Issue link: https://www.massageandbodyworkdigital.com/i/78617
MYOFASCIAL TECHNIQUES Once you've assessed both sides, spend comparatively more time on the side where you found the harder ligament or less boney space. Beginning with the upper or proximal end of the ligament, find a level of pressure that your client can relax into, and wait for a sense of tissue release in each place before moving slightly to the next part of the ligament. Avoid sliding or friction—static, focused, firm but receptive touch will allow your client to release the tissues in a way that won't be possible if your touch is active or moving. Around the coccyx itself, work patiently to gradually release the ligaments and tissues surrounding the tailbone using sensitive, stationary thumb pressure. Again, spend more time on the shorter, harder, or narrower side of the coccyx. Rather than attempting to straighten any boney crookedness you find in the coccyx, your goal is evenness of tissue tone on each side of the tailbone, along with gentle desensitization of any painful or excessively guarded areas. If the coccyx has been injured, for example in a fall or in childbirth, it can be extremely sensitive. If you work slowly enough that your client can continue to relax and breathe freely, you'll see any hypersensitivity diminish. After working the upper end of the sacrotuberous ligament, continue working down the length of each ligament, one area at a time. If there is peroneal pain or numbness, pay special attention to the midsection of the sacrotuberous ligament, since it is here that the pudendal nerve can be entrapped between the sacrotuberous ligament and the deeper sacrospinous ligament. Continue your step-by-step release until you reach the ischial tuberosity. Alternatively, you can add passive or active leg rotation to access different aspects of the ligament (Image 6). Another alternative is to work the sacrotuberous ligament with your client in a side-lying position, carefully using the elbow to address the ligament on the lower side of the body. Finish your sacrotuberous ligament work on each side with special attention to the medial aspects of the tuberosities and ischial ramus, where pudendal nerve impingements can also occur in the area of the ligament's falciform process (Image 1).6 SUMMARY Done sensitively and properly, this work will feel deep and very effective, rather than invasive or overly personal. Including the sacrotuberous ligaments in your work will help you more effectively address a wide variety of structural and functional conditions, reflecting the critical role these structures play in efficient posture and function. ABMPtv.com "Sacrotuberous Ligament Technique" Watch Til Luchau's technique videos and read his past Myofascial Techniques articles in Massage & Bodywork's digital edition. The link is available at Massageandbodywork.com, at ABMP.com, and on Advanced- Trainings.com's Facebook page. Notes 1. S. Gracovetsky, The Spinal Engine (New York: Springer-Verlag, 1988). 2. J.P. van Wingerden et al., "The Spine-Pelvis-Leg Mechanism; with a Study of the Sacrotuberous Ligament," First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint (San Diego: Rotterdam ECO, 1992): 147–8. 3. Warren Hammer, Functional Soft-Tissue Examination and Treatment by Manual Methods (Connecticut: Jones & Bartlett Learning, 2007): 438. 4. A. Vleeming et al., "The Sacrotuberous Ligament: A Conceptual Approach to its Dynamic Role in Stabilizing the Sacroiliac Joint," Clinical Biomechanics 4, no. 4 (1989): 200–3. 5. It would be ungracious not to mention Primal Pictures here, to whom I owe much thanks for the use of their outstanding anatomical imagery, which I use with my clients, in our trainings at Advanced-Trainings.com, and in this column. 6. The falciform process of the sacrotuberous ligament, present on about five people in six, blends with the fascial sheath of the internal pudendal vessels and nerves. Til Luchau is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is also a Certified Advanced Rolfer and has taught for the Rolf Institute of Structural Integration for 22 years. Contact him via info@advanced-trainings.com and Advanced-Trainings.com's Facebook page. Visit the newly designed ABMP.com. Log in. Explore. Enjoy. 117