IFR Testimonials June 2010 London Course

The Course

Very good course, enlightening….definite catalyst for further study

The practical application of the IFR throughout the course & the realization of the importance of light touch & the speed at which release happens.

Practical element, global approach to dysfunction.

Sharing with such an advanced group. Radically different paradigm of treatment.

I feel I”ve gained a real understanding of how applying very little pressure you can get great results with the client. Doing the course has opened my eyes to a whole new area which resonates much more with me than my traditional sports massage. John D.

Very enjoyable course!

Lecturer very enthusiatic, great knowledge, good use of case studies & ””””making it real.””””

Helpful in terms of individuals putting the basics together.

Informal & not too clinical. taking into account responses from the ANS autonomic nervous system.

The course, the content & how Steven was able with his eloquence & simplicity to convey material.  it was both fun & stimulating, challenging and made a lot of sense. Mary C.

The Lecturer

Lecturer very enthusiastic, great knowledge, good use of case studies & ””””making it real.””””

Helpful in terms of individuals putting the basics together.

Very interesting, friendly & accessible. Able to adapt to all levels. Very tuned to class in maintaining concentration & not overloading (unless on purpose!)

Was fantastic! depth of knowledge was extensive, very approachable, passionate about the subject & took me to a new place in learning & understanding.  I am bewildered, unsure & very excited about what I have to learn. Trevor S

Exciting teaching style & delivery!

An ability to mix serious & fun, making a good learning environment. Peter C.

Teaches in an interesting & entertaining way that kept us engaged. Plenty of humor & clarity

Enjoyed watching integration of humor & visual images to explain complicated theories. Observing that “play” with tissues is very individualized & Steven is very accepting of that. Wendy H.

Dynamic, fun, exciting, loves what he does. Gets across the information in a simple understandable way. Peter M

Knowledgable, full of insight, very informative.

Brilliant & friendly…takes time to explain individually as well as the group.

The joy of learning this weekend and was in the ease & flow of how Steven conveyed his information-even the heavy-duty scientific knowledge & background. Mary C.

IFR Intermediate Calgary Oct 2009

Instructor Roy Smith enjoys some shoulder leverage compression with Steven

AAMT- Geelong-Surf Coast Feb 2010 Introductory Class #2

AAMT- Geelong-Surf Coast Feb 2010 Introductory Class

AAMT sponsored Victorian Division IFR Introductory Workshop held at Surf Coast Yoga Centre near Bells Beach.

We drew over 20 participants with excellent fundamentals instilled and easily applied techniques to utilize into their practice obtained!

Geelong-Surf Coast Vic IFR Intro Feb 2010

Geelong Surf Coast Shire IFR Introductory workshop was sponsored by AAMT Victoria Division in February 2010.

The turnout was excellent with 20+ participants, at a wonderful venue, the Surf Coast Yoga Centre near Bells Beach

Workshop was able to draw interest for a July 31st-August 1st workshop to be held at the Bellbrae Hall on School Road.

Fundamentals were introduced which included fascial line palpation of myofascial line tension.

The lines palpated included Superficial Front Line, Superficial Back Line & Lateral Line tension.

Osteopathic principles of ”ease” & ”bind”.

Basic MFR techniques included static compression at the high leverage points in the myofascial net, fundamentals about the Autonomic Nervous System, the use of the Two Point & the Fulcrum.

2011 Schedule-London & Edinburgh in March 2011

New Dates Confirmed for UK!

Bodywork Professional Development of the UK Presents

IFR Foundations Workshop-London, England

March 19-21st, 2011 Saturday to Monday

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Bodywork Professional Development of the UK Presents

IFR Fibromyalgia Workshop-Edinburgh, Scotland

March 26-27th, 2011

Venue: Scottish Massage Organization Conference Location TBA

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Bodywork Professional Development of the UK Presents

IFR Intermediate Workshop-London, England

April 1st-3rd, 2011 Friday to Sunday

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

NEW! Fascial Articulation Workshop NEW!

Fascial Articulations Concepts & Information

Fascial Articulations will be presented as a AAMT sponsored workshop for  AAMT Sydney-Post National Conference Workshop Monday May 24th, Cairns- Sunday July 25th,  Adelaide- Sunday August 8th & Hobart Sunday September 12th, 2010

A window of alternatives to the prevailing approach

This workshop has come about due to my attempt to present how I currently treat clients in my clinical practice.  As any practitioner can attest, the development of their skill and skill set evolves over time.  This process of learning takes the therapist along many avenues in their attempt to refine how to assess and deliver a consistent and quality outcome of manual therapy care.

The approach and style, the orientation of their understanding, and their passion for particular modalities, all create and embody the uniqueness and manner through which the artistic expression of the therapist shines forth.  My manner and expression has changed over time, and now the hybrid of my understanding allows me to enjoy and find playfulness in pursuit of passion and intuitiveness for soft-tissue dysfunction through the delivery of a variety of applications.

These applications consist of direct and indirect myofascial release, with an emphasis on autonomic expression that manipulates the sensory receptors of soft-tissue. I also learned from my studies and practice, that targeting muscles alone as the source of soft-tissue dysfunction will yield less than satisfactory results. This led me on a journey of investigating the nature of myofascial and from that, I now recognize clinically, as researchers have scientifically, that the myofascia is a dynamic partner in the tonality of the musculature.

What’s more interesting to my clinical experience is that the other main soft-tissue constituents; tendon, ligament and joint capsule, are all main contributors to the dynamic interplay of fibrosis, adhesion, congestion and excess tonality surrounding the musculature.

I tend to treat from a differing perspective. Whereas, most therapists assess and treat muscles at the beginning of a treatment, I employ most of my muscle applications towards the end of a treatment.  I’ll begin with assessment of the cardinal lines of myofascial tension (Myers 2000) and the high leverage points that anchor myofascial within the myofascial net (Schleip 2003).

The three main lines that correspond to main muscular and habitual patterns of motion that we all employ are:  sagittal which mediates flexion/extension, coronal/frontal which mediates abduction/adduction and horizontal/transverse which mediates rotation. Myers named these lines as SBL Superficial Back Line, SFL Superficial Front Line and LL lateral Line. The assessment of three cardinal lines ensure you a more global relaxation in the fascial tension and restoration of increase mobility corresponds along these lines.

Once I have assessed myofascial tension, I assess joint ROM from a fascial perspective. You may ask how can one assess from a myofascial perspective for ROM?  Essentially the distinct difference is not moving into the limit of anatomical integrity, instead the assessment of joint motion is confined to the level of first resistance. That is, where you feel the first tug, snag or glitch to the smoothness and quality of this motion. The reason is this will usually indicate the congestion of the connective tissue in the form of superficial fascia or fibrous connective tissue component as capsular or ligament restriction.

Remember myofascial surrounds each and every muscle group as a unit, muscle fibres and even muscle fascicles have a connective tissue wrapping. Therefore when you feel the first level of resistance you are keying into the first level of myofascial restriction that prohibits smooth joint motion.

I then move the joint through its muscular range but again feel the first level of restriction as it nears end feel.  Again the rationale is autonomic and neurological. When a therapist moves a muscle into its end range, and if restriction is present, the client will feel the pull or strain. When they feel the strain, they cannot help but to unconsciously guard or the very least, respond by flinching.

The guard response is what I’m attempting to avoid. Again if I can avoid any reactive distress by my passive range of motion assessment, I avoid moving the client back into a sympathetic state.  Micheal Shea (1995) is found of stating, and I quote; “all soft-tissue release is predicated on how the autonomic nervous system is discharging its impulses.”

The nervous system discharges, soft-tissue releases. You cannot accomplish soft-tissue change without a compliant nervous system.  That said, of course, if you are strategically deciding to assess ROM and need to employ a special test, say for example an anterior drawer test of the knee joint, you would use excessive force provocatively, as it is necessary to assess if anterior cruciate  ligaments are damaged.  This is referred to as a provocative test.  However, there is always a price to be paid from an autonomic or neurologic standpoint regarding excessive compressive force.  The body will always respond whether the practitioner is aware or unaware of this. You have chosen to over ride the ANS, by re-producing pain to substantiate your assessment or diagnosis. Once pain is provoked, the ability for the soft-tissue to change is diminished.  This is nervous system  Cause and Effect.  The sophistication of the central and autonomic nervous systems is a wonder to behold.

The other forgotten component in changing persistent and stubborn soft-tissue dysfunction is change to joint capsule and ligamentous structures. Although once considered inert and non-contractile structures, they are major contributors to the holding of tensional and tonal states of the muscles.  The sooner you understand that all the soft-tissue is in dynamic interplay, the better it is for you regarding your clinical outcomes.

Once assessment is complete, I initiate technique with the ANS autonomic nervous system in mind, to ‘settle the system’ by use of the gentle ‘Two Point’, this facilitates the ANS to enter into a parasympathetic state, with the lowering of high sympathetic tone (Shea 1995). The Two Point is applied either to transverse planes or the major peripheral joints, i.e. knee, ankle, shoulder, elbow or wrist.

This then leads me to address the quality and quantity of range regarding any involved joint by utilizing indirect technique approaches that are osteopathic in nature.  Among them is joint play, that is, combining accessory motion (anterior/posterior, lateral translation, distraction or rotational movements of approximated positions (close pack)), with crowding or approximation to the joint mechanoreceptors that facilitate a neurologic response of relaxation.

The other assessment component employed is the use of the assessment of ease or bind motion of the crowded joint by assessing the three planes of distortion within an ease or bind position.  This in osteopathic parlance is called stacking. Stacking is the engagement of two or more planes of distortion simultaneously to re-organize and transform congested soft-tissue.  It is a highly effective approach for changing proprioceptive mechanoreceptors in the joint capsule and surrounding ligamentous structures.

I address the musculature & joint restrictions by utilizing low load resistive (modified MET’s). This is directionally based rather than muscle specific. My intent is to target joint capsule, fibrous connective tissue responds well to low load resistives, thus joint capsule & ligaments respond to this type of technique.  Upon conclusion of all the above, I then address musculature. Clearly there are very appropriate times to address and release muscular hypertonicity straight way. My point is that when muscles are not responding or releasing, then you need to change your strategy and orientation.

FASCIAL PLANES OF DISTORTION

When palpating to distinguish the direction of a myofascial distortion, it is recommended that the therapist palpate the surface of the skin to determine the plane(s) of restriction. This method was first noted in osteopathic literature and is commonly held throughout all manual therapy disciplines.

The osteopathic concepts of ‘ease’ and ‘bind’ are assessed in two ways: either the direction of the restriction or barrier is palpated or the direction of the motion barrier or restriction is assess by PROM passive range of motion as a motion restriction. Ease is always away from the barrier or the greatest degree of movement. Bind is the barrier or where movement has the greatest degree of restriction

HOW TO LOCATE SUPERFICIAL FASCIA

Palpate the skin with your palm or fingertips in a manner that forms to the shape of the skin over the area you are palpating.  Do not tense your hand or forearm and your shoulders should be relaxed as you perform this assessment.

Next engage through the skin by increasing the depth of your pressure to the first layer of muscle, then back off. You should be between skin and muscle.  This is the space where superficial fascia resides. Palpation is to the first level or layer of restriction.

The skin should be assessed for its mobility.  Place your hands flat upon the surface of their skin and move the skin in all directions.  Ideally, the skin should move equally in all directions, except around tendinous insertions into osseous structures.  If it does not move well in a particular direction, this will indicate the underlying fascia is restricted.

If the skin does move in one particular plane of movement, say in a cephalic or sagittal direction, a myofascial technique can be applied in the direction of the restriction.

Skin adhesion is an indication of the ease or bind of the superficial fascia below it. You can easily assess fascial restriction by moving the skin over superficial fascial tissue. Assess the four cardinal directions by moving the skin proximal/distal medial/lateral or inferior/superior

DIRECT & INDIRECT TECHNIQUE: CONCEPTS OF EASE & BIND

The direction(s) the skin moves easily is called ‘ease’. The direction(s) that the skin resists moving is called ‘bind’. This is the method to assess planes of fascial distortion.

You engage bind by using a static compression of the skin into the superficial fascia and you will release the current assessed bind and create both a new ease and bind position.   If the skin moves easily in the area you are assessing, then you are probably able to use techniques that are more muscular oriented.  If however, the skin does not move easily, then in a general sense you are dealing with myofascial that needs to be released before you can achieve desired results from your muscular approaches.
This simple assessment can be utilized to assess superficial back and front line restrictions or lateral line restrictions. (Myers 2000) “Manual therapy comprises direct & indirect techniques.  Direct techniques load or bind tissue and structure. The tissue is moved towards a barrier on one or more planes.  The direction of displacement of the soft-tissue is in the least mobile, most restricted & most limited direction. Techniques are performed at or just before the barrier. The result is a change of the position of the barrier which will move closer to what would be the end of a more normal range of motion. For example, a direct approach might be employed to treat elbow flexion contracture with shortened and contracted biceps that limits elbow extension, a direct technique would be to move the elbow into extension. At the barrier, or just before the barrier at the interbarrier zone, a technique is performed with the result an increase in range of extension motion.

Indirect techniques unload or ease the tissue or structure.  The tissue is moved away from the barrier on one or more planes. The direction of movement of the tissue is the most mobile, least restricted, least limited direction. The distortion is thereby exacerbated.  The problem is exaggerated. For example, with limited extension, there is relatively too much flexion. The problem could be described as excessive flexion. The treatment would be towards flexion.  The result is a ‘release’ phenomenon: the soft-tissues “let go” of tension in a tissue tension release.” (Giammatteo & Kain, Integrative Manual Therapy 2005 Vol.4, p70 North Atlantic Books)

MYOFASCIAL SLEEVE RESTRICTIONS

Myofascia behaves as a superficial wrapping as seen from Serge Paoletti’s anterior fascia of the low extremity.
Which brings me to assessment & palpation of fascial sleeves. Most practitioners are used to assessing rotation of the humerus or femur which determines movement at the shoulder or hip.
Another assessment that can be included is assessment of restriction of upper or lower extremity fascial sleeves. This is assessment is crucial to improving motion at the joint and for allowing the smoother movement of the muscle through its fascial sheath.

When addressing the scapular complex (GH joint, AC joint, SC joint & scapula-thoracic joints, humeral ulnar, radial ulnar, radial carpal), sleeve restrictions often will be the first restriction to release.  Since myofascial loves to be encased through fascial ‘grasps’, this simple static compressive technique can clear fascial tissue quite quickly.

• Assess which direction of rotational restriction is ease and which direction is bind.
• Engage myofascial by using a grasp and apply the twist in the direction of ease to unload the tissue, or bind to load the tissue.
• Usually the engagement of the superficial myofascial wrapping is enough to create a myofascial glide, usually within 10-30 seconds. However if this isn’t successful, then here are some points to consider:
• From a palpation standpoint you are pressing too hard
• You will need to engage a second plane of fascial distortion, which is to put a direction or vector on the myofascial by creating a ‘lateral shear’. Osteopaths call this ‘stacking’
• You may ask the client to use slight movement as you engage the myofascial, usually in a rotational direction.
• Micheal Stansborough and other direct myofascial release authors call this Active Movement Participation AMP.
• You will find once you’ve cleared a rotational distortion or restriction you will increase ROM at the joint and the clarity of the restriction will become more focal.
• Myofascial restrictions & distortions will obscure the ability to distinctly palpate the muscular structure beneath it.

AAMT 2010 6th National Conference in Sydney

Australian Association of Massage Therapists

21-23 May 2010

6TH NATIONAL CONFERENCE Held at the Sydney Hilton

INCLUDING INTERNATIONAL PRESENTERS FROM THE USA & CANADA!

American presenter Whitney Lowe

Whitney Lowe has been a massage professional for over 20 years and is widely
known for his expertise in assessment and massage therapy treatment approaches
for chronic pain and injury conditions. His contributions to the massage fi eld are
wide-ranging and include extensive research and professional publications, teaching,
clinical work, consulting, and participation in national boards and committees.
Research and publication are a priority for Lowe. Lowe’s texts, Orthopedic
Assessment in Massage Therapy and Orthopedic Massage: Theory and Technique,
are used by massage therapy professionals and schools in their massage training
programs. In addition, he is a contributing author to several other books and his
articles appear regularly in professional peer-reviewed journals and popular
magazines, such as Massage Today, Massage & Bodywork and Massage Magazine.

Invitation
On behalf of the Australian Association of Massage Therapists (AAMT), it gives me great pleasure to invite you to attend our 6th National Conference, held at the Sydney Hilton, May 21-23 2010. For 2010, we are excited to announce 5 International presenters from North America offering a diverse and exciting selection of sessions to cover the wide interest of AAMT members: Whitney Lowe (Oregan, USA) – Orthopedic Assessment and Massage
John Barrera (Texas, USA) – Assessment and treatment techniques for the Atlas/Axis/Cranial base
Mya Breman (Florida, USA) – CranioSacral Therapy
Colleen MacDougall (Edmonton, Canada) – The regulatory changes in Alberta, Canada and the effects to membership
Paul Buffel (Saskatoon, Canada) – Yoga presentation
Importantly, I would like to thank those who attended our 2009 national conference in Hobart and took time to fill out session feedback forms and rated the overall success of the conference. Once again, we have created a streamed program, which will result in every delegate having an opportunity to be involved in a hands-on workshop on one of the afternoons. Needless to say, workshop allocations are done on a fi rst in fi rst served basis so please register early to avoid disappointment.
As with all past AAMT conferences, the Gala Dinner ticket is included and I strongly encourage you to attend this important event, which includes a 3-course dinner and beverages. It is also the time to let your hair down and have fun with like-minded people in our industry. Please note that there is no discount on conference fees for delegates unable to attend our Gala Dinner, as we negotiate venue costs based on a variety of expenses and catering makes up a large part of this.
Finally, I’d like to thank our sponsors and trade exhibitors for their generous support and we look forward to seeing you at our 6th AAMT National Conference in Sydney.
CU in Sydney!

David Sheehan
AAMT Conference Coordinator
CPE Points

This is an offi cial AAMT event and will attract 40 CPE points to registered members
of the AAMT. The program in this brochure may be subject to change.

PRINCIPAL SPEAKERS

John D. Barrera

John D. Barrera is a clinical Massage Therapist and International presenter with over 25 years of active medical/clinical massage experience. He has spent the last nine years furthering the development of Atlas/Axis/ Cranial Base balancing for the massage therapist.
John has authored three measurement and treatment strategy flow charts that will further the understanding of the massage therapist and other allied health professionals in this emerging and fascinating field of study. The Atlas/Axis/Cranial Base Connection could be an answer to relentless head, neck and body pain.

Mya Breman

Mya’s career underwent a drastic shift when she left TV and radio to join the Upledger Institute as marketing director in 1989. Impressed by the results, she returned to school to study manual therapy. She has now become an experienced Licensed Clinical Social Worker and extremely fortunate to be mentored by Dr. Upledger in CranioSacral Therapy and Dr. Bruno Chikly in Lymphatic Drainage Therapy. She loves blending structural and emotional therapy in everyday problem solving, as well as, the most complex trauma. In addition to seeing private clients at UI HealthPlex, she frequently lectures at conventions, conferences and schools worldwide.

Susan Davis

Susan Davis is a registered nurse, holds a B.HSc and several diplomas in the practice of remedial massage therapy. She has been in the massage profession for over 30 years.
Susan has continued her education at the leading edge of developing knowledge. She teaches
practical massage at Sydney University and has been a mentor to many young therapists through the Davis Health Centre. Susan is completing her Masters in Lifestyle Medicine under Professor Garry Egger. Her thesis on the relationship of musculoskeletal pain and disorders as an indicator of more serious chronic lifestyle issues is the cornerstone of her presentation at the conference.

Paul Hermann

Paul is an Osteopath and one of Australia’s leading experts in Swiss Ball Training and Exercise Rehabilitation. He is the owner and Director of Stay Tuned Sports Medicine and has worked in the Health and Fitness industry for over 17 years as a Gym Instructor, Personal Trainer, Coordinator of successful exercise rehabilitation programs, and lectures nationally and internationally.

Richard Hill

Richard Hill is internationally regarded for his knowledge and understanding of the workings of the brain, body and mind. He specialises in the interplay between the mind and the body and how the conversation in both directions alters the way we function both physically, behaviourally and neurobiologically. He has spoken at the AAMT National Conference in 2008 and at the National Health Practitioners of Canada Conference in 2009. He lectures to the psychotherapy profession and the business community making the very complicated
processes of brain, mind and body easy to understand.

Brad Hiskins

Brad is a veteran of the Sports Soft Tissue Industry with 11 years at the Australian Institute of Sport, four Olympic Games (two as Head Soft Tissue Therapist), two Commonwealth Games (both as Head STT) and 19 world championships with varying teams. Brad is the founder of the website ‘soft tissue therapy’ and the STT eMag. He currently operates Clinic 88 and also treats in 8 health clinics in Canberra and the East Coast while teaching nerve assessment and treatment at Canberra Institute of Technology. Brad has 55 published articles in numerous
magazines and journals and was a contributor to the development of Australia’s national competency standards.

Paula Nutting

Paula has been involved in the musculo-skeletal fi elds in many facets; nursing, remedial massage, personal training and cemented her studies with the Musculo-skeletal Degree. Her work concentrates in the muscle timing dysfunctions and how it creates many of the common conditions seen by practitioners.

2010-2011 Schedule New!

AAMT Sponsored IFR Introductory Workshop

February 21st, 2010 in  Geelong, Victoria

Scheduled for Geelong, Victoria Sunday February 21st

Contact: Pippa Tuppen for registration & costs

Continuing Learning Officer AAMT
Level 6, 85 Queen Street,Melbourne  VIC  3000

Phone: 1300 138 872    fax:      03 9602 3088
Email: pippa@aamt.com.au Web: www.aamt.com.au

AAMT Sponsored IFR Introductory Workshop

February 28th, 2010 in Newcastle, NSW

Scheduled for Newcastle (Hunter), NSW Sunday February 28th, 2010

Contact: Pippa Tuppen for registration & costs

Continuing Learning Officer AAMT
Level 6, 85 Queen Street,Melbourne  VIC  3000

Phone: 1300 138 872    fax:      03 9602 3088
Email: pippa@aamt.com.au Web: www.aamt.com.au

IFR Foundations 3 Day Course March 12-14th, 2010

Armidale, NSW

Scheduled for Armidale, NSW March 12-14th, 2010

Cost: Early Bird Registion before February 14th $575

$625 includes morning & afternoon tea

Armidale Bowling Club, Armidale, NSW

Contact Katie Byrnes  0428 438 580

AAMT Sponsored IFR Introductory Workshop

April 10th, 2010 Brisbane, Queensland

Scheduled for Brisbane, Queensland Saturday April 10th, 2010

Contact: Pippa Tuppen for registration & costs

Continuing Learning Officer AAMT
Level 6, 85 Queen Street,Melbourne  VIC  3000

Phone: 1300 138 872    fax:      03 9602 3088
Email: pippa@aamt.com.au Web: www.aamt.com.au

AAMT Sponsored Sydney Post Conference

One Day Workshop: May 24th, 2010

IFR Fascial Articulations for the Shoulder & Pelvis

Scheduled for Sydney, NSW, Monday May 24th, 2010

Contact: Pippa Tuppen for registration & costs

Continuing Learning Officer AAMT
Level 6, 85 Queen Street,Melbourne  VIC  3000

Phone: 1300 138 872    fax:      03 9602 3088
Email: pippa@aamt.com.au Web: www.aamt.com.au

Bodywork Professional Development of the UK Presents

IFR Foundations Workshop-London, England

June 25-27th, 2010

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

IFR Level 1  Geelong, Victoria

July 31st-August 1st, 2010

Scheduled for Geelong, Victoria

VENUE TBA

To register contact Steven Goldstein
Phone: 0402 068 658 Email: myofascia@optusnet.com.au

AAMT Sponsored IFR Introductory Workshop

Sunday, August 8th, 2010 Hobart, Tasmania

Venue TBA

Contact: Pippa Tuppen for registration & costs

Continuing Learning Officer AAMT
Level 6, 85 Queen Street,Melbourne  VIC  3000

Phone: 1300 138 872    fax:      03 9602 3088
Email: pippa@aamt.com.au Web: www.aamt.com.au

IFR Level One – Perth, Western Australia

August 28-29th, 2010

Scheduled for Perth, Western Australia Date: August 21-22nd, 2010

Venue: Endeavour College of Natural Health

170 Wellington Street, East Perth, WA

Cost $495 Practicing Therapists/$375 Students in Diploma of Massage Programs/Deposit Required $250

To register contact Steven Goldstein
Phone: 0402 068 658 Email: myofascia@optusnet.com.au

AAMT Sponsored IFR Introductory Workshop

Sunday, September 12th, 2010 Adelaide, SA

Venue TBA

Contact: Pippa Tuppen for registration & costs

Continuing Learning Officer AAMT
Level 6, 85 Queen Street,Melbourne  VIC  3000

Phone: 1300 138 872    fax:      03 9602 3088
Email: pippa@aamt.com.au Web: www.aamt.com.au

Fibromyagia One Day Workshop

Sunday September 19th, 2010

Includes Fibromyalgia DVD & Manual

Scheduled for: Melbourne, Victoria, Australia Date: September 19th,  2010

Cost: $245
Venue:
Melbourne High School-South Yarra Sports Centre
679 Chapel Street, South Yarra, Victoria

To register contact Steven Goldstein
Phone: 0402 068 658  Email: myofascia@optusnet.com.au

Fibromyalgia:

Clinical Approaches for the Manual Therapist

October 16-17th, 2010 Central Washington State, USA

Venue: Barlen Institute of Massage-ellensburg, Washington

201 N. Pine
Ellensburg, WA 98926

509.962.3535
info@barleninstitute.com
Fax 509.962.3185

IFR Foundations Workshop-Pacific Northwest USA

October 22-24th, 2010 Seattle, Washington

Venue Seattle, Washington: Cortiva Institute Seattle

Catherine (Weigel) North, LMP
Manager of Continuing Education
Cortiva Institute – Seattle
425 Pontius Ave. N. #100 . Seattle . WA . 98109
t 206-204-3143 (direct) f 206-282-9183
e cnorth@cortiva.com  http://www.cortiva.com

AAMT Sponsored IFR Introductory Workshop

Sunday, November 14th, 2010 Cairns, Queensland

Venue TBA

Contact: Pippa Tuppen for registration & costs

Continuing Learning Officer AAMT
Level 6, 85 Queen Street,Melbourne  VIC  3000

Phone: 1300 138 872    fax:      03 9602 3088
Email: pippa@aamt.com.au Web: www.aamt.com.au

IFR Level 3 Melbourne Course

November 27-28th, 2010

Scheduled for: Melbourne, Victoria, Australia Date: July 10-11th, 2010

Cost: $425
Venue:
Melbourne High School-South Yarra Sports Centre
679 Chapel Street, South Yarra, Victoria

To register contact Steven Goldstein
Phone: 0402 068 658 Email: myofascia@optusnet.com.au

Bodywork Professional Development of the UK Presents

IFR Foundations Workshop-London, England

March 19-21st, 2011 Saturday to Monday

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Bodywork Professional Development of the UK Presents

IFR Fibromyalgia Workshop-Edinburgh, Scotland

March 26-27th, 2011

Venue: Scottish Massage Organization Conference Location TBA

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Bodywork Professional Development of the UK Presents

IFR Intermediate Workshop-London, England

April 1st-3rd, 2011 Friday to Sunday

Venue: London, England: British School of Osteopathy

Contact Nicola Brooks T +44 (0)7526 925734

http://www.bodyworkcpd.co.uk/

info@bodyworkcpd.co.uk

Fibromyalgia:New Perspectives for the Manual Therapist



Introduction

By Steven Goldstein BHSc MST, BA Education

Fibromyalgia classically presents as wide spread musculoskeletal pain and we know that the origin of this pain is multifaceted and systemic.  Because of this, a more comprehensive understanding is required of you to be successful in your treatment options.  In this article I’m going to introduce the concept of ‘Central Sensitization’,  a fibromyalgia research blog, and the FIQ Fibromyalgia Impact Questionaire. All three of these components will give you a greater understanding of how to work with and treat your Fibromyalgia client.

There has been much written regarding Fibromyalgia and Massage Therapy, but a short review may be in order to the salient features of the syndrome.

Fibromyalgia FMS is a syndrome that is considered by many to be a chronic, culmative overload of the body’s coping and cushioning mechanisms (1. Gillick) in which on going residuals of macro-traumas (whiplash, system disorders, post traumatic stress syndrome, are perpetuated with numerous and cumulative micro-traumas (chronic sinusitis, repeated impact trauma, musculoskeletal dysfunction in the upper or lower extremities, positional sleep traumas) which sensitizes the central nervous system in such a manner as to amplify pain 24/7 and create pain from usually non-painful stimuli.

This is known as Hyperalgesia: the amplification of pain sensations and Allodynia: non-painful sensations such as touch, noise, vibration, lights or smells are painful.

Prevalence indicates usually affecting women over men by a 4/1 ratio, but Fibromyalgia can occur at any age. Although it usually manifests between the ages of 30 to 50. (Rattray p983)

There is an enormity of presenting symptoms with a wide range of variance as to fool the manual therapist, and probably the best source for the presenting symptoms would be to check out Dr. Devin Starlanyl’s website: http://homepages.sover.net/~devstar/.  I’ll cover presenting symptoms in a subsequent  article.

Central Sensitization

“Fibromyalgia (FM) pain is frequent in the general population but its pathogenesis is only poorly understood. Many recent studies have emphasized the role of central nervous system pain processing abnormalities in FM, including central sensitization and inadequate pain inhibition. However, increasing evidence points towards peripheral tissues as relevant contributors of painful impulse input that might either initiate or maintain central sensitization, or both.

It is well known that persistent or intense nociception can lead to neuroplastic changes in the spinal cord and brain, resulting in central sensitization and pain. This mechanism represents a hallmark of FM and many other chronic pain syndromes, including irritable bowel syndrome, temporomandibular disorder, migraine, and low back pain. Importantly, after central sensitization has been established only minimal nociceptive input is required for the maintenance of the chronic pain state.  Additional factors, including pain related negative affect and poor sleep have been shown to significantly contribute to clinical FM pain. Better understanding of these mechanisms and their relationship to central sensitization and clinical pain will provide new approaches for the prevention and treatment of FM and other chronic pain syndromes.”

Central sensitisation is defined as ‘‘an augmentation of responsiveness of central pain-signalling neurons to input from low-threshold mechanoreceptors’’ (Meyer et al.,1995). “While peripheral sensitisation is a local phenomenon, central sensitisation means that central pain processing pathways localised in the spinal cord and the brain are sensitised.”

The science is fascinating, but the clinical implications through the application of this understanding is essential.  An important and ongoing source of pain is required before the process of peripheral sensitisation can establish central sensitisation. Progression towards chronic widespread pain is associated with injuries to deep tissues which do not heal within several months (Vierck, 2006).

Consequently, appropriate and effective manual therapy in those with (sub)acute musculoskeletal disorders is important to prevent evolvement from an acute, localized musculoskeletal pain problem to complex clinical cases, characterised by chronic widespread pain and even symptoms outside the musculoskeletal system such as increased sensitivity to bright lights, auditory loudness, odours, and other sensory stimuli. Pain due to damage or inflammation of peripheral tissues is clearly capable of causing chronic widespread pain/FM (Clauw, 2007). 15-20% people with whiplash injuries develop chronic pain and disability (Spitzer et al., 1995; Radanov and Sturzenegger, 1996; Coˆ te´ et al., 2001). Regardless of whether FM is present in chronic whiplash, altered central pain processing and central sensitisation is evident (Curatolo et al., 2001; Sterling et al., 2002, 2003, 2006; Banic et al., 2004). Moreover, altered central pain processing rather than impaired motor control has been identified as one of the prime prognostic factors for developing chronic whiplash (Sterling et al., 2003, 2006).

Excerpted below from ‘From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: Application of pain neurophysiology in manual therapy practice .’

Science Direct Manual Therapy 14 (2009) 3e12

Myofascial Treatment

“Anecdotally, muscles and fascia often become hypertonic and develop trigger points in people with chronic widespread pain/FM. Soft-tissue mobilisation is required to free up restrictions and restores local blood flow. However, it is important not to increase pain during treatment. The vicinity of myofascial trigger points differs from normal muscle tissue by its lower pH levels (i.e. more acid), increased levels of substance P, calcitonin gene-related peptide, tumour necrosis factor-a and interleukine-1b, each of which has its role in increasing pain sensitivity (Shah et al., 2005). Sensitised muscle nociceptors are more easily activated and may respond to normally innocuous and weak stimuli such as light pressure and muscle movement (Shah et al., 2005). Therefore, starting the soft-tissue mobilisation superficially with well-tolerated strokes along the length of the muscle fibres (referred to as ‘stripping’ in Benjamin and Tappan, 2005) and progressing towards deeper strokes that go perpendicular to the soft-tissue fibres is recommended Aggressive ways of treating trigger points (e.g. by using ischaemic pressure) are usually not well tolerated and therefore not recommended.”

The research is clearly demonstrating a lighter approach is needed when applying soft-tissue therapies with the sufferer of fibromyalgia.  We know from the studies of ‘facilitation’ with regard to active and latent trigger points, that once the dorsal horn of the spinal cord is switched on, it maintains its’ ‘facilitation’, with a low thresh hold  barrage of stimulus.

An awareness is needed of the mechanisms that activate the autonomic nervous system, such as ‘flight and fight’; and the de-activation of ‘high sympathetic tone’ (Shea 1995), so that the therapist modulates the ANS from a lower sympathetic state into a parasympathetic state which is demonstrated by ‘rest and repose’. With this type of client, modification of duration of treatment, amount of force or pressure and specific tissues totarget, i.e., myofascial tissue, are all essential to a greater degree of success through the cessation of the barrage of nocioceptive stimulus.

The clinical approach I utilize, uses a skill set that employs lighter touch, autonomic nervous system modulation, the use of mind-body techniques such as neuro-linguistic programming (NLP), awareness and imagery technique, along with low load resistive for targeting intrinsic ligament and axial spinal muscle groups, forms of applied kinesiology, reflexology; all have efficacy in the treatment application of the sufferer of fibromyalgia.

Finally remember you have to have a strong referral network due to the systemic nature of the presentation, that means you need to refer to qualified therapists who practice CAM therapies, including naturopaths, CAM therapy friendly allopath physicians, mind body therapists, rheumatologists, and cognitive therapists that deal with emotional and psychological issues that are part of the overall clinical picture.

Fibromyalgia Impact Questionnaire

A very important tool for the manual therapist in their treatment of Fibromyalgia is the FIQ or Fibromyalgia Questionaire.  This is the tool recognized for use in clinical trials around the world, and therefore is the major current tool to measure changeable outcomes for your client.

It was developed by Dr. Robert Bennett in the 1980’s in Portland Oregon in an attempt to capture the total spectrum of problems related to fibromyalgia and the responses to therapy. It was first published in 1991 and since that time has been extensively used as an index of therapeutic efficacy. Overall, it has been shown to have a credible construct validity, reliable test-retest characteristics and a good sensitivity in demonstrating therapeutic change. The original questionnaire was modified in 1997 and 2002, to reflect ongoing experience with the instrument and to clarify the scoring system. The latest version of the FIQ can be found at the web site of the Oregon Fibromyalgia Foundation (www.myalgia.com / F I Q / F I Q). The FIQ has now been translated into eight languages, and the translated versions have shown operating characteristics similar to the English version.

Based on an intake questionnaire used in the OHSU Rheumatology Clinic and informal discussions with fibromyalgia patients, the initial version of the FIQ was developed in 1986. In particular, the functional component of the questionnaire was purposely biased to the use of large muscle groups rather than fine hand movements.

Make sure you download the questionnaire and thoroughly read the research behind the study, as it will allow you the insight about how the questions were formed and why they were asked. In particular the scoring is designed to target physical functioning versus physical impairment. The categories are such as to ascertain how ADL activities of Daily Living are affected.

Every client should be filling out this questionnaire and then you actually have the ‘research tool’ in your hand to validate and contribute to studies and findings from a research perspective.

FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQ)

Name: _________________________________ Date:           /             /

Directions: For questions 1 through 11, please circle the number that best describes how you did overall for the past week. If you don””t normally do something that is asked, cross the question out.

Always  Most  Occasionally Never

Were you able to :

1. Do shopping? ……………………………………………         0                  1                    2                3

2. Do laundry with a washer and dryer? ……..             0                   1                  2                 3

3. Prepare meals? …………………………………..              0                   1                  2                 3

4. Wash dishes/cooking utensils by hand?…..            0                   1                  2                   3

5. Vacuum a rug?…………………………………….             0                   1                  2                   3

6. Make beds? ………………………………………..              0                  1                  2                  3

7. Walk several blocks? …………………………..               0                   1                  2                  3

8. Visit friends or relatives? ………………………             0                   1                  2                  3

9. Do yard work?……………………………………..             0                   1                  2                 3

10. Drive a car? ………………………………………..           0                    1                2                  3

11. Climb stairs? ………………………………………             0                    1                2                  3

12. Of the 7 days in the past week, how many days did you feel good?
0      1      2      3      4      5      6      7
13. How many days last week did you miss work, including housework, because of fibromyalgia?
0      1      2      3      4       5      6      7

FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQ) – page 2

Directions: For the remaining items, mark the point on the line that best indicates how you felt overall for the past week.

14. When you worked, how much did pain or other symptoms of your fibromyalgia interfere with your ability to do your work, including housework?

●___І ___І___І ___І___І ___І ___І ___І ___І___●

No problem with work            Great difficulty with work

15. How bad has your pain been?

●___І ___І___І ___І___І ___І ___І ___І ___І___●

No pain                                                           Very severe pain

16. How tired have you been?

●___І ___І___І ___І___І ___І ___І ___І ___І___●

No tiredness                                                              Very tired

17. How have you felt when you get up in the morning?

●___І ___І___І ___І___І ___І ___І ___І ___І___●

Awoke well rested                                    Awoke very tired

18. How bad has your stiffness been?

●___І ___І___І ___І___І ___І ___І ___І ___І___●

No stiffness                                                                   Very stiff

19. How nervous or anxious have you felt?

●___І ___І___І ___І___І ___І ___І ___І ___І___●

Not anxious                                                         Very anxious

20. How depressed or blue have you felt?

●___І ___І___І ___І___І ___І ___І ___І ___І___●

Not depressed                                               Very depressed

See Dr. Robert Bennett FIQ Abstract as a PDF file download for results of clinical study.

Robert Bennett, MD, FRCP, FACP, Professor of Medicine, Department of Medicine (OP09), Oregon Health and Science University, Portland, OR 97329, USA. E-mail: bennetrob1@comcast.net Clin Exp Rheumatol 2005; 23 (Suppl. 39):S154-S162.

© Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2005.

Current Clinical Studies

(from the The Fibromyalgia Research Blog http://www.blogcatalog.com/blogs/fibromyalgia-research-blog.html)

If your going to stay ahead of your contemporaries as a therapist, then you need to maintain and seek out current evidence based research about the condition you are specializing in. We live in an age of information overload, however that can be an advantage for the therapist if you can select material to wade through that is relavant to your interest. I subscribe through my email inbox, to numerous journals and blogs which automatically send me the latest research. Here are examples of studies from the Fibromyalgia Research Blog….

Sunday, December 21, 2008

Biochemical Basis of Myofascial Pain Syndrome

Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome is the title of an article published by members of the Rehabilitation Medicine Department of the National Institutes of Health (Bethesda, MD). The article “discusses muscle pain concepts in the context of myofascial pain syndrome (MPS) and summarizes microdialysis studies that have surveyed the biochemical basis of this musculoskeletal pain condition.” Myofascial pain condition is extremely common in fibromyalgia patients, though it is unclear whether MPS can cause fibromyalgia or vice versa.

The pathophysiology of MPS is “only beginning to be understood due to its enormous complexity.” It is considered to be characterized by the presence of myofascial trigger points (MTrPs), which should not be confused with fibromyalgia tender points. Myofascial trigger points are hyperirritable nodules located within a taut band of skeletal muscle. These bumps or bands can usually be felt through the skin. The authors of this article write that “MTrPs may be active (spontaneously painful and symptomatic) or latent (non-spontaneously painful).” Active trigger points can refer pain to other parts of the body as well as being painful to direct touch.

Painful MTrPs activate muscle nociceptors that, upon sustained noxious stimulation, initiate motor and sensory changes in the peripheral and central nervous systems. This process is called sensitization. The researchers sought to discover what influences this sensitization process using a microdialysis technique that was created in order to “quantitatively measure the biochemical milieu of skeletal muscle.”

They found significant biochemical differences between active and latent myofascial trigger points (MTrPs) as well as biochemical differences between healthy muscle tissue and muscle tissue afflicted with trigger points.

Sunday, December 21, 2008

40% of Patients with Cervical (Neck) Myofascial Pain Syndrome Also Have Fibromyalgia

A study from Selcuk University in Turkey (PMID: 19085177) recently analyzed the demographic features, clinical findings and functional status of a group of cervical (neck) myofascial pain syndrome patients. They evaluated the patients using the short form health survey (SF-36), pain and depression levels, patient demographics and physical examinations. They used the visual analog scale, Beck Depression Inventory, and medical history to evaluate the patients. A total of 82 patients had a diagnosis of cervical myofascial syndrome. Almost 88% of these patients were female, and they were around 37 years of age on average. 53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign Joint hypermobility syndrome.

They concluded that younger female patients who present with autonomic system dysfunctions and early onset cervical spine injury should be “examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients.”

Sunday, November 08, 2009

Changes in Hippocampal Metabolites After Effective Fibromyalgia Treatment

The Clinical Journal of Pain just published a case study that evaluates the impact of fibromyalgia on hippocampal brain metabolite ratios. Researchers at the Department of Family Medicine, Anesthesiology and Psychiatry at Louisiana State University”””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””’’s Biomedical Research Institute based this case study on the results of previous studies that used single voxel magnetic resonance spectroscopy (1H-MRS) to reveal an association between fibromyalgia and disruptions in hippocampal brain metabolite ratios in fibromyalgia patients with no psychiatric conditions. The hippocampus is an area of the brain located in the temporal lobes and near the amygdala. It is part of the limbic system and is involved in long-term memory (it”””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””’’s the first area to be affected by Alzheimer”””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””’’s Disease) as well as spatial navigation. It is extremely vulnerable to stress.

Exposure to stress is considered a risk factor for the development and exacerbation of fibromyalgia symptoms. Basic science has demonstrated the hippocampus to be exquisitely sensitive to the effects of stressful experience, which results in changes including alterations in metabolite content and frank atrophy.

The case study detailed in the report is of a 47-year old female fibromyalgia patient who, when evaluated, was shown to have a “profound depression of the ratio of N-acetylaspartate to creatine in her right hippocampus” when she participated in another study assessing brain metabolite disturbances in fibromyalgia. This irregularity had been diagnosed using single voxel proton magnetic resonance spectroscopy. The research team came up with an individualized treatment strategy based on the “physiological abnormalities associated with the disorder and symptoms that characterized the patient”””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””””’’s unique clinical profile.” What they discovered upon evaluating her after nine months of treatment was an “improvement in her clinical profile and normalization of the NAA/Cr ratio within her right hippocampus.” The researchers concluded that:

Therapeutic strategies aimed at demonstrable lesions associated with fibromyalgia appear to represent rational targets for pharmacological intervention. The rationale for development of novel pharmacotherapies for this unusual disorder is discussed.

Study Details: Clin J Pain. 2009 Nov-Dec;25(9):810-4. PMID: 19851163.

References

1. DR. John S. Gillick, How to Tame Fibromyalgia © 2001 This is the original paper presented for the first time at the American Occupational Health Conference on April 26, 2001 in San Francisco California by Dr. John Gillick of UCSD San Diego

2. Rattray F. & Ludwig L. Clinical Massage Therapy: Talus Inc. Toronto, Ontoario, Canada, 2000. Fibromalgia & Chronic Fatique Syndrome p 981

3. Science Direct: From acute musculoskeletal pain to chronic widespreadpain and fibromyalgia: Application of pain neurophysiology in manual therapy practice. Jo Nijs a,b,*, Boudewijn Van Houdenhove c
a Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Belgium b Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, University College Antwerp, Van Aertselaerstraat 31, B-2170 Merksem, Belgium c Faculty of Medicine, Katholieke Universiteit Leuven, Belgium Received 4 December 2007; accepted 9 March 2008

4. Benjamin PJ, Tappan FM. Tappan’s handbook of healing massage techniques. Classic, holistic, and emerging methods. New Jersey: Pearson Prentice Hall; 2005. p. 127.

5. Clauw DJ. Fibromyalgia: update on mechanisms and management. Journal of Clinical Rheumatology 2007;13:102e9.

6. Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, et al. Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining ‘‘whiplash’’ and its management. Spine 1995;20:S1e73.

7. Sterling M, Treleaven J, Edwards S, Jull G. Pressure pain thresholds in chronic whiplash associated disorder: further evidence of altered central pain processing. Journal ofMusculoskeletal Pain 2002;10:69e81.

8. Shah JP, Philips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. Journal of Applied Physiology 2005; 99:1977e84.

9. Vierck CJ. Mechanisms underlying development of spatial distributed chronic pain (fibromyalgia). Pain 2006;124:242e63.

10. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Robert Bennett, MD, FRCP, FACP, Professor of Medicine, Department of Medicine
(OP09), Oregon Health and Science University, Portland, OR 97329, USA.E-mail: bennetrob1@comcast.net
Clin Exp Rheumatol 2005; 23 (Suppl. 39): S154-S162.© Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2005.

11. Fibromyalgia Syndrome: An Overview: Susan Krsnich-Shriwise  Phys Ther. 1997;77:68-75.1

1st IFR Intermediate Workshop in Calgary, Alberta Oct 2009

IFR Foundations Class in Edmonton October 2009

Each Foundations class has a different flavour for an instructor…what I can say generally about Canadian practitioners that is different from their American or Australian counterparts, is that their somatic education  is much more institutionalized in the delivery of their underpining knowledge….NHP Canada fosters this and several of the provinces allow for much more somatic content and exploration…that said these participants in my workshops already understand indirect technique, energetic approaches and to a certain part somato-emotional release.  It is an honour and privilege to travel with these folks to interesting places and great heights….

Fibromyalgia Workshop at NHP Canada National Conference in Saskatoon, Saskatchewan October 2009

Practicing Spinal Awareness Exercise

I was able to present at the 21st National NHP Canada conference my Fibromyalgia: Clinical Approaches to the Manual Therapist. What a great day! Particpants are practicing an imagery & intent exercise called spinal awareness float using an airbed. Again the quality of presence and somatic awareness was astounding. Luminous moments are the best way to describe the experience. I was astounded as much as the participants were by the results. Great tools to help the Fibomyalgia sufferer.

Also introduced was the Two Point technique & ””Fulcrum”” (Giammatteo) to use with those of great soft-tissue sensitivity.

Kingscliff IFR 1 July 2009

Group photo of IFR Level One held in Kingscliff, NSW in mid July 2009.

Front row from left to right : Rowena Langdon, Linda Alexander

Back row from left to right: Linda Howard, Maria Arena, Kristie Melling, Katie Byrne, Steven, Sonya Leslight and Linsie Davies

Posture:Alternatives to the Prevailing Paradigm

Posture: Alternatives to The Prevailing Paradigm

By Steven Goldstein, B.A. Education & B.Health Science MST Musculoskeletal Therapy

Abstract:

In this lecture series we will look at an overview of the modalities that can be alternatives to a standardize approach for postural assessment, that is an external orientation or what we term as an objective view that manual therapists take when assessing and intervening with postural dysfunctions.

In the first part of the series we will identify what has been the prevailing view of posture from teachings of mainstream perspectives and in the second and third parts of the series introduce to you differing viewpoints that hopefully will assist you in your practice.

Introduction

All you need do is type the word posture onto an internet search engine and in .11 seconds you have about 1,720,000 hits. And as you scan the dizzying array of responses, one can retrieve information about postural related aids and devices that include postural balls, ergonomic chairs, or find information all about posture; how to maintain correct posture when meditating or how to maintain a balanced and correct posture according to a variety of disciplines and modalities.

Some self-help manuals like Kit Laughlin’s have an integrated approach utilizing his background in yoga along with rehabilitation and sports exercise, dance, gymnastics and forms of martial arts he has been exposed to that assist in postural transformation. 1

Other sites prefer a health-oriented corporate workplace approach to helping employees become more productive by maintaining a conscious awareness of how they sit when performing various activities for their daily work regimen. And these tips include keeping your eyes level, shoulders level and not shrugged, elbows resting close to the torso, etc., all seemingly to take what appears to be a scientific physiotherapeutic approach to maintaining correct posture.

If one scans the responses further, there are aids to assist in assessing posture by the manual therapist and postural professional; these include a $349 USD Postural Evaluation Kit that will include a program for keeping postural records of your client, a plastic postural grid that can be suspended from the ceiling or wall, suspension cord and plumb bob for alignment.  If you so desire you can use a PALM device known as a palpation meter.

“This device combines the ease and proprioceptive of palpation with the objectivity and reliability of calliper and inclinometer measurements. The calliper determines the distance in centimetres between two palpating fingers. The inclinometer will give you accurate measurement in degrees between two palpating fingers.”

As manual therapists, how do we make sense of all this information? For one thing, all of the sites I viewed seemed to convey and portray a physical orientation of what correct posture is meant to be.  That is, assessing posture from an external point of view. Secondly, the sites describe how to counteract poor posture by re-educating one’s muscles utilizing movement in the form of specific exercises.

Are their any other approaches to normalizing posture and how do they compliment or conflict with a standardized approach that these sites convey?

Traditional Approaches to Postural And Musculoskeletal Dysfunction

Static Postural Images

If we peruse various massage anatomy and physiology texts or modality manuals, we find laid out for us a process and procedure that is taught and adhered to, based upon postural assessment or analysis; that is, a step by step procedure of looking at the structural landmarks of the body, both in weight-bearing and non weight-bearing positions.

That is usually an analysis of the body form from a static standing position. If we look to analyse the body in motion, we usually refer to it as ‘gait analysis’.  This is the logical and normal approach that is taken, it focuses our attention and awareness on our client when they present themselves for observation and assessment of postural considerations.

Ideal Postural Alignment

Faulty Postural Alignment

Muscle Testing and Function

Kendall and McCreary (1949), one of the bibles in the field for muscle testing and function have wonderfully dated black and white photographs of men and women in relation to a grid and plump line bob.  The photographs describe ideal plumb line and faulty plumb alignment.

Accordingly the authors state a premise about muscle function in relation to posture;

“posture is the composite of the positions of all the joints of the body at any given moment. If a position is habitual, there will be a correlation between alignment and muscle test findings.  If a reasonable assessment of a joint position is made, then an assessment also can be made regarding muscles in elongated positions and that are in shortened positions.  In faulty posture, those muscles in slightly shortened positions tend to be stronger, and those in slightly elongated positions tend to be weaker than the muscles that work in opposition to them.” 2

With this quote we have all the components for addressing physiologic functions that affect posture and the dysfunctions that occur.   We include joint play, movement, habituation (nervous system adaptation), agonist and antagonist muscle function, all of which can lead us into a discussion about sensory-motor nerve function.

So why is it we view postural dysfunction by the use of symmetrical comparison of bony landmarks and usually in context of muscle shortness and contracture?  Well for reason, it suits us to consider posture in the context of symmetry.  And if we can balance muscle groups there is a sense that posture can self-correct.

This is generally how manual therapists approach postural dysfunction. But is there more to postural dysfunction than asymmetry and muscle contracture? It is often more complicated and interesting than detailed extrinsic explanations.

Patterns of Musculoskeletal Dysfunction

Postural and tonic muscles and Janda’s syndrome patterns
Anatomic and physiologic responses to stress

No discussion on posture can occur without an understanding of the function of muscles.  .

One contributor to how muscle function in patterns has been a Czech researcher named Vladimir Janda.  He describes the patterns that affect posture by understanding the relationship between postural type 1 muscles and phasic type 2 muscles.  Predictable patterns emerge that he elaborates upon that he named Upper and Lower Crossed Syndromes.

Essentially postural or tonic muscles shorten while phasic often weaken.

Type 1 or Postural fibres contract slowly and are able to burn oxygen more efficiently than phasic muscles, which allows them to work slowly, and steadily over long periods of time. Over time with misuse and disuse, these muscles will shorten.  This is a clinically important distinction in tonic muscles response to stress. 3

Phasic or Type 2 fibres of which there are two main categories will weaken under prolonged stress and the fibres will tend to lengthen.

Type 2a fast-twitch fibres which contract more speedily than type 1 and are moderately resistant to fatigue with high concentration of mitochondria (the fuel-producing refineries of the cell) and myoglobulin (protein that speeds up the conversion of calcium ions) Usually used in walking and sprinting. 4

Type 2b fast-twitch glycolytic (uses blood sugar) are less fatigue resistant and depend on more glycolytic sources of energy. Usually used in strength training such as weight lifting.

Upper Crossed Syndrome

Involves the following imbalance:

Pectoralis Major and Minor    All tighten and shorten    Tonic or Postural Muscles
Upper Trapezius
Levator Scapulae
Sternocleidomastoid

While

Lower and Middle Trapezius    All Weaken            Phasic Muscles
Serratus Anterior
Rhomboid Major and Minor

When this occurs they alter the relative position of the head, neck and shoulders as follows:

1.    Occiput with C1 and C2 hyperextend with the head translating anteriorly
2.    The lower cervicales down to 4th thoracic are now stressed.
3.    Rotation and abduction of the scapula occur as the upper trapezius and levator scapulae become shortened and contracted.  This inhibits the lower trapezius and serratus anterior.
4.    As a result the scapula loses stability, which puts excess demand on the humerus now involving the levator scapulae, upper trapezius and supraspinatus to maintain functional efficiency.

Janda believed that by identifying the shortened structures and releasing these, they will improve overall function and posture.

Lower Crossed Syndrome

The lower-crossed syndrome involves the following imbalance:

Tonic or Postural Muscles
Iliopsoas, Rectus Femoris, Tensor Fascia Latae and Erector Spinae group

All tighten and shorten

While
Phasic Muscles
Abdominal and Gluteal    All weaken

Resulting in a reaction that tilts the pelvis forward on the frontal plane. Flexing the hip and exaggerating lumbar lordosis.  L5-S1 will have soft-tissue and joint distress with accompanying pain and irritation.

Also on the sagittal plane:

Quadratus Lumborum     Shortens

While

Gluteus Maximus and Medius    Weaken

With the instability of the lower cross, the sacroiliac joint becomes unstable and you start to find piriformis involvement.  Thus piriformis syndrome can be present.5

Many researchers have studied how muscle function affects posture.  The understanding of the body’s adaptability and how fibre types can change based upon the demands that function places upon structure has been a prevailing approach.

Anatomic and Physiologic Adaptations to Stress

Several authors continue the discussion of posture by viewing physiologic changes from factors that result in a complex sequence of events activated as a result of stress responses to soft-tissue structures. 6.

1.    Congenital and inborn factors
2.    Overuse, misuse and abuse
3.    Immobilization, disuse
4.    Postural stress
5.    Inappropriate breathing patterns
6.    Chronic negative emotional states such as depression and anxiety
7.    Reflexive influences (trigger points, facilitated segments)

Others view anatomic approaches

1.    Laxity of ligamentous structures
2.    Fascial tightness
3.    Muscle tonus
4.    Pelvic angle
5.    Joint position and mobility
6.    Neurologic outflow and inflow. 6

As a result of these types of factors a sequence of events can occur that have dramatic effect and consideration for the manual therapist.

The events are systemic and physiologic.  Without listing the complete list, here are the highlights:

•    ‘Something’ leads to increased muscular tone.
•    If increased tone is anything but short term you have metabolic waste build-up.
•    Increased tone means simultaneous local oxygen deficiency.
•    Ischemia, although not a producer of pain, is a major contributor of pain.
•    Increased muscle tone over long period leads to a degree of increased oedema.
•    All these factors, retention of waste/ischemia/oedema all contribute to creating pain.
•    Pain reinforces hypertonicity.
•    Inflammation may result.
•    Neurological reporting stations in these distressed tissues bombard the CNS with information regarding their status leading in time to a degree of neural sensitisation and hyperirritability and hyper activity.
•    Macrophages are activated, increased vascular and fibroblastic activity
•    Connective tissue production increases with cross linkage, leading to shortened fascia
•    Chronic muscular stress results in gradual development of hysteresis in which collagen fibres are rearranged to produce an altered structural pattern.
•    This results in tissues that are far more easily fatigued and prone to damage, if strained.
•    Since all fascia and other connective tissue is continuous throughout the body, any distortions that develop in one region can potentially cause fascial deformation elsewhere.
•    Hypertonicity in any one muscle will produce inhibition of its antagonists and aberrant behaviour in its synergists.
•    Energy wastage leads to unnecessarily sustained hypertonicity and an excessively active musculature leads to generalized fatigue and local energy crises, i.e. Trigger points.
•    These in turn create functional changes that affect respiratory function and body posture!  7

When we observe the posture of a client, we have in front of us a very complex picture.  We are in a sense seeing a current end product based upon a variety of factors that have caused the body form to be in the condition your presented with.

We need to look beyond assessing and observing asymmetries or contracture of certain muscle groups. We need to take into account other considerations. These considerations are those that are directly linked with our internal sensory awareness and the physiologic changes that occur from an over stimulated and highly stressed nervous system.

Alternative Postural Influences

• Autonomic nervous system and soft-tissue release

• Alternative postural and autonomic influences:

• Sympathetic activation, habituation and response to stress

• Hans Selye’s theory

The Autonomic Nervous System

The autonomic nervous system ANS is best known for its regulation of the sympathetic SNS “flight or fight” response and the parasympathetic PNS “rest and repose” response.  The SNS and PNS work together to maintain homeostasis through a feedback loop system.  Excessive sympathetic “tone” (Shea 1996) or output causes most of the stress related disorders that physicians encounter.

What is important to manual therapists is the relationship the ANS has with soft-tissue release and postural dysfunction.

All soft tissue has sympathetic innervation.  There is virtually no parasympathetic innervation of your soft-tissue.  All of your cardiovascular system has a sympathetic nerve attached to it.  Therefore it is the regulator of your vasomotor system.  The rate and flow of blood is controlled by the SNS. So neuromuscular and cardiovascular systems are sympathetically regulated.

The vagus nerve, the 10th cranial nerve that innervates the head, neck, thorax and abdomen is a mixed sensory and motor nerve and has 75% control of your parasympathetic system, and has some control over the heart and viscera.  The parasympathetic part helps regulate the visceral system (digestive organs) and forms a link to your enteric (gut) nervous system.

The parasympathetic system is called the cranial-sacral system with the vagus nerve and in the pelvis the sacrococcygeal plexus. The sympathetic system is called the thoraco-lumbar based upon nerve root plexuses.

There is a tuning or mediation between the two systems.  Since the sympathetic is the highest consumer of energy in the body, producing more waste, and using more oxygen, it is considered the primary system of the body.  The viscera or enteric nervous system keeps digesting food and producing amino acids along with fatty acids and fuel for metabolism.  When we start to stress, abuse or misuse our bodies, not have proper exercise, all of this begins to tighten the soft-tissue. This in turn decreases activity of the viscera with much more over-stimulation of the neuromuscular system occurring.  Over time this imbalance becomes the General Adaptive Response (Seyle 1984).  Soft-tissue dysfunction becomes prominent, including ulcers, diarrhoea, irritable bowel syndrome, constipation, etc, and with continued habituation comes adaptation and comprising the immune system. 8

This has a profound effect on our soft-tissue and postural dysfunction.

Adaptation, Habituation and Response to Stress

Selye’s:

• General Adaptation Syndrome GAS

• Local Adaptation Syndrome LAS

At the heart of postural considerations is the important premise of habituation. A prominent theory introduced is based upon the research of Hans Selye (1956).  Selye has contributed in understanding how adaptation and habituation –GAS and LAS is in relationship to somatic and postural dysfunction.

” That musculoskeletal dysfunction is a result of adaptive demands exceeding the capacity to absorb the load, while attempting to maintain something approaching normal function.  Elastic limits may at times be exceeded, resulting in structural and functional modifications.  Assessing these dysfunctions patterns-making sense of what can be observed, palpated, demonstrated- allows for detection and guidance towards remedial action.”
The demands that lead to dysfunction can either be forceful, violent, single events or they can be cumulative influence of numerous minor events.  Each such event is a form of stress and provides its own load demand on the local area as well as the body as a whole
.
Selye called stress the ‘non-specific element’ in disease production. He described the general adaptation syndrome as being comprised of three distinct stages:

•    the alarm reaction when initial defence responses occur (‘flight or fight’)
•    the resistance (adaptation) phase
•    the exhaustion phase (when adaptation fails) where frank disease emerges.

GAS affects the organism as a whole whilst LAS Local Adaptation Syndrome goes through the same steps but ofcourse is local in its orientation.  Repetitive activities over long periods of time result in somatic and muscular adaptation that can result in chronic hypertrophy of specific muscle groups.  The same activity repeated over time sees the body respond to the demand by adapting to the needs placed upon it.  When the demands become excessive, that is usually when we see injury or postural dysfunction.  When an individual is acutely alarmed, stressed or aroused, homeostatic mechanisms are activated.  If the alarm status is prolonged or if adaptive demands are excessive, long-term chronic changes can occur and these are at the expense of optimal functional integrity.”

“ The results of repeated postural and traumatic insults over a lifetime, combined with somatic effects of emotional and psychological origin, will often present a confusing pattern of tense, shortened, bunched, fatigued and, ultimately, fibrous tissue.”  9

Part 2

Sensory Awareness and Movement Modalities

• Thomas Hanna and Somatics

• Moshe Feldenkrais

• F.Mathias Alexander

Thomas Hanna’s Somatics

Thomas Hanna (1928-1990) borrowed heavily from Hans Selyes, Moshe Feldenkrais and F.Mathias Alexander’s research to develop a modality that sought to counteract the habitual state of forgetfulness called sensory-motor amnesia.

Hanna goes on to say in his book on Somatics, “It is a memory loss of how certain muscle groups feel and how to control them.  And, because this occurs within the central nervous system, we are not aware of it, yet it affects us to our very core. The reflexes that cause sensory-motor amnesia are very specific.  There are three…named Red light reflex, Green light reflex and Trauma reflex.”

Red Light Reflex.  (Left)

Essentially Red Light reflex is associated with the abdominal muscles and what Hanna termed the Withdrawal Response.  It is associated with distressful events.  It is a protective response to negative events that threaten us.

From head to toe, the Red Light reflex involves the following movements:

Closing the eyes, tensing the jaw and face, pulling forward of the neck, lifting of the shoulders, flexing the elbows, clenching the fists, flattening the chest, tightening abdominal muscle, contracting the diaphragm and holding the breath, contracting perineum including sphincters of the anus and urethra, contracting gluteus minimus muscles to rotate thighs inward, thus feet are pigeon toed, adduction of the thighs, contraction of the hamstrings to bend knees, flexing and supinating the feet. (Each foot lifts and inverts, tilting up the arch) the sensory feedback of all these movements constitutes the subjective feeling of the Red Light Reflex: Fear.

Green Light Reflex (Right)

From head to toe, the green Light Reflex involves the following movements:

Opening the eyes, jaw and face, pulling backward of the neck, pulling downward of the shoulders, extending the elbows, opening of the hands, lifting the chest, lengthening the abdominal, relaxing the diaphragm and freeing breathing, relaxing anal and urethral sphincters in the perineum, contracting the gluteus medius muscle to rotate the thighs outward (feet are duck like), abduction of the thighs, contraction of the thigh extensors to straighten the knee to hyper-extension, extension and pronation of the feet.  The sensory feedback of all these movements constitutes the subjective feeling of the Green Light Reflex-Effort. 10

Trauma Reflex

The trauma reflex according to Hanna is a reaction of the sensory-motor system in response to pain.  It seemingly causes the body to tilt.  Hanna viewed scoliosis, as a sideways twisting that was a result to some trauma that has occurred sometime in a person’s life.  Triggered by an injury, a fall, severe damage to the body, surgery, and whiplash all cause a protective pattern around the site of the injury.

Hanna went on to create a series of Somatic exercises whose primary task is to focus your attention on the internal sensations of movement.  By paying attention, moving slowly and gently with the least possible effort, not forcing any movement, you can clear the brain to receive uncluttered sensory feedback, thus aiding in alleviating a variety of postural and somatic dysfunctions. 11.

The Feldenkrais Method

The Feldenkrais method is a system that approaches human development and the improvement of functioning through physical movement and directed touch. How we learn and form habits is of central importance in the practice of the Feldenkrais method.  Our posture and the ways that we move were learned, even if the learn is not conscious.  Thus, physical difficulties or limitations are seen from this perspective, as the result of either incomplete learning or trauma that can lead to dysfunctional habit patterns.  The Method utilizes functionally based variation, innovation, and differentiation in sensory motor activity to break down habitual patterns and allow new ways of thinking, feeling and action to emerge. 12

Some quotes from Moshe Feldenkrais (1904-1984), give a flavour of how posture is integrated in his approach.
“The way the mind and body are united has preoccupied human beings throughout the centuries. ‘A healthy mind in a healthy body’ and similar sayings show a conception of one kind of unity.[...]
I believe that the unity of mind and body is an objective reality. They are not just parts somehow related to each other, but an inseparable whole while functioning. A brain without a body could not think; at least, the continuing of mental functions is assured by corresponding motor functions.
[...]
There is little doubt in my mind that the motor function, and perhaps the muscles themselves, is part and parcel of our higher functions. This is not true only of those higher functions like singing, painting and loving, which are impossible without muscular activity, but also of thinking, recalling, remembering and feeling.
The advantage of approaching the unity of mental and muscular life through the body lies in the fact that the muscle expression is simpler because it is concrete and easier to locate. It is also incomparably easier to make a person aware of what is happening in the body; therefore the body approach yields faster and more direct results. On acting on the significant parts of the body, such as the eyes, the neck, the breath, or the pelvis, it is easy to effect striking changes of mood on the spot.
[...]
A person is made up of three entities: the nervous system, which is the core; the body – skeleton, viscera and muscles; and the environment, which is space, gravitation, and society. These three aspects, each with its material support and its activity, together give a working picture of a human being.
[...]
Individually acquired action (onto genic action) pertains to the senses. Such action can be altered or learned as one can become aware of the actual differences, such as the extent of the effort, its coordination in time, the body sensation, the spatial configuration of the body segments, the standing, the breathing, the wording, etc.
This kind of aware learning is complete when the new mode of action becomes automatic or even unconscious, as all habits do. The advantage of a habit acquired by awareness is that when it shows unfitness or maladjustment when confronted with reality, it easily provokes new awareness and so helps one to make a fresh and more efficient change.
My inmost belief is that, just as anatomy has helped us to get an intimate knowledge of the working of the body, and neuroanatomy an understanding of some activities of the psyche, so will understanding of the somatic aspects of consciousness enable us to know ourselves more intimately. 13.

Posture and Alexander Technique

It is a testament to the power of this method that it has endured the passage of time to still be extremely relevant and timely in a world out of touch with internal sensory awareness.
Born in Tasmania, F.M.Alexander (1869-1955) was a successful actor and reciter whose career was cut short by loss of voice during performances. With no help forthcoming from the medical profession, Alexander undertook an intensive examination of himself in action, convinced that the source of his voice problem lay in the way he used his body. A long period of research led him to discover certain principles affecting mind/body co-ordination applicable to every kind of physical activity.  With this knowledge he went on to cure his own voice problem and found hat he could also help others.

It was at this point that teaching his method became the main focus of his life.
Alexander arrived in England in 1904 and during the next 25 years built up a practice in London and the USA. He had many influential supporters among those were Sir Henry lrving, John Dewey, Aldous Huxley and Sir Stafford Cripps.
In 1931 he began training others to teach the Technique and continued to do so until his death at the age of 86.
Today the importance of Alexander’s discoveries is confirmed by the existence of a rapidly growing body of teachers of his method.

Quotations:

You come to learn to inhibit and to direct your activity.
You learn, first, to inhibit the habitual reaction to certain classes of stimuli, and second, to direct yourself consciously in such a way as to affect certain muscular pulls, which processes bring about a new reaction to these stimuli.’

Boiled down, it all comes to inhibiting a particular reaction to a given stimulus.
But no one will see it that way. They will see it as getting in and out of a chair the right way. It is nothing of the kind. It is that a pupil decides what he will or will not consent to do. They may teach you anatomy and physiology till they are black in the face – you will still have this to face, sticking to a decision against the habit of life.
There is no such thing as a right position, but there is such a thing as a right direction.

You can’t do something you don’t know, if you keep on doing what you do know.
Trying is only emphasizing the thing we know already Sensory appreciation conditions conception – you can’t know a thing by an instrument that’s wrong.
To know when we are wrong is all that we shall ever know in this world.

You are not here to do exercises or to learn to do something right, but to get able to meet a stimulus that always put you wrong and to learn to deal with it. 14

How does the Alexander Technique reduce stress?

F. M. Alexander identified the fact that most of us are in a perpetual state of “fight or flight syndrome”; also know as the startle response. If you have ever seen a newborn or young infant react to a loud, unexpected noise, you may recall their shoulders come up to their ears and their heads are pulled or fall back – they are clearly startled by the experience. In a few moments, as the event passes, they return to their prior state, which is relaxed, alert, and engaged.
As we grow up in our fast paced society, we face a constant onslaught of stressful events. We are in the process of recovery from one event when yet another stimulus hits our systems, and so we begin to function in a constant state of startle response. Because our nervous system adapts to the new level of stress, we cease to register it as too much and so never fully return to the easeful state of the newborn. Instead, we increase muscular effort throughout our lives. The analogy I use to describe this constant state of over-contraction is that of driving with the parking brake on. We use much more energy to perform simple activities than we actually need, which are a wasteful process.
F. M. Alexander’s recognition that his sensory feedback was unreliable gave him a window into changing his chronic overuse of muscle effort to a more efficient, appropriate level when accomplishing his activities. By learning to inhibit his startle response upon receiving stimulus, he was not only able to change muscle tension in his body; he was also able to change the biochemical messages being sent through his nervous system. What was once stressful when performed with the old habit patterns became easeful, poised and appropriate to the task at hand. This tool of inhibiting the old response is a skill that can be learned and enhanced with practice. This is how the Alexander Technique reduces psychophysical stress. 15

Part 3 Gravitational Orientations

• Rolfing

• Structural Integration: The Guild

• Structural Integration: The Institute

• Hubert Goodard and Tonic Function

Rolfing: Structural Integration

Structural Integration, the offspring of Ida Rolf, began by attempting to view the body three-dimensionally as an aggregate of blocks attempting to balance in the flow of gravitational energy. 16

Ida Rolf (1896-1979) had a decidedly different view of structure and posture.

Rolf states, “…The first question is, what is structure?  What is structure in anything? In humans, it is decidedly not posture, although most people seem to think the two words are synonymous.  Etymologically, the word posture contains an element of placement.  The root of the word is the Latin, ponere, “to place”.  The past participle, positum, means, “It has been placed”.  Applied to humans, posture implies that something has been placed, or for the most part forced, into space where properly and structurally it does not belong.”

”Shoulders back, guts in”, is a military adage.  It means to force you to do what does not come naturally. The minute you force yourself to maintain a posture of this sort, you betray that all is not well with your world.  You show the world that your structure and your posture are at war.

In any plane, physical or non-physical, structure implies relationship.  Living bodies are such forceful and intimate expressions of vital energy or its lack that the fact that they are also material manifestations in a three-dimensional world often disappears.

Balance reveals the flow of gravitational energy through the body.  Asymmetry and randomness betray lack of support by the gravitational field.  All these considerations are inherent in the word structure as it is applied to any three-dimensional system….In no world can the flow of gravity reinforce imbalanced, asymmetric structure.  Since it is segmented, the human unit is more plastic than an inorganic unit, and succumbs more quickly to the unequal torques of everyday life.” 17.

Rolf viewed the basis of balance in the face of gravitational influence to be best dispersed by the soft-tissue fabric that disperses it-Fascia. Much her life was spent in the pursuit of researching and understanding the role fascia plays in the organization and maintenance of human uprightness.

Schools of Gravitation Orientation

Ida Rolf’s influence in the realm of a broad worldwide movement along with the likes of Moshe Feldenkrais and Mathias Alexander has been significant. Be it those who have attempted to be the keeper of the realm such as her advocates in the Guild for Structural Integration whose mission is to keep intact the teachings and message Rolf promoted.

Her is an excerpt from the Guild’s website:

The Guild is dedicated to the traditional teachings of Dr. Ida P. Rolf. The product of her life’s work and teaching is the “Recipe”; a ten- session sequence of structural, fascial and educational goals which establishes order in human structures. Due to its efficacy in symptom alleviation, both physical and emotional, there is little doubt that the Recipe will survive in various forms as techniques; it is not certain that it can endure as art and craft without the special dedication of those individuals who are inspired by the potency of intention and wisdom of process concealed within. The Recipe is not technique. The Recipe is more than a discrete succession of myo-fascial goals and intentions. The Recipe is, rather, a process, based on a set of relationships, which establishes structural balance and order. These relationships are based upon sound theoretical physics as well as some traditional metaphysical hypotheses. Relationships belonging to the realm of art,  are non-linear. Technique is better suited to scientific and linear analysis. The Recipe, as taught in other schools, has been modified or, perhaps, specialized in several ways. Some of these modifications ignore the underlying priorities in Dr. Rolf’s teaching. The Guild is formed to insure that the Recipe does not lose its potency of intention, its expression as art, nor its comprehension as process

Dr. Rolf’s teaching emphasizes the concept of the personal line of vertical intention, the “Line.”
The Line passes through the centres of gravity of the body’s vertical blocks. The Line, in our concept of the Structurally Integrated human, does not pass through bone, except at the top of the head. In actual fact, this weight-bearing line does pass through bone in all but the most exceptional human structures. Indeed, it was Dr. Rolf’s observation that our species had not yet successfully completed its journey to uprightness. The Recipe is designed to offer personal assistance in this evolutionary voyage. The emergence of the unstressed vertical, the Line that passes only through soft tissue is evidence of progress toward this goal. The Line being defined as a set of theoretical points in space is not real, but experiential, and it can be, perhaps, must be, intentional. The horizon is the horizontal reference for the Line. The shoulder girdle and the pelvic girdle must contain true horizontal balance to define and support vertical extension. The Line goes through the top of the head and through the bottom of the feet to infinity. The Line forms a relationship between the field, which is man, and the field, which is earth, the field of gravity. The Line is transcendental, it relates the realm of material particles, of basic physics to the non-material, the world of energy fields. While Dr. Rolf’s metaphysical hypotheses concerning the Line are not original, her use of the Recipe as a tool for exploring them is unique. The idea of using a vertical line of extension to integrate one’s personal energy field with the energy field of the earth is a compelling idea with both practical and visionary implications. The Guild recognizes the singular importance of the Line as raison d’ etre for the recipe. We believe that effort to clarify and develop a clear sense of vertical extension should be a path for personal growth. And further, that instruction concerning the Line is an essential educational aspect of the practice of Structural Integration.

Whilst those that did not wish to remain true and in their words “static” to the teachings of Rolf, decided to evolve the teachings and continue the exploration of human uprightness that we refer to as posture along varying lines. 18

The Rolf Institute of Structural Integration excerpt about its ‘ raison d’etre’ has a similar flavour:

Rolfing® Structural Integration is named after Dr. Ida P. Rolf. She began her inquiry more than fifty years ago, devoting her energy to creating a holistic system of soft tissue manipulation and movement education that organized the whole body in gravity; she eventually named this system Structural Integration. She discovered that she could achieve remarkable changes in posture and structure by manipulating the body myofascial system.
“Rolfing” is the nickname that many clients and practitioners gave this work, and is now a registered service mark in 27 countries. Rolfing structural integration has an unequalled and unprecedented ability to dramatically alter a person”””””””’’s posture and structure. Professional athletes, dancers, children, business people, and people from all walks of life have benefited from Rolfing. People seek Rolfing as a way to ease pain and chronic stress, and improve performance in their professional and daily activities.

It is estimated that more than 1 million people have received Rolfing work.
Research has demonstrated that Rolfing creates a more efficient use of the muscles, allows the body to conserve energy, and creates more economical and refined patterns of movement. Research also shows that Rolfing significantly reduces chronic stress and changes in the body structure. For example, a study showed that Rolfing significantly reduced the spinal curvature of subjects with lordosis (sway back); it also showed that Rolfing enhances neurological functioning.  19

It is in this fertile ground of investigative bodywork that very interesting approaches to working with and treating postural dysfunctions are presented and practiced.  One such theory to postural dysfunction has come from the work of Hubert Goodard.

The Theory of Hubert Goodard

Course Notes From Body Wisdom Conference

I had the brief pleasure to attend one of Hubert Goodards mini workshops that he gave at the Body Wisdom Conference held at the Coramandel Peninsula in New Zealand in February 2003. I confess I was taken by his elegance and his approach to viewing posture.  One of the ideas that I came away with is how profound a person’s internal sensory awareness is to how people orient themselves in space.

Goodard had us become aware of both external awareness and breath along with internal awareness in breath.  He had us perform an exercise where you would coincide the rhythm of a persons breathing with very small movements of internal and external rotation of the lower legs.  Whilst the practitioner attempted to coincide that particular rhythm, the client would breathe in an external awareness and breathe out an internal awareness.  This awareness had interesting effects on various individuals.  Although all is anecdotal, I still found it interesting what other practitioners and body workers described as their experience.

Some reported an altered state of awareness (consciousness?); others found that at least temporarily there was improved mobility.  What is it that Goodard is trying convey and what to what end does it affect posture?

From the notes I took I will attempt to convey what he presented.

He entitled his lecture/workshop Posture, Breathing and Sensory Habits.  Goodard gave a historical perspective.  In our mind or head we have an internal awareness of how our body moves, a map so to speak that he labelled ‘schema’.  We also have a body image of ourselves that is internal in orientation but we can get a sense of when for instance, we look at ourselves in a mirror.

So we have a body image and we have the real body. The schema or map is our relationship with oriented space.

We have an ongoing relationship with our image, our map or schema and our real body.
That relationship is imposed upon our real body, or as Goodard referred to as the organic body.  Their exist a symbolic relationship we have with our organic body that includes our body image and our map.  We have opportunities to ‘touch’ this image and map which represents a potential for action.

And when we view postural dysfunction are we seeing our organic real body or our body image?

Goodard also look at breath as not belonging to the body but to the ‘relationship’ with the image and map.

So the schema then represents the ‘Where” we are, the ‘MAP”, in oriented space.
And where we are in our body. And where we are in the world. And where we are in our selves.

The body Image represents the ‘Who I Am”.

The schema or map is linked to our surroundings.

The first thing we do as human beings is grasping our orientation to that surrounding.  It is in our short-term memory at an unconscious level.  This is the proprioceptive activity versus the awareness of proprioceptive, this is our body image.  All of this proprioceptive activity, vision, sound, skin, inform the body schema and is completely linked to the surroundings.

He goes on the state that the Image of who I am can become disconnected from the surroundings.

He looked at long-term memory, the cortical, the word memory, this is the Who I am.
The who is connected with perceptual activity, with emotions (limbic system interface with the conscious and the unconscious) and with conceptual belief systems.

Goodard said the image of who I am is coming outside of ‘who I am’.  The feedback I receive from outside my self is how I build my body image.  He gave an example; we have a child without arms. The schema or map has no proprioception on the organic real body, but does have an image because of the reflection the child has of humanity with arms.

The self is exproprioceptive.  The question of the interconnection between the two is of tremendous import.

We know that there is a strong mind-body link with belief systems.  If you think, conceptualise a problem, i.e. breast cancer, it can physically manifest.  And the person with breast cancer will see a retracting breast in their body image that can create reduction in a physical sense.

Goodard believes ‘conception’ changes ‘perception’. This has an emotional component along with it.  Our brain has a somatic sensory and motor map in the cerebral cortex.  When there is a loss of sensation, other parts of the brain take over and the area is ‘lost’ (Goodards words).

If we discuss exproprioceptive awareness we can include the sense of sight.  We have

GAZE 
Fovea Centralis (rod less area of the retina that affords acute vision) vs. Peripheral Vision

BODY IMAGE 
Fovea relates to the Cortex whilst the Peripheral is Subcortical

So essentially Goodard is saying that our ‘Where’, our schema or map is peripheral, subcortical and not attached to language.  The ‘where’ in seeing feeds the body schema.  So that Gaze is an interpretation.  When we look at ourselves in a mirror we see our ‘self’ but the point Goodard makes is we are seeing our body image.  He said to look as if seeing someone behind the mirror.  That is look for your image.

SIGHT is SCHEMA-MAP

GAZE is IMAGE

Goodard used an example of when we have surgery.  We have scar tissue.  The metaphor or image is the body still feels as if the knife is still in the body.  We need to rebuild where the wound is in the body image.

Finally he made a distinction between the GROUND and SPACE.  He said we tend to strongly organize and identify with either one or the other.

I would be disingenuous if I said I understood from my note taking that a Frenchman speaking English as a second language, I understood what he was attempting to convey!  In fact I had more questions than any clear understanding.  So it motivated me to search out a clearer understanding of his work.  That led me onto various Rolfing sites that helped somewhat with my lack of understanding about his theory. 20

What follows is from the work of two advanced certified rolfers who have studied with and written about Hubert Goodards work, Kevin Frank and Arline Newton.  What I have gleaned is articles that were published in the mid 1990’s in Rolf Lines, a research publication for Structural Integrationists.

Tonic Function: Basic Concepts in the Theory of Hubert Goodard

I will draw heavily on Arline Newton’s published work of Hubert Goodard theory that appeared in the March 1995 Rolf Lines publication.  You can read and/or download the complete article from www.resourcesinmovement.com/Articles.

The basic premise that Newton states about Goodard is a key insight of Rolfing in general, that we need to have an appropriate relationship with gravity that is basic to our health.  From a structural point of view, this relationship is commonly described in terms of alignment.  From a functional point of view, it is described in terms of biomechanics, studying the movement of various joints and the impact of forces upon them.  Newton goes on to state,” … that both perspectives carry a kind of objectification, a denial (or ignoring) of human experience….Alignment and mechanics leave out the effect of what is occurring in the mind/body of the individual involved.”

Newton says the consideration of experience is phenomenological. That is philosophers wanted to study the perceptual experience in a purely subjective aspect.  Not at all accepting a traditional division of subject and object.  From this perspective the body does not exist separately from the body as lived.  A person does not exist separately from the environment but is embedded in it.  We do not live in a vacuum, so therefore it behoves us not to study the human form as if we do.

Action Systems

Newton visited the work of Edward Reed, who studied motor responses.  He observed most studies took place in a laboratory under artificial conditions.  Often to isolate specific movements, that is studied outside of the context.  In fact all movement is takes place in context.  And to some extent we now study the body in context especially when assessing performance athletes.  Reed suggested the study of movement be taken in terms of functions-which he called action systems.  These included the locomotion system that we amble around in, the expressive system that allows us to look and listen, and the semantic system that lets us speak.  The concept allows movement to be studied in terms that make sense.  These are purposeful activities that cannot be reduced to the sum of individual motor units.  And it cannot be studied separately from the function.  We begin to acquaint behaviour with structure and function.

The fundamentals of these action systems are the activities of lying, sitting or standing.
These basic activities enable of to survive and thrive and have a viable relationship within the gravity field.

Tonic Function

Goodard calls the body’s ability to organize itself in gravity, ‘tonic function’.

Tonic function is fundamental, and is at the root of every action.  It is taking place below the level of conscious awareness.

The example Goodard and Newton describe is you are standing and are asked to raise your arm.  What is the first muscle to contract when performing that action?  Most will imagine arm or shoulder muscles, but in fact the answer is the soleus muscle.  It is a key muscle in maintaining uprightness in gravity.  “Even before the intended movement occurs, the gravitity function is ensured.”

Anatomically tonic function involves the part of the body- brain, nerve pathways, fascia, muscle spindles, Golgi tendon organs and tonic muscles- all functions to coordinate the body’s negotiation with gravity.  What Newton will describe is that an individual’s particular tonic organization cannot be adequately described without taking more than anatomy into consideration.  It cannot be re-educated without a broader vision.

Uprightness

For human beings, the relationship with gravity is expressed in how we stay upright, or oriented.  This is one of the essential aspects of our uniqueness as human beings.  If we are unable to maintain uprightness, it becomes more than a problem with standing.  It is the fundamental basis for our emotional and psychological orientation with the world.

Newton equates uprightness as having a symbolic dimension.  It is a problem with significance and meaning in life.  Our language metaphorically as with touch, reflects this orientation, as we link verticality with morality; an ‘upright individual’, or a person of ‘good standing’.

If as Newton quotes Erwin Strauss in an article entitled Upright Posture,” …because upright posture is the ‘leitmotiv’ in the formation of the human organism, an individual who has lost or is deprived of the capacity to get up and keep themselves upright, depends for his or her survival, completely on the aid of others.  Ultimately without their help the organism is doomed to die.  A biologically oriented psychology must not forget that upright posture is indispensable condition of man’s self-preservation.”

What Newton claims is that when we view posture from this perspective we are tapping into a “primordial, instinctive relationship that is so profound as to be almost invisible.”

Tonic Function and Individual Development

The key concept that Strauss continues to elaborate upon is that upright posture characterizes the human species.  “Every individual has to come to terms with gravity and their own unique uprightness.  Psychologically this comes with the development of the ability to control movement.”

Newton states,  “the nerves and muscles that make up the tonic system-that register and respond to our changing relationship with gravity-these are the very same pathways that will fulfil this basic developmental function.”

Their has been numerous research done on patterns of movement and childhood development.  Newton sites Judith Kestenberg, a psychoanalyst trained in Laban movement.  Kestenberg describes the patterns of movement developed in infancy.  “The simpliest explanation for changes in muscle tension is the physiological interplay between agonist and antagonist muscle groups.  A free flow of tension occurs when agonists are not met with counteraction by antagonists.  The constraint in movement called the bound flow of tension, occurs when antagonists contract along with agonists.
A newborn infants toes stiffen periodically in bound flow.  His/her legss fling and bicycle in spurts of free flow.  An influx of suddenly emrging free flow, may enable him/her to hold its fist there for a brief moment.”

These movements form the basis of interaction with the enviromewnt.

The shape of the body changes during movement.  As we inhale and exhsale, it changes shape. We grow with the ingestion of food, and shrink with the expelling of waste.  We grow toward pleasant stimuli and shrink away from noxious.  Growing and shrinking are the basic elements of shape flow.  They alternate periodically, this rythymic alternation…provides a structure for the organisms interaction with their environment.

Goodard believes that tension flow and shape flow are basis of movement patterns.

And he suggests these are related to the tonic system.

Tonic Function and Communication.

Newton continues the discussion by quoting the previous authors that “we learn from movement studies that their is not only a correspondence between specific drives and specific objects, but also a correspondence between certain feeling tones and modes of expression.”

When we become annoyed, we express that by a furrowing of our brows, while pleasure is recognized by others when we broaden our face when smiling.

References

1.    Laughlin, Kit 2004 website http://www.pandf.com.au/pages/articles/articles.html
2.    F.P. Kendall, McCreary E.K. 1983 3rd Ed. p 270.
3.    Frank, Kevin, March 1995 ‘Tonic Function’ ROLF LINES p.3
4.    Chaitow, Leon, De Lany Judith Walker, 2000 Clinical Application of Neuromuscular Technique, Vol 1 Chap 2 Muscles p 22, Juhan, Deanne, 1987 Job’s Body: A Handbook for Bodywork Chap 5 Muscle p 128, Tortora, Gerald, Grabowski, Sandra, 2003, Priniciples of Anatomy and Physiology 10th Ed. Chap 10 Muscle p296)
5.    Chaitow, Leon, De Lany Judith Walker, 2000 Clinical Application of Neuromuscular Technique, Vol 1 Chap 5 Patterns of Dysfunction, pp 55-57
6.    Chaitow, Leon, De Lany Judith Walker, 2000 Clinical Application of Neuromuscular Technique, Vol 1 Chap 4 Causes of Musculoskeletal Dysfunction pp 43-44, Magee, David J., 1992 Orthopaedic Physical Assessment, 2nd Ed. Chap 15 Assessment of Posture, p. 581
7.    Chaitow, Leon, De Lany Judith Walker, 2000 Clinical Application of Neuromuscular Technique, Vol 1 Chap 4 Causes of Musculoskeletal Dysfunction pp 44-45.
8.    Shea, Michael, 1995 Myofascial Release Textbook, Expression of the Autonomic Nervous System pp45-46
9.    Chaitow, Leon, De Lany Judith Walker, 2000 Clinical Application of Neuromuscular Technique, Vol 1 Chap 4 pp 44-45.
10.    Hanna, Thomas,1988  Smantics: Reawakening the Mind’s Control of Movement, Flexibility and Health. Chap 10 The Sum of Neuromuscular Stress p68)
11.    ibid. Chap 13 How to Give Yourself the Maximum Benefit of Somatic Exercise p 97
12.    Johnson Don Hanlon, 1997, Groundworks, Narratives of Embodiment: Editor, Elizabeth Beringer article pp 81-82.
13.    Dr Moshé Feldenkrais, Body and Mind (article), 1980
14.    Alexander Website
15.    Lieb, n. Brooke, 2001Certified Teacher of the Alexander Technique; Member, American Society for the Alexander Technique (AmSAT); Faculty Member, American Center for the Alexander Technique (ACAT); brookelieb@mindspring.com o www.brookelieb.com Alexander Technique
16.    Rolf, Ida P., 1977 Rolfing, The Integration of Human Structures, Chap 2 Roadmap to Structure p30)
17.    ibid.
18.    http://www.rolfguild.org/mission.html
19.    http://www.rolf.org 2000 the Rolf Institute, 205 Canyon Blvd., Boulder, CO 80302, USA
20.    Goldstein, Steven, 2003, Course Notes on Lecture-Demonstration by Hubert Goodard.  February 2003 at The Body Wisdom Conference, Waimana, Coromandel, New Zealand.

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