Soft Tissue Releases

CRANIAL / STRUCTURAL
SOFT TISSUE RELEASES

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

In our last issue, we talked about the effectiveness of integrating cranial techniques and soft tissue massage to produce major positive changes for our clients.  I also drew a brief distinction between Cranial/Structural and craniosacral techniques, which opened the door to expanding upon Cranial/Structural soft tissue releases.

Cranial/Structural techniques are very different from craniosacral techniques in intent and application.  Craniosacral techniques are applied within the soft tissue restrictions of the normal cranial motion. Cranial/Structural techniques release the soft tissue restrictions of the normal cranial motion resulting in structural changes throughout the body.  Let’s take an in-depth look at the need for Cranial/Structural techniques.

Within the structure of every client’s body there exists a core distortion pattern.  Many liken it to a spiral that runs throughout the structure resulting in an anterior/posterior rotation of the iliums, a tipped sacrum and a degree of classic scoliosis.  This spiral is evident from the top of the head down to the feet, and not surprisingly is also found in the relationship of the bones and soft tissue of the cranium.  When clients are experiencing musculoskeletal pain, there is an observable increase in the degree of this distortion.  This can be viewed as a degree of structural collapse, or a lack of structural support.  The resulting pain can either be evidenced in the compensation for this increased distortion, or in the strain in the musculature of the actual distortion.  Thus, the key to relieving the painful symptoms and rebalancing the structural support system lies in releasing this exaggerated core distortion.

For years, in developing my soft tissue protocols, I struggled with the major components of this core distortion in an effort to bring clients relief from pain.  Whether it was whiplash flexion/extension injuries, headaches, neck pain, shoulder pain, degenerative disc disease or bulging disc, carpal tunnel, nerve entrapment, sciatica, low back pain, hip pain, knee pain, or foot pain – it was usually related to the musculoskeletal structure.  Therefore, addressing and releasing the core distortion pattern was a viable way to achieve pain relief, homeostasis, and return to normal function.

Within every collapsed structure I found an anterior/posterior rotation of the iliums, stretched ligaments between the sacrum and the ilium at the SI joint, and a tipped sacrum. The degree of distortion was directly influenced by the degree of the rotation of the iliums, the degree of stretched ligaments, and the degree of tippage of the sacrum.  Further, the degree of distortion in the body was directly proportional to the intensity of the pain and symptoms that the client was experiencing.  The longer the client remained in this distortion, the more the entire musculoskeletal system distorted into the lack of support, which usually resulted in an extended recovery process.

One of the greatest challenges was stabilizing the SI joint.  While the client was on the table, the position of the iliums could be shifted through soft tissue releases, and the feet and legs could be aligned to support the shift.  However, when the client became weight bearing, the weakened ligaments would not be able to stabilize the SI joint, and the sacrum would again slip and tip recreating the structural collapse.  Wedges could also be used to reduce the rotation of the iliums and tippage of the sacrum, but, again, the structure would collapse when the client became weight bearing.

Enter Cranial/Structural! A missing link in the treatment to stabilize the pelvis was found in the relationship between the cranial bones, reciprocal tension membrane, dura, and the myofascial planes of the body.  Dr. G. Dallas Hancock, a chiropractic physician, discovered the relationship between two of the cranial bones (the sphenoid and the occiput), the sphenobasilar synchondrosis (SBS) where they meet, and the torsion of the pelvis.  The rotation of the iliums and tippage of the sacrum were mirrored in the rotation of the wings of the sphenoid and the tippage of the occiput.  He developed a technique of releasing the cranial torsion of the SBS in an attempt to release the torsion of the pelvis.  Guess what?  It worked!

One of the ways to understand the effect of this incredible discovery of Dr. Hancock’s is to view these two cranial bones (sphenoid and occiput) as handles for the reciprocal tension membrane, dura, and the entire myofascial plane of the body.  The distortion found in the SBS joint is supported by the restrictions in the reciprocal tension membrane, dura, and fascia, which affect the entire structure of the body.  The techniques developed by Dr. Hancock to unwind the torsion of the SBS released the restrictions in the reciprocal tension membrane and dura, which, in turn, released the restrictions in the myofascial planes of the body that related directly to the dura.  In addition, with the release of the restrictions in the dura, its relationship to the sacrum allowed the sacrum and the iliums to balance.  The greatest significance of this was that the weight bearing separation of the SI joint was corrected, even through the ligaments had been stretched.  Another exciting discovery was that clients would not return to this weight bearing structural collapse unless another severe trauma was experienced.  It was also discovered that, with the balancing of the SI joint and iliums, the myofascial planes of the body down to the feet were also beginning to unwind and balance bringing support back into the entire structure.

The torsion found in the cranium was also the principle cause of problems like TMJ.  When the torsion was taken out of the cranium (SBS), a balancing of the bite took place.  Most clients who suffered TMJ symptoms would have an immediate improvement, and, without even focusing on the usual TMJ soft tissue treatments, would continue to improve, and often become pain free.

Cranial work that focuses on this structural shift is called Cranial/Structural due to its direct relationship to structural balance.  Prior to having these techniques to balance the SBS, and correct the weight bearing collapse found in the core distortion pattern, I was not able to achieve a long-term correction of the distortion in the pelvis.  However, with the Cranial/Structural techniques, my clients showed dramatic changes in the initial session, and I was able to correct this distortion throughout the body in only a few treatments by integrating my soft tissue protocols with the Cranial/Structural.

Something else evolved, though.  Now that the pelvis was weight bearing and no longer in the torsion pattern, the structure of the body was not strong enough to maintain total balance.  What emerged was a series of other sub patterns that the body would move into in its unwinding process.  It was discovered that each of these sub patterns also had a cranial component that needed to be addressed.

After the initial correction of the pelvic distortion, I found that there were approximately 20 other sub patterns, all of them less degenerative and less distorted than the original core distortion pattern, but still capable of causing imbalance and pain.  Each of these sub patterns that were found in the body also had direct correlations to cranial patterns, sutures, and restrictions.  Thus, I followed a process of discovery of these relationships and how to best release them through the cranium and soft tissue treatments.

I found that approximately 2/3 of these patterns were weight bearing (down to the feet).  These were viewed as being structural because the basic support system for the body was affected from the feet on up.  The other 1/3 did not involve the feet and were viewed more as functional patterns.  At this point a chicken and egg question entered.  Did the cranium lock into a distortion causing the body to distort, or did the soft tissue of the body become restricted and distorted causing the cranium to lock up in  compensation?  The only answer is yes to both.  Phenomena can be observed starting in the cranium or in any of the soft tissue in the body.

Cranial/Structural is most effective when applied at the beginning of the first session to release the core distortion pattern and balance the SI joint.  However, the soft tissue (duro, reciprocal tension membrane, and fascia) would only release just so far using the Cranial/Structural techniques alone.  The structure of the body is then trying to move into balance, but the soft tissue that was tightened forming adhesions and restrictions in the holding pattern of the core distortion would impede the process.  To complete the balancing process, it is absolutely necessary to include specific myofascial release, myofascial unwinding, and scar and adhesion fiber work to allow the whole body to begin to move into structural balance.  In this balancing process, treating the sub patterns first with Cranial/Structural releases, followed by specific soft tissue protocols further facilitated the total unwinding process to bring clients out of pain.  This order of doing the Cranial/Structural prior to the soft tissue work in each session started the body balancing immediately, and allowed the soft tissue releases to be applied to the tissues that were resistant to the balancing.

As you can see, Cranial/Structural is most effective when integrated with effective balancing deep tissue therapy.  When this integration takes place, it is the most effective form of body restructuring and rehabilitation therapy that a massage therapist can use.  This is the basis of Structural Energetic Therapy®, and in the future could very well be the basis of most body restructuring.  It accelerates the process of balancing 10-fold, and resolves the weight bearing issues between the sacrum and the ilium leading to long-term pain relief and rehabilitation.  Using kinesiology there is a definite increase in strength and function to the whole musculoskeletal system when it balances.  So far, its limited application in sports massage has shown tremendous potential.

The Evolution of SET

BEYOND THE BOX

EVOLUTION OF STRUCTURAL ENERGETIC THERAPY
(THE INTEGRATION OF CRANIAL/STRUCTURAL TECHNIQUES and SOFT TISSUE)

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

A mind stretched by a new idea never regains its original dimension
~author unknown

The well-being of my clients is a top priority in my therapeutic massage techniques and protocols. I have had the great fortune of training in several different modalities with many of the most highly regarded teachers in this profession, but my observations of structural distortions and imbalances contrasted with the limitations inherent in the techniques I was learning. This prompted me to think beyond the box. The process of modifying and integrating a number of highly effective soft tissue therapies to address the basic cause of structural imbalances and body pain led to the birth of Structural Energetic Therapy® (SET) in the late ’70’s. Then, with the integration of NICS Craniostructural Integration techniques in the ’80’s, the present form of SET evolved.

I noted that the majority of my clients presented with a basic distortion pattern that involved an imbalance of the pelvis. I was convinced that balancing the structure was key to reducing multiple pain syndromes. I trained in Postural Integration, a 10-session body restructuring methodology that uses deep tissue myofascial restructuring, and was very excited to be practicing what I felt was state of the art bodywork in the mid 70’s. This model was initiated in the ’60’s with Structural Integration, along with CORE bodywork and Lomi bodywork, to name a few. It is still considered to be one of the more advanced and effective forms of bodywork. However, clients with very painful conditions throughout the body (i.e. whiplash, lumbar sprain/strain, degenerative disc problems, hip and knee and foot pain, shoulder and arm nerve entrapment symptoms) needed to have these painful areas treated first rather than progressing through ten sessions before addressing their primary individual symptoms. My choices were to follow the ten-session model and not pay special attention to their initial area of complaint, or to treat their primary area of pain in the first session, which was usually out of sequence and philosophically contrasted the current beliefs.

To move out of sequence I needed to disregard several strong beliefs associated with the 10-session model. One was that the fascia could only be released within a certain sequence to produce balance. Second, the core distortion, or spiral, should not be reduced because everyone has this structural pattern. However, my associates and other 10-session practitioners had belief systems and attitude blocks which Herbert Spencer eloquently describes in this quote: 

There is a principle which is a bar against all information, which is proof against all arguments, and which will never fail to keep a man in everlasting ignorance – that principle is contempt prior to investigation. Therefore, I looked elsewhere and not to my colleagues.

My clients became my best teachers! They insisted that I try new methods and techniques. The majority of clients had an anterior rotation of the left ilium and a posterior rotation of the right ilium. This created compensatory curvatures and imbalances throughout the spine and body that could well be the basis of most body pain. This was also referred to as the spiral or core distortion as observed by other 10-session body workers. Clients experienced elevated pain levels when this distortion increased to the point that the SI joint (sacrum and ilium) could not maintain weight bearing support and balance when they were standing, which shifted their bodies further into distortion (structural collapse). In observing my clients, it became obvious that accidents, life experiences, and stresses would move an already weakened body further into distortion. As the degree of distortion increased, the dysfunction and pain increased. Thus, rebalancing this core distortion to be weight bearing became the focus of my work and investigation.

I began looking at the sacral-occipital technique (SOT) chiropractic model and discovered a new balance paradigm for the body. The SOT practitioners sought to balance the anterior/posterior tilt of the iliums to provide a level base for the sacrum and lessen the scoliotic curvature (from the core distortion) and other distortions of the entire spine and body. However, there was one major problem: while the client was on the table, the use of SOT blocks would reduce the rotation of the iliums and the tippage of the sacrum, and the feet and legs could be aligned to support the shift. Yet, when the client became weight bearing, the weakened ligaments were not able to stabilize the SI joint. The sacrum would again slip and tip to the side recreating the structural collapse.

Therefore, I began combining the SOT techniques to reduce the rotations of the iliums with the specific deep tissue protocols that I had already developed to address muscle imbalances of the distortion. I was able to directly address the fascia and other soft tissue that was resisting the necessary structural changes throughout the body while the iliums were in balance on the table after using the SOT blocks. With this new approach clients experienced a noticeable reduction of pain in the first session. Confidence was building that they could be pain free soon.

This was a major breakthrough, but it had its limitations. Sometimes it took 10 to 15 sessions to stabilize the sacrum/ilium relationship, and usually clients could not maintain this balance for more than four weeks due to the iliums once again rotating and the sacrum slipping. However, this was still better than not addressing this distortion at all leaving the SI joint imbalanced with no support for the spine. Results from the pelvis in balance were not only observable throughout the whole spine, but throughout the entire structure. As this distortion decreased and the structure became more balanced, painful symptoms from the spine extending distally to wrists and hands decreased, and many knee and foot problems disappeared. The paradigms had shifted again.

With these results, it was now possible to observe how the core distortion collapse affected all other structural or soft tissue problems and painful symptoms throughout the rest of the body, and to begin treating them by addressing the core distortion and its direct effect on the area of client’s symptoms. Thus, the birth of Structural Energetic Therapy® (SET) in the late 70’s.

You evolve, not by seeking to go elsewhere,
but by paying attention to and embracing what’s in front of you
~author unknown

My clients continued to teach me. The body was now trying to balance via the correction of the iliums using the SOT blocks. Now, all the soft tissue that was holding the old pattern at all levels resisting the move to the new pattern of balance needed to be released. Many of these areas were also the areas of pain and inflammation and were painful to touch. Since I would be working into deep levels of fascia and muscle in the first sessions, I needed to develop an approach to working the deep tissue that would effectively release the conditions causing their pain while respecting their pain tolerances. This led to the development of the three-step approach.

The Three-Step approach to deep soft tissue treatment

The first step releases the swelling, fluids, ischemia, inflammation and surface trigger points with their related pain referral zones using milking strokes with tolerable pressure to clear surface and intermediate layers of tissue. These very slow strokes allow the client to accept the pressure without resistance, and are applied with the intention of releasing the surface fascia and fluid with their direct effect on the structural distortion. ‘The deeper you go the slower you go’ became my motto.

The second step is the directed myofascial unwinding process. To unwind the myofascial holding pattern, deeper strokes are applied in specific directions to facilitate a more precise release into structural balance, rather than releasing randomly. Many very rigid holding patterns in deeper layers of fascia soften and unwind more completely and almost painlessly when these strokes are applied very slowly without exceeding the client’s pain tolerance level. There is a direct relationship of the client’s level of pain to the resistance in the tissue with these deeper strokes. Moving slowly, just meeting the resistance of the soft tissue, allows the release of the deep holding pattern with minimal sensation while working with the client.

The third step is the individual fiber releases. When most of the holding pattern has been released, the only remaining tissues resistant to structural balance are individual fibers of muscles or fascia, scar tissue and adhesions within the fascia. Having prepared the tissue using the first two steps of this three-step process, the most resistant fibers can now be isolated and treated with direct pressure. Areas that were initially painful to light palpation are now able to be released with deep slow strokes due to the previous steps. The deep individual fiber strokes are similar to the directed myofascial unwinding strokes in that the deeper you go the slower you go. This allows the tissue to release under steady constant pressure at a level tolerable for the client.

This three-step approach makes it possible to work from superficial to deep, including some of the deepest muscles and fibers in the body in the initial sessions, while staying within the client’s pain tolerance. Using this approach, significant long-term structural change is initiated with a significant reduction of pain in the very first treatment session, and subsequent sessions become even more effective.

As clients released dysfunctional structural holding patterns, they also released trapped emotional energy blocked by chronically tightened soft tissue. Wilhelm Reich referred to this as character armor. Many of the emotions and blockages were from early childhood, and had been limiting psychological development since their inception. The blocked emotional energy behind the character armor was also part of the reason for many adult diseases that clients were experiencing. With the direct release of the core distortion pattern, it became evident that clients were releasing old behavioral emotional patterns at an accelerated rate. The deeper, slower strokes of the three-step process encouraged clients to relax and release without shifting tension to deeper layers of tissue to block off the expression of the emotional energy. By going slower and allowing for the release of the emotional energy, I had moved into areas outside the norm of deep tissue therapy, and was again moving beyond the box. The increase in client’s well-being with the release of this character armor and blocked emotional energy proved that the release of this negativity was part of the complete healing process.

As I mentioned earlier, the focus of this therapy was on releasing the core distortion pattern (anterior/posterior rotation of the iliums) that was evident in all my clients. It was also very possibly the basis of 90% of the painful symptoms and conditions they experienced. With the use of SOT blocks and specific soft tissue protocols, I had achieved a level of success, but I could not be confident that my clients would not slip back into this distortion through some life activity or trauma. Consequently, clients would need long-term treatment. I came to call this a structural collapse syndrome due to its effect on the overall structure and the inability of the sacrum and iliums to stabilize to maintain structural integrity. The search to find a long-term stable correction of the SI joint continued to be the focus of my study and investigation.

Enter Cranial/Structural – the missing link.

Cranial/Structural soft tissue technique was a natural progression in the development of the Structural Energetic Therapy® . This technique has the ability to release and unwind structural holding patterns, which greatly facilitates structural balance and enhances the body’s healing abilities. Consequently, studying this osteopathic based modality and integrating it into my therapies became a necessity.

It was my privilege to share clients with Dr. Dallas Hancock, DC, LMT, as he was developing his Craniostructural Integration techniques. He discovered that he could stretch and release the adhesions and restrictions of the soft tissue within the craniosacral mechanism by using the sphenoid and occiput as handles. Thus, he was no longer limited to working within the existing soft tissue restrictions of the cranial motion. He observed that the torsion pattern found in the pelvis was mirrored in the cranium in the relationship of the sphenoid and occiput via the Sphenobasilar Synchondrosis, the joint where the two bones meet. When he released the cranial soft tissue restrictions that were holding this torsion in the cranium, he discovered that the torsion of the iliums and tippage of the sacrum released and began moving into balance. This in itself was a major breakthrough! Even more significant was that, once released, the pelvic distortion did not return, and the sacrum/ilium relationship was able to maintain structural integrity long term. The apparent weakness of the ligaments and connective tissue between the sacrum and ilium appeared strengthened to the degree that they would no longer have a weight bearing separation that had been the basis of the structural collapse syndrome.

The body began immediately unwinding (releasing) the structural distortions and chronic myofascial holding patterns from the feet to the head, but a substantial portion of the soft tissue remained resistant to this change. So, I combined Craniostructural Integration techniques with my specific soft tissue protocols to facilitate the maximum reduction of the old structural distortion, and found that clients were attaining and actually maintaining a level of pelvic balance and structural integrity within the first couple of sessions. Previously this had not been possible. Now we were really ”outside of the box” – a whole new paradigm.

This was one more reason not to be restricted to the 10 session series. Every step I took to this point in developing structural balancing techniques now paid off in quantum leaps when coupled with the Craniostructural Integration releases. When I first started using the Craniostructural Integration techniques, they were in the initial stages of evolution. What began as one untorquing motion of the cranium evolved into the current system of many sophisticated cranial release patterns that include structural as well as functional releases utilizing kinesiology for evaluation and confirmation.

New Frontier

Long-term pelvic balancing was seldom accomplished prior to incorporating the Craniostructural Integration techniques. Now the structure of the body would start to balance as soon as the cranium was mobilized by using these new techniques. At this point, the basic difference between Dr. Hancock’s Craniostructural Integration techniques and my therapeutic techniques began to emerge. His techniques did not involve any soft tissue releases beyond the cranium and dura, but soft tissue work was an integral part of the therapeutic techniques I was using to facilitate the release of the soft tissue restrictions throughout the body that maintained the old structural patterns and inhibited structural balancing. Every one of my sessions began with a structural evaluation, cranial evaluation and cranial correction/mobilization, followed by specific deep soft tissue myofascial techniques to release the most restrictive soft tissue of the of the old structural pattern. Using this combination of techniques, the release of the distortion throughout the whole structure was initiated with cranial releases, and the client’s initial area of discomfort was addressed by the soft tissue work.

Basic differences in the results that Dr. Hancock and I were achieving with our clients also developed. The release of the core distortion pattern using both the cranial techniques and specific soft tissue protocols facilitated the process of unwinding into balance more quickly and efficiently than using the Craniostructural Integration techniques alone. After a more complete release of the core distortion pattern using the integration of craniostructural and the soft tissue releases, secondary patterns began emerging. Not only did I need to develop new soft tissue protocols to address these changes, but also additional cranial techniques to release the new structural sub-patterns. Thus, the cranial techniques used in Structural Energetic Therapy are now referred to as Cranial/Structural Therapy verses Dr. Hancock’s Craniostructural Integration.

As time went on even more sub-patterns emerged, and the work took on another new flavor. A new evolution had come. Each sub-pattern had a cranial distortion associated with it. The release of the cranial distortion initiated the release of the sub-pattern structurally, but it could not be totally released without the application of the specialized deep soft tissue protocols. At present there are at least 12 distinct sub-patterns with many individualized variations.

Also of interest is that the progression through the sub-patterns is unique to each client. There appear to be a number of reasons for this. These sub-patterns can be related to:

• additional injuries that were not directly related to the core distortion.
• how the client compensated for the core distortion.
• body personality characteristics.
• the strength and development of the musculature based on the client’s previous physical activities.
• the client’s overall condition and muscle tonus.
• the client’s general physical and emotional health.
• the blocking of emotional expression.
• pattern injuries such as one-sided sports activities, or internal rotation of arms while working on computers.

These are just a few of the characteristics that illustrate the individuality and uniqueness of each client. Consequently, in the process of unwinding into balance, some clients will progress through many sub-patterns, others will only experience a few, and each client will respond at a different rate to the corrections. The structural sub-patterns are challenging in that they need to be evaluated with body reading and kinesiology at the beginning of each session. However, the cranial correction and specific soft tissue protocol, when properly applied, will alleviate the majority of their symptoms and ultimately bring the body into balance long term. This creates a therapy that focuses on the unique needs of each client, not on a predetermined progression of treatment. Clients receive totally individualized treatment based on their structural distortions, life history, and overall physical and emotional health. Their treatments are discontinued when they can maintain structural balance and resume normal life activities pain free.

Combining Cranial/Structural techniques with specific protocols for deep soft tissue releases results in the maximum level of total rehabilitation possible for each client, physically and emotionally. This is Structural Energetic Therapy® , and it will continue to evolve and expand as the awareness and understanding of the variety and uniqueness of our clients and their needs grow.