Healthcare and Medicine Reference
In-Depth Information
Fig. 3.19 When the knee is flexed, the myofascia of the thigh and the myofascia of the lower leg function separately (A). When the knee
is extended, these myofasciae link into one connected functioning unit (B), like the interlocked hands of a pair of trapeze artists (C -
compare to Fig. 3.18). The configuration is reminiscent of a reef or square knot; able to form a tight knot, yet readily loosened as well (A
versus D).
even flexing the knees is not enough to allow a full
forward bend.
The distal hamstrings
The interface between the heads of the gastrocnemii
and the 'feet' of the hamstrings can get tied up; the result
is usually not a flexed knee but a tibia that seems to sit
behind the femur when viewed from the side.
This technique requires some finger strength, but
tenacity will be rewarded. It also requires precise finger
placement to avoid pain for the client. Have your client
lie prone, with one knee bent to near 90°. Support this
foot with your sternum or shoulder, so that the ham-
string can temporarily relax. Hook your fingers, palms
facing laterally, inside the hamstrings at the back of the
knee, 'swimming' in between these tendons (two on the
inside and one on the lateral side) to rest on the heads
of the gastrocnemii (Fig. 3.18). Be sure to take a little skin
with you and keep your fingers moving out against the
hamstring tendons to avoid pressuring the endanger-
ment site in the middle of the popliteal space. This tech-
nique should not produce any nerve pain or radiating
sensations. Have your client retake control over her leg,
then remove your support. The hamstring tendons will
pop out as they tense, so keep your fingers in position.
Have your client slowly lower her foot to the table as
you move slowly up the inside of the hamstring tendons
(but mostly simply maintaining your position, while the
client does the work). The client will be lengthening
both the hamstrings and gastrocnemii in eccentric con-
traction, freeing their distal ends from each other. When
effectively done, this will result in the tibia moving
forward under the femur (DVD ref: Superficial Back Line
Fig. 3.20 When the knees are bent (A), the upper and lower parts
of the SBL are relatively separate, and it is easier to fold at the
hips. With the knees extended (B), the SBL is linked into one unit,
and a forward bend may not be as easy.
them extended (Fig. 3.20). A very slight flexion of the
knees is sufficient to allow significantly more forward
bend in the spine and hips. The traditional explanation is
that the hamstrings are shortened by the knee flexion,
thus freeing the hips to flex more. In fact, bending the
knees only a tiny amount, e.g. moving the knees forward
a mere inch or a few centimeters, does not shorten the
distance from the ischial tuberosity to the lower leg
appreciably, and yet it frees the hip flexion considerably.
Our explanation would be that even a slight flexion
loosens the square knot, unlinking the lower part of the
SBL from the upper. The linked SBL is harder to stretch
into a forward fold; the unlinked SBL is easier.
The entire SBL is a continuity in a regular standing
posture. In yoga, for instance, postures (asanas) which
utilize a forward bend with straightened legs (as in the
Downward-Facing Dog, Plow, Forward Bend, or any
simple hamstring stretch) will engage the SBL as a
whole, whereas forward bends with the knees bent (e.g.
Child's pose) will engage only the upper myofascia of
the line, except in those with very short SBLs, for whom
From knee to hip
Assuming, then, that the legs are straight and the knees
extended, we continue up the myofascial continuity
provided by the hamstrings, which takes us to the pos-
terior side of the ischial tuberosities (Fig. 3.21). The dual
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