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tmj ears - make me want to give up

Hi everyone,

I've been in treatment for a year with my tmj problems. I also see a physiotherapist, take part in yoga classes and eat very well. (asides from tmj disorder, I'm very healthy) go figure. I've had tmj problems for 2 years which started when my ears blocked after a drive, then a month later my jaw problems started.

This week I started doing some ear exercises to get my ear muscles working again. I held my nose, swallowed and then would blow out my nose. I heard lots of bubbling, crackling etc and I felt quite confident that this technique would be good for my ears. I didn't push too hard.

A day later and I feel incredibly dizzy and my ears feel even worse. I feel I've irritated my ears and they've affected my middle ear - balance part.

Honestly, when do these tmj ear problems go away?? My joints aren't arthritic and I am a muscular problem.
I've seen ENTS, now onto my 3rd dentist, physios, massage therapists, accupuncturists - you name it.

I just can't handle this anymore. Do people really get better after tmj treatment?
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replied January 2nd, 2012
Experienced User
I feel your pain. I've been under neuromuscular dental treatment for almost a year now and have yet to get ANY relief from the pressure that has been in my left ear for about 5 years now.
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replied January 8th, 2012
Experienced User
Tell us more about your NM dental treatment.

Where are you receiving your work?

Are you seeing an LVI trained dentist?

What Phase of the process are you in, now?
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replied January 8th, 2012
I'm seeing a neuromuscular dentist and have a lower orthotic phase 1. Yes - LVI trained. I've been seeing a physiotherapist for 6+ months. Kiteflyer, do you have any advice that might be helpful for my situation? And for Saltyk9?
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replied January 8th, 2012
Experienced User
Reply
Gosh, I'm not a dentist.... I am not an MD, nor am I a physical health/ adjunct practitioner.

So, I don't have any specific advice for you.


I keep writing replies, only to find out the computer website is logging me off.

So, I'll try and keep it simple.

Seems to me that, ruling out any craniofacial anomalies (Have you had this checked? Even the best, most well-trained dentists sometimes seem to skip this one). Check your ears and your cranial sutures/skull formation.

....Are you coupling Craniosacral therapy and Rolfing with the dental work? Did you have a CBCT taken (3D computerized cone beam tomography)before starting the work?

Have you seen a neurologist to rule out any benign tumores [or, let's hope not,...malignant] cranial growths that may be affecting your intracranial pressure and CSF circulation...that can back up and cause vomiting.

Are you taking care of your cranial sutures, CSF (fluid and circulation) and entire body fascia as your jaw and joints are being set to the neutral/NM position?

Did you have a skilled Rolfer work on all 10 sessions with you before or during the NM dental work? Many Rolfers find that even though the patient has seen them for all the sessions, the patient still keeps having persistent problems. Rolfers, I do not believe, are trained to reset the head position like NM dentists do, through relevant orthodontic work, etc.... This may be why Roflers, despite all their good work, do not find lasting results with the patients.

On the other hand, not seeing a Rolfer and a CST may be the reason why NM dentists are not having good results with Phase I of the process.

I havenot seen an LVi dentist, much less a NM trained dentist. I thought I saw one, and he wa a posturodontist. Which seemed to foot the bill, given the postural deficits I seem to have. However, even reading this guy'd literature, he does not address craniofacial anomalies (misshapen skulls). Don't you think that would affect the way a person's teeth form? How they hold their head? How this may affect their fascia of the head, neck? and entire body?

In my case, I cannot imagine NOT starting with a full workup at the neurologist to rule out anything awry inside the cranium, having a CBCT taken, then doing the Rolfing AND the CST with the dental work. Remember, I have a craniofacial anomaly and also have been through several traumatic accidents.

I recently had uncontrollable projectile vomit. I've never had that before. I had poor dental work done recently. I am also living in an Asian country where the seat heights are 4 inches shorter EVERYWHERE I go.

Fascia is important and runs throughout the body.

It must be attended to just as the cranial sutures and CS fluid should be attended to while you get your work done. The A/O joint must to be assessed, too (I'd do it before you get started, simply as a point of reference).

Anything else is like asking for nothing. I've been through PT. Off the cuff, seems like facia must be addressed thorugh gravity. Which, if you look at Rolfers technique, certain aspects of it is done seated in the upright position. Massage is with the patient lying down on the table, which resonates with me just like poor dental work, where the bite is checked with the patient seated in a reclined dental chair.

I my case, I have a unique situation, in that I've got some kind of torticollis coupled with scolisis and fascial-related issues of the head neck down through the hips and legs. I thought it was just muscle pain, however, it clearly is webbed-up/fibrotic fascia, over the years. All of this has recently started to release in the back of the neck and hip areas and has changed for me, when I open and close the jaw and rotate my neck.

Plus, I have a skull anomaly (a deformation) that goes slightly beyond the usual "oh everybody's face is not symmetrical"). I haven't had this checked, yet, with CBCT, but I think I may have a fused lamboidal cranial suture, or a fused suture somewhere else on the skull.

Did you get your Atlanto Occipital joint assessed? Are you healthy in that region?

Hard for me to say what's right for you, eh?

Get out of the static yogic postures, especially as you reset your body via the head.

As for that, I'd see a skilled/trained Rolfer if your fascia is holding your muscles (most Rolfers are very highly trained) and a craniosacral therapist while you get the NM work done.

Cannot imagine it any other way.

This is a process, not an orthosis fix.



I'd skip the yoga, as it assumes you are holding your head and neck properly years before you were fitted with an orthosis,and that the fascia is healthy, and you've not got a displaced A/O nor a misshapen skull. Remember, the orthosis is a process, not a final solution.

I recommend the work of Emilie Conrad, for Cerebrospinal fluidity and health. Her techniques also may help release your fascia, which many people are not aware of. They simply think it is a nerve being pinched or a taut muscle here and there...

I took a course over 10 years ago at a Creativity Conference in Michigan. It was taught by Lynette Kessler, who, back then, was circulating her own copies of a DVD she produced, titled "Being on the Ball." The DVD only touches the surface of what we all participated in and experienced, first hand, in the class.

Let's put it this way, in all my years of seeing massage therapists and PTs, I finally had my body back.

Yet the work I did never held, since my head and neck are off IN THE gravitational position.

Lynette's DVD seems to be no longer be available, but you may contact her at Dance Camera West in L.A. website. That project was only in it's infancy stage when I met her in Michigan over 10 years ago.

Lynette may be too busy to respond, directly, yet if you are persistent, I am sure she can get you a copy of her DVD. She studied under Emilie Conrad.

Either that, or check out Emilie Conrad's site for upcoming workshops she holds across the USA. I've not tried it in conjunction with the NM dentistry, but it's worth a shot if you are not sick nor vomiting, and only wish for fascial release.

In your case, the CSF/cranial pressure will constantly change with your NM dentistry.
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replied January 8th, 2012
Experienced User
lizzyjw:

I am going out on a limb, here, and quoting some other researchers. You may find this useful if you have been through shoe lift therapy with a chiropractor or even a physiatrist/physiotherapist.

I found the following article somewhat interesting...

---
Beaudoin L, Zabjek KF, Leroux MA, Coillard C, Rivard CH.

Departement de chirurgie, Faculte de Medicine, Montreal, Quebec, Canada.

A small leg length inequality, either true or functional, can be implicated in the pathogenesis of numerous spinal disorders. The correction of a leg length inequality with the goal of treating a spinal pathology is often achieved with the use of a shoe lift. Little research has focused on the impact of this correction on the three-dimensional (3D) postural organisation. The goal of this study is to quantify in control subjects the 3D postural changes to the pelvis, trunk, scapular belt and head, induced by a shoe lift. The postural geometry of 20 female subjects (X = 22, sigma = 1.2) was evaluated using a motion analysis system for three randomised conditions: control, and right and left shoe lift. Acute postural adaptations were noted for all subjects, principally manifested through the tilt of the pelvis, asymmetric version of the left and right iliac bones, and a lateral shift of the pelvis and scapular belt. The difference in the version of the right and left iliac bones was positively associated with the pelvic tilt. Postural adaptations were noted to vary between subjects for rotation and postero-anterior shift of the pelvis and scapular belt. No notable differences between conditions were noted in the estimation of kyphosis and lordosis. The observed systematic and variable postural adaptations noted in the presence of a shoe lift reflects the unique constraints of the musculoskeletal system. This suggests that the global impact of a shoe lift on a patient's posture should also be considered during treatment. This study provides a basis for comparison of future research involving pathological populations.
Spine. 2003 Nov 1;28(21):2472-6.

---

Also, anatomist Gil Hedley addresses fascial tissues through his teachings and workshops. I believe you may find some of his students' work useful (those dissecting the cadavers). One student found that the suboccipital muscles in a particular cadaver --- these muscles which affect the position of the A/O joint --- was completely fibrous like a ligament, instead of the suboccipitals actually being/grown as muscles, which are normally muscles covered with fascia. This was unusual. The cadaver's muscles in this case, were not acting as they normally do in all other human subjects they have seen, before.

I wonder about this, and believe that somehow the synovial fluids inside of the TMJ capsule, a synovial joint which is encapsulated, may affect other head/neck tissues, (which may then become arthritic? (spreading).

Just a pondered thought.

I offer you this article, which clearly states the difference of innervations of all the joint types in the body, including the TMJ and the dura mater.

Fascial mechanoreceptors and their potential role in deep tissue manipulation
Excerpt from: Schleip R 2003: Fascial plasticity - a new neurobiological explanation.
(You can look it up, it is on the internet for download)

Then, there's this (you may not care so much about this):

Am J Anat. 1988 May;182(1):16-32.
Mechanoreceptors in articular tissues.
Zimny ML.
Source

Department of Anatomy, Louisiana State University Medical Center, New Orleans 70112-1393.
Abstract

The morphology, distribution, and function of mechanoreceptors in joint capsules, ligaments, knee-joint menisci, and articular disks of the temporomandibular joints of animals, including humans, have been reviewed. In addition to free nerve endings, three types of joint receptors are present in most animal joints: 1) a Ruffini-like receptor situated in the capsule, 2) a Golgi tendon organ situated in a ligament; and 3) the encapsulated Pacinian-like corpuscle. In the anterior cruciate ligament, nerve fibers enter from the subsynovial connective tissue and terminate in receptors. Most of the receptors are found in the distal portion of the ligament. In the meniscus, nerves penetrate the outer and middle one-third of the body and the horns from the perimeniscal tissue, with a greater concentration at the horns. In the temporomandibular articular disk, the mechanoreceptor density is greatest at the periphery and progressively decreases toward the center. If a joint has an intra-articular structure, mechanoreceptors undoubtedly are present within it. The concentration of mechanoreceptors appears greater in areas related to the extremes of movement and probably represents the first line of defense in sensing these extremes. These afferent discharges elicit support from discharging mechanoreceptors located in the joint capsule and subsequently from those in the surrounding muscles. This total afferent output alerts the central nervous system of impending injury, which can then be averted through reflex mechanisms.

---
I don't know why I find the article, below, interesting but then again...why am I in Asia?

This is some research out of Japan, which discusses what's inside the synovial joint of the TMJ, potentially causing the breakdown of the joint:

Int J Oral-Med Sci 5(1):6-11, 2006
Stimulation of Gro-Gene Expression and Production by IL-1 [beta]in
Synovial Fibroblasts from Human Temporomandibular Joints
Hideo Hosaka,Naomi Ogura,Toshirou Kondoh, and Yoshimitsu Abiko
Elevated levels of IL-1 have been found in synovial fluid from patients with temporomandibular disorders (TMD)and are thought to be involved in pain and progression of TMD. Synovial cells in the
temporomandibular joint have important roles in progression of synovitis ; however, their biological roles are poorly understood. ....

That's it for tonight!

Have to catch some shuteye.


There is one good article on the proprioception of the mandible which makes sense if you can read it thoroughly in French.

Rev Stomatol Chir Maxillofac. 1985;86(3):137-46.
[Proprioceptive sensitivity and orofacial functions].
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replied January 9th, 2012
Thank you so much for all your helpful information! I'm going to read it properly now and write back to you.
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replied January 9th, 2012
Experienced User
okay
Not certain that was helpful...There are some professional websites with blogs of professional practitioners who are paid for their work who have links to most, if not all of the .pdfs I have listed.

If I think of it over the New Year, upcoming, I'll try and find the urls and send them forward.

Good luck to you and with your finding better health.

All the best
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replied January 9th, 2012
Experienced User
For now, I am still waiting on someone to research and publish good results pertaining to what problems i have.

There doesn't seem to be too much out there, yet. While there is a wealth of information through Cranio journal, which is a very good journal -- and the likes, I haven't really found what I am looking for.

For now, I'll stick to what researchers are saying about horses' TMJ. The researcher (DVM) at the end, below, states much about stomatognathics and TMJ quite eloquently. Human beings do not seem to be quite as fascinating in that aspect, at least enough to publish precise information about what is really going on... I haven't found one abstract pertaining to humans in the gravity field, that addresses stomatognathics and musculoskeletal issues, altogether, quite as well as the article pertaining to horses, below. I'd like to see this coupled with CSF in human beings as a subject.


Here is proof (although 2009 is so OLD when it comes to "medicine and science")

International Journal of Stomatology & Occlusion Medicine
Volume 2, Number 1, 2-10, DOI: 10.1007/s12548-009-0001-4

Systematic Topical Review
Occlusion, orthodontics and posture: are there evidences? The example of scoliosis
P. Amat

Abstract
The relationship between posture and occlusion has been a constant source of interest to health care professionals. However, a certain amount of confusion still beclouds in this connection because of the great variety of therapeutic approaches proposed for dealing with it as well as the lack of methodological rigor employed for most of the scientific studies published on it. This presentation addresses the questions raised by the connections between posture and occlusion as well as their therapeutic implications. A review of the literature shows that there is a lack of reliable experimental publications devoted to this subject. The data that is available points to the existence of this correlation and also asserts the prevalence of associations between cranio-facial anomalies and idiopathic scoliosis in adolescents. In presenting the interactions between dental occlusion and posture published data tends to lend comfortable support for the subjective convictions and clinical impressions we have already formed. The physiological continuum tying occlusion to posture does not appear to be a univocal and linear relationship but instead a complex ensemble made up of numerous contributing factors. To find more answers we need to undertake basic and clinical research projects that could eventually establish the validity of a cause and effect relationship between dental occlusion and posture that would put therapy on evidence-based foundation.

Keywords Evidence-based medicine - Posture - Dental occlusion - Scoliosis - Dento-facial orthopedics


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LIVING WITH GRAVITY: POSTURE AND THE STOMATOGNATHIC SYSTEM
Karen Gellman, DVM, PhD
Equine dental specialists have long been aware of the anecdotal connection between good dental
care and athletic performance. In some cases of dental pathology, horses can show obvious signs of
mouth discomfort while being ridden or driven, including head-tossing, bit avoidance, and teethgrinding.
These behaviors, often alleviated by the equine dentist, are assumed to be the cause of the
horse’s poor performance. Post-dentistry, the difficulty in picking up a right canter lead or taking a
tricky line of fences magically disappears along with the head-tossing. The assumption has been that
oral pain was such a distraction to the horse that it could not perform at its best. But that does not
explain the horse that never gave any prior indication of mouth pain who shows remarkable improvement
in athletic performance after dental correction. This scenario is common to any experienced
dental practitioner. Successful dental corrections of this type are often the results of experience
and medical intuition. This presentation will explain the mechanics, or the scientific basis of
what the equine dentist often instinctively knows about their work.
First, we need to consider the workings of the neuro-musculoskeletal system (muscles, tendons,
ligaments and nerves) as a complex interaction of many synergistic parts. Complexity science offers
a new perspective in recognizing biological organisms as self-organizing, self-healing, complex
systems made up of many interdependent parts: systems, organs, tissues, cells, molecules.
The characteristics of a complex system are emergent properties, which is to say, they emerge
from the interaction of the parts, not from the characteristics of individual components. Alteration
of the individual components will change the interactions, which alters emergent properties such
as posture locomotion, and performance.
All athletic endeavors—indeed, all activities of living—are governed by the fundamental laws of
physics, most importantly, by gravity. Whether an animal is standing or moving, it continually expends
energy against gravity. The musculoskeletal system of any living organism is specifically
adapted to help it effectively resist gravity in its particular environment, so that it can accomplish the
critical tasks of life: eating, sleeping, protection and reproduction. Since gravitational effects are
mass dependent (remember-- weight = mass x gravity?), a large animal, such as the horse, has special
musculoskeletal adaptations to resist gravity with optimal metabolic efficiency. We see these
anatomic adaptations in the passive stay apparatus (the locking mechanism of the stifles), and the
isolated tendons of the distal limbs, and the nuchal ligament (elastic connective tissue bands connecting
and supporting the head, neck and withers) which allow the horse to stand with minimal expenditure
of muscular energy. Equine stance must be held for long periods without fatigue—often
for 20-22 hours a day. Except for brief periods of recumbent deep sleep, horses perform all their essential
body functions standing.
A horse’s standing posture, then, is a window into the overall integration of the complex neuromusculoskeletal
system. The standing posture that is observed in a normal, sound horse at rest is
called neutral stance. Neutral stance balances and stabilizes the body’s center of mass, allowing
rapid, accurate mobilization when necessary. It defines the most prevalent orientation of the major
muscle group’s fascia (the connective tissue coating of muscles), which is critical for the effective
transfer of force and stabilization of joints during locomotion. Maintaining static posture involves
constant work against gravity, the integration of multiple neuro-musculoskeletal structures, and unconscious
dynamic evaluation of balance and stability. While maintaining a neutral stance, the horse
is able to prioritize and perform its essential functions of body maintenance: feeding, sleeping, and
healing from injury. In neutral stance, all four legs are square and cannon bones are perpendicular to
the ground. Any other posture is a compensatory stance, an abnormal posture resulting from external
or internal alterations to the reflexive postural control mechanisms. The most common causes of
compensatory stance are: structural damage (scars) to the musculoskeletal system, altered nerve signal
transmission due to inflammation along the nerves or spinal cord, receptor damage or down regulation
(number of receptors is decreased), or distortion of the normal structures of regions rich in
postural signals, such as the upper cervical muscles, feet or temporo-mandibular and dento-aveolar
joints. These distortions are often a by-product of living with people: training, dentistry, shoeing or
environmental changes. In particular, the integrity of the stomatognathic system in domestic horses
is commonly compromised by human intervention.
The head and neck of any vertebrate is critical to numerous survival functions. Protecting the
brain is the highest priority for the nervous system, so the head needs to maintain positional stability
with respect to the rest of the body and the ground. Sensory perception is located in the cranial region:
vision (important for predator/prey detection and vestibulo-ocular reflexes), smell (environmental
monitoring, food location), hearing (environmental monitoring, communication) and the inner
ear structures that maintain posture and balance. All of these systems work optimally when the
head is upright and balanced from side to side. Maintaining an upright posture is the second priority
of the nervous system. With an intact brain and a head correctly positioned for optimal perception,
an animal is able to respond to the third priority of the nervous system, which is external stimuli,
such as food, predator threats or reproductive opportunities. Pain is the lowest priority, and is easily
ignored if there is a threat to any higher priority.
The stomatognathic system is a complex kinematic chain that involves the teeth and dentoalveolar
joints, temporo-mandibular joint (TMJ), the skull, jaw, hyoid apparatus (suspension of the
larynx), sternum, and all of their muscular and ligamentous attachments. Functionally, the connections
of the brain’s tough coating (dura mater) to the skull, first two cervical vertebrae and associated
structures (1,2,3), can mechanically engage the remainder of the spine through to the sacrum, which
is the site of the most distal dural attachments. Therefore, abnormalities of skull and TMJ function
can potentially have repercussions for locomotion and posture far beyond the direct inputs to the
vestibular centers of the brain from the sensory nerves of the TMJ (4, 5, 6).
The TMJ is highly innervated, because of its dual function in mastication (an essential body
process), and as a contributor of postural information. The highest concentration of mechanoreceptor
(sensory nerves that report shape change) cells is found in the periphery of the disc and its attachments
via the lateral ligaments to the joint capsule (7, Cool. This proprioceptive (position signaling)
array, similar to that found in the soles of the feet and upper cervical muscles, suggests that data
about the position of the disc and forces acting upon its capsular suspension system are used by the
central postural system to perform balance and righting tasks. The articular surface of the equine
TMJ is functionally concentric with the curvature of Spee, which is the complex curvature of the occlusal
surfaces (9, 10). The most profound implication of this relationship is that any change made
in the curve of the occlusal surface through human intervention will result in neurologic adaptation,
cartilage and bone remodeling in the TMJ and concurrent functional changes in the entire stomatognathic
system (11, 12). These changes may affect head position, center of gravity and balance as receptors
reset in response to changes in jaw movement.
The highest priority of the stomatognathic system is to protect the teeth. Mechanoreceptors
innervating the TMJ and the dento-alveolar joints evaluate and neutralize prematurity of
tooth strike or restrictions in TMJ movement by minutely altering muscle bundle contraction
within the fan-like architecture of the masseter and medial pteregoid muscles, much like a
bicycle wheel is balanced by tuning the spokes. However, avoiding prematurity of strike and
asymmetric occlusion can distort information to the righting mechanisms (a complex interaction
of signals and responses designed to keep the animal upright with respect to the ground).
During neutral stance, as long as there is no pathologic muscle restriction on the TMJ, the
weight of the mandible (responding to gravity) will drop the jaw. Once the mandible is
freely moving, with respect to gravity alone (like a gyroscope) joint and capsular receptors
can evaluate the jaw’s movement and its connective tissue and neural attachments to the hyoid,
skull and upper cervicals (11). In this way, the freely swinging mandible contributes important
information about jaw position in relation to the skull to upper cervical righting
mechanisms and the intrinsic righting reflexes of the postural system.
Recent research has shown that balance and posture are closely linked to TMJ function, with direct
innervation from the trigeminal nerve afferents (sensory nerves) of the TMJ to the vestibular nuclei
of the brain, where all postural information is processed (4, 5, 6). One of the important reasons
for this connection is the need for postural adjustment during mastication, since the jaw movement
of chewing changes the instantaneous center of mass of the head and neck, triggering coordinated
neck position adjustment (13, 14).
The repercussions of this postural relationship, in cases of congenital malocclusions or TMJ pathology,
have been noted anecdotally since the 1920s. In humans, the most common congenital
malocclusion patterns are identified as Class II (overbites) and Class III (underbites) malocclusions.
Overbites in humans have been shown to be associated with excessive extension, or arching of the
cervical spine, and forward shifted posture. Underbites are seen with humping of the cervical spine
and backwards shifted posture. (15, 16). Acquired TMJ disorders have also been shown to be associated
with faulty body posture (17). In addition to the front to back malocclusions described above,
there has been shown to be a high prevalence of lateral malocclusions in human patients with scoliotic
(laterally distorted) spines (1Cool. Along this vein of research, a recent experimental study showed
that rat pups with a one-sided, experimentally induced lateral molar malocclusion exhibited scoliotic
changes in their thoracic spines after one week (19). Most significantly, these changes were shown
to be reversible within a week, by rebalancing the dental occlusion, in 84% of subjects.
The stomatognathic system and its neurologic connections have been shown, experimentally, to
integrate stabilizing support actions and distal (foot) proprioceptors for gaze stabilization (i.e. the
ability to hold the head steady to focus on a distant object) and visual acuity, essential functions for a
prey animal (20, 21). Skilled marksmen, using occlusal splints that either centered or lateralized
their molar occlusion, were found to have a variable level of performance in postural control and
shooting tasks. The subjects’ best performances were correlated with centered occlusion, next best
when lateralized in their habitual orientation, and worst in opposite lateralization. Gaze stabilization
and postural function, presumably, are dependent upon cortical integration of a wide range of sensory
information. Impaired gaze stabilization from congenital malocclusion might prove to be a fatal
disability for a prey animal, which would be selected against in wild horses. In domestic horses,
however, survival is not dependent upon this degree of intact neurologic function.
Why do domestic horses have such a high prevalence of dental abnormalities? In a natural environment,
the structures directly involved in chewing, especially the occlusal surfaces and the TMJ
articulation, are adapted for use in a grazing stance, with head and neck lowered and fully stretched
out. By contrast, most horses living in domestication have several profound differences from wild
horses: they commonly prehend and chew their food with raised heads, they eat concentrated, partially
digested carbohydrates (grain pellets and sweet feeds), and they acquire only a small part of
their overall nutrition from traditional grazing. In traditional grazing, horses shear more abrasive
material with the premolars (i.e. plant roots with accompanying soil), keeping the front cheek teeth
more evenly worn with the back molars. The rostral cheek teeth, along with the tongue and cheek,
also act as an auger, spirally propelling the foodstuffs from the front of the mouth to the back of the
mouth for chewing (22). When a domesticated horse eats only precut forage (hay) or concentrated
grains, the back molars, which now perform the grinding, are preferentially worn. The fiber content
and dryness of the food material has a significant affect on the size of the lateral excursions during
the power stroke, as observed in video and EMG studies (23). It can be surmised that in a natural
environment—to which the horse has adapted over the past 50 million years—there would be seasonal
changes in the fiber and water content of the available food, balancing the wear patterns in the
mouth over the course of a year. Loss of this natural cycle of varying foodstuffs and the evolutionarily
programmed head position has resulted in a broad range of dental problems in the modern horse,
including molar waves, ramps, shears, incisor imbalances, excessive transverse ridging (ETR), and
prematurity of strike (9, 24). Dietary changes can also affect the programmatic shedding of deciduous
teeth, creating an initiating factor for steps, waves and ETR.
While horses certainly can chew in a raised head position, observation of the natural ecology of
horses suggests that this is not the predominant posture for mastication for a horse in a herd setting
(25). The bony TMJ joint, with its complex surfaces and movements, is not inherently stable. It relies
upon an intra-articular disc, much like the meniscus of the knee, to compensate for the lack of
congruence between articular surfaces (26, 27). In other words, without the disc, the TMJ joint
would be very loose and unstable. The tissue of the disc adapts to “fill up” the space in the joint.
With the head in a normal grazing position, the weight of the mandible (via gravity) will induce a
specific spatial relationship of the bones within the joint, to which the disc will model. Mastication
with a raised head will create a different spatial relationship, with its own adaptations. It would be
difficult to argue that raised head mastication, so unlike that observed in nature, could be more beneficial
to the horse. The raised, alert head position is also neurologically associated with sympathetic
fight or flight responses, which conflicts with the parasympathetic autonomic dominance appropriate
for feeding and digestion.
Horses subject to human management (diet, environment, dentistry), commonly sustain oral pathology
that is incompatible with neutral posture and balanced locomotion. The nervous system will
do its best to stay upright and balanced, but there are limits in its ability to compensate for distorted
neural input, especially when bad information comes from a variety of sources, like malocclusion
coupled with poor hoof balance. Structural distortion of these critical regions, like feet and teeth,
results in chronic alterations in standing weight-bearing and joint stabilization. This can also be the
primary initiating cause of many limb problems seen in horses. For example, an overbite is known
to cause spinal lordosis, which pitches the overall center of mass to the rear. If a horse carries too
much of its body weight on its hind limbs while standing 20 hours a day, it will sustain overload injuries
to the weight-bearing cartilage of its distal joints, causing hock or stifle osteoarthritis and
OCD--conditions seen commonly in performance horses. Abnormalities in standing weight-bearing
often are accompanied by abnormalities in gait timing, joint stabilization and foot placement, leading
to a high prevalence of traumatic injuries during athletic performance. This happens because abnormal
balance in stance, such as rear pitch or diagonal tilt, changes how quickly the feet can leave
the ground in the gait pattern. When structural abnormalities are corrected, the horse can reprogram
its standing posture and gait patterning to achieve a neutral posture and properly stabilized stance
phase of gait. Changing the horse’s neurologically programmed abnormal pitch and tilt from malocclusion
is the reason for improved locomotion performance after competent dental equilibration of
trapezoidal distortions of the mouth, such as diagonal (wedge) incisors and the accompanying cheek
teeth malocclusions. Accurate manipulative therapy aimed at recalibrating the proprioceptors of the
upper cervical muscles can also be an important part of rehabilitation from postural abnormality.
Equine dentistry is a field undergoing enormous transition. The last ten years have seen incredible
changes in knowledge and technology. We need, however, to clearly differentiate between a
practitioner who rasps pre-molar points in an unsedated horse without a speculum, and someone
with the education to evaluate and treat abnormalities of occlusion which are interfering with the
horse’s most basic interpretation of gravity. It is critical for veterinary dentists to evaluate and treat
all the teeth in the mouth, not just the ones that are easy to reach. A dentist who removes hooks on
the sixes and elevens but ignores whole mouth balance and occlusion in the name of being “conservative”
is leaving a job half done. All dental specialists should learn how to equilibrate the horse’s
mouth, and be able to critically evaluate their final occlusion so that the horse can live up to its true
performance potential.
Acknowledgments: This presentation was developed in conjunction with Dr. Judith Shoemaker, who
originated the clinical concepts.
CITATIONS
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the rectus capitis posterior minor muscle and the dura mater. Spine; 20(23): 2484-6, 1995.
2. Humphreys BK ; Kenin S ; Hubbard BB ; Cramer GD: Investigation of connective tissue attachments
to the cervical spinal dura mater. Clin Anat, 16(2): 152-9, 2003.
3. Dean NA ; Mitchell BS: Anatomic relation between the nuchal ligament (ligamentum nuchae) and
the spinal dura mater in the craniocervical region. Clin Anat, 15(3): 182-5, 2002.
4. Meyer J, Baron JB: Participation of trigeminal afferents in tonic postural regulation. Static and
dynamic aspects, Aggressiologie 17:33-40 1976.
5. Pinganaud G, Bourcier F, Buisseret-Delmas C, Buisseret P: Primary trigeminal afferents to the
vestibular nuclei in the rat: existence of a collateral projection to the vestibulo-cerebellum, Neuroscience
Letters 264: 133-136, 1999.
6. Buisseret-Delmas C, Compoint C, Delfini C, Buisseret P: Organization of reciprocal connections
between trigeminal and vestibular nuclei in the rat, J Comp. Neurol. 401:153-168, 1999.
7. Tahmasebi-Sarvestani A, Tedman RA, Goss A: Neural structures within the sheep temporomandibular
joint, J Orofac Pain, 10(3): 217-31,1996.
8. Wink CS, St Onge M, Zimny ML: Neural elements in the human temporomandibular articular
disc, J Oral Maxillofac Surg. 50(4):334-7, 1992.
9. Baker G, Easley J: Equine Dentistry, 2nd ed. Philadelphia, 1998, W.B. Saunders, chapters 1, 2, 6.
10. Dixon PM: The Gross, Histological and Ultrastructural Anatomy of Equine Teeth and their Relationship
to Disease, AAEP Proceedings, 48: 421-437, 2002.
11. Piette E: Anatomy of the human temporomandibular joint. An updated comprehensive review,
Acta Stomatol Belg. 90(2):103-27, 1993.
12. Esposito V, Leisman G: Neuromuscular Effects of Temporomandibular Joint Dysfunction, International
Journal of Neuroscience, 68:3-4, 1993.
13. Eriksson PO, Haggman-Henrikson B, Nordh E, Zafar H: Co-ordinated mandibular and headneck
movements during rhythmic jaw activities in man, J Dent Res, 79(6): 1378-84, 2000.
14. Dessem D, Luo P: Jaw-muscle spindle afferent feedback to the cervical spinal cord in the rat,
Exp Brain Res, 128(4): 451-9, 1999.
15. Nobili A, Adversi R: Relationship between Posture and Occlusion: A Clinical and Experimental
Investigation. Journal of Craniomandibilar Practice, 14 (4): 274-285, 1996
16. Milani RS, Deville de Periere D, Lapeyre L, Pourreyron L. Relationship between dental occlusion
and posture. J. Craniomandib Pract 18 (2): 127-133 2000
17. Zonnenberg AJ, Van Maanen CJ, Oostendorp RA, Elvers JW. . Body posture photographs as a
diagnostic aid for musculoskeletal disorders related to temporomandibular disorders (TMD). Cranio.
Jul;14(3): 225-32, 1996
18. Huggare JA, Raustia AM. Head posture and cervicovertebral and craniofacial morphology in
patients with craniomandibular dysfunction. Cranio 10 (3): 173-177 1992
19. D’Attilio M, Filippi MR, Femminella B, Festa F, Tecco S: The influence of an experimentally
induced malocclusion on vertebral alignment in rats: a controlled pilot study. Cranio 23(2) 119-29
2005
20. Milani RS, Deville de Periere D, Micallef JP: Relationship between dental occlusion and visual
focusing, J. Craniomandib Pract 16(2):309-318, 1998.
21. Gangloff P, Louis J-P, Perrin PP: Dental occlusion modifies gaze and posture stabilization in human
subjects, Neuroscience Letters 293:203-206, 2000.
22. Baker GJ: Equine Temporomandibular Joints (TMJ): Morphology, Function and Disease, AAEP
Proceedings, 48: 442-447, 2002.
23. Collinson M: Food processing and digestibility in horses (Equus caballus) B.Sc. Dissertation,
Monash University, 1994.
24. Allen T: Manual of Equine Dentistry, St. Louis, 2003, Mosby, pp. 81-84, 92-107.
25. Waring GH, Horse Behavior, 2nd edition, Park Ridge, NJ, 2002, Noyes Publications.
26. Piette E: Anatomy of the human temporomandibular joint. An updated comprehensive review,
Acta Stomatol Belg. 90(2):103-27, 1993.
27. Detamore, M.S., Athanasiou, K. "Structure and function of the temporomandibular joint disc:
Implications for tissue engineering." Journal of Oral and Maxillofacial Surgery, 61 (2003): 494-
506.
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replied January 9th, 2012
Experienced User
I am in Phase I of my NM treatment. I started in February of 2011 so it has been almost a year.

I'm being treated in Arizona and my dentist is LVI trained.

As far as my success goes, I have had significant reduction in pain. Some symptoms have gone 100%, but there are some, like the ear pressure as I mentioned before, which have been untouched. I still clench my teeth hardcore, primarily when sleeping. I believe I have a very restricted airway which causes the clenching to help me breathe better. CLENCHING is not normal, so there is definitely something missing.

I went to an A/O chiropractor a few weeks ago to check out my cervical area. I have a misaligned atlas (c1) and axis (c2). I have just begun working with this AO chiro and my dentist to do the adjustments in conjunction. I'm hoping this may help aid in my improvement.
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replied January 19th, 2012
Experienced User
This is a response to lizzjw:

Since you are a physical therapy patient, plus TMJ patient, I thought I'd send along an article discussing important information regarding the body in gravitational field. This may (or may not) help explain why you may (or may not be) experiencing positive (or maybe not positive) results with your physio plus jaw/dental treatments. This is about structural integration from an interdisciplinary approach, meaning, NOT JUST ONE simple approach.

For your information, explanation of meaningful abbreviations: CST = Craniosacral therapy, VM = visceral manipulation, SI = Structural Integration (usually referring to, Rolfing)

I have provided the emphasis on the text about the gravity field, first excerpting a few paragraphs, then posting the entire article for your reading. For the text of the article plus images, you may PM me, that way, you can find the complete article posted online (by sending the URL).

excerpt By Jeffery P. Burch...
"Contrary to the classic SI recipe which proceeds from surface to center, the experience of Structural Integrators who are also trained in CST and VM is that approaching these core compartments first is often the most effective and efficient approach to integrating the human structure with respect to the gravitational field.

However, this does not end the discussion of core and sleeve. There are, after all, more candidates for core. What this writing provides is practical steps toward more effective and efficient Structural Integration.


Methods, an Introduction
Some practitioners of CST and VM will wonder why bring in the SI perspective at all, since, on their own, CST and VM greatly increase order in the body. To answer this question, we must return to gravity. Gravity is a large force we are subject to all the time. One way to appreciate the strength of gravity's force is to weigh yourself, then pick up the scales and hold it against the wall at chest level. Then with your hands on the scale try to push your own body weight. Most people can only push about half their weight. Yet, in standing we balance our weight against gravity with little effort. In CST and VM classrooms, gravity is rarely, if ever, mentioned. Balances are established between tissues in the body, but the body is treated as if it were an open, kinetic chain. The closed kinetic chain balance within the gravitational field is a powerful fact largely (or entirely) overlooked. SI brings in this vitally important perspective on gravitational relationship.


Arcing, a primary CST assessment method, is usually done with the client supine. "Listening" (actually very sophisticated palpation), the primary assessment method of VM, is usually done with the client standing for the posterior compartment and supine for the anterior compartment. From the SI perspective, it is important to do all of these assessments with the client standing. It may also be useful to do them with the client supine or even side-lying, but the standing closed, kinetic chain relationship must be included, otherwise body parts will be related to each other, and not to the earth's gravitational field. In addition to assessing the standing body, it is frequently advisable to work on the standing or sitting client. In his recent book, Cranial Sutures, Analysis, Morphology and Manipulating Strategies, Mark Pick describes compelling reasons for working on the cranium with the client seated."


----
The follwing article was written by : Jeffrey P. Burch, MS, BA, [who] studied biology at the University of Oregon before becoming a Certified RolferTM at the Rolf Institute of Structural Integration in 1977. He practiced in London and Honolulu before earning his Advanced Rolfing Certification in 1989. Burch served as a diplomat of the American Psychotherapy Association, was a member of the Rolf Institute ethics committee...

SI: Finding Balance
Interdisciplinary Structural Integration

By Jeffrey Burch

Originally published in Massage & Bodywork magazine, April/May 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.


SI: Finding Balance
Interdisciplinary Structural Integration

By Jeffrey Burch

Originally published in Massage & Bodywork magazine, April/May 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.


The essence of Structural Integration is the dynamic tonal balance between the surface of the body and the body's core. The nature and location of "core," however, has long been debated among Structural Integrators. Herein, let's explore several avenues of thought about core and synthesize them into a practical whole, citing research that is opening new vistas to understanding the mechanism of Structural Integration and related disciplines.


Structural Integration (SI) is distinguished from other disciplines by its primary attention to gravity. Other bodywork systems seek tonal balance, energy balance and emotional balance. While SI attends to all of these, its primary goal is to alter the structure of the human body so that instead of fighting gravity, one can use it as an energy source. After a complete series of 10 SI sessions, clients look taller and more balanced, and report they not only feel lighter, but also physically uplifted. This lift is due to the client's new relationship to gravity. Once this has been felt, no other state will do.

While the results of SI are long-lasting, injury or illness can reduce the lift originally achieved. Such a reduction can change one from feeling like a soaring bird into Jabba the Hutt. Tune-up sessions, either after stressful events or at six- to 24-month intervals as preventive therapy, maintain that graceful and balanced dance with gravity.


Some Principals of SI
Structural Integration works with the continuity and plasticity of connective tissue. The human body has only one piece of connective tissue - all fasciae, periostia, ligaments, tendons, etc. are continuous. Collectively, these tissues make up 20% of human body weight and form the element of support that maintains spatial relationships amongst organs, bones, muscles and all other tissues. Structural Integrators know the map of this connective tissue. With that in mind, they apply analytical skills to choose where to make the most meaningful interventions to restore damaged or habit-worn tissues. The greatest challenge when studying SI is to learn these analytical skills. In classic Rolfing, most of the information is gathered visually.

In order to integrate the human structure into the gravitational field, several tonal balances must be considered. Left and right sides of the body must have similar tone and span in each segment, from toe to scalp (Fig. 1). Similarly, the tone and span of the posterior aspect of the body must balance the front of the body at each level. It is also customary to consider upper-body, lower-body balance.

As the reference to "each level" indicates, balance above and below the waistline must be extended to balance between all segments of the body. For example, the tone in the feet must match that in the leg, that in the thigh, and so on. If each of these three dimensions of balance is improved in a series of sessions, the result will be a good level of Structural Integration.

In addition to these three dimensions of balance, there is a fourth, which if achieved, will bring integration a quantum level higher. This dimension, called core-sleeve balance, occurs when surface tone balances core tone and is less often achieved. It is difficult because, as mentioned before, the exact location and nature of core continues to be obscure. Let's take a closer look at core.



Defining Core
The definition of core has been debated in SI circles for at least the last 50 years. Functionally, Structural Integrators can recognize when a person has core-sleeve balance. A person living in such balance quickly learns to recognize it, too. Movement can be initiated in any direction with equal ease. "Effortless" is the usual description, like a sailboat with all the sails trimmed just right and singing together.

Naming the structures that are core and teaching another to produce this balance comes much harder than recognition of the balanced state.

Surface is easier to describe than core. The superficial fascia is a discreet unit, enveloping the whole body. Deeper fasciae, such as intermuscular septa, connect to the superficial fascia. Any consideration of layered myofascial relationships deeper than the superficial fascia is open to interpretation. Deeper layers overlap and interpenetrate.

The extrinsic muscles lie nearer the surface of the body and tend to move the body quickly and strongly, but somewhat imprecisely. Intrinsic muscles lie generally deeper in the body and move more slowly and more precisely. When these two are functionally balanced, the body can move with strength and precision.

The extrinsic musculature is one definition of sleeve, but exactly where does extrinsic end and intrinsic begin? The spinal rotatores muscles are clearly intrinsic because they are the deepest muscle in that area. The soleus lies deep to the gastrocnemius and is challenging to directly contact. Yet functionally, the soleus is extrinsic, a prime extensor of the ankle. Although structurally deep, lying next to bones, under a large muscle, the soleus is functionally not as intrinsic as the pedal lumbrical muscles. Yet, penetrating through certain portions of the distal plantar aspect of the foot, the lumbricals are the first muscle layer encountered.

So far we have considered core-sleeve relationships with respect to muscles and myofascial structures. But there are more ways to describe core:
- Ida P. Rolf described core in several ways, including "everything you can't live without." This is an intriguing statement, but far from clear in its application to Structural Integration.

- The bones. We think of them as deep structures, but in some places, such as the shin, they immediately underlie the superficial fascia. In the human body, bones serve as spacers in a tensional matrix similar to Buckminster Fuller's tensegrity structures. In this model, the surface-core relationship is translated into balance between the thrust of the bones and the tension in the fascial planes enveloping and connecting them. The internal structure and tensions of the bones can be quickly modified by manual means, producing prompt improvement in the overlying soft tissue tone. Craniosacral therapy (CST) and visceral manipulation (VM) are among the therapies that work with the internal structure of the bones.

- Jan Henry Sultan and other Rolfing instructors use "the visceral space" as core. By this they mean not the viscera themselves, but the container of the viscera and the pressure system inherent in the visceral space and its container. Management of these pressure relationships is essential to Structural Integration, and yet this is not the whole story of core.



New Ways of Defining Core
Certain concepts developed in other disciplines are now giving Structural Integrators new and highly useful ways of defining core. Although craniosacral therapists do not focus on core-sleeve relationships in the way structural integrators do, from the viewpoint of Structural Integrators, CST practitioners treat the dural membranes as core. Certainly the dura are deep in the body, lying inside the skull and within the spinal vertebrae. Cranial manipulation and its descendant, craniosacral therapy, ably demonstrate that altering the tone and span of the dural membranes produces profound and immediate change in tone of body tissues at any distance from the dura. These changes may be either highly tissue-specific or quite general. If the dura is ignored, core sleeve balance is incomplete.

Dural restrictions affect other tissues in three or more ways.
1. A severe dural restriction may put direct pressure on the central nervous system (CNS). Even slightly impaired CNS will result in skewed monitoring and control of body processes.

2. The spinal dural must have flexibility to accommodate spinal movement. The spinal cord must lengthen by several centimeters to accommodate full extension and flexion of the spine. If the dural tube lacks this flexibility, the spinal musculature will reflexively stiffen to protect the spinal cord.

3. Autonomic reflexes will create localized areas of tissue tension at any distance from the spinal cord in seemingly quirky patterns.



CST, VM Inform the Structural Integration Core Search
In the classic 10-session SI recipe, work proceeds, session by session, from surface to center. The CST recipe taught to beginners starts at intermediate depth within the horizontal diaphragms of the body and proceeds deep to the dural core. Advanced CST practitioners may begin on some clients with the dura itself.

It is important to remember that the name craniosacral therapy represents the historical origins of this discipline. Today, craniosacral therapists apply techniques developed in working with the dura to tissues at any depth in any part of the body.

For Jean Pierre Barral, creator of visceral manipulation, the pleura, pericardium, peritoneum and other membranes and ligaments which support the viscera are core. In visceral manipulation, the work usually proceeds from the core out. When the viscera are released, related musculature will automatically release in response. The most effective way to free spinal restrictions is often to work on the connective tissue suspending the viscera. If a visceral structure is tense, associated myofascial structures will tighten to protect it. Specific stretches or other types of release for the visceral support system will result in prompt and lasting release of the myofascia. Here are two examples:


Roots of mysentery.
Structure: The 30 feet of small intestine are anchored by a set of membranes called the mesenteries. All the planes of the mesenteries collect into a line running from the ileocecal valve in the lower right quadrant of the abdomen to the duodeno-jejunal junction in the upper left quadrant of the abdomen.

This line, called the root of the mesentery (see Fig. 5), is anchored to the back wall of the abdomen, crossing the lumbar spine on a diagonal line from upper left to lower right.

Dysfunction: Because of the diagonal attachment of their root, any tension in the mesenteries will rotate the lumbar spine. By this mechanism, either a stomach flu or an emotional experience that ties our guts up in knots can result in lumbar dysfunction and pain.

Long Chains of Visceral Connective Tissue
Structure: Consider this strong and continuous line of connective tissue (see Fig. 6):
a. Body of the sphenoid bone
b. Anterior longitudinal ligament
of the spine
c. The continuous skein of ligament attaching the posterior aspect of the pericardium to the anterior surface of the bodies of all of the vertebrae C4-T4
d. The pericardium
e. Round ligament of the liver
f. The falciform ligament
g. The umbilicus
h. The urachus
i. The anterior bladder support ligaments
j. The wall of the bladder
k. The posterior bladder support ligaments

Dysfunction: Bladder support ligament tension can show up symptomatically as a dowagers hump and/or by way of the brachial plexus as arm pain. Conversely, a whiplash injury affecting the base of the neck can produce pathological changes in bladder function. Because it can also displace and or distort the sphenoid, which contains the pituitary gland, a whiplash can also produce endocrine dysfunction.

The last two examples cited describe mechanical means by which restriction at one area can cause dysfunction in a distant area. Conversely, Structural Integrators and other bodyworkers have long observed how manual therapy in one area can produce change far away in areas without obvious mechanical linkage. A second mechanism for change at a distance is autonomic mediation.

J. Staubesand of the University of Leipzig provided us with groundbreaking research on the structure of connective tissue that describes a physiologic mechanism whereby the autonomic nervous system may refer structural change at any distance in the body.

Staubesand created electron micrographs of sections of human crural fascia. He found this fascia contains smooth muscle cells scattered through it, each with autonomic nervous system innervation. This is intriguing news. Up until now we knew the fascia had some contractility, but did not know how. We eagerly await follow-up studies looking for the same arrangement in other fasciae.

If this arrangement is found in fascia throughout the body, it provides a key to exactly how freeing an organ or the dura frees a muscle. Such release could be quickly mediated through the autonomic nervous system. Recall that smooth muscle cells do not fatigue in the same way striated skeletal muscle does. Given reasonable nutrition, smooth muscle can contract indefinitely. This allows a muscle to stay tense for decades and then release in seconds with appropriate manipulation of dural or visceral tissue. (Note: To view Staubesand's photomicrographs of crural fascia and read an English-language interview with him, see Robert Schleip's Web site at www.somatics.de.)

We do know if an area of the dura or a membrane supporting an organ has reduced elasticity, then associated muscles will tighten, limiting range of motion to protect that membrane from further injury. In CST and VM, we routinely observe that releasing deep restriction will immediately release the associated musculature. Through Staubesand's discovery, we now have a physiological mechanism to describe this referred change.


FIG. 6

Interdisciplinary Integration of the Core Concept
To our core-sleeve model we must add another element. There are actually two cores, the anterior (or visceral) compartment, and the posterior (or dural) compartment. Tensional forces must be balanced within and between these two cores, along with all the other balances mentioned above.
Contrary to the classic SI recipe which proceeds from surface to center, the experience of Structural Integrators who are also trained in CST and VM is that approaching these core compartments first is often the most effective and efficient approach to integrating the human structure with respect to the gravitational field.

However, this does not end the discussion of core and sleeve. There are, after all, more candidates for core. What this writing provides is practical steps toward more effective and efficient Structural Integration.


Methods, an Introduction
Some practitioners of CST and VM will wonder why bring in the SI perspective at all, since, on their own, CST and VM greatly increase order in the body. To answer this question, we must return to gravity. Gravity is a large force we are subject to all the time. One way to appreciate the strength of gravity's force is to weigh yourself, then pick up the scales and hold it against the wall at chest level. Then with your hands on the scale try to push your own body weight. Most people can only push about half their weight. Yet, in standing we balance our weight against gravity with little effort. In CST and VM classrooms, gravity is rarely, if ever, mentioned. Balances are established between tissues in the body, but the body is treated as if it were an open, kinetic chain. The closed kinetic chain balance within the gravitational field is a powerful fact largely (or entirely) overlooked. SI brings in this vitally important perspective on gravitational relationship.


Arcing, a primary CST assessment method, is usually done with the client supine. "Listening" (actually very sophisticated palpation), the primary assessment method of VM, is usually done with the client standing for the posterior compartment and supine for the anterior compartment. From the SI perspective, it is important to do all of these assessments with the client standing. It may also be useful to do them with the client supine or even side-lying, but the standing closed, kinetic chain relationship must be included, otherwise body parts will be related to each other, and not to the earth's gravitational field. In addition to assessing the standing body, it is frequently advisable to work on the standing or sitting client. In his recent book, Cranial Sutures, Analysis, Morphology and Manipulating Strategies, Mark Pick describes compelling reasons for working on the cranium with the client seated.

Visceral listening provides a particularly valuable method to assess balance between the cores. One part of visceral listening is selective inhibition, whereby tissues are induced to temporarily forget their compensations. This allows a pair-wise comparison of bodily restrictions to determine which dysfunction should be manipulated first to produce the greatest positive change for the whole body.

Using listening with inhibition, the cores and the sleeve can be brought into better balance within themselves and between each other. A VM strategy called stacking-a-line-of-tension (SALT) can be employed to bring the level of order even higher. In this paradoxical method, two related areas are manipulated concurrently, one with each hand. Once the two areas are located with listening and selective inhibition, each one is mobility tested in three planes. One hand is placed on each structure. Then each structure is moved into its directions of ease in three planes, until a first barrier is reached. The therapist waits until that barrier is felt to ease. Each structure is again mobility-tested to assess how much its previously poor directions of movement have been improved. The procedure is repeated as necessary. SALT can potentially be used to improve the tonal relationship of any two structures. Applying SALT to the relationship between the two cores, as well as between the cores and the sleeve, leads to great improvement in integration of the structure, particularly if the pre-test and post-test assessment are done with the client standing in the gravitational field.


Perspective
Bringing CST and VM perspectives to Structural Integration might appear to lengthen the session, because there are naturally more things to do. SI practitioners who incorporate one or both of these other perspectives find, however, that with a broader selection of skills, sessions are shorter and require less effort, while producing better results for the client. SI, CST and VM are all descended from early osteopathic manipulation. The reunion of these separate lines of development is a fortuitous marriage of cousins.
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