In the last issue, we introduced our approach to BodyReading—or visual structural assessment. To review, before adding to what we did last time, we offered quite a few caveats:
• Be careful of assigning moral value to straight, balanced, or symmetrical posture—these attributes are pointers, not goals in themselves.
• Be doubly careful not to see your client as a collection of faults or problems —biologically and functionally they are massively successful to be able to choose you and afford you, so be aware of their strengths and resources at least as much as their problems and symptoms.
• Assessment of the skeleton from landmarks without X-rays shows a lot of inter-operator unreliability—not just in massage therapy but in physiotherapy,1 chiropractic,2 and osteopathy as well.3
• Assessment of standing posture is only an approximation of the real deal, which is assessing functional movement. Stance is simply one such revealing functional “movement.”
• The method we are proposing is just one of many valid ways to approach visual assessment; we hope this vocabulary will someday be objective, but cannot say we are there yet.4
In search of that objectivity, we set out a positional vocabulary for the skeleton we used to describe inter-osseous relationships, to create a picture of where the skeleton hangs out in space.5
Our thesis was that even though these relationships will change in movement, and “one can never step in the same river twice,” as Heraclitus warned us, there are recognizable characteristics in movement and posture—a bit like an accent in the voice—to which people return again and again.
The object of most therapies is to somehow break into these neuromyofascial patterns to make fundamental changes in these relationships. We could reverse that, at the risk of sounding a little negative, to say that if a therapy is not somehow altering these fundamental relationships, its results are likely to be temporary and unsatisfying to therapist and client alike.
(I hasten to add that all the therapies I personally know, from the most medical to the most holistic, from the most evidence-based to the most woo-woo, are capable of making deep changes or capable of sliding around the surface of these ingrained patterns. It’s the how, not the what.)
But our thesis is also that the more you can see and feel these patterns in the body, the better chance you have of seeing their body-wide connections, and thus the better chance you have of getting the postural weeds out by the roots.
To get the subtleties of the position of the skeleton in space, we used four general terms—tilt, bend, rotate, and shift—in very specific ways to make clear the body’s segmental relationships. You can review that in the last issue (Massage & Bodywork, March/April 2011, page 74) or in Chapter 11 of Anatomy Trains (Elsevier, 2009) or via the BodyReading 101 three-DVD set available from www.anatomytrains.com, which has many examples for you to practice on.
Grasping the common elements of postural position is only the first step of a multistep process of arriving at a soft-tissue strategy for any given pattern. In subsequent issues, we are going to go through the second step of asking the question: What soft tissues could be responsible for creating or maintaining that skeletal position?
While these patterns can stem from individual muscles (meaning neurological patterning in most cases), ligaments, or connective tissue structures (including the brain’s dura or the organs’ attachments to the body wall), subsequent articles in this series will be looking at the kinds of patterns the longitudinal meridians of myofascial linkage (from the Anatomy Trains foundation) can create and participate in. In other words, we will be going through some postural patterns line by line.
We will touch on the subsequent steps of the process—creating a story that fits the picture, creating a strategy (whether for a move, a session, or a series), and reassessing to confirm or alter your strategic route—but these are skills more properly conveyed in a classroom setting.
This time, let us make a few refinements to what we laid out previously, and dive cautiously (Can you “dive cautiously”? Although that is an obvious contradiction in terms, it is what we do everyday in an alive and aware practice) into the subjective and psychological element in BodyReading—the somatoemotional realm of spatial medicine.6
Last time, we saw that bends and tilts could be backward, forward, or sideways left or right (sagittal and coronal planes), that shifts could be all of these plus up or down, and that rotations (a complex series of events in most people that we could merely touch on in an article) could be right or left, or medial or lateral in the paired structures (all in the horizontal or transverse plane).
We saw that use of just these four descriptors could bear the weight of a body-wide detailed analysis, or simply to sketch out the major features of a pattern. Here is a chart, Image 1B, the kind we commonly use in class (don’t get married to it, we change these charts frequently as students suggest improvements). The marks show the tilts, bends, rotations, and shifts we see as we start; your intended strategy for the session can be marked in another color, or on another sheet.
The rest of this article is a bit of a ragbag of elements that do not fit easily into the positional vocabulary of the previous installment. We start from the most objective and move toward ever more subjective psychosocial factors.
Four Pelvic Types
There are many details of complex bits of anatomy like feet and shoulders that just cannot be stuffed into these short articles. One factor, however, commands attention because of its centrality—the pelvis.
If we posit that tilt is the tilt of the pelvis on the femur, such that anterior tilt equals hip flexion, and posterior tilt equals hip extension, and we remember that pelvic shift is either a position anterior or posterior to the line of the ankle, then we get the following four pelvic types.
Posterior shift/posterior tilt, Image 2A.
This pattern often presents with a flattened (flexed) lumbar curve, and (excuse me) no butt, because the pelvis is tucked under. Once only found on plumbers and lumberjacks (it gives them that little vertical smile in back when their jeans hang low), the increasing use of improper sitting (on the tailbone) in front of computers is giving this postural pattern a real comeback.
Posterior shift/anterior tilt, Image 2B. Favored by toddlers everywhere, the hips are pushed back but the pubic bone pulled down with hip flexion. Normal for a toddler (who has yet to develop balance in the psoas complex and deep lateral rotators), but if you see this pattern in the adult, one can suspect neurological deficiency or somatoemotional immaturity.
Anterior shift/anterior tilt, Image 2C. This pattern creates a lot of compression in the low back and strain along the front. This person needs relaxation along their back line, and some toning in both the superficial anterior muscles and their core. This dumping forward is exactly what both Ida Rolf and Joseph Pilates saw a lot of and were trying to correct.
Anterior shift/posterior tilt, Image 2D. Perhaps the most common posture you will see—anteriorly shifted because we are all trying to get ahead in this world, and staying on your toes is how you do it. This one can be deceiving, because with the anterior shift, the pelvis can look anteriorly tilted as well, but often another look (sorry, but look at some of your yoga/Pilates/fitness-obsessed clients to see this in action) will show you these folks are really tucked under, overly tight in the pelvic floor or surrounding ligaments, and not the happiest of campers, despite all their work.
So which type is the person you are working on? The strategies differ. For more detail on these pelvis types, visit Liz Gaggini’s site, www.connectivetissue.com.7
The Weighted Foot
Another important factor in BodyReading is where the weight falls on the feet. It is worth asking where the weight falls on each individual foot—inside or outside; front or back—as this bears on our soft-tissue strategy, and also where it falls between the two feet. Often people have far more weight on one foot than the other.
The quick and dirty way to assess this is to simply run a mental vertical line between the two feet to see how much of their body falls on either side of the line. Some folks are tricky, but in others, the line will go straight up through one eye or the other, a sure sign they are more heavily weighted on the opposite foot.
The only way to know for sure is to get two scales, put them side by side, and have the client step up onto them, one foot on each, looking straight ahead. The two readings will add up to their weight, and the discrepancy between the two is measured in pounds (or kilos, for you metricists). Have them move to where the two readings are the same, and they will probably say, “Oh, that feels very one-sided,” because they are used to reporting their usual weighting as normal.
Another pattern that takes practice to see is when someone has more weight on the ball of one foot and the heel of the other. A pressure plate assessment is the only way to get the exact reading on this pattern for sure, but with practice you can see it after your client has been standing for a few minutes. When you see this, look above—there is almost always a pelvic or spinal twist above the feet with this pattern.
Cylinders
Although the following pattern can be described in terms of tilt, bend, rotate, and shift, it is much easier just to look at how the cylinders are rotated, Image 4, page 77. It is easy to imagine that the lower body is two cylinders—our two legs are essentially two cylinders. Our leg cylinders can be medially rotated or laterally rotated, and they are sufficiently independent that one can be rotated medially and the other laterally.
In your imagination, extend those two cylinders right up through the torso to the shoulders, so that each hip, waist, and ribs become part of these cylinders. This is, of course, just a metaphor, an image—but it is a useful one. If I turn all the cylinders laterally, I look big and wide in the front, and narrow and pinched at the back. If I internally rotate these cylinders, I look narrow across the front and wide across the back. These types correspond to John Upledger’s cranial extension and flexion patterns (which he extends right up into the head), or Jan Sultan’s internal/external model.8
But in each section of the body these cylinders can turn somewhat independently—a commonly seen one being someone who is narrow across the chest (as if the rib and shoulder cylinders are medially rotated) with a broad belly and laterally rotated knees (as if the cylinders from the waist down were laterally rotated). But you will see a lot of variation in these cylindrical patterns.
The soft-tissue strategy for such cylindrical patterns is simple: widen the narrowed parts and get them to tone and draw in the too-wide parts. The complexities come in where the two tendencies meet: there is often a troubled area, either fixed and immoveable, or painful to the client. Unwinding the cylinders is a prerequisite for getting the problem to loosen up; that area is doing the best that it can to deal with strong and opposing forces.
Balancing the Cardinal Planes
This is one of the easiest bits of BodyReading to do, so it is an early segment in educating our practitioners to bodyread. Nevertheless, it can reveal a lot of information and give your overall strategy an important direction.
Dividing the body at the three cardinal planes gives you three “halves” to compare: right/left, front/back, and top/bottom. It’s a useful exercise to view your client from the front, one side, and the back to have a quick check of which of these is the most challenging for the client.
Right and left are, of course, the easiest to assess, as they are the most anatomically symmetrical. How do the right and left compare? Some people have obvious anomalies—one shoulder or one hip higher then the other—while others have more subtle differences between who lives in the right side and who inhabits the left.
Turn them to the side, and compare front to back. Front and back are not anatomically the same, but they still need to balance each other in dynamic posture. Often the front looks fallen compared to the back. Lots of anterior/posterior shifts between the body segments indicate poor front/back balance.
Now look from the back. This time, look at the top/bottom balance, with the horizontal plane between them being the waist (though sometimes it can vary from a hipster’s waist to an empire waist). Does the top feel proportionally bigger than the bottom, or vice versa? A way to see this clearly is to obscure the bottom half with your hand or a clipboard, and look at the top. Then obscure the top half and look at the bottom—is that what you expected to see? Do the top and bottom fit, or does one seem outsized compared to the other?
Now, the following is a bit simplistic, but check it out and see if it works for you as it does for me. People with big right/left differences are often working out the differences between their masculine and feminine sides, their animus and anima. This struggle may express itself in many ways in different people and it is not “wrong” in any way, but you will find that this dichotomy is expressing itself in their life. That knowledge can help you help them—to resolve it, or at least make a better marriage between their left and right sides.
People with strong front/back imbalances often have strong public/private issues—what they show and what they (try to) hide. Someone with a Napoleon complex, for example, may puff up in front to make himself look big, not realizing how small he then looks from the back.
Strong top/bottom dichotomies seem to correspond to introversion/extroversion; the person with the proportionally large top is usually an extrovert, while the person with a proportionally larger lower half is often introverted.
Somatotyping
This is a large discussion, which we must leave for another venue, but it is useful to place your client in the triangle of ectomorphic, mesomorphic, and endomorphic. Though thin, muscular, and fat are the simplest ways to characterize these somatotypes, the truth is more complex.
Ectomorphs are tuned more to their skin and nervous system and are highly reactive; mesomorphs more tuned to their blood and muscular systems and are big on doing; and endomorphs more governed by their organs and intuitional feelings. Everyone lies somewhere in the triangle made by these extremes.
If your client is toward the center of the triangle, this is probably not so useful a distinction to make. If, however, she tends strongly toward one or the other of these types, it is worthwhile knowing that each type responds differently to soft-tissue change. Basic information on the types is available in a lot of places (if you are familiar with ayurvedic medicine, these types correspond to the doshas), but the basic work comes from William Sheldon, and is documented in The Varieties of Human Physique.9
Orientation
Some people orient more to the ground, and then reach out from there. Others orient by reaching out to others, or into the environment, and then find their ground from that connection. A simple test shows which is dominant (and an indeterminate result indicates balance between the two):
Stand behind the client and have her jump lightly and repeatedly on the balls of her feet. It does not matter how high or well she does this. Make two tests, repeating these movements on successive jumps. Either: 1) Lift her slightly from the sides of her rib cage as she goes up, or 2) Press her lightly into the earth on her shoulders as she comes down. Which slight impetus movement produces the more organized result in the client—pressing down or lifting up? The ones for whom a slight pressing down results in a more organized spring up are oriented to the ground; those for whom even a few ounces of lift on your part produce a large result in terms of height and delight achieved, are oriented out into the environment around them.10
Breathing Tendency
Breathing patterns can hover around one end or the other of the respiratory cycle. Those stuck on the exhale side of the pattern tend toward depression and introspection, relying too heavily on their own internal world, while those stuck around the inhale end of the cycle tend toward a bluff heartiness, relying too heavily on the impressions and responses of others for their sense of self. Artists of all sorts tend toward the former, the latter can often be found among car salesmen, TV talk show hosts, and politicians.
Soft-tissue work around the affected parts, along with reeducation of the missing part of breathing, can often help bring these folks toward balance.
Somatic Maturity
Many systems have sprung up around bodytyping and psychology— from Hippocrates’ four humours through Wilhelm Reich and the bioenergeticists who followed him.11
Grasping the kind of patterning in the skeletal geometry (as we have been) and the myofascial meridians of tension (as we will do in subsequent issues) can lead to a different level of seeing, and thus a deeper level of work. One of the most interesting contributions that can be made by quality manual and movement work is related to maturational development.
Can you see that the pelvis of the young woman in Image 8, left, looks younger than the rest of her structure? Can you see the underlying very small boy within the postural pattern of the middle-aged man in Image 6A (page 81)? Are such observations clinically useful?
Realizing Potential
In this article, we have stepped over the line from remediation of biomechanical inefficiency toward the realm of the somatic psychologist. In my humble opinion, the two are intimately related, and being able to recognize such restrictions, parse out the underlying patterns, and realize such potentialities is one of the more important jobs for the manual therapists of the coming century.
I am specifically not recommending stepping into the psychologist’s role with your clients, but simply recognizing what the body pattern is trying to express can often facilitate change without your saying a word. Like most therapists, I have seen many such patterns, and I have been privileged to watch them change under my hands, but the therapist is acting as a midwife to that change, not as a psychologist.
The Anatomy Trains map, not specifically developmental, is one way into seeing such underlying patterns. It is bodyreading the specifics of these longitudinal myofascial meridians to which we will turn our attention in the next issue.
Thomas Myers is the founder of Anatomy Trains. He studied with Drs. Ida Rolf, Moshe Feldenkrais, and Buckminster Fuller, and has practiced integrative bodywork for more than 30 years in Europe, the United Kingdom, and the United States. He incorporates many movement and manual disciplines in his work. For more information, visit www.anatomytrains.com.
Notes
1. D. Hollerwöger, “Methodological Quality and Outcomes of Studies Addressing Manual Cervical Spine Examinations: A Review,” Manual Therapies 11, no. 2 (May 2006): 93–8.
2. M.A. Seffinger et al., “Reliability of Spinal Palpation for Diagnosis of Back and Neck Pain: A Systematic Review of the Literature,” Spine 29, no. 19 (October 1, 2004): E413–25.
3. Michael T. Haneline, DC, MPH, and Morgan Young, DC, “A Review of Intraexaminer and Interexaminer Reliability of Static Spinal Palpation: A Literature Synthesis,” Journal of Manipulative and Physiological Therapeutics (June 2009).
4. Judith Aston, Aston Postural Assessment Workbook (San Antonio: Therapy Skill Builders, 1998).
5. Thomas Myers, Anatomy Trains (Edinburgh, United Kingdom: Elsevier, 2009).
6. Thomas Myers, “Kinesthetic Dystonia,” Journal of Bodywork and Movement Therapies 2, no. 2 (1998): 101–14.
7. L. Gaggini, The Biomechanics of Alignment, 6th ed. (Boulder: Connective Tissue Seminars, 2005). Available at www.connectivetissue.com.
8. Jan Sultan, “Toward a Structural Logic—The Internal-External Model,” Notes on Structural Integration 86 (1986):12–18. Available from Dr. Hans Flury, Badenerstr 21, 8004 Zurich CH.
9. W.H. Sheldon, The Varieties of Human Physique (New York: Harper & Brothers Publishers, 1940).
10. This orientation work from Hubert Godard is available in English in the book How Life Moves, by Caryn McHose and Kevin Frank (North Atlantic Books, 2006).
11. Here are some references for this type of work: W. Reich, Character Analysis (New York: Simon and Schuster, 1949); Ron Kurtz, Body-Centered Psychotherapy (San Francisco: Liferhythms: 1990); Stanley Keleman, Emotional Anatomy (Berkeley, California: Center Press, 1985); A. Lowen, The Language of the Body (New York: Hungry Minds, 1971); Thomas Hanna, Somatics (Novato, California: Somatics Press, 1968).