Bodywork Therapies – Structural Framework
The musculoskeletal system is the body’s largest user of energy. It is through the this system that we walk, talk, run, jump, feed ourselves, paint pictures, perform delicate surgery, make music, war and love, and generally express our human individuality. It is also the “organ” that is most likely to produce symptoms severe enough to take you to a doctor. Bodywork and movement therapies aim to restore harmonious balance to the integrated structures of the musculoskeletal system and to ease restriction, pain and dysfunction.
The human body has a structural framework of bones, ligaments, tendons, muscles and joints, all held together by connective tissue. The connective tissue framework extends down to the most microscopic level where minute fibres support individual cells and help to carry information – even into the cell nucleus.
The body’s central co-ordination depends on the brain and central nervous system and the body’s tissues are nourished and oxygenated through the circulation. The structural framework allows us to move freely and painlessly, while also providing space, protection and support for the vital organs and glands that regulate the biochemical activities that fuel and repair the body.
The musculoskeletal system is organised and held together in a structure that is remarkable for its ability to absorb external forces and inner tensions in one part of the body, and to spread the load evenly to the other parts. This flexible ability comes from a quality known as tensegrity, a word derived from “tension” and “integrity”.
The most widespread soft tissue in the body is connective tissue, sometimes known as fascia. It forms a thin network or mesh around nerves and between muscles, and a more dense network in cartilage, ligament, tendon and bone. It supports, divides, wraps, connects, invests, separates and gives cohesion to all the other soft tissues of the body.
The connective tissue network is a kind of fascial web that comprises one single continuous tensegrity structure, which reaches from the soles of the feet (plantar fascia) to the inner lining of the skull (the dura). As a result, any distortions and restrictions that occur in one part of the web can influence all the other parts, with body-wide implications. Understanding how connective tissue works helps us to grasp the interconnectedness of the entire body – for example, how fallen arches in the feet can directly influence the neck and head.
Since connective tissue gives shape and cohesion to everything else in the body – including the organs, muscles, blood vessels, nerves and cells – the fascial web can be accurately seen as a single structure. This means that the fascial “sheets” attached to the inside the skull, such as the falx cerebri and the tentorium cerebelli (which divide different parts of the brain and give shape to the structures inside the head), merge with the lining of the skull (the dura). They are connected, without interruption, to the dura surrounding the spinal cord and the fascia of the neck, thorax, diaphragm, lower pelvis, legs and feet. In fact, they are connected to every joint, muscle, tendon and ligament in the body!
It is no surprise that tensions and distortions in any one part can influence the entire network. This influence may range from slight to a great extent, depending on many factors, such as the degree of distortion and the person’s age and general state of suppleness and fitness. Many of the progressive changes that tighten, shorten, distort and restrict the fascia and the associated body parts are reversible – either wholly or partially – by means of appropriate treatment and self-care.
Recent research suggests that it is through connective tissue structures – specifically the cleavage planes where the individual muscle groups are separated from each other – that many of the beneficial effects of manual therapy, as well as acupuncture, acupressure and trigger-point deactivation, are achieved.
Form and function of cells
The body’s fascial web extends into the connective tissue (cytoskeleton) inside every cell and minute protrusions (integrins) on their surfaces. These two key features have been shown to determine the overall efficiency of a cell’s function, and of the way a cell expresses itself genetically.
According to recent research, the fascia of a cell becomes distorted in a gravity-free environment. This effect alters the cell’s shape and modifies the way it processes nutrients. Put simply, when the structure of a cell changes, its function changes too, meaning that it cannot absorb and metabolise nutrients properly.
A cell’s inability to nourish and ultimately to reproduce itself has enormous implications for the health of the whole body. We do not need to travel in outer space to create changes in our fascial structure, since the processes of adaptation, compensation, ageing and disease, which affect us all, create localised warping, crowding, compression and distortion of the fascia – right down to a cellular level. Over time, this is potentially harmful to normal cellular life, and therefore to general health and well-being because the changes caused restrict healthy circulation of fluids and the flow of information which organs need to stay healthy.
Cartilage, bones and joints
The fascial web of connective tissue is anchored to the bones of the skeleton by elastic tissues (muscles, tendons, ligaments) that form a series of interconnected “poles” and “guy-wires”. These allow loads and tensions to be shared by the structure as a whole, of which the bones of the skeleton can be seen as the “struts”. Bones seldom actually touch each other in normal conditions. Instead, they “meet” at a joint, which is held in place by ligaments and tied to muscles that move it via tendons.
The primary purpose of semi-moveable joints, such as the sacro-iliac joint in the pelvis, is to provide stability – they are protected by pads or discs of cartilage that absorb the pressure of external loads and forces. Joints that move freely, such as the elbow and knee, offer flexibility and mobility – they are protected and lubricated by synovial membranes and fluid. To some extent, all joints provide both stability and mobility.
Wear and tear, inefficient supporting structures, such as weak muscles and lax ligaments, and the ageing process are the main enemies of joints. These problems are further aggravated by overuse, misuse, disuse and abuse. When joint surfaces become irritated, arthritic changes usually begin.
The spine and the rest of the bony skeleton provide a “protective cage” that offers a safe place for the vital organs, such as the heart and liver. The health of these organs can be greatly influenced by distortions and crowding of the skeletal structures. When a slumped posture becomes a habit, for example, it can put stress on the connective tissue around the organs, negatively affecting their nerve and blood supply, as well as their lymph drainage. It may even affect how well the organs actually work.
A tendon connects a muscle to a bone, providing the muscle with the anchorage it needs to contract and exert a force. However, tendons can become inflamed or irritated, often when the muscle to which they are attached contracts repetitively or frequently. This can lead to problems such as Achilles tendonitis and many localised painful areas close to joints, especially those prone to overuse, such as the knees, wrists and elbows. Trigger points are frequently located in the muscles associated with such irritable, overused tendons.
Ligaments are specialised connective tissue that support and bind joints. They are particularly important (and sometimes vulnerable) in joints that are prone to damage when excessively stressed or strained, such as the knees and ankles. Approximately one person in ten has lax ligaments (i.e. is “double-jointed”), a condition known as hypermobility. In Asian and Arab women, as many as four out of ten may be born with this characteristic. Hypermobile individuals are more likely than others to develop conditions sometimes labelled “soft-tissue rheumatism” (involving muscles rather than bones or joints) and conditions such as fibromyalgia and spinal scoliosis.
These muscles are attached to the various bones of the skeleton and are composed of bundles of fibres that can be made to contract voluntarily. The bundles, or fasciculi, usually lie side by side in a parallel fashion and are individually enclosed in a thin connective tissue sheath known as the endomysium.
There are two types of muscle fibre: type 1 muscle fibres will shorten when continually stressed by overuse, misuse or abuse; type 2 muscle fibres, when similarly stressed, become weak and may lengthen. As a result, imbalances develop between opposing muscle groups, with negative effects on both the muscles and the joints they serve.
For example, the neck and shoulder muscles of someone with a slumped posture and head poked forwards are tense and tight. The deep muscles at the front of the neck (the deep neck flexors) are usually weak and inhibited, putting the joints of the neck under stress and causing awkward movements, usually involving some stiffness and probably discomfort. In time, the nerves emerging from the spine and the discs between vertebrae may become irritated, leading to painful symptoms, both locally and at a distance.
Another example of imbalance is the tight, arched low back of a person who displays a protruding and sagging abdomen. When this is chronic, symptoms of backache and abdominal and pelvic organ dysfunction are likely.
Smooth muscles form the circular walls of the bladder, blood vessels, bronchioles and many of the hollow digestive organs, such as the gastrointestinal tract. A smooth muscle has a circular control over the tube it surrounds, often contracting in a wave-like manner – for example, in peristalsis (the action that propels food through the gut).
Tens of thousands of smooth muscle cells are also embedded in the fascial web. When they contract they increase the tension in the connective tissue, sometimes excessively, leading to body-wide stiffness and restriction.
Smooth muscles contract when the blood becomes more alkaline than normal, such as takes place during hyper¬ventilation. Therefore, people with a tendency to an anxious, upper-chest breathing pattern tend to have an increased degree of tone/tension in the fascia, which may affect the entire musculoskeletal system and probably encourage trigger-point formation.