Background
Looking at the Erik Dalton's DVDs we come across the Upper and Lover crossed syndrome first presented by Vladimir Janda. These syndromes have two major components: 1. Tight, Facilitated muscles that create imbalance and 2. Weak, Inhibited muscles that allow that imbalance to happen.

Discussion
I don't know about you but this Facilitated and Inhibited concepts where not covered in massage school and I got great difficulty at finding a good description of what they are and how they are created. I've spent many hours searching the web and books through google books and found partial and sometimes contradictory answers, especially between the physios and the osteopaths books. I would like to get an answer from someone who clearly understand how it works. Yes, that would be you Erik ;)

Questions
1. Muscle facilitation and inhibition, what does it really mean? How does that phenomenon occur?
2. What are the symptoms? Is it muscle tightness? Is it jerky motor control? Is it loss of strength?
3. How can the bodyworker find out if a muscle is facilitated or inhibited? Is there a special test?
4. What can we do about it?


Even though I don't clearly understand the concepts yet, I've developed my own theory which I can use practically. I've decided to associate a tight muscle (higher tone) with a facilitated motor nerve and a weak muscle (reduced tone) with an inhibited motor nerve. I'm pretty sure that this is not the complete picture but that's enough to be usable. The second part of the theory would be that a series of impulses from the nervous system would reach the motor neuron. When there is enough impulses to pass the firing "threshold", the motor neuron would fire and the muscle fiber would start to increase in tone or contract. So there would be two variables here: 1. The amount of impulses going to the motor neuron and 2. The threshold in the motor neuron that could be high or low.Since some of these impulses can be controlled by the bodyworker (decompressing a joint, relaxing the person, shortening a muscle) this allows us to control the amount of input going to the motor neuron and eventually affect the tonicity. Same with spindle work, as mentioned by Erik, this could increase the amount of impulses going to the CNS and it might just make the decision of sending more impulse back to the motor neuron of that same muscle.

Examples:

Shortening muscle -> Decrease firing of receptors (spindles, golgi, etc) -> CNS (decision) -> Decrease firing to motor nerve -> Decrease tone.

Spindle work -> Increase firing of spindles -> CNS (decision) -> Increase firing of motor nerve -> Increased tone.

That's the way I understand facilitation / inhibition. The problem here is that I don't understand why, in the upper crossed syndrome, the pecs get facilitated when they should stop pulling and rhomboids inhibited when they should be pulling. I would expect the CNS to make the decision of sending lots of impulses to the motor neurons of the rhomboids so they would contract like mad and bring the shoulders back. Something is wrong somewhere in that principle and I hope it's my understanding.

Thanks for clarifying this.

Cheers

From talking with an osteopath, he mentioned this: Some muscles pull and some muscles are being pulled. When you palpate a muscle and it feels tight it could be either. Though, this means a totally different treatment for each. If it is being pulled, you have to relax what is pulling it.

I'm wondering if this would make sense:

UCS

1. The persons start a new career in IT and sit a desk all day long. Hands and head forward as he gets tired, gravity wins.
2. After a few months, even a few years, the body adapt and since the pecs are always in a shortened position and the rhomboids are always stretched, they adapt to the task and keep that shape permanently.
3. When the person stands up though, the pecs and rhomboids are not happy about the standing straight posture and are not really adapted to maintain the shoulder in the straight position anymore. The person tries to stand straight but has to contract the rhomboids harder, which pulls the shortened pecs. The pecs spindles are not happy about being overstretched so the pecs start the contract back (stretch reflex), there is a fight between the pecs and the rhomboids. The pecs win and the rhomboids become tired. Do the pecs win because they are stronger or do they win because reciprocal inhibition has priority over proper positioning of the joint? ... interesting anyway.

Some of your first post theory goes a bit over my head, first because I have not studied for a while, second, when I try to analyze complicated things, I feel like a dog biting its own tail, third most theories are someday proven wrong or incomplete. But hey, it's all good questions.
Personally, I don't think the CNS ever stops firing signals to the rhombs. Pain is there speaks for itself.
I am in physical therapy for this exact problem pec/rhombs battle and I am waiting for my epiphany!
My sense is that the Rhombs are trying to fight back but they are to weak and they give in to the pecs. At this point exercise to strengthen the rhombs is creating more pain and trigger points in them and paraspinals (and probably more joint subluxation in my case). On the other hand, if I regularly stretch my pecs only, I am able to keep the pain in the rhombs at bay.
I have to carefully self-monitor my exercises to make sure I don't recruit other muscles to "help out". Ultimately, this the problem, it's not just about Rhombs and Pecs. They don't operate in a vacuum. When pain is involved many other muscles become involved too.
The outcome of PT is very discouraging at the moment (X 1 week).

My repsonse to your Q "Do the pecs win because they are stronger or do they win because reciprocal inhibition has priority over proper positioning of the joint?"
is yes to the 1st and no to the 2nd because to it's to scary to think it would.
In chronic issues, after a period of time the CNS registers some dysfunction as non priority and stops sending pain signals so I heard. That's probably how discs can degenerate without causing symptoms. I don't beleive that reciprocal inhibition has priority per se but maybe that the CNS registers the situation and new joint position as normal because it is chronic.
If that is true, I have no idea how long it takes for the CNS to adapt but I have been in pain for years so I am guessing reciprocal inhibition does not get priority overnight if it does at all.

I hope my answer makes some sense, but hey if it contradicts itself
at any point, just blame it on my foggy brain function. :))

Deviations from ideal alignment predispose the person to muscle imbalances to maintain an upright posture and a mechanical response to a change in the center of gravity. Faulty alignment may give rise to what Kendall and McCreary call "stretch weakness" or adaptive shortness of muscles and their fascial bags. Conversely, muscle weakness or shortness may cause faulty postural alignment.

It is impossible to distinguish a cause-and-effect relationship when dealing with established postural faults. Perpetuation of the faulty posture only serves to further perpetuate the muscular imbalances that contribute to faulty movement patterns.

This is a reply to Serge's first post:

Rather than further discussing the neurology of how bombardment of afferent stimuli can up-regulate neuron excitability causing facilitation, I think it's easier to discuss the resultant muscle imbalances, i.e., upper & lower cross syndromes.

Muscular imbalances may result from abnormal afferent information due to (1) faulty posture, (2) joint blockage, (3) CNS malregulation, (4) painful stimuli, (5) excessive physical demands, (6) habitual movement patterns, and (7) psychological stressors.

Overloading the musculoskeletal system seems to facilitate the postural muscles (pecs, upper traps, etc.) causing hypertonicity and shortening…especially when the person is fatigued. Dynamic muscles (rhomboids, lower traps, etc.), become inhibited from overload causing substitution by the postural muscles during principle movement patterns which reinforces and perpetuates the imbalances.

Janda believed our sedentary society’s lack of variety of movement patterns also facilitates the postural muscle system. We’ve all seen how prolonged sitting in flexed positions allows gravity to pull the heavy head forward on the shoulder girdle and the shoulders forward on the rib cage which perpetuates the upper cross syndrome (see www.erikdalton.com/articles.htm )

When developing a treatment program, it’s important to know which muscles behave as postural or dynamic muscles and to investigate (via clinical reasoning) the possible causes for abnormal afferent information. This allows the therapist to treat not only the muscular imbalances but also correct the cause of the aberrant stimuli.

Some muscles tighten from fascial adhesions and some from facilitation. It's important to include techniques that address both the neurologic as well as the fascial contracture issues. But what about fascial myofibroblasts? Are they stretch receptors? How do you treat 'em?

So, that's what I have been missing out on!
Got to take one of your classes Erik, so I might actually be able to answer something here!
Thanks for your "pretty" responses.

Love to see you in class. We discuss lots of neurology but keep it simple and practical while relating it to the hands-on technique being discussed.

i'm surprised there's no discusion of reciprocal inhibition, sensory motor amnesia related to stabilizers (e.g., transverse abdominus, multifidus, etc.) and antagonist co-contraction. i have found understanding & applying these concepts (i.e., strengthening stabilizers) to be very helpful in rehabilitating upper & lower crossed syndrome cases.

The theory of facilitation is best explained in my opinion by Professor Michael Patterson. He states,” The concept of the facilitated segment states that because of abnormal afferent or sensory inputs to a particular area of the spinal cord, that area is kept in a state of constant increased excitation. This facilitation allows normally ineffectual or subliminal stimuli to become effective in producing efferent output from the facilitated segment, causing both skeletal and visceral organs innervated by the affected segment to be maintained in a state of overactivity.”
I love my wife and it is because of her that I remain grounded. I love to study. Although I find the above statement extremely enlightening, when I begin explaining theories as above to my clients, my dear wife pulls me aside and gently says “stop it, they do not have a clue what you are talking about”.
Erik, that is when I really want to get out my old Alice’s Restaurant album and 8”x 10” glossy photos of people exhibiting upper cross syndrome. As the album plays with its three part harmony, I will explain why they have pain. Calmly stating,” One can’t keep dumping the garbage over the cliff by eating donuts, coffee and being in a flexion position sixteen hours a day and not have one’s body react.” Haha!
However, I gently put then in a standard anatomical postural position and have them feel their muscles and then let them fall back to their ‘normal’ position and have them describe how they feel as I point to positional agonist and antagonist muscles.
I tell them that we have two types of muscles. One type of muscle (phasic) is for moving the body. The other type (tonic) is to maintain the body’s posture and support the body against gravity. When the body is abused or stressed like sitting at a computer for hours at a time day after day, the body begins to react. The phasic muscles upon stress tend to become more elongated, weak and inhibited to normal flexion. The tonic posture/support muscles tend to get tighter, and it gets worse. They become neurologically facilitated, that is nerve communication from the brain keeps them working even when they are not supposed to be working. Two apposing muscle groups can not contract at the same time.
As the agonist (facilitated muscle) takes over and the antagonist muscle continues to be inhibited the structural integrity and range of motion of the joint is lost.
I, through Myoskeletal Alignment Techniques, will normalize the joint movement and pain by balancing the muscle length tension across the joint. I will do this by releasing, stretching and calming down the continued nerve input of the facilitated and tight muscles and help activate, and excite the nerve to strengthen the weak muscles.

the law of reciprocal inhibition is broken when we perform antagonist co-contraction... the role of postural muscle fibers

Thank you Ken for your plain english. I am glad to realize that I am practicing these techniques instinctively.
I guess our clients's bodies remain our first teachers!

When we begin discussing the function of 'core' stabilizers, i.e., multifidus, respiratory diaphragm, transversus abdominis and pelvic diaphragm, we're led down a very slippery slope beginning with the goofy 1996 study by Hodges and Richardson which kicked off the core co-contraction revolution with the transversus abdominis as the mantra. Probably need to first review the latest studies by Stuart McGill...the foremost authority (in my opinion) of this subject.

Meantime, here are some earlier studies that refute the importance and/or existence of core stability and co-contraction. (The explanations for this referenced material appears in my "Don't Get Married article @ http://erikdalton.com/article_DontGetMarried.htm )

In Spine, 2006, Brown, et al., reported that people in an externally loaded state appear to select a natural activation pattern appropriate to sufficiently maintain spine stabilization. Any attempt to make conscious adjustments to individual muscles disrupted their natural pattern and decreased stability and the margin of safety.2

Kavic, et al’s Spine research found that no single muscle dominated in the enhancement of spine stability. Individual roles continuously changed according to specific tasks. Their advice was to focus on enhancing motor patterns that incorporate many muscles rather that targeting only a select few.3

In 2006, Mens, et al., found that increasing intra-abdominal pressure caused patients to exert potentially damaging forces on pelvic ligaments. The authors recommend teaching patients techniques to reduce intra-abdominal pressure as opposed to core stability exercises.

Dr. Tim Noakes, professor of exercise and sports science at the University of Cape Town in South Africa, stated in his research, “There is no basis to expect training effects from one exercise to transfer to any other form of exercise. Training is absolutely specific.”

In Manual Therapy, 2006, MacDonald, et al., reported that EMG studies refute the belief that the multifidus is tonically active during static posture, trunk movement or gait, making it unlikely that core stability training of the multifidus can restore normal function.4

It's an interesting subject if we want to go down that path...

Not to ignore the last couple of posts, I'll say, I don't understand much of that discussion and to go back to the original questions:
I think this is potentially out of the massage therapist scope of practice but understanding the muscle spindle and the the glogi tendon functions (which produce the facilitation and inhibition) would be important if one intends to use positional release and muscle energy technique to relax the client's muscle tone and improve range of motion.

Outside the scope of practice in what way?

I suppose positional release is okay but isn't MET considered therapeutic exercises?
I personally don't see why MTs can't learn these. I use them as I know too well that massage alone is not always sufficient. There was an article in the last Massage and Bodywork Magazine discussing how much (or how little in this case) MTs are supposed to perform and therapeutic exercises did not seem to fit the mold. Let me find that article.

http://massagebodywork.idigitaledition.com/issues/8/
starting page 57

I couldn't agree more SC.

Fred Mitchell Sr. developed mucle energy technique with the original intention to isolate down to the dysfunctional vertebral, SI joint or rib fixation, apply a slow contract/relax stretching force through the soft tissues, and restore joint play and proper functional alignment.

Today, muscle energy technique has expanded to include almost any kind of soft tissue contract/relax (stretching) release. However, that was not Fred's original intent according to Philip Greenman and his son Fred Mitchell Jr.

In fact, no one really knows who decided to name Fred's discovery muscle energy but his son is convinced Fred would not have picked that title since it was primarily designed to compliment (and some say take the place of) high-velocity thrust.

Probably because of the name, muscle energy today is used as a contract/relax soft tissue stretching technique applied to all the body's myofascia and joints...and that's a good thing.

Some believe it steps outside the scope of practice when the technique is used to strengthen muscle groups. Doesn't make much sense to me since so many forms of bodywork do exactly the same thing, i.e., active isolated stretching/strengthening, PNF, Thai massage, and some forms of structural integration technique.

But some people are only content when trying to control the lives of another person (or group)...much like our politicians. Everybody wants to draw lines in the sand rather than just keeping in their own little box and learning all they can to try to be the very best therapist they can be in an effort to improve the lives of the clients they serve.

Just noticed in an earlier post you were complaining and being treated for chronic "between-the-blade" pain. You stated: "I am in physical therapy for this exact problem pec/rhombs battle and I am waiting for my epiphany!"

Without observing you, I'd bet the house you have a condition termed a "dual-fixation". There are many presentations for this ornery disorder but if you have a flat spot between-the-blades where there should be thoracic curve, then there are a group of facets stuck closed. This can be a bilateral dysfunction or what osteopaths term "stacked non-neutrals", i.e., one stuck closed on one side and the one above on the other and so on.

When facets stick closed, the contralateral rib(s) can get stuck in internally rotation. This can be a very painful and long term dysfunction if the therapist doesn't treat the dysfunction in the proper order. The facet problem must be corrected first to restore joint play. Sometimes the contralateral rib(s) will regain movement when vertebral function is restored and all is well....but you still need to be doing wall-presses or some other home-retraining exercise to keep the facets open and moving properly to down-regulate the hyperexcited mechanoreceptors (and possibly chemoreceptors if there is inflamation from prolonged jamming of the articular cartilages or demi facets at the rib heads).

Conversely, if you have facets stuck open (FRS) in one or more of the vertebral segments, the ipsilateral adjoining rib can get stuck in external rotation. This is easier to fix but, again, the facet fixation must be fixed first. Then the therapist follows the adjoining rib laterally out to the iliocostalis muscle attachment at the rib angle and if there is exquisite tenderness at that firm attachment, you also have rib dysfunction. This is also easy to fix if the therapist is familiar with structural rib fixations.

Most good manipulative osteopaths understand this prevalent dysfunction and can get you on your way back to a pain free life. Just remember, the rhomboids, erectors and transversospinalis muscles may be weakened (neurologically inhibited) from the joint dysfunction. Any attempt to stretch the muscles crossing the dysfunctional joint(s) will only reinforce the dysfunction which will lead to greater inhibition and more pain.

This is why I believe massage therapists should be taught basic joint mechanics in massage training (like they do in many Canadian institutions). Pressing down on a facets that are already stuck closed as in the "dorsal dish" situation described above, is totally contraindicated. I'm not saying massage therapists should necessarily treat the problem, but should at least recognize what they're dealing with so proper referrals can be made. This is the basis of the Myoskeletal method.

If you're perorming deep tissue work, you need to have a good basic understanding of spinal biomechanics and the 'Laws of Spinal Motion'. Muscles and joints are inseparable...what affects one ALWAYS affects the other so it is nice to know how your deep tissue techniques are affecting the adjoining articular structures...best of luck with this enormously misunderstood problem.

Jaya: and I would also add Lombard's Paradox: http://en.wikipedia.org/wiki/Lombard's_Paradox

Let's go back to the original questions:

1. Muscle facilitation and inhibition, what does it really mean?

It means that the CNS for a reason or another, alter the efferent stimulus to the motor nerve which controls the muscle, affecting its tone.

Some of these reasons are within the scope of practice (ex: joint overapproximation) and some aren't (ex: psychological stress from a divorce). This is raising a few issues. First, we have to find out what is the cause of the facilitation, before we treat, or else we are just doing random bodywork with the hope of doing the right thing. This is not always obvious so we might have to go by elimination, starting with what you can do as a bodyworker. When, after a few sessions you are not getting any results, I believe it would be worth referring to another specialist that would address the other areas outside your scope. I'd like to know how long each of you spend on a client before realizing that what you are doing is not addressing the cause? Maybe that question should go on another topic. (moderator please)

How does that phenomenon occur?

The CNS for some reason, after receiving afferent stimulus from a receptor detecting a stress of some sort (mechanical, chemical, psychological, name it), makes the decision of increasing the stimulus. We don't know why the CNS makes this decision. Does anyone have an answer to that?

2. What are the symptoms? Is it muscle tightness? Is it jerky motor control? Is it loss of strength?

My understanding: Facilitated = Hight tone (tightness), Weak, and Jerky motor control. Inhibited = Low tone (too soft), weak (less strength), and Jerky motor control.

Can anyone correct me please?

3. How can the bodyworker find out if a muscle is facilitated or inhibited? Is there a special test?

Well, there are always the models like the crossed syndromes and the reflexes like reciprocal inhibition but aside what I've put in question 2, that is feeling the tightness and jerkyness during mobilization and observing imbalances visually I'm not aware of any other techniques.

4. What can we do about it?

Depends on the cause. If the cause can be addressed by bodywork, the information given by Erik in his DVD collection should be enough to treat the basics. If the person needs to learn how to move properly and stretch that is still something we can do. The last thing we can do to help our client would be to refer to another specialist when there is no improvement. (Though I don't know where that line is, 3 sessions??)

Thanks for your feedbacks!

Serge:
Responding to " The CNS for some reason, after receiving afferent stimulus from a receptor detecting a stress of some sort (mechanical, chemical, psychological, name it), makes the decision of increasing the stimulus. We don't know why the CNS makes this decision. Does anyone have an answer to that?"

We do know why:
Fight of flight response is an ingrained defense mechanism in all species.

here's more although I am sure you already know about this:http://www.thebodysoulconnection.com/EducationCenter/fight.html

"We don't know why the CNS makes this decision."

Though, as I mentioned in the second post, would it be possible that when we have a need for agonist contraction and the antagonist is being stretched too far, triggering the stretch reflex, this would facilitate the antagonist (being pulled) and inhibit the agonist (pulling).

http://www.thestretchinghandbook.com/images/stretch_reflex.jpg

An example:

1. A person with Upper Crossed syndrome tries to stand upright.
2. The shoulder joint is out of alignment, the CNS decides to tell the rhomboid to contract to bring the shoulders back.
3. As the rhomboids contract, the pecs are being pulled backwards.
4. Because the pecs are short (as we know in upper crossed syndrome) the pull from the rhomboid is too much and the spindles in the pecs fire and trigger the stretch reflex for the pecs group.
5. The stretch reflex, which is an older reflex, *may* have priority over proper alignment of the joint which takes mental computing. Hence facilitating the pecs and inhibiting the rhomboids (to stop the pull and protect the short pecs)
6. This person is now stuck in a loop.

That's my theory anyway, I'd like if anyone can correct it.

Cheers

Erik,
I really appreciate you taking the time to give me an potential explanation of the structures at play in my complaint. I feel like it is time for me to go back to the books although I am much more of a kinesthetic learner! Your input makes sense and I wish that it was all there is to it but I suspect other underlying issues at this point (like disk degeneration maybe even a dormant virus). I suspected disk problems for my low back 5 years ago when I started to develop hip pain and a limp but it took the doctors the same amount of time to confirm the disk herniation and degeneration. That's what happens when you have a crappy health insurance. I am going to pay a visit to an osteopathic practitionner I have seen in the past , he might be able to help with this too. Thank you for your collegiality.

Yes, if you're problem is chronic low back pain, discs can certainly be a factor. I thought you were battling thoracic cage pain, i.e., between-the-blades. Of course, disc degeneration/osteophytes, etc. are much less common in the T-spine since the ribs prevent excessive motion.

DO's who've decided to do their residency in manual medicine are some of my favorite practitioners but very rare. Most choose to make more money pushing drugs, surgery, etc. The problem today is that pain management is finally gaining popularity as doctors realize they have inadequate tools to treat the baby-boomer's musculoskeletal complaints and decide to do manual therapy.

Therefore, we see a lot of DOs who've not done their residency in manual medicine placing ads in the yellow pages saying something like, "Specializing in Pain and Posture Problems". Regrettably, this group of osteopaths have only had one year's training in manual medicine and some schools only require a semester. Bottom line: Make sure you're USA osteopath did a three to four year residency in manual medicine and if possible is board certified as an FAAO.

Erik-

In my original post, I mentioned being in PT because I was speaking from my experience regarding the Rhombs/Pecs battle discussion. The truth of the matter is that I am battling with pain at all 3 levels in my spine.( I guess since MDs can only handle a few square inches of a body at a time, I have learned to complain about only one issue at a time).Your opinion about what is going on at the thoracic level is still valuable and possibly correct. I was just think and writing out loud when I threw in the lumbar disc issue. Sorry about the confusion.

I am well aware of the scarcity of DO (MP) in the US so I was lucky when I discovered James Bucciarelli last year. He trained under Phillipe Druelle, the founder of: http://www.osteopathie-canada.ca/. My sister who is also an osteopath in France trained at the same place as Druelle (http://www.atman.fr/home). Sorry,the latter is in french! In nutshell, the video talks about introducing ostepathy in the work place since the french misnistry of health has finally decided to recognize Osteopathy as a valid therapie. It is of great interest to me since 90% of my work is in companies and I could use this knowledge. I just can't see myself going back to school for 5 or 6 years.

I only found James Bucciarelli last December at the time when my disc ruptured. Anyhow, I think I'll be in good hands with him, he does have about 5 years experience as a DO(MP) and has a M.ed in sports medecine since 1976. I just have to make a point in seeing him instead of DCs and PTs.

You are certainly in good hands. I also recommend co-treatment with a good Certified Advanced Rolfer....the two therapies work beautifully together. E-mail me if you need a referral....good luck dude!

To SC, RE: "Fight of flight response is an ingrained defense mechanism in all species."

It makes sense indeed that the organism would try to preserve itself by avoiding the stressor. I guess individual differences would make different CNS perceive the threat differently and have a different reaction.

To Serge:
We all absorb life but we all process it in our own unique way, because we each have our own lessons to learn and obstacles to overcome. We all have strengths and weaknesses and our stressors know where to find our weak spots. Sometimes, I feel as though life is just a game we play with ourselves. Most of the time we seem to like scaring and hurting ourselves though. Maybe that's the game for our CNS to play!

Gee, I am off topic!! I think I need to catch up on sleep.

That's not off track at all Serge...but you do need some sleep.

I don't even have a clue what you are talking about...I think I remember the words being used in massage school 20 years ago but I don't care about it. I just work on tight muscles. I haven't had any problems in getting results with clients. I see all sorts of things - carpal tunnel, herniated discs, pulled muscles, neck problems, fibroymyalgia, athletes trying to stay healthy and run faster...

Julie ---- :-))

Good for you Julie. Some therapists are gifted with what I call "innate kinesthetic palpatory awareness". These bodyworkers seem to possess a greater ability than some of us to tune in to their client's dysfunctions and offer pain relief.

While attending massage college in San Diego in 1979, we were privy to little scientific data to support our work and, therefore, addressed the tissue we could best evaluate and relate to...muscles. So, for a couple of years, every client that came to see me had a muscle problem. In 1982 I entered the Rolf Institute and everything became a fascial problem. Took a couple of James Cyriax workshops and became convinced everything was a ligament problem. Broke my neck in a clumsy judo fall in 1989 which led me through a couple semesters of PT school and then to post-graduate workshops at Michigan State College of Osteopathic Medicine and everything became a joint problem.

The fact is…all soft tissues are innervated and can be pain-generators. Since massage therapists are considered by most to be “soft tissue experts”, it is necessary we have tools to assess and treat all the body’s soft tissues.

For example, one of the first structures that should be evaluated in sciatic cases are the iliolumbar ligaments. When strained by excessive sidebending, they often become fibrotic and because they have ‘hoods’ that lay on the L4-5 and L5-S1 sciatic nerve roots, are often the first structures to compress the overlying capillary beds and dural membrane. Soon the irritated sciatic nerve develops intraneural edema and swells. As inflammatory waste products collect, sensitive chemoreceptors flood the spinal cord’s neuronal pool setting off pain-spasm-pain cycles that causes the brain to lay down protective muscle guarding. In the short term, muscle work to the hypertonic (facilitated) erector muscles may make the client feel better as the cutaneous (skin & fascial) receptors are calmed by the deep slow manual pressure. But be prepared to dig out the erector spasm session-after-session until the ligament issue is properly addressed. Same with SI Joint induced sciatic conditions.

Some muscles are tight (facilitated) and require restoration of extensibility and some are weak (neurologically inhibited) and require restoration of contractibility. Randomly lengthening all tissues presents many obvious problems. The most common example educator’s like to use is the pec/rhomboid balance issue. Creating extensibility in stretch-weakened rhomboids and lower traps reciprocally (and fascially) allows the pecs to further pull the shoulder girdle forward on the ribcage…dragging the heavy head with it. Clients often hurt 'between-the-blades' but should we be digging on these weak/inhibited muscles.

As the legendary Vladimir Janda, MD once said: "No pain management approach is truly successful unless posture has generally been improved". Chasing the pain by working where the client hurts is, at best, a temporary quick fix.

Good post Erik. So, practically, when facilitated muscles are found to not release after some work, a good example being the erector spinea, one has to look for underlying causes around ligaments and joints. I know, you have already mentioned that in your DVDs ;)

I have a problem with the erectors / sacrospinalis in particular. I have great difficulty at achieving results with the longissimus and other long-ranged erectors. 1) I look at the posture distortion: ok it's pulling there and there .... 2) I palpate the tissues ... ok it's tight here and there... 3) I use some techniques (joint mobilization / positional release / met / TrP release (if TrP found) / deep-tissue myofascial release) ... not much improvements. I get outstanding results using that approach in others area of the body but not with those muscles. The best I could achieve is by working on the "front line" (Tom Myers) to open up the front and allow the ribcage to rotate posteriorly back in place. Even then.. there was still hypertonicity.

When I talk to other practitioners, they avoid the topic or answer something vague about how they can fix it but they can't show me. Others on post have given techniques that I'm already doing without success.

Any idea or content you can point me to?

Excuse my writing by the way, I'm french canadian and learned most of my english from in Australia ;)

Yes, you French-Canadians are pretty weird folks. In the early '70's, our Flying Burrito Brothers band toured extensively (opening for the Steve Miller Band) throughout eastern Canada all the way over for a concert on Prince Edward Island. Loved the country and the people. Serge Gracovetsky lives 8 months of the year in Montreal and co-sponsors the 'International Society for the Study of the Lumbar Spine'. Attended that conference a few years ago. You gotta there if you still live in the neighborhood.

Here's a 'fly-by' opinion about the erector spinae problem that concerns so many structurally-oriented pain management therapists. Recall the the erector spinae and the transversospinalis muscles are really one neurologically functioning unit that has segmental innervation. In the presence of joint dysfunction (facets stuck open or closed), the first muscles affected are the rotatores, multifidi, intertransversarii, levator costalis, and then simultaneously, the erector spinae group.

The articular and ligamentous mechanoreceptors gradually send noxious stimuli to the cord reporting that they're not happy with the loss of joint-play. If the articular cartilages or ligaments become damaged, inflammatory waste products accumulate setting off the chemoreceptor hyperexcitibility which also floods the neuronal pool with noxious afferent information. Together, they can stimulate the nociceptors which fast track messages to various centers of the brain and the brain typically reacts by laying down protective muscle spasm to 'splint' the area. The transversospinalis and erector groups are the first to feel this spasm and begin pulling unilaterally or bilaterally on the spine (segmentally).

In time, the cortex may begin to gate the nociceptive messages and downgrad the spasm causing the surrounding paravertebral tissues to go from a hypertonic to inhibited state. This is what we often see in our flexion-dominate society when gravitational exposure begins to have its way with the spine.

Prolonged computer work or bodywork (arms out front and internally rotated) often causes the T-spine facets to become locked open around bra line and the heavy head is dragged forward creating loss of cervical curve and hyperextension at the O-A. With the arms doing their duties at the computer or during bodywork sessions, the T-spine erectors and scapula begin to migrate laterally creating stretch-weakness in the rhomboids, lower traps, serratus anterior. This reciprocally facilitates the pecs and other muscles/fascia of the front line.

Of course, you need to get the erectors back toward the mid-line to encourage trunk extension and address the loss of cervical curve but what about the stuff in front? Ida Rolf used to begin each Rolf series at the feet and then would systematically work her way up in each session. Then she discovered greater success by addressing the thorax function which allowed better respiration, thus, more nutrients to the tissues.

With the client supine feet flat on the table, she's take those big ole fingers and hook the erectors and push them back toward the midline. Then to the respiratory diaphragm, intercostal muscles, pecs, rectus abdominis (back toward the midline), pelvic diaphragm, etc. And yes, we had to dig between each rib in session one in addition to digging pec minor off the ribs. I soon discovered people weren't coming back for session two. But, as I developed better touch and began to add enhancers (client activated movements), the client felt less discomfort and most returned for another try.

This could go on for ever and I'm not sure I even touched on your question Serge but I gotta get going...off to teach in Denver this week. Thx for the posts and I'll get back with you when I return.

the theory I have developed and use is Muscle Release Therapy, MRTHh®. Understanding that muscles contract both concentrically and eccentrically it is important for the therapist to understand where the contraction became inhibited or where the action potential stopped its movement pattern. This inhibition is normally generated by an improprietory perceived by the proprioceptors that alter movement patterns. Often times the movement pattern that is needed is altered because of muscle already in an inhibited pattern or the mind's perception of trauma. Overuse injuries will alter posture, the inability of the spinal rotation patterns are altered, curvatures of the spine are not in balance, stability in either the pelvis or feet could create this inhibition aspect or any form of alteration to the body's neutral posture. In this neutral posture I am not talking about an anatomical posture but the posture of comfort that each individual is born with. Conceptual movement in the embryo is when this posture is developed and formed. As we alter the posture in any of the aforementioned ways, the neurological law of faciliation becomes impaired. Nerves that would normally not alter a movement pattern are now called on to facilitate movement in method of comfort. When assessing issues it is imperative for the therapist, through palpation, to determine when a muscle is "stuck" in improper contracture, facilitate that muscle or tissue to finish its action potential and allow it to return to a neutral posture. It is also important to understand that fascia, ligaments, tendons and muscles all have different patterns of contracture. The fascia permits the sliding or gliding effect not only of tendons and muscles but the nerve fibers and blood vessels. So a generalized eccentric stretch to the fascia is not always the what the body is in need of. Treating the ligaments, as they are proprioceptors is necessary also and understanding their relavance to movement before tendons and muscles are addressed is necessary. There is much that could be written but these are some of the basics that I attribute to this question.