MYOFASCIAL RELEASE part 1

Transcription

1 MYOFASCIAL RELEASE part 1 PART ONE. Description of "fascia". The three layers of fascia. The nature of fascia. The molecular structure of fascia. The function of fascia. "What is Myofascial Release? Fascia Man - diagrammatical description of fascia throughout the body. Conclusion. PART TWO. Myofascial Release - the Treatment. Cross Hand Releases. The Time Factor - the importance of time in the release procedures. General Instructions for the application of the technique. Steps for Applying Myofascial Release Techniques. Contraindications. The Mind Body Connection - explains the importance of "body memory" for fascia release. PART THREE. Transverse Fascial Planes - explaining the importance of the 3 transverse planes. Respiratory Diaphragm Release - procedure. Pelvic Diaphragm Release - procedure. Thoracic Inlet Release - procedure. The Arm Pull - procedure. Psoas Release - procedure. Bilateral Horizontal Pectoral Release - procedure. Trapezius/Shoulder Release - procedure. Vertical Thoracic Release - procedure. Horizontal Thoracic Release - procedure. Lumbar-sacral Release - procedure. Arm Releases - procedure. Tensor fascia latae Muscle Release - procedure. Leg Releases - procedure. The Leg Pull - procedure MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

2 PART ONE Description of Fascia. Every muscle, fibril and micro fibril in the body down to the cellular level is surrounded by smooth fascial sheath. Therefore fascia determines the length and function of tissue. Fascia is connective tissue that extends continuously throughout the body in a three dimensional web from head to foot. Fascia permits the body to retain its normal shape, maintain vital organs in position and allows the body to resist internal and external stresses. Fascia covers muscles, bones, nerves, organs and vessels down to the cellular level. Trauma, poor posture or inflammation can bind down these body components. This restriction may result in the poor or temporary results from conventional medical, dental and therapeutic treatments. The continuous nature of fascia produces seemingly unrelated clinical results in adjacent areas of the body when under tension from restriction. This results in pain and decreased range of motion. Fascia Has Three Layers. 1. The first - superficial layer is directly below the dermis and contains fat, nerve endings and blood vessels. 2. The second layer is deep and consists of muscle, bone, nerves, blood vessels and organs. 3. The third - sub-serous layer is the dura of the craniosacral system, which encases the central nervous system and the brain. The Nature of Fascia At a cellular level fascia supports, protects, separates, aids respiration, elimination, metabolism and fluid and lymphatic flow. This in turn influences cellular health and the immune system. Fascia shrinks when it is inflamed and is slow to heal because of its poor blood supply and it is a focus of pain from the restriction of its rich nerve supply. FASCIA Nerves Blood Vessels Osseous Structures WHEN RESTRICTED Causes Entrapment Ischaemia leading to pain. Misalignment of body 2006 MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

3 Molecular Structure Connective tissue is composed of collagen, elastin, and ground substance (polysaccharide gel) to provide strength, support, elasticity and cushioning. Collagen fibres provide tremendous tensile strength which guards against overextension. Elastin is intrinsically rubber like to absorb tensile forces. Tendons, skin and arteries contain these elasto-collagenous fibres. A ground substance fills the spaces between fibres and lubricates collagen, elastin and muscle fibres so they can slide over each other with minimal friction. This gel is absorbs the compressive forces of movement. (eg. cartilage-a shock absorber-contains much water rich gel) When the forces are not excessive the gel is designed to absorb shock and disperse h throughout the body. If the fascia is restricted the dispersal effect is retarded and the body is subjected to greater impact. Therefore even someone who simply does not have enough flexibility can be severely injured by a lesser impact. An athlete with fascial restrictions in their body will not absorb the shocks of continued activity throughout his/her body and therefore too many impacts to the body without the protective absorption during performance will cause breakdowns. The same effect takes place in the body of someone with a torsioned pelvis (leg length difference) each step causes microtrauma, which builds to become injury. Myofascial Release techniques reduce these symptoms, increase range of motion, eliminate fascial restrictions and restore the body s' ability to absorb shock. Functions of Fascia 1. Functional, biomechanical efficient movement depends on intact, properly distributed fascia. 2. Fascia has a function as a transport medium for tissues, blood and lymph. (nutritive function) 3. Fascia is an ensheathing layer - it enhances venous and lymphatic flow and provides additional area for muscle attachments. 4. Fascias' fibroplastic qualities assist in healing injuries by depositing collagenous fibres. (scar tissue) Collagen comes from the ancient Greek word that means, "glue producer". Myofascial Release is like glue stretching- the therapist follows this sensation with sensitive hands through the barriers until an increased range of movement is achieved. A therapist using Myofascial Release correctly cannot overstretch the fascia. The improvement after the technique is applied is due to stretching of the elastic component, shearing of the cross links that adhere the tissue and the change in the ground substance from a solid to more of a gel state. It is important to add these techniques to our current treatment programs so as to implement a whole body approach when addressing "dis-ease" and restriction MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

4 What is Myofascial Release? Myofascial Release is a hands on approach with a focus on the fascial system. Physical trauma, inflammation, infection, structural imbalance-from dental malocclusion, osseous restrictions, leg length discrepancies and pelvic rotation, all create repetitive actions and inappropriate fascial strain. Myofascial Release relies entirely on the correctly interpreted, non-verbal feedback received by the therapist through the clients tissue. Fascial strains can slowly tighten and over time the tightness spreads like a pull in a sweater or stocking. Flexibility and spontaneity are lost setting the body up for additional trauma, pain and limitation of movement. These fascial restrictions pull the body out of alignment causing inefficient movement and posture. Fascia Man (right)- a simplified view of how fascial restrictions spread throughout the body and produce symptoms from the lumbar/sacral area to the upper cervical regions (antero-posterior), to the thoracic region and the extremities on the posterior of the body. The appropriateness of treatment is sensed, right brain, through touch. The practitioner will find the directions of stretch, the amount offered and duration of stretch is governed by the non-verbal feedback interpreted by the practitioner. In order to give the Myofascial Release techniques taught in this course the optimum chance of success the practitioner needs to make the following assumptions: 1. The techniques work even though just how is yet to be determined. 2. By utilising the non-verbal feedback restricted structures can be stretched in a more comfortable manner than with traditional methods. 3. Stretching this way removes restrictions that impede efficient movement. 4. Myofascial Release stretching, properly applied, is safe and there is no danger that the practitioner will overstretch the client. The practitioner is working with the client NOT on the client. Myofascial Release leads to postural and alignment changes and is assessed by body alignment and overall posture. This allows for the most efficient use of energy for daily tasks. The key is prevention of future injury while dealing with the current problem. Soft tissue injuries fall between the cracks of medical specialities and medical treatment may simply mask the pain without addressing the restrictions and dysfunction. When first using Myofascial Release the techniques are performed mechanically. Transformation of this mechanical technique into a therapeutic art comes with practice. Conclusion At the core of Myofascial Release is the sensitivity that the practitioner develops-in his/her hands, so the practice of the technique is essential. Next learn to open your mind and trust what you are feeling through your hands. Be comfortable with yourself be relaxed and explore your relationship with your clients and develop your responsiveness to them MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

5 PART TWO. Myofascial Release the Treatment Deep Release - the aim is to release restrictions within deep layers of fascia. These deep releases are applied in all areas of the body, in all directions. Explain thoroughly what you are going to do and why, assure the client that they will not be harmed in any way and encourage them to relax as completely as they are able. Cross Hand Release. Myofascial Release can be applied in any direction Full hand contact for large areas and fingertips for small areas. 1. Palpate area to determine area and degree of restriction. 2. Stretch tissue with the grain of the muscle fibres until a resistance is met. 3. Hold this tension until the tissue under the hands is felt to relax. The "release" or relaxation of the tissue is sensed by the practitioner and client. It is a "softening" or "letting go". 4. Stretch the tissues again to take up the slack created by the release and hold again. 5. Repeat the process until further stretching of the tissue will no longer be tolerated. Be gentle and do not force the client or control the direction. Do not allow hands to slide on the skin until the very end of the treatment MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

6 Cross hands, apply pressure and slowly open hands. Prior to release the practitioner or the client may feel heat or fluttering or throbbing. At release motion will be felt under the practitioners' hands - go with it. "Emotional Release" can occur as a response to any physical contact from various forms of bodywork. If this happens encourage the client to express themselves fully without judging or advising them. While applying Myofascial Release techniques observe other areas of the client s body for heat and redness that can be an indication of additional areas that may need attention. "Fascial Voice" is a pulling sensation in another area of the body quite distant to where you are working. If the client reports this then perform the techniques in this area also to ensure a "complete" treatment. The Time Factor The key to Myofascial Release is sustained pressure over time. Elongation of the fascial tissue in Myofascial release produces different results than other techniques. Time is needed for lasting fascial releases. A minimum of seconds is necessary to begin the process (Pressure only to 1st barrier) and 3-5 minutes per barrier after that. The fascial system is forgiving so no injury will result from spending too much time on an area or treating the wrong area. Most other bodywork techniques are too fast for the body and its fascial tissue to adjust. Myofascial Release addresses this need for time for effective elongation. The techniques or pressures are applied slowly and released slowly so there is no rebound effect on the musculature. General Instructions. Relaxation and focus - as with all bodywork - is extremely important to enable the practitioner to respond to the non-verbal feedback from the clients bodily tissue. Work in a room with dim lighting, with eyes closed to heighten your senses. A meditative state is common and constructive for both practitioner and client when Myofascial Release is being applied. This heightens the awareness of the practitioner and the relaxation of the client MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

7 Steps for Applying Myofascial Release Techniques. 1. Take a full case history. 2. Evaluate the clients condition by observation of their body alignment standing and lying down, leg lengths, R.O.M. testing. 3. Explain the treatment and why you may need to treat areas at a distance from the obvious initial source of the problem. 4. Clear your mind and focus on the tissue under your hands. Close eyes. (Open your eyes periodically to check on responses from client, eg. facial changes fists clenching etc. Communicate with client on these responses.) 5. Treat. 6. Retest and observe changes in alignment. Warn client that there may be some pain for several days after the treatment, as negative patterns in the clients body will resist being released. Rashes or pimples in the areas treated are a common symptom of the purification that can occur. Encourage the client to drink water to flush any toxins out of the body. Contraindications. 1. Neck work should be preceded by a vertebral artery test. 2. Active malignancy. 3. Rheumatoid Arthritis. 4. Aneurysm. 5. Haematomas, open wounds or healing fractures. 6. Cellulitis - inflammation, redness, oedema, pain. (infection?) 7. Febrile state - feverish. 8. Systemic or localised infection. 9. Osteomyelitis - inflammation of bone due to infection. 10. Obstructive Oedema. 11. Sutures 12. Osteoporosis - decreased mass of bone, bone weakness. 13. Anticoagulant therapy. 14. Advanced diabetes. 15. Hypersensitivity of skin. Before treatment is undertaken clearance by a doctor is advised. The Mind Body Connection. Both natural therapists and medical practitioners agree that stress can be held within the body tissues such as fascia and bone and that stress can precipitate illness. Stored emotions produce lessons in literal or symbolic form that can become blocks that hinder development and recovery. The therapist can often contribute to the removal of these blockages by a trained counsellor, by bringing them to the surface during body therapy sessions. Emotional blocks from accidents and trauma are locked within the fascia and the body is eventually forced to change shape to accommodate the layers of emotional stress MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

8 In order to release this "Body Armouring" Myofascial Release techniques are used to unlock the fascial restrictions and release the stress via the channel of entry or exit for the shock, trauma or emotional block. Withheld emotions can have a pain remembrance bank in the mind. With the gentle unlocking release of the fascia endorphins and polypeptides are released which make the connection in the memory cells in the brain, causing an emotional release therefore unlocking the fascia. We now have a physiologic basis for emotions and a connection between emotions and structure that cannot be denied. During the process of a release the client can experience fear, grief, confusion, anger and the therapist needs to be sensitive to this and supportive. Be observant of arm or leg movement (unwinding, twitches) or hysteria (laughing or crying) and allow or assist this, as it can be important for the wholistic healing of the client. When a fascial barrier is engaged or "unwinds" and the tissue releases often a memory or emotion surfaces. This electro physical event produces a positive change in the client. It is very necessary for the therapist to realise that these releases (physical or emotional) will only happen when it is the right time for the client. Some people will choose to hold on to their emotions despite the detrimental effects to their health MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

9 PART THREE. Transverse Fascial Planes. Fascia in the body runs predominantly vertical however there are transverse planes at the pelvic diaphragm, respiratory diaphragm, thoracic inlet and at each Joint. Fascial planes are areas of major dysfunction. They correspond to transition vertebrae (ie C7+T1, T12+L1, L5+S1), which handle the majority of the body's stress. The client lies supine for all transverse fascial plane releases with the practitioner seated beside and facing the client. The practitioner should remain as comfortable and relaxed as possible throughout the treatment. General Procedure: The posterior hand is a firm supportive foundation. The anterior hand applies a light anterio-posterior force. After seconds you will feel a subtle torsional motion or movement under your hands. Follow this movement while maintaining the light force until no movement is felt. The hands do not slide on the skin. Too much force will cause the body tissue to contract; the therapist must allow the body to self correct. Remove hands slowly, evaluate tissue softening and check the body for heat and redness (as an indication for further treatment areas). Also get feedback from the client as the "fascial voice"(what they felt and where) will indicate areas for further treatment. Respiratory Diaphragm Release Procedure. Place supporting hand posteriorly under the thoroco-lumbar junction. The dominant hand is placed over the epigastrium, xiphoid process and anterior/inferior costal margins. Apply pressure anterior to posterior with the anteriorly placed hand. Continue as per "general procedure" instructions. Lumbar Pelvic Area. Pelvic balance is extremely important, as the pelvis is the pivotal area that supports the rest of the body. With the feet firmly on the ground the balance, strength and mobility of the pelvis are critical to the function of the total structure. Leg length differences and fascial restrictions in the feet or lower extremities alter the pelvic balance with each step that is taken. Neurological dysfunction can transmit imbalance downwards and upset the very foundation of the support system therefore symptomatic discomfort can be far removed from the source of a problem. Dysfunctions in the male pelvis are caused by trauma (at birth, falls, auto accidents, performance injuries). In the female pelvis its anatomic and specific functions are also to be considered. Myofascial Release techniques can assist with endometriosis, back and pelvic pain, bladder pain and infection, discomfort of pregnancy, elimination difficulties, coccygeal pain and painful episiotomy scars. The fascia forms a powerful net around the pelvic structures. Premenstrual fluid accumulates here creating extra pressure on nerves and blood vessels inside the net. Cramps, backache and elimination problems are the result. Myofascial Release can also relieve the physical and emotional pain from miscarriages, or abuse (rape, beatings) MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

10 Pelvic Diaphragm Release Procedure. Place supporting hand posteriorly under the sacrum. Place dominant hand so that the hypothenar eminence covers the superior border of the pubic bone. Apply light anteriorposterior compressive force. Continue as per "general procedure instructions. Thoracic Inlet Release Procedure. While sitting at the clients head place supporting hand under the cervico-thoracic junction (C7 - T2). Place dominant hand at the midline on the chest just below the stemal notch (covers the stemoclavicular joints and suprasternal notch). This will place your-forearm and elbow along the clients cheek and you may feel a progressive relaxation of the clients head and neck. Arm Pull Procedure. The Arm Pull is good for finger, wrist, elbow and shoulder dysfunction. Standing at the side of the client with their arm supinated and held gently by the hand. A hand release is done before commencing the arm pull. With thumbs on the back of the hand and fingers meeting in the middle of the palm apply pressure to the palm and then lateral traction. Now holding the arm in a natural, comfortable position (by wrist and forearm) apply a gentle amount of traction. As the arm lets go a little apply more traction - continue this pattern until you achieve an "end feel"(no further stretching available). Now slowly bring the arm out into abduction, maintaining the entire arm in external rotation and maintaining the traction. Continue this process taking the arm right through into full abduction. Then continue the motion across the body and still maintaining the traction hook your fingers under the medial border of the scapula and pull laterally. After the final release occurs slowly reverse the arm pull back to the starting point (still maintaining traction). Abdominal and Psoas Release Procedure. (A cross hand release) Abdominal and psoas releases are good for any abdominal, pelvic, lumbar and menstrual problems. One hand is placed above the umbilicus, applying pressure towards the head and the other hand is placed below the umbilicus, applying pressure towards the feet. For a psoas release this should be applied unilaterally directly over the affected psoas. This technique should always be done before doing lumbosacral decompression. Bilateral Horizontal Pectoral Release Procedure. (A cross hand release) Hands with heel of hand at sternum and fingers splayed out in a lateral direction apply lateral pressure on the stemal area 2006 MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

11 Trapezius and Shoulder Release Procedure. (A cross hand release) Client supine with practitioner sitting behind clients head. Place one hand on the clients shoulder (pressure downward and lateral and place the other hand on the neck (pressure upward towards head). Proceed with releases through all the barriers as previously instructed. This release can also be done bi-laterally with hands on both shoulders pressing downwards and laterally. Vertical Thoracic Release Procedure. (A cross hand release) Place a hand centrally or unilaterally on the upper thoracic pushing upwards towards the head. Place the other hand on the lower thoracic area pushing downwards to the feet. Apply sustained pressure and continue as instructed previously. Horizontal Thoracic Release Procedure. (A cross hand release) Place heels of hands on the medial borders of the scapula and apply pressure laterally. Continue as instructed previously. Lumbosacral Area Release Procedure. (A cross hand release) Place one hand on the high lumbar/low thoracic area and apply pressure upwards to the head. Place the other hand on the sacrum and apply pressure downwards to the feet. This release can be applied centrally or unilaterally also. Continue as previously instructed. Arm Release Procedure. This can be applied as a cross hand release along the muscles of the arm, upper or lower, anterior or posterior aspect. Releases can be achieved also with thumbs on the posterior aspect of the forearm and fingers applying pressure to the anterior aspect. Tenser Fascia Latae Release Procedure. (A cross hand release) Lay the client on their side with knees bent and a pillow between the knees and a pillow placed under the clients head. The practitioner is seated at the side of the table at hip level facing the client. Place the top hand (heel of hand) on the hip and apply the pressure towards the head. Place the bottom hand on the tensor fascia latae (lateral aspect of the leg) and apply the pressure downwards. Continue as previously instructed MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

12 Leg Release Procedure. This can be applied as a cross hand release along the muscles of the leg, upper or lower, anterior or posterior aspect (hamstrings, quadriceps, calves, anterior compartment-lower leg). Gastrocnemius can also be released with the leg bent at the knee. Place thumbs gently on anterior aspect of lower leg with fingers on gastrocnemius applying pressure in a lateral direction. Continue as previously instructed. Leg Pull Release. With the client supine and the practitioner standing at the foot of the table the practitioner takes hold of the foot of the leg to be pulled with both hands. Take the whole leg into external rotation and the foot into dorsiflexion. Apply traction and slowly move the leg into abduction. Proceed as for arm pull until full abduction of the leg is achieved. Then move back through the arc by adducting the leg (all the time maintaining the traction) and continuing the adduction across the body into internal rotation. When the release is complete return the leg through the arc to the neutral position. Extra technique - After the leg has been returned to neutral position it is then raised to a vertical position, maintaining dorsi flexion of the foot and a vertical traction is applied. This extra procedure may not be practicable for all combinations of clients and practitioners MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

13 MYOFASCIAL RELEASE part 2 PART ONE. Craniosacral System Anatomical parts of the Craniosacral System. Other systems the Craniosacral System is related to. Detecting the Craniosacral Rhythm at the Feet -procedure. Cervical Area Techniques Cranial Base Release or Occipital Condyle Release procedure. Cervical Stretch -procedure. Cervical Release for Extension, Side Bending, and Rotation -procedure. Still Point -procedure and theory. PART TWO. Bilateral Leg Traction procedure. Transverse Arch of the Foot procedure. Longitudinal Arch of the Foot procedure. Psoas Area Release. Technique 1 -procedure. Technique 2 -procedure. Soft Tissue Mobilisation for Psoas -procedure. Lumbosacral Decompression Release 1 -procedure. Release 2 -procedure. Release 3 -procedure. Sphenoid Compression / Decompression -procedure. PART THREE. The Dural Tube. Anatomy of the Dural Membrane System. Balancing the Dural Tube procedure. Balancing the Dural Tube and Cranial Rhythm procedure. Balancing the Dural Tube -two person technique procedure. Postural Indications of Muscle Imbalance MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

14 PART ONE Anatomical Parts of the Craniosacral System. 1. The meningeal membranes. 2. The osseous structures to which the meningeal membranes attach. 3. The other non-osseous connective tissue structures that are intimately related to meningeal membranes. 4. The cerebrospinal fluid. 5. All structures related to production, resorption and containment of the cerebrospinal fluid. Other Systems the Craniosacral System is related to:- 1. The nervous system. 2. The musculoskeletal system. 3. The vascular system. 4. The lymphatic system. 5. The endocrine system. 6. The respiratory system. Abnormalities in the function or structure of any of these systems may influence the Craniosacral system and vice versa. The Craniosacral system is characterized by rhythmic, mobile activity with a rate of 6-12 cycles per minute. To perceive movement of the Craniosacral system one needs to close off one's logical thinking and trust and believe in your feelings and senses. The touch must be extremely light as the rhythm is very gentle and very subtle, hence the need for the practitioner to be relaxed physically and mentally. The motion is flexion and extension. In flexion the head widens transversely and the body externally rotates. Detecting the Craniosacral Rhythm at the Feet Procedure. The client lies supine on the table and the practitioner stands at the clients feet holding the heels in their hands. Now tune into the external rotation (flexion phase) then internal rotation (extension phase). Check for the evenness of the movements flexion to extension. Decide which way they move the easiest and the next time the feet move in that direction resist the following movement by making your hands immovable. After having done this a few times the Craniosacral system will shut down for a short period of time (still point) after which ft will resume its rhythmic movement. The movement will now be more even and more exaggerated. During still point the client may experience fight perspiration and a change in breathing patterns. This rhythm can be detected also on the shoulders, hips and thighs MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

15 Cervical Area Techniques. Prior to using any upper cervical area techniques a vertebral artery test needs to be performed. Do this by placing the neck into hyperextension and fully rotating the neck. Hold in this extreme range for 10 to 20 seconds and observe the clients pupils for dilation. If the client complains of vision disturbances or light-headedness do not proceed with neck work. If with gentle palpation of the carotid pulse there is a noticeable discrepancy in strength from one side to the other (they should be fairly equal) then be cautious about any neck work. Because of the great number of nerve and blood supply structures in the neck and shoulder area it is advisable to perform a thoracic inlet release before doing a vertebral artery test or any other neck procedures. Dysfunction of the upper cervical region can be related to dysfunctions in the pelvic region and the lower extremities. Cranial Base Release or Occipital Condyle Release Procedure. Client lies supine with the practitioner seated at the head of the table, elbows on table. Place hands supine under clients neck with fingers pulling upwards at the occipital ridge. Fingers should then move towards clients feet slipping into the occipital space between the occipital ridge and the spinous process ofc2. Elevate the cranium by pushing up vertically with fingers (90' angle at knuckles). Fingers are now taking the full weight of the clients head. Hold for a few minutes until there is a release - fingers will slip deeper into the sub occipital space. Keep ring fingers in sub occipital space and move middle and index fingers to occiput and apply pressure upwards (back towards self) open the space without releasing the pressure as releases occur. Cervical Stretch Procedure. Client lying supine and far enough down the table so that practitioners elbows can be placed comfortably on the table. Cradle clients head in your palms and take elbows outwards swivelling hands so that the occiput rests on the heels of your hands (do not press on ears) To increase the stretch lift elbows off the table and allow clients head to rest against your chest. Do this procedure slowly with appropriate waits for releases. Then gently lower clients head supporting all the way down to the table MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

16 Cervical Release for Extension, Side Bending and Rotation. This procedure releases the upper pectoral, hyoid and antero-posterior cervical area. Client lies supine with shoulders off the table at T5. The practitioner is seated at the head of the table supporting the clients head in the palms of hands. Lock fingers under the occiput and apply traction slowly, hold for release. Maintaining traction with one hand, place the other hand on the sternum and apply pressure towards feet. Wait for release, allowing the head to drop into extension. Maintaining the traction from the occiput place the other hand on the clients shoulder and allow the cranium to move into side bending and or rotation. After releases are achieved change hands and release other side. Maintain the traction while the client moves back onto the table and the head is fully supported again. Still Point Procedure from the Cervical Region. Client supine with the practitioner seated at the head of the table. Cup hands with fingers crossing and thumbs together. Place under clients neck with the occiput resting on the heels of hands. Feel the flexion and extension of the craniosacral rhythm (the widening of the cranium on your hands). Feel it shut down - still point - and when it starts up again check that it is even and let go while it is widened into external rotation MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

17 PART TWO. Bi-lateral Leg Traction Procedure. Client lies supine with the practitioner at the foot of the table holding both feet at the calcaneus. Keeping back straight and using your body weight apply traction to both legs and wait for a release. Maintain the traction through the release and follow the body movement laterally or into rotation. Next place hands on feet plantar surface and push feet into dorsi flexion, waiting for releases. Then holding feet by the dorsal aspect apply traction to the legs again and wait for releases. Transverse Arch of the Foot Procedure. Client supine with practitioner at the side of the table at ankle level facing feet. With thumbs on dorsal aspect of foot and index fingers (knuckles) applying pressure laterally over metatarsals, wait for releases. Longitudinal Arch of the Foot Procedure. Client lies supine with the practitioner at the foot of the table facing the clients head. Grasp metatarsals with one hand and calcaneus (heel) with the other hand and spread open. With thumbs apply pressure to the arch of the foot and wait for releases. Psoas Area Release Procedure. Client supine with practitioner at side of table closest to leg to be worked with. Technique 1. With lower hand apply traction to client s thigh longitudinally (with thigh off the table). With other hand apply pressure to tissue above the pubic bone and wait for release. Technique 2. Bend leg at knee with foot flat on bed. Place one hand on knee and the other hand over psoas above the pubic bone. Change the height of the knee with the first hand and at each change wait for a release under the second hand. Soft Tissue Mobilisation for Psoas Procedure. This procedure should precede lumbosacral decompression if psoas techniques have not released psoas muscle. It should not be performed on pregnant women or patients with pelvic area disease or aneurysm. Client is supine with practitioner at the side of the table. With fingers extended and pointing posteriorly downward pressure is applied slowly and deeply into the abdomen one-inch lateral to the belly button (use straight leg raise to check for location of psoas). Leg on side to be treated is flexed at hip and knee joints. Then use transverse stroking on the length of the psoas muscle MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

18 Lumbo Sacral Decompression Procedure. Client supine with practitioner at the side of table at waist level. Release 1. Release 2. Place hand under sacrum. Allow sacrum to sit comfortably in palm/hand and wait for a release (sacrum can appear to float when the release occurs). Hook fingers of hand under sacrum over the top of the sacrum and apply traction down towards clients feet. Place the other hand in a fist under the lumbar spine with the spinous processes between the heel of the hand and the clenched fingers. Wait for releases. The client can assist by applying light medial pressure on both hips (ilia). Release 3. The hand under the sacrum maintains the traction towards the feet while the other hand is removed from the lumbar spine and is placed on the abdomen above the pubic bone. This hand applies pressure and you wait for a release. Sphenoid Compression/Decompression Procedure. Client supine with practitioner seated at the head of the table with elbows resting on the table for support. Cradle the occiput with fingers with thumbs gently over the greater wings of the sphenoid (soft temple area). Phase 1 - Compression. Apply gentle pressure with thumbs both medially and posteriorly and wait for a release. Phase 2 - Decompression. Apply gentle pressure with thumbs both medially and anteriorly and wait for a release MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

19 PART THREE. The Dural Tube. The Anatomy of the Dural Membrane System. The brain is enclosed within the cranium compartment and there are three layers of tissue surrounding the brain and spinal cord. The pia mater (the thinnest) adheres to the surface of the brain and spinal cord, next is the very delicate arachnoid mater and the outer and thickest layer is the Dura Mater. Between the first and second layers in the sub-arachnoid space is the cerebrospinal fluid. The dura mater and the cerebrospinal fluid provide support and protection for the brain and spinal cord. The dura mater attaches to the 2nd sacral segment and goes all the way up through the foramen magnum and attaches to all the cranial bones. Because of its high level of innervation it has a great effect on the central nervous system. Balancing the Dural Tube and Balancing the Cranial Rhythm Procedure. This procedure is one that you would do to compliment other treatments as a "big gun" to make sure or to make a treatment hold longer. I have used it also to calm distressed or nervous clients. Client lying on side with pillow under head and in a comfortable flexed position (pillow between knees?). The practitioner is seated next to the table facing the clients back. Place one hand on the occiput with light pressure upwards and wait for a release. Take off pressure. Place the other hand on the sacrum fingers pointing downwards and follow the occiput and sacrum through their flexion and extension cycles (flexion-body will flex, extension-body will extend). Assist to still point to regulate the rhythm. Balancing the Dural Tube - 2 person s technique. Client is supine; one practitioner in position as for Lumbosacral Decompression while the other practitioner sits at the head of the table. Practitioner 1 applies pressure upwards with the heel of the hand on the sacrum and with the other hand placed above the pubic bone applies pressure downwards. Practitioner 2 applies traction to the occiput upwards. (If preferred a thoracic inlet release position can be applied) Wait for a release maintaining traction at both ends of the spine MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct

20 Postural Indications of Muscle Imbalance, Ears not level Shoulders not level Hips not level Shoulders twisted Pelvis twisted Hands turned differently Hands held away from body Belly curved or back curved out. Bowed legs Knock-knees Knees hyper extended Forward lean Sideways curve of the back Ankle turned in or flat feet Foot turned in (pigeon toed) Ankle bowed out Difficulty placing hands behind back Neck muscles, rhomboids, psoas, sacrospinalis, and gluteus medius. Latissimus dorsi, neck muscles, deltoids, gluteus medius, upper trapezius. Psoas, adductors, gluteus medius. Levator scapulae Psoas, tensor fascia latae, sartorius, abdominal muscles. Teres Minor Gluteus medius Sacrospinalis Adductors, tensor fascia latae, gluteus medius. Gracilis, sartorius Popliteus, gastrocnemius, quadriceps group. Soleus Abdominal muscles, sacrospinalis, latissimus dorsi Psoas, tibialis anterior. Psoas Peroneus Trapezius, teres major 2006 MCPT Myofascial Release Diploma (HLT50307) Version 1 Oct