Healthcare and Medicine Reference
In-Depth Information
to describe interosseous relationships in standing
posture. The vocabulary derives from Structural Inte-
grationist Michael Morrison. 5 This language has the
dual advantage of making sense to (and thus empower-
ing) clients, students, and patients, while also being
capable of bearing the load of sufficient detail to satisfy
the most exacting practitioner-to-practitioner or practi-
tioner-to-mentor dialogue. It has the disadvantage of
not conforming to standard medical terminology (e.g.
'varus' and 'valgus', or a 'pronated' foot). Because
these terms are often used in contradictory or imprecise
ways, this disadvantage may prove an advantage in the
long run.
The four terms employed are: 'tilt', 'bend', 'rotate', and
'shift'. The terms describe the relationship of one bony
portion of the body to another, or occasionally to the
gravity line, horizontal, or some other outside reference.
They are modified with the standard positional adjec-
tives: 'anterior', 'posterior', 'left', 'right', 'superior', 'infe-
rior', 'medial', and 'lateral'. These modifiers, whenever
there is any ambiguity, refer to the top or the front of the
named structure.
As examples, in a left lateral tilt of the head, the top
of the head would lean to the left, and the left ear would
approach the left shoulder. A posterior shift of the rib
cage relative to the pelvis means that the center of
gravity of the rib cage is located behind the center of
gravity of the pelvis - a common posture for fashion
models. In a left rotation of the rib cage relative to the
pelvis, the sternum would face more left than the pubic
symphysis (while the thoracic spinous processes might
have moved to the right in back). Medial rotation of the
femur means the front of the femur is turned toward the
midline. This use of modifiers is, of course, an arbitrary
convention, but one that makes intuitive sense to most
listeners (Fig. 11 .3).
One strength of this terminology is that these terms
can be applied in a quick overall sketch description of
the posture's major features, or used very precisely to
tease out complex intersegmental, intrapelvic, shoulder
girdle, or intertarsal relationships.
Compared to what?
Because the terms are mostly employed without refer-
ence to an outside grid or ideal, it is very important to
clarify exactly which two structures are being compared.
To look at one common example that leads to much
misunderstanding, what do we mean by 'anterior tilt of
the pelvis' (sometimes termed an 'anterior rotation' of
the pelvis, but in our terminology, it will be an 'anterior
Imagining that we share a common understanding of
what constitutes an anterior tilt pelvis, we are still open
to confusion unless the question, 'Compared to what?'
is answered. If we consistently compare the tilt of the
pelvis to the horizontal line of the floor, for instance, this
reading will not lead us to useful treatment protocols of
femur-to-pelvis myofascia since these tissues relate the
pelvis to the femur, not the pelvis-to-floor (compare Fig.
11.4A and B). Since the femur can also be commonly
anteriorly tilted, the pelvis can easily be (and often
enough is) anteriorly tilted compared to the ground
while at the same time being posteriorly tilted corn-
Fig. 11 .3 These deliberately
exaggerated postures show (A) a left
shift of the pelvis relative to the feet,
right shift of the ribs relative to the
pelvis, and left shift of the head
relative to the ribs. Notice that the
head is not shifted relative to the
pelvis. Although we cannot directly
see them, we can presume multiple
bends in the spine. The pelvis has a
right tilt, and the head and shoulders
have a left tilt. In (B), we see an
anterior shift of the head relative to
the ribs, and an anterior shift of the
ribs relative to the pelvis. This
involves posterior bends in both
cervical and lumbar curves, as well
as lateral rotations in all four limbs.
The pelvis appears to have an
anterior tilt, but neither the ribs nor
the head are tilted relative to the
ground. In (C), we can see a right tilt
of the pelvis, a left tilt of the rib cage
and shoulder girdle, and a right tilt of
the head, with a concurrent right
bend of the lumbars and left bend in
the thoracics. The right femur shows
a lateral rotation while the left
demonstrates a medial rotation
relative to the tibia.
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