by Stefano Beconcini, MSc Physics, Structural Bodywork practitioner

STRUCTURAL BODYWORK: AN EFFECTIVE HANDS-ON APPROACH FOR CHRONIC MYOFASCIAL PAIN RELIEF Background

Common myofascial chronic pains (low back pain, headache, carpal tunnel syndrome, neck pain and any other musculoskeletal problem) are poorly understood conditions causing disability and loss of productive time in the work force.
The connective tissues enwrapping the muscles ( fascia) are believed to play an important role in the pathophysiological mechanisms leading to chronic myofascial pains.
The human body relates continually to the force of gravity.
The structure is the spatial relationship between the body segments. If the body structure is well organized, its various segments must be aligned one on the top of the other: pelvis, abdomen, chest and head balance easily when their centers of gravity are in the same vertical line, so that the upright balance can come from the deep muscles which are mainly pushing against gravity (expansional core balance).
This easy structural relationship can be disorganized by many factors: injuries, emotional traumas, bad movement patterns and poor postural habits.
This structural unbalance may be the main reason for chronic myofascial pain conditions.
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Fascia forms a network of soft connective tissue that holds the body in its shape. The bones are enmeshed in this fascial network and act as space-makers.
As we struggle to move in the gravity field, the fascial web adapts to support our movement patterns.
Fascia can thicken and increase its stiffness in some areas of the body in response to tensions and micro-lesions in the muscles due to over-use syndrome or as consequence of decreased mechanical stress due to hypomobility or immobilization.

The continuity of the fascial network implies that changes will happen through the whole body, much as a local strain in a sweater distorts the whole sweater.
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Fascia can be re-organized through deep pressures and stretching for re-establishing the natural alignment of the human body. This connective tissue plasticity may explain the beneficial effect of many manual therapies involving external application of mechanical forces (structural bodywork).
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ANATOMY OF THE FASCIA
All the structures of the body , muscles, bones, joints, nerves, blood vessels and organs, are embedded in a matrix of soft connective tissue called fascia.
The fascial sheet protects all these body components from direct abrasion by surrounding structures and provides a pathway through which neurovascular bundles can easily penetrate.
Fascia is a continuos network throughout the whole body.
There are 4 primary fascial layers:
1) superficial fascia is mainly composed of loose connective tissue and fat and surrounds the entire torso and the extremities except over the orifices.
2) deep to the superficial layer is the deep fascia composed of denser and irregular connective tissue investing muscles, tendons, ligaments, aponeurosis, bones and joint capsule.
The soft connective tissue associated with the muscles can be referred to as muscle fasciae (myofasciae).
Each individual muscle is surrounded by epymisium, a layer that is continuous with the tendons attaching to the periosteum, the connective tissue investing the bone.
The perimysium is a continuous network dividing the muscle into muscle fiber bundles.
Within each bundle, the endomysium is a continuous web of connective tissue that separates individual muscle fibers.

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3) meningeal fascia which surrounds the nervous system.
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4) visceral fascia surrounding the body cavities and packing around the organs.
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EXPANSIONAL BALANCE
Structural Bodywork is essentially remodeling the fascial network for re-organizing the balance and the movement of the human body in the gravity field.
A good biomechanical model is required to understand how the body should move .
A dynamic relationship to gravity can be expressed by the concept of “Expansional Balance”: “a well-balanced body doesn’t feel pressed down by gravity. Instead, it seems to expand by pressing against the ground and at the same time expanding upwards” (Ed Maupin).
EXPANSION is the result of a balanced relation between the extrinsic muscles and the intrinsic ones (Ida Rolf).
Basically, the extrinsic muscles are the voluntary ones that we control consciously to do whatever we want to do.
The intrinsic are the deepest level mainly engaged in maintaining our position in the gravity so that we don’t fall over when we do our movements.
The intrinsic level is the core that is pushing against the gravity.

Injuries,st9

negative emotions
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and the over-use syndrome
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cause an overall pattern of tensions in the body which is the person’s unique system of dealing with gravity.

For these reasons most of the people don’t have a body that is able to expand. Instead it’s limited by contractions.
This poor biomechanical organization will lead to the myofascial chronic pain.

The expansional balance takes place across 2 dimensions: vertical and horizontal .
Vertical polarity is our upright balance.
Horizontal polarity refers to the arms and the shoulder girdle.
When the 2 polarities are open, the expansion of the body is experienced as internal extension.
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Understanding how to open the polarities depends on analyzing the body structure in terms of geometric planes.
We look for balance across these planes.
Only if the body structure is well-balanced across the planes, the body is able to find its internal extension.
3 transverse planes intersecting the body at pelvis, at diaphragm and at shoulder level give rise to 3 important geometric rings: pelvic ring, diaphragm ring and shoulder ring.
In a well balanced body, the centers of all these 3 rings must be in the same vertical line (the Line).
Any deviation from this easy structural alignment will create a pattern of muscular tensions that is the root cause for any myofascial chronic pain.

Structural Bodywork

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STEP 1: ESTABLISH THE PELVIC EXTENSION
The center of the vertical polarity is the sacrum. The sacrum is the dividing point between the legs and the spine. The lumbar spine rests on the table provided by the top of the sacrum.. The legs may be thought to begin at the top of the sacrum, the sacrolumbar hinge.
So establishing the pelvic extension means to find the connection between the movement of the legs and the top of the sacrum..
Unrolling exercise is very useful to experience the pelvic extension.
The standing up is essentially created by the downward pushing of the feet.

Organizing the entire leg across the bisecting sagittal plane which bisects it into a medial and a lateral half, is part of this step.
All the hinges of the leg should be working on this plane: the hip, the knee, the ankle and the toes.
When the hinges are not working on a single plane, then additional effort is required to make the leg stable. In order to do that external muscles must tense.

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Vertical line

STEP 2: RELATE THE PELVIC EXTENSION TO THE LUMBAR SPINE
Once the legs are extending down through the pelvis, this can be related to the three major hinges of the lumbar spine.
1)Sacrolumbar hinge (L5-S1)
2)Lumbar hinge (L2-L3)
3)Dorsal hinge (L1-T12)
All these 3 hinges are aligned on the same vertical line (the Line).
So in step 2 the movement of the legs is connected to the lumbar spine through the pelvic girdle.

PELVIC EXTENSION
The dorsal hinge is located where psoas and diaphragm attachments on lumbar spine meet. Basically the dorsal hinge is a complex biomechanical unit where the upper and lower parts of the body integrate.
It’s an extremely complex area since the basic breathing movement occurs here and arms and legs movements as well.In a well-balanced and integrated body, the centers of the pelvic ring and the diaphragm ring lie on the same vertical line (the Line).
body integrateThere are 2 core muscles that are keystone for organizing the pelvic extension: psoas and piriformis.
Psoas role is to support the lumbar spine from the front.
Psoas is the main core muscle connecting the leg to the top of the sacrum (sacrolumbar hinge).
The walking must begin from the top of the sacrum.
Piriformis muscles connect the legs to the sacrum and their role is supporting the sacrum from the front.

The pelvic ring is supposed to be horizontal. To keep the pelvis horizontal there must be a balanced relation between the psoas (hip flexors), the rectus abdominis , the erector spinae and the hip extensors and the deep hip lateral rotators (piriformis and company).
The function of the rectus abdominis is to lift the pelvis up.

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Any imbalance of the pelvic ring is connected to an improper walking gait.

Pelvic roll is a good movement exercise to get the feeling of the connection between the legs and the lumbar spine.
Roll the pelvis anteriorly and posteriorly by simply pressing the feet into the floor. DO NOT engage the abdominals muscles, but engage the deep core muscle Psoas.

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STEP 3: ORGANIZING THE SHOULDER GIRDLE
In order for the vertical polarity to pass through the upper body, the horizontal polarity of the arms and the shoulder girdle must be established.
The horizontal polarity is an expansion from the spine through the shoulders into the elbows out to the hands, so that any arm movement begins at the spine.
The shoulder ring includes the clavicles, the scapulae and the shoulder sockets. It is designed to allow free movements of the arms.

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In releasing the horizontal polarity a crucial role is played by rhomboids that connect the scapulae to the spine. So any arm movement is related to the spine through the rhomboids.
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The shoulder ring is supposed to be horizontal and on top of the diaphragm ring.
The diaphragm ring is the foundation for the shoulder girdle.
The center of the shoulder ring must be on the vertical “Line” together with the lumbar hinges.
The upper part of the body (shoulder ring) and the lower part (pelvic ring) integrates at the diaphragm level.
In a well-balanced body the vertical polarity goes through the centers of all the 3 rings along the vertical Line.

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STEP 4: RELEASING THE HEAD UPWARDS
With the shoulder girdle released to the side, the vertical polarity can go through
the neck up to the crown of the head.
The top of the head should feel as it were the top end of the spine effortlessly
lifting.
“Neck free to let the head come forward and up”.
We analyze the head extension in terms of geometric planes.
Any deviation from these planes mean that the extrinsic and the intrinsic
myofascial tissues of the neck are not well balanced.
Head forward is a common dysfunctional pattern.
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The intrinsic layer is formed by the deep neck muscles which are core musclesmainly supporting the neck so that the head movement (“yes” and “no”movements) are possible in an efficient way.The C1-C2-Occiput complex is crucial for the rotational movement of the head.Balancing the head on the neck at the atlas-occipital joint involves work insidethe mouth because the jaw has important myofascial connections with the upperneck.All the above structures form a cranio-cervical-mandibular biomechanicalunit.Only after releasing the tensions in the jaw, the internal extension of the neck upto the crown of the head will be possible!

tensions in the jaw

BIBLIOGRAPHY
“Rolfing. Re-establishing the natural alignment of the human body for vitality and well-being”, Ida Rolf
“A dynamic relation to gravity”, vol.1 and 2, Ed Maupin
“Structural metaphor”, Ed Maupin
“Anatomy trains”, Tom Myers
“The endless web. Fascial anatomy and physical reality”, Louis Schultz
“Neuromuscular therapy”, Jack Baker
“Sen healing bodywork”, Itthidet Manarat Ongdam
“The Structural Typology”, Hans Flury
“The Physiology of the joints”, Kapandji