The movement will be found to be more easily accomplished if your partner has arms folded as suggested as above.
The repetitive movement forwards, into the position described, and back to neutral, is initiated by the motive hand, while the listening hand evaluates the changes created by this.
The comparison which is being evaluated is of one palpated area with another in response to this normal motion demand.
As Stiles and his colleagues state it, "It is not anterior direction of motion compared with posterior direction, but rather a testing of motion into the anterior compartment only, comparing one area with the ones below and the ones above, and so on."
Your listening hand is asking the tissues whether they respond easily or with resistance to the motion demanded of the trunk. In this way try to identify those areas, large and small, which bind as the movement forward is carried out.
Compare these areas with those identified when the breathing assessment was used.
The patterns elicited in 1C involve movement initiated by yourself, whereas the information derived from 1A and 1B involved intrinsic motion, initiated by exaggerated respiration.
Stiles and his colleagues have in these simple exercises taken us through the initial stages of palpatory literacy in relation to how tissues respond to motion, self-initiated or externally induced.
Hoover poses a number of questions in the following exercises (‘experiments’ he calls them) the answers to which should always be ‘yes’. If your answers are indeed positive at the completion of the exercise then you are probably sensitive enough in palpatory skills to be able to effectively utilise functional technique.
Hoover’s Thoracic Exercise
Suggested time for this exercise is 5 to 7 minutes.
- Stand behind your seated partner whose arms are folded on their chest. Having previously assessed by palpation, observation and examination the thoracic or lumbar spine of your partner, lightly place your listening hand on those segments which are most restricted or in which the tissues are most hypertonic.
- Do nothing as your hand ‘tunes’ in to the tissues. Make no assessments as to structural status. Wait for at least 15 seconds. Hoover says "The longer you wait the less structure you feel. The longer you keep the receiving fingers still, the more ready you are to pick up the first signals of segment response when you proceed to induce a movement demand."
- With your other hand and by voice guide the patient into flexion and then extension. The motive hand should apply very light touch, just a suggestion in which direction you want movement to take place. The listening hand does nothing but wait to feel the functional response of ease and bind as the spinal segments move into flexion and then extension.
- A wave-like movement should be noted as the segment being palpated is involved in the gross motion demanded of the spine. A change in the tissue tension under palpation should be noted as the various phases of the movement are carried out. Can you feel this?
- Practice the assessment at various segmental levels and try to feel the different status of the palpated tissues during the phases of the process, as bind starts, becomes more intense, eases somewhat and then becomes very easy before a hint of bind reappears and then becomes intense again.