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The following was a treatment plan submitted during our clinical training at the Swedish Institute in NYC. It provides detailed, step-by-step instruction on a western style, medical massage approach for clients dealing with severe rheumatoid arthritis. While it might be more on the technical side, it should underscore the amount of consideration taken in a clinical setting where massage is administered every week, for a 6-8 week period.

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Goals for treatment should include: increasing flexibility and range of motion (ROM); relieving aches and pains related to muscle stiffness; increasing circulation – especially in clients with cardiovascular issues; reducing inflammation and joint pain during chronic flare ups/remissions; reducing contractures and adhesions; reducing anxiety and depression related to RA.

Bolstering to the knees, hip/lower back, and cervical spine may aid in relieving undue stress at these joints. Staying within a client’s pain threshold and using care to not apply overpressure when performing ROM, should also be observed. Some clients may develop osteoporosis, so caution should be taken with the amount of pressure used during a session.

Starting in supine, so as to better perform ROM and stretching techniques, we would begin at the arms. Moving the shoulder joint through coronal abduction/adduction, flexion/extension, medial/lateral rotation several times in order to warm up the joints and increase ROM. Moving down to the elbow and performing flexion/extension, supination/pronation, and finally the wrist with flexion/extension, radial/ulnar deviation, and circumduction. Taking the client through these gentle movements is invaluable in breaking up any fibrotic changes that may have taken place.

Applying myofascial release with passive stretching to the wrist flexors, biceps at the forearm, and pectoralis major at the shoulder, is a great way to promote length along these potentially hypertonic muscles. Resisted isometric tests (RIT) to the clavicular and sternal fibers of pectoralis major, followed by circular friction, will help to open up the chest and promote deeper breathing in this restricted area. Trigger point work, especially to the flexors of the wrist, may help to break up adhesions and promote blood flow to the area. Passive extension of the digits of the hand along the MP & DIP joints will promote lengthening in flexor digitorum superficialis and flexor digitorum profundus, respectively. Care should be taken with any ROM techniques at the wrist and fingers, since arthritic flare-ups and local osteoporosis are very common in these areas.

At the knees and ankles, gentle ROM would be performed. Cross fiber friction along the patellar ligament and muscle stripping of the quadriceps would promote length in these muscles. Mobilization of the patella itself, if not too painful for the client, would help to break up any fibrotic adhesions related to joint degeneration. Muscle stripping the tendons of the plantar-flexors and peroneals, would promote length and increase ROM. Cross fiber friction to the tendons would help to realign any scar tissue that may be present. Deep effleurage and petrissage to the foot will help to relax the client and increase blood flow to the extrinsic muscles of the foot.

In prone, vibration up the paraspinal muscles, followed by some myofascial release, would promote a deep state of relaxation and provide a nice warm-up of the area. Circular friction along the attachments for levator scapulae and upper trapezius would help to separate and realign its fibers. Muscle stripping and cross fiber friction to the erector spinae would help to release any adhesions related to muscle imbalance. At the hip, deep petrissage and circular friction along the fibers of quadratus lumborum would help to increase circulation and alleviate any pain resulting from contracture of this hip hiker muscle. Finally, RIT to the Hamstrings followed by myofascial release along its fibers would increase inhibition and allow for a deeper stretch of the fascia and its fibers.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Rheumatoid arthritis (RA) is an autoimmune disease which causes chronic inflammation of the joints of the body. Systemic by nature, it can also affect surrounding structures such as muscles, tendons/ligaments, blood vessels, and organs. The most commonly affected sights, however, include the small joints of the hands and feet, elbows, ankles, and knees. Women are three times more likely to be affected and its onset commonly occurs between the ages of 40 and 60.

RA often impacts multiple joints in an insidious, bilateral fashion (that is, if the right wrist is affected, the left will be as well). Sufferers often experience episodic flare-ups followed by remissions, which can last weeks to years. During flare ups, symptoms can range from fever, chills, fatigue, muscle pain, loss of appetite, to joint inflammation (redness and heat) and joint stiffness – which in most cases gets progressively worse.

In extreme cases, the condition can lead to gnarled and distorted deformities of the joint, loss of range of motion (ROM), and chronic pain. Inflammation of organs such as the heart and lungs can cause serious cardiovascular disorders and invariably results in organ failure. It has also been known to cause a condition called Vasculitis (inflammation of the blood vessels), which if not treated properly, can lead to necrosis of tissue. Since RA is a degenerative joint disease, it is not uncommon for suffers to eventually develop some form of muscular atrophy and local osteoporosis surrounding the affected joints.

The causes of RA are unknown, although it is thought to be a genetically inherited condition. Triggers such as streptococcus infections, viral and other bacterial infections, as well as smoking in some cases, are all believed to play a part. For some unknown reason, the body’s immune system attacks the synovial membranes of the body. Antibodies (RA factor) and inflammatory mediators produced by lymphocytes and white blood cells are produced and proliferated throughout the joint spaces and synovial linings. An inflammation response ensues, causing the synovial lining to thicken and swell. A substance called “Pannus”, which is produced by the cells of the lining, slowly erodes away the joint capsule, the articular cartilage, and eventually the bone. As a result, scar tissue develops and forms an ankylosis. Whether it be a fibrotic ankylosis restricting the ROM of a joint, or a bony ankylosis which fuses the bones together, the results can be debilitating.

The emotional and psychological implications of the condition are commonly fraught with chronic pain and daily limitations. During flare-ups, sufferers often experience pain in the morning and after prolonged periods of inactivity. This fact makes getting up in the morning and facing the day a particularly daunting task. As a result, sufferers tend to group their errands and tasks into as few activities as possible – so planning and forethought is of major importance. Socially, people with RA tend to curtail their interactions and engagements with others out of sheer necessity. Dancing, playing sports, or even going for a stroll, take on a whole new meaning. Emotionally speaking, this decrease in contact with others can take its toll on some.

Common treatments for RA can include taking aspirin and cortisone to reduce inflammation to anti-biotics and physical therapy for long-term sufferers. Immunosuppressants such as methotrexate have become popular in preventing further joint degeneration. NSAIDS, gold salt injections, and various other anti-inflammatory drugs have been used to alleviate pain. And as we will see, a treatment plan during periods of remission to help increase circulation, ROM, and decrease stiffness and pain at the affected joints.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

What is considered good posture? According to the Physical Therapy Dictionary, good posture is defined as “the state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, stooping) in which the structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded the thoracic and abdominal organs.” By contrast, the American Academy of Orthopedic Surgeons defines poor posture as “a faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.”

To better understand the implications of this, let us consider how the position of the head can have an effect on the muscles of the neck and shoulders. The average human head is said to weigh approximately 10-11lbs. When it rests squarely upon the neck and shoulders, the weight is translated down the spine placing little to no strain on the muscles of the head and neck. According to physiatrist Rene Cailliet, MD, the weight of the head is effectively increased by a factor of ten for every inch of displacement. If your head pitches forward by 2 inches for example, you’re essentially adding an extra 20lbs of pressure to the surrounding structures! Doing so places the muscles of the neck and shoulders under tremendous strain. Research has shown that faulty postures can lead to bone and soft tissue changes, which in turn can create a whole host of other issues — such as chronic neck & shoulder tension and headaches.

The spine is made up of 33 individual vertebrae. Nine of these vertebrae fuse together through a process known as ossification by the time we reach adulthood – 5 in the Sacrum (S1-S5), and 4 (sometimes 3-5) in the Coccyx or tailbone. That leaves 24 moveable vertebrae: 5 – cervical, 12 – thoracic, and 5 –lumbar. The spine has what is known as primary and secondary curves. Primary curves are the curves in the spine that we’re born with; namely the thoracic and sacral curves. These curves are formed in the developing fetus and are structural in nature. Secondary curves on the other hand are formed in response to muscle strengthening and develop a little bit later. The cervical curve for example takes shape as the newborn learns to lift his/her head. The lumbar curve develops after this as the child begins to sit up. Because of the nature of secondary curves, they are more susceptible to being over and underdeveloped, and as a result can lead to faulty postures. Let’s take a look at some examples.

The first image in the diagram below depicts what is considered “good posture.” The plum line suspended along side the lateral view of the body serves a reference point for the head, shoulders, hips and feet. As you can see in the first image, the head sits squarely on the shoulders so that the ear is in front of the line. The shoulders are then evenly aligned with the plum line so that they don’t round too far back or too far forward. Make note of the gentle curves in the spine in relation to the faulty postures. When we get down to the hips, we see a natural tilt that is approximately 30 degrees. This is considered normal. An anterior pelvic tilt will show an increase of more than 30 degrees and posterior pelvic tilt will show a decrease of less than 30 degrees. As the line continues down to the feet, we can see that the anklebone sits just behind the plum line.

Faulty Postures

As we move on to the various types of faulty postures, we must first consider the degrees to which these deformities take shape. There are three classifications of postural deformities.

1st degree deformities: Also known as postural or functional deformities. These variations in posture are a result of muscle imbalances. There are no structural or boney changes and the person can self correct.

2nd degree deformities: Also known as transitional deformities. These are also due to muscle imbalances formed from soft tissue contractures. There are no structural or boney changes, but because these have become so entrenched, the person cannot self correct.

3rd degree deformities: These deformities are structural in nature. There are definite boney changes, which are congenital in nature or born out of degenerative changes. A person cannot self correct.

Faulty Postures

A) Here we see a relaxed faulty posture. Notice the increased angle of the pelvis. This is considered a 1st degree deformity and through strengthening of key muscle groups and postural re-education, this type of posture can be corrected.

B) A kyphosis is the result of an exaggerated, posterior curve of the thoracic spine. There are two different types:

  1. Kyphosis Arcuata: This considered a 1st degree deformity. Both the shoulders and the upper back are rounded forward. The front of the shoulders are rolled inward and the head and neck pitched forward. Poor postural habits as well as psychogenic causes (i.e. emotional and psychological) can lead to this muscle imbalance of the upper body.
  2. Kyphosis Angularis: This is considered a 3rd degree deformity. Also known as a “hunchback” deformity. This exaggerated posterior curve of the thoracic spine is often caused by osteoporosis or Pott’s disease – a tuberculosis of the spine.

The counterpart to a kyphosis is a lordosis. A lordosis is an increased or exaggerated anterior curve of the lumbar spine. This means that the forward tilt of the pelvis is greater than 30 degrees. This is considered in most cases a 1st degree deformity. Some common causes could include obesity, pregnancy, or some form of muscle imbalance due to poor postural habits.

C) A sway back posture occurs when the angle of the pelvis is greater than 30 degrees and there is a forward shift of the pelvis, forcing the hip joint into hyperextension. As a result, a long kyphosis of the thoracic and upper lumbar spine develops. Considered a 1st degree deformity, this posture is usually the result of a muscle imbalance due to poor postural habits.

D) A flat back is the result of a posterior pelvic tilt (less than 30 degrees) which flattens out the normal curve of the lumbar spine. If not addressed properly this first-degree deformity, caused by a muscle imbalance and poor postural habits, can lead to a flattening of the thoracic spine.

E) A round back posture can either be a result of a kyphosis arcuata or a kyphosis angularis. In this representation, a flat back in the lumbar spine accompanies a kyphosis of the upper back. The angle of the pelvis is less than 30 degrees creating a roundness to the back. Notice the angle of the upper back in relation to the kyphosis represented in B. Notice also how the knees and lower legs are hyper extended.

Scoliosis: Another deformity of the spine not represented in the diagram is what’s known as a side bending or lateral curve of the spine – a scoliosis. A scoliosis can develop in the cervical, thoracic and lumbar segments of the spines. If the scoliosis occurs in only one part of the spine, it’s referred to as a “simple curve” or “C curve.” On occasion it can develop in several parts of the spine creating a “double/compound curve” or “S curve.”

There are two primary types of scoliosis. A postural scoliosis is considered a 1st degree deformity and is often the result of a muscle imbalance. An idiopathic scoliosis has no known cause, is considered a 3rd degree structural deformity, and is the most common form.

Developing good posture

For most of us, developing good postural habits can be a bit of a challenge. Some habits have become so entrenched and so much a part of who we are, that changing them will require some work. But the benefits are well worth the price.

Tight, contracted muscles have a way of restricting oxygen and nutrient rich blood flow to our cells. As a result, metabolic waste can accumulate in the tissue creating pain and imbalance. Chronically contracted muscles also burn up more energy and place an undue strain on the joints of the body. Over time these conditions can lead to illness, fatigue, and arthritis. Let’s not forget the psychological effects our posture plays in our lives. Walking around with our shoulders and our heads hanging low may initially be a way of coping with social anxiety or poor self esteem, but over time these postural habits can actually influence our state of mind. On the other hand, walking with our shoulders back and our heads held high has a way of creating and conveying confidence.

It all starts with awareness. Developing a certain amount of body awareness is crucial for any kind of change to occur. How many of us walk around stiff as a board and completely tense…without realizing it?! Check in with yourself a couple of times a day. Doing so will train your mind to catch moments of tension and contraction in the body before they set in below the level of awareness. Taking a break from the computer or office desk to get up and move around is a great way of doing this.

Exercise is the great equalizer. Whether it’s a full blown work out at the gym or a 20min walk in the park, getting your heart rate up and your body moving is a great way of breaking up stagnant energy and increasing blow flow to your muscles. And the powerful practices of yoga, tai chi, and Pilates can all help strengthen and stretch key muscle groups and create balance in our bodies.

Here are a few other tips to keep in mind.

When standing:

  • Make sure your feet are shoulder width apart
  • Keep the weight of your body on the soles of your feet
  • Keep your shoulders square with your body
  • Pull your head back and tuck in your chin
  • Stand so that your spine is erect, your head rests comfortably on your shoulders and your arms hang loosely by your side

When sitting:

  • Sit up straight with small of your back pressed up against the back of your chair (doing so will help prevent slouching)
  • Adjust the armrests on your chair so that your arms rest comfortably at an angle of 75-90 degrees
  • Both feet should rest on the floor so that your knees are bent at approx a 90 degree angle
  • If you’re in front of a computer, make sure the monitor is placed at comfortable viewing distance to prevent eye fatigue and neck strain. Avoid angles that force your head to pitch up or down or crane to the side. Using ergonomically designed keyboards and chairs are a great way to start.

With the advent of social media and mobile devices, we now have a tendency to constantly be looking down at our phones and tablets to check emails, update our facebook page, send texts and tweets, etc… This is creating unprecedented amounts of head, neck, and shoulder issues. To avoid making this potentially harmful and rudimentary mistake, always make sure to hold your device UP so that it’s at eye level. And don’t forget to breathe….


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

In this article we’ll consider the various manifestations of hip pain and what could be at the root of some of these aches and pains. But first we’ll need an understanding of the anatomical structure of the hip itself.

Each hip bone is comprised of three smaller bones: the ilium, the ischium, and the pubis. At birth these three bones are joined together by cartilage. By the time we reach our mid-twenties, they fuse together through a process known as ossification. The two hip bones are joined together by the sacrum and coccyx to form the pelvis.

The sacrum is also formed by unfused bones, namely five vertebrae, which begin to ossify by our late teens. The tail end of the sacrum, or what’s known as the tailbone or coccyx, is formed by 3-5 boney segments. Together these two bones join the two hip bones into what’s known as the sacro-iliac joint (SI joint).

Hip

All the bones of the pelvic girdle are held together by strong fibrous ligaments. The weight of the upper body rests on top of the pelvis and is then transferred diagonally into the hip sockets and down the legs. Although the SI joints are limited in movement, the two hip bones are designed to rock forward and backward independently of one another as we walk. On occasion the SI joint can get locked in place, whether due to injury or constant tension in the hip muscles, and prevent the natural movement to transfer up the spine. Since each hip bone can move independently of one another, it’s also possible for them to get locked into an anterior or posterior tilt, creating a leg length discrepancy.

The hip is capable of six different movements: flexion, extension, abduction, adduction, medial and lateral rotation. The hip joint is considered a ball and socket joint, which affords it the unique ability to move on so many planes. As mentioned in a previous post, there is what’s considered a normal degree of movement or “range of motion” for each plane.

Flexion:           80-90 deg w/extended knee — 110-120 deg w/flexed knee

Extension:      10-15 deg

Abduction:      30-50 deg

Adduction:      30 deg

M. Rotation:   30-40 deg

L. Rotation:    40-60 deg

Each movement in turn is performed by a series of muscles. Some of these muscles are known as primary movers, while others are known as synergists – that is, they assist the primary movers in their function. Flexion is done with a total of 10 muscles, extension – 6 muscles, abduction – 5 muscles, adduction – 6 muscles, medial rotation – 6 muscles, and lateral rotation – 8 muscles. When the hip is functionally optimally, all these muscles and joints work free of pain and with a normal range of motion. But as we’ll see, age, injury, and normal wear and tear are just some of the factors which can contribute to hip pain.                                  

Hip Injuries and Conditions

Of the many muscles that cover the hip and allow it to function, there are a number of them that also cross over into the low back and down into the legs — any of which can become strained. There are also a number of ligaments and bursa (fluid fill sacs) in and around the hip which can become lax or inflamed due to overuse. The exact placement of the pain therefore becomes an important factor in determining what the source of the pain could be. Here are several of the most common forms of hip pain. (For nerve pain that affects the hip, see a previous post on sciatica).

Anterior/Medial (Front & Inside) Hip Pain:

Adductor Strain (aka: Groin or Rider’s Strain)

The adductors are a group of five individual muscles located on the inner part of the thigh that move the hip and leg towards the midline of the body. Pain associated with an adductor strain will present itself as a sharp, stabbing pain in the groin area. An injury to any of the muscles that originate on the pubis is the most common cause. Irritation of these muscles can also lead to inflammation. On occasion, bruising and swelling may occur several days after the injury. If not addressed properly, an injury to any of these muscles can lead to chronic pain. Abduction of the hip (swinging the leg away from the midline of the body), will stretch adductors and elicit the pain.

Quadricep Strain (aka: Rectus Femoris Strain)

The quadriceps muscles are found along the front, inner and outer parts of the upper leg. They are considered primary movers in knee extension. The quadriceps get their name from the fact that there are four individual heads. Only one of these heads however crosses both the knee joint and the hip joint – that muscle is called rectus femoris. It is the most central head of the quadriceps and by far the most commonly injured. This is due in part to the fact that it contracts both concentrically and eccentrically, and is the only head of the quadriceps which assists in hip flexion. As a result it can become easily fatigued and overused in sports involving kicking, cutting (side to side), and start & stop movements.

Pain is usually felt in the front and inner parts of the thigh where the muscle originates on the hip. With first degree or mild strains, your gait will not be affected – but it will be with more severe strains. Stretching the muscle by flexing the knee and extending the hip will elicit the pain, as will contraction of the muscle through hip flexion and knee extension.

Iliopsoas Strain

The iliopsoas is considered a strong hip flexor and primary mover in hip flexion. In reality, the iliopsoas muscle is actually two muscles — the psoas and the iliacus. The psoas originates along the lumbar spine and the iliacus along the front of the pelvic bone. They blend together to cross the hip joint and attach on the femur. Pain from an iliopsoas strain will be felt in the groin area – that is, the front and inner part of the thigh. In severe strains it may be difficult to stand up straight without causing pain. The iliopsoas is most commonly injured when the hip is forced into extension from a maximally flexed position.

Since the muscle attaches itself along the inner part of the femur, abducting the hip (swinging the leg out), extending the hip or internally rotating the leg will stretch the muscle and cause pain. Contracting the muscle through hip flexion will also be painful.

* Pain associated with any pathology of the hip joint itself is typically felt in the groin and antero-medial aspect of the thigh.

Posterior (Back) Hip Pain:

Hamstring Strain

The hamstrings consist of 4 individual heads located along the back of the thigh. Three of these heads cross both the hip and knee joints – two along the medial aspect of the thigh and one along the lateral aspect of the thigh. The 4th head is found along the lateral aspect of the thigh but does not cross the hip joint. The lateral head that does cross both joints is known as biceps femoris. It is this part of the hamstrings that’s most commonly injured.

Since three of the hamstrings including the biceps femoris originate on the ischial tuberocities (aka: your sitz bones), the pain associated with a hamstring strain is usually felt at this insertion point. The hamstrings can also be injured at their insertion points on the inner and outer aspects of the knee, but more often than not the pain will start at the sitz bones and radiate down the leg. If not treated properly, a hamstring injury can become a chronic problem.

The hamstrings are primarily involved in hip extension and knee flexion. They’re also involved in medial and lateral rotation of the leg. They’re most commonly injured in sports involving running, kicking, or any activity that suddenly over stretches them. The pain can be exacerbated by sitting, fast running or stretching.

Ischial Bursitis

Located between the sitz bone and the gluteus maximus is a small fluid filled sac known as a bursa. Bursa are found around the joints of the body. They provide cushioning and reduce the amount of friction muscles and tendons exert as they glide over the boney prominences of a joint. The ischio-gluteal bursa as it’s known can become irritated from prolonged bouts of sitting – although this is not usually the cause of inflammation. This inflammation can on occasion irritate the sciatic nerve and cause pain down the leg.

The pain resulting from ischial bursitis however is pin point and con-scribed to the area around the sitz bones. It can come on suddenly and make sitting or sleeping on the affected side rather painful. Coughing, sneezing or any bearing down can exert pressure on the bursa and cause pain. People with ischial bursitis will often shorten their stride as they walk or lean away from the affected side while sitting to help alleviate the pain.

Lateral (Side) Hip Pain:

Abductor Strain

The most commonly strained muscle in an abductor strain is the gluteus medius muscle. Located on the outside of the hip, the gluteus medius is partly buried beneath its bigger brother — gluteus maximus. The other half of the muscle is superficial and easily felt along the pelvic bone toward the lateral and anterior aspect of the hip. The gluteus medius does a little of everything. Its primary function is hip abduction (swinging the leg out), but segments of this muscle are also involved in  flexion, extension, and medial and lateral rotation.

One of the most important functions of this muscle is stabilization of the hip. As the weight of the body shifts onto each leg as we walk or run, the gluteus medius must contract and exert enough force equal to twice our body weight! If this key muscle becomes weakened or strained from overuse, it will loose its ability to stabilize the hip and allow it to buckle while weight bearing.

There are several factors which could strain this muscle. Being overweight can exert more pressure over this muscle than it can bear. A cross-over gait or running on banked surfaces can also overload this muscle. Over time the weakened side will force the opposite hip to drop and adaptively shorten, causing a functional shortened leg.

Pain from an abductor strain is felt along the lateral, outside aspect of the thigh. The pain can be particularly acute while running and often mimics the pain of trochanteric bursitis. Stretching the abductors by swinging the leg inward will cause pain, as will contraction of the abductors (swinging the leg out).

Trochanteric Bursitis

An inflammation of the three bursa found around the hip socket is known as trochanteric bursitis. The bursa can become inflamed due to arthritis, obesity, or a strain of any of the hip or lower back muscles. This in turn can lead to faulty postures and abnormal gaits. Shortening of these strained muscles can contribute to chronic tension along the hip socket and eventually irritate the bursa.

The pain from trochanteric bursitis can be a deep, dull pain or a sharp ache along the outside of the hip that extends down the lateral part of the leg. The pain is usually worse at night and can make it difficult to sleep on the affected side. A cross-over gait while running can lead to irritation of the bursa, as well as a leg length discrepancy or a pronated foot.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Myofascial release is a form of bodywork that helps to relieve soft tissue restrictions by engaging the layers of fascia within the body. The work usually involves slow, broad, deep strokes, with the use of little to no oil. The purpose of this is to create a certain amount of “drag” and resistance within the tissue, which can then be used to slowly release trigger points and other fascial adhesions. Some people find myofascial release very relaxing and highly effective. But in order to understand why, there are a few things we need to know about fascia.

The term “myofascial,” was first used by Dr. Janet Travell in the 1940’s in her work with trigger points. If we break down the word, myo means muscle and fascia means elastic band. In actuality, fascia is a thin layer of connective tissue that covers all the organs and muscles in the body. Think of it as a continuous web of tissue that connects all your muscles, organs, bones, blood vessels and nerves together. There are three layers of fascia within the body. The first layer is called “superficial fascia.” This topmost layer lies directly below the skin and subcutaneous tissue. The second layer, known as “deep fascia,” surrounds and is interwoven into the muscles, bones, blood vessels and nerves. The third and final layer is called “deepest fascia.” This layer is found within the dura of the cranium. If we stop to consider the fact that all three layers are connected to one another, then it’s easier to see how a myofascial stretch applied in one area of the body (i.e. the foot) has the potential to affect a very different area of the body (i.e the head).  In reality, releasing fascial adhesions in one area will affect tension within the whole fascial system.

Fascia is made up of collagen fibers suspended in a ground substance. Normal, healthy tissue will have a certain amount of extensibility and elasticity due to something known as “critical interfiber distance.” Collagen fibers must maintain a certain distance from one another or they begin to stick together and eventually form fascial adhesions. The ground substance, which holds these collagen fibers apart, does this by retaining water. Therefore the more hydrated it is, the better it is at maintaining this distance.

Another element of fascia, and the one that makes myofascial release effective, is something known as thixotropy. Thixotropy is a property of fluids and gels that allows them to become less viscous (less stiff) and more fluid when stress is applied. In the context of a massage, the depth and direction of the stroke is the stress which melts the fascial adhesion and makes the surrounding fascia more fluid. There are many factors which can affect the thixotropic nature of fascia. Injury, stress, and inactivity are just a few of the most common. Damage to the ground substance can lead to fluid depletion and a build up of metabolic waste, which can eventually lead to soft tissue restrictions.

Another important aspect of fascia is that, within this continuous system of connective tissue, are meridians or “trains” of fascia than run in very specific directions. In his book “Anatomy Trains,” Thomas Myers describes several meridians that run at various lengths throughout body, stopping at boney landmarks along the way. Myers lists 11 distinct meridians that criss-cross the body from different angles. But for the sake of this article, we’ll take a look at two.

The image below is depicts the “superficial back line” or SBL. The “tracks” run from the plantar surface of the feet, up the back of the legs, into the glutes, along the spinal muscles, and around the top of the head to your forehead. The “stations” are the boney prominences the fascia runs over. In this case it’s the heel bone, sitzs bones, sacrum, skull, and brow ridge.

SBL_0001

This second image shows the “superficial front line” or SFL. See how it runs from the tops of the feet to the backs of the ears.

SFL_0001

These meridians clearly illustrate how a muscle strain or adhesion in one area of the body can create tension all along that fascial line. Myofascial release endeavors to meet that restriction and stretch it past its barrier to create a release. It’s normal for certain areas to be more tender or sore than others depending on how bound the tissue is. This can also be a sign of a trigger point, which can at times relay it pain signals along this fascial network. Freeing up trigger points and adhesions along these meridians can have a dramatic affect on the whole “train.”

One final note on this fascial network should help to underscore the continuity of the body as a whole. From a classical anatomy perspective, muscles and bones are given separate names and functions. Bones act as the struts and levers, and the muscles, tendons and ligaments as pulleys and stabilizers. However, due to the presence of this fascial network, the body act more like a “tensegrity” structure than anything else. The word tensegrity is a combination of the words “tension” and “integrity.” It describes a structural unit whereby its integrity is created by an even distribution of tensional forces throughout the system. So your skeletal bones are no longer viewed as the framework your whole body rests upon, but rather, as “spacers” “floating” within the body. This radical perspective is more in line with how the body truly acts than the conventional machine-like paradigm we’ve grown accustomed to. So this means that tension (whether traumatic or therapeutic) applied to an area of the body will be absorbed and distributed throughout the whole body. It kind of makes you wonder what’s really causing that headache or pain in your foot…


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

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116 Clinton St, Brooklyn Heights
July 2020
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