Issue link: https://www.massageandbodyworkdigital.com/i/365665
116 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 4 MYOFASCIAL TECHNIQUES to the latissimus dorsi that connects the back to the arm (Images 1 and 3). Using a soft fist, sink into the space between the iliac crest and the 12th rib. Use a light touch so you can glide from the lateral to medial aspects of this space using slow, patient friction to move each layer in turn. Use no lubricant; the friction is the therapeutic tool that increases layer differentiation. Check with the client to make sure your pressure is comfortable—the TLF sub-layers are richly innervated and are sometimes more sensitive than the deeper layers underneath. Feel for increased tissue elasticity and increased gliding of one layer upon another. Repeat until you've worked the surface tissues between the pelvis and ribs. Once you've prepared the outer layers with several lighter passes, ask your client for slow, active movement ("Let your knee slowly come toward your chest," or "Very slowly, reach up above your head"). Make sure your client is breathing easily to broaden the effects of your work and evoke more powerful Golgi and nervous system responses. Erector and Multifidus Layer The spinal erectors and multifidi lie between the TLF's posterior and middle layers. Many practitioners are accustomed to addressing the erectors posteriorly. With our client in a side-lying position, gravity enables a different approach. Use a soft fist to feel for the lateral edge of this large group of muscles (Image 6), which will be several inches thick, and constitutes the bulk of the muscle mass next to the lumbar spine (Image 7). Rather than sliding on the surface, sink into the thick lateral aspect of the erector group (Image 7). Lower your table so you can stay above your client and use gravity to assist you. If there is enough space between your client's ribs and pelvis, you can carefully use your forearm to work the erector's lateral aspects (Image 8). Use the broad, flat surface of your ulna, being gentle and cautious; avoid using your elbow itself. If your client is uncomfortable with your pressure or pace, more preparation and a slower approach are indicated. Use your forearm to feel, rather than manipulate. Wait for a softening of this thick, muscular layer. Your touch is static, deep, and perceptive to evoke sensation and change, both within the muscles and their enveloping fasciae. As a variation, ask your client for slow, active movement, as you did with the outer layers. This will move the fascia under your static touch and help facilitate neuromuscular reeducation as you coach your client to find new ways to initiate movement. At this level, movements must be slow and deliberate, since they will intensify your client's sensations. Cue your client to make minute movements, as you work slowly and deeply. Avoid putting pressure directly on the transverse processes, as overly aggressive lumbar work bruises the tissue by pushing it against the pointed processes. Know your client's comfort level; don't try to "rub away" any bumps or apparent knots—they might be bone. Quadratus Lumborum Layer The QL lies between the middle and anterior layers of the TLF, just anterior to the erectors (Image 3). It is a key stabilizer of the trunk/pelvis relationship and is a postural muscle that is active in balancing, bending, breathing, and walking. The QL and the fascia around it can be a source of many kinds of back discomfort. To find the QL and its fascia, use the Iliac Crest Technique to follow the crest medially until you encounter the attachments of the QL. Then, use your two thumbs together (Image 9) to isolate the QL layer. Don't hyperextend your thumbs or apply excessive pressure; use static pressure and active client movements. Work the QL from its attachments on the iliac crest to its insertion 6 7 8 Images 6, 7, and 8: The Thoracolumbar Fascia Technique works three-dimensionally to differentiate the TLF's various layers, from superficial to deep, as it wraps around the thick muscle mass of the low back ( Image 7). Image 8 shows very gentle work with the ulna on the erector layers. Use caution around the sharp and sensitive transverse processes of the spine, as well as the ends of the floating ribs. Image 7 courtesy Primal Pictures. Images 6 and 8 courtesy Advanced-Trainings.com.