bodyreading the meridians

BY THOMAS MYERS

74 massage & bodywork march/april 2011

VISUAL ASSESSMENT
OF POSTURAL PATTERNS
What can you do for your
work by looking—really
looking—at your client?
A lot. Ida Rolf said, “Seeing is
touch at a distance,” and you
can use your vision as a way of
pre-feeling into any old dings
in your clients’ frames, any
hitches in their functional “git
along,” and even subtleties of
their psychological approaches
to life. This information can
guide your strategies, shorten
your guesswork, and make
your sessions twice as effective
via the integration of your
unwinding.
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We are going to unfold this
BodyReading approach as a series in
this and subsequent issues, including a
set of practical webinars for developing
these skills. Now, you already have a
lifetime’s experience of making these
visual assessments—you can recognize
a friend from a couple of blocks
away, long before you see his or her
face, just by the movement pattern,
can’t you? Sure you can, so it’s just a
matter of putting your native visual-
kinesthetic skills to work for you.
But we need to put a strong logical
foundation under those intuitive
skills, so let’s get serious for a bit.
Many forms of structurally oriented
manipulation, including the method
of Structural Integration put forward
by Dr. Ida Rolf or our version, Kinesis
Myofascial Integration or KMI (www.
anatomytrains.com/kmi), use an
analysis of standing posture or gait as a
guide in forming a treatment strategy.
Chiropractors, physiotherapists, soft-
tissue practitioners, and movement
educators such as Alexander, yoga,
and Pilates teachers have used various
grids, plumb lines, and charts to help
assess the symmetry and alignment
of the client (Image 1, page 77).1
Our approach favors the inter-
relationships within the person’s
body, rather than his or her relation
to anyone else or a platonic ideal like
a line or a grid. For this reason, the
photographs we use are devoid of such
outside reference, except, of course,
the line of gravity as represented
in the orientation of the picture.
GLOBAL POSTURAL
ASSESSMENT
An easy upright alignment within the
strong and shadowless gravitational
field of the earth is inescapably a
benefit to health. The advisability,
however, of compelling left/right
symmetry or even a straight posture
on a client is far more dubious.
Alignment and balance are dynamic
and adaptive, not static and fixed.
The goal in making such an analysis
is to understand the pattern, or story
if you will, inherent in each person’s
musculoskeletal arrangement—insofar
as such a task is possible using any
analytical method. Using what we
show you here merely to identify
postural faults will severely limit your
thinking, the client’s empowerment,
and the longevity of the results.
Once the pattern of relationships
is grasped, use any treatment method
available to resolve or unwind the entire
pattern. The idea is to assist the client
in the process of “growing out of the
pattern,” not to impose symmetry or a
particular ideal. As people resolve these
patterns, they more closely approach a
natural balance, which amounts—with
allowance for different muscle fiber
types and fascial densities—to an
evenness of tone throughout the entire
myofascial system. Accompanying this
even tone comes anecdotal evidence
of increased length, ease, generosity
of movement, and adaptability in both
somatic and psychosomatic terms.
BODYREADING THE MERIDIANS
Here, we offer a leg-up to the
five-step method of structural
analysis we use in the KMI Structural
Integration school, in hopes that it will
aid in forming your own successful
strategies, whatever your modality.
This system is designed to be simple,
consistent, nonjudgmental, and easy
to learn (though practice does help).
The five steps are 1.) a description
of the skeletal geometry, 2.) an
assessment of the soft tissues creating
or maintaining that position, 3.) the
development of an integrating story
that accounts for as much of the overall
pattern as possible, 4.) the development
of a short- and long-term strategy to
help resolve the undesirable elements
of the pattern, and 5.) evaluation and
revision of the strategy in the light of
observed results and palpatory findings.
Only the first step—a map of
skeletal positioning—will occupy us
for this article.2 In subsequent articles
and webinars, we will apply the second
and third step, using the Anatomy
Trains Myofascial Meridians as a map
to soft-tissue patterning around these
skeletal imbalances.3 Steps 4 and 5 are
method-specific and are taught in our
classes, or via our self-study videos.
A POSITIONAL VOCABULARY
FOR THE SKELETON
In order to define the position of the
skeleton in space, let us use a simple,
intuitive, but unambiguous language,
which has the advantage of making
sense to (and thus empowering) clients,
students, and patients, while being
capable of bearing the load of sufficient
detail to satisfy the most exacting
practitioner. It has the disadvantage of
not conforming to standard medical
terminology, (e.g., protraction, varus
and valgus knee, or a pronated foot),
76 massage & bodywork march/april 2011
but, since these terms are often used in
contradictory or imprecise ways, this
disadvantage may prove an advantage.
Our terms describe the relationship
of one bony portion of the body to
another, or occasionally to the gravity
line, horizontal, or some other specified
outside reference. The four terms
employed are: tilt, bend, rotate, and
shift. These terms are modified with
the standard positional adjectives:
anterior, posterior, left, right, superior,
inferior, medial, and lateral. These
modifiers refer to the top or the front
of the named structure. In other words,
in a left tilt of the head, the top of the
head would point to the left. In a left
rotation of the rib cage relative to the
pelvis, the sternum would point more
left than the pubic symphysis (while
the thoracic spinous processes might
have moved to the right in the back).
This use of modifiers is, of course,
an arbitrary convention, but one that
makes intuitive sense. Right and left
always refer to the client’s right and left.
One strong advantage of this
terminology is that these terms can
be applied in a quick, overall sketch
description of the posture’s major
features, or used very precisely to
tease out complex spinal, intra-
pelvic, shoulder girdle, or intertarsal
relationships. For this article, we are
going to stick to the more obvious
and visible problems; the more
complex relationships are best taught
in a class. We have included a few
diagrams, but we strongly recommend
that you learn the terms and test
the patterns by putting your own
body into the suggested positions.
COMPARED TO WHAT?
Because the terms are mostly employed
without reference to an outside
grid or ideal, it is very important to
clarify exactly which two structures
are being compared. To look at one
common example that leads to much
misunderstanding, what do we mean by
“anterior tilt of the pelvis”? Imagining
that we share a common understanding
of what constitutes an anterior tilted
pelvis (and there is really not a shared
definition for pelvic neutral), we are still
open to confusion unless the question,
“Compared to what?” is answered. If
we consistently compare the tilt of
the pelvis to the horizontal line of the
floor, for instance, this reading will not
lead us to useful treatment protocols of
femur-to-pelvis myofasciae since these
tissues relate the pelvis to the femur,
not the ground. Since the femur can
also be commonly anteriorly tilted, the
pelvis can easily be anteriorly tilted
compared to the ground, while at the
same time being posteriorly tilted
compared to the femur. Or, a pelvis can
be posteriorly tilted when compared to
the femur, but anteriorly tilted when
compared to the rib cage (see Image
1C). Both descriptions are accurate as
long as the point of reference is agreed.
To create this common pattern,
let your pelvis shift forward over your
toes, but scrunch your butt muscles to
posteriorly tilt the pelvis and lean your
chest back a bit over your heels. Look
at yourself sideways in the mirror. Your
pelvis may look anterior tilted, but it is
really those posterior tilters—the deep
lateral rotators—that need a break.
Let’s define the terms and then put
them to use:
Tilt. This describes simple deviations
from vertical or horizontal, in other
words, a body part or skeletal element
that is higher on one side than another.
Tilt is modified by the direction to
which the top of the structure aims.
Thus, in a left tilt of the pelvic girdle,
the client’s right hip bone would be
higher than the left, and the top of
the pelvis would lean to the client’s
left (Image 2). An anterior tilt of
the pelvic girdle would involve the
pubic bone going down relative to
the posterior spines. In a posterior
tilt of the head, the eyes look up,
the back of the head approaches the
spinous processes of the neck, and the
top of the head points posteriorly.
Tilt is commonly applied to the
head, shoulder girdle, rib cage, pelvis,
and tarsum of the feet. Tilt can be used
for a broad sketch of the client’s pattern,
such as “a right tilt of the ribs relative
to gravity” or “a medially tilted foot”
(instead of a pronated foot). But this
language will also support very specific
intersegmental analysis: “an anterior tilt
of the left scapula relative to the right,”
“a posterior tilt of the left inominate
bone relative to the sacrum,” “a right
rotation of T11 on T12,” or “a medial
tilt of the navicular on the talus.”
Once again, for clarity in
communication and accuracy in A
translating this language into soft-
tissue strategy, it is very important to
understand to what the term being
used is related. An “anterior pelvic Some find grids very useful
tilt relative to the femur” is a useful to assess posture (A).
observation: a simple “anterior pelvic ©1998 David Kent.
tilt” opens the door to confusion. All Rights Reserved
It has taken a number of words www.kenthealth.com.
to formally describe a tilt—but
it is a simple concept, and easily Here we choose to emphasize the
understood on a common level. intra-skeletal relationships. This
woman (B), who is strong and fit (a
Bend. This refers to a series of tilts martial arts instructor), is revealed
resulting in a curve, usually applied as weak and out of alignment (C)
to the spine, but occasionally also when we orient her body so that
applicable to the legs. If the lumbar the rib cage is in alignment with
spine is side-bent, this could be gravity. From her rib cage’s point of
described as a series of tilts between view, you can see how far forward
each of the lumbar vertebrae, which her head is and how retracted
we usually summarize as a bend, her pelvis is in comparison.
which can, like a tilt, be to either left Photo courtesy of the author.
or right side, forward, or back. Image
2A has a right bend of the lumbar

B C

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BODYREADING THE MERIDIANS
Tilts occur when the horizontality of a body
segment is disturbed, causing an anterior,
posterior, left, or right tilt. A shows a left tilt of
the pelvis with a right tilt of the thorax on top.
B shows an anterior tilt of the pelvis and neck,
and a posterior tilt of the rib cage and head.
C has an anterior tilt of the leg, and the pelvis
is in posterior tilt relative to the femur, even
though it is in anterior tilt compared to the floor.
All rotations take place in the horizontal
plane around a vertical axis. Experiment with
the simple single twist in (B) to see how many
muscles are involved.
78 massage & bodywork march/april 2011
spine; Image 2B has a posterior bend
of both lumbar and cervical areas.
The normal lumbar curve thus has a
posterior bend, and the normal thoracic
spine an anterior bend. A lordotic
spine could be generally described as a
“strong posterior bend in the lumbars,”
or could be specified in more detail:
“the lumbars are strongly posteriorly
bent from L5–S1 to about L3, but show
an anterior bend from L3 to T12.”
This kind of observation allows
a grounded logic to apply to our
assessments. If we see the rib cage tilted
off to the left, we can presume that
either 1. the pelvis is likewise left-tilted,
or 2. the lumbar spine has a left side
bend. Further, spinal mechanics dictates
that the left bend in the lumbars very
Postural shifts mean that the center of gravity
likely involves a right rotation of some
of one part is out of true with the center of
of those vertebrae involved. Et voilà,
gravity of another part. Here we see right-
we have a strategy for undoing the
left shifts, as well as anterior-posterior shifts.
pattern: the left psoas and quadratus
Occasionally there are superior or inferior
lumborum are going to figure high
shifts. Underlying the shifts are tilts, bends,
on our list of keys to the solution.
and rotations that must be teased out.
But that’s jumping into step 2;
let’s continue with our definitions.
situation is quite common, as most
Rotation. In standing posture, rotations
people have rotations in their spine,
occur around a vertical axis in the
but most people still prefer their eyes
horizontal plane, and thus often apply
going in the same direction as their
to the femur, tibia, pelvis, spine, head,
feet—so rotations often come in twos.
humerus, or rib cage. In singular
In paired structures like the arms
structures, such as the rib cage or spine,
and legs, we use medial or lateral
the rotation is named for the direction
rotation. While this is in common
in which the front of the named
use in regard to femoral or humeral
structure is pointing. For instance, in a
rotation (in other words, a medially
left rotation of the head (relative to the
rotated femur is, in our language,
rib cage), the nose or chin would face
exactly what you think it is), we extend
to the left of the sternum (Image 3A).
this vocabulary to all structures.
Notice that, if the rib cage were
What physiotherapists commonly
left rotated relative to the pelvis, the
call a “protracted” scapula would,
head could be right rotated relative to
in our vocabulary, involve various
the rib cage and still be neutral relative
amounts of lateral shift, anterior tilt,
to the pelvis or feet (Image 3B). This
and medial rotation—thus “protracted”
is simply not an exact enough term
on which you can build an effective
soft-tissue strategy. The amount of
medial rotation—in other words,
how much are the points of the
shoulders pulled toward each other
in the front—will dictate where we
or two minutes to perform and note
down what you see. Of course, more
Everyone
might look for a soft-tissue solution. usual language such as “fallen arches”
or “pronated feet” can be used when has a story,
Shift. This broader, but still useful they meet the needs of the moment,
term for displacements of one center-
of-gravity relative to another: right-left,
but reversion to this BodyReading
terminology can be used for argument
and without
anterior-posterior, or superior-inferior
(Image 4). Shifts may or may not
or simple accuracy to resolve ambiguity.
Once the skeletal geometry of the
doubt the most
involve a tilt. Balinese dance involves
a lot of pure head shifting—side-to-
client’s standing, resting posture has
been described to the satisfaction of interesting and
side movement while the eyes stay the practitioner—and we are going
horizontal. “A right shift of the head
over the rib cage” means that the
to practice this for the rest of this
article—we would proceed to step 2.
accomplished
center of gravity of the head is to
the right of the center of gravity of
Step 2 is to see how those skeletal
relationships might have been created
people with
the ribs. “A posterior shift of the rib
cage relative to the pelvis” means that
or are being maintained by shortness
in the soft tissue. Individual muscle whom I have
the rib cage has dropped back over shortness might be responsible, or
the pelvis (and thus more weight is
directed down through the sacroiliac
feel free to use some other way of
analyzing the soft-tissue patterning.
had the
joints)—a pattern commonly seen in the
models that grace the fashion pages.
The Anatomy Trains Myofascial
Meridians represent one such model
pleasure and
Shifts of the rib cage or pelvis,
of course, can commonly involve
(one we are prejudiced toward and
will be using in subsequent articles challenge to
tilts, bends, and most often rotations and the webinars) but other available
of individual vertebrae as well. We
can use our terminology to specify
models could be employed as well.4 If
you can see the skeleton clearly in the
work have
these particular relationships when
called for, but we have found that
body, you also can make up your own
soft-tissue strategies and apply them.
had strongly
“left shifted rib cage” or “the head
is shifted to the right relative to the
It is very important to note here
that there is no virtue involved in asymmetrical,
pelvis” to be a useful shorthand. having a symmetrical, balanced
The mobile scapula is commonly
shifted in any of the six modifying
structure. Everyone has a story, and
without doubt the most interesting
unbalanced
directions. The pelvis is commonly
described as being anteriorly or
and accomplished people with
whom I have had the pleasure and
structures.
posteriorly shifted relative to the challenge to work have had strongly
ankles, with the understanding asymmetrical, unbalanced structures.
that some tilts must occur along
the way for that to happen.
The BodyReading 101 DVD self-study
PUTTING IT TO USE course is available at www.anatomytrains.com
This intuitive terminology requires
only two or so hours of practice to
for those who want more examples to study.
manage, and only a couple of weeks An analysis is included.
of regular use of the notation for
reasonable facility with the process.
In practice, it becomes a matter of one

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While this man is very muscular and shows signs
of lots of enthusiasm, his chest has an anterior
shift relative to his pelvis, and his head a further
anterior shift relative to the ribs. He cannot
maintain such a posture without a good deal of
standing tonus in his back muscles. The arrow
shows a line of pull in the underlying fascia
between pubic bone and the mastoid process.
Again, a strong and upright individual, but with some
real structural anomalies. His legs have an anterior
tilt that leave his pelvis anteriorly shifted relative
to his feet. The rib cage tilts posteriorly (making a
posterior bend in the lumbars), the neck anteriorly,
and the head posteriorly. This Jacob’s ladder of
alternating tilts creates a balance of a sort, but not
an ideal one, as so much shortening is involved.
This well-toned young woman nevertheless shows
some interesting challenges. Her ribs and head
are right shifted relative to her pelvis, due to the
right tilt of the pelvis, which is in turn resting on
a functionally shorter right leg. There is a left
bend in her thoracolumbar spine at the level of
the braline. Like your children, postural segments
often yell, “It’s not my fault!” To really resolve
the recurrent pain in this woman’s left shoulder,
you would need to untwist her right leg.
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BODYREADING THE MERIDIANS
In contrast, some people with naturally
balanced structures face few internal
contradictions, and as a result can
be a bit bland and less involved.
Assisting someone with a strongly
challenged structure out of his or
her pattern toward a more balanced
pattern does not make them less
interesting, though perhaps it will allow
them to be more peaceful or a better
performer or less neurotic or to carry
less pain. Just, at this juncture, let us
be clear that we are not assigning any
ultimate moral advantage to being
straight and balanced. Each person’s
story, with so many factors involved,
has to unfold and resolve, unfold and
resolve, again and again over the arc
of a life. It is our privilege as manual
therapists to be present for, and
midwives to, the birth of additional
meaning within the individual’s story.
In practice, a couple of steps precede
the skeletal analysis. First, take note
of your initial impression when you
first cast your eyes on your client. You
have a lifetime of first impressions in
your experience box, and this is an
important moment.5 Notice what you
notice—it will come in handy later.
Secondly, don’t just look for the
faults, but take note of the strengths
your clients bring to the process as
well. I assure you, many more things
are going right than are going wrong.
Are they well-toned, basically right-
left symmetrical, or have a twinkly
attitude? Great. Take note of the
advantages they bring, as well as the
problems. These are resources clients
bring, and aspects you can employ to
help. At the very least, it tells you the
good parts that don’t need work.
And finally, a note on method:
when you first start this, it is easiest
for you to see when standing in front
of semi-clothed clients and having
them turn to show you their front,
 TUNE IN FOR FREE ABMP WEBINARS WITH THOMAS MYERS
WHEN HE’LL EXPLORE HIS BODYREADING THE MERIDIANS
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The best way to build these skills is

to practice on your clients or friends,
via looking at them or through photos if
you take client photos for your records.
In developing this talent, go for the
obvious anomalies; if you have to get
out your micrometer to measure the
differences between one hip and the
other, it probably is not a significant
functional problem, so let it be.
Next time, we will include
some refinements to these basic
skills, and start taking our analysis
into the soft-tissues.

Thomas Myers is the founder of Anatomy

Trains. He studied with Drs. Ida Rolf,
Moshe Feldenkrais, and Buckminster Fuller,
and has practiced integrative bodywork
for more than 30 years in Europe, the
This young woman has obviously trained her core to be strong, and has good tone throughout,
United Kingdom, and the United States.
but the right tilt of the shoulder girdle and the left tilt of the pelvis tell a different story of
He incorporates many movement and
structural imbalance and insecurity. Such tilts and bends are often the handmaidens of rotations,
manual disciplines in his work. For more
which we can see in her right lower leg (A). The real rotational story, however, is seen when
information, visit www.anatomytrains.com.
we look down on the body (B), where we can clearly see the right rotation of the pelvis on the
feet, the left rotation of the ribs on the pelvis, and a right rotation of the shoulders on the ribs.
NOTES
1. Judith Aston, Aston Postural Assessment Workbook
(San Antonio: Therapy Skill Builders, 1998). W.H.
sides, and back. But understand that “Can you see one shoulder is higher Sheldon, The Varieties of Human Physique (New York,
this can be very confrontational, than the other?” and let that guide New York: Harper & Brothers Publishers, 1940). Stanley
Keleman, Emotional Anatomy (Berkeley, California:
especially in this culture where we are you into the other details. Most clients
Center Press, 1985). R.M. Alexander, The Human
judged and found wanting if we don’t start by being reluctant to look at Machine (New York: Columbia University Press, 1992).
measure up to the cover of Allure or themselves, and they have a long list
2. M. Morrison, “Structural Vocabulary,”
Men’s Health (and none of us do). of things they don’t like, but many get Rolf Lines (Winter 2001).
You can take the sting out of this fascinated when they start seeing these
3. Thomas Myers, Anatomy Trains (Edinburgh,
process—and turn it into an involving structural asymmetries, especially if United Kingdom: Elsevier, 2009). This book
piece of client education—by standing they are introduced to them with the also contains an expanded version of this
them in front of a full-length mirror. nonjudgmental language we have just method with a number of examples.
Stand behind and to the side of clients, set out. 4. J. Sultan, “Toward a Structural Logic—The Internal-
so you can see their image in the Let’s practice the basic assessment External Model” Notes on Structural Integration
mirror, as well as seeing them. Right vocabulary on some real people: 86:12–18, 1986. (Available from Dr. Hans Flury,
Badenerstr 21, 8004 Zurich CH). Stanley Keleman,
away, you are on their side, and you are (You can cover the analysis below
Emotional Anatomy (Berkeley: Center Press, 1985).
both looking in the same direction, at each picture with your hand to Judith Aston, Aston Postural Assessment Workbook
that person in the mirror. This makes see what you see before you read (San Antonio: Therapy Skill Builders, 1998). Leopold
it much easier for you both right away. what we have written. These analyses Busquet, Les Chaines Musculaire, Tome 1–1V;
Gently lead clients through their only point out a few of the more Freres, Mairlot, Maitres et Cles de la posture. 1992.
strengths first, “See how open your obvious patterns in each photo.) 5. Malcolm Gladwell, Blink: The Power of Thinking
chest is,” or “You feel very grounded.” Without Thinking (New York: Back Bay Books, 2007).
Then you can guide them into some
of the aspects you hope to correct:

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