Introduction
Aromatherapy has extended the horizons of massage therapists by taking them into the realms of herbal/botanic medicine in a way which allows them to incorporate the powerful healing potentials of plants into their existing methodologies.
In a different way the soft tissue techniques which have evolved out of osteopathy allow a further expansion of the range of conditions which massage therapists and aromatherapist can successfully address.
Osteopathy has gradually moved (and continues to move) away from the traditional means of joint mobilisation (high velocity thrusts for example) towards increased use of methods which accepts that most dysfunction in joints is the result of soft tissue dysfunction. Techniques for normalisation are therefore less invasive and aggressive.
These methods which include what are generally called ‘muscle energy’ techniques as well as functional methods (including Strain/counterstrain) and Neuromuscular Techniques (which address local soft tissue dysfunctions including trigger points) are loosely combined under the heading of soft tissue manipulation.
Many osteopaths now find that by using such approaches they can deal more effectively than previously with joint restrictions and pain, in less time, with less effort, and far more safely.
From the perspective of the massage therapist and aromatherapist this opens a treasure chest of technique possibilities.
The only factor retarding aromatherapists and massage therapists seems to be a significant (in some cases) lack of knowledge of anatomy and physiology, something which can be remedied by additional study….after which the availability in workshop settings of training in use of these safe and powerful soft tissue methods can allow a significant widening of the scope of what can be successfully treated.
Assessment
In order to adequately deal with soft tissue dysfunction the therapist needs to be able to assess and identify what is dysfunctional. The questions which need answering include:
- Which muscle groups have shortened and contracted?
- Which have become significantly weaker?
- What ‘chain reactions’ of imbalance have occurred as one muscle group (because of its excessive contraction) has inhibited and weakened its antagonist?
- What postural stresses have such changes produced and how is this further stressing the body as a whole, affecting its energy levels and function?
- Within particular muscle areas which are stressed how can we rapidly (using at least five different palpatory method) identify local soft tissue dysfunction such as trigger points?
In other words what palpable, measurable, identifiable evidence is there which relates to the symptoms (pain, restriction, fatigue etc) of this patient ?
And what can be done to remedy the situation, safely, effectively and quickly.
These are the questions and answers which the methodology of soft tissue manipulation offers.
Different Muscles Respond Differently to Stress
One of the most exciting revelations over the past decade has come from research which shows without question that particular muscles will shorten when stressed while others will not shorten but become increasingly weak (see reference 1 in particular).
The stress can result from poor posture, occupational patterns, repetitive movement, injury, emotional or other stress factors.
The muscles which shorten are the primarily postural ones and it is possible to learn to conduct, in a short space of time (ten minutes or so) a diagnostic sequence of simple tests in which these can be identified as being short/contracted or normal.
Postural Muscles
Those muscles which respond to stress by shortening comprise the following :
Gastrocnemius, soleus, medial hamstrings, short adductors of the thigh, hamstrings, psoas, piriformis, tensor fascia lata, quadratus lumborum, erector spinae muscles, latissimus dorsi, upper trapezius, scalenes, sternomastoid, levator scapulae, pectoralis major and the flexors of the arms.
Once any of these is identified as being short (as mentioned, a rapid screening of all is possible and desirable) there exist a powerful range of easily applied methods which allows them to be painlessly stretched back to a more normal state.
This is called ‘Muscle Energy Technique’.
Muscle Energy Methods
The following methods are suggested for use in any shortened soft tissue as long as the starting point is at the restriction barrier (for acute conditions) or short of it (for more chronic conditions).
Note: Restriction barrier in this and all other instances is defined as the first signs of resistance as the muscle is taken towards its end of range, not the furthest position obtainable.
Starting from the appropriate position, based on degree of acuteness or chronicity, the patient is asked to exert a small effort AWAY from the restriction barrier (20% of available strength say) towards an unyielding resistance provided by the operator’s hands.
This effectively isometrically contracts the shortened muscle(s) and this contraction is held for 7 to 10 seconds (longer, up to 30 seconds, if the condition is chronic) together with a held breath (if appropriate).
On slow release of the contraction the shortened muscle is taken (painlessly) to its new restriction barrier if acute or slightly and painlessly beyond the new barrier if chronic (and if chronic, held there for 7 to 10 seconds in slight stretch).
This pattern is repeated until no further gain in length is achieved.
Alternatively the antagonists to the short muscles can be used by introducing a resisted effort TOWARDS the restriction barrier followed by a painless stretch to the new barrier (acute) or beyond it (chronic).
Use of antagonists in this way is less effective than use of agonist but may be a useful strategy of trauma has taken place.
Example: PSOAS
As an example of what one ‘trouble-maker’ postural muscle can do we can examine psoas.
- Psoas has a powerful reciprocal agonist-antagonist relationship with rectus abdominus with important postural implications since as psoas shortens it results in ever increasing weakness of the abdominal muscles.
- Lewit tells us in addition that Psoas spasm causes abdominal pain, flexion of the hip and typical antalgesic (stooped) posture. Problems in psoas can profoundly influence thoraco-lumbar stability.
- If you see or palpate the abdomen ‘falling back’ rather than mounding when the patient bends forwards this indicates normal psoas function. Similarly when lying supine if the patient flexes knees and ‘drags’ heels towards buttocks (keeping them together) the abdomen should remain flat or ‘fall back’.
If the abdomen mounds or the small of the back arches, psoas is incompetent.
- If the supine patient raises both legs into the air and the belly mounds it shows that the recti and psoas are out of balance. Psoas should be able to raise the legs to at least 30 degrees without any help from the abdominals.
- Goodheart points out that there exists an intimate link between psoas behaviour and sternomastoid behaviour (a psoas in spasm will influence SCM on the opposite side of the body and vice versa. Increased tonus in one will produce similar increase in tonus in the other).
- Psoas fibres merge with (become ‘consolidated’ with) the diaphragm and it therefore influences respiratory function directly (as does quadratus lumborum).
If the lumbar erector spinae group of muscles is in a weakened state then bilateral psoas contraction/spasm/shortening will result in a loss of the lumbar curve, or even a reversal of it.
If however the erector group are hypertonic then similar psoas problems will produce an increase in lumbar lordosis.
- It is useful to assess changes in psoas length when treating by periodic comparison of apparent arm length.
Patient lies supine arms extended above head, palms together so that length can be compared. A shortness will commonly be observed in the arm on the side of the shortened psoas, and this should normalise after successful treatment.
- Basmajian informs us that the psoas is THE MOST IMPORTANT postural muscle.
If it is hypertonic the abdominals will weaken and a chain reaction of imbalance will result.
Treatment of Shortened PSOAS
1. Psoas can be treated with the patient lying face down. The operator lifts with one hand the thigh (knee bent or straight) to its EASY resistance barrier (no force). The other hand stabilises the sacrum to prevent arching of the back.
The patient takes the thigh towards the table with a slight effort for 7 to 10 seconds and the releases and relaxes. as the leg is extended through the resistance barrier for a short stretch. This is repeated until no further gain is possible.
2. A better position is to treat from the supine position, in which the patient is at the very end of the table, non-treated leg flexed at hip and knee and held in that state by the patient.
The leg which is to be treated hangs down.
If the condition is acute the leg is allowed to commence treatment from the restriction barrier, whereas if chronic it is taken into a somewhat more flexed position to be in the mid-range.
The patient’s effort is to lift against resistance.
After the isometric contraction, using effort suitable to the degree of acuteness/chronicity, the thigh should either be taken to the new restriction barrier, without force, if acute, or through that barrier with slight, painless, force if chronic and held there for 10 seconds or so. Repeat until no further gain is achieved.
Note: Direct inhibitory pressure techniques onto the origin of psoas, through the mid-line is an effective alternative approach.
Conclusion
Massage therapists / Aromatherapists have in Soft Tissue Manipulation a powerful additional set of methods combined with simple and accurate diagnostic methods.
References
1. Karel Lewit Manipulative Therapy in Rehabilitation of the Locomotor System Butterworth Heinemann 1992
2. Irvin Korr Neurobiological Mechanisms in Manipulation Plenum Press 1980
3. J. Basmajian Muscles Alive Williams and Wilkins 1978
4. Leon Chaitow Soft Tissue Manipulation Thorsons/Harper
Collins 1989
5. Leon Chaitow Palpatory Literacy Thorsons/Harper Collins 1991
6. David Simons and Janet Travell The Trigger Point Manual William and Wilkins 1983