1556432283

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 © 1996 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 per mission of the publisher. For information contact North Atlantic Books. Published by North Atlantic Books P.O. Box 12327 Berkeley, California 94712 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 edu cational corporation whose goals are to develop an educational and crosscultural perspective linking various scientific, social, and artistic fields; to nur ture 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: 978-1-55643-228-6 Library of Congress Cataloging-in-Publication Data Schultz, R. Louis (Richard Louis), 1927The 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 web site at www.northatlanticbooks.com or call 800733-3000.

Includes bibliographical references and index. ISBN 1-55643-228-3 (paper) 1. Manipu latio n (Therapeutics) 2. Fascia (A nat omy ). 3. Rolfing. I. Feitis, Rosemar y. II. Title. [DNLM: 1. Fascia. 2. Manipulatio n, Orthopedic. 3. Hum an Body. 4. Holistic Health. WE 50 0 S387e 1996] RD736.M25S38 1996 615.8'2—dc2 0 DNLM/DLC for Library of Congress

8

96 -3 15 50 CIP

9 10 11 12 TRANS 12 11 10 09 08

Dedicated  

A

promise

to Ida

P.

Rolf 

fulfilled—with

love

Our thanks go   for the

his

computer production

manuscript,

the physical

to Sean Hellier

book

without would

on

which not

exist

Contents Introduction Part I

Early De ve lo pm en t Pre- an d Post- Birth 1

Emb ryol ogy: Intr oduc tio n to Con nec tiv e Tissue

3

2

E a r ly 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

Factor s in the Gr ow th of th e Em br yo

11

4

D e v e l o p m e n t o f M e s o d e r m a l T i s s u es

13

5

Emb ryo nic Limit atio ns and Early Structural Organization

Part II

6

Th e Effe ct of th e Bir th Proc ess

7

Dev elo pme nta l Transitions in the Ne wbo rn

8

21

23

Myofas cial Structures: The Spine as an Exa mpl e of "Living Ana tom y"

27

Mo ve me nt and Gravity

34

10

Body Co nto ur

40

11

Emo tio ns and the Fascial Web : Body Awareness and Respons e Patterns

46

9

Bod y Reti nacu lae (Bands /Strap s) 12

The Chest Band: Implications for Mo vem ent and Behav ior

13

Part IV

15

Con nec tiv e Tissue Body

and Youn g Chil d

Part III

vii

53

The Inguin al Band and the Structure and Fun cti on of the Vertebral Co lu mn in Relation to the Band s

61

14

Th e Eye Ban d an d Ch in Ba nd

68

15

The Collar Band , Umbi lica l Band , and Groi n Ban d

73

An at om y and Fun cti on 16

Propri ocepti on: Intern al Body Awareness

83

17

Upp er Bod y

85

18

Axial Ske let on

93

19

Pelvis an d Up pe r Legs

98

20

The System of Horizo ntal and Vertical Myofa scial Structures

106

vi

TH E ENDLESS WE B

Part V

21

Reciprocity of Movement

109

22

 Joints

114

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 The muscle-bone concept presented in standard anatomical description gives a purely mechanical model of movement. It separates movement into dis crete functions, failing to g ive a picture of the s eamless integration seen in a living body. Wh e n one part mov es, the body as a who le responds. Fu ncti on ally, the only tissue that can mediate such responsiveness is the connective tissue. This is the heart of the c oncept that we ar e proposing in this book. Including an understanding of fascia/connective tissue in the evaluation of movement gives an more accurate picture of the physical reality of the body. T h e c o n n e c t i v e t i ss u e c o n c e p t w e d i s cu s s a c c o u n t s f o r m u c h o f t h e s u c c e s s of Rolfin g. This is a concept that was or iginal and un ique with Dr. Rolf at the time she was developing her method of working with bodies. She started in the late 1930s. At that time and up in to the 1950s, r eceived wisd om stated that soft tissue could n ot hold a change. Myofascia per se was not ev e n c on s i d e r ed a s a d e t e r m i n a n t o f s t r u c t u r e . B o n e - s e t t i n g ( o s t e o p a t h y , c h i r o p r a c t i c ) was the only treatment for structure that was then considered effective. Today, ma ny forms of bod ywo rk inclu de a soft tissue tec hni que . This is one of the two ideas about bodywork that Dr . Rolf established through he r work. Her other semin al id ea has to do with the concept of gravity as it acts on the ph ysical body—the stress lines th rough the bod y that ideally establish and r einforce physical struc ture. This, too, is im pl e mented through the connective tissue component. In fact, the centrality of connective tissue to Rolfing and our attempt to understand connective tissue has been the impetus for this book. The way bodies change during Rolfing is not satisfactorily explained by any of the usual descriptions of physical ma keu p. Traditional an ato mic al attitudes about connective tissue do not giv e us a livin g picture of the dynamics involved in the changes we see in our work. What has interested us is the body's apparently great capacity for stru ctural change at any ag e. We are confronted daily with very wide deviations from standard anatomical description in people who function perfectly well. People look very different even thou gh the y are ma de of the same co mp on en t parts. We have com e to the working hypothesis that this variability is a function of certain properties of the connective tissue best illustrated by its development from embryonic mesoderm into mature tissue. Our ideas and concepts have come directly out of our experience as Rolfers—a combined total of more than forty-five years. People tend to approve and disapprove of their bodi es piecemeal. I t' s rare for them to look at themselves and say they're all bad or all good. Rath er, it's "My belly sticks out," "I'v e always had knock k nees ," "My left foot is bigger than my right foot." On those occasions when they are feeling good about themselves, they like the sh ape of their head or th e set of their should ers. Women say they look good in those shoes, while men say , "That cut of   jacket brings out the best in my shoulders."

viii

THE

END LES S

WE B

Not only do they see themselv es this way, they also have the same impr es sion of oth ers. For ma ny , cer ta in parts of th e bo dy are mor e attra ctive: " I' m a leg man," or "I like men with big shoulders." In our national cultur e, it seems to be accepted that one's business, economic, social, and sexual suc cesses are less if one is fat. A man fears that if his pelvis moves when walk ing, running, or other kinds of movement, the whole world will question his sexual preferences. A woman' s br oad shoulders are t aken as a sign of agg res sion and masculinity. Most of inner-body awareness is also piecemeal, and generally negative: "I have an upset stomach," "My knee hurts," "My neck is stiff," "My nose is stuffed." Mor e than lik ely this is a carry-ov er fro m the Puritan notion that it is unseemly to speak well of on eself. When I brag, I am con ceited, wh ich is   bad. This ge ts internalized so that when I feel go od about myself, go od about my body, I end up feeling guilty. Even when the aim is to improve the ph ysical self, the focus is on one thing at a time. A man will do push-ups and lift we ights to broaden h is shoulders; a woman will do leg lifts to slim down h er legs and hips. Yet those h ips or those shoulders are an expression of everyth ing else in th at   body. They're the result n ot only of its structur e , but also and recipr ocally of how everything else in th at body is used. This kind of connectedness is easy to understand in impact injuries. When I stub my toe, the injury resonates through my whole body, all the way to my head, whethe r I notice it or n ot. Th e pai n in the toe make s me not want to stand on it, and my wh ole body shifts i n order to avoid feeling weight on the pain ful part. I walk ligh tly on the s ide that hurts, mor e heav ily on the sid e that doesn't. If I'm not aware of d oing this, my tendenc y is to keep the shift in weigh t to one side long after the toe is n o longer painful. The pain ful side h as contracted away from th e sourc e of pain and is sh ort ened. This is especially true if the toe was broken , and the pain has persi sted for a long time. The compensation (shortening and deviation) becomes a permanent part of structure. An even more obvious example is a broken arm or leg . Even after th e cast is remov ed, th ere is the physical habit of all owing for the weight and   bulkiness of the cast, as well as the f ear of once again freely using the part that was broken. People tend to carry an arm that w as once brok en ha lf   bent, as though it were still in a sling or a cast. These are straightforward responses to straightforward injuries. Our bodies tend to record our responses to the even ts in our l ife like a calculator wi th a memory. In our living tissue, the record becomes fixed with constant replay ing. Like an orchestra, each part relates to the ot her segments. In an orches tra whose members have many years of experience playing together, if one section goes off key or plays off tempo, th e rest o f the orchestra atte m pts to compensate and blend in. In the human body, compensation is life supportive. If I were to give in completely to a broken leg or a whiplashed neck, I would be in bed. I

INTRO DUCTI ON

wouldn't be able to function. The body's tendency is to go toward as much   balance in any given moment as it can find, giving us maximum operational support for that moment. The problem occurs when we keep the compensa tion after the injury has healed . On e of the mos t co m m o n exa mpl es of this is the tendency to keep birth trauma as a part of one's physical makeup. What has fascinated us as Rolfers in our work with clients and in our experien ces of our own bodies is the mec ha ni sm of this record. How and where do we keep this memory of old injury? Ida Rol f' s answer was to e xam ine a system of the body that has been neglected, b oth by scientists a nd by medically oriented practitioners: the connective tissue or myofascia. To use the orchestra analogy, the connective tissue is the score on which the notes are written; bone, muscle, and organ systems are the instruments. The con nective tissue is the record; it is an infor mation bank for the body. Visualize a net curtain or a hammock. When a hook p ulls on one part of tha t web , the resultin g dist orti on influ enc es ever y part of th e system to som e degree. As we look at connective tissue, its high ly structured direction al or i e n t a t i o n i s s u g g e st i v e o f t h i s k i n d o f i n f o r m a t i o n s y s t e m . B y t r a c i n g c o n n e c  tive tissue's orig in, fun ction, and appearance in t he bod y, th is book s hows how myofascia creates an informational whole of the living organism. It is the unifying factor in the movement system we call the body. Thickening, snagging, or holding in any part of the connective tissue web results in a general heaviness of movement. What at first is a w ay to protect a part of the bod y (particularly a part that h ur ts) eventuall y r esults in a loss of flu idity throughout the entire body. Perhaps th e best image of fluidity is a tiger on it s way through the for est , not making a sound as it moves across leaves and tw igs and past bushes. Its "knee bone is connected to its . . . arm bone" without restriction, allowing a spring-like action among all parts of its bod y. Our dream is to have all of us moving surefootedly through our forests—be they of wood, of steel and con crete, or of humanity.

ix

PAR T

ONE

Early Development Pre- and Post-Birth

ONE

Embryology Introduction to Connective Tissue

The basis for all body form is embry ology. In

A bone can be remodeled throughout life

understanding embryology, we understand

as the r elativ e stresses on it ch ange. This is

how the adult structure came to be. Embry ol

how braces work on the jaw (now being used

ogy doesn't stop at birth; we have that pote n

for all ages): con stan t pr essur e creates some

tial for change all along. In a sense, we are

change in the bone formation and, thereby,

embryos throughout our lifetime. The aging

in th e contour of the upper and lower jaw

process is also a part of the embryological

  bones. Research has been published which

process. Death is a normal part of d evelop

d e s c r i b e s t h e r e su l t s o f c h a n g i n g a n d i n c r e a s 

ment. Degeneration is a normal part of the

ing the pressure on one en d of a bone. Th e

life cycle of tissue, which grows and dies from

  bumps on bones are places where muscle ten

the early months of prenatal life.

dons attach. The bumps are therefore regions

To the embryologist, the term "embryo"

of localized rapid growth of bon e as a r esult of

is applied to development through the first

prol onge d tens ion on that spot. If ten sion is

trime ster of pre gna ncy. Later stages are

applied to a different area, the new area is

termed "fetal development." We are generaliz

stimulated to create an increased amount of

ing the term, using embryological in a much

  bone, another bump. What then appears to

  broad er sense, as a time when things develop

happen is that on the other side of the bone

and differentiate. All tissue goes th rough this

there is some localized resorption of bo ne ,

state, bones as well as soft tissue. In general,

resulting in an indentation. It seems that a

this stage marks the origin of potential

certain volume of bone is needed in the body;

organs. Undifferentiated cells develop into

its configuration adapts to changing stresses

p o t e n t i a l l i ve r , 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 means that if we hold our

The body is always at potential—to change,

selves in a bent position, bone ultimately

and for new things to develop.

accommodates its shape to that position.

Birth is a change in environment, one of many that occurs throughout life. We know

Under prolonged stress the bone can get a different configuration, a slightly different

that cells turn over within organs—that is,

curv ing. The se cha ng es are slight, but if th ey

they live, d ie, regenerate. This is true of

were plotted over time they would neverthe

every organ except the brain , and even that

less probably be measurable. We all see people

is beginning to be question ed. Each cell has

  become more bent with age. The bone has

a finite lifetime, normally considered seven

changed its configuration. It doesn't happen

years. Within seven years, every cell in an

in one month or six; it takes place over many

organ dies and is replaced. Theoretically that

years.

means there is a potential in th ese cells to

Connective tissue literally connects and

regenerate in a different direction. This may

supports. It forms the structure of th e body.

  be wh at happens in aging. In our view, all

This is a new concept. We tend to think of

change is the first step in new possibilities.

structure in terms of m uscle an d bone. But in

This is what we mean by developmental

fact, structure is the result of th e organization

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 t i s s u e, i n

4

THE

EN DL ES S

WE B

response to movement, is the organizing

Connective tissue supports the organ,

factor. Muscle tissue is enfolded within the

nerve, and vascular systems. It makes up

fascia; the combination is called myofascia.

a hig h propor tion of bod y mass, reaching

Mo ve me nt is the out com e of emb edded mus

through all body elements lik e a supportive

cle tissue action on the surrounding connec

net or spider web. This is a good image

tive tissue. (Fig. 1-1). Structure is thus the

  because it is organized but irregular—the

result of movement, the characteristic muscle

fibers of a spider web are also not in a com

action on the connective tissue bed as a

pletely regular pattern. A spider web d epends

who le. Conn ect iv e tissue (myofa scia) defines

on its support—twigs or the window ledge it's

the body contour and is the organ of structure

spun around—for its shape. Similarly, myofas

and movement (as Ida Rolf called it) in the

cia is adaptive.

 body.

Most of the forces actin g on a body are from the outside. But forces also arise from inside, in the interconnections within the   body. Interconnections are maintained with movement or inhibited with lack of move ment. Many people move only a part of their

Epimysium

  backs when they walk, for example. As a result, connective tissue in th e back loses its elastic, spider web quality and is much less adaptable or movable. Perpetuating this

Perimysium'

immobility, connective tissue thickens and hardens. There is research showing that pre ssure or tension or friction applied in one area of th e

Endomysiunr

embryo results in in creased secretion of fibers   by th e conn ective tissue cells at the stimu lated place. Th ese fibers tend to arrange them selves along the lin e of the pull or friction or

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

tension. The connective tissue then changes from a lacelike elasticity to something more dense. If a fly gets caught in a spider web, there's a snag, a tig htening of the web in

EMBRYOLOGY

that area. E verything is pulled toward that snag, particularly as the fly moves around. Similarly, if there's a snag in the my ofascial web, it tends to gr ab—con nective tissue fibers concentrate there.

•

We have said that ever ything in the body is supported by connective tissue. Within

B

that tissue is a rich network of capillary beds. When an area is compre ssed , the blood sup ply to that area is also compressed and thus impeded. This then affects the ph ysical state of the intercellular matrix, wit h far-reaching results on particular stages of development. Connective tissue is alive in the sense that it responds to stimulus. It has certain ph ysical laws that it lives by. Ther e are chemical laws as well, but the phy sic al ones are more readily apparent. A given situation always gives rise to a specific reaction. Con nective tissue cells

C

D

(fibroblasts) build an d secr ete fibers. Under a certain kind of stimulus, such as pressure, this process c an be speeded up. T his is not unusual; it is the normal way for a ten don or ligament to grow an d take shape before birth. As the embryo g ets bigger, the bones g et big

Figure 1-2 This schematic shows an idealized sequence of normal development of tendon from early gesta tion to just before the baby is born. The process continues throughout life.

ger. In growin g, the bon e pushes out, creating a directional pressure in the connective tissue   bed between the two growing heads (end s) 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 ligamen ts an d (where there is muscle

(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.

tissue) of ten dons. The direction of the liga ment or tendon is determined by the direc tional pull. The pattern of muscle and tendon and ligament is established very early, in the first couple of month s of gestation. In the later months, structures become more elab orate, more set, and larger.

(C) Beginning of a more recognizable tendon shape; note that potential muscle tissue is devel oping 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 big jump from the first germ cell to the

Extraembryonic, mesoderm

formation of germ layers that are the first recogn izable for m of the emb ry o. There are three germ layers:

Amnion Embryonic,, disc

Ectoderm Endoderm*

• th e ec to der m gives rise to th e bra in an d nervous system and the superficial epi

Primitive yolk sac

dermis (skin) • th e en do de rm gives rise to th e digestive system and the digestive glands • t h e m e s o d e r m g i v e s r i se t o m u s c l e , b o n e ,

Second week of pregnancy

  blood, the urogenital system, and con nective tissue in gen eral

Head

By abo ut the end of the second we ek of pregnancy, the cell has become a disk th at is surrounded by cavities filled with fluid. The embryo grows by the multiplication of cells, which organize into layers at about the sec

Amnion-

ond week. The disk h as a top layer (ectoderm) Tail

and a bottom layer (endoderm). Direction in the embryo 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), when an area of more rapid cell formation develops in one part of the disk.

Primitive streak

Ectoderm Endoderm-

Primitive^ yolk sac

At the beginning of the third week, the embryo is about the size of the tip of a pen cil Early third week of pregnancy

point. The area of greater proliferation is approximately a quarter of the total surface area. It r apid ly cond enses in to a line which is called the primitive str eak . This is the tail end of the emb ryo ; it event uall y be com es the anal

Nolochord Primitive -"streak

region. When the primitive streak is estab lished, the middle layer (mesoderm) begins to Mesoderm

develop . The process of grow th in the emb ry o Figure 2-1 A three-dimensional view of the embryo at the beginning of the third week of pregnancy, show ing 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.

Ectodernr  Endodemv

Late third week of pregnancy

EMBRYOLOGY

7

no w be com es twofo ld: cell mult ipli cati on by division of existin g cells, and the gener atio n of new cells from the primitive streak. The embryo at this stag e is roughly oval and becoming more elongated as it grows. Having established top and bottom (ectoderm and endoderm) as well as a tail (primitive streak) and therefore a head for our embryo, we can now know which are its right and left sides. Cells proliferating from the primitive streak are enlarging and elongating the disk. Cells immediately in front of the source (the pri miti ve streak) devel op into the rest of th e  body. Logically, we would expect that either everything is established at the same time in the embryo and grows bigger and more com plex; or, since everything grows from the primitive s trea k (tail), this end develops first (initially tail, then the pelvis , then chest, neck, a nd finally the head) . In fact, neith er is the cas e. Nature doe sn't sh are our sense of logic. The primitive streak remains primitive (undifferentiated). The new cells created from the primitive streak become the head and then the rest of the body from the top down. The head is gradually pushed away from the source as th e rest of the body grows between . The top end is pushed farther and farther away from the source. Multiplication of cells is taking place throughout the embryo, not only at the source, although the greatest generation is there. The embryo is growing geometrically: lengthwise, sideways, and internally. The shape chan ges from a disk into a round,   body-like sh ape. The circular dis k was like a slab of "silly putty" that got pulled lengthFigure 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

EN DL ES S

WE B

wise. As longitudinal pressure increases, the

the old est part of the digestive system is the

edges begin to cur ve inward , closing to form

mouth. The back of the mouth is older than

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

the esophagus, the stomach is older than the

outs ide ( whi ch was th e top of th e disk) is the

small intestin e, and so forth. The sigmoid

ectoderm. The inside (originally the bottom

colon just in fron t of the anus is th e "newest"

of the disk) is the endoderm. The mesoderm

part of th e body. At birth, th e most diffe rentia ted part of the

is the f illing between these two layers. The primitive str eak is the first "structure"

embryo is the head. The least differentiated

different iated from the general mass of the

(the least mature) is the pelvis. Dif ferentiation

primitive embryo. It later becomes the anal

occurs when cells have been in one location

region, so th at we may say that this region is

long enough to have multiplied and elabo

the "old est" part of the body. After the anus,

rated. The primitive local structures mature. Endodermal cells multiply and differentiate into specifically endodermal structures; ecto

Primitive streak

Ectoderm-

dermal cells into th e various ectodermal struc tures, and so for th. Even tually , cells be co me

Endoderm^

specific—a muscle cell, a liver cell, a brain

Notochord'"

cell. Tail

At the earliest stages of embryonic develop ment, a cell in a given position h as a number of potentialities. A cell somewhere in the head, for example, when it divides into two, may be dividin g into the left and rig ht sides of the head . Wh en these in turn divide, the y may become structures in front and back. As

Heart, primordium

cells con tinue to divid e, they split their potentiality, becoming more and more focused toward a purpose. Each cell creates its own specific environ ment within the general matrix. There are structural and chemical changes within the cell as it zeros in on becomin g on e thing , one organ. The surrounding cells make up the

Heade fold

env ir on me nt of that organ, contri buti ng to its structure, its shape. If the central cell is put in

Heart, primordium'

another par t of the body early enough, it can Tail -•fold

  become a differ ent organ. Yet at some point in tim e, its envir onment has shaped it suff i ciently that it can become only itself. For example, potential liver at first is just a

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

little tube whose cells are se parating from the rest of the gut. As long as these cells stay inside the tube, this environment will deter mine that they become liver. If one could

EMBRYOLOGY

dissect away one of those cells and put it in a

integrity of the growing vertebral column.

nearby environment, it could become a pan

The resulting complexity of pulls along and

creas. As described in many standard embry 

  between the developing bones results in the

ology texts, it has been shown that potential

differentiated ligaments that connect the

pancreas does not differentiate into mature

 bones

(Fig.

9

2-4).

pancreas cells unless it is in a specific meso

In ad dition to a grid-like suppor t from

dermal environment (potential fascia). Rela

  bone, tendon, and ligament, the body gets a

tionship to the surround ing fascial tissue is

"packing material" support from connective

important; it may be the specific energy field

tissue. Fat is a part of this material. It is

that makes th e dif ference for this tissue.

another kind of connective tissue. Depending

About the end of the fourth week, the

on its density, it acts to cush ion, protect, an d

embryo has developed primitive arms and

pad the bod y or to provide suppo rt and spac

legs as well as a primitive brain, primitive

ing where it's more dense. In adipose (fat)

spinal col umn , and the beginn ings of verte

tissue, cells enlarge by accumulating droplets

  brae to protect the central nervous system .

of in tracellular fat; fibers and matrix are

It is now shaped like a tube and is getting

pushed aside by the engorged cells. This tissue

  bigg er, particularly at the head end. Its shape

is important in the spatial arrangement of

is the result both of self- pr oliferation and of

structures. Fat is one of the body's ways of

the space restrictions as determined by its

immobilizing or wedging an area.

outside environment. Around all of these pr imitive structures primitive cells are proliferatin g into "filler." This filler is mesodermal tissue—primitive fascia made up of cells, fibers, and inter cell ular matrix. Its texture is like glass wool or angel hair, the kind of stringy, fluffy stuff

 A

that sticks to your fingers. T he matrix is sticky

B

a n d s o m e w h a t l i ke J e l l - O i n t e x t u r e . I n m o s t places in the body, it stays soft until birth. In other places, pressures and tensions, both internal and external, cause it to respond by getting hard and directional—ligaments and tendons begin to form. Hardness and direc tion of fiber ar e the no rmal factors cr eatin g structure in connective tissue. In the places wher e bone will form, th e soft matrix becomes more rigid, establishing a directional pull. This internal tension, together with e xter nal pressures from the

C

D

confining walls of the uterus, stimulates cells locally to in crease production of fibers. An example is prevertebr al cartilage. As it gr ows, its push into the conn ective tissue bed creates a stress line, organizing and maintaining the

Figure 2-4 Tendon/ligament formation.

10

TH 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.

material, it is necessarily restricted in mobility. This

Fully developed endodermal tissue is held in position

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

Ectoderm and endoderm structures are func

ment has been necessarily sketchy and gen

tionally both more discrete and more stable

eral. Howev er, it provid es a framewor k for

in form. Yet connective tissue becomes

discussion of embry ologi cal conce pts as the y

increasingly important, establishing the

predispose and influence the shape and char

arrangement of structures as the embryo

acteristic movement of the individual.

grows in size. Th ere have been few tissue

Descriptive embryology tells only part of the

studies of late pregnancy that detail what

story. It is a history of general patterns of

goes on un der ne ath the skin of the develo p

growth. Minor variations in this developmen

ing infan t. It is reasonable to suppose th at the

tal pattern allow prediction of th e individual's

great spurts in growth that tak e place towar d

future structure and behavior.

the e nd of pregnancy are the result of an

The re are shifts in the im po rt an ce of on e factor o ver another as the em bryo grows. At

increase in the volume of connective tissue. The body grows organically, solving prob

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

lems and meeting needs as they arise, rather

ma y be the most import ant. At anot her time,

than being set up accordin g to a predeter

internal growth and differentiation may

mined plan. Genetic predetermination sets

take preced ence. As d escribed in Section 1,

the stage; variations are a kin d of problem

a change in th e dir ectional stress in the mes

solving. No two of us are the sam e. No two

enchyme modifies the organization of sur

sides of the bod y are the same. These varia

rounding tissue. E very growth stage thus

tions relate to differences in environment,

creates new demands and challenges in the

bo th intern al and external, of the kind we

internal envi ron me nt of the embr yo. In gen

have been describing. As body structures

eral, the response is a greater degree of spe

develop, they change the internal environ

cialization of function.

me nt of the imme dia te area, creating cha nge s

The external environment becomes

at the anatomical level. There are many slight

increasingly important as the embryo gets

differences in the rate of dev elo pme nt inside

larger. Within the womb, there may be some

the embryo. The orchestration of these vari

insufficiency of the placenta (th ere are chil

ables makes up the physical components of

dren who are born with malnutrition). If the

individuality. T his is true long before birth,

mother's diet is inadequate, the embryo will

even before the embryo is recognizably

  be affected. If the mother takes medication or

human.

drugs, this will have a greater or lesser influ

On e factor in this kind of pro ble m solving

ence depending on the drug, the stag e of ges

is that cells have a much wid er ability to

tation, and dosage an d/or frequency. If sh e is

respond to changing environment than is

constipated during much of the pregnancy,

generally believed. Mesoderm is a prime

this exerts pressure on th e uter us.

example. It has types of nonspecific cells that

As the embryo d evelops, in terms of struc

apparently give rise to dif ferent kinds of spe

tural organization, connective tissue is the

cialized cells as needed. These cells are present

least spec ific of the developing tissues. Me so

in the embryo, the child, and in the mature

derm remains relatively amorphous.

adult. We have termed this the "embryonic

12

THE

EN DL ES S

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area as a whole. I f this h appens at one time schedule, it creates one kind of structure. If it happens later, it creates a slightly differ ent structure. Even a matter of hours is sig nifi cant. This is th e reason that drug effects can   be so devastating at one em bryonic stag e and less so at another. Th alid omide is a recent illust ration . If it was taken early, wh en ar ms and legs were just beginning to develop, th ere would be no arms or legs at all. If taken later, only fingers or forearms might be af fected. The embryo develops in all its parts both Figure 3-1 The way the baby lies within the uterus determines the ultimate pattern of the spine.

on a general timetable (the genetic contribu tion) and on its own individual timetable. This can be a little lagging or a little ahead of the average pattern. Development takes place

potential of mesoderm." Reticular cells and

in spurts. By the end of the secon d or third

lymphocytes are examples of this type of cell.

month of pregnancy, all the elements are in

Reticular cells in connective tissue very proba

place. From then on, growth is a matter of

  bly act as source cells, giving rise to special

  becoming bigger, more coiled, or more com

ized cells on demand. Lymphocytes in blood

plex. After the third month of pregnancy,

and lymphoid tissue accumulate near an area

the embryo has dealt with the problem of

of infection, where it seems that they are able

  becoming what it is—an identifiable creature

to assume multiple functions as needed in the

of hu ma n type. From the n on, it is dealing

healing process, even metamorphosing into

with a different problem, namely the develop

phagocytic (restructuring cells) or becoming a

ment into a bigge r, more differentiated sys

source of additional connective tissue cells.

tem. Increasingly, external environment

Such morphological (shape and structure) responses to environment are the extreme.

  becomes a major factor. Also at this point, individual variations

Yet all cells change their rate of growth in

  become increasingly apparent. The embryo

response to environmental stimulus. Even

shows individual body shape and conforma

in the adult, if a kidney is removed, within

tion. The way the baby lies in the uterus

a short time the remaining kidney doubles in

dete rmin es the ultimat e pattern of the spine

size to compensate. Cells for this regeneration

(Fig. 3-1). Whether the head is to the right or

come from within the body As the kidney

to the left or between the two legs, how the

grows, it continues to function as a kid ney. Its

arms are cur led around —all these are impor

cellular processes are fully loaded—even over

tant factors in the final shape. As it grows, the

loaded—yet it can make this compensation.

embryo (and the infant and adult) expands in

Th e coo rdin ati on of tim ing is a ma jor

size but retains the early patter n of rotation.

factor in embryonic development, meshing

Internal environment is primary at the

internal and external environmental

cellular level, more influential when the

demands. For example, as a few cells bud

embryo is very young. As the fetus becomes a

off the endoderm tube to begin to form the

child and then an adult, external environ

liver, this changes the environment of the

ment takes on an increasingly significant ro le .

FOUR

Development of Mesodermal Tissues We need to d igress for a moment to discuss

study of tissues) , the fascial wrapping of

the development of those mesodermal tissues

mature muscle is not a true wrapping. It is

that will become the bones, ligaments, ten

  better described as an area of greater con

dons, muscle, and myofascial elements of

cent rati on of con nec tiv e tissue. Ther e is no

connective tissue. These are the str uctural

  beginning or end to th ese structures. Liga

com po nen ts of mes oder m; they share a char

ments and tendons do not really attach to

acteristic pattern of growth .

  bone—they are continuous with the perios

It is usually assumed that connective tissue

teum (a fibrous covering of the bone), which

(fascia) condenses around a muscle because

in turn is continuous with the next tendon

existing muscle tissue needs a wrapper. It is

or ligament.

(Fig.

4-2).

our belief that the direction of the connective

Anatomists tend to describe the body in

tissue (tend on or ligament) is establish ed first.

terms of its dissectible parts. A livin g body is

Potential muscle tissue caught within this

a continuous whole. This is especially true of

directional pull differentiates into mature

its connective tissue components. The error

mus cle orien ted alo ng the line of pull. Mus cle

arises whe n we thin k of fascia as a tubular

itself is spong y, able to expand an d con tr act and so exert pressure and friction on its sur rounding fascial bed. Musc le tissue is sim ilar in consistency to taffy. Connective tissue gives it shape, direction , and organization, much as the candy wrapper shapes the taffy. Because it is continuous throughout the body,

B

connective tissue generalizes local muscle action. For example, as the biceps move, the whole arm moves, including the shoulder and neck. This interaction develops early, in th e first o r s e c o n d m o n t h o f p r e g n a n c y . M u s c l e t i s s ue is caught in the middle of the connective tissue directionally while it is still prim itive. The clump of primitive muscle cells elongates through d ir ectional pressure. At this stage the group of prim itive mus cle cells ch an ge s int o differentiated muscle cells. Further growth increases muscle size by cell reproduction.

c

D

This development may be stimulated by the physical tension present in the connective tissue, or it may be stimulated by the associ ated en ergy field (Fig. 4-1). In terms of histology (the microscopic

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

THE

EN DL ES S

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  bone) pushes out into the connective tissue   bed, directional stress lines are established. These have one character along the bone and

Periosteum^

another between the bones. The connective

Tendon'

tissue component within these stress lines is stimulated to increase fiber production, and

Fascia>-

these f ibers are arr an ged along stress lines. Brachialis-

Intramuscular  -connective tissue fibers

This reinforces th e directional pull within the connective tissue bed, stimulating more fiber production.

Tendon*

Traditional anatomy describes the average soft tissue structur es of th e body. We have found a variety of atypical connective tissue   bands an d com pr essions that are illustrated in no anatomy text. We have interpreted these as an individual response to idiosyn cratic

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

patterns. These patterns can include habitual gestures or posture, compensation to injuries, i n d i v i d u a l r a t es o f g r o w t h , a n d e n v i r o n m e n  tal stresses of all kinds. This kind of individual

covering around muscle tissue. It is more

response is appar ent as early as the third

accurate to say that tendon goes through

month of intrauterine life.

muscle than that the muscle lies within the tendon. Keep in mind that in the embryological

Around the sixth month of pregnancy, size limitations in the uterus become a factor . Th e more stringent this limitation, the greater the

stage of dev elo pme nt, all of these structures

likelih ood of adapta tion. In ma ny infants, for

are potential. What starts as potential tendon

example, the connective tissue on the outside

or ligament has potential muscle developing within it. The connective tissue around the potential muscle loses its tendonous character and becomes fascia (bedding). The ends of the original band of fibers remain as the tendo nous attachments. Where the connective tis sue ban ds exten d across a broad area of the   body, such as the back, they are called apo

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

neuroses. This is a wid er, flatter equivalent of tendon as it connects to the broader muscles. We have isolated a particular part of meso

of the leg becom es thickened. The leg s ar e held folded within the uterus so that tension

dermal differentiation—that of tendons and

is created between th e knee cap and the hip.

ligaments and associated muscle within the

Where there is this kind of pressure, the stim

connective tissue bed as a whole. What do we

ulation causes a heavier concentration of

mean by differentiation? What really happens

fibers, formin g a thickened sheet of fascia.

when connective tissue structures get organ

This is not a respon se to internal need, but

ized? As cartilage (which will be replaced by

a response to outside pressure (Fig. 4-3).

FIVE

Embryonic Limitations and Early Structural Organization As the fetus grows, environmental pressures

where it is called th e ilio-tibial tract. The ante

  begin to dominate. At six months, the fetus

rior superior spine acts like a hook suspen ding

is really being pressed by the limitations of

a piece of fabric. The muscles of the thigh lie

space. Th is is particularly tr ue if the mother's

within the folds.

posture or structure supports the pregnancy

Another pull is down to the pubic bone

with d ifficulty. The child m oves around quite

from the rib region. The muscle most directly

a bit, so that it does have some o ngoing

influenced is the rectus abdominis, the "sit-

choice. Especially toward the eighth month

up " muscl e on the front of the ab do me n. Its

of pregnan cy, however, this mo ve me nt tends

ease and length seem to relate to the degree

to be restricted to the limbs because there is

of curl as the child lies in the uterus.

so little space.

Nowhere are these pulls in isolation. There

The child's position in the uterus is thus

are always cross-tensions among them. We

important in its structural development and

have d escribed a line of f orce down to the

alignment. Whether the head is to the right

pubic bone and one up to the anterior supe

or to the left of the knees, wher e the arm s

rior spine. In ad dition, there is a torsion

are in relationship to the spine—these factors

  between these two bony protuberances.

establish the individ ual pattern of the verte

The soft tissue organ izes as a shee t acr oss

  bral column. We assume that the position of

this area, which is the groin. Within the sheet

the head on the neck is determined by these

there are specific areas of concentration of

s p i n a l r o t a t i o n s (Fig. 5-1). It was Ida Rolf's

connective tissue fibers. The most apparent is

assumption that this relationship is estab

the inguinal ligament, a rope-like band from

lished as early as the f irst week of pregnancy.

the anterior superior spine to the pubic bone.

Such primary rotations are augmented and

When this is too h eavy and short, it restricts

compensated by intrauterine limitations during late pregnancy. Other places in the body may show idio syncratic changes in structure, changes away from simple efficiency. What, then, is simple efficiency? It may be visualized in terms of the concept of an embryonic, undifferenti ated connective tissue bed in which there are directional pulls. As the bones grow into th is   bed, their protuberanc es act as h ooks, pro viding focal points of soft tissue tension (Fig. 5-2). For instance, th e anterior superior spine of the ilium (the top front corner of the h ip   bone) "snags" the broad fascial sheet that comes up the leg from the knee. T his creates convergin g folds at that point. The sheet of fascia also thicken s on the side of the th ig h,

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

16

THE

EN DL ES S

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movement; when it is insufficiently estab lished, the groin sags. The lumbo-dor sal fascia, which lies in a heavy vertical band on the back, is a soft tis A.S.I.S.

Rectus abdominis m.

Inguinal ligament

sue structur e that is establish ed by the hook ing effect at th e spin al flexures, those places whe re the degree of be nd in g in th e spine is greater. The fetal spine does not describe a smooth continuous "C" curve; it is a seg mented curve. These segmental junctions

Ilio-tibial tract

are established before th e bones start to form. These junctions probably determine regional .Sartorius m.

vari atio ns in th e shap e of th e verte brae. The fetal curve itself is not a response to restric tion from th e womb; there seems to be gen etic determination for that curve that is later reinforced and redir ected by the muscular

Rectus femoris m.

pressure of the uterine walls as the child grows. By the time the fetus is full term and ready to be born , it is a balanced network of soft tissue pulls reflecting the interaction between its gen etic blueprint and intrauterine str esses. When the ch ild is born, it has to start work

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).

ing—literally—to counteract some of the hab its that are already established in its body. Its spinal curve and a kind of crouched position of leg s and arm s must be open ed and length ened

(Fig.

5-3).

EMB RYO NIC

LIMI TATIO NS

AND

EARLY

At birth, the h ead nods forward and the

STR UC TUR AL

17

ORG ANI ZAT ION

leg. This structure is f un ctional in the

hip turns under. A human being in the womb

womb and as the child cr awls. But as th e

is born in a natural stoop. He straightens for

  body begins to stan d, the shortness is felt as

many reasons: for comfort, to mimic, for effi

a restriction that inhibits secure upright bal

ciency of movement, to explore. As these new

ance. Gradually, as demand for stable move

physical habits are established, they induce

ment increases, this tissue must lengthen. Or,

additional cross-stresses within the connec

as is more usual, the growing child finds com

tive tissue network. Pre viously establish ed

pensations around the shortness to serve its

stresses d issipate from lack of use, th ey may

needs. The lum bar spine (lower back) m ay

  be modified , or they may remain as a sub

come too far for war d, or the legs may be pulled up and into the body .

structure within the bod y. The knee-up position in the fetus makes

There are numerous examples of such

an almost d irect line of restriction across the

restrictions in fascial sheets and connections

pelvis between the lower back an d the inside

as the child develops in the womb. This may

of the thigh. This stress line is continuous

  be the origin of so-called spontaneous curva

with the fascial thick ening on the small of the

tures. Children who have shown no prior

  back. The combination is a compressed, lean

structural problems can suddenly develop a

ing "S" curve between the lower back and the

curvature (scoliosis) just before puberty. Th is is not a rare occurrence. It is possible that the pattern of the curve may have been estab

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

lished in the soft tissue relationships of the spine early on. The demands from growing   body weight and increasing control of move ment then bring out the inherent weakness.

C

D

PA RT

TW O

Connective Tissue Body

SIX

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

instituted deliveries of the baby under water.

emotional impact. From a physiological point

First efforts to clean off the baby were d one

of view, th e actual passage ne ed no t be struc

in the water and no suctioning of airway was

turally dam ag ing. Ther e might be some dif fi

deemed necessary. More traditional birthing

culty because of the size of the h ead and

now includes vigorous toweling and drying

shoulders, yet th is should be transitory. A

the baby as well as suctionin g to clear the

prolonged period of labor may be a source of

airway. Birthing techniques of the 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 the feet until the first cry was

make that much difference to structure.

heard to be sure the airway was clear.

Birth is an extraordinary condition. The

What happens to the diaphragm and the

infant is experiencing a total change in envi

ribs with breathing in th e diff erent k inds of

ronment. It has no established ways of d eal

  birthing? Intrauterine breathing movements

ing with all this n ewness. At birth, the baby

have to be shallow because the abdomen and

is a wide-open system. New stimuli, because

upper ribs are sharply c ompressed in the fetal

they are new, ar e magnified in their import

position. Only the lower ribs (and possibly

  both physically and emotionally. It is a truism

the diaphragm) can be involved. The first

in psychology that what we learn under panic

  breath after birth star ts the process of pushing

conditions is with us f or life. Traumatic sen

th e fluid out of th e lung s. B re at hin g has actu

sory attack, such as being held upside d own

ally started before birth, and some amniotic

under bright lights, can ind uce structural con

fluid needs to be e xpelled . That was the ratio

tractions or sensory shutdown that may never

nale for the shock. The spanking and holding

go away. This is a cultural rather than a physi

the newborn upside down were used to

ological part of the birth process.

ensure that the lungs were cleared.

Birth is the beginning of new environmen

As adults, we tend to be either chest

tal influen ces on structure, ones arising out of

  breathers or abdominal breathers. Does the

cognitive impact. Th ere are basically two dif

first breath of the neonate initiate the pat

ferent kinds of malfunction in the body—

tern? In abdominal breathing, the diaphragm

those caused by traumatic (external) stress

moves up and down and the increased vol

and those that result from developmental

ume of air is accommodated in the abdomen.

(internal) stress. We tend to accept the latter

In chest breathing, the diaphragm also moves

  because "that's just the way the world is" or "that's just the way my body is." We have no

up and down, but not as much. Abdominal   breathing quiets the body and draws the

comparisons. We can never know how we

focus of e nergy lower in the body, a patter n

would f eel without that stress.

well suited to meditation. Chest breathing draws the focus of ene rgy upwar d in to a mo re

Breathing is one of the major new things that h appens with birth. It would be inter

active pattern. (In our view, the desirable rest

esting to compare a LeBoyer f ilm of th e first

ing state is a balance between the two—see

minutes of infant delivery with a film of more traditional births. The French obstetrician

 

Fig.

6-1.)

As the support of uteri ne const rict ion is

22

THE

EN DL ES S

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very thin . Both light and sound can and do come through. There may even be an intra uterine need f or the infant to withdr aw by contracting. Touch is the earliest sen se response, estab lished at about one month of gestation. Tac tile stimulation ch an ges rad ically at birth. In the uterus, there is fluid coverin g the ch ild in addition to the uterine musculature. At birth, this amniotic fluid is n o longer there. At birth there are sudden intrusions of for eign textures such as sheets, rubber-gloved fin gers, suction ing devices, and rectal thermometers. The whole skin is an organ of touch. The laying on o f gentle hands at bir th is someth ing we Figure 6-1 In a balanced combination of chest and abdom inal breathing, the abdomen lengthens (vertical arrow) and the rib cage widens (horizontal arrow). The inhale is shown in Figure (2); we have exag gerated the drawing for greater visual impact— this is what it feels like but the visible effect is less than this illustration suggests.

all know to be important. It is good to see it so beautifully represented in L eBoyer's* film of birthing. With the work of the second gen eration of progressive ideas in birthing / gen  tle ways of stimulating sensory awakening have been found—for example, blowing air on th e chest or using th e mother's voice in a low monotone to stimulate breathing.

lost at birth, there are new pressures fr om

The change in the quality of sensory

  blankets, sheets, diapers. Diapers are th e most

response to the new environment is the

insistent pr essur e, but even sheets and blan

first challenge the baby faces. How this

kets probably create more pressure than we

change is han dled has a marked effec t on

suspect. It was once common to pin down

identity. Structurally, a d efense r espon se

inf ant sh eets. Lately, in ste ad of put tin g th e

is expressed as tissue contr ac tion and with

child under a blan ket, he or she is put into

drawal. A sh ock to the system, taking the

one or more sleeper s and has a little more

infant directly into defense, may start a way

freedom of movement.

of bei ng. Of ten , it seem s as th ou gh a baby's

The child was exposed to light and sound

first cries are really angry or fearful. The con

in the womb, but these were muffled. At

nective tissue r espon se to that first emotion

  birth, sensory input is increased in intensity.

can last through life.

Probably it becomes a traumatic factor only if it is sudden and/or h ighly intrusive. A fetus is subjected to more sound than we suspect. When the uterine wall is fully extended, it is

*See Frederick LeBoyer, Birth Without Violence (New York: Knopf, 1975). fSee Michel Odent, Birth Reborn (New York: Pantheon, 1984).

SEVEN

Developmental Transitions in the Newborn and Young Child Development is not complete at birth. Birth

is largely cartila ge, wit h small disks of b on e

marks a transition toward a greater and ulti

(Fig. 7-1). Because the hip cartilage is mal

mately more refined use of movement. The

leable, how a child habitually lies in the cr ib

connective tissue is the system by which we

has great effect on this lower structure. If he

mediate movement, yet structurally, the least

or sh e lies on the back or front, the legs tend

complete system is the connective tissue.

to be splayed out because of limited pelvic

Increased demand for movement furthers

ossification as well as lack of soft tissue tone

maturation of the connective tissue. As we

to pull the legs together.

use a part, it becomes more capable, mor e

At birth, the most developed pelvic mus

skilled. In turn, as we become more skilled ,

culature is in the back. The gluteus maximus

we explore a wider range of movement.

muscle is very well developed. The erector

Feedback systems can oper ate to increase

spinae (long muscles of th e back) are strong,

the range of movement, or the circuit can get

while th e belly wall is less so. Those muscles

shunted and go into a downward spiral. Feed

that tend to pull the leg towar d the middle

  back systems are characteristic of all living

(adductors) are even less stron g. Swadd ling,

organisms.

the practice of binding a newborn closely

There is very little information available about muscle, connective tissue, and organ

in cloth, wraps the leg s so that they are held close together. It may be that isometric move ments of the infant within this wrapping stimulate balance in the hip joint.

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 ossifi cations in the pelvis and legs when compared to the shoulders and ribs.

Developmental rates and patterns set up the stresses; learning to use the body rein forces the process. The majority of children, when they start to stand up in th eir cribs, pull themselves up with their arms and shoulders. They are using their stronger parts to hoist themselves up on the cartilaginous, rubbery legs and pelvis. Observe a small ch ild wh o has just discover ed h ow to stand. The child spends the day going up and down, pulling up with his arms, getting rubbery on his leg s,

development late in th e fetal cycle. After th e

falling down, coming up, getting rubbery,

f i rs t 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 the growth of

an ce possibilities in his pelvis. If th e hi p join t

external form. The sequence in which the

has re ach ed the stag e where the tissues are

head develops ahead of the tail and the back

mature enough to sustain this exerc ise , all is

ahead of the belly is maintained, as far as we

well. But ch ildren (and parents) ar e often too

can tell, after birth.

eager. Overuse or use of a joint before it is

In the newborn, the bones of the head and

adequately developed can physically change

chest are relatively well d eveloped. The pelvis

th e shap e of th e joi nt itself (Fig. 7-2). Or the

24

THE

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course, movement cannot "flow through" to the bones. Range of movement is restricted. Maturity in a joint is the exploration of the

Cartilage

full range of possibilities while still r etain ing Synovial membrane Cleft -

stable movement.

Joint cavity Joint capsule

Perichondrium -

Mesenchyme

  Joints become mature with use. This

Articular cartilage

process accelerates after birth with kicking,

Periosteum

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

Immature

Mature

start with walking. I f the child doesn't c rawl   before it walks, it is likely to have motor

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

uncoordination for life. The child may also have a brain incoordination, manifesting as disabilities in thinkin g, reading, seeing, an d learning. In crawling , an infant works with the connection of the fascial sheets between the

misuse may be less drastic—simply a habitual way of moving. We define a myofascial structure as imma ture when it is insufficiently developed to meet the demand for movement. Any joint can be im matur e either structurally or in its patte rn of use. The heel is an excel lent exa m ple of this. Wi th ou t a well-deve loped heel, the foot would be more like a long extension of th e leg. A mature heel acts as a fulcrum through which the foot and leg relate to each

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 and tissue elements are presen t, but th e soft tissue hasn't been shaped by use. When the child starts to walk, it usually stands on the

•Tibia

  balls of the feet. It h as to because th e heel can't reach the floor; the muscles connecting

Talus

up the leg are not yet exten ded and the two •Calcaneous

heel bon es are still wedged up into the ankle   joint between the tibia and fibula. Eventually, the bones are worked free and the mature

Mature

heel rests firmly on th e gr oun d. Adequate flexibility at the joints is the anatom ical definition of maturity. Wher e there is immaturity in a joint, it is ch iefly a quality of the soft tissue portion of th e joint. When 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.

DE VE LO PM EN TA L

TR AN SI TI ON S

IN

outside of th e kn ee and the hip and 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

NE WB OR N

AND

YO UNG

CHILD

25

stability in position is harder to keep. An eld erly person with a sev ere scoliosis is

the flexures of th e fetal position. It is neces

at the other end of the spectrum of malleabil

sary f or the child actively to use this position

ity of cartilaginous tissue. There are mineral

  before going on to the elongations of the

deposits in the disk s between the vertebrae,

  body required in walking. Crawling seems

which then become more or less rigid. Disks

to establish the lower back (lumbar) cur ve.

cons ist of fibro cartila ge, whi ch is den se an d

It reinfor ces a simultan eous pattern of right

fibrous. Functionally it is similar to bone;

angles at both the h ip and the knee. Crawling

histologically it is an intermediate stage be

develops th e use of the pelvis, br inging it

tween cartilage and bone tissue. Fibrocartilage

toward the level of maturity of the shoulder s

itself comprises a spectrum of density—it can

and belly. A crawlin g child practices synchro

  be rigid like bone or rubbery like cartilage.

nizing the arm s an d legs, as well as right and

The difference between one kind of connec

left sides.

tive tissue and another is in the amount and

At birth, the pelvis and legs are prim ar ily

organization of the fibers and in the density

cartilage. Proportionately, the arms have more

of the intercellular matr ix. Wit hi n limits, any

  bone, there is a f air amount of bone in the

of these tissues may move in the direction of

ribs, and the upper vertebrae have more bone

increased rigidity or at an other tim e, reve rse

than the ones down toward the lumbar

to the direction of gr eater fluidity . Th is can

region and the sacrum. The full replacement

happen at any age.

of cartilage by bone in the skeleton is not complete until the age of twenty to twenty-

Reversibility of tissue density is an instance of the embryol ogical nature of conn ectiv e

five. When there is still cartilage in the ver

tissue in the adult. Impacted areas, such as

tebral column, it may be easier to change its

  between the shoulde r blades or across the top

conformation because of its greater mallea

of the pelvis, can feel like tendons. Like ten

  bility. At the same time, it may be that any

dons or ligaments, they are the functional response to need. We all have ways of shoring

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

A

B

ourselve s up agai nst th e stresses of wei ght an d constriction. We create short "ropes" and

C

D

26

THE

END LES S

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folds across a joint or wide cross bands to

structure of the newborn into a competent,

stabilize an unbalanced shoulder or hip.

independent child.

The problems begin when we attempt to

There are also less obvious demands—

work against rather than with gravity as w e

subtle expectations that start very young. We

move. When a ch ild f irst starts to walk, sh e

expect differen t things from a baby girl than

gets up and aims toward a table or some oth er

from a baby boy, for example. Some of th is

support. She sort of falls forward, and her legs

may even start befor e birth; in so many cases,

move un der her to keep her upright. If she

the c hild is talked about as "he. " Infants an d

leans back at all, she sits. She soon learns to

children are natural performers and they get a

prefer falling on her bottom to falling forward

great deal of re in forcement to act, to mimic.

on her face. The result is that she starts to

("Isn't that cute; just like his f ath er.") Another

  balance on the back of her le gs. If this pattern

way of saying th e same thin g is that children

persists in the adult, ther e will be trouble.

are natural seekers of attention and approval.

When a child is held with his arms up, he

A woman who had a lot of injuries to one leg

  brings his legs forward to walk (Fig 7-5). As

said, "My m other used to tell me that when I

his leg s move out in fron t, he fee ls that he is

was about three years old I f ollowed my father

falling backward and starts compensating: the

around in the garden and imitated his limp."

lower back comes forward, the shoulders go

Perhaps not sur pr isingly, this was the same

  back, and the head comes forward to balance.

leg sh e repeatedly injur ed.

A further complication is that bulky diapers

As a baby learns to use its body, it has

force the legs apart. It is interesting to see

many option s. As it grows older, this wide-

how many adults walk with this kind of con

open r an ge of possibilities narrows in favor

figuration—head forward and legs splayed.

of greater precision of mo ve me nt . Premature

After birth, t he activities of brea thin g,

use, inappropriate imitation, or a too-early

turning over, sitting up, grabbing things,

demand for precision can skew the joint out

looking for things, crawling, and walking are

of tr ue, creating r estriction, 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 movement in the

connective tissue. It is a heavier condensation

body, th at mak es a structural who le of us, is

of f ibers at the surface of muscle. Myofascia

the mesodermal tissue—the connective tissue.

also exists as layers between muscles, relating

These hard and soft tissues tog ether make up

the more superficial surface muscles to th ose

what Id a Rolf called the "organ of structure."

deeper in the body as well as connecting

Connective tissue varies in terms of the phy si

adjacent muscles into groups. We consider

cal nature of its intercellular matrix an d in

fascia to be a continuous system, extending

the number and density of its fibers. In

throu ghou t the body between the deepest

descriptive terms, th is means that some is

  bone level (periosteum-tendon-ligament)

harder or softer, some is more elastic or more

(Fig. 8-1) and the layer just under the skin

rigid. Connective tissue is continuous

(the superficial fascia) . It is a layerin g of sheet s

throughout the body from toe to head. Bone,

of f ibrous tissue that f lows through the body,

for example, is a concentration of hard inter

eddying around bony protuberances that

cellular matrix within a connective tissue bed.

compress and redirect its flow . It is the pack

Histologically, therefore, bone is continuous

ing material of th e body; it makes up our

with the total bed of connective tissue.

contours and holds us in place.

Myofascia, too, is a specialized type of

Muscle lies within fascial sheaths. In addi tion, fascial fibers interpenetrate the muscle, wrapping around smaller muscle fiber groups (Fig. 8-2). M u s c l e f i b e r s 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, th e fibrous Tendon^

Fasciar-

Brachialis-

Intramuscular  -•connective tissue fibers

Epimysium

Tendorw

Perimysium'

Endomysium.

1

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.

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

28

TH E

EN DL ES S

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Coracoclavicular ligament & Subclavius m.

fascial sheath then transmits the movement to the periosteum of the bone with which it is continuous. In adults as well as in the embryo and neonate, where the myofascial covering

Coracoid process

has become toughened (as it does through habitual tension or holding), it condenses

Coracobrachialis m.

.Pectoralis minor m.

to encase th e muscle in such a way that there is less capacity to leng th en and to move. As we have said, the myofascial bed of the adult, as well as of th e embr yo , r espo nds to

Biceps m. (short head)

habitual tension with a localized increase of fibroblasts and increased secretion of fiber in the dir ection of pull. This creates a tough envelope that encases the muscle, reducing its capacity to leng th en or move freely. The focus of Rolfing is this toughened myofascia, and it can be felt to regain its natural elasticity as Rolfing proceeds. We therefore have r eason to   believe that this toughening of the myofascial sheath is reversible. Fascial sheaths get "snagged" on bony hooks. An example is the coracoid process, a bo ny proje cti on on th e inside of the shou lder   blade just above the arm pit. Fascia extends as a continuous sheet from the hand, arm, and chest all the way up to the nec k and head. The coracoid process reaches into that fascial c o n t i n u u m , m o d i f y i n g i ts fl o w (Fig. 8-3). Similarly, the tailbone ( coccyx) acts lik e a hook, interrupting the continuity of fascial tissue from the outside into the inside of the pelvis. Hooks are one way that bone an d myofascia interact to red irect, stabilize, or magnify movement potential. These are therefore areas or structur es that with im proper use may become foci of inhibition of movement. Hooks are frequ ently points of att ach men t for myofascial structures. For example, the

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).

coracoid process is the point of attachment of muscles from th e arms to the shoulder. On the other hand, the tailbone is only min imall y a poi nt of at ta chm ent for the muscles from the leg to the trunk. Yet the tailbon e's

MYOFASCIAL

STRUCTURES

29

effect on leg movement becomes apparent if it has been displaced in any way—moved to the right or the left, too deep or too close to the surface—then there is interference with the easy swing of the leg. Injuries to the coc cyx are common in childhood, and easily ignored. They are difficult to treat—it is impossible to put a cast on a tailbone. Bone projects into the connective tissue   bed with broad surfaces as w ell as with hooks. The upper r im of the hip bones, the ed ge of the lower ribs, and the shin bones are exam ples. These, too, serv e as areas of attachment for myofascial units. I n gen eral, these broader surfaces are connected with more superficial

Figure 8-4 Dowager's hump.

soft tissue organization. Smaller points of attachment usually serve to redirect deeperlying tissue. There is a functional reasonableness to the

arm moves, that movement should continue wavelike through the neck and into the head.

combination of myofascial sheets and bony

Yet there is frequently a blocking of the move

points of referen ce. The growing bon e sets up

me nt. For exa mpl e, at the jun cti on of the

stresses (d irectional pulls) in the con nective

neck with the chest vertebrae, there is often

tissue in utero. When these are from a single

a chronic holding pattern that in later life in

point (for example, the way the hamstrings

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

attach to the ischial tuberosities), the r esult

Since th e spine is the focus of so man y

tends to be a grouping of rope-like structures.

movement difficulties, we will go into some

When the pulls are fr om a broad area (for

detail about its structure as an example of

example, the transverse muscles covering

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

the abdomen), the result is more like a broad

spinal column's 186 joints are involved in

sheet.

every movement of the body. This is espe

"Point of attachment" designates the sup

cially well demonstrated in breathing, which

posed endpoint of movement for a muscle or

is not generally thought of as a "movement."

group of muscles. It is important to remember

There are three or four articulations between

that fascia con tin ues past this poin t of refer

each vertebra. In the ch est region , ther e are

ence. Points of attachment change the quality

three articu lations of eac h of the twelve tho 

of movement. They change the strength of

racic vertebrae with its associated r ib. There

the g estur e and absorb some of the energ y of

are functional articulations between the cen

a movement before transmitting it to the rest

tral bodies of the v ertebrae as they relate to

of th e body.

the disks between them (these are not usually

Ideally, movement from a gesture travels

considered true joints, but they do function

through the arm or leg or head toward the

as joints). Holding patterns can and do occur

spine. Movement transmits as a wave down

be twe en an y on e or ( usually) mo re of the se

the spine as well as acr oss the spine and into

articulations, restricting movement through

the other side of the body. Thus, when the

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

30

THE

EN DL ES S

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We include bone, f ascia, an d muscle in our d e f i n i t i o n o f a s p i n a l c o l u m n (Fig. 8-6). I n d i  Costal facet of  transverse

Inferior costal

process

articular facet

vidual vertebrae must both separate vertically and rotate with every body movement. The spinal column as a whole integrates rotation with lengthening and shortening to allow for

Superior costal

diagonal movements. These types of move

articular facet

ments are combined to give the spring-like action of the spine that is c haracteristic of virtually all movement in a truly mobile spine. In dissection, a spiral pattern is visible in the connective tissue around the spine. Movement between individual vertebrae is propagated through this spirally arranged connective tissue into th e spin e as a whole. The spinal column is constantly moving Figure 8-5 In the thorax, the articulations of the ribs with the vertebrae add another level of complexity to spinal mechanics.

in response to breathing, heartbeat, blood circulation, cranial rhythm, etc. For example, when we inhale, there is a tendency for the column to lengthen; spinal curves decrease in angle. When we exhale, the body settles back into its n ormal curves (Fig. 8-7). N e i t h e r t h e spine nor the co nnective tissue that wraps th e vertebrae an d their associated muscles is ever

Anterior  longitudinal ligament

„ Interspinous ligament

1

"at rest." As movement becomes more active, con nective tissue wraps more tightly around the

Intervertebral, disc

-Ligamentum flavum

Vertebral body (centrum)

spine. The pattern of connective tissue then goes f rom 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).

MYOFA SCIAL

STRU CTUR ES

31

to a spiraling, narrower wrapping around the

protein solutions is their response to changes

vertebr ae and muscl es. The acti on of th e mu s

in tem per ature—th ey will be fluid (sol) in

cle fibers is rachet- like, unidirectional, and

warmer temperatures, thick (gel) in colder

modular (all or nothing). The action of con

temperatures. This type of solution is called

nective tissue is based on elastic recoil, which

a colloid; gelatin, for example, is a colloid.

is less rigidly patterne d. Recoil can be partial,

W he n an area of the body is no t stimulate d

it is multidirectional, and it is pr opag ated in

  by movement, the underlying chronic muscu

waves. As the connec tiv e tissue wraps m ore

lar tension (holding pattern) cuts off capillary

closely to the spine, its elastic recoil proper

circulation to the area. Blood circulation

ties become an increasingly larger proportion

normally provides heat as well as nutrients

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

and waste removal. As capillary circulation

  behind the movement, the greater the in

decreases, the colloid matrix changes state

volvement of the connective tissue. Gesture

from sol to gel, and its consistency becomes

then becomes both faster and more integrated

more glue-like, trapping connective tissue

(smoother).

fibers into a non-moving matted mass. As

The contraction of muscle fiber impels the

we h av e described, fibers proliferate wherever

connective tissue to wrap itself mor e closely

there is tissue stress. The resulting mass of

around muscle and vertebrae, paradoxically

thickened matrix and increased fiber mass

causing the spine to elong ate. As the muscle

can be palpated as an unmoving, painful

fiber relaxes, the con nective tissue recoils,

thickening.

maintaining and spreading movement

This kind of buildup can be reversed by the

through the spine an d out into the body.

intervention of manipulative or movement

It is this wavelike propagation of movement

techniques. The immediate effect is to modify

through the bod y as a whole that supports

the physical nature of the matr ix. Th e ensu

continuity of movement and creates move

ing greater fluidity of matrix gives rise to a

ment that is smooth rather than jerky.

changed movement pattern and eventually

The elastic recoil of the connective tissue

to a chan ge in fiber density and direction.

arises from the ar rangement of f ibers within

Manipulation appears to be a faster method

the connective tissue matrix. Collagen fibers

of cha nge ; intelligen t exercise and /or stretch

themselves are not e lastic, but they are coiled

ing also has the desired e ffect. In either case,

and their in terweaving allows for elastic dis

an improved positioning with respect to the

placement and return. When these fibers are

gravity line is essen tial to a c hange in fiber

densely matted or not aligned in the direction

density.

of movemen t, their elastic potential is dis

The connective tissue matrix is an impor

persed. This is th e case wher e there is thicken

tant factor in tissue resilience. Where the

ing and bunching of connective tissue. This

matrix is the primary factor in a holding pat

can be palpated and is sensed as restriction

tern, it can be palpated as a glassy mass. Th is

and/or pain.

is one of the most troublesome types of tissue

The physical state of the matrix also plays

restriction. It is g enerally close to the bon e

a role in the ability of the connective tissue

and is usually difficult to inf luen ce toward

to respond to movement. Connective tissue

renewed movement. Some common examples

fibers do not exist in a vacuum . They are

are areas under the shoulder blad e or kn ots

embedded in a matrix that itself is high ly

  just along the spinal vertebrae (at th e spin ous

organized. This intercellular matrix is a pro

processes). T hese are places that are often very

tein solut ion. O ne of the chi ef prope rties of

sore as well as tight. Other sor e places, closer

32

THE

EN DL ESS

WE B

to the body surface, tend to be where large

connective tissue serves this function. Mus-

muscle mass es cross each other or attach to

cles, in this model, provide the source and

 bone

(Fig.

direction of movement energy. Muscles exe-

8-8).

We describe the concept of joints in more detail later (see Section 22), but it s hould be

cute movement. In th e classically ta ught picture of the

mentioned now that between each of the

  body, bones are th e supporting structures.

ma ny articulati ons of the spinal col um n (as

However, bones do not touch . It is thus

well as in any join t of the body ) there is f luid

impossible for them to support the body the

that is similar in composition to the intercel-

way a table is supported by its legs. Support

lular matrix. As bones articulate, they are not

in a moving structure is very different from

in direct contact with each other. They have

support in a static structure, such as a h ouse.

fluid between them. Bones "float" in relation-

Support in a moving structure arises from the

ship to each other. As the connective tissue

organ izatio n and arr ang emen t of the conne c-

compresses around the spinal column, the

tive tis sues. Wh en we speak of a movement

fluid capsules become longer and thinner,

  being supported, we are describing the action

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 t i ss u e g r o u p s. T h e

The spinal column is lengthened by a combi-

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 t i s-

nat ion of the narrow er coilin g of the con ne c-

sue support both muscle and bon e by their

tive tissue an d th e pressure of th e compr ess ed

elastic capability.

fluid between bones.

As in the spine, all joints should lengthen

This is a new picture of physical structure.

with movement as the connective tissue

Here the connective tissue is the supportive

wraps and supports the joint caps ule. For

aspect of the structure. Bones are spacers,

this to happen, the connective tissue must be

serving to position and relate different

resilient. This resilience is felt as ease; in phys-

areas of th e co nn ec ti ve tis sue. Bone s are no t

iological terms, it is des cribed as tone. An

the supporting structures of the body; the

increase in connective tiss ue resilience is one of the goals of wa rmup before exercise. The concept of physical support of movement is simplified if we think in terms of the

E

Levator  'scapulae m.

connective tissue bed rather than 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 shoul der (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.

MYOFASCIA L

STRUC TURE S

33

muscle movement. Physical action alters the

resilient, either generally or locally, holding

shape of the connective tissue bed through-

patterns become habitual. There is a concomi-

out the structure, creating greater change

tant loss of range of movement and of energy.

where movement originates and rippling into

Many physical therapies address this loss of

more attenuated change farther away from

ability. The Rolfing intervention is the one we

the origin of movement. Bones are spacers,

know best. By working to enhance the resili-

like the members of a geodesic dome. A sim-

ence of the connective tissue bed, Rolfing

plified model is a ten t, where the ten t pole is

reeducates the body toward an improved

held upright by the balanced tension between

relationship to the gravity line.

ropes on both sides.

Both Rolfing and mass age might be c lassi-

We tend to have an eas ier time envisioning

fied as direct intervention techniques. Shi-

support from below from a base such as the

atsu, acupu nctu re, an d reflexolog y act by

earth or a chair. Support in a living, moving

releasing energy through the connective tis-

  body comes from above as well as from below.

sue. Other therapies work through retraining

The head and the finge rtips a re as much a

movement, either passively (Trager method)

part of the support structure as are the toes.

or actively, or by a c ombin ation of active a nd

Adequate length in the neck and adequate

passive (Rolfing Movement work, Alexander

lift in the head are essential to th e movement

work, Feldenkrais Functional Integration).

integrity of the body as a whole.

Exercise that is properly done also tones and

When the connective tissue bed is not

lengthens connective tissue. Some forms of exercise, such as yoga, t'ai chi, and 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 con nective 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-

min g, are by design activators of con nec tiv e tissue ton e. Poorly done exercise and exercising wh en exhaust ed, however, have an opp osite effect on connective tissue, caus ing it to harden and contract.

NINE

Movement and Gravity W h en an y part of the body move s, the entire

the joints of the bones going from heel

  body respond s. We alway s move from a base

to toes, there is also widening between the

o f s u p p o r t . I d e a l l y , w h e n w e s i t, m o v e m e n t

  bones of the foot that are side by side. This

is initiated from th e part of the pelvis that is

cushioning of movement acts both to protect

resting on the chair. When moving forward,

the structure an d to provide spring for the

the pelvis r ocks for ward, th e pubic bone drops

next step. The spring action comes from

slightly toward the sitting surf ac e, and the

the lengthening provided as the connective

tai lbo ne is elev ated off tha t surface (Fig 9-1).

tissue wraps and extends the joints. The leg

The movem ent is like a spring. It starts at the

  becomes longer with movement. This is the

pelvis and is quickly transmitted through the

result of lean ing f orward from th e base of

  body up to the head an d d own to the feet.

support, allowin g the leg to come f orward

This falling-forward motion takes only sec onds; it is the first part of any forward move

  by len gthening at all of its joints. The hip joint len gthens as well as widens

ment. As forward motion starts, the pelvis

with movement. Connective tissue wraps the

widens, however slightly. There is an increase

interface between the head of the leg bone

in the space across the sacroiliac junction

(femur) and the hip socket (acetabulum), so

and a widening at the pubic bone (pubic

that the head of the fe mur drops slig htly out

symphysis). As a result, the hip bones (gene

of th e socket and downward. This f rees the

rally considered relatively immovable) also

pelvis for two of the three movements charac

widen.

teristic of walk ing : rock ing forwar d and back

In walking, we push off fro m the grou nd

and from side to side. (The thir d movement is

using the joints in the foot (Fig. 9-2). T h i s

swiveling, which results from the freedom of

initiates movement in the first split-second;

movement between sacrum and ilium).

movement is then transmitted to the ankle.

A base of support is an unmoving surface

Above the ankle, the shin bone comes for

or structure from which movement is initi

ward while the heel bone slides backward,

ated. Ideally, all parts of the body are free to

thereby increasing the horizontal space in the

respond to movement. But this is seldom

foot as well as the vertical space between foot

fully realized. More often , in walking we con

and ankle. Once again, this is movement by

tract some part rather than fully lengthening.

lengthening. As the shin bone comes forward,

The leg may be pulled up against the hip

the remainder of the body is propelled for

j o i n t ; t h e h i p m a y b e i m m o b i l i z e d a n d u s ed

ward. Ideally, the resulting movement is

as an internal base of support. As the leg is

literally a falling for war d of the whole body

pulled up, th e hip joint is compressed, short

—unless some part of the body is held back.

ened. The pattern of compression is trans

In walking, and particularly in running,

mitted through the body. The most extreme

there is a great impact on th e foot. The spaces

exaggeration of this kind of walkin g is the

bet wee n the bone s of the foot widen and

goose step.

lengthen as the foot comes in contact with

  Jogging an d running are a matter of lean

the ground; they narrow and arch as the foot

ing farther forward than when walking; you

lifts up. No t only is there lin ear extension in

adjust your speed in walking or running by

MO VE ME NT

how far you lean forward. This is th e hardest

AND

GRAVITY

35

Many people have a tendency to carry their

thing for us to do; we tend to resist letting

heads as tho ug h the y were indep end ent struc

everythin g go forward. We bring the shoul

tures. A more workable image is to consider

ders bac k, the ass back, and/or hang on to our

the skull as a great big vertebra sitting on top

spine in some way, in order to have a feeling

of the spine. T his allows us to visualize how

of control. A common exaggeration of this is

the head can move "in line" with the rest of

holding the body tensely upright as we walk

the spine. When the movement of the spine

or run, with the result that the legs are in

is like a spring, the head is its last segment.

front of th e torso. The body is then literally

Movement reverberates through the spine

leaning backward.

and is released thr oug h mo ve me nt of the

In moving with length, as movement is

head. Holding anywhere in the structure

initiated, the joints open (lengthen) spon

reflects most strongly at the e nds of the

taneously and sequentially. First the ankle

  body—between the ankle and heel and

opens. As it reaches the proper limit, the knee

  between the head and neck. Holding can

  joint open s, and so on. Insofar as the joints

also originate at the top end. Almost uni

are free to open, the movement of walking

versally, when we think of something or

ripples all the way through the body to the

conc ent rat e in an y way, we hol d our heads

head.

rigidly. This holding travels down through the spine and in to the leg s, resulting in an audibly heavier tread. When thinking (which is most of the time ), we com e down heavily on our heels. In day-to-day living, we don't think about movement in anatomical terms. A more accessible concept has to do with controlled/ allowed movement. Holding the head rigidly on the neck is control. This kind of rigidity is almost always a response to unconscious fear:

Figure 9-1 Rising

we are afraid our head will fall off, we are afraid that we will be so jarred that our head will be seriously disturbed, we' re almost afraid our brains will get rattled. When we want to focus on som eth ing , most of us aut omat ical ly feel as though we have to hold still. We are afraid we will lose the image. This happens when we are visualizing internally (looking at the pictures in side our head) as well as when we are seeing externally. It is a misuse of our abilities, yet it is very common. Th e othe r end of this con ti nu um is allowed movement. We can be confident that as we walk our brains will not be r attled . We can

Figure 9-2 Walking.

  be sure that we can see the world in moving pictures. We all are able to see and un derstand

36

THE

END LES S

WE B

movies even though they show a new frame

the leg and control rotation between the

twenty-four times a second. We don't have

two bones as the foot moves. The density

to hold each frame still in order to see it. We

and ar rangement of the fiber s as well as the

don't need to control every aspect of our

physical nat ure of the intercellular matrix

movement; we need to let ourselves move

must be differen t, to give the necessary dif 

and absorb and let g o.

ference in compressor ability (resistance to

The idea that structure determines function is an old one . Id a Rolf gave exp an de d me an 

compression). We exist in gravity—we have weight and

ing to the reverse concept—that function

we rest on the surface of the Earth. In general,

determines structure. Using the connective

a body's only good choice with respect to

tissue model, we can elaborate how parts of

gravity is verticality. The concept is, however,

the body that are analogous structurally (arms

merely a useful abstraction. Because the bod y

and legs) are fun ctionally differ ent. The differ

is constantly moving, there is rarely static

ence lies in the way the limbs attach to the

verticality.

trunk, reflec tin g a difference in need and use.

Bodies also don't move str aig ht for war d.

In the leg, attachments are primarily for lin

Every gesture is on a diagonal, and these diag

ear track ing. Ther e is the need for the leg to

onals are balanced. It is this balance among

go f orward and back and for the joints of the

cross-movements that creates functional ver

leg to move without excess rotation. In the

ticality in the movin g bod y. For example, in

arm and should er, the primary need is f or

walking, one leg and hip come forward to

rotation as well as for mobility in all the

gether with the opposite shoulder and arm

  joints. This is a very different kind of

while the other leg and hip with the opposite

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 t i s su e

always this kind of reciprocal movement tak

in th e legs th erefore need s to be different

ing place ar o und th e central axis of the body.

from that of th e arm. In the leg, it is struc

Turning the body is initiated from the base

tured for stability; in the arm, it is more elas

of suppor t which , in walking, is mediated

tic for flexibility. T he shoulder blade and

through the feet. There must therefore be

collarbone ideally float freely in the connec

enough elasticity of action at the ankle joint

tive tissue, while the hip bone an d leg are

and between the foot bones to allow not only

more closely knit. In many movements, the

for bending at the joint but also for rotation

arm acts in response to the rest of the body

so as to move quickly and smoothly from

while the legs initiate movement. The t'ai

one side to the other.

chi concept is that the ar ms flow like ribbons

With some caution, we use the ambiguous

after movement has been initiated in the

word "core" for the body's central axis. I t is

legs and pelvis.

another useful abstr action ; ther e is no struc

We believe th at there is a d ifference in the

tural correlate for this c ore. The balanced

composition of the connective tissue in the

diagonals of the limbs function best in com

legs and the ar ms, par ticular ly in structures

  bination with the f ree spring action of the

like the interosseou s me mb ra ne s of the fore

core. We have d iscussed the sprin g action of

arm an d lower leg. In the arm, the interos

the spine. The concept of a core includes both

seous membrane needs to be elastic so that

spine (with head, sacrum, and coccyx) and

the bones can rotate with the multidirectional

the viscera. Th ere is reason to believe that the

use of th e han d. In the lower leg , the inter

connective tissue of th e organs is also a part

osseous membrane must be denser to support

of movement. This can be demonstrated in

MO VE ME NT

AND

GRA VIT Y

37

dissection and is visible in behavior. The viscera themselves, th en, also have a spring action that helps to organize movement in the bod y as a whole. The literal cen tr al axis of the body travels through the viscera, not through the 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, asthma—all deflect the body from verticality as much as or more than a muscle spasm or a rotated vertebra. Func tionally, then, the viscera are included in the core structure and ar e a determinant of verticality. Even when the primary movement is straight forward , such as walking across an unimpeded floor, the joints of support in the   body still need to be free to rotate slightly. The clearest example of this (and the large st rotation in walking in a straigh t line) is in the connection between the sacrum (the base of th e spine) an d th e two bon es of th e hip . T he sacrum rem ain s relatively stable as the two hip bones rock with each mov em en t of the leg. The movement is alm ost like a figure eight, absorbing and accommodating the swivel action as one leg and then the next

Figure 9-3 Central axis of the body.

reaches the floor. (Think of Marilyn Monroe on her way across the floor. This is an exag

  becomes functionally lighter. The muscles of

geration, but it is graphic.)

the back of the ne ck and the shoulders ca n

When we are stand ing more or less still, if we are in ali gn men t, our wei ght is com fo rt

then start to relax. The concept of gravity is particularly

able and we need less effort to keep ourselves

appropriate to a moving body. The body

upright. In standing still, th e conce pt of

in motion is still aligned—the head is in line

weight is a good way of analyzing structure.

with the shoulders, the sh ould ers are in line

The classic example has to do with the posi

with the abdomen, the abdomen is in line

tion of the h ead . If the head is too far forward

with the pelvis, the pelvis is in line with the

—that is, if the ch in or forehead is leading the

knees—no matter how far or in what direc

rest of the bod y—then it is not supported by

tion the body leans. The exception is the one

the n eck. It is cantilevered. Since the head

leg th at is forward to preven t the body from

weighs somewhere between ten and fifteen

falling. When the leaning body is in align

pounds, we must then use the lar ge muscles

ment, this forward foot is direc tly under the

in the back of the shoulders and neck literally

h e a d (Fig. 9-4). The support for the head is

to hold onto our heads. As soon as the head

the forward foot. Gravity then acts through

is moved back in to a position where it is

the body in the whole space that it occupies,

centered on and supported by the neck, it

a broad base between the two fe et.

38

THE

EN DL ES S

WE B

pla cem ent of the organs is asymm etrical . Further, it seems possible that differences in   brain function engender asymmetrical move ment preferences resulting in structural asym metry. These nor mal difference s are slight and, ideally, it is possible to visualize hori zontal lines through the body. There is a furth er measure of proper align ment. This is the relationship of the d eep to the more superficial structures, the balance   between surface tissue an d tissue that is close to the bone. Th is is visible in the surface Figure 9-4 Walking.

contour. Where there is excessive knotting or f labbin ess, there is this kin d of surf ac e-todeep tissue imbalance.

In looking at the connective tissue arrange

When inner and outer structures are in

ment in dissections of human bodies, we

  balance, the tissue has what we call proper

noted that there was seldom a linear (vertical

tone, much the way a violin string that is

or horizontal) arrangement of connective

in per fect tension has perfect pitch . All the

tissue fibers on the surface or deep within

words we use to descr ibe tissue ton e ar e sub

the body. The fibers tended to run diagonally

  jective—they have to do with personal experi

across the body. F or in stan ce, we saw a heavy

ence rather than objective standards. Yet good

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 s id e

tone is something we all recog nize. It is a

of the chest acro ss to the opposite side of

springiness to the touch and suppleness in

the abdomen and down to the opposite hip.

movement.

Fascial crisscrosses seen in d issection seem to

Vertical in tegrity and good ton e are our

relate to the normal rotations in a moving

measures of a properly aligned body. What

  body. When crisscrosses have heavy concen

gets in the way of this ideal structure? For Ida

trations of fat and gristle, th is is the excessive

Rolf, the balance of the pelvis w as paramount.

response of a body that is not in alignment.

She felt that every session in Rolfing has as its

Many of these padded oblique angles can be

ultimate goal the creation of better balance in

seen on the surf ac e of the body. They ar e usu

the pelvis. This h as to do with the relations of

ally fold s, frequently folds that people refer to

the hip bone (ilium), the sacrum, and the

as fat that they can't get rid of. But they are

lower back (lumbar) vertebrae. These relations

actually heavier bands of connective tissue,

are not simple. Trouble—pain, awkwardness,

usually a response to abnormal rotation of

stiffness, heaviness—is a prod uct of misalign 

the body in movement. In an aligned body,

ment (rotation) of any one of these elements

oblique fascial structures are not random.

with r espec t to another. In th e pelvic reg ion,

They are necessary for normal movement.

the hip bone can be rotated in its relation to

The obliques on the front of the body are

the sacrum or the leg bone. The sacrum can

in balance with those on the back.

  be rotated with respect to th e lumbar spine

Seen from the front, a well-aligned person

or the tailbone or the hip bone. There may be

should approach symmetry, but we are never

further rotations between individual lumbar

entirely symmetrical. For one thing, the

vertebrae.

MO VE ME NT

When we speak of the rotation of bones

AND

GRAVITY

front or back, scoliosis is a sid eways S-shaped

with respect to each other , we are talking

  bend in th e spine, which should be more or

about the " ho m e" position of the bo ne . This

less straight in this view.

is the position that the bone returns to when

39

Scoliosis and lordosis are clinical terms

it is at rest. I n movement terms, the restric

that identify spinal exaggerations. In using

tion would be noticeable as a loss of range of

the terms, we speak as though the imbalance

m o v e m e n t . A ll 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 mostly confined to the spine.

  bones are maintained by the soft tissue—mus

But a scoliosis is manifestly an imbalance of

cle, ligament, connective tissue. The discom

the bod y as a whole. Arms, legs, head, pelvis,

fort we feel arises from our awareness of soft

and rib cage are all part of the aberration. We

tissue tension rather than bone imbalance.

can't even say th at the spine is wh at is hold

Rotation is a combination of tilting and

ing the body in th e scoliotic posture. Our

swiveling of body parts, creating imbalances

experience as Rolfers is that when we release

in th e vertical and horizontal plan es. Here we

the tissue of arms or legs or rib cage, the spine

encounter an interesting difficulty in translat

starts to unwind . Co nversely, the spine will

ing from the visual to the verbal. Seen in pro

not unwind until external structures are given

file, excessive pelvic tilt throws off the vertical

greater range of movement. So we prefer to

line. Se en from the front (or the back), a pel

speak of curvatures of the body as a whole

vic tilt th rows off the horizontal line across

rather than curvatures of the spine.

the body. Images are two-dimensional; the

There are other factors involved in id eal

body is three-dimensional . The combi nat ion

structural vertical and horizontal alignment.

of vertical and h orizontal tilting in the body

For example, if a person with a fairly broad

is what we call rotation, a spiral twist.

pelvis stands with his feet too close together,

There is a welter of term in ology used to

he's obviously not g oing to be in easy bal

describe the var ious types of rotation of the

ance. He'll have to tig hten some part of his

pelvis/sacrum/lumbar spine area. They are

bod y to keep him self upr ight —gr abb ing with

precise as diagnostic tools, but unfortunately

the toes, locking his knees, tightening the

they tend to confuse the situation for most

  buttocks, and/or contracting the shoulders.

of us. Diagn osis atte mpt s to ide ntif y th e mo st prominent aspect of a problem. We and our

If his feet are slightly farther apart, th ey can   balance the broad pelvis. The two leg s are

doctors say, "I have a lordosis (scoliosis,

functionally a unit, a base for everything

kyphosis)." But these ter ms tend to lock the

above them. Adequate width and depth of

  body into a static picture. What we n otice so

the body, as well as fr ee range of motion,

often is that rotations are not static, they don' t

are all a part of evaluation of str ucture.

stay put. For example, th e dancer with too

The human body is obviously an enclosed

concave a lumbar curve in standing will often

system. We exist within the circumference of

show an exaggerated convex curve in sitting.

our skin and f asc ia. The head is the opposite

What are these technical terms, and how

end of a ten sio n line f rom the feet. Proper

do they relate to our con ce pt of bo dy align

length and extension within that circumfer

ment? Seen fr om the side, lordosis is an exag

ence allows for adequate tone throughout.

geration of th e normal curves of the spine.

This leads us back to the c ircular concept

(There seems to be no medical terminology

that we h av e talked about in r eference to

for a back that is too flat, even though this

othe r aspects of bala nce. Cause and effect

can create a lot of mischief.) Seen from the

in the body become interrelated.

TEN

Body Contour When we look at the contour of the whole   body , we can see it as a map of the unde rlying

A photograph of a body shows shadows and highlights that can be seen as hills an d

structures as they affect the connective tissue

v a l l e y s (Fig. 10-1). There are areas wh ere the

  bed. Muscles expand and contract in response

tissue bulges and areas where it appears to be

to demand. Habits lay down pads, sometimes

held deep. Highligh ts (hills) correspond to

containing fatty accumulations. The position

thickened pads of tissue between skin and

of bon es within musc le and con nec tiv e tissue

  bone (and/or muscle). These pads are of ten

controls the direction of movement. Volition,

made up of fatty tissue in association with

habit, and self-image shape the connective

fibrous con nective tissue. T he shadows (val

tissue, which in turn supports and restricts

leys) appear to be areas where skin alm ost

the activity of muscle, bone, and other func

sticks to bone (and /or muscle). What is creat

tions such as circulation, breathing, and

ing these adhesions seems to be a c ompacted

digestion. The result is a person's shape.

  bed of collagen fibers mixed with intercellular

The contour of the body is based on con nective tissue. As it interacts with bones and

matrix in its gel state. Both of these modifiers of con tour ref le ct

muscles, these soft tissues are the primary

the way the body is used. Heavy fat and con

determinant of body shape. This is in contrast

nective tissue pads are visible in areas that

t o t h e u s u a l a r ti s t ' s c o n c e p t i o n o f m u s c l e

have been under tension for a lifetime. Two

anatomy as determining the outline of the

pads that are present in almost all bodies are a

  body . Body shape is the refore affected by the

very heavy thickening at the base of the skull

holding patterns that we have described.

and a heavy pad at the base of the spine, over 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

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 expecta tions of how these bodies will move.

are overused in th ese two areas. The large,   broad muscle at the base of the skull (trapez ius) is in constant partial contraction to sup port a for war d h ead . Th e upper margin of the gluteus maximus habitually contracts to hold

BODY

CO NTO UR

41

the pelvis r igid. Chronic tension has r esulted in a heavy pad on the body surface. Indentations are likewise visible in areas that have been under tension for a lifetime. The bone appears to be right at the ind ented surface, just under the skin . Actually , the   bone lies under several layers of toughened connective tissue. The skin sticks to the leath ery (or glassy) connective tissue. On the other hand, where the connective tissue layer over   bone is in good tone, the skin can move freely over bone and tissue. We never actually touch   bone in palpating the body. There is always a connective tissue layer of greater or lesser complexity beneath the skin. Contour is idiosyncratic even at birth. In a detailed dissection on two stillborn infants, there was a consider able differ ence in muscle devel opme nt. In one, th e muscu latur e of the   body was relatively und eveloped, while in the other the pattern was well defined and 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 tis sue containing fat. Note the similar padding across the shoulders and up into the neck. down to the tiniest muscle. However, the pat terns of connective tissue padding in the two

.Trapezius m.

  babies were in many way s similar (Fig. 10-3). In both, there was a heavy pad of fibrous con nective tissue acr oss the upper poster io r bor

Erector  spinae m. Fat& -.connective tissue pad

der of the lar ge h ip bones, crossing over and tying the hip bones to the sacrum. There were also pads of fatty connective tissue between th e legs (b etw een the regio n of th e an us and the genitals). These pads were thick, some

.Gluteus maximus m.

what like a diaper beneath the skin. The pres ence of this padding at birth would indicate th at it is a no rm al part of bo dy conto ur. It is onl y wh en it is overdev eloped and thick ene d that it becomes a problem. We tend to think that heavy muscle is good

Figure 10-2 Fat and connective tissue pads.

and that the more a muscle is developed, the better off we are. Overd evelop ed muscle s look

42

THE

EN DL ES S

WE B

impressive, but they tend to reduce free range

and therefore cannot move straight forward

of movement. 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 combined with stretching and body

and short eni ng at the joints . For bal ance , a

awareness (e.g. yoga), it is sometimes possible

heavy muscle needs another equally heavy

to maintain adequate freedom of movement

muscle to offset its contractiveness. Where

in the joints along with development of the

there has been more persistent effort at mus

muscle mass.

cle building on on e side of the joint than th e other, the joint torques (twists).

10-4). W h e r e b o d y b u i l d 

A reasonable amou nt of bodybuilding is a good thing, creating tone and strength.

A bodybuilder who conscientiously works

Too much of a g ood thing in this case causes

on all of the muscles can ach ieve a balance of

restriction and exacerbates preexisting habit

tightness around individual joints. This bal

ual distortions. Excessive d emand on a body

ance is based on partial contraction; it will be

part always brings out whatever compensa

functional as long as the program of exercise

tions or restriction s alr eady exist in the part.

is maintained. But when such a person walks,

This is true for pumping iron, working out

he or she en ds up wit h a ki nd of wad dle. T he

on machines, running or jogging, or ballet.

leg is not able to le ng th en out of th e joi nt

Unless there is mod ification of the exercise to accommodate individual idiosyncrasies, there will even tually be problems. In addition , chal lenging workouts are generally associated

Proportionately small head

with exercising past the poin t of efficiency.

Short neck

This is where most of the mischief occurs. It is virtually impossible not to create chronic Arms pulled into shoulders

and/or acute injury when repeatedly exercis ing in an e xh austed state. Our ad vice is to let pleasure be your guide. How many people

Shortened torso

have you seen smiling while running? Arms go wide

The concepts of contour and posture over lap and blend into each other . Both ar e the result of habitual holding pattern s. Postur e is apparent in the static photograph as overall   body balance or imbalance. From the front,

Legs pulled into pelvis

we see imbalance when one shoulder is

Legs go

higher than the other, one arm longer than

wide

the other, one side of the hip canted upwar d, one knee tending more in or o ut. From the side, we have alread y mentioned the dev ia tions f rom vertical such as the head forwar d, shoulders up or round ed, chest depressed, pelvis tipped forward or tucked back. One of the great determinants 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.

in the body is the psoas musc le. Its connec tive tissue ramific ation s are especially impor tant. The psoas myofascia is interwoven with the fascia of the muscles on the inside of the

BODY

CO NTO UR

43

pelvis as well as with the diaphragm fascia.

pelvic brim, chronically flexes the body at

In the groin area, just to the side of the pubic

the level of th e groin, so that it prevents truly

bo ne , the direct ion of th e psoas c han ges . This

erect posture."*

allows it to act as a kind of pulley. The psoas

The prefer ences of the psoas are not obvi

tendon attaches to th e femur at the top of the

ous at birth. They start to show when the legs

inner thigh and is thus commonly bound up

adjust to bearing weight, as the child crawls

with th e fascia of the lon ger musc les goi ng

and starts to stand up. Nevertheless, muscular

down the leg.

imbalances do exist in the neonate. As we

When the psoas is habitually contracted,

have said, children are born with more devel

all kin ds of postural and functional difficul

oped m uscle in back than in front. At about a

ties can arise. The psoas can be too short, too

year old, in order to walk, the child has some

wide, too narrow, too flaccid. Mor eover, even

how to solve the problem inherent in this

though centrally located in the body, it is

muscular and connective tissue imbalance.

a bilate ral muscle. The two sides are rarely

One fairly common solution is to overuse the

symmetrical in tone, placement, and size. A

psoas, pulling the lumbar vertebrae forward.

physically asymmetrical psoas then leads to

This is the or igin of the typical big- bellied

lumbar rotations an d pelvic tilts (Fig. 10-5).

  baby look.

According to Ida Rolf, the psoas is one of

Immature body patterns frequently persist

the m ost significant muscles of th e body. It maintains body structure and body relation ships (Fig.

10-6A and 6B). The psoas origi

*Ida P. Rolf, Rolftng: The Integration of Human S tructures (New York: Harper & Row, 1977), p. 110.

nates along the upper lum bar spine; for part Lateral pelvic tilt

of its length it runs along the fr ont surface of the lumbar vertebrae. Its origin is in close proximity to the two tabs of the diaphragm called the crura; through these neighbors, the psoas can involve the respiratory patter n. It diagonally traverses the cavity of the pelvis, and inserts by a ten don shared with the iliacus (the iliopsoas tendon) into the lesser tro cha nt er of the f emur . T he iliacus lines th e

Psoas ' longer lax

ilium, the lar ge bone of the pelvic basin. Structurally, the psoas is a bridge between

Psoas shortened;, pulls pelvis up

upper bod y and legs. "If a body is nor mal, the psoas should elongate during flexion and fall back toward the spine. This pr evertebral support ensures length in the lumbar spine as a whole, irre spective of general body positi on. Wi th the psoas functioning in this normal pattern, lengthening with every movement of flexion, the lumbar vertebrae cannot slip into the compression and misalignment that is the   beginning of the bad lower back. A deterio rated psoas, glued down as it crosses the

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 the phy sical structure is able to evolve. On the other hand, physical culture experts attempt to modify structural patterns by   building up muscle mass. A familiar example are all those exercises designed to "tighten the tummy." It is our contention that it is not effective to sh orten the belly muscles to match the tight back muscles. We believe that no am oun t of sit-ups will improve a structure whose key is a compulsively tilted pe lvis. Moreover, no physical pr oblem exists in iso lation, so we cannot ameliorate structure by focusing on one symptom. For example, there are two ty pical holding patterns reinforcin g a   belly th at sticks out. One is a depression of the r ib arch ( costal arch). The other is an immobility at the groin (inguinal) region. These start to dev elop in the small c hild. T hey too are exacerbated as th e child starts to walk. Bo th of the se patte r ns wou ld be reinfo rced rather than corrected with improper sit- ups. Another example of a common 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 is focused at th e base of the neck (seventh cervical vertebra). At its extreme, th e head is pushed ver y far forward. Th e shoulder blad es are so h igh th at it almost looks as though they are push ing th e head forward , cantilev-

into adulthood. They intensify to pervade the

ering it out over the chest. A variation of this

  body and th e personality of the adult. Start

pattern is often seen in older women and

ing with the work of Wilhelm Reich,* there

men. The "dowager's hump" is the result of

has been the tendency to classify characteris

creating an excessive pad at th e base of the

tic body postures in clinical ter ms. Reich clas

neck.

sifications were hysteric, psychotic, schizoid.

Like the f olds of a curtain, when the head

The basis for th ese types is considered to be

is forward, everything in the body appears to

  body armoring, which is what we call holding

hang from the base of the neck. There is no

pattern s. Psychologi cal tre atm ent of chara cter

way th is posture can be corrected by simply

armoring is designed to release these patterns.

"holding your head up." It is too hard to hold

We prefer not to classify physical habits in

your head up; you will stop the effort as soon

psychological terms. Our assumption is that

as your attention is deflected from bettering your posture. T o get the neck straight, you

*See Wiilhelm Reich, Character Analysis (New York: Noonday Press, 1990), p. 72.

must exert con stan t effor t to pull again st depressed ribs and collarbone. You must push

BODY

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45

against hunched or rounded shoulder blades. Even assum ing yo u could do all that , th er e are furth er holding patterns all the way d own to the feet. Rolfers h av e been talkin g about the way people use their structures inefficien tly, squandering their energies and working against themselves. How can an efficient body   be described? Rolfers like to talk in terms of vertical and horizontal planes. They evaluate the body in terms of the logic of mechanics and draw lines through the body in the mind's eye. The total body tissue—bone, muscle, and especially connective tissue— acts together to create the structure that gives these imaginary lines. These lines are more apparent in a body that is still, but body workers learn to evaluate the underly ing structure of a moving body. The goal, th en, is not so much to achieve perfect vertical and horizontal structure lines in a body. Rather it is to free the soft tissues so that the body can move freely by balancing through planes that are horizontal and verti cal. Our goal is to have joints move as th oug 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 nor mal tone of the rectus abdominis. One very com mon 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

thos e early fears. In Wil liam Ja me s' famou s

we do in life, and yet it is taken for granted

dictum, "I don't run because I am afraid;

that we k now h ow to use our bodies. It's

I am afraid because I run."

assumed that we need to learn how to use

Movement patterns express personality

our brains, but presumably using our bodies

patterns as well as vice versa. Fear man ifests

is doing what comes naturally. No one gives

as a gener al characteristic in all aspects of

us information on how to create balance or

the individual's identity—in body, emotion,

change physical problems.

energy, mind . Th e true nature of f ear (lack

W h e n a chi ld starts to walk, it is no long er

of trust) is that it is a signal to pay attention.

an object to be car ried around (however lov 

Yet we h abitually misinterpret it as a signal to

ingly). It is becoming independent in the

fight or flight. Even in the case of a body part

world, taking charge of its own life. Just the

that hurts when it is m oved, fear is more

fact that the baby is up on two legs in stead of

appropriately a sig nal for caution . It should

down on all f our s seems miracle enough. I t

not cause us automatically to tighten that

would be gilding the lily to try to instill form,

area. Th e more we tighten it, the more it will

even though this would be the best time to

hurt. This "natural" reaction has an outcome

show a child how to use its legs.

that is the rever se of our intention. The f ear

Imagine, for a moment, a baby's first steps.

of being unsteady pr ecipitates all sorts of

There is unsteadiness in the feet and legs,

unconscious modifications—locked neck,

accompanied by attempts at balancing with

grabbed toes, sucked- in ass, held shoulders,

the arms. When the baby was crawling on all

clenched jaws. These are all in response

fours, security lay in keeping th e back steady

to our fear of being unable to control our

and pus hin g off with the han ds and knees.

movement or ar e done to avoid ridicule or

When there is unsteadiness in walking, the

embarrassment.

  baby again attempts to control with arms

Integrated movement centers around the

and knees and by h olding the spine rigid .

concept of leaning forward so that gravity

W h e n adult s ho ld a chi ld to help it walk,

rather than effort initiates action. For many

they generally hold under the armpits or by

people, the suggestion to lean or fall forward ,

the hands. This again reinforces the pattern

instead of creating a relaxation response,

of cont roll ed shoulders to stabilize walking.

starts a process of tightenin g in the body.

This persists as the hold ing pattern of the

The result is a grabbing point (or several).

adult

(Fig.

11-1).

Most holding patterns are related to emo

This holding is unnecessary. The whole body can be in a fluid state at all times. The reason

tio nal f ear, lack of trust. Rea son abl e cau tio n

someone doesn't allow himself to "fall" for

and attempts at control by the infant as it

ward into movement is that he doesn't trust

learns to walk can be retained as movement

his structure.

patterns in the adult. The adult is not afraid

Often this lack of trust starts with a rational

of losi ng ba la nc e an d falling , but as th e adult

fear. When we ar e small and learning to walk

walks, he/she unconsciously restimulates

too early, we can't len gthen the joints to the

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point where leaning forward is comfortable.

Ideally, any physical sensation can be

The child finds some way to pull its balance

experienced through the body the way a

  back. Later, in the adult, the same kind of

shiver goes f rom the feet all the way to the

reaction persists. This is particularly evident

crown of th e head. Holding the bre ath is a

in sports. In skiin g, f or example, it is essential

way of stopping that physical flow. Perhaps

to lean f orward. There is more control in the

we d o this because we don't want to experi

tips of the skis, more lift in turning, and less

ence the sensation or the emotion (emotions

chance of falling down on steep or bumpy

are physically experienced). When we are in a

slopes. Th ere is also more mobility because of

state of fear or caution, we usually try to stop

a greater control in the knees. Most beginning

things so we can think about them, explain

or intermed iate skiers, however, do not lean

them, get ourselves comfortable. This too is

forward. When they fall, they generally fall

when we stop our breath; we have d ifficulty

  backward. They sit dow n. Th is is the reaction

maintaining our rhythm of breathing and

we taught ourselves in childhood . Th e after-

thinking at the same time.

the-fact explanation is that we are af raid to

As we h ave said, response patterns th at are

fall forward because we're af raid we might hit

repetitive and unconscious tend to become

our heads. Not true. We're m uch more likely

chr oni c. In the case of the breat h, wha t we

to fall forward on to hands and knees.

see is a partial holding. Many people have a

We're not taught to walk as ch ildren, and

stored reservoir of air in the lower part of the

we're not taught to breathe. The most com

chest; the lower ribs move very little or not at

mon tendency of anyone frightened is to

all. As a result, there is a tendency to barrel or

hold his or her breath. An example is jump

round out in the lower ch est. A second area

ing into cold water. With th e initial shock

where there is little breath activity is in the

of th e cold, our tendency is to g asp, to draw

upper tip of the lungs. The ribs just under the

the breath into th e lungs and to hold it ther e.

collar bones an d h igh up inside the armpit are

The whole body tightens and is unable to

une xpl ore d terr itor y—m ost of us do not feel

adjust to the coldnes s of the water. Let ting

or move these topmost ribs. The tips of the

the breath out allows the body to relax; the

lungs extend up to this re gion, so we should

water no longer feels as cold. Similarly, when

  be able to move these ribs f reely with every

we experience physical pain, gasping and

  breath. Being restricted at the top and the

holding the breath are common, but they

  bottom of the rib cage, we rarely experience

only serve to r etain pain.

a full breath.

Figure 11-1

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One way to establish a full breath is to

Evaluating bod ies, we ten d to foc us on

concentrate on the exhale. As you come to

the physical things that have gone wrong—

th e en d of yo ur usual exh ale , allo w mo re air

illnesses, accidents, ways we got pushed out

to leave the lungs. T his does not mean push

of shape. This is a habit, a point of view, an

ing the air out with the abdomen, but rather

attitude that is shared by most people. In

allowing th e rib cage to relax, especially the

general, we ten d to take notice only when

topmost and lowest ribs. Put your h an ds on

we're hurt. I know about my ankle because

your lower ribs just abov e the abdome n. Feel

that little twinge remin ds me that I n eed to

the movement of these ribs as you breathe,

  be careful of it. I th ink about my shoulder

concentrating on the exhale. The exhale

  because it catches ever y time I move my arm

bec om es the active part of the brea thi ng

in a certain way.

cycle; the inhale occurs spontaneously. Holding the breath is a pattern most of us

Pain is one way the body communicates to us. We have other k inds of physical aware

use to ward off un wa nt ed feeling s. To som e

ness, but the y too are usually negative—we

extent, we are taught to hide emotion. For

have portions of our bodies that we d on't like.

example, exasperated parents sometimes do

This is a different kind of communication.

almost anything to stop their children from

One is a direct message in terms of pain or

crying. Th e crying may be reasona ble. For on e

sensation; the other is an emotional message,

thing, it is a very good way of lettin g all the

a judgment.

air out of the lungs, and it is also a way of

When something hurts, we first check to

letting a physical problem work through the

  be sure that nothing is injured or broken. If

  body. When a child has to stop its crying, it

there is no injury, we try to put the pain out

must tighten or cringe—tense up. Another

of mind. In a way, this is life supportive. If my

common message to children is to stop that

ankle hurts and that's all I think about, I'm

feeling, stop that activity, stop that n oise.

not going to get much done. But there is a

When a child must stop doing something,

problem. If I sh ut off sensation in my an kle

arrest its momentum, its only recourse is

so I d on't f eel pain, I shut out other sensa

to hold some part of its bod y—its breath or

tions from my ankle as well. Now I have a

  back or jaw. This is th e momen t (in a child

  body image that doesn't include my ankle,

or adult) when the emotion gets stored in

perhaps doesn't include my h ip, and so forth.

the connective tissue.

My sense of vitali ty is dim ini she d. The same

Usually we don't know that we're holding our breath, any more than we know when we make other habitual gestures. They're uncon

kind of process occurs with respect to emo tional pain. People hunch their shoulders or hold them

scious , a nd as Ju ng say s in h is Collected Works,

  back in response to being told n ot to slump.

"The unconscious is really unconscious."

This kind of holding pattern puts the body

These responses are so habitual that they're

into a position that is strained, that is not

part of our self-im age, part of wh at is. We

inherent in its original physical design. I t

don't learn them the same way we learn to

results in a similar kind of deadening of

read or to cook or to do algebra. We learn

awareness. People are rarely aware of the

  by copying our peers, our siblin gs, our elders.

strain in their posture. Over time, the strain

Patterns that we have absorbed unconsciously

  begins to tell. As we age, we feel all sorts of

are harder to change. They are more ingrained

aches and creaks.

in our characters than those that are absorbed knowingly, by conscious learning.

Then there is the chronic pain. Constant low-level back pain is common. This is often

EM OT IO NS

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49

the r esult of a pr ecept taught to the very

as a whole. It simply gets stuck at our weak

young that little boys (and girls) don't wiggle

link; this stoppa ge is the sen sat ion of pai n.

their rear en ds. Even when th e holding pat

The cause, the initial eve nt, is often unre

tern has orig inated in the child, th e awar eness

lated. F or example, if you break a leg or sprain

of r estriction and pain can start at any age.

an ankle, compensation sets in at the hip and

These restrictions arise from gen eral attitudes

  back to favor that leg. Any future pain or

in the culture. Th ere are also individual kinds

problem in the leg, unrelated to the original

of contr acti on and holding .

accident, reinforces the initial compensatory

(A personal note from one author: "Once,

habit. In time it is impossible to determine

for example, when I was walking up one of

which is cause and wh ich is effect. It is more

the steep stree ts in San Francisco, my knee

accurate to describe physical problems in

started to twinge. Soon the pain was so sever e

terms of areas of acute or less acute sensation.

that I felt I wouldn't be able to reach the next

Physical and emotional awareness are con

street corner. Nor could I find a convenient

nected. We feel emotions physically. Imagine,

place to sit down. And then I sudden ly real

for example, the characteristic shiver that is

ized that in the tension of the climb an d try 

fear. A variation of this is the d elighted thrill

ing to get where I was going in a hurry, I had

of terror in a horror movie or on a roller

  been holding my jaw clam ped . When I let my

coaster. It is probably true that the physical

  jaw relax, the knee pain went away and I was

manife station of emo tio n is a secondary phe

able to get up the hill." A movement connec

nomenon, a response to the actual emotion.

tion between jaw and knee seems obscure, but

And yet th is response, this expression of the

there it was. It is an example of the common

emotional impulse, is part and parcel of the

ph en om en on of how move men t at one end

e m o t i o n i t s el f . 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. T here is an initial germ of

though the rationale behind the connection

awareness. It is expressed intellectually, emo

is not clear at the moment.)

tionally, physically, or all th ree, and this then

The sensation of pain is a signal that some thing is going on that isn't right. The m ore we're unaware of our bodies, the more we

feeds back into the system to be enhanced, muted, redirected, etc. The physical response to emotion is

need a guide to let us k now how an d where

through the soft tissue. The f asc ia is the emo

things need to get back to true. Unfortunate

tional body. That's a metaphysical concept;

ly, we usually think of pain as the cause of the

we could c all it meta-anatomy. Ideally, feel

problem. Then the "logical" response is to try

ings are felt in the total body—emotions

to get rid of the pain. The area that hurts is

travel through the fascial web. We then in

not n ecessarily the cause of the pain; the

terpret the physiological sensation as anger,

  body as a whole is out of balance and one

affection, love, in terest, and so forth.

place is taking the brunt of the strain. Most

Proprioception is the ability to sense

of us have a weak link, a place that twin ges,

one's own physical being. Emotion and

aches, or contracts whenever we experience

energy also have a physical component that

stress. Almost any emotional or physical

we are including in this ter m. It is this phys

trauma will give rise to pain in this stress site,

ical proprioception that we inhibit when

even though th e trauma is not to that area.

emotion or energy or structural events are

We react as systems to any situation. A

incon veni ent. O ne such type of inhib ition

  blow, an emotional upset, whatever trouble

is transferring awareness from one modality

we get into reverberates through the organism

to another. For example, people who do not

50

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wish to recognize that they have an emo

are hunched af ter a bad fall. Both have be

tional pain frequently transform it into phys

come a part of the structure and part of the

ical pain, as in a tension headache.

physical ma keu p of the body. Conversely,

Our goal is to clarify that wh ich is physical

it is hard not to exper ience a mixture of

and to allow that which is emotional to be

depression and anxiety when a bad back

seen as such. It is always easier to deal with

or a chronic headache flares up.

a situation in its own modality. P hysical pain,

Physical and emotional sensations overlap

for example, is what you feel when you break

and influence each other. It is important to

your arm. It is n ot appropriate to try to deal

distinguish them in terms of a choice of ther

wit h a br ok en arm in ter ms of yo ur resent

apy. In the example of th e broken arm, there

ment at the person who pushed you.

is a ling ering fear (em otion) th at the arm is

On the other hand, the reason your neck

fragile. In physical fact, the healed break has

can't straighten and lengthen may be because

made the arm str onger; all that remains is

of the shock of being continually bullied in

to let go of the emotion and move the arm

childhood. Physical work will only partially

freely.

open that problem unless there is recognition that there may be an emotional origin. When

We have shown how a body functions and

we can see emotional situations clearly, we

some of the h istor y of it's growth. We have

are then in a position to move through and

"fleshed out" the concept of a connective tis

away from them.

sue body and giv en images an d descriptions

What makes the pain seem physical is that

of how this concept came into being and how

it does include a structural component. An

it works itself out in an actual physical body.

emotionally held part of the body becomes

In the next section, we use that in formed

rigid after being held tightly over years.

perception to look at and analyze body

Shoulders that are hunched from fear are

contour.

difficult to distinguish from shoulders that

PART

TH RE E

Body Retinaculae (Bands/Straps)

TWELVE

The Chest Band Implications for Movement and Behavior

In order to feel alive and comfortable, we

soft tissue structures. The contour patterns

need free flow, whether we call it a free flow

we discuss in this section are a series of seven

of energy or of movement. This freedom is

such band s. As we describe these individually,

visible physically in body contour: it is possi

we talk more about what they imply about

  ble to infer from someon e's shape the state

  both movement and behavior.

of h is or h er energy and ease of movemen t. The most obvious aspect of the bod y is

Straps represent a functional connecting structure through the body where there are

proportion. An example is the balance

no traditional anatomical connections from

  between the top and bottom halves of the

front to back. We describe the straps as being

  body . We often say that a man's head is too

  just under the skin because th at is w here we

small for his should ers, that a woman's hips

see them. As the body moves, they seem,

are too wide, that a kid's legs are too skinny.

however, to g o all th e way through as well

A sense of proportion is a matter of aesthetic

as around the surface. T hey may be visualized

  judgment; standards vary from one culture

as planes through the body.

to another. Aesthetic proportion is one way of inter

These straps on the surface of the body are similar in function to the armor of an arma

preting body contour. A silhouette outline

dillo. The seg men tat ion of the armo r hold s

shows th e hills and valleys of the body . The

each part r igid with respect to its neig hboring

hills refer to bulges and the valleys to tigh t

section while nevertheless permitting some

places where surface tissue appears stuck to

movement. Similarly, in the human body, the

underlying tissue. Theoretically, an ideal body

straps preserve external structure, preventing

has a more or less smooth contour. When

too deep an infolding as the body bends. To

muscles are not being used, they should be

some degree, this is probably an effective way

able to relax and thus create no marked

of shoring ourselves up. It is a pattern we see

  bulging. Muscles contract and thicken as

in all human beings.

they are used; as they relax, the ar ea flattens.

Straps seem to arise in much the same way

In an area that does not flatten, there are

as tendons and ligaments, which they appear

often accumulations of connective tissue and

to resemble in structure. T he telltale sign of

fat that have become cemented into place

the presence of a strap is a flattening or de

over the muscle tissue.

pression running horizontally through the

Besides ind ividual variations in contour,

bo dy surface. It ma y be cont inu ous or inter

there are also patterns that are m ore or less

rupted—like a dotted line. What defines these

common to all bodies. These patterns appear

as restrictive bands is th eir inflexibility; they

as straps—bands that we see running horizon

  break the flow of movement.

tally around the bod y, almost like retaining

The most obvious strap, evident in almost

  belts holding in the soft tissue (Figs. 12-1 &

everyone, is a horizontal depression in mid-

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 below the nipples. Seen from the

muscle anatomy of the body. They are unex

front, th is is locate d at the ju nc tio n of the

pected and unexplained, but they are visible

upper insertion of the rectus abd omi nis

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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 down ward 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 lumbo sacral junction. 3. The third band crosses the abdomen (belly/umbilical band) and is perhaps the most variable in location. It may cross at the umbili cus (sometimes creating a crease in the abdomi nal wall extending out on either side of the umbilicus), or it may lie midway between the umbilicus and the midcostal arch (tying together 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 tho racic and lumbar vertebrae. 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

along the lower border of the pectoralis major, across the mid-lateral chest, and down the lat eral 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 dor sal hinge of the spine. When this strap is pro nounced, there is not only a depressed midchest, but an inability to expand the ribs side ways in breathing. 5. The fifth strap at the shoulders (collar band) involves the clavicle and is part of the tis sue 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 cer vical and thoracic 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 cervi cal vertebra (atlas). 7. The top band (eye band) is the most diffi cult 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). Reprinted from

Rolf Lines,

The Journal of the

Rolf Institute, 1995, with permission.

NOTE: For the body retinaculae, we have used the terms "band" and "strap" interchangeably.

musc le and the lower insertion of the pect o

of the chest, hinging between the fifth and

r a l i s m a j o r m u s c l e (Fig. 12-3). T h e b a n d i s

sixth ( or sixth and seventh) thoracic verte

slightly higher as it moves around to the back

  brae. This d ivision of th e rib cage into two

  because the ribs characteristically are an gled

parts was apparent in our dissections. Th e

downward in front. The back extension of

angle of the r ibs changed visibly and re la

this strap seems to be the dor sal hinge, a

tively abr uptly; the quality of the tissue dif

functional division of the chest (thorax). The

fered as well.

dorsal hinge is visible as a change in move  ment pattern between upper and lower halves

In front, the strap starts about an inch above the low er tip of the ster num. T his also

TH E

A

Figure 12-2 Body Straps: (A) side view; (B) front view

CH ES T

BA ND

B

tissue over the sternum an d ribs, it is eas ier to see where the connective tissue has become glued to the bony surf ace.

defines the con ne cti on from on e side of the

55

The ban d at its deepest level involves

  body to the other. We tend to ignore this

the underlying ribs and the intercostal mus

right-to-left relationship across the sternum,

cles, restri cting full f ull ex pa n nss io n of this part pa rt of

yet it is an important one, reinforcing and

the rib cage in breathing. Sup erf icially, the

often cementing side-to-side variations in

muscles that are visibly inhibited in their

movement. Because there is little muscle

movement are the rectus abdominis and the

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pectoralis major. The rectus abdominis spans from the pubic bone to the middle ribs of th e chest. It crosses the lower margin of th e rib cage (costal arch) an d of ten adheres to it. In fact, there is a hea vy thickenin g on the underside of the rectus abdominis at the costal arch , giving the a ppearance that th e muscle extends only from the bottom part of the rib cage to the pubic bon e. By anatom ica l design, relaxation of the rectus abd om in is allows th thee fron t of th e rib rib cage to lift. The abdomen then lengthens from the pubic bone to the ribs. The rectus abdominis also p rovides vertical stability to coun ter bal anc e the action of the long muscles of the back. When it is held tightly, th ere is a shortening between the mid-chest and the pubic bone. The result is a folding in of the A

abdominal region and a depression at the lower ma rg in of the rib cage. This is true whether th e holding is caused by a postural holding (sit-ups or a sucked-in belly) or a structural holding (stuck connective tissue). Immediately contiguous with the upper attachment of the rectus abdominis is the lower margin of the pectoralis major muscle. This a tta ches at the middle ribs, near the ster num, traveling from there to the upper part of the arm bo ne (hume rus) . Wh at we have, then, at this superficial soft tissue level of the body, is a vertical pull from the mid-ribs downward and a diagonal pull from the mid ribs upward. The overlap of these two pulls is at the sternum and includes the lower and middle part of the rib cage. Ideally, each of

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.

these two muscles is sheath ed in its f lexible envelope of connective tissue, allowing it to shift as the body moves from side to side, walks, etc. The muscle tissue of the rectus abdominis and the pectoralis major is sepa rate, but their connective 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 r e f l ec ec t e d i n t o the other.

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57

The superficial muscle and connective tis sue pattern here may be imaged as a Y with a   broad double base. Movement is transmitted vertically and diagonally across the chest. Where there is habitual restriction, the effect on movement is progressive. Where connec tive tissue is originally on ly lightly h eld down, bodily activity then tends to drag the marg in inss of the two adjac ent muscl es closer together, causing the connective tissue to thicken. As th e strap continues around the side, going toward th e back, it crosses the upper margin of the latissimus dorsi, a broad muscle arising from all the spines of the vertebrae from about T6 to the sacrum. Above, it nar rows into a tendon th at runs along the lateral outside margin of the shoulder blade (scap ula). It ends in an attachment to the arm bon e (humerus) . The atta chm ent s of the pec toralis major a nd the latissimus dorsi on th e arm are adjacent. They counterbalance each other and dete rmin e the opennes s of the armpit. The Y form on the f ront of the body (rectus abdominis and pectoralis major mus cles) is thus balanc ed by a V form (latissimus dorsi muscle) on the back (Fig.

12-4).

The horizontal compression that we are calling a s trap crosses from mid-sternum around to the side, overlapping the space where the pectoralis major and the latissimus dorsi muscles approach each other. These muscles s hould be free to slip vertically with respect to each other, leaving the arm full range of movement. When they are caught up in a restriction, the armpit is compress ed. The strap here is very much like the bodice of a dress with an Empire waistline. Another image that comes to mind is the scaffolding of the bottom edge of a brassiere. The strap restricts lateral rib movement as well as

Figure 12-4 The "Y" of the front and the "V" of the back.

movement to raise the arms. From the lateral margin of the pectoralis

the ribs and the mus cle s of th e bac k, an d

major, the strap then crosses the lower tip of

ends approximately at the dorsal hinge. When

the sca pula. It continues across the back of

the strap is heavy and tight, it inhibits the

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m o v e m e n t o f t h e s c a p u l a . I d e a ll y , t h e s c a p u l a

stress at the dorsal hinge. Pudgy adolescent

is suspen ded an d can "float" freely over the

  boys also can be uptight about nipples and

ribs as the arm moves. For example, when

  breast tissue, and th ey hunch over for the

you reach the arm forward and up, the

same reason . An aberran t pattern takes hold

scapula drops. As the reach continues, the

in th e body where there is the desire to hold

scapula then floats upward. When there is a

down , contro l, hide. Con trol is really the

restriction by a band, neither the downward

most descriptive term here.

nor the upward movement of the scapula is possible without exertion and the recruitment of

extraneous

m u s c l e (Fig.

12-5).

As the strap runs from front to back, it

There are a lim ite d number of ways to effect control in the body. While emotional rationales underlying any given structure vary, the phy sical h olding falls into patterns.

crosses over a number of additional deeper

These patterns are what we see as straps. In

muscles as well as the superficial ones we

mid-chest, the strap may be caused by an

have described. The connective tissue asso

accident, by a desire to hide the breasts, by

ciated with all of these has directional pulls

a desire not to breath e, by the need not to

that modify the horizontal quality of the

look differ ent from everybody else, or by res

strap. This is particularly true at the sides.

piratory disease. All these d ifferent causes

There are pulls up into the arm pit, down

manifest in the body as a similar pattern.

towa rd the lower late ral mar gi n of th e rib

The chest str ap ties in with the familiar

cage, an d toward the pelvis. T he result is a

gesture of hold ing the arms to the side to

torquing that pulls the strap away from its

guard the armpits. Arm pits are sensitive and

main path around the chest.

the protective gesture is similar in all ind ivid

This, then, is the physical description of

uals. As the strap becomes tigh ter and more

the mid-chest strap—the nipple binder. We

firmly established, diff erent parts of the body

have covered its path in some anatomical

get drawn in. The pressur e of hiding the

detail to show the muscle and connective

armpits reinforces th e tightness of the strap

tissue pathways by which it influences the

and inhibits the late ral (side) expansion of

  body. This broad ef fect is probably a reason

the whole top of th e rib cage.

that breathing dysfunctions are so widespread

For example, in baby pictures at less than

and influence every aspect of the body.

a year old, one child's shoulders were very

How do straps come into being? The

narrow and high, obscuring the neck. The

reasons are generally multiple and cumula

arms were closely pulled in to the sid es of the

tive. First, restrictions tend to set in as we go

  body, protecting the armpits. As this child got

thr oug h the chall enges of growin g up. The y

to be about eight or nine, he went through

are like seeds in a pearl. Som etime we success

a period of being a "sulky c hild." This gave

fully incorporate them with minimal connec

impetus to the hunched-up physical pattern.

tive tissue disturbance. Other times we grow

As an adult, his chest seemed too narrow in

successive connective tissue layers to cushion

proportion to the rest of his body. The effe ct

and protect ourselves from the irritation. The

of bodywork was dramatic: h is chest got four

seed ma y be physical or emot ion al in origin.

coat sizes bigger. The bodywork didn't g ive

We have described several scenarios of physi

him the new chest; it merely allowed him

cal origin.

to use what was there.

As some girls first begin to develop breasts,

A more emotionally based way of express

they try to h ide them. They cave in at the

ing what we mean is that the blueprint of the

sternum and hunch their shoulders, creating

structural pattern starts in the baby , becomes

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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.

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established as the character type, and then

and the others follow. Decid ing which is first

is embedded as an attitude in the adult. It's

cause is difficult and usually not necessary .

not so much that the contractions start in

The body has certain places whe re it can most

any one place and then spread outward. The

easily control its own movement. These create

pattern as a whole is sketched in and then

characteristic patterns of inhibition regardless

  becomes reinforced and more pronounced

of cause.

with age and use. Judging from the two babies

The straps are not exactly th e same in all

that we d issected, th e pattern is laid d own in

individuals. Th ere is some variation in place

utero. As early as in the n ewborn, we have the

ment and sh ape. T he strap is the structure as

  beginnings of fibrous concentrations. Later,

a whole. Individual variations pull it down in

if aberrant tensions are maintained, these

one place, tighten it in another. The attach

  become like a broad tendon. The structure

me nt s of the strap, the differences in em pha 

sometimes looks like tendon in dissection;

sis, may be the difference between someone

it certainly feels lik e tendon under the sk in.

who is barrel-chested and someone who is

But in "normal" anatomy no tendons are

very narrow fron t-to-back and wide side-to-

described in that location.

side. We emphasize again that the str ap is

The restrictions inhibit our evolution to

not a structure per se. It is a local change

an "upright stance." Shoulders get raised as

in the balance between fiber and matrix

the chest sinks down and the head comes

organization within the total connective

forward. Or th e head may come forward first,

tissue bed.

THIRTEEN

The Inguinal Band and the Structure and Function of  the Vertebral Column in Relation to the Bands Another visually obvious strap is what might   be called the chastity belt or inguinal 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 bony protuberances of the hip bone (the ASIS or anterior superior spines of th e ilia). This con nection is like a half-moon shape, curving

Rectus abdominus m.

Costal arch/

downward from these protuberances. The rectus abdominis muscle inserts on the pubic

.Inguinal 'band

  bone so that the strap crosses the lower part of th is muscle. Th e strap broadens across the lower abdomen. In many people it includes

Inguinal ligament " 1

Pubic tbone

not only fascial fiber s but f at d eposits as well. These can extend deep into the pelvis, f illing the pelvic bow l. This kind of fat is a type of connective tis sue. Its cells have become engorged with an accumulation of fat droplets. There is very little intercellular matrix in th is kind of tissue. The fibers ar e crowded in between the c ells. Because of th is lack of intercellular matrix,

B

the f at tissue has becom e inflexible. It is therefore an effective inhibitor of energy and movement. The strap across the g roin is particularly apparent in people who perform constant repetitive exercises such as sit-ups and leg lifts. Gy mnasts, for example, tend to have an almost horizontal line across the groin, forming a sh elflike ridge in the lower abdo men. Th is can be felt as a tough margin halfway between the belly button and the pubic bone. The abdomen immediately above the r idge is noticeably more pliable, less rigid to the touch. One of our freque nt lam ents is, "No mat ter

A.S.I.S. Sacral pad'

, Inguinal band

i Inguinal ligament -.Pubic bone

how much I diet, I never seem to get rid of my belly; it still sticks out." Th e bulge, how ever, has nothing to do with a n eed to d iet.

Figure 13-1 Inguinal band: Front and side views.

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The inguinal strap continues around the sides of the hips. It seems to cross just below the upper edge of th e hip bone (crest of the ilium). T his creates a tension across the bone and pulls the connec tiv e tissue in to folds. These folds come into being much the way pulling on a corner of a sheet creates deep pleats in the fabric. Similarly, pulls across the   back of the upper pelvis and the sacrum give rise to ten don-like structures across the lower   back. T hese can feel literally like small ropes or cables und er the skin. In some individuals, it almost feels as though these r ope s have knots in them. They form a stressed connec tion across the upper margin of the sacrum and the lower lum bar vertebrae, tying left and righ t sides together. Most "lower back pain" appears to come from this region. These ropes tying together the three bones (sacrum and two ilia), inhibit sacroiliac movement. This immobility across Figure 13-2

Figure 13-3

the sacrum is the major contributor to lower   back syndrome. Children typically show a lot

It is th e body' s way of escaping th e restr ic

of movement across the sacrum. This move

tions resulting from tightness above (chest

ment often d isappears in later life, probably

strap) and tightness below (gr oin strap). Or

in th e teens. We all seem to want/need to

the tightness may bind at mid-belly; we talk

control pelvic movement.

about a strap there in Section 15. In general, there are two aberrant abdomi

The inguinal band blends into the fascial and/or fatty pad normally present on the

nal patterns, each with variations. One is the

sacrum. When this is too th ick, it adds to the

individual whose lower belly is h eld in; his

immobility of the area. The band thereby is

  back then becomes 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

design, it resembles a jockstrap or dancer's

person who tightens the area between the

  belt. The bottom part extends down between

lower m ar gin of the rib cage and the belly

the legs to the V -shaped bony base of the

  button. Here, the upper abdomen becomes

pelvis. Here it blends with the fat an d fibr ous

tight and the area below the belly button

tissue that is the n ormal filling of the 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 i s b e i n g

  between the legs (between the coccyx, pelvic

held, the other must of necessity stick out;

rami, and pubic bone). When the V of the

the tissue has to go someplace. Not only the

rami is compressed and too narr ow, particu

soft tissue but also breath needs space. P eople

larly in men , this tissue can feel like cement

  breathe predominantly in the upper or lower

and it often beco mes a filler through the

abdomen. In either case, the holding inter

whole basin of the pelvis. Thus straps are not

feres with the free flow of breath, energ y, and

only surface phenomena but traverse the

movement.

  body space.

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63

The front of this ban d is easy to see and feel an d is much the same in all people, although it varies in d egree of tension. In   back, in addition to the surface ropes that run parallel across the upper margin of th e pe lvis, there is often a deeper set of tensions near the top and side of the sacrum. This is assoc iated with the fascia of the gluteal muscles and runs f rom the sur face to de ep in the pelvis, down to the bone. Many men are too narrow at the base of th e pelvis, between the legs.

Fascia of  -erector spinae  jlumbo-dorsal fascia)

This results in an abdomen that is proportion ally too wide in front. T he hip bon e looks as though it wings out. This again adds to a wide abdominal contour. In men, the connection across the front of

.Sacroiliac  junction Fascia of  -•gluteus maximus m.

the groin se ems like a band trying to hold the lower abdomen together. In women, the same kind of narrowness is more common in back,

Jlio-tibial tract

across the sacrum. In both cases, the tension on th e outside of the pelvis produces a corr e sponding tension on the insid e. There is a complete set of muscles on the inside of the pelvis as well as on the outside. Th e connec tive tissue of the outside muscles (surface) relates the movement of the lower back region to the outside (lateral side) of the le g

(Fig.

13-4).

The connective tissue of the psoas extends from the inside lower back to the 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) of th e thigh at the lesser trochanter (Fig. 13-5). The two fascial planes (surface

of th e ilium wing out in front. Th e iliacus

and deep) balance each other. Tightness in

then tightens and is too short to function

one will be reflected in the other with ever y

with ease. The br im of the pelvis is pulled

movement of the leg or pelvis.

forward and down toward the pubic bone.

In walking, the most prominently involved

When the iliacus is very short, the insid e of

muscle structure fr om insid e the pelvis is th e

the leg is held too tightly into the hip socket.

iliopsoas an d its associated fascia. We will

The result of all this is a ten sion around the

discuss the psoas muscle in Section 19. The

pubic bon e. A band of strain ( inguinal strap)

iliacus, the other part of the iliopsoas com

across the lowest part of the abdomen

plex, lines the insid e of the bowl of the pelvis.

attempts to balance that internal shortness,

It diagonally cr osses the pubic bon e and

often resulting in a heavy fatty connective

attaches on the inn er part of the leg at the

tissue band on top of the pubic bone.

lesser trochanter. When the pelvis is bound tightly in back, the anterior superior spines

In men, both sexual function and feelings about castration are connected to this band.

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Restriction in the g roin and pubic region often serves to block or dampen sexual en joy ment. It's almost as though the penis is hung through the band, so that the tightness of the   band can block the orgasmic wave to the rest of the body. This limits sexual enj oy me nt to the penis. Another element in sexual blocking is men 's castration wor ries. These seem to be centered not around the scrotum, but at a more lateral region of the groin where, before   birth , the testes leave the protection of the   body . They descend betwee n the th in layers of the lower abdominal wall down into the 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). The inguinal canal is the target of a variety of prob lems , particularly in me n. In guinal hernias seem to be the result of excessive strain and postural holdin g on an area that is vulnerable and unprotected. We have found that lessening the tightness of the groin band 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 the severity of th e hern ia or elimi nates it. The g roin area is tight in most men, who often have a "don't touch" signal there such as ticklishness. For both men and women, the band often shows up in the breathing pattern; abdominal movement from the breath goes as far down as the band ing, not all the way down to the pubic bone. In women, the strap is more com monly focused deeper in the lower abdomen, shelving underneath the ovaries and func

inguinal canal (pathway of  spermatic cord)

Pathway of  -"testes' descent before birth

tionally separating the ovaries from the gen itals. This is a large factor in premen strual syndrom e and the reason PMS so often does

Inguinal ligament H (inferior junction of  internal and external abdominal obliques) i

not yield to medication. The banding tends to   be deep and shelflike, so that accommodation of the necessary changes in posture caused by pregnancy is inhibited. In pregnancy, the weight of the baby rests down into this shelf, causing it to become thicker and less resilient. After birth, the thickened band remains. The pelvic strap widen s in back, often ris

Figure 13-6 Inguinal band and descent of testes.

ing as high as the twelfth rib, whe re it mesh es with th e fascia of the muscles alon g the spin e.

THE

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AND

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65

As we have said, the band at mid-chest blends with the fascia of th e dorsal hinge in the

(1) Junction at

region of the sixth d orsal vertebr a. Clearly,

lambda/

therefore, the structural inhibition created by

sphenoid

the bands influences spinal integration and

(2) Occipital-cervical

m o v e m e n t . I n tu r n , r e st r i c t i o n o f m o v e m e n t -(3) Cervico-dorsal

at the junctions of the vertebral column increases the tightness of th e bands. Interf er ence in spinal function leads to characteristic changes in posture and physical behavior. We

(7) Dorsal hinge

therefore digress to describe some aspects of the structure and function of the vertebral column in relationship to the bands. The muscles and fascia that run longitudi nally from the neck to the sacrum are a com

(4 )Lumbo-dorsal

plex interweaving of lay ers. They stabilize the variety of movements of the different bony vertebrae that make up the spinal column. Although the ver tebrae are similar in shape,

.(5) Lumbo-sacral

they are different in details of design and size. These dif ferences imply differen ces in range

•(6)Sacro-coccygeal

and direction of mo ve me nt . In general, the   band s relate to jun ctions of the spinal col umn, places where the vertebrae change shape. These junctions are between the head

Figure 13-7 Junctions of the spine.

and neck (occipito-cervical), between the neck and chest (cervico-dorsal), between chest

On th e inside of th e body , just in front

and lower back (lumbo-dorsal), between lower

o f t h e s p i n e , l i e s t h e a u t o n o m i c n e r v o u s s ys 

  back and sacrum (lumbo-sacral), and between

tem (ANS). This runs longitudinally from the

the sacrum and tailbone (sacro-coccygeal).

  base of the spine up into the h ead . Along its

The dorsal hinge is Ida Rolf's addition to this

length there are a number of spinal plexi.

list

(Fig.

13-7).

The change in vertebral shape at the d or

These are interruptions in the flow of infomation along the system. They serve much the

sal hin ge is mor e subtle; the change in move

same function as a busy telephone exchange;

ment pattern is most visible in a living, mov

they are plac es where neural messages can g et

ing body. The reason for this apparently is

transmitted in diverse directions. Generally

that the change in function and morphology

speaking, the ANS nerv e plexi ar e locate d near

here entails the sof t tissue and outlying bones

the spinal junctions that we listed above. It is

as well as the vertebrae themselves. This is

interesting to note that these places of maxi

somewhat true everywhere along the spine,

m u m mov em en t of the spine are associated

of course, but it is m ore important in the

with centers of most complex ANS activity.

upper chest. The add itional stabilizing inf lu

W h e n there is ease of mo ve me nt at these

ence from the shoulder blade and its soft tis

jun cti ons there can be stim ulat ion of the

sue connections to these vertebrae modifies

nervous impulses that control metabolic

their

activity.

movement.

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As the embryo is enfolded in the womb, its back describes a C curve (Fig. 13-8). As we have said, this is not a smooth curve; it is a series of be nds in th e bac k. T h ese ben ds ar e located at wh at will become the spinal junc tures. The embryonic C curve opens after   birth as the child explores and learns to stretch and lengthen. Ultimately, there is a change in th e direction of some of th e angles, creating the sn ak e-like form of an adult upright spinal column. 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 Develop mental Movement Sequences* graphically *See Bonnie Bainbridge Cohen, Sensing, Feeling, and   Action: The Experiential Anatomy of Body-Mind Centering (Northampton, Massachusetts: Contact Editions, 1993).

C

D

THE

IN GU IN AL

BAND

AND

THE

VE RT EB RA L

CO LU MN

67

demonstrate how these flexures interact with movement. As she describes the sequence, in

- (1 ) Junction at

lambda /

the f irst days af ter birth the newborn extends

sphenoid

its head. Soon it r aises th e head, then pushes

(2) Occipital-cervical

off wit h its han ds. Full mo bi li ty in creases with homolateral movements—fishlike swing

-(3)

Cervico-dorsal

ing from side to side. Then con tralater al creeping and rocking prepare the body for crawling

(Fig.

13-9). (7) Dorsal hinge

These movements correspond to the activa tion of both the spinal flexures and th e asso ciated ANS plexi: (1) junction at the sphenoid (see Section 14 on the eye band, be low); (2)   junction between head and neck; (3) junction

(4 )Lumbo-dorsal

  between neck and chest; (4) junction between chest and lower back; (5) junction between lower back and sacrum; (6) jun cti on bet wee n (5)Lumbo-sacral

sacrum and coccyx; (7) junction at dorsal 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 ) S a c r o - c o c c y g e a l

when a par t of this sequence is omitted in chil dhoo d, there can be dysf uncti on, and that this dysfunction is correctable even in the adult as the missing movement pattern is

Figure 13-10 Spinal junctions.

practiced. There is often resistance to activat ing some or all of these spinal junctions. The

they compress the body at spinal junctions.

reasons relate to many lif e traumas. One of

Th e straps creat e a sys tem of trans verse rein

the m ost jolting can come ver y early in life.

forcing structures where we d on't wan t to (or

Dangling a newborn by its f eet at birth shocks

can't) trust the undulations of an upright

the safety of th e curve with almost a sn apping

spine. T heir tenden cy is to pull us forward

movement. The resulting position as the child

and down in front. Kin esthetically, this is

hangs head back and spine locked in a back

sensed as resistance to the feeling of openness

ward curve cause s an acute wr enching and

that comes with being upright. It isn't that

ripping of fragile fascial connections. This

the spine (and the body) contracts; it's that

is ver y similar in effect to a whiplash injury

it ref used to open up. Emotionally, we feel

in an auto accident.

that safety lies in the curled-in-on-oneself

Most people unconsciously try to retain

position. It's really a rem embered safety. True

some part of their f etal c ur ve. The body

adult stability and safety lie in bein g upright,

straps are a way of fostering this because

flexible, and resilient.

FOURTEEN

The Eye Band and Chin Band There are two straps that restrict movement of the head—a chin strap attached at the junc tion between the atlas and the occiput and another strap that seems to g o right across the eyes lik e a mask. Be cau se of th e ten sio n tha t these straps spread through the head, most of us aren't able to sense the balance of the cra nium as a whole. Habitual tension in th e sur  face tissue of the skull chang es the relations of the bones. The bones involved are not only the larger external bones of the cranial vault and jaw, but also a complex arrangement of delicate bones centering around the eyes and   back th rough th e skull at eye level. The strap like tension fr om the surface generalizes to these bones. The areas indirectly affected include the brain stem, the limbic system, and the pituitary and pineal glands.

Figure 14-1 Eye strap.

The eye strap lies roughly across the eyes and above the ears (Fig. 14-1). In the back, it is at abou t the mai n junc tio n of bon es of the skull. Starting at the front midline, this band crosses the musc les on the bridg e of th e nos e, the c ircular muscles ring ing the eye sockets, the upper muscles that let you wiggle your Frontal

ears, and the tem por alis m uscle an d its fascia attaching to the jaw.

Lacrimal

The eye sock et is composed 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 bone, which continues on as the majo r bo ne of the foreh ead. Medially,

Ethmoid

there are lacrimal and ethmoid bones, which also form the upper medial part of the nasal Maxillary

cavity. Th e lower part of th e orbit is a con ti n uation of the maxilla (upper jaw). Laterally there is the zygomatic bone, which continues as a bony arch toward the ear. Po ster iorly ( the

Mandible

  back of the orbit) there is the sphenoid bone, which also forms part of a shelf below th e   brain. These bon es are tied together by sutures that anatomists consider to be

Figure 14-2 Bones of the eye socket.

TH E

Anterior 

fontanelle Posterior 

EY E

BA ND

AND

CH I N

69

BA ND

tiny increments of movement, they neverthe less significantly affect facial expressiveness as well as th e free use of th e senses— sigh t, hea r

fontanelle

ing, smell, taste. Anterolateral fontanelle

Tension across th e orbit of the eye can result in a narrowin g of the entire facial regi on. Th e bo ne s of th e orbit are sque eze d

Posterolateral fontanelle

together. There is chronic tension in the eye socket and on the eyeball itself. Good vision relies on minute muscular adaptations for

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.

nea r an d far visi on. As we said, con ne ct iv e tissue is tightened—loses adaptability— when its associated bones are compressed. Prolonged immobility and compression in the socket distort the shape and adaptability of th e eyeball itself. This may account for a number of common visual problems. When, through habitual tensions, the eyes are fixed

Frontal

Ethmoid

in one attitude, the free range of em oti on al expression is also diminished.

-Sphenoid

This topmost band relates to the suture called lambda (at the posterior fontanelle). This is not as obviously a spinal flexure as are the vertebral flexures. In embryological terms,

'Temporal

it is the fusion of the apical (t opmo st) bo nes . In fact, embryologically this is the site of the first flexure of th e body (Fig. •Parietal Occipital

14-3).

We have talked about the sphenoid bone in relationship to the eye socket. The sphe no id can also be consi der ed the hub of th e   b o n y s k u l l w h e n s e e n f r o m a b o v e (Fig.

14-4).

It is shaped like a butterfly wh ose wings reach Figure 14-4 Notice the juncture between the sphenoid and occipital bones at the base of the skull. This inter face is the focus of most cranial manipulation.

to the surface of the head in the flat area just lateral to the eyes. Because of its location, the sphenoid can g et locked in place as a result of tensions from the surface. When the eye band tightens, the sphenoid can't move. Converse

immovable joints. William Sutherland,* the originator of cranial osteopathy, realized that slight inter 

ly, what happen s on the inside of the h ead is reflected on the surface. On the cover of The Protean Body b y D o n

osseous movements, which he termed the

J oh ns o n/ there is a drawing of the sph eno id

  breathing of the skull, are necessary for the

floating in th e air . Seen like this, in isolation

head to function. Although these are very

from the rest of the bo nes of th e cranium, it

*See William G. Sutherland, The Cranial Bowl (Meridian, Idaho: The Cranial Academy, 1948).

tSee Don John son, The Protean Body (New York: Harper & Row, 1977).

70

THE

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respond freely, the other en dpoint is also restricted, inhibited, or immobilized. The strap just under and including the chin (Fig. 14-5) is related to th e junc tur e of th e head with the first two vertebrae of the neck . This is the juncture of the occiput with th e atlas and axis. It is very much like the kind of chin strap advertised in the bac k pages of an old-time fashion magazine, designed to lift sagging or d ouble chins. It surrounds and   bind s down a floating bon e on th e front of the neck called the hyoid. This U-shaped   bone defines the angle between the chin and the throat. Th e hyo id anchor s ma ny of the so-called str ap muscles of the throat. It is the keystone of the bridge between breastbone (sternum) and the angle of the jaw. Like any other place of muscle attachment, the h yoid is a focus of tissue buildup when Figure 14-5 Chin and collar straps.

there is habitual tension. It is tugg ed d own ward when the strap muscles of the throat are o v e r l y t e n s e (Fig. 14-5). This is seen as a dou

is easily mistaken for the bony pelvis. This similarity is more th an visual. In fluid body

  ble chin. The band continues from the hyoid and

movement, sphenoid and pelvis move in

under the chin in an upwar d path across the

conc ert and reci proca lly If on e doesn 't mo ve,

angle of the jaw. It frequently forms a pad on

the other is inhibited in its movement, as has

the angle of th e jaw, just below th e ear. When

  been demonstrated in Sutherland's cranial

the band is particularly tight, an increasingly

osteopathic work. A further relationship

dense and deep pad of tissue virtually imm o

  between sphenoid and the bony pelvis lies

  bilizes the angle of the jaw. The jaw is both a

in the fact that they both house important

sliding and a hinged joint. When th e jaw is

endocrine glands. The pituitary gland lies in

strapped back, the sliding motion is limited

an indentation at the center of the sphenoid.

and may disappear. As we see it, this is a

The gonads develop within the protection of

major factor underlying temporo-mandibular

the bony pelvis.

  joint (TMJ) problems.

Cranial osteopaths have made the obser

The cont inua tion of the band thickens

vation that the sphenoid rocks. There is some

around the mastoid process behind and below

controversy about whether this movement is

the e ar and g oes on to restrict the junction

the result of an inhe ren t body rhy th m or a

  between the occiput, atlas, and axis. When

response to the rh yt hm of the breath ing. In

this happens, nodding becomes an effort and

either case, the movement is observable and

the head's gliding response to walkin g is

palpable. We have seen this rocking reflected

  bound down.

  between pelvis and sphenoid. When one of the end poi nts of this flow can no longer

Th e actual jun ct io n of th e skull with th e top two vertebrae is covered by a heavy fascial pad

I II I

1

YI

HA ND

AN D

C H I N

HA ND

71

about an inch thick. This is one example

this generalizes tension into the back of the

where a natural padding in the body can serve

ton gue . We don't thi nk of the tong ue being

as part of a surface band such as we are describ

tense, but it can be. Moreover, the condition

ing. Th e difficulty arises when the ten sion is

of the esoph agus and trach ea is unde r the

excessive and becomes a tight surface strap.

infl uenc e of these tensio ns. Voice students,

Extreme tension at the back of the head

for example, learn to release these tensions

pushes the skull bones too far for ward over

and control these tissues with minute

the neck bon es, giving the appearance of a

awareness.

very flat back of the head . As the band con tracts and distorts th e position of the hyoid ,

Figure 14-6 Upper body bands.

Visualization of the upper body bands on photographs is shown in Figure 14-6.

FIFTEEN

The Collar Band, Umbilical Band, and Groin Band Like the ch in strap, the next strap—the collar

ac rom ion just in front of the shou lder joint.

strap (Fig.

This is traditionally designated as a slightly

15-1)—is of great importance to

singers, whe th er opera or shower singers. It

movable joint, which can be a misleading

involves primarily th e base of the throat, the

concept. For example, in a wheel with ball

upper tip of the lungs, an d th e upper margin

  bearings, the ball bearings move only slightly.

of the shoulder s. When this strap is very

But if on e is stuck, the larger mo v em en t of

tight, its most strikin g feature is a tightness

the wheel stops or eccentrically grinds down

underneath the Adam's apple where the two

its components.

clavicles (collarbones) meet the sternum

The strap continues toward the back along

(breastbone). The most common result is

the inn er and outer margi n of the scapula. I t

compression around the base of the neck.

ends by spreading out over the area of th e

The collarbones are tightly glued down to

dowager's hump—from the upper medial tip

the upper ribs in fron t and tightly held to th e

of the scapula to the cervicothoracic junction.

upper margins of the shoulder blades (scapu

This strap at th e base of th e throa t, like the

lae) in the back. Deep hollows at the base of

other straps, can be compared to a piece of

the neck, just behind the collarbones, are

cloth in which par t of the weaving is very

evidence of tension when this strap has

tight an d part of it is very loose. The tightest

  become too tight.

area bind s the clavicle and the upper part of

In front, the strap seems to enclose the

the scapula. The looser extensions broaden its

whole length of the collarbone as well as the

influence out into the upper part of the arm,

two uppermost ribs. It in cludes a small muscle

pulling the arm in c lose r to the body and

called the subclavius. This connects the mid dle section of eac h colla rb one to the fir st and second ribs and continues as ligaments to the sternum and coracoid process, medially and

Fascia of _  scalene m

laterally, respectively. Th is small muscle is active in respiration when the collarbone moves in relation to the ribs. When th e fas

Hyoid bone Collar  strap

.Fascia of  strap m.

cial covering of the muscle is thickened, the

• Clavicle

subclavius is immobilized between the two  bones. The collar strap contin ues along the clav icle to the tip of the sh ould er blade ( ac ro mion). This projects like a bony shelf over

Coracoid process

Acromion Scapula

the topm ost part of the arm bon e (hume rus) . When ther e is a heavy pad on top of the acromion, any movement is inhibited   between clavicle and scapula and acts as a   brake on the lateral (sideways) movement of th e arm. T he clavicle ar ticulates with the

Figure 15-1 The collar strap.

•Sternum

74

THE

EN DL ES S

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rotating it slightly out of its socket. Other

horizontal direction and in the vertical cross-

fibers extend into the armpit, closing the

  bandings. When both pulls are unusually

armpit and compressing the upper ribs. These

strong, the whole area becomes a thickened

concentrations of fibers we c all straps not

mass of tissue.

only circle the body on its surface but have

This kind of interaction also occurs

a third dimension going deep inside, crossing

  between the ch in strap and the collar strap,

the body like a sh elf. In the collar strap, the

an d it strongl y infl uenc es the front of th e

shelf can be seen on the surface of the body.

throat. Four muscles (commonly termed the

It crosses over th e often- hollow spot in the

strap muscles) attach the hyoid bone to the

base of the nec k con ta ini ng the scalene mus

upper tip of the breastbone. The lar ger ster

cles (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

nocleidomastoid overlies these and provides

can and often does have a fascial connection

a direct vertical connection between the

to the upper tip of th e lungs. Very few of us

two straps. Ch ronic te nsion in the fascia

are aware that lungs extend so high up in the

surrounding these muscles brings the front

body, a nd a mi nis cu le num be r of us mak e use

part of th e two straps closer togeth er, as can

of this upper tip of our respiratory capacity.

  be seen in people who "lead with their

Two characteristic movement patterns rein force the tightness of this strap—compressing

chins." Tension in this area affects speech as

the armpits and hunching the shoulders.

well as more complex vocalizations such as

Armpit compression is a kind of guarding,

singing or playing a wind instrument. Any

protecting the body because of ticklishness,

stressful situation can serve to tigh ten the

habitual anxiety, protecting the breasts, etc.

throat area. When an gry, one's voice may rise

Shoulders pulled up can also be a r espon se

or wor ds may not come out. In gr ief we g et

to perpetual an xie ty , or it can be carrying th e

"all choked up." This is at least part of the

weight of the world on your shoulders. Mind

me ch an is m that underlies fear of public

set very quickly becomes bodyset. Both result

speaking.

in lack of mobility in the upper ribs and a kind of breathless feeling. Like the oth ers, the collar strap is present

The chest strap (see Section 12) interacts with th e collar strap via the c onnective tissue of the pectoralis major; this can cause a v erti

in all bodies to one degree or another . Some

cal compression on the upper chest. Re duced

times it is visible as a light banding on the

range of m otion in the shoulder (collar strap)

surface. Sometimes it is less visible but can be

correlates with lack of movement in the up

felt as a very tigh t ban d almost at bone level.

per ribs and shor tness of breath. Tightness

Very deep hollows in the body, areas that ar e

fr om bot h of the se straps int o th e arm pit

ticklish or painful to the touch, and marked

inhibits freedom of movement of the arm

cha nge s in color are all indic ation s of ch ang e

at the shoulder joint f rom above and below.

in connective tissue fluidity and body flexibility. Functionally, the straps overlap. For exam

The strap associated with the um bilicus (Fig. 15-2) in the fr ont and the lumbo-dorsal

ple, the eye strap and th e chin strap pull on

hinge in the back tends to make the body

each other in the region just behind the ear .

look as though it were divided into an upper

Both act on the mo ve me nt of the jaw and

and a lower half. It is variable in its position

the tippin g of the hea d. Wh er e strong vertical

relative to th e umbilicus. It can r un just under

muscular and fascial pulls cross the bands, th e

the small c ar tilag e at the bottom of the ster

strap then becomes locally denser both in its

num (the xiphoid process), a few inches

THE

CO LL AR

BAN D,

UM BI LI CA L

BAN D,

AND

GR OI N

BAND

75

above the umbilicus. It may run d irectly across the umbilicus, forming a deep inden tation exten ding out to either sid e. Or it may extend across the abdomen an inch or so   b e l o w t h e u m b i l i c u s (Fig.

15-3).

The band continues toward the sides, in most cases a little below the arch of the ribs. It seems to run both inside and outside the ribs, generally pulling the free ends of those ribs deep inside th e body. In doing so, it may

11th&12th, ribs

•Umbilicus

compress the action of the lateral par t of the •Umbilical strap

diaphragm. The strap continues to the back   by way of the twelfth rib in to the lumbodorsal junction, often immobilizing the free tips of the tenth and eleventh ribs. Ther e is som e sem bl anc e of this strap in eve ryo ne. At the sides, it is a componen t of the very com mon tension centered on the free margins of the lower ribs. T he tip of the eleventh rib is pulled deep into the body in most people.

Figure 15-2 Note that the area of the eleventh and twelfth ribs is the lumbo-dorsal junction.

Ideally, the eleventh rib lies just below a th in shea th of mu scl e an d skin and estab lishe s th e width of the lower ch est in the back. How deeply it is pulled into the bod y seems to influence the position o f the strap (and vice versa). It is possible for the twelfth rib to be deflected down almost to the rim of the pelvis. Similarly, the eleven th r ib can be pulled down toward th e pad on the crest of the hip bone. The free ribs—tenth, eleventh, and twelfth —are attached to the diaphragm and establish its width and range of movement. The umbil

Costal arch

Umbilicus

Umbilical ^trap (variable locations)

ical strap is thus closely associated with the diaphragm on th e side. The result of tightn ess in the strap is a diaphragm that is function ally and structurally too narr ow and conse quently overworked. Breathing capacity is more labored and the diaphragm begins to act like a retaining shelf across the body. An extreme version of this is known as a pigeon  breast. The pubic or groin strap is the lowest strap i n t h e a b d o m e n (Fig. 15-4). It may be seen on

Figure 15-3 The location of the umbilical strap is variable

76

THE

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the f ront of the body in the dense pad of connective tissue on the surface of the pubic   bone. It continues sideways around the body, crossing the groin. A diagonal heavy ligament (the inguinal ligament) connects the anterior superior spines of the hip bone to the lateral points of the pubic bon e. This is crossed by the h orizontal pull of the pubic band. After it crosses the inguinal ligament, the band con tinues laterally over the greater troc hanter (at the top of the thig h bo ne) , mix in g with the   buildup of fat and fibrous tissue so often found over that protuberance. To the 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 contributes to (and sometimes forms) the gluteal f old. It blends into the

Figure 15-4 Groin strap, anterior view (also showing inguinal strap and ligament).

heavy pad found on the ischial tuberosities (sitting bones). Strong cross-pulls are associated with this   band. In th e center fron t, ther e is a vertical connection between the rib cage and the pubic c rest associated with the rectus abdo m i n i s a n d i t s c o n n e c t i v e t i s s u e (Fig. 15-6). This vertical retaining band for the fr ont of the body is very commonly hypertoned (overstrong). This relates to our cultural preference for a flat belly and to our tendency to overexercise. The act of habitually suck ing in the   belly itself shorten s the fr ont of the body. On either side of the pubic bone, crosspulls on the band tend to be somewhat oblique. One arises from the lower margin

Figure 15-5 Groin strap, posterior view.

of the obliq ue muscles of the ab do me n as they come down to form the inguinal liga

as a V-shaped thicken ing on the inside of

ment. As the strap crosses the greater

the leg s, along th e pubic ramus. The strap

tr oc ha nte r of th e fem ur, the re are pulls fr om

is split—part of it goes between the legs and

  below, coming from the leg, and from above,

part goes around the legs.

co mi ng from the crest of the hip bon e.

The pubic str ap is a complex weaving in

As was the case in the collar strap, some

and out of the bon y structure at the base of

of the fibers of the pubic ban d r un deep to

the abdomen. Two internal cross-structures

the h ip joint rather than acr oss its outer sur 

are located here—the pelvic and urogenital

face, alterin g the way the f emur tits into the

diaph ragm s. The internal exte nsio n of the

hip socket. In ad dition, parts of the strap exist

pubic strap is continuous with the connective

THE

CO LL AR

BAN D,

UM BI LI CA L

BA ND,

A ND

GR OI N

BAN D

77

tissue of both of these. I n turn, these dia phragms are penetrated by, and continuous with, the muscul atur e of the rectu m, urethra, and vagina

(Fig.

15-7).

Th e locat ion of the tailbo ne is im por tan t   because it is one en d of support for the h am  mock called the pelvic floor. It is also, at its connection with the sacrum, the endpoint of the pubic strap. Unfortunately, the tailbone is one of the most vulnerable and accidentprone locations in the body. Children repeat edly fall backward onto their tailbones. In later life, accidents in volving bicycles, roller skates, and many team sports seem somehow to focus on the tailbone and its aptitude for getting jammed. In general, we don't consider this damage—no bone is broken, it isn't seri ous. But this can be one of the lon gest lasting kinds of imbalance in the body. A wrenched Figure 15-6 Groin strap with rectus abdominis.

tailbone has no support to pull it back into position; no one h as ever seen a plaster cast on a tailbone. Most doctors, bodyworkers, and sports trainers don't think the coccyx is very important. To us, seen anatomically, it is rem iniscent of the tip of an arrow. The Vshaped sacrum is the arrowhead, and the ver tebral column is the shaft. The coccyx, like the arrow tip, guides th e direction of move ment; the spine compensates by flexion, extension, and rotation. When the pubic strap tightens down, it red uces flexibility, cementing the coccyx into a fixed attitude. The pelvic and pubic straps have v ery heav y vertical int erc onn ect ion s in front and   back. In front this is partly the continuation of the lower r ectus abd ominis fascia as it tra verses th e apron of the pelvic strap toward the pubic str ap. It has sideways r am ifications that thicken the inguinal ligament. In the back, the two straps are connected by a heavy pad on both the in side and the outside of the sacroiliac junction. This configuration, with the connections in front and back, and the

Figure 15-7 The pelvic and urogenital diaphragms.

straps between, gives a modified "jock strap" or "chastity belt" under the skin.

78

THE

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Figure 15-8

BODY

Figure 15-9

RETINACULAE

(B A N D S / S T R A P S)

79

PA RT

FOU R

Anatomy and Function

SIXTEEN

Proprioception Internal Body Awareness

Movement can be evaluated from the outside

okay to zip your fly and brag about that. It's

  by a trained observer. It is ev aluated from the

okay as a teenager to be athletic and to show

inside by proprioception. This is the internal

off your physical prowess. It's not okay to

physical sensation of positi on in thre e-di men 

swank your hips or push out your breasts.

sional space . Mos t of us can sen se our bod ies

When we give up the freedom to feel our

to some degree. When we tun e in, h owever, it

  bodies in this way, it is not a freedom easily

is surprising how man y parts of our bodies we

regained. The teenager who chooses not to

don't feel. For example, m ost people walk

feel m ovement in his or her hips may find as

around with one shoulder higher than the

an adult that there is a loss of sexual feelin g.

other, one eyebrow higher than the other, etc.

Pelvic movement, sexual identity, and the

Yet we are rarely aware of this. We are startled

like are load ed areas of awar enes s. Ev en if we

when someone points it out, and usually find

turn to something neutral, such as throwing a

it dif ficult to sense even then . With som e

  ball, proprioception of the movement will be

effort, we may feel our feet, but find it impos

defined by body image, mo ve me nt image,

sible to sense our ankles. We may be able to

accidents, and physical structure.

reach our lower leg s, but somehow can't get a sense of our inn er thighs. The older we get, the more we tend to limit

Proprioception is the summ ati on of our physical history into the moment of present activity. As I throw a ball, I may feel my wrist

our body sense to what hurts. Children often

snapping as the ball is released but have less

seem to have a pleasurable sense of their bod

awareness of ho w my elbo w exte nds. I may

ies. Through training, accidents, and unwel

feel my arm as I throw, but n ot how my arm

come sensations, adults learn not to take

connects to my back or how my back is sup

pleasure in their bodies. Everything from

ported through my pelvis and legs. In the

cultural taboos to unwanted emotions and

Midwest, the ter m for this kind of who le body

painful memories (physical and emotional)

engagement is "body English." Every physical

teach adults to be less aware of their bodies.

act reverberates through the whole body, and

Proprioception is the conscious part of

this can be consciously felt. Proprioception,

  body awareness. There is also an unconscious

then, is sensing the mechanics of movement.

aspect of the body, and it is her e that cultural

Where there is a gap in proprioception, there

  body images are the most profoundly influen

is a habi tual inhi bit ion of mo ve me nt . This is

tial. Victorian ideas of "niceness" still exist in

anchored in the flesh by loss of elasticity in

the modern guise of ok ay -ness. It's okay to

the connective tissue, a reduction in its ability

feel my shoulders; it's less okay to feel my

to stretch and th en return to its original

  breasts, although it's more okay to feel my

shape. Releasing these contractions in the

  breasts when I'm alone than when I'm in

connective tissues is a matter of ph ysical or

public, an d th is is again different from breast

mental awareness.

self-examination. Little children are taught

The straps inhibit physical responsiveness

that it's okay, even wonderful, to tie your

and proprioception. An image of how a strap

shoelaces and brag about it. It's m uch less

would feel proprioceptively is a woman in the

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early part of this century wearing a corset.

much smaller than the actual physical struc

S h e h a s li t t l e o r n o a r t i c u l a t i o n o f m o v e m e n t

ture. We usually feel our arm s to be shorter

  between the top and bottom halves of her

than their length, or our legs, particularly th e

  body. As she walks, undulation from her legs

thigh bones, as sh orter than they are. Possibly

through her waist into her chest and shoul

this reflects psychological assumptions about

ders is inhibited. When we do not feel move

our capac ity . Th ere is also a physical result

ment in the waist or at the top of the pelvis,

of this kind of attitude. When I'm not aware

a similar structure under the skin occurs.

of the full space in my head, the skull bones

Connective tissue can harden to the point

compress. This shows as a narrowness at th e

where it acts like a corset. We tend not to feel

temples, creating a head that is too long and

this as a restriction. If we did, it would be

too deep.

irritating. Instead, we simply feel the com

One indicator of the difference between

forting familiarity of not being able to move

reality and inter nal image is the sense of un-

our waists. It is not alway s possible to r elease

familiarity when we're faced by a three-way

structures like this by physical means alone.

mirror. We may be accustomed to our f rontal

A Rolfer c an set the stage f or the release, but

image, but fee l surprise at our profile and

until the individual is ready to feel movement

even more at our sh ape in bac k. It's worth

through the area, the only thing a Rolfer can

no ti ng here , too, tha t we are a "do in g" soci

do is allow the person to become more pre

ety, oriented towar d what is in front of us. As

cisely aware of the area of holding. The let

we see ourselves in a mirror, it is com mon to

ting go is d one by the client.

make automatic adjustments to "look better."

Proprioception is filtered through percep

We are apt to assume a "better" posture, pull

tual style. There are people who ar e pr edomi

our shoulders back, stand up "straigh ter."

nantly visual and those who are auditory.

We are rarely at rest in front of a mirror.

Visualizers tend to see and k now about their

Static proprioception becomes more com

external physical image. Auditory types com

plex in movement. Normally, we are in move

pare what they perceive physically to verbal

me nt , and in mo ve me nt the limita tions of a

descriptions and ar e more often aware of

structure become much more apparent. Struc

internal structure and imbalances.

tural aberrations and prefer ences are f un da

Often people are unwilling to occupy all

mentally a matter of h olding some part rigid.

of their potential space. They don't use their

When the body moves, it must move around

full chest, the full potential of th eir rib cage,

the held place. Wh en the hip is restricted, for

or a full pelvis. Unconsciously, they shorten

example, eff ort has to be expended to hold it

th e body , d evel op curva tures of th e spin e,

rigid while walking. Movements such as walk

pull th e legs into the hip, sh orten the nec k.

ing down the street or up steps, or eating at a

Women often have thin arms; there may be

table all show characteristic body habits.

an unwillingness to demonstrate the potential

Proportion and balance ar e the keys to

or power that is available in arms and shoul

movement. Anomalies in physical proportion

ders. Men of te n have thin legs, perhaps a

or balance, whether seen from the outside or

tightening of the legs in response to a tight

sense d inter nally , are signs of the conn ect iv e

ening of the pelvis.

tissue pattern under the skin , reflecting the

W h en people bec om e aware of these gaps

connective tissue structur e we have been talk

in proprioception and the accompanying

ing about—the surface body straps, vertical

habitual attitudes, they are surprised. Almost

holdings, diaphragms, and shelves through

invariably, people sen se their head as being

the body.

SEVENTEEN

Upper Body There are many ways to analyze human struc

the r ibs in fr ont to com e upward. For each

ture. Osteopaths, orthopedists, physiatrists,

person, the initial ch an ge is different. B ut f or

and chiropractor s see people in terms of bone

on e of these habit s to be modifie d, th e other

placement—how straight the spine is, how

two must change as well.

well the alig nment stack s up from heel to ear.

The position of the head, upper chest, and

General medical practitioners generally evalu

shoulders is not separate from the rest of the

ate health in terms of the soft tissues—mus

  body . When the upper ribs are compressed,

cles, blood and n erve supply , internal organs.

very often the lower ribs are overexpanded.

We are proposing another perspective—evalu

The extreme of this is the pear-shaped body,

ation of the con nective tissue bed of the body.

in wh ich the lower ribs flare outward wh ile

This includes the conformation of muscle and

the upper ribs are so compressed th at the

  bone but is not limited to these.

shoulders are drawn together and narrow.

The straps we have described give a sense

It is th e soft tissue configurations that give

of h ow connective tissue can cre ate structures

rise to these silhouettes. A more detailed anat

that overlap and interconnect. The direction

omy of the c hest and upper back is n eeded to

of the connective tissue is not determined by

flesh out our point. The connective tissue

any one muscle or muscle group. Our purpose

conforms to the muscle. In fact, it would be

is to giv e an image of ph ysiognomy that is

more accurate to say that the connective tis

more inclusive, more directly related to the

sue guides the muscle pathways. Furthermore,

experience of structure and to movement.

it is convenient to say that muscle attaches to

In order to discuss structure, we analyze the

  bone, but this is not strictly true. The connec

  body roughly in terms of its upper and lower

tive tissue extensions around muscles (ten

halves. The easiest way to begin talking about

dons, aponeuroses) continue on as the

the upper body is to look at the position of

con nec tiv e tissue cover ing of bo ne (perios

the ribs. In most peo ple, th e ribs angle too

teum). Bone and muscle lie embedded within

sharply d ownward in front. Ideally the ribs

the connective tissue web.

would hang more horizontally, although nor mally there is always some slight angle. The typical body configuration that accom

In th e fro nt of th e ches t, the ma jo r mu s cle of the outer layer is the pectoralis major, the "pecs" that muscle builders attempt to

panies depression of th e upper r ibs in cludes a

d e v e l o p (Fig. 17-1). It is a large fan-shaped

sunken and flattened upper chest, elevated

muscle covering the majority of the upper

shoulders, and a h ead thrust f orward. Th ese

chest, extending from the middle ribs up

three go together. If the upper ribs were raised

along the side of the breastbone and the mid

in front, the shoulders would automatically

dle half of the collarbone. The fan converges

drop an d the head come back to a more

across the shoulder in front, and end s by

upright position. Likewise, if the f ocus is on

attaching to the humerus an inch or two

  bringing the head back, it is necessary to

  below the shoulder joint.

allow more space for the breath to come up

In the back, th ere is the trapezius, the

into th e upper ribs. Or if th e shoulders relax,

w e i g h t l i f t e r ' s " s t r a p s " (Fig.

space is made for the head to com e back and

nates fr om the back of the skull and runs

17-2). This origi

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along the back of the spines of all the neck vertebrae an d the upper seven or eight ch est vertebrae. It, too, is fan-shaped, converging on an attachment to the tip of the shoulder Fascia of  sternocleido mastoid m.

Fascia of  trapezius m.

called the acromion. The acromion is a bony shelf that can be palpated at the corn er of the   junction between the shoulder and the arm. The lower part of the trapezius, as it crosses

Fascia of  pectoralis major m.

the shoulder blade (scapula), also attaches to the acromion as well as to th e scapular spine. In the back, another large fan-shaped mus Fascia of  • latissimus

dorsi m.

cle flows up from below, called th e latissimus dorsi—the weightlifter's "lats." It attaches to the spine s of the lower chest vertebrae as well as to the spines of the lumbar vertebrae down to the sacrum. Th e poin t of this fan converges upward, obliquely crossing over the lower tip of th e shoulder blad e. It th en runs alon g the lateral marg in of th e shoulder blade and ends

Figure 17-1 Anterior arm and shoulder fascia.

  by attaching to the humerus (arm bone) just   behind the attachment of the pectoralis major. These three muscles make up what we call the external muscle and connective tissue layer of the ch est, relating the chest to the shoulder and arm, to the head, and to the lower back. The next layer, which serves to

Fascia of  deltoid m.

Fascia of  trapezius m. Acromion

stabilize the position of the shoulder blad e, is more difficult to visualize as a layer. In the front, underneath the pectoralis major, lies t h e p e c t o r a l i s m i n o r (Fig. 17-3). This is a nar row small m uscle that attaches to the middle

Scapula Septum

(dotted line) Fascia of  latissimus dorsi m.

ribs and angles upward to attach on the cora coid process. This hook-like projection for ward from the inside of the shoulder blade can be f elt just underneath the collar bon e, in the depression between th e larger arm muscles and the side s of the ribs. The pectoralis minor acts like a lever on the coracoid process, moving the shoulder   blade. T he cor acoid process is very much like

Figure 17-2 Posterior arm and shoulder fascia.

a hook on a suspen ded metal plate (the scap ula). When the hook is tugged near the top,

UPP ER

the lower border of the plate is raised like a

Coracoclavicular  ligament &

drawbridg e. If the pectoral is mi no r in front

Subclavius m.

BO DY

87

is habitually tight, the pull on the coracoid process results in what we call "winged " scapulae in the back (Fig. 17-4). T h e m e d i a l margin of th e shoulder blade will project

Coracoid. process Coracobrachialis m.

.Pectoralis minor m.

outward. Two other attachments to the coracoid process are connected down into the arm.

Biceps m. (short head)

The short head of the biceps brachii (com monly called simply the biceps) crosses both the shoulder and the elbow joints. Thus, tightness in this muscle on th e front of the arm will also reposition the scapula. The coracobrachialis is a shorter muscle that spans fro m the c ora coid pr ocess to th e in sid e of th e humerus about halfway down the arm, rein forcing th e action of the biceps on the scapula (Fig.

17-3).

A ligament from the cor acoid process to the underside of the clavicle contains the subclavius muscle, a small muscle whose function is traditionally considered minimal.

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.

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. 17-3), its function is probably a factor in the nor ma l pos iti oni ng of th e scapul a. To us, this is not a ligament, but a tendon through which the subclavius muscle is attached to the cora coid process. Th e act ion of th e sub clavius through this connective tissue attach ment is not gr eat in terms of movement. I ts importance lies in the way it stabilizes th e fascial sheath of the chest as a whole. T here is an analogous structure in the leg. This is the muscle and attach ed fascial bridge called the tensor fascia lata and iliotibial band. T he   band is a later al thickening of the fascia cov ering the thigh as a wh ole (the fascia lata). The action of the compara tivel y small tensor muscle serves to stabilize the whole of the 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 the coracoid process, we can visualize the fascial involvements. From the coracoid process, there are strong connections to the middle ribs, to the radius and ulna of the Tensor  fasciae latae

forearm, to the humerus of the upper arm, Gluteus maximus

and to the mid dle clavicle. Tension on any or all of these will result in a d egree of immobi lization between the upper chest and the arm and the position of the scapula in the back. Movement through a fascial plane is always   broader than movement by an individual

Ilio-tibial

muscle.

tract

On the back, the sh ould er blade is sus pended in three places. On its surface, the trapezius connects to its most lateral tip, pri marily at the acromion . At a deeper layer, the rhomboids and the levator scapulae form a   broad sheet of attachment to the medial ridge of the spine. Also in this deeper layer, the two teres muscles, major and minor, connect the

Figure 17-5 Connections between knee and hip.

scapular tr ian gle to the upper arm (Fig. 17-6). The scapula is thus suspended from all o f its sides: from th e head by way of the trapez ius, fr om th e thora cic spi ne by way of the rhomboids and levator, and from the upper arm by way of the teres. The elasticity of the connective tissue of each of these allows the shoulder to float on top of the rib c ag e. The

. Trapezius m. , Supraspinal

Levator  scapula m.

tightness of any of these will engender tight ness in the oth ers and will fix the shoulder   blade. This, in turn, will reduce the flexibility

Teres minor/ infraspinatus

Rhomboids. m.

of th e n eck and head, th e upp er back , and the arm. Rhomboids and teres between them form a sling that stabilizes the movement of the lower part of the scapula. When th e ar m

Trapezius m.

v

Teres major  m.

moves sideways, the distance between the arm bone and th e scapula widens and the teres should be able to lengthen. When the muscles reach the limit of their elasticity, the shoulder blade will start to move sideways. Its movement is stabilized by the elasticity of the

Figure 17-6 Scapular suspension.

rhomboids. If the shoulder blade is winged out, the teres must then also tr y to stabilize

UPP ER

BOD Y

the lowe r margin of the shoulder blade to prevent it from moving too far out, away from the flat of the ribs. The teres were n ot designed for this purpose, and so they shorten. The surrounding connective tissue Rhomboid m.'s

  becomes overtense. Wh en the teres lose elas ticity, the shoulder blad e is dragged along with every arm movement. Many people's teres are much too sh ort and tight. T he other half of the slin g for the scapula, the rhomboids, then are less used and become flaccid. Higher up, the levator scapulae becomes extremely tight, forming a heavy pad. The att ac hme nt of the levator on the upper mid dle cor ner of the scapula is that place where, if yo u press it on almo st any on e,

iSerratus anterior m.

External abdominal oblique m.

he or she will sig h, "Oh, that hurts so good!" Another muscle of th e mid dle layer , the serratus anterior, conn ects the lower ribs to the undersid e of the scapula (Fig. 17-7). Both serratus anterior and subscapularis lie   between the rib cage and the shoulder blade. The serratus attach es on the lower ribs an d angles upward toward the medial border of the scapula, attaching just adjacent to the

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.

att ach men t of the rhombo ids. The subscapu laris lines the unde rside of the shoulder blade, with its fibers conv erging toward the fibr ous capsule of the shoulder joint. These form another reciprocal set of slings, f loatin g the shoulder blade between the ribs and shoulder

Fascia of  trapezius m.

join t. Normally , the func ti on of th e serratus anterior seems to be to stabilize the shoulder   blade as the arm swings overhead. Its f ascia

Acromion

Clavicle

Fascia of  deltoid m.

often glues the muscle to the periosteum and fascia of th e ribs and intercostal muscles. Two sm all muscles on the outer sur face of the scapula, the supraspinatus and infraspina t us (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 o f

Septum

the shoulder blade in relation to the shoulder   joint. These lie on the surface of the scapula, above and below the scapular spin e. In pal pation, they often feel like bone when the shoulder blade is in trouble. We have been talking about how the

Figure 17-8 The deltoid fascia interweaves with the septum dividing the anterior (biceps) and posterior (tri ceps) areas of the arm.

89

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shoulder blade is suspended in its reciprocat

a yawn. Note that in this k ind of stretch, the

ing muscular slings. The arm and shoulders

shoulder blade is suspended from the arms.

also relate in this way. Hanging down, th e

There are two major factors to consider in

arm swings from the shoulder blade. When

a r m m o v e m e n t — t h e m o v e m e n t o f m u s cl e s

we reach up, the reverse is true—the sh ould er

over the tip of the shoulder blade and m ove

  blades hang from the arm.

ment in the ar mpit. Ideally, the arm can be

The major surface connection between

raised without elevating the shoulder blade,

shoulder and arm is the deltoid muscle,

which drops as a counterbalance. In addition,

which covers the shoulder joint. This muscle

the ar m must be able to freely move away

a c t s l ik e a c o n t i n u a t i o n o f t h e t r a p e z i u s , e m 

from both the rib cage and the shoulder

  bracing its attachment on the clavicle, acro-

 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

There is no way that we can freely use an

ext ends musc ular actio n of the trapezius

arm without opening the armpit, yet armpits

from the head and neck across the shoulder

are the focus of a wide variety of emotional

and down into the middle of the upper arm.

concerns. We have all sorts of reasons why we

At a deeper layer, the bic eps br ach ii and

don't want to be, in eff ect, that open. Protec

the coracobrachialis both suspend the arm

tive g estures, fearful gestures, holding one's

from the coracoid process of the shoulder

  breath, an gry gestures all focus on tig htening

  blade. In add ition, there is the triceps brachii.

the arms down to the ribs. These are gestures

Of its three attachments, two connect to

repressing response to emotion. We are inhib

the hum eru s itself an d one —ca lle d the long

iting what we would like to do with our arms:

head—connects to the outside margin of

war ding off anger, fear, res ent men t, etc.

the shoulder blade just below the shoulder  joint. These three muscles govern the lengthen

Trapezius, deltoid, pectoralis major, and latissimus dorsi are commonly called the extr insi c (outer) muscl es of the shou lder area,

ing out of the arm from the shoulder blade.

connecting the arm and trunk. To simplify,

The arm should be able to lengthen as it is

we can think of the trapezius an d deltoid as

raised upward an d to the side, such as when

a single, functionally continuous structure

stretching your arms wide and up toward the

(Fig. 17-9 A). These are the musc le s that raise

ceiling in the relaxing stretch that goes with

the arm. Th e latissim us d orsi and pectoralis

Figure 17-9 Shoulder and arm movement depe nds on the continuity of fascia— (A) lateral shoulder, (B) anteri or shoulder, (C) posteri or shoulder.

UP PE R

BO DY

91

major, acting together, bring the arm down

true of very sm all muscles as of larger sh eet

(Fig. 17-9 B & C). These muscles of th e outer

like ones. Part of the way heavy immobile

(extrinsic) layer counterbalance each other.

tissue pads are created is by our insisten ce on

For example, when the arm is raised to the

trying to use the muscle as a whole instead of

side, deltoid an d trapezius c ontract as pec

sequencing through the muscle as body posi

toralis major an d latissimus dorsi relax, allow

tion demands. A major source of confusion in

ing the arm to extend away from the body . As

the practical appli cation of kines iolog y is tha t

the arm returns to the side, pectoralis an d

no muscle exists in isolation. The connective

latissimus contract as trapezius and deltoid

tissue bed provides connections between mus

lengthen.

cle layer s as well as between adjacent muscles.

Two kinds of movement are possible here—

These interfaces have the greatest potential

dropping the arm, which is faster, or sequen

for adhesion, thickening, and shortening.

tially letting the arm down, which is slower.

Elasticity of the connective tissue between

I n b o t h m o v e m e n t s , o n e s et o f m u s c l e s c o n 

structures is essential for an effective relation

tracts. The difference between the two move

ship between deep and superficial (intrinsic

ments is in the counterbalancing set of

and extrinsic) muscle layers. In the front,

muscles. When the movement is fast, the

pectoralis minor lies under pectoralis major.

opposing muscles simply let go and th e con

Toward the center front, both muscles affect

nective tissue bed elastically stretches. When

th e act ion of th e ribs. I n th e should er , th e

a movement is slow and controlled, the

pectoralis minor attaches to the coracoid

antagonist muscle lengthens sequentially. It acts as a brake to modulate the movement. In either fast or slow movem ents, the ulti mate limit on the movement will be the limit of elasticity of the connective tissue bed. What we call sequencing in muscle move ment is a factor in how the lar ge flat surface muscles are used. For example, as the arm is raised, the first muscle activity starts at the portion of the trapezius between neck and shoulder and continues down the deltoid. As the arm comes f ur th er up, muscle activity concentrates further down the trapezius. The continuing upward movement of the arm is supported by the vertebrae because of th e action of diff erent parts of the trapezius. Anatomical nomenclature occasionally reflects this stepwise use of the surf ace mus cles by dividing them into specifically named sections. Ideally, in no movement do we use all fibers of a muscle simultaneously. At the deeper layer of fascia and muscle, sequencing moves through a ser ies of muscles rather than through the plane of one muscle. This is as

Figure 17-10 Common "knots."

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mid-back place under the lower tip of the shoulder blade that is so often painful. Another mid-back place on the spine that is commonly painful is where the lower tip of th e trapezius crosses the uppermost attach ment of the latissimus to the vertebra. (Fig. 17-10).

This

spot

almost always contains a sensitive knot of tis sue. This is in the area that we h av e been call ing the d orsal hinge. The part of the latis simus toward th e humerus lies immedi ately adjacent to the Figure 17-11

teres major. The teres major is a bridge

process while the pectoralis major attaches to

  between the lower tip of the scapula and the

the humerus. When the fascial pad between

armbone. The latissimus connects the arm

the two becomes less pliable, the muscles no

  bone to the lower back an d th e pelvis. We

longer operate individually. They are unable

frequently see latissimus and teres major

to slide on each other. As a result, the shoul

  bound together , with the result that the lower

der blade and the arm are activated together

tip of the scapula is immobilized. These inter

in any gesture inv olv ing the front of th e

actions are conceptually straightforward and

chest.

give a partial picture of th e effect of the con

In the back, th ere are two places wh ere this

nective tissue on movement between arm,

kind of confusion is likely to occur. The tr a

shoulder blade, and ribs. For a more c omplete

pezius overlies the rhomboids and levator

and complex view, we recommend considera

scapulae, although here the muscle fibers run

tion of the ef fect of connective tissue on the

crosswise to each other. At the center back, all

underside of the deltoid. This muscle over lies

attach to the vertebrae. The trapezius attaches

att ach men ts of the teres ma jor and minor ,

laterally to th e tip of the sh ould er blade (acro

pectoralis major and minor, biceps brachii,

mion), while the rhomboids and levator scap

coracobrachialis, and infraspinatus.

ulae attach medially to the medial border of

Our anatomical illustrations in this section

the scapula. When the connective tissue bed

attempt to depict the interactions of muscle,

  between these muscles loses elasticity, th e

  bone, and connective tissue in movement.

shoulder blade cannot rotate. Its only option

The interactions with the deltoid are too com

is to be shrugged up. This is a factor in that

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 not yet talked about th e long mus cles of the spine, which are also a part of the

to the vertebra immediately above it. The heavy fascial sheath covering all of

soft tissue layers of the upper body. Collec

the erector spinae is called the lumbo-dorsal

tively, these are called the ere ctor spinae,

fascia (Fig. 18-2). I t c o n t i n u e s u p w a r d t o t h e

and they travel the length of the spine from

neck and to the occipital ridge. Below, the

the skull to the sacrum (Fig. 18-1). I n b o t h

lumbo-dorsal fascia is continuous with the

appearance and structure, they are much like

sacral pad and ends on the coccyx. T his fascia

a multistrand rope. Th e muscles closer to the

is very heavy ; it acts as an apon eur osis (broad

outer surface of the body are longer; as we go

attachment), connecting the latissimus dorsi

progressively deeper through the layer s, mus

to the lower half of the spine. Above, the fas

cle segments become shorter and shorter. The

cia is less heavy; it lies under the middle mus

deepest muscular layer connects one vertebra

cle layer (rhomboids and 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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Upper back and shoulder problems are usu

the organ but penetrating through it. This

ally interconnected through this fascia, which

is particularly apparen t in th e lungs, wh ere

feels like a glass plate when it is in trouble.

connective tissue surrounds the branching

In the lower back, restriction in the lumbo-

system of trache a, bro nch i, bronchiol es, and

dorsal fascia will show as a longitudin al rope

even alveoli.

like rigidity, sometimes modified by a cross-pull from the latissimus dor si. At the deepest level, there is a connective

The conn ective tissue on the inner surface of th e ribs and intercostal m uscles is continu ous with a vertical connective tissue septum

tissue continuity that includes the joint cap

that divides the right and left sides of the

sules and the periosteum that ensheaths each

c h e s t c a v i t y (Fig. 18-3). This is called the

  bone. In the chest, this layer continues both

mediastinum. It connects the underside of

inside and outside the rib cage and contains

the sternum (breastbone) to the vertebrae of

the intercostal muscles between the ribs. This

the chest region. The mediastinum contains

fascia is continuous with the fascia position

the heart. It sh ould be elastic enough that

ing the internal organs, not only surrounding

heart movement can be accomplished with out inhibition. Furthermore, this connection   between front an d back of the chest must also be able to adjust with each breath. When there is tension and 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 clavi cles, the respiratory diaphragm, the two pelvic diaphragms.

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mediastinum, both heart function and   breathing are hindered. Externally, tension in the med iastin um is visible as a chest that is too thick from fron t to back—a bar rel ch est. In a chest that is too n ar row from front to   back—a concave chest—the mediastinum and heart are pushed off to the left, which again will create ten sion on the heart. Displacing the h eart then constricts the lung and restricts breathing. At its lower margin, the mediastinum is continuous with the connective tissue of the diaphragm. The diaphragm is an approx imately horizontal curved layer of muscle that divides the chest cavity from the abdominal cavity. It is made up of a heavy circular cen tral tendon surrounded by a rin g of muscle. The muscle flares outward from this central

Figure 18-4 The action of the respiratory diaphragm.

tendon and blends into the musc le wall of the chest and abdomen. The diaphragm attaches to the inner

to protrude in this way, it must shorten when inhaling. This is a learned pattern, one that

margin of the rib cage (the costal arch) and

is mentally controlled. Movements that are

extends sideways to the tips of the free ribs,

mentally controlled lack adaptive flexibility.

the tenth, eleventh, and twelfth. It cr osses

The tendency is to over-focus on what has

the tip of the ver y short twelfth rib and th en

  been learned. In this case, the abdomen is

  blends into th e oblique m uscles of the abdo

moved in preference to the ribs.

men. The diaphragm is thus not quite hori

Exhaling involves the combined action

zontal across the body; it has an oblique angle

of the diaphragm and one layer of the in ter

downward to th e back.

costal muscles between the ribs. In a normal,

The action of the diaphragm is like a sail

unforced exhale, muscle action originates in

that bellies in the wind (Fig. 18-4). Its middle

the diaphragm and continues to the abdomi

  bellies up into the chest cavity with each

nal obliques. Th is brings the rib down and

exhale (1); it flattens with every inhale (2).

allows the diaphragm to recoil to its normal

With exhalation each rib is r aised by rotating

dome shape up into the pleural (lung) cavity.

in its joints with the vertebrae. As the ribs lift

Air is pushed out of the lung s. The system

and expan d the chest, air en ters the lun gs.

is not dependent on the presence of a lung.

Ideally, the diaphragm is lifted at its marg ins

Even people with only one lung can achieve

as the r ibs rise and expand sideways with

normal chest movement on both sides.

inhalation. In order for this to happen, the abdomen must lengthen when inhaling. Abdominal breathing is often depicted as

Rib action during breathing involves three separate types of rib mov em en t. The se are well described in most anatomy and physi

a pattern in which the abdomen protrudes

ology texts. We would like to emphasize the

in front with each inhale. Many disciplines

need for eac h rib to move separately and

teach a type of abdominal breathing that is

freely. If any one rib fails to main tain its por

anatomically questionable. For the abdomen

t i o n o f t h e c h e s t c o n t o u r , a d j a c e n t ri b s a n d

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scalenes ser ve a function analogous to that of the respiratory diaph ragm , expa ndin g and contracting when breath enters the upper tip of th e lun g. Sin c e the scalenes atta ch to the processes of the neck vertebrae, tension in the neck restricts breathing in the uppermost part of th e lung s. And tens ion in th e nec k has reached endemic proportions in our overachiever culture. The neck can be seen as a continuation of the c onnective tissue str uctures of the chest. All structures in the neck have a broader con tinuation below, m uch in the way a plastic   bag is gathered together with a twist at the top. Th e deepest layer of the neck in clud es the con tin ua tio n of the erector spinae; the middle layer includes the scalenes. T he outer most surface laye r consists of the trapezius and the sternocleidomastoid. The sternocleidomastoid extends from the   base of the skull just behind th e ear (mastoid process) down to the connection between the clavicle and the breastbone (sternum). It often   becomes very prominent in older people from Figure 18-5 Diaphragms of the body cavity.

overuse in moving the h ead. Id eally, this pair of muscles only stabilizes the movements of nodding the head and turning the head from side to side. Whe n the h ead is h abitually

eventually th e whole r ib cage are distorted. I f

pitched forward , as is too often the case, the

this process r eaches a critical level, there is a

upper trapezius becomes a primary support of

general connective tissue response. This can

the h ead. It is used to hold the head on, and

  be felt as an overall rig idity in the connective

it loses much of its functional role in head

tissue of the chest, which feels almost lik e a

movement. The sternocleidomastoid then

strait jacket under the skin.

takes on almost the entire function of the

Filling the space in the notch between the clavicle in front and the heavy musculature

trapezius. The connective tissue of the outer layer of

of th e neck and shoulder blade in the back ar e

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 a r e t h e m u s c l e s

tissue of the jaw. The pad over the angle of

in the depression on eith er side at the base of

the jaw ties into the sternocleidomastoid

the neck. They attach to the upper ribs. The

(Fig. 18-6). It can act as an inhibitor to the

lungs extend up just underneath them. The

free dom of mo ve me nt in the jaw and so

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indirectly affect movement of the head as a who le. If yo u cl am p you r jaw as a habit , you yo u will also be clam pin g you r h hea ea d. I f yo u clam p your jaw hard en oug h, it will be difficult to shake your head "n o," and also difficult to shake your head "y es." The fascia on the underside of the jaw is continuous with that of the tongue. The inside of the mouth and tongue are thereby included in restrictions of the face and head. The erector spin ae extend up to attach to the base of the skull, mingling with the heavy pad that is found on the back base of the skull. On the back of the neck, the fascia of the sternocleidomastoid and trapezius is con tinuous with the skullcap of connective tissue on the head . At the deepest level, along the spines of the neck vertebrae an d up onto the   bump on the back of th e skull, there is a very heavy rope of con nective 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 the pr ojection at the back of the skull (occiput), form ing almost a T shape. It acts like a septum in the back of the neck, dividing righ t and left halves of the nec k into separate compartments. Its action as a septum serves to connect the superficial and deep layers of muscle to each other in the back. This ligament becomes especially thickened, almost bony, in people who habitually thrust the head forward. The septum of the liga men tum nuc hae is a normal connection between outer and deeper layers of soft tissue. There are similar septa elsewhere in the body. They provide ad di tional strength because a ligament is denser and more stable than its fascial coun terpar t. Septa also divide and compartmentalize func 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 There are sev eral ways in which the shoulder

tract ends on th e lateral protrusions of the

and pelvis differ from one an other. Initially,

tibia and fibula, below the knee . In normal

i n t h e fi fi rs rs t 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 ,

function, the gluteus maximus acts between

  both arms and le gs are extended directly out

the back part of the hip an d the lower leg,

to the sid es. A useful image is that of falling

  bypassing th e femur. Very often, however, as

spread-eagled backward into water. The arm s

the gluteus maximus passes over the hip, it

are out to the sides with palms forward. The

sticks to the greater trochanter, creating an

legs are straight out to the sides with the

aberrant drag on the f emur.

inside arch of the foot facing forward . (This

The small tensor fascia lata attaches on

position of the legs is n ot possible to an ad ult

the anterior superior iliac spine, which is the

structure.) B y the time a baby is born, the

uppermost bony protrusion on the front of

arms are down to the sides, retaining a wide

the pelvic curve. Th e muscle angles down and

range of motion. The legs have come down

sideways, blendin g into the fibers of the ilio-

  beneath and in line with the trunk. They are

tibial tract. Frequently, the ten sor feels like

rotated so that the knee, which originally

  bone. This tiny muscle balances the backward

pointed headward, is now facing forward.

pull of the massive gluteus maximus on the

This me an s that the myofasci al web of the leg

ilio-tibial tract. B y desig n, th e action of the

has rotated, creating soft tissue spirals in the

muscle is all along th e tract, d own to its

legs (and to a lesser degree in the arms). A functional difference between shoulder and pelv ic girdle is in th e use of the limbs. The major activity of the pelvis is weight  bearing, while in the arms and shoulders it is mobility. Pelvic mobility has been modified   because the need for support h as taken precedence. On the outsid e of the pelvis there ar e three, possibly four muscles that we c lassify as superficial. They attach to the outsid e of the hip and continue to the lower leg. These are the gluteus maximus, the tensor fascia lata, an d th e sartorius. The rectus femoris is the fourth candidate for this classification (Fig.

19-1)

The gluteus maximus has a very wide attachment centrally, from the posterior margin of the ilium and from the sacroiliac   junction down to and including the tailbone. The muscle angles diagonally across the pelvis down toward the leg, endin g in the long fibrous track called the ilio-tibial tract. This

Figure 19-1 The suspension of the knee from the hip.

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attachment below the knee. It is functionally

on the fr ont of the knee, like a pebble in a

shortened when its underside is stuck to the

stream. The patella itself is not a stationary,

g r e a t er er 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

weight-bearing bone. It is a modification of

happens, its extreme rigid ity is a measure of

the connective tissue within the patellar liga

the str ess on the muscle.

ment (a sesamoid bone).

The sartorius is attached on the tip of the

On the inside of the legs, the adductors are

anterior superior iliac spine, immediately

the primary component of the V shape of the

adjacent to the atta chm ent of the tensor fas

inner thigh. The gracilis is the only adductor

cia lata. It diagonally crosses the thigh in an

that crosses both the knee joint and the hip

S shape, attac hing to the tibia below the knee,

  joint. It is thus classified as a superficial leg

on the inside of the leg.

muscle. The other, deeper adductors cross

  Just deep to th e sartorius, the rectus

only the hip joint; they do not extend below

femoris attach es on th e anterior inferior iliac

the knee. T he gracilis is a broad band of mus

spine. It descends the front of the leg in a

cle that, with its fascia, is attached on the

straight line, blending into the upper part of

pubic ramus. It continues to the knee, coming

the patellar tendon above the knee. The ten

to lie underneath the sartorius and attaching

don contin ues acr oss the front of the kn ee to

to the medial projection of the tibia below

the f ront of the tibia. T he patella (kneecap)

the knee joint.

sits within the tendon like a bony cushion

On the bac k of th e leg leg are are the ham str ing s. Thre e of these muscl es exte nd from the sit ting bone (ischial tuberosity), which is a bony projection of the hip bone in back and below. Two hamstrings continue to the inside (me dial) side of th e kn ee; the third attaches later ally below the knee joint. The combined action of the long super ficial muscles affects both the knee and the hip joints. Like th e shoulder, the knee is a suspended structure. On its lateral side, posi tion and function are determined by the glu teus maximus, the tensor fascia lata, and the lateral hamstring (biceps femoris). On the med ial sid sidee of th e kne e, the re is th e int er erac ac  tio n of th e sartoriu s, gracilis, gr acilis, and the th e two hamstrings (semitendinosus and semimembranosus). Medially and laterally, th is superficial sus pension of the knee resembles two inverted tripods. Medially, the suspensions are from the an terior superior iliac spine, pubic ramus, and ischial tuberosity. L ater ally , they are the ischial tuberosity, the sacroiliac joint, an d the

Figure 19-2 The psoas connects the lumbar spine (deep) with the lesser trochanter of the femur (superficial).

lateral side of the anter ior super ior iliac spine. It is our professional experience that knee problems originate in the knee only when

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Lateral pelvic tilt

there has been d irect trauma to the knee. A kn ee that tracks straight for ward implies that its attached muscles are in equal tension. Unequal tension in the knee muscles origi nates in the hip, which then modifies the tracking of the knee. Over tim e, using a knee in a deviated position will result in a "knee injury" which has originated in the pelvis. This analysis of k nee injuries is borne out by many bodyworkers, who report best results ameliorating the knee problems of dancers or runners when working with the hip. A big surprise in our classification of mus cles as super ficial or d eep comes when we c o n s i d e r t h e p s o a s (Fig. 19-2). This was Ida Rolf's favorite muscle; one might term it the Rolfer's muscle. It lies on the inside of the   body and attaches in feriorly deep within th e leg. It is never theless a muscle that cr osse s more than two join ts, and we therefore define it as an extrinsic, superficial structure. On th e

Figure 19-3 The tilt of the pelvis changes/is changed by the tone of the psoas.

inside of the pelvic bowl, the psoas is in fact the most superficial tissue. It crosses the whole of the pelvis with out attachin g to it. The upper attachment of the psoas is on the lower thoracic and upper lumbar verte   brae. It crosses the pelvic bowl at an angle, forming almost an S shape. It flows d iago nally over the pubic bone just med ial to the anterior superior iliac spine. Its lower attach  m en t is on th e insid e of th e thi gh, o n an inner projection of the femur called the lesser trochanter. I t can be palpated by placin g your finger on the anterior superior iliac spine and then moving just medially. The action of the psoas c a n be palpate d if yo u kick your leg while sittin g. The psoas is a m ajor factor in th e curv e of th e lower back (lumba r) regio n. It thereby indirectly determines the vertical tilt of the pelvis. When a pelvis is tilted side

Figure 19-4 Psoas and iliacus fasciae come together at the groin, forming the iliopsoas tendon. The iliacus fascia is continuous with the deep pelvic fascia, e.g. the obturator internus.

ways, the psoas will be tighter on one side and more flaccid on the other (Fig.

19-3).

The deeper layer of m uscles in the hip affects on ly the hip joint. T hese muscles   balance and stabilize the leg as one moves

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through them sequentially in walking. In a general way, these deeper muscles form almost a circle of muscle and fascia around the upper part of th e femur. T heir range of movement is small but their shortness gives them a great mechanical advantage. The extent of their effect is g reat because of their fascial connections up into the trunk and down into the leg. Trouble comes when the superficial and deep muscle layers are glued together. The iliacus muscle lies deep to the psoas inside the pelvis (Fig. 19-4). It lines the in ner pelvic bowl. It attaches along the entire inner curve of the ilium, just below the crest. In some people, the attachment extends medi ally to th e inner side of the sacrum and is thus often a factor when ther e are sacroiliac problems. The muscle continues down across the pubic bone in a funnel shape, crossing the h ip bone ne xt to the psoas. The 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 and/or vice versa.

follows the path of the psoas to the lesser tro chanter and often joins with it to f orm a com

continue down to the upper part of the inside

mon tendon. The iliacus lines the entire inner

of the f emu r. Of the se, th e add uct or lon gus is

surface of the pelvic bowl. A h abitual contrac

most commonly overused. It can be felt as a

tion in this muscle cr eates a f eeling of spasm

heavy cord just to th e side of the genitals. Its

on the insid e of the pelvis. B ot h iliacus and

tightness is unrelenting; it almost never

psoas are involved in th e place ment of the

relaxes.

pelvis and lum bar spine.

The adductor longus attaches to the in

The term "lower back" includes the lumbar

side upper thir d of the femur, just below the

spine, th e sacrum, and the two ilia. The ilia

att ach me nts of the iliacus an d the psoas. The

cus is a major inner determinant of the place

pectineus, another adductor, lies between the

ment of the ilium; the psoas is a major inner

adductor longus and the psoas. It can be felt

determinant of the placement of the lumbar

on palp ati on of th e gro in region, in a depres

spine. When the psoas is glued down onto

sion between the two longer musc le s. It is a

t h e il i a c u s, 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

short, flat, often fairly f lac cid muscle designed

  bones, as well as of the muscles, is lost. There

to dr aw the leg more toward the cen ter.

is not a free flow of movement through the

The largest of the adductors is the ad duc

lower back vertebrae, th e pelvic bowl, or th e

tor m ag nus. It arises as a large mass from the

femur. The delicate rocking movement within

wh ol e le ng th of th e pub ic ramu s. It fills th e

the pelvis that is essential for a fluid stride is

space deep to the gracilis and ends by wrap

lacking.

ping around the back of the femur, behind

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 attac h to the pubic ramus and the

adductor magnus is the basis for the charac

f r o n t o f t h e p u b i c b o n e (Fig.

teristic shape that is often seen on the inner

19-5). T h e y

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side of the th igh. Like the pectineus, it is usu ally underdeveloped and underused. When the knee is r otated out of true, th e gracilis takes over the fun ction of the adductor mag nus. The deeper muscle then cannot achieve its true tone and function. In addition, when the hamstrings are stuck to the adductor mag nus, the usual result will be spasms or cramps in the hamstr ings that no amou nt of stretch ing can relieve. At the intermediate level, there is a fanFigure 19-6 A midthigh cross section illustrating the major compartments: flexor, extensor (hamstrings), adductor, and abductor (ilio-tibial tract). The rela tionships change higher and lower in the thigh.

shaped m uscle called the gluteus medius on the side of the pelvis (Fig. 19-7). Its upper attachment is on the crest of the ilium. It funnels downward and attaches on the top of th e greater trochanter of the femur. It is partially covere d by th e upper margin of the gluteus maximus. When the upper border of the g luteus maximus is stuck to the gluteus med ius , th e hea d of th e fem ur is pushed into the hip socket, imped ing the free swing of the leg . A hallmark of th is kind of holding or shortening is the thickened tissue on the sid e of the hips, on the crest of the ilium. Underlying the gluteus maximus and me diu s ther e is a group of seven mu scles , six of wh ic h are classified as lateral rotat ors of th e l eg (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 " i s an anatomist's term, y et a move of purely lateral rotation is almost never made.These muscles serve more functions than purely lateral rotation of the leg . All seven muscles attach like a fan to the back part of the greater trochanter of the femur. We will discuss on ly some of them in detail. The lowest of th e lateral rotators is the quadratus f emoris. I t attaches on the lower margin of the greater trochanter and contin ues to the pelvic ischial tuberosities. It form s a part of the fold or crease of the buttocks,

Figure 19-7 The gluteus medius is influenced by the gluteus maximus, which overlaps it. The fascia of the glu teus medius is continuous with that of the abdomi nal obliques at the iliac crest. This is the structural basis for the more tenacious "love handles."

underlying the posterior portion of the groin   band. When the quadratus femoris and its fascial covering are tight, this is visible as a marked dimpling below the pelvis, which accompanies a "flat ass."

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Another lateral rotator, th e obturator internus, lies headward o f the quadratus femoris (Fig. 19-9). Its external part is a tendon that attaches on the gr eater trochanter and crosses the back part of the pelvic bon e, midway   between the ischial tuberosity an d the tail   bone. The muscle itself fills the lower inside   bowl of the pelvis, attaching ar oun d the cir cular opening called the obturator foramen. The muscle body is on the inside of the pelvis; its tend on attaches on the outside o f t h e h i p . T h r o u g h i ts c o n n e c t i o n w i t h t h e inner tissue of th e pelvis, the obturator in ternus is ver y likely to be connected with men strual or premenstrual tension and cramps in women. A very tight obturator internus in men tends to show as an extreme narrowness of th e pelvis at the bottom, with a correspon ding winging-out of the upper margin of the pelvis. The piriformis, also a lateral rotator, attaches to the back part of the g reater trochanter, slightly above the obturator in ternus. I t angles h ead ward to attach to the

Figure 19-8 The rotators of the hip include the piriformis, quadratus femoris, internal and external obtura tors, and the superior and inferior gemelli. For clarity we have omitted the lines of force of the minute gemelli; the obturator externus is not visi ble from this angle. We are including the lines of force of the gluteus minimus to complete the pic ture of this fascial layer.

underside of the sacrum. The piriformis crosses into the pelvis th rough the greater sciatic foramen, along with the large sciatic nerve. When this muscle is cramped or chron ically tensed, it fr equen tly giv es rise to the pain that is called sc iatica. The gluteus minimus is not included as a lateral rotator in classical anatomy. To us, th is fan-shaped muscle completes the larger fan of the lateral rotator group. It lies deep to the gluteus medius and attaches on the outsid e of th e ilium to the upper part of the greater trochanter. Tightness in the lateral rotators as a group provides the dimple in the back of the but tocks that looks so cute to some people. Ac tually, bodies with that dimple tend to walk with a waddle, with feet and legs splayed side ways. An attempt to correct th e situation by forcing th e feet to point straight forward is not successful because the problem arises in

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 m uscle use is necessary for stability in the leg as well as the shoulder. As one muscle or group of muscles is called into action to in duce move ment of the leg, the opposing muscle or mus cle group should relax and lengthen. Muscles are held in readiness (tonus) and can the n contract or lengthen as needed. It is difficult for most of us to allow the leg to move independently in its pelvic socket. Ideally, we should be able to swing the leg in the hip joint while th e pelvis rocks. You can test this by standing sideways on a stair with one leg and allowin g th e other leg to swing over the lower stair . Usually the leg can move only as a unit with the w hole side of the h ip. Figure 19-10 Fascial continuity: adductors -> obturator internus -> iliacus -> internal abdominal obliques -> diaphragm.

In walking, this fascial tigh tn ess in the hip results in a gait that is initiated in the lower   back, bypassing the hip joint—a str uttin g gait. The shape on th e insid e of the pelvic bowl (pelvis and sacrum) is like two bowls, a larger

the tightness of tissue in the hip. When the

  bowl on top of a smaller one. The upper,

hip is tightly bound , forcing the feet to track

greater bowl, which is the inner surface of

straight forward puts a torque into th e leg

the ilium, is lined by the iliacus muscle and

that peaks at the knee.

its fascia. The lower, smaller bowl is lined on

In discussing movement of the arm at the

its sides by the obturator internus and its fas

shoulder (Section 17), we described the nec

cia. Since the two bowls are con tinuous, it

essary sequencing of muscles as th e arm is

is easy to visualize the fascial continuity

raised. All muscles should not function simul

  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 down the lower bowl, a

(or part of the muscle) has its effect. This

sling-like arrangement of muscle and fascia

allows for precise control combined with

divides it into upper and lower parts. This

flexibility in the shoulder joint.

is the pelvic floor, also called the pelvic dia

In the hip, th e usual concept is that the leg must be tightly held so that movement will

phragm. Above this diaphragm lies the blad der, rectum, and in women th e uterus and

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105

ovaries. T he mar gin s of th e pelvic d iap hra gm are continuous with the obturator internus fascia.

(Fig.

19-11).

The pelvic diaphragm is composed of four muscles. The pubococcygeus is the largest of these. It connects the back of the pubic bone,   behind the pubic symphysis, to the inside of the second or third seg ment of the coc cyx . Fanning out from this muscle ar e the iliococcygeus, the ischiococcygeus, and the coccygeus. Collectively, these are often referred to anatomically as the levator ani. We refer to them in th is text as th e pelvic diaphr ag m. Blended into the muscles of the pelvic diaphragm are the sphincter muscles of the anus, bladder, and in women the vagina. There is a mutual balance between these sphincter muscles and th e sling muscles of the pelvic floor mentioned above. The tone of one is reciprocally determined by the tone of the other. When the lumbar spine is angled

Figure 19-11 The margins of the pelvic diaphragm are continous with the obturator internus fascia.

too sharply forward or backward , the tilt of the pelvis will follow suit. The soft tissue of

females, the perineum is bisected by the

the pelvic diaphragm will show the stress.

opening to the vagina. The labia majora are

The tone of this diaphragm is a major factor

frequently almost glued to the bones of the

in healthy reproductive and elimination

rami. This means that the opening to the

systems.

vagina is relatively rig id and lacks the

Below the pelvic d iaphr ag m, filling the space horizontally between the V-shaped   bones of the pubic rami, is the urogenital

resilience and flexibility that is important for sex and childbirth. The area between the ischial tuberosities

diaphragm, also known as the perineum.

and the tailbone is referr ed to as the isch io

In males it contains the perineal muscles,

rectal fossa. The urogenital diaphragm does

including the muscles at the base of the pen is.

n o t e x t e n d t h i s fa r b a c k . T h e o n l y m u s c l e

This area is often compressed by clenching

contained in this area is the external sphinc

the muscles of the buttocks, which has an

ter of the anus. T he remainder of the ar ea is

effect on th e function of the penis. In

filled with a fat pad.

TWENTY

The System of Horizontal and Vertical Myofascial Structures What we have tried to do in our considera tion of the m uscles of the body is to show how muscles and connective tissue interact, focusing in the greatest de tail on the trunk and pelvis. We use muscle anatomy to orient ourselves in the connective tissue bed. The connective tissue is responsible for the conti nuity of movement through the body. The connective tissue is responsible for establishing the spaces of the body by means 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 that cr oss through the body. The lower most two of these diaphragms are in the pelvis. The urogenital diaphragm is below, with the pelvic diaphragm slightly above it. There is the respiratory diaphragm in the trunk separating the abdominal cavity from the chest cavity. We have also mentioned the scalene muscles at the base of th e neck as acting like a diaphragm affecting the top of the lungs. In addition to this system of horizontal

Figure 20-1 The connective tissue establishes the spaces of the body.

myofascial structures, we have d escribed a vertical (core) system through the body 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  tinuum includes the interosseous membrane of the legs, th e deep fascia of the thigh, the internal fascial linin g of the bowl of the pelvis, and the mediastinum. It continues by way of the fascia around the cervical viscera (esophagus and trachea) to the back of the mouth and pharynx, and ends as the fascial septum that lies between th e two halves of the brain. Acute tensions are communicated through the body by way of these horizontal and ver tical connective tissue pathways. This results in a generalized tension through the inner aspect of the body that is characteristically

Figure 20-2 The plumb line.

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107

expressed as a kind of overall irritability. It is a feeling of "don't touch me" or "I can't cope" rather than an acutely debilitating pain. When we refer to spaces within the body, it should be remembered that these spaces are no t empty . The y are fill ed with organs, c on nective tissue, muscles, etc. The vertical and horizontal myofascial pathways we have described above exist as a normal par t of the structure of the body. W h e n this is out of bal ance , con nec tiv e tissue fillin g the inter vening spaces responds by establishing stress lines. These are secondary functional struc tures. They are established in response to need and may be resorbed as function is modified. For example, there are connections from the respiratory diaphragm down into the pelvis. Where the abdominal diaphragm lies adjacent to the vertebral column, it sends 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.

extensions (crurae) down as far as the upper part of the sacrum (Fig. 20-3). Just lateral to each side of the vertebral column, the psoas penetrates these crurae and extends up to attach to the lower vertebrae in the chest cavity. In this way, the fascia of the psoas is continuous with the fascia of the lower bor der of the diaphragm. Th e fascia of the psoas via the iliacus is also continuous with that of the obturator internus, which then blends into the diaphragms in the pelvis. In the back , the con nec tiv e tissue of the psoas is continuous with that of the quadratus lumborum and the erector spinae. On the sides, the respiratory diaphragm   blends into the transverse and oblique abdominal muscles. In the front, the diaphragm is continuous with the fascia on the underside of the rectus abdom ini s. The rectus abdominis provides a connection   between the fr ont of the respiratory dia phragm and the pubic bone. The abdominal

Figure 20-4 Fascial connection between pubic bone and humerus.

o b l i q u e s a re a c o n t i n u a t i o n o f t h e r e s p i r a t o r y diaphragm down to the crest of the ilium, continuing into the pelvic diaphragms by

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way of the fascia of th e iliacus an d obturator internus. Fascial pathways on the body surface also contribute to the balance among the diaphragms. These connections tend to be in broader and longer sheets, covering more of the body. On e conn ec ti on up across the abdomen is by way of the superficial abdom inals, extending across the pectoralis major to t h e a r m (Fig. 20-4). Fascial sheets on the sur face of the obliques tie upward into those on the serratus an terior und er th e scapula (Fig. 20-5). In the back, th e fascia over the gluteus maximus flows upward obliquely into that of the latissimus dorsi connecting on up into the Figure 20-5 Fascial connection from front of abdomen to upper back.

arm. The often leathery covering of the er ec tor spinae can immobilize the vertical play of any or all of the diaphragm s.

TWENTY-ONE

Reciprocity of Movement Spinal curves are reciprocal. Th e curve of the

restriction in your breathing. Notice that

lumbar spine is reflected in the curve of the

when the h ead is held very still, the br eath is

cervical spine. If th e lumb ar spine is curv ed

bo th shallower and more labored. I f yo u on ce

too far forward, the cervical spine will also be

again let your head be very easy, along with

curved too far forwar d. If th e lumb ar spine is

the rest of yo ur body, y ou ca n feel a greate r

too flat or straight, the cervical spine will be

ease in breathing. There is more fullness of

too flat or straight.

  breath with less effort.

It is tempting to classify th e balan ce of the

Another example of this can be seen in

spine by the way a person h olds himself when

walking. Allow your head and shoulders to

he is standing still. In actuality, the spine is

be as lim ber an d loos e as possi ble. If yo u can

like a spring, expanding and contracting as

even let them flop a bit, th is will give you an

the person moves an d breathes. The true diag

exaggeration. Then, while still walking, hold

nosis of the spine is not in its curvature but in

your head still. Concentrate on a thought,

its quality of movement. No part of a moving

and register how this h olding results in rigid

spine should be quiet or still. If on e segment

ity in the wh ole back. You will notice an

of the vertebral c olumn is being held still,

increased heaviness on your heels as you

freedom of movement throughout the spine

walk. After walking in th is more stressful

will be inhibited.

position, again let your head go easy, nod

When we talk about movement, we usually

ding gently yes (or no, if th at's your attitude).

think of large gestures like walking, doing

Feel how your back lengthens and moves

work, picking up the baby , wash ing the

with g reater ease. Your step will becom e

dishes, driving the car. Yet movement can

much softer.

  be as subtle as slow breathing during sleep.

These are two examples of how holding

A body never stops m oving. Even the smallest

one part of the bod y affects the rest of the

movement creates a ripple throughout the

  body. Th ey are deliberate gestures. We all

entire organism. The tissue through which

have holding patterns in our bodies that

this ripple is transmitted is the connective

are involuntary. Whether the holding is of

tissue. When connec tiv e tissue is in tone, it

a single muscle or of a larg er part, the whole

is much like the catgut on a pr oper ly strung

  body will be affected . When you hit the side

cello. It transmits vibrations; it transmits

of a table, the resonanc e of the blow vibrates

movement. So maybe we should say that

through the entire table. Similarly, any ges

when we are properly in tone, we hum—to

ture vibrates throughout a living body. We

each person his or her characteristic tone.

tend to forget that we are a sin gle vibration al

We can d emonstrate this for ourselves by two awareness exercises. Sit or stand , letting your head and arms be very loose, and sense

unit. Hold ing one par t still constitutes an interference with our resonance. There is a toy called a Slinky   , a highly r M

your breathing . Be aware of your breat hin g

tempered, very long spring coil of steel. One

with y our body relaxed as much as possible.

of the things that a Slinky will do is pull itself

If you th en hol d your head still (like starti ng

down stai rs. If yo u star t by pullin g on e end of

to think about something), you will sense a

the c oil down one step, each circle in the coil

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will pull the next one after it. This is an ex

tissue of the back, alte rnating from one side

ample of movement reverberating through a

to the other of the vertebral column.

structure. Although it is not made of steel, th e elasticity and organization of the connective tissue reverberates like a Slinky in the body. This kind of reciprocity of movement is

The erector spinae ar e cover ed by a heavy fascial sheet, th e lumbo-dor sal fascia, which   blends into the heavy connective tissue pad on the sacrum and coccyx. From the sacrum,

especially apparent in the spine. Because the

the fascia continues diagonally across the

superficial muscles are the longest, holding

  buttocks and on into the ilio-tibial band (Fig.

patterns at a superficial level affect a broad

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

expanse of the back. Hold ing at deeper levels

holding the legs have a clear effect on the

affects smaller segments. Usually, holding in

  back all the way up to the head. Conversely,

an area occurs at m ore than one level, an d to

problems in the back are generalized to the

a differen t degree at each level. Sideways cur

  buttocks and legs as well as to the h ead.

vatures of th e back, as in scoliosis, are accom pan ied by stepwise compre ssio n of the 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.

Through its connection with the fascia of the latissimus dorsi, the lumbo-dorsal fascia

Figure 21-2 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 dimen sion.

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111

mediates a reciprocal effect o n the freedom of the sh ould er and arm (Fig. 21-2). The fascial crossover point between th e trapezius and the latissimus dorsi (the dor sal hinge) is at about 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). Holding patterns or pain in th e arms (such as from a tennis elbow) are felt as a

i

Fascia of  erector  spinae m.

H

Fascia of  quadratus lumborum m.

spinal restriction in th is ar ea. In short, the fascial covering of the back is continuous with all other parts of th e body. The broad fascial co nn ec ti on s on th e surface of th e bo dy allow restriction s to be generalized over the

Fascia of  psoas m.

whole structure. This can give short-term relief in acute trauma, but ultimately such restriction becomes chronic and difficult to track d own and release. On the inside of the spine are the deep flexors of the tr un k. In the lumbar r egion, there is the psoas, which attaches to most of the lumbar vertebrae. The quadratus lumbo rum is a short muscle that lies between the psoas and the erector spinae (Fig. 21-4). T h i s muscle is defined as connecting the twelfth rib ( the lowest, sh ortest free rib) to th e upper mar gin (crest) of the iliu m. The quadr atus lumborum is the connection between the inside and outside of the bod y at the waist.

Figure 21-4 The deep muscles of the lumbar region.

The fascial sheets of the erector spinae, quad  ratus lumborum, and psoas are continuous (Fig. 21-5). This fascial blendin g travels later ally to for m the connec tiv e tissue covering of the abdominal oblique muscles and the rectus abdominis. Distortion in any one will distort all to some degree. In the lumbar region, movements are ob viously n ot straight f orward or straight back ward. The most frequen t mo ve me nt s of the lower back —walk ing, leaning over, re ac hi ng — all include twisting or spiraling. What is desir able is a balance of the twisting on the two sides. Most of us have a slight rotation to one side somewhere in the mid-trunk. Standing relatively still, one h ip and leg habitually stand slightly forward of the oth er, wh ile the shoulders and arms are reversed in rotation

Figure 21-5 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.

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(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 one direction, while the top half goes in the other. I n walking, the leg and hip that are slightly forw ar d have less distance to travel and therefore tend to move more straight forward. T he opposing leg and hip, which ar e slightly behind, have to work h arder and tr a verse a g reater d istan ce. Usually this side moves diagonally and with a swin g. The dif ference is perhaps a half an inch or less. Over years of constant use, th e side that works harder will show the str ain in the back. One side will shorten , giving the impression of a shorter leg and a slight limp. Very slight dif ferences in distance in the bod y create large effects. Figure 21-6 Habitual rotation of the body.

The peak of torsion in overall body spirals will be most apparent at the waist, wh ich thickens and shortens. Most people have no functional waistline and therefore few people have a concept of it. The waistline becomes apparent when the body unrotates and the lower free ribs literally lift off the pelvis. Mus cles and fascia on th e inside and outside of the v ertebral column hold the lower ribs down into the tissue accumulation on the   brim of the pelvis. As th e lower back unro tates and lengthens, a waistline may miracu lously appear. This can result in ecstasy and a new wardrobe for women. Men may experi ence consternation if they believe the pelvis is not supposed to exist except as a small path way be twe en th e large ches t an d large thig hs. Nevertheless, they too will have a more ami able relationsh ip with their tailor. The upward continuation of the erector spinae into the neck blends w ith the pad at the back of the head. The largely vertical action of these muscles is modified by a lat

Figure 21-7 For clarity, we have depicted the deep muscles of the neck separated on the two sides. The compos ite of the two sides make up the total myofascial complement.

eral pull from the more superficial trapezius. The flexors on the front of the n eck balance the erector spinae in back , which are exten sors of the neck. At the deepest level are two pairs of muscles that lie directly in front of

REC IPR OCI TY

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113

the transverse proc esses o f the cervical verte   brae. The upper pair (long us capitis) con nect the c ervical vertebrae to the base of the skull in f ront of the spinal column . These flex the head on the top cervical vertebrae. The sec ond set (longus colli) extend s down from the transverse processes of th e cervical v ertebrae to the tr ansverse proc esse s of the upper chest (thoracic) vertebrae. Th ese muscles flex the neck on the trunk (Fig. 21-7). At a slightly more superficial level, fanning out to the side, ther e ar e the scalene muscles. These attach to the transverse proce sses of the c ervical vertebrae an d continue on to th e surface of the fir st an d second ribs. These ar e active in both flexing the neck and turning the neck from side to side. At the most super ficial level, on the front of the neck, are the sternocleidomastoid muscles

(Fig.

21-8).

These large muscles m ove the h ead with re spect to the neck as well as movin g the neck vertebrae on the trunk. T he f ascial wrapping

Figure 21-8 Superficial fascia of the neck.

of all th ese muscles is continuous. In the neck, fascial gluing can occur between flexors

are not very apparent. I t was Ida Rolf's convic

and extensors as well as between lay ers, creat

tion that spin al balance relies chiefly on stabi

ing problems in the freedom of movement of

lizing the concave curves of the spine. The

the neck and head.

psoas stabilizes the concave inn er surface of

The ideal myofascial blueprint is thrown

the lumbar spine; the longus colli and longus

out of kilter when the head is thrust too far

capitis together stabilize the concave inner

forward. When this is the case, most h ead

surface of th e ne ck po rti on o f th e spine. I n

movements must be controlled by the sterno

Dr. Rolf's view, the dorsal curve of the spine

cleidomastoid. The erector spinae and the

is supported along its outside surf ace by the

trapezius are th en used alm ost exclusively to

rhomboids. This is an unusual view of body

hold the head on. Their function as extensors

mechanics, and one that depends for its logic

in balance with the flexors on the fr ont of

on questions of balance, mov em ent , and

the neck is r educed. When the head is too far

transmission of weight.

forward, these flexors on the f ront of the neck

Spinal curves are always changing. With

(longus colli and lon gus capitis) lack the span

every mo ve, incl udin g brea thin g, these

to function properly. The sternocleidomastoid

curves undulate, going from more curved

then becomes both the chief flexor and exten

to straigh ter and bac k. If there is f luid ity of

sor of the n eck. This is an awkward situation

movement through all parts of the vertebral

and one that lead s to very restricted move

column, the rest of the body will readily

ment of the head.

arrange itself into appropriate balance for

In the chest region, prevertebr al muscles

the person, time, and gesture.

TWENTY-TWO

Joints   Joints are the most complex and also the

when a joint is distended with too much

most interesting focus for the way different

fluid (fluid on the joint) , loosenin g the con

densities in con nective tissue affect and deter

nective tissue above and below the joint

mine movement. The differences among

results in a return to normal size. This can

  joints is thoroughly described and classified

  be accomplished without the need to touch

in anatomical texts. Our interest is in discov

the actual distended area.

ering the way s joints are similar to each other

The joint capsule is made up of fiber s that

and in analyzing the overall function of joints

have formed in the embryo in response to

within the connective tissue bed. In the tradi

directional tension lines between bones. A

tional classification of joints, there is the

mature joint capsule also lays stress lines to

implication that each joint functions in isola

ac co mm od at e the different rotation s of mov e

tion. Our attitude throughout this book has

ment. The result is an interweaving of fibers

  been that no one part of the body moves

around the end of the bones. This encloses

without interaction with all other body parts.

the fluid-filled space betwee n the bones, and

The elements of a joint are: • Two or mo re bon es; • T he relatively nonr esil ient ten don s and ligaments; • Th e fluid-filled joi nt capsu le;

i s 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) There is a tendency for connective tissue to wrap a joint as stress within the joint increasingly calls for more stability. When the join t is well-balanced and h as full range

• The mor e resilient musc ular and con  nective tissue combination known as myofascia. At the d eepest level, by means of th e fibrous joint capsule, the periosteum of one   bone is continuous with the periosteum of the next bone. Within the joint capsule,   bathing the en ds of the bones, is joint fluid. It is very similar in composition to the inter cellular matrix of all connective tissue. This description applies to all joints th at are tra ditionally classified as freely movable. Our feeling is that it also applies to those joints classified as slightly movable or immovable. They differ only in the proportion of fluid within the joint capsule. A normal joint com prises adjacent bones, which literally float wit h r espe ct to one ano the r. If th e end s of th e   bones ar e drawn too close to each other, irri tation of som e kin d will result. Conversely,

Figure 22-1 The joint capsule matures.

J O I N T S

115

of movement, this wrapping will be sufficient

has created is simply h eav y tissue padd ing

to stabilize the joint and yet f lexible enough

over a contracted and narrowed structure.

to ease off wh en the jo int is no long er in

The padding can become very tough, even

active use. When a joint is unbalanced or

like bon e. It is not possible f or this to have

shortened, we see an accumulation of excess

the resilience and potential of a truly flexible

tissue, what we would call "bandaging." This

structure.

  band ag ing cannot be released un til we can learn to trust the stability of th e joint.

Dr. Rolf realized that the bones of th e   body act as spacers within the connective

An example of what we are talkin g about

tissue bed. Bones are hard connective tissue

is the thickening and shortening that so fre

elements within the softer connective tissue

quently occurs in kn ees. Many knees are

elem ents of the body. Ea ch bo ne floats with

wrapped in such a way that they are held

respect to the other. The sk eleton as a whole

in a permanently bent position, unable to

floats within the fluid connective tissue bed.

lengthen out. Or the knee may be h eld in a

A joint is a mor e organized area of th is struc

locked-back position. In either case, the knee

ture, one where movement is expressed.

is tightly bound. A well-balanced knee is one

An analogy is the batten or strut in an

in wh ich the joint feels very slightly bent;

uphol stere d piece of furniture. Th e ma in

there is fluidity in the structure so th at the

support for the upholstered piece is fr om its

knee is on "go."

stuffing; the wood adds stability. The strut or

Wrapping or thickening is one hallmark of

  batten is what keeps the couch from sagging

what we call immaturity in a joint. The cause

with ag e. Likewise, we can con sider bones as

could be injury or lack of development or

  being present to prevent us from collapsing

r e g r e s s i on o u t o f n e g a t i v e e m o t i o n . T h e p h y s 

with y ears of use and disuse.

ical effect in the body, in the joint, is always

Underdeveloped structure is common in

contraction in the connective tissue structure.

the foot and an kle. A baby's foot at birth is

Moving a joint that is tightly bound will

no t yet funct iona l for walking . The heel (cal

eventually cr eate tissue irritation. This is felt

caneus) is drawn up into the ankle joint. The

as chronic joint pain.

foot projects m ore or less as a straight exten

Immaturity in a joint is the absence of ease

sion of the lower leg. This is a ballet dancer's

and full range of movement. This physical

dream but makes for stilted walking . Part of

immaturity is not usually a whole-body con

the structural maturation that comes with the

dition. We can h ave a well-for med and fully

transition from baby to child occurs in the

functioning rib cage and sadly lacking hips

foot. For stable walking , the heel must drop

and legs. This is a type that is often seen in

down and back. This also establishes the

men. The reverse is often seen in women—

necessary arches of the foot.

fully formed, voluptuous hips and a c hild-like top.

These have become stereotypes, symbols of

Movement of the ankle includes both flexion and sliding. In many people, the heel remains wedged forward into the ankle joint,

what is d esirable in a woman or man. A man

and sliding motion is lost. Ankle movement is

may h ave a small rib cage an d through the

th en limited to fle xio n—t he front of the foot

wonders of muscle-building create massive

coming up and down. This places excessive

  bulk on top. He can mock up th e look of male

strain on th e muscl es of th e shin . Ideally,

maturity that is currently favored . Yet his is

flexion in the front of the foot is counterbal

not a truly mature structure; he can not fully

anced by a sliding motion extending the heel

expand his rib cage an d shoulders. What he

down. In addition, in stepping down, the

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THE

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  joints of the foo t flatte n and then spring back

keep th e scarecrow uprigh t. These deep sup

into the arch as weight is transferred. This,

ports in the living body ar e so hard they

too, is lost when the ankle is immature.

almost seem like steel. Yet they , too, have

Immaturity of the ankles does not neces sarily imply an immature individual. And yet there will be a constant awareness of lack of support. The consciousness may simply be

their origin in the connective tissue sleeve   between and surrounding the bones, tendons, and muscles. Instead of a static image of bodies, we

that my feet h ur t. It doesn't mean that I nev er

would like to offer a different concept. Bodies

feel good about anything. It does mean that

are n ever completely still. When we are quiet,

even when I feel won derful, I am also aware

the fine mo ve me nt s of brea thin g and balanc

that my feet are bothering me.

ing are reverberating from h eel bone to skull.

Body types sh ow different ways of using

At a level below con scious awareness, ther e

the connective tissue as a whole. Our favorite

is the constant vibration of tissue that is in

imag inat ive illustration of this is to be fou nd

tone, ready to move.

in

The Wizard ofOz.

The Tin Woodsman is

In this sense, the body is much like a car

one common type. The outside of the body

that is not turned off. When it is not moving,

has been so toughened that the joints feel

it is idling. I ts movement is merely a shifting

rusted. We almost must ad d oil to get them to

into gear. We may think that in order to m ove

work. It's as though this person has no confi

we h av e to pull ourselves out of a deep immo

dence in the deeper structur e; most of the

  bility and iner tia, but this is not the case. We

support is on the surface.

can be aware of our constant movement and

At the other extreme is the example of

vibration. We can be aware that g estur e and

the Scarecrow. He is soft and structureless

activity are a shift of g ear. They are changes

and pliable on the surface. T his is what Ida

in the intensity and direction of movement,

Rolf ter med a "soft bod y." An ext rem e exam 

  but not a ch an ge in state.

ple would be a person who is double-jointed.

One expression of this attitude is in the

Yet within this str ucture, at the deepest level,

old song, "I wan t to dance with a dolly with

there is a thin core that is under extreme

a hole in her stocking while her knees keep

tension. This is similar to the thin stick s that

a-knocking and her toes keep a-rocking."

PA RT

FIV E

Practical Applications

TWENTY-THREE

Doing Bodywork Based on the Connective Tissue Concept As our ideas have gained clarity, we realize

where does it hurt; point with one finger.

that the connective tissue concept can be of

Does the pain radiate? Are there associated

use in any kind of bod ywo rk. It isn't possib le

pains in other body parts? What brings the

to provid e a "recipe" for work. What we can

pain on? When is it most intense? What

do in this section is open a way of thinking

makes it better? Was there an injury? Has

and an approach to tissue. Ideally th is will

there been a h istor y of repeated injury? Is

lead the bodyworker to develop appropriate

the pain constant or intermittent?

strategies for cond itions as they arise. This section is d ivided into several

Fro m the point of view of imm edi ate inter vention, probably the most important ques

subsections: evaluation, first intervention,

tion is, "How painful is it right now?" Th is

how to go deeper , how to touch, and how

will tell you when and how to in tervene. It is

to make changes last. We h ave taken specific

your best barometer for assessing when it may

conditions as examples for th e sake of

  be detrimental to do work. When acute pain

demonstration.

is not a problem, it is probably possible to

Evaluation— Example: knee pain

work directly on the area (see section on first intervention). Often knee pain arises only with move

Evaluation can be visual, through palpation,

ment. Cautious movement is a part of evalu

or by observing movement. It is not necessary

ation. What can the knee do with comfort?

to do an exhaustive evaluation but rather to

What movement creates the pain? Client fear

find a place to star t. The concepts underlyin g

and apprehension are an inevitable part of

evaluation are contour, symmetry, and pro

acute pain. Ideally this can be allayed to get

portion. In practical terms, this means com

a clearer picture of the actual tissue problems.

paring both kn ees from the front, sid es, an d

Reassurance that pain is not the same as dam

  back. It also means considering the extension

age sh ould help. Obviously it will be neces

of the knee down to the foot and at least as

sary to be gentle and slow. Your aim is to find

far up as the hip, if not farther. It is helpful

out wha t the kne e can do and exact ly wh en

to consider the anatomy involved. The knee

and where pain starts.

is composed of two bone s—f emur and tibia —

At this point, anatomical information is

and two outriders—the fibula and the patella.

essential to good visualization of the prob

It also he lpful to consider gravity/body

lems involved. For clarity we are using muscle

weight. The knee is the interface between

nomenclature; we are actually referring to

the torso/hips and the ground. The hip and

local tensions in the connective tissue bed

the ankle can be c onsidered upper and lower

(Fig.

extensions of the knee.

23-1).

The tibia is suspended by the hamstrings

The above are elem ents of practi tioner

posteriorly and by the quadriceps anteriorly.

evaluation. Full initial evaluation is a com

Medially and laterally, th ere is the adductor

  bination of these an d the client's report.

group and the ilio-tibial band , respectively.

Listening to the client and asking the right

The interface between the tibia and fibula can

questions at the outset are critical: Exactly

  be locked down by the popliteus behind the

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knee. Thus this very small muscle controls

the knee tissue against ever-gr eater knee flex

the interosseus membrane between these

ion and extension. This allows the client to

two bones. Tibial rotation is manifest at the

feel safe be cause he/she can control the

ank les. The degree of ten sio n in th e Achill es

degree of movement.

tendon is an index of severity of rotation   between the tibia and calcaneus. Evaluation is a sequence from visualization

It should be remembered that one cause of in termittent acute pain in the knee is a meniscal te ar . This is not an absolute contra

to movement to evaluation by touch. As we

indication to work; cautious easing of the

move the part, we are starting to evaluate by

  joint will be helpful. Ultimately, h owever,

touch. It is almost impossible to know when

there may have to be surgery. An absolute

evaluative touch ends and treatment touch

contrain dication to manipul ation of the knee

starts. If the pain is acute, it is potentially

(except by an expert) is a tear in one of the

hazardous to tre at the acutely pain ful area

cruciate ligaments. Such a tear may be f elt as

directly. It sh ould be possible to ease the pain

hyp erm obil ity of the knee in the anterior-

with educated intervention above and below.

posterior direction and is obvious with even

Your knowledge of anatomy and your careful

slight movemen t. A fracture is, again, an

evaluation will tell you where to start. Some

absolute contraindication to bodywork except

times it is helpful to work fairly far afield in

in the hands of an expert. If the client is able

other parts of the body—associated areas of

to walk into your off ice without crutches, it is

reported pain or probable areas of d ysfunc

unlikely that either of these two catastrophes

tion (see list in How to Make It Last section,

has occurred.

p. 126). Before we go more extensively into ments on treatment of acute knee problems.

First Intervention— Example: chronic neck ache

Eventually it will be possible to gently star t

Some practitioners are more experienced with

to work on th e fascial wrappin g of the knee

visual evaluation and some with palpation.

itself. A simple way to do this is to restrain

Furt herm ore, o ne of the oddities of bodywo rk

first intervention, we need to add a few com

tends to be that the more experienced the practitioner, the less extensive the evaluation. In part, this is because bodyworkers continu ally evaluate as they work. E valuation is n ot an endpoint, it is an ongoing process. It is important to start work with the most superficial layers of tissue. Wor king superfi cially usually will allow deeper tissue prob lems to emerge th at were not appar ent at first. The client will often report that the n ature or loca tion (or bot h) of the pain has cha nge d and he/she can often be more specific about the pain. This is to be e xpected as a normal part of practice. Early in practice, it can be confusing and humbling when this happens. Going too deep too fast will almost always Figure 23-1 Superficial muscles of the thigh.

create unnecessary problems and usually creates more pain.

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What does it mean to work on a superficial

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the tissue "layers" and direction of fascial

layer of tissue? How is this d one? Easily the

fibers. As you work, the fiber direction under

most important maneuver is to go into tissue

your hands will tell you what level of tissue

at an angle. Going straight in allows the tis

in the body you are working on. Th ere can be

sue no escape, no movemen t; the tissue is

times where no dominant tissue directionality

trapped. Going straigh t in also often causes

is apparent; this is common in the most

  bruising. In practical terms, this means that

superficial subcutaneous layers.

tissue is moved in a dir ection, toward an

Ida Rolf was wo n t to say, "I f th e tissue

intended endpoint. Once again, a knowledge

doesn't move when you go in one direction,

of anatomy is essential.

try going in the other d irection." This is a rule

In the neck and shoulder assem bly , the

of t h um b tha t has sto od us in go od stead for

most superficial muscle is the trapezius. It

ma ny years. It should be poi nted out that

fans out from the occiput, th e cervical verte

fascial fibers do not n ecessarily follow the

  brae, and the upper thor ac ic vertebrae, across

exact path of the associated muscle fibers.

the sh ould er blades to the collarbone s and

Fascial fibers respond to th e directional pulls

the acromion. The sternocleidomastoid mus

exerted on them; muscle fibers are one ty pe

cle is a fairly superficial rope from the mastoid

of pull, but the re ar e oth ers . Fo r ex am pl e, th e

process to the sternum and the clavicle. Poste

fascia superficial to the trapezius has multiple

riorly and deeper, the levator scapulae sus

fine layers in multiple direction s. It is not

pends the shoulder blade from the cervical

necessary or possible to organize each of th ese

vertebrae. At a similar depth, the scalenes

fascial sheets. Creating order in one tend s to

suspend the ribs from the cervical vertebrae

organize sheets above and below. Direction

(Fig

of work may be toward a joint, away from a

23-2).

Even this partial list of the muscles in

join t, al ong the pla ne of th e mu scl e, or eve n

volved in chronic neck ache makes it obvious

across the muscle fibers. With attentiveness

that the associated fascia is a web; the muscles

and delicacy of touc h, your hands will tell

are not layered like a cake, but interwoven

you what to do. What you are hoping to

like a mesh. A reasonable working knowledge

achieve, the feeling you want under your

of local anatomy gives an understanding of

ha nds , is th e feel ing of elasticity .

Figure 23-2 Fascial tensions in the neck and back.

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The shoulder and neck assembly is one of

Our struggle in this book has been to put

the more complex structures in the body. One

into words what is so obviously happening

image that gives an ov erview is that tissue is

under our hands. We find it impossible to

gathered up into the neck much the way a

give a verbal description of intention. The

plastic bag is gathered at its closure. In this

concept is often apparent when watching

image, an y twist on one part of the neck will

another bodyworker . It can be a useful ques

spread downward to the structures below.

tion when the progress of work is stalled. A

Therefor e as the supe rficial layers of the n eck

change in in tention or goal can restore f low.

are eased, tension below also starts to ease.

What to do when an area is touchy or tick

Bones will shift their home position; muscles

lish? We have found that the tissue d eep to

will shift their plane of action. This happens

a ticklish spot is invariably excessively tight.

gradually, over time. Much happens between

Even though ticklishness has a "don't touch"

  bodywork sessions. Changes are subtle at first;

aspect to it, it is a signal that bodywork needs

they are cumulative and soon become clearly

to be done. A ligh t touch is generally not

apparent.

helpful. Easing around the area can be usef ul.

At some point going deeper becomes a

One maneuver that can work is to make use

natural extension of the work in progress.

of the body' s neural wiring. Light touch an d

Occasionally this is a therapeutic decision,

deep touch are mediated by two different sets

more often it is the obvious next step. One

of n erve endin gs. It is possible to place the

sign is that the tensions start to be more obvi

whole hand firmly over the sensitive are a

ously associated with specific muscle 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 lig ht

With deeper work there is always the

touch, it will now be necessary to ease the

potent ial of disco mfor t while working. Some

tissue by working f ur ther afield. In neck pain,

clients are able to feel through this m omen

working at the rotator cuff, the shoulder

tary d iscomfort to the relief that is h appen

joi nt, t he back of th e ul na just ab ove the

ing. Their usual com ment is th at it is "g ood

elbow, or the marg in of the occiput will bring

pain." There are at least two components to

relief.

these sensations. Th ere is the tissue sensation,

These are not by any means the deepest layers. We are workin g our way gradually

which can be warm or hot or burning. This is akin to what happen s when you move a

through the layers over a number of sessions

part that has not moved for a long time. It is

—three or four spaced about a week apart.

the characteristic feeling of connective tissue

The client's report of pain and your hands'

stretching. Another component of tissue pain

report of tissue resistance will be your g uid es

is very much lik e a star tle response; it is more

on how fast to progr ess. It is almost never

mental than physical.

advisable to use force to go th rough pain or

Both aspects of tissue sensation will usually

tissue resistance. This brin gs us to the diffi-

  be presen t, but one will be more prominent

cult-to-describe, intangible concept of inten

than the other. In either c ase, it is useful to

tion. Intention has to do with how deep your

make sure that the client is not holding his/

hands go, how deep your focus is, how deep

her breath. A lon g slow exhale is the best way

you want to get with a giv en maneuver. It is

to ease the strain and allow the stretch. It is

hard to believe that intention is a major fac

also good to focus attention exactly where

tor; it is even harder to believe that ther e is

the stretch is occurr ing and/or to move a

any such thing as intention.

related body part (wig gle th e fing ers). T here

DOIN G

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ON

THE

are theoretical reasons why these maneuvers

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The rotators of the hip attach to the ilium ,

work but it's probably enough simply to know

ischium, or sacrum. Although they are small,

that they do wor k.

they are short an d d eep; they powerfully

To finish up treatmen t of neck pain, the

influence the basic structure of the pelvis

deepest structures under tension will be the

when they are in spasm. T hey are a major

levator scapulae and the layers of th e cervical

factor in sciatic pain. They can be readily

muscles closest to the vertebrae. T he small

influenced by wedging the space behind the

transverse muscles at the atlanto-occipital

greater trochanter and asking for straight leg

  junction can be so contracted as to be barely

external

palpable. Working in layers to ease th ese is

rotation

(Fig.

23-3).

The ischial tuberosity is the bottommost

the answer. In addition, two movement ma

edge of the hip assembly; it provides an en d-

neuvers will be helpful: a small chin thr ust

point for the tendons of the hamstrings.

(like a nod) and turning the head. When

When the hamstrings are tight, they pull

turning the head, the movement is initiated

downward on the ischium. As a result, the

from the angle of the jaw just below th e ear,

sacrum is overworked with any movement.

which is a way of creating precise movement

Release must necessarily include work to

  between the atlas an d axis.

release the hamstrings. How to know whe re to start? Observing

How to Go Deeper— Example: chronic sciatica

normal movement is usually helpful—walk

At the deeper level, anatomical knowledge is

principles was "take the part to normal and

essential to accuracy. Sciatic pain arises from

make it move." We want to evaluate the bal

tension on the sciatic nerv e, usually at its

a n c e d m o v e m e n t o f t h e j o i n t — t h e i n i t i al

outlet, which is variably located n ear the mid

movement from an ideal home position. For

dle of the sacro iliac junction. Sciatic pain is

testing purposes only, in the hip and leg, the

ing, sitting, stan ding. One of Ida Rolf's f irst

most commonly a radiating pain, extending to the thigh, leg, or foot, depending on th e portion of the n erve that is impinged. Piri formis pain, on th e other hand , is local to the hip, does not r ad iate, an d can be elicited by pulling the bent kn ee across the body. In piri formis pain, it is usually possible to palpate the taut rope of the muscle thr oug h the over lying gluteus maximus. The piriformis runs from the in side of the lower tip of the sacrum to the greater tr ochanter of the femur. The relationship of the piriformis to the sciatic ner ve is variable. Piriformis ten sion can con tribute to sciatic nerve pain. The nerve is not entrapped by bon e but by the ligamentous bindings of the sacroiliac junc tion. As the tissue lay ers of th e hip assembly start to release, the location of th e sciatic pain and its radiation of ten changes. This is in f act a sign that work h as been effective.

Figure 23-3 Rotators of the hip.

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TH E

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ideal standing position is as follows: feet

is a variable mid-back location where shoul

together, ankles touching, heels about an

der movement and body support intermesh.)

inch apart. In th is position, a shallow kn ee

The groin and particularly the ing uin al liga

  bend will gr aphic ally reveal tension s in th e

ment are anterior aspects of sciatic pain.

sacrum and groin. In the knee bend, the knee

When there are true physical deficits such

should come straight forward over the second

as a scoliosis or a missing portion of a verte

toe; th e back is kept straight. A second move

  bra, there will be an ongoing need for body

ment, leaning over to touch the toes, shows

work. This does not mean an office visit once

the ability of the hams trin gs to len gth en and

a week or even once a month. It can mean

the ischial tuberosities to appropriately

a batch of work every couple of years. The

widen.

client is th e best judge of what he/sh e need s.

Three main strategies interact in this deep

Under stress, whether traumatic or repetitive,

level of work; tra cti on, tissue stre tchi ng, an d

the body will ten d to return to patter n. T his

client movement. Traction can be passive or

does not mean th at earlier bodywork was not

active on the clien t' s part. Active traction

effective. Generally speaking, renewed work

involve s stretch ing to the limit of the gesture.

will be easier, less uncomfortable, and prog

For example, a heel stretch activates the

ress will be faster.

Achilles tendon, the back of the knees, the This can be combined with other movements,

How to Touch— Example: carpal tunnel syndrome

e.g. heel stretch with h ip rotation or leg lift.

In this section we ar e bringing together poin ts

Movements should be guided for precision to

about touch from prior sections.

hamstrings, and up into the ischial tuberosity.

give maximum 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 guidin g principle in soft tissue work is

accident, repeated injury, or r epe titiv e use

"wh at' s do ne is do ne ." Dr. Rolf used to say, "If

under stress. C ar pal tunn el syndrome is a

at first you don't succeed , get the hell out." A

classic example of repetitive use und er stress.

more long-winded way of saying the same

A most common version arises from compu

thing is that wh en tissue in an area won't

ter use. T he gesture includes tensely staring

stretch, it's because it's not ready to stretch .

at a small (usually too low) screen while over-

Work in another area has to happen f irst.

focusing the eyes and thrusting the head

The art of a bodyworker is knowing where to work next. Par tly this is a matter of experi

forward. This sets up an imbalance at the shoulder—the scapula rides up, the clavicle

ence. Work can proceed contiguously: sacroil

and acromion are elevated, an d the arm has

iac junction—lumbar area—lower ribs. Work

lost its base of support. Even if the screen is

ca n mo ve to th e ot her side of th e joi nt. O ne

not too low and the keyboard position is ade

non-obvious sequence involves looking at the

quate, prolonged eye tension and head thrust

cou nte rba lan cin g structure. In the case of the

create a problem. Tension and overuse are

hip, th is would be the spine an d the bridge

the culprits here. Fr om this brief analysis it

would be th e psoas. Just as the position of the

is obvious that there cannot be much help

foot ( by way of the leg) fixes the angle of the

for carpal tunnel syndrome without work

pelvis fr om below, so doe s th e pos iti on o f th e

on the shoulder, neck, and occipital ridge.

spine fix the pelvis from above. The holding

(B) Acute spasm is a sig nal for caution.

pattern can originate in the lumbar spine, at

Work can begin on th e superficial layers or

the d orsal hinge, or even the occiput. (As we

on surr oun ding areas. The idea is to g ive the

have explained in the text, the dorsal hinge

tissue under spasm relief before workin g on

DOI NG

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BASE D

ON

THE

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it directly. I n acute car pal tunn el pain , it is

sheath around the wrist, respond s well to this

helpful to reduce tension in the interosseus

approach. It is also useful wher e tissue is v ery

me mb ra ne of the fore arm and to restore free

tight but not in spasm—behind the elbow, on

rotation between the r ad ius and ulna at the

the arm just below the shoulder joint (junc

elbow. Almost always, there is a lock on

ti on of th e trapeziu s an d delt oid) , and just

movement of the ulna 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

elasticity here will start to ease the acute pain

support under a structure being worked in

at the wrist.

this way.

(C) "Resistive movement" is our phrase for

(F) On e of th e mor e subtle aspects of bo dy 

th e ma ne uv er of wed gin g a tissue space op en

work is recognizing and asking for appropriate

while the client moves. In carpal tunnel syn

movement. Most kinesiology texts describe

drome, th is is particularly useful in open ing

range of motion; this is not exactly what we

the spaces between the small bones at th e

are looking f or. We want to define and use the

  base of the hand. One specific example of a

initial gesture from the "home" position. For

small muscle that seems to get particularly

exa mpl e, the hom e posit ion of the elbow

tight is the opponens, which adducts the

while lying on the back is pointing away from

thumb across the palm. Wedging at the

the trunk. This is not the "anatomical posi

  base of the thumb while ask in g the client

tion" described in texts. Normal movement

to adduct the thumb will eventually release

here in our ter ms is the ability to slide the

this area. Wed ging on th e opposite side of

elbow away from the body and back without

the hand (hypothenar space) produces further

twisting at the elbow or elevating the shoulder.*

opening. Although the hypothenar move

When lying on the back, the home posi

ment is subtle, there is a gesture lik e grasping

tion of the scapula is flat against the ribs, part

with the base of the hand that will help this

way down the back. In normal movement,

opening.

the scapula does not rise with movement of

(D) Getting th e feel of tissue is an ongoing

the ar m. In fact, it dr ops slightly as a coun

study f or a body worker. Th e ultimate goal is

terweight as the arm is raised. When lying

to move the fascial sheaths in such a way as

on the back, the home position of the wrist

to restore elasticity . Some cues: Lift the tissue,

allows the palm to re st flat with elbow point

try not to compre ss it. Be sure th at you are

ing away from the trunk. When raising the

taking the tissue in a direction rather th an

hand,it should be possible to lengthen

compressing it to the bone. Be attentive to

through the palm by first raising the finger s

anatomy; fiber direction will often inform

and then raising the rest of the palm in sec

you about the depth of tissue you are inf lu

t i o n s (Fig. 23-4). F l e x i o n i s t h e s a m e r o l l i n g

encing. T ry not to overwork tissue; when new

gesture in rever se.

stretch has been ach ieved, let the tissue rest

(G) Using movement allows freeing of the

and integrate. Know that a tense surface layer

structure at a level unattainable with the use

will usually have fascial fibers going in many

of ma nip ula tio n alon e. However, this mus t

directions.

  be precise, educated movement, as we have

(E) A special approach to tissue involves

described above in the case of the arm. It is

going across th e direction of tissue fibers. This is not a common maneuver; it can be very helpful in the rig ht place. In carpal tunnel syndrome, the retinaculum, a thin binding

*For an excellent exposition of this concept, see Ida P. Rolf, Confinia Psychiatrica, Vol. 16, pp. 77-78, 1973. Avail able from the Rolf Institute, Box 1868, Boulder, Colorado 80306.

126

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change is recent, the comparison is most vivid. Too much information can be overwhelm ing. A glut of new body sensations is merely confusing. Keep in mind that in the period   just following bodywork, body and mind are in a fluid state. One or at most two new things to focus on is all th at can reasonably   be incorporated. One of the client questions that bedevils the bodywork er is "Am I doing it righ t?" Am I walking right, breathing right, sleeping right? The only way out of this dilemma of "T ight ness" is to help increase client sensitivity. The feel of the body is the best guide. An ide Figure 23-4 Wedging the muscles of the forearm in combina tion with movement of the hand.

alized "correct" position has to be grad ually approached. For example, in a client who is pigeon-toed, forcing a straight-ahead foot position before the knees and especially the

generally not possible to use movement early

hips can accommodate the new position is

in manipulation because the structure is too

damaging to the structur e as well as confusing

compressed to get accurate movement. There

to the client.

are exce ptio ns, of course. Wit h som e ma nu al

We have alluded to the need for work on

assist, correct movement may be possible

compensating patterns. Knowing where that

early on.

compensation is likely to be is often a matter of experience. We list a few be low that have

How to Make It Last The element of time is important in body work. We have talked about not diving in   before the structure is r ead y to open, of pre paring the way. Another aspect of timing is

  been useful to us: carpal tun nel

nec k and shoulder

sprai ned ank le

twel fth rib

sciatic pai n

lu mb ar verteb rae, dorsal hinge, atlanto-occipital

the integration that happens between sessions

  junction, short leg ,

and af ter a gr oup of sessions. This is an exam ple of latency in th e learning process. It is just as necessary to allow time for integration   between work as it is to do the work. Client education is an essential part of   bodywork. Ideally this has been happening in an ongoing way throughout the sessions.

groin, and psoas kne e pain

hip; som etim es ankle

shou lder bursitis

ribs and dia phr agm ; little fin ger

ten nis elb ow

wrist

As Dr. Rolf often said, "Wh ere you think it

A primary goal of such education is refining

is, it ain' t. " We have used th e conn ective tis

the ability to sense physical change. There

sue concept in the context of Rolfing and it

will be changes in stance, shoulder height,

has been valuable to us in opening up new

posit ion of the ar m— th e best time to not ice

vistas. We hope that it will expand your h ori

these is when the change is new. The mind

zon as well, no matter what tr ad ition of body

learns best by comparing sensation; when

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, 21-6. 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, 21-3.

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, 20-3. 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, 21-5. pubic band/strap 12-2 A&B. quadratus lumborum m. 21-4, 21-6. rectus abdominis m. 5-2, 12-3A, 12-3B, 13-1A, 15-6, 20-3. 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, 21-3. 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. 23, 99, 101-102, 119 atlanto-occipital junction 68, 70, 123, 126 belly band/strap 74-75 calcaneus 115, 120 cervico-dorsal junction 29, 65, 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 fibrocartil age 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 53-58, 65 Odent, Michel 22 pelvic diaphragm 104- 105 , 106, 107 piriformis m. 103, 123 primitive streak 6, 7, 8 proprioception 49-50, 83-84 psoas m. 42- 43, 63, 100 -10 1, 107, 111 , 113, 124, 12 5 pubic band/strap 62, 75-7 7, 1 02 Reich, Wilhelm 44 Rolf, Ida P. vii, ix, 2, 15, 27, 28, 36, 38, 43, 65, 100, 113, 115, 116, 121, 123, 124, 126, 131 sacro-coccygeal junction 65, 67, 75 sacro-iliac junction 34, 77, 98, 123, 124 sphenoid b. 67, 68, 69-70 Sutherland, W.G. 69, 70 tendon/ligament formation 3, 5, 13, 14, 15, 43, 44, 53, 57, 58, 73, 76, 77, 85, 87, 95, 97, 99, 101, 103, 116, 123 umbilical band/strap 74-75 urogenital diaphragm 76, 105, 106