A central element in the work we do is identifying the location, direction, and degree of restrictions. Here, I want to consider some of the ways we might keep the question of location awake in our practices.
I recall being introduced, many years ago, to the exercise of pulling on a sheet (on a massage table) that had small weights placed on it, trying to identify the location of the weights by the drag on the sheet.(Ever notice how often we work with eyes closed?) Clients, of course, are three-dimensional—but this exercise has serious real-world relevance. When I pull, for example, on a client’s feet, I can feel the degree of restriction in the sacrum and low back. And as I continue to meet the restriction, I begin to change it.
In my everyday practice, I use weight-bearing palpation to identify the pattern of segmental balance in the body. Depending on how I palpate, I may also begin to feel restrictions, or I may just identify “areas of interest” to be explored once the client is on the table. For me, it has become normal to move tissue in its fiber direction (grain) to feel the quality and degree of available movement. There’s a 3-D perception involved that I often call “sonar” for lack of a better word. We pull on tissue and feel how the tissue pulls back. As we subtly change the direction of our pull, we get more feedback from the body, and this creates an “image” of the restriction. This is one of the essential skills in bodywork.
This same skill can show up in other contexts. For example, if I do a passive range of motion test, do I simply note how far a limb moves, or do I also register the location of the restriction that stops the movement?
Manual therapists of all kinds develop this skill with experience. And it's not just about evaluation, but also treatment. As we like to say, "If you can feel it, you can move it." The big question, for me, is: how can we be as clear as possible about our method, so that we can deliberately and consciously refine this skill?