The developer of functional technique, HV Hoover, explained the essence of this approach in the words of the founder of osteopathy, Andrew Taylor Still: ‘I am doing what the body tells me to do’.
Hoover (1969) asks the beginner to perform the following three ‘experiments’, grouped together in Exercise 8.8. In each case a question is posed, the answer to each being ‘yes’.
Your answers will tell you whether you are ready to use this method – whether you have achieved palpatory literacy.
EXERCISE 8.8: HOOVER'S CLAVICLE PALPATION Time suggested: 20–30 minutes
8.8A
Question 1 : Does the clavicle move in a definite and predictable manner, when demands are made upon it by definite movements of an adjacent part?
Stand facing your seated palpation partner and place the pads of the (relaxed) fingers of your right hand lightly over the right clavicle, just feeling the skin overlaying it (see Fig. 8.2). This hand is the listening hand. It is there to evaluate what happens.
With your left hand, hold the right arm close to the elbow (this is your motor or moving hand).
Your partner must be relaxed, passive and cooperative, not helping or hindering the introduction of movements by your motive hand.
The listening hand should barely touch the skin, no pressure at all being applied to the clavicle.
Raise and lower the arm slowly, several times, until you are certain that it is relaxed, that you have the weight of the arm without assistance. The exercise can now begin.
Slowly take the arm backwards from the midline, introducing shoulder extension, just far enough to sense a change in the tissues under the palpating hand. Then return the arm to its starting position.
Do not move quickly or jerk the arm, so ensuring that the sensations being picked up by both the motive and the listening hand are accurate.
Repeat this several times, slowly, so that you become aware of the effect of a single, simple, movement (remember the question you are asking your partner’s body).
Now take the arm forward of the midline (shoulder flexion) and again assess the effect on the palpated tissues (clavicle and surrounding tissue).
Subsequently, in no particular sequence, abduct and then adduct the arm; rotate the arm externally and subsequently internally, each time slowly and if necessary repeatedly, each time noting the tissue response to a single direction of movement.
What response was noted to each of these single physiological movements?
Remember this was not an exercise in which you were meant to compare the effect of one movement with another (that comes next), but a time to evaluate what effect single movements produced, as perceived by your palpating hand and also by the motive hand.
Fig 8.2 Assessing positions of the arm which induce ease or bind at the acromioclavicular joint (after Hoover 1969).
Revisit Exercises 5.16A and B, where you evaluated the feeling of resistance as you moved the leg into abduction, as well as the palpated feeling of ‘bind’ in the medial hamstrings and other adductors.
8.8B
Question 2 : Are there differences in ease of motion, and feeling of ease and bind in the tissues associated with this clavicle, when it is caused to move in different physiological motions?
Follow the same starting procedure until the exercise proper begins (i.e. ensure a relaxed, supported arm, with your palpating contact in place).
Move the arm backwards into extension very slowly, as you palpate the changes in the tissues around the clavicle.
Compare the feeling of the tissues when this is done with what happens as you take the arm into flexion, bringing it forwards.
Now compare the feelings in the listening hand as you abduct and then adduct the arm, slowly, deliberately, gently.
Compare the tissue changes (ease/bind) as you first internally and then externally rotate the arm.
Did there appear to be directions of motion which produced enhanced feelings of ease in the tissues? What were they?
8.8C
Question 3 : Can the differences of ease of motion, and tissue texture, be altered by moving the clavicle in certain ways?
Repeat the introductory steps up until the exercise proper begins.
Flex the patient’s arm, bringing it forward of the midline, slowly and gently until you note the clavicle moving or the tissue texture under your palpating hand changing. Stop at that point.
Now extend the arm backwards from the midline, slowly and gently until you note the clavicle moving or the tissue texture under the palpating hand changing. Stop at that point.
Find a point of balance between these two states, a point of balance from which movement, in any direction, causes the clavicle to move, along with a change in tissue texture.
Hold this point of physiological balance, which Hoover called ‘dynamic neutral’. Starting from this first position of ease, you should next find the point of balance between adduction and abduction.
Once this has been established you will have found a combined position of ease between flexion and extension, as well as adduction and abduction.
Starting from this combined ease position you should then move on to find the point of balance between internal and external rotation.
You will then have achieved a state of reciprocal balance between the arm and the clavicle.
From here Hoover leads you to another important finding.
8.8D
Holding the arm and clavicle in reciprocal balance, dynamic neutral, as at the end of 8.8C above, test to see whether any of the six physiological motions (flexion/extension/adduction/abduction/internal and external rotation, as in 8.8B), on its own, gives a sensation of improved tissue texture, compared with the other physiological motions.
One of the directions may be found which does not increase bind or which increases ease more than the others.
Having found this motion, slowly and gently continue to repeat it for as long as the sensory hand continues to report that tissue conditions, motion of the clavicle, are gaining in ease.
Should bind begin to be noted as this is done, Hoover suggests that the various directions of motion should all be rechecked, to find that which introduces the most ease. If none do, then stop at this point, noting what it is that you have been feeling.
If a further direction of motion producing ease is found, this is repeated until bind seems to occur again.
Repeat the retesting procedure of all the directions of motion.
Hoover says:
This process of finding the easy physiological motion, and following it until bind starts, and then rechecking, may go on through two or more processes, until a state of equilibrium is found from which tissue texture indicates ease in all [directions of] physiological motion.
8.8E
In order to perform this final part of Hoover’s experiment, the untreated, opposite clavicle should be taken through stages 8.8A, B
and C.
When you have reached a reciprocal balance between arm and clavicle, reliance is placed on the tissues to ‘tell’ you what movements are required by it to achieve maximum ease.
You need to relax and become entirely passive as the sensory (or listening) hand detects any change in the clavicle and its surrounding tissues. Such a change if felt by the listening hand, sends the information to the reflex centres, which relay an order to the motor hand to move the arm so as to maintain the reciprocal balance or neutral. If this is the appropriate move, there will be a feeling of increasing ease of motion and improved tissue texture.
This process continues through one or more motions until the state of maximum ease or quiet is attained.
This is a process known as fascial unwinding, which is the natural culmination of functional technique when patiently applied.
This functional palpation/treatment approach can be employed, with the addition of translation motions, for any extremity or spinal joint, as a means of identifying directions of ease and bind.
EXERCISE 8.9: COMBINED FUNCTIONAL AND SCS PALPATION OF ATLANTOOCCIPITAL JOINT Time suggested: 10–15 minutes
8.9A
Your palpation partner is supine. You sit at the head of the table, slightly to one side, so that you are facing the corner. One hand (your caudal hand) cradles the occiput, with opposed index finger and thumb palpating the soft tissues adjacent to the atlas. The other hand is placed on the forehead or the crown of the head.
The caudal hand assesses for feelings of ‘ease’, ‘comfort’ or ‘release’ in the tissues surrounding the atlas, as the hand on the head directs it into a compound series of motions, one at a time.
As each motion is ‘tested’, a position is identified where the tissues feel at their most relaxed or easy. This position of the head is used as the starting point for the next element in the sequence of assessment.
In no particular order (apart from the first movements into flexion and extension) the following directions of motion are tested, seeking always the position of the head and neck which elicits the greatest degree of ease in the tissues around the atlas, to
‘stack’ onto the previously identified positions of ease:
flexion/extension (suggested as the first directions of the sequence) side bending left and right
rotation left and right
anteroposterior translation (shunt, shift) side-to-side translation
compression/traction.
Once three-dimensional equilibrium has been ascertained (known as dynamic neutral) in which a compound series of ease positions have been ‘stacked’, the person is asked to inhale and exhale fully, to identify which stage of the breathing cycle enhances the sense of palpated ‘ease’, and then to hold the breath in that phase of the cycle for
10 seconds or so.
The final combined position of ease is held for 90 seconds before slowlyreturning to neutral.
Note that the sequence in which directions of movements are assessed is not relevant, providing as many variables as possible are employed in seeking the combined position of ease.
This held position of ease is thought to allow neural resetting to occur, reducing muscular tension, and also to encourage improved circulation and drainage through previously tense and possibly ischaemic or congested tissues.
8.9B
With your palpation partner lying supine and with you seated at the head of the table, palpate the tissues around the atlantooccipital joint, using drag palpation, and locate what you consider to be the area of greatest sensitivity/tenderness.
Apply a single-digit pressure to this sensitive area, sufficient to evoke a reported score of ‘10’ on the pain scale (where 10 = marked discomfort and 0 = no pain).
Maintain this pressure as you carefully reposition (fine-tune) the head and neck, in order to reduce the pain score to 3 or less.
The most likely position to ease reported pain of this sort is slight extension, followed by slight side bending toward, and slight rotation away from, the painful point.
If such a combination is not effective, fine-tune until you identify the head/neck position which reduces the score most.
Once you have established this position of ease, hold it for 90 seconds and then, on release, repalpate to see whether the tissues are less sensitive.
Pay particular attention to the final position of ease and decide whether it is in any way similar to the final position achieved when you sequentially stacked positions of ease, in Exercise 8.9A.
This exercise offers you the chance to explore the two major methods of positional release technique and also gives you a very useful method for easing distressed tissues in this sensitive and vulnerable area.
Conclusion
The exercise in this chapter are extremely important. They are elegant in their objectives (to locate comfort/ease/balance), apparently simple and yet demanding of intense focus.
They also represent, as clearly as it is possible, the objective of a seamless transition from assessment to treatment. This is so because once the point of optimal ease has been identified, for as long as this is held, self-generated, homeostatic, normalisation processes are operating. The tissues take advantage of being held in a state of ease to commence normalisation, of circulation, neural status, tone. Everything negative that is taking place when tissues are tense and contracted (increased pain perception, ischaemia, drainage impairment, mechanical and chemical irritation, etc.) is put into reverse. So finding the point of ‘ease’ by palpation is the task of the practitioner, while using that position advantageously is the prerogative of the body itself.
If these concepts excite you then you are urged to investigate further by studying the practice of positional release (Chaitow 2002, D’Ambrogio & Roth 1997, Deig 2001).
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