Healthcare and Medicine Reference
In-Depth Information
Fig. 3.22 With a knife, it is possible to isolate the sacrotuberous
ligament as a separate structure. In life, though, it (at least
superficially) connects both up to the sacral fascia and the erector
spinae and down to the biceps femoris.
Erector spinae fascia
The methods for treating the back muscles are so myriad
and diverse that many books would be required to
detail all of them. We include a few global consider-
ations and techniques.
Since the erector spinae cover the posterior side of the
spinal curves, they co-create the depth of these curves,
along with the muscles that attach to the front of the
spine in the neck and the lumbars (see Ch. 9 on the Deep
Front Line). With that in mind, our first consideration is
the depth of the curves in the spine: is there a lumbar
or cervical lordosis, or a thoracic kyphosis? Observe: do
the spinous processes protrude like bumps or a ridge
beyond the surrounding tissue (are they 'mountains'?);
or do they sink below the surrounding myofascial tissue
in a groove (do they form 'valleys'?).
The general rule is counter-intuitive: pile up on the
mountains, and dig out the valleys. Myofascial tissue
has spread away from the spinous processes that pro-
trude (as in a kyphosis), widening and sticking to sur-
rounding layers. These tissues need to be moved
medially, toward the spinous processes, not only to free
the tissues for movement, but also to give some forward
impetus to those vertebrae that are too far back. Con-
versely, when the vertebrae are buried deep (as in a
lordosis), contiguous myofascial tissues migrate medi-
ally and tighten, forming the 'bowstring' to the spinal
bow. These tissues must be moved laterally and length-
ened progressively from superficial to deep. This will
allow the buried vertebrae some room to move back.
To assess the ability to lengthen at various levels of
the spine, seat your client on a stool (or on the edge of
a treatment table, provided it is low enough for the cli-
ent's feet to be comfortably on the floor). Help your
Fig. 3.23 The erector spinae form the next track of the SBL. The
muscles run from the sacrum to the occiput; the fascia runs from
the sacrotuberous ligament to the scalp fascia. On the left are
some of the underlying 'locals' of the transversospinalis -
intertransversarii, rotators, and levatores costarum.
client assume an upright posture, with the weight on
the ischial tuberosities and the head lengthened away
from the floor but still horizontal (looking straight
ahead). Instruct your client to drop his chin toward his
chest until he feels a comfortable stretch in the back of
the neck. Let the weight of his forehead begin to carry
him forward, 'one vertebra at a time', while you stand
beside him and watch. Look for places where the indi-
vidual spinous processes do not move away from each
other like a train pulling out of the station one car at a
time. In all but the healthiest of spines, you will find
places where a couple or even a whole clump of verte-
brae move together, without any differentiation. Really
bound clients may move the spine as a whole, getting
most of their forward motion through flexion at the
hips, rather than by curling or flexing the spine itself
(Fig. 3.25).
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