Healthcare and Medicine Reference
In-Depth Information
Step 3: the development of an
integrating story
convincing story is a subjective process, very much
subject to revision in light of experience, but a valuable
one nonetheless.
In the third stage we bring these skeletal and soft-tissue
threads together to weave a 'story' - an inclusive view
of the musculoskeletal and movement pattern, based
on the client's history and all the factors we can see or
ask about taken together. A simple (and single-pointed)
version of this process might sound like this:
A client presents with shoulder pain in his dominant
right side. In looking at the client's pattern, we observe
shortness in the left Spiral Line, the right Front Func-
tional Line, and the right Lateral Line, not unlike the
exaggerated posture in Figure 11.3C. The client is an avid
tennis player, and in watching him mock up how he
plays tennis, we see all three of these lines are shortened
to pull the shoulder down and forward off the rib cage.
This short-term attempt to gain more power has long-
term negative consequences in straining the trapezius,
rhomboids, and/or levator scapulae, and throwing off
the head-neck-shoulder balance.
Based on this, you construct a story that aggressive
tennis playing has shortened the right side and pulled
the shoulder off the torso. Lengthening these lines, while
getting the weekend warrior to center his stroke in the
middle of his body rather than out at the shoulder, will
both improve his game (after a temporary disruption, of
course, which some clients cannot endure) and his lon-
gevity with the game.
It could be, of course, that the shoulder being pulled
off the axial torso and the shortening of the right
side pre-dates the interest in tennis, so hold your story
lightly and be ready to abandon it in the face of new
information.
Include as much as you can in the story you con-
struct, relating the various elements into a whole. In
real life, the story can be much more complex, and may
have a strong somato-emotional component. Your story
may not account for all of the elements observed; after
all, the client has had a long life, and not everything
fits in neatly like a jigsaw puzzle. The attempt to relate
a tilted pelvis (and accompanying sacroiliac pain) to
the medially rotated knee and the medially tilted
ankle on the opposite side is an instructive one. The
story can help you know where to begin, even though
it is some distance away from the site of pain, strain, or
injury.
Perhaps you remember those clever Chinese wood
puzzle boxes, where, in order to have the drawer open,
several little pieces of wood would have to be slid past
each other successively. As a child, you struggle to open
the drawer, until some adult comes along to show you
the sequence. Likewise in manual therapy, we struggle
to fix some offending part. What the Anatomy Trains
map, and this method of bodyreading in particular, does
for us is to show where the other bits are - way on the
other side of the 'box' - that need to move beforehand,
so that when we return to the offending area, it just slips
into place more easily.
Putting the observed skeletal misalignments and
the soft-tissue pulls into a comprehensive and self-
Step k\ the development of a strategy
Using the 'story' from Step 3, the fourth step is to for-
mulate a strategy for the next move, a session, or a series
of sessions, based on that global pattern view. Continu-
ing this process for our tennis-playing client (again with
the proviso that we are examining only one factor out
of the multitude any given client would present), we
decide to work up the right Lateral Line from hip to
armpit, up the left Spiral Line from left hip to right
scapula, and up the Front Functional Line toward the
front of the right shoulder - all in an attempt to take
away the postural elements that are pulling the shoul-
der off its supported position on the rib cage. We can
then apply trigger point, positional release, cross-fiber
friction therapy - whatever is appropriate to the specific
injury - to the structure in trouble (perhaps the supra-
spinatus tendon, or the biceps tendon), secure in the
knowledge that it has a far better chance of healing and
staying healed if the shoulder is in a position where it
can do its job properly without extra strain. Having
lengthened the locked-short tissues, we can construct
homework for the client to strengthen and tone the
locked-long tissues.
In working more complex problems, the strategy may
involve more than one session. The general strategy of
Structural Integration (as we teach it - see Appendix 2)
involves exploring and restoring each line over the
course of a full session, resulting in a coherent series of
sessions, each with a different strategy. With the role of
each line in the 'story' noted down, it is quite possible
to stay on a multiple session treatment strategy without
addressing the injured part (except for palliation) until
it is appropriate and fruitful.
If the strategy is less injury/pain oriented, and the
work is being used for performance enhancement or as
a 'tonic' for posture and movement, the story and strat-
egy are still important to unwind the details of each
person's unique and individual pattern.
Step 5: evaluation and revision
of the strategy
Keep reassessing Steps 1 through 4 in light of results and
new information. After completing the strategy from
Step 4 on our putative client, we find that the shoulder
is mostly repositioned, but now immobility is apparent
between the scapula and the humerus in back, so we
revise/renew our strategy to include the infraspinatus
and teres minor tissues of the Deep Back Arm Line.
After completing any given treatment strategy, an
honest assessment is required as to whether the strategy
has worked or not, and what, precisely, the results are.
We are required to make a fearless re-examination, i.e.
go back to Step 1. If our strategy has worked, the skeletal
relationships will have altered. We can note these, and
go on to Step 2 to see what new set of soft tissues we
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