Getting Lost and Re-orienting in manual therapy

I’ve been thinking about the experience of being lost — and all the ways humans have for being found. We use our senses, sight and sound especially. We palpate; think of finding your way in a new setting at night, with little light. We also use language –verbal and visual– for making maps or signs, leaving a trail. East, west, north, and south. Another example I love for its intimacy with landscape is ‘mauka’ and ‘makai’: ‘toward the mountain,’ and ‘toward the sea’ respectively. When you’re moving in relation to those large mountains, or the sea surrounds your patch of land, these terms become very helpful.

In bodywork, our terrain is the human body in all its 3D complexity, and we have lots of words for that terrain:

On the vertical we have upper/lower, more egalitarian in tone, but not as specific as superior/inferior. In CST we often see cephalad/caudad: toward the head/toward the tail. What’s unusual here is that these terms usually describe our hands in relation to their body. All other terms orient to the client’s body–reflecting the foundational principle that it is the client’s body, their terrain that is our focus.

On the horizontal we have toward or away from midline, or medial/lateral. With nerves, we find a combination of vertical and horizontal: distal/proximal. This is useful, in the way that upstream and downstream are useful. Nerves meander wriggling paths, but have an overall orientation toward or away from the central nervous system.

In depth (coronal plane), we have anterior/posterior. In my classroom experience, this is the direction that gets the most double-checking during demos. My take on that is twofold:
1) Because we’re often working with people face up or face down (supine/prone!), we get used to thinking of people as 2-sided.
2) Another thought that comes to mind: our working map is strongly influenced by our own sensory awareness. From the fields of neurology and consciousness studies, we know that humans have less awareness of what’s behind them. So using ‘posterior’ will ask us to orient to a hazy place on our map; there be dragons?

Likewise, we have the in-between: inner/outer, deep/superficial. These are so relational that it gets tricky when we aim to describe more than 2 layers, such as ‘superficial,’ ‘deep,’ ‘deep investing’ fascia.

Directionality in treatment

The kind of work we do, the kind of work we teach, has a strong emphasis directionality. That is: when there is a limitation in movement or function, it has a quality of directionality to it. Myofascia is not simply “short” or “long”, but they are short or long in a particular direction. Being able to identify this directionality gives us key information for how we treat the tissue.

Ida Rolf is remembered for saying: “Put it where you want it to go, and call for movement.” Putting something where you want it to go involves at least 2 ideas: it is not where it should be, and to make a correction, we can change its position. This is easy to imagine with fascial work, which has its felt qualities of hold and resistance to mobilization.

In Myofascial Balancing, we consistently assess for shear patterns across the tissue or the joint or bony position. When a 3D tract of tissue or segment has a distortion in it, it will have an “easy way” and a “hard way” that it likes (or doesn’t like) to move. The easy way is indicative of the shear pattern that currently exists; the hard way is indicative of the direction that would ‘neutralize’ the shear (take it to neutral).

The directionality of the easy way is called “indirect”; the directionality of the hard way is called “direct.” These same terms are used for the way the fluid body holds directional distortions: into the pattern = indirect; away from the pattern or toward neutral = direct. (This language is used to describe patterns as well as corrective techniques.) The feeling of moving tissue or fluids ‘indirectly’ is one of ease, of melting, of going with the system. The feeling of moving tissue or fluids ‘directly’ is one of meeting resistance, a stop or catch, of challenging the system out of its current mode. What is lovely: both ways generate change!

We can use an analogy from sailing: another way that humans travel with the forces of nature. When describing location in relation to the wind, we have ‘windward’ and ‘leeward.’ Windward means facing the wind, ‘into’ the wind — this takes more energy and effort. Leeward is sheltered from the wind, ‘away’ from the wind — as the Irish blessing would imply, this takes less energy or effort. Travel well!

May the road rise up to meet you,
May the wind be always at your back,
May the sun shine warm upon your face,
The rains fall soft upon your fields.
And until we meet again,
May God hold you in the palm of His hand.


See my next post for a poem about being lost and found.