Healthcare and Medicine Reference
In-Depth Information
as high as the 5th rib to achieve sufficient stability for
all the strong actions it must perform. The lower 'abdom-
inal' ribs, with their long cartilaginous attachments to
the sternum, would be too mobile to provide a stable
attachment for the SFL, especially considering their
large excursion during breathing.
Mobilization and freeing extra adhesions where the
rectus abdominis attaches is frequently rewarded with
expanded breathing movement (DVD ref: Superficial
Front Line, 40:38-45:26).
The rectus abdominis
The poor rectus abdominis: over-exercised by the 'go
for the burn' crowd, and under-treated by the manual
therapist. It is important to understand that the SFL
involves at least three layers at this level: the fascial
aponeurosis that runs in front of the rectus, the muscle
itself, and the fascial sheet that runs behind it (Fig. 4.18).
These aponeuroses are shared with the other abdominal
muscles, and will come up for consideration with other
lines (see Chs 5, 6, 8, and 9). For now, we will concern
ourselves with the span of the rectus itself between the
pubis and the 5th rib.
As we view the rectus, then, we must assess three
separate parts: the tonus of the muscle itself, and the
tonus of the two enveloping sheaths, in front and behind
the muscle. If the rectus is flat - a set of 'six-pack' abs -
then we can suspect high tonus in the superficial sheet
and in the muscle itself. If the rectus bulges out, we must
assess the tonus of the muscle, but we can be fairly sure
that the deeper sheet, behind the muscle, is shortened
(DVD ref: Superficial Front Line, 33:15-35:05).
To free the front sheet and the muscle, have your
client lie supine with his knees up, feet on the table.
Facing cephalad, hook the tips of flexed fingers into the
lower part of the muscle and move tissue upward,
toward the ribs, taking a new purchase each time you
reach one of the tendinous inscriptions in the rectus. You
can repeat this move as necessary to continue the process
of freeing the superficial aspect of the rectus up to the
5th rib.
To reach the back of the rectus requires a more inva-
sive but very effective technique. First, we must assess
the nature of the shortness. If the lumbars are hyper-
extended into a lordosis, or the pelvis is held into
an anterior tilt, the lumbars may simply be pushing
the abdominal contents forward into the restraining
rectus. In that case, it is necessary to free the SBL in the
lumbars to give the abdomen more room to drop back
(see Ch. 3).
If this is not the case, the bulging abdomen can also
be due to enlargement of the abdominal contents caused
by overeating or bloating, which must be solved by
dietary means. Or, of course, there can be excess fat,
either subcutaneously or, especially in men, in the
omentum underlying the peritoneum.
In any case, even if the belly sticks out and the muscle
tonus seems low, it is possible that the tonus of the wall
behind the rectus is quite high, tight, and responsible
for restricting breathing or pulling on the back. With no
bones near to work against, how can we isolate the
sheath that runs behind the rectus but in front of the
peritoneum? Since the back of the rectus sheath is part
of the Deep Front Line, see Chapter 9 for the answer (or
DVD ref: Deep Front Line, Part 2).
The various tracks which crisscross the abdomen will
be discussed in Chapters 6 and 8; for the moment we
are moving due north on the rectus and its accompany-
ing fascia. Of course, these abdominal lines all interact,
but the SFL runs a straight (though widening) track up
to its next station at the 5th rib. The rectus must reach
The chest
From the 5th rib we can continue in the same direction
via the sternalis muscle (if present) or its associated
fascia (which almost always is), including the sternal
fascia passing up the surface of the sternum, along with
the pectoralis fascia out as wide the sternochondral
joints at the lateral edge of the sternum (Fig. 4.19). (The
rectus attachment at the 5th rib will make another
appearance when we consider, in Chapter 7, the anterior
Arm Lines, which both start from the 5th rib attachment
of the pectoralis minor and major. The rectus fascia thus
Fig. 4.19 The rectus abdominis attaches strongly to the 5th rib,
but the fascia continues up the sternalis myofascia and the fascia
running along the sternochondral joints. The rectus also links
fascially into the pectoralis major and minor, connecting the SBL
to both the Front Arm Lines (see Ch. 7).
Search Pocayo ::

Custom Search