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can work your way more deeply into this septum in its
'S'-shaped course toward the linea aspera (see Fig. 9.13).
In those where the adductor magnus is 'married' to the
hamstrings, however, the septum and surrounding
tissues may be too bound to follow the valley very far
into the tissue; indeed, the septum may feel instead like
a piece of strapping tape between the muscles. Having
the space between these muscle groups open and free is
the desired state, and fingers insinuated into this divi-
sion accompanied by flexion and extension of the knee
can lead to freer movement between the hamstrings and
posterior adductors.
The upper end of this valley will emerge at the
postero-inferior point of the ischial tuberosity. You can
usually orient yourself at this point by placing your
fingers in the lower posterior corner of the IT with your
model side-lying, and having your model adduct (lift
the whole leg toward the ceiling). Adductor magnus,
attaching to the bottom of the IT, will 'pop' your fingers
in this movement.
To isolate the hamstrings, alternate this movement
with knee flexion (leg relaxed on the table while press-
ing the heel against some resistance you offer with your
other hand or your outer thigh). The hamstrings attach
to the posterior aspect of the IT; you will feel this attach-
ment tighten in resisted knee flexion (Fig. 9.16). Place
your fingers between these two structures and you will
be on the upper end of the posterior adductor septum.
The septum runs in a straight line between the femoral
epicondyle and this upper end. In cases where the valley
is impenetrable, work to spread the fascial tissues later-
ally and relax surrounding muscles will be rewarded
with the valley appearing, and, more to the point, dif-
ferentiated movement between pelvis and femur, and
between hamstrings and adductor magnus (DVD ref:
Deep Front Line, Part 1, 43:25-44:59).
The adductors themselves are amenable to general
spreading work along their length (DVD ref: Deep Front
Line, Part 1, 36:20-42:00), and to specific work up on the
medial area of the hip joint near the ischial ramus, espe-
cially for correcting a functionally short leg (DVD ref:
Deep Front Line, Part 1, 45:00-52:20).
From the adductor magnus, there is connecting fascia
from the IT along its medial surface to the obturator
internus fascia, and from this fascial sheet onto the pelvic
floor sheets via the arcuate line (Fig. 9.18). Palpating in
this direction is not for the faint of heart and should ini-
tially be practiced with a friend or tolerant colleague, but
it is a rewarding and not very invasive way of affecting
the pelvic floor, the site of so many insults to structure,
especially for women. On your side-lying model, place
your hand on the inside posterior edge of the IT. Keep
your index finger in contact with the sacrotuberous liga-
ment as a guide, rather than being any further anterior
on the ischial ramus, and begin to slide upward and
forward in the direction of the navel, keeping your fin-
gerpads in gentle but direct contact with the bone. A little
practice will teach you how much skin to take - stretch-
ing skin is not the object (Fig. 9.19).
Above the IT/ramus you will feel the slightly softer
tissue of the obturatur internus fascia under your fin-
Fig. 9.19 A difficult but highly effective technique for contacting
the posterior triangle of the pelvic floor involves sliding into the
ischiorectal fossa along the ischial tuberosity in the direction of the
navel until the pelvic floor is felt and assessed. Depending on its
condition, manual therapy can be used to either lower both the
tone and the position of the posterior pelvic floor, or encourage its
increased tone.
gerpads. Care must be taken to stay away from the anal
verge, and some verbal reassurance is often helpful.
Continue upward along the obturator fascia until you
encounter a wall ahead of your fingertips. This wall is
the pelvic floor, the levator ani muscle.
Although no words will substitute for the experien-
tial 'library' of assessing the state of the pelvic floor in
a number of subjects, many pelvic floors, especially in
the male of the species, will be high and tight, meaning
that your fingers will have to run deep into the pelvic
space before encountering a solid-feeling wall. Fewer
clients - more female, and often post-partum - will
present with a lax pelvic floor, which you will encounter
much lower in the pelvis, and with a spongy feel. Only
occasionally will you find the converse patterns - a low
pelvic floor that is nonetheless highly toned, or the
spongy pelvis floor which is nonetheless located high in
the pelvis.
For those clients with the common pattern of a high,
tightened levator ani, it is possible to hook your fingers
into the obturator fascia just below the pelvic floor, and
bring that fascia with you as you retreat toward the IT
(Fig. 9.19). This will often relax and lower the pelvic
floor. For those with a toneless or fallen pelvic floor,
pushing the fingertips up against the pelvic floor while
calling for the client to contract and relax the muscles
will often help the client find and strengthen this vital
area.
The thiqh - lower anterior track
Returning to the inside of the thigh just above the knee,
we can take the other track of the DFL in the thigh, the
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