Structural Integration practitioners typically assess and palpate the body very differently from other healthcare providers. Generally speaking, we are not assessing and palpating for muscle tightness and contraction. We are looking and feeling for the mobility of fascial layers, and where they have become adhered along a myofascial continuum. We are assessing for where fascial layers have adhered to bony surfaces, and where muscles contained within these continua have adhered together and thus altered our clients’ movement patterns.
What we assess and palpate for in each session will also be radically different and depend on the depth of the layers we intend to mobilize, the bony structures we intend to mobilize and the intentions of the session we are attempting to follow.
A discussion of assessment is really a discussion of intent. And knowing what to assess for in each session can be a major challenge for beginning students and new practitioners. So, some general guidelines can be helpful.
In Sessions One, Two and Three, we are assessing for the mobility of the body’s most superficial layers and the overall mobility of the extrinsic myofascial ‘envelope’ that surrounds the body. Palpation of these outer layers will typically be at very oblique angles and in three dimensions. Using both hands and feeling for the mobility – and lack of mobility – of these large planes of tissue will be the first challenge.
In Sessions Four through Seven, we are assessing for the mobility of the body’s intrinsic myofascial layers surrounding the spine. We also assess the mobility of the internal transverse planes and diaphragms, of the shoulder and pelvic girdles, and of our client’s ability to transfer breath and motion through their vertical center.
Assessing for the mobility of the body’s bony girdles, vertical myofascial continua and mobility of its transverse planes will, of course, be is different from assessing and palpating for the mobility of the body’s outer myofascial sleeve.
When assessing the mobility of the shoulders, it is important to determine what is keeping the shoulder locked in an elevated or rotated position. Typically, it will be adhesion between the upper portion of the trapezius, levator scapulae and scalene layers, keeping the shoulders and upper ribs held in elevation and rotation. The shoulder’s ability to move independently from the arm will also be of concern, as will the client’s ability to rotate their arm fully from the lateral edges of the scapula, the humeral head and A-C joint.
When assessing the mobility of the shoulder girdle, we look and feel for the clavicles to be free to move upward with the first and second ribs, for the shoulders to extend as the client breathes and for the scapula to ‘inferiorly glide’ on the posterior thorax. Again, using two hands to assess the mobility of the three-dimensional girdle will be helpful. With one hand in back and one hand in front, feel for the clavicle to be free to move upward in front and the scapula to be free to move downward on the posterior thorax in back. Feel for the lateral edges of the scapula to be free to move separately from layers connecting them to the upper arms.
When assessing the mobility of the bones of the arms and legs, having the client rotate these bones – as you lightly hold on to their surrounding myofascial envelopes – will help you to feel where fascial layers are adhered to these bones. It is critical at this point to stay focused upon the mobility of the bones deep in the musculature!
Assessing the mobility of the neck begins with determining its ability to move independently from the cranial base at the occiput, and from the temporal bones at the mastoid processes. With the client’s head and neck turned towards the side, feel for adhesion of the SCM layers to the mastoids processes, and to the head’s surrounding fascial ‘hood.’ Feel for adhesion of layers to the edges of the occiput, and as the client nods their head downward, move these layers downward off the bone.
With the client’s head and neck turned towards the side, feel for independence between the upper portion of the trapezius, levator scapula and posterior scalene layers by attempting to spread these layers apart and to move them forward.
When assessing the mobility of the cranial base from the occipital, feel for the occiput and temporal bones to be free to retract (shift back) and to move independently from the myofascial layers surrounding them. Typically, you will feel torsion between the temporal bones, with one side forward of the other. It will be important to support the cervical curve and to move it slightly forward as you work to free the cranial base and support its ability to shift back. Freeing these layers will take time, and the cranial base will often still be unable to retract fully until the medial pteriods and intrinsic layers holding the cranial base have been released.
When assessing the mobility of the thorax, we must think in three dimensions and ask questions such as, ‘Do I see movement in the ribs when my client breathes, and do the back of the ribs and sides of the ribs move as much as the front of the ribs? Do the ribs feel horizontal when I palpate them?’ Typically, if the shoulder girdle has been held in elevation and rotation, the first and second ribs beneath the girdle will also be held in elevation, rotation or diagonal strain – upward in back and downward at the sides and in front.
When assessing the mobility of the thorax, look for the scapula and sides of the thorax to move independently when the client rotates their thorax. Look for the shoulder to extend when the client inhales, and for the costal margins to widen and move independently from the abdominal wall as the client breathes.
Assessing the mobility of each of the body’s major weight-bearing segments – and how well these segments integrate and move as a system – is, of course, a huge discussion. And it is a skill that will accrue over time. This post is only meant to be a precursor to our class discussion on assessment of the upper body.