(BL) Spinal Manipulation Made Simple A Manual of Soft Tissue Techniques#2 PDF

"Meeting the plasticity of the body with a flexible
and gentle somatic response"
As somatic therapists our goal is not to make clients measure up to

some external standard that we impose on them by means of somatic
ideals and formulistic protocols, but to try to discover the limitations
that stand in the way of them becoming who they are—and then to
release their fixations in the right order. — f r o m the text
In Spacious Body: Explorations in Somatic Ontology, Jeffrey Maitland e x p l o r e d

the philosophical implications of Rolfing, interrogating different kinds of
will and showing h o w p e o p l e can b e g i n to understand their c o r e fixations
a n d c o n f l i c t e d o r i e n t a t i o n s a n d m o v e t o creative t r a n s f o r m a t i o n s . His
m o v i n g descriptions o f healing s h o w e d h o w a n e w u n d e r s t a n d i n g o f h o w
the h u m a n b o d y works can create a transformation of the spirit.
In this new m o r e physiological b o o k , Maitiand stays with the myofascial
release techniques invented by Rolfing, b u t focuses the reader's attention
o n the p r o b l e m o f j o i n t fixations w h i c h u n d e r l i e m a n y soft-tissue pain
syndromes. His attention is especially on h o w to ease back pain and bring
the b o d y into a m o r e comfortable alignment, because back pain is a major
c o m p l a i n t dealt with by c h i r o p r a c t o r s , Rolfers, massage therapists, a n d
physical therapists. Maitland shows h o w to elegandy release j o i n t fixations
in the spine, sacrum, pelvis, and ribcage by using subtle soft-tissue tech-
niques, rather than the high-velocity low-amplitude thrusting techniques
that " p o p " the j o i n t s . This gentler kind of individualized Rolfing w o r k is
t h o r o u g h l y d e s c r i b e d within an e x p l a n a t i o n of b i o m e c h a n i c s , a i d e d by
drawings and p h o t o g r a p h s which d e p i c t t e c h n i q u e s and anatomy.
Jeffrey Maitland, Ph.D., is a philosophical counselor and advanced Rolfer. He is

a senior instructor and Director of A c a d e m i c Affairs at the International Rolf
Institute. Spacious Body: Explorations in Somatic Ontology was published by North
Atlantic Books in 1 9 9 5 . He lives and practices in Scottsdale, Arizona.
Health/Somatics US $20.00 / $24.95 CAN
North Atlantic Books

Berkeley, California
www.northatlanticbooks.com
Spinal
Manipulation
Made Simple
Spinal
Manipulation
Made Simple
A Manual
of Soft Tissue
Techniques
Jeffrey Maitland
Photographs by Kelley Kirkpatrick
N o r t h Atlantic B o o k s
Berkeley, California
Copyright © 2001 by Jeffrey Maitland. Photographs © 2001 by Kelley Kirkpatrick.
All rights reserved. No portion of this book, except for brief review, may be repro-
duced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise without the writ-
ten permission of the publisher. For information contact North Atlantic Books.
Published by
North Atlantic Books
P.O. Box 12327
Berkeley, California 94712
Cover photograph by Brandy Wilkins

Cover and book design by Paula Morrison
Printed in the United States of America
Spinal Manipulation Made Simple is sponsored by the Society for the Study of Native
Arts and Sciences, a nonprofit educational corporation whose goals are to develop
an educational and crosscultural perspective linking various scientific, social, and
artistic fields; to nurture a holistic view of arts, sciences, humanities, and
healing; and to publish and distribute literature on the relationship of mind,
body, and nature.
ISBN-13: 978-1-55643-352-8
Library of Congress Cataloging-in-Publication Data

Maitland, Jeffrey, 1943-
Spinal manipulation made simple : a manual of soft tissue techniques /
by Jeffrey Maitland.
p. cm.
ISBN 1-55643-352-2 (trade paper : alk. paper)
1. Spinal adjustment—Handbooks, manuals, etc. 2. Manipulation
(Therapeutics)—Handbooks, manuals, etc. I. Title.
RZ265.S64 M35 2000

615.8'2— dc21
00-041133
6 7 8 9 1 0 DATA 11 10 09 08 07
ACKNOWLEDGMENTS
Spinal Manipulation Made Simple answers a q u e s t i o n that m a n y s o m a t i c

manual therapists have p o n d e r e d : Is it possible to release spinal fixations
without resorting to high-velocity, l o w - a m p l i t u d e thrusting t e c h n i q u e s
e m p l o y e d by osteopaths and chiropractors? This b o o k delineates my very
straightforward a n d simple technical solution to this p r o b l e m . But sim-
ple solutions often have c o m p l e x histories that result f r o m the c o n f l u e n c e
of many disparate influences. T h e r e are so many p e o p l e that have h e l p e d
me find my way that I w o u l d be disrespectful and remiss if I d i d n ' t try to
thank s o m e o f t h e m .
With respect to somatic therapy, the m o s t i m p o r t a n t i n f l u e n c e on the
evolution of my a p p r o a c h c o m e s f r o m the m a n y p e o p l e at the R o l f Insti-
tute w h o l a b o r e d in the service of teaching me the t h e o r y a n d art of the
Rolfing® m e t h o d of Structural Integration and h o w to teach it. I am espe-
1
cially i n d e b t e d to the teaching a n d gifts of senior teachers Jan Sultan a n d

Michael Salveson a n d I want to a c k n o w l e d g e their untiring d e d i c a t i o n to
the education of Rolfers. T h e i r i n f l u e n c e can be f o u n d in various places
t h r o u g h o u t this b o o k . I am also v e r y grateful f o r what I l e a r n e d f r o m
E m m e t t Hutchins a n d Peter M e l c h i o r w h e n they were still m e m b e r s o f
the Rolf Institute. My understanding of the functional side of somatic ther-
apy has benefitted greatly f r o m the work of the m o v e m e n t teachers at the
Rolf Institute, especially f r o m the following p e o p l e : H u b e r t G o d a r d , J a n e
Harrington, M e g a n James, Vivian Jaye, Gael O h l g r e n , a n d H e a t h e r W i n g .
I also want to acknowledge J o h n (Nottingham, physical therapist, researcher,
and R o l f e r n o t o n l y f o r his s u p p o r t , generosity o f heart, a n d sparkling
intellect, but also for his sensational research on holistic manual and m o v e -
m e n t therapy. I feel privileged to have w o r k e d with h i m and to have b e e n
able to publish two articles with h i m . His research is n o t only elegant, b u t
s o m e of the best on holistic manual therapy.
SPINAL MANIPULATION MADE SIMPLE
I have greatly benefitted, b o t h professionally and personally, f r o m the

wonderful work of osteopathy. I owe a special debt of gratitude to the guid-
a n c e a n d generosity of my friend a n d m e n t o r , the late Dr. Walter Wirth,
D . O . His brilliant w o r k a n d teaching c h a n g e d n o t only my body, but the
d i r e c t i o n of my w o r k as a somatic practitioner. I am also grateful for the
i n t r o d u c t i o n to the mysteries of the c r a n i u m a n d i n d i r e c t t o u c h that I
received f r o m Dr. J o h n Upledger, D . O . early in my development as a Rolfer.
I feel especially fortunate to have b e e n able to train with the U p l e d g e r
Institute and Didier Prat, D . O . in the revolutionary Visceral Manipulation
d e v e l o p e d by Jean-Pierre Barral, D . O . Many thanks to Dr. Marilyn Wells,
D . O . a n d the o t h e r A r i z o n a osteopaths with w h o m I have had the great
pleasure to associate. I have learned m o r e than I can say from a great n u m -
b e r of b o o k s on osteopathy, but I particularly appreciate the work of Phillip
Greenman, D.O.
I also want to thank Dr. J o s e p h D e B r i u n , D.C. a n d Dr. L . J o n P o r m a n ,
D.C. f o r their e x c e l l e n t w o r k o n m y j o i n t s a n d f o r i n t r o d u c i n g m e t o the
principles and practice of Dynamic Chiropractic. Although I do n o t employ
c h i r o p r a c t i c t e c h n i q u e in my p r a c t i c e , I have f o u n d their a p p r o a c h to
m o t i o n testing a n d u n d e r s t a n d i n g spinal fixation invaluable.
I am by instinct a n d training a p h i l o s o p h e r a b o v e all else. Philosophy
has m a n y faces, b u t the o n e I am m o s t attracted to c o n c e r n s the nature
o f b e i n g . A n o t h e r i m p o r t a n t aspect o f p h i l o s o p h y consists i n e x p o s i n g
and e x a m i n i n g the veracity of the presuppositions that i n f o r m o u r every
a t t e m p t t o u n d e r s t a n d the nature o f reality. T h i s a s p e c t has l e d s o m e
thinkers to d u b p h i l o s o p h y "the q u e e n of the sciences." A l t h o u g h it may
n o t be immediately o b v i o u s , these two c o n c e r n s are at work in the back-
g r o u n d of this manual. To all the p h i l o s o p h e r s w h o have c o n t r i b u t e d so
m u c h to my growth over the years I give heartfelt thanks.
O n e of the greatest practical p h i l o s o p h e r s with w h o m I have had the
g o o d f o r t u n e to study is my Z e n teacher. I c a u g h t my first glimpse of h o w
the b o d y speaks to an o p e n heart while c u d d l i n g my infant daughters. But
this truth a b o u t the activity of b e i n g d i d n o t really b l o s s o m until it was
simultaneously articulated and manifested by my Roshi. His influence c o n -
tinues to alter the c o u r s e of my life a n d work. Even the O x f o r d English
Dictionary c a n n o t supply e n o u g h w o r d s to express the d e p t h of my grat-
itude to h i m . I r e m e m b e r asking h i m , " H o w do y o u heal p e o p l e ? " With a
ACKNOWLEDGMENTS
spacious imperturbability that s h o w e d no hesitation, he said, " A h h , y o u

must b e c o m e o n e with t h e m ! " His simple answer p o r t e n d s a great d e p t h .
Today, twenty years later, I think I am just b e g i n n i n g to grasp the w i s d o m
he demonstrated. I h o p e s o m e small part of his p r o f o u n d teachings has
also f o u n d its way into this b o o k .
I want to thank Kelley Kirkpatrick f o r h e r w o n d e r f u l p h o t o g r a p h s that
so clearly demonstrate my t e c h n i q u e s . H e r skill, p a t i e n c e , a n d aesthetic
sensitivity are a gift. Also m a n y thanks go to David R o b i n s o n , Rolfer, w h o
generously agreed t o b e the m o d e l .
Finally, I want to give thanks to my pain f o r leading me to a n e w a n d
better life. But m o s t of all, I want to give my d e e p e s t b o w of gratitude to
my detractors. F r o m t h e m I have l e a r n e d the impossible.
Note
1. Rolfing® is a service mark of the R o l f Institute of Structural Integration.
ILLUSTRATIONS
Permission to use their illustrations was granted from the following publications:
The illustrations of the spine in forward and backward bending and the dys-
functional vertebrae (Figures 2.1, 2.2, and 2.3) come from Greenman, Phillip E.
The Principles of Manual Medicine, second edition. Baltimore, Maryland: Williams
and Wilkins, 1996, figures 5.24 and 5.25 on p. 61 and figure 6.1 on p. 67.
The illustration of rib tender points (Figure 9.5) comes from DiGiovanna,
Eileen L. and Schiowitz, Stanley. An Osteopathic Approach to Diagnosis and Treat-
ment. New York, New York: Williams and Wilkins, 1991, figures 17.7 and 17.10 on
pp. 261-262.
The following illustrations come from Kapandji, I. A The Physiology of the Joints,
Vol Three. New York, New York: Churchill Livingstone, 1974.
Figure 4.2 is 34 on p. 193.
Figure 7.14 and 10.11 are 8, 9, and 10 on p. 61.
Figure 7.13 is 2 on p. 11.
Figure 8.1 is 11 and 12 on p.63.
Figurel0.3 is 11 and 12 on p. 63.
Figure 10.7 is 75 p.233.
Figure 10.10 is 6 on p. 59 and 8, 9, 10 on p. 61.
The photograph in Figure 8.3 displaying an posteriorly tilted and anteriorly
shifted pelvis comes from Kendall, Florence Peterson and McCreary, Elizabeth
Kendall. Muscles: Testing and Function, Third edition. Baltimore, Maryland: Williams
and Wilkins, 1983, p. 284.
The illustration of the of the Ideal Body (Figure 10.8) comes from Kendall,
Florence Peterson and McCreary, Elizabeth Kendall. Muscles: Testing and Func-
tion, Third edition. Baltimore: (Williams and Wilkins), 1983, p. 280.
The illustration of the rib/vertebral complex (Figure 9.1) comes from Schultz,
R. Louis and Feitis, Rosemary. The Endless Web. Berkeley, California: North Adantic
Books, 1996, figure 9.1 is 8.5 on p. 30.
The illustration of the possible positions of the sciatic nerve in relation to the
piriformis muscle (Figure 10.4) comes from Ward, Robert, ed. Foundations for
Osteopathic Medicine. Baltimore, Maryland: Williams and Wilkins, 1997, figure 10.4
is 49.6 p. 606.
The illustration of the ideal spine (Figure 10.9) comes from Rolf, Ida P. Rolf-
ing: The Integration of Human Structures. Santa Monica: Dennis-Landman Pub-
lishers, 1977, figure 10.9 is 13.3 on p. 209.
CONTENTS
Introduction xi
Chapter 1: O u r Fine Spine: T h e B a c k b o n e of Structural Integrity 1
Chapter 2: Primates in T r o u b l e
Or where d o e s y o u r back go w h e n it g o e s out? 13
Chapter 3: Finding and Fixing the Fixations 27
Chapter 4: T h e N e c k 35
Chapter 5: M o t i o n Testing the Cervical Spine 51
Chapter 6: T h e Atlas a n d O c c i p u t 61
Chapter 7: T h e Sacrum 71
Chapter 8: T h e Pelvis 95
Chapter 9: T h e Ribs 113
Chapter 10: O d d s a n d Ends 129
Bibliography 157
Index 161
INTRODUCTION
T HIS B O O K G R E W O U T O F M Y B A C K P A I N A N D M Y D E E P A P P R E C I A T I O N F O R
the somatic manual therapists w h o allowed me to heal a n d find a n e w

life. I r e m e m b e r all t o o well the day my back "went o u t " f o r the first time.
I was 27 years o l d , fresh o u t of graduate s c h o o l , and into my s e c o n d semes-
ter of teaching p h i l o s o p h y at P u r d u e University. Feeling the n e e d to get
into better shape, I had b e g u n a rather thoughtless p r o g r a m of exercise.
A few days later, I awoke to a nasty pain in my lower b a c k c o n f i n e d to an
area about the size of a 50-cent piece. By n o o n I c o u l d n ' t stand up straight.
I was p i t c h e d forward at a 45-degree angle and f o r c e d to lean on a b r o o m
h a n d l e t o m o v e a b o u t . M y wife arrived h o m e f r o m r u n n i n g e r r a n d s t o
find m e i n this d e p l o r a b l e c o n d i t i o n . She d r o v e m e t o the l o c a l e m e r -
g e n c y r o o m w h e r e I was p r o d d e d a n d p o k e d , a n d then sent h o m e with
muscle relaxants. T h e muscle relaxants were useless; their only effect was
to turn me into a s t u p o r o u s version of the local village idiot. W h e n the
effects w o r e off, I immediately flushed my m e d i c a t i o n s d o w n the toilet.
That day m a r k e d the b e g i n n i n g of a seven-year search f o r relief.
At first I tried the c o n v e n t i o n a l m e d i c a l a p p r o a c h . On the first visit to
my doctor, an o r t h o p e d i c surgeon, I was i n f o r m e d I had back pain because
h u m a n beings were n o t d e s i g n e d to stand upright. " W h a t a bizarre the-
ory!" I thought. " D o e s he think that I w o u l d n o t have d e v e l o p e d back pain
if I had spent my life crawling a r o u n d on my hands a n d knees? Obviously
we are n o t d e s i g n e d f o r that way of getting a b o u t either." I k n e w better
than t o express m y o b j e c t i o n s t o his t h e o r y b e c a u s e h e , like t o o m a n y
o t h e r authoritarian practitioners, m a d e up s p e c i o u s explanations at the
d r o p of a hat. Besides, I was in pain, a n d at that m o m e n t in my life he was
my only h o p e . I certainly d i d n ' t want h i m angry with m e . He t h e n sent
me to a physical therapist w h o gave me a set of useless exercises. Over time
xi
my pain subsided a n d I b e g a n j o g g i n g in the naive belief that I was h e l p -

ing my back problem.
O v e r the n e x t few years my back regularly "went out." W h e n the pain
was at its worst, I m a d e another a p p o i n t m e n t with my doctor. Even though
I h a d n o p a i n radiating d o w n e i t h e r leg, h e i n f o r m e d m e , without the
b e n e f i t o f X-rays o r any o t h e r k i n d o f i m a g e s o f m y b a c k , that I h a d a
b u l g i n g disk, a n d said, "You know, if I have to see y o u t o o often, we are
g o i n g to have to do surgery." His ultimatum was c o m p e l l i n g and I drew
the only c o n c l u s i o n I c o u l d — I w o u l d never go to see h i m again.
"Surely," I t h o u g h t , " s o m e b o d y must understand h o w backs work, why
they get in trouble, a n d h o w they can be h e l p e d . " A friend r e c o m m e n d e d
that I go to a c h i r o p r a c t o r w h o had h e l p e d her. I m a d e an a p p o i n t m e n t .
His secretary a p p l i e d ultrasound to my low back and then he "adjusted"
it. He sold me a back brace and after a few weeks of his treatment, my pain
b e g a n to subside. I w o u l d make an a p p o i n t m e n t every time my back flared
u p . Unfortunately, even t h o u g h my c h i r o p r a c t o r c o u l d ease my pain, he
c o u l d never k e e p me that way. After many treatments my n e c k also b e g a n
to cause me trouble a n d every session I had to r e m i n d h i m to "adjust" my
n e c k . I c o n t i n u e d to j o g a n d my pain c o n t i n u e d to get worse.
A n u m b e r of years later I a l l o w e d a n o t h e r c h i r o p r a c t o r to strap me
o n t o a table that l o o k e d like it h a d b e e n built in the last century. As he
tightened the straps I felt vaguely uneasy a n d had a m o m e n t a r y vision of
myself as a victim of the Crusades. As he slowly t u r n e d the crank, I was
tortuously a n d painfully stretched. I c o u l d barely stand afterwards and I
s o o n d e v e l o p e d a h o r r i b l e case of sciatica. If y o u have never e x p e r i e n c e d
this pain, y o u never want to. It is like having the world's worst t o o t h a c h e
in y o u r butt and legs. So I knew I h a d to find a n o t h e r way.
W h i l e I was o n sabbatical f r o m P u r d u e , o n the r e c o m m e n d a t i o n o f
f r i e n d s I m a d e an a p p o i n t m e n t with a very talented Rolfer. To make a
l o n g process short, after thirty five or so sessions with a n u m b e r of o t h e r
Rolfers a n d with the a d d i t i o n a l h e l p of a gifted o s t e o p a t h , I was finally
freed of my b a c k pain. I subsequently b e c a m e a R o l f e r a n d then a Rolf-
ing teacher.
As my u n d e r s t a n d i n g a n d ability as a Rolfer grew, my frustration with
certain aspects of the traditional a p p r o a c h to Rolfing also grew. O l d style
R o l f i n g was often t o o painful a n d m u c h t o o general to p r o p e r l y handle
xii
INTRODUCTION
local areas of immobility a n d pain. B e f o r e b e c o m i n g a Rolfer, I h a d b e e n

practicing Z e n meditation intensely f o r a n u m b e r of years a n d h a d s o m e -
what unintentionally d e v e l o p e d the ability to feel e n e r g y in a n d a r o u n d
my clients' b o d i e s . Unfortunately the heavy pressure I was taught to use
when applying the techniques of Rolfing m a d e it impossible f o r me to feel
the subde energy c o n n e c t i o n s t h r o u g h o u t the body. For a n u m b e r of years
I e x p e r i m e n t e d with trying to find a gentler a p p r o a c h that w o u l d n o t sac-
rifice the p r o f o u n d structural changes f o r w h i c h Rolfing is k n o w n . I b u m -
bled along until I finally learned h o w to feel the energies of the b o d y while
still applying the heavy pressure often required by Rolfing. My c o n f i d e n c e
grew as I realized that I was able to apply a full range of pressures, f r o m
very light to very heavy, w i t h o u t causing u n n e c e s s a r y d i s c o m f o r t to the
client or sacrificing the goals of Rolfing. T h e s e e x p l o r a t i o n s also allowed
m e t o penetrate m o r e d e e p l y i n t o and t h r o u g h the b o d y ' s tangled webs
of fascial and energetic c o n f u s i o n .
My clients were happy because I was getting better results without caus-
ing unnecessary discomfort. Many r e p o r t e d that their e x p e r i e n c e of mas-
sage was actually m o r e u n c o m f o r t a b l e than the way I R o l f e d . I was feeling
better a b o u t my w o r k because I was also able to be very specific without
losing sight of the whole. Unfortunately, I did n o t remain c o n t e n t for long.
As if some universal principle were being worked out in my life that n o b o d y
had i n f o r m e d me a b o u t , the better a Rolfer I b e c a m e , the m o r e difficult
my client's p r o b l e m s b e c a m e .
While I was training to b e c o m e a teacher of advanced Rolfing I learned
that two senior teachers, Jan Sultan a n d M i c h a e l Salveson, were already
in the process of trying to solve m a n y of the same p r o b l e m s that I h a d
b e e n struggling with. I was able to build on their insights a n d my investi-
gations revealed that many of the traditional R o l f i n g t e c h n i q u e s were all
t o o often incapable of releasing facet restrictions in the spine a n d o t h e r
joints of the body. As Rolfing instructors, we had no interest in teaching
the high-velocity, low-amplitude thrusting techniques p i o n e e r e d by osteo-
paths and later a d o p t e d by chiropractors. Since R o l f i n g is a f o r m of m y o -
fascial m a n i p u l a t i o n a n d e d u c a t i o n , w e w a n t e d o u r t e c h n i q u e s t o l o o k
and feel like a variation of o u r already established a p p r o a c h to soft-tissue
m a n i p u l a t i o n . C r u d e l y stated, high-velocity t e c h n i q u e s are d e s i g n e d to
" p o p " j o i n t f i x a t i o n s free, b u t they l o o k a n d feel n o t h i n g like Rolfing.
xiii
We h a d e x p l o r e d o t h e r soft-tissue t e c h n i q u e s similar to ours, b u t s o o n

realized that they were incapable of p r o d u c i n g the global structural changes
of Rolfing. We also d i s c o v e r e d that m a n y of the p o p u l a r i z e d myofascial-
release t e c h n i q u e s that were m i s a p p r o p r i a t e d f r o m osteopathy a n d Rolf-
i n g t e n d e d to merely " u n w i n d " the tissue a r o u n d the j o i n t without ever
releasing the actual fixation. O u r goal was to find m e t h o d s of mobilizing
j o i n t fixations that were consistent with the way Rolfing works with soft tis-
sue, but we had no interest in importing techniques f r o m other disciplines.
After studying h o w j o i n t s w o r k a n d b e c o m e restricted, I e x p e r i m e n t e d
with a n d finally m a n a g e d to d e v e l o p a range of soft-tissue techniques that
effectively release j o i n t fixation without resorting to high-velocity thrust-
ing techniques or any other techniques d e v e l o p e d in other systems of man-
ual therapy. T h e s e soft-tissue t e c h n i q u e s , c o u p l e d with an understanding
of h o w the spine gets in a n d o u t of trouble c o m p r i s e the c o n t e n t of this
book.
Like s o m a n y o t h e r p e o p l e struggling t o o v e r c o m e debilitating back
pain, I was w o r k e d on by m a n y different practitioners f r o m many differ-
e n t s c h o o l s of therapy. I n o t i c e d that a few were astonishingly m o r e effec-
tive than others a n d that they all h a d similar qualities a n d abilities that
were missing in the average therapist. Y o u will often hear the average prac-
titioner boast that his t e c h n i q u e or a p p r o a c h is so m u c h better than all
the others b e c a u s e he d o i n g s o m e t h i n g remarkably and uniquely differ-
e n t f r o m e v e r y o n e else. But my e x p e r i e n c e as a patient a n d teacher of
m a n u a l therapy l e d me to just the o p p o s i t e c o n c l u s i o n : what makes f o r a
really g o o d practitioner is n o t what is different about his or her approach,
b u t what he or she shares in c o m m o n with all great practitioners in every
discipline. In the e n d there is nothing unique about being unique, because
the p o w e r is n o t in what is u n i q u e , b u t in what is c o m m o n .
T h e s e qualities are fairly easy to state, b u t n o t so easy to teach. All of
the gifted practitioners w h o w o r k e d with me e x h i b i t e d an u n c a n n y per-
ceptual vitality a n d sensitivity that allowed t h e m to see and feel the details
of my p r o b l e m s with an exquisite specificity and mastery of technique that
never lost sight of my w h o l e p e r s o n . T h e y were capable of releasing local
areas of dysfunction in a way that benefitted my entire body. T h e y released
my symptoms without ever getting caught in the trap of chasing them and
they w e r e always able to track h o w their l o c a l m a n i p u l a t i o n s c a s c a d e d
xiv
INTRODUCTION
t h r o u g h o u t my w h o l e body. As a result, they almost always k n e w w h e r e to

work next and they rarely drove p r o b l e m s to o t h e r areas of my body. Since
my b o d y was constantly c h a n g i n g a n d i m p r o v i n g u n d e r their care, they
rarely repeated the same session. But most importandy, because they c o u l d
k e e p the w h o l e of me in view a n d affect the w h o l e as they addressed local
areas of my body, their w o r k often p r o d u c e d far-reaching a n d long-last-
ing changes.
All of these practitioners were also w e l l - e d u c a t e d a n d well-versed in
their disciplines. T h e y h a d a t h o r o u g h a n d detailed k n o w l e d g e that they
continually e x p a n d e d t h r o u g h further study a n d research. Part of what
m a d e them masters of their arts was their daunting k n o w l e d g e , their c o m -
mitment to always learning m o r e , a n d a most remarkable mastery of tech-
nique. But there was another, m o r e elusive, factor that contributed to their
mastery—their way of being. At least for the duration of each session, they
lived their art with a clarity, compassion, and openness quite b e y o n d every-
day life. I felt that my b e i n g and pain were seen and u n d e r s t o o d . I was n o t
treated like a s p e c i m e n with a p r o b l e m w h o was in n e e d of s o m e sort of
outside intervention that f o r c e d me to measure up to s o m e objective stan-
dard o f normality. T h e i r u n c a n n y p e r c e p t i o n , exquisite discrimination,
and sense o f t o u c h were n o t r o o t e d i n any sort o f objective, j u d g m e n t a l
separation f r o m m e , b u t in a d e e p l y felt participatory u n d e r s t a n d i n g free
of conflict, grandiosity, and self-importance. T h e y never tried to c o n v i n c e
me that they knew what was best f o r me or that only they h a d the answer
to my p r o b l e m s . If I d i d n ' t r e s p o n d to their treatment as they e x p e c t e d ,
they d i d n ' t make me feel like it was my fault and were always willing to try
another approach or refer me to o t h e r practitioners. Unlike so many prac-
titioners w h o only chased symptoms while paying lip service to a holistic
a p p r o a c h , they were truly holistic practitioners.
This way o f b e i n g , n o t the m e r e a c c u m u l a t i o n o f t e c h n i q u e s , i s b o t h
the source of all healing and the limitless heart of life itself. W o r k i n g this
way is n o t a matter of g o i n g into an altered state, b u t of returning to o u r
senses, to o u r native c o n d i t i o n free of the contaminations a n d conflicts of
self and culture. O n c e we are freed f r o m o u r conflicts, we see a n d feel the
world differently, a n d we no l o n g e r stand apart f r o m what we sense. We
live and perceive o u r world with a participatory sensorial affinity that g e n -
tly embraces and is e m b r a c e d by b o t h s o m a and nature. T h e r e is a w i s d o m
XV
and spacious clarity that arises f r o m resting in o u r primordial unconflicted

s t a t e — w i t h o u t it a therapist is b u t a m e r e technician; b u t with it amazing
things are possible.
F o r this w i s d o m to evolve i n t o a healing ability, however, it must also
be c o u p l e d with the right kind of rationality and objective knowledge that
is t h e n fully i n t e g r a t e d i n t o the s o m a t i c i n t e l l i g e n c e of the t h e r a p i s t —
k n o w l e d g e a n d w i s d o m must go h a n d in h a n d . To paraphrase Kant: wis-
d o m without k n o w l e d g e is blind and k n o w l e d g e without wisdom is empty.
Since I have already discussed the nature of transformation in my b o o k
Spacious Body, I will n o t dwell on this way of b e i n g h e r e , I only m e n t i o n it
b e c a u s e it is so i m m e n s e l y i m p o r t a n t . Every p r a c t i t i o n e r has p r o b a b l y
e x p e r i e n c e d m o m e n t s o f this s p a c i o u s o p e n n e s s , i n w h i c h every inter-
v e n t i o n p r o d u c e s almost magical a n d effortless results. It is, after all, the
heart of all healing. T h r o u g h its cultivation the healer heals herself and
b e c o m e s effortlessly m o r e effective in healing others.
W h i l e no less i m p o r t a n t than articulating the healer's way of b e i n g ,
this b o o k is n o t so ambitious. It is rather a practical manual of techniques
f o r treating the spine. It offers all m a n u a l therapists s o m e of the knowl-
e d g e a n d specificity of t e c h n i q u e that is r e q u i r e d to treat a n u m b e r of
d i f f e r e n t kinds of s o m a t i c dysfunctions that they see every day in their
practices.
However, k n o w l e d g e and specificity of t e c h n i q u e , is n o t the be-all and
end-all of therapy. It is o n e thing to k n o w h o w to apply techniques and it is
quite a n o t h e r to k n o w w h e n and in what o r d e r to apply them. Beyond the
m e r e application of t e c h n i q u e there are the three fundamental questions
of therapy: "What do I do first, What do I do next, and W h e n am I finished?"
Answering these questions to the benefit of o u r clients is crucial f o r any
holistic a p p r o a c h . However, as important as understanding these consid-
erations is to the d e v e l o p m e n t of every practitioner, this b o o k is also n o t a
treatise on the clinical decision process, b u t a manual of techniques.
T h e mastery of t e c h n i q u e is i m p o r t a n t f o r m a n y obvious reasons, n o t
the least of w h i c h is the b e n e f i t it p r o v i d e s f o r o u r clients. But there is
a n o t h e r b e n e f i t f o r the p r a c t i t i o n e r w h o puts the time a n d effort i n t o
learning h o w to effectively apply technique: this mastery is o n e of the n e c -
essary stepping stones f o r cultivating the healer's way of being. Just as prac-
ticing scales can be p r e p a r a t o r y f o r the inspired p e r f o r m a n c e of music,
xvi
INTRODUCTION
s o t o o can p r a c t i c i n g t e c h n i q u e s b e c o m e part o f the cultivation o f the

healer's way of b e i n g .
No matter what f o r m of manual therapy you were trained in, and regard-
less of w h e t h e r y o u w o r k with a corrective or holistic a p p r o a c h , y o u will
find these techniques deceptively simple to apply a n d yet highly effective
in dealing with m o s t f o r m s of b a c k pain. T h e t e c h n i q u e s all arose f r o m
my frustration with my inability to resolve the m o r e difficult b a c k p r o b -
lems that I was seeing in my practice. After I c r e a t e d these t e c h n i q u e s I
tested them in my practice, classes, and in collaboration with my colleagues,
Jan Sultan and Michael Salveson, at the R o l f Institute.
Understanding this b o o k requires a working k n o w l e d g e of the anatomy
of the muscular a n d skeletal systems. I discuss a n a t o m y w h e r e it is rele-
vant, but in the simplest of terms. My goal is to give y o u the skills y o u n e e d
t o evaluate a n d i m m e d i a t e l y treat y o u r patients. T h e r e are m a n y w o n -
derful b o o k s available that go into c o n s i d e r a b l e detail r e g a r d i n g manual
therapy and I see no n e e d to repeat what has already b e e n said well. T h e
texts I have f o u n d m o s t useful are i n c l u d e d in the bibliography.
xvii
CHAPTER
1
Our Fine Spine: The Backbone
of Structural Integrity
F Y O U R BACK HAS EVER " G O N E O U T , " T H E EASE W I T H W H I C H Y O U G O
about your life goes right out the window with it. A n d you are n o t a l o n e —
at least 80 million A m e r i c a n s are in the same fix. Many m a k e the mis-
take of thinking that w h e n their pain disappears their p r o b l e m also g o e s
away. But e x p e r i e n c e d clinicians k n o w that this b e l i e f is based on an illu-
sion. We c o u l d term the confusion of the experience of pain with the p r o b -
l e m causing the pain the "fallacy of misplaced h o p e . " A facet restriction
can exist at a subclinical level, showing no obvious signs of pain, and then
suddenly rear its painful c o u n t e n a n c e at the most i n o p p o r t u n e times. Y o u
arise from a chair to greet a friend and suddenly there's that stabbing pain
i n y o u r back again. Back pain can c o m e a n d g o , b u t the p r o b l e m almost
always remains. A n d if left untreated, it often gets worse as time a n d grav-
ity take their unforgiving toll on o u r b o d i e s .
W h o l e disciplines a n d theories o f manual therapy have b e e n created
based on the idea that the spine is the most important and sometimes the
only area of the b o d y that n e e d s to be treated. As naive as that view is, it
i s certainly n o t h a r d t o a p p r e c i a t e its a p p e a l . Y o u d o n ' t n e e d a l o t o f
research to understand that if y o u c a n n o t treat spinal dysfunctions, y o u
are incapable of h e l p i n g m a n y p e o p l e . If y o u are a holistic practitioner
trying t o p r o v i d e h i g h e r a n d h i g h e r levels o f o r g a n i z a t i o n a n d b a l a n c e
for y o u r clients a n d y o u c a n n o t release p e o p l e f r o m their spinal dysfunc-
tions, then y o u r grandest n o t i o n s of what can be achieved f o r t h e m will
1
n o t b e realized. T h e r e i s n o d o u b t a b o u t it: u n d e r s t a n d i n g a n d success-

fully treating the spine is important to every somatic practitioner, no mat-
ter what y o u r p o i n t of view.
In o r d e r to be effective w h e n y o u a t t e m p t to release a painful j o i n t ,
y o u n e e d to k n o w h o w the j o i n t works w h e n it's n o r m a l and h o w it works
w h e n it's in t r o u b l e — a n d h o w to tell the d i f f e r e n c e . In o r d e r to experi-
e n c e what we are g o i n g to be discussing b e f o r e y o u read a lot of theory,
h e r e is a simple exercise y o u can do with y o u r o w n spine.
Stand u p a n d p l a c e y o u r t h u m b s o n y o u r s p i n e o v e r the transverse
processes ( T P ) of L4 or L5. D o n ' t w o r r y t o o m u c h at this p o i n t about h o w
a c c u r a t e y o u are. Just use y o u r t h u m b s t o m a k e y o u r best guess. N o w
s i d e b e n d ( o r laterally flex) to y o u r left. W h e n y o u s i d e b e n d to the left,
the left side of y o u r lumbar spine will be c o n c a v e and the right will be c o n -
vex (Figure 1.1). Notice what happens u n d e r your thumbs. As you sidebend
to y o u r left, y o u r right t h u m b is f o r c e d posteriorly a bit while y o u r left
t h u m b sinks anteriorly a little. N o w s i d e b e n d the o t h e r way a n d n o t i c e
that just the o p p o s i t e o c c u r s : y o u r left t h u m b is p u s h e d a little posteriorly
a n d y o u r right t h u m b sinks anteriorly.
W h a t y o u are feeling is y o u r vertebra rotate as y o u s i d e b e n d . T h e c o n -
v e n t i o n f o r d e s c r i b i n g rotation is to d e s c r i b e the d i r e c t i o n in w h i c h the
a n t e r i o r f a c e o f the v e r t e b r a turns. S o while standing o r sitting, i f y o u
s i d e b e n d right, y o u r vertebra will rotate left, and if y o u sidebend left, your
vertebra will rotate right. S i d e b e n d i n g is difficult to feel at first and n o t
s o m e t h i n g y o u n e e d to be c o n c e r n e d with at this p o i n t . But rotation is
easy to palpate. As y o u will s o o n see, by k n o w i n g the direction in which a
vertebra is rotated y o u can gather lots of the necessary i n f o r m a t i o n f o r
dealing with a painful back.
If y o u have a history of b a c k trouble, y o u may n o t i c e that the vertebral
m o v e m e n t y o u are m o n i t o r i n g with y o u r thumbs is n o t exactly the same
as y o u s i d e b e n d f r o m side to side. This discovery may be no surprise to
y o u — i t p r o b a b l y means y o u have a facet restriction that is inhibiting nor-
m a l m o t i o n t h r o u g h the area y o u are p a l p a t i n g . I f o n e o f the facets i s
restricted, y o u will feel the vertebra rotate m o r e as y o u s i d e b e n d o n e way
a n d less as y o u s i d e b e n d the other. If y o u feel rotation m o r e in o n e direc-
tion than the o t h e r a n d y o u haven't h a d a history of back trouble, d o n ' t
panic. Perhaps y o u haven't p l a c e d fingers in quite the right area or maybe
2
OUR FINE SPINE: THE BACKBONE OF STRUCTURAL INTEGRITY
Figure 1.1 Figure 1.2
y o u are having trouble clearly differentiating b e t w e e n what the vertebra

is d o i n g and h o w the soft tissues are r e s p o n d i n g . In s o m e p e o p l e the t o n e
of the musculature a l o n g the sides of the spine is n o t the same a n d as a
result each side responds differently to s i d e b e n d i n g . Of c o u r s e , it c o u l d
m e a n that y o u do have s o m e sort of facet restriction that hasn't r e a c h e d
y o u r awareness t h r o u g h the attention-getting m e d i u m of pain. But again
d o n ' t panic, we will learn h o w to deal with these p r o b l e m s a little later.
What you have learned so far is that sidebending and rotation are always
c o u p l e d . W h a t y o u are a b o u t to feel n e x t is that they are n o t always c o u -
p l e d the same way in the thoracic a n d l u m b a r spines. Stand up again a n d
place y o u r thumbs on either L4 or L5. If y o u have a history of b a c k pain
and y o u r b a c k is presently in t r o u b l e y o u may n o t want to try this n e x t
exercise. But if y o u are g a m e , first b e n d way f o r w a r d a n d then s i d e b e n d
to the left (Figure 1.2). As y o u s i d e b e n d left y o u will n o t i c e that the left
transverse process pushes y o u r t h u m b a little posteriorly and on the right
transverse process y o u r o t h e r t h u m b sinks anteriorly a bit. W h a t y o u are
feeling can be d e s c r i b e d by saying that as y o u s i d e b e n d left in f o r w a r d
b e n d i n g y o u r vertebra rotates left. N o w , while y o u are still in the f o r w a r d
3
b e n t position, sidebend right and you will notice that your vertebra rotates
right. Next, straighten up and then back b e n d . In the back-bent position,
s i d e b e n d right and left, a n d n o t i c e that y o u r vertebra behaves the same
way as it d i d in the forward b e n t position: as y o u s i d e b e n d left, your ver-
tebra rotates left a n d as y o u s i d e b e n d right y o u r vertebra rotates right.
Standing or sitting with the spine comfortably straight is called the neu-
tral position In neutral position the facets do n o t e n g a g e w h e n you side-
b e n d . I n the n o n - n e u t r a l p o s i t i o n s o f f o r w a r d b e n d i n g a n d backward
b e n d i n g the facets of the thoracic a n d l u m b a r spines do get e n g a g e d and
their relationship alters the way the vertebrae rotate. What you have learned
t h r o u g h d i r e c t p a l p a t o r y e x p e r i e n c e are two i m p o r t a n t facts a b o u t the
thoracic a n d l u m b a r spines: 1) in neutral position, s i d e b e n d i n g and rota-
tion are always oppositely c o u p l e d a n d 2) in the non-neutral positions of
forward a n d backward b e n d i n g , s i d e b e n d i n g and rotation are always c o u -
p l e d to the same side. So in neutral p o s i t i o n w h e n y o u right s i d e b e n d ,
y o u r vertebra rotates left and w h e n y o u left sidebend, your vertebra rotates
right. In the non-neutral positions, w h e n y o u s i d e b e n d right, y o u r verte-
bra rotates right a n d w h e n y o u s i d e b e n d left, y o u r vertebra rotates left.
W h e n s i d e b e n d i n g a n d rotation are c o u p l e d to o p p o s i t e sides it is called
T y p e I m o t i o n a n d w h e n they are c o u p l e d to the same sides it is called
Type II m o t i o n . This classification of spinal m o t i o n into Type I and Type
II is a d e s c r i p t i o n of n o r m a l m o t i o n . Dysfunction arises only if there is
s o m e sort o f restriction o r facet f i x a t i o n involved.
A n i m p o r t a n t p o i n t t o r e m e m b e r i s that s i d e b e n d i n g a n d rotation
always h a p p e n t o g e t h e r a l o n g the spine. A vertebra or g r o u p of vertebrae
can n e v e r rotate w i t h o u t also s i d e b e n d i n g a n d never s i d e b e n d without
also rotating. Interestingly, the l u m b a r spine can s i d e b e n d m o r e than it
can rotate a n d the thoracic spine can rotate m o r e than it can s i d e b e n d .
T h e cervical spine behaves differendy f r o m the lumbar and thoracic spines
in o n e very important respect: regardless of whether you forward or back-
ward b e n d , the m o t i o n of C 2 - C 7 is always Type II. T h e n e c k is different
e n o u g h f r o m the thoracic and lumbar spines that it deserves its own chap-
ter. So f o r the r e m a i n d e r of this c h a p t e r and t h r o u g h the next c o u p l e of
chapters we will be discussing only the thoracic a n d lumbar spines.
Since we will be using rotation as o u r starting p o i n t f o r d e t e r m i n i n g
and treating facet dysfunction, let's e x p l o r e palpating vertebral rotation
4
a bit m o r e . If y o u are a soft-tissue practitioner a n d y o u h a v e n ' t assessed

vertebral rotation b e f o r e , y o u r highly d e v e l o p e d palpatory skills f o r assess-
ing soft tissue strain and tightness may mislead y o u in y o u r first attempts
to feel b o n e . If y o u are like m a n y soft-tissue practitioners I have taught,
when y o u try to get a sense of the tissue b e n e a t h y o u r fingers, y o u often
gently niggle i t — y o u p o k e a bit h e r e a n d p r o d a bit t h e r e — o f t e n y o u
m o v e y o u r fingers up a n d d o w n , back a n d forth, a n d in small circles. But
w h e n y o u feel f o r b o n e , y o u must resist the temptation to palpate in this
way. Instead, y o u s h o u l d apply gentle b u t firm a n d constant pressure as
you let your fingers sink into the tissue until they c o m e to an obvious stop-
ping p o i n t where they can sink no further. W h e n they can sink no further
and y o u feel a hard s t o p p i n g p o i n t , y o u have r e a c h e d b o n e . T h i s h a r d
stopping p o i n t feels different than tight or strained soft tissue.
I m a g i n e that a v e r t e b r a y o u are p a l p a t i n g is right r o t a t e d . As y o u r
thumbs sink t h r o u g h the tissue a n d c o m e to rest on the b o n y surface of
the vertebra, y o u will n o t i c e that y o u r right t h u m b stops sinking into the
tissue b e f o r e the left t h u m b d o e s . To say it differently, y o u will n o t i c e that
y o u r right t h u m b has c o m e to rest on a b o n y b u m p that is a little m o r e
p o s t e r i o r a n d p r o m i n e n t than w h e r e the left t h u m b l a n d e d . Y o u r left
t h u m b in contrast seems to have sunk into a littie indentation and is h e n c e
a little m o r e anterior than the right t h u m b . If y o u niggle the tissue as y o u
are letting y o u r thumbs sink toward the vertebra, y o u can easily get c o n -
fused a b o u t what y o u are feeling.
Ask o n e o f y o u r friends o r clients t o v o l u n t e e r his b a c k a n d sit c o m -
fortably straight in the neutral position. K e e p y o u r t h u m b s in the same
horizontal plane facing e a c h other, e a c h j u s t slightly lateral to the spin-
ous processes of the vertebra y o u are palpating. Make sure that the palmer
surfaces o f y o u r t h u m b s c o v e r the transverse p r o c e s s e s . K e e p i n g y o u r
thumbs in this horizontal position, run t h e m up a n d d o w n y o u r friend's
thoracic spine until y o u find a vertebra with o n e transverse process that
is obviously m o r e posterior or p r o m i n e n t than the others (Figures 1.3 and
1.4, p a g e 6 ) . D o n ' t w o r r y a b o u t t h o s e v e r t e b r a e that y o u are n o t sure
a b o u t — i g n o r e t h e m f o r n o w a n d o n l y l o o k f o r the m o s t o b v i o u s o n e s .
O n c e y o u find a transverse process that is obviously m o r e p r o m i n e n t or
posterior on o n e side, y o u have f o u n d a rotated vertebra. T h e vertebra is
rotated to the side w h e r e y o u feel the p r o m i n e n t transverse process. T h e
5
Figure 1.3
Figure 1.4
6
easy way to r e m e m b e r h o w to designate rotation is to r e m e m b e r that the

side of the bump is the side of the rotation. If y o u feel the b u m p on the left (with
an indentation on the r i g h t ) , the vertebra is left-rotated. If y o u feel the
b u m p on the right (with an indentation on the left), the vertebra is right-
rotated.
T o b e m o r e p r e c i s e i n y o u r d e s c r i p t i o n , y o u s h o u l d f o l l o w the c o n -
vention and designate the rotation y o u feel in r e f e r e n c e to the n e x t ver-
tebra just b e l o w it. This c o n v e n t i o n makes g o o d sense b e c a u s e what y o u
are ultimately interested in u n d e r s t a n d i n g is j o i n t fixation a n d y o u can-
n o t have a j o i n t , let a l o n e a fixated o n e , without two c o n t i g u o u s b o n e s .
So if you find that T7 is right-rotated, y o u w o u l d say that T7 is rotated right
on T8. You can say it any reasonable way y o u want to, of course, a n d there
are many different conventions for designating rotation. But I have a d o p t e d
the conventions of the osteopaths, because they constantly scrutinize their
language for consistency and accuracy. I should m e n t i o n that even t h o u g h
I use descriptive c o n v e n t i o n s derived f r o m osteopathy, I do n o t discuss or
b o r r o w their t e c h n i q u e s f o r this b o o k . Unless o t h e r w i s e n o t e d , all the
techniques y o u will learn in this b o o k were my o w n creation a n d are soft-
tissue techniques, n o t high-velocity, low-amplitude osseous manipulations.
E x p e r i m e n t with feeling f o r rotation with a lot of different backs a n d
always begin with the most obvious rotations along the thoracic spine first.
On the w h o l e it is m u c h easier to feel rotations of the thoracic spine in a
sitting position than it is to feel t h e m in the lumbar spine. A b o v e all, d o n ' t
fret a b o u t the vertebrae w h o s e rotational patterns are n o t clear to y o u r
fingers. As y o u gain c o n f i d e n c e in f e e l i n g f o r the o b v i o u s cases, in time
y o u will also gain sensitivity in feeling f o r the less o b v i o u s o n e s .
After y o u gain s o m e c o n f i d e n c e with the thoracic spine, try feeling f o r
rotations in the lumbar spine. First feel f o r rotation in the sitting position.
T h e n ask y o u r volunteer to lie p r o n e on y o u r treatment table and feel the
same areas in this position. In the sitting position the erectors are work-
ing to maintain an upright posture a n d since many p e o p l e ' s back muscles
are o v e r d e v e l o p e d , y o u will find that it is o f t e n difficult to feel t h r o u g h
these muscles to the b o n e b e n e a t h . In the p r o n e position y o u will find it
is m u c h easier to feel the transverse processes t h r o u g h the b a c k muscles.
I n o r d e r t o better d e t e r m i n e w h i c h vertebrae y o u are palpating y o u
n e e d a few landmarks f r o m which to take your bearings. If y o u trace a h o r -
7
izontal line across from

the crest of the ilium to
Iliac crests
at level of L4 the spine, y o u r fingers
will l a n d the s p i n o u s
Sacral
p r o c e s s o f L 4 (Figure
base
1.5). F r o m t h e r e y o u
can c o u n t down o n e
spinous process to find
L5 or up to d e t e r m i n e
L 3 , L 2 , and L I .
To find Tl place
Figure 1.5 y o u r fingers o n y o u r
best guess to locate C6
a n d ask y o u r v o l u n t e e r to b e n d his h e a d a n d n e c k backward. If y o u are
on C6 as y o u r v o l u n t e e r b e n d s , it will slide obviously anteriorly. If you are
on C7 it will n o t m o v e in this way at all. If y o u d o n ' t have a volunteer as
y o u read this, y o u can try it on yourself. O n c e y o u have l o c a t e d C6 y o u
can easily c o u n t d o w n spinous processes to find T l , T 2 , and so forth. This
test f o r anterior sliding of C6 with b a c k b e n d i n g works quite well most of
the time f o r m o s t p e o p l e . But be f o r e w a r n e d : on o c c a s i o n y o u will find a
p e r s o n w h o s e c e r v i c o t h o r a c i c j u n c t i o n is fixated in a way that makes this
test useless.
A n o t h e r useful landmark f o r finding y o u r way through the spine is the
inferior tip of the scapula. If y o u trace a horizontal line f r o m the inferior
tip to the spine, y o u r fingers will m o s t likely land a r o u n d T 8 .
A Simple Indirect Technique
N OW T H A T Y O U HAVE SOME EXPERIENCE PALPATING ROTATION, WE CAN
build on y o u r k n o w l e d g e by practicing a simple, indirect t e c h n i q u e

f o r derotating vertebrae. This t e c h n i q u e was discovered by a n u m b e r of
therapists i n d e p e n d e n t l y o f e a c h o t h e r . Ask y o u r v o l u n t e e r t o sit c o m -
fortably. Find the m o s t obviously rotated vertebra in his thoracic spine.
F o r the p u r p o s e of this discussion, let's assume that y o u find that T4 is
right rotated on T 5 . W h a t y o u will feel is y o u r right t h u m b resting on the
b u m p (the p r o m i n e n t , posterior transverse process o f T 4 ) and y o u r left
8
Figure 1.6
t h u m b resting in an indentation (the anterior transverse process of T 4 ) .

To begin the technique, use your left t h u m b to apply a c o u p l e of p o u n d s
of gentle b u t firm pressure to the left transverse p r o c e s s ( T P ) with the
intention of m a k i n g it sink m o r e anteriorly (Figure 1.6). If y o u are n o t
used to this sort of t e c h n i q u e , the idea of p u s h i n g the anterior TP m o r e
anteriorly may seem counter-intuitive a n d a bit o d d . Y o u m i g h t be think-
ing that it w o u l d make m o r e mechanical sense to push the right posterior
TP anteriorly as a way to derotate it. But b o d i e s are n o t machines a n d they
have p r o f o u n d l y interesting ways of r e s p o n d i n g to intelligent pressure
that will m a k e y o u r life as a somatic p r a c t i t i o n e r easier than y o u m i g h t
imagine. This is called an indirect t e c h n i q u e b e c a u s e it d o e s n o t directly
f o r c e c h a n g e on the spine the way high-velocity, low-amplitude thrusting
techniques d o . Indirect techniques b e g i n by p u s h i n g a dysfunctional seg-
m e n t further into its dysfunction a n d letting it w i n d its way b a c k to w h e r e
a n o r m a l p o s i t i o n is. D o n ' t w o r r y a b o u t why this t e c h n i q u e works. Just
enjoy h o w y o u r volunteer's b o d y r e s p o n d s to p u s h i n g the left anterior TP
m o r e anteriorly.
9
W h e n y o u apply y o u r pressure to the left TP of T 4 , imagine that y o u

are pushing a boat away f r o m a d o c k . If y o u push t o o quickly and t o o hard,
y o u will e x p e r i e n c e resistance. But if y o u push in a slow, gentle, firm way,
the b o a t will almost effortlessly drift away f r o m the d o c k . As y o u first push
anteriorly on the left TP, n o t h i n g h a p p e n s f o r a few s e c o n d s . But n o t i c e
that as y o u k e e p the pressure u p , y o u r left t h u m b b e g i n s to sink a little
m o r e anteriorly as y o u r right t h u m b b e g i n s to m o v e a little m o r e poste-
riorly. Y o u are actually feeling T4 go further into right rotation. You may
even feel it go i n t o s i d e b e n d i n g . Maintain the i m a g e of p u s h i n g a b o a t
away f r o m a d o c k in the back of y o u r m i n d , and k e e p the pressure u p , but
d o n ' t f o r c e the issue; just push a n d c o n t i n u e to follow this m o t i o n until
it stops. B e f o r e it stops the vertebra may rotate a n d s i d e b e n d in o d d and
u n p r e d i c t a b l e ways. D o n ' t w o r r y a b o u t it or q u e s t i o n it, j u s t f o l l o w the
m o t i o n until it stops.
At that p o i n t , T4 will have m o v e d as far it can go into right rotation.
T h e r e will be a pause, s o m e t i m e s a c c o m p a n i e d by the feeling of a little
pulsation u n d e r y o u r thumbs. Just wait a n d s o o n y o u will feel the impulse
of the vertebra to start derotating as if it were m o v i n g into left rotation.
Y o u may feel it s i d e b e n d and rotate left, then right, and in o t h e r o d d and
u n p r e d i c t a b l e ways b e f o r e it finally stops, b u t stay with it. It will stop mov-
ing w h e n it is d e r o t a t e d and w h e n it stops y o u will also feel a softening of
the tissues u n d e r y o u r t h u m b s . If y o u wait a little l o n g e r y o u may also feel
the spine l e n g t h e n i n g a b o v e a n d / o r b e l o w y o u r t h u m b s , a s i f the b o d y
were organizing itself a l o n g vertical lines in response to the release of the
vertebra. W h e n y o u feel the tissue softening a n d sense the b o d y organiz-
i n g itself a l o n g the sagittal p l a n e y o u are finished. If y o u d o n ' t feel the
b o d y o r g a n i z i n g itself a l o n g this l i n e , d o n ' t w o r r y a b o u t i t — a s l o n g a s
y o u r thumbs remain in contact with the body, it will organize itself a r o u n d
the release w h e t h e r y o u feel it or n o t . Just wait f o r the softening and then
wait j u s t a bit l o n g e r afterward. If y o u use this t e c h n i q u e with the e x p e c -
tation of feeling that y o u can sense h o w the b o d y organizes itself a r o u n d
the vertical release, in time y o u will actually sense this o r t h o t r o p i c effect.
B e i n g able to feel h o w the b o d y organizes or fails to organize itself in
relation to y o u r intervention is a very useful skill to learn a n d it will allow
y o u to tell immediately what o t h e r areas b o d y require intervention. Inter-
estingly, n o t only d o e s the b o d y o r g a n i z e itself a r o u n d the sagittal plane,
10
it also organizes itself simultaneously a r o u n d the transverse a n d c o r o n a l

planes. K n o w i n g h o w to feel f o r the p r e s e n c e or a b s e n c e of this o r t h o g o -
nal relationship tells y o u w h e n y o u are finished with y o u r t e c h n i q u e a n d
where to go next.
T h e simple t e c h n i q u e y o u have just l e a r n e d will o p e n m a n y interest-
ing doorways for y o u if y o u just k e e p practicing it and feeling f o r as m u c h
information as y o u can. But this indirect t e c h n i q u e , like so m a n y indirect
techniques ( o r so-called " u n w i n d i n g t e c h n i q u e s " ) , is n o t always effective.
You will n o t i c e that s o m e t i m e s y o u will achieve easy a n d amazing results
with it and at o t h e r times the p r o b l e m y o u t h o u g h t y o u had taken care of
reasserts itself within a matter of m i n u t e s or h o u r s . T h e d r a w b a c k with
most u n w i n d i n g techniques is that they often do n o t address o n e of the
most i m p o r t a n t aspects of a painful b a c k — t h e u n d e r l y i n g facet restric-
tion. Most indirect t e c h n i q u e s t e n d to u n w i n d the tissues a n d vertebra
a r o u n d the j o i n t fixation. Since the j o i n t fixation has n o t b e e n resolved,
the p r o b l e m quickly returns. To deal with the facet restriction, y o u first
n e e d to understand h o w facet fixations w o r k a n d then y o u n e e d a soft-tis-
sue technique that challenges the j o i n t fixation. This is what y o u will learn
in the next two chapters.
II
CHAPTER
2
Primates in Trouble,
or where does your back go
when it goes out?
O W MANY TIMES HAVE Y O U H E A R D T H I S SURPRISED C O M M E N T FROM
a client? ' Y o u know, I was just b e n d i n g over to p i c k up s o m e t h i n g ,

w h e n all of a s u d d e n I felt s o m e t h i n g slip in my lower b a c k a n d
the next thing I k n o w I'm on my knees in terrible p a i n ! "
T h e r e are m a n y levels to, a n d c o m p e t i n g e x p l a n a t i o n s for, h o w the
spine b e c o m e s c o m p r o m i s e d . T h e i m p o r t a n t p o i n t is that facets n o t only
get e n g a g e d in forward b e n d i n g and s i d e b e n d i n g , they s o m e t i m e s esca-
late an already strained r e l a t i o n s h i p i n t o a b a d m a r r i a g e a n d r e m a i n
severely f i x a t e d . W h e n w e f o r w a r d b e n d o r b a c k b e n d a n d t h e n twist
( s i d e b e n d ) , w e p u t o u r l o w backs a t risk. I f y o u w e r e t o e x a m i n e y o u r
client's u n h a p p y marriage w h e n he is in the neutral position (sitting or
standing c o m f o r t a b l y straight), y o u w o u l d discover that o n e o r m o r e o f
his lumbar vertebra is stuck so that it is s i d e b e n t a n d rotated to the same
side. In neutral position, thoracic and l u m b a r vertebrae are n o t s u p p o s e d
to act this way. So if y o u find a vertebra in neutral p o s i t i o n that is stuck
rotated and sidebent to the same side, y o u are p r o b a b l y l o o k i n g at a per-
son in pain.
At this p o i n t y o u may be thinking, "Wait a m i n u t e , if, as y o u say, it is
m u c h easier to feel rotation than sidebending, h o w can y o u k n o w whether
a vertebra is rotated to the same or o p p o s i t e side of the s i d e b e n d i n g ? "
T h e answer is simple: every time y o u find a vertebra in neutral position
that is stuck sidebent a n d rotated to the same side, v o u have d i s c o v e r e d
13
restricted facets. Because the facets are restricted, there is loss of n o r m a l

m o t i o n in the area. If facets are fixed, the vertebra will n o t be able to m o v e
normally in back b e n d i n g a n d forward b e n d i n g . T h e restricted facets will
act as fixed pivot points that will f o r c e the vertebra to m o v e in character-
istically errant ways as y o u r client b e n d s f o r w a r d a n d backward. By feel-
i n g h o w the vertebra rotates a r o u n d this fixed pivot p o i n t in forward and
b a c k b e n d i n g y o u will b e able t o d e t e r m i n e precisely w h i c h facets are
restricted a n d h o w they are restricted. O n c e y o u k n o w this, treating t h e m
is easy a n d obvious.
But b e f o r e we c o n s i d e r the facet-restriction test, let's deal with a very
i m p o r t a n t clinical question: w h e r e d o e s y o u r b a c k g o w h e n i t g o e s out?
This is o n e of those o d d questions like " W h e r e d o e s y o u r lap go when you
stand u p ? " or " W h e r e d o e s fire go w h e n it goes out?" that seems as though
it s h o u l d have an answer, b u t d o e s n ' t . T h e s e sorts of questions d o n ' t have
answers n o t because they are t o o difficult for anyone to answer, but because
they are c o n f u s e d questions.
I stated the q u e s t i o n this way to m a k e an i m p o r t a n t p o i n t a b o u t the
nature of spinal dysfunction. Somatic therapists and non-therapists alike
t e n d to describe b a c k pain by saying, ' Y o u r back is out." But this expres-
sion is imprecise a n d even quite misleading. T h e critical p o i n t is n o t that
a client's b a c k "went o u t , " as if its n e w position were the primary p r o b l e m ,
b u t that there are facet restrictions and loss of function associated with the
client's pain. T r e a t m e n t consists n o t of putting it b a c k where it b e l o n g s ,
b u t in releasing the restricted facets in o r d e r to restore function. W h e r e
the vertebra goes after y o u release it f r o m its facet restrictions is sometimes
quite different f o r e a c h p e r s o n . A l o n g the same lines, if y o u were able to
get the vertebra to " g o back to where it belongs" (derotate it) and you didn't
release the restricted facets, the person's b a c k w o u l d still be dysfunctional
a n d it w o u l d n o t be l o n g until the pain returned. If y o u have b e e n exper-
i m e n t i n g with the simple indirect t e c h n i q u e i n t r o d u c e d in the last chap-
ter, y o u already k n o w that it is n o t always effective. N o w y o u k n o w why.
S o m e vertebral dysfunctions also have very little to do with the posi-
tion of the vertebrae. For e x a m p l e , often the facets on b o t h sides of the
spine can be restricted, but the vertebra shows no obvious palpatable signs
o f b e i n g " o u t o f p l a c e " (rotated a n d s i d e b e n t ) . W h e n b o t h sides are re-
stricted, y o u r client will have pain a n d loss of m o t i o n in the area. Again,
14
PRIMATES IN TROUBLE, OR WHERE DOES YOUR BACK GO WHEN IT GOES OUT?
the treatment goal is to release the facet restrictions so that y o u can restore
p r o p e r f u n c t i o n i n g , n o t r e p o s i t i o n vertebrae. M a n y times y o u will f i n d
vertebrae that are rotated and still perfectly functional b e c a u s e no facet
or myofascial restrictions are interfering with m o t i o n in the area. Given
the unique structure of that person in relation to h o w his b o d y has adapted
to gravity and the stresses of life, his vertebrae p r o b a b l y can only be right
where they are. T h e y are n o t likely to be functional in any o t h e r position.
If y o u had the p o w e r to f o r c e his vertebrae into s o m e version of the ideal
position, y o u w o u l d probably just create pain f o r h i m .
In o r d e r to m o r e clearly understand the role of j o i n t manipulation and
the role of positioning b o d y structure a n d segments, it is very helpful to
preview the words of physiologist I.M. Korr. Discussing the n o n - s e g m e n t e d
" s y m p h o n i e s " of m o t o r activity that are orchestrated a n d c a r r i e d o u t by
the spinal c o r d and h i g h e r centers, he says:
T h e important point is that these patterns of activity involve neu-

rons up and d o w n the spinal c o r d , e a c h b e i n g called i n t o play
a c c o r d i n g to the pattern required at the m o m e n t — n o t a c c o r d -
ing to where the n e u r o n is l o c a t e d in the c o r d b u t a c c o r d i n g to
what structure it innervates. W h e r e it "lives" segmentally is of
no importance . . .
This presents us with an interesting p a r a d o x : the n o r m a l pat-
terns of activity mediated by the spinal c o r d are completely n o n -
segmental in nature . . . yet the spinal c o r d is obviously segmented
and the physician is very m u c h c o n c e r n e d with segmental rela-
tionships Nevertheless, in n o r m a l life s e g m e n t a l relation-
ships d o n o t appear.
T h e reason f o r this p a r a d o x may b e best c o n v e y e d b y [ a n ]
illustrative simile. Consider a beautifully executed parade of skilled
marching m e n , where the many ranks and c o l u m n s are seen as
patterned activity of the w h o l e parade. We do n o t see individual
ranks a n d certainly n o t individual m a r c h e r s , we see p a t t e r n e d
motion. But let something go wrong, let o n e of the marchers lose
step and his rank immediately b e c o m e s c o n s p i c u o u s . T h e o t h e r
marchers cannot compensate in a c o o r d i n a t e d m a n n e r and s o o n
the ranks on either side are thrown into c o n f u s i o n a n d then we
15
do see segmental relationship. It is something like this that causes

segmental relationships in the spine to e m e r g e into v i e w . . . . A
s e g m e n t "in view" is a s e g m e n t in trouble
H o w shall we r e c o n c i l e this p a r a d o x ? First by realizing that
the thing that is s e g m e n t e d is the a r m o r that houses and p r o -
tects the c o r d In n o r m a l life the segmentation is n o t of the
spinal c o r d itself; the segmentation is in the assembling of the
nerve fibers into " c a b l e s " — r o o t s and n e r v e s — t h a t can pass o u t
to the tissues innervated. What is segmented is ingress and egress,
n o t the function of the c o r d itself. 1
W e can see even m o r e clearly f r o m Dr. Korr's w o n d e r f u l e x a m p l e o f

the m a r c h e r s h o w spinal m a n i p u l a t i o n is n o t a simple matter of reposi-
t i o n i n g o r p u t t i n g b o n e s " b a c k i n t o p l a c e . " T h e ultimate aim o f spinal
m a n i p u l a t i o n i s the r e c o v e r y o f n o r m a l p a t t e r n e d m o t i o n , n o t the cre-
ation of an ideal position f o r the segments. By implication, the aim is also
n o t the creation of a spine that measures up to s o m e ideal pattern. W h e n
a vertebral s e g m e n t or a g r o u p of vertebrae b e c o m e "segments in view,"
to use Dr. Korr's phrase, we perceive a loss of patterned m o t i o n through-
o u t the s p i n e . Part of what we see are breaks or fixations in the overall
continuity of structure and m o v e m e n t . We see loss of continuity and appro-
priate m o t i o n . T h e "segments in view" often show up as fixations in the
myofascial, ligamentous, and articular systems. These fixations create vary-
i n g d e g r e e s of local immobility, w h i c h in turn inhibit n o r m a l integrated
m o v e m e n t t h r o u g h o u t the w h o l e body.
With this new understanding, let's reconsider those p e o p l e whose backs
"went o u t " w h e n they b e n t over. All of t h e m were well on their way to hav-
ing b a c k p r o b l e m s b e f o r e they first e x p e r i e n c e d back pain. T h i n k of what
h a p p e n s w h e n y o u p u t water o n the stove t o b o i l . Y o u turn u p the heat
a n d the water gets h o t t e r a n d hotter. S u d d e n l y it passes a certain tem-
perature threshold a n d boils. If the water were c o n s c i o u s , the first time it
was b r o u g h t to a b o i l it m i g h t say, ' Y o u k n o w it was really weird, I was just
h a n g i n g o u t on the stove f e e l i n g the heat w h e n all of s u d d e n I b e g a n to
b o i l ! " A n a l o g o u s l y y o u r clients' backs were "heating u p " t o " g o o u t . "
Myofascial, l i g a m e n t o u s , a n d facet restrictions were already present;
there were larger overall patterns of i m b a l a n c e in their b o d i e s ; their legs
16
probably were n o t p r o v i d i n g adequate s u p p o r t ; there were dysfunctional

adaptations to o l d injuries and to gravity; and vertebrae were slighdy m o r e
toward a T y p e II p o s i t i o n than was g o o d f o r t h e m . T h e n the fatal day
arrived when your client passed his critical threshold by b e n d i n g over a n d
slightly twisting ( s i d e b e n d i n g ) to p i c k s o m e t h i n g u p . D u r i n g this m o v e -
m e n t , his vertebra slipped a little t o o quickly and a little t o o far past what
was n o r m a l f o r a Type II position. T h e nervous system registered the dan-
ger and sent the muscles into a fearful spasm thereby l o c k i n g the verte-
bra into a Type II position and creating facet restrictions. T h e r e are o t h e r
ways y o u can l o c k up y o u r back, of c o u r s e , b u t this simple case is useful
b e c a u s e i t allows u s t o u n d e r s t a n d h o w facets b e c o m e restricted. T h e
i m p o r t a n t p o i n t is that f a c e t fixations create a m o t i o n restriction that
adversely affects the way the rest of the spine behaves in walking and o t h e r
forms of m o v e m e n t . A n d over time it can facilitate o t h e r facet restrictions.
I f y o u r spine has n o facet restrictions, w h e n y o u f o r w a r d b e n d , y o u r
facets slide o p e n i n a n a c c o r d i o n - l i k e fashion a n d w h e n y o u b a c k b e n d
they slide closed. As you forward b e n d , each vertebra in relation to the o n e
inferior to it slides slightly superiorly and anteriorly. W h e n y o u b a c k b e n d
the opposite occurs: each vertebra slides slightly inferiorly a n d posteriorly.
Now, if facets are restricted, they will act as a fixed p o i n t a r o u n d w h i c h
the vertebra will b e f o r c e d t o rotate w h e n y o u f o r w a r d a n d b a c k b e n d .
T h e side on which the facets are restricted remains fixed d u r i n g f o r w a r d
and backward b e n d i n g , while the o t h e r side appears to rotate and d e r o -
tate. To say it differently, o n e side of the vertebra remains a f i x e d pivot
point a r o u n d which the o t h e r side moves anteriorly a n d posteriorly in for-
ward and backward b e n d i n g , respectively.
Figures 2.1 a n d 2.2, page 18, show rather clearly the effects of f o r w a r d
b e n d i n g and backward b e n d i n g on the behavior of the facets. During back
b e n d i n g the facets slide toward a closed position and during forward b e n d -
ing they slide toward an o p e n position.
Figure 2.3 shows a dysfunctional vertebra. W h a t y o u are l o o k i n g at are
two v e r t e b r a e in neutral p o s i t i o n . T h e s u p e r i o r v e r t e b r a is stuck right
rotated and right sidebent. Notice h o w the facets on the left have slid o p e n
and the facets on the right have slid closed. Since we are l o o k i n g at a Type
II dysfunction, o n e side must be restricted. Either the left facets are fixed
o p e n (in flexion or forward b e n d i n g ) or the right facets are fixed c l o s e d
17
Figure 2.1 Figure 2.2 Figure 2.3
(in e x t e n s i o n or backward b e n d i n g ) . But w h i c h facets are fixed?

R e m e m b e r that restricted facets create a fixed pivot point around which
the vertebra is f o r c e d to rotate in f o r w a r d a n d backward b e n d i n g . So if
y o u were t o p l a c e y o u r t h u m b s o n the transverse processes o f the supe-
rior vertebra and feel f o r h o w it rotates a n d derotates during forward and
b a c k w a r d b e n d i n g , y o u c o u l d d e t e r m i n e w h i c h facets w e r e f i x e d . Y o u
w o u l d k n o w w h e t h e r the left facets w e r e f i x e d o p e n o r the right facets
w e r e f i x e d c l o s e d . A n d o n c e y o u k n e w w h i c h a n d h o w the facets were
restricted, y o u c o u l d simply a n d easily release t h e m .
But b e f o r e y o u learn h o w to apply the test, let's e x p l o r e a t e c h n i q u e
f o r releasing facet restrictions first. For many somatic therapists, learning
a simple facet release t e c h n i q u e that d o e s n ' t require precise k n o w l e d g e
of w h i c h facet is fixed is the best way to d e e p e n their palpatory and c o n -
ceptual u n d e r s t a n d i n g of h o w to apply the test. Many hands-on therapists
find that if they can get this understanding into their hands first, they have
an easier time getting it into their heads. T h e t e c h n i q u e y o u are a b o u t to
learn is a kind of shotgun a p p r o a c h to a m o r e specific way to address facet
restrictions. F r o m the clinical s t a n d p o i n t , this a p p r o a c h is less efficient
than the o n e y o u will use o n c e y o u k n o w h o w to apply the test. But f r o m
the learning standpoint this a p p r o a c h is a far m o r e effective teaching tech-
n i q u e . Y o u will also be h a p p y to k n o w that it is, f o r the m o s t part, as effec-
tive as the m o r e efficient a p p r o a c h .
18
W h e n y o u find a rotated vertebra, j u s t p r e t e n d that it is a Type II fixa-

tion. It may turn o u t , of c o u r s e , that the rotated vertebra y o u p i c k e d is
n o t dysfunctional at all. If it isn't stuck rotated a n d sidebent to the same
side w h e n in the neutral position a n d y o u apply this s h o t g u n a p p r o a c h ,
the worst thing that will h a p p e n is that you will have wasted your time (and
your client's). Since rotated vertebrae with restricted facets are m o r e c o m -
m o n than flowers in the Spring, the best thing that will h a p p e n is that y o u
will actually p u t y o u r f i n g e r o n the s o u r c e o f y o u r client's p a i n a n d b y
applying this t e c h n i q u e release h e r f r o m h e r misery.
If the rotated vertebra y o u pick is sidebent and rotated to the same side
in the neutral p o s i t i o n , it will have restricted facets a n d it will be a dys-
functional Type II. A n d this is always true: either the facets are fixed closed
on the side of the p r o m i n e n t or posterior TP (the same side to w h i c h it
is rotated) or they are fixed o p e n o p p o s i t e to the side of the p r o m i n e n t
TP ( o p p o s i t e to the side to w h i c h it is r o t a t e d ) .
T h e t e c h n i q u e f o r releasing fixed o p e n or fixed c l o s e d facets is sim-
ple. Since you d o n ' t k n o w which facets are restricted, y o u simply treat b o t h
sides as if they were fixed. Let's say that y o u f o u n d T3 is right rotated on
T 4 . If the p r o b l e m is with the right facets, it is because they are fixed closed
and c a n n o t o p e n in forward b e n d i n g . If the p r o b l e m is with the left facets,
they are fixed o p e n and c a n n o t close in back b e n d i n g . Pick the right facets
first. If y o u r client is sitting, ask h i m to curl over i n t o a f o r w a r d b e n t posi-
tion. Put a knuckle or e l b o w in the right spinal g r o o v e on the p r e s u m e d
fixed closed facets (Figures 2.4 a n d 2.5, p a g e 2 0 ) . Slowly a n d firmly apply
5 to 10 p o u n d s of c o n t i n u o u s pressure to the facets a n d let y o u r k n u c k l e
or e l b o w sink to w h e r e it can go no further. Wait until y o u feel the tissue
soften a n d give way u n d e r y o u r p r e s s u r e . ( S e e i f y o u c a n also f e e l the
o r t h o t r o p i c effect as the b o d y l e n g t h e n s a n d o r g a n i z e s itself a l o n g the
sagittal plane after the facets release.) T h e n return y o u r client to a n e u -
tral sitting position. Put y o u r k n u c k l e or e l b o w in the left spinal g r o o v e
on the facets that are p r e s u m e d fixed o p e n . Instruct y o u r client to b a c k
b e n d while y o u slowly a n d firmly apply 5 to 10 p o u n d s of pressure (Fig-
ure 2.6, page 2 1 ) . Let y o u r knuckle or e l b o w sink to w h e r e it can sink no
further and wait until y o u feel the tissue soften a n d give way u n d e r y o u r
pressure. (Again, see if y o u c a n f e e l the o r t h o t r o p i c e f f e c t as the b o d y
l e n g t h e n s a n d o r g a n i z e s itself a l o n g the sagittal p l a n e after the facets
19
Figure 2.4
Figure 2.5
20
Figure 2.6
release.) After y o u have a p p l i e d this t e c h n i q u e to b o t h sides, c h e c k T3 to

make sure that it is no l o n g e r rotated.
W h e t h e r y o u are releasing fixed c l o s e d or fixed o p e n facets, as l o n g as
y o u k e e p the pressure up (just waiting f o r the softening, the sense of the
tissue giving way, a n d the spine l e n g t h e n i n g a n d o r g a n i z i n g itself a l o n g
the sagittal plane) it is e n o u g h to release the facets. W i t h time a n d prac-
tice you may begin to feel the facets actually close or o p e n , but it is n o t n e c -
essary f o r y o u to feel the facets release f o r the t e c h n i q u e to work. As y o u
learn to feel the facets release, y o u will also b e g i n to feel a corollary p h e -
n o m e n o n , namely that n o t m u c h h a p p e n s u n d e r y o u r fingers w h e n y o u
apply pressure to unrestricted facets. In time y o u want to be able to feel
the facets release, the tissue soften, a n d the b o d y l e n g t h e n and organize
itself a l o n g the sagittal plane. A l t h o u g h tenderness or pain is n o t always
the best evaluative tool, y o u will often find that the soft tissues associated
with the problematic facets is t e n d e r or painful w h e n y o u apply pressure.
Practice this s h o t g u n t e c h n i q u e on the t h o r a c i c v e r t e b r a e first with
y o u r client in a sitting p o s i t i o n . T h e n practice it with the l u m b a r verte-
21
Figure 2.7
Figure 2.8
22
brae. Until y o u are m o r e c o n f i d e n t

in y o u r ability to feel rotation in the
lumbar vertebrae, always c h e c k what
y o u f e e l in t h e sitting p o s i t i o n a-
gainst w h a t y o u f e e l i n t h e p r o n e
p o s i t i o n . O n c e y o u are sure that a
l u m b a r vertebra is rotated, y o u can
use t h e sitting p o s i t i o n t o release
facet restrictions in m u c h the same
way y o u l e a r n e d to release the t h o -
racic vertebrae.
Y o u can also release lumbar facet
restrictions with y o u r client p r o n e .
S u p p o s e y o u f i n d that L5 is left
rotated. Begin with the assumption
that the right facets are fixed o p e n .
Figure 2.9 Instruct y o u r client to raise himself
up on his elbows a n d to rest in that
position. T h e n apply pressure to the right side of the spinal g r o o v e w h e r e
the p r e s u m e d fixed o p e n facets are a n d wait f o r t h e m to release (Figure
2.7). T h e n d o u b l e over a pillow a n d place it u n d e r y o u r client's a b d o m e n
so that the lumbar spine is appropriately flexed. A p p l y pressure to the left
side w h e r e the p r e s u m e d f i x e d c l o s e d facets are a n d wait f o r t h e m t o
release (Figures 2.8 a n d 2 . 9 ) .
T h e side-lying position is also a very effective way to release facet restric-
tions in b o t h l u m b a r a n d thoracic vertebrae. To release p r e s u m e d fixed-
closed facets, instruct y o u r client to lie in a tight fetal position on the side
of his b o d y o p p o s i t e the c l o s e d facets. A p p l y pressure with y o u r k n u c k l e
or elbow to the facets and wait f o r t h e m to release (Figures 2.10, 2.11, and
2.12, pages 24 a n d 2 5 ) . Ask h i m to roll o v e r on his o t h e r side a n d b a c k
b e n d as y o u apply pressure to the p r e s u m e d f i x e d o p e n facets a n d wait
for t h e m to release (Figure 2.12).
It will m a k e y o u r life as a m a n u a l therapist j u s t a little easier if y o u
u n d e r s t a n d s o m e t h i n g a b o u t h o w the t h o r a c i c facets o f the s p i n e are
arranged: parallel to the c o r o n a l plane. Y o u can use this a r r a n g e m e n t to
your advantage. W h e n y o u are releasing c l o s e d thoracic facets y o u will be
23
Figure 2.10
Figure 2.11
slightly m o r e effective a n d efficient if y o u apply pressure in a c e p h a l a d

direction. With o p e n - f i x e d thoracic facets, the t e c h n i q u e will work just a
litde bit better if y o u apply pressure in a caudad direction. T h e lumbar and
cervical facets are clearly n o t a r r a n g e d in the same way as the thoracic
facets, so the direction in which y o u apply pressure is n o t as important.
As you practice this technique y o u will quickly understand why it is m o r e
24
effective than the indirect technique intro-

d u c e d i n the last chapter. T h e p r o b l e m
with the i n d i r e c t t e c h n i q u e is that it
d o e s n ' t address the fixed facets, whereas
this new technique actually challenges the
facet restrictions. If the facets are f i x e d
closed the technique requires that you put
y o u r client in a forward-bent position to
e n c o u r a g e the facets t o o p e n while y o u
release the tissues r e s p o n s i b l e f o r the
restriction. In the same way, w h e n the
facets are f i x e d o p e n , b a c k b e n d i n g e n -
courages the facets to close as y o u release
the restricting tissues. T h e indirect tech-
nique is probably only successful when the
restrictions are n o t very severe. Generally
Figure 2.12
speaking, if you want to release a j o i n t any-
where in the body, it is almost always m o r e
effective to use a technique that challenges the restricted facets rather than
a technique that simply unwinds tissue a r o u n d the fixation.
K e e p practicing this shotgun a p p r o a c h until y o u gain c o n f i d e n c e with
feeling rotation a n d releasing facet restrictions. In the n e x t chapter, y o u
will learn h o w to apply the test so y o u d o n ' t waste time trying to release
what is n o t restricted.
Note
1. Korr, I.M. "Vulnerability of the Segmental N e r v o u s System to Somatic
Insults" in The Physiological Basis of Osteopathic Medicine, G e o r g e W. N o r t h u p
ed., (New York, 1 9 8 2 ) , p p 5 6 - 5 7 . Emphasis a d d e d .
25
CHAPTER
Finding and Fixing the Fixations
HENEVER YOU ARE LOOKING AT A VERTEBRA T H A T IS ROTATED
and sidebent to the same side (Type I I ) , w h e t h e r it is dysfunc-

tional or n o r m a l , the facets on the side with the p r o m i n e n t TP
(the side to which it is rotated) are always c l o s e d a n d the o p p o s i t e facets
are o p e n . If all is n o r m a l a n d no facets are restricted, n o r m a l m o t i o n is
p o s s i b l e t h r o u g h the area. If the situation is d y s f u n c t i o n a l , t h e r e are
restricted facets a n d an o b v i o u s loss of m o t i o n . So w h e n y o u find a rota-
tion, you n e e d a way to d e t e r m i n e which facets are restricted so y o u d o n ' t
waste time trying to release facets that are n o t restricted. If y o u find re-
stricted facets in the l u m b a r or thoracic spine, then they are either fixed
o p e n o r f i x e d c l o s e d . A g a i n , y o u n e e d a way t o d e t e r m i n e w h e t h e r the
o p e n facets are fixed or the c l o s e d facets are fixed to avoid wasting time.
T h e cervical facets are unlike the thoracic a n d l u m b a r facets in that o n e
side can be fixed o p e n while the o t h e r is fixed closed. If C3 is right-rotated
and right sidebent on C4, it is possible for the right facets to be fixed closed
and the left facets to be fixed o p e n . But this kind of bilateral fixation d o e s
n o t o c c u r in the thoracic a n d l u m b a r facets. For n o w we are only g o i n g
to deal with the l u m b a r a n d thoracic facets. In the n e x t c h a p t e r we will
e x a m i n e the cervical facets.
T h e test f o r d e t e r m i n i n g which thoracic or lumbar facets are restricted
and h o w they are restricted is fairly easy to p e r f o r m , b u t s o m e w h a t c o m -
plicated to explain, although there is a very simple way to r e m e m b e r the
27
i m p o r t a n t i n f o r m a t i o n y o u can gather f r o m it.

W i t h y o u r client in a sitting position, find the m o s t obviously rotated
t h o r a c i c v e r t e b r a . Say y o u f i n d that T 3 i s right r o t a t e d o n T 4 a n d let's
assume that the left facets are the restricted o n e s . Since they are fixed
o p e n , in a position of flexion or forward b e n d i n g , when y o u r client b e n d s
f o r w a r d the left TP r e m a i n s stationary, f i x e d slightly anteriorly. M e a n -
while, y o u r right t h u m b will follow the right TP as it moves anteriorly dur-
ing forward b e n d i n g . T h e right TP moves anteriorly during forward
b e n d i n g , b e c a u s e that is what it d o e s normally. But because the left side
is already fixed anteriorly, the right TP is f o r c e d to pivot a r o u n d the o p e n -
f i x e d left f a c e t as y o u r c l i e n t b e n d s f o r w a r d . As a result, the right side
appears to derotate. To say it differently, w h e n y o u r client forward b e n d s ,
the b u m p on the right seems to disappear and the indentation on the left
stays where it is (Figure 3.1). W h e n y o u r client returns to neutral position,
the b u m p on the right reappears. If y o u r client n o w back bends, the b u m p
on the right will a p p e a r to get m o r e e x t r e m e a n d the vertebra will m o v e
m o r e into right rotation (Figure 3.2). As y o u r client back b e n d s the fixed
pivot p o i n t created by left facets keeps the left TP fixed anteriorly. Since
b a c k b e n d i n g forces the right side to m o v e m o r e posteriorly in c o m p a r i -
s o n to the fixed indentation on the left, the right TP appears to m o v e fur-
ther i n t o right rotation.
N o w let's imagine the o p p o s i t e situation in which the right side is fixed
closed, as if the right facets were backward b e n t ( o r e x t e n d e d ) . As a result,
the right TP will be fixed posteriorly. W h e n y o u r client b a c k b e n d s , y o u r
t h u m b s feel the vertebra derotate a n d the b u m p seems to go away. Why?
Because the right TP is already fixed posteriorly a n d the left TP is f o r c e d
to pivot a r o u n d the fixed right facets a n d m o v e posteriorly as y o u r client
b a c k b e n d s . Since the left side is free to m o v e posteriorly a n d the right
side is fixed posteriorly already, back b e n d i n g removes the indentation as
the left T P m o v e s p o s t e r i o r l y t o m a t c h the right TP. W h e n y o u r client
returns to neutral, the b u m p on the right returns. If y o u r client n o w for-
ward b e n d s , the b u m p seems t o b e c o m e m o r e e x t r e m e . Since the right
facets are fixed closed, the right TP is fixed posteriorly. Since the left facets
are free, as y o u r client f o r w a r d b e n d s they allow the left TP to m o v e ante-
riorly in c o m p a r i s o n to the right TP w h i c h is fixed posteriorly. T h e dif-
ference between the two TP's is n o w m o r e extreme and your thumbs seem
28
FINDING AND FIXING THE FIXATIONS
Figure 3.1
Figure 3.2
29
to sense that the vertebra has m o v e d into a m o r e extreme right rotation.

T h e p r e c e d i n g p r o c e d u r e is the basis of the test f o r d e t e r m i n i n g rota-
tion a n d s i d e b e n d i n g , a n d identifying w h i c h facets are restricted. But let
me caution y o u a b o u t a very i m p o r t a n t p o i n t : if y o u are like most o t h e r
practitioners w h o are n e w to this test, y o u will p r o b a b l y try to think y o u r
way t h r o u g h what h a p p e n s each time y o u p e r f o r m the test. As y o u r client
f o r w a r d a n d backward b e n d s , y o u will be t e m p t e d to describe to yourself
what y o u are f e e l i n g , similar to the way I j u s t d e s c r i b e d it. D o n ' t do it,
because there is an easy way to r e m e m b e r the i n f o r m a t i o n f o r identifying
which facet to release. Describing to yourself a c o m p l i c a t e d p h e n o m e n o n
(that also d e m a n d s that y o u d e d u c e the side o n w h i c h the facets are
restricted f r o m the way a vertebra rotates a n d derotates d u r i n g forward
and backward b e n d i n g as y o u r e m e m b e r that it is sidebent and rotated to
the same side) while simultaneously trying to feel what is happening under
y o u r thumbs f o r the first time in y o u r life is 100 times m o r e difficult than
trying to follow this awkward sentence I am writing trying to describe what
y o u s h o u l d n ' t attempt. W h a t y o u n e e d is a simple rule that will allow y o u
to identify a n d treat the facet fixation with palpatory ease and very little
conceptual thought.
First y o u d e t e r m i n e rotation in neutral position. K e e p your thumbs on
the TP's of the rotated vertebra, forward and backward b e n d your client,
and feel a n d watch what h a p p e n s u n d e r y o u r thumbs. L o o k for the posi-
tion (whether in forward or backward b e n d i n g ) where the b u m p (the pos-
terior or p r o m i n e n t TP of the rotated vertebra) disappears. S o m e p e o p l e
object to saying the b u m p disappears and like to say that the vertebra appears
to derotate. This is a matter of taste, so use whatever description works best.
But r e m e m b e r this important point: the position where the bump disappears (or
the vertebra appears to derotate) is the position in which the facets are restricted. If
the b u m p disappears in forward b e n d i n g , the facets are fixed in the for-
ward b e n t position, which means the facets are fixed o p e n (flexion fixed).
If the b u m p disappears in back b e n d i n g , the facets are fixed in the back
b e n t position, which means the facets are fixed closed (extension fixed).
T h e r e is o n e m o r e i m p o r t a n t r e m i n d e r : if the b u m p , or posterior TP,
disappears in forward b e n d i n g , the fixed-open facets are on the opposite
side of the rotation, or posterior TP. If the b u m p disappears in back b e n d -
ing, the fixed-closed facets are on the same side of the rotation. In o t h e r
30
words, if a vertebra in neutral position is rotated and sidebent to the same

side (Type II dysfunction), it has a facet restriction and the facets are either
fixed o p e n or fixed closed. If they are fixed closed, the fixed facets are on
the same side as the rotation, or p o s t e r i o r TP. If they are fixed o p e n , the
fixed facets are on the o p p o s i t e side of the rotation, or p r o m i n e n t TP.
So h e r e are two very simple rules that will allow y o u to k e e p y o u r san-
ity as y o u practice this test:
In backward bending if the prominent TP disappears,

the facets on the side of the rotation are fixed closed.
In forward bending if the prominent TP disappears,
the facets on the side opposite to the rotation are fixed open.
Y o u can reformulate these rules any way y o u want, b u t k e e p a c o p y of
t h e m where y o u can easily see t h e m as y o u practice p e r f o r m i n g the test.
Again, d o n ' t try to think t h r o u g h the l o g i c of this test as y o u p e r f o r m it.
Learn h o w to apply the test a n d get the i n f o r m a t i o n y o u n e e d by using
these rules first. In time, if it is i m p o r t a n t to y o u to be able to state the
logic of the test to yourself or to others, y o u can practice d o i n g it. For now,
use this easy m e t h o d to d e t e r m i n e w h e t h e r the facets are restricted a n d
whether they are fixed o p e n or c l o s e d so that y o u can directly a n d effort-
lessly release t h e m .
T h e t e c h n i q u e s f o r releasing facet restrictions are the same as t h o s e
you learned in the last chapter. Since y o u n o w have a q u i c k way to deter-
m i n e whether y o u are dealing with fixed o p e n o r f i x e d c l o s e d facets, y o u
only n e e d to apply the t e c h n i q u e to the side with the facet restriction. So
if the facets are fixed o p e n , apply the t e c h n i q u e in any of the b a c k b e n d -
ing positions (sitting, p r o n e , or sidelying). If the facets are fixed c l o s e d ,
apply the t e c h n i q u e in any of the f o r w a r d b e n d i n g positions.
Previously I m e n t i o n e d that facets can be bilaterally fixed o p e n or closed.
These fixations are n o t as easy to find t h r o u g h palpation because they do
n o t show up as rotated a n d sidebent. Test f o r t h e m by putting y o u r client
in the sitting position. Find the suspected vertebrae a n d p u t a finger or
t h u m b on the spinous process of the superior vertebra a n d p u t the finger
or t h u m b of the o t h e r h a n d on the spinous process immediately inferior,
and instruct y o u r client to b e n d forward a n d backward (Figures 3.3 a n d
31
Figure 3.3
Figure 3.4
32
3.4). If your thumbs m o v e away f r o m each o t h e r in forward b e n d i n g , b u t

do n o t approximate in backward b e n d i n g , the facets are bilaterally fixed
o p e n . If your thumbs approximate in backward b e n d i n g , but do n o t m o v e
apart in forward b e n d i n g , the facets are bilaterally fixed closed.
Releasing either is quite simple. A g a i n with y o u r client in the sitting
p o s i t i o n , p l a c e the k n u c k l e o f y o u r right f o r e f i n g e r i n the right spinal
g r o o v e and the knuckle of y o u r left f o r e f i n g e r in the left spinal g r o o v e . If
the facets are bilaterally fixed o p e n , ask y o u r client to back b e n d over y o u r
knuckles as y o u apply pressure to b o t h sides a n d wait f o r the release (Fig-
ure 3.5). If the facets are bilaterally fixed c l o s e d , ask y o u r client to f o r -
ward b e n d , apply pressure to b o t h facets, and wait f o r the release (Figure
3.6). Y o u can apply these techniques in the p r o n e or sidelying positions
if you wish, b u t f o r obvious reasons y o u will p r o b a b l y find the sitting posi-
tion the easiest a n d m o s t efficient.
As you practice the test for unilateral facet restrictions, y o u will find ver-
tebrae that are obviously rotated, b u t do n o t r e s p o n d to forward and back-
ward b e n d i n g by appearing to rotate and derotate. Y o u will p r o b a b l y also
notice that these vertebrae often g r o u p themselves together into a curva-
33
ture. W h a t y o u are l o o k i n g at are T y p e I g r o u p fixations. W h e n y o u for-

ward a n d backward b e n d clients with g r o u p fixations, the rotated verte-
brae stay in their rotated position all the way through the process of forward
a n d backward b e n d i n g . If, as is often the case, they are a part of a r o t o -
scoliosis (Figure 3.7), their positions are fixed because of larger myofascial
restrictions and because the shape of the vertebrae has b e e n altered as part
of the curvature. Type I dysfunctions tend n o t to be restricted at the facet
level by the small muscles and the ligaments like Type II dysfunctions are.
Y o u s h o u l d be aware that within a Type I curvature y o u can find indi-
vidual dysfunctional Type II vertebrae. As y o u might imagine, they are a lit-
tle hard to find. Suppose your client's thoracic vertebrae are all right sidebent
a n d left rotated, e x c e p t f o r o n e . T h a t o n e vertebra c o u l d b e left rotated
a n d left sidebent or right rotated and right sidebent. If it is rotated right
a n d sidebent right it will be nearly impossible to differentiate it f r o m the
o t h e r vertebrae that are also right rotated by feel alone. If it is left rotated
and left sidebent, since it is also shaped in the Type I pattern, it will still be
very difficult to differentiate. You can find it if you apply the f o r w a r d / b a c k -
ward b e n d i n g test. But realize that it is also part of the curvature, so d o n ' t
expect it to appear to derotate all the
way. S i n c e o n e of the facets is r e -
stricted, it will appear to rotate and
Crossover
d e r o t a t e to s o m e d e g r e e . A n d it is
that d e g r e e of rotating and derotat-
ing y o u have to get a feel f o r if y o u Apex
want to locate Type II dysfunctions
in the midst of Type I patterns.
Crossover
In any case, if y o u find s o m e ver-
tebrae in thoracic or l u m b a r spine
that d o n o t c h a n g e h o w they are Apex
rotated in forward and backward
b e n d i n g , they are T y p e I fixations.
T h e y r e q u i r e a slightly m o r e c o m - Crossover
p l i c a t e d t e c h n i q u e than what y o u
h a v e l e a r n e d s o far a n d y o u will
learn these t e c h n i q u e s in C h a p t e r
Ten. Figure 3.7
34
CHAPTER
The Neck
N H I S M O N U M E N T A L W O R K , The Interpretation of Dreams, F R E U D S A I D T H A T
the royal r o a d to the u n c o n s c i o u s is t h r o u g h d r e a m interpretation. His

brilliant c o l l e a g u e , W i l h e l m R e i c h , said that the royal r o a d is t h r o u g h
understanding the body. Well, after m a n y years of w o r k i n g with p e o p l e in
various kinds of distress, I have c o m e to see that they are b o t h w r o n g —
it's the n e c k !
Of course, my claim is an exaggeration. But like all such exaggerations
it contains s o m e d e g r e e of truth. T h e cervical vertebrae s u p p o r t a rather
large and heavy e g g s h a p e d thing that is constantly m o v i n g a b o u t , stick-
ing a fleshy p r o t u b e r a n c e called a n o s e i n t o situations that o f t e n d o n ' t
c o n c e r n it. O u r e m o t i o n s often b e g i n their j o u r n e y toward expression in
o u r bellies and wind their way t h r o u g h o u r n e c k — o n e o f the m a j o r thor-
o u g h f a r e s t h r o u g h w h i c h they eventually g e t e x p r e s s e d . If we suppress
o u r e m o t i o n s , we often do it by tightening the c o m p l i c a t e d musculature
of the neck. If we do this over a l o n g e n o u g h p e r i o d of time, we can lose
a g o o d deal of o u r flexibility and create a rather painful b o t t l e n e c k . A l s o ,
since the cervical spine is n o t e m b e d d e d as securely in bony, myofascial,
m e m b r a n o u s structures as the thoracic and l u m b a r spines, it can m o v e in
many interesting and c o m p l i c a t e d w a y s — a n d as a result get into trouble
m o r e easily. Since the n e c k is so highly flexible, it is better able to adapt
to imbalances in the rest of the b o d y than o t h e r parts of the spine.
Try standing up and sidebending to the right. Notice h o w your shoulder
35
girdle a n d n e c k r e s p o n d . Y o u w o u l d actually be m o r e c o m f o r t a b l e if your

n e c k f o l l o w e d the s i d e b e n d i n g . But because of y o u r righting reflexes y o u
instinctively l o o k a h e a d with y o u r eyes r o u g h l y horizontal to the g r o u n d
p l a n e . N o t i c e h o w y o u r n e c k loses s o m e of its flexibility as y o u attempt to
k e e p y o u r h e a d on straight while s i d e b e n d i n g . In a less exaggerated, b u t
no less i m p o r t a n t way, o u r necks are always adjusting to imbalances every-
w h e r e in o u r b o d i e s . Since n o n e of us have perfectly b a l a n c e d b o d i e s , to
s o m e e x t e n t we have all lost s o m e d e g r e e of mobility and adaptability in
the cervical r e g i o n . B e c a u s e of this loss of adaptability, y o u will almost
always find p r o b l e m s with p e o p l e ' s necks, even those w h o do n o t c o m e to
y o u c o m p l a i n i n g a b o u t their necks. Y o u will find restrictions in the necks
of y o u n g p e o p l e and see the effects of unresolved restrictions in the severely
restricted necks of o l d e r clients. T h e implication of these observations is
significant: m u c h of the time it will be difficult to adequately treat n e c k
p r o b l e m s unless y o u u n d e r s t a n d a n d m a n a g e the imbalances a n d c o m -
pensatory patterns in the w h o l e body. A l t h o u g h this situation is especially
true f o r the n e c k , it also applies to the entire body. Any time y o u consider
manipulating a local restriction, do y o u r best to also understand h o w it is
related to all the o t h e r areas of c o m p e n s a t i o n a n d strain t h r o u g h o u t the
body. If y o u r client's b o d y c a n n o t adapt to or support the release of a local
fixation, then either the local area will revert to its dysfunctional state or
strain will be driven e l s e w h e r e — o r b o t h .
A l t h o u g h necks are very c o m p l i c a t e d , describing their m o t i o n is easy.
With the e x c e p t i o n of C I , all m o t i o n of the cervical spine is always Type II.
W h e n y o u s i d e b e n d a n d rotate y o u r n e c k , w h e t h e r y o u forward o r back
b e n d , and whether there are facet restrictions or not, sidebending and rota-
tion are always c o u p l e d to the same side. This fact makes your life as a ther-
apist a litde easier. Unlike the rest of the spine, o n c e you know how a cervical
vertebra is rotated y o u automatically k n o w it must be sidebent to the same
side. F r o m the previous chapters y o u also k n o w that the facets on the side
to which the vertebra is rotated are closed and that the facets on the o p p o -
site side are o p e n . Y o u c o u l d use the f o r w a r d / b a c k w a r d b e n d i n g test you
learned in the last chapter to d e t e r m i n e which facets are restricted, but if
y o u try it y o u will realize rather quickly that it is n o t easily applied to the
n e c k and that a different test w o u l d be useful. It turns o u t that there is a
rather elegant m o t i o n test f o r d e t e r m i n i n g facet restrictions, but we will
36
THE NECK
save it f o r the next chapter. In this c h a p t e r y o u will learn s o m e easy tech-

niques that do n o t require k n o w i n g w h i c h facets are fixed. T h e rationale
f o r this a p p r o a c h is b a s e d on e x p e r i e n c e a n d is the s a m e as the o n e I
explained in Chapter T w o : on average, somatic practitioners tend to learn
t h e o r y and t e c h n i q u e m o r e easily a n d quickly w h e n they can g e t their
hands to understand first.
Indirect Cervical Techniques
T HE FIRST T W O TECHNIQUES WE ARE G O I N G TO L O O K AT ARE SIMPLE
indirect techniques that do n o t c h a l l e n g e facet restrictions. T h e y are

similar to the first t e c h n i q u e y o u l e a r n e d f o r derotating l u m b a r a n d t h o -
racic vertebrae in Chapter O n e . Even t h o u g h these indirect t e c h n i q u e s
are n o t as consistently effective as the t e c h n i q u e s that c h a l l e n g e the re-
stricted facets, they can be effective on m a n y o c c a s i o n s a n d they are fun
to practice. But m o r e importantly they can assist y o u r learning in two very
useful ways: practicing t h e m will give y o u e x p e r i e n c e in f e e l i n g i n t o a n d
through the body, a n d they will also teach y o u r h a n d s and m i n d the clear
difference between addressing the myofascial level and the articular level.
In o r d e r to d e t e r m i n e w h e t h e r to apply these indirect t e c h n i q u e s the
only piece of information you n e e d to know is whether a vertebra is rotated.
With your client supine, place the tips of y o u r i n d e x fingers t o u c h i n g each
o t h e r o n o n e o f the s p i n o u s processes o f the cervical s p i n e . M a k e sure
that y o u r fingers are on the same horizontal plane a n d that they are per-
p e n d i c u l a r to the sagittal p l a n e . T h e n slowly pull y o u r fingers laterally
apart a l o n g the horizontal plane. A l m o s t immediately y o u will feel y o u r
fingertips sink into the spinal g r o o v e . If the vertebra is right rotated, y o u
will feel that y o u r right finger is a little posterior a n d y o u r left finger is a
little anterior. T h e b u m p is on the right and the indentation is on the left.
Test all of the cervical vertebrae in this way until y o u find o n e that is obvi-
ously rotated. A n d again, d o n ' t fret a b o u t the o n e s that are n o t clear. For
now, just find the o n e s that are obviously rotated.
If y o u are n o t familiar with locating cervical vertebrae, h e r e is a sim-
ple m e t h o d f o r f i n d i n g y o u r way. L o c a t e the i n f e r i o r tip of the mastoid
process and let y o u r finger sink f r o m there medially i n t o the e d g e of the
cervical spine. Your finger will land on the articular pillar a n d transverse
37
Figure 4.1
process of C2. T h e cervical vertebrae are spaced about a finger-width apart

f r o m e a c h other. F r o m C 2 , m o v e d o w n o n e f i n g e r - w i d t h and place y o u r
first finger on the right articular pillar of C3. T h e n let y o u r o t h e r fingers
fall in line u n d e r y o u r i n d e x finger on e a c h successive vertebrae. You n o w
have y o u r m i d d l e f i n g e r o n C4, y o u r ring f i n g e r o n C 5 , and y o u r pinky
o n C 6 (Figure 4 . 1 ) .
Figure 4.2 is a illustration of a typical cervical vertebra. T h e anterior
a n d posterior tubercles in this particular vertebra constitute its transverse
processes. In o t h e r cervical vertebrae, the transverse process is c o m p o s e d
o f only o n e p r o m i n e n c e . O n c e y o u realize h o w close the articular pillars
are to the tubercles, or transverse processes, y o u can appreciate h o w your
fingertips, in m a n y cases, are b i g e n o u g h to cover b o t h at o n c e . T h e artic-
ular pillars are also k n o w n as the articular processes. If y o u l o o k at h o w
the cervical vertebrae line u p o v e r o n e another, y o u can easily see h o w
these articular processes f u n c t i o n as s u p p o r t i n g pillars.
Let's go back to y o u r client's n e c k a n d find the most obviously rotated
cervical vertebra so that y o u can practice the first indirect t e c h n i q u e f o r
38
THE NECK
Facet
Body
Anterior tubercle
Posterior tubercle
Facet Spinous process
Articular pillar
Figure 4.2
derotating it. Let's assume y o u d i s c o v e r that C3 is right r o t a t e d on C 4 .

Place the tips of y o u r thumbs on the TP's of C3 a n d let y o u r forefingers
sink into the spinal g r o o v e at the level of C3 (Figures 4.3 a n d 4.4, p a g e
4 0 ) . Gently b u t firmly s q u e e z e C3 b e t w e e n y o u r fingers t o g e t h e r in the
following way: press the tips of y o u r thumbs toward each o t h e r in a medial
direction as y o u squeeze your forefingers into the spinal g r o o v e in an ante-
rior and slightly superior direction. Wait a n d y o u will feel the m a r v e l o u s
response of y o u r client's b o d y to y o u r t o u c h as it begins to c o r r e c t itself.
Y o u will probably first feel C3 m o v e further i n t o right rotation a n d right
s i d e b e n d i n g a n d t h e n c h a n g e d i r e c t i o n a n d possibly m o v e toward left
rotation and left s i d e b e n d i n g , perhaps m o v i n g in u n p r e d i c t a b l e a n d sur-
prising ways before it setdes and releases. D o n ' t try to anticipate its m o t i o n ,
just follow the d a n c e . W h e n it releases y o u will feel the associated tissues
soften and the n e c k o r g a n i z e itself a l o n g the sagittal p l a n e . If the t e c h -
n i q u e was successful y o u r client will r e p o r t that his pain is either g o n e or
lessened a n d y o u will n o t i c e that C3 is no l o n g e r right rotated. Practice
this t e c h n i q u e f o r a while until y o u try the n e x t o n e .
39
Figure 4.3
Figure 4.4
40
THE NECK
T h e s e c o n d indirect t e c h n i q u e is n o t only simple, b u t rather elegant.

It was created by my friend a n d c o l l e a g u e , Jan Sultan, w h o j o k i n g l y a n d
appropriately calls it "Dial-a-Neck." Y o u may f i n d this t e c h n i q u e a little
m o r e effective than the previous o n e because it involves larger m o v e m e n t s
of the h e a d and n e c k w h i c h may, in turn, have m o r e of an effect on the
facet restrictions.
Grasp the T P ' s o f C 3 b e t w e e n the t h u m b a n d m i d d l e f i n g e r o f y o u r
right h a n d (Figures 4.5, 4.6, a n d 4.7). W i t h y o u r left h a n d grasp the t o p
of y o u r client's h e a d a n d rotate it to the right so that its rotation, a c c o r d -
ing to your best guess, matches the rotation of C3. N o w wait f o r a m o m e n t
and you will e x p e r i e n c e a remarkable d e v e l o p m e n t — C 3 and y o u r client's
head will b o t h b e g i n to m o v e further i n t o right rotation. Just f o l l o w this
m o t i o n until the h e a d and n e c k rotate no further a n d wait. In a few sec-
o n d s y o u may feel a slight pulsation u n d e r y o u r fingers (it d o e s n ' t really
matter whether y o u feel this pulsation or n o t ; b u t since m a n y therapists
do feel it, it is worth m e n t i o n i n g ) . Continue to wait for a few m o r e m o m e n t s
and y o u will feel an impulse in y o u r client's n e c k a n d h e a d to c o m e o u t
Figure 4.5
41
Figure 4.6
Figure 4.7
42
THE NECK
of its extreme rotation. Again, just follow the directions in w h i c h the h e a d

and n e c k want to m o v e . T h e y may rotate to the left a n d then b a c k to the
right as they s i d e b e n d , f o r w a r d a n d b a c k w a r d b e n d , this way a n d that.
D o n ' t impose your notions of what is possible or what y o u think they should
d o , j u s t f o l l o w the d a n c e . Eventually, the h e a d a n d n e c k will c e a s e all
s i d e b e n d i n g and rotating, and setde in a straight line. Wait f o r the tissues
to soften u n d e r y o u r fingers a n d f o r the o r t h o t r o p i c effect as the n e c k
lengthens and organizes itself a l o n g the sagittal axis. Palpate C3 a n d see
if it derotated. If the technique was successful, C3 will no l o n g e r be rotated,
the tissues will feel m o r e relaxed, a n d y o u r client will r e p o r t that his pain
is lessened or c o m p l e t e l y g o n e .
Y o u may have n o t i c e d that my favorite expression f o r h o w to r e s p o n d
to the b o d y as it finds n o r m a l is "Just f o l l o w the d a n c e . " T h e refined aes-
thetic sensibilities of s o m e Italian students that I o n c e taught in R o m e l e d
them to coin the phrase, ' T h e D a n c e of the Tissues " t o describe this aston-
ishing ability of the b o d y to f i n d its way b a c k h o m e w h e n given p e r m i s -
sion. With a little practice a n d p a t i e n c e e v e r y o n e can learn to p e r c e i v e
this d a n c e . All it requires is that y o u let go of y o u r t e n d e n c y to anticipate
and c o m m e n t on the process that is u n f o l d i n g u n d e r y o u r h a n d s a n d let
what is h a p p e n i n g u n f o l d in its o w n way. Resist the temptation to step o u t
of the flow of lived-experience a n d reflect on what is h a p p e n i n g .
Reflectively thinking a b o u t e x p e r i e n c e certainly has a place in life, b u t
n o t w h e n y o u are applying these t e c h n i q u e s . Athletes s o m e t i m e s refer to
this pre-reflective way of b e i n g a n d d o i n g as the " Z o n e . " If a basketball
player were to think to himself as he was a b o u t to score the w i n n i n g p o i n t
in the last s e c o n d s of the g a m e , " O h , this is great I am a b o u t to s c o r e two
b i g o n e s , " he p r o b a b l y w o u l d n ' t . If, d u r i n g an inspired p e r f o r m a n c e , a
great c o n c e r t musician were to continually c o m m e n t to herself, "I am play-
ing this beautifully, Mozart w o u l d be so impressed!" h e r inspiration w o u l d
s o o n b e c o m e a fleeting m e m o r y . In the same way, if y o u reflect on the
process or c o m m e n t to yourself in elation, skepticism, or self-doubt, y o u
will just as surely lose y o u r ability to f o l l o w the d a n c e of the tissues.
All t o o often w h e n therapists first attempt to f o l l o w the d a n c e of the
tissues they a d o p t all sorts of silent, self-defeating m o n o l o g u e s a n d atti-
tudes that instantly h i n d e r their ability to feel the obvious. Since they are
often n o t p r e p a r e d f o r the e x p e r i e n c e o f the b o d y m o v i n g u n d e r its o w n
43
d i r e c t i o n i n d e p e n d e n t l y o f their o r the client's c o n s c i o u s c o n t r o l , they

d o u b t what they are feeling. S o m e t i m e s their skepticism gets in their way
a n d they think, " O h , this c a n ' t be h a p p e n i n g ! " a n d s u d d e n l y what they
were feeling disappears u n d e r their hands. At other times their own aston-
ishment brings the d a n c e to a c o m p l e t e standstill. Before they even touch
the b o d y , s o m e therapists assume that they are n o t sensitive e n o u g h to
feel such m o v e m e n t s a n d just as surely as they let their feelings of inade-
q u a c y take over, they lose their innate ability to f o l l o w the d a n c e of the
tissues. However, y o u can learn to p u t all such n o t i o n s aside a n d just let
yourself feel what the b o d y wants to d o .
T h e most c o m m o n mistake that b e g i n n i n g followers of the dance make
is to anticipate what the b o d y wants to do as it transitions f r o m o n e posi-
tion to a n o t h e r . At first they f i n d themselves f o l l o w i n g the d a n c e quite
well as the b o d y c o n t i n u e s to rotate a n d s i d e b e n d in o n e direction. But
at the very m o m e n t the b o d y stops m o v i n g in the direction they are fol-
lowing a n d b e g i n s to shift in a n o t h e r direction, they immediately w o n d e r
what is h a p p e n i n g , a l t h o u g h m o r e than likely they will n o t even f o r m a
c o m p l e t e t h o u g h t a b o u t it. Either the m o m e n t a r y cessation of m o v e m e n t
in a clear d i r e c t i o n or a slow b u t o b v i o u s c h a n g e of d i r e c t i o n c o m p e l s
t h e m to instinctively w o n d e r a b o u t what is g o i n g o n . It is m u c h like what
happens when you see m o v e m e n t from the c o r n e r of your e y e — y o u instinc-
tively a n d inquisitively turn to see what the m o v e m e n t is. A l t h o u g h no
w o r d s may b e s p o k e n , y o u r o r i e n t a t i o n a n d c o m p o r t m e n t say "What's
that?"
It d o e s n ' t really matter what therapists say or d o n ' t say to themselves
w h e n the b o d y c h a n g e s directions d u r i n g treatment. W h a t matters is that
they step o u t of the flow of lived-experience and lose track of the d a n c e .
If y o u are n o t pre-reflectively there to f o l l o w the b o d y ' s lead, y o u are no
l o n g e r able to r e c o g n i z e its pattern of strain—there is no l o n g e r anything
f o r y o u to f o l l o w a n d so y o u stop m o v i n g . Since it takes two to tango, the
b o d y also stops m o v i n g . If this h a p p e n s to y o u d u r i n g the transitions, all
that y o u n e e d to do is simply stop thinking a b o u t what y o u are feeling.
Let g o o f y o u r surprise, p u z z l e m e n t , o r wordless "What's that?" and just
feel again h o w the b o d y slow d a n c e s toward its o w n c o r r e c t i o n .
L e a r n i n g to w o r k this way is an exercise in learning h o w n o t to think,
h o w n o t t o worry, a n d h o w t o b e h a p p y with what is. T h e m o r e y o u learn
44
THE NECK
to live in this place of no-thinking, the h a p p i e r y o u will b e c o m e . E x p l o r e

this o p e n way of n o t reflectively thinking a b o u t what is o c c u r r i n g , because
it is a gateway into the healer's way of b e i n g that I briefly m e n t i o n e d in
the i n t r o d u c t i o n . E x p l o r e this s p a c i o u s way o f b e i n g w h e n y o u are n o t
working with clients and y o u can transform your life. Explore it while work-
ing with y o u r clients a n d their b o d i e s will reveal m o r e a n d m o r e of what
they n e e d f r o m y o u . I n time y o u will b e less a n d less c o n c e r n e d a b o u t
i m p o s i n g your will and presuppositions on y o u r clients, or the world, a n d
things will u n f o l d with an i m p e c c a b l e clarity.
Like most indirect techniques of this nature Dial-a-Neck will sometimes
p r o d u c e w o n d e r f u l and astounding results and at o t h e r times it will s e e m
like a waste of effort. N o w you know w h y — i t ' s because these techniques do
n o t direcdy challenge j o i n t fixations. Since we are a p p r o a c h i n g all j o i n t fix-
ations in this b o o k f r o m the soft-tissue perspective, we n e e d a way to chal-
l e n g e the j o i n t fixation without resorting to high-velocity, low-amplitude
thrusting techniques, and that is what the next technique will accomplish.
A Joint Challenging Technique
T HIS J O I N T - C H A L L E N G I N G T E C H N I Q U E IS VERY LIKE T H E S H O T G U N
t e c h n i q u e y o u l e a r n e d in Chapter T w o to release facet restrictions in

the thoracic and l u m b a r sections of the spine. A l t h o u g h there are a n u m -
b e r o f small d i f f e r e n c e s , let m e d e s c r i b e the t e c h n i q u e simply, w i t h o u t
m e n t i o n i n g these differences so y o u k n o w y o u are in familiar territory. It
works just as y o u might expect: y o u locate the rotated vertebra and assume
that it is fixed c l o s e d on the side to w h i c h it is rotated a n d fixed o p e n on
the opposite side, put pressure on the fixed-closed facets in forward b e n d -
ing and wait f o r the release, a n d p u t pressure on the f i x e d - o p e n facets in
backward b e n d i n g a n d wait f o r the release.
Y o u will be h a p p y to learn that this s h o t g u n t e c h n i q u e d o e s n o t waste
as m u c h time w h e n a p p l i e d to the cervical spine. In the thoracic or l u m -
bar spines, the facets are either fixed o p e n or fixed c l o s e d . So every time
you apply this shotgun a p p r o a c h to a lumbar or thoracic vertebra, y o u are
always addressing o n e side t o o many. But the cervical spine is different.
Very often y o u will find that the facets on b o t h sides are fixed. It is very
c o m m o n to find a cervical vertebra that is bilaterally restricted with facets
45
that are f i x e d c l o s e d o n o n e side a n d f i x e d o p e n o n the o t h e r side. Your

efficiency, t h e r e f o r e , g o e s up s o m e w h a t w h e n y o u use this t e c h n i q u e for
the n e c k .
T h e r e are s o m e important differences between the vertebra of the neck
a n d the rest of the spine that y o u n e e d to understand. O n e of these dif-
f e r e n c e s is reason f o r c a u t i o n . T h e r e are two vertebral arteries that run
a l o n g a n d inside the cervical vertebrae and irritating or cutting them off,
especially in o l d e r clients, can be very d a n g e r o u s . T h e vertebral arteries
are especially at risk at C 6 , C 7 , a n d at the occiptioatlantal j u n c t i o n . Even
if y o u r arteries are n o r m a l , w h e n y o u rotate y o u r n e c k they can narrow as
m u c h a s 9 0 % o n the side o p p o s i t e the r o t a t i o n . F o r w a r d b e n d i n g and
s i d e b e n d i n g the n e c k will n o t put these arteries at risk, but back b e n d i n g
will greatly exaggerate what h a p p e n s in rotation. Back b e n d i n g a client's
n e c k while applying a high-velocity, low-amplitude thrusting t e c h n i q u e ,
f o r e x a m p l e , is a very d a n g e r o u s a p p r o a c h . Be careful. W h e n y o u are
attempting to release o p e n fixed cervical facets, even using the soft-tissue
t e c h n i q u e s taught in this b o o k , y o u must m o d i f y t h e m and n o t put your
clients's n e c k very far i n t o extension.
If y o u p u t y o u r client into back b e n d i n g a n d rotation by mistake and
she c o m p l a i n s of dizziness or y o u notice that her eyes begin to m o v e invol-
untarily in a rhythmic b a c k a n d forth pattern ( k n o w n as nystagmus) take
h e r o u t of e x t e n s i o n immediately a n d suggest that she see her doctor. If
y o u have any d o u b t s a b o u t the integrity of a client's vertebral arteries,
there is a simple test y o u can apply. Put y o u r client in a sitting position
with h e r spine c o m f o r t a b l y straight. Ask h e r to back b e n d h e r h e a d and
then turn h e r h e a d to the right a n d to the left. Watch f o r the appearance
of nystagmus or dizziness.
Since the n e c k is c a p a b l e of m o r e m o t i o n than the rest of the spine,
y o u can i n t r o d u c e s i d e b e n d i n g a n d rotation as a way to further challenge
facet restrictions. In fact, y o u should use sidebending and rotation in place
of i n t r o d u c i n g significant extension as y o u manipulate o p e n fixed facets.
I n the case o f closed-fixed facets, y o u can apply e x t r e m e f o r w a r d b e n d -
i n g without w o r r y w h e n y o u apply s i d e b e n d i n g a n d rotation.
N o t i c e also h o w the facets are arranged in the cervical spine. N o t only
are they are almost parallel to the transverse p l a n e , the facets are acces-
sible to y o u r fingers in three places: in the spinal g r o o v e , at the lateral
46
THE NECK
e d g e s w h e r e the articular pillars a n d transverse p r o c e s s e s are, a n d j u s t

slighdy anterior and medial to the articular pillars and transverse processes.
Having a n u m b e r of places w h e r e the facets are accessible to y o u r fingers
makes the application of this t e c h n i q u e just a little bit easier, because y o u
can adjust the application of pressure to allow f o r h o w the b o d y is best
able to release.
So let's take a m o r e careful l o o k at this t e c h n i q u e . For the p u r p o s e s of
illustration, assume again that C3 is right rotated on C4. Either the right
facets are fixed c l o s e d or the left facets are fixed o p e n — o r b o t h sides are
fixed. Since C3 is right rotated, you know that it also must be right sidebent.
If it is right sidebent, it will be restricted in left s i d e b e n d i n g a n d rotation,
which means that it can easily s i d e b e n d a n d rotate right, b u t c a n n o t side-
b e n d and rotate left. Y o u n e e d to k n o w the direction in w h i c h C3 c a n n o t
s i d e b e n d and rotate in o r d e r to c h a l l e n g e the facets.
Release the right facets first. Cradle the b a c k of y o u r client's h e a d in
y o u r left h a n d a n d lift it o f f the table. L e a n y o u r e l b o w on the table so
that y o u can c o m f o r t a b l y s u p p o r t y o u r client's h e a d . T h e n left s i d e b e n d
and left rotate y o u r client's h e a d a n d n e c k as far as they will c o m f o r t a b l y
g o . Forward b e n d i n g and sidebending b o t h challenge the p r e s u m e d fixed-
closed right facets. T h e n put your i n d e x or m i d d l e finger on the p r e s u m e d
fixed c l o s e d facets in the right spinal g r o o v e or on the articular pillars, as
shown in Figure 4.8, p a g e 48. As y o u k e e p y o u r client's h e a d in its left-
s i d e b e n t p o s i t i o n , let y o u r f i n g e r sink i n t o the spinal g r o o v e a n d wait.
W h e n the facets release, y o u will n o t i c e the usual indicators: softening of
the tissue and a sense of the n e c k l e n g t h e n i n g a l o n g the sagittal p l a n e .
But y o u will also feel s o m e t h i n g else. R e m e m b e r that C3 is n o t able to
sidebend and rotate left because of the p r e s u m e d right-fixed facets. W h e n
the facets release, you will also feel your client's head and neck left sidebend
and rotate just a little further. If these are the only facets restricted in the
neck, then the left s i d e b e n d i n g a n d rotation will be very obvious.
N o w let's release the p r e s u m e d fixed-open facets on the left. A g a i n ,
cradle the back of y o u r client's h e a d in y o u r right h a n d , lift it u p , a n d rest
your e l b o w on the table. Put y o u r left i n d e x or m i d d l e finger on the fixed
o p e n facets by placing y o u r left finger in the left spinal g r o o v e or between
the articular pillars as s h o w n in Figures 4.9 a n d 4.10, p a g e 49. To m a k e
things easier f o r yourself, allow y o u r client's h e a d to rest on the w e b b i n g
47
Figure 4.8
between the t h u m b a n d forefinger of y o u r left h a n d . Push ever so slightly

in an anterior d i r e c t i o n to give just the suggestion of back b e n d i n g . With
y o u r right h a n d , s i d e b e n d a n d rotate y o u r client's h e a d and n e c k to the
left as far as they will c o m f o r t a b l y go a n d wait. W h e n the facets release,
y o u will feel the tissues soften, the sense of l e n g t h e n i n g a l o n g the sagittal
plane, and y o u r client's h e a d and n e c k turning further into left sidebend-
ing a n d rotation.
It is a g o o d idea to e x p e r i m e n t with a n d m o d i f y this t e c h n i q u e a bit.
Try different p l a c e m e n t s of y o u r left i n d e x finger. See h o w the technique
works for you when you put your index finger in the spinal groove, between
the TP's of C3 a n d C 4 , or j u s t slightly in front of and between the TP's of
C3 a n d C4 as y o u s i d e b e n d a n d rotate y o u r client's h e a d and n e c k to the
left. A l s o , y o u d o n ' t have to wait passively f o r the facets to release. Exper-
i m e n t with gently twisting a n d j i g g l i n g y o u r client's h e a d in the direction
o f left s i d e b e n d i n g a s y o u apply pressure either o n the o p e n o r c l o s e d
facets. Y o u can also very effectively c o m b i n e the direct and indirect ap-
p r o a c h e s . By twisting a n d then j i g g l i n g y o u r client's h e a d and n e c k in the
48
THE NECK
Figure 4.9
Figure 4.10
49
d i r e c t i o n i t c a n n o t s i d e b e n d a n d rotate, y o u are c h a l l e n g i n g the facet

restriction by p e r f o r m i n g a direct t e c h n i q u e . But if y o u then wait for your
client's b o d y t o r e s p o n d t o y o u r direct c h a l l e n g e and f o l l o w the d a n c e o f
the tissues y o u are a p p r o a c h i n g the fixation indirectly. Try j i g g l i n g and
rotating while waiting f o r the d a n c e , and then m o r e j i g g l i n g and rotating
a n d again waiting f o r the d a n c e , a n d so on until y o u secure a satisfactory
release. D o n ' t be surprised if y o u have to p e r f o r m the t e c h n i q u e a c o u -
ple of times to c o m p l e t e l y release the fixation.
This j o i n t - c h a l l e n g i n g t e c h n i q u e can also be used with a n e w m o t i o n
test f o r d e t e r m i n i n g w h i c h facets are fixed a n d h o w they are fixed. That
y o u will learn in the n e x t chapter. T h e test will allow y o u to be m o r e effi-
c i e n t in y o u r a p p r o a c h a n d p r o v i d e an i m p o r t a n t indicator of facet fixa-
tion. R e m e m b e r that fixation is m o r e i m p o r t a n t than position. C h e c k i n g
f o r rotation b e f o r e and after the application of a t e c h n i q u e is n o t a per-
fecdy reliable indicator of dysfunction or its release. A vertebra may appear
to have derotated and yet n o t have b e e n completely released f r o m its facet
restriction. Y o u should also realize that a vertebra can appear to be slightly
rotated a n d n o t actually have any facet restrictions. T h e m o t i o n testing
that y o u are a b o u t to learn will give y o u a very clear way to know, without
relying on palpating rotation, w h e t h e r y o u have discovered cervical facet
restrictions a n d w h e t h e r y o u were successful in releasing t h e m .
50
CHAPTER
Motion Testing the Cervical Spine
HE MOTION TEST DEVELOPED BY OSTEOPATHS FOR DETERMINING
facet restrictions in the cervical spine is called the Translation Test.

Translation in this context refers to m o t i o n i n d u c e d along a straight
or c u r v e d plane. T h e test is simple and quite elegant: y o u forward b e n d
and backward b e n d y o u r client's h e a d a n d n e c k a n d then push e a c h ver-
tebra f r o m right to left and f r o m left to right a l o n g a horizontal p l a n e . If
y o u find that the vertebra m o v e s f r o m right to left b u t n o t f r o m left to
right, y o u have discovered a facet restriction.
W h e n y o u h o l d y o u r client's n e c k i n forward b e n d i n g while y o u trans-
late the vertebra, y o u are testing to see if the facets can o p e n . If there are
no facet restrictions, the facets will o p e n in forward b e n d i n g a n d y o u will
be able to translate the vertebra f r o m left to right a n d right to left. H o w -
ever, if y o u find that y o u can translate f r o m right to left, b u t n o t f r o m left
to right in forward b e n d i n g , y o u have discovered fixed c l o s e d facets that
will n o t p e r m i t translatory m o t i o n . Likewise, w h e n y o u p u t y o u r client's
n e c k in a back b e n d i n g position and translate, y o u are testing f o r whether
the facets can close. If y o u find that y o u c a n n o t translate f r o m right to left
with y o u r client's n e c k in backward b e n d i n g , then y o u have d i s c o v e r e d
fixed o p e n facets that will n o t p e r m i t translatory m o t i o n .
T h e absence o f translatory m o t i o n indicates the l o c a t i o n o f the facet
restriction. In the forward b e n d i n g position, loss of m o t i o n indicates fixed-
closed facets and in the backward b e n d i n g position, loss of m o t i o n indi-
51
cates fixed-open facets. In the forward b e n d i n g position the facet restric-

tion is on the side o p p o s i t e the m o t i o n restriction a n d in the backward
b e n d i n g position the facet restriction is on the same side as the m o t i o n
restriction. This may s o u n d o d d , or even paradoxical at first, but it makes
perfectly g o o d sense o n c e y o u u n d e r s t a n d the l o g i c o f the test and the
Type II biomechanics of C 2 - C 7 .
D o n ' t c o n c e r n yourself with the logic of the test just yet or with h o w to
d e t e r m i n e on which side the facet restriction is. We will get to these impor-
tant aspects of the test s o o n e n o u g h . B e f o r e we d o , there is an important
distinction to k e e p in m i n d . N o t understanding or hearing this simple dis-
tinction at the outset has b e e n e n o u g h to drive s o m e rather intelligent
and n o r m a l therapists a r o u n d the b e n d . T h e distinction is between a facet
restriction a n d a motion restriction.
A facet restriction is the cause of the m o t i o n restriction. If you c a n n o t
translate a c e r v i c a l v e r t e b r a in o n e d i r e c t i o n , the cause of this lack of
m o t i o n is a facet restriction. After y o u apply this test y o u then use the dis-
c o v e r y of the m o t i o n restriction to d e d u c e w h e r e the facet restriction is.
Unlike what y o u l e a r n e d in the forward a n d backward b e n d i n g tests for
the t h o r a c i c a n d l u m b a r spines, y o u will b e d e d u c i n g facet restrictions
f r o m m o t i o n restrictions in the cervical spine, n o t f r o m the h o w the ver-
tebra appears to derotate. R e m e m b e r this distinction and that you are tak-
i n g y o u r r e f e r e n c e p o i n t f r o m m o t i o n restriction, n o t f r o m rotation.
In o r d e r to understand what translation is a n d h o w it works, practice
it with y o u r client's h e a d lying c o m f o r t a b l y on the treatment table, mak-
i n g sure that his n e c k is relatively straight. Admittedly, this position is n o t
very useful f o r getting the i n f o r m a t i o n y o u n e e d f o r d e t e r m i n i n g facet
restrictions. Y o u must use translation in the f o r w a r d a n d b a c k b e n d i n g
positions to get that i n f o r m a t i o n . However, we are practicing translation
this way first so that y o u can understand h o w it works without the a d d e d
effort o f m a i n t a i n i n g y o u r client's h e a d a n d n e c k i n forward and back-
ward b e n d i n g .
Let's start by translating C3 with y o u r client's h e a d and n e c k lying c o m -
fortably straight on the table. Find C3 a n d place y o u r i n d e x and m i d d l e
fingers on each TR Use y o u r palms and thenar e m i n e n c e s to stabilize and
h o l d the u p p e r part of the cervical spine and the h e a d . I n t r o d u c e trans-
lation by m o v i n g y o u r fingers and hands (as a w h o l e , as if their were no
52
MOTION TESTING THE CERVICAL SPINE
j o i n t s i n y o u r h a n d s ) f r o m left t o r i g h t
a n d f r o m right to left a l o n g the h o r i z o n -
tal plane (Figure 5.1). Be certain that y o u
are i n t r o d u c i n g m o t i o n o n l y a l o n g the
horizontal p l a n e — b e very careful n o t t o
actually s i d e b e n d y o u r client's n e c k . T h e
n e c k a n d C3 will automatically s i d e b e n d
as a result of m o v i n g it a l o n g t h e h o r i -
zontal. If y o u inadvertently s i d e b e n d y o u r
client while y o u are attempting to trans-
late C 3 , y o u will n o t get a clear reading.
Feel w h a t h a p p e n s u n d e r y o u r f i n g e r s .
D o e s C3 m o v e better left to right or right
t o left? I f y o u are n o t sure c h e c k C 2
t h r o u g h C7 until y o u find a vertebra that
clearly d o e s n o t m o v e a s easily i n o n e
Figure 5.1 direction as it d o e s the other. D o n ' t worry
yet a b o u t h o w to interpret y o u r findings.
Y o u may actually find s o m e vertebrae that d o n ' t translate at all. I g n o r e
these cases until y o u find a vertebra that obviously translates o n e way a n d
n o t the other. Just make sure y o u are translating correctly a n d n o t inad-
vertently i n t r o d u c i n g s i d e b e n d i n g into y o u r m o t i o n . D o y o u n o t i c e h o w
translation a l o n e is sufficient to create s i d e b e n d i n g ?
O n c e y o u are c o m f o r t a b l e with translating C 2 - C 7 , try translating C3
in the forward b e n d i n g position. P r o p y o u r elbows on the table. Cradle
and stabilize y o u r client's h e a d and cervical vertebrae a b o v e C3 with y o u r
palms a n d thenar e m i n e n c e s a n d lift the h e a d o f f the table (Figure 5.2,
page 5 4 ) . It is very i m p o r t a n t that y o u p r o p up y o u r elbows so that y o u
are n o t e x e r t i n g a l o t of u n n e c e s s a r y effort trying to h o l d y o u r client's
h e a d still. Many clients have a difficult time relinquishing c o n t r o l of their
necks to your hands, so the m o r e stable and secure they feel in y o u r hands,
the m o r e they can give up c o n t r o l . If y o u c a n n o t comfortably m a n a g e this
position f o r yourself, y o u m i g h t try using a face cradle f o r y o u r table that
will allow y o u r client's h e a d to rest easily on it in the f o r w a r d a n d back-
ward b e n d i n g positions (Figure 5.3).
In any case, put y o u r client's n e c k in flexion by lifting it o f f the table.
53
Figure 5.2
Figure 5.3
54
Stabilize t h e h e a d a n d C 1 - C 2 with y o u r
palms and thenar eminences, and then trans-
late C3 along the horizontal plane from right
to left a n d t h e n f r o m left to right. D o e s it
translate better o n e way than another? If so,
you have discovered a m o t i o n restriction that
will allow y o u to d e d u c e the side on w h i c h
the facets are fixed c l o s e d . If C3 translates
f r o m right to left, b u t n o t f r o m left to right,
the m o t i o n restriction is on the left. D o n ' t
c o n c e r n yourself right n o w with h o w t o d e -
d u c e the side with the f i x e d - c l o s e d facets
f r o m the discovery of m o t i o n restriction, just
feel the restriction. If C3 translates both ways,
go l o o k i n g f o r a vertebra that d o e s n ' t .
N o w try translating i n the b a c k w a r d
Figure 5.4 b e n d i n g position. To achieve an easy exten-
sion of the neck, simply slide the lateral e d g e
of y o u r forefinger u n d e r the n e c k and gently push it in an anterior direc-
tion while y o u simultaneously a n d gently push y o u r client's h e a d in an
inferior position. Stabilize the head and C 1 - C 2 with your palms and thenar
eminences, and translate C3 first o n e way and then the o t h e r (Figure 5.4).
If y o u find that C3 translates o n e way better than another, y o u have dis-
c o v e r e d a m o t i o n restriction that will allow y o u to d e d u c e the side on
which the facets are fixed o p e n . If C3 translates f r o m left to right, b u t n o t
f r o m right to left, the m o t i o n restriction is on the right. Again, d o n ' t c o n -
c e r n y o u r s e l f at this p o i n t with l e a r n i n g w h i c h side is f i x e d o p e n , j u s t
learn to feel f o r the m o t i o n restriction. If y o u d o n ' t find a m o t i o n restric-
tion at C3 on C4, then test other cervical vertebrae until y o u find a m o t i o n
restriction.
Practice translation on all the cervical vertebrae with the e x c e p t i o n of
C I : in forward and backward b e n d i n g until y o u are fairly c o n f i d e n t that
you can locate each individual vertebra and feel its free or restricted motion.
After practicing on a n u m b e r of different clients, y o u will be a m a z e d at
the p r o f o u n d differences between necks. S o m e necks seem to be very flex-
ible, with supple soft tissues, a n d yet still s h o w facet restrictions. O t h e r
55
necks s e e m to be tight a n d rigid at every level. Of c o u r s e , y o u will find

those necks that s e e m at first as t h o u g h they s h o u l d be fixated at every
level, b u t are relatively free of facet restrictions. W h a t e x p e r i e n c e teaches
y o u is that everyone is different and that the feeling of a restriction in o n e
p e r s o n may b e u n r e s t r i c t e d m o t i o n f o r a n o t h e r . Ultimately, n o matter
what part of the b o d y y o u are evaluating, y o u must learn to feel what c o n -
stitutes a restriction f o r e a c h individual p e r s o n .
N o w that y o u have s o m e familiarity with translation, let's l o o k a little
m o r e closely at the m o t i o n test a n d the i n f o r m a t i o n y o u can glean f r o m
it. Translation automatically i n t r o d u c e s s i d e b e n d i n g a n d rotation to the
same side. Since s i d e b e n d i n g and rotation are always c o u p l e d to the same
side in the n e c k (with the e x c e p t i o n of C I ) , if y o u k n o w which direction
a vertebra c a n n o t sidebend, y o u also k n o w the way it cannot rotate. Regard-
less o f w h e t h e r y o u translate y o u r client's n e c k i n f o r w a r d o r backward
b e n d i n g , if C3 can translate f r o m the right to the left, b u t n o t f r o m the
left to the right, y o u immediately k n o w that the vertebra is right sidebent
a n d right r o t a t e d , with f i x e d facets s o m e w h e r e that are p r e v e n t i n g left
s i d e b e n d i n g a n d left rotation.
Figuring o u t w h i c h facets are restricted is quite simple. Suppose in for-
ward b e n d i n g y o u can translate C3 f r o m right to left, b u t n o t f r o m left to
right. T h e discovery of a m o t i o n restriction on the left means that C3 is
right sidebent a n d right rotated on C4 a n d that C3 c a n n o t left s i d e b e n d
a n d left rotate. Since y o u are testing in forward b e n d i n g , y o u also k n o w
that y o u have d i s c o v e r e d fixed c l o s e d facets. So since C3 has facets that
are fixed c l o s e d and C3 is right sidebent and right rotated, then you know
the fixed c l o s e d facets must be on the right.
S u p p o s e y o u test a n o t h e r client's n e c k in back b e n d i n g and y o u find
the same m o t i o n restriction. In back b e n d i n g you discover a m o t i o n restric-
tion on the left: C3 translates easily f r o m right to left but, n o t f r o m left to
right. This discovery tells y o u that C3 is right sidebent and right rotated
a n d c a n n o t left s i d e b e n d a n d left rotate. Since y o u are testing in b a c k
b e n d i n g , y o u k n o w that y o u have discovered fixed o p e n facets. Since C3
is right s i d e b e n t a n d right rotated on C4 a n d the facets are fixed o p e n ,
y o u k n o w that the fixed o p e n facets must be on the left.
T w o simple rules immediately e m e r g e f r o m this exercise: 1) w h e n y o u
translate in forward b e n d i n g and m e e t a m o t i o n restriction, the facets are
56
fixed c l o s e d on the side o p p o s i t e to the m o t i o n restriction, a n d 2) w h e n

y o u translate in b a c k b e n d i n g a n d m e e t a m o t i o n restriction, the facets
are fixed o p e n on the same side as the m o t i o n restriction.
D o n ' t let y o u r m e m o r y o f the forward a n d backward b e n d i n g tests f o r
the thoracic a n d l u m b a r spines c o n f u s e y o u r u n d e r s t a n d i n g of the trans-
lation test. R e m e m b e r that f o r the cervical spine y o u are d e d u c i n g w h e r e
the facet restriction is f r o m d e t e r m i n i n g w h e r e the m o t i o n restriction is.
Y o u are n o t d e d u c i n g the l o c a t i o n of the facet restriction f r o m h o w the
vertebra appears to derotate, as y o u did in the thoracic and lumbar spines.
T h e reference p o i n t y o u are using to d e d u c e the facet restriction in the
cervical s p i n e , is m o t i o n restriction, n o t r o t a t i o n . F o r the t h o r a c i c a n d
l u m b a r spines, y o u d e d u c e that the fixed-closed facets are on the same
side as the rotation and that the fixed-open facets are on the o p p o s i t e side
o f the rotation. I n the cervical s p i n e , y o u d e d u c e that the f i x e d - c l o s e d
facets are on the side opposite to the m o t i o n restriction a n d that the fixed
o p e n facets are on the same side as the m o t i o n restriction. W i t h cervical
translation, the r e f e r e n c e p o i n t — t h e side to w h i c h the facet fixation is
either o p p o s i t e or the s a m e — i s reversed in relation to the f o r w a r d a n d
backward b e n d i n g test f o r the thoracic a n d l u m b a r spines.
W h y d o e s it w o r k this way? Let's stick with the same e x a m p l e . If there
are no fixed-closed facets, then w h e n y o u forward b e n d y o u r client's n e c k
all the facets will o p e n and when you translate you will n o t m e e t any m o t i o n
restriction. W h e n y o u translate i n f o r w a r d b e n d i n g a n d m e e t a m o t i o n
restriction, the cause is fixed closed facets. In o u r e x a m p l e translation tells
y o u that C3 is right s i d e b e n t a n d right rotated on C4 a n d that the right
facets are fixed closed. W h e n y o u translate right to left the left facets must
be free to o p e n to allow that m o t i o n to o c c u r . S i n c e the left facets are
i n d e e d free to o p e n , y o u are able to translate right to left. But w h e n y o u
try to translate left to right the situation changes. Translating left to right
can o n l y h a p p e n i f the right facets c a n o p e n . But since they are f i x e d
closed, they c a n n o t o p e n a n d will n o t p e r m i t left-to-right translation. Y o u
feel the m o t i o n restriction on the left, b e c a u s e the right facets will n o t
o p e n , and are f i x e d c l o s e d . Y o u d o n o t feel the m o t i o n restriction o n the
right because the left facets are able to o p e n as y o u translate right to left.
W h e n y o u b a c k b e n d y o u r client's n e c k , i f t h e r e are n o f i x e d - o p e n
facets, all the cervical facets will close a n d y o u will n o t m e e t any m o t i o n
57
restrictions w h e n y o u translate. If y o u m e e t a m o t i o n restriction while

translating in b a c k b e n d i n g , the cause is f i x e d o p e n facets. Translation
tells y o u that C3 is right sidebent and right rotated on C4 and that the left
facets are fixed o p e n . In back b e n d i n g , w h e n y o u translate f r o m right to
left, the right facets must be capable of closing f o r that m o t i o n to occur.
Since the right facets are free a n d able to c l o s e , y o u can easily translate
f r o m right to left. In o r d e r f o r y o u to be able to translate C3 f r o m left to
right, the left facets must be capable of closing. But since they are fixed
o p e n , they c a n n o t close, a n d h e n c e y o u c a n n o t translate C3 f r o m left to
right. Y o u feel the m o t i o n restriction on the left, because the left facets
will n o t c l o s e , b e c a u s e they are f i x e d o p e n . Y o u d o n o t feel the m o t i o n
restriction on the right, because the right facets are able to close to per-
mit translation f r o m right to left.
After translating the necks of a n u m b e r of p e o p l e , y o u may n o t i c e a
rather c o m m o n o c c u r r e n c e , i n w h i c h y o u m e e t a m o t i o n restriction o n
the same side in b o t h forward and backward b e n d i n g . For e x a m p l e , sup-
p o s e y o u f i n d that y o u can translate C 4 f r o m left t o right b u t n o t f r o m
right to left in b o t h forward and backward b e n d i n g . W h e n y o u discover
a case like this w h e r e the m o t i o n restriction is on the right in b o t h for-
ward a n d backward b e n d i n g , it m e a n s that the facets on b o t h sides are
fixed. T h e left facets are fixed c l o s e d a n d the right facets are fixed o p e n .
If y o u d e t e c t a m o t i o n restriction on the left in b o t h f o r w a r d a n d back
b e n d i n g , it m e a n s that the right facets are fixed c l o s e d and the left facets
are f i x e d o p e n .
Y o u will also e n c o u n t e r necks that exhibit m o t i o n restriction on b o t h
sides in b o t h forward a n d backward b e n d i n g . Bilateral m o t i o n restriction
can be the result of arthritis or s o m e t h i n g simple, like rigid tight muscles
a n d fasciae. In the latter case, y o u must release these myofascial restric-
tions first.
W h e n y o u are first learning h o w to m o t i o n test the neck for facet restric-
tions, do n o t c o n f u s e yourself by trying to elucidate the logic of the test.
Just learn to feel f o r m o t i o n restrictions and use the simple rules provided
to d e d u c e the facet restriction. Unlike the forward and backward b e n d -
i n g tests f o r the thoracics a n d lumbars, cervical translation involves n o t
only s i d e b e n d i n g , rotation, forward b e n d i n g , and backward b e n d i n g , but
also left a n d right translation. Trying to understand the results of the test
58
while attempting to r e m e m b e r all these c o n d i t i o n s can b e c o m e very c o m -

plicated. So h e r e are the simple rules f o r C 2 - C 7 :
If translation reveals a motion restriction in backward bending, then

the facets are fixed open on the same side as the motion restriction.
If translation reveals a motion restriction in forward bending, then the
facets are fixed closed on the side opposite to the motion restriction.
As with the o t h e r rules p r o v i d e d , y o u can r e f o r m u l a t e these any way
that suits y o u r understanding. If y o u m e m o r i z e these rules or k e e p a c o p y
where y o u can see t h e m , y o u will save yourself a lot of grief as y o u w o r k
with y o u r clients. If y o u are like m o s t therapists, y o u do n o t want to try to
think y o u r way t h r o u g h the l o g i c of these tests while y o u are a p p l y i n g
t h e m — y o u just want to apply the tests so that y o u can quickly d e t e r m i n e
which facets are fixed.
If y o u have b e e n practicing the s h o t g u n t e c h n i q u e s f r o m C h a p t e r 3
that c h a l l e n g e cervical facet restrictions, then y o u already k n o w h o w to
release them. T h e translation test gives you the a d d e d ability to locate m o r e
precisely w h e r e a n d h o w the facet is restricted. T h e translation test has
another great advantage. As previously n o t e d , if y o u r only way of k n o w i n g
whether a cervical facet restriction has b e e n released is the a p p e a r a n c e of
d e r o t a t i o n , then y o u do n o t have a fully reliable indicator. Translation
gives y o u a far m o r e accurate way to d e t e r m i n e whether the facet has b e e n
released than c h e c k i n g f o r derotation.
As y o u practice these techniques, allow yourself the f r e e d o m to let the
client's b o d y tell y o u h o w it wants to release itself. W h e n y o u rotate a n d
s i d e b e n d the h e a d a n d n e c k to c h a l l e n g e a facet restriction, s o m e t i m e s
the b o d y wants to rotate and sidebend to the opposite side before it releases.
Be p r e p a r e d to follow the d a n c e of the tissues, even if it m e a n s f o l l o w i n g
the b o d y into seemingly o d d positions. Learn to easily shift f r o m direct to
indirect techniques and back again as the b o d y d e m a n d s . W h e n y o u b e g i n
with challenging a facet restriction, wait to see h o w the b o d y r e s p o n d s to
y o u r invitation. T h e h e a d a n d n e c k may want to rotate a n d s i d e b e n d to
the side o p p o s i t e to h o w y o u are h o l d i n g t h e m . T h e y may want to go into
flexion and then extension as they s i d e b e n d a n d rotate this way a n d that
until they finally release. Or the facets may simply go directly into a release
59
in the direction y o u are e n c o u r a g i n g it to g o .

Always c h e c k the results of y o u r work. After y o u have a p p l i e d a tech-
n i q u e , translate the cervical vertebra again to make sure y o u released the
facet restriction completely. D o n ' t be surprised if y o u have to apply the
t e c h n i q u e a few times b e f o r e the facets release to y o u r satisfaction. Unlike
the t e c h n i q u e s y o u l e a r n e d f o r releasing the rest of the spine, the cervi-
cal vertebrae s o m e t i m e s require a few applications of the t e c h n i q u e until
the facets release.
In the n e x t c h a p t e r y o u will learn h o w to release atlas-on-axis restric-
tions a n d occiput-on-atlas restrictions.
60
CHAPTER
The Atlas and Occiput
O C O M P L E T E Y O U R U N D E R S T A N D I N G O F T H E NECK Y O U NEED T O K N O W
h o w to release atlas on axis (AA) restrictions a n d o c c i p u t on atlas

( O A ) restrictions. T h e t e c h n i q u e s are similar t o w h a t y o u have
already learned and are very easy to apply.
Ninety p e r c e n t of n o r m a l atias m o t i o n on the axis is rotation. T h e r e is
some sidebending, but from a clinical standpoint it is n o t important e n o u g h
to w o r r y about. W h e n the atlas gets in t r o u b l e , it is d u e to restricted rota-
tion. Y o u can d e t e r m i n e w h e t h e r C I i s r o t a t e d o n C 2 b y p a l p a t i n g f o r
whether o n e TP is anterior a n d the o t h e r is posterior, b u t in m a n y necks
CI rotation is sometimes difficult to feel. Besides, sometimes the atlas can
be slightly rotated and show no restricted facets. In general, the m o s t reli-
able way to d e t e r m i n e dysfunction is by using a simple m o t i o n test.
Begin with y o u r client in a s u p i n e p o s i t i o n on y o u r treatment table.
Grasp his h e a d with b o t h h a n d s a n d flex the cervical s p i n e so that the
h e a d is lifted up a b o u t 45 degrees. Positioning the cervical spine in this
way locks C 2 - C 7 and forces the atlas to rotate with the o c c i p u t . Maintain
the cervical spine in this position a n d rotate y o u r client's h e a d to the left
and then to the right (Figures 6.1 and 6.2, page 6 2 ) . If CI is n o t restricted
on C 2 , then y o u will be able to easily a n d obviously rotate his h e a d freely
to each side. If the atlas rotation is restricted, y o u will be able to rotate his
h e a d easily in o n e d i r e c t i o n , b u t n o t as far in the o t h e r . So if his h e a d
rotates to the right a n d n o t as well to the left, CI is r i g h t r o t a t e d a n d
61
Figure 6.1
Figure 6.2
62
THE ATLAS AND OCCIPUT
restricted in left rotation. If his h e a d rotates better to the left than the
right, then the atlas is left rotated a n d restricted in right rotation.
Releasing the atlas is easy: k e e p y o u r client's h e a d in 45 d e g r e e s flex-
ion and rotate it in the direction it is restricted. If the test shows y o u that
the atlas is left rotated, turn his h e a d to the right as far as it can c o m f o r t -
ably g o . Place y o u r right i n d e x a n d / o r m i d d l e fingers o n the p o s t e r i o r
arch of the adas close to the posterior surface of the right transverse process
(Figure 6.3, page 64) and let the full weight of his h e a d rest on y o u r fin-
gers (Figure 6.4). Make sure y o u d o n o t place y o u r f i n g e r s o n the tip o f
the right transverse process of the atlas. N o t only will this t e c h n i q u e n o t
work with this finger p l a c e m e n t , it will also create unnecessary pain f o r
y o u r client. Just let his weight rest on y o u r fingers while y o u wait f o r the
release. Y o u will feel all the familiar indications of release as his h e a d an
atlas b e g i n to slowly rotate m o r e a n d m o r e to the right. Y o u can either
wait for the tissues to release or e n c o u r a g e the release by gently turning
a n d / o r j i g g l i n g his h e a d to the right. Retest to m a k e sure y o u have c o m -
pletely released the rotation restriction. It may take m o r e than o n e appli-
cation of this t e c h n i q u e to c o m p l e t e l y release the atlas.
Restrictions o f the o c c i p u t o n the atlas are very c o m m o n a n d i f n o t
released these restrictions will c o m e back to haunt you. T h e m o s t sterling
and p r o f o u n d releases o f the C 1 - C 7 o f t e n will n o t relieve y o u r client's
pain if you do n o t address the influence of the o c c i p u t . S o m e t i m e s an OA
restriction is e n o u g h to reestablish an AA restriction e v e n after the AA
restriction has b e e n r e l e a s e d . A n d o v e r time t h o s e restrictions c a n b e
r e s p o n s i b l e f o r o t h e r restrictions s h o w i n g u p t h r o u g h o u t y o u r client's
spine.
W h e t h e r n o r m a l o r a b n o r m a l , i n b o t h forward o r backward b e n d i n g ,
all m o d o n of the o c c i p u t on the atlas is Type I. T h e r e are no discs between
the o c c i p u t and the atlas, and the j o i n t s do n o t o p e n and close in forward
and backward b e n d i n g the way they do in the rest of the spine. Rather the
c o n v e x condyles o f the o c c i p u t glide posteriorly o n the s u p e r i o r c o n c a v e
facets of the atlas when you forward b e n d and glide anteriorly on the adas
when you backward b e n d . W h e n y o u s i d e b e n d t o the right, f o r e x a m p l e ,
the right c o n d y l e will slide inferiorly on a facet of the atlas a n d the left
condyle will slide superiorly. If y o u find an OA restriction, y o u can say that
the o c c i p u t is fixed in extension ( o r backward b e n d i n g ) or in flexion ( o r
63
Figure 6.3
Figure 6.4
64
forward b e n d i n g ) . Since the c o n d y l e s d o n o t o p e n a n d close i n f o r w a r d

and backward b e n d i n g , y o u c a n n o t say that they are fixed c l o s e d or fixed
open.
You can reliably test f o r restrictions of the o c c i p u t on the atlas by using
the lateral translation test. If y o u m e e t a restriction while translating in
forward b e n d i n g , it m e a n s that the occipital c o n d y l e c a n n o t glide p o s t e -
riorly because it is fixed anteriorly, in e x t e n s i o n , or back b e n d i n g . If y o u
m e e t a m o t i o n restriction while translating in backward b e n d i n g it m e a n s
that the occipital c o n d y l e c a n n o t glide anteriorly because it is fixed p o s -
teriorly, in flexion, or forward b e n d i n g .
You can easily and quickly release OA restrictions by using a t e c h n i q u e
that is almost the same as the o n e you learned f o r releasing the atlas. T h e
only difference between the two techniques is where y o u place your fingers.
To locate the restriction, translate y o u r client's h e a d f r o m right to left
and f r o m left t o right i n b o t h f l e x i o n a n d e x t e n s i o n . S u p p o s e y o u f i n d
that y o u can translate y o u r client's o c c i p u t f r o m left to right b u t n o t f r o m
right to left in forward b e n d i n g . Since translation i n t r o d u c e s s i d e b e n d -
ing and y o u are testing in forward b e n d i n g , finding a m o t i o n restriction
on the right means that his o c c i p u t is left s i d e b e n t a n d right rotated a n d
f i x e d i n e x t e n s i o n , o r backward b e n d i n g . T o release this b a c k - b e n d i n g
restriction, k e e p his h e a d a n d n e c k in the f o r w a r d - b e n d i n g p o s i t i o n to
challenge the facet restriction. S i d e b e n d a n d rotate h i m in the d i r e c t i o n
he c a n n o t s i d e b e n d , w h i c h in this case is to the right. Place y o u r right
i n d e x and m i d d l e f i n g e r s o n the base o f the o c c i p u t near the right o c c i p -
ital c o n d l y e and let the full weight of his h e a d rest on y o u r fingers (Fig-
ure 6.5, page 6 6 ) . Again, either just wait f o r the release or e n c o u r a g e the
release b y gently t u r n i n g , s i d e b e n d i n g a n d / o r j i g g l i n g his h e a d t o the
right. You will feel the tissues soften while his h e a d slowly s i d e b e n d s a n d
turns right. Retest to make sure y o u released the restriction completely.
T h e test and t e c h n i q u e are basically the same in the backward b e n d -
ing p o s i t i o n . Backward b e n d y o u r client's h e a d a n d n e c k a n d translate
the o c c i p u t b o t h ways. If his h e a d translates easily f r o m right to left b u t
n o t f r o m left to right, then y o u k n o w that the o c c i p u t is right s i d e b e n t ,
left rotated, and fixed in flexion or forward b e n d i n g . To release this for-
ward-bending restriction, k e e p his h e a d in a back b e n d i n g position a n d
s i d e b e n d a n d turn it to the left while resting the base of the o c c i p u t —
65
Figure 6.5
n e a r the left occipital c o n d y l e — o n y o u r left i n d e x a n d m i d d l e fingers.

Again, just wait f o r the release or e n c o u r a g e the release by gently turning
a n d / o r j i g g l i n g the h e a d m o r e to the left. Y o u will feel the tissues soften
as his h e a d s i d e b e n d s a n d turns left. Be sure to retest y o u r results a n d
d o n ' t b e surprised i f i t takes m o r e than o n e a p p l i c a t i o n t o adequately
release O A restrictions.
D e s c r i b i n g the b i o m e c h a n i c s o f O A restrictions can b e c o m p l i c a t e d ,
but testing f o r and releasing them, as y o u have discovered, is fairly straight-
forward. If translation reveals a m o d o n restriction in forward or backward
b e n d i n g , y o u s i d e b e n d a n d turn the h e a d in the direction it w o n ' t trans-
late, which is the direction in which it c a n n o t s i d e b e n d . K e e p the head in
either f o r w a r d o r backward b e n d i n g , d e p e n d i n g o n which position y o u
find the m o t i o n restriction, a n d apply pressure a c c o r d i n g l y — t h a t ' s all
there is to it.
Y o u may be t e m p t e d to formulate a rule f o r yourself like the following:
when y o u translate the o c c i p u t on the atlas in forward and backward b e n d -
ing the side on which y o u m e e t the m o t i o n restriction is the side on which
the facet restriction is f o u n d . T h e t e c h n i q u e actually works as if this rule
66
were correct, b u t it's not. W h e n y o u m e e t a m o t i o n restriction in forward

b e n d i n g the facet restriction is on the side o p p o s i t e the m o t i o n restric-
tion. In backward b e n d i n g the facet restriction is on the same side as the
m o t i o n restriction. In backward b e n d i n g it makes g o o d clinical sense to
both turn y o u r client's h e a d in the direction of the m o t i o n restriction a n d
apply y o u r pressure to the side of the m o t i o n restriction. But in forward
b e n d i n g , since the facet restriction is on the side o p p o s i t e the m o t i o n
restriction, although it makes g o o d sense to turn y o u r client's h e a d in the
direction of the m o t i o n restriction, it d o e s n ' t s e e m sensible to apply y o u r
pressure to the side of the m o t i o n restriction. Y o u w o u l d think it w o u l d
be m o r e effective to apply y o u r pressure to the side o p p o s i t e the m o t i o n
restriction. Interestingly, the t e c h n i q u e works quite well in forward b e n d -
ing, but I d o n ' t k n o w exactly why it d o e s . I c o u l d speculate a b o u t why and
h o w it works, b u t I am n o t sure that w o u l d further y o u r technical skills.
Instead let's l o o k at why the rule is n o t c o r r e c t a n d try to c o m e up with a
rule that reflects the specifics of what is actually g o i n g on a n d that will
allow y o u to be m o r e specific in h o w y o u apply the t e c h n i q u e .
W h e n y o u b a c k b e n d a n d translate the o c c i p u t o n the atlas, y o u are
testing f o r whether the occipital condyles can glide anteriorly. If y o u find
a m o t i o n restriction it m e a n s that o n e of c o n d y l e s is f i x e d posteriorly.
W h e n you forward b e n d and translate the o c c i p u t , y o u are trying to deter-
m i n e whether the condyles can glide posteriorly. Finding a m o t i o n restric-
tion indicates that o n e of the c o n d y l e s is fixed anteriorly. To f o r m u l a t e
the c o r r e c t rule we n e e d to k n o w h o w to d e d u c e the fixed c o n d y l e f r o m
a m o t i o n restriction.
S u p p o s e y o u translate y o u r client's o c c i p u t in b a c k b e n d i n g a n d dis-
c o v e r that it can translate f r o m left to right, b u t n o t f r o m right to left.
Since y o u k n o w that the o c c i p u t always s i d e b e n d s a n d rotates to o p p o s i t e
sides, the discovery of this m o t i o n restriction tells y o u that the o c c i p u t is
left sidebent and right rotated. In back b e n d i n g , since translation tests f o r
the ability of the condyles to glide anteriorly, if y o u m e e t a m o t i o n restric-
tion you also k n o w that o n e of the c o n d y l e s is fixed in flexion or forward
b e n d i n g . If it is fixed in flexion or forward b e n d i n g , then it is fixed p o s -
teriorly. Y o u n o w have all the i n f o r m a t i o n y o u n e e d to figure o u t the side
on which the condyle is fixed. If the o c c i p u t is right rotated, then the right
side of the o c c i p u t is p o s t e r i o r a n d the left side is anterior. If it is fixed
67
posteriorly a n d right rotated, the posterior fixation must be on the right.

W h y d o e s it w o r k this way? In b a c k b e n d i n g , translation of the o c c i p u t
r e q u i r e s that the o c c i p i t a l c o n d y l e s g l i d e anteriorly. W h e n y o u m e e t a
m o t i o n restriction translating right to left it means that the right c o n d y l e
is fixed posteriorly a n d will n o t p e r m i t anterior glide. Y o u can translate
the o t h e r way, f r o m left to right, because the left c o n d y l e is n o t fixed and
will p e r m i t anterior glide. Since the right c o n d y l e is fixed posteriorly, left
s i d e b e n t , a n d right r o t a t e d , w h e n y o u translate f r o m left t o right, the
occiput sidebends left and rotates right. As a result, the left occipital condyle
glides anteriorly a n d s i d e b e n d s left, while the right side of the o c c i p u t
slides posteriorly, in the direction it is already rotated and posteriorly fixed.
So when y o u translate the occiput in back bending, you will feel the motion
restriction on the same side as the facet restriction.
N o w s u p p o s e y o u translate y o u r client's o c c i p u t i n f o r w a r d b e n d i n g
a n d m e e t a m o t i o n restriction g o i n g f r o m right to left, but n o t f r o m left
to right. T h e facet restriction is on the left, the side opposite to the m o t i o n
restriction. But h o w d o y o u g e t t o this c o n c l u s i o n ? Finding the m o t i o n
restriction on the right tells y o u that the o c c i p u t is left s i d e b e n t , right
rotated, and that o n e of the condyles is fixed anteriorly because it is unable
to glide posteriorly. O n c e y o u k n o w that the o c c i p u t is right rotated and
o n e c o n d y l e is fixed anteriorly, y o u k n o w that the anteriorly fixed condyle
has to be on the left. If the o c c i p u t is right rotated, it is posterior on the
right a n d anterior on the left. Since translation revealed that a c o n d y l e is
fixed anteriorly, y o u k n o w that the fixation must be on the left.
Y o u can p r o b a b l y figure o u t yourself why it works this way in forward
b e n d i n g , b u t let's go t h r o u g h the l o g i c of it. In o r d e r f o r the o c c i p u t to
translate b o t h ways, the condyles must be capable of gliding anteriorly. In
the a b o v e e x a m p l e , the m o t i o n restriction i s o n the right. T h e o c c i p u t
can translate f r o m left to right b e c a u s e it is c a p a b l e of s i d e b e n d i n g left
while the left c o n d y l e glides anteriorly. As the left c o n d y l e glides anteri-
orly the occiput rotates right. Since the right condyle is already right rotated
a n d posterior, it can glide in that direction. But in o r d e r f o r y o u to trans-
late the o c c i p u t f r o m right to left, the left c o n d y l e must be capable of glid-
ing posteriorly. Since the left c o n d y l e is fixed anteriorly, it will n o t permit
translation a n d y o u will feel the m o t i o n restriction on the right.
Y o u can use the "as if r u l e " a n d simply turn y o u r client's h e a d in the
68
direction of the m o t i o n restriction a n d apply pressure to that side in b o t h

forward and backward b e n d i n g to very effectively release the gliding fix-
ations of the occipital condyles. Or y o u can be m o r e specific in y o u r tech-
n i q u e n o w that y o u k n o w w h e r e the gliding fixations are to be f o u n d in
flexion and extension. T h e rules are: in forward b e n d i n g the anteriorly
fixed condyle is on the side opposite to the m o t i o n restriction and in back-
ward b e n d i n g the p o s t e r i o r l y fixed c o n d y l e is on the s a m e side as the
m o t i o n restriction.
If y o u find a m o t i o n restriction in backward b e n d i n g , j u s t apply the
technique outlined above. If you find a m o t i o n restriction in forward b e n d -
ing y o u can vary y o u r t e c h n i q u e to directly address the posteriorly fixed
c o n d y l e . S u p p o s e y o u find a m o t i o n restriction in forward b e n d i n g while
translating f r o m left to right b u t n o t f r o m right to left. T h e right c o n d y l e
is fixed anteriorly and the o c c i p u t c a n n o t s i d e b e n d to the left. H o l d y o u r
client's h e a d in f o r w a r d b e n d i n g , a n d s i d e b e n d a n d rotate it to the left
with y o u r left h a n d . Place y o u r right i n d e x a n d / o r m i d d l e f i n g e r s near
the right anteriorly fixed c o n d y l e a n d apply pressure in a p o s t e r i o r supe-
rior direction as if y o u were trying to pry the right c o n d y l e f r o m its ante-
riorly fixed position (Figure 6.6, p a g e 7 0 ) . Or try laying the radial e d g e
of y o u r left i n d e x finger a l o n g the base of the o c c i p u t a n d place the tip
of your right t h u m b into the area near the right anteriorly fixed c o n d y l e .
Apply pressure with y o u r t h u m b in a posterior superior d i r e c t i o n as y o u
s i d e b e n d a n d rotate y o u r client's h e a d to the left (Figure 6 . 7 ) . Y o u are
c h a l l e n g i n g the facet restriction by t u r n i n g y o u r client's h e a d left a n d
applying pressure with y o u r right fingers or t h u m b . T u r n i n g y o u r client's
head left e n c o u r a g e s left s i d e b e n d i n g a n d right rotation a n d h e n c e p o s -
terior glide. Meanwhile, the fingers or t h u m b of y o u r right h a n d are clear-
ing the restrictions so that p o s t e r i o r glide can actually o c c u r . As always,
just wait f o r the release, or e n c o u r a g e it a little by gently turning a n d / o r
j i g g l i n g the h e a d m o r e to the left. D o n ' t f o r g e t to f o l l o w the d a n c e a n d
always c h e c k y o u r results by retesting.
In the next chapter we will turn o u r attention to the o t h e r e n d of the

spine and l o o k at the b i o m e c h a n i c s of the sacrum and h o w to release it
f r o m its restrictions.
69
Figure 6.6
Figure 6.7
70
CHAPTER
The Sacrum
HE SACROILIAC J O I N T IS INFAMOUS IN ITS R E P U T A T I O N FOR CAUSING
pain to featherless bipeds. Given the e n o r m o u s a m o u n t of discomfort

and pain that is associated with this joint, it is very curious that the
w o r d " s a c r u m " means "the sacred b o n e . "
T h e sacroiliac (SI) j o i n t is f o r m e d by the articulation of the pelvis a n d
the sacrum. Dysfunction of this j o i n t can result f r o m h o w the pelvis impacts
on the s a c r u m or h o w the s a c r u m impacts on the pelvis. If the pelvis is
responsible f o r a fixed SI j o i n t , then it is called a iliosacral dysfunction. If
the sacrum is responsible, then it is called a sacroiliac dysfunction. In this
c h a p t e r y o u will learn h o w to r e c o g n i z e a n d m a n i p u l a t e sacroiliac dys-
functions a n d in the n e x t y o u will learn a b o u t h o w to deal with iliosacral
dysfunctions.
A c c o r d i n g to s o m e experts the sacrum is capable of 14 different types
o f m o t i o n . D e s c r i b i n g all o f these m o t i o n s can b e very interesting, b u t
s o m e w h a t tedious unless y o u j u s t h a p p e n to love such activities. My a p -
proach in this chapter is to provide a series of quick and easy ways to release
the sacrum without first l o a d i n g y o u d o w n with c o m p l i c a t e d b i o m e c h a n -
ical explanations. We will start o u r e x p l o r a t i o n of the s a c r u m with o n l y
the simplest of b i o m e c h a n i c a l descriptions so that y o u can b e g i n practic-
ing techniques f o r releasing the sacrum right away. After y o u r h a n d s are
familiar with h o w the sacrum works, y o u will learn a m o r e t h o r o u g h ap-
p r o a c h to the b i o m e c h a n i c s .
71
Sacral Motion
W H E N Y O U F O R W A R D B E N D , Y O U R SACRAL BASE MOVES IN A POSTERIOR
a n d slighdy s u p e r i o r d i r e c d o n . W h e n y o u b a c k b e n d y o u r sacral
base m o v e s in the o p p o s i t e direction, anteriorly and inferiorly. This ante-
rior and posterior m o v e m e n t of the sacrum occurs a l o n g a transverse axis
that runs t h r o u g h S2. T h e anterior a n d posterior m o v e m e n t of the sacral
base is called nutation and counternutation, but I will use the simpler des-
ignations of anterior nutation a n d p o s t e r i o r nutation w h e n referring to
this m o t i o n . T h e w o r d "nutation" m e a n s " n o d d i n g . "
To find the sacral base on y o u r client, first locate the spinous process
of L 4 . Begin with y o u r client seated in neutral position. With o n e of y o u r
fingers trace an imaginary horizontal line f r o m the crest of the ilium to
the spine. T h e s p i n o u s process y o u r finger lands on b e l o n g s to L4 (Fig-
u r e 7.1). C o u n t d o w n t o the s p i n o u s p r o c e s s o f L 5 a n d then o n e m o r e
n o t c h to the sacral base. Or find the sacral base by finding the sacral sul-
cus (Figure 7.2). T h e sacral sulcus are vertical grooves that y o u r thumbs
will sink i n t o if y o u roll t h e m just medially o f f the posterior superior iliac
spines (PSIS). Place y o u r right t h u m b on the right sacral base or sulcus
a n d y o u r left t h u m b on the left sacral base or sulcus. Ask y o u r client to
forward and backward b e n d while you m o n i t o r h o w the sacral base nutates
posteriorly in forward b e n d i n g a n d anteriorly in backward b e n d i n g .
Iliac crests at
level of L4
Sacral sulcus Sacral base
Median sacral crest
PSIS
Inferior lateral
angle
Ischial tuberosity
Figure 7.1
72
THE SACRUM
Figure 7.2
Figure 7.3
73
It is useful to be able to feel sacral m o t i o n in a n u m b e r of positions so

y o u can d o u b l e c h e c k y o u r results. So ask y o u r client to lay in a p r o n e posi-
tion on y o u r treatment table. Again place y o u r thumbs on the sacral base.
Ask y o u r client to raise himself up and p r o p himself on his elbows as illus-
trated in Figure 7.3, p a g e 73, while y o u feel f o r w h e t h e r the sacral base
moves anteriorly. Ask y o u r client to lie back d o w n and to then tilt his pelvis
posteriorly. This action will a c c o m p l i s h the same results as forward b e n d -
ing. Since m o s t p e o p l e do n o t understand what tilting their pelvis poste-
riorly means, y o u m i g h t suggest that he turn his pelvis u n d e r as if to slowly
thrust his p u b i c area forward toward the surface of the table. As he tilts his
pelvis posteriorly, feel for whether the sacral base nutates posteriorly. If you
do n o t feel the sacral base nutate either posteriorly or anteriorly, y o u have
discovered a bilateral sacral fixation. Either the sacral base is fixed in bilat-
eral posterior nutation or bilateral anterior nutation.
Sacrums are also capable of s i d e b e n d i n g and rotating. If there are no
j o i n t fixations, then this is what y o u r sacrum d o e s in walking as you shift
y o u r weight f r o m o n e leg to the other. Most experts agree that the sacrum
only exhibits Type I m o t i o n and that sidebending and rotadon are c o u p l e d
to o p p o s i t e sides. S i d e b e n d i n g and rotation of the sacrum are also called
torsion. Rotation and torsion of the sacrum are n a m e d the same as rotadon
of the vertebrae. If the right sacral base is posterior, then the sacrum is right
rotated or right torsioned (and left sidebent). If the left sacral base is pos-
terior, then the sacrum is left rotated or left torsioned (and right sidebent).
It is m o r e accurate b u t also m o r e c o m p l i c a t e d to d e s c r i b e rotation and
s i d e b e n d i n g in terms of torsion but let's leave these complexifies for later.
If the sacral base is right rotated in neutral position then it is probably
dysfunctional a n d h e n c e the j o i n t is fixed in s o m e way. Either the right
sacral base is fixed in posterior nutation or the left sacral base in fixed in
anterior nutation, b u t h o w do y o u d e t e r m i n e which side is the fixed side?
Forward and backward b e n d your client and watch h o w each side behaves.
W h e n y o u r client f o r w a r d a n d backward b e n d s , if the rotation of his
sacrum appears to go away in forward b e n d i n g and gets worse in backward
b e n d i n g , then y o u k n o w that the right side of his sacrum is fixed posteri-
orly. T h e right side of the sacrum b e c o m e s a fixed p o i n t a r o u n d which the
sacrum is f o r c e d to turn in forward and backward bending. Since his sacral
base is fixed posteriorly, it c a n n o t m o v e anteriorly in backward b e n d i n g .
74
THE SACRUM
So in backward b e n d i n g his right sacral base stays w h e r e it is, posteriorly

fixed, while his left sacral base moves further in an anterior direction thereby
making it appear that the sacral rotation has w o r s e n e d . In forward b e n d -
ing his right sacral base again stays w h e r e it is, while his left sacral base
moves posteriorly, making it appear that the rotation has disappeared.
What happens if y o u r client's sacrum is right rotated, left sidebent, and
the left sacral base is fixed anteriorly? His left sacral base in this case will
be the fixed pivot p o i n t a r o u n d w h i c h his s a c r u m turns in f o r w a r d a n d
backward b e n d i n g . W h e n y o u r client f o r w a r d b e n d s , his left sacral base
stays fixed anteriorly a n d his right sacral base m o v e s further in a p o s t e -
rior direction and as a result the rotation seems to worsen. W h e n y o u back
b e n d y o u r client, again his left sacral base r e m a i n s fixed in its a n t e r i o r
position, but this time his right sacral base moves in an anterior direction,
making it s e e m like the rotation disappears.
Thus, when y o u find a rotated sacrum, y o u can create a simple rule f o r
d e t e r m i n i n g which side is fixed. If sacral rotation b e c o m e s m o r e e x t r e m e
in back b e n d i n g , then the side to which the sacrum is rotated is fixed p o s -
teriorly. If sacral rotation seems to disappear in b a c k b e n d i n g , then the
side o p p o s i t e to the rotation is fixed anteriorly. Y o u can state the rule dif-
ferently if y o u wish. I c h o o s e to state the rule solely in terms of back b e n d -
ing because so often my evaluation of sacral dysfunction takes place with
my client in a p r o n e position on my treatment table. Rather than asking
the client to get o f f the table a n d sit on the e x a m i n a t i o n stool, it is usu-
ally m u c h m o r e c o n v e n i e n t a n d easier to read sacral rotation with h i m in
the p r o n e position. For the sake of practice, however, y o u s h o u l d learn to
test the sacrum in b o t h the p r o n e a n d seated positions.
In any case, there are always a n u m b e r of ways to state these rules. H e r e
is a n o t h e r possibility y o u m i g h t prefer: if the rotation disappears in b a c k
b e n d i n g , then the sacrum is fixed anteriorly on the side o p p o s i t e its rota-
tion, and if the rotation disappears in forward b e n d i n g , then the sacrum
is fixed posteriorly on the side to w h i c h it is rotated.
Techniques
F PALPATION REVEALS T H A T T H E S A C R U M IS R O T A T E D , Y O U CAN USE A
simple indirect technique to derotate it. Recall the first indirect technique
75
that y o u l e a r n e d in C h a p t e r O n e to derotate vertebrae: it can be applied

in the same way to the sacrum. With your client in either a seated or p r o n e
p o s i t i o n , place y o u r thumbs on e a c h side of the sacral base. If his sacrum
is left rotated, the left sacral base will be posterior and the right sacral base
will be anterior. Push the sacrum further into rotation by increasing the
pressure of y o u r right t h u m b , wait, f o l l o w the d a n c e , and let the sacrum
derotate itself.
As y o u already know, this sort of indirect t e c h n i q u e d o e s n o t challenge
the facet restriction. As a result, it tends to be a less effective way to release
fixations. B e f o r e y o u can c h a l l e n g e a j o i n t fixation, y o u must k n o w the
l o c a t i o n of the fixation a n d w h e t h e r it is fixed anteriorly or posteriorly.
Do this by using the forward and backward b e n d i n g test in o r d e r to deter-
m i n e w h e t h e r o n e side is fixed anteriorly or posteriorly.
If the sacrum is right rotated a n d fixed posteriorly on the right, back
b e n d y o u r client to e n c o u r a g e the right side of his sacrum to m o v e ante-
riorly a n d apply several p o u n d s of pressure to his right sacral base in an
anterior a n d slightly inferior d i r e c t i o n . Wait f o r the d a n c e of the tissues
a n d f o r the release. Y o u can apply this t e c h n i q u e with y o u r client in a
seated position (Figure 7.3), o r with y o u r client p r o n e p r o p p e d u p , and
resting on his elbows as a way to back b e n d a n d c h a l l e n g e the posteriorly
fixed side (Figure 7.4).
If his sacrum is right rotated a n d fixed anteriorly on the left, forward
b e n d y o u r client to e n c o u r a g e the left side of the sacrum to m o v e poste-
riorly. Apply several p o u n d s of pressure to his left base in an inferior direc-
tion with your t h u m b . With your other t h u m b , push the right base, or push
further d o w n on the right side, in an anterior direction, as if y o u were try-
ing to lever the left side free by pushing on the right. Wait for the d a n c e
a n d the release. Y o u can use this t e c h n i q u e with y o u r client in a seated
position (Figure 7.5, page 78) or p r o n e . In the p r o n e position place a d o u -
b l e d - u p p i l l o w u n d e r y o u r client's a b d o m e n t o f o r w a r d b e n d and chal-
l e n g e the anteriorly fixed side and then apply y o u r pressure (Figure 7.6).
If y o u r evaluation of the sacrum reveals that it is bilaterally fixed in pos-
terior nutation, then b a c k b e n d y o u r client to challenge the bilateral fix-
ation a n d equally apply several p o u n d s of pressure with y o u r thumbs to
e a c h side of his sacral base (Figure 7.7). A p p l y y o u r pressure in an ante-
rior a n d slightly inferior direction and wait f o r the d a n c e and the release.
76
THE SACRUM
Y o u can of c o u r s e use this t e c h n i q u e

with y o u r client in either a seated or
p r o n e position.
If the sacrum is bilaterally fixed in
anterior nutation, forward b e n d y o u r
client to c h a l l e n g e the bilateral fixa-
tion and equally apply several p o u n d s
of pressure to b o t h sides of his sacral
base in an inferior d i r e c t i o n (Figure
7.8, p a g e 7 9 ) . Wait f o r the d a n c e a n d
f o r the release. A g a i n y o u c a n apply
this t e c h n i q u e in either the seated or
p r o n e position. If y o u elect to release
a s a c r u m f i x e d in bilateral a n t e r i o r
n u t a t i o n , use a d o u b l e d - u p p i l l o w
u n d e r your client's a b d o m e n to en-
Figure 7.3 c o u r a g e p o s t e r i o r nutation.
Figure 7.4
77
Figures 7.5
Figure 7.6
78
THE SACRUM
Figures 7.7
Figure 7.8
79
LR RSB RR LSB
Left torsion (or rotation) on Right axis Right torsion (or rotation) on Right axis
Sacral Torsion
O U N O W HAVE E N O U G H I N F O R M A T I O N A N D T E C H N I Q U E S T O RELEASE
I m o s t sacral dysfunctions. T h e r e is a n o t h e r kind of sacral dysfunction

that involves a sacral shear, b u t b e f o r e we e x p l o r e this, let's e x p a n d o u r
u n d e r s t a n d i n g of sacral torsion. To s o m e d e g r e e y o u already k n o w what
sacral torsion is, because I introduced it as rotation and sidebending. Intro-
d u c i n g torsion as a n o t h e r way to talk a b o u t sacral rotation and sidebend-
i n g will n o t require learning any new techniques. T h e techniques remain
the s a m e — o n l y the language changes. Y o u m i g h t be t e m p t e d to skip this
discussion, b u t I r e c o m m e n d that y o u persist because it will h e l p y o u to
b e c o m e a m o r e effective therapist.
S i d e b e n d i n g a n d r o t a t i o n o f the s a c r u m are c a l l e d " t o r s i o n " w h i c h
o c c u r s a r o u n d either right or left o b l i q u e axis. T h e c o n v e n t i o n states that
the left o b l i q u e axis runs f r o m the superior aspect of the left articulation
of the sacrum on the ilium to the right inferior aspect of the sacrum where
it articulates with the right ilium a n d the right o b l i q u e axis runs f r o m the
superior aspect of the right articulation of the sacrum on the ilium to the
left inferior aspect of the sacrum w h e r e it articulates with the left ilium.
T h e right a n d left o b l i q u e axes a n d varieties of torsion are shown in
Figures 7.9, 7.10, 7.11, a n d 7.12. N o t i c e that each of the f o u r kinds of tor-
80
THE SACRUM
Posterior nutatioji Anterior nutation
RR LSB LR RSB
Right torsion (or rotation) on Left axis Left torsion (or rotation) on Left axis
sion s h o w n is d e s c r i b e d in terms of the o b l i q u e axis on w h i c h it is tor-

sioned and as well as in terms of rotation a n d s i d e b e n d i n g . So, f o r e x a m -
p l e , Figure 7.12 shows a s a c r u m in left t o r s i o n on the left o b l i q u e axis
which is also designated as LR and RSB (left rotated and right s i d e b e n t ) .
Y o u can correctly say that the s a c r u m is left rotated on the left o b l i q u e
axis or left torsioned on the left axis.
P r o p e r b o d y m o v e m e n t while walking is i n f l u e n c e d by ability of the
sacrum to torsion left on the left axis a n d right on the right axis. Since
most walking is a c c o m p l i s h e d with y o u r spine relatively u p r i g h t a n d ver-
tical, f o r the p u r p o s e s of illustration we will assume that y o u r spine a n d
sacrum are in neutral while y o u walk. Y o u m i g h t want to stand and slowly
do what is a b o u t to be d e s c r i b e d h e r e so y o u can get a sense of what h a p -
pens with y o u r b o d y in n o r m a l walking.
As y o u r right leg m o v e s f r o m h e e l strike to toe off, y o u r b o d y weight
begins to m o v e over y o u r right leg, causing y o u r pelvis to shift laterally to
the right. As the m o v e m e n t c o n t i n u e s toward t o e off, y o u r right pelvic
i n n o m i n a t e b o n e b e g i n s to rotate anteriorly while y o u r left i n n o m i n a t e
begins to rotate posteriorly. As y o u r right i n n o m i n a t e rotates anteriorly,
y o u r sacrum m o v e s into right torsion on the right o b l i q u e axis (i.e., right
rotates and left sidebends b e c a u s e the left sacral base m o v e s in anterior
81
nutation). Your lumbar spine sidebends right and rotates

left, y o u r thoracic spine sidebends left and rotates right,
and y o u r cervical spine sidebends right and rotates right.
As the left leg m o v e s f r o m weight bearing to toe off, the
left i n n o m i n a t e , the sacrum, lumbars, and thoracics tor-
sion, rotate, and sidebend in an opposite manner. Notice
in Figure 7.13 h o w this same c o m p l e x pattern of pelvic
shift, sacral torsion, spinal s i d e b e n d i n g , a n d rotation is
i n t r o d u c e d as the weight of the b o d y shifts to rest on the
left leg. Walking and standing with y o u r weight over o n e
l e g i n t r o d u c e s a n d requires this k i n d o f curvature f o r
normal movement.
T h e way o u r axial c o m p l e x alternately undulates in
s i d e b e n d i n g a n d rotation as we walk is very interesting
a n d very i m p o r t a n t to o u r well-being. Its m o v e m e n t is
Figure 7.13 reminiscent of the vermicular u n d u l a t i o n of a snake as
it slithers through the grass. T h e big difference, of course,
is that o u r snake-like spine has b e e n u p - e n d e d and given two legs on which
to walk. Can y o u i m a g i n e h o w a snake w o u l d be f o r c e d to m o v e through
its w o r l d if we were to snap a n u m b e r of very tight r u b b e r b a n d s a r o u n d
its b o d y ? T h e resulting dis-ease w o u l d spread t h r o u g h its entire b u t lim-
ited e x p e r i e n c e a n d b o d y . In an a n a l o g o u s , b u t m o r e c o m p l i c a t e d way,
j o i n t fixations anywhere along o u r spine act like the r u b b e r bands a r o u n d
the snake's body. So if at the level of the sacroiliac j o i n t we e x p e r i e n c e any
fixation, w h e t h e r it is d u e to pelvis on s a c r u m or s a c r u m on pelvis dys-
functions, it can eventually cause trouble t h r o u g h o u t o u r b o d i e s .
So far I have only d e s c r i b e d neutral sacral t o r s i o n s — R on R or L on L
torsions. W h e n y o u f o r w a r d b e n d a n d s i d e b e n d y o u i n t r o d u c e n o n - n e u -
tral m e c h a n i c s i n t o y o u r sacroiliac j o i n t a n d y o u create what are called
b a c k w a r d or p o s t e r i o r t o r s i o n s . T a k e a l o o k at the d i a g r a m s (Figures
7 . 9 - 7 . 1 2 ) a n d y o u will see that in backward or p o s t e r i o r sacral torsions
the s a c r u m either torsions ( o r rotates) right on the left axis or torsions
( o r rotates) left on the right axis. N o t i c e that w h e n the sacrum torsions
R on L the right sacral base m o v e s posteriorly a n d w h e n the sacrum tor-
sions L on R the left sacral base m o v e s posteriorly.
N o w j u s t as the sacrum can torsion normally in these f o u r ways, it can
82
THE SACRUM
also g e t stuck in any o n e of these ways. So if y o u f i n d a rotated s a c r u m

when y o u r client is in neutral position, either seated or p r o n e , y o u can be
pretty sure y o u are l o o k i n g at a dysfunctional sacrum. In the n e x t c h a p -
ter on the pelvis y o u will learn a n o t h e r test to d e t e r m i n e sacral dysfunc-
tion. It is called the sitting flexion test. But f o r the time b e i n g use rotation
as y o u r guide. T h e n use the forward and back b e n d i n g tests to d e t e r m i n e
whether o n e side is fixed anteriorly or posteriorly. If y o u discover that the
sacral base is fixed anteriorly, it is dysfunctional a n d y o u have d i s c o v e r e d
what is called an anterior sacral torsion. If the sacral base is fixed p o s t e -
riorly, it is called a posterior sacral torsion. L o o k o n c e again at the draw-
ings of sacral torsion a n d n o t i c e that there are f o u r ways the sacrum can
b e c o m e dysfunctional in torsion: 1) if the sacrum is t o r s i o n e d left on the
left o b l i q u e axis (L on L) a n d the right sacral base is fixed anteriorly, 2)
if the sacrum is torsioned right on the right o b l i q u e axis (R on R) and the
left base is fixed anteriorly, 3) if the sacral base is t o r s i o n e d right on the
left o b l i q u e axis (R on L) and the right sacral base is fixed posteriorly, and
4) if the sacral base is t o r s i o n e d left on the right o b l i q u e axis (L on R)
and the left sacral base is posteriorly fixed.
Sacral Shear
T HERE IS ONE LAST TYPE OF SACRAL DYSFUNCTION T H A T Y O U S H O U L D
k n o w a b o u t , called sacral shear. Shear o c c u r s w h e n two surfaces in

contact with each o t h e r slide on each o t h e r in a direction parallel to their
plane of contact. Imagine putting two pieces of glass t o g e t h e r w h o s e sur-
faces are wet and pushing t h e m so that they slide on each other. Y o u have
just created a shear. Sacral shear is m u c h less c o m m o n than torsion a n d
its origin, as you probably guessed, is usually traumatic. Sometimes a sacral
shear can result f r o m a long-standing l u m b a r lordosis or a rotoscoliosis
in which the l u m b a r spine curves in o d d a n d u n e x p e c t e d ways.
If y o u palpate only the sacral base, y o u c a n n o t distinguish shear f r o m
torsion. You might be surprised to know, however, that the techniques y o u
just l e a r n e d f o r releasing dysfunctional sacral torsions will also, by a n d
large, release sacral shears, w h e t h e r y o u correctly distinguish t h e m f r o m
torsions o r not. S o even i f y o u d o n o t k n o w the d i f f e r e n c e b e t w e e n shear
and torsion, y o u c o u l d u n k n o w i n g l y release a sacral shear, thinking y o u
83
Figure 7.14
are releasing t o r s i o n . F o r the m o s t part, the very same t e c h n i q u e s y o u

l e a r n e d to release torsion will also release shear. Since these techniques
d o d o u b l e duty f o r t o r s i o n a n d shear, y o u c o u l d skip this discussion o f
sacral shear a n d still do a lot of g o o d f o r y o u r clients. But there are s o m e
i m p o r t a n t subtleties that can s o m e t i m e s m a k e a stunning d i f f e r e n c e in
y o u r effectiveness in dealing with sacral dysfunctions. I will discuss o n e of
these subtleties a little later, b e c a u s e it reveals why the m e r e mechanical
application of t e c h n i q u e is n o t as effective as i n f o r m e d t o u c h .
Figure 7.14 shows quite clearly h o w the facet of the sacrum fits into a
facet on the innominate. T h e facets are shaped like a fat " L " or " C . " Notice
h o w the wide variations in the shape a n d c o n t o u r of these facets are c o r -
related to types of spinal curvature. T h e s e drawings dramatically d e m o n -
strate that any attempt to reposition the sacrum is limited by these inherent
shapes a n d u n d e r s c o r e s o n c e again the clinical priority of releasing j o i n t
restrictions o v e r a t t e m p t i n g t o r e p o s i t i o n b o n y s e g m e n t s a c c o r d i n g t o
s o m e external ideal.
W h e n the sacrum is fixed in a shear the sacral base slips anteriorly or
posteriorly a r o u n d a transverse axis on the facet of the innominate. W h e n
84
THE SACRUM
Transverse axis y o u first palpate the sacral base in a

s a c r u m that has g o t t e n stuck i n
shear, y o u will think y o u are feeling
r o t a t i o n , b e c a u s e o n e side o f the
sacral base will be posterior a n d the
o t h e r anterior. So y o u n e e d another
r e f e r e n c e p o i n t o n the s a c r u m t o
differentiate shear f r o m torsion.
In o r d e r to distinguish the two,
y o u palpate the right a n d left sides
of the inferior lateral angle (ILA) of
Left ILA Right ILA
the sacrum. Y o u can find the p o s t e -
rior aspect of the ILA by locating the
Sacral hiatus
sacral hiatus. Find the sacral hiatus
Figure 7.15 b y running o n e o f your f i n g e r s d o w n
the c e n t e r of the s a c r u m a l o n g the
spinous processes until y o u r finger lands in the indentation of the sacral
hiatus. F r o m the sacral hiatus m o v e y o u r thumbs laterally a b o u t o n e half
to three quarters of an i n c h and y o u will land on the p o s t e r i o r ILA. T h e
posterior ILA is the transverse process of S5 (Figure 7.15). Let y o u r thumbs
slip inferiorly just ever so slightly so that they are resting on the inferior
aspect of the ILA a n d use this aspect of the ILA as y o u r r e f e r e n c e p o i n t .
Let's imagine that y o u find a sacrum in w h i c h the right base is poste-
rior and the left is anterior. If the sacrum is t o r s i o n e d , the ILA's will fol-
l o w the p a t t e r n o f the t o r s i o n a n d also b e p o s t e r i o r o n the r i g h t a n d
anterior on the left. But if the sacrum is fixed in anterior shear, then the
left sacral base will be anterior a n d the left ILA will be m o r e inferior a n d
posterior than the right ILA. T h e left ILA also will be m o r e inferior than
it is posterior. So in o r d e r to distinguish b e t w e e n shear a n d torsion, y o u
should always palpate n o t just the sacral base, b u t also the ILA's. If the left
sacral base is anterior a n d the left ILA is anterior a n d the right ILA is p o s -
terior, then y o u are l o o k i n g at a torsion. If the left sacral base is anterior
and the left ILA is m o r e inferior a n d p o s t e r i o r than the right I L A ( a n d
m o r e inferior than p o s t e r i o r ) , then y o u are l o o k i n g at a sacral shear.
Anterior sacral shear is m u c h m o r e c o m m o n than posterior sacral shear.
S o m e think that posterior sacral shear may be no m o r e than j u s t a t h e o -
85
retical possibility, b u t I have f o u n d t h e m and k n o w they exist. So for exam-

p l e , in a right p o s t e r i o r shear of the sacral base, the right sacral base is
posterior a n d the left sacral base is anterior. T h e right ILA is m o r e supe-
rior a n d anterior than the left ILA a n d the right ILA will be m o r e supe-
rior than it is anterior.
A sacrum fixed in anterior shear is called a unilateral sacral flexion or
a unilateral anteriorly nutated s a c r u m , a n d a s a c r u m fixed in posterior
s h e a r is c a l l e d a unilateral sacral e x t e n s i o n or a unilateral posteriorly
nutated sacrum. But I p r e f e r to call these two fixations anterior and p o s -
terior shear of the sacral base. This way of n a m i n g shear is a bit clearer, I
believe, in that it designates the fixation in the description and therefore
immediately tells y o u w h e r e y o u n e e d to w o r k to facilitate a release. Y o u
can call it what y o u will, of c o u r s e , b u t the critical question f o r y o u as the
therapist is to d e t e r m i n e w h e t h e r the sacral base is f i x e d in anterior or
p o s t e r i o r shear.
First y o u palpate the sacral base. If y o u find that o n e side is posterior
a n d the o t h e r is anterior, in o r d e r to differentiate shear and torsion y o u
then palpate the I I A ' s . If palpation of the ILA's reveals shear, y o u r n e x t
step is to d e t e r m i n e w h e t h e r the anterior base or the posterior base is the
fixed side. Testing f o r w h e t h e r the sacral base is fixed in anterior or p o s -
terior shear is the same as testing f o r
w h e t h e r the sacral base is f i x e d in
Anterior shear
anterior or p o s t e r i o r sacral torsion.
You forward and back b e n d your
client and watch h o w the sacral base
behaves.
Let's l o o k at anterior sacral shear
first (Figure 7.16). If the left sacral
base is fixed in anterior sacral shear,
the left sacral base will be anterior
a n d the right sacral base will be pos-
terior. T h e left ILA will be m o r e infe- Left ILA Right ILA
rior a n d posterior than the right inferior/ superior/
posterior anterior
ILA, a n d the left I L A will b e m o r e
inferior than it is posterior. Put y o u r
t h u m b s o n e a c h side o f the sacral Figure 7.16
86
THE SACRUM
base a n d watch what h a p p e n s in f o r w a r d a n d backward b e n d i n g . Since

the left side is fixed in anterior shear, it will b e c o m e a fixed pivot p o i n t
a r o u n d which the right sacral base will be f o r c e d to m o v e in f o r w a r d a n d
backward bending. W h e n y o u forward b e n d your client her left sacral base
will stay fixed anteriorly and the right sacral base will m o v e in a m o r e p o s -
terior direction making the difference between the two sides m o r e extreme.
W h e n y o u backward b e n d y o u r client h e r left anterior base remains fixed
anteriorly and h e r right sacral base m o v e s in a m o r e anterior d i r e c t i o n ,
making the difference b e t w e e n the two sides disappear.
Let's l o o k at what h a p p e n s if y o u r client's right sacral base is fixed in
posterior shear (Figure 7.17). Palpation will reveal that h e r left sacral base
is anterior a n d her right sacral base is posterior. It will also s h o w that the
right ILA is m o r e superior a n d anterior than the left ILA, a n d the right
ILA is m o r e superior than it is anterior. In f o r w a r d a n d backward b e n d -
ing her right sacral base b e c o m e s the fixed pivot p o i n t a r o u n d w h i c h h e r
left sacral base is f o r c e d to m o v e . W h e n y o u backward b e n d y o u r client,
her right sacral base will stay in its posteriorly fixed position a n d h e r left
sacral base will m o v e m o r e in an anterior d i r e c t i o n . As a result, the dif-
f e r e n c e between h e r two sides will b e c o m e m o r e e x t r e m e . W h e n y o u for-
ward b e n d y o u r client h e r right sacral base maintains its posteriorly fixed
p o s i t i o n a n d h e r left sacral b a s e
m o v e s in a m o r e posterior position,
m a k i n g the d i f f e r e n c e b e t w e e n the
two sides disappear.
The forward and back bending
test reveals w h e t h e r the sacral base
is f i x e d anteriorly or posteriorly in
exactly the s a m e way f o r b o t h tor-
sion a n d shear. T h e r e f o r e , y o u can
use the s a m e r u l e s w e f o r m u l a t e d
for torsion to help y o u figure out
Left ILA Right ILA whether the sacral base is fixed ante-
inferior/ superior/ riorly or posteriorly in sacral shear.
posterior anterior
T h u s , f o r e x a m p l e , if the p o s t e r i o r
sacral base remains posterior while
Figure 7.17 the a n t e r i o r side m o v e s anteriorly
87
d u r i n g b a c k b e n d i n g , then the posterior side is fixed in posterior shear.

If the anterior sacral base remains anterior while the posterior side moves
anteriorly d u r i n g back b e n d i n g , then the anterior side is fixed in anterior
shear.
The Rum pel stilts kin Effect

F Y O U DO N O T PALPATE T H E ILA's, Y O U HAVE NO WAY TO D I S T I N G U I S H
b e t w e e n shear a n d torsion. T h e same is true if y o u only use the forward

and backward b e n d i n g tests. Forward and backward b e n d i n g can only test
f o r w h i c h side is fixed anteriorly or p o s t e r i o r l y — i t c a n n o t tell y o u all by
itself w h e t h e r the anterior or posterior fixation it reveals g o e s with a tor-
sion or a shear. Y o u must palpate the ILA's to d e t e r m i n e the difference.
Interestingly e n o u g h the very same t e c h n i q u e s y o u l e a r n e d f o r releasing
an anteriorly or posteriorly fixed sacral base in a torsion will also release
an anteriorly or posteriorly fixed sacral base associated with shear. T h e
u p s h o t of this discussion is a bit peculiar. If y o u o n l y palpate the sacral
base a n d use the f o r w a r d a n d backward b e n d i n g tests without palpating
the ILA's, and if y o u only use the j o i n t challenging techniques y o u learned
f o r releasing sacral torsions, y o u will also be able to release sacral shear
without b e i n g aware that it even exists. In practical terms, since the tech-
nique is pretty m u c h the same in b o t h cases, it might seem as though know-
i n g h o w to differentiate shear f r o m torsion is unnecessary.
S o y o u m i g h t b e w o n d e r i n g why b o t h e r l e a r n i n g h o w t o distinguish
b e t w e e n shear a n d torsion in the first place? O n e answer is that a thera-
pist s h o u l d j u s t k n o w these things. A n o t h e r answer is that o n c e y o u k n o w
what these differences are y o u can a d d variations to y o u r techniques that
will make t h e m m o r e effective in releasing shear. T h e last answer is harder
to understand, b u t is probably the most significant. Knowing what y o u are
releasing in a client's b o d y adds to y o u r clarity of p u r p o s e a n d actually
makes y o u a m o r e effective therapist. If y o u k n o w what it is that n e e d s to
c h a n g e , then the t e c h n i q u e s y o u apply will be m o r e effective than if y o u
d o n ' t k n o w precisely what y o u are releasing. T h i s characteristic o f the
somatic m a n u a l arts r e m i n d e d my wife of the psychotherapeutic setting
w h e r e , metaphorically, y o u must n a m e y o u r d e m o n s if y o u want to get rid
of t h e m . She calls this p h e n o m e n o n , " T h e Rumpelstiltskin Effect."
88
THE SACRUM
As strange as it may s o u n d , I am c o n v i n c e d that y o u r r e c o g n i t i o n of

the fixation is m o r e than j u s t an intellectual a c c o m p l i s h m e n t that h a p -
p e n s to a c c o m p a n y y o u r a p p l i c a t i o n of a t e c h n i q u e — i t is actually an
important part of the t e c h n i q u e itself. B e f o r e I knew h o w to tell the dif-
f e r e n c e b e t w e e n shear a n d torsion, I h a d d e v e l o p e d the t e c h n i q u e s d e -
scribed in this chapter for releasing torsion. During the time I was reading
about and trying to understand shear, I was working with a client w h o had
what I believed was a posterior torsion in w h i c h the right base was p o s t e -
riorly fixed. For a n u m b e r of sessions I had applied my t e c h n i q u e f o r p o s -
terior torsion. I was able to give him s o m e relief from his pain, but I couldn't
get rid of all of it. My client told me at the b e g i n n i n g a n d e n d of every ses-
sion that even t h o u g h the o t h e r pains a r o u n d his low back area had g o n e
away, the pain in his butt never went away. T h e pain he was c o m p l a i n i n g
a b o u t was in close proximity to the right ILA. I n o w realize that it is c o m -
m o n for clients with sacral shear p r o b l e m s to c o m p l a i n of pain in the area
of o n e of their ILA's, especially in weight bearing situations. W h e n I finally
g o t clear about h o w to tell the difference between shear a n d torsion, I pal-
pated my client's ILA's and discovered that he had a right posterior sacral
shear. A d d i n g this r e c o g n i t i o n — t h a t his sacrum was actually in posterior
shear, n o t posterior t o r s i o n — t o the very same t e c h n i q u e I had used w h e n
I believed his sacrum was posteriorly t o r s i o n e d fully released his sacrum
for the first time. A n d f o r the first time the pain in the right side of his
buttocks disappeared.
This e x a m p l e is n o t an isolated case. My e x p e r i e n c e a n d the e x p e r i -

e n c e of my friends and colleagues has shown us o v e r a n d over again that
knowing and n a m i n g what y o u are working on is an essential part of effec-
tive therapy. I have a l o t of ideas a b o u t why this is so a n d c o u l d lay o u t
what I think is a rather interesting t h e o r y a b o u t what is h a p p e n i n g . But
it w o u l d require a rather lengthy philosophical discussion that w o u l d take
us well b e y o n d the s c o p e of this manual. If y o u r u n d e r s t a n d i n g is stimu-
lated by poetry, y o u m i g h t appreciate h o w a line f r o m the great p o e t , Ste-
fan G e o r g e , explains h o w p r o f o u n d l y o u r lives can be i n f l u e n c e d by n o t
knowing the n a m e o f s o m e t h i n g : " W h e r e the n a m e breaks off, n o thing
may b e . "
In any case, my observation is very easy to test a n d w o u l d m a k e f o r an
interesting study in somatic manual therapy. Find 20 e x p e r i e n c e d thera-
89
pists a n d 20 patients with sacral shear. T e a c h 10 therapists h o w to r e c o g -

nize a n d treat f o r sacral torsion only, teach the o t h e r 10 therapists h o w to
treat a n d r e c o g n i z e the d i f f e r e n c e b e t w e e n shear and torsion, and make
sure b o t h g r o u p s of therapists learn the same t e c h n i q u e f o r releasing an
anterior a n d p o s t e r i o r sacral base. T h e n turn t h e m l o o s e on the patients
a n d see what h a p p e n s .
T h e most important c o n c l u s i o n f o r y o u as a therapist to draw f r o m this
discussion is that the clearer y o u are a b o u t what y o u are w o r k i n g on the
m o r e effective y o u will b e c o m e . In terms of the techniques y o u learn from
this b o o k , y o u will find that the simple indirect a n d shotgun techniques
are less effective f o r the reasons already given earlier, b u t also b e c a u s e
they d o n ' t d e m a n d the same level of k n o w l e d g e as the t e c h n i q u e s that
are specific to the j o i n t fixation. I i n t r o d u c e d these simple techniques first
as a p e d a g o g i c a l device. T h e i r simplicity is d e s i g n e d to give y o u a kind of
palpatory understanding that prepares the way and makes it easier under-
standing the m o r e c o m p l i c a t e d b i o m e c h a n i c a l descriptions.
If a therapist is m o r e i n c l i n e d to use these simple indirect and shotgun
techniques, it usually means that he d o e s n ' t fully grasp the biomechanical
descriptions a n d h o w t o m o r e precisely locate the j o i n t f i x a t i o n . T h e b i o -
m e c h a n i c a l descriptions are important to y o u r grasp of your client's p r o b -
l e m . If a therapist d o e s n ' t have this u n d e r s t a n d i n g , he w o n ' t fully grasp
the p r o b l e m in his client's body. As a result he w o n ' t have the same clarity
of p u r p o s e as the therapist w h o is oriented toward the specifics of the j o i n t
fixation—and without this clarity of p u r p o s e , his application of technique
will be less effective. If a therapist knows h o w to locate the j o i n t fixation,
she will c h o o s e the t e c h n i q u e that specifically addresses the p r o b l e m ,
because the other m e t h o d is inefficient and time consuming. But the expe-
r i e n c e d therapist also picks the m o r e specific a p p r o a c h because at s o m e
level she understands the Rumpelstiltskin effect and h o w powerful clarity
of p u r p o s e is f o r effective therapy. This understanding also constitutes part
of what I d e s c r i b e d in the i n t r o d u c t i o n as the healer's way of being.
Variations on Technique
EFORE W E C O N C L U D E T H I S C H A P T E R O N T H E S A C R U M , I W A N T T O PRESENT
s o m e variations on the t e c h n i q u e s that y o u l e a r n e d f o r anterior and
90
THE SACRUM
posterior torsion that make t h e m m o r e specific to anterior a n d p o s t e r i o r

shear. T h e idea is to help you b e c o m e m o r e specific and h e n c e m o r e effec-
tive in y o u r a p p r o a c h to anterior a n d p o s t e r i o r shear. Y o u may want to
refer to the drawings of the sacrum in anterior and posterior shear ( 7 . 1 6 -
7.17) as y o u read t h r o u g h these variations
Recall the technique f o r manipulating a torsioned sacrum with an ante-
riorly f i x e d sacral base. Y o u f o r w a r d b e n d y o u r client, p u t y o u r t h u m b s
on each side of the sacral base, apply pressure in an inferior d i r e c t i o n to
the anteriorly fixed base, wait f o r the d a n c e of the tissues, a n d then the
release. R e m e m b e r that y o u can further a d d to y o u r effectiveness if y o u
also a d d s o m e pressure in an i n f e r i o r / a n t e r i o r d i r e c t i o n to the o p p o s i t e
sacral base or in an anterior direction to the o p p o s i t e ILA as a way to lever
the anteriorly fixed base in a posterior direction.
N o w for the sake of c o m p a r i s o n let's say y o u find a sacral shear in which
the left sacral base is fixed anteriorly. Y o u can use pretty m u c h the same
t e c h n i q u e : ask y o u r client to forward b e n d a n d apply pressure in an infe-
rior direction to the left sacral base (Figure 7.18). Y o u can also apply s o m e
Figure 7.18
91
Figure 7.19
anterior pressure to the right sacral base to lever the anterior fixed side
in a p o s t e r i o r d i r e c t i o n . But make sure y o u d o n ' t use the o t h e r variation
f o r anterior torsion in w h i c h y o u apply anterior pressure to the right ILA.
It works f o r left anterior torsion b e c a u s e the right ILA is p o s i t i o n e d pos-
teriorly. But it w o n ' t w o r k f o r left anterior shear, because the right ILA is
p o s i t i o n e d superiorly a n d anteriorly. Instead, y o u c o u l d a d d to y o u r effec-
tiveness by applying pressure to the right ILA in an inferior direction, as in
Figure 7.19, where the client is lying on a d o u b l e d - u p pillow. Or you c o u l d
a d d to y o u r effectiveness by w o r k i n g with the left ILA. Since the left ILA
is p o s i t i o n e d inferiorly a n d posteriorly, y o u can facilitate the release of
the left sacral base by applying pressure to the left ILA in a superior and
a n t e r i o r d i r e c t i o n . S o , f o r e x a m p l e , with y o u r client in a f o r w a r d b e n t
position (in Figure 7.20 the client is again lying on a d o u b l e d - u p p i l l o w ) ,
y o u can p u t o n e t h u m b on the left sacral base a n d the o t h e r on the left
ILA. W i t h y o u r t h u m b s p o s i t i o n e d in this way y o u can r o c k the left side
of the s a c r u m o u t of its anterior fixation. Alternately push inferiorly on
the left sacral base, a n d superiorly a n d anteriorly on the left ILA. R o c k
92
THE SACRUM
the left side of the s a c r u m

in this way in a c o n t i n u o u s
easy m o t i o n , stop, and then
apply appropriate pressure
to either the left base or the
left I L A a n d wait f o r the
d a n c e a n d release.
Recall h o w y o u m a n i p -
ulate a t o r s i o n e d s a c r u m
with a posteriorly fixed
sacral base. Y o u b a c k b e n d
y o u r client, apply pressure
in an anterior d i r e c t i o n to
the posteriorly f i x e d base,
wait f o r the d a n c e , a n d
then the release. For c o m -
p a r i s o n , let's s u p p o s e y o u
find a sacrum fixed in right
Figure 7.20
posterior shear. Y o u can o f
c o u r s e use the s a m e t e c h -
n i q u e for posterior shear that y o u used f o r p o s t e r i o r torsion. Or y o u can
further your effectiveness by a d d i n g s o m e pressure to the right ILA. Since
the right ILA is positioned superiorly and anteriorly, y o u c o u l d push supe-
riorly on the right ILA while y o u c o u l d push anteriorly on the right p o s -
teriorly fixed sacral base (Figure 7.21, page 9 4 ) . Or y o u can put o n e t h u m b
on the right posteriorly fixed sacral base a n d the h e e l of y o u r o t h e r h a n d
on the left ILA. Since the left ILA is p o s i t i o n e d superiorly a n d posteriorly,
y o u c o u l d push anteriorly a n d inferiorly on the left ILA while y o u push
anteriorly on the right sacral base (Figure 7.22).
O n c e y o u have a clear u n d e r s t a n d i n g of the type of fixation y o u are
dealing with a n d the ways the s a c r u m c a n b e p o s i t i o n e d , t h e n y o u can
make up y o u r o w n t e c h n i q u e s and variations.
In this chapter y o u l e a r n e d h o w to r e c o g n i z e a n d manipulate sacroil-
iac dysfunctions that were caused by eight different sacral fixations. In the
next y o u will learn h o w to r e c o g n i z e and release fixations that are created
by the pelvis.
93
Figure 7.21
Figure 7.22
94
CHAPTER
The Pelvis
H E SACRUM A N D T H E PELVIS A R E S O CLOSELY T I E D T O G E T H E R T H A T
w h e n they exist freely in their natural state of c o o p e r a t i v e i n d e -

p e n d e n c e life can b e grand. But w h e n o n e o r the o t h e r interferes
with n o r m a l m o t i o n , pain a n d misery can d e s c e n d quickly, like a black
c l o u d c a p a b l e o f o b s c u r i n g even the best o f o u r s h i n i n g m o m e n t s . Y o u
already know the ways the sacrum can create painful p r o b l e m s in this area.
T h e influence of the pelvis on the sacroiliac (SI) j o i n t can be just as p r o b -
lematic. Knowing h o w to recognize and treat the many dysfunctions caused
by the pelvis is extremely i m p o r t a n t if y o u want to be able to resolve y o u r
client's low back pain. If you do a great j o b of releasing your client's sacrum,
but do n o t take care of its interaction with the pelvis, m u c h of y o u r w o r k
will be in vain. If y o u do n o t release iliosacral (pelvis on sacrum) fixations,
it will n o t be l o n g b e f o r e most, if n o t all, of y o u r client's pain returns.
Like every area of the b o d y y o u d e c i d e to study, the pelvic area is very
c o m p l i c a t e d a n d i n t e r c o n n e c t e d to the rest of the body. In this c h a p t e r
y o u will be learning primarily a b o u t j o i n t dysfunction, b u t y o u also want
t o a p p r e c i a t e the i n t i m a t e c o n n e c t i o n s that exist b e t w e e n t h e pelvis,
sacrum, spine, and the rest of the body. W h e n y o u study Figure 8.1, p a g e
96, showing the iliosacral and sacroiliac ligaments, y o u can clearly see h o w
tightly c o n n e c t e d the pelvis, sacrum, L4, a n d L5 are. W h e n e v e r y o u w o r k
on any of these structures, r e m e m b e r h o w they are c o n n e c t e d and be cer-
tain that y o u have released all the associated restrictions. As y o u are a b o u t
95
1 Superior band of the iliolumbar ligament

2 Inferior band of the iliolumbar ligament
3 3 & 4 Intermediate plane of the sacroiliac

ligaments
5 4
6 Anterior plane of the sacroiliac ligaments
6
7 1
2
8 8&9 Anterior sacroiliac

9 ligament
7 Sacrotuburous ligament 7
6 Sacrospinous ligament 6
Figure 8.1
to learn, the pelvis can cause p r o b l e m s in three ways. Any o n e or c o m b i -

nation of these patterns of pelvic dysfunction will also strain the ligaments
a n d create further dysfunction in the low back and sacrum.
Be aware that the i l i o l u m b a r , s a c r o s p i n o u s , a n d s a c r o t u b e r o u s liga-
m e n t s are t h r e e very i m p o r t a n t l i g a m e n t s in this area. A l o n g with the
pelvic rotaters (especially the piriformis) and the psoas, they must be capa-
ble of adapting to your manipulations in order to create l o n g lasting change
f o r y o u r clients. Y o u probably already have y o u r favorite ways of releasing
these muscles a n d ligaments. Make sure y o u address t h e m either b e f o r e
or after releasing all sacroiliac or iliosacral fixations.
L i g a m e n t o u s structures are clearly i m p o r t a n t f o r p r o p e r j o i n t f u n c -
tion, b u t so is overall b o d y structure and posture. T h e alignment of y o u r
b o d y in gravity can p r o f o u n d l y affect h o w y o u r pelvis is p o s i t i o n e d and
this in turn can d e t e r m i n e h o w well y o u r j o i n t s f u n c t i o n . T h e drawings
in Figure 8.2 represent f o u r ways the pelvis can be positioned with respect
to the entire body. " Tilt" refers to the anterior or posterior torsioning of
the entire pelvis a r o u n d a transverse axis that runs t h r o u g h the inferior
a s p e c t o f the sacroiliac j o i n t . "Shift" refers t o the a n t e r i o r o r p o s t e r i o r
96
THE PELVIS
Anterior Tilt Anterior Tilt Posterior Tilt Posterior Tilt

Posterior Shift Anterior Shift Anterior Shift Posterior Shift
Figure 8.2 TILT occurs as an anterior or posterior torsioning of the entire pelvis around a trans-
verse axis that runs through the inferior aspect of the sacroiliac joint.
S H I R occurs as an anterior or posterior translation of the entire pelvis along the
transverse plane.
translation o f the entire pelvis a l o n g the transverse p l a n e . T h e c u r v e d

arrows represent tilt and the straight arrows indicate shift. T h e difference
b e t w e e n tilt a n d shift was first r e c o g n i z e d by Jan Sultan a n d is part of a
brilliant typology he d e v e l o p e d f o r identifying c o m m o n structural types
and their associated myofascial strain a n d gait patterns. His u n d e r s t a n d -
ing of tilt/shift was further refined by Swiss Rolfer, Dr. Hans Flury.
Many myofascial structures c o n t r i b u t e to these overall patterns. F o r
e x a m p l e , a posteriorly tilted pelvis is often tied to tight, short hamstrings
while an anteriorly tilted pelvis is often tied to tight, short quadriceps. These
postural issues are also often associated with typical sacral dysfunctions.
W h e n the sacrum gets stuck bilaterally in posterior nutation it often drags
the lumbars with it, especially L4 and L5. As it turns out, a p e r s o n w h o s e
pelvis inclines toward posterior tilt will m o r e likely show bilateral posterior
nutation fixations of the sacrum than a p e r s o n with an anterior pelvis.
N o t recognizing the difference between tilt a n d shift has mislead many
97
therapists in their evaluations of clients' overall alignment.

W h e n a client's pelvis is p o s t e r i o r l y tilted, b u t shows an
a n t e r i o r shift well b e y o n d the mid-sagittal axis, it is c o m -
m o n to misread this pattern as a lordosis or a swayback. As
the pelvis shifts anteriorly, the thorax shifts posteriorly giv-
i n g the p e r s o n the a p p e a r a n c e of falling backward. But if
y o u l o o k carefully, y o u will often see a l u m b a r spine that is
actually lacking an appropriate lordosis. T h e illusion of a
swayback is created by an anterior shift of the pelvis. Fig-
ure 8.3 is f r o m Kendall and McCreary's Muscles: Testing and
Function a n d is a clear case of an anteriorly shifted pelvis
1
with a posterior tilt. N o t i c e that this person's lumbar spine

is actually rather flat and displays very little lordotic curve.
A l t h o u g h this e x a m p l e is n o t e x t r e m e , clearly Kendall and
M c C r e a r y are misled by the anterior shift of a posteriorly
tilted pelvis a n d wrongly describe this p e r s o n as having a
swayback p o s t u r e . T h i s pattern of the a n t e r i o r shift of a
posteriorly tilted pelvis can b e slight f o r o n e p e r s o n a n d
very e x t r e m e in another, b u t in most cases y o u will see that
the l o r d o t i c c u r v e is lacking to s o m e d e g r e e .
A l t h o u g h dealing with these many a n d varied postural
issues is well b e y o n d the s c o p e of this m a n u a l , s o m e dis-
cussion is helpful. It serves to r e m i n d y o u of the of i m p o r -
tance of always trying to understand h o w local fixations are
intimately related to w h o l e b o d y structure a n d gravity. In
Figure 8.3
a very real sense, y o u can never work on any local area of
the b o d y without b e i n g in contact with the whole b o d y and
its c o m p l i c a t e d network of c o m p e n s a t i o n s . If a local c h a n g e is i n t r o d u c e d
i n t o a b o d y without taking a c c o u n t of its network of c o m p e n s a t i o n s and
p o s t u r a l habits, t h e n typically the b o d y will n o t be able to sustain the
c h a n g e . If it c a n n o t adapt above or s u p p o r t the c h a n g e below, then either
the b o d y will return to its original dysfunction or d e v e l o p strain and dys-
function elsewhere—or both.
98
Testing and Palpating for Iliosacral Dysfunction
E T ' S LEAVE T H E S E L A R G E R ISSUES A N D T U R N O U R A T T E N T I O N T O T H E
specifics of h o w the pelvis creates j o i n t fixations. T h e three ways the

pelvis can create dysfunction are t o r s i o n , flare, a n d shear. First y o u will
learn what these patterns are and then you will learn h o w to test and release
them. You have already encountered pelvic torsion in the last chapter where
I d e s c r i b e d the vermicular u n d u l a t i o n of the spine d u r i n g walking. Y o u
may recall h o w n o r m a l walking requires that each i n n o m i n a t e rotate ( o r
torsion) anteriorly and posteriorly in response to h o w each leg moves f r o m
heel strike to toe off. Torsion of the i n n o m i n a t e s o c c u r s a r o u n d a trans-
verse axis that runs t h r o u g h the inferior aspect of the sacroiliac j o i n t . Just
as it is possible for the innominates to torsion normally, it is also possible
for o n e of t h e m to get stuck in either anterior or posterior torsion.
Flare of the i n n o m i n a t e can o c c u r as either out-flare or in-flare. W h e n
out-flared, the ilium rotates laterally, or away f r o m the mid-sagittal axis as
the ischial tuberosity rotates medially, or toward the mid-sagittal axis. In-
flare behaves in the o p p o s i t e fashion: the ilium rotates medially toward
the mid-sagittal axis and the tuberosity rotates away f r o m the mid-sagittal
axis.
Shear is a just a bit m o r e c o m p l i c a t e d , because it can o c c u r in two dis-
tinct ways, either as a n t e r i o r / p o s t e r i o r shear or s u p e r i o r / i n f e r i o r shear.
In s u p e r i o r / i n f e r i o r shear, also k n o w n as up-slip a n d down-slip, o n e of
the innominates either slips upward on the sacrum in relation to the o t h e r
i n n o m i n a t e or it slips downward. In a n t e r i o r / p o s t e r i o r ( A / P ) shear, o n e
of the innominates either slips anteriorly in relation to the o t h e r i n n o m -
inates or it slips posteriorly. Y o u c o u l d reasonably call A / P shear anterior
and posterior slip.
Y o u are p r o b a b l y w o n d e r i n g h o w y o u d e t e r m i n e w h e t h e r a c l i e n t is
manifesting o n e of these iliosacral fixations a n d , if she is, h o w y o u tell
whether the i n n o m i n a t e is fixed anteriorly or posteriorly or inferiorly or
superiorly. As y o u m i g h t have guessed, the osteopaths have created s o m e
rather simple tests to h e l p y o u answer these questions.
T h e first test f o r d e t e r m i n i n g iliosacral d y s f u n c t i o n is the s t a n d i n g
flexion test. To p e r f o r m it y o u n e e d to place y o u r thumbs on the inferior
99
Iliac crests at
level of L4
Sacral
sulcus Sacral base
Median sacral
Inferior slope crest
of PSIS
Inferior lateral
angle
Ischial
tuberosity
Figure 8.4
slopes of the p o s t e r i o r s u p e r i o r iliac spines (PSIS), illustrated in Figure

8.4. Y o u can find the PSIS by l o o k i n g f o r the d i m p l e s most p e o p l e have
in this area, l o c a t e d a b o u t two inches lateral to the lumbosacral j u n c t i o n .
By p l a c i n g the pads of y o u r thumbs over t h e m y o u will find the most p o s -
terior aspect of the PSIS. Drag y o u r thumbs in an inferior direction until
y o u find the inferior slopes of the PSIS. Y o u will k n o w y o u are there when
y o u feel y o u r thumbs just b e g i n to slide off the inferior aspect of the PSIS.
With y o u r client standing, place the pads of y o u r thumbs on the infe-
rior s l o p e of the PSIS a n d ask h i m to b e n d forward as far as he c o m f o r t -
ably c a n . W a t c h what h a p p e n s to y o u r t h u m b s . If there is an iliosacral
fixation, o n e of y o u r t h u m b s will ride up in a superior direction and the
o t h e r o n e will stay w h e r e it is. T h e side on w h i c h the t h u m b rides up is
the fixed side. Figure 8.5 shows the restriction on the right side. This test
works quite well, unless the hamstrings or the quadratus l u m b o r u m are
asymmetrically tight. If the hamstrings are tight on the side o p p o s i t e to
w h e r e y o u r t h u m b rides u p , or if the quadratus l u m b o r u m is tight on the
same side as w h e r e y o u r t h u m b rides u p , the superior m o v e m e n t of y o u r
t h u m b will n o t be a true indicator.
T h e standing flexion test will n o t tell y o u w h e t h e r o n e i n n o m i n a t e is
100
THE PELVIS
in-flared o r out-flared, w h e t h e r o n e i n n o m i n a t e i s u p - s l i p p e d o r d o w n -
slipped, whether o n e is anteriorly slipped or posteriorly slipped, or whether
o n e is posteriorly torsioned or anteriorly torsioned. T h e tests will only tell
y o u the side on which the i n n o m i n a t e is fixed on the sacrum. In o r d e r to
tell what kind of iliosacral fixation y o u are l o o k i n g at y o u must palpate a
n u m b e r of o t h e r areas on the pelvis, a t e c h n i q u e that will be d e s c r i b e d
shortly. For now, j u s t practice the standing flexion test a n d n o t i c e what
h a p p e n s to y o u r thumbs.
N o w that y o u have l e a r n e d h o w to use this test to d e t e r m i n e iliosacral
dysfunction, y o u can use the sitting version of it to h e l p y o u d e t e r m i n e
unilateral sacroiliac fixations. Ask y o u r client to assume a seated position,
o n c e again place the pads of your thumbs on the inferior slope of the PSIS,
and ask him to forward b e n d as far as he c o m f o r t a b l y can. If o n e of y o u r
thumbs rides superiorly, as it d o e s in Figure 8.6, y o u have d i s c o v e r e d a
sacroiliac fixation. Like the standing flexion test, the sitting flexion test
only tells y o u on w h i c h the side the sacral fixation exists, it d o e s n ' t tell
whether it is fixed in anterior/posterior torsion or anterior/posterior shear.
101
T h e sitting flexion test effectively

r e m o v e s the i n f l u e n c e o f y o u r client's
legs and pelvis on the sacrum and there-
f o r e allows y o u t o d e t e r m i n e w h e t h e r
sacroiliac fixations are present. In c o n -
trast, the standing flexion test adds the
influence of the pelvis and legs, and lets
y o u d e t e r m i n e w h e t h e r iliosacral f i x a -
tions are p r e s e n t . If y o u r t h u m b rides
up in b o t h the sitting and standing flex-
i o n tests, t h e n y o u have d i s c o v e r e d a
s a c r o i l i a c a n d iliosacral d y s f u n c t i o n .
K n o w i n g h o w to use these tests is h e l p -
ful to sorting o u t what kind of fixations
are present.
Often you may be working with clients
w h o s e low back p r o b l e m s create t o o
Figure 8.7 m u c h p a i n w h e n they try t o f o r w a r d
b e n d f r o m a standing position. In these
cases, a n d as a way to d o u b l e c h e c k y o u r results, the so-called stork test is
also very useful. Ask y o u r client to stand facing a wall so he can stabilize
himself while p e r f o r m i n g the test. Put the pad of your right t h u m b on the
posterior aspect of his right PSIS and y o u r left t h u m b at the same level on
the m e d i a n sacral crest, which is basically the mid-line of the sacrum. Ask
y o u r client to raise his k n e e to at least 90 d e g r e e s a n d watch what y o u r
right t h u m b d o e s (Figure 8.7). If there is no iliosacral fixation, y o u r right
t h u m b will r i d e inferiorly as he raises his l e g a n d y o u r left t h u m b will
remain where it is. If there is a fixation, then y o u r right t h u m b will remain
w h e r e it is a n d n o t m o v e inferiorly. Test the o t h e r side in the same way.
Place y o u r left t h u m b on the p o s t e r i o r aspect of his left PSIS a n d y o u r
right t h u m b at the same level on the m e d i a l sacral crest, ask h i m to raise
his k n e e to at least 90 d e g r e e s , a n d watch h o w y o u r left t h u m b responds.
If it d o e s n ' t m o v e inferiorly, y o u have discovered an iliosacral fixation.
If either the standing flexion or the stork test reveals an iliosacral fix-
ation, the n e x t part of y o u r evaluation requires y o u to figure o u t by means
of palpation w h e t h e r y o u are dealing with flare, shear, torsion, or a cora-
102
THE PELVIS
bination of s o m e or all of t h e m . Let's take a simplified l o o k at an e x a m -

ple. Suppose you find an iliosacral fixation on the right by using the stand-
ing flexion test, and you palpate the innominates to discover that the right
i n n o m i n a t e seems out-flared a n d the left seems in-flared. If y o u had pal-
pated the i n n o m i n a t e s without having p e r f o r m e d the standing f l e x i o n
test, it w o u l d be very difficult f o r y o u to be able to say w h e t h e r the right
i n n o m i n a t e was out-flared or the left i n n o m i n a t e was in-flared. But since
y o u p e r f o r m e d the standing flexion test a n d it revealed that the fixation
was o n the right, y o u c a n c o n c l u d e that the right i n n o m i n a t e m u s t b e
fixed in an out-flared position. So h e r e is h o w it works: first y o u d e t e r m i n e
the side on which the fixation is present; then y o u palpate to d e t e r m i n e
whether the iliosacral fixation is an in-flare or out-flare, an anterior or p o s -
terior shear, an up-slip or down-slip, an anterior or p o s t e r i o r torsion, or
some combination.
Palpating for In-flare/Out-flare

Let's l o o k m o r e carefully a t w h e r e a n d h o w y o u palpate f o r e a c h o f these
c o n d i t i o n s . We will b e g i n with palpating f o r in-flare a n d out-flare. Find
the anterior superior iliac spine (ASIS) (Figure 8.8) with y o u r client in a
supine position. T h e easiest way to do this is to first place y o u r palms over
the ASIS to locate it a n d n o t i c e h o w the shape of this area feels to y o u r
t o u c h . T h e n p l a c e the p a d s o f
y o u r thumbs on the medial infe-
r i o r e d g e o f e a c h ASIS. N e x t
draw an imaginary line d o w n the
center of your client's b o d y to
r e p r e s e n t the mid-sagittal axis.
On most p e o p l e the navel is on
this c e n t e r line. T h e n c o m p a r e
Inferior
h o w far each t h u m b is f r o m this s l o p e of
center line. If the t h u m b on the ASIS
right ASIS s e e m s c l o s e r t o the Left
pube
m i d l i n e than the left, t h e n y o u Ischial
are p r o b a b l y l o o k i n g at an u n i - tuberosity
lateral in-flare or out-flare. If the
standing flexion test or the stork Figure 8.8
103
test reveals a fixation on the right, then y o u have d i s c o v e r e d a right in-

flare. If the tests show that the fixation is on the left, then y o u have f o u n d
a left out-flare.
Palpating for Up-slip/Down-slip (Superior/Inferior Shear)

Shear is most often the result of trauma and although down-slips do occur,
they are very rare. W h e n o n e d o e s o c c u r it is usually c o r r e c t e d by walk-
ing. So if y o u r palpation reveals o n e i n n o m i n a t e that seems inferior and
o n e that seems superior, y o u can pretty m u c h be assured that you are look-
i n g at up-slip. B e g i n y o u r palpation s e q u e n c e with y o u r client in a p r o n e
position. Be sure that y o u r thumbs are always p l a c e d on exactly the same
level. Place the pads o f y o u r t h u m b s o n e a c h o f the ischial tuberosities
and c o m p a r e their relative positions to o n e another. D o e s o n e seem supe-
rior a n d the o t h e r inferior? If so, a n d the standing flexion and stork tests
s h o w a fixation on the same side as the superior tuberosity, then you have
p r o b a b l y discovered an up-slip. T h e position of the tuberosities is a fairly
reliable indicator, b u t y o u can b e m i s l e d u n d e r certain circumstances.
Sometimes what appears to be an up-slip is the result of curvature in which
the l u m b a r s p i n e s i d e b e n d s to the same side as the a p p a r e n t up-slip. A
T y p e I g r o u p curvature with a right s i d e b e n d i n g , f o r e x a m p l e , will make
the right i n n o m i n a t e s e e m m o r e superior than the left.
N e x t palpate the PSIS's f o r their relative s u p e r i o r / i n f e r i o r positions
and then roll y o u r client over and palpate the ASIS's. If the ASIS and PSIS
o f o n e o f the i n n o m i n a t e s are b o t h superior, then y o u are probably l o o k -
i n g at an up-slip. Ask y o u r client to return to a p r o n e position and c h e c k
the s a c r o t u b e r o u s ligaments. To find these ligaments, place y o u r thumbs
b e t w e e n the a p e x of the s a c r u m a n d the ischial tuberosities. T h e sacro-
t u b e r o u s ligament will be lax on the same side as the up-slip a n d tight on
the same side as the down-slip. Ask y o u r client to turn over again and in
a s u p i n e p o s i t i o n palpate the s u p e r i o r e d g e s of the p u b e s to see if they
s e e m s u p e r i o r a n d i n f e r i o r with respect to e a c h other. Lastly c h e c k the
inguinal ligaments f o r t e n d e r n e s s . T h e inguinal l i g a m e n t will likely be
t e n d e r on the same side as shear: if it's a right up-slip, it will be tender on
the right, a n d if it's a left down-slip, t e n d e r on the left. Be aware that ten-
derness is a less reliable i n d i c a t o r than position. If the standing flexion
a n d stork tests reveal a fixation on the right and all palpatory indicators
104
THE PELVIS
show the right side superior in relation to the left, y o u have d i s c o v e r e d a

right up-slip.
Palpating for Anterior/Posterior Shear
With y o u r client in a supine p o s i t i o n p l a c e the p a d s of y o u r t h u m b s on

the most anterior aspect of each p u b e and evaluate for whether o n e seems
anterior a n d the o t h e r posterior. If the standing f l e x i o n a n d stork tests
reveals a fixation on the right and the right p u b e is anterior, then the right
innominate is fixed in anterior shear. If the tests reveal the fixation on the
left, then the left i n n o m i n a t e is fixed in posterior shear.
Palpating for Anterior/Posterior Torsion
I left torsion f o r last because of all the f o r m s of dysfunction we have dis-

cussed, it is usually the least likely type of pelvic dysfunction. S o , I suggest
that in your palpation s e q u e n c e y o u also save torsion f o r last. If y o u find
a shear or flare fixation c o r r e c t t h e m first b e f o r e y o u even palpate f o r tor-
sion. A l m o s t everybody's i n n o m i n a t e s torsion in the same way. T h e n o r -
mal a n d e x p e c t e d pattern y o u will see o v e r a n d o v e r again is the right
i n n o m i n a t e t o r s i o n e d anteriorly a n d the left posteriorly. If y o u find the
o p p o s i t e situation y o u may be l o o k i n g at trauma, or a s o c c e r player w h o
kicks with his left foot. If the standing flexion test and the stork tests reveal
an iliosacral fixation and y o u palpate torsion first y o u will predictably find
the right i n n o m i n a t e t o r s i o n e d anteriorly a n d the left posteriorly. M o r e
than likely the torsion is n o r m a l a n d the fixation the test revealed is d u e
to shear or flare. So y o u r best b e t is to palpate f o r shear a n d flare first,
c o r r e c t what y o u find, a n d p e r f o r m the standing flexion a n d stork tests
to c h e c k y o u r results. If the fixation is no l o n g e r present, there is no n e e d
to b o t h e r yourself with palpating f o r torsion. If the fixation persists after
correcting shear and flare, then c o r r e c t f o r torsion. But if y o u palpate f o r
torsion b e f o r e you paipate f o r flare or shear, y o u may be mislead into c o r -
recting a torsion fixation w h e n n o n e is present.
Palpate f o r t o r s i o n with y o u r client in a s u p i n e p o s i t i o n . Place y o u r
thumbs on the ASIS's and c o m p a r e their relative positions to o n e another.
D o e s o n e i n n o m i n a t e s e e m t o r s i o n e d anteriorly a n d the o t h e r posteri-
orly? Let's assume that either y o u have already released flare or shear dys-
functions or n o n e are present. If the standing flexion and stork tests show
105
a fixation on the right a n d the right i n n o m i n a t e is t o r s i o n e d anteriorly,

then the right i n n o m i n a t e is fixed in anterior torsion. If y o u discover the
fixation on the left a n d the left i n n o m i n a t e is t o r s i o n e d posteriorly, then
the left i n n o m i n a t e is fixed in posterior torsion.
I have never w o r k e d with a client w h o s h o w e d all three iliosacral fixa-
tions at o n c e , b u t I believe it is possible. O f t e n , however, y o u will find a
c o m b i n a t i o n o f two o f these f i x a t i o n s . D e p e n d i n g o n the uniqueness o f
e a c h client's body, s o m e t i m e s it is very easy to palpate these patterns and
o t h e r times it is m o r e difficult. D o n ' t be d i s c o u r a g e d if at first y o u are n o t
quite sure what pattern y o u l o o k i n g at. If y o u are n o t certain, c o r r e c t f o r
what y o u think the p r o b l e m is a n d retest. T h e t e c h n i q u e s d e s c r i b e d in
this b o o k f o r releasing iliosacral fixations are gentle e n o u g h that they will
n o t cause h a r m i f y o u misread the p o s i t i o n o f the i n n o m i n a t e a n d c o r -
rect f o r a p r o b l e m that is n o t present. If the standing flexion a n d stork
tests s h o w a fixation a n d y o u are u n c l e a r f r o m palpation whether y o u are
l o o k i n g at shear or flare, c o r r e c t f o r b o t h on the side on which the fixa-
tion shows u p . For instance, c o r r e c t f o r shear a n d then retest and, If the
test is negative y o u k n o w the p r o b l e m was shear. If the test is still positive,
c o r r e c t f o r flare a n d retest again. Always palpate b e f o r e and after m a n i p -
ulation so that y o u learn to see and feel subtle but important differences.
A n d in time y o u will learn to see a n d feel m o r e and m o r e subtle patterns.
Techniques for Pelvis-on-Sacrum Dysfunctions
A L L O F T H E T E C H N I Q U E S Y O U ARE A B O U T T O LEARN W O R K BEST I F Y O U
free up all the associated soft tissues a n d ligaments in this area. For
e x a m p l e , be sure that the hamstrings, gluteals, rotators, psoas, quadratus
l u m b o r u m , e r r e c t o r s , a n d ligaments are b a l a n c e d a n d free e n o u g h f o r
y o u r client's pelvis to a c c e p t pelvic manipulations.
Out-flare
Put y o u r client in a supine position. On the out-flared side bring o n e of

y o u r client's knees up ( f o o t flat on the table). Sit on the same side of the
table as the out-flare. Place the fingers of o n e h a n d on the medial surface
of the ischial tuberosity a n d the h e e l of the o t h e r h a n d on the ilium with
fingers w r a p p e d a r o u n d the ASIS (Figures 8.9 and 8.10). Gently but firmly
106
THE PELVIS
Figure 8.9
Figure 8.10
107
traction the tuberosity laterally while

p u s h i n g the ilium medially a n d wait.
Either the i n n o m i n a t e will release its
restriction by g o i n g t h r o u g h a d a n c e
or by moving directly to its normal posi-
tion. This technique was created by Jan
Sultan.
In-flare
Place y o u r client in a supine position

a n d stand on the o p p o s i t e side of the
table f r o m the in-flare. A s s h o w n i n
Figure 8.11, reach across to the k n e e
o f the in-flared side. B e n d the k n e e ,
h o o k y o u r a r m u n d e r n e a t h , lift, a n d
b r i n g it across the midline as y o u pull
it in a superior direction. As y o u h o l d
Figure 8.11
the knee in this position, pull it toward
y o u ever so slightly to stabilize the
tuberosity. Put the h e e l of y o u r o t h e r h a n d j u s t m e d i a l to the ASIS and
gently b u t firmly push the ilium laterally a n d wait. Either the i n n o m i n a t e
will go t h r o u g h its d a n c e a n d release or it will m o v e directly to its n o r m a l
position.
Up-slip
With y o u r client lying on the side o p p o s i t e the up-slip, use the leg of the
up-slipped side as a handle to guide the innominate. Using the direct tech-
n i q u e y o u gently b u t firmly pull the leg inferiorly a n d wait for the i n n o m -
inate to glide into its normal position (Figure 8.12). T h e indirect technique
requires a few m o r e steps. Use the f e m u r to gently b u t firmly a n d slowly
push the i n n o m i n a t e superiorly a n d h e n c e further into its up-slip. Wait.
Y o u will feel the i n n o m i n a t e m o v e further into the up-slip. N e x t y o u may
feel a pulsation a n d then an impulse in the client's b o d y f o r the i n n o m i -
nate t o m o v e inferiorly. W h e n y o u f e e l the i m p u l s e t o m o v e inferiorly,
e n c o u r a g e that m o v e m e n t by slowly a n d gently pulling the leg inferiorly
at a s p e e d that matches the s p e e d with w h i c h the client's b o d y releases. If
108
THE PELVIS
Figure 8.12
at first y o u are u n a b l e to feel the impulse of the b o d y to m o v e inferiorly,

d o n ' t w o r r y a b o u t it. P e r f o r m the t e c h n i q u e as d i r e c t e d : use the f e m u r
to push the i n n o m i n a t e further into its up-slip, a n d simply h o l d it in that
position f o r a b o u t 5 to 10 s e c o n d s , a n d then traction the l e g a n d pelvis
inferiorly. T h e s e two m e t h o d s f o r releasing an up-slip were also created
by Jan Sultan.
Down-slip
Simply reverse the direct and indirect up-slip t e c h n i q u e . Y o u can use y o u r
client's leg t o directly push the pelvis superiorly. O r y o u c a n pull y o u r
client's leg inferiorly to increase the down-slip a n d wait f o r the i m p u l s e
to release superiorly.
Anterior Shear
With y o u r client p r o n e , stand on the same side of the table as the ante-
rior shear. Place the fingers of o n e h a n d on the anterior p u b e a n d place
the f o r e a r m o f y o u r o t h e r a r m o n the o p p o s i t e i n n o m i n a t e . W i t h y o u r
f o r e a r m , stabilize the pelvis while y o u gently b u t firmly push the anterior
109
p u b e in a p o s t e r i o r d i r e c t i o n (Figure
8.13) a n d wait. Either the i n n o m i n a t e
will d a n c e to its release or it will m o v e
directly to its n o r m a l position.
Posterior Shear
W i t h y o u r c l i e n t p r o n e , stand o n the
opposite side of the posterior shear. Use
the same h a n d a n d f o r e a r m p l a c e m e n t
as d e s c r i b e d f o r the anterior shear, but
this time use y o u r fingers to stabilize the
p u b e while you use your forearm to gen-
tly b u t firmly push the o p p o s i t e i n n o m -
inate (with the p o s t e r i o r p u b e ) in an
a n t e r i o r d i r e c t i o n . Wait. Either the in-
n o m i n a t e will release its restriction by
Figure 8.13 d a n c i n g this way and that or by m o v i n g
directly to its n o r m a l position.
Anterior Torsion
W i t h y o u r c l i e n t s u p i n e , stand o n the
s a m e side as the a n t e r i o r t o r s i o n a n d
place the heel o f o n e h a n d o n the ASIS
o f the anteriorly t o r s i o n e d i n n o m i n a t e
(Figure 8 . 1 4 ) . Bring the f e m u r p e r p e n -
dicular to the table with the k n e e b e n t
a n d lean a little of y o u r b o d y weight on
the k n e e . With y o u r o t h e r h a n d , gently
b u t f i r m l y apply pressure o n the ASIS
in the d i r e c t i o n of posterior torsion as
y o u use y o u r b o d y weight t o m o v e the
f e m u r t o e n c o u r a g e the p o s t e r i o r tor-
s i o n i n g o f the i n n o m i n a t e a n d wait.
Either the i n n o m i n a t e will go t h r o u g h
its d a n c e or it will m o v e directly to its
n o r m a l position. Figure 8.14
110
THE PELVIS
Figure 8.15
Posterior Torsion
With your client p r o n e , stand on the side with the posterior torsion. Place
o n e hand u n d e r the f e m u r just above the knee of the posteriorly torsioned
i n n o m i n a t e a n d the o t h e r h a n d o n the p o s t e r i o r aspect o f the i n n o m i -
nate itself. Lift the f e m u r slightly o f f the table a n d place y o u r k n e e u n d e r
it so y o u d o n ' t have to h o l d the leg up as y o u p e r f o r m the t e c h n i q u e (Fig-
ure 8 . 1 5 ) . Gently b u t firmly apply pressure to the i n n o m i n a t e with the
o t h e r h a n d in the d i r e c t i o n of an a n t e r i o r torsion a n d wait. Either the
i n n o m i n a t e will release its restriction by u n w i n d i n g or by m o v i n g directly
to its n o r m a l position.
As a general rule, r e m e m b e r that these iliosacral techniques, as well as all

the o t h e r techniques discussed in this b o o k , work best if y o u prepare the
myofascial and ligamentous tissues associated with the fixations y o u are
attempting to release. Preparing the tissues means that y o u release the asso-
ciated strain patterns and bring e n o u g h balance to the appropriate areas
of your client's b o d y so that he is able to adapt to y o u r manipulations. It
111
also helps if y o u are able to address the alignment of the whole b o d y along
with its m a n y patterns of c o m p e n s a t i o n . As a s o m a t i c p r a c t i t i o n e r y o u
already have y o u r favorite ways of releasing a n d b a l a n c i n g these tissues,
a n d y o u r t e c h n i q u e s are certainly a useful adjunct to the techniques y o u
learn f r o m this b o o k . However, even if y o u do n o t h i n g to p r e p a r e the tis-
sues or address patterns of c o m p e n s a t i o n , the t e c h n i q u e s taught in this
b o o k are still p o w e r f u l e n o u g h to get g o o d results all by themselves.
Note
1. Kendall, F l o r e n c e Peterson a n d McCreary, Elizabeth Kendall. Muscles:
Testing and Function. T h i r d e d i t i o n , B a l t i m o r e : (Williams a n d W i l k i n s ) ,
1983.
112
CHAPTER
The Ribs
N T H E L A S T C H A P T E R Y O U L E A R N E D H O W T H E PELVIS C O N T R I B U T E S T O
back pain. In this chapter y o u will learn h o w the ribs c o n t r i b u t e to a n d

h e l p perpetuate b a c k pain. T h e organization of the thorax, as well as
its myofascial, ligamentous, a n d articular fixations, can p r o f o u n d l y affect
the organization, integrity, a n d f u n c t i o n i n g of the w h o l e body. If y o u c o n -
sider only the j o i n t s of the thorax, there are 150 articulations, a n d m o s t
ribs can be involved in 6 articulations a l o n e . Just by f r e e i n g a myriad of
thoracic restrictions, w h i c h m i g h t i n c l u d e rib fixations in the ribs, ster-
n u m , clavicles, the l i g a m e n t s a n d fascia f r o m w h i c h the l u n g s are sus-
p e n d e d , a n d so o n , it is s o m e t i m e s possible to release n e c k a n d low b a c k
facet restrictions w i t h o u t ever e v e n w o r k i n g o n the n e c k o r l o w e r b a c k
themselves. In this chapter, however, we will limit o u r discussion to the
ribs only. O n c e y o u learn h o w to r e c o g n i z e a n d release rib dysfunctions,
y o u will be surprised a n d pleased at h o w this k n o w l e d g e will c o n t r i b u t e
greatly to your ability to release many facet restrictions in the thoracic and
cervical spines.
The Influence of the Ribs
S INCE T H E RIBS A R T I C U L A T E W I T H T H E SPINE I N VERY SPECIFIC WAYS,
they play a significant role in spinal dysfunction. Rib 1 articulates with

Tl and ribs 11 and 12 articulate with T i l and T 1 2 respectively. Ribs 1 , 1 1 ,
113
and 12 articulate with the spine by means of unifacets, whereas ribs 2 - 1 0

articulate by m e a n s of demifacets. All the ribs, with the e x c e p t i o n of 11
and 12, articulate in the front of the thorax by means of strong cartilagi-
n o u s attachments and this cartilage in turn also articulates with the ster-
n u m . L o o k at the front of the thorax and y o u will see that there are really
two attachments, called the c o s t o c h o n d r a l and sternochondral j u n c t i o n s ,
that are associated with most of these ribs. T h e costochondral j u n c t i o n acts
like a j o i n t a n d is f o r m e d by the insertion of the c o n c a v e e n d of the rib
into a c o n e - s h a p e d p i e c e of cartilage. T h e s t e r n o c h o n d r a l articulation is
f o r m e d by the costal cartilage inserting into the triangular notches of the
sternum, in which are f o u n d small synovial joints. M o t i o n occurs at b o t h
of these articulations a n d releasing a rib requires addressing the c o s t o -
c h o n d r a l j u n c t i o n and sometimes the sternochondral articulations as well.
T h e c o m p l e x relation between the ribs and vertebrae illustrated in Fig-
ure 9.1 shows why dysfunctional rib torsions usually result f r o m vertebral
rotations and Type II dysfunctions in the thoracic spine. T h e ribs that c o n -
n e c t to the s p i n e by m e a n s of d e m i f a c e t s articulate with two vertebrae.
Inferior costal Costal facet of transverse

articular facet process
Superior costal
articular facet
Figure 9.1
114
THE RIBS
Let's l o o k at the fifth rib as an e x a m p l e . R i b 5 attaches to the i n f e r i o r

costal facet of T 4 , the superior costal facet of T 5 , a n d the costal facet of
the transverse process of T 5 . If T4 rotates right on T 5 , T4 pulls the s u p e -
rior aspect of the rib with it, while the inferior aspect of the rib, w h i c h is
attached to T 5 , remains u n a f f e c t e d by the rotation. T h e right rotation of
T4 will thus cause the right fifth rib to torsion externally a n d the left fifth
rib to torsion internally.
Ribs that articulate by m e a n s of d e m i f a c e t s have two c o s t o v e r t e b r a l
c o n n e c t i o n s a n d o n e costotransverse c o n n e c t i o n . T h e floating ribs, 1 1
and 12, which attach by m e a n s of a unifacet do n o t have a costotranverse
articulation. Even t h o u g h they do n o t attach to the front of the rib cage
itself, they do have interesting c o n n e c t i o n s to the muscles of the p o s t e -
rior a b d o m i n a l wall. T h e s e c o n n e c t i o n s are important, because w h e n the
articulations of ribs 11 or 12 are fixed, they are a c c o m p a n i e d by myofas-
cial strain patterns in the a b d o m i n a l muscles. As my c o l l e a g u e a n d friend
Jan Sultan discovered, these strain patterns are often in the f o r m of a vor-
tex and they must also be released if y o u want to successfully release these
ribs as well. T h e ribs even have a t o u g h little ligament that attaches to the
annulus of the intervertebral disk. All of these c o n n e c t i o n s m e a n that a
rib in trouble can often cause m o r e pain than a dysfunctional vertebra
and learning h o w to release rib fixations will c o n t r i b u t e greatly to y o u r
skills.
D u e to the intimate relationships between ribs and spine, y o u can often
release rib dysfunctions simply by releasing the vertebral dysfunctions. So
the best strategy is to release Type II fixations first. But m a n y times releas-
ing the dysfunctional thoracic vertebra will n o t be e n o u g h to release the
rib. So always test and retest b o t h vertebral and rib fixations to make sure
y o u r manipulations are successful. Just r e m e m b e r that releasing Type II
fixations will sometimes release the rib a n d s o m e t i m e s n o t . Be aware that
it also works the other way—Type II fixations will not always remain released
until the rib fixations are released.
If y o u successfully release a dysfunctional thoracic vertebra, y o u r client
will p r o b a b l y immediately r e p o r t f e e l i n g better. But if y o u d o n ' t release
the associated rib fixation, y o u can e x p e c t to hear h o w the pain r e t u r n e d
within a few h o u r s or days. S o m e t i m e s this r e p o r t m e a n s that the u n r e -
solved rib fixation was e n o u g h to make the facet restriction reassert itself.
115
A n d o t h e r times it m e a n s that y o u r client is still in pain b e c a u s e of the

u n r e s o l v e d rib fixations, even t h o u g h y o u r release of the vertebral dys-
f u n c t i o n was c o m p l e t e l y successful. Ribs are very i m p o r t a n t in p e r p e t u -
ating back and n e c k pain. Many cervical fixations are held and maintained
by u p p e r rib fixations. I have seen t o o m a n y clients w h o received treat-
m e n t s f r o m therapists w h o k n e w h o w t o release vertebral dysfunctions,
b u t d i d n o t k n o w h o w to release rib fixations. T h e result of only releasing
the thoracic vertebrae is that often the rib fixations worsen a n d the client
ends up with m o r e pain than b e f o r e she started treatment. So always c h e c k
f o r a n d release rib fixations. Y o u r clients will love y o u f o r it.
Finding the Fixed Ribs
R IBS C A N G E T I N T O T R O U B L E I N A N U M B E R O F W A Y S . T H E Y C A N T O R S I O N
internally or externally, they can sublux anteriorly or posteriorly, the

first rib can slip superiorly, a n d they can b e c o m e distorted a n d dysfunc-
tional t h r o u g h trauma. We will e x p l o r e h o w to understand a n d treat tor-
sion, subluxation, a n d first rib dysfunction.
T h e technique for releasing the ribs is very simple and straightforward.
All y o u n e e d to k n o w is h o w to locate the fixed rib. T h e r e are two simple
ways to locate a fixed rib that do n o t require y o u to k n o w whether the rib
is torsioned or subluxed. O n c e y o u locate the fixed rib, applying the tech-
n i q u e will tell y o u h o w the rib is p o s i t i o n e d as y o u f o l l o w h o w it dances
toward its r e l e a s e — e v a l u a t i o n and treatment m e r g e t o g e t h e r as o n e and
the same process.
N o t i c e that there are two grooves associated with the spine. T h e spinal
g r o o v e is b e t w e e n the spinous a n d transverse processes of the spine. A n -
o t h e r groove is f o r m e d where the ribs articulate with the spine at the costo-
transverse j u n c t i o n . Illustrated by the drawing in Figure 9.2, this articulation
is r o u g h l y at the lateral b o r d e r s of the errectors. To find this rib g r o o v e ,
place the p a d of y o u r t h u m b on the spinous process, and drag your t h u m b
laterally. A l m o s t immediately y o u will feel y o u r t h u m b sink into the spinal
g r o o v e . C o n t i n u e to drag y o u r t h u m b laterally over the transverse process
until y o u feel it o n c e again fall i n t o an i n d e n t a t i o n or g r o o v e . This sec-
o n d g r o o v e is the costotransverse g r o o v e and y o u will n o t i c e that it is n o t
as d e e p as the spinal g r o o v e . Practice finding the costotransverse g r o o v e
116
THE RIBS
b e c a u s e the two tests that

y o u will learn f o r d e t e r m i n -
ing rib fixations require y o u
to p l a c e y o u r fingers h e r e .
Although the costotransverse
g r o o v e is the b e s t p l a c e to
Rib angle
feel for rib fixations, it is n o t
as useful if y o u are trying to
palpate f o r t o r s i o n o r s u b -
luxation.
Before y o u learn the two
methods for determining rib Costotransverse groove Spinal groove
fixation, let's first look at how

Figure 9.2
to palpate for torsion and
subluxation. A l t h o u g h it is
n o t altogether necessary, it helps if y o u can l o o k at a skeleton while prac-
ticing rib palpation. T h e first thing to n o t i c e is that the superior b o r d e r s
of ribs are n o t as easy to feel as the inferior b o r d e r s . T h e shape and posi-
tion of these b o r d e r s is such that the s u p e r i o r b o r d e r feels less distinct
than the inferior border. So d o n ' t let this feature of h o w the ribs are shaped
mislead y o u into thinking y o u are palpating internal torsion.
To d e t e r m i n e torsion, palpate the superior and inferior b o r d e r s of the
suspected rib at about the rib angle. If the rib is externally torsioned, then
y o u will find two telltale signs: the s u p e r i o r b o r d e r will be m o r e p r o m i -
n e n t a n d the i n f e r i o r less p r o m i n e n t than n o r m a l , a n d the intercostal
space above the rib will be wider a n d the intercostal space b e l o w the rib
will be narrower than n o r m a l . Internal torsion displays j u s t the o p p o s i t e
features. T h e inferior b o r d e r of the suspected rib will be m o r e p r o m i n e n t
and the superior b o r d e r will be less p r o m i n e n t than n o r m a l , and the inter-
costal space b e l o w the rib will be wider a n d the intercostal space a b o v e
the rib will be narrower than usual.
T o d e t e r m i n e subluxation, palpate the h e a d o f the s u s p e c t e d rib o n
the front of the rib cage at the c o s t o c h o n d r a l j u n c t i o n a n d the rib angles
on the posterior side of the rib c a g e . T h e n c o m p a r e the suspected rib to
the rib on the o t h e r side. Is the p o s t e r i o r rib angle of the suspected rib
m o r e a n t e r i o r / p o s t e r i o r ? Is the rib h e a d m o r e a n t e r i o r / p o s t e r i o r than
117
the rib on the o t h e r side at the c o s t o c h o n d r a l j u n c t i o n ? If the rib angle

a n d the rib h e a d at the c o s t o c h o n d r a l j u n c t i o n are b o t h m o r e anterior in
c o m p a r i s o n to the rib on the o t h e r side, then the suspected rib is p r o b a -
bly anteriorly s u b l u x e d . If the rib a n g l e a n d the rib h e a d at the c o s t o -
c h o n d r a l j u n c t i o n are b o t h m o r e posterior than the rib on the o t h e r side,
then the suspected rib is p r o b a b l y posteriorly s u b l u x e d .
Palpating ribs f o r torsion a n d subluxation can be difficult, especially
on clients w h o s e b a c k musculature is highly d e v e l o p e d . To increase y o u r
palpatory skills it is best f o r y o u to practice feeling these rib patterns. But
fortunately, y o u really d o n ' t have to go t h r o u g h the a b o v e process of pal-
p a t i o n to find a fixed rib a n d free it. Y o u can simply p u t y o u r t h u m b in
the costotransverse g r o o v e on the suspected rib and m o t i o n test it.
Use the so-called "spring test" to motion-test ribs. Put y o u r t h u m b on
the suspected rib where it articulates with the costotransverse process and
with firm pressure quickly push anteriorly a n d j u s t as quickly release the
pressure. Do this a c o u p l e of times in rapid succession so that y o u can feel
w h e t h e r the rib springs or not. If y o u c a n n o t feel the rib spring, it is p r o b -
ably fixed. Spring test a n u m b e r of ribs until y o u can feel the clear dif-
ference between a fixed rib that has no spring to it and a free rib that easily
springs with pressure.
A n o t h e r way to m o t i o n test for rib fixations is through a kind of assisted
spring test. Place y o u r client in a sitting position and ask h i m to put each
h a n d on his o p p o s i t e s h o u l d e r so that his arms are crossed. Stand b e h i n d
y o u r client a n d h o l d up his crossed arms at his elbows with o n e of y o u r
hands. Make sure that y o u r client gives you the full weight of his arms and
is n o t unconsciously trying to help you h o l d his arms u p . Place your thumb
in the area of the suspected rib a n d then s m o o t h l y b u t rapidly raise and
lower y o u r client's arms. As y o u raise his arms, push y o u r t h u m b anteri-
orly a n d then let the pressure o f f as y o u lower his arms (Figures 9.3 and
9 . 4 ) . If either or b o t h the costotransverse or costovertebral joints are fixed,
y o u r t h u m b will n o t sink in an anterior direction as y o u raise y o u r client's
arms. If y o u r t h u m b d o e s n ' t sink anteriorly as y o u raise your client's arms,
y o u have d i s c o v e r e d a fixed rib.
B o t h of these tests will give y o u all the information y o u n e e d to release
rib fixations, b u t the assisted spring test is a little m o r e reliable a n d accu-
rate, especially if y o u are n e w to palpating f o r rib fixations. N o t i c e that
118
»
THE RIBS
these tests only tell y o u w h i c h ribs are fixed b u t they do n o t also tell y o u
whether the ribs are fixed in anterior or posterior subluxation or in exter-
nal or internal torsion. Fortunately y o u d o n ' t really n e e d to m a k e these
kinds of discriminations in o r d e r to use the t e c h n i q u e f o r releasing ribs.
Y o u only n e e d to k n o w w h e r e the fixation is l o c a t e d .
By the way, as a m e t h o d to increase evaluation skills, y o u s h o u l d also
k n o w that rib fixations are usually a c c o m p a n i e d by characteristic t e n d e r
points in the soft tissues, illustrated in Figure 9.5, p a g e 120. N o t i c e that a
n u m b e r o f these t e n d e r points are a l o n g the e d g e o f the scapula. W h e n
clients have fixed ribs, it is quite c o m m o n f o r t h e m to tell y o u that they
are experiencing pain at the e d g e of their scapula. However, d o n ' t be mis-
l e d b y w h e r e y o u r clients tell y o u t o l o o k f o r painful spots. M o r e o f t e n
than n o t the pain they feel in the area of the r h o m b o i d s is s e c o n d a r y to
and a result of the rib fixation. If y o u release the r h o m b o i d s a n d do n o t
release the o f f e n d i n g rib, y o u r client's pain will return very shortly. H o w -
ever, after y o u release the rib, releasing the myofasciae a l o n g the shoul-
d e r blade will s u p p o r t y o u r release of the rib.
119
Rib tenderpoints
Figure 9.5
A n o t h e r way to locate fixations is to run y o u r thumbs or fingers d o w n

the costotransverse g r o o v e o n o n e side o f the spine and then the other,
a n d n o t i c e if y o u feel s o m e t h i n g that makes y o u want to investigate. Do
this w i t h o u t any p r e c o n c e p t i o n s a n d y o u will be surprised by h o w often
y o u r fingers will land on a rib fixation. Y o u can do the same thing in the
spinal g r o o v e if y o u want to practice a quick way to find vertebral facet fix-
ations. O n c e y o u gain c o n f i d e n c e in y o u r ability to feel for fixations in this
way, y o u c a n search o u t dysfunctions in the same way anywhere in y o u r
client's body. This m e t h o d of locating p r o b l e m s in your clients is quite ele-
gant a n d s o m e t h i n g y o u can easily practice every time y o u treat them.
As y o u may r e m e m b e r , the first rib behaves a little differently than ribs
2 - 1 0 . W h e n the first rib b e c o m e s dysfunctional it tends to get fixed in a
superior position. W h e n it is in trouble y o u will also find that the scalenes
will be hypertonic on the same side as the fixed rib and that there will be
m a r k e d tenderness in the area of the superior aspect of the first rib near
where it articulates with T l . Have y o u ever had the e x p e r i e n c e of d o i n g a
great j o b of releasing your client's cervical pain only to have him report that
his n e c k still h u r t s — a n d that it especially hurts when he turns his head to
o n e side where he feels the pain shooting along the right superior edge of
his traps? Such a report is usually an indication that the right first rib is fixed.
120
THE RIBS
T h e r e are two ways of testing f o r whether the first rib is in trouble. T h e

first m e t h o d is just a n o t h e r variation of the spring test. With y o u r client
in a sitting position, place the p a d of y o u r t h u m b over w h e r e the first rib
articulates with Tl and spring test downwardly in a c a u d a d direction. If it
d o e s n ' t spring it is p r o b a b l y fixed. A n o t h e r way to test the first rib is to
p u t y o u r client in a sitting p o s i t i o n a n d p l a c e the fingers of e a c h h a n d
over the first ribs, with y o u r forefingers very close to the spinal articula-
tion a n d ask y o u r client to take a d e e p b r e a t h . If o n e of the first ribs is
fixed it will n o t m o v e with the inhalation.
Rib Techniques
B EFORE Y O U R E L E A S E A N Y R I B F I X A T I O N S , B E C E R T A I N T H A T T H E S O F T
tissues o f the t h o r a c i c r e g i o n are a d e q u a t e l y p r e p a r e d , e s p e c i a l l y

a r o u n d the costotransverse, costovertebral, c o s t o c h o n d r a l , a n d s t e r n o -
c h o n d r a l regions. First release all T y p e II facet fixations in the t h o r a c i c
spine.
All o f the f o l l o w i n g t e c h n i q u e s f o r releasing ribs are d o n e with the
client in a sitting position. For dysfunctions of ribs 2 - 1 0 , place the finger
o r t h u m b o f o n e h a n d o n the costotransverse articulation a n d a f i n g e r o f
the o t h e r h a n d on the c o s t o c h o n d r a l articulation of the dysfunctional rib
(Figures 9.6, 9.7, a n d 9.8, pages 1 2 2 - 1 2 3 ) . Slowly, b u t with g e n t l e , firm
pressure push y o u r fingers toward each other. As y o u apply pressure, ask
your client to sidebend his b o d y to the same side as the fixed rib. H o l d and
wait. Follow the d a n c e of the rib as it unwinds, releases its restrictions, a n d
the tissue softens. C o n t i n u e to h o l d a n d wait until y o u feel the b o d y orga-
nize itself as m u c h as it can a r o u n d vertical a n d h o r i z o n t a l planes. Y o u
may r e m e m b e r f r o m earlier chapters that there are two stages to the final
release of a j o i n t fixation. First y o u will feel the s o f t e n i n g of the tissues
and then, if y o u waitjust a little longer, y o u may feel the o r t h o t r o p i c effect
as y o u r client's b o d y organizes itself a r o u n d the sagittal, transverse, a n d
c o r o n a l planes. For m o s t somatic practitioners feeling the b o d y o r g a n i z e
itself a r o u n d vertical lines is the easiest. So d o n ' t w o r r y a b o u t n o t feeling
all of these planes c o m e in d u r i n g the release. Just practice f e e l i n g what
you can and in time you will feel even m o r e . These planes intersect at right
angles and as a short h a n d way to talk a b o u t h o w the b o d y organizes itself
121
Figure 9.6
Figure 9.7
122
THE RIBS
a r o u n d these planes, I refer to it as

o r t h o g o n a l organization.
Let's s u p p o s e the rib y o u are at-
tempting to release is stuck in exter-
nal torsion. As the rib g o e s t h r o u g h
its d a n c e , y o u will n o t i c e it o f t e n
m o v e s further i n t o external torsion
b e f o r e it releases. T h e rib will m o v e
in m a n y o d d ways, b u t eventually it
will m o v e further i n t o external tor-
s i o n . W h e n the rib c o m p l e t e s this
m o v e m e n t it will then m o v e o u t of
external torsion toward a m o r e n o r -
mal position. Tracking this rib m o -
tion and taking n o t e of its positions
while y o u are attempting to release
Figure 9.8 it is the way y o u d e t e r m i n e h o w the
rib is stuck. W h e n the rib finally comes
to rest in what is n o r m a l position in relation to the rest of the body, it will
stop m o v i n g . Y o u will t h e n feel the tissue soften a n d the characteristic
attempt of the b o d y to organize orthotropically and o r t h o g o n a l l y a r o u n d
the release.
For dysfunctions of the 11th a n d 12th ribs, place the t h u m b or finger
of o n e h a n d as close as possible to the costovertebral articulation a n d the
forefinger and t h u m b of the o t h e r h a n d a l o n g the length of the rib as it
wraps its way a r o u n d the body, as shown in Figures 9.9 a n d 9.10, page 124.
Slowly apply gentle b u t firm pressure to the costovertebral j u n c t i o n a n d
sidebend your client to the side on which the rib is fixed. Follow the d a n c e
and wait f o r the rib to release a n d f o r the b o d y to o r g a n i z e orthogonally.
D o n ' t forget that there are fascial vortices in the posterior a b d o m i n a l wall
that are often associated with restrictions in the 11th a n d 12th ribs, a n d
that these myofascial strain patterns must also be released f o r this tech-
n i q u e to be fully effective.
To release these associated fascial vortices, ask y o u r client to lie supine.
If any vortices are present, they will be f o u n d medial to the tips of the 11th
and 12th ribs roughly in the area of the external a b d o m i n a l o b l i q u e , trans-
123
Figure 9.9
Figure 9.10
124
THE RIBS
versus, a n d rectus a b d o m i n u s . To search f o r these vortices, gently push

the pad of your t h u m b or forefinger and m i d d l e finger into various places
in the area just d e s c r i b e d and wait to see if y o u r fingers are drawn d o w n
and into the tissue in a spiraling fashion, as shown in Figures 9.11, 9.12,
and 9.13. If this h a p p e n s y o u have d i s c o v e r e d a fascial vortex. Place the
forefingers, o r the forefingers a n d m i d d l e f i n g e r s , o f b o t h h a n d s i n the
area of the vortex a n d gently sink i n t o the tissue waiting f o r the b o d y ' s
response. M o r e often than n o t y o u r fingers will gently follow the tissue by
spiraling d e e p e r i n t o the vortex. W h e n y o u r e a c h the e n d o f the spiral-
ing, y o u will feel a softening of the tissue a n d an i m p u l s e f o r the v o r t e x
to unwind itself up a n d o u t of its spiral. Let this h a p p e n . S o m e t i m e s y o u r
fingers just spiral d o w n into the tissue and the b o d y will simply release the
strain without spiraling back out. Either way the release h a p p e n s , y o u will
know the technique is finished when y o u feel the tissues soften and release
along a vertical line. Like all releases, the b o d y will try to o r g a n i z e itself
orthogonally, but feeling the o t h e r planes while releasing fascial vortices
is sometimes a little difficult.
Figure 9.11
125
Figure 9.12
Figure 9.13
126
THE RIBS
If y o u m o t i o n test and find a restricted first rib, m o r e than likely it will

be fixed superiorly. Let's s u p p o s e y o u find the restriction in the right first
rib. With y o u r client in a sitting position, snuggle the e d g e of y o u r ulna
(the part that is closest to y o u r o l e c r a n o n ) o n t o your client's first rib where
it attaches to Tl at the costotransverse j u n c t i o n . Ask y o u r client to d r o p his
head as far forward as is c o m f o r t a b l e and to remain in this position while
he slowly turns his head to the left. As he turns left, let y o u r e l b o w sink fur-
ther into the j o i n t space (Figure 9 . 1 4 ) . T h e n ask h i m to b r i n g his h e a d
back to center and very slowly turn to the right, all the while k e e p i n g his
head in the forward b e n t position (Figure 9.15). As he slowly turns right,
continue to apply gentle but firm pressure in a caudad direction to the rib
head. Wait f o r the rib to go through its unwinding, release its restriction,
and f o r the tissues to soften. C o n t i n u e with the pressure until the b o d y
organizes itself o r t h o g o n a l l y as m u c h as it c a n . T h e n be sure to release
scalenes on the ipsilateral side.
This chapter on the ribs really brings this manual on spinal manipula-
tion to a close. In the next and last chapter I will discuss a few o d d s and ends
that will clarify s o m e important points and suggest a few o t h e r techniques.
127
CHAPTER
10
Odds and Ends
T HE BODY IS N O T A SOFT MACHINE OR A C O M P L E X T H I N G M A D E OF
parts. It is a seamless unified living w h o l e capable of adapting to an

e v e r - c h a n g i n g internal a n d e x t e r n a l e n v i r o n m e n t . W h a t w e are
t e m p t e d to call "parts" of the b o d y are really n o t parts at a l l — o u r b o d i e s
are n o t c o b b l e d t o g e t h e r f r o m p r e - s h a p e d parts the way m a c h i n e s are.
Any attempt to take apart a b o d y the way y o u might disassemble a m a c h i n e
into its parts only results in a heap of lifeless pieces that c a n n o t be reassem-
b l e d as a body. So we speak t o o loosely w h e n we refer to the liver or brain
or the f o o t as a part of the body. W h e n e v e r we refer to s o m e aspect of the
living body, such as the h a n d or the heart, we are really r e f e r r i n g to an
aspect or expression of the w h o l e . An organ is n o t in the b o d y in the same
way a c a r b u r e t o r is in a car. Conceptually, we can distinguish these dif-
ferent aspects of the w h o l e , but no o n e of these aspects is functionally sep-
arate f r o m the w h o l e .
What we call organs and other anatomical structures are in reality orga-
nized, unified relationships related to the living whole which is also a living,
organized, unified relationship. Every unified relationship is c o m p o s e d of
other unified relationships and every relationship is an integral aspect of
other relationships. T h e connections, c o m m u n i c a t i o n networks, and forces
between bodily relationships are themselves unified relationships and the
way they all function together is a unified relationship. What we are tempted
to call parts are n o t only unified relationships, but also organized wholes.
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T h e s e o r g a n i z e d w h o l e s exist in relationship to o t h e r o r g a n i z e d wholes

a n d overlap as networks of c o m m u n i c a t i o n a n d c o n n e c t i o n that are all
expressions of a deliquescent, b u t exquisitely and hierarchically organized
w h o l e . S o m e u n i f i e d r e l a t i o n s h i p s , like the h e a r t a n d b r a i n , are m o r e
i m p o r t a n t to the survival of the w h o l e than others. But since the b o d y is
n o t c o m p o s e d of parts, there is n o t h i n g m o r e fundamental to the makeup
a n d organization of the w h o l e than the w h o l e itself. Since the b o d y is an
i r r e d u c i b l e c o m p l e x i t y a n d n o t c o b b l e d t o g e t h e r f r o m pre-shaped parts,
every detail of the w h o l e is an expression of the unified, seamless o r g a n -
ization o f the w h o l e . T h e shape o f every b o n e i n y o u r body, f o r e x a m p l e ,
is a matchless manifestation of y o u r u n i q u e m o r p h o l o g y .
All living organisms are self-organizing a n d we h u m a n s are the most
highly plastic of all. O r g a n i s m s persist o v e r time b e c a u s e they are c o n -
stantly i n the p r o c e s s o f f o r m i n g a n d r e - f o r m i n g their b o u n d a r i e s i n
response to their ever-changing e n v i r o n m e n t s . Living beings are able to
accomplish this remarkable feat in the face of persistent internal and exter-
nal c h a n g e b e c a u s e their o r d e r a n d organization is self-maintained and
self-contained. An o r g a n i s m is like a fountain of water w h o s e constituent
materials are b e i n g rapidly r e p l a c e d , while variations in the f o r m remain
the same o v e r time. But unlike a fountain w h e r e the f o r m is maintained
b y o u t s i d e f o r c e s , o r g a n i s m s have the i n h e r e n t p o w e r t o maintain a n d
adapt their f o r m to their e n v i r o n m e n t . Maintaining, adapting, and evolv-
ing bodily f o r m in an ever-changing environment are part of what it means
to be alive. H o w well o u r b o d i e s a c c o m p l i s h these amazing feats are also
an i m p o r t a n t part of what d e t e r m i n e s o u r level of health, happiness, and
sense o f well-being a n d f r e e d o m .
T h e s e characteristics result in a b o d y that is also highly adaptive and
plastic. If a p e r s o n is i n j u r e d , say in an a u t o m o b i l e a c c i d e n t , h e r b o d y
often d e v e l o p s patterns of c o m p e n s a t i o n in relation to the original pat-
tern of injury. T h e a u t o m o b i l e a c c i d e n t d o e s n o t just cause a local p r o b -
l e m with s o m e "part" of the body, it also creates global patterns of strain
that in turn affect the o r g a n i z a t i o n a n d f u n c t i o n i n g of the entire b o d y
a n d its relation to gravity.
T h e o r i g i n a l p a t t e r n o f injury m o r e o f t e n than n o t i s laid d o w n o n
o t h e r previous injuries a n d postural imbalances. A l o n g with the resulting
p a t t e r n s o f c o m p e n s a t i o n i n r e l a t i o n t o gravity, these i m b a l a n c e s a n d
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ODDS AND ENDS
injury patterns result in a complicated loss of inherent plasticity and adapt-

ability throughout the entire body. Over time, further losses in m o v e m e n t ,
plasticity, and adaptability will appear as the b o d y struggles with gravity in
its daily activities. If these c o m p l i c a t e d patterns of strain a n d c o m p e n s a -
tion are n o t released, a n d perhaps m o r e importantly, n o t released in the
p r o p e r order, the b o d y will n o t be able to r e s p o n d p r o p e r l y to interven-
tions d e s i g n e d to release the original injury site or any o t h e r area of dys-
function. Treating the b o d y as an assemblage of dysfunctional parts a n d
releasing the parts s y m p t o m by s y m p t o m is the m o s t c o m m o n way that
somatic practitioners a p p r o a c h therapy. This m e t h o d o l o g y can be called
the " c o r r e c t i v e a p p r o a c h . " It certainly has its p l a c e in the t h e r a p e u t i c
arena, b u t it is usually less effective than the "holistic a p p r o a c h " w h i c h
requires understanding the i n t e r c o n n e c t e d living w h o l e in which all these
local dysfunctions are e m b o d i e d .
T h e h u m a n b o d y is a m a z i n g in its i n t e r c o n n e c t e d , i r r e d u c i b l e c o m -
plexity a n d equally a s t o u n d i n g in its seamless simplicity. T h e m o r e we
understand a b o u t the unified, systematic, i n t e r c o n n e c t e d nature o f o u r
b o d i e s a n d h o w the w h o l e p e r s o n r e s p o n d s t o injury and i n t e r v e n t i o n ,
the better o u r therapy b e c o m e s . This realization m e a n s that as m u c h as
possible we must k e e p e x p a n d i n g o u r u n d e r s t a n d i n g of, a n d o u r ability
to feel, this unified living w h o l e that we are. It also m e a n s that if we want
o u r manipulations to be l o n g lasting, we must e x p a n d o u r u n d e r s t a n d i n g
so that we can work holistically rather than just correctively. T h e holistic
a p p r o a c h to somatic therapy aims n o t o n l y to r e m e d i a t e s y m p t o m s , b u t
also to e n h a n c e the w h o l e p e r s o n . Effective holistic somatic therapy d e -
m a n d s that the practitioner n o t only be able to perceive the w h o l e , b u t
to also track the effects of her local manipulations on the w h o l e .
So in a sense, even t h o u g h this b o o k is a b o u t spinal m a n i p u l a t i o n , it
should also be a b o u t the w h o l e body. But such a goal is t o o vast f o r a m a n -
ual of technique. In order to make this b o o k manageable, I have approached
therapeutic intervention f r o m the corrective perspective. Unfortunately,
since the corrective a p p r o a c h tends to understand the client as a c o l l e c -
tion of symptoms, it is almost always just a little t o o shortsighted. Since so
many local areas of dysfunction are tied to, a n d h e l d , by m o r e global pat-
terns of strain, the holistic perspective is r e q u i r e d to gain s o m e u n d e r -
standing of these whole b o d y connections. That is why I mention the holistic
131
perspective n o w a n d also why I have taken s o m e limited excursions into

o t h e r areas of the body. Like all therapists, y o u want y o u r clients to e x p e -
r i e n c e long-lasting relief as a result of y o u r spinal manipulations. T h e s e
digressions will h e l p y o u to u n d e r s t a n d a n d treat s o m e of the m o r e sig-
nificant c o m p e n s a t i o n s and fixations that contribute to your client's b o d y
maintaining its d y s f u n c t i o n s — b u t obviously n o t all of them.
T h e i n h e r e n t difficulties with the corrective a p p r o a c h to therapy can
only be o v e r c o m e with a m o r e complete discussion of the holistic approach.
Such a discussion w o u l d have to show that the corrective approach is based
on a mechanical understanding of the b o d y that sees it as a c o m p l e x thing
m a d e of parts. It w o u l d also have to articulate a p r o p e r p h i l o s o p h y and
s c i e n c e of living w h o l e s that w o u l d f o r m the biological f o u n d a t i o n f o r a
holistic m e d i c a l system. It w o u l d also i n c l u d e understanding and treating
the w h o l e body, n o t just the spine. T h u s , we w o u l d also have to e x p l o r e
h o w to treat the c r a n i u m , the extremities, a n d the o r g a n s , the c e l o m i c
sacs, and the m a n y energetic d i m e n s i o n s , n e u r o l o g i c a l and psychological
dysfunctions, a n d s o o n .
Even assuming that we had all this k n o w l e d g e and were able to effec-
tively treat all these different aspects of the w h o l e person, it w o u l d still n o t
be e n o u g h . On what basis do we take all of the information gathered from
o u r evaluation a n d prioritize all the relevant techniques into a treatment
strategy that takes a c c o u n t of h o w o u r client's w h o l e b o d y can adapt to
a n d s u p p o r t o u r interventions? H o w w e answer the three f u n d a m e n t a l
questions of therapy is critical: W h a t do I do first, W h a t do I do next, and
W h e n am I finished?
After we have fully evaluated o u r client's kinds a n d levels of dysfunc-
tion, we n e e d a way to create a treatment strategy that is based on s o m e -
thing other than simply following already d e t e r m i n e d formulistic protocols
or j u s t treating the p r o b l e m s s y m p t o m by s y m p t o m . Treating clients by
following a treatment recipe is a useful way to learn in the beginning stages
of b e c o m i n g a s o m a t i c practitioner, b u t this m e t h o d is n o t fully a p p r o -
priate f o r m o s t clients a n d it is n o t a p p r o p r i a t e f o r us as we c o n t i n u e to
mature as therapists. In o r d e r to learn h o w to treat o u r clients in all their
individuality, w i t h o u t the b e n e f i t of formulistic p r o t o c o l s , we must also
k n o w h o w t o e n g a g e i n a p r i n c i p l e - c e n t e r e d clinical d e c i s i o n - m a k i n g
process. So a c o m p l e t e discussion of holistic somatic therapy w o u l d also
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ODDS AND ENDS
require a lengthy investigation into the principles of intervention: what a

principle is, h o w principles are different f r o m strategies, h o w principles
function in formulating treatment strategies, a n d j u s t exactly what these
principles are.
All of these important topics are obviously b e y o n d the s c o p e of a m a n -
ual on soft-tissue t e c h n i q u e s . But m e n t i o n i n g t h e m illuminates the full
scope of somatic therapy and discussing t h e m keeps us h u m b l e by r e m i n d -
ing us h o w m u c h we have to learn.
Since we have to start s o m e w h e r e , and this b o o k marks a way to b e g i n ,
let's return to a m o r e m a n a g e a b l e task. This c h a p t e r of the b o o k will be
d e v o t e d to a few details that I purposely left f o r the e n d . U n d e r s t a n d i n g
them will contribute further to y o u r ability to manipulate the spine. S o m e
of these details c o n c e r n the issue of adaptability—in this discussion y o u
will learn what can appropriately be called preparatory t e c h n i q u e s . But I
also want to give y o u a few simple ways to a p p r o a c h spinal curvature. Y o u
may r e m e m b e r that I briefly talked a b o u t curvature w h e n I i n t r o d u c e d
what are called T y p e I g r o u p curves toward the e n d of C h a p t e r T h r e e .
We will l o o k at adaptability issues first a n d then take a b r i e f tour of spinal
curvature.
Adaptability
A S I S U G G E S T E D A B O V E , F O R M U L A T I N G A T R E A T M E N T S T R A T E G Y T H A T IS
n o t d e p e n d e n t on formulistic p r o t o c o l s or treating y o u r clients symp-

t o m by s y m p t o m requires a clinical-decision m a k i n g process that is based
on the principles of intervention. I f o r m u l a t e d a principle-centered d e c i -
sion-making process in c o l l a b o r a t i o n with my c o l l e a g u e a n d f r i e n d , Jan
Sultan. O n e of the principles is called the "Adaptability Principle." I have
discussed the rationale b e h i n d this principle a n u m b e r of times t h r o u g h -
out this b o o k . T h e idea b e h i n d it is simple and quite obvious: if your client's
b o d y i s n o t capable o f adapting t o o r a c c e p t i n g y o u r i n t e r v e n t i o n , t h e n
either his b o d y will return to its dysfunctional state or y o u r m a n i p u l a t i o n
will drive strain to o t h e r areas of his b o d y — o r b o t h . This is very often the
u n w e l c o m e c o n s e q u e n c e o f treating s y m p t o m b y s y m p t o m . But e x p e r i -
e n c e d holistic therapists understand what happens w h e n they do n o t p r o p -
erly prepare a client's b o d y to adapt to the effects of their manipulations.
133
Y o u r c l i e n t c o m p l a i n s that his pain r e t u r n e d a l m o s t i m m e d i a t e l y after

y o u r treatment, or that his pain is n o w worse, or has spread to o t h e r areas
of his body. Of course, there c o u l d be o t h e r explanations for why this hap-
p e n s , b u t failure to p r e p a r e the client's b o d y is certainly o n e of the m o r e
c o m m o n reasons.
Techniques f o r preparing y o u r client's b o d y so that it can adapt to your
interventions can vary f r o m simply relaxing the appropriate tissues around
a vertebra b e f o r e y o u release its facet restriction to making sure that the
b o d y as a w h o l e can adapt to y o u r manipulations above and support them
below. S o m e t i m e s p s y c h o l o g i c a l issues interfere with y o u r intervention.
It is n o t at all u n c o m m o n to treat clients w h o have b e e n sexually and phys-
ically abused. For s o m e of these clients every attempt y o u make to m a n i p -
ulate the pelvis a n d l o w b a c k is m e t with u n c o n s c i o u s resistance. T h e s e
u n f o r t u n a t e clients c a n n o t adapt to y o u r intervention because they are
n o t p s y c h o l o g i c a l l y p r e p a r e d t o deal with the m e m o r i e s a n d e m o t i o n s
that m i g h t result if they were to allow c h a n g e s in their b o d i e s .
A n o t h e r very important principle of intervention is the "Support Prin-
c i p l e . " It is actually a specific application of the adaptability principle and
also derived f r o m the p i o n e e r i n g work of Dr. Ida P. Rolf. It says that o r d e r
is a f u n c t i o n of available s u p p o r t in gravity. A g a i n , the rationale b e h i n d
this principle is simple and obvious: if y o u r client's b o d y is n o t able to sup-
p o r t the c h a n g e s y o u i n t r o d u c e , then either it will revert to its p r i o r dys-
functional state or y o u will drive strain e l s e w h e r e — o r b o t h . If y o u d e c i d e
to release a n u m b e r of fixations in the pelvic and lumbar region, for exam-
ple, and your client's legs are n o t u n d e r him properly supporting the pelvis
a n d the rest of his b o d y , then the ability of y o u r client to h o l d o n t o the
results of y o u r treatment will be limited.
I m a g i n e h o w y o u m i g h t p r o c e e d if y o u r evaluation revealed that y o u r
client c o u l d neither adapt above o r below, o r s u p p o r t y o u r interventions.
Y o u w o u l d have to create a treatment strategy that addressed all of h e r
specific adaptability a n d s u p p o r t issues. In a situation like this, it is usu-
ally best to b e g i n by addressing the m o s t important adaptability issues first
a n d the s u p p o r t issues last. T h e reason f o r this particular a p p r o a c h rests
on the observation that w o r k on the feet a n d legs tends to release upward
through the body. If y o u r client's b o d y c a n n o t adapt above to this upwardly
rising wave of release that almost always results f r o m w o r k i n g on feet and
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ODDS AND ENDS
legs, then y o u r manipulations c o u l d cause s o m e nasty p r o b l e m s in y o u r

client's thorax, n e c k , a n d h e a d . O n l y after these adaptability a n d s u p p o r t
issues have b e e n h a n d l e d should y o u b e g i n working to release the myofas-
cial and j o i n t fixations in the pelvic r e g i o n .
A s y o u p r o b a b l y realized, there are o t h e r p r i n c i p l e s o f i n t e r v e n t i o n
and other considerations a b o u t h o w to evaluate the structural, functional,
and energetic aspects of the w h o l e p e r s o n that are important to this holis-
tic decision-making process. I m e n t i o n only the s u p p o r t a n d adaptability
principles because they are o b v i o u s a n d can be used to give y o u an idea
of h o w p r i n c i p l e - c e n t e r e d d e c i s i o n m a k i n g works a n d a sense of h o w a
holistic somatic practitioner operates a c c o r d i n g to principles.
In this c h a p t e r we will limit o u r discussion to issues of local adaptabil-
ity. Discussing the m o r e g l o b a l c o m p e n s a t i o n s a n d strain patterns that
manifest in a p e r s o n ' s structural, f u n c t i o n a l , e m o t i o n a l , a n d e n e r g e t i c
ways of b e i n g w o u l d require another b o o k on h o w to evaluate these global
patterns, as well as a c o m p l e t e discussion of the p r i n c i p l e s of i n t e r v e n -
tion. To k e e p things simple we will o n l y discuss those local areas of the
b o d y that are directly relevant to releasing the j o i n t fixations we have dis-
cussed in this b o o k .
What to Prepare
T HIS SECTION DESCRIBES MANY OF T H E LOCAL AREAS OF MYOFASCIAL
and ligamentous dysfunction that are c o m m o n l y associated with j o i n t

fixations. As a general r u l e , y o u s h o u l d c o n s i d e r releasing these associ-
ated areas first b e f o r e d e a l i n g with the s p e c i f i c j o i n t f i x a t i o n . Y o u c a n
release the tissues after y o u release the j o i n t fixation, b u t it is usually eas-
ier on y o u a n d on y o u r client if y o u release the relevant tissues first. As I
m e n t i o n e d previously, all the t e c h n i q u e s I discuss in this b o o k will w o r k
quite well if you do n o t attempt to release these associated soft tissue restric-
tions. But y o u definitely will be m u c h m o r e effective if y o u release these
myofascial a n d ligamentous restrictions first. This discussion is n o t m e a n t
to be exhaustive, it contains only the most important a r e a s — the o n e s y o u
s h o u l d always be sure n o t to o v e r l o o k .
Also I will n o t devote m u c h discussion to the techniques to use to release
these areas, because there are many ways to accomplish the desired results
135
and m o s t readers of this b o o k already k n o w many of them. Besides, there

are m a n y classes and workshops on soft tissue techniques readily available
to somatic practitioners in b o t h the U n i t e d States a n d E u r o p e .
T h e m o s t i m p o r t a n t r e c o m m e n d a t i o n I want to make is to find ways
to release soft-tissue restrictions that do n o t cause u n n e c e s s a r y pain to
your clients. W h e n it c o m e s to treating the h u m a n body, m o r e is n o t always
better. T o o m a n y soft tissue practitioners apply way t o o m u c h pressure to
the b o d y and willfully push their way through the tissues. This willful appli-
cation of elbows a n d knuckles n o t only causes unnecessary pain and tis-
sue d a m a g e , it also interferes with your ability to feel the orthotropic effect.
A p p l y i n g the " n o pain, no gain" p h i l o s o p h y is n o t the most effective ap-
p r o a c h , a n d can o f t e n be abusive. Use what y o u have l e a r n e d f r o m this
b o o k w h e n y o u a p p r o a c h the release o f myofasciae a n d ligaments, and
d o n ' t f o r c e y o u r way t h r o u g h the tissue. L e t y o u r client's b o d y tell y o u
what it wants a n d h o w it wants to release. If y o u respect the way the b o d y
wants to release a n d find its way to its o w n i n h e r e n t order, y o u can apply
heavy pressure a n d n o t w o r r y a b o u t causing unnecessary pain. Sink into
the tissue a n d wait f o r the d a n c e . Your clients will be m u c h happier if you
do a n d y o u r results will also be better.
Dr. Rolf, the c r e a t o r a n d f o u n d e r of R o l f i n g , taught a s h o t g u n tech-
n i q u e that is s o m e t i m e s useful f o r releasing the musculature of the back,
b u t it also has its dangers. Since this t e c h n i q u e has gained a lot of p o p u -
larity a m o n g m a n y o t h e r somatic practitioners, I want to make sure you
k n o w w h e n to use it a n d w h e n n o t to.
T h e t e c h n i q u e works this way: p l a c e y o u r client in a sitting position
a n d l e a n y o u r r i g h t e l b o w o n his right u p p e r b a c k a t a b o u t the cervi-
cothoracic j u n c t i o n over the spinal g r o o v e and transverse processes. D o n ' t
use the p o i n t of y o u r elbow, use the flatter aspectjust superior to the o l e -
c r a n o n . Let y o u r e l b o w sink into the tissue by letting y o u r weight do most
of the work. Ask y o u r client to slowly b e n d forward (Figure 10.1). As he
d o e s so, k e e p y o u r pressure up a n d slide y o u r e l b o w d o w n his back at a
rate that k e e p s up with the rate at w h i c h the tissue releases. Be sure to
slide your elbow all the way d o w n and through the tissue around the sacroil-
iac j o i n t (Figure 1 0 . 2 ) . Ask y o u r client to sit up a n d repeat the process on
the left side. Y o u can run y o u r e l b o w d o w n y o u r client's back a c o u p l e of
times on each side. As a matter of course you may even release s o m e closed
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ODDS AND ENDS
fixed facets. But as y o u also p r o b a b l y realized, this t e c h n i q u e wall have no

effect on all the o p e n - f i x e d facets.
This technique is a very useful shotgun a p p r o a c h f o r releasing the back
musculature. But be careful with it. If y o u r client has severe b a c k p a i n ,
degenerative j o i n t disease, a n d / o r disc p r o b l e m s , d o n ' t use this technique,
because y o u can actually make h e r b a c k pain m u c h m u c h worse. I f y o u r
client has disc p r o b l e m s y o u may even cause the disc to herniate further.
A n y time y o u release sacroiliac, iliosacral, o r l u m b a r facet f i x a t i o n s ,
c h e c k the hamstrings, the gluteals, the pelvic rotators, the a d d u c t o r s , the
quadratus l u m b o r u m , the psoas, the myofasciae o f the l u m b a r a n d t h o -
racolumbar regions, and the pelvic ligaments. Normalize those areas where
y o u find strain, tightness, a n d imbalances f r o m side to side. Figure 10.3,
p a g e 138, shows the c o m p l e x l i g a m e n t o u s structure of this area. W h e n
releasing the sacrum, be sure to pay special attention to the sacrotuber-
ous ( 7 ) , sacrospinous ( 6 ) , sacroiliac ( 5 ) , a n d the piriformis (Figure 1 0 . 4 ) .
W h e n y o u are releasing the sacrum, L 5 , a n d L4 also be certain y o u c h e c k
137
1
2
3
5
4 85% 10%
1
2
8 2-3% 1%
7
6
the i l i o l u m b a r ligaments (1 a n d 2 ) .
If y o u r client is c o m p l a i n i n g of sciatic pain, y o u want to be sure to eval-
uate L 4 , L 5 , the sacrum, the ligaments previously m e n t i o n e d , a n d espe-
cially the piriformis muscle. It is usually n o t e n o u g h to release the c o m -
pression o n the sciatic n e r v e a t L 4 o n L 5 , b e c a u s e L 5 , the s a c r u m , the
ligaments, a n d the pelvic rotators, especially the piriformis, are often part
of the p r o b l e m . T h e drawings in Figure 10.4 present f o u r different ways
the sciatic n e r v e can thread its way a r o u n d or t h r o u g h the piriformis and
the p e r c e n t a g e of time e a c h shows up in the h u m a n p o p u l a t i o n . It also
dramatically illustrates why sciatic pain can be maintained by a dysfunc-
tional piriformis muscle l o n g after the c o m p r e s s i o n on the nerve r o o t has
b e e n alleviated. So always c h e c k the piriformis muscle when you are releas-
i n g the s a c r u m or dealing with sciatic pain.
T h e hamstrings a l m o s t always c o n t r i b u t e to m a i n t a i n i n g strain and
fixation t h r o u g h the l u m b a r a n d pelvic regions. T i m e a n d again I have
w a t c h e d a s a c r u m d e r o t a t e as I released the hamstrings. W h e n y o u see
l u m b a r s i d e b e n d i n g , m o r e than likely y o u will also see b o t h a tight and
138
ODDS AND ENDS
short psoas a n d quadratus l u m b o r u m on the side to w h i c h the s p i n e is

sidebending. T h i n k of the l u m b a r spine as a tent p o l e a n d the psoas mus-
cles as guy wires. Every l u m b a r vertebrae is attached to the psoas a n d if
o n e of these guy wires is pulling m o r e than the o t h e r it is sure to u n b a l -
ance the spine. Even if y o u j u s t find the c o m m o n dysfunctional pattern
where L4 a n d L5 are sidebent a n d rotated to the same side, y o u s h o u l d
treat the psoas and the quadratus l u m b o r u m on the side to which L4 and
L5 are sidebent.
You s h o u l d also pay attention to the a d d u c t o r s , especially w h e r e they
attach at the pelvic ramus. Manipulating dysfunctionally s h o r t e n e d a d d u c -
tors will gready contribute to y o u r attempt to release the sacrum and l u m -
bars. Since the a d d u c t o r s a n d the psoas are intimately c o n n e c t e d in this
area, if y o u release the adductors y o u s h o u l d also release the psoas. A n d
then make sure that the l u m b a r a n d t h o r a c o l u m b a r myofasciae will per-
mit the full release of this area. It is very c o m m o n to find myofascial strain
and tightness in the t h o r a c o l u m b a r r e g i o n of clients w h o have had a his-
tory of low back pain.
Even if y o u have p r e p a r e d all the associated tissues properly, and d o n e
a great j o b of releasing all the fixations in the sacrum, lumbars, and pelvis,
s o m e t i m e s y o u r client c o m p l a i n s that he still has j u s t a little bit of pain
and stiffness either in the center of his sacrum or a r o u n d the SI joints a n d
ILA's. If this h a p p e n s , y o u p r o b a b l y n e e d to be m o r e specific in h o w y o u
release the associated myofasciae a n d ligaments. Ask y o u r client to sit on
y o u r treatment b e n c h and forward b e n d as far o v e r as he is c o m f o r t a b l e .
Use the knuckles of b o t h hands to apply 20 to 30 p o u n d s of pressure to
the area a r o u n d the right side of the lumbosacral j u n c t i o n . Sink into the
tissues and wait f o r t h e m to r e s p o n d (Figure 10.5, p a g e 1 4 0 ) . W h e n y o u
feel the tissues begin to soften, slide inferiorly a l o n g the right SI j o i n t with
y o u r left knuckle on the m e d i a l side of the SI j o i n t a n d the right k n u c k l e
on the lateral side of the SI j o i n t . Slide t h r o u g h this area at a s p e e d that
m a t c h e s t i s s u e s ' release, t h e n d o the o t h e r side. I f y o u r c l i e n t i s c o m -
plaining of lingering pain in the c e n t e r of the s a c r u m , place the k n u c k -
les of each hand close together, apply the same a m o u n t of pressure starting
at the lumbosacral j u n c t i o n , sink into the tissues, wait f o r t h e m to soften,
and slide inferiorly a l o n g the b o d y of the sacrum. This t e c h n i q u e can be
s o m e w h a t i n t e n s e f o r the c l i e n t ( m e a n i n g i t m a y h u r t ) , b u t i t i s v e r y
139
effective f o r releasing this last bit of

strain. Apply the technique a c o u p l e
of times in a way that your client can
tolerate a n d h e s h o u l d feel i m m e -
diate relief.
W h e n e v e r y o u release fixations
at o n e e n d of the spine, be sure you
attend to the o t h e r e n d and release
whatever fixations you find. A
c h a n g e i n the l u m b a r s c a n create
c h a n g e in the c e r v i c a l s a n d visa
versa. So it is always a g o o d idea to
m a k e sure that b o t h e n d s o f the
spine are happy and free b e f o r e you
send y o u r clients h o m e .
B e f o r e y o u release facet restric-
tions in the neck, use whatever tech-
Figure 10.5 niques y o u know to ease and release
the muscles and fascial sheets along
the back a n d sides of the n e c k and the tissues a r o u n d the O A . Figure 10.6
shows a useful shotgun technique you may want to try. Pick up your client's
h e a d a n d rest the b a c k of his h e a d in the c r o o k of y o u r right h a n d (the
part f o r m e d b y w e b b i n g o f y o u r t h u m b a n d f o r e f i n g e r ) . With the i n d e x
a n d / o r m i d d l e fingers of y o u r left h a n d , apply pressure and sink into the
tissue of the left spinal g r o o v e a r o u n d the atlas. W h e n y o u feel the tissue
soften, slide inferiorly with the fingers of y o u r right h a n d to a b o u t Tl and
T 2 . Reverse y o u r hands and treat the right cervical spinal g r o o v e the same
way. Besides releasing the posterior myofasciae, this t e c h n i q u e will often
release s o m e of the less severe fixed-closed facets. Of course it w o n ' t release
the fixed-open facets, b u t because it d o e s double-duty in releasing soft tis-
sues a n d extension restrictions, it saves y o u time and energy.
W h e n e v e r y o u work in the n e c k area be sure that y o u always attend to
the suboccipital muscles. This r e g i o n is almost always involved with dys-
f u n c t i o n a l patterns in the n e c k . In Figure 10.7, n o t i c e h o w all of these
suboccipital muscles, with the e x c e p t i o n of the obliquus capitus inferior
(3) ( a n d the interspinous muscles), attach to the base of the o c c i p u t . T h e
140
ODDS AND ENDS
Figure 10.6
2
2 Rectus capitus posterior minor
4
4 Obliquus capitus superior
l Rectus capitus posterior major
3
3 Obliquus capitus inferior
5 Interspinous m u s c l e s
Figure 10.7
rectus capitus posterior m a j o r (1) attaches to the spinous process of C2

and the o c c i p u t , the rectus capitus posterior m i n o r (2) attaches to CI and
the o c c i p u t , the o b l i q u u s capitus superior (4) attaches to the transverse
141
process of CI and the occiput, and the obliquus capitus inferior (3) attaches
to C2 a n d the transverse process of C I . N e w dissection p r o c e d u r e s have
revealed the existence of a previously u n k n o w n muscle and ligament c o m -
p l e x that e x t e n d s f r o m the suboccipital muscles to the dura mater that
s u r r o u n d s the brain. W h e n y o u p u t this newly u n d e r s t o o d c o n n e c t i o n to
the cranial dura t o g e t h e r with what h a p p e n s w h e n the suboccipital mus-
cles get tight a n d short in response to stress or facet restrictions, then you
easily u n d e r s t a n d why these muscles can be the s o u r c e of a real pain in
the n e c k — a n d s o m e really nasty h e a d a c h e s . So always m a k e sure this
entire r e g i o n is soft a n d at ease b e f o r e y o u e n d y o u r treatment.
B e f o r e y o u release ribs, it is very helpful to ease the back musculature
a n d the tissues a l o n g the sides a n d the f r o n t of the rib c a g e , especially
a r o u n d the s t e r n u m , a n d the c o s t o c h o n d r a l a n d ster-
n o c h o n d r a l j u n c t i o n s . Pay special attention to the inter-
costal muscles, especially a b o v e a n d b e l o w the fixed ribs
y o u plan to treat, a n d m a k e sure they are at ease. As I
m e n t i o n e d in C h a p t e r N i n e , the r h o m b o i d s are always
involved in rib restrictions, but y o u should also pay atten-
tion to the levator scapulae and serratus posterior supe-
rior muscles.
Curvature
T r e a t i n g curvatures in the h u m a n b o d y is a very c o m -
plicated affair. Curvature is i n h e r e n t to o u r b o d i e s a n d
a l o n g with curvature c o m e s asymmetry. Many schools of
manual and m o v e m e n t therapy l o o k u p o n all bodily cur-
vature and asymmetry as dysfunctional a n d try their best
to i n t e r v e n e a n d c h a n g e these patterns. Many of these
s c h o o l s a d h e r e t o s o m e n o t i o n o f a n "Ideal B o d y " that
they use as a s t a n d a r d against w h i c h to evaluate their
clients' b o d i e s .
A g o o d e x a m p l e of the t h e o r y of the ideally aligned
b o d y and its use in evaluating dysfunction is described by
Kendall and McCreary. Pictured in Figure 10.8, the ideal
1
b o d y is d e f i n e d by d r o p p i n g a p l u m b line t h r o u g h the Figure 10.8
142
ODDS AND ENDS
center of gravity of the b o d y (i.e., slightly anterior to the first or s e c o n d

sacral s e g m e n t ) . If the centers of gravity of the o t h e r segments fall a l o n g
this p l u m b line, it is c o n s i d e r e d properly aligned. A c c o r d i n g to this view,
the line of gravity should fall t h r o u g h the m i d d l e of the ear l o b e , t h r o u g h
the middle of the a c r o m i o n process, through the greater trochanter, slighdy
anterior to the axis of the k n e e j o i n t , a n d slightly anterior to the lateral
m a l l e o l u s . T h i s c o n c e p t o f the ideal b o d y has i n f l u e n c e d m a n y practi-
tioners, w h o o f t e n i n a p p r o p r i a t e l y evaluate a n d treat their patients in
terms of h o w well they measure up to this external ideal. Unfortunately
this c o n c e p t i o n rests on the gratuitous assumption that the h u m a n b o d y
is equally d e n s e t h r o u g h o u t . Since it is n o t , it c a n n o t be lined up the way
y o u m i g h t align a pile of blocks.
Like Dr. R o l f and many o t h e r theorists, Kendall and M c C r e a r y assume
that the closer b o d i e s match this ideal, the better they f u n c t i o n . This view
has s o m e truth to it, b u t w h e n a p p l i e d indiscriminately to every patient,
d y s f u n c t i o n c a n result. C o n s i d e r a few o b v i o u s e x a m p l e s . A p r e g n a n t
w o m a n or an overweight patient with a large " p o t belly" w o u l d be aligned
in a most peculiar way if any attempt were m a d e to b a l a n c e t h e m a r o u n d
the line of gravity. C o n s i d e r patients with u p p e r n e u r o n p r o b l e m s like
cerebral palsy. In many of these patients, any attempt to align their heads
on t o p of their b o d i e s , as this ideal r e c o m m e n d s , will often result in tonal
overflow to the extremities, possible increase in non-functional reflex pat-
terns o f m o v e m e n t , a n d loss o f c o n t r o l .
We s h o u l d n ' t automatically assume that clients are manifesting s o m e
sort of dysfunction solely because their b o d i e s do n o t measure up to this
external ideal of g o o d posture. A n y attempt to c o m p l e t e l y rid the b o d y of
curvature and asymmetry is a h o p e l e s s enterprise. If such an impossible
goal c o u l d be realized, it w o u l d p r o b a b l y cause the u t m o s t distress a n d
pain to the p o o r p e r s o n w h o received this well-intentioned therapy.
As you might well imagine, most theorists w h o believe that there is stan-
dard that all b o d i e s should measure up to also believe in an "Ideal Spine."
Figure 10.9, page 144, shows Dr. R o l f s view of what this ideal spine s h o u l d
l o o k like. But w h e n y o u c o m p a r e h e r view to what actually exists, y o u see
there is quite a disparity. T h e f o r m a n d curvature of any given spine is a
u n i q u e expression of the m o r p h o l o g y and f u n c t i o n i n g of the entire body.
If y o u l o o k carefully at the great differences b e t w e e n y o u r clients' spines,
143
y o u will realize that any attempt to manipulate t h e m to

m a t c h the shape of the ideal spine is an impossible goal.
Do y o u r e m e m b e r Figure 10.10? It a c c o m p a n i e d the dis-
cussion of the shape of the facets of the i n n o m i n a t e and
sacrum in Chapter Seven. Notice h o w clearly it shows the
r e l a t i o n s h i p b e t w e e n the facets a n d the s h a p e o f the
sacrum. T h e impossibility of ever manipulating the sacrum
of spine A in Figure 10.10 toward a position like spine B's
is all t o o obvious. T h e r e is no way to c h a n g e the position
of a s a c r u m with that s h a p e , b e c a u s e the shape of the
facets w o u l d never permit it. R e m e m b e r , the shape of any
given b o n e is an expression of the u n i q u e m o r p h o l o g y
of the entire body. If y o u c a n n o t get the sacrum into this
idealized position, you will never get the spine there either.
I have seen t o o m a n y dysfunctional spines that l o o k just
like the ideal spine and many very functional spines l o o k
like spine A. So we c a n n o t automatically c o n c l u d e that
Figure 10.9
A c B
Figure 10.10
144
ODDS AND ENDS
just because a client's spine or b o d y d o e s n ' t measure up to an ideal that

it is dysfunctional a n d in n e e d of m a n i p u l a t i o n . In fact, m a n y times the
attempt to make a client's b o d y c o n f o r m to an ideal either has no effect
or, worse, actually creates further dysfunction.
Somatic practitioners in every discipline have b e e n taught to evaluate
clients by comparing their bodies to some conscious or unconscious somatic
ideal. T o o often, c o n t o u r , position, curvature, a n d asymmetry are used as
the o n l y i n d i c a t o r s o f s o m a t i c d y s f u n c t i o n a n d d i s o r d e r . O n c e w e see
t h r o u g h the limitations o f evaluating o u r clients against these s o m a t i c
ideals, we will see the o d d c o n t o u r s a n d the o d d p o s i t i o n i n g of segments,
curvatures, and asymmetries that show up in every b o d y in an entirely dif-
ferent light. All of these o d d patterns must be evaluated in terms of the
u n i q u e limitations a n d possibilities f o r e a c h b o d y a n d e a c h b o d y type.
Rejecting the n o t i o n s of an ideal b o d y a n d ideal positions f o r individual
segments d o e s n o t u n d e r m i n e o u r ability to evaluate o u r clients' b o d i e s .
T h e r e are recognizable patterns of dysfunction that show up in every b o d y
type, as well as c o m m o n patterns of asymmetry that s h o w up in various
types of bodies, and there are asymmetries u n i q u e to the individual client.
S o m e of these patterns are associated with dysfunction a n d s o m e are n o t .
W h e n patterns that are associated with structural, functional, a n d e n e r -
getic fixations are properly m a n a g e d in a c c o r d a n c e with individual needs,
overall function can b e restored a n d e n h a n c e d .
So w h e n y o u see o d d l y p o s i t i o n e d segments, curvature, a n d asymme-
tries, what do y o u do a b o u t them? My suggestion is that y o u view an o d d l y
positioned segment or curvature as no m o r e than a clue to possible somatic
dysfunction or disorder, n o t the certainty of it. So always l o o k f o r loss of
function in the f o r m of fixations first (myofascial, articular, energetic, e t c ) .
Unless a c c o m p a n i e d b y s o m e level o f fixation, asymmetries a n d c u r v a -
tures may n o t be even clinically significant. Asymmetries, oddly positioned
segments, curvatures, and o d d c o n t o u r s d o n o t always d e m a n d interven-
tion. W h e n they do d e m a n d attention and manipulation, it is usually u n d e r
the following c o n d i t i o n s : 1) w h e n they are a c c o m p a n i e d by a fixation or
fixations (at the structural, functional, a n d / o r e n e r g e t i c levels), 2) w h e n
they c o n t r i b u t e to a d y s f u n c t i o n or f i x a t i o n , or 3) w h e n m a n i p u l a t i n g
them will clearly e n h a n c e the overall f u n c t i o n i n g of the w h o l e .
So o u r j o b is to always try to u n d e r s t a n d a n d r e c o g n i z e the c o m m o n
145
patterns o f d y s f u n c t i o n w i t h o u t l o s i n g sight o f the u n i q u e n e s s o f e a c h

individual client a n d h o w h e r o r g a n i s m is o r g a n i z e d as a w h o l e . For each
individual, the appropriate position of structures is d e t e r m i n e d by a p p r o -
priate f u n c t i o n . If a s e g m e n t seems to be in an o d d p o s i t i o n , b u t works
the way it is s u p p o s e d to, d o n ' t mess with it. T h e same is true f o r all local
a n d global asymmetries. A p e r c e i v e d asymmetry may be dysfunctional in
o n e b o d y a n d entirely f u n c t i o n a l a n d n o r m a l i n a n o t h e r . A p p r o p r i a t e
f u n c t i o n is d e t e r m i n e d by u n d e r s t a n d i n g what is possible in relation to
e a c h individual's u n i q u e patterns o f c h a n g i n g a n d u n c h a n g i n g limita-
tions. In turn, these limitations must be seen in terms of h o w well the per-
son has adapted to gravity and his or her environment. Position can never
be abstracted f r o m what is functionally appropriate f o r each individual in
relation to gravity a n d the e n v i r o n m e n t .
So what is n o r m a l , then? Etymologically, "normal" is rooted in the idea
of measuring up to a n o r m , m o d e l , or pattern, like a carpenter's square.
This m e a n i n g is the o n e m o s t often associated with somatic idealism. But
" n o r m a l " also carries another meaning. It can m e a n "natural" in the sense
of " b e i n g in a c c o r d a n c e with the i n h e r e n t nature of a p e r s o n or a thing."
This m e a n i n g is at w o r k w h e n we say that a p e r s o n is a natural-born artist
o r healer.
W h e n I use the w o r d " n o r m a l " I m e a n it in this s e c o n d sense as b e i n g
natural o r i n h e r e n t t o the b e i n g o f the w h o l e p e r s o n . T h i s c o n c e p t o f
" n o r m a l " is clearly quite different in s c o p e and implication f r o m the idea
of m e a s u r i n g up to a n o r m , statistical average, or standard that is exter-
nal to the b o d y . T e m p l a t e s a n d n o r m s m a k e sense w h e n y o u r aim is to
mass p r o d u c e m a c h i n e s a n d o t h e r non-living p r o d u c t s . Templates a n d
n o r m s are important in the d e v e l o p m e n t of quality controls. But o u r b o d -
ies are n o t m a c h i n e s or p r o d u c t s , a n d it makes little sense to claim that
all h u m a n b o d i e s f u n c t i o n best w h e n they measure up to s o m e external
standard or statistical average.
" N o r m a l " in the sense in w h i c h I use it, refers to what is appropriate
a n d optimal f o r each individual p e r s o n . It c a n n o t be d e t e r m i n e d without
a careful case-by-case examination of what is possible for each person, given
the fixations a n d limitations i n h e r e n t to his or her body. N o r m a l is also
n o t a static state that we can attain permanently. Living organisms are self-
organizing, self-regulating wholes characterized by the continual o n g o i n g
146
ODDS AND ENDS
attempt to balance, organize, e n h a n c e , a n d h a r m o n i z e their lives. Given

the t r e m e n d o u s plasticity and resulting diversity that actually exist a m o n g
humans, clearly there c a n n o t be o n e ideal way f o r every b o d y or every seg-
m e n t of the body. O u r world and lives are always in flux, and, whether o u r
b o d i e s m a i n t a i n severe fixations o r n o t , w e are always striving t o w a r d
b e c o m i n g m o r e fully ourselves. S o m e o f o u r limitations are t i m e - b o u n d
and c h a n g e a b l e a n d s o m e are n o t . W h a t is n o t c h a n g e a b l e in the present
may be changeable in the future. W h a t is c h a n g e a b l e f o r o n e p e r s o n may
n o t be f o r a n o t h e r . N o r m a l i t y is an a c h i e v e m e n t that is w o n again a n d
again in the course of o u r lives.
As a somatic therapist y o u are always up against three limitations: y o u r
own limitations as a therapist, the limitations of the therapeutic discipline
that y o u l e a r n e d , and the limitations of y o u r client. S o m e of these limi-
tations c a n n o t b e o v e r c o m e . Most f o r m s o f manual therapy will n o t c u r e
cancer, for e x a m p l e . But m a n y of these limitations can be o v e r c o m e . For
instance, y o u can always learn m o r e a n d i m p r o v e y o u r skills. W h a t o f t e n
appear to be severe limitations in y o u r clients can c h a n g e over time a n d
what was i n c a p a b l e of c h a n g i n g yesterday may c h a n g e t o m o r r o w . So we
must learn to r e c o g n i z e a n d respect what we can c h a n g e today, what we
can change in the future, and what we cannot change at a l l — a n d of course,
h o w to tell the d i f f e r e n c e . As somatic therapists o u r g o a l is n o t to m a k e
clients measure up to s o m e external standard that we i m p o s e on t h e m by
means of somatic ideals and formulistic p r o t o c o l s , b u t to try to discover
the limitations that stand in the way of t h e m b e c o m i n g w h o they are a n d
then to release their fixations in the right order. Normality is n o t a mat-
ter of measuring up to an ideal f o r m or way of f u n c t i o n i n g , b u t a matter
of uncovering what is natural or inherent in the being of the whole. Somatic
therapy is, therefore, best practiced as a process of discovery, n o t as an act
o f i m p o s i n g p r e d e t e r m i n e d standards o n o u r clients b y m e a n s o f f o r -
mulistic p r o t o c o l s .
Let's return to the m o r e practical issues at h a n d and l o o k at h o w to deal
with curvature. As I m e n t i o n e d earlier, curvature is a c o m p l i c a t e d affair.
As y o u know, the spine has a n u m b e r of curves in the a n t e r i o r / p o s t e r i o r
dimension. These are the lumbar lordosis, the thoracic kyphosis, a n d the
cervical lordosis. T h e s e A / P curves can b e shallow o r d e e p , d e p e n d i n g o n
the structure of each p e r s o n . A n d like all curvature, understanding t h e m
147
r e q u i r e s u n d e r s t a n d i n g the struc-
ture of the w h o l e body.
Crossover
We are n o t g o i n g to discuss h o w
to manipulate these A / P curves, but
rather only Type I curves where Apex
there is an appreciable lateral devi-

ation from the sagittal axis. T h e draw- Crossover
i n g in F i g u r e 10.11 is a s c h e m a t i c
representation of a scoliosis that dis-
Apex
plays h o w s i d e b e n d i n g and rotation
are c o u p l e d to opposite sides. T h e r e
are f o u r p l a c e s i n the s p i n e w h e r e Crossover
the curve might cross over and b e n d
in the opposite direction. These typ-
ical transition p o i n t s are the l u m -
b o s a c r a l , the t h o r a c o l u m b a r , the Figure 10.11
c e r v i c o t h o r a c i c , a n d atlantocciptal
j u n c t i o n s . T h r e e o f these transitional j u n c t i o n s are displayed schemati-
cally in the drawing. Y o u can almost always c o u n t on these crossover points
b e i n g the site of myofascial strain a n d tightness. T h e r e are many differ-
e n t kinds of laterally deviated curvatures a n d no two are the same. But
they all involve c o m p l i c a t e d twisting patterns that go t h r o u g h the entire
b o d y f r o m the c r a n i u m to the feet a n d they all involve varying degrees of
characteristic c h a n g e s in the shape of the b o n e s . Figure 10.12 shows the
d i r e c t i o n of the scoliosis a n d its effect on the shape of a vertebra. N o t i c e ,
f o r e x a m p l e , h o w the shape of the facets a n d the spinal canal have b e e n
m o d i f i e d by the twisting forces of the curvature. Since the shape of the
vertebrae and other b o n e s of the b o d y sometimes have b e e n so profoundly
m o d i f i e d by the scoliosis, your ability to affect curvature will be constrained
by these b o n y c h a n g e s .
Y o u s h o u l d always r e m e m b e r that a scoliosis is really a curvature that

twists a n d spirals t h r o u g h o u t the w h o l e b o d y at every l e v e l — i t is n o t j u s t
a c u r v a t u r e of the s p i n e . A n y a t t e m p t to m a n i p u l a t e the spine without
addressing h o w the entire b o d y is involved in the curvature is almost always
h o p e l e s s . B e f o r e y o u can e x p e c t any significant and lasting c h a n g e , y o u
must make sure the c r a n i u m , the pelvis, the extremities, a n d the ribs are
148
ODDS AND ENDS
able t o a d a p t t o any u n w i n d i n g o f
the c u r v a t u r e y o u m i g h t m a n a g e .
Facets Many times a curvature will w i n d its
way d o w n m o r e i n t o o n e l e g than
the o t h e r a n d r e l e a s i n g the c o m -
p e n s a t o r y patterns in that l e g c a n
s o m e t i m e s significantly c h a n g e the
curvature.
Treating a scoliosis requires being
able to p e r c e i v e the w h o l e with all
its compensatory patterns and b e i n g
Figure 10.12 a b l e t o track t h e e f f e c t o f y o u r
manipulations on the w h o l e . This is
a b i g a n d c o m p l i c a t e d j o b . A scoliosis is a m u l t i d i m e n s i o n a l shape that
d o e s n o t r e s p o n d to a two-dimensional treatment a p p r o a c h . If y o u h a d a
magic wand that p e r m i t t e d y o u to o n l y affect the spine by f o r c i n g the S-
shaped curvature straight (the way that surgically implanting H a r r i n g t o n
rods d o e s , f o r e x a m p l e ) , y o u w o u l d alter the s i d e b e n d i n g without signif-
icantly c h a n g i n g the rotational f o r c e a n d , as a result, send a mess of spi-
rals a n d c o m p e n s a t o r y strain patterns t h r o u g h o u t the entire b o d y . T h e
holistic a p p r o a c h is really the best m e t h o d f o r treating a scoliosis, because
it is based on seeing a n d treating the w h o l e . T h e corrective a p p r o a c h is
almost always less than satisfactory. A holistic a p p r o a c h s o m e t i m e s p r o -
duces amazing results, especially when the curvature is n o t t o o p r o n o u n c e d
and has n o t dramatically spun its way d o w n i n t o the legs or up i n t o the
cranium. In s o m e clients y o u may see an actual lessening of the curve and
in o t h e r cases no significant c h a n g e at all. W h a t y o u can reasonably h o p e
f o r is a general l e n g t h e n i n g of the b o d y a n d the spine, a n d greater free-
d o m and mobility t h r o u g h o u t y o u r client's body. L e n g t h e n i n g the b o d y
and the spine gives the scoliosis a softer a n d less c o m p r e s s e d a p p e a r a n c e .
Technique for Type I Group Curvatures
T HE TECHNIQUE FOR TREATING T Y P E I CURVATURES WAS CREATED BY MY
c o l l e a g u e , Jim Asher, an a d v a n c e d R o l f i n g Instructor. If y o u k e e p all

the above considerations in m i n d , y o u may find his a p p r o a c h very useful.
149
Y o u can certainly attempt to apply the t e c h n i q u e without addressing the

w h o l e body, p r o v i d e d y o u make sure b o t h ends of the spine are relatively
free and at ease, that y o u have released iliosacral, sacroiliac, and all spinal
facet ( i n c l u d i n g the O A ) a n d rib restrictions. If y o u release these areas
first, y o u will n o t cause any h a r m to y o u r client if y o u do n o t address the
rest of the b o d y — y o u may even see s o m e surprising results.
S o m e g r o u p curvatures are easy to see a n d others are quite difficult.
If y o u are n o t quite sure w h i c h way the spine is sidebent, ask y o u client to
stand or sit and s i d e b e n d to the right a n d then to the left. If y o u r client
can s i d e b e n d m o r e easily to the right than the left, y o u will n o t i c e that in
right sidebending the curve is clear and p r o n o u n c e d while in left sidebend-
ing the spinal curvature is n o t as p r o n o u n c e d . Y o u will also notice that in
r i g h t s i d e b e n d i n g the v e r t e b r a e will rotate m o r e than they d o i n left
s i d e b e n d i n g . C h e c k each curve in the spine the same way and n o t e where
the a p e x of e a c h c u r v e is on the c o n v e x side.
In preparation f o r u n d e r s t a n d i n g this t e c h n i q u e , also n o t i c e h o w on
the c o n v e x side of the c u r v e the errectors are pulled toward, and p a c k e d
in c l o s e t o , the s p i n e in a way that s e e m s to d i m i n i s h the d e p t h of the
spinal g r o o v e . On the c o n c a v e side the errectors are pulled away f r o m the
spine a n d s e e m to be lying flat across the ribs.
Let's assume y o u r client has a curvature like the o n e previously illus-
trated. His lumbar spine is right sidebent and left rotated and his thoracic
spine is left sidebent and right rotated. For ease of understanding we will
start on the thoracic spine. Place y o u r client in a side-lying position on his
left side with his left a r m b e h i n d h i m , as shown in Figure 10.13. This posi-
tion c h a l l e n g e s the existing s i d e b e n d i n g a n d rotational pattern. Place
y o u r fingers (Figure 1 0 . 1 4 ) , e l b o w (Figure 10.15, page 1 5 2 ) , or knuckles
in the right spinal g r o o v e a l o n g the convexity of the curvature. Sink into
the spinal g r o o v e , wait f o r the tissues to soften, and then push in a lateral
direction away f r o m the spine. Your effort should be partly directed toward
freeing the tissue f r o m b e i n g p a c k e d in t o o close to the spinal g r o o v e . If
y o u start at the b o t t o m of the convexity, push laterally as y o u m o v e supe-
riorly. If y o u start at the t o p of the convexity, push laterally as y o u m o v e
inferiorly. Be sure to p u t s o m e extra effort into the a p e x of the curve.
T h e n ask y o u r c l i e n t t o roll o v e r o n t o his o t h e r side. But d o n ' t ask
h i m to lay with his a r m b e h i n d his back. Place y o u r e l b o w (Figure 10.16),
150
ODDS AND ENDS
Figure 10.13
Figure 10.14
151
Figure 10.15
fingers, or knuckles (Figure 10.17) on the lateral b o r d e r s of the erectors

a l o n g the concavity of the curvature. Sink i n t o the tissue as if y o u were
trying to g e t u n d e r the erectors, wait f o r the softening, and then push in
a m e d i a l d i r e c t i o n toward the spine. Since these tissues are pulled wide
and away f r o m the spine, y o u r effort is directed at easing them toward the
spine.
T h e t e c h n i q u e f o r treating the l u m b a r curvature is exactly the same.
T h e only d i f f e r e n c e is h o w y o u position y o u r client's legs to challenge his
right sidebending, left rotational pattern. Use the side-lying position again
a n d instruct y o u r client to lay on his right side with his right k n e e slightly
b e n t . In o r d e r to c h a l l e n g e the curvature a bit m o r e , ask h i m to place his
left leg in front of his b o d y a n d b e n d his k n e e to 90 d e g r e e s as shown in
Figure 10.18, p a g e 154. W o r k in the left spinal g r o o v e a l o n g the length of
the convexity of the curvature. A g a i n , apply pressure laterally, as if y o u
were trying to release the tissues away f r o m the spinal g r o o v e and put a
little m o r e e f f o r t i n t o the a p e x o f the c u r v e (Figure 1 0 . 1 9 ) . T u r n y o u r
c l i e n t o v e r on his left side, b u t this time m a k e sure he k e e p s his knees
152
ODDS AND ENDS
Figure 10.16
Figure 10.17
153
Figure 10.19
154
ODDS AND ENDS
Figure 10.20
t o g e t h e r a n d slightly b e n t . A p p l y pressure to the lateral b o r d e r s of the

errectors toward the spine a l o n g the length of the concavity of the c u r v e
(Figure 10.20).
E x p e r i m e n t with this t e c h n i q u e , b e c a u s e on o c c a s i o n it may p r o d u c e
surprising results. S o m e t i m e s y o u will see an actual r e d u c t i o n or length-
e n i n g of the curvature. Many times y o u will see a g e n e r a l i m p r o v e m e n t
in range of m o t i o n t h r o u g h o u t the entire spine, b u t s o m e t i m e s y o u will
see no obvious change at all. Always try to see the whole p e r s o n with w h o m
y o u are working and track the effects of y o u r local manipulations on the
w h o l e , m a k i n g sure y o u r client can adapt to y o u r interventions.
R e m e m b e r that this b o o k is just an introduction to the spine and I have
left out s o m e discussion of the o d d things spines d o . For e x a m p l e , the cer-
vical vertebrae have a b a d habit of side slipping in s o m e clients. Also, many
p e o p l e ' s spines have vertebrae that have slipped j u s t a little bit t o o p o s t e -
rior. T h e y are n o t full b l o w n e x a m p l e s of what is called a retrolisthesis,
but they are just posterior e n o u g h to cause s o m e loss of m o t i o n t h r o u g h
the entire s p i n e . I have also d i s c o v e r e d that the facets c a n be f i x e d in
155
planes o t h e r than the o n e s p r e s e n t e d in this b o o k . Unfortunately, delin-

eating the tests and techniques f o r addressing these fixations w o u l d make
this b o o k unnecessarily complicated. As y o u probably suspected, n o t every-
b o d y is in full a g r e e m e n t that the spine works in the ways this b o o k d e -
scribes. This is no surprise, b u t if y o u use the i n f o r m a t i o n and techniques
p r e s e n t e d h e r e , they will serve y o u well. A b o v e all else, d o n ' t forget to do
everything y o u can to i m p r o v e y o u r understanding, y o u r technical skills,
a n d y o u r ability t o see a n d feel y o u r way i n t o the simple c o m p l e x i t y o f
what we h u m a n s truly are in relation to all of this to w h i c h we are neither
identical n o r separate.
G o o d luck! It has b e e n a pleasure writing this b o o k f o r y o u .
Note
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1983.
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160
INDEX
A backward bending and, 46, 5 1 - 5 2 , 59

AA (atlas on atlas) restrictions, 61, 63 bilateral fixations in, 4 5 - 4 6
Adaptability, 1 3 3 - 1 3 5 finding rotated vertebrae in, 3 8 - 3 9
Adductors, 139 forward bending and, 5 1 - 5 2
Anterior nutation, 72 indirect techniques for, 3 7 - 4 5
Anterior superior iliac spine (ASIS), joint-challenging technique for,
1 0 3 - 1 0 6 , 108, 1 1 0 45-50
Articular pillars/processes, 38 locating vertebrae, 3 7 - 3 8
A s h e r j i m , 149 motion of, 4, 36
Atlantocciptal junction, 148 motion testing, 5 1 - 6 0
Atlas, 61, 63. See also AA restrictions; OA sidebending and, 3 5 - 3 6 , 56
restrictions vertebral arteries and, 46
Cervicothoracic junction, 148
B Corrective approach, 1 3 1 - 1 3 2
Back. See also Spine Costochondral junction, 114, 142
"goes out," 14, 1 6 - 1 7 Costotransverse groove, 1 1 6 - 1 1 7
pain vs. problems, 1 6 - 1 7 Counternutation, 72
releasing musculature of, 1 3 6 - 1 3 7 Curvature, 1 4 2 - 1 5 5
Backward bending as clues, 145
cervical spine and, 46, 5 1 - 5 2 , 59 "ideal body," 1 4 2 - 1 4 5
lumbar and thoracic spine and, 17, Type I, 148, 1 4 9 - 1 5 5
30-31
OA restrictions and, 6 5 - 6 9 D
sacrum and, 74—75 Dance of the tissues, 4 3 - 4 4
Bilateral fixations Demifacets, 1 1 4 , 1 1 5
cervical, 27, 4 5 - 4 6 Dial-a-Neck technique, 4 1 - 4 5
lumbar and thoracic, 31, 33 Down-slip, 99, 1 0 4 - 1 0 5 , 1 0 8 - 1 0 9
sacral, 7 6 - 7 7
F
C Facet restrictions. See also Techniques
C2-C7 backward bending and, 17
finding, 8, 38 bilateral fixations, 27, 31, 33, 4 5 - 4 6
Type II biomechanics of, 52 discovery of, 1 3 - 1 4
Cervical spine. See also Neck forward bending and, 17
arrangement of facets in, 24, 4 6 - 4 7 motion restrictions vs., 52
161
sidebending and, 2 - 3 K
test for, in cervical spine, 5 1 - 6 0 Kendall, Florence, 143
test for, in lumbar and thoracic Korr, I.M., 1 5 - 1 6
spine, 2 7 - 3 1 Kyphosis, 147
Flare, 99, 1 0 3 - 1 0 4 , 106, 108
Flury, Hans, 97 L
Forward bending L4, finding, 8
cervical spine and, 5 1 - 5 2 Levator scapulae, 142
lumbar and thoracic spine and, 17, Ligamentous structures, 9 5 - 9 6 , 136
30-31 Lordosis, 83, 98, 1 4 7
OA restrictions and, 6 5 - 6 9 Lumbar spine
sacrum and, 72, 7 4 - 7 5 arrangement of facets in, 24
psoas a n d , 1 3 9
G rotation and, 4, 7
shotgun technique and, 21, 23
Gait patterns, 97 test for finding facet restrictions in,
27-31
H Type I fixations in, 34
Hamstrings, 97, 138 Lumbosacral junction, 148
Holistic approach, 1 3 1 - 1 3 2
I M
"Ideal body," 1 4 2 - 1 4 5 McCreary, Elizabeth, 143
ILA. See Inferior lateral angle Motion restrictions
Iliolumbar ligament, 96 cervical spine and, 5 6 - 5 9
Iliosacral dysfunction, 71, 95. See also facet restrictions vs., 52
Pelvis OA restrictions and, 65, 69
flare, 99, 1 0 3 - 1 0 4 , 106, 108 Myofasciae, 135, 136, 139
shear, 99, 1 0 4 - 1 0 5 , 1 0 8 - 1 1 0
techniques for, 1 0 6 - 1 1 2 N
testing and palpating for, 9 9 - 1 0 6 Neck. See also Cervical spine
torsion, 99, 1 0 5 - 1 0 6 , 1 1 0 - 1 1 1 AA (atlas on atlas) restrictions, 61, 63
Iliosacral ligament, 95 emotions and, 35
Indirect techniques imbalances and, 3 5 - 3 6
for cervical spine, 3 7 - 4 5 OA (occiput on atlas) restrictions,
drawback of, 1 1 , 25 63, 6 5 - 6 9
for lumbar and thoracic spine, 8 - 1 1 ribs and, 1 1 6
nature of, 9 sidebending and, 46
sacral, 7 5 - 7 6 suboccipital muscles and, 1 4 0 - 1 4 2
Inferior lateral angle (ILA), 8 5 - 8 9 , 139 Neutral position, 4
In-flare, 99, 1 0 3 - 1 0 4 , 108 "Normal," definition of, 1 4 6 - 1 4 7
Innominates, 84, 99 Nutation, 72
Interspinous muscles, 140 Nystagmus, 46
162
INDEX
O techniques for, 1 2 1 - 1 2 7
OA (occiput on atlas) restrictions, 63, tender points and, 1 1 9 - 1 2 0
65-69 torsion of, 1 1 7 - 1 1 8 , 123
Obliquus capitus inferior, 140, 142 Rolf, Ida P., 134, 136, 1 4 3
Obliquus capitus superior, 141 Rotoscoliosis, 34, 83
Occiput, 63, 1 4 0 - 1 4 2 . See also OA Rumpelstiltskin effect, 8 8 - 9 0
restrictions
Organisms, 130 S
Organs, 129 Sacral base, 72
Sacral sulcus, 72
Out-flare, 99, 1 0 3 - 1 0 4 , 106, 108 Sacroiliac dysfunction, 71. See also
Sacrum
P
Pelvis, 9 5 - 9 8 . See also Iliosacral palpating for, 72, 7 4 - 7 5
dysfunction shear, 8 3 - 9 3
Piriformis, 96, 138 techniques for, 7 5 - 7 7 , 9 0 - 9 3
Posterior nutation, 72 torsion, 74, 8 0 - 8 3
Posterior superior iliac spine (PSIS), Sacroiliac joint, 71, 95, 139. See also
1 0 0 - 1 0 2 , 104 Pelvis; Sacrum
Preparation techniques, 134, 1 3 5 - 1 4 2 Sacroiliac ligament, 95
Pre-reflection, 4 3 - 4 5 Sacrospinous ligament, 96
Psoas, 96, 139 Sacrotuberous ligament, 96
Q Sacrum, 7 1 - 7 5 . See also Sacroiliac
Quadratus lumborum, 139 dysfunction
Quadriceps, 97 Scapula, pain at edge of, 1 1 9
Sciatic pain, 138
R Scoliosis, 1 4 8 - 1 4 9
Rectus capitus posterior major, 141 Serratus posterior superior, 142
Rectus capitus posterior minor, 141 Shear
Retrolisthesis, 155 pelvic, 99, 1 0 4 - 1 0 5 , 1 0 8 - 1 1 0
Rhomboids, 142 sacral, 8 3 - 8 8
Ribs, 1 1 3 - 1 2 7 Shift, 9 6 - 9 8
articulating with spine, 1 1 3 - 1 1 4 Shotgun techniques
dysfunctional thoracic vertebrae and, cervical, 4 5 - 5 0
1 1 5 - 1 1 6 , 121 lumbar and thoracic, 1 8 - 2 5
11th and 12th, 123 preparation, 1 3 6 - 1 3 7 , 1 4 0
findingfixed,116-121 Sidebending
f i r s t , 1 2 0 - 1 2 1 , 127 cervical spine and, 35—36, 56
floating, 115 lumbar and thoracic spine and, 2 - 4
influence of, 1 1 3 - 1 1 6 sacrum and, 74, 8 0 - 8 2
motion-testing, 1 1 8 - 1 1 9 Sitting flexion test, 1 0 1 - 1 0 2
preparation for, 142 Skepticism, 4 3 - 4 4
subluxation of, 1 1 7 - 1 1 8 Spinal groove, 1 1 6
163
Spine. See also Cervical spine; Curvature; shotgun technique and, 21

Lumbar spine; Thoracic spine test for finding facet restrictions in,
classification of motion of, 4 27-31
explanations for compromise of, 13 Type I dysfunction in, 34
"ideal," 15, 16, 1 4 3 - 1 4 5 Type II dysfunction in, 114, 115, 121
importance of treating, 1 - 2 Thoracolumbar junction, 148
landmarks, 7 - 8 Tilt, 9 6 - 9 9
neutral position of, 4 Torsion
ribs articulating with, 1 1 3 - 1 1 4 pelvic, 99, 1 0 5 - 1 0 6 , 1 1 0 - 1 1 1
segmentation and, 1 5 - 1 6 rib, 1 1 7 - 1 1 8 , 123
Spring test, 1 1 8 - 1 1 9 sacral, 74, 8 0 - 8 3
Standing flexion test, 9 9 - 1 0 2 Translation Test, 5 1 - 6 0
Sternochondral junction, 114, 142 Tranverse processes, 5, 7, 38
Stork test, 102 Treatment strategy, creating, 132, 133
Suboccipital muscles, 1 4 0 - 1 4 2 Type I dysfunctions, 34, 148, 1 4 9 - 1 5 5
Sultan, Jan, 41, 97, 1 1 5 , 133 Type II dysfunctions, 17, 19, 27, 31, 114,
Support Principle, 134 115,121
Swayback, 98 Type I motion, 4, 63, 74
Type II motion, 4, 36
T
Tl U
finding, 8 Unified relationships, 1 2 9 - 1 3 0
first rib articulating with, 1 2 0 - 1 2 1 Unilateral sacral extension, 86
T8, finding, 8 Unilateral sacral flexion, 86
Techniques Unwinding techniques. See Indirect
for AA restrictions, 63 techniques
cervical, indirect, 3 7 - 4 5 Up-slip, 99, 1 0 4 - 1 0 5 , 1 0 8 - 1 0 9
cervical, joint-challenging, 4 5 - 5 0
Dial-a-Neck, 4 1 - 4 5 V
iliosacral, 1 0 6 - 1 1 2 Vertebrae. See also Spine
lumbar and thoracic, direct, 31, 33 derotating, 8 - 1 1
lumbar and thoracic, indirect, 8 - 1 1 , designating rotation of, 7
25 landmarks, 7 - 8
lumbar and thoracic, shotgun palpating, 2 - 5 , 7
approach, 1 8 - 2 5 sidebending and, 2 - 4
for OA restrictions, 6 5 - 6 9 tranverse process and, 5, 7
preparation, 134, 1 3 5 - 1 4 2 Type II motion and, 27
rib, 1 2 1 - 1 2 7
sacroiliac, 7 5 - 7 7 , 9 0 - 9 3 W
for Type I curvatures, 1 4 9 - 1 5 5 Walking, 8 1 - 8 2 , 99
Thoracic spine
arrangement of facets in, 2 3 - 2 4
rotation and, 4, 7
164

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"Meeting the plasticity of the body with a flexible

and gentle somatic response"

As somatic therapists our goal is not to make clients measure up to

In Spacious Body: Explorations in Somatic Ontology, Jeffrey Maitland e x p l o r e d

Jeffrey Maitland, Ph.D., is a philosophical counselor and advanced Rolfer. He is

Health/Somatics US $20.00 / $24.95 CAN

North Atlantic Books

Photographs by Kelley Kirkpatrick

Cover photograph by Brandy Wilkins

Library of Congress Cataloging-in-Publication Data

RZ265.S64 M35 2000

Spinal Manipulation Made Simple answers a q u e s t i o n that m a n y s o m a t i c

cially i n d e b t e d to the teaching a n d gifts of senior teachers Jan Sultan a n d

I have greatly benefitted, b o t h professionally and personally, f r o m the

spacious imperturbability that s h o w e d no hesitation, he said, " A h h , y o u

Chapter 1: O u r Fine Spine: T h e B a c k b o n e of Structural Integrity 1

Or where d o e s y o u r back go w h e n it g o e s out? 13

Chapter 3: Finding and Fixing the Fixations 27

Chapter 5: M o t i o n Testing the Cervical Spine 51

Chapter 9: T h e Ribs 113

Chapter 10: O d d s a n d Ends 129

the somatic manual therapists w h o allowed me to heal a n d find a n e w

my pain subsided a n d I b e g a n j o g g i n g in the naive belief that I was h e l p -

local areas of immobility a n d pain. B e f o r e b e c o m i n g a Rolfer, I h a d b e e n

We h a d e x p l o r e d o t h e r soft-tissue t e c h n i q u e s similar to ours, b u t s o o n

t h r o u g h o u t my w h o l e body. As a result, they almost always k n e w w h e r e to

and spacious clarity that arises f r o m resting in o u r primordial unconflicted

s o t o o can p r a c t i c i n g t e c h n i q u e s b e c o m e part o f the cultivation o f the

F Y O U R BACK HAS EVER " G O N E O U T , " T H E EASE W I T H W H I C H Y O U G O

n o t b e realized. T h e r e i s n o d o u b t a b o u t it: u n d e r s t a n d i n g a n d success-

Figure 1.1 Figure 1.2

y o u are having trouble clearly differentiating b e t w e e n what the vertebra

a bit m o r e . If y o u are a soft-tissue practitioner a n d y o u h a v e n ' t assessed

easy way to r e m e m b e r h o w to designate rotation is to r e m e m b e r that the

izontal line across from

A Simple Indirect Technique

N OW T H A T Y O U HAVE SOME EXPERIENCE PALPATING ROTATION, WE CAN

build on y o u r k n o w l e d g e by practicing a simple, indirect t e c h n i q u e

t h u m b resting in an indentation (the anterior transverse process of T 4 ) .

W h e n y o u apply y o u r pressure to the left TP of T 4 , imagine that y o u

it also organizes itself simultaneously a r o u n d the transverse a n d c o r o n a l

O W MANY TIMES HAVE Y O U H E A R D T H I S SURPRISED C O M M E N T FROM

a client? ' Y o u know, I was just b e n d i n g over to p i c k up s o m e t h i n g ,

restricted facets. Because the facets are restricted, there is loss of n o r m a l

T h e important point is that these patterns of activity involve neu-

do see segmental relationship. It is something like this that causes

W e can see even m o r e clearly f r o m Dr. Korr's w o n d e r f u l e x a m p l e o f

probably were n o t p r o v i d i n g adequate s u p p o r t ; there were dysfunctional

Figure 2.1 Figure 2.2 Figure 2.3

(in e x t e n s i o n or backward b e n d i n g ) . But w h i c h facets are fixed?

W h e n y o u find a rotated vertebra, j u s t p r e t e n d that it is a Type II fixa-

release.) After y o u have a p p l i e d this t e c h n i q u e to b o t h sides, c h e c k T3 to

brae. Until y o u are m o r e c o n f i d e n t

slightly m o r e effective a n d efficient if y o u apply pressure in a c e p h a l a d

effective than the indirect technique intro-

Finding and Fixing the Fixations

HENEVER YOU ARE LOOKING AT A VERTEBRA T H A T IS ROTATED

and sidebent to the same side (Type I I ) , w h e t h e r it is dysfunc-

i m p o r t a n t i n f o r m a t i o n y o u can gather f r o m it.

to sense that the vertebra has m o v e d into a m o r e extreme right rotation.

words, if a vertebra in neutral position is rotated and sidebent to the same

In backward bending if the prominent TP disappears,

Figure 3.5 Figure 3.6