The premise asserted in the first two articles of this series is that physically freeing the space around the heart can make a significant contribution to the quality of life for your clients and may reduce the chronic component of their ongoing somatic difficulties. The last article described a technique for equalizing the pressure between the thoracic and abdominal-pelvic cavities. This same technique has also shown itself to assist mobilizing the posterior vertebral/rib articulations of the region.

It is proposed that reducing the pressure within the thorax both decreases the internal resistance to the heart's expansion resulting in greater cardiac output and enhances the efficiency of venous and lymphatic return back to the heart. Two additional steps were added to the initial screening assessment protocol. (A review of the assessment protocol and the suggested techniques can be accessed online at www.massagetoday.com).

This article proposes that elongating the esophageal tube can contribute to freeing the heart. The heart actually enfolds the muscular tube of the esophagus. Even less appreciated is that the upper 2/3's of esophageal fibers are striated fibers while the lower 1/3 -- the part that is juxtaposed to the heart as it pierces the diaphragm and becomes the stomach -- is comprised of smooth muscle fibers.¹

There are many implications of this dual innervation and its potential participation in heart-related problems. Selecting the most obvious, consider how any type of cervical whiplash could re-set the resting length of the striated fibers of the esophagus toward varying degrees of chronic contraction or spasm. And, that this shortening of the esophagus may lie dormant for years going undetected yet, adding a posterior resistance to the heart's expansion, as well as influencing the onset of hiatal hernia symptoms and the reflux of stomach acid leading to chronic "heartburn." A shortened esophagus adds friction between itself and the sac of the heart, the pericardium. Friction begets irritation and irritation eventually incites inflammation. Chronic inflammation is increasingly considered the bridge between stress-related ailments and the onset of many pathological progressions during the aging process, including cardiovascular disease.²

Common sense suggests that the sac around the heart cringes in its attempt to prevent the acid from penetrating its protective sheathing. And, should the acid reach the fibers of the heart muscle, it creates an irritable reaction within them. Might this relate to a host of the different heart ailments that increasingly are described both in abnormalities of electrical transmission within the heart and the increasing frequency of atrial fibrillation?

Many years ago I had the unique opportunity to work with an exceptionally gifted physical therapist who was known for her success with helping infants and children. An infant was bought to her office with a diagnosis of non-epileptic brain seizures. As she was a graduate of Ohio State University, she called there and was referred to a Pediatric GI specialist. On the conference call, we both had a galvanizing learning moment as the specialist described that the infant may have been born with a congenitally short esophagus and that the seizures may stem from its central nervous system's attempts to elongate the tube.³ What a concept. He further noted that it was a fairly rare condition but that he had seen it enough times that his model for dealing with such unexplained seizure activity now included this as a possibility.

The epiphany for me was that along a continuum of genetic possibilities, not only could the esophagus be congenitally short, but that in many individuals, it is predisposed to contracting strongly and may re-set its resting length in response to intense emotional reactions and prolonged stress, in addition to the physical provocations described earlier. The most pertinent physical implication of the esophageal fibers bunching is its potential to limit the heart's expansion phase posteriorly. Thousands of clinical experiences with clients now validate this notion for me. The neurological implications of a shortened esophagus will be explored in the next article.

It has long been known that mid-sternal pain more likely relates to esophageal contraction or spasm, whereas pain associated with the left breast area is more likely to relate to some aspect of possible heart dysfunction or impending crisis.⁴ I carefully inquire with new clients to make sure that they have had a cardiology work-up if they present with either of these and insist that they see their physician if they haven't. It is prudent for us all to encourage clients to rule out any possible pathological or congenital predisposing scenarios.

The addition to the screening protocol I have found to be consistent with esophageal involvement is to palpate along the occipital ridge for the space and ease of distraction of the occiput from the atlas bone. The more close packed and resistant to distraction, the more the esophagus is a variable has become my clinical interpretation. Another primary myofascial structure that co-participates in the compaction of the head upon the neck are the SCM's (sternocleidomastoid muscles). It is my clinical experience that the SCM's function as the guard dogs of preserving the cranium's safety in the event of a sudden shift in position of the head as may happen in a fall, the body flung forward or backward (bicycle or motorcycle accident) or impact trauma of all kinds. So, the answer to the question of what can you do to help your clients is to use whatever techniques you have learned to reduce the tension of the SCM muscles.

A unilaterally contracted SCM or bilaterally so, compresses the jugular foramen through which both the vagus nerves and the accessory nerves exit from the brain. Old time anatomists suggested that the accessory nerve functions as an overflow valve for vagal tensions.1 And, let's remember that the accessory nerve innervates the trapezius muscles as well as the SCM's. Thus, tight traps are also a tip off that compression of the jugular foramen is a variable and that a contracted esophagus may be a crucial variable flying under the radar as a soft tissue structure that we need to treat.

Assisting the esophagus to elongate is accomplished by anchoring the occipital ridge and softly compressing the left side of the sternum along its length toward the left hip with an emphasis around ribs five and six and then into the soft tissue of the abdomen just beneath the left costal arch.⁵

In the next installment to this series, we will further explore the role of the esophagus along with those of the pericardial sac and explore the possibility that sometimes the heart may shift form its normal position in the thorax. It is my clinical experience that all of these variables can be positively influenced through bodywork, massage, movement and energetic therapies.⁶

To date, this series has endeavored to offer an assessment sequence and a couple of fairly specific techniques that have clinically shown themselves to assist an easing of thoracic rigidity. The clinical inference is that by doing so we are reducing the workload of the heart to deliver newly oxygenated and nutritious blood systemically.

Assessment Sequence for Freeing the Heart

The central theme is to assess the degree of pliability and distensibility of the thoracic cage. My experience suggests that when the left sternal border and the intercostal space associated with ribs five and six are rigid that the heart is definitely having to work harder to push out newly oxygenated and nutritious blood. Restriction to the lateral excursion of either or both hemi-diaphragms only adds to the workload of the heart.

1. Softly depress their chest on either side of their upper sternum toward the table.
2. Compress the sides of their ribs toward the midline, first one side, then the other.
3. Slide your hands and fingers under their back and lift the rib angles.
4. With their knees bent/feet standing, contact the medial costal arch of each hemi-diaphragm and softly glide it laterally (do both sides).
5. Lift the client's head, memorize its weight.
6. Palpate the tension of the abdominal wall. At the end of any bodywork session, not only do we want the chest to become more distensible, we would also like the head to weigh less and the tension of the abdominal wall to ease. All three markers are reliable indicators in my clinical experience that the pressure between the cavities has equalized to some degree.
7. The addition to the screening protocol I have found to be consistent with a shortened esophagus is to palpate along the occipital ridge for the space and ease of distraction of the occiput from the atlas bone. The more close packed and resistant to distraction, the more the esophagus is a variable has become my clinical interpretation. Remember that releasing the tension of the SCM's is an essential first step to accessing the fibers of the esophagus.

Technique Review for Freeing the Heart

Let's review one "inside-out" technique that can jump-start the easing of thoracic pressure. Its effectiveness relies on the loosely organized areolar connective tissue along the posterior margin of the diaphragm muscle.

1. Standing on the right side of your supine client, posteriorly contact the opposite side of the spinous processes, beginning at C7, with your upper hand and placing the palm of your lower hand just below the anterior costal arch. Softly anchor C7 with finger tips in contact with the opposite side of the vertebra, then stretch the abdominal tissue inferior and medial toward the belly button. Feel for the connectedness between your hands. Your intention is to stretch the internal tissues within the chest so that at the interface of the diaphragm, the downward and medial stretch gaps the loose connective tissues allowing the thoracic pressure to flow from an area of greater concentration to one with a lower concentration. A diffusion gradient is being manually produced. This same procedure can be repeated along each vertebra from C7 - T12. Yes, do both sides. And, this technique allows for a two for one potential effect. This same long lever stretching while anchoring each vertebra creates a potential rocker effect to the vertebral/rib complex, which is theorized to hydrate and contribute to mobilizing the posterior thoracic spine.
2. Use whatever techniques you have learned to reduce the tension of the SCM muscles.
3. Assisting the esophagus to elongate is accomplished by anchoring the occipital ridge and softly compressing the left side of the sternum along its length toward the left hip with an emphasis around ribs five and six and then into the soft tissue of the abdomen, just beneath the left costal arch.⁵

References

1. Human Structure, Cartmill, Hylander, Shafland, Harvard Univ. Press, 1987.
2. Innate immunity and inflammation in aging: a key for understanding age-related diseases, Federico Licastro www.immunityageing.com/content/2/1/8/#ins1, Giuseppina Candore, www.immunityageing.com/content/2/1/8/#ins2, Domenico Lio www.immunityageing.com/content/2/1/8/#ins2, Elisa Porcellini www.immunityageing.com/content/2/1/8/#ins1, Giuseppina Colonna-Romano www.immunityageing.com/content/2/1/8/#ins2, Claudio Franceschi www.immunityageing.com/content/2/1/8/#ins3, www.immunityageing.com/content/2/1/8/#ins4, www.immunityageing.com/content/2/1/8/#ins1 and Calogero Caruso www.immunityageing.com/content/2/1/8/#ins2, www.immunityageing.com/content/2/1/8.
3. Janice M. Alexander, P.T., Integrated Health Solutions, New Philadelphia Ohio, 1996.
4. Cope's Early Diagnosis of the Acute Abdomen, 21st edition, William Silen M.D., Oxford university Press, 2005
5. Dr. Jean-Pierre Barral D.O., Developer of Visceral Manipulation, class notes, 1986 - 1993.
6. Lansing Barrett Gresham, Founder of Integrated Awareness(R), personal and professional experience, 1989 - present.