There is no structure in the body that quite compares to the spine. Its centrality, size, and crucial role in support and movement, as well as its integral relationship with the central and peripheral nervous systems, all mean that the spine has a unique and important role in hands-on work.
The importance of the spine is reflected in the way we use its name in everyday speech. Roget’s Thesaurus lists the word spine as a synonym for “core,” “foundation,” and “basis” (as in “the spine of his philosophy”), as well as for “perseverance,” “decisiveness,” nerve,” and “fearlessness.”1 Think about what it means to “have a backbone,” or to be “spineless”; linguistically, we relate our spine to our very character, strength, and human resilience.
Embryologically and evolutionarily, the spine’s precursor (the notochord) is one of the first structures to distinguish itself from the matrix of rapidly dividing cells in a developing. After just 20 days, a human embryo has segmented its midline into the somites that will become our individual vertebrae (Image 1). These proto-vertebrae give rise to other structures as well: many of our musculoskeletal and connective tissue structures develop outward from this longitudinal arrangement of cells as we grow, making the spine the root structure for much of our musculoskeletal form.2
The spine and vertebrae are directly involved in several of the most common client complaints, including:
• Rib pain (since the ribs articulate directly with the vertebrae at the ligamentous costovertebral joints).
• Neck pain or injury, including whiplash (the neck being the uppermost section of the spine, and thus dependent on the supporting sections below for its stability and ease).
• Sacroiliac issues (the sacrum and its paired sacroiliac joints being the base of support for the entire spine, and in turn subject to the forces of flexing, extending, bending, and twisting coming from the long lever of the spine above).
• Sciatic pain (especially axial sciatic pain, as discussed in “Assessing Sciatic Pain,” Massage & Bodywork, July/August 2011, page 110).
• And of course, back pain itself (which affects 9 in 10 people at some point in their lives3), as well as other spine-related issues such as scoliosis, spondylolisthesis, etc.
The mobility of the spine, both of individual vertebra and of the entire structure, plays a role in each of these issues. Since “increased options for movement” is one of the primary goals of Advanced Myofascial Techniques work, we can often play a helpful role for our clients with these spine-related issues.4

Vertebral Motion Disparities
Coupled-motion biomechanics is a set of principles that have influenced numerous manual therapy disciplines, including osteopathic manipulation, physical therapy, Rolfing structural integration, rehabilitative massage, and other manual therapy modalities.5
At the risk of oversimplification, I’ll attempt a brief overview. The spine’s overall mobility is determined by the combined smaller motions between individual vertebrae. This motion between vertebrae can be restricted by their surrounding ligaments and myofascia (Image 2), and in the thoracic spine, by soft tissues surrounding the costovertebral joints (Image 3). When these soft tissues are elastic and differentiated enough to allow unrestricted vertebral motion, normal activities like breathing, walking, and bending will cause the vertebrae to move in all three dimensions in relationship to their neighbors.
Most biomechanics authors (though not all) agree that due to their bony shapes and complex soft-tissue interconnections, these movements are often coupled so that movement in one plane is automatically accompanied by motions in the other two planes (Image 4).6 According to one moderately large study (n=369), physiotherapists of diverse backgrounds view coupling biomechanics as an important part of their hands-on approach, with more than 85 percent of therapists surveyed indicating that lumbar coupling biomechanics were ‘‘very important’’ or ‘‘important’’ in their application of manual therapy.7
Interestingly, in spite of the importance placed on biomechanical coupling by many practitioners, there is little agreement about the optimal direction of this coupling, with several conflicting models of “normal” spinal biomechanics in existence. For example, some models (such as Fryette’s Laws) assert that in a neutrally positioned spine, when the lumbars sidebend to the left, they rotate right; others (Lovett) say the opposite (i.e., left sidebending is coupled by left rotation); while still others (Roland) say there is no coupled motion at all in this situation.8 Real-world studies of asymptomatic 3D spinal motion have not settled these disputes, as different studies have shown “variable” and contradictory results, particularly at different levels of the spine.9 One likely possibility (which has been documented in coupled motion controversies about other parts of the body10) is that healthy individuals’ joints do not all seem to move in the same ways, probably due to differences in bone and joint shape. One recent overview of biomechanical theory concludes that although cervical dynamics are similar from person to person, “no consistent coupling behavior has been demonstrated in the thoracic or lumbar spine.”11 In other words, in spite of being an important aspect of many hands-on modalities, some of the fundamental “laws” of spinal biomechanics don’t seem to apply in many cases.
As practitioners, where does this contradiction and uncertainty leave us? Speaking only for myself, after having studied, used, and taught Greenman-influenced coupled-motion biomechanics for many years, my approach has become more pragmatic than theoretical.12 My current working hypothesis is that mobility is indeed vitally important for pain-free, easy functioning, but that concepts of “normal” or correct biomechanical motion are probably less predictably meaningful. As a guiding principle, it might be said simply that when things don’t move enough, and in different directions, they don’t feel good; when we can help them move again, they feel better.

Vertebral Mobility Technique
A good example of this simple principle at work is the Vertebral Mobility Technique. Because it allows the practitioner to feel, see, and address vertebral mobility restrictions, and because it can quiet and focus the client’s attention, we use this technique in our Advanced Myofascial Techniques trainings before performing other work with the spine or rib cage. On its own or in combination with other techniques, it is indicated as assessment and preparation for many of the spine-related conditions listed at the beginning of this article.
Standing beside your prone client, gently, but firmly, grasp the spinous processes of several thoracic vertebrae (Image 5). When the spinal erectors are very large, the spinous processes can be deep and hard to grasp; if this is the case, use a deeper touch, or the sides of your fingers, rather than fingertips alone.
Use the spinous process as a handle to gently move the group of vertebrae from side to side, using small, rhythmic motions to rock this group of vertebrae within their attachments to the surrounding ribs (Image 3). Begin delicately, feeling for the amount of subtle mobility that is possible with very little force. Is the motion and resistance the same left and right? Don’t confuse position with mobility—a vertebra’s spinous process can be hooked or bent to the side, independent of its mobility. Does movement vary from place to place? Investigate this subtle rotational movement throughout the spine, noting restrictions as you find them. Often, these small, focused movements will result in more vertebral movement, probably as a result of mechanoreceptor stimulation, postural reflex shift, and increased proprioception.
After assessing subtle mobility, you can begin to move a bit more vigorously, still within your client’s level of comfort, of course. Use a fuller, firmer rocking motion on any areas where you found restrictions. Use caution if any of the usual contraindications to deep work apply—in particular, suspected osteoporosis (see “Working with Rib Restrictions,” Massage & Bodywork, January/February 2012, page 112), recent injuries, or acute disc issues. But in most cases, the motion can be spirited, strong, and adventurous throughout the lumbar and thoracic spine. The vertebrae are firmly held by their ligamentous and articular connections, so you can use the body’s momentum to assess and increase their side-to-side mobility.
Feel both for grouped restrictions, and, by moving single vertebrae against each other, for pairs of vertebrae that are fixed together (Images 6 and 7). Go back and forth between these global and local levels, feeling also for whole-spine harmonics (waves that move all the way up and down), and for the small-scale jiggling of individually immobile vertebra.
With care, you can also apply this technique to many of the cervical vertebrae, gently feeling for side-to-side mobility of each of the neck vertebrae that you can palpate. A face cradle or tabletop bolstering system is necessary, so that the neck is not rotated to one side.
This technique assesses and increases the rotational freedom of the vertebrae. That doesn’t imply that the other directions of movement aren’t also important; in the Advanced Myofascial Techniques series, we use different techniques to assess and mobilize those motions as well. Especially with issues such as scoliosis or long-term fixations, you’re likely to identify areas with this assessment that you’ll want to address with other techniques and methods. But even by itself, this assessment and preparatory technique can be quite effective and satisfying. As a client, the experience of having each of your vertebrae mobilized in this way can be deeply relaxing, leaving you primed and ready for the rest of your session.

Notes
1. Roget’s 21st Century Thesaurus, 3rd ed. (Princeton: Philip Lief Group, 2009).
2. Thomas W. Sadler, Langman’s Medical Embryology, 12th ed. (Lippincott Williams & Wilkins, 2012): 63.
3. J. W. Frymoyer, “Back Pain and Sciatica,” New England Journal of Medicine 318, no. 5 (February 1988): 291–300.
4. Til Luchau, Advanced Myofascial Techniques, Vol. 1 (Handspring Publishing, 2015): 8.
5. C. Cook and B. Showalter, “A Survey on the Importance of Lumbar Coupling Biomechanics in Physiotherapy Practice,” Manual Therapy 9, no. 3 (August 2004): 164.
6. Lisa A. DeStefano, Greenman’s Principles of Manual Medicine, 4th ed. (Lippincott Williams & Wilkins, 2010).
7. Cook and Showalter, “A Survey on the Importance of Lumbar Coupling Biomechanics in Physiotherapy Practice,” 167.
8. Ibid., 165.
9. Ibid., 166.
10. M. Bozkurt et al., “Axial Rotation and Mediolateral Translation of the Fibula During Passive Plantarflexion,” Foot & Ankle International 29, no. 5 (May 2008): 502–7.
11. Jon Parsons and Nicholas Marcer, Osteopathy: Models for Diagnosis, Treatment and Practice (Elsevier Health Sciences, 2006): 36.
12. Lisa A. DeStefano, Greenman’s Principles of Manual Medicine.

Til Luchau is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout North America and abroad. He is a Certified Advanced Rolfer and originator of the Advanced Myofascial Techniques approach. Contact him via info@advanced-trainings.com and Advanced-Trainings.com’s Facebook page.

An expanded version of this column will appear in Til Luchau’s upcoming book, Advanced Myofascial Techniques, Vol. 2, to be published early 2016 and available at Advanced-Trainings.com.