Myofascial manipulation techniques involve the direct, manual application of pressure in dense, slowly changing, work-hardened regions of tissue. The magnitude of compression and torque-related forces that must be generated to change tissue at acceptable rates are significant and have the potential for inducing strain and chronic problems in the structure of the practitioner. This is a problem that beginning students and experienced practitioners are continually forced to deal with.
Practitioners often work with their hands shaped in the closed “fist” configuration to apply pressure (Figure A, Top). This shape can be susceptible to mechanical distortion, stress and pain (Figure B). The necessary tensions, inadvertent vibrations, and active muscle tremors required to maintain the hand in this configuration also increases our client’s potential for discomfort.
GETTING A GRIP
I have found that high-resolution silicone rubber poured casts (or grips), made of the shape created inside a closed fist (Figures C-D), can help to solve this problem. Almost completely enclosed in the fist during use, grips enhance and facilitate manual contact. Grips are waterproof and washable. They easily fit in a pocket or bag and are simple to introduce to our clients who quickly get used to the idea.
Appropriately made hand-grips allow redistribution of the working forces through the palms while protecting the surfaces from the tips of the fingers (Figure A, Bottom). Each knuckle receives custom shaped and cushioned support for the pressure and torsion of working forces through the palm. The whole fist is passively and resiliently held in correct working alignment, dramatically improving solidity of contact.
Hand stabilization can be very appropriate for our beginning students while they develop the strength and structural adaptations appropriate for functioning in their intended field of work. Experienced practitioners can benefit through having improved ergonomic efficiency, relief of chronic work-related strain and extended professional longevity. Other benefits of grip use include reduced chronic compensations and muscular work tensions along with concomitant gains of manual sensitivity and increased awareness and relief from chronic work strain.
Figures C to E show examples of grips.
STRAPPING IN
When arms are viewed as levers, fulcrum placement determines the ways they may be supported and used. Circular, variablelength straps, made of modern polymer webbing or leather, together with a buckle and buckle stay, can function as portable, flexible, very effective supports for therapeutic manual contact.
Straps can be positioned to flexibly support the backs of a practitioner’s hands, wrists, forearms or upper arms. In use, the practitioner reaches through the circle to contact or hold the client. Work pressures applied through the arms or hands against the straps are directed inwards, towards the client. This results in a steady, solid support for the precise application of as much force, subtle or intense, as may be called for by any of the techniques in the broad range of modern myofascial manipulation strategies.
The strap’s easily variable length allows for precisely adjustable leverages and quickly facilitates a firm grip on anatomical contours of all sizes. For example, short lengths can be used to support work with hands, feet, knees and elbows. Medium lengths are useful for spanning the head (for cranial contact and manipulation), the depth of the torso, upper legs, and arms.
Straps can be used to support functional contact across distances normally too large to allow functional contact such as the breadth of hips and shoulders or across even longer body segments such as arms and legs.
Figures G through S illustrate various aspects and applications of strap supported contact.
…AND TAKING OFF!
Combining the use of two custom-cast grips with a circular strap for supporting both hands creates an integrated tool set that is exceptionally powerful, comfortable and mechanically stable. Use of this gripping technology enables much more effective use of traction, compression and torque than is possible using unassisted techniques.
Experienced practitioners will find that it is possible to decrease the amount of effort required for working in deep layers and dense tissues as well as to functionally differentiate between grip and traction. This means that minimal grip strength is required in order to apply quite high levels of traction or torque.
There are no rigid pieces in this set of hand tools. Its intrinsic adaptability enables ease of access to many kinds of bilateral and asymmetric contacts. When unique working geometries are combined with an expanded vocabulary of techniques we may expect the creation of unique treatments and innovative strategies for problem solving in the areas of human functional morphology and whole system biomechanics.
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Figure A, Top
This alignment of the carpal bones with the forearm results in excess tension in the extensors and compression in the flexors.
Figure A, Bottom
Grip enabled contact shifts the contact area to the tips of the knuckles and normalized the flexor-extensor balance in the forearm.
Figure B
Pressure on a closed fist can hyper-flex knuckle joints and drive fingernails into the palmar surface of the hand.
Figure C
A pair, right and left, of silicone rubber casts or grips.
Figure D
Grips are custom casts made from the inner shapes creat
Figure E
A grip may be used to support the shape of the fist.
Figure F
The client is horizontal and prone (head to the lower left of the photo). A hand-grip is being used to solidify contact to the posterior region of the leg.
Figure G
(A) Unsupported contact requires constant stabilization efforts from the practitioner’s shoulder girdle. In this geometry, contact with the client tends to spread sideways, forcing pectoral muscles to work as compensating adductors.
(B) Strap supported contact and forearm stabilization requires no holding or compensation efforts from the pratictioner.
Figure H
The client is horizontal and supine. The strap is being used to reinforce bilateral contact in the regions of the serratus and latissimus.
Figure I
The client is seated with both arms raised overhead. The strap is stabilizing bilateral contacts at the lateral margins of both scapulae, giving access to teres and subscapularis.
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Figure J
The client is seated and instructed to bend forward. The strap is being used to augment bilateral contact with the erectors.
Figure K
The client is standing, being asked to slowly bend and straighten his knees. The strap is being used to stabilize and strengthen contact with the superior portion of the iliotibial band.
Figure L
The practitioner is working with the seated client’s right shoulder. The strap is stabilizing contact to both the anterior and posterior portions of the deltoid. This contact not only facilitates specific work in the anterior posterior portions of the deltoid but can also ,e used to lift the superior portion as well.
Figure M
Figure N
The practitioner is working with a seated client’s right shoulder. The right hand is stabilizing and the left is working in the levator, rhomboid and serratus regions near the scapula.
Figure O
The client is horizontal and supine. The practitioner is working around the client’s right ankle, just in front of the medial malleolus.
Figure P
The client is horizontal and prone, with his left foot just off the edge of the treatment table. The strap is being used to stabilize contact around the lateral edges of the calcaneus.
Figure Q
The client is horizontal and supine. The practitioner is working with the client’s right hand, applying strap-reinforced contact to the palmar fascia.
Figure R
The practitioner is working across the length of a single digit on the client’s right hand.
Figure S
The client, horizontal and supine, is being asked to flex and extend his knee while the hand-grip assisted practitioner reinforce,, correct tracking of the knee joint.Contact Stabilization for Bodywork Practitioners
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