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Ligamentous Articular Strain: Osteopathic Manipulative Techniques for the Body
BOOK REVIEW
Book review Ligamentous Articular Strain: Osteopathic Manipulative Techniques for the Body Conrad Speece, William Thomas Crowe Eastland Press Seattle, 2001, ISBN 9 780939 616312 This remarkable little book (180 pages) contains a number of true clinical gems. The methods described as Ligamentous Articular Strain (LAS) techniques focus on areas outside the craniosacral axis, although they are based (in large part) on the original work of William G. Sutherland, the founder of Cranial Osteopathy. These methods were resurrected from the past by members of an informal osteopathic study group which met for many years, originally under the guidance of the legendary osteopath Rollin Becker, in Dallas, Texas. (The story of study groups as told by one of the authors of the book, William T. Crowe D.O., is to be found in this issue of JBMT.) The book traces the historical background of this dynamic, yet gentle, approach, starting with an overview of the concepts of both Sutherland and Andrew Taylor Still, Osteopathy’s founder. The selection of quotes from these two pioneers of manual medicine, and the conceptual insights they offer, are pertinent to the focus ........................................... Journal of Bodywork and Movement Therapies (2003) 7(1), 28^29 doi:10.1016/S1360-8592(02)00079-7 S1360-8592/03/$ - see front matter
of the book, which then moves on to evaluate the scientific basis and principles underlying ligamentous articular release methodology. The basic principles are to: disengage (via compression or decompression); exaggerate (returning the dysfunctional part to its position of strain); and, finally, to balance – maintaining tissues at the point of balance until a release is perceived. These methods will be familiar to anyone who has worked with cranial osteopathic (or craniosacral or sacro-occipital) methods, or who has understood the principles of positional release methodology (strain/counterstrain, functional technique, facilitated positional release, etc.) or who has studied zero-balancing.The second section of the book is devoted to descriptions of general osteopathic (aka ligamentous articular release) techniques, applied to the lower extremities, pelvis and lower abdomen, abdomen and thorax, spinal column, and upper extremities. The methods are clearly described and illustrated, both with line drawings and photographs. Some methods are direct (engaging restriction barriers) and some indirect (disengaging). [One of the indirect methods is described in this review, with permission from the publishers, Eastland Press, and both authors] Box 1 and Fig. 1. The third section of the book, entitled ‘Integration’, is devoted to
chapters on ‘The Key lesion’; ‘Bowstring’ (anterior longitudinal fascial structures), and finally ‘Coordinating the eight diaphragms’. Each of these chapters is worthy of a book on its own, and yet, by carefully constructed descriptions, combined with excellent illustrations, the authors have managed to create a masterful introduction to osteopathy at its best. The methods are of course applicable across disciplines, and I foresee their use spreading rapidly throughout the world of manual therapy. Here, a caution is called for. As William Crow informs us in his description of Study Groups in this issue, the group to which he now belongs insists that its membership is only open to those who have taken a course in osteopathy in the cranial field before being allowed to participate. There are dangers that some of the procedures described in the book could cause harm if the therapist is not familar with the extreme gentleness and subtlety demanded by cranial work. This book should be bought and studied by every practitioner and therapist interested in facilitating the self-regulating mechanisms operating in the body. And educators (not only those in osteopathic colleges) should ensure that the basic principles enshrined in these methods are taught to their manual therapy students. And students should insist that
28
J O U R NAL O F B O DY WO R K AN D MOVE M E N T TH E R APIE S JANUARY 20 0 3
Book Review
Box 1
Fig. 1. Sternum technique (used with kind permission from the publishers, Eastland Press, Seattle, and of the authors, Conrad Speece and William Thomas Crowe). (1) Contact the sternum with the heel of your hand on the manubrium and with the fingertips at the xyphosternal junction. Press in the direction shown; (2) compress the sternum between your hand and fingertips and (3) balance the sternum in the directions shown.
these methods are part of their training. If that’s not done then they should consider starting a study group!
Technique: Supine indirect ligamentous articular release of the sternum. Symptoms/diagnosis: Anterior midchest pain. Patient: supine. Physician/practitioner: Standing at the head of the table, facing the patient’s feet. Procedure: Place the heel of your dominant hand on the manubrium, and grasp the body of the sternum just above the xyphoid process (the xyphosternal junction) with the pads of your fingers. Press the manubrium posteriorly and inferiorly. Contract your hand slightly to increase the flexion at the angle of Louis. If necessary, reinforce the compression with your other hand by placing it over the dorsum of the treating hand. Now that you have the sternum disengaged, see if it tips left or right. If it does tip, slightly exaggerate the tip in that direction, and maintain the tip as you try rotating the sternum clockwise and counterclockwise. Rotate in the direction of least resistance. Maintain all these vectors of force until the release occurs. The sternum should rotate back to midline, level out from side to side, and flex or extend as needed to return to its normal physiologic position. Once the release has occurred, the sternum will start flexing and extending with the ‘tide.’
Leon Chaitow School of Integrated Health, University of Westminster, London, UK
29
J O U R NAL O F B O DY WO R K AN D MOVE M E N T TH E R APIE S JANUARY 20 0 3
Book review Ligamentous Articular Strain: Osteopathic Manipulative Techniques for the Body Conrad Speece, William Thomas Crowe Eastland Press Seattle, 2001, ISBN 9 780939 616312 This remarkable little book (180 pages) contains a number of true clinical gems. The methods described as Ligamentous Articular Strain (LAS) techniques focus on areas outside the craniosacral axis, although they are based (in large part) on the original work of William G. Sutherland, the founder of Cranial Osteopathy. These methods were resurrected from the past by members of an informal osteopathic study group which met for many years, originally under the guidance of the legendary osteopath Rollin Becker, in Dallas, Texas. (The story of study groups as told by one of the authors of the book, William T. Crowe D.O., is to be found in this issue of JBMT.) The book traces the historical background of this dynamic, yet gentle, approach, starting with an overview of the concepts of both Sutherland and Andrew Taylor Still, Osteopathy’s founder. The selection of quotes from these two pioneers of manual medicine, and the conceptual insights they offer, are pertinent to the focus ........................................... Journal of Bodywork and Movement Therapies (2003) 7(1), 28^29 doi:10.1016/S1360-8592(02)00079-7 S1360-8592/03/$ - see front matter
of the book, which then moves on to evaluate the scientific basis and principles underlying ligamentous articular release methodology. The basic principles are to: disengage (via compression or decompression); exaggerate (returning the dysfunctional part to its position of strain); and, finally, to balance – maintaining tissues at the point of balance until a release is perceived. These methods will be familiar to anyone who has worked with cranial osteopathic (or craniosacral or sacro-occipital) methods, or who has understood the principles of positional release methodology (strain/counterstrain, functional technique, facilitated positional release, etc.) or who has studied zero-balancing.The second section of the book is devoted to descriptions of general osteopathic (aka ligamentous articular release) techniques, applied to the lower extremities, pelvis and lower abdomen, abdomen and thorax, spinal column, and upper extremities. The methods are clearly described and illustrated, both with line drawings and photographs. Some methods are direct (engaging restriction barriers) and some indirect (disengaging). [One of the indirect methods is described in this review, with permission from the publishers, Eastland Press, and both authors] Box 1 and Fig. 1. The third section of the book, entitled ‘Integration’, is devoted to
chapters on ‘The Key lesion’; ‘Bowstring’ (anterior longitudinal fascial structures), and finally ‘Coordinating the eight diaphragms’. Each of these chapters is worthy of a book on its own, and yet, by carefully constructed descriptions, combined with excellent illustrations, the authors have managed to create a masterful introduction to osteopathy at its best. The methods are of course applicable across disciplines, and I foresee their use spreading rapidly throughout the world of manual therapy. Here, a caution is called for. As William Crow informs us in his description of Study Groups in this issue, the group to which he now belongs insists that its membership is only open to those who have taken a course in osteopathy in the cranial field before being allowed to participate. There are dangers that some of the procedures described in the book could cause harm if the therapist is not familar with the extreme gentleness and subtlety demanded by cranial work. This book should be bought and studied by every practitioner and therapist interested in facilitating the self-regulating mechanisms operating in the body. And educators (not only those in osteopathic colleges) should ensure that the basic principles enshrined in these methods are taught to their manual therapy students. And students should insist that
28
J O U R NAL O F B O DY WO R K AN D MOVE M E N T TH E R APIE S JANUARY 20 0 3
Book Review
Box 1
Fig. 1. Sternum technique (used with kind permission from the publishers, Eastland Press, Seattle, and of the authors, Conrad Speece and William Thomas Crowe). (1) Contact the sternum with the heel of your hand on the manubrium and with the fingertips at the xyphosternal junction. Press in the direction shown; (2) compress the sternum between your hand and fingertips and (3) balance the sternum in the directions shown.
these methods are part of their training. If that’s not done then they should consider starting a study group!
Technique: Supine indirect ligamentous articular release of the sternum. Symptoms/diagnosis: Anterior midchest pain. Patient: supine. Physician/practitioner: Standing at the head of the table, facing the patient’s feet. Procedure: Place the heel of your dominant hand on the manubrium, and grasp the body of the sternum just above the xyphoid process (the xyphosternal junction) with the pads of your fingers. Press the manubrium posteriorly and inferiorly. Contract your hand slightly to increase the flexion at the angle of Louis. If necessary, reinforce the compression with your other hand by placing it over the dorsum of the treating hand. Now that you have the sternum disengaged, see if it tips left or right. If it does tip, slightly exaggerate the tip in that direction, and maintain the tip as you try rotating the sternum clockwise and counterclockwise. Rotate in the direction of least resistance. Maintain all these vectors of force until the release occurs. The sternum should rotate back to midline, level out from side to side, and flex or extend as needed to return to its normal physiologic position. Once the release has occurred, the sternum will start flexing and extending with the ‘tide.’
Leon Chaitow School of Integrated Health, University of Westminster, London, UK
29
J O U R NAL O F B O DY WO R K AN D MOVE M E N T TH E R APIE S JANUARY 20 0 3