Now that we have determined where the Area of Greatest Restriction (AGR) is located, we must figure out WHAT problem (s) we are dealing with. One of the Principles of Osteopathy is that we know that the body protects around a Hierarchy of Importance.

The body responds to an injury in a certain order to protect crucial parts of the body from damage and increase the chances for survival. Andrew T. Still, DO called this the “Rule of the Artery” because the blood supply is vital for every living creature. He felt that this hierarchy was essential for survival. For example, if the blood supply were compromised secondary to an injury, there would be limited life force available to help the body heal.

HIERARCHY OF IMPORTANCE

1. Vascular System (arterial/venous), Lymphatic System, and unifying Fascia
2. Central, Peripheral, and Autonomic Nervous System
3. Organs (Viscera)
4. Endocrine System
5. Musculoskeletal System

But if a muscle is “stuck” in contraction (spasm), it is not “moving” anything and is “protecting” around something. The next step is to find out what that something is. Using the hierarchy model listed above while examining the AGR, this will help you decide the appropriate technique for the problem.

For example, a sub-lumbar muscle spasm (e.g. iliopsoas) may arise from a problem with nearby vascular structures (e.g. the aorta), Cisterna Chyli (lymph), nervous system structures (e.g. spinal cord and nerves), organs (e.g. kidneys and ureters); endocrine system (e.g. ovaries) or a problem with the muscle itself.

This diagnostic process is essential. “We cannot treat without knowing what we are treating!
We learn through touch – thinking, feeling, seeing, knowing fingers.” – (Dr. Sutherland, DO)

In summary: In Animal Normalization Techniques (ANT), we use the musculo-skeletal exam to determine the Area of Greatest Restriction using the concept of muscles are “movers” or muscles are “protectors“. Muscles should be moving bones, and when the muscles are in spams, what are they protecting around? – is the GOLDEN question? ANT uses the Hierarchy Protection Model to figure out what we are protecting around! When we have located the area of greatest restriction, we decide what is the appropriate technique for the problem we have found.