[email protected]
www.brucestark.com.au
Indirect Techniques – Stimulating the
Mechanisms for Structural Change
AAMT National Conference 2015
Workshop Overview

Review the mechanisms of indirect techniques

Outline the principles of structural work from a positional release perspective

Learn basic release positions for the neck, thoracic outlet and knees

Activate proprioceptive re-education of the cervical and upper thoracic spine and knees

Practise client home exercises for maintaining postural changes and structural alignment
Learning Objectives

Understand the basic principles of positional release and indirect techniques

Release stress and structural imbalances in the neck, upper thoracics and knees

Understand the dynamics of postural alignment and orientation

Stimulate proprioceptive awareness through targeted movements

Teach clients exercises that will support on-going postural change
Key developers of positional release

Andrew Taylor Still (1828-1917) Developed osteopathy
1|Page
Copyright 2015 Bruce Stark

William Sutherland (1873-1954) Cranial osteopathy

Lawrence Jones (1913-1996) Developed Strain-Counterstrain; published “Spontaneous
Release by Positioning” 1964

Arthur Lincoln Pauls (1929-1997) Developed Phased Reflex Techniques, later called OrthoBionomy
Principles of Positional Release






Structure governs function
Exaggeration of the preferred posture/preferred direction commonly the distortion
The body will release imbalances when it is in positions of comfort - no pain to release pain
Follow what the body is doing rather than forcing it
Use tender points to monitor the tissue for maximum relaxation or softening to identify the
release position
“Fine tune” the position by using gentle movements to stimulate the maximum state of
relaxation around the joint
Quality of Contact and Interaction





Generally a gentle compression will stimulate and speed up the release within a joint or its
surrounding tissues
The most effective method is to do less to initiate the self-corrective reflex and to allow the
person to do more for themselves - “Less is more”
Non-investment in change - it is more important to notice what the outcome is rather than
to try to create a specific outcome
The body has many of the resources to balance itself - our role as Practitioner is to facilitate
these naturally occurring processes
Relaxed hand contact allows greater sensing capacity for the Practitioner
Body Schema
Proprioception (from Alter 1996)
Articular mechanoreceptors
Type I – Located in the external layers of the joint capsule; low-threshold, slow-adapting; static and
dynamic



Signal direction, amplitude and velocity of joint movements produced actively or
passively
Regulating joint pressure changes
Significant contribution to postural and kinaesthetic sensation
2|Page
Copyright 2015 Bruce Stark


Facilitates the CNS in regulating postural muscle tone and muscle tone during joint
movement
Producing an inhibitory effect on the flow of nociceptive afferent activity from the Type
IV receptors
Type II – Located in the deeper layers of the fibrous joint capsule and in the articular fat pads, found
more in joints located more distally than proximally; dynamic

Measure quick changes in movement such as acceleration and deceleration
Type III – Located in the surfaces of joint ligaments (collateral and intrinsic); high-threshold, slowadapting; dynamic


Monitor direction of movement
Activate strong reflex inhibition of the muscles operating over the joint
Type IV – IVa located in joint fat and throughout the entire thickness of the joint capsule; IVb
located in the intrinsic and extrinsic ligaments; NOT present in synovial tissue, intraarticular menisci
and articular cartilage; very high-threshold, non-adapting

Nociceptors – pain receptors
Muscle Spindles



Located in nearly all skeletal muscle, and present in much higher concentration in the small,
delicate muscle of the hand and eye
Intrafusal fibres measuring stretch in the motor unit
Conscious interaction to create muscular contraction comes through the gamma efferent
neuronal activation
Golgi Tendon Organs
.
 Located in the muscle-tendon junctions and not within tendons
 Highly sensitive to stimuli and precisely localise and relay information to CNS
 Lie in series to muscle fibres (as opposed to muscle spindles lying parallel with muscle fibres)
Interoception

Sensing one’s internal states including hot/cold, pain, respiration
General Protocol for Release Techniques



Assess the imbalance or identify the point of tenderness or discomfort
Move the body into a position which either exaggerates the direction of ease or folds around
a point of discomfort and maximally softens the area
Apply a gentle compression (sometimes traction) into the joint - only enough to gently
stimulate a response from the body
3|Page
Copyright 2015 Bruce Stark






Wait 10 to 30 seconds (sometimes up to a minute) for the body to respond
After the response slowly move out of the position
Gently move the area or explore a little range of motion
Recheck the imbalance or point of discomfort
When monitoring a point of tenderness or discomfort the amount of pressure by the
monitoring finger is feather light - the quality of touching a butterfly wing without breaking
it
Releases can be any change in tissue quality, pulse, temperature, rebound, recoil or any
other sign from the joint or tissues
Neck
Movement Preferences
Rotation





Gently rotate the neck to one side and then to the opposite side.
Assess the direction of rotation which is most comfortable or moves most easily.
Rotate the neck to the easier/preferred side.
Gently compress from the crown of the head directly down the spine.
After the release gently bring the neck back to neutral and recheck the rotation.
Lateral Flexion





Gently laterally flex the neck to one side and then to the opposite side.
Assess the direction of lateral flexion which is most comfortable or moves most easily.
Laterally flex the neck to the easier/preferred side.
Gently compress from the crown of the head directly down the spine.
After the release gently bring the neck back to neutral and recheck the lateral flexion.
4|Page
Copyright 2015 Bruce Stark
Flexion and Extension





Gently flex the neck forward and then extend the neck back.
Assess the direction which is most comfortable or moves most easily.
Flex or extend the neck to the easier/preferred direction.
Gently compress from the crown of the head directly down the spine.
After the release gently bring the neck back to neutral and recheck the range of motion.
Imbalance Indicators
Assess for tenderness, tightness or restriction along the transverse processes of the cervical spine.
You can also assess along the spinous processes and anywhere else on the neck posteriorly and
anteriorly.
Note: When working with the neck it is recommended to begin with the mid-neck before releasing
the rest of the neck as this will facilitate greater movement in the upper and lower neck regions.
Mid Neck (C3-6)




Laterally flex and rotate the neck toward the point of restriction
Incorporate extension or flexion of the neck if either of those increases softening of the
tissue at that point
Apply a gentle compression (or alternatively traction if that is more comfortable) directly
from the crown of the head toward the point
After the release, slowly return the head and neck to the midline and recheck the point.
5|Page
Copyright 2015 Bruce Stark
Lower Neck (C6-T1)





Rotate the head and neck toward the opposite direction from the point of restriction
Maintaining the head in this rotated position laterally slide the head and neck towards the
midline without any rotation in the neck
Slightly rotate the neck back towards the midline stopping when the indicator point is most
relaxed
Apply a gentle compression (or alternatively traction if that is more comfortable) directly
from the crown of the head toward the point
After the release, slowly return the head and neck to the midline and recheck the point
6|Page
Copyright 2015 Bruce Stark
Upper Neck – Atlas and Axis (C1-2)




Laterally deviate (“lateral slide” or “Balinese” movement) directly away from side with the
point of restriction
Extend the neck (chin moves upwards) and gently rotate the neck toward the point of
restriction
Apply a gentle compression (or alternatively traction if that is more comfortable) directly
from the crown of the head toward the point
After the release, slowly return the head and neck to the midline and recheck the point.
Note: All of the releases above can be modified for points of restriction located anywhere on the
neck by incorporating more neck extension for posterior points or flexion for more anterior points as
required.
7|Page
Copyright 2015 Bruce Stark
First Rib
Because of the anatomical positioning of the first rib in relationship to the scalene muscles of the
neck and the brachial plexus for enervating the arm an isometric/isotonic can be particularly helpful
in releasing tension and imbalances in the neck, shoulder and upper ribcage areas.
Isometric: An active contraction by the client in which the muscle length does not change (the
practitioner holds the client stationary) – “same” “length”
Procedure for an isometric:





The practitioner holds the client in the release position whilst the client actively pushes out
of the position into the practitioner’s resistance.
The practitioner holds the isometric for 7 – 10 seconds—any longer and the reflex responses
could be fatigued. The client only uses 10-20 per cent of their strength.
After 7 – 10 seconds the practitioner tells the client to stop pushing or to release the
contraction/relax
Then the practitioner follows through with the movement by taking the arm through the
range of movement that the client was trying to accomplish but the practitioner was
restricting.
For the first rib it is often helpful to follow the isometric with a positional release by
abducting the shoulder softening the area around the first rib and then compressing the
scapula gently towards the spine.
Shoulder Flexed/Elbow Bent Isometric





With clients elbow bent practitioner brings client’s shoulder in flexion so that the arm is
perpendicular to the table
Practitioner holds this position as client presses arm towards the table (shoulder extension)
After 7 – 10 seconds the client relaxes and the practitioner follows through with the
movement towards the table
Practitioner brings client’s arm into abduction and gently compresses the shoulder girdle
towards the first rib until there is a softening of the first rib area
After the release, replace the arm and shoulder on the table.
Repeat the isometric 2 – 3 times
8|Page
Copyright 2015 Bruce Stark
Shoulder Elevated (“Shrugged”) Isometric
Use this isometric if the client is unable to flex or abduct their shoulder






Shrug client’s shoulder on the affected side towards the client’s ear
Practitioner slides their arm between the client’s arm and torso hence shrugging the
shoulder more
Client tries to push their shrugged shoulder inferiorly towards their feet whilst the
practitioner resists
After 7 – 10 seconds client relaxes and the practitioner follows through with the movement
of the shoulder towards the client’s feet
Practitioner folds the client’s arm against the ribcage and gently compresses the shoulder
girdle towards the first rib until there is a softening of the first rib area
After the release, replace the arm and shoulder on the table.
9|Page
Copyright 2015 Bruce Stark
Knee
Imbalance Indicators
Pain in the knee cap, knee joint, surrounding muscles, restriction in range of motion and pain with
use may be indicators of imbalances in the knee.
Patella (Knee Cap)



Assess the patella for movement ease or preferences in the following directions:
superior/inferior and medial/lateral
Practitioner gently exaggerates the preference or direction of ease of the patella and applies
a gentle compression of the patella towards the knee joint
After the release or rebound, gently reposition the patella and reassess the movement
preferences
Intrinsic Movements of the Knee Joint
Rotation


Practitioner stabilises the client’s thigh with one hand whilst assessing movement
preference or ease with the lower leg rotating medially and laterally
Practitioner gently exaggerates the movement preference and compresses the femur and
the tibia toward the knee joint simultaneously
10 | P a g e
Copyright 2015 Bruce Stark

After the release or rebound, gently reposition the knee and reassess the movement
preference
Lateral/Medial Movement



Practitioner stabilises the client’s thigh with one hand whilst assessing the direct lateral and
medial movement of the knee joint by flexing the lower leg towards the midline and laterally
Practitioner gently exaggerates the movement preference and compresses the femus and
the tibia toward the knee joint simultaneously
After the release or rebound, gently reposition the knee and reassess the movement
preference
11 | P a g e
Copyright 2015 Bruce Stark
Femoral Over Ride (Anterior Slide) and Under Ride (Posterior Slide)
The anterior and posterior slide of the femur along the top of the tibia is held in check by the cruciate
ligaments (posterior cruciate ligament [PCL] prevents anterior slide and anterior cruciate ligament
[ACL] prevents posterior slide).
Assessment for Exaggerated Anterior OR Posterior Slide




Practitioner stabilises the client’s thigh with one hand
Placing the other hand proximal and posterior to the ankle the practitioner gently attempts
to hyperextend the client’s knee
If there is restriction or incomplete extension of the knee joint then there is likely a Femoral
Over Ride
If there is an excess of hyperextension or a large amount of hypermobility then there is likely
a Femoral Under Ride
Releasing a Femoral Over Ride




Practitioner places their arm under the leg of the affected knee and rests their hand on the
anterior of the opposite thigh thereby bringing the femur of the affected side more anterior
Practitioner places the other hand just distal to the knee on the shin and gently presses the
tibia posteriorly
Practitioner may also apply compression of the tibia into the femur
After the release or rebound, the practitioner repositions the leg and reassesses using the
imbalance indicator assessment
12 | P a g e
Copyright 2015 Bruce Stark
Releasing a Femoral Under Ride




Practitioner stabilises the client’s thigh with one hand whilst placing the other hand distal
and posterior to the knee
Practitioner then gently draws the tibia directly anteriorly (thereby exaggerating the
posterior movement of the femur)
Practitioner may also apply compression of the tibia into the knee joint of that is
comfortable
After the release or rebound, the practitioner repositions the leg and reassesses using the
imbalance indicator assessment
Tender Points Around the Knee






Assess for points of restriction or tenderness around the knee joint especially on the
posterior aspects of the medial and lateral condyles of the femur and tibia where the
hamstring and calf muscles attach
Monitoring the point of imbalance the practitioner flexes the client’s knee until the point is
maximally softened
If the point is on the medial aspect of the knee the leg is generally dropped laterally whilst
bringing the foot towards the midline thereby softening the medial aspect of the knee (the
foot may also be inverted to assist the softening further)
If the point in on the lateral aspect of the knee the leg is generally rotated toward the
midline and the foot is brought out laterally thereby softening the lateral aspect of the knee
(the foot may alse be everted to assist the softening further)
Practitioner gently compresses the tibia into the knee joint from the bottom of the foot
After the release or rebound, the practitioner repositions the leg and reassesses the
imbalance points
13 | P a g e
Copyright 2015 Bruce Stark
Self Care and Re-education Exercises
Neck
Phased Yoga
Releases pain, tension and stress in the neck
All variations done lying down with pillows supporting the head as needed.
o Lateral Flexion: lie on your back and side bend your neck towards each shoulder.
o Rotation: lie on back and rotate your neck one side and the other.
o Flexion and extension: lie on your side and bring your chin towards your chest (flexed)
or arching your neck back (extension)
 Find the position of greatest comfort/maximum ease;
 Allow yourself to relax in this position up to 5 minutes;
 Visualise moving in the opposite direction for about 30 seconds without actually doing so;
14 | P a g e
Copyright 2015 Bruce Stark

Move to the opposite direction, rest for a brief moment and then straighten back out
coming back to a neutral position.
Self Isometrics
Releases pain, tension and stress in the neck and re-educates the postural support of the neck




Use rotation, side bending, and flexion/extension of the neck to find the preferred position;
Place hand or arm on the side of the head away from the preferred position;
Initiate an isometric contraction pressing "out" of the position (isometric means to contract
the muscles without letting them move);
Release the contraction and move the head toward the position opposite of the preferred
position and return to neutral.
Pencil in Ear
Releases tension and strain along the sides of the neck



Visualise a pencil sticking out of your ear with the point in the air;
Slowly write the letters of your name or draw in the air at the end of the "pencil";
Visualise the pencil in the other ear and repeat.
Ceiling Spirals
Releases tension and strain in the back of the neck


Visualise a beam of light radiating from the crown of the head and going up toward the
ceiling;
Move the "beam of light" to make spirals on the ceiling.
Knees
Resets the alignment of the femur and tibia and releases tension around the menisci






Stand with your feet hip-width apart
Slowly move your knees apart allowing your inner arch to lift up but keeping your lateral
arch on the ground
Maintain that position whilst slowly lifting the heel off the ground shifting your weight to the
ball of the foot at the base of the little toe
Slowly bring your knees together transferring the weight across the ball of the foot to the
base of the big toe
Reverse the movements and bring the knees back to neutral
Repeat slowly 5-10 times
15 | P a g e
Copyright 2015 Bruce Stark
References
Alter, Michael (1996) Science of Flexibility, 2nd edition. Human Kinetics Publishing, Champaign IL
Chaitow, Leon (2007) Positional Release Techniques, 3rd edition. Churchill Livingstone Elsevier,
London
Fogel, Alan (2009) Body Sense: The Science and Practice of Embodied Self-Awareness. WW Norton,
New York, NY
Fogel, Alan (2009) The Psychophysiology of Self-Awareness: Rediscovering the Lost Art of Body
Sense. WW Norton, New York NY
Jones, Lawrence (1981) Strain and Counterstrain. American Academy of Osteopathy, Indianapolis IN
Kain, Kathy with Jim Berns (1997) Ortho-Bionomy: A Practical Manual. North Atlantic Books,
Berkeley CA
Overmyer, Luann (2009) Ortho-Bionomy: A Pathe to Self-Care. North Atlantic Books, Berkeley CA
Still, A T. (1910) Osteopathy: Research and Practice. Reprinted 1992, Eastland Press, Seattle WA
Sutherland, William (1990) Teachings in the Science of Osteopathy. Sutherland Cranial Teaching
Foundation.
Watkins, James (2010) Structure and Function of the Musculoskeletal System, 2nd edition. Human
Kinetics Publishing, Champaign IL
Resources
For further training opportunities visit www.brucestark.com.au to get course offerings, class
descriptions and further resources for learning Ortho-Bionomy and structural bodywork.
www.facebook.com/BruceStarkOrthoBionomy
@brucestark
Detailed information on Practitioner Training Programmes can be found at:
Ortho-Bionomy Australia Ltd
www.ortho-bionomy.org.au
Society of Ortho-Bionomy International
www.ortho-bionomy.org
Photographer: Chris Griffith Model: Hank Adam
Thank you Chris and Hank for your help!
16 | P a g e
Copyright 2015 Bruce Stark