Deep Tissue (or structural integration) is a style of body work that uses postural analysis to decipher what is out of alignment in an individual's musculo-skeletal system and move it closer to a neutral balance. To achieve this, deep tissue utilizes methods that transform the deep myofascia. In this modality the practitioner uses his fingers, fists, forearms, and elbows to grip, twist, and shift layers of tissue to reorganize the system. This is a coarse level, quite direct approach to shifting structure. It combines well with other modalities, such as cranio-sacral or myo-fascial release, which are great for integration of musculo-skeletal shifts into the nervous system. Combining structural work with work that repatterns use, like Axis Syllabus or Feldenkrais, is also highly effective.
Sometimes deep tissue work can bring clients towards their edge. There are times when it is helpful to break up old thick scar tissue through cross-fiber friction, or use other intense interventions. It is important to have clear communication with the client throughout the process. Encourage them to breathe and stay present at such times. While going to an edge and waiting to see if that edge expands can create more space and remove old blockages, going over an edge creates contraction and resistance. Some clients are slow to speak up when their edge is being crossed, thus it is important to keep tracking their physical cues. These include breath, heart beat, facial expressions, and muscle tone in the immediate and distal muscles. Sometimes the client will mentally abandon ship while they are being worked with. If the client cannot bring some part of their awareness to the work, the effect will not be as strong and could reinforce old psychological strategies of dissociation under stress. A practitioner can keep their client present with the experience by checking in regularly. It is always preferential to work with the client and not on the client.
The deeper the practitioner is going, the slower the stroke should be. This gives the client time to integrate. The practitioner's job is to be patient while the tissues are coaxed. Not only is going too hard too fast likely to have the client in resistance, but it does not recognize the nature of the tissues being addressed. Fascia, the structure that holds us in our shape, is a sol-gel. It is solid until extended pressure, heat, or stretching acts upon it, at which point it gets re-hydrated and can more readily change its shape. It takes 30 seconds to a few minutes for the tissues to undergo this transformation (Clay, 2003, p. 10). Quick strokes will not be effective.
As a deep tissue worker, postural analysis is of utmost importance. None of us are symmetrical. To work symmetrically on the body in the face of this asymmetry would be ineffective. It is important to trace what is rotated, what is raised posterior or dropped inferior, where the hip is in-flared or out flared, what is rotated in or rotated out, what muscles are held short or held long. In short, it is important to deduce what is going on before intervening.
Earlier in the chapter, permaculture was referenced as a metaphor for Axis Syllabus. In this moment I call up permaculture again for its first tenent: observe first, then look for the intervention that will get the most pay-off for the least effort (Holmgren, 2002, p. 17). This is equally true for postural analysis and structural integration. There’s another guideline that applies to both fields. “If it ain’t broke, don’t fix it!” There is no need to rip deeply into muscles that are doing just fine. The intention is to create balance, so if a hamstring is pathologically tense, creating a pelvic tuck on one side, work deeply on the hamstring, but not so deeply on the quad of the same side. The two work in opposition. If you work evenly on both sides, you antidote your balancing effect.
Some other considerations worth taking into account during postural analysis:
Most pain and pathology is a result of rotation. Flexion/extension and superior/inferior variations don’t tend to create the same degree of difficulty. By de-rotating the sections of the spine and skeleton that are out of neutral, many issues can be relieved.
The applicable element of this law states that when the neutral spine is side-bent on one side it will be rotated posteriorly on the other side. It is often easier to identify which side is side-bended than which is rotated. If the side-bend can be identified, the rotation can be addressed based on this law. (It is important to clarify that this law uses the term side-bent in the mono plane definition, and not as the tri-axial alignment phenomenon that AS proposes. That being said, the two phenomena point towards the same conclusion. The structures of the body are tri-axial).
It is worth mentioning that recent research on spinal mechanics show that Fryette's Law is a simplification and is not always accurate in subtle nuances. It is still being taught in many osteopathic and physical therapy education programs and generally provides a great functional starting point for therapeutic work.
The Kinematic Chain:
This is a phenomenon often utilized for robotics, but is applicable to the neutral human skeleton as well. Essentially it says that linked elements in a mechanical structure will demonstrate compensational patterns in relation to gravity. This idea has huge consequence for body work and functional movement. To give an example, if the calcaneus is inverted (supinated), with rare acceptions, the tibia will be externally rotated, the femur will be internally rotated, and the ilium will have a slight out-flare. Conversely, an everted calcaneus (pronated) will lend itself to an interior rotation of the tibia, an external rotation of the femur, and an inflare of the ilium (Chan, 2011).
According to low-back and hip specialist and PT, Alco Chan, founder of the structural balance modality, Body Optimalization, one should work whenever possible in an “anti-gravitational” capacity. The human form is subject to the compressive force of gravity all of every day. Especially when someone is out of alignment, the compression of the skeleton into the joints has major consequence. By directing strokes in a manner that tractions the tissues in a direction opposite of what gravity suggests, we can counter some of the daily wear and tear of gravity. This means working from the sacrum up, rather than from the head down (as many practitioners do) when working on the back. From the legs down, this directionality would be reversed. The tendency is for ground force to be directed up into the hip joint and down into the lower back. By working against this directionality, we counter the effects of gravity.
Some Other Miscellaneous Strokes
Stripping refers to strokes that go along the lines of the tissue. This lengthens and tractions the tissue while breaking apart adhesions.
Cross-Fiber Friction goes against the grain of the muscle and is good for breaking up thicker adhesions and scar tissue.
Mobilization while working the tissue opens up access to new fibers of the tissue while giving the nervous system proprioceptive information to begin integrating.