PT Classroom - Total Body Balancing: A holistic approach to treatment, balance and integration by Kerry D’Ambrogio, D.O.M., A.P., P.T., D.O.-M.T.P.

Kerry D’Ambrogio is a physical therapist, osteopath and board-certified acupuncture physician. He is the president and director of the D’Ambrogio Institute and Therapeutic Systems, Inc., in Sarasota, Fla. He is the co-author of Positional Release Therapy (Mosby). D’Ambrogio is a graduate of the physical therapy program at the University of Toronto (Canada), the osteopathic program at the Canadian Academy of Osteopathy (Hamilton, Ont.), the John Wernham College of Classical Osteopathy (Maidstone, England), and the acupuncture program at the Academy of Chinese Healing Arts (Sarasota, Fla.).

Total Body Balancing: A holistic approach to

treatment, balance and integration

It is a common scenario for bodyworkers: You make progress with a client during a session only to find at the next appointment that the changes didn’t hold. Why is that? More importantly, how can that outcome be turned around—especially in the face of multiple symptoms and numerous possible contributing factors?

In my own practice, I have found full-body integration to be the key—more particularly, Total Body Balancing (TBB). This hands-on approach seamlessly integrates thorough evaluation, critical thinking and effective, noninvasive treatment. It accomplishes this via a full-body template into which countless modalities can be easily incorporated. What’s more, the entire body can be integrated in as few as 20 minutes using the TBB template.

TBB considers multiple influencing structures to identify the root cause of a patient’s symptoms.

Total Body Balancing incorporates both evaluation and treatment based on the philosophy of classical osteopathy, which looks at the body as a vital mechanism in which every part is interconnected and interrelated.

For example, rather than assume that a patient’s shoulder pain is coming from the structures of the shoulder itself, we would be wise to consider the influence of the sacrum and lumbar spine, lower thoracic spine, and lower ribs through the fibers of the latissimus dorsi muscle and its fascia. These attach into the humerus and can affect the biomechanics of the shoulder.

We also should investigate the ribcage for restriction, keeping in mind that the visceral organs and abdominal fascia could be restricting the motion of the ribs and shoulder joint. Cranial tension also could be affecting motion and creating discomfort in the shoulder complex by way of the sternocleidomastoid muscle and/or the upper fibers of trapezius. It is important to remember that even restrictions in the foot or knee could be influencing the range of motion in a shoulder simply as a result of the vast interconnections of the posterior chain of fascia.

The Total Body Balancing template of treatment evolved from the Body Adjustment introduced by John Wernham, a British osteopath and one of the key players in the development of classical osteopathy. In his work he referred to an osteopathic treatment that is based on critical thinking, philosophy, anatomy, physiology and principles. He believed that he could seamlessly address all of the systems of the body with the Body Adjustment. This complete treatment approach ensured that no aspect of diagnosis or body part was overlooked while creating an internal environment for healing.

Total Body Balancing addresses all of the interconnections and contributing lines of tension by helping to realign the body to the lines of force acting upon it and to re-establish a healthy homeodynamic state.

A.R.T.S. for evaluation; a five-phase template for treatment

Total Body Balancing incorporates a user-friendly yet comprehensive evaluation process based in the principle known as A.R.T.S., which stands for asymmetry, range of motion, tension tests and special tests. Its effectiveness comes from the ability it provides therapists to evaluate and monitor change prior to and during the treatment process. Here is how it works:

Asymmetry. A healthy body is a body aligned with gravity. TBB teaches you tools to use to evaluate asymmetry in the body, whether it be through posture, tissue tension or range of motion.

Range of Motion. This aspect of the evaluation teaches you how to evaluate range of motion of the spine, ribcage, and upper and lower extremities, and to determine patterns of resistance and limitation.

Tension Tests. Healthy tissue feels soft, supple and has a springy end feel. If the sensation is hard and restrictive, this is an indication that somatic dysfunction is present.

Special Tests. The quick, yet concise evaluation taught within Total Body Balancing utilizes orthopedic testing to confirm previous findings. These findings paint a picture of the overall pattern of tension and body armoring that is representative of the stress that the patient is carrying, be that physical, mental, emotional, or a combination of all three.

Your evaluation will help not only to determine your focus within the treatment sequence, but it also will help patients to see where they are holding tension.

Following evaluation, a typical balance starts in supine position and works from the base upward using gentle, rhythmical oscillatory movements. Oscillation is an inherent motion in the body, and it works to balance sympathetic and parasympathetic activity while increasing circulation of arterial, venous, lymphatic and axoplasmic flow. The calming of the nervous system aids in decreasing pain and improving mental and emotional outlook. In the supine position we also address the bowstring, which is the influence of the ribcage and the organ system above and below the diaphragm on the spine.

Once tension patterns have been addressed in supine position, the treatment continues with positioning in prone. During this phase the pelvis is further mobilized. This is followed by rhythmical release of the entire spine and shoulder girdle, which is now made easier after the release of the bowstring from the supine position. Oscillation performed in prone position serves to further increase organ motility.

The third, fourth and fifth stages are performed in side-lie and seated positions. Re-evaluation is an important final step to mark progression and change of the A.R.T.S.

Applying the TBB template allows you to work with multiple systems simultaneously. It also gives you a foundation into which you can incorporate more specific techniques that you may have at your disposal. TBB provides you with a starting point to help you determine when to incorporate these tools as well as an end point to allow you to integrate any releases that may have occurred during the treatment. Of the many modalities that I have to offer my clients, I find Total Body Balancing to be an invaluable approach to holistic treatment, balance and integration.

For more information regarding Total Body Balancing, how it can benefit your patients, and training seminars, please go to

Last revised: June 18, 2013
by Dr. Kerry D’Ambrogio, D.O.M., A.P., P.T., D.O.-M.T.P.

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