SOFT TISSUE THERAPY Spine

Figure 1: Clavicular angle elevated, pectoralis major muscle development larger, head tilted to left, shoulder higher

Figure 2: Elevated right shoulder, shortened dis- tance between the acromion process and cervical spine

The spine has natural curvatures these can become exaggerated in one direction or another and the client can present with postural condi- tions such as flat back, sway back, lor- dotic-kyphotic and scoliosis Scapulae Are there any height differences in the inferior angle? Do they rest flat against the upper back or is there “winging”? Shoulders Are they level or is one higher? Is the distance from the acromion process to the cervical spine the same? Arms How do they hang at the sides? Are they hanging close to the sides or sitting away from the body? Are the “windows” equal?

Head The head should not be tilted, retracted, rotated or forward. The eyes should stay on a level plane, vertically and horizontally, hence, a client can have an exacerbated spinal curvature but the head will adjust itself to compensate because of this tendency.

It is not always ideal to use this procedure but after doing it a few times an imaginary plumb line starts to take its place. Once adept with this procedure, practitioners can obtain information from clients during the history-taking section of the interview. A practitioner can observe for any of the above when a client walks into the room, while they are sitting in the chair or lying on the plinth without the inconvenience of having someone stand baring all and feeling uneasy and conspicuous. This will give a good baseline of information followed up by palpation through the hands.

USE THE EVIDENCE By using their skills and experience, a practitioner can work their way back and follow the evidence to the original source. Of course, it does not always follow the expected pathways. If it doesn’t resolve, keep asking questions, dig a bit deeper, refer and get advice as appropriate and mostly keep at it. There is nothing like the feeling of satisfaction when you are able to resolve some- thing that has been persistently elusive.

Postural assessment, as a tool, is essential. You need to develop 20

Figure 3: Head tilted, knee creases non- existent, feet show evidence of lapsed arches

col-

Figure 4: Hyperextended knees, plumb line too far forward of the mid line of the knee and lateral malleolus, kyphotic posture

it, along with other palpation and assessment skills, as it can help lead you to answers and give you valuable skills to improve your success rate and skills as a sports massage practitioner.

THE AUTHOR

Susan Findlay is the director of the North London School of Sports Massage. Originally from Canada, she has a BSc in nursing and has headed numerous health and fitness programmes in conjunction with GPs. She acquired her foundational understanding of posture and biomechanics after spending the first 22 years of her life as a classical dancer and competitor in gymnastics. Susan lectures on a range of courses at the NLSSM and LSSM. She also has a busy clin- ic in North London. To contact Susan you can go to www.nlssm.com or email at apply@nlssm.com.

References 1. Kuchera M. Postural considerations in coronal, horizontal and sagittal planes - in Ward R. Foundations for osteopathic medicine (second edi- tion). Lippincott, Williams & Wilkins 2003. ISBN:0781734975 2. Magee D. Orthopaedic physical assessment, fourth edition. Saunders 2002. ISBN 0721693520 3. Kendall, McCreary, Provance, Rodgers, Romani. Muscle testing; Function with posture and pain 2005(5):60-63,86-88

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