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Maintaining Body Balance, Flexibility & Stability: A Practical Guide to the Prevention & Treatment of Musculoskeletal Pain & Dysfunction
I first met Leon Chaitow in 1988 when he taught a workshop in soft tissue
manipulation in Seattle, Washington. What I learned in that workshop changed
forever the way I would practice medicine. I was shown a set of tools that has
allowed me to be far more help to my patients than I might otherwise have
been. To this day, I use these techniques with almost every patient I see whether
their complaint is musculoskeletal or not.
The human body is a complex collection of bones, muscles, connective
tissues, nerves, and organs. It is all of these parts, working together in concert,
which make us what we are. The important part of that last sentence is ‘working
together’. When these parts aren’t cooperating, disease and dysfunction result.
In a very real sense, we are what we have become as a result of our adaptation
to stress. We may adapt well or we may adapt poorly, but we will adapt in some
way. What should be obvious is that we need to learn to adapt well.
Unfortunately, much of our adaptation is without thought and intent and
becomes maladaptation. We survive, but we don’t function well.
Stress causes us to prepare for ‘fight or flight’, but we don’t fight or fly, we
just stay tight and ready. We armor, we guard, and we never let go. Many of us
sit all day slumped in front of a computer or over a desk with our heads forward
and our shoulders up. Eventually our brain begins to think that’s the position
we want to be in and we adapt. Then we develop mid back pain and perhaps
chronic headaches. Often we begin to develop numbness and tingling in our
arms and hands that some inexperienced doctor thinks is carpal tunnel
syndrome and off we go to surgery that doesn’t help. Instead, we should be
stretching the muscles in our neck and back that are crushing the nerves to our
arms. We should learn a better adaptation to that stress.
Sitting, we allow the muscles in the front of our thighs to shorten and
tighten and when we stand up that tension pulls our pelvis forward. When that
happens, we adapt with a ‘sway back’, develop chronic low back pain and
occasionally sciatic neuralgia. And it’s off to surgery we go for a herniated
lumbar disk that isn’t really the problem.
I recently saw a patient with this very condition. He had been treated with
chiropractic. He had been treated with massage. He had been treated with
strengthening exercises by a physical therapist. He had been sent for an MRI
that showed a little disk disease, but he never got any relief from his low back
pain. A friend suggested that he come to see me.
I found that his quadriceps were tight (the muscles in the front of his thighs),
his pelvis was tilted forward, and his low back muscles were tight and short as
they adapted to the anterior tilt of his pelvis. I stretched his quadriceps and low
back extensors, adjusted his lumbar spine and pelvis, and showed him how to
viii Foreword
stretch at home. After two visits he came back, said he felt better than he had
in 10 years, and asked me why no one had shown him the stretches before. All
I could say was ‘nobody who you saw knew’. With this book, no one has an
excuse for not knowing.
It is through the application of simple, straightforward techniques such as
those presented here that we learn a better way to adapt. I believe that everyone
alive today would benefit from the advice contained here. For those persons
lucky enough to have a practitioner who uses these techniques the book will act
as a reminder and guide for self-care. For anyone not that lucky, it may act as a
guide in the selection of a new (and better) practitioner.
I, and several thousand of my patients, owe a debt of gratitude to my friend
Leon Chaitow for introducing me to this work. Since 1990 I have taught much
of this material to my students at Bastyr University and it has served them well
in their practices also. I hope that you find the information contained herein to
be as useful for yourself. And I hope that you introduce the book to your
friends and families so that they might obtain and Maintain(ing) Body Balance,
Flexibility and Stability.
Douglas C. Lewis
Washington, USA, 2003
How to use this book
The most common problems we take to our doctors relate to aches and pains
and restrictions of the musculoskeletal system, the ‘machinery’ of the body.
There is a great deal that individuals can do for themselves to prevent such
problems, as well as to help in treatment and rehabilitation once problems have
The book is not intended to be a substitute for professional attention and
treatment, but should be used to support the treatment and guidance of the
treating practitioner. It offers ways of preventing new or recurrent musculo-
skeletal problems as well as outlining first-aid options for the self-management
of aches, pains and restrictions until professional advice and treatment can be
obtained. The book also contains numerous options for self-application of
toning, stretching and mobilizing exercises which may be used as part of a
planned recovery and rehabilitation program under the guidance of a medical
doctor, chiropractor, physiotherapist, osteopath, massage therapist, athletic
trainer or other healthcare provider.
The individual exercises and techniques described and illustrated should
therefore be seen as ways of complementing professional attention, not as a
substitute for this. Practitioners may wish to recommend that their patients
refer to the book as a reminder on how to carry out the exercises and
techniques they have instructed them to use. Many common muscle and joint
problems can be eased by the use of self-help variations of osteopathic systems
of care, known as muscle energy technique (MET) and strain/counterstrain or
positional release technique (PRT). A detailed summary of these useful and safe
first-aid bodywork methods is given in later chapters. Most descriptions of self-
help exercises or techniques will contain details of the aims and objectives of the
particular method and the correct position to get into, how to perform the
maneuver and the timing and frequency of the exercise or technique.
Sometimes there will also be notes on particular patterns of breathing and eye
movement to assist in successful application of the method. Choices for helping
to prevent, or to ease, musculoskeletal problems are therefore easy to identify,
either for first aid, or as homework following the advice of a healthcare provider.
In general, if a muscle or joint restriction exists, one or other of the variations
of MET can be used to produce more relaxed soft tissues, so that stretching or
increased range of movement can follow. If muscular weakness exists, other
versions of MET can be used to increase tone and strength. Before using any of
these methods it is important to recognize that if any pain is felt while
performing them, which is more than simple discomfort, they should be
x Preface
stopped. If the correct technique has been selected, and is used as described,
then there should be no pain. Detailed descriptions of how MET works are
given in Chapter 1.
MET, when used to generally loosen muscles which have become tight,
whether through misuse or overuse, is safe and effective. However, it is
important to remember that the human body is complex, and apart from using
these methods as first aid, individuals should always seek the advice of a
qualified expert before applying MET or other self-care methods.
Traditionally, the methods used in osteopathy to release and relax tense, tight
muscles and joints have involved a variety of maneuvers in which the tissues
have been stroked, stretched, pressed and generally manipulated by the
practitioner. In recent years we have learned to better understand the ways in
which the muscles and other soft tissues work, and this has led to new methods
of treatment. Some of these are suitable for self-use because they are so safe and
gentle that it is almost impossible to cause harm.
The words ‘muscle energy’ suggest that the effort and energy of the person
or patient performing the movements provide the primary force involved in the
process, as distinct from the effort and energy of a practitioner.
The conditions which can be helped, and often completely overcome by
these methods are many, and include a wide range of joint and muscle
complaints involving stiffness, restriction of movement, pain and disability. If
the problem involves actual pathology, such as an arthritic condition in which
damage has occurred to aspects of the joint surface, then the amount of possible
improvement from use of (say) MET would be limited by the structural
damage. Even so, even with an arthritic joint in the background, MET methods
should usually be able to produce some degree of improvement in movement
or reduced discomfort, even if this is not always long lasting.
MET methods can be used to strengthen weak muscles as well as to loosen
tight ones. Not all the variations of MET are suitable for self-application, as
some require the restraining or supporting hands of another person. A family
member or friend can often provide this extra pair of hands if the method has
been approved by the practitioner/therapist. In many situations an expert is
required to control the precise directions and degrees of effort, and so in the
text of this book I have attempted to indicate just where self-use is possible, and
where outside aid is necessary.
It is recommended that anyone attempting to use any of the individual
techniques and exercises described in later chapters should first ensure that they
understand the reasons for the use of these methods and their underlying
mechanisms. There is no more certain way of failing to obtain benefits than by
wrongly using what appear to be simple methods.
The most common mistakes made when using MET are those which involve
excessive use of force, over too prolonged (or too short) a period of time. Apart
from the direction in which the effort is made, these two factors are the most
important, and emphasis will be placed on them many times.
Essential questions to ask are, therefore:
For how long must a MET effort be maintained?
With what degree of force?
In which direction(s)?
And what should be done after the contraction is complete?
These are the key elements in muscle energy technique.
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