Healthcare and Medicine Reference
In-Depth Information
Fig. 11.16 A primary thoraco-
lumbar rotation to the right.
the two posterior superior iliac spines (PSISs), with
your fingers resting on and below the iliac crest. Adjust
the client's pelvis so that the PSISs are equally lined up
with the heels (thus temporarily and artificially elimi-
nating any rotation in the legs, such as we saw in some
of the clients above). Now peer down the client's back
from above, as we have in all the 'E' pictures above (the
short practitioner may need a stool to assess the tall
client). By noting the tissues about an inch (2 cm) on
either side of the spinous processes, one can see which
side is more anterior or posterior (closer to you or further
away). These differences are only rarely due to differen-
tial muscle development on either side of the spine. At
any given level of the spine, the side closest to you
indicates the direction of rotation of the spine as the
transverse processes push the overlying myofascial
tissue posteriorly.
In our experience, most clients will show a dominant
rotation in the thoracolumbar area, which we term the
'primary' rotation (Fig. 11.16). Counter-rotations fre-
quently occur in the legs or in the neck, but sometimes
also within the thoracolumbar area itself. Infrequently,
it can be difficult to tell which is the primary and which
is the secondary rotation; in which case, further therapy
may clear the picture, or the two rotations may indeed
be nearly equal, and therefore the designation 'primary'
has less meaning. With practice, one can gather quite
detailed and specific information about the inherent
spinal rotations using this method.
Another simple movement assessment can yield yet
more information: Kneel behind the client, again with
the hands steadying the pelvis and the thumbs on the
PSISs. Give the client the instruction to 'look over your
shoulder'. By not saying which shoulder, you allow
them to choose, and they will almost always choose
their preferential side - the side with the primary rota-
tion. As they turn, encourage them to use the whole
torso to turn, while you keep the pelvis steady relative
to the feet with your hands. Observe where the spine
rotates. Have them turn the opposite way, and observe
the difference. Anyone with a significant primary rota-
tion will have palpable or observable differences in
where in the spine the rotation occurs on the two
sides.
A
B
Fig. 11.15 In this model, we see a mild form of the alternation of
'cylinders'. In the torso area, the cylinders are turned outward, so
that the front looks wider than the back. In the pelvis and legs, the
'cylinders' appear to be turned in, making the back appear wider
than the corresponding area in front.
laterally (internally or externally) rotate. Imagine that
these two cylinders extend into the trunk. In the pelvis,
these two rotational preferences have a name - inflare
and outflare - but the phenomenon extends to the belly,
ribs, and shoulders. If the cylinders are rotated medially,
that segment of the body looks wide in the back and
narrow in the front. If the cylinders are rotated laterally,
the segment looks wider in the front and narrower
in the back. These patterns can sometimes alternate,
with the lower back/belly segment in external rotation,
counterbalanced by a chest segment in internal rotation
(Fig. 11.15) In these cases, the narrow part of the seg-
ments needs repeated widening.
F. Primary rotation
Everyone I have worked on or observed over 30 years
of practice has had a primary rotation to the spine. (Gal-
axies and DNA grow in spirals, why not us? Observe
the photos of fetuses by Lennart Nilsson and others 2 1 -
each one can be seen to have a nascent spiral in the
spine. Could this be a natural part of development, or
must it be considered an aberration?) Observing the
direction of that rotation, its degree, and the specific
areas of counter-rotation that always accompany it are
essential data for the most efficient unwinding of the
entire pattern.
To observe spinal rotation quickly without benefit of
an X-ray, stand behind the client. Place your thumbs on
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