SERIES: FELDENKRAIS THEORY AND RESEARCH

The physics of Feldenkrais

Part 2: no strain, no gain
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John C. Hannon
The topic of posture, and how the individual uses their body is central to most bodywork and movement therapies and approaches. This new series of peer reviewed papers will explore the issues around this core topic from a particular perspective. The reader is invited to participate by communicating with the author, or the editor, with comments, ideas and constructive criticism. Alternative viewpoints will be published in future issue of the Journal of Bodywork and Movement Therapies. Editor

Abstract In the last issue, which was the rst of this series, the Principle of Least Eort was introduced. (Use the least eort necessary to achieve the maximum in eciency). Two sitting self-awareness explorations were presented to help deepen this understanding and to encourage a visceral comprehension of another principle: Control follows awareness. This issue features additional clinical examples and an explanation of several terms of art in bodywork: stress, strain, translation and rotation. These words help to stake out the territory of bodywork. There are only ve forms of strain and only two basic movements in any form of bodywork. We shall see the practical advantages of understanding the concepts these words carry. Clinical results may be enhanced with improved physical safety to both the therapist and client. Secondly, a sure grasp of the technical meanings of these words is essential for delving further into the treatment applications of the Principle of Least Eort. # 2000 Harcourt Publishers Ltd

John Charles Hannon DC Certied Feldenkrais Practitioner, Private Practice, 1141 Pacic Street, Suite B, San Luis Obispo, CA 93401, USA Correspondence to: J. C. Hannon Tel: +1 805 542 9925; Fax: +1 805 541 2391; E-mail: [email protected] Received February 2000 Accepted February 2000
........................................... Journal of Bodywork and Movement Therapies (2000) 4(2),114^122 # 2000 Harcourt Publishers Ltd

The rst installment of this series began with the lament: `We don't know what we don't know'. Overcoming this challenge may be aided by the use of principles. Principles are signposts pointing the way towards self-discovery of the inside workings of manual therapy. To the extent that we understand the mechanisms underlying manual therapy we may improve our accuracy and ecacy. The Feldenkrais Method1 was chosen to illustrate several physical principles common to all forms of bodywork. This is because Feldenkrais received his doctorate in physics and then spent many years discovering how physics could be used to aid people in improving their function. His writings and lectures demonstrate a scientist's devotion to the precise denitions of physics.
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A clear distinction needs to be made about the Feldenkrais Method1.1 It is a method of

1 The Feldenkrais Method1 is currently being taught in more than 50 trainings in 15 countries. Since the death of Dr Feldenkrais in 1984, the method has expanded to include 37 trainers and about 1200 practitioners certied by the Feldenkrais Guild of North America. The 34 year practitioner training involves 8001000 h of training combining several forms of learning. Lectures are used sparingly; more emphasis is placed upon exploring precisely structured movement through thinking, sensing, moving and imagining exercises called Awareness Through Movement lessons. Training is also provided leading toward competence in Functional Integration; which is the other form of expression of the Method. This hands-on form of tactile and kinesthetic communication aims at aiding the student in becoming more self-aware and in reorganizing their movement strategies. More information may be obtained by contacting the Feldenkrais Guild of North America (www.feldenkrais.com), or the International Feldenkrais Federation ([email protected]).

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The physics of Feldenkrais1 learning, rather than a form of bodywork, yet it often uses hands-on contact to communicate to the client. Other forms of bodywork such as transverse friction massage limit their purpose to the purely mechanical changes made in their target body tissues. In any case, a common feature of both categories of therapy is movement. And, any time movement occurs, passive or active, forces come into play and work is performed. Before beginning to clarify these meanings, it may be useful to ask what kind of `work' occurs in bodywork? The physical concept of work is a force moving through a distance (Fig. 1). Manual therapy ts this description well although both the force and the distance often are quite small. Smaller still is the amount of deformation or strain occurring in the tissues being treated. Certain words in bodywork are freighted with multiple meanings; `stress' and `strain' are examples. Consider the following: `Straining to follow the logic, Dr Vernacular continued reading the classic osteopathic text, Strain Counterstrain, to see if the technique would be useful to her next patient who had suered a muscle strain. Instead of stress, she felt relief recalling Hooke's Law2: `As long as a body remains within its elastic limit, the strain produced is
2 I promise that this Law will be the rst and the last Law mentioned in this series. Instead of reviewing the many Laws of physics, these articles will attempt to cultivate a deeper, more visceral, awareness of the applications of such laws to clinical situations. Such applications are best learned through personal experience and the process of self-discovery. An important disclaimer follows: the best comprehension of this material will follow enthusiastic exploration of the exercises. Please do only what can be accomplished with ease and safety. In addition, please apply clinical techniques only if you are certain that there are no contraindications and that you possess the necessary skill and experience to make the technique valuable to the patient..

Fig. 1 Work is the product of force moving through distance. Notice that less force is needed when there is little resistance.

directly proportional to the stress causing it'. There is an old word: hamartia. Murphy (1972) described it as originally meaning `...being o the target in archery or some such, and then it came to mean being o the target in general in all your life. It got to mean a aw in the character'. It may be useful to consider hamartia, in its original sense, in both the application of bodywork and its description. To help reach the bull's eye, it makes sense to use biomechanical terms with distinction. Work is the product of force and distance. Imagine screwing o the top of a bottle of shampoo. Your ngers squeeze the top and twist. Work is accomplished as the top revolves away from the bottle. This movement occurs only because the ngers are able to get purchase upon the top. The stress applied is the force of the ngers squeezing. The strain is the result of the plastic top being deformed. We forget the long hours spent early in our childhood learning the basics of movement. This is when we learned how to move our arms and ngers
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appropriately to accomplish tasks such as opening tops, especially child-proof ones. That this learning remains an important skill becomes apparent watching someone slowly recover common skills in the process of throwing o the eects of a stroke. Since the bottle top is now o, let us consider the ve forms of strain used in shampooing. Moving the scalp back and forth across the skull is an example of shearing strain. Here the skin is moved as if it were a kitchen drawer being drawn in and out. If we drag the drawer against its tracks to create enough friction the drawer will not slide well. Accuracy in applying forces to the tissues makes a dierence. Torque is another form of strain; an example is the twisting motion used in removing the bottle cap. Sadly, our bottle is almost out of shampoo; but bending it, another form of strain, forces out more. The last two categories of strain are long axis compression and long axis extension. If you have ever tugged on your hair or pushed the scalp downwards upon the skull you have used these two forms of strain.

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Hannon Reducing friction in the body occurs in many ways; slippery cartilage is oiled with synovial uid, tendons slide in slippery sheaths, muscles contract with bursae reducing drag against the neighboring tissues. All these moving parts are organized around skeletal joints. Joints permit easy movement in certain directions but not others. Our discussion separated actions as if each form of strain occurs without the others; in most instances, some combination of these forms of strain is applied simultaneously. It staggers the imagination to consider the permutations of these ve forms of strain used in the morning, when entire populations, still half awake, manage to cleanse themselves for the new day. Let us consider two more terms before exploring clinical applications of strain: translation and rotation. Translation describes movement taking place in a single plane; an example would be sliding kitchen drawer in and out. Rotation refers to movement about an axis. In a marvelous structure such as the human body, you often will see both forms of movement occur at the same time. For example, jut your lower jaw outwards from the skull while turning your head. Here the mandible slides forward along the plane of the upper palate while the head turns about the pivot of the C2 vertebra's odontoid process. In knee exion, the two movements of rotation and translation occur simultaneously during much of the range. The axis of rotation moves during this part of the range; each position of the movement having its own instantaneous axis of rotation. The rst installment of this series included two exercises. (See Volume 4:1, p29). In the rst exercise, the feet were translated forward and backward upon the oor. Ideally, this translatory movement involved

Fig. 2 The ve forms of strain. Box 1 Examples of the ve forms of strain Shear . Slapping a hockey puck . Pulling, successfully, a tablecloth out from under a ower vase . Transverse Friction Massage (the transverse component) Torque . . . . Rolling a bowling ball A CD player playing a disc Myofascial Release (the twisting component) Mobilizing the head in rotation upon the neck

Bending . . . . Knot tying Folding clothes Skin rolling techniques Bending and unbending nger joints

Long axis compression . . . . Driving in tent stakes Inserting a key into a lock Maitland (1991) Joint compression techniques Travell (1983) Ischemic compression techniques

Long axis distraction . Pulling out a cork from a wine bottle . Pulling a hose out straight . Maitland (1991) Joint distraction techniques

only a shearing strain of the foot against the ground. Some people slide their feet while simultaneously
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turning their feet in as if pigeontoed; applying both shear and torque forces. A person with mild

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The physics of Feldenkrais1 cerebral palsy might induce three forms of strain. In addition both torque and shear, they might also long axis compress their feet into the oor. This would greatly increase the resistance; reducing the grace and eciency of the movement. It takes a great deal of experimentation, and maturing of the nervous system, before a person nds the right formula for easy foot sliding. One strategy is to raise the foot slightly to allow for easy translation of the foot along the oor. It seems an easy task, simply hoist up the leg a bit. Actually, since the foot is being moved away from the person's center, shifting of the person's weight away from the side of the sliding foot is necessary as well. All of this has to be monitored and adjusted during the entire trajectory of the foot's travel. Let us consider how these concepts apply to various forms of bodywork. Cyriax popularized a treatment method he termed Transverse Friction Massage many years ago. An important innovation which he brought to this form of manual therapy was noting that muscle broadens as it contracts. He hypothesized that a scar would disrupt this normal broadening and that a therapeutic disruption of this scar would allow a return to normal functioning. He therefore was quite specic in ordering that the friction massage be applied perpendicular to the bers of a muscle. He invented ingenious postures of the treating ngers and supporting arrangements of the limbs and trunk to make this form of therapy eective. In Figure 4 the knee is seen with the coronary ligaments. Cyriax saw that a very specic form of transverse friction massage would be necessary. He saw that the application of force must be precise to reach the ligament rather than the ledge of the tibial plateau. He required that the frictions be applied both perpendicular and cutting transversely across the ligament. For more information about the three dimensional relationships in the knee refer to the many inspired illustrations by Kapandji (1987). Before continuing our look at specic examples of the use of strain in therapy, let us consider the body

Fig. 4 Transverse friction massage of the coronary ligament of the knee. Notice both compressive and shearing strain as the treating ngertip presses onto the ligament and then shears across the bres in a transverse plane.

Fig. 3 Slide your foot forward and backward while sitting comfortably. Sit comfortably with your feet at on the oor. Slide the right foot forward and back. Attempt to make the eort as easy and simple as possible. 1 17

posture of the therapist. Recalling the Principle of Least Eort we know that we must attend to the details of posture in order to reduce unnecessary eort. This is very true when working with those who are unable to relax. Often, these people are susceptible to increasing their muscle tension at a moment's notice. Any excess tension on the part of the therapist often is transmitted, as if they were contagious, to the susceptible client. From our exploration described in Box 2, we may suspect that movements out of the ordinary may bring out excess tensions on the part of the therapist. These might appear in the form of clenching of the jaw, holding of the breath, gripping of the thighs and ngers, stiening of the trunk, adducting of the arms and so forth. It is speculated that an eective treatment, applied with the least eort, will require the therapist's body to be arranged subject to two conditions. One, the bones carry as much load as possible. Secondly, gravity is the primary mover during the treatment. Once in place, the therapist's muscles would act primarily to direct the force of

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Hannon trunk rotation should occur around the spinal axis with moderate action of the abdominal and back muscles. The neck musculature remains relaxed with the arms and shoulders remaining as relaxed as is consistent with the task. Trunk rotation begins at the thoracolumbar junction and proceeds upwards with the inferior angles of the scapulae remaining in place without divergence. The pelvis and legs also remain still (Fig. 5). Notice the unneeded eorts in the incorrect example. The neck is both turned and exed forward, the shoulders are hunched and the lack of abdominal and back muscle action creates adverse strain, torque and shear, at the lumbopelvic junction. Not only does this incorrect way of turning fail to follow the Principle of Least Eort, it may create harmful stresses in the body. You may wish to observe this movement in yourself and others. To do so, nd a stable stool allowing a comfortable perch with the feet fully at on the oor. Place the stool within arms reach of a rack of shelves. Start with a book resting in the person's lap. Instruct them to

Box 2 Movement Exploration Write your name, in cursive script, three times in the following three dierent ways. First, write it in your normal way. Next, write it again with the pen held in a loose st. Last of all, maximally make a st. Note in what ways does the writing degrade? What about writing from within a maximal st with the other hand? Consider how you might choose to work with someone whose spinal extensions and hip adductors stay as contracted as a st. You can experience something of what this might be like by walking while squeezing a football between your thighs as hard as possible. What happened to your jaw muscles and breathing during this writing and walking. Often it is extremely dicult to unbundle these eorts. In other words, it is hard to do one task without unnecessary actions elsewhere. Return to the earlier task of jutting the jaw while turning the head and repeat the movement many times but in a slower manner. Do you nd that there are times where either movement becomes jerky? Discovering how to smooth our own movements often can be quite useful not only for ourselves but also in improving our eorts with clients.

gravity through the bones. In the next issue of JBMT the author will describe a treatment for the proximal thigh, (Stillness, salience and the sensibilities of stroma), which illustrates how this skeletal arrangement might appear. To realise the universal presence of adverse muscle tensions, simply observe a child attempt a task beyond their development. Or, look in a mirror as you write your name backward with your non-dominant hand. The facial grimaces, interrupted breathing and excessive eorts of unneeded muscles immediately present themselves for viewing. So what might a healthy treatment posture look like? If we want to direct a therapeutic force precisely, it makes sense to launch such a force from a stable platform. One such platform is a stable spine capped at either end by a stable composition of the shoulder and pelvic girdles. An easy example is a sitting posture with the feet at on the oor and the elbows perched solidly upon the thighs. Empirically, it seems that this is best accomplished with the treatment stool and the therapy plinth being the same height, as that of the therapist's leg, (the distance from

the sole to the inferior pole of the patella). The ischia are poised upon the stool without either forward or backward tilt of the pelvis. This poise is easily inuenced to allow tilting of the trunk and pelvis in any direction. This unstable equilibrium will be further discussed in subsequent issues of this series. Lewit (1991) describes the normal attributes of proper sitting while turning the trunk to reach the arm out at eye level. He notes that sitting

Fig. 5 Lewit's sitting coordination rotate and reach test. (A) correct; (B) faulty. Note the feeling of elegant graceful strength seen in the rst gure and the hunching of the shoulder and neck; the abby tone of the back and abdomen in the second gure. Not only does the second posture look impoverished, it fails to follow the Principle of Least Eort and puts the person at risk of injury due to the adverse strains placed across the dierent tissues of the body. 1 18

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The physics of Feldenkrais1 place the book on a shelf at eye level. Observe carefully, you may wish to instruct them to repeat the movement several times slowly. In addition to observing the coordination of the dierent parts of the body throughout the motion, you may wish to look for evidence of changed respiration patterns. Our next strain to be considered is torque; it is found in many dierent forms of bodywork. In fact, it is hard to nd movements which lack a torque component. Let us consider a therapeutic twisting of the topmost scapula with the client lying on their side (Fig. 6). The scapula is designed to be quite mobile upon the rib wall. Normally the blade can be translated approximately three nger-widths in all directions in those people able to relax. If the person is tense bilaterally, often they will be unable to recognize their lost scapular ranges of motion. For this reason, a passive mobilization of the scapula may remind the client of the neglected range. The therapist positions himself so that his sternum faces the client's scapular spine. He adjusts the table plinth height until an easy folding of the trunk is possible by forward bending at the hips. His hands surround the top-most scapula with the elbows hanging downward to help relax the scapulars elevators. By taking a broad stable stance, it is possible for him to arrange his pelvis and trunk to counter-poise each other. In other words, by suitable arrangements, he creates an unstable equilibrium of his trunk upon the pelvis and his legs upon the ankles. The value of an unstable equilibrium lies in the ease of which it is possible to move away from the poise of the stable position. In our example, the therapist, by rocking his trunk forward upon his femoral heads, and by rocking his lower extremities backward upon his ankles, is able to maintain his balance (Fig. 7). The reason for insisting upon a sense of balance is to avoid tensing of the ngers, stiening of the arms, and holding of the breath yet allow the therapist to induce a therapeutic strain by merely tipping forward. Once at peace and in a stable position, the therapist's two hands encircle the scapula and passively move the blade in all directions discovering which are restricted. By consciously adducting the arms, the canny therapist is able to lock out certain skeletal joints. This arranges his locomotor frame into a conguration both stable and harmoniously purposeful. In this case it would be the slight exion of the trunk which mobilises the client's scapula rather than the movements of the therapist's limbs. Clients report that such a contact feels comfortable, even restful. This feeling of comfort allows the client to further relax any ambient muscle tension which, of course, is the purpose of the technique. The next form of a strain to consider is bending. At times it is useful to mobilize the head and neck. Consider that there are thirty-ve spinal joints between the skull and rst ribs. This large number of moving surfaces give rise to many opportunities for idiosyncratic movements that may congeal into habitual patterns. The head may be turned with a variable amount of side-bending. Many people carry their heads forward of the gravity line.3 With the head forward, the head tends to turn while simultaneously
The gravity line is a plumb line dropping straight to the ground from the center of the head, (from the side, this point is approximately centered at the ear opening). In the standing position, the most ecient placement of the head is directly over the feet. In fact, as we recall from the denition of work as force multiplied by distance, the more forward the head, the more work is necessary to hold that position. But, with increase in anterior head position, the amount of work grows very fast since the additional work is not added but multiplied.
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Fig. 6 Therapeutic torque applied to the side-lying scapula. The hands are molded to the shoulder blade with the therapist's body arranged to allow their skeleton to comfortably fall, ever so slightly, upon the client's scapula. How would you improve the positioning to take advantage of the Principle of Least Eort?

Fig. 7 Standing unstable equilibrium to allow gravity to be the prime force in mobilising the scapula. The pelvis translates backwards with the leg rotating backwards at the ankles while the arms move forwards while the trunk rotates forwards at the hips. Try this to see how dicult it is to maintain stillness of the spinal curves while rotating the trunk over the femoral heads. Generally, people habitually ex at the lumbosacral hinge joint. 1 19

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Hannon side-bending such that the ear drops towards the shoulder. If such a movement occurs often enough, it may become habitual. If such a habit should become too persistent, there may be clinical utility in reintroducing the client to a dierent movement pattern. Here is one way. The client lies comfortably supine with the head and neck supported such that the scapular elevators and sternocleidomastoids relax. The head is rolled by the therapist's hand from side to side with the hand resting on the middle of the forehead. The hand remains in a plane tangential to the globe of the head (Fig. 8). We can see that the hand translates through space but it rotates and side-bends the head by rolling it on the plinth. This pattern often feels quite natural to the client; it may even be soothing particularly if the range of motion is carried out very slowly. Another way of moving the head attempts to highlight rotation and reduce side-bending. In this situation, the therapist must recall the simplest axis of rotation of the head intersects the odontoid process of C2, (the axis vertebra). Passive rotation of the head around this axis often produces quite a dierent feeling of movement. The dierence may be visualized by comparing two dierent hand movements. The rst example would be inserting a key to unlock a door; here we see a rotation of the forearm around its long axis. The second example would be running the palm of the hand over the surface of a large world globe. In the second example, the arm circumducts at the same time as the forearm rotates. Here the forearm rotation is slower with the sensations of circumduction being added to the mix. There are other sensations to consider as well. In both cases of head turning, the back of the head feels a changing relationship to the treatment table plinth. When the head both rotates and side-bends, the scalp rolls as would a bicycle tyre upon a patch of road. In the second example, spinning rather than rolling occurs when the head is rotated about the odontoid; this means a reduction of the pressure of the head upon the plinth and a resulting reduction in the sensation of pressure. Interestingly, although roughly the same part of the scalp contacts the plinth during the movement a very dierent feeling occurs. It is as if the tyre is spinning without gaining traction. The head turns but does not move sideways through space. Often, this dierent sensation gives the client a deeper perception of the volume of their head. Rywerant (1983) describes this aspect of the learning process as a desired outcome of the Feldenkrais method, `... a learning process in which the relevant terms are dyadic: aware-unaware, ecient-inecient, clear-unclear, intentional-unintentional, dierentiated-undierentiated, habitual-nonhabitual. Each of these pairs designates the two extremes of a denite functional and dynamic dimension in the `space' of human action. Any human action nds its place within this multi-dimensional space, and Functional Integration makes the point that this place is not necessarily xed- that with a change of place, the quality of the action improves.' In this case, the feeling of the head's volume may help the client to revise an inner self-image of

Fig. 8 Rotation versus rolling of the head. There are many movements which may be introduced to a client's head. Here are two. (A) When the head is rolled by a translatory movement of the therapist's hand, there is much side-bending which accompanies the rotation. (B) When the head is rotated about the odontoid of the axis vertebra, side-bending is held to a minimum with the resulting feeling of the head moving but remaining in the same volume in space. Due to the great number of extero-receptors in the head, the client often feels extraordinary sensations when this maneuver is performed precisely with little eort to distract the client from their inner sensations. 120

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The physics of Feldenkrais1 the orientation of the head to the rest of its world. Since the head is one pole of the body axis, the end with all the extero-receptors, it must be well oriented in space to allow safe self-expression of movement. Just ask anyone who has recently bumped their head against a low ceiling. Our last forms of strain, long axis compression and extension, are best considered in the shoulder. A wondrous anatomical arrangement occurs in the glenohumeral joint of the healthy adult. The joint is unusually lax to allow great mobility of the arm (Fig. 9). In order to ensure strength and safety, the design assumes that the scapula and humerus align appropriately at the glenoid surface. Often, this arrangement is distorted by a habitual elevation of the shoulder girdle as a postural compensation due to a combination of tightened and weakened muscles (Janda 1983). Should this be the case, a therapist may wish to passively model the possible range of motion of the glenohumeral joint in shoulder elevation and depression. This may be done in the supine position. The shoulder is brought to the edge of the plinth. The therapist is sitting comfortably as described earlier. She takes a comfortable two-handed grasp of the esh of the proximal arm and this esh is distracted proximally until the humerus is moved toward the client's ear. At this point, the therapist makes certain of her poise and re-adjusts her posture accordingly. Her sternum should be facing the glenohumeral joint with the client's nearest ear and shoulder in line with her hands and eyes. The gentle grasp of the arm, which emphasizes long axis compression, is retained while her trunk bows forward. This trunk exion allows gravity to be the motive force, her muscles acting only to direct the maneuver. The shoulder is approximated to the ear as closely as is comfortable. At this point, the client is instructed to actively pull the shoulder to the ear several times. After this eort, the client is encouraged to breathe easily and to deeply relax the shoulders, head and neck. This next movement is the crux of the procedure. The client has shrugged actively the shoulder and is now resting. Without disturbing the mood, the therapist long axis distracts the glenohumeral joint along the long axis of the humerus. This often allows the client to experience a greater range than was felt to be possible. Long axis compression then returns to the beginning of the cycle which is repeated several more times. Conclusion We have dened strain and we have identied the ve forms of tissue deformation. These forms of strain, alone or in combination, represent the most basic reduction of any therapeutic manual intervention. We also have examined translation and rotation, the only two forms of movement possible. We have considered these movements within the context of physics and with the expectation of being able to delve into the Principle of Least Eort. If we are successful in exploring these concepts, it is this author's opinion that increased therapeutic success will occur due to our increased skill at accomplishing our intentions. Certainly, a better use of our own bodies will cultivate

Fig. 9 The glenohumeral joint. In (A) which is the only one drawn to scale, notice the vast dierence in the small surface area of the humeral head and the larger mating surface of the glenoid. Also, note the glenoid's pear shape with the narrow end oriented upwards. (B) shows a stable arrangement due to the larger skeletal connection of the humerus and the wide part of the glenoid surface. (C) demonstrates a poor connection; when the humeral head loads onto the scapula in this upper position, structural stability is degraded. This occurs when the arm is shrugged upwards. In this position, in order to centrate the joint surfaces, additional muscular eorts are required thus betraying the Principle of Least Eort.

Fig. 10 Long axis compression and distraction of the glenohumeral joint. The shoulder is brought to the edge of the plinth. Manual compression and distraction of the supine shoulder often results in a greater relaxation of the surrounding muscles and a resulting increased range of motion. Often the sensation of this increase is wildly dierent to the client, who experiences the passive movement, than that of the therapist who actively creates the change. 121

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Hannon and maintain our health and perhaps improve our sensitivity. This illustrates our other Principle, Control Follows Awareness. Feldenkrais (1972) felt that `if you know what you are doing, you can do what you want'. Perhaps we can use some of the ideas and explorations presented here to oset that other piece of wisdom, `you don't know what you don't know.' Acknowledgements
The author wishes to thank Anat Baniel, Feldenkrais1 Trainer, whose remarkable skills and interest were instrumental in encouraging the long cultivation it took for these principles to take root and become fruitful.
Lewit K 1991 Manipulative Therapy in Rehabilitation of the Locomotor System. Butterworths, London Rywerant Y 1983 The Feldenkrais Method: Teaching by Handling. Keats, New Canaan, p. 200 (Also see: Poincare H 1952 Science and Hypothesis, Dover, New York, for a mathematician's explanation of some relationships between spatial orientation and sensation) Maitland GD 1991 Peripheral Manipulation. Butterworth-Heinemann, London Murphy M 1972, Golf in the Kingdom. Delta, New York Travell JG Simons DG 1983 Myofascial Pain and Dysfunction The Trigger Point Manual. Williams and Wilkins, Baltimore

REFERENCES
Adler SS Beckers D Buck M 1993 PNF in Practice: An Illustrated Guide. Springer-Verlag, Berlin Cyriax J 1982 Textbook of Orthopaedic Medicine, volume one Diagnosis of Soft Tissue Lesions. Bailliere Tindall, London Feldenkrais M 1972 Awareness Through Movement. Harper and Row, New York Janda V 1983 Muscle Function Testing. Butterworths, London Kapandji IA 1987 The Physiology of the Joints, volume 2: Lower Limb. Churchill Livingstone, Edinburgh

BOOK REVIEW

Book review
Cranial Sutures
Mark Pick Eastland Press Seattle,1999, ISBN 0-939616-29-7 In this superbly illustrated text Mark Pick focuses on the morphology of the cranial sutures and oers a series of extremely detailed palpation protocols for evaluation of their status. Indeed the development of the practitioner's palpatory skills is a primary objective of the book, along with the imparting of a clear understanding of how sutures articulate morphologically. Hand positions, degrees of pressure and an extraordinary range of palpation exercises (one involving use of a watermelon!) form the rst 80 page segment of the book. The bulk of the remaining over 400 pages is taken up by photographs and a systematic description of almost every conceivable sutural junction in the skull (including the inaccessible and the facial ones). A short but useful section completes the book, in which Tuina techniques are described and illustrated for treatment of `tissue aberrations'. It is hard to conceive a more practical text for those who wish to know all there is to know about how the bones of the head meet and articulate with each other, and how to palpate these. Leon Chaitow Senior Lecturer Centre for Community Care and Primary Health, University of Westminister, UK

........................................... Journal of Bodywork and Movement Therapies (2000) 4(2),122 # 2000 Harcourt Publishers Ltd

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