Issue link: https://www.massageandbodyworkdigital.com/i/72103
SUBJECTIVE ELEMENTS In the last issue, we introduced our approach to BodyReading—or visual structural assessment. To review, before adding to what we did last time, we offered quite a few caveats: • Be careful of assigning moral value to straight, balanced, or symmetrical posture—these attributes are pointers, not goals in themselves. • Be doubly careful not to see your client as a collection of faults or problems —biologically and functionally they are massively successful to be able to choose you and afford you, so be aware of their strengths and resources at least as much as their problems and symptoms. • Assessment of the skeleton from landmarks without X-rays shows a lot of inter-operator unreliability— not just in massage therapy but in physiotherapy,1 chiropractic,2 and osteopathy as well.3 • Assessment of standing posture is only an approximation of the real deal, which is assessing functional movement. Stance is simply one such revealing functional "movement." • The method we are proposing is just one of many valid ways to approach visual assessment; we hope this vocabulary will someday be objective, but cannot say we are there yet.4 In search of that objectivity, we set out a positional vocabulary for the skeleton we used to describe inter-osseous relationships, to create a picture of where the skeleton hangs out in space.5 Our thesis was that even though these relationships will change in movement, and "one can never step in the same river twice," as Heraclitus warned us, there are recognizable characteristics in movement and posture—a bit like an accent in the voice—to which people return again and again. The object of most therapies is to somehow break into these neuromyofascial patterns to make fundamental changes in these relationships. We could reverse that, at the risk of sounding a little negative, to say that if a therapy is not somehow altering these fundamental relationships, its results are likely to be temporary and unsatisfying to therapist and client alike. (I hasten to add that all the therapies I personally know, from the most medical to the most holistic, from the most evidence-based to the most woo-woo, are capable of making deep changes or capable of sliding around the surface of these ingrained patterns. It's the how, not the what.) But our thesis is also that the more you can see and feel these patterns in the body, the better chance you have of seeing their body-wide connections, and thus the better chance you have of getting the postural weeds out by the roots. To get the subtleties of the position of the skeleton in space, we used four general terms—tilt, bend, rotate, and shift—in very specific ways to make clear the body's segmental relationships. You can review that in the last issue (Massage & Bodywork, March/April 2011, page 74) or in Chapter 11 of Anatomy Trains (Elsevier, 2009) or via the BodyReading 101 three-DVD set available from www. anatomytrains.com, which has many examples for you to practice on. Grasping the common elements of postural position is only the first step of a multistep process of arriving at a soft-tissue strategy for any given pattern. In subsequent issues, we are going to go through the second step of asking the question: What soft tissues could be responsible for creating or maintaining that skeletal position? While these patterns can stem from individual muscles (meaning neurological patterning in most cases), ligaments, or connective tissue structures (including the brain's dura or the organs' attachments to the body wall), subsequent articles in this series will be looking at the kinds of patterns the longitudinal meridians of myofascial linkage (from the Anatomy Trains foundation) can create and participate in. In other words, we will be going through some postural patterns line by line. We will touch on the subsequent steps of the process—creating a story that fits the picture, creating a strategy (whether for a move, a session, or a series), and reassessing to confirm or alter your strategic route—but these are skills more properly conveyed in a classroom setting. This time, let us make a few refinements to what we laid out previously, and dive cautiously (Can you "dive cautiously"? Although that is an obvious contradiction in terms, it is what we do everyday in an alive and aware practice) into the subjective and psychological element in BodyReading—the somatoemotional realm of spatial medicine.6 earn CE hours at your convenience: abmp's online education center, www.abmp.com 73