Jim
Steven’s
Blog
The Hierarchy of
Tissues
May 2016
If you’re interested in a little more
about what I’m thinking when
conducting manual therapy for you
-- read on. This post describes types
of tissues in your body and their
function and how they relate to
your health and pain you may be
experiencing. If you have questions
during your manual therapy, let me
know.
“A tissues importance depends on
both its probable effects on other
tissues and the systemic qualities of
its anatomy.”
This being stated we have laid out a hierarchy of
tissues from most to least importance as it applies
to freeing lesions within the body. It must be
understood that that far more important than our
intellectual understanding of these things, is our
willingness to “always trust the tissues”. The
tissues themselves have neither the ability nor the
desire to mislead us, where our reason and logic
often do.
Our understanding leads us to believe that the
majority of pain and immobility within the human
body is, for the most part, the body protecting itself.
In other words, “pain should be viewed as a
protective ideal or as a defense mechanism.“ Some
tissues receive more protection than others do,
based on what we refer to as the “Reflexogenic
effect”. The Reflexogenic effect states that the body
will shut down any movement pattern that has the
potential to further damage or inflame the
protected tissues. As an example a nerve cell has
limited regenerative ability, therefore it must
remain functioning for an entire lifetime. The body
will create immobility in order to prevent further
damage to the neural tissues.
From this thinking comes the theory of the
‘Hierarchy of Tissues’. Stating, “Any tissues that
are of greater importance to the body’s survival,
will be protected by the tissues of a lesser
importance“. All chronic pain is caused by a
reduction of blood flow. This blood supply may be
limited to the activated pain receptor nerve, or to
the surrounding tissues, causing localized
dehydration and inflammation. It is for this reason
we agree with the Osteopathic principle that “The
artery is supreme.”
Artery / Vein:
Blood flow is paramount to all cells, as all
tissues rely on the oxygen, nutrients, and
waste removal carried out by the cardio-
vascular system. An artery may be
compressed, impinged, or stressed. When an
artery is stressed, the smooth muscle
contracts, thereby decreasing the diameter of
the artery. Any lesions within or near the
artery will therefore cause reduction in blood
flow to all points distally along the arterial
pathway, thereby affecting any tissues
present. The veins, while of less importance
can also be compressed causing a reverse
pressure into the capillary beds, arterial, and
lymphatic systems. This causes a reduction in
blood supply, by creating congestion.
Nervous Tissue, Cerebral Spinal Fluid, Nerves
(spinal and cranial) and Brain:
Neural response is a necessary function for
nearly every cell in the body. The nerve cells,
though well protected in their adipose and
connective tissue sheathes, are easily
entrapped at the point they enter or exit
another tissue. This restriction causes
budding (rupture), and inflammation, thereby
preventing the nerve from moving and
protecting the nerve from further damage.
The importance of the nervous tissue cannot
be understated. These tissues are highly
protected by what we call the “Reflexogenic
effect“. The brain and spinal cord tissues are
also susceptible to inflammation and
adhesions, either to the surrounding Mata, or
within the brain itself. When these lesions
occur, they limit the CFS from fully
nourishing the tissue thereby depleting its
functionality.
Ligament / Suspensory ligament:
Ligaments are generally identified as a thick
connective tissue that holds bone to bone at
the joints or bony articulations. In the case of
an injury to these ligaments, there is obvious
compensation throughout the body to aid in
avoiding pain and further damage to the
injured tissues. We almost consciously change
our gait, or use a different arm in order to
protect and prevent further damage.
A suspensory ligament by contrast is any
thickening of the connective tissue membrane
that attaches and holds any organ to another
tissue or organ; they are most common in the
viscera of the internal organs. Any tissue that
connects one tissue to another or creates a
tunnel (i.e. a retinaculum) through which a
vessel or tendon moves should be considered
a ligament.
Fascia:
We view the fascia as one continuous whole
and is connected to and part of all other
tissues. Any lesion within the facial matrix
must therefore effect all surrounding tissues
as well as the tissues along its lesional chain,
specifically those portions of the fascial
sheaths that share fibers.
Lymphatic:
The passive portion of the circulatory system
may be viewed as important as the blood
vessels themselves. Its systemic nature and its
presence within every organ and nearly every
tissue, creates a vulnerability in which the
smallest of lesions or pathology can cause
disruption anywhere in the body.
Sphincters and Valves:
Sphincters are the valves within or conjoining
to the alimentary canal. Just one sphincter
working incorrectly can cause dysfunction
within the entire digestive system. It can
affect the internal pressures in both the
abdomen and thorax, thereby creating lesions
disrupting movement patterns throughout the
body. Please do not underestimate the
importance of these sphincters, it has been
stated that these sphincters should be the first
area of evaluation, or in the case of time
restraints, the only treatment. Similarly, if the
valves of the heart are strained they cannot
function optimally, thus influencing the vast
majority of the body’s functions.
Viscera (Organ systems):
Internal organs, designed to glide across one
another and to move in easy patterns that
aids in their function. When organs are
immobilized completely or in part due to
lesions or adhesions, the biomechanical and
physiological effects are staggering. The
abdominal peritoneum has almost no value to
modern medicine. We feel the peritoneum
should be considered as, and treated as an
organ unto itself. Although it does not so
much have “a” function as an organ, lesions
within the peritoneum often have a negative
biomechanical affect on abdominal and
thoracic organs, as well as abdominal,
thoracic, and cranial vasculature.
Periosteum:
As the interface between bone and soft tissue,
any lesion within the periosteum will affect
all interfaces directly related to the bone.
Conversely, any soft tissue lesion must reflect
into the periosteum. As the surrounding
connective tissue of the bone, any neural or
vascular lesion occurring within the interface
of the bone itself will most likely be at this
level.
Bone:
Bones are a great holder of trauma. When
applied force, through injury or accident is
driven into the bony matrix, trauma results.
The effected portion of the bone becomes
hard and inflexible. This inflexibility reduces
the bones ability to absorb shock, thereby
increasing the possibility of fracture, torn
ligaments, or injury elsewhere in the body.
Tendon:
A tendon is essentially the entire connective
tissue of a particular muscle coming into one
cumulative whole as it connects to the
periosteum of the bone. Therefore, we
consider working with this portion of the soft
tissue to be more effective than working
within the muscle itself.
Muscle:
Muscles are seldom the root cause of tension
within the body, except for cases of overuse as
in the case of exercise and fatigue. Few
muscles can have any “great affect” on the
surrounding tissues. The two most well
known muscles of this variety are the
subclavius and the illio-psoas. However it is
our belief that muscle pain, discomfort, and
even injury is due to a cause outside of the
muscle itself. For this reason, we consider
muscles to be of less importance than the
other tissues. Releasing or softening muscles
does give the body momentary relief, there is
no doubt. The relief is often short lived,
because the root cause or lesion that the tight
muscles were protecting has not yet been
addressed.
Adipose:
Adipose is more commonly known as fat.
Although this tissue can cold lesions, (i.e.
cellulite) lesions within this tissue are
generally isolated and do not have much if
ant affect on neighboring tissues. Healthy
adipose is soft and pliable, which allows it to
move well even with lesions.
© 2022, Jim Stevens Manual Therapy
Master Manual
Therapist & Physical
Trauma Specialist
Relieving pain and
injury since 1994