There is no real difference between structure and function; they are two sides of the same coin. If structure does not tell us something about function, it means we have not looked at it correctly. (A T Still, founder of osteopathy)
The old division between a problem being either a neuromotor control issue or a structural disorder is certainly dissolving. Two decades ago a person with a neurologic disorder might be treated with neurodevelopmental treatment (NDT), propriocep- tive neuromuscular facilitation (PNF), Feldenkrais or other neuromotor-oriented approaches. An ortho- pedic dysfunction would traditionally receive a more structural approach, with joint and soft tissue restric- tions, as well as strengthening, being the foci of treatment.
A more inclusive approach is increasingly popular. Therapists tend to draw from a variety of approaches in treating a client, whether the diagnosis is of an orthopedic condition or a neurologic one. Clearly, clients with neurologic disorders also have fascial and joint restrictions which may be secondary to, or predate, the neurologic lesion. However, they are still a hindrance to function.
Direct technique myofascial release will improve a client’s ability to incorporate movement reeduca- tion. Changes to functional patterns should only be introduced as the myofascial and nervous systems become sufficiently plastic for their incorporation. Once these two systems are able to support the change, the client can explore new movement sug- gestions. If premature, the attempt to introduce new functional patterns can create more strain as the client seeks to incorporate movements the body is not ready for. A good, if simple, example of this is the strain we eventually feel if we attempt the out- moded directive, ‘stand up straight’. Here we see the classic problem of forced co-contraction in an attempt to control posture or movement. It is exhausting and thus unsustainable.
Even intelligent movement repatterning methods – the mostly excellent Pilates method, for example – can fail due to the person’s inability to
achieve a sufficient state of neurofascial plasticity to incorporate the suggested stabilization patterns. Direct technique MFR in conjunction with Pilates or other core stabilization endeavors may assist in the development of this underlying plasticity. Movement teachers of all kinds are encouraged to consider it when students are unable to connect with the required contraction sequences.
In the client with orthopedic problems, neuro- motor control is also compromised. This may take the form of muscle guarding, reflexive inhibition, posttraumatic sensory amnesia or, often, all of these. As the ongoing work into lumbar and pelvic stabil- ity has shown, inefficient neuromotor controls will often contribute to the original injury. These aber- rant neural patterns can hinder or even prevent recovery as well as increase the risk of reinjury. Neuromuscular reeducation may augment myof- ascial release and accelerate the resolution of an orthopedic problem. This book seeks to introduce approaches to treatments that incorporate elements of both.
LESIONS
In the person with a central nervous system lesion, myofascial release can be an important adjunct to function-oriented treatments, although I must point out that the outcomes are highly variable. In general terms, working with myofascia in the man- ner shown here allows a desirable response in the
neuromotor system. Therapy is more likely to assist in the establishment of balance and stability against gravity when the fascia is released from chronic restriction, whether that is mechanical or neuro- logic in nature. With neurofascial release comes better sequencing of muscle activation and more coordination of the body against gravity.
MFR also helps develop a more normal meta- bolic function. This is no doubt due to the effect on the ANS and its relationship with the digestive and endocrine systems.
The importance of approaching the body in this way should not be underestimated. I have observed, as have the pediatric therapists I have worked alongside, these changes in decades of work with children with cerebral palsy. There is too much clinical evidence to ignore the value of this approach as an adjunct to the function-based ones that form the basis of pediatric therapy. I have seen direct technique myofascial release accelerate and deepen the work of both sensory integration and NDT. And even without specific integrated functional activities, I have seen an increase in the control of fine and gross motor skills.
Reference
1. Griffith CH, Wilson JF, Langer S et al House staff nonverbal communication skills and standardized patient satisfaction. Journal of General Internal Medicine 2003; 18(3):170–175
In bodywork and movement literature, it is fre- quently stated that defacilitation in the practitioner is necessary for their work to be effective. This is often found in descriptions of approaches to doing good cranial work, although I believe that the same state would be desirable in any bodywork setting. In fact, it may be central to the kind of open communi- cation that makes for meaningful touch therapy. But what, or who, is being defacilitated? How can it be cultivated? How do we go about this ‘defacilitation’ thing?
Contemplative practices are marriages of medita- tion with an activity. As such, they are a blend of the calmness that accompanies meditation with move- ment. Brush-stroke calligraphy, some martial arts and ikebana are diverse examples of activities that have a history of deliberate contemplative intent; they have historical credentials and they’re worth examining to find out more about this deliberate cultivation of movement with awareness. However, we could fairly say that all of life offers a potential for contemplative action. An exposition on how to develop this mindful movement points to ‘defacili- tation’ and contemplative practice as being close cousins, if not identical twins. One has a technical moniker, the other a more humanistic one.
One of the hallmarks of these practices is that the state of the practitioner during the activity is as important as the form of the activity. Curiosity about our selves in relation to the form is central to the process. With this attitude of mindfulness comes freshness. Each situation is new. A mechanistic response is less likely when we drink in the refresh- ing sensation of the relationship between self and the environment that is forming in each moment. Attachments to perfect outcomes seem less relevant when we allow this sense of relationship to develop more fully. This is the open road of non-competitive
action. It is not available, for example, via the ritual hardening that accompanies excellence in sport in which the body is split from the mind to bring it under full control. Imperfection is not allowed in this scenario, curiosity is irrelevant. The only useful outcome is victory.
As many of us have already discovered, bodywork is an excellent place to deepen the contemplative approach. For somatic therapists their work is already that – a situation where the rush of a time- oriented world is replaced by feelings of timeless- ness, openness and increased awareness. A wandering mind, adrift in a discursive fantasia, can be reminded to ‘come to its senses’ and rejoin the bodily moment. We return quite literally to the situation ‘at hand’. And for our clients this is felt as a shift in the relationship – the touch is more responsive, curious and friendly. They feel listened to through this type of touch, rather than done to.
One way to explore further this kind of dynamic interchange between perception, intent and action is to begin meditation practice. In the Buddhist tra- dition there are two related components. The first,
shamatha, translates from the Sanskrit into tranquil-
ity or calm abiding. Bringing attention to an object of meditation, often the breath, helps stabilize the mind and body. Thoughts and emotions – strong psychophysical sensations – are experienced as they arise and allowed to dissolve on the outbreath. They are not repressed or ignored, simply noticed. This is not a soporific state, nor is there an attempt to travel into an altered state of consciousness free from connection with the corporeal world. It is an open and honest experience of the various textures that constitute our being.
The other component, vipashana, is a natural outgrowth of shamatha. A stable mind and body give birth to insight or clear seeing. The emotions begin