Massage & Bodywork

MAY | JUNE 2016

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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 109 3 The ITB (visible as an indentation at the arrows in these thigh cross-sections) extends deep within the leg via an intermuscular septum that attaches it to the femur along its entire length. The posterior aspect of the body is at the top of the image; note also the attachment of the gluteus maximus to the ITB. Image courtesy the National Library of Medicine Visible Human Project, used with permission. our work, it may be helpful to imagine that our work sensitizes and gently awakens the sensory and coordinative capacity of our own highly sentient lateral line. ILIOTIBIAL TRACT TECHNIQUE With your client comfortably side-lying, gently use the knuckles of your soft fists to engage your client's skin and superficial fascia (Image 5, page 110). The bony prominences of the knuckles have the right balance of slickness and hardness that will allow you to modulate the amount of pressure and friction you use, so you can precisely tune the pressure and speed of your technique to your client's comfort level. With slow, patient, and gentle touch, apply friction to the skin and superficial fascia of the side of the leg. Begin at the hip, and as the tissue softens, its viscoelastic change will allow you to glide distally to the knee. Work layer by layer, a little deeper each time, making sure your pressure has the right balance of evoking sensation (which is the point of the technique), while not being so intense or painful that your client begins to tighten, guard, or resist. After a few slow passes, you'll be able to feel past the now-mobile surface layers to the deeper layer of the fascia lata and ITB. Remember that this deeper, denser ITB layer is the top of a Y-shaped arrangement that goes all the way to the femur (Image 3). Variations include active knee or hip movement; using a gentle forearm instead of a soft fist; or Advanced-Trainings.com instructor Larry Kola's "Frozen Hose" The highly sensitive ITB can be thought of as a lateral-body sense-organ, analogous to the lateral-line sense-organ of a fish (visible as a row of dark spots) which helps the fish sense movement and force vectors. Image courtesy A. Pogrebnoj, used under CCA3.0. 4 compression, such as that from a roller or elbow, would provide very little stretching force anyway). 3 This is in line with research showing that the forces needed to produce change in high-density fascia (such as the ITB) are probably much too strong to be accomplished by manual manipulation. 4 However, others have countered with the observation that many people's function and symptoms seem to improve as a result of ITB work. 5 In our Advanced Myofascial Techniques trainings, this has been our faculty's experience as well—we see many benefits to including the ITB in our protocols, and work it in both our hip and knee sequences. It is very likely, however, that the improvements seen are not the result of any permanent lengthening of the ITB. In fact, a more up-to-date view of fascial properties emphasizes the sensitivity (mechanoreception, nociception, proprioception, etc.) of fascia over its mechanical qualities. Dense fascia like the ITB is richly innervated with many kinds of mechanoreceptors, such as Golgi tendon organs (sensitive to strong stretch) and Ruffini corpuscles (which sense both stretch and tangential, or shearing, forces). Both of these mechanoreceptors lower tissue tone when stretched with slow, deep pressure. 6 As anyone who has used a foam roller can confirm, the ITB is sensitive. (And so are the tissues around the ITB, such as the highly innervated loose connective tissue and fat between the ITB and the tibial condyle, which is thought to be a major source of ITBS pain. 7 ) The function of sensitive tissues is to sense, and in the case of the ITB, it's likely this sensing helps us coordinate and stabilize our standing, walking, and running. In other words, we use our ITBs to perceive the forces passing around our hips and knees. The sense-organ capacity of the laterally positioned ITB makes it analogous to the lateral-line sense-organ of fish, which use theirs to sense the movement and forces around them (Image 4). So rather than thinking about lengthening the ITB with

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