Unilateral weight-bearing palpation and the Year of the Shoulder

By Richard M. Polishuk, LMT, Aston-Patterning | December 29, 2015
First, I’ll follow up on my last post, from September: yes, it turns out to be much easier to teach A/P shoulder assessment UNILATERALLY, as noted there. But there’s more…as of December, I’m now teaching a similar unilateral strategy in the entire lower body. What’s the general procedure? One hand above the relevant joint, one below. Counter-shift in the A/P plane to evaluate relative balance. It’s so much easier to teach! Bilateral weight-bearing evaluation is still interesting to me, but now it can be a counterpoint to unilateral assessment. 
 
Meanwhile, it has turned out to be the Year of the Shoulder. I feel much clearer about sensing the poise, or lack thereof, of the girdle atop the ribcage. The unilateral evaluation described in the 9/14 post was the key. The most common feature that I see more clearly is the combination of posterior shift and anterior tilt in a scapula…usually, the right one. 
 
The next time I lead a shoulder class (April, in Port Townsend) should be fun.

Weight-bearing palpation upgrade, upcoming MFB shoulder and arms course

By Richard M. Polishuk, LMT, Aston-Patterning | September 14, 2015

Earlier this year, I made a breakthrough in evaluation that was exciting for me: I realized that it was much easier to evaluate the front-to-back balance of the pelvis on the femoral heads if I did it unilaterally. For the last couple of months, my protocol has been to stabilize the upper leg with one hand and glide the ipsilateral ilium back and forth with my other hand. This change has really enhanced my clarity of assessment in a critical part of the body. 

This past weekend, as we taught an MFB Spine and Ribcage class, I suddenly realized that I could make exactly the same improvement when evaluating the front-to-back balance of the shoulder girdle on the ribcage! Now, I'm stabilizing the side of the ribcage with one hand, and gliding the ipsilateral shoulder girdle with the other. It's a similarly huge improvement for me. 

I know that in the next few weeks, I'll be gathering a lot of data about the implications of this change. Luckily for me, we're teaching an MFB class about the Shoulder Girdle and Arms in November (11/7-8), and I'll get to share this improvement with some students. 

Fluffing the butt

By Richard M. Polishuk, LMT, Aston-Patterning | August 23, 2015

One of the things I was reminded of this weekend (see Aston-Patterning Reunion) was a perfect outgrowth of a trend that's been creeping up on me lately. 

More and more clients (especially the more athletic ones), when I investigate their "butt pain," wind up directing me to somewhere on the back of their sacrotuberous ligament. Back in the day (the Eighties), I was introduced to the idea that this ligament could be a source of pain. But it's also a large part of the origin of the gluteus maximus. So are we thinking of the ligament as a structural element in the pelvic girdle, a pain production site, or as an attachment site of an important muscle? Yes and yes and yes. 

So back to getting reminded: as I received some work from my colleague Valerie Lyon this weekend, she pointed out that as my leg swung forward in gait, it was pulling my pelvis into a posterior tilt. As the work proceeded, it became clear to me that my gluteus maximus had gotten used to stabilizing in a shortened position…not so good. As things reorganized, I could feel the space between the front of the sacrum and the back of the upper femur opening up…which seems to live in Aston-Patterning language as "fluffing the butt." I don't think I had made the connection between that narrowing and the gait problem. I don't think I'm going to forget about this again! It's definitely a refined expression of pelvis/femur balance. 

Aston-Patterning reunion

By Richard M. Polishuk, LMT, Aston-Patterning | August 23, 2015

This weekend, I had a lovely opportunity to meet with 2 of the Aston-Patterning practitioners I like best. (The third invitee, Elaine Marquez, couldn't make it from the Methow because of the forest fires.) The two who came were Beth Berkeley, who just returned to Seattle after 15 years in the New York area, and Valerie Lyon of Portland. Everybody, including my family, got some good work, and we talked shop a lot. 

My favorite thing about Judith Aston's teaching has always been its strong emphasis on principles rather than methods. Since the principles can be applied in so many ways, practitioners are delightfully diverse. My rather high expectations for the weekend were exceeded; I was reminded of aspects of the work that I've neglected, and some of my blind spots about my own body were illuminated. 

The thing I'll probably be thinking about the most is the tension between specific problem-solving work and more general smoothing-out work (usually called "blending" in the Aston world). When to emphasize one or the other is a question without a simple answer. 

Motion Barriers

By Richard M. Polishuk, LMT, Aston-Patterning | August 2, 2015

The concept of the motion barrier comes, as far as I know, from osteopathic principles, but it’s now widely distributed in the therapeutic world. Fundamentally, the idea is that tissue mobility is always limited, and that we can make clinical decisions based on our evaluation of these limitations.
In our work, we use motion barriers to tell us about the shape, degree, and direction of restrictions. One of the very interesting things about motion barriers is that the more refined our touch is, the more quickly we’ll feel motion barriers when we’re assessing tissue. A delicate touch will improve our precision in assessment, but it doesn’t make a heavier touch wrong—just less efficient. Often, students are surprised by how quickly Lauren and I evaluate tissue in the classroom. The “secret” is that we feel motion barriers with very little movement of the tissue. The second layer of the secret is that, with practice, we shift from feeling directional barriers in movement to feeling the underlying directional bias of the tissue. This second layer makes evaluation even faster. Some students find feeling bias easier than motion testing…which saves them a lot of trouble! 

The Short Loop

By Richard M. Polishuk, LMT, Aston-Patterning | August 2, 2015

One aspect of our mode of treatment is shortening the loop of assessment and treatment—making a session into many, many short loops. In our paradigm, we move from standing evaluation to the table with a clear sense of what we want to change and the ability to quickly change it. Once we can tell that we’ve successfully made a change, we can move to the next need or have the client stand to take in what’s happened.

Counterbalancing at the top of the body

By Richard M. Polishuk, LMT, Aston-Patterning | July 9, 2015

In my previous post, I started writing about counterbalancing body patterns. Here, I want to talk about balancing the part of the body most people think about when they think about their “bad posture”: the shoulder girdle, neck and head.

First, let’s put it in context. If you think your only postural problem is that things fall forward in the upper body, you’re wrong. Anything that falls forward has to be counterbalanced by other parts that fall back. (In standing position, the most common candidate would be the lower-to-mid ribcage.)

The shoulder girdle counterbalances with the sternum and mid-ribcage below. In other words, if you’d like your shoulder girdle (and upper ribs) to shift back, you’ll need your sternum to shift forward. When people try to improve their posture, they often pull the sternum up and back; for most of us, that’s not going to work.

When you play with this, a simple logic emerges: what we’re looking for is front-to-back depth at the upper ribcage and shoulder girdle. If you can feel that as you gently shift the shoulders back, your sternum moves forward, you’re on the right track. If you can feel that as you gently shift the sternum forward, your shoulders move back, you’re on the right track.

It’s easy to tell when you’ve gone too far: it’s when you shift the front (sternum) so far forward that the shoulders come forward too, or when you shift the back (shoulder blades) so far back that the sternum comes back too. 

Finally, notice that the head and neck, broadly speaking, like to follow the shoulder girdle…forward or back. (Some people, in fact, may find it easier to lead with the head when counterbalancing, rather than the shoulder girdle.) In any case, when the sternum, upper ribcage and shoulder girdle make a big, deep base of support, the head and neck have much improved opportunities for graceful poise.

Alignment and Tone (and Counterbalancing)

By Richard M. Polishuk, LMT, Aston-Patterning | July 9, 2015

I’ve always been suspicious of practices or disciplines that involve deliberately tightening a muscle—even though I know that others use this strategy with great success. The reasons for my suspicion are that: (1) you can tighten a muscle without significantly changing your alignment and (2) it seems to me that the body has already worked out the best pattern of tone for a given alignment, and I doubt that we can cognitively do better. Consequently, my preference has always been to prioritize improving alignment, letting the muscles take their cues from the position.

I’m not saying that this is always easy! How are we supposed to know what better alignment is? I’ve talked about some of the answer in an earlier post, “Gravity and Neutral.” Part of what I said there is that neutral (segments stacking well) has the feeling of length without deliberate effort. But there’s more to say. 

One of the realities is that, when you move from one pattern of alignment to another, everything has to change. So the appropriate use of the mind in this situation is to say, “I’m going to try changing the position of one part, and then let everything reorganize to match what I just changed.” It’s an interesting mix of deliberateness and surrender. When you practice this skill, part of what emerges is the logic of body patterns in gravity. 

One of the most important parts of the logic is counterbalancing. For example, if you shift your femoral heads backwards in standing, your upper body will have to shift forward. Otherwise, you’ll fall over backwards. A good way to begin to practice shifting patterns is to shift the femoral heads (tops of the legs) forward and back, allowing the upper body to counterbalance. If, on the other hand, you deliberately try to shift the femoral heads without letting the upper body counterbalance, you’ll get a change to feel the body saying, “NO, that doesn’t make sense.”

Shape and mobility of the mid-foot

By Richard M. Polishuk, LMT, Aston-Patterning | June 20, 2015
I recently realized that I have had a blind spot—with a few dimensions—about feet. 
 
I have high arches, and I’ve sometimes had foot pain. I’ve had a bit of plantar fasciitis, but more commonly I’ve had pain in the left mid-foot. My improved clarity came when I realized that the foot pain seemed to be coming from the joints between the metatarsals and cuneiforms, and that the pain was related to stiffness (lack of dorsiflexion) in the joints. Working on my foot to improve dorsiflexion—something I never really tried to do before—has really helped the foot feel better. I realize that I took the shape of my arches for granted, and assumed that they couldn’t change. I’ve been looking at everyone else’s feet with new eyes, and I’ve had some nice breakthroughs with clients who had limitations similar to mine. One connection I’ve made is that these stiff, high medial arches seem to drive weight into the heel.
 
Interestingly, arthritic changes to these joints seem to be better known in people with the opposite problem: flat feet. I don’t think I’ve seen that in my practice, but I’ll be on the lookout now.

 

Self-care and clinical assessment

By Richard M. Polishuk, LMT, Aston-Patterning | May 31, 2015
As many practitioners know, pelvic torsions are very often held in the pubic symphysis and can be neutralized by resisted adduction. It’s the one alignment pattern for which I’ll interrupt a standing palpatory assessment, since it’s so quick and easy to fix. For years, I’ve had a habit of asking clients to do this maneuver to themselves (usually in a seated position), rather than doing it with my help. When I do it this way, I’m making sure that not only are they able to perform the maneuver, but that it’s also correcting the problem. 
 
For quite awhile, this was really the only example in my practice of what could be a category: 
(1) assess a problem; 
(2) ask the client to do a corrective maneuver;
(3) reassess to confirm that the correction worked
 
This year, I’m beginning to collect a few more examples. Here are 2 of them:
 
(1) I find a sacral rotation or tilt in a prone client. Before attempting any other corrective measures, I ask the client to turn over, bend his knees, and push them out against a strap around his legs. When he turns over again, the sacral misalignment is greatly improved. (Since I wrote this, I’ve changed my procedure: when a prone client pushes his thighs outward against my hands, that gaps the SI joints adequately. This simplifies the process.)
 
(2) I find a Type II flexed lumbar fixation in a prone client. I ask her to lie on the floor with a small foam roller beneath her mid-lumbar spine and sink into the flexed spot for a few moments, then recheck the spine. The flexed fixation is gone. 
 
It’s fair to say that both practitioner and client are going to be more confident about a self-care measure when they’ve seen it work. I’m going to see how many examples of this I can find in the next few months. 

 

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