Photos by Erin Murdoch.Originally published in Massage Bodywork magazine, April/May 2004.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
Do you have clients who have tried everything to get rid of pain, stiff muscles, and decreased range of motion in their joints? Have they tried everything from stretching to strengthening, undergone treatment after treatment, and finally a doctor has recommended medication to free them from the pain they've felt for years?
Intuitively, as a practitioner, you know there is a better way for your clients to regain their former selves. Regardless of how they have come upon their pain or stiffness from injuries, past or current health issues, or stress-related traumas, Hanna Somatic Education (HSE) may be the answer.
It is commonly accepted in rehabilitation, when there is any type of injury, trauma, or change in health status, that the central nervous system is involved. The extent of the involvement depends on the type and severity of the injury. When there is any type of tissue damage, whether it is bone, tendon, ligament, cartilage or a combination of these, there is a disruption of feedback to the brain. When there is a disturbance of nervous system flow to the brain from the body's sensory organs, the person's perception of the external environment is changed and the brain will make adjustments to maintain the person's past awareness of the world. Essentially, the brain will reorganize the body so the person's internal awareness of the outside world will remain constant. The alteration of the body may produce certain movement patterns to maintain a contemporary external environment. Bones will heal and all of the soft tissues will repair themselves over time, but the altered movement patterns will remain. HSE addresses "stuck" movement patterns in an attempt to reinstate
a sense of well-being.What is Hanna Somatic Education?
Upon first view, HSE looks like any other discipline within the somatic realm. The client lies comfortably on a table with loose-fitting clothes to facilitate easy movements. A practitioner of HSE (called Hanna Somatic Educators) sits or stands by as the client is given gentle and varied sensory feedback through touch and verbal encouragement as they explore certain movement patterns. These movement patterns have been previously identified by the educator in a postural intake or screening. The movements are specific, natural, gentle, safe, and pain-free to allow the client to maintain complete control. At this point, similarities to other somatic modalities cease.HSE is "brain" work.
As human beings progress through their lives, they develop very specific patterns of movement based on necessity. In movement they use their skeletons as support for the muscles to propel them forward, or in any other direction they choose. The central nervous system supplies the planning, motor scheme, and nervous impulses to guide and direct the muscles. The brain then sorts through information sent back from the muscles during the movement to continually guide the desired task. Some of these patterns often become "wired" or habituated into the central nervous system through overuse. When this happens, the brain continually runs the motor program and applies it to posture and everyday tasks. These patterns, while beneficial at one time but useless when no longer needed, may become a type of "reflex" that is continually used by muscular systems of the body. These reflexes can be one of the main causes of confusion and disruption in movement patterns. The confused muscular systems then interfere with efficient movement, postural control, and support, and cause musculoskeletal and other types of pain to develop over time. This type of developmental pain, stiffness, or loss of awareness has been termed Sensory-Motor Amnesia (SMA) by Thomas Hanna, and is specifically dealt with in HSE lessons.HSE is education.
When a client is working with a Hanna Somatic Educator, she will be engaged in a kinesthetic dialogue allowing her to gain a deep awareness of how her musculoskeletal system works. Through this dialogue, movement routines are simplified to increase awareness of postures and holding patterns. The beauty of HSE is that the client is actually a participant and must actively contribute to the session instead of being passively manipulated. Inviting the client to become an integral part of the lesson can add to the educational benefits, but can also assist her in becoming more pain-free, self-determined, and self-balanced. HSE is self-help in the definitive form.
Either in a group or private session, the client learns to move efficiently with SMA, as well as to release and regain control over stuck muscles. This can cause other positive changes in one's life, which may result in living more productively and comfortably. These small pieces of awareness can allow the client to identify when an injury or stressor has taken place, how to reverse the situation, and begin the healing process on her own. This renewed capacity for self-care allows her to sustain continuous improvement.Postural Evaluation with Hanna Somatic Education
Hanna Somatic Educators view their clients as whole beings or "somas." The clients' postural presentation is important because it shows how they use their body in relation to gravity in their daily tasks. Postural evaluation can also identify certain reflexive postures that can be present when viewed standing. During a postural intake, a client's soma is viewed from the front, both sides, and the rear. Viewing the client in many ways can allow for the identification of tight muscles or constricted muscle groups. The client may also be asked to move in particular ways to allow the practitioner to see if any particular postural presentations or muscular holding patterns are accentuated. Common postural presentations identified through HSE are the red light, green light, and trauma reflexes.
Red Light Reflex
Photo 1 - Postural presentation of the red light reflex.
The red light reflex is often referred to as the "startle response" or the "escape response" (see Photo 1). This particular reflex helps an animal escape or withdraw from a perceived threat, and is present in all types of vertebrates, as well as some non-vertebrates, and provides the specific function of protection and survival with an immediate response. In mammals, particularly humans, the red light reflex is very fast, out of conscious awareness, and controlled by the brainstem. If a loud sound is made nearby (i.e., a car backfiring on a street, slamming of a door, etc.) the face will contract, the eyes will close, the shoulders will rise up toward the ears, and the head will be brought forward. The neural impulse will continue through the nervous system to the abdominal muscles, bringing the trunk forward while producing a bend at the waist that pulls the rib cage down and stops, or slows, breathing. The shoulders will roll forward, a bend forms in the elbows, and the hands are pulled in toward the body's center. The impulses radiate down the body to the legs, bending the knees, and pulling the toes upward. All of this extremely fast nervous system action makes the body smaller, withdrawn, and harder to be seen by a predator or threat.
The amazing amount of nervous system activity involved in the red light reflex has many other effects on the body. A stooped forward
posture not only causes painful and stiff muscles, but it can also cause shallow breathing and changes in respiration patterns, frequent urination from increased pressure on the bladder, increased heart rate, elevated blood pressure, and stiff or painful joints.
The red light reflex is manifested in specific muscle groups causing a very distinct pattern to emerge. HSE works with the specific muscle groups using certain protocols to assist the client in regaining flexibility and more comfortable range of motion in movement.
Green Light Reflex
Photo 1 - Postural presentation of the green light reflex.
The green light reflex (see Photo 2) is a response to the neuromuscular system being called into action. This reflex is so strong, yet so misunderstood. It has not only eluded our internal perception, but has also baffled the finest of physicians because of the back pain difficulties it can cause.
The green light reflex is functionally opposite of the red light reflex in activity and necessity of survival. The red light reflex is one of withdrawal, while the green light reflex is one of assertiveness and action. The red light reflex will use the flexors of the body to pull the trunk forward, while the green light reflex contracts the extensor muscles on the posterior aspect of the body, pulling the trunk more upright while lifting and arching the back (see Photo 3). HSE can help in gaining a greater awareness and control of the neuromuscular system to avoid excessive overuse of the green light reflex and decrease, control, and possibly eliminate back pain.
Infants are very good at using their flexor muscles to move themselves about and cling to their mother or father for protection and nurturing. As development continues, the infant needs to acquire the ability to move around to get the things he needs to learn and develop independently. In order to progress and acquire these things, he must be able to use the extensor muscles of the back.
Photo 3 - Exploration of green light movement patterns in the client with feedback from the practitioner.
The first action to be mastered in using the muscles of the back is to lift the head so the infant may see what is in front of him. With this new realm of visual input, he begins to attain a new sense of balance and a new horizon. The acquisition of horizontal references and first attempts at movements requiring balance puts the infant on the path toward standing on two feet and walking upright.
When we become fully developed, we feel as though we are able to move through space and time with little effort, and all of the past motor learning may seem trivial. The continued firing of the green light reflex can be due to an increasing amount of stress in one's life. As we grow from infancy to adulthood we assume more responsibility. Not only do we need to take care of ourselves, but we have loved ones to tend to, bills to pay, etc. As we go through our daily tasks, we fire the green light reflex, stimulate the response of action, and trigger the muscles that we need to move our bodies forward and complete what we need to do. In stressful times, we continually use the green light reflex, no matter the cost of fatigue, or the sore muscles in our upper and lower back, neck, shoulders, and buttocks.
Photo 4 - Postural presentation of the trauma reflex.
The trauma reflex (see Photo 4) deals directly with compensatory muscles that allow the body to function following any type of injury to the musculoskeletal system. It is commonly understood that when an injury occurs, there is an equal and opposite reaction that takes place within the human frame.
Generally, the body will contract and retract to splint the injury site and, in some cases, rotate regions of the body to allow the neuromuscular system to function while the healing process occurs. All of these processes of the trauma reflex are responsible for protection, allowing the body to heal itself over time.
The trauma reflex is a compensation of muscular patterns that involve mostly the muscles on the sides of the body. This reflex becomes very evident, for example, in people who have injured an ankle or knee and have not been effectively educated on how to regain the use of their body following the injury. If an ankle or knee is injured, they may assume a small limp in order to take the pressure off the injured joint. This removal of pressure is accomplished by a contraction or lifting of the hip on the same side. Tightening of the hip may lead to an internal rotation of the same leg and increased muscular contractions in the lower back. The compensation continues into the opposite hip to anchor the body's shift in its center of gravity. This example shows the continued influence of compensation on the entire body as a self-correcting organism. Without proper action, the pattern will perpetuate throughout the rest of the muscular system, so the body continues to function and relieve the injured site, but it may initiate other aches and pains not directly caused by the injury. HSE has very specific techniques for helping the client to "unwind" these various compensatory rotations of the human frame.The Importance of Stress Reflexes
All of these reflexes serve distinct purposes in life. Since habituation from constant use in particular movement patterns is the simplest form of learning, the key is to assist clients in understanding the reflexes in their own context. Learning about reactions to stress and trauma can help clients deal with any significant deficits in movement awareness, flexibility, and pains of unknown origins.
Any of these reflexes can occur singularly, but most likely occur in some sort of combination with one another. HSE identifies proper protocols and offers suggestions for working with clients so they may begin to help themselves become more flexible and comfortable in movement. Education provided by the practitioner guides the client toward distinguishing when a particular response is occurring and learning to correct themselves with their new understanding and awareness. Methods of Hanna Somatic Education
To stimulate the motor learning process, Hanna Somatic Educators use three distinct forms of movement -- "means-where-by," "kinetic mirroring," and pandiculation. They are also adept at providing feedback through kinesthetic touch.
Photo 5 - Using the Means-Where-By to explore rotation of the trunk upon the pelvis.
Early in his self-explorations, F. M. Alexander, the founder of the Alexander Technique, began to use movements to free muscular holding patterns in his body. In a sense he was breaking down large movements into smaller ones so that over time he was eventually able to attain the more complex movement. Using this process, he was able to cognitively, kinesthetically, and proprioceptively explore and make his movements with an increased awareness.
HSE therapists use variations of movements, often without an intended goal in mind, to assist the client in gaining a greater awareness of a particular muscular system or movement pattern (see Photo 5). These particular patterns may be verbally guided or assisted with hands-on proprioceptive input.
Photo 6 - Using kinetic mirroring to release muscular tension of the shoulder girdle.
Thomas Hanna's instructor Moshe Feldenkrais used a technique called "kinetic mirroring" to allow his clients to experience certain easy and gentle movements of the muscles or muscular systems.
Hanna Somatic Educators use various postures or movement patterns to allow the client to gain a greater awareness of how they can effectively turn off or release muscles by having the skeletal or gravitational tension removed. Shortening muscles or muscle groups and allowing their antagonists to experience an increase in length, hence the term "mirroring," accomplishes this release of tension (see Photo 6). This kinesthetic information is then brought together with the "means-where-by" so the client can attain a particular movement free from pain and move toward efficiency and neuromuscular control.Pandiculation
Of the three particular techniques employed by practitioners, Hanna's contribution to the process was truly remarkable. He added the unique aspect of HSE termed "pandiculation" to involve the client in the experience of movement patterns. Pandiculation is broken down into three parts consisting of pandicular movement, quick release, and a lock-in.
Defined, pandiculation means to stretch out the limbs, as if to yawn when awakening from normal sleep. This simple action, used by all vertebrates upon rising from rest, allows the sensory motor cortex of the brain to establish contact with the muscular system and ready the soma for activity. This gentle motion of lengthening the body's muscles and preparing them for work moves them into a direction of relaxation and efficient movement.
Photo 7 - Using pandiculation to lengthen the middle trapezius while providing feedback from the practitioner.
The pandicular movement process involves the client's active participation. To begin, the Hanna Somatic Educator assists the client in comfortable body positioning to be able to access the desired muscles or muscular systems most efficiently. The client is asked to contract the muscle while the Hanna Somatic Educator provides kinesthetic and proprioceptive feedback through the entire range of motion (see Photo 7).
Using a quick release, the Hanna Somatic Educator helps the client in stressing the new pattern and range of motion without pain. Feedback is maintained between the client and the educator, with the client eventually moving through a range of motion at a comfortable, yet increased speed.
At the end of a quick release, the client is given the opportunity to complete the motor feedback loop with a "lock-in" maneuver. With the client at the comfortable end position of their range of motion, they will be asked to engage the muscular antagonist to utilize reciprocal inhibition and allow a renewed awareness of the overall pattern.
Pandiculation is a safe and effective process for the client. Using pandiculation, a practitioner can help clients to eventually make strong, pain-free movements to increase the brain's motor output and override reflex patterns. It provides a direct stimulus to the nervous system to change the information flow through the brain's pathways involved in movement and physiology.Reaping the Benefits
Remember, if they can't feel it, they can't move it. If they can't move it, they may be compensating for their immobility. If they are compensating, then they are not free of pain and may not be accessing their fullest physical potential. HSE is not a quick fix form of therapy, or a medical solution; it is truly a mind-body learning experience that can help clients understand their bodies in a unique and beneficial way ... with education. Charlie Murdach is a certified Hanna Somatic Educator from San Francisco, Calif. Murdach earned a bachelor's of science degree in physical education from California State University, Sacramento, and a master's degree in kinesiology from San Jose State University. He works with the Cardiovascular Research Institute of the University of California, San Francisco, in the Adult Pulmonary Function and Exercise Physiology Laboratory as a technician and research assistant. He can be contacted at firstname.lastname@example.org.