Healthcare and Medicine Reference
In-Depth Information
umbilicus, thus linking into the many myofascial and
visceral connections that radiate from there.
hair level and diving directly behind the bone - will not
work. In clients with a tough layer of fat, overdeveloped
abdominals, or in those not accustomed to intra-abdom-
inal work, successive tries and reassuring words may
help achieve this contact.
NOTE: Even this palpation (let alone work) is contraindi-
cated in anyone with a bladder or any lower abdominal
infection.
The pelvic floor
A second approach to the pelvic floor (the first appears
above, in 'Palpation guide 2: lower posterior track', p.
187; techniques that involve entering body cavities are
not included in this topic) can be made from the pubic
bone. Have your model lie supine with his knees up,
and with a recently emptied bladder. This palpation
requires that we reach the posterior side of the pubic
bone, and by an indirect route. Place the fingertips of
both hands on the belly about halfway between the top
of the pubis and the navel. Sink gently down into the
abdomen toward the back. Desist in the face of any
pain.
Now curl your fingertips down toward the model's
feet to come behind the pubic bone. Have your client
gently bring the pubic bone up over your fingertips
toward his head, pushing from the feet to avoid the use
of the abdominal muscles (which, if used, will push you
out). Then turn your fingertips up to come in contact
with the back of the pubic bone (Fig. 9.33). Your fingers
are now curled in a half circle, as if you are holding a
suitcase handle. When you can find this spot properly,
especially in someone whose body is open enough to
allow you to get there easily, you can almost lift the
'suitcase' of the pelvis off the table by this 'handle'.
When you have contact with this aspect of the pubic
bone, have your model squeeze the pelvic floor, and you
and he both should be able to feel the contraction where
the pelvic floor attaches to the posterior superior edge
of the pubis. The connection between the pelvic floor
and the rectus abdominis is also clear in this position.
This access can be used to loosen the too tight anterior
pelvic floor, or to encourage increased tone in those with
a weak pelvic floor or urinary incontinence (DVD ref:
Deep Front Line, Part 2).
To attain the proper placement, it is important to start
high enough. The direct approach - starting at the pubic
The umbilicus
The umbilicus is a rich source of emotional connections
as well as fascial ones, being the source of all nourish-
ment for the first nine months of life (Fig. 9.34). Although
the umbilicus is easily reached on the front of the
abdominal fascial planes, the holding is most often in
the posterior laminae of the abdominal fascia, so we
must find our way behind the rectus abdominis. This
layer is in contact with the peritoneum, and therefore
has many connections into the visceral space, including
connections to the bladder and the falciform ligament
dividing the liver.
To reach these layers, position your model supine
with the knees up, and find the outer edge of the rectus.
If it is hard to feel in a relaxed state, having your client
lift the head and upper chest to look at your hands will
bring the edge into relief. Position your hands with
elbows wide, palms down, and the fingertips pointing
toward each other under the edges of each rectus. Bring
your fingers slowly together, being sure that the rectus
muscle - not just fat tissue - is ceilingward of your
fingers.
When you feel your fingertips in contact with each
other, the tissues on the inner aspect of the umbilicus
will be between your fingers. Gauge your pressure -
even minimal pressure can be painful or emotionally
challenging to some clients. Getting truly informed
consent and staying engaged to the degree consistent
Fig. 9.33 The fascial connection between the abdominal fasciae
and the pelvic floor behind the pubic bone is a potent spot for
structural change, but must be approached with caution and
sensitivity.
Fig. 9.34 A view looking forward at the posterior of the belly wall.
The umbilicus, not surprisingly, since it is the fundamental source
of nourishment for our first nine months of life, has numerous
fascial connections in all directions.
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