It is at the upper thoracic and shoulders in the human form that typically has the least interosseous space available and first begins to hold and fixate. These holdings translate into blockages and compressions into the fluid aspects of the neurological system, compromising the flow of cerebrospinal fluid (CSF). Fixations and distortions in the upper thoracic and shoulders in turn also hold distortion and patterns throughout the rest of the body. ... To unlock the twist we must begin where the twist is most locked. |
Ribs 2, 3 & 4
These Ribs also share double tendencies towards distortion. Both Ribs display a tendency to fixate into the larger ribs below, however, the tendency is exacerbated by the shoulder girdle - acromion, scapula, and clavicle. The weight and spacial restrictions of the shoulder girdle heighten the tendencies for Ribs 2, 3, & 4 to fixate laterally - i.e.: in the armpit, under the shoulder as well as under the scapula. Cumulatively, we have a multitude of reasons to be quite suspicious of the entirety of the upper thoracic and shoulder girdle and many grounds to first focus our energies there. However, we still need to get more specific and answer the question: Where do we start? The Left Axis Here we reference back to Theoretics 2 to put that information to work for us. In the picture to the right, we again have a random sampling of past clients, most of which show a tendency for body mass in the upper thoracics to have shifted rightwards of a center line/axis going through their pelvis and legs. As body mass shifts to the right, the vertical axis itself relatively shifts to the left. I refer to this as the "Left Axis" and find that in the average human body, the vertical axis of orientation, rotation and structural distortion generally shifts leftward in the body. This means that as a human structure distorts, it is not necessarily distorting from a point of reference that is through the intended center of the body. This point of reference, of orientation, of balance in the human body, is itself distorted. As the human body shift rightwards of a left axis, the structure essentially "pinches" on the left side. As it does so, interosseous space, which is already in short supply in the shoulder girdle, is compromised and closes even more through the left side relative to the right. Hence, and bearing in mind that we want to work with the biggest blockages in the system, this tendency in structural distortion points us towards the left shoulder and left lateral thoracic as the smarter places to begin our interventions with manual therapy. It is here that interosseous space is generally compromised the most and first, relative to the rest of the body. Scoliosis Let's also take a look at some X-Rays, pictures, and depictions of the typical scoliosis pattern. We can also note where the spine in those instances tend to deviate from a center axis. We can definitely see a similar "Left Axis" orientation. But what else? Bear in mind that we've argued here that the scoliotic pattern is a compensatory pattern - essentially a way for the human body to distribute strain while staying upright in gravity. Scoliosis is a pattern which is arguably a general innate tendency in all human bodies as it distorts in the field of gravity. It is most easily recognizable when it occurs early in life (juvenile idiopathic scoliosis); when there is a great deal of interosseous space available through which the whole-body compensatory pattern may flourish. How does a scoliotic pattern occur? Commonly, a scoliosis not occurring after an identifiable trauma is called an "idiopathic" scoliosis - ("cause unknown"). While certainly a broad subject, many scoliotic patterns appear to wind their way up the spine, plausibly beginning with a twist in the coccyx and sacrum. I would again note that our species is the only mammal on the planet which regularly traumatizes the coccyx and sacrum area while learning to walk. Serious trauma at an early age to this area can cause a structural twist at the coccyx, sacrum and pelvis that would likely result in the compensatory pattern freely working its way up the spine with plentiful interosseous space in which to do so. The pattern would ultimately fixate in the shoulders, locking the distortion below. In an older, less-spacious body, the scoliotic pattern is also commonly seen, although it is often much more difficult to perceive - loss of space and decades of traumas (major and minor) can cloud the already clouded picture. With interosseous spacial restrictions gradually increasing with age, compensatory demand to structural distortion becomes that much harder to meet. Strain abounds, movement ceases and the structure is able to absorb less and less demands for change over time. Hence the lack of space assures that the older structure will not change in the same way or to the same degree as the younger scoliosis. However, the same patterns, the same forces, the same innate tendencies to the human makeup are equally as present. Scoliosis effects millions upon millions of people, in differing degrees and severities - from mild to debilitating. It is a common thing. In fact, spinal distortion itself, and acutely in the aged, is the norm. ... |
Typical scoliotic patterns. Note the closing of rib space through the left sides.
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The Importance is in the Commonalities
Given the typical scoliotic pattern taken in conjunction with the 'normal' deviation from a center vertical line seen in the 'normal' body, we can note two commonalities that tend to occur to the human spine and in particular to the upper thoracic and shoulder girdle. Both are rightwards shifts. With a scoliosis, we almost always see a strong, noticeable rightwards lateral shift at the thoracic level. In the average body, we also commonly note a rightwards shift to a center-line (the Left Axis). Thus, in a very large chunk of the human population, arguably the majority, we are seeing the same tendencies occurring in the thoracic and especially the upper thoracic. Are these two commonalities linked? Well, it is unlikely that the scoliotic tendencies we see are purely coincidental to the general tendencies seen in the random, average body. It is much more likely that we are looking at a similar problem and patterns expressed quite differently over time. Regardless of connection however, we are also looking at huge swaths of the human population that have relatively more compression to the neurologic system through the left thoracic relative to the right. (See also, Theoretics 2, High pressures and asymmetrical stresses in the scoliotic disc: https://www.ncbi.nlm.nih.gov/pubmed/17319969) Again we are chiefly concerned not with what is different in the human body across the species, but what is the same. And until we understand what is normal, we will never truly grasp what is different. Our strength of inquiry lies in the commonalities. From here we will begin to marry understanding and basic assessment into technique and practical application. |
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more general "holes" in the body, both in "normal" and scoliotic spines, often tends to be the left lateral thoracic - particularly, the left shoulder and left upper thoracic.
The "hole" is generally the concave aspect to a spinal curve. Below are some approximate starting points for structural interventions into the body that focus on the concave side of a lateral thoracic curvature. |
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All too often however this is lacking in manual therapy and especially in the world of massage, where the standard massage is 50 minutes face-down and 10 minutes face-up. The industry norms, bolstered by client expectations supported by glossy marketing, produce a decidedly unbalanced "therapy" in which the posterior aspects of the body receive the majority of the work.
The "prone" position, i.e. face-down in a head cradle, is generally a strained position for anyone with spinal distortion. Spinal distortion is again, the norm, especially over 50 years old. This equates to a staggeringly high percentage of the population experiencing discomfort from standard massage, simply by virtue of the positioning alone. The area where the thoracic "hump" so often occurs later in life, also happens to be the area of the posterior that is most accessible to the average, well-intentioned massage therapist. It is thus generally the posterior thoracic which receives a great portion of the work done; the posterior fascial membranes are softened, while significantly less attention is paid to to the anterior or lateral aspects of the body. By virtue of imbalanced work focused in the wrong place, this "standard" massage may compel a negative structural change over time, although it is the 'deep' tissue brand of massage that poses the heightened and more immediate dangers.
... Lateral Deviation We can now take the same understanding as applied to structural distortion occurring anterior to posterior (above) and apply it to spinal deviations that are more lateral in nature. In either case the structure and spine is in strain; movement is limited and the structure braces to remain erect in the field of gravity. Where, in the kyphosis example above, we were concerned that releasing holding patterns that would allow the body to fall further into anterior to posterior distortion, here we are concerned that releasing the incorrect tissue will allow the body to fall further into a lateral distortion. Again, because interosseous space is relatively more limited through the lateral aspects of the body, the neural space there is likely to be relatively more squeezed. Hence, in terms of sequencing our interventions into the body, the focus early on should be quite a bit into the sides of the body, especially above rib 6, where the ribs begin to get consecutively smaller and the risk of fixation into a rib below becomes heightened. On the average body, these lateral deviations are often hard to see. Typically, it will be the anterior to posterior distortion that catches our eye and our attentions. But it is the more hidden lateral distortion that may compress and effect the neural system to a greater degree and of which should take priority in the sequencing of our interventions. And again, these lateral deviations, distortions and fixations will impair movement through the entirety of the spine. Left unattended, they will derail any attempts to change other problems of the spine. ... Taken broadly, a manual therapy practitioner may be well-advised to prioritize work in the lateral holes and shallows of the body. Pay attention to the left side even though it may be the right side that is more symptomatic. Lateral Distortions will be addressed in greater detail in Methodology 2. Be advised, I am not trying to over-emphasize anything or any body part here, or just yet. The goal is comprehensive, whole-body change, which essentially requires attention everywhere. The intent is not for a practitioner to start spending half a session in the upper left thoracic. Indeed, as we shall see, we are first simply pressing for balanced work and the mere inclusion of the upper thoracic in standard manual therapy, particularly in the lateral aspects. ... |
Standard massage often focuses on the thoracic 'hump'. This norm is strengthened by typical marketing - try a Google search of "massage" and then click on 'images'.
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Practical Issues in Working With the Sides
We'll finish this section with a brief detour here to explore some of the practical realities in working with the lateral aspects of the body, i.e. the sides. In Rolfing/Rolf Structural Integration and it's various offshoots, a significant amount of time is dedicated to opening the sides of the body. The entire 3rd session of the ten-session Rolf 'recipe' is spent in the lateral aspects with attention all the way up into the armpit. Not surprisingly and congruent with our discussion here, the 3rd session of the Rolf recipe is typically regarded as the most profound session of the ten. While many other factors may contribute to the successes of Rolf/Rolfing Structural Integration, the mere attention to the sides of the body also appear to correlate. The use of the side-lying position also serves to differentiate the field from more standard manual therapy and mainstream massage. With massage particularly, the sides of the body typically receive very little attention, especially in proportion to other areas. Again, the typical massage consists of 50 minutes in a face-down position and 10 minutes face-up in a given hour. Side-lying, despite being the most comfortable and least vulnerable position available, is not regularly incorporated into standard massage -- due to the difficulties encountered in draping a naked body. It is, unfortunately, the widespread practice of receiving massage in the buff that helps drive the process. Naked massage is the norm, which then requires a specific draping of sheets and coverings. Draping is easy enough in supine or prone but in side-lying it is somewhat difficult and time-consuming for the therapist to do and slightly inconvenient to the client to get. For the average massage therapist, with a new client who has never experienced such a thing as side-lying and a diaper-drape, skipping the whole thing is ultimately the far more attractive option. This needs to change. |
The industry norm. Side-lying work remains difficult and rare in standard massage because of the draping issues with naked clients.
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