The Shorthand gave you the language: you can take a card written by a stranger and say every line of it aloud. This article is what stands between reading that card and giving it — the patient has to be put somewhere, and put there correctly, before a single line can be delivered.
Placement is not preparation for the treatment. It is part of it. The same foot, on the same square inch of the same thigh, is one point when the leg is propped straight and another when the patient is holding it straight herself — and a student learning position from a page gets it wrong in ways he cannot see. So this article is exact about the body, and says plainly what each error costs. (Figure 15.1)
Watch
What the position decides
Change the arrangement and you change the treatment, not its strength
A formula is a list of point applications in a fixed order, and each carries silently a fifth instruction alongside its place, count, angle and order: the arrangement of the body receiving it. Change the arrangement and you change the angle at which pressure enters, the length and tension of the muscle it enters, and what lies underneath — a different treatment, not a gentler version of the same one.
The four positions, and what the arrangement of the atlas is telling you
Every treatment point in this therapy is given in one of four positions:
पीठ के बल लिटाकर — supine, laid on the back. Supine कुर्सी पर बिठाकर — seated, on a chair. Seated करवट में लिटाकर — side-lying, laid on one side. Side-lying उलटे यानि पेट के बल लिटाकर — prone, laid face down. Prone
The atlas is filed under these four headings and nothing else, and the reason is practical: turning a patient costs time, comfort and dignity, and in a frail patient more than all three. So a formula is performed as a route through the four positions — everything one position yields is gathered before the patient is moved.
A therapist who reads a card straight down the page and turns the patient at every line has understood the formula, not the session.
The five general rules of giving, before any point is named
1. Pressure may be given either with the hand or with the feet.
If with the feet, lay the patient down between two upturned chairs and, taking your weight on your hands upon the chairs, give the treatment. Place a pillow at the proper place as required.
2. Wherever pressure is to be given, at all such points it is ordinarily held 6 seconds and released.
3. While giving pressure, place your heel or your palm so that the weight falls over a broad surface, not on a single point, and so that the muscles are drawn inward, not outward.
4. When treating very small children, use the soft part of the palms, so laid that the whole palm rests on their thigh and the pressure is not felt as pressure. If the palm is held crooked, or pressure is given with the edge of the palm or with the fingers, they will not bear it and will begin to cry.
5. When giving pressure with the foot or the heel, your body weight must be so directed that the muscles are drawn inward, not outward — otherwise the patient will have a great deal of pain, because it would be against the natural direction of the muscles.
Rules 3 and 5 are the whole physics of this therapy in two words. Broad, and inward. Broad, because the same weight through a wide flat contact is a firm even push and through an edge is a blade. Inward, because a muscle belly sits in a sleeve of tough tissue that already packs it toward the bone: press along that packing and it takes the load as it is built to; press the other way and you are prising the sleeve open sideways. (Figure 15.3)
The two chairs, taught as technique
Close, square, moved rather than reached over — the dosing instrument
Before You Touch Anyone put the two chairs in the room; see also → Before You Touch Anyone, "Before You Touch Anyone". Here they become the instrument by which the dose is measured out.
Two ordinary four-legged chairs are stood facing each other and turned over, so their seat and back frames make parallel rails at about hip height. The patient lies between them; you stand astride, both hands on the frames, and most of your body weight rides on your arms. What reaches the patient is only as much of you as you deliberately let down, and you can take it back in an instant. A therapist without chairs has one setting: all of himself. (Figure 15.2)
The rule for the paired-limb treatments and the rule for the single-thigh treatments differ, and each is complete where it stands.
Where the weight goes — two stances, each with its own treatments
For Liv and its family — both feet on the patient. Keep the weight equal on both feet, and as far as possible try to keep your own knees straight, so that you will not tire. Both sides
For Gal and Spl — one foot on the patient. Do not bend your knee. Give the pressure with the middle part of your sole, lift the other foot clear of the ground and stand straight, so that your full weight comes onto the patient.
In the first, two feet share; in the second, one carries and the other is deliberately lifted clear so nothing is left behind on the ground. In both the knee is straight. Left Right
Propped straight, not held straight
If the patient's legs stay straight, better results come.
But if the patient straightens their own legs, the muscles stay tight and they will be uncomfortable — so place a pillow on the outer side of the legs for support, to stop them rolling outward.
A muscle the patient is actively holding is short, stiff and cannot lengthen under your pressure; propped in the same shape it is quiet, long and receptive. The shape is identical; the tissue is not.
Loading one foot at a time
One foot without pressure, then the second, and only then your weight
This is the rule most often abandoned once a student is confident, and the one that prevents accidents.
When it is ignored, nothing dramatic happens — which is the difficulty. Both feet arrive together, the abdomen tightens, and you read that as the thigh "being hard today". The treatment goes into a braced body week after week, and improvement is slower than it should be for reasons nobody can name.
The soft middle of the sole
Broad, flat and thickly padded: the toes prick, the heel leaves pain
The sole is the palm's larger cousin — the thickest skin on the body, padded with fat divided into small sealed chambers by tough partitions, so a load spreads sideways instead of driving through. But only part of it is the tool.
Always from the middle part of the sole
Always give pressure from the middle part of the sole only.
If you press with the toes — the patient will feel a pricking sensation on the thigh, and you yourself may get pain in your calves.
If you press with the heel — the patient will feel pain at that place for a long time after the treatment.
Whichever part is named, rule 3 above still governs how it is laid. ▲ Take care
The toes are a row of small bones with almost no padding under their ends, so your load arrives through narrow ridges rather than one broad pad — hence the pricking; and to press with them you must rise onto the forefoot, holding your body on tiptoe six seconds at a time, fifty times a morning — hence your calves. The heel is a blunt bone with a pad built for brief, high, repeated loads in walking — the wrong shape for delivering somebody else's weight into a soft thigh for six continuous seconds, because it arrives over a small, hard, curved area and stays. Injury from outside pressure depends on how much, over how small an area, for how long, and the heel is bad on all three. The middle is broad, flat, thickly padded and genuinely soft: that is the tool. A thigh that feels dense does not need a smaller contact; it is a finding.
None of which forbids the heel where a treatment names it — and several do: the lumbosacral work is given with both sole and heel touching the back, the sacral points with the heels, and Pit with both heels very close to one another, pressed downward and inward. Where the heel is the named contact, rule 3 governs: lay it so the weight falls over a broad surface, not on a single point. It is forbidden as a substitute for the mid-sole, not where it is prescribed.
The station rule — no empty space between joints
Three places ordinarily — but the rule is the bare space, not the count
Most treatments are given not at one spot but at a series running down a limb, and the places are called stations. Students want a number; the therapy gives one, then tells you the number is not the instruction.
How many places, and the rule that decides it
For Gas, Gas I, Gal, Spl, Liv, Mu, Lt. Ov., Rt. Ov. and WD, three places is enough for an ordinary person — but this depends on the length of the patient's thigh and the width of the therapist's foot.
The main issue is that no space should be left empty from one joint to the other joint.
a. For a tall patient, four places may be enough for an ordinary therapist — but if the therapist is a young child, then even five places may be needed, and that too is correct. b. For a very small child, even two places may be enough. c. This is a matter of experience.
And where both feet are on the patient: while giving WD and Pit, keep equal weight on both soles → pay attention to this. Both sides
Nobody tells a painter how many strokes; they tell him not to leave bare wood. Lay each contact where the last ended, work from the upper joint to the lower, and count afterwards — deciding the stations before any weight goes down, and writing the number you used on the card.
Position one — supine Supine
Rolled down onto the side, legs propped straight, pillow at the thighs
Printed along the foot of every page of the supine atlas, applying to all of them:
The standing pillow rule, and its two exceptions
Place the pillow at the proper place as needed — but never under the head, and never under the back. Supine ▲ Take care
Why not the head. Unless it is needed, no pillow should be placed under the head, so that the spine stays straight. A head lifted on a pillow flexes the neck and tilts the whole column out of the line your pressure travels along.
Why not the back. The pillow must not come under the patient's waist, or they may get back pain during or after the treatment. Supine on a firm floor the low back already sits in a slight arch, and a pillow there deepens it and holds it so all session. A pillow at the knees is a rest; a pillow at the waist is a strain held for half an hour.
First stated exception — the head, in one named circumstance. Those who have cervical spondylosis may become giddy while taking the Pan treatment. They may be given a thin pillow under the head. Note every qualifier: cervical spondylosis, the Pan treatment, giddiness, a thin pillow.
Second stated exception — the head, for a whole position. In all the side-lying treatments a pillow under the head is needed, so the neck rests comfortably; for those who have neck pain or cervical spondylosis this precaution is compulsory. The rule against a head pillow belongs to the supine atlas; it does not travel onto the side.
The back has no exception. While treating on the chest, take care that no pillow lies under the back. None. A pillow there arches the ribcage up into your pressure, and the chest wall takes your load with no give left and the spine acting as a fulcrum. ▲ Take care
Before You Touch Anyone carries the full pillow table, treatment by treatment — one under both thighs for Pan and Gal–Spl; two for Liv⁰ and Mu⁰, the second under the shoulder with its edge against the side of the chest and not pushed in; a flat uniform pillow under the hand for the arm treatments; as a rule none for WD. The principle belongs here: a pillow is not comfort, it is positioning, and a treatment given without its pillow is a different treatment.
Where the therapist stands, supine. Five stances cover the group. Astride at the joint of thigh and waist, for both thighs or one thigh from hip to knee — Pan, Gal, Spl. Both sides Astride at hip level, one foot to an arm and one to a thigh — Liv Left , Mu Right , Liv⁰, Mu⁰. At the head end, feet either side of the neck, for both arms elbow to wrist — WD, the feet brought to the elbows one by one. At the shoulder, heels turned in, for the armpit and chest. ▲ Take care And beside the heel, standing, for the legs and feet raised by hand — ONS, raised only to the height of your own standing hands.
The points belong to The Front of the Body I, "The Front of the Body — I", and The Front of the Body II, "The Front of the Body — II". Notice the pattern: you stand at the joint above what you are treating and work downward toward the joint below — hip to knee, elbow to wrist, the way the muscles run and the drainage goes.
Position two — seated Seated
Feet flat, back supported — and lying down if the patient is weak
The brain, medulla, neck, head, face, jaw, ear and sinus points are given on a chair, almost all of them with the hands. On the mat the governing questions are balance and weight; on the chair they are the height of your own hands, the patient's neck and your fingernails.
The seated position has a stated alternative
If the patient is very ill or very weak, these treatments may also be given lying down.
That is a rule, not a concession, and it carries through the whole seated group: a patient who cannot sit unsupported for fifteen minutes spends them holding herself up, recruiting every muscle from pelvis to jaw — including the ones you are treating.
One group crosses the other way. Organ Clearance can be given lying prone or seated on a chair, the therapist sitting on the patient's left side either way. And the standing and bending treatments are given seated on a chair, or laid straight — and if lying, the legs bent, both heels near the buttocks, both knees pointing up at the sky but somewhat apart from each other, the left leg first, then the right.
Where the therapist stands. Three stances, each named in the treatment that uses it: on the patient's left side — the commonest, for the neck and medulla work, the palm made round to cover both sides of the neck; behind, for the shoulder lifts, both hands over the tops of the shoulders; and in front, for the leg and standing treatments.
Position three — side-lying Side-lying
Head, knees and shoulder: three things, and two of them differ
Students get this position wrong most often: a body on its side has three things to arrange — head, knees, shoulder — and two differ between treatments.
In all the treatments given lying on the side, give a pillow under the head as well, so that the neck rests comfortably on it.
The rule for the whole side-lying group
Especially for those who have neck pain or cervical spondylosis, this precaution is compulsory. Side-lying ▲ Take care
Lie on the floor on your side without one and the reason is plain: the head hangs toward the floor and the neck is held in a sideways bend by the muscles above it for as long as you stay there. On a stiff degenerative neck, half an hour of that is a treatment in itself — and not one you prescribed.
Read the second row across and you have this article in one line: three knee arrangements — under the bent knee, between both knees, straight with the body — and three shoulder arrangements, one the opposite of another. Get Parkhoo's knees right and Acid's shoulder wrong and neither has been given properly. (Figure 15.4)
The number of pillows is not the instruction — the level of the knee is
The rule for the group says one or two pillows. The Acid instruction says two or three pillows, so that the knee is at the level of the waist.
Neither is counting pillows. The instruction is a level: the upper knee must not fall below the level of the waist. On a broad-hipped woman with a firm pillow that is one; on a thin man with soft ones it is three. Build to the level, then write the number on the card.
And note whom the rule names: for those whose thighs are very thin the pillow between the knees is especially compulsory — there is nothing between the two knee bones to keep the upper leg up, and the pelvis rolls forward the moment you begin.
Turning her is done in one piece. Ask her to bend both knees while still on her back; lay her upper arm across her chest; then, with one hand at the shoulder and the other at the hip, roll the whole trunk as one unit — rolled shoulder-first, a trunk twists along its length. Then the head pillow, the knee pillows, the shoulder.
Position four — prone Prone
The 1½ pillows under the chest, compulsory on every page of the group
The back, the spine, the sacrum, the backs of the legs and the soles are worked face down. Prone carries the strictest pillow rule in the therapy, repeated as a footer on every page of the group because it is the one people skip.
For the treatments given face down, putting 1½ pillows under the chest is compulsory — that is: (Figure 15.5)
Half of the lower pillow should stick out beyond the end of the mat.
The 1½ pillows — compulsory, and exactly what it means
The chest should rest on the upper pillow.
Their chin should rest comfortably on the lower pillow.
(Repeated on every single page of this group:) In all these treatments, do not forget to give 1½ pillows under the chest. Prone ▲ Take care
The chest is lifted so your pressure passes into the trunk rather than crushing the breastbone and rib cartilages against the floor; and the chin, resting forward on the projecting half-pillow, means the face points downward and the head stays straight — the neck is not turned to let the patient breathe.
Where the therapist stands, prone. Four stances, each named in the treatments using it: astride, feet on the ground between the waist and the thigh, the full weight on the hands with the chairs' support; standing comfortably near the waist, again with the weight on the hands; facing the other way, toward the patient's heels — the reverse of every other stance, stated as such where required; and sitting between the patient's feet, the heels facing each other.
Patients who must be treated by hand and not by foot
Small children, the very weak, osteoporosis — and those who cannot feel
The foot is the tool of an adult treatment. For four kinds of patient it is not the tool at all, and the substitution is a technique with its own rules.
How the hand is used on a very small child
Use the soft part of the palms, so laid that the whole palm rests on their thigh and the pressure is not felt as pressure. If the palm is held crooked, or pressure is given with the edge of the palm, or with the fingers, they will not bear it and will begin to cry.
Hear that the right way round. The crying is the measuring instrument — the only report you will get, and it reports one fault: a contact that has become narrow.
And the stations change with the size: for a very small child, even two places may be enough — the same rule, applied to a shorter thigh. × 3
For the elderly and the frail, four adjustments carry most of the way. Shorten the lever — work closer to the joint above. Support everything — every unsupported part is one she is holding up herself. Shorten the session, not the formula. Turn less.
Changing position in the middle of a formula
Group the card by position; change only in the gap between formulas
Any formula of length will move the patient at least once, and doing it without losing the sequence, count or timing rests on one decision taken before the session starts.
That last rule is arithmetic, not principle. Several treatments have a rest written into them: a pass at one station, then stop for one minute, then the next, through six. The vitamin group is counted 2, 4, 4 — press and release twice, after ten seconds four times, after ten seconds again four times. Those intervals are part of the treatment exactly as the six seconds are: a minute written into a formula is a minute of the treatment, not spare time.
What the gaps are for — all four kinds
1. The rest inside a formula.
Written into the treatment — stop for one minute, after ten seconds — and timed as precisely as the six-second hold; its work happens in the tissue during the interval, in the flush of blood that follows a release.
2. The gap between formulas. Where the position is changed, the chairs moved, the pillows re-laid, the patient re-draped.
3. The gap in which you speak. Ordinarily one does not talk to the patient during treatment. But when different formulas are given in one session, then in the gap after each formula one must certainly ask the patient how they are feeling.
4. The gap that makes the session bearable. For common ailments about thirty minutes a day is enough — and not continuously: according to the formula there may be gaps of a few minutes.
How a turn is performed. Tell her what is coming — "now I turn you onto your right side; do not help me." Re-drape before you move her; move her as one unit; head pillow, knees, shoulder; then place your chairs again and check your balance before any weight goes down. Under a minute rehearsed; three improvised in front of the patient. (Figure 15.6)
Questions students ask
- 1. I am twenty and strong. Do I really need the chairs, or can I just be careful? You need them, and not for strength. The chairs let you take your weight back in the middle of a six-second hold, instantly and without a step. A therapist balancing on a patient has no reverse gear.
- 2. The card says three stations and my patient is six foot two. Do I follow the card? Follow the rule the card is built on: no space left empty from one joint to the other. Three suits an ordinary thigh and an ordinary foot; on a tall patient it may be four, and if the therapist is a child, five. Write on the card how many you used.
- 3. I am a retired teacher learning this for my husband, and my knees will not let me stand for long. Much of the seated group is given standing beside a chair, some sitting beside the patient; and on the mat the weight rides on your arms, not your knees. If the stance is beyond you, the hand treatments are open. See also → The Child, the Elder and the Frail, "The Child, the Elder and the Frail".
- 4. I am a physician. Is there anything in the positioning I should be alert to that you have not said? Three things: prolonged supine lying in pregnancy beyond about twenty weeks, where a left lateral tilt is safer; prone positioning in anyone significantly breathless; and sustained end-range neck rotation, which the 1½-pillow arrangement exists to avoid.
- 5. Why does the therapy insist the patient not help, when helping is faster? Because the muscles doing the helping are usually the muscles under your foot, and a contracting muscle is short, stiff and unable to lengthen. It is also the commonest way a correctly placed pillow ends up wrong.
- 6. I have no science at all. Why is the flat middle of the foot better than the heel? Both are the same foot. Press your own thigh with the flat of your palm, then with a knuckle, using the same effort: two different sensations, because the same force in a smaller patch is a bigger pressure on every square inch beneath it. The heel is the knuckle of the foot.
- 7. Two of our therapists place the side pillow differently for the same point, and both say they were taught that way. Look at what the rule measures. There the instruction is a level — the upper knee not below the level of the waist — not a number of pillows, so two firm ones and three soft ones may both achieve it. If the levels differ, one is wrong.
- 8. I work alone in a village and there is nobody to hold a leg up. A pillow, a folded blanket or a wall will hold most things a hand would; what you must not do is ask the patient to hold it. Where a treatment needs a second person, recruit whoever came with her and teach them their one job.
Questions patients ask
- 1. "Why do you keep moving me? Can't you do it all with me lying like this?" I could give the treatments that belong to this position but not the others — each point is given in one particular arrangement of the body, and given in another it becomes a different treatment. What I can do is move you as few times as possible: today, twice.
2. "I want a pillow under my head. Why won't you give me one?" Because lying flat keeps your spine straight, and the treatment is planned for a straight spine. It feels strange for a few minutes and then it does not. There are two situations where you will have one — a thin one if you become giddy during one particular treatment and you have a neck problem, and always when you are lying on your side.
- 3. "My back hurts after the session. Is that the treatment?" It should not be. It usually means the position rather than the pressure — most often a pillow that has travelled under the waist because the patient lifted her hips to be helpful. Tell me the moment it starts, and we change it today.
- 4. "I feel ashamed lying face down with my back uncovered." Then we will not do it that way. You stay covered, I uncover only the part I am working on, and I tell you before I move the cloth. If you would like someone of your own to sit with you, I will ask them in.
5. "My feet burn at night and I can't feel anything under them by day. Should you be treating my feet?" Not with my foot, and not on the soles. The safety of this therapy rests on your being able to tell me that something hurts; where feeling has gone that warning cannot reach me, so below the knee I work with my hands and gently. And look at your soles every night with a mirror: a crack, a blister or a callus with a dark centre goes to the foot clinic this week.
Words used here
| Hindi | English | Neurotherapy code / usage |
|---|---|---|
| सीधा लिटाकर / पीठ के बल (sīdhā liṭākar / pīṭh ke bal) | Laid straight; on the back — supine | The position of most of the atlas; Supine |
| कुर्सी पर बिठाकर (kursī par biṭhākar) | Seated on a chair | The brain, neck, head and face group; Seated |
| करवट में लिटाकर (karvaṭ meṁ liṭākar) | Laid on the side — side-lying | Always on a named side, right or left; Side-lying |
| उल्टा लिटाकर / पेट के बल (ulṭā liṭākar / peṭ ke bal) | Laid face down — prone | 1½ pillows under the chest, compulsory; Prone |
| तकिया (takiyā) | Pillow | Positioning, not comfort. Never under the head, never under the back |
| डेढ़ तकिया (ḍeḍh takiyā) | One and a half pillows | The prone arrangement; the chin rests on the projecting half |
| तलवे का बीच (talve kā bīc) | The middle of the sole | The contact surface for all foot pressure |
| एड़ी (eṛī) | Heel | Used only where a treatment names it, laid so the load spreads |