Myofascial Induction™ 2-volume set

An anatomical approach to fascial dysfunction

Andrzej Pilat

• Publisher: Handspring Publishing Limited
• Year: 2022
• ISBN:
  9781912085286
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

In these unique and lavishly illustrated books and their accompanying videos, the practitioner can for the first time see the effect of manual interventions on underlying body structures.

Using over 700 photographs and diagrams these volumes reveal fascial architecture to the reader in all its glory, and sets out the principles and practice of Myofascial Induction. The author's own teaching and practice provide the material that explains and illustrates fascial anatomy and therapeutic procedures. The beautiful full color photographs and videos of dissections of non-embalmed cadavers show the continuity of the fascial system and its dynamic links to other body systems. By demonstrating the effect that therapy has on body structures the book will be of interest and practical value to the physical therapist, osteopath, chiropractor, physician and all bodyworkers dedicated to manual therapy, as well as to researchers wishing to build on this ground-breaking material.

Volume 1 covers the science and principles of Myofascial Induction and its applications to the upper body. Volume 2 addresses its applications to the thoracic and lumbar spine, the pelvis, and the lower body.

1

Cultivating a growth mindset

Case study

Jean came in to see me because she had persistent back pain. She owns a shop that requires her to stand and move around throughout the day.

I observed Jean as we spoke, and I noticed she had a tendency to lean back, arching her chest forward. We did a few things and I noticed this was her tendency every time she stood still. She had developed a habit of leaning back in order to “stand up straight.”

I had her shift her weight forward so her torso came forward over her hips. This immediately lessened the arch in her back. Then I had her move the ribs toward the floor by exhaling, bringing her chest down and centering her weight over her feet. Her persistent back pain in the “new” position was suddenly gone.

I told her that I wanted her to practice observing her standing position when she was at work or waiting in line. If she noticed her back was achy, I told her to shift her torso position and see if she could find a place that was more comfortable, or use her exhale to shift her rib position. “What you perceive as standing up straight is actually leaning back,” I explained to her.

This was enlightening for Jean, and the next time she came in, she reported less back discomfort during standing. “Whenever I would notice it, I would shift my position, and most of the time, it worked.” As Jean’s awareness about how she held herself in her daily life continued to grow, she began to feel more ease. Her discomfort continued to decrease, and, while she needed to gain strength and mobility to help her feel more stable as she moved through her day, altering her position and checking in with herself occasionally created an opportunity for connecting with her body. Her habitual standing pressure wasn’t wrong or harmful; however, she had become sensitized to it, which means it was causing discomfort. Her perception of where she was in space was also altered. Her sense of straight was actually leaning back. Giving her options for her position also gave her an opportunity to enhance her body schema.

When things like stiffness or pain are viewed as permanent situations, then that is what they will become. If you ask your clients and students to become active observers of their discomfort through inquiry, you are empowering them by giving them control over their bodies and their positions. Asking, “What happens if you change the way you’re moving or holding yourself?” is very different than telling someone their posture is potentially injurious.

How do your clients view the physical sensations they experience on a regular basis? When clients have an ache or pain that persists regularly, do they tell you, “I can’t go down stairs because it bothers my knees”? Or maybe they tell you, “My back is bad so there are certain exercises I can’t do.”

The acceptance of certain physical conditions and the assumption that a person’s current physical state is their forever state is an example of a fixed mindset. The potential trouble with a fixed mindset is it reduces intrinsic motivation. Intrinsic motivation is related to motivation, curiosity, and the desire to learn throughout the lifespan (Ng 2018). If there is reduced curiosity about physical skills and a decrease in confidence navigating the physical world, an individual’s movement options begin to decrease. Things like difficulty balancing or not feeling strong can lead to anxiety (Gordon et al. 2017; Shefer et al. 2014), resulting in the cessation of certain activities because of a reduced sense of trust in the body’s physical capabilities.

How you talk with your clients and students can have a direct impact on their mindset. How can you choose words or cues that shift their thinking? What if instead of emphasizing muscle groups or contraction and relaxation, you incorporated cues and movements that demonstrated that body parts and muscles don’t function in an isolated way? What if instead of suggesting pain was a permanent state and indicative of a biomechanical issue, you asked students to be curious about their sensations and explore different positions or different ways of performing a movement, observing how changing the load in the tissues could potentially alter their experience? Persistent joint and nerve pain should, of course, receive medical attention, but so much of what people perceive as pain is feedback from the neuromuscular system saying, “Hey, can you consider shifting the weight elsewhere so the load is dispersed across a different area?” I invite you to consider that the way your clients and students experience balance, coordination, and breathing, and the way they use their body could be changed because they are capable of learning; one of your jobs as a movement teacher is to ask the right questions and offer opportunities for learning.

Researcher and psychology professor Carol Dweck writes in her book, Mindset: The New Psychology of Success, “In fact, every word and action can send a message. It tells children – or students, or athletes – how to think about themselves. It can be a fixed-mindset message that says: You have permanent traits and I’m judging them. Or it can be a growth-mindset message that says: You are a developing person and I am committed to your development” (Dweck 2006: 173). She has spent her career studying mindset, specifically how our beliefs influence our motivation. Understanding growth versus fixed mindsets can help you understand how students view their world and their physical abilities. How you speak about movement and their movement will influence their beliefs about their ability to improve body awareness, mobility, and strength.

People begin a movement program because they want to change something, or explore a different way of using their bodies. This indicates they arrive primed with a desire to change. However, they don’t always have a clear picture of their body and how it moves in space. They don’t view body awareness as a skill to be learned and instead are simply seeking a physical change in weight, strength, or function. Showing people through the right inputs that they are capable of altering their behaviors/actions/physical state reinforces the fact that they have the capacity to learn and change with practice and hard work, instilling a growth mindset around the physical self. This makes it easier to recover from setbacks such as injury; it also makes movement interesting and (it is hoped) incites a desire to continue to explore movement throughout the lifespan.

A (brief) overview of how the brain and movement are interrelated

Let’s pretend you decide you want to pick up a grocery bag. Your brain makes this decision before your body begins to carry out the physical act of reaching for the bag (Mosconi et al. 2015). Once the decision has been made, deep inside the recesses of your brain, your brain communicates with your body via the nervous system to find out what options are available for picking up the bag. If you always pick up the bag with your right hand, your brain takes the information from the afferent (sensing) nervous system and spits out information via the motor nervous system about how to execute the task. The limbs and the muscles will carry out the act of picking up the bag. All of this happens so fast it’s unconscious and feels automatic.

And it is. If you had to think about every single movement you were making, you would be mentally exhausted and you would get a lot less done.

The central nervous system is comprised of the brain and the spinal cord. It’s divided into two branches: the sensory (afferent) nervous system and the motor (efferent) nervous system. We will discuss this in more detail in Chapter 2, but, for now, you just need to know that, with regard to the nervous system, the afferent branch is the information-gathering part and the efferent branch is the reacting part. There are a lot of things that affect the information you gather and the brain’s interpretation of the information.

Occasionally, the brain will receive information that certain movements, or that a specific body part, hurts. Let’s pretend your right arm is bothering you and you aren’t sure why. And let’s pretend for the purposes of this example the pain is vague, a nagging irritation in the upper arm that’s a bit diffuse. You can’t quite figure out how to get it to go away, and, because of your background, you throw a lot of things at it like massage and corrective exercises. When you go to the doctor, they diagnose you with an overuse injury, which is a little perplexing, because you aren’t sure how you are suddenly overusing the right arm. You begin to worry there is something more serious going on, even though the imaging comes back normal.

What if when the pain originally started, you began noticing how you used your right arm throughout the day and you noticed you always picked up things with your right arm, including the grocery bags? And what if when you noticed this, you began picking things up with your left arm occasionally to give your right arm a break? Maybe this slows you down a little bit, because you aren’t used to picking things up with your left arm and your left arm can’t lift as much because it’s a little bit weaker than your right, but maybe this change to how you normally do things is enough to make your right arm feel better. Do you still feel there is something potentially wrong with your right arm?

I have worked with two clients in the last year who originally came to see me because of the scenario described above. Asking the right questions, focusing their attention on how they moved, asking them to use the left arm, and giving them alternative movement options with the right arm caused a significant reduction in pain within a short amount of time. Creating an environment where it was okay to be curious about moving a different way also reframed their views of their shoulders, changing their narrative from “my right arm is bad/weak/injured” to “I can learn how to use my right arm differently and my left arm more.”

What about posture?

Creating awareness about a person’s physical habits is not the same thing as trying to create a certain position or posture. Motor control researchers define “posture” as stabilizing the body’s center of mass and maintaining balance during internal and external perturbations (Dutt-Mazumder et al. 2018). A perturbation is a disturbance that alters position; posture is the place a person returns to after the disturbance. Even in quiet standing, there is something called postural sway, subtle movements the body makes to maintain its upright position. The neuromuscular system self-organizes, meaning it chooses how to stand based on previous experience, specifically what has worked well in the past. It also takes into account information it receives from your eyes, the vestibular system (the system that determines balance and orientation based on inner ear information), and the proprioceptive system (which gives the brain feedback about where the body is located in space through cells located in the muscles and joints) (Purves et al. 2001). We will explore all of these systems in greater detail in subsequent chapters.

Another way to view posture is as the transition between movements. It’s the pause between being seated at a coffee shop and standing up to grab your bag. It’s the moment before you roll over in bed, or before you swing your legs over to the side of the bed in preparation for getting up. It’s the pause to glance out at the ocean before you resume walking.

Modern postural demands ask very little from us in terms of variability. Most people in developed countries work on hard surfaces, sit on soft surfaces, and sleep on soft surfaces. The density is consistent, which means our posture is consistent.

For some, the consistency in posture is heavily influenced by what others suggest we “should” be doing. At some point, good posture became synonymous with throwing the shoulders down and back and standing up “tall.” These words sometimes backfire; interfering with the body’s ability to self-organize can alter proprioception and kinesthetic awareness, aka the body’s sense of where it is located in space and/or the internal image of what the body looks like.

This modern-day postural consistency is in contrast to how our ancestors likely navigated the environment. They stood and moved around on surfaces that weren’t perfectly level and weren’t always the same density. They sat on different surfaces, and they weren’t able to choose which density they wanted for their pillow and mattresses. Their environment was varied, which means their posture was also varied and adaptable to a variety of situations.

Research is conflicting about whether posture corresponds to the development of pain (Murrie et al. 2003; Nourbakhsh & Arab 2002; Nakipoglu et al. 2008; Tavares et al. 2018; Wirth et al. 2018). But strong postural habits such as sitting the same way on the same chair, standing exactly the same way on similar surfaces, or driving in exactly the same position...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Foreword by Joanne Elphinston
• Foreword by Christine Ruffolo
• Foreword by Kathryn Bruni-Young
• About the Author
• Preface
• Acknowledgments
• Introduction
• Chapter 1: Cultivating a growth mindset
• Chapter 2: Body awareness and proprioception
• Chapter 3: Breath and interoception
• Chapter 4: Attention, neuroception, and mindful movement
• Chapter 5: Balance, part I: the feet
• Chapter 6: Balance, part II: an integration of systems
• Chapter 7: The spine
• Chapter 8: The hand and the shoulder: an overview
• Chapter 9: The pelvis
• Conclusion
• Appendix 1: Low back pain
• Appendix 2: Hypermobility
• Appendix 3: Assessment checklist
• Index