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Massage Today
September, 2005, Vol. 05, Issue 09

The Inside-Out Paradigm: Small Facts, Big Implications

By Dale G. Alexander, LMT, MA, PhD

Why do the human neck and back experience pain so often? Because much of what sustains our lives is suspended forward from them. The basic principle is that tensions in the front of the body are transferred to the posterior aspect of the human spine, where the sensory nerves register the strain and stimulate the muscles of the back and neck to contract.

Our bodies valiantly endeavor to distribute this strain. Eventually, clients present with musculoskeletal problems that do not resolve, but instead, emerge and persist. Quality of life starts to diminish.

Let's begin at the top. The esophagus is tethered from a slip of fascial tissue that bridges the sphenobasilar junction, right behind your eyes. Contraction, contracture or spasm of this connecting tube between the cranium and the upper abdomen pulls the head down upon the neck, and eventually pulls it forward and down. Wherever the head goes, the rest of the body must follow. The strain might be felt into the neck, upper-back or mid-back regions.

During our embryonic development, the heart and the diaphragm muscles begin their descent from the 2nd cervical segment. During this same descent, the pericardial sac of the heart becomes welded to the diaphragm muscle. Our lungs also hang from the neck via Sibson's fascia, which interdigitate with the scalene muscles as far up as the 4th cervical segment. This has many implications; consider two of the most obvious. Breathing difficulties of all varieties and cardiac dysfunction of any kind will inevitably and literally pull the human neck and upper back forward and down toward the pelvis.

Let's return to the esophagus again. The heart has an indentation for the passage of this muscular swallowing tube between itself and the spine. What might be the effect of contracture of the esophagus on heart function? How might the body attempt to distribute this strain? Where will it be felt? The clinical principle here is that where clients report pain is rarely the true source of its origin.

The colon is suspended from the space between the 9th and 10th ribs and is anchored into the hip bones internally. Consider a contracture of the ascending colon on the right side of the body. Might this exert a strong influence for the spine to side-bend to the right and rotate left, resulting down the kinetic chain in the common observation of a short left leg?

Even less appreciated is the fact that the mesenteric root of the small intestine is suspended forward from the 3rd lumbar vertebra. Given that the length of this crucial organ of digestion is approximately 8-12 feet long and that its weight may exceed 50 pounds, it is little wonder that low back dysfunction is a leading source of diminishing quality of life.

What all these small facts lead to is a need to shift our therapeutic perception to working from the "inside-out." What is happening internally is where the real action is. Our organ systems are what replenish our energy and cleanse our bodies. This does not negate the influence of traumatic incidences that "flash freeze" the body's sense of balance in relation to gravity. Rather, internal relationships and their dysfunctions predispose the lines along which trauma tends to fixate the system. Any locking of the system will progressively reduce the body's ability to allocate its resources of oxygen and nourishment to all of its systems. Aggregately, this creates a breeding ground for all varieties of chronic problems to emerge, and even for pathology to develop.

Our task as massage therapists is to stem this tide - and if possible, to help turn the boat toward assisting the body to redistribute its strain and reallocate its resources more equitably. This is perhaps a functional definition of physical healing.

Click here for more information about Dale G. Alexander, LMT, MA, PhD.


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