Guest blogger and 2018 FHT Training Congress speaker, James Earls, shares a few pointers to help therapists feel at ease when performing a postural analysis.
Performing a postural analysis can be nerve wracking for the therapist and the client. I remember my first few appointments after qualifying in structural integration – I was supposed to be some kind of expert with my certificate on the wall but, when confronted with an uncomfortable client standing in front of me in their underwear, it was nearly impossible to see anything clearly. Sweat ran down my sides, my brain shut down and I rushed to let the client get onto the couch and relax.
Once my client was on the table (usually face-down) and we were both back in our comfort zones, I could think clearly and get back to doing everything I learnt in basic bodywork class.
Eventually, I realised I was doing a disservice to everyone involved. I was rushing into a treatment with no real plan, thereby undermining my own professionalism and the training that required a lot of my time and money. Most importantly, the client was not getting ‘their’ treatment, just a re-hash of a range of numerous techniques that might correct some muscle issues but not necessarily the ones that were most significant for their overall pattern.
The privilege of teaching bodywork for 20 years has shown me that I was not alone in this experience. Many therapists practise bodyreading in the safe environment of the class where there is a mutual understanding of the process, but then have some degree of shyness, panic and/or discomfort when it comes to the privacy of the clinic room.
Here are a few pointers I hope will support you through the process of becoming more at ease.
1. Practise. The more you look the more you will see. Stay relaxed and don’t be hard on yourself. It takes time to see things and you will find there is a feedback loop between understanding something and seeing it more clearly. Seeing clearly will help you understand it a little better because you can now see it.Our visual system is tuned to pick up things that we already know. If you are new to a situation and information, it will take repetition for the visual cortex to re-tune itself. It is important to remind yourself of this in classes where the ‘expert’ points things out and you and your friends may not see what they are talking about. To a certain degree, it is true that you can’t see it as you didn’t know about the concept or the anatomy and your cortex needs time to learn the necessary algorithms. After a while these things become clear – but only with practice.
2. Positives. When assessing someone, especially for the first time, make sure you start with positives. What is working well in their structure? What is strong, balanced, open, grounded or light? Make sure your comments are clear and specific as possible; don’t make generic platitudes. But also, more importantly, don’t make them suggestive – choosing your words carefully is another important skill to practise.
While it might seem less important to find the ‘right’ things than the ‘wrong’, think of the process from the client’s point of view. They have an in-take session in which they list all of the negatives about themselves, often they already feel some degree of low self-esteem coupled with any pains and discomforts that inspired the appointment, and then we ask them to remove their clothes and stand in front of us while we list their faults, many of which they didn’t even know they had.
If we’re going to make our clients feel better, why not start from the outset and reinforce the fact that there are many good things in their system, not just the painful, stiff, or ugly ones they notice.
3. Feedback. Practise with friends, family or the regular clients who are already invested in your success. Ask them for feedback on how they feel about the process. Things like the position of mirrors, room temperature, draughts, your own posture and gestures – anything they notice should be considered for your clients’ comfort.
4. Real and relative. To bring it now to the technical – there are two methods of assessing posture, reading the real position of the bone in gravity and understanding its relative position to its bony neighbours. Few references, if any, make this clear.
Most standard texts measure a bone’s relationship to gravity and the floor; this is the usual plumb line approach. We will call this the real position because we are only considering one bone’s position in space. The most common example is pelvic tilt and while there are many versions of what it ‘should’ be, most of those measure the pelvis to the floor by assessing the angles between the PSIS, ASIS and pubis.
Measuring the bone angle is fine but it excludes a lot of other information about the relationship to the rest of the body. For example, the pelvis can be anteriorly tilted by standard measurements and we would therefore expect the hip to be in flexion but this is not always the case. To really understand what is happening with the soft tissues, we need to assess joint positions.
A joint is a relationship between at least two bones and is independent of gravity. We refer to this as the relative position because it compares one bone relative to another. Reading the relative position requires seeing the relationship between bones. In the case of pelvic tilt, the relationship between the pelvis and the femur.
It is possible, in fact it is very common, for the pelvis to be anteriorly tilted in gravity but ‘posteriorly tilted’ relative to the femur. The implication is that the hip is actually in extension, and not in flexion, making the flexors longer and the hip closer to its normal end of range – could this be why so many people are diagnosed with ‘short, tight hip flexors’?
Coming to terms with the relationships through the body and how it all fits together requires clarity in what you are seeing – both the real position of the bone in space and its relationship to other bones.
5. Practise. This is so important it is worth repeating. You won’t learn to see until you start practising seeing.
Learn more at the 2018 FHT Training Congress
You can learn more about postural analysis at the 2018 FHT Training Congress in the NEC Birmingham:
Postural analysis – adding the next dimension to your treatment
With James Earls (supported by Lotus Publishing)
Room 2, Monday 21 May, 2pm – 3pm
Postural analysis is often considered diagnostic – it isn’t. Posture is only the starting position from which movement takes place and it gives information about a client’s potential for movement. Performing quick postural screenings allows therapists to ask better questions and getting better information is an essential element of giving a good treatment.
You have one day left to pre-book your seminar tickets as sales will close this Friday at 4.30pm. Any remaining tickets will be sold on a first-come first-served basis at our Training Congress.