Like oppositional arm and leg pulls, side-lying arm and leg pulls can be performed by one therapist with effective client positioning or by two therapists with one tractioning the arm and the other tractioning the leg, as shown in the photo.
■ Stand at the top or bottom of the treatment table close to the limb you will be working
with. If working with a second therapist, the other therapist should stand at the opposite end of the table.
■ Have the client lie diagonally across the treatment table with the top leg straight and
positioned slightly behind the client and over the edge of the table.
■ Place a small pillow or rolled-up towel beneath the waist to keep the lumbar spine
neutral.
■ If the client is able, have her place her top arm over her head (or as far in front of her
as she can) to maximise the entire lengthening of the lateral tissue.
■ Lift either the arm or the leg up from the treatment table (the arm will already be in
shoulder flexion and the leg will be positioned in slight hip extension), and apply traction to the end-feel and barrier of resistance.
■ Wait for the yielding sensation and an elongation of the limb into the body and along
the lateral side. When this happens, take up the slack to the next barrier of resistance and continue following release after release.
■ Dialogue with the client about any effects of and responses to the treatment.
■ Replace the limb gently, move to the opposite end of the treatment table and apply
gentle traction to the tissue barrier of the same-side limb, waiting and following for any release and elongation offered.
■ Remember never to force the
barrier in any direction or to slip over the skin. Always perform the technique for a minimum of five minutes, sometimes longer, for optimal results.
■ Lift the client’s arm and leg
back to the midline after com- pleting this technique.
oPPoSitionAL And Side-Lying PuLLS
CLient tALk
Although this technique is a great technique for general back and hip, or pelvic, issues, take care with the positioning of any client who has disc or nerve issues. Cease the technique if the client begins to experience nerve pain; perform the technique with the client in the prone position instead.
Tip
Arm and leg pulls can take anywhere between 5 and 10 minutes (and sometimes longer) to perform if you include full circumduction of the limb. Make sure to check your body mechanics so that you don’t tire when performing these techniques.146 Myofascial Release
Closing Remarks
Longitudinal plane releases work really well as both an assessment tool and technique in their own right. They are also great to combine with the cross-hand release techniques described in chapter 6. It’s always an interesting experiment to perform a supine right arm pull followed by a prone right arm pull because it shows how the line of drag and traction affects different structures in different ways.
Arm and leg pulls offer valuable insight into the location of restrictions, increasing kinaesthetic awareness in both therapist and client. Arm and leg pulls will help you feel along the line of traction and notice where that felt sense ends or where the tissue glide comes to a dead halt. Where the tissue feels stuck will be a restriction harbour- ing dysfunction. Continue to perform an MFR technique in the area that feels stuck to release the restriction, and complete the release by applying another longitudinal plane technique.
Quick Questions
1. What positions can arm and leg pulls be performed in?
2. What must be placed at the client’s lateral low back area when performing a side-lying longitudinal plane release?
3. What must you avoid doing when holding the client’s wrist whilst performing an arm pull?
4. What are the three planes, or directions, of movement employed in an arm pull technique?
5. Can you perform full circumduction of the arm in the arm pull technique on a client with a frozen shoulder?
8
Compression release techniques are techniques in their own right. They are also very useful when cross-hand release techniques or longitudinal plane release techniques fail to provide results because of client discomfort or tissue that is so bound down that it cannot soften and yield.
Restriction binds tissue together pulling adjacent structures out of alignment and forcing tension onto pain-sensitive areas anywhere in the line of pull. If we apply an MFR technique to these restrictions, eventually the tissue will release its hold and begin to yield and lengthen. However, sometimes the tissue is so tight, as a result of chronic dysfunction, habitual holding patterns and emotional trauma, that it cannot, or is not ready to, soften and yield. This is where compression techniques come into their own. Because fascia is a three-dimensional tissue, release can be encouraged by waiting for the tissue to soften and yield in any direction including compression. Once the tissue has softened and released three-dimensionally from performing a compression release technique, subsequent lengthening can be obtained from a cross-hand or longitudinal plane release technique.
As with all MFR techniques, compression techniques are performed skin on skin at the tissue restriction barriers, or end-feel. You lean into, or traction to, the tissue barriers without slipping or gliding over the skin. The tissue should never be forced, and each technique should last for five minutes or more.
Tip
Have you ever tried to pull a drawer out of a chest of drawers and found that it simply wouldn’t budge? If you push the drawer back in and then pull it out again, the drawer often glides out more easily. This is the concept of compression release techniques: compressing the tissue followed by lengthening it allows it to return to a better range and function.Compression
Releases
148 Myofascial Release
Essentially, compression release techniques are the opposite of cross-hand release techniques. Instead of crossing your hands, you place the hands side by side, allowing them to sink into the body to the tissue depth barrier of resistance. Then, instead of taking up the slack between your hands by separating your hands, you allow them to drift closer together to the tissue barrier and then follow any other direction and release offered, through barrier after barrier of resistance.
Like cross-hand release techniques, compression release techniques can be performed anywhere on the body. Following are a few compression release techniques for you to practise; once you get the idea and felt sense of the technique, you can apply the process to any restriction. As in the previous technique chapters, the initial technique is described in full for you to use as a reference when learning all of the ones that follow.