Atherosclerosis, also called Arteriosclerosis, the hypertrophy and fibrosis of the large muscular arteries (the aorta and its major branches) eventually weakens and disrupts the elasticity of these arteries. This loss of elasticity contributes to high blood pressure. The hardened and scarred arteries do not freely expand and contract with the varying needs of blood during exertion or rest.
The entire picture is much more complicated, but let’s just stay with the image of the “stressed out” wall of the artery and understand that it may well eventually break apart, pouch out, like a worn out tire, where the fabric pouches out between the cracked rubber and bursts.
We call this an aneurysm, a focal weakness and distension of an artery most commonly associated with Arteriosclerosis and Hypertension. Some evidence exists that there may be a genetic basis to this problem. There are many possible aneurysms, some in the arteries mentioned above, some in the small arteries of the head, some in the large arteries of the extremities.
I will only address a major and highly significant one for us, the Aortic Aneurysm, because we often touch our clients’ abdomen deeply when we reach for the iliacus insertion or the psoas tendon or more superficial structures like the rectus abdominis fascia… and should an Aortic Aneurysm dissect or burst in our office, the client would most certainly die in the next few minutes.
This problem does not happen that often and mostly happens to the elderly, but Arteriosclerosis and High Blood Pressure are rampant, don’t count on statistics, rely on your hands and knowledge. It is said to happen to men more than women (ratio 5:1) and after the age of 50, and mostly in the abdominal aorta below the bifurcation of the renal arteries.
What would the client tell us, if we asked the right questions?
He mostly does not sense anything scary, a mild back problem, a vague pain. He may tell you that the pain radiates to the chest (if you ask). This pain can be persistent or intermittent, it can also be felt in the lower abdomen.
These early symptoms of an Aortic Aneurysm could, of course, indicate a myriad of different problems and may also indicate nothing at all. Just do yourself a favor! If you have the combination: elderly man or woman, Arteriosclerosis, high blood pressure, back pain radiating to the chest or to the abdomen… turn your intuitive alarm lights on! …and let’s hope that a person with advanced symptoms like severe pain has the good sense to go to the doctor.
What could we see?
Mostly nothing at all. If the aneurysm has expanded to a dangerous level you may see an abnormal contour of the abdominal wall (see illustration below) when the client lies supine. This could also indicate many other things, it certainly would tell you that this client needs to be examined by a physician who knows that the client intends to be Rolfed.
What could we feel?
If you have come this far and are a beginning Rolfer, do nothing. Refer for medical examination and make sure the client does not fall on the staircase. If you are confident and have a good sense of how far the normal aortic pulsations radiate through the tissues, you may, with a very light finger or flat hand palpation, feel a large pulsating mass portending catastrophe.
An Aortic Aneurysm can certainly be felt by a skilled palpator but cannot be positively diagnosed by palpation, it can be diagnosed on a simple lateral lumbar X-ray film (provided the walls are calcified, which they only are 50% of the time), it can be diagnosed via ultrasound (echo graphy) and with a C.T. (computerized tomography) scan. These are non-invasive methods. It can also be visualized via angiography, which is a risky procedure (if the client is your granddad, oppose that method).
This is a drawing I made by tracing from a C.T. scan image. Compare the size of the aneurysm to the size of a normal aorta. Imagine the pressure in the wall of that artery!
Transverse View of the Lower Abdomen
Now comes the best part: Some people walk around with Aortic Aneurysms, but they are not very large. Their physicians know about it, the people may have been told about it or they may have no idea. The reason for this is that a small aneurysm will most certainly evolve slowly unless for some reason the person’s blood pressure rises dramatically or they have a major car accident. This is a calculated risk by the medical profession. The surgery for this problem is highly risky and expensive. A normal aorta could measure more or less 3.8 cm at that level. Surgery is only recommended if the aneurysm has expanded to a diameter of 5 cm. It is prone to rupture after 5 cm.
Many physicians do not know that we actually work in the abdomen. That is why you need to refer for examination if there are signs of danger, and make certain that you find out that the abdominal vasculature is sound…. and as a general rule of thumb: Stay off the thompers!
Now comes the very best part: Some people surely walk around undiagnosed. That is why you have to keep your heart open and cover your a…