A PRACTICAL MANUAL docx

dis-ludicator Poillts Anyspecific area of discomfort Ot tension can beused as an "indicator point." Ths point, whenmonitored during a release position, allows thepractitionertofeel an' c

A PRACTICAL MANUAL

*

with Jim Berns

North Atlantic Books

Th1

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 youwho proofread, offered

sugges-tions., 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

appro-priate 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

mis-use of any of the rechniques presented here.

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.

'1OcSand Dollar design, Society of Onho-Bionomy

International- and Ortilo-BionomyTM are used by

permis-sion 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

Ortho-Bionomy 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-Bionomynltsa rn.demark of the Society of

Orrha-Bionomy 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, piloto- copying, recording, or otherwise-without written permiS- sion 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.APractiwl MalUmlis sponsored by the Society for the Srudy of Nati\'c Arts and Sciences a non- profit educational corporadon whose goals are to Jc\'e!op

an educational and crossculturaI perspective linking ous scientifIC, social, and amstic fields; [0 nonure a holIS- tic view of arts SCIences, humanities, and healing; and to publish and distribute literature on the relationship of mind, body, and nature.

Table of Contents

Section 1: Introduction

Section 3: The Pelvis

Ankle • 103

Foot 109 Section 5: The Upper Limbs Shoulder • 119

Scapula • • 131

Clavicle • • • • 135

Srernum • • • 141

Elbow • 145

Wrist • • • 153

Hand • 159

Section 6: Post-techniques

Course Descriptions and Training Information 179

The intent of this manual istopresent 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,

learningtopractice Ortho-Bionomy effectively

requires not only study of written material but

direct pr-aetical experience with the techniquesthemselves We encourage students co take ad\'an-rage of the deeper exploration of Ortho-Bionomythatisavailable with the guidance of an experi-enced instructor and let this manual be a supportfor your learning

In the seventeen years that I've been practicing

Ortho-Bionomy I've learned that life changes and

bodychanges intertwine: ifOUTlifc changes, our

body willchange;if our body changes our life

willchange The Phase 4 techniques of

Ortho-Bionomy provide a potent form of accessing

physical change

Ibelievemuch of the effectiveness of

Ortho-Bionomy comes from its ability toinform us of

relationship: of oneself co oneself; oneself to

envi-ronment and oneself to others Ifany 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 livesin physical or energetic fenns It acts

as a reflecrion for recognizing life patterns that

don't work or that create pain Ifwe cannot move

our arm, we may adjust to this restriction so

effec-tively 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

cre-ate change that is natural, non-intrusive and

self-generated

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 Ifyou watch small children you will sec

that they have an immediate understanding of

what iscomfortable and what isn't We slowly

subvert this understanding of harmonious

func-tion through injury, through forcing ourselves to

remain in stressfuJ or tension producing situations

and positions Evemually, we train ourselves not

to notice our body's attempt to communicate itSneeds Ortha-Bionomy helps to remind us of theavailability of comfort and of change It isn'ttcaching us something new, it's "'teaching" uswhat we already know That's another form

of education, probably most accurately called education

re-The beauty is that the re-education often happensspontaneously [t's not a laborious process oflearning prescribed postures or positions, butrather a spontaneous rediscovery of the form

of comfort Through techniques like Bionomy we can learn again to beourselves-

Ortha-in comfort

Kathy L KainBerkeley, 1997

ix

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 itcame to be called, started

with the coming rogethcr of two apparentlydjs~

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 Judocomes the understanding

that the greatest strength and fluidity come from

movingWITHour 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 exposedtoosteopathy from the

patient's point of view "Itdid me a lot of good

But then I realized there was no real lasting

com-fort 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

miss-ing "'I came co understand that the real

osteopa-thy is when the practitioner nurtures the parts of

the body back to where they belong so they

func-tion bettcr and the client has an understanding

of that improved function."

But Pauls still hadn't figured out how todo 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 intheJournal of Osteopathy

from The D.O of January 1964).1 was veryimpressed by this demonstration I had a copy

of Jones' article made and 1 started using thesetechniqucs with my cliems and realized that thiswas what 1 wamed to do."

The article presented Dr Jones' experience, overthe course of 10 years, of correcting osteopathiclesions (usually described as "abnormal" place-ment of the bones within a joint) by placingpatients in positions of comfort, rather than per-forming a manipulation Strangely enough, Dr.Jones had discovered, the comfortable positionalmo.st invariably was an exaggeration of the

"abnormal bony relationship found upon nation." In other words, an exaggeration of ancccentric posturc Aha! Here was something thatmade sense to the Judo instructor: you moveWITH the body, not against it It also made sense

exami-in Pauls' patient experience; the patient necds tocometoa physical understanding of how theimbalance occurrcd in order to avoid future return

to old patterns of i.njury or misuse By letting thebody find its own balance without force, inherentre-education was possible

At this point, l)auls' own exploration took over.Combining his Judo experience, his osteopathictraining his knowledge of various systems such ashomeopathy, and the simple approach outlined in

Jones' article, Pauls began to evolve a system thateventually became Ortho-Bionomy Through thetwenty-two years of development since that initialintroduction to Joncs' work, Pauls came to includemuch understanding about the cmotional andenergetic implications of structural imbalance Thefollowing is a brief introduction tohis philosophy

3

A Few Words from the Founder

The root words of Ortho-Bionomy can be broken

down as follows: "Qrrho" means straight or

cor-rect; "bio" means life; "nomy" means pertainingto

laws.So the term Ortho-Bionomy can bedefined

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

isthe literal skeleton upon which our life is built

When youc structtJre works right, your circulation

works better,yOllfeel better, you think better

The body is very limited Itrequires great

disci-pline to stay alive in a human body without

hav-ingit injured in one way or another.Ifyou don't

stay within its limitations you end up hurringit

very badly Staying within healthy bounds takes

learning about space and time We occupy space

in the universe Ifwe don't respect that space, then

we're goingtoget in our own way and in other

people's way; this is called an accident Ifwe

hap-pen 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

our-selves 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 thing you take away.Ifthere's trouble in a partic-ular part of the body, it's not the body part that'sthe problem It's the person being out of harmo-

some-ny, who is the problem

In Ortho-Bionomy, we help a person to recognizethe state of their own limitations We show thebody, rhrough physical and energetic patterns,how to understand its own fWlCtioning Then wehelp the person to re-discover how to keep theirbody functioning in a harmonious way The per-son must come to the point where they realize thatonly THEY are responsible for keeping themselveshealthy As practitioners, our job is not to makeperfect bodies There are no perfect bodies We'rehere to help people to find a better workingarrangement with their structure Most peoplearen't interested in great health, they are interested

in functioning well enough to use their body, mindand heart for what they feel good about

Ifwe want to change, we can begin with our ical structure and move on from there Our bodiesare capable of correcting themselves, but we must

phys-be given the motive to discover how to make thechange 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 head-aches, we become repeatedly emotionally re-involved in our involvements (stuck patterns)until they become evolvements In other words,

if we get stuck in a pattern (emotional or cal), we generally repeat it until something hap-pens to break the pattern It becomes a tight circlewith no exit, no beginning, no end

Ifwe want to move onward, we must break the

circle We must evolve past the stuck pattern Part

of our job, then, in Ortho-Bionomy istohelp the

client recognize these stuck patterns (sometimes

by repeatedly calling their attention to them

6

through exaggeration), and then to recognize thatthey have the energy within themselvestochange.Through the principles of Ortha-Bionomy, we canhelp the client to find their own motive, their ownway 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 attachedtostakes

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.Ifwe

push the pole upright we may approximate

align-ment bystretching the tightened wire But there's

an easier way of returning the pole to its tcue

bal-anced 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

some-times 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 tion and rate of movement (Proprioception =per-ception of oneself.) H you've ever had the experi-ence of sitting or Jying still for a period of time.and then noticing that you can't feel the position

posi-of your arms or legs you've had a direct ence of the function of proprioceptors Thesenerve endings are stimulated by movement, specif-ically by movement of a joint You can anesthetizeall the soft tissue surrounding a joint, and by mov-ing the joint you can still get the information nec-essary to know where that part of the body is inrelation tothe rest of your body, and how quicklythat part of your body is moving

experi-Spraining the ankle is the classic example of ficient proprioceptor communication As you take

insuf-a step insuf-and overextend the insuf-ankle the tors send the neurological equivalent of "alert,alert, you're aboutto hurr yourself!" Ifthat mes-sage doesn't get through quickly enough for you

propriocep-to recover your equilibrium, you don't have time

to reposition your weight to prevent injury to thejoint When you injure a joint in this way, youoften injure the proprioceptive nerve endingswithin and around the joint, limiting their ability

torespond in similar situations in the future This

is one of the reasons that injuries tend to reoccur

in the same joints Their communication links areslightly damaged in an initial injury, increasing thelikelihood that warning information will not bereceived in time to change joint position or rate

of movement in order to save further injury.III Ortho-Bionomy, we usc this proprioceptivecommunication system as a way of communicar-ing with the body through direct neurologicalinformation Moving the affected joint stimulatesthe proprioceptors, effectively sending the signal:

"hey, pay attention here." Once a release position

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

Itwould be lovely if it werc all exactl}' that

sim-ple, 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/imi-tations that compljcates the process of restoring

balance to joints This first requires a little

expla-nation of some basic ph}·siolog}'

Eycry joint has two ranges of movement:

physio-logical and anatomical The physiophysio-logical 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

fur-ther toward the palm b}' gently pushing on it This

additionallirnit of movement is called the

anatom-ical 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

nat-ural shock absorber [t allows you to sustain a

mild overextension of the joint without injur}'

is not the usual physiological range, it is now yowown individual physiological range for that finger

So the distance between your ph}'siological rangeand your anatomjcal range for rhat finger is quitelarge and movement wirhin that distance is un-available to you from the inside However, fromthe outside, the practitioner rna}'be able to movethe joint within thar restricted range, finding ways

to access movement This in rurn gives access tothe possibiljt}, of altering the restriction

Another wa}' thar patterns of holding can keep

us from moving back to alignment on our own isrepeated stress or injury that creates compensat-ing patterns Ifwe spend many years using incor-rcct posture, repeating rnovemems that arestressful to the body and generally subjectingourselves to the wear and tear of daily life, wecreate stress patterns that bring the body ro theedge of irs limjts of accommodating any excessstrain Then one day we bend over to pick upthat box which is just a little hit roo heavy andARGH! [call this the Myth of AII-of-a-Sudden

"I've had no problems with my back before, thenall 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 ing rhe box There are probably numerousunderlying imbalances in the muscles of theback the struceure of the pelvis, perhaps thebones of the spine or ribcage The immediatepain of the back may be eliminated rather quick-

lift-ly, bUI the underlying imbalances will still bethere Sometimes it's like unravelling a snarledball of twine: rou follow the red string, only todiscover that you have to unknot the blue stringbefore you can free the red one

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 howto 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

redis-cover balance and comfort The map of the

jour-ney is created in the very process of releasing held

patterns

Introduction

Aswe come to greater understanding of how thebody responds to stress and tension, and developmore flexibiliry and relaxation, we are bener able

to respond appropriately to future stressors Wealso tend tostart noticing earlier in the processwhen we are overstepping our limits or when we

;are using our bodies incorrectly As happens at thespecific muscular and joint level, the body as awhole has more information available about how

it is experiencing itself The changes in the wholebody affect change at the muscular and joint leveland so on in a continuously linked cycle of changeand self-discovery

Kathy L. Kain

Introduction to Practice

Procedures - Introduction

In order nor to burden the main text with

repeti-tions of the procedures whichwill bethe 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 particularpartof the body

needs attention, howtofine tune release positions

and how to re-chcck the original indicators of

imbalance In this section we also present

infor-mation on the general practice ofOrtha-monamy

such as taking a client history and how to know

when your work is complete This section is

for-matted as awalk~throughof 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

sec-tion to the specific informasec-tion 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 isto

ensure your client's safet)' The techniques

present-edin this manual are not intended to replace or

precede appropriate medical attention Jfa client

has a problem that )'ou suspect mightbeserious

enough to need medical attention, have that

per-son 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 withthe presenting problem, or with the client's otherhealth problems which might affect your work.Educate )'oursclf enough toknow what is a threar-ening problem and what can besafely workedwith We recommend that )-OUdevelop an ongoingworking relationship with a ph)'sician or othermedically-trained health practitioner who is will-ing to consult with you about your clients

Taking a Client History

Taking a client history (also called an intake view in some professions) gives you access to theinformation you will need both to ensure yourclient's safet), and to make a preliminary plan foryour initial session Some practitioners perform avery thorough interview which includes a detailedhistOry of accidents, injuries, illnesses and so on.Others ask just the limited number of questionsnecessary to establish the starting point and theimmediate history of the problem In either case,it's beSt to know in advance what)'OU will needtoknow from the client in order to feel comfortablewirh proceeding into the session

inter-E\'entually)'OUwill develop )'our own form of tory taking that fits with your style of working Atminimum,)'OU will usually need to know what theclient's presenting problem is and its immediate his-tory It is also wise to ask if there are any currentinjuries or medical problems that you need to knowabout before proceeding

his-The information the client gives you as part ofthe history taking interview will also help youorganize the session so you can allow enough time

to work with each area that needs attention Yourna)' also find ir helpful to establish certain com-munication guidelines with the client For exam-ple, man)' people are used toreceiving work that

11

is uncomfortable You may need fOstate quite

clearly, and emphasize during the session, that the

client should let you know immediately if

any-thing you are doing is uncomfortable

Beginning

Kltowing Where to Starl

After you've gathered the basic information about

the client's condition, you will needfO determine

wheretobegin 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 wheretobegin within that

particu-lar area

There are various ways to determine where to

work Thefust: 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 asyou

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

prac-tical level, the client may not beabletolie

com-fortably 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

observa-tions to tell you where tobegin, both in a general

arca and specific points wimin rhar area Over

12

time, )'our proficiency at observing subtle tors and at "reading" the client's non-verbal cueswill increase In the beginning, )'OUare likely toobserve only thc larger signals (like the client notbeing able to lift her arm above her head)

indica-EXfXrience is the best teacher of observation andpalpation skiJIs ~a start the following is a basiclist of some of the signs to take note of as youdecidc 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; withhis head turncd slightlytoone side; with one orboth of his legs rolled externaJly; without lettinghis back rest flat on the table? (What mighrthese signals mean? Perhaps his psoas muscle

is contracted pulling his body into a curve;perhaps his neck is tight on one side; perhapsh,is femurs arc rotated externally; maybe hislumbar spine is tight.)

• Arc there any areas that jusr seem to get yourattention: they aren't as relaxed as the surround-ing area; the client's breath is restricted in thatarea; the skin looks different than surroundingareas; the muscles look contracted or tight

• You may want to gently check the range ofmotion of the joint yOU will be working with

or jusr gently move the general area Noricewherher there is restriction in the movement,

or discomfort during the movement Take note

of any strong preferences of movement in onedirection or another (pay attention nOt only tohow far the joint moves but also how comfOrT-ably it moves)

Specific indicators

Once you've decided on the general area you will

beworking with (e.g., the shoulder or the neck),you will still need to decide where, specifically, towork in rhat area

• 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

sen-sation You may find that a specific area simply

attracts your attention Many practitionets who

wotk with clients who have chronjc problems

h.1.ve learnedtofocus 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 isinthe numb

stage Pain happened years ago Pain

informa-tion is no longer neurologically available

because after a certain amount of time of

send-ing indications of pain the nerve endsend-ings simply

stop firing This is a survival mechanism that

Introduction

allows the organism to continue to function.Until those nerve endings are reawakened, theclient will have no sensation of pain even in

an area of her bod)' which is in tremendous tress Soasking her ifsomething is comfortable

dis-or uncomfdis-ortable is an irrelevant question.With clients like this, you will likely need tofocus on available joint movement and thequality of the soft tissue in the area Take theaffected joint through its a\'ailable range ofmotion as mentioned in the General1odicatorssection Any restricted area then becomes yourfocus for release work 10 the soft tissue, anysigns of tension such as knots or overstretchedmuscles will beyour focus of work, regardless

of whether or not the client experiences comfort there

dis-ludicator Poillts

Anyspecific area of discomfort Ot tension can beused as an "indicator point." Ths point, whenmonitored during a release position, allows thepractitionertofeel an)' changes that happen as

a result of that position It also gives the dent afocus for the position and allows for feedbackabout any change in the level of sensitivity or ten-sion Mainrainjng contact with the indicator pointduring the release work allows you to monitor thepossible positions for release totell which gives themOSt change at the indicator point Keeping con-tact with rhe indicator point also ensures that yousta}' on the same point as you move the client, inturn guaranteeing that you knowifthe pointreleased or not Remember, however that itis therelease position that catal)'Zes the release not theindicator point You don't needtopress or mas-sage the indicator point Once rou know thar theindicator point is tight or sensitive, you don'r need

to keep pressing on the point Maintain a gendecontact with the point only as deep as is needed

to notice changes during the release position

13

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 needto know the release position

in advance, you can discover it by following the

client's lead Literally.youcould do a pretry

effec-tive sessionbysimply presenting oprions of

JX>si-tions and asking: "which do you prefer, this or

that?" and following the most preferred positions

untilfOUget 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

accept-ed; 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\'e-ments 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

Ifyou 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 toa 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

the atm around to the front of the shoulder andchest

This principle usually works because tion of one set of muscles will usually curve thesurrounding area around that contraction Somaking a curve around a tight or sensitive areawill oftenbean exaggeration of an existingcontraction

contrac-• 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 jointconrracted at the same time) also has a position

of exaggeration: compression There is little or

no movement within an area so you exaggeratethat lack of movement by compressing orshortening all the muscles at the same time Asthe area begins to open and movement becomesavailable, then you can follow an)' expressedpreference

Gettillg the "Right'3 Release Positioll

How do rou know when you've gOt the bestrelease position for the specific area with which)'ou're working?

• The tissue in the indicator point that you'rcmonitoring rna)' soften and relax

• The client will ohen feel more comfortable in therelease position than in the neutral position

• You may feel more comfortable in rour own

body

• There maybea pulsation in the indicator point

• Knots in the tissue may "dissolve."

• There may be changes in skin color

• Breathing rna)' change (usually a deepening ofthe breathe or a sigh)

• Skin or body temperature ma)' change

• TIle affected area "sinks" deeper imo the

In the (ext you will find instructionsto"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

varia-nons 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

posi-tion 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

some-times feel bener for the cliem.Ifthe client resists

compression you may bepushing too firmly

Lighten up on the pressure H she still resists the

compression, tty gently pulling The line of

com-pression 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

ten-sion, )'OUarc communicating to the cljent that it's

okay to make )'ourse1f uncomfortable

Ortho~Bionomyuses more lifting than massage

and many other bodywork techniques This makes

Introduction

it important to prOtect your own back as rouwork As much as possible keep rour spinestraight as you lift and rake the client's weightdown through your pelvis and legs rather than in)'our arms and back This t<'lkes a little pf<'lctice toget used to, but it actually makes lifting easier andwill save injury to your back

Holdillg the Release Positioll

Once )'ou've found the best release position youwill usually hold that position for 1(}-60 seconds

or until the release indicators that you are toring signal that the release is completing

moni-Gcncrall}'.}Ollwant to hold the position longenough for the body to come to a level of stability

in the releasing process For example, ifyOll arenoticing a pulsation in an indicator point, youprobably don't want to move out of the rele<'lseposition while the pulsarion is increasing instrength Once the pulsation has levelled off andbecome regular, it's probably fine to move out of[he release position You don't need to hold theposition 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-checkingthe indicators This means you will go back to)'our original indicators of imbalance or tensionand check to see if they've changed If you wereusing a specific indicator point, is it still sensitive

or conrracted? Ifyou were using the restriction in

movement in a joint as your indicator, has thatrestriction lessened? If you re-check the indicatorsand find that they haven't changed, or have onlypartially improved you may need to keep findingvariations on the release positions It is possiblethat tension in surrounding areas rna) keep thearea that you're working with from releasing com-pletely If you've tricd a few release positions for aspecific area and find no change in the indicators,

go on to work with adjoining areas and comeback to the original area later

15

Once the indicators have all improved tothe 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 beginningtowork 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}'OUCworkisfinished Ina

spe-cific area, are all the indicator points soft, relaxed

and comfortable?Ifnot, there's probably more

worktodo Are the muscles and other soh tissues

in the areas with which you've been working

re-laxed and comfortable when you palpatethe 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

other-wise seems ideal; no changein muscle tone

after the release position, etc

• The client begins to over-respond to releasepositions: muscles spasm as you move into aposition; the release position produces a burn-ing sensation in the indicator point, etc

• An area that was feeling comfortable begins toache again

• The client "disappears" energetically, or thereseems to beno 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 towardsdiscomfort aftet an area has released well, that's

an indication to stop working on that area, or haps StOp working altogether If you find yourselfwondering if the client has had enough work, heprobably has

per-Integrating

After you've finished work in a specific area, youwill wanr ro make sure that the changes that havetaken place are integrated with the current bal-ance in the resr of the body The easiest way to

do this kind of integrating is to make some gentlemovements within the area with which you've JUStworked and slowly exrend that movement intosurrounding areas

For example, if )'ou've done a lot of work withthe pelvis you might wanttogentl)' rock the pelvisback and forth and then extend that rockingmotion up into the spine and down into the legs.Some practitioners make it a practice to do somemovement or rocking with each part of the body

as a wa)' to bring the session to completion

This integrating time also includes the internal gration the client might need ro do Leaving a littleextra time at the end of the session to let the clientrest quietly can provide her with thetimeshe needs

inte-to check in ITom the inside and notice how things

ha\'e changed Some practitioners encourage their

dients todoa 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 bedone, discussing the session at the

end may help clarify what was accomplished

dur-ing the session As with the history takdur-ing

inter-\·jew, there are a wide variety of wars to bring the

sessiontoa close

Some practitioners prefer to keep the talking to

a minimum and gather only enough information

ro knowiftheir workW<lSeffective, that there is

nothing else that needs doing for the day and to

make arrangements for follow up appointments, if

any Other practitioners perform a fairly thorough

assessment after the session taking note of changes

ineach area and finding out from the c1iem how

each area fccls and what rna)' need additional

work in the future hom that information, a plan

for subsequent sessions maybeworkedOut.client

home exercises given and future session dates

arranged

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 besafe to drive or return to work

11ltroductioJt

Taking Notes

Most Ortho-Bionomy practitioners maintain somekind of client files As with the history taking inter-view and discussion after the session there is awide range for how these records arc kept Manypractitioners keep note cards or file folders foreach client, with brief notes as to the dates of ses-sions and what was done in each of those sessions.Other practitioners keep extensive files withintake interview information, detailed notes ofwhat was done in each session and recommenda-tions for follow-up work or referrals to othertypes of health care pro\'iders.Ifrou arc working

in a more structured environment, such as aphysical therapy clinic those arc the types ofrecords you will probably be required tokeep.If

you arc working independently or in a less tllTed environment, you arc free to establish thekind of noce-taking process that suits yOllr needs

Struc-We recommend that you keep sufficient notes to

beable todetermine what general work you didwith a client if, for example, a client comes back

to sec )'ou after a rear or two with no contact

17

Section 2

VERTEBRAL

TIleneckismade 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

inthc 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

trans-verse processes A common image associated with

the first cervicalisthat 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,

Vertebral Column & Thorax - Neck

"yes'" and "no'" movements of the head) So therelease positions for this part of the neck will usual-

ly include a combination of these two movements.The remaining five cervicals have some

flexion/extension, rotation and lateral bendingavailable between each two vertebrae If you cupyour hands around the middle of your neck, youwill notice that yOll still have some rotation andquite a bit of flexion/extension available, but areseverely restricted in your side-bending That'sbecause the middle portion of the neck has lateralflexion (side-bending, ear toward shoulder) and

Figure 2.1

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_

Thesixth and seventh ccrvicals have thicker and

wider transverse processes than do the other ccrvicals

1beseventh cervicalhasa longer spinous process,

which shows as a Imnp at thebaseof your neck when

you drop your head toward your chest

Thc accumulatcd movcmcnt of the individual

ver-tebrae 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

lum-bar spine by the size of its vertebrae

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 Asyou 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

24

General Evaluation / Release

Ifthc client's neck is comfortable enough to allowmovement, you may begin with a simple evalua-tion of his neck's range of motion and with gener-

al release positions Ifthe client has relativelyminor discomfort and restriction in the movement

of his neck, sometimes general release positionsarc sufficient to bring relief from discomfort andincreased ease of movemcnt

1 Gend)', and without forcing, rotate the client'shead tothc 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 headinto whichcver position is most comfortable.Compress down the line of the spine Hold for10-60 seconds_ Rerum the head tothe neutralposition and recheck the movcment

2 Gently flex the client's head up toward hischest See Figure 2.1 Then bring his head

back down to the table and gently extend hischin 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 ofmovement into flexion or extension, andmove the cliellt into whichever is most com-fortable Hold for 10-60 seconds Rcrurn thehead to the neutral position and re-check themovemellt

)

Figure 2.2

ifthere is greater movement, or case of menttoonc side or the other Move thediem's

move-head into whichever position is most able Compress down the line of the spine Holdfor 10-60seconds Return the head to the neu-tral position and rc-eheck the movement

comfort-Neck - Specific Evaluation

If the client is uncomfortable during the generalmovements, or he has morc complex tension pat-terns you may need tobegin with motc specificrelease techniques

For release purposes, the neck is divided into threegeneral areas: upper, middle, lower The upperneck consists of the first two cen'ical vertebrae(Cl-2) The middle neck consists of the next threecervicals(C3-S). The lower neck consists of thelaSllwo cervicals (C6-7), and sometimes theuppermost thoracics (Tl-2) These divisions willvary slightly from client ro client, but are presenr-

edhere as general guidelines for deciding whichrelease 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 andlower areas of the neck are usually a litde easier towork with, but you may find that a different orderworks better for your panicular style of working

or for certain clients Experimenr with differentcombinations and usc whichever works best forrou (Sec"Nores" at the end of the neck secrionfor additional information on choosing positions.)Usually, you need only perform release positionsfor those areas of the neck where you find tension,discomfort or restriction

Vertebral Column 6'"Thorax - Neck

For each area of the neck, gently contact the

specif-ic point or points with whspecif-ich you arc working Youmay use a single finger (usually the middle finger

is most sensitive), or two/three fingers to contactlightly enough that you arc not causing any discom-fort Remember that it is the position that facilitatesthe 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.

Figure2.3

t. Using the pads of your fingers, not your thumbs,gently palpate the client's neck for specificareas of tension or discomfort See Figure 2.3.

Include the muscles both along the side andback of his neck Notice if there is any discom-fort in any of the areas you are contacting Anyarea of sensitivity, cOlHraction, or restrictedmovement may be used as an "indicator point"for a release position Other things10 noticeinclude knots, stiffness or a stringy feel in thetissues, swelling or lack of tone in the muscles

2 Contact the vertebrae themselves, at [he verse processes on each side, and gently rockthem from side to side NOliceifthere is anydiscomfort or restriction in the movement ofthe bones

trans-• You may check specific joint movements For

example, you may have checked the general

movement of the shoulder Now you may want

faspecifically 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 necdcdTOgather information,

and do your best not to create discomfort

Gently feel the condition of the tissue in the

affectedarea and notice if there isdiscomfort;

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 willnot

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

sen-sation 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

informa-tion is no longer neurologically available

because aher a certain amount of rime of

send-ing indications of pain the nerve endsend-ings simply

stop firi.ng This is a survi"al mechanism that

11llroduction

allows the organism to continue to function.Until those nerve endings are reawakened, thecliem will have no sensation of pain, even in

an area of her body which is in tremendous tress.Soasking her if something is comfortable

dis-or uncomfdis-ortable is an irrelevant question.With clients like this, you will hkel}' need tofocus on available joint movement and thequality of the soft tissue in the area Take theaffected joint through its available range ofmotion as mentioned in the General Indicatorssection Any restricted area then becomes yourfocus for release work In the soft tissue anysigns of tension such as knots or overstretched.muscles will beyour focus of work, regardless

of whether or not the client experiences comfort there

dis-Indicator Points

Any specific area of discomfort or tension can beused as an "indicator point." This point, whenmonitored during a release position, allows thepractitioner to feel any changes that happen as

a result of that position It also gives the client afocus for the position and allows for feedbackabout any change in the level of sensitivity or ten-sion Maintaining contact with the indicator pointduring the release work allows you to monitor thepossible positions for release to tell which gives themost change at the indicator point Keeping con-tact with the indicator point also ensures that youstay on the same point as you move the client, inturn guaranteeing that you knowifthe pointreleased or not Remember~however, that it is therelease position that catalyzes the release, not theindicator point You don't need to press or mas-sage the indicator point Once yOll know that theindicator point is tight or sensitive you don't need

to keep pressing on the point Maintain a gentlecontact with the point, only as deep asisneeded

to notice changes during the release position

13

Neck - Specific Release

Middle 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 handtoslowly rotate

and side-bend the neck around the poinr until

there is maximum softening of the point, and

maximum comfort for the client Compress

slight-ly from the top of the client's head down toward

the indicator point, or down the line of the neck

Chock with the clienttoensure that you are

using a comfortable amOllnr of compression

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

Figure2.4

Lower Neck

Ifyou simply side-bend and rotate the head, most

of the curve of the position isabsorbed by themiddle of the nock This makes it difficult to get

an accurate release position in the lower neck Forthis reason you will usc a "sct-up position" forthe lower neck The purposc of this sct·up posi-tion is to focus rhe curve of the release positioninto rhe lower part of the neck

Making sllre thar your contact is in toward theneck, not down toward the shoulder, gently con·tact the specific point or area of the client's lowerneck with which you are working With the otherhand, gently rotate the client's headaUlayfromthe point, (i.e., if working with a point on the leftside of the neck, rotate the head to the right) 00

nor force rhe movement, bur simply let the headroll tothe side opposite the point.This is yourset·up position See Figure 2.5.

Figure2.5

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

lineofthe neck toward the point.See Figure 2.6.

Hold for 10-60seconds Renlrn the c1iem's head

tothe 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

Figure 2.6

NOTE:The most common error students make

with this release position istomove 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

Usually, the nosewill not mO\'e pa!;tmid~line in

this position [fthe curve created in this position

m(wcsup 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 ~;tarrthe

rrleasc movement over

Upper Neck

As with the lower neck, you will need to use a

set-up position for the set-upper neck to focus the releaseposition at the top of the neck

Gently contact the specific point on the upperneck with which you are working With bothhands supporting the diem's head, gently lift hishead and side-shift it directly to the sideaway

from the point (i.e.,ifthe point is on the left,move the head to the right) Do not rotate or side-bend his head The client's face stays in a directline with the front of his torso (like the side-to-side head movement the Balinese dancers make).Youwill need to support the head in this side-shifted position becausc it will tend to slip back tothe neutral position See Figure 2.7.

•

Figure 2.7

27

Figure 2.9

Ortho-Bionomy

[fpossible, maintain conract with the indicator

point while you move into the release position

From the side-shifted position, gentlyCUT\'Cthe

c1iem's neck and head around the point by

rotat-ing.side~bcm.ling and extending the head You

may need to practice making each of these

move-ments 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

r

Figure 2.8

Ifthere arc no other imbalances prescnr:

• There will beincreased range of morion and

ease of movement in the neck

• There willbeincreased comfort and decreased

tension inthe soft tissue (indicator points) of

thened

• There will beincreased comfon and decreased

re!>1.ricrion of movement in the individual verre~

brae of the neck

Notes

1 Notice that in each area of the neck, rcgardless

of the starring position, the final movementinto the release position is the same: curvearound the affected point

2 For points toward the back of the ncx:k in eacharea, you may need more extension in the releaselX'Sition If necessary, you may gentlyliftat theback of the client's necktoget his head intoextension.See Figure 2.9 For points toward the

front, more flexion maybeneeded (rememberthe idea of creating a curve around the point).You may work on the front of the neckifnced-

ed, butbeaware that most people are somewhatnervous about contact in such a vulnerable area.Keep yOut cOntact light and check ,\lith the clientabout the comfort of your touch

3 In any of the release positions, if you pass theposition of maximum sohening in the indicatorpoint and it begins to stiffen, you have proba-bly passed the best release position Go back tothe neutral position and begin again

4 The compression llsed in all release positionsshould be comfortable Check with the client as

to whether he wants more or less compression

Thoracic

THORACIC - ANATOMY

See lllustration 2.3

PROCESS

THQRACtC VERTEBRAE AND RIBS

SPINOUS PROCESS

uvillustration2.3

The thoracic spine consists of those twelve

verte-brae to which the ribs connect What many

peo-pie call their backbone is actually the spinous

processes of the thoracic spine The joints of the

thoracic vertebrae permit all movements:

rota-non, flexion/extension and lateral bending The

mo\'ements within each joint arc slight, but the

Krumulated movement of the twelve vertebrae

makethethoracic spine quite flexible It has its

putest mobility on the rotational plane, as

com-paredtothe lumbar which has its widest range

illmeflexion/extension movemem

Vertebral Column & Thorax - Thoracic

The transition from thoracic to lumbar spine ismade at the twelfth thoracic vertebra The upperpart of this bone has the facets of a thoracic ver-tebra, its lower facets arc those of a lumbar verte-bra This is an abrupt shift from the less mobilethoracic joints to the more mobile lumbar jointsand makes the twelfth thoracic the vertebra mostsusceptibletostrain The eleventh and twelfththoraces are the mOSt commonly fractured in

a broken back The twelfth thoracic is also theuppemloSt origin of the psoas muscle, which mayaccount for some of that muscle's vulnerability

to chronic contraction

With the diem prone:

1 Check for sensitivity or contraction in themuscles along each side of the thoracic spine

Do this by palpating along the length of thethoracic within an inch on either side of thespmous processes

2 Check for movement of each thoracic vertebra

Do this by rocking the c1iem's pelvis and

visual-ly noting whether the movement of the pelvis istransferred up the full length of the spine Thenplace your thumb or finger against the sides oftwo adjoining spinolls processes Continue therocking of the pelvis and feci for movementbetween each successive pair of vertebrae Anyarea of sensitivity, contraction, or restrictedmovement may be used as an "'indicator point'"for a release poSition

Figure2.11

All of the following release positions are per4

formed with the client in the prone position Toavoid straining the dent's neck, her face should

be turned, if possible toward the side of her bodythat is being lifted

Upper Thoracic

Stand on the saOle side as the sensitive or

contract-ed point (the "indicator" point) reach over thedient's back and slide your hand under her oppo-site shoulder Gently lift her shoulder and bring itback towards the indicator point until the pointsoftens and relaxes Fine tune the position formaximum softening of the point Gently compressfrom tbe shoulder towards the point Hold for1D-60 seconds Return the shoulder to the neutralposition and re'"Check the point.See Figure 2.10.

• For points high in the upper tboracic (11-3)you may want to gently shrug the shoulder uptowards the ear as youlift it Becareful not tocause discomfort in the neck or upper shouldeL

to the neutral position and re-check the point

See I=igmc 2.11.

ec-NOTE: Because of the angle of the ribs, your

lift-inghand will be placed lower on the ribcage than

me hand contacting the point

Lower Thoracic

Stand on the same side as the indicator point

Reach over the client's body and slide your handunder herhip bone Making sure that your con-tact is secure and comJocrabJe.lift her hip up andback towards you until you find a position thatrelaxes thepoint FinetW1C the position Compressfrom the hip toward the point and hold for 10-60seconds Return tothe neutral position and re-

check the point See Figure 2.12.

Flgure 2.12

NOTE:Ifitis more comfortable for you or forlour diem, you may have your client "frog" her

leg slightly,on the side being lihcd Noticethatthis

bending of the knee will begintolift the pelvis

Vertebral Column & Thorax - Thoracic

RELEASE INDICATORS

THORACIC-If there are no other imbalances present:

• There will be reduced sensitivity and tion along the spine

contrac-• There will be increased mobility of the thoracicvertebrae

Notes

• After each of the release positions, yOll maywant to do some gentle rocking of the entirethoracic spine as a way of integrating anychanges that may have occurred

• If you find that a thoracic vertebra does notrelease with the above positions try liftingfrom the same side of the spine as the indicatorpoint Ifthat doesn't work, check the associat-

ed rib.It may be holding the vertebra fromreleasing

• lMPORTANT: As you find the most able position for the client make sure that youfind a comfortable position for yourself Youwill be lifting a considerable amount of weightwhen working with the spine so it is important

comfort-to take care of the health of your own backwhile working Ifnecessary, use pillows to sup·port the positions

Ribs

RST RIB - ANATOMY

, Illustration 2.4

1£the rib itself is rigid, or there is pai.n on contact,you may also use this as an indication that the ribneeds attention

FIRST RIB - RELEASE,e first and second ribs have a particular influ-

ce on the shoulder and the neck due to

inter-ating 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~

'jorattaches to the second rib These muscles

particular link tension in the neck to

imbal-ce of the first and second ribs The plaimbal-cement

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 1ndateach side of the neck)

laches at the clavicle, again linking the function

the neck with that of the shoulder girdle and

IJXr ribcage

Isometric Release

With the c1iem supine, have her bend her elbow

on the affected side and bring that arm up so herelbow is pointing toward the ceiling With onehand, contaer the cliem's first rib, or the musclesoverlying the rib, on the affected side With theother hand, cup the client's elbow You will usethe hand on the client's elbow to provide resis-tance to an isometric movement of her arm.Have the client initiate a small movement of herarm, as if she is beginningto bring her elbowback down toward the table, (so it would restdirectly next toher torso) At the same time, pro-vide gentle but firm resistance to the client'sattempted movement so her arm stays basicallystill.See Figure 2.13

NOTE: This is NOT a contest of strength

The most common error made with the isomerricrelease is to use too much muscle contractionwhich brings the focus of the movement into the

1

2 Use an isotonic mther than an isometric This

is similar to the standard isometric release.However, as the client attempts to move herelbow down toward the fable, instead of resist-ing the movement completely, slowly allow herelbowto move toward the tablc as you contin-

ue offering some resistance

3 With the client supine, scand at the side of themassage 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; herarmpit will beagainst 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 andhold for 10 seconds Havc the client relax herarm as you follow through on her attemptedmovement by drawing the shoulder downtoward her foot Then, as in the standard iso-metric, draw the client's bent elbow out to theside and compress up the line of the arm intothe shoulder

If this isometric does not completely release thefirst rib, try one of the variations listed below, orthe positional release that follows

Variations on the Isometric

1 Try the isometric movementat various angles(i.e., with the arm next to the torso; pushingrhe elbow straight out to the side; pushing fromthe shoulder straight up toward the head, etc.)

40

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

Ortho-Bionomy

Figure 2.14

Agure 2.13

Hold the isometric for approximately 10 seconds

Have the client relax her arm asyou 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.

First Rib - POSiti01UlI Release

With the client in a supine or side posture, shrug hisshoulder up towards his ear Compress straight intothe shoulder joint/upper rilxagc from the outside

edgeof the shoulder.See Figures 2.15 and 2.16.

t.lonilOf the muscles at thetopofthe shoulder andchoose the position that maximizes softening andcomfort in these muscles Hold for 10 60 seconds,

then re-check the first rib

Figure2.15

Figure2.16

If thisposition does not completely release thefir5frib,tryvariations on positions (i.e., with theann out to the side, with the shoulder rolled for~

ward) until you find one thatworks

Vertebral Column & Thorax - First Rib

FIRST RELEASE INDICATORS

RIBS-Ifthere arc no other imbalances present:

• The muscles at the top of the shoulderwill bemore relaxed and comfortable

• The first rib itself will have increased flexibilityand comfort on contact

Notes

The word "isometric" means same (iso) measure

or length (metric) An isometric exercise is defined

"Contraction of a muscle that is not accompanied

by movement of the joints that would normally bemoved by that muscle's action The muscle length

is not changed by this type of exercise."

The word "isotonic" means same (iso) tone (tonic).Taber's defines an isotonic exercise as: " equaltension on the muscle is maintained while thelength of the muscle is decreased Contraction

of a muscle during which the force of resistance

to the movement remains constant throughout theranb'C of motion."

BS - At'lATOMY

·1/I"stmtiorlS2.5 and 2.6

THORACIC SPINE AND RIBCAGE

,I1C:t-- ElEVENTHAND

TWELFTH-FLOATING-

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

>\-mthand twelfth ribs are called floating ribs

causetheyconnect only to the thoracic spine

d hue no attachment to the sternum The

mus-:sbl:tween the ribs, called the intercostals, assist

chtbteathing process and give the ribcage addi·

, 031St3biliry

Itbones oftheindividual ribs are quite flexible, as

dJ:ribcage as a whole This flexibility allows the

ngrto do its job of surrounding and protecting

Vertebral Column & Thorax - Ribs

Before you begin, you may wanttovisually checkthe ribcage for its balance As mentioned in theanatomy section, the physical shape of the ribcagedoes not necessarily indicate its actual conditionand function However, the shape of the ribcagemay provide dues regarding an imbalance Forexample you may see that one side of the ribcageappears to besmalJer than the othet: This mightindicate that the ribcage is constricted on thatside, or that there is a rotational tension pattern,making it appear smaller

Ifthe imbalance in the ribcage is due to an overallpattern of distortion, ot to minor distortions insome of the ribs, a general release movement may

be sufficient to restore balance and f1exibiliry

43

Ribs - General Evaluation / Release

The general evaluation/release movements maybe

done with the client either prone or supine The

ribcage will have more general movemenravail~

able when the client is supine

I Gently rock the client's ribcage directly from

one side to the other (laterally) Notice if there

ISmore mo"ement, or more case of mO''emcnt

in one direction or the other Gently pull the

ribcageinthe direction of greatest movement

and hold for 10-60 seconds.See Figure 2.17.

Release the position and re-ehcek the movement

If one side is resisting compression toward thetable, you may lift that side and, if comfortable,compress the opposite side toward the table

See Figure 2.19.

3 Gently flex each side of the client's ribcagedown 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 sidetoward the dient's feet Hold for ID-60 sec-onds, release the position and re-check themovement

You may use the pattern of three breaths, asdescribed in the Specific Release section,toincrease compression in the ribcage during thegeneral release positions