, t h e

i n t o t h e u p p e r ribs. O r i f t h e s h o u l d e r s r e l a x ,

w e i g h t l i f t e r ' s " s t r a p s " (Fig.

space i s m a d e for t h e h e a d t o c o m e b a c k a n d

n a t e s f r o m t h e b a c k o f t h e skull a n d r u n s

17-2). T h i s o r i g i -

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a l o n g t h e b a c k o f t h e s p i n e s o f all t h e n e c k vertebrae and the upper seven or eight chest v e r t e b r a e . It, t o o , i s f a n - s h a p e d , c o n v e r g i n g on an a t t a c h m e n t to t h e tip of the shoulder Fascia of sternocleidomastoid m.

Fascia of trapezius m.

called t h e a c r o m i o n . T h e a c r o m i o n is a b o n y shelf that can be palpated at the corner of the junction between the shoulder and the arm. T h e l o w e r p a r t o f t h e t r a p e z i u s , a s i t crosses

Fascia of pectoralis major m.

t h e shoulder blade (scapula), also attaches to t h e a c r o m i o n as well as to t h e scapular spine. In t h e b a c k , a n o t h e r large fan-shaped musFascia of • latissimus dorsi m.

cle flows up f r o m below, called t h e latissimus dorsi—the weightlifter's "lats." It attaches to t h e s p i n e s o f t h e l o w e r c h e s t v e r t e b r a e a s well as to t h e spines of the lumbar vertebrae down to t h e sacrum. T h e point of this fan converges upward, obliquely crossing over the lower tip of t h e shoulder blade. It t h e n runs along the lateral m a r g i n of t h e shoulder blade a n d ends

Figure 17-1 Anterior arm and shoulder fascia.

b y a t t a c h i n g t o t h e h u m e r u s (arm b o n e ) just b e h i n d the a t t a c h m e n t of the pectoralis major. These three muscles make up what we c a l l t h e e x t e r n a l m u s c l e a n d c o n n e c t i v e tissue layer of t h e chest, relating t h e chest to t h e shoulder and arm, to the head, and to the l o w e r b a c k . T h e n e x t layer, w h i c h serves t o

Fascia of deltoid m.

Fascia of trapezius m. Acromion

stabilize t h e position of t h e shoulder blade, is m o r e d i f f i c u l t to v i s u a l i z e as a layer. In t h e f r o n t , u n d e r n e a t h t h e p e c t o r a l i s m a j o r , lies t h e p e c t o r a l i s m i n o r (Fig. 17-3). T h i s is a n a r row small muscle that attaches to the middle

Scapula Septum

(dotted line) Fascia of latissimus dorsi m.

ribs a n d a n g l e s u p w a r d t o a t t a c h o n t h e c o r a c o i d p r o c e s s . T h i s h o o k - l i k e p r o j e c t i o n forward from t h e inside of the shoulder blade c a n b e felt just u n d e r n e a t h t h e collar b o n e , i n t h e d e p r e s s i o n b e t w e e n t h e larger a r m m u s c l e s a n d t h e sides o f t h e ribs. T h e p e c t o r a l i s m i n o r a c t s like a l e v e r o n t h e coracoid process, m o v i n g t h e shoulder b l a d e . T h e c o r a c o i d p r o c e s s i s v e r y m u c h like

Figure 17-2 Posterior arm and shoulder fascia.

a h o o k on a suspended metal plate (the scapula). W h e n the h o o k is tugged near the top,

UPPER

t h e l o w e r b o r d e r o f t h e p l a t e i s raised like a

BODY

87

Coracoclavicular ligament & Subclavius m.

drawbridge. If the pectoralis m i n o r in front is habitually tight, t h e pull on t h e c o r a c o i d p r o c e s s results i n w h a t w e c a l l " w i n g e d " s c a p u l a e i n t h e b a c k (Fig. 17-4). T h e m e d i a l margin of t h e shoulder blade will project outward.

Coracoid. process Coracobrachialis m.

.Pectoralis minor m.

Two other attachments to the coracoid p r o c e s s are c o n n e c t e d d o w n i n t o t h e a r m . T h e short head of the biceps brachii (com-

Biceps m. (short head)

m o n l y called simply t h e biceps) crosses b o t h the shoulder and the elbow joints. Thus, tightness in this muscle on the front of the a r m will a l s o r e p o s i t i o n t h e s c a p u l a . T h e c o r a cobrachialis is a shorter m u s c l e t h a t spans from the coracoid process to t h e inside of t h e humerus about halfway d o w n the arm, reinforcing t h e action of t h e biceps on the scapula (Fig.

17-3).

A ligament from the coracoid process to the underside of t h e clavicle contains t h e subclavius muscle, a small muscle w h o s e function is traditionally considered m i n i m a l . C a l l e d t h e c o r a c o c l a v i c u l a r l i g a m e n t (Fig.

Figure 17-3 The deeper layer of the chest muscles; the arrows indicate the line of force of these muscles. The focus here is on the coracoid process of the scapula and therefore includes lines of force of the relevant arm muscles.

17-3), its f u n c t i o n is p r o b a b l y a f a c t o r in t h e n o r m a l p o s i t i o n i n g o f t h e s c a p u l a . T o us, t h i s is n o t a l i g a m e n t , b u t a t e n d o n t h r o u g h w h i c h the subclavius muscle is attached to the coracoid process. T h e action of t h e subclavius t h r o u g h this c o n n e c t i v e tissue a t t a c h m e n t i s n o t g r e a t i n t e r m s o f m o v e m e n t . Its i m p o r t a n c e lies i n t h e w a y i t s t a b i l i z e s t h e fascial s h e a t h o f t h e c h e s t a s a w h o l e . T h e r e i s a n a n a l o g o u s s t r u c t u r e i n t h e leg. T h i s i s t h e m u s c l e a n d a t t a c h e d fascial bridge called t h e t e n s o r f a s c i a lata a n d i l i o t i b i a l b a n d . T h e b a n d i s a lateral t h i c k e n i n g o f t h e f a s c i a c o v ering t h e t h i g h as a w h o l e (the fascia lata). The action of t h e comparatively small tensor m u s c l e serves t o s t a b i l i z e t h e w h o l e o f t h e thigh

(Fig.

17-5).

Figure 17-4 In this pose, the pectoralis minor is contracted; the result is a "winged" scapula.

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By identifying the muscles that connect to t h e c o r a c o i d process, we c a n visualize t h e fascial i n v o l v e m e n t s . F r o m t h e coracoid process, t h e r e are strong c o n n e c t i o n s to t h e m i d d l e ribs, t o t h e r a d i u s a n d u l n a o f t h e

Tensor fasciae latae

forearm, to the humerus of the upper arm, Gluteus maximus

and to t h e middle clavicle. Tension on any or all o f t h e s e w i l l r e s u l t i n a d e g r e e o f i m m o b i lization between the upper chest and the arm a n d the position of t h e scapula in the back. M o v e m e n t t h r o u g h a fascial p l a n e is always broader t h a n m o v e m e n t by an individual

Ilio-tibial tract

muscle. O n t h e b a c k , t h e s h o u l d e r b l a d e i s susp e n d e d i n t h r e e p l a c e s . O n its s u r f a c e , t h e t r a p e z i u s c o n n e c t s t o its m o s t l a t e r a l t i p , prim a r i l y a t t h e a c r o m i o n . A t a d e e p e r layer, t h e r h o m b o i d s a n d t h e levator scapulae form a b r o a d s h e e t o f a t t a c h m e n t t o t h e m e d i a l ridge o f t h e s p i n e . A l s o i n t h i s d e e p e r layer, t h e t w o teres muscles, m a j o r a n d m i n o r , c o n n e c t t h e

Figure 17-5 Connections between knee and hip.

s c a p u l a r t r i a n g l e t o t h e u p p e r a r m (Fig. 17-6). T h e s c a p u l a i s t h u s s u s p e n d e d f r o m all o f its s i d e s : f r o m t h e h e a d b y w a y o f t h e t r a p e z ius, f r o m t h e t h o r a c i c s p i n e b y w a y o f t h e r h o m b o i d s a n d levator, a n d from t h e upper a r m b y w a y o f t h e teres. T h e elasticity o f t h e c o n n e c t i v e tissue of e a c h of these allows t h e s h o u l d e r t o f l o a t o n t o p o f t h e rib c a g e . T h e

Levator scapula m.

. Trapezius m. , Supraspinal

t i g h t n e s s of a n y of t h e s e will e n g e n d e r tightn e s s i n t h e o t h e r s a n d will fix t h e s h o u l d e r blade. T h i s , in turn, will reduce t h e flexibility

Teres minor/ infraspinatus

Rhomboids. m.

of the neck and head, the upper back, and the arm. R h o m b o i d s a n d teres b e t w e e n t h e m form a sling t h a t stabilizes t h e m o v e m e n t of t h e lower part of t h e scapula. W h e n the arm

v Trapezius m.

Teres major m.

m o v e s sideways, t h e distance b e t w e e n t h e arm b o n e a n d t h e scapula widens and the teres s h o u l d b e able t o l e n g t h e n . W h e n the m u s c l e s r e a c h t h e limit of their elasticity, t h e s h o u l d e r b l a d e will start t o m o v e s i d e w a y s . Its m o v e m e n t is stabilized by t h e elasticity of t h e

Figure 17-6 Scapular suspension.

r h o m b o i d s . If the shoulder blade is winged o u t , t h e t e r e s m u s t t h e n a l s o t r y t o stabilize

UPPER

BODY

the lower margin of t h e shoulder blade to p r e v e n t i t f r o m m o v i n g t o o far o u t , a w a y f r o m t h e flat o f t h e r i b s . T h e t e r e s w e r e n o t designed for this purpose, a n d so t h e y shorten. T h e surrounding c o n n e c t i v e tissue Rhomboid m.'s

b e c o m e s overtense. W h e n t h e teres lose elasticity, t h e s h o u l d e r b l a d e i s d r a g g e d a l o n g with every arm m o v e m e n t . M a n y people's teres are m u c h t o o s h o r t and tight. T h e o t h e r half of t h e sling for t h e s c a p u l a , t h e r h o m b o i d s , t h e n a r e less u s e d and b e c o m e flaccid. Higher up, t h e levator scapulae b e c o m e s extremely tight, f o r m i n g a heavy pad. T h e a t t a c h m e n t of the levator on the upper middle corner of the scapula is that p l a c e w h e r e , i f y o u press i t o n a l m o s t a n y o n e ,

iSerratus anterior m.

External abdominal oblique m.

h e o r s h e will s i g h , " O h , t h a t h u r t s s o g o o d ! " A n o t h e r m u s c l e o f t h e m i d d l e layer, t h e serratus a n t e r i o r , c o n n e c t s t h e l o w e r r i b s t o t h e u n d e r s i d e o f t h e s c a p u l a (Fig. 17-7). B o t h serratus a n t e r i o r a n d s u b s c a p u l a r i s lie b e t w e e n t h e rib c a g e a n d t h e s h o u l d e r b l a d e . T h e serratus a t t a c h e s o n t h e l o w e r ribs a n d angles upward toward the medial border of t h e scapula, a t t a c h i n g just a d j a c e n t to t h e

Figure 17-7 The subscapularis (not shown) lines the undersurface of the scapula. Its direction of pull is roughly perpendicular to that of the serratus anterior.

attachment of the rhomboids. The subscapularis l i n e s t h e u n d e r s i d e o f t h e s h o u l d e r b l a d e , w i t h its fibers c o n v e r g i n g t o w a r d t h e f i b r o u s capsule of the shoulder joint. These f o r m a n o t h e r r e c i p r o c a l set o f s l i n g s , f l o a t i n g t h e s h o u l d e r b l a d e b e t w e e n t h e ribs a n d s h o u l d e r joint. Normally, t h e f u n c t i o n of t h e serratus anterior seems to be to stabilize t h e shoulder b l a d e a s t h e a r m s w i n g s o v e r h e a d . Its f a s c i a often glues t h e m u s c l e t o t h e p e r i o s t e u m a n d

Fascia of trapezius m. Acromion

Clavicle

Fascia of deltoid m.

fascia o f t h e ribs a n d i n t e r c o s t a l m u s c l e s . Two small muscles on t h e outer surface of the scapula, the supraspinatus a n d infraspinatus (Fig. 17-6) f u r t h e r r e f i n e t h e m o v e m e n t of

Septum

the shoulder blade in relation to the shoulder j o i n t . T h e s e lie o n t h e s u r f a c e o f t h e s c a p u l a , above a n d below t h e scapular spine. In palp a t i o n , t h e y o f t e n f e e l like b o n e w h e n t h e shoulder blade is in trouble. We have been talking about h o w the

Figure 17-8 The deltoid fascia interweaves with the septum dividing the anterior (biceps) and posterior (triceps) areas of the arm.

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s h o u l d e r b l a d e i s s u s p e n d e d i n its r e c i p r o c a t -

a yawn. Note that in this kind of stretch, the

ing m u s c u l a r slings. T h e a r m a n d shoulders

shoulder blade is suspended from the arms.

also relate in this way. H a n g i n g d o w n , t h e

T h e r e are t w o m a j o r factors to consider in

arm swings from t h e shoulder blade. W h e n

arm m o v e m e n t — t h e m o v e m e n t of muscles

we reach up, t h e reverse is t r u e — t h e shoulder

over t h e tip of the shoulder blade and m o v e -

blades h a n g from the arm.

m e n t i n t h e a r m p i t . Ideally, t h e a r m c a n b e

T h e m a j o r surface c o n n e c t i o n b e t w e e n

raised w i t h o u t elevating t h e shoulder blade,

shoulder and arm is the deltoid muscle,

w h i c h drops as a c o u n t e r b a l a n c e . In addition,

w h i c h covers the shoulder joint. This muscle

t h e a r m m u s t b e able t o freely m o v e away

acts like a c o n t i n u a t i o n of t h e trapezius, e m -

f r o m b o t h t h e rib c a g e a n d t h e s h o u l d e r

b r a c i n g its a t t a c h m e n t o n t h e c l a v i c l e , a c r o -

blade.

m i u m , a n d s c a p u l a r s p i n e (Fig. 17-8). It

T h e r e is no way t h a t we c a n freely use an

e x t e n d s muscular a c t i o n of t h e trapezius

arm without opening the armpit, yet armpits

f r o m t h e h e a d a n d n e c k across t h e shoulder

are t h e focus of a wide variety of e m o t i o n a l

and down into the middle of the upper arm.

c o n c e r n s . W e h a v e all sorts o f r e a s o n s w h y w e

A t a d e e p e r layer, t h e b i c e p s b r a c h i i a n d

d o n ' t w a n t to be, in effect, t h a t o p e n . Protec-

the coracobrachialis b o t h suspend the arm

tive gestures, fearful gestures, h o l d i n g one's

from the coracoid process of the shoulder

b r e a t h , a n g r y g e s t u r e s all f o c u s o n t i g h t e n i n g

blade. In addition, there is the triceps brachii.

t h e a r m s d o w n t o t h e r i b s . T h e s e are g e s t u r e s

O f its t h r e e a t t a c h m e n t s , t w o c o n n e c t t o

r e p r e s s i n g r e s p o n s e t o e m o t i o n . W e are i n h i b -

t h e h u m e r u s itself a n d o n e — c a l l e d t h e l o n g

i t i n g w h a t w e w o u l d like t o d o w i t h o u r a r m s :

h e a d — c o n n e c t s to the outside margin of

w a r d i n g o f f a n g e r , fear, r e s e n t m e n t , e t c .

t h e shoulder blade just b e l o w t h e shoulder joint. These three muscles govern the lengthen-

Trapezius, deltoid, pectoralis major, a n d latissimus dorsi are c o m m o n l y called t h e extrinsic (outer) m u s c l e s of t h e shoulder area,

ing out of the arm from the shoulder blade.

c o n n e c t i n g t h e a r m a n d trunk. T o simplify,

T h e arm should be able to lengthen as it is

we c a n t h i n k of t h e trapezius a n d deltoid as

raised u p w a r d a n d t o t h e side, s u c h a s w h e n

a single, functionally c o n t i n u o u s structure

stretching your arms wide and up toward the

(Fig. 17-9 A). T h e s e a r e t h e m u s c l e s t h a t raise

ceiling in t h e relaxing stretch that goes with

t h e a r m . T h e latissimus dorsi a n d pectoralis

Figure 17-9 Shoulder and arm movement depends on the continuity of fascia—(A) lateral shoulder, (B) anterior shoulder, (C) posterior shoulder.

UPPER

BODY

91

major, acting together, bring the arm down

true of very small m u s c l e s as of larger sheet-

(Fig. 17-9 B & C). T h e s e m u s c l e s of t h e o u t e r

like o n e s . Part o f t h e w a y h e a v y i m m o b i l e

(extrinsic) layer c o u n t e r b a l a n c e e a c h other.

t i s s u e p a d s are c r e a t e d i s b y o u r i n s i s t e n c e o n

For e x a m p l e , w h e n t h e a r m i s r a i s e d t o t h e

trying to use t h e muscle as a w h o l e instead of

side, d e l t o i d a n d t r a p e z i u s c o n t r a c t a s p e c -

sequencing through the muscle as b o d y posi-

toralis m a j o r a n d latissimus dorsi relax, allow-

tion d e m a n d s . A m a j o r source of c o n f u s i o n in

ing the arm to extend away from the body. As

the practical application of kinesiology is that

t h e a r m returns t o t h e side, pectoralis a n d

no muscle exists in isolation. T h e c o n n e c t i v e

latissimus contract as trapezius a n d deltoid

tissue b e d provides c o n n e c t i o n s b e t w e e n m u s -

lengthen.

cle layers as well as b e t w e e n a d j a c e n t muscles.

T w o kinds o f m o v e m e n t are possible h e r e —

These interfaces have t h e greatest potential

d r o p p i n g t h e a r m , w h i c h i s faster, o r s e q u e n -

for adhesion, t h i c k e n i n g , a n d s h o r t e n i n g .

tially letting t h e a r m d o w n , w h i c h is slower.

Elasticity of t h e c o n n e c t i v e tissue b e t w e e n

I n b o t h m o v e m e n t s , o n e set o f m u s c l e s c o n -

structures is essential for an effective relation-

tracts. T h e difference b e t w e e n t h e two m o v e -

ship b e t w e e n deep a n d superficial (intrinsic

m e n t s i s i n t h e c o u n t e r b a l a n c i n g set o f

a n d extrinsic) m u s c l e layers. In t h e front,

m u s c l e s . W h e n t h e m o v e m e n t i s fast, t h e

p e c t o r a l i s m i n o r lies u n d e r p e c t o r a l i s m a j o r .

o p p o s i n g m u s c l e s s i m p l y let g o a n d t h e c o n -

Toward t h e center front, b o t h muscles affect

n e c t i v e tissue b e d e l a s t i c a l l y s t r e t c h e s . W h e n

t h e a c t i o n o f t h e ribs. I n t h e shoulder, t h e

a m o v e m e n t is slow and controlled, t h e

pectoralis m i n o r attaches to the coracoid

antagonist muscle lengthens sequentially. It acts as a brake to m o d u l a t e t h e m o v e m e n t . I n e i t h e r fast o r s l o w m o v e m e n t s , t h e u l t i m a t e limit o n t h e m o v e m e n t will b e t h e limit of elasticity of t h e c o n n e c t i v e tissue bed. W h a t w e call s e q u e n c i n g i n m u s c l e m o v e m e n t i s a f a c t o r i n h o w t h e large flat s u r f a c e m u s c l e s are u s e d . For e x a m p l e , a s t h e a r m i s raised, t h e first m u s c l e a c t i v i t y starts a t t h e portion of t h e trapezius b e t w e e n n e c k a n d shoulder and continues down the deltoid. As the arm comes further up, muscle activity concentrates further d o w n t h e trapezius. T h e continuing upward m o v e m e n t of the arm is supported by the vertebrae because of the a c t i o n of different parts of t h e trapezius. Anatomical nomenclature occasionally reflects t h i s s t e p w i s e u s e o f t h e s u r f a c e m u s cles b y d i v i d i n g t h e m i n t o s p e c i f i c a l l y n a m e d sections. Ideally, i n n o m o v e m e n t d o w e u s e all fibers o f a m u s c l e s i m u l t a n e o u s l y . A t t h e deeper layer of fascia a n d m u s c l e , s e q u e n c i n g m o v e s t h r o u g h a series o f m u s c l e s r a t h e r t h a n through the plane of one muscle. This is as

Figure 1 7 - 1 0 Common "knots."

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mid-back place under t h e lower tip of t h e shoulder blade that is so often painful. Another mid-back place on the spine that is c o m m o n l y painful is w h e r e t h e lower tip o f t h e t r a p e z i u s crosses the uppermost attachm e n t of the latissimus to t h e v e r t e b r a . (Fig. 17-10).

This

spot

a l m o s t always c o n t a i n s a s e n s i t i v e k n o t of tiss u e . T h i s i s i n t h e area t h a t w e h a v e b e e n calling t h e dorsal h i n g e . T h e p a r t o f t h e latissimus toward the h u m e r u s lies i m m e d i ately adjacent to the Figure 17-11

teres m a j o r . T h e teres m a j o r is a b r i d g e

process while the pectoralis m a j o r attaches to

b e t w e e n t h e lower tip of the scapula and the

t h e h u m e r u s . W h e n t h e fascial p a d b e t w e e n

a r m b o n e . T h e latissimus c o n n e c t s the arm

t h e t w o b e c o m e s less p l i a b l e , t h e m u s c l e s n o

b o n e t o t h e lower b a c k a n d t h e pelvis. W e

longer operate individually. T h e y are u n a b l e

f r e q u e n t l y see l a t i s s i m u s a n d t e r e s m a j o r

t o slide o n e a c h o t h e r . A s a r e s u l t , t h e s h o u l -

b o u n d together, w i t h t h e result t h a t t h e lower

der b l a d e a n d t h e a r m are activated t o g e t h e r

tip of t h e scapula is i m m o b i l i z e d . These inter-

in a n y gesture involving t h e front of t h e

a c t i o n s are c o n c e p t u a l l y s t r a i g h t f o r w a r d a n d

chest.

give a partial picture of t h e effect of t h e c o n -

I n t h e b a c k , t h e r e are t w o places w h e r e this

n e c t i v e tissue o n m o v e m e n t b e t w e e n arm,

k i n d of c o n f u s i o n is likely to occur. T h e tra-

s h o u l d e r blade, a n d ribs. For a m o r e c o m p l e t e

pezius overlies t h e r h o m b o i d s a n d levator

a n d c o m p l e x view, w e r e c o m m e n d considera-

s c a p u l a e , a l t h o u g h h e r e t h e m u s c l e fibers r u n

t i o n o f t h e e f f e c t o f c o n n e c t i v e tissue o n t h e

c r o s s w i s e t o e a c h o t h e r . A t t h e c e n t e r b a c k , all

underside of t h e deltoid. This muscle overlies

attach to t h e vertebrae. T h e trapezius attaches

a t t a c h m e n t s o f t h e teres m a j o r a n d m i n o r ,

laterally to t h e tip of t h e shoulder blade (acro-

pectoralis major and minor, biceps brachii,

m i o n ) , while the r h o m b o i d s and levator scap-

coracobrachialis, and infraspinatus.

ulae attach medially to the medial border of

Our a n a t o m i c a l illustrations in this section

t h e scapula. W h e n t h e c o n n e c t i v e tissue b e d

attempt to depict the interactions of muscle,

b e t w e e n these m u s c l e s loses elasticity, t h e

b o n e , a n d c o n n e c t i v e tissue i n m o v e m e n t .

s h o u l d e r b l a d e c a n n o t r o t a t e . Its o n l y o p t i o n

T h e i n t e r a c t i o n s w i t h t h e d e l t o i d are t o o c o m -

is to be shrugged u p . This is a factor in t h a t

p l e x t o s h o w i n t w o d i m e n s i o n s (Fig.

17-11).

EIGHTEEN

Axial Skeleton We have n o t yet talked about t h e long muscles o f t h e s p i n e , w h i c h a r e a l s o a p a r t o f t h e

t o t h e v e r t e b r a i m m e d i a t e l y a b o v e it. T h e h e a v y f a s c i a l s h e a t h c o v e r i n g all o f

soft tissue layers o f t h e u p p e r b o d y . C o l l e c -

t h e erector spinae is called t h e lumbo-dorsal

tively, t h e s e are c a l l e d t h e e r e c t o r s p i n a e ,

f a s c i a (Fig. 18-2). It c o n t i n u e s u p w a r d to t h e

a n d t h e y travel t h e l e n g t h o f t h e spine f r o m

n e c k a n d to t h e occipital ridge. Below, t h e

t h e skull t o t h e s a c r u m (Fig. 18-1). I n b o t h

l u m b o - d o r s a l fascia is c o n t i n u o u s with t h e

a p p e a r a n c e a n d s t r u c t u r e , t h e y are m u c h l i k e

sacral pad a n d e n d s o n t h e c o c c y x . T h i s fascia

a multistrand rope. T h e muscles closer to t h e

is very heavy; it acts as an aponeurosis (broad

outer surface of t h e b o d y are longer; as we go

a t t a c h m e n t ) , c o n n e c t i n g t h e latissimus dorsi

progressively deeper t h r o u g h t h e layers, m u s -

t o t h e l o w e r h a l f o f t h e s p i n e . A b o v e , t h e fas-

cle segments b e c o m e shorter a n d shorter. T h e

c i a i s less h e a v y ; i t lies u n d e r t h e m i d d l e m u s -

deepest muscular layer c o n n e c t s o n e vertebra

cle layer ( r h o m b o i d s a n d levator scapulae).

Figure 18-1 In these schematics of the erector spinae, the arrows indicate the direction and length of muscle groups. The most superficial muscle groups are the longest, while the deepest are very short.

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U p p e r b a c k a n d s h o u l d e r p r o b l e m s are usu-

t h e o r g a n b u t p e n e t r a t i n g t h r o u g h it. T h i s

ally i n t e r c o n n e c t e d t h r o u g h this fascia, w h i c h

is particularly apparent in the lungs, where

feels like a glass p l a t e w h e n it is in t r o u b l e .

c o n n e c t i v e tissue surrounds t h e b r a n c h i n g

In the lower back, restriction in the l u m b o -

system of trachea, bronchi, bronchioles, and

dorsal fascia will s h o w as a l o n g i t u d i n a l rope-

even alveoli.

l i k e rigidity, s o m e t i m e s m o d i f i e d b y a cross-pull f r o m t h e latissimus dorsi. At t h e deepest level, t h e r e is a c o n n e c t i v e

T h e c o n n e c t i v e tissue o n t h e i n n e r surface o f t h e ribs a n d i n t e r c o s t a l m u s c l e s i s c o n t i n u o u s w i t h a v e r t i c a l c o n n e c t i v e tissue s e p t u m

tissue c o n t i n u i t y t h a t includes t h e j o i n t cap-

t h a t d i v i d e s t h e r i g h t a n d left sides o f t h e

sules a n d t h e p e r i o s t e u m t h a t e n s h e a t h s e a c h

c h e s t c a v i t y (Fig. 18-3). T h i s is c a l l e d t h e

b o n e . In t h e chest, this layer c o n t i n u e s b o t h

mediastinum. It connects the underside of

i n s i d e a n d o u t s i d e t h e rib c a g e a n d c o n t a i n s

t h e sternum (breastbone) to the vertebrae of

t h e intercostal muscles b e t w e e n t h e ribs. This

the chest region. The mediastinum contains

fascia is c o n t i n u o u s with t h e fascia position-

t h e heart. It should be elastic e n o u g h that

ing the internal organs, not only surrounding

heart m o v e m e n t can be accomplished without inhibition. Furthermore, this c o n n e c t i o n between front and back of the chest must also b e able t o adjust with e a c h breath. W h e n there is t e n s i o n a n d vertical shortening of the

Figure 18-2 Continuity of fascia of erector spinae and gluteals.

Figure 18-3 Continuity of fascia within the body cavity. The diaphragms of the body cavity: one at the clavicles, the respiratory diaphragm, the two pelvic diaphragms.

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95

mediastinum, both heart function and b r e a t h i n g are h i n d e r e d . E x t e r n a l l y , t e n s i o n in t h e m e d i a s t i n u m is visible as a c h e s t t h a t is t o o thick from front to b a c k — a barrel chest. In a chest that is t o o narrow from front to back—a concave chest—the mediastinum and h e a r t are p u s h e d o f f t o t h e left, w h i c h a g a i n will c r e a t e t e n s i o n o n t h e h e a r t . D i s p l a c i n g the heart t h e n constricts t h e lung and restricts b r e a t h i n g . A t its l o w e r m a r g i n , t h e m e d i a s t i n u m is c o n t i n u o u s with t h e c o n n e c t i v e tissue of the diaphragm. The diaphragm is an approximately horizontal curved layer of m u s c l e t h a t divides t h e c h e s t c a v i t y f r o m t h e a b d o m i n a l cavity. I t i s m a d e u p o f a h e a v y c i r c u l a r c e n tral t e n d o n s u r r o u n d e d b y a r i n g o f m u s c l e . T h e m u s c l e flares o u t w a r d f r o m t h i s c e n t r a l

Figure 18-4 The action of the respiratory diaphragm.

t e n d o n a n d blends into t h e muscle wall of the chest and a b d o m e n . The diaphragm attaches to the inner

t o p r o t r u d e i n t h i s way, i t m u s t s h o r t e n w h e n inhaling. This is a learned pattern, o n e that

m a r g i n o f t h e rib c a g e ( t h e c o s t a l a r c h ) a n d

is m e n t a l l y c o n t r o l l e d . M o v e m e n t s t h a t are

extends sideways to t h e tips of t h e free ribs,

m e n t a l l y controlled lack adaptive flexibility.

the t e n t h , eleventh, a n d twelfth. It crosses

T h e tendency is to over-focus on what has

t h e t i p o f t h e v e r y s h o r t t w e l f t h rib a n d t h e n

b e e n learned. In this case, t h e a b d o m e n is

blends into the oblique muscles of the abdo-

m o v e d i n p r e f e r e n c e t o t h e ribs.

men. The diaphragm is thus not quite hori-

Exhaling involves the c o m b i n e d action

zontal across t h e b o d y ; it has an o b l i q u e angle

of t h e d i a p h r a g m a n d o n e layer of t h e inter-

downward to the back.

costal m u s c l e s b e t w e e n t h e ribs. In a n o r m a l ,

T h e a c t i o n o f t h e d i a p h r a g m i s like a sail

unforced exhale, muscle action originates in

t h a t b e l l i e s in t h e w i n d (Fig. 18-4). Its m i d d l e

the diaphragm and continues to the abdomi-

bellies u p i n t o t h e c h e s t c a v i t y w i t h e a c h

n a l o b l i q u e s . T h i s b r i n g s t h e rib d o w n a n d

exhale (1); it flattens with every inhale (2).

a l l o w s t h e d i a p h r a g m t o r e c o i l t o its n o r m a l

W i t h e x h a l a t i o n e a c h rib i s raised b y r o t a t i n g

d o m e shape up i n t o t h e pleural (lung) cavity.

i n its j o i n t s w i t h t h e v e r t e b r a e . A s t h e ribs lift

Air i s p u s h e d o u t o f t h e l u n g s . T h e s y s t e m

a n d e x p a n d t h e c h e s t , air e n t e r s t h e l u n g s .

is n o t dependent on the presence of a lung.

Ideally, t h e d i a p h r a g m i s l i f t e d a t its m a r g i n s

Even people with only o n e lung can achieve

a s t h e ribs rise a n d e x p a n d s i d e w a y s w i t h

n o r m a l c h e s t m o v e m e n t o n b o t h sides.

inhalation. In order for this to h a p p e n , t h e abdomen must lengthen when inhaling. Abdominal breathing is often depicted as

Rib a c t i o n during b r e a t h i n g involves three separate types of rib m o v e m e n t . T h e s e are well described in m o s t a n a t o m y a n d physi-

a pattern in which the a b d o m e n protrudes

o l o g y texts. W e w o u l d like t o e m p h a s i z e t h e

in front with each inhale. M a n y disciplines

n e e d f o r e a c h rib t o m o v e s e p a r a t e l y a n d

teach a type of a b d o m i n a l breathing that is

freely. I f a n y o n e rib fails t o m a i n t a i n its p o r -

a n a t o m i c a l l y q u e s t i o n a b l e . For t h e a b d o m e n

t i o n o f t h e chest c o n t o u r , a d j a c e n t ribs a n d

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scalenes serve a f u n c t i o n a n a l o g o u s to t h a t of t h e respiratory diaphragm, expanding and contracting w h e n breath enters the upper tip of the lung. Since the scalenes attach to the processes of the n e c k vertebrae, tension in the n e c k restricts b r e a t h i n g i n t h e u p p e r m o s t part of the lungs. And tension in the neck has reached endemic proportions in our overachiever culture. T h e neck can be seen as a continuation of t h e c o n n e c t i v e tissue structures of t h e chest. All s t r u c t u r e s i n t h e n e c k h a v e a b r o a d e r c o n t i n u a t i o n below, m u c h in t h e way a plastic bag is gathered t o g e t h e r with a twist at the t o p . T h e deepest layer of t h e n e c k includes the c o n t i n u a t i o n of the erector spinae; the m i d d l e layer includes t h e scalenes. T h e outerm o s t surface layer consists of t h e trapezius and the sternocleidomastoid. The sternocleidomastoid extends from the b a s e o f t h e skull j u s t b e h i n d t h e ear ( m a s t o i d process) d o w n to t h e c o n n e c t i o n between the clavicle a n d the breastbone (sternum). It often b e c o m e s very p r o m i n e n t in older people from Figure 18-5 Diaphragms of the body cavity.

o v e r u s e i n m o v i n g t h e h e a d . Ideally, t h i s pair o f muscles o n l y stabilizes t h e m o v e m e n t s o f nodding the head and turning the head from side t o s i d e . W h e n t h e h e a d i s h a b i t u a l l y

e v e n t u a l l y t h e w h o l e rib cage are distorted. If

p i t c h e d forward, as is t o o o f t e n t h e case, t h e

t h i s p r o c e s s r e a c h e s a c r i t i c a l l e v e l , t h e r e is a

upper trapezius b e c o m e s a primary support of

general c o n n e c t i v e tissue response. This c a n

the head. It is used to hold the head on, and

be felt as an overall rigidity in t h e c o n n e c t i v e

i t l o s e s m u c h o f its f u n c t i o n a l r o l e i n h e a d

t i s s u e o f t h e c h e s t , w h i c h f e e l s a l m o s t like a

movement. The sternocleidomastoid then

strait j a c k e t u n d e r t h e s k i n .

takes on almost t h e entire f u n c t i o n of t h e

Filling t h e space i n t h e n o t c h b e t w e e n t h e clavicle in front a n d t h e h e a v y musculature

trapezius. T h e c o n n e c t i v e tissue of t h e outer layer of

o f t h e n e c k a n d s h o u l d e r b l a d e i n t h e b a c k are

the neck is continuous with the connective

t h e s c a l e n e s (Fig. 18-5). T h e s e are t h e m u s c l e s

tissue of t h e jaw. T h e pad over t h e angle of

i n t h e d e p r e s s i o n o n e i t h e r side a t t h e b a s e o f

t h e j a w ties i n t o t h e s t e r n o c l e i d o m a s t o i d

t h e n e c k . T h e y a t t a c h t o t h e upper ribs. T h e

(Fig. 18-6). I t c a n a c t a s a n i n h i b i t o r t o t h e

lungs e x t e n d u p just u n d e r n e a t h t h e m . T h e

freedom of m o v e m e n t in the jaw and so

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97

indirectly affect m o v e m e n t of t h e h e a d as a whole. If you c l a m p your jaw as a habit, you will a l s o b e c l a m p i n g y o u r h e a d . I f y o u c l a m p y o u r j a w h a r d e n o u g h , i t will b e d i f f i c u l t t o shake your h e a d " n o , " a n d also difficult to shake your head " y e s . " T h e fascia o n t h e underside of the jaw is continuous with that of the tongue. T h e inside of the m o u t h and t o n g u e are t h e r e b y i n c l u d e d i n r e s t r i c t i o n s of t h e face a n d h e a d . T h e erector spinae extend up to attach to t h e b a s e o f t h e skull, m i n g l i n g w i t h t h e h e a v y pad that is found on the back base of t h e skull. O n t h e b a c k o f t h e n e c k , t h e f a s c i a o f the sternocleidomastoid and trapezius is c o n tinuous w i t h t h e skullcap of c o n n e c t i v e tissue on t h e h e a d . At t h e deepest level, a l o n g t h e spines o f t h e n e c k vertebrae a n d u p o n t o t h e b u m p o n t h e b a c k o f t h e skull, t h e r e i s a v e r y h e a v y rope of c o n n e c t i v e tissue fibers. This is k n o w n a s t h e l i g a m e n t u m n u c h a e (Fig.

18-7).

Figure 18-6 The connective tissue of the outer layer of the neck.

It fans out over t h e projection at the back of t h e skull ( o c c i p u t ) , f o r m i n g a l m o s t a T s h a p e . I t a c t s like a s e p t u m i n t h e b a c k o f t h e n e c k , dividing right a n d left halves o f t h e n e c k i n t o s e p a r a t e c o m p a r t m e n t s . Its a c t i o n a s a s e p t u m serves t o c o n n e c t t h e s u p e r f i c i a l a n d d e e p layers o f m u s c l e t o e a c h o t h e r i n t h e b a c k . This ligament b e c o m e s especially thickened, almost bony, in people w h o habitually thrust the head forward. T h e septum of the l i g a m e n t u m n u c h a e is a normal c o n n e c t i o n between outer and deeper layers o f s o f t t i s s u e . T h e r e a r e s i m i l a r s e p t a elsewhere in t h e body. T h e y provide additional strength because a l i g a m e n t is denser a n d m o r e s t a b l e t h a n its f a s c i a l c o u n t e r p a r t . Septa also divide a n d c o m p a r t m e n t a l i z e f u n c tion by separating myofascia.

Figure 18-7 The ligamentum nuchae forms a surface covering for the muscles on both sides at the base of the skull. It then dives deep to form a septum between the right and left muscle masses.

NINETEEN

Pelvis and Upper Legs

T h e r e are several ways in w h i c h t h e shoulder

tract e n d s o n t h e lateral protrusions o f t h e

a n d pelvis differ f r o m o n e a n o t h e r . Initially,

tibia a n d fibula, b e l o w t h e knee. In n o r m a l

i n t h e first m o n t h o f e m b r y o n i c d e v e l o p m e n t ,

f u n c t i o n , t h e gluteus m a x i m u s acts between

b o t h a r m s a n d legs a r e e x t e n d e d d i r e c t l y o u t

t h e b a c k p a r t o f t h e h i p a n d t h e l o w e r leg,

t o t h e sides. A u s e f u l i m a g e i s t h a t o f f a l l i n g

bypassing t h e femur. Very often, however, as

spread-eagled backward i n t o water. T h e arms

t h e gluteus m a x i m u s passes over t h e h i p , it

a r e o u t t o t h e sides w i t h p a l m s f o r w a r d . T h e

sticks t o t h e g r e a t e r t r o c h a n t e r , c r e a t i n g a n

legs a r e s t r a i g h t o u t t o t h e sides w i t h t h e

aberrant drag o n t h e femur.

inside arch of t h e foot facing forward. (This

T h e small t e n s o r fascia lata attaches on

p o s i t i o n o f t h e legs i s n o t p o s s i b l e t o a n a d u l t

t h e anterior superior iliac spine, w h i c h is t h e

structure.) By t h e t i m e a b a b y is born, t h e

uppermost b o n y protrusion on the front of

a r m s a r e d o w n t o t h e sides, r e t a i n i n g a w i d e

the pelvic curve. T h e muscle angles d o w n and

r a n g e o f m o t i o n . T h e legs h a v e c o m e d o w n

s i d e w a y s , b l e n d i n g i n t o t h e fibers o f t h e i l i o -

b e n e a t h a n d in line with t h e trunk. T h e y are

t i b i a l t r a c t . F r e q u e n t l y , t h e t e n s o r feels like

rotated so that the knee, w h i c h originally

b o n e . This tiny muscle balances the backward

pointed headward, is n o w facing forward.

pull of t h e massive gluteus m a x i m u s on the

T h i s m e a n s t h a t t h e m y o f a s c i a l w e b o f t h e leg

ilio-tibial tract. By design, t h e a c t i o n of the

h a s r o t a t e d , c r e a t i n g s o f t t i s s u e spirals i n t h e

m u s c l e i s all a l o n g t h e t r a c t , d o w n t o its

legs ( a n d t o a lesser d e g r e e i n t h e a r m s ) . A functional difference between shoulder a n d pelvic girdle is in t h e use of t h e l i m b s . T h e m a j o r activity of t h e pelvis is weightbearing, while in the arms and shoulders it is mobility. Pelvic m o b i l i t y has b e e n modified because t h e n e e d for support has taken precedence. O n t h e outside o f t h e pelvis t h e r e are three, possibly four muscles t h a t we classify as superficial. T h e y attach to t h e outside of t h e h i p a n d c o n t i n u e t o t h e l o w e r leg. T h e s e are t h e gluteus m a x i m u s , t h e t e n s o r fascia lata, a n d t h e sartorius. T h e rectus femoris is t h e fourth candidate for this classification (Fig.

19-1)

T h e gluteus m a x i m u s has a very wide a t t a c h m e n t centrally, f r o m t h e posterior margin of t h e ilium a n d from t h e sacroiliac junction down to and including the tailbone. T h e m u s c l e angles diagonally across t h e pelvis d o w n t o w a r d t h e leg, e n d i n g i n t h e l o n g fibrous track called t h e ilio-tibial tract. This

Figure 19-1 The suspension of the knee from the hip.

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99

attachment below the knee. It is functionally

o n t h e f r o n t o f t h e k n e e , like a p e b b l e i n a

s h o r t e n e d w h e n its u n d e r s i d e i s s t u c k t o t h e

s t r e a m . T h e patella itself is n o t a stationary,

greater t r o c h a n t e r o f t h e f e m u r . W h e n t h i s

w e i g h t - b e a r i n g b o n e . It is a m o d i f i c a t i o n of

h a p p e n s , its e x t r e m e r i g i d i t y is a m e a s u r e of

t h e c o n n e c t i v e t i s s u e w i t h i n t h e p a t e l l a r liga-

t h e stress o n t h e m u s c l e .

ment (a sesamoid bone).

T h e sartorius is a t t a c h e d on t h e tip of t h e

O n t h e i n s i d e o f t h e legs, t h e a d d u c t o r s a r e

a n t e r i o r s u p e r i o r iliac s p i n e , i m m e d i a t e l y

the primary c o m p o n e n t of the V shape of the

a d j a c e n t t o t h e a t t a c h m e n t o f t h e t e n s o r fas-

i n n e r t h i g h . T h e gracilis i s t h e o n l y a d d u c t o r

cia l a t a . I t d i a g o n a l l y c r o s s e s t h e t h i g h i n a n

t h a t crosses b o t h t h e k n e e j o i n t a n d t h e h i p

S shape, attaching to t h e tibia below t h e knee,

j o i n t . It is t h u s c l a s s i f i e d as a s u p e r f i c i a l leg

o n t h e i n s i d e o f t h e leg. Just deep to t h e sartorius, t h e rectus

muscle. T h e other, deeper adductors cross only the hip joint; they do not extend below

femoris attaches on t h e anterior inferior iliac

t h e k n e e . T h e gracilis is a b r o a d b a n d of m u s -

s p i n e . I t d e s c e n d s t h e f r o n t o f t h e leg i n a

c l e t h a t , w i t h its f a s c i a , i s a t t a c h e d o n t h e

straight line, b l e n d i n g i n t o t h e upper part of

pubic ramus. It continues to the knee, coming

the patellar t e n d o n above t h e k n e e . T h e t e n -

t o lie u n d e r n e a t h t h e s a r t o r i u s a n d a t t a c h i n g

d o n c o n t i n u e s across t h e front of t h e k n e e to

to t h e medial projection of t h e tibia b e l o w

the front of the tibia. T h e patella (kneecap)

the knee joint.

sits w i t h i n t h e t e n d o n like a b o n y c u s h i o n

O n t h e b a c k o f t h e leg are t h e h a m s t r i n g s . T h r e e o f t h e s e m u s c l e s e x t e n d f r o m t h e sitting b o n e (ischial tuberosity), w h i c h is a b o n y projection of the hip b o n e in back and below. Two hamstrings c o n t i n u e to the inside (medial) side o f t h e k n e e ; t h e t h i r d a t t a c h e s l a t e r ally b e l o w t h e k n e e j o i n t . T h e c o m b i n e d a c t i o n o f t h e l o n g superficial m u s c l e s a f f e c t s b o t h t h e k n e e a n d t h e h i p j o i n t s . Like t h e shoulder, t h e k n e e is a s u s p e n d e d s t r u c t u r e . O n its l a t e r a l s i d e , p o s i t i o n a n d f u n c t i o n are d e t e r m i n e d b y t h e gluteus m a x i m u s , t h e t e n s o r fascia lata, a n d t h e lateral h a m s t r i n g (biceps femoris). O n t h e m e d i a l side of t h e k n e e , t h e r e is t h e interact i o n o f t h e sartorius, gracilis, a n d t h e t w o hamstrings (semitendinosus and semimembranosus). M e d i a l l y a n d l a t e r a l l y , t h i s s u p e r f i c i a l suspension of the knee resembles two inverted tripods. Medially, t h e s u s p e n s i o n s are f r o m t h e a n t e r i o r superior iliac spine, p u b i c r a m u s , a n d ischial tuberosity. Laterally, t h e y are t h e ischial tuberosity, t h e sacroiliac joint, a n d t h e

Figure 19-2 The psoas connects the lumbar spine (deep) with the lesser trochanter of the femur (superficial).

l a t e r a l side o f t h e a n t e r i o r s u p e r i o r i l i a c s p i n e . It is our professional experience that knee problems originate in the knee only w h e n

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Lateral pelvic tilt

there has b e e n direct trauma to t h e knee. A knee that tracks straight forward implies t h a t its a t t a c h e d m u s c l e s are i n e q u a l t e n s i o n . U n e q u a l t e n s i o n i n t h e k n e e m u s c l e s originates in the hip, w h i c h t h e n modifies the tracking of the knee. Over time, using a knee in a d e v i a t e d p o s i t i o n will result in a " k n e e i n j u r y " w h i c h has originated in t h e pelvis. This analysis of knee injuries is borne out by m a n y b o d y w o r k e r s , w h o r e p o r t b e s t results ameliorating the knee problems of dancers or runners when working with the hip. A b i g surprise i n o u r c l a s s i f i c a t i o n o f m u s cles as superficial or deep c o m e s w h e n we c o n s i d e r t h e p s o a s (Fig. 19-2). T h i s w a s Ida Rolf's f a v o r i t e m u s c l e ; o n e m i g h t t e r m i t t h e Rolfer's m u s c l e . I t lies o n t h e i n s i d e o f t h e b o d y and attaches inferiorly deep within the leg. It is n e v e r t h e l e s s a m u s c l e t h a t crosses m o r e t h a n two joints, and we therefore define it as an extrinsic, superficial structure. On t h e

Figure 19-3 The tilt of the pelvis changes/is changed by the t o n e of the psoas.

inside of t h e pelvic b o w l , t h e psoas is in fact t h e m o s t superficial tissue. It crosses t h e w h o l e o f t h e p e l v i s w i t h o u t a t t a c h i n g t o it. T h e upper a t t a c h m e n t of t h e psoas is on t h e lower thoracic and upper lumbar vertebrae. It crosses t h e pelvic bowl at an angle, f o r m i n g a l m o s t a n S s h a p e . I t flows d i a g o nally over t h e p u b i c b o n e just medial to t h e a n t e r i o r s u p e r i o r i l i a c s p i n e . Its l o w e r a t t a c h m e n t is on the inside of the thigh, on an i n n e r p r o j e c t i o n o f t h e f e m u r c a l l e d t h e lesser trochanter. It can be palpated by placing your f i n g e r o n t h e a n t e r i o r s u p e r i o r iliac s p i n e a n d t h e n m o v i n g just medially. T h e a c t i o n o f t h e p s o a s c a n b e p a l p a t e d i f y o u k i c k y o u r leg while sitting. T h e psoas is a m a j o r factor in t h e curve of t h e lower back (lumbar) region. It t h e r e b y indirectly determines t h e vertical tilt o f t h e p e l v i s . W h e n a p e l v i s i s t i l t e d side-

Figure 19-4 Psoas and iliacus fasciae c o m e t o g e t h e r at the groin, forming the iliopsoas tendon. The iliacus fascia is continuous with the deep pelvic fascia, e.g. the obturator internus.

w a y s , t h e p s o a s will b e t i g h t e r o n o n e side a n d m o r e f l a c c i d o n t h e o t h e r (Fig.

19-3).

T h e deeper layer of muscles in t h e h i p affects only t h e hip joint. These muscles b a l a n c e a n d s t a b i l i z e t h e leg a s o n e m o v e s

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through t h e m sequentially in walking. In a g e n e r a l way, t h e s e d e e p e r m u s c l e s f o r m almost a circle of m u s c l e a n d fascia a r o u n d the upper part of t h e femur. Their range of m o v e m e n t is small b u t their s h o r t n e s s gives t h e m a great m e c h a n i c a l a d v a n t a g e . T h e extent of their effect is great because of their fascial c o n n e c t i o n s u p i n t o t h e t r u n k a n d d o w n i n t o t h e leg. T r o u b l e c o m e s w h e n t h e superficial a n d d e e p m u s c l e l a y e r s are g l u e d together. T h e i l i a c u s m u s c l e lies d e e p t o t h e p s o a s i n s i d e t h e p e l v i s (Fig. 19-4). It l i n e s t h e i n n e r pelvic bowl. It attaches along t h e entire i n n e r curve of t h e ilium, just b e l o w t h e crest. In some people, the attachment extends medially t o t h e i n n e r side o f t h e s a c r u m a n d i s thus o f t e n a factor w h e n t h e r e are sacroiliac problems. T h e muscle c o n t i n u e s d o w n across the pubic b o n e in a funnel shape, crossing t h e hip b o n e n e x t t o t h e psoas. T h e iliacus

Figure 19-5 The fascia of the adductor group (longus, gracilis, magnus) is continuous up into the pelvic bowl and influences the urogenital and pelvic diaphragms. Tension is transmitted from inner thigh to pelvis a n d / o r vice versa.

f o l l o w s t h e p a t h o f t h e p s o a s t o t h e lesser t r o chanter and often joins with it to form a c o m -

c o n t i n u e d o w n to t h e upper part of t h e inside

m o n t e n d o n . T h e iliacus lines t h e entire i n n e r

of the femur. Of these, the adductor longus is

surface of t h e pelvic b o w l . A h a b i t u a l c o n t r a c -

m o s t c o m m o n l y o v e r u s e d . I t c a n b e felt a s a

tion in this muscle creates a feeling of spasm

h e a v y c o r d j u s t t o t h e s i d e o f t h e g e n i t a l s . Its

on t h e inside of t h e pelvis. B o t h iliacus a n d

tightness is unrelenting; it almost never

p s o a s are i n v o l v e d i n t h e p l a c e m e n t o f t h e

relaxes.

pelvis a n d l u m b a r s p i n e .

T h e adductor longus attaches to the in-

The term "lower back" includes the lumbar

side u p p e r t h i r d o f t h e f e m u r , j u s t b e l o w t h e

s p i n e , t h e s a c r u m , a n d t h e t w o ilia. T h e ilia-

a t t a c h m e n t s o f t h e iliacus a n d t h e psoas. T h e

cus is a m a j o r i n n e r d e t e r m i n a n t of t h e place-

p e c t i n e u s , a n o t h e r a d d u c t o r , lies b e t w e e n t h e

m e n t of the ilium; the psoas is a m a j o r inner

a d d u c t o r l o n g u s a n d t h e psoas. I t c a n b e felt

determinant of the placement of the lumbar

on palpation of t h e groin region, in a depres-

spine. W h e n t h e psoas is glued d o w n o n t o

sion b e t w e e n t h e t w o longer muscles. It is a

t h e iliacus, i n d e p e n d e n t m o v e m e n t o f t h e s e

s h o r t , flat, o f t e n f a i r l y f l a c c i d m u s c l e d e s i g n e d

b o n e s , as well as of t h e m u s c l e s , is lost. T h e r e

t o d r a w t h e leg m o r e t o w a r d t h e c e n t e r .

i s n o t a free f l o w o f m o v e m e n t t h r o u g h t h e

T h e largest of t h e adductors is t h e a d d u c -

lower back vertebrae, t h e pelvic bowl, or t h e

t o r m a g n u s . I t arises a s a l a r g e m a s s f r o m t h e

femur. T h e delicate rocking m o v e m e n t w i t h i n

w h o l e l e n g t h o f t h e p u b i c r a m u s . I t fills t h e

t h e p e l v i s t h a t is e s s e n t i a l f o r a fluid s t r i d e is

space d e e p t o t h e gracilis a n d e n d s b y wrap-

lacking.

ping around the back of the femur, b e h i n d

On the inside of the thigh, three adductor

a n d d e e p t o t h e h a m s t r i n g s (Fig.

19-6). T h e

muscles attach to the pubic ramus and the

adductor m a g n u s is t h e basis for t h e c h a r a c -

f r o n t o f t h e p u b i c b o n e (Fig.

teristic shape t h a t is o f t e n seen on t h e i n n e r

19-5). T h e y

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side o f t h e t h i g h . Like t h e p e c t i n e u s , i t i s u s u ally u n d e r d e v e l o p e d a n d underused. W h e n t h e k n e e i s r o t a t e d o u t o f t r u e , t h e gracilis takes over t h e f u n c t i o n of t h e adductor magnus. T h e deeper muscle t h e n c a n n o t achieve its t r u e t o n e a n d f u n c t i o n . I n a d d i t i o n , w h e n t h e h a m s t r i n g s are s t u c k t o t h e a d d u c t o r m a g n u s , t h e u s u a l r e s u l t will b e s p a s m s o r c r a m p s in t h e hamstrings that no a m o u n t of stretching c a n relieve. At t h e i n t e r m e d i a t e l e v e l , t h e r e is a f a n Figure 19-6 A midthigh cross section illustrating the major compartments: flexor, extensor (hamstrings), adductor, and abductor (ilio-tibial tract). The relationships change higher and lower in the thigh.

shaped muscle called t h e gluteus medius on t h e side of t h e p e l v i s (Fig. 19-7). Its u p p e r a t t a c h m e n t is on t h e crest of t h e ilium. It funnels downward and attaches on the top of t h e greater t r o c h a n t e r of t h e femur. It is partially covered by the upper margin of the gluteus m a x i m u s . W h e n t h e upper border of t h e gluteus m a x i m u s is stuck to t h e gluteus medius, the head of the femur is pushed into t h e h i p s o c k e t , i m p e d i n g t h e free s w i n g o f t h e leg. A h a l l m a r k o f t h i s k i n d o f h o l d i n g o r s h o r t e n i n g i s t h e t h i c k e n e d t i s s u e o n t h e side o f t h e hips, o n t h e crest o f t h e ilium. Underlying the gluteus m a x i m u s and m e d i u s t h e r e i s a g r o u p o f s e v e n m u s c l e s , six o f w h i c h a r e c l a s s i f i e d a s lateral r o t a t o r s o f t h e l e g (Fig. 19-8). T h e t e r m " l a t e r a l r o t a t i o n " is an anatomist's term, yet a m o v e of purely lateral r o t a t i o n is a l m o s t never m a d e . T h e s e m u s c l e s serve m o r e f u n c t i o n s t h a n purely l a t e r a l r o t a t i o n o f t h e leg. All s e v e n m u s c l e s a t t a c h like a f a n t o t h e b a c k p a r t o f t h e g r e a t e r t r o c h a n t e r o f t h e f e m u r . W e will d i s c u s s o n l y s o m e of t h e m in detail. T h e lowest of t h e lateral rotators is t h e quadratus femoris. It attaches on the lower m a r g i n of t h e greater t r o c h a n t e r a n d continues to t h e pelvic ischial tuberosities. It forms

Figure 19-7 The gluteus medius is influenced by the gluteus maximus, which overlaps it. The fascia of the gluteus medius is continuous with that of the abdominal obliques at the iliac crest. This is the structural basis for the more tenacious "love handles."

a part of t h e fold or crease of t h e buttocks, underlying t h e posterior portion of the groin b a n d . W h e n t h e q u a d r a t u s f e m o r i s a n d its f a s c i a l c o v e r i n g a r e t i g h t , t h i s is v i s i b l e as a m a r k e d d i m p l i n g b e l o w t h e pelvis, w h i c h a c c o m p a n i e s a "flat ass."

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A n o t h e r lateral rotator, t h e o b t u r a t o r intern u s , lies h e a d w a r d o f t h e q u a d r a t u s f e m o r i s (Fig. 19-9). Its e x t e r n a l p a r t is a t e n d o n t h a t attaches on t h e greater t r o c h a n t e r a n d crosses t h e b a c k part o f t h e pelvic b o n e , m i d w a y b e t w e e n t h e ischial tuberosity a n d t h e tailb o n e . T h e m u s c l e i t s e l f fills t h e l o w e r i n s i d e b o w l o f t h e p e l v i s , a t t a c h i n g a r o u n d t h e circular o p e n i n g called t h e obturator f o r a m e n . The muscle body is on the inside of the pelvis; its t e n d o n a t t a c h e s o n t h e o u t s i d e o f t h e h i p . T h r o u g h its c o n n e c t i o n w i t h t h e i n n e r tissue o f t h e p e l v i s , t h e o b t u r a t o r i n t e r n u s i s very likely t o b e c o n n e c t e d w i t h m e n strual o r p r e m e n s t r u a l t e n s i o n a n d c r a m p s in w o m e n . A very tight obturator internus in m e n tends to show as an extreme narrowness o f t h e pelvis a t t h e b o t t o m , w i t h a c o r r e s p o n ding winging-out of the upper margin of the pelvis. T h e piriformis, also a lateral rotator, attaches to t h e b a c k part of t h e greater trochanter, slightly above t h e obturator internus. It angles headward to attach to t h e

Figure 19-8 The rotators of the hip include the piriformis, quadratus femoris, internal and external obturators, and the superior and inferior gemelli. For clarity we have omitted the lines of force of the minute gemelli; the obturator externus is not visible from this angle. We are including the lines of force of the gluteus minimus to complete the picture of this fascial layer.

underside of the sacrum. T h e piriformis crosses i n t o t h e p e l v i s t h r o u g h t h e g r e a t e r sciatic f o r a m e n , a l o n g w i t h t h e large sciatic nerve. W h e n this muscle is cramped or chroni c a l l y t e n s e d , i t f r e q u e n t l y g i v e s rise t o t h e pain that is called sciatica. T h e gluteus m i n i m u s is n o t included as a lateral r o t a t o r i n c l a s s i c a l a n a t o m y . T o u s , t h i s fan-shaped m u s c l e c o m p l e t e s t h e larger fan of t h e l a t e r a l r o t a t o r g r o u p . I t lies d e e p t o t h e gluteus medius a n d attaches o n t h e outside of the ilium to t h e upper part of t h e greater trochanter. Tightness in t h e lateral rotators as a group provides the dimple in the back of the butt o c k s t h a t l o o k s s o c u t e t o s o m e p e o p l e . Actually, b o d i e s w i t h t h a t d i m p l e t e n d t o w a l k w i t h a w a d d l e , w i t h f e e t a n d legs s p l a y e d s i d e ways. An a t t e m p t to correct t h e situation by f o r c i n g t h e feet t o p o i n t s t r a i g h t f o r w a r d i s n o t s u c c e s s f u l b e c a u s e t h e p r o b l e m arises i n

Figure 19-9 Note the relation of the fascia of the obturator internus to the deep pelvic fascia.

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be stable. In actuality, sequencing of muscle u s e i s n e c e s s a r y f o r s t a b i l i t y i n t h e leg a s w e l l as the shoulder. As o n e muscle or group of muscles is called into action to induce movem e n t o f t h e leg, t h e o p p o s i n g m u s c l e o r m u s cle group should relax a n d lengthen. Muscles are h e l d in readiness (tonus) a n d c a n t h e n contract or lengthen as needed. I t i s d i f f i c u l t f o r m o s t o f u s t o a l l o w t h e leg t o m o v e i n d e p e n d e n t l y i n its p e l v i c s o c k e t . Ideally, w e s h o u l d b e a b l e t o s w i n g t h e leg i n t h e h i p j o i n t w h i l e t h e p e l v i s r o c k s . You c a n t e s t t h i s b y s t a n d i n g s i d e w a y s o n a stair w i t h o n e leg a n d a l l o w i n g t h e o t h e r leg t o s w i n g o v e r t h e l o w e r stair. U s u a l l y t h e l e g c a n m o v e o n l y a s a u n i t w i t h t h e w h o l e side o f t h e h i p . Figure 1 9 - 1 0 Fascial continuity: adductors -> obturator internus -> iliacus -> internal abdominal obliques -> diaphragm.

In walking, this fascial tightness in t h e h i p results in a gait t h a t is initiated in t h e lower b a c k , b y p a s s i n g t h e h i p j o i n t — a s t r u t t i n g gait. T h e shape on t h e inside of t h e pelvic bowl ( p e l v i s a n d s a c r u m ) is like t w o b o w l s , a larger

t h e tightness o f tissue i n t h e h i p . W h e n t h e

bowl on t o p of a smaller o n e . T h e upper,

h i p is tightly b o u n d , forcing t h e feet to track

greater bowl, w h i c h is t h e i n n e r surface of

straight forward puts a t o r q u e i n t o t h e leg

t h e ilium, is lined by t h e iliacus m u s c l e a n d

that peaks at the knee.

its f a s c i a . T h e l o w e r , s m a l l e r b o w l i s l i n e d o n

In discussing m o v e m e n t of the arm at the shoulder (Section 17), we described the nec-

its sides b y t h e o b t u r a t o r i n t e r n u s a n d its fasc i a . S i n c e t h e t w o b o w l s are c o n t i n u o u s , i t

essary s e q u e n c i n g of muscles as t h e a r m is

is easy to visualize t h e fascial c o n t i n u i t y

r a i s e d . All m u s c l e s s h o u l d n o t f u n c t i o n s i m u l -

between the obturator internus and the

taneously. Each must be called into action as

iliacus

the arm reaches the angle where that muscle

(Fig.

19-10).

About halfway d o w n t h e lower bowl, a

( o r p a r t o f t h e m u s c l e ) h a s its e f f e c t . T h i s

sling-like a r r a n g e m e n t of m u s c l e a n d fascia

allows for precise c o n t r o l c o m b i n e d w i t h

divides it i n t o upper a n d lower parts. This

flexibility in t h e shoulder joint.

i s t h e p e l v i c floor, a l s o c a l l e d t h e p e l v i c dia-

In t h e h i p , t h e usual c o n c e p t is t h a t t h e leg m u s t b e tightly h e l d s o t h a t m o v e m e n t will

p h r a g m . A b o v e t h i s d i a p h r a g m lies t h e b l a d der, r e c t u m , a n d i n w o m e n t h e u t e r u s a n d

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ovaries. T h e margins of t h e pelvic d i a p h r a g m are c o n t i n u o u s w i t h t h e o b t u r a t o r i n t e r n u s fascia.

(Fig.

19-11).

T h e pelvic diaphragm is c o m p o s e d of four muscles. T h e p u b o c o c c y g e u s is t h e largest of these. It connects the back of the pubic b o n e , behind the pubic symphysis, to the inside of the second or third segment of the coccyx. F a n n i n g o u t f r o m this m u s c l e are t h e iliococcygeus, the ischiococcygeus, and the coccygeus. Collectively, these are o f t e n referred to a n a t o m i c a l l y as t h e levator a n i . We refer to t h e m in this text as the pelvic diaphragm. Blended into the muscles of the pelvic d i a p h r a g m are t h e s p h i n c t e r m u s c l e s o f t h e anus, bladder, a n d i n w o m e n t h e vagina. There is a m u t u a l b a l a n c e b e t w e e n these sphincter muscles a n d t h e sling m u s c l e s of t h e pelvic floor m e n t i o n e d above. T h e t o n e o f one is reciprocally determined by the t o n e of the other. W h e n the lumbar spine is angled

Figure 19-11 The margins of the pelvic diaphragm are continous with the obturator internus fascia.

t o o sharply forward or backward, t h e tilt of t h e p e l v i s will f o l l o w suit. T h e s o f t t i s s u e o f

females, the perineum is bisected by the

t h e p e l v i c d i a p h r a g m will s h o w t h e stress.

o p e n i n g t o t h e v a g i n a . T h e labia m a j o r a are

T h e t o n e of this diaphragm is a m a j o r factor

frequently almost glued to the b o n e s of the

in healthy reproductive and elimination

rami. This means that the opening to the

systems.

v a g i n a i s r e l a t i v e l y rigid a n d l a c k s t h e

Below t h e pelvic diaphragm, filling t h e space horizontally b e t w e e n t h e V-shaped bones of the pubic rami, is the urogenital

resilience a n d flexibility that is i m p o r t a n t for sex and childbirth. T h e area b e t w e e n t h e ischial tuberosities

diaphragm, also k n o w n as t h e p e r i n e u m .

a n d t h e tailbone is referred to as t h e ischio-

In males it contains the perineal muscles,

rectal fossa. T h e urogenital d i a p h r a g m does

including the muscles at the base of the penis.

n o t e x t e n d t h i s far b a c k . T h e o n l y m u s c l e

T h i s area i s o f t e n c o m p r e s s e d b y c l e n c h i n g

c o n t a i n e d in this area is t h e e x t e r n a l s p h i n c -

the muscles of the buttocks, w h i c h has an

ter of t h e anus. T h e r e m a i n d e r of t h e area is

effect on t h e f u n c t i o n of t h e penis. In

filled w i t h a f a t p a d .

TWENTY

The System of Horizontal and Vertical Myofascial Structures W h a t we h a v e tried to do in our consideration of the muscles of the body is to show h o w m u s c l e s a n d c o n n e c t i v e tissue interact, focusing in t h e greatest detail on the trunk a n d pelvis. We use m u s c l e a n a t o m y to orient ourselves in t h e c o n n e c t i v e tissue bed. T h e c o n n e c t i v e tissue is responsible for t h e c o n t i nuity of m o v e m e n t through the body. T h e c o n n e c t i v e tissue is responsible for establishing t h e spaces of the b o d y by m e a n s o f w h a t w e h a v e c a l l e d t h e d i a p h r a g m s (Fig. 20-1). T h e s e a r e h o r i z o n t a l m y o f a s c i a l s t r u c tures t h a t cross t h r o u g h t h e body. T h e lowerm o s t t w o o f t h e s e d i a p h r a g m s are i n t h e pelvis. T h e urogenital d i a p h r a g m is below, w i t h t h e p e l v i c d i a p h r a g m s l i g h t l y a b o v e it. There is t h e respiratory diaphragm in t h e trunk separating the abdominal cavity from t h e chest cavity. We h a v e also m e n t i o n e d the scalene muscles at the base of the neck a s a c t i n g like a d i a p h r a g m a f f e c t i n g t h e t o p of the lungs. In addition to this system of horizontal myofascial structures, we have described a

Figure 20-1 The connective tissue establishes the spaces of the body.

vertical (core) system t h r o u g h t h e b o d y in e a r l i e r s e c t i o n s (Fig. 20-2). T h i s v e r t i c a l c o n t i n u u m includes the interosseous m e m b r a n e o f t h e legs, t h e d e e p f a s c i a o f t h e t h i g h , t h e i n t e r n a l fascial l i n i n g o f t h e b o w l o f t h e pelvis, a n d t h e m e d i a s t i n u m . It c o n t i n u e s by w a y of t h e fascia a r o u n d t h e cervical viscera (esophagus and trachea) to the back of the m o u t h a n d p h a r y n x , a n d ends a s t h e fascial s e p t u m t h a t lies b e t w e e n t h e t w o h a l v e s o f the brain. Acute t e n s i o n s are c o m m u n i c a t e d t h r o u g h t h e b o d y b y way o f these horizontal a n d vertical c o n n e c t i v e tissue p a t h w a y s . T h i s results in a generalized tension through t h e inner aspect of the body that is characteristically

Figure 2 0 - 2 The plumb line.

HORIZONTAL

AND

VERTICAL

MYOFASCIAL

STRUCTURES

107

e x p r e s s e d as a k i n d of o v e r a l l i r r i t a b i l i t y . It is a feeling of "don't t o u c h m e " or "I can't c o p e " rather t h a n an acutely debilitating pain. W h e n w e refer t o s p a c e s w i t h i n t h e b o d y , it s h o u l d be r e m e m b e r e d t h a t t h e s e spaces are n o t e m p t y . T h e y are f i l l e d w i t h organs, c o n nective tissue, muscles, etc. T h e vertical a n d horizontal myofascial pathways we have described above exist as a n o r m a l part of t h e structure of t h e body. W h e n this is out of b a l a n c e , c o n n e c t i v e tissue filling t h e interv e n i n g s p a c e s r e s p o n d s b y e s t a b l i s h i n g stress lines. T h e s e are s e c o n d a r y f u n c t i o n a l structures. T h e y are established in r e s p o n s e to need and m a y be resorbed as function is modified. For e x a m p l e , t h e r e are c o n n e c t i o n s f r o m t h e respiratory diaphragm d o w n i n t o t h e p e l v i s . W h e r e t h e a b d o m i n a l d i a p h r a g m lies Figure 20-3 It is obvious from this diagram that changes in any part of the abdomen and pelvis will affect all of the abdomen and pelvis.

adjacent to the vertebral c o l u m n , it sends e x t e n s i o n s ( c r u r a e ) d o w n a s far a s t h e u p p e r p a r t o f t h e s a c r u m (Fig. 20-3). J u s t l a t e r a l t o e a c h side o f t h e v e r t e b r a l c o l u m n , t h e p s o a s penetrates these crurae and extends up to attach to the lower vertebrae in the chest c a v i t y . I n t h i s way, t h e f a s c i a o f t h e p s o a s i s c o n t i n u o u s with t h e fascia of t h e lower border of t h e d i a p h r a g m . T h e fascia of t h e psoas via t h e iliacus is also c o n t i n u o u s w i t h t h a t of the obturator internus, which then blends i n t o the diaphragms in the pelvis. In t h e back, t h e c o n n e c t i v e tissue of t h e psoas is continuous with that of the quadratus l u m b o r u m and the erector spinae. O n t h e sides, t h e r e s p i r a t o r y d i a p h r a g m blends into the transverse and oblique abdominal muscles. In the front, the d i a p h r a g m is c o n t i n u o u s with t h e fascia on t h e underside of t h e rectus a b d o m i n i s . T h e rectus a b d o m i n i s provides a c o n n e c t i o n b e t w e e n t h e f r o n t o f t h e respiratory diaphragm and the pubic bone. The abdominal

Figure 2 0 - 4 Fascial connection between pubic bone and humerus.

o b l i q u e s are a c o n t i n u a t i o n of t h e respiratory diaphragm d o w n to t h e crest of t h e ilium, continuing into the pelvic diaphragms by

108

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W E B

way of t h e fascia of t h e iliacus a n d obturator internus. Fascial p a t h w a y s o n t h e b o d y surface also c o n t r i b u t e t o t h e b a l a n c e a m o n g t h e diaphragms. These connections tend to be in broader and longer sheets, covering more o f t h e body. O n e c o n n e c t i o n u p across t h e a b d o m e n i s b y w a y o f t h e superficial a b d o m inals, e x t e n d i n g across t h e pectoralis m a j o r to t h e a r m (Fig. 20-4). F a s c i a l s h e e t s o n t h e surface o f t h e obliques tie upward i n t o t h o s e o n t h e s e r r a t u s a n t e r i o r u n d e r t h e s c a p u l a (Fig. 20-5). I n t h e b a c k , t h e f a s c i a o v e r t h e g l u t e u s m a x i m u s flows upward obliquely i n t o t h a t of t h e latissimus dorsi c o n n e c t i n g o n u p i n t o t h e Figure 2 0 - 5 Fascial connection from front of abdomen to upper back.

a r m . T h e o f t e n leathery covering of t h e erector spinae c a n immobilize the vertical play of a n y o r all o f t h e d i a p h r a g m s .

TWENTY-ONE

Reciprocity of Movement

S p i n a l c u r v e s are r e c i p r o c a l . T h e c u r v e o f t h e

restriction in your breathing. Notice that

lumbar spine is reflected in t h e curve of t h e

w h e n t h e h e a d i s h e l d v e r y still, t h e b r e a t h i s

cervical spine. If t h e lumbar spine is curved

b o t h shallower and more labored. If y o u o n c e

t o o far f o r w a r d , t h e c e r v i c a l s p i n e will a l s o b e

a g a i n let y o u r h e a d b e v e r y easy, a l o n g w i t h

c u r v e d t o o far f o r w a r d . I f t h e l u m b a r s p i n e i s

t h e rest o f y o u r b o d y , y o u c a n f e e l a g r e a t e r

t o o flat o r s t r a i g h t , t h e c e r v i c a l s p i n e will b e

ease in b r e a t h i n g . T h e r e is m o r e fullness of

t o o flat o r s t r a i g h t .

b r e a t h w i t h less e f f o r t .

It is t e m p t i n g to classify t h e b a l a n c e of t h e

Another example of this can be seen in

spine by the way a person holds himself w h e n

walking. Allow your head and shoulders to

h e i s s t a n d i n g still. I n a c t u a l i t y , t h e s p i n e i s

be as limber and loose as possible. If you can

like a s p r i n g , e x p a n d i n g a n d c o n t r a c t i n g a s

e v e n let t h e m flop a bit, this will give y o u an

t h e person m o v e s a n d b r e a t h e s . T h e true diag-

e x a g g e r a t i o n . T h e n , w h i l e still w a l k i n g , h o l d

n o s i s o f t h e s p i n e i s n o t i n its c u r v a t u r e b u t i n

y o u r h e a d still. C o n c e n t r a t e o n a t h o u g h t ,

its q u a l i t y o f m o v e m e n t . N o p a r t o f a m o v i n g

a n d r e g i s t e r h o w t h i s h o l d i n g r e s u l t s i n rigid-

s p i n e s h o u l d b e q u i e t o r still. I f o n e s e g m e n t

ity in t h e w h o l e b a c k . You will n o t i c e an

o f t h e v e r t e b r a l c o l u m n i s b e i n g h e l d still,

increased heaviness on your heels as you

freedom of m o v e m e n t throughout the spine

w a l k . A f t e r w a l k i n g i n t h i s m o r e stressful

will b e i n h i b i t e d .

p o s i t i o n , a g a i n let y o u r h e a d g o easy, n o d -

W h e n w e talk a b o u t m o v e m e n t , w e usually

d i n g g e n t l y y e s (or n o , i f t h a t ' s y o u r a t t i t u d e ) .

t h i n k o f large g e s t u r e s like w a l k i n g , d o i n g

Feel h o w y o u r b a c k l e n g t h e n s a n d m o v e s

work, picking up t h e baby, w a s h i n g t h e

w i t h greater ease. Your step will b e c o m e

d i s h e s , d r i v i n g t h e car. Yet m o v e m e n t c a n

m u c h softer.

be as subtle as slow breathing during sleep.

T h e s e are t w o e x a m p l e s o f h o w h o l d i n g

A b o d y never stops m o v i n g . Even t h e smallest

o n e p a r t o f t h e b o d y a f f e c t s t h e rest o f t h e

m o v e m e n t creates a ripple t h r o u g h o u t t h e

b o d y . T h e y a r e d e l i b e r a t e g e s t u r e s . W e all

entire o r g a n i s m . T h e tissue t h r o u g h w h i c h

have holding patterns in our bodies that

this ripple is t r a n s m i t t e d is t h e c o n n e c t i v e

are i n v o l u n t a r y . W h e t h e r t h e h o l d i n g i s o f

tissue. W h e n c o n n e c t i v e tissue is in t o n e , it

a single m u s c l e or of a larger part, t h e w h o l e

i s m u c h like t h e c a t g u t o n a p r o p e r l y s t r u n g

b o d y will b e affected. W h e n y o u h i t t h e side

cello. It transmits vibrations; it transmits

of a table, t h e resonance of t h e blow vibrates

m o v e m e n t . S o m a y b e w e s h o u l d say t h a t

t h r o u g h t h e entire table. Similarly, a n y ges-

w h e n w e are p r o p e r l y i n t o n e , w e h u m — t o

ture vibrates t h r o u g h o u t a living body. We

each person his or her characteristic t o n e .

t e n d to forget t h a t we are a single v i b r a t i o n a l

W e c a n d e m o n s t r a t e this for ourselves b y t w o a w a r e n e s s e x e r c i s e s . Sit o r s t a n d , l e t t i n g your head and arms be very loose, and sense

u n i t . H o l d i n g o n e p a r t still c o n s t i t u t e s a n interference with our resonance. T h e r e is a t o y c a l l e d a S l i n k y

r M

, a highly

your breathing. Be aware of your breathing

tempered, very l o n g spring coil of steel. O n e

with your b o d y relaxed as m u c h as possible.

of t h e t h i n g s t h a t a Slinky will do is pull itself

I f y o u t h e n h o l d y o u r h e a d still (like s t a r t i n g

d o w n s t a i r s . I f y o u start b y p u l l i n g o n e e n d o f

t o t h i n k a b o u t s o m e t h i n g ) , y o u will s e n s e a

t h e coil d o w n o n e step, e a c h circle in t h e coil

110

T H E

E N D L E S S

W E B

w i l l p u l l t h e n e x t o n e a f t e r it. T h i s i s a n e x -

t i s s u e o f t h e b a c k , a l t e r n a t i n g f r o m o n e side

ample of m o v e m e n t reverberating through a

to t h e other of the vertebral c o l u m n .

structure. A l t h o u g h it is n o t m a d e of steel, t h e

T h e e r e c t o r s p i n a e are c o v e r e d b y a h e a v y

elasticity a n d organization of t h e c o n n e c t i v e

f a s c i a l s h e e t , t h e l u m b o - d o r s a l fascia, w h i c h

tissue reverberates like a Slinky in t h e body.

b l e n d s i n t o t h e h e a v y c o n n e c t i v e tissue p a d

This kind of reciprocity of m o v e m e n t is

on the sacrum and coccyx. From the sacrum,

especially apparent in the spine. Because the

t h e fascia c o n t i n u e s diagonally across t h e

superficial m u s c l e s are t h e longest, h o l d i n g

b u t t o c k s a n d o n i n t o t h e i l i o - t i b i a l b a n d (Fig.

p a t t e r n s at a s u p e r f i c i a l l e v e l a f f e c t a b r o a d

21-1) T h u s , b o t h c l e n c h i n g t h e b u t t o c k s o r

e x p a n s e of t h e b a c k . H o l d i n g at deeper levels

h o l d i n g t h e legs h a v e a c l e a r e f f e c t o n t h e

affects smaller s e g m e n t s . Usually, h o l d i n g in

b a c k all t h e w a y u p t o t h e h e a d . C o n v e r s e l y ,

an area occurs at m o r e t h a n o n e level, a n d to

p r o b l e m s i n t h e b a c k are g e n e r a l i z e d t o t h e

a different degree at e a c h level. Sideways cur-

b u t t o c k s a n d legs a s w e l l a s t o t h e h e a d .

vatures of t h e b a c k , as in scoliosis, are a c c o m p a n i e d by stepwise c o m p r e s s i o n of t h e soft

Figure 21-1 The superficial fascia of the back is layered. It starts with the continuity of the whole back with the leg. The change in direction converges on the sacrum.

T h r o u g h its c o n n e c t i o n w i t h t h e f a s c i a o f t h e l a t i s s i m u s d o r s i , t h e l u m b o - d o r s a l fascia

Figure 2 1 - 2 As we include the fascia of the latissimus dorsi, the change in directional pull converges over a wider area.

Figure 21-3 Still at a superficial level, the fascia of the trapezius adds yet another dimension.

RECIPROCITY

OF

MOVEMENT

111

mediates a reciprocal effect on t h e freedom of t h e s h o u l d e r a n d a r m (Fig. 21-2). T h e f a s c i a l crossover point between t h e trapezius a n d t h e latissimus dorsi (the dorsal h i n g e ) is at a b o u t t h e s i x t h a n d e i g h t h t h o r a c i c v e r t e b r a e (Fig. 21-3). H o l d i n g p a t t e r n s o r p a i n i n t h e a r m s

Fascia of i erector spinae m.

( s u c h as f r o m a t e n n i s e l b o w ) a r e felt as a spinal restriction in this area. In short, t h e fascial c o v e r i n g o f t h e b a c k i s c o n t i n u o u s w i t h all o t h e r p a r t s o f t h e b o d y . T h e b r o a d fascial c o n n e c t i o n s o n t h e s u r f a c e o f t h e b o d y allow restrictions to be generalized over t h e w h o l e structure. T h i s c a n give s h o r t - t e r m

Fascia of psoas m.

H

Fascia of quadratus lumborum m.

relief i n a c u t e t r a u m a , b u t u l t i m a t e l y s u c h restriction b e c o m e s c h r o n i c a n d difficult to track d o w n a n d release. O n t h e inside o f t h e spine are t h e d e e p flexors of t h e trunk. In t h e l u m b a r region, there is the psoas, w h i c h attaches to m o s t of the lumbar vertebrae. T h e quadratus l u m b o r u m i s a s h o r t m u s c l e t h a t lies b e t w e e n t h e p s o a s a n d t h e e r e c t o r s p i n a e (Fig. 21-4). T h i s muscle is defined as c o n n e c t i n g the twelfth rib ( t h e l o w e s t , s h o r t e s t free rib) t o t h e u p p e r m a r g i n (crest) o f t h e i l i u m . T h e q u a d r a t u s lumborum is the connection between the inside a n d outside of t h e b o d y at t h e waist.

Figure 2 1 - 4 The deep muscles of the lumbar region.

T h e fascial s h e e t s o f t h e e r e c t o r s p i n a e , q u a d ratus l u m b o r u m , a n d p s o a s a r e c o n t i n u o u s (Fig. 21-5). T h i s f a s c i a l b l e n d i n g t r a v e l s l a t e r ally t o f o r m t h e c o n n e c t i v e t i s s u e c o v e r i n g o f the a b d o m i n a l oblique muscles a n d t h e rectus a b d o m i n i s . D i s t o r t i o n i n a n y o n e will distort all t o s o m e d e g r e e . I n t h e l u m b a r r e g i o n , m o v e m e n t s are o b viously n o t straight forward or straight backward. T h e m o s t frequent m o v e m e n t s o f t h e lower b a c k — w a l k i n g , l e a n i n g over, r e a c h i n g — all i n c l u d e t w i s t i n g o r s p i r a l i n g . W h a t i s desirable is a balance of the twisting on t h e t w o sides. M o s t o f u s h a v e a s l i g h t r o t a t i o n t o o n e side s o m e w h e r e i n t h e m i d - t r u n k . S t a n d i n g r e l a t i v e l y still, o n e h i p a n d leg h a b i t u a l l y stand slightly forward of t h e other, while t h e s h o u l d e r s a n d a r m s are r e v e r s e d i n r o t a t i o n

Figure 2 1 - 5 This diagrammatic cross section of the abdomen is in the region of the lumbar spine. The continuity of the fascia as it ensheathes the muscles and the vertebra is emphasized.

112

THE

ENDLESS

WEB

(Fig. 21-6). T h e b o t t o m h a l f o f t h e b o d y g o e s in o n e direction, w h i l e t h e t o p half goes in t h e o t h e r . I n w a l k i n g , t h e l e g a n d h i p t h a t are s l i g h t l y f o r w a r d h a v e less d i s t a n c e t o t r a v e l a n d therefore t e n d t o m o v e m o r e straight f o r w a r d . T h e o p p o s i n g l e g a n d h i p , w h i c h are s l i g h t l y b e h i n d , h a v e t o w o r k h a r d e r a n d trav e r s e a g r e a t e r d i s t a n c e . U s u a l l y t h i s side m o v e s d i a g o n a l l y a n d w i t h a s w i n g . T h e diff e r e n c e i s p e r h a p s a h a l f a n i n c h o r less. O v e r y e a r s o f c o n s t a n t u s e , t h e side t h a t w o r k s harder will s h o w t h e strain in t h e back. O n e side w i l l s h o r t e n , g i v i n g t h e i m p r e s s i o n o f a s h o r t e r l e g a n d a s l i g h t l i m p . V e r y s l i g h t diff e r e n c e s i n d i s t a n c e i n t h e b o d y c r e a t e large effects. Figure 2 1 - 6 Habitual rotation of the body.

T h e p e a k o f t o r s i o n i n o v e r a l l b o d y spirals will be m o s t a p p a r e n t at t h e waist, w h i c h thickens and shortens. Most people have no f u n c t i o n a l waistline a n d therefore few people h a v e a c o n c e p t o f it. T h e w a i s t l i n e b e c o m e s apparent w h e n the body unrotates and the l o w e r f r e e ribs l i t e r a l l y lift o f f t h e p e l v i s . M u s cles a n d fascia on t h e inside a n d outside of t h e v e r t e b r a l c o l u m n h o l d t h e l o w e r ribs d o w n i n t o t h e tissue a c c u m u l a t i o n o n t h e b r i m of t h e pelvis. As t h e lower back unrotates a n d lengthens, a waistline m a y miraculously appear. This c a n result in ecstasy a n d a n e w wardrobe for w o m e n . M e n m a y experie n c e c o n s t e r n a t i o n i f t h e y b e l i e v e t h e pelvis i s n o t supposed to exist except as a small pathw a y b e t w e e n t h e l a r g e c h e s t a n d large t h i g h s . Nevertheless, t h e y t o o will h a v e a m o r e amia b l e r e l a t i o n s h i p w i t h t h e i r tailor. T h e upward continuation of the erector spinae into t h e neck blends with the pad at t h e b a c k o f t h e h e a d . T h e largely vertical a c t i o n o f t h e s e m u s c l e s i s m o d i f i e d b y a lat-

Figure 2 1 - 7 For clarity, we have depicted the deep muscles of the neck separated on the two sides. The composite of the two sides make up the total myofascial complement.

eral p u l l f r o m t h e m o r e s u p e r f i c i a l t r a p e z i u s . T h e flexors on t h e front of t h e neck balance t h e e r e c t o r s p i n a e i n b a c k , w h i c h are e x t e n sors o f t h e n e c k . A t t h e d e e p e s t l e v e l are t w o p a i r s o f m u s c l e s t h a t lie d i r e c t l y i n f r o n t o f

RECIPROCITY

OF

MOVEMENT

113

t h e transverse processes of t h e cervical vertebrae. T h e upper pair (longus capitis) c o n n e c t t h e c e r v i c a l v e r t e b r a e t o t h e b a s e o f t h e skull in front of t h e spinal c o l u m n . These flex t h e h e a d o n t h e t o p cervical vertebrae. T h e seco n d set ( l o n g u s c o l l i ) e x t e n d s d o w n f r o m t h e transverse processes of t h e cervical vertebrae to the transverse processes of t h e upper chest (thoracic) vertebrae. These muscles flex t h e n e c k o n t h e t r u n k (Fig. 21-7). At a slightly m o r e superficial level, f a n n i n g o u t t o t h e side, t h e r e a r e t h e s c a l e n e m u s c l e s . These attach to the transverse processes of t h e cervical vertebrae a n d c o n t i n u e on to t h e s u r f a c e o f t h e first a n d s e c o n d r i b s . T h e s e are active in b o t h flexing t h e n e c k a n d t u r n i n g t h e n e c k f r o m side t o s i d e . A t t h e m o s t s u p e r ficial l e v e l , o n t h e f r o n t o f t h e n e c k , are t h e sternocleidomastoid

muscles

(Fig.

21-8).

T h e s e large m u s c l e s m o v e t h e h e a d w i t h r e spect to t h e n e c k as well as m o v i n g t h e n e c k vertebrae o n t h e trunk. T h e fascial w r a p p i n g

Figure 2 1 - 8 Superficial fascia of the neck.

o f all t h e s e m u s c l e s i s c o n t i n u o u s . I n t h e n e c k , fascial g l u i n g c a n o c c u r b e t w e e n f l e x o r s

a r e n o t v e r y a p p a r e n t . I t w a s I d a Rolf's c o n v i c -

a n d extensors as well as b e t w e e n layers, creat-

t i o n t h a t s p i n a l b a l a n c e relies c h i e f l y o n s t a b i -

ing problems in t h e freedom of m o v e m e n t of

lizing t h e c o n c a v e curves of t h e spine. T h e

the neck and head.

psoas stabilizes t h e c o n c a v e i n n e r surface of

T h e ideal m y o f a s c i a l b l u e p r i n t i s t h r o w n o u t o f kilter w h e n t h e h e a d i s t h r u s t t o o far

the lumbar spine; the longus colli a n d longus capitis t o g e t h e r stabilize t h e c o n c a v e i n n e r

forward. W h e n this is t h e case, m o s t h e a d

surface of t h e n e c k p o r t i o n of t h e spine. In

movements must be controlled by the sterno-

Dr. Rolf's v i e w , t h e d o r s a l c u r v e o f t h e s p i n e

cleidomastoid. T h e erector spinae and the

i s s u p p o r t e d a l o n g its o u t s i d e s u r f a c e b y t h e

trapezius are t h e n used a l m o s t exclusively to

rhomboids. This is an unusual view of body

hold the head on. Their function as extensors

m e c h a n i c s , a n d o n e t h a t d e p e n d s f o r its l o g i c

in b a l a n c e with t h e flexors on t h e front of

on questions of balance, movement, and

t h e n e c k i s r e d u c e d . W h e n t h e h e a d i s t o o far

transmission of weight.

forward, these f l e x o r s o n t h e front o f t h e n e c k

Spinal curves are always c h a n g i n g . W i t h

(longus colli a n d longus capitis) lack t h e span

every m o v e , including breathing, these

to f u n c t i o n properly. T h e sternocleidomastoid

curves undulate, going f r o m m o r e curved

then becomes both the chief flexor and exten-

to straighter a n d back. If there is fluidity of

sor o f t h e n e c k . T h i s i s a n a w k w a r d s i t u a t i o n

m o v e m e n t t h r o u g h all p a r t s o f t h e v e r t e b r a l

a n d o n e t h a t leads t o very restricted m o v e -

c o l u m n , t h e rest o f t h e b o d y w i l l r e a d i l y

ment of the head.

arrange itself i n t o appropriate b a l a n c e for

In the chest region, prevertebral muscles

t h e person, time, a n d gesture.

TWENTY-TWO

Joints

J o i n t s are t h e m o s t c o m p l e x a n d also t h e

w h e n a joint is distended with too m u c h

m o s t interesting focus for t h e w a y different

f l u i d (fluid o n t h e j o i n t ) , l o o s e n i n g t h e c o n -

densities in c o n n e c t i v e tissue affect a n d deter-

n e c t i v e tissue a b o v e a n d b e l o w t h e j o i n t

m i n e m o v e m e n t . T h e differences a m o n g

r e s u l t s i n a r e t u r n t o n o r m a l size. T h i s c a n

j o i n t s is t h o r o u g h l y described a n d classified

be accomplished without the need to touch

in anatomical texts. Our interest is in discov-

t h e actual distended area.

ering t h e ways j o i n t s are similar t o e a c h o t h e r

T h e joint capsule is m a d e up of fibers that

a n d in analyzing t h e overall f u n c t i o n of joints

have formed in the e m b r y o in response to

w i t h i n t h e c o n n e c t i v e tissue b e d . In t h e tradi-

directional tension lines between bones. A

tional classification of joints, there is the

m a t u r e j o i n t c a p s u l e a l s o lays stress l i n e s t o

i m p l i c a t i o n that e a c h joint f u n c t i o n s in isola-

a c c o m m o d a t e the different rotations of m o v e

tion. Our attitude throughout this b o o k has

m e n t . T h e result is an interweaving of fibers

b e e n t h a t n o o n e part o f t h e b o d y m o v e s

around the end of the bones. This encloses

w i t h o u t i n t e r a c t i o n w i t h all o t h e r b o d y p a r t s .

t h e fluid-filled s p a c e b e t w e e n t h e b o n e s , a n d

T h e elements of a joint are: • Two or m o r e b o n e s ; • T h e relatively nonresilient t e n d o n s and ligaments; • T h e fluid-filled j o i n t capsule;

is c o n t i n u o u s w i t h t h e p e r i o s t e u m (Fig. 22-1) T h e r e i s a t e n d e n c y f o r c o n n e c t i v e tissue t o w r a p a j o i n t a s stress w i t h i n t h e j o i n t increasingly calls for m o r e stability. W h e n t h e j o i n t i s w e l l - b a l a n c e d a n d h a s full r a n g e

• T h e m o r e resilient muscular a n d c o n nective tissue c o m b i n a t i o n k n o w n as myofascia. At t h e deepest level, by m e a n s of t h e fibrous joint capsule, the periosteum of o n e b o n e is continuous with the periosteum of the next b o n e . W i t h i n the joint capsule, b a t h i n g t h e e n d s of t h e b o n e s , is j o i n t fluid. It is very similar in c o m p o s i t i o n to the interc e l l u l a r m a t r i x o f all c o n n e c t i v e t i s s u e . T h i s d e s c r i p t i o n a p p l i e s t o all j o i n t s t h a t a r e traditionally classified as freely m o v a b l e . O u r feeling is t h a t it also applies to those joints classified as slightly m o v a b l e or i m m o v a b l e . T h e y differ o n l y i n t h e p r o p o r t i o n o f fluid within the joint capsule. A n o r m a l joint c o m prises a d j a c e n t b o n e s , w h i c h l i t e r a l l y f l o a t with respect to o n e another. If t h e ends of t h e b o n e s a r e d r a w n t o o c l o s e t o e a c h o t h e r , irrit a t i o n of s o m e k i n d will result. Conversely,

Figure 22-1 The joint capsule matures.

J O I N T S

of m o v e m e n t , this wrapping will be sufficient

115

has created is simply h e a v y tissue p a d d i n g

t o stabilize t h e j o i n t a n d y e t f l e x i b l e e n o u g h

over a contracted a n d narrowed structure.

t o ease o f f w h e n t h e j o i n t i s n o l o n g e r i n

T h e padding can b e c o m e very tough, even

active use. W h e n a j o i n t is u n b a l a n c e d or

like b o n e . It is n o t possible for this to h a v e

s h o r t e n e d , w e see a n a c c u m u l a t i o n o f e x c e s s

t h e resilience a n d potential of a truly flexible

tissue, w h a t w e w o u l d c a l l " b a n d a g i n g . " T h i s

structure.

bandaging c a n n o t be released until we c a n learn to trust t h e stability of t h e j o i n t .

Dr. R o l f r e a l i z e d t h a t t h e b o n e s o f t h e b o d y act as spacers w i t h i n t h e c o n n e c t i v e

A n e x a m p l e o f w h a t w e are t a l k i n g a b o u t

t i s s u e b e d . B o n e s are h a r d c o n n e c t i v e t i s s u e

i s t h e t h i c k e n i n g a n d s h o r t e n i n g t h a t s o fre-

e l e m e n t s w i t h i n t h e softer c o n n e c t i v e tissue

q u e n t l y occurs i n knees. M a n y knees are

e l e m e n t s o f t h e body. Each b o n e floats w i t h

w r a p p e d i n s u c h a w a y t h a t t h e y are h e l d

respect to t h e other. T h e skeleton as a w h o l e

in a permanently bent position, unable to

floats w i t h i n t h e fluid c o n n e c t i v e tissue b e d .

lengthen out. Or the knee m a y be held in a

A j o i n t is a m o r e o r g a n i z e d a r e a of t h i s s t r u c -

locked-back position. In either case, t h e knee

ture, o n e w h e r e m o v e m e n t is expressed.

is tightly b o u n d . A well-balanced k n e e is o n e

An a n a l o g y is t h e b a t t e n or strut in an

i n w h i c h t h e j o i n t feels v e r y s l i g h t l y b e n t ;

upholstered piece of furniture. T h e m a i n

there is fluidity in t h e structure so t h a t t h e

s u p p o r t f o r t h e u p h o l s t e r e d p i e c e i s f r o m its

knee is on "go."

stuffing; t h e w o o d adds stability. T h e strut or

Wrapping or thickening is o n e hallmark of

b a t t e n is w h a t keeps t h e c o u c h f r o m sagging

w h a t we call i m m a t u r i t y in a j o i n t . T h e cause

w i t h age. Likewise, we c a n consider b o n e s as

could be injury or lack of d e v e l o p m e n t or

being present to prevent us from collapsing

regression out of negative e m o t i o n . T h e phys-

w i t h years of use a n d disuse.

ical e f f e c t i n t h e b o d y , i n t h e j o i n t , i s a l w a y s

Underdeveloped structure is c o m m o n in

c o n t r a c t i o n in t h e c o n n e c t i v e tissue structure.

the foot a n d ankle. A baby's foot at birth is

M o v i n g a j o i n t t h a t is tightly b o u n d will

n o t y e t f u n c t i o n a l f o r w a l k i n g . T h e h e e l (cal-

eventually create tissue irritation. T h i s is felt

caneus) is drawn up into the ankle joint. The

as chronic joint pain.

f o o t p r o j e c t s m o r e o r less a s a s t r a i g h t e x t e n -

I m m a t u r i t y in a j o i n t is t h e a b s e n c e of ease

s i o n o f t h e l o w e r leg. T h i s i s a b a l l e t d a n c e r ' s

a n d full r a n g e o f m o v e m e n t . T h i s p h y s i c a l

d r e a m b u t m a k e s f o r s t i l t e d w a l k i n g . Part o f

immaturity is n o t usually a w h o l e - b o d y c o n -

the structural m a t u r a t i o n that c o m e s with t h e

dition. We c an have a well-formed a n d fully

transition from baby to child occurs in the

f u n c t i o n i n g rib c a g e a n d s a d l y l a c k i n g h i p s

foot. For stable walking, t h e h e e l m u s t drop

a n d legs. T h i s i s a t y p e t h a t i s o f t e n s e e n i n

d o w n a n d back. This also establishes t h e

m e n . T h e reverse i s o f t e n seen i n w o m e n —

necessary arches of the foot.

fully formed, v o l u p t u o u s hips a n d a child-like top. These have b e c o m e stereotypes, symbols of

M o v e m e n t of the ankle includes both flexion a n d sliding. I n m a n y people, t h e heel remains wedged forward into the ankle joint,

w h a t is desirable in a w o m a n or m a n . A m a n

a n d sliding m o t i o n is lost. Ankle m o v e m e n t is

m a y h a v e a s m a l l rib c a g e a n d t h r o u g h t h e

then limited to flexion—the front of the foot

wonders of muscle-building create massive

c o m i n g up and down. This places excessive

bulk on top. He can m o c k up the look of male

strain o n t h e m u s c l e s o f t h e s h i n . Ideally,

m a t u r i t y t h a t i s c u r r e n t l y f a v o r e d . Yet h i s i s

flexion in the front of the foot is counterbal-

n o t a truly mature structure; he c a n n o t fully

a n c e d by a sliding m o t i o n e x t e n d i n g t h e heel

e x p a n d h i s rib c a g e a n d s h o u l d e r s . W h a t h e

down. In addition, in stepping down, the

116

THE

ENDLESS

WEB

joints of t h e foot flatten a n d t h e n spring back

keep t h e scarecrow upright. T h e s e deep sup-

into t h e arch as weight is transferred. This,

p o r t s i n t h e l i v i n g b o d y are s o h a r d t h e y

t o o , is lost w h e n t h e ankle is i m m a t u r e .

a l m o s t s e e m like s t e e l . Yet t h e y , t o o , h a v e

Immaturity of the ankles does n o t neces-

t h e i r origin in t h e c o n n e c t i v e tissue sleeve

sarily i m p l y a n i m m a t u r e i n d i v i d u a l . A n d y e t

between and surrounding the bones, tendons,

t h e r e will be a c o n s t a n t awareness of lack of

and muscles.

support. T h e consciousness m a y simply be t h a t my feet hurt. It d o e s n ' t m e a n t h a t I never

Instead of a static image of bodies, we w o u l d like t o o f f e r a d i f f e r e n t c o n c e p t . B o d i e s

feel g o o d a b o u t a n y t h i n g . I t does m e a n t h a t

a r e n e v e r c o m p l e t e l y still. W h e n w e are q u i e t ,

e v e n w h e n I feel w o n d e r f u l , I am also aware

t h e fine m o v e m e n t s of breathing and balanc-

t h a t m y feet are b o t h e r i n g m e . Body types s h o w different ways of using

i n g a r e r e v e r b e r a t i n g f r o m h e e l b o n e t o skull. At a level b e l o w c o n s c i o u s awareness, there

t h e c o n n e c t i v e tissue as a w h o l e . Our favorite

i s t h e c o n s t a n t v i b r a t i o n o f tissue t h a t i s i n

imaginative illustration of this is to be found

tone, ready to move.

in

The

Wizard ofOz.

T h e T i n W o o d s m a n is

I n t h i s s e n s e , t h e b o d y i s m u c h like a car

o n e c o m m o n type. T h e outside of the b o d y

t h a t i s n o t t u r n e d off. W h e n i t i s n o t m o v i n g ,

h a s b e e n s o t o u g h e n e d t h a t t h e j o i n t s feel

it is i d l i n g . Its m o v e m e n t is m e r e l y a s h i f t i n g

rusted. W e a l m o s t m u s t add oil t o get t h e m t o

i n t o gear. W e m a y t h i n k t h a t i n o r d e r t o m o v e

w o r k . It's a s t h o u g h t h i s p e r s o n h a s n o c o n f i -

we h a v e to pull ourselves o u t of a deep i m m o -

dence in t h e deeper structure; m o s t of t h e

bility a n d inertia, b u t this is n o t t h e case. We

support is on t h e surface. At the other extreme is the example of

can be aware of our constant m o v e m e n t and vibration. We c a n be aware t h a t gesture a n d

t h e Scarecrow. He is soft a n d structureless

a c t i v i t y are a s h i f t o f gear. T h e y a r e c h a n g e s

a n d pliable on t h e surface. T h i s is w h a t Ida

in the intensity and direction of movement,

Rolf termed a "soft body." An extreme e x a m -

b u t n o t a c h a n g e in state.

ple w o u l d be a person w h o is double-jointed.

O n e expression of this attitude is in the

Yet w i t h i n t h i s s t r u c t u r e , a t t h e d e e p e s t l e v e l ,

old song, "I w a n t to dance with a dolly with

there is a t h i n core t h a t is u n d e r e x t r e m e

a h o l e in her stocking while her knees keep

t e n s i o n . T h i s is similar to t h e t h i n sticks t h a t

a-knocking a n d her toes keep a-rocking."

PART

FIVE

Practical Applications

TWENTY-THREE

Doing Bodywork Based on the Connective Tissue Concept

A s o u r i d e a s h a v e g a i n e d clarity, w e r e a l i z e

where does it hurt; point with o n e finger.

t h a t t h e c o n n e c t i v e tissue c o n c e p t c a n b e o f

D o e s t h e p a i n r a d i a t e ? Are t h e r e a s s o c i a t e d

use i n a n y k i n d o f b o d y w o r k . I t i s n ' t p o s s i b l e

pains in other b o d y parts? W h a t brings t h e

to provide a " r e c i p e " for work. W h a t we c a n

pain on? W h e n is it most intense? W h a t

do in this section is o p e n a way of t h i n k i n g

makes it better? Was there an injury? Has

a n d an a p p r o a c h to tissue. Ideally this will

there b e e n a history of repeated injury? Is

lead t h e b o d y w o r k e r t o d e v e l o p a p p r o p r i a t e

the pain constant or intermittent?

strategies f o r c o n d i t i o n s a s t h e y a r i s e . This section is divided i n t o several

From the point of view of immediate intervention, probably the most important ques-

s u b s e c t i o n s : e v a l u a t i o n , first i n t e r v e n t i o n ,

t i o n is, " H o w p a i n f u l i s i t r i g h t n o w ? " T h i s

h o w t o g o deeper, h o w t o t o u c h , a n d h o w

will tell y o u w h e n a n d h o w to i n t e r v e n e . It is

t o m a k e c h a n g e s last. W e h a v e t a k e n specific

your best b a r o m e t e r for assessing w h e n it m a y

c o n d i t i o n s as e x a m p l e s for t h e sake of

be detrimental to do work. W h e n acute pain

demonstration.

is n o t a p r o b l e m , it is p r o b a b l y possible to

Evaluation— Example: knee pain Evaluation c a n be visual, t h r o u g h palpation,

w o r k d i r e c t l y o n t h e a r e a (see s e c t i o n o n f i r s t intervention). O f t e n k n e e p a i n arises o n l y w i t h m o v e m e n t . Cautious m o v e m e n t is a part of evalu-

or by observing m o v e m e n t . It is n o t necessary

ation. W h a t can the knee do with comfort?

to do an exhaustive evaluation but rather to

W h a t m o v e m e n t creates t h e p a i n ? C l i e n t fear

f i n d a p l a c e t o start. T h e c o n c e p t s u n d e r l y i n g

a n d a p p r e h e n s i o n are a n i n e v i t a b l e part o f

e v a l u a t i o n are c o n t o u r , s y m m e t r y , a n d p r o -

acute pain. Ideally this c a n be allayed to get

portion. In practical terms, this m e a n s c o m -

a clearer picture of t h e actual tissue p r o b l e m s .

p a r i n g b o t h k n e e s f r o m t h e f r o n t , sides, a n d

Reassurance that pain is not the same as dam-

back. It also m e a n s considering t h e e x t e n s i o n

age s h o u l d h e l p . O b v i o u s l y it will be n e c e s -

of t h e k n e e d o w n to t h e f o o t a n d at least as

s a r y t o b e g e n t l e a n d slow. Y o u r a i m i s t o f i n d

far u p a s t h e h i p , i f n o t f a r t h e r . I t i s h e l p f u l

out what the knee can do and exactly w h e n

to consider the a n a t o m y involved. T h e knee

a n d w h e r e p a i n starts.

is composed of two bones—femur and tibia—

At this point, anatomical information is

and two outriders—the fibula and t h e patella.

essential to good visualization of t h e prob-

I t also h e l p f u l t o c o n s i d e r g r a v i t y / b o d y

l e m s i n v o l v e d . For clarity we are u s i n g m u s c l e

weight. T h e knee is the interface between

n o m e n c l a t u r e ; we are actually referring to

the torso/hips and the ground. The hip and

local t e n s i o n s in t h e c o n n e c t i v e tissue b e d

the ankle can be considered upper and lower

(Fig.

extensions of the knee.

23-1).

T h e tibia is suspended by t h e h a m s t r i n g s

T h e a b o v e are e l e m e n t s o f p r a c t i t i o n e r

posteriorly and by the quadriceps anteriorly.

e v a l u a t i o n . Full i n i t i a l e v a l u a t i o n i s a c o m -

M e d i a l l y a n d laterally, t h e r e is t h e a d d u c t o r

bination of these and the client's report.

group a n d t h e ilio-tibial b a n d , respectively.

Listening to the client and asking t h e right

T h e interface b e t w e e n t h e tibia a n d fibula c a n

questions at t h e outset are critical: E x a c t l y

be locked down by the popliteus behind the

120

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E N D L E S S

W E B

knee. Thus this very small muscle controls

t h e k n e e tissue against ever-greater k n e e flex-

the interosseus m e m b r a n e between these

ion a n d e x t e n s i o n . This allows t h e client to

t w o b o n e s . Tibial rotation is manifest at t h e

feel safe b e c a u s e h e / s h e c a n c o n t r o l t h e

ankles. T h e degree of tension in t h e Achilles

degree of m o v e m e n t .

t e n d o n is an i n d e x of severity of rotation between t h e tibia a n d calcaneus. Evaluation is a s e q u e n c e f r o m visualization to m o v e m e n t to evaluation by touch. As we

It should be r e m e m b e r e d that o n e cause of i n t e r m i t t e n t acute pain in t h e knee is a m e n i s c a l tear. T h i s i s n o t a n a b s o l u t e c o n t r a indication to work; cautious easing of the

m o v e t h e part, w e are starting t o evaluate b y

j o i n t will b e h e l p f u l . U l t i m a t e l y , h o w e v e r ,

touch. It is almost impossible to know w h e n

t h e r e m a y h a v e t o b e surgery. A n a b s o l u t e

evaluative touch ends and treatment touch

contraindication to manipulation of the knee

starts. If t h e p a i n is acute, it is p o t e n t i a l l y

(except by an expert) is a tear in o n e of the

hazardous to treat t h e acutely painful area

c r u c i a t e l i g a m e n t s . S u c h a t e a r m a y b e felt a s

directly. It s h o u l d be possible to ease t h e pain

hypermobility of the knee in the anterior-

with educated intervention above and below.

posterior direction and is obvious with even

Your knowledge of a n a t o m y a n d y o u r careful

s l i g h t m o v e m e n t . A f r a c t u r e is, a g a i n , a n

e v a l u a t i o n will t e l l y o u w h e r e t o s t a r t . S o m e -

absolute contraindication to bodywork except

t i m e s i t i s h e l p f u l t o w o r k f a i r l y far a f i e l d i n

in t h e h a n d s of an expert. If t h e client is able

o t h e r parts o f t h e b o d y — a s s o c i a t e d areas o f

to walk i n t o your office w i t h o u t crutches, it is

reported p a i n or p r o b a b l e areas of dysfunc-

unlikely that either of these two catastrophes

t i o n (see list i n H o w t o M a k e I t Last s e c t i o n ,

has occurred.

p. 126). Before we go m o r e extensively into first i n t e r v e n t i o n , w e n e e d t o a d d a f e w c o m ments on treatment of acute knee problems.

First Intervention— Example: chronic neck ache

E v e n t u a l l y i t will b e p o s s i b l e t o g e n t l y start

S o m e practitioners are m o r e e x p e r i e n c e d with

t o work o n t h e fascial wrapping o f t h e k n e e

visual evaluation a n d s o m e with palpation.

itself. A s i m p l e w a y t o d o t h i s i s t o r e s t r a i n

Furthermore, o n e of the oddities of bodywork tends to be that the more experienced the p r a c t i t i o n e r , t h e less e x t e n s i v e t h e e v a l u a t i o n . In part, this is because bodyworkers c o n t i n u ally evaluate as t h e y work. Evaluation is n o t an endpoint, it is an o n g o i n g process. I t i s i m p o r t a n t t o start w o r k w i t h t h e m o s t s u p e r f i c i a l layers o f t i s s u e . W o r k i n g superfic i a l l y u s u a l l y will a l l o w d e e p e r tissue p r o b l e m s t o e m e r g e t h a t w e r e n o t a p p a r e n t a t first. T h e client will o f t e n report t h a t t h e nature or l o c a t i o n (or b o t h ) o f t h e p a i n h a s c h a n g e d a n d h e / s h e c a n o f t e n b e m o r e specific about t h e pain. This is to be expected as a n o r m a l p a r t o f p r a c t i c e . Early i n p r a c t i c e , i t c a n b e confusing a n d h u m b l i n g w h e n this happens. G o i n g t o o d e e p t o o fast will a l m o s t a l w a y s

Figure 23-1 Superficial muscles of the thigh.

create unnecessary problems and usually creates m o r e pain.

DOING

BODYWORK

BASED

ON

THE

W h a t does it m e a n to w o r k on a superficial

CONNECTIVE

TISSUE

CONCEPT

121

t h e tissue "layers" a n d direction of fascial

layer o f t i s s u e ? H o w i s t h i s d o n e ? E a s i l y t h e

fibers. As y o u work, t h e fiber d i r e c t i o n u n d e r

m o s t i m p o r t a n t m a n e u v e r is to go i n t o tissue

y o u r h a n d s will tell y o u w h a t level o f tissue

a t a n a n g l e . G o i n g s t r a i g h t i n a l l o w s t h e tis-

i n t h e b o d y y o u are w o r k i n g o n . T h e r e c a n b e

sue n o e s c a p e , n o m o v e m e n t ; t h e t i s s u e i s

times w h e r e n o d o m i n a n t tissue directionality

trapped. G o i n g straight in also often causes

is apparent; this is c o m m o n in the most

bruising. In practical terms, this m e a n s that

superficial s u b c u t a n e o u s layers.

tissue i s m o v e d i n a d i r e c t i o n , t o w a r d a n

I d a R o l f w a s w o n t t o say, " I f t h e t i s s u e

intended endpoint. O n c e again, a knowledge

doesn't m o v e w h e n you go in o n e direction,

of a n a t o m y is essential.

try g o i n g in t h e o t h e r d i r e c t i o n . " T h i s is a rule

In the neck and shoulder assembly, t h e

of t h u m b t h a t has stood us in g o o d stead for

m o s t superficial m u s c l e i s t h e t r a p e z i u s . I t

m a n y years. It should be pointed out that

fans out from t h e occiput, t h e cervical verte-

f a s c i a l fibers d o n o t n e c e s s a r i l y f o l l o w t h e

brae, and the upper thoracic vertebrae, across

e x a c t p a t h o f t h e associated m u s c l e fibers.

the shoulder blades to the collarbones a n d

F a s c i a l fibers r e s p o n d t o t h e d i r e c t i o n a l p u l l s

the acromion. The sternocleidomastoid mus-

e x e r t e d o n t h e m ; m u s c l e fibers a r e o n e t y p e

c l e i s a fairly s u p e r f i c i a l r o p e f r o m t h e m a s t o i d

of pull, b u t t h e r e are o t h e r s . For e x a m p l e , t h e

process to t h e sternum and t h e clavicle. Poste-

fascia superficial to t h e trapezius has m u l t i p l e

riorly a n d d e e p e r , t h e l e v a t o r s c a p u l a e sus-

fine layers in m u l t i p l e directions. It is n o t

pends the shoulder blade from t h e cervical

necessary or possible to organize each of these

vertebrae. At a similar d e p t h , t h e scalenes

fascial sheets. C r e a t i n g order in o n e t e n d s to

s u s p e n d t h e ribs f r o m t h e c e r v i c a l v e r t e b r a e

organize sheets above and below. Direction

(Fig

of work m a y be toward a joint, away from a

23-2).

E v e n t h i s p a r t i a l list o f t h e m u s c l e s i n volved in chronic neck ache makes it obvious

joint, along the plane of the muscle, or even across t h e m u s c l e fibers. W i t h a t t e n t i v e n e s s

t h a t t h e associated fascia is a w e b ; t h e m u s c l e s

a n d delicacy o f t o u c h , y o u r h a n d s will tell

a r e n o t l a y e r e d like a c a k e , b u t i n t e r w o v e n

y o u w h a t t o d o . W h a t y o u are h o p i n g t o

like a m e s h . A r e a s o n a b l e w o r k i n g k n o w l e d g e

achieve, the feeling you want under your

o f l o c a l a n a t o m y gives a n u n d e r s t a n d i n g o f

h a n d s , is t h e feeling of elasticity.

Figure 2 3 - 2 Fascial tensions in the neck and back.

122

T H E

E N D L E S S

W E B

The shoulder and neck assembly is one of

O u r struggle in this b o o k has b e e n to put

t h e m o r e c o m p l e x structures in t h e body. O n e

into words what is so obviously happening

i m a g e t h a t gives an overview is t h a t tissue is

under our hands. We find it impossible to

gathered up into the neck m u c h the way a

give a verbal description of i n t e n t i o n . T h e

p l a s t i c b a g i s g a t h e r e d a t its c l o s u r e . I n t h i s

concept is often apparent when watching

i m a g e , a n y t w i s t o n o n e p a r t o f t h e n e c k will

a n o t h e r bodyworker. It c a n be a useful ques-

spread d o w n w a r d to t h e structures below.

t i o n w h e n t h e progress of work is stalled. A

T h e r e f o r e as t h e superficial layers of t h e n e c k

c h a n g e i n i n t e n t i o n o r g o a l c a n r e s t o r e flow.

a r e e a s e d , t e n s i o n b e l o w a l s o starts t o e a s e .

W h a t t o d o w h e n a n area i s t o u c h y o r t i c k -

B o n e s will shift their h o m e p o s i t i o n ; m u s c l e s

lish? W e h a v e f o u n d t h a t t h e tissue deep t o

will shift their p l a n e o f a c t i o n . T h i s h a p p e n s

a t i c k l i s h s p o t is i n v a r i a b l y e x c e s s i v e l y t i g h t .

gradually, over t i m e . M u c h h a p p e n s b e t w e e n

Even t h o u g h ticklishness has a "don't t o u c h "

b o d y w o r k sessions. C h a n g e s are subtle at first;

a s p e c t to it, it is a s i g n a l t h a t b o d y w o r k n e e d s

t h e y are c u m u l a t i v e a n d s o o n b e c o m e clearly

to be d o n e . A light t o u c h is generally n o t

apparent.

h e l p f u l . E a s i n g a r o u n d t h e area c a n b e u s e f u l .

At s o m e point going deeper b e c o m e s a

O n e m a n e u v e r t h a t c a n w o r k i s t o m a k e use

natural e x t e n s i o n of t h e work in progress.

of t h e body's neural wiring. Light t o u c h and

O c c a s i o n a l l y this is a t h e r a p e u t i c decision,

d e e p t o u c h a r e m e d i a t e d b y t w o d i f f e r e n t sets

m o r e often it is the obvious n e x t step. O n e

of nerve endings. It is possible to place the

s i g n i s t h a t t h e t e n s i o n s start t o b e m o r e o b v i -

w h o l e h a n d f i r m l y o v e r t h e s e n s i t i v e area

ously associated w i t h specific m u s c l e action.

while working more deeply with the other

Because the spasm in these muscles can be

hand underneath the covering hand.

so severe that acute pain is elicited with light

W i t h deeper work there is always t h e

t o u c h , i t will n o w b e n e c e s s a r y t o e a s e t h e

potential of discomfort while working. Some

tissue by w o r k i n g further afield. In n e c k pain,

c l i e n t s a r e a b l e t o feel t h r o u g h t h i s m o m e n -

w o r k i n g at t h e rotator cuff, t h e shoulder

tary d i s c o m f o r t to t h e relief t h a t is h a p p e n -

joint, t h e back of t h e ulna just above t h e

ing. Their usual c o m m e n t is that it is " g o o d

e l b o w , o r t h e m a r g i n o f t h e o c c i p u t will b r i n g

p a i n . " T h e r e are at least t w o c o m p o n e n t s to

relief. T h e s e are n o t b y a n y m e a n s t h e deepest layers. We are w o r k i n g our w a y gradually

t h e s e s e n s a t i o n s . T h e r e i s t h e tissue s e n s a t i o n , which can be warm or hot or burning. This is akin to what happens w h e n you m o v e a

t h r o u g h t h e layers over a n u m b e r of sessions

part t h a t has n o t m o v e d for a l o n g t i m e . It is

— t h r e e or four spaced a b o u t a week apart.

t h e c h a r a c t e r i s t i c f e e l i n g o f c o n n e c t i v e tissue

T h e client's report of pain and your hands'

s t r e t c h i n g . A n o t h e r c o m p o n e n t o f tissue p a i n

report of tissue resistance will be y o u r guides

is v e r y m u c h like a s t a r t l e r e s p o n s e ; it is m o r e

o n h o w fast t o p r o g r e s s . I t i s a l m o s t n e v e r

mental than physical.

advisable to use force to go t h r o u g h pain or

B o t h a s p e c t s o f t i s s u e s e n s a t i o n will u s u a l l y

t i s s u e r e s i s t a n c e . T h i s b r i n g s u s t o t h e diffi-

b e p r e s e n t , b u t o n e will b e m o r e p r o m i n e n t

cult-to-describe, intangible concept of inten-

t h a n t h e other. In either case, it is useful to

tion. Intention has to do with how deep your

m a k e sure t h a t t h e client is n o t h o l d i n g his/

h a n d s g o , h o w d e e p y o u r f o c u s is, h o w d e e p

her breath. A l o n g slow e x h a l e is t h e best way

y o u w a n t to get w i t h a given m a n e u v e r . It is

to ease t h e strain a n d allow t h e stretch. It is

hard to believe t h a t i n t e n t i o n is a m a j o r fac-

also good to focus attention exactly where

tor; it is even harder to believe that there is

t h e stretch is occurring a n d / o r to m o v e a

any such thing as intention.

related b o d y part (wiggle t h e fingers). T h e r e

DOING

BODYWORK

BASED

ON

THE

are t h e o r e t i c a l r e a s o n s w h y t h e s e m a n e u v e r s

CONNECTIVE

TISSUE

CONCEPT

123

T h e rotators of the hip attach to t h e ilium,

w o r k b u t it's p r o b a b l y e n o u g h s i m p l y t o k n o w

i s c h i u m , o r s a c r u m . A l t h o u g h t h e y are s m a l l ,

that they do work.

t h e y are short a n d deep; t h e y powerfully

To finish up t r e a t m e n t of n e c k pain, the

i n f l u e n c e t h e basic structure of t h e pelvis

deepest structures u n d e r t e n s i o n will be t h e

w h e n t h e y are i n s p a s m . T h e y a r e a m a j o r

levator scapulae a n d t h e layers of t h e cervical

factor in sciatic pain. T h e y c a n be readily

muscles closest to t h e vertebrae. T h e small

influenced by wedging the space b e h i n d the

transverse muscles at t h e atlanto-occipital

g r e a t e r t r o c h a n t e r a n d a s k i n g f o r s t r a i g h t leg

junction can be so contracted as to be barely

external

p a l p a b l e . W o r k i n g i n layers t o e a s e t h e s e i s the answer. I n addition, t w o m o v e m e n t m a -

rotation

(Fig.

23-3).

T h e ischial tuberosity is the b o t t o m m o s t edge of t h e hip assembly; it provides an end-

n e u v e r s will b e h e l p f u l : a s m a l l c h i n t h r u s t

p o i n t for t h e t e n d o n s of t h e h a m s t r i n g s .

(like a n o d ) a n d t u r n i n g t h e h e a d . W h e n

W h e n t h e h a m s t r i n g s are tight, t h e y pull

turning the head, the m o v e m e n t is initiated

d o w n w a r d on t h e i s c h i u m . As a result, t h e

f r o m t h e a n g l e o f t h e j a w j u s t b e l o w t h e ear,

sacrum is overworked with any m o v e m e n t .

w h i c h is a way of creating precise m o v e m e n t

Release m u s t necessarily i n c l u d e work to

b e t w e e n t h e atlas a n d axis.

release t h e h a m s t r i n g s . H o w to k n o w where to start? Observing

How to Go Deeper— Example: chronic sciatica

n o r m a l m o v e m e n t is usually helpful—walk-

A t t h e d e e p e r level, a n a t o m i c a l k n o w l e d g e i s

principles was "take t h e part to n o r m a l a n d

e s s e n t i a l t o a c c u r a c y . S c i a t i c p a i n arises f r o m

m a k e it m o v e . " We w a n t to evaluate t h e bal-

t e n s i o n o n t h e s c i a t i c n e r v e , u s u a l l y a t its

anced m o v e m e n t of the j o i n t — t h e initial

i n g , s i t t i n g , s t a n d i n g . O n e o f I d a R o l f ' s first

outlet, w h i c h is variably located near the mid-

m o v e m e n t f r o m a n ideal h o m e p o s i t i o n . For

dle o f t h e s a c r o i l i a c j u n c t i o n . S c i a t i c p a i n i s

t e s t i n g p u r p o s e s o n l y , i n t h e h i p a n d leg, t h e

most c o m m o n l y a radiating pain, extending t o t h e t h i g h , leg, o r f o o t , d e p e n d i n g o n t h e p o r t i o n o f t h e n e r v e t h a t i s i m p i n g e d . Piriformis pain, on t h e other h a n d , is local to the hip, does n o t radiate, a n d c a n be elicited by p u l l i n g t h e b e n t k n e e a c r o s s t h e b o d y . I n piriformis pain, it is usually possible to palpate the taut rope of the muscle t h r o u g h the overlying gluteus m a x i m u s . T h e piriformis runs from t h e inside of t h e lower tip of t h e sacrum to t h e greater t r o c h a n t e r of t h e femur. T h e relationship of the piriformis to the sciatic nerve is variable. Piriformis t e n s i o n can contribute to sciatic nerve pain. T h e nerve is not entrapped by b o n e but by the ligamentous bindings of the sacroiliac junct i o n . A s t h e tissue layers o f t h e h i p a s s e m b l y start t o r e l e a s e , t h e l o c a t i o n o f t h e s c i a t i c p a i n a n d its r a d i a t i o n o f t e n c h a n g e s . T h i s i s i n f a c t a sign t h a t w o r k h a s b e e n e f f e c t i v e .

Figure 23-3 Rotators of the hip.

124

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E N D L E S S

W E B

ideal s t a n d i n g position is as follows: feet

is a variable m i d - b a c k l o c a t i o n where shoul-

together, ankles touching, heels about an

der m o v e m e n t a n d b o d y support intermesh.)

i n c h apart. In this position, a shallow knee

T h e g r o i n a n d p a r t i c u l a r l y t h e i n g u i n a l liga-

b e n d will graphically reveal t e n s i o n s i n t h e

m e n t are anterior aspects of sciatic pain.

sacrum and groin. In the knee bend, the knee

W h e n t h e r e are true physical deficits such

should c o m e straight forward over the second

as a s c o l i o s i s or a m i s s i n g p o r t i o n of a v e r t e -

toe; the b a c k is kept straight. A s e c o n d m o v e -

bra, t h e r e will b e a n o n g o i n g n e e d for b o d y -

m e n t , leaning over to t o u c h the toes, shows

w o r k . T h i s d o e s n o t m e a n a n o f f i c e visit o n c e

t h e ability of t h e hamstrings to l e n g t h e n a n d

a week or even o n c e a m o n t h . It can m e a n

the ischial tuberosities to appropriately

a b a t c h of work every couple of years. T h e

widen.

client is the best judge of what he/she needs.

T h r e e m a i n strategies interact in this deep

U n d e r stress, w h e t h e r t r a u m a t i c o r r e p e t i t i v e ,

level of work; traction, tissue stretching, a n d

t h e b o d y will t e n d t o return t o pattern. This

client m o v e m e n t . Traction c a n be passive or

d o e s n o t m e a n t h a t earlier b o d y w o r k w a s n o t

active on t h e client's part. Active traction

effective. Generally speaking, renewed work

involves stretching to t h e limit of t h e gesture.

w i l l b e easier, less u n c o m f o r t a b l e , a n d p r o g -

For e x a m p l e , a h e e l stretch activates t h e

ress w i l l b e faster.

Achilles t e n d o n , t h e back of the knees, t h e This can be combined with other movements,

How to Touch— Example: carpal tunnel syndrome

e.g. h e e l s t r e t c h w i t h h i p r o t a t i o n o r l e g lift.

In this s e c t i o n we are b r i n g i n g t o g e t h e r points

M o v e m e n t s s h o u l d b e guided for p r e c i s i o n t o

about t o u c h from prior sections.

hamstrings, a n d up into the ischial tuberosity.

give m a x i m u m assistance to tissue stretching.

(A) C o n s i d e r t h e o r i g i n o f t h e p r o b l e m —

A guiding principle in soft tissue w o r k is

accident, repeated injury, or repetitive use

" w h a t ' s d o n e i s d o n e . " Dr. R o l f u s e d t o say, " I f

u n d e r stress. C a r p a l t u n n e l s y n d r o m e i s a

a t first y o u d o n ' t s u c c e e d , g e t t h e h e l l o u t . " A

c l a s s i c e x a m p l e o f r e p e t i t i v e u s e u n d e r stress.

m o r e long-winded way of saying the same

A m o s t c o m m o n v e r s i o n arises f r o m c o m p u -

t h i n g is t h a t w h e n tissue in an area w o n ' t

ter use. T h e gesture includes tensely staring

s t r e t c h , it's b e c a u s e it's n o t r e a d y t o s t r e t c h .

at a small (usually t o o low) screen while over-

W o r k i n a n o t h e r a r e a h a s t o h a p p e n first.

focusing t h e eyes a n d thrusting t h e head

T h e art o f a b o d y w o r k e r i s k n o w i n g w h e r e

f o r w a r d . T h i s sets u p a n i m b a l a n c e a t t h e

to work n e x t . Partly this is a m a t t e r of experi-

s h o u l d e r — t h e s c a p u l a rides u p , t h e c l a v i c l e

e n c e . W o r k c a n proceed contiguously: sacroil-

a n d a c r o m i o n are elevated, a n d t h e a r m has

iac j u n c t i o n — l u m b a r area—lower ribs. W o r k

l o s t its b a s e o f s u p p o r t . E v e n i f t h e s c r e e n i s

c a n m o v e t o t h e o t h e r side o f t h e j o i n t . O n e

n o t t o o low a n d t h e keyboard position is ade-

non-obvious sequence involves looking at the

quate, prolonged eye tension a n d head thrust

c o u n t e r b a l a n c i n g structure. In t h e case of t h e

c r e a t e a p r o b l e m . T e n s i o n a n d o v e r u s e are

hip, this would be t h e spine a n d t h e bridge

t h e culprits here. From this brief analysis it

would be the psoas. Just as the position of the

is obvious that there cannot be m u c h help

f o o t (by w a y o f t h e leg) fixes t h e a n g l e o f t h e

for carpal t u n n e l s y n d r o m e w i t h o u t work

pelvis f r o m below, so does t h e position of t h e

o n t h e shoulder, n e c k , a n d occipital ridge.

s p i n e fix t h e p e l v i s f r o m a b o v e . T h e h o l d i n g

(B) A c u t e s p a s m is a s i g n a l f o r c a u t i o n .

pattern can originate in the lumbar spine, at

W o r k c a n b e g i n o n t h e s u p e r f i c i a l layers o r

t h e d o r s a l h i n g e , o r e v e n t h e o c c i p u t . (As w e

o n s u r r o u n d i n g a r e a s . T h e i d e a i s t o give t h e

have explained in t h e text, t h e dorsal h i n g e

tissue u n d e r s p a s m relief before w o r k i n g on

DOING

BODYWORK

BASED

ON

THE

CONNECTIVE

TISSUE

CONCEPT

125

i t directly. I n a c u t e c a r p a l t u n n e l p a i n , i t i s

s h e a t h a r o u n d t h e wrist, responds well to this

helpful to reduce tension in the interosseus

a p p r o a c h . It is also useful w h e r e tissue is very

m e m b r a n e o f t h e f o r e a r m a n d t o r e s t o r e free

tight but n o t in s p a s m — b e h i n d the elbow, on

rotation b e t w e e n t h e radius a n d u l n a at t h e

t h e a r m just b e l o w t h e shoulder j o i n t (junc-

elbow. Almost always, there is a lock on

t i o n of t h e trapezius a n d deltoid), a n d just

m o v e m e n t of t h e u l n a because of tissue

above and below the spine of the shoulder

tightness at the back of the elbow. Restoring

blade. Care must be taken that there is good

e l a s t i c i t y h e r e will start t o e a s e t h e a c u t e p a i n

support under a structure being worked in

a t t h e wrist.

this way.

(C) " R e s i s t i v e m o v e m e n t " i s o u r p h r a s e f o r

(F) O n e o f t h e m o r e s u b t l e a s p e c t s o f b o d y -

t h e m a n e u v e r of w e d g i n g a tissue space o p e n

work is recognizing a n d asking for appropriate

while t h e client m o v e s . In carpal t u n n e l syn-

m o v e m e n t . Most kinesiology texts describe

drome, this is particularly useful in o p e n i n g

range of m o t i o n ; this is n o t exactly what we

t h e spaces b e t w e e n t h e small b o n e s at t h e

are l o o k i n g for. W e w a n t t o d e f i n e a n d u s e t h e

base of t h e h a n d . O n e specific e x a m p l e of a

initial gesture f r o m t h e " h o m e " p o s i t i o n . For

small muscle that seems to get particularly

example, the h o m e position of the elbow

tight is the opponens, w h i c h adducts the

while lying on the back is pointing away from

t h u m b across t h e p a l m . W e d g i n g at t h e

t h e trunk. This is n o t the " a n a t o m i c a l posi-

base of the t h u m b while asking t h e client

t i o n " described in texts. Normal m o v e m e n t

to adduct t h e t h u m b will e v e n t u a l l y release

h e r e i n o u r t e r m s i s t h e a b i l i t y t o slide t h e

t h i s a r e a . W e d g i n g o n t h e o p p o s i t e side o f

elbow away from the body and back without

the h a n d ( h y p o t h e n a r space) produces further

twisting at t h e elbow or elevating t h e shoulder.*

opening. Although the hypothenar move-

W h e n lying o n t h e back, t h e h o m e posi-

m e n t is s u b t l e , t h e r e is a g e s t u r e like g r a s p i n g

t i o n o f t h e s c a p u l a i s flat a g a i n s t t h e ribs, p a r t

with t h e base o f t h e h a n d t h a t will h e l p this

way down the back. In normal movement,

opening.

t h e s c a p u l a d o e s n o t rise w i t h m o v e m e n t o f

(D) G e t t i n g t h e feel o f t i s s u e i s a n o n g o i n g

t h e a r m . In fact, it drops slightly as a c o u n -

study for a bodyworker. T h e u l t i m a t e goal is

terweight as t h e a r m is raised. W h e n lying

to m o v e t h e fascial s h e a t h s in s u c h a w a y as

o n t h e back, t h e h o m e p o s i t i o n o f t h e wrist

t o r e s t o r e e l a s t i c i t y . S o m e c u e s : Lift t h e t i s s u e ,

a l l o w s t h e p a l m t o rest flat w i t h e l b o w p o i n t -

t r y n o t t o c o m p r e s s it. B e sure t h a t y o u a r e

ing away from t h e trunk. W h e n raising t h e

taking t h e tissue in a direction rather t h a n

hand,it should be possible to l e n g t h e n

compressing it to the bone. Be attentive to

t h r o u g h t h e p a l m b y first r a i s i n g t h e f i n g e r s

a n a t o m y ; fiber d i r e c t i o n w i l l o f t e n i n f o r m

a n d t h e n r a i s i n g t h e rest o f t h e p a l m i n s e c -

y o u a b o u t t h e d e p t h of tissue y o u are influ-

t i o n s (Fig. 23-4). F l e x i o n is t h e s a m e r o l l i n g

encing. Try n o t t o overwork tissue; w h e n n e w

gesture in reverse.

s t r e t c h h a s b e e n a c h i e v e d , l e t t h e t i s s u e rest

(G) U s i n g m o v e m e n t allows freeing o f t h e

and integrate. K n o w t h a t a tense surface layer

structure at a level u n a t t a i n a b l e w i t h t h e use

will u s u a l l y h a v e f a s c i a l fibers g o i n g i n m a n y

of m a n i p u l a t i o n alone. However, this must

directions.

be precise, educated m o v e m e n t , as we have

(E) A s p e c i a l a p p r o a c h to t i s s u e i n v o l v e s going across t h e direction of tissue fibers. T h i s is not a c o m m o n maneuver; it c a n be very helpful in the right place. In carpal t u n n e l syndrome, the retinaculum, a thin binding

described above in the case of the arm. It is *For an excellent exposition of this c o n c e p t , see Ida P. Rolf, Confinia Psychiatrica, Vol. 16, pp. 7 7 - 7 8 , 1 9 7 3 . Available from t h e Rolf Institute, B o x 1 8 6 8 , Boulder, Colorado 80306.

126

THE

ENDLESS

WEB

c h a n g e is recent, the comparison is most vivid. Too m u c h information can be overwhelming. A glut of n e w b o d y sensations is merely confusing. Keep in m i n d that in t h e period just following bodywork, b o d y a n d m i n d are in a fluid state. O n e or at m o s t t w o n e w t h i n g s t o f o c u s o n i s all t h a t c a n r e a s o n a b l y be incorporated. O n e of t h e client questions that bedevils t h e b o d y w o r k e r is " A m I d o i n g it r i g h t ? " Am I walking right, b r e a t h i n g right, sleeping right? T h e o n l y w a y o u t o f t h i s d i l e m m a o f "Tightn e s s " is to h e l p increase client sensitivity. T h e feel o f t h e b o d y i s t h e b e s t g u i d e . A n ideFigure 2 3 - 4 Wedging the muscles of the forearm in combination with m o v e m e n t of the hand.

alized " c o r r e c t " p o s i t i o n has to be gradually a p p r o a c h e d . For e x a m p l e , in a client w h o is pigeon-toed, forcing a straight-ahead foot position before the knees a n d especially the

generally n o t possible to use m o v e m e n t early

hips can a c c o m m o d a t e the n e w position is

in m a n i p u l a t i o n because the structure is too

d a m a g i n g to t h e structure as well as confusing

compressed to get accurate m o v e m e n t . There

to the client.

are e x c e p t i o n s , o f course. W i t h s o m e m a n u a l

We have alluded to t h e n e e d for work on

assist, c o r r e c t m o v e m e n t m a y b e p o s s i b l e

compensating patterns. Knowing where that

early o n .

c o m p e n s a t i o n is likely to be is o f t e n a m a t t e r

How to Make It Last

b e e n useful to us:

The element of time is important in bodywork. We have talked about n o t diving in before t h e structure is ready to o p e n , of preparing t h e way. A n o t h e r aspect of t i m i n g is

o f e x p e r i e n c e . W e list a f e w b e l o w t h a t h a v e

carpal t u n n e l

neck and shoulder

sprained ankle

t w e l f t h rib

sciatic pain

l u m b a r vertebrae, dorsal hinge, atlanto-occipital

t h e integration t h a t h a p p e n s b e t w e e n sessions

j u n c t i o n , s h o r t leg,

a n d after a group of sessions. This is an e x a m ple of latency in t h e learning process. It is just as necessary to allow t i m e for integration b e t w e e n work as it is to do t h e work. Client education is an essential part of bodywork. Ideally this has b e e n h a p p e n i n g in an o n g o i n g way t h r o u g h o u t t h e sessions. A p r i m a r y goal of such e d u c a t i o n is refining

groin, a n d psoas knee pain shoulder bursitis

hip; sometimes ankle ribs a n d d i a p h r a g m ; little finger

tennis elbow

wrist

A s Dr. R o l f o f t e n said, " W h e r e y o u t h i n k i t is, i t a i n ' t . " W e h a v e u s e d t h e c o n n e c t i v e tis-

the ability to sense physical change. There

sue c o n c e p t i n t h e c o n t e x t o f R o l f i n g a n d i t

will be c h a n g e s in stance, shoulder height,

has been valuable to us in opening up new

position of the a r m — t h e best time to notice

vistas. We h o p e t h a t it will e x p a n d y o u r hori-

these is w h e n the change is new. T h e m i n d

z o n as well, no m a t t e r w h a t tradition of body-

learns best by comparing sensation; w h e n

work you practice.

Illustration Index acromion 15-1, 17-2, 17-8. adductor magnus m. 19-5. atlanto-occipital junction 13-7. amnion 2-1. belly band/strap 12-2 A&B. brachialis m. 4-2. calcaneus 7-3. cervico-dorsal junction 13-7. cervical-thoracic junction 13-7. chest band/strap 12-2 A&B. chin band/strap 12-2 A&B, 14-5. clavicle 14-5, 15-1, 17-8, 18-3. collar band/strap 12-2 A&B, 14-5, 15-1. coracobrachialis m. 8-3. coracoid process 8-3, 15-1. costal arch 13-1A, 15-3, 15-4, 15-6. deltoid m. 17-2, 17-8, 17-11. dorsal hinge 12-3B, 13-7. ectoderm/ectodermal 2-1, 2-2, 2-3. endoderm/endodermal 2-1, 2-2, 2-3. erector spinae m. 10-2, 18-2, 21-2, 21-4, 2 1 - 6 . external abdominal oblique m. 17-7, 19-7. eye band/strap 12-2 A&B. flexures (junctions of the spinal column) 13-7. fontanelles 14-3. gluteus maximus m. 10-2, 15-5, 17-5, 18-2, 19-1, 19-7, 21-2, 21-3. gluteus medius m. 19-7. gluteus minimus m. 19-7, 19-8. gracilis m. 19-1, 19-5, 19-6. groin band/strap 12-2 A&B, 15-4, 15-5, 15-6. hyoid b. 14-5, 15-1. iliacus m. 19-4, 19-10. iliotibial tract 5-2, 17-5, 18-2, 19-1, 19-6, 21-2, 21-3. inguinal band/strap 12-2 A&B, 13-1A, 13-1B, 15-4. inguinal ligament 5-2, 13-1A, 13-1B, 13-6, 15-6. ischial tuberosity 18-3. junctions of the spinal column 13-7. latissimus dorsi m. 8-8, 12-3B, 17-1, 17-2, 17-11, 21-2, 2 1 - 3 .

levator scapulae m. 8-8, 17-6. ligamentum nuchae 18-7. lumbo-dorsal junction 13-7. lumbo-sacral junction 13-7. mediastinum 18-3. mesoderm/mesodermal 2-1, 2-2. midchest band/strap 12-2 A&B, 12-3 A. notochord 2-1, 2-2, 2-3. obturator internus m. 15-7, 19-4, 19-8, 19-10. pectoralis major m. 12-3A, 12-3B, 17-1, 17-11. pectoralis minor m. 8-3. pelvic diaphragm 15-7, 18-3, 2 0 - 3 . perichondrium 7-2. periosteum 4-2, 7-2. piriformis m. 19-4, 19-8. primitive streak 2-1, 2-3. psoas m. 10-5, 10-6A, 19-2, 19-3, 19-4, 20-3, 21-4, 2 1 - 5 . pubic band/strap 12-2 A&B. quadratus lumborum m. 21-4, 2 1 - 6 . rectus abdominis m. 5-2, 12-3A, 12-3B, 13-1A, 15-6, 2 0 - 3 . sacro-coccygeal junction 13-7. sacro-iliac junction 18-2. sacrospinous ligament 19-4. sartorius m. 5-2, 19-1, 19-6. scalenus anterior m. 15-1, 18-3, 21-7. scalenus medius m. 15-1, 18-3, 21-7. scalenus posterior m. 21-7. semispinalis capitis m. 18-7. semispinalis cervicis m. 18-7. semimembranosus m. 19-1. semitendinosus m. 19-1. serratus anterior m. 17-7. sphenoid b. 14-4. sternocleidomastoid m. 14-5, 17-1, 18-7. supraspinatus m. 8-8, 17-6. tensor fascia lata m. 17-5, 19-1. trapezius m. 17-1, 17-2, 17-6, 17-8, 18-7, 2 1 - 3 . umbilical band/strap 12-2 A&B, 15-2, 15-3. urogenital diaphragm 15-7, 18-3, 19-5.

Subject Index acromion 73, 86, 88, 92, 121, 124 adductor magnus m. 2 3 , 99, 101-102, 119 atlanto-occipital junction 68, 70, 123, 126 belly band/strap 74-75 calcaneus 115, 120 cervico-dorsal junction 29, 6 5 , 67 cervical-thoracic junction 73 chest band/strap 58-60, 62 chin band/strap 68, 70-71, 73, 74 Cohen, Bonnie Bainbridge 65, 66, 67 collar band/strap 73-74, 76 dorsal hinge 54, 57, 58, 67, 74, 92, 111, 124, 126 ectoderm/ectodermal 11 endoderm/endodermal 10, 11, 12 eye band/strap 67, 68-69, 74 fibrocartilage 25 flexures 16, 25, 67, 69 groin band/strap 62, 75-77, 102 inguinal band/strap 15, 61-65 LeBoyer, Frederick 21, 22 lumbo-dorsal junction 65, 67, 75 lumbo-sacral junction 65, 67

midchest band/strap 5 3 - 5 8 , 65 Odent, Michel 22 pelvic diaphragm 1 0 4 - 1 0 5 , 106, 107 piriformis m. 103, 123 primitive streak 6, 7, 8 proprioception 4 9 - 5 0 , 8 3 - 8 4 psoas m. 4 2 - 4 3 , 63, 1 0 0 - 1 0 1 , 107, 111, 113, 124, 125 pubic band/strap 62, 75-77, 102 Reich, Wilhelm 44 Rolf, Ida P. vii, ix, 2, 15, 27, 28, 36, 38, 4 3 , 6 5 , 100, 113, 115, 116, 121, 123, 124, 126, 131 sacro-coccygeal junction 6 5 , 67, 75 sacro-iliac junction 34, 77, 98, 123, 124 sphenoid b. 67, 68, 6 9 - 7 0 Sutherland, W.G. 69, 70 tendon/ligament formation 3, 5, 13, 14, 15, 4 3 , 44, 53, 57, 58, 73, 76, 77, 8 5 , 87, 9 5 , 97, 99, 101, 103, 116, 123 umbilical band/strap 74-75 urogenital diaphragm 76, 105, 106

About the Authors

R. Louis Schultz, Ph.D.,

trained as a Rolfer in 1 9 7 3 . T h e following year he

established t h e a n a t o m y program for t h e Rolf Institute a n d b e c a m e a Struct u r a l P a t t e r n e r (later c a l l e d R o l f i n g M o v e m e n t T e a c h e r ) . H e h a s p r e s e n t e d w o r k s h o p s for Rolfers in m a n y states in t h e U n i t e d States as well as in Germ a n y , Italy, E n g l a n d , Brazil, a n d A u s t r a l i a . I n 1 9 7 2 , Dr. S c h u l t z r e t i r e d f r o m the University of Colorado School of Medicine and Dentistry, where his final position was Professor a n d C h a i r m a n o f t h e D e p a r t m e n t o f H u m a n Biology. He is t h e author of over forty scientific publications. He received his Ph.D. in physiology from the University of Wisconsin in 1 9 5 5 ; currently he practices R o l f i n g i n N e w York C i t y . R o s e m a r y Feitis, D . O . , a t t e n d e d B a r n a r d C o l l e g e a n d t h e U n i v e r s i t y o f C a l i f o r n i a a t B e r k e l e y . S h e i n i t i a l l y w o r k e d w i t h Dr. R o l f o n t h e b o o k Rolfing a n d eventually w e n t on to train as a Rolfer in 1 9 6 9 . She worked intensively w i t h Dr. R o l f f o r a n u m b e r o f y e a r s , " k e e p i n g t h e i n f a n t R o l f i n g a l i v e , " a s Dr. R o l f o n c e said, a s w e l l a s e x p l o r i n g s o m e o f t h e i n t e r e s t i n g b y w a y s o f t h e h u m a n p o t e n t i a l m o v e m e n t . I n 1 9 7 8 , s e e i n g t h e n e e d f o r a less f o r m a l b o o k o n R o l f i n g , s h e e d i t e d Rolfing and Physical Reality, a c o l l e c t i o n of q u o t a t i o n s f r o m Dr. Rolf's l e c t u r e s . S h e a n d L o u i s S c h u l t z are c o - e d i t o r s of Remembering Ida Rolf, a c o l l e c t i o n o f s t o r i e s a b o u t t h e f o u n d e r o f R o l f i n g . Dr. Feitis r e c e i v e d h e r degree in o s t e o p a t h y in 1 9 9 0 a n d currently practices Rolfing a n d h o m e o p a t h y in N e w York City. D i a n a Salles e a r n e d h e r M a s t e r s D e g r e e i n M e d i c a l I l l u s t r a t i o n f r o m t h e U n i v e r s i t y o f M i c h i g a n . S h e i s c u r r e n t l y s e n i o r artist f o r t h e A m e r i c a n M u s e u m of Natural History in N e w York City. Ronald T h o m p s o n has b e e n a Rolfer for twenty-five years. Before t h a t he did considerable work in underwater photography. He is currently a m e m b e r of the a n a t o m y faculty and t h e Rolfing faculty of t h e Rolf Institute a n d practices Rolfing in T a m p a , Florida.