Joint Motility

The following document, "Joint Motility: Discoveries, Techniques, & Explanations," is the intellectual property of Elizabeth Gaggini. Any part of or the whole of this document may only be copied or electronically transmitted for the purpose of consideration for publication in Rolf Institute Journal Rolf Lines. Any other reproduction, electronic transmission or use in any manner of any part or the whole of this document must have the express written approval of Elizabeth Gaggini. This statement must be attached to all reproductions or electronic transmissions of any parts or the whole of this document.
Author
Translator
Pages: 8-15
Year: 1996
Dr. Ida Rolf Institute

ROLF LINES, Vol XXIV nº 03 August 1996

Volume: 24
The following document, "Joint Motility: Discoveries, Techniques, & Explanations," is the intellectual property of Elizabeth Gaggini. Any part of or the whole of this document may only be copied or electronically transmitted for the purpose of consideration for publication in Rolf Institute Journal Rolf Lines. Any other reproduction, electronic transmission or use in any manner of any part or the whole of this document must have the express written approval of Elizabeth Gaggini. This statement must be attached to all reproductions or electronic transmissions of any parts or the whole of this document.

What is Motility?

Many Rolfers have begun to talk about working with motility. I was first introduced to the term motility in visceral trainings with the Up ledger Institute and again in my Advanced training in 1993. I believe the phenomenal of motility is also what I had been exploring as “unwinding” since my pre Rolfing days doing craniosacral work. Motility has been defined by Jean Pierre Banal in his first volume on visceral manipulation as “intrinsic motion.” The dictionary defines motility simply as “spontaneous motion.”

In his March 1995 Rolf Lines article on states of consciousness, Michael Salveson defined motility very inclusively as “The small, autonomous motions and flows, the streaming and pulsation that characterize much of our inner sensation…” Recently, other Rolfers have made similar broad extrapolations, characterizing many inner sensations, energetic experiences and the processes of consciousness as motility. In a posting on the electronic Rolf forum Anngwyn St. Just, quoting from a paper co written with Darrell Sanchez, speculate’s, “If we conceive of mobility as finite movement, motility can be thought of as non finite and continuous motion. The idea of embodying non finite motion also implies embodying infinite motion, and the potential for experiencing ourselves within a continuum of unending motion which is as vast as the universe itself.” And in the same forum, Bill Smythe explained motility metaphorically, saying, “In essence the whole human organism is like an `ocean’ with its various array of living creatures seeking, their own impulse or life expression.” The capacity to be self aware of intrinsic, non-cortical, spontaneous activity, as of similar events in our waking and dream consciousness, is a welcome frontier in our exploration of life’s potential. These notions combine well with Jeff Maitland’s discussion of the allowing core and the willing surface in his book Spacious Body.

From this visionary perch I am driven back to the ground of my Rolling office. I have learned in my Buddhist practice that vision works better when it must wrestle with practicality. Every thing that we can imagine must someday play itself out in the physical world or it disappears. This is what I like about Rolling. It presents the opportunity to find in matter that which we are imagining to be true about life. This is where I would like to begin this discussion of motility-in the earth of the body and trusting the experience that is to be had under the hands, yet, with the curiosity of implications and the spaciousness of unanswered questions keeping me afloat.

Motility at the Joints

The first distinction to be made is between the spontaneous motion of motility and the voluntary movements produced by muscles. At an organ, motility is felt as the “to and fro” gliding of each organ independent of any voluntary or physiologic motion, including respiration, peristalsis, blood circulation, and possibly the cranio sacral rhythm. It is my position with this paper that this same type of intrinsic and spontaneous gliding can be detected at the joints, also independent of voluntary or physiologic actions.

If you read Barral’s first volume you will see that he has gone to great laboratory lengths to try to instrumentally verify motility and yet, he finds himself with this conclusion: “We have no scientific explanation for the phenomenon and are aware of it only from experience.” As Rolfers we can sympathize. The same is true for the phenomenon of motility at the joints. Michael Salveson ventured into joint motility in his presentation on the knee at the 1995 Annual Meeting. Here, in greater inclusion, he considered the actively introduced action of joint play as an example of motility. He also used the term “unwinding” as synonymous with the therapeutic result of manipulating motility. At this time I do not consider joint play to be an example of motility. However, the generic treatment of the phenomenon of unwinding, with which many of us are familiar, opens up many more possibilities of our using motility in furthering integration at the joints. I mention unwinding at this point to relate working with motility to previous experience with this motion, and, also to indicate that motility is the field in which we play when we do “indirect work.”

Motility at a joint is the bony surfaces spontaneously gliding through the ligamentously available planes of motion for that joint. It can be described in terms of amplitude and quality. In a healthy joint, the unassisted articulating bony structures of the joint will move in relation to one another in some slight length along all of the natural planes of motion. For example, a vertebra will move in rotation, in side bending and in flexion and extension in relation to the vertebrae above and below it. In a healthy joint the motion of motility will have a feeling of being of equal strength and speed (amplitude) in each of the paired directions (rotation to the right and left for instance, are one pair), and will have a quality of undisturbed glide curving to match the shape of the anatomically given articulating surfaces. I call this quality symmetry or balance.

The range of motility is limited by the anatomical structure of the ligaments. What joint motility ultimately tells us about is the condition of the ligamentous tissues. Working in the field of motility provides us with a way of making corrections at the level of the ligaments for improved structural integration. Simply put, if the ligamentous layer is distorting the shape of the joint, the lines of transmission through that joint will be similarly distorted.

“The deep ligamentous structure of joints mirrors the state of more superficial members. The chemistry and physics of both levels are determined by the way the joint moves within the force field of gravity.”
Dr. Rolf

By accessing the force and pattern of motility (see the palpation exercise described below) we have the opportunity to assess the lines of strains though the joint and to correct restrictions in the myofascial fibers of the ligaments. The essential thing to remember in using motility is that restriction lies at the end point of the direction toward which there is the most excursional ease. The pattern of motility is pulled toward the pathological shortness. For example, if in assessing a knee joint, the most easy, largest and/or prominent motion that is made in the motility pattern is a left side bend, the shortness of first importance is in the ligaments that lie on the left. These ligaments would have to elongate to allow a neutral position or right side bending. This can get more complex when imbalances are discovered in several planes of motion. However, as I will detail later on, using motility we have a choice of assessing and treating one restriction at a time or several at once.

The existence of fascial restrictions in the non ligamentous soft tissues around the joints can inhibit the action of motility. Before using indirect techniques to correct ligamentous imbalances discovered in the motility pattern, we need to be sure to have balanced the extrinsic fasciae that are affecting a joint’s alignment. If I discover an imbalance while working indirectly, I will often switch out of the indirect technique and check the extrinsic structures to see if the fixation that is preventing balanced motility can be corrected there. Often making this type of correction first corrects the more gross disturbances found in the initial listening at the joint. Returning to sensing the joint’s motility, I often find more subtle indications of a remaining fixation in the ligaments that can then be addressed with indirect techniques. While sensing restrictions in the joint using indirect techniques, we can “end feel” through the structure and discover wider perimeters for that restriction. This can tell us about patterns of restrictions in extrinsic fasciae as well as about restrictions that might be echoed in the ligamentous tissues of other joints.

It would be rare indeed to find a major strain pattern in the ligaments that was not carried into the extrinsic fasciae and rare to find extrinsic strain patterns that had not affected the ligamentous layer. Working with motility does not throw standard Rolfing out the door. It is also not a guarantee of safety. We have the opportunity to create fixations and distort joints while working indirectly (just ask anyone who has done a lot of cranial work). In working with motility, we must understand the interventions we are using, and we must be aware of the actual anatomical patterns of the joints’ soft tissues and the shapes of their bony surfaces.

We are beginning to understand the interface of motility and the presence of integrated function in the structure. Often this understanding has surfaced in discussions of whether motility precedes mobility. That is, must there be the function of intrinsic motion present for movement to occur. I can offer a few clinical observations. I have seen persons with enough mobility to walk into my office who have no motility that I can sense at one of their knee joints. However, in watching their gate closely they appear to be walking around the knee joint rather than through it. There is limited activity of flexion and extension in the knee but these motions mostly occur when the joint is not weighted. In this case the leg is hauled forward and back by extra exertion and movement at the hip, ankle and foot. Some change in this functional pattern happens with direct work on the extrinsic fasciae from the hip through the foot. However, if I also do indirect work at the joints, particularly the knee, there is a great functional shift toward movement that includes the action of walking through the knee, and there is greater mobility at the knee when weighted. Therefore, I would say that the lack of motility does not completely preclude mobility. What mobility that exists, however, seems to be of greater strain, rigidity, and caution. It would appear that the presence of motility enhances the quality of mobility, making it easier, fuller and more dynamic.

“…the moving orders do not come from some mysterious ‘gravity’ acting in some mysterious way from the center of the Earth or the center of the Sun. Instead, the moving orders come from the geometry of space and time right where [we] are located … We only have to remove the soil to be left in a condition of free float.”
John Archibald Wheeler

What’s Gravity Got to go With It

While Barral has said that there are no scientific explanations for motility, he speculates about an etiology in embryologic formations and in the cranio sacral rhythm. I have begun to wonder about motility being an expression of our living in the gravitational field. I have long had an interest in examining the real world significance of Einstein’s theories. I find in his explanation of gravity a possible description for what we are encountering with joint motility. I am not going to extrapolate relativity and quantum theory into metaphysics. For this discussion, I intend to stay in the tissues. The description of gravity provided in relativity theory is very applicable to general Rolfing principles. I will only briefly cover that here and hopefully leave you with enough understanding of Einstein’s view of gravity for you to carry it along other pathways of structural integration for yourselves.

Einstein’s description of what he called “geometric gravity” is the accepted description of gravity in physics today. It was the starting point for his general theory of relativity and is its keystone. As we all know, Einstein’s lasting contribution to the progress of science was to look at the world from a relative perspective. That is, to see the occurrence of events as inclusive of, not separate from, and relative to any subject of the event. Newton’s descriptions of gravitational force appear true only when events are viewed from a distance. At the locality where the events occur, the gravity of relativity physics is evident. With gravity, it appears from a distance as if there is a force which pulls and holds objects to the earth. Within an object, gravity is not a force pulling down, but a motion of free float that is being interrupted by the earth. This is important to Rolfers because we deal with the experience of structural integration where it is occurring, that is, within the client’s structure. This is why Dr. Rolf’s description of lift and span in the integrated body make sense with her insights about gravity being the therapist.

It is not a mistake that we can locate the strongest sensations of intrinsic anatomical motility in the viscera and around the joints. This is where we have the most material for float. It is here that we have structured spans and fluid filled spaces. The motion of the organs and the joints, prescribed by their ligamentous boundaries, are excursions, explorations if you will, into space. Via the proprioceptive mechanoreceptors in the ligaments, we are given information about the status of our float or, in Rolfing terms, about the status of our lift. Restrictions to motility may be local stoppings of free float. In the healthy joint these ligamentous boundaries, or stoppings, are engineered for the best possible balance, i.e., float, of the entire structure. When these stoppings are pathological, the balance, i.e., float, of the entire structure is no longer optimal. It will appear from a distance that the body is surrendering to the pull of gravity. It will be experienced locally that we have lost of our lift.

Dr. Rolf, in Rolfing: The Integration of Human Structures, made several references to the relationship between the human form and the gravitational field in energetic terms. Here is one such reference:

“…any mirror or photograph would reveal that a great many problems are matters of structure, of physics of a three-dimensional body fitting very badly into a greater material universe (the earth), which has its own energy field (gravity). Help must be sought in the terms of the problem in the physics of the spatial relations, of man in his environment, of man as a hole in the energy field of the earth, gravity. And help can be found. The war within can end in a lasting peace.” p.17

Rolfers often describe intrinsic spontaneous motions in energetic terms. There is a possibility that the energetic expression that is gravity could be a factor in the activity of motility at the joints. When we can begin to hold the view that gravity is not a force but a motion, we may be better able to conceive of the human being as an energetic pattern of expression rather than as a stack of parts in a soft machine. The inclusion of specified and understood interactions with motility in our Rolfing work can begin to transform our metaphors, be they energetic, oceanic or infinite, into practical and real contributions to the evolution of life’s potential.

“In a class that my friend and colleague, Dr. Peter Levine, and I taught together in Denmark in 1909, we creatively defined motility as “floatility” as a way of giving expression to what many of our students said was their felt sense.”
Bill Smythe

PRACTICAL APPLICATIONS

Palpating Joint Motility-An Exercise

Motility can be detected at all joints. Cartilaginous joints such as the pubic symphysis or the vertebral column just have smaller excursions of motion than the more mobile synovial joints. Two of the easiest places that I have found to palpate joint motility are at the knee and at one of the thoracic vertebrae. Pick what you believe to be a fairly functional joint (and not one of your own) for this exercise. You should probably be seated because you are going to want to remain still and stable for some time. In the case of the knee, wrap each hand around either side of the joint at the femoral and tibia] condyles, avoiding the fibial head. The palms of your hands should be in good contact with the anterior surface of their respective bones. You are in position to begin sensing the joint’s motility. Your contact should be just firm enough to sense through the superficial fasciae but not so firm as to interfere with your ability to sense slight motions. For the thoracic vertebra, place your index fingers or thumbs on either side on the posterior surface of the transverse processes. Your quality of touch should be as with the knee. You will be sensing for motility at the joints above and below the vertebra you have chosen, though, it may seem as if you are sensing the motility of the vertebra.

Next, you will want to stay sensorially engaged and “manipulatively” disengaged and “listen” for the intrinsic motion of the joint. Those of you familiar with cranio sacral touch will probably need to increase the strength of your contacts lightly from that of the cranial technique to filter out the cranio sacral rhythm. You will begin to sense a movement of the bone(s) with respect to its neighbor(s). There is nothing definite to say about the speed of the motion as it varies, but, over all we could say that it is slow. I could say that it is about the speed of a small ant crawling across the floor but I don’t know how fast the ants move in your neck of the woods. At some point the motion will change direction. It can go still for several seconds but it will start up again. If you follow along for several rotations of the motion you will begin to perceive a pattern to the motility. If the joint (joints in the case of the vertebra) is healthy, the pattern will express all of the possible paired planes of motion (left and right rotation being one pair) in relatively equal speed and strength of excursion. What is important is to get a sense of the overall pattern of the motility. What is the length and amplitude of motion in all of the directions that there is motion? Is there any direction in which there is no motion? Is there a quality of hesitation or even friction along one of the pathways? Remove your hands and then come back again. Is the pattern of motility the same? If you change the quality of your touch, is there a corresponding change in the pattern?

If you are having trouble palpating the motion, pull your hands away and try a different amount of pressure. Bill Smythe has suggested that the touch should be one of “equal meeting” rather than merging. He has also said, “An essential component of tracking, observing, or palpating motility in a client is that the practitioner must be aware of his/her own motility.” I often experience a sense of relative spatial shift in my perception of the motion. That is, in my mind’s hands, the motion, while staying true to pattern and speed, feels quite a bit bigger than the anatomical joints actually allows. (This would indicate that some shift in state of consciousness might be helpful.) It comes in handy when listening to cartilaginous joints and the smaller joints of the hands, feet and face. You still have to figure out how to get your fingers on either side of them, however.

Specific Indirect Techniques

In understanding how to work with joint motility, what we have been calling “indirect work” or, in the vernacular “going indirect” and “unwinding,” can benefit from some further clarification. I hope that the definitions and descriptions that follow can begin a more discriminating language about what we are experiencing in our indirect interventions.

Induction

The primary indirect technique is known in osteopathy as induction or, at times, facilitation. To use induction with joint motility, after sensing the whole pattern of motility we would follow the largest and most undisturbed motion in the pattern to its end point, the point of greatest excursion, and hold there. We may sense motion further along this line. We would follow this, as well, to its end point and hold. We continue working in this way, holding against any motion in the reverse and, in the strictest sense of induction, following any motion that continues along the same line. We might be tempted to try to push in the opposite direction along a line of less or excursion. Barral warns against this, considering it to be allopathic and an act of aggression against the body. Up ledger counsels its use with the slightest of intrusion in hopes of finding greater success when returning to the induction technique. Barral will also surrender to a judicious direct entree toward a restriction when all else fails.

We end the induction manipulation when we get no further voluntary excursion along the line we are following. My experience of completion is that the primary direction of motion in no longer significant. It no longer has any push or vitality. We can withdraw from the process at this time, allowing the joint to return to its motility pattern. Then, listening again to the pattern, if we still find asymmetry, we can follow the line of greatest ease (which could be the same one or different) repeating the induction technique until the entire pattern of motility achieves symmetry.

Unwinding

There is the possibility that from the point of greatest excursion the motion will continue in a completely different directional line. In the strictest sense of induction, these variant directions of motion would be ignored while waiting for a further same-line motion as above. If, however, we follow the excursion in a new direction we will have another indirect technique, one that I call unwinding. For example, at a knee we may have been tracking a left side bend as the greatest motion. We hold at the end point of this left side bending and then, instead of continuing further in that line, the motion may turn and go into flexion, extension, or rotation. We can follow this new motion to its end and hold, waiting for the next motion either further along this line or in some new direction. We are always allowing the knee joint to choose its direction, with one exception. We would not follow a motion that directly back tracks the most recent line of excursion. This is the one we are holding against when we stop at the point of greatest excursion.

The end of the manipulation in unwinding is often experienced as a “relaxation” in the entire joint. Descriptions of this relaxation will very. My experience is that, in addition to the latest direction of motion no longer having any push or vitality, no new motion presents itself, and a general sense of greater span or space comes into the joint (or joints above and below in the case of the vertebrae). Releasing involvement and listening again to the pattern of motility, there is most often a high amount of symmetry and balance.

The difference in application of the techniques of induction and unwinding is, that with induction, we would not follow the motions that shift direction, and with unwinding, we would. Both ways of working have their value and differing situations of application. I have found with highly traumatized joints or cases of general systemic caution that induction is at first and sometimes continually the only technique that brings results. In these cases, very often, same line motion is the only type of motion that the joint will present. I find myself following several cycles of differing same line releases to achieve the result of whole joint span and balance. In unwinding, when we are following different-line motions as they are presented, we are essentially stacking several same-line excursions in one manipulation. If it is available, it is more efficient to follow multi-directional motions with the unwinding technique.

Direct-Indirect

When there are severe restrictions that aren’t being freed using the methods above, there is an effective technique that can be used. Barral calls this a direct technique. Because it is entered through sensing motility, as Rolfers we could include it in our catalogue of indirect techniques, reserving the term direct for our more forceful pressures on the connective tissue matrix. Michael Salveson refers to this method as “bossy indirect,” I believe, borrowing the term from Georgette Delvaux. To initiate this direct-indirect technique begin as with induction. At the barrier, make a few light thrusts along the line of excursion. This light intrusion feels to me like a slight rocking into the restriction. It essentially takes the restriction further into itself. Then, holding at the barrier to see if any further same-line motion occurs, we carry on as in the induction technique, releasing when we get no further excursion. We should also release if no new motion occurs after our thrusts. After releasing, reevaluate the motility pattern. Generally, some good line of motion immediately appears in the pattern of motility that then can be further processed with induction or unwinding techniques. I have found this direct-indirect technique most helpful when very little ease of motion is detectable in any potential part of the motility pattern or when the pattern is continues to skew in the same direction after repeated application of the induction technique.

Other Phenomena

At the end point of the in direct work, when a symmetry or balance of the joint’s motility can be sensed, other phenomenon can be described. Salveson has talked about a full pulsation in the joint that he associates with the return of chi to the area and he encourages further facilitation of this pulsing. When release occurs and general symmetry returns to a joint’s motility, I often observe parasympathetic activation in the entire system. This parasympathetic phenomena is part of a general autonomic pattern that includes sympathetic arousal during the induction and unwinding techniques. This would indicate that greater patterns of trauma are being touched, if not resolved, in working with joints in this way. For further speculation about autonomic and trauma resolution phenomena I suggest a look at Bill Smythe’s, Anqwyn St. Just’s, Darrell Sanchez’s and Peter Levine’s work and at John Up ledger?s descriptions of somato emotional release, energy cysts and unwinding.

Many Rolfers describe experiences of larger patterns of motility in the body that they have worked with indirectly. The large fascial sheaths, septa between muscle groups, periostium, etc. have, at their points of contact with other structures, functional joints in the broadest sense of the term. (A joint is any place where two parts meet.) We may be sensing the motility of these joints. We often use the term glide to express the quality of motion around these structures. It could further structural integration to assess and intervene with the patterns of motility at these larger “joints”. We could, as well, consider exploring the motility at the joint between the whole body and the space around it. Might we find treatable fixations at this joint, as well?

Footnotes

1 Barral, Jean-Pierre & Mercier, Pierre. Visceral Manipulation, Eastland Press, Seattle, 1988.

2 Salveson, Michael. “The Evocation of Unique States of Consciousness as a Consequence of Somatic Practice,” Rolf Lines, March, 1995.

3 In March , 1996 there was a discussion about motility via Email on the electronic Rolforum. These statements were parts of longer messages that were both posted on 3/24/96. Anngwyn St. Just’s and Dar ell Sanchez’s article, “Relative Balance in an Unstable World: The Need for New Models of Trauma Education and Recovery” (1992) is available through the ERGOS INSTITUTE for SOMATIC EDUCATION (303) 6510500.

4 The tape, “A Rolfers Approach to the Knee Joint,” is available from Sounds True in Boulder.

5 Wheeler, John Archebald. A Journey into Gravity and Space time, Scientific American Library, N.Y., 1990. The geometry in “geometric gravity” refers to the general relativity understanding of four dimensional space which includes the dimension of time, thus being known as space time. Gravity is the manifestation of the curvature of space time around mass. Wheeler’s repeated “nut shell” for geometric gravity is, “Space time grips mass, telling it how to move and mass grips space time, telling it how to curve.” Newtonian formulas concerning mass and energy become reconciled as mom energy (momentum and energy) and are formulated in Einstein’s field equation, the Law of Geometro dynamics, which fostered the formulation of the big bang theory, the understanding of universal expansion, and an explanation of black holes.

6 Johansson, Hakan & Sjolander, Per. “Neurophysiology of the Joints” in Wright, Verna & Radin, Eric L. Mechanics of Human Joints, Marcel Decker, N.Y., 1993. For a very interesting and foundational discussion of the neuro sensory function of ligaments, I highly suggest, Brand, R.A. “Knee Ligaments: A New View,” Journal of Biomechanical Engineering, Vol. 108, May 1986, Pg. 106-109.

7 From a posting on the Electronic Rolf forum, March 26, 1969

8 Upledger, John & Vredevoogd, Jon D. Cranio sacral Therapy, Eastland Press, Seattle, 1983.[:de]What is Motility?

 

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