Handbook of Assisted Pandiculation [2nd Edition]

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ABOUT THIS HANDBOOK This handbook describes "assisted pandiculation" maneuvers for many regions of the body and patterns of movement not covered by Thomas Hanna in his seminal, 1990 training in Hanna Somatic Education. These maneuvers were developed through intuitive insight, somanautical exploration, experimentation, and refinement. I present the most simple version first, followed by elaborations that produce higher levels of integration. The higher the degree of integration, the more complete and satisfactory the outcome — in other words, the faster the progress. At the beginning of each section, I talk about the somatic functions affected by the pandiculation sequences to follow. Rather than make these words a matter of intellectual understanding, I invite the reader to explore the functions described somatically, through feeling and movement. Such explorations will give those introductory words more meaning and answer questions that a mere reading may raise. I wish to thank, with gratitude, Leonard Contier, Karen Hewitt, Maggie Munroe, and JoAnna B. for their participation, feedback, and assistance in the creation of this handbook.

Lawrence (Lorenzo) Gold Certified Hanna Somatic Educator Associate Instructor, Somatic Explorer and Guide December 14, 1997 [email protected] • on the World Wide Web at somatics.com

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FOREWORD In his 1990 training, Thomas Hanna amply covered the clinical, hands-on lessons for the Red Light, Green Light, and Trauma Reflex lessons described in his book, Somatics: Re-awakening the Mind's Control of Movement. Flexibility and Health. Those lessons and the preparation needed to deliver them continue to constitute the content of the first two sessions of training sponsored by the Novato Institute for Somatic Research and Training and delivered by Thomas' students. The maneuvers described here have particular value when dealing with the Trauma Reflex and with conditions that would have been addressed in the second and third years of training with Dr. Hanna, had he lived to conduct them. They are best applied after the client has received the basic lessons for the Red Light, Green Light, and Trauma Reflexes. Please understand that differences of technique exist among practitioners; the following lessons show my way of applying the principles of Hanna Somatic Education. These differences will cease to be problematic as soon as you realize that techniques accomplish an intention, and that techniques can be applied in a variety of ways to accomplish the same intention. This handbook will equip you to teach your clients to master certain conditions in themselves. If you identify a clear intention for each maneuver (e.g., "free the ribs"), you will discover what must be done with each client to accomplish it, beyond what can be formalized in instructions. The effectiveness you experience will depend greatly upon how well you sense, how well you move, and how well you apply yourself in your work. The best results come when you move from your somatic center as the whole body. In addition to pandicular maneuvers, I also address certain nuances of somatic education to which Dr. Hanna alluded during that training or discussed in his books, Somatics and The Body of Life. Particularly, I address the effect of the emotional state of the client, rules of thumb for precise positioning, and the state of the client's attention. One who has read Dr. Hanna's writings, and especially one who has practiced his methods of somatic education, may recognize the relevance and fitness for inclusion of these nuances in this handbook. In some cases, I describe pandicular manuevers first done by other of Dr. Hanna' students during that summer of 1990. Other maneuvers I describe here grew from more rudimentary maneuvers shared by others during the summers of 1991 or 1992. And some, I developed in my somanautical explorations, driven by necessity. The point here is not to claim or assign credit for what has been developed (though I give credit where I know to whom to give credit), but to share and preserve techniques that have not, as yet, been widely communicated, to serve the body of Hanna Somatic Educators.

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To some extent, these pandicular maneuvers can dispell patterns of contraction associated with unresolved emotions about past life-experiences. I have included instructions on Pandiculation of Emotions to assist in this process. I developed the method experimentally during my own high-stress period. For emotional reactions to current life-situations, other procedures outside the precise scope of Hanna Somatic Education can be useful; I can direct those who are interested to sources of training in those procedures through personal communications. For the student of Hanna Somatic Education who wants to learn these maneuvers, my best suggestion is to team up with a partner (who will read the instructions and make sure what you do looks like what I describe) and a subject. That makes three of you. Doing it this way will keep you from going nuts trying to learn this stuff from a book. Another alternative is to use audio-tapes of these instructions to guide you as you work with a single partner.

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CONTENTS ABOUT THIS HANDBOOK FOREWORD MATTERS OF TECHNIQUE Following Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T-l Assisted Pandiculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T-2 Kinetic Mirroring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T-4 Reverse Pandiculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T-5 Aiming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T-6 Pandiculation of Emotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T-7 About Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T-8 After Bone Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T-10 On Neurophysiology and Neuroanatomy . . . . . . . . . . . . . . . . . . . . . . . . T- l l Observations on Various Dysfunctions . . . . . . . . . . . . . . . . . . . . . . . . . T-18 LESSONS FOR THE LOWER EXTREMITIES About the Lower Extremities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L- l The Internal Rotators of the Hip Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . L-3 The External Rotators of the Hip Joints . . . . . . . . . . . . . . . . . . . . . . . . . L-6 The Iliopsoas-Abdominal Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . L-18 Lorenzo's Lollapalooza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L-20 The Hamstrings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L-21 The Quadriceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L-26 The Peroneals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L-28 The Lower Legs: Plantar Flexors and Dorsiflexors . . . . . . . . . . . . . . . . L-31 The Feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L-34 IMPROVING BREATHING Point of View about Breathing Problems . . . . . . . . . . . . . . . . . . . . . . . . . B-l Freeing the Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3 Freeing the Shoulders from the Ribs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-5 Freeing the Ribs from Each Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-6 Quadratus Lumborum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-6 Restricted or Painful Ribs (Intercostal Muscles) . . . . . . . . . . . . . . . . . . . . B-7 Serratus Anterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-10 Ribs Stuck in Inhalation Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-12 Upper Ribs and Clavicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-14 Integrating Rib Movements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-16 Integrating Rib and Shoulder Movements . . . . . . . . . . . . . . . . . . . . . . . B-18 Freeing the Upper Ribs from the Neck (scalenes) . . . . . . . . . . . . . . . . . N-10 LESSONS FOR THE UPPER-EXTREMITIES Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-l

LESSONS FOR THE UPPER-EXTREMITIES (continued) The Clavicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-2 Freeing a Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-3 Upper Trapezius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-3 The Deltoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-5 The Arm Adductors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-8 The Teres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-10 Biceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-ll Triceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-14 The Forearm and Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-15 The Fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-17 Lorenzo's Funky Chicken Maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . U-19 A NECK SEQUENCE About the Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-l Using Kinetic Mirroring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-l The Importance of Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-l The Layers of the Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-2 Freeing the Neck from the Shoulders . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-5 The Trapezius Lengthening the Neck . . . . . . . . . . . . . . . . . . . . . . . . . . N-8 Multifidus and Cervical Extensors Centering the Neck and Head. . . N-10 Anterior Scalenes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-10

Posterior, Cervico-Thoracic Intervertebrals "THE TEN-MINUTE HEADACHE CURE" . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-13 Posterior Scalenes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-19 The Cervico-Thoracic Junction . . . . . . . . . . . . . . . . . . . . . . . . . . N-21 Lateral Scalenes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-23 The Deep Layer of the Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-26 Deep Anterior Cervicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-28 The Sub-occipitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-30 Kinetic Mirroring Rotators of the Neck . . . . . . . . . . . . . . . . . . . . . . N-32 Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-34 LESSONS FOR THE JAWS About Jaw Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pandiculation for Biting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sub-Occipital/Neck Extensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Masseter and Temporalis Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Neck Flexors, Masseter and Temporalis Muscles . . . . . . . . . . . . . . . . . . . Pandiculation for Grinding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lateral Jaw Clenching Movements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Pterygoids: Muscles of Jaw Protrusion & Retraction . . . . . . . . . . . .

J-l J-4 J-4 J-6 J-7 J-9 J-9 J-ll

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FOLLOWING DIRECTIONS

For practical purposes, you may want to explain directions of movement to your client as follows: "forward"

toward the front of your body

"backward"

toward the back of your body

"up"

away from the earth, against gravity

"down"

toward the earth, with gravity

"north"

toward the head

"south"

toward the feet

If you say, "turn to the right," and they turn to the left, tell them, "the other

right!" With some people who act before hearing your complete instructions, it is helpful to begin instructions with an adverb, as in, "Slowly lower your leg." If you say, "Lower your leg slowly," by time you say "slowly," their leg may already be down!

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ASSISTED PANDICULATION a. Client contracts. b. Educator meets, matches, and opposes client's effort, c. Client steadies in position until attention steadies, d. Client eases off, lengthening. e. Lock-in. (Integrating the antagonist.) RULES OF THUMB: o Look to see what your client is doing (a posture is an action) so you can have them do it consciously. For example, observe the posture of retraction; have them retract. Pandiculate out. Whatever you see, have them do it more, then less. o Work proximally-to-distally. Do the standard lessons (#1 Green Light, #2 Trauma, #3 Red Light) lessons first. o The client sets the strength level. Coach him/her to maintain firm contact with you at a strength level within the comfort zone and always less than “shaking” strength. o ON LOCK-IN: In SMA, a contracted agonist muscle group has overpowered its antagonist group. In other words, the person is stronger when moving in one direction than when moving the opposite direction. The Lock-in balances the strength available for movement in both directions. The strong contraction of the antagonist in a Lock-in also signals the agonist to relax further by reciprocal inhibition ("When flexors contract, extensors relax.") In my opinion, to get the greatest increase of sensory-motor integration in the neural network, a Lock-in should involve the sudden switch from a strong contraction in the agonist to a strong contraction in the antagonist with virtually no time lag in between. NOTE: In cases of muscular weakness, rapid functional gains can sometimes be made by having the person do a series of quick reverses (pushes in opposite directions) along the range of motion (with the involved body part sandwiched between your hands).

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o ON "SOFT" PANDICULATION: Some people return to contraction immediately after assisted pandiculation. They may do this because 1) they are compulsive "helpers" unused to relaxing and "letting it be," or 2) they treated the pandiculation as a struggle in which they "lost". The solution: follow your standard, strong, assisted pandiculation with a very low-force pandiculation. This variation awakens them to a gentle, more subtle response from which they can get the message, "relax." You may need to do this more than once. o In some cases of leg dysfunction, the person has injured him/herself distally (e.g., at the ankle) and suffers discomfort and SMA more proximally (e.g., at the hips or waist). If the hamstrings are involved, the person probably has balance problems, though (s)he may not know it. Help him/her regain confidence in the legs, working first at the site of injury; that will give him/her the security needed to be willing to let go of protective contractions at the Somatic Center. Then work from the Somatic Center, outward. o Remember that shoulders and hips work together and complementarily. If you get incomplete resolution in one girdle, free the other and give him/her a few days.

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KINETIC MIRRORING

This technique was developed by Moshe Feldenkrais and was so named by Thomas Hanna. Yochanan Rywerant, a prominent practitioner of Feldenkrais Functional Integration, calls it, "substituted effort." The technique also appears in osteopathy, in cranio-sacral therapy, and probably in other approaches. In involves bringing the two ends of a hypertonic muscle closer together, generally by moving the client into a position that accomplishes that end. After less than a minute, the muscle will usually relax. You may get faster results if you ask your client to take a few full, deep breaths during kinetic mirroring. The "mirroring" involves duplicating the action of the muscle, which is to bring the bones held by its two ends closer together ~ showing the action of the muscle to the person. The explanation given for the effectiveness of this maneuver is that the body's proprioceptors, which monitor movement and posture, sense that the job of the muscle (to maintain a particular position) is being done, whether or not the muscle is tense. Thus "comforted," the neuromuscular system relaxes.

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REVERSE PANDICULATION

When a client releases reluctantly or incompletely during pandiculation (perhaps in fear of pain), use Kinetic Mirroring or Reverse Pandiculation to prepare them and to give them confidence. Reverse pandiculation makes the act of contracting more conscious and more acceptable; a person brings more feeling to it. As a preparatory move prior to standard pandiculation, Reverse Pandiculation works something like "active Kinetic Mirroring.11 STEPS

1.

Do pandiculation of the antagonist. (Removes some of the "reason" for the agonist staying contracted.)

2.

Have your client assume the position that brings the amnesic muscle/group to its longest comfortable length.

3.

Have your client contract the amnesic muscle/group as you match resistance.

4.

Yield by steps. (Client "pursues" educator.) Instruct your client to keep their pressure against you constant. Give in by 2", pause in place, wait for your client to get steady and strong, give in another 2", etc.

5.

Have client move the part freely.

6.

Do a standard pandiculation.

If results are still unsatisfactory, look for the larger movement pattern of which the painful area is a part. Do standard assisted pandiculation with what you find. If necessary, do a reverse pandiculation series more proximally. Otherwise, you will need to use your somatic awareness to create a lesson.

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Handbook of Assisted Pandiculation Matters of Technique

Page T-6 November 1, 1994 AIMING

The instructions for the lessons of Hanna Somatic Education, including those taught in the Certification Training, include positioning of the client and practitioner. Wordinstructions, however, can be only approximate. Accurate positioning, for best results, requires fine-tuning by sensing the exact position(s) that most directly "point to" (or specifically use) the amnesic muscles or muscle fibers. If you are sufficiently sensitive and if you and your client are relatively undistracted by the maelstrom of thinking and guarding that surround pain, you may be able to position your client precisely without their assistance. You may find it easier, however, to have your client help you position them. Get them into the general position, then have them gently perform the movement appropriate to the maneuver against your resistance; note the location of their contraction, have them relax, and reposition them until the amnesic, contracted area contracts. Or, you may ask them to adjust until they find a "hot spot" ~ a sore, tight, or weak spot. Have them find the very center or core of the troubled area. That is the most effective position for pandiculation or the other techniques. Your client may experience multiple points of discomfort when positioning themselves this way. Excellent. Have them 1) position themselves so that they feel both (or all) points simultaneously and of equal intensity; then have them pandiculate or 2) locate and pandiculate for each point, systematically. I cover this general technique (which I call "Connect the Dots") more specifically in certain of the lessons in which it can best be used. It's up to you to generalize its application to other lessons.

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PANDICULATION OF EMOTIONS

Occasionally, a person's SMA has to do with an emotional response they are currently making to an ongoing life situation. Unless they change their attitude about the situation to which they are responding, there is little you can do. If their response involves a past situation, you can assist them in releasing it by "emotional pandiculation." METHOD:

linking an emotional state (mood) with the feelings of contraction and release

The key to "emotional pandiculation" is the acknowledgement of ones control over the added emotion one has generated. (One doesn't believe one is trapped by an emotion one is voluntarily generating.) As you begin pandiculation, have your client identify (to themselves -- you don't need to know) any emotion, image, memory, or belief they may be experiencing. Have them intensify it as they intensify the muscular effort and gradually reduce it as they reduce the muscular effort. Periodically have them pause in place and feel the emotion, then relax it as they relax their effort. Three passes or so may be required before the response disappears.

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Page T-8 November 1, 1994 Handbook of Assisted Pandiculation Matters of Technique ABOUT PAIN THE SPECTRUM OFSENSATION

awareness of movement ticklishness fatigue painful to touch soreness in movement pain

= = = = = =

freedom tendency to contract constant low-level contraction constant medium-level contraction constant high-level contraction Oy veh!

PAIN AS A MARKER

Your client's pain is a most useful marker of where the trouble is. In general, you will encounter two types of pain. o local pain o referred pain Local pain marks the location of either hypertonic muscles or of joint compression. With joint compression, the tendon(s) of the hypertonic muscle(s) cross the joint. Thus, in both cases, address the local hypertonicity to clear up the pain. Referred pain results from entrapment, by muscle or bone, of the nerve communicating with the painful area. Sciatica is an example of referred pain; entrapment may occur either at L3/L4, L4/L5 or at the piriformis muscle, through which the sciatic nerve sometimes passes. You may find that your client's muscles are loose in the painful area; if so, suspect referred pain and look for entrapment along the nerve route, starting at the spinal column. Knowledge of neuroanatomy or an atlas of human anatomy can help, here.

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PAIN AND POSITIONING FOR PANDICULATION

Give areas priority for pandiculation in the following order: 1) painful areas 2) muscle groups causing a tilt or rotation 3) areas of tension The rule of thumb is, "Have your client position themselves to feel the painful area more clearly." Assist them in aiming into the pain; encourage them to work gently enough to keep the pain within the intensity they are willing to feel. To aim this way can vastly improve the effectiveness of pandiculation. If the intensity is too great for your client to pandiculate without cringing or fear, begin with kinetic mirroring or reverse pandiculation.

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AFTER BONE FRACTURES

There will be times when spasticity traces back to a bone fracture in the person's history. Imagine what happens during a bone fracture — the bone moves from its normal position in the soft tissue. The impulse to withdraw (trauma reflex) combines with the impulse to hold on to the distal end of the break. Then, imagine what happens when setting the bone -- forced movement counter to the impulse to withdraw. Lots of trauma reflex! In developing a pandiculation of an area involved in a break, first determine what direction of motion created the fracture. The spasticity will probably be trying to counter that motion. Pandiculate accordingly. If the person is unwilling or afraid to pandiculate in the area of prior injury due to pain, do a pandiculation series for the other side. Then find out, through movement, which movements of the injured side feel safe. Watch the movement carefully. Feel your client move with your hands. That's the plane of pandiculation in which to begin. Then, begin with Kinetic Mirroring or reverse Pandiculation to set them at ease. Expand out from there with pandiculation in directions more and more directly in line with the pattern of contraction.

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ON NEUROPHYSIOLOGY AND NEUROANATOMY

You may find knowledge of neurophysiology and neuroanatomy useful from three viewpoints: 1:

To understand and creatively use some of the mechanisms of the central nervous system in your lessons

2:

To address referred pain resulting from nerve entrapment by muscle or bone

3:

To speak medical jargon with health professionals, such as doctors and physical therapists, so that they listen to you

In the following pages, I include an outline of what I consider to be knowledge useful for practice of and communication about Hanna Somatic Education. Its purpose is to give you a line of study. In general, the topics are simple, not lengthy, and yield to quick understanding. To apply the understanding developed to your practice will possibly require some pondering or conversation with someone who has internalized the applicability.

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Handbook of Assisted Pandiculation Matters of Technique NEUROPHYSIOLOGY SUBJECTS

I

REFLEXES

A. Spinal

1. Myotatic/stretch a. muscle spindles b. golgi tendon organs B.

Cortical 1. The Landau (Green Light) Reflex a. postural changes 2. The Startle (Red Light) Reflex a. postural changes b. physiological changes 3. The Trauma Reflex a. postural changes

C.

Clearing Fixated Cortical Reflexes

1. Pandiculation 2. Kinetic mirroring

II

COORDINATION

A.

Reciprocal Innervation

1. Sensory-motor feedback loop 2. Agonist-antagonist pairs 3. Reciprocal inhibition

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Handbook of Assisted Pandiculation Matters of Technique B.

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Muscular Recruitment

1. synergy 2. sequence of recruitment a. by degree of effort i. (use palpation to reveal) b. by change of position ii. (use Somatic Kinesiology to demonstrate) 3. intrinsic/extrinsic movement a. definition of muscle layers b. Sensory-Motor Amnesia c. sensory-motor awakening C. Balance, Head Position, and Head Movement 1. the vestibular apparatus and oculo-motor nerves a. "The Purpose of Vision is to Organize the Body for Move merit." 2. the vestibular apparatus and somatic integration

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III TIIE CENTRAL NERVOUS SYSTEM A. The Homunculus (review) 1. Distribution of nerves a. 1/3 speech / face b. 1/3 hands/forearms c. 1/3 the rest of the soma (mostly in the feet) B. The Spinal Cord 1. Sensory-ascending a. dorsal nerve roots 2. Motor-descending a. ventral nerve roots C. The Major Plexi 1. Location 2. Function a. How to Recognize Impaired Function i. organ dysfunction b. Referred Pain: the relationship of patterns of contraction to impaired function i. tingling ii. numbness

iii. burning

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Handbook of Assisted Pandiculation Matters of Technique

IV THE AUTONOMIC NERVOUS SYSTEM A. Sympathetic-dominant side 1. location of spinal sympathetic ganglia 2. function a. objective definition b. subjective experience 3. physiological changes a. triggering i. carbon dioxide level in the blood b. responses: visible and invisible i. adrenalin ii. accelerated heartbeat, etc. iii. histamine reaction (rash) iv. changes of body temperature v. associated behaviors B. Parasympathetic-subdominant side 1. location of ganglia 2. function a. objective definition b. subjective experience

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3. physiological changes (visible and invisible) a. associated behaviors C. The Central Nervous System is Free Only When the Autonomic Nervous System is in Balance D. Recognizing Fixation in Either Mode

1. Somatic approaches to release a. equalizing/balancing the right and left sides of the body V LEARNING A. How Learning Works: the sensory-motor nature of memory 1. Linkage of Sensations and Motor Responses 2. The Somatic Nature of Attention a. directing the sense organs to the area of greatest stimulus 3. The Somatic Nature of Intention a. reactivation and organization of muscles into potentiated patterns of movement/response b. the resulting sensations B. How Kinetic Mirroring Works

1. How to Do It 2. What it Does 3. When to Use It

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C. How Pandiculation Works

1. review: cortical --> sub-cortical motor patterns 2. review: What it Does 3. When to Use It a. standard pandiculation b. "reverse" pandiculation c.

pandiculating the antagonist of a muscle in trouble i. when the muscle in trouble is too painful

d. pandiculating at 90 degrees to the direction of SMA contraction ii. when the muscle in trouble is too painful VI PATHOLOGY A. Distinguishing Spinal Lesions from Brain Lesions 1. Effects of Stroke 2. Effects of Spinal Cord Injury B. Distinguishing Structural Limitations/Lesions from Functional Limitations 1. Congenital Deformities 2. Organic Diseases 3. Surgical Deformities

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OBSERVATIONSONDYSFUNCTIONS: ADHESIVE CAPSULITIS:

Associated with "frozen shoulder." May be misdiagnosed: there may be no adhesions; instead, the musculature may be contracted in SMA. Proceed with care to work within the comfort range of the client. ARTHRITIS:

Catch-all term for joint pain and inflammation. Often results from joint overcompression due to muscles in SMA contraction. If cartilage remains, may often be reversed by dispelling SMA; otherwise, surgery may be necessary. Sign of no cartilage: "squeaky drawer" feeling in movement. Sign of fibrous invasion of joint ("bandaging"): restricted motion after pandiculation. Rheumatoid arthritis may not respond well to Hanna Somatic Education. ASTHMA:

Miscoordination of Abdominus Rectus with Diaphragm; Abdominus tightens upon inspiration. Co-contraction of internal/external intercostal muscles; immobilizes rib movement and hardens rib cage. Related to contracted emotional states, e.g., sorrow, fear. Speculation on bronchial constriction: Restricted movement of the ribs deprives the lung tissues of the stimulating effects of motion; the cilia of the bronchial lining become sluggish, allowing foreign matter and mucus to accumulate. The lining becomes irritated and constricts, further worsening the problem, which becomes self-perpetuating. ASYMMETRY, POSTURAL:

Asymmetries reflect Trauma Reflex, congenital deformity or restricted/disorganized/contracted fascia. Vertical balance is the easiest, most economical posture requiring a minimum of muscular maintenance.

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BALANCE PROBLEMS (see dizziness):

SMA of Biceps Femoris (hamstring) interferes with fibular adjustment and foot position. Poor contact of the feet with the ground Unstable foundation. BLOOD PRESSURE, HIGH:

Tight Abdominus Rectus -- > hyperventilatory response -- > faster, shallower breathing. More carbon dioxide in the blood triggers sympathetic dominance of the autonomic nervous system, which constricts surface blood vessels. The combination of decreased vascular volume, faster heartbeat, and backpressures from habitual muscular tension increases blood pressure. CHRONICDEPRESSION:

Habituation of Startle Reflex, including SMA of the intercostal muscles and deficient breathing. May be reinforced by negative beliefs about life. May be viewed as a response, rather than as an illness. CONSTIPATION:

Related to SMA of IlioPsoas and internal rotators of the femur at the hip. The hypogastric plexus, which mediates motility (intestinal movement) lies embedded in the Psoas. A contracted Psoas in SMA toxifies the surrounding tissues, including the plexus, leading to sluggish function; the Psoas coordinates with the rotators in walking. May also indicate improper diet (e.g., insufficient fiber) and toxicity.

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DISLOCATIONS, FREQUENT:

Uneven tonus among hypertonic joint muscles. DISPLACED PATELLA (dancers!):

Quadriceps imbalance. Hypertonicity. Integrate the hamstrings, as well. DIZZINESS:

Semicircular canals belong vertically over the somatic center. Therefore, appropriate balance depends on appropriate head position. Free the neck muscles to permit omnimobility. May occur when the person is in both somatic retraction and in neck trauma. May temporarily occur when the scalenes are first released from SMA. DOWAGER'S HUMP:

SMA of Abdominus Rectus, intercostals (ribs affect vertebral position), Anterior Scalenes, and suboccipital muscles. FOOT PAIN/FATIGUE:

Related to swayback (and posture associated with the Landau response). Weight-forward overburdens the front of the feet. FREQUENT URINATION:

Startle reflex contracting the Abdominus Rectus and perineum. Interabdominal pressure on the bladder reduces its capacity for expansion, creating a premature pressure on the pressure receptors within the urethra, giving the false impression of fullness.

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GENERAL HYPER-AROUSAL OF CNS:

Tight forearms. Tight speech apparatus (elevated pitch, tight TMJ). HEADACHES (Tension Headaches):

Tension: habituated Landau (paraspinals -> neck) Migraine: cardiovascular (check for Startle reflex), SMA of the Scalenes and deep neck musculature HEMORRHOIDS:

Startle reflex at perineum Contracted perineum interferes with excretion. The individual "strains at the stool", forcing blood to abdominal cavity. Blood vessels swell at the same time as fecal matter passes through anus. Mechanical strain produces stretching = "hemorrhoids." IMPOTENCE:

Related to contracture of the perineum, restricting blood flow. Startle and/or Trauma reflex. INCONTINENCE:

Sensory-motor amnesia at perineum. JOINT PAIN:

Overcompression by muscles in SMA. Dispell SMA and integrate muscular functioning on all sides of the troublesome joint. Look also for unbalanced weightbearing due to postural distortions, which places execessive burden on the troublesome joint(s). NOTE: If joint damage has occurred, muscles may contract to brace the unstable joint and not respond well to pandiculation. That may be a job for a surgeon.

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KNEE SWELLING:

Laterally bent knees often swell with synovial fluid. Trauma reflex with tilt likely. Eliminate tilt and establish better balance: removes undue strain from the knee. MIGRATING PAIN:

Sometimes experienced by people receiving massage or chiropractic adjustments. Forced relaxation or postural shifts without somatic education evoke postural responses (muscular contractions) from other areas. May also indicate (1) an emotional response (sometimes the desire for social power or economic gain through the “victim game” or litigation) (2) an emotional trauma stimulating somatic retractions, or (3) incomplete somatic education which has left some areas involved in a chronic response as yet untouched. MYOFASCITIS:

Descriptive term that may describe the irritation of muscles contracted in SMA. OBESITY:

Obesity often masks (and results from) chronic muscular contraction beneath the fat layer. Circulation is impaired, in such areas, allowing metabolic wastes, water, (osmotically attracted), and fat to accumulate over long periods, while slowing their removal by circulation during the relatively short periods of dieting and exercising. By opening the area (by relieving SMA) circulation improves and deposits tend to lessen by themselves, over time. Of course, contracted, sore people don't like to exercise, either. Dietary habits (including "dieting") and genetic characteristics may also contribute.

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POKER SPINE (Ankylosing Spondylitis)

Spontaneous, fibrous spinal fusion. Looks like Startle Reflex. Bone grows upon the demand of muscular pulls. This condition may be mimicked by habituated Startle Reflex combined with Landau Reaction. SCIATICA:

Landau + Trauma rfxs. --> side tilt (on side w/sciatica) and entraps the nerve in foramena (L4,5). Contraction of the Piriformis: the sciatic nerve sometimes passes through the body of the Piriformis muscle. SCOLIOSIS:

Apparent assymmetrical hip width, rotation of ribs, and distortion of spinal curves If congenital, deformity of bone growth exists. Etiology, functional scoliosis: lower-extremity injury, often in youth ==> loss of support, one-sided support ==> compensatory growth / balancing compensations of musculature. Look for muscular contraction patterns in the intercostal muscles as well as more superficial muscles of the trunk. SWALLOWING PROBLEMS:

SMA of muscles attaching to the hyoid bone, e.g., digastricus, mylohyoid, stylohyoid --> styloid processes. Affected by rniscoordination of the deep muscles of the throat, e.g., Longus Capitus and Longus Colli. THORACIC OUTLET SYNDROME:

Impingement of the brachial plexus resulting from SMA of the muscles of the cervical (scalenes) and/or clavicular areas.

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TMJ SYNDROME: Can be relieved by releasing the movements of the cranium AND SPINE from the mandible in all directions. Free the cranium from the mandible by restraining the mandible and moving the cranium. Related to tight Sterno-Cleido-Mastoid and Pterygoids (secondarily related to Masseter and Temporalis). The sub-occipital muscles are also involved, as they contract when the mouth is opened fully to position the head for biting. More severe cases may involve the deep muscles of the throat (Longus Colli and Capitus) associated with the larynx, the musculature associated with the tongue, and the entire rib cage. TINNITUS:

Related to Sternocleidomastoid (secondarily related to Masseter and Temporalis). Tight neck problems. May also arise from cranial trauma (blow or brain infection) evoking somatic retraction, and from auditory nerve damage. UNEVEN LEGLENGTH:

Sometimes bona fide; often misdiagnosed (even when measured). Often the consequence of leg retraction in trauma reflex; sometimes results from ace tabular joint degeneration over the long term (loss of cartilage) from chronic leg retraction. Look to the pectineus, obturators, and leg abductors. WHIPLASH:

Trauma reflex associated with sudden motion of head and neck. Pain and dizziness result from muscular contraction and interference with reflexive control of upright head position. May be complicated by retraction by the head and neck (startle reflex). Work gently as soon as possible after the incident unless instructed otherwise by the attending physician. Persistent symptoms indicate SMA; acute symptoms may reflect soft-tissue damage.

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BODY LANGUAGE ELBOW ROOM:

The freedom to be humerus in a situation.

GLUTEUS MAXIMUS:

A Roman general who made an ass of himself on the battlefield.

NECKING: The act of putting oneself in an awkward position to get intimate with someone. NOSEY:

Overly probing, as with ones proboscis.

PULLING SOMEONE'S LEG:

A Yankee tactic for helping get someone's feet back on the

ground. PAIN IN THE ASS: A situation that triggers the resistance we have to being the butt of one of

life's little jokes. PAIN IN THE NECK: Someone who has been jerked around and wants to make sure it never

happens again. RIBBING: The act of reminding someone of a subject about which they are a little closed and

uptight and would rather forget.

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ABOUT THE LOWER EXTREMITIES Ideally, in walking, the joints at ankle, knee, and foot flex around parallel, horizontal axes. This pattern of movement, which minimizes the effort of walking, permits walking to be initiated by the iliopsoas, gluteus minimus and plantar-flexors of the foot, continued by the force of gravity (by pendulum-action), and finished by active hip flexion, knee extension, and foot dorsiflexion. The musculature involved in those three motions, and their antagonists, must be free and coordinated for that easiest pattern of movement to occur ~ and for there to be spring in your step! That understood, I have invented a systematic, yet flexible lesson for the lower extremities. THE LESSON SEQUENCE

1. 2. 3. 4. 5. 6. 7. 8.

Internal Rotators of the Femur at the Hip Deep External Rotators of the Femur at the Hip Iliopsoas/Rectus Abdominis Hamstrings Quadriceps Peroneals The Lower Legs (anterior/posterior direction) The Feet

The fact that the legs work reciprocally (in equal and opposite directions, simultaneously) provided an important clue for understanding the hamstrings (see Hamstring Sequence #2): the hamstrings of one leg reciprocally inhibit those of the other leg; relaxation of the hamstrings of one leg ought to be coupled with contraction of the hamstrings of the other leg. However, the hamstrings are incapable of a truly anteriorposterior movement unless the hip rotators function freely, for reasons which I will present later.

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The fact that the fibula links the fibular head of the biceps femoris with the peroneals provided another important clue: Optimum balance in walking requires coordination of the hamstrings (which control flexion and rotation of the tibia at the knee) with the peroneals (which control rotation of the tibia at the ankle, and so, foot position). These two muscle groups provide an important key to balance (i.e., "grounding"). Include or omit segments of this sequence according to your client's needs.

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INTERNAL ROTATORS OF THE HIP JOINTS

The internal rotators of the femur at the hip counterbalance and assist the Iliopsoas to produce straight-forward knee movement (hip flexion). If your client has an anteriorly tipped pelvis (pubes back) you may need to do this sequence before you work with the external rotators. Many clients need a "bathroom break" after this one possibly due to effects upon the Iliopsoas, in which the hypograstric plexus (which controls intestinal function) is embedded. People who have constipation and/or trouble sitting cross-legged may find this maneuver very helpful. The internal rotators include the gluteus minimus, anterior fibers of the gluteus medius, and the tensor fascia lata. Fasciculi (muscle-fiber clusters) of these muscles can be felt by palpation anterior to the greater trochanter, with the knees up and feet planted. When functioning normally, they are relaxed in this position and you can feel the trochanter. Otherwise, they are sore to the touch, so probe gently. These muscles have a dual function: internal rotation and flexion of the leg at the hip. We therefore choose a starting position that uses both functions. STARTING POSITION: CLIENT:

supine, knees up, feet planted

EDUCATOR:

1.

next to your client's hip, facing "south"

Place the hand nearest your client above their knee; with the other, gently grasp the mass of muscles around the greater trochanter. Use your thumb to locate contracted, sore muscles.

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Have your client gently lift the knee (against your resistance) and press down with the other foot. Monitor with your thumb. You will feel the Femoris Rectus get taut.

3.

Have your client slowly turn their knee medially, with you still providing resistance. You will feel the more lateral muscles begin to take up the load. When the knee is in exactly the right position, you will feel the amnesic muscle grow taut, and your client may report that that is the sore muscle. Good. You are on target.

4.

With the knee in that position, have your client lift higher (pressing down more with the other foot).

5.

Meet, match, and resist their force.

6.

Instruct your client to lay the leg down slowly, keeping the foot barely off the surface. Have him/her reach out of or from the waist (tighten the opposite side waist). When your client has relaxed completely, ask them to let go of the kneecap. Miracles and wonders! You will feel him/her relax further. NUANCE: With your resisting hand, guide the knee to an externally rotated position;

with your monitoring hand, follow the tension down to the bone.

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Page L-5 March 12, 2007

Cupping your hand over their knee joint, roll their leg side to side until they are loose and floppy. If your client is squeamish about the knee, place your hand above (proximally) or below (distally) to it. When you look, their hip will appear flatter, longer, and more spacious. Now, do the other side.

8.

Sit at your client's feet. Place the palm and fingers of a hand along the outside of their foot with the thumb against their sole.

9.

Tell your client, "Feel this at your waist," and push. Push and release a few times until they know what it is to retract their leg by tightening at the waist.

10.

With one hand, grasp behind the heel; with the other, grasp the instep of the foot (dorsal surface, medial arch).

11.

Tell your client, "Tighten at your waist and pull your leg to create that same sensation." NUANCE:

Have your client reach for the side of their knee (with the hand of the active side). This action tightens their waist further. 12.

Meet, match, and resist.

13.

Have your client ease off. Repeat twice.

14.

LOCK-IN: Place the palm and fingers of your hand along the outside of their foot with the thumb against the sole. Have your client push against your hand.

Starting Position

Deep to the Tendon:

Step 2: Knee to Chest

Step 4: Kick the sky.

Step 5: Lower the Drawbridge.

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KICK THE SKY In the following sequence, you guide your client through a series of movements that coordinates both legs in hip flexion, knee extension and relaxation. One leg presses down as the other lifts up. You guide your client in positioning so that (s)he locates and uses the rectus femoris muscle distinctly from the gluteus minimus and psoas muscles. You use this sequence when palpation reveals that the rectus femoris tendon is taut when in a “slack” position (knees up). In this maneuver, both legs operate simultaneously, one in pandiculation (active side) and the other (bracing side) pushing down into the surface as a brace for the active side, to help keep the back flat on the surface. RECTUS FEMORIS / HIP FLEXION / KNEE EXTENSION STARTING POSITION: CLIENT:

supine, knees up, feet planted somewhat near buttocks, hands on belly

EDUCATOR: seated beside the client, facing “south”, your "north" hand anterior/proximal to the

knee, your “south” hand palpating at the tendon insertion at the anterior inferior iliac spine (AIIS), with the thumb deep to (beneath) the tendon, not on top. 1.

Your client presses down (into the surface) with the bracing-side foot.

2.

In that position, (s)he lifts the active leg in a knee-to-chest movement, knee bent, until the hip joint is bent to about 90°.

3.

Educator meets, matches, resists.

4.

Client slowly “kicks the sky” (extends the knee) until the space behind the tendon hardens up in tension.

5.

With knee straight, client lowers the active side leg like a drawbridge, legs close or touching like the blades of scissors, supporting side leg bracing for stability, keeping the back flat.

Step 7: Lock and Reach

Step 8: Roll the leg.

Palpate to evaluate.

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Page L’-5b March 5, 2007

6.

When down, client relaxes fully.

7.

LOCK-IN: Educator instructs client to lock the knee straight, pull toes toward knee (pushing heel), hold for a moment, relax.

8.

PASSIVE MOVE: Educator rolls the client’s leg side-to-side (hand above knee).

9.

Palpate to evaluate whether repetition is necessary. When finished, the tendon is soft and one can palpate to feel the bone, beneath.

Starting Position Self-Palpation

Working Position (seated)

Step 3: slide foot toward other foot

Step 5: slide + turn

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FREE THE PSOAS Psoas/iliopsoas contraction shows up to palpation as a “strap” of tendon medial to the rectus femoris tendon. Palpation reveals that it traverses a line under the inguinal ligament into the pelvis. The owner of a tight psoas may feel pain in the groin, testicle, or in the inner surface of the ilium up to its crest, and a bellyache where the psoas runs to the lumbar spine. Observation reveals a deep ravine along the groin and a lumbar lordosis, which flatten out as the psoas relaxes. ILIO-PSOAS PANDICULATION (#1) STARTINGPOSITION: CLIENT: supine, one leg straight, the foot of the other leg on the front of the straight leg, foot inverted (turned) sharply so the curve of the longitudinal arches fits the contour of the front of the straight leg. EDUCATOR: facing “north”, elbow hooked around the bent knee, one hand holding the hooked arm wrist, balanced for retreat backward 1.

Client slides foot toward straight-leg hip.

2.

Educator meets, matches, resists; instructs client to ease off and yet stay positioned to feel the tight place continuously.

3.

Client slides foot toward straight-leg foot.

4.

Client reverses direction.

5.

Client resumes motion toward straight-leg foot, dropping the knee to the side as needed to feel the tight psoas tendon continuously. Client alternates the direction of movement in a progression that moves toward the straight-leg foot.

Steps 7 and 8: position for second pandiculation Step 9: Client pandiculates turns head opposite

Step 10: Lock-in

Step 11: rolling the leg

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6.

Client relaxes completely at the movement’s end, knee still bent.

7.

Educator assumes position for second pandiculation: one hand on the lateral side of the knee.

8.

Client presses side of knee against hand of educator, who meets, matches, resists.

9.

Client eases off in lateral-to-medial movement, turning head in opposite direction.

10.

LOCK-IN: Educator puts one hand medial to bent knee, other hand on greater trochanter. Client squeezes knee medially.

11.

Educator rolls client’s leg for sensory feedback, hand either above or below the knee.

12.

Palpate to evaluate need for repetition. The tendon will always be palpable, but should feel relaxed and blend in with the surrounding tissue.

Starting position

Palpation

Step 3: Means-whereby for locating working position

Step 5: Start pandiculation.

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Page L’-5e March 5, 2007 CLEAN-UP

Sometimes, something is left over from this set of pandiculations: contraction slightly medial to the rectus femoris tendon and lateral to the psoas’. We use a variation of the gluteus minimus pandiculations; instead of the knee turned medially and foot, laterally, the client simply separates their legs to locate the residual contraction – slowly enough to feel the position that activates it. You, the educator, must remain attentive to feel the position and coach the client, as needed, to stop in correct position. Your client may also need some means-whereby instruction to understand the movement of separating the legs.; otherwise, instead of abduction, (s)he may do an external rotation of the leg. STARTING POSITION: CLIENT:

supine, knees up, feet planted near buttocks.

EDUCATOR:

facing “south” with hand nearest the client above the knee, the other hand

palpating 1.

Client gently presses “bracing-side” foot down, flattens the back.

2.

Client lifts “pandiculating side” knee toward chest, toes toward knee.

3.

Educator instructs client (with means-whereby demonstration, as needed) to separate the legs by moving the pandiculating side leg laterally until (s)he feels the sore place.

4.

Client adds effort (within comfort zone).

5.

Educator meets, matches, resists.

Step 9: Extend leg to relaxation.

Step 12: rolling the leg Step 13: Evaluate need to repeat.

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Page L’-5f March 5, 2007

8.

Client may lift head to “look at” the sore place. (This action increases the effectiveness of the pandiculation.)

9.

Client pandiculates by lowering the point of the heel to the surface. Upon light contact, the client extends the leg straight, maintaining contact.

10.

Client relaxes.

11.

LOCK-IN: knee straight, reach with the leg (opposite waist tightens), push with the heel (toward toward knee).

12.

Educator rolls the leg.

13.

Palpate to evaluate for need to repeat. When complete, the region is comfortable to deep palpation.

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EXTERNAL ROTATORS OF THE HIP JOINTS Ida Rolf called the hip joints, "the joints that determine symmetry." The old lady had a point. Tension among the hip rotators has several effects: It may induce: 1)

rotation of the legs, relative to the pelvis

2)

rotation of the pelvis relative to the torso (a postural correction for 1) in walking)

3)

held tensions and postural shifts in the shoulder girdle (a balancing compensation)

4)

wobbliness in the legs during walking, leading to leg tension

Item 4) may require more explanation. The external rotators converge from the sacrum and ilium to the greater trochanter in an arrangement something like spokes of a wheel converging at the hub. In walking, the forward-to-backward, weight-bearing movement sends waves of tension across those spokes. Excessive tension in any of those spokes introduces abduction and/or rotation to that movement, i.e., wobbliness; other muscles throughout the leg contract to counter the effect, hence, the crucial importance of free and balanced movement at the hips. The standard movements of the Trauma and Red Light lessons assist pandiculation of the hip rotators. However, they do so in relatively few positions. Because they are part of standard lessons taught in the Basic Certification Training, I do not include them here.

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The deep rotators of the femur in the hip coordinate differently according to the degree of extension or flexion at the time. This sequence effectively integrates their functions in a range of positions. It is especially useful to relieve pain at the sacro-iliac joint. It takes about thirty minutes to do. This sequence helps as preparation for a Hamstring Series. Both sequences involve leg rotation and so affect each other. However, before you go to the hamstrings, you will need to make a judgment-call: Does your client need to release their internal rotators? Their Ilio-psoas? If their pelvis is anteriorly-tipped (pubes--back), the answer may be, "Yes." Do those first. For pandiculation of the deep external rotators, the Rule of Thumb is this: The line between the knee and the hip joint points to the muscles most active in the movement. Palpate and intuit for precision alignment with the most painful area or have your client position themselves to find it. IMPORTANT NOTE:

The sequences for the external hip rotators prepare a person for the lesson on Freeing the Ribs from Each Other in the module on IMPROVING BREATHING. You make take your client directly from one to the other.

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EXTERNAL ROTATORS OF THE HIP JOINTS, SEQUENCE #1 This sequence is the logical extension of the standard "Green Light Reflex" lesson. It provides a much more specific way of releasing and coordinating the muscles of the buttocks with the entire spine and head. STARTING POSITION: CLIENT:

prone, hands stacked on top of each other, palm down, under the forehead, legs together EDUCATOR:

1.

sitting next to the client's thigh, facing their head

Show your client, by moving them, what abduction feels like, what external rotation feels like, and what the combination feels like through the range of motion. We call that movement "steering" the leg.

2.

Bring your client's legs together and ask them to lift the one nearest to you.

3.

Ask them to move the leg slowly out to the side until they find a sore (hot) spot in the buttock. Put your hand on that spot to provide sensory feedback. Most of the time, they will be able to locate a spot. If they cannot, and you can sense one, guide them to it. If not, they may not need this sequence. HIGHER INTEGRATION: Have them steer their knee and foot into the position that makes

the sore spot easiest to sense. 4.

Ask them to slowly lower the leg. Follow the relaxation into the buttock with your hand.

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5.

Repeat the sequence with the other leg.

6.

Now, have them locate a hot spot with the first leg, keep that leg lifted, and find a hot spot with the other leg. They now have two spots, simultaneously.

7.

Have them inhale and lift their head. HIGHER INTEGRATION 1: Have them move their head side-to-side to find the position

where the intensity of the two sensations is equal. HIGHER INTEGRATION 2:

In addition, have them lift their arms and hands.

HIGHER INTEGRATION 3:

In addition, have them turn their head and bring their chin closer to the shoulder as they position themselves. 8.

Have them exhale and slowly relax.

9.

Repeat Steps (6. - 8). in ever wider positions of abduction.

10.

Finish by having them bring their legs back to center for one final pandiculation.

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Your client may report soreness or muscular activity in the underside rotators as they do this sequence. Of course! They are using the "underside" rotators to brace themselves as they lift! In really painful cases, you may wish to begin with the less painful side up. STARTING POSITION: side-lying, hips flexed at 120 degrees, the foot of the top leg planted just

below the internal malleolus of the underside leg; this is a secure "saddle" for the topside foot. Give your client a pillow for their head. 1.

Sit behind your client's legs, facing their head. Place one hand on the side of the knee and the other over the external rotators above the greater trochanter (to monitor).

2.

Your client leaves their foot down while lifting their knee (sideways). Now, have them bring both legs "north" until they feel soreness in the buttock (a "hot spot").

3.

Meet, match, and resist their force; do not overpower ~ this is a strenuous position in which to work. (Try it yourself!)

4.

Have your client ease off slowly and smoothly.

5.

Your client takes a full breath and lets go.

6.

Repeat in the same position.

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Place your hand between the knees and have your client squeeze the knees together to "lock in." ("Squeeze.") NUANCE:

Have your client push their head down into the surface.

8.

Your client now lifts their knee and repositions their legs closer to their chest until they find the next hot spot.

9.

Repeat the cycle of lowering, breathing, lock-in, and repositioning until their hips are flexed to close to their chest.

NEW POSITION: CLIENT:

sidelying as before, with knees and ankles side-by-side, matched to each other.

EDUCATOR: facing the client's thighs (Reposition to face theicalves when the legs are far

enough "south" to make it comfortable for you.) This position affects the rotators differently and coordinates a better balance at the hip joint 1.

Place one hand on your client's knee and the other on their calf above the ankle.

2.

Instruct your client to lift both their knee and ankle. One inch lift is sufficient. Have your client keep the pressure against your two hands equal. Be sure to keep your hands at the same height. NUANCE: Have your client slowly press the calf of theirHmderside" leg down as they

lift their "topside" leg. NUANCE: Have your client turn the sole of the "topside" foot out (everted) as they lift.

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Have your client move both legs south (with knees still bent) until they feel a hot spot. NUANCE:

Have your client lift their head, then curl forward or arch back to find the position in which they feel strongest lifting the leg. 4.

Meet, match, and resist your client's strength.

5.

Pause in place until attention steadies.

6.

Have your client ease off so knee touches knee and ankle touches ankle. HIGHER INTEGRATION: Have your client reach with the arm to lengthen the entire side.

7.

Your client takes a deep breath and relaxes.

8.

Repeat.

9.

LOCK-IN. ("Squeeze.") NUANCE:

Your client pushes their head down into the surface.

.

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10.

Have your client reposition their legs further away from their chest until they find the next hot spot; repeat the cycle.

11.

Continue pandiculating and repositioning until your client's legs are nearly straight. At this point, rather than having your client reposition by moving their legs, have them leave their legs where they are and shift their hips forward, in effect straightening their legs.

12.

Perform the two or so cycles that remain.

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INTEGRATION MOVE NEW POSITION:

sidelying, knees forward (hips flexed to ninety-degrees)

1.

Have your client lift the leg, as before. Meet, match, and resist their effort.

2.

Instruct your client to maintain the same sideways push into your hand as they draw their knee toward their chest. Follow them up.

3.

From that position, have your client straighten their leg all the way and let go. Their knee will drop inward toward the table surface.

4.

Place your hand under their knee and have your client lock in. ("Squeeze.") Repeat the entire sequence on the other side.

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EXTERNAL ROTATORS OF THE HIP JOINTS, SEQUENCE #3

Sometimes, your client will complain of pain just behind the greater trochanter. The following sequence reaches that region. Do both sides. Before beginning, palpate to find the painful area. You will need to have your client position themselves with precision, using the beginning steps of this sequence. STARTING POSITION: CLIENT:

supine, knees up, feet down, no pillow under he head. Have your client spread their feet, slightly. EDUCATOR: sitting facing the client's knees, one hand on the side of their knee and the other in

the area of pain 1.

Have your client push gently sideways with their knee. You meet, match, and resist. If the painful area does not become more distinct to your client and percepta-bly tighter under your touch, have them move their feet further apart or closer together and repeat Step (1.) until it does.

2.

Have your client push sideways with their knee; meet, match, and resist.

3.

Pause in place maintaining pressure, until their (and your) attention steadies.

4.

Have your client ease off; as they do, have them reach up with the arm of the same side to stretch that whole side long.

5.

LOCK-IN. Repeat if needed.

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EXTERNAL ROTATORS OF THE HIP JOINTS, SEQUENCE #4

To begin, palpate to find the painful area. You will need to have your client position themselves with precision, using the beginning steps of this sequence. STARTING POSITION: client supine, knees up, feet down, propped up on their elbows or

on their

arms (behind them), head held up 1.

Have your client spread their feet, slightly. Place one hand on the side of their knee and the other on the area of pain.

2.

Have your client push gently sideways with their knee. You meet, match, and resist. If the painful area does not become more distinct to your client, have them inch their feet further apart. Repeat Steps (1.) and (2.) until you find the position.

3.

Have your client push sideways with their knee; meet, match, and resist.

4.

Have your client ease off; take up the slack. HIGHER INTEGRATION: Have

your client arch their back and look over the shoulder of the pandiculating side (leaning their head back and eyes up). This nuance brings in the spinal extensors in a very satisfying way. HIGHER INTEGRATION:

Have your client look at the hand of the pandiculating side (bowing their head and eyes down) and posteriorly tilt the pelvis (pubes forward), to tuck their tail between their legs. This movement coordinates the rectus abdominis and the iliopsoas.

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5.

Pause in place maintaining pressure, until their (and your) attention steadies.

6.

Have your client ease off; as they do, have them reach up with the arm of the same side to stretch that whole side long. HIGHER INTEGRATION:

Have your client maintain a constant rocking pelvic motion as they release their hip joints. 7.

LOCK-IN. Have your client press their knee into the surface.

Repeat if needed.

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Page L-18 November 1, 1994

TIIE ILIOPSOAS-ABDOMINAL COMPLEX

The Iliopsoas initiates walking. It so happens that the Iliopsoas also initiates creeping on all fours. If this muscle is contracted, the lumbar area will be chronically lordotic and the fold at the groin will look like a gulley, rather than a flat plain. STARTING POSITION: on all-fours: knees and elbows: knees vertically below the hips, head

hanging freely 1.

Position yourself at your client's feet.

2.

Slide one hand along the inside border of the foreleg until you can wrap your hand above the knee. Place the other hand near the insertion of the Femoris Rectus. Your fingertips can now reach and palpate the insertion of the Iliopsoas.

3.

Draw your client's leg back 2-3 inches and have them place their weight on the other knee.

4.

Instruct your client to EXHALE and pull the knee forward, as if creeping. Meet, match, and resist their force.

5.

Have your client INHALE and ease off. Tell them, "Sit down toward your heel." Take up the slack. Their leg will straighten somewhat.

6.

Instruct your client to EXHALE and pull the knee forward again. Meet, match, and resist their force; do not let the knee come forward.

Handbook of Assisted Pandiculation The Lower Extremities 7.

Page L-19 November 1, 1994

Have your client inhale and ease off. Take up the slack. The leg will straighten further.

8.

Continue this cycle of pandiculation until their leg is completely straight Their side will be stretched long, and because their other hip is flexed, their lumbars will be convex posteriorly.

9.

Your hand still remains above their knee. Instruct your client to lift their knee off your hand. This action uses the hamstrings in a lock-in.

10.

Repeat this cycle for the opposite side. Go for full extension and symmetry.

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LORENZO'S LOLLAPALOOZA

The Iliopsoas slightly rotates the femur externally. This maneuver pandicularly brings your client to extreme internal rotation and frees the iliopsoas considerably. There may be soreness, so let your client go slowly and in small movements --1/4" to 1/2", if necessary. STARTING POSITION: sitting, one knee dropped out, one knee dropped in so the sole of the

"out" knee rests against the "in" knee (See Lesson 6 of Somatics). 1.

Have your client place hands on the outside of the "in" knee.

2.

Place your hands on top of theirs.

3.

Have them lift that knee, leaving the foot on the floor.

4.

Meet, match, and resist the force of lifting.

5.

Have your client lean their head toward the raised knee.

6.

Instruct your client to ease off, slowly, leaning toward the knee.

7.

LOCK-IN: When the knee is completely down, place your hand under it and have your client push down, into your hand. Repeat, if necessary, then do the other side.

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HAMSTRING SEQUENCE #1

Sometimes, a person gets a poor result from the standard Thigh Adductor pandiculation. People often "confuse" (misuse) the hamstrings and the adductors. Such people need to learn to use their adductors without the hamstrings. Start with standard Red Light adductor pandiculations. If your client can't separate the adductors from the hamstrings, they need a hamstring series. Hamstrings send fibers into the medial aspect of the knee to the meniscus, according to Kapandji. Tight hamstrings (and sometimes tight gastrocs) contribute to medial knee pain. STARTING POSITION: client

on all-fours, hips vertically above knees, foot of active side up on

toes. EDUCATOR:

1.

sitting or kneeling at your client's feet

Place one hand outside the lateral side of the ankle and the other, behind the transverse arch of the foot (for bracing). Have your client turn heel-out. Meet, match, and resist. NUANCE:

Make a soft fist with the bracing hand and place the flat part of it against

the foot. NUANCE:

Move from your somatic center and lean in the direction of your resistance. Position yourself so you can keep your balance. 2.

Pandiculate from heel-out to heel-in.

3.

LOCK-IN: Client turns heel-in; you resist.

4.

Switch to the other leg. Pandiculate from heel-in to heel-out (the opposite pattern to the first leg).

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5.

LOCK-IN: Client turns heel-out; you resist.

6.

Switch legs and do the process from the opposite direction.

7.

Have your client flex at the knee (lift their foot) and make a "fist" of the foot. Your hand grasps the heel; your forearm rests along the sole of their gently curled foot.

8.

Instruct your client to keep their foot off the surface as they slowly lie down prone. Meet, match, and resist.

9.

When they are down, release the leg.

10.

With your hand at the ankle, roll their leg from side to side.

11.

Switch legs. HIGHER INTEGRATION:

Have client practice rocking forward and back 2-3". Then repeat (1.) through (11.) while rocking continuously. The rocking adds lots of sensation and interrupts the habitual pattern of contraction, which aids further release in a big way.

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HAMSTRINGS SEQUENCE #2 STARTING POSITION: CLIENT: supine, knees up, feet planted, arms alongside their head, elbows bent to 90 degrees. EDUCATOR:

sitting next to the client's leg, facing their head

This variation uses the walking pattern to gain control of the hamstrings. Walking involves an equal-and-opposite movement of the two legs. (First version: J. R. Ward) 1.

Place your client's achilles tendon on your shoulder with your head lateral to the knee.

2.

Have your client press straight down on your shoulder, so as to lift their hip, slightly. Have them rehearse until they have a straight up-and-down movement. If necessary, move them they way you want them to move, so they understand.

3.

Place your interlaced fingers above their knee.

4.

Have your client push down firmly on your shoulder; have them slightly lift the other foot (1/4"). Meet, match, and resist. This action engages the walking pattern.

5.

Have your client ease off; as they do, have them press the opposite foot down. Take up the slack.

6.

Maintain position and have them push down again. Meet, match, and resist. Remember to have them lift the opposite foot, slightly.

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Page L-24 November 1, 1994

Have your client ease off; as they do, have them press the opposite foot down. Take up the slack. Repeat until the knee is nearly straight.

8.

At that point, place a hand behind their knee in the popliteal space. Their calf is still on your shoulder.

9.

Instruct them to push against your hand, leaving their leg straight.

10.

Have your client ease off; as they do, have them press the opposite foot down. Take up the slack.

11.

Repeat until no further progress occurs. At that point, instruct them to keep their leg up in the air.

12.

Place your hand above their knee and grasp snugly. Ask your client to push against your hand; meet, match, and resist.

13.

Instruct your client to lower their straight leg slowly, like a drawbridge (against your resistance). NUANCE:

Remind them to push down with the opposite foot. NUANCE:

Instruct your client to stretch their heel long (dorsi-flex). 14.

Once down, place your hand on your client's knee and roll their leg from sideto-side.

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15.

LOCK-IN: Place your hand under their heel, aim their foot straight up, and have them push down into your hand (backward).

16.

LOCK-IN: Repeat (15.) plus have them push their upper arm into the surface. You will feel the diagonal connection between leg and opposite shoulder, when they've got it. Ask them to repeat until you feel it.

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THE QUADRICEPS

Once your client has mastered the hamstrings sufficiently, they will be able to turn the foreleg independent of the thigh. This ability permits them to get the most out of the following sequence. The variations in leg position reach to the different heads of the quadriceps. STARTING POSITION: CLIENT:

sitting on the edge of the table, preferably on their sitbones, so their feet touch

the floor. EDUCATOR: Slide your arm behind their thigh in a lateral direction to act as a lift and a brace. ADVANCED STARTING POSITION:

client propped up on their elbows or fully supine, lower legs

dangling over the edge 1.

Place your hand at the front fold of your client's ankle, thumb along the medial side, web across the front, fingers around the lateral side.

2.

Have your client extend their foreleg. Allow them to do so, then when almost straight, meet, match, and resist.

3.

Have your client ease off; take up slack all the way.

4.

Place your hand behind their achilles tendon.

5.

LOCK-IN: Your client pulls their foot back.

6.

Release: You say, "Release." Your client releases, you straighten their leg. When it's straight, say, "Release," and let their leg fall freely. Repeat until loose.

.

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HIGHER INTEGRATION:

1.

Have your client turn their foot outward (evert and pronate). This action involves the vastus lateralis more.

2.

In that position, have them extend their foreleg.

3.

Proceed as before.

4.

Now, have your client turn their foot inward (invert and supinate) and proceed as before. This action involves the vastus medialis more.

5.

Now, have your client center their foot, lift their toes (dorsiflex), and proceed as before. HIGHER INTEGRATION:

Have your client rock their pelvis. Synchronize their pandicular contraction (knee extension) with the forward tipping (pubes back) movement and their pandicular release (knee flexion) with the backward tipping (pubes forward) movement. You will need to get clear about this movement in yourself by practicing it so you can make sense to your client.

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THE PERONEALS

The peroneals run from the lower part of the fibula into the foot. It so happens that the upper part of the fibula runs to the Biceps-Femoris. So the Hamstrings and the Peroneals have a great deal to do with each other and with foot position; tight Hamstrings pull upon the fibula, rotate it posteriorly, and supinate the foot, affecting the Peroneals and the contact of the feet with the ground. Having done the Hamstrings, therefore, you may want to do the Peroneals. There are three Peroneals: Longus, Brevis, and Tertius. All turn the sole of the foot out, laterally. The degree of plantar- or dorsi-flexion of the foot determines which of the Peroneals works most. STARTING POSITION:

sidelying, the "under" knee forward, the other leg straight

1.

Sit at the foot of the table, at the corner, with the leg on your lap.

2.

Grasp the foot with your hand and show your client the side-to-side movement of the foot. Define "out" and "in" for them by movement.

3.

Your client plantar-flexes the foot and turns the sole "out." As they do so, FEEL THE EXACT DIRECTION OF THEIR MOVEMENT; meet, match, and resist it. You may want to have your client repeat this move a couple of times to get an exact sense of their direction of movement. Find a handhold that your client finds comfortable.

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4.

Your client eases off; you follow.

5.

Have your client lock in.

6.

Move your client's foot to a neutral position and show them "in" and "out" again.

7.

Have your client turn their foot "out." Meet, match, and resist as before.

8.

Your client eases off; you follow.

9.

LOCK IN.

10.

Move your client's foot to a dorsi-flexed position and define "in" and "out."

11.

Have your client turn the foot "out"; meet, match, and resist.

12.

Your client eases off; you follow.

13.

LOCK IN.

NEW POSITION: supine

1.

Sit facing the foot of the table with your client's leg on your lap.

2.

Have your client plantar-flex (point their toes).

3.

Reach under their sole and grasp the medial border of their foot. Your palm touches their sole.

Handbook of Assisted Pandiculation The Lower Extremities 4.

Your client turns their foot "in." Meet, match, and resist.

5.

Your client eases off; follow.

6.

LOCK IN.

7.

Have your client dorsi-flex.

8.

Your client turns their foot "in." Meet, match, and resist.

9.

Your client eases off; you follow.

10.

LOCK IN.

Page L-30 November 1, 1994

Invite your client to walk. Watch to distinguish the differences between the two legs. Now, do the other leg.

Athletes Prayer . . . starting position

Foot Position, step 1

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THE LOWER LEGS

When the ankle is stiff, a person must lift their knee more to get foot clearance when walking, and their foot doesn't meet the ground as well. You can see it; their walking always has an adolescent, "up and down bouncy" look; it's not smooth. This kind of walking points to tight plantar flexors -- the triceps surae (i.e., gastrocs and soleus). If a person has pain in the arch of the foot, you have a different situation. Look to the deep flexors of the toes in the calf (crural flexors). Their functions are to grip the floor with the toes and to elevate the arch of the foot; hence, pain when stepping down. The following maneuver gets better results than the usual athlete's stretch and can easily be taught to convince people that pandiculation works. THE ATHLETE'S PRAYER FOR FREE CALVES STARTING POSITION: standing, hands against the wall or a post at shoulder height, one foot back,

feet pointing straight-forward, head in line with the torso (not looking at the wall or looking down) 1.

Have your client raise the heel of the back leg to plantar flex to the extreme, with weight through the foot. Place the web of your thumb over the heel at the achilles tendon, so you can push down. NOTE:

Only extreme plantar flexion engages the soleus.

NUANCE:

the foot.

Have your client push the wall to send more force through

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Page L-32 November 1, 1994

2.

Instruct your client to grip the floor with the toes.

3.

Client eases off 1/2" or so, gradually relaxing the toes.

4.

Client contracts and grips the floor with their toes. Meet, match, and resist.

5.

Client eases off. Repeat (2.) through (5) until the heel touches down. NUANCE: Instruct your client to aim so the heel touches the ground squarely (on

neither the outside nor inside edge). 6.

When your client is down, ask them to sink into the ground and to let their foot spread.

7.

Repeat.

8.

Have your client walk. Observe differences between the feet.

9.

Switch sides.

START

Position 1 FINISH

START

Position 2

FINISH

START

Position 3

FINISH

Handbook of Assisted Pandiculation The Lower Extremities NEW POSITION:

Page L-33 November 1, 1994

supine, knees up and slightly apart (2-3"), feet down

1.

Sit at your client's feet.

2.

Place the web of your thumb at the front fold of the ankle with your thumb along the medial surface of the foot. The fold of your palm fits their instep snugly.

3.

Have your client dorsi-flex ("Lift your foot, like you were coming off the accelerator of your car.") Meet, match, and resist.

4.

Have your client ease off.

5.

LOCK-IN: Have your client stamp their foot on the table. They'll like it.

6.

Slide your client's foot away from them, a little.

7.

Repeat the process.

8.

Repeat (6.) and (7.).

Starting Position

Result of Step 3

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Page L-34 November 1, 1994 TIIE FEET

The feet have three arches and a hinge. The three arches are the medial longitudinal (first three toes), which takes about 35% of the weight; the lateral longitudinal arch (outside two toes) which takes about 5% of the weight, and the transverse arch (at the ball of the foot); the remaining 60% of the weight goes to the heels. (This design of the foot resulted from millions of years of evolutionary development and resulted in the invention of the suction-cup and the plumber's friend.) The hinge at the talus defines the depth of the longitudinal arches and is controlled by the deep muscles of the calf. We pandiculate to recover the flexible relationship between those arches so the feet meet the ground better. The following maneuver helps "square" a "turned in" calcaneus (supinated foot). STARTING POSITION: sitting, one knee dropped out, one knee dropped in so the sole of

the "out"

knee rests against the "in" knee (See Lesson 6 of Somatics). 1.

Place your hand on the lateral malleolus.

2.

Have your client lift the heel by turning the lower leg. Meet, match, and resist.

3.

Have your client ease off.

4.

Once down, have your client dorsi-flex and plantar flex ("Wiggle your foot."), with you still on their malleolus.

5.

Repeat.

To square a “turned out” calcaneus (pronated foot), at Step 1., place your hand on the side of the calcaneus instead of the lateral malleolus.

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6.

LOCK-IN: Place your hand under their heel and have them press down.

7.

Switch position and feet. This next maneuver defines the relationship between the longitudinal arches.

NEXT POSITION:

sitting up against the wall, legs outstretched (If they can't do this, they're not ready; do more, proximally!) 1.

Reach around the medial side of their foot so your palm enfolds it, with your fingers underneath and your thumb on top.

2.

With your fingertips, find and define (by probing, informing touch) the line between the lateral and medial arch, starting at the heel. Let your client have time to feel it.

3.

Place your other hand on top (dorsal side) of the lateral arch.

4.

Have the client evert the foot. Meet, match, and resist.

5.

As they ease off feel the articulation between the arches fold.

6.

Place the fingertips of your "top" hand under the sole of their foot; the fingertips of one hand lie next to the fingertips of the other, so together, they can create a spreading motion.

Handbook of Assisted Pandiculation The Lower Extremities

7.

Page L-36 November 1, 1994

Now, have your client invert (toe in/down) the foot and make a gentle fist with it. Meet, match, and resist.

8.

As they ease off, spread the two arches apart.

9.

Have them wiggle their toes.

10.

Move your hands to the center of the transverse arch.

11.

Have your client make a gentle "foot fist"; meet, match, and resist.

12.

As they ease off, take up slack and spread the arch.

13.

Now, enwrap the width of their foot with your hands.

14.

Have your client spread their toes. Meet, match, and resist.

15.

As they ease off, guide their foot into a fist, deepening the transverse arch.

This next maneuver defines the relationship between the calcaneus and the rest of the foot (the hinge). Use it only for high arches. STARTING POSITION: sidelying

1.

Grasp the foot so you can spread the calcaneus away from the arch with your fingertips.

2.

Have your client point their foot and make a "foot fist." Meet, match, and resist.

opening the hinge, step 3

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Page L-37 November 1, 1994

As (s)he eases off, spread the calcaneus away from the toes. Make the foot longer. Follow and guide the soft tissue. NUANCE:

Have your client wiggle his/her toes.

.

.

IMPROVING BREATHING

The problem of breathing difficulty usually comes from arrested (or restricted) movements of breathing. The muscles involved -- the diaphragm, the abdominal muscles, and the muscles that move the ribs (including the scalenes of the neck) -- hold residual tension. As a result, people either exhale incompletely or inhale incompletely. People who exhale incompletely may have a big, rounded or hanging belly, high shoulders, and a shortened neck. The belly comes from a diaphragm that, being always partially contracted, pushes the abdominal contents down and out of their normal position; the high shoulders come from contracted scalenes lifting the upper ribs in a chronic attempt to get more air into the upper volume of the lungs. The person may also feel chronically tired or sore in the ribs. People who inhale incompletely may have a hard, flat belly and ribs that are down and flattened in front. This flattening across the front comes from tight (1) abdominal and (2) intercostal muscles. These muscles, when chronically tight, (1) prevent the diaphragm from flattening and pulling air into the lungs and (2) reduce chest volume. (The dome-shaped diaphragm functions like a piston. When it contracts, the dome flattens and pulls away from the area inside the chest, sucking air in. It also lifts the ribs, something like the way a Can-Can dancer lifts her skirt.) Closer observation may reveal that in breathing, certain ribs move more than others. Areas over less mobile ribs often feel ticklish or sore. Such areas deserve special attention. To do a neck series, especially for the scalenes, can also make a big difference in breathing. A NOTE ON THE INTERCOSTALS

The intercostals do more than mechanically move the ribs in breathing; they also create the sensations of emotion and attitude. Their patterns of contraction create these familiar feelings.

.

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Page B-2 November 1, 1994

When the intercostals contract the ribs in chronic sorrow and fear, for example, we may find asthma. The intercostals may also chronically expand the ribs, in the posture of boistrousness and self-aggrandizement (overinflated self-image), or in a puffing-up to counter the contracting tendency of the fear reaction or feelings of inadequacy The following sequences address both conditions.

Handbook of Assisted Pandiculation Improving Breathing

Page B-3 November 6, 1994 BREATHING

In general, do a special Breathing lesson only after you have done the standard Green Light, Red Light, and Trauma reflex lessons. SUMMARY OF STEPS:

1. 2. 3. 4. 5.

Free the diaphragm. Free the shoulders from the ribs. Free the ribs from each other (intercostals) Integrate rib and shoulder movements. Free the upper ribs from the neck (scalenes).

FREEING THE DIAPHRAGM STARTING POSITION: CLIENT: supine with knees up, feet planted near buttocks, arms on table near their head

1.

Place your hands over (and gently ride upon) the client's belly over the diaphragm. Spread your fingers so they define the shape of the diaphragm; place equal pressure on each finger.

2.

Client inhales, then exhales; meet, match, resist, and follow the movement in. Multiple repetitions will get you deeper.

3.

Client holds their breath OUT (closes epiglottis -- the air-stopping muscle of coughing).

.

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Page B-4 November 6, 1994

Client exerts the muscles of inhalation while keeping air out. INSTRUCT:

"Suck in your gut. Now, push your belly against my fingers."

Feel the diaphragm push out; meet and exactly match that resistance. 5.

Client gradually, slowly, and smoothly relaxes. Assist pandiculation of the diaphragm to define a deep dome. Have the client rock their pelvis to aid relaxation of the diaphragm.

6.

Client relaxes completely, then inhales. As your client inhales, lift off gradually. Coach them into filling fully.

7.

Have your client take deep breaths and watch for what doesn't move. Assist pandiculation there and repeat to a satisfactory result.

8.

LOCK-IN: Have the client take and hold a breath. Have them force the ball of air back and forth between their belly and their chest, (a la Thomas' "piston" breathing exercise in Somatics.)

.

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Page B-5 November 1, 1994

FREEING THE SHOULDERS FROM THE RIBS

Tight shoulders encase the ribs and restrict breathing. Tight muscles of the shoulder girdle, attached to the rib cage, pull upon the ribs. Before the intercostals can function freely, the ribs must be free of the shoulder girdle. I:

Perform the shoulder pandiculation sequence from the Landau (Green Light) lesson.

II:

Perform the shoulder/abdominis rectus pandiculation from the Startle (Red Light) lesson.

III:

If necessary, repeat the portions of the Trauma lesson for the lateral and anterior aspects of the obliques. With each step, ask your client to breathe and notice what moves and what doesn't. Assist pandiculation in the directions where movement is restricted.

The maneuvers named above are taught in the Certification Training in Hanna Somatic Education. Lacking that knowledge, you may instruct your client in the standard Somatics lessons 1-4, found in the book, Somatics, by Thomas Hanna and the audio-instructional programs, Outgrowing the Myth of Aging and Beyond Outgrowing the Myth of Aging. The going will be slower - and the job will get done.

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Page B-6 November 7, 1994

The ribs articulate both between neighboring vertebrae and (except for the floating ribs) at the sternum. The lower ribs move laterally with inhalation; the upper ribs move anteriorly and upward with inhalation; and the ribs in between move obliquely. The ribs inflate. By watching your client take full, deep breaths, you can discern which ribs move freely, and which do not. The following maneuvers can dramatically improve breath volume and substantially integrate movements of the ribs, legs, neck, and head. FREEING SEQUENCE

In this sequence, you will guide your client through a series of movements that coordinate lifting, breathing, and lowering. You will guide them in positioning themselves so that they use the most contracted, amnesic muscles restricting their rib movements. QUADRATUS LUMBORUM STARTING POSITION: CLIENT:

sidelying, knees near their chest, knees and ankles matched

EDUCATOR: behind the client's buttocks, facing north, "south" hand grasping the ASIS (anterior

superior iliac spine), "north" hand palpating the Quadratus Lumborum (QL) from the side, deep to the Erectors Spinae 1.

Have your client leave their knees together as they lift their "topside" foot.

2.

In that position, have them slowly move their legs behind them; with your palpating hand, locate the position at which the QL contracts most. Have your client stop there; confirm that they feel the contraction there.

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Have your client lift their head and turn their ear (ear canal) toward the sensation at the QL. This will further contract the QL. Fine-tune the position, if necessary. NUANCE: Have them bring the point of the elbow of the "topside" arm as near as

possible to the place of greatest contraction. 4.

Place the palm of your palpating hand behind the lower ribs. (Your other hand still grasps the ASIS.)

5.

Have your client relax slowly, then re-contract; meet, match, and resist NUANCE:

Have them exhale as they contract.

6.

Have your client relax, inhale, and sink. Take up the slack, helping the QL lengthen.

7.

Repeat as needed.

RESTRICTED OR PAINFUL RIBS (INTERCOSTALS) STARTING POSITION: CLIENT: sidelying, legs half-way to the chest, pillow under the head, pillow under the lower

ribs and waist optional EDUCATOR:

1.

sitting behind the client facing "north"

Have your client show you a couple of full, deep breaths. Observe and palpate to locate which ribs move and which do not.

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Page B-8 November 7, 1994

2.

Place your fingertips in a line along the intercostal space (between the ribs that do not move freely). Start with the lowest ribs. Press firmly enough to create sensation, gently enough to be comfortable.

3.

Ask your client to lift their head.

4.

Ask them to curl forward or arch back to find the position that most contracts the amnesic area. Sometimes, they may need you to guide them into position, if you can feel what they cannot. RULES OF THUMB:

1)

Curling forward activates increasingly anterior abdominal muscles

2)

Arching backward activates increasingly posterior back muscles.

NUANCE:

3)

Turning the face downward (not "south") activates anterior, oblique muscles

4)

Turning the face upward activates posterior, oblique muscles

5.

When they have located the best position, ask them to extend and then to lift their "topside" leg.

6.

Ask them to move their leg forward or backward until they find the position that makes it easiest for them to keep their head up. This position also activates the muscles at the amnesic area.

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Page B-9 November 7, 1994

Have your client exhale strongly. Exhalation contracts the ribs for pandiculation.

8.

Have your client inhale to fullness, then sink while continuing the effort to inhale. As (s)he sinks, use your fingertips to create more sensation, to help him/her recognize and release habitual tension. This action expands breathing capacity beyond its usual maximum. NUANCES: Have your client reach "north" with the "topside" arm to lengthen the

side. For contraction of posterior muscles, have them reach somewhat forward, away from the contraction; for contraction of anterior muscles, have them reach "north" and backward to spread the ribs. 9.

When they have relaxed completely, tap on and around the area, defining lines of motion in breathing.

10.

Repeat steps (1.) - (9.) until you reach the second rib, or so.

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"JUDO" TO FREE THE SERRATUS ANTERIOR This maneuver frees ribs from the grip of the Serratus Anterior muscles. STARTING POSITIONS: CLIENT:

sidelying, "topside" arm folded, elbow against their side

EDUCATOR :

kneeling behind the client, facing "north", arm under the client's arm, hand over their shoulder, their upper arm nestled in the crook of your folded elbow, which is deep toward their armpit 1.

Ask your client to squeeze down against your arm.

2.

Meet, match, and resist.

3.

Have your client exhale.

4.

Ask them to inhale slowly, to relax, and to turn their head toward their shoulder.

5.

Take up the slack, drawing their shoulder wide and back. Periodically, you will need to change position for balance and stability. At those times, change position in mid-stream and have your client re-contract; continue the pandiculation. Continue until their shoulder meets the table and their head is turned all the way. IMPORTANT NOTE: If your client finds this move painful, have them recontract to move back into their comfort zone, then continue. If they still find the move painful, they may not have adequate freedom in the anterior obliques, which control rib movement. Redo the Trauma Reflex Lesson maneuver for that area.

.

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Page B-ll November 1, 1994

LOCK-IN: Place your hand between their shoulder and the table and have them push down as you lift up.

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TO RELEASE RIBS STUCK IN INHALATION

Use the following sequence to move ribs stuck in inhalation (elevated) into line with the other ribs. STARTING POSITION: CLIENT: sidelying,

"under" leg bent with the knee directly forward of the hip joint; head unsupported, if possible; otherwise, start with a pillow and remove it when they can tolerate the side-bending. EDUCATOR: With

your forearm on the ribs, "moosh" north and south to locate hard spots, where rigid ribs protrude. Address your maneuvers to those areas. 1.

Sit behind your client facing toward their head.

2.

Place the soft part of your forearm on their ribs and lean on the protruding rib(s); with your other hand, locate the vertebrae that move in response. These are the positions in which you have two points of contact with the same rib(s).

3.

Place two fingers on the "under" side of the lamina of the vertebrae you have located.

4.

Have your client lift their head and their "topside" leg. NUANCE:

They may exhale as they lift.

NUANCE:

Have your client flex or extend their neck to find the position that most directly contracts the muscles that move those ribs. 5.

Assist the lift with your two fingers under the lamina. Press down and medially with your other forearm to assist rib movement medially and posteriorly toward the spine.

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Page B-13 November 1, 1994

Have your client breathe gently as they slowly lower. Continue to lift with two fingers and press down with your forearm until their are fully relaxed. (Make sure they let their head sag.) NUANCE: You may press down with your fingers to coax separation of the ribs and

vertebrae. 7.

Move your fingers up one vertebra and complete (1.) - (5.). Continue until you reach C7.

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UPPER RIBS AND CLAVICLES

The Sub-clavian Muscles move the clavicles in relation to the upper ribs. This maneuver, a variation of the Red Light Lesson shoulder maneuver, relaxes the Subclavians and the Intercostals of the upper ribs, permitting fuller breathing. STARTING POSITIONS: EDUCATOR:

sitting next to the client's ribs, facing "north", nearby hand cupped over the shoulder joint, far hand free to guide the client's arm rotation CLIENT:

supine, arm abducted to shoulder level and lying across the educator's lap

1.

Guide and instruct your client in rolling (pronating) the arm so that the shoulder curls forward, then supinating their arm so that their shoulder curls backward and tucks behind them.

2.

By palpating, identify the contracted or sore muscles of the upper ribs that keep them from moving freely. Bring this area to your client's attention.

3.

Have your client pronate; meet, match and resist the rolling forward of their shoulder. NUANCE:

Have your client lift their head and look away from their shoulder. NUANCE:

Have them exhale as they lift. NUANCE:

Have them aim their ear (the hole of their ear canal) toward the sore spot on their upper ribs you have identified. This maneuver contracts those muscles for pandiculation.

Handbook of Assisted Pandiculation Improving Breathing 4.

5.

Page B-15 November 1, 1994

Have your client roll (supinate) the arm so the shoulder rolls back and under. Assist in tucking the shoulder under. NUANCE:

Have your client turn their head to look at the active-arm hand.

NUANCE:

Have him/her inhale as (s)he lets the head sink, to expand the upper ribs.

Find another sore spot and repeat, as necessary.

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INTEGRATING RIB MOVEMENTS

Once you have gone through the basic "freeing" sequence, integration is in order. The following maneuvers accomplish that integration. (They can also produce some improvement in breathing by themselves, without the "freeing" sequence.) STARTING POSITION: CLIENT:

sidelying, knees forward, "under" arm cradling the head, "top" arm gently folded with the elbow against the side of the ribs. You may wish to place a pillow beneath the "under" shoulder for a "kinetic mirroring" effect. EDUCATOR:

behind the client's ribs, facing "north"

1.

Place yourself so you can lean down against your client's arm (hand over their shoulder, forearm against their elbow).

2.

Have your client exhale. Follow the motion down into the chest.

3.

Have your client inhale so their ribs move "against" their elbow, so their arm rises into your hand. Feel, rise with, and match that push. Now, you are ready to assist pandiculation.

4.

Have your client exhale slowly through their nose. Follow the sinking of their elbow into the side of their chest.

5.

Have your client inhale. Resist, then gently ease off so they expand. Resist. . . ease off. . . resist. . . ease off . . . until full. Repeat twice more.

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NEXT POSITION: same as above, except that your client rests the hand of their "top" arm

across the Pectoralis of the opposite side. 6.

Perform the sequence as before. Ride your client's arm into their chest. Repeat twice more. Switch sides and repeat Steps (1.) - (6.)

NEXT POSITION: CLIENT:

supine, hands crossed over the sternum, knees up.

EDUCATOR POSITION: sitting at client's head, facing "south"

1.

Place your hand on top of theirs. Position yourself so your forearm, wrist, and hand line up.

2.

Perform the sequence, as before. As they inhale, resist. .. ease off... resist . . . ease off . . . until full. Repeat twice more.

NEXT POSITION:

supine, each hand on the opposite Pectoralis Major

1.

Place a hand on each of theirs.

2.

As they exhale, guide the movement toward the xyphoid process.

3.

As they inhale, resist. . . ease off. . . resist. . . ease off. . . until full. Repeat twice more.

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INTEGRATING RIB AND SHOULDER MOVEMENTS STARTING POSITION: CLIENT:

sidelying knees forward, "top" arm laying straight against their side.

EDUCATOR:

Place one of your hands behind their lower ribs, the other over their shoulder grasping the clavicle from behind and cupping the "round" of their shoulder joint in your palm. 1.

Have your client exhale, bow their head toward their navel, and pull their elbow behind them. Meet, match, and resist the movement of the lower ribs.

2.

Have your client inhale, reach their arm forward and then headward, arch their back, and look up at their brow. Assist the movement of the ribs.

3.

Have your client relax in place. ("Sag in place.")

4.

Thump your client's ribs to make a sound like a drum. This action aids further awareness and relaxation.

5.

Repeat as desired. Have your client turn over and repeat.

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NEXT POSITION: CLIENT: supine

near the end of the work surface, with a pillow behind the thoracic area, arms by sides, elbows against the work surface. 1.

Have your client exhale, raise their head, and push their elbows into the work surface.

2.

Have your client inhale, lay back, stretch their arms forward and over their head, and look up at their brow.

3.

Have your client relax in place. ("Sag in place.")

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See the neck sequence for the scalenes, page N-10 (MODULE 5).

.

LESSONS FOR THE UPPER EXTREMITIES

Variety of motion is the expression of freedom especially magnified in the manipulative abilities of the human soma. Whereas our lower extremities take us primarily forward (secondarily, sideways, and occasionally, backward), our upper extremities function omnidirectionally. Accordingly, the lessons for the upper extremities cultivate omnidirectional freedom and control with pandiculations in a variety of positions and directions. The pandiculations in this section prepare someone for pandiculations involving the neck. The reason: binding of the shoulder girdle to the ribs affects breathing and often pulls assymmetrically upon the neck. If the "righting reflex" contracts the neck in response to such distortions, you may not be able to get relaxation; the neck contraction is part of a larger condition, all of which may need to be addressed. THE SEQUENCE

1. 2. 3. 4. 5. 6. 7. 8. 9.

Clavicles Deltoids Arm Adductors Teres Biceps Triceps Forearm and Wrist Fingers Lorenzo's Funky Chicken Maneuver

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Page U-2 November 1, 1994

We start at the center: THE CLAVICLES Pandiculation of the clavicles is as simple as can be. In startle reflex, the clavicles get pulled down not only by the indirect effect of the Pectoralis Minor, but also by the Sub-clavian Muscles. A standard Red-Light lesson may not sufficiently result in freedom, here. If not, add the following movement. STARTING POSITION: CLIENT:

supine, knees up, arms wide at shoulder height

EDUCATOR:

sitting next to the client, facing "north"

1.

Place the palm of your hand over the front of their shoulder.

2.

Have your client roll their arm (pronate) until their shoulder rolls forward. Meet, match, and resist. NUANCE:

Have them lift the head and look down their nose.

3.

Have them ease off and roll the other way. Take up slack. Use your other hand to guide the shoulder down and under.

4.

LOCK-IN: Place your hands at their wrist and shoulder; have them supinate their arm as you resist.

5.

TEST FOR FREEDOM:

Lift and drop their arm. Repeat (1. - 4.) as needed to get freedom of movement.

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FREEING A SHOULDER

A frozen shoulder is contracted every which-way. Before your get into the shoulder, do a Red-Light lesson, a Trauma lesson, and, if necessary, a neck series. ELEVATORS OF THE SHOULDER UPPER TRAPEZIUS (Scott/Contier) STARTING POSITION: sidelying, underside hand cradling the head; the other arm along their side

1.

Sit behind your client, facing their feet.

2.

Place one hand on their acromio-clavicular (A-C) joint.

3.

Have your client tighten the elevators of the shoulder (shrug "up"). Let their push show you with how much force to resist them.

4.

Resist and assist pandiculation. (Client relaxes slowly.) Take up the slack as they give it.

5.

Have your client breathe and relax.

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6.

LOCK-IN: Place one hand on their A-C joint; place the other below the elbow (distal side). Have them shrug into and against your hand. Count from four to zero; at zero, have your client suddenly relax ~ and - push their elbow into your other hand.

7.

Have your client breathe and relax.

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THE DELTOIDS

The Deltoids have three aspects: anterior, lateral, and posterior. They respond to different arm positions. LATERAL DELTOID STARTING POSITION: CLIENT: sidelying, painful side up, knees forward for stability, elbow against their side, arm

folded EDUCATOR: sitting behind the client, facing "south", hand on the lateral side of their elbow

1.

Have your client raise their arm like a wing. Meet, match, and resist.

2.

Pandiculate.

3.

Place your hand between their elbow and their side.

4.

LOCK-IN: Have your client squeeze their arm against their side.

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ANTERIOR DELTOID NEW POSITION:

Externally rotate the humerus; all else, the same

1.

Place your hand just below the elbow.

2.

Pandiculate (beginning with abduction) and lock in.

NEXT POSITION: Prone, arms by sides, hand turned so that the web between thumb and

index

finger faces into the surface EDUCATOR:

sitting facing the client's head, near-by hand resting below the scapular spine (a handle to hold) 1.

Have your client push their hand harder into the surface. You will see their shoulder lift.

2.

Meet, match, and resist

3.

Have your client pandiculate to relaxation.

4.

LOCK-IN: Have your client lift their hand off the surface.

Handbook of Assisted Pandiculation Upper Extremities POSTERIOR DELTOID

This maneuver also reaches the triceps. NEW POSITION:

client sidelying, elbow straight, humerus internally rotated

1.

Place your hand just below (distal to) the elbow.

2.

Have your client abduct the arm; meet, match and resist.

3.

Have your client pandiculate to relaxation.

4.

LOCK-IN: Arm adduction in place.

Page U-7 November 6, 1994

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THE ARM ADDUCTORS STARTING POSITION: CLIENT:

supine, arm by their side

EDUCATOR:

sitting behind the client, facing "south"

1.

Slide your hand between their elbow and their side. Secure the shoulder joint capsule with your other hand.

2.

Have your client adduct both arms and both legs; meet, match and resist.

3.

Client eases off (all limbs); draw the secured arm into abduction. NUANCE: With the hand on their shoulder, encourage their scapula to move, too.

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NEXT POSITION (CONTIER): CLIENT:

supine, humerus externally rotated, shoulder tucked under

1.

Slide your hand between their elbow and their side. Secure the shoulder joint capsule with your other hand.

2.

Have your client adduct and externally rotate both arms and both legs; meet, match and resist. NUANCE: By

applying abduction to the arm, have your client locate any positions of weakness or pain as they go into external rotation. Pandiculate in each such position. 3.

Client eases off (all limbs); draw the secured arm into abduction, NUANCE: With the hand on their shoulder, encourage their scapula to move, too.

4.

LOCK-IN: Client abducts in external rotation.

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THE TERES

The Teres rotate the humerus along its long axis. The Red-Light lesson pandiculations reach the Teres Major and Subscapularis, to some extent. The following maneuver depends upon prior freedom and comfort in abduction. STARTING POSITION:

sidelying, painful side up, arm abducted to 90 degrees, elbow bent to 90

degrees Using the forearm as a lever and the elbow as a pivot, assist pandiculation in both directions of rotation. (See photo for positioning.) NUANCE:

Assist your client in reaching their elbow wide as they pandiculate.

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BICEPS

The biceps adducts the arm, flexes the elbow and supinates the hand. STARTING POSITION:

sidelying, arm along the side, elbow bent to 90 degrees

1.

Have your client supinate their hand.

2.

Pandiculate to pronation (a modest, small move to do.)

3.

Have your client pronate their hand.

4.

Pandiculate to supination.

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REVERSE PANDICULATION, TIGHT BICEPS: NEW POSITION:

lying prone, elbow overhanging table edge 2" or so.

1.

Place your hand on your client's wrist.

2.

Your client progressively straightens the arm, hand pronated; every 2" or so, resist your client's progress to allow them to "catch up" with you and develop strength (control) in that position. Keep your balance.

3.

QUICK RELEASE: When your client reaches full extension, tell them you are about to count from four (4) to zero (0); have them release all-at-once when you reach zero.

NORMAL PANDICULATION NEW POSITION:

supine, forearm across the belly, palm against belly

1.

Place your hands medial to the elbow and at the wrist, as if to pry their forearm away from their torso.

2.

Have your client flex strongly at the elbow while adducting.

3.

Pandiculate in a slow arc, opening the elbow.

4.

LOCK-IN: straighten the arm.

Handbook of Assisted Pandiculation Upper Extremities NEW POSITION:

Page U-13 November 6, 1994

sitting, elbow propped as in "arm-wrestling" position

1.

Engage your client hand-to-hand, sitting with your elbow propped in a position that permits you to push their forearm straight down (no rotation of humerus).

2.

Have your client contract; meet, match, and resist.

3.

Pandiculate to relaxation.

NEW POSITION: same as before, except that your client positions their arm laterally so their

humerus aims out to the side (pandiculation same as above:) 1.

Engage your client hand-to-hand, sitting with your elbow propped in a position that permits you to push their forearm straight down.

2.

Have your client contract. Meet, match, and resist.

3.

Pandiculate to relaxation.

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TRICEPS STARTING POSITION:

lying prone, elbow overhanging table edge 2" or so.

1.

Place your hand on your client's wrist.

2.

Have your client straighten their elbow, hand pronated. Meet, match, and resist.

3.

Pandiculate by stages, from elbow straight-to-flexed.

4.

LOCK-IN: Have your client flex their elbow.

NEXT POSITION: CLIENT:

lying supine, elbow against side, arm supinated and folded at the elbow

EDUCATOR:

sitting next the the client's shoulder, facing "south", hand against the dorsal, proximal (ulnar) side of the elbow 1.

Have your client push their elbow into the surface (extend at the shoulder). NUANCE:

Have your client straighten their elbow against your resistance.

2.

Meet, match, and resist.

3.

Have your client ease off (their elbow lifts off the surface).

4.

LOCK-IN: Place your hand distal to their elbow; have them lift off the table against your resistance.

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THE FOREARM AND WRIST

The forearm consists of three major layers which coordinate closely. The outer layer moves the wrist and flexes the fingers at the large, first (proximal) joints of the fingers. The next-deeper layer affects finger flexion at the next, smaller joint; other muscles at that layer rotate the forearm. The deepest layer affects flexion at the smallest, most distal joint. Having dealt with the rotation function of the forearm in the Biceps Series, you can now address wrist function. Address wrist movement in all four directions of movement: extension of the hand at the wrist, flexion of the hand at the wrist, ulnar deviation and radial deviation. STARTING POSITION:

sitting, arm relaxed, forearm pronated

1.

Sit facing your client's side. Take their arm; support the elbow. By testing, observe freedom of movement of their wrist along both axes.

2.

Grasp their forearm with one hand and their hand with the other.

3.

Have your client extend at the wrist. Meet, match, and resist.

4.

Pandiculate to flexion.

5.

Have your client flex at the wrist. Meet, match, and resist.

6.

Pandiculate to extension.

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7.

Have your client ulnar-deviate at the wrist (side-bend toward their ulna). Meet, match, and resist.

8.

Pandiculate to radial deviation.

9.

Have your client radially-deviate at the wrist (side-bend toward their radius). Meet, match, and resist.

10.

Pandiculate to ulnar deviation.

NEW POSITION:

sitting, arm relaxed, forearm supinated

Repeat the sequence above.

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FINGERS

As described earlier, the deeper the muscular layer, the finer the motion controlled. The integration of all three layers makes for smooth curling and uncurling of the fingers.

EXTENSION-TO-FLEXION STARTING POSITION:

sitting, arm pronated, hand available to you

1.

Grasp the outer (ulnar) border of your client's hand with a snug grip.

2.

Have them extend their first (index) finger. With your other hand, meet, match, and resist.

3.

Pandiculate to flexion, leaving the finger straight.

4.

Repeat for the other four fingers.

FLEXION-TO-EXTENSION 5.

Make a "V" with your first and second fingers. Slide their index finger between your two fingers so the finger pad rests above and between the proximal knuckles of your first two fingers.

6.

Have them flex their first finger. Meet, match, and resist.

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7.

As they ease off, guide their finger into hyperextension, then instruct them to relax their wrist so the entire wrist also extends.

8.

Repeat for the other three digits.

THUMB ABDUCTION-TO-ADDUCTION 9.

Grasp the back of their hand from thumb to little finger.

10.

Have your client spread their hand wide. Meet, match, and resist.

11.

Pandiculate to closure.

12.

Grasp your client's hand with both of your hands so your fingertips form a line along the thenar eminence (pudge of the thumb). NOTE:

You may also address fingers individually in both abduction and adduction. THUMB ADDUCTION-TO-ABDUCTION

13.

Have your client contract their thumb into opposition with their 5th finger. Meet, match, and resist.

14.

Pandiculate to a spread hand.

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No lesson for the Upper Extremities would be complete without. . LORENZO'S FUNKY CHICKEN MANEUVER

(so named by Maggie Munroe) This maneuver integrates movements of the arms, shoulders, neck, and head. Had Colonel Sanders had this maneuver done with him, he would still be alive, today. STARTING POSITIONS: EDUCATOR: standing on the table behind the client, hands on your client's shoulders CLIENT:

sits at the edge of the treatment table, legs overhanging, thumbs hooked under their armpits, arms hanging Have your client rehearse (1. - 3.) until proficient: 1.

+ + +

shrug and hold raise their elbows like wings inhale deeply and high in the lungs

2.

Have your client begin "flapping" their arms in slow motion.

3.

Have your client begin turning their head left and right. RULE OF THUMB:

have them flap their arms twice as fast as they turn their head (two flaps for one turn to one side) NUANCE:

4.

turn the eyes as well as the head

When they can combine the movements of (1. - 3.), meet, match, and resist their shrug.

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As they flap their arms and turn their head, have your client simultaneously: + +

exhale slowly relax their shoulders

6.

Take up the slack. Proceed to complete exhalation and release of the shoulders. Stay with it until you feel their shoulders go soft.

7.

Repeat as needed for full relaxation.

.

.

ABOUT THE NECK

Functionally, the neck does not begin at C7; it begins at the lumbo-dorsal junction, behind the diaphragm -- and it functionally includes the ribs. Consider: in deep breathing, the Scalenes lift the upper ribs, which attach via the intercostals to all the other ribs. Tightness in the neck often shows up in tightness in the ribs, and vice versa; relaxation of one often relaxes the other. So, if you don't get resolution of neck tightness by working the neck, look to the ribs, as addressed in the breathing sequences, and vice versa. Three conditions for which neck pandiculation helps are: o standard tension headaches (posterior thoracic and cervical intervertebrals and sub-occipitals) o dizziness (Scalenes) o TMJ pain (deep anterior cervicals near the larynx) Migraine headaches appear to originate from tension in the deepest lateral layers of the neck. USING KINETIC MIRRORING

For conditions that resulted from sudden injury, use Kinetic Mirroring early on. It relaxes the protective guarding (trauma reflex) and can bring your client substantial relief.

See the section on the Sub-Occipitals for guidelines on positioning. THE IMPORTANCE OF POSITIONING

The neck comprises many muscles, some of which can substitute for others, in SMA. Effective kinetic mirroring and/or pandiculation require(s) precise positioning, determined by your palpation during movement and/or your client's self-positioning (to highlight sore spots by making them contract). In other words, for certain maneuvers, you will find it quicker and easier to guide your client into position; in others, your client can find the position quicker and more accurately by themselves (with your verbal guidance). See the sections on AIMING and ABOUT PAIN under MATTERS OF TECHNIQUE (MODULE 1).

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THE LAYERS OF THE NECK

The muscles of the neck operate in layers, each of which has a different main function. With painful conditions, one may use positions that use one layer without involving the others; otherwise, during pandiculation the muscles under voluntary control in one layer may substitute for amnesic muscles in other layers. The most superficial layer: o o o o

Sterno-Cleido-Mastoid Platysma Trapezius Levator Scapula

These muscles control the position of the head with respect to the shoulders. They shrug the shoulders and move the head forward-and-down. The next-deeper ("middle") layer: o Scalenes o Multifidus These muscles control neck position. The Scalenes move the neck forward and back or side-to-side; they also lift the upper ribs during extreme inhalation (or chronically, in asthma). The Multifidus extends or hyper-extends the neck. Assymmeterical pulls induce neck rotation. The remarkable thing about this layer is that opposite sides (right and left) always co-contract with movement of the head/neck to either side. One side initiates the tipping (by concentric contraction) and the other side stabilizes or guides the movement (by eccentric contraction). With trauma, you will see concentric contraction on both sides, shortening the neck; the greater the trauma, the greater the co-contraction, the more the shortening. This is retraction, as Dr. Hanna described it in The Body of Life.

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The deepest layer: o Longus Colli and (laterally) Capitus o Intervertebrals o the sub-occipital muscles The Longus Colli straighten the neck, as when you tuck your chin in; they run the length of the neck down and into the thoracic area; they cooperate with the posterior intrinsics to shorten (retract) the neck. The intervertebrals gather individual cervical vertebra together to create the functional entity we know as "the cervical spine"; this gathering-together occurs as you form an intention to move. The sub-occipitals fan out from the atlas to the cranium; they tip the head to different angles with respect to the neck and they participate in rotation. A remarkable thing about this layer is that opposite sides (front and back) always co-contract with movement of the head/neck forward. The more caudal (footward) anterior muscles coordinate with the more cranial (headward), posterior muscles to produce the movement of craning forward. With trauma, you will often see this movement, as in the startle reflex. This is also part of retraction, as Dr. Hanna described it in The Body of Life. All of the muscles of the neck bend the spine the way a bowstring bends the archer's bow. In addition, you will see "diagonal" patterns of contraction: In the headforward position, the sub-occipitals and posterior extensors contract above and the Anterior Scalenes contract below. To bring a head back and to lengthen a neck, one must relax and integrate all. You may find it easiest to start with the more superficial layers; your client's pain, however, may dictate otherwise (clear up the painful areas, first).

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Handbook of Assisted Pandiculation The Neck THE SEQUENCE

1.

FREEING THE NECK FROM THE SHOULDERS

The Trapezius 2.

LENGTHENING THE NECK

Multifidus and Cervical Extensors

3.

CENTERING THE NECK AND HEAD Anterior Scalenes Posterior,

Cervico-Thoracic Intervertebrals "THETEN-MINUTEHEADACHECURE"Posterior Scalenes The Cervico-Thoracic Junction Lateral Scalenes 4.

THE DEEP LAYERS OF THE NECK

Deep Anterior Cervicals The Sub-occipitals Kinetic Mirroring 5.

ROTATORS OF THE NECK

6.

INTEGRATION

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FREEING THE NECK FROM THE SHOULDERS SUPERFICIAL LAYERS:

Sterno-Cleido-Mastoid, Platysma, Trapezius, and Levator Scapulae

These muscles participate in the standard Startle lesson. You can have your client pandiculate the more anterior muscles unassisted by doing the "Folding See-Saw" movement described in the Handbook of Somatic Movement Exercises (Solo Work). You can reach the Levator Scapulae in the sequence for the Posterior Scalenes.

THE TRAPEZIUS STARTING POSITION: prone,

face turned toward the tight side, humerus pointing straight out to the side, elbow bent to 90 degrees (palm down). Movement done in this position (elbow at 90 degrees abduction or greater) uses the Trapezius in a special way. 1.

Have your client lift their elbow, as in the Green Light lesson.

2.

Resist and assist pandiculation, as in the Green Light lesson.

START

follow into contraction STEP 3

pandiculation in progress STEP 4

lock-in STEP 6

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TRAPEZIUS PANDICULATION #2 (Hewitt/Gold) NEXT POSITION: sidelying, one hand cradling the head; the other arm along their side

1.

Sit behind your client, facing their head.

2.

Place one hand on their acromio-clavicular (A-C) joint; with the other hand, grasp their wrist.

3.

Have your client tighten the elevators of the shoulder (shrug "up") and contract their Biceps strongly (flex at the elbow), with their forearm pronated. Let their pull show you with how much force to resist them.

4.

Resist and assist pandiculation. (Client relaxes slowly.) As they pandiculate, their arm will straighten. Take up the slack as they give it.

5.

Have your client breathe and relax. LOCK-IN:

6.

(a)

Grasp their hand in "handshaking position" with their arm in line with their torso. Have them push into your hand. Meet, match, and resist. (Leonard Contier) VARIATION:

As they push and you match them, instruct them not to let you move their arm. Then, move their arm in various directions. Have them develop the ability to resist your movement in all directions. (Leonard Contier)

Handbook of Assisted Pandiculation The Neck (b)

7.

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Place one hand on their A-C joint. Have them shrug into and against your hand. Count from four to zero; at zero, have your client suddenly release — and — place your hand below the elbow (footward side) and have your client push into it (Contier/Scott)

Have your client breathe and relax.

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LENGTHENING THE NECK MIDDLE LAYERS

MULTIFIDUS and CERVICAL EXTENSORS STARTING POSITION:

supine, knees up, feet near buttocks, arms at sides

1.

Place your hands behind your client's occiput.

2.

Have your client tilt their head chin-up, look up at their brow, and press down into your hands. You may also have them open their mouth as wide as they can.

3.

Instruct your client to press their feet down into the surface and inhale. (This act involves all the spinal extensors over which they have control.)

4.

Have your client ease off, look down their nose, and "sink." Carry their head up toward their chest to the resistance point.

5.

Have your client contract again as you resist to prevent motion.

6.

Repeat the process until no further progress occurs. Your client is now curled forward.

7.

LOCK-IN: Instruct your client to "stay in that position" as you back away.

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After "LOCK-IN", cradle your client's head again and ask them gently to push your hands down toward and to the surface. Have them keep their chin near to their neck. Frequent reminders may be necessary.

9.

Your client takes a full breath and lets go.

PROCEED TO THE SUB-OCCIPITALS, PAGE N-30. 10.

Place your hand firmly against the top of their head; by rocking yourself forward and back, induce a rocking motion through your client.

By observing that motion, you can detect where in their ribs and spine muscular tensions may be blocking free movement.

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CENTERING THE NECK AND HEAD

THE SCALENES

The Scalenes (which move the neck and upper ribs) can inadvertently be substituted by the Sterno-Cleido-Mastoids (which move the head-and-neck). Therefore, it is necessary to distinguish neck movement from head movement; the techniques are so designed. Viewed from above, the Scalenes look something like an asterisk (*) or sixpointed star. The Anterior Scalenes counterbalance the Posterior Scalenes of the opposite side. So you will want to address both. Since the Scalenes work as a system, it is best to do all three divisions in a single lesson and sometimes helpful to alternate among them in a cyclical fashion. NOTE @ 12/28/05: A new protocol for the Scalenes has since been developed.

ANTERIOR SCALENES

Begin by palpating the Anterior Scalenes. Sit at your client's head and reach to grasp the side of their neck, as follows. Place the line of your thumb alongside the trachea and wrap your fingers around the back. You now have hold of one-half of their neck. Now, gently "walk" your hand down the neck to trace the shape of the musculature. As you approach the notch of the manubrium, you will feel the thick band of the Anterior Scalenes under your thumb diving just behind the clavicle and the Sterno – Cleido - Mastoid (S-C-M), about one inch wide. Trace this band so your client can feel it. Now, begin a series of Kinetic Mirroring maneuvers. Lift your client's head and neck so that their ear (of the contracted side) comes closer to the insertion of the Scalenes. Hold for a few breaths, then slowly lower them. Palpate and repeat as needed.

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. . . for most clients. . . STARTING POSITION:

supine, knees up, feet planted, arms outstretched to the sides

HIGHER INTEGRATION:

one arm extremely supinated (on the side of the neck to be pandiculated), the other arm extremely pronated (as in "The 4-Way Twist" somatic exercise) 1.

Locate and touch the Anterior Scalene of one side with the line of your thumb. Then, with your fingers identify and define the rest of the most contracted mass of the Scalene. It is lateral to the S-C-M. Distinguish them clearly.

2.

Have your client lift their hips high.

3.

Have your client lift the head slightly and tuck the chin in toward the throat. You will feel the Anterior Scalenes and S-C-M contract. You may want to use gentle pulses of pressure (at the speed of the heartbeat) to remind them "where" to feel. Keep your touch gentle, not a hard pressure, lest they tighten further to guard against you.

4.

Instruct your client to inhale deeply.

5.

Have your client let the opposite hip sag.

6.

Your client now relaxes slowly and exhales gently. Follow your client down. Maintain contact with the muscles to provide sensory feedback. NOTE 12/23/2005: This procedure has been updated/modified.

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As you feel them relax, help their neck lengthen. HIGHER INTEGRATION:

Guide their head into the turn, continuing to "pulse" with your hand on their neck. You'll feel their whole neck soften and lengthen. 8.

Repeat as necessary, then do the other side.

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POSTERIOR CERVICO-TIIORACIC INTERVERTEBRALS "THE TEN-MINUTE HEADACHE CURE"

Some people may develop a headache from the sequence for the Anterior Scalenes. Others may just have a headache. The following sequence has consistently been effective for clearing up tension headaches. The intention is to create space between the vertebrae. STARTING POSITION:

client on knees and elbows, head hanging freely

1.

Kneel next to your client.

2.

With one hand, palpate to locate the space between the laminae of the thoracic spine. Place one finger on either side of that space, left and right.

3.

Place your other hand lightly at the back of your client's head.

4.

Have your client look up with their eyes and lift their head, so their back arches. Instruct them, "fold over my fingers." Meet, match, and resist. Your purpose is to produce sensation with your fingertips. Have your client pause for a moment so they feel what you are touching. As they lift, you will feel their vertebrae come closer together. Meet, match, and resist.

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Have your client ease off, lowering their head. Follow and assist pandiculation with both hands in their places, so you feel the vertebrae spread. Encourage the vertebrae to separate.

6.

Move "north" by one vertebra.

7.

Repeat the process until you reach C5/C6. When you reach the cervical spine, there will be a lot of "meat" in the way. Reposition accordingly:

NEW POSITION:

Place your thumb and third finger on either side of the thick muscular bands that parallel the cervical spine, slightly forward so you touch the lateral processes. This position produces sensation. Resist at the center, between the laminae, or from the sides, on either side of the vertebrae. 8.

Continue pandiculation. When you reach the sub-occipitals, have the client tip their head way back so your fingers get buried deep in the sub-occipital fold.

9.

Pandiculate. Get the feeling of separating the atlas from the occiput.

10.

Now, do the sequence described in LENGTHENING THE NECK, for the Multifidus.

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. . . for clients in more delicate condition . . . STARTING POSITION:

supine, knees up, feet down, arms stretched out at shoulder height,

palms up 1.

Place the line of your thumb alongside the trachea and wrap your fingers around the back. You now have hold of one-half of their neck.

2.

Your client lifts his neck off the surface, leaving the head behind -- and - rolls their hands palm down until their shoulders curl forward. Keep your hand wrapped around their neck to provide sensory feedback. Meet, match, and resist as they move into position, preparing for pandiculation.

3.

Your client inhales deeply.

4.

Your client exhales, sinks, rolls their arms the opposite direction, to the extreme, and tucks in their chin. Continue assisting the pandiculation, drawing their neck long.

5.

As the muscles relax, you will feel them sink into the neck. Keep your touch against them and follow the tension in toward the core of the neck.

6.

Have your client gently roll their head from side to side.

7.

Repeat several times until no further progress occurs.

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8.

Gently tap the length of the muscle on one side and then the other to provide a contrasting sensation (tight/hard versus loose/soft).

9.

Do the other side.

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. . . for clients in a still more delicate condition . . . This exercise uses the interrelation between the muscles of the eyes and those of the neck. These two muscle groups coordinate in the act of turning to look at something; their coordination is genetically inherent, though modifiable through conditioning. This exercise frees them from each other and improves the coordination of the neck. STARTING POSITION:

supine, knees up, feet down, arms stretched out at shoulder height, palms up, eyes straight ahead 1.

Your client fixates their eyes on some object before them and begins to nod (as if to say "yes"). (4 times slowly) Be sure they continue to breathe evenly and gently.

2.

Your client moves their eyes a few degrees to the side, fixates on another object and continues to nod. Their head remains straight forward, unless they choose to move it.

3.

Your client moves their eyes a few degrees further to the same side, fixates on another object and continues to nod.

4.

Your client continues nodding and repositioning until their eyes are directed sideways to the extreme.

5.

Have your client begin to turn their eyes to the opposite direction and continue nodding.

6.

Reposition eyes and continue until their eyes are directed to the opposite extreme.

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Have your client reverse the progression until their are centered, straightforward.

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POSTERIOR SCALENES

In this pandiculation, you may affect more than the Scalenes; you may also affect the Serratus Posterior Superior, which affects upper rib position. To use the Posterior Scalenes, your client must position their head correctly. Rule of thumb: more lateral muscles pull the neck more laterally; more medial muscles pull the neck more directly posteriorly. The closer the chin is to the shoulder, the more lateral the muscles that will be active. STARTING POSITION: CLIENT:

prone, head turned toward the contracted side, arms down at the

sides EDUCATOR:

sitting along your client's contracted side.

1.

Palpate to find the contracted area. You are feeling deeper than the Trapezius. It may help to have your client gently lift their head so you can feel what contracts. Help them position themselves for maximal activity in the contracted region.

2.

Trace out the contracted region, by touch. Now, aim your client's arm so that the line between elbow and shoulder points at the contracted region.

3.

Kinetic Mirroring: Lift the shoulder and upper arm of your client medially toward the neck. Ask your client to breathe and relax. Tap the area with your other hand.

4.

Gently lower your client's shoulder and continue to tap the scalene area.

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Place your fingers on the contracted region and have your client inhale and lift their head and the leg of the same side. Feel the contracted region contract further. NUANCE:

Have your client lift their head tuck their chin closer to or further away from their shoulder to aim with greater precision. They should feel the tight muscles more keenly. NUANCE:

Have your client lift their leg and by abducting it to a greater or lesser degree, aim to get the thoracic extensors of the neck to participate. NUANCE:

Have your client reach wide (push) with their arm. This action puts the entire burden of lifting on the neck (rather than shoulder) muscles. 6.

Have your client slowly relax.

7.

Repeat several times until no further progress occurs.

8.

Have your client repeat the above maneuver with the opposite leg, if needed.

9.

HIGHER INTEGRATION:

out.

Have your client pull their arm in (retract), then pandiculate

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THE CERVICO-TIIORACIC JUNCTION

This maneuver assists with lower cervical and upper-rib mobility problems. It bears similarity to the "spinal lengthening/vertebral highlighting" procedure found in the second half of the Green-Light lesson; your client, however, rather than passively yielding to your neck traction, actively pandiculates, as follows. STARTING POSITIONS: CLIENT:

prone, head turned to one side, the hand of the same-side arm next to the mouth and nose, the other arm by their side EDUCATOR:

sitting next to the client, facing their face, "north" hand wrapped around their neck near the occiput, thumb of the "south" hand at C6 or a vertebra "south" of that. Go by feel. 1.

As your client's head faces to the side, move it in a passive, nodding movement to demonstrate the way you want them to move. Use your "north" hand.

2.

Instruct them to resist you as you draw their head toward a "chin tucked" position. Allow them to prevent you from moving them. With the thumb of your other hand, anchor the vertebra at its spinous process (lamina). Keep the pressure within their comfort zone. Ask your client for feedback.

3.

Ask them to ease off. As they do, take up the slack and draw their head into a "chin tucked" position. Your thumb still anchors the vertebra. As they ease off, their head will begin to roll "nose into the table." Stay with them through their progressive relaxation, until complete. Make sure they're comfortable having their nose smooshed; if not, do a smaller move.

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Release their head. It should roll loosely back to the table.

5.

Move your "south" hand south one vertebra and repeat until you feel you have achieved the desired result.

6.

Do the other side.

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LATERAL SCALENES STARTING POSITION:

side-lying, knees forward, head tipped all the way toward the "down" side, underside arm bent at the elbow, topside hand wrapped around the elbow of the underside arm. You are about to do a shoulder pandiculation followed by a combination neckand-shoulder pandiculation. SHOULDER PANDICULATION

The movement is to shrug the shoulder toward the ear. Fine tune your instructions so that your client contracts the already amnesic area of the neck and/or shoulder. "Shrug your shoulder toward here". (Touch a point, such as the mastoid process.) Assist them in finding that direction, if necessary, by passively moving them toward it so they can feel the direction you mean. 1.

Place your hand against the top of their shoulder, fingers draped along the deltoid.

2.

Your client shrugs, pushing you back. Meet the match their force.

3.

Have your client pause in place for a moment.

4.

Have your client ease off, slowly.

5.

Follow with a "quick release" pandiculation. Have your client push into your hand for a count of four, then release.

6.

LOCK-IN: Place your other hand below their elbow and have them push into it.

lateral scalenes, PALPATION

top of head toward table (intent) STEP 1

lift neck, shrug shoulder, STEP 2

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Continue with the lateral movements of the thoracic spine described in FREEING THE RIBS FROM EACH OTHER (MODULE 3), beginning at the lumbodorsal junction. Those movements help integrate side-bending of the ribs and neck. Once you have done that sequence, have your client turn onto their back and do the Arch & Curl somatic exercise. Now, palpate the Lateral Scalenes. Sit behind your client's back (remember, they are side-lying) and reach to grasp the side of their neck. Place the web of your thumb along the hollow of the neck and shoulder; wrap your fingers around the front (finger tips next to the trachea) and place the line of your thumb alongside the cervical vertebrae. You now have hold of their neck. You know you have a good hold if you can shake them (gently!) by the neck. By palpation, locate the contracted area. If the Lateral Scalene is contracted, you will feel a tight band about one inch wide. Define this band with your touch so your client can feel it. 1.

Have your client tip the top of their head toward the table; in that position, have them lift their head off the surface. Monitor the Scalene with one hand. Be sure they contract the desired area or guide them into position until they do (neck flexion/extension, chin tucked or presented).

2.

Your client now shrugs the shoulder as if to hide and protect the part of the neck you have defined for them. Provide resistance. NUANCE: Have your client stretch the down-side leg long to further tighten the top side.

3.

Your client inhales deeply.

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4.

Your client exhales, sinks, and allows the shoulder to drift away from the neck. The effect is of spreading the neck and shoulder area.

5.

Repeat until no further progress occurs.

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THE DEEP LAYER OF THE NECK As stated earlier, the front and back of the deep layer cooperate. So you will get much better results if your client contracts both the front and the back at the same time. In fact, many times when a client complains of posterior neck pain which does not resolve through pandiculation, the problem is the deep anterior cervicals. Palpation: The Longus Colli and Capitus lie along the front surface of the cervical vertebrae. In fact, these muscles, in over-contraction, create the lumpy sensation of a "sore throat." To palpate these muscles, gently touch the side of the trachea, using the "soft" of your finger pads more than your fingertips. Keep your hand and wrist soft. Now, follow the contour of the trachea laterally and keep going deeper until you touch something hard. If the Longus Colli are amnesic, they will feel sore; if not, you can touch the front of the cervical vertebrae with your client in complete comfort. Go slowly and gently; your client may feel spooky about this area. Another "remarkableness" about this area is that when the deep anterior cervicals near the larynx are tight, palpation may create or intensify pain in the temporomandibular joint of the same side. Relaxation of that region will bring more space and more comfort to that joint. (Lump in the throat - repressed emotion/repressed communication? H-m-m-m.)

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Since the deep anterior muscles of the neck coordinate with the deep posterior muscles of the neck, one can sometimes evoke relaxation of the deep, cervico-thoracic muscles (which drape down the back like a young girl's hair) by relaxing the deep anterior cervicals. Functionally, the neck does not end at C7; it ends at the lumbodorsal junction. Having located and identified the state of the deep anterior cervicals, you are now in a position to assist your client.

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DEEP ANTERIOR CERVICALS

The following maneuvers resolve tension headaches and certain chronic effects of whiplash injuries related to the Trauma and Startle reflexes. STARTING POSITION: supine, knees up, feet planted HIGHER INTEGRATION:

one arm extremely supinated (on the side of the neck to be pandiculated), the other arm extremely pronated (as in the "4-Way Twist" somatic exercise) 1.

Locate and touch a contracted portion of the anterior cervicals with the line of your thumb. Start at the center, near the larynx.

2.

Have your client tuck their chin near their neck. Make sure they keep their neck down on the table surface.

3.

Have your client close their eyes and with their inner vision, "look at" the painful area. Instruct them to look directly at it with their mind’s eye.

4.

Instruct and assist your client first to tuck their chin in and then to turn slightly toward the contracted side until they feel those muscles more distinctly. Allow up to twenty seconds for them to find them. You will distinctly feel those muscles grow more taut. If they can't find them, guide them passively into position and then ask them to hold that position. NUANCE: In

addition to rotation, they may need to add some "side tilt" (ear toward shoulder) to find them.

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With your fingers, locate the tightest band of the posterior cervicals and have your client contract those also, and then the whole side of the neck. These muscles coordinate with the deep anterior muscles. When you have the right hold, your client will know and will report it to you.

6.

Your client now lifts their hips, then lets the non-contracted side sag.

7.

Instruct your client to inhale deeply.

8.

Your client now relaxes slowly and exhales gently. Follow your client down. Maintain contact with the muscles to provide sensory feedback and to help the neck lengthen.

9.

As you feel them relax, instruct them to look north to the opposite (non-contracted) side. Assist them in turning that way, as they relax. HIGHER INTEGRATION:

("4-Way Twist" (“washrag”)pattern)

Your client drops their legs toward the tight side, turns their face away from their legs, rotates their arms in opposite directions and sags. You'll feel their whole neck soften and lengthen. 10.

Have your client take a deep breath, let it all go, and sag. Repeat as necessary, then do the other side.

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THE SUB-OCCIPITALS

When awakening the deep anterior cervicals, and/or freeing the Scalenes, it is desirable to follow by awakening the sub-occipitals. Positioning is very important. GUIDING YOUR CLIENT INTO POSITION

To identify the movement that engages the amnesic muscle or group, palpate the painful area (gently), using the "soft" of your finger pads more than your fingertips. Keep your hand and wrist soft. With your other hand under the head, move the head and neck toward the amnesic (contracted) region until you feel the spine under your fingertips curve directly away from your touch; that is, your fingers rest at the deepest point of a concavity. That is the position and movement that your client must do. However, before you have them pandiculate, ask them to relax into that position and take a few slow, deep breaths (Kinetic Mirroring). Note that you are feeling the spinal vertebrae "through" the amnesic muscle group. (NOTE: If you cannot feel the atlas, the overlying muscles are contracted.) Once you have moved your client into the correct position, have them actively keep that position as you begin pandiculation. Details follow, below. STARTING POSITION: CLIENT:

lying supine, legs outstretched

1.

Palpate along the sub-occipital ridge to locate spasticity.

2.

Position your client to be able to use the spastic region.

3.

Instruct your client, "Actively hold that position."

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4.

Meet, match, and resist. Beware of using too much force; to work gently works better; otherwise, larger, surface muscles may take over, leaving the deeper ones as before.

5.

Have your client ease off; you take up the slack and lengthen the neck.

6.

Move to the next contracted sub-occipital muscle(s) and repeat the sequence.

Proceed to the first Pandiculation for Biting, page J-4.

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ROTATORS OF THE NECK

Rotation of the neck involves more sophisticated coordination of the muscle layers addressed above. The following maneuver, when used after the preceding, preparatory maneuvers, improves people's mobility and the sense of security about their neck. STARTING POSITION:

1.

supine, knees up, feet down, arms by the sides

Sit at your client's head and place your hand lightly across their forehead. Gently rock their head from side-to-side to determine freedom of movement. Unless the pain is too much, have your client pandiculate first in the more restricted direction. If your client is tighter going left, have them tighten right and relax left.

2.

Place your hand behind their neck with your forearm along the side of their head; that is your "resistance surface."

3.

Cup their neck in your hand and grasp securely.

4.

Have your client turn their head. Give them some slack to turn, a bit, then meet and resist with your forearm. IMPORTANT:

Have your client use only moderate force, i.e., within the range of sensation they are willing to feel. We don't want them contracting in fear of the pain that "might" happen!

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Your client eases off; you take up the slack, guiding the head and neck into rotation. NUANCE: As you follow the movement, plant your feet and move from your somatic center. Keep your balance so you can follow them smoothly.

6.

At the first "resistance point," have your client push more ("reverse direction") and give them an inch or so.

7.

Meet, match, and resist your client's pressure and instruct your client, "Pause in place, for a moment."

8.

Instruct your client, "Slowly ease off."

9.

Continue until you feel that your client has relaxed all they can.

10.

LOCK-IN: With your other arm, provide a resistance surface on the other side of their head. Have them turn against you.

11.

Repeat the entire cycle on the opposite side.

12.

When they have done both sides, have your client place their hand on their forehead, and by pushing with the heel of the hand, rock their head side-to-side. Have them build up to a loose, floppy movement, then switch hands.

Handbook of Assisted Pandiculation The Neck

Page N-34 November 1, 1994 INTEGRATION

This maneuver integrates movements of the neck, torso (ribs), hip, and ankle. Its special virtue is that it allows a person to release patterns of tension held in place by complex patterns of compensation throughout the body. In this maneuver, your client targets and brings comfort to sore spots in their neck, under your guidance. In some ways, it is much easier than some of the other neck pandiculations. Once you have practiced it, you may find it to be the maneuver of choice for neck pain, and choose to use the other maneuvers only for more difficult cases. You will want to be very familiar with this sequence so you can keep your mental clarity while using it with a client. Practice with a friend -- or put it on tape and practice it by yourself! STARTING POSITIONS: CLIENT: sidelying,

"underside" leg bent at the knee, half-way to the chest, "underside" arm outstretched straight-forward EDUCATOR: sitting behind the client, facing "north"

1.

Have your client lift their head and, by curling forward or arching backward, locate a sore spot in their neck. NUANCE: In

that position, have your client turn their head left or right to locate the exact center (most intense point) of the sore spot. 2.

Ask your client to notice the place on their ribs that presses into the table. NUANCE: Have your client roll a bit forward or backward on their ribs (without moving

their head) to locate a position that further highlights the sore spot in their neck.

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3.

Have them press those ribs more firmly into the table.

4.

Do VARIATION A when the client has tension of the extensors of the thoracic spine. Do VARIATION B when the client has tension at the atlanto-occipital junction. You may end up doing both variations. o VARIATION A: Have your client lift their "topside" leg and, by moving forward or backward, locate the position that keeps them balanced over the spot on their ribs. NUANCE:

o

Have your client evert (toes-out) the "topside" foot.

VARIATION B: Have your client stretch the "underside" leg straight and long, and draw their "topside" leg "north." NUANCE:

Have your client place the forearm of their "topside" arm over their ear (as a weight). 5.

Have your client exhale, then inhale, slowly sink down onto the spot where their ribs press into the table, and sag. Doing so will encourage them to lengthen, as they relax.

6.

Have your client take a full breath and let go. Doing so will enable him/her to relax further.

.

.

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7.

LOCK-IN: Have your client press their head and "topside" leg into the table.

8.

Repeat the process until your client has erased (as much as time permits) all sore spots.

9.

Have your client turn over and do the other side.

.

ABOUT JAW FUNCTIONS

Your clients may come to you with a variety of complaints related to the jaws: pain at the TMJ, inability to close the mouth without catching, inability to open their mouth, improper bite, or teeth that don't match up when their mouth is closed. Some may have jaws so tight that they have tinnitis (ringing in the ears). Your solution is the same in every case: guide them through pandiculations that give them freedom of jaw movement in all directions. Since the jaws mediate the relationship between the head and the neck, begin with the neck maneuvers shown in Module 4. A little clue: the mandible is functionally and feeling-ly associated with the throat (e.g., via swallowing), while the maxilla/cranium is associated with the spinal column; instruct your client to feel those associations as you guide them through pandiculations. The jaw functions can be summarized as follows: o o o

biting grinding speech

BITING

Biting has two major functions: aggression (including aggressive play) and eating. When animals get angry (or playful), they sometimes bite; so do humans, especially children. It involves a clenching movement of the jaws and a pulling movement of the neck and head. With dysfunctions of the TMJ, the clenching of the jaws may have to do with aggressive biting or with trauma from injury or dental work. However, it may also have to do with restrained speech/undelivered communications (as in "biting ones tongue" or gritting ones teeth).

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If at some time a person wants to bite someone (and who doesn't?) and they suppress the urge, the dual motivations (wanting to bite and suppression) do not automatically cancel each other and disappear. To the degree that the urge to clench their teeth seems to be "happening to them", it indicates a residual state of arousal. You can see it. The jaws do not move much when they talk. You may have seen it in movie portrayals of "high society" types. When you deal with that condition, you are dealing with an emotional response, and emotional pandiculation, as described above, may decidedly help. In any case, you will have to treat that response differently than you do dental trauma; more below. In other cases, where trauma is involved, such as an accident or dental work, simple pandiculation ought to suffice. GRINDING

Obviously, what you have bit off, you will want to chew. The grinding movement involves both forward-and-back and a side-to-side (not to mention opening and closing) movement of the jaws. The pandicular sequence I describe addresses those movements. SPEECH

As I said, earlier, "Emotional Pandiculation" may be helpful when the clenchin' is the tension from not mentionin' ones dissention. Feel it? In assisting pandiculation under these conditions, have the client use the amount of force they would when moving the jaws in speaking. Otherwise, a pandiculation may be felt as a contest of wills in which nothing lasting gets accomplished. Gentle work works.

.

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In the sequence for the neck, I noted that palpation of the deep anterior cervicals, particularly adjacent to the larynx, may stimulate pain in the TMJ of the same side, and that pandiculation of those muscles brings ease to the TMJ. Both the larynx and the TMJ participate in speech, which may explain the functional relationship. SEQUENCE

1. 2. 3. 4. 5.

Sub-occipital/Neck Extensors Masseter and Temporalis Muscles Neck Flexors, Masseter and Temporalis Muscles Lateral Jaw Clenching Movements The Pterygoids: Muscles of Jaw Protrusion and Retraction

step 1

step 2

step 6

step 8

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PANDICULATION FOR BITING

Since biting involves the jaws, neck, and head, we address them all, as follows. The first maneuver described is also suitable for speech-related tension; have your client use an amount of force comparable to that used in speech. SUB-OCCIPITAL/NECK EXTENSORS STARTING POSITIONS: CLIENT:

supine, knees up, feet planted, arms along the sides

EDUCATOR:

sitting at your client's head, facing "south".

1.

Slide your hands under the occiput. Grasp snugly.

2.

Have your client tilt their head back and look up toward their brow. NUANCE:

3.

Have your client open their mouth wide, to the limit.

Meet, match, and resist your client's force. NOTE: Unlike the photo, a more ideal practitioner position is with practitioner kneeling, elbows propped on the table (minimizes practitioner effort)

4.

Have your client lift their hips, slightly.

5.

Meet, match, and resist the added force felt at the neck.

6.

Instruct your client to "ease off and sink" (mouth, too). Take up the slack, lifting their head.

.

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As your client's chin approaches their chest, you may encounter their first line of resistance. If so, do Step (7.). 7.

Have your client push you back and pause in place until their attention steadies.

8.

Instruct them to ease off and take up slack. Continue until your client's chin is on or near their chest and no further progress occurs.

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MASSETER AND TEMPORALIS MUSCLES NEXT POSITION:

supine, knees up, feet planted

1.

Place your thumbs along the notch of their chin and your fingers under their jawline. Get securely positioned there.

2.

Have your client gently bite down. Meet, match, and resist.

3.

Instruct your client to leave their jaw where it is, to look up at their brow, and to tip their head backwards (i.e, hyperextend the neck while opening the mouth). Rather than keep their head steady and move their mandible, they keep their mandible steady and move their head. This alternate way of moving produces a novel sensation that adds greatly to sensory input. NUANCE:

Invite them to place their own hands where yours were to restrain the movement of their own jaw. (This teaches them how to continue at home, on their own.) 4.

When no further opening occurs, invite them to bite down, again; then have them continue tipping backward.

5.

LOCK-IN: Have your client open their jaws against your resistance. You may also have them place the heel of their hand under their chin and open against their own resistance.

6.

Move their jaw passively to test for results.

7.

Repeat 2-3 times, as needed.

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NECK FLEXORS, MASSETER AND TEMPORALIS MUSCLES NKXT POSITION: supine, legs flat. Have your client

slide toward you until their head is on your

lap. 1.

Place your thumbs along the notch of their chin and your fingers under their jawline. Get securely positioned there.

2.

Have your client lift their head slightly off your lap and bite down. Meet, match, and resist

3.

Instruct your client to leave their jaw where it is (i.e., slowly relax), to look up at their brow, and to let their head sink backwards. (S)he keeps the mandible steady and in place and moves the head. NUANCE:

Help keep the lower jaw from moving and be attentive to the strength level of the neck. If they have done a neck lesson already, clients are much more fit for this maneuver. 4.

When no further progress occurs, place a hand behind their head and help them lift again; deposit their head on your lap. Let them rest.

5.

LOCK-IN: Have your client open their jaws against your resistance.

6.

Test their jaw for free movement.

7.

Repeat until you get no further improvement.

.

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As homework, you may instruct them to lie in bed with their head over the edge, place the web of their hand (between thumb and index finger) in the notch of their chin (where your thumbs were), lift their head, and as they lower themselves again, to restrain their own jaw as you have just done.

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PANDICULATIONS FOR GRINDING LATERAL JAW CLENCHING MOVEMENTS STARTING POSITION: CLIENT:

supine, legs flat, arms along their sides

EDUCATOR: sitting at your client's head, facing "south"

1

Place your thumbs along the notch of their chin and your fingers under their jawline. Get securely positioned there.

2.

Your client opens their jaws lightly.

3.

Have your client choose a side. Explain that you want them to let their jaws close with the lower jaw moving to that side, i.e., deliberately bite crookedly. Have them rehearse that move; assist as needed.

4.

Your client now tilts their head backward and opens their jaws (straight and centered). Meet, match, and resist.

5.

Have your client ease off, slowly letting their jaw drift to the chosen side. Work toward a straight diagonal movement.

6.

Repeat 3-times.

7.

Do the same thing for the other side.

8.

Have your client open their jaws.

9.

Meet, match, and resist their force.

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Handbook of Assisted Pandiculation The Functions of the Jaws 10.

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Have your client slowly move their mandible to one side in an arc (rather than a straight diagonal). If (s)he lacks sufficient feel for how to do it, have him/her relax and demonstrate the movement (means-whereby) with him/her feeling passively.

11.

Repeat slowly 3-times.

12.

Now, have your client open (you resist) and close the mandible to the opposite side. Have him/her go for a smooth arc. Be gentle as you assist in working out the kinks, or (s)he may resist at the expense of feeling and control. NUANCE:

Have your client look to the side opposite the way they are pushing the mandible: mandible left, eyes right. Try it yourself. Now, look to the same side. 13.

Test for free movement by wiggling the jaw side-to-side.

Repeat as needed until you get the desired result or no further progress occurs.

Opening mouth slightly, STEP 1

(rehearsing jutting mandible forward)

Hand at chin, client juts mandible forward, STEPS 2 & 3

Client relaxes, STEP 4

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THE PTERYGOIDS: MUSCLES OF JAW PROTRUSION AND RETRACTION

The Pterygoids anchor the mandible to the sphenoid bone, a bone that runs from the space just behind the upper wisdom teeth to the roof of the nasal cavity (in other words, just under the pituitary gland in the brain). This bone sends out "wings" that form part of the orbit of the eye, at the temple. The sphenoid is the deepest bone in the body. Chronic jaw tension can thus pull that bone into a twisted position that makes one feel slightly mentally deranged. This is understandable if you consider the attitude of someone who is jutting their jaw forward in anger. The following maneuver helps. STARTING POSITION: CLIENT:

supine, knees up, feet planted

EDUCATOR:

sitting at the client's head, facing south

1.

Have your client open their mouth, slightly.

2.

Place the heel of your hand lightly on their chin.

3.

Have them push their jaw forward against your hand. Meet, match, and resist.

4.

Have them slowly relax. Guide their mandible into its deeply-seated position in the TMJ. If their jaw does not go straight backward, work some more with the lateral movements of clenching.

5.

Repeat 2-3 times.

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6.

Have your client open the jaw and, with two fingers, hook behind his/her own lower front teeth.

7.

Have him/her retract (pull backward) with the jaw.

8.

Have him/her slowly ease off, using the fingers to draw the jaw forward. NUANCE:

Have him/her nod the head as (s)he does so.

NUANCE:

Have him/her rock the pelvis as (s)he does so.

9.

Hook two fingers of each hand behind the angles of the mandible and, by lifting and releasing, test for free movement.

10.

Repeat as needed to get free movement.