CAPA si_aug_1990

Technical Catalogue – IV

Pages: 37-39
Year: 1990
Notes on S.I

Notes on Structural Integration – August 1990 – 90/1

Volume: 90/1

The techniques are described outside the context of integrating the whole. They must not be used this way but only if properly indicated by that context. They can otherwise introduce disorder into the structure instead of order.

Lengthening of the Pectorals

With internals the shoulders are anterior and so the pectorals are generally primary short. This is accentuated on the right side. The right shoulder is usually more anterior and medial, drawn onto the thorax, than the left as part of the standard rotation of the body.

The method described is not very specific but more general. It is suited for making a little more room and space in the anterior wall of the axillary cavity prior to and facilitating more specific work which follows. I also use it in later stages to reestablish quickly length from the shoulders which is usually needed for organizing the costal arch and the abdominal wall down to the pubes.

The client lies supine on the table with his arm up. The axis of the upper arm is at 90° to the midline of the body, the elbow is flexed 90°. In this position the forearm is supinated. The legs down give a little stretch to the pectorals. With the legs up they are more relaxed and the axilla will be even more open during the move. I sit beside the client and the hand of my caudal arm goes up to the client’s wrist and lifts it so the forearm points straight up in the air, the elbow staying in place down in the mattress.

I place the tips of the fingers II-V of my other hand along the caudal edge of the clavicle at about its middle or a little more medial. The palm of this hand hangs low and almost rests on the pectoralis major. The thumb goes around the “package” and comes to lie on the lateral thoracic wall under it. I tend to use more the radial side of the thumb’s volar face because it senses more clearly and sharply. The thumb goes under the pectoralis major at about its free lateral edge and comes to lie as long as possible to the thoracic wall.

In this position the caput humeri is still anterior, and the pectoralis major and its tendon is stretched and pulled down over it. The space between pectoralis major and chest and caput humeri below is closed. Now I lift the arm a little with the hand holding the wrist, asking the client to relax arm and shoulder completely. Any holding is detected easily by sensing the weight of the arm. This manoeuvre lets the caput humeri fall back and slide out lateral. The pectoralis major is now free of the bone and the axillary space opens maximally in front.

The client’s forearm is pronated in this position. I bring it toward supination as far as is possible without any forcing before lifting. This brings back a little more the insertion of the pectoralis major and stretches it mildly. It also helps the shoulder to fall back and come out a little more.

The fingertips of my working hand below the clavicle ignore the pectoralis major. It is usually thin here, and often an edge can be felt which marks the upper border of the stronger pars sternalis. The fingertips are flat and feel as if glued to the fascia covering the upper ribs. Now I drop my wrist and pronate my arm. This results in traction on the fascia held by the fingertips. It should be light and as if only by the weigth of my arm. The pull is not so much caudal and away from the clavicle but more out along it in the direction of the slight tension induced by the client’s lifted arm.

The thumb follows the movement of my arm and hand and comes up in the direction of the clavicle along the thoracic wall almost automatically. It slides up, taking some tissue along until a sense of contact with the fingertips above and on the outside is established. Thumb and the tips of the other fingers now hold the pectoralis minor together from above and below, from outside and inside. Its tissue is gathered together between them but should not be compressed. The pectoralis major is out of the way as the lifted arm with the shoulder dropped back has opened the space between it and the pectoralis minor.

The wrist of my working hand is low so that if thumb and fingers are compared with pliers they are very flat and broad. The feeling is of them hanging on to the pectoralis minor, lifting it away from the thoracic wall and pulling slightly lateral tangential to it. With my other hand I take the client’s arm a little up and down, lift more and drop it some, and supinate and pronate slightly. This adds passive tension and relaxes again which allows the working hand to lengthen the pectoralis minor rhythmically. It arrives at the attachment to the coracoid process eventually. Here thumb and fingers touch practically where there is only the end of the tendon. The coracoid is freed some from the thoracic wall and coaxed farther lateral giving some more length to the pectoralis minor indirectly. The hand holding the client’s arm assures that the scapula does not only rotate externally by paying attention that it also shifts lateral and away from the spine in back.

It is often useful and necessary to lengthen and differentiate the pectoralis major first. The fingertips from above and the thumb from below then circle the pectoralis major and separate and lengthen the inner fascia facing the thoracic wall. This can go out over the coracoid process and beyond the caput humeri, from which the pectoralis major is free because of lifting the client’s arm in the fashion described. If the tendon of the pectoralis major is followed further out caution is necessary, however. Here the internal twisting of fascia and tendon must be respected.

When working on the attachment of the pectoralis minor the fingers slide behind its tendon. A certain degree of detachment of the shoulder girdle can be effected here by coaxing the scapula lateral via its coracoid process. Care must be taken that it is not just pushed back. My hand holding the client’s wrist helps this by fairly wide movements. When the area is already differentiated enough, the working hand can also create some space between coracoid and humerus, which are usually tightly bound together, again helped by moving the client’s arm appropriately.

The method is fairly effective and amazingly easy for the client in an area which is considered notoriously painful. This depends on the fingers staying soft and requires sensitivity also in the thumb. I usually settle the palm of my working hand on the humerus of the client which allows even finer monitoring. But it is not really the “working hand” which works much. It rather holds on while lengthening and organizing is effected by the movements of the client’s arm from which direction and degree of tension are controlled.

Hans Flury

Widening the Pelvic Floor of Externals on the Bench

The pelvic floor of regular externals is usually narrow as indicated by the distance between the tuberosities. One factor is probably the anterior pelvic shift. The tension in the front of the sleeve tends to pull the pelvis wide in front and let it collapse medially in back. Regular externals share this with locked-knee internals. Another seems to be the posterior pelvic tilt which also leads to a loss of tone in the back of the pelvic segment. This factor is shared by symmetrical externals. But most important seems to be the fact that regular externals rely more or less on compressional “support” in their lower girdle. The narrowness of the pelvic floor appears as proportional to the degree with which the compressional regime is in evidence. And lastly one has the impression that the constricted types are even narrower than the collapsed ones.

With regular externals it is of course a dominant theme for a whole basic series to produce a semblance of tensional balance and competence in the lower girdle structure. The method described cannot do that for the pelvic floor by itself. It is useful and can be repeated in various sessions to prepare the ground or, especially so, to secure gains made by the extensive work of a session.

The client sits on the bench with the feet in front of the knees and the legs in line. They may diverge laterally a little to make the move easier. The client is asked to lift his body up and off the bench by using his arms and hands to extend against it. This invariably results in a posterior convex midline of his body which does not matter at this point, however. I place my hands below his pelvis with their back on the bench. Now I ask the client to let the weight of his body come down on them slowly and completely. My hands receive it, and the fingers II-V are now on the inside of the bony pelvic ring, the inferior ramus of the os pubis and the ramus ossis ischii, on both sides. This is delicate and I tell the client so that he knows I’m aware of it. He is in the posterior tilt sitting position now. I ask him to turn only his pelvis anterior, keeping the upper body back. To make the tilting of the pelvis clearly segmental he should extend a little against the floor through his feet with the focus on the sitting bones which come back because of it. My hands help by pulling back the caudal rim of the pelvis from below but without sliding, i.e. they only assist the movement back and the sinking forward and down of the pelvic segment as a whole. If the upper body has been held back long enough, the client arrives in a “normal” posture with: the tuberosities and hip joints back, the front of the trunk elongated and convex, the back extended.

The movement is continued until the upper body is slanted at about 45° or less, depending on its structural possibilities. My hands feel when passive tissue tension in the pelvic floor which is pulled wide by it is optimal. When the forward movement goes too far, adaptations occur which defeat the purpose. The clearest indicator for this is when the tuberosities begin to lift off the bench. They should stay down and back. The knees should not go lateral.

The movement back is the phase in which the pelvic floor widens plastically. Success depends largely on the movement forward having maximally lenthened the midline and maintained optimal balance. The upper body moves back horizontally by extension against the floor. Special attention must be given as usual to the chest which must not be raised, the shoulder girdle which must not contract in back, and the head which must not participate actively in the movement. The client should have a sense of the thorax gliding back horizontally and being raised exclusively because of the passive resistance of the pelvis, which remains in its anterior tilt, on the bench below.

My hands on the bench with the fingers in the pelvic floor have a double function. Intersegmentally, they pull back a little the pelvic segment which wants to go forward so it is able to keep its anterior tilt. The client aids this by staying completely relaxed in his abdominal wall. More specifically, the fingers begin to slide back on the bone, “cleaning” it, and keeping the rami of both sides wide apart. They want to come together medially and give up the passive tension induced by the forward movement before. I imagine the rami of the ischium and the pubis forming a bony clamp or clip, similar to the mandibula. When it wants to “close” in relaxation, keeping it wide and open induces a plastic lenthening in its transverse dimension.

At the end, when the client arrives in the normal sitting position and settles the weight of his body completely down, my fingers are back on the inside of the ischial tuberosities, still holding the bones apart and back for a moment while the client lets his breath sink down to the bench.

It is useful sometimes to stop the client’s movement back at a certain moment. Then I ask him to let his knees come together, which widens his tuberosities some more, and I get a little additional “prestretch” in the pelvic floor.

Usually my hands don’t work symmetrically. Because of standard torsion the right tuberosity is more medial and posterior. It generally needs widening more while the left one must come back more. The thumbs of my hands are on the outside behind the hip joints and give me a more vivid sense of the torsion. I also use them to indicate to the pelvis that it should keep its anterior tilt while shifting back.

The move is delicate for both Rolfer and client, and optimizing the technique is beneficial for both. It is of course legitimate to protect one’s hands by something soft covering the bench. But in principle one should be able to do it on hard wood without damage to the hands. It is an indication of a false technique if this is not possible. When the weight of the client’s body comes down initially, I sense the back of my hands being pressed flat against and into the bench. I imagine my metacarpals as if made of rubber and being flattened by the weight. During the whole move there must be a feeling as if letting one’s hands be pressed into the bench and so making space for the pelvis to sink back and widen. The fingers “sticking up” must be as soft as possible.

Hans Flury

<img src=’https://novo.pedroprado.com.br/imgs/1990/1038-1.jpg’>
Fig.1 – Before and after pectoralis method on the right side only.

<img src=’https://novo.pedroprado.com.br/imgs/1990/1038-2.jpg’>
Fig.2 – Before and after widening the pelvic floor.

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