Osteopathy: Specific Adjusting Technique – part two

ASOMI College of Sciences is engaged in health and, especially osteopathy. Therefore, ACS recommends this adaptation from Gerald Lamb’s paper on Specific Adjustment Technique (SAT). This is the second, and the more specific part of the article. Click here for the first part. Finding the pivot function Now that we know what is SAT and how to apply the spine, let us proceed with the rest of the details. Next, let’s ask where the mobility of the movement of head and neck ends if we are not moving the shoulder girdle. Palpation shows that a simple flexion of chin to chest ends with motion at T3 on T4. This accords very well with Littlejohn’s interchange of  the polygon of forces being slightly anterior to the bodies of T3/T4. So we could call this junction a pivotal segment since it is vital that it moves to support spinal   function. The next question is where does the thoracic motion end and lumbar motion begin. At first sight, we may say at T12 on L1 but, by considering mobility, it cannot be T12 and T11 for the floating ribs. The real change in function is therefore probably T10 but, considering the attachments of the diaphragm and the fact that T10 often has a weak or an absent rib attachment, we arrive to the conclusion that T9 is  a much better candidate for pivot. Let’s skip for a moment to L5 since this is a true pivot where the lumbar function ends and the sacral function begins; L5 is therefore undoubtedly a point of functional change. L3 mobility We are now left with a consideration of the mid arch of the lumbar spine and here we  find the L3 segment that plays a vital role for the lumbar spine. It is the keystone of the arch and the apex of the small triangle of force in the Littlejohn mechanics; and, practically, L3 mobility is essential for good functioning of pelvis and legs. As long as the crucial elements of overall functioning of the spine are considered, there is one final pivotal area. Namely, it is known that, due to the heightened ratio of muscle spindles to muscle fibers, the upper cervical  segments can be disturbed in function unlike other parts of the spine. Thus, this makes the upper neck highly susceptible to force unlike anywhere else in the spine. In fact, it is precisely this sensitivity of control that leads to positional lesioning.   Therefore, from a functional point of view, the pivot curve relationship now gives us something very close to Littlejohn’s model and we have two pivotal areas in the neck; namely upper cervical and C5, two in the thorax T3 and T9, including two in the lumbar L3 and L5. One could then say that if the pivots are free to function then we  will have a good curve function and a smooth transition between neck, thorax and lumbar. Littlejohn’s assertion was that if the curves are functioning well or that we make sure  that they do, then the pivotal segments will release themselves naturally. This is true, but equally  true is the SAT practitioner’s assertion that, if the pivots are functioning well, then also the  curves are balanced. It is not just a simple matter that in the SAT approach the pivots are the target of adjustment but it is true that, whatever the specific mobilisation adopted, it is in order to establish good pivotal function.

Positional lesions

Finally, a word about positional lesions. It is this concept that makes the SAT approach unique. When the upper neck is subject to physical trauma, such as a blow or a whiplash to the head, the segments of the upper neck go into lesion in a unique way. Such a force may cause the hyper-sensitive upper neck to ‘freeze’ and the segments get set in a one-to-one relationship like in the case of an unnormal physiological lesioning. It is possible for the segments to solve in a relationship having one segment holding bended forward and the other one below it bending backward. This kind of presentation is hardly ever illustrated in normal mobility restrictions. This happens because it is impossible to make these lesions undergo a mobility test because everything closes down and the segments will thus feel hard and unyielding.

This happens not because the segments are displaced, in fact they are still within their range of movement, but because they are at odds with the above and below segments. One might think  of the segments as being up against the ropes and thus, to use a boxing analogy, with nowhere to move. It is also possible for one segment to be held in rotation on one side and the one below on the other side. Besides, side shift is another possible element of presentation.

This disturbed relationship in apparent positional disparity is why these post traumatic lesions are called positional and that is why they need a very particular way of mobilizing to restore their functional normality.

The way they are adjusted is called floating field adjustment. After having diagnosed the vectors of the lesion, the practitioner seeks to reverse the vectors in one motion. It is about taking all the vectors into account and reversing them with a really fluent maneuvers. The lining up is first achieved physiologically and then the practitioner keeps the position of locking in their mind whilst they ease off the alignment. Then, with a very light floating action the lesion is taken subtly toward the barrier but just for a short engagement, until the practitioner is ready to engage and follow through in one  fluent action. It is precisely this fluency that corrects the lesion and brings out all the interior force. An ordinary mobilization does not resolve the force which might return.

In other words

In conclusion, SAT’s contributes to traumatically induced lesions in the atypical areas of the spine, respectively the upper neck and the pelvis. Theses lesions are positional in nature and therefore need to be corrected as such  thus not according to the mobility findings. Once corrected, the specialized practitioner will attend to one segment per treatment, usually the pivots of the spine, until a satisfactory balance has been achieved.

Although the practice of positional adjusting requires a little reflex skill from the practitioner, it is a skill that can be learned with practice. Its performance, following one segment at a time, effectively gives the body back to itself with very little interference  by the practitioner and is true to Still’s fundamental precept of ‘find, fix it, and leave it alone’