Sciatica Approach

BASIC PREMISE

Integrative Fascial Release functions upon the basic premise, that “all soft-tissue release is based upon how the autonomic nervous system is discharging its impulses” (Michael Shea 1995). Accordingly, from this myofascial perspective, the autonomic nervous system is the primary mechanism that allows for the release of fascia.

CONNECTIVE TISSUE PROPERTIES

In addition to the autonomic nervous system premise we add therapeutic methods that affect the sol-gel relationship of the connective tissue ground substance. Utilizing thixotrophic effect (fascia becomes for fluid when it is stirred up, and more solid when it sits without being disturbed (Juhan 1987) & piezoelectric events (changing a mechanical force to electrical energy (Mark Barnes 1997), we have the basis for integrative and interactive change in the physiology and structure of the myofascial connective tissue.

PROPRIOCEPTION, PAIN RECEPTORS & THE AUTONOMIC NERVOUS SYSTEM

Maintaining the premise of the autonomic nervous system-soft-tissue relationship; then pain is considered an autonomic nervous system phenomenon. Pain triggers the neuromuscular system to maintain a sympathetic response. Shea postulates this as sympathetic tone.

Nociceptors register pain that become sensitised when chronically stimulated, leading to a drop in their threshold (Chaitow-DeLany 2000). With acute or chronic pain, soft-tissue dysfunction maintained by the ANS maintains high sympathetic tone. Once you intervene in the decrease of pain, even marginally, then soft-tissue will respond to manual pressure.

Fascia not only holds nociceptors but a host of other receptors. As excerpted from Clinical Application of Neuromuscular Techniques Volume One, (Chaitow-DeLany, Churchill-Livingston 2000); Bonica (1990) suggests that fascia is critically involved in proprioception, and that, after joint and muscle spindle imput is taken into account, the majority of remaining proprioception occurs in fascial sheaths (Chaitow-Delany 2000).

These receptors hold the key for stimulation of the autonomic nervous system. Once reflexively stimulated by manual pressure engaging superficial fascia, the receptors register within the ANS, thus relaxing and lowering sympathetic tone.

Parasympathetic response creates autonomic phenomenon that is visually discernible by manual engagement of the myofascia. It is in the threshold of parasympathetic that we can use indirect methods of myofascial release to lower pain, and neuromuscular and emotional holding patterns that facilitate soft-tissue response.

MYOFASCIAL RELEASING METHODS

By employing three broad myofascial methods both directly, as manual pressure and movement, and indirectly, by nervous system response, we can affect soft-tissue dysfunction profoundly. This is the basis for how Integrative Fascial Release treats clinical soft-tissue dysfunction.

TWO-POINTING TECHNIQUE WITH THE TREATMENT OF SCIATICA

With regard to treatment of sciatica, we have a variety of sciatic nerve dysfunctions; nerve root compression, disc protrusion and nerve impingement usually by contracted musculature (piriformis syndrome). Depending upon the severity of the symptoms, our first approach is the reduction of pain.

Integrative Fascial Release uses manual pressure engaging superficial fascia in the form of two-pointing. Two-pointing refers to the placement of hands usually beginning within the visceral seat of parasympathetic response, the abdomen and the pelvis.

By placing hands superiorly upon the abdomen and inferiorly on or around the sacrum, along with the engagement of the superficial layer of fascia, the autonomic nervous system responds with various autonomic phenomena to lower sympathetic tone and create a parasympathetic response.

AUTONOMIC NERVOUS SYSTEM RESPONSE

This response usually takes the form of fasciculation activity (trembling or twitch response), shaking, jerking, skin colour changes, clamminess, laughing, peristalsis (tummy rumbles and gurgles) and glazing or glassiness of the eyes; these are all signs of autonomic discharge. (Shea 1995)

TRANSVERSE FASCIAL PLANES

Simultaneously two-pointing the abdomen allows reflexive relaxation to the deeper transverse fascial planes known as diaphragms. Relaxing deeper transverse planes allows for more consistent re-organization of fascial restrictions.

LOW FORCE-LONG DURATION

Since fascia is continuous and ubiquitous, along with its’ ability to respond to low-force and long duration stretch or compressive force (Leon Page 1950), it has the potential to alter the sol-gel relationship; thus relaxing and changing functional and structure dysfunction along with the reduction of pain.

PREPARING THE AREA INDIRECTLY

This greatly assists with any sciatica dysfunction. Thus preparing an area by the fascial use of two-pointing with upmost consideration given to autonomic phenomena, will allow for more rapid and speedy intervention with regard to a dysfunction like sciatica.

TWO-POINTING WITH LEVERAGE COMPRESSION

Two-pointing is just the first in a series of fascial techniques employed to work with sciatic conditions. Essentially determine whether stretch or compressive force technique is desirable, and then used in conjunction with movement techniques (usually passive positional release); one can reflexively relax the whole gluteal structure, thus employing deeper and effective muscular intervention. By considering the myofascial component, one can effectively treat sciatica-like dysfunction usually lowering pain significantly.

PREPARING THE AREA

After parasympathetic response is achieved, the soft-tissue is ready to be cued and facilitated towards release and movement. This can be achieved by using either ischemic direct pressure, stretch or compressive methods. In IFR we will use compressive methods, if possible, over stretching technique. The visceoelastic-plastic nature of the tissue allows for the reflexive phenomena of unwinding. If one attempts to exaggerate a distortion pattern instead of attempting to elongate or stretch, the nervous system response proprioceptively will be to “let go”, unwind and release. Thus achieving critical collangenous inter-fibre “space”.

FASCIA AS A FUNCTIONAL JOINT

Fascia is actually considered a “functional joint” (Oschman 1997). It allows for freedom of movement when properly relaxed. Creating space and support is the primary function of the fascia. Once a “slackening” is achieved within the “fascial sleeve”, the ability to facilitate muscular change is increased.

References

1. Jobs Body, a Handbook for Bodywork, Deane Juhan, Hill Press, Inc. NY. 1987 Chapter 3 pp 68-69
2. Myofascial Releasing, John Barnes, P.T. & Rehabilitation Services, Inc. 1990
3. Myofascial Release Textbook, Michael Shea, Ph.D Somatic Psychology, Self-Published, 1995 pp 45-56
4. Readings on the Scientific Basis of Bodywork, Energetic & Movement Therapies, James & Nora Oschman, Self-published Collection, 1997
5. Clinical Application of Neuromuscular Techniques Vol. One, Leon Chaitow & Judith Walker DeLany, Churchill Livingston, 2000, Chapter 3 pp 30-31