Unwinding Joints
Facet Joints, Indirect Technique/Unwinding, and the Angle of Attack
In this section we'll be looking at indirect technique/unwinding and how to apply it specifically to facet joints. This style of working has been within structural bodywork for many years. Jeffrey Maitland, Senior Instructor of the Rolf Institute, states that an "indirect technique does not directly force change on the spine the way hight-velocity, low-amplitude thrusting techniques do. Indirect techniques begin by pushing a dysfunctional segment further into its dysfunction and letting it wind its way back to where a normal position is." (Maitland, Jeffrey, Spinal Manipulation Made Simple, p. 9 (2001)).
I'm going to break down Sir Jeffrey's text a bit:
The "dysfunctional segment" Jeffrey is referring to is an out-of-position/subluxed/distorted vertebrae with relatively "stuck" facets. The "normal position" is how that vertebrae relates to an adjoining vertebrae in space and alignment. "Pushing a dysfunfunctional segment further into its dysfunction" essentially means pushing a segment further into the restriction - which typically means, the joint itself.
The same understanding may be applied to other bones as well, not just vertebrae. The general idea is to take two bones comprising a joint and push them together in order to create space in-between. A seemingly counter-intuitive concept; to gain space in the joint, we actually shorten everything and increase pressure within a fluid-filled synovial joint. Indirect unwinding remains the end-around solution; a curveball to the body.
Pushing bones together in order to indirectly unwind them was a method originally shared with me by Michael Salveson, also a Senior instructor at the Rolf Institute. In his instruction, it was noted that the best results were obtained by pushing the bones directly together - in a manner absent of any sort of shearing force - i.e.: force applied at an angle to the joint. Done correctly, the more direct the pressure was into the restricted joint, the greater was the engagement into the whole of the joint. And because no shearing force was applied to the joint, no tissue strained during the engagement, allowing a fuller local relaxation and an easier time performing the technique and obtaining the release.
In this section, I will take that understanding from Michael and dig a bit deeper to see how we can be more effective with it as well as how to apply it specifically to facet joints - a la Jeffrey. I will also describe how facet joints change throughout the spine and how the direction of applied force exerted by a practitioner should change as well.
Note: This is how I work and what works best for me. The descriptions and instructions herein are for working without any movement assistance from the client. The side-lying position is recommended. I am not making any distinctions between facets that are "fixed" open or closed. We are instead working statically while simply seeking the best angle of attack/engagement into the facet joints for the purposes of indirect unwinding only.
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As described in Practical 1, to unwind, we will be pushing into the restrictive joint, then backing off our pressure slightly as we engage into the restriction. Pressure is gentle and firm, but also relaxed and consistent. Even with fingertips, a practitioner should be moving from their core. As we apply and hold pressure, the joint will likely start to "dance" or move subtly on it's own beneath our fingers. From there we may hold our pressure or back off slightly while following the movement that is occurring under our fingers. Keep following until "release". The release may be signaled by a subtle softening in the area and joint, followed by an audible visceral sound or "gurgle" that may be heard when a joint space related to the neurologic system has been opened or changed.
A demonstration of audible visceral noises recorded during indirect unwinding:
https://youtu.be/pTpiew__mGg
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"Angle of Attack" is another way of describing the direction of pressure exerted by the practitioner. Again, with unwinding, an "indirect" technique, we are looking to push further into the restriction rather than trying to pull away from it. Hence we want to apply our pressure in the most efficient manner and from the smartest direction.
But what does pushing "into" the restriction mean when it comes to our direction of pressure/angle of attack? Well, generally the concept requires an angle of attack of applied pressure that is, more or less, perpendicular to the joint surface - the same direction by which the joint surface is 'facing'. This direction of applied pressure allows for a fuller engagement into the joint while allowing for a relaxation of the surrounding tissue: we want to shorten tissue with indirect technique, including ligament beds, not stress it.
In this section we'll be looking at indirect technique/unwinding and how to apply it specifically to facet joints. This style of working has been within structural bodywork for many years. Jeffrey Maitland, Senior Instructor of the Rolf Institute, states that an "indirect technique does not directly force change on the spine the way hight-velocity, low-amplitude thrusting techniques do. Indirect techniques begin by pushing a dysfunctional segment further into its dysfunction and letting it wind its way back to where a normal position is." (Maitland, Jeffrey, Spinal Manipulation Made Simple, p. 9 (2001)).
I'm going to break down Sir Jeffrey's text a bit:
The "dysfunctional segment" Jeffrey is referring to is an out-of-position/subluxed/distorted vertebrae with relatively "stuck" facets. The "normal position" is how that vertebrae relates to an adjoining vertebrae in space and alignment. "Pushing a dysfunfunctional segment further into its dysfunction" essentially means pushing a segment further into the restriction - which typically means, the joint itself.
The same understanding may be applied to other bones as well, not just vertebrae. The general idea is to take two bones comprising a joint and push them together in order to create space in-between. A seemingly counter-intuitive concept; to gain space in the joint, we actually shorten everything and increase pressure within a fluid-filled synovial joint. Indirect unwinding remains the end-around solution; a curveball to the body.
Pushing bones together in order to indirectly unwind them was a method originally shared with me by Michael Salveson, also a Senior instructor at the Rolf Institute. In his instruction, it was noted that the best results were obtained by pushing the bones directly together - in a manner absent of any sort of shearing force - i.e.: force applied at an angle to the joint. Done correctly, the more direct the pressure was into the restricted joint, the greater was the engagement into the whole of the joint. And because no shearing force was applied to the joint, no tissue strained during the engagement, allowing a fuller local relaxation and an easier time performing the technique and obtaining the release.
In this section, I will take that understanding from Michael and dig a bit deeper to see how we can be more effective with it as well as how to apply it specifically to facet joints - a la Jeffrey. I will also describe how facet joints change throughout the spine and how the direction of applied force exerted by a practitioner should change as well.
Note: This is how I work and what works best for me. The descriptions and instructions herein are for working without any movement assistance from the client. The side-lying position is recommended. I am not making any distinctions between facets that are "fixed" open or closed. We are instead working statically while simply seeking the best angle of attack/engagement into the facet joints for the purposes of indirect unwinding only.
.....
As described in Practical 1, to unwind, we will be pushing into the restrictive joint, then backing off our pressure slightly as we engage into the restriction. Pressure is gentle and firm, but also relaxed and consistent. Even with fingertips, a practitioner should be moving from their core. As we apply and hold pressure, the joint will likely start to "dance" or move subtly on it's own beneath our fingers. From there we may hold our pressure or back off slightly while following the movement that is occurring under our fingers. Keep following until "release". The release may be signaled by a subtle softening in the area and joint, followed by an audible visceral sound or "gurgle" that may be heard when a joint space related to the neurologic system has been opened or changed.
A demonstration of audible visceral noises recorded during indirect unwinding:
https://youtu.be/pTpiew__mGg
...
"Angle of Attack" is another way of describing the direction of pressure exerted by the practitioner. Again, with unwinding, an "indirect" technique, we are looking to push further into the restriction rather than trying to pull away from it. Hence we want to apply our pressure in the most efficient manner and from the smartest direction.
But what does pushing "into" the restriction mean when it comes to our direction of pressure/angle of attack? Well, generally the concept requires an angle of attack of applied pressure that is, more or less, perpendicular to the joint surface - the same direction by which the joint surface is 'facing'. This direction of applied pressure allows for a fuller engagement into the joint while allowing for a relaxation of the surrounding tissue: we want to shorten tissue with indirect technique, including ligament beds, not stress it.
A simplified 'joint' between two bones. Facet joints are fluid-filled, synovial joints.
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While joint surfaces are rarely flat, the applied pressure for indirect unwinding of the joint should often be as perpendicular to the joint surface as possible. This direction of force allows a practitioner to engage the entirety of a joint.
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The Cervical Facets
We will begin with the orientation of the Cervical Facet Joints.
With each vertebrae, there are 4 facet joints - Left bottom, right bottom, left superior, right superior. The bottom facet joints of a vertebrae articulate with the top facet joints of the adjoining vertebrae below.
In the Cervical, the lower facets of the superior vertebra lie slightly on top and behind the upper facets of the inferior vertebrae. In the pictures at bottom, we see the lower facets of superior vertebrae (in this case, C5) are lying slightly on top of the upper facets of inferior vertebrae (C6).
We will begin with the orientation of the Cervical Facet Joints.
With each vertebrae, there are 4 facet joints - Left bottom, right bottom, left superior, right superior. The bottom facet joints of a vertebrae articulate with the top facet joints of the adjoining vertebrae below.
In the Cervical, the lower facets of the superior vertebra lie slightly on top and behind the upper facets of the inferior vertebrae. In the pictures at bottom, we see the lower facets of superior vertebrae (in this case, C5) are lying slightly on top of the upper facets of inferior vertebrae (C6).
C5, the bottom left facet joint articulates with the the top left facet of C6. From a posterior viewpoint, the lower facets of C5 lie slightly on top of the upper facets of C6. This sort of arrangement continues through the thoracics all the way to T12/L1.
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Here I am inserting a large playing card into the articular space. This is to show the orientation of the joint. Pressure/force applied will be perpendicular to this orientation.
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To compress the joint and work into the restriction (the joint itself) we will apply perpendicular pressure to the joint. The direction of pressure will be anterior and slightly downwards. Please note that in the pictures I am not demonstrating actual technique, just the direction of applied pressure.
Here I am pressuring the facet joint of C4/C5. The force is applied perpendicularly to the surface orientation of the joint. The touch pressure is slightly downwards (towards the sacrum) and anterior (towards the chest) in direction.
Finding Cervical Facets, Atlas & Axis
In practice, I find the most beneficial positions for both finding and working on cervical facet joints is the supine position (face-up) or the side-lying position. The face-down position, in a cradle, is especially poor for cervical work as it tends to compress the cervical spine. This all-too-common position puts the cervical spine in a vulnerable position for treatment or even palpation. Supine (face-up), on the other hand, is typically very comfortable and safe for the client and allows for a full range of movement in the neck.
In practice, I find the most beneficial positions for both finding and working on cervical facet joints is the supine position (face-up) or the side-lying position. The face-down position, in a cradle, is especially poor for cervical work as it tends to compress the cervical spine. This all-too-common position puts the cervical spine in a vulnerable position for treatment or even palpation. Supine (face-up), on the other hand, is typically very comfortable and safe for the client and allows for a full range of movement in the neck.
From supine I am engaging the left facet of C4/C5. The pressure is gentle but firm.
In identifying cervical vertebrae and figuring out where we are, we will be using bony landmarks and noting common differences in bone size that can easily be felt in palpation. C1 & C2 - the Atlas & Axis, have several prominent bony features which will allow us to accurately identify which one is which. On C1, we will almost always find a smaller spinous process than on C2. A "spinous process" is the rearmost bony prominence/aspect to each vertebrae and is typically the only thing that may be visible to the casual observer. On C1, it's hardly there. The larger C2 spinous process often dominates the area between C3 and C1. On many people, C3 will often feel tucked up into C2. C1 may also feel "scrunched" between C2 and the cranium. So, when palpating from the posterior, find the larger spinous process of C2 and count up or down from there, using the spinous processes of each vertebrae. Note: it is very easy to miss C3.
The spinous process of the Axis (C2) is typically large and easily palpable. At the lower cervical, it is usually C7 that has the largest spinous process and we may note a significant change in size relative to C6.
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The Atlas (C1) is typically wider than the Axis (C2).
On the sides of the vertebrae, we will find that C1, overall, is wider than C2. C1 has the wider transverse processes as compared to C2. The transverse processes are the bony projections off the right and left side of each vertebrae.
So, given these bony landmarks and distinctions, when we are feeling through the back of the upper neck, C2 is most readily palpated. On the lateral sides, it is C1 that will be the widest and easiest to feel. |
In the lower cervical we will also look for bony landmarks to orient from. Most often we'll find the spinous process of C7 to be appreciably larger that that of C6. This relative distinction and it's proximity to Rib 1/T1, make C7 fairly easy to identify. Once we've identified C2 and C7, we will be able to more easily identify the remainder of the cervical vertebrae by counting their respective spinous processes.
As you find each spinous process, the (lower) facet that articulates with the vertebrae below will be almost directly to the side of the spinous process. So, to find the facet of C5 & C6, find the spinous process of C5 and move your fingers slightly laterally. To find the facet of C4 & C5, find the spinous process of C4 and move your fingers laterally. And so on...
As you find each spinous process, the (lower) facet that articulates with the vertebrae below will be almost directly to the side of the spinous process. So, to find the facet of C5 & C6, find the spinous process of C5 and move your fingers slightly laterally. To find the facet of C4 & C5, find the spinous process of C4 and move your fingers laterally. And so on...
Atlas and Axis Facets
At the facets of C1 & C2, we will note several important changes. The facets of C1 & C2 show a significant change in orientation and joint size, relative to their cervical brethren. This change begins at the top facets of C2.
At the facets of C1 & C2, we will note several important changes. The facets of C1 & C2 show a significant change in orientation and joint size, relative to their cervical brethren. This change begins at the top facets of C2.
C1 at top. C2 at bottom. The articular surfaces are larger than the other facets in the cervical and are orientated to face vertically.
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The articular surface of both C1 and C2 face up & down - ie: the shape of the bottom of the cranium.
In examining the facets of the atlas and axis, the articular surfaces on both are typically larger than the facet surfaces of the other cervical vertebrae below. Additionally, and very importantly, the articular surfaces on both C1 and the top of C2 face vertically - up and down. This orientation is a necessity as the top facets of C1 articulate with the cranium and must conform to the shape of the occiput.
But because the articular surface at C1 & C2 changes significantly, so will our application of pressure in unwinding them. And here, we must be a bit more creative in our engagement. |
C1 top and bottom articulations - C1 to Occiput (top) and C1 to C2 (bottom facet). The wide transverse process of C1 will be utilized to apply pressure to either articulation.
We will use C1 to engage into both sets of articulations - C1 to Occiput, C1 (bottom) to C2 (top). The orientation of the facets requires that our pressure be, as much as possible, straight up (towards the head) or straight down (towards the feet). This is a challenge.
The space here, in general is quite crowded, with the auditory meatus and styloid process of the temporals along with the mandible (jaw) in rather close proximity. However, the wide transverse process of C1 is palpable and fairly easy to locate, and we can use it to compress and lever into our facet articulations with a reasonable degree of perpendicular pressure. Please note that in the pictures at right I am again not showing any sort of technique or 'proper' hand position. That is for a later section. I'm only showing the angle of attack. I do however recommend the supine position for this work. Also, in order to access the transverse process of C1, a practitioner may relax the local tissue by laterally tilting and slightly rotating the client's head to the same side. Only a small degree of tilt and rotation is required. This may help you to both palpate and engage the transverse process. |
To pressure the C1/C2 facet, apply pressure towards the feet to the top of the C1 transverse process.
To pressure the articulation between the C1 top facet and the occiput, pressure the transverse process from underneath, directly into the cranium.
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Thoracic Facet Joints
The orientation of the facet joints in the Thoracic is similar to those in the Cervical (from C2 down) but with some important changes. Generally, facets in the thoracic begin to turn out slightly laterally, especially as we go down the spine. This requires an engagement of pressure that is anterior, slightly lateral, and also downwards in direction.
The orientation of the facet joints in the Thoracic is similar to those in the Cervical (from C2 down) but with some important changes. Generally, facets in the thoracic begin to turn out slightly laterally, especially as we go down the spine. This requires an engagement of pressure that is anterior, slightly lateral, and also downwards in direction.
The facet of T2/T3. As compared to the cervical spine the orientation of the thoracic facet joint surface changes slightly to face more anteriorly, less downward and slightly more laterally.
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Perpendicular pressure to the joint orientation now requires a slightly lateral engagement/force along with a pressure that is both anterior and slightly downwards in direction.
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Here I am applying a directional pressure to the left facet of T4/T5. The pressure is downwards, anterior, and slightly lateral in direction.
Finding Thoracic Facet Joints
Before we move on through the thoracic and into the lumbars, some guidance in locating thoracic facets will be helpful. The complex nature of the thoracic presents some difficulty in locating the facets with accuracy. While you may be working just fine in a more intuitive manner with little regard to which facet you are engaging, knowing where you are will allow you to track results and note commonalities and important locations both with a particular client and across the full spectrum of clientele. With this information, a practitioner can create their own source of research on common problems, patterns, and solutions for their clients. From there a practitioner may also compare notes with other practitioners and work to expand the communal body of knowledge.
Before we move on through the thoracic and into the lumbars, some guidance in locating thoracic facets will be helpful. The complex nature of the thoracic presents some difficulty in locating the facets with accuracy. While you may be working just fine in a more intuitive manner with little regard to which facet you are engaging, knowing where you are will allow you to track results and note commonalities and important locations both with a particular client and across the full spectrum of clientele. With this information, a practitioner can create their own source of research on common problems, patterns, and solutions for their clients. From there a practitioner may also compare notes with other practitioners and work to expand the communal body of knowledge.
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To locate facets throughout the spine, we're typically utilizing bony prominences to find our way, and the thoracic is no exception. It is helpful to first locate at least two easily identifiable bony points in order to then locate a thoracic facet - and in this case we'll use the appropriate spinous process and the attached rib.
The spinous processes can be counted from the bottom-up as well as the top-down. It is recomended that both methods be utilized, at least initially, in order to increase accuracy. Please refer to Practical 2. In counting thoracic spinous processes from the top down, it is often easiest to first locate C7 and C6. C7 will, more often than not, be the top "knobby" that is easily palpable. Above C7 there is quite often a rather large change both in the immediate palpability of C6 and in reduction in relative size. C6 will often feel quite small in comparison to C7 and will also typically feel and appear deeper into the body. Once C7 is identified, a practitioner may "walk" their fingers down the spinous processes, counting as they go. This little technique with our spinous processes is important in other ways; as we are counting and becoming accurate, we are also assessing the mobility of each vertebrae as we go. With palpation, we can engage the whole of each vertebrae "by its nose" and with our engagement, we can start to get a feel for how mobile the vertebrae is and where it may be restricted. As well, just with the spinous process in our fingers, we can feel quite a bit into the whole of the vertebrae. The more you work on this particular technique, the more you will feel. Your knowledge will increase while your accuracy improves. ... |
The spinous process of C6, C7. Of the two, C7 is larger and more readily palpable.
The spinous process can be thought of as the "nose" of the vertebrae, and by engaging the nose, we may feel through the entirety.
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As we walk our fingers down, for example, to T4, we can notice that the length of the "nose" of the spinous process can vary greatly. In this skeletal model we can note a significant difference between the length of the T5 spinous process as compared to T4. This variance in length will impact our accuracy if we are solely gauging our accuracy by the spinous processes alone.
Hence it is recommended that we utilize as many bony landmarks as available to build our accuracy and help to essentially "triangulate" the position of the facets. Luckily, the ribs are there to help... |
The length of the T4 spinous process or "nose" is appreciably shorter than it's adjoining neighbor at T5.
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Starting from the top of Rib 1 we can count the ribs down to rib 4 by using the easily palpable route of the "rib angle". The rib angle(s) can be felt as we go a few inches laterally towards the scapula. There we can feel where the ribs begin their turn around the body. These "angles" align down the back to create a continuous vertical "ridge" on either side of the thoracic. Typically these angles are accompanied by thickened fascia.
Working with the rib angles is often critical in releasing rib fixations, and that will be addressed in detail in later sections. For now though, we will concentrate on using the ribs to find our facets.
Working with the rib angles is often critical in releasing rib fixations, and that will be addressed in detail in later sections. For now though, we will concentrate on using the ribs to find our facets.
As the ribs begin their turn around the body there is a noticeable increased angle in each rib. Accompanying each angle is a thickening in connective tissue/fascia. Together, the rib angle(s) forms a vertical prominence/ridge on either side of the thoracic.
While you are palpating and counting, it may help to position the arm of your client so that the scapula is out of the way as much as possible but without causing the surrounding tissue to tension. Relaxed tissue here will grant you entry, while tense tissue will push you out.
Counting to Rib 4, we can then drop our fingers into the area between Rib 4 and Rib 5. From there we can then follow the 'between-space' towards the vertebrae which will take us directly into the bottom left facet of T4, intersecting with the top left facet of T5.
Counting to Rib 4, we can then drop our fingers into the area between Rib 4 and Rib 5. From there we can then follow the 'between-space' towards the vertebrae which will take us directly into the bottom left facet of T4, intersecting with the top left facet of T5.
Counting to Rib 4, we may drop into the space between Rib 4 and Rib 5 to arrive at the left facet joint between T4 and T5.
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Note the curvature of the ribs. It can be a source of confusion.
To help visualize the path and curvature of the ribs: the shape of the vertebrae and attached ribs can be thought of as resembling a "batwing" or the wing of a bird, and seeing this shape may help you trace the route. 
The curvature of the ribs into the vertebrae can be visualized as a "batwing".
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The left facet joint of T4/T5.
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Once some familiarity has been established with the vertebrae and ribs, accurately finding the facet becomes a quicker process. The key is often just initially taking the time to figure out where you are and familiarize yourself with the territory, even if it adds extra time to your session. Accuracy is not always easy but your attention here will pay off. Your level of detail will be noted by your clients and you will stand out amongst the crowd. Accuracy is also like target practice - you will never be perfect but expect to get better with practice. And as your accuracy gets better, you will get better. Your clients will get better. |
T12 and the Lumbar Change
At the T12 vertebrae, the facet surface changes it's orientation dramatically. The top facets of T12 that articulate with T11 have a similar orientation to the rest of the thoracic facets. However, the bottom facets of T12 that articulate with T1 change significantly to face much more laterally. This facet orientation then continues down to the sacrum and into the articulation between the sacrum and L5. With this change in joint orientation, our angle of attack and strategy to engage and unwind T12/L1 and below will change as well.
At the T12 vertebrae, the facet surface changes it's orientation dramatically. The top facets of T12 that articulate with T11 have a similar orientation to the rest of the thoracic facets. However, the bottom facets of T12 that articulate with T1 change significantly to face much more laterally. This facet orientation then continues down to the sacrum and into the articulation between the sacrum and L5. With this change in joint orientation, our angle of attack and strategy to engage and unwind T12/L1 and below will change as well.
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Ida Rolf, founder of Rolfing Structural Integration, was particularly interested in T12 as an important bone and location in the body. In Theoretics 1 we discussed how the T12 area undergoes a drastic change in movement potential (how well vertebrae can move) and we note that at this junction, the movement potential of the vertebrae significantly decreases as we go up into the thoracic by virtue of a plethora of attachments, most notably - the ribs. The ribs complicate movement, and significantly add to spacial restrictions in the structure. Because of this, we may state with reasonable certainty that the T12 juncture signals a negative change in the movement potential of the vertebrae as we go up the spine and into the thoracic. T12 is a junction - a changeover.
Here, we may note another important distinction with T12 - that it sees the most significant change in facet orientation of any vertebrae in the spine. This adds a layer of complexity to T12 and it's articulations. And without hesitation, we may also say that the joint movement between T12 & L1 will be mechanically different than the movement between T12 & T11. |
T12 highlighted. Notice the change in the shape and orientation of the facets.
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Using a playing card to show the orientation of T12 to T11. The orientation is similar to the rest of the thoracic.
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At T12-L1 the facets turn to face laterally.
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This change in facet orientation from T12 & L1 remains consistent through the lumbar facets all the way down to the Sacrum and L5. To engage these laterally facing joints requires lateral pressure - either from the side or from a mid-point working outwards.
From the sides, the facets may be accessed between the spinous processes of the lumbar vertebrae. The facets may also be accessed from the spinal groove (a running groove or indentation on either side of the spinous processes occurring the length of the spine) with pressure applied from the midline outwards. When space allows, a lumbar facet may also be pressured from both directions at the same time.
Again, note that in these pictures I am only showing the direction of pressure (while trying to stay out of the way of the camera). Technique here will differ. Sections to come will detail hand technique, mechanics and positioning, as well as working from underneath the client.
From the sides, the facets may be accessed between the spinous processes of the lumbar vertebrae. The facets may also be accessed from the spinal groove (a running groove or indentation on either side of the spinous processes occurring the length of the spine) with pressure applied from the midline outwards. When space allows, a lumbar facet may also be pressured from both directions at the same time.
Again, note that in these pictures I am only showing the direction of pressure (while trying to stay out of the way of the camera). Technique here will differ. Sections to come will detail hand technique, mechanics and positioning, as well as working from underneath the client.
Pressuring the facet of L2 & L3 from the side, between the spinous processes.
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Pressuring the articulation between the sacrum and L5 from the spinal groove.
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Unwinding and The Comprehensive Approach
Older Clients
In his book on Spinal Manipulation, Jeffrey Maitland states, "Indirect technique (or so-called "unwinding techniques"), is not always effective. You will notice that sometimes you will achieve easy and amazing results with it and at other times the problem you thought you had taken care of reasserts itself within a matter of minutes or hours. The drawback with most unwinding techniques is that they often do not address one of the most important aspects of a painful back - the underlying facet restriction." (Maitland, Jeffrey, Spinal Manipulation Made Simple, p. 9 (2001)).
Jeffrey goes on to detail a number of direct interventions utilizing quite a bit of client movement (dynamic work). It is fantastic stuff, and I highly recommend checking it out. Here however, we are mostly working statically and only indirectly. I find this type of work to be more suitable especially for older clients.
Jeffrey also mentions that the drawbacks with many unwinding techniques includes facet restriction, and we're addressing that here from a different angle, but I also find and have no doubt Jeffrey would agree, success with the technique, especially long-term success, requires a comprehensive effort.
I'm going to break this down a bit:
a. In order to address the underlying facet restrictions, static unwinding technique is consistently more successful when applied in the manner described above and at the appropriate angle of attack to the articulating surface.
b. Success and permanency of change at the facet however is dictated by a number of factors. For instance, and from my own experience, let's say I want to unwind a facet at T3/T4. I'd likely begin the process by first working through lateral rib restrictions in the armpit and under and around the scapula. From there I would then address rib restrictions in the anterior and posterior, focusing my work to also help ease whatever twist is present - generally this means focusing and opening more on the "shallow" side of a twist, and releasing tissue "where I want things to go". Then I'd look to release and unwind all the way through the anterior chest and rib cage and into the front aspects of Vertebrae T3 and T4 while focusing my efforts on whichever of the two vertebrae was the more shifted (translated) posteriorly (i.e.: deeper in the body).
From there I'd probably spend some time unwinding directly on the rear aspect of whichever of the two was shifted more anteriorly. At that point I might take a shot at the rear facets and rib articulations but I might also just continue working outwards from T3/T4 in the same manner, all the way down to the pelvis and up to the head. All utilizing indirect method. Soft tissue, ligament bed - everything. Towards the end of the session I'd start focusing more on the facets. But the better the set-up before, the better the release.
The key is of course comprehensiveness - Ida Rolf's system of adaptation: to change a part we must change the whole.
So, a facet might release right off the bat or not. Be aware though, this isn't magic. You must create the circumstances by which the release happens and holds.
c. Perhaps one of the biggest advantages to working with indirect technique and working statically is it's applicability to working on older people. Unwinding and indirect technique works pretty much the same on the old and elderly as it does on the young and younger. It retains it's effectiveness - even as it moves up the age bracket. I can't understate how valuable this is.
To my knowledge this is rare ground indeed in the world of manual therapy and especially within realms of spinal manipulation - where direct, high velocity manipulations are really not suitable for older people. That type of thing can result in a hospital visit, or worse.
For the old, heavy-handed soft-tissue techniques are not suitable either. Many times, nothing more than very light massage can even be applied to an elderly person. Often there is a lack of soft tissue to even be heavy-handed with or even massage. Over-tonus/tension in soft-tissue typically isn't the problem either, it's more often a lack of it. Scraping grandpa's femur with an elbow is not going to help him, or balance his pelvis. Rubbing a saggy chest will not effect T5. It isn't muscle tone that an elder is looking to equalize or do something about; it's that feeling that bone is rubbing on bone. Space is the issue...joint space - everywhere.
Now I'm not going to say that working on older people is just as easy as working on younger people - it isn't. And what you can expect to achieve in a given timeframe must be dialed-down to realistic. But unwinding works the same way with the same beneficial structural effect. There is no contra-indication. It's gentle, it's gradual, it's patient, it's particular and it's kind. And that is what is needed.
This, all against a societal backdrop of an aging population, with fewer and fewer people to take care of the old, and spinal issues being recognized as a dominant factor in health, functionality, and pain - for which an opioid crisis presently exists.
How can we find a solution? I have a suggestion...
And even if a person of business interests was just looking at all this from a financial angle, perhaps they would ask the question, "Where is money and capital being increasingly concentrated?" -- well, it's not with the under 40 crowd. That is for sure.
Older Clients
In his book on Spinal Manipulation, Jeffrey Maitland states, "Indirect technique (or so-called "unwinding techniques"), is not always effective. You will notice that sometimes you will achieve easy and amazing results with it and at other times the problem you thought you had taken care of reasserts itself within a matter of minutes or hours. The drawback with most unwinding techniques is that they often do not address one of the most important aspects of a painful back - the underlying facet restriction." (Maitland, Jeffrey, Spinal Manipulation Made Simple, p. 9 (2001)).
Jeffrey goes on to detail a number of direct interventions utilizing quite a bit of client movement (dynamic work). It is fantastic stuff, and I highly recommend checking it out. Here however, we are mostly working statically and only indirectly. I find this type of work to be more suitable especially for older clients.
Jeffrey also mentions that the drawbacks with many unwinding techniques includes facet restriction, and we're addressing that here from a different angle, but I also find and have no doubt Jeffrey would agree, success with the technique, especially long-term success, requires a comprehensive effort.
I'm going to break this down a bit:
a. In order to address the underlying facet restrictions, static unwinding technique is consistently more successful when applied in the manner described above and at the appropriate angle of attack to the articulating surface.
b. Success and permanency of change at the facet however is dictated by a number of factors. For instance, and from my own experience, let's say I want to unwind a facet at T3/T4. I'd likely begin the process by first working through lateral rib restrictions in the armpit and under and around the scapula. From there I would then address rib restrictions in the anterior and posterior, focusing my work to also help ease whatever twist is present - generally this means focusing and opening more on the "shallow" side of a twist, and releasing tissue "where I want things to go". Then I'd look to release and unwind all the way through the anterior chest and rib cage and into the front aspects of Vertebrae T3 and T4 while focusing my efforts on whichever of the two vertebrae was the more shifted (translated) posteriorly (i.e.: deeper in the body).
From there I'd probably spend some time unwinding directly on the rear aspect of whichever of the two was shifted more anteriorly. At that point I might take a shot at the rear facets and rib articulations but I might also just continue working outwards from T3/T4 in the same manner, all the way down to the pelvis and up to the head. All utilizing indirect method. Soft tissue, ligament bed - everything. Towards the end of the session I'd start focusing more on the facets. But the better the set-up before, the better the release.
The key is of course comprehensiveness - Ida Rolf's system of adaptation: to change a part we must change the whole.
So, a facet might release right off the bat or not. Be aware though, this isn't magic. You must create the circumstances by which the release happens and holds.
c. Perhaps one of the biggest advantages to working with indirect technique and working statically is it's applicability to working on older people. Unwinding and indirect technique works pretty much the same on the old and elderly as it does on the young and younger. It retains it's effectiveness - even as it moves up the age bracket. I can't understate how valuable this is.
To my knowledge this is rare ground indeed in the world of manual therapy and especially within realms of spinal manipulation - where direct, high velocity manipulations are really not suitable for older people. That type of thing can result in a hospital visit, or worse.
For the old, heavy-handed soft-tissue techniques are not suitable either. Many times, nothing more than very light massage can even be applied to an elderly person. Often there is a lack of soft tissue to even be heavy-handed with or even massage. Over-tonus/tension in soft-tissue typically isn't the problem either, it's more often a lack of it. Scraping grandpa's femur with an elbow is not going to help him, or balance his pelvis. Rubbing a saggy chest will not effect T5. It isn't muscle tone that an elder is looking to equalize or do something about; it's that feeling that bone is rubbing on bone. Space is the issue...joint space - everywhere.
Now I'm not going to say that working on older people is just as easy as working on younger people - it isn't. And what you can expect to achieve in a given timeframe must be dialed-down to realistic. But unwinding works the same way with the same beneficial structural effect. There is no contra-indication. It's gentle, it's gradual, it's patient, it's particular and it's kind. And that is what is needed.
This, all against a societal backdrop of an aging population, with fewer and fewer people to take care of the old, and spinal issues being recognized as a dominant factor in health, functionality, and pain - for which an opioid crisis presently exists.
How can we find a solution? I have a suggestion...
And even if a person of business interests was just looking at all this from a financial angle, perhaps they would ask the question, "Where is money and capital being increasingly concentrated?" -- well, it's not with the under 40 crowd. That is for sure.
Thanks folks I hope you enjoyed this section and that it helps you in your practice. I learned quite a bit in writing it.
Donations for this site are kindly accepted through PayPal.
From concept to pictures & art to editing, a section like this takes me over a month to put together. If this information helps you and your clients, help me do more. Blessings and happy bodywork.
Donations for this site are kindly accepted through PayPal.
From concept to pictures & art to editing, a section like this takes me over a month to put together. If this information helps you and your clients, help me do more. Blessings and happy bodywork.