F hoặc hơn 30 năm, Sharon Weiselfish Giammatteo đã tìm kiếm câu trả lời cho những cơn đau mãn tính. Không bao giờ hài lòng rằng cô ấy luyện tập thể chất truyền thống liệu pháp là đủ cho khách hàng, cô ấy ... mày mò tìm kiếm các kỹ thuật và phương thức mới. Năm 1981, cô phát hiện ra Lawrence Jones và phương thức đáng chú ý, căng thẳng và phản xạ, đó là một kỹ thuật loại bỏ sự bảo vệ co thắt cơ thông qua vị trí chính xác của thân hình. WeiselfishGiammatteo rất ấn tượng với kết quả từ kỹ thuật này, cô ấy đã có toàn bộ nhân viên được đào tạo về căng thẳng và phản ứng, và sự kiện đồng minh bắt đầu dạy kỹ thuật. Sau khi làm việc với căng thẳng và công nghệ phản xạ niques, WeiselfishGiammatteo quan sát thấy rằng một số bệnh nhân phản hồi tốt, trong khi những người khác nhận được ting chỉ có kết quả một phần và chỉ là giảm nhẹ tạm thời. Cô nhận ra rằng các cấu trúc quan trọng hơn, chẳng hạn như mạch và nội tạng, có thể đi vào trạng thái co thắt cơ tective theo cách tương tự như cơ xương phím nào. Năm 1990, với sự phù hộ của Jones, Weiselfish Giammatteo bắt đầu nghiên cứu và phát triển toàn bộ cách mới để sử dụng kỹ thuật của mình. Cô ấy đã áp dụng các nguyên tắc tương tự để tự động hoạt động trơn tru cơ bắp và tạo ra bộ đếm căng thẳng nâng cao. Tổng quan nhanh Bộ đếm dòng nâng cao là một tổ chức của kỹ thuật định vị cho mạch máu và nội tạng các hệ thống. Đối với mỗi kỹ thuật, nhà trị liệu bị động đặt cơ thể của khách hàng vào một vị trí chính xác, chính kéo dài nó trong một phút. Đây là tư thế gián tiếp tions, có nghĩa là cơ thể được đưa vào nhạn biển nơi nó muốn đi, có thể cảm thấy vô cùng Các vị trí tạo ra một đòn bẩy dài, để nhà trị liệu không phải đặt tay trực tiếp trên cấu trúc đang được phát hành thiết kế của vị trí thực hiện nó. khá đơn giản và bởi vì chúng rất chính xác, rất ít lực lượng hoặc nỗ lực được yêu cầu. Toàn bộ quá trình chỉ cần 60 giây, khiến nó trở thành một người nghiện dễ dàng tion cho bất kỳ buổi mátxa và chăm sóc cơ thể. Tại sao phải giải quyết các tàu máu Và các cơ quan? Trong lĩnh vực massage, chúng tôi nói về những lợi ích xoa bóp để cải thiện lưu thông. Tốt hơn lưu lượng máu giúp vết thương mau lành hơn cải thiện dinh dưỡng tế bào và giảm tắc nghẽn tĩnh mạch và bạch huyết. Điều này rất tốt cho một loạt các nhu cầu, từ việc tăng cường thể thao hiệu suất để thúc đẩy chữa lành vết thương. Chúng tôi cũng nghĩ về các vấn đề mạch máu trong liên quan liên quan đến các tình huống nghiêm trọng đe dọa tính mạng, chẳng hạn như bệnh tim và đột quỵ. Chúng tôi có thể tin rằng những vấn đề này vượt ra ngoài lĩnh vực massage liệu pháp. Tuy nhiên, còn nhiều điều chúng ta có thể làm cho những khách hàng mỏng manh hơn của chúng tôi vì những công nghệ này nics rất nhẹ nhàng. Chúng tôi cũng được dạy để tránh công việc xoa bóp xung quanh cấu trúc mạch máu bởi vì nó không sẵn sàng tạo áp lực lên mạch máu, nhưng hệ thống mạch máu có cơ và cân bằng deltoids và latissimus dorsi của chúng tôi. Những mô có thể được hưởng lợi rất nhiều từ thân xe thích hợp. Ý tưởng ban đầu của Lawrence Jones về một công nghệ định vị nique là một cách tiếp cận lý tưởng cho các cấu trúc tinh vi bởi vì vị trí thực hiện tất cả công việc cho nhà trị liệu. Không cần thiết phải chạm vào mạch máu và các cơ quan trực tiếp. Hệ thống bảo vệ Hệ mạch, dây thần kinh và nội tạng ở trên cùng của cái mà chúng tôi gọi là phân cấp bảo vệ. Cho kỳ thi ple, động mạch chủ là động mạch lớn nhất trong cơ thể và nhà phân phối chính của máu động mạch đến phần còn lại của cơ thể. Kích thích động mạch chủ sẽ là quan trọng hơn đối với cơ thể hơn là dây chằng ciate. Hiểu hệ thống phân cấp này của bảo vệ có thể cung cấp cho bạn một hiểu biết hoàn toàn mới hình thành các mô hình căng thẳng của cơ thể. sống với mắt cá chân bị bong gân, các tế bào sẽ chết bên trong phút mà không có oxy do động mạch cung cấp. Toàn bộ cơ thể sẽ tập hợp để bảo vệ những gì quan trọng hơn cấu trúc và hệ thống. Cơ bắp sẽ co lại, dây chằng ments và fascia sẽ thắt chặt, các khớp sẽ trở nên cứng nhắc và tư thế cơ thể sẽ trở nên méo mó. Tính linh hoạt và chuyển động được hy sinh để nẹp và cố định động mạch, tĩnh mạch, dây thần kinh bị tổn thương hoặc đàn organ. Cơ xương và cân xuống danh sách, vì sự khó chịu trong các hệ thống này là không nguy hiểm đến tính mạng. Sử dụng khái niệm này cho bạn một chìa khóa để mở ra các kiểu đau mãn tính cho những khách hàng quay lại phiên này qua phiên khác với các mô hình căng thẳng giống nhau. Mặc dù có thể có nhiều lý do cho các mô hình căng thẳng, cơ bảo vệ co thắt mạch máu hoặc nội tạng có thể là nguyên nhân mary hoặc yếu tố đóng góp.
Technique Slug Here ADVANCED strain COUNTERSTRAIN Text and Illustrations by Lissa Wheeler 72 Massage Therapy Journal • Wi n t e r 0 PHOTO BY SEAN JUSTICE/GETTY IMAGES This gentle new approach addresses protective muscle spasm at its core Wi n t e r 0 • www.amtamassage.org 73 Technique or more than 30 years, Sharon WeiselfishGiammatteo had been looking for answers for chronic pain Never satisfied that her training in traditional physical therapy was enough for clients, she continually sought out new techniques and modalities In 1981, she discovered Lawrence Jones and his remarkable modality, strain and counterstrain, which is a technique that eliminates protective muscle spasm through precise positioning of the body Weiselfish-Giammatteo was so impressed with results from this technique, she had her entire staff trained in strain and counterstrain, and eventually began teaching the technique After working with strain and counterstrain techniques, Weiselfish-Giammatteo observed that some patients responded beautifully, while others were getting only partial results and merely temporary relief She realized that the more vital structures, such as vasculature and viscera, could go into states of protective muscle spasm in the same way skeletal muscles In 1990, with Jones’s blessing, WeiselfishGiammatteo began to research and develop a whole new way to utilize his technique She applied the same principles to autonomically innervated smooth muscles, and created advanced strain counterstrain F A Quick Overview Advanced strain counterstrain is an organization of positional techniques for the vascular and visceral systems For each technique, the therapist passively places the client’s body in a precise position, maintaining it for one minute.These are “indirect” posi- tions, meaning that the body is taken into the pattern where it wants to go, which can feel incredibly relaxing.The positions create a “long lever” release, so that the therapist doesn’t have to put hands directly on the structure that is being released—the design of the position does it The positions appear quite simple, and because they are so precise, very little force or effort is required The whole process requires only 60 seconds, making it an easy addition to any massage and bodywork session Why Address Blood Vessels And Organs? In the field of massage, we talk about the benefits of massage for improving circulation Better blood flow helps injuries heal faster through improved cellular nutrition and reduction of venous and lymphatic congestion.This is great for a wide range of needs, from enhancing athletic performance to promoting wound healing We also think about vascular problems in relation to serious life-threatening situations, such as cardiac disease and stroke We may believe that these problems are beyond the realm of massage therapy However, there is much that we can for our more fragile clients because these techniques are so gentle We are also taught to avoid massage work around vascular structures because it is inappropriate to apply pressure to a blood vessel, yet the vascular system has muscles and fascia just like our deltoids and latissimus dorsi These tissues can greatly benefit from appropriate bodywork 02 ARTERY VEIN NERVE VISCERA LYMPHATIC TISSUE BONE MUSCLE CONNECTIVE TISSUE Dorsal Root 74 External forces from injuries and accidents, or internal stressors from toxicity and inflammation, can initiate a protective response What Causes Arteries And Veins To Go Into Spasm? 01 When you hear the words spasm and artery, you might think of heart attack and stroke Protective muscle spasm also happens in much less dramatic ways throughout daily life External forces from injuries and accidents, or internal stressors from toxicity and inflammation, can initiate a protective response The body can often repair these problems on its own.With enough chronic stress, a self-perpetuating cycle can occur, which will not be able to resolve itself Why Does It Work? The explanation for why strain and counterstrain works is conjecture at this point.The theory that best explains this self-perpetuating phenomenon is the Afferent Fibers Gamma Efferent Alpha Efferent Muscle Spindle Dorsal Root Ganglion Extrafusal Fibers Intrafusal Fibers ARTERY LAYERS Massage Therapy Journal • Wi n t e r 0 Vasculature, nerves and viscera are at the top of what we call the hierarchy of protection For example, the aorta is the largest artery in the body and the primary distributor of arterial blood to the rest of the body An irritation to the aorta would be more significant to the body than an irritated cruciate ligament Understanding this hierarchy of protection can give you a whole new understanding of body tension patterns While someone can live with a sprained ankle, cells will die within minutes without the oxygen provided by an artery The entire body will rally to protect the more vital structures and systems Muscles will contract, ligaments and fascia will tighten, joints will become rigid and body posture will become distorted Flexibility and movement are sacrificed to splint and immobilize a vulnerable artery, vein, nerve or organ The skeletal muscle and fascia are further down on the list, as irritation in these systems is not life-threatening Utilizing this concept gives you a key to unlocking chronic pain patterns for those clients who return session after session with the same tension patterns.While there can be many reasons for tension patterns, protective muscle spasm in the vasculature or viscera can be a primary or contributing factor MUSCLE SPINDLE 01 The tunica media is the muscular layer (red layer) of the artery that goes into protective muscle spasm The Hierarchy Of Protection A typical postural distortion is a forward head with protracted shoulders, which is usually accompanied by neck and back pain, and possibly temporomandibular joint (TMJ) dysfunction What vascular structure might this person be trying to protect? What runs along the front of your spine? The aorta This forward head posture can be taking stress off the aorta Spinal flexion and extension are often very limited, because the body’s protective mechanism wants to prevent any further stretch on the aorta.The respiratory diaphragm will tighten around the passageway of the aorta to immobilize the chest area and give stability to this vital structure 03 MUSCLE SPINDLE CLOSEUP Hierarchy Of Protection A Common Example Of The Hierarchy Of Protection Lawrence Jones’s original idea of a positional technique is an ideal approach for delicate structures because the position does all the work for the therapist It isn’t necessary to touch blood vessels and organs directly Alpha Motor Neuron Ventral Root 04 Extrafusal Muscle Fibers ANATOMY OF PELVIC DIAPHRAGM Wi n t e r 0 • www.amtamassage.org 75 Technique concept of the myotatic reflex arc, or what’s often called the stretch reflex reaction This is a reflexogenic response that we need to protect muscles, joints and other soft tissues from overstretching and becoming injured This becomes a problem if the reflex becomes chronically hyperactive and never allows the muscle to lengthen By removing all stretch stimulation to the affected muscle through the positioning techniques, the reflexogenic activity of the stretch reflex arc is stopped This happens by relaxing the muscle spindle proprioceptors within the skeletal muscle.This then eliminates the afferent gain, which then eliminates the gamma gain that finally eliminates the alpha gain Relaxing The Muscle Spindle 02 The concept of the stretch reflex arc is the same for both autonomically innervated muscles and for skeletal muscles It starts with the reaction of the muscle spindles The muscle spindles are the tiny proprioceptors within the muscle fibers, which are responsible for detecting changes in muscle fiber length They will initiate a muscle spasm if the muscle is stretched too far They are made up of delicate intrafusal fibers that wrap themselves around the large extrafusal fibers of the skeletal muscle (see illustration, page 86) These intrafusal fibers are set to a specific level of tension If the skeletal muscle becomes longer than what the muscle spindle can accommodate, the intrafusal fiber tension becomes too tight, and the spindle immediately starts sending an alarm message to the central nervous system This mes- sage is called a high frequency discharge, which signals the skeletal muscle to tighten in order to take the tension off the intrafusal fibers Muscle spindles sustain this high frequency discharge for as long as they are stimulated This means they never become fatigued and maintain muscles in perpetual chronic states of contraction Attempts to stretch out the muscle further only increase the high frequency discharge and the subsequent muscle spasm The stretch reflex arc also relates to spasticity Cerebral palsy and hemiplegia are good examples Because the spasming muscle cannot be stretched out, a typical solution for these people is to cut the tendons of the spastic muscle or inject botox into it to eliminate the spasm Strain and counterstrain techniques can be a welcome noninvasive alternative to help eliminate spasticity in these individuals The Cycle Of Afferent Gain Afferent gain is what strain and counterstrain seeks to eliminate The discharge from the muscle spindle is conveyed up the sensory afferent nerve to the dorsal horn of that particular spinal segment This is called afferent gain The afferent gain is information that is immediately relayed to the spine’s anterior horn to the alpha motor nerve The alpha motor nerve innervates the skeletal muscle fiber, making it contract The goal of the alpha gamma nerve is to satisfy the muscle spindle requirement for shorter muscle fibers If the muscle is now shortened enough, via the contraction, all mechanical tension should be off the 07 05 ASCS RESPIRATORY DIAPHRAGM ASCS PELVIC DIAPHRAGM spindle.The spindle will stop its firing, and return to a resting state The muscle must never elongate past its limit or else the spindle will start firing, and the whole cycle of afferent gain starts again What if we could reprogram the muscle spindle so that it would allow the muscle to lengthen? That is what strain and counterstrain achieves The Hyperactivity Of The Gamma Motor Nerve Loop 03 The gamma motor nerve is responsible for muscle spindle sensitivity Normal muscle resting tone comes from the gamma bias, which maintains the alpha motor nerves in a moderately excited state In that state, muscles not have excess tension, nor are they flaccid.They have a healthy tone.The gamma motor nerve’s job is to control the tension in the spindle via contraction or relaxation of the intrafusal fibers If the gamma excitation increases (this is called gamma gain), the spindle excitation also increases, and therefore the muscle contraction increases Lawrence Jones discovered that by eliminating any mechanical stimulation of the spindles, the gamma excitation would immediately cease, which would stop the pattern of hyperactivity and allow the muscle to lengthen Hypothetical Model This brings us to the theory of how strain and counterstrain technique works.When the muscle sends its high frequency discharge to the dorsal horn of its spinal segment, this information is conveyed to all the structures innervated by the segment.The exces- sive discharge of the muscle spindle affects more than the muscle fibers in which it is invested This discharge is communicated throughout the entire central nervous system It directly affects all other muscles that are innervated by the same segment For example, the C5 spinal segment innervates the supraspinatus, subscapularis, deltoid and biceps Dysfunction in any one of these muscles will increase gamma gain to all the muscles at this segment If you strained the supraspinatus muscle after lifting a heavy massage table, the rest of the muscles at this segment would also go into protective muscle spasm All the muscles in your entire body would be affected, as their dorsal roots will receive this discharge If this gamma/afferent/alpha gain is maintained long enough, a self-perpetuating cycle occurs where the spindles cannot relax and they continue to fire a high-frequency discharge.Thus, the muscles can never fully relax and elongate, causing chronic protective muscle spasm This entire pattern is called the “facilitated segment.” If you strained the supraspinatus muscle after lifting a heavy massage table, the rest of the muscles at this segment would also go into protective muscle spasm Smooth Muscle Spasm An individual spinal segment innervates skeletal muscle, smooth muscle and organs For example, the same C5 that innervates the supraspinatus also innervates contractile fibers of blood vessels that supply the neck and shoulder C5 is also the innervation of the phrenic nerve, which contracts the diaphragm An irritation at the diaphragm or any of the neck vasculature would initiate this same high frequency discharge, creating the same protective muscle spasm as the strained supraspinatus 08 THORACIC INLET DIAPHRAGM 06 RESPIRATORY DIAPHRAGM 09 ASCS THORACIC INLET DIAPHRAGM 76 Massage Therapy Journal • Wi n t e r 0 Wi n t e r 0 • www.amtamassage.org 77 Technique Implementing The Method Each technique in advanced strain counterstrain has been specifically designed to reduce pressure on the muscle spindles of that particular organ or vascular structure This eliminates the hyperexcitation of the muscle spindles, which instantly reduces spasm Applying these simple but profound techniques is easy to incorporate into a massage session.They can be performed prior to the massage, before the client undresses They can also be performed during the session, with attention to draping the client during positioning of the technique There are no contraindications with these techniques, as you are simply putting the body into a position of comfort.The only contraindication would be if the position weren’t comfortable for the client Each position should be maintained for 60 seconds to eliminate the spasm of autonomically innervated structures They can be used at any time during a bodywork session Used before a massage, they will create a more profound relaxation, because you have removed a core source of tension.An entire session can be comprised of these techniques these techniques A vascular problem, such as vascular insufficiency or high blood pressure, generally responds well to this modality Study the client’s anatomy and begin to question whether a postural deviation and loss of range of motion appears to be protecting a vascular structure The techniques may be repeated as often as desired, but after the first time, the tension pattern will never be as severe A general philosophy with this approach is that if the same tension pattern returns with the same intensity, a different technique is needed The best place to begin is generally at the most proximal aspect, and then work out to more peripheral structures The techniques presented in this article for the aorta, superior vena cava and inferior vena cava are excellent places to start and will benefit everyone The four diaphragm techniques are included in this article as well They should be released first before any vascular technique is performed All the vasculature must travel through the diaphragms You want to open these passageways to allow room for increased blood flow Seven Techniques When To Use Advanced Strain Counterstrain These gentle techniques can be used for many types of clients They can be integrated within a regular massage and bodywork session or comprise an entire session An individual with a chronic pain pattern that is not responding to musculoskeletal modalities would benefit from These seven techniques offer a wonderful foundation for reducing tension in the autonomic nervous system Release the four diaphragms first Position the body according to the instructions (Photos are included to demonstrate the positions.) As you set up the positions, be aware of the structure you are affecting Use just enough pressure to maintain the position FOUR CASE STUDIES The following case studies illustrate a wide range of application with these techniques Standard range of motion testing was used to show objective changes Two of these individuals have histories of severe health issues or injuries Small changes in range of motion are very significant for them.The remaining two individuals are in good health and responded to the techniques with more dramatic changes in range of motion Case Study LEFT KNEE PAIN AND DYSFUNCTION AFTER TOTAL KNEE REPLACEMENT This case study is a good example of how releasing vascular spasm can reduce swelling This woman had three total knee replacements because of subsequent staph infections When she was told to have a fourth, she sought an alternative through massage and bodywork She has been receiving integrative manual therapy as part of her rehabilitation for more than a year.The goal of this particular session was to reduce swelling and pain in her left knee Advanced strain counterstrain techniques were performed for all four diaphragms, lymphatic vessels, iliac and femoral arteries, and superficial veins of the left leg Following the session, she experienced a reduction in pain and an increase of 20 degrees in knee flexion The photo on the far right shows the changes in circumference of her left thigh Before and after measurements of her leg were taken in four places with measuring tape BEFORE AFTER SPINAL FLEXION BEFORE = 15 DEGREES SPINAL FLEXION AFTER = 65 DEGREES SPINAL EXTENSION BEFORE = 20 DEGREES SPINAL EXTENSION AFTER = 45 DEGREES Case Study LIMITATION OF SPINAL FLEXION AND EXTENSION This case study is a good example of how tension in the vascular system can affect spinal range of motion.Techniques for the aorta and superior and inferior vena cava were performed on this client 10 ANATOMY SHOT: CRANIAL BASE 11 DEMO OF TECHNIQUE: ASCS CRANIAL BASE 78 Massage Therapy Journal • Wi n t e r 0 Wi n t e r 0 • www.amtamassage.org 79 Technique The pelvic soft tissue is almost always in a state of spasm, especially because of the incidence of sacroiliac biomechanical imbalance Remember that the specificity of the position does all the work for you It takes only 60 seconds to release the protective muscle spasm You can hold the position longer, for five to 20 minutes, to release the facial restrictions related to the structure There are no precautions for these techniques other than checking that the client is comfortable in the position Four Diaphragm Techniques These four techniques ideally should be performed within the same session because all the diaphragms work together as a system The status of one diaphragm will affect the status of all the others.The goal is to release hypertonicity of each diaphragm, which will improve breathing, circulation and reduce congestion All techniques are performed with the client side-lying on the opposite side For example, if the right diaphragm is being worked on, have the client lie on his or her left side 04 Pelvic Diaphragm The pelvic soft tissue is almost always in a state of spasm, especially because of the incidence of sacroiliac biomechanical imbalance This technique can be used during pregnancy, during labor to facilitate delivery and immediately after delivery to promote healing of the pelvic floor Follow these steps: • Flex both hips to 70 degrees • Flex both knees to 70 degrees 05 • Lift both feet towards ceiling six inches off the table • Push on the illium, two inches below the iliac crest, mid-axillary line Push with three pounds of force 06 Respiratory Abdominal Diaphragm This technique specifically improves breathing and is an excellent support for any pulmonary, cardiac or spinal problems Follow these steps: • Flex hips to 50 degrees • Flex knees to end of range • Gently side bend the neck, as far it will go comfortably • Press on the lower lateral rib cage towards the floor 07 08 Thoracic Inlet This technique is good to use before performing any cranial techniques in order to open up venous drainage This will also improve lymphatic drainage, as the lymph terminus is located in the thoracic inlet Swelling and congestion of the entire body will be reduced Follow these steps: • Use a pillow under the head and neck to keep them in midline • Abduct the ipsilateral shoulder to 70 degrees • Gently press the ipsilateral shoulder girdle toward the feet with three pounds of pressure 09 10 CASE STUDIES CONTINUED Case Study THE EFFECT OF THE AORTA TECHNIQUE ON SPINAL MOTION AND LEFT SHOULDER EXTENSION BEING DEMONSTRATED BY WEISELFISH-GIAMMATTEO When the aorta is in a state of protective muscle spasm, there can be considerable limitation in spinal motion and left shoulder range of motion Typically, this includes limitation in spinal extension and guarding of left shoulder movement in order to protect the aorta from further stretching Releasing the protective muscle spasm in the aorta allowed the client to have considerable increases in her range of motion in these areas SPINAL EXTENSION BEFORE = DEGREES SPINAL EXTENSION AFTER = 45 DEGREES ARM EXTENSION BEFORE = 25 DEGREES ARM EXTENSION AFTER = 50 DEGREES Cranial Diaphragm This technique will prepare the body for cranial work, as it releases protective muscle spasm in the Case Study TRAUMATIC BRAIN INJURY 12 13 AORTA ASCS AORTA Reducing vascular spasm can be significant in the rehabilitation of neurologically injured clients This man sustained a traumatic brain injury, which affected all functions, including walking, bowel and bladder Advanced strain counterstrain has been part of his rehabilitation process At the time of this session, he was just beginning standing and gait training The technique for the right iliac artery was performed to increase his ability to abduct his hip as preparation for his gait training session Spasm of the iliac artery was preventing his ability to abduct his right hip After this technique was performed, he gained 20 degrees in right hip abduction This improved his hip stability, which increased his ability to stand and take steps LEG ABDUCTION PRE-TECHNIQUE ROM LEG ABDUCTION POST-TECHNIQUE 80 Massage Therapy Journal • Wi n t e r 0 Wi n t e r 0 • www.amtamassage.org 93 Technique tentorium There may be a change in vision because the tentorium is no longer compressing the cranial nerves, which innervate the ocular muscles that must pass through this structure Ear pain, tinnitus, hearing and equilibrium may also improve from pressure being released from these cranial nerves and the ear canal Seizure disorders may occasionally improve from release of pressure in the temporal lobe All head, face and neck pain clients can benefit from this technique Follow these steps: • Place the palm of your hand over the ear (meatus), with fingers also covering the temporal bone superior to the meatus • Press the medial toward the floor • Place the other hand in the axilla of the ipsilateral side and push the axilla up toward the meatus of the ear 11 Vascular Techniques Please release all four diaphragms before performing these techniques These structures travel through the diaphragms, and if the diaphragm is in spasm, the vessel will not be able to relax fully Ideally, all three techniques are performed There is a circular flow of arterial to venous to arterial and so on.You don’t want to increase one system’s flow without balancing the others Aorta When the aorta is hypertonic, there will be limitations, especially in the left shoulder, to prevent more tension on the aorta Measure pulse and Both the superior and inferior vena cava techniques are excellent for reducing edema, lymphedema, lipedema, all fibromyialgialike symptoms, scars and other connective tissue problems blood pressure, as with pre- and post-testing for all cardiac and pulmonary problems.There will be immediate changes in ranges of motion, especially in the left shoulder and spine There can be a change in total body edema, secondary to extracellular edema from tension surrounding the aorta Heartburn may be occasionally affected from releasing pressure on the esophagus, which sits between the heart and aorta Thoracic outlet syndrome and reflex sympathetic dystrophy clients will also benefit Follow these steps: • Have the client sit on a table or on a chair without a back • Rotate the trunk to the right 10 degrees • Side bend the trunk to the right 10 to 15 degrees • Rotate the head and neck to the right 10 degrees • Side bend the head and neck to the right five degrees • Move the spinous processes of T2,T3 or T4 Pick the most rigid segment and gently flex this segment toward the front of the body.The aorta sits right in front of the spine Think of taking the pressure off the top of the aorta • Press L3 up toward the other hand.Think of taking the pressure off the bottom of the aorta 12 13 14 Superior Vena Cava Follow these steps: • Sit to the right of the client Place one hand under the spine at the level of T5 and compress both transverse processes toward each other Think of gently taking pressure off the back of the heart, where the superior vena cava enters the heart 14 • Bend the right knee and rest the left ankle on the right knee • Side bend the trunk to the right 10 to 15 degrees • Flex the neck 30 degrees • Rotate the head and neck to the right 10 degrees • Side bend the head and neck five degrees • Gently compress the right anterior eighth rib, oneinch lateral to the intercostal cartilage in a posterior, superior, lateral direction Use to 10 grams of pressure.Think about taking tension off the superior vena cava by holding up the inferior vena cava 15 16 Inferior Vena Cava Follow these steps: • Sit to the right of the client • Place one hand under the spine at the level of T8, and compress both transverse processes toward each other Think of gently taking pressure off the back of the heart, where the inferior vena cava enters the heart • Bend the left knee and rest the right ankle on the left knee • Gently compress the right anterior eighth rib, one-inch lateral to the intercostal cartilage in a posterior, superior, lateral direction Use a very light pressure, about to 10 grams, which is a little more than the weight of a nickel Think about taking tension off the path of the inferior vena cave as it travels up to the heart 17 Both the superior and inferior vena cava techniques are excellent for reducing edema, lymphedema, lipedema, all fibromyialgia-like symp- 16 ANATOMY SHOT: SUPVC ANATOMY SHOT: IVC toms, scars and other connective tissue problems Cardiopulmonary and cardiovascular problems are also helped with these techniques, and all brain and spinal cord dysfunction whether mild or severe, chronic or acute Lissa Wheeler is certified in muscular therapy, shiatsu, Trager® Approach, neuromuscular therapy and integrative manual therapy She is an instructor at the Connecticut School of Integrative Manual Therapy Wheeler teaches courses nationally and internationally for Dialogues in Contemporary Rehabilitation (DCR) She has a master’s degree in clinical psychology, and is currently completing a Ph.D in integrative manual therapy Bibliography Giammatteo, Thomas and Sharon WeiselfishGiammatteo Utilizing Advanced Strain and Counterstrain Technique Integrative Manual Therapy For The Autonomic Nervous System And Related Disorders Berkeley, California: North Atlantic Books, 1997 Jones, Lawrence Strain And Counterstrain Indianapolis, Indiana: American Academy of Osteopathy, 1981 Marieb, Elaine Human Anatomy and Physiology Boston, Massachusetts: Addison Wesley Longman Inc., 1998 Netter, Frank Atlas of Human Anatomy Summit, New Jersey: Ciba-Geigy Corp., 1989 Weiselfish-Giammatteo, Sharon Integrative Manual Therapy For The Upper and Lower Extremities Berkeley, California: North Atlantic Books, 1998 17 DEMO OF TECHNIQUE: ASCS IVC 15 ASCS SUPVC 94 Massage Therapy Journal • Wi n t e r 0 Wi n t e r 0 • www.amtamassage.org 95 ... principles to autonomically innervated smooth muscles, and created advanced strain counterstrain F A Quick Overview Advanced strain counterstrain is an organization of positional techniques for the vascular... technique, she had her entire staff trained in strain and counterstrain, and eventually began teaching the technique After working with strain and counterstrain techniques, Weiselfish-Giammatteo observed... spasm Strain and counterstrain techniques can be a welcome noninvasive alternative to help eliminate spasticity in these individuals The Cycle Of Afferent Gain Afferent gain is what strain and counterstrain