Releasing Pain

Copyright © 2018 by Nancy Griggs PT.

Library of Congress Control Number:   2017916256

ISBN:                  Hardcover                      978-1-5434-5986-9

                            Softcover                         978-1-5434-5987-6

                            eBook                              978-1-5434-5988-3

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

This publication provides recommendations and ideas for rehabilitation and pain management. All efforts have been made to ensure the accuracy of the information contained in this book. Consultation with a qualified medical professional prior to beginning any new exercise or health program is advised. The author and publisher of this material are not responsible in any manner whatsoever for any injury or adverse effects that may occur through following the instructions contained in this material.

Courses to train health care providers for continuing education purposes are available through the author. Information can be obtained on the website releasingpainnancy.com.

Rev. date: 09/07/2018

Xlibris

1-888-795-4274

www.Xlibris.com

738194

Contents

Chapter 1   Releasing Pain

Chapter 2   What Is Rapid Release?

Chapter 3   Rapid Release- Better Than Stretching!

Contraindications and Precautions

Chapter 4   Answering Your Questions … Helping Yourself

Chapter 5   Examples of Effectiveness

Releasing Knee Pain

Releasing Hip Pain

Releasing Balance Dysfunction

Releasing Ankle Dysfunction

Releasing Low Back Pain

Releasing Neck Pain

Releasing Shoulder Pain

Releasing Headaches

Releasing TMJ Pain

Releasing the Elderly

Releasing Pain during Hospitalization

Chapter 6   Why Does It Work?

Chapter 7   Putting It All Together

Acknowledgements

Thanks to my brother, Jeff, who patiently helped me with a seemingly

never ending list of illustrations without ever complaining.

And, to my many patients. This book could not be a source of encouragement

for others if you had not put in the effort to validate the effectiveness

of this method.

Foreword

"Rapid Release is an exciting and innovative approach to the rehabilitation of recovering patients. I have had the pleasure of witnessing the success of this therapy for my injured patients. Nancy’s ideas and theories regarding the possible prevention of the long term effects of traumatic injury are insightful and thought provoking."

Thomas R. Howdieshell, MD

Professor of Surgery

Trauma/Surgical Critical Care

Department of Surgery

University of New Mexico HSC

Albuquerque, New Mexico

I have watched Nancy use her techniques to improve patient outcomes in many different settings for several years now. Her understanding of how posture and positioning effect patient care provides an excellent opportunity to improve collaboration of care between therapists and nursing. I look forward to working with her to make improvements in our treatment practices for the good of our patients. This book will be an essential tool to help us do that!

Kathy Lopez-Bushnell APRN, EdD, MPH, MSN

Director of Nursing Research

University of New Mexico Hospital

"Everyone should have The Rapid Release Progressive Flexibility Program in their physical therapy toolbox. Rapid Release is not just a ‘program,’ but a mindset, to look at the total patient with past traumatic injury and limitations of mobility and pain affecting the whole body. I have used this method with patients and it is progressive with the ability to jump into lymph drainage and improved mobility after releasing total body fascial restrictions. If one finds something that works, use it and let your clients benefit!"

Amanda Cannady PT CLT LANA

"I have clinically found that Nancy’s Rapid Release program is very effective in promoting correct postural alignment, increasing range of motion and decreasing pain, which ultimately leads to increased functional mobility and improved emotional state of patients. I feel this program can be applied to a variety of patient populations in all settings of physical therapy."

Christina Munoz, DPT

Supervisor Rehabilitation Services

University of New Mexico Hospital

"Rapid Release is a fabulous approach to improving one’s structural alignment and kinesthetic behaviors with simple movements designed specifically to access fascial planes and previous traumas within the body. These techniques can help influence both physical and emotional patterns, promoting a holistic reduction of dysfunction on many levels."

Patricia Marie Hubard MOTR/L CLT LMT

"My experience with Rapid Release is that the eye movement exercises were able to access the fascial connections to deep core musculature in my back and achieve the release of tension that - for me - has been present for years. By massaging the muscles under my tongue, I experienced a release of the complimentary psoas musculature, which has been a chronic problem as well. That, to me, is just amazing!

Julie Cleveland, PT

Nancy’s approach offers a gentle option to improve posture, increase range of motion, and decrease pain. This is a wonderful alternative for any individual for whom the traditional approach to Physical Therapy is not working.

Alexa Allen, OT, MOTR/L

Preface

The practice of physical therapy is more than the application of science to rehabilitation. It is also an art. An artist must first understand the properties and characteristics of his paints, brushes, and canvas. Years of practice help him refine the methods and techniques of his craft. The blending of his knowledge and tools with his vision and message yield the ultimate artistic expression.

The exercise program I will introduce in this text is a similar expression. My formal education as a physical therapist was completed at the University of New Mexico in 1977. The combination of the academic training and lessons I have learned from personal injury has been polished by hundreds of hours spent with my patients. This has resulted in a new method of rehabilitation.

The beginnings of the Rapid Release Progressive Flexibility Program occurred in March of 1982. I was on my way to work when my car hit black ice on a winding mountain road. I was next seen at the bottom of a forty-foot ravine. When I finally arrived at the hospital as a patient rather than an employee, X-rays revealed a compression burst fracture of the third lumbar vertebra in my lower back. The next day, my complete lumbar spine was fused together with two steel rods and multiple metal screws. My surgery went very well, but when the cast came off six months later, I was left with a permanent deformity of my lower back and a very unusual gait pattern. As I would learn years later, the normal amount of lordosis, or sway back, a person should have measures thirty degrees on X-ray. My X-rays revealed the curve of my lower back was forty-two degrees, but in the opposite direction. I had a seventy-two-degree shift in the alignment of my spine. As you can see from my X-rays, my posture was hugely distorted.

After my cast was removed, my roommate from physical therapy school suggested I see the massage therapist at her clinic. The longer I live, the more I know she gave me some of the best advice I would ever receive. I was more than a little surprised by the extreme discomfort I experienced in response to the therapist’s very light touch, and it covered my entire body. I was unaware of this hidden pain buried in the soft tissues of my body prior to that first massage. Over the course of the next month, I received three full body massages per week. As the discomfort lessened during the treatments, my gait became more normal, and my tolerance for activity also improved.

Surgically removing my original hardware in 1984 eased the discomfort I experienced at the end of one rod. I took the next eight years off from work after my accident to have my three daughters. During this time I managed my pain by walking, stretching and receiving regular chiropractic adjustments.

I returned to work as a physical therapist in 1992. I took courses in neuromuscular therapy and craniosacral therapy to meet the continuing education requirements I needed to maintain my physical therapy license. Neuromuscular therapy is a specific massage technique that teaches the therapist how to examine and treat each muscle of the body from the origin of the muscle to its insertion. Craniosacral therapy teaches the therapist how to release soft tissue restrictions along the spine as well as around and beneath the skull. These two therapies form the foundation from which I continue to practice. As I applied these therapies to my own body and to my patients, I gained valuable insights into soft tissue dysfunction I would not have learned apart from my own injury.

The Rapid Release Progressive Flexibility Program is a way to mobilize these tissues with movement. The classroom of my body has given me an understanding of pain I never received in an academic classroom. Listening to and observing my patients showed me that, regardless of their current complaint, we all have far more in common than I ever imagined.

In the fall of 2000, the rheumatology department at the hospital where I was working asked for help in caring for their fibromyalgia patients. I was hopeful my manual skills would help this population, so I volunteered to try. I checked out a book about fibromyalgia from the hospital library to get additional ideas for treating this condition. The most important suggestion I found in the book was to exercise these patients in supine, or flat on their back. The book explained that supine should be the most comfortable position for exercise because it is the position in which the body becomes the most weightless. The effects of gravity on movement are the least when the body is positioned in supine. What I soon learned, however, was most of these patients were most uncomfortable in supine. I also noted how distorted their cervical, or neck, posture was in this position. It was either very difficult or impossible for them to independently position their neck in correct alignment. Most of my patients tilted their head back so their chin was pointing toward the ceiling to some extent.

In an effort to implement the suggestion of supine positioning for exercise, I began to first provide as much compensation as was needed to correct the posture of the cervical spine. I would also provide compensation under their knees to ease any lower back pain without deviating from a position of correct posture any more than necessary. The exercises I gave to each patient were specifically directed to the area of their primary pain complaint. If they were referred to therapy for shoulder pain, I gave them exercises for their shoulder. If their complaint was knee pain, I gave them exercises for their knee. The only difference was they were doing their exercises lying down on their back as opposed to sitting or standing.

In the spring of 2001, I decided to try some of the suggestions I had been giving to a woman I was treating for lower back and hip pain on myself. I had completed some work in my backyard that required hours of forward bending at the waist. When I completed my work, the tension in my lower back made standing straight virtually impossible. As I lay down in the grass and started to do some very basic active range-of-motion exercises, I sensed how my body wanted to respond to each movement. I followed the leads my body gave me and was soon aware the movements released tension in each other as I alternated them. After only five to ten minutes of very non-strenuous exercise, I was able to stand straighter and was more flexible and buoyant in my legs.

Once I became familiar with the movement patterns for my lower body, I wondered if the same types of alternating movements would be effective for the neck. As it turned out, the exercises not only helped my neck but also promoted even greater flexibility in my lower body. Exercises for the upper body were next to fall into place. Then one day I randomly started the eye exercises with a patient suffering from cervical pain. I continue to be amazed daily at the help so many people receive by doing these very simple eye exercises. This book will show you how to use this series of exercises to help you with your problem.

I had no idea what would become of this exercise program that day in my backyard. The past eighteen years have been a remarkable journey of revelation and discovery for me. What I appreciate most about this program is the fact that it is so safe. Rapid Release provides a new entry level to exercise for those who have an obvious need for exercise but have not found a form of exercise they can tolerate. Because it is intended to be used within a pain-free range of motion, there are virtually no contraindications. Caution should be used, however, by those who are extremely frail and/or elderly. Other precautions are explained on pages 69-71.

The things I most enjoy about the program are its simplicity and versatility. Within eighteen months of its completion, I realized these exercises could benefit every type of patient I saw. It is a postural balancing program, so it is helpful and relaxing even for individuals who do not have pain. When pain is present, it does not matter whether it is chronic or acute. It is particularly good for post-motor vehicle accident, falls, or fibromyalgia, where there can be multiple pain sites. I have used it equally as well for diverse orthopedic referrals, preoperatively or postoperatively, including rotator cuff tears or total knee replacements, which appear to be more localized and straightforward. These exercises have helped with balance disorders, vertigo, and migraine headaches as well as more involved neurological conditions, such as cerebral palsy, Parkinson’s disease, multiple sclerosis, and post CVA (cerebrovascular accident), or stroke. Even individuals who are highly athletic and exercise regularly have experienced the positive effects of these exercises. I have used them in a variety of settings, including outpatient clinics, skilled nursing facilities, home health, hospitals, my private office, and my mother’s living room floor. All age groups have responded surprisingly well whether they be adolescents or the elderly in their eighties and nineties. Rapid Release is easy to teach and easy to learn.

The comprehensive exercise program I present in this text is a noninvasive therapeutic approach to pain management that can be used to supplement or enhance existing techniques. My ideas resonate with several other theories and concepts that have been documented for decades. What is different is how the ideas are packaged and applied. This program is my offering to those who are looking for help with their unresolved pain issues. It is a new tool for the health-care providers’ toolbox to help make their job easier while they continue to provide the best possible care for their patients.

I have included more than seven dozen case examples in this book to help you understand how this treatment approach can help you. Each case example represents a common situation or diagnosis. As you read the patients’ history and their response to treatment, my hope is for you to be encouraged about the possibility for your own improvement. Until now, I have worked alone with each one of my patients. No one, except an occasional family member, close friend, student, or curious therapist, has been with me to share the fun I have had as I have seen my patients remarkably respond to these very simple movements. You are now invited to share some very surprising and rewarding moments. Forty-five testimonial letters from a few of my patients will validate the results you may achieve with this method.

The majority of you who implement these exercises will experience some degree of success by doing these exercises. I tracked the outcomes of one hundred consecutive patients in 2014. These patients had nothing in common, except they all received this exercise program as the foundation of their therapy. Fifty-eight percent reached all their functional and pain goals. Another seventeen percent partially reached their goals. The final twenty-five percent were not helped by this method. If you are a patient, this method offers you a seventy-five percent chance to feel and function better. If you are a therapist, these concepts will provide you an option for patients who are not responding to traditional therapy.

The more I implement this program, the more I feel like the blessed recipient of it than the developer of it. It has given me such great joy to watch people improve by doing these very simple exercises. I am excited the time has finally come for me to share them with you. I hope you will be encouraged by the following letter written by a personal friend of mine. She brought her daughter to me for help, but later learned the exercises were good for her and her husband too. Maybe this sort of thing will happen in your home as well.

Dear Nancy,

We want you to know how much we appreciate what your rehabilitative exercises did for our family. When we came to you, we were out of options. Our daughter, who was ten years old at the time, had suffered a horseback riding accident two years prior to our initial visit. We were under the care of a well respected chiropractor, but we were making very slow progress. The chiropractic care brought our daughter temporary relief, but we were praying for more than that!

During the two years after the riding accident, our daughter could no longer enjoy bike rides, swimming, archery, or softball—and she had been a pretty good little pitcher too! If she did a little too much, she would sometimes cry when the tightness and sharp pains would grab her upper back. We tried so hard to avoid any over exertion that would send us back to the chiropractor for adjustments and electrotherapy. And because of her reduced activity, she put on weight. It broke our hearts to see her endure so much pain!

When I heard that your program was having such tremendous success, we had to try it. After meeting with you one time, we began doing the exercises like you showed us. They were simple and easy! I could tell her body alignment improved after the first time she did them. And she experienced immediate relaxation. Within a few days, she noticed she was enjoying a larger range of motion. After two weeks, we knew she was going to have a complete recovery! We kept doing the exercises for two months, even though she seemed to be completely better after the first month.

Today our daughter continues to be pain-free, without any recurring symptoms of trauma. My husband and I have used the same exercises to achieve relief from back pain too. We used to be regulars at the chiropractic clinic, but we have not been back now for a long time.

We are so happy you are publishing this book! We know God is going to bless many people through this! We thank Him for sending you our way.

Chapter 1

Releasing Pain

It is the job of the physical therapist to help their client recover from functional deficits. Lingering pain following injury or surgery is often a prohibitive factor to the rehabilitation process. Most people have experienced the inability to function at their best capacity when their back is hurting or their head is pounding. Everyone knows what a bother pain can be. No pain, no gain is the mantra of many in their attempt to overcome their pain, only to find that provoking pain begets even more pain.

I am convinced the pain we visit our doctors about is a symptom of a more extensive scenario. I believe any trauma we sustain to our body stays with us to some degree until it is intentionally addressed. I also believe a progressive tension develops in the body after an unresolved trauma, which provokes an increased pressure in the body. This pressure can and will manifest itself through a variety of symptoms. The key to resolving the obvious and the immediate pain complaint is to release the tension to relieve the pressure. The key to preventing future pain and a variety of other problems is also to release the tension to relieve the pressure. I am hopeful the case examples I present in this book will make a case for an early comprehensive intervention following traumatic injury. I believe the possibility of providing an intentional new avenue of preventive care is an attainable reality.

It is controversial to assume past physical trauma will create problems later in life. Many people would doubt a motor vehicle accident or a fall several years ago, or even months ago, could be the source of a current pain complaint. If the trauma occurred decades ago, it would certainly be disregarded by many people. I, on the other hand, believe the overwhelming majority of our problems can and do extend back to these traumatic events in our past. It is my hope the common thread of past traumatic injury coursing through the case examples I will present will motivate us to consider new holistic plans of care following traumatic injury.

Let me use an illustration to validate my point. My dad loved to get a great deal on a car. At one point in his life, Dad met a guy who restored damaged vehicles and sold them at the car auction. Dad enjoyed nothing more than getting a top-of-the-line vehicle at an unheard-of low price. There are many people who would never consider buying a restored vehicle. If you ask them why, they would probably tell you it is because they are afraid of the unseen damage. They don’t know what problem(s) might surface in the future that are not so obvious today. We are very quick to acknowledge the damage impact and force can have on steel and metal. We disregard the fact that the same impact and force that mangled the car can and will have a lasting effect on the flesh, bones, and soft tissue that drove the very same vehicle.

Acknowledging the lasting effect(s) of a previous trauma helps make sense of the mysterious and the frustrating. Quite often, physical problems spontaneously appear in an individual’s body. They are unable to recall any particular injury to the area that is now painful or dysfunctional, but the pain they perceive is very real. The sequence of events that tend to follow is, unfortunately, very common. Initially, resting the part or cutting back on certain activities is tried, along with topical creams and heat or cold applications as a remedy for the pain. If the person next tries over-the-counter or prescription medications unsuccessfully, the situation becomes somewhat worrisome and frustrating. Discouragement develops if tests such as X-rays and MRIs are completed and return normal. So far, there is no explanation for this curious pain, much less a solution. Depending on the intensity of the pain and the degree to which it is changing the person’s lifestyle, some people are on the verge of hopelessness.

Acknowledging the theory that a previous trauma has lasting effects on the body gives us hope for understanding the current problem. As we begin to consider the effects of force, tension, and pressure on and within the body, we are given a new perspective on what we previously perceived as inexplicable. Addressing the problem now has some very practical solutions. New treatment options can be considered that otherwise would not have been thought of. The process of preventing future complications can also begin.

Force

Anytime I must learn something new, I do best if I have a clear definition of my terms. So I will begin there for you. All trauma begins with an impact that generates force. By definition, a force has acted on a system anytime there is a change in the state of that system; a force may be understood by the effects it produces: deformation, movement, heat, or friction.¹ A force either pushes or pulls on an object. The vector of the force describes its magnitude and direction. There are two basic classes of force. Contact forces act on an object by touching it at a specific point. Long-range forces act on an object without making physical contact. Magnets and gravity demonstrate long-range force. You have undoubtedly held a magnet over a paper clip and watched it leap up to the magnet. Or, seen your coffee cup fall to the ground if you release your grasp.² Motor vehicle accidents and falls involve both types of force.

Even contact force can cause far-reaching effects. For example, when a person slips on ice and falls back onto their buttocks, a force enters their body at the site of impact. There may or may not be visible bruising or soreness. This energy will proceed through the body toward its final destination. If the force is electricity, it leaves a larger wound at the point of exit than at the point of entrance. The force generated by the impact will not leave a visible exit wound, except in the instance of a compound fracture; instead, the force settles in the body somewhere, doing more damage where it settles than where it enters. The damage the force generated by the impact is often invisible unlike the damage from electricity, which is visible. The damage done by the force generated from an impact can enter the body from any direction and varying magnitudes. Understanding the mechanism of injury is always helpful in making practical sense of current pain complaints.

We have all witnessed the rippling effect of a rock being thrown into a body of water. This demonstrates how areas other than the point of contact are affected by and absorb the impact and force generated by the rock hitting the water. On a much larger scale, none of us will ever forget the sight of the World Trade Center collapsing after being struck at a very specific location on the building. The force of the impact traveled throughout the entire building, weakening it at every level. In the same way, the force of the impact generated by a motor vehicle accident or a fall will be absorbed directly and indirectly. The damage it does can be obvious, but the damage often occurs at the site where it settles unrecognized. This explains why a person who recalls no injury to their neck may experience neck pain at some time following a fall onto their tailbone.

Osteopathy is a system of medical practice based on a theory that diseases are chiefly due to loss of structural integrity, which can be restored by manipulation and massage of the bones, joints, and muscles. The presence of whole-body dysfunction and the need to treat a person holistically is at the premise of their practice. As stated, Lesions, or damaged areas, occur not only locally at the point of contact, but also at distant sites as a result of shock waves or similar phenomena. A global lesion is far removed from the symptom. It reflects the belief that nothing is isolated in a living organism and that all structures and processes are inter-dependent. Clinically, this concept leads us to treat people instead of symptoms, and to look at the entire person and his bodily structure instead of simply the place that hurts. The concept of the global lesion is at the foundation of osteopathy.³

As the body absorbs the force of any impact, whether it be the result of a collision or fall, it will stress all different types of tissue. For the purpose of this text, we will consider its effect on the fascia of the body. Fascia is comprised of layers and layers of connective tissue within the body that virtually holds everything together. When the skin is removed from a piece of chicken, the fascia is easily seen as the sheer membrane overlying the muscle. But fascia is not only present where it interfaces with muscle. Fascia is the connective tissue matrix that holds everything in its place, literally connecting anything in the body to everything else. Instead of wrapping up a muscle to separate it from other structures, fascia acts like a spiderweb to connect each structure in the body to its neighbor. In my experience, restricted fascia has made me feel as if I was wrapped up too tightly on the inside. One patient told me her skin did not feel like it was big enough for her body.

In its healthy state, fascia is a connective tissue fabric that distributes mechanical forces in the body. The shape of the fascial tissue is the result of tension and compressive forces in the area. This form can be altered by strain or stress. While muscle is designed to contract and relax either slowly or quickly, fascia is not. Muscle is elastic, but fascia is plastic. When muscle is stretched, it will attempt to recoil back to its resting length. When fascia is quickly stretched, it can tear. If the stretch is applied slowly enough, it will deform plastically: it will change its length and retain the change.⁴ Fascia can become stronger and denser in response to stress and strain. The best analogy I can give from personal experience to describe what areas of increased fascial density feel like is my insides have been starched. Comparing the injured fascial web to phyllo dough that has become baklava is another helpful word picture.

Because fascia is literally everywhere in our body, it can affect everything. Imagine how difficult it would be to enjoy a workout of running or weight lifting if you wrapped yourself up in plastic wrap prior to exercising. So it is with a person whose motion and function are restricted by tight fascia. Imagine yourself wearing a piece of clothing that fits you nicely and hangs comfortably on your body, but the lining of the garment is one or two sizes too small. Even though everything seems fine from the outside, you feel uncomfortable. So it can be with the fascia. There may or may not be any external evidence to the effect(s) it is having on the inside of the body.

Body workers and massage therapists have long said The body has memory. Examining the body for fascial restrictions enables us to see the memory trapped in the body in the form of damaged fascia. There are currently no ways available on a large scale to objectively evaluate the condition of the fascial system, so it can often be overlooked or forgotten. The tone or the tension of the fascia can be palpated and treated, however, through the hands of another person, which brings us to consider tension.

Tension

Our bodies basically function like an elaborate pulley system. When all the muscles, or pulleys, are balanced and harmoniously exerting the correct amount of tension among themselves, the system functions efficiently. We have all experienced those times, however, when one area is tighter than another. We feel the discomfort of being out of balance. If the imbalance is significant enough, it will visually manifest itself as postural distortions or gait discrepancies. The pulleys may be imbalanced enough to make standing still or walking a straight line difficult. If this loss of equilibrium provokes an actual fall, whether from tripping while walking or during a sporting event, the result is a pulley system sprained and/or strained further out of balance. No one has ever fallen while maintaining a perfect posture. This opens the door for a painful tension to develop, alerting us to our body’s need for correction. As we consider how tension relates to pain, there are three things to keep in mind.

First of all, adverse tension in a muscle does not always limit movement. It is possible to have a great range of motion but still experience pain in a certain muscle when it is used or palpated. This is because a section of the muscle may be tight, but the area of tension is not actually large enough to hinder the overall motion. These areas of increased tone are referred to as trigger points. They are painful because the tension is significant enough to hinder blood flow to the area. While trigger points may hinder muscle lengthening, they do not always do so. Trigger points can cause pain locally, or they can refer pain to other areas as well.

Second, if the range of motion is hindered in a particular direction, it is not necessarily the result of excessive tension in an opposing muscle group. The restriction may be the result of tightness within the muscle working to produce the motion instead. For example, if I cannot fully straighten my knee, it would be logical for me to suspect the muscle that bends my knee is too tight, which then prevents the knee from completely straightening. What may actually be limiting the motion instead are the trigger point areas within the muscle that straightens my knee. These areas prevent the complete muscle from contracting, and range of motion is limited. This is, in part, why stretching or strengthening only the areas of obvious deficits in our bodies will not produce the movement we are striving for. If you reconsider the body as a pulley system, it is easy to understand you cannot make an adjustment on one side without affecting the other. Any time there is an obvious problem, it is safe to say there is a secondary problem close by that may not be quite as obvious.

The third way tension affects the body relates to pain perception. It is not only a little more surprising, but also easy to understand. The best way to explain this point is through another illustration. If I stood in front of you and tied a rope around your arm and then pulled on the rope, you would feel the discomfort from the pull in the back of the arm. In an effort to reduce the discomfort, I could rub the back of your arm or heat it repeatedly, but neither of these things would help as much as if I just released my pull from the front. The primary source of pain in an area frequently can be found as adverse tension on the opposite side of the body.

The best and most common example of this is lower back pain and the muscle that flexes, or bends, the hip. The psoas (so-as) muscle attaches to the anterior, or front, side of the vertebrae, or bones in the lower back. The muscle passes through the abdomen to reach its point of insertion at the top of the femur, or the long bone in the thigh. When this muscle becomes too tight, which it often does with prolonged sitting, it exerts a pull on the vertebrae in the lower back. The pain or tightness is felt in the lower back, but it is best resolved by releasing the pull from the front of the body in the abdomen.

a. Normal length of the psoas muscle in standing.

b. The lower half of the psoas becomes shortened during prolonged sitting.

c. When the psoas is required to lengthen during standing, the upper half of the muscle must pull the vertebrae of the lower back forward to compensate for the overall length that has been lost to tightness in the lower half of the muscle.

The effect is the same if I pull on the front of your shirt to make it pull tightly across your lower back. This is why applying heat or cold directly to the low back is only partially and/or temporarily effective in relieving lower back pain. While it is okay to treat the symptoms directly, more pain relief will be realized if you do not neglect the source of the discomfort by applying heat or cold to your abdomen. Decrease the pain in your back by treating the tension in the front—in the abdomen.

In the same way, discomfort in our upper bodies or torso is often the result of a downward pull from the tight fascia in the lower body and/or lower extremities. If I applied a downward pull on the hem of your shirt, you would experience the pressure and tension from the pull across the top of your shoulders. That same pressure would be relieved by interrupting the pull on the hem of the shirt. Because the fascia is a continuous sheath covering the entire body, it actually acts more like a hooded bodysuit than just a shirt. As you visualize this example, it is easy to see how tension in the lower body can affect the head, neck, and upper torso. Or, tension from above can also affect an area below.

Adverse tension in the body can develop in several different ways. It can be the result of a sedentary lifestyle or prolonged positioning that is not corrected with regular stretching. It may be the result of a very direct or indirect injury or trauma. Regardless of the cause, increased tension in the connective tissue creates increased pressure on the underlying structures, which brings us to my final point.

Pressure

Pressure is defined as the force applied perpendicularly to the surface of an object per unit area over which that force is distributed. Pressure is a pushing force. Tension is a pulling force. What I have observed clinically is that increased fascial tension applies pressure on whatever lies beneath it as it pulls across the underlying structure. Because the fascial web is continuous from the feet to the head, and even inside the head, I have seen how increasing tension by dorsiflexing the foot, or pulling the toes towards the nose, can increase the pressure in a person’s head, or lifting their arm can increase the pressure in their head. What I see most commonly can best be illustrated by thinking about the body as if it is a rectangular water balloon.

The body is largely comprised of water. Normal values for total body water expressed as a total body weight will vary between 45 percent and 75 percent. The total body water can be divided into two major fluid compartments. Thirty-four percent of this fluid is in the extracellular compartment consisting primarily of the plasma found in blood vessels and in the interstitial fluid that surrounds the cells. Lymph, cerebrospinal fluid, joint fluids, and humors of the eye are, also, considered extracellular fluid. The remaining sixty-six percent is intracellular fluid which is the water found inside the cells.⁵

What I began to notice very early in the application of this program to my treatments was areas of pain or joint stiffness were best relieved by movement at the opposite end of the body from the symptoms. The tension in the lower body increased pressure and/or provoked symptoms above. When the tension was released in the lower body, the symptoms resolved in the upper body, neck, and/or head. The same principles applied to tension above and symptoms below. When it came to symptoms more in the middle, like shoulder pain, the tension needed to be released above and below.

So how does this affect treatment?

Opening my eyes to this concept has completely turned my treatment techniques upside down. I mean this quite literally. I usually get my best results by treating the opposite end of the body from the symptoms. To say this approach is unorthodox in the world of physical therapy is an understatement. I am hopeful the observations, ideas, and concepts I present in this text will help us approach rehab more holistically through the conventional vehicle of exercise, but with a new intention.

Understanding these concepts has shown me how to be more thorough in my caregiving. I now have reasons to look elsewhere for contributing factors to a problem or even for the cause. I have options to consider that almost always provide solutions for even the toughest conditions. Most of the stubborn symptoms lingering in the shoulders, upper back, head, or neck can be resolved by thoroughly addressing the lower body. Greater success is achieved in the lower back and legs as the eyes, head, and neck are treated. Neither my patients nor I have to settle for unsatisfactory results.

Understanding how one end of the spine, or one area of the body, influences the opposite end of the spine, or another area of the body, has specific implications for potential rehab outcomes. I believe our best results will come when the spine is treated as one continuous unit. We should not separate our treatments of the cervical and lumbar spine, or of the neck and the lower back.

Unfortunately, there is no current way to objectively measure or evaluate the integrity of the fascial system. Decreased range of motion, decreased function, and increased pain are indicators of its condition. Any one or all three of these symptoms may be present when the fascia is not healthy and functioning efficiently. Improvements in the fascia will manifest themselves as increased range of motion, improved function, and decreased pain.

Regardless of the fact that radiographic imaging is not available to the majority to objectify changes within the fascial system, it can be assessed through the palpation skills of anyone trained to do so. Fascia will release tension in response to light touch or gentle manual stretching. While these manual techniques can be effective, much of the patient’s improvement is dependent upon the intervention of the manual therapist.

The Rapid Release Progressive Flexibility Program is unique from other forms of exercise because of its apparent effect on the fascia as it is engaged through gentle movement from a position of correct alignment. It is a home exercise program that allows the patient to take an active part in their healing. Gently moving the soft tissue prepares it for the treatment it receives from the therapist. Time previously spent during the therapy session to initiate change in the tissues is used instead to advance further release and flexibility. The therapist is able to focus treatment time on stubborn areas of connective tissue restriction that have not changed in response to exercise. The positioning the patient uses to complete the exercises helps the therapist identify the source of the problem, which is not usually in the same place as the patient’s primary complaint. This partnership between the therapist and the patient translates into quicker recovery and improved pain relief for the patient.

When I take a history from my patients, I want to know about any motor vehicle accident, fall, or trauma that has occurred at any time in their lives. As I collected data on three separate occasions from a total of 450 new patient evaluations, an average of 96 percent* of those patients had some episode of significant trauma in their lives in the form of a motor vehicle accident, fall, or both. From that group, the trauma for 88 percent of them occurred more than three to five years ago. For many of those patients, the trauma was identified as a specific incident that occurred even several decades ago. My palpation evaluation usually uncovers a pattern of dysfunction in addition to localized pain or dysfunction. I could have treated these patients locally at the site of the primary complaint, but I believe I managed my patient’s care better by treating them as a whole person.

I believe most of the aches and pains we suffer with on a daily basis could be prevented by early comprehensive treatment of the soft tissue following any type of traumatic injury. The Rapid Release Progressive Flexibility Program is one way to do just that.

*   This 4 percent might be less if people’s memories were better. I worked with one woman who came to therapy for lower back pain. She had no recollection of any trauma to her body at the time of her initial evaluation. Almost a full month into her treatment, she remembered the time she fell down twenty-five marble steps on her tailbone. She was bedridden for three weeks. This is an extreme example of a forgotten trauma. Less serious accidents than this have happened to others that were still significant enough to contribute potentially to future problems.

Chapter 2

What Is Rapid Release?

Rapid Release is an active range-of-motion exercise program that promotes flexibility more effectively than conventional stretching. This is accomplished by addressing restrictions throughout the complete full body fascial system. The purpose of the exercises is to restore good posture and function by lengthening the soft tissues. How this is done is explained on p. 17-37. The exercises used in this program are illustrated in chapter 3. Moving the body from a position of correct alignment is very important to the success of this method.

The exercises are done in four sections of the body:

1. the lower extremities and the pelvis

2. the upper extremities and the scapula, or shoulder blades

3. the neck and the occiput, or the base of the head

4. the eyes

Improved functional mobility is achieved by first improving the quality of movement in each section and then adding them together. We are the sum of our parts.

Multiple pairs of movements are done within each section to release tension in that section as the motions are alternated. As flexibility improves in each section, one section helps relax tension in another section. For example, a certain degree of flexibility can be achieved by doing the exercises for the head and neck. If the lower body exercises are then done and release tension in the lower back, the head and neck may release even more tension, even though no additional exercises have been done directly in that area. Lengthening the soft tissues of the entire body is the purpose of the exercises. When Rapid Release is done in its entirety, maximum flexibility is achieved secondary to the thoroughness of the approach.

The Rapid Release exercise program is unique from other forms of exercise in five different ways. These differences include the position of the body, the position of the head and neck, the type and quality of the motion, the manner of exercise progression, and the theory behind its effectiveness.

1. The Position of the Body

• Correct supine alignment •

All the exercises from the original program are done in the supine, or flat on your back, position. The illustration above represents the correct alignment of the body in the supine position, which is referred to as the 0 (or zero) position throughout this exercise program and on the exercise flow chart on p. 98. There are positional variations and supplemental exercises to the basic program that will be explained after the original program design has been thoroughly explained. Pay special attention to the Seated Worker series on pages 74-76. I now use this version of the program to begin the exercises for most of my patients.

The first step in the program is to assess the alignment and the comfort of your body in the supine position. The best place to do this is on the floor if you are able to get up and down from the floor without injuring yourself. A