seitai module 6-2007 arm and shoulder

© Amatsu Association Ireland (AAI) and Amatsu Therapy Association (ATA), April 2006 1

COMPETENCY SHEET FOR SEITAI MODULE 6 – THE UPPER EXTREMITY

Student Tutor 1. Prerequisites for Module 6 Student has shown knowledge of the bones and joints of the arm and shoulder

2. Location of anatomy Student is shown how to locate and palpate the following bones:

Phalanges and metacarpals - Carpals - Ulna and Radius - Clavicle - Scapula -

3. Pleural Dome Ligaments Student has been shown the location of the pleural dome ligaments Student is able to test the function of:

Transverse pleural ligament - Costo-pleural ligament - Pleuro-vertebral ligament -

4. Integrated Assessment of the Upper Extremity Student is shown how to perform the following techniques:

Review of muscle tests - Asymmetry, range and texture - Subclavius test - Clavicle assessment -


Pleural dome assessments -

5. Correction of the Upper Extremity

Student is shown how to: Load and engage the foot to engage the spine - “Walking” up the arm whilst holding the stack - Use of kyushu at the thumb - Use of kyushu at the 1st rib - 1st rib release - 3rd rib release and its importance in lymphatic drainage - Bicipital groove -

6. Distal Effects of Upper Extremity Protocol Student understands the distal effects as a result of balancing the arm and shoulder Student understands the need to check the following before and after the balance:

Fossae - Gaits - Pitch, Roll and Yaw -

7. Distal Effects of Spine and Rib Protocol Student understands the distal effects as a result of balancing the Spine and Ribs Student understands the need to check the following before and after the balance:

Fossae - Gaits - Pitch, Roll and Yaw -


SEITAI

MODULE SIX


THE UPPER EXTREMITY

CONTENTS CONTENTS....................................................................................................................................... 4 THE UPPER EXTREMITY AND THE SHOULDER ....................................................................... 7

THE SHOULDER.................................................................................................................................... 7 Bones and Joints.............................................................................................................................. 8 Ligaments and Tendons................................................................................................................ 9 Muscles .............................................................................................................................................. 12 Nerve.................................................................................................................................................. 12 Blood Vessels .................................................................................................................................. 13 Bursae................................................................................................................................................ 13


ELBOW ANATOMY.............................................................................................................................. 14 Bones and Joints............................................................................................................................ 16 Ligaments and Tendons.............................................................................................................. 16 Muscles .............................................................................................................................................. 18 Nerves................................................................................................................................................ 19 Blood Vessels .................................................................................................................................. 20

HAND ANATOMY ................................................................................................................................ 20 Bones and Joints............................................................................................................................ 20 Wrist ligaments .............................................................................................................................. 21 Nerves................................................................................................................................................ 22 Blood Vessels .................................................................................................................................. 24

CONDITIONS OF THE SHOULDER ........................................................................................... 25 Impingement Syndromes........................................................................................................... 25 Rotator Cuff Tears......................................................................................................................... 25 Frozen Shoulder ............................................................................................................................. 25 Osteoarthritis of the acromio-clavicular joint..................................................................... 26 Osteoarthritis of the gleno-humeral joint ............................................................................ 26 Rheumatoid Arthritis of the Shoulder.................................................................................... 26 Dislocation........................................................................................................................................ 27 Postural Conditions ....................................................................................................................... 27 Cautions ............................................................................................................................................ 28

CONDITIONS OF THE ELBOW .................................................................................................. 28 Tennis Elbow ................................................................................................................................... 29 Golfer’s Elbow ................................................................................................................................. 29 Cubitus Varus or Valgus ............................................................................................................. 29 Ulna Neuritis.................................................................................................................................... 30 Olecranon Bursitis ......................................................................................................................... 30 Pulled Elbow .................................................................................................................................... 30 Osteoarthritis .................................................................................................................................. 30 Rheumatoid Arthritis .................................................................................................................... 30

CONDITIONS OF THE WRIST ................................................................................................... 32 Colles’ Fracture............................................................................................................................... 32 Ganglions .......................................................................................................................................... 33 Osteoarthritis .................................................................................................................................. 33 Rheumatoid Arthritis .................................................................................................................... 33 Carpal Tunnel.................................................................................................................................. 33 Ulna Carpal Tunnel ....................................................................................................................... 34 Summary .......................................................................................................................................... 34

A BIO-TENSEGRITY MODEL ...................................................................................................... 35 THE FIRST RIB ............................................................................................................................. 37

Assessment of First Rib............................................................................................................... 37 Correction of the First Rib.......................................................................................................... 37

THE THUMB ................................................................................................................................... 38 Assessment of the thumb .......................................................................................................... 39 Correction of the thumb ............................................................................................................. 39

HAND-HOLDS FOR CORRECTING THE SHOULDER ............................................................. 42 Shoulder............................................................................................................................................ 42


Scapula .............................................................................................................................................. 43 Sterno-Clavicular Joint ................................................................................................................ 44

ENERGY BASICS .......................................................................................................................... 46 THE MERIDIANS................................................................................................................................. 46 THE AURA ............................................................................................................................................. 46 THE CHAKRAS..................................................................................................................................... 47 MERIDIANS OF THE BODY ............................................................................................................. 48

Conception Vessel ......................................................................................................................... 48 Governing Vessel........................................................................................................................... 49 Stomach Meridian ......................................................................................................................... 49 Spleen Meridian ............................................................................................................................. 50 Heart Meridian ................................................................................................................................ 52 Small Intestine Meridian............................................................................................................. 52 Bladder Meridian............................................................................................................................ 53 Kidney Meridian ............................................................................................................................. 54 Circulation Sex/Pericardium...................................................................................................... 55 Triple Warmer ................................................................................................................................. 57 Gall Bladder Meridian................................................................................................................... 59 Liver Meridian ................................................................................................................................. 61 Lung Meridian ................................................................................................................................. 62 Large Intestine Meridian............................................................................................................. 64

BIBLIOGRAPHY AND REFERENCES ......................................................................................... 65


THE UPPER EXTREMITY AND THE SHOULDER

THE SHOULDER

The shoulder is a very complex joint. It has many actions and articulations within its structure. It is vital that each part is working well because the shoulder affects every other part of the body significantly. The obvious connections are into the head, neck, upper extremity and the whole of the back. Postural changes have dramatic effects on the whole of the Godai. Because of the complexity of the articulations and muscle structure, injuries can be very persistent, complex and tend to cause whole body problems. The shoulder can cause dramatic changes to the cranial system because of the direct link of the trapeziums muscle to the occiput, mastoid process and the TMJ.

The shoulder is an elegant piece of machinery. It has the greatest range of motion of any joint in the body. However, this large range of motion can lead to joint problems. Understanding how the different layers of the shoulder are built and connected helps the understanding of how the


shoulder works, how it can be injured, and how challenging recovery can be when the shoulder is injured.

SHOULDER ANATOMY

Bones and Joints

The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone). The roof of the shoulder is formed by a part of the scapula called the acromion.

There are actually four joints that make up the shoulder. The main shoulder joint, called the gleno-humeral joint, is formed where the ball of the humerus fits into a shallow socket on the scapula. This shallow socket is called the glenoid cavity.


The acromio-clavicular (AC) joint is formed where the clavicle meets the acromion. The sterno-clavicular (SC) joint supports the connection of the arms and shoulders (clavicle) to the main skeleton on the front of the chest (sternum). A false joint is formed where the shoulder blade glides against the thorax (the rib cage). This joint, called the scapulo-thoracic joint, is important because it requires that the muscles surrounding the shoulder blade work together to keep the socket lined up during shoulder movements.

Articular cartilage is the material that covers the ends of the bones of any joint. Articular cartilage is about one-quarter of an inch thick in most large, weight-bearing joints. It is a bit thinner in joints such as the shoulder, which don't normally support weight. Articular cartilage is white and shiny and has a rubbery consistency. It is slippery, which allows the joint surfaces to slide against one another without causing any damage. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to make motion easier. Articular cartilage exists where two bony surfaces move against one another, or articulate. In the shoulder, articular cartilage covers the end of the humerus and the glenoid cavity.

Ligaments and Tendons

There are several important ligaments in the shoulder. Ligaments are soft tissue structures that connect bones to bones. A joint capsule is a watertight sac that surrounds a joint. In the shoulder, the joint capsule is formed by a group of ligaments that connect the humerus to the glenoid cavity. These ligaments are the main source of stability for the shoulder. They help hold the shoulder in place and keep it from dislocating.

© Amatsu Association Ireland (AAI) and Amatsu Therapy Association (AT

Coracoacromial ligament

Trapezoidligament

A), April 2006 10

Conoid Ligament

Acromioclavicular Ligament

Conoid Ligament

Trapezoid Ligament

Coraco-humeral ligament Gleno-humeral

ligament

The acromio-clavicular ligament attaches the clavicle to the acromion in the AC joint. Two ligaments, the conoid and the trapezoid ligaments, connect the clavicle to the scapula by attaching to the coracoid process, a bony knob that sticks out of the scapula in the front of the shoulder. Together these form the coraco-clavicular ligament.

A special type of ligament forms a unique structure inside the shoulder called the labrum. The labrum is attached almost completely around the edge of the glenoid cavity, like a ring. When viewed in cross section, the labrum is wedge-shaped. The shape and the way the labrum is attached create a deeper cup for the ball of the humerus to fit into. This is important because the glenoid cavity is so flat and shallow that the ball of the humerus can not fit tightly into it without the presence of the labrum.

The labrum is also where the biceps tendon attaches to the glenoid cavity. Tendons are much like ligaments, except that tendons attach muscles to bones. Muscles move the bones by pulling on the tendons. The biceps tendon runs from the biceps muscle, across the front of the shoulder, to the glenoid cavity. At the very top of the glenoid cavity, the biceps tendon attaches to the bone and actually becomes part of the labrum. This



connection can be a source of problems when the biceps tendon is damaged and pulls away from its attachment to the glenoid.

The tendons of the rotator cuff are the next layer in the shoulder joint. Four rotator cuff tendons connect the deepest layer of muscles to the humerus.

Muscles

The rotator cuff tendons attach to the deep rotator cuff muscles. This group of muscles lies just outside the shoulder joint. These muscles help abduct the arm and rotate the shoulder in many directions. They are involved in many day-to-day activities. The rotator cuff muscles and tendons also help keep the shoulder joint stable by holding the humeral head in the glenoid cavity.

The rotator cuff comprises the following four muscles:

o Supraspinatus o Infraspinatus o Teres Minor o Subscapularis

The large deltoid muscle is the most superficial layer of shoulder muscle. The deltoid is the largest, strongest muscle of the shoulder. The deltoid muscle takes over lifting the arm once the arm is away from the side. The supraspinatus muscle initiates this action but is not strong enough to sustain full abduction. .

Nerves

All the nerves that travel down the arm pass through the axilla (the armpit) just under the shoulder joint. Three main nerves begin together at the shoulder: the radial nerve, the ulnar nerve, and the median nerve. These nerves carry the signals from the brain to the muscles that move the arm. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.


Blood Vessels

Travelling along with the nerves are the large vessels that supply the arm with blood. The large axillary artery travels through the axilla. If you place your hand in your armpit, you may be able to feel the pulsating of this large artery. The axillary artery has many smaller branches that supply blood to different parts of the shoulder. The shoulder has a very rich blood supply.

Bursae

Sandwiched between the rotator cuff muscles and the outer layer of large bulky shoulder muscles are structures known as bursae. Bursae are everywhere in the body. They are found wherever two body parts move against one another and there is no joint to reduce the friction between them. A single bursa is simply a sac between two moving surfaces that contains a small amount of lubricating fluid.

Think of a bursa like this: If you press your hands together and slide them against one another, you produce some friction. In fact, when your hands are cold you may rub them together briskly to create heat from the friction. Now imagine that you hold in your hands a small plastic sack that contains a few drops of salad oil. This sack would let your hands glide freely against each other with less friction.

As you can see, the shoulder is extremely complex, with a design that provides maximum mobility and range of motion. Besides lifting, the shoulder joint is also responsible for placing the hand in the right position for


any function. When you realise the many different positions we put our hands in every day, it is easy to understand how hard daily life can be when the shoulder isn't working well.

ELBOW ANATOMY


Bones and Joints

The bones of the elbow are the humerus (the upper arm bone), the ulna (the larger bone of the forearm, on the opposite side of the thumb), and the radius (the smaller bone of the forearm on the same side as the thumb). The elbow itself is essentially a hinge joint, meaning it bends and straightens like a hinge. But there is a second joint where the end of the radius (the radial head) meets the humerus. This joint is complicated because the radius has to rotate so that you can turn your hand palm up and palm down. At the same time, it has to slide against the end of the humerus as the elbow bends and straightens. The joint is even more complex because the radius has to slide against the ulna in order to rotate the wrist as well. To allow these movements, the end of the radius at the elbow is shaped like a smooth knob with a cup at the end to articulate with the end of the humerus. The edges are also smooth where it glides against the ulna.

In the elbow, articular cartilage covers the end of the humerus, the end of the radius, and the end of the ulna.

Ligaments and Tendons

In the elbow, two of the most important ligaments are the medial collateral ligament and the lateral collateral ligament. The medial collateral is on the inside edge of the elbow, and the lateral collateral is on the outside edge. Together these two ligaments connect the humerus to the ulna and keep it tightly in place as it slides through the groove at the end of the humerus. These ligaments are the main source of stability for the elbow. They can be torn when there is an injury or dislocation to the elbow. If they do not heal correctly the elbow joint can be too loose, and therefore unstable.

There are several important tendons around the elbow. The biceps tendon attaches the large biceps muscle on the front of the arm to the radius. It allows the elbow to bend with force (e.g. bend while lifting a weight). You can feel this tendon crossing the front crease of the elbow when you tighten the biceps muscle.


The triceps tendon connects the large triceps muscle on the back of the arm with the ulna. It allows the elbow to straighten with force, such as when you perform a push-up.

The muscles of the forearm cross the elbow and attach to the humerus. The outside, or lateral, bump just above the elbow is called the lateral epicondyle. Most of the muscles that straighten the fingers and wrist all come together in one tendon to attach to this area. The inside, or medial, bump just above the elbow is called the medial epicondyle. Most of the muscles that bend the fingers and wrist all come together in one tendon to attach to this area. These two tendons are a common location of tendonitis.


Muscles

The main muscles are the biceps, the triceps, the wrist extensors (attaching to the lateral epicondyle) and the wrist flexors (attaching to the medial epicondyle).


Nerves

All of the nerves that travel down the arm cross the elbow. Three main nerves begin together at the shoulder: the radial nerve, the ulnar nerve, and the median nerve. These nerves carry signals from the brain to the muscles that move the arm. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.

Some of the more common problems around the elbow are problems of the nerves. Each nerve travels through its own tunnel as it crosses the elbow. Because the elbow must bend a great deal, the nerves must bend as well. Constant bending and straightening can lead to irritation or


pressure on the nerves within their tunnels and cause problems such as pain, numbness, and weakness in the arm and hand.

Blood Vessels

Travelling along with the nerves are the large vessels that supply the arm with blood. The largest artery is the brachial artery that travels across the front crease of the elbow. If you place your hand in the bend of your elbow, you may be able to feel the pulsing of this large artery. The brachial artery splits into two branches just below the elbow: the ulnar artery and the radial artery that continue into the hand. Damage to the brachial artery can be very serious because it is the only blood supply to the hand.

HAND ANATOMY

The hand needs to be mobile in order to position the fingers and thumb. The muscles in the hand must be co-ordinated to perform fine motor skills with precision. The structures that form and move the hand require proper alignment and control in order to produce normal hand function.

Bones and Joints

There are 27 bones in the wrist and hand. The wrist itself contains eight small bones, called carpals. The carpals join with the two forearm bones, the radius and ulna, forming the wrist joint. Further into the palm, the carpals connect to the metacarpals. There are five metacarpals forming the palm of the hand. One metacarpal connects to each finger and thumb. Small bone


shafts called phalanges line up to form each finger and thumb.

The main knuckle joints are formed by the connections of the phalanges to the metacarpals. These joints are called the metacarpo-phalangeal joints (MCP joints). The MCP joints work like a hinge when you bend and straighten your fingers and thumb.

There are 15 bones that form connections from the end of the forearm to the hand. The wrist itself contains eight small bones, called carpal bones. These bones are grouped in two rows across the wrist. The proximal row is where the wrist creases when you bend it. Beginning with the thumb-side of the wrist, the proximal row of carpal bones is made up of the scaphoid, lunate, and triquetrum. The second row of carpal bones, called the distal row, meets the proximal row a little further toward the fingers. The distal row is made up of the trapezium, trapezoid, capitate, hamate, and pisiform bones.

Articular cartilage can be up to one-quarter of an inch thick in the large, weight-bearing joints of the body, such as the hip. It is thinner in joints such as the wrist that don't support much of weight.

Wrist ligaments

As its name suggests, the ulnar collateral ligament (UCL) is on the ulnar side of the wrist. It crosses the ulnar edge (the side away from the thumb) of the wrist. It starts at the ulnar styloid, the small bump on the edge of the wrist (on the side away from the thumb) where the ulna meets the wrist joint. There are two parts to the cord-shaped UCL. One part connects to the pisiform (one of the small carpal bones) and to the transverse carpal ligament, a thick band of tissue that crosses in front of the wrist. The other goes to the triquetrum (a small carpal bone near the ulnar side of the wrist). The UCL adds support to a small disc of cartilage where the ulna meets the wrist. This structure is called the triangular fibrocartilage complex (TFCC). The UCL stabilizes the TFCC and keeps the wrist from bending too far to the side (toward the thumb).


The radial collateral ligament (RCL) is on the thumb side of the wrist. It starts on the outer edge of the radius on a small bump called the radial styloid. It connects to the side of the scaphoid, the carpal bone below the thumb. The RCL prevents the wrist from bending too far to the side (away from the thumb).

In the PIP joint (the middle joint between the main knuckle and the DIP joint); the strongest ligament is the volar plate. This ligament connects the proximal phalanx to the middle phalanx on the palm side of the joint. The ligament tightens as the joint is straightened and keeps the PIP joint from bending back too far (hyperextending). Finger deformities can occur when the volar plate loosens because of disease or injury.

The tendons that allow each finger joint to straighten are called the extensor tendons. The extensor tendons of the fingers begin as muscles that arise from the backside of the forearm bones. These muscles travel towards the hand, where they eventually connect to the extensor tendons before crossing over the back of the wrist joint. As they travel into the fingers, the extensor tendons become the extensor hood. The extensor hood flattens out to cover the top of the finger and sends out branches on each side that connect to the bones in the middle and end of the finger.

The place where the extensor tendon attaches to the middle phalanx is called the central slip. When the extensor muscles contract, they tug on the extensor tendon and straighten the finger. Problems occur when the central slip is damaged, as can happen with a tear.

Nerves

The radial, median and ulnar nerves travel to the hand cross the wrist.


The radial nerve runs along the thumb-side edge of the forearm. It wraps around the end of the radius bone toward the back of the hand. It gives sensation to the back of the hand from the thumb to the third finger. It also goes to the back of the thumb and just beyond the main knuckle on the back surface of the ring and middle fingers.

The median nerve travels through a tunnel within the wrist called the carpal tunnel. The median nerve gives sensation to the palm sides of the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the thenar muscles of the thumb. The thenar muscles help move the thumb and allow the pad of the thumb to touch the tips each of each finger on the same hand, a motion called opposition.

The ulnar nerve travels through a separate tunnel, called Guyon's canal. This tunnel is formed by two carpal bones (the pisiform and hamate), and the ligament that connects them. After passing through the canal, the ulnar nerve branches out to supply feeling to the little finger and half the ring finger. Branches of this nerve also supply the small muscles in the palm and the muscle that pulls the thumb toward the palm.

The nerves that travel through the wrist are subject to problems. Constant bending and straightening of the wrist and fingers can lead to irritation or


pressure on the nerves within their tunnels and cause problems such as pain, numbness, and weakness in the hand, fingers, and thumb.

Blood Vessels

Travelling along with the nerves are the large vessels that supply the hand with blood. The largest artery is the radial artery that travels across the front of the wrist, closest to the thumb. The radial artery is where the pulse is taken in the wrist. The ulnar artery runs next to the ulnar nerve through Guyon's canal (mentioned earlier). The ulnar and radial arteries arch together within the palm of the hand, supplying the front of the hand and fingers. Other arteries travel across the back of the wrist to supply the back of the hand and fingers.


CONDITIONS OF THE SHOULDER

The most common cause of pain to the shoulder is cervical Spondylosis. Pain from nerve root can be referred into the shoulder. The condition can cause a “chicken and egg” effect with the neck affecting the shoulder and the shoulder then affecting the neck in return.

Impingement Syndromes Compression of the shoulder joints may occur during gleno-humeral movements. This most commonly occurs subacromially, causing a painful arc of movement between 70-120° abduction. Compression may also occur in the subacromial joint where there will be pain in the last 30° of motion. This condition normally occurs either from sporting injuries or in people with degenerative changes.

Rotator Cuff Tears This most commonly occurs as a result of trauma. It can also happen as a result of weakening due to repetitive minor injuries. Most commonly the supraspinatus is involved giving problems with abduction. On other occasions the acromion is affected and a painful arc syndrome occurs. If the condition is not treated it can become very similar to the symptoms of frozen shoulder. In severe cases, with no treatment, degenerative changes can occur causing collapse of the bone leading to the need for joint replacement.

Frozen Shoulder This condition has many different causes but can be identified by the general loss of movement in many different planes. Pain is often severe and causes sleeping problems, especially when the client leans on it during the night. It is seen more in middle age, often from degeneration of the rotator cuff. A minor trauma can then set off the condition. It is more


common in the left arm and in diabetics. Fibrotic changes can occur especially around the coraco-humeral ligament. It is very easy to over treat this condition causing more pain from over mobilisation. Often the muscles of the neck and upper back lock the shoulder and will be under much stress when used in movements of the gleno-humeral joint. The range of motion can be improved by working out the inhibitor to the restriction. This can be done using circuit locking. The Subclavius muscle is often involved, as its function is to lift the clavicle to allow the full movement of the arm. Kyushu in the subclavicular triangle is also often useful here.

Osteoarthritis of the acromio-clavicular joint This presents as pain and restriction of the shoulder with localised tenderness of the acromion. Lipping of the joint from arthritic changes can also occur. Gentle mobilisation of the joint can help, but ideally the tensegrity of the joint should be considered and the inhibitor to the restriction should be identified by circuit locking. Correction of this allows the humerus to once again “float” in its joint space and prevents the bones grinding together.

Osteoarthritis of the gleno-humeral joint This condition is rare and usually occurs from pathological damage caused by disease to the joint itself. It can also occur after radiotherapy to the breast but again this is uncommon.

Rheumatoid Arthritis of the Shoulder Rheumatoid arthritis is an auto-immune condition and generally affects several joints at a time. The symptoms are redness, swelling, heat and pain around the joints with a limited range of motion. Massage to the area is often contra-indicated as it can cause any inflammation to flare up. Instead, in Amatsu, we would look for the inhibitors to the restrictions and reinstate the bio-tensegrity of the joint.


Dislocation Recurrent dislocation is often seen in the 20-40 years age group. It generally starts with a trauma that damages the ligaments holding the shoulder in place. Repeated dislocations can then occur with less and less trauma involved. Great care must be taken when working on a client with this condition as induction of a dislocation can occur quite easily from repatterning. You may see a client post operatively. Surgery may stop the dislocations but will often leave them with reduced range of movement or mobility.

Postural Conditions This is the cause of many problems found by clients. The posture of the shoulders will have dramatic effects on the whole of the rest of the body. The link between the back and shoulder is complex, each one affecting the other. Changes in the curves of the spine will cause the position of the shoulder girdle to change considerably. These changes can cause symptoms to occur in the shoulder, the upper back and the neck. The areas you need to pay attention to are:-

• Pectoral muscles • Sacrum and lumbar spine mobility • T6, T12 • Latissimus Dorsi • Occiput • Sternocleidomastoid

Any problems in these areas can adversely affect the correction of a shoulder problem. You may have to do considerable work on these areas before attempting direct shoulder work. Obviously this works both ways. Correcting the neck is effectively dependent on a well functioning shoulder. Circuit locking, anma and repatterning with a gentle approach are most useful when treating shoulders. Often it is necessary to work at releasing the areas affecting the shoulders first, possibly taking several treatments to


do this, before finally reaching the heart of the problem, in the shoulder itself.

Cautions Sometimes, when you release the shoulder, the occiput can be affected by reactive spasm 24-48 hours later. Often this can cause headaches around the occiput and across the eyes because of the sphenoid and occiput fixing in flexion. The client will usually say that painkillers had no effect. It is difficult to predict when this might happen because on leaving the clinic the sphenoid may well be in the correct position. The client may complain of the above symptoms at the next session and treatment will often resolve the problem. If it occurs again the symptoms will usually be milder.

CONDITIONS OF THE ELBOW

The elbow is a very close fitting, stable joint, achieved by both a very tight fit between the ulna and the trochlea and strong collateral ligaments. Because of the tight nature of the joint, any changes can cause a range of symptoms including fractures, strains and long term regular overuse, or repetitive strain.

Strains can be caused by problems with triceps during forced extension or with biceps during flexion. Pronation and supination can also cause problems at the elbow, wrist and hand. Pay close attention to the pronator teres, quadratus lumborum, biceps and supinator muscles. The interosseous tissue between the radius and the ulna is extremely strong and will cause large distortion patterns if traumatised by either falls or RSI problems. When a trauma occurs the line of force must travel somewhere. When someone attempts to break a fall by putting out their arm, the line of force usually travels up the arm and can affect each joint the whole way up to the shoulder, neck and into the head. You must look at the tatara as a whole.


Tennis Elbow This is commonly seen in clinic. It is more accurately called lateral epicondylitis. It is generally thought to be a strain to the common extensor origin or fibrosis in extensor carpi radialis brevis or even nerve entrapment. Even on the most common elbow condition the cause is not really known, so conventional physiotherapy has limited success. It is vital that the sacrum and latissimus dorsi are checked when presented with this condition. It is very rare to find a tennis elbow without a latissimus dorsi weakness. Localised treatment to the elbow will be far more effective when stability to the pelvis and the shoulder is attained. Often the clients have had, or have been advised to have steroid injections. This is far less common now than 5-10 years ago. Although this may treat the inflammation, the cause may not be corrected; therefore the condition often repeats itself with little provocation.

Golfer’s Elbow This is far less common than tennis elbow, and is more correctly called medial epicondylitis. This is pain and tenderness to the medial elbow and affects the common flexor tendon.

Cubitus Varus or Valgus This is when the angle at which the elbow is carried is decreased or increased. This often occurs because of a fracture at the elbow. When the fracture has not been corrected properly there may be deterioration to the joint or there may be palsy of the ulna nerve.


Ulna Neuritis This condition often causes muscle wasting and sensory impairment in the hand. It can be because of trauma at the elbow. This may cause too much mobility of the ulna nerve leading to frictional damage. If the client is known to have diabetes, please refer them to their GP or diabetic nurse, as neuritis can be a sign that their diabetes is not well-controlled.

Olecranon Bursitis This can be caused by repeated trauma to the posterior elbow. It can also be as a result of rheumatoid arthritis. The swelling is often painless except if accompanied by an infection.

Pulled Elbow This occurs when a child under 5 is pulled sharply, possibly by a parent. The radial head slides out from under the annular ligament. , which usually holds the radial head against the ulna during pronation and supination. Pain and loss of supination are often the symptoms. Spontaneous reduction often occurs within 48 hours, but it is important to remove the pattern of the torsion from the limb, to prevent problems in later life.

Osteoarthritis This can occur due to over use or poor positioning of the joint. Often loose pieces of tissue may break off inside the joint capsule and “lock” the joint. The client may be able to unlock the joint themselves although this may just sustain the problem leading to further damage.

Rheumatoid Arthritis This condition can affect the elbows as well as other joints. Often supination and pronation is affected with the elbow held in fixed flexion.


CONDITIONS OF THE WRIST

The carpals form complex articulations with each other, the radius, ulna and the meta-carpals. They are subject to compression, extension and all directions of motion during the working day. Wrist problems are common. Wrist function is dependent on how it is supported both physically (from the shoulder and elbow) and neurologically. ICV dysfunctions often manifest as wrist problems, due to fluid retention causing compression on the nerves and structures of the wrist. The anatomical snuff-box, the opponens pollicis muscle and the area around acupuncture point Large Intestine 4 (the web between the thumb and forefinger) are often involved in ICV dysfunction. Identify particular actions of the client that may be contributing to the client. Take a history of their occupations and hobbies. Activities such as computer use, sports and lifting and carrying children may all indicate the underlying cause. Examine all directions of mobility, look for swelling and any changes in tissue texture. Pay attention to where the client is noticing pain and where exactly any sensory or motor disturbances are. This will indicate which nerves are involved and what cervical spine region needs to be examined.

Colles’ Fracture A Colles’ fracture occurs at the distal end of the radius. It is the most common type of all fractures and is usually due to a fall on an outstretched hand. As a result of the fracture the common problems are deformity, restriction of movement and pain. The common deformity is the radial deviation of the hand. The inferior radio-ulna joint is also affected with a Colles’ fracture leading to pain lateral to the ulna styloid. Swelling and stiffness of the fingers can occur a few weeks after the fracture. This is called Sudeck’s atrophy. Carpal decalcification is often a problem with this condition. Most of these conditions depend on how well the break has been set as a better repair means a lesser chance of deformity.


Ganglions These are very common in the wrist and the hand. They are often spherical, fluid filled sacs, firm to the touch and have no real connection to any other underlying structure. They are formed from outgrowths of synovial membrane lining tendon sheaths. They are filled with synovial fluid that is unable to return to the joint because the pouch of membrane becomes cut off from the tendon sheath or joint. They can cause pain and swelling with some discomfort and loss of use of the wrist. They tend to dissipate spontaneously, but by finding the inhibitors to the restrictions that are causing the ganglion, good results can be obtained.

Osteoarthritis This is relatively rare in the wrist and only tends to occur after necrosis of the scaphoid after a fracture, or with fractures on the articular surface of the radius.

Rheumatoid Arthritis The wrist and hands are a very common site for this condition with synovial thickening of the joints and tendon sheaths leading to gross swelling and pain.

Carpal Tunnel Usually found in women between 30-60 years of age. Normally there is compression of the medial nerve leading to pain, loss of function and changes in sensory ability. The client may claim that all the fingers are involved but the little finger should not be, because it has a different nerve supply. Paraesthesia (pins and needles) may radiate from the elbow down and pain can occur here as well. Often symptoms are worse in the early hours of the morning. It is, on occasions, difficult to differentiate from conditions caused by neck problems. Cervical spondylosis can cause similar symptoms so care must be taken when a client says that she has carpal tunnel. She may or may not have, but it may be caused by lack of correct nerve and muscle ability in the tension/compression aspect of the


whole body. This condition is often linked with ICV dysfunction due to the accumulation of fluid in the body, which typically causes compression in this area and leads to nerve impingement.

Ulna Carpal Tunnel The ulna nerve can become compressed as it passes through the ulna tunnel between the pisiform and the hook of hamate. Sensory and/or motor functions may be affected but it is less common that both are affected. Muscle wasting and weakness in the hand may occur. Again, check that the cervical spine has good function to make a differential diagnosis.

Summary You must always consider that conditions of the wrist may occur as a result of trauma to the wrist itself, but it could also occur as part of the tensegrity pattern of the whole body. Remember that although RSI may be a result of a particular behaviour, the rest of the body will know the tatara. You must deal with the tatara and tensegrity of the whole body and not just the local symptoms.

© Amatsu A

A BIO-TENSEGRITY MODEL

Amatsu practitioners view the body as a bio-tensegrity model rather than a classical Newtonian model. According to Levin (1995) by applying Newtonian laws to natural movement, for example, anterior deltoid contraction to raise the humerus with a 25Kg weight, the result would be severe damage to the stabilising back muscles.

25Kg

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tsu Therapy Association (ATA), April 2006 35

es on the body are very large and if efficiently.

ed with four spokes and a hub in the rigid and capable of handling the

considering a bicycle wheel with wire across all members, the shape of the es, so the tension is even throughout. re omni-directional load distributors.

derstood, it can be applied to the he bicycle wheel in modelling the he wheel to be the scapula and the ts around the scapula; the scapula , therefore any forces are transmitted model. The scapula acts as a relay ial skeleton. The shoulder, therefore, ture as levers become eliminated. It is nd ligaments are always under some segrity structure.


When working, practitioners should always consider the interplay between themselves and their clients as extremely important, any unnatural forces applied through Newtonian laws will not fit the bio-tensegrity model of the body and are therefore unnatural. Any contact made must be in keeping with the client’s tensegrity. In doing this correctly, you will get a sense of the whole person. This will allow you to be led to the most influential points for change. Skin drag will reveal linear pulls which are areas which will need to be worked upon.

The word tensegrity is a merging of two words: tensional integrity. Structures that are omni-directional so that the tension elements always function in tension, no matter what the direction of applied force. If the human frame can be seen as a bio-tensegrity structure, then any applied force will register in the whole, as the tensioned elements adjust accordingly. The combinations of anatomical knowledge and taijutsu will give a predictable change of forces through the tensegrity of the extremity. To enhance this skill, a multi contact (often forming a triangle) is useful to get feedback as the limb is engaged and loaded.


THE FIRST RIB

The first rib can be viewed as a major balance point for the upper extremity. It plays an important role in drainage at the thoracic inlet. It also helps unlock the clavicle in shoulder movements and crucial any restrictions there will affect the head on neck reflexes.

Assessment of First Rib

• Therapy localise the 1st rib. • Challenge the clavicle, first rib and sternum functionally. • Palpate the dynamics of the first rib and clavicle by placing the thumb

at the split tendon of the S.C.M and the other fingers take position at the 1st and second rib, clavicle and acromion process. Do this on both sides. Use taijutsu to feel the movement potential of the rib and clavicle.

Correction of the First Rib

Load the structures as detailed above and get a sense of the tensegrity of the area, then change the shape of your Ningu to facilitate disengagement at the area of dysfunction. In other words, find the inhibitor to the restrictions. The inhibitor is often posterior to the clavicle, just above the first rib. It can be found using skin drag and therapy localisation. Tension couple and fire the inhibitor by using taijutsu. Consolidate this by checking the first rib again by therapy localisation, challenging and palpation.


THE THUMB

When looking at the upper limb you must consider it as a whole. When looking at any injury, notice what is happening above and below the injury site. On many occasions, the problem comes from lack of support from the shoulder. This then is obviously related to the neck and back. Make sure that there is a stable pelvis, free cervical spine and shoulder before embarking on localised treatment. A careful case history must be taken when assessing any condition of the upper extremity. Often long running repetitive actions cause the background postural problems that then allow an acute injury to occur. Commonly this includes computer work, driving and repetitive sports. With any condition of the upper extremity, look very carefully at the cervical spine and the cervical plexus. This will allow you to appraise symptoms, muscle dysfunction and any relationships to the cervical vertebra. Also consider the Lovett Reactor and check the “brother relationship” in the lumbar area.

The thumb should be viewed with the same importance as the big toes. Although not directly used for upright gait; its dexterity allows the hand to be used with great precision.


The opposition of the thumb with the fingers is the first function to be examined. The opponens pollicis test gives us a great deal of information, such as wrist or elbow problems or ICV involvement but more important than the test is the client’s ability to get the extremity into the position for the test. Quite often they show some compensation in their movements; this will not only show you a weakness, but also it will indicate where the problem might be.

Assessment of the thumb

• Place the index finger in the anatomical snuffbox and the thumb on the thenar eminence, the other fingers should support the thumb at its medial aspect leaving the little finger cradling underneath. Assess the presence of linear pulls.

• Therapy localise the segments of the thumb to ascertain the area of concern.

• Challenge the thumb by moving it in different vectors, and incorporating a PIM, to assess if a particular direction is a problem.

• Perform the opponens pollicis muscle test, both palm up, and palm down.

Correction of the thumb From the Ningu described above, distract the thumb whilst monitoring any pulls at the wrist or into the elbow/arm. Find the best position for release by feeling for inhibitors to any restrictions. Some of the inhibitors will be local, probably in the anatomical snuff-box, and some will be further up the arm. Inhibitors are often found in the inter-osseous tissue between the radius and ulna.


HAND-HOLDS FOR CORRECTING THE SHOULDER

The upper extremity is a much more mobile structure than that of the lower extremity. Not all the repatterning needs to be done from the thumb. In fact there are often other kyushu points or inhibitors to the restrictions further up the arm, shoulder or even into the ribs. These can be monitored by placing a hand onto one of these areas to feel the release occurring, or to facilitate the release. The most effective method for correct shoulder problems is to engage, stack and load as many parts of the upper extremity as possible. This is performed by engaging each part in turn, starting with the thumb or fingers, and once engagement has occurred, “walk” up the arm, by holding the stack in place with one hand, and feeling for the next part of the stack with the other hand. Use the body to hold the stack in place, by holding the arm with one’s elbow and chest.

Shoulder

Take the thumb at the anatomical snuff box while monitoring the ball and socket joint of the shoulder with the other hand. More local corrections may be performed by monitoring the shoulder with one hand and finding inhibitors to the restrictions in the area around the scapula with the other hand.


Scapula

Take the thumb at the anatomical snuff box and engage the stack. Work up the arm, maintaining the stack, remembering that the scapula is a relay station, in a similar way to the talus. Placing the fingers around the edge of the scapula will give access to potential spots which will fire inhibitors. Take time to load the appropriate points, and fire by using taijutsu.


Sterno-Clavicular Joint Stack the thumb at the anatomical snuffbox, and work up the arm whilst maintaining the stack. As with all these techniques, taijutsu and flexibility in the approach are vital. The inhibitors to any restrictions can be fired from either of the sterno-clavicular junctions. Circuit locking will show which inhibitor is key to the release.


ENERGY BASICS

THE MERIDIANS In simple terms, the meridians are energy pathways that supply our physical and subtle bodies with vital energy. If the energy flow is disturbed or disrupted, the result is sickness, disease and ultimately death. It is proposed that the meridians run beneath the skin; the areas where the meridians come close to the surface of the skin are referred to as acupuncture points. Specific meridian pathways are linked to specific muscles in the body and specific organs although energy also extends into the chakras and the aura so the above model is over simplistic and can be studied in great depth. Because of this there is more than one way of accessing and clearing the energies in the meridians. In Traditional Chinese Medicine (TCM) there are 12 main meridians that flow on each side of the body. Up the centre of the front of the body runs the Central Meridian, and down the centre of the back is the Governing Meridian which links each side of the 12 meridians.

THE AURA The aura is a field of subtle energy that penetrates and extends out from the physical body. It is composed of many layers or levels of vibration. The layers interpenetrate each other and are said to be composed of different kinds of consciousness. Each level of the aura is connected to a respective chakra and has a similar vibration and energy as that chakra. As an example, the innermost level of the aura, which is very close to the surface of the body, is connected to the root chakra. This auric field is linked with physical health and vitality, which is similar to the energy of the root chakra. The next auric field is connected to the sacral chakra and is a little further out. The sacral chakra is linked with physical enjoyment and attractiveness. Each successive level of the aura is connected to the next higher chakra, has similar energy, and is a little further from the body. The outermost or seventh layer extends out to four or five feet for the average person.


The overall size of the aura can increase or decrease, depending on the quality of one’s thoughts and feelings and on the kind of recent experiences. As an example, if someone has had a bad day, and is feeling tired and defeated, their aura may recede to only two or three feet from their body. The auric field may be skewed to one side if someone has been “knocked sideways” by a shock or trauma. On the other hand, after receiving healing or an energy therapy, the aura can extend out much further than normal, sometimes as far as twenty to thirty feet or more.

THE CHAKRAS The chakras are part of the subtle energy system and play an important role in health and healing. Blocks and negative energy are sometimes lodged in the chakras and, if present, need to be released in order for healing to take place. The chakras are like subtle energy transformers. They take the Qi that is all around us and transform it into the various frequencies we need and bring it into our subtle energy system. They can also be thought of as points where the soul connects to the physical body. There are seven basic chakras starting with the root chakra at the base of the spine, and ending with the crown chakra at the top of the head. The chakras are responsible for creating the various kinds of consciousness operating within our energy systems and are also connected to the complete spectrum of human experience.

1. ROOT CHAKRA: The root chakra is connected to the base of the spine and points down between the legs toward the ground. Its energy is involved with our need for food, shelter and the basic necessities of life.

2. SACRAL CHAKRA: This is connected to the sacrum and its colour is orange. It is involved with reproduction, sexuality, physical enjoyment and the attractive aspects of relationships. It is also one of the places people hide guilt and humiliation.

3. SOLAR PLEXUS CHAKRA: This is connected to the solar plexus area. Its colour is yellow. It brings in and sends out energy necessary for self-expression. It is also called the power centre. Confidence, purpose and will, as well as fear and anger can be located here.


4. HEART CHAKRA: This is connected to the centre of the chest near the physical heart. Its colour can be green or pink. It is related to love, joy, respect and surrender. Spiritual guidance and higher consciousness can also come through the heart chakra.

5. THROAT CHAKRA: The fifth chakra is located at the throat area. Its colour is sky blue. It is involved in the expression of creativity through speaking and writing. It is also involved with contemplation, and some aspects of thinking and planning, and the way we relate to others.

6. THIRD EYE CHAKRA: This is located between the eyebrows. Its colour is indigo and it is involved with self-awareness, wisdom, higher consciousness, clairvoyance, visualization and conceptual thinking.

7. CROWN CHAKRA: This is located at the top of the head and extends far above the head. Its colour is purple or white. It connects directly with “the higher power” and spiritual consciousness.

MERIDIANS OF THE BODY

Conception Vessel This is the vessel through which original energy was thought to enter the body at conception. It includes the umbilicus which is the obvious point of entry for such energy.

Muscle Vertebral reflex

Fixation indicator

Nerve supply Organ

Supraspinatus

C1,2

Emotional problems

C5,6

Brain


Governing Vessel This vessel passes from the tip of the coccyx to the top lip. It includes GV20, the very top of the head. This point is known as “the cure of one hundred diseases”.


Fixation indicator

Nerve supply

Organ

Teres major

T2

Thoracic

C5,6,7

Thoracic spine

Stomach Meridian The stomach has the function of receiving food and separating the “essence” or chi before it passes on to the spleen. The natural function of the stomach is to send the chi in a downward direction. If the stomach function is impaired, there is an upward direction to the symptoms, e.g. belching, hiccups, regurgitation, nausea and vomiting. It rules descending action, moving things downward. The stomach is associated with honouring of self and nurturance. It is paired with the spleen, so its associated emotion is worry and anxiety.


Fixation indicato

Nerve supply

Organ


r

Levator scapulae

T8, C5

C3,4,5

Lungs Parathyroids

PMC

T5

C5,6,7

Stomach

Neck flexors

C2

C1-8

Sinuses

Neck extensors

C2

Sacrum Iliac

C1-8

Sinuses

Biceps

C5,6

Stomach

Spleen Meridian In Oriental medicine, the spleen is seen as the primary organ of digestion and conversion from food energy to available chi. The spleen and pancreas meridians run in the same channel. The energy from this channel is responsible for transforming food into energy and regulating the


maintenance of the body’s blood. The spleen rules ascending transformation and is associated with high self-esteem and forgiveness. The pancreas is associated with caring and devotion. The emotion associated with the spleen is worry, anxiety. Concentration problems are also associated with this organ.

Healthy spleen Unhealthy spleen

Good appetite Poor digestion Good digestion Abdominal distension and

diarrhoea Plenty of energy Fatigue and obesity Good muscle tone Poor muscle tone and flabby

muscles Good concentration

Poor concentration

Clarity of thought Muzzy head No easy bruising Easy bruising Smooth edge to tongue

Scalloped edge of tongue (tooth marks)


Fixation indicator

Nerve supply

Organ

Latissimus dorsi

T7

C6,7,8

Pancreas

Middle Trapezius

T5,6

C2,3,4

Spleen

Lower Trapezius

T6

Thoraco-dorsal

C2,3,4

Spleen

Opponens pollicis

C4

C6,7

Stomach

Triceps

T1

C6,7,8,T1

Pancreas


Heart Meridian The heart is associated with controlling blood flow through the vessels of the body. The yin energy that circulates in the heart channel rules the head and houses the spirit. It also houses the “Shen”; this represents the myriad of mental, psychological and spiritual faculties that constitute a central feature of the human condition. The heart’s function is manifested in the skin, so a healthy glow means the heart meridian is fine and a dull complexion shows a deficiency or block in the meridian. Sweating is also governed by the heart so excess sweating may indicate a problem with the heart meridian. Impaired functioning of the heart meridian may lead to cold extremities, abnormal pulse patterns and chest pain. The emotion associated with the heart is joy.


Fixation indicator

Nerve supply

Organ

Subscapularis

T2

C5,6

Heart

Small Intestine Meridian The small intestine energy channel is responsible for drawing out the energy contained in food, leaving the remaining matter to be eliminated as waste. The small intestine separates pure from impure. It allows extraction of chi under the control of the spleen, after which the impurities are passed to the large intestine and the bladder. It performs this function with bodily fluids, so is linked to the heart. Its associated emotion is joy and is associated with self-acceptance and integrity.


Fixation indicator

Nerve supply

Organ

Quadriceps

T10

Sagittal suture

L2,3,4

Small intestine


Abdominals

T6

Various

Small intestine

Bladder Meridian The bladder stores urine and controls excretion. In Oriental medicine this means that the bladder receives waste body fluids from the lungs, small and large intestines and under the influence of the kidneys, it stores and excretes this as urine. The bladder is paired with the kidney. Its associated emotion is fear and fright. Westerners do recognize this link in the phrase “to wet oneself with fear”. It is also associated with risk-taking and an affirmation of life.


Fixation indicator

Nerve supply

Organ

Peroneus

T12

L5, S1

Bladder

Posterior tibialis

L5

L5, S1

Bladder

Sacrospinalis

T12

Various

Bladder

Anterior Tibialis

L5

L4,L5, S1

Bladder


Kidney Meridian The kidney meridian is involved in the storage of the energy that you were born with, known as the life essence. This determines our constitutional health. The kidney channel oversees the maintenance of the bones and stores the body’s reproductive energy. If the kidney meridian is impaired in any way this can lead to:

• Retarded growth • Learning difficulties • Infertility • Sexual disorders • Senility • Tinnitus • Blurred vision • Impaired thinking • Back pain • Fatigue • Poor digestion • Asthma and breathing difficulties • Hearing problems • Dull, lifeless and brittle hair • Premature greying and/or baldness • Feelings of weakness and timidity

The emotions associated with the kidney are fear and anxiety, like the bladder. It is also associated with spontaneity and independence. The navicular has links with the kidney, so the maintenance of the arch of the foot is vitally important for the kidney meridian, and consequently the whole body.


Fixation indicator

Nerve supply

Organ


Psoas

T12

Occiput

L2,3

Kidney Navicular

Iliacus

T11

ICV

L1,2,3

Kidney

Upper Trapezius

C7

C3,4

Kidney Eye / Ear

Circulation Sex/Pericardium This involves the energy that supplies the sexual organs, and the circulation of blood and sex hormones. The muscles that are linked to this channel are the large muscles around the pelvis. It is obvious that imbalance of these may lead to a change in position or function of the reproductive organs. It is also obvious that the presenting features of a weakness in these muscles may be back or pelvic pain. The emotion linked to the pericardium is that of joy as the yin energy that circulates in the pericardium protects and oversees the heart.


Fixation indicator

Nerve supply

Organ

Gluteus medius

L5

L4,5,S1

Reproductive

Adductors

L1

Pubic

L2,3,4

Reproductive

Piriformis

S1

Iliac

S1,2

Reproductive


Gluteus maximus

C2

Upper cervicals

L5,S1,2

Reproductive


Triple Warmer This may be described as the San Jiao. It co-ordinates water functions in the body. In modern terms this can be translated as the endocrine system and the maintenance of homeostasis. It is linked to the pericardium. Problems associated with an imbalance in the triple warmer may be linked to hormonal problems. Upper extremity and neck problems, facial pain and TMJ dysfunction may also be linked. The triple warmer is associated with discernment and acceptance.


Fixation indicator

Nerve supply

Organ

Teres minor

T2

C5

Adrenals Thyroid Thyroid

Sartorius

T11

L2,3

Adrenals

Gracilis

T12

L3,4

Adrenals

Soleus

T11,12

S1,2

Adrenals

Gastrocnemius

T11,12

S1,2

Adrenals


Gall Bladder Meridian The gall bladder stores bile and excretes it into the digestive tract to aid digestion and transform food into energy. The theory of Chinese medicine sees the gall bladder as bestowing the capacity to make judgments. Gall bladder imbalances can lead to either an inability to make decisions or to the making of ill-thought out decisions. Physically, symptoms may present such as headaches, depression, TMJ dysfunction, back pain, sciatica, hearing and eye problems, and facial pain. It is linked to the liver meridian and the associated emotion is irritability. The gall bladder is also associated with creativity and motivation.


Fixation indicator

Nerve supply

Organ

Anterior deltoid

T4

Cervico-dorsal junction

C5,6

Lung Gall Bladder

Popliteus

T12

Lower cervicals

L4,5,S1

Gall bladder


Liver Meridian The liver channel regulates the flow of energy throughout the body and oversees the maintenance of the body’s blood supply. It is associated with blood storage and the regulation of blood in circulation. In women this is closely associated with menstruation; so many gynaecological problems are likely to be related to a liver imbalance. Other physical problems linked to liver meridian imbalance are headaches, muscle problems, nail brittleness and eye problems such as glaucoma. The liver is seen as the control centre, so if the liver is balanced and functioning well, we can exercise control over the events in our life. If the liver meridian impairment occurs there may be a tendency to become over controlling, rigid and inflexible or to have lack of self-control leading to the main emotions associated with the liver: anger and irrationality. Liver meridian imbalances are always present in any stress-related disorder. The liver is also associated with healthy change and exploration.


Fixation indicator

Nerve supply

Organ

PMS

T5

C6,7,8,T1

Liver

Rhomboids

T5

C4,5

Liver


Lung Meridian Lungs in Eastern medicine have a different role from that perceived by Western doctors. The lung meridian governs the energy that is obtained from inhaled air, and also the regulation of the passage of water through the body. Lungs also control the energy in the outermost parts of the body, i.e. the skin. In other words, the lungs rule the circulation and dissension of Qi therefore regulate the entire energy system of the body. Dysfunctions in the lung meridian may lead to symptoms such as:

Asthma and other chest problems Rough dry skin Eczema Allergies

Emotions linked to the lung meridian are grief and melancholy.


Fixation indicator

Nerve supply

Organ

Anterior serratus

T3,4

C5,6,7

Lung

Coraco-brachialis

T2

C6,7

Lung

Deltoids

T3,4

Cervico-dorsal junction

C5,6

Lung

Diaphragm

T12

T11,12,L1

Phrenic, C3,4,5

Lung


Large Intestine Meridian The large intestine has the role of expelling impurities from the body, and to extract any remaining nutrient and energy from the matter passed from the small intestine. It is linked with the lung, and the emotions associated with the large intestine meridian are grief and melancholy, also with release and moving on. The muscles linked to this meridian are those that join the pelvis to the legs. Any imbalance in these may cause pelvic instability, and perhaps gut problems and back pain. Irritable bowel syndrome will usually cause a weakness in these muscles.


Fixation indicator

Nerve supply

Organ

Tensor fascia lata

L2

Iron deficiency

L4,5,S1

Large intestine

Hamstrings

L4,5

Sacral fixation

L5,S1

Large intestine, rectum

Quadratus lumborum

L4,5

T12,L1,2,3

Large intestine, appendix


BIBLIOGRAPHY AND REFERENCES

• Bartram D.E, Amatsu Notes Active Balance Ltd Duffy C, Amatsu Association Training Bates S Active Balance Training Limited 2004, Langston J, Muscle Testing, Amatsu Modules 1 & 2, Amatsu Training

School Langston J, Directed Learning Exercises for Seitai, Amatsu Training

School Faruqi T, Hand P, Anmajutsu Modules 1, 2 and 3, , Life Skills Centre Myers T, Attitude Anatomy, A History of Anatomy for the Somatic

Therapist Walther, Applied Kinesiology Synopsis 2nd Edition Kapandji I.A, The Physiology of the Joints Vol. 1,2 and 3 Touch for Health, A practical guide to health improvement based on

the book Touch for Health by John Thie D.C. Books 1&2, published by Toni Gralton, Australia

Dananberg HJ DPM, Subtle gait malfunction and chronic musculo-skeletal pain

Todd M. E, The Thinking Body Prof. Hatsumi Lectures Japan 1995 • Prof. Hatsumi directed teachings form 1995 onwards. Personal tuition to Dennis Bartram, William Doolan and Christopher Rowarth. • Dennis Bartram Amatsu notes from conversations, personal tuition and direct oral transmission of ancient historical scrolls from Dr. Hatsumi.


Year 2: Module 5 & 6 Homework

1. Read up on the endocrine and excretory systems. 2. Revise the structures of the hand and elbow. 3. Keep learning the origin, insertion and actions of all muscles.

4. The endocrine system is a big subject. Apply your Amatsu knowledge to

explain in detail the interaction between the emotions and the endocrine system, thus explaining the detrimental effect excess stress can have on health and in particular on the immune system.

5. Define “endocrine” and “exocrine”.

6. Compare and contrast an example of a positive feedback loop and a

negative feedback loop.

7. What are the functions of the kidneys?

8. How is urine produced and what factors affect urine production?

9. Differentiate between diabetes mellitus and diabetes insipidus.

10. Read up on: The bones of the head and neck

i. The cranial nerves ii. CSF and spinal cord


iii. The immune system

11. List the cranial bones. How many of each is there? 12. What are the functions of the paranasal sinuses?

13. Describe the structure and functions of the immune system with

respect to the Godai. Do not just paraphrase Tortora!!

14. What are the functions of CSF? Where is CSF made and where does it circulate? Draw diagrams to illustrate your answer.

15. What are the functions of each cranial nerve and where can they be

found?

16. How do cranial nerves differ from spinal nerves?

17. How many spinal nerves are there?

18. What is a dermatome?

19. What is a synapse?

20. List the meningeal layers.

seitai module 6-2007 arm and shoulder

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