Standing on the same side as the leg being treated, at the level of the client’s waistline.
1. The belly and origin of biceps femoris can be treated using the same proto-
cols as for the ‘semis’ (Fig. 6.15).
Figure 6.15
MFR of the lateral hamstrings using an elbow.
2. The distal tendon can be treated in the same manner as the ‘semis’. Follow
the line of tension down to the head of the fibula (Fig. 6.16). Client
Therapist
Technique
Figure 6.16
Using the knuckles to release the distal tendons of the lateral hamstrings.
As for the ‘semis’.
The posterior aspect of the upper leg is a good place to explore palpation skills. Use a flat, soft hand to test for the mobility of layers and the overall tension in the tissue. Do this by placing the hand flat onto the leg. Engage the tissue with around 30 grams of force. Move the tissue in a number of directions, mentally noting when bind is encountered. Using the same flat hand, sink into the tissue with the intention of springing the tissue – a kind of trampoline test. Again, only sufficient force to test for the tensioning and recoil of the tissue is used. This is often much less than we think. Retest with both approaches after treating. The confirmation of change is immediate and, importantly, can be felt by the client as well. This is a chance – there are, of course, many others – to establish that changes in length, pliancy and texture are actually possible through manual therapy. This can be a new concept for many people who have learnt, regrettably, to think of their bodies as unchanging, unfriendly machines that drag them around from place to place.
Extend this style of work into any other areas in the posterior leg that pres- ent as stiff and fibrous. This kind of joyful exploration, discovery and subse- quent friendly meeting with the local residents of an area is always appropriate. Initially, a treatment might be guided by the descriptions in this book. Curiosity and good palpation skills will find fertile zones for work that do not conform to these guidelines. With the hamstrings, a common line of fascial restriction is between the medial and lateral hamstrings. Another zone to take a look into is between the ‘semis’ and the adductors. Here you can discover many forms of myofascial congestion, often associated with a great tenderness. Go slow.
Prone position also gives good access to the posterior aspect of adductor magnus. This myofascia is often bunched tight up against the pelvis. Release here feeds superiorly into the pelvic floor and inferiorly into the entire poste- rior aspect of the leg. Clients often report feelings of space and ease around the sacrum, coccyx and lumbosacral area after this release (Fig. 6.17).
Figure 6.17
Using the fingers to release the posterior aspect of the adductors.
Movement Comments
ADDUCTORS
Sidelying with lower leg extended at the hip and flexed at the knee to around 30°. The upper leg is flexed to 45° at the knee and hip. Position client with their back close to the edge of the table nearest you.
Standing behind the client, facing headward, at about the level of the feet.
1. Begin just above the medial epicondyle. Sink into the first layer of restric-
tion, followed by a line of tension in a superior direction. Use an elbow, soft fist or well-supported fingers. Treat in increments, dividing the leg into 3–4 zones of contact (Figs 6.18, 6.19). Initially, work on the midline and then
Figure 6.19
Using a fist to release the mid-section of the medial thigh. Client Therapist Technique Figure 6.18
Position of the fingers to release the distal portion of the adductors.
emphasize other areas according to need. Getting close to the pelvis means more myofasciae to work through. Work more deeply as the layers become available. When working slowly, the psoas insertion can be contacted at the lesser trochanter.
2. Use the fingertips to sink slowly into the fasciae along the ramus of the
ischium. The initial contact is with the whole hand into the adductor compart- ment. Then the hand is moved, without gliding across the surface of the leg, in a superior direction until the middle finger contacts the bone. There is only a thin layer and it responds best to sustained contact rather than forceful. Allow the finger to buckle slightly and the index and ring fingers may also make contact (Fig. 6.20). Often, the response takes 45–90 seconds. Maintain the
Figure 6.20
Using the fingerpads to contact the ramus of
the ischium.
contact for up to 3–4 minutes if the release continues. The response can be felt by the client as an unwinding in the pelvic floor and even as high as the respiratory diaphragm. A common report is an overall sense of relaxation in the viscera. When in the adductors, ask for mindful lengthening, ‘with direction’ move- ments that involve anterior–posterior tilt.
When working up against the ischial tuberosity, ask for awareness of the breath coming to meet the fingers.
This is a tender and guarded area on many people, because a number of factors combine to create stiffness and high tone. The proximity to the femoral artery means a primitive protective response; it’s on the medial aspect of the leg and covered by deep layers of muscle for a reason, so when we work there we are asking for a shift from reflexive guarding to opening. Psychosexual issues are wrapped around the myofasciae here and may contribute to the tightness.
Clarity of purpose from the therapist needs to be conveyed via some verbal introduction to the technique and what it involves. A confident, non-invasive touch is easily developed if the anatomy is well understood and the beneficial Movement
effects of the work have been tracked over a number of clients. The first is eas- ily mastered by reviewing the anatomy in a good atlas. Like all aspects of man- ual therapy, the second takes time and is basically a numbers game: the more you do, the better you get. I use this work at the floor of the pelvis with many low back and SIJ clients. Signs that it is indicated include inability to isolate the movement of anterior–posterior pelvic tilts in either sitting or lying supine with the related condition of a poor sense of pelvic and lumbar position when sitting and no breath response in the pelvis while lying (prone or supine). The release of a pelvic floor in spasm is a powerful component of restoring normal function to the low back and SIJs.
QUADRICEPS/ANTERIOR ASPECT OF THIGH