Sequential unfolding

Posted 11/08/21 by Malcolm Hiort and filed under:

A name for the levels of compensation in the body and the process of interpeting changes in assessment as those client compensations abate with therapy. Here is a brief case study to illustrate.

I have assumed that experienced therapists are conscious of changes to a client’s somatic status (how their body tensions feel to the hands) during a treatment session.

I hadn’t seen Margaret for a year, with only two treatments in the last 21 months, but she was a regular client and I knew her body well, having started in 2002. Recent acute lower back pain was her prime issue. When I was passively palpating her sacrum and ilia my felt memory registered that her pelvis felt different to the usual compensation pattern she has.

I was prompted to write today by the very distinct changes, from one presentation to another better state, with each application /variation of my technique, as her pelvis slowly normalised. This is very familiar to me but today there was not just one potentially misleading overlay of compensation, with its temporary indications of what was wrong, but several.

As we worked with her pelvis for the entire hour I would regularly reassess, as I usually do, with subtle leg tractions. I teach and use a ‘tablecloth’ analogy to help locate the restriction pattern at that time. (If I slowly pulled it, whereabouts on a tablecloth would I feel a weight, resistant to movement?) Hope I’m not losing you.

Each time after a technique her ilia /hip levels were changed, but still not balanced. There is more to it than this, but let’s stick just with the ilia in the transverse plane. We went through perhaps five quite distinct phases or layers of her patterns. This was the most layers I have ever consciously encountered. It had been a year since her last treatment, so her body had built up a few of them.

To bring this description to a discussion point for: if I had assessed her only once at the beginning, (as seems common amongst massage therapists and bodyworkers) I would have been eventually working in the wrong, less effective places, and her hips may never have normalised.


The Presentation of the client could have been anything; likewise the assessment methods used could have been anything. My discussion point is the cascading, unfolding nature of client responses, and how assessment needs to keep up with that, not be harpooned to an initial, perhaps only, assessment rock, which in my opinion can shackle and sabotage the treatment.

Assessment sounds good, but does it recognise the evolving signals from the client’s body during the session, and lead to the ‘most effective’ treatment options? We try our best, but could it be better if our methods were more dynamic and in-time, instead of operating on redundant information?

Regardless of what we think is wrong with the client ‘first up’, it is good practice to keep checking that

Malcolm Hiort 25/1/20 (ed 8/11/21)