Ortho-Bionomy: A Practical Manual

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Th1

A PRACTICAL MANUAL

*L.

by Kathy

Kain

with Jim Berns

North Atlantic Books Berkeley, California

Acknowledgements We would like ro thank all of our teachers and students who ha\'c accompanied us on our exploration of Ortho-B'onomy. In panicular, we wam to dunk Arthur Lincoln Pauls, Founder of Ortha-Bionomy for sharing his vision with us. Many thanks to all of you who proofread, offered suggestions., corrt~rcd our errors and held our hands. Special thanks to Vicki Pearson-Rounds and Carolyn B!!ck Reynolds for Icuing the heart of Ortho-Bionomy express i!Se1f in rOUt photos and drawings. Moods; Leslie Baa, h'Y Kohler, Angela Ramos, Bill Rounds Figure I'hotography: Vicki Pearson-Rounds

information in this book is nOl a substitute for appropriate medical care. If the client has any injury, illness or other condition that may need medical attention, that care: should be sought prior to use of any of the techniques in tillS book. 'Jlte authors take no responsibility for the misuse of any of the rechniques presented here.

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If you think thi... work is valuable enough 10 pass on to a friend, please support it by asking thcm to purchase a book rather than making a copy of this one. Thank )'ou.

'1Oc Sand Dollar design, Society of Onho-Bionomy International- and Ortilo-BionomyTM are used by permission of the Society of Ortho-Bionomy international, loc. TIle Sand Dollar design is a registered trademark of the Society of Orlho-Bionomy International, Inc_ and cannot be used without wrirren permission from the Society of Orrho-Bionomy International, rnc. Socict), of Orrho-BlOnom}' Inremational- is a registered

collective membership trademark of the Society of OrthoBionomy Inremational, Inc. and is used by the Sociely (Q indicate that a person using the mark is a member of the Sociely of Ortha-BionolllY Intemational, Inc. and cannot be used \\ ithout written permiSSIon from the Society of Ortho-Bionomy International, Inc. Orrho-Bionomynl ts a rn.demark of the Society of OrrhaBionomy International, Inc. and cannot be used without written permission frolll the Society of Orrha-Bionomy Inlernational, inc.

Ortha-Bionomy, A Practical Mamwl Copyright C 1997 by )(athy Kain_ All rights rcscrved, No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any mcans--electrofllc. mechamcal, pilotocopying, recording, or otherwise-without written permiSsion of the publisher, Published by Nonh Atlantic Books P.O. Box 12327 Berkeley, California 94712 Co\'cr JlJustnuions by Carolyn Buck Reynolds Co\'cr and book design by Nancy Koerner Printed in the Umted Statt1; of America

Ortha-BiOllorny. A Practiwl MalUml is sponsored by the Society for the Srudy of Nati\'c Arts and Sciences. a nonprofit educational corporadon whose goals are to Jc\'e!op an educational and crossculturaI perspective linking various scientifIC, social, and amstic fields; [0 nonure a holIStic view of arts. SCIences, humanities, and healing; and to publish and distribute literature on the relationship of mind, body, and nature.

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Table

of Contents

Preface

vii ~ ...............•............•........

Foreword

. ix

Section 1: Introduction The Development of Ortho-Bionomy

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A Few Words from the Founder

5

Generallntroduetion .................•...........•................ 7 Introduction to Practice

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Section 2: Vertebral Column & Thorax eck

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Thoracic .................................•............•........ 31 Ribs .........•....•...............•.....•..................... 37 Lumbar .................................•..................... 49

Section 3: The Pelvis IJiopsoas

61

Ilium ...................•..................................... 69 Sacrum

77

Section 4: The Lower Limbs Femur

85

Knee .....•....•.........•..........•...........•.............. 93

Ankle ................................................•....... 103 109

Foot

Section 5: The Upper Limbs Shoulder ................................................•..... 119 Scapula ..............•....................•................... 131 Clavicle .............................•....•.....•........•.... 135 Srernum ...•.........................•...................•.... 141 Elbow ...........................................•............ 145 Wrist ...........•....•.........•............................. 153 Hand ............................................•........... 159

Section 6: Post-techniques Post-techniques

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167

Course Descriptions and Training Information

179

Bibliography

181

Glossary

183

Index

187

Preface The intent of this manual is to present the Basic (Phase 4) techniques in a way that captures the simplicity and the essence of Ortho-Bionomy!M As with the learning of any hands-on technique, learning to practice Ortho-Bionomy effectively requires not only study of written material but

direct pr-aetical experience with the techniques themselves. We encourage students co take ad\'anrage of the deeper exploration of Ortho-Bionomy that is available with the guidance of an experienced instructor and let this manual be a support for your learning.

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Foreword In the seventeen years that I've been practicing Ortho-Bionomy I've learned that life changes and body changes intertwine: if OUT lifc changes, our body will change; if our body changes our life will change. The Phase 4 techniques of OrthoBionomy provide a potent form of accessing physical change.

to notice our body's attempt to communicate itS needs. Ortha-Bionomy helps to remind us of the availability of comfort and of change. It isn't tcaching us something new, it's "'teaching" us what we already know. That's another form of education, probably most accurately called reeducation.

I believe much of the effectiveness of OrthoBionomy comes from its ability to inform us of relationship: of oneself co oneself; oneself to environment and oneself to others. If any of these relationships are not working well, the body will express this. As a metaphor for our lives, our bodies don't lie. Ortho--Bionomy mirrors the srory of our lives in physical or energetic fenns. It acts as a reflecrion for recognizing life patterns that don't work or that create pain. If we cannot move our arm, we may adjust to this restriction so effectively that we stop noticing it. Ortho-Bionomy helps bring the noticing back. We may have so much pain that we forget how to pay attention to comfort. Ortho-Bionomy is a way for us to notice comfort. It gives a way to access choice and create change that is natural, non-intrusive and selfgenerated.

The beauty is that the re-education often happens spontaneously. [t's not a laborious process of learning prescribed postures or positions, but rather a spontaneous rediscovery of the form of comfort. Through techniques like OrthaBionomy we can learn again to be ourselvesin comfort. Kathy L. Kain Berkeley, 1997

Ortha-Bionomy is also a form of education, but not in the usual sense of that word. Educacion implies that we are learning something we don't already know. The ability to find comfort and balance is an ability that is inherent in us from birth. If you watch small children you will sec that they have an immediate understanding of what is comfortable and what isn't. We slowly subvert this understanding of harmonious function through injury, through forcing ourselves to remain in stressfuJ or tension producing situations and positions. Evemually, we train ourselves not

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Section 1

INTRODUCTION

The Development of Ortho-Bionomy The hisrory of the development of Orrha-Bionomy gives some important clues to its current practice. Ortha-Bionomy, as it came to be called, started with the coming rogethcr of two apparently djs~ parate arts: osteopathy and Judo. The background of osteopathy gives Ortha-Bionomy a strong grounding in the understanding of the physical S(ruc[Ucc. Through Judo comes the understanding that the greatest strength and fluidity come from moving WITH our partner, not against him. Combined, these two elements provide a potent tool for bringing about change in our bodies. The founder of Grtha-Bionomy, Dr. Arthur Lincoln Pauls, was a Judo instructor in England when he was exposed to osteopathy from the patient's point of view. "It did me a lot of good. But then I realized there was no real lasting comfort to it because I just went back the next week and injured the same parts I'd worked on the week before." Eventually, Pauls went on to study osteopathy hi.mself, and brought with him this curiosity about how the structure could be "'repaired" while thc understanding of the change necessary to keep it in good repair could be missing. "'I came co understand that the real osteopathy is when the practitioner nurtures the parts of the body back to where they belong so they function bettcr and the client has an understanding of that improved function." But Pauls still hadn't figured out how to do that kind of nurturing in a way that was consistent with his understanding of movement from Judo. The missing piece was provided by the work of Lawrencc Joncs, D.O., an American Osteopath. A substitute instructor in one of Pauls' osteopathy courses provided the introduction: "He showed us, and demonstrated on some of us, this ncw thing called Spontaneous Release by Positioning

by Joncs (reprintcd in the Journal of Osteopathy from The D.O. of January 1964).1 was very impressed by this demonstration. I had a copy of Jones' article made and 1 started using these techniqucs with my cliems and realized that this was what 1 wamed to do." The article presented Dr. Jones' experience, over the course of 10 years, of correcting osteopathic lesions (usually described as "abnormal" placement of the bones within a joint) by placing patients in positions of comfort, rather than performing a manipulation. Strangely enough, Dr. Jones had discovered, the comfortable position almo.st invariably was an exaggeration of the "abnormal bony relationship found upon examination." In other words, an exaggeration of an cccentric posturc. Aha! Here was something that made sense to the Judo instructor: you move WITH the body, not against it. It also made sense in Pauls' patient experience; the patient necds to come to a physical understanding of how the imbalance occurrcd in order to avoid future return to old patterns of i.njury or misuse. By letting the body find its own balance without force, inherent re-education was possible. At this point, l)auls' own exploration took over. Combining his Judo experience, his osteopathic training. his knowledge of various systems such as homeopathy, and the simple approach outlined in Jones' article, Pauls began to evolve a system that eventually became Ortho-Bionomy. Through the twenty-two years of development since that initial introduction to Joncs' work, Pauls came to include much understanding about the cmotional and energetic implications of structural imbalance. The following is a brief introduction to his philosophy.

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A Few Words

from the Founder

The root words of Ortho-Bionomy can be broken down as follows: "Qrrho" means straight or correct; "bio" means life; "nomy" means pertaining to laws. So the term Ortho-Bionomy can be defined as the "correct application of the laws of life." It is just a word used to define the philosophy behind the work we do called Ortho-Bionomy. That work is really about understanding your whole life cycle. Naturally, we focus on the structure because that is the literal skeleton upon which our life is built. When youc structtJre works right, your circulation works better, yOll feel better, you think better. The body is very limited. It requires great discipline to stay alive in a human body without having it injured in one way or another. If you don't stay within its limitations you end up hurring it very badly. Staying within healthy bounds takes learning about space and time. We occupy space in the universe. If we don't respect that space, then we're going to get in our own way and in other people's way; this is called an accident. If we happen to be in a car when we get in someone else's way, this is called a car accident. We're in the wrong place at the right time, or the right place at the wrong time. I believe that accidents are an emotional expression of how we feel about life, how we feel about ourselves, how we love ourselves and those around us. An accident is also a physical expression of our misunderstanding of our place in time and space. 1 believe we are all born with great understanding. We are all born equal, with equal opportunity to understand ourselves and our place in the greater scheme of things. Misunderstanding, I believe, is literally missing the understanding that we were born with. The understanding is still there, we

just have to learn to recognize it by dropping the "miss" - it's not something you add, it's something you take away. If there's trouble in a particular part of the body, it's not the body part that's the problem. It's the person. being out of harmony, who is the problem. In Ortho-Bionomy, we help a person to recognize the state of their own limitations. We show the body, rhrough physical and energetic patterns, how to understand its own fWlCtioning. Then we help the person to re-discover how to keep their body functioning in a harmonious way. The person must come to the point where they realize that only THEY are responsible for keeping themselves healthy. As practitioners, our job is not to make perfect bodies. There are no perfect bodies. We're here to help people to find a better working arrangement with their structure. Most people aren't interested in great health, they are interested in functioning well enough to use their body, mind and heart for what they feel good about.

If we want to change, we can begin with our physical structure and move on from there. Our bodies are capable of correcting themselves, but we must be given the motive to discover how to make the change. Unless there is some level of recognition of the problem, and then a motive for correcting it, there will be no action. Like the vicious circle: headaches cause tension; tension causes headaches, we become repeatedly emotionally reinvolved in our involvements (stuck patterns) until they become evolvements. In other words, if we get stuck in a pattern (emotional or physical), we generally repeat it until something happens to break the pattern. It becomes a tight circle with no exit, no beginning, no end.

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Ortho-Bionomy

If we want to move onward, we must break the circle. We must evolve past the stuck pattern. Part of our job, then, in Ortho-Bionomy is to help the client recognize these stuck patterns (sometimes by repeatedly calling their attention to them

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through exaggeration), and then to recognize that they have the energy within themselves to change. Through the principles of Ortha-Bionomy, we can help the client to find their own motive, their own way out of the cycle of their seuck patterns.

General Introduction One of the simplest metaphors I've found to explain the principles of Ortho-Bionomy is the tem pole example: Imagine a pole being held straight by <'l number of wices attached to stakes in the ground. The tension of each wire pulling against the other holds the pole upright and aligned without any strain on the pole itself. Now, a large wind comes up and whips the pole around. causing a knot to form in one of the wires. This shortened wire pulls the pole out of balance. If we push the pole upright we may approximate alignment by stretching the tightened wire. But there's an easier way of returning the pole to its tcue balanced posicion. Pull the pole in the direction of the tightened wire, use the slack created to loosen the knot, and Jet the existing tension in the remaining wires pull the pole back into its original position. We use this same principle in Ortho-Bionomy. If a muscle is contracted, perhaps even to the point of creating an imbalance of the bones within a joint, we position the body in such a way as to contract the muscle a little further. This positioning does a few things at the same time. First, it takes the strain off of the contracted muscle by allowing it to complete the motion of contracting, much the same as the wires in the example above. This in turn sets off a reflexive response within the body to begin adjusting the position of the opposing muscles to accommodate this change in muscle length. As with the tent pole and it's supporting wires, this muscular rebalancing alone is sometimes enough for the body to return to a state of balance. But there is an additional neurological response that happens in conjunction with this muscular response. This neurological response happens through the proprioceptive reflexes. Proprioceptive nerves are the nerves, usually clustered in and around the

joints. that give us information about body position and rate of movement. (Proprioception =perception of oneself.) H you've ever had the experience of sitting or Jying still for a period of time. and then noticing that you can't feel the position of your arms or legs. you've had a direct experience of the function of proprioceptors. These nerve endings are stimulated by movement, specifically by movement of a joint. You can anesthetize all the soft tissue surrounding a joint, and by moving the joint you can still get the information necessary to know where that part of the body is in relation to the rest of your body, and how quickly that part of your body is moving. Spraining the ankle is the classic example of insufficient proprioceptor communication. As you take a step. and overextend the ankle. the proprioceptors send the neurological equivalent of "alert, alert, you're about to hurr yourself!" If that message doesn't get through quickly enough for you to recover your equilibrium, you don't have time to reposition your weight to prevent injury to the joint. When you injure a joint in this way, you often injure the proprioceptive nerve endings within and around the joint, limiting their ability to respond in similar situations in the future. This is one of the reasons that injuries tend to reoccur in the same joints. Their communication links are slightly damaged in an initial injury, increasing the likelihood that warning information will not be received in time to change joint position or rate of movement in order to save further injury. III Ortho-Bionomy, we usc this proprioceptive communication system as a way of communicaring with the body through direct neurological information. Moving the affected joint stimulates the proprioceptors, effectively sending the signal: "hey, pay attention here." Once a release position

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Ortho-Bionomy

is found, compression (pushing gently inro the joint) is uSWllly applied. Compression is another way the proprioceprors are stimulated, so an even dearer message is sent: "He}', notice n-HS." Now we have combined muscular and neurologiGlI information available to the body about how the bod}' is experiencing itsclf at this moment. III Orrho-Bionom}'. the focus is on finding a release position that creates comfort, so that the body notices how ro be comfortable. Once the body is comfortable, it relaxes. When it relaxes, as with the wires in the tent JX)le example, the natural, inherent harmony of the physical structure can reasscrt itself. It would be lovely if it werc all exactl}' that simple, and sometimes it is. But the reality is that most of us have physical and energetic panerns of holding that interfere with our inherent ability to find alignment. These patterns can develop through injury, Stress, misuse or any number of other causes. Let'S look at one of the physical/imitations that compljcates the process of restoring balance to joints. This first requires a little explanation of some basic ph}·siolog}'.

Eycry joint has two ranges of movement: physiological and anatomical. The physiological range is the available range of movement of a joint which can be performed without outside assisrance_ ff you bend your finger down toward the palm of your hand, your physiological range extends to the limit of this movement. But there is a small additional range of movement available with the application of outside pressure or forcc. Notice that you can slightl}, flex }'our finger a little further toward the palm b}' gently pushing on it. This additionallirnit of movement is called the anatomical range. It is the absolute limit of movement a\,ailable ro the joint before it is dislocated. This additional "cushion" of movement acts as a natural shock absorber. [t allows you to sustain a mild overextension of the joint without injur}'.

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The distance between the physiological and anatomiGll range can be increased through injury or other restriction to avaibble joint movement. Let's sa}' }'ou can only mO\re }'our finger 10 degrees toward the palm of }'our hand. Even rhough this is not the usual physiological range, it is now yow own individual physiological range for that finger. So the distance between your ph}'siological range and your anatomjcal range for rhat finger is quite large and movement wirhin that distance is unavailable to you from the inside. However, from the outside, the practitioner rna}' be able to move the joint within thar restricted range, finding ways to access movement. This in rurn gives access to the possibiljt}, of altering the restriction. Another wa}' thar patterns of holding can keep us from moving back to alignment on our own is repeated stress or injury that creates compensating patterns. If we spend many years using incorrcct posture, repeating rnovemems that are stressful to the body and generally subjecting ourselves to the wear and tear of daily life, we create stress patterns that bring the body ro the edge of irs limjts of accommodating any excess strain. Then one day we bend over to pick up that box which is just a little hit roo heavy and ARGH! [call this the Myth of AII-of-a-Sudden. "I've had no problems with my back before, then all of a sudden it JUSt went out on me." This "all of a sudden" type of injury is not a simple case of letting the muscles relax from the srrain of lifting rhe box. There are probably numerous underlying imbalances in the muscles of the back. the struceure of the pelvis, perhaps the bones of the spine or ribcage. The immediate pain of the back may be eliminated rather quickly, bUI the underlying imbalances will still be there. Sometimes it's like unravelling a snarled ball of twine: rou follow the red string, only to discover that you have to unknot the blue string before you can free the red one.

Introduction

The unravelling process in itself provides an important element of re-education. Contained within patterns of holding and tension is the information the body needs about how to return (0 balance. By unravelling the strands of our intertwined patterns we often come to new understanding about how to return to balance spontaneously, without outside assistance. I often use the analogy of driving someone around in a car, explaining the landmarks about how to get to the final destination: turn right at that big cree, go straight six miles. In Orthe-Bionomy, the body provides the guidance for what it needs to rediscover balance and comfort. The map of the journey is created in the very process of releasing held patterns.

As we come to greater understanding of how the body responds to stress and tension, and develop more flexibiliry and relaxation, we are bener able to respond appropriately to future stressors. We also tend to start noticing earlier in the process when we are overstepping our limits or when we ;are using our bodies incorrectly. As happens at the specific muscular and joint level, the body as a whole has more information available about how it is experiencing itself. The changes in the whole body affect change at the muscular and joint level and so on in a continuously linked cycle of change and self-discovery. Kathy L. Kain

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Introduction to Practice Procedures - Introduction In order nor to burden the main text with repetitions of the procedures which will be the same from section to section, we have summarized them in this introduction to practice. Her( you will find such information as the specific indicators to look for that tell you that a particular part of the body needs attention, how to fine tune release positions and how to re-chcck the original indicators of imbalance. In this section we also present information on the general practice of Ortha-monamy such as taking a client history and how to know when your work is complete. This section is formatted as a walk~through of a session, beginning with the taking of the initial client history, then outlining the process of determining where and how to work, and ending with suggestions for bringing the session to a close. Those of )'OU who are just beginning in Ortho-BionolU)' may find the general information to be more than you need at the moment. Feel free to skip fon.vard in this section to the specific information thar you need, but please don't skip this section altogether because the text is written on the assumption that )'OU have read the summarized information. As )'ou progress in your training, you can come back to this section as is appropriate.

Before You Begin There are certain responsibilities you have when you work with the public. One of the first is to ensure your client's safet)'. The techniques presented in this manual are not intended to replace or precede appropriate medical attention. Jf a client has a problem that )'ou suspect might be serious enough to need medical attention, have that person check with his or her medical practitioner first, or take the time to check w1th the medical practitioner )'oursclf. In other words, use )'our

common sense if )'ou don't have experience with the presenting problem, or with the client's other health problems which might affect your work. Educate )'oursclf enough to know what is a threarening problem and what can be safely worked with. We recommend that )-OU develop an ongoing working relationship with a ph)'sician or other medically-trained health practitioner who is willing to consult with you about your clients.

Taking a Client History Taking a client history (also called an intake interview in some professions) gives you access to the information you will need both to ensure your client's safet), and to make a preliminary plan for your initial session. Some practitioners perform a very thorough interview which includes a detailed histOry of accidents, injuries, illnesses and so on. Others ask just the limited number of questions necessary to establish the starting point and the immediate history of the problem. In either case, it's beSt to know in advance what )'OU will need to know from the client in order to feel comfortable wirh proceeding into the session. E\'entually )'OU will develop )'our own form of history taking that fits with your style of working. At minimum, )'OU will usually need to know what the client's presenting problem is and its immediate history. It is also wise to ask if there are any current injuries or medical problems that you need to know about before proceeding. The information the client gives you as part of the history taking interview will also help you organize the session so you can allow enough time to work with each area that needs attention. You rna)' also find ir helpful to establish certain communication guidelines with the client. For example, man)' people are used to receiving work that

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Ortho~Biononty

is uncomfortable. You may need fO state quite clearly, and emphasize during the session, that the client should let you know immediately if anything you are doing is uncomfortable.

Beginning Kltowing Where to Starl After you've gathered the basic information about the client's condition, you will need fO determine where to begin working. In a general sense, this means you will need to decide which part of the body to start with. Then. specifically, you will need to decide where to begin within that particular area. There are various ways to determine where to work. The fust: is to gather information from the client as to where they eXfXriencc discomfort, restricted movement and so on. This you will have done in the history taking discussion, or as part of thc ongoing discussion during the session as you work. The client's information is likel)' to have narrowed down the choices somewhat. Perhaps the cliem complains of a stiff neck. discomfort in her shouldcrs and pain in her lower back. You will probably begin with one of those areas. At a practical level, the client may not be able to lie comfortably on her stomach unril her neck is less stiff, so you may ha\'e to start there. at least with some general releases. In the beginning, you rna)' want to develop rour own pattern of working (sa)'. beginning at the tOp of the body and moving down) until you feel more Cl'rtain of how to choose among the various options presented by the cliem, and by your own observarions. Often, m spite of the infonnation the client may give you in the history taking interview or as you work. you will need to rely on your own observations to tell you where to begin, both in a general arca and specific points wimin rhar area. Over

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time, )'our proficiency at observing subtle indicators and at "reading" the client's non-verbal cues will increase. In the beginning, )'OU are likely to observe only thc larger signals (like the client not being able to lift her arm above her head). EXfXrience is the best teacher of observation and palpation skiJIs. ~ a start. the following is a basic list of some of the signs to take note of as you decidc where to work.

General Indicators • Notice the way the c1iem is lying on the table. Is he lying with his body in a slight curve; with his head turncd slightly to one side; with one or both of his legs rolled externaJly; without letting his back rest flat on the table? (What mighr these signals mean? Perhaps his psoas muscle is contracted. pulling his body into a curve; perhaps his neck is tight on one side; perhaps h,is femurs arc rotated externally; maybe his lumbar spine is tight.) • Arc there any areas that jusr seem to get your attention: they aren't as relaxed as the surrounding area; the client's breath is restricted in that area; the skin looks different than surrounding areas; the muscles look contracted or tight. • You may want to gently check the range of motion of the joint yOU will be working with. or jusr gently move the general area. Norice wherher there is restriction in the movement, or discomfort during the movement. Take note of any strong preferences of movement in one direction or another (pay attention nOt only to how far the joint moves but also how comfOrTably it moves).

Specific indicators Once you've decided on the general area you will be working with (e.g., the shoulder or the neck), you will still need to decide where, specifically, to work in rhat area.

Introduction

• Vou may check specific joint mo\'ements. For example, you may have checked the general movemenr of the shoulder. ow you may want to specifically check the movement of each joint within the shoulder and whether or not the client is uncomfortable with any of the specific movements. • Vou may feel (palpate) the soft tissue in that specific area. When palpating, use the pads of rour fingers, not your thumb, so you don't press tOO hard or tOO specifically. Palpate onl)' as firmly as is needed to gather information, and do your best not to create discomfocr. Gendy feel the condition of the tissue in the affected area and notice if there is discomfort; if there are knots in the tissue; if the muscle is overstretched or tight; if the connective tissue is rigid and so on. In each area worked, make sure your palpation covers the entire area of the joint. For example. in the neck you will not onl)' palpate directly on the side of the neck over the transverse processes, but also along the entire back surface of the neck. In the shoulder you will check the entire front, tOp and back of the shoulder in addition to the specific shoulder joint. • You don't always have to focus on pain as an indicator. You may focus on movement or lack of movement, or sensation versus reduced sensation. You may find that a specific area simply attracts your attention. Many practitionets who wotk with clients who have chronjc problems h.1.ve learned to focus on pain as a secondary indicator of problems. Often a diem with chronic problems is very much past the poinr where pain is relevant - she is in the numb stage. Pain happened years ago. Pain information is no longer neurologically available because after a certain amount of time of sending indications of pain the nerve endings simply stop firing. This is a survival mechanism that

allows the organism to continue to function. Until those nerve endings are reawakened, the client will have no sensation of pain. even in an area of her bod)' which is in tremendous distress. So asking her if something is comfortable or uncomfortable is an irrelevant question. With clients like this, you will likely need to focus on available joint movement and the quality of the soft tissue in the area. Take the affected joint through its a\'ailable range of motion as mentioned in the General1odicators section. Any restricted area then becomes your focus for release work. 10 the soft tissue, any signs of tension such as knots or overstretched muscles will be your focus of work, regardless of whether or not the client experiences discomfort there.

ludicator Poillts Any specific area of discomfort Ot tension can be used as an "indicator point." Ths point, when monitored during a release position, allows the practitioner to feel an)' changes that happen as a result of that position. It also gives the dent a focus for the position and allows for feedback about any change in the level of sensitivity or tension. Mainrainjng contact with the indicator point during the release work allows you to monitor the possible positions for release to tell which gives the mOSt change at the indicator point. Keeping contact with rhe indicator point also ensures that you sta}' on the same point as you move the client, in turn guaranteeing that you know if the point released or not. Remember, however. that it is the release position that catal)'Zes the release. not the indicator point. You don't need to press or massage the indicator point. Once rou know thar the indicator point is tight or sensitive, you don'r need to keep pressing on the point. Maintain a gende contact with the point. only as deep as is needed to notice changes during the release position.

13

Ortho-Bionomy

Working Once you've decided which specific area to work with. you may then experimem with different release positions until you find the most effective one. You don't need to know the release position in advance, you can discover it by following the client's lead. Literally. you could do a pretry effective session by simply presenting oprions of JX>sitions and asking: "which do you prefer, this or that?" and following the most preferred positions until fOU get the best one. Then repeat for the entire area. It would be tedious for the client, but would probably work vcry well to release the area. The diem can conununicate his preferences directly or you can gather the information by observing how his body responds to the release positions: which positions are resisted and which are accepted; which positions allow the most movement and breath; which positions encourage the client's entire body to relax and so on. As mentioned previously, some clients can't tdt what's comfortable. In this case, find the mO\'ements which are easiest. As discussed previously, it is common to find that the position of release is one which exaggerates the eccentric posture, or exaggerates rhe current imbalance. Notice which movements the joint with which you're \I,.oorking prefers and do more of that movement. If you can't remember a specific technique for the area with which you're working, there are a few general rules of thumb that will probably get you close to a workable release position: • If therc's pain in a specific point or a general area. find a position that lessens or eliminates the pain. • Make a curve around the sensitive area. For example, for tightness or sensitivity on the right side of the neck, you will probably curve the neck around to the right. For sensitivity on the front of the shoulder, you will probably curve

14

the atm around to the front of the shoulder and chest. This principle usually works because contraction of one set of muscles will usually curve the surrounding area around that contraction. So making a curve around a tight or sensitive area will often be an exaggeration of an existing contraction. • H you find a muscle that's contracted (i.e., short· ened). find a position that shortens it further. • Remember that rigidity (all muscles of the joint conrracted at the same time) also has a position of exaggeration: compression. There is little or no movement within an area so you exaggerate that lack of movement by compressing or shortening all the muscles at the same time. As the area begins to open and movement becomes available, then you can follow an)' expressed preference.

Gettillg the "Right'3 Release Positioll How do rou know when you've gOt the best release position for the specific area with which )'ou're working? • The tissue in the indicator point that you'rc monitoring rna)' soften and relax. • The client will ohen feel more comfortable in the release position than in the neutral position. • You may feel more comfortable in rour own body. • There may be a pulsation in the indicator point. • Knots in the tissue may "dissolve." • There may be changes in skin color. • Breathing rna)' change (usually a deepening of the breathe or a sigh). • Skin or body temperature ma)' change.

Introduction

• TIle affected area "sinks" deeper imo the release position. • The diem's overall body comfort and relaxation increases. • There is an increased liveliness in the tissues.

Fine Ttmi1lg In the (ext you will find instructions to "fine tune the position." This means that you may have found a reasonabl} effective release position, but )"OU want to make sure it's me best one. Try small varianons in the position: try a slightl), different ang.lc.; more or less compression; more or less rotation and so on, and keep choosing the best of me various options. Keep this up until thcre is no other position that feels better than the one )'ou've got, and then stay in that position for 1(}-60 seconds.

Compression In Ortho-Bionomy. we usually use compression as part of the release position. However, traction (pulling slightl), on the affected joint) may sometimes feel bener for the cliem. If the client resists compression. you may be pushing too firmly. Lighten up on the pressure. H she still resists the compression, tty gently pulling. The line of compression is usually toward the indicator point or into thc joint.

Usi/lg Your Oum Body Correctly Be aware of how you use your own body. Comfort and presence within yourself will be communicated in your touch. Relaxation on )'our part will allow more sensiriviry to perceiving what's happening wim rour client. Once you get the dient into a comfortable release position, take a moment to check in with your own body and ensure that rou ace also comfortable. If you hold yourself in tension, )'OU arc communicating to the cljent that it's okay to make )'ourse1f uncomfortable. Ortho~Bionomy uses

more lifting than massage and many other bodywork techniques. This makes

it important to prOtect your own back as rou work. As much as possible. keep rour spine straight as you lift and rake the client's weight down through your pelvis and legs rather than in )'our arms and back. This t<'lkes a little pf<'lctice to get used to, but it actually makes lifting easier and will save injury to your back.

Holdillg the Release Positioll Once )'ou've found the best release position. you will usually hold that position for 1(}-60 seconds. or until the release indicators that you are monitoring signal that the release is completing. Gcncrall}'. }Oll want to hold the position long enough for the body to come to a level of stability in the releasing process. For example, if yOll are noticing a pulsation in an indicator point, you probably don't want to move out of the rele<'lse position while the pulsarion is increasing in strength. Once the pulsation has levelled off and become regular, it's probably fine to move out of [he release position. You don't need to hold the position until the pulsation diminishes entirely. just until it has crested past its full momentum.

Re-checkillg In the text, you will find references to re-checking the indicators. This means you will go back to )'our original indicators of imbalance or tension and check to see if they've changed. If you were using a specific indicator point, is it still sensitive or conrracted? If you were using the restriction in movement in a joint as your indicator, has that restriction lessened? If you re-check the indicators and find that they haven't changed, or have only partially improved. you may need to keep finding variations on the release positions. It is possible that tension in surrounding areas rna) keep the area that you're working with from releasing completely. If you've tricd a few release positions for a specific area and find no change in the indicators, go on to work with adjoining areas and come back to the original area later.

15

Ortha-Bionomy

Once the indicators have all improved to the point where there is no discomfort or restriction in the area (or as much improvement as seems available for the moment), you may move on to the next area, or finish up.

Finishing How to Know When You're Finished 1be finishing of the work process is almost a mir· ror image of the beginning to work process. Rather than checking indicator points, tissue condition and joint movement as a way of figuring our where to begin, you will check these same indicators as a way to determine if }'OUC work is finished. In a specific area, are all the indicator points soft, relaxed and comfortable? If not, there's probably more work to do. Are the muscles and other soh tissues in the areas with which you've been working relaxed and comfortable when you palpate the area? Has the range of motion within specific joints, or in the combination of joints that you worked with improved? Sometimes there's more work to be done, but the client has simply had enough. There's been enough physical, energetic and emotional input for today. If you persist in working at this stage, you may begin to overload the client's ability to respond, undoing some of the work you've just done togetheL How will you know if this is happening? • Areas that released earlier in the session start tightening again. • You no longer get responses from the areas you're working with: no change in indicator points even when the release position otherwise seems ideal; no change in muscle tone after the release position, etc.

16

• The client begins to over-respond to release positions: muscles spasm as you move into a position; the release position produces a burning sensation in the indicator point, etc. • An area that was feeling comfortable begins to ache again. • The client "disappears" energetically, or there seems to be no further invitation to work. • The area with which you are working comes to a stable resting place that seems fairly complete. Generally, if the client starts C)'ding back towards discomfort aftet an area has released well, that's an indication to stop working on that area, or perhaps StOp working altogether. If you find yourself wondering if the client has had enough work, he probably has.

Integrating After you've finished work in a specific area, you will wanr ro make sure that the changes that have taken place are integrated with the current balance in the resr of the body. The easiest way to do this kind of integrating is to make some gentle movements within the area with which you've JUSt worked and slowly exrend that movement into surrounding areas. For example, if )'ou've done a lot of work with the pelvis you might want to gentl)' rock the pelvis back and forth and then extend that rocking motion up into the spine and down into the legs. Some practitioners make it a practice to do some movement or rocking with each part of the body as a wa)' to bring the session to completion. This integrating time also includes the internal integration the client might need ro do. Leaving a little extra time at the end of the session to let the client rest quietly can provide her with the time she needs

11ltroductioJt

to check in ITom the inside and notice how things ha\'e changed. Some practitioners encourage their dients to do a little moving or stretching at this point to bring specific anennon to areas where change may have occurred.

Talking About the Session Just as the taking of the client's history at the beginning of the session helps determine what work will be done, discussing the session at the end may help clarify what was accomplished during the session. As with the history taking inter\·jew, there are a wide variety of wars to bring the session to a close. Some practitioners prefer to keep the talking to a minimum and gather only enough information ro know if their work W
Taking Notes Most Ortho-Bionomy practitioners maintain some kind of client files. As with the history taking interview and discussion after the session. there is a wide range for how these records arc kept. Many practitioners keep note cards or file folders for each client, with brief notes as to the dates of sessions and what was done in each of those sessions. Other practitioners keep extensive files with intake interview information, detailed notes of what was done in each session and recommendations for follow-up work or referrals to other types of health care pro\'iders. If rou arc working in a more structured environment, such as a physical therapy clinic. those arc the types of records you will probably be required to keep. If you arc working independently or in a less StructllTed environment, you arc free to establish the kind of noce-taking process that suits yOllr needs. We recommend that you keep sufficient notes to be able to determine what general work you did with a client if, for example, a client comes back to sec )'ou after a rear or two with no contact.

As with the history taking interview, you will eventually develop your own style for bringing the session to a close. At minimum, we recommend that you make sure that the client is clear and alert enough to be safe to drive or return to work.

17

Section 2

VERTEBRAL COLUMN & THORAX

Neck

\

. I ~.;. I \ I I I

- \ \V ~I

Vertebral Column & Thorax -

NECK -

Neck

ANATOMY

See Illustrations 2.1 and 2.2

)t1~~~~~;OCCIPITAL RIDGE

CERVICAL VERTEBRAE

::::q~~~~=+~~ATlAS

(e,) AXIS (C2) FIRST AlB

CERVICAL VERTEBRAE

AllAS (el) AXIS (C2)

FIRST

RIB

ANTERIOR VIEW Illustration 2.2

u Illustration 2.1

TIle neck is made up of seven vertebrae, called the ccrvicals, numbered one to seven from the top of the nock dO\Vl1. The first and second cervicals have forms that are different from the other vertebrae in thc rest of the spine. These two vertebrae are the ooly vcrtebrae in rhe spine with no disc between them. The first cervical, called the Atlas, rests just below the base of the skull and has very wide transverse processes. A common image associated with the first cervical is that of Atlas holding up the \\'orld on his shoulders and arms. The Atlas has almost no central body to the vertebra. instead it has a large hole at its center. The second cervical,

caJled the Axis, has a finger-like projection (the dens) that protrudes through the 9pening in the Atlas. The Atlas pivots upon this axis, giving the first and second cervicals more rotational ability than the other five cervicals. The Atlas has a spinous process which is smaller than that of the other cervicals, which allows for more flexion and extension than is available in the other cervicals. If you cup your hands at the very top of your neck, including the base of your skull, yOll will notice that you have some rotation, quite a bit of lateral flexion and almost no flexion/extension available. That's because the primary movements of the first two cervicals are flexion/extension and rotation (the "yes'" and "no'" movements of the head). So the release positions for this part of the neck will usually include a combination of these two movements. The remaining five cervicals have some flexion/extension, rotation and lateral bending available between each two vertebrae. If you cup your hands around the middle of your neck, you will notice that yOll still have some rotation and quite a bit of flexion/extension available, but are severely restricted in your side-bending. That's because the middle portion of the neck has lateral flexion (side-bending, ear toward shoulder) and

23

Ortho-Bionomy

rOtation as its primary movements. So the release positions for this section of the neck will usually mclude a combination of those tv..o mo\'cments_

The sixth and seventh ccrvicals have thicker and wider transverse processes than do the other ccrvicals. 1be seventh cervical has a longer spinous process, which shows as a Imnp at the base of your neck when you drop your head toward your chest. Thc accumulatcd movcmcnt of the individual vertebrae gives the neck great flexibility. However, it also makes the neck vulnerable to injury because it hasn't the built-in stability given the thoracic spine by irs attachment to the ribcage or the lumbar spine by the size of its vertebrae.

NECK -

EVALUATION

Becausc of the neck's vulnerability to stress and injury it is especially important to take an injury history before beginning to work. DO NOT WORK ON SOMEONE'S NECK IF TIfERE IS A POTENTIALLY DANGEROUS rNJURY THAT HAS NOT BEEN CHECKED BY A MEDICAL PRACTTTIONI=.R. The neck is also one of the areas of the body that is oftcn quitc strongly guarded. As you work, make sure you support your client's head gently and securely, without sqUCC7ing and without pulling his hair. MOVE SLOWLY. Abrupt or fast movcments of the head may cause your clicnt to tighten and hold his neck.

General Evaluation / Release If thc client's neck is comfortable enough to allow movement, you may begin with a simple evaluation of his neck's range of motion and with general release positions. If the client has relatively minor discomfort and restriction in the movement of his neck, sometimes general release positions arc sufficient to bring relief from discomfort and increased ease of movemcnt. 1. Gend)', and without forcing, rotate the client's head to thc left and to the right. Notice if there is greater movement or more ease of movemcnt to onc side or thc othcr. Move thc clicnt's head into whichcver position is most comfortable. Compress down the line of the spine. Hold for 10-60 seconds_ Rerum the head to the neutral position and recheck the movcment. 2. Gently flex the client's head up toward his chest. See Figure 2.1. Then bring his head back down to the table and gently extend his chin up toward the ceiling, giving an arch to the back of the neck. See Figure 2.2. Notice if there is greater movement or more ease of movement into flexion or extension, and move the cliellt into whichever is most comfortable. Hold for 10-60 seconds. Rcrurn the head to the neutral position and re-check the movemellt.

)

Figure 2.1

24

Figure 2.2

t

,

It

lC

"

Vertebral Column 6'" Thorax - Neck

3. Gently laterally flex the neck by bringing the client's ear toward his shoulder. This is usually done most comfortably by including some rotation of the head in the movement. Notice if there is greater movement, or case of movement to onc side or the other. Move the diem's head into whichever position is most comfortable. Compress down the line of the spine. Hold for 10-60 seconds. Return the head to the neutral position and rc-eheck the movement.

Neck -

For each area of the neck, gently contact the specific point or points with which you arc working. You may use a single finger (usually the middle finger is most sensitive), or two/three fingers to contact lightly enough that you arc not causing any discomfort. Remember that it is the position that facilitates the release, not pressure on the indicator point. Keep your conract at the side or back of the neck so yOll don't impinge on breathing or blood flow in the neck. See Figure 2.3.

Specific Evaluation

If the client is uncomfortable during the general movements, or he has morc complex tension patterns. you may need to begin with motc specific release techniques. For release purposes, the neck is divided into three general areas: upper, middle, lower. The upper neck consists of the first two cen'ical vertebrae (Cl-2). The middle neck consists of the next three cervicals (C3-S). The lower neck consists of the laSllwo cervicals (C6-7), and sometimes the uppermost thoracics (Tl-2). These divisions will vary slightly from client ro client, but are presenred here as general guidelines for deciding which release posirions ro use. Generally, you will release the middle neck first, then the lower neck and finally the upper neck. This order is uscd simply because the middle and lower areas of the neck are usually a litde easier to work with, but you may find that a different order works better for your panicular style of working or for certain clients. Experimenr with different combinations and usc whichever works best for rou. (Sec "Nores" at the end of the neck secrion for additional information on choosing positions.) Usually, you need only perform release positions for those areas of the neck where you find tension, discomfort or restriction.

Figure 2.3

t. Using the pads of your fingers, not your thumbs, gently palpate the client's neck for specific areas of tension or discomfort. See Figure 2.3. Include the muscles both along the side and back of his neck. Notice if there is any discomfort in any of the areas you are contacting. Any area of sensitivity, cOlHraction, or restricted movement may be used as an "indicator point" for a release position. Other things 10 notice include knots, stiffness or a stringy feel in the tissues, swelling or lack of tone in the muscles. 2. Contact the vertebrae themselves, at [he transverse processes on each side, and gently rock them from side to side. NOlice if there is any discomfort or restriction in the movement of the bones.

25

11llroduction

• You may check specific joint movements. For example, you may have checked the general movement of the shoulder. Now you may want fa specifically check the movement of each joint within the shoulder and whcthcr or nor rhe c1icm is uncomfortable with any of rhe specific movements. • You may feel (paJpate) the soft rissue in that specific area. When palpating, use the pads of your fingers, not your thumb, so ),ou don't press too hard or tOO specifically. Palpate only as finnly as is necdcd TO gather information, and do your best not to create discomfort. Gently feel the condition of the tissue in the affected area and notice if there is discomfort; if there are knots in the tissue; if the muscle is overstretched or tight; if the connective tissue is rigid and so on. In each area worked, make sure your palpation covers the entire area of the joint. For example, in the neck you will not only palpate directly on the side of the neck over the transverse processes, but also along the enti.re back surface of the neck. In the shoulder you will check the entire front, top and back of the shoulder in addition to the specific shoulder joint. • You don't always have to focus on pain as an indicatOr. You may focus on movement or lack of movement, or sensation versus reduced sensation. You may find that a specific area simply attracts yOUT attention. Many practitioners who work with c1iems who have chronic problems have learned to focus on pain as a secondary indicator of problems. Often a client with chronic problems is very much past the point where pain is relevant - she is in the numb stage. Pain happened years ago. Pain information is no longer neurologically available because aher a certain amount of rime of sending indications of pain the nerve endings simply stop firi.ng. This is a survi"al mechanism that

allows the organism to continue to function. Until those nerve endings are reawakened, the cliem will have no sensation of pain, even in an area of her body which is in tremendous distress. So asking her if something is comfortable or uncomfortable is an irrelevant question. With clients like this, you will hkel}' need to focus on available joint movement and the quality of the soft tissue in the area. Take the affected joint through its available range of motion as mentioned in the General Indicators section. Any restricted area then becomes your focus for release work. In the soft tissue. any signs of tension such as knots or overstretched. muscles will be your focus of work, regardless of whether or not the client experiences discomfort there.

Indicator Points Any specific area of discomfort or tension can be used as an "indicator point." This point, when monitored during a release position, allows the practitioner to feel any changes that happen as a result of that position. It also gives the client a focus for the position and allows for feedback about any change in the level of sensitivity or tension . .Maintaining contact with the indicator point during the release work allows you to monitor the possible positions for release to tell which gives the most change at the indicator point. Keeping contact with the indicator point also ensures that you stay on the same point as you move the client, in turn guaranteeing that you know if the point released or not. Remember~ however, that it is the release position that catalyzes the release, not the indicator point. You don't need to press or massage the indicator point. Once yOll know that the indicator point is tight or sensitive. you don't need to keep pressing on the point. Maintain a gentle contact with the point, only as deep as is needed. to notice changes during the release position.

13

Ortho-BiOPlomy

Neck - Specific Release

Lower Neck

Middle Neck

If you simply side-bend and rotate the head, most of the curve of the position is absorbed by the middle of the nock. This makes it difficult to get an accurate release position in the lower neck. For this reason. you will usc a "sct-up position" for the lower neck. The purposc of this sct·up position is to focus rhe curve of the release position into rhe lower part of the neck.

With one hand, gently contact the specific point or area of the client's middle neck with which you are working. Maintaining contact with the indica· tor point, use your other hand to slowly rotate and side-bend the neck around the poinr until there is maximum softening of the point, and maximum comfort for the client. Compress slightly from the top of the client's head down toward the indicator point, or down the line of the neck. Chock with the client to ensure that you are using a comfortable amOllnr of compression. See Figure 2.4. Hold for 10-60 seconds. Return the head to its neutral position (nose toward ceiling). pulling gently out of the compression as you do so, and re-chock the point. Repeat for any other points in the mid-nock that need attention.

Figure 2.4

26

Making sllre thar your contact is in toward the neck, not down toward the shoulder, gently con· tact the specific point or area of the client's lower neck with which you are working. With the other hand, gently rotate the client's head aUlay from the point, (i.e., if working with a point on the left side of the neck, rotate the head to the right). 00 nor force rhe movement, bur simply let the head roll to the side opposite the point. This is your set·up position. See Figure 2.5.

Figure 2.5

Vertebral Coltmm & Thorax - Neck

Maintaining contact wi.th the indicator point, and maintaining light compression down the li.ne of the neck, slowly and gently curve the dient's neck and head back around the point (you may also de-rotate the head slightly.) Hold in the posirion that maximizes softening of the indicator point and comfort for the client. Compress down the line of the neck toward the point. See Figure 2.6. Hold for 10-60 seconds. Renlrn the c1iem's head to the neutral position (nose toward ceiling),

pulling gently OUt of the compression as you do so. Re-check the point. Repeat for any other areas of the lower neck that need attention.

Upper Neck As with the lower neck, you will need to use a setup position for the upper neck to focus the release position at the top of the neck. Gently contact the specific point on the upper neck with which you are working. With both hands supporting the diem's head, gently lift his head and side-shift it directly to the side away from the point (i.e., if the point is on the left, move the head to the right). Do not rotate or sidebend his head. The client's face stays in a direct line with the front of his torso (like the side-toside head movement the Balinese dancers make). You will need to support the head in this sideshifted position becausc it will tend to slip back to the neutral position. See Figure 2.7.

• Figure 2.6 NOTE: The most common error students make

with this release position is to move too quickly and too far into the position. The best release position is most often found at the beginning of the movement. Go slowly and pay attention to what happens in the point.

Figure 2.7

Usually, the nose will not mO\'e pa!;t mid~line in this position. [f the curve created in this position m(wcs up imo the middle of the neck, you've gone too far into the release posirion. RenJrn the dient's head to the neutral posirion and ~;tarr the rrleasc movement over.

27

Ortho-Bionomy

[f possible, maintain conract with the indicator point while you move into the release position. From the side-shifted position, gently CUT\'C the c1iem's neck and head around the point by rotating. side~bcm.ling and extending the head. You may need to practice making each of these movements separately at first. Evennlally it should be one fluid movement. See Figure 2.8.

Compress down the line of the neck, or toward the point. Hold for 10-60 seconds, return the head to the neutral position and re-chock the poim. Repeat as needed for other points in rhe upper neck.

Notes 1. Notice that in each area of the neck, rcgardless of the starring position, the final movement into the release position is the same: curve around the affected point. 2. For points toward the back of the ncx:k in each area, you may need more extension in the release lX'Sition. If necessary, you may gently lift at the back of the client's neck to get his head into extension. See Figure 2.9. For points toward the front, more flexion may be needed (remember the idea of creating a curve around the point). You may work on the front of the neck if nceded, but be aware that most people are somewhat nervous about contact in such a vulnerable area. Keep yOut cOntact light and check ,\lith the client about the comfort of your touch.

r Figure 2.8

NECK - RELEASE INDICATORS If there arc no other imbalances prescnr: Figure 2.9

• There will be increased range of morion and ease of movement in the neck. • There will be increased comfort and decreased tension in the soft tissue (indicator points) of the ned. • There will be increased comfon and decreased re!>1.ricrion of movement in the individual verre~ brae of the neck.

28

3. In any of the release positions, if you pass the position of maximum sohening in the indicator point and it begins to stiffen, you have probably passed the best release position. Go back to the neutral position and begin again. 4. The compression llsed in all release positions should be comfortable. Check with the client as to whether he wants more or less compression.

Thoracic

Vertebral Column & Thorax -

Thoracic

THORACIC - ANATOMY See lllustration 2.3

PROCESS THQRACtC VERTEBRAE AND RIBS SPINOUS PROCESS

u v

illustration 2.3

The thoracic spine consists of those twelve vertebrae to which the ribs connect. What many peopie call their backbone is actually the spinous processes of the thoracic spine. The joints of the thoracic vertebrae permit all movements: rotanon, flexion/extension and lateral bending. The mo\'ements within each joint arc slight, but the Krumulated movement of the twelve vertebrae make the thoracic spine quite flexible. It has its putest mobility on the rotational plane, as compared to the lumbar which has its widest range ill me flexion/extension movemem.

The transition from thoracic to lumbar spine is made at the twelfth thoracic vertebra. The upper part of this bone has the facets of a thoracic vertebra, its lower facets arc those of a lumbar vertebra. This is an abrupt shift from the less mobile thoracic joints to the more mobile lumbar joints and makes the twelfth thoracic the vertebra most susceptible to strain. The eleventh and twelfth thoraces are the mOSt commonly fractured in a broken back. The twelfth thoracic is also the uppemloSt origin of the psoas muscle, which may account for some of that muscle's vulnerability to chronic contraction.

THORACIC - EVALUATION With the diem prone:

1. Check for sensitivity or contraction in the muscles along each side of the thoracic spine. Do this by palpating along the length of the thoracic within an inch on either side of the spmous processes. 2. Check for movement of each thoracic vertebra. Do this by rocking the c1iem's pelvis and visually noting whether the movement of the pelvis is transferred up the full length of the spine. Then place your thumb or finger against the sides of two adjoining spinolls processes. Continue the rocking of the pelvis and feci for movement between each successive pair of vertebrae. Any area of sensitivity, contraction, or restricted movement may be used as an "'indicator point'" for a release poSition.

33

Orrho-Bionomy

THORACIC -

RELEASE

All of the following release positions are per formed with the client in the prone position. To avoid straining the dent's neck, her face should be turned, if possible. toward the side of her body that is being lifted. 4

Upper Thoracic Stand on the saOle side as the sensitive or contracted point (the "indicator" point). reach over the dient's back and slide your hand under her opposite shoulder. Gently lift her shoulder and bring it back towards the indicator point until the point softens and relaxes. Fine tune the position for maximum softening of the point. Gently compress from tbe shoulder towards the point. Hold for 1D-60 seconds. Return the shoulder to the neutral position and re'"Check the point. See Figure 2.10. NOTE: • You may find that you need to experiment with different ways of holding the shoulder: a. If holding on the outside of the client's shoulder is uncomfortable for you or for her, try holding under her arm, with your hand on the front of her shoulder. b. If it is comfortable for the client, youlllay bend her arm and lift her shoulder from the elbow. This position is usually most comfortable for the practitioner, but is sometimes too much of a strain on the client's shoulder.

Figure 2.10·

Middle TIJOracic Stand on the same side as the indicator point. Reach over the client's back and gently hold the side of her ribcage. (If it is not comfortable for th client to be held directly on her ribcage, you may bold her arm against the ribcage and usc it to cllshion the lift.) Gently lift the ribcage up and back towards the indicator point until you find a comfortable position that softens the point. Fine tunc the position. Gently compress with the liftin: hand towards the point and hold for 10-60 seconds. Lift away and return the arm and ribcage to the neutral position and re-check the point. See I=igmc 2.11.

• For points high in the upper tboracic (11-3) you may want to gently shrug the shoulder up towards the ear as you lift it. Be careful not to cause discomfort in the neck or upper shouldeL

Figure 2.11

34

-:...::a.

_

Vertebral Column & Thorax -

NOTE: Because of the angle of the ribs, your lifting hand will be placed lower on the ribcage than me hand contacting the point.

Thoracic

THORACICRELEASE INDICATORS If there are no other imbalances present:

Lower Thoracic Stand on the same side as the indicator point. Reach over the client's body and slide your hand under her hip bone. Making sure that your contact is secure and comJocrabJe.lift her hip up and back towards you until you find a position that relaxes the point. Fine tW1C the position. Compress from the hip toward the point and hold for 10-60 seconds. Return to the neutral position and recheck the point. See Figure 2.12.

• There will be reduced sensitivity and contraction along the spine. • There will be increased mobility of the thoracic vertebrae.

Notes • After each of the release positions, yOll may want to do some gentle rocking of the entire thoracic spine as a way of integrating any changes that may have occurred. • If you find that a thoracic vertebra does not release with the above positions. try lifting from the same side of the spine as the indicator point. If that doesn't work, check the associated rib. It may be holding the vertebra from releasing.

Ie

the "y

t

I

,d a

one ~ting

ecFlgure 2.12

NOTE: If it is more comfortable for you or for lour diem, you may have your client "frog" her leg slightly, on the side being lihcd. Notice that this bending of the knee will begin to lift the pelvis.

• lMPORTANT: As you find the most comfortable position for the client. make sure that you find a comfortable position for yourself. You will be lifting a considerable amount of weight when working with the spine so it is important to take care of the health of your own back while working. If necessary, use pillows to sup· port the positions.

35

Ribs

Vertebral Column & Thorax -

RST RIB -

First Rib

ANATOMY

, Illustration 2.4

FIRST RIB -

CLAVICLE

RSTRIS

STERNUM

illustration 2.4

,e first and second ribs have a particular influce on the shoulder and the neck due to interating muscle attachments, nerve and blood pplies. The first rib connects from the sternum the first thoracic vertebra, passing under the lvide at the front of the shoulder. The scalenus teriar and medius muscles, which originate at ~ transverse processes of the cervical vertebrae, -ach directly to the first rib. The scalenus pos~ 'jor attaches to the second rib. These muscles particular link tension in the neck to imbalce of the first and second ribs. The placement the clavicle in relation to the first rib makes IUsceptible to disruption by an imbalance of efirst rib, in tum disrupting the function of the olllder. The sternocleidomastoid muscles of the ck (the large muscle h..1nd at each side of the neck) laches at the clavicle, again linking the function the neck with that of the shoulder girdle and IJXr ribcage.

EVALUATION

With the client supine, her arms at her sides, locate the muscles at the top of the shoulder in the wide part of the "V" formed by the clavicle and scapula. With your fingertips, gently palpate these muscles for contraction or discomfon. If the muscles are contraered to (he point that you cannot feel the underlying rib, use this as an indication that the first rib needs attention. H there is enough softness in the muscles to allow you to feel the rib underneath (the first rib), gently contact the rib itself. You should be able to gently flex the rib without causing discomfort to the client. 1£ the rib itself is rigid, or there is pai.n on contact, you may also use this as an indication that the rib needs attention.

FIRST RIB -

RELEASE

Isometric Release With the c1iem supine, have her bend her elbow on the affected side and bring that arm up so her elbow is pointing toward the ceiling. With one hand, contaer the cliem's first rib, or the muscles overlying the rib, on the affected side. With the other hand, cup the client's elbow. You will use the hand on the client's elbow to provide resistance to an isometric movement of her arm. Have the client initiate a small movement of her arm, as if she is beginning to bring her elbow back down toward the table, (so it would rest directly next to her torso). At the same time, provide gentle but firm resistance to the client's attempted movement so her arm stays basically still. See Figure 2.13 NOTE: This is NOT a contest of strength. The most common error made with the isomerric release is to use too much muscle contraction which brings the focus of the movement into the

39

Ortho-Bionomy

If this isometric does not completely release the first rib, try one of the variations listed below, or the positional release that follows.

Variations on the Isometric 1. Try the isometric movement at various angles

(i.e., with the arm next to the torso; pushing rhe elbow straight out to the side; pushing from the shoulder straight up toward the head, etc.).

Agure 2.13

arm rather than the shoulder. The client should initiate only as much movement as needed to engage the muscles of the shoulder. You should provide only enough resistance as needed to keep her arm from moving. Hold the isometric for approximately 10 seconds. Have the client relax her arm as you follow through on hCt attcmptcd movcmcnt by gently bringing het atm down to the tablc and, without pausing, bringing it out to the side and compress· ing through the line of the upper arm and into the shoulder. See Figure 2.14. Re-eheck the first rib.

v

1 Figure 2.14

40

2. Use an isotonic mther than an isometric. This is similar to the standard isometric release. However, as the client attempts to move her elbow down toward the fa ble, instead of resisting the movement completely, slowly allow her elbow to move toward the tablc as you continue offering some resistance. 3. With the client supine, scand at the side of the massage table. Slide your arm (palm down) under the client'S armpit and hold the top edge of the table. The back of your forearm will be under the back of the client's shoulder; her armpit will be against the crook of your elbow. Ha\'e the client initiate a small movement with ,her arm, as if she is reaching reward her foot. Provide gentle resistance to this movemcnt and hold for 10 seconds. Havc the client relax her arm as you follow through on her attempted movement by drawing the shoulder down toward her foot. Then, as in the standard isometric, draw the client's bent elbow out to the side and compress up the line of the arm into the shoulder.

rom

c.).

Vertebral Column & Thorax -

First Rib - POSiti01UlI Release With the client in a supine or side posture, shrug his shoulder up towards his ear. Compress straight into the shoulder joint/upper rilxagc from the outside edge of the shoulder. See Figures 2.15 and 2.16. t.lonilOf the muscles at the top of the shoulder and choose the position that maximizes softening and comfort in these muscles. Hold for 10--60 seconds,

then re-check the first rib.

FIRST RIBSRELEASE INDICATORS If there arc no other imbalances present: • The muscles at the top of the shoulder will be more relaxed and comfortable. • The first rib itself will have increased flexibility and comfort on contact.

Notes The word "isometric" means same (iso) measure or length (metric). An isometric exercise is defined in Taber's Cyclopedic Medical Dictionary as: "Contraction of a muscle that is not accompanied by movement of the joints that would normally be moved by that muscle's action. The muscle length is not changed by this type of exercise."

iist-

her

tin-

he

dge be

ow. 'lth

First Rib

Figure 2.15

Dl.

The word "isotonic" means same (iso) tone (tonic). Taber's defines an isotonic exercise as: "... equal tension on the muscle is maintained while the length of the muscle is decreased ... Contraction of a muscle during which the force of resistance to the movement remains constant throughout the ranb'C of motion."

and

,et

d

10-

lhc

to

Figure 2.16

If this position does not completely release the fir5f rib, try variations on positions (i.e., with the ann out to the side, with the shoulder rolled for~ ward) until you find one that works.

41

Vertebral Column & Thorax -

BS - At'lATOMY

Ribs

FJRSTRIB

STERNUM

·1/I"stmtiorlS 2.5 and 2.6

illustration 2.6 THORACIC SPINE AND RIBCAGE

ElEVENTH ,I1C:tAND TWELFTH

-FLOATINGRIBS

the vital organs such as the heart and lungs, but it also makes the ribcage susceptible to distortion. In sportS which cause repeated stress to the ribcage, such as polc·vaulting, it is not uncommon for the ribs to take on unusual shapes. Many people have distortions in the shape of individual ribs, or in the entire ribcage, that do not impair the function of the ribcage. For this reason, when evaluating the ribs and ribcage, it is generally best to look for di.scom· fort and/or restriction of movement, rather than for anatomical differences in the shape of the ribs.

u

u

Illustration 2.5

e twelve ribs on each side of the ribcage form ulf-eirclc, with the upper ten ribs attaching to : sremum on the front of the torso and to the rrespooding thoracic vertebra on the back. 111e >\-mth and twelfth ribs are called floating ribs cause they connect only to the thoracic spine d hue no attachment to the sternum. The mus:s bl:tween the ribs, called the intercostals, assist cht bteathing process and give the ribcage addi· ,..031 St3biliry.

of the individual ribs are quite flexible, as dJ: ribcage as a whole. This flexibility allows the

It bones

ngr to do its job of surrounding and protecting

RIBS -

EVALUATION

Before you begin, you may want to visually check the ribcage for its balance. As mentioned in the anatomy section, the physical shape of the ribcage does not necessarily indicate its actual condition and function. However, the shape of the ribcage may provide dues regarding an imbalance. For example. you may see that one side of the ribcage appears to be smalJer than the othet: This might indicate that the ribcage is constricted on that side, or that there is a rotational tension pattern, making it appear smaller.

If the imbalance in the ribcage is due to an overall pattern of distortion, ot to minor distortions in some of the ribs, a general release movement may be sufficient to restore balance and f1exibiliry.

43

Ortho~Bio"omy

Ribs - General Evaluation / Release The general evaluation/release movements may be done with the client either prone or supine. The ribcage will have more general movemenr avail~ able when the client is supine. I. Gently rock the client's ribcage directly from one side to the other (laterally). Notice if there IS more mo"ement, or more case of mO''emcnt in one direction or the other. Gently pull the ribcage in the direction of greatest movement and hold for 10-60 seconds. See Figure 2.17. Release the position and re-ehcek the movement.

2. Gently rock the client's ribcage down toward the table (anteriorly if she is prone, posteriorly if she is supine). See Figure 2.18. If there is more movement. or more ease of movement, on one side or the other. In this plane of movement, you have a few choices for finding the best release position. On the side that moves most easily toward the table, you may compress (as you have done in the evaluation movements). If one side is resisting compression toward the table, you may lift that side and, if comfortable, compress the opposite side toward the table. See Figure 2.19.

I

, a

3. Gently flex each side of the client's ribcage down toward her feet (inferiorly). This move~ ment is sometimes easier to do with the client on her side. If there is more movement or ease of movement on one side, compress that side toward the dient's feet. Hold for ID-60 seconds, release the position and re-check the movement. You may use the pattern of three breaths, as described in the Specific Release section, to increase compression in the ribcage during the general release positions. Rgure2.17

•

•

Figure 2.19 Figure 2.18

44

1

Vertebral Columll & Thorax - Ribs

=

Iy

"~e-

~fu,

nts).

able,

Ribs - Specific Evaluation If general release positions are not sufficient to rrstort flexibility and comfort to the ribcage, you may need to evaluate the balance of, and then

mast, individual ribs or adjoining groups of ribs. In evaluating the balance of the ribs, you ha\'e the ad\Ol.nr:age of having fuU access to the entire lengrh oEthe rib bone. If you are not certain what you arr feeling in one area of the rib, simply trace aklng the rib to its opposite end and see if this g1\"!:S rou a better idea of its position. Gmdy feel for the position of the individual ribs

to their adjoining ribs. Notice if each nb IS aligned with the ribs next to it. Also norice If there is restriction in the movement of any indi\1dual ribs or if there is discomfort on contact wuh the rib. Remember that the ribcage has a \Io1de range of "'correct" variations. If you find a rib thai seems to be out of balance, check for dis· comfort and/or restriction in movement as well as for physical distortion.

( Figure 2.20

111 relanoo

Ribs - Specific Release he

The following release positions are given for mediem in a supine position. You may use the same techniques with the client prone or in a side posture. I. For a rib that protrudes beyond the line of the surrounding ribs:

Contacting directly on the affected rib, lift it fur· lhtt above the line of the surrounding ribs. At the sa~ time, compress eadl adjoining rib in the opposite direction. See Figure 2.20.

If this simple release position doesn't work. try the following variation: Contacting the ribs as described above, add the following pattem of three breaths. which uses the lungs to add further compression to the release position.

a. With minimal pressure on the ribs, have the client take a deep breath. As she exhales. com· press the ribs on each side of the affected rib and lift the affected rib.

b. While maintaining the compression on the adjoining ribs, have the client take another deep breath. (Let the affected rib lift with the inhalation). As the client exhales, go a bit deep· er into the compression on the adjoining ribs (if comfortable). c. As the client takes another deep breath. let the expansion of her ribcage slowly push her ribs Out of the compression (i.e., you release the compression as she inhales). Gently rock the area of the ribcage you've been working with to integrate possible changes.

45

Ortho·Bionomy

2. For a rib that is depressed in relation to the surrounding ribs: Contacting directly on the affected rib, depress it further. At the same time, lift each adjoining rib. See F;gllre 2.21.

RIBS - RELEASE INDICATORS If there are no other imbalances present: • The ribcage as a whole will be more symmetrical and will have more flexibility. • There will be more movement available in each plane of movement in the ribcage. • Each side of the ribcage will move as easily as the other side. • The individual ribs will have more movement and less discomfort. • The individual ribs will be balanced in relation to the surrounding ribs.

Figure 2.21

You may use the same panern of three breaths as described abo~'e, compressing the affected rib on the exhalations, and letting the surrounding ribs lift with the inhalation. 3. You may perlorm specific positional releases: 3.

If some of the ribs are too dose together, squeeze them doser together and hold for lQ--60 seconds.

b. If a rib is slightly rotated, rotate it a little more and hold for lQ--60 seconds. c. If a few adjoining ribs arc compressed (or lift~ ed), compress (or lift) them a little morc. Again, you may usc the three-breath pattern to add additional compression.

46

Vertebral Column & Thorax - Ribs

IDles

.If a rib doesn't release, check the conesponding thoracic vertebra.

. When working with the ribcage, you will need to know how to cope with two problems that typically arise: how to WOT"k with someone who IS ticklish; and how to appmpriately and comfortably work around the area of the breasts. a. If your cliem is ricklish, try using a firmer pressure as you work. This usually eliminates the ticklish response. If that doesn't work, you will probably need to contact in a different area of the ribcage in order to comfortably perform the release position. If ticklishness is a sensation in me tissues (as opposed to a trained response) lOU may use this as an indicator of problems. The sensation of tickling is produced by the same IYl've endings as those which indicate pain; it's just that fewer nerve endings fire. So tickling may be interpreted as a mild pain response.

You also need to be aware of the appropriateness of your contact near yoUI' client's breasts. Generally speaking, it is considered inappropriate to touch your client's breasts as you work. However, there may be occasions when some contact in the breast area is appropriate. For example, a female practitioner may work with a woman who is at ease about non·sexual contact with her breasts. In this case it would be appmpriate to simply move the breast tissue aside in order to make contact with the underlying ribs. It is essential that you have dear permission from yOllT" client before making any kind of contact that might be considered inappropriate.

b. When working near the breasts you need to be aware that some women will have physical discomfort in this area and sometimes under their annpits also, especially around the time of menstruation. YOLI may need to vary the pres· sure of your contact, or the placement of your hands in order to avoid creating discomfort as rou work.

47

Lumbar

!,

II

II

,I ,,

Vertebral Column & Thorax -

LUMBAR -

ANATOMY

See Illustration 2.7

The lumbar spine, which rests above the sacrum, IScomposed of five vertebrae, numbered from lop to bottom. The weight-bearing requirements of the individual vertebrae increase as the spine descends, so the vertebral bodies become larger from the cervical to the lumbar area. The discs also become correspondingly larger.

LUMBAR SPINE

'"UM

Lumbar

Because movements between individual vertebrae are greatest where the discs are thickest and where the joint surfaces are largest, the lumbar region is subjected to considerable strain. The structure of the lumbar spine allows for full flexion and extension, and some lateral bending. If rotation were also available, the torsion on the lumbar discs would be excessive. Consequently, the lumbar vertebrae have an interlocking joi.nt structure that severely limits rotation. However, even with the added protection of restricted rotation, the lumbar discs arc the most prone to injury.

-----+---J 1+_

SACAUM---i

i-_~/._'

POSTERIOR VIEW

illustration 2.7

51

Ortho-Bionomy

LUMBAR - EVALUATIONIRELEASE In the lumbar spine, it is common to have no actllal discomfort at the spine itself, even when there is an imbalance present. In addition, this part of the spine is heavily muscled, sometimes making ir difficult to assess the condition of the spine with direct palpation.

PSIS ASIS

--1.3 TRIGGER

- - l 4 TRIGGER

For these reasons, trigger poinrs are used to e\'aluate the condition of the lumbar. Chock for sensiti\'ity, discomfort or contraction at the trigger points indicated. See l//ttSlrotions 2.8, 2.9mtd 2.10.

L1

ASIS

TRIGGER

ILIUM .1----1;-"

L2

TRIGGER PUBK; SYMPHYSIS

Illustration 2.9 Illustration 2.8

Notes 1. Trigger points are specific areas of sensitivity which are remote from the area for which they indicate an imbalance. For example, the trigger points for the lumbar spine are located on \'arious parts of the pelvis. Information on myofascial triggers is widely available through the writings of Jones, Chapman, Travell, Pnldden, etc.

52

2. The area to check for triggers is within a 3-fingers' width of the point indicated, to ensure that you don't miss the area of sensitivity. 3. Softening in the trigger point area is an indication of the correct release position. It is impor· rant to remember that it is not the rriggers you are releasing, it is the spine. When the spine is released the tenderness at the trigger will lessen or disappear. The trigger is a clear indicator of the change in the spine.

Vertebral Column & Thorax -

Lumbar

GER

1-

-\

lUMBAA SPINE

GER _-'H,--ILiUM

-i-It:t..-

l5 TRIGGEA----1~~;;:__

l-..f-,.,iL----1r- PSIS ~--,P\--'\-SACRUM

I POSTERIOR VIEW

illustration 2.10

The location of trigger points may vary from person to person. Presented here arc the most commonIyagreed upon locations. However~ you may U!lany specific area of discomfort in the approximate area of the listed points as a trigger.

client and/or which softens the nigger point. Compress from the knees into the hip joint and hold for 10-60 seconds. If possible. stay in gentle conraet with the trigger point so you can monitor for signs of release. See Figure 2.22.

11 Trigger Location: In the muscle inside the medial edge ofthc ASIS. See llJustration 2.8.

nsure

lica-

lJX>ryou

)(; IS ~sen

"

LI Release - Supine Draw both of the client's knees up [Oward her chest and drop her knees slightly toward the side lting released. Generally the feet I lower legs are then brought slightly [0 the side opposite from the knees. However, it is sometimes more comfortable fonhe client if the lower legs are left in line with the knees, or brought to the same side as the kntes. Experiment with the lower legs position and notice which is most comfortable for the

Figure 2.22

53

NOTE: This is the standard release position for L 1 and L2. 111e side posture release described below is an alternative if the client is unable to lie comfortably on her back. Lt Release - Side posture Draw both of the c1ienr's knees toward her chest (in fetal position) and adjust the position of her legs until the trigger area softens or discomfort lessons. Hold for 1D-60 seconds.

ing until maximum softening and/or comfort is found. It may be more comfortable for you or the client to have her bend her knee and bring it out ro the side (thjs is sometjmes called "frogging" the leg). Hold for 10-60 seconds. See Figure 2.23.

L2 Trigger Location: Immediately superior and/or inferior to the inguinal ligament at its midpoint between the ASIS and the pubic symphysis. See l/ltlstration 2.8.

L2 Release Same procedure as L1. 111e position will be slightly different because you are working on a slightly lower point on the spine. Monitor the trigger point and choose the position that softens/relaxes the point most thoroughly. Generally, the legs will be at a less severe angle for L2 than for L 1. See Figure 2.22.

Figure 2.23

L3 Trigger

NOTE: This is the standard release position for L3 and L4. The alternate supine release position may be used if the dient cannot lie comfortably on her stomach.

Location: At the posterior edge of the tensor fasciae latae on a direer line posteriorly from the ASIS. Alternately, you may also locate the point by moving 2-3 inches lateral and inferior to the PSIS. If a line were drawn straight through the body, front to back, L3 would be approximately opposite L 1. See l/Itlstration2.9.

1.3 Release - Supine Similar procedure as Lt. The position will be slightly different because you are working on a lower point on the spine. Monitor the trigger point and choose the position that softens/relaxes the point most thoroughly. Generally, the legs will be at a less severe angle for L3 than for Ll or L2.

U Release -

P,.one Holding at the client's ASIS (hip-bone), lift and compress her opposite hip toward the trigger point. Monitor the point and adjust the position-

54

Vertebral Column & Thorax -

Lumbar

L4 rrigger

h,

t

'he

Location: Mid-buttock. Slightly superior to the midpoint of the gluteus maximus. [f a line were

drawn straight through the body, front to back, L4 would be approximately opposite L2. See Illustration 2.9.

l4 Release - Prone As in the L3 release. lift and compress the client's opposite hip [Oward the trigger poim. The position will automatically be different because you 3rc lifting toward a point lower on the pelvis. See Figure 2.23.

L4 Release - Supine Similar [Q L1 through L3, with the release position adjusted for the difference in point location.

000

See figure 2.22.

IS rrigger location: On the medial or lateral side of the PSIS. See lllustrotion 2.10.

"Dn

L5 Release - Prone

Iy

the one most comfortable for the client.

You may use one of twO release positions. Choose

1. Sund on the same side as the sensitive trigger.

a

axes I will

. L2.

Have the client move toward the edge of the table on lhat side. Bend her knee, and bring her leg off the edge of the table. With her knee poiming down toward the floor, compress, from the knee, straight up the leg into the hip joint. If the compression is uncomfortable, simply support the leg without compression. See Figure 2.24.

Figure 2.24

NOTE: There are two ways to easily support the leg in this position. You may sit next to the table and support the knee/leg in your lap, while holding the client's leg in the position that is most comfortable for her. Alternately, you may stand next co the table, while holding the client's leg at the ankle and resting her knee against one or both of your legs for support. Make sure the client's weight is balanced on the table. This may be accomplished by having the client move to a more diagonal position, with the affected hip at one edge of the table, and the upper torso at the opposite edge. When you lower the client's leg off the table, make sure you bring her knee down toward the floor and not directly out to the side. This will avoid strain at her hip joint. Caution: Make sure YOU move the client's leg back onto the table. DO NOT let her lift her own leg.

55

Ortha-Bionomy

2. Stand on the same side as the sensitive trigger. lift the client's leg on the side opposite the trig· ger. Hold her leg just above the knee (leg may be straight or bent) and bring it slightly toward you. Be aware of both the client's comfort and your own as you do this. It is particularly imporrant to protect your back as you lift. See FigllTe 2.25.

LUMBAR-

RELEASE INDICATORS If there are no other imbalances present: • The triggers will be soher and more comfortable. • There will be more freedom of movement in the lumbar spine. • There will be less discomforr in the lumbar spine.

Figure 2.25

NOTE: Position 1 is usually more comfortable for a client with a relatively flat lumbar spine; position 2 is usually more comforrable for a client with a relatively deep lumbar curve. These are the standard 1..5 release positions. The alternate supine position may be used if the client cannot lie comfortably on her stomach. L5 Release - Supine Similar to 11 through 4 with the position adjusted for the difference in point location. See Figure 2.22.

56

Section 3

THE PELVIS

Iliopsoas

\

\

\

The Pelvis -

IPSOAS -

Jliopsoas

ANATOMY

'1ustratio1ls 3.1 a1ld 3.2

1---+--- PSOAS PSOAS'

PSOAS MINOR-iY'

ILIACUS--+~

:Il~:=,:.,r-t---PU8IS

FEMUR

Illustration 3.1

mopsoas group is made up of three muscles: major, the psoas minor and the iliacus. pr.oas muscles originate at the transverse esses of the twelfth thoracic vertebra and t first four lumbar vertebrae. They pass from ow back, cross the front of the ilium and the £ bone (passing under the inguinal ligament) attach at the inside of the femur at the lesser hamer. The iliacus originates at the anterior itt ofthe ilium and is overlapped by the psoas des as it follows the same path to attach to the nrochanter. See l//ustration 3.1.

tSOOS

'M~AJ~O~R=:;
\.-......:\-_ _I,lIUM-

CONTRACTED ILIOPSOAS WITH ATIENDANT DISTORTION OF lliE TORSO.

Illustration 3.2

The iliopsoas muscles act to slightly lateral flex and rotare the trunk and, if the femur is fixed, to increase the lumbar curvature. They are used to tilt the pelvis forward (anteversion) and hollow the lower back while sitting or standing. W'hen the lower back is fixed, these muscles assist in lifting and rotating the leg.

See l//uslration 3.2.

63

Ortho-Bio1Jomy

IUOPSOAS - EVALUATION Each of the following indicarors can mean something other than iliopsoas tension, so you may get mixed indications. Don't worry. Either take the strongest indicator, or check all indicators to see if a pattern emerges to indicate the affected side. To check for tension at the iliopsoas: 1. Compare resistance to internal rotation of the femur. Because the iliopsoas attaches to the lesser trochanter of the femur, the iliopsoas stretches when the femur is internally rotated. If the iliopsoas is contracted, it will resist this stretch. Therefore, tension in the iliopsoas can be detected by testing its resistance to internal rotation of the femur. To do this with the client supine, grasp her ankles, lift her legs slightly, and firmly rotate them internally. If there is no iliopsoas contraction, the legs should rotate evenly and withour resistance. lhis is a test of the condition of a muscle that attaches at the head of the femur, so make sure your rotarian is focused at the hip, and not at the ankJe or knee. See Figure 3.1.

NOTE: The results of this test can also be an indicator of external femur rotation or of tension at the sacro-i1iac joint. An externally rotated femur or a tight sacro-iliac will resist internal rotation with a bone·to-hone resistance. A tight iliopsoas will resist internal rotation, but with some muscu· lar stretch available at the limit of the rotation. 2. Compare leg length. As the psoas contracts, it brings the femur with it, making the leg appear shonet. Therefore, the short leg is generally the side of the contraction, or in the case of two iliopsoas contractions, the side with the stronger of the two contractions. You can compare leg length at either the ankles or the feet. With the client supine, make sure she is lying straight on the table, with her legs in line with her pelvis and torso. Bring her legs and feet as close together as is comfortably possible. C0mpare the length of her legs by one or hoth of the following: a. Flex her feet and notice if her heels are even with each other. See Figure 3.2.

,".

Figure 3.1

Figure 3.2 the right

64

Note that the left leg rs s1i!1ltty shorter

The Pelvis -iliopsoas

indiat

nut

on oas

uscuon.

IS,

,pear the , ilio· :r of

kles e she n line ~ feet . Com,f the

ven

b. Place your thumbs under the ankle bones on the inside of the legs (at the inferior surface of the medial maleolus) and notice if your thumbs are \n:el with each other.

NOTE: This test may also indicate an ilium rotatiro. To determine if it is the ilium or the iliopsoas, ,heck the balance of the ilium at the pelvis. if the p;his is in balance and the legs are uneven, it is bkely [0 indicate an iliopsoas contraction. his not common that legs are anatomically different lengths, but it is sometimes the case. This test may occasionally indicate an actual anatomical difference in leg length.

You may test for this preference of movement with the client supine by gentl}· pulling the entire ribcage first to one side and then to the other. Notice if one side moves more easily than the other.

NOTE: This test may also indicate an imbalance in the thoracic spine and/or the ribcage.

5. Compare arm length. As the iliopsoas con~ tracts. it pulls the trunk into a slight curve on the side of the contraction, making the arm appear shorter. Therefore, the side of the contraction will generally be on the side of the shorter ann.

J. Oleck for tension or discomfort wlthin the muscle itself. On the side of tension, the muscle mar be sore to me rouch, or feel tight. To check kit this, gently contact the muscle at the point where it comes ncar the surface, midway between the ASIS and the navel.

To check for this, with the client supine, pull her arms above her head, so they are in a straight line with her body. Maintaining a constant and even tension on both arms, have the client straighten her fingers. Bring her hands together without releasing the tension and check for a difference in the arm length.

I\OTE: This test may also detect lumbar referred

NOTE: This test may also indicate an imbalance

P'Jll.

in the arm or shoulder.

4. Preference of movement with the ribcage.

Because the psoas originates at the twelfth thoracinertebra and at the upper four lumbar vertebrae, if it is contracted it v.':ill tend to pull the uunk imo a slight curve on the side of the conlJ1rnon. The ribcage will express this curve by trAl'l'ing more easily to the inside of the curve (the ule of the contraction).

horter than

65

Ortho-Bionomy

ILIOPSOAS -

RELEASE

t. Shoulderlbip compression. Stand on the affecred side. With the cliem supine, bring her leg on the affected side straight out to the side, with her foot and leg rotated slightly outward. Hold her wrist on the same side (she may also hold your wrisr for additional support). Gently compress into the client's hip from her footlleg, while pulling her arm/shoulder gently toward her feet. The client's body will automatically move into a slight curve on the side of the contraction, exaggerating the position the iliopsoas would produce if severely contracted. Hold for 10-60 seconds. See Figure J.J. It is important in this release position that you rake care of your own comfort, in addition to that of your client.

Figure 3.4 3. Ribcage release. Gently pull the ribcage toward the side to which it moves most easily. Hold fot 10-30 seconds. This movemenr may need to be repeated once or twice more for complete release. See Figure 3.5.

Agure 3.3 Note that the client's leg is abducted. Figure 3.5

2. Knees toward chest position. Stand on the affected side. Draw both of the client's legs up, knees bent, coward her chest. Lean her knees slightly toward the side of the contraction and gently compress into her hip from her knees. Twist her lower legs slightly toward me side of the contraction to further shorten the affected muscles. Hold for 10-30 seconds. See Figure 3.4.

66

liard

The Pelvis -lliopsoas

ILIOPSOASRELEASE INDICATORS [f there are no other imbalances present: • The legs will rotate intemally without resistance. t

The legs will be the same length.

• Discomfort or tension in the muscle itself will be reduced or eliminated. Movement of the ribcage will be even. t

The arms will be the same length.

Noles 1. The iliopsoas muscles are strongly involved in the "fight or flight" mechanism, making them particularly reactive to any stressful situation. Since the psoas is such a reactive muscle, it is difficult for it to stabilize in the released state. particularly if the contraction is a chronic one. Teach your clients the release positions so they can work with the psoas regularly to help speed the change in its contraction pattern. 2. The psoas will tend to respond to the release positions more readily than other parts of the body, so you may need to move out of the release positions within 10-15 seconds_

~ase.

67

Ilium

The Pelvis - IIi"m

IlJUM -- ANATOMY See JIIustrations 3.3, 3.4 and 3.5

'\A--_--AS
s

-\-H----ILlUM----!----\:J:::~£~~, ~I++_--SACAUM--I__-+~~:::_' . ~~~l----ACETABULUM

..........~~

Jt~~~~e~1~~===,PUBIS----r 11 ISCHIUM--+-+" +-I---FEMUA

Illustration 3.3 Illustration 3.4

Tht: iUum, commonly called the hip bone, is a lan-shaped bone that connectS with the sacrum to ilrm a weight-bearing arch which direcrs the body Vttight to the femurs. Hy adulthood, the ilium has We:! with the ischium (the sit-bone) at the back, ald wilh the pubic bone on the frone. The three qtther, combined with the sacrum, form the ~ns. In the lower portion of the ilium, where it h.1sfustd with the pubis and the ischium, is the bpsocket (acetabulum). The ilium on each side bms one half of the sacro- (sacrum) iliac (ilium) jtllIt. When people talk about the movement dthe ilium, they are actually talking about the mmement of the pelvis on eadl side of the Solcrum.

The pelvis varies in shape from one person to the next. In addition, the pelvis of the male is shaped differently than that of the female. Principally, the male pelvis is narrower and longer than the female's. The female pelvis is wider, with a larger opening to allow for passage of the infant during birth.

71

Orlho·Biollomy

ILIAC CREST

ILIUM

"-~?'~2.-+I'_:.....---~-r- FIFTH LUMBAR VERTEBRA

-----I-iL_

:.

't--I--,--~--+--PSIS SACRUM

--+---""""",,.......-i! ~~~~J..-J:....~:---j-1

COCCYX

ISCHIUMI-+-t---<'+_ _--.l~

I PELVIS-POSTERIOR VIEW

Illustration 3.5

ILIUM - EVALUATION The ilium can pivot at the sacro-iliac joint in various ways. To simplify evaluation of the balance of the pelvis, the indicatOrs given are foe posterioclanrerioe rotation of the ilium. When moving your c1iem intO the release position. it is important to notice fine vaeiations in the peefee. ence of movemenc and to foUow them.

72

There are rwo simple tests to use to check for imbalance of the ilium: 1. Compaee the balance of the ilium al the pelvis. An imbalance of the ilium may be detected by

comparing the position of each ilium in relatioo ro the other. Two places that are convenienr bony land macks are the iliac crest and the PSIS. To check for an imbalance with the client prone, place your thumbs at the iliac crest or

The Pelvis -

Ilium

PSIS on each side. If the ilium is balanced, ~

points are level with each other. If the

ilium rotates anteriorly, the iliac crest and the PSIS on that side will move superiorly to those

on the other side. In a posterior rotation they will move inferiorly. See Figure 3.6.

T

R

Figure 3.6 Note that the leh PSIS appealS to be than the PSIS on the right.

_than

1 Compare leg length. When onc side of the pelvis moves, (he hip socket located within it

will also move. Consequently, if the top of the ilium rotates posteriorly, the hip socket located m lower portion of the bone will be levered forward and lip, hringing the leg with it. This

me

r

Illustration 3.6 Nole thai the posterior rotation 01 the ilium makes the lelt leg appear shorter.

"ill give (he leg on that side the appearance of ~mg shoner. On the other hand, if the tOP of the ilium moves anteriorly, the hip socket will be levered back and down, giving the leg 00 that side the appearance of being longer. Str Ilfltstration 3.6. Th:ufore, comparing the length of the legs at ankles or at the bottoms of the feet may gm~ an indication of the movement of the pd\is. See Figure 3.7.

me

Figure 3.3

Note that the dient's leg is abducted.

73

Ortho-Bionomy

NOTE: This indicaror is not always an accurate indicator of the balance of the pelvis. A difference in leg length may be anatomical, or it may indicate a contraction of the psoas muscle.

NOTE: Experienced practitioners find that it often takes longcr- to check all of rhe triggers than it does to simply try the release positions as recommended in #1.

You may find that the pelvis is our of balance, bur at this point yOll don't know which is the affected side. You may lise any of the following tests to determine which side has moved (it is possible that both sides have rotated, either in the same direction, or in opposite directions so be aware that rou rna)' get mixed indicators}:

lLUUM - RELEASE

1. Try the appropriate release position on each

side. The side that moves most easily into the release position, and is most comfortable in the release position, is likely to be the affected side. II rou can't tell by the feel of the movement, ask the client which is more comfortable.

Posterior rotation (short leg) Pro1le

Bend the client's knee on the affected !>ide. Bring his leg out to the side and let it rest in this position. This is sometimes referred to as «frogging the leg." With one hand on the ASIS and the other on the ischium. gently rotate the ilium posteriorly. Hold for 10-60 seconds and release. This release is performed most easily by standing at the side opposite the ilium being released, and reaching across rhe dienr's body. See Figure 3.8.

2. Check for discomfort at the triggers for the sacro-iliac: • 1 inch from the PSIS. at 5 o'clock on the right and at 7 o'clock all the left; • at the posterior superior surface of the greater trochanter of the femur; • on the superior margin of the pubic bone 1 Y2 inches lateral to the pubic symphysis. If some or all of the triggers are tender on only one side, that is likely to be the affected side. If some or all of the triggers are tender on both sides. it is likely that both sides are affected. 3. Discomfort at the center of the wrist andlor ankle joints may indicate an ilium imbalancc. Check both wrists and both ankles for discomfort. If the triggers on only one side are tender, that is likely to be the affected side. If triggers are tender on both sides, it is likdy that both sides are affected.

74

Figure 3.8

Side posture The client lies on the unaffected side with his bonom leg straight and his top leg bent. On me affected side, place one hand all the ASIS. the other on the ischium and rotate the ilium posteriorly. Hold for 10-60 seconds and release. This release is performed most easily by standing, facing the client's back. See Figure 3.9.

L

The Pelvis -

Ilium

Side posture Have the client lie on the unaffected side, with his bottom leg bent, and his top leg straight. Stand at his back. Gently push anteriorly on the crest of the ilium, while bringing his leg straight back toward )'OU. Hold for 10-60 seconds and release.

as

See Figure 3.11.

ng 1-

g other iorly. ase de g

Figure 3.9

Anterior Rotation (long leg) Prone Sund 011 the affected side. Gently 1m the client's Its on that side straight up toward the ceiling and, \l11h the other hand 011 the top of the ilium, rotate

lheilium anteriorly. Hold for 10-60 seconds and rtleast. See Figure 3.10.

Figure 3.11

IHUM - RELEASE INDICATORS If there arc no other imbalances present: • The iliac crest and PSIS on each side will be level with one another. • The legs will be the same length. • The discomfort at the referred pain points will be relieved.

Noles r9Jre3.10 IS

the

,he

)ostc-

. This

1. Note that the side postures simply duplicate the prone release positions, bur on a different plane of movement. 2. All positional movements are done firmly, slowly and gently.

'&

75

Sacrum

I~

!

!

!

The Pelvis - Sacrum

\CRUM - ANATOMY elllustrations 3.7 and 3.8

__-------..-+__--'LIAC CREST IUUM---+f--

'-lo.v?fY,'l-i-----tl- FIFTH LUMBAR VERTEBRA

PSIS

SACRUM --+--t=""+-~

tJ-.f--':'\---f-+--COCCYX ISCHIUM

-1--+-..:..;---->,,;....;; PELVIS-POSTERIOR VIEW

Illustration 3.7

;De five sacral vertebrae fuse to form this single It transmits the body weight to the hip

SACRUM - EVALUATION

MiS via irs articulation with the pelvic girdle. At am side, the sacrum meets the ilium, forming the aero-iliac joint. At its upper edge it forms a joint r1lh the fifth lumbac v<"ebca.

1. With the client prone, check the general movement of the sacrum. Use "sof[" hands, one on top of the other. Move slowly and ask the client to tell yOli immediately if there is any

1OOr.

79

Ortho-BiOPwmy

SACRUM IUUM

~~~~__tt-r-SACAUM

Positional Release If there is a preference for movement in any particular direction (i.e., feels more comfortable rotating to the right), gently exaggerate rhar posi· tional preference and hold for 10-60 seconds. Usually. gentle compression will be used as one element in posirioning. See Figllre ].12.

( Illustration 3 ..8

discomfort. Check for a slight flex in the movement. The sacrum (more accurately, the sacroiliac joinr) should nor be rigid. • Gently and slowly compress the sacrum straight down toward the tablelAoor. • Wim genrle, ret firm, pressure on the sacmm, check rotational movement (as if gently unscrewing [he cap of a jar clockwise and counrer..dockwi~)_ See Figure ].12. • Check the sacmm's ability to rock in various directions (like a teereHorrer). 2. Check for any discomfort or tension along the edge of rhe sacrum. Pay particular attention to the edge of the sacrum where it meers me ilium at it:'.o uppermost points.

80

RELEASE

Figure 3.12

The Pelvis -

Point Release An)' sensitive area on the surface of the sacrum or at its margin may be used. as a release point.

". 051-

Ie

Position me sacrum/ilium to relieve tension or discanfon. Gener-allr, compression of the sacrum .1II be lo\vards the sensitive point. See Figure 3.13. Often, compression srl"aight in roward the sacrum from me hip will be effective for releasing tension oorhr opposite sacral border. The leg may be tSrd to assist in positioning (such as lifting the leg s5ghtly and compressing up the line of the leg into ~sacro--iliac joint).

F~",

Sacrum

SACRUMRELEASE INDICATORS If there are no other imbalances present; • The general movement of the sacrum will inCl"case. • Imbalances in the movement will even out. There will be a lessening of discomfort and tightness at the sacrum.

3.13

81

Section 4

THE LOWER LIMBS

Femur

The Lower Limbs - Femur

FEMUR -

ANATOMY

See Illustrations 4.1 and 4.2

....,p_ ILIUM _-.."{--£

ANTERIOR VIEW

POSTERIOR VIEW

Illustration 4.1

The femur is commonly called the thigh bone. It allows the weight of the upper body, as supported by the pelvis, to be transferred down the legs through the knee joints and the feet. At the knee, the femur forms the knee joint with the tibia and the patella. The head of the femur rests in the acetabulum (hip socket), forming a ball and socket joint.

87

Ortho·Bimlomy

FEMUR - EVALUATION If the femur is not balanced in its connection to the pelvis and/or knee, it will disrupt the balance of weight distribution. This in turn affects stand· ing posture and walki.ng. To check for an imbalance of the femur: 1. With the client supine, notice if his feet are naturally resting at a slight angle externally (towards the outside). If the feet are turned externally more than 45 degrees from midline, this may indicate an external rotation of the femur. If they rest pointing straight up toward the ceiling, or in towards midline, this may indicate an internal rotation.

2. With the client supine, hold both legs under the ankles and gendy lift and ["Otate them externally and internally. Remember that rou are checking the movement of the femur, so the focus of the rotation should be at the hip joint, and not at the knees or ankles. Notice if the legs move more easily one way or the other. If they resist intemal rotation, this may indicate an external rotation; if they R"Sist external fOtarion, this rnay indicate an internal rotation. See Figure 4.1.

NOTE: Resistance to internal rotation may also indicate a contraction of the psoas muscle, since it attaches to the femur. A psoas con· traction will have a muscular "bounce" to the restriction. A rotation of the femur will usually have a mOfe solid bone/joint restriction. 3. With the client supine, notice the balance of the legs at the thigh. An internal rotation will present as a rounded thigh and an external rotation as a Oat thigh.

FEMUR -

Positional Release Exaggerate whichever imbalance is indicated b}" using one of the following two release positions; 1. External rotation: On the affected side, bring

the client's leg laterally (out to side) and rotate his footlJeg externally. Gently compress from the foot, up the line of the leg into the hip joint. See Figure 4.2.

Figure 4.2

Figure 4.1

88

RELEASE

The Lower Limbs -

Fen1m

llntemal rotation: On the affected side, lift the client's leg slightly across midline (toward the inside) and rOtate it internally. Gently compress from the fOOt. into the hip joint. Return the leg to its neutral position and recheck the indicators. If the imbalance is still presem, tty the isometric release described

below: Isometric Ha,<e the client sit on the edge of the table. On the affected side, bring his ankle up to rest on his opposite knee (as if he were going to cross one leg (l\'U the other, but stopped with the ankle resting III the knee), with the knee dropped comfortably roward the table.

b) os: rlOg tate m

joint.

(

From this position, you will do one of the followmg two isometrics: I. External rotation: Face the client. Place one hand on the inside of his bent knee (as if to push his knee toward the table) and )'our other hand flat against the front of his opposite shoulder. The client gently attemprs to bring his shoulder and knee toward each other (with equal pressure) as if they would meet in front of his chest. While he attempts this movement, )'OU will provide gentle, but firm, resistance so that his knee and shoulder stay basically still. Hold for approximately 10 seconds. The client rdaxes and you follow through on the attempted movement (i.e., you bring his knee and shoulder toward each other, only as far as is comfortable). See Figure 4.3.

Figure 4.3

2. Inlemal rotation: Face the client. 1"11e client brings his knee on the affected side and his opposite shoulder together so they touch in front of his chest (or as close to this position as he can comfortably get). Place one hand on the outside of his knee, the other on the back of his opposite shoulder. The client gently attempts to "open" the posture by pushing his knee and shoulder away from each other. Gently resist the movement for approximately 10 seconds. The client relaxes and you follow through with the movement by gently moving the shoulder and knee away from each other. See Figure 4.4.

Figure 4.4

89

Ortho-Bionomy

FEMUR - RELEASE INDICATORS

Notes

If there are no other imbalances present:

• Ask the client to norice the movement in his hil socket as he performs the isometric. This will help him focus on the movement of the muscle in the hip rather than in the knee.

• The legs will rest at a more b3laoced angle. • The legs wiU rotate internally and externally without resistance.

• An easy way ro remember the isometric exerc~ is: If the femur is rotated OUT, you hold tht client OlIT; if the femur is rotated lN, you hoi the client IN.

• If the rotation is chronic (long-standing), it ~ take more than a few sessions to come back te balance. There will usuaUy need to be additional work done to change standing and waD ing patterns so the muscles can realign with d new joint balance. • The client can perform the appropriate exera at home by holding his own knee to pcovid~ r necessary resistance.

90

Knee

\

The Lower Limbs -

KNEE -

Knee

ANATOMY

See l/llistration 4.3

,

\

FEMUR---'r-t

PATEllA

"

KNEE INDtCATOR POINTS

£i--!---FEMUR

l..-.-je-,FEMUR

,

~

'..I

,

%

FIBULA

nBIA

FIBULA

I I, !'

TIBIA SIDE VIEW

ANTERIOR VIEW

POSTERIOR VIEW

Illustration 4.3

The two main bones of the knee are the femur fcommonl)' called the thigh bone) and tbe tibia loommonl)' called the shin bone). In order [0 maintain the stability required in the knee. these t'Al) bones are lashed together by a series of cartilages, ligaments and tendons that severely restrict t!lt movement available in the knee. The resulring

joint, called a hinge joint, is basically only capable of flexion and extension. Aside from minor movements within the joint itself, there is no rotation or lateral bending available in the knee. The knee is at its most vulnerable when it is straight, because an)' rotation or side pressure will immedi· atel)' stress the joint.

95

Ortho-Bionomy

The patella, commonly called the kneecap, is an unusual type of bone which develops within a tendon. The patella is held by this tendon over the front of the knee joint. When the knee is bent, the patella naturally fits into the gap created at the front of the joint, giving bony protection to the underlying soft tissue. The second bone of the lower leg, called the fibula, does nOt meet I he (ernul:, but connects underneath the lateral aspect of the head of the tibia. The importance of the fibula to the health of the knee is often overlooked. The fibula and tibia are constructed something like a bow and its drawstring, with the fibula being the flexible bow and the tibia being the taught bowstring. This combination makes a natura] shock absorber of the lower leg. When the fibula loses its flexibility, the lower leg also loses its shock absorption ability and the stress of walking, running., etc. is transferred directly to the knee.

KNEE -

EVALUATION/RELEASE

Before releasing the knee joint itself, it is important to check the condition of the patella, and to work with it if necessary. In order to bend the knee without strain, the patella must move. The condition of the patella is your first line of information on the rigidity or flexibility of the knee. If the patella is rigid, or has tOO much movemtTl~ rou already have enough information to know ro move slowly and carefully as you proceed with your work.

Patella -

Evaluation and Release

1. With the client supine, check the movement of her patella by gentl)' sliding it in its available planes of movement: superiorly, inferiorl)', laterally, medially. You may want to combine these movements 10 check diagonal mO\'emerlS as well.

a. The patella will naturally have more lllO't'f· ment available medially than laterally, but all other movements should be approximately equal. If the patella shows a preference of movement in any particular direction. take It in that direction and hold for 10-60seronds. Re-check the movement and perfom1 an)' release positions that may be indicated. b. If the patella does not move. or there is discomfort upon movement, gently compr~ from the kneecap straight back against the joint. Support the back of the knee as you do this so you do not hyperexrend the Imer. Compression of the patella will generall)' to free up enough movement to begin to n preferences in the available range. If there tinues to be no movement of the patella, br very cautious with an)' movements of the that involve bending. You rna)' nor be ablero move into some of the release positions for knee until the patella has some movemenrto

96

The Lower Limbs -

=

2. Check around the edge of the patella for spe~ cine areas of discomfort. If there is sensitivity, position the patella to relieve the discomfort. For example, if there is a point on l'he lateral edge of the patella that is uncomfortable you may t'ry pulling the patella towards that point and gemly compressing it straight back against the joint.

Knee

f'

Knee - General Evaluation IRelease The techniques used to evaluate the knee's condi~ lion are also the techniques used to create release positions. Each of the evaluation techniques in Ihis section will place a slight' strain on the knee joim, so move slowly and check with }'our client aoout the comfort of what you are doing.

Check the fonowing intrinsic movements of the

ts

k""" I. With the client supine, check for incomplete extension of her knee. First, visually notice if the client's knees are fully extended. Then, hold the client's thigh firmly against the table and gently lift her ankle towards t'he ceiling. The knees should be resting relatively flat on the table and there should be a slight flex avail~ able when lihing the ankle.

in :e n-

•

)

Ie

n.

If the knees are slightly bent, or there is no hyperextension available: Stand on the affected side and slightly bend the client's knee on that side. Slide your arm, palm down, under that knee and place it on top of the client's opposite thigh, just above her knee. The client's lower thigh on the affected side will now be resting on the back of yOUf forearm.

Figure 4.5

2. With the client's leg st'faight, place one hand above her knee on the front of the thigh, the other below the knee on the front of the shin. Check the knee's intrinsic rotation by holding the femur stable and gently rotating the tibia first medially and then laterally. There should be rOllghly equal, though slight, movement in each direction. If there is restriction or discomfort upon movement in one direction, rotate the tibia in the opposite direction and compress from the lower leg into the knee joint. Hold fOf 10-60 seconds. Re-check the movement. You may also check this rotational movement" with the knee flexed. There should be more rotation available in the knee joint when the knee is bent than when it is straight. See fjgure 4.6.

Place your other hand just below the client's bent knee. Gently compress the client's lower leg straight back/down towards the table. Hold for 10-60 seconds. Re~chl.'Ck the extension of the knee. See figure 4.5. Figure 4.6

97

Ortho·Bionomy

3. Check for available lateral slide within the knee joint. Side-pressure on the knee with the leg straight is the most stressful movement possible for the knee. The movements )'ou will be looking for in this test ace minute, so go slowly and sta}' within the range of movement that is comfortable for the client. Some people fmd this lateral slide movement uncomfortable so if you or your client have any concerns about doing this test just leave it out of the work you do with the knee.

Check the knee's extrinsic movement: With the client supine. bend her knee up towards her chest. If possible. gently bounce her hetl toward her bun<X-k. There should be enough range of motion available in the knee for it to have a slight "bounce" when it is fully flexed. If there is not, straighten the dient's leg and c0mpress into her knee joinr from both the upper and lower leg. See Figure 4.8.

)

With the client's leg straight, place one hand on the medial side of her knee, just above the joint, the other hand on rhe lateral side of her knee, just below the joint. Slightly slide the lower hand medially. while restricting any movement if the thigh. Reverse the position of your hands and repeat the movement. with the lower hand sliding laterally. There should be a slight flex in both of these directions. If there is not:, hold the leg in whichever of these twO positions has the greatest possible movement and which is most comfortable for the client. Compress into the joint. Hold for 10-60 seconds. See Figure 4.7.

Figure 4.7

98

Figure 4.8

The Lower Limbs - K"ee

Knee - Specific EvaluationIRelease Indicator Points As with the shoulder, specific points may be used to indicate

possible areas of tension in the knee. For each specific area of tension or discomfort that }'OU find, you may gentl)' contact that point and use the appropriate release position as given below. The release positions described are approx~ unare starring places onl}'. You will need to fine tune (hem by finding the slight variations which maximize the softening of the point. Figure 4.9

Location of points: Trace around the heads of the femur, the tibia and the fibula, paying particular attention to the artaS where the heads of the bones narrow down roward the necks of the bones. Any area of sensi· th'iry may be used as an indicator point. The most common points of rension are shown in lIllis/ration 4.3. Rtlease positions for medial points: Stand on the affected side. With the client supine, flo.: her knee and allow it to drop slightly toward roo (Iaterall)'). Place your hand on hee foot as shown in Figure 4.9 and flex her heel to the inside {Invert her foot). Monitor the indicator point and \lith a combination of inversion of the foot and fltxion of the knee, find the posirion that maximitts the softening of the indicator point. Com~ from the foot, up the line of the leg. into the knee. Hold for J0-60 seconds. Re-ehcck the indicator point.

the foot) and with a combination of eversion of the foot and flexion of the knee, fine tune the posi~ tion to maximize softening of the indicator point. Compress into the knee joint from the foot. Hold for 1D-60 seconds. Re-check the point.

Figure 4' {Q

Retease positions for lateral points:

Stand on the affected side. With the client supine, flex her knee and allow it to lean slightly away from you, across tbe midline (medially). Support tu knee with one hand and hold her foot as shown in Figure 4.10. Flex the foot laterally (evert

if the above position is uncomfortable for the client, try the alternative position of bringing the foot and lower leg below the line of the table. This position will relieve strain at the hip socket by reducing the angle of the leg.

gg

Ortho-Bionomy

Fibula Release As mentioned in the Anatomy section, the fibula plays an important role in the health of the knee. The lateral release position described above will often relieve minor tension in the connection of the fibula to the tibia. However, there will sometimes be a more severe imbalance in the fibula that will need a more specific position. To evaluate the balance of the fibula you will do much the same kind of test as you did when testing the intrinsic rotation of the tibia. But you will restrict the movement to the fibula only. To do this, with the client supine, gentl)' hold the heads of the fibula at each end (near the knee and the ankle). Gently flex the fibula back toward the table (posteriorly) and then forward toward the front of the shin (anteriorl)'). Make sure that it is only the fibula that is moving, not the entire lower leg. There should be a slight flex in the fibula in both of these directions. U there is not, roll the fibula in the direction that is most comfortable, or that has the mosr available movement. Hold for 1D--60 seconds. Re-check the movement and repeat the release position if neel.ossary. NOTE: You may need to use yollt thumb in order to get a firm enough contact for the release movement. but be careful not to cause discomfort. If making contact directly on the head of the fib. uta is uncomfortable for the client. try moving your contact further up or do\\'ll the length of the bone.

100

1£ there was restriction in the intrinsic t1lO\'emmi of the knee that did nOt resolve with the reltasr positions given in that section. tty the samt menrs now that the fibula has been released. Sometimes restriction in the movement of the fibula will, in turn, restrict movemt--nt of the ri

KNEE -

RELEASE INDICATORS

If there are no other imbalances present: • The patella will move freely and without dis· comfort. • Intrinsic movements of the knee w1l\ be more balanced and comfortable. • Extrinsic movement of the knee will be COOlfortable and will have full range of morioo. • The indicator points will have reduced sensitivity. • There will be comfortable and balanced mo\ ment available in the fibula.

Ankle

The Lower Limbs - Ankle

'lNKLE -

ANATOMY

lee ll/ltstratiOPts 4.4 and 4.5

I".b-Hr-__- - - - F I B u L A llBIA---

-LL

~S=----TALUS---~~~~

'~~

MEDIAL VIEW

LATERAL VIEW

illustration 4.4

POSTERIOR VIEW

mTERIOR VIEW

W-H- FIBULA--+~r.ua J.-I._-TIBIA_ _U

('t~~TALUS CALCANEUS

Illustration 4.5

The ankle joint is the connection of the leg to the foot and is formed by the tibia and fibula meeting the talus. \Vhat many people call their ankle bones (the bumps on each side of the ankle) are actually the heads of the tibia and fibula. On the inside of the leg the head of the tibia is called the medial maleolus, on the outside of the leg the head of the fibula is called the lateral maleolus. The names for the anatomical movements available in the ankle are somewhat different than those of other joints. Flexing the foot is called dorsiflexion and pointing the toes is called plantacflexion. Rolling the foot to the inside is called inversion and rolling it to the outside is called eversion. When you are standing or walking, these two movements are called supination and pronation. The movements of compression and traction are especially important in the ankle because the amount of compression or traction in the ankle joint helps us determine how our foot is placed in relation to our legs and whether or not we have the correct weight distribution needed to maintain balance.

105

Ortho-Bionomy

ANKLE -

EVALUATION

Check for imbalance in the ankle by taking thc joint through its possible movement patterns. Hold the leg stable and move the fOOf through dorsiflexion, plantarflexion, inversion, cvcrsion, compression and traction. The foot will nannaHy have slightly more movement in inversion than eversion, but otherwise there should be relatively equal movement available in thc full anatomical range. Norice if there arc any movements in thc ankle that are restricted or uncomfortable.

ANKLE -

RELEASE

Ge11eral Positional Releases If one movement is uncomfortable, try the opposite movement as a releasc position. For example, if there is resistance or discomfort on eversion, invert thc foot and compress from the bottom of the foot into the ankle joint for 10-60 seconds. Give some gentle traction to thc joint as you move out of the position, and rc-eheck the movement. See Figure 4.11.

Release for Incomplete Flexion If the ankle is unable to completely dorsiflex or plantarflex, try each of the following two release positions and use the one that is most comfortable for the client. 1. With one hand, hold the c1icnt's leg firmly on the table. With the other hand under the client's heel, gently and firmly pull her foO( straight up toward the ceiling. This will produce a sliding movement in the anklc joint, with thc talus sliding anteriorly. 2. With one hand, lift thc client's ankle slightly off the table. With the other hand on the top of thc foot, near the ankle. gently and firmly push the foot straight down towards the tabk. This will produce a movement of the talus sliding posteriorly. See Figure 4.12.

Figure 4.12

Flgure 4.11

106

Hold for 1~60 seconds. Give some gentle nae· tion to the ankle joint as you move out of this position, and re-eheck thc movemcnt.

The Lower Limbs - Ankle

ANKLE -

RELEASE INDICATORS

If there are no orher imbalances present: • There will be comfortable and balanced range of motion in the ankle joint.

Notes 1. Because the ankle joint bears so much weight as

part of its natural function, firm compression is usually required when working with it. Check with the client to ensure that your compression is adequate, or if you are using too much.

2. When the ankle has almost no movement available (fot example, an ankle recovering after having been in a cast), you may need to begin with simple compression or traction until the joint regains enough movement to express a preference.

107

Foot

The Lower l.imbs -

Foot

JOT - ANATOMY ~ T1lustratiotl

4.6 DORSAl VIEW

PLANTAR VIEW

1--- PHAlANGES

I---METATARSALS .,~~~

JNEIFORMS-

NAVICULAR

iVK::ULAR

-----~,J~j rt---CUBOID

WS

-jilf-+--TALUS

--------t~,nr""'"

~l-t-CALCANEUS

IULA_.,......-..,,~

+-+--TIBIA

lOS

TALUS

t9t;) TRANSVERSE ARCH

LATERAL ARCH

MEDIAL ARCH

Illustration 4.6

foot can be divided into three general segItS: rarsals, metatarsals, and phalanges. The als are at the rear of the foot and are composed he calcaneus, the talus, the navicular, the cuboid the three cuneiforms. TIle metatarsals are the long bones that make up the midsection of the . 1ltey are numbered. one to five, from the ~al side of the foot to the lateral side. The pha :es are the fourteen bones that form the toes. 4

The foot is a very powerful weight-bearing structure. Its bony architecture has twO difficult jobs, both made {X>SSible by its arches: to balance the body as it moves, and to absorb the shock created by movements such as running and jumping. nle foot is commonly thought to have onc arch, running the length of the foo(. Anatomically, the foot: actuaUy has three arches: the medial longitudinal arch, the lateral longitudinal arch and the transverse arch.

111

Ortho--Bioltom)'

FOOT - EVALUATION GePleral EvaluatioPllRelease You may need to work with the ankle before the foot will release completely. Check the movement of the arches of the foot: 1. Place your hand on the bottom of the client's foot. Gently dorsiflex her foot, first with the emphasis on the lateral arch of the foot, then with the emphasis on the medial arch. There should be enough flex in these n\'o arches to absorb most of the movement without trans· ferring it up the leg. If there is not, gently squeeze the entire midsection of the foot while compressing the midsection back towards the heel. Re-check the movement of the arches. If there is stilt not adequate movement, you may need to do some specific releases as described below. 2. Place your fingertips on the top of each side of the client's foot, near the base of her toes. On the underside of the foot, place your thumbs in the center of the ball of the foot. Using your thumbs, gently flex the center of the transverse arch up towards the top of the foot, while pulling down on the ourer edge of the foot. Then, reverse the mO\'ement by using your fingertips to gently press the center of the arch down toward the bottom of the foot, while lifting up on the edges of the foot with your thumbs. These two mO\'ements look something like shuffling a deck of cards. There should be a slight flex available in both of these planes of mo\·ement. If there is not, choose whichever of the two movements is most comfortable for your client and gently squee7..e her foot while it is in that position.

112

Check the movement of each of the general segments of the foot: 1. Check for balanced movement in the tarsal area of the foot in relation to the ankle (see ankle section for a complete description of these movements and the associated release positions). 2. Gently rotate the front section of the foO( medially and laterally to check the movement of the metatarsal section in relation to the tarsal area. If there is more movement available in one direction of rotation, hold rhe front section of the foor in that rotation and compress it straight back towards the heel. See Figure 4.13. You have already checked the movement withm the metatarsal area itself when you checked tilt movement in the lateral and medial arches.

Figure 4.13

3. Check rhe general movement of the toes in roration, flexion and extension. Hold the roes in any positions of preference and compress into the associated joint.

Ortho-Bio"omy

• Bunion Technically. a bunion is an inflammation of the bursa of the metatarsaL In common usage, however. the word "bunion" is used to describe an enlargement (possibly accompanied by inflammation) of the joint at the base of the big toe. Some people may have a "bunion" with no associated pain, while for others it is a painful and debilitating condition. In working with a "bunion" you may approach it as you would an imbalance in any of the other metatarS
• Specific Points of Discomfort Tn the course of working wirh the dient's foot, if you find any specific points of discomfort. you lTlay release these points with a positional release that maximizes softness and comfon in the affected point. See Figme 4.16.

114

Figure 4.16

FOOT -

RELEASE Il\TJ)[CATORS

If there are no other imbalances present: • There will be increased flex in all of the arches of rhe foor. • There wiU be incre~d mO\'ement in each of rhe general segments of the foor. • There will be increased comforr and movemenl in each of the joints of the foot. • Discomfon in specific points on the foot \\1U bl reduced.

The Lower Limbs -

Specific Evaluation/Release If the general releases described above do nOt free up the movement of the foot. it may be necessary to perfonn specific releases for individual bones of thr foot. As you evaluate the movements of the urious bones of the foot, it is important to remember that the natural movement available y,ithin the joints is quite small compared to other joints in the body. If you are nOt sure how to evaluate the movement of the bones, base your release positions on how comfortably the bone moves. There are 26 bones in each foot. This can make working with the foot seem complex. A simple 110'3)' to approoch working with the foot is ro begin al the heel and work forward on the foot, check· q each joint for flexibility and comfort. Some suggested release positions are given. How· t\"tt, the best approach is to experiment with different release positions for each joint and use whichever is most comfortable for the client.

•TALUS: TIle release positions for the talus are effectively the same as for the ankle releases. • CALCANEUS: Hold the client's ankle still while gently moving just the calcaneus (heel) in its \'3rioUS JX>SSible movements. Hold it in whichever plSirion is most comfortable and compress the . heel towards the ankle. Also check the movement

Foot

of the calcaneus in relation to the rest of the tarsals. Hold in the mOst comfortable position and compress. See Figure 4.14. • NAVICULAR, CUBOID, CUNEI FORMS, Move each bone in relation to the surrounding bones. Hold the individual bones, or that section of the foot. in the most comfortable position and compress. A combination of compression by squeezing the foot and simultaneously compressing the frollt section of the foot rowards the heel is usually most effective. For the navicular and cuboid. experiment with rotation of the from section of the foot (metatarsals) in combination with compression. See Figure 4.13. • MITATARSALS: Move each individual metatarsal. Use a combination of compression and rotation to find the most comfortable position. Check the head of the metatarsal on the underside of the foot, JUSt below the base of the toes. If there is any discomfort in this area. you may use the toe associated with the affected metatarsal as a lever. Use the toe to push the head of the metatarsal inferiorly by flexing the toe and compressing it straight down rowards the bottom of lhe fOOl. See Figure 4.15.

Figure 4.15

F'tgure 4.14

113

Section 5

THE UPPER LIMBS

Shoulder

4

The Upper Limbs - Shoulder

SHOULDER -

ACROMION;~:::::;~~~~;;3"'~~~

ANATOMY

CORACOID

See lllustrations 5.1 aud 5.2 The shoulder is made up of a series of joints and muscle attachments. The clavicle fOnTIS the onl)' bon)' conncction of the shoulder to the twnk. Therefore, there is more mobiJit)' than stability WI the shoulder joint.

PROCESS HEAD OF THE HUMERUS

CLAVICL.E SCAPULA

lONG HEAD OF BICEPS BK:IPITAL GROOVE OF THE HUMERUS

SHOAT HEAD OF BICEPS

The scapula attaches to the clavicle at (he fTOnl of the shoulder. It attaches to the ribcage only through muscular connections.

ANTERIOR VIEW Illustration 5.1

FIRSTA1B~====~;~~~~~J~

ClAVICLE --

_

ACROMION

SPINE OF THE SCAPULA

DELTOID -------j

SCAPULA

HUMERUS--------t--4

ANTERIOR VIEW

POSTERIOR VIEW

Illustration 5.2

121

Ortho~B;o"omy

There are thrce arTiculations (joints) within the structure of the shoulder:

SHOULDEREVALUATION/RELEASE

1. acromio-clavicular -the ioint between a projection of the scapula, called the acromion, and the clavicle.

In assessing the balance of the shoulder, a series of points is used to indicate possible areas of tension. See llluslTat;orl 5.3. The points are numbered for convenience and do not necessariJy have 10 be released in the order given. Evaluations! releases for the scapula, clavicle and sternum will be gr,en separately.

2. sterno-clavicular - the joint between the sternum and the davicle. 3. scapulo-humeral- the john between the scapula and the humerus.

SHOULDER POINT 2 SHOULDER POINT 8 SHOULDER POINT~

SHOULDER POINT 1 SHOULDER _ _, POINT 6

»I,l~r-

SHOU.OOl POINT'

SHOULDER POINT 7

SHClU.OO POINT 5

ANTERIOR VIEW

POSTERIOR VIEW

Illustration 5.3

122

The Upper Limbs - Shoulder

For each of these points, you will gentl). COntact the point, obscrving any tension or discomfort. For any poims that are tender usc the release position described for that point. The release positions described arc approximate starting places only. You will need to fine tunc them by finding the slight variations which maximize the softening of tl-t- point. You don't need to release the points that aren't tender or tight. When moving into the release position, the contact on the point should be gentle and at skinlevel. [t is the I'OSITION that helps catalyze the release, not the point. If you cannOt easily monitor the indicator point while holding the release position, it is bener to focus on [he position and rc-c.heck the point afrer the release. When moving out of the release position, unwind back out with a slight, gentle pull &om the joint.

Shoulder Point 1 Location: Coracoid process of the scapula (a thumb-like projection of the SL'3pula that protrudes toward the front of the ribcage). See lIl115tralion$ 5.3 a"d 5.4. To find 51: First find the head of the humerus. Then, move slightly medial into the soft tissue. Feel for a point (about the size and shape of a fingertip), that protrudes more than the surrounding rissue. 51 Release: With the client supine, bring his arm across his chest with his elbow bem, to form a right angle to the chest. Fine tUlle the position by rotating the forearm and/or changing the angle of the humerus (i.e., reach further across the chest. bring arm down toward abdomen, etc.). Compress slightly down the line of the arm from the elbow into the joint. Hold for 10-60 seconds. Bring the arm back to the neutral position and re-<:hcck the point. See Figure 5.1.

POINT?

Figure 5.1

ANTERIOR VIEW

Illustration 5.4

123

Ortho-Biollomy

Shoulder Point 2 Location: Inside the V formed b}' the acromioclavicular joint. See lllustTatio,t 5.3. To find 52: On top of the shoulder, find the inside tip of the V formed by the clavicle meeting the scapula. Make sure you are contacting all the way out to the very tip of the V, almost at the point where the shoulder begins to curve around to the arm.

b. If the above position is not comfortable, try bringing the client's arm. (with the elbow bent and the hand resting on his opposite shoulder) across his chest. The elbow should be pointing toward the opposite hip, as if the client is gi,·ing himself a half-hug. Gently compress his elbow straight down against his ribcage (toward the table). Hold for 10--60 seconds. Bring the arm back to the neutral position and re-check the point. See Fig,lre 5.3.

52 Rdease: With the client supine, usc whichever of the two following release positions is most comfortable for him. a. Bend the client's elbow. Bring his arm directly out to the side. The release position is generally within the arc between the 90 degree and 180 degree sweep of the arm. When you find the arm position that feels most comforta ble for the client, comprCSS gently from his elbow into the shoulder joint. Hold for 1Q-60 seconds. Bring the arm back to the neutral position and recheck the point. See Figure 5.2.

Figure 5.3

Shoulder Point 3 Location: Anywhere along the inferior edge of tht spine of the scapula {the bony proje<."tion that roll just below the upper edge of the shoulder blade}. See Jl/ustTation 5.3. v

Figure 5.2

124

53 Release: \'(Tith the diem prone or in the side posture, bend his elbow. Then bring his ann back toward the scapula, and fine tune the position. Compress up the line of his arm into the shoulder joint. See Figure 5.4.

The Upper Limbs -

Shoulder

Shoulder Point 4 Location: At the midpoint in the triangle of the scapula. See 1f{l/stratiOtI 5.3.

Poin13

S4 Release: Usc the same starting position as for Point 3. The specific release position will be slightly different because you arc working a differ· ellt part of the shoulder. Monitor the point and position for maximum sofrness and comfort. See Figures 5.4 alld 5.5.

Shoulder Point 5 gure 5.4

Location: At the upper deltoid separation on the posterior of the shoulder. See 1f{Jlstraticm 5.3.

the side posture. the shoulder can also be lied back toward the point and additional comeMion given straight into the ribcage from the ouldcr/ann. Hold for 10-60 seconds. Bring earm back to the neutml position and re-check e point. See Figure 5.5.

To find 55: With the client's ann against the side of his ribcage, the point is approximatel)' 2 inches above the armpit crease on the back of his shoulder. 55 Release: With the client supine, bend his arm and bring his elbow below the level of the shaul· der so it is pointing toward the floor. This position may be sufficient for releasing the poinr. If not, shrug the shoulder forward, fine tune the position, and gentl)' compress from his elbow up inro the shoulder joint. Hold for 10-60 seconds. Bring the arm back to the neutral position and rc·check the point. See Figure 5.6.

gure 5.5

Figure 5.6

125

Orlho- Bionomy

5ide posture: With client's arm bent, bring his elbow back toward the spine (similar to the release for Points 3 and 4). See Figure 5.5. Shrug his shoulder forward and compress from the elbow into the shoulder joint. Hold for 10-60 seconds. Bring the arm back to the neutral position and re-check the point.

Shoulder Point 6 Location: On the side of the arm. at the midpoint of the upper deltoid (approximately 2-3 inches inferior from the tip of the shoulder.) See IlIustrat;ou 5.3. 56 Release: With the client supine, bend his elbow, and bring his arm straight out to the side (at a right angle to the side of his body.) Rotate the humerus superiorly (toward head) or inferiorly (toward fcet) tultil the point is at the maximum relaxation. Compress from his elbow into the shoulder joint. Hold for ID-60 seconds. Bring the arm back to the neutral position and re-check the point. See Figure 5.7.

Shoulder Point 7 Location: At the bicipil'al tendoll of the humcflJ$. See IlIustratio'l 5.4. To find 57: Locate the head of the humerus. Directly on the anterior aspect of the head of the humerus, you should feci the tendon of the bKe~ as it passes over (he humeral head to attach to the shoulder blade. Feel for tension 1-2 inches down the line of the bicipital tendon, into (he biceps itself. 57 Release: a. Bend the client's elbow slightly, and bring hJs arm across his chest, as if he were trying to touch his opposite hip. Roll the humerus internally (in toward the ribcage). Compress dircal)' from the side of the shoulder into the ribcage. Hold for 10-60 seconds. Bring the ann bad: to the neutral position and re-check the point. See Figure 5.8.

Figure 5.8 Figure 5.7

126

The Upper Limbs - ShoHlder

b.lf the above position docs not release the point: bend the client's elbow and bring his ann across his chest to form a right angle to the chest (forearm is above chest and parallel to the table). Gently twist his upper arm muscles internally (toward the inside of the arm). At the same time, gemly rotate his forearm toward his face (as if he were brushing a fly off his nose). Compress from his elbow into the shoulder joint. Hold for 10-60 seconds. When lifting out of the position, gently rotate the upper arm tissue back out of the twist. See Figure 5.9.

Shollider Poi", 8 location: The lateral aspect of the acromioclavicular joint (the outside tip of the V of the clavicle and scapular joint.) This point is opposite Point 2. See Illustraticms 5.3 alld 5.4. S8 Release: The release positions are similar to the release positions for Point 2. The arm will usuall}' be at more than a 90 degrce angle from the torso. The most common release position is shown in Figure 5.10.

'> ? Figure 5.10 figure 5.9

SHOULDERRELEASE INDICATORS If there are no other imbalances present: • The points will be softer and more comfortable. • The ease of movcment will be increased. • There wiIJ be increased rangc of motion for the shoulder.

127

Ortho-Bionomy

Notes • Notice that the points and release positions are numbered so they form a spiral around the shoulder when counted from 1 to 8. This is a simple way to remember the location and release positions for the point's. • These are not the only points you rna}' work in the shoulder. They are common problem areas and approximate release positions. You may usc any points of tension as release points and experiment with various positions of release. • The shoulder is particularly su!>ceptible to "'freezing" up and becoming restricted in its movement. Lf }'OU cannot get enough move· ment in the shoulder joint to perform the standard release positions, start with various angles of compression into the shoulder, with the ann kept dose to the torso. See Figure 5.5. This will often free up enough movement in the shoulder fO usc the more common release positions. You may need to supplement release work with gentle movement exercises for the client to do at home. • There is sometimes a shoulder-opposite hip connection. Sometimes releasing the pelvis assists in relaxing the shoulder.

128

Scapula

The Upper Limbs - Scapula

SCAPULA - ANATOMY See IlIustratro,lS 5.5 atld 5.6

CLAVICLE SPINE OF THE SCAPULA

SCAPUlA

ANTERIOR VIEW

POSTERIOR VIEW

illustration 5.5

SPINE OF THE

SCAPULA

' - _ ) , , ; : - - - - SCAPULA

ACROMION

RIBS ClAVICLE

Illustration 5.6

133

Clavicle (\.

Ortho-Bionomy

The scapula, commonJy called the shoulder blade, is a triangular-shaped bone which attaches to the clavicle at the front of the torso_ Through a series of muscle attachments, the scapula "floats" on the back of the ribcage. Notice that you cannot lift your arm straight above your head without the glide of the scapula across the ribs. Also notice how much further fOT\vard your reach is extended when the scapula is included in the movement.

SCAPULA - EVALUATION The movement of the scapula may be restricted by contraction in the muscles which attach it to the ribcage, with no apparent imbalance or discomforr in the shoulder joint itself. It is important to check the movement of the scapula, even if the shoulder points are not sensitive. To do this, with the client prone or on his side, gently slide the scapula through its range of motion: superiorly, inferiorly, laterally, medially. You may keep the client's arm against his side and move only the scapula, or you may include his arm in the range of movement. Check for tension or discomfort in the muscles along the entire border of the scapula.

134

SCAPULA -

RELEASE

With the client prone or in the side posture, roU his shoulder back towards his spine, monitoring the muscles at the edge of the scapula. Find the position which maximizes relaxation and comfon of the muscles bordering the scapula. Compress the shoulder straight in towards the ribcage. U possible, gently lih the edge of the scapula away from the ribcage, to give the muscles a slight stretch before you move out of the release position. See Figmes 5.4 and 5.5_

SCAPULARELEASE INDICATORS If there arc no other imbalances prescnt: • There will be increased ease and range of mon:mem of the scapula. • There will be increased relaxation and comEon in the muscles along the border of the scapula.

The Upper Limbs - Clavicle

CLAVICLE -

ANATOMY

ACROMION

See IllustratiOlIS 5.7 and 5.8

HUMERUS CLAVICLE

The clavicle (collar bOlle) joins the sternum at onc end, and thc scapula at the other. It fonns the only bony connection of the shoulder to the torso. For such a small bone. it bears a lot of stress from supporting the shoulder and absorbing the force of its movement. Consequently. the clavicle is the most-often broken bone in the body.

-f.-- SCAPULA

As the clavicle acts mainly as a stabilizer, 1[S joints (the sterno-clavicular and the acromio-clavicular) have little movement. When checking for move· ment, as described in the Evaluation section. remcrnlx:r that the movements will be slight.

ANTERIOR VIEW

Illustration 5.7

~ _ ~_ _ SCAPULA

STERNUM

Illustration 5.8

137

Orrho-Bionomy

CLAVICLEEVALUATlONIRELEASE Check for an imbalance in the various planes of movement: 1. With one hand on the sternal end of the c1avi-

de, the other hand at the scapular end. gently rock each end altematcl)' toward the table (like a teeter-totter). Hold in the preferred position. You may bring the shoulder forward to exaggerate the position. See Figure 5.11. Figure 5.12

4. Bilateral balance: Compare the movemcm of one clavicle to the other by rocking the shoulders in their various planes of movement (i.e., down towards feet). Hold in an exaggeration of any imbalance found. Release and rock both c1aviclcslshoulders to integrate. Check for discomfort:

Agure 5.11

If there is discomfort or tension ncar the joim, at either end of the clavicle. gently position with onc or both shoulders and/or compression on the stcrnum to release. (See shoulder points 2 and 8 for acrol1lio-clavicular releases.)

2. Gently holding the clavicle along the length of the bone (with fingcrtips or the edge of the hand), rock inferiorly (toward feet) or superior· ly (toward head). Hold in the preferred position. See Figure 5.12.

CLAVICLERELEASE INDICATORS

3. Check for preference in the rotational movemcnt by gently holding the clavicle ncar each end and slightly rotating in each direction. Hold in the preferred position. See Figure 5.12.

138

If there are no other imbalances present: • There will be more balance in the planes of movement. • There will be less discomfort at the joinr(s) of the clavicle.

Sternum

The Upper Limbs - Sternum

STERNUM - ANATOMY See Illustration 5.9 The sternum (breast bone) is the narrow plate to which the upper tell ribs attach on the front of the chest. The clavicle (collar bone) joins the shoulder to the torso through its connection with the sternum.

MANUBRIUM

_----+----1

BODY OF STERNUM

XIPHOID PROCESS

--+---/~ ~~~~?3

---.j....----1~~~

illustration 5.9

STERNUMEVALUATIONIRELEASE With the client supine, check for imbalance in any of the ptanes of movement of the sternum by gently rocking it towards the table alternately all each side, and at its superior and inferior ends. To chock the general flexibility of the sternum, gently compress it in a posterior direction (straight down towards the table.) The sternum should have a slight flex in all ofthesc movements. See Figure 5.13.

Figure 5.13

143

Ortho-Bionomy

Use the ribs and shoulders to assist in positioning the sternum in the preferred position. For example, if the sternum rocks easily toward the right side. bUl doesn't move on the left at all. you may compress on the right side and lift the left shoul· der and ribcage to exaggerate the imbalance. Hold 10-60 seconds. Bring the shoulder(s) back to the neutral position and re~check the movement of the su=rnum. See Figure 5.11.

144

STERNUMRELEASE lNDICATORS If there are no other imbalances prescnt: • There will be increased casc of movement of the stemum. • There will be more balance in the planes of movement of the sternum.

=

Elbow

The Upper Limbs - Elbow

ELBOW -

ANATOMY

See Illustration S.lO

l-__~__-HUMERUS RADIUS

Along their entire lengths, the radius and the ulna are held together by the interosseus ligament. or membrane, that runs between the twO bones. This membrane should be taut only when the hand is midway between pronation and supination and should be somewhat relaxed in complete pronation or supination.

ELBOWEVALUATIONIRELEASE

ULNA

Illustration 5.10

Working with the elbow is similar to working with the knee, and the basic evaluation and releasc techniques are much the samc. As with the knce, the techniqucs used to evaluate the elbow's movement arc also the techniques used to create release positions. Begin with a general evaluation and release of the elbow and move on to specific points of tension and thcir associated release positions as needed.

Elbow -General Evaluation/Release The elbow joint is a hinge joint made up of three bones: thc upper arm bone, called the humerus; the bone on the thumb side of the forearm, called the radius; and the second bone of the forearm, called the ubla. The olecranon (head) of the ulna cups around the back of the head of the humerus, holding the ulna still during rotation of the forearm. During this rotation, the radius rolls across !he ulna. if you alternately pronate (palm down) and supinate (palm up) your forcarm, you may notice that the radius and the ulna stay relatively still at the elbow, and that the rotation is achieved by the radius crossillg over the ulna as you turn )'our hand. It is casiest to Dotice this rotational movemcm with the elbow bent SO the rotation of the hwnerus is not included in the movemcnt. Wtth the elbow bent, the forearm normally has a range of 140-180 degrees of rotation available.

Check the general movement of tbe elbow joint: 1. Gently flex and extend the client's elbow joint.

Notice if full flexion and extension are avail· able and if the movements can be made without strain or discomfort in the elbow.

If the client's arm will not fully extend, flex her arm and compress down the liJ1e of the forcarm into the elbow. If the arm will not fully flex, straighten it and compress into the elbow from the forearm. Repeat as needed, with variations in the anglc of flexion/extension and with the addition of rotation of the forearm.

147

Ortho-Biollom)'

2. Gently rotate the c1iem's forearm in each direction (pronation and supination), both with the elbow bent and with it straight. Notice if full rotation is avai.lable in each direction without restriction or discomfort.

If there is an imbalance in the rotation of the forearm, rotate the forearm in the direction of most available movement and compress up the line of the forearm into the elbow joint. For example, if there is more internal rotation than external rotation available, bcgiJl by placing the diem's ann flat on the table. palm up. With one hand just above the c1iem's elbow, gently rotate her humerus externally. With the other hand, gemly rotate the client's forearm internally (pronation). Compress up the line of the fore· arm into the elbow and hold for LQ-.60 seconds. Rerum to the neutral position and re-eheck the movement. See Figure 5.14.

Figure 5.14

148

If the forearm has little or no rOtation available, begin by compressing into the elbow joint, both from the forearm and from the upper arm. Try slight variations on the angle of compression until enough movement is a"ailable in the joint to express a clear preference of position.

Elbow - Specific Evaluation /Release Indicator Points As with the shoulder and the knee. specific poim may be used to indicate possible areas of tension in the elbow. For each specific area of tension or discomfon that you find, you may gentl)' contact that point and use the
The Upper Limbs -

Elbow

Gcncrally, the medial elbow indicator points release most easily with the forearm pronated and the hand extcndcd. leaning the c1jenl's foreann slightl), toward hcr torso may also assist in the release. For lateral points, thc release position usually includes supination of the forearm, some flexion of the hand, and leaning the c1ienr's foreann away from hcr torso. For both medial and lateral points, compression down the line of the forearm into the elbow joint is included in the release position.

Interosseus Ligament

Illustration 5.11

Indicator Point Release Positions: Experiment with a combination of flexing the c1icnt's elbow, rotating her forearm and flexing/cXtcnding her hand until there is maximum sohcning and comfon in the indicator point. Compress down the line of the foreann into the elbow joint. Hold for 10-60 seconds, return to the neutral position and re-chcck the points. See figure 5.15.

Check for tension or contraction along the interosseus ligament by gently palpating the area along thc middle of the forearm between the ulna and the radius. Notice if thcre is any tension. scnsitivity or areas of contraction along the ligament. Use the combination of elbow flexion and foreann rotation that maximizes softening in the affccted area of the ligament. Sometimcs simply squcczing thc radius and the ulna togcthcr along the length of thc forearm will release general tension in the ligament. Combine this forearm squceze with rOtation of the forearm and positioning of the hand to release the ligament along it's entire length so therc arc no areas of discomfort or tension along the forearm. You may find that you need to work with the wrist before the interosseus ligament releases completely.

Figure 5.15

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Ortho-Bionomy

Movement ofIndividual Bones

ELBOW -

Check for the movement of the individual bones at the elbow by gently «bouncing'" or flexing thc hcad of each bone. Thc hcad of each bonc should mon° slightly within the joint. Jf it does not, compress into the elbow from the forearm and the upper amI, at various angles, until movcmcnt within the joint is restored. Remember that the radius and thc ulna arc the same bones that form thc wrist joint, so if the relcases at the elbow do not free up thc movement of the bones. try the reJcases described in the wrist section.

If there arc no othcr imbalances prescnt:

150

RELEASE INDICATORS

• The range of motion of thc elbow will be balanced and movement will be comfortable. • Specific areas of tension or discomfort around the elbow joint. or along the forearm, will relax and become more comfortable. • The individual bones within the elbow joint will have adequate movement. NOTE: Problems with the elbow may originate at the shoulder or wriSt. Be sure to include releases for these joints when addressing elbow pain.

Wrist

The Upper Limbs - Wrist

WRIST - ANATOMY See Illustration 5.12

PHAlANGES

METACARPAlS

CARPAlS

PALMAR VIEW

, DORSAL VIEW

The wrist joint is fonned b)' the meeting of the bones of the forcann (the radius and the ulna) with the metacarpals of the hand. The primar)' movements of the wrist arc flcxionJextension and abduction/adduction (tilting the hand to the ulnar side of the wrist/tilting the hand to the radial side of the wrist). Aexion and extension arc nonnaJl)' about equal in the degree of mm'cment available, but there is usuall)' greater movement available in adduction than abduction. The combination of these movcments of the wrist with supination and pronation of thc forearm allows the hand to lic in an)' planc of space in rclation to the forearm. Illustration 5.12

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Ortho-Bionomy

WRIST-EVALUATION lRELEASE

Specific Evaluation IRelease

General Evaluation I Release

Indicator Points

As with the c1bow, the wriSt may be taken through its range of motion as a beginning evaluation of irs balance. Take the client's hand through its full range of flexion, cxtension, abduction and adducrion. Notice if there is full and balanced movement available in each of these ranges, and tbat the wrist is comfortable through all types of movcment.

You may also usc any specific arcas of tension or discomfort at or around the wrist joint as indicator points. As with knees and elbows, the most common areas of tension are at thc heads of the bones.

If the wrist's movcmcnt is not balanced and comfortable, find the most comfortable position for the wrist and compress fcorn thc hand into the wrist joinr. For example, if thcre is restriction in e),,'tcnding the cliem's hand, flex her hand and comprcss from the hand into the wrist joint. If there is restriction to one side or the other in the hand's tilting movement (abduction/adduction), tilt the hand to the side which has thc most movement available and is mOSt comfortable. Compress from the hand into the weist. Hold for 10-60 seconds, return to the neutral position and re-ehcck the movement. See Figure 5.16.

Figure 5.16

156

Experiment with a combinarion of flexing and tilting thc c1iem's hand until you find the posirion that maximizes comfort and softening in the indicator points. Compress into the wrist from the hand and the forearm. Hold for 10-60 seconds, return to the neutral position and re-check the point. Check the movement of the individual bones: The individual hones of the wrist joint should have slight movements within the joint itself. Gently flex, or "bounce," the heads of the ulna and the radius. If there is little or no mO\'emCtlt available in these bones, gently compress into the wrist joint, from the hand and &om the forearm. Repeat the compression, with slight variations in the angle, until movement within the joint is restored. Remember that the bones at the wrist arc the same ones that form the elbow joint, so if the releases at the wrist don't free up the movement of the bones, try the releases dcscribed in the elbow section.

The Upper Limbs -

Wrist

WRIST - RELEASE INDICATORS [f

there are no other imbalances present:

• The range of motion of the wrist will be balanced and movement will be comfortable. • Specific areas of tension and discomfort will relax and bccome more comfortable. • The individual bones within the joint will have adequate movcment.

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&

Hand

The Upper Limbs -

HAND -

Hand

ANATOMY

See Il/ustratioIl5.13 The 27 bones of the hand can be divided inro three general segments: the 8 carpals that form the base of the hand where it connects to the forearm; the 5 metacarpals which complete the body of the hand; and rhe 14 phalanges that make up the fingers (3 per finger, 2 per rhumb).

,

• PHALANGES

METACARPAlS

~, PAlMAR VIEW

DORSAL VIEW Illustration 5.13

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Ortho-Bionorny

HAND-EVALUATION I RELEASE General Evaluation IRelease Working with the hand is similar to working with the fool. The primary difference is tbe opposable thumb, which means the hand has gripping movement available. Check the movement of each of the general segments of the hand: Like the arch in the foot, the arch of the hand (thc body of the hand) should have flexibility. (,neck for the general ncxibility of thc hand by gendy flcxing the body of the hand, both from the palm side and the back side of the hand. If therc is littlc or nO flex avaiJable, )'OU may begin with a general compression (squeeze) of thc entire hand. Adding compression into the body of the hand frolll the fingers sometimes aids in the release. This general compression is sometimes enough to free up the movement of the hand. If nOt, go on to specific release positions as given below.

Check the movcment of all of the fingers together as a single segment. Gently curl the fingers down toward the palm of the hand. Then gently flex them back toward the back of the hand, first with the fingers straight, then with the fingers bent. Notice if the range of movement available is the same for both hands. The fingers should be able to curl all the way into a fist and to flex back to approximately a 45 degree angle from the palm of the hand. It is not uncommon to find that the fingers of the most-used hand (the right hand for moSt people) have a much more restricted range of movement than those of the least-used hand. Many people assume that the fingers arc designed only to bend forward, but in a relaxed hand thc fingers can ex'tend back far enough to create a distinct angle at the back of the hand.

162

If the fingers arc restricted in their general movement, hold them in the position of greatest comfort and greatest available movement and compress gently from the fingers into the body of the hand. For example, if the client's fingers cannot extend back towards the back sidc uf the hand morc than about 10 degrees, curl her fingcrs into a fist and gently comprcss from the fingers into the body of the hand. Hold for 10-60 seconds then re-eheck the range of movement.

Sec the Specific Release section for a more detailed description of releasing restriction in individual finger movement.

Specific EvaluationlRelease Check for movement of the individual bones of the hand. • Carpals: In the carpal section of the hand, check for a slight flex in each of the boncs. If there is little or no movement available, compress from the body of tbe hand into the carpal section. Repeat as needed. varying the angle of compression. • Metacarpals: Each metacarpal should have movement separate from the adjoining bones. Check this by holding the head of each metacarpal separately and moving it forward and back (anteriorly and posteriorly). There should be a distinct movement of each bone. If there is not, compress from the associated finger into the metacarpal, and from the metacarpal into the base of the hand. Hold for 10-60 seconds, then re-eheck the movcment. Each metacarpal should also have some rotation available in each direction. Check this by gently rolling each metacarpal fcom side to side. Lf there is uneven movement available, gently roll the metacarpal in the direction of

The Upper Limbs -

most movement and most comfort and compress down the line of the bone into the base of the hand. Hold for 10-60 seconds, return to the neutral position and r~beck the movement. • Phalanges: Check the rotation and flexion! extension of each of the phalanges. If there is restriction in any of these movements, hold the individual phalange in whichever position is most comfortable and has the most available movement. Compress into the associated joint. Hold for 10-60 seconds, return to the neutral position and re-check the movement. Sometimes incomplete extension of the fingers is coming from tightness of the muscles in the hand. Try some pOSitional releases, curving the palm in on itself, then re-check the finger move-ment. If the extension is still restricted, work with the individual joints. Curve the finger for~ ward and compress the base of the finger into tlx: joint. Hold for 10-60 seconds, then recheck the movement. Repeat as needed, varying the angle of compression and with the addition of rotation of the affected joint. In the case of incomplete flexion, compress into the affected joint with the finger straight. Repeat as needed, varying the angle of compression and with the addition of rotation of the affected joint.

Indicator Points Check for specific areas of sensitivity in the palm of the hand, particularly around the base of the thumb, and around the heads of each of the bones. AJso check for areas of sensitivity around the joints of each of the fingers.

Hand

Use whichever combination of rotation and flexion in each joint maximizes softening and comfort in the indicator points. For example, if there is discomfort at the base of the thumb, rotate and flex the thumb until the indicator point is soft and comfortable. Compress from the thumb into the joint. Hold for 10-60 seconds, return to the neutral position and re-check the point. See Figure 5.17.

Figure 5.17

HAND - RELEASE INDICATORS If there are no other imbalances present: • There will be increased flexibility and increased comfort of movement in the hand. • The individual bones of the hand will ha\'e balanced and comfortable movement available. • Specific areas of tension and discomfort will relax and become more comfortable.

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Section 6

POST-TECHNIQUES

Post-techniques Post-techniques are used to integrate the changes that may have occurred in the spine during rele
As with other Onho~Bionomy techniques, the post-techniques should only be done in a way that's comfortable for the client. Since these techniques specifically move the discs. you may not be able to use them if your client has disc problems. Foe a client with severe disc problems, such as a herniated or ruptured disc, you should nor use the post-techniques for the affected area of the spine unless you have the medical training necessary to ensure your client's safety. These are naturally occurring movements for the spine when it is relaxed. However, for someone with a tight spine, even small movements can be extreme. Move slowly and notice the body's willingness to mm'e, cather than imposmg a movement that may be too much of a stretch for the client. Particularly in the neck, keep your attention on the available movement and don't force through any restrictions. Go back and do some more release work, if necessary, then come back to the post-technique. The techniques presented here ate the most commonly used post-techniques. There are some additional post-techniques that are beyond the scope of this simplified presentation. If you are interested in a more detailed present3tion of the Onho-Bionomy posHechniques, there are specific classes available.

Some of the post-techniques, notably those foe the neck. may be adapted to use as evaluation tech· niques prior to working. Specifically, you may use the post-techniques as you would a range of motion tcst to notice restrictions in mO\'ement. Because some of the post-techniques are the equivalent of light exercise for the spine, yOll will generally use them only after the muscles around the spine have been wanned up with some release work or gentle movement.

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Ortho-Bionomy

POST-TECHNIQUES - NECK Each of the following post-techniques gives a slightly different movement to the venebrae and discs of the neck. Some of these techniques have acquired commonly-used nick-names. These names are included in parentheses to help identify the technique to students who may have learned it by that name.

1. With youc hands holding the client's head as shown in Figure 6.2, gently flex his head up toward his chest. See Figure 6.3. Rerum ltis head to the neurral position, resting on the table.

Neck - Lateral Rocking On each side of the c1iem's neck, place your fingertips on the transverse processes of a single venebra. Gently rock the vertebra from side to side (Iaterallr). You may begin at either the top or the bottom of the neck. Work your way up or down the neck, gently continuing the rocking movemenrs. See Figure 6.1.

Figure 6.2

Figure 6.1 Figure 6.3

Neck - F/exiolllExtellsion (Swan Dive) This exercise begins with two separate movements that may be combined into one fluid movement, if the flexibility is available in the client's neck.

168

Post-techniques

2. Gently extend the client's chin. See Figure 6.4. If necessary, gently lift at the back of the client's neck to assist in the extension.

Neck - Spinous Process Expansion (Bulter lV,i(e) With one of youe hands fully supporting the client's head, flex his head forward toward his chest. Place the index finger of your other hand benveen two adjoining spinous processes at the back of the neck. See Figure 6.5. Gently bring the client's head back toward the table. At the same time, gently lift up on the finger that is between the spinous processes. See Figure 6.6.

NOTE: If the lift with the finger is uncomfonable for the client. you may leave it out.

Figure 6.4

3. Jf both flexion and extension are comfoTtable for the diem, you may combine these separate movements into one continuous movement. Begin b)' fully extending the client's neck (chin pointed toward ceiling). Maintaining as full an extension as possible, slowly life the client's head off the table.

Figure 6.5

You will find that his head will stan to roll toward flexion once the neck reaches its complete extension. Gently follow this flexion forward until the client's chin is flexed toward his chcst as far as is comfortable. Following the forward roll of the head, gently bring the back of the head back down to the table. See Figures 6.2, 6.3 and 6.4. You may wam to repeat this movement a few more times.

NOTE: When full range of motion is available in the neck, the chin will make a complete circle during this movement. If full range of motion is not available, the neck may need additional release worl.

Figure 6.6

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Ortho-Bionomy

Neck - Stair-Step IS/ide (The Chicken) With both hands holding the client's head as shown in Figure 6.2, gently compress straight down the line of his neck. This will help yOll control the movement of the head/neck in the next: stage of the exercise. Continuing the compression, gently lift the head straight up toward the ceiling. See Figure 6.7. Rcturn the client's head to the neutral position, resting on the table. Repeat the exercise a few times.

Figure 6.7

170

When this exercise is done correctly, you will feel each individual vertebra slide forward past the one below it as you lift, producing a "'pecking" movemcnt similar to the movement a chicken makes with its head as it walks.

NOTE: It is important to keep the client's face pointed straight up toward the ceiling. You are not flexing or extending the neck in this exercise.

Post-techniques

POST-TECHNlQUES - SPINE Spine - Prone Positions Spine - Lateral Rock This technique is a good beginning flexibility exercise foe rigid spines because it puts minimal stress on the spine and yet encourages movement. It also works well as an integrating mm'emenr. With one hand, gently rock rhe client's pelvis finnIy enough to create movement up the length of her spine. With tbe other hand )'ou may add an additional rocking in a specific area of the spine, or you mar use a broad contaer on the spine and ribcage co assisl in rocking rhe entire torso.

Sacral- Spinal Balallce (Cat Paws) 1. Place one of your hands fully on top of the client's sacrum, the other hand flat on her lower spine. Gently, but firmly, push straight forward (toward the table) on the sacrum. With the other hand, notice if this movement of the sacrum is tmnsmitted up the spine. 2. Slowly release the pressure on the sacrum. At the same time, gently compress straight forward (toward the table) on the spine itself. Notice if there is movement in the sacrum in response to the flex of the spine.

NOTE: If pressure on any area of the spine is uncomfortable for the client, do not press in that area. 3. Slowly release the pressure on rhe spine. At the same time, gently press on the sacrum again. Then, keeping your hand in place on the sacrum, move rour other hand slightly higher on the spine and repeat the exercise.

Continue until you have "walked" rhe second hand up to the rop of the thoracic spine. A flexible spine will transmit subtle movement rhrougb its entire length. Any areas that are uncomfortable or have restricted movement in this exercise may need additional release work.

Spine -

Side Postures

In aU of the following exercises, the cliem lies on her side, wilh a pillow supporting her head to keep the spine aligned. Each of rhese exercises is designed to flex the spine on a particular plane of movement. Those exercises which are one-sided in their movement will have ro be repeated with the client lying on her opposire side (these are noted in the text). You may do all of the onesided exercises rogerher on one side before having the client roll to her opposite side. In each of these exercises, the movemenrs are made slowly and without strain on either you or the diem.

Lumbar Lateral Flexion (The Pump) The diem lies on her side, facing yOll, with her knees bem and drawn up toward her chesr. With one hand, hold the client's ankles. Place the other hand f1ar on the client's lumbar spine. Gently lift her ankles straight toward the ceiling, only as far as is comfonable. Monitor the movement at the lumbar, making sure there is no strain and thar the pelvis does not roll back toward the table. Bring the legs back down towards the table. Repeat the pumping movements a few times, with a steady rhythm. This exercise will need to be repeared on both sides, because it "opens" the part of rhe spine closest ro rhe table. See Figure 6.8.

171

Ortho-Bionomy

Figure 6.8

Lumbar Flexion IExtension Isotonic The client lies on her side, facing you, with her knees bene and drawn up roward her chest. With one hand, hold the client's ankles. Place your other hand flat on her lumbar spine. Place the diem's knees against your bellylhips as shown in Figure 6.9. In this exercise you will use your body to provide resistance to rhe dient's movement. so it's important that yOll are in a balanced stance, with your spine comfortably straight.

Figure 6.9

Have the dient gently attempt to straighten her legs. Provide gentle resistance to her movement through the full range (i.e., let her "'push" you gently with her knees as she straightens her legs.). See hgllre 6. JO. Notice that her lower spine will flex slightly against your hand as she does this movement. You may ask the dient to push against your hand with her lower back as she straightens her legs so her focus stays on the spine. Bring the diene's knees back co the starting posirion and repeat the enrire exercise a few more times. Ideally, the srraightening{bending movemenrs are done with a continuous flow, with no pause in between.

172

Figure 6.10

NOTE: If you can't comfortably support the dienr's legs with one hand, it is better to use both hands and leave out the conract with the lumbar.

Post-techniques

Spinal Bounce (Fanny Kick) Use the same starting position as for the two previous exercises. Gently bounce the client's heels toward her buttocks (as if she is kicking up her heels). Support the lower back if necessary. Repeat the kicking movements a few times. See Figure 6.11.

This is NOT a forceful rotation or manipulation of the spine. It is a gentle, comfortable, SLOW stretch. If a steady stretch is not comfortable, you may slightly rock the client'S hip forward (or the shoulder back) as a beginning movement for the stretch.

Figure 6.12 Agure 6.11

Spinal Rotation and Stretch TIle c1ieTlt lies on her side, bottom leg straight, top leg bent. Pull the client's lower arm forward so she is lying on the back (not the tip) of her shoulder. This position will naturally give the spine some rotation. Stand facing the client with one hand on the back of her hip and the other on the front of her shoulder. Cently stretch the spine by rolling the shoulder back and pulling the hip forward. See FigJlre 6.12.

You or your client may find the following variation more comfortable: With your arm bent, place the inside of your elbow on the back of the client's hip, with your forearm following the line of her spine. Use your elbow to pull the client's hip forward and suppon/monitor the stretch in her spine with your hand and forearm as you roll her shoulder back with your other hand.

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Grtho-Bionomy

Spine and Ribcage - Seated Postures Thoracic Flexion (Disc Fluffer) The spine should be warm and relatively mobile for this exercise. Don't do this as a beginning movement of the spine. Ha\'c me client sit on me edge of thc table. with her hands placed on the back of her head_ Stand behind her with one hand on her lower belJy, the other hand on the back of her head (on top of her hands). Support the client's belly as she rolls forward into a Ccun-e. It is important that the client doesn't simpl}' collapse: down onto her pelvlS. compressing the spine C3ther than curving it. Continuing to support the client's belly. use the hand on the back of her head to gently bounce her head and upper torso down toward her knees. At the same time, bring her torso fonvard so she leans farther over her knees; then back toward you. See Figure 6.13.

a. With the client seated. have her cross her arms and place her left- hand on her right shoulder and right hand on her left shoulder (as if giving herself a hug). Have her roll forward into the C-cun'e as above. Gently bounce forward and back as above. but with the compression on the client's shoulders rather than on her head/neck. b. If the first variation is still too much of a stretch, have the client hang her hands off the edge of the table. on either side of her knees. Instead of bouncing her torso, gently rotate her shoulders from side to side as she leans fonvard and back. This will provide a very gentle stretch in the spine while allowing for some movement of the discs. 2. The Disc Fluffer is often recommended by practitioners as a home exercise for the client, especially for those whose spine has a tendency to tighten.

Notice that the focus of the compression will move higher in the spine as the c1iem leans back, and lower in the spine as she leans forward. This exercise literally pumps or "fluffs" the discs of the entire spine.

Notes I. For some clients, the stretch in their spines will be too much with the above exercise. If your client experiences discomfort with this exercise, try one of the following variations and use whichever the diem prefers.

Figure 6.13

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Post-techniques

Seated Spinal Rotntion (L<we Seat) This exercise will need to be repeated on each side of the spine. For ease of explanation, assume you are beginning on the client's right side for the fo(~ lowing description.

Place your left hand on the client's back. with your thumb against the side of the spine closest to you. See Figure 6.15.

With the client seated on the table, sit next to her on her right side, but facing the opposite direction. Your right hips should be immediately next to each other. Wi.th your right arm, reach in front of the client's right shoulder, across her chest and under her left armpit. Your right hand should end up flat on the back of her left shoulder, or gently holding under her left armpit. See Figure 6.14.

Figure 6.15

Rotate the client around toward her right by pulling her left shoulder slightly forward and toward you. At the same time gently push on the side of her spine with your left thumb, to give the spine a slight flex. See Figures 6.14 and 6.15. Move your hand up and down the spine as you repeat the rotation. Continue until you have moved your hand up the full length of the spine. Figure 6.14

Change sides and repeat the exercise. NOTE: In order to support the client'S movement adequately in this exercise. you will need to rotate your entire torso (rather than just pulling her shoulder forward with your hand). If necessary, put one of your feet on the floor, or rest one or both feet on a chair so you have a stable base from which to move.

175

Course Descriptions and Training Information The original term that Dr. Pauls used for OrthoBionomy was the Phased Reflex Techniques. This was the name that was used in the experimentarion stage that he conducted with his osteopathic instructor, Dr. K. D. A. Basham. They used the teon "phased" because the work was developed in phases. The term "'reflex" was used because reflexive response within the body seemed. to be the COnstant factor among all of the techniques they were drawing upon in their research. Phase 1 was the name they gave to Jones' original work, with Phases 2 and 3 denOting further refinements. When they arrived at what they called Phase 4, they were finding that the results produced with these teehniques lasted longer than any other techniques they had encountered in their osteopathic training.

This is what we call the Basic phase of OrthoBionomy and is the phase about which this manual is written. Phase 4 is made up of the physical, technique-oriented work of Onho-Bionomy. It relies primarily on static positions of release that are largely determined from physical feedback from the client and sometimes verbal feedback as to what is comfortable and easy and what causes discomfort. Within this phase are included specialized techniques such as Posture and Posttechniques, Isometrics and other physically-oriented techniques.

Basham and Pauls eventually went their separate ways. Pauls retaining the term Phased Reflex Techniques of Ortho·Bionomy and Basham using the term The Basham Technique. Slowly, in Ortho-Bionomy. the term Phased Reflex Techniques has fallen out of use and just the term Ortho-Bionomy is commonly used. But we still use the titles of the different aspects of the work based on the idea of phases. The following is a summary of the different phases of OrthoBionomy and of the allied courses presented in Ortho-Bionomy training programs.

This is a bridging phase between purely physical and purely energetic work. This is where the energetic movements of the human form can be accessed as they are expressed at a physical leveL There is a particular quality of energetic relationship between the client and the practitioner in Phase 5 that catalyzes spontaneous but. at the same time, passive movements on the part of the client. The practitioner follows and supports those movements. The release positions of Phase 5 tend to be movement-oriented, rather than the more static positions of Phase 4.

PHASES 1-3

PHASE 6

These phases can best be described as the education process that Pauls went through in developing Ortho-Bionomy. They can also be described as the learning phases that a student goes through before arriving at the sensitivity necessary to perform Phase 4 well. The human form also has a version of these phases in its attempts to come to balance on its own.

This can be called the purely energetic phase of Ortho-Bionomy. Some practitioners perform Phase 6 while physically touching the client, while others may follow energetic patterns with little or no physical contact with the client. As can happen at a physical level, there may be energetic disruptions that cause distress or discomfort for the client. These energetic imbalances can be worked with in much the same way as in Phases 4 and 5.

PHASE 4

PHASES

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Ortho.Bio1Zomy

PHASE 7 This Phase of Ortho--Bionomy uses a more general energetic pattern rhat influences not only the client's individual energetic form, but their encr· geric relationships with others and with their environment.

POST-TECHNIQUES Post-tc<:hniques arc designed to give exercise to the spine and to increase mobility and flexibility. Some basic posNec:hniques are presented in this manual.

Iymphati<: system and for showing the relationsrup betwccn structure and endocrine balance. This system of reflexes is presented from an OrrhoBionomy perspective.

In addition to the specific techniques summarized above, the Ortho-Bionomy Practitioner Training Program includes additional classes related to the general practice of Ortho--Bionomy such as Ethics and Emotional Issues, Elements of a Successful Practice and so on.

CHAPMAN'S NEUROLYMPHATlC REFLEXES

Bay Area Ortho-Bionomy is an alliance of instruc· tors in the San Frandsco Bay Area which offers various training options. For those interested in a fuU study program, we offer Practitioner and Senior Practitioner training programs that fulfill the Society of Ortho-Bionomy requirements. The basic program consists of approximately 350 hours of course work and an additional 150 hours of practical experience in sessions. The senior program has a similar number of class hours, with a more advanced focus, and additional practice hours. Completion of the basic and senior practitioner programs is a prerequisite for entry into instructor training. The practitioner training pro-gram is designed to give students a well-rounded exposure to the techniques, practice and philo· sophical hase of the work. We assume those studying in this program intend to use OrrhoBionomy as their primary form of practice, although we encourage students to blend their experience and srudjes into a system of pr:lctice that expresses their own personal philosophy of work. Students arc also free to study OrthoBionomy on a more informal basis, integrating it into their current form of practice.

Although not rcchni<:ally a part of Ortho· Bionomy, Chapman's Reflexes arc an important tool for ~isting in improving the function of the

For specific training information, please contact Bay Area Ortho-Bionomy, P.O. Box 7538, Berkeley, CA 94707.

POSTURE The posture work in Ortho--Bionomy is a cambi· nation of techniques that assist in understanding balan<:ed posture and help clients cortec:t their posture and walking patterns. It also includes specifk home exetcises for working with specific spinal imbalances su<:h as scoliosis and spinal rigidity.

EXPLORATION OF MOVEMENT PATTERNS These techniques focus on observation and explotation of joint and muscle movement pat· terns and their inrcr·relationship with tension patterns.

ISOMETRICS Teaches the usc of isometrics consistent with the prindples of Ortho~Bionomy.

180

Bibliography 1. Basham, K.D.A. and A.l. Pauls. "Phased Reflex Techniques." Unpublished article, 1975. 2. Basmajian, John V. Primary Anatom)'. 7th ed. Baltimore: The Williams & Wilkin Company, 1976. 3. Calais-Germain, Blandine. Anatomic pour Ie Mouvement, Introdll~t;o" a J'anal-)'se des techniques corporelles. Meolans-Revel. France: Association A.M.S., 1989.

4. Display Atlas of Eleme1l1ary A"ato"1)~ London: Wolfe Medical Publications, 1980. S. Cennain, Patrick. £collomie du Geste. fascias et mOtll/emetlt. Meolans*Revel, Frnnce: Editions Desiris, 1989. 6. Gorman, David. The Body Moveable. Blueprints of the Hlnttan Musatl05keJetal S')'stem its Structure, Mechanics. Locomotor and Postural Frmctiolls. Guelph, Ontario: Ampersand Printing Co., 1981. Volumes I-Ill. 7. Jones, l.H. "'Spontaneous Release by Positioning." TI,e D.O., 4:109-16, Jan. 1964. 8. Kapit, Wynn and Lawrence M. Boon. The Ariotonl)1 C%ri"g Book. New York: Harper & Row, 1977. 9. McMinn, R.M.H. and R.T. Hutchings. Color At/os of Httmmt Medical Publishers, 1977.

A1Iotom)~ 4th

ed. Chicago: Year Book

10. Pauls, A.L. "'The Philosophy of Ortho-Bionomy: The Evolvement of the Original Concept." Unpublished article, ci.rca 1980. 1].

Tober's C)'clopedic Medical Dictio1lory, 13th and 15th editions, ed. Davis Co., 1977, 1985.

c.L. Thomas.

Philadelphia: EA.

NOTE: Many of the anatomy illustrations in this manual we~ derived from Gorman's The Bod)' Moveable. We highly recommend this three-volume functional anatomy text. It can be ordered from: Ampersand Printing CO.,ll3 Woolrich St., Guelph, Ontario, Canada, NtH 3Vl. (519) 836-8800.

181

Glossary Abduction - To draw away from the median line of a bone or muscle, or from an adjacent pan or limb. Adduction - To draw toward the median line of a bone or muscle, or toward an adjacent part or limb. Affected side - The side of the body which is uncomfortable, our of balance, or which is being worked with. Anterior -

Front of the body; toward the from.

Articulation - A joint between bones or between moveable parts. ASIS - Anterior Superior Iliac Spine. commonly called the hip bone. Associated rib - The rib connected to a specific vertebra. C-curvc - To place the body in a posture resembling the letter "e": scated, with the head down and the torso curved forward.

Chronic -long, drawn out; lasting or developing over a long period. Compress/compression - Gentle pressure; a squeezing together; state of being pressed together. Contraetlcontraction - To draw together; a shortening or tightening; restricted area; holding or held point. Disc (or disk) - .. A round, flat, platelike structure. Specifically, the intervertebral discs are fibro cartilage substances between vertebral surfaces. It may rupture but it does not slip. It serves as a shock absorber. The gelatinous mass in the center is called the nucleus pulposus. When the disc protrudes into the neural canal, pressure on the adja· cent nerve root is manifested by pain. This is called hemiation of an intervertebral disc.

Symptoms will depend upon the location of the herniation. Those in the cervical area produce distinctive signs and symptoms in the cervical area. Those in the lumbar area cause symptoms of lumbar nerve root pressure." - Taber's. Disrortion - A twisting out of regular shape; deviation from natural shape or position. Dorsiflexion - Flexing the foot up with the toes lifted toward the front of the knee. Eversion - Rolling the foot outward to bring the sole facing away from the other foot. Extension - The straightening of a pan of the body; lengthening of a limb or the body. In the neck, extension is accomplished by moving the chin up and away from the chest. ExtcmaUextemaUy - Exterior; opposite of medi· al or internal; outwardly. Extrinsic - Coming from without; movement of a joint. [n muscles, the extrinsic muscles are those which are partly attached to the trunk and partly to a limb. Facet - Any small smooth surface on a bone or other hard surface. Fine tune - Making small, subtle changes in positioning to find the best release position; bringing the indicator point to maximum softness and comfort. flex/Oexion - The act of bending or being bent. In the neck, flexion is accomplished by moving the chin down toward the chest. Head of bone - Technically, the proximal (closest to the hean) end of a bone. The distal end is furthest from the heart. In this text the term "head of the bonc" is used as a general term to describe thc cnd of a bone.

183

Ortho-Bimmmy

Hinge joint - A hinge-like joim allowing only flexion and e>.:tension.

Lateral f1exionJbending side of the body.

Hypcrcxtcnd -

McdiaVmediaUy - Toward the middle of the body.

Extension beyond nOl'mallimirs.

Imbalance - An area or joint that is not in irs natural state of balance or balanced movement/function. Indicator point - Specific areas of sensitivity. discomfort or contraction; focal area. Inferior -

Lower toward the foot of the body.

Inferior aspect -

Lower side.

Insertion - The place of attachment of a muscle to the bone which it moves. usually lower in the body than its origin. IDtemaVintcrnaUy medially.

Located inside; inwardly;

Intrinsic - Located within or belonging solely to a body part; mo\-ement within a joint. In muscles. the intrinsic muscles are those which have their origins and insertions entirely witmo a structure. Inversion - RoBing the foot to the inside to bring the sole facing toward the other foot. Isometric - Contraction of a muscle during which the force of resistance to the movement is in continuous movement throughout the range of motion. Muscular contraction in which the muscle does not change its length_ Isotonic - Contraction of a muscle during which rhe force of resistance to the movemem remains constant throughout the range of motion. Muscular contraction in which the muscle maintains constant tension by changing irs length during the action. Laterall1aterally - Toward the outside edge of the body; away from the median line.

184

Bending toward the

Midline - Middle line of the body going from the head to the toes. Mobility - Movement; range of motion; availability of movement. Monitor -

Bring anemion to changes.

Neutral position - Place of body before being moved; body in resting position. Origin - The more fixed attachmem of a muscle. usually higher in the body than the insertion. Palpate - To examine by touch or feel. Pattern - A combination of contractions. or movemenrs. that is idemifiable as distinct and repeated. For example: one shoulder dropped. o~ leg rotated externally and an imbalance in the pelvis can be seen as a body pattern of tension and imbalance. Or; a shoulder which has a restricted range of motion will have a particular pattern of movement that expresses that restriction. Having habitual muscle contractions in the neck could be a pattern of tension or will produce a pattern of muscle response. Plane - Used as points of reference by which positions of parts of the body are indicated. Plantarflexion - Straightening or extending the toes.

Positional release - The use of generalized positions to release a restricted or contracted area. Posterior - The back of the body; toward the back of the body.

Glossary

Preferred position - The position of a specific part of the body, or of the entire body, in which the dient is most comfortable. Pronate - To rum the palm or foot downward or backward. Prone - Lying face down. PSIS - Posterior Superior Iliac Spine, a protrusion of the ilium ncar the sacro-iliac joint.

Transverse process - A bony protrusion projecting laterally from the side of the vertebra. Trigger point - A specific area of pain or reactivity related to a specific, but distant, area of the body. "Any place on the body that when stimulated causes in a specific area a sudden pain, especially a type of pain previously felt spontaneously at the same location." - Taber's.

Re-
Lying on the back or with face upward.

Symmetrical- Equal on both sides. Traction -

Process of dra\ving or pulling.

185

Index Acromio-c1avicular joint, 122

release, 88

Ankle, 103

release indicators, 90

Ilium, 69 anatomy, 71

anatomy. 105

Fibula, 96, 100

evaluation, 72

evaluation. 106

Fine rune, 15

release, 74

release, 106

First rib, 39

release indicators. 75

release jodie.noes, 107 ASIS (Anterior Superior Iliac Spinel,71 Adas, 23 Axis, 23

Indicator point, 13

evaluation, 39

Integrating, 17

release, 39

Interosseus ligament, 147, 149

release indicators, 41

Isometric,

Foot, 109

Bunion, 114 Calcaneous, Ill, t 13

Carpals, 161 Cervicals,23 Clavicle, 121, 135 Compression, 15

Cubo;d, III, 113 Cuncao~.

anatomy, 39

Ill, 113

Elbow, 145 anatomy. 147 evaluation/release, 147

release indicators, 150 Exaggeration, 3, 5 Femur,85 anatomy, 87

definition, 41

anatomy, 111

femur, 89

general evaluation/release. 112

first rib. 39

specific evaluation/release. 113

Isotonic-definition, 41

release indicators, 114

Knees, 93

General indicators, 12

anatomy. 95

Hand, 159

general evaluation/release, 97

anatomy, 161

specific evaluation/release, 99

evaluation/release. 162

release indicators, 100

release indicators, 163

Lumbar, 49

Iliacus, 63

anaromy,51

Iliopsoas, 61

evaluation/release, 52

anatomy, 63

release indicators, 56

evaluation, 64

Maleolus, 105

release, 66

Metacarpals. 16]

release indicators, 67

Metatarsals, 111,113

evaluation, 88

187

Ortho-Biollom)'

Navicular, 111, 113

Radius, 147, 155

Specific indicators, 13

Neck,21

Re-checking, 16

Stemo-c1avicular joint, 122

anatomy, 23

Release Position, 14

Sternum, 141

general evaluation/release, 24

Ribs, 37, 43

Talus, 111, 113

specific evaluation, 25

anatomy, 43

Tarsals, 111

specific release, 26

general evaluationlrelease, 44

Thoracic, 31

release indicators, 28

specific evaluation/release. 45

anatomy, 33

release indicators. 46

evaluation. 33

Olecranon, 147 Patella,96

Sacrum,

n

release, 34

Phalanges, 111, 161

anatomy, 79

release indicators, 35

Phased Reflex Techniques, 179

evaluation, 79

Tibia, 96, 105

Phases 1-7. 179

release. 80

Trigger points, 52

Post-techniques, 165

release indicatOrs, 81

Ulna, 147. 155

introduction, 167

Scalenus, 39

neck,168

Scapula, 121, 131,

anatomy, 155

spine, 171

Scapulo-humeral joint, 122

evaluation/release, 156

Shoulder, 119

release indicators, 157

Proprioception, 7 PSIS (Posterior Superior Iliac Spinel, 71 Psoas muscles, 63

188

anatomy, 121 evaluation/release, 122 release indicators, 128

Wrist, 153

I

Kathy L. Kain

]imBems

Kathy has been reaching and pmcticing OnhoBionomy since 1980. She has trained extensively with, and co-taught classes and Instructor Training Seminars with, Arthur lincoln Pauls, the founder of Orrho-Bionomy. She was President of the Society of Orrha-Bionomy Intcrnational~ for six years. overseeing the creation of the Practitioner Training Program curriculum, and is both an Advanced Instructor and Advanced Instructor Trainer of Orrha-Bionomy. More recently the focus of Kathy's work has moved roward the fields of somatics and trauma recovery. She is one of the Senior Trainers of the Somatic Therapy and Psychotherapy training program offered by the College for Experiential Psychotherapy in Sydney, Australia and offers a somatically-oriented training program in the San Francisco Bay Area. She teachcs regularly in Austtali~ Europe, Canada and thc U.S. and maintains a privatc pracrice in Berkeley, California, whcre she livcs.

Jim is a Registcred Advanced Instructor of OrthoBionomy and has been trained directly by the founder, English Osteoparh Arthur Lincoln Pauls, D.O. He has been a Rcgistcrcd Insrructor since 1980, and has taught Ortho-Bionomy internationally. Jim's background in the hcalth education field includcs: B.A. in Sociology. Californi3 cClTified instructor in Massage TherOlpy, trOlining Olnd instruction in numerous body them pies, personal growth seminOles and communication skills. Jim has served on the Board of Directors and the Pracritioner Evaluation Committee of the Society of Ortho-Bionomy International. He resides and has a private practice in NOlThern California.

The Society of OlTho-Bionomy oversees training programs and provides certification of Ortho-Bionomy Practitioners and Instructors. The Society can be contacted at: Society of Orrho-Bionomy International P.O. Box 869 Madison, WI 53701·0869 U.S. and Canada roll free: (800) 743-4890 International: (608) 257-8828

Additional copies of this manual may be ordered from: North Atlantic Books P.O. Box 12327. Berkeley, CA 94712 Phone, (510) 559-8277

Fa., (510) 559-8279

189

1-55SH-25Q..X

S19.95

Health/Psychology

This is the first book on Ortho-Bionomy, a bodywork technique which is quickly gaining popularity among laypeople and therapISts from all bodywork disciplines. Grtho-Bionomy was cre;"'.ted twenry years ago by Dr. Arthur lincoln Pauls, an osteopath with training in the martial arts. Pauls wanted <1 system of bodywork which would reach structural understanding of the body simply and safely enough that anyone could learn to work with their family and friends. For the last f\venry years Onho-Bionomy has maintained the tradition of keeping the techniques sirr.!,le enGLIgh for anyone to learn. Kathy Kain gives clear descriptions of the philosophy and conceptS of OnhaBionomy. The illustrations and eas)··to-undersrand technical instructions show the standard releases taught in Ortho--Bionomy classes. The student is guided from the beginning of a session to the end. in leaming this gentle. effective approach to somatic re-education. Onho-Bionomy's primary benefit lies in helping people to break the cycle of pain b)' learning how to correct structural and somatic dysfunction and to relc::t~e Stress. This non-invasive, quick-acting anproach is an effective 'l:·~tion) movement and therapeutic exercise. preparafl

ft1--t' "(f...xJ \

"

,

•••

"Kathy Kain, one of the foremost international instructors of Orrho-Bionomy, has manage(1 in this book to be both technically and humanly accurate. Anyone who wants to lx: qualified at a master level of practice in bodywork would benefit from being fully familiar with the methods and philosophy of Orrho-Bionomy." - Julie Henderson. Ph.D., Somaticist, author of The Lover \Vithi" and Restoring The Mother

5~Iliff

~ Noeth Atlantic Books ~ Berkeley, California

Distributed to the book trade by Publism-rs Group West

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