Issue link: https://www.massageandbodyworkdigital.com/i/398416
F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 107 As their name suggests, the iliolumbar ligaments connect the iliac crests to transverse processes of the lumbar vertebrae (Image 1). Rather than being discrete bands of tissue, as they are usually depicted in anatomy illustrations, these ligaments are simply areas of greater thickness and fiber density within the sheet- like TLF. This area's tissue density varies between different individuals, and this means we need to approach each person uniquely. You'll find these ligaments are easily accessible on some people, while others may require several sessions of preparatory work—differentiating and increasing the elasticity of each of the outer layers—before you can comfortably access the iliolumbar ligaments. Some sources even describe the iliolumbar ligaments as too deep to be palpated in living bodies, since they are just inside (slightly anterior to) the iliac crest. 5 Although it is probably true that palpating the iliolumbar ligaments is impossible from a posterior direction (for example, working from behind with a prone client), our thorough preparation of the surrounding tissues and the use of a side-lying position will allow us to gently approach the ligament from an anterolateral direction. This allows us to access the ILL by going around and in front of the thick mass of the erectors. After preparing and relaxing the outer layers of the low back and hip, including the erectors and the iliac crest region, use your two thumbs together to slowly, gently sink into the area just anterior to the iliac crest, and just anterior to the mass of the erector muscles (Image 2). This area will be sensitive or even ticklish on many people, so a slow, patient approach is imperative. Take your time, and while you do, care for your thumbs by maintaining a small amount of flexion at each thumb joint. Stop and readjust your position, body use, pace, or direction (or do additional preparation) if the work is uncomfortable for either you or your client. Once you've arrived at the lower corner of the space described by the iliac crest's juncture with the lumbars (Image 3), pause and allow your client to relax even more. Small, active movements of your client's hip, or deep, slow breathing can facilitate the reduction in tonus, increased fascial elasticity, and proprioceptive refinement that are our goals. Patiently, gently, with minimal movement on your part, work both left and right iliolumbar ligaments. 12TH RIB TECHNIQUE Ida Rolf, the originator of Rolfing structural integration, placed special importance on freeing the 12th rib. 6 As the posterior bony attachment of the diaphragm, and a stopover structure for many myofascial layers of the low back (including the TLF, Image 4, page 109), the smallest pair of ribs plays an outsized role in posture, breathing, and back health. The Iliolumbar Technique. Thoroughly preparing the outer tissue layers of the low back is important before attempting to work at the deep level of the ligaments. Images courtesy Advanced-Trainings.com. 2 3 Our aims in working with the 12th rib region are increased mobility, fascial elasticity, and proprioception. All of these are beneficial in and of themselves, and often result in less back pain. Although the 12th rib is a floating rib and so potentially quite mobile, when there is back pain, the rib is often sunk deep into dense, inelastic myofascial structures of the lower mid-back. When these structures are differentiated and proprioceptively awakened, people often experience increased fullness of breath, as well as freer, less painful movement of the back. As the upper border of the lumbar space (the soft-tissue region between the rib cage and pelvis), the 12th rib can be thought of as the complement or reflection of the iliac crest, which forms the lower margin of this same space. Starting far apart at their medial junctures with the spinal column, the 12th rib and iliac crest are much closer together at their lateral extremes. The distance between the end of the 12th rib and the iliac crest varies from person to person, affected by both the overall shape of the skeleton (such as torso length), and the elasticity of the TLF and the muscles it surrounds. When these soft tissues are denser and shorter, the distance between the rib end and the crest diminishes, and in some cases (such as with very short, compact waists or severe scoliosis) the rib can actually overlap the iliac crest and be found inside the pelvic bowl. Left/right differences in this space's size can indicate spinal scoliosis or rib cage asymmetries, even when too mild to be otherwise noticeable. From a classical Rolfing and structural integration perspective, more distance and greater left/right evenness are generally considered desirable. 7 We take a slightly different view in our Advanced Myofascial Techniques approach, where we emphasize evenness of mobility, elasticity, and body sense