by Rob McWilliams | Sep 29, 2008 | Uncategorized
In addition to the previous posts, I want to suggest the relative importance of balanced tone between the abductors and adductors attaching to the big toe/first metatarsal/phalangeal joint area. The adductor hallucis longus pulls the above mentioned joint in towards the mid-line of the foot, actively supporting the anterior arch of the foot( aka,for dancers, the metatarsal arch) while the abductor hallucis longus lifts the medial arch of the foot, spreading the big toe away from the mid-line. Dancers tend to overtrain the adductors as part of pointing the foot, in addition to rotational issues caused by turn-out and other hip/leg/ankle/foot misalignments.This unfortunately exacerbates the bunion pattern by bring the big toe in towards mid-line. Basically, dancers, the forefoot needs to be able to spread, not just contract into mid-line for the point!Rolfers can freely email me their pet treatments here! Mine are: address and differentiate the above structures; work the ligamentous/tendinous bed at the big toe/first metatarsal/philangeal joint area; call for abduction movements of the big toe ( tremendously hard to do, but worth the effort for them); work to counter-rotate and balance at first phalange/first metatarsal/tarsals/talus/malleoli/knee/hip/etc! Movement suggestions are listed in previous posts about feet and toes!.
by Rob McWilliams | May 2, 2008 | Uncategorized
Movement, Stability & Lumbopelvic Pain: Integration of research and therapy, 2nd Edition, Edited by Andry Vleeming, Vert Mooney and Rob Stoekart
By Robert McWilliams, Certified Rolfer®, BFA, MFA Dance
Movement, Stability & Lumbopelvic Pain: Integration of Research and Therapy (2nd Edition; Churchill Livingston, Elsevier 2007) is a compendium of articles on lumbopelvic function and pathology from over fifty authors, including many hundreds of book and study source citations. As the editors state in the preface, one individual author could never put forward so many diverse aspects of the anatomy, epidemiology, clinical treatment experience and theory of this subject. All the material presented is “evidence based,” and as it doesn’t all agree yet, the editors seek to help clinicians develop an “evidence informed” approach to helping clients with lumbopelvic pain. For me, as a “non-scientist” and new Rolfer, it was hard to get through some of it, because of the density and depth of presentation. I have, however, found the sections I persisted with to have paid off. In practical terms, the work has given me a clearer sense of structures to free, connect and stabilize in order to achieve a particular effect. It is an opportunity for Rolfers who are not yet familiar with the vocabulary employed by physical therapists, osteopaths and orthopedists, to become more so. Concepts ranging from the lumbopelvic “self-bracing mechanisms” of form and force-closure, “moments of force” in joint kinesiology, and coupling motion concepts in the spine with alterations depending on the center of rotation are detailed and explained. For example, a different center of rotation will create either a counterclockwise, clockwise or fixed position of a vertebral problem given the same mix of lordosis and side-bend, a fact which has definite implications in “spinal mechanics” work with clients.
The opening chapter starts off describing the continuous ligamentous “stocking” in which the lumbar vertebrae and sacrum are positioned as being a key to its support, stability and function through the “self-bracing mechanism” of the area. It goes through a series of layer-by-layer dissections, with clear descriptions of the interconnections of the fascial layers and muscles affecting the whole region, ranging from the hamstrings to connections through to the mid-thoracics. Much discussion is devoted to potential stabilizing and de-stabilizing factors for the sacroiliac joint (SIJ), and lumbars. I think most Rolfers would find the images and discussion contained in the first chapter enlightening, as it includes clear imagery and concepts based on new information. The evidence in the work is often based on porcine and cadaver studies. Some of this information is hard to make out with the grayscale used, and some of the graphics were not always the easiest to follow, but definitely worth the effort.
This 2nd edition is significantly updated from the previous one, with new authors, and drawing on many studies as recent as 2006. Though it seeks to be based on hard science, it is not monolithic. Several points of view are represented, and some of them conflict. For example, questions about form closure versus force closure at the SI joint remain unresolved, in sum, by the array of varying ideas, dissections and kinematic studies presented. The work is full of amazing facts to ponder, such as “the degree of pain perceived from injury to the spinal ligaments is related to the speed of the injury and not to its extent” (Willard, referring to Olmarkrer et al., 1990). This would speak to the trauma and problems caused by car accidents, and some of the difficulty treating them.
In addition to sections on lumbar and sacral anatomy, the book focuses on function, clinical experience, kinematics, theory of SIJ stability, instability, form and/or force closure, diagnostic methods including CAT, MRI and x-ray, and demonstrates many manual tests for instability at the SIJ. In a photographed case study, Diane Lee shows the clinical benefits of specific motor control retraining of the multifidi and associated stabilizers to ease lumbar pain. Levin presents tensegrity theory, and theories on the possible evolution of the pelvis from costovertebral joints are gently disputed within various articles throughout the work. I was intrigued by Serge Gracevotsky’s wide-ranging discussion of “stability or controlled instability” that rolls through evolutionary subjects, gait, “creep”, spinal coupling, until concluding with the importance of a ridge structure at the tip of the transverse processes of S1 and S3 that locks into the innominates and “transfers the vertical loads” that he considers to be weight-bearing.
If there is a fault, it might be the decidedly mechanistic slant of most of the articles, as if “lack of stability in structure X here is remedied by exercising muscle Y there,” which is clearly limited as an approach. There is no real development of ideas anywhere on psychosomatic pain in the lumbopelvic region. Many passages on rehabilitative movement and exercise contain no discussion of quality of motion. Anticipatory reflex action mechanisms and their importance in setting muscle tone are discussed in a fascinating article, “Motor Control in Chronic Pain: new ideas for effective intervention” by G. Lorimer Mosely. Diane Lee and Andry Vleeming are given the last word in “An integrated therapeutic approach to the treatment of pelvic girdle pain.” This article focuses on combining the physical and emotional/cognitive factors involved in influencing joint motion, termed a “functional integration” approach to detrimental motor and patterns.
No Rolfers are quoted in the work, but some of the authors are probably already familiar to the Rolf community: Jean-Pierre Barral is cited; so are Serge Gracevotsky, author of The Spinal Engine, Diane Lee, an eminent clinician/author on pelvic pain, and Stephen M. Levin, MD, who writes here about the tensegral model. To me this begs the question: why no mention of Rolfing®? It would seem that Rolfing is completely off their radar. Because of the focus on fascial planes, functional “slings” and the interconnectedness and relatedness of structures in cases of dysfunction and pain, it would seem that the editors are looking for a general, holistic model. Perhaps some scientific minded Rolfer can present it to them in a way that is “evidence-based.”
by Rob McWilliams | Feb 20, 2008 | Uncategorized
What would perfect posture be for you? Even the process of asking yourself that is a sort of meditation. Ask yourself:
What would complete support feel like?
What would complete freedom of movement allow me to do with my body?
What would an elegant sense of poise and balanced tone feel like?
One thing that happens is the experience of this “perfect” alignment can actually be “unremarkable”. This means that nothing stands out, and in some ways the body ceases to be a nuisance or irritant.
This can also mean a heightened sensitivity to inner subtlety, coupled with an increased tolerance for outer agitation and worldly troubles.
For me, the first consideration is the issue of support: how well is my body resting into ground, in standing,walking and general movement? How effortlessly is this happening? What’s getting in the way?
How well does the rest of my body adapt to these needs for support from the ground? When we have structural integrity throughout our body-system, the body takes up its natural space, without being collapsed in on itself or pressed outwards tensely. This is what is alluded to above by “balance of tone” in the body. The lines of movement release out in to space in all directions, and we retain a sense of depth, and of weight, in motion and stillness. There are words for this: “palintonicity”, a word coined by Jeffrey Maitland to mean “even tone”, and also meaning a balance of tensions extending inward and outward in all directions, effortlessly. To me this also implies an ability to connect experientially, in the moment, to the opposite side of the focus of our conscious attention in movement. For example, sensing the back of the hand while efforting to mold or sculpt a client’s tissue in bodywork; to use the feet/legs to push up from the floor while lifting a heavy box or just yielding into the ground to allow a wave of ease up through my body after working with a task that keeps my arms and hands busy way over my head for too long.These can be subtle cues, these reminders to maintain a balanced tone! Even with this subtlety, great power and potential is made available to us in this way.
Please notice that I have tried to avoid being doctrinaire regarding Rolfing®, spiritual practices, diet, exercise, sexuality, ethics and all of the various “postures” we can ( and should) maintain in life. Everyone has their own path. This being said, Rolfing Structural Integration is a highly effective method for pursuing the definition of “perfect posture” for you which you can apply to yoga, dance, sports, work and play. Please see the rest of this site at rolfinginboulder.com for more information on Rolfing.
by Rob McWilliams | Feb 20, 2008 | Uncategorized
As an aging yet still active Modern/Ballet dancer, I have the opportunity to keep trying out myofascial, perceptual and conditioning techniques on myself.
Here are a couple more helpful hints, following up on the previous blog.
Use a theraband to stretch and strengthen the toes as well as the deeper muscles( tibialis posterior and peronius longus and brevis) of the lower leg/ankle/foot. I am larger and use a grey band, but most people prefer something lighter in tension, like blue, that allows them to isolate the muscles better. Note, the work on eversion and inversion,if properly balanced according to your needs, can also help you point your foot better!
by Rob McWilliams | Feb 7, 2008 | Uncategorized
As Rolfers do, I’ve been reading up on research lately. The idea is to find ideas and data that can help me be a better clinician. Of late, I had the opportunity to work my way through “Movement, Stability and Lumbo-pelvic Pain: Integration of Research and Therapy, 2nd edition” edited by Andry Vleeming, Vert Mooney and Rob Stoeckart. This is a compendium of articles attempting to understand the scientific bases of lumbo-pelvic pain, and to establish evidence-based methods of diagnosis and treatment.The book is aimed at Orthopedists, “Physiotherapists” (Physical Therapists, as termed in the US), Osteopaths and Chiropractors.The language is scientistic, and the world-view is decidedly biomechanical. This is a work that doesn’t have space to mention any cultural or psychological influences on pelvic pain! On the other hand, there are many interesting discussions of the healthy function of the Sacroiliac Joint, as well as it’s pathology. In this investigation, a lot of emphasis is placed on soft-tissue stabilizing structures of ligament, tendon, muscle and fascial connections. The concept of force and form closure is investigated, as is the evolution of the SIJ over millions of years, based on fossil research.Lumbo-pelvic pain, in a nutshell, is seen as a result of a lack of stability across the joints of the area.Exercises are suggested to add tone to weakened areas, primarily the Transverse Abdominus, Multifidi, Gluteals, Hamstrings and secondarily ranging from Obliquus Internus and Externus to Latissimus Dorsi and Quadriceps. Along with stability, the idea of a balance of forces is presented. In other words, some times the Gluteals grab and “splint” in response to a lack of stability in the lower back or at the Sacrum, and what is needed for relief and improved function is more “stiffness” and support from the deeper spinal muscles (mostly the Multifidi).As a life-long dancer, I really like the idea of helping someone mobilize an area, rather than just “taking the knots out”, as most people conceive of soft-tissue manipulation like Rolfing®. At the same time, there is something very two-dimensional about this view of human movement and resolution of pain. Just as it can be empowering to recognize the connections between humans and the rest of the animal kingdom structurally, there are limitations to this kind of approach that can’t be transcended. For example, a posture is pictured that “strengthens the Transverse Abdominal Muscle” Well, it can, but it probably won’t without proper coaching by a skilled hands-on practitioner who is able to offer imagery and cues that work for that particular client.My reaction to the articles was often: why does the scientific community need to plow through such outmoded body and movement paradigms? Fluidity is also empowering! I won’t bother the reader waxing on about the power of water, etc. The point is that some modalities may overemphasize looseness and laxity in tissue, where others are focused on rigidity and stiffness as the solution.Certified Rolfers look for the imbalances across important junctures in the body that may be triggering painful spasms elsewhere as part of their overall “body reading.” We also are taught to key into the client’s perceptual preferences, and try to get them to feel how these influence daily movement choices that continue to sculpt their form in space/time. For this reason Rolfing® is considered a wholistic, “3rd Paradigm” modality, in contrast to the work of “1st Paradigm” Massage Therapists, who focus on systemic relaxation (very helpful, certainly) or “2nd Paradigm” Physical Therapists, who are more symptom-focused. These last seem to primarily use a very direct therapeutic approach: exercise this muscle group to stiffen/strengthen that support, etc.It reminds me of the difference between a bodybuilder and a talented athlete. Michael Jordan was more often compared to a cat than a block of concrete. Shaquille O’Neil has the nickname “Diesel”, but there are many large men who have his brute strength but nowhere near the fluidity, savvy and skill he could muster in his prime!The information contained in “Movement, Stability and Lumbo-pelvic Pain; Integration of Research and Therapy, 2nd edition” can be very helpful, then, to wholistic practitioners as well as PT’s and the like. It gives useful new data to help frame the question: is my approach giving the body system space and fluidity sufficient for them to naturally create the stability they need for pain free and optimal functioning? Are there specific exercises I can give them to assist this process?This research and self-questioning can be very well integrated into a wholistic approach, even if it seems difficult for the scientist to look at this the other way around. Movement models that consider the mind/body connection need to be included and better understood in an “evidence-based” discussion of the human structure. Examples of truly optimum human motion contain elements of grace and fluidity more reminiscent of Jordan, Isadora Duncan, Bruce Lee and Mikhail Baryshnikov and less like the semi-paralyzed monsters towing fire engines with their teeth in a world’s “strongest man” competition.
