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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 97 3 4 5 In the left image, the therapist's forearms pin the pec fascia as the client internally and externally rotates his arms. On the right, the therapist applies a full-body front-line stretch as the client performs slow pelvic tilts. Romberg Test: with the client's feet together and eyes closed, the therapist observes for "first" direction of body sway. Notice that the head is also tilted to the side of the sway. To manually stimulate vestibular tone to the weak right side, the therapist left sidebends the client's head 20 degrees and asks him to chin tuck. The therapist's hands follow this head flexion movement and then apply 2 seconds of overpressure to help release the tight suboccipitals, allowing the right occipital condyle to glide posteriorly on the atlas. The therapist repeats 3–5 times and retests with the Romberg Test for improved balance. rotational crossing patterns, I always check for vestibular imbalance side to side. Let's look at an example of this dysfunctional pattern. BAD BALANCE, BAD POSTURE Massage therapists are aware of the role good balance plays in enhancing performance and avoiding falls. However, many do not realize how activation of the inner ear's vestibular system helps our clients stand tall and move with more precision. The inner ear transmits sensory information to the pons based on the client's head position. Therefore, head-on-neck alignment is a critical factor in improving balance. Although I teach several vestibular tests and corrections in workshops and videos, the classic Romberg Test is the simplest way to expose the weak stability side. Notice in Image 4 how the client's head tilts right, which forces his body to sway in that direction. This may indicate right vestibular weakness due to occipitoatlantal (O-A) alignment problems. In Image 5, I show my favorite head-on-neck myoskeletal technique for leveling the eyes and activating the vestibular system. To enhance vestibular tone at home, I recommend activities like mini-trampoline bouncing, walking on uneven surfaces, and proprioceptive enhancers such as wobble boards. UNDERSTANDING POSTURAL PLASTICITY With a healthy PMRF resisting flexion and a highly functioning vestibular system promoting extension, we're better able to get our upper-crossed clients standing taller and moving better. Remember, your brain sets the tone for all your muscles. Like an overprotective mother, it decides how much activation to allow—and it always errs on the side of caution. The brain can activate or inhibit muscle tone and balance depending on what it determines to be the safest course. We are wired for survival. Your brain is designed to protect you and, when functioning properly, knows when too much or too little of a good thing is just right for you. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit

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