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Most manual therapists are given at least basic instruction on body mechanics in their courses. While the quality of this input varies a great deal, one recur- ring theme is the need to use bodyweight rather than muscular effort where possible. This is useful but insufficient. For instance, it fails to address the fact that transmitting the force of bodyweight through the upper extremity into a client’s body requires an equivalent amount of work to be done in stabilizing the shoulder joint and girdle. Otherwise we would lean into our work through our hands only to have our shoulders move in the opposite direction and ren- der the contact ineffective. Since this only happens to a small extent, it’s clear that we are stabilizing that joint, whether we are aware of it or not.

There are necessary additions to be made to this advice about gravity. Try working with the hip hinge as the primary axis of movement for lowering the bodyweight towards the client. At the same time, maintain an awareness of the sacrum and coccyx dropping down, away from the movement of the head, which is reaching forward. (For more information on the value of reaching in a specific direction, see below.) Bringing your weight forward in this way will contribute to an overall lengthening of the spine, with an associated opening of the chest, while working (Fig. 5.13).

Activating the hip, while allowing the coccyx to ‘reach’ in the opposite direction to the contact being made with the client, will enable the therapist to elongate the hamstrings, lengthen the front line of the trunk and maintain access to the diaphragm. Working in this manner means the therapist can be exploring internal space, stability and elongation during treatments! The same attitudes can be brought to work done from the seated position (Fig. 5.14).

This has to be better than getting locked into exaggerated thoracic kypho- sis, with accompanying internal rotation of the humeral heads, dropped clavi- cles, depression of the upper ribs, exaggerated cervical flexion with associated capital extension, a posterior pelvis, short hamstrings and disconnection from the feet and ground (Figs 5.15 & 5.16).

Figure 5.12

Correct: the thumb is protected from any strain

Try to get the pelvic and shoulder girdles facing in the same direction as much as possible. Too much counterrotation between the two girdles can cause facet joint pain and stiffness in the thoracic and lumbar spines, asymmet- rical muscle tone and even functional scoliosis – a surprisingly frequent set of problems brought on by the work of manual therapists.

Figure 5.14

Correct: seated position enables the same sense of support, direction

and span.

Figure 5.13

Correct: the hips are engaged as the major point of flexion while the spine is stable, elongating and dynamic.

Working from a position of support means much more than saving our bod- ies from excessive wear and tear. Doing direct technique MFR is about com- munication. When there is ease and balance in the body of the therapist, this is transmitted to the client as clear intention and a purposeful, responsive touch. This same attitude of economy of effort frees up energy for the therapist to feel, or in other ways sense, the variety of responses of the client to the input

Figure 5.16

Incorrect: loss of support and direction leads to shortening and collapse.

Figure 5.15

Incorrect: loss of support and direction leads to an overall shortening of the therapist’s body. Resting on the elbows forces the shoulders into the ears.

Try again but this time the person with the extended arm ‘reaches’ with their intention to a point on the wall behind you or even through the wall. In other words, they have a specific sense of direction rather than simply resist- ance. Generally, the pusher will find the arm much harder to push down while the reacher will feel much stronger and more stable (Fig. 5.18).

What is happening here? And how does this ‘Karate Kid’ energy stuff help us in our work? Although it’s beyond the scope of this book to fully explore the neurology of this cute parlor trick (some of you may have already come across it in schools of chi development and so on), it can be said that movement made with a sense of direction recruits the appropriate muscles but not their antago- nists. The first movement, where effort was made to resist the downward force, without any deliberate direction, generates a high degree of contraction in the agonist and the antagonists. The muscles work against each other and effec- tively weaken in a mistaken attempt to make stronger.

The Feldenkrais teacher Ruthy Alon suggests that these kinds of contrac- tions involve what she terms ‘parasitic’ muscles whose involvement we are not they are receiving. This dynamic feedback loop is at the heart of doing good therapy. Establishing a consistency in economical body use goes a long way toward cultivating this potential.

An experiment

Try this simple experiment. Stand beside a friend whose shoulder should be flexed to 90° with the elbow extended. Grasp their arm and attempt to push it toward the ground while asking them to resist (Fig. 5.17). Both persons should note the effort involved.

Figure 5.17

Stability attempted without direction.

usually aware of as they are habitual and not easily brought into awareness.1 These automatic subroutines are generally going on all the time and they inter- fere with many aspects of balanced tonus.2_{This is a shot-gun approach to mus-} cle contractions; getting everything to fire will certainly move something but without finesse. And with fatigue.

For therapists this has far-reaching consequences, if you’ll pardon the pun. As we do the various actions to explore the positions suggested above, we can add another dimension that will significantly diminish the effort we make as we work. It’s about direction rather than effort. If you work into the myo- fasciae of the hip triangle but think about reaching through that anatomic region into the table or through to the floor (or the center of the earth?), you add direction. The muscular effort will diminish while the effectiveness of your work will increase. While this can be hard to learn – the Protestant work ethic may have captured vast tracts of your nervous system – it can happen if you pay attention to it. Think direction rather than wrestling match.

The process of decompressing and releasing is a potential in the client’s body. The best way to activate it is to communicate with just the right amount of effortlessness. Zero effort and you have, perhaps, energy work, Reiki and the subtlest ends of the cranial spectrum. This might not be the agreement for ther- apy that you have made with your client. Too much effort and you can be goug- ing, ripping or thumping. This is probably not the agreement for therapy that you have with your client either. (Please, really, no ripping or thumping, ever.)

If you like this fun game then it can be developed in other ways. While stand- ing, and before making contact with the arms/fingers/elbows onto the client, find, clearly, the awareness of your feet. This is all about sensation – temperature, pressure and texture can each be contacted. Then extend this into an imagined sense of being supported at a point about a meter below you – or the center of

Figure 5.18

Stability with a deliberate sense of direction.

the earth if you have a good imagination – rather than at the floor and allow your imagination to take your awareness through to that point. The first time it may take a few seconds; subsequent visits take much less. Note the relative sense of support when contrasting this more deliberate direction-specific con- nection with your normal habit. One consistent feature of the sensation-rich approach to orienting against gravity is a sharp reduction in tiring patterns of muscular co-contraction.

For the technique driven this can appear to be a frivolous diversion from the real tasks of manual therapy. Of course, some people are blessed with a natu- rally flexible, robust nervous system. Many are not, though. I see many clini- cians who are fatigued from doing soft tissue work with a lot of over-exertion. A friend calls work like this white collar laboring. The burnout rate amongst the manual therapy laboring class is, regrettably, very high. Perhaps there’s a place here for the old ‘Work smarter, not harder’ maxim, given here with some hints that may allow it to integrate into your working days.

So … feeling tired or crunched in a session? Disconnected? Check and see if you’ve lost sensory awareness of your feet/hands/back/head. Orient to sen- sation and then add direction to feet/hands/back/head and see if this unwraps you without any big attempt to adopt correct form (remember the wasted effort made in the unbendable arm game).

I suspect that many of the really fine manual therapists who contact their clients across a spectrum of levels, from the energetic to the dense, are engaged with this type of low-effort, direction-specific contact. Milne describes his approach to cranial work in the beautifully titled ‘The Heart of Listening’.3_This book is rich in the kind of evocative imagery and metaphoric language that can shift us away from the hard yards of soft tissue slug fests in ‘resistant tis- sues’. One can see how this style of sensation-rich contact, married with a sense of direction, could lead us to a new appreciation of what it means to touch, work and listen at the same time. This kind of dynamic, of saying hello through touch and listening for the response, is central to what this book is about.