Exercise & Posture: Are We Strengthening Our Poor Postural Patterns?

Our understanding of fascia and tensegrity, the alignment of the body through compression and distraction forces within the connective tissue, continues to broaden. As we learn more, we have begun to recognize the importance of postural alignment in relation to the health of the soft tissue, joints, nervous, lymphatic, and circulatory systems. While we promote daily exercise in our wellness education, we may want to start first with alignment principles that will promote injury free movement.

How often have you heard about certain exercise classes (such as yoga or Zumba) that end up injuring students? I propose that it is not the activities in and of themselves that cause the injury, but in fact the result of the individuals pushing themselves beyond their available fascial mobility. This type of injury occurs when we feel like we need to keep up with our neighbor, or have failed to listen to the small cues that our body is using to speak to us.

So how can we promote healthy movement and encourage individuals to adopt a healthy and balanced exercise routine that takes into account these small bodily cues? The solution involves teaching our clients to understand the basic principles of alignment, fascia, and overall fascial fitness.

Our bodies connective tissue runs in “sheets” from front to back, side to side, laterally, and diagonally. These connective tissue continuums create a balancing tensional pattern throughout our structure to align and maintain normal tension patterns in our circulatory, nervous, and lymphatic systems. In turn, this maintains normal tension and compression patterns throughout our skeletal/joint structures. With this knowledge, it is clear that our focus as movement and manual therapists needs to be centered around this balanced connective tissue netting. By educating our clients about this system and the importance of maintaining its health and balance, we can teach them strategies to promote wellness.

We can achieve this goal by educating clients about how the foods that they ingest affect the hydrous makeup of this system, and highlighting the importance of hydration as part of the creation of a healthy environment for stability. Through education around ergonomics and modifications to our external environment, we can continue to promote proper alignment in those we treat. By using movement retraining strategies such as Feldenkrais, Gyrotonics, Alexander technique, and more, we can succeed in instituting healthy long-term exercise programs.

Concurrently, we can train clients in body awareness strategies that promote awareness practices regarding postural holding patterns and sympathetically driven tension patterns. These can include meditation practices, which promote awareness through body scanning, diaphragmatic breathing, and general mindfulness; as well as slow rhythmic movements like tai chi and chi gong practices. As these actions are incorporated into general daily habit patterns, the client will be able to safely and readily incorporate them into an exercise program that is balanced, safe, and effective.

By assisting our clients in a whole body approach with the emphasis being on whole body health and fascial health, we can empower our clients to be successful in a lifelong exercise program.

Reblogged from One Step At A Time
Reblogged from Yoga Chocolate Love
Reblogged from One Step At A Time

Bowenwork: A New Concept in Pain Management

Greater understanding in the last ten years about the brain and pain has produced a plethora of data on the role of the autonomic nervous system (ANS) in pain perception and the importance of creating a balance of the sympathetic and parasympathetic systems in pain perception and healing. As our society is dealing with the growing healthcare crisis, especially related to the treatment of chronic pain, a new form of manual therapy has emerged in rehabilitation which directly affects the ANS. This new form of manual therapy, Bowenwork, was developed by the late Tom Bowen in Geelong, Australia in the 1970s and 80s. The treatment technique has been taught internationally since the late 80s and was introduced in the early 90s in the United States.

Bowenwork is a gentle, cross fiber, soft tissue manipulation technique that is performed over specific locations in a specific sequence throughout the body, with pauses after procedures to allow the ANS to respond. The procedures can be administered over clothing, which makes this technique easy to provide in any treatment setting.

I learned about Bowenwork while I was working in a surgical center as an occupational therapist and a certified hand therapist. I was treating patients with shoulder, elbow, wrist and hand injuries, utilizing traditional manual therapy strategies, modalities, and exercise.

After receiving a Bowenwork treatment myself and experiencing the effects, I saw the potential benefits that this could offer my patients, and I began my Bowenwork training. After one year of study and subsequent certification, I began applying this technique to my chronic pain population who were suffering from fibromyalgia, repetitive strain disorders, back pain, neck pain, and complex regional pain syndrome. I was astounded by the rapid and, many times, profound results that I began seeing in my patient population. I began my search to understand how such a minimalistic manual therapy technique could have such profound results on the body.

My curiosity led me on a search to better understand the effects that sensory stimulation and cross fiber, light touch pressure on proprioceptors could have on the nervous and myofascial systems. I began to study the specific sites on the body where Bowen moves are administered, and the particular types of fiber and proprioceptive receptors that are located at those sites.

How does this technique work?

Bowenwork is a gentle but powerful technique that works by balancing the ANS, which controls more than 80 percent of our bodily functions. A Bowen treatment consists of a series of gentle but precise soft tissue mobilizations, cross fiber in nature, performed by the thumbs or fingers on muscles, tendons, ligaments, or nerve sheaths. The technique is unique in the following way. First, the skin is pulled to the side of the structure; gentle pressure is then applied to the edge of a muscle. A gentle, rolling move is then performed over the structure in a perpendicular fashion while maintaining gentle pressure on the site. This stimulates the proprioceptors, sending information via the nervous system to the ANS. A pause is applied after this rolling motion, allowing the nervous system to fully respond and the muscles to reset to their normal tissue tension state.

Many of the Bowen moves are done at the musculotendinous junctions where the golgi tendon organs (GTOs) are found. By stimulating these sites and providing a “wait time” after the stimulation, we observe changes in the tension of the connective tissue. Bowen moves may also affect the spindle cells and the joint receptors, which allow the body to respond by affecting muscle tension and proprioception. Muscle spindles and GTOs are continuously monitoring the degree of muscle contraction and tension within the tendons. Spindle cells detect the length of a muscle and are primarily located in the muscle belly. GTOs, on the other hand, are designed to detect muscle tension and are located at both ends of muscle tendons. GTOs complement the action of spindle cells, and vice versa, continually balancing each other’s actions.

We are learning now through newer fascial research that the stimulation of light touch affects the superficial fascial layer of connective tissue, which directly affects the deep fascial matrix. In his book Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists, Myers (2009) has prolifically identified specific fascial lines that run throughout the body.  By applying pressure to one part of the body, we can see a direct and profound release in another part of the system. It is this direct fascial connection that begins to make sense of what I see clinically. I can choose to include Bowen moves that affect these fascial lines in various parts of the body and will see the client have a whole body response that balances out the abnormal tensional patterns throughout the whole system. I frequently have clients report after a session that they feel taller, more relaxed, with an increased ease in maintaining postural alignment and subsequently more range of motion and less pain with their functional movement patterns.

Most Bowen treatment plans for particular diagnoses last anywhere between two-eight sessions. The treatments are very gentle and can be performed on children, adults, and the elderly. There are no precautions and contraindications for this form of manual therapy. Because of its gentle approach both on the patient and the therapist, it can easily be incorporated into a standard treatment program that involves patient education, ergonomics, therapeutic exercise, energy conservation, work simplification, and the progression of a home exercise program. Positive preliminary findings about the Bowen technique have been published on improved shoulder function (Carter, 2002), hamstring range of motion (Marr, Baker, Lambon, & Perry, 2011) and heart rate variability changes (Whitaker, Gilliam, & Seba). I anticipate that we will continue to see further positive studies coming out about this technique.

Because of our constant search as health care providers to find low cost, easy to implement techniques that demonstrate measurable functional changes as well as cost savings, I anticipate that we will continue to see Bowenwork successfully incorporated in a number of health care settings, such as schools, rehabilitation hospitals, acute care (Godfrey, 2001), outpatient therapy, skilled nursing facilities, and also in the wellness population.

For further information about Bowenwork and continuing education training opportunities in the United States, contact www.bowenacademyusa.com. Bowenwork is currently available in over 33 countries, and certification can be found internationally through the Bowen Academy of Australia at www.bowtech.com.

{Kelly Clancy, OTR/L, CHT, is the owner of The Seattle Center for Structural Medicine, an integrated health center in Seattle, Washington. She received her certification as a Bowenwork practitioner through the Bowen Academy of Australia. In 2010, she became a North American Bowen instructor through the Bowen Academy USA.}

References

Carter, B. (2002, November). Clients’ experiences of frozen shoulder and its treatment with Bowen technique. Complementary Therapies in Nursing and Midwifery, 8(4), 204-210. doi:10.1054/ctnm.2002.0645

Godfrey, J. (2001). The Bowen technique: gentle and effective antidote to pain. Nurse2Nurse, 1(12). Retrieved August 27, 2013, from https://www.chisuk.org.uk/ArticleItem-19kSEyxg-The_Bowen_Technique__gentle_and_effective_antidote_to_pain.html

Marr, M., Baker, J., Lambon, N., & Perry, J. (2011). The effects of the Bowen technique on hamstring flexibility over time: A randomised controlled trial. Journal of Bodywork and Movement Therapies, 15, 281-290.

Myers, T. W. (2009). Anatomy trains: Myofascial meridians for manual and movement therapists (2nd ed.).

Whitaker, J., Gilliam, P. P., & Seba, D. B. (n.d.). The Bowen technique: A gentle hands-on healing method that affects the autonomic nervous system as measured by heart rate variability and clinical assessment. Retrieved August 27, 2013, from The Bowen Technique: European College of Bowen Studies: http://www.thebowentechnique.com/Studies/bowen-and-heart-rate-variability.html

An Integrated Approach to Health

Pain affects more Americans than diabetes, heart disease and cancer combined. In 2011, the Institute of Medicine of the The National Academics, estimated the number of sufferers of chronic pain in America to be as high as 100 million people.

As we see a dramatic rise in the reported cases of chronic pain, one cannot help but examine the pace and lifestyle that our society currently demands. It is the combined chronic stress patterns, with the focus on multitasking and productivity, as well as the fear and economic uncertainty that we live with which inevitably is affecting our structures and our resultant embodiment of pain. It is not only the societal low level fear and anxiety that we all are exposed to and internalize on a daily basis but our mind and bodies response to these perceived threats.

Lissa Rankin, MD in her new book Mind Over Medicine describes this cycle, which is epidemic in our society as the Repetitive Stress Response. This constant state of fight or flight involving multi-tasking with the fight against time slowly changes our bodies ability to balance and self regulate its own systems thus eroding our bodies ability to fight off disease.

In our current model of pain intervention, our healthcare systems looks primarily only at the site of reported pain for evaluation and treatment. The site of pain or numbness is treated locally, and the symptoms may or may resolve. This current treatment model being reductionist and isolated, reduces the patient’s complaint to its simplest form. The isolation to the one part of the body and one system of the body acting in isolation has becomes very costly, very quickly, as the patient must approach a separate specialist physician and occupational or physical therapists for each isolated physical problem. These treatments may lead to temporary relief of symptoms but may not address the root cause of these often migrating symptoms.

In many cases the interventions applied create side effects on other systems creating imbalances in other parts of the body. If conservative management is not satisfactory, often surgical intervention is implemented to the localized painful area. It is not uncommon for a patient to have multiple surgeries especially in areas like the upper extremity or back in an attempt to “put out the fires” of complex multi-system symptoms.

The answer to holistic treatment may lie in the unknown organ of structure called fascia. Fascia is made up primarily of densely packed collagen fibers that create a full body of sheets, chords and bags that wrap, divide and permeate muscles, bones, nerves, blood vessels and organs.

Within the fascial system lies the musculoskeletal, vascular, nervous, and lymphatic systems. Any adverse presentation of those isolated or combines systems will directly be influenced by the health and positioning of the connective tissue matrix. By treating the fascial system directly, all these systems will potentially be self-regulated and restored by returning them to their original length strength and function..

Biotensegrity is a newer approach to understanding how bodies work based on the insight that we are primarily tensegrity structures and our bones do not directly pass load to each other. Thus, forces primarily flow through our muscles and fascial structures and not in a continuous compression manner through our bones. In fact, our bones do not directly touch each other, and are actually “floating” in the tension structure created by our fascial network. Thus, biotensegrity represents a significant conceptual shift from the common sense view that our bones are the load bearing structures in our bodies like the framing of a house.

As we transpose these tensional and compressive elements to the biotensegrity model, we can see that the disruption to one part of the body’s fascia necessitates tugging and pulling on the body’s connective tissues. The fixed laxity of the fascial system determines how much give the system has overall to weather such disruptions. Once the fascia is highly disrupted, physical intervention in the form of bodywork or movement therapies are necessary to return the body’s structure to its original state of optimum support for the entire body. Strengthening of an isolated muscle does not restore fascia to its original tissue length. However, strengthening other muscles in the postural alignment throughout the body may restore integrity to alignment and, thus, provide more flexible tensioning in the myofascia throughout the whole system.

For complex chronic patients, practitioners may have to address the nervous system directly as a primary intervention to help down regulate the others; For example, a patient who has lived with chronic pain for several years may require a preliminary intervention for his or her nervous system, and a modality like Bowenwork would be an appropriate precursor to more intensely focused myofascial work. Once the nervous system can become more balanced, the lymphatic, musculo-skeletal, and vascular system will become more optimized. By identifying the organ of structure as the primary intervention to affect the other systems, we can then bring the Autonomic system to balance and fascilitate the bodies own healing response and mechanisms. Once the bodies systems have become more organized, health and wellness strategies can be incorporated into the treatment plan to empower the patients to gain more control and insight into their responses to environmental demands, thus changing these stress patterns long term, giving the patient the tools they need to live the happy healthy pain free life that they desire.

For more information about Bowenwork and other forms of manual therapy and whole body wellness, go to www.scfsm.com and www.kellyclancy.com

Kelly Clancy, OTR/L, CHT, SMS is the owner of The Seattle Center for Structural Medicine in Seattle, Washington-an integrated wellness center incorporating bodywork, Gyrotonics, Pilates, nutrition, and health and wellness consulting. She also teaches ongoing classes on postural assessment, manual therapy, and whole body wellness to clients and practitioners both locally in the Seattle area and nationally.

Trust the energy that courses through you , trust and then take surrender even deeper. BE the energy. Don’t push anything away. Follow each sensation back to its source in vastness and pure presence. Emerge so fresh and so new that you don’t know who you are. Welcome in the seasons of monsoons. Be the bridge across the flooded river and the surging torrent underneath. Be unafraid in consummate wonder. Be the energy and blaze a trail across the clear sky. Be the energy and blaze a trail across the clear night sky like lightening. DARE to be your own illumination.
— Dana Fall