Healthcare and Medicine Reference
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band that can be clearly felt on the lateral aspect of the
lower thigh. Like the Achilles tendon, the ITT widens
and thins as it passes superiorly. By the time it reaches
the hip, it is wide enough to hold the greater trochanter
of the femur in a fascial cup or sling {Fig. 5.9). The tension
on the ITT sheet, which is maintained and augmented
by the abductors from above and the vastus lateralis
from beneath, helps keep the ball of the hip in its socket
when weight is placed on one leg. This arrangement
also acts as a simple tensegrity structure to take some of
the direct compressive stress of our body weight off the
femoral neck.
The LL continues to widen above the trochanter, to
include three muscular components: the tensor fasciae
latae along the anterior edge, the superior fibers of
the gluteus maximus along the posterior edge, and
the gluteus medius, which attaches to the underside, the
profound side, of the ITT's fascial sheet (see Figs 5.3 and
5.4).
All these myofasciae attach to the outer rim of the
iliac crest, stretching from the ASIS to the PSIS. This
entire complex is used in the weighted leg in every step
to keep the trunk from leaning toward the unweighted
leg. In other words, the abductors are less often used to
create abduction, but are used in every step to prevent
hip adduction. This involves a stabilizing tension along
the whole lower LL.
Depending on the postural angle of the pelvis, it may be
advisable to work the leading or following edge of the
ITT more strongly. Left-right imbalances in ITT tone will
be present in lateral tilts of the pelvis. Imbalance between
the ITT and adductor muscles will be present in genu
varum and valgum (laterally or medially shifted knees).
The ITT can be worked in a manner similar to the
peroneals: with the client side-lying and the knee sup-
ported, the practitioner can work either up or down the
ITT and associated abductors, spreading laterally from
the lateral midline with knuckles or loose fists. Since
fibers of the ITT are meshed with the circumferential
fibers of the fascia lata, it can also be useful to work
the side of the leg vertically. Use the flat of the ulna,
placing one just under the iliac crest, the other just above
the greater trochanter. Slowly but deliberately bring
the lower elbow toward the knee, stretching the ITT. The
client can help by bringing the knee forward and back
(DVD ref: Lateral Line, 19:13-25:51).
Searching fingers can assess: Is the anterior edge of
the ITT thicker, more fixed, or tighter than the posterior
edge? If so, then the angle of the forearm on the leg can
be adjusted, like changing the angle of a violin bow to
sound another string, to emphasize either the anterior
portion or the posterior portion.
The abductor muscles and the
greater trochanter
The iliotibial tract
The abductor muscles themselves, tensor fasciae latae
and the three superficial gluteal muscles, can be worked
generally by working with the point of the elbow or
well-placed knuckles to move the tissue in a radiating
pattern away from the greater trochanter toward and up
to the iliac crest. You may wish to work these tissues
differentially in the case of anteriorly tilted pelvis, say,
where the anterior tissues, acting as flexors, will be very
much shorter and denser. Do not neglect the 'facets' of
the greater trochanter itself, which can be very produc-
tive of new and freer movement (DVD ref: Deep Front
Line, Part 1: 25:52—30:57).
In terms of its role in the LL, the ITT can be considered
to begin at a point at the bottom (the tibial condyle, but
really the whole outside of the knee), spreading upward
to three points at the top (the ASIS, PSIS, and the strong
fascial attachment at the middle of the iliac crest).
Derailment
As we move from the appendicular portion to the axial
portion of the LL, we face another derailment - a break
with the general Anatomy Trains rules. To carry on, we
would need to find sheets or lines of myofasciae that
continued to fan outward and upward from these points,
or at least from the front and back extremes (the ASIS
and PSIS). The ITT - in fact, the whole lower LL - looks
a bit like the letter 'Y' (Fig. 5.9); to continue we would
have to keep going up and out on the upper prongs of
the 'Y' (as in Fig. 5.1 OA). We will find these continuations
in the Spiral and Functional Lines (Chs 6 and 8). If,
however, we look at how the myofascia arranges itself
along the lateral aspect of the trunk from here on up, we
find that the fascial planes cross back and forth in a
'basket weave' arrangement (Figs 5.2 and 5.1 OB).
Although these sharp changes in direction break the
letter of the Anatomy Trains rules, the overall effect of
Fig. 5.9 The second major track of the Lateral Line consists of the
iliotibial tract and the associated abductor muscles, the tensor
fasciae latae, the gluteus medius, and the superior fibers of the
gluteus maximus.
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