technique MYOFASCIAL TECHNIQUES Tools for Working with Differentiation, Elasticity, and Perception By Til Luchau

Fascia is famous. Growing Epidermis numbers of conferences, scholarly Dermis studies, magazine articles, Superficial retinacula cutis fibers exercise systems, and self-help Fat books feature this suddenly Superficial fascial membrane popular tissue. Although fascia Deep retinacula cutis fibers has had champions as far back Deep fascial membrane as Andrew T. Still, the originator 1 Hyaluronic acid layer of osteopathy (1828–1917), and Epimysium Ida P. Rolf, the founder of Rolfing Muscle structural integration (1896–1979), Cross section of layers from skin to musculature, showing the fascial membranes interspersed their emphasis on fascia was FASCIAL QUALITIES with cells, fluids, nerves, and vessels. Note the Our last column, “Understanding unconventional and far ahead of thin layer of hyaluronic acid just under the deep Fascial Change” (Massage & Bodywork, fascial membrane, which allows the musculature its time. Until relatively recently, May/June 2014, page 114), described to move freely beneath the outer layers. Image fascia and its qualities in detail. As fascia was often considered a courtesy of Joe Muscolino. Originally published a brief review, fascia can vary from in MTJ, Body Mechanics column, Spring 2012. throwaway tissue—the whitish dense to loose, and from very regular “packing material” that anatomists fiber organization (such as or ligaments) to irregular (for example, of fascial work, the Flexor took pains to remove and discard superficial fascia, Image 1, or scar Technique brings together many in dissections and illustrations. tissue). These many varieties of fascia pieces of the fascial puzzle. share several common qualities, More recently, opinions about which can change depending on the Preparation fascia’s importance have changed tissues’ degree of health. Fascia can Prepare for this technique by palpating dramatically. Between 1970 and 2010, be stiff, bound, and painful when it the layers of fascia surrounding the the annual number of papers about has been distressed (through injury anterior, or palm side, of the . fascia in peer-reviewed scientific or disease), neglected (through lack of Using your fingertips or pads, feel the journals grew fivefold.1 Fascial movement), or overused (by activity, outermost layers of tissue over the wrist theories are significantly influencing posture, or habit). Skilled - and finger flexors of your client’s lower acupuncture, chiropractic, osteopathy, on work can change each of these arm. Don’t use oil or lubricant, as you’ll sports conditioning, yoga, and, of problematic qualities, helping the actually be using the friction between course, massage and other manual body’s fascia regain differentiation, layers to perceive and mobilize any therapies. One sign of this is the elasticity, and refined perception; adhesions or restrictions you may find. ever-increasing number of manuals, this column will describe two hands- At first, move just the surface media, modalities, and seminars on techniques to do just that. layers of the lower arm, feeling how focusing on fascial and myofascial you can slide the skin on the muscles approaches (including our own FOREARM FLEXOR TECHNIQUE underneath. If you slow down and Advanced Myofascial Techniques Although there are many techniques feel for more detail, you’ll be able seminar and DVD series). we could use to illustrate the principles to discern that there are multiple layers of wrappings, some clearly distinguishable, and others blending

114 massage & bodywork july/august 2014 ABMPtv.com “Forearm Flexor Technique”

Watch Til Luchau’s technique videos and read his past Myofascial Techniques articles in Massage & 2 3 Bodywork’s digital edition. The varying fiber direction in deep fascia. Hyaluronic acid is one of the slippery fluids Image courtesy Ron Thompson, used by permission. that lubricate and nourish the fascial layers. with adjacent layers. Gently stretch fascia, but over the fascia of the muscles and move these layers, and you’ll find themselves. The deep fascia is in some that they slide or stretch to different places called aponeuroses and, where degrees, and in different directions. it dives deeper between muscles, is The superficial fascia (or referred to as the investing fascia or subcutaneous layer) lies just under the intermuscular septa. These contiguous skin. Some sources reserve the term structures tend to be denser and more superficial fascia solely for the fibrous resilient than the freer superficial membrane between the dermis and layers. They are usually composed of 4 the deeper fascia surrounding the several sublayers of collagen fibers. muscles; others define it as including Some of these fiber layers are arranged all of the looser tissue layers adjacent to parallel to the muscle fibers underneath, this membrane. Whichever definition and others are organized at oblique we use, it is here that we find the angles, like the layers in plywood, in retinacula cutis fibers: the numerous order to resist differing lines of force and minute small skin ligaments that (Image 2). Between the deep fascia and are arranged above and below a fibrous the fascial wrappings of the individual membrane (Image 1). These tiny, muscles below them (the epimysia) 5 column-like skin ligaments suspend is a thin layer of slippery hyaluronic The Forearm Flexor Technique begins with the this fascial membrane between the acid (Images 1 and 3), which allows outermost layers of arm fascia. Use the forearm dermis above and the deeper fascia the large amount of gliding necessary to palpate the layers before going deeper to gently below. The retinacula cutis’ varying for free muscular movement. feel between the fascial compartments of the arm. angles are responsible for the palpable Once you can distinguish these Image 4 courtesy Primal Pictures, Image 5 courtesy “grain” of the superficial layers—the layers from one another (see “Exercise: Advanced-Trainings.com. way in which these layers slide easier Layers”), switch from using your in some directions than others. The fingertips to your forearm (Images spaces between the retinacula cutis 5 and 6). Use the broad, flat surface fibers are filled with fatty tissue, nerves of your , just distal to the . and nerve endings, vasculature, and Avoid using the point of the elbow interstitial tissue fluids, giving these itself (the process) at this outer layers their looser or softer feel. point. The forearm is a powerful tool, Just below these superficial layers, so focus mainly on perception rather you can feel the deeper antebrachial than manipulation. Take some time fascia (Images 4 and 8).2 This glove- to explore these outer layers again. 6 like layer is part of the deep fascia: the Compare the lower arm’s palm side, tough membranes that surround the where the skin is thin and the layers Actively close and open the to further differentiate layers and compartments. entire body just under the superficial are usually clearly palpable, with the Courtesy Advanced-Trainings.com.

It pays to be ABMP Certified: www.abmp.com/go/certifiedcentral 115 MYOFASCIAL TECHNIQUES

thicker layers on the forearm’s dorsum and intramuscular fascia that define (back-of-the-hand side). Make sure these bundles can vary. In people who you’re still feeling just the wrappings use their or hands for repeated of the arm, and aren’t yet working into motions like gripping, typing, etc., the muscles themselves. This can be they are often thicker, firmer, and a challenge, especially if you’re used more adhered into a single mass. to massaging muscles rather than As with the outer wrappings, our differentiating fascia. Feel for places aim is to encourage both differentiation where the outer layers are thicker, or and elasticity, so feel both for stiffer don’t seem to slide against one another. areas of tissue, and for any places Try moving in a proximal direction—as where bundles or layers don’t seem well as distally, medially, and laterally— to slide against one another. Your in order to feel the differing fiber pressure should be firm and specific, direction at various depths. When you but never so much that your client find such places, gently move them in has to tense or withdraw in any way. the more difficult direction (a direct When you find a motion-restricted release), and wait for a change. area, wait patiently with static pressure In addition to increasing your skill or glide just a bit, at a super-slow at palpating specific tissue layers, this pace, until you feel a softening or slow, specific mobilization of the arm’s easing response in the tissue. 7 outer wrappings has therapeutic effects. To get even better differentiation Moving layer on layer helps accomplish between the arm flexors, ask your client our first fascial goal ofdifferentiation , to slowly flex and extend the wrist, or as these layers will become freer and open and close the hand (Image 6). more slippery the longer you work With your own forearm, continue to them. You’ll notice that the slower search for the furrows and separation you move, the more fluidlike the between muscle bundles. Sensitively tissue feels—go slow enough, and and slowly, you can use the tip of your tissue restrictions seem to melt away elbow a bit more now to feel between on their own, which brings in greater the forearm’s muscular compartments elasticity (our second fascial goal). (Image 10). Ask the client to participate And because the outer fascial layers by making individual finger motions. are so rich with free nerve endings This will allow you to more accurately and other mechanoreceptors, we are feel the individual flexors, and to sink also stimulating fascial sensitivity between them as your client moves. and perception (our third goal). Use much gentler pressure over the wrist, of course, and do not use so much pressure or speed that you cause pain. FASCIAL COMPARTMENTS You can get all the therapeutic effects Once you’ve thoroughly explored we’ve discussed by being patient and 8 the outer fascial layers that wrap the focused, rather than heavy and fast. lower arm, sink a bit deeper. Keep the In the Forearm Extensor Technique, use the Continue this work throughout the same sensitivity to layering and fiber knuckles of your soft fist (Image 7) to differentiate entire flexor surface of the lower arm. direction. Rather than just mashing the outer fascial layers of the arm (Image 8). Image the muscles until they are softer 7 courtesy Advanced-Trainings.com. Image 8 FOREARM EXTENSOR TECHNIQUE everywhere, use the tip of your forearm courtesy Primal Pictures. Once you’ve differentiated the tissue to gently feel down in between the layers and muscle bundles on the muscles, looking for the spaces between anterior (palm) side of the lower arm, the various muscular compartments repeat the process on the posterior and bundles (Image 5). The consistency side. The majority of muscles in and density of the wrappings, septa, this region relate to finger and wrist

116 massage & bodywork july/august 2014 Exercise: Layers As a touch experiment, see if you can distinguish three different layers: 1. Skin: first, simply glide on the surface of the skin (as you would do with oil or lubricant). 2. Superficial fascia: next, barely under the surface, move just the outermost tissues as you feel for the slight sponginess, looseness, and “grain” within the extension, though you’ll also find superficial layers (which themselves are composed of multiple sublayers). 3. Deep fascia: slightly deeper (but still not into the belly of the muscles), thumb and elbow muscles here. feel the tougher membrane that glides easily on the muscles Because the posterior side of the underneath; this is the deep fascia sliding on its hyaluronic acid layer. arm is less fleshy and more sensitive An analogy might be helpful: imagine a sheet on a massage table. The first level than the anterior side, we’ll use a of movement would be to feel the texture of the sheet’s surface; the second, different tool: the soft fist. Keeping the stretch and weave of the sheet fabric itself; and the third, the way the sheet your fingers open and your wrist slides on the table underneath. straight (Images 7 and 9) will allow you to work sensitively and deeply with very little effort. The skin of WRAP-UP the knuckles is hard and smooth Although there are many tools for enough to allow for good control working with fascia, I have described when gliding layer over layer while just two examples here: the forearm working the antebrachial fascia. Once and the soft fist. As a pair, these two you’ve worked the superficial layers, tools will give you effective ways to the shape of the knuckles allows you invite greater fascial differentiation to gently sink between the extensor and elasticity almost anywhere in the compartments in the forearm in body. The forearm is well suited for order to separate and differentiate large areas, such as fascia over the their structure and function. spinal erectors, or the iliotibial tract. Again, ask for slow, steady wrist The soft fist is useful for detailed and finger movement, in all directions. work, such as the superficial fasciae As before, invite your client to use of the neck, the plantar fascia, etc. these active movements to further The other important “tool” we’ve differentiate the fascial structures on used for working with fascia is your the extensor side. Examples of ways 9 client’s active movement. By asking to cue this exploration might be: “Let your client to feel into the work your fingers flex and extend, one at a and move in a way that facilitates time, as if playing a scale on the piano,” differentiation and elasticity, we or, “Pretend you’re typing. Find the leverage fascia’s perceptive qualities finger movements that are harder in the service of lasting change. than others, and play with those.” In addition to the mechanical Notes effects of increased differentiation 1. Robert Schleip et al., Fascia, The Tensional and elasticity, the combination of slow Network of the Human Body (Elsevier, 2012), xvi. active movement and pressure floods 2. C. Stecco et al., “The Palmaris Longus your client’s brain with novel sensation Muscle and its Relations with the Antebrachial related to proprioception and movement Fascia and the ,” Clinical control. Imagine that you’re turning up Anatomy 22, no. 2 (2009): 221–9. the volume on the signals your client uses for proprioceptive coordination. 10 Til Luchau is a member of the When you find a movement Advanced-Trainings.com faculty, which limitation—one finger extending less After working with the outer fascial layers, ask offers distance learning and in-person than the others, for example—you for active finger and wrist movements to help seminars throughout the United States can use this combination of focused differentiate the deeper fascial compartments and abroad. He is a Certified Advanced pressure and proprioceptive refinement between the muscles of the forearm (Image Rolfer and originator of the Advanced to evoke new movement possibilities. 9). Image 10 shows the fascial compartments Myofascial Techniques approach. Contact The changes in range of motion and of the lower leg, where the compartmental him via [email protected] and refined control are often dramatic, and architecture is similar to the lower arm. Image Advanced-Trainings.com’s Facebook page. because they involve neuromuscular 9 courtesy Advanced-Trainings.com. Image 10 learning as well as tissue change, courtesy Robert Schleip, www.fascialnet.com. these changes tend to last over time. Used by permission.

It pays to be ABMP Certified: www.abmp.com/go/certifiedcentral 117