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rotation of some of those vertebrae. The spine can
have one uncompensated bend, but commonly has
two bends that compensate each other, and more
complex spinal patterns, e.g. scoliosis, can have
three or even four bends over the two dozen
vertebral segments.
• Rotation. In standing posture, rotations usually
occur around a vertical axis in the horizontal plane,
and thus often apply to, for example, the femur,
tibia, pelvis, spine, head, humerus, or rib cage.
Rotations are named for the direction in which the
front of the named structure is pointing. For
instance, in a left rotation of the head (relative to
the pelvis), the nose or chin would face to the left of
the pubic bone (Fig. 11.6A). In Figure 11.6A, both the
head and rib cage are right rotated relative to the
pelvis. Relative to rotation, the head and the rib
cage are neutral to each other. Making this
observation is crucial to strategy: attempting to de-
rotate the head of this person via the neck muscles
would fail; it is the structures between the ribs and
pelvis that govern this rotational pattern.
Notice that, if the rib cage were left rotated relative
to the pelvis, the head could be right rotated
relative to the rib cage and still be neutral relative
to the pelvis or feet (Fig. 11.6B). In this case,
therapeutic strategy would need to consider the
twist/rotational imbalance in both the cervical and
lumbar tissues (as well as shoulder-to-axial
structures) to resolve this more complex pattern.
In paired structures, we use medial or lateral
rotation (Fig. 11.6C). While this is in common use as
regards femoral or humeral rotation, we extend this
vocabulary to all structures. What is commonly
called a 'protracted' scapula would, in our
vocabulary, be a 'medially rotated' scapula, since
the anterior surface of the scapula turns to face the
midline. A medially rotated calcaneus often
accompanies what is commonly called a 'pronated'
foot (which we would call, and not just to be
confusing, a 'medially tilted' foot).
• Shift. 'Shift' is a more broad but still useful term for
displacements of the center of gravity of a part
(right-left, anterior-posterior, or superior-inferior).
Balinese and Thai dance involves a lot of head
shifting - side-to-side movement while the eyes
stay horizontal. The rib cage likewise can shift to
the back or side while still staying relatively vertical
relative to the ground (Fig. 11.7A and B). Such shifts,
of course, commonly involve tilts and bends, and
often accompany rotations as well. We can use the
terminology to specify these particular relationships
when called for, but we have found that phrases
such as 'left lateral shift of the rib cage' or 'the head
is shifted to the right relative to the pelvis' are a
useful shorthand when making an initial
evaluation.
The mobile scapula is commonly shifted in any of
the six modifying directions. The pelvis is
commonly described as being anteriorly (as in Fig.
11.7A) or posteriorly shifted relative to the malleoli,
with the understanding that some tilts must occur
along the way in the upper or lower leg for that to
happen. A protracted shoulder involves a lateral
shift of the scapula on the ribs. A wide stance could
be described as a lateral shift of the feet relative to
the hips. Genu varus involves a lateral shift (and
probably a medial rotation as well) of the knees.
Fig. 11.7 In (A), there is an anterior
tilt of the legs that results in the pelvis
being anteriorly shifted relative to the
feet, but the pelvis has a posterior tilt
relative to the femurs. The rib cage in
this diagram is posteriorly shifted
relative to the pelvis, and the head is
anteriorly shifted relative to the rib
cage, in a pattern that is sadly
commonplace in the Westernized
world. Notice that the ribs are fairly
neutral relative to the feet, and the
head is fairly neutral relative to the
pelvis. Undoing this pattern involves
soft-tissue release in nearly every
segment of the body. In (B), we see
the pelvis neutral relative to the feet,
but the ribs are right shifted relative
to the pelvis, and the head left shifted
relative to the ribs. The pelvis and
head are thus relatively neutral, but
as you begin to shift the rib cage on
the pelvis via manipulation or training,
the head will generally shift right
relative to the pelvis, requiring work
between the ribs and head.
A
B
C
Fig. 11.6 Rotations all take place in the horizontal plane around a
vertical axis, and are therefore modified only with left or right (for
axial structures - (A)) or medial and lateral (for paired structures -
(C)). Rotations frequently counter each other from the ground
up (A). One rotation in the middle, as in (B) (or mocked up in
Fig. 11.3A), is not as simple as it looks to unwind.
A
B
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