"We usually build habits in mind and body unconsciously, and although the habits are sometimes convenient, they all too often constrict us. So, as we age, the conditioning process limits movement in the body, and we become tighter. Tightness in the muscles affects glands, circulation, nerves—our energy—thus accelerating the body's breakdown. When the body becomes less flexible and open, it has a direct effect on the mind and personality. There is no way to stay the same. Life is change, and change in a person can take only two directions. You either become more rigid and crystallized, more set in your ways, or you continue to grow, transform, and open up to yourself and the world you live in."
—Joel Kramer
Life is change, states Joel Kramer in the quote above, and change in a person can take only two directions: people either become more rigid and crystallized, or they continue to grow and open up. Somatic Technique is a set of neuromuscular reeducation procedures designed to help release the chronically tight muscles that cause rigidity and crystallization, while at the same time giving patients a new and more dynamic awareness of themselves in their bodies and in their relationship to the world around them.
The work in this manual is designed as an ancillary technique to the other hands-on musculoskeletal procedures normally used by chiropractors, massage therapists, bodyworkers, physical therapists, and osteopaths. There are twenty-one basic techniques covering the muscles of the trunk, shoulder girdle, hips, neck and temperomandibular joint, and twelve additional techniques for the extremities. The work is relatively easy to learn and takes only a couple of minutes to apply, which makes it a very useful adjunct to any form of hands-on practice.
With these techniques you will be able to relieve many problems of chronic muscular pain and stiffness that do not respond to other methods. At the same time, you will be educating your patients to be more present and aware in their bodies. Somatic Technique will help them regain control of their sensory-motor system, so that they can contract and relax their muscles at will. This enhanced awareness and control tends to result in improved posture, flexibility, strength, and health.
In Chapter Eight of this manual suggestions are given as to how to successfully integrate Somatic Technique into your practice. In the meantime, let me outline a simple four step procedure for getting started. Follow the steps as I suggest, and you—and your patients—will enjoy a smooth and easy transition into this work.
Step 1
Read some of this manual daily until you get a good understanding of the work, and the neurophysiological principle—the sensory-motor feedback "loop"—behind it. Begin reading some of the other material I have referred to, such as Thomas Hanna's book, Somatics.
Step 2
Start using some of the techniques with your patients, following the guidelines given in Chapters Five and Six.
Step 3
While you are still becoming familiar with Somatic Technique, I suggest you use it on an "as-needed" basis. That's the way I started. Each technique addresses specific problems in the body (See Appendix A—Symptom Checklist). When you see a patient with that problem, try the technique out. Play with it. Don't be afraid to experiment—this work is generally quite safe to use (Chapter Four deals with contraindications, and these are spelled out again, where appropriate, in the technique notes themselves).
Step 4
Once you begin to feel some confidence with this work, experiment with using the Twelve Visit protocol, which is described in detail in Chapter Eight.
A Guide To The Manual
This manual is presented in a clear, logical, and easy-to-follow format. After reading this introductory chapter, you will come to Chapter Two—Origins And Principles Of Somatics. Read this to get a basic understanding of the roots of the somatic approach; the relationship between the mind and movement; the kinds of results obtained with somatic techniques; principles of sensory-motor control; and the causes of sensory-motor amnesia.
Chapter Three—Neurophysiology, details the negative effects of sensory-motor amnesia (SMA); how SMA is corrected through reawakening cortical control; subcortical neurological mechanisms; dealing with weak muscles; comparing the somatic approach to muscle energy, Proprioceptive Neuromuscular Facilitation (PNF), and related active muscle relaxation techniques; and using Somatic Technique as an alternative to high-velocity osseous adjusting.
Chapter Four—Evaluation And Contraindications tells you how to diagnose, or analyze, your patient. You will be given some specific criteria, things that show up consistently, to indicate whether or not there is a somatic problem. Because Somatic Technique is safe to use and can benefit almost everyone, there are only a few contraindications that need to be understood.
Next, study Chapter Five—How To Learn This Work. This section will tell you how to learn this work without being overwhelmed by it. It will give you a step-by-step method for easing your way into it, beginning with learning the key elements of the technique itself.
You will note that, regardless of which muscle or group of muscles you are working with, the technique (with the exception of the TMJ) is always the same. Learn to perform it correctly and efficiently, and your patient will receive the maximum benefit in the shortest time.
After learning the basic technique, you will come to the techniques themselves, described and illustrated in Chapter Six—The Twenty-One Basic Techniques. Study them in the order suggested in Chapter Six. Practice the techniques on your assistant or another practitioner. Go through the various stages in each technique until you get a "feel" for how the technique is done. Then, once you have learned the main techniques, begin incorporating the others into your somatic repertoire. Be sure to practice the accompanying individual exercises, too, as they are an important adjunct to the techniques.
Chapter Seven—Extremity Techniques, deals with the extremities. You may find yourself using these techniques less often than the basic ones. Once you release somatic tension in the middle of the body—the lower back, the abdomen, the waist, and the shoulder girdle—many extremity problems, which are often compensatory in origin, will clear up. Learn these additional techniques as and when the need arises
The next section, Chapter Eight—Integrating Somatic Technique Into Your Practice, will show you how to integrate this work into your current style of practice, and how to introduce it to your patients so that they understand it and get enthusiastic about it.
In Chapter Nine—Healing The Whole Person, I go into some of the emotional and psychospiritual aspects of somatic problems, and how internal mental or emotional tension manifests as stress and imbalance in the body. For those practitioners interested in relating to and serving their patients in the most complete way possible, the information in this chapter may prove invaluable. It is designed to complement and round out the more straightforward sensory-motor data and techniques presented in the main part of this book.
Lastly, there is Chapter Ten—Basic Exercises. These exercises are fundamental to the long-term success and effectiveness of the hands-on work you do. They help repattern the neuromuscular system and maintain the clinical results you've achieved with the patient. You will teach them to your patients and, ideally, will be doing them yourself as part of your own daily health maintenance regimen.
There are three appendices. In Appendix A you will find a chart of somatic symptoms and problems, and the appropriate techniques for correcting them. Appendix B shows a sample somatic evaluation form. Appendix C tells you where to go for further information and training in the somatic field, and also mentions some other resources you may find useful.
The Somatic Perspective
The theory, or principle, behind Somatic Technique is simple. The actual method of applying the technique is simple. But it is also true that what is simple is not necessarily so easy to grasp. Somatic Technique involves a different way of seeing the body. Most chiropractors, as well bodyworkers, are trained to see the body structurally—as a "thing" that is either "in" alignment or not. In traditional chiropractic, the adjustment is aimed at correcting the structural alignment so that function will improve.
This perspective is based on a mechanistic, Newtonian model of health, where physical reality is viewed as being somewhat like a clockwork mechanism with, ideally, all the parts running smoothly and in harmony with each other. When things are not running optimally, then it is a matter of locating the part that is misfiring or is out of balance with the rest of the mechanism, and making whatever mechanical or chemical corrections are necessary.
However, this is a model that is becoming increasingly outmoded. Quantum physics is revealing to us that the universe is actually much more fluid, uncertain, and paradoxical than the Newtonian model would have us believe. In his book, Perfect Health, Deepak Chopra, M.D., points out that: "We tend to see our bodies as 'frozen sculptures'—solid, fixed, material objects—when in truth they are more like rivers, constantly changing, flowing patterns of intelligence."2 It is this "flowing pattern of intelligence" that underlies and drives our seemingly random universe which, in spite of our desire for stability and constancy, is always in a dynamic and highly creative state of flux.
In the quantum perspective on healing, the key to returning the organism to a state of optimal health does not lie in tinkering with the parts or physiological process, as it does in the Newtonian model. Applying the Newtonian view to healing, as is the case in allopathic medicine, where drugs or surgery are utilized to correct the offending part or process, or in certain chiropractic techniques, where the spinal vertebra are frequently made to conform to some theoretically ideal alignment, can have negative side effects. The negative, inimical side effects of prescription drugs are well-documented. As for surgery, in just one example, back surgery, a 1988 study revealed that of 250,000 surgeries performed that year, only 10% were actually necessary.3 One can only wonder as to what permanent damage may have been done to the spines of the 90% who did not actually need the surgery their doctors convinced them to go through.
The negative effects of chiropractic structural adjustments are not as well-documented and this is probably because, by its very nature, chiropractic is essentially a benign therapeutic procedure. This is especially so when the chiropractic adjustment is delivered by a skilled and sensitive practitioner. Such a practitioner learns intuitively just how much force to use, the timing involved in delivering a precise and gentle thrust, and—above all—when not to manipulate. Unfortunately, not all chiropractic doctors have refined their manipulative art to the highest degree of skill and sensitivity possible. There have been some studies showing a very small incidence—ranging from 1:300,000 to 1:3,000,000—of serious complication resulting from cervical spine manipulation.4 Ribs also occasionally get broken, and perhaps a vertebral process or two. Probably the most common negative effect are muscle spasms and inflammatory reactions caused by adjustments that are too abrupt or severe.
Perhaps the main limitation of the structural model in chiropractic—and this is purely speculative, an observation based on my own twenty years clinical experience in the field—is that repeated structural adjustments, without any understanding of the subtler aspects of the patient's physical, mental, and emotional dynamics, may not do very much good at all. It is also quite possible that repeatedly manipulating a vertebral joint over a period of many years could weaken the ligaments and create hypermobile facets. This, in turn, could initiate a degenerative, osteoarthritic process in the joints as the body's intelligence seeks to stabilize the now unstable vertebral motor unit by laying down calcium deposits.
The argument between structure and function is an old one in chiropractic, as old as that between "straights" and "mixers." Interestingly, both the structuralists and the functionalists—at least those who adhere to the "straight" school—acknowledge that what is fundamentally happening with the chiropractic adjustment is the release and stimulation of the body's own innate healing forces, or intelligence. In this regard, chiropractic always has been, and very much still is, in the vanguard of what might be called the "new wave" of healing.
This "new wave" is the quantum model—and it is also the somatic perspective. Chopra addresses the quantum approach with great clarity and depth in his book, Quantum Healing.5 Essentially, the quantum/somatic perspective is a functional one. It sees the organism as an interactive, highly dynamic, mind/body phenomenon. The mind cannot be separated from the body, and the body cannot be separated from the mind. In the quantum model, the state of the patient's consciousness is an integral aspect of well-being. The thoughts and attitudes a patient holds in his mind intimately affect the physiological processes in the body and the degree of muscular tension or relaxation—and vice-versa. In his book, Chopra details the convincing scientific evidence for this.
The Role Of Consciousness And Innate Intelligence In Health
Consciousness itself is our faculty of awareness—what Chopra, born and raised in a mystical Eastern tradition, calls the "silent witness." It is that in us which is aware of the continual arising and falling away of thoughts, images, sensations, feelings. When we are able to be totally present in the moment, awake and alert with all our faculties of perception—seeing, listening, feeling, tasting, smelling—then we experience our body not as a solid, mechanical, three-dimensional "structure," but rather as a dynamic and continually self-regulating process. We have physical boundaries, yes, and these are defined by the musculoskeletal system. Yet these boundaries are not at all fixed or static. They are continually changing, moving, responding to stimuli, adapting to stress, ever seeking, through through the body's innate homeostatic mechanisms, a healthy state of functioning—that point of perfect balance between tension and relaxation.
What guides this whole process is the body's innate intelligence coupled with the conscious awareness and cooperation of the patient himself. In his book, Chopra draws three specific conclusions about intelligence: "First, that intelligence is present everywhere in our bodies. Second, that our own inner intelligence is far superior to any we can try to substitute from the outside. Third, that intelligence is more important than the actual matter of the body, since without it, that matter would be undirected, formless, and chaotic. Intelligence makes the difference between a house designed by an architect and a pile of bricks."6
As a chiropractor, I found these comments particularly relevant, given that the philosophical basis of chiropractic is built around the body's innate intelligence and powers of self-healing. In chiropractic philosophy, it is the "educated mind"—knowledge acquired from the outside—that interferes with the flow of innate. The natural state of expression of the body is health, just as the natural state of expression of a quiet mind and an open heart is happiness. This is one of the fundamental teachings of the Tao Te Ching, the ancient Chinese manual on the art of harmonious living: that knowledge is a barrier to truth, and that when we put all our learning aside and just learn to be at ease in the moment, relaxed in body and mind, life unfolds in its own intelligent and perfectly appropriate way. It is when we interfere with the natural flow of events that things go awry. To illustrate to my seminar students how this can happen, I share with them the following limerick, about the plight of a centipede who made the mistake of stopping to think about how he managed to coordinate the movement of his one hundred legs:
About its walk the centipede never wondered
Until a frog came along and thundered,
"I'd like to know, please
How you move with such ease."
At which the centipede tripped and blundered!
In Quantum Healing, Chopra is, in effect validating the philosophical basis of chiropractic—which is interesting, given that he himself is a medical doctor, and a former prominent endocrinologist. The difference, however, and the way in which Chopra's views expand the chiropractic philosophical perspective, is that intelligence is not just confined to the nervous system. Rather, as he observes in his book, it flows throughout each cell, like a "river."
The more in tune we are with the body's ceaseless flow of intelligence—which manifests, at the somatic level, as sensation, feeling, and movement—the more likely we are to become aware of the "fourth dimension" to well-being, which is the faculty of consciousness itself. In the somatic model, the development of consciousness—the ground from which all sensation and movement arise—is the key to healing and rehabilitation.
In the structural model of health, the three-dimensional, linear view prevails. Consciousness is rarely acknowledged, other than, perhaps, recommending a change from a negative to a more "positive" attitude. Rather, the focus is on the pain or problem and things are done to the patient to bring him back into alignment and balance. The practitioner is separate from the patient. He is the active "expert." He "does" something to the patient in order to bring about a desired change. The patient is not usually required to be more aware of or sensitive to the functioning of his body/mind. He is usually a passive player in the healing process, waiting for the doctor or practitioner to, hopefully, "cure" him. Once the symptoms have gone, he goes about his life, probably not very much more conscious of his body than he was before it started acting up and making him uncomfortable.
In the quantum, functional, somatic model, consciousness is everything. The practitioner is partnered with the patient. He is acting as a coach. He is teaching the patient to become more aware of his body, focusing on guiding him to a more holistic relationship with it. He helps him get acquainted with the fourth dimension through becoming more aware of himself and the way he breathes, moves, holds tension, and so on. This enhanced awareness shows up as presence. The patient is more centered within himself, more grounded. He is in his body.
Being present in this way allows the patient to have more control over his muscles so that he can bend, stretch, and move with more freedom and ease. He is able to align his own will and intention with his body's innate flow of intelligence. When the mind is not obstructing or fighting the cellular wisdom of the body through negative thinking and unconscious emotional and behavioral patterns—which is what tends to happen in people who are not grounded and at ease in their bodies—then the body's wisdom has room to operate and carry out the homeostatic and self-healing work it is meant to do.
Benefits Of Learning This Work
Somatic Technique, then, will add a truly educational and rehabilitative component to your work. It is important to be patient with yourself as you learn this new approach, because it involves above all a change of consciousness in the way you view the body, as much as it does the learning of any new therapeutic technique. The more present and aware you are in your own body, the easier it will be for you to help your patients or clients become present in theirs.
As for the techniques themselves, study them as I suggest in Chapter Five and experiment with using some of them in your office. Use them on problem cases, especially where the difficulty seems to be primarily neuromuscular—where the patient has lost awareness, and therefore ease and flexibility, in some part of his body.
Notice that you may find some of the techniques, especially at first, a little bit physically demanding. Some of the techniques may actually feel like "work."
Learning Somatic Technique involves effort on your part, because it is a hands-on technique, and a new one at that. As you get better at it, however, it becomes easier. Through your own explorations you'll discover ways of doing the different techniques with minimum expenditure of your own energy. After a while you won't even think about the "work" aspect of Somatic Technique. Your attention will be on the "play" of it, on enjoying the creative element in the work and the responsiveness you feel as the patient participates in the process.
Take your time. Find out how far you want to go with this. Do a little bit each day, as I did when I started learning this work, and gradually you will become good at it. In time it will become an important part of your practice and your patients will value what you do for them somatically. Of all the adjunctive therapies and educational tools available to hands-on practitioners, Somatic Technique is one of the simplest to learn and easiest to use. At the same time it is one of the most effective in terms of results because of the way it helps patients regain control of their own sensory-motor processes.
Developing mastery in the technique also brings a number of very real benefits to the practitioner, and I would like to conclude this introductory chapter by outlining a few of them here:
1. As a practitioner of Somatic Technique, you will enjoy the strength and conviction that come from having a valid, scientific, and "cutting-edge" rationale behind what you do. As you will learn, Somatic Technique is based upon sound neurophysiological principles. It makes sense and, once you grasp the principle yourself, is easy to explain to your patients and your professional colleagues.
2. Your knowledge of the body's sensory-motor learning system, and its relationship to healthy neuromuscular functioning, will enhance your overall understanding of the nature of health and disease. It will become clear to you that when people are not consciously relaxed and at ease in their bodies, but rather are tense and relatively inflexible, a whole host of health problems can arise. You will have a better and more intuitive understanding of Deepak Chopra's quantum healing model, which represents the "new wave" of health optimization and care.
3. In the clinical work, you will have a powerful set of techniques for releasing the chronically tight muscles that cause pain, stiffness, postural imbalance, spinal misalignment (including both fixation and subluxation), and low energy.
4. Your patients will appreciate this work and what it does for them. They will see that it really does give them a new sense of freedom and well-being in their bodies. They will report being able to sense and feel muscles they didn't know they had. As one of my patients once said, "It's as if I am learning to think with my muscles."
5. You will have the satisfaction of knowing that you are making a genuine contribution to the long-term well-being of your patients by giving them tools that both educate and empower them. Patients frequently comment on the fact that they feel as if they are regaining control of their bodies—a faculty they had lost, until they started the somatic work.
6. Your reputation as a health professional in your community will be enhanced. Whether you are a chiropractic doctor, a physical therapist, massage therapist, or bodyworker, you will become known as a practitioner who brings state-of-the-art neuromuscular understanding and technique to the care of his or her patients. Professional referrals will increase as you talk about and, especially, demonstrate your work to other practitioners.
7. Doing the basic exercises, and having the clinical work done on you by other practitioners, will give you more energy, and will help you feel better physically, mentally, and emotionally.
8. Your study of Somatic Technique in particular, and the somatic field in general, will open up your mind and enlarge your perspective on the true nature of healing. You will have a better understanding of what it means to be a healthy, or "whole," human being. As you learn to embody your new understanding, to make it your own, it will increase the level of satisfaction and success you enjoy both in your practice and in your personal life.
References
1. Kramer, J., "The Third Perspective and Yoga: Bringing East and West Together," Yoga Journal (Nov-Dec, 1981).
2. Chopra, D., Perfect Health (Harmony Books, 1990), pp 11—12.
3. Saal, J. A. & Saal, Joel S., Non-Operative Treatment of Herniated Lumbar Intervertebral Disc with Radiculopathy: An Outcome Study (San Francisco Spine Institute, 1988).
4. Croft, A. C., Keeping An Eye Out, (California Chiropractic Association Journal, May, 1994), p 37.
5. Chopra, D., Quantum Healing: Exploring the Frontiers of Mind/Body Medicine (Bantam, 1989).
6. Ibid, p. 45.
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