Healthcare and Medicine Reference
In-Depth Information
on the feet and a slight right rotation of the ribs on the
pelvis (look at the bra line for this), whereas the shoul-
ders are again left rotated on the ribs.
Client 1 (Fig. 11.9A-E)
In taking an initial look at a prospective client from the
front (A), we do well to tot up the advantages and
strengths the client brings to the collaborative process
before we detail any problems that concern her or our-
selves. Here we see a strong young woman who seems
securely planted, fairly well aligned, a long core, and
with a gentle demeanor and a healthy glow. There is a
slight 'down' feeling in the face and chest that goes
against this basic vitality, with a deeper tension in what
Phillip Latey would call 'the middle fist' or loss of heart
energy, seen in the relative lack of depth in the rib cage. 1 1
The grounding and muscular responsiveness evident in
this client are qualities that will help us in our journey
if we call them forth.
Step 2
Proceeding to Step 2, we make the following surmises
based on our observations in Step 1. Looking from the
side, we can see that the Superficial Front Line (SFL) is
pulled down along most of its length. The shortness
from the mastoid process to the pubic bone is readily
visible, and the shortness along the front of the shin
accompanies it.
The Superficial Back Line (SBL) is pulled up from the
heels to the shoulders, and shortened through the neck
and the back of her head.
The right Lateral Line (LL) is shorter than the left
from ear to hip, while the left lower LL is shorter than
the right on the outside of the leg.
We would expect to find the right upper Spiral Line
(SPL) shorter than its left complement, as the right ribs
are drawn toward the left hip, and the head is tilted
slightly to the left. The anterior lower SPL (TFL, ITT, and
tibialis anterior) is shortened on the right leg, where the
left shows a more even-toned balance.
Pectoralis minor is pulling the right shoulder forward
over the ribs and there is some adduction going on in
both arms, probably due to the coracobrachialis or the
myofascia of the back of the axilla. The humeri seem a
little laterally rotated for her body (look at the cubital
fossa) but not by much.
Step 1
Having noted these general (and somewhat value-laden,
so hold them lightly) considerations, we proceed to Step
1, describing as objectively as possible the relative skel-
etal position. Looking at lateral deviations from the
front, this client presents with a slight left tilt to the
pelvis, which causes a slight left shift of the rib cage
(note the difference in the waist on the left and right to
see this imbalance). This is combined with a right tilt of
the ribs that brings the sternal notch back to the midline.
The shoulders counterbalance this with a slight right
The back view (B) shows the same picture a little
more clearly, and shows that the left leg is the more
heavily weighted one. This makes some sense, because
the rotation is in the right leg. As shown by the patella,
the right femur seems to be medially rotated compared
to the tibia-fibula, which seem laterally rotated. From
the back, we can also see that the shoulders look medi-
ally shifted (retracted), laterally tilted (downward rota-
tion), and superiorly shifted (lifted).
If we look at the side views (C and D), we see the
head shifted forward (so we can presume an anterior
bend in the upper thoracics, and a posterior bend
(hyperextension) in the upper cervicals. Old Ida Rolf
would have urged her to put her hair on top of her head
so that it would not act as a counterweight for her head
position. We can see that her shoulders, especially the
right one, are superiorly shifted and posteriorly shifted
relative to the rib cage, and the left one, though better
situated in general on the ribs, has a slight anterior tilt.
(Read this from the vertebral border of the scapula: the
left is vertical like a cliff; the right is tilted a bit like
a roof.)
The lumbars have a long curve, speaking to her long
core structure, but what remains for the thoracic spine
means a fairly sharp thoracic curve. The long lumbar
curve relates to her knees, which are slightly posteriorly
shifted (hyperextended). The pelvis, however, looks
fairly neutral relative to both the femur in terms of tilt
and the feet in terms of shift, though some would feel
she has a slight anterior tilt.
Looking down from the top (E), and using the feet as
a reference, we can see a slight left rotation of the pelvis
Step 3
Bringing all these observations into a coherent story
would require weaving them in with a full history, but
in general, we can say that most of this woman's pattern
is built on:
1. The shortening and downward motion of
the fascia in the front of the body, restricting the
excursion of the ribs and the placement of the
head, requiring compensation (lifting and hiking)
in the shoulders and back.
2. She has a slightly longer right leg (probably
functional, but we cannot tell from a simple
photograph), which accounts for several things:
the twist in the right leg is attempting to equalize
the leg length, the tilt in the pelvis results from the
length discrepancy, and the shift in the ribs away
from the high hip is a common compensation.
Additionally, the small twists in the torso and legs
come from trying to accommodate the differences
in what looks like a strong exercise regimen.
Step k
Based on this assessment, we can move toward Step 4,
a general strategy leading to a specific treatment plan.
The major elements of the overall plan for this client
would include:
1. Lift the tissues of the entire SFL, especially in the
areas of the shin, chest and subcostal angle, the
neck fascia and sternocleidomastoid.
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