Massage News Alert - August 2007

 

Dear Bodyworkers,

 

Beside online videos, you can now listen to Podcast, not to soothing massage music but useful topics and interviews related to bodyworks. There are two great websites  where you can listen and also download the mp3 to your iPod. Inside SI http://www.insidesi.com/ publishes mainly the subject of structural integration, has great interviews with the Bodywork Gurus such as Tom Myers, Michael Stanborough, Til Luchau, Jeff Maitland, Mary Bond. Massage Therapy Radio http://massagetherapyradio.com/ is a general for massage therapist with various topics from techniques to marketing tips.

 

This edition brings you research articles on foot. Thanks to Michael for the tips and info. We look at the controversial foot over-pronation, flat foot or high heel and more.

 

Following on last month's article on the prevalence of massage therapist to injuries in Canada, we also would like to conduct similar survey mainly in Australia. So please help us in in participating this Survey. As a reward you will have a chance to win one of the two Massage DVDs (Lymphatic Drainage by Sean Riehl, and Stone massage by Meade Steadman) each worth $70. To win a lovely DVD simply follow this link and complete our simple online survey http://www.terrarosa.com.au/poll/index.htm

 

We will be away from the end of this week for couple of weeks, so we will not be able to deliver order during this time.

 

This newsletter is our attempt to bring you what's happening in the latest research and news on massage related issues. We sell massage videos and books so the little advert is at the end of this page. Archive of our past news is at: http://www.terrarosa.com.au/news.htm

If you do not wish to receive email from us, please reply to this email with subject “Unsubscribe”.

Happy reading and stay healthy… from us at www.terrarosa.com.au

 

 

Inside this issue:

Are you overpronated?

It's OK to Be Flat-Footed

Plantar Fasciitis and Obesity

Treating a stiff neck can help reduce blood pressure

Scientists Link Brain Function To Knee Injuries

Sciatica surgery has no significant difference with conservative treatment

Ankle dorsiflexion delay can predict falls in the elderly

Exercise on Lower Back Pain

The M technique

 

New Books

New DVDs

 

 

Are you overpronated?

 

Recently I was alerted by the fact that 90% of the general population's feet are over-pronated. Pronation is the motion of the foot as it roles inward after the foot makes contact with the ground. Over or excess-pronation causes the arch of the foot to flatten excessively placing stress and pressure on tissues and ligaments of the foot. Over-pronation (flat foot) can lead to many foot problems including plantar fasciitis, ankle pain, lower back pain etc.

 

It is curious where does this data or statistics come from. Start with Google, we found various websites mainly selling foot orthoses or related products (Foot Orthoses or orthotics are simply custom fitted shoe inserts, which are prescribed to treat or prevent foot injuries). The most prominent is a chiropractor who runs a company in San Diego with several versions of this "fact":

This is resonated by others who also happen to own company in sports injuries treatment, or selling orthosis

Where does the number come from? 50, 60, 70, 80, 90% You name it.

Although it has been asserted that it was stated by "many authors" and "several well-known authors" we never find any reference in the above articles. There is no single article that quote or mention the reference or source.

 

In a large scale population based study in Europe, the study found that orthopedic foot conditions (pes planus - flat foot, pes cavus - high arched foot, pes varus, pes valgus, pes equinus, pes talus, hammer toes) is the largest foot conditions of the population. And the number is  20-25% of the whole population.

 

A study done in 1984 conducted in British Columbia, Canada (Clement et al), which looks at the treatment of Achilles tendinitis. Of the 109 runners in the study, 56% displayed functional over-pronation. Another reference also related to runners injuries is: James et al. (1978) who found an increased pronation in 60% of injured runners

Guess from this 60% related to runners with injuries participating in clinical trials, others can just simply extrapolate to the whole population and it became 90%!

 

While we cannot confirm whether this figure is right or wrong, a foot expert that we consulted said that not all people with over-pronation have problems. In fact, more recent research is starting to show that high-arched feet (i.e. under-pronators) have more problems. Whether the figure (60-90%) is right or wrong, it is pretty meaningless.

 

Reference


James S, Bates B, Osternig L. Injuries to runners. Am J Sports Med 1978: 6: 40-50.

The American Journal of Sports Medicine 12:179-184 (1984) Achilles tendinitis and peritendinitis: Etiology and treatment.  D.B. Clement, J.E. Taunton, G.W. Smart http://ajs.sagepub.com/cgi/content/abstract/12/3/179

 

It's OK to Be Flat-Footed

Flat or high-arched feet have long been thought to predispose to injury, but this has not been studied rigorously. A study published in 1993 evaluated foot morphology and injury risk in 246 male army recruits followed during 12 weeks of intensive training. The recruits' feet were marked to indicate anatomic landmarks and photographed to assess arch height.

The 20% of trainees with the flattest feet had the lowest injury risk. In contrast, the 20% with the highest arches (a ratio above 0.27) had a 6-fold greater injury risk than the flat-footed group. The middle 60% of trainees had an intermediate risk. The effect of arch height was independent of activity level, prior injury, and other predictors.

This simple, well executed study should dispel the notion that flat-footed people are prone to injury during exercise. But people with high arches should be advised to pursue non - weight-bearing exercise, particularly if they have a rigid deformity.

High-arched foot or supinated foot or underpronated or pes cavus usually characteriesed by high medial longitudinal arch, plantar-flexed first metatarsal and clawing of the digits. Population-based studies suggest the prevalence to high arched foot is 10% and the cause is idiopathic in nature. And estimated 60% of people with high arch experience foot pain auch as plantar heel pain.

Reference

Cowan DN et al. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med 1993 Jul 2 773-777.

Burns J, Crosbie, J., Ouvrier R, Hunt A. Effective orthotic therapy for the painful cavus foot. Australasia J Podiatric Med, 2006; 40 (3): 61-6.

 

Plantar Fasciitis and Obesity

Chronic plantar heel pain (CPHP) is one of the most common conditions affecting the foot. CPHP has become a generalised term encompassing a broad spectrum of conditions affecting the heel, including subcalcaneal bursitis, neuritis, plantar fasciitis and subcalcaneal spur usually the true pathology is unclear. However, plantar fasciitis is considered to be the most common cause of pain and the terms are used interchangeably in the literature. CHCP has been reported to account for 15% of all adult foot complaints requiring professional care. It is usually observed in the 40 to 60 year old age bracket, but has been reported in people from 7 to 85 years and appears to be more common in females. Symptoms typically include pain under the medial heel during weight bearing, especially in the morning and at the beginning of weight-bearing activities.

A study was conducted at LaTrobe University to examine the association between CPHP and a number of commonly hypothesised causative factors. Eighty participants with CPHP is compared with 80 control participants on body mass index (BMI), foot posture, ankle dorsiflexion range of motion (ROM), occupational lower limb stress and calf endurance.

The results showed the CPHP group had significantly greater BMI, a more pronated foot posture and greater ankle dorsiflexion ROM. No difference was identified between the groups for calf endurance or time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting. The authors concluded that people with CPHP were more likely to be obese and to have a pronated foot posture. 

Irving, DB, Cook, JL,  Young, MA, Menz, HB. Obesity and Pronated Foot Type May Increase the Risk of Chronic Plantar Heel Pain: A Matched Case-Control Study. BMC Musculoskeletal Disorders. July 2007. http://www.medscape.com/viewarticle/559871_1

 

Treating a stiff neck can help reduce blood pressure

A chance discovery in the lab has helped University of Leeds scientists to show how the treatment for a stiff neck could do wonders for your blood pressure. A study lead by Jim Deuchars found pathways between the neck and the brain to show how the neck muscles could play a crucial role in controlling blood pressure, heart rate and breathing.

Their study provides the first evidence for a role for these connections in influencing brain regions which control body functions that we don't need to think about, such as breathing and blood pressure. The area of the brain where the signals from the neck terminate were first identified by "Godfather of Neuroscience" Ramon Y Cajal, more than 100 years ago, though its function was not understood. What happened after these signals arrived remained a largely-overlooked area of research until new techniques allowed the Leeds team to take the work forward.

"Cells in the area that receive neck signals jumped out at us when we labelled sections with particular markers. We wanted to know how these cells were organised and the other brain regions to which they were connected," the researchers said. The team, which includes researchers from Japan and Hungary, found a link between these cells and the nucleus tractus solitarius, an area of the brain that is pivotal in control of autonomic functions - body functions under unconscious control.

They propose that nervous signals from the neck could play a key role in ensuring that adequate blood supply is maintained to the brain as we change posture, such as from lying down to standing up. Where such signalling fails, we can suffer problems with balance and blood pressure.

"Reports from chiropractic journals say that manipulating the neck region helps to reduce blood pressure in some people. By identifying the pathways we can see why these treatments might work and it could also explain why some people suffering whiplash injuries may experience a change in their blood pressure," Prof Deuchars explained. "The work also contributes to understanding postural hypotension - fainting which can be caused by standing up too fast. The neck muscles could be a part of the system which normally prevents this from happening by sending signals to the brain upon neck movement that posture has changed," he added.

More research is now needed to see which sensory nerve fibres and precisely which cells are involved in the process. Amongst other things, the team would now like to know what other brain regions the neck muscle termination site connects to. They believe that there are many malfunctions associated with whiplash injuries to the neck that could be better understood by unravelling these connections. They hope that this knowledge could be used to design more effective treatments for such injuries. The implication is of course a regular neck massage could help to prevent heart attacks.

Reference:

Ian J. Edwards, Mark L. Dallas, Sarah L. Poole, Carol J. Milligan, Yuchio Yanagawa, Gábor Szabó, Ferenc Erdélyi, Susan A. Deuchars, and Jim Deuchars The Neurochemically Diverse Intermedius Nucleus of the Medulla as a Source of Excitatory and Inhibitory Synaptic Input to the Nucleus Tractus Solitarii Journal of Neuroscience Aug 2007; 27: 8324 - 8333 http://www.jneurosci.org/cgi/content/full/27/31/8324

 

Scientists Link Brain Function To Knee Injuries

While being tackled can tear this major knee ligament, most athletes actually “do themselves in”--they don't collide with a person or object, they end up injuring themselves when they land off-balance during a jump or run. But why? In a first-ever study of its kind, University of Delaware scientists have shown that differences in brain function may be to blame, predisposing some of us to “noncontact” knee injuries.

The research, which involved scientists from UD, Michigan State University, West Chester University and St. Joseph's University, is reported in the June edition of the American Journal of Sports Medicine. "We had some data from previous research which suggested that these non-contact knee injuries occur when a person gets distracted or is 'caught off guard," Charles Buz Swanik, the UD assistant professor of health sciences who led the study, said. These awkward movements have the biomechanical appearance of a knee buckling, but can be reproduced safely in the lab to study how people mentally prepare and react to unanticipated events.

"This made me wonder if we could measure whether these individuals had different mental characteristics that made them injury-prone," Swanik said. To identify subjects for their study, the researchers administered neurocognitive tests to nearly 1,500 athletes at 18 universities during the preseason. This testing also provided baseline data for athletes who might sustain a concussion after the season started, Swanik said. Visual memory, verbal memory, processing speed, and reaction time all were assessed. For example, a color-matching test was used to measure reaction time and processing speed. Each athlete was asked to click in a box as quickly as possible only if the word “red” was displayed on the computer screen in a red color, not if the word appeared in the color green or blue.

After the season started, a number of the tested athletes ended up sustaining non-contact anterior cruciate ligament (ACL) injuries. These athletes were identified, and 80 of them were matched up to a control group of 80 non-injured athletes according to height, weight, age, gender, sport, position and years of experience at the college level. Male and female athletes in 10 intercollegiate sports were represented, including football, soccer, lacrosse, basketball, volleyball, field hockey, gymnastics, wrestling, fencing and softball. Then the pre-season test results from the two groups of athletes were compared.

In analyzing the data, the scientists found that the athletes who ended up with non-contact ACL injuries demonstrated significantly slower reaction time and processing speed and performed worse on visual and verbal memory tests when compared to the control group. "These results suggest that slower processing speed and reaction time, as well as lower visual and verbal memory performance may predispose certain individuals to errors in coordination during physical activity that can lead to injury," Swanik said.

But can we do anything to improve our brain function and protect ourselves from injury? This study means that there may be an alternative application for neurocognitive testing in the area of injury prevention, Swanik noted. It's hard to say at this point how much we can alter these characteristics with training, but certainly the brain has great potential for learning and adaptation. Controlling stress and anxiety must be considered, as both cause changes in muscle tone and concentration and the narrowing of our attention field.

"There is likely an optimal state of arousal for each individual to maximize performance and injury avoidance, but future studies will have to determine the relationship between our results and anxiety," Swanik added. A follow-up study is now under way in UD's state-of-the-art Human Performance Laboratory with support from the University of Delaware Research Foundation. "We're trying to identify people who are or are not 'caught off guard' during different landing tasks," Swanik said. “Then we'd like to match the neurocognitive characteristics of people who are easily distracted or have awkward landings. This would allow us to search for injury-prone or perhaps accident-resistant people.”

An estimated 200,000 anterior cruciate ligament injuries occur annually in the United States, mostly in young, healthy, active individuals. According to Swanik, it is not uncommon to have one or two ACL injuries every season on a football team, and the incidence is likely even greater on women's sports teams. Young women are actually at the highest risk for these injuries, particularly in soccer and basketball.

http://www.sciencedaily.com/releases/2007/07/070716190754.htm

 

Sciatica surgery has no significant difference with conservative treatment

When you have back pain there are circumstances when you’ve no choice about back surgery and that’s usually when you have incredibly severe pain that is not easing and signs of nerve damage. No one argues about the benefits there but that’s not the typical story, because most people get better regardless.

Even so, what about longer standing back pain going down into your buttock and leg – sciatica - that’s been going on between 6 and 12 weeks? A recent trial involving about 400 people compared surgery to relieve pressure from the protruding disc to non-surgical treatment like physio and pain relief with surgery available if needed or requested.

People having early surgery felt they improved faster and more rapid improvement in leg pain. – mostly in the first six months. But on average, at one year there were no differences between the two groups. 95% of the patients in both groups reported recovery. There were few surgical complications. Two people had tears of the lining of the spinal canal and one had a blood clot in their wound.

A commentary on the study makes it clear that the choice for consumers depends on the value we place on faster recovery, accepting that a year down the track, back surgery may not have given any added benefits.

http://www.abc.net.au/health/minutes/stories/s1993248.htm

Peul WC et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine 2007;356:2245-2256.

 

Ankle dorsiflexion delay can predict falls in the elderly

Fall prevention is important as people age, as falls cause hospitalisation, nursing home admission and death.

Walking has been shown to require between 5 and 15 degrees of dorsi-flexion when an individual walks on a flat surface. In the study of walking in people aged 60 to 77 years undertaken by Kemoun et al in France it was found that elderly who fell walked more slowly and tended to use a double support for a longer period of time. Fallers were less powerful but mainly showed fewer power and moment variations. The range of motion at the ankle and the hip was reduced. The researchers also noticed a change in the walking pattern, showing a delay in the dorsiflexion of the ankle at the swing phase.

Another research showed that vitamin D can prevent falls, as it may actually strengthen muscles in its own right. A group in Boston brought together all the trials of vitamin D and falls and found that it reduced the risk of a fall by about 20 per cent, and that 15 people aged around 70 needed to take vitamin D for anything up to three years for one person to avoid a fall. Most of the research was in women so the effectiveness in men isn't known, nor is whether there should be calcium supplementation as well.

Bischoff-Ferrari HA et al Journal of the American Medical Association 2004, vol 291, pp 1999-2006

http://www.abc.net.au/health/minutes/stories/s1122064.htm

Kemoun G, Thoumie P, Boisson D, Guieu JD. Ankle dorsiflexion delay can predict falls in the elderly. J Rehabil Med. 2002 Nov;34(6):278-83.

 

Exercise on Lower Back Pain

Lower back pain is a common condition. The main goal of treatment for recent-onset back pain is to decrease pain so that patients can return to their normal activities. Traditional treatments for low back pain include drugs (painkillers, anti-inflammatory drugs, and muscle relaxants); physical therapies, such as exercise, massage, and manipulation; and education about the back and advice about ways to deal with back pain. Although exercise and advice are commonly recommended, the effectiveness of these treatments in recent-onset low back pain is unclear.

A study was conducted to determine whether there were benefits of physiotherapist-directed exercise, advice about back pain, or both for patients with low back pain.

259 adults with subacute low back pain. Subacute low back pain is back pain that has been present for at least 6 weeks but no longer than 3 months. Patients who were pregnant, had previous spine surgery, had serious conditions that caused the low back pain, or could not exercise could not participate in the study.

The researchers assigned patients to receive either 12 real or 12 pretend exercise sessions and either 3 real or 3 pretend advice sessions over 6 weeks. Physiotherapists (physical therapists) provided the treatments in this study. Physiotherapists are trained professionals who use physical therapies, such as exercise, manipulation, or massage, to restore or maintain mobility and function.

The researchers measured patients' pain and function after 6 weeks and 12 months of treatment. During real exercise sessions, a physiotherapist used a personalized exercise program to improve patients' ability to do activities made difficult by back pain. During the pretend exercise sessions, a physiotherapist pretended to give ultrasound treatments by using a nonworking machine. During real advice sessions, a physiotherapist gave a standard educational program on low back pain. During the pretend advice sessions, the physiotherapists talked with patients about low back pain but did not give them advice. The pretend exercise and advice sessions let all patients spend time with physiotherapists. This is important because contact with the physiotherapist alone might make people feel better even if the exercise and advice programs did not help.

The researchers found that Patients who received both exercise and advice had the most benefit at 6 weeks. At 12 months, most of the benefits were no longer present.

These results do not apply to exercise or advice that is not delivered by a physiotherapist or to patients with back pain that has been present for less than 6 weeks (acute) or more than 3 months (chronic). The study also did not compare exercise and advice to specific types of drugs or to other treatments for low back pain.

The implications of the study is: A combination of physiotherapist-directed exercise and advice seems to improve pain and function in the short term (6 weeks) for patients with subacute low back pain more than no treatment or either exercise or advice alone.

L.H.M. Pengel, K.M. Refshauge, C.G. Maher, M.K. Nicholas, R.D. Herbert, and P. McNair. Physiotherapist directed exercise, advice or both for sub-acute low back pain. Annals of Internal Medicine 2007;146:787-796

 

The M technique

The M Technique is a gentle touch therapy that involves a structured sequence of rhythmic stroking movements called . It claims to be able to stimulate  the parasympathetic part of the nervous system, which is responsible for reducing heart rate, and good for Stress and chronic illness.

The technique was originally developed by an intensive care nurse to relax distressed patients. Its inventor, Jane Buckle, worked there as a critical care nurse in the mid1990s. Today the technique is used in more than 40 US hospitals and at least seven hospices in the UK, particularly to help with pain relief and to calm the terminally ill.

“My postoperative patients were connected to lines, drips and catheters,” recalls Dr Buckle, who has a PhD in health service management. “I wanted them to know that I was there for them and I found myself patting them. As I wasn’t sure how to touch very sick people, I trained as a massage therapist, but nine-tenths of what I learnt was inappropriate for intensive care. I started improvising movements and watching the monitors to see what happened. I found that if I did at least three strokes of the same type, the patient’s pulse and breathing slowed and their blood pressure came down,” she says. This, she says, is the calming parasympathetic nervous system at work, the opposite from the flight or fight response of the sympathetic nervous system. “At the first touch, the body registers surprise; on the second it recognises the feeling; and by the third it is reassured that this is something it can cope with.”

Over the ensuing years, Dr Buckle developed and trademarked the M (for manual) Technique. It is a choreographed series of stroking movements that, unlike massage and yoga, are always delivered in the same way and the same order, at a set pressure and speed. Each stroke is delivered three times.

The technique, which can be learnt in two days, appears simple but seems to have profound effects on the body. In 2005, research was carried out at University of Pennsylvania using SPECT (Single Photon Emission Computed Tomography) analysis. A radiopharmaceutical was injected intravenously into subjects who were SPECTed then ‘m’ed and then SPECTed again. The scans before and after the 'm' technique® were compared (65 areas of the brain). The results to be presented at the American Massage Therapy Association annual convention in September, will show,  how the M Technique produces changes in 32 areas of the brain.

“People drift in and out of consciousness while having the M Technique,” says Dr Buckle. “They don’t really go to sleep, but afterwards they cannot remember the whole session. There are three sounds you look for: a deep sigh; a tummy gurgle as the digestive system relaxes; and finally a snore.”  The technique is particularly popular among those who work with the very sick and can be taught to relatives of the terminally ill. “It makes people relax and seems to work as a kind of hypnotherapy for pain,” says Bridget Bircumshaw, a holistic practitioner who uses it at Cancer Support Warsop, a centre for cancer patients and their carers in Nottingham.

For more info on the M technique: www.rjbuckle.com .

http://women.timesonline.co.uk/tol/life_and_style/women/body_and_soul/article2152112.ece

 

 

New Books

 

Deep Tissue Massage. A Visual Guide to Techniques (Revised Second Edition) by Art Riggs

Deep Tissue Massage presents a wealth of information in a way the therapist can immediately utilize. This new edition has been thoroughly revised and includes a preface to the new edition, a foreword by Tom Myers, an index, a Suggested Reading list, and extended sections on integrating deep tissue massage into bodywork practice and the psychology of treating injuries. http://www.terrarosa.com.au/dvd/dtm3.htm

The New Rules of Posture, How to Sit, Stand, and Move in the Modern World by Mary Bond

Mary Bond approaches postural changes from the inside out. She explains that healthy posture comes from a new sense we can learn to feel, not by training our muscles into an ideal shape. Drawing from 35 years of helping people improve their bodies, she shows how habitual movement patterns and emotional factors lead to unhealthy posture. She contends that posture is the physical action we take to orient ourselves in relation to situations, emotions, and people; in order to improve our posture, we need to examine both our physical postural traits and the self-expression that underlies the way we sit, stand, and move. The way we walk, she says, is our body’s signature. http://www.terrarosa.com.au/dvd/dtm3.htm

The History of Massage: An Illustrated Survey from around the World

The first comprehensive history of massage, the definitive resource for all students and professionals in the fields of massage and bodywork. From the people of ancient Greece to the tribes of the Pacific Ocean, massage has been a significant element in medicine, midwifery, folk healing, and athletics. Yet the rich presence of healing touch is rarely manifest in the telling of human history. Now, for the first time, Robert Noah Calvert offers a comprehensive history of massage that spans the globe. Starting with the healing art's ancient foundations, Calvert's History of Massage leads us through Greek temples and Middle Eastern bathhouses, Chinese martial arts traditions and Native American sweat lodges, to discover the significant role of touch therapy in the life of the world's people. http://www.terrarosa.com.au/book/index.htm

Supercharging Quantum Touch Advanced Techniques by Alain Herriott

This is the companion to the best selling Quantum-Touch. In this book, prominent teacher Alain Herriott takes students and followers of Quantum-Touch beyond the basics, sharing the techniques used by the best, most effective practitioners.From the hundreds of workshops he’s conducted around the world, Herriott has gathered questions that he addresses here in a direct way that refines, clarifies, broadens, and deepens the work. http://www.terrarosa.com.au/cst/cst.htm#super

Fascial Manipulation by Antonio Stecco

Beside Anatomy Trains, the Italian School also has a model explaining the myofascial continuity in the body. Specially imported from Italy, this book illustrates: The connections of the fascia with muscles, bones, articulations and nerves (anatomy of the fascia), The coordinating function of the fascia with regards to all components of the locomotor apparatus (physiology of the fascia), The way to manipulate densified or condensed fascia in order to restore it to its physiological state (treatment of the fascia). http://www.terrarosa.com.au/book/fm.htm

 

New DVDs

 

Coming Soon in September 2007

Advanced Myofascial techniques with Til Luchau

These instructional DVDs clearly present practicing manual therapists with unique, interesting, and fresh approaches that will increase effectiveness and inspire innovation. Join Certified Advanced Rolfers and Rolf Institute® Faculty members Til Luchau and Larry Koliha. Filmed at actual Rolf Institute®-sponsored trainings in the popular "Advanced Myofascial Techniques" series. Check it out.

http://www.terrarosa.com.au/til/amt.htm The DVDs will be available in Mid September 2007

 

Introduction to Ortho-Bionomy

Ortho-Bionomy is a non-invasive, body therapy which is highly effective in treating chronic stress, injuries, pain and problems associated with postural and structural imbalances. Similar to Positional Release, practitioner uses gentle, comfortable movements and positions to facilitate change in stress and pain patterns and to re-educate the body’s ability to function more efficiently. This 2 hrs DVD present the theory and demonstration of Ortho-Bionomy by Bruce Stark. Highlights · Release positions for all major joints in the body · Cervical, thoracic and lumbar spine and pelvis imbalances · Shoulder and arm pain and restrictions · Knee pain and dysfunction and ankle and feet imbalances.  http://www.terrarosa.com.au/dvd/position.htm#ortho