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Massage Today
June, 2013, Vol. 13, Issue 06

Freeing the Heart: Protection of the Hip and Shoulder Joints

By Dale G. Alexander, LMT, MA, PhD

As we continue with this current series of articles on Freeing The Heart, if we consider the basic physiology of the human circulatory system, it seems evident that when the heart and lungs reach full expansion with a minimum of resistance, the heart will eject more blood and at a greater velocity.

When more blood exits the heart with greater speed, these variables increase the probability that freshly oxygenated and nutritious blood will reach all body tissues. Thus, as massage therapists, focusing our attention on reducing resistances to the expansion of the heart and lungs is one clear way that we may assist our clients with chronic somatic dysfunction; including those with either identified or unidentified cardiovascular disease.

In previous articles of this series, the major "intrinsic resistances" to the heart's expansion have been described. However, there are three additional "extrinsic" variables that reflexively contribute to the chronic tension of the thoracic cage. The first two are hip and shoulder subluxations, while the third is known as a Lateral Trauma Reflex.1,2

Typically, massage therapists do not use the word subluxation, yet this is what I consistently find in the hips and shoulders of most clients with chronic somatic dysfunction. To my perception, the generic definition of a subluxation in this regard is when the head of the femur or the humerus has moved far enough to the edge of its joint capsule so that the potentially unstable position stimulates the reflexive protection of the surrounding myofascial elements whose job it is to prevent dislocation. These subluxations may be mild, moderate or severe in my experience. Since first identifying and tracking these dysfunctions as significant variables to therapeutic progress some 25 years ago, more than 70% of my clients have presented with one or the other or both of these dysfunctions.

hip joint - Copyright – Stock Photo / Register Mark I have a theory about the reason why these subluxations occur as often as they do. My speculation is that our primate ancestors developed a more flexible anterior shoulder capsule and a more flexible posterior hip capsule as a functional adaptation to their day to day reality. Should they fall from a height, say from a tree, these joint capsule adaptations would assist their ability to tuck and roll suddenly (anterior shoulder going forward while the opposing posterior hip moves backward), creating a spin of their bodies such that upon impact their chances of survival would be enhanced and therefore their genes passed on.

When either femoral head slides posterior, then the job of weight bearing shifts to the sacroiliac joints and the lower three lumbar vertebrae with attendant splinting of the deep lateral rotator and gluteal myofascial structures of the pelvic girdle. Weight bearing also continues to shift up the kinetic chain to the deeper paraspinal structures which are designed to guide normal vertebral motions. This shift in weight bearing distribution has implications for the high incidences of low back dysfunction, sciatic syndromes, hip or knee degeneration and may also influence the internal function of the bowel, bladder or reproductive organs. These implications will be addressed in future articles.

My premise is that when a hip subluxation occurs, a subcortical reflex is set off that subtly stimulates the person to pull their arms against the sides of their chest. This, of course, becomes yet another resistance to the heart and lungs to reach their respective full expansions.

I owe a debt of gratitude to Thomas Hanna, PhD, for introducing me to the power of our subcortical human righting reflexes.1,2 And, what I have briefly described acknowledges the wisdom of Ida Rolf's famous statement that, "when the body is not supported from below, it will attempt to hang from above."3 Andrew Still, the father of osteopathic medicine, placed great value on the integrity of the hip joints inferring that all physiological processes worked better when their function was efficient and proper.4

In the shoulder joint, if the head of the humerus slips forward enough to stimulate the protective reflexes of either or both of these joints, then the result is the same. The body will pull the arm against the lateral chest and usually the same sided scapula will lose its ability to slide freely. The loss of ability of the scapulae to move freely has many implications for respiratory efficiency, as well as thoracic inlet inflexibility, cervical dysfunction and other upper extremity difficulties. Any or all of these symptoms contribute to an extrinsic resistance to heart/lung expansion.

The 3rd subcortical reflexive protection that I have clinically observed and treated repeatedly since 1988, is what Dr. Hanna called the Lateral Trauma Reflex. It is hypothesized that this reflex is most often stimulated by sudden movements like a severe fall or the act of being thrown through the air such as snow skiing, or being ejected from a car in an accident, being thrown off a motorcycle, bicycle, water skiing or jet-skiing.1,2 Certainly, other events may trigger this reflex as well.

One can easily assess whether this reflex is lingering in your clients by requesting that they out-stretch their arms over their head while grasping their wrists and gently pulling superiorly. If this reflex is present, then one side will resist normal elongation not only at the shoulder, but down along the full side of their body.

Dr. Hanna's explanation was when stimulated by sudden movements such as the ones described above, the subcortical elements within the brain stem reflexively contract tissues such as the latissimus and the abdominal oblique myofascial structures to create a generalized state of contraction.1,2 My clinical experience suggests that this reflex participates in the perpetuation of recurring hip and shoulder subluxations.

As it relates to the full expansion of the heart and lungs, the internal result is the same. The reflexive protection of the shoulder(s) or of an entire side of the body increases the resistance that these organs must overcome to reach toward full expansion and ultimately requires the heart to work harder.

I would speculate that as "successful adaptation" is the hallmark of our species, both the good news and the bad news is that the heart alone can only work harder for so long before the autonomic nervous system activates its back-up plan which is to systemically narrow the blood vessels (known as hypertension and high blood pressure) and finally resorts to racing the blood back to the heart. This final adaptation progressively is proposed to decrease the delivery of freshly oxygenated blood to various tissue sites usually the larger joints and various organ structures in a fashion that perhaps only genetic predisposition, psycho-emotional possibilities and a client's trauma or illness history might help us to understand.

The irony here is that the innate righting reflexes which evolution provided in order to survive long enough to reproduce may also "reduce our quality of life" as we age far beyond our childbearing years. The intention of this series has been to unravel the "mystic of cardiovascular disease progression" and empower us in our profession to realize and understand how we may positively contribute to our clients' quality of life.


  1. Thomas Hanna Ph.D., course notes and personal sessions with him 1988-90.
  2. Somatics: Reawakening The Mind's Control Of Movement, Flexibility, And Health,Thomas Hanna Ph.D., Da Capo Press, 1988.
  3. Rolfing: The Integration of Human Structures, Ida P. Rolf, Ph.D., Dennis Landman Publishers, 1977.
  4. Richard MacDonald D.O., tutorial Muscle Energy Technique practicum 1988-90 and during his Functional Anatomy courses taught through the Upledger Institute.

Click here for more information about Dale G. Alexander, LMT, MA, PhD.


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