Healthcare and Medicine Reference
In-Depth Information
None of these terms are mutually exclusive. A rib
cage can have its center of gravity shifted relative to the
pelvis, with or without a tilt, and additionally with or
without a rotation. Identifying one event does not pre-
clude the others.
Yet more detail
This simple yet comprehensive vocabulary allows for a
quick sketch or can be used to describe a series of rela-
tionships in minute detail. What might initially present
as the easily seen 'left tilted shoulder girdle' in our
quick sketch (as in Fig. 11.5A) could parse out, with
more detailed examination, as 'a left tilted shoulder
girdle with an anterior tilt and a medial rotation in the
right scapula, and a medially shifted left scapula'. This
allows the practitioner to be as detailed or as general as
necessary. The description can be noted down quickly,
and accurately conveyed to another practitioner or
mentor in a phone call or e-mail when seeking assis-
tance or describing a successful strategy for others to
follow.
In terms of this greater level of detail, it is worth
focusing on the spine, shoulders, and feet to clarify how
this vocabulary can be consistently applied. As noted,
we could give a general description (e.g. 'the spine in
the torso is generally right rotated'), or we could fill it
in to whatever level of detail is necessary (e.g. 'the
spine is left side tilted and right rotated from the
sacrum through L3, right side tilted and left rotated
from L3 through T10, and then right rotated from
T10 through about T6, forward bent through the upper
thoracics, and again left rotated in the cervicals to
bring the head to face in the same direction as the
pelvis'). The general sketch is quite helpful in getting a
global handle on which myofascial meridians might be
involved. The more detailed description aids in specific
strategy for de-rotating vertebrae and getting specific to
local muscle or even particular muscle slips in treatment
plans.
Fig. 11.8 Here we see shoulders
that are posteriorly shifted -
relative to the rib cage - but then
medially rotated to bring the
glenum anterior to the vertebral
border, thus bringing the anterior
face of the scapula to face the
midline more; hence, a 'medial
rotation' of the scapula is an
essential part of protraction.
fascia or the upper slips of pectoralis minor. The anterior
tilt element would send us to the lower pectoralis minor
and the clavipectoral fascia. The posterior shift would
lead us to strategize about the middle trapezius and to
add work in the axilla. With this level of description, we
approach our work with greatly increased precision. It
also allows a discourse in the bodywork field where
logical thinking can displace magical thinking.
Feet
The human plantigrade foot is complex enough to
warrant special attention. When we use 'rotation' in
describing the head or spine, we have a good intuitive
sense of what is meant. The same is true for tilts of the
pelvis and shoulder girdle, and rotations in the humerus
and femur. When we get to the feet, however, the long
axis of the metatarsals and of the foot itself is horizontal.
Therefore, 'lateral rotation' of the foot will designate
that the toes are pointing more lateral than the heels -
but then we need to say, 'Relative to what?'. Does the
rotation take place in the foot itself, at the ankle, within
the knee, or at the hip?
If the top of the foot is farther lateral than the sole
and the weight shifts to the outside (a supinated foot),
we would say the foot is 'laterally tilted'. Conversely,
falling onto the inside of the foot would be 'medially
tilted' (see Fig. 9.49, p. 201). In the extremes of these
patterns, one can also have a 'rotation' within the foot,
meaning that the metatarsals are pointing more lateral
or medial than the heel. The person with bunions could
be pedantically described as having a 'laterally rotated
hallux' or 'laterally rotated big toe' (in other words, use
the midline of the body, rather than the midline of the
foot, as the reference).
Since the calcaneus is often the key to support of the
back body and sacroiliac joint, a few examples of calca-
neal description are also offered. For the person who has
the top of the calcaneus more toward the body midline
than the bottom we would say, 'medially tilted calca-
neus'. If a calcaneus has the lateral side farther forward
Shoulders
Though in a general sketch, the shoulder girdle might
be described as a whole - e.g. left or right tilt, or superior
shift - closely reasoned strategy requires far more
detailed description of each clavicle and scapula.
Scapulae are particularly interesting because of their
great mobility. To simply describe a shoulder as 'pro-
tracted' or 'retracted' can easily, even necessarily, miss
much of the detail that lies at the heart of soft-tissue
specificity. Imagine a scapula described as follows: 'the
right scapula is medially rotated, anteriorly tilted, and
posteriorly shifted' (Fig. 11.8). The term 'protracted'
might be applied to these scapulae, but would not dis-
tinguish the degree of medial rotation, or specify the
anterior tilt, or how the shoulder was positioned in the
A-P axis on the rib cage. All these characteristics,
however, have significant implications for how the per-
son's use pattern is understood and thus for our working
strategy. A laterally shifted shoulder would lead us
directly to the serratus anterior or the subscapularis
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