What do we mean when we talk of facilitated and inhibited muscles?

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Comment by Erik Dalton on October 26, 2009 at 7:40pm

Yes, I'll start another post on my new blog @ http://www.daltonbodyworktraining.com/daltonmyoskeletal/welcome-to-...

Just got home from a trip and am trying to get caught up. Will keep you posted ~ ERIK

Comment by Serge Rivest on October 26, 2009 at 6:54pm

Erik - Well, I think Ida Rolf did the right thing in trying to bring the myofascial structures from the ribs towards the spine hence giving some slack to the spinal muscles that have an attachment on those ribs. I'll try out that technique and come back to you.

On another note, I now live in Tasmania > Australia so I won't be able to attend Serge's talk at a Conference anytime soon ;) .. Maybe the world massage conference 2009.

SC - Interesting point, distortion from left to right could definitely be part of the problem. Or even rotational distortion for that matter.

We should probably put these posts in another topic as they relate to erectors and not facilitation / inhibition (Moderator please)

Comment by SC on October 15, 2009 at 8:35pm

Would it be it correct to say that facilitated muscles are stuck in concentric contraction and inhibited muscles are stuck in eccentric contraction? Or do I have this all wrong.

Erik-

The front to back relationship is discussed a lot but what about the side to side relationship.
I find that there's always a combination of the the two involved in the muscle imbalance because of side dominance. L and R upper back muscles often appear to be at a tug of war maybe more so than the front to back sometimes. I find that I get better result if I start by addressing the imbalance between R and L before I start looking at the front to back.

Serge- Bonjour, je suis française mais de France. I learned oxford english in french schools but the TV is the US was a great language teacher when I first arrived here some 23 years ago.

Comment by Dennis Gibbons on October 15, 2009 at 8:55am

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.

Comment by Erik Dalton on October 14, 2009 at 10:58am

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.

Comment by Serge Rivest on October 13, 2009 at 9:50pm

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

Comment by Serge Rivest on October 13, 2009 at 9:47pm

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?

Comment by Erik Dalton on October 11, 2009 at 3:35pm

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.

Comment by SC on October 10, 2009 at 8:00pm

Julie ---- :-))

Comment by Julie Onofrio on October 10, 2009 at 5:59pm

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...

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