Healthcare and Medicine Reference
In-Depth Information
well, but in the shins the SFL is pulling strongly down.
In the SBL, the low back is an obvious place for length-
ening, but the lower hamstrings beg for lengthening as
The left LL is short from hip to ankle, and the right
LL needs lengthening from waist to ear. The shift in the
ribs will require some complex unwinding in the lower
back of both sides. The tissue is clearly pulled in overall
on the left side, but the tissue running from the 12th rib
to the lumbars is clearly shorter on the right. Once again,
the left upper SPL will be shorter than its right-side
The Deep Front Line is shorter up the inside of the
left leg than the right, and is probably mediating the
twist of the pelvis on the feet. Obviously the Deep Front
Line is involved with the confusion in the lumbar area
and the rib shift.
Client 5 (Fig. 11.13A -E)
This very fit young woman arrives with basic good
balance, a long core, and obviously well-trained muscle
tone. Nevertheless, even this young woman shows ten-
dencies which, if left unchecked, could lead to troubles
in later life.
Step 1
Looking from the front, the most obvious feature is the
left shift of the ribs relative to the pelvis. If we 'read' the
waist, we can see that from the left waist, we only have
to go out a little bit horizontally before we could drop
vertically clear of the trochanter. If we do the same on
the right, we see how much farther we must go horizon-
tally before we could drop clear of the greater trochanter
vertically. This is a good way to read the shift of the ribs
on the pelvis; measuring the space between the arms
and the body, although it works in this case, is not a
good measurement tool.
The shift of the ribs is correlated with the right tilt of
the rib cage, and the right tilt of the shoulder girdle
follows along. The neck tries to tilt a bit to the left to
counterbalance the right tilt of the ribs, but the head
again tilts right.
A third and more subtle effect of the weight shift to
the left can be seen in the left knee, where the strain on
the medial side is clearly visible, and the rotation at the
knee between the medially rotated femur on the later-
ally rotated tibia further increases the strain through this
joint. At her age, she may feel none of this, but the stage
is being set for medial collateral or anterior cruciate liga-
ment problems some years down the road.
From the side, and working up from the bottom, we
can see that her heels are anteriorly shifted - pushed
into the foot, as it were - so that most of the body is
located over the anterior foot (see p. 80 for further dis-
cussion). The knees tend toward hyperextension, and
the pelvis is both anteriorly shifted relative to the feet,
and anteriorly tilted relative to the femur.
There is a strong and sharpish posterior bend at the
top of the lumbars, which sets the rib cage into a poste-
rior tilt. The lower neck has an anterior tilt (again, if we
held the rib cage vertical, the head would go further
forward), and the occiput is anteriorly shifted on the
Shifts are most often accompanied by rotations, so in
looking from above, we see a right rotation of the pelvis
on the feet, a left rotation through the lumbars and
lower thoracics, a right rotation in the upper thoracics
(with which the shoulders go along), and therefore there
must be a mild left rotation in the cervicals to bring the
eyes to the front.
Finally, we note that the left calcaneus is medially
tilted, whereas the forefoot on the right seems medially
Step 3
We wonder whether something happened to the right
leg that she shifted the weight off it onto the left, but in
the absence of a history to refer to, or a living, speaking
client, we can only surmise. In any case, almost every-
thing in this structure is a result of that shift, right
down to the feet, and up the head. There seems to be a
slight maturity issue in the pelvis - it seems 'younger'
than the rest of her - with the knees locked back, the
pelvis in front of the feet, and the upper body leaning
Step k
A treatment strategy for this person would involve
dealing with the front-back issues to some degree before
tackling the main issue of the rib shift. The SBL would
need to be dropped and opened in the lumbars, and an
attempt made to get the lower leg under the upper leg.
At the same time, the lower part of the SFL would need
to be lifted, and the anterior track of the Deep Front Line
opened to let the pelvis return toward a neutral tilt.
Once these tissues were somewhat resilient, the left-
right issues could be addressed, releasing the LL on the
left from hip to ankle and the LL on the right from hip
to ear. The left SPL could be released, and then and only
then would it be profitable to go into the psoas complex
on the left, lifting the lumbars up and away from the left
hip, and resettling the ribs in a more balanced place.
Getting more stability through the left heel and the
right medial arch/forefoot would figure in our plans, as
would balancing the head on the neck.
The adductors of the Deep Front Line on both sides,
but perhaps more on the right, are involved with main-
taining the twist between the pelvis and the feet. The
psoas is clearly pulling the rib cage off to the left, but
passive tension in the right psoas may be contributing
to the left rotation in the lower thoracics. Getting these
tissues balanced would be the main task of our interac-
tion with this fit young woman. The strain in the knees
should be relieved by these manipulations, but some
attention to the knees themselves would be called for if
they did not.
Step 2
The obvious discrepancy front and back brings our
attention to the relation between the SFL and the SBL.
The SFL is 'up' in the chest mostly and in the neck as
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