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Error code: DatasetGenerationCastError
Exception: DatasetGenerationCastError
Message: An error occurred while generating the dataset
All the data files must have the same columns, but at some point there are 3 new columns ({'output', 'input', 'instruction'}) and 1 missing columns ({'text'}).
This happened while the json dataset builder was generating data using
hf://datasets/jakeveo05/massage-therapy-dataset/massage_therapy_qa.json (at revision f609a196a2634e6bf5514e0246719916fbe7d878)
Please either edit the data files to have matching columns, or separate them into different configurations (see docs at https://hf.co/docs/hub/datasets-manual-configuration#multiple-configurations)
Traceback: Traceback (most recent call last):
File "/usr/local/lib/python3.12/site-packages/datasets/builder.py", line 1831, in _prepare_split_single
writer.write_table(table)
File "/usr/local/lib/python3.12/site-packages/datasets/arrow_writer.py", line 714, in write_table
pa_table = table_cast(pa_table, self._schema)
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File "/usr/local/lib/python3.12/site-packages/datasets/table.py", line 2272, in table_cast
return cast_table_to_schema(table, schema)
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File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1339, in compute_config_parquet_and_info_response
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raise DatasetGenerationCastError.from_cast_error(
datasets.exceptions.DatasetGenerationCastError: An error occurred while generating the dataset
All the data files must have the same columns, but at some point there are 3 new columns ({'output', 'input', 'instruction'}) and 1 missing columns ({'text'}).
This happened while the json dataset builder was generating data using
hf://datasets/jakeveo05/massage-therapy-dataset/massage_therapy_qa.json (at revision f609a196a2634e6bf5514e0246719916fbe7d878)
Please either edit the data files to have matching columns, or separate them into different configurations (see docs at https://hf.co/docs/hub/datasets-manual-configuration#multiple-configurations)Need help to make the dataset viewer work? Make sure to review how to configure the dataset viewer, and open a discussion for direct support.
text
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allistic Stretching
Neural Stretching
CHAPTER 4 Risks of poor flexibility and stretching
CHAPTER 5. Back Pain
Perception of low back
The low back anatomy
Actions of the Spine
Types of low back pain
Management of low back pain
CHAPTER 6 High-thigh Pain
Strains of quadriceps muscle
Tendon rapture of quadriceps
Groin strain
Hip pointer
Bursitis Trochanteric
Hamstring strain
Fracture of femoral neck
Hips avascular necrosis
Hip osteoarthritis
CHAPTER 7 Knee Stiffness
Meniscal tears
Tear in the anterior cruciate ligament (ACL)
PCL(posterior cruciate ligament) tear
Tear in the medial collateral ligament (MCL)
Damages of lateral collateral ligament (lcl)
Anterior knee pain
Ache femoral, patello (chondromalacia patella)
Jumper's knee
Osteoarthritis of the knee
CHAPTER 8 Ankle And Foot Stiffness
Ankle sprains / instability of the ankle
Fractures
Tendonitis achilles
Achilles tendon rupture
Fasciitis plantar
Tension fractures
Tipor tendinitis of the tibial issues
CHAPTER 9 Lumbar spondylosis
Pathophysiology
Grading
CHAPTER 10 Biceps Tendinopathy
Pathophysiology
Mechanic theory
Vascular theory
Neural modulation
CHAPTER 11 FIbromyalgia
Definition
Nomenclature
CHAPTER 12 Exercises for effective stretching
CHAPTER 13 Back Stretching
Double knee to chest stretch
Lower trunk rotation Stretch
Rotation stretch in the mid-back (spinal cord)
Back stretch
Cobra stretch
Baby pose (prayer stretch)
Double knees to side stretch
One leg to side stretch
CHAPTER 14 Neck Stretching
Neck glide
Neck elevati
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ble knees to side stretch
One leg to side stretch
CHAPTER 14 Neck Stretching
Neck glide
Neck elevation
Neck turning
Lateral extension
Sharp shrugs
Forward tilting flexion
Deep stretching
Presses of Resistance
Towel pull
CHAPTER 15 Upper Limb Stretch
Flexion extension stretching of the shoulder
Abduction-adduction stretching at the shoulder
Internal and external rotation stretching for shoulder
Flexion-extension stretching for elbow
Supination-pronation stretching of the forearm
Flexion-extension stretching for wrist
Finger flexion-extension stretching
Thumb extension
CHAPTER 16 Lower Limb Stretching
The adductors stretch
Quadriceps stretch
Calf stretch
Hamstring stretch
Piriformis stretch
Gluteal stretch
CHAPTER 17 Stretching Plan/Routine
How stretching helps
A beginner Stretching plan
Additional effective and optional stretching plan
Motivation for adequate stretch
What to expect after stretching
Conclusion and Summary
INTRODUCTION
I (the document’s author) make no claims to being a stretching, anatomy,
physiology, or other biological science expert.
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hor) make no claims to being a stretching, anatomy,
physiology, or other biological science expert. I’m just trying to put together
data that I’ve read in books or been given by sources who are knowledgeable.
The methods, concepts, and recommendations in this document are not meant
to be a replacement for expert medical advice! Any unaccustomed exercise or
exercise technique should be discussed with a doctor or other health care
provider before beginning, especially if you are pregnant, nursing, elderly, or
have any recurring conditions. The reader is solely responsible for deciding
whether to use any of the methods, concepts, or recommendations contained
in this document.
"I'm not a doctor, and I don't play one on TV," or something similar I will not
be held liable for any losses or harm you may incur as a result of relying on
the information in this document, no matter how awful and useful it may be.
No, not at all, even if the data is false. If you have any questions (or even if
you don't) before beginning any unfamiliar exercise or exercise technique,
you should always consult your doctor.
The anatomy of stretching, which was initially published in 2007, was the
first book to briefly discuss the anatomy and physiology of stretching and
flexibility. The subject has now been made into a popular course by many
writers.
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of stretching and
flexibility. The subject has now been made into a popular course by many
writers. Other than the original publication, no other book on the subject
provides more examples of stretches and exercises or is able to describe them
in a way that allows readers to find them useful and comprehend their
advantages.
You'll learn in this book that the anatomy of stretching is far more complex
than you ever imagined. It will take you inside the body and demonstrate to
you how the major and secondary muscles work when you stretch.
Anatomy of Stretching Points, including the Value of Stretching, Types of
Stretching, Effective Stretching Techniques, and Rules and Procedures for
Safe Stretching.
To assist readers stretch correctly and efficiently, the topic of physiology has
been enlarged, it has introduced 15 new stretches, and it has also provided a
greater explanation of anatomy.
CHAPTER 1
ANATOMY, FLEXIBILITY AND PHYSIOLOGY
AN INTRODUCTION TO STRETCHING
Stretching is a form of physical exercise when a particular skeletal muscle (or
muscle group) is purposefully extended, frequently via abduction from the
torso, to increase the muscle’s perceived flexibility and reestablish
comfortable muscular tone.
As a result, there is a sense of improved muscular control, flexibility, and
range of motion. Stretching is another effective method for treating pains.
Stretching is an uncontrollable and natural behavior that many animals,
including humans, engage in on a daily basis.
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ncontrollable and natural behavior that many animals,
including humans, engage in on a daily basis. Yawning may go along with it.
Stretching frequently happens on impulse after rising from sleep, after
extended periods of inactivity, or after leaving restricted situations and
regions.
Stretching increases flexibility, which is one of the fundamental principles of
physical fitness. Stretching is a frequent practice among athletes to prevent
injury and boost performance before and after training.
Strong muscles are necessary for stretching safely and efficiently, since
stretching may help muscles become more flexible.
Stretching, when done improperly, may be harmful. There are various
methods for stretching in general, but certain methods may be useless or
harmful, even to the point of permanently damaging the tendons, ligaments,
and muscle fiber, depending on which muscle group is being stretched.
PHYSIOLOGY
Studies have provided information about titin, a large protein found in
skeletal muscles.
According to a research, myofibrils—not extracellular as previously believed
—are the primary source of passive muscle tension, which develops during
stretching.
Adults often cannot extend most muscle groups to their maximal extent
without training due to the activation of muscular antagonists once the
muscle achieves its normal range of motion because of neural protections
against damage.
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s once the
muscle achieves its normal range of motion because of neural protections
against damage.
FLEXIBILITY
According to one's unique bodily flexibility score, some people are more
flexible than others. This includes sex differences, with women often being
more flexible than men.
Stretching could not enhance range of motion but instead raise each person’s
threshold for stretching, which is bad for athletic performance. These
investigations also evaluate Flex-Score, joint-muscle compliance, and
capsular mobility.
BENEFITS OF FLEXIBILITY
Despite its many advantages, we sometimes disregard flexibility in a workout
environment. The ability to move with flexibility might actually be the
difference between reaching your goals and failing because of pain or injury.
I discuss the benefits of flexibility for your fitness and quality of life in each
of the sections below.
1. Enhances Posture
Stretching helps the body rebalance the stiff muscles, which in turn improves
posture. Poor behavioral patterns and a sedentary lifestyle lead to damage to
the soft tissue structures in the bodies of a majority of people. Stretching may
reposition soft tissue structures, promoting healthy posture and injury
prevention. In addition to better posture, stretching the body properly also
often results in significant decreases in severe pain, such as lower back
injury. Tight muscles that support and shield the spine might result in low
back stiffness.
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er back
injury. Tight muscles that support and shield the spine might result in low
back stiffness. Therefore, by appropriately stretching the hamstrings,
quadriceps, hip flexors, glute medius, etc., tension on the lower back is
reduced, which can reduce or even eliminate stiffness.
2) Increased Performance and Lower Injury Risk
Stretching properly improves physical performance as well. Muscles and
joints may move across a wider range of motion and with more force when
they are more flexible. Moreover, increased flexibility makes movement
more efficient and effective since it requires less effort to reach full range of
motion. Stretching reduces tissue structures' resistance, making them more
flexible and less prone to damage from overextension or inappropriate
movement.
3) Eliminates Muscle Shortening in Number Three
Chronic muscular shortening causes a variety of issues. When someone
engages in resistance training, their muscles are repeatedly tightened. This
will eventually result in reduced mobility, incorrect movement patterns, joint
pain, and loss of full range of motion. However, by just doing warm-up and
cool-down stretches, these issues may be resolved. Stretching can also be
used in place of exercise on days off. You may even do it while watching
television or when you have a few free minutes. Think of it this way: your
muscles shorten when you contract them. They lengthen when they are
stretched.
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of it this way: your
muscles shorten when you contract them. They lengthen when they are
stretched. In order to prevent shortened muscles, it is necessary to balance
out your exercises with stretching.
4) Improves blood flow and assists in decreasing muscular stiffness and pain
Stretching aids in removing the tight aching muscles the next day by
removing the buildup of lactic acid in the muscle that is being exercised.
Additionally, it facilitates blood flow to the tissue. Blood carries the essential
nutrients for tissue healing after exercise. Stretching raises the tissue’s
warmth, which boosts circulation.
RESEARCH AND DISCUSSION
Stretching too much or till you feel pain is not advised and might be harmful.
Predisposition to injury and potential nerve damage are two effects that may
have both short- and long-term effects on performance.
According to additional studies, rigorous stretching exercises will promote
muscle compliance and suppleness while decreasing muscle-tendon viscosity.
Stretching practices may be harmful to athletic performance in sports
involving little to no short-stretching cycles, such as cycling, running, etc.,
and have no impact on injury prevention.
Stretching can also bring muscle ischemia, which lowers oxygen levels and
on.
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on injury prevention.
Stretching can also bring muscle ischemia, which lowers oxygen levels and
on. More metabolic waste produces a catalyst that causes muscles to contract.
Individual performance might result in muscular injuries from this.
Other explanations suggest that active static stretching increases the amount
of Ca2+ that enters the muscles being stretched from extracellular spaces.
Ca2+ augmentation decreased muscle twitch tension by up to 60%. The
finding that stretching makes people more susceptible to weariness than those
who do not stretch support this statement.
FACTORS AFFECTING FLEXIBILITY
While some people can contort themselves into pretzel shapes, others find it
difficult to stand up after prolonged sitting. Who are you? Your joints’ range
of motion and the length of the muscles that span them are two aspects of
your flexibility, also known as limberness. Most people will benefit from
regular massage by maintaining and increasing their natural flexibility.
Because you can move more easily, you’ll feel better.
Your level of adaptability will rely on a number of variables, some of which
you can influence and others which you cannot. The following five elements
will affect your flexibility:
Joint Structure: The human body has a variety of distinct types of joints.
Some people’s range of motion (ROM) is larger than others’. For instance,
the ball and socket joint on your shoulder has the broadest range of motion of
any joint.
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instance,
the ball and socket joint on your shoulder has the broadest range of motion of
any joint. Compare your elbow’s hinge joint, which only enables you to bend
and extend, with your shoulder joint, which can move in nearly all directions.
Age and Gender: As you age, your range of motion and flexibility naturally
reduce. This is caused, in part, by the fibrosis of the fibrous connective tissue
that substitutes for muscle fibers. Regardless of age, females often have more
flexibility than males because of differences in bone structure. Flexibility can
be improved at any age with training, such as yoga, or appropriate stretching,
much like strength and endurance.
After a night’s sleep, you have less movement when you wake up. You
frequently get the urge to stretch because of this. The body temperature and
ROM rise after ten minutes in a warm bath. Massage and exercise.
Connective Tissue: Deep connective tissue, such as tendons and fascia, can
restrict range of motion (ROM). These tissues differ in their capacity to
stretch and then return to their original length (elasticity) as well as their
propensity to maintain a longer length after stretching (plasticity). Although
not elastic, ligaments can respond to stretching. The collagen in ligaments
and tendons may grow thicker and less flexible as connective tissues age and
lose water content.
Bulky Muscles: Large muscles might negatively affect the ROM.
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e tissues age and
lose water content.
Bulky Muscles: Large muscles might negatively affect the ROM. Certain
stretches may be challenging for exceptionally heavy athletes to execute
because their muscle mass gets in the way. For instance, a person with
massive pec muscles could find it difficult to raise their arms above their
heads. Big muscles may be more significant than ROM for some
athletes.Flexibility may also reduce during exercises with enormous weights
as muscle mass and density rise.
Proprioceptors: Proprioceptors are tinier sensors that are found inside the
fibers of muscles. They are responsible for sensing joint angle, muscle length,
and muscular tension. Stretching slowly and deliberately can prevent these
sensors from inducing reflex responses or contractions that do not promote
flexibility. There are other things that might make you less flexible, such past
injuries. Regardless of the cause, a skilled massage may significantly
improve range of motion (ROM) and restore lost flexibility.
CHAPTER 2
PRINCIPLE OF STRETCHING
If you don’t utilize it, you lose it, according to the principle of stretching as it
relates to exercise and fitness training. It strongly connected the biological
concept of use and disuse to this theory, which has a firm foundation in
exercise research.
Extended rest intervals lower physical fitness even if they’re required for
recuperation following exercises.
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est intervals lower physical fitness even if they’re required for
recuperation following exercises. Over time, fitness training’s physiological
effects fade, causing the body to return to its pretraining state.
After you stop exercising, detraining takes place very soon after. 8 weeks
after training ends, only around 10% of strength is lost, but during the same
time, it lost muscle endurance by 30–40%.
Retaining abilities does not fall inside the scope of the Principle of
Stretching. Stopping the practice of motor abilities, whether weightlifting
exercises or athletic skills, has significantly varied effects.
When a skill is learned, especially if it is well learned, it is never forgotten.
Particularly for continuous abilities, coordination seems to be stored in long-
term motor memory and lasts for decades almost perfectly (e.g., riding a bike,
swimming). If you quit exercising, you will eventually lose your strength,
endurance, and flexibility, but you will still be able to recall how to carry out
the necessary movements and actions.
GUIDELINES ON APPLYING THE PRINCIPLE OF STRETCHING
1. Start a conditioning program to restore your base of strength and
endurance after lengthy rest periods.
2. To lessen the consequences of detraining during the offseason, engage in
an active rest for sports.
3. After a lengthy layoff, gradually and consistently increase your workout.
Regarding recovering your previous level of fitness, be patient.
4.
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istently increase your workout.
Regarding recovering your previous level of fitness, be patient.
4. After a lengthy layoff, avoid attempting to carry colossal weights without
the necessary fitness. You’ll remember how to do the exercises correctly, but
if you think you can lift more weight than you actually can, you risk getting
hurt.
5. Stretching activities should be addressed to recover joint flexibility. For
older persons who play senior sports, this is particularly crucial.
CHAPTER 3
TYPES OF STRETCHING
STATIC STRETCHING
Static stretching is a sort of stretching in which you push a muscle to the limit
until you feel a light stretch in the muscle belly and then keep it there.
Stretches should be pain free and held for 20 to 60 seconds at a time.
Static stretches are effective because the muscle relaxes while you hold the
posture while keeping it stiff. When this happens, stretching the muscle a bit
more is possible without experiencing any pain.
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iff. When this happens, stretching the muscle a bit
more is possible without experiencing any pain. Reduce the stretch if you
experience any pain or discomfort to avoid overstretching and damaging your
muscles.
The most popular type of stretching is static, in part because the
comparatively moderate amounts of tension created make it the safest sort of
stretching.
Stretches that are static might be passive or active.
Active stretches require the athlete to move the joint through its range of
motion and hold it at the stretch point.
Passive stretching, commonly referred to as partner stretching, is moving a
joint to the point of muscular tension and keeping it there while the athlete
relaxes. Communication is key when employing this sort of stretching to
make sure the partner is aware of any muscular pain and eases off as
necessary.
DYNAMIC STRETCHING
In place of static stretches during a warm-up, dynamic stretching, sometimes
referred to as active stretching, is currently preferred since it mimics the
movements found in most sports and can be customized for each athlete and
discipline.
By starting with a tiny movement and progressively increasing the
movement’s range and speed, dynamic stretches include moving a muscle
through its entire range of motion.
Examples:
These exercises include lunges, high knees, and cariocas.
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ugh its entire range of motion.
Examples:
These exercises include lunges, high knees, and cariocas.
A minimum of five of these drills, each performed six to eight times at
moderate, medium, and high speeds, are typically included in the dynamic
stretches that are performed during a warm-up after an initial period of CV
activity (jogging, cycling, etc.). Every action should be completely
controlled.
PNF STRETCHING
Proprioceptive Neuromuscular Facilitation, or PNF for short, can occur in a
variety of ways, including as hold-relax, contract-relax, and rhythmic
initiation. PNF gained popularity in the 1960s and has since been a standard
course of therapy for many physiotherapists and other specialists in sports
injuries.
PNF can be entirely passive (in which case the therapist moves the limb
through its ranges of motion) or active aided, in which case the patient
actively participates in the healing process. Here, an isometric contraction
must come before the stretch.
Example:
The athlete would lay on their back and elevate the straight leg off the bed,
contracting the rectus femoris and iliopsoas to return to the beginning
position. This is a hold-relax PNF technique for the hamstrings.
From here, the athlete isometrically contracts the hamstrings (as if trying to
press the foot back down to the floor) for a minimum of 6 seconds as the
therapist or partner applies resistance.
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back down to the floor) for a minimum of 6 seconds as the
therapist or partner applies resistance. The athlete then raises the leg higher
and stretches the hamstrings even more by contracting the hip flexors once
more.
This utilizes the post-isometric relaxation and reciprocal inhibition (or
innervation) ideas. Based on a reflex loop managed by the muscle spindles,
reciprocal inhibition works. It suppressed the antagonist muscle when an
agonist muscle contracts (for example, the quadriceps, which cause knee
extension), forcing it to relax (in this case, the hamstrings), enabling the
antagonist muscle to fully extend (knee extension).
The “golgi” tendon organs, which act as sensors inside the muscle and are
sensitive to muscular tension, are hypothesized to regulate post-isometric
relaxation. Isometrically contracting a muscle for a while causes a restriction
of the muscle, which leads to relaxation.
In addition to stretching, PNF may be utilized for various types of therapies,
such as muscular strengthening in a rehabilitation context. Spiral-diagonal
motions are employed in PNF in this way, as they are in most daily tasks and
athletic endeavors.
There are very few activities that involve only one plane of motion; instead,
most include two or all three (flexion/extension, adduction/abduction, and
rotation).
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ion; instead,
most include two or all three (flexion/extension, adduction/abduction, and
rotation). PNF uses these spiral-diagonal motions to assist the body to be
trained in the way that it is most frequently used.
MUSCLE ENERGY TECHNIQUES
A different type of active-assisted stretch that was created about the same
time as PNF in the osteopathic community is known as a “muscle energy
technique” (or “MET”).
It isometrically contracted the agonist before being stretched in METs, same
like in PNF. The isometric contraction’s force is different, being much less in
METs.
Example:
Using the hamstrings, execute the following MET stretch:
On the athlete’s back, the therapist flexes the hip until they reach the point of
resistance, or when the exercise becomes stiff owing to tight hamstrings. For
15 to 20 seconds, they remain in this posture. The athlete is then instructed to
attempt to press the leg back down to the couch while they gradually let off
the stretch, which generates an isometric contraction of the hamstrings.
This contraction should represent no more than 20% of the athlete’s overall
strength in METs. The therapist instructs them to relax and presses the limb
farther, lengthening the stretch, until they felt once again resistance. They
sustain this contraction for around 10 seconds.
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tretch, until they felt once again resistance. They
sustain this contraction for around 10 seconds. For each muscle, they
typically perform the treatment 3-5 times.
BALLISTIC STRETCHING
Ballistic stretching is a sort of bouncing stretching in which you push the
muscle almost to its breaking point and then bounce to lengthen it. For
instance, stooping to touch your toes while bouncing to extend the range.
Because risk of injury and lack of benefit compared to other, safer kinds of
stretching like PNF and dynamic stretches, this sort of stretching is rarely
advised.
NEURAL STRETCHING
Stretching the nervous system’s structures is referred to as neural stretching.
When there is excessive neural stress or a limitation in the mobility of neural
structures, as is frequently the case around the neck, shoulder girdle, or pelvic
region, this is required.
The slump test and the upper limb stress test are two examples of neural
tension tests that have been modified into neural stretches. It brings the limb
to the point of stretch and kept there for not more than 10 seconds. However,
this may just be 3–4 seconds to prevent nerve injury.
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there for not more than 10 seconds. However,
this may just be 3–4 seconds to prevent nerve injury. Only a licensed
therapist should be present to supervise this sort of stretching.
CHAPTER 4
RISKS OF POOR FLEXIBILITY AND STRETCHING
Back Pain
High-thigh Pain
Knee Stiffness
Ankle And Foot Stiffness
Lumbar spondylosis
Biceps Tendonitis
FIbromyalgia
CHAPTER 5
BACK PAIN
PERCEPTION OF LOW BACK PAIN
According to statistics, 80% of all people will at some point in their lives
suffer from low back stiffness. The working population as a whole admits to
having annual low back pain in 50% of cases.
Around 15% to 20% of Americans report having low back pain each year.
Two percent of Americans suffer from low back pain, which can be either
temporary or continuously affecting.
Each year, on-the-job accidents affect millions of workers and cost the
economy $100 billion in missed earnings, productivity, and time.
It's critical to realize that you have a wonderful possibility of getting better
soon from your low back pain.
According to research, 74% of people with back pain return to work within 4
weeks, and > 90% do so in 3 months or fewer.
Some medical professionals believe that experiencing low back pain is
similar to getting a cold; you have it, and it eventually goes away.
In conclusion, there is a good probability that you will feel low back pain, a
good chance that you will heal, but a big chance that you will do so again.
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l feel low back pain, a
good chance that you will heal, but a big chance that you will do so again.
According to medical study, an aggressive exercise regimen will lessen
impairment and maybe stop future pain attacks.
THE LOW BACK’S ANATOMY
The lumbar spine, often known as the low back, is a remarkable feat of
engineering. It is made up of nerves, tendons, muscles, ligaments, discs,
joints, and bones.
ACTIONS OF THE SPINE
The spine serves three basic purposes.
1) It joins the head and trunk to the pelvis.
2) The spinal cord, which is made up of billions of nerves connecting the
brain to the majority of the body’s major organs, is protected by it.
3) The spine gives us the stability, equilibrium, flexibility, and movement we
need to go about our daily lives.
While allowing you to swing a golf club, it also absorbs and transmits
enormous pressures.
Let’s use an example where you weigh 150 pounds and bend over around 65
degrees. Your back muscles exert 375 pounds of effort to prevent you from
toppling over, and your muscles exert around 700 pounds of force if you are
also carrying a 50-pound object.
A closer look reveals five vertebrae (bones) piled on top of one another, each
with a disc filled with fluid in between. The lumbar spine is designed to
balance powerful forces and resembles a hollow, C-shaped curvature (also
known as the lumbar lordosis).
The lumbar lordosis, or curvature, makes the spine 15 times stronger than it
would be if it were straight.
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bar lordosis, or curvature, makes the spine 15 times stronger than it
would be if it were straight. The spinal cord is located within the “hollow” of
the spine. Clearly stated, the nerves in the spinal cord connect your brain to
your muscles and instruct them when to contract.
Along with other things, these nerves are also in charge of touch and pain
perception. They are known as nerve roots and come out of openings called
intervertebral foramen, which means between the vertebrae.
The vertebral bodies, which contain cartilage and plates that connect to the
discs, support the majority of the weight. Transverse processes are two bones
that point to the sides and arise as spinous processes from the rear of a spine.
These procedures act as the connection points for ligaments and muscles.
A jelly-doughnut-shaped disc filled with fluid sits between each spinal body.
The inner jelly is known as the nucleus pulposus, while the outside fibrous
component is known as the annulus fibrosis. A healthy disc gives the spine
the height it needs, disperses forces, and absorbs stress.
Ligaments, which connect one or more bones, are strong, non-elastic (they
stretch very little), and rigid structures.
Several ligaments support the lumbar spine. The anterior longitudinal
ligament holds together the front of the vertebral bodies.
The posterior longitudinal ligament holds together the rear of the vertebral
bodies.
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tebral bodies.
The posterior longitudinal ligament holds together the rear of the vertebral
bodies. The transverse and spinous processes are connected by the
interspinous and inter-transverse ligaments, respectively.
The ligamentum flavum aids in protecting the spinal cord by holding the back
part of the vertebra together.
The thoracolumbar fascia is a substantial portion of ligamentous tissue that
interacts with muscles to support the spine and aids in holding the whole
lumbar vertebra together.
The spine is moved and stabilized by a group of more than 140 muscles.
Around the lumbar spine is where several of these muscles are located.
They are abdominal muscles, the erector muscles, the hip muscles, and lateral
stabilizing muscles.
The rectus abdominis, internal and external obliques, and transverse
abdominals are the muscles of the abdomen.
Together, they serve as your body’s natural “back belt,” support your front
while promoting excellent posture, and retain your abdominal organs in the
proper position.
The muscles that go up and down your back, known as the erector spinae,
help you keep your posture upright and help you straighten up after bending
forward.
A layer of muscles that supports side bending and rotating motions is located
further deeper.
The gluteus maximus, hamstrings, and psoas are the primary hip muscles that
move the pelvis and thighs.
Your main lifting muscles are the gluteus maximus and hamstrings.
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that
move the pelvis and thighs.
Your main lifting muscles are the gluteus maximus and hamstrings.
In essence, the muscles in your gluteus maximus and hamstrings govern the
hips, which account for around 67% of the bending when you bend over to
touch your toes. Your psoas muscle supports your spine and aids in lifting
your thigh.
The thoracolumbar fascia allows the quadratus lumborum and latissamus
dorsi, the lateral stabilizers, to enter into the spinous and transverse
processes. They also help to move and support the spine. Any one component
or group of structures can affect the curvature of lumbar lordosis.
TYPES OF LOW BACK PAIN
MECHANICAL LOW BACK PAIN
Mechanical low back pain has been linked to trauma (chronic or sudden),
including falls, car accidents, twisting, prolonged poor postures, mental
stress, exhaustion, disc extrusion (also known as a slipped disc, rupture, or
disc herniation), occasionally painful degenerative disc disease (also known
as arthritis), aging, congenital defects, limited flexibility, etc.
Infections, hormone imbalances, fractured bones, systemic diseases, and
cancers are major medical conditions that need immediate attention but are
extremely uncommon and outside the scope of this essay.
Mechanical low back pain (LBP) continues to be the second most frequent
symptom-related cause of doctor visits.
Fortunately, the majority of people with LBP recover within 2-4 weeks.
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ated cause of doctor visits.
Fortunately, the majority of people with LBP recover within 2-4 weeks.
Mechanical LBP is the most prevalent kind of disability among those under
45, and a work-related injury typically accompanies it.
Mechanical LBP is the third most frequent cause of disability for those over
45, and diagnostic, treatment, and management depend greatly on a thorough
history and physical exam.
ACUTE LOW BACK PAIN: Exercise intolerance characterizes acute low
back pain brought on by lower back or back-related leg symptoms that have
lasted less than three months.
CHRONIC LOW BACK PAIN: Chronic low back pain is consequently
described as discomfort or issues that endure longer than three months.
Any mechanical low back pain, regardless of its origin or length, is likely to
result in injured soft tissue, which can inflame nerves and create pain.
It is essential to understand that isolating the particular tissue(s) responsible
for the low back discomfort is effectively impossible. Since the reason for
someone’s discomfort is unclear, it’s possible that you are also in pain.
It could consist of a muscle, a ligament, a disc, a tendon, a joint, or other
connective tissue.
All of them have the potential to cause comparable symptoms, which
frequently manifest as back discomfort on one side or throughout the back. It
could spread into the thigh or the buttock.
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back discomfort on one side or throughout the back. It
could spread into the thigh or the buttock. Quite frequently, it will be
followed with a painful muscular cramping condition known as a muscle
spasm.
An MRI revealed good results for disc abnormalities in two out of three
patients, however, they do not experience pain. One in three people may have
disc bulges that cause no pain at all.
Low back pain is frequently referred to as “pain in quest of pathology” by
medical practitioners. This implies that a patient’s medical tests will come out
negative or falsely positive. Several structures might be the root of the
problem.
MANAGEMENT OF LOW BACK PAIN
So how can we handle a situation if we don’t know what the issue is
specifically? We are aware that soft tissue injury is the root cause of
mechanical low back discomfort. Damage activates nociceptors, which are
pain receptors.
Instead of only treating the pain, the aim is to encourage the repair of the
injured soft tissue, which will end the pain and anguish. You accomplish this
via a software that is made specifically for you.
THE STEPS ARE AS FOLLOWS:
1. Safeguarding the soft tissue injury to stop future deterioration. Rest and
positioning are used to protect the soft tissue injury region. While the low
back recovers, painful activities should be avoided. You should employ pain
management strategies, which your physical therapist will go through with
you.
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u should employ pain
management strategies, which your physical therapist will go through with
you. The typical duration of bed rest is 1-3 days (longer periods of bed rest
have not been proven to be beneficial).
2. Enhancing blood flow and mobility. By doing this, the right structures
will be delivered (proteins, oxygen, proteins, repair cells called fibroblasts,
etc.), inflammatory and waste products that accumulate in painful tissues will
be removed, and it will prevent tissue atrophy. Walking and doing painless
stretching, strengthening, and range of motion activities help to increase
circulation.
3. Treating the dysfunctions (weakness, bad posture, and lack of flexibility)
that led to the initial issue. Your low back will experience less strain as a
result of progressive strengthening exercises, flexibility training, and body
mechanics knowledge, which will also aid in healthy rehabilitation.
CHAPTER 6
HIP THIGH PAIN
STRAINS OF QUADRICEPS MUSCLE
This injury frequently occurs as a result of sudden sprints or pauses during
running.
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RICEPS MUSCLE
This injury frequently occurs as a result of sudden sprints or pauses during
running. Localized pain or a “bulge” in the sensitive area of the thigh are
signs of a muscle strain.
Lifting the thigh (a straight leg raise), going up or down stairs, or standing up
from a chair, all worsen the discomfort.
TENDON RUPTURE OF QUADRICEPS
This injury frequently happens as a result of hard kicking or a tumble that
causes a severe impact on the tendon.
The ability to walk is impaired, there is discomfort and swelling above the
kneecap, and there is extreme quadriceps weakness that prevents climbing or
descending steps.
Surgery is required for the repair.
GROIN STRAIN (ADDUCTOR STRAIN)
This injury frequently happens in sports that call for cutting, sidestepping, or
rotating. The legs frequently separate violently, or the toe frequently twists
outward.
Pain and soreness in the inner thigh area are signs and symptoms.
HIP POINTER
In sports like football, rugby, and soccer, a direct impact on the hip bone
causes hip pointers.
Pain, bruising, and soreness at the body part on the side of the hip are signs
and symptoms.
Rest, cold, and compression are typically used as treatments.
BURSITIS TROCHANTERIC
A bursa is a bag filled with fluid that lessens sheer pressures between bodily
tissues.
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ROCHANTERIC
A bursa is a bag filled with fluid that lessens sheer pressures between bodily
tissues. The bursa between the IT Band and the greater trochanter is subjected
to excessive tension, which results in trochanteric bursitis (bursa infection).
Pressure on the outside of the hipbone is one of the warning signs and
symptoms. This pain is frequently made worse by laying on the afflicted side,
standing on the affected leg, or taking long walks.
Rest, ice, and compression are frequently used as treatments, along with
physical therapy that includes stretching and gradual strengthening. Steroid
injections may also be beneficial.
HAMSTRING STRAINS
A slight muscular tear is called a strain. The most frequent reason for
hamstring injuries is sudden acceleration during sprinting or cutting. Back of
thigh popping or a slight tugging may be experienced.
Pain, swelling, and the inability to run are the symptoms.
Treatment consists of physical therapy, rest, ice, compression, and elevation.
FRACTURE OF THE FEMORAL NECK
The thigh bone can shatter or fracture as a result of a major fall or impact to
the hip, usually in the area of the femoral neck.
The joint might gradually deteriorate if the damaged bone is not adequately
healed. Necrosis of the joint may result from reduced or interrupted blood
flow via the femoral head.
HIP’S AVASCULAR NECROSIS
Avascular necrosis is the term for bone death brought on by a lack of blood
flow.
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VASCULAR NECROSIS
Avascular necrosis is the term for bone death brought on by a lack of blood
flow. When the neck of the femur is broken, dislocated, or repeatedly injured,
the blood flow is disturbed.
Stiffness, a restriction in mobility, and pain when walking are all signs.
Decompression surgery or a complete hip replacement may be required.
HIP OSTEOARTHRITIS
The acetabulum and the head of the femur’s cartilage coverings wear out,
resulting in osteoarthritis of the hip. When you put weight on the injured leg,
it gets worse. In particular, hip flexion and internal rotation have a limited
range of motion.
Joint mobility and stretching can significantly reduce pain, according to
recent studies.
CHAPTER 7
KNEE PAIN STIFFNESS
MENISCAL TEARS
The knee’s menisci, or plural for meniscus, are cartilage cushions that serve
to absorb compressive stresses. The lower leg may be forcefully bent and
twisted, which can cause one or both of these cushions to tear.
Joint line discomfort, locking, and knee swelling are signs and symptoms.
The rip frequently resembles a bucket handle or a parrot’s beak.
Rest, ice, compression, and elevation should be the major components of
treatment.
For a significant tear, arthroscopic surgery is advised.
TEAR IN THE ANTERIOR CRUCIATE LIGAMENT (ACL)
The cruciate (or crossing) ligament stabilizes the knee.
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AR IN THE ANTERIOR CRUCIATE LIGAMENT (ACL)
The cruciate (or crossing) ligament stabilizes the knee. When the knee is bent
past its usual range of motion or with extreme twisting, the anterior cruciate
ligament (ACL) may totally rupture.
Signs and symptoms include a "pop" feeling along with severe pain and
edema. A feeling of instability or the knee giving way is present.
Rest, cold, elevation, and compression are part of the first course of therapy.
Physical therapy that includes functional activity and incremental
strengthening could aid recovery. Surgery is advised if knee instability
continues. The missing ligament may be recreated using the middle part of
the patellar tendon, the hamstrings, or the cadaver ligament.
Teenage female athletes frequently suffer from ACL tears. Injuries to the
anterior cruciate ligament (ACL) in female teenage athletes can be
dramatically decreased with a preventative training program, according to
some of the greatest clinical/sports medical data to date.
PCL (POSTERIOR CRUCIATE LIGAMENT) Tear
Injuries to the posterior cruciate ligament (PCL) are less frequent and
stronger.
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TE LIGAMENT) Tear
Injuries to the posterior cruciate ligament (PCL) are less frequent and
stronger. Injury from a car collision occurs frequently when the knee (s)
violently strike the dashboard.
Rest, cold, elevation, and compression are part of the first course of therapy.
Physical therapy that includes functional activity and incremental
strengthening could aid recovery.
Usually, surgery is not necessary.
TEAR IN THE MEDIAL COLLATERAL LIGAMENT (MCL)
MCL tears are a frequent injury. The MCL may extend and get injured if
there is a strong tension on the outside of the knee.
Knee swelling and inner-side soreness are among the signs and symptoms.
With significant trauma, medial meniscal rips and ACL damage are possible
(commonly occurs during football and soccer).
Treatment entails rest, ice, elevation, compression, bracing, and
rehabilitation. Surgery can be needed for severe tears.
DAMAGES OF LATERAL COLLATERAL LIGAMENT (LCL)
Less frequently occur lateral collateral ligament (LCL) tears.
Due to bracing and rehabilitation, rest, ice, elevation, and compression are
required.
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(LCL) tears.
Due to bracing and rehabilitation, rest, ice, elevation, and compression are
required. Infrequent is surgery.
ANTERIOR KNEE PAIN
Many people have pain in the skeleton femoral joint, which connects the
femur (the bone in the leg) to the kneecap.
Three typical reasons for pain at the front of the knee include quadriceps
tendinitis/tendinosis, patellar tendonitis/tendinosis, and excessive forces on
the bottom of the kneecap (which painfully stress the cartilage on the
underside of the kneecap).
Another typical diagnosis of discomfort in the anterior knee is
chondromalacia patella (softening of the cartilage).
These disorders are frequently linked to overuse and weak hips. These issues
can be treated with physical therapy, knee and hip tape or bracing, and the
right eccentric and hip stabilization exercises as directed by your therapist.
ACHE FEMORAL, PATELLO (CHONDROMALACIA PATELLA)
Chondromalacia, which describes the softening of the patellar cartilage, is a
common false diagnosis. It is only possible to detect cartilage softening
during surgery if the cartilage is clearly visible.
Patello-femoral The proper diagnosis for pain and swelling below the
kneecap is discomfort.
Rest, ice, compression, and elevation are all methods of pain treatment.
Swelling must be controlled. Anti-inflammatory medications, physical
therapy, and bracing are usually beneficial. The quadriceps must be gradually
strengthened.
The use of foot orthoses is occasionally possible.
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. The quadriceps must be gradually
strengthened.
The use of foot orthoses is occasionally possible. Rarely, surgery is required
to help realign the kneecap by loosening the close-fitting structures around it
and reefing the inner ones.
JUMPER’S KNEE (PATELLAR TENDINITIS)
Sports involving jumping, like basketball and volleyball, impose a significant
amount of stress on the kneecap and its tendons.
Patellar tendonitis symptoms include discomfort when the tendon is touched
directly and, on rare occasions, swelling.
Physical therapy and activity moderation are part of the treatment.
A particular condition of the patellar tendon, where it connects to the base of
the kneecap, is known as Sinding-Larsen-Johansson.
Osgood-Schlatter disease, on the other hand, affects the tendon where it joins
to the leg’s tibial tuberosity. Both conditions are prevalent in developing
adolescents.
Physical therapy, activity moderation, and surgical removal of the
accompanying necrotic material are all forms of treatment.
OSTEOARTHRITIS OF THE KNEE
When the cartilage coverings on the top of the tibia and the end of the femur
deteriorate, osteoarthritis of the knee results.
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s on the top of the tibia and the end of the femur
deteriorate, osteoarthritis of the knee results. Two menisci, or unique
cartilage pads, are located on the tibia (one is called a meniscus).
This cartilage flattens, bone spurs develops, the joint becomes inflamed,
range of motion is decreased, and weakness, discomfort, and trouble moving
around—including getting in and out of chairs and ascending stairs—result.
Physical therapy aids in the recovery of range of motion, pain management,
strength, balance and walking abilities after total knee replacement, also
known as a total knee arthroplasty.
You must exercise patience when people ask you, "Why did I have this
surgery? I'm worse off now." Allow yourself at least three months to heal.
CHAPTER 8
ANKLE AND FOOT STIFFNESS
ANKLE SPRAINS / INSTABILITY OF THE ANKLE
Sprains of the ankle happen frequently.
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AND FOOT STIFFNESS
ANKLE SPRAINS / INSTABILITY OF THE ANKLE
Sprains of the ankle happen frequently. They typically happen when the foot
is twisted or inverted violently.
GRADING
Category I (minor tear),
Class II (partial tear),
The anterior talofibular ligament and, less frequently, the calcaneofibular
ligaments are damaged in the outer ligament complex in grade III (complete
tear into two pieces).
Rare injuries to the inner ankle often lead to a fracture before ligament
damage manifests itself.
Symptoms and signs
ankle pain to the side,
swelling and a feeling of unsteadiness
TREATMENT:
Rest,
Ice,
Compression,
augmentation, and
splinting the hurt ankle.
Faster recovery is made possible by early rehabilitation.
The only time surgery (ligament reconstruction) is required is when the ankle
has been twisted repeatedly.
FRACTURES (BROKEN BONES) (BROKEN BONES)
Both the inside and outside of the leg are susceptible to fractures.
SIGNS AND SYMPTOMS: Bony deformities, swelling, and pain.
Treatment calls for an urgent “reduction,” which involves putting the bones
close together to promote healing. Open surgery may be required in extreme
circumstances to reduce the fracture.
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r to promote healing. Open surgery may be required in extreme
circumstances to reduce the fracture. To keep the reduction in place, pins,
plates, and screws are frequently employed.
TENDONITIS ACHILLES
The gastrocnemius and soleus muscles of the calf are joined to the heel by the
Achilles tendon.
Acute Achilles tendonitis Excessive stress or a tight or fatigued calf muscle
can result in microtrauma, degeneration, and even inflammation of the
tendon- a condition called Achilles Tendonitis/Tendinosis.
RISKS: excessive running can bring this condition on, jumping, or prolonged
walking.
A similar condition called Achilles Tendinosis may be to blame for a gradual
onset of pain and a protracted recovery, according to recent research.
In contrast to tendonitis, tendinosis is a chronic degenerative condition and
does not involve inflammation. Considering the fact that tendon pain
frequently does not come with the traditional inflammatory symptoms of
swelling, redness, and warmth, it is probably more prevalent than tendinitis.
Treatment typically entails rest, non-steroidal anti-inflammatory drugs
(NSAIDs), ice, stretches, strengthening, and a gradual return to work or sport.
ACHILLES TENDON RUPTURE
The Achilles tendon may rupture (completely tear) in response to a strong
calf muscle contraction.
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The Achilles tendon may rupture (completely tear) in response to a strong
calf muscle contraction. It happens when you jump, run, or cut, and it’s quite
common in baseball and basketball players.
The patient frequently describes feeling as though their lower calf has been
struck or kicked hard. The tendon above the heel is inflamed and has a
“divot” in it.
Treatment options include both surgical and non-surgical rehabilitation.
Those who are physically active may benefit more from surgical repair.
Progressive care may be needed for six to twelve months during
rehabilitation.
FASCIITIS PLANTAR
The most typical cause of heel pain is inflammation of the fascia on the
bottom of the foot.
CAUSES: Plantar fasciitis can have many known causes.
Lack of arch support, a sudden increase in activity, poor footwear, being
overweight, excessive pronation, or conditions involving repetitive stress are
all potential causes of poor calf flexibility (long distance running).
Poor footwear, excessive walking on hard surfaces, being overweight, and
poor cushioning of the heel due to fat pad atrophy (shrinkage in size of the fat
pad) are common causes of a bruised heel bone.
SYMPTOMS: The prevalence of plantar fasciitis varies between 8 and 21%
of the population, according to various medical studies. The front of the
calcaneus base is usually where the pain is felt.
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ding to various medical studies. The front of the
calcaneus base is usually where the pain is felt. Less frequently, the pain
spreads along the foot arch.
The plantar fascia is microtorn where it connects to the base of the calcaneus
as a result. An inflammatory reaction follows, causing discomfort, edema,
warmth, loss of function (difficulty standing or walking), and less frequently,
redness.
When one gets out of bed in the morning, plantar fasciitis is frequently at its
worst. According to theories, the inflamed fascia shortens while we sleep and
may even be trying to heal.
TENSION FRACTURES
Repetitive, sub-maximal loads being placed on the foot, ankle, and leg (in
athletes, over-training) typically cause these fractures.
They frequently occur in female athletes and long-distance runners.
SITES: The lower leg (in runners), calcaneus, talus, metatarsals in distance
runners, and the big toe are common stress fracture sites.
Pain and point tenderness are the symptoms.
Rest, mobility, and cross-training are the most common treatments for
healing.
Exercise with low impact, and wear supportive footwear.
TIPOR TENDINITIS OF THE TIBIAL ISSUES
Due to tendon degeneration, this frequently happens in overweight, middle-
aged women and men.
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SUES
Due to tendon degeneration, this frequently happens in overweight, middle-
aged women and men. There may be pain below or behind the inside of the
ankle bone and the rupture may be partial or complete (medial malleolus).
Commonly, an arch will flatten.
Orthotics, surgical debridement, and anti-inflammatory treatment (physical
therapy modalities) are common treatments.
CHAPTER 9
LUMBAR SPONDYLOSIS
Midway through the 1800s, Kilian, Robert, and Lambl published the first
description of spondylolysis and spondylolisthesis in the literature.
After Naugebauer’s anatomical studies in the late 1800s, the variety of spinal
abnormalities causing the development of spondylolisthesis became clear.
PATHOPHYSIOLOGY
A par interarticularis defect called spondylolysis may or may not be
accompanied by the forward translation of one vertebra in relation to another
(spondylolisthesis).
To clarify the causes of vertebral translation in the anterior direction, Wiltse,
Macnab, and Newman created a classification.
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rtebral translation in the anterior direction, Wiltse,
Macnab, and Newman created a classification.
These are some of their categories:
Spondylolisthesis occurring at birth
Spondylolisthesis isthmus
Spondylolisthesis with degeneration
Spondylolisthesis after trauma
Spondylolisthesis spondylopathy
Dysplastic sacral facet joints that allow one vertebra to move forward in
relation to another define congenital spondylolisthesis.Forward translation
may be allowed by the facets being oriented in an axial or sagittal plane,
which would put undue strain on the pars and possibly cause a fracture.
Isthmic spondylolisthesis results from a stress fracture forming in the pars
interarticularis.
A frequent cause of degenerative spondylolisthesis is intersegmental
instability brought on by facet arthropathy. This variation typically only
affects adults and only progresses to grade I spondylolisthesis in a small
number of cases (see grading system below).
Traumatic spondylolisthesis can very rarely result from sudden stresses
(trauma) to the facet or pars.
The facet mechanism may become unstable due to any bone condition, which
could result in pathologic spondylolisthesis. Last but not least, a surgeon who
is too eager to remove too many facet joints may cause iatrogenic
spondylolisthesis.
The grading system Meyerding proposed in 1947 is the one that is most
frequently used for spondylolisthesis.
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ng system Meyerding proposed in 1947 is the one that is most
frequently used for spondylolisthesis. The percentage of the distance the
anteriorly translated vertebral body has advanced in relation to the superior
end plate of the vertebra below is used to calculate the degree of slippage.
The following grading scheme is used for classifications:
1–25% slippage in Grade 1
Grade 2: Slippage of 26–50%
Slippage in Grade 3: 51–75%
Slippage in Grade 4: 76–100%
Grade 5: A slippage of more than 100%
CHAPTER 10
THE BICEPS TENDINOPATHY
Biceps tendinopathy is a condition that causes pain and tenderness near the
biceps tendon. Overuse injuries are especially prone to occur at the biceps
musculotendinous junction, especially in people who engage in frequent
lifting.
This condition is frequently misdiagnosed as rotator cuff tendinopathy, and
vice versa. Rarely are biceps tendinopathy observed alone. Along with other
shoulder pathologies like rotator cuff tendinopathy and tears, shoulder
instability, and imbalances of the dynamic stabilizers, it coexists with them.
95% of biceps tendinopathy patients have “impingement syndrome” as their
main medical condition.
PATHOPHYSIOLOGY
Biceps tendinitis is the term historically used to describe all biceps tendon
disorders.
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PHYSIOLOGY
Biceps tendinitis is the term historically used to describe all biceps tendon
disorders. There is evidence to support the idea that tendon degeneration can
take place without inflammation.
Biceps tendon pain may still have an inflammatory pathology as a valid cause
in severe cases.
Inflammation of the tendon and the paratendon is referred to as tendinitis.
Chronic overload is typically to blame for this, which results in microscopic
tendon tears that set off an inflammatory response.
The inflammation of the tendon sheath or paratendon is known as
peritendinitis. Tenosynovitis, which usually results from the tendon rubbing
against a bony prominence, is caused by a direct injury or irritation.
Histologically speaking, tendinosis refers to degenerative changes in the
tendon.
A degenerative tendon examined under a microscope reveals soft,
disorganized tissue that is yellow or brown (mucoid degeneration).
The microscopic view reveals fibrosis and degenerative changes to collagen.
In tendinosis, inflammatory mediators are typically absent.
Tendinosis is a more significant part of injuries lasting longer than 3 months
than persistent inflammation is, in most cases.
Symptomatic tendon clinical presentation are referred to as tendinopathy.
This definition does not take into account the underlying pathology, whether
it is inflammatory or degenerative.
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on does not take into account the underlying pathology, whether
it is inflammatory or degenerative.
There are three known etiologies of tendinopathy, which are as follows:
Mechanical theory: According to this theory, the tendon degenerates
microscopically as a result of repeated loading. Within the tendon, fibroplasia
results in the formation of scar tissue.
Vascular theory: In accordance with this theory, focal areas of vascular
compromise lead to tendon degeneration.
The third theory, neural modulation, focuses on the idea that neurally
mediated tendinopathy causes substance P release and mast cell
degranulation.
To better understand the connection between tendinopathies and the
peripheral nervous system, more research is required.
Understanding biceps tendinopathy requires knowledge of the biceps
brachii’s anatomy.
There are two heads of the biceps brachii.
The coracoid process of the scapula’s short head forms its tip.
The superior labrum passes through the intertubercular groove between the
greater and lesser tubercles of the humerus, and the long head emerges from
the supraglenoid tubercle of the scapula.
By depressing the humeral head close to it, the long head of the biceps serves
as a shoulder stabilizer.
The distal arm is where the two heads combine to form a single, powerful
tendon that inserts on the radial tuberosity at the upper end of the radius.
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orm a single, powerful
tendon that inserts on the radial tuberosity at the upper end of the radius. The
tendon releases the bicipital aponeurosis distally (an expansion that blends
with the flexor forearm muscles, extending to the ulna).
The musculocutaneous nerve innervates the biceps brachii (C5, C6).
The biceps brachii muscle contracts to flex the elbow, supinate the forearm,
depress the humeral head, and extend the shoulder (short head primarily).
CHAPTER 11
FIBROMYALGIA
Complex disorder fibromyalgia was not recognized until the latter part of the
20th century. Though the condition was described in medical literature as
early as the early 17th century, it was actually discovered much earlier.
Many medical professionals deny the existence of fibromyalgia and would
rather avoid treating patients with this complex condition. A lack of relevant
research in the past could be the cause of the underdiagnosis and lack of
treatment for fibromyalgia.
Currently, the diagnosis of this disease is supported by a wealth of research
and medical evidence.
Some experts advise doctors to adopt a new paradigm in order to treat
patients successfully with fibromyalgia.
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s advise doctors to adopt a new paradigm in order to treat
patients successfully with fibromyalgia. Science’s technological
advancements are no longer reliable.
None of the results, despite the use of sophisticated imaging and laboratory
tests, support the diagnosis of fibromyalgia.
The foundation for diagnosing and treating fibromyalgia continues to be a
doctor skilled in taking a careful history, paying attention to the patient’s
concerns, and conducting a thorough examination.
The Physician’s Oath requires that the doctor uphold his or her scientific
integrity and adhere to evidence-based medicine. We must uphold our
commitments to serve and care for those who are ill and in need while
avoiding bias.
DEFINITION
A common disorder called fibromyalgia is a syndrome made up of a
particular set of symptoms. Long considered a “wastebasket” diagnosis,
fibromyalgia.
The American Medical Association (AMA) did, however, recognize
fibromyalgia as a legitimate illness and a potential contributor to disability in
1987. Fibromyalgia has been acknowledged as a valid clinical entity by
numerous reputable organizations, including the American Medical
Association (AMA), the National Institutes of Health (NIH), and the World
Health Organization (WHO).
Today, fibromyalgia is acknowledged as one of many central pain-related
syndromes that are widespread in society.
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algia is acknowledged as one of many central pain-related
syndromes that are widespread in society. Recent developments in research
have led to the conclusion that central sensitization-related disturbances of
the central nervous system (CNS) are the most likely cause.
Before receiving an accurate diagnosis, fibromyalgia patients frequently
consult with several doctors. Before a proper diagnosis is made, patients may
seek medical advice for more than five years, and more than half of patients
end up with the wrong diagnosis and may needlessly undergo surgery.
NOMENCLATURE
Although there have been other names for the syndrome, the term
“fibromyalgia” was first used in that year.
The Latin roots fibro (fibrous tissue), my (muscles), al (pain), and gia are
used to create this word (condition of).
Most people incorrectly referred to fibromyalgia as fibrositis, where "itis"
denoted an inflammatory component.
CHAPTER 12
EXERCISES FOR EFFECTIVE STRETCHING
The stretches that follow are designed to lengthen your muscles or give your
joints the freedom to move in all directions. To reduce muscle tightness, try a
daily stretching routine.
Special Note: If you have tightness in one of your arms or legs, you will
experience resistance when moving those parts. By applying more slow,
steady pressure to the limb, you can overcome this resistance. Stop moving if
you experience pain.
In as little as 20 minutes, you can complete the entire stretching exercise
program.
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perience pain.
In as little as 20 minutes, you can complete the entire stretching exercise
program. Repeat several times, up to ten times, holding each stretch for 5
seconds.
CHAPTER 13
BACK STRETCHING
We experience muscle strains more frequently than other physical conditions.
At some point in their lives, four out of every five people will experience
back pain, which is typically brought on by muscular strain.
Back pain is actually the second most painful disorder after headaches.
Muscle strains of all kinds can be avoided with regular stretching exercises.
In actuality, the majority of instances of muscular strains are brought on by
weak muscles and poor posture.
You can avoid future muscle strains by performing the exercises below, or
you can use them to recover from current ones. However, if you are in a lot
of pain, you shouldn’t do these exercises.
Before beginning any of these exercises, consult your doctor.
DOUBLE KNEE-TO-CHEST STRETCH
1. Lie flat on your back.
2. Pull both knees close to the chest until your lower back is comfortably
stretched.
3. Maintain a relaxed back position. For 45 to 60 seconds, hold.
4. Let go of. Repetition twice.
5. Perform once daily.
FLEXIBLE TRUNK STRETCH
1. With your knees bent, tuck your chin and arch your back.
2. Sit back on your heels gradually, allowing your shoulders to drop to the
floor.
3. Maintain a relaxed back.
4. Maintain for between 45 and 60 seconds.
5. Discharge. Repetition twice.
6.
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ntain a relaxed back.
4. Maintain for between 45 and 60 seconds.
5. Discharge. Repetition twice.
6. Perform once daily.
LOWER TRUNK ROTATION STRETCH
1. Lie flat on your back.
2. Bring both knees to your chest and maintain a 90-degree angle.
3. Gently squat down until your left knee touches the floor.
4. Maintain a relaxed back.
5. Maintain for between 45 and 60 seconds.
6. Discharge. On each side, repeat twice.
7. Execute once daily.
ROTATION STRETCH IN THE MID-BACK
1. Lie on your stomach. Lift the body so that only the feet and hands are on
the ground.
2. With your chest as close to the floor as you can, reach out to each side as
far as you can.
3. Maintain for 45 to 60 seconds before releasing.
4. Do this twice, once on each side.
5. Perform once daily.
BACK STRETCHES
Lower back stretches should be a part of your exercise regimen.
The lower back often becomes quite tight as a result of our sedentary
lifestyles and extended hours of sitting.
The structures of the spine are subjected to additional strain when the lower
back is tight because it cannot move appropriately.
Additionally, demanding abdominal workouts like leg raises and sit-ups
would be more challenging to complete with a tense lower back.
Additionally, all abdominal workouts will have a reduced range of motion if
your lower back is rigid.
One aspect that might reduce the effectiveness of abdominal workouts is a
lack of flexibility in the lower spine.
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t might reduce the effectiveness of abdominal workouts is a
lack of flexibility in the lower spine. Here are some lower back stretches to
increase flexibility.
COBRA STRETCH
Starting Position: In a stomach-down position.
Form: Extend your body backward while gently raising your body off the
ground with your hands. After holding for 20 to 30 seconds, reset to the
beginning position.
Personal Trainer Advice: Move slowly and deliberately. Only advance as far
as you are at ease.
BABY’S POSE ( PRAYER STRETCH )
Sit back on your heels in the starting position and let your arms hang freely
above your head.
Personal Trainer Advice: This famous yoga position is excellent for
stretching out the lower back after a challenging core or abs workout.
DOUBLE KNEES TO THE SIDE
Laying on your back with your feet bent is the starting position and form.
Slowly bend your knees to the side while maintaining your feet on the
ground. Slide your knees to the opposite side after holding for 20–30
seconds.
Use your arms to balance your body, according to personal trainer's advice.
Your lower back should feel well stretched.
ONE LEG TO THE SIDE,
Lie face up with your arms spread to the side as your starting position and
form. As high as it will go, extend your left leg, and then gradually lower it to
the ground.
Personal Training Advice: Exert yourself as far as you can without
discomfort.
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er it to
the ground.
Personal Training Advice: Exert yourself as far as you can without
discomfort. You may move your leg until it comes in contact with your hand.
CHAPTER 14
NECK STRETCHING
Having strong, flexible muscles and joints that can withstand tension and
damage is the greatest approach to avoid becoming hurt. There is mobility in
the neck and back. Long lengths of time spent in a static posture, such as
hours spent staring at a computer screen, increase the risk of back and neck
stiffness.
Movement is the greatest preventative treatment for neck and back pain.
Stretch frequently throughout your time away from the computer.
Here are some simple stretching exercises for uncomplicated cases of neck
discomfort that might provide relief. Some of them can even be used at work
to reduce neck tension.
Neck GLIDE
Start off with a straight neck. Slide your chin forward gradually. Return to
your starting position after holding for 5 seconds.
ten times.
NECK ELEVATION
Slowly turn your head backward to look upward without arching your back.
Take a five-second hold. Go back to your starting point. To avoid neck
discomfort at work, try performing this exercise.
NECK TURNING
Start by focusing on the direction ahead. Turn your head slowly to the left.
Hold for 10 seconds, then get back to where you were. Turn your head
carefully to the opposite side after that.
Ten seconds of holding. Go back to your starting point.
Make 10 repetitions.
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osite side after that.
Ten seconds of holding. Go back to your starting point.
Make 10 repetitions. This is a useful exercise to perform while working,
especially if you must maintain a stable head posture for long periods of time,
such as when using a computer.
To avoid neck tension, perform this exercise every half-hour.
LATERAL EXTENSION
Start by focusing directly in front of you. Slowly turn your head to the left.
Use the muscles in your neck to press on it while using your left hand as
resistance.
Return to your starting position after holding for 5 seconds. Next, softly
incline your head to the opposite side. Hold for 5 seconds. Go back to the
beginning point.
Repeat ten times. This is a beneficial exercise to perform while working,
particularly if you must maintain a stable head posture for long periods of
time, such as when using a computer.
To prevent neck tension, perform this exercise every half-hour.
SHARP SHRUGS
Look straight ahead to begin. Raise your shoulders slowly. After holding for
five seconds, go back to your starting position.
Make ten repetitions. This is a beneficial exercise to perform while working,
particularly if you must maintain a stable head posture for long periods of
time, such as when using a computer.
Perform these exercises every 30 minutes to avoid neck strain.
FORWARD TILTING FLEXION
Start by concentrating on the future course. Gradually tuck your chin into
your chest. Hold for five seconds, then restart to the initial position.
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dually tuck your chin into
your chest. Hold for five seconds, then restart to the initial position. 10 times
in total.
This is a useful exercise to do while working, particularly if you have to keep
your head in a steady position for extended periods of time, such as when
using a computer.
Perform this exercise every 30 minutes to prevent neck pain.
DEEP STRETCHING
Maintaining good posture, let your head droop toward your shoulder. You
can exert pressure with your hand, as was shown.
On the other side, you may keep holding on to your chair. After 30 seconds
of holding, repeat three times.
PRESSES OF RESISTANCE
Maintain a neutral head posture at all times. The following head pressure
positions should be applied for 5 seconds, then released.
Put your hand on your forehead to flex. Hand extension: position it behind
the head.
TOWEL PULL
Wrap the towel around your neck, holding the ends in place with your hands.
Roll your head over the towel while you slowly stare up as far as you can.
As you stretch your head back, nuzzle a towel on your cervical spine for
support. Don't remain in that situation. Instead, go back to where you were.
Ten times in total.
CHAPTER 15
UPPER LIMB STRETCHING
FLEXION-EXTENSION STRETCHING OF THE SHOULDER
With one hand, grasp the forearm. Grab the top of the shoulder joint with the
opposite hand to stabilize it. Keep the elbow fairly straight while turning the
palm inside so that it faces the body.
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abilize it. Keep the elbow fairly straight while turning the
palm inside so that it faces the body. From the side of the torso, raise the arm
over the head.
ABDUCTION-ADDUCTION STRETCHING AT THE SHOULDERS
Put one hand on the shoulder to help the shoulder joint remain stable. Support
the forearm and turn the palm outward while using the other hand to grasp
the elbow. As far as it will allow, extend the arm out to the side and away
from the body.
INTERNAL AND EXTERNAL ROTATION STRETCHING FOR THE
SHOULDER
Lean one shoulder with your hand. Hold the forearm firmly in your other
hand. Shoulder-level arm extension is required. You should turn the arm to
point the hand upward. After then, lower the arm back down until the hand is
pointing towards the ground and the upper arm is twisting at the shoulder
joint.
FLEXION-EXTENSION STRETCHING FOR ELBOW
With one hand, hold the forearm; with the other, the upper arm. The elbow
should be bent such that the hand contacts the shoulder. After that, fully
extend the arm straight.
SUPINATION-PRONATION STRETCHING OF THE FOREARM
Hold the wrist with one hand and the area under the elbow with the other.
Twist the forearm while turning the palm of the hand so that it faces up
toward the ceiling, then downward toward the floor.
FLEXION-EXTENSION STRETCHING FOR WRIST
With one hand, grasp the forearm just above the wrist. Put the fingers and
thumb of the other hand on either side of the palm.
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rearm just above the wrist. Put the fingers and
thumb of the other hand on either side of the palm. Holding the hand in this
position, bend it roughly 90 degrees up at the wrist and down at the wrist.
Naturally, the fingers will straighten.
FINGER FLEXION-EXTENSION STRETCHING
Put the palm of the hand down. Flex the fingers up and raise the wrist. Next,
extend your fingers while bending your wrist downward.
THUMB EXTENSION
The thumb should bend and straighten. To expand the “web space,” extend
the thumb to the side.
CHAPTER 16
LOWER LIMB STRETCHING
GUIDE FOR STRETCHING
1) The muscles should feel like they are softly being pulled during a stretch.
2) It shouldn’t be uncomfortable.
3. Pay attention to your body’s cues to avoid overextending yourself or
becoming unproductive. Hold each stretch for around 10 deep breaths or
thirty seconds.
4) Take slow, deep breaths during all stretching activities.
THE ADDUCTORS STRETCH
Place your feet apart as you stand. While maintaining the left knee straight,
bend the right knee. Until the left inner thigh on the other side stretches,
bend.
QUADRICEPS STRETCH
Place your right foot on the ground and lean against the wall. Holding the left
foot on the buttocks while bending the left knee. Keep moving forward with
your hips. Keep your right knee slightly bent.
CALF STRETCH
Your left leg should be behind your right. Bend the right knee while
maintaining a flat left heel on the ground. If you like, lean your upper body
against the wall.
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ile
maintaining a flat left heel on the ground. If you like, lean your upper body
against the wall. Maintain a totally straight left knee. When your rear calf
starts to stretch, lean forward.
HAMSTRING STRETCH
Lay your back flat. Wrap your right foot with a towel. Use the towel to raise
your right leg into the air after straightening it. Keep your shoulders from
tensing up.
PIRIFORMIS STRETCH
With your legs bent, lie on your back. Your left ankle should be resting on
your right knee when you cross your legs. Draw your right knee close to your
heart.
GLUTEALS STRETCH
Lay down on your back. Holding it there with both hands, bring your right
knee to your chest.
CHAPTER 17
STRETCHING PLAN/ROUTINE
HOW STRETCHING HELPS
Stretching is the best method for providing pain relief and long-term
discomfort avoidance when it comes to tight muscles. As I’ve previously
explained, stretching involves moving one end of a muscle away from the
other, which causes the muscular tissue to actually lengthen.
The joints will undoubtedly be more flexible as a result, allowing chiropractic
treatments to last longer because the joint won’t freeze up and get subluxated
again too soon. However, when muscle tissue lengthens, tension is released,
and that painful, achy sensation that is a part of the tight muscle experience
starts to go as well.
The body becomes flexible and free via frequent stretching.
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muscle experience
starts to go as well.
The body becomes flexible and free via frequent stretching. I tell my
customers that people could save 50% of the patient visits I see in any given
week if they just stretched often. I now see that this is poor practice
management since, after all, shouldn't physicians want more patients to seek
treatment for their pain? Yes, but not in my practice, at least.
I attempt to impart physical empowerment techniques to others. I would like
that they just require chiropractic maintenance and wellness care when they
arrive. However, chiropractic practices will continue to operate and treat
individuals in pain as long as people ignore the need to stretch their muscles.
That is simply a reality right now.
A BEGINNER STRETCHING PLAN
So getting you started, I’d like to provide you with a stretching practice for
beginners. I’m aware that it’s crucial to be realistic when addressing activity
frequency, especially with novices.
In an ideal world, you would perform these stretches three times per week,
but I understand that this may be too demanding. Even three times per week
will benefit your health and your life.
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d that this may be too demanding. Even three times per week
will benefit your health and your life. Although there is no specific order in
which these stretches should be done, I prefer to start with my legs and
buttocks before moving on to my neck, chest, shoulders, and arms.
ADDITIONAL EFFECTIVE AND OPTIONAL STRETCHING PLAN
Try the following stretching practice if you’re a more experienced stretcher—
someone who has taken yoga, played sports, or now stretches at the gym, in a
dancing class, or with a trainer.
Pigeon:
Sit with your feet flat on the ground and your knees bent. Place your arms
behind you for support. While maintaining the foot flexible, cross your right
ankle over your left knee. To improve the stretch, move your left foot up
closer to your hip.
Thigh stretch:
Lie on your right side to stretch your thighs.
To extend the front of the thigh, grab the top of your left foot and slide your
heel toward your left buttock.
Knees should remain in contact.
On the opposite side, repeat.
Neck Stretch:
Start off with your back straight and your head directly above your shoulders.
Drop your chin toward your chest for 15 to 30 seconds.
Remain calm and raise your head gradually.
Tilt your chin forward and toward the ceiling, bringing the base of your head
toward your back.
Several times, repeat the set.
Shoulder stretch:
With your arms and elbows at a 90-degree angle, stand in a doorway.
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eat the set.
Shoulder stretch:
With your arms and elbows at a 90-degree angle, stand in a doorway.
Your palm and right forearm should be in the doorway as you raise your right
arm to shoulder height.
Stretch out gently, only as far as being comfortable.
Up to 30 seconds can be spent holding the stretch.
Change sides and repeat.
Forearm stretch:
With your other hand, bend your hand downward and gently pull it in your
direction. Your elbow and forearm will be tense. Spend 15 to 30 seconds
holding the stretch. Remain calm, go back to your starting posture, and
stretch your other hand.
MOTIVATION FOR ADEQUATE STRETCHING
Everyone who stretches should be aware that the amount of time one holds
the stretch is what truly adds length to the muscles. The least amount of time
required to add muscle fibers to the end of a stretched muscle is thirty
seconds.
Thirty seconds will be fine, however, sixty is preferable. Therefore, you must
maintain that stretch, no matter how difficult it may be, in order to get all the
advantages of muscle lengthening—reduced pain, improved range of motion,
and pain avoidance. Just wait!
You may also stretch differently, which I refer to as “cobweb stretching.”
When there isn’t enough time to stretch regularly, this should be done
instead.
Cobweb stretching is when you hold a stretch for a shorter period than usual,
like 10 seconds.
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ead.
Cobweb stretching is when you hold a stretch for a shorter period than usual,
like 10 seconds. This allows you to complete your practice and “get the
cobwebs out” even if you are pressed for time.
Before you conclude that this form of stretching offers little benefit, realize
that holding a stretch for even a little period will allow the muscles to relax,
allowing you more range of motion. My hectic routine frequently includes
cobweb stretching, and it is beneficial to me. Anyone who wants to keep their
muscles flexible and live pain-free should try it, in my opinion.
WHAT TO EXPECT AFTER STRETCHING
Starting a new stretching routine has predictable outcomes. The ache of
stretching tight, uncared-for muscles is the very first thing newbies
encounter. Some people’s pain is only a tightness, while others may also
experience burning. Do not worry; this is typical. Lactic acid is being
produced by the muscular tissue when you experience burning.
However, as you start to feel the lactic acid burn, ease up on the stretch since
you don’t want to go too far. Do not be alarmed if you have never
experienced this sensation; what I am describing is simply a “Indian burn,”
the type we used to give each other as kids.
The tightness of the early stage of stretching will pass quite fast, and then the
stretch will start to feel nice.
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f the early stage of stretching will pass quite fast, and then the
stretch will start to feel nice. It’s interesting that you continue to feel the same
sensation, but your perspective changes as a result of the way your mind
begins to analyze it.
Although it is very remarkable how this occurs, I am aware from 10 years of
experience that stretching hurts forever. Instead, I now crave for it and make
the most of every opportunity. Crazy, but real.
CONCLUSION AND SUMMARY
Stretching maintains the muscles’ flexibility, strength, and health. In
actuality, we require that flexibility to preserve a joint range of motion. The
muscles shrink and tighten without it. The muscles become weak and are
unable to fully expand when you then ask for activity in them.
Stretch and keep safe above everything else.
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©2009, Elsevier Limited. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by
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publisher. Permissions may be sought directly from Elsevier’s Rights Department:
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First published 2009
ISBN 978-0-443-06814-0
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
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Notice
Neither the publisher nor the Author assumes any responsibility for any loss or injury
and/or damage to persons or property arising out of or relating to any use of the material
contained in this book. It is the responsibility of the treating practitioner, relying on
independent expertise and knowledge of the patient, to determine the best treatment
and method of application for the patient.
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owledge of the patient, to determine the best treatment
and method of application for the patient.
The
Publisher’s
policy is to use
paper manufactured
from sustainable forests
Printed in China
CHAPTER
1
Introduction
When I first learned Thai Massage in 1992 it was barely known in
England. The School of Oriental Massage was the only place offering
courses in the UK. Our teachers Harry McGill and Stephen Brooks sup
plied us with the book Traditional Thai Massage published in Thailand
by Sombat Tapanya in 1990. This, they imported themselves from
Thailand and at that time it was the only book available.
Little did I realise then what an excellent choice of training I was
making. After just four weekends of study and plenty of practice I had
gained a diploma in Traditional Thai Healing Massage and profes
sional insurance. The ‘Life Centre ’ had just opened in London’s Notting
Hill and I applied to work there. I was ‘auditioned’ by the owner and
on the basis of that massage I was offered a beautiful place to work.
The novelty of Thai Massage in 1992 guaranteed me plenty of pub
licity and patients and in a short time I had a thriving practice. I soon
came to see that there was an enormous difference between practising
in a classroom and practising in a clinic. I offered one-and-a-half-hour
sessions and often I was fully booked with six sessions back-to-back.
In a short time I had to learn a lot about timing, pacing and efficiency.
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x sessions back-to-back.
In a short time I had to learn a lot about timing, pacing and efficiency.
I realised that many of the techniques, although fun in the class
room, simply did not work on ordinary patients of average flexibility.
I pruned my technique until I was left only with the most safe and
2
A Myofascial Approach to Thai Massage
effective ones. Two years later I was asked to start teaching Thai
Massage at Morley College in London.
My aim back then was not to begin a long-term career as a massage
therapist but to find a way of financing my training as a psychother
apist. In 1991 I had happened upon Stanley Keleman’s extraordinary
book Emotional Anatomy. Serendipity led me to Belgium, where I joined
a workshop Keleman was leading. There began my interest in body
work, albeit under the influence of Keleman’s ‘hands off ’ approach.
I returned to London and signed up for a three-year training in inte
grative psychotherapy. Practising Thai Massage was supposed to be a
way of paying for my training and of ‘learning on the job ’. Instead, it
became my main occupation for 15 years. But then that’s its beauty;
despite being quite simple to learn it provides a wonderful structure
in which to keep on learning. Thai Massage became for me my medi
tation, my relaxation, my yoga and my tai chi. All of these possibili
ties are folded into this direct and intimate form of bodywork.
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my tai chi. All of these possibili
ties are folded into this direct and intimate form of bodywork. Thai
Massage also taught me that my strength as a therapist lay not with
words but with touch.
There are three main activities involved in the practice of Thai
Massage. They are:
● the manipulation of a series of lines known as ‘sen’;
● the application of passive stretches and postures derived from
Hatha Yoga;
● the induction of a deep ‘meditation-like’ relaxation in the
patient.
The balance of these three activities is quite individual and the mas
sage will vary considerably depending on the massage therapist’s pref
erences. Some massage therapists are more attracted to the yoga aspects
of the work and offer quite dynamic massage sessions.
Some are drawn more to the stretches, and practise Thai Massage
with a ‘no pain, no gain ’ style similar to that found in sports massage.
The approach to Thai Massage covered in this book focuses mainly
on the manipulation of the sen and on relaxation. This is the style
encouraged by my teachers. One of them, Asokananda (aka Harald
Brust), with whom I studied advanced Thai Massage in 1995, says of
Thai Massage that it ‘ … always was and is centred around intensive and
complete line work ’ ( Brust 1996 ).
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ge that it ‘ … always was and is centred around intensive and
complete line work ’ ( Brust 1996 ).
Many people liken the sen used in Thai Massage to the channels
used in acupuncture and generalise Thai Massage as a form of ‘energy
work ’ similar to Japanese shiatsu or Chinese acupressure (Brust 1990,
Mercati 1998, Gold 2007). I had already studied Traditional Chinese
Acupuncture with JR Worsley in the early 1980s. Although there were
some similarities between the sen used in Thai Massage and the chan
nels used in acupuncture, for me this was a perilous comparison. What
it revealed were major shortcomings in our knowledge of the sen.
3
Introduction
■
CHAPTER 1
In Thai Massage there was no sense of a complete system comparable
to acupuncture channels and there was no system of diagnosis with
which to justify the term ‘energy work ’. In acupuncture there is a very
clear, if difficult to learn, system of diagnosis with which to detect and
interpret imbalances in the channel system.
Despite these shortcomings, Thai Massage nevertheless performs
well under clinical conditions. In my practice many patients became
regulars, finding benefit enough to build Thai Massage into their
schedules. Despite claiming to offer no more than relaxation, many
patients reported improvements in other aspects of their lives.
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ffer no more than relaxation, many
patients reported improvements in other aspects of their lives. These
improvements included resolution of physical problems, improvement
in sleep patterns, clearer thinking, improvement in work and social
relationships and more. Although I was smart enough to not claim too
much credit I was nevertheless curious to understand just why such a
simple massage could have such beneficial effects on my patients.
In 1995 I signed up for a series of ‘structural integration ’ sessions
in the hands of a therapist trained by the system’s founder, Ida Rolf.
Structural integration or ‘Rolfing ’ involves the application of deep, sus
tained pressure into the body’s fascial binding and myofascial planes
in order to break up postural habits fixed into the fibre of the fascia.
The aim of structural integration is, over a series of ten sessions, to
improve the body’s orientation to the field of gravity. Energy bound up
in maintaining poor posture and balance is freed for living.
Two aspects of the experience strongly influenced my understanding
of the practice of Thai Massage. The first of these was the aliveness of the
practitioner’s contact. I soon came to appreciate that the pressure applied
into the fascia of my body was not just dumb force but carried with it
a clear sense of the therapist feeling the changes occurring beneath his
knuckles.
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arried with it
a clear sense of the therapist feeling the changes occurring beneath his
knuckles. This experience of being felt rather than just worked on offered
me a measure by which to judge all future massages. There is a world
of difference between receiving a massage from an engaged and present
massage therapist and from someone simply doing techniques.
The other aspect was the realisation that many of the fascial planes
employed in structural integration were similar to the sen on which I
worked while giving Thai Massage. This started a process of exploration
as I attempted to integrate the practical techniques I had learned as
Thai Massage with the idea of myofascial planes. This book is another
step in that process.
References
Brust H ( 1990 ) The Art of Traditional Thai Massage, p. 6 . Editions Duang
Kamol : Bangkok, Thailand .
Brust H ( 1996) Thai Traditional Massage for Advanced Practitioners, p. 18 .
Editions Duang Kamol : Bangkok, Thailand .
Gold R ( 2007) Thai Massage, p. 12 . Mosby Elsevier : St Louis, MO.
Mercati M ( 1998) Thai Massage, p. 10 . Marshall Publishing : London .
4
A Myofascial Approach to Thai Massage
Resources
Asokananda died on Friday, 24 June 2005. The Sunshine Network continues
his work and offers Thai Massage courses in the Lahu village where
Asokananda made his home and school in Northern Thailand.
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assage courses in the Lahu village where
Asokananda made his home and school in Northern Thailand.
http://www.thaiyogamassage.infothai.com/#thailand
CHAPTER
2
Past and present
CHAPTER CONTENTS
A brief history
5
Jivaka Kumar Bhaccha
6
Thai Massage today
8
A brief history
Thai Massage is one of the three branches of Traditional Thai Medicine.
The others are naturopathic (including dietary) medicine and spir
itual practices. Traditional Thai Medicine is intimately entwined with
Theravada Buddhism, the esoteric and monastic branch of Buddhism
practised in Southeast Asia and Sri Lanka. In Thailand traditional
medicine is still generally offered under the auspices of the Buddhist
monastic community.
It is not known exactly when Buddhism came to Thailand. Some
accounts suggest that Asoka, India’s first Emperor, sent missionaries in
the second century BC. Asoka embraced Buddhism in response to the
terrible cruelty he saw during the conquest of Kalinga. He came to be
known as ‘The Prince of Peace ’ ( Kinder & Hilgemann 1978 ).
A stone inscription from 1292 AD records the declaration of Rama
Khamheng, King of Siam, that Buddhism be recognised as the coun
try’s official religion ( Gold 2007 ). Beyond that little more is known.
6
A Myofascial Approach to Thai Massage
Fig. 2.1 Three of 60
epigraphs carved on stone
at Wat Pho.
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A Myofascial Approach to Thai Massage
Fig. 2.1 Three of 60
epigraphs carved on stone
at Wat Pho. Reproduced
from a photograph by John
Glines with permission
When the Burmese invaded Thailand in 1767 they destroyed the
old royal capital of Ayutthia and with it most historical and medical
texts.
In 1832 King Rama III gathered what fragments of the medical texts
survived and had them carved into stone and set into the walls of the
Wat Pho, the main Buddhist monastery in Bangkok. These carvings
comprise 60 figures and are believed to indicate treatment lines and
points on the human body with explanatory notes ( Fig. 2.1 ) ( Brust
1990 ).
Jivaka Kumar Bhaccha
Most Thais venerate the North Indian physician Jivaka Kumar
Bhaccha as the father of Thai medicine. The Foundation of Dr Shivaga
Komarpaj preserves Jivaka’s name in its Thai version. The foundation
runs the Old Medical Hospital in Chiang Mai where it offers courses in
Thai Massage.
Jivaka Kumar Bhaccha was a member of the community (sangha)
that gathered around the Buddha 2500 years ago. His story is included
in the Vinaya Pitaka, a Theravadin document that records the life of
that original sangha and lists the 227 rules governing monastic life.
7
Past and present
■
CHAPTER 2
According to this account Jivaka’s father was King Bimbisara, a con
temporary of the Buddha, and the ruler of the Magadha Empire in
North India.
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ing Bimbisara, a con
temporary of the Buddha, and the ruler of the Magadha Empire in
North India. King Bimbisara was a passionate man who lusted after
beautiful women. One day he was travelling by elephant in the coun
tryside when he came upon the house of a wealthy merchant. The mer
chant was away on business. The merchant’s wife, who was alone, saw
the king and told him she wished to present him with a garland. The
king asked her to come outside but she refused and, instead, requested
that the king come inside. When the king entered the house they were
both overcome with lust and slept together.
A few months later the merchant’s wife went to the king and told
him that she bore his child. The king gave her a linen cloth and a ring
in acknowledgement of their relationship. He told the merchant’s wife
‘ if a daughter is born, she is yours. If a son is born, bring him to me
dressed in the linen and wearing the ring.’
Some time after this meeting the woman received a letter from her
husband saying that he would soon be returning home. She was wor
ried as she was now heavy with child. She immediately went to the
king and told him of the letter. The king sent a messenger with instruc
tions that the merchant should search for a precious stone before
returning home.
The merchant’s wife gave birth to a beautiful son, Jivaka Kumar
Bhaccha. She dressed him in the king’s linen and put the ring on his
finger.
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ul son, Jivaka Kumar
Bhaccha. She dressed him in the king’s linen and put the ring on his
finger. She went to the palace and left the baby there in a basket. When
the king found the child he recognised him as his own son. He gave
the child to the care of Zhonu Jigme.
One day the young Jivaka saw a group of people dressed in white.
He asked his father who they were. The king told him they were doc
tors who cured diseases. Jivaka realised his vocation. He asked his
father’s permission to study under Atreya, the renowned Rishi physi
cian who lived in Taxila. Atreya was the personal physician to Padma
dPal, the father of King Bimbisara.
The years of study under Atreya bore fruit and Jivaka stood out as
the most brilliant student in his class. It is said that on three occa
sions he even corrected his teacher. Over time Jivaka became famous
as a skilled and competent physician. He grew proud and boasted that
he was the supreme physician. He boasted that nobody could cure a
somatic disorder, as could he; just as nobody could cure a psychologi
cal disorder, as could the Buddha.
Like many of his contemporaries Jivaka went to the Buddha to
learn the path by which he could free himself from his suffering.
The Buddha taught him extensively but his teachings seemed to have
no effect on Jivaka. Realising that Jivaka was unable to perceive the
truth, the Buddha sent him to the King of Mountains in the Land
of the Snow (the Himalayas) to gather medicinal ingredients.
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to the King of Mountains in the Land
of the Snow (the Himalayas) to gather medicinal ingredients. Jivaka
was afraid to go alone so the Buddha sent Vajradhara (the primordial
Buddha) as his companion.
8
A Myofascial Approach to Thai Massage
When Jivaka returned, the Buddha asked him to name the vari
ous medicinal ingredients. Although Jivaka could name many, there
were others about which he knew nothing. The Buddha named them
and gave an extensive explanation of their powers, actions, uses and
contraindications.
Cured of his pride, Jivaka realised that the Buddha was indeed the
supreme physician and he submitted himself to his teachings. The
Buddha then taught Jivaka the four noble truths; the basis of what was
to become Theravada Buddhism:
● the truth of suffering (disease);
● the truth of the cause of suffering;
● the truth of freedom from suffering (health);
● the truth of the path (medicine).
It is said that on occasion Jivaka offered his skills as a physician to
the Buddha. He also attended his own half-brother, Ajatashatru, who
had killed their father, King Bimbisara, in order to seize the throne.
King Ajatashatru went on to become a devotee of the Buddha and
became patron of the community that gathered around him.
Jivaka was, during his lifetime, three times crowned ‘the King of
Physicians ’. According to legend he finally attained enlightenment and
freedom from death ( Rapgay 1981 ).
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s ’. According to legend he finally attained enlightenment and
freedom from death ( Rapgay 1981 ).
Thai Massage today
Until the late 1980s Thai Massage was little known outside of Thailand.
Even within the country the traditional medical system to which the
massage belonged was losing favour. In common with many of its
Asian neighbours, Thailand was embracing a Western model of indus
trial and economic development and the modern medical system it
brought with it.
While Buddhist monks administered most aspects of Traditional
Thai Medicine from their monasteries, massage was also practised
within families and offered by village practitioners. Formal training
in Thai Massage was available through the two main massage schools
of Wat Pho in Bangkok and the Old Medical Hospital in Chiang Mai.
Village practitioners more often learned their craft through family
lines.
Thai Massage is now enjoying a new lease of life in Thailand as
well as finding its way into massage centres and hotel spas around the
world. This revival owes much to the interest shown by Western travel
lers, some of whom found their way to the traditional massage schools
or studied directly with village massage therapists.
Thai Massage was typically taught as a practical study with little the
ory to explain the techniques.
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i Massage was typically taught as a practical study with little the
ory to explain the techniques. Despite and possibly because of this lack
9
Past and present
■
CHAPTER 2
of theory some of these early Western students discovered an affinity
with the practice and went on to become teachers themselves.
Between 1990 and the present day much has changed in the world
of Thai Massage. There are now many more schools offering courses in
Thailand as well as around the world. There is now an abundance of
books on the subject. ‘Thai Reflexology ’ and ‘Thai Head Massage ’ have
emerged as standalone therapies. Even aspects of Thai herbal medicine
have entered the mainstream and it is now quite common to see the
use of ‘Thai herbal compresses ’ in hotel spas.
Thai Massage has also found its place in the academic world. In 1997
Thai Massage was first offered as a short course within a graduate pro
gramme at the University of Westminster in London. In 2005 research
ers from the Department of Health, Physical Education and Dance at
the City University of New York and the Department of Exercise and
Wellness at Arizona State University conducted a study comparing the
effect of a single session of either Thai or Swedish massage on mood
and tension/anxiety measures ( Cowen et al. 2006 ). Although both
Thai and Swedish massage produced significant improvement on these
measures they scored equally on effectiveness.
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h massage produced significant improvement on these
measures they scored equally on effectiveness.
Despite the global reach of Thai Massage there has been little devel
opment in understanding the medical system to which the massage
belongs. Given that Thai Massage is but a small part of a Buddhist
approach to medicine this is, perhaps, not so surprising. Buddha
taught Jivaka Kumar that the cause of all suffering, whether physical or
mental, is the greed, anger and ignorance generated by the unenlight
ened mind. Although traditional Buddhist medicine includes naturo
pathic remedies and physical therapy, of far greater importance is the
spiritual teaching and practical guidance offered by the lama physi
cians of the monastic community. Buddhist medicine is taught within
the broader context of Buddhist philosophy and medical intervention
is similarly prescribed.
What is known is that Thai Massage is based on the manipulation
of treatment lines called ‘sen’. These are documented in the stone carv
ings of Wat Pho. It is generally accepted that these carvings refer to a
network of 72 000 lines or channels permeating the body. Ten of these
are used for massage. These are known as the ‘ten sen ’. The lack of a
coherent model with which to explain the sen leads many Western
practitioners to better-documented systems for information. These
include Traditional Chinese Medicine, Ayur-vedic Medicine and Hatha
Yoga.
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for information. These
include Traditional Chinese Medicine, Ayur-vedic Medicine and Hatha
Yoga. Each of these traditions acknowledges a system of channels with
similarities to the sen.
References
Brust H ( 1990 ) The Art of Traditional Thai Massage, p. 5 . Editions Duang
Kamol : Bangkok, Thailand .
10
A Myofascial Approach to Thai Massage
Cowen VS, Burkett L , Bredimus J , et al. ( 2006 ) A comparative study of Thai
massage and Swedish massage relative to physiological and psychological
measures. Journal of Bodywork and Movement Therapies (JBMT) 10:
266 – 275 .
Gold R ( 2007) Thai Massage: A Traditional Medical Technique, p. 6 . Mosby
Elsevier : St Louis, MO.
Kinder H & Hilgemann W ( 1978) Atlas of World History, Vol. 1, p. 43 .
Penguin Books : Middlesex, UK .
Rapgay L ( 1981 ) Tibetan Medicine, No 3: pp. 11–14 . The Library of Tibetan
Works and Archives : Dharamsala, India .
CHAPTER
3
Ten sen – West meets East
CHAPTER CONTENTS
Ten sen
11
Sen and Traditional Chinese Medicine
22
Sen, Ayur-veda and yoga
22
Ten sen
The following descriptions of the pathways of the ten sen are based on
those given in the Handbook for Traditional Thai Massage issued by the
Foundation of Dr Shivaga Komarpaj in Chiang Mai.
12
A Myofascial Approach to Thai Massage
1. Sen sumana
Sen sumana ( Fig.
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hiang Mai.
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A Myofascial Approach to Thai Massage
1. Sen sumana
Sen sumana ( Fig. 3.1 ) starts at the navel and ascends inside the throat,
terminating at the base of the tongue.
Fig. 3.1 Sen sumana
13
Ten sen – West meets East
■
CHAPTER 3
2. Sen ittha
Sen ittha ( Fig. 3.2 ) starts at the navel and travels down the inside front
of the left thigh. It turns around the left knee and travels up the back
of the left thigh. The line continues up the left side of the spine and
over the top of the head, terminating at the left nostril.
Fig. 3.2 Sen ittha
14
A Myofascial Approach to Thai Massage
3. Sen pingkhala
Sen pingkhala ( Fig. 3.3 ) follows the same pathway as sen ittha but on
the right side of the body. Sen pingkhala starts at the navel and travels
down the inside front of the right thigh. It turns around the right knee
and travels up the back of the right thigh. The line continues up the
right side of the spine and over the top of the head, terminating at the
right nostril.
Fig. 3.3 Sen pingkhala
15
Ten sen – West meets East
■
CHAPTER 3
4. Sen kalathari
Sen kalathari ( Fig. 3.4 ) starts at the navel and divides into four
branches.
Two branches travel down to the groins and continue down the
inside of the legs to the toes.
Two branches travel up to the armpits and then down the inside of
the arms to the fingers.
Fig.
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Two branches travel up to the armpits and then down the inside of
the arms to the fingers.
Fig. 3.4 Sen kalathari
16
A Myofascial Approach to Thai Massage
5. Sen sahatsarangsi
Sen sahatsarangsi ( Fig. 3.5 ) starts at the navel and travels down the
inside of the left leg. It crosses the foot and then travels up the out
side of the left leg. The line continues up the left side of the abdomen,
chest and neck terminating at the left eye.
Fig. 3.5 Sen sahatsarangsi
17
Ten sen – West meets East
■
CHAPTER 3
6. Sen thawari
Sen thawari ( Fig. 3.6 ) follows the same path as sen sahatsarangsi but
on the right side of the body. Sen thawari starts at the navel and travels
down the inside of the right leg. It crosses the foot and then travels up
the outside of the right leg. The line continues up the right side of the
abdomen, chest and neck terminating at the right eye.
Fig. 3.6 Sen thawari
18
A Myofascial Approach to Thai Massage
7. Sen lawusang
Sen lawusang ( Fig. 3.7 ) starts at the navel and travels up the left side of
the chest. It continues up the left side of the throat and terminates at
the left ear.
Fig. 3.7 Sen lawusang
19
Ten sen – West meets East
■
CHAPTER 3
8. Sen ulangka
Sen ulangka ( Fig. 3.8 ) follows the same path as sen lawusang but on
the right side of the body. Sen ulangka starts at the navel and travels up
the right side of the chest.
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ight side of the body. Sen ulangka starts at the navel and travels up
the right side of the chest. It continues up the right side of the throat
and terminates at the right ear.
Fig. 3.8 Sen ulangka
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A Myofascial Approach to Thai Massage
9. Sen nanthakrawat
Sen nanthakrawat ( Fig. 3.9 ) travels down from the navel and divides
into two branches:
● sen sukumang terminates at the anus;
● sen sikinee terminates at the urethra.
Fig. 3.9 Sen nanthakrawat
21
Ten sen – West meets East
■
CHAPTER 3
10. Sen khitchanna
Sen khitchanna ( Fig. 3.10 ) starts at the navel and descends to the
sexual organs:
● in women the line becomes sen khitcha and terminates at the
clitoris;
● in men the line becomes sen pitakun and terminates at the
penis.
Fig. 3.10 Sen khitchanna
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A Myofascial Approach to Thai Massage
Apart from these descriptions, little more is known about the nature
and function of the ten sen or the system of 72 000 sen to which they
belong. It is possible that this knowledge exists within the monasteries
of Thailand but it has yet to find translation into English.
Sen and Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) today represents the fruit of
2500 years of development and refinement. Chinese acupuncture, one
branch of TCM, first attracted the attention of Western patients and
medical professionals in the 1960s.
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of TCM, first attracted the attention of Western patients and
medical professionals in the 1960s. As it proved its effectiveness as a
medical intervention it inspired an enormous amount of study and
research both in the West and in China in an effort to understand just
why this ancient medical system should be so effective.
In common with Traditional Thai Medicine, TCM also includes
naturopathic preparations, nutritional advice and manipulative ther
apy. Traditional Chinese Medicine is based on an anatomical model
similar to that used in the West but with the addition of acupuncture
channels and treatment points. The channels are used to describe the
interconnection of the various functional systems of the body. Until
recently this system of channels has been considered alien to Western
medicine and to the anatomical and physiological models on which
Western medicine is based. Because of occasional similarities, the sen
used in Thai Massage are often likened to the channels used in TCM.
In Traditional Chinese Medicine, however, there are not 10 but 14
main channels. There are, in addition, numerous secondary channels.
These include connecting channels, muscle channels and cutaneous
regions. The connecting channels branch further into minute connecting
channels, blood connecting channels and superficial connecting chan
nels ( Maciocia 1991 ). These form an intricate web involved in the dis
tribution of fluids and energies throughout the human body.
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m an intricate web involved in the dis
tribution of fluids and energies throughout the human body. Although
there is no specific reference to 72 000 channels in TCM it seems fair
to assume that this web of channels does have something in common
with the system of sen referred to in Traditional Thai Medicine.
Sen, Ayur-veda and yoga
Another source of information about Thai Massage is to be found in
India. Here in the homeland of Jivaka Kumar, patron of Traditional
Thai Medicine, a vast historical record exists. These are known as the
Upanishads and the Vedas, and they document the development
of the indigenous medical and spiritual system that forms the basis
of the Hindu and Buddhist religions. The oldest Upanishads, the
23
Ten sen – West meets East
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CHAPTER 3
Brhadaranyaka and the Chandogya, have been dated to the eighth
century BC, while the Vedas date from 1000 BC ( Milne 1995 ).
Ayur-veda, a naturopathic approach to medicine still practised
in India today, dates from the Vedic Period (1800–1000 BC) and is
believed by many to be the source of Traditional Thai Medicine. The
oldest existing encyclopaedic medical work is the Sushruta-Samhita.
Although much of this work was completed in the early Christian era,
parts of this collection are pre-Buddhist (Feuerstein 1990, p. 88 ).
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d in the early Christian era,
parts of this collection are pre-Buddhist (Feuerstein 1990, p. 88 ).
Hatha Yoga, the style of yoga practice most familiar in the West,
is documented in a series of Upanishads written between the sixth
and fourteenth centuries AD. This period saw the birth and develop
ment in India of the philosophy of Tantrism, the aim of which was
‘ to overcome the dualism between the ultimate Reality (Self) and the
conditional reality (ego) by insisting on the continuity between the
process of the world and the process of liberation or enlightenment ’
(Feuerstein 1990, p. 251 ).
Although for many Westerners Hatha Yoga represents little more
than a system of exercise, for its founders it was the distillation of centu
ries of research. The result is a psycho-spiritual system designed to inte
grate the spiritual life with the physical reality of the body. Hatha Yoga
means ‘yoga of the force ’ and its aim is nothing less than ‘the blissful
state of ecstatic merging with the Divine ’ (Feuerstein 1990, p. 246 ).
In the Yoga-Upanishads we find reference to ‘nadis’, the Ayur
vedic equivalent of the sen. The renowned, contemporary Hatha Yoga
teacher, BKS Iyengar, refers to the nadis as channels ‘through which
nervous energy passes ’ (Iyengar 1984, p. 117 ). In common with the
Thai system, some of the Yoga-Upanishads refer to 72 000 nadis.
Others, however, refer to 350 000.
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Thai system, some of the Yoga-Upanishads refer to 72 000 nadis.
Others, however, refer to 350 000. Similarly, some refer to ten impor
tant nadis but others refer to 14 or 15 (Motoyama 2003, p. 135 ).
There are other similarities between the Thai sen and the Ayur-vedic
nadis. In both systems three channels are considered to be particu
larly important. In Thai Massage they are sen sumana, sen ittha and
sen pingkhala. In Ayur-veda they are sushumna-nadi, ida-nadi and
pingala-nadi. Sen ittha and ida-nadi are in both systems symbolised
by the moon and associated with the feminine quality while sen ping
khala and pingala-nadi are symbolised by the sun and associated with
the masculine quality.
Hereafter we discover more differences than similarities. In the Thai
description, sen sumana starts at the navel and ascends inside the
throat, terminating at the base of the tongue. Sen ittha and sen ping
khala are described as lines that run either side of sen sumana and then
continue down into the legs. In the yogic tradition these lines are usu
ally depicted as a caduceus. Sushumna-nadi forms a central core while
ida-nadi and pingala-nadi weave a double helix, intersecting sushumna
nadi at a series of seven centres along the vertical axis of the body. In
Sanskrit these centres are called ‘chakras’, meaning wheel or vortex. They
are thought to relate to nerve plexuses ( Motoyama 2003, pp. 197–198 ) .
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ing wheel or vortex. They
are thought to relate to nerve plexuses ( Motoyama 2003, pp. 197–198 ) .
24
A Myofascial Approach to Thai Massage
24
According to the yogic tradition, sushumna-nadi means ‘the current
that is most gracious ’ ( Feuerstein 1990, p. 260 ). BKS Iyengar calls it
the nadi of fire and locates it inside the spinal column. He says it is the
main channel for the flow of nervous energy ( Iyengar 1984, p. 439 ).
Although there are some variations, most traditional yogic sources
agree that sushumna-nadi begins at the perineum and continues up to
a point called ‘Brahman Gate ’ at the top of the head ( Motoyama 2003,
p. 141 ).
The Yogic tradition goes still deeper, identifying within sushumna
nadi another channel called vajra-nadi and within that yet another
called citrini-nadi (Feuerstein 1990, p. 260 ). According to the Shat
Chakra-Nirupana, written in 1577 by a Bengali guru known as
Purananda, there is within citrini-nadi yet another called the Brahma
nadi (Motoyama 2003, p. 164 ).
It soon becomes clear when reviewing yogic literature that the nadis
are part of a complete and complex system involved not only in medi
cine but also in the development of consciousness. What we know
of this system in the West is generally limited to the practice of yoga
asanas.
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ess. What we know
of this system in the West is generally limited to the practice of yoga
asanas. According to the yoga Sutras, compiled some time between the
second century BC and the second century AD by Patanjali, the asanas
are one of the eight disciplines of yogic practice. Hiroshi Motoyama, a
Japanese Shinto priest, veteran yoga practitioner and scientist organ
ises these eight disciplines into five groups ( Motoyama 2003, p. 32 ).
TABLE 3.1 The eight disciplines of yoga as organised by Hiroshi Motoyama
Aim
Discipline
Activity
Moral training
Purification, harmonisation of the mind
Yama
Abstention from evil action
Niyama
Virtuous conduct
Physical training
Regulation of vital energy, blood
circulation, nervous and muscle function
Asana
Physical postures
Pranayama
Regulation of the breath
Mental training
Breaking through the shell of the self
through introversion and control of
consciousness
Pratyahara
Withdrawal of the senses
Dharana
Concentration
Spiritual training
Attaining superconsciousness and contact
with spiritual beings
Dhyana
Meditation
Samadhi
Oneness with the divine
Samadhi
Union of subject and object
We can see from Table 3.1 that yogic practice is a broad and pro
found training. Motoyama says of it:
There are those who may claim that it is too grandiose a wish for us humans
to become more than human.
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e are those who may claim that it is too grandiose a wish for us humans
to become more than human. But it must be stated that this wish is neither
impossible nor too dangerous, as long as the correct practices are performed
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Ten sen – West meets East
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CHAPTER 3
without error. It should also be added that the guidance of a qualified
teacher is essential in case difficulties are encountered along the way.
(Motoyama 2003, p. 29 )
In concluding this chapter, Tibetan Medicine should also be
mentioned. It too finds its roots in Ayur-veda, although by the seventh
century AD the Tibetans were learning from and sharing knowledge
with physicians not only from India but also from Nepal, China,
Persia and Greece ( Rapgay 1985 ). In the Tibetan system we find once
again reference to 72 000 channels, although here referred to as ‘tsa’ or
‘ subtle psychic channels ’ ( Clifford 1989 ).
Traditional Chinese Medicine, Ayur-vedic Medicine, Tibetan
Medicine and Traditional Thai Medicine are all very much alive in their
country of origin. Curiously, all but Traditional Thai Medicine can be
studied in the West. Of Traditional Thai Medicine all that we have in
the West is Thai Massage and it carries with it no more than a fragment
of the medical system to which it belongs. Ironically, in this may lie its
strength.
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n a fragment
of the medical system to which it belongs. Ironically, in this may lie its
strength. Freed from the weight of a substantial theoretical foundation
and from the rigour to be expected of a medical system it nevertheless
stands its ground as an excellent massage technique. In the following
chapter we will seek to understand why.
References
Clifford T ( 1989) The Diamond Healing , p. 68 . Crucible : Wellingborough, UK .
Feuerstein G ( 1990 ) Yoga, The Technology of Ecstacy. Crucible :
Wellingborough, UK .
Iyengar BKS ( 1984) Light on Yoga . Unwin : London .
Maciocia G ( 1991 ) The Foundations of Chinese Medicine, p. 152 . Churchill
Livingstone : Edinburgh .
Milne H ( 1995) The Heart of Listening , p. 48 . North Atlantic Books :
Berkeley, CA .
Motoyama H ( 2003) Theories of the Chakras. New Age Books : New Delhi,
India .
Rapgay L ( 1985) Tibetan Therapeutic Massage, Introduction . Published by
Dr. Lobsang Rapgay: Dharamsala, India.
Further reading
Feuerstein G ( 1990 ) Yoga, The Technology of Ecstacy. Crucible :
Wellingborough, UK .
Motoyama H ( 2003) Theories of the Chakras. New Age Books : New Delhi,
India .
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ngborough, UK .
Motoyama H ( 2003) Theories of the Chakras. New Age Books : New Delhi,
India .
CHAPTER
4
Myofascial pathways –
East meets West
CHAPTER CONTENTS
Introduction
26
Connective tissue
27
A note on neuromuscular technique (NMT)
34
Dreambody
37
Introduction
When I studied acupuncture in the early 1980s we learned about a
system of meridians permeating the human body and involved in
the distribution of ‘qi’. Acupuncture points along the meridians were
used to adjust the balance and distribution of qi using fine needles or
heat. Back then we thought of these meridians as invisible channels
unknown to Western anatomy and of qi, which translated as breath or
vital energy, as a mysterious life force that Western medicine refused to
or was unable to acknowledge.
Twenty years on much has changed in our understanding of
Traditional Chinese Medicine. In part this is thanks to an extraordinary
exchange of knowledge between Western and Eastern medical practi
tioners and in part because of incredible scientific advances that allow
us to observe in the human body what was once only discerned by the
senses of our ancient forebears.
We once referred to qi with a vagueness that feigned superior knowl
edge and disguised ignorance. It is now understood that qi manifests in
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Myofascial pathways – East meets West
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CHAPTER 4
the human body in many forms and with many functions.
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ial pathways – East meets West
■
CHAPTER 4
the human body in many forms and with many functions. Its forms
include original qi, food qi, gathering qi, true qi, nutritive qi and defensive
qi; while its functions include transforming, transporting, holding, raising,
protecting and warming ( Maciocia 1991 ). We now understand that qi is
not simply a generic ‘energy’ but a way of describing and understanding the
myriad exchanges and transformations occurring within the living body as
it converts air, food, water and light into growth, activity and behaviour.
James Oschman, a researcher in the field of life energy, has described qi as
consisting, ‘at least in part, of bioelectric, biomagnetic, biomechanical, and
bioacoustic signals moving through collagen fibres, ground substance, and
associated layers of water molecules ’ ( Larson 1990, p. 25 ).
We find a similar concept to qi in the yogic system where it is
referred to as ‘prana’. Like qi, prana also has a number of different
forms and functions. The five primary functions of prana all relate to
the breath and it is these aspects that gave rise to pranayama or breath
control, one of the eight aspects of yogic practice mentioned in the
previous chapter (Feuerstein 1990, p. 258 ).
The complexities of qi are beyond the capacities of this massage
therapist’s mind but the medium of transmission is what fascinates
this massage therapist’s hands.
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therapist’s mind but the medium of transmission is what fascinates
this massage therapist’s hands. As we have seen, Traditional Chinese
Medicine refers to an intricate web of smaller and smaller channels
branching from the 14 main channels used in acupuncture. These
channels may not have been invisible to our Western eyes so much
as overlooked. There is a growing conviction that they relate to the
connective tissue network, the ubiquity of which is so complete as to
‘ connect the various branches of medicine ’ (Juhan 2003, p. 63 ).
Connective tissue
Our body comprises four principal types of tissue. These are muscle,
nervous tissue, epithelial tissue and connective tissue. Of the four, con
nective tissue is the most abundant and widely distributed. Connective
tissue, along with all skeletal muscles, most smooth muscles, all car
diac muscles, bone, blood and cartilage derives from the embryological
mesoderm. Although bone, blood and cartilage are types of connective
tissue these three are so specialised that they are usually treated sepa
rately from connective tissue proper.
Connective tissue proper comprises a matrix of three basic elements.
These are ground substance, fibres and cells. Ground substance is a gel-
like fluid with a consistency that ranges from a viscid state to a more
fluid state depending on the fibres it contains (Juhan 2003, p. 64 ).
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rom a viscid state to a more
fluid state depending on the fibres it contains (Juhan 2003, p. 64 ). As
well as providing support and binding for cells it is also the medium
of exchange between cells and blood and is significant in processes
such as tissue development, migration, proliferation and metabolism.
The cells of the connective tissue are macrophages, plasma cells,
mast cells and fibroblasts. Macrophages provide defence by engulfing
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A Myofascial Approach to Thai Massage
invading bacteria and cellular debris. Plasma cells aid defence through
the secretion of antibodies. Mast cells produce histamine, which
dilates small blood vessels during the process of defence and repair in
response to injury or infection (Tortora & Grabowski 1996, p. 104 ).
Fibroblasts have a unique place in our cellular world with their abil
ity to migrate anywhere in the body and modify their activities accord
ing to local need. Fibroblasts secrete ground substance and synthesise
the various fibres that give each type of connective tissue its special
quality. These fibres are collagen, elastin and reticular fibres. The type
and arrangement of these fibres within the ground substance vary
according to location and purpose (Juhan 2003, p. 66 ).
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se fibres within the ground substance vary
according to location and purpose (Juhan 2003, p. 66 ).
TABLE 4.1 Summary of the different types of connective tissue excluding blood, cartilage and bone
Connective tissue types
Type
Subtype
Matrix
Cells within
the matrix
Quality
Location
Loose
Areolar
Ground
substance
with randomly
arranged
collagen,
elastin and
reticular fibres.
Semifluid
Fibroblasts,
macrophages,
plasma cells,
adipocytes
and mast cells
Provides
strength,
elasticity and
support
Subcutaneous
layer of skin.
Papillary region of
dermis. Mucous
membranes.
Blood vessels.
Nerves.
Surrounds body
organs
Adipose
Ground
substance
Adipocytes
that store fats
and oils
Provides heat
insulation,
energy storage,
support and
protection
Subcutaneous
layer of skin.
Surrounds
the heart and
kidneys. Yellow
bone marrow
of long bones.
Padding around
joints.
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n.
Surrounds
the heart and
kidneys. Yellow
bone marrow
of long bones.
Padding around
joints. Behind
the eyeball in the
socket
Reticular
Ground
substance with
interlacing
reticular fibres
Reticular cells
Provides a soft
framework
(stroma) for
some organs
and binds
together
smooth muscle
tissue cells
Stroma of liver,
spleen, lymph
nodes and red
bone marrow
(Continued)
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CHAPTER 4
TABLE 4.1 Continued
Connective tissue types
Type
Subtype
Matrix
Cells within
the matrix
Quality
Location
Dense
Dense regular
Ground
substance
appears
shiny white
with mostly
collagen fibres
arranged
in parallel
bundles
Fibroblasts in
rows between
the collagen
bundles
Provides strong
attachments
between
structures
Tendons
Attach muscle to
bone
Ligaments
Attach bone to
bone
Aponeuroses
Sheet-like
tendons attach
muscle to muscle
or muscle to bone
Dense
irregular
Ground
substance
with mostly
collagen fibres
arranged
randomly
Some
fibroblasts
Usually forms in
sheets. Provides
strength
Reticular region
of dermis of skin.
Perichondrium
(membrane
around cartilage).
Periosteum
(membrane
around bone).
Joint capsules.
Dura mater.
Membrane
capsules around
kidneys, liver,
testes, lymph
nodes. Heart
valves.
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les.
Dura mater.
Membrane
capsules around
kidneys, liver,
testes, lymph
nodes. Heart
valves. Fasciae
Elastic
Ground
substance
with freely
branching
elastin fibres
Fibroblasts
present
in space
between
fibres
Allows
stretching in
some organs
Lung tissues,
trachea and
bronchial tubes.
Walls of elastic
arteries. True
vocal cords.
Suspensory
ligament of penis.
Ligamenta flava
of vertebrae
There are two general types of connective tissues, loose and dense.
Loose connective tissue includes the subtypes of areolar, adipose and
reticular. Areolar is the most widely distributed. It contains collagen,
elastin and reticular fibres in a loose and random arrangement. This
structure suits its role of holding organs and epithelia in place and as
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A Myofascial Approach to Thai Massage
the subcutaneous layer attaching the skin to the underlying tissues and
organs (Tortora & Grabowski 1996, p. 107 ).
Adipose connective tissue is always found in the company of areolar
connective tissue. It contains adipocytes, derived from fibroblasts. These
cells are adapted for the storage of fats and oils. This makes adipose tis
sue especially suited to cushioning and supporting organs, thermal insu
lation, lubrication (primarily in the pericardium) and energy storage.
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orting organs, thermal insu
lation, lubrication (primarily in the pericardium) and energy storage.
Reticular connective tissue contains a network of fine interlacing
reticular fibres that forms a soft framework known as a ‘stroma’; found
in the lymph nodes, red bone marrow, liver and spleen (Tortora &
Grabowski 1996, p. 108 ).
Dense connective tissue includes two subtypes, dense regular and
dense irregular. Dense regular connective tissue is packed with colla
gen fibres arranged in parallel bundles. This gives it the great strength
necessary for its role of providing attachments between structures. As
tendon it attaches muscle to bone and as ligament it attaches bone to
bone. Aponeuroses are sheet-like tendons that attach muscle to muscle
or muscle to bone.
Dense irregular connective tissue is usually found as sheets. It con
tains randomly arranged collagen fibres giving it great strength as well
as flexibility. This suits its role as the major part of the dermal layer of
the skin. It also forms the strong, protective membrane wrapping carti
lage, bones, joints, kidneys, liver, testes, lymph nodes and heart valves
as well as the dura mater, the membrane that protects the brain and
spinal cord (Tortora & Grabowski 1996, p. 109 ).
Fascia is the general name for the dense, irregular connective tissue
layer surrounding muscles, bones and joints. It provides support and
protection and gives structure to the body.
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ing muscles, bones and joints. It provides support and
protection and gives structure to the body. Ida Rolf says of it, ‘fascia
forms an intricate web coextensive with the body, central to the body,
central to its well-being, central to its performance. Clearly fascial tone,
fascial span, is a basic contributing factor to bodily well-being ’ (Rolf
1989, p. 39 ).
Fascia consists of three layers: the superficial, the deep and the sub-
serous. The superficial fascia is located directly under the subcutis of
the skin. Its functions include the storage of fat and water and it pro
vides passageways for nerves and blood vessels. In some areas of the
body, it also houses a layer of skeletal muscle, allowing for movement
of the skin.
The deep fascia lies beneath the superficial fascia. It aids muscle
movement and, like the superficial fascia, provides passageways for
nerves and blood vessels. In some areas of the body, it also provides
an attachment site for muscles and acts as a cushioning layer between
them.
The subserous fascia lies between the deep fascia and the mem
branes lining the cavities of the body. There is a potential space
between it and the deep fascia that allows for flexibility and movement
of the internal organs.
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Myofascial pathways – East meets West
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CHAPTER 4
Myofascia extends from the deep fascia as a thin, elastic and dynamic
membrane that covers, supports and separates the skeletal muscles.
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as a thin, elastic and dynamic
membrane that covers, supports and separates the skeletal muscles. As
endomysium it wraps and separates each muscle fibre. As perimysium
it wraps each bundle of muscle fibres into a fascicle. As epimysium it
wraps each muscle itself. These three varieties of myofascia each con
tribute collagen fibres to the connective tissue that attaches the muscle
either to bone or to other muscles. These attachments may also extend
beyond the muscle as tendon or aponeurosis (Tortora & Grabowski
1996, pp. 240–241 ).
Between adjacent muscles the epimysium provides a protective
route for blood vessels, nerves and lymph ducts. The muscles, ideally,
act as cushions for these vessels. However, the quality of cushioning
depends on the tone of the muscle as well as the dynamism of the
myofascial pathways. If the surrounding muscles are hypertonic they
will limit the flow of blood and lymphatic fluid through the epimy
sium and reduce the flow to the surrounding tissue.
Andrew Taylor Still (1828–1917), who in 1874 founded osteopa
thy, always reminded his students that the physician’s task ‘was to
remove with gentleness all perceived mechanical obstructions to the
free-flowing rivers of life (blood, lymph, and cerebro-spinal fluid).
Nature would then do the rest ’ ( McPartland & Skinner 2005 ).
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lymph, and cerebro-spinal fluid).
Nature would then do the rest ’ ( McPartland & Skinner 2005 ). Perhaps
an ancient appreciation of the significance of myofascia in relation to
those rivers of life was what inspired the thousands of years of research
and development that has culminated in some of the traditional medi
cal systems still available to us today.
In 1990 Dick Larson, an acupuncturist and Rolfer, wrote a paper dis
cussing the link between the myofascial planes used in structural inte
gration and the channels used in acupuncture and suggested that the
ancient Chinese were well aware of the significance of connective tissue
in the living body. According to Larson, during the Han Dynasty (206
BC–220 AD) ‘Prince Mang ordered physicians and butchers to perform
surgery on live political prisoners to measure their organs and to estab
lish the source and route of blood vessels ’ (Larson 1990, p. 25 ).
Larson quotes the work of another Rolfer, Stanley Rosenberg, who
in 1986 suggested that ‘ … the acupuncture meridians are a map of the
planes of fascia. By putting my hands on the meridians in certain ways
(other than traditional acupressure), I can produce some predict
able improvements in structure, easily and with little effort ’ (Larson
1990, p. 29).
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ome predict
able improvements in structure, easily and with little effort ’ (Larson
1990, p. 29).
Kiiko Matsumoto and Stephen Birch, who have done a great deal
of research into the relationship between acupuncture channels and
connective tissue, suggest that ‘Perhaps the fascia, the tissues that cover
and line the body and organs, have some special qualities, properties
or functions that were recognised by the medical authors of the Han
Dynasty’ (Larson 1990, p. 26).
Fascia (or, more correctly, connective tissue) does indeed have
some special qualities. The first is that it provides a physical means of
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A Myofascial Approach to Thai Massage
communication from the outside of the body to the heart of every cell
and from the heart of every cell to the heart of every other cell. Each
individual cell contains a cytoskeleton that provides a framework of
support, structure and communication for the various cellular and
nuclear elements within. Proteins called integrins reach out from the
cytoskeleton, across the cell surface to the surrounding connective tis
sue matrix. At the outermost layer of the skin, tonofilaments reach in
from the epidermis and are attached via hemidesmosomes to the der
mal connective tissue. From here anchoring fibrils link in to the con
nective tissue matrix (Oschman 2000, pp. 45–47 ).
Another of the special qualities of connective tissue is the presence
of collagen fibres within the matrix.
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f the special qualities of connective tissue is the presence
of collagen fibres within the matrix. As shown in Table 4.1, fascia and
myofascia are types of dense, irregular connective tissue and as such
consist mainly of randomly arranged collagen fibres within the ground
substance. Collagen is the ‘longest molecule that has ever been iso
lated’ and is ‘stronger in tensile strength than steel wire ’ (Juhan 2003,
p. 72 ), qualities ideal in its role of providing support and connectiv
ity in the body. Collagen is also hollow, which suits its role in circula
tion and communication. Curiously, it is said that within the collagen
tubule is not, as we might expect, lymph or ground substance but cere
brospinal fluid (Juhan 2003, p. 73 ). If this is true it is evidence of an
extraordinary communication from the ventricles in the middle of the
brain to, potentially, every cell in the body.
Yoshio Manaka, who died in 1989, contributed much to our mod
ern understanding of acupuncture through scientific research. He did
not specifically refer to the connective tissue but said, ‘While we can
offer no clear description of the body’s hardware, we propose that it is
better to examine and define the software first’ (Manaka 1995, p. 55 ).
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End of preview.
Massage Therapy Dataset
First comprehensive dataset for Massage Therapy on HuggingFace, covering various massage techniques, chiropractic, anatomy, and therapeutic methods.
Dataset Summary
| Metric | Value |
|---|---|
| Total Q&A Samples | 54,421 |
| Total Pre-train Chunks | 21,460 |
| Total Characters | 27,161,790 |
| Languages | English, Vietnamese |
| Created | 2026-01-24 |
Categories
| Category | Description |
|---|---|
| thai_massage | Traditional Thai Massage techniques |
| chiropractic | Chiropractic adjustments and spine care |
| tui_na | Chinese Tui Na massage |
| deep_tissue | Deep tissue and myofascial techniques |
| anatomy | Muscle, bone, and circulatory system |
| reflexology | Reflexology and acupressure |
| stretching | Stretching and flexibility exercises |
| general | General massage therapy knowledge |
Files
1. massage_therapy_qa.json
- Format: Alpaca (instruction, input, output)
- Use: Instruction fine-tuning
2. massage_therapy_pretrain.jsonl
- Format: JSONL with text chunks
- Use: Continued pre-training
Data Sources
Books from various domains:
- Thai Massage techniques
- Chiropractic principles and practices
- Chinese Tui Na massage
- Deep tissue and myofascial therapy
- Anatomy and physiology for massage therapists
- Reflexology and hand therapy
- Sports and soft tissue injuries
Usage
from datasets import load_dataset
# Load Q&A dataset for fine-tuning
ds = load_dataset("jakeveo05/massage-therapy-dataset", data_files="massage_therapy_qa.json")
# Load pre-training data
ds = load_dataset("jakeveo05/massage-therapy-dataset", data_files="massage_therapy_pretrain.jsonl")
License
CC-BY-4.0 - Educational and research use.
Citation
@dataset{massage_therapy_dataset,
title={Massage Therapy Dataset},
author={TuanOS},
year={2026},
url={https://huggingface.co/datasets/jakeveo05/massage-therapy-dataset}
}
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