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(BQ) Part 2 book “Advanced myofascial techniques” has contents: The superficial cervical fascia, the deep posterior neck, the scalenes, the masseter, temporalis, and digastrics, the medial and lateral pterygoids,… and other contents.
Cervical Issues 11 The Superficial Cervical Fascia 12 The Deep Posterior Neck 13 The Scalenes The superficial cervical fascia (transparent outer layer) and the deep cervical fascia (violet inner layer) are continuations of superficial and deep fascial layers that surround the entire body The deeper myofascial structures of the neck that these layers surround are also visible in this view, and include the scalenes, the transversospinalis, the platysma, etc Primal Pictures, used by permission The Superficial Cervical Fascia 11 The Importance of the Superficial Layers What are the most common client issues that you see in your practice? Chances are, neck pain and discomfort are high on the list Although cervical complaints and conditions can have many causes, you’ll almost always see better results if you begin your work with these very common issues by addressing restrictions in the superficial layers of the neck and shoulders Whether caused by deep articular fixations, posture and misalignment, habits, stress, injury, or other reasons, neck issues respond quicker and stay away longer when the differentiation and elasticity of the outer wrappings is addressed first As with other parts of the body, many seemingly deeper neck issues resolve when the external layers have been freed In this chapter, I’ll describe how to work with these superficial but important layers, which will also prepare for working the neck’s deeper structures (which are covered in the next chapter) Figures 11.1/11.2 (overleaf) The superficial fascia of the neck, in green, surrounds the deeper cervical structures, like a sleeve or cowl It is continuous with similar layers in the face, head, shoulders, back, and chest Encircling the neck and shoulders like an over-large turtleneck sweater, or a surgical collar (Figures 11.1 and 11.2), the neck’s outer wrappings are composed of multiple layers of myofascia These include superficial layers just under the skin (such as the fascia colli in back, and the fascia colli superficialis in front), as well as the investing fascia that surrounds the outer neck muscles (such as the trapezius, sternocleidomastoid, infrahyoids, and the platysma, Figure 11.3) Together, these cowl-like superficial layers extend from their superior attachments on the occipital ridge and convergence with the fascia of the lower face, to their merging with the outer layers of the shoulders, chest, and upper back at their inferior margin ( 1) Like a sleeve, they encircle the deeper myofascial, skeletal, and visceral structures of the neck’s core The outer layers of the neck have a surprising thickness and resilience When they lose pliability or are undifferentiated and adhered to other structures (due to injury, postural strain, or other reasons), the outer layers have the ability to restrict movement range, disrupt balanced alignment, and bind the structures they surround Imagine trying to move in a wetsuit that is a size too small (Figure 11.4)—the outer layers of the neck can tether, distort, and constrain movement in the same way And the thickness, elasticity, and sliding of these layers can directly correlate to pain In one ultrasound study of living subjects, neck pain was seen to be proportional to the thickness of the cervical fasciae, which in turn was observed to measurably change as a result of hands-on fascial techniques ( 2) In another ultrasound study, sliding between fascial layers in people with neck or back pain has been seen to measurably improve after myofascial work ( 3) Assessing superficial restrictions Try this: observe your standing client turn his or her head from side to side Watch what happens with the superficial layers of the neck, shoulders, chest, and back Are there areas of the torso’s fascia that move along with the head and neck? Or, you see lines of tension and pull appearing in the skin and outer layers? Often, these signs of fascial inelasticity, binding, and lack of differentiation will be most visible at the extremes or end-range of the movement Look from both the front and the back; compare left and right sides for any differences Then, look again as he or she gently looks up and down Your client might feel different kinds of restrictions when moving; including pulls in the deeper musculature, or catches involving neck articulations or the upper ribs For now, we’re going to leave these aside and focus on the outer layers first Figure 11.3 The superficial layers of the neck, in cross-section (after an illustration from Ida Rolf’s 1979 “The Integration of Human Structures”) Sometimes superficial fascial tension will be visible as linear “tug” patterns in the skin (Figure 11.5) In other cases, a whole sheet of fascia will move or creep along with the rotating or nodding head Linear “tug” patterns are more commonly seen in the thinner layers of the anterior neck and chest, while the “creep” of whole fascial sheets is seen more often when looking at the thicker posterior layers of the back If it is difficult to see restrictions in the superficial layers, you can use your hands instead to feel for tugs and pulls in the outer layers while your client rotates his or her head Whether watching or feeling, note any areas that don’t display a smooth, even lengthening of the dermis and superficial fasciae when the head moves When testing for fascial tension with active movement, don’t confuse movements of deeper structures for movement in the superficial fascia For example, you’ll sometimes see the ribcage turning along with the head, or a shoulder roll forward, etc Some of this movement is normal; if you see exaggerated or asymmetrical movement of the ribcage or shoulder, this might be because of deeper or larger restrictions Make a note to check for and address these patterns later, but remember that since these deeper movements might also be caused by restrictions in the outer layers, releasing the superficial layers is the logical first step Releasing Superficial Restrictions Once you’ve seen or felt where your client’s outer layers are tugging or creeping along with head and neck movement, you can go to work A word about sequencing your superficial work on the upper torso: most clients will feel more balanced if you begin by working the posterior restrictions of the upper back, and end by addressing the anterior restrictions This is the order we’re using in this chapter Why this back-to-front progression? Since most of us tend to have our heads forward of the coronal midline to some degree, and are narrower across the front of our chest than across our upper back, the anterior fascial layers of the chest and shoulders can be thought of as shorter than the posterior layers of the shoulders and back Ending with the anterior restrictions counterbalances the earlier work on the posterior side of the body, and usually leaves the client with a greater sense of anterior width, length, and freedom, and so helps with overall postural balance and ease A possible exception to this ordering: if your client has a very flat upper thoracic curve, you may want to reverse the sequence, and end with work on the back to encourage more spinal flexion Figure 11.4 The superficial layers of the neck can restrict motion of the neck, jaw, shoulders and chest, much like a too-tight wetsuit might Over-The-Edge Technique Ask your client to lie face down on your table, arms at the sides, with his or her head and neck just over the top edge of the table The edge of the table should fall an inch or two below the top of the sternum Your client may need to adjust upwards or downwards a bit so that the edge is comfortable You won’t want to leave your client like this too long, but you’ll usually have at least two or three minutes to work before his or her head starts to feel too full Once your client is comfortable, ask for active side-to-side head and neck rotation, as you observe again or feel the outer tissue layers This allows you to recheck your findings, and compare this pattern to what you saw in an upright stance Look at the flexion/extension (up-and-down) movements too, again using care to avoid excessive neck compression with extension Because the effects of gravity are different in this position, you may see or feel additional undifferentiated areas that weren’t obvious in standing Often, this prone position will make the superficial restrictions even more obvious The tool we’ll use to differentiate these less-pliable layers is the flat of our forearm; specifically, the first few inches of the ulna just distal to the elbow (Figure 11.6) Use this tool to gently anchor the inferior margins of the areas where you saw or felt superficial restrictions Don’t use oil or cream; we’ll be using friction more than pressure to contact the layer we want to release Also, we won’t be sliding much—different from a passive “stroke,” our client will actively provide the movement needed for layer differentiation and increasing elasticity Figure 11.5 Assessing superficial restrictions: fascial strain visible as “tugging” of the outer layers with head rotation Figure 11.6 The Over-the-Edge Technique for addressing the superficial layers of the upper back and shoulders Although relatively safe, head-down positions are usually contraindicated for clients with uncontrolled high blood pressure, glaucoma, a history or risk of strokes, vertigo, or acute sinus issues Once you have the outer layers gently but firmly anchored with your forearm, ask your client to slowly turn his or her head away from the side you’re working Feel for the direction of your pressure that gently lengthens the superficial layers being pulled on by the head movement Imagine that you’re helping your client lengthen and free herself inside the wetsuit-like outer layers of superficial fascia Alternatively, you can ask your client to lift and lower the head (extend and flex the neck and spine) as you lengthen the layers of the back inferiorly You’ll find this technique most effective on the eccentric phase of the motion, that is, while your client is lowering his or her head Remember, your client may become uncomfortable if you leave them in this position for more than a few minutes Although relatively safe, head-down positions are probably contraindicated for clients with uncontrolled high blood pressure, glaucoma, history or risk of strokes, vertigo, or acute sinus issues See video of the Over-the-Edge Technique at www.a-t.tv/wb08 Figure 11.7 An open palm or the tips of curled fingers may be used to anchor the pectoralis fascia in the Cervical/Pectoralis Fascia Technique Key points: Over-the-Edge Technique Indications include: • Neck, shoulder, or back pain • Movement restrictions or stiffness • Fascial layer creep or tug observed with neck rotation Costovertebral Joint Technique D Intercostal Space Technique D Vestibular Orienting Technique I P Breath Motility Technique P D I Cervical Core/Sleeve Technique D I Lateral Cervical Translation Technique D I Over the Edge Technique D P Cervical/Pectoralis Fascia Technique P Nod Test P D I Technique Preparation Differentiation Integration Transversospinalis Technique P D I Cervical Wedge Technique D I Anterior Scalene Technique D Mother Cat Technique P TMJ Tracking P Masseter and Temporalis Technique P D I I D I Anterior Digastric Technique D I Posterior Digastric Technique D I Masseter (Intraoral) Technique D Medial Pterygoids D Lateral Pterygoids D Masseter (Intraoral) Technique D Mandibular Fascia Technique I Galea Aponeurotica Technique P D I Nuchal Window Technique P D I External Acoustic Meatus P Technique Palate Technique I D Sacrum Technique P I Table 20.1 Optimally, each session (as well as an entire series of sessions) is a progression of techniques that accomplish the preparation-differentiation-integration cycle Table 20.1 lists possible usage of the techniques in this volume, with the most common function of a technique listed in bold type when a technique can serve more than one function The proportion of time, techniques, or sessions you spend in each of these phases can be adjusted, depending on the stability, fragility, responsiveness, or stubbornness of the issues being addressed In complex, unstable, or lesspredictable conditions, such as spinal disc issues, hot whiplash, or symptomatic scoliosis, a very cautious approach (Figure 20.12) with proportionally more time spent in preparation and integration than with a typical progression gives you time to observe how your client responds to the work; and if necessary, to course-correct before aggravating the condition In other cases, where the body or symptoms seem slow to show any response, a bolder, more direct approach might be appropriate Even in slow-to-respond conditions, the results are usually greater when the preparation-phase functions of assessment, rapport, relaxation, and peripheral mobility have been thoroughly addressed Finally, whatever sequencing protocols you choose, the adage “less is more” seems to hold true Whether it is from trying to give clients their money’s worth, or inexperience with prioritization and time management, or fear of leaving something out, a common trait of beginning therapists is to more than is necessary The results can be overworking the client past the point of maximum benefit, dilution of the educational value of a few clear concepts for the client to incorporate, and practitioner burnout There is almost always benefit in slowing down and spending more time with fewer techniques, than in rushing through as many as possible in the allotted time On occasion, try “cooking” your sessions with just one or two spices, instead of using every seasoning in the cabinet Or, let the sessions you compose have the spare beauty and spaciousness of a string quartet, rather than always going for the lushness of the full symphony orchestra The effectiveness and satisfaction that both you and your client get from your work, depends less on how much you can fit in, and more on the art of leaving things out References [ 1] Rolf, I.P (1989) Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being Healing Arts Press [ 2] http://www.merriam-webster.com http://www.merriam-webster.com/dictionary/preparation [Accessed December 2015] [ 3] Johnson, D.H (1989) Presence In: Carlson, R and Shield, B Healers on Healing J.P Tarcher p 133 [ 4] Borrell-Carrió, F., Suchman, A.L., and Epstein, R.M (2004) The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry Annals of Family Medicine 2(6) p 576–582 [ 5] Scrivani, S.J., Keith, D.A., and Kaban, L.B (2008) Temporomandibular disorders The New England Journal of Medicine 359 p 2693–2705 [ 6] Pinto, R.Z et al (2012) Patient-centred communication is associated with positive therapeutic alliance: A systematic review Journal of Physiotherapy 58(2) p 77–87 [ 7] Stecco, C., Stern, R., Porzionato, A., Macchi, V., Masiero S., Stecco A., and De Caro, R (2011) Hyaluronan within fascia in the etiology of myofascial pain Surgical and Radiologic Anatomy 33(10) p 891–896 [ 8] Reiser, K., McCormick, R.J., and Rucker, R.B (1992) Enzymatic and nonenzymatic cross-linking of collagen and elastin The FASEB Journal 6(7) p 2439–2449 [ 9] Butler, D.S and Moseley, G.L (2013) Explain Pain 2nd ed NOI Group [ 10] Allisona, G.T., Nagyb, B.M and Hall, T 2002 A randomized clinical trial of manual therapy for cervico-brachial pain syndrome: A pilot study Manual Therapy 7(2) p 95–102 [ 11] Scaer, R (2014) The Body Bears the Burden: Trauma, Dissociation, and Disease 3rd ed Routledge p 166 [ 12] DiMatteo, R.M (2004) Social support and patient adherence to medical treatment: A meta-analysis Health Psychology 23(2) p 207–218 [ 13] Howgego, M., Yellowlees, P., Owen, C., Meldrum, L., and Dark, F (2003) The therapeutic alliance: The key to effective patient outcome? Australian and New Zealand Journal of Psychiatry 37(2) p 169– 183 Picture credits Figures 20.1, 20.7, 20.8, 20.9, and 20.10 Thinkstock Figure 20.2 courtesy Ron Thompson, used by permission Figures 20.3, 20.5, 20.12, 20.13, and 20.14 Advanced-Trainings.com The three Koch snowflakes in Figure 20.3 are used under CC BY-SA 3.0 Figure 20.4 Photographer: Jon Sullivan PDPhoto.org Public domain image Figure 20.6 From Guillaume-Benjamin-Amand Duchenne de Boulogne, Mécanisme de la physionomie humaine ou, Analyse électro-physiologique de l’expression des passions des arts plastiques 1862 Public domain image Figure 20.11 The fractal Julia set (in white) for the rational function associated to Newton’s method for f: z → z3−1 Coloring of Fatou set according to attractor (the roots of f) Public domain image, created by Georg-Johann Lay Study Guide Sequencing The Cervical Translation Technique is given here as an example of a technique that helps with: a preparation b differentiation c integration d cervical mobility Which of these statements maintains the closest meaning to the way the same idea is phrased in the text? a In order to be maximally effective towards our interpersonal goals, the client’s physical goals must be addressed b In order to be maximally sensitive towards our clients’ intra-personal goals, their physical goals need to be secondary c In order to be maximally effective towards our physical goals, the social aspects of the working relationship need to be established d In order to be maximally effective in the working relationship, the practitioner’s therapeutic goals need to be primary Which of these is closest to the text? “The psychological aspect of preparation could be defined within hands-on work as…” a “…fostering the interpersonal conditions necessary for change to occur.” b “…fostering the internal conditions necessary for change to occur.” c “…getting clear about clients’ reasons for seeking work, and their hoped-for results.” d “…getting clear about the practitioner’s therapeutic goals and hoped-for results.” 4 “Reducing motor tonus through autonomic calming” is cited as an a goal typical of: a preparation b differentiation c integration d biospychosociology 5 Which of these is NOT listed in the text as an interpretation of Ida Rolf’s practice of working with the neck and pelvis at the end of her sessions? a quieting the nervous system by working areas of parasympathetic concentration b emphasizing the body’s longitudinal axis in order encourage vertical alignment c ensuring adaptability at each end of the spine to prevent later discomfort d working the midline of the body after working each side Even though we draw inspiration from this fundamental sequencing in our Advanced Myofascial Techniques work (and even though many Rolfers and structural integration practitioners are amongst our faculty and alumni of our in-person trainings), I should clarify that this work is not Rolfing® (which is trademarked by the Rolf Institute of Structural Integration®) or structural integration per se, because we are focusing on techniques to address specific conditions, rather than on integration of the entire body in the field of gravity, which is the aim of structural integration 2 Fascia’s unique properties of continuity, plasticity, and sensitivity, and the ways these qualities inform our work, are discussed in detail in the first two chapters of Volume 1 INDEX Note: Page number followed by f and t indicates figure and table respectively A Abdomen, hands-on work with, 31–32, 34, 47 See also Mesentery; Mesentery Technique Abdominal adhesions, surgery-induced, abdominal massage on, 38–39 Anterior Digastric Technique, 146–147, 148f Anterior Scalene Technique, 129–132, 132f, 133f Atlanto-occipital (A/O) joint, 119, 120 See also Nod Test Autonomic nervous system (ANS), 79, 88, 89, 211 B Back pain, 4, 11, 23, 43, 48 See also thoracolumbar fascia (TLF); Psoas Benign paroxysmal positional vertigo (BPPV) See Vertigo Biopsychosocial approach, 210 Bone density screening, 72 Breath Motility Technique, 91–93, 93f Bruxism, 167 Bucket Handle Technique, 69 C Cervical hyperextension, 119, 119f Cervical lordosis, 127, 128 Cervical/Pectoralis Fascia Technique, 114–116, 114f, 115f Cervical Wedge Technique, 122–125, 123f, 124f Cleft palate, 192, 192f Cluster headaches, 187–188, 188f Cold whiplash, 89, 97 Cervical Core/Sleeve Technique, 97–99, 98f, 99f and hot whiplash, distinction between, 88t, 97 Lateral Cervical Translation Technique, 99–102, 100f, 101f, 102f, 103f working with, goal in, 97 Costal Arch/Diaphragm Technique, 58–60, 61f Costochondritis, 72 Costovertebral joints, 67, 67f Costovertebral Joint Technique, 67–69, 67f, 68f, 69f Coupled-motion biomechanics, 4–6 Cranium, superficial fascia of, 178, 178f C-tactile afferents, 179 D Deep posterior neck, 119 Cervical Wedge Technique, 122–125, 123f, 124f Nod Test, 119–120, 119f, 120f Transversospinalis Technique, 120–122, 121f, 122f Diaphragm, 57, 57f, 58f breathing, role in, 57–58, 59f contraction and relaxation of, 57 as core stabilizer, 60–61 Costal Arch/Diaphragm Technique, 58–60, 61f lumbar and low back pain, 58, 60f movement of, in breathing, 62, 62f Dizziness See Vertigo Dowager’s hump pattern, 127 E Ear stones, 78 Enteric nervous system, 32, 47 Epley’s maneuvers, 79 Erector spinae group, 65–66, 65f Erector Technique, 65–67, 66f F Floating Sacrum Technique, 203–204, 204f, 205f Forearm tool, 66 G Galea Aponeurotica Technique, 178–180, 178f, 179f, 180f, 181f Golgi tendon organ response, 14, 147, 148, 149f, 155 H Headaches, 177 See also specific type migraines, 185–197 musculoskeletal, 177–183 primary, 177 secondary, 177 Hot whiplash, 88t, 89 Breath Motility Technique, 91–93, 93f working with, 90–91, 92f Hyaluronic acid, 213 I Iliac crests, 13 See also Iliac Crest Technique; Thoracolumbar fascia (TLF) Iliac Crest Technique, 13–15, 14f Iliocostalis, 65f, 66 Iliolumbar ligaments (ILLs), 24–25, 24f and back pain, 24 Iliolumbar Ligament Technique, 24–26, 24f, 25f Intercostal Space Technique, 69, 70–71, 70f, 71f, 72f, 73f J Jaws, 141, 172 See also Pterygoids alignment, coordination, and myofascia, 142, 143f Anterior Digastric Technique, 146–147, 148f digastrics, 146, 148f, 150f, 151f myofascial contributors to jaw deviation, 144, 145t Posterior Digastric Technique, 147–148, 147f, 149f temporomandibular joint pain and discomfort, 142, 150, 153 TMJ Tracking Technique, 142, 142f, 144–145, 144f, 145f, 146f L Lateral arcuate ligament, 28 Lateral Cervical Translation Technique, 99–101, 100f, 101f, 102f, 103f variations of, 101–102 Lateral pterygoid Lateral Pterygoid Technique, 158–161, 158f, 159f, 160f and TMJ health, 156f, 157–158, 157f Longissimus thoracis, 65f, 66 Low back pain (LBP), 11, 23 causes of, 11 thoracolumbar fascia and (see Thoracolumbar fascia (TLF)) Lumbar lordosis, 58 Lumbodorsal fascia See Thoracolumbar fascia (TLF) M Mandibular Fascia Technique, 170–172, 171f Masseters, 144, 170–171 forces of, 165–166 function of, 165 and jaw pain, 165, 167 Mandibular Fascia Technique, 170–172, 171f manual therapy, role of, 168 Masseter Technique (Intraoral), 168–170, 169f multipennate arrangement, 166 resting tone of, high level of, 166–167, 166f, 167f tense and reactive, 167 TMJ Tracking Technique, 144, 144f, 145f, 146f Masseter Technique (Intraoral), 168–170, 169f Medial pterygoids, 153–155 belly and inferior attachments of, 154f, 155 and masseters, 153, 153f Medial Pterygoid Technique, 154f, 155–156, 155f uppermost attachments, 154f, 155 Mesentery, 31f, 32 See also Mesentery Technique anatomy, 33, 33f–38f intestines and, 31f, 32, 32f Mesentery Technique, 34 easing mesenteric net, 35–37, 40f indications for, 37–38 results, 38–39 rolling peritoneal bubble, 34–35, 38f, 39f Migraines, 177t, 185, 196–197 characteristics of, 185, 185f, 186f cluster headaches, 187–188, 188f decompressing head, 189–190 External Acoustic Meatus Technique, 194–196, 195f, 196f and musculoskeletal headaches, 189–190, 189f (see also Musculoskeletal headaches) neurological factors in, 187, 188f Palate Technique, 190–194, 190f, 191f, 192f, 193f, 194f techniques for, 188–189 triggers, 186–187 vasodilation and, 185–186, 187f in women, 186 Military neck pattern, 124 Mother Cat Technique, 132–134, 134f, 135f Musculoskeletal headaches, 177–178, 177t Galea Aponeurotica Technique, 178–180, 178f, 179f, 180f, 181f Nuchal Window Technique, 182–183, 182f, 183f N Neck pain, 109, 110 See also Deep posterior neck; Superficial cervical fascia Nod Test, 119–120, 119f, 120f Notochord, 3 Nuchal ligament, 182 Nuchal Window Technique, 182–183, 182f, 183f O Osteoporosis, 72 Otoliths, 78 Over-The-Edge Technique, 112–114, 113f P Parotid fascia, 170, 172f Pelvic diaphragm, 61–62 Pelvic lift, 202–203 Piano key method, 67–68 Platysma muscle, 115–116 Pleurisy, 72 Posterior Digastric Technique, 147–148, 147f, 149f Prevertebral muscles, 124 Psoas, 43 See also Psoas Technique anatomy, 43–45, 44f, 45f benefits from work on, 48 controversies related to, 43 emotional responses from clients, 47–48 safety in working with, 46–48 sensitive nature of, 45, 46f, 47f and spinal erectors, 45, 45f working with, 43 Psoas major See Psoas Psoas minor, 45 Psoas Technique indications for, 48 lateral, 50–51, 51f supine, 48–50, 49f, 52f Pterygoids, 153, 161 lateral pterygoid, 156f, 157–158, 157f Lateral Pterygoid Technique, 158–161, 158f, 159f, 160f medial pterygoids, 153–155, 153f, 154f Medial Pterygoid Technique, 154f, 155–156, 155f Q Quadratus lumborum, 58 R Respiratory diaphragm See Diaphragm Ribs, 65, 65f Costovertebral Joint Technique, 67–69, 67f, 68f, 69f Erector Technique, 65–67, 66f Intercostal Space Technique, 70–71, 70f, 71f, 72f, 73f pain considerations, 65, 72 restricted rib motion, 65 work on, 65 Rolf, Ida P., 208, 208f Rolfing structural integration, 62 S Sacrum, 201–202, 201f, 202f Floating Sacrum Technique, 203–204, 204f, 205f pelvic lift, 202–203 shape of, 202 Scalenes, 127 angled orientation, 127f Anterior Scalene Technique, 129–132, 132f, 133f as cervical extensors, 127–128, 129f compression of brachial plexus by, 129, 131f in head-forward postures, 127, 128f Mother Cat Technique, 132–134, 134f, 135f pleural ligaments and, 128, 130f postural and positional issues, 127–128 soft tissue and bones of neck, 127, 128f whiplash injuries and, 128 working with, indications for, 129, 131f Second brain See Enteric nervous system Sequencing, 208–209, 209f differentiation, 212–214, 213f, 214f integration, 214–216 micro/macro repetition of three-phase progression, 209, 209f, 216, 216f need of, 207–208 preparation, 209–212, 210f, 211f, 212f proportion of time/techniques/sessions spent in each phase of cycle, 216–218, 216f, 217t Rolfing® Structural Integration, 208 Serotonin, 32 Spine, 3 back pain and, 4 embryological development of, 3, 3f mobility, 4 neck pain/injury and, 3 rib pain and, 3 sacroiliac issues and, 4 sciatic pain and, 4 Sternocleidomastoids (SCM), 97 Suicide headaches See Cluster headaches Superficial cervical fascia, 97, 109–110, 109f, 110f, 111f, 116 Cervical/Pectoralis Fascia Technique, 114–116, 114f, 115f fascial tension as linear tug patterns in skin, 111, 113f Over-The-Edge Technique, 112–114, 113f releasing superficial restrictions, 111–112 restriction in, 110, 112f superficial restrictions, assessment of, 110–111, 113f T Techniques: role of, 207–208, 207f See also specific techniques sequencing of, 208, 217t (see also Sequencing) Temporomandibular Joint and Muscle Disorders (TMD), 141, 150, 153 See also Jaws; Masseters; Pterygoids Temporomandibular joints (TMJs), 141 Temporomandibular Joint Syndrome, 141 Tension-type headaches See Musculoskeletal headaches Thoracic outlet syndrome, 129 Thoracolumbar fascia (TLF), 11, 23–24, 23f See also Thoracolumbar Fascia Technique client conditions, involvement in, 13 Iliac Crest Technique, 13–15, 14f Iliolumbar Ligament Technique, 24–26, 24f, 25f and low back pain, 12–13, 24 multiple layers structure of, 12, 13f 12th Rib Technique, 25f, 26–28, 27f working with, 24 Thoracolumbar Fascia Technique, 15–20 considerations in, 18–20 disc issues and, 19–20 erector and multifidus layer, 15–17, 16f–17f quadratus lumborum layer, 17, 18f, 19f superficial and posterior layers, 15 transverse processes, pressure on, 18–19 TLF See Thoracolumbar fascia (TLF) TMJ Tracking Technique, 142, 144–145 assessment, 142, 142f masseters, 144, 144f, 145f, 146f temporalis, 144–145, 145f, 150f Torticollis, 127 Transversospinalis Technique, 120–122, 121f, 122f Trigeminal nerve, 193, 193f, 194f 12th Rib Technique, 25f, 26–28, 27f U Urogenital diaphragm, 61 V Vagus nerve, 32 Valsalva maneuver, 60–61 Vertebrae, 3 issues related to, 3–4 motions between, 4 (see also Vertebral motion) Vertebral Mobility Technique, 6–8, 6f, 7f pair of vertebrae, assessment and mobilization of, 7f rotational freedom of group of vertebrae, assessment of, 6f Vertebral motion, 4 biomechanical coupling, importance of, 5 disparities in, 4–6, 4f, 5f lumbar vertebral motion model, 5f restrictions in, 4, 4f unrestricted, 4 Vertigo, 78–79 See also Vestibular Orienting Technique; Vestibular system after whiplash, 88, 88f Vestibular Orienting Technique, 80–84, 82f Vestibular system, 77–80, 77f, 78f See also Vestibular Orienting Technique ampullary cupulae, 78, 80f, 81f body’s sense of balance, role in, 77 development of, 77, 78f disquiet, 79 head movement, detection of, 78 linear motion, detection of, 78 rotational motion, detection of, 78 semicircular canals arrangement, 78, 79f stimulation, 79 W Whiplash, 87, 103–104 See also Cold whiplash; Hot whiplash effects of, 87–88 hands-on body therapy for, 87 hot and cold, 88t, 89, 91f motor vehicle accident and, 87 psychobiological impact of, 87 tips from Advanced Myofascial Techniques faculty, 104 ... (20 13) Ultrasonography in myofascial neck pain: Randomized clinical trial for diagnosis and follow-up Surgical and Radiologic Anatomy Aug 23 [ 3] Tozzi, P., Bongiorno, D., and Vitturini, C (20 11) Fascial release effects on patients with non-specific... References [ 1] Breul, R (20 12) The deeper fasciae of the neck and ventral torso In: Robert Schleip et al (eds) Fascia: The Tensional Network of the Human Body Elsevier p 46 [ 2] Stecco, A., Meneghini,... which in turn was observed to measurably change as a result of hands-on fascial techniques ( 2) In another ultrasound study, sliding between fascial layers in people with neck or back pain has been seen to measurably improve after myofascial work ( 3)