Trigger Points and Muscle Chains (eBook)

1 Introduction

Role of Muscle Chains in the Body

The musculoskeletal system and muscle chains are the primary focus of this book. Myofascial structures participate in all somatic functions: Emotional states present as muscle tension. Physical labor requires muscle activity. Circulation, breathing, and digestion depend on an intact locomotor system.

Manual therapists—physical therapists, chiropractors, osteopaths, or Rolfing practitioners—examine and treat the locomotor system differently and with different motivations. Physical therapists and Rolfing practitioners treat the musculoskeletal system primarily to resolve discomfort (pain, tension, etc.) in the area being treated. Chiropractors and especially osteopaths view the myofascial system as a component of the body that can cause or result from dysfunction or pathology in other body systems. Another group of professionals—podologists or posturologists—are aware of the negative impact on the whole body that can result from minor shifts in weight or foot misalignments.

All somatic functions depend on well-functioning myofascial structures. The nervous system takes on the role of coordinator and controller. To avoid overloading the cortex, many activities are managed by subcortical reflexes and behavior patterns. Viscerosomatic and somaticovisceral reflexes have also been scientifically proven, which emphasize the special significance of muscle imbalances, especially of the paravertebral muscles.79,112

Motor and posture patterns of the human body involve the entire organism, in the same way that all physical activity results from interactions of all body systems. Osteopaths and chiropractors employ this fact in their diagnosis and therapy.

Segmental innervation of all body structures and adaptation mechanism patterns provide indications for structural involvement. Many sports injuries or musculoskeletal pain result from dysfunctions in parts of the myofascial chains. Understanding myofascial connections enables diagnosis and appropriate treatment. The osteopathic mindset provides a thought-provoking explanation for the mechanisms involved in the development and treatment of disorders.

Dr. Still’s Osteopathy

When Dr. Andrew Taylor Still presented his philosophy of healing, during a phase when he rejected the medicine practiced at the time, he called it osteopathy. He knew full well that this term had a different meaning in the medical world at the time. His desire was to help medicine return to its origins by placing humans at the center and natural laws in the foreground. Osteopathy was the most appropriate term to illustrate that disease (pathos) results from dysfunctions in the body. Dr. Still viewed the musculoskeletal system and especially the spine as playing a central role. He recognized that all diseases and functional disorders involved mobility limitations of the spine. Osteopathy is derived from the Greek words “osteon” for bone and “pathos” for disease.140

Dr. Still knew from experience that treating symptoms did not bring about healing. Successful healing required expert treatment of the causes of disease. He had no doubt that disease started with circulatory disorders and that the cause was to be found in the connective tissue.140 Therefore, this is where disease needed to be examined and treated. Myofascial tissue is of special importance in this process82,140 because of its ability to serve as the following:

• Connector (co nnective tissue).

• Pathway for veins, lymphatics, arteries, and nerves.

• Supporting tissue (stroma, matrix) for organs and bones.

• Protective structure.

For Still, the nervous system and its surrounding fluids (cerebrospinal fluid [CSF]) are possibly even more significant than connective tissue. The nervous system serves as a control center and regulating organ and is responsible for all adaptation mechanisms between individual body systems. It initiates and coordinates all functions in the entire body and is responsible for all adaptation and compensation mechanisms.

Still refers to CSF as possibly “the highest known element” in the entire organism. Its composition is similar to blood and lymph serum. CSF is connected to blood via the choroid plexuses and with lymph via the peripheral nerves of the interstitium. In addition to its protective and nourishing functions for the central nervous system, Still and especially his student William Garner Sutherland attributed a special function to the CSF:54,140,142,143 it carries the “breath of life” into all cells of the body.

Still’s experience in his early years likely gave rise to the development of osteopathy. As a physician, religious believer, and son of a Methodist preacher, Still had a close connection to religion and to God. This is reflected in all his writings: God gave humans health and disease is abnormal. Still believed that the osteopath’s task is to search for health in the body of patients.

In his search for true medicine, Still was inspired by two opposing directions: spirit healers and bone setters. In his view, spirit healers embody therapists who believe in God. They tune into tissues and, through their hands, focus energy into a pathologic area. The “breath of life” (Sutherland) then performs the healing. Bone setters, on the other hand, also achieve great success through physical manipulation (adjustments).

Still combined both directions in his osteopathic treatments. His special talents as a therapist derived from his precise understanding of anatomy and his excellent sense of touch, combined with his belief in the power of self-healing and his intention to help. His anatomical and physical knowledge enabled him to precisely visualize structures. His sense of touch allowed him to feel tension in tissues and apply targeted, appropriate techniques in each individual case.

As an osteopath, Still embodied both the spirit healer and the bone setter. He compared the human body to a machine and the osteopath to a mechanic who repairs the mechanics of the machine.140

One characteristic of Still’s osteopathy was that he combined biodynamics with biomechanics. Nowadays, it seems that some of his successors have divided this duality. Some osteopaths are pure “mechanics” who emphasize the laws of anatomy and physiology and manipulate the whole body using gentle and less gentle techniques. They represent the biomechanical direction of osteopathy.

Others are more biodynamically oriented. They place less importance on biomechanics and more emphasis on their sense of touch and the body’s power of self-healing. Like spirit healers, they attempt to activate the self-healing powers in tissues, with the difference being that they employ the body’s rhythms in diagnosis and therapy.8,9,72

Of interest in this context is a statement by Viola Frymann (continuing education 2000). She says that (Sutherland’s) primary respiratory mechanism (PRM) clearly manifests in healthy tissue. However, with dysfunctions, the PRM’s power of expression is impeded. This means that the PRM can be employed in diagnosis and therapy. Biodynamic therapists take advantage of this phenomenon by using their hands to establish a fulcrum in the tissue.8,72,135 After a certain period of time, the PRM expresses itself in its various rhythms, which is an indicator that the tissue is regaining its function.

The difference between classic cranial osteopathy and biodynamics is that classical cranial osteopathy examines the tissue for motion and motion limitations and then guides the structure to be treated into unrestricted motion and holds it there. This allows the PRM to develop freely without tension and carry out its therapeutic effect.

The motions of the sphenobasilar synchondrosis (SBS) palpated and described by Sutherland correspond to motions of the head in the three planes of space, plus translations in the sagittal plane (up and down strain) and in the horizontal plane (lateral strain) . Functional techniques applied to the locomotor system work according to the same principle. Therapists search for a balance point in all planes (stacking) and maintain the tissue in a relaxed position until automatic relaxation takes place. This shows that the principles employed in cranial osteo pathy are identical to those that apply to the rest of the body.

Opinions vary about which mechanisms are ultimately responsible for tissue relaxation. Practitioners of biomechanics maintain that it involves a reflexive response originating in the tissue receptors. Biodynamic practitioners believe in the effect of the PRM.

In his therapy, Still employed a combination of so-called direct and indirect techniques. Direct techniques manipulate the segment to be treated in the corrective direction. Indirect techniques move the segment in the direction of dysfunction.

Richard Van Buskirk23 conducted research into Still’s treatment methods by asking older patients, who were treated by osteopaths in their childhood or youth, to recall the techniques used in their treatment. Some of these patients were still able to describe those techniques and Van Buskirk was surprised to find that they resembled the few...