Arm and Shoulder

COMPETENCY SHEET FOR SEITAI MODULE 6 – THE UPPER EXTREMITY
Student Tutor
1. Prerequisites for Module 6

Student has shown knowledge of the bones and joints of
the arm and shoulder
2. Location of anatomy
Student is shown how to locate and palpate the following
bones:
Phalanges and metacarpals
-
Carpals -
Ulna and Radius
-
Clavicle -
Scapula -
3. Pleural Dome Ligaments

Student has been shown the location of the pleural dome
ligaments
Student is able to test the function of:
Transverse pleural ligament
-
Costo-pleural ligament
-
Pleuro-vertebral ligament -
4. Integrated Assessment of the Upper Extremity

Student is shown how to perform the following techniques:
Review of muscle tests
-
Asymmetry, range and texture
-
Subclavius test -
Clavicle assessment -
© Amatsu Association Ireland (AAI) and Amatsu Therapy Association (ATA), April 2006 1
Pleural dome assessments
-
5. Correction of the Upper Extremity

Student is shown how to:
Load and engage the foot to engage the spine
-
“Walking” up the arm whilst holding the stack
-
Use of kyushu at the thumb
-
Use of kyushu at the 1st rib -
1 rib release
st -
3 rib release and its importance in lymphatic drainage
rd
-
Bicipital groove
-
6. Distal Effects of Upper Extremity Protocol

Student understands the distal effects as a result of
balancing the arm and shoulder
Student understands the need to check the following
before and after the balance:
Fossae -
Gaits -
Pitch, Roll and Yaw -
7. Distal Effects of Spine and Rib Protocol

Student understands the distal effects as a result of
balancing the Spine and Ribs
Student understands the need to check the following
before and after the balance:
Fossae -
Gaits -
Pitch, Roll and Yaw -
SEITAI
MODULE SIX
THE UPPER EXTREMITY
CONTENTS
CONTENTS....................................................................................................................................... 4
THE UPPER EXTREMITY AND THE SHOULDER ....................................................................... 7
THE SHOULDER.................................................................................................................................... 7
Bones and Joints.............................................................................................................................. 8
Ligaments and Tendons................................................................................................................ 9
Muscles .............................................................................................................................................. 12
Nerve.................................................................................................................................................. 12
Blood Vessels .................................................................................................................................. 13
Bursae................................................................................................................................................ 13
ELBOW ANATOMY.............................................................................................................................. 14
Bones and Joints............................................................................................................................ 16
Ligaments and Tendons.............................................................................................................. 16
Muscles .............................................................................................................................................. 18
Nerves................................................................................................................................................ 19
Blood Vessels .................................................................................................................................. 20
HAND ANATOMY ................................................................................................................................ 20
Bones and Joints............................................................................................................................ 20
Wrist ligaments .............................................................................................................................. 21
Nerves................................................................................................................................................ 22
Blood Vessels .................................................................................................................................. 24
CONDITIONS OF THE SHOULDER ........................................................................................... 25
Impingement Syndromes........................................................................................................... 25
Rotator Cuff Tears......................................................................................................................... 25
Frozen Shoulder............................................................................................................................. 25
Osteoarthritis of the acromio-clavicular joint..................................................................... 26
Osteoarthritis of the gleno-humeral joint ............................................................................ 26
Rheumatoid Arthritis of the Shoulder.................................................................................... 26
Dislocation........................................................................................................................................ 27
Postural Conditions....................................................................................................................... 27
Cautions ............................................................................................................................................ 28
CONDITIONS OF THE ELBOW .................................................................................................. 28
Tennis Elbow ................................................................................................................................... 29
Golfer’s Elbow ................................................................................................................................. 29
Cubitus Varus or Valgus ............................................................................................................. 29
Ulna Neuritis.................................................................................................................................... 30
Olecranon Bursitis ......................................................................................................................... 30
Pulled Elbow .................................................................................................................................... 30
Osteoarthritis .................................................................................................................................. 30
Rheumatoid Arthritis .................................................................................................................... 30
CONDITIONS OF THE WRIST ................................................................................................... 32
Colles’ Fracture............................................................................................................................... 32
Ganglions.......................................................................................................................................... 33
Osteoarthritis .................................................................................................................................. 33
Rheumatoid Arthritis .................................................................................................................... 33
Carpal Tunnel.................................................................................................................................. 33
Ulna Carpal Tunnel ....................................................................................................................... 34
Summary .......................................................................................................................................... 34
A BIO-TENSEGRITY MODEL ...................................................................................................... 35
THE FIRST RIB ............................................................................................................................. 37
Assessment of First Rib............................................................................................................... 37
Correction of the First Rib.......................................................................................................... 37
THE THUMB................................................................................................................................... 38
Assessment of the thumb .......................................................................................................... 39
Correction of the thumb ............................................................................................................. 39
HAND-HOLDS FOR CORRECTING THE SHOULDER ............................................................. 42
Shoulder............................................................................................................................................ 42
Scapula.............................................................................................................................................. 43
Sterno-Clavicular Joint ................................................................................................................ 44
ENERGY BASICS .......................................................................................................................... 46
THE MERIDIANS................................................................................................................................. 46
THE AURA ............................................................................................................................................. 46
THE CHAKRAS..................................................................................................................................... 47
MERIDIANS OF THE BODY ............................................................................................................. 48
Conception Vessel ......................................................................................................................... 48
Governing Vessel........................................................................................................................... 49
Stomach Meridian ......................................................................................................................... 49
Spleen Meridian ............................................................................................................................. 50
Heart Meridian ................................................................................................................................ 52
Small Intestine Meridian............................................................................................................. 52
Bladder Meridian............................................................................................................................ 53
Kidney Meridian ............................................................................................................................. 54
Circulation Sex/Pericardium...................................................................................................... 55
Triple Warmer ................................................................................................................................. 57
Gall Bladder Meridian................................................................................................................... 59
Liver Meridian ................................................................................................................................. 61
Lung Meridian ................................................................................................................................. 62
Large Intestine Meridian............................................................................................................. 64
BIBLIOGRAPHY AND REFERENCES ......................................................................................... 65
THE UPPER EXTREMITY AND THE SHOULDER
THE SHOULDER
The shoulder is a very complex joint. It has many actions and articulations
within its structure. It is vital that each part is working well because the
shoulder affects every other part of the body significantly. The obvious
connections are into the head, neck, upper extremity and the whole of the
back. Postural changes have dramatic effects on the whole of the Godai.
Because of the complexity of the articulations and muscle structure, injuries
can be very persistent, complex and tend to cause whole body problems.
The shoulder can cause dramatic changes to the cranial system because
of the direct link of the trapeziums muscle to the occiput, mastoid process
and the TMJ.
The shoulder is an elegant piece of machinery. It has the greatest range of

motion of any joint in the body. However, this large range of motion can
lead to joint problems. Understanding how the different layers of the
shoulder are built and connected helps the understanding of how the
shoulder works, how it can be injured, and how challenging recovery can
be when the shoulder is injured.
SHOULDER ANATOMY
Bones and Joints
The bones of the shoulder are the humerus (the upper arm bone), the
scapula (the shoulder blade), and the clavicle (the collar bone). The roof
of the shoulder is formed by a part of the scapula called the acromion.
There are actually four joints that make up the shoulder. The main shoulder
joint, called the gleno-humeral joint, is formed where the ball of the
humerus fits into a shallow socket on the scapula. This shallow socket is
called the glenoid cavity.
The acromio-clavicular (AC) joint is formed where the clavicle meets the
acromion. The sterno-clavicular (SC) joint supports the connection of the
arms and shoulders (clavicle) to the main skeleton on the front of the chest
(sternum). A false joint is formed where the shoulder blade glides against
the thorax (the rib cage). This joint, called the scapulo-thoracic joint, is
important because it requires that the muscles surrounding the shoulder
blade work together to keep the socket lined up during shoulder
movements.
Articular cartilage is the material that covers the ends of the bones of any
joint. Articular cartilage is about one-quarter of an inch thick in most large,
weight-bearing joints. It is a bit thinner in joints such as the shoulder, which
don't normally support weight. Articular cartilage is white and shiny and has
a rubbery consistency. It is slippery, which allows the joint surfaces to slide
against one another without causing any damage. The function of articular
cartilage is to absorb shock and provide an extremely smooth surface to
make motion easier. Articular cartilage exists where two bony surfaces
move against one another, or articulate. In the shoulder, articular cartilage
covers the end of the humerus and the glenoid cavity.
Ligaments and Tendons
There are several important ligaments in the shoulder. Ligaments are soft
tissue structures that connect bones to bones. A joint capsule is a
watertight sac that surrounds a joint. In the shoulder, the joint capsule is
formed by a group of ligaments that connect the humerus to the glenoid
cavity. These ligaments are the main source of stability for the shoulder.
They help hold the shoulder in place and keep it from dislocating.
Coracoacromi
al ligament
Trapezoid
ligament
Conoid Ligament
Acromioclavicular
Ligament
Conoid Ligament
Trapezoid
Ligament
Coraco-humeral
ligament
Gleno-humeral
ligament
The acromio-clavicular ligament attaches the clavicle to the acromion in

the AC joint. Two ligaments, the conoid and the trapezoid ligaments,
connect the clavicle to the scapula by attaching to the coracoid process,
a bony knob that sticks out of the scapula in the front of the shoulder.
Together these form the coraco-clavicular ligament.
A special type of ligament forms a unique structure inside the shoulder

called the labrum. The labrum is attached almost completely around the
edge of the glenoid cavity, like a ring. When viewed in cross section, the
labrum is wedge-shaped. The shape and the way the labrum is attached
create a deeper cup for the ball of the humerus to fit into. This is important
because the glenoid cavity is so flat and shallow that the ball of the
humerus can not fit tightly into it without the presence of the labrum.
The labrum is also where the biceps tendon attaches to the glenoid cavity.
Tendons are much like ligaments, except that tendons attach muscles to
bones. Muscles move the bones by pulling on the tendons. The biceps
tendon runs from the biceps muscle, across the front of the shoulder, to the
glenoid cavity. At the very top of the glenoid cavity, the biceps tendon
attaches to the bone and actually becomes part of the labrum. This
connection can be a source of problems when the biceps tendon is
damaged and pulls away from its attachment to the glenoid.
The tendons of the rotator cuff are the next layer in the shoulder joint. Four
rotator cuff tendons connect the deepest layer of muscles to the humerus.
Muscles
The rotator cuff tendons attach to the deep rotator cuff muscles. This group
of muscles lies just outside the shoulder joint. These muscles help abduct the
arm and rotate the shoulder in many directions. They are involved in many
day-to-day activities. The rotator cuff muscles and tendons also help keep
the shoulder joint stable by holding the humeral head in the glenoid cavity.
The rotator cuff comprises the following four muscles:
o Supraspinatus
o Infraspinatus
o Teres Minor
o Subscapularis
The large deltoid muscle is the most superficial layer of shoulder muscle. The
deltoid is the largest, strongest muscle of the shoulder. The deltoid muscle
takes over lifting the arm once the arm is away from the side. The
supraspinatus muscle initiates this action but is not strong enough to sustain
full abduction. .
Nerves
All the nerves that travel down the arm pass through the axilla (the armpit)
just under the shoulder joint. Three main nerves begin together at the
shoulder: the radial nerve, the ulnar nerve, and the median nerve. These
nerves carry the signals from the brain to the muscles that move the arm.
The nerves also carry signals back to the brain about sensations such as
touch, pain, and temperature.
Blood Vessels
Travelling along with the nerves are the large vessels that supply the arm
with blood. The large axillary artery travels through the axilla. If you place
your hand in your armpit, you may be able to feel the pulsating of this large
artery. The axillary artery has many smaller branches that supply blood to
different parts of the shoulder. The shoulder has a very rich blood supply.
Bursae
Sandwiched between the rotator cuff muscles and the outer layer of large
bulky shoulder muscles are structures known as bursae. Bursae are
everywhere in the body. They are found wherever two body parts move
against one another and there is no joint to reduce the friction between
them. A single bursa is simply a sac between two moving surfaces that
contains a small amount of lubricating fluid.
Think of a bursa like this: If you press your hands together and slide them
against one another, you produce some friction. In fact, when your hands
are cold you may rub them together briskly to create heat from the friction.
Now imagine that you hold in your hands a small plastic sack that contains
a few drops of salad oil. This sack would let your hands glide freely against
each other with less friction.
As you can see, the shoulder is extremely complex, with a design that
provides maximum mobility and range of motion. Besides lifting, the
shoulder joint is also responsible for placing the hand in the right position for
any function. When you realise the many different positions we put our
hands in every day, it is easy to understand how hard daily life can be
when the shoulder isn't working well.
ELBOW ANATOMY
Bones and Joints
The bones of the elbow are the humerus (the upper arm bone), the ulna
(the larger bone of the forearm, on the opposite side of the thumb), and
the radius (the smaller bone of the forearm on the same side as the thumb).
The elbow itself is essentially a hinge joint, meaning it bends and straightens
like a hinge. But there is a second joint where the end of the radius (the
radial head) meets the humerus. This joint is complicated because the
radius has to rotate so that you can turn your hand palm up and palm
down. At the same time, it has to slide against the end of the humerus as
the elbow bends and straightens. The joint is even more complex because
the radius has to slide against the ulna in order to rotate the wrist as well. To
allow these movements, the end of the radius at the elbow is shaped like a
smooth knob with a cup at the end to articulate with the end of the
humerus. The edges are also smooth where it glides against the ulna.
In the elbow, articular cartilage covers the end of the humerus, the end of
the radius, and the end of the ulna.
Ligaments and Tendons
In the elbow, two of the most important ligaments are the medial collateral
ligament and the lateral collateral ligament. The medial collateral is on the
inside edge of the elbow, and the lateral collateral is on the outside edge.
Together these two ligaments connect the humerus to the ulna and keep it
tightly in place as it slides through the groove at the end of the humerus.
These ligaments are the main source of stability for the elbow. They can be
torn when there is an injury or dislocation to the elbow. If they do not heal
correctly the elbow joint can be too loose, and therefore unstable.
There are several important tendons around the elbow. The biceps tendon
attaches the large biceps muscle on the front of the arm to the radius. It
allows the elbow to bend with force (e.g. bend while lifting a weight). You
can feel this tendon crossing the front crease of the elbow when you
tighten the biceps muscle.
The triceps tendon connects the large triceps muscle on the back of the
arm with the ulna. It allows the elbow to straighten with force, such as when
you perform a push-up.
The muscles of the forearm cross the elbow and attach to the humerus. The
outside, or lateral, bump just above the elbow is called the lateral
epicondyle. Most of the muscles that straighten the fingers and wrist all
come together in one tendon to attach to this area. The inside, or medial,
bump just above the elbow is called the medial epicondyle. Most of the
muscles that bend the fingers and wrist all come together in one tendon to
attach to this area. These two tendons are a common location of
tendonitis.
Muscles
The main muscles are the biceps, the triceps, the wrist extensors (attaching
to the lateral epicondyle) and the wrist flexors (attaching to the medial
epicondyle).
Nerves
All of the nerves that travel down the arm cross the elbow. Three main
nerves begin together at the shoulder: the radial nerve, the ulnar nerve,
and the median nerve. These nerves carry signals from the brain to the
muscles that move the arm. The nerves also carry signals back to the brain
about sensations such as touch, pain, and temperature.
Some of the more common problems around the elbow are problems of
the nerves. Each nerve travels through its own tunnel as it crosses the
elbow. Because the elbow must bend a great deal, the nerves must bend
as well. Constant bending and straightening can lead to irritation or
pressure on the nerves within their tunnels and cause problems such as
pain, numbness, and weakness in the arm and hand.
Blood Vessels
Travelling along with the nerves are the large vessels that supply the arm
with blood. The largest artery is the brachial artery that travels across the
front crease of the elbow. If you place your hand in the bend of your
elbow, you may be able to feel the pulsing of this large artery. The brachial
artery splits into two branches just below the elbow: the ulnar artery and
the radial artery that continue into the hand. Damage to the brachial
artery can be very serious because it is the only blood supply to the hand.
HAND ANATOMY
The hand needs to be mobile in order to

position the fingers and thumb. The muscles in
the hand must be co-ordinated to perform
fine motor skills with precision. The structures
that form and move the hand require proper
alignment and control in order to produce
normal hand function.
Bones and Joints
There are 27 bones in the wrist and hand. The

wrist itself contains eight small bones, called
carpals. The carpals join with the two forearm
bones, the radius and ulna, forming the wrist
joint. Further into the palm, the carpals connect
to the metacarpals. There are five metacarpals
forming the palm of the hand. One metacarpal
connects to each finger and thumb. Small bone
shafts called phalanges line up to form each finger and thumb.
The main knuckle joints are formed by the connections of the phalanges to
the metacarpals. These joints are called the metacarpo-phalangeal joints
(MCP joints). The MCP joints work like a hinge when you bend and
straighten your fingers and thumb.
There are 15 bones that form connections from the end of the forearm to
the hand. The wrist itself contains eight small bones, called carpal bones.
These bones are grouped in two rows across the wrist. The proximal row is
where the wrist creases when you bend it. Beginning with the thumb-side of
the wrist, the proximal row of carpal bones is made up of the scaphoid,
lunate, and triquetrum. The second row of carpal bones, called the distal
row, meets the proximal row a little further toward the fingers. The distal row
is made up of the trapezium, trapezoid, capitate, hamate, and pisiform
bones.
Articular cartilage can be up to one-quarter of an inch thick in the large,

weight-bearing joints of the body, such as the hip. It is thinner in joints such
as the wrist that don't support much of weight.
Wrist ligaments
As its name suggests, the ulnar collateral ligament (UCL) is on the ulnar side
of the wrist. It crosses the ulnar edge (the side away from the thumb) of the
wrist. It starts at the ulnar styloid, the small bump on the edge of the wrist
(on the side away from the thumb) where the ulna meets the wrist joint.
There are two parts to the cord-shaped UCL. One part connects to the
pisiform (one of the small carpal bones) and to the transverse carpal
ligament, a thick band of tissue that crosses in front of the wrist. The other
goes to the triquetrum (a small carpal bone near the ulnar side of the wrist).
The UCL adds support to a small disc of cartilage where the ulna meets the
wrist. This structure is called the triangular fibrocartilage complex (TFCC).
The UCL stabilizes the TFCC and keeps the wrist from bending too far to the
side (toward the thumb).
The radial collateral ligament (RCL) is on the thumb side of the wrist. It starts
on the outer edge of the radius on a small bump called the radial styloid. It
connects to the side of the scaphoid, the carpal bone below the thumb.
The RCL prevents the wrist from bending too far to the side (away from the
thumb).
In the PIP joint (the middle joint between the main knuckle and the DIP
joint); the strongest ligament is the volar plate. This ligament connects the
proximal phalanx to the middle phalanx on the palm side of the joint. The
ligament tightens as the joint is straightened and keeps the PIP joint from
bending back too far (hyperextending). Finger deformities can occur when
the volar plate loosens because of disease or injury.
The tendons that allow each finger joint to straighten are called the
extensor tendons. The extensor tendons of the fingers begin as muscles that
arise from the backside of the forearm bones. These muscles travel towards
the hand, where they eventually connect to the extensor tendons before
crossing over the back of the wrist joint. As they travel into the fingers, the
extensor tendons become the extensor hood. The extensor hood flattens
out to cover the top of the finger and sends out branches on each side
that connect to the bones in the middle and end of the finger.
The place where the extensor tendon attaches to the middle phalanx is
called the central slip. When the extensor muscles contract, they tug on the
extensor tendon and straighten the finger. Problems occur when the
central slip is damaged, as can happen with a tear.
Nerves
The radial, median and ulnar nerves travel to the hand cross the wrist.
The radial nerve runs along the thumb-side edge of the forearm. It wraps
around the end of the radius bone toward the back of the hand. It gives
sensation to the back of the hand from the thumb to the third finger. It also
goes to the back of the thumb and just beyond the main knuckle on the
back surface of the ring and middle fingers.
The median nerve travels through a tunnel within the wrist called the carpal
tunnel. The median nerve gives sensation to the palm sides of the thumb,
index finger, long finger, and half of the ring finger. It also sends a nerve
branch to control the thenar muscles of the thumb. The thenar muscles
help move the thumb and allow the pad of the thumb to touch the tips
each of each finger on the same hand, a motion called opposition.
The ulnar nerve travels through a separate tunnel, called Guyon's canal.
This tunnel is formed by two carpal bones (the pisiform and hamate), and
the ligament that connects them. After passing through the canal, the
ulnar nerve branches out to supply feeling to the little finger and half the
ring finger. Branches of this nerve also supply the small muscles in the palm
and the muscle that pulls the thumb toward the palm.
The nerves that travel through the wrist are subject to problems. Constant
bending and straightening of the wrist and fingers can lead to irritation or
pressure on the nerves within their tunnels and cause problems such as
pain, numbness, and weakness in the hand, fingers, and thumb.
Blood Vessels
Travelling along with the nerves are the large vessels that supply the hand
with blood. The largest artery is the radial artery that travels across the front
of the wrist, closest to the thumb. The radial artery is where the pulse is
taken in the wrist. The ulnar artery runs next to the ulnar nerve through
Guyon's canal (mentioned earlier). The ulnar and radial arteries arch
together within the palm of the hand, supplying the front of the hand and
fingers. Other arteries travel across the back of the wrist to supply the back
of the hand and fingers.
CONDITIONS OF THE SHOULDER
The most common cause of pain to the shoulder is cervical Spondylosis.

Pain from nerve root can be referred into the shoulder. The condition can
cause a “chicken and egg” effect with the neck affecting the shoulder
and the shoulder then affecting the neck in return.
Impingement Syndromes
Compression of the shoulder joints may occur during gleno-humeral

movements. This most commonly occurs subacromially, causing a painful
arc of movement between 70-120° abduction. Compression may also
occur in the subacromial joint where there will be pain in the last 30° of
motion. This condition normally occurs either from sporting injuries or in
people with degenerative changes.
Rotator Cuff Tears
This most commonly occurs as a result of trauma. It can also happen as a

result of weakening due to repetitive minor injuries. Most commonly the
supraspinatus is involved giving problems with abduction. On other
occasions the acromion is affected and a painful arc syndrome occurs.
If the condition is not treated it can become very similar to the symptoms of
frozen shoulder. In severe cases, with no treatment, degenerative changes
can occur causing collapse of the bone leading to the need for joint
replacement.
Frozen Shoulder
This condition has many different causes but can be identified by the
general loss of movement in many different planes. Pain is often severe
and causes sleeping problems, especially when the client leans on it during
the night. It is seen more in middle age, often from degeneration of the
rotator cuff. A minor trauma can then set off the condition. It is more
common in the left arm and in diabetics. Fibrotic changes can occur
especially around the coraco-humeral ligament.
It is very easy to over treat this condition causing more pain from over
mobilisation. Often the muscles of the neck and upper back lock the
shoulder and will be under much stress when used in movements of the
gleno-humeral joint. The range of motion can be improved by working out
the inhibitor to the restriction. This can be done using circuit locking. The
Subclavius muscle is often involved, as its function is to lift the clavicle to
allow the full movement of the arm. Kyushu in the subclavicular triangle is
also often useful here.
Osteoarthritis of the acromio-clavicular joint
This presents as pain and restriction of the shoulder with localised

tenderness of the acromion. Lipping of the joint from arthritic changes can
also occur. Gentle mobilisation of the joint can help, but ideally the
tensegrity of the joint should be considered and the inhibitor to the
restriction should be identified by circuit locking. Correction of this allows
the humerus to once again “float” in its joint space and prevents the bones
grinding together.
Osteoarthritis of the gleno-humeral joint
This condition is rare and usually occurs from pathological damage caused
by disease to the joint itself. It can also occur after radiotherapy to the
breast but again this is uncommon.
Rheumatoid Arthritis of the Shoulder
Rheumatoid arthritis is an auto-immune condition and generally affects

several joints at a time. The symptoms are redness, swelling, heat and pain
around the joints with a limited range of motion. Massage to the area is
often contra-indicated as it can cause any inflammation to flare up.
Instead, in Amatsu, we would look for the inhibitors to the restrictions and
reinstate the bio-tensegrity of the joint.
Dislocation
Recurrent dislocation is often seen in the 20-40 years age group. It

generally starts with a trauma that damages the ligaments holding the
shoulder in place. Repeated dislocations can then occur with less and less
trauma involved.
Great care must be taken when working on a client with this condition as
induction of a dislocation can occur quite easily from repatterning. You
may see a client post operatively. Surgery may stop the dislocations but
will often leave them with reduced range of movement or mobility.
Postural Conditions
This is the cause of many problems found by clients. The posture of the
shoulders will have dramatic effects on the whole of the rest of the body.
The link between the back and shoulder is complex, each one affecting
the other. Changes in the curves of the spine will cause the position of the
shoulder girdle to change considerably. These changes can cause
symptoms to occur in the shoulder, the upper back and the neck.
The areas you need to pay attention to are:-

• Pectoral muscles
• Sacrum and lumbar spine mobility
• T6, T12
• Latissimus Dorsi
• Occiput
• Sternocleidomastoid
Any problems in these areas can adversely affect the correction of a

shoulder problem. You may have to do considerable work on these areas
before attempting direct shoulder work. Obviously this works both ways.
Correcting the neck is effectively dependent on a well functioning
shoulder.
Circuit locking, anma and repatterning with a gentle approach are most
useful when treating shoulders. Often it is necessary to work at releasing
the areas affecting the shoulders first, possibly taking several treatments to
do this, before finally reaching the heart of the problem, in the shoulder
itself.
Cautions
Sometimes, when you release the shoulder, the occiput can be affected
by reactive spasm 24-48 hours later. Often this can cause headaches
around the occiput and across the eyes because of the sphenoid and
occiput fixing in flexion. The client will usually say that painkillers had no
effect.
It is difficult to predict when this might happen because on leaving the

clinic the sphenoid may well be in the correct position. The client may
complain of the above symptoms at the next session and treatment will
often resolve the problem. If it occurs again the symptoms will usually be
milder.
CONDITIONS OF THE ELBOW
The elbow is a very close fitting, stable joint, achieved by both a very tight
fit between the ulna and the trochlea and strong collateral ligaments.
Because of the tight nature of the joint, any changes can cause a range of
symptoms including fractures, strains and long term regular overuse, or
repetitive strain.
Strains can be caused by problems with triceps during forced extension or

with biceps during flexion. Pronation and supination can also cause
problems at the elbow, wrist and hand. Pay close attention to the pronator
teres, quadratus lumborum, biceps and supinator muscles.
The interosseous tissue between the radius and the ulna is extremely strong
and will cause large distortion patterns if traumatised by either falls or RSI
problems. When a trauma occurs the line of force must travel somewhere.
When someone attempts to break a fall by putting out their arm, the line of
force usually travels up the arm and can affect each joint the whole way
up to the shoulder, neck and into the head. You must look at the tatara as
a whole.
Tennis Elbow
This is commonly seen in clinic. It is more accurately called lateral

epicondylitis. It is generally thought to be a strain to the common extensor
origin or fibrosis in extensor carpi radialis brevis or even nerve entrapment.
Even on the most common elbow condition the cause is not really known,
so conventional physiotherapy has limited success.
It is vital that the sacrum and latissimus dorsi are checked when presented
with this condition. It is very rare to find a tennis elbow without a latissimus
dorsi weakness. Localised treatment to the elbow will be far more
effective when stability to the pelvis and the shoulder is attained. Often the
clients have had, or have been advised to have steroid injections. This is far
less common now than 5-10 years ago. Although this may treat the
inflammation, the cause may not be corrected; therefore the condition
often repeats itself with little provocation.
Golfer’s Elbow
This is far less common than tennis elbow, and is more correctly called
medial epicondylitis. This is pain and tenderness to the medial elbow and
affects the common flexor tendon.
Cubitus Varus or Valgus
This is when the angle at which the elbow is carried is decreased or

increased. This often occurs because of a fracture at the elbow. When the
fracture has not been corrected properly there may be deterioration to the
joint or there may be palsy of the ulna nerve.
Ulna Neuritis
This condition often causes muscle wasting and sensory impairment in the
hand. It can be because of trauma at the elbow. This may cause too
much mobility of the ulna nerve leading to frictional damage. If the client
is known to have diabetes, please refer them to their GP or diabetic nurse,
as neuritis can be a sign that their diabetes is not well-controlled.
Olecranon Bursitis
This can be caused by repeated trauma to the posterior elbow. It can also
be as a result of rheumatoid arthritis. The swelling is often painless except if
accompanied by an infection.
Pulled Elbow
This occurs when a child under 5 is pulled sharply, possibly by a parent. The
radial head slides out from under the annular ligament. , which usually
holds the radial head against the ulna during pronation and supination.
Pain and loss of supination are often the symptoms. Spontaneous
reduction often occurs within 48 hours, but it is important to remove the
pattern of the torsion from the limb, to prevent problems in later life.
Osteoarthritis
This can occur due to over use or poor positioning of the joint. Often loose
pieces of tissue may break off inside the joint capsule and “lock” the joint.
The client may be able to unlock the joint themselves although this may just
sustain the problem leading to further damage.
Rheumatoid Arthritis
This condition can affect the elbows as well as other joints. Often
supination and pronation is affected with the elbow held in fixed flexion.
CONDITIONS OF THE WRIST
The carpals form complex articulations with each other, the radius, ulna
and the meta-carpals. They are subject to compression, extension and all
directions of motion during the working day. Wrist problems are common.
Wrist function is dependent on how it is supported both physically (from the
shoulder and elbow) and neurologically. ICV dysfunctions often manifest
as wrist problems, due to fluid retention causing compression on the nerves
and structures of the wrist. The anatomical snuff-box, the opponens pollicis
muscle and the area around acupuncture point Large Intestine 4 (the web
between the thumb and forefinger) are often involved in ICV dysfunction.
Identify particular actions of the client that may be contributing to the

client. Take a history of their occupations and hobbies. Activities such as
computer use, sports and lifting and carrying children may all indicate the
underlying cause. Examine all directions of mobility, look for swelling and
any changes in tissue texture. Pay attention to where the client is noticing
pain and where exactly any sensory or motor disturbances are. This will
indicate which nerves are involved and what cervical spine region needs
to be examined.
Colles’ Fracture
A Colles’ fracture occurs at the distal end of the radius. It is the most
common type of all fractures and is usually due to a fall on an outstretched
hand. As a result of the fracture the common problems are deformity,
restriction of movement and pain. The common deformity is the radial
deviation of the hand. The inferior radio-ulna joint is also affected with a
Colles’ fracture leading to pain lateral to the ulna styloid.
Swelling and stiffness of the fingers can occur a few weeks after the
fracture. This is called Sudeck’s atrophy. Carpal decalcification is often a
problem with this condition. Most of these conditions depend on how well
the break has been set as a better repair means a lesser chance of
deformity.
Ganglions
These are very common in the wrist and the hand. They are often
spherical, fluid filled sacs, firm to the touch and have no real connection to
any other underlying structure. They are formed from outgrowths of
synovial membrane lining tendon sheaths. They are filled with synovial fluid
that is unable to return to the joint because the pouch of membrane
becomes cut off from the tendon sheath or joint. They can cause pain and
swelling with some discomfort and loss of use of the wrist. They tend to
dissipate spontaneously, but by finding the inhibitors to the restrictions that
are causing the ganglion, good results can be obtained.
Osteoarthritis
This is relatively rare in the wrist and only tends to occur after necrosis of the
scaphoid after a fracture, or with fractures on the articular surface of the
radius.
Rheumatoid Arthritis
The wrist and hands are a very common site for this condition with synovial
thickening of the joints and tendon sheaths leading to gross swelling and
pain.
Carpal Tunnel
Usually found in women between 30-60 years of age. Normally there is

compression of the medial nerve leading to pain, loss of function and
changes in sensory ability. The client may claim that all the fingers are
involved but the little finger should not be, because it has a different nerve
supply. Paraesthesia (pins and needles) may radiate from the elbow down
and pain can occur here as well. Often symptoms are worse in the early
hours of the morning. It is, on occasions, difficult to differentiate from
conditions caused by neck problems. Cervical spondylosis can cause
similar symptoms so care must be taken when a client says that she has
carpal tunnel. She may or may not have, but it may be caused by lack of
correct nerve and muscle ability in the tension/compression aspect of the
whole body. This condition is often linked with ICV dysfunction due to the
accumulation of fluid in the body, which typically causes compression in
this area and leads to nerve impingement.
Ulna Carpal Tunnel
The ulna nerve can become compressed as it passes through the ulna
tunnel between the pisiform and the hook of hamate. Sensory and/or
motor functions may be affected but it is less common that both are
affected. Muscle wasting and weakness in the hand may occur. Again,
check that the cervical spine has good function to make a differential
diagnosis.
Summary
You must always consider that conditions of the wrist may occur as a result
of trauma to the wrist itself, but it could also occur as part of the tensegrity
pattern of the whole body. Remember that although RSI may be a result of
a particular behaviour, the rest of the body will know the tatara. You must
deal with the tatara and tensegrity of the whole body and not just the local
symptoms.
A BIO-TENSEGRITY MODEL
Amatsu practitioners view the body as a bio-tensegrity model rather than a

classical Newtonian model. According to Levin (1995) by applying
Newtonian laws to natural movement, for example, anterior deltoid
contraction to raise the humerus with a 25Kg weight, the result would be
severe damage to the stabilising back muscles.
25Kg L 1m
This class 1 lever shows that the stresses on the body are very large and if
this model were true it would not work efficiently.
Consider a wagon wheel. It is designed with four spokes and a hub in the
middle; each of the spokes must be rigid and capable of handling the
whole weight of the carriage. When considering a bicycle wheel with wire
spokes the weight is distributed evenly across all members, the shape of the
wheel is maintained by all of the spokes, so the tension is even throughout.
Levin states that tensegrity structures are omni-directional load distributors.
When the bio-tensegrity model is understood, it can be applied to the

whole body. When Levin applied the bicycle wheel in modelling the
shoulder, he considered the hub of the wheel to be the scapula and the
spokes are the muscular attachments around the scapula; the scapula
floats freely with no bony articulations, therefore any forces are transmitted
omni-directionally as in the tensegrity model. The scapula acts as a relay
station from the extremity to the axial skeleton. The shoulder, therefore,
becomes a much more efficient structure as levers become eliminated. It is
important to remember that muscles and ligaments are always under some
tension and this helps maintain the tensegrity structure.
When working, practitioners should always consider the interplay between
themselves and their clients as extremely important, any unnatural forces
applied through Newtonian laws will not fit the bio-tensegrity model of the
body and are therefore unnatural. Any contact made must be in keeping
with the client’s tensegrity. In doing this correctly, you will get a sense of the
whole person. This will allow you to be led to the most influential points for
change. Skin drag will reveal linear pulls which are areas which will need to
be worked upon.
The word tensegrity is a merging of two words: tensional integrity. Structures

that are omni-directional so that the tension elements always function in
tension, no matter what the direction of applied force. If the human frame
can be seen as a bio-tensegrity structure, then any applied force will
register in the whole, as the tensioned elements adjust accordingly. The
combinations of anatomical knowledge and taijutsu will give a predictable
change of forces through the tensegrity of the extremity. To enhance this
skill, a multi contact (often forming a triangle) is useful to get feedback as
the limb is engaged and loaded.
THE FIRST RIB
The first rib can be viewed as a major balance point for the upper
extremity. It plays an important role in drainage at the thoracic inlet. It also
helps unlock the clavicle in shoulder movements and crucial any
restrictions there will affect the head on neck reflexes.
Assessment of First Rib
• Therapy localise the 1st rib.

• Challenge the clavicle, first rib and sternum functionally.
• Palpate the dynamics of the first rib and clavicle by placing the thumb
at the split tendon of the S.C.M and the other fingers take position
at the 1st and second rib, clavicle and acromion process. Do this
on both sides. Use taijutsu to feel the movement potential of the rib
and clavicle.
Correction of the First Rib
Load the structures as detailed above and get a sense of the tensegrity of
the area, then change the shape of your Ningu to facilitate
disengagement at the area of dysfunction. In other words, find the inhibitor
to the restrictions. The inhibitor is often posterior to the clavicle, just above
the first rib. It can be found using skin drag and therapy localisation.
Tension couple and fire the inhibitor by using taijutsu. Consolidate this by
checking the first rib again by therapy localisation, challenging and
palpation.
THE THUMB
When looking at the upper limb you must consider it as a whole. When
looking at any injury, notice what is happening above and below the injury
site. On many occasions, the problem comes from lack of support from the
shoulder. This then is obviously related to the neck and back. Make sure
that there is a stable pelvis, free cervical spine and shoulder before
embarking on localised treatment.
A careful case history must be taken when assessing any condition of the
upper extremity. Often long running repetitive actions cause the
background postural problems that then allow an acute injury to occur.
Commonly this includes computer work, driving and repetitive sports. With
any condition of the upper extremity, look very carefully at the cervical
spine and the cervical plexus. This will allow you to appraise symptoms,
muscle dysfunction and any relationships to the cervical vertebra. Also
consider the Lovett Reactor and check the “brother relationship” in the
lumbar area.
The thumb should be viewed with the same importance as the big toes.
Although not directly used for upright gait; its dexterity allows the hand to
be used with great precision.
The opposition of the thumb with the fingers is the first function to be
examined. The opponens pollicis test gives us a great deal of information,
such as wrist or elbow problems or ICV involvement but more important
than the test is the client’s ability to get the extremity into the position for
the test. Quite often they show some compensation in their movements; this
will not only show you a weakness, but also it will indicate where the
problem might be.
Assessment of the thumb
• Place the index finger in the anatomical snuffbox and the thumb on
the thenar eminence, the other fingers should support the thumb at
its medial aspect leaving the little finger cradling underneath.
Assess the presence of linear pulls.
• Therapy localise the segments of the thumb to ascertain the area of
concern.
• Challenge the thumb by moving it in different vectors, and
incorporating a PIM, to assess if a particular direction is a problem.
• Perform the opponens pollicis muscle test, both palm up, and palm
down.
Correction of the thumb
From the Ningu described above, distract the thumb whilst monitoring any
pulls at the wrist or into the elbow/arm. Find the best position for release by
feeling for inhibitors to any restrictions. Some of the inhibitors will be local,
probably in the anatomical snuff-box, and some will be further up the arm.
Inhibitors are often found in the inter-osseous tissue between the radius and
ulna.
HAND-HOLDS FOR CORRECTING THE SHOULDER
The upper extremity is a much more mobile structure than that of the lower
extremity. Not all the repatterning needs to be done from the thumb. In
fact there are often other kyushu points or inhibitors to the restrictions further
up the arm, shoulder or even into the ribs. These can be monitored by
placing a hand onto one of these areas to feel the release occurring, or to
facilitate the release. The most effective method for correct shoulder
problems is to engage, stack and load as many parts of the upper
extremity as possible. This is performed by engaging each part in turn,
starting with the thumb or fingers, and once engagement has occurred,
“walk” up the arm, by holding the stack in place with one hand, and
feeling for the next part of the stack with the other hand. Use the body to
hold the stack in place, by holding the arm with one’s elbow and chest.
Shoulder
Take the thumb at the anatomical snuff box while monitoring the ball and
socket joint of the shoulder with the other hand. More local corrections
may be performed by monitoring the shoulder with one hand and finding
inhibitors to the restrictions in the area around the scapula with the other
hand.
Scapula
Take the thumb at the anatomical snuff box and engage the stack. Work
up the arm, maintaining the stack, remembering that the scapula is a relay
station, in a similar way to the talus. Placing the fingers around the edge of
the scapula will give access to potential spots which will fire inhibitors. Take
time to load the appropriate points, and fire by using taijutsu.
Sterno-Clavicular Joint
Stack the thumb at the anatomical snuffbox, and work up the arm whilst
maintaining the stack. As with all these techniques, taijutsu and flexibility in
the approach are vital. The inhibitors to any restrictions can be fired from
either of the sterno-clavicular junctions. Circuit locking will show which
inhibitor is key to the release.
ENERGY BASICS
THE MERIDIANS
In simple terms, the meridians are energy pathways that supply our physical
and subtle bodies with vital energy. If the energy flow is disturbed or
disrupted, the result is sickness, disease and ultimately death. It is proposed
that the meridians run beneath the skin; the areas where the meridians
come close to the surface of the skin are referred to as acupuncture points.
Specific meridian pathways are linked to specific muscles in the body and
specific organs although energy also extends into the chakras and the
aura so the above model is over simplistic and can be studied in great
depth. Because of this there is more than one way of accessing and
clearing the energies in the meridians.
In Traditional Chinese Medicine (TCM) there are 12 main meridians that flow
on each side of the body. Up the centre of the front of the body runs the
Central Meridian, and down the centre of the back is the Governing
Meridian which links each side of the 12 meridians.
THE AURA
The aura is a field of subtle energy that penetrates and extends out from
the physical body. It is composed of many layers or levels of vibration. The
layers interpenetrate each other and are said to be composed of different
kinds of consciousness. Each level of the aura is connected to a respective
chakra and has a similar vibration and energy as that chakra. As an
example, the innermost level of the aura, which is very close to the surface
of the body, is connected to the root chakra. This auric field is linked with
physical health and vitality, which is similar to the energy of the root chakra.
The next auric field is connected to the sacral chakra and is a little further
out. The sacral chakra is linked with physical enjoyment and attractiveness.
Each successive level of the aura is connected to the next higher chakra,
has similar energy, and is a little further from the body. The outermost or
seventh layer extends out to four or five feet for the average person.
The overall size of the aura can increase or decrease, depending on the
quality of one’s thoughts and feelings and on the kind of recent
experiences. As an example, if someone has had a bad day, and is feeling
tired and defeated, their aura may recede to only two or three feet from
their body. The auric field may be skewed to one side if someone has been
“knocked sideways” by a shock or trauma. On the other hand, after
receiving healing or an energy therapy, the aura can extend out much
further than normal, sometimes as far as twenty to thirty feet or more.
THE CHAKRAS
The chakras are part of the subtle energy system and play an important
role in health and healing. Blocks and negative energy are sometimes
lodged in the chakras and, if present, need to be released in order for
healing to take place.
The chakras are like subtle energy transformers. They take the Qi that is all
around us and transform it into the various frequencies we need and bring
it into our subtle energy system. They can also be thought of as points
where the soul connects to the physical body.
There are seven basic chakras starting with the root chakra at the base of
the spine, and ending with the crown chakra at the top of the head. The
chakras are responsible for creating the various kinds of consciousness
operating within our energy systems and are also connected to the
complete spectrum of human experience.
1. ROOT CHAKRA: The root chakra is connected to the base of the spine
and points down between the legs toward the ground. Its energy is
involved with our need for food, shelter and the basic necessities of
life.
2. SACRAL CHAKRA: This is connected to the sacrum and its colour is
orange. It is involved with reproduction, sexuality, physical enjoyment
and the attractive aspects of relationships. It is also one of the places
people hide guilt and humiliation.
3. SOLAR PLEXUS CHAKRA: This is connected to the solar plexus area. Its
colour is yellow. It brings in and sends out energy necessary for self-
expression. It is also called the power centre. Confidence, purpose
and will, as well as fear and anger can be located here.
4. HEART CHAKRA: This is connected to the centre of the chest near the
physical heart. Its colour can be green or pink. It is related to love,
joy, respect and surrender. Spiritual guidance and higher
consciousness can also come through the heart chakra.
5. THROAT CHAKRA: The fifth chakra is located at the throat area. Its
colour is sky blue. It is involved in the expression of creativity through
speaking and writing. It is also involved with contemplation, and
some aspects of thinking and planning, and the way we relate to
others.
6. THIRD EYE CHAKRA: This is located between the eyebrows. Its colour is
indigo and it is involved with self-awareness, wisdom, higher
consciousness, clairvoyance, visualization and conceptual thinking.
7. CROWN CHAKRA: This is located at the top of the head and extends
far above the head. Its colour is purple or white. It connects directly
with “the higher power” and spiritual consciousness.
MERIDIANS OF THE BODY
Conception Vessel
This is the vessel through which original energy was thought to enter the
body at conception. It includes the umbilicus which is the obvious point of
entry for such energy.
Muscle Vertebral Fixation Nerve supply Organ

reflex indicator
Supraspinatus C1,2 Emotional C5,6 Brain

problems
Governing Vessel
This vessel passes from the tip of the coccyx to the top lip. It includes
GV20, the very top of the head. This point is known as “the cure of one
hundred diseases”.
Muscle Vertebral Fixation Nerve Organ

reflex indicator supply
Teres T2 Thoracic C5,6,7 Thoraci

major c spine
Stomach Meridian
The stomach has the function of receiving food and separating the
“essence” or chi before it passes on to the spleen. The natural function of
the stomach is to send the chi in a downward direction. If the stomach
function is impaired, there is an upward direction to the symptoms, e.g.
belching, hiccups, regurgitation, nausea and vomiting. It rules descending
action, moving things downward. The stomach is associated with
honouring of self and nurturance. It is paired with the spleen, so its
associated emotion is worry and anxiety.

reflex indicato supply
r
Levator Lungs
scapulae T8, C5 C3,4,5 Parathyroid
s
PMC T5 C5,6,7 Stomach
Neck C2 C1-8 Sinuses

flexors
Neck Sacrum
extensors C2 Iliac C1-8 Sinuses
Biceps C5,6 Stomach
Spleen Meridian
In Oriental medicine, the spleen is seen as the primary organ of digestion

and conversion from food energy to available chi. The spleen and
pancreas meridians run in the same channel. The energy from this channel
is responsible for transforming food into energy and regulating the
maintenance of the body’s blood. The spleen rules ascending
transformation and is associated with high self-esteem and forgiveness. The
pancreas is associated with caring and devotion. The emotion associated
with the spleen is worry, anxiety. Concentration problems are also
associated with this organ.
Healthy spleen Unhealthy spleen

Good appetite Poor digestion
Good digestion Abdominal distension and
diarrhoea
Plenty of energy Fatigue and obesity
Good muscle tone Poor muscle tone and flabby
muscles
Good Poor concentration
concentration
Clarity of thought Muzzy head
No easy bruising Easy bruising
Smooth edge to Scalloped edge of tongue (tooth
tongue marks)

Latissimus
dorsi T7 C6,7,8 Pancreas
Middle
Trapezius T5,6 C2,3,4 Spleen
Lower Thoraco-
Trapezius T6 dorsal C2,3,4 Spleen
Opponens
pollicis C4 C6,7 Stomach
Triceps T1 C6,7,8,T1 Pancreas
Heart Meridian
The heart is associated with controlling blood flow through the vessels of the
body. The yin energy that circulates in the heart channel rules the head
and houses the spirit. It also houses the “Shen”; this represents the myriad of
mental, psychological and spiritual faculties that constitute a central
feature of the human condition. The heart’s function is manifested in the
skin, so a healthy glow means the heart meridian is fine and a dull
complexion shows a deficiency or block in the meridian. Sweating is also
governed by the heart so excess sweating may indicate a problem with
the heart meridian. Impaired functioning of the heart meridian may lead
to cold extremities, abnormal pulse patterns and chest pain. The emotion
associated with the heart is joy.

Subscapular T2 C5,6 Heart

is
Small Intestine Meridian
The small intestine energy channel is responsible for drawing out the energy
contained in food, leaving the remaining matter to be eliminated as waste.
The small intestine separates pure from impure. It allows extraction of chi
under the control of the spleen, after which the impurities are passed to the
large intestine and the bladder. It performs this function with bodily fluids,
so is linked to the heart. Its associated emotion is joy and is associated with
self-acceptance and integrity.

Sagittal Small
Quadricep T10 suture L2,3,4 intestine
s
Small
Abdominal T6 Various intestine
s
Bladder Meridian
The bladder stores urine and controls excretion. In Oriental medicine this
means that the bladder receives waste body fluids from the lungs, small
and large intestines and under the influence of the kidneys, it stores and
excretes this as urine. The bladder is paired with the kidney. Its associated
emotion is fear and fright. Westerners do recognize this link in the phrase
“to wet oneself with fear”. It is also associated with risk-taking and an
affirmation of life.

Peroneus T12 L5, S1 Bladder
Posterior L5 L5, S1 Bladder

tibialis
Sacrospinal T12 Various Bladder

is
Anterior L5 L4,L5, S1 Bladder

Tibialis
Kidney Meridian
The kidney meridian is involved in the storage of the energy that you were
born with, known as the life essence. This determines our constitutional
health. The kidney channel oversees the maintenance of the bones and
stores the body’s reproductive energy. If the kidney meridian is impaired in
any way this can lead to:
• Retarded growth
• Learning difficulties
• Infertility
• Sexual disorders
• Senility
• Tinnitus
• Blurred vision
• Impaired thinking
• Back pain
• Fatigue
• Poor digestion
• Asthma and breathing difficulties
• Hearing problems
• Dull, lifeless and brittle hair
• Premature greying and/or baldness
• Feelings of weakness and timidity
The emotions associated with the kidney are fear and anxiety, like the
bladder. It is also associated with spontaneity and independence. The
navicular has links with the kidney, so the maintenance of the arch of the
foot is vitally important for the kidney meridian, and consequently the
whole body.
Psoas T12 Occiput L2,3 Kidney
Navicul
ar
Iliacus T11 ICV L1,2,3 Kidney
Upper C7 C3,4 Kidney

Trapezius Eye /
Ear
Circulation Sex/Pericardium
This involves the energy that supplies the sexual organs, and the circulation
of blood and sex hormones. The muscles that are linked to this channel are
the large muscles around the pelvis. It is obvious that imbalance of these
may lead to a change in position or function of the reproductive organs. It
is also obvious that the presenting features of a weakness in these muscles
may be back or pelvic pain. The emotion linked to the pericardium is that
of joy as the yin energy that circulates in the pericardium protects and
oversees the heart.

Gluteus
medius L5 L4,5,S1 Reproducti
ve
Adductors L1 Pubic L2,3,4 Reproducti

ve
Piriformis S1 Iliac S1,2 Reproducti

ve
Gluteus
maximus C2 Upper L5,S1,2 Reproducti
cervicals ve
Triple Warmer
This may be described as the San Jiao. It co-ordinates water functions in

the body. In modern terms this can be translated as the endocrine system
and the maintenance of homeostasis. It is linked to the pericardium.
Problems associated with an imbalance in the triple warmer may be linked
to hormonal problems. Upper extremity and neck problems, facial pain
and TMJ dysfunction may also be linked. The triple warmer is associated
with discernment and acceptance.

Teres minor T2 C5 Adrenals

Thyroid
Thyroid
Sartorius T11 L2,3 Adrenals
Gracilis T12 L3,4 Adrenals
Soleus T11,12 S1,2 Adrenals
Gastrocnemiu T11,12 S1,2 Adrenals

s
Gall Bladder Meridian
The gall bladder stores bile and excretes it into the digestive tract to aid
digestion and transform food into energy. The theory of Chinese medicine
sees the gall bladder as bestowing the capacity to make judgments. Gall
bladder imbalances can lead to either an inability to make decisions or to
the making of ill-thought out decisions. Physically, symptoms may present
such as headaches, depression, TMJ dysfunction, back pain, sciatica,
hearing and eye problems, and facial pain. It is linked to the liver meridian
and the associated emotion is irritability. The gall bladder is also associated
with creativity and motivation.

Anterior T4 Cervico- C5,6 Lung

deltoid dorsal Gall
junction Bladder
Popliteus T12 Lower L4,5,S1 Gall

cervicals bladder
Liver Meridian
The liver channel regulates the flow of energy throughout the body and
oversees the maintenance of the body’s blood supply. It is associated with
blood storage and the regulation of blood in circulation. In women this is
closely associated with menstruation; so many gynaecological problems
are likely to be related to a liver imbalance. Other physical problems linked
to liver meridian imbalance are headaches, muscle problems, nail
brittleness and eye problems such as glaucoma. The liver is seen as the
control centre, so if the liver is balanced and functioning well, we can
exercise control over the events in our life. If the liver meridian impairment
occurs there may be a tendency to become over controlling, rigid and
inflexible or to have lack of self-control leading to the main emotions
associated with the liver: anger and irrationality. Liver meridian imbalances
are always present in any stress-related disorder. The liver is also associated
with healthy change and exploration.

PMS T5 C6,7,8,T1 Liver
Rhomboids T5 C4,5 Liver
Lung Meridian
Lungs in Eastern medicine have a different role from that perceived by

Western doctors. The lung meridian governs the energy that is obtained
from inhaled air, and also the regulation of the passage of water through
the body. Lungs also control the energy in the outermost parts of the body,
i.e. the skin. In other words, the lungs rule the circulation and dissension of
Qi therefore regulate the entire energy system of the body. Dysfunctions in
the lung meridian may lead to symptoms such as:
Asthma and other chest problems

Rough dry skin
Eczema
Allergies
Emotions linked to the lung meridian are grief and melancholy.

Anterior T3,4 C5,6,7 Lung

serratus
Coraco- T2 C6,7 Lung

brachialis
Deltoids T3,4 Cervico- C5,6 Lung

dorsal
junction
Diaphragm T12 T11,12,L1 Phrenic, Lung

C3,4,5
Large Intestine Meridian
The large intestine has the role of expelling impurities from the body, and to
extract any remaining nutrient and energy from the matter passed from the
small intestine. It is linked with the lung, and the emotions associated with
the large intestine meridian are grief and melancholy, also with release and
moving on. The muscles linked to this meridian are those that join the pelvis
to the legs. Any imbalance in these may cause pelvic instability, and
perhaps gut problems and back pain. Irritable bowel syndrome will usually
cause a weakness in these muscles.

Tensor L2 Iron L4,5,S1 Large

fascia lata deficien intestine
cy
Hamstrings L4,5 Sacral L5,S1 Large

fixation intestine,
rectum
Quadratus L4,5 T12,L1,2,3 Large

lumborum intestine,
appendix
BIBLIOGRAPHY AND REFERENCES
• Bartram D.E, Amatsu Notes Active Balance Ltd

Duffy C, Amatsu Association Training
Bates S Active Balance Training Limited 2004,
Langston J, Muscle Testing, Amatsu Modules 1 & 2, Amatsu Training
School
Langston J, Directed Learning Exercises for Seitai, Amatsu Training
School
Faruqi T, Hand P, Anmajutsu Modules 1, 2 and 3, , Life Skills Centre
Myers T, Attitude Anatomy, A History of Anatomy for the Somatic
Therapist
Walther, Applied Kinesiology Synopsis 2nd Edition
Kapandji I.A, The Physiology of the Joints Vol. 1,2 and 3
Touch for Health, A practical guide to health improvement based on
the book Touch for Health by John Thie D.C. Books 1&2,
published by Toni Gralton, Australia
Dananberg HJ DPM, Subtle gait malfunction and chronic musculo-
skeletal pain
Todd M. E, The Thinking Body
Prof. Hatsumi Lectures Japan 1995
• Prof. Hatsumi directed teachings form 1995 onwards. Personal tuition
to Dennis Bartram, William Doolan and Christopher Rowarth.
• Dennis Bartram Amatsu notes from conversations, personal tuition and
direct oral transmission of ancient historical scrolls from Dr. Hatsumi.
Year 2: Module 5 & 6 Homework
1. Read up on the endocrine and excretory systems.
2. Revise the structures of the hand and elbow.
3. Keep learning the origin, insertion and actions of all muscles.
4. The endocrine system is a big subject. Apply your Amatsu knowledge to

explain in detail the interaction between the emotions and the endocrine
system, thus explaining the detrimental effect excess stress can have
on health and in particular on the immune system.
5. Define “endocrine” and “exocrine”.
6. Compare and contrast an example of a positive feedback loop and a

negative feedback loop.
7. What are the functions of the kidneys?
8. How is urine produced and what factors affect urine production?
9. Differentiate between diabetes mellitus and diabetes insipidus.
10. Read up on: The bones of the head and neck

i. The cranial nerves
ii. CSF and spinal cord
iii. The immune system
11. List the cranial bones. How many of each is there?
12. What are the functions of the paranasal sinuses?
13. Describe the structure and functions of the immune system with
respect to the Godai. Do not just paraphrase Tortora!!
14. What are the functions of CSF? Where is CSF made and where does
it circulate? Draw diagrams to illustrate your answer.
15. What are the functions of each cranial nerve and where can they be
found?
16. How do cranial nerves differ from spinal nerves?
17. How many spinal nerves are there?
18. What is a dermatome?
19. What is a synapse?
20. List the meningeal layers.

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COMPETENCY SHEET FOR SEITAI MODULE 6 – THE UPPER EXTREMITY

1. Prerequisites for Module 6

3. Pleural Dome Ligaments

4. Integrated Assessment of the Upper Extremity

5. Correction of the Upper Extremity

6. Distal Effects of Upper Extremity Protocol

7. Distal Effects of Spine and Rib Protocol

The shoulder is an elegant piece of machinery. It has the greatest range of

Bones and Joints

Ligaments and Tendons

The acromio-clavicular ligament attaches the clavicle to the acromion in

A special type of ligament forms a unique structure inside the shoulder

The rotator cuff comprises the following four muscles:

Ligaments and Tendons

The hand needs to be mobile in order to

Bones and Joints

There are 27 bones in the wrist and hand. The

Articular cartilage can be up to one-quarter of an inch thick in the large,

The most common cause of pain to the shoulder is cervical Spondylosis.

Compression of the shoulder joints may occur during gleno-humeral

Rotator Cuff Tears

This most commonly occurs as a result of trauma. It can also happen as a

Osteoarthritis of the acromio-clavicular joint

This presents as pain and restriction of the shoulder with localised

Osteoarthritis of the gleno-humeral joint

Rheumatoid Arthritis of the Shoulder

Rheumatoid arthritis is an auto-immune condition and generally affects

Recurrent dislocation is often seen in the 20-40 years age group. It

The areas you need to pay attention to are:-

Any problems in these areas can adversely affect the correction of a

It is difficult to predict when this might happen because on leaving the

CONDITIONS OF THE ELBOW

Strains can be caused by problems with triceps during forced extension or

This is commonly seen in clinic. It is more accurately called lateral

Cubitus Varus or Valgus

This is when the angle at which the elbow is carried is decreased or

Identify particular actions of the client that may be contributing to the

Usually found in women between 30-60 years of age. Normally there is

Ulna Carpal Tunnel

Amatsu practitioners view the body as a bio-tensegrity model rather than a

When the bio-tensegrity model is understood, it can be applied to the

The word tensegrity is a merging of two words: tensional integrity. Structures

Assessment of First Rib

• Therapy localise the 1st rib.

Correction of the First Rib

Assessment of the thumb

Correction of the thumb

MERIDIANS OF THE BODY

Muscle Vertebral Fixation Nerve supply Organ

Supraspinatus C1,2 Emotional C5,6 Brain

Muscle Vertebral Fixation Nerve Organ

Teres T2 Thoracic C5,6,7 Thoraci

Muscle Vertebral Fixation Nerve Organ

PMC T5 C5,6,7 Stomach

Neck C2 C1-8 Sinuses

Biceps C5,6 Stomach

In Oriental medicine, the spleen is seen as the primary organ of digestion

Healthy spleen Unhealthy spleen

Muscle Vertebral Fixation Nerve Organ

Triceps T1 C6,7,8,T1 Pancreas

Muscle Vertebral Fixation Nerve Organ

Subscapular T2 C5,6 Heart

Small Intestine Meridian

Muscle Vertebral Fixation Nerve Organ

Asthma and other chest problems