PT Classroom - Total Body Balancing: An integrative approach to optimum treatment and balance 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: An integrative approach to

optimum treatment and balance

Each day as a practitioner I am faced with the challenge of trying to understand, communicate and make a difference with each of my clients. As therapists, we are all faced with the frustration of dealing with multiple symptoms and countless possible contributing factors. It is very easy to get caught up in the call of symptoms and pain and to lose perspective of what is really going on.

From the many modalities that I have to offer my clients, I find Total Body Balancing (TBB) to be an invaluable approach to holistic treatment, balance and integration. TBB seamlessly integrates thorough evaluation, critical thinking and effective, non-invasive treatment by way of a full-body template into which countless modalities can be easily integrated.

TBB is based in classical osteopathy

Total Body Balancing incorporates both evaluation and treatment based on the philosophy of classical osteopathy. This five-phase template of treatment has evolved from the Body Adjustment introduced by John Wernham, a British osteopath and one of the key players in the development of classical osteopathy. I was honored to study with and be inspired by Wernham who, at the age of 99, was still treating patients and was still passionate about and constantly trying to improve upon his work.

Wernham felt that this complete treatment approach ensured that no aspect of diagnosis or body part was overlooked while creating an internal environment for healing. The rhythmical utilization of long levers (ie. An arm, leg, head/neck or torso) aims to relax muscles and their attachments; to release fascial tension around muscles, organs and the central nervous system; and to increase functional range of motion in joints and ligaments, thus improving circulation while appealing to and inhibiting the nervous system.

John Wernham did not discuss separate techniques like craniosacral therapy, visceral manipulation, myofascial release, muscle energy, or strain and counterstrain. Instead, he referred to 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.

To fully understand the philosophy behind and benefits of Total Body Balancing, it is important to take a closer look at the principles upon which osteopathy is built. It looks at the body, not as a machine made up of independent parts, but as a vital mechanism. This implies that every part of the body is not only interconnected but interrelated.

Dr. A.T. Still, the founding father of osteopathy, emphasized the importance of this understanding by stating that the body is a whole and that the whole is greater than the sum of its parts. This treatment philosophy is often termed the maximal approach as opposed to the minimal mindset that lures us into treating based on symptoms alone.

When we approach the body holistically, we can see how a pumping motion applied through the long axis of the leg releases fascial tension through the ankle, knee and hip. It also encourages lymphatic flow and releases joint restriction through the hip and sacroiliac joints while coaxing out tension in the dural tube, craniosacral system, and entire vertebral column. We begin to understand how creating a rocking motion through the spine of a patient in prone position not only addresses articular restriction in the facet joints, but it also releases visceral tension while inhibiting an overly stimulated sympathetic nervous system.

The Total Body Balancing template not only allows us to work with multiple systems simultaneously, but it also gives us a foundation into which we can incorporate more specific techniques. If you have multiple therapeutic tools at your disposal, Total Body Balancing will give you a starting point to help you to determine when to incorporate these tools as well as an end point to integrate any releases that may have occurred during the treatment.

TBB addresses interconnections and contributing lines of tension

As manual practitioners, we are often faced with the dilemma of attempting to identify the root cause of a patient’s symptom. If we consider a painful low back, we must also appreciate the correlation of multiple influencing structures.

For instance, rather than assuming that the 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 which attach into the humerus and can affect the biomechanics of the shoulder. We should also investigate the rib cage 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 could also 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 restriction 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.

Where do we start? What is the key to unlocking the dysfunction? The beauty of the Total Body Balancing treatment is in its ability to address 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. Its effectiveness, however, comes from the ability to evaluate and monitor change prior to and during the treatment process.

TBB uses A.R.T.S. to evaluate

The osteopathic-based approach to treatment begins and ends with evaluation. Not only does evaluation help the therapist to determine the nature of the dysfunction as well as the priority of treatment, but post-treatment evaluation helps to build the confidence and credibility of the practitioner while reassuring the patient of his or her continued improvement.

Total Body Balancing incorporates a user-friendly but comprehensive evaluation that will become an invaluable tool in your practice. Evaluation is based in the principle known as A.R.T.S.

The A stands for 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.

R stands for 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.

T stands for 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.

Finally, S stands for 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.

TBB follows a five-phase treatment template

If you are using evaluation within your practice pre- and post-treatment, do you ever wonder why the changes that you elicit during one treatment don’t seem to last from one session to another? Perhaps it is the aspect of integration that you are missing from your practice. Total Body Balancing gives you a template through which you can integrate the whole body in as few as 20 minutes.

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.

This gentle and appealing approach is appropriate for a wide range of clientele—from pediatric to geriatric patients, acute or chronic pain patients, athletes with sports injuries, orthopedic patients, and internal-medicine patients. If you are looking for an effective and efficient way of evaluating and treating that will lead to longer-lasting results, while taking the guessing game out of treatment, then consider adding Total Body Balancing to your practice.

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

Last revised: January 18, 2015
by Dr. Kerry D’Ambrogio, D.O.M., A.P., P.T., D.O.-M.T.P.

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