|
Thomas Gordy, Rolf Practitioner, LMT
Acknowledgements and Disclaimers
Many thanks to past teachers, assistants, colleagues, and participants for their assistance in the development of this work and this manual. Teachers who have influenced these materials include Neal Powers, Emmett Hutchins, Liz Gaggini, Til Luchau, Nilce Silvera, Andy Goodwin, Michael Salveson, Art Riggs, and Jan Sultan, to name a few. Of course, also to be mentioned is the groundbreaking pioneer in this field, Dr. Ida P. Rolf, without whom, none of this would have been possible.
Special thanks to Linda White and Billie Shea, great teachers and practitioners here in Nevada, striving to better both the field of bodywork and the practitioners within it. And of course, many thanks to Eric Asay, the photographer and web site designer making this presentation possible.
Disclaimer: This course teaches soft-tissue techniques for students and practitioners of manual therapy/massage therapy/bodywork. This is not a course in Rolf Structural Integration.
These methods do not constitute medical treatment and a physician should be consulted in advance about any conditions that are questionable or might contraindicate this work. While every attempt is made to insure the safety of the techniques taught, participants assume all risk for participation and subsequent application of the techniques learned.
It is recommended that students review anatomy before the class begins and use anatomical charts or books to aid in the understanding of this material.
Preface
The pelvis is the cornerstone of the body. The two hip joints are the joints that, more so than any other joints in the body, largely determine symmetry throughout the rest of the body. Hence, the importance of a mobile and balanced pelvis cannot be understated.
When we say mobility, we are talking about freedom at both hips as well as at the sacrum. Hip freedom means that the legs swing easily forwards and backwards (flexion and extension) with little or no fascial restriction. This translates into efficiency as the greater amount of swing that is in the hip joints, the less muscle power will be necessary to flex and extend. Further, hip freedom means that the legs swing easily front to back, without unnecessary pulling outwards (abduction) or inwards (adduction). To have such freedom, it is necessary to create space in the hip joints. One common cause of hip pain and, later, hip surgery, is a hip joint that is restricted or compressed, forcing the head of the femur deeper into the acetabulum (socket), causing an imbalance in the hip joint itself, or an added compression to the joint. By freeing the muscles and fascia surrounding the hip joints, we decompress the joints, allowing for greater movement and fluidity, creating better circulation through the joints, and staving off what could be a later date with an orthopedic surgeon. In my opinion, bodyworkers could and should be helping a great number of potential surgery candidates avoid going under the knife.
Mobility in the pelvis also has a great effect on the lower back. Almost all lower back issues have their roots in the pelvis. We must, of course, always be considerate of our foundations when we are working with human structure. One constant in our work is gravity, with its force coming straight down. Thus, like a house, the body must have a proper foundation if it is to thrive. The pelvis (as well as the legs and feet) is thus the foundation for the upper body. Lack of mobility or symmetry in the pelvis will often be most acutely felt in the low back, although the effects certainly go much higher. Immobility in the pelvis also causes the joints above (the lumbar spine) to compensate. Often, an immobile or out of balance pelvis (and sacrum) will force an inordinate amount of pressure and compensation to happen at the joint directly above – L4/L5. It is no wonder why we see so many herniations and problems at this space.
Symmetry also begins at the hip joint. When we are looking at symmetry of the pelvis, we are considering first the relationship between the pelvis and femurs. How the femurs relate to the pelvis here will largely determine the body’s structural pattern as a whole. The pattern in the pelvis will always be a combination of an anterior or posterior tilt with an anterior or posterior shift. This pattern can be bilateral and also unilateral. For instance, one side can be in an anterior tilt and posterior shift, and the other side of the pelvis will be in a posterior tilt and anterior shift (relative to the other side). That pelvic pattern will then be reflected in the shoulder girdle, where the exact mirror opposite will most often occur. There are of course, different combinations of tilt and shift that can make up a pattern.
Without going into too much detail about tilt and shift patterns, just by understanding the muscle groups (and associated fascia) that influence these patterns, we will be able to help balance the pelvis by working bilaterally (evenly) throughout these groups. And solely by balancing the pelvis with the femurs (the hip joint) we will give symmetry to the pelvis, which will be reflected into the structures above it. Remember, the structures above (back, neck, shoulder girdle) most often only have pattern distortion due to the distortions in their foundation – the pelvis.
It needs to be said as well that we are not necessarily overly concerned with “correcting” a particular pelvic pattern – for instance, if your client has a bilateral anterior tilt, we aren’t necessarily seeking to correct that pattern and try to create the “perfect” spine. There is no such thing as “normal” or perfect when it comes to spines. Most importantly, if your client has always had such a pattern and the accompanying lordotic curvature, both the sacrum and the vertebrae themselves have adapted to the pattern, and trying to shift the pattern too far away from what has been there can cause great discomfort to the client, especially at the sacrum. There are of course instances where the pattern is excessive, but in normally working through the myofascia of the pelvis, as described here, we will free the pelvis to find its normal and comfortable resting place. That being said, introducing the topics and discussing pelvic positions and patterns enhances our understanding (and sometimes confusion). We thus begin to inquire further and to strive to see more. Although we are working through the entire region, front to back, side to side, our understanding of patterns will give us a better understanding of how we are affecting the body’s alignment and where to focus our work.
Pelvic Dysfunction/Distortion
Why does it happen? What was the cause?
Why(?) is an interesting question and the answer can range from poor movement to possible child birth trauma. Thus there are a myriad of reasons. You might find discrepancies in the feet and ankle that are adding to problem, or, very rarely, there is a bone-length discrepancy. Or there might have been an accident early in age, or car accidents later in life. Please note that the question of how a pelvis first came to be dysfunctional is less important than the question of what we can do to help it, and what type of behavior or movement patterning the client is engaging in presently that is reinforcing the distortion that is there. Poor learned patterns from childhood will of course typically persist into adulthood.
In American society, males often imitate their father figures or other masculine figures in their life. Regrettably, any motion in the hips is often seen as “girly” or “gay” and frowned upon. Hence children will often mimic the “rigid-hipped” walk of other males around them. This lack of movement in the hips leads to problems later, both with the hips directly and often in the low back.
Kids today will often adopt the “cool” posture – feet turned outwards, jeans slung low, an intentional hitch in their gait, hips held rigid while the low back hikes the hips and rotates in order to walk. A recipe for a bad back later in life.
Ballet students are forced to turn their legs and feet out. Often this is fine but if there is a normal tendency for a particular femur to rotate medially, this puts great stress at the hip and eventually may lead to “dancer’s hip”.
In any case, the above examples illustrate how our learned movement patterns are involved in creating or reinforcing pelvic dysfunction. Dance classes, Rolf Movement, Aston Patterning, Gyrotonics, Pilates, Yoga, personal training focusing on balance, and other movement based therapies go far to address this problem, and if you note some serious movement patterns that seem to be hurting rather than helping, suggesting that your client take up a movement based-therapy is a good idea. Still, just opening up the pelvis will give the client a new awareness there and new opportunities to move in an increased space and in a different manner. Additionally, our work will include movement re-education. Your work will allow the client to move differently – more fluidly with greater ease and grace. How quickly they can grasp these new opportunities of movement is up to the client, but these opportunities in movement will be theirs to utilize and enjoy.
Setup Considerations
A. Draping – underwear vs. bare
Having the client in underwear allows for easier positioning and draping. At times, less draping will be necessary making underwear essential. Underwear also gives the client a greater sense of safety. Clients are often “used” to being naked and often expect this, however, in a clinical setting where you may need the client to be in multiple positions; underwear makes the whole time-consuming issue of draping one that is less pressing and certainly less stressful.
The rules of draping where drafted with overtones of prostitution and sexual assault in mind (which unfortunately remain a reality to this day). However, when it comes to working with a client in a clinical sense to resolve a particular musculo-skeletal issue, these rules do nothing but inhibit us as practitioners. To work more effectively, one must be able to “see”, whether that is while working with a client during a session, or before the session even begins, assessing where tissue is held or shortened.
In working with the pelvis, it is very useful to have the client in underwear or a pair of loose shorts as much of the work takes place in sidelying position (and draping in sidelying is a pain in the derriere). We will also be moving the client’s from position to position, and often it is useful to have the client’s stand and move around so that we, as practitioners, can see the work in progress, and the client better feel the changes as they happen in the field of gravity.
B. Table Height
Clinical and deeper work often requires the table height to be lower than for other modalities, such as Swedish. The table height should be such that the practitioner can bring his/her weight to bear with arms in a fairly straight position. Also of use here is a small stool from which the practitioner can stand in order to bring more weight to bear. The important thing here is to be able to work comfortably, and if you cannot use your weight to do the work and are instead relying on muscle power, you are straining yourself. As much of pelvis work is done in sidelying, the table must often be a bit lower as the client’s body “height” will be higher than in prone or supine.
C. Lubrication
For deep work, clinical work, and myofascial release, less rather than more lubrication is necessary. You can’t use your weight if you are sliding off of your clients. The key here is to engage tissue, not slide over it. Less lubrication allows for slower work, allowing you to feel what is happening.
For clinical work, it is recommended that you use a lotion rather than oil. Often, you may only want to use a small amount of over the counter skin moisturizer – enough to ensure that the client will be comfortable as you engage the tissue, but not too much that you unintentionally slide. Over-lubrication actually makes it harder to work and causes you to strain.
D. Speed
Most deep, clinical, or myofascial work should be done at a much slower pace. This allows tissue to respond and minimizes any bruising. Further, working slow allows us to feel what is happening...and that allows us to learn. Go in slow, work slow, and come out slow. For lighter or more vigorous massage such as a pre-event sports massage, speed may be required, but most of the time, slowing down is both beneficial for us as practitioners, and for our clients who feel a more relaxed, easy, and sensitive touch.
E. Unilateral vs. Bilateral work.
Your approach to a session is extremely important. My advice to all students and practitioners that it is very important to work both sides of the body. Deep/Myofascial work can and will change structure. Unless you well-schooled in biomechanics and are certain of which tissue structures need unilateral/asymmetrical attention, always work both sides of the body -- this will insure the safety of the client. In the context of working with the pelvis, we should work through all muscle groups, as listed below.
Overview of Anatomy
When we look at the pelvis we are most often thinking from the feet up. Feet, ankles, and lower legs can absolutely have an effect on the pelvis, but for our purposes, we will mainly be concerned with the more controlling muscles and associated fascia of the upper leg and pelvis.
For clarity, muscles are listed here. This list is not exclusive. Always in consideration of the muscle is the fascia associated with that muscle: superficial fascia on top of the muscle and the fascia around the muscle and through it (deep fascia). More so than trying to achieve changes in the muscle tissue itself, we are actually more concerned with the fascia associated with it, both deep and superficial. This fascia controls the length, shape and tonus of a muscle much more than the actual muscle fibers themselves.
Although for clarity we are listing individual muscles, what is more important, in terms of movement, is distinction and separation between the muscle groups. The body does not operate in terms of telling specific muscles to fire...instead it recruits all available muscle fibers in an area to perform a specific operation – say, flexion at the hip. Thus, flexion can include both adductors as well as flexors – whatever it takes to get the job done. Where we run into trouble is when, for example, our adductors are indeed doing a large share of the flexion. This results in a decrease in efficiency as well as a typical deviation from the leg moving in a straightforward manner during flexion (it may have a tendency to move medially as well). Hence, flexors should flex, extensors should extend...and so on.
Hip Flexors
Rectus Femoris
Iliacus
Tensor Fascia Latae
Sartorius
Pectineus – (listed here, although technically an adductor, has a strong influence on hip flexion and pelvic shift)
Hip Extensors
Hamstring group – biceps femoris, semitendinosus, semimembranosus
Hip Adductors
Adductors Longis, Brevis, Magnus
Pectineus
Gracilis
Hip Abductors
Glute medius, minimus
Deep Hip Rotators
Piriformis
Gemellus Superior
Obturator Internus
Gemellus Inferior
Quadratus Femoris
Technique: Working with the tissue
As bodyworkers, we touch the body from the outside in. The body itself, fascially-speaking, is composed of layers of fascia, starting with superficial fascia, directly below the skin. It is here that we must first work, before we attempt to go deeper. Ideally, we’d like to have uniform freedom of the superficial layer on the entire body before going deeper, but for our specific purposes, we need to at least address the superficial layer of the pelvis (and thigh) first before diving deeper. Doing so will create much better results and help those results to stick. We will divide techniques into muscle (and associated fascial) groups and first work with superficial fascia before going deeper.
In your approach to a session, if you have a client that you are reasonably sure will be back to your office, you may want to spend a whole session addressing just the superficial fascia of each muscle group, and then do your deeper work in the next session. You may be surprised just how much change you can achieve simply by working with the superficial fascia.
1. Hip Abductors
Hip Abductors move the leg laterally, away from the midline. Abductors will fire to stabilize the lateral aspect of the leg with every step.
Often you will find a client with one hip visibly higher than the other. If this is the case, the hip abductors are where you will be typically be focusing your work. Often this type of structural deficiency is incorrectly diagnosed as a bone length discrepancy between the two legs. Most often, however, the only discrepancy is the joint space within the hips where on the higher hip, the joint will be compressed, resulting in the appearance of a bone-length discrepancy.
Hip abductors (glute medius, minimus) also have the effect of tilting the pelvis forward (anterior tilt).
These muscles are rarely touched in most bodywork sessions, which is unfortunate given their strong influence on the lower back. The fascia of the abductors has great continuity with the fascia of the lumbars, and often time pain in the lumbars can be attributed to very tight abductors (glute medius and minimus) and their associated fascia. Compression and restriction here will also contribute to a “shortening” of the waist line, where the space between the bottom of the ribs and the top of the hip is visually small or even non-existent. Making space and freeing the abductors will thus make space for the lumbars. With that in mind, we start with the lateral superficial fascia, continuous from the knee to the lumbars.
A. Superficial Fascia
1) ITB
The Ilio-Tibial Band is essentially a thickening of the fascia lata – the fascial wrapping of the thigh. It runs the length of the lateral thigh and is tightened chiefly by glute maximus and tensor fascia latae.
With every step the glutes and the tensor fascia latae will contract, tightening the ITB and stabilizing the lateral aspect of the leg. Overuse and abuse will cause the ITB to thicken and stick to the tissue below it. Often times too you will find that the ITB has clearly palpable edges to it. This is typically not good.
Fascially speaking, the ITB also has fascial continuity with the fascia of the glute medius and minimus, and then runs up into the quadrates lumborum and into the back. Hence, the ITB becomes an important place to work for both the pelvis and the back.
To free the ITB we are using a broad fist, forearm, or fingers to un-stick the tissue from the deeper quad fascia below it. The best position here is sidelying. Where we feel a palpable border, our goal is to actually smooth these borders out, pushing the tissue away from center of the ITB towards either the hamstrings or front quads. Try drawing an imaginary line from the greater trochanter to the most lateral aspect of the knee. Spread the ITB away from this line. Doing so will give much better results for those suffering with “ITB” syndrome than simply trying to lengthen the ITB. Be aware here of the depth that you are working at. The ITB isn’t deep. Rather it is directly below the skin and above the quads.
2) Greater Trochanter
Fascia from the ITB runs up and over the greater trochanter of the femur. As superficial fascia often gets ‘stuck” on bony protrusions, we want to make sure that no fascia is sticking to the greater trochanter. When it does, it reduces swing in the hips, which then requires more muscle output by the client to walk or run. Further, it will add to compression of the hip joint, also limiting movement.
In sidelying, free the fascia running over the greater trochanter by pushing it off of the greater trochanter in a “star” like pattern. We can use our fingers or elbows here.
3) Iliac Crest
The bony iliac crest is also where glute medius and minimus attach. As we clean the fascia off of the bone, we also have a great effect on these glutes and on the lumbar area above, giving both space.
With the client in sidelying, using either your fingers or an elbow, slowly work the fascia off of the bony aspects of the iliac crest, taking the tissue down and back.
B. Hip Abductors Deep Fascia, Muscle
1) Gluteus Medius, Minimus
Gluteus minimus largely runs beneath glute medius and they are often very difficult to tell apart. This makes no difference. We are interested in freedom and fluidity of both muscles. As described previously, we want to make sure our abductors are only abducting, and not being used in flexion and extension, thus in sidelying we will be using the “knee forward” and “knee back” movements to simulate walking. Thus we will have the client perform flexion and extension while we engage the tissue of the glutes.
Using an elbow in sidelying, first engage the tissue of glute medius and minimus (between the iliac crest and the greater trochanter). Look for hard, restricted spots and patiently wait for them to release. Have the client provide active assistance by having them move their knee forward or back. As this motion takes place, you will want to monitor the lumbar area, which should be extending and lengthening as the knee comes forward. The hip, as the knee comes forward, should be “dropping out”. Clients with low back issues almost inevitably do not lengthen in their lumbars and glutes as their legs swing forward. Client’s with severe low back issues will often shorten or compress in their pelvis and lumbars as their legs come forward. It is your job to change this movement pattern so that with every step there is length and motion.
With a client who has a one hip higher than the other, after working through the above areas, spend some time working the QL on the higher side. This will further help the hip to drop to its position. Sidelying once again is the better position to access QL. Start laterally and work medially through the tissue, having the client perform the same forward and back leg/knee movement to facilitate space and length.
2. Hip Adductors
The adductor group is principally responsible for medial stabilization of the leg. These muscles are remarkably strong and, when over toned (tight) are chiefly responsible for tilting the pelvis forward (anterior tilt) and causing the front of the pelvis to move medially (in-flare). This is contrary in some respects to many other “authorities” which claim that the hip flexors cause anterior tilt. While this seems reasonable based solely on anatomical insertions and attachments, physics, biomechanics and your practice will dictate otherwise.
Adductor and inside of the leg fascia runs up into the pelvic floor, and that fascia runs up deeply into the spine. By this very reason we can appreciate how important this area can be.
Freeing the adductors gives stability to the pelvis and the lumbars above. With this work the client tends to feel more “grounded”.
Adductors can often work hard as hip flexors, although as we will see, this is not something we desire and is instead typically wasted movement and energy.
A. Superficial Fascia
1) The inside of the leg
While we are principally concerned with the adductors, we will first give our attention to the layer of superficial fascia that covers the entire inside of the leg, typically looking from the ankle on up. Superficial fascia here tends to be thin, tender, and easy to work with. The hard part about working through the inside of the leg is may be that your client has very seldom, if ever, received work in this area. Be aware too that the inside of the leg can be very tender.
To work in this area, it is preferable to have your client in sidelying. Top leg will be bent and supported by a pillow (or two) and the bottom leg will be straight. Try to keep the pelvis (and client) in a purely sidelying position to the table otherwise the area you are trying to work on will be twisted away from you by the client.
To free this area your more sensitive hands and fingers work best. Like the ITB we are essentially drawing a line down the inside of the leg and spreading the tissue towards the front and back of the leg. Again, we are engaging superficial fascia only and patiently waiting for the tissue to “melt” or release rather than forcing it.
B. Deep Fascia/Adductors
1) With the client in a purely sidelying position, the first thing we need to assess is the movement pattern of the client. To do so, place your fingers in the adductor “triangle” area and have the client move their knee (of the same leg) forwards and backwards (flex and extend). As we discussed with hip abductors, this type of movement is the job of the hip flexors and extensors. The adductors should not be firing. If they are, this is wasted muscle movement that either hinders or upsets what should be easy and fluid hip flexion and extension. Also, excessive involvement of the adductors here can often cause leg motion to have a medial tendency or hitch when in forward and back movement. Such a tendency will upset the gait pattern and pelvic movement.
Typically you will find adductor tissue nearer to the hip flexors that fire during flexion. With extension, you will often find adductor tissue located near the hamstrings that will fire with the movement. Why does this happen? As with the abductors, the body is simply recruiting whatever tissue it has available to do a particular job – in this case, flexion and extension. In freeing the hips and pelvis, however, the body no longer needs this tissue to perform the movement and it becomes only wasted energy and a hindrance to movement.
To release the adductors, we will be sinking our fingertips into the muscle groups, paying particular attention to the tissues that are contracting or holding during flexion and extension. It often helps here to work as closely to the bone (the pubic bone) as possible, thereby stimulating the golgi tendon organs to relax the muscle as a whole. When your fingers have sunk in, ask the client to again flex and extend at the hip (knee forward, knee back) while you hold the tissue. This may at first be very difficult for the client to perform but will become easier as the muscles release and, by virtue of you holding the muscles that are trying to contract, the movement pattern is neurologically changed and retrained.
 
3. Hip Flexors
Hip flexors, in general, can contribute to a shift of the pelvis. Shifts happen in the sagittal plane – in other words, parallel to the floor. Most often with clients who have significant back pain, there will be an obvious asymmetrical shift to the pelvis – with one hip coming forward, and one hip going to the back. Observe your clients in a normal standing position. Even fully clothed, a shift may be obvious.
It is best to focus your hip flexor work on the side that is shifted posteriorly. This may be counterintuitive to what you see and would expect, but stop and think about it. Shortened hip flexors cause the hip to flex, and when that happens, the pelvis naturally goes back.
When in doubt, just work both sides evenly.
As a unit, rather than just from side to side, the pelvis may shift (and tilt) posteriorly or anteriorly. An overly shifted pelvis will often be relieved by equal and even work in the hip flexors – along with work in the deep hip rotators, as we will later see.
A. Superficial Fascia of the Hip Flexors
1) The upper leg
With the client in supine and using a loose fist, fingers, or a forearm, engage and release the superficial fascia of the quadriceps area, starting from the knee and working up towards the Anterior Inferior Iliac Spine (“AIIS”) and Tensor Fascia Latae (“TFL”). Here we are most concerned with just freeing the superficial fascia rather than taking it in a general direction, thus we can also work from the top of the leg (near the AIIS) down as well.
 
2) Hip flexor attachment area (AIIS and TFL)
With the client in supine use a palm, elbow, fingers, or a loose fist, to engage the superficial fascia of TFL and the fascia near the AIIS (mainly rectucs femoris) pushing down towards the knee. To facilitate have the client do a posterior pelvic tilt (flattening the lumbars and opening the space you are working in).
B. Deep Fascia and Muscle of the Hip Flexor
1) Rectus Femoris and Sartorius
In supine, utilizing the method in #2, above, engage Rectus and Sartorius at the attachments on the ASIS and AIIS, stimulating the golgi tendon organs. Wait for the tissue to soften.
2) Iliacus
Iliacus is a hip flexor that can also contribute to pelvic shift and the distortion or dysfunction of a sacrum. It affects the sacrum by connecting into the Ilio-Lumbar ligament, which has attachments at the sacrum. An overly taut iliacus will have the effect of pulling, on the same side, the sacrum (at the sacro-iliac joint) deeper into the joint (anteriorly). The sacro-iliac area will feel “deeper” on that side.
To address Iliacus, have the client in supine with the knees raised (feet on the table). Engage Iliacus with the finger tips, waiting for tissue to soften and slowly moving around the inside of the pelvis.
3) Pectineus
Medial and slightly posterior to the attachment of rectus femoris lies pectineus. Known as an adductor but often a strong hip flexor that has a significant impact in the shift of a pelvis. Engage with an elbow, slowly and carefully (it can be very tender). Have the client rotate his leg laterally to assist or rotate it yourself.
4) Quadriceps group
Using a forearm and with a deeper intention, slowly push through the muscles starting from the knee and working up. Wait for the tissue to soften before forcing your way through.
A note about Iliopsoas:
You will note that Iliopsoas is not covered here. Your principle hip flexors are rectus femoris and tensor fascia latae. Contrary to popular belief, iliopsoas is a rather weak hip flexor. Having fascial attachments all along the pubis, the muscle, when correctly used, stabilizes the lumbars by pulling upwards on the pubis, stabilizing and somewhat flattening the lumbar curve. Thus, thinking that you will remedy an anterior tilting pelvis by jamming your fingers in the psoas is a rather misplaced proposition. Further, psoas is the filet mignon of the human body – it is a very supple and tender piece of tissue with very little dense fascia that runs through it. Accordingly, it does not take much to change psoas (for better or worse) and it is the type of tissue where problems often end up rather than begin. Because of this, psoas often just responds to pelvic position, rather than dictating pelvic position. If you can change the pelvic position by working other myofascial units, psoas will change by itself. Finally, directly on top of psoas are the ureters running from the kidneys to the bladder. By upsetting, moving, or damaging the ureters (i.e. digging your fingers and elbows into psoas and the ureters on top), you can upset the natural movement of the kidneys, which can and will cause very uncomfortable back pain. All in all, without training in visceral manipulation, or only limiting your work to the lateral and medial borders of psoas and its lower attachment, the best advice may be to put your fingers elsewhere.
4. Hip Extensors
Essentially, we’re talking hamstrings here. Overly tight hamstrings will cause the pelvis to tilt posteriorly, flattening the lumbar curve. In practice, those with a flattened lumbar curve typically have more back problems than those with good lordotic curvature or even excessive lordotic curvature. The reason for this is as the lumbars straighten, they lose the ability to absorb shock and bear weight. Disc compression ensues. And, either it is my imagination, or it seems that a lot of people lose their lumbar curvature as they get older, possibly due to excessive sitting (shortening of the hamstrings) and not enough stretching or moving. Hamstrings attach up on the ischial tuberosities of the pelvis (the “sit-bones”). Overly tight hamstrings pull down on the ischial tuberosities, rotating the pelvis posteriorly flattening the lumbar curve. Thus, a large part of the solution to straight lumbars/posterior pelvis is releasing and lengthening the hamstrings.
A. Superficial Fascia of the Hamstrings
With the client in prone, working from the knee up, engage and release the superficial fascia of the hamstring group, pushing the tissue towards the buttocks. Concentrate on areas that seem restricted, thick or “sticky”. Often times this is the tissue of the lower hamstrings/back of the knee. You can assist the work by levering the client’s lower leg as you engage and hold the superficial fascia.
 
B. Hamstrings Muscle and Deep Fascia
1) The Ischial Attachments
This is the classic “camping” technique. In prone and using your elbow, engage the tendons of the hamstring group directly below the ischial tuberosity (“sit bones”). Wait for the tissue to soften or have the client assist by pushing her knee into the table.
2) Separating the Hamstrings
Relatively simple but tedious technique, use an elbow, knuckle or fingers to separate the hamstring muscles. Especially important is to separate the hamstrings from the quads laterally and the adductors medially.
3. Lengthen Hamstrings
Using a forearm and with a deeper intention, slowly push through the muscle starting from the knee and working up. Wait for the tissue to soften before forcing your way through.
5. Deep Hip Rotators
Deep Hip Rotators work against the hip flexors in shifting the pelvis. The side of the pelvis that is shifted anteriorly (to the front) will have deep hip rotators that are over-toned (shortened).
To test the relative length of the deep hip rotators, with your client in prone and the legs bent, lever the lower leg to the outside and feel for the maximum range of motion while you are medially rotating the femurs. Focus your work on the shortened side.
To release the deep hip rotators in prone, engage the deep hip rotator tissue (between the greater trochanter and the sacrum) with an elbow, fist, or fingers. Wait for tissue to soften or use the client’s leg as a lever, shortening and lengthening the tissue as you work. Work from the top of the group to the bottom.
 
6. Sacrotuberous Ligament
In releasing the pelvis as a whole we will also want to pay some attention to the sacrotuberous ligament, which is fascially continuous with the hamstrings and can help determine both sacral position and freedom. The sacrotuberous runs bilaterally from the sacrum to the ischial tuberosity. It can be felt below the glutes as a rope-like structure, often feeling like bone. Another “camping” opportunity, use firm pressure and engage the ligament, waiting for it to soften. Have the client assist you by pressing his knee into the table or engaging his pelvic floor.
Conclusion
This manual is certainly not an end-all, be-all magic guide to the pelvis, but presents fairly easy methods to bring balance to the structure. Regardless of whether you understand or are even trying to understand what you are seeing in a structural sense, working bilaterally through all of the pelvic tissue as presented here will bring balance to the pelvis and the structures above, ease strain, and promote a healthy back. There is assuredly more to learn, and it is your eyes, ears, and fingers that will serve as your best teacher as you continue in this journey; this limitless exploration of human structure and function.
|