Side Lying Release - The Geek Details

Side Lying Release - The Geek Details

Side Lying Release (SLR) is an amazing technique developed, as far as I know, by Carol Phillips, DC of Dynamic Body Balancing.  Since then it has become standard fare of the Spinning Babies approach to caring for families who are expecting babies.  In this entry I am going to discuss what SLR does and does not do.  If you want to learn HOW to do it, sign up for a Dynamic Body Balancing class or a Spinning Babies class.

What SLR does in prenatal care....

Side lying release is one my favorites!  I use it in a majority of sessions that occur in my office.  Prenatally SLR is used to release the hip, pelvis, and the leg.  These structures are released with passive stretching.  The muscles released (in a majority of people) are:

• gluteus maximus and gluteus medius
• tensor fascia lata
• iliotibial band
• the 6 lateral hip rotators of the posterior pelvis
• piriformis
• gemellus superior
• obturator externus
• gemellus inferior
• obturator internus
• quadratus femoris
• vastus lateralis
• biceps femoris
• adductors
• in some cases where fascia is very tight, the lower leg and foot will be stretched as well

It also has the benefit of giving the pelvic floor muscles a wee break when very gentle compression is applied.
Let's walk through together step by step....

When the parent lifts their leg 20 - 30 degrees upward we are engaging the central nervous system (CNS) in the pelvis, core, and leg to let the CNS know we are going to ask the body to do something different.  Lifting the leg up in addition to the standard SLR is going off the principle of agonist and antagonist activation of the muscles.  Or, in simpler terms, the muscles on the back of the body have to stop firing when the muscles on the front of the body fire, and vice versa. The parent will then swing their leg forward over the edge of the bed or massage table.  (I ask them to kick their partner in the derriere - butt.)  Again, we are notifying the central nervous system that something is going to change.  Then the parent gets to let their leg dangle down to be soft and as relaxed as possible.  As the top leg is crossing the midline (middle) of the body we believe a gentle pull is created in the lower segment of the uterus.  This pull, along with the lengthening of the surrounding musculature can help baby rotate, untwist the uterus, and release tension in the pelvic floor.

In the meantime, a partner is supporting the pregnant parent at the anterior superior iliac crest (ASIS) with one hand, and applying VERY gentle downward pressure - as light as a small bag of sugar - on the greater trochanter of the femur or the flare of the iliac crest.  The gentle pressure at the greater trochanter is what gives the pelvic floor muscles a break, especially the horizontal muscle fibers.  Here are some anatomy pictures to help you understand the geekery.

Illustration by Adrienne C. Caldwell  Copyright 2016

As the pregnant parent is dangling their top leg over the edge of the massage table or bed their bottom leg needs to be gently engaged.
So what is being stretched?  We are stretching the tensor fascia latae, the lateral quadriceps, the lateral hamstrings, gluteus maximus, gluteus medius, piriformis, gemellus superior and inferior, obturator internus and externus, quadratus femoris, the upper portion of adductor magnus, and the posterior aponeurosis of the back.  And that is if the fascia is not twisted up the leg and back.
If the fascia of the lower leg is twisted then parents can feel the stretch all the way down to their toes.  If the fascia of the lower back is dysfunctional this can be felt into the low back muscles that attach to the top of the pelvis.
The partner's very gentle pressure at the greater trochanter of the femur - the big knob on the hip - creates slack in the pelvic floor.   How often does your pelvic floor get a break from being stretched between the bones?  Not often.  This slack may help any muscle, fascia, ligament, or tendon fibers get the chance to reorganize themselves so the pelvic floor is more functional.  We do not have objective evidence for this yet.  But I am going on the theory and application of scar tissue redirection techniques as taught by James Waslaski of the Center for Pain Management.  Scar tissue can only become well organized and functional with movement after warming and loosening.  I may address accessing pelvic floor muscles - not internally - another day.

In short, prenatal application of the SLR opens the hip, pelvic muscles, lateral upper leg, sometimes the lower leg and foot, and allows for the pelvic floor to take a little break.

SLR in labor....

Side Lying Release in active labor has shown the miracle of how versatile and agile the human body is under duress.  According to the Spinning Babies approach we use SLR for several scenarios.

• When labor stalls out
• Slow progress 
• High baby
• When baby is awkwardly positioned
• When the parent is having back labor (typically indicative of posterior baby)
• When the parent is having sacral pain

The standard of care, according to Spinning Babies, is to do 1 - 3 side lying release (SLR) on each side, during contractions.  I usually do 3 SLR on one side, and then 3 SLR on the opposite side.  I know practitioners who alternate between sides.  I believe it is good to use your best judgement as to what is appropriate for each individual scenario you encounter.   Again, the best place to learn application, and technique is not from a blog post, but from the teachers themselves.

We have so many stories of how SLR has turned a labor around so quickly it would be ridiculous to try and post them all here in a blog.  This one move can bring comfort to the laboring parent, help the baby rotate into a better position, restore progressive dilation to the cervix, relieve muscle spasm, and so many more scenarios.  Just ask any Spinning Babies trained provider.

What SLR does not do...

Side lying release will not release a psoas muscle.  It may help to lengthen it a bit, but the leg needs to move into extension and external rotation to fully release the psoas.  I have seen, and heard this misconception in several groups.  The psoas is a hip adductor and flexor.  Therefore to stretch it, the opposite has to happen.

When not to do SLR...

• If someone has symphysis pubis dysfunction (SPD).  This move can and will aggravate this condition.  If the SPD has been resolved, move into using SLR with caution and comfort.  
• If someone has unusual bleeding.
• If someone has a circulatory disorder and cannot lie on their right side.
• If someone has just had surgery on any part of their leg - wait at least 6 weeks.
• If someone does not want to do it.

It is my hope that this is helpful for the birth and bodywork community.  As I stated earlier, if you want to learn HOW to do this move, please take a class from Carol or Spinning Babies.  Side lying release is an incredibly valuable tool!

Also a warm and heart felt Thank you to Carol, Gail, and Deb for editing and commenting before the final draft was published.

All the best,
Adrienne

Information in the post is not medical advice, nor is it intended or meant to replace medical treatment.  Please consult your primary care provider to be certain new movements are appropriate for your situation.