LIBRA

A way to freedom of movement and balance of spine and joints

by

Dr.Daniele Gould,
Naturopath

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Table of content
Origin, definitions, ethics energy, aura, chakras Meridians Grounding Basic anatomy Yin meridians of the arm Muscular system 49 Upper & middle back 54 Lower back 57 Neck & head 61 Chest 64 Shoulder & arm 66 Forearm & hand 71 Abdomen 73 Hip & leg 78 Foot 82 The cell 83 RSI 84 Kinesiology 91 Integral (prone) 93 Yang meridians of the arm 94 Joints 102 Spine 106 Adjustment of joints 107 Nervous system 111 Gate theory 112 Integral (lateral) 113 Yin meridians of the leg 114 Frequent joint problems 121 Cerebro spinal fluid (CSF) 123 Vertebras adjustment 126 Reading X-rays 128 Integral (supine) 130Yang meridians of the leg 131 Posture 138 Maintaining exercises 143 Environment 144 Diagnosis 147 Body reading 153 Muscles specific alimentary needs 156 Useful herbs 157 Abdominal aortic aneurysm (AAA) 158 Shoulder shiatsu 159 Touch for Libra 160 Manual techniques 165 Trigger points 166 Setting up a practice 171 Bibliography Illustrations based on: Grays Anatomy by Henry Gray, F.R.S., Muscle management by Elizabeth Andrews, Muscles testing and function by Florence Peterson Kendall, Elizabeth Kendall McCreary and Patricia Geise Provance, The muscle book by Paul Blakey, The internet.

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Lesson 1
Origin
When I was 8 years old, I fell down a whole floor of stairs. I suffered from back pain ever since that accident despite doing a lot of physical exercise as a ballet teacher. This and other incapacitatingly painful incidents, made me discover the help of chiropractic. But after all those years, my condition had become chronic and required regular chiropractic attention. Our moving from England to Israel interrupted the treatment and my pains came back. By then, I had enough and decided that since it was my body, it should be my responsibility to help it. So I experimented on myself and started to feel better. Slowly but surely, the pains disappeared. Later, I studied with a chiropractor who taught me the basis of anatomy and chiropractic. I worked with him for a year in his clinic until he encouraged me to start on my own. I furthered my studies in anatomy and physiology, then formulated what I had intuitively done on myself and developed a system: Libra was born. Libra is a system for adjusting the spine and joints.

Definitions
There are several practicalities that should be dealt with at this point:

Any information that we gain on the health of our patients has to be considered as confidential and should not be disclosed without their consent. All through this work the patient is referred to as he for convenience but is meant to imply she as well. The tenet of Libra is that whatever the body did to itself, it can also undo. The natural urge of the body is to be healthy and whole yet people work very hard against this natural law. They acquire diseases, that is to say, the cessation of ease. It should be emphasised to the patient that, since pain is a way of communication from the body, it should never be ignored. Consequently, stoicism not only is depriving the practitioner from a valuable source of information, but can actually be detrimental.

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The human body has developed to enjoy a balanced life style, diet, and activities both physical and mental. Deviation from any of these, including accidents, will result in disharmony. This may be in a physiological, physical, mental, or all of

We have already understood that the body is much more than what we see: It is physical and this is what we do see, including physiological and pathological symptoms (Libra can be involved at this level by adjusting bones and joints, balancing muscles, providing energy); It is emotional and makes us react to things, events, and people (Libra can be involved at this level by releasing tensions and restrictions always related to physical equivalents); and It is spiritual and allows us to rationalise, reflect, decide, etc. (Libra can be involved at this level by reminding the patient to be responsible for his health and his bodys maintenance, possibly changing his ways of life).

Energy
In other words, the human organism is more than a mere sum of its physical components. It is made the most obvious at the moments of conception and death when the life force or energy materialises or volatilises. The basis for energy medicine is the laws and principles that govern the electromagnetic field of the human body. This basis can be considered its dynamic plane, a plane inconceivably complex, which nevertheless conforms to laws and principles, grounded in electromagnetic concepts of resonance, harmony, reinforcement, and interference. Already, Paracelsus (Renaissance alchemist and physician) reported that energy radiated from one person to another and could act at a distance. Energy can be imparted or stored in objects (like the energy trapped in coal or crystals) and connects the individual with the ultimate unity of the universe (1). Attempts at a scientific explanation of this vital force and its various properties have been made. (1, 2) Every element of the body not only is intimately involved with the whole of the other elements of the body, but also with the whole of its energy. Besides, the life force links us to the universal energy. There are two words for the same energy in the same way as Mediterranean Sea and Pacific Ocean are two names for the same water surrounding the earth. Universal energy is governing the laws of gravity,

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light, etc. Universal energy seems also to be a pool of knowledge from which some people are at times able to extract fragments. All big inventions have been made within small variations of concept, place and time by several scientists. As a personal example, some of Libras principles are very similar to those of Sotai developed by Keizo Hashimoto, MD, in Japan in 1927. I was not born yet and never knew of Dr Hashimoto or Sotai until my shiatsu teacher told me about it when I treated her with Libra after un accident.

Figure 1

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Not surprisingly, the energy we spoke about earlier is involved in these different aspects of the body. In fact, it surrounds the body with seven layers, in a way very similar to that of the onions skin (Fig. 1). First layer of the aura The first layer is the etheric body or aura. It is visible to gifted and trained people. But it is also visible to anybody through Kirlian photography, a high voltage photography invented by the Russian couple Kirlian, in the seventies. The aura phantoms the physical body. It is often referred to as the etheric double since it replicates all the organs. Indeed, the entire body is a physical manifestation of the etheric body. (3) A very good demonstration of this is the phantom limb where a person who has had a limb amputated still feels it. Another good example is that of the experiments made by Dr. Robert Becker, (4) who, after various experiments on salamanders discovered that there was indeed a larger intelligence that existed as an electrical field that surrounds and infuses the salamanders body.(3) Becker proved that this larger electrical body, a morphogenic field, actually organises and orders the DNA to reproduce whatever the body needs at a particular site. (3) Second layer of the aura The second layer is that from which all our emotions emerge. It is common amongst all animals and is our link with the animal kingdom. Its integrity is affected by the kind of emotions we allow ourselves to be governed by: Positive emotions like love, joy and hope are always accompanied by feelings of well being, security and increased energy (physiologically translated by a strengthened immune response); Negative emotions like anger, hatred, fear, shame or guilt are usually accompanied by feelings of loneliness, exhaustion and often by specific physical/physiological symptoms (fear, for example, is the most damaging belief. It increases the heart rate, respiration, blood glucose and muscular activity, depresses immune response and, if chronic, elevates significantly the levels of cholesterol, imbalances some hormones, restrains the respiration and tenses muscles often to the point of spasm).

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Emotions are of course directly linked to our thoughts. Third layer of the aura The third layer, the mental body, is responsible for our thoughts: the intellectual functions, the conscious and the unconscious, and many memories. The mental body coordinates the physiological activities, including conscious and autonomic functions. Amongst the important content of the mental body are the unexamined ideas, beliefs, judgments and concepts that give rise to our behaviour and can inhibit our growth (racism, chauvinism, superiority/inferiority), or prompt us to act in a way inappropriate to our current situation (looser, talent less, weak, hidden tape in our subconscious convincing us of its message); or prevent us from seeing situations in a fresh, new light (being stuck). Many psychological projections reside in the mental layer. Fourth layer of the aura The fourth layer is that of the para-consciousness, that of all the extraordinary abilities such as intuition, extrasensory perception, image projection, spiritual sight, clairvoyance, and compassion. Rudolph Steiner maintains that one form of intuition is the ability to join with another person, to feel his life condition, to know his pain and suffering. Out of such intuition comes compassion for another human being.(3) The ability to allow this layer and higher ones to express itself depends on the clarity and good condition of the lower layers. Fifth layer of the aura The fifth layer is the causal body, the place within us that knows why we are on earth, which knows our lifes purpose. It gives us the exhilarated feeling of fulfilment and achievement when we learn lessons we were meant to learn, associate with people we were meant to associate with, etc. Sixth and seventh layers of the aura The sixth and seventh layers are the cosmic and spiritual consciousness that are our most intimate links with God/Nature/ Universal energy. These layers offer us the experience of direct union and are responsible for the occasional moments of enlightenment that some people experience. Not much is known about these levels of the field, simply because they are so rarefied and lofty that very few people consciously experience them and then write about their experiences.

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What we do know is that the sixth and seventh layers of the field possess a tremendous force of energy that, when it grounds in the body, can create a host of psychological disorders if the person is not prepared for such an experience, or if the body itself is not in sufficient health. The Dead Sea Scrolls lend credence to this theory and point to the fact that the early Hebrew were well aware of the power of these upper levels of the field (3). According to some scholars, the Essenes (a sect of Jews who produced the scrolls in Qumran) were purifying themselves, through location in the desert and special strict dietary laws, with the intention of creating a familial line of great constitutional strength which could eventually produce a son whose physical powers would be sufficient to hold the energies of the sixth and seventh layers. The seven layers all interact and must be in harmony with each other. Together, they form a protective shell or cocoon around the physical body. Additional element of the aura In addition to the standard layers, there is another characteristic of the field, which I call the central tube. (3) It is a channel in which the spiritual life force enters at the top of the head and runs, like a river, down the centre of the body to the base of the sex organs. There the energy can pass out of the body and the earths energy can enter. In the centre of the body, just below the solar plexus and above the umbilicus, is the centre of the being known as the vibral core where spirit and matter join and become one. It is where the vital energy flows from the practitioner to the patient.

Chakras
Chakra is a Sanskrit word meaning wheels or circles of movement. The chakras (Fig. 2) are spirals of concentrated life force. There are seven primary chakras arranged in a straight line on the front of the body with the points of their spirals entering the body and the ever-widening ends spiralling outwards into the energy field. They correspond roughly to the seven layers of the field and act as funnels for the life force. We are continually bathed in an unlimited flow of electromagnetic energy, or life force, which sustains our lives. We breathe in the life force, receive it through the five senses, channel it through

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the fields, and draw into us through the seven chakras. Each chakra is the site of a specific consciousness, a realm that offers its own specific set of values. None of us has integrated all seven levels of consciousness into our being. It is the very rare person who is awake and functioning at all seven levels of consciousness. (3) The few chakras we utilise determine our physical needs, values and spiritual awareness. Those that are not used are still alive (otherwise we would be dead), but the organs they serve are weakened and might even atrophy or develop some kind of disease. 7th chakra

6th chakra 5th chakra 4th chakra

3rd chakra 2nd chakra

1st chakra

Figure 2

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First chakra The first chakra is located at the base of the spine and is referred to as the root of the person. It provides life force to the adrenal glands, the large intestine, rectum, bones, legs and feet, grounds your life in physical existence, is the source of your survival instinct, and, therefore, maintains the sense of smell. The first chakra is associated with the earth and the colour red and is characterised by cohesiveness, inertia and a certain amount of stagnation. From it, we experience our aloneness. It is symbolised by a giant black elephant holding the world. In his writing about the first chakra, Carl Jung wrote that the elephant represents the enormous power and strength that supports human consciousness. Second chakra The second chakra, or centre, is located just under the navel at the height of the first lumbar vertebra. It provides life force to the sex organs and their hormones, to the kidneys, bladder, circulatory system and developing foetus. It also governs our sense of taste and our deep breathing (according to Chinese medicine, weak kidneys cause shallow breathing, timidity, nervousness and fear). It is the centre of the personality and, for the Japanese, of the gravity as hara, as they call it: from hara we can maintain balance in whatever circumstances and so control our environment and ourselves without lifting a finger. This is the base of all martial arts, wherever from. It is also the centre through which we perceive other peoples emotions. The second chakra is associated with the element water and the colour orange and is characterised by sexuality, fertility, relationship, consciousness, choice, healing and rebirth. It is symbolised by the leviathan that is the embodiment of the enormous power and mystery that lies beneath the surface of the sea. Sigmund Freud is the master spokesman for the second chakra (5). Third chakra The third chakra, the gem centre, is located at the solar plexus. It provides life force to the pancreas, liver, gall bladder, spleen, stomach and their secretions, and metabolism. It is about personal power and self-mastery, and governs our mind. It gives will power, courage, leadership, and stubbornness but also passion, impetuousness, assertiveness and violence. Our mind is to bring all these characteristics under control in order to be acceptable in our societies.

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Frustration is often felt by physical pressure in our solar plexus. We can respond by using our mind, reflect, and use a new approach to the situation, or by using stubbornness resulting in more frustration and possibly violence. The third chakra is associated with the element fire and the colour yellow and is characterised by passion, raw power and untamed mind. It is symbolised by the ram, a sacrificial animal. Carl Jung points out that we have to sacrifice our wild passions so that personal mastery and power can be achieved. It encourages us to be responsible for our own fate. Fourth chakra The fourth chakras Sanskrit name, Anahata, means un-struck. It means emitting a cosmic sound beyond the realm of our five senses, without origin, yet existing. The Greek philosopher and mathematician Pythagoras called it the music of the spheres. It is located on the era of the heart. It gives us the ability to sense the unity between people, their shared life. It provides life force to the heart, thymus gland, lungs, arms and hands and the sense of touch. It focuses on compassion and healing. It is a matrix through which all the chakras express themselves. The fourth chakra is associated with the element air and the colours green and pink. It is symbolised by the gazelle with its speed, lightness and gentleness. By articulating the collective unconscious and the archetypal world, Carl Jung is a leading spokesman for the fourth chakra. Fifth chakra The fifth chakras Sanskrit name, Visudha, means pure and is located over the throat. It provides life force to the thyroid, parathyroid, larynx, neck, shoulders, arms, hands, ears, hearing and speech centre. It is the realm of communication, the transition to the world of ideas and symbols, of energy, sound and light. Light because words and ideas illuminate the darkness of ignorance. It is also where our spirit communicates with our mind. The fifth chakra is associated with the element ether and the colour blue. It is symbolised by the moon-white elephant, a mythological creature representing the powerful and mystical base upon which the mind and the world of ideas are founded. For most of us, it is the instrument of the first three chakras.

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Sixth chakra The sixth chakras Sanskrit name, Ajna, means command and is located between the eyes, above the eyebrows. It is on the third eye and according to the Atlas of Human Anatomy by Samuel Smith and Edwin B. Steen some evidence suggests that it [the pineal gland] is a vestigial organ, the remnant of a third eye. It is therefore no wonder that this sixth chakra provides life force not only to the eyes and much of the central nervous system and the brain, but also to the pituitary and pineal glands (the pineal gland is also associated with the seventh chakra by some authorities). The sixth chakra controls various states of concentration and consciousness and allows extrasensory perception, clairvoyance, vision, psycho kinesis, intuition, telepathy, etc. Its world is that of cosmic law, harmony, perfect order and vibration. There, all paradoxes, seeming contradictions are harmonised and opposites are brought together as one. It is the realm of pure ideas, Platos world of forms. It requires insight into the past, present and future and is perfect knowledge and wisdom. The sixth chakra is associated with no element since it is beyond material existence, but with the colour indigo. It is symbolised by Om, the cosmic sound representing the beginning and the end of all things. Seventh chakra The seventh chakras Sanskrit name, Sahasraha, means thousand and is located at the back of the head, slightly above the crown. Some maintain that it hovers there. It also provides life force to the cortex and much of the central nervous system and synchronises all the senses and faculties. It unifies understanding and integrates all ideas and state of consciousness. It is associated with the pineal gland that, for centuries, was associated with light, intuition and truth. Rene Descartes, seventeenth century French philosopher, insisted that it was the seat of the soul. Until very recently, scientists thought it had no function at all. But it turned out that it is in charge of our circadian rhythms, brain chemistry and moods. So, who knows, there might be even more to the pineal gland than has been found until now (the pineal gland is also associated with the sixth chakra by some authorities). As intuitively assumed, it is very sensitive to light and deprivation of it can cause Seasonal Affective Disorder (SAD): the pineal gland then raises its level of melatonin which consumes the chemical neurotransmitter serotonin used by the brain to create

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of well being, positive thoughts, increase concentration and deep and restful sleep. The seventh chakra is not associated with any colour although Hills says it is violet. (3) It symbolises the ocean of life to which we all return. It is the ultimate and indefinable state of love and bliss. (3) There are secondary chakras on the palms of the hands, backs of the knees and soles of the feet, and some tertiary ones on the tip of each finger and toe.

Meridians
Chakras interrelate amongst each other and amongst the seven layers of the energy field. But this energy is also diffused all around the body through a transport network called meridians. (Fig. 319) Chinese medicine uses meridians extensively with acupuncture and Japanese medicine uses them with shiatsu. You can think of meridians like roads deserved by public busses: they have terminals, stations, and traffic jams! There are 14 major meridians each corresponding and named after the organ or function connected to its energy flow. When all is well, the energy flows smoothly, the organs function normally and the person is in good balance and health. But, like on a road, the traffic may be interrupted by obstruction: there will be congestion before the obstacle and emptiness after it until the problem is removed and the circulation can resume its interrupted course. Once you become aware of these energy channels and the ways in which they connect the different limbs, organs and muscles of the body, your entire concept of health will change. You will begin to see the body as a kind of network of highways, with all the places in it connected directly to each other. Stiffness and pain in a particular part of the body will no longer seem an isolated phenomenon, but a signal that other places along the meridian line are aching too.(6) The use of the meridian can be achieved by strengthening its flaw (through tracing it in its natural direction) or weakening it (through tracing it in its reverse direction) using the appropriate finger. In the same way that triturations potencies homeopathic medicine, the further from the body the tracing of the meridian the more effective it proves. Each finger has its specific polarity. The energy of the index is negative (pushes away, weakens) and that of the major is positive (attracts, strengthens).

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LV Liver

Start

1st
To strengthen:
1st: LV 8 + KD 10 2nd: LV 4 + LU 8

2nd

To weaken:
1st: LV 2 + HT 8 2nd: LV 4 + LU 8

1st
Figure 3

2nd

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LU Lung

End

1st

2nd

To strengthen:
1st: LU 9 + SP 3 2nd: LU 10 + HT 8

1st

2nd

To weaken:
1st: LU 5 + KD 10 2nd: LU 10 + HT 8

Figure 4

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LI Large intestine

Start Start
To strengthen:
1st: LI 11 + ST 36 2nd: LI 5 + SI 5

To weaken:
1st
1st: LI 2 + BL 66 2nd: 2nd 5 + SI 5 LI

To weaken:
1st: LI 2 + BL 66 2nd: LI 5 + SI 5

1st

2nd

Figure 5

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ST Stomach

End

To strengthen:
1st: ST 41 + SI 5 2nd: ST 43 + GB 41

1st To weaken:

2nd

1st: ST 45 + LI 1 2nd: ST 43 + GB 41

1st

2nd

Figure 6

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SP Spleen

9.00-11.00

Start
To strengthen:
1st: SP 2 + HT 8 2nd: SP 1 + LV 1

1st

2nd

To weaken:
1st: SP 5 + LU 8 2nd: SP 1 + LV 1

2nd

1st

Figure 7

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SI Small intestine

Start

To strengthen:
1st: SI 3 + GB 41 2nd: SI 2 + BL 66

1st

2nd

To weaken:
1st: SI 8 + ST 36 2nd: SI 2 + BL 66

1st

2nd

Figure 8

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BL Bladder

End

To strengthen:
1st: BL 67 + LI 1 2nd: BL 54 + ST 36

2nd

1st

To weaken:
1st: BL 65 + GB 41 2nd: BL 54 + ST 36

2nd

1st

Figure 9

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KD Kidney

Start
To strengthen:
1st: KD 7 + LU 8 2nd: KD 5 + SP 3

1st

2nd

To weaken:
1st: KD 1 + LV 1 2nd: KD 5 + SP 3

1st

2nd

Figure 10

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HC Heart constrictor/Pericardium
End

To strengthen:
1st: HC 9 + LV 1 2nd: HC 3 + KD 10

1st

2nd

To weaken:
1st: HC 7 + SP 3 2nd: HC3 + KD 10

1st

2nd

Figure 11

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TW Triple warmer

Start

To strengthen:
1st: TW 3 + GB 41 2nd: TW 2 + BL 66

1st

2nd

To weaken:
1st: TW 10 + ST 36 2nd: TW 2 + BL 66

1st 2nd

Figure 12

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GB Gall bladder

End
To strengthen:
1st: GB 43 + BL 66 2nd: GB 44 + LI 1

1st

2nd

To weaken:
1st: GB 38 + SI 5 2nd: GB 44 + LI 1

1st

2nd

1st: GB 43 + BL 66 2nd: GB 44 + LI 1

Figure 13

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HT Heart

11.00-13.00

End

To strengthen:
1st: HT 9 + LV 1 2nd: HT 3 + KD 10

2nd

1st

To weaken
Instead of weakening the heart, strengthen the small intestine 1st: SI 3 + GB 41 2nd: SI 2 + BL 66

1st

2nd

Figure 14

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GV Governing vessel

Figure 15

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VC Vessel of conception

Figure 16

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The first step of any treatment is the centring or grounding of the practitioner. Each of you will develop your own method, but all require a comfortable and relaxed posture, a little concentration, some slow and deep breathing, and some visualisation: of roots growing from some part of your body and fixing it to the earth for example; or imagining plugging your feet, as the two prongs of an electric plug, into the socket of the earth. Those initiated to Reiki will open themselves to the Reiki energy and there is always room for a little introspection. When working on a dressed patient, thick pieces of clothing, content of pockets, glasses and belts should be removed. The waist band of jeans should be unbuttoned as they are too thick to allow any feeling. When working on the bare skin, we make sure that our hands are warm as well as the oil that will be used. Aromatherapy blends in beautifully here and can be very helpful. The oil is necessary to allow the flow of the movement, in the same way as the clothes do, without causing burning of the skin, but care should be taken not to apply too much of it: at the end of the treatment, all the oil should be absorbed.

Basic anatomy
The tissues are arranged to form organs, and the organs are grouped into systems. The systems do not work independently. The body works as a whole. Health and well-being depend on the coordinated effort of every part. And this is the tenet of the holistic alternative medicine. The systems are: the digestive system, (Fig. 17) the cardio vascular system, (Fig. 18) the lymphatic system, (Fig. 19) the respiratory system, (Fig. 20) the urinary system, (Fig. 21) the endocrine system, (Fig. 22) the reproductive system, (Fig. 23) the central nervous system, (Fig. 24)

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the skeletal system, (Fig. 25) the muscular system. (Fig. 26 & 27)

Man eats the substances which plants (and through them, animals) have made. These are broken down in man's body into simpler chemical units which provide: - building and protective materials which are more or less the same elements as plants require, such as minerals. Most must be built up for him by plants organically combined like carbon, nitrogen, sulphur, etc essential amino acids, essential fatty acids, and some vitamins; - energy which is stored originally by plants, released in man's cells by oxidation and gives up energy on being burned. Most of this appears as heat and is used for keeping the body warm; some is used for work of cells. The body building / maintenance / repairs requirements determine the quality of the diet, the energy requirement of the individual determine the quantity of the diet. The less perfectly balanced the diet of a person, the least able this person's body will be to build/maintain/repair its various components; it is important to keep this consideration in mind when we are presented with cases of recurring sprains, misalignment of vertebras, etc These might be symptomatic of the body's lack of magnesium or mal-handling of calcium which often go together (as well as other imbalances of essential minerals). Magnesium is essential for the muscles to retain their elasticity and for nervous impulses. Calcium is essential not only for the strength of the skeleton but also for that of the ligaments, release of neurotransmitters at nerves' endings, and muscles contraction.

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Figure 17

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Figure 18

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Figure 19

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Figure 20

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Figure 21

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Figure 22

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rights reserved MALE REPRODUCTIVE SYSTEM

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Figure 23

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Figure 24

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Figure 25

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Figure 26

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Figure 27

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Lesson 2

Yin meridians of the arm

(Fig. 28)

Figure 28

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Lesson 2
Muscles
There are two kinds of muscles: Visceral muscles, which form organs like the heart, the stomach. Skeletal muscles, which attach to the skeleton and orm the bodys shape. (Please check this link:
http://www.meddean.luc.edu/lumen/meded/GrossAnatomy/dissector/mml/mmlregn.htm

They amount to sixty per cent of the mass of the body. A fresh injury refers to a pain having occurred within a maximum of two weeks. A chronic problem can include: * an acute pain having appeared over two weeks ago from an external cause; * a sudden aggravation of an existing condition; and/or an old condition which has slowly become worse. Libra treatments are concerned with the skeletal muscles.(8, 9, 10, 11, 12) Muscles can contract or relax. No muscle ever works alone; they always work in opposition and as a team. When a muscle contracts, it shortens, bringing its two ends closer together. Since both ends are attached to different bones by tendons, one of the bones has to move. (Fig. 29) The muscle that contracts to move the joint is the prime mover or agonist. The opposite muscle has to relax and exercise a braking control on the movement; it is the antagonist. For example, in figure 28, during the flexion, the agonists are the biceps and the antagonists are the triceps. However, during the extension, the agonists are the triceps and the antagonists are the biceps. Other muscles steady the bone giving origin to the prime mover so that

Figure 29

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only the insertion will move; these are the fixators. Yet other muscles, the synergists, help to steady the joint being moved for most efficient movement.

The Composition of Muscles

All skeletal muscles have elongated cells (Fig. 30, 31 & 32). Their cytoplasm contains numerous myofibrillae embedded in sarcoplasm and wrapped in a thick covering membrane, the sarcolemma, to form fibbers arranged in bundles, the fasciculi. Each fasciculus is surrounded by a sheath called perimysium. The fibbers within a fasciculus are surrounded by and held together by delicate reticular fibrils forming the endomysium.
Figure 30

Figure 31

Figure 32

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The skeletal muscles are formed of voluntary muscles and are the most highly specialised, for very rapid and powerful contractions of individual fibbers. The coordinated group action of muscles is made possible by the many synaptic connections between interneurons of the ingoing (proprioceptive) neurons of one muscle group and the outgoing (motor) neurons of the functionally opposite group of muscles. (Fig.33)

Figure 33

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Most reflex actions involve several reflex arcs (Fig. 34): if we walk on a nail, instinctively we lift the wounded foot, shout, look at the place where the pain originates, etc.

Figure 34

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Awareness of Muscular Activity

In skeletal muscles, tendons and joints are found general proprioceptors. They are sense organs stimulated by movement of the body itself and make us aware of the movement or position of our body in space and of the various part of our body to each other. They are important to the adjustment of both posture and tone. Their end-organs, or receptors, may be linked with centres in the cerebellum or the parietal lobe of cerebral cortex. The reporting mechanisms in and around joints are:

Ruffini receptors situated within the joint capsule, each responsible for a degree of rotation but overlapping each other and recruited progressively as the joint moves so that the movement is smooth and not jerky. They are fatigue resistant and are primarily concerned with steady position and direction of the movement Golgi receptors are in the ligaments associated with the joint. They adapt slowly and continue to discharge over a lengthy period information about where the joint is at any given moment, irrespective of muscular activity. Pacinian corpuscles are found in peri-articular connective tissue, adapting rapidly, triggering discharges and ceasing to report in a very short space of time. As the messages occur successively during motion, the Central Nervous System can be aware of the rate of acceleration of movement taking place in the area.

There are other receptors but these three provide information as to present position, direction and rate of movement of any joint (Fig. 35). Muscle spindle detects, evaluates reports and adjusts the length of the muscle in which it lies, setting its tone. It acts with the Golgi tendon body, reporting most of the information as to muscle tone and movement. The spindles lie parallel to the muscle fibbers and are attached to either skeletal muscle or the tendinous portion of the muscle. Golgi tendon receptors indicate how hard the muscle is working, reflecting its tension rather than its length. If the tendon organ detects excessive overload, it may cause cessation of function of the muscle to prevent damage, producing relaxation. According to the sum total of these informants, orders from the

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brain relate to whole motions and not to individual muscles. There are cases of external trauma which can jam the system with too many contradictory reports causing cessation of activity for lack of adequate response: spasm or splinting for example. In such cases, a de-scrambling technique can be used very effectively. A great deal of pain and dysfunction originates from the soft tissues of the body: skeletal, arthrodial and myofascial structures. The comprehensive term of somatic dysfunction can be applied to all lesions of the skeletal muscles system and can be defined as the impaired or altered function of related components of the somatic system: the body soft tissues and their related vascular, lymphatic and neural elements. There is a structural and functional continuity between all of the skeletal muscle systems elements, so no local lesion or injury should ever be considered in isolation. Our study of skeletal muscles will proceed by muscle groups selected for their involvement in problems most frequently presented by patients.

Figure 35

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Muscles of the upper and middle back

Erector spinae (sacrospinalis), (Fig. 36) is a composite muscle made up of many parts. ; It joins the ribs to the spine, ribs to other ribs, the pelvis to the ribs, the pelvis to the spine, the back of the head and neck. It can also be said to include all the tiny muscles that join one vertebrae to the next or to the one or the beyond that. It balances the abdominal muscles to keep the spine up right against gravity, extends the spine on backwards bent, helps to rotate it and, on one sided contraction, and allows sideways flexion of the spine or pelvis. Origin: Transverse processes; Insertion: Transverse processes several levels above. Nerve: Posterior primary rami.

Figure 36

Latissimus dorsi, (Fig. 37) twists the arm inwards and holds it to the body, helps to hold the shoulder blade down and in against the body and gives the power to pull the torso up in chin-ups, keeping the body straight. Origin: Spine T7, spinous processes and supraspinous ligaments of all lower thoracic, lumbar and sacral vertebrae, lumbar fascia, posterior third iliac crest, last four ribs and inferior angle of scapula; Insertion: Floor of bicipital groove of humerus. Nerve: Thoracodorsal nerve (C6, 7, 8) (from posterior cord).

Figure 37

Diaphragm (Fig. 38) is the main breathing muscle and alters the pressure around the lungs to allow inspiration and holding of the breath. It forms the floor of the thoracic cavity and the roof of the abdominal cavity. During respiration, it descends as it contracts and ascends as it relaxes. Origin: from the circumference of the Figure 38 thoracic outlet; Insertion: converge into a central tendon situated near the centre of the vault formed by the muscle, but somewhat closer to the front than to the back of the thorax, so that the posterior muscular fibres are the longer; Nerve: phrenic nerve.

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Rotatores brevis (Fig. 39) runs between adjacent vertebrae. It can, in unilateral action, rotate the spine to the opposite side or bilaterally extend the spine. Origin: from transverse processes; Insertion: to higher spinous process.
Figure 39

Rotatores longus (Fig. 40) skips one segment each time. It can, in unilateral action, rotate the spine to the opposite side or bilaterally extend the spine. Origin: from transverse processes; Insertion: to higher spinous process.

Trapezius

Figure 40

upper, (Fig. 41) raises the shoulder girdle, helps the deltoids to raise the arm from 90 to the vertical and bends the head and neck to one side when only one is contracted. Right and left work against each other to hold the head and neck centrally on the shoulder. Origin: occipital protuberances, spineous process of C7; Insertion: distal/lateral 1/3 of the clavicle, acromion process and the scapular spine; Nerve: accessory nerve Cranial nerve Figure 41 route XI (posterior aspect of the brain).

middle, (Fig. 42) It draws back acromion process, keeps the shoulder blade in and turns it; Origin: spinous process of 1st 5th thoracic vertebrae; Insertion: superior border of spine of scapula; Nerve supply: spinal accessory nerve and ventral ramus, (C2, C3, C4);

Figure 42

lower, (Fig. 43) rotates and stabilises the shoulder blade, draws it and helps keep the middle spine upright. Origin: spinous process of 6th to 12th thoracic vertebrae; Insertion: medial 1/3 of spine of the scapula; Nerve supply: spinal accessory nerve and ventral ramus, (C2, C3, C4);
Figure 43

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Subscapularis, (Fig. 43) pulls the head of the humerus in and down when the arm is raised and allows the shoulder blade to glide over the rib cage. Origin: Medial two thirds of subscapular fossa; Insertion: Lesser tuberosity of humerus, upper medial lip of bicipital groove, capsule of shoulder joint. Nerve: Upper and lower subscapular nerves (C5, 6).

Figure 43

Supraspinatus, (Fig. 45) holds the very top of the humerus in the socket and pulls more horizontally than the deltoid group. It lifts the arm out sideways as a help to the stronger deltoid muscle. Origin: medial 2/3 of supraspinatus fossa above spine of scapula; Insertion: superior surface of greater tuberosity of humerus and capsule of shoulder joint; Nerve supply: suprascapular, (C4, C5);

Figure 45

Teres major, (Fig. 46) It draws the arm in towards the body, turning it inwards, whilst pulling it behind the body to be nearer the shoulder blade. Origin: dorsal surface of inferior angle of the scapula on the lower 1/3 of scapular lateral border; Insertion: medial lip of bicipital groove of humerus and medial to latissimus dorsi tendon; Nerve supply: lower subscapular, (C5, C6, C7);

Figure 46

Teres minor, (Fig. 47) holds the upper arm into the shoulder joint, draws the arm in and twists the upper arm outwards. It is often joined to the infraspinatus and directly opposes the subscapularis. Origin: Middle third lateral border of scapula Figure 47 above teres major; Insertion: Inferior facet of greater tuberosity of humerus (below infraspinatus) and capsule of shoulder joint. Nerve: Auxillary nerve (C5, C6).

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Levator anguli scapulae (Fig. 48) lifts the shoulder blade and draws it in towards the spine. It assists the trapezius in bearing weights or shrugging the shoulders. It also inclines the neck to the corresponding side and rotates it in the same direction. Origin: tendinous slips from the transverse processes of the atlas and axis and from the posterior tubercles of the transverse processes of the third and fourth cervical vertebra. Insertion: into the vertebral border of the scapula, between the medial Figure 48 angle and the triangular smooth surface at the root of the spine. Nerve: the third and fourth cervical nerves, and frequently by a branch from the dorsal scapular. Rhomboids, (Fig. 49) major: draws the shoulder blades together and joins the shoulder blade to the spine; Origin: spinous process of 2nd to 5th thoracic vertebrae; Insertion: medial border of scapula from spine to inferior angle; Nerve supply: dorsal scapular (C4, C5); minor: It adducts and aids elevation Figure 84 49 of scapula; Origin: nuchal ligament, spinous process of C7 and T1 ; Insertion: medial border of scapula at the root of the spine of scapula; Nerve supply: dorsal scapula (C4, C5); Infraspinatus, (Fig. 50) holds the arm in the shoulder joint, more or less opposite to the subscapularis. Origin: Medial three quarters of infraspinous fossa of scapula; Insertion: Middle facet of greater tuberosity of humerus and capsule of shoulder joint; Nerve: Suprascapular nerve (C5, C6 ) (from upper trunk)
Figure 54 50

Splenius (Fig. 51) together, draws the head directly backwards and assist in supporting the head in the erect position Acting separately, they draw the head to one side or the other, and slightly rotate it, turning the face to the same side. Origin: Lower nuchal ligament, spinous processes and supraspinous ligaments T1-3; Insertion: Lateral occiput between superior and inferior nuchal Figure 97 51 line. Nerve: Posterior primary rami of C3, 4

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Serratus anterior or serratus magnus (Fig. 52, on contraction, pulls the whole shoulder blade and tips it so that the shoulder joint is fixed in the glenoid cavity; it also holds the shoulder blade onto the rib cage with the rhomboids and middle trapezius. It carries the scapula forward and is concerned in the action of pushing. It also takes over the action of the deltoid, with the trapezius, to raise the arm from a right angle to the trunk to an almost vertical position. It also elevates the ribs Figure 52 Origin: Upper eight ribs and anterior intercostal membranes from midclavicular line. Lower four interdigitating with external oblique; Insertion: Inner medial border scapula. 1 and 2: upper angle; 3 and 4: length of costal surface; 5-8: inferior angle; Nerve: Long thoracic nerve of Bell (C5, 6, 7) (from roots) slips from ribs 1 and 2: C5; 3 and 4: C6; 5 -8: C7).

All rights reserved Muscles of lower back

Erector spinae (sacrospinalis), (Fig. 53) is a composite muscle made up of many parts. ; It joins the ribs to the spine, ribs to other ribs, the pelvis to the ribs, the pelvis to the spine, the back of the head and neck. It balances the abdominal muscles to keep the spine up right against gravity, extends the spine on backwards bent, helps to rotate it and, on one sided contraction, and allows sideways flexion of the spine or pelvis. Origin: Transverse processes; Insertion: Transverse processes several levels above. Nerve: Posterior primary rami

55

Latissimus dorsi, (Fig. 54) twists the arm inwards and holds it to the body, helps to hold the shoulder blade down and in against the body and gives the power to pull the torso up in chin-ups, keeping the body straight. Origin: Spine T7, spinous processes and supra spinous ligaments of all lower thoracic, lumbar and sacral vertebrae, lumbar fascia, posterior third iliac crest, last four ribs and inferior angle of scapula; Insertion: Floor of bicipital groove of humerus. Nerve: Thoracodorsal nerve (C6, 7, 8) (from posterior cord). .

Figure 53

Figure 54

Quadratus lumborum, (Fig. 55) It joins the back of the pelvis to the lower spine and lowest rib; it helps the sacrospinalis and stabilises the lower back. In one-sided contraction, it flexes the upper body down to the hip of that side. It also helps the diaphragm in breathing by stabilising the lowest rib. Origin: Inferior border of 12th rib; Insertion: Apices of transverse processes of L1-4, iliolumbar ligament and posterior third of iliac crest; Nerve: Anterior primary rami (T12-L3)
Figure 55

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Gluteus: medius, (Fig. 56) and minimus, (Fig. 57) can be considered as one since they work very similarly. They help prevent excessive swaying of the hips on walking and running. They come into action in the weight bearing leg when lifting the other to take a step. They also are hip abductor, taking the legs out to the side. Origin: Outer surface Figure 56 Figure 57 of ilium between posterior and middle gluteal lines; Insertion: Posterolateral surface of greater trochanter of femur; Nerve: Superior gluteal nerve (L4, 5, S1). maximus, (Fig. 58) stabilises the back of the hips on stepping up, prevents the forward tipping of the pelvis therefore helping the abdominals to maintain an upright posture against gravity when standing. It helps the hamstrings and replaces them when they are inactivated on bending the knees. It comes into action primarily when arching the whole body backwards, running, hoping, skipping and jumping. Origin: Outer surface of ilium behind posterior gluteal line and posterior third of iliac crest, lumbar fascia, lateral mass of sacrum, sacro-tuberous ligament and coccyx. Figure 58 Insertion: Deepest quarter into gluteal tuberosity of femur, remaining three quarters into iliotibial tract. Nerve: Inferior gluteal nerve (L5, S1, 2).

Hamstrings (biceps, semitendinosus and semimenbranosus), (Fig. 59) flex the leg upon the thigh and hold the back of the hip down towards the knee. On walking and running each end of these muscles contracts as in a wave going down the muscle. This has to be Figure 109 coordinated with other muscles and lack of coordination is a common Figure 59 cause of accidents. Origin: just underneath the Gluteus Maximus on the pelvic bone; Insertion: tibia and fibula; Nerve: Sciatic and tibial nerves.

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Iliacus, (Fig. 60) pulls the femur up both from the sides and the back and so flexes and medially rotates the hip. Origin: Iliac fossa within abdomen. Insertion: Lowermost surface of lesser trochanter of femur. Nerve: Femoral nerve in abdomen (L2, 3). Pyriformis, (Fig. 61) is a postural muscle (it contracts on sitting with knees spread sideways); it draws the pelvis forward when it has been inclined backward, and a s s i s t i n steadying it upon the head of the femur. Externally rotates the hip & abducts thigh at the hip. Origin: anterior surface of sacrum, capsule of sacroiliac articulation, margin of the greater sciatic foramen and sacro-tuberous ligament. Insertion: superior border of greater trochanter of femur; Nerve: sacral plexus, (L5, S1, S2);

Figure 60

Figure 61

Psoas, (Fig. 62) is a hip flexor since it draws the femur forward (it is the first muscle used in bringing the leg forward in a running stride); it also helps stabilise the sacro-iliac joint and Figure 62 laterally rotates the hip. Origin: Transverse processes of L1-5, bodies of T12-L5 and intervertebral discs below bodies of T12-L4. Insertion: Middle surface of lesser trochanter of femur. Nerve: Anterior primary rami of L1, L2. Tensor fascia latea (tensor fascia femoris), (Fig. 63) stabilises the outside of both the pelvis and knee joint. It abducts and rotates the thigh inwards. Origin: Outer surface of anterior iliac crest between tubercle of the iliac crest and anterior superior iliac spine. Insertion: Iliotibial tract (anterior surface of lateral condyle of tibia). Nerve: Superior gluteal nerve (L4, 5, S1).

Figure 63

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Muscles of the neck and head

Obliquus capitis inferior (Fig. 64) Rotates atlantoaxial joint. Origin: Spinous process of axis (C2). Insertion: Lateral mass of atlas (C1). Nerve: Suboccipital nerve (C1).

Figure 64

Obliqus capitis superior (65) laterally flexes atlantoccipital joint. Origin: Lateral mass of atlas (C1). Insertion: Lateral half inferior nuchal line. Nerve: Suboccipital nerve (posterior primary ramus of C1)
Figure 65

Rectus capitis anterior major & minor (fig. 66) are the direct antagonists of the muscles at the back of the neck, serving to restore the head to its natural position after it has been drawn backward. These muscles also flex the head, and Figure 66 from their obliquity, rotate it, so as to turn the face to one or the other side. Origin: four tendinous slips, from the anterior tubercles of the transverse processes of the third, fourth, fifth, and sixth cervical vertebra. Insertion: into the inferior surface of the basilar part of the occipital bone. Nerve supply: C 1, C2;

Rectus capitis lateralis (Fig. 67) Acting on one side, it bends the head laterally. Origin: from the upper surface of the transverse process of the atlas; Insertion: into the under surface of the jugular process of the occipital bone. Nerve supply: C 1, C2;

Figure 67

Rectus capitis posterior major, (Fig. 68) extends the head and rotates it to the same side; Origin: from the lateral process of the axis; Insertion: the lateral part of the inferior nuchal line of the occipital bone and the surface of the bone immediately inferior to the line; Nerve supply: a branch of the dorsal ramus of the sub-occipital nerve;

Figure 68

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Rectus capitis posterior minor (Fig. 69) extends the head at the neck; with the rectus capitis major, they are the direct antagonists of the muscles at the back of the neck, and serving to restore the head to its natural position after it has been drawn backwards. They also serve to flex the head and rotate it so as to turn the Figure 69 face to one side or the other side. Origin: the tubercle on the posterior arch of the atlas; Insertion: the medial part of the inferior nuchal line of the occipital bone and the surface between it and the foramen magnum; Nerve supply: a branch of the dorsal primary division of the. Suboccipital nerve;

Scalene (scalenus anticus, scalenus medius and scalenus posticus) (Fig. 70) elevate the first and second ribs and are therefore respiratory muscles. They also bend the spinal column to one or the other side. When both sides act, lateral movement is prevented but the spine is slightly flexed. Origin: for the anterior scalene is the second rib, and the mid and posterior Figure 96 70 scalenes originate on the first rib. Insertion: For all three of the scalenes, on the transverse processes of the second through seventh cervical vertebrae. Nerve: 2nd to 7th cervical.

Splenius (Fig. 71) together, draws the head directly backwards and assist in supporting the head in the erect position Acting separately, they draw the head to one side or the other, and slightly rotate it, turning the face to the same side. Origin: Lower nuchal ligament, spinous processes and supraspinous ligaments T1-3; Insertion: Figure 97 71 Lateral occiput between superior and inferior nuchal line. Nerve: Posterior primary rami of C3, 4

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Sternocleido mastoid (Fig. 72) when working singly, draws the head towards the shoulder of the same side and rotates the head so as to carry the face towards the opposite side. When the head is fixed, the two muscles assist in elevating the thorax in forced inspiration. Origin: Sternal head: on the anterior surface of the top-front of the sternum. Clavicular head: upon the upper surface of the medial half of the clavicle. Insertion: Upon the lateral surface of the mastoid process and the Figure 72 superior nuchal line of the occiput. Its nerve supply is unusual in that it is double this makes it an important muscle for the balance and self righting mechanism of the head in relation to the body. Occipito frontalis (Fig. 73) is formed of 2 parts: the occipital and the frontal (some sources consider it as 2 distinct muscles). Neerve: facial nerve.

Occipital part weakly moves the scalp skin posteriorly. Origin: from the lateral two-thirds of highest nuchal line of occipital bone and the mastoid part of temporal bone. Nerve: from the posterior auricular branch. Frontal part weakly moves the scalp skin anterior, wrinkles the forehead and elevates the eyebrows. Origin: from the superior fibres of the superior facial muscles including: procerus, corrugator supercilii and orbicularis oculi. Nerve: from the temporal branches. Both part scalp. insertion into the galea aponeurotica over the

Figure 73 Figure 72

Orbicularis palpebrarum (Fig. 74) acts involuntarily, closing the lids gently, as in sleep or in blinking. Origin: from the bifurcation of the medial palpebral ligament. Insertion: into the lateral palpebral raph. Nerve: facial nerve.
Figure 74 Figure 73

Temporalis (Fig. 75) elevates mandible and post fibres retract. Origin: Temporal fossa between inferior temporal line and infra temporal crest. Insertion: Medial and anterior aspect of coronoid process of mandible. Nerve: Deep temporal branch from anterior division of mandibular nerve (C 5).
Figure 75

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Superior constrictor of the pharynx (Fig.76) constricts the wall of the pharynx during swallowing. It is one of the paired external muscles of the pharynx. Origin: inferior twothirds of medial pterygoid plate and on mandible. Insertion: backward into the median raphe. Nerve: via the pharyngeal plexus.

Figure 76

Buccinator (Fig. 77) aids mastication, tenses cheeks in blowing and whistling, aids closure of mouth. Origin: External alveolar margins of maxilla and mandible. Insertion: into various muscles at the corner of the mouth. Nerve: Buccal branch of facial nerve (VII).

Figure 77

Corrugator supercilii (Fig. 78) wrinkles forehead. Origin: Medial superciliary arch. Insertion: Skin of medial forehead. Nerve: Temporal branch of facial nerve (VII).

Figure 78

External pterygoid (Fig. 79) is a chewing muscle: it brings the jaw forward and opens it. Origin: inferior head from the pterygoid process, and superior head from the sphenoid bone. Insertion: into the mandible and the articular disk. Nerve: from the lateral pterygoid branch of the trigeminal nerve.

Figure 79

Internal pterygoid (Fig. 80) is a chewing muscle that raises the mandible and closes the jaw. Origin: from the pterygoid fossa of the sphenoid bone and the tuberosity of the maxilla. Insertion: into the medial surface of the mandible. Nerve: from the medial pterygoid branch of the mandibular division of the trigeminal nerve.

Figure 80

Masseter (Fig. 81) elevates mandible (enables forced closure of mouth). Origin: Anterior two thirds of zygomatic arch and zygomatic process of maxilla. Insertion: Lateral surface of angle and lower ramus of mandible. Nerve: Anterior division of

Figure 81

All rights reserved Muscles of the chest

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Diaphragm (Fig. 82) is the main breathing muscle and alters the pressure around the lungs to allow inspiration and holding of the breath. It forms the floor of the thoracic cavity and the roof of the abdominal cavity. During respiration, it descends as it contracts and ascends as it relaxes. Origin: from the circumference of the thoracic outlet; Insertion: converge into a central Figure 82 tendonsituated near the centre of the vault formed by the muscle, but somewhat closer to the front than to the back of the thorax, so that the posterior muscular fibres are the longer; Nerve: phrenic nerve. Intercostal external (Fig 83) fixes intercostal spaces during respiration. It aids in quiet and forced inspiration by elevating ribs; it is responsible for the elevation of the ribs, and expanding the transverse dimensions of the thoracic cavity . Origin: Inferior border of ribs as far back as posterior angles; Insertion: Superior border of ribs below, passing obliquely downwards and backwards; Nerve: Muscular collateral branches of intercostal nerves; internal (Fig 84) fixes intercostal spaces during expiration. Aids forced inspiration by elevating ribs; it is responsible for the depression of the ribs decreasing the transverse dimensions of the thoracic cavity; Origin: Inferior border of ribs as far back as posterior angles; Insertion: Superior border of ribs below , passing obliquely downwards and backwards; Nerve: Muscular collateral branches of intercostal nerves; innermost (Fig. 85) fixes intercostal spaces during respiration; Origin: Internal aspect of ribs above and below; Insertion: Internal aspect of ribs above and below; Nerve: Muscular collateral branches of intercostal nerve;
Figure 85

Figure 83

Figure 84

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Levator costalus brevis (Fig. 86), twelve in number on either side, assist in the elevation of the thoracic rib cage. Origin: from the ends of the transverse possesses of the seventh cervical and upper eleven thoracic vertebrae; Insertion: each is inserted into the outer surface o the rib immediately below the vertebrae from which it takes origin; Nerve: dorsal rami (C8-T11).

Figure 86

Levator costalus longus (Fig. 87), twelve in number on either side assist in the elevation o the thoracic rib cage. Origin: from the ends of the transverse processes of the seventh cervical and upper eleven thoracic vertebrae; Insertion: each of the four lower muscles divides into two fasciculi, one of which is inserted as for the brevis, the other passes down to the second rib below its origin; Nerve: dorsal rami (C8-T11).

Figure 87

Subcostalis (Fig. 88) depresses lower ribs and supports the muscles of the spine while lifting and keeping abdominal organs such as the intestines in place; it is usually welldeveloped only in the lower part of the thorax; Origin: Internal posterior aspects of lower six ribs; Insertion: Internal aspects of ribs two to three levels below; Nerve: Muscular collateral branches of intercostal nerves;

Figure

88

Transversus thoracis (Fig. 89) is in the same layer as the subcostal; it depresses the upper ribs; it separates the thoracic cage from the parietal pleura. Contraction aids in forced expiration by decreasing the transverse diameter of the thoracic cage. Origin: Lower third of inner aspect of sternum and lower three costo-sternal junctions; Insertion: Second to sixth costal cartilages; Nerve: Muscular collateral branches of intercostal nerves

Figure

89

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Pectoralis major clavicular (PMC), (Fig. 90) pulls the arm in and upwards towards the opposite ear. Origin: anterior surface of the medial half of the clavicle; Insertion: humerus; Nerve: lateral pectoral nerve and medial pectoral nerve (C5C6); major sternal (PMS), (Fig. 90) draws the arm in and down and turns the arm Figure 90 with the palm facing outwards Origin: anterior surface of the sternum, the superior six costal cartilages, and the aponeurosis of the external oblique muscle; Insertion: humerus; Nerve: lateral pectoral nerve and medial pectoral nerve (C7C8T1); minor, (Fig. 91) draws the ribs and shoulders together, stabilises the front of the shoulder, and raises the ribs in forced inspiration or when there is a problem with normal breathing. Origin: 3, 4, 5 ribs; Insertion: Medial and upper surface of coracoid process of scapula; Nerve: Medial pectoral nerve (C8, T1) (from medial cord).

Figure 91

Serratus anterior or serratus magnus (Fig. 92), on contraction, pulls the whole shoulder blade and tips it so that the shoulder joint is fixed in the glenoid cavity; it also holds the shoulder blade onto the rib cage with the rhomboids and middle trapezius. It carries the scapula forward and is concerned in the action of pushing. It also takes over the action of the deltoid, with the trapezius, to raise the arm from a right angle to the trunk to an Figure 92 almost vertical position. It also elevates the ribs Origin: Upper eight ribs and anterior intercostal membranes from midclavicular line. Lower four interdigitating with external oblique; Insertion: Inner medial border scapula. 1 and 2: upper angle; 3 and 4: length of costal surface; 5-8: inferior angle; Nerve: Long thoracic nerve of Bell (C5, 6, 7) (from roots) slips from ribs 1 and 2: C5; 3 and 4: C6; 5-8: C7).

All rights reserved Muscles of the shoulder and arm

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Anconeus (Fig. 93) It is a weak extensor of elbow and abducts ulna in pronation. Origin: Smooth surface at lower extremity of posterior aspect of lateral epicondyle of humerus; Insertion: Lateral side of olecranon. Nerve: Radial nerve (C7, 8)
Figure 93

Biceps, (Fig. 94) It flexes the elbow. Origin: long head: supraglenoid tuberosity of the scapula; short head: apex of coracoid process of scapula; Insertion: bicipital tuberosity of the r a d i u s ; N e r v e : musculocutaneous (C5, C6).

Brachialis anticus, (Fig. 94) Figure 94 flexes the elbow and protects the elbow joint. Origin: from the lower half of the front of the humerus; Insertion: into the tuberosity of the ulna and the rough depression on the anterior surface of the coronoid process. Nerve: from cervical nerves (C 5, C 6).

Brachioradialis, (Fig. 95) It flexes the elbow when the arm is turned so that the palm faces in and down. It only comes into action with lifting a weight above 2kg. Origin: Upper two thirds of lateral supracondylar ridge of humerus and lateral intermuscular septum; Insertion: Base of styloid process of radius. Nerve: Radial nerve (C5, 6).

Figure 95

Coraco-brachialis, (Fig. 96) draws the arm up and in. Origin: from the apex of the coracoid process, in common with the short head of the biceps brachii, and from the intermuscular septum between the two muscles; Insertion: by means of a flat tendon into an impression at the middle of the medial surface and border of the

Figure 96

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humerus between the origins of the triceps brachialis. Nerve: the musculocutaneous nerve. Deltoids (Fig. 97) Anterior: lifts the arm forward anterior border and upper surface of the lateral third of the clavicle; Middle: lifts the arm sideways at right angle with the trunk. Origin: from the lateral margin and upper surface of the acromion;

brachii

and

Origin:

from

the

Posterior: lifts the arm Figure 97 backwards Origin: from the lower lip of the posterior border of the spine of the scapula, as far back as the triangular surface at its medial end. . Insertion: all the fibers converge and are inserted into the V-shaped deltoid tubercle on the middle of the lateral aspect of the shaft of the humerus. At its insertion the muscle gives off an expansion to the deep fascia of the arm., Nerve: Axillary nerve (C5,C6) and lateral supraclavicular;

Infraspinatus, (Fig. 98) holds the arm in the shoulder joint, more or less opposite to the subscapularis. Origin: Medial three quarters of infraspinous fossa of scapula; Insertion: Middle facet of greater tuberosity of humerus and capsule of shoulder joint; Nerve: Suprascapular nerve (C5, 6 ) (from upper trunk)
Figure 98

Subclavius (Fig. 99) depresses clavicle and steadies it during shoulder movements. Origin: junction of 1st rib. Insertion: Subclavian groove on inferior surface of middle third of clavicle. Nerve: Nerve to subclavius (C5, 6, upper trunk).
Figure 99

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Triceps (Fig. 100) straightens the arm and also helps to pull the upper arm in; Origin: Long head: infraglenoid tubercle of scapula. Lateral head: upper half posterior humerus (linear origin). Medial head: lies deep on lower half posterior humerus; Insertion: Posterior part of Figure 100 Figure 60 upper surface of olecranon process of ulna and posterior capsule. Nerve: radial.

Muscles of the fore arm and hand

Abductor pollicis brevis, (Fig. 101) abducts the base of the thumb and assists in opposition, flexion and medial rotation. Origin:Transverse carpal ligament, the scaphoid and trapezium. Insertion: Radial base of thumb proximal phalanx and the thumb extensor mechanism; Nerve: motor branch of median nerve.
Figure 101

Adductor pollicis, (Fig. 102) holds the straight thumb against the palm under the index finger. Origin: transverse head: distal 2/3 of palmar surface of 3rd metacarpal bone; oblique head: capitate bone, base of 2nd and 3rd metacarpal bone; Insertion: two heads converge to insert onto ulnar sesamoid, lateral tubercle of proximal phalanx and the volar plate; Nerve supply: ulnar (C8-T1);

Figure 102

Extensor carpi radialis brevis and longus (Fig. 103) extends and abducts hand at wrist. Origin: common extensor origin on anterior aspect of lateral epycondyle of humerus; Brevis: Insertion: Posterior base of 3rd metacarpal; Nerve: Posterior interosseous nerve (C7, 8).

Figure 103

Longus: Insertion: base of 2nd metacarpal; Nerve: Radial nerve (C6C7);

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Extensor carpi ulnaris, (Fig. 104) extends and abducts the wrist and assists in the flexion of the elbow. Origin: common extensor origin on anterior aspect of Figure 104 lateral epicondyle of humerus; Insertion: Base th of 5 metacarpal via groove by ulnar styloid; Nerve: Posterior interosseous.

Extensor communis digitorum (Fig. 105) extends the phalanges, then the wrist, and finally the elbow. It acts principally on the proximal phalanges, the middle and terminal phalanges being extended mainly by the interossei and lumbricals. It tends to separate the fingers as it extends them. Origin: Common extensor tendon from lateral epicondyle of humerus, and deep ante-brachial fascia. Insertion: By four tendons, each penetrating a membranous expansion of the dorsum of the second to fifth digits and dividing over the proximal phalanx into a medial and two lateral bands. The medial band inserts Figure 105 into the base of the middle phalanx while the lateral bands reunite over the middle phalanx and insert into the base of the distal phalanx. Nerve: deep radial.

Extensor pollicis brevis & longus occasionally fuse together.

(Fig.

106)

Brevis extends the proximal phalanx. Origin: from the dorsal surface of the body of the radius. Insertion: into the base of the first phalanx of the thumb. Nerve: from the median nerve. Longus extends the terminal phalanx of the thumb; in combination with the extensor pollicis brevis, it helps to extend and abduct the wrist. Origin: from the lateral part of the middle third of the dorsal surface of the Figure 106 body of the ulna. Insertion: into the base of the last phalanx of the thumb. Nerve: Posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve.

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Flexor carpi radialis (Fig. 107) Flexes and abducts hand (at wrist). Origin: Medial epicondyle of humerus. Insertion: Base of 2nd metacarpal. Nerve: Median nerve (C6 and C7).

Flexor carpi ulnaris (Fig. 108) Flexes and adducts Figure 107 hand (at wrist). Origin: humeral head: medial epicondyle of humerus, ulnar head: olecranon and posterior border of ulna. Insertion: Pisiform bone, hook of hamate bone, and 5th metacarpal bone. Nerve: Ulnar nerve (C7 and C8).
Figure 108

Flexors digitis Brevis minimi digiti, (Fig. 109) flexes proximal phalanx of little (5th) finger. Origin: Hook of hamate and flexor retinaculum. Insertion: Medial side of base of proximal phalanx of little finger. Nerve: Deep branch of ulnar nerve (C8 and T1).

Figure 109

Profundus digitorum (Fig. 110) flexes distal phalanges at distal inter-phalangeal joints of medial four digits (one group flexes the second phalanx of each finger and the other group flexes the last phalanx of each finger.); assists with flexion of hand. Origin: Proximal 3/4 of medial and anterior surfaces of ulna and interosseous membrane. Insertion: Base of the distal phalanx of digits 2 5. Nerve: medial part: ulnar nerve (C8 and T1), lateral part: anterior interosseous branch of median nerve (C8 and Figure 110 T1).

Sublimis / superficialis digitorum, (Fig. 111) flexes the middle phalanges of the fingers at the proximal inter-phalanx joints, however under continued action it also flexes the metacarpophalangeal joints and wrist joint. Origin: median epicondyle of the humerus (common flexor tendon) as well as parts of the radius and ulna. Insertion: bases of the proximal phalanxes of the four fingers. Nerve: median nerve (C8 and Figure 111` T1).

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Flexor pollicis brevis, (Fig. 112) flexes the phalanxes of the thumb and assists its opposition to the little finger. Origin: Flexor retinaculum and tubercles of scaphoid and trapezium. Insertion: Lateral side of base of proximal phalanx of thumb. Nerve: Recurrent branch of median nerve (C8 and T1).

first

two

Figure 112

Flexor pollicis longus, (Fig. 113) flexes the thumb in towards the base of the little finger. Origin: Anterior surface of radius and adjacent interosseous membrane Insertion: Base of distal phalanx of thumb. Nerve: Anterior interosseous nerve (C7, 8).

Figure 113

Lumbricals (Fig. 114) with the help of the interosseous muscles, simultaneously flex the metacarpo-phalangeal joints while extending both interphalangeal joints of the digit on which it inserts. Origin: on the lateral side of the flexor digitorum profundus tendon corresponding to the same finger. Insertion: on the extensor expansion. Nerve: The first and second lumbricals (i.e. the two that are most lateral) are innervated Figure 114 by the median nerve (C8, D1). The third and fourth lumbricals (i.e. the most medial two) are innervated by the deep branch of the ulnar nerve (C8D1). Opponeus minimi digit (Fig. 115) draws the 5th metacarpal bone forward so as to deepen the hollow of the palm. Origin: convexity of the hook of the unciform bone. Insertion: into the whole length of the metacarpal bone of the little finger. Nerve: ulnar nerve (C8).

Figure 115

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Opponeus pollicis, (Fig. 116) flexes the base of the thumb in towards the little finger side of the palm. Origin: palmar surface of the ridge on the trapezium. Insertion: the whole length of the metacarpal bone of the thumb. Nerve: Median nerve (C6).

Figure 116

Pronator quadratus, (Fig. 117) rotates forearm and maintains ulna and radius opposed. Origin: Lower quarter of antero-medial shaft of ulna; Insertion: Lower quarter of anterolateral shaft of radius and some interosseous membrane; Nerve: Anterior interosseous nerve (C8)
Figure 117

Pronator radii teres (Fig. 118) helps to rotate the radius upon the ulna, rendering the hand prone (so that the palm faces downs towards the feet when the arm is bent, or behind when the arm is straight). When the radius is fixed it assists the other muscles in flexing the forearm. Origin: from the humerus for the larger head, from the inner side of the coronoid process of the ulna for the thinner head. Insertion: at the middle of the outer surface of the radius. Nerve: median nerve (C6).

Figure 118

In order to turn the arm as far as possible both pronator radii teres and pronator quadratus are needed.

Supinator brevis & longus, (Fig. 119) turns the forearm from palm down to palm up. Origin: Lateral epicondyle of humerus, radial collateral and annular ligaments; Insertion: Lateral, posterior and anterior surfaces of proximal 1/3 of radius. Nerve: Deep branch of radial nerve (C5 and C6).
Figure 119

All rights reserved Muscles of the abdomen

Abdominis, Obliquus externus (Fig. 120) flexes the trunk, twists the upper spine against the hips, diminishes the capacity of the abdomen and draws the chest down. Obliqus Origin: on the lower eight ribs; externus Insertion: on the outer anterior abdomini crest of the ilium and (via the sheath of the rectus abdomini Obliqus muscle) the midline linea alba; internus abdomini Nerve: from the ventral branches of the lower thoracic nerves.

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Figure 120

internus (Fig. 120) acts as an antagonist to the diaphragm, helping to reduce the volume of the thoracic cavity during exhalation. . Also, its contraction rotates and side-bends the trunk by pulling the rib cage and midline towards the hip and lower back, of the same side. Origin: from Pouparts ligament/inguinal ligament and the inner anterior crest of the ilium; Insertion: the lower two third in common with fibres of the external oblique and the underlying transversus abdominis, into the linea alba. The upper third inserts into the lower six ribs. Nerve: lower intercostal.

rectus, (Fig. 121) supports the digestive organs, flexes the trunk, aids forced expiration, raises intra-abdominal pressure and stabilises the spine. Origin: Pubic crest and pubic symphysis; Insertion: 5, 6, 7 costal cartilages, medial inferior costal margin and posterior aspect of xiphoid; Nerve: Anterior primary rami (T7-12). transversus (Fig. 122) helps to compress the ribs and viscera, providing thoracic and pelvic stability. Origin: from the lateral third of the inguinal ligament, from the anterior three-fourths of the inner lip of the iliac crest, from the inner surfaces of the cartilages of the lower six ribs,
Figure 121

Figure 122

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inter-digitating with the diaphragm, and from the lumbodorsal fascia; Insertion: together with the internal oblique muscle, into the crest of the pubis and pectineus line; Nerve: lower intercostal nerves, as well as the iliohypogastric nerve and the ilio-inguinal nerve; Pyramidalis, (Fig. 123) stabilises the spine, supports the digestive organs, twists the upper spine against the hips but is more active when the upper part of the body leans forward. Origin: Pubic crest anterior to origin of rectus abdominis; Insertion: Lower linea alba; Nerve: Subcostal nerve (T12).

Figure 123

When constricting the cavity of the abdomen with the help of the descent of the diaphragm, they expel: foetus from the uterus, faeces from the rectum, urine from the bladder and the stomach content in the act of vomiting. They also assist expiration, bend the thorax directly forward when muscles of both sides are working or to either side when those of the two sides act alternatively, rotation of the trunk at the same time taking place to the opposite side. Together, they can draw the pelvis upward as in climbing or, acting singly, they draw the pelvis upwards and bend the spine to one side or the other.

All rights reserved Muscles of the hip and the leg

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Adductors (brevis, longus and magnus) (Fig.124) pull the leg inwards and roll the thigh outwards (especially used in horse exercise). Adductor brevis and longus assist the psoas, pectineus and iliacus in fixing the thigh upon the pelvis. On walking, these muscles assist in drawing forward the hinder leg. Brevis: Origin: outer surface of inferior ramus of pubis; Insertion: on a line extending from lesser trochanter to linea aspera and proximal 1/4 of linea aspera; Nerve: Obturator, (L2, L3, L4); Longus: Origin: anterior of pubis in angle between crest and symphysis; Insertion: middle 1/3 of medial lip of linea aspera; Nerve: Obturator, (L2, L3, L4); Magnus: Origin: posterior fibres: ischial tuberosity and anterior fibres: ramus of ischium and pubis; Insertion: from a line extending from the greater trochanter Figure 124 along linea aspera, medial supracondylar line and adductor tubercle on medial condyle of femur; Nerve: obturator and sciatic nerves (L2, L3, L4, L5, S1);

Gastrocnemius, (Fig. 125) flexes the femur upon the tibia. It is constantly called upon in standing, walking, dancing, pushing the foot down or standing on the toes. Origin: Lateral head: posterial surface of lateral condyle of femur and highest of three facets on lateral condyle. Medial head: posterior surface of femur above medial condyle; Insertion: Tendo calcaneus to middle of three facets on posterior aspect of calcaneus; Nerve: Tibial nerve (S1, 2).

Figure 125

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Gluteus: maximus, (Fig. 126) stabilises the back of the hips on stepping up, prevents the forward tipping of the pelvis therefore helping the abdominals to maintain an upright posture against gravity when standing. It helps the hamstrings and replaces them when they are inactivated on bending the knees. It comes into action primarily when arching the whole body backwards, running, hoping, skipping and jumping. Origin: Outer surface of ilium behind posterior gluteal line and posterior third of iliac crest, lumbar fascia, lateral mass of sacrum, sacro-tuberous ligament and coccyx. Insertion: Deepest quarter into gluteal Figure 126 Figure 105 tuberosity of femur, remaining three quarters into iliotibial tract. Nerve: Inferior gluteal nerve (L5, S1, 2). medius and minimus, (Fig. 127) can be considered as one since they work very similarly. They help prevent excessive swaying of the Back hips on walking and running. They come into action in the weight Back Figure 127 bearing leg when lifting the other to Figure 127 take a step. They also are hip abductor, taking the legs out to the side. Origin: Outer surface of ilium between posterior and middle gluteal lines; Insertion: Posterolateral surface of greater trochanter of femur; Nerve: Superior gluteal nerve (L4, 5, S1). Gracilis, (Fig. 128) adducts the thigh inwards but also flexes the knee and hip together. It works together with sartorius. It also stabilises the inside of the knee joint. Origin: Outer surface of ischiopubic ramus; Insertion: Upper medial shaft of tibia below Sartorius; Nerve: Anterior Figure 128 division of obturator nerve (L2, 3). Peroneus, (Fig. 129) raises the foot from the little toe side (therefore working in opposition to both posterior and anterior tibials). It gives stability to the outside of the ankle. Origin: Upper two thirds of lateral shaft of fibula, head of fibula and superior tibiofibular joint. Insertion: Plantar aspect of base of 1st metatarsal and medial cuneiform, passing deep to long plantar ligament. Nerve: Superficial peroneal nerve (L5, S1).
Figure 129

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Popliteus, (Fig. 130) stabilises the back of the knee so that it will not bend backwards. It is especially called into action at the beginning of bending the knee, by producing a slight inward rotation of the tibia that is essential in the early stage of this movement. Origin: Posterior shaft of tibia above soleal line and below tibial condyles. Insertion: Middle of three facets on lateral surface of lateral condyle of femur. Tendon passes into capsule of knee to posterior part of lateral meniscus. Nerve: Tibial nerve (L5, S1). Psoas, (Fig. 131) is a hip flexor since it draws the femur forward (it is the first muscle used in bringing the leg forward in a running stride); it also helps stabilise the sacroiliac joint and laterally rotates the hip. Origin: Transverse processes of L1-5, bodies of T12-L5 and intervertebral discs below bodies of T12-L4. Insertion: Middle surface of lesser trochanter of femur. Nerve: Anterior primary rami of (L1, L2).

Figure 130

Figure 131 Pyriformis, (Fig. 132) is a postural muscle ( i t contracts on sitting with knees spread sideways); it draws the p e l v i s forward when it has been inclined backward, and assist in steadying Figure 132 it upon the head of the femur. Externally rotates the hip & abducts thigh at the hip. Origin: anterior surface of sacrum, capsule of sacroiliac articulation, margin of the greater sciatic foramen and sacro-tuberous ligament. Insertion: superior border of greater trochanter of femur; Nerve: sacral plexus, (L5, S1, S2);

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Quadriceps, (rectus femori, (Fig. 133) vastus intermedialis, (Fig. 134) lateralis (Fig.135) and medialis (Fig. 136) are a group of four muscles that sit on the anterior or front aspect of the thigh and extend the leg by straightening the knee. Rectus femori is also a hip flexor. Origin: at the top of the femur except for the Figure 133 Figure 134 Figure 135 Figure 136 Rectus femori which originates on the pelvis. Insertion: to the front of the tibia. Nerves: from femoral nerve (L2-3) and for the rectus femori also from the spinal nerve (L4);

Sartorius, (Fig. 137) helps to stabilise both the outside of the hip joint and inside of the knee. It helps the quadriceps as a hip flexor and knee extensor. Origin: Immediately below anterior superior iliac spine. Insertion: Upper medial surface of shaft of tibia. Nerve: Anterior division of femoral nerve (L3, Figure 137 4).

Soleus, (Fig. 138) points the foot and helps the gastrocnemius. On standing, it steadies the leg upon the foot and prevents the body from falling forward, to which there is a constant tendency from the superincumbent weight. Origin: Soleal line and middle third of posterior border of tibia and upper quarter of posterior shaft of fibula including neck; Insertion: Tendo calcaneus to middle of three facets on posterior surface of calcaneus; Nerve: Tibial nerve (S1, 2).
Figure 138

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Tensor fascia latea (tensor fascia femoris), (Fig. 139) stabilises the outside of both the pelvis and knee joint. It abducts and rotates the thigh inwards. Origin: Outer surface of anterior iliac crest between tubercle of the iliac crest and anterior superior iliac spine. Insertion: Iliotibial tract (anterior surface of lateral condyle of tibia). Nerve: Superior gluteal nerve (L4, 5, S1).

Figure 139

Tibialis: anterior, (Fig. 140) pulls the big toe side of the foot upwards towards the head, stabilises the inside of the ankle and controls swaying when standing. Origin: Upper half of lateral shaft of tibia and interosseous membrane. Insertion: Infero-medial aspect of medial cuneiform and base of 1st metatarsal. Nerve: Deep peroneal nerve (L4, 5).

Figure 140

Posterior, (Fig. 141) stabilises the inner ankle joint and helps to point the toes by pointing the foot. It is an important factor in maintaining the arch of the foot. Origin: Upper half of posterior shaft of tibia and upper half of fibula between median crest and interosseous border, and interosseous membrane. Insertion: Tuberosity of navicular bone and all tarsal bones (except talus) and spring ligaments. Nerve: Tibial nerve (L4, 5).

Figure 141

All rights reserved Muscles of the foot

Abductor hallucis (Fig. 142) abducts the great toe from the others and flexes its proximal phalanx. Supports medial longitudinal arch. When weak, this muscle often leads to formation of bunion, flat foot and consequent knee problems. Origin: Medial process of posterior calcaneal tuberosity & flexor retinaculum; Insertion: Medial aspect of base of proximal phalanx of big toe via medial sesamoid; Nerve: Medial plantar nerve (S1, 2).

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Figure 125 142

Dorsal interossei (Fig. 143) assists in flexing the proximal phalanx and extending the middle and distal phalanges of the toes. It also abducts the toes from the longitudinal axis of the 2nd toe. Origin: there are 4 dorsal interossei which arise by double fibres from the bases and sides of the bodies of adjacent bones; Insertion: base of the proximal phalanx and aponeurosis of the tendons of the extensor digitorum longus. The first dorsal interosseous (arising from the 1st and 2nd metatarsals) inserts into the 2nd toe. The 3rd to 4th dorsal interossei insert into the lateral sides of the 2nd, 3rd, and 4th toes; Nerve: Lateral plantar, (S1, S2).

Figure 126 143

Extensor digitorum brevis, (Fig. 144) extends the phalanx of the four inner toes, but only acts on the first phalanx of the big toe. Origin: Superior surface of anterior calcaneus; Insertion: Four tendons into proximal phalanx of big toe and long extensor tendons to toes 2, 3 and 4; Nerve: Deep peroneal nerve (L5, S1).

Figure 127 144

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Extensor digitorum longus (Fig. 145) extends toes and extends foot at ankle. Origin: Upper two thirds of anterior shaft of fibula, interosseous membrane and superior tibio-fibular joint; Insertion: Extensor expansion of lateral four toes; Nerve: Deep peroneal nerve (L5, S1).

Figure 145

Extensor hallucis brevis (Fig. 146) extends the big toe. Origin: Superior surface of anterior calcaneus; Insertion: Proximal phalanx of big toe; Nerve: Deep peroneal nerve (L5, S1).

Figure 146

Extensor hallucis longus (Fig. 147) extends big toe and foot. Inverts foot and tightens subtalar joints; Origin: Middle half of anterior shaft of fibula. Insertion: Base of distal phalanx of great toe; Nerve: Deep peroneal nerve (L5, S1).

Figure 147

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Flexor digitorius brevis, (Fig. 148) flexes lateral four toes and supports medial and lateral longitudinal arches. Origin: Medial process of posterior calcaneal tuberosity; Insertion: Four tendons to four lateral toes to borders of middle phalanx. Tendons of flexor digitorum longus pass through them. Nerve: Medial plantar nerve (S1, 2).

Figu8re 148

Flexor digitorius longus (Fig.149) flexes distal phalanges of lateral four toes and foot at ankle. It also supports lateral longitudinal arch. Origin: Posterior shaft of tibia below soleal line and by broad aponeurosis from fibula; Insertion: Base of distal phalanges of lateral four toes; Nerve: Tibial nerve (S1, 2).

Figure 149

Flexor hallucis brevis, (Fig. 150) flexes metatarso -phalangeal joint of big toe. It also supports medial longitudinal arch. Origin: Cuboid, lateral cuneiform and tibialis posterior insertion over the two remaining cuneiforms; Insertion: Medial tendon to medial side of base of proximal phalanx of big toe. Latera tendon to lateral side of same, both via sesamoids; Nerve: Medial plantar Figure 150 nerve (S2, 3).

Flexor hallucis longus (Fig. 151) flexes all joints of the big toe and plantar flexes the ankle joint. Origin: posterior aspect of upper 1/3 of the fibula; Insertion: base of distal phalanx of hallux; Nerve: tibial nerve, (S1 & S2 nerve roots).

Figure 151

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Lumbricals (Fig. 152) extend toes at interphalangeal joints and flex metacarpalo-phalangeal metatarsophalangeal joints. Origin: Lateral 3: bipennate origin from cleft between the four tendons of flexor digitorum longus. Medial 1: unipennate origin from medial aspect of 1st tendon; Insertion: Dorsal extensor expansion; Nerve: First: med plantar N (L4, 5). 2-4: deep branch of lateral plantar nerve (S2, 3).

Figure 152

Plantar interossei (Fig. 153) adducts 3rd 4th and 5th toes to axis of 2nd toe and assists lumbricals in extending interphalangeal joints whilst flexing metatarso-phalangeal joints. Origin: Inferomedial shafts of 3rd, 4th and 5th metatarses (single heads); Insertion: Medial sides of bases of proximal phalanges with slips to dorsal extensor expansions of 3rd, 4th and 5th toes; Nerve: Deep branch of lateral plantar nerve (S2,S3). Figure 153 Quadratus plantae (Fig. 154), flexes toes, stabilises the inside of the ankle and helps in pointing the foot (for ballet dancers). Origin: Lateral headtuberosity of calcaneus, medial head-medial side of calcaneus; Insertion: Lateral border long flexor tendons; Nerve: Lateral plantar (S2, S3).

Figure 154

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The cells structure

All living things are made of microscopic units called cells. The of one cell only. Man is made of widely in structure and function common. protoplasm which exists in amoebae in pond water consist millions of cells which vary but have certain features in

The cells function

At conception, all there is of the embryo is a little ball of inner cells mass. Through division and relocation, will grow rom this a baby! In order to specialise and be more efficient, cells have modified their structure and lost or reduced their versatility:

- fat cells lose their power of contraction and secretion; muscle cells reproduction; have diminished powers of secretion and

- nerve cells lose their power of reproduction; A nerve will only be able to restore itself by growing a new axon which is the main conducting fibre of the nerve, a bundle of these making up the peripheral nerves. The repair is anyway much slower than that of a muscle which should be kept in mind when assessing a patients condition.

Cells extra dimension

Cells seem to have an intelligence of their own: the first pressing of an olive gets much less oil than the subsequent ones, once the olive has understood what is wanted of it. A physical exercise is often executed better at the second or third attempt: athletes are given 3 trials at jumping or throwing weight or javelin. J. Upledger reports studies indicating a degree of "decision making" taking place in the hands of a musician without CNS input. He suggests "perhaps these powers develop in these peripheral locations in response to a person's need to develop certain skills." (28) Cells seem to have a memory too: homeopathic remedies do not contain anything left of the initial ingredient, yet not only convey but even magnify their properties. The Bach flowers are another example. Also area of old injuries healed long ago can still be tender although without recognisable reason. "An area of the body that has been seriously hurt is going to send thousands of sensory messages into the spinal cord segments and brain areas

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be . imprinted into the nervous system similar to imprinting a message on a tape recorder." (21) "The tissues and the nervous system "remember" the injury and its pattern of dysfunction long after healing has occurred." (29)

Cells formation
Cells alike are arranged together to form tissues: - epithelia (lining) is a sheet of cells with minimum intercellular substance that lines all internal and external surfaces of the body; - connective (supporting) is formed of cells and large amount of intercellular matrix and extra cellular elements and forms framework connecting, supporting and packing tissues for the body; - muscular is formed of elongated cells with special development of contractility; - nervous is divided into neuron or nerve cells (specialised in irritability, conduction and integration) and Glial cells, (accessory and supporting cells, NOT receptive, NOT conducting); The tissues are arranged to form organs, and the organs are grouped into systems. The systems do not work independently. The body works as a whole. Health and well-being depend on the coordinated effort of every part. And this is the tenet of the holistic alternative medicine.

Repetitive stress injury (RSI)

The repetitive use of a muscle or group of muscle in an excessive way may cause an inflammation of the fibres that is referred to as repetitive stress injury. It usually is relieved by massaging and balancing of the tonus of the muscles involved.

All rights reserved Kinesiology

Definition

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Kinesiology (from the Greek words "KINEIN", to move, and "LOGOS", to study) is the scientific study of movement. The primary aims of Kinesiology are: understanding the human body's physiological and psychological responses to acute short-term physical activity, understanding the various adaptations of the human body to chronic or long-term physical activity, understanding the cultural, social, and historical importance of the physical activity, understanding the mechanical qualities of movement, understanding the processes that control movement and the factors that affect the acquisition of motor skills, and understanding the psychological effects of physical activity on human behavior. To achieve these aims, research in Kinesiology requires the use of a variety of scientific knowledge and research techniques from such fields as biology, chemistry, history, physics, psychology, and sociology. The areas of investigation within Kinesiology are quite extensive because the responses of the human body to physical activity can be examined at many levels (from cellular to whole society). Applied kinesiology Applied Kinesiology (AK) evaluates structural, chemical and mental aspects of health using manual muscle testing with other standard methods of diagnosis. Treatments may involve specific joint manipulation or mobilization, various myofascial therapies, cranial techniques, meridian and acupuncture skills, clinical nutrition, dietary management, counselling skills, evaluating environmental irritants and various reflex procedures. AK uses the Triad of Health. That is Chemical, Mental and Structural factors that balance the major health categories. The Triad of Health is interactive and all sides must be evaluated for the underlying cause of a problem. A health problem on one side of the triad can affect the other sides. For example, a chemical imbalance can cause mental symptoms. AK enables the practitioner to evaluate the triad's balance and direct therapy toward the imbalanced side or sides.

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Dr. George Goodheart Jr., D. C. (Fig. 155)

Figure 155

Dr. George J. Goodheart, Jr., D.C. (1918 - 2008) He was a chiropractor who practiced in association with his father in Chicago. He served in the World War II in innovative air operations research and was released from the United States Air Force when 22 as the youngest major ever. He resumed active practice with his father until his death in the early '60s. His time in the Air Force had given him a taste for innovative opportunities, and also taught him a practical method of dealing with problems. He accidentally successfully treated unusual cases by: massaging the attachment of a muscle found weak upon testing it according to Kendall & Kendall's Muscle Testing. palpating a "problem" muscle.

the use of Dr. Frank Chapman's neurolymphatic reflexes based on the theory of a relationship between muscles and the fact that the bones of the skull move as you breathe. (He refined it by the way with controlled respiration as an application of cranial technique). These points increase the lymphatic drainage, upon massaging, with resulting improvement of the state of the organ, glands or muscles in the area. Applying/verifying many of the Bennett reflexes related to muscle weakness. There now was another method, called the neurovascular reflex technique. Dr. Terence Bennetts neurovascular points, were found, on stimulation, to increase the blood flow to specific organs and muscles. Relating to kinesiology the acupuncture knowledge that four points stimulate and four points sedate an area or organ, He wrote the first book showing acupunctures relationship to applied kinesiology in 1966.

Applied kinesiology is based upon the fact that body language never lies. The opportunity of understanding body language is enhanced by the ability to use muscles as indicators of body language. The method for testing muscles and determining function remains the original method first advocated by Kendall and Kendall (This method is used by military, civil and government agencies to rate

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Once muscle weakness has been ascertained, a variety of therapeutic actions is available. The body heals itself in a sure, sensible, practical, reasonable, observable, predictable manner. "The healer within can be approached from without." Man possesses a potential for recovery through the innate intelligence or the physiological homeostasis of the human structure. Touch for health It is a simple, non-intrusive method of re-educating body and mind to help balance all aspects - structural, postural, chemical, nutritional, mental and emotional. It is for Practitioners and nonpractitioners alike and has no prerequisites.

Figure 156

Dr. John F. Thie (19332005) (Fig. 156) Even before their marriage, Carrie and John Thie had a vision of helping families to be healthier through natural methods. After working with Goodheart for a number of years, Carrie and John felt that a book for lay people should be written, and encouraged George to write it on numerous occasions. Eventually he said, "If you want a book for lay people, you will have to write it yourself." The Charter members of the International College of Applied Kinesiology (ICAK) formed the consensus that the ICAK was to be exclusively for licensed-to-diagnose professionals. When the first TFH school was set up the people trained to be certified TFH Instructors were only required to agree to teach only Touch for Health in their classes. They agreed that if they added or deleted significant material to their teaching of the TFH material, they would call their class something other than Touch for Health. Hence the rapid development of so many varied approaches to Kinesiology, which share as their foundation the basic concepts and techniques of TFH. Touch for Libra is one of them!

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Figure 157

Paul E. Dennison, PhD & his wife, Gail Hargrove Dennison (Fig. 157) BRAIN GYM is the registered trademark for Educational Kinesiology and is the introductory level Edu-K program. It develops the brain's neural pathways the way nature does: through movement. BRAIN GYM addresses the physical (rather than mental) components of learning. It builds on what the learner already knows and does well and feature self-help activities. Patterns of stress and addiction are explained in terms of the brain and physiology. The 7 Dimensions of Intelligence After he discovered his Laterality Re-patterning, he started focusing on adults. Edu-K In Depth is The 7 Dimensions of Intelligence. It is a facilitated process that is experienced oneon-one with a Licensed Instructor/Consultant and helps the repatterning of the various sections of the brain and facilitates their integrative functions. Creative Vision material, In 1984, he began working with Gail Hargrove Dennison with whom he developed other elective courses. Gail Dennison helped to systematize the Edu-K materials and, together they developed : Vision Gym activities, and Vision circles program. Health Kinesiology

Figure 158

Jimmy Scott, Ph.D (Fig. 158) He was interested in the use of muscle testing to help people overcome allergies, environmental pollution and geopathology. He developed what is now a worldwide group of health workers using his method which he calls Health kinesiology.

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Emotional Freedom Technique - EFT

Figure 159

Cary Graig is the pioneer of EFT (Fig. 159) This technique is based on the meridian system which transports energy around the body. Fear and stress result in blockages in this system. EFT stimulates a number of major meridian points. When the blockage is softened or removed, energy flows freely and you experience a sense of calm and well being. EFT protocol can be used for addictions, anxiety, fears and much, much more. Tapas Acupressure TechniqueTAT

Figure 160

It was developed in 1993 by the acupuncturist Tapas Fleming (Fig. 160). She furthered EFT to clear negative emotions and past traumas.

Testing
The way to practice kinesiology is by using the muscles of the patient. One usually choose a convenient muscle like the supra spinatus and very lightly the practitioner presses on the patients arm who must resist him. Since the pressure is very light, the resistance should also be.

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Libra, and anything connected to it, may be practiced on a clothed patient or on his bare skin. If the clothed version is chosen, very thick coats or pullovers should be removed as well as shoes, belt, glasses and the content of pockets emptied in order not to cause discomfort. Patients wearing jeans should be requested to open up the 1st button as the seams are too thick to permit any feeling. If the bare skin version is preferred, the sexual organs remain covered by a towel provided and an oil is used to allow the gliding of the hand on the skin without causing any burning. Here aromatherapy blends in beautifully (see Useful herbs p 157). Besides these, Libra may also use the trigger points or any of the various techniques referred to latter, in the section of Manual techniques.

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This is not a treatment but an integration of various techniques that can relax a patient sufficiently to bring his body to a state of receptivity to a treatment. It can be done indifferently on clothes or on the bear skin. The contact is at no moment interrupted between the patients body and your hands. Prone position 1. After grounding yourself, very gradually allow your hands to penetrate through the various layers of the patients aura until they finally rest on his body at both ends of the spine. 2. Gentle, easy gliding massage along both sides of the spine to start from the bottom to the top, repeated 2-3 times and finishing at the top to allow 3. Massaging of the neck, shoulders, down both arms until joining both hands with the patients and stretching his arms downwards; 4. Leave his hands and place yours on the side of his hips, massage the sacral area and slowly go up again whilst crowding the whole length of the spine 5. Gently pull the hair of the patient, lock after lock, to cover the whole of his scalp (whenever there are any hair!) 6. With the 2nd knuckle of the bent indexes, supported by the thumbs under them, massage strongly in one long slow stroke, from the base of the skull to the coccyx, exactly on either side of the spine (on the erector spinae/sacrospinalis); 7. Come back to the head, without contact, and resume the same long slow stroke towards the coccyx but, this time, with the whole of the flattened 1st and 2nd phalanxes of the 4 fingers 8. Come back to the head, without contact, and resume the same long slow stroke towards the coccyx but, this time, with the whole of the hand and, instead of stopping at the coccyx, slide on down the whole length of both legs, down the foot and toes and throw this energy away (preferably on a plant) 9. One arm at a time is massaged from shoulder to hand with side to side stokes 10. The hand is lifted whit your 2 thumbs between the patient thumb and index and ring finger and auricular. Your other fingers are then free to make a deep massage in slight traction 11. With the heel of your hands you pick up and uncurl the patients naturally curled up fingers. With both hands around the patients wrist, you massage all his arms meridian. 12. Then you pass onto the other arm; 13. One leg at a time is being swung gently to and fro, the knee is returned to the table in a slightly opened position and the foot of that leg is pressed on in order to approach it from the

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opposite buttock, without forcing. 14. The leg is then kept bent at 90o and the hamstrings and gas trocnemius are swung gently side to side 15. The leg is then stretched on the table, the ankle resting on your thigh so that you can massage the sole of the foot and toes; 16 Make an anklet with your 2 hand around the ankle of the patient and gently rub them to stimulate all the legs meridians.

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Lesson 3
Yang meridians of the arm
((Fig. 161)

Figure 161

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Where two or more bones articulate together, there is a joint.(8, 13) (Fig. 162) The bones meeting surface is covered by cartilage. In order to avoid friction between two surfaces moving on one another, a synovial membrane secretes a lubricant: synovia. Joints involve bones, c a r t i l a g e s , ligaments, synovial membranes and synovia. There are three sorts of joints: immovable, Figure 162 mixed and movable. However, there is a slight movement, even in the immovable joints like those of the cranium, and this is in fact the basis of cranial adjustment.

Joints Head

of

the

The skull (Fig. 163) comprises 8 bones, amongst which we are interested in: the sphenoid, which articulates with all the bones of the cranium; the occipital, which articulates, amongst others, w i t h t h e parietals, the temporals, the sphenoid and the attached to 12 muscles, amongst interested in:

atlas. It is which we are

Figure 163

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- the occipito-frontalis, since it is liable to cause constricting headaches; - the trapezius and SCM (sterno-cleido-mastoid), since they are liable to cause stiff neck as well as headaches on the side of the head; - the various capitis, since they are liable to cause tensed neck and headaches at the back of the head; and - the superior constrictor of the pharynx, since it is liable to cause a knotted pain at the back of the throat. the two parietals, which have temporal, which is liable to head as well as toothache in each others, the occipital, temporal. only one muscle attached to them: the cause headaches on the side of the the back teeth. They articulate with the sphenoid, the frontal and the

the frontal, which articulates with 12 bones, amongst which the sphenoid, the parietals, the superior maxillaries and the malars. It is attached to 3 pairs of muscles: - the corrugator supercilii, which is responsible for headaches from frowning; - the orbicularis palpebrarum, which is responsible for headaches from eye fatigue; and - the temporals, which are liable to cause headaches on the sides of the head as well as toothaches in the back teeth. the two temporals, which articulate with 5 bones, amongst which the occipital, the parietals, the inferior maxillary, the sphenoid and the malars. They are attached to 15 muscles, amongst which we are interested in: - the temporals, which are liable to cause headaches at the sides of the head and toothaches in the back teeth; - the masseters, which are liable to cause headaches at the sides of the head and toothache in the back teeth; - the SCM (sterno cleido mastoid), which is liable to cause headaches at the back or the sides of the head and aches on the chin, the face and the front of the upper neck; - the occipito-frontalis, which is liable to cause constricting headaches; and

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- the splenius, which is liable to cause headaches at the top of the head. The face includes 14 bones, amongst which we are only interested in: the two nasals, which, amongst other bones, articulate with each other and the frontal. They are attached to a few fibres of the occipito-frontalis. the two maxillae or superior maxillary, which are attached to 12 muscles, amongst which we are only interested in: - the masseters, which are liable to cause headaches at the sides of the head as well as toothache in the back teeth. the two malars, which are attached to 4 muscles, amongst which we are only interested in: - the masseters, which, amongst other bones, articulate with the frontals, the temporals, the sphenoid and the maxillae. They are liable to cause headaches at the sides of the head as well as toothaches in the back teeth.

the mandible or inferior maxillary, which is attached to 15 pairs of muscles, amongst which we are only interested in: - the masseters, which articulate with the temporals. They are liable to cause headaches at the side of the head and toothaches in the back teeth.

Joints of the Neck and Trunk

The spine (Fig. 164) The following joints are available to treatment:

Figure 164

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the occipital to the atlas. (Fig. 165) Its flexion is due to the action of the rectus capitis and the SCM (sterno cleido mastoid). Its extension is due to the action of the rectus capitis, the splenius, and the upper trapezius, amongst others. Its lateral movements are Figure 165 due to the action of the trapezius, the splenius and the SCM of the same side, amongst others; the 33 vertebrae which articulate on each other and with the disks between them through various ligaments found in front of the spine, behind it, and between the various parts of the vertebrae; (Figures 166, 167 & 168)

Figure 166 Figure 167

Figure 168

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the ribs with the vertebrae; the cartilage of the ribs with the sternum involves the origin of the pectoralis major; and (Fig. 169) which

Figure 169

the spine to the pelvis through ligaments linked to the psoas and the quadratus lumborum. The pelvis (Fig. 170) The following joints are available to treatment: the sacrum to the ischium through the great sacro-sciatic ligament in which originates the gluteus maximus, and which intermingles with the

Figure 170

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pyriformis and the sacrum to the coccyx (Fig. 171 & 172) through 5 ligaments, one of them being connected to the gluteus maximus. The ossa pubis This joint involves 5 ligaments, one of them mixed with the external oblique and the rectus.

Figure 171

Figure 172

Joints of the Upper Extremities

the sterno clavicular joint involves 6 ligaments, all affected indirectly by the trapezius, the levator scapulae and the SCM as well as by the rhomboids to raise the clavicle, the pectoralis minor helping the trapezius in depressing it, the rhomboids and the trapezius drawing it back and the serratus magnus and pectoralis minor drawing it forward; the acromion clavicular joint involves 4 ligaments affected by the trapezius, the deltoid and the supraspinatus; the shoulder joint involves 4 ligaments affected by the brachialis anticus, the triceps, the teres minor, the subscapularis, the infraspinatus, the biceps and the deltoids; the elbow joint involves 4 ligaments affected by the brachialis anticus, the triceps, the flexor carpi ulnaris and the supinator brevis; the radio ulnar joint is affected by the biceps, the supinators brevis and longus and the pronator and extensor brevis pollicis. All the following joints are affected in some degree by the flexor and extensor carpi: the wrist joint; (Fig. 173) the carpal joint; (Fig. 173)

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the metacarpal joint of the thumb with the trapezium; (Fig. 173) the metacarpal joint of the 4 fingers with the carpus; (Fig.173) the metacarpal joints with each others; (Fig. 173) the metacarpal phalangeal joints; (Fig. 173) and the phalanx joints. (Fig. 173)

Figure 173

Joints of the Lower Extremities

the hip joint (Fig. 170) involves 5 ligaments affected by muscles including the psoas, the iliacus, the rectus, the gluteus minimus, the pectineus and the pyriformis. the knee joint (Fig.174) involves 12 ligaments affected by the quadriceps, the sartorius, the gracilis, the popliteus, the gastrocnemius and the hamstrings. the tibia with the fibula joint involves 3 ligaments affected by the tibialis anticus and posticus and the peroneus. the ankle joint involves 4 ligaments affected by the toes extensor and flexor, the tibialis anticus and posticus and the peroneus. The following joints are affected in some degree by the peroneus, the tibialis posticus, and the toes extensor and flexor: the tarsal joint; (Fig. 175) the tarso metatarsal joint; (Fig. 175)

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the metatarsals joints (Fig.. 175) ) with each others.

Figure 174

Figure 175

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The spine is involved with the rest of the body in different ways:

Structurally, giving support to the head and trunk, and articulating the head, the ribs and the hips.

Figure 176

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enervating the various organs can, and often do, affect functioning of the organ itself or of the muscles around it.

the

Figure 177

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In many cases a single spinal nerve supplies an area of the skin called dermatomes, (Fig. 178) or a group of muscles called myotomes, (Fig 179).

Figure 179

Figure 178

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A sclerotome is a deep somatic track that is innervated by the same spinal nerve. When the tissue of a sclerotome is irritated, pain is felt as originating from all of the tissues that are innervated by the same nerve, or along the sclerotome. (Fig. 180)

Figure 180

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For the adjustment of any joint in the body, the practitioner has one hand holding the painful joint and with the other hand he gently activates the joint within the limits of its ease and comfort. He will then understand the type of misalignment and decide on which muscles to correct so that they can again maintain the bones of this specific joint in their rightful position. However, there are some joints that cannot be held in the practitioner's hand: those of the ribs with the vertebraes, those of the ribs and clavicle to the sternum, those of the pelvic to the sacrum, The sacrum itself, that can have one side tilted forward; All these joints, can be treated in exactly the same manner as the vertebraes. The joints of the wrist and ankle deserve a special mention: because of the multifaceted articulation that their various bones have one with the other, it is impossible to adjust one specific bone. The solution is to gently stretch the painful wrist or ankle and carefully move it in the direction opposite to the pain: given the space to move freely, the bones will return by themselves to their rightful position.

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If it is thanks to the muscles that the bones are kept in place, it is thanks to the nerves that the muscles are activated. The nerves form the nervous system. The nervous system (Fig. 181) is divided in groups: the brain and spinal cord that form the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). As its name implies, the PNS is made up of a collection of nerves either taking messages from wherever in the body to the spine or from it to wherever in the body. In the CNS, the spine either passes on the information of the PNS to the brain through various pathways and conveys the brain decisions, or shortcuts this process and relays an automatic message to the muscles or organs.

Figure 181

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Libra has no influence on the CNS nor on the autonomic nervous system (part of the PNS that controls visceral functions) but it can affect the rest of the PNS. (Fig. 182, 183 & 184)

Trigeminal nerve
Figure 182

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Arms nerves

Figure 183

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Legs nerves

Figure 184

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The Gate Control (Fig. 185) theorys idea was that of Dr. Melzack and Dr. Wall. In 1965 they observed that small diameter nerve fibres carry the pain stimuli through a gate mechanism, but large diameter nerve fibres going through the same gate inhibit the transmission of the smaller nerve fibres. In other words, the pain signals can be interfered with by stimulating the periphery of the pain site, the appropriate nerve (that carries the signals) at the spinal cord or particular corresponding areas in the brain stem or cerebral cortex. In practice, this gives the practitioner the
possibility to enable relief of pain through massage, rubbing, etc. Like Molieres Bourgeois gentilhomme who spoke in prose without knowing it, we apply the Gate theory whenever we rub the spot we just hurt!

Figure 185

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Lateral position The side you start on is irrelevant since you work on both. The head rests on a pillow and so does the folded leg of the opposite side the patient lays on. The leg he is laying on is straight. 1. 2. Gently massage 3 points on the temple in a vertical line going from the hairline to the ear Same gentle massage to 3 points at the back of the middle of the ear, at the back of the bottom of the ear and at the fold of the ear with the jaw Take the neck between the opened thumb and index (the other fingers in the direction of the head) and slowly ring the neck on 3 different levels (from near the mandible towards the shoulder and from the front to the back) With both hands you hold the upper trapezius and swing it back and forth, each hand in its different direction The arm of the patient is lifted and your outer hand placed, from below his arm, on the front of his shoulder (your fingers should be facing you). You hold the shoulder firmly in place and with the heel of your other hand you press the base of his skull in a slow stretching. The hand that was at the base of the skull replaces our other hand which take the patients forearm just above the wrist and give an other long, slow stretch. the arm is then folded with the hand up and gently rotated from the front to the back in slight upward stretching Whilst the outer hand holds the arm, the other one, laying on the shoulder with the fingers forwards, rotates the shoulder from back to front Then the 2 rotations are repeated simultaneously 2 or 3 times The fist is placed on the patients hip, like a Cossack, and the whole arm is massaged in slow circular bracelets going down from the shoulder to the wrist and from the front to the back The hand is held between your 2 hands and you play with the metacarpal bones, then massaged each finger individually from the palm of the hand to their tips The hand is gently placed on the treating bed in front of the patient and the TFL and peroneus are massaged in a descending side swaying massage the whole length of the folded leg The massage flows to the straight supporting legs tibialis and adductor The same is repeated on the other side

3.

4. 5.

6.

7. 8.

9. 10.

11.

12. 13. 14. 15.

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Lesson 4
Yin meridians of the leg
(Fig.186)

Figure 186

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Common joints problems

In the head, a recurring condition is that of the temporal mandibular joint referred to as TMJ (Fig. 187)

Figure 187 In the spine, the most current problem is usually referred to as slipped disc, expression that can cover a wide variety of disc problems. However, a disc cant slip because of the way it attaches to the spinal bones above and below it. A disc can bulge. It can tear. It can herniate. It can thin. It can dry out. And it can collapse. But it cant slip (Fig. 188)

Figure 188

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The thinning or degeneration of the disc may cause a nerve impingement (Fig. 189) and the disc herniation may cause a spinal stenosis (Fig. 190).

Figure 189

Figure 190

Another condition related to aging is called spondylitis: it is a bony over growth of the vertebrae with eventual fusion of the vertebraes (Fig. 191)

Figure 191

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Another condition of the spine is known as spinal shock due to an injury to the spinal cord. It develops within a few minutes of the injury and is not permanent. For the first 3-4 weeks there will be *Relaxed muscles; *Complete lack of reflexes; *Loss of control autonomic; *Loss of all sensations under the siege of the lesion; Afterwards: *Exaggerated reflexes; *Spastic paralysis; *Return of autonomic activities, but damaged. In the shoulder, we speak of frozen shoulder (Fig. 192) and in the elbow, of tennis elbow (Fig. 193)

Figure 192

Figure 193

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A very current problem of the wrist is the carpal tunnel syndrome (Fig. 194): the median nerve is compressed by irritated and swollen tendons and/or by slightly misplaced radius and ulna.

Figure 194

The problems in the hand can be caused by osteoarthritis (Fig 195) or by an irritation of the flexor tendon of one of the fingers. Its swelling may then catch on at its entrance in the particular joints tendon sheath and cause a trigger finger (flexor tendinitis) (Fig 196). Another accident may occur on impact of the end of the finger with a sudden force causing the rupture of the extensor tendon (mallet finger) (Fig. 197)

Figure 196

Figure 195

Figure 197

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Problems in the hip joint are usually due to osteoarthritis (Fig.198).

Figure 198

Those of the Knee joint can be caused by osteoarthritis (Fig. 199), by overuse of the patellar tendon from jumping (Fig. 200), bursting of the synovial bag from blow (Fig. 201) or damage to the cruciate ligaments (Fig. 202) or to the meniscus (Fig. 202).

Figure 199

Figure 200

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Figure 202

Usual problems of the ankle involve sprains (stretching of the ligaments), sub luxation (tearing of the ligaments) or luxation (the torn ligaments allowed bones movements) (Fig. 203 & 204)

Figure 203

Figure 204

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A lot, if not all, the usual problems of the foot are self inflicted through wearing the wrong shoes (Fig. 205, 206, 207, 208 & 209). I am referring here to bunions, heel spur, tendonitis, fasciitis, Haglunds deformity and hallux vagus.

Figure 205

Figure 206

Figure 208 Figure 207

Figure 209

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Cerebro-spinal fluid (CSF)

For the spines energetic involvement, we have to look at the CSF. It is secreted from special points of the membrane of the walls of 4 cavities (ventricles) in the brain. It is made of water, minerals, glucose, plasma proteins, creatinine and urea and is slightly alkaline. There is some re-absorption by some cells of the ventricules. CSF has 4 functions: To support and maintain the brain and the spinal cord. To maintain a uniform pressure around them. To act as a cushion or shock absorber between the brain and the cranial bones. To keep the brain and the spinal cord moist. There might also be an exchange of nutrients and waste products with the nerves cells. CSF flows from the roof of the 4th ventricle, and completely surrounds the brain and the spinal cord. According to medical books, its circulation is assured by the pulsation of blood vessels, respiration and change of posture. However, we also know that CSF travels through the lymphatics to all areas of the body (14, 15). And, as to its functions, it has been described as an intelligent potency that is more intelligent than your own human mentality.(16) It seems to act as a storage field and a conveyor for the ultrasonic and the life energies... it is the liquid medium for the life energy radiation, expansion and contraction. Where this life energy is present there is life and healing with normal function. Where it is not acting in the body, there is obstruction, spasm or stagnation and pain.(17)

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Cranial sacral therapy uses the cranial rhythmic impulse (CRI) and cranial sutural mobility (Fig. 210). We do not study CRI here, but in conjunction with Libra, basic techniques of cranial sacral therapy can be employed. Holding tissues, sutures, joints in a position of relative comfort or ease (as in the Vspread technique or 4th ventricular compression) often lead to a normalisation, or balancing, or release of the dysfunctional pattern, either completely or partially.(18) The signs to wait for to know that the release has been completed are: - A sense of steady, strong pulsation or greater warmth filling the area; - A very definite reduction in palpated tone and - A sense releasing. that the tissues being held are lengthening or
Figure 210

A soothing massage is then suitable locally. Such release may also involve deeper emotional unblocking which may be accompanied by any of the following symptoms: - Flushing. - Perspiration on the upper lip or the brow. - Change in breathing pattern. - Rapid eye movement. - Restlessness, twitching, trembling. - Vomiting, crying, or laughing. Psychological knowledge is needed to manage the reappearance of emotions which might have been bottled up for decades and that the patient might neither understand nor know how to deal with. The patient should be referred to professional help.

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Since we are not performing an operation or taking an X ray, we have no mean to know the situation of the biggest part of each vertebra. What we can do, however, is feel their spinal process (or central protuberance) with a finger, running it gently, firmly and slowly along the line of these protuberances. It is obvious that if the central process has moved, it has not done so alone but indeed together with the rest of the vertebrae! We start with the middle and lower dorsal area as it is the easiest to feel and work on. Very soon the practitioner realises that here and there the smoothness of the line is interrupted: the spinal process protrudes straight out, or on a side, or sinks in, again either straight in or on a side. There are combinations of the placing which might entail a protruding part of the process whilst the rest is sunk in! In these cases, it is a good idea to get the whole of the process either in or out and then, finalise the placing. The patient experiencing pain at the same point usually confirms the palpation of the practitioner identifying the location of the problem. There are a few cases, especially chronic ones, where the problem has existed for so long that the muscles around, even after relaxation, are still tensed enough to protect it and not allow pain. If, on palpation, a problem is noticed which does not arise pain, it should be returned to after correction of the nearest painful luxation and relaxation of the related muscles. In all probability, the pain will now be allowed to be felt. If not, the problem might be congenital or some birth condition which does not require attention. After correction of a problem, the patient will confirm, that no pain remains and another vertebra can be taken care of. So far, through palpation, we have located the luxation. All that is left to do is to figure out which muscle, on activation, will return the vertebra into place. (The vertebra is being referred to since its process has obviously not moved independently). The following are only general rules as no two bodies are identical and the degree of suppleness and fitness of the patient means a lot of difference in the treatment. For the middle dorsal, the lifting of the arm for protruding vertebra, or pressing of them for sunken in vertebra is usually successful. For the majority of people, the activation of the arm opposite the side of the problem is the rule. But there are exceptions to all rules and here again, occasionally, we meet with a patient who requires an activation of the same side as the problem.

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When it is a question of straight out or in, both arms have to move together, using the same strength. Again it should be emphasised that there is no competitive spirit in the exercises. Indeed, it is not the completion of the movement but rather its initiation which is important: the mobilisation of energy to accomplish it is what matters. This leads to two further points. The first is that a complete relaxation is necessary between each repetition of the movement. The second is that even if the patient is too weak to actually move his arm, the concentration of his energy towards this purpose is enough. An easier variation of the arm movement is that of the elbow, or sometimes the shoulder. The raising or bending of the head is also very useful: since the spine starts at the base of the skull and finishes at the coccyx, the motion of the head affects the entire spine. Also pressing of a fist, knee, foot or forehead can be effective. A further improvement is the execution of any exercise on exhaling. In some cases, the practitioner can assist the patient by raising his arm or leg and gently rotating it. If it is the arm, care has to be taken to rotate it from front to back to avoid any risk of dislocation. All these possibilities can be done freely or against the practitioner's resistance, but again, it is never a competition or show of strength. When the practitioner decides that he should apply some resistance, this is obviously measured and adapted to the tonus, fitness and strength of the patient: Arnold Schwarzenegger would not require the same resistance than a toddler or a grand mother would! During all the treatment the palpating finger of the practitioner should remain on the vertebra being treated as it serves a double purpose: through it, the practitioner is constantly monitoring the effectiveness of the treatment, but also it helps the body to concentrate its effort to this specific vertebra and none other. And so it is that the same movement will correct individually vertebra after vertebrae by just moving the monitoring finger from one to the other. There are some obese patients on whom it is impossible to feel any spineous process because of the amount of fat tissues that cover them. The practitioner has there to rely on his patient's comments and use his guidance to decide which movements to carry on doing.

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It is useful to get a patient's cooperation as to the progress of the treatment: the original pain can be marked at ten, its absence at zero and the progress towards its disappearance on this scale between zero and ten. Never forget to advocate a long, hot shower as soon as possible after the treatment: the warmth of the water will further the relaxation as will, too, the gentle massage of the shower. Baths are never a good idea since the entrance into and exit from the bath require tricky coordination and the sitting/laying inside the bath is against the golden rule of a healthy spine. It is wise to prepare the patient to the possibility of a reaction to the treatment: despite its extreme gentleness, an exacerbation of the original pain occasionally occurs and the patient, if warned, will accept it without panic. From the ninth dorsal, the motion of the arm needs usually to be replaced by that of the legs, or knees, or hips with exactly the same variations as for the arms, elbows and shoulders. For the lumbar and sacral vertebras and the coccyx we follow exactly the same procedure as for the lower dorsal. We can choose a variety of movements to be performed by the head, legs, knees or hips. The cervical vertebras are the most limited in the choice of movement since they can only be affected by the head, down to the fifth cervical. Then the arms exercises can also be effective.

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(Fig. 211, 212, 213, 214, 215, 216 & 217)

Figure 212

Figure 211

Figure 214

Figure 213

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Figure 215

Figure 217

Figure 216

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Supine position The patient has a pillow under his head and under his slightly folded knees 1. With your 2 thumbs, trace a (not too!) firm line from the top of the nose (between the eyebrows) to the hairline 2. Another 2 on either side, opening like a fan 3. Place one hand on the patients ear of the same side and ever so gently turn his head until the whole weight of his head rests into your hand. 4. With the other ones thumb, caterpillar walk firmly on a line going from the back lower part of the ear, around its curb, till its meeting of the front of the ear with the hairline, then trace back again but aiming higher until you reach the middle of the back hairline, and up again opening the arc even further to reach the bony corner of the forehead, and back again, this time aiming for C1. Its makes a curvy zigzag! 5. You place your hand on his hear and again, ever so gently, turn his head the other side yo repeat the same and very slowly return the head in a straight position 6. With both thumbs, 3 very hard massages on the eyebrows, directly above and still a little higher 7. Back on the eyebrows, down along both sides of the nose and as a moustache between the tip of the nose and the upper lips, from the centre to the side, very hard (it should open up the sinuses that may have been blocked by the laying proned) 8. Now, as hard as you used your 2 thumbs just now, use them so delicately that y9ou could be massaging the wings of a butterfly in order to give 1 slow stroke to the eyelids and directly under the eye, from the nose to the side. 9. On each side in turn, return to very firm points pressing all along the edge of the ocular cavity (take car NOT to press on the eye) 10. Rub your 2 hands together to gather energy and cup the eyes with them, without pressing, and gradually lifting your hands when you feel it is time 11. Massage firmly 3 points along the ear on either side of the cheeks (top, middle and lower meeting of the ear with the cheek) 12. Massage under the zygomatic bone and open to points-press along the edge of the maxillary. 13. As you reach the middle of the chin, you repeat the same but on the under side of the maxillary going up, this time, to the ears. 14. Each ear should be given a complete massage between thumb and index, then the whole ear should be pulled towards the top of the head, to the back and towards the feet

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15. Place both flat hands on the forehead and glide them gently down towards the neck to open up at the clavicles and glide towards the shoulders. Repeat 2-3 times 16. One hand on the floating ribs glides diagonally between the breasts to the opposite shoulder, alternating, one side after the other a few times 17. On getting the patients agreement, place both hands flat on his abdomen and circularly massage it by simply pressing the edge of your hands without moving them 18. Again, swing the abdomen between both tips of your fingers and both heels of your hands, 19. Placing your hand vertically and using the tips of all your fingers together, IN TIME WITH THE PATIENTS BREATING (in on his expiration and out on his inspiration), deeply press your fingers as if they were on the segments of a clock 20. Put both your hands under the waist of your patient as in an embrace and all but lift his body up whilst sliding your hands forwards, crossing them over in the air over his abdomen and turning your body to allow you to resume the same position, but inversed. 21. Take one forearm, just above the wrist, and vigorously shake it on the bed (like a dusty carpet). Keep one hand as a bracelet above the wrist and the other under the armpit to give a long, slow stretching. Repeat on the other arm. 22 Massage in a swinging zigzag down the leg of one of the legs, then move the cushion onto the other leg only, fold it slightly more and swing the completely relaxed muscles sideways Do the same to the other leg. 23. Sit down to be at the level of the patients feet and give each one of them a thorough massage (this is not reflexology). Finish by holding both his 3rd toes between your thumbs and your majors to reunhite both halves of his body and allow him to lay down a few minutes whilst you wash your hands off his energy.

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(Fig. 218 & 219)

Figure 218

BL

Figure 219

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Lesson 5
Posture
A correct use of the body is the key to avoid the need for Libra! ...amongst mammals, man has the most economical of antigravity mechanisms once the upright posture is attained. The expenditure of muscular energy for what seems to be a most awkward position is actually extremely economical. (19) Posture is a composite of the positions of all the joints of the body and muscle balance at any given moment. Our bodies have evolved with two gentle curvatures in the spine which give it a spring-like quality. This has the effect of absorbing the impact shock of our weight against the floor we stand on, walk on, run on or jump on. Through this spring, our weight should fall straight between our two feet, exactly in front of the base of our legs, at the highest point of the bridge of the feet: the neutral position of the pelvis is conductive to good alignment of the abdomen and trunk, and that of the extremities below. The chest and upper back are in a position that favours optimal function of the respiratory organs. The head is erect in a well-balanced position that minimises stress on the neck musculature. (11) This description of the perfectly poised posture is seldom met and we tend to look more like one of the illustrated figures below (Fig. 220).

Figure 220

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Yet, we can see and recognise this perfect posture amongst top dancers and athletes who, no matter their specialty and the pressures they might meet in their performances, always emanate a feeling of grace and ease. Also, they always seem to have all the space and time they need because they are in perfect harmony with themselves and the world For most of us, however, this posture might be that of a dream or, even, we might never have contemplated the possibility to aim at it. Yet, whatever shape our body is, it has served us reasonably well so far: you are more alive than dead, you are more out of pain than in it, and you are more in than out of balance. (20) Recognition can be the start of a journey towards the natural state of ease, balance, and integration. (20) So let us observe our posture and see whether we are respecting our bodys design or abusing it. Again, we notice that this affects all levels of our person: when respected, a balanced posture structurally enables us to breath fully, our blood circulation is unimpaired, our digestion unobstructed; with this optimum services, the body emanates its maximum energy, allows clear thinking, undisrupted concentration, confidence, efficacy and level temper. When we deviate from our blueprint, all levels will also be affected: constriction in whatever area will affect negatively at least one, if not all, of our basic functions. With poorer maintenance, our bodies will only provide us with limited amounts of energy, whilst some of it will be wasted in posturing and compensating in order to attempt to maintain our regular activities. This constant restriction of freedom of movement is coordinated by our subconscious giving it a constant managing task which distracts some of its thinking and concentrating power. Thus handicapped, we become unsecured, hesitant, less competent and irritable. Modern man seems to have lost his innate knowledge of what is good for him to do or eat. He needs instructions, more and more detailed, to compensate for his growing lack of common sense in the use of anything from a car to dental floss. We are born with a built in users instructions manual that young children use instinctively . Up to the age of two, the toddler who has conquered gravity instinctively knows how to bend down, to crouch, and to sit. He has not yet had time to learn from and imitate his parents and their errors or problems. The genetic explanation, although convenient, does not cover character traits running in families like protruding bottoms, pushed out stomachs or sunken-in chests. The fact that adopted children

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eventually achieve some resemblance with their adoptive parents proves that a lot is imitative posturing or expression. This should then be a manual for correct use of our body to enable us to enjoy its performances to their optimum and for a guaranteed life time!

Standing
Lots of us have been amused by the seemingly complete passivity of sentries (Fig. 221). Seemingly, because in order to resist the pull of gravity, there is an incessant ballet of muscles adjusting each other within the context of constant movements like breathing, heart beats, blood circulation, etc... If we observe ourselves in a mirror whilst standing, we will notice that there is a constant adjustment between the muscles of our lower back and our ankles. A side view of us standing will allow us to detect whether, or not, and where we deviate from the ideal elongated S we are supposed to have. It will enable us to see whether our weight is falling directly in front of our legs, on our toes or on our heels; and to see how our hands are falling, whether they are facing our body as they should, or whether they are facing back when the shoulder girdle is too relaxed, or front when it is too tight. A front view will help us to determine whether our feet are well placed under our hips, or too far apart or too close together; and whether our weight falls evenly distributed between the heels, the small toe and the base of the big toe.
Figure 221 Once we have observed where we deviate from the ideal still with the help of the mirror we should try to correct our stance. Since there is no strong construction without solid basis, a good idea is to start from the feet and work our way upwards. Although the result witnessed by the mirror might be satisfying, it very often feels awkward if not simply uncomfortable. It is time to let go, relax in our usual ways, and shake ourselves back to our old patterns. Then, with closed eyes, this time, we should try again to reach this ideal stance, from the feet upwards, remembering the inside map of corrections we had to make. Once we feel confident we stand correctly, we open our eyes and check in the mirror for confirmation. After having done this exercise several times, we should be more able to judge the precision of our alterations and reach a

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satisfying result quickly. This does not mean that we are yet feeling more comfortable in this correct posture. In order for this to be achieved we will have to first attempt to stand correctly as often as we can think about it: whilst we are queuing for a bus, at the bank, speaking on the phone, waiting, etc... It might not be for more than a few seconds at a time, but very quickly our bodies will understand the point of the exercise and find a way to remind us about it: like feeling tired, with a lower backache, or pains in the legs or feet which will disappear on correcting our stance. We might go through a transitional phase where we actually experience slight discomfort from groups of muscles that are suddenly put to work after having been redundant for many years. It will take a long time for this ideal posture to become ours naturally again, if ever. But, very quickly, if we are attuned to our body reminders, we will be able to actively maintain it often enough and for long enough to experience its benefit.

Sitting
Again, if we look at a toddler sitting down (Fig. 222): he is quite at ease, with his legs apart and relaxed on the ground, and his torso directly above his pelvis. When we sit down on the ground, we tend to tense our legs and either arch our torso to place it in front of our pelvic girdle, or slouch it behind our pelvic girdle with our shoulders rounded. The same is true for sitting on a chair with the added complication of our legs going either forward and slouching our backs, or under the chair and arching it forward, or being crossed one on the top of the other with the possible combination of either the forward Figure 222 or backward tilt but, in any case, seriously impeding our blood circulation. The same method of corrections by the side of a mirror will help us achieve and maintain a posture of comfort and ease.

Sitting down and getting up

It is not by chance that our stomach muscles are amongst the strongest muscles we have: they are supposed to provide a support for the

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free-standing lumbar part of the spine. Below, it is taken care of by the pelvis, above by the ribs, and the neck section is seemingly encased in a tube-like system of muscles. And as muscles need antagonists, we have on our thighs again very strong muscles indeed. These come into action with the stomach or should do, each time we sit down or get up: between the three of them, they should concentrate our centre of gravity and allow a smooth and controlled ascent or descent, instead of the too common dumping and hoisting often requiring the help of the shoulders and arms muscles too.

Walking and running

Once we stand properly, it is childs play to walk properly. The only extra care is the use of the foot. It is surprising how few people merely lift their foot up, place its heel on the ground in a straight line in front of the corresponding hip and roll on it whilst passing their weight over it. There are all kinds of deviations to this straightforward procedure: some people give a kind of incomplete kick inwards, towards their supporting leg, or outwards, or they roll their supporting foot in, or out, or they place their foot flat on the ground not allowing any rolling at all... The centre of gravity should always remain between the two legs. Running is more of a step. The give speed very much the same as walking, simply faster and with spring to allow an exaggerated motion and length of centre of gravity should then be slightly forward to to the motion.

Jumping
Oddly enough, few mistakes are made whilst jumping. Presumably, the motion is too fast for any body to have time to concentrate in making mistakes. The only recurring one is to tense the shoulders upwards supposedly in an attempt to lift up the weight of the body. The landing is sometimes awkward, forgetting that the bending of the knees and their use as shock absorbers is vital. Their use as springboard at the beginning of the jump is better applied, instinctively.

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Bending
Forwards: (Fig. 223 & 224) Before anything, the golden rule remains that any heavy weight should be picked up through bent knees, like weight lifters do. However, a lot of bending forward involves no weight at all, like putting ones shoes on. In these cases it is important to remember the way a crane functions the heavier the load the crane has to lift, the further it moves its counter-weight away. The human body is built on the same principle and if we take into account the weight of our head, arms and trunk, we find that they probably weigh about twelve kilograms all together. According to how much we intend to lower this dead weight, we should push out our buttocks (our built-in counter-weight) through our stomach muscles. The motion can be minute, like when sweeping the floor, or quite noticeable, when picking up a fallen tissue. The best example is laying down plates on a table: there is no way that we can throw the plates, nor can we genuflex to deposit each plate on the table. Yet there is a slight bending involved and, for each plate, there should be a slight push from our stomach muscles sending the top of our legs and our buttocks out and supporting the arch of our bending lower back.

Figure 223

Figure 224

There is a further detail which needs attention: on this bending forward, and especially with a person who is suffering from lower back pains, the tendency will be to point the behind out, not using the stomach muscles and, if bending the back at all, doing so in the middle or upper areas. The mistake is easy to detect since the curvature of the lumbar section is then concave and a hand placed on the stomach will feel it completely relaxed. The correct forward bending should present a convex curvature of the

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A correct use of the body is indispensable after a Libra treatment in order to maintain its benefit. In specific cases, when the practitioner feels the need, he can give some maintaining exercises to his patient to do.

Maintenance exercises
In many cases, despite the agreement from the patient that the pain on the vertebra itself has disappeared, it remains around the vertebra or on one of its side. Even in the absence of this confirmation, the muscles in the area are still perturbed and the whole muscular system around the correction has to be again relaxed and encouraged to keep it up by rebalancing their tonus. An easy way to do so is using "Touch for Libra". Usually, at this stage, the cause of the luxation has become clear. Advice should be given to avoid its recurrence. This might include adjusting the height of a chair, moving a television or computer The time has also come to speak about exercises to complete and preserve the adjustment. Until there is no more pain, none should ever be encouraged: a moved vertebra is nothing else than a sprain and rare are those who decide that a brisk, long walk is what a sprained ankle needs! Everybody agrees that the minimal use of the ankle for a few days will ensure a prompt recovery. Once this is established, a gradual return to full activity will precede some further training to strengthen the injured muscles. The same protocol should be applied for any sprain, irrelevant of its site. Exercises will vary according to the vertebra involved. None should ever be repeated a great number of times or for hours. It is much more profitable to do an exercise only once or twice but regularly every day. Lots of the following exercises can be done under a shower whilst the hot water is lightly massaging the affected part. When they require laying down, it is never on a bed but rather on a carpet. For the cervical and upper dorsal These are very useful for computer/machinery operator or students and can be done in situs.

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For the upper and middle back "top stretch" (Fig. 225): hands are clutched and inverted and arms are raised above the head as far back as possible. When this is comfortable, the head can be rolled from side to side.
Figure 225

"back stretch" (Fig. 226): with the arms at the back, the hands are clutched and inverted and then raised as high as possible. Again, when comfortable, the head can be rolled from side to side.
Figure 226

"hanging" (Fig. 227): hang by the hands from the top edge of a door jamb and take a few deep breathes.

Figure 227

For the lower back and lumbar/sacral region "belly dancing" (Fig. 228): with knees slightly bent and perfectly immobile shoulders, do a belly dance in both directions.

"gate" (fig. 229): a knee is lifted until the thigh is parallel to the ground, then the leg is turned sideways like a gate being "opened". This is finished off by the foot of the raised leg giving a quick backwards. This should be done by both legs, in turn.

Figure 228

Figure 229

"soft jumps": a few soft, gentle jumps, kept low and relaxed, on the same spot. The feet may barely leave the ground.

"fencing jump" (Fig. 230)

small, low, short jumps with one leg in front lounge. It should be repeated an equal number of times with both legs or done alternatively, changing legs during the jump unless otherwise specified by the practitioner.
Figure 230

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For the lower back more especially, but also the rest of the spine "cobra" (Fig. 231): sitting on the feet from a kneeling position, bending forward through the stomach muscles only, the head is placed on the floor and straight arms are stretched forward on the ground. With the inspiration, the body is raised "on four" and its weight shifted forward until the abdomen lies on the floor and the torso is raised on the two straight arms. In this position, the expiration is started with the head Figure 231 tilted back. It is continued whilst bending the head down and reverting the movement of the body all the way back to the starting position. "pussy cat" (Fig. 232): on all four, sitting on the feet, the elbow and hands placed flat on the floor. The feet, knees, hips, shoulders, elbows and hands should aim at making two parallel lines. We pretend to be a cat busy licking milk spilled in front of it. At the furthest point of the stretch, when the back is concave, we notice a dog and arch our back (now convex) before resuming the starting position. Figure 232 For the whole of the spine To be done first thing in the morning and last thing at night: "camel" (Fig. 233: from a kneeling position and sitting on the feet, bend forward through the stomach muscles only until the head is placed on the floor. The arms are laid, relaxed, along the Figure 233 torso, on the ground. In this position, take a few deep breaths and enjoy! To get up, again with the stomach muscles only, raise the body back to the starting position. This can also be done whilst sitting down, bringing the chest on the knees and letting the head and arms hang down. But, here again, the stomach muscles are the only one to lower, and then raise the torso back to normal sitting position. For the pelvic "the sink" (Fig. 234): hold the edge of the sink or any stable piece of furniture. Stand bare feet with the legs apart making sure that the feet are placed directly under the hips. Without raising the heels from the floor, nor protruding the behind, we crouch all the way down opening the

Figure 234

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all the way down opening the knees sideways if needed and take a few deep breathes in that position before getting up again. If we cannot go all the way down, it is more important to respect the position than to shift it to go lower. In time, we will reach the floor correctly. It is more profitable to do this exercise once each time we approach the sink than several times in succession at long intervals. For the stomach to protect the lower back "sitting back" (Fig. 235): sitting on the floor, arms close to the chest, hands on the shoulders, elbows glued to the torso, knees bent up and feet flat on the floor, we slowly go backwards, using the stomach muscles only until we feel we cannot go any further without falling. We come back up and repeat the exercise a few times. "climbing" (Fig. 236): laying on the back, the legs are raised straight at right angle with the ground, feet stretched. Raising the head and shoulder, we attempt to slide our hands up our legs to touch our toes.

Figure 235

"Yael's" (Fig. 237): laying on the back, knees bent, feet flat on the ground, we lift our feet quickly up and down just off the ground for a minimum of twenty times. The number of repetition can be increased as the tonus of the muscles improves.

Figure 236

Figure 274

"pelvic tilt" (Fig. 238): laying on the back, knees bent, feet flat on the floor, arms on the floor on either side, the lower part of the buttocks is raised from the ground, so little that the hips do not loose contact with Figure 238 it. The position is not kept. Instead it is repeated in rhythm with the breathing, the pelvic gently and smoothly rocking a few times. bottom lifting (Fig. 239): laying on the back, legs straight up at 90o, arms on the floor on either side, we lift legs and behind off the ground upwards through the stomach muscles only.
Figure 239

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For the whole of the back muscles: "1-2-3-4" (Fig. 240): laying on the stomach, arms straight up on either side of the head, on one, we lift both arms, without the head, as high as possible without holding the position. On two, we lift the whole of both legs straight up as high as possible, without holding the Figure 240 position. On three, both arms are lowered to the side of the body and we bend sideways to try and reach the knee with one hand, without holding the position. On four, we repeat the same movement on the other side.

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Lesson 6
Environment
We have already noted the inter-relation and influence that the physical body and the emotive field have on each other. When a patient cannot explain a symptom through a physical cause, it usually has an emotive one: caught necks and backs have been caused by difficulties within a couple, the disappearance of a partner with the cash, problems at work... The probing has obviously to remain extremely discreet and never intrude into the privacy of the patient, but questions like: Have you had a particular worry just before the appearance of your symptom? is often greeted as a revelation mixed with disbelief. As soon as the connection is acknowledged, the treatment will be more efficient, the muscles will let themselves get unwound and the pain will disappear. But there are also physical factors that can influence the body to the point of causing problems. Ecological ones can involve cold draught eventually freezing a group of muscles, noise, magnetic and low electrical field pollutions causing enough tension to cramp muscles. A television watched at an angle, a computer badly placed, and a telephone cradled in a shoulder, are often the culprits in many neck, shoulder and back problems. Colours, as such or as lights,(26) can also be involved: black is extreme and allows the visible world to go into the spiritual; blue softens body tissues, dissolves structures; its use may help remobilising of psychological and physiological patterns, removing obsessional ideas and behaviour patterns and reducing tension; it calms, relaxes, and expands the space; blue-violet is warm, comforting, and good for sufferers of claustrophobia, asthma and inferiority complex; brown sacrifice; is the colour of integration and offering, even

gray is the colour of denial, perhaps the most negative of all the colours, that of self denial, evasion and non commitment; green reduces the body rhythms, hardens; its use is physically balancing, helps feel enclosed in a secure space, removes fear, anchors and increases tension but it is a static environment which does not promote vitality nor assist relaxation; it is the most unpleasant illumination and can deplete very quickly; magenta is an enhancer of the effects of violet and induces relaxation to the point of avoiding challenge, detachment, ultimately dangerous for those so inclined since they may resort to

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suicide; red is energising, speeds up the body rhythms, invigorating and produces activity but, if overpowering, it may induce violence; its use may help concentrating and recovering selfawareness; red-orange is compelling and as a pattern, the more complex, the more absorbing it will be to the detriment of anything else; turquoise is calming to nervous dispositions and stressful conditions; violet synchronises the body rhythms; its use may help raising of dignity and self respect and balancing out of manic depressive and depressive states of mind; it brings out the devout, religious and pious aspects of the personality; white excludes, isolates; it is purity as a non experience; yellow causes hyperventilation and may let us lose our anchorage or focus; its use may be tension inducing and may help reduce introverted personality; as a combination of colour and light, it is not a good environment for humans and induces a detachment from consciously responsible behaviour, irrationality, nervousness, uncertainty and even violence; Smells They can, too, be influential on the health and, when negative, may cause postural tension. Some homeopathic treatments are being given by merely sniffing the remedy. Inversely, some smells can originate headaches, nausea, etc.

Diagnosis
Ohashi devoted a whole book on Reading the body which I have tried to summarise here. The patient is intelligently guessing as to the diagnosis, the physician is scientifically guessing as to the diagnosis, but the patients body knows the problem and is out picturing it in the tissues. (21) It is therefore all important to be able to assess these symptoms. This is our diagnosing. It includes several approaches: - seeing, observing the patient; - touching the patient, feeling his life; - asking questions of the patient; - listening to and smelling the patient. Seeing We usually think of observing with our eyes, but here we should

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observe with our whole body. To succeed, the first requisite is to make the patient sense our openness, our absence of prejudices or judgment, our conviction that together, we will find a way to better health. (22) Then, we let the patients energy wash over us, his personality impresses itself on us, his life force affects us, to get a sense of his vibration. This empathy is the best proof of our readiness to understand the patient fully and let him remain at ease, unselfconscious. So now we can observe the body language of our patient: the way he stands, walks, sits, and talks taking care not to lose ourselves in details but to keep to the meaningful larger picture. Sometimes I ask the person to lie on a mat and I cover him or her from head to toe with a sheet. This is so revealing! Now I do not see any details of the persons face or clothes. I do not get distracted... I see only the most obvious contours of the body. (22) We should act as artists looking at the patient like a great work of art. And like all art, the more we practice it, the better we get at it. Touching Then we should touch the patient, but also his inner core. A good example is a handshake. The very fact that we are not ready to shake hands with everybody is an admission that through a handshake there is a subtle communication of information about our inner self. When we touch a patient, our fingers and palms become our sight to the extent that it is sometimes easier to close our eyes. We are trying to understand this patient on every level: physical, emotional, psychological and spiritual. Questioning The obvious diagnostic technique is that of asking questions. Less obvious, however, is our attitude. We should listen to the answers to our questions, but also to what is not said. A good example is that of a patient who came to me for a scoliosis but forgot to mention the cancer she had just recovered from...! Abundant facial or hand movements may try to distract us from the topic covered. Legs or arms crossing may close the body off on a sensitive issue. This is the area where sensitivity and respect of the patients privacy have to be applied. We are to probe unobtrusively within the limits allowed to us by the patient and not demand and walk away with extracted information. It is more important to have but a partial knowledge and retain the trust of the patient so that a relationship is established which will enable further treatment and, may be, further disclosure, than to have a complete, even if reluctant, coverage and lose him. For this reason, it

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is vital that neither embarrassment nor humiliation intrude in our patients rapport. Listening We listen to the words our patient is uttering, their meaning, the way they are said. But, also, we listen to the quality of the voice, not just with our ears, but again with our whole body in order to feel where its vibration comes from: a deep voice might come from as low down as the navel; an emotional voice will come from the heart; an angry one from the liver; a frightened one from the kidney; a weak or thin one from the sinuses; a sympathetic one from the spleen. Although words, their choice and the subject they cover can hide feelings and emotions, the voice often will reveal them. Smelling Smelling does not mean that we have to go sniffing all over the patients body! An obvious example is that of the cigarette smoking habit: a non-smoker can instantly detect a smoker because of the definite smell he carries with him. Carnivorous people smell stronger than vegetarians because their bodies are filled with ammonia. These people will usually favour heavy deodorants, perfumes or aftershaves. It will indicate, too, that their sense of smell is weak. Strongly smelling perspiration, when not due to obvious lack of hygiene, can be due to a mineral imbalance.

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Body reading
Already, we should have a general picture of our patient and his health. But now, we can look for finer details. Ying and Yang Life, nature, the universe, all is based on the concept of opposites needing each other: life has value only because of death, day because of night, heat because of cold, love because of indifference, etc... In the Orient, these opposites are named Yin and Yang. Yin is anything yielding, receptive, gentle, feminine, upward going, moist, expanding, nocturnal, and light. Yang is anything strong, penetrating, aggressive, masculine, downward going, dry, contracting, diurnal, and heavy. These two extremes occur and need each other in degrees in everybody, in the body: the head is more yin and the feet more yang, the hearts contraction is yang and its expansion is yin, exercise has a yang strengthening effect as well as a yin limbering one... Face First let us look at the face. Because the face and cranium have between them ten muscle systems totalling nearly forty individual muscles, it gives the face an extraordinary flexibility and highly articulated expression. Except for pathological liars, it is difficult to prevent the face from revealing feelings, and health. Japanese maintain that by the age of forty, we are responsible for our own face: as you grow older, the principles to which you truly subscribe become etched on your face. If we stand in a crowded place, we are surrounded by a bewildering array of shades and colours of faces, eyes and hair. These seemingly endless variations are all achieved from a basic ball with hair, two eyes, a nose, a mouth and two ears! It seems impossible to say anything else than each human face is unique. Yet, generalizations are possible. The yin face (Fig. 241 & 242) looks like an upside down drop: narrow and pale with a large forehead, narrow chin, large eyes, rounded eyebrows set wide apart and slanting down towards the outside edge of the face, narrow bridge of the nose and nostrils, moderately wide pale lips. The yin body is lean Figure 242 and sometimes frail. Yin people have Figure 241 poor blood circulation which makes their bodies cooler so that they dislike cold weather and prefer to remain indoors. They do not like hard

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physical work and prefer to work with their head. Their approach to food can be merely utilitarian or that of the refined gourmet, but they have small appetites. Together with the fragility of the yin constitution, their love of good food might cause them digestive problems. They are usually gentle, refined, extremely sensitive but having difficulty in expressing their emotions, often caught up in their own past, melancholic, intellectual and intuitive. They have a soft voice and enjoy staying up late at night. The yang face (Fig. 243 & 244) is red and round or square with strong-looking wide jaws, a wide mouth and nose, flared nostrils, medium to small eyes, thick eyebrows nearing each other and average to small forehead. Yang people have strong appetite and excellent digestion that they often abuse because of their love of alcohol, fatty food and tobacco leading them to heart disease, high blood pressure and Figure 243 Figure 244 problems of the colon including cancer. They have strong, muscular bodies but have a tendency to become overweight. They have strong voices, sometimes boisterous. They have strong emotions, are very demonstrative but might be insensitive to others. They sleep deeply and easily at natural hours, are very energetic but sometimes to the extreme of neglecting everything else than their goal. They enjoy physical activities, outdoor life and cooler weather. Some people can have a yin face and a yang athletic body: they have extremes of the two opposites and should be aware of it so that to try and achieve a balance. Micro and macro Another principle we have to speak about is that of the micro in the macro.(23, 24) It really means that the whole of the body is present and can be diagnosed in certain of its parts if not all of them. Thus we have the representation of a whole body in the face, the ears, the eyes, the tongue, the hands, the feet, and the large intestine. The following illustrations will be worth pages of explanations (Fig. 245, 246, 247, 248, 249, 250 and 251).

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Figure 245 Figure 246

Figure 247 Figure 248

Figure 249

Figure 250

Figure 251

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Once this concept is clear, it is easy to read or interpret the signs present or the imbalance which might occur between different areas of the part under scrutiny. For example, if the face is being looked at, and we notice a prominent forehead, that person is very intellectual but has little will power. The tendency will be to aloofness, criticism and possibly cynicism. If the middle region of the face is prominent, that is to say between the eyebrows and the tip of the nose, that person is very emotional, maternal, and artistic but may be mercurial and moody. If the lower region of the face is prominent, the person has a powerful will, is practical, focused, tenacious and materialistic but might lack compassion and understanding. The eyes are directly connected to the brain and mirror it as well as the nervous system generally. When the white shows below the iris, (Fig. 252) it denotes exhaustion, illness, nervous system imbalance, weakened intuition or lack of harmony with the energy of the cosmos which may lead to danger for that person, but from the outside; when the white shows above the iris, (Fig. 253) it denotes violence and the potential danger is within the person who may be a threat to himself and others; balanced iris (Fig. 254) correspond personality, sound judgment; to balanced

Figure 252

Figure 253

Figure 254

The study of the irises as such forms the basis of iridology which sees the whole persons representation in the irises. This is not the aim of our study but the big lines can be helpful: when the structure woven it indicates system (Fig. 255); of the iris is closely a strong natural immune
Figure 255

when there are gaps between the fibres indicates a metabolic weakness (Fig. 256);

it

Figure 256

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recurrent condition of specific muscles (10) can also be indicative of imbalances in given system since some muscles are associated with certain organs, according to the following illustration (Fig. 257) specific points on the skull (13) seem to store stress from given muscles, according to following diagrams. (Fig. 258)

Figure 257

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Figure 258

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Lesson 7
Muscle-specific alimentary needs
It is recognised that certain muscles are affected by certain foods or their lack: The abdominals are connected to stress; they need the vitamin E and to avoid excitant (like caffeine, alcohol) and refined carbohydrates; The adductors need the vitamins E and C; The brachioradialis are associated with stomach problems and gluten sensitivity; they need the vitamin B complex; The coracobrachialis are vitamin C and water; connected to lung problems and need

The deltoids (anterior) are affected by rich foods and toxins and need water and the vitamin A The diaphragm is connected to lung problems but also with digestive ones where many small meals might help the heart burns felt; it needs water and the vitamin C; The gastrocnemius are connected to allergies (especially to tobacco), hypoglycaemia and emotional strain or shock condition; The gluteus medius and maximus are function; they need the vitamin E; connected to glandular

The gracilis are connected to the sugar metabolism and to water retention; they need the vitamin C; The hamstrings are connected to constipation, haemorrhoids, colitis and dehydration; they need the vitamin E and water; The illiacus react malfunction; to stress, overeating or iliocaecal valve

The infraspinatus are connected to thymus and thyroid functions; they need iodine; The latissimus dorsi are connected to stress and sugar metabolism problems like diabetes and hypoglycaemia; they need the vitamin A; The levators scapulae are connected to stress and hydrochloric acid problems in the stomach causing dyspepsia; they need the vitamin B complex and to avoid refined carbohydrates; The opponeus pollicis longus need the vitamins A and B6; The pectoralis major clavicular are connected to stress, digestive problems and food allergies; they need the vitamin B; The pectoralis major sternal are connected to the liver; they need the vitamin A;

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The pectineus need the vitamins E and C; The peroneus need the vitamin B1, and calcium. The popliteus are connected to the gall bladder; they need the vitamin A; The pronators of the arms can be associated with stomach problems and need the vitamin B complex; The psoas are affected by dehydration and caffeine; they need the vitamins A and E, and water; The pyriformis need the vitamins A and E; The quadratus lumborum need the vitamins A, C, and E; The quadriceps are connected to stress, especially from too much new information; when indigestion, bloating or gas occurs on standing up, avoid excitant (like caffeine, alcohol), refined carbohydrates, and milk products; they need the vitamin B complex; The rhomboids are connected to the liver and the stomach; they need the vitamin A; The seratus (anterior) are connected to lung problems and need vitamin C and water; The soleus are connected to allergies, especially to tobacco; they need the vitamin C; The subscapularis need the vitamins B and E; The supinators of the arms can be associated with stomach problems and need the vitamin B complex; The supraspinatus are connected to the liver; they need to avoid refined carbohydrates and medications with epinephrine and cortisol (unless prescribed by a doctor); they need lecithin; The tensors facia latea are connected to dehydration; when weakness occurs with constipation, massage their length from knee to hip; when it occurs with diarrhoea, massages are from hip to knee; they need water, vitamins B and lactobacillus; The teres major are connected to an imbalance of acid/alkali and/ or warts on the soles of the feet; kelp might help in case of profuse perspiration; zinc may be needed when food seems tasteless; they need protein; The teres minor are connected to thymus and thyroid functions; they need iodine; The tibials are connected to bladder problems and drained adrenals; they need the vitamins A and E and reduced stress; The trapezius (middle and lower) are connected to the spleen, sore throats and anaemia; they need the vitamin C;

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The trapezius (upper) is connected to the eyes, vision, the ears, hearing, and balance; it needs the vitamins A, B complex and C; The triceps are connected to stress and sugar metabolism problems like diabetes and hypoglycaemia; they need the vitamin A;

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USEFUL HERBS
Boswellia: in capsules For pain/swelling in joints, morning stiffness In the same time it lowers cholesterol and sedimentation sanguine, is a liver tonic and against auto immune diseases. Curcuma (Turmeric): Not to be used when on anti coagulant or with heat waves. Anti inflammatory even stronger than hydrocortisone Can be used as spice. Harpagophytum: Not in acute conditions. Analgesic of big joints and vertebraes, anti inflammatory. Hypericum: as refined oil Can be massaged into skin for sciatica, joints pain and toothaches Can also be taken at the same time internally as tincture or in teas. Petroselinum crispum(Persley): Analgesic for arthritis, rheumatisms, sciatica and period pains. Can be taken internally as tincture or as food- and rubbed in the skin of the affected area. Piscidia erythima: Anti spasmodic especially of back muscles; also analgesic and sedative. Valerian: Specific for neck and shoulder muscles, general relaxant and soporific. Verbenna: Not for pregnant women. For nerves inflammation, in compress, tincture or teas. How to make teas: pour boiling water on the herb (1 pinch for 1 cup) and let it stand 10 minutes; drink freely. tinctures: place 1 volume of dried herb in 5 volumes of Vodka in a sealed jar. Place the jar in the shade and shake it daily for 2 weeks. Strain the formula into a dark glass jar and label it straight away. It will keep up to 3 years. oils: put a few drops of tincture in a table spoon of olive/ almond/wheat/coconut/sesame oil. compresses: sprinkle a few drops of formula on a gauze or a bandage or soak it in a cool herbal tea and place it on the affected part.

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Abdominal aortic aneurysm (AAA)

We remember that the large artery that supplies blood from the heart to the abdomen, pelvic and legs is the aortic artery. There is a condition when the walls of the aorta have a weak point where they balloon, exactly like a weak point on an old worn tire. It is a serious condition since it can rupture and cause virtually instant death. This condition is called abdominal aortic aneurysm (AAA) (Fig. 259). It is also called the silent killer since it very often does not present any symptom and remains undetected. It may occur anywhere in the body. However, the reason we are speaking about the abdominal aortic aneurysm is that, in the few cases where it does develop symptoms, one of them may be pain in the lower back. We should therefore be aware of its possibility in the cases where the patient comes to us with lower back pain after having had his kidneys checked. If the pain persists once we have made sure that there is no vertebral or muscular cause, we should then suggest to the patient to request his general practitioner to rule out the possibility of AAA. Its treatment is an operation where the surgeon inserts an artificial blood vessel into the aorta (from above the aneurysm to under it) to seal off the aneurysm from all blood contact.

Figure 259

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Shoulder shiatsu

(Fig. 260)

The patient lays prostate. The practitioner grounds himself and lay is hands on the patients back. He stands on the let side of the patient. 1. The practitioner takes one of the patients hand, the left one, and places it in the patients back. 2. He asks the patient whether this position causes pain in his left shoulder. In the affirmative, the shoulder shiatsu should not be done to this shoulder. 3. The practitioner warns the patient not to move his left arm or hand. 4. The practitioner slides his left knee under the patients left shoulder so that the patients shoulder plate points out. He gets hold of the edges of the patients shoulder plate with both his hands, placing his fingers tips in the under side of the shoulder plates and squeezes upwards around nearly the whole of the periphery (blue arrows). At the same time, with his right forearm, he presses gently down on the patients left elbow in order to keep the shoulder plate as out as possible. Along the red arrows, the fingers cannot go under the shoulder plates but just on its edge. 5. After having completed the edges of the shoulder plate, the practitioner massages the place marked with a X in a circular motion, in the direction of a clock. 6. The practitioner lets go of the shoulder blade and gently moves the patients left hand back along the side of the patients body whilst all the while supporting the patients left upper arm. 7. The practitioner places his left hand in the patients arm pit whilst holding the patient forearm slightly above his wrist with his right hand to pull the arm down. 8. The practitioner goes to the patients right side and repeats the whole procedure.

Figure 260

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Lesson 8
Touch for Libra
The testing of the muscles with Touch for Libra is the same as that of the conventional medicine. The testing is done on the same muscle on both sides of the body in order to:

compare their strength and detect stronger or weaker than the other)

any

imbalance

(one

side

To make sure that their testing does not cause any pain or discomfort. In the affirmative, pain or discomfort on the same side as that of the muscle being tested indicates that this specific muscle is weak. It needs to be strengthened. If the pain or discomfort is felt on the side opposite to that of the tested muscle it means that this specific muscle is stronger than its equivalent on the other side. It can either be weakened or its equivalent on the opposite side may be strengthened.

However, some muscles cannot be tested individually because of their size or place. In these cases their testing is done through a surrogate muscle, like in kinesiology: a convenient muscle is chosen, for example the supra spinatus; it is then tested to make sure it is balanced; then the practitioner requests it to act in place of the given muscle, like the corrugator supercilii, for example (simply by addressing it in thought); This practice is also used in the case of unconscious patients or very young children. The strengthening or weakening of any given muscle is done through the same principle as kinesiology: tracing of the meridian, use of the strengthening or weakening points, neurovascular points, neurolymphatic points and, when possible, massaging of the relevant vertebrae. For the tracing of the meridian, we trace it according to its flow using the middle finger (positive energy, strengthening) to strengthen, or against its flow with the index finger (negative energy, weakening) to weaken. The tracing is done the furthest possible from the patients body: like in homeopathy, the further from the original, the stronger the potency

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Manual techniques

Figure 261

This cartoon (Fig. 261) was on a pamphlet and I have not been able to trace the cartoonist. However it illustrates wonderfully what a massagist should NOT do! Libra is not a massage technique but does use massages in order to alert the area treated, to make it aware that something is coming so that it will be more relaxed and receptive. Libra can be practiced on dressed patient provided that thick pieces of clothing, content of pockets, glasses and belts should be removed. The waist band of jeans should be unbuttoned as they are too thick to allow any feeling. When working on the bare skin, aromatherapy blends in beautifully here and can be very helpful. The oil is necessary to allow the flow of the movement, in the same way as the clothes do, without causing burning of the skin.

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Whether on the skin or on clothes, the first contact should always be very gentle. It is a good idea to start with a few long gliding strokes. According to the area involved they can be long or broad circling strokes. At this stage, feathering is rarely used because of time limits. A few medium depth strokes will pull, knead or wring according to the area. The deep tissue strokes are only used after the problem has been rectified and the muscles adjusted. Besides the classic thumb rolling and pressures of fingertips and heel of the hand, a rapid brushing in effleurage or feathering is excellent to resolve knots and tensions in the previously affected muscles and tendons. The percussion techniques are not required since they are stimulating and the aim is to relax. At no time should the skin ever be pinched or such pressure applied as to cause bruising. In order that the muscles should be relaxed enough to allow an adjustment, or to keep it, Libra also makes use of various techniques that have been developed, recognised and applied by the conventional medicine through physiotherapy, osteopathy,

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Muscle Energy Techniques, MET: It involves the joint efforts of practitioner and patient for the treatment of the latter. When their efforts are equal to each other, they counteract each other and there is no movement. It is an isometric contraction. When the practitioner overcome the effort of the patient and moves the area of his body in the opposite direction to where the patient wants, it is an isotonic eccentric contraction, sometimes also called isolytic contraction. It stretches and alters the muscles and improves elasticity and circulation in fibrotic states. When the practitioner retards but allows the effort of the patient, it is an isotonic concentric contraction. It has a strengthening effect on the muscle. When the patient increases his effort from a weak one to a progressively maximal contraction of the muscle against the practitioners effort, to exercise a full range of motion, it is an isokinetic contraction. It is a very effective strengthening and training method. It should never be a competition of strength between patient and practitioner. After an isometric contraction, the muscle experience a brief period of relaxation: the Post Isometric relaxation, PIR. Proprioceptive neuromuscular facilitation:

Figure 262

It is the ancestor of PIR, and stressed the importance of rotational components in the function of joints and muscles. It used this in isometric exercises. (Fig. 262) Pressure away from the belly of the muscle or on the belly towards the middle spindle are relaxing and weakening. Pressure from either the Colgi tendon

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When a muscle is isometrically contracted, its antagonist is inhibited and relaxes immediately afterwards. It is a reciprocal inhibition that can be used to ease a shortened muscle. Inhibition can be effected by direct pressure on the tender point or trigger point. The Ischaemical pressure may be constant or intermittent. MET allow the correction of both the shortened, often fibrotic, antagonist. weakened muscle and its

There are several approaches to positional release but they have in common the moving away from any resistance barrier towards comfortable positions. It is important to note that technique, when applied to chronic conditions, will reduce hyper tonicity but not the fibrosis. So the pain relief and improved mobility may be only partial or temporary. Strain/Counter-strain modified/simplified:

all and any the the

It is an exquisitely gentle method based on the placing of the patient into a position of ease since it has been bio-mechanically and neurologically reasoned that strained tissues can normalise by a slow and painless return to the position of strain. Soft tissue changes, due to acute or chronic dysfunction, have to be located by palpation. The monitoring hand detects with minimal force the tissue changes as it moves into a relaxed state of comfort, ease and reduced resistance upon moving the patient into a position of relief. No additional pain should be produced anywhere else. Exaggeration: When the patient presents a recent luxation he will feel a relief on accentuating it. This position should be kept for sixty to ninety seconds and he should then slowly return to a normal posture. The whole procedure may be repeated a few times till no improvement is noticed or complete relief. Repeating: When the patient presents a recent distortion as a result of a sudden movement in the middle of an effort he needs to slowly repeat the sequence until relief of the spasm. This position is kept for sixty to ninety seconds and the whole procedure can be repeated until no further improvement or complete relief is achieved.

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Strain Counter Strain (SCS) on any painful point: Any point identified as painful can be treated with any of the previous techniques. The position of release should be held from sixty to ninety seconds before a slow return to a normal posture. Facilitated Positional Release (FPR): This consists in first placing the affected area in a position of freest motion followed by crowding or torsion of the tensed tissues until relief is felt by the monitoring hand. The position is held for no more than three to four seconds before slow return of the patient to a normal posture. Trigger points: (Fig. 263) They are hyper-irritable points, painful on pressure and which refer pain or problems at a distant site. They have been mapped, each of them corresponding to a pain or dysfunction in a specific muscle. Libra uses effleurage on trigger points, very successfully. Despite the gentleness of the MET method as well as Libra, pain can be experienced between a few hours to a day after the treatment. The application of a hot shower on the area treated, immediately after the treatment, tends to alleviate this possibility. The patient is being warned of this possibility before hand and to explain that it should be short lasted. No cure is needed for this kind of reaction if it occurs, as it is due merely to an adaptive process of the muscles. Like for Libra itself, it should be emphasised to the patient that, since pain is a way of communication from the body, it should never be ignored. Consequently, stoicism not only is depriving the practitioner from a valuable source of information, but can actually create further problems.

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Figure 263

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Lesson 28
Setting up of the clinic
The local can be at home or out but it has specific requisites. It should be: clean, spotlessly so; light and airy (with a window); quiet both in decibels and colour scheme; welcoming; sufficiently spacious so that you can demonstrate the exercises; The equipment is minimal. All that is needed is: - one treating table with a hole for the face when the patient is prone; - three chairs (one for the patient, one for the possible parent/ spouse/friend and one for the practitioner); - one shelve/table to take notes on; - one low stool/step for less agile or smaller patients to climb on the table; - two pillows (one rice pillow for under the head and one sausage for under the knees; - one blanket; - one sheet; - one roll of paper sheet; - one big dustbin; - one bucket (in case of the patient being sick); - one box of tissues; - one box of freshener tissues;

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- one long/tall mirror; - one carpet; There should also be facilities for the practitioner to wash his hands between each patient. Toilets have to be available to the patient.

The practitioner
Always make sure you are comfortably dressed, but also unprovocatingly: whilst bending in the course of treating, an otherwise innocent dcollet may become extremely revealing! Too much jewellery can be a handicap, especially long chain or necklace that will dangle into the patient's face. Watches, bracelets and rings might hurt during massages. Indeed, some feel jewellery is obstructing the flow of energy. Yet, stone or metal own energy might be beneficial. Shoes should be comfortable enough for prolonged standing. Your personal cleanliness should be immaculate, no body odours, no hair dangling into the patients face The hands deserve a special paragraph since they not only are part of your general outlook, but also your main tool: The nails have to be very short (when exerting pressure, they must not dig into the patient) and spotlessly clean. The hands themselves have to be not only clean (nobody is prepared to be touched by dirty hands), but also smooth enough to be pleasant during massages on the skin. Punctuality is a sign of professionalism. Ethical principles are forever respected and any mention of a particular treatment can only be done in a general way or with the patients agreement, if more specifically.

Principles to remind oneself

We are never to judge our patient. The one and only feeling we should approach him with is love. It is obviously not sexual love that is involved here, but rather the love of a mother, never ending in its patience and understanding. This love will not only allow us to sympathise with his predicament but also to empathise with him.

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Empathy will enable us to actually feel the pain, restriction, frustration and distraction experienced by the patient. There is no place here for counselling, except for those of us who are trained in this field. But, often, a non judgmental ear is enough to help a lot on the level of pent up feelings and emotions. If there is an obvious need for suggestions, care should be taken that these are only given on a friendly basis, NOT as a professional psychologist advice.

Running of the clinic

Advertisement is usually ineffective. The best form is by personal recommendations: treat friends and relatives and let them speak about the results to their friends and relatives A card or folder should be opened for every patient stating: - name, age, - address, phone numbers, - date of the visit; - how the patient heard of you or through whom he was referred to you; On the first visit, a brief history should be taken: - what the symptoms are which brought the patient to you; - how and when it started; - what does the patient think caused it; - according to the case and with your understanding of muscular connection or spinal involvement, are they other complains which can be relevant? - is there any medical problem which should be taken into account: high blood pressure, heart problem, recent heart attack or cancer, fractures, operations, etc... On palpation, record is taken of the various misplacements and their position. Finally, note is made of the muscles which needed balancing. These notes are confidential and should be kept away from indiscretions.

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First contact with the patient

This will happen either by telephone or directly. In either case, the patient is the one who solicits your aid. You have to make clear to him: The kind of treatment that you can offer him; The duration of the cession (a minimum of 55 minutes and maximum of 2 hours); The number of treatments (this cannot be predicted since every body respond individually but a fresh injury will take less time than a long established problem); The price of the treatment; The time of his appointment; The address of your clinic; Make it clear that a cancellation has to be made at least 24 hours before the appointment and that a failure will be charged; The situation might arise where you actually feel repulsion for the patient. In this case, one should simply explain that you cannot carry on the treatment. According to the case, you might want to refer him to somebody else or plainly explain why it is that you feel unable to treat him. If the patient is dirty, explain that you cannot treat him to day because he has not washed and that he should do this first before his next visit. In the event of pornographic request or suggestion, remain calm and in control of the situation. Explain, firmly and plainly, that this is not part of the kind of treatment that you offer, get up and open the door for him to go. If the patient bursts in tears, try to feel what his needs are: does he want you to comfort him, simply be present or to leave him alone? Then follow your instincts. If the patient has a heart attack, asthma attack immediately ring the Red Cross and put him in a semi-sitting position in the meantime. If he faints or loses consciousness, apply the necessary resuscitating techniques. Do not give anything to drink or any medicine, only be present and comforting.

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Self care
Between patients Drink a glass of water and wash your hands from the previous patients energy; Do the "stretch exercise" without holding any of the positions: - go on tip toes, arms linked and stretched above the head, the head bent backwards; - place hands behind the kidney, feet flat on the ground and slightly apart, stretch upwards and then bend back as far as possible; - place your hands on your legs, stretch upwards and slide your hands down your legs until they reach the ground; - stretch your 2 arms in front of you and swing them freely once on either side, letting your torso turn with them; If at all possible take a few deep breaths in front of the open window;

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Bibliography
1) George Vithoulkas: The Science of Homeopathy, Grove Press Inc., N. Y., 1980; 2) Will Wilson: The New Physics of CRI, International Journal of Alternative and Complementary Medicine, August 1998; 3) Deborah Cowens with Tom Monte: A gift for Healing, Crown Trade Paperbacks, N. Y., 1996; 4) Dr. Robert Becker: Cross Currants: The Perils of Electro pollution; the Promise of Electro medicine, Jeremy P. Tarcher, 1990; 5) Ram Dass: The only dance there is, Anchor Books, 1974; 6) Wataru Ohashi: Do-it-yourself Shiatsu, Unwin Paperbacks, 1977; 7) Amy Wallace and Bill Henkin: The psychic healing book, Dell Publishing Co, 1978; 8) Henry Gray, F. R. S.: Anatomy, descriptive and surgical, Running Press, U. S. A., 1974; 9) B. R. Mackenna & R. Callander: Illustrated Physiology, Churchill Livingstone, U. K.; 10) Leon Chaitow: Soft tissue manipulation, Thorsons Publishing Group, U. K.; 1987; 11) Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance: Muscles testing and function, Williams & Wilkins, 1993; 12) Paul Blakey: The muscle book, Bibliotek Books Lt., 1992; 13) Elizabeth Andrews: Muscle Management, Thorsons, U. K., 1991; 14) A. Speransky: A basis for the theory of medicine, International Publishers, N. Y., 1944; 15) R. Ehrlinghauser: Circulation of CSF through the connective tissue system, 1959 Yearbook Academy of Applied Osteopathy; 16) W. G. Sutherland: The cranial bowl, The Osteopathic Cranial Association; 17) Dr. Randolph Stone: Polarity Therapy, The Complete Collected Works, CRCS Publications, Reno, U. S. A.;

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18) Leon Chaitow: Masterclass, International Journal of Alternative and Complementary Medicine, February 1999; 19) J. V. Basmajian, D. J. de Luca: Muscles alive, Williams & Wilkins, U. S. A., 1985; 20) Joseph Heller & William A. Henkin: Bodywise, Wingbow Press, U. S. A., 1993; 21) Rollin Becker 22) Ohashi: Reading the body, Arkana Books, U. S. A., 1992; 23) Avi Grinberg: Foot analysis, Samuel Weiser Inc.,U. S. A., 1993; 24), Bernard Jensen: What is iridology? Bernard Jensen, U. S. A., 1984; 25) John F. Thie, D. C.: Touch for health, De Vorss & Co. U. S. A., 1979; 26) Theo Gimbel: Healing through color, C. W. Daniel Co. Ltd., England, 1980; 27) Leon Chaitow: Positional Release Techniques, Churchill Livingstone, U. K., 1996; 28) J. Upledger: Craniosacral therapy II: Beyond the Dura, Eastland Press, 1987; 29) Leon Chaitow: Palpatory literacy, Thorsons, 1991.