RECTUS ABDOMINIS AND THE WAY TO THE HEART

It is said the way to a man’s heart is through is stomach.  This turns out to be more literally true than one might think.  The rectus abdominis muscle runs from the pubic bone all the way up to the fifth rib, which overlies the heart.  There the fascia interweaves with pectoralis major - so practically the rectus can be seen as going up to the clavicle near where it meets the sternum.  Fascinatingly, this place is the very end of the kidney meridian, a point often translated, provocatively, as “Elegant Mansion”.  The kidney meridian, associated with the “water” element in acupuncture is paired with the bladder meridian which parallels the kidney meridian by running down the back of the body as the kidney does up the front.   Thus, the bladder meridian is running down through the erector spinae, which are the antagonists to  rectus abdominis. The balance of the front and posterior torso muscles is largely responsible for our erect posture.  So treating the back without the front is treating only half of what may be needed. The iliopsoas has a great reputation, but it may ultimately be less connected to your postural and neurological health than rectus abdomnis!

DEEP MASSAGE WITH RECTUS ABDOMINIS

I recommend asking your client before the session begins if they are fine with you working on their belly.  Since it’s a more vulnerable or possibly more defended area some people prefer it not be included.  However, most will be fine, especially if we respectfully ask their permission and then work the area with clarity and care.

Working with rectus abdominis can result in enormous psychological and physical benefit.  So central is it to our being that I sometimes say it is arguably the most important muscle we can work on. 

The most serious and common structural distortion we see is forward flexion of the torso.  That compromises our posture, compresses our organs, and forces the back to constantly strain to overcome the effects of flexion and gravity pulling the torso forward and down. 

Some major gains of working here are then to give dramatic relief from back tension, to restore uprightness, and to decompress the organs and spine.   Rectus abdominis work, by amplifying the graceful verticality of the front torso, helps restore the head to its rightful position above the torso, rather than hanging out in front of it.

In addition the rectus abdominis is interwoven with fibers from the other abdominal muscles that go around the entire waist.  Therefore, the healthy effects of working here commonly radiate around to the back.  Indeed, when a client’s spasming back muscles are too sensitive to be touched, fulcrums into rectus abdominis can give dramatic relief without ever touching the back!

Ideally, the rectus abdominis is stretched with every full inhalation.  When it’s shortened or tense, this limits the fullness of breath.  With diminished breath, we have diminished cellular respiration, which then compromises the structural and energetic functioning of the entire organism.

Energetically, the rectus is linked to a whole world of feeling and sensation - intuition, gut feelings, having courage, fortitude, freedom of breath, digesting and assimilating literal and figurative nourishment, and the feeling of the uplifted heart.  Biologists now recognize the belly region as home to the “second” brain, called the “enteric” nervous system.  This vast and semi-independent community of nerves is responsible for all the actions and interactions of our visceral organs.

Soothing the “enteric” nervous system and freeing tension in the belly will help balance and optimize the signals these nerves are sending to your stomach, spleen, pancreas, bladder, small and large intestines, liver and gall bladder.

With this vast array of effects, it is not surprising that Asian cultures have clearly identified this area, especially the lower abdomen, as the center of our whole being.  Located in fact in the precise center of gravity, the hara in Japanese or dan tien in Chinese, is an area approximately two inches in front of the second sacral segment.  Traditionally and energetically, the hara is regarded as the emotional and physical center of the body – from which our energy radiates out in all directions – just like a sun.

FULCRUMS FOR RECTUS ABDOMINIS

Reminder on boundaries – the rectus abdominis, through its attachments to the pelvis and upper ribs, reaching as high as nipple level with fascial continuity up to the base of the neck.  It spans and touches on a number private areas. 

Before the session, ask for permission to work with the front torso.  During the work, be sensitive to the person’s sense of boundaries and check in as needed, being extremely clear where we are going and why.

Center yourself as you begin.  Stand at pelvis level facing up toward the torso at about 45°.  Let’s assume we are starting with the client’s right side, with the belly undraped.

Place the whole of your right hand palm on the lower belly. The heel of the hand is resting just above the side of the pelvis, palm and fingers aiming approximately to the area an inch beneath the navel.  Let the warmth of the whole hand resting here provide reassurance in this sensitive area.

You will be starting this fulcrum working into the thickest part of the belly of the rectus abdominis muscle, about one inch lateral to the body’s midline.

Now just place your left palm on top of your right hand.  Gently press the finger pads of the left hand onto those of the right, and take out the looseness with direct pressure into rectus abdominis.  The direction is posterior, i.e. toward the table surface.

Take a moment to further free your own breath.  Then gently relax your knees just a little, using this relaxation to rest just a bit further into the belly of rectus abdominis, taking up the slack.  The client should feel NO discomfort.  Now, not necessarily pressing in further but just resting, allow the client to breathe and to relax any tension held at this level in the rectus abdominis.  Even if you find no tension, do rest in for the duration of one breath. 

Reminder that it is better to err of the side of conservativeness with shorter fulcrums, rather than overworking – each fulcrum here will usually be 3-5 seconds.  Have faith in the cumulative effect of successive points and the healing impact of yourself working with deep relaxation, giving the person non-verbal permission to rest, relax and heal from inside out.

Now clearly disengage, gently lifting off on the client’s inhale.  Pause.

Then start approximately an inch and a half higher and, following the same steps as above, do a fulcrum into the rectus at this next level up.

The key to comfort in working here is 1) the overall warmth of contacting the belly with your whole palm; 2) the specificity of contacting the rectus abdominis in the thickest part of its belly, halfway between the midline and its lateral border; 3)  working only as deeply as is comfortable for your client – quality of contact here is much more important than depth.

Repeat these steps in successively higher places up the abdomen – each time clearly disengaging, pausing and re-engaging an inch and a half or so higher.  Usually I will do a four or five fulcrums through the belly of rectus abominis, perhaps more depending on the length of the person’s waist.

For the last fulcrum into the belly, just beneath the ribcage let your upper hand gently create more looseness, tractioning ribs seven and eight down.  Then, with your right hand, you can more comfortably work beneath their ribs, melting gently in toward the right shoulder.  In this way you may help not only the rectus, but also the external oblique and the diaphragm to relax.

For the next phase of work with the rectus and its fascia, we’ll first describe working on a man, then revisit boundary issues for working the chest area.

When you have finished the fulcrums into the abdominal part of this muscle, you shift to working with its tendons and the fasciae with which they interweave.  These fibers extend from the body of the sternum and medial costal cartilages up to the fifth rib, the level of the nipples – quite high up!  Then the fascia interdigitates with that of pectoralis major and with it, extends up to the undersurface of the clavicle, near its attachment to the sternum.

First, change your body position.  The point of working here is explicitly to lift the front and side of the ribcage up.

With a man you can now undrape the chest.

Position your feet even farther down the table (at about the level of the knees) so that when you lean into this fulcrum you will be somewhat more in the horizontal plane, in a “lunge” position.

Place your right palm with fingers gently curved and in between the costal cartilages 7-8.  You are just lateral to the xiphoid process, which is at the bottom of the sternum.  For this entire moving fulcrum you must err on the side being overly medial rather than lateral (especially with women). 

Place your left palm, fingers naturally spread, along the side of the ribcage.  This hand will be gently tractioning the whole ribcage upward, whilst the right hand, where your primary interface is, will be stretching the fascia of the rectus and pectoralis major up the sternum and medial costal cartilages.

Your whole right hand is virtually flat, heel resting gently on the upper abdomen and finger pads on the lower cartilages and sternum.  Take out the looseness by gently sinking in between the costal cartilages, curving your fingers a little.  Simultaneously take out the looseness by gently yet clearly pressing into the ribcage with your left palm with your left palm.

Now take up the slack with both hands.   Your left hand adds upward traction to the ribcage with your right hand adding a vector of stretch toward the head.

Add additional vectors now, particularly with the right hand, where your primary focus is.  Begin a slow, medium deep effleurage, up the front of the sternum and medial costal cartilages.  Your main interface is between your finger pads and the structural-energetic landscape you’re traveling through

Continue to ascend slowly.  As you sustain this slow moving fulcrum, feel not only the stretching of the rectus and pectoral tendons but also the ribs lifting, the spaces between them opening up and the client’s breathing opening the front torso and heart/lung area from inside out.

Monitor for working signs - most often the client’s facial expression will show a deep relief and pleasure at the experience of the fullness of their breath and the uplifting of the torso.  Observe for signs of overall relaxation and use them to guide the rhythm of your movement.

Your left hand remains mostly stationary, sustaining a wonderful  uplifting sensation by tractioning the ribcage upward (headward).  You may choose to position the left hand higher at some point so the client feels clearly addressed at more or less the same level by both hands.

Sustain this long moving fulcrum until the right hand contacts the undersurface of the clavicle just near its sternal end.  Hold for a moment.

Now clearly disengage.  Pause.  Give the person time to integrate the experience and enjoy the new length, the greater room for breath, the deep relief of tension that may have been held in the belly and heart areas.

Then repeat these steps on the left side, switching which hands are working.  As on the right, you will do point of reference fulcrums as needed into the belly of the rectus abdominis, and then a long moving fulcrum to the rectus and its associated fasciae and the ribs above the belly up as far as the undersurface of the clavicle near the sternum.

It is important to note, when working the upper tendons of rectus abdominis and pectoralis major, especially with women, that the area is clearly draped. 

There are varied ways for keeping good boundaries through the draping here.  My most frequent method involves taking a pillowcase and folding it into two triangles by bring the bottom left corner up to the upper right corner.  Then place the pillowcase over the sheet in a position so that, when you pull the sheet down, the two triangles of the pillowcase clearly drape the chest.

Now pinning down the pillowcase at its top, along the clavicles, so that the person feels its presence, pull the sheet down to the level of the lower ribcage.

Then you can freely work up the sternum and medial costal cartilages without exposure, but with one important difference of hand positioning.  With a woman (if working on the right side) let your right hand work up to the level of the fifth rib.  Then disengage the right hand and with your left hand, fingers pointing down, come from above the drape, pull up from ribs 5-3 with the left hand.  Finally, for the last inch or so, work up again with the right hand (that will be easier on the wrist).