Liz Holey

Connective Tissue Manipulation

Summary Connective tissue manipulation (CTM) is a soft tissue manipulative technique which stretches connective tissue, restoring mobility at dermis/hypodermis and dermis/fascia interfaces and promoting remodelling of collagen. It is often described as a neural therapy because of its powerful reflex effects. Visible skin and connective tissue zones are stimulated to influence visceral and circulatory functions. This was demonstrated vividly by the German founder of CTM, Elizabeth Dicke, who found that pulling the tissues of her low back relieved her back pain, restored the circulation to her almost gangrenous leg, and reduced digestive problems. Physiotherapists are often deterred from using CTM by the belief that it is underpinned by little in the way of sound scientific theory. This assumption is challenged in this paper. Research from several physiological fields is drawn together and evaluated in the light of observed effects of CTM and, where overlap occurs, traditional massage. The contribution of wide dynamic range neurones in lamina V of the spinal cord; the anatomy and physiology of segemental and suprasegmental autonomic reflexes; biomechanics of connective tissue; and the significance of the physiology of sympathetically-maintained pain to zone formation and clinical research, will be briefly used to justify the premise of the paper. This is an extended version of a paper presented to the CSP Congress, September 1994.

Connective Tissue Zones: An introduction

Summary Connective tissue zones are those based on the work of Head and McKenzie which are identified and interpreted as denoting autonomic imbalance during Bindegewebsmassage, or connective tissue manipulation (CTM). The changes which occur in the skin, subcutaneous fascia and muscle are described and the theoretical background to their formation and treatment is discussed, with pertinent reference to research into cutaneous-visceral reflexes.

Inter-Rater Reliability of Connective Tissue Zones Recognition

Summary Inter-rater reliability of the identification of the separate components of connective tissue reflex zones was measured across a group of novice practitioners of connective tissue manipulation. Recognition of the visual, palpatory and tissue mobility components of ten connective tissue zones across five subjects were monitored in seven models. Percentage agreement was high (89/150 80% agreement or higher) but the kappa coefficient statistic which takes account of chance was low. These results suggest that a trend of agreement was demonstrated but percentage agreement scores should be treated with caution unless a large group of raters is involved. Possible explanations for the results are made with suggestions for further research.

Soft Tissue Pain and Disability

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