THE INTEGRATIVE FASCIAL RELEASE (IFR) COURSE; PART 2 – Fascial Articulations – Jo’burg; 13-14 Feb 2016; R3350

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South Africa

2016 International Series

 

ISTR Foundations 2 FASCIAL  ARTICULATIONS

By Steven Goldstein  Bachelor of Arts in Education, Western Washington University 1984

Bachelor of Health Sciences Musculoskeletal Therapy, Australian College of Natural Medicine 2007

 

 

Syllabus for Fascial Articualtions

Intermediate course

DAy one

Session 1 ; 1 Hour

Brief Revision from the AM Workshop

Introductions and Background Information

Four Primary Modalities Utilized

 

The Autonomic Nervous System

• Sympathetic-Parasympathetic Spectrum
• Coordinating the Diaphragms
  • Two Point
  • Stacking
  • Fulcrum

 

Myofascial Patterns – Global Line Restrictions

 

• Cardinal Line Restrictions: Anterior, Posterior & Lateral
• Myers: Anatomy Trains: SFL, SBL, LL
• Paoletti: Fascial Chains: Anterior, Posterior
• Schleip; High Leverage Points in the Myofascial Net
• Schultz: Endless Web-Body Straps: circumference restrictions

 

Tissue Loading

• Compression Loading
• Tension Loading

 

Muscular Patterns

• Assessing muscular patterns is necessary to understand soft-tissue dysfunction
• Basic patterns such as Upper and Lower cross syndrome (Janda)
• Muscular subsystems functioning:
  • Lateral Subsystem LSS
  • Deep Longitudinal DLS
  • Posterior Oblique POS
  • Anterior Oblique AOS

 

• MET Modified for ISTR
  • Lower Force Contractions 10% or less
  • Use of Reciprocal Inhibition to change pain or pressure sensation
  • Compound Resistive

 

Joint Position & Play

• Concepts, Information & Theory
• Glide patterns
  • Compression/distraction
  • Anterior/posterior
  • Translatory-medial/lateral

 

Osteopathic MET for Joints & Directional Restrictions

• Concepts, Information & Theory
• Low patient effort/force used between 5-10%

 

Session 2 Two         .75 Hour

 

Brief Revision from AM Workshop

Passive Technique to Effect System Wide Autonomic Response

Autonomic Nervous System Applied Technique Leading to Articular Receptor Stimulation

• Demonstration for the use of the Two-Point© Sequence 1.1 & 1.2
  • Two-Point Application and Technique the Respiratory-Solar Plexus
  • Two Point Application and Technique for Joints
• Demonstration of the Fulcrum – Sequence 1.4
  • Giammatteo Integrative Manual Therapy Technique: 3 Planes of ‘Ease’

 

 

Session 3 three

 

Brief Revision from AM Workshop

Global MFR to prepare for Low Extremity Levering

Palpating and Locating Cardinal Line Restrictions

Palpation Techniques for Locating Superficial Fascia:

• Locating Superficial Fascia: Palpate skin, press into muscle tissue and back off

 

High Leverage Points in the Myofascial Net

Areas to which fascia adheres:

 

• Bony prominences
• Musculotendinous junctures
• Muscular boundaries and layers

 

Compound  Tensegrity Techniques

• Compression
• Tension
• Bend
• Rotation
• Shear

 

Session 4 four

Brief Revision from AM Workshop

Global MFR to prepare for Low Extremity Levering

 

Compound Technique Sequence 2.1

Compression Loading Treatment Protocol for Superficial Front & Back Line:

Side Lying Position:

Compound Static Compressions for:

• Sacrum/Pubic Symphysis
• Diaphragm/Dorsal Hinge
• Sternum/Upper Thoracic
• C7/Trapezius Sleeve with Anterior Throat

 

Global Myofascial Approach Sagittal & Coronal Planes – Sequence 2.2

Fascial Lines of Tension – Passive Compression Compound Release

• Superficial Front Line
• Superficial Back Line
• Lateral Line

Compound Technique

Treatment Protocol for Lateral Line: Sequence 2.1

 Side Lying Position:

Static Compression for:

• Greater Trochanter
• Serratus Anterior/Lateral thorax
• Scapular Complex

 

Compound Technique Sequence 1.4

Palpation: Ease and Bind – An Osteopathic Assessment:

• Palpation and Motion Restrictions
  • Used for myofascial restrictions
  • Joint motion assessment
• Application of Force

 

Session 5 five

The Use of ‘Paired Levering’.

 

Sequence 8

Articulations for Lower Body:

This sequence introduces the practitioner to more complex paired levering. Paired levering gives the opportunity to ‘drive’ the pelvis and effect SI Joint patterns.

 

Sequence 8.1

Long Femoral Levers

Passive Compression  ‘Stair-Stepping Walking’

• This is to utilize joint compression in a lighter manner. Stair stepping allow to assess how leverage moves the axial spine with a ‘push-pull’ manner.
• It can be utilized both paired and single alternative leg, with light push-pull to move the head in extension and flexion

Sequence 8.2

Long Femoral Levers

Paired Protocol for Lower Extremity

Active Compression-Tensional: ‘Push-Pull’

Supine

• This technique is similar to ‘stair-stepping’, however it is an active technique used to assess and attempt to ‘ease’ or clear a pelvic obliquity pattern.
• This pattern is considered an ‘upslip’ pattern unilaterally.
• The technique is designed as a ‘push-pull’, where the practitioner establishes the ‘ease’ pattern of one leg in compression versus tension. Usually in this pattern, whichever leg is ease in compression, the other is ‘ease’ in tension.
• Once this is established, the technique is to use 5% force asking the client to push the compressed side and pull the tension side.
• Wait 7-10 seconds at low force 5-10%.
• Upon release mobilize each paired opposite direction passively.

Sequence 8.3

Short Femoral Lever

Compression: ‘Wedge’ for SI Joint & Adductors Muscle Group

Compound Technique

This technique was developed for the problem a practitioner will encounter when attempting to abduct a client’s thigh/leg outward when in the supine position.

The adductors are usually fine if attempting to purely abduct.

The moment the practitioner attempts to externally or internally rotate the femur, the adductors will usually not allow the rotation and the sensation by the client is usually a ‘grabbing’ feeling

How does one mitigate this ‘grabbing’ sensation? The answer lies in creating a ‘wedge’.

Two variables need to occur.

1. The rotation of the pelvis to the opposite side at about 20-30°
2. The verticality of placing the Hip and S.I. Joint with the aim to assess and relieved any anterior/posterior distortion in optimal joint play motion.

Technique

Circumduction

• To begin, place your medial aspect of your thigh on the table
• Ask your client to slightly roll their entire body as a long axis roll to the opposite side with enough clearance to place your thigh/knee on the table.
• Make sure the table height is adjusted to handle this position
• Also make sure the weight of your client is not excessive, so that you are unable to feel the SI Joint rest comfortably on your inner thigh.
• Once you have the ‘wedge’ in position, circumduct the hip joint, and usually they will be an audible ‘click’ from the joint motion and/or a ‘snap’ of adhesion letting go.

Vertical Anterior/Posterior Restriction Active-Passive / Compression-Tension

• Next assess vertical anterior/posterior movement of the Hip/S.I. Joint.
• As before place in the ‘ease’ position
• Ask your client to resist in the direction of ‘bind’
• Then mobilize passively in both directions.
• Re-assess for greater mobility and continue to clear distortion
• Use of force for all techniques remains at 5-10% patient effort
• No more than 3x to not overtreat.

 

Sequence 8.4

Compression: ‘Wedge-Scour’ for SI Joint

Short Femoral Lever

• This technique is designed to ‘break’ up capsular adhesions by utiliising three variables: Compression into the joint capsule, movement through the range of the capsule as practitioner maintains a constant compressive force; and finally using internal and external rotation with constant compressive force .
• It is akin to visualizing a ‘mortar and pestle’ and grinding out the adhesions
• I use a clock-face motion. That is, I move in diagonal directions. 12 to 6, 1 to 7, 8 to 2, 9 to 3.
• Make sure you can bring knee across into adduction, then abduction.

 

 

Session 6 SIX

Sequence 8.5

Side Lying

Unilateral Femoral Long Levers Compression

 

• Neutral long lever
• Twist in the Sleeve
• Medial Femoral Rotation
• Lateral Femoral Rotation
• Assess medial & lateral sleeve
• distortion of ITB and Adductor medial sleeve.

 

Sequence 8.6

Side Lying Position

Femoral Long Lever Tension

 

• Ask client to push through hip toward foot with 5% force
• Upon release, lengthen slightly
• Ask client to push through hip toward foot as you slightly compress hip with long lever.
• Upon release, lengthen slightly
• Now create a push-pull oscillatory motion to treat the pelvic obliquity motion

 

Sequence 8.7

Joint Receptor Enhancement Femoral Levers:

Side Lying

Femoral Short Levers Lumbar Spine

 

• Place in flexed knee & hip position at 45°
• Apply paired resistive patient effort force at 5% or less to the paired knees in the following planes of motion:
• flexion/extension
• SB/Rotation
• Hip abduction/adduction

 

Sequence 8.7.1

External Paired Rotation

• Ask client to resist as before.
• Passively mobilze and articulate the motion

 

Sequence 8.8

Active Paired Compression/Tension Extremity Levering for Combined Upper and Lower Extremity

 

• Assess paired tension/compression of upper & lower extremity levers.
• You can do this by alternating the push-pull pattern by pulling the leg and pushing the arm and then reversing to determine ‘ease’ or ‘bind’ motion
• Decide on barrier you wish to change utilizing the balance between compression & tension.
• If the leg is in compression, then ask your client to push their leg simultaneously pulling the tensioned arm at 5% force for 5-7 seconds
• Upon release of the patient force, mobilize by passively ‘pushing’ and ‘pulling’ the arm-limb combination.

Clinical Pearl: The primary pattern is upper extremity arm ‘pull’ with low extremity leg ‘push’. When this pattern release, an audible click will be ‘felt-heard’ at the radius. This ‘gapping’ release of the radius-scaphoid is normal when the pattern is engaged and releases.

 

Session 7 seven

Compound Releases

Sequence 9

Sequence 9.1

The Spiral Line Palpation

 

The spiral line loops around the body in a helix, joining one side of the skull across the back to the opposite shoulder, and then across the front of the same hip, knee, & foot arch, running up the back of the body to rejoin the fascia on the cranium. We will address just one important spiral release below, the Scapular ‘X’.

 

Sequence 9.2

Spiral Line Release: Scapular ‘X’

Sidelying Position

• Palpation of the Spiral Line High Leverage Points
• Tracing the Spiral Line
• Organize applied technique to restrictions of this line
• If you are treating the right splenius capitis, bring the left serratus anterior toward the splenius capitis whilst grasping the splenius in an oblique fiber orientation that matches the opposite side rhomboid.
• By considering the fiber direction and applying technique to this direction, the fascia component is engaged and considered.
• Often deep tissue massage is applied to the oblique fiber orientation but only either at rhomboid depth or not in conjunction of the continuity of direction with the serratus anterior and splenius capitis,
• Scapular X:
• Splenius capitis/Serratus anterior compression for Rhombo/Serratus Post release
• Serratus Anterior/External/Internal Obliques

 

 

Sequence 9.3

Abdominal ‘X’

Supine

Diagrams to right illustrate the spiral component and the need to understand the behavior of the abdominal spiral.

The immediate left is drawn from Luigi Stecco’s Fascial Manipuation showing not only external oblique connections, but also with thorax and shoulder.

The far right diagram indicates a relationship with the contra-lateral adductors.

This release can start with a more basic emphasis, engaging the ipsilateral external oblique with the contralateral internal oblique.

The pattern of engagement begins with:

1. Place both hands in an oblique directions.
2. The application can be applied in two fundamental ways
   1. Both hands travel in the same oblique directions as a unit
   2. Both hands move together or move apart depending on the ‘ease’ direction
   3. Once ascertained which barrier is to be released, apply as a simple static compression. ( two variables: compression which is already applied and the direction into a barrier)
3. Check contralateral EO/IO relationship on the other side.

 

Sequence 10

Sacrum-Lumbar Spine ‘Curling ‘Releases

 

The ‘Curl-up’ came about attempting to balance an Autonomic Nervous System release that had overall parasympathetic effect systemic effect with a positional release technique for the sacrum-lumbar spine.

 

The ‘art’ is getting your client to relax and let you place them in a curled position.

The ‘difficulty’ for the practitioner is handling your clients weight, and to do so in a manner in which both the client and practitioner can relax.

 

This is a highly therapeutic and potentially emotional ‘charged’ position.

It also puts the practitioner in a position of therapeutic ‘intimacy’ with the client.

The ‘act’ of allowing oneself to completely relax and let go into a ‘fetal’ position is very powerful.

 

If you are able to place them in this position, you may find yourself ‘holding’ the position for up to 2-3 minutes.

 

Once you have felt the ANS response, the positional release PR is to have the client  allow the practitioner to circle the paired legs in rotational and ‘swiveling’ motion until a lumbar spine release, ‘letting go’, occurs.

 

Sequence 10.1

Passive

Rolling Motion Releases

‘Curl-Ups’

Side Lying to Supine rolling Release

 

• Assess barriers to motion
• Assess flexion/extension for pelvis
• Assess pelvic rotation
• Assess pelvic ‘swivel’

 

 

Sequence 10.2: 

Active

Flexed Hip Swivel Oscillation for the Sacrum

Supine

• Assess ‘Swivel’ of the sacrum by turning paired flexed knees together in a rotational manner
• Place in ease position barrier & apply downward compression to engage barrier
• Low load resistive is applied in both rotational directions
• Cross one leg over the other and assess for which crossed-over leg is bind and which is ease.
• Engage the ease position and await release

 

 

Sequence 11

Cross Leg Techniques

Sequence 11.1

Paired Cross Leg

Long Lever (Straight-Leg) Both Femoral Levers

• Assess which cross legged position is bind and which position is ease
• Lift both legs in this position and engage barrier-await release point

 

Sequence 11.2

Paired Cross Leg

Long Lever (Straight-Leg) Both Femoral Levers with Rotation

• Assess which cross legged position is bind and which position is ease
• Lift both legs in this position and engage barrier-await release point

 

 

Sequence 11.3

Paired Long Lever (Straight Leg) with Short Lever (Bent-Knee) for Lower Extremity

• Assess ease position and engage barrier
• Assess pelvic rotation
• Assess which cross legged position is bind and which position is ease
• Lift both legs in this position and engage barrier-await release point
• Lift both legs in this position and engage pelvic rotation in ease
• Once release occurs, switch legs, the bind position should be more amenable for engaging compression.

 

Sequence 11.4

Paired Short Lever (Bent-Knee) for Lower Extremity

 

• Cross one leg over the other and assess for which crossed-over leg is bind and which is ease.
• Engage the ease position and await release

 

Sequence 12

Deep Front Line

 

Sequence 12.1

Diaphragm Release

 

Treat the splenic side first due the proximity of the liver on the contralateral side.

Meet first levels of resistance only.

Do not attempt to force technique

Place one hand with three fingers as a unit, sing the side of the fingers to access first level of fascial restriction.

With the other hand bring skin over costal ribs, and using both hands as a unit, explore the margins to the central tendon.

Work with the breath. This includes forced exhalation.  The diaphragm is a muscle, and therefore should be treated as a muscle. It has expansion and contraction, it descends on the inhalation breath and ascends on exhalation out breath.

In class we will work with the low intercostals wrapping our fingers under the ribcage to ‘peel back’ with ‘shifting’ motion and modified MET.

 

Sequence 12.2

Psoas Release

 

Sequence 12.3

Illacus Tendon

Sequence 12.4

Pectineus

Sequence 12.5

Obdurators Release                

 

Sequence 12.6

Adductor Magnus

Sequence 13

Spiral Line Release for Upper Extremity – Stecco Spirals

 

Posterior view with dotted lines anterior portion of view

 

Sequence 13.1

 

Trace this spiral running your hand over the pathway in a light efferauge glide.

 

Sliding glide strokes are effective, as you trace the line.

 

Sequence 13.2

Tricep-Olecranon ‘X’

 

The ‘X’ patterns

 

• Steven is very helpful in terms of individuals putting the basics together.
• Very interesting, friendly & accessible. Able to adapt to all levels. Very tuned to class in maintaining concentration & not overloading (unless on purpose!).
• Was fantastic! His depth of knowledge was extensive, very approachable, passionate about the subject & took me to a new place in learning & understanding. I am bewildered, unsure & very excited about what I have to learn. Trevor S
• Exciting teaching style & delivery!
• An ability to mix serious & fun, making a good learning environment. Peter C.
• Steven teaches in an interesting & entertaining way that kept us engaged. Plenty of humor & clarity
• Enjoyed watching integration of humor & visual images to explain complicated theories. Observing that “play” with tissues is very individualized & Steven is very accepting of that. Wendy H.
• Stev is dynamic, fun, exciting and loves what he does. Gets across the information in a simple understandable way. Peter M
• Knowledgeable, full of insight, very informative.
• Steven was great as a teacher and we”ll definitely be on the other courses with him to come. Got a lot of great insight and he was willing to share his extensive knowledge, very respectful towards other techniques/teachers in the field. Worth every minute and every cent. Thanks Steven!!!
• Brilliant & friendly…takes time to explain individually as well as to the group.

 

• The joy of learning this weekend was in the ease & flow of how Steven conveyed his information – even the heavy-duty scientific knowledge & background. Mary C

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View the course times:

• Day 1: 9:00am – 5:00pm
• Day 2: 9:00am – 5:00pm