Like father, like son, like mother like daughter is often applicable to postural carriage. The reason for this is that from an early age humans learns to mimic their role models. Many other factors influence the adopted habitual postural stances such as:
1. ergonomic activities resulting in long hours of habitual biomechanical use in a particular manner
2. habitual postural sets resulting in muscles strengthening and weakening to support the stresses and strains on the frame
3. injury resulting in biomechanical limitations result in dysfunctional use
4. emotional vulnerability resulting in the adoption in protective or aggressive stances
Despite the causes of habitual stances structural compensation takes place along the lines of stress and tension created by the load on the structures. The load-bearing muscles become strong developing an abundance of red muscle fibres and non-load-bearing muscles become weak developing an abundance of white muscle fibres.
Strong muscles shorten to support load and weak muscles extend reciprocally. Load-bearing muscles develop energy conserving fascial support along the lines of tension locking the muscles in the short position. This in turn causes restricted movement and shifts the body’s postural centre causing uneven pressure and tension on joints resulting in eventual uneven wear and tear if left untreated. This causes degeneration of the articular cartilage that is often the cause of osteoarthritis resulting in lifelong chronic joint pain and further postural compensation to avoid pressure on the joint.
Locked long, weak muscles stretch the nerve sheath placing the nervous tissue under tension resulting in pain. This results in alterations to postural position to unconsciously shorten the long muscles to ease tension on the stretched nervous tissue in an attempt to relieve the pain. This once again causes a shift in the postural centre and if left untreated results in lines of fascial shortening developing to support the new stance, red and white fibres adjusting once again to accommodate the load distribution.
MICROSTRUCTURE OF SKELETAL MUSCLES
The microstructure of skeletal muscle tissue is adapted according to function as follows:
Muscles that are adapted to support load are termed postural muscle and are able to sustain slow continuous contraction without becoming fatigued. They have an abundance of mitochondria and a well developed network of capillaries to ensure that metabolic demands are sustained by the delivery of sufficient nutrients. These muscles fibres appear red to the naked eye due to the rich blood supply.
Muscles that are adapted for movement on the other hand are termed phasic muscles and these are able to move in and out of contraction repeatedly but are not able to sustain the contraction for extended periods. Phasic muscles do not require large quantities of mitochondria to sustain contraction but they do however have a well developed sarcoplasmic reticulum with an abundant store of calcium ions to facilitate repeated contraction and relaxation on demand. These muscles appear white to the naked eye due to the lesser quantity of capillaries and the more developed sarcoplasmic reticulum.
Skeletal muscles are made up of bundles of muscles fibres wrapped in fascial sheaths ranging from the fascicle which contains the actin and myosin fibres to the endomysium which forms the outermost wrapping holding the muscles groups together.
SKELETAL MUSCLE ADAPTATION TO LOAD
Any shifts in load on muscles which is sustained for a period of time, will result in the adaptation of the stressed muscle fibres ensuring that red muscle fibres support load and white muscle fibres facilitate movement. Further support is provided to muscles that are subjected to habitual stress and tension in a particular manner through the development of fascial lines of tension along the short muscles which brace to carry the load. The connective tissue support in the form of fascial lines of tension fixes the postural stance and restricts the range of movement of the muscles involved. This can easily be determined by using passive movement techniques to put the muscles through their range of movement. Those that are restricted by fascial lines of tension will not be able to move through the full range of movement and will not increase their range of movement in response to the application of reflexive techniques.
Fascial lines of tension can develop through habitual movement in a particular way e.g. habitual movement required to perform particular sporting activities (termed functional lines of movement) or to support postural stances. Since all fascial lines of tension alter postural positioning with short muscles distorting the pressure on the joint articular surfaces it is important to respond to any chronic pain by seeking treatment to realign musculoskeltal structures to prevent long term complications.
Releasing fascial lines of tension to restore both postural integrity as well as normal range of movement requires a thorough assessment of the patient to determine exactly which muscles are long and which muscles are short by conducting appropriate tests that will provide accurate information. Short muscles need to be lengthened but it is important not to further lengthen long muscles as this will destabilise the patient.
RELEASE OF FASCIAL LINES OF TENSION
Due to the thixotropic nature of fascia, specific connective tissue techniques such as direct fascial technique and myofascial release and in some cases friction are required to rehydrate and lengthen the tissue. It is important to ensure equal lengthening is achieved on the left and right sides of the body during treatment to restore postural integrity. The visco-elastic effects of fascia in response to connective tissue techniques, sustains some of the lengthening of the fascial sheaths achieved during treatment.
Muscles adapt to the stresses and strains of biomechanical use or to postural bracing. It is important to respond to postural misalignments before structural integrity is compromised through uneven wear and tear. Pain is initially caused by stretch on the nerve sheaths of the long muscles, but develops into irreversible chronic pain once the articular cartilage surfaces have been worn down due to uneven wear and tear on joints. Once a continual inflammatory cycle is established the condition cannot be reversed but requires ongoing care in the form of condition management to release the pressure on the joints and remove the metabolic by-products which aggravate pain.
It is important that these lines of tension support posture within its natural design as poorly articulating joint surfaces are required to be stabilized by muscles, fascia, tendons and ligaments. Therapeutic Massage plays a vital role in restoring the natural postural alignment according to the natural design of the human body.
For example, a person’s postural carriage is influenced by all aspects of their lives (emotional, professional, personal etc) and the habitual postural set a person adopts has a profound effect on both biomechanical use and physiological function. Incorrect posture creates uneven load on joints, which results in some muscles locking in the short position to take the load whilst antagonistic muscles become locked in a long position. The pressure changes in the muscle compartments influencing the pumping of fluids in and out of the compartments that in turn effects the environment in which the cells perform creating physiological consequences. Stress and tension on the nerves, either caused by compression or stretch resulting in pain which is further compounded by uneven wear and tear on joints.
Therapeutic Massage is one of the few professions that not only prevents the development of inappropriate fascial lines of tension, but to a greater or lesser degree treats all aspects involved in their development. Whether the problem arises ergonomically, or through habitual postural stances, or as a result of injury or emotional defences, the therapeutic massage therapist will identify the problem via a comprehensive interview and postural / biomechanical analysis, Treatment can either consist of treatment exclusively using therapeutic massage therapy or via a multi-disciplinary approach with the patient consulting an ergonomic specialist, psychologist or physiotherapist / chiropractor among others.
It is important that the therapist identifies the problem and advises the patient appropriately as the cause of the problem has to be identified and corrected for the patient to realise lasting results. Since by nature, human beings are habitual, we should continually ensure that we include stimulus in our lives to counteract our habitual activities. Incorporating regular stretch routines is a good way of maintaining normal muscles length.