INDEX Page C ontent ontents s 1 2 8 10 13 16 19 21 23 30 33 39 44 56 56 57 59
Index O utlin utline e syll ylla b us for Anma A nma c o urs urse C ode od e of Eth Ethiic s Intro ntro duc tion tion to Amats A matsu u and a nd C o urs urse O utli utline History of Amatsu Anma Kyushu The The God G oda ai Switching witc hing Polarity M us usc c le testi testing ng Massage Anatomy and Physiology – The Skeletal System Rec ommende ommended d rea ding ding Referenc eferenc es a nd A c knowledgements nowledg ements A p p e ndix nd ix 1 – G loss lossa ry of ter te rms Appe Ap pendi ndix x 2 – C ode od e of Eth Ethiic s of the AA AAI
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Amat Ama tsu Therapy herapy Prac titione itioner r C ourse - Year Yea r 1 Outline Syllabus for Anma C ourse ourse Tutors utors:: J enny McG Mc Gann & Derek Plunkett Teac ea c hing hing Assis Assisttants: J ohn Nola Nolan n
C lass lassroom room Tuitio uition: n: 120 hours Home Study: Module Modules s and C ase Studies udies 160 160 hours hours
Module Module 1: 1: Intr Introduc oducttion to Amat Amatsu C ours ourse outlin outline, e, ex e xpec pe c tations tations,, and a nd goa go a ls History of Amatsu Introd ntrod ucti uc tion on to Anma A nma Intr Intro d ucti uc tio o n to Swit Switc c hing and a nd M us usc c le Test Testing ing Dia Dia gnosi gnosing a nd pos po st chec c heck king o f • Strong trong Ind Ind ic a tor Musc Musc le • A rm Mento M entorr test test • M us usc c les of the lower lowe r ba c k inc inclluding: o Pso Pso a s (K) o Iliac Iliac us (K) o Latissimus Dorsi (Sp) o Q uad ua d ra tus Lumbor umbo rum (LI) (LI) o Sa c ro sp inali ina lis s (B) (B) Introd ntrod ucti uc tion on to Ther Thera a py Loc a lisa tion tion a nd C hal ha llengi eng ing Introduction to Anma Massage and Taijutsu; massage of the five main lower ow er ba c k musc musc les Anatomy: • Orientation of the body • Ba sic skeleta keletall bones bo nes • The The five main ma in lo lo wer we r b a c k mus musc c les • The joints • Ana A natomi tomic c a l termi terminolog nology y Module 2: Foot Introduction to Meridians ©A mats ma tsu u As A sso c iation Irela Ireland nd & Ama A mats tsu u Therap Therap y As Ass so c iation England for Ama tsu tsu Tr Tra ining ining Sc hoo ho o l of Irela Ireland nd Ltd
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Amat Ama tsu Therapy herapy Prac titione itioner r C ourse - Year Yea r 1 Outline Syllabus for Anma C ourse ourse Tutors utors:: J enny McG Mc Gann & Derek Plunkett Teac ea c hing hing Assis Assisttants: J ohn Nola Nolan n
C lass lassroom room Tuitio uition: n: 120 hours Home Study: Module Modules s and C ase Studies udies 160 160 hours hours
Module Module 1: 1: Intr Introduc oducttion to Amat Amatsu C ours ourse outlin outline, e, ex e xpec pe c tations tations,, and a nd goa go a ls History of Amatsu Introd ntrod ucti uc tion on to Anma A nma Intr Intro d ucti uc tio o n to Swit Switc c hing and a nd M us usc c le Test Testing ing Dia Dia gnosi gnosing a nd pos po st chec c heck king o f • Strong trong Ind Ind ic a tor Musc Musc le • A rm Mento M entorr test test • M us usc c les of the lower lowe r ba c k inc inclluding: o Pso Pso a s (K) o Iliac Iliac us (K) o Latissimus Dorsi (Sp) o Q uad ua d ra tus Lumbor umbo rum (LI) (LI) o Sa c ro sp inali ina lis s (B) (B) Introd ntrod ucti uc tion on to Ther Thera a py Loc a lisa tion tion a nd C hal ha llengi eng ing Introduction to Anma Massage and Taijutsu; massage of the five main lower ow er ba c k musc musc les Anatomy: • Orientation of the body • Ba sic skeleta keletall bones bo nes • The The five main ma in lo lo wer we r b a c k mus musc c les • The joints • Ana A natomi tomic c a l termi terminolog nology y Module 2: Foot Introduction to Meridians ©A mats ma tsu u As A sso c iation Irela Ireland nd & Ama A mats tsu u Therap Therap y As Ass so c iation England for Ama tsu tsu Tr Tra ining ining Sc hoo ho o l of Irela Ireland nd Ltd
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Dia Dia gno sis a nd a ssess essment of o f the foo t with with empha e mpha sis o n Functi Func tio o nal na l H Ha a llux llux Limitalus Walking Patterns, (to include Pitch, Roll and Yaw) Dia Dia gno sis o f pa tterns tterns o f tors torsion thro thro ugh ug h musc musc le tes te sting ting a nd p a lpati lpa tio o n. M us usc c le testing: testing: • Therap Therapy y Lo Lo c a lis lisa tio tio n • Introd Introd ucti uc tio o n to G a it Testi esting ng • Mus M usc c les of the foo t and lower ow er leg incl nc luding: o Peroneus Perone us (B) (B) o A nterio nterio r and a nd Pos Po sterio terio r Tibiali ibia lis s (B (Bl) l) o Soleus (TW) o G a stro tro c nemius (TW) (TW)
Anma a p proac proa c hes to the foot foo t with with emphas empha sis on the musc musc les that ac a c t on the Meta M etatar tars so-pha o-p halla ngea nge a l J oints oints (M.P.J ), the the Ta Ta lus a nd G a it Reflex Points Points Key Ningu (hand holds) for Anma approaches Key Kyusho Kyusho (fulc rums for fo r intervention intervention)) in so so ft tis tissue o f lowe low e r limb limb Study of o f the Ta Ta ijuts ijutsu u (natur (na tura a l bod bo d y mo mo vement) in all tec tec hniques employed employe d Anatomy: • Bones Bone s a nd musc musc les with with or o rig in and insert insertion ion a t the foo fo o t • Mus M usc c le str struc uctur ture, e, c la ssifica ifica tion tion a nd func tio tio n • Skin
Module 3: Knee Dia Dia gno sis a nd a ssessment essment of o f the knee with with empha e mpha sis o n po p o p litea itea l drainage Dia Dia gno sis o f pa tterns tterns o f tors torsion thro thro ugh musc musc le testi testing ng a nd p a lpati lpa tio on Anma a p proac proa c hes to the knee wi w ith empha sis on the musc musc le gr g roups oup s involved nvolved in the ac a c tion tion o f the the knee • Q uad ua d ric eps ep s (SI) (SI) • Hams Ha mstr tring ings s (LI) (LI) • A dd uctor uc tors s (CX (C X) • Po p liteus iteus (GB) • Tensor Fascia Lata (LI) • G a stro tro c nemius ne mius (TW) (TW) • Sa rtor to rius (TW) • G ra c ilis ilis (TW) (TW) Key Ningu Ningu for Anma Anma a pp roa c hes Key Kyusho in soft tissue of lower limb Study of o f the Ta ijuts jutsu in all a ll tec hniques empl emp lo yed Anatomy: ©A mats ma tsu u As A sso c iation Irela Ireland nd & Ama A mats tsu u Therap Therap y As Ass so c iation England for Ama tsu tsu Tr Tra ining ining Sc hoo ho o l of Irela Ireland nd Ltd
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• Bones and muscles with origin and insertion a t the knee • Review o f joints, and actions of joints and levers
Module 4: Femoral Heads and Pelvis Diagno sis and assessment of the femoral hea ds with emphasis on toe-in test Diagno sis of patterns of torsion using muscle testing and palpation through all the lower extremity and the pelvis (asc ending and descending faults) Diagno sis and assessment of the pelvis with emphasis on psoas function and fascia Anma approaches to the pelvis with emphasis on the muscle groups involved in the action of the pelvis and relationships to the sciatic nerve (i.e. piriformis) Pitch, roll and yaw testing Anma approaches to the femoral hea ds with empha sis on the muscle groups involved in the action of the hip joint • Psoas (K) • Iliacus (K) • Tensor fascia lata (LI) • Piriformis (C X) • Q uadriceps (SI) • Sartorius (TW) • G luteus medius (C X) • Add uctors (CX) • G luteus maximus (C X) • Gracilis (TW) • Hamstrings (LI) Key Ningu for Anma app roa ches Key Kyusho in soft tissue of adductors, femoral hea d and psoas Study of the Taijutsu in all tec hniques employed Anatomy: • The leg • Nervous system • Urinary system
Module 5: Pelvis and Sacrum Diagnosis and assessment of: • Sacro-iliac joint ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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• Pelvis • Inguinal ligament and other pelvic liga ments • Fossa test Introd uction to c loa cals and nec k righting reflex Review of g ait testing Introduction to the Ileo-caec al valve Key Ningu for Anma app roa c hes Key Kyusho in soft tissue of the pelvis Study of the Taijutsu in all tec hniques employed Anatomy: • Pelvic structure a nd func tion • Digestive system • Reproduc tive system • Lympha tics
Module 6: Spine and Ribs Diagno sis and assessment of the sterno-clavicular junction and the drainage of the thoracic inlet Diagnosis of patterns of torsion through the sterno-clavicular and first rib area Anma app roa ches to the sterno-c lavic ular area emphasis on the muscle groups involved in particular the subc lavius and S.C .M. Key Ningu for Anma app roa ches Key Kyusho in soft tissue, around first rib a nd corac o-c lavicular fulcrum Diagnosis and assessment of the spine with emphasis on triangulation pulls between the twelfth rib, femoral head and isc hium Diagno sis of pa tterns of torsion through muscle testing a nd palpation through the spine (a sc ending or descending faults) Muscle testing o f • Psoas (K) • Latissimus dorsi (Sp) • Middle and Lower Trapezius (Sp) • Abdominals (SI) • Sacrospinalis (B) • Pectoralis minor (St) • Anterior serratus (L) • Diaphragm (L) • Q uadratus lumbo rum (LI) • Retrograde lymphatics Anma approaches to the spine with emphasis on the muscle groups ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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involved in the action of the spine and relationships to the rotary muscles and influence on vertebrae Key Ningu for Anma app roa ches Key Kyusho in soft tissue of psoa s and paraverteb ral muscle group s Study of the Taijutsu in all tec hniques employed • Ana tomy: Spine and thorax • Respiratory system • C irculatory system
Module 7: Upper Extremity (hand, wrist, elbow and shoulder) Diagnosis and assessment of the upper extremity with emphasis on the thumb, interosseous tissue and bicipital tendo n Diagno sis of patterns of torsion using muscle testing and palpation through the upper extremity Muscle testing of: • Pec toralis major (St) • Latissimus dorsi (Sp) • Deltoid (L) • Subsc apularis (H) • Supraspinatus (C V) • Infraspinatus • Teres major (GV) • Teres minor (TW) • C oracob rachialis (L) • Levator scapulae (St) • Triceps (Sp) • Bicep s (St) • Opp onens pollicis (Sp) Anma approaches to the upper extremity Key Ningu for Anma app roa ches Key Kyusho in soft tissue, inter osseous tissue and muscle groups Study of the Taijutsu in all tec hniques employed Anatomy: • Upper extremity • Endocrine system
Module 8: Head and neck Diagno sis and assessment of the Stomatognathic system Diagno sis of pa tterns of torsion through the Platysma, T.M.J . and C ranium Muscle tests for: ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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• Nec k extensors • Neck flexors
Therapy loc alisation of the jaw Anma approaches to the platysma, T.M.J . and cranial area with empha sis on the musc le groups involved in particular the S.C .M., pterygoids and temporalis Key Ningu for Anma app roa ches Key Kyusho in soft tissue, around pterygoids Study of the Taijutsu in all tec hniques employed Anatomy: • C entral nervous system • C ranium
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INTRODUCTION TO AMATSU
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AIMS AND OBJ ECTIVES FOR MODULE ONE
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Welcome to the c ourse
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Safety information
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Switching theory and practical
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Musc le testing theory and prac tic al
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Musc le tests of the lumbar region
Latissimus dorsi
Psoas
Iliacus
Quadratus lumborum
Sacrospinalis
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C lient appraisal
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Building a client base
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Anma to the lumbar region
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Self maintenance of hands
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COURSE OUTLINE, EXPECTATIONS AND GOALS
Welcome to the training c ourse in Amatsu. This yea r we will be studying A nma – the first of four aspec ts within Amatsu. Anma literally mea ns to push and pull. In C hina, this approac h is now c alled Tuina. Anma works by pushing and pulling on spec ific areas of the body to release tension and tightness, therefore restoring normal flows of blood and lymph to promote growth, repair and restoration of normal func tion. Throughout the first year of this c ourse you will rec eive prac tic al tuition in this hea ling a rt, supported by the sc ienc e behind it. This and subsequent modules have been designed to build over the year into a referenc e boo k on Amatsu. At the end of each module you will be supplied with homework questions or an assignment to assess your comprehension and learning of the information you have rec eived. The homework also includes prac tic al wo rk. This is an essential part of the c ourse and the completion of nine case studies in the first year is mandatory. C ase studies during training usually bec ome your first paying c lients on qualific ation, so maintain a professional manner throughout. If you have any questions rega rding your homework or case studies, please do not hesitate to contact the tutors. C ompleted homework should be posted to the offic e by the a ssignment dea dline for marking. If you have any problems please write down your questions and send them in for our appraisal. A glossary is included to allow you to become familiar with some J apanese Amatsu terms. As you study, you will bec ome familiar with many sc ientific and medical terms. It is recommended that you purchase a good medical dictionary to increase your medical vocabulary.
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There will be two written examinations and a prac tic al exam at the end of eac h year. The final assessments will inc lude continuous assessment, homework and c ase studies. Overall, your c ase studies should demonstrate that you have been able to assess and treat clients using the range of methods and protoc ols taught over the full yea r of study. You will receive guidance on how to set out the c ase studies. The c ourse is designed to build your skill a nd knowledge in a progressive and incremental wa y. The prerequisites are an open and inquiring mind, and a n enthusiastic attitude. It is our aim to support and guide you into becoming the best Amatsu Practitioner you can possibly be.
Breakdown for final assessment
Anatomy and physiology written examination Pass mark 65% Amatsu Theory written examination
Pa ss mark 65%
Prac tical examination
Pass mark 65%
Homework and assignments
Pa ss mark 65%
Attendanc e
Minimum of 90%
9 individual case studies, treated a minimum of 3 times eac h
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HISTORY OF AMATSU
Amatsu is a blend of modern research and ancient J apa nese physic al therapy modalities dating bac k some three thousand yea rs. The principles that form Amatsu were an integral pa rt of J apa nese culture. Anma for instanc e, would be passed down through the families and even taught to children in kindergarten. It was common practice for family members to treat each other with these methods. The Amatsu principles taught today are from the Anc ient School of Hi C hi Bu Ku Goshin J utsu. This is a school of breathing techniques and physical modalities of well-being a nd translates as “The Sec ret Sc hool of the O pening Flower”. The Amatsu Tatara are scrolls whic h rec ord the ba sis of the Amatsu we are lea rning today. They are in our be lief ‘J apan’s best kept sec ret’. Until very recently, this knowledge and skill was shared with only a handful of people in each generation. This knowledge a nd skill has been pa ssed down in an unbroken chain. The present day head of this tradition is Dr Masaaki Hatsumi of Noda C ity, J apa n. In addition to being the guardian of The Amatsu Tatara, Dr Hatsumi is the Grand Master of nine martial traditions that stretch bac k over 1,000 yea rs. His teacher, the late Takamatsu ‘Sensei’ (teacher/doctor) passed these skills and knowledge on to him during a 15 year period. Dr Hatsumi is an acc omplished artist, President of J apa n’s Foreign Writers’ Guild, a n exc ellent singer and dancer, movie star, adviser to the film industry and ‘Nice G uy’. Visitors to his house are welcomed with green tea and fresh fruit, which he prepares for them. Until rec ently he operated a clinic from his house, but now heads the ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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‘Bujinkan’ association, with thousands of world wide members in many countries practicing his ‘Taijutsu’ (integrated body movement) which he c onsiders to be the highest level of Amatsu. He says” By re-learning how to move our body in a natural and integrated manner, we enhance more than just body movement capabilities. We return to natural human beings. The essence of these movements is to be natural like a cat or other animal. This doe s not mea n that we bec ome a cat, it mea ns that we move and a ct as natural human beings.” Amatsu is a therapeutic approach that enhances these natural movements thus correcting any imbalances that prevent a natural and integrated movement. Therefore, in essenc e, Amatsu medicine works at enhancing and facilitating integrated movement in all direc tions or pa ralaterally. Once this is obtained, Amatsu is utilised to ‘balance’ or maintain ‘balance’ of the body and therefore prevents further disease. The major benefit of Amatsu is to aid in the restoration of health by focussing on the core principles of self-regulation of the body. In 1986, Dr Hatsumi invited three osteopaths from the British Isles to learn the art of Amatsu. Dennis Bartram from Hartlepool, Chris Roworth from Hillingdon and William Doolan from Dublin trained with Dr Hatsumi over a prolonged period. During this time, they used Western methods to evaluate the effects of Amatsu and formulate a therapy that was true to Dr Hatsumi’s tea c hings yet scientific enough for the Western world. They returned to their home towns, and set up training schools to fulfil Dr Hatsumi’s wishes: that the world should know about Amatsu. This has allowed A matsu to grow in Europe with the formation of new Amatsu schools in Dublin, Hartlepool – (NE England), Doncaster (England), St Albans (North London), C roxley Green (North West London) and G ermany.
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J enny McGann: J enny set up the Amatsu Training School of Ireland with her teaching partner, Derek Plunkett in February 2004. She was originally taught by Tomas Ronan in 2001, William Doolan and C hristine Duffy in 2002. She was approached, by William and C hristine a fter c ompleting her Shinden J itsu post graduate c ourse in 2003, to teach Amatsu in Ireland. J enny’s background as a qua lified Primary Sc hool Tea cher has provided her with a firm founda tion in teaching. She wa s rec ognised by the Institute of C omplementary Med icine as a Trainer of Amatsu and a s an external examiner for Amatsu in 2004 after completing a refresher course in Training and C ontinuing Educ ation with the National University of Ireland, Maynooth in 2004. She ha s also taught with Dennis Bartram of Amatsu UK Ltd, in Hartlep ool, where she attend s regular sessions of C ontinuing Professiona l Development (C PD), and has taught with J ane Langston of Amatsu Training School - England.
In the past J enny has studied different forms and levels of Yoga, C allanetic s, Tai C hi, Qi Gong a nd Nin J itsu. She started her study into M usc le Testing and Kinesiology by doing a basic course in 1988. She then completed a Touch for Health C ourse in 2001 and went on to do a more a dvanc ed Kinesiology course in Quantum Cellular Hea ling. She has also c ompleted courses in C hinese C upping and Moxibustion. J enny was the C hairperson of the Amatsu Assoc iation of Ireland between 2004-2007, and is currently Assistant C hairperson a nd Tea c her Representative of the AAI. She a lso takes an active role in the Amatsu Therapy Association Tea c hers C ommittee and runs a busy clinic in Lucan, C o Dublin.
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Derek Plunkett: Derek founded the Amatsu Training School of Ireland with J enny Mc Gann in February 2004. Derek was taught by Dennis and Billy in 1991, having previously completed an ITEC course in Massage. He ha s also studied C ranio-Sac ral Therapy and Kinesiology. He has trained extensively in the Martial Arts and this gives him an excellent combination of knowledge in Body Movement, Tai J utsu and Bod y Work. Derek has been involved in Transformational Healing since 1999 which c omplements his Amatsu work. He was recognised by the Institute of Complementary Medicine as a Trainer of Amatsu and as an external examiner for Amatsu in 2004 after c ompleting a course in Training and C ontinuing Educ ation with the National University of Ireland, Maynooth in 2004. He a ssists Dennis Bartram of Amatsu UK Ltd, in Hartlepool, where he attends regular sessions of C ontinuing Professional Development (C PD). Derek is c urrently a member of the Amatsu Association of Ireland in the role of Teacher Representative and takes an active role in the Amatsu Therapy Assoc iation Tea c hers’ C ommittee. Derek runs a busy clinic in C londalkin, West Dublin, Ireland. It can be seen that although Amatsu has been in existence for thousands of years, its history in Europe is very short. J oining Amatsu at the beginning of its history in Europe is a uniquely exc iting plac e to be!
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ANMA Anma is believed to have c ome into J apa n from C hina about 1,500-2,000 yea rs ago. However some people spec ulate that Anma could have originated in India as long ago as 10,000 yea rs. Whatever the route, Anma entered J apa n and was refined into the J apa nese methods. In J apa n there a re numerous styles of Anma, depending on which family line they originate from. The methods taught on this course a re the methods utilised by Dr Masaaki Hatsumi. He says “There is an old text called the I Shin Bo detailing traditional J apanese medicine. In this text it rec ords that only high ranking people were permitted to undertake Anma. True Anma is very different to modern Anma. Modern Anma is more a massage therapy that makes the person feel good. This is important, but Anma is used like other methods of Amatsu Ryho (Amatsu medic ine) to bring out the wellness that already exists inside the person. If you just push with your fingers or hands like this (demonstrating) this is just a finger pressure. The important thing is the feeling.”
Anma can be interpreted as the massage level of Amatsu, but it enc ompasses the applic ation of natural movement principles on soft tissue struc tures. Anma means to push and p ull and its application on the body influences many structures and systems depending on the practitioner’s skill level. The stroking, stretching and kneading of the tissue is an ancient art, not only in man, but in all animal spec ies. One only has to see and understand the need for a mother cat to nurture her new kittens by repeatedly lic king a nd wa shing her young.
This short extract from the book “Touc hing” by Ashley Montague, explains the skin’s glob al intelligenc e: “C ontinuous ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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stimulation of the skin by external environment serves to maintain both sensory and motor tonus. The brain must rec eive sensory feedback from the skin in order to make such adjustments as may be called for, in reference to the information it receives. The feedbac k from the skin to the brain even in sleep is continuous.” Hatsumi Sensei explained that in the beginning, ancient man had no real knowledge of pathology or deep anatomical struc ture. The knea ding or stroking would be applied to injuries or pa in ac c ording to instinctual feel. He explained that by coming from their hearts through their thumbs, ancient man would bring out the wellness in other people. Ancient men were more in touch with nature and certainly more instinctual than logical in their approach.
Dr. George Goodheart, Chiropractor made this quote on the Applied Kinesiology researc h papers in 1976: “Man, as you know, is a structural-chemical-psychological equilateral triangle, and he possesses the potential for recovery through the innate intelligenc e of the human struc ture. This rec overy potential with which he is endowed merely waits for your hand and your heart and your mind to bring to potential being and allow the recovery to take place which is man’s natural heritage. This benefits man, and it benefits you, and it benefits our profession.” This suggests that the C hiroprac tic profession has evolved from the same views of innate na tural princ iples.
The dexterity of the tools we make using our limbs to perform Anma is known as Ningu. In fact it is much more than just dexterity, it is a totally integrated body feeling. The na tural movement that is used to turn simple techniques into a “feeling” is known a s Taijutsu. In this movement the principles we employ were born in nature and utilise nature’s flow methods and simplic ity. Hatsumi taught us to understand ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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nature and perc eive energy thus developing a strong spirit and a superior Taijutsu. There is a saying: “Simple things are simply seen but rarely understoo d.” Hatsumi would tell us to observe nature and living creatures in order to understand and adopt the tec hniques of Amatsu.
These funda mentals of nature are at the heart of Amatsu’s heritage. The natural movement Hatsumi talks about is the way in which animals, mammals and birds utilise the motion c rea ted by air/water as propellants, thus conserving energy by using inertia, minimal body movement, natural flow and total integrated body motion.
Anma Tec hniques
J unetsu Knea ding movements, whic h include grasping and twisting Kyokute Perc ussion, to listen, feel and treat Shinsen Vibrational movements, with and without physical movement Haa ku Pulling the tissue and squeezing it Ten Chi Holding the top of the head and the tailbone ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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Anpuka Abdomen and visc eral squeeze/ tonific ation Ashi Use of the feet, and methods applied on the feet Tekyo Special hand trea tments, squeezing the fingers KYUSHU In all lesion patterns, there are critical points which serve as catalysts to unwind and relea se the lesion pattern. In Anma these points are known as Kyushu. They can also be described a s “chinks in one’s armour”. Acupressure and Shiatsu philosophies c lassica lly follow the Tsubo points on the acupuncture meridian lines. Dr. Hatsumi explained to us that the Kyushu can be anywhere in the tissue but co-incidentally may be over a Tsubo point. The area around a Tsubo is affec ted by the strain in the tissue and c rea tes imba lance in the meridian link up. As you affec t the factors of the strain with your touc h this also c hanges the effec t on the Tsubo a nd meridian. Many of the Kyushu we will study are vulnerable points in the bo dy’s anatomical make up. They provide windows were we c an assess tensions, pulls, physiological and pathological changes in the tissue.
In J apanese military history, an in-depth study of these vulnerable sites wa s undertaken. To allow movement in armour there had to be minimal protec tion around the joints so shoulders, nec k, elbows etc would need to be left expo sed. These are the vulnerable sites or windows that we refer to as Kyushu. From the ana tomy of these sites, techniques were developed to injure, maim and kill. This anatomical ac curac y also, parado xically, led to the development of many techniques for correction and maintenance of health. This information and research is highly valuable in therapy. It is used to reverse the effects of trauma and forms part of Amatsu’s medical and self-help treatments.
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Pred ators hunting prey instinctively know a victim’s weak spots. A cheetah has the body control to trip his prey whilst running at 50 mph and suffocate its victim without breaking its skin. This is all achieved on the move in the rough and tumble o f the fall. The natural movement skills of the Budo Warrior would allow him to reac h vulnerable places in his victims. They would be attacked in a variety of wa ys including striking, cutting, loc king their joints. By understanding the physiological adaptation from the succ ess of these attac ks, techniques of anatomical significanc e developed . Amatsu utilises this skill of ancient knowledge to c orrec t conditions with natural physica l mod alities, handed down and evolved through the a ges.
Anma, the basis of Amatsu, involves soft tissue relea ses at critical anatomical points, affecting the ancient limbic brain and its balancing influenc e on the upright walking body. These Anma principles use skills and tools designed to enable you to palpate, diagnose and correct with safety and competence.
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THE GODAI According to the Amatsu Tatara, our well-being is maintained by five factors, which are termed ‘The Godai’, which literally translates as the Big Five. The Godai are c ompletely interdependent: a small c hange in one will have an impact on any or all of the others.
The physic al part of the Godai inc ludes our bones, liga ments; the struc tural elements of our bodies. The chemic al part includes the food and drink that is ingested, the digestive process itself, the delicate biochemical balance of minerals, vitamins, proteins, hormones etc within the body. The emotional part is the way that we think and our moods. The elec tric al or energy part is more nebulous. It includes the electro-chemical mechanisms that govern nerve impulses, brain ac tivity and heart beat regulation, and in a more esoteric way, also includes acupuncture meridians, chakras and the “spark of life” or C hi. The environmental part is the way we live our lives, and how we interac t with others. It inc ludes our habitat, oc c upa tion and family set-up. It therefore follows that hea lth is reliant on a perfec t ba lance of all these forc es. Ill©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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hea lth results from an imbalance o f the G odai. STRUCTURAL ENVIRONMENTAL ELECTRICA L CHEMICAL EMOTIONAL
Example of the Godai A frail and malnourished 80 year old lady falls over a crooked paving stone in the street (ENVIRONMENTAL), and breaks her leg (PHYSICAL). She is in shoc k and severe pain (ELEC TRICAL), so is given pain relief and a saline drip in hospital (C HEMICAL). She is extremely angry at herself for not noticing the paving stone, and also at the local council for not maintaining the pavement (EMOTIONAL). In hospital she rec eives exc ellent c are, and her leg begins to hea l (PHYSIC AL). She eats well and mana ges to gain some weight (C HEMICAL). As her bones knit together (PHYSICAL and C HEMICAL) she needs less pain relief med ication (C HEMICAL) as she is in less pain (ELEC TRICAL). She enjoys the company of the other folk on the ward (EMOTIONAL), but longs for her independence which she achieves when she is discharged from hospital when her broken leg appears to be completely healed (ENVIRONMENTAL). The principle of the Godai will be applied throughout the c ourse. C an you apply it to yourself? Look at others; c an you apply it to them? As a qualified practitioner, this princ iple is central to understanding the underlying cause of a problem. Educating the client about the Godai helps them to take responsibility for the maintenance of their own good health.
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SWITCHING
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SWITCHING
Switching is the term given to describe neurological disorganisation or confusion of the electrical circuits of the body. This disturbanc e relates in one wa y or another with the nervous system or the electrical circuiting of the body. We can therefore assume that our bodies are either “unswitched” (neurologically organised) or “switched” (neurologically disorganised ). C ompare our bodies to the elec trical circuits in our houses; if the fuse blows in our houses, the elec tricity switc hes off. Similarly if "fuses" blow in our bodies, then parts of the neurological system in our bodies will switch off, causing rec ognisable symptoms. If a client is assessed without checking the body’s electrical circuiting and the body is neurologically switched, the responses to the tests will not be a c c urate. We must therefore make sure that the body is unswitched before we start assessment. This is done to fine tune the body so that we get the correct responses when testing. If a body is switched , not only does it mean results of tests may be inaccurate, but it also negatively affec ts the person’s energy a nd hea lth.
Implications of being switched Tiredness, lack of c onc entration, lac k of c o-ordination, thirst, and pain are some of the main implications of being switched. This is bec ause the neural messaging is not going to the right plac es and therefore placing stresses on the body.
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Causes of neurological disorganisation
Structural
The most c ommon c ause is dysfunction of the c ranial-sac ral primary respiratory mechanism. The sec ond most c ommon cause is foot dysfunction.
Chemical
C hemical c auses usually relate to some form of nutritiona l sensitivity which will affec t neurotransmitters.
Environmental
These may be intrinsic to the patient’s physiolog or extrinsic to his environment and interac tion wi people.
Emotional
Attitude and state of mind will influence the neurotransmitters.
Electrical
These may be due to ac upuncture meridian imbalance or a problem with the c hakras.
Common areas of neurological disorganisation There are certain areas in the body that, if not working properly, will switch the body electrics off, therefore these areas need to be checked before proceeding to muscle test. There are many such areas but the following are the important checking points and form the first step in a protocol of an Amatsu trea tment. The points should be stimulated o n yourself ea ch da y, and b efore you trea t every client.
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1. Up/ down the body: (pitch)
These points are on the G overning Vessel (GV27) at the upper lip and C entral Vessel (C V24) lower lip. This test tell us if the top o f the body is communicating with the bottom of the body. Hold points and test a previously strong indicator muscle. C orrec tion: Hold points GV27, CV24 and the navel and rub.
2. Left side/ right side of the body: (roll)
These are the found on the kidney meridian (K27), just below the c lavicle and either side of the manubrium. They tell us if the body is communicating on both sides. Hold points and test a p reviously strong indicator muscle. C orrec tion: Hold K27's and the navel and rub.
3. Front/back of the body: (yaw)
This is the navel (CV8) and coc cyx (GV1). This tells us if the body is communicating front and ba ck. C orrec tion: Hold Navel and Coc c yx and rub.
4. Blood chemistry energy test:
This relates to the pancrea s (SP21) and sugar levels in the bod y. It gives an indication if suga r is handled well by the b od y. C orrec tion: Hold K27 and SP21 on both sides and rub.
5. Hydration: Relates to water integration in the body. Has the body enough water at the moment? Inad eq uate hydration causes spurious results when muscle testing. To test for adeq uate hydration, hold a strand of the c lient’s hair and muscle test the indicator muscle. A wea k indicator musc le mea ns that the c lient is switching b ec ause they are dehydrated. C orrec tion: Have the c lient drink a large glass of water, and then retest all of the above points.
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Switching points on the body To unswitch yourself and your client, the following sets of points should be rubbed, using your tai jutsu for 10-20 seconds. C entral Vessel CV24 / Governing Vessel GV27 and Navel CV8 Kidney Meridian - K27’s and Navel CV8 K27’s and Spleen Meridian - Sp21 C oc cyx GV1 and Navel C V8 Heel Tap on both Heels, direc ting the vortex to the opposite shoulder.
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Module One Practical One – Switching Rub the following points firmly for 10-20 sec onds, firstly on yourself, then on your partner.
Yourself Your pa rtner C V24/ GV27 and C V8 K27 and C V8 C V8 and G V1 K27 and SP21
Difficulties/Disc overies:
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POLARITY What is Polarity? Polarity: In elec tro-magnetics, it is the term used to describe the qua lity of having two oppositely c harged poles, one po sitive one negative. Body Polarity: is to d o with the Elec trical Circ uits in our Body having a positive or nega tive charge. It is the pa iring of c omplimentary capabilities. In all organisms, physiological polarity connects the individual's sensory and motor capabilities. Elec tric c harge of the bod y is caused by piezo elec tric current. This c urrent is produced when pressure is applied to cells of the bo dy ie movement/wa lking. Every movement of the body, every pressure and every tension everywhere, generates a variety of osc illating bio-elec tric signa ls or mic ro-c urrents. Bec ause of the c ontinuity of the c onnec tive tissue, these signals spread through the tissues and cells. The signals are essentially biological communic ations that inform neighbouring cells and tissues of the movements, loads, compressions and tensions arising in different pa rts of the body. The fully integrated body is a body that is entirely free of restrictions to the flow of signals. Whic h side of an elec trical circ uit is the positive? Whic h is the nega tive? Polarity is the term desc ribing which is which. The property of having two opposite poles, sides or ends (for example, humans have left-right polarity, also front-ba c k po larity and hea d-tailwa rd polarity). To have c orrec t polarity we need to have a Positive (+) Energy Reading on one side of the body and a Negative (-) Energy Rea ding on the other side of the body. The Positive/ Negative energy c an be on either side, the important thing is that there is ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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+/- on the front and -/+ on the bac k. Therefore: If the Left side of the Body has a Positive energy reading on the front, it will have a Nega tive energy rea ding on the back of the body and the Right Side of body should have a Negative energy rea ding on the front and a Positive energy rea ding on the bac k of the Body. And the reverse is correc t if the Left side of the Bod y has a Negative Energy Rea ding. Why do we Check our Polarity?
We should alwa ys c hec k Polarity before we Balance a person as Polarity can become reversed or unstable due to mec hanisms in the Elec tric al Fields of our body and our environment (whic h will ac t on the body) and we c an end up with 2 Negatives or 2 positives on the front of the body. This disturba nce will switc h the body a nd you will not get c orrec t Musc le Test Respo nses and a ny cha nges made to the body during a trea tment will not hold, due to the elec tric al imbalance. How do we C heck?
The balancing of the body's elec tromagnetic energy is done by plac ing hands on the bod y's energy centres and poles to redirect the flow. In Amatsu we use a simple tec hnique of: 1. C ontac t two points on one side of the bo dy – Lung 1 and Spleen 13 and pressing gently, then test a PIM. You will get either a strong or a weak musc le test. 2. C ontact L1 and Sp13 on the other side of the body and test a PIM. You should get the op posite response to the first side, ie if side one tested weak (negative), then side two should test strong (positive). How do we C orrec t Unstable Po larity? ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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C ontac t L1 and Sp13 on the same side (for instance Left Side). Press both points together. Take hand from L1 point and bring it over to right side L1 whilst still holding Sp13. Onc e you a re “tension c oupled ” with L1 on right side, then bring your other hand from Sp13 (left side) to “tension c ouple” with Sp13 on right side. Press. Now repeat the proc ess by “wa lking” ba ck ac ross the bod y with your hands and p ressing a ga in, now c hec k your PIM. This should be repeated until one side tests Negative and the other side tests Positive. What effec ts does unstable Polarity have on our systems? Reversed po larity: An elec tric al rec eptac le outlet with a reversed polarity condition is an outlet with a n improper wiring c ondition a nd such conditions may be ha zardous and repa ir is required. Unstable Polarity causes Neural Disorga nisation a nd therefore it “Switc hes” the bo dy a nd our “ba lances” will not c onsolida te.
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MUSCLE TESTING
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MUSCLE TESTING Muscle testing is an art – and like all art needs practice to perfec t. That means working with many people bec ause every individual responds differently. In order to use Amatsu effec tively, we must have an ac c urate musc le test. It is through accurate feedback from the body that we find energy and musc ular imbalances. In musc le testing we are c hec king the communication or message coming from the brain, which tells the musc le to c ontract, we a re no t testing musc le strength.
80% of the musc le test is in the mind – only 20% is actually physic al.
The brain’s c omputer gives the rea d-out on whether a musc le will loc k or not lock. This is the key to muscle testing – assessing the ‘loc k or unlock’ o nly – not for the full range of motion of the musc le. The most common mistake is OVER-PO WERING; that is, applying more pressure than nec essary to c hec k the ‘loc k’.
For example: testing a strong musc le like the quadriceps. If you use a lot of pressure, it will test stronger bec ause the person’s system rec ruits other musc le groups to hold the leg up. Only when you use just enough pressure to test the ‘loc k’ will you get an acc urate result.
‘J ust enough pressure’ means an inch to a n inch and a half; that’s all. No more is needed. Test with the same attitude that you would adop t if you were c limbing a tree. When you test the branch to see if it can take your weight, you instinctively know without putting your full weight on the branch. Another analogy is wa lking on wobbly stepping stones. You know when a stone won’t take your weight without actually transferring all your weight onto it. By testing with this attitude you will feel instinc tively that the musc le test is weak or strong. ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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Your basic attitude is important when you muscle test. For a variety of reasons on the part of both tester and client, too often a musc le test turns into a c ontest of strength. A good muscle test is one in which both people are interested in disc overing imba lances, not a ga me of ‘I win / you lose’. Remember – you are looking for the ‘lock’, not for the full range of motion. Explain this and demonstrate exac tly wha t you are going to do with ea ch new client. What you want is c ooperation, not competition. Since the body will recruit other muscle groups to maintain strength in the muscle being tested, watch out for elbows bending, torsos twisting, hands clenching, breath holding etc. When this happens, tell the client what you observe and reposition the limb being tested. You c an over-power a lmost a ny musc le in almost a nyone but this risks doing actual damage to the muscle and tendons. After all, you want your clients leaving you in better shape than when they arrived! With this in mind, use a testing strength appropriate for the person you’re working with. If a p erson is basically weak in constitution or of frail build, monitor the pressure you ap ply by using only one or two fingers. If your client is extremely strong and you doubt the accuracy of the result you are getting, feather the neuro-lymphatic points for that muscle (as quoted in the Touch for Health book) to weaken it and test aga in. Now ‘shaky’ or a ‘slight wea kness’ will be notic ed. This will be your benc hmark for the rest of the musc le tests. When you apply pressure, remember – your pressure should be no more than an inch to an inch and a half. Hold for not more than two sec onds and release. THEN determine whether the muscle is weak or strong. If you continue to add pressure to the muscle while deciding, you may fatigue it, causing your rea ding to be invalid. You are in effec t overpo wering it. ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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Range of motion when muscle testing The range of motion of the muscle test is in the opposite direc tion from the musc le’s normal function. When musc le testing, we bring origin and insertion of the muscle together and then test the function of the musc le. For example – quadriceps brings the leg up. The range of motion we test brings the leg down.
Positioning The ob jec tive in positioning is to bring the origin and insertion of the muscle as c lose together as possible before testing. This puts the musc le in a c ontrac ted state. Remember, positioning should be exact so isolating only the muscle to be tested.
Bilateral imbalance Remember to note an imbalance in muscle testing results on either side of the body. The right may be strong and the left weak, when a given muscle is tested. The same muscle may be weak on both sides. This is important information as we will see in later modules.
Counter motion by the person being tested During the testing process, the client often makes a countermotion, or over-resistance – for instance, pushing up while you are testing a muscle whic h needs a downward a ction. Don’t counter resist. J ust let your hand go with that person’s movement. Then re-po sition; explaining you wa nt him or her to ‘just hold it there’.
Use the word ‘hold’ instead of ‘resist’ Resist keys in all kinds of negative mental and emotional factors. It puts the person in an automatic ‘fight or flight’ mode. The word ‘hold’ puts the person’s attention on maintaining a specific localised function or position. ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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Your mind may be influencing your testing procedures For example – you may think the same muscle tests ‘weak’ in almost everyone; your experienc e has c onvinced you. C hec k it out; your mind-set may have a lot to d o with it. If you suspec t this is happening, the next time you test: repeat the alphabet to yourself mentally while you test that musc le. If you think the other person may be invalidating the test by willing that a given muscle be strong, have that person recite the alphabet aloud while you retest. This works bec ause it literally and figuratively ‘c lea rs the mind’.
The Testing Procedure 1. Before testing – protect yourself and the other person. Briefly explain what musc le testing is and what it involves. Then ask if there is any reason we should not musc le test you. Find out if there has been rec ent surgery, whiplash, or if there is any existing intense pain. This protec ts you bo th from any inadvertent damage being done, or unnec essary stress put on their system.
2. Show range of motion previous to making each test. Notic e if there is any tension in the client’s body while you do the demonstration – such as clenched hands, ankles crossed, or the entire body thrown into resistanc e. If you see this happen, tell them to unc lench, uncross and relax. Be sure their hands are not placed on their body as this constitutes therapy localisation, which will be covered later. 3. Tell the person to ‘hold’ then make the test, moving in slowly to give the brain time to respond through the muscle being tested. (Remember the rule: no more than an inch to an inch and a half pressure held no longer than 2 sec onds at the most!) ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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M us usc c le tes te sting ting is suc h an a n impo imporrtant ta nt to to o l. You Yo u will will b e gi g iven plenty of opportunity to practise muscle testing throughout the course.
FAC TORS AFFECT ECTING A GOOD MUSC LE TEST
• re re c ruitme uitment nt of othe o therr musc musc les • breath holding • chewin c hewing g gum g um • therap therapy y loc loc a lisa tio tio n • unpleasant smells in the room • po p o o r p o sitio tio ning ning of o f lilimb • po p o o r p o sture ture (tai (ta ijutsu) utsu) of o f pr p ra c titi titio o ner ne r • dehydration • inadequate unswitching • a tti ttitude o f pra pra c titi titione onerr • a tti ttitude o f cl c lient • counter-motion on testing • trance-like state of client • pr p ro ximity mity of mob mo b ile telepho telep hone nes s • har ha rmonis mo nise ers • usa usa ge of magne ma gnets ts • eye eye c ontac ontac t
WHAT DOES IT MEAN WHEN WE MUSCLE TEST? MUSCLE TESTING A MUSCLE OR A PREVIOUS INTACT MUSCLE (PIM) ©A mats ma tsu u As A sso c iation Irela Ireland nd & Ama A mats tsu u Therap Therap y As Ass so c iation England for Ama tsu tsu Tr Tra ining ining Sc hoo ho o l of Irela Ireland nd Ltd
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STRONG MUSCLE / PIM
WEAK MUSCLE / PIM
MUSCLE DOES NOT CHANGE
MUSCLE CHANGES
MUSCLE DOES NOT INDICATE
MUSCLE INDICATES
NOTHING MOVES THEREFORE IS NOT A A PRIORITY
MUSCLE MOVES THEREFORE IS A PRIORITY
NO PROBLEM IN MUSCLE/ENERGY SYSTEM
ACTIVE PROBLEM IN MUSCLE/ENERGY MUSCLE/ENERGY SYSTEM
HAVE CONGRUENCY WITH OTHER BODY SYSTEMS
THERE IS INCONGRUENCY INCONGRUENCY WITH OTHER BODY SYSTEMS
POSITIVE BODY POLARITY CIRCUIT IS WORKING
NEGATIVE BODY POLARITY BROKEN CIRCUIT
CORRECT ENERGY (CHI) IN SYSTEM
INCORRECT ENERGY (CHI) IN SYSTEM
NO ACTION OR REMEDY NEEDED
YES ACTION IS NEEDED TO REMEDY And this would be a “No” as it is not maintaining body homeostasis.
It is b est not no t to use use a YES / NO Q uesti uestio on when whe n Mus M usc c le Te Te sting, but b ut if yo yo u must must use these terms, then this would be a “YES” it is a neurologica neurolog ica l cir c irc c uit that is maint ma inta a ining ining b o d y homeo home o stas ta sis. is.
Prac tica ic al Two – Fac tors that af affec t musc musc les te testing
Find a stro tro ng ind ind ica ic a tor mus musc c le test, test, for ins insta tanc nce e , the a nteri nterio r d e ltoi to id o r a rm mentor mento r test. test. Using this this stro tro ng indic ind ica a tor tor, think think the e motions, motions, o r c o mmand s a s d e tai ta ile d be b e lo w. Re c o rd the re re sults ults ©A mats ma tsu u As A sso c iation Irela Ireland nd & Ama A mats tsu u Therap Therap y As Ass so c iation England for Ama tsu tsu Tr Tra ining ining Sc hoo ho o l of Irela Ireland nd Ltd
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in the table provided, i.e. strong or weak. Did thes the se re sults surpris urprise you? you?
M us usc c le test test result Thi Think nk “y “yes es” ” Thi Think nk “no” Thi Think nk “s “sa ad thoughts” Thi Think nk “happy “hap py thoughts” C lenc h your teeth ee th Hunch unc h your shoulders
Diffic Difficult ultiie s/ d isc isc o ver verie s:
Psoas
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Iliacus
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Latisimus Dorsi
Quadratus Lumborum
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Sacrospinalis – layers of:
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Practical Three – The effect of switching on muscle tests
Perform and record the muscle tests for the lumbar area as detailed below. Then switch your c lient using GV27/C V24 and C V8 K27 and C V8 C V8 and G V1 SP21 and K27 •
• • •
Repeat the musc les tests and rec ord the results. Are the p ostswitching musc le tests different from the pre-switching tests? Pre switching
Post switching
Psoas Iliac us Quadratus lumborum Latissimus dorsi Sacrospinalis
Difficulties/disc overies:
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Practical Four – Appraisal of client using observational skills and muscle testing, pre and post Anma to lumbar area Appraise the client by observing asymmetry, range and texture. Rec ord your ob servations in the table below. Some landmarks etc have been added to the table alrea dy. C an you think or see a ny other landmarks that you might use? Switc h your client then perform the muscle tests of the lumba r area . Rec ord them below. Perform Anma to the lumbar region, then reappraise and record your results. Did A nma make a differenc e?
Pre Anma
Post Anma
Asymmetry Eyes Ears Shoulders Hips Knees Legs
Range
Texture
Muscle tests
Arms Legs Neck
Hot spots Skin drag
Psoas Iliac us Quad Lumborum Lat dorsi
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Sac rospinalis Difficulties/disc overies:
Protocol for first year case studies In the next three time blocks, between courses you need to do case studies on three different people, three separate times, i.e: April – J uly Three clients, three times eac h = nine balances J uly – September Three c lients, three times ea c h =nine balances September – Exams Three clients, three times eac h = nine balances This gives a total of 27 ba lances on nine different people.
Section One Plea se make up your own client questionnaire. For ea c h new case study you will have to complete a health history questionnaire only once. The questionnaire should inc lude the following: Name Date of ba lanc e Date of birth Occupation • • • •
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• •
• • • •
• •
Relevant hobbies and pa stimes Medication, including “over the counter” and prescribed Diet, including allergies /sensitivities Injuries/operations Previous med ical history Information about consultations with other healthcare professionals Exerc ise regimes History of : heartburn, irritable bowel syndrome, headaches, migraine, breathing problems, diabetes, epilepsy, cancer, deep vein thrombosis, high or low blood pressure, c ardiac problems, pregnancy
Section Two Plea se rec ord the following: •
•
•
Initial observations: walking, standing, demea nour, asymmetry, range , texture
general
Presenting symptoms Pre balance evidence of weaknesses in: Switching Gait tests Pitch, roll and yaw Fossa tests Musc le testing (please include ALL muscle tests learnt from module one to the present!) Therapy loc alisations Challenges
•
Summary of action taken, including what Anma you performed and reasons why you took this action
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•
Post treatment musc le testing All previously weak musc les All major ba c k stabilising musc les Psoas Latissimus dorsi Quadratus lumborum Gaits Pitch, roll and yaw Fossa tests
• • • • • •
•
•
Learning outcomes – what you have learnt from this c ase study, and any diffic ulties you had. Any prob lems plea se email J enny on
[email protected] or telephone me on 087 7993868.
Glossary Anma Anpuka Ashi Bilateral Budo Chakra Chi Contralateral Gairon Godai Haaku Hara Hi Chi Bu Ku Goshin J utsu Ryu Homolateral Ipsilateral J unetsu
Push - pull, J apa nese massage principles Ab do minal and visceral squeezing and tonification Use of the feet, and methods ap plied on the feet Two sides of the bod y The warrior way, or martial art Energy vortices on the energy body that comp rise pa rt of the energy system Energy, life force On opposite sides The interconnec tedness of all things, sensing the bigger picture The "Big 5"; physical, emotional, chemical, electrical and environmental Pulling the tissue and squeezing it C entre o f the bo dy, loc ated just in front of the sacrum Preservation o f the self through the hidden secrets of the opening flower One side of the bod y Same side of the bod y Knea ding movements, which include grasping
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and twisting
Kenku jutsu
Amatsu approach to ba lanc ing the cranial mec hanism of the hea d, spine and pelvis
Kihon Kinesiology Kyokute Kyushu Meridian
Basics, fundamentals, curiosity Study of muscles and movement Percussion; to listen, feel and trea t Points on the bod y that are c ritical for cha nge to occur. They may be described a s "chinks" in the bo dy's armour. The pathways and networks of the acupuncture system that supply the physical and subtle body with vital energy
Nagare Ningu Paralateral
The interplay of natural principles in a flow The dexterity of the tools we make with our limbs In all direc tions A trilogy, e.g. hea ven, earth and man; beginning, middle and end
San shin Seitai
Shinden jutsu
Shinsen Tai jutsu Tatara Tekyo Ten chi Tsubo
Body alignment ad justments to coa x the strained musculo-skeletal system ba ck into position and promote b od y tone and co-ordination Working on the ligament and fluid mechanisms, in a heartfelt way, to maintain the position of vital organs and the stability of the skeleton Vibrational movements, with and without physical movement Natural integrated b ody movement A stac ked lesion pa ttern in the bo dy Spe cial hand trea tments, squeezing the fingers Holding the top of the head and the tailbone Energy points of the body
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ANMA MASSAGE
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BENEFITS OF MASSAGE •
Massage dilates the blood vessels, improving the c irc ulation and relieving c ongestion throughout the bod y • acts as a “mechanical cleanser”, stimulating lymph circulation and hastening the elimination of wastes and toxic debris • relaxes musc le spasm and relieves tension • increases blood supply and nutrition to muscles without adding to their load of toxic lactic acid, produced by voluntary musc le contraction. Massage, therefore, helps to prevent the build up of harmful “fatigue” products resulting from strenuous exerc ise or injury • improves muscle tone and helps prevent or delay muscular atrophy caused by forced inactivity • can partly compensate for the effects of forced inactivity from injury, illness or age, by helping the return of venous blood to the heart • may have a sedative or stimulating effect on the nervous system depending on the type and length of massage treatment given • by improving the general circulation, increases nutrition of the tissues. It is ac compa nied or followed by an increased interchange of substances between the blood and tissue c ells, heightening tissue meta bolism • increases the excretion (via the kidneys) of fluids and waste products of protein metabolism, inorganic phosphates and salt in normal individuals • stretches connec tive tissue, improves its c irc ulation a nd nutrition and so breaks down or prevents the formation of adhesions and reduces the danger of fibrosis • improves the circulation and nutrition of the joints and hastens the elimination of harmful deposits. It helps lessen inflammation a nd swelling in joints and so alleviates pain • disperses the oedema following injury to tendons and liga ments, lessens pain and fac ilitates movement • makes you feel good – a natural mood enhancer
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CONTRA-INDICATIONS OF MASSAGE
• Recent trauma – fractured bone, whiplash, sprains • Any ac ute inflammatory c ondition • Fever • Any condition where pus is present • Rec ent damage to liga ments , tendons or musc le • O pen skin problems – burns, sores etc • Lympha ngitis • Infec tious skin disease o Viral e.g. cold sores o Bac terial o Fungal e.g. ringworm, athlete’s foot • Thrombosis or a previous history of thrombosis • Tumours or cancer • Rec ent surgery • Rec ent bleeding from brain, lungs, blad der or gastrointestinal trac t • Bleeding disorders • Stones in kidney, ureter or bladder • Low blood pressure – although massage can still be performed if sensible • High blood pressure or heart condition • Osteoporosis or brittle bones • Varic ose veins • Loose joints/joint displac ement • Multiple sc lerosis • Diabetes • Pregna nc y – no abdominal massage in first trimester • Myositis ossific ans IF IN DOUBT – LEAVE IT OUT!
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MASSAGE TECHNIQUES 1. Effleurage
This technique is the principa l diagnostic and trea tment tool used in massage and c an be performed in a variety of ways. It is used in a general way to apply oil to the body; long smooth strokes spread the oil and give comfort and wa rmth. The strokes should be performed with the palms of both hands covering a large area. When treating a limb, more pressure is applied with a long upward stroke towards the heart and a lighter pressure on the return stroke. It establishes rapport with the client, allowing them to relax. The func tion of effleurage is to increase blood flow to the area , thus wa rming it.
2. Petrissage
This is also known as “kneading”. It is performed with both hands working together in a smooth, rhythmic al wa y. Eac h hand in turn is opened fully to grasp across the muscle, then squeezes and lifts the tissues; as one hand releases its grip, the other takes up a grip a djac ent to it. It takes prac tic e to get the rhythm c orrec t, but when established, this tec hnique stimulates the circulation, generally loosens and softens the tissues, and has a grea t warming effect.
3. Friction
This is the deepest tec hnique used in massage and is targeted at specific areas of soft tissue damage, such as scar tissue and adhesions. A digit, or elbow is used in a similar wa y as with deep effleurage, but even grea ter pressure is applied. It is first applied passively until sufficient depth is reac hed. Then lesions that have been located can be treated by using friction – ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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rotation or short rocking movement while maintaining the same deep pressure. Great sensitivity is required as this tec hnique c an be very pa inful. Fric tion is a powerful tec hnique which c an damage the tissues or bruises if used too forcefully. It should never be used in acute conditions and only with caution in the early rec overy stages. It is an excellent therapeutic tec hnique for breaking down scar tissue and adhesions; it loosens and realigns tangled fibres and stimulates local c irc ulation.
4. Percussion or Tapotement
Percussion techniques are made with alternate hands, striking the skin in very rapid suc cession. A c upped ha nd or the ulnar side of the hand c an be used to stimulate circulation. It c an be used to wake a client up before he leaves as it is stimulating to the nervous system.
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ANATOMY AND PHYSIOLOGY Skull Cervical Vertebrae
Clavicle Scapula Sternum Rib
Humerus
Spinal column
Upper
Pelvis Radius Ilium Ulna
Sacrum Pubis
Coccy Isc x hium
Carpals
Metacarpals Phalanges
Femur
Patella
Lower
Fibula
Tibia
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THE SKELETON The skeleton is regarded as having two main divisions: The Axial Skeleton is the central part or axis of the body, c omprising the skull, spinal column, sac rum, ribs and sternum. The Appendicular Skeleton c omprises the bones of the shoulder girdle, Pelvis (exc ept the Sac rum) and the limbs. This is sometimes thought of as the “added-on” bits.
Classification of Bones Bones are usually grouped under six headings:
1. Long Bones - the "classic" bone shape with a long, hollow, central shaft, like a tube, and a bulge known as the head at ea c h end. These are levers, c apa ble of achieving a large movement with a relatively small muscle a c tion. These include the bones of the limbs exc ept the carpals and tarsal. Examples include the femur, tibia, fibula, ulna, radius and humerus.
2. Short bones - squat bones, found where it is desirable to have mainly strength and solidity, with a small movement c omponent. Small gliding movements are possible within these groups of bones, and between them and adjacent bones of the hand and foot. Examples include the c arpals and the tarsals. 3. Flat bones - found where there is a need for protection of vital softer tissues, or to provide a big surfac e for musc le attachments or both. Examples include the cranial bo nes, the sternum and the scapula. 4. Irregular bones - fall into none of the other categories and are named bec ause they are irregularly shaped . Examples ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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include the vertebrae, and the bones of the inner ear.
5. Sesamoid Bones - usually very tiny bones shaped like a sesame seed which form in a tendon, that is, not attached to the main skeleton but found where the tendon makes an angle around a bony surfac e, espec ially ac ross a joint. They are most common in the hands and feet, and are generally thought to help brac e the tendon as it c rosses the joint. The patella, which grows inside the Quadriceps tendon, is the largest one in the body. 6. Sutural bones – these are the tiny bones that are found between the sutures of the skull. Bone Function
Function Support
Details Struc tural support for the entire body. Individual bones or groups of bones provide a framework for the a ttac hment of soft tissues and organs. Storage of The c alcium salts of bone are a valuable minerals mineral reserve that maintain normal concentration of calcium and phosphate ions in body fluids. Bloo d c ell Red and white blood cells and other blood production elements are p roduc ed in red marrow. Protec tion Many soft tissues and organs are surrounded by skeletal elements such a s the c ranium enclosing the brain, and the ribs enclosing the heart and lungs. This offers protec tion to the delicate organs. Storage of Energy reserves stored as lipids are found in lipids areas of the bone filled with yellow marrow.
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Leverage/ locomotion
Many bones function as levers that can change the magnitude and direction of the forces generated by skeletal musc les. The movements produced range from the dainty motion of a fingertip to c hanges in the position of the entire body.
Bone as Living Tissue It is important to remember that bone is living tissue. Throughout life bones can change shape and density in response to:
Stresses or lack of stress - exercise and heavy work will strengthen bone tissue; lac k of exercise will lead to a thinning. Traumas and accidents - will change weight-bearing patterns, producing responses in bones (as will putting on or taking off weight). Life or lifestyle changes - such as changes in diet or metabolism, pregnancy, carrying children, puberty and growth changes, menopause and c hanges of work and leisure, for example, retirement. C hildren need activity to help form their bones, older peo ple need exercise, no matter how little to help maintain their bones. Everyone needs calcium in their diet, and the ability to digest and metabolise it to keep their bones healthy.
Bone Structure Most people's image of bone is formed by seeing long-dead skeletons in museums etc . However these rema ins are only part of a living bone. The salts, mainly calcium phosphate and calcium carbonate, give bone its hardness and rigidity, similar in action to adding a hardener to a putty mix. The orga nic or living pa rt of the bone consists of bone cells in a fibrous matrix. Fibres of a protein c alled c ollagen wea ve tough threa ds through a very thick gelatinous material, in which the bone salts are deposited or ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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removed, depending on other bod y proc esses and needs. The proportion of calcium salts in bones tends to gradually increa se with age, making them more brittle in old age. In a c ross sec tion of bone, you c an see two types of structure:
Compact Bone looks dense and solid, and makes up the outside wall of every bone. It has a very fine network of c anals containing blood vessels which carry materials for its own maintenanc e and rep air. The microscopic struc ture imparts its rigidity and strength.
Spongy Bone which looks but doesn't feel like a sponge, is strong, but the spaces make it light and flexible. Spo ngy bone is always covered by compa ct bone a nd therefore protec ted by it. In the long b ones, spongy bone is found only in the heads of the bone; in all other bones it forms the central mass of bone within a c ompa ct bone lining. This latticework of bone is more resilient to pressure than solid bone would be. It works in a similar way to the steel framework of a multi-storey building. It is also muc h lighter. It has its own blood c irculation, fed by vessels passing through the covering of compa ct bo ne via holes called foramina. Spongy bone is also known as cancellous bone. Both types of bone respond to the dema nds of use by thickening where nec essary for extra strength. Long bones contain a long hollow space in the shaft surrounded by compact bo ne, which in adulthood is filled with yellow marrow, c onsisting primarily of fat cells, for fat storage. In foetal life a nd at birth, there is red marrow throughout the skeleton, some of which is gradually replaced by the yellow marrow in the shafts of long bones, beginning at about age five. In adults, the spaces in most spongy bone a re still filled with red bone marrow, in which blood cells are manufac tured.
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Longitudinal cross-sec tion through a typical long bone
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Bone Coverings A living bone is almost completely covered by periosteum, a thick gristle wrapping like tight layers of c ling-film. This periosteum protects the bone, especially as it grows, and holds in place the nutrient blood vessels and nerves that feed the bone via the foramina (singular-foramen). The tendons and ligaments normally knit into the periosteum, not direc tly into the bone itself. The only bony surfac e not covered by periosteum is where it articulates with or rubs against another bone at a joint. The smooth surfac e here is covered by hyaline ("glassy") cartilage - also c alled "artic ular c artilage". The function of the cartilage is to protect the joint from excessive bone-wear due to movement at the joint. The smooth surfac e of the artic ular c artilage allows ea sy smooth movement.
Bone Growth Most bones are formed from an initial "mould" or "template" of c artilage, similar to the slightly more flexible cartilage tha t remains in the ears and the end of the nose. Ossification is the replacement of cartilage by bone - a process of co-operation between firstly the bone producing cells, osteoblasts and then the bone-removing c ells, osteo clasts. Initially, the osteoblasts lay down solid bone and then osteoclasts sculpt it by removing unwanted bone to maintain the optimum thickness of the compact lining in a growing bone, and create the areas of spongy bone and the marrow c avities. This proc ess commences during foetal life and is normally not completed until adolescence, and in some bones not until 20-25 years of age. Long bones usually ossify initially at the centre a nd the ends, and growth or elongation then takes place in between these. C artilage "plates” or epiphysea l plates rema in between the growing surfac es. These plates are where new bone is mad e and where the bo ne ac tually grows in length. This continues until adolescence, when the growing surfaces meet and the final length of the bone is attained. There will still be further ossification of remaining c artilage a reas, as well as filling out of the width of the bone. Many bones’ growth radiates ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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from a number of area s - the sc apula, for example, ha s eight or more c entres of ossific ation. In some cranial bones, a sinus c an develop - an air-filled c avity in the bone. These c an grow through out life, giving the more prominent ridges and brows of a ge.
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Diagram showing bone growth ©Amatsu Association Ireland & Amatsu Therap y Association England for Ama tsu Training School of Ireland Ltd
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Bone Repair When a bo ne ha s been broken, and then set, it undergoes calcification - the laying down of new bone to repair the damage. Initially an exc ess of bone will be laid down to "splint" the break, which is then gradually reduced by the osteoclasts, so that a broken bone, properly set, will return to nearly as good as new. However, calcification can also be an attempt to fix bones together to replac e torn liga ments around a joint, thus stiffening it; or occasionally a metabolic process goes wrong causing the lining of blood vessels or musc les with c alcium salts resulting in disease.
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RECOMMENDED READING • Principles of Anatomy and Physiology.
Grabo wski and
th
• • • • • •
Tortora 10 edition Poc ket Atlas of the Moving Bod y. Mel C ash The Human Body. J ane de Burgh 1-84013-538-7 Touc h for Hea lth. J ohn Thie 0-87516-180-4 The Scienc es Good Study Guide. Andrew Northledge et all. The Open University Press 0-7492-3411-3 Sport and Remedial Massage Therapy. Mel C ash 0-09180956-8 Applied Kinesiology (synopsis). David S Walther 0-92972100-4
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• The Muscle Book. Pa ul Blakey 1-873017-00-6 • The Physiology of the J oints, Volumes 1, 2 and 3. Kapandji 0-443-01209-1
I.A.
REFERENCES AND ACKNOWLEDGEMENTS • Module One - Amatsu Training School Ireland Ltd 2004 J enny Mc Gann Mod ule One – Amatsu Training School England 2005 J ane Langston • Anma J utsu - Amatsu UK Ltd. Dennis Bartram • Module O ne - Amatsu UK Ltd. Dennis Bartram • Touch for Health. J ohn Thie •
APPENDIX 1 - Code of Ethics Amatsu Association of Ireland (AAI)
This C ode of Ethics will be adhered to by all Members of the Amatsu Assoc iation of Ireland. The range of treatments offered by individual Amatsu Prac titioners (AP) will vary according to their level of expertise in the profession of Amatsu therapy.
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This can lead to a client visiting more than one prac titioner in the co urse of a treatment programme and the following guidelines are written with that in mind. This Code of Ethics (Co de) provides a framework within which prac titioners of Amatsu therap y are expected to work, whilst allowing the public to see the c riteria used to protec t their interests.
The Amatsu Prac titioner must: Respect the c lient’s individua lity and beliefs. Treat every client with care and c onsideration. Explain treatments in a way that a client can understand. Listen to the client’s views and fully answer any questions. Respect the c lient’s right to be involved in their trea tment. Ensure that the practitioner’s own beliefs do not prejudice the needs of the client. Respect and protec t confidential information. Be p repared to explain the c hosen c ourse of treatment to c lients and collea gues. Work with collea gues in ways that best serve the c lient’s interests. Avoid any ac t or situation that could c ompromise the dignity or privac y of the c lient. Respect a client’s right to request a sec ond opinion. Be trustworthy in contacts with other health professionals. Strive to represent the profession with honesty and integrity. Be aware of new developments and skills. Work within the ethical criteria and ethos of the p rofession. Be fully insured to p rotect both themselves and the client. Rec og nise the limits of their own p rofessional c ompetenc e and refer on when appropriate. 1. ENTRY TO THE AAI 1.1 The AAI is a group of professional Amatsu Prac titioners (AP) offering trea tment using specific skills. 1.2 The standards, range o f competenc es and approp riate supporting knowledge for each of these skills are stipulated by the AAI. See Appendix 1. 1.3 An annua l fee must be p aid for membership. In the c ase of Amatsu Students the st
nd
Ama tsu Training Schoo l of Ireland (ATSI) will pay each student membership in 1 and 2 year. Once a student is a q ualified prac titioner he/ she must pay the annual fee. 1.4 Prac titioner insuranc e must inc lude Professiona l Indemnity and Public Liability. This insuranc e must be in ac cordance with the c urrent ICM Ap proved Insuranc e Scheme. 1.5 Prac titioners living and / or working ab roa d must have insurance according to the lega l requirements of that country. 2. RELATIONS WITH OTHER PRACTITIONERS
2.1 This C od e p rovides the b asis for a professional working relationship between health care professionals in confo rmity with the requirements of client safety and the law.
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2.2 It is desirable that Practitioners be aware o f other complementary disciplines / therap ies / tec hniques to facilitate co-operation b etween all the professiona l services that may be involved.
3. DEVELOPMENT OF SKILLS AND LIMITS OF COMPETENCE 3.1 The p urpo se o f the C od e o f Ethics is to ensure that the members of the AAI maintain the highest level of responsibility in their prac tice. 3.2 A minimum of four da ys C ontinuing Professional Develop ment per annum must be undertaken and recorded. See Appendix 2. 3.3 AP’s must take all reasonable steps to monitor, develop and advance their professional competenc e to the highest level and to work within that competenc e.
4. DIAGNOSIS 4.1 Practitioners will be required to make a diagnosis within the terms of the A matsu therap y discipline, determine a programme of treatment where appropriate; and / or refer a client on to another health professional. 4.2 The AP will use a number of techniques to assess the p resenting symptoms of the client, the underlying c auses and the po tential treatment(s) which may be a pprop riate. 4.3 Distinction should be made, wherever possible, between potentially life-threatening conditions and chronic states.
4.4 In the c ase o f 4.2 the c lient may bring a medica l history based on a series of allopathic diagnoses, which will serve to p rovide a n indication of a named condition. However, the AP will need to assess the case from different criteria and no attempt should b e made to d escribe a C omplementary diag nosis in allopathic terms unless the prac titioner is so qua lified. 4.5 Practitioners who wish to refer clients for an allop athic diagno sis or tests should exercise care in the way in which they describe their appreciation of the p resenting symptoms. For example: The A P may find that the client’s Tatara might indicate torsion or weakness in the knee, but it may be outside their competenc e to put an allopa thic medical name i.e. torn cruciate liga ment to the c ondition.
5. RELATIONS WITH CLIENTS 5.1 AP’s must ensure that the client understands what the treatment entails. Any risks should be c learly described . Post trea tment advice should also be given. It is not po ssible to guarantee the outc ome of a ny course of treatment, therefore the terms on which it is offered should b e c learly stated b efore the first session of trea tment. Any changes in the treatment should be discussed with the client and agreed in advance.
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5.2 The c harge for the initial co nsultation and subsequent trea tments must be made clear prior to c ommenc ement of treatment. 5.3 When AP offers treatment without payment of a fee they work under the same professiona l obligation to the client as when a fee is pa id. 5.4 AP must take all reasonable steps to ensure client safety and conform to health regulations as appropriate. 5.5 C lients should b e wa rned when a spe cific trea tment requires the removal of c lothing where this is not immediately obvious. Practitioners must apprec iate the c lient’s need fo r privac y and modesty and a llow them to have another person o f their choice present if they so wish. 5.6 The AP must be aware o f the ‘comfort’ of the c lient. i.e. p ain levels and warmth. 5.7 C lients will have d iffering opinions of intrusive touc hing in sensitive a rea s. The A P must ask the client for and be given permission to touc h on each and every oc casion. The client dec ides what is sensitive for their bod y not the A P. 5.8 The AP retains the right to refuse to treat a client. 5.9 The AP must always be prepared to justify the c ourse o f any trea tments and their ac tions therein to the c lient and if ap propriate to the A AI. 5.10 The AP should be aware of the requirements of the Criminal Rec ords Burea u and should evaluate their own practice as to the value of undertaking this validation. It is strongly recommended that this process be followed.
6. CONFIDENTIALITY 6.1 The A P will rec ognise the client’s right to have c onfidential information kept sec ure and private. An AP is persona lly ac countab le for their individua l prac tices and of professional accountability. 6.2 Confidential information may have b een provided b y the c lient or a c ollea gue. It may also b e discovered b y cha nce or during the c ourse of normal working prac tices. 6.3 A client has the right to expect that information given in confidence will be used only for the purpo se for which it was given and will not be relea sed to others without their permission. 6.4 Clients have a right to know the standards of c onfidentiality maintained b y those providing their care a nd these standards should be ma de known by the AP at the first point of contact. These standards of co nfidentiality ca n be reinforced by leaflets or po sters at the prac tice. 6.5 It maybe imprac tical to obtain the consent of the c lient every time there is a need to share information with other health professionals or other staff involved in the health c are of that client. It is impo rtant that the c lient understand s that some information may be available to others involved in the delivery of their care. The c lient must know who the
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information will be shared with. 6.6 If it is app rop riate to share information with other health or soc ial work professionals, the information will be kept in strict professional confidence and be used only for the purpose for which the information was given. 6.7 The AP is required to obtain the explicit consent of a client before disclosing specific information. The c lient must be able to make an informed response as to whether that information c an b e d isclosed. 6.8 Disclosure of information occurs: With the c onsent of the c lient Without the consent of the client when disclosure is required by law or by order of a court Without the consent of the client when the disclosure is considered to be necessary in the public interest. The public interest means the interests of an individual, or groups of individuals or of society as a who le, and would, for example, covers matters such as serious crime, child abuse, drug trafficking or other ac tivities which plac e others at serious risk. 6.9 The d eath of a client do es not give the AP the right to break c onfidentiality. 6.10 C onfidentiality should only be broken in exceptional circumstanc es and after careful co nsideration. A written rec ord of the c ircumstanc es will be kept as justification for the ac tion taken. Should it become necessary, the dec ision c an be reviewed later in the light of future developments.
6.11 The AP should a lways discuss the matter fully with other professional collea gues and, if app rop riate, consult the AAI o r BRC P before making a decision to release information without a c lient’s permission. 6.12 Ac cess to records for teaching, research and aud it. If client rec ords are required to help students ga in knowledge and skills, the same principles of c onfidentiality apply to the information. This also a pplies to individuals engaged in research and audit. The AP is responsible for the sec urity of the information, ensuring that all others are a lso a ware of this requirement. The c lient should know about any individua l having a ccess to their rec ords and should b e a ble to refuse that ac cess if they wish.
7. CONSENT 7.1 A c onsent form must be signed and kept as a doc umentary rec ord of the c lient’s agreement for assessment and treatment using Amatsu therapy techniques. 7.1.1 It does not form a legal waiver, and if a c lient for example rec eives insufficient information on which to make a decision, then the c onsent form although signed may be invalid. 7.1.2 The form will also serve as a reminder of wha t has been discussed , however, the written information should not b e regarded a s a replacement for verba l communication
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and discussion. 7.2 Everyone aged sixteen and over is presumed competent to give consent for themselves, unless it ca n be demonstrated otherwise. 7.2.1 A c hild under the age of sixteen who has the intelligence and understanding of the therapy proposed is also able to consent for themselves. 7.2.2 Children under sixteen who a re legally co mpetent and sixteen and seventeen year olds are d eemed ab le to sign for themselves, but a counter signature from a competent adult is advisable. 7.2.3 A child unable to consent for themselves may have consent given for them by someone with parental responsibility as they are deemed to be responsible for that child. 7.3 If the client is over eighteen and is not legally competent to give consent, treatment should NO T be provided. A c lient is not legally co mpetent to c onsent if: 7.3.1 They are unable to comprehend and retain information material to making the decision for treatment and / or they are unable to weigh and use this information in making a decision. 7.3.2 It is the respo nsibility of the A P to a ssess the above. A note should be made if the client has specifically asked the practitioner to make decisions on their behalf.
8 DATA PROTECTION ACT 8.1 The AP is responsible for the safekeeping of rec ords in their prac tice. 8.2 Ownership of a nd ac cess to records. Organisations which employ staff who make records are the legal owners of those rec ords, but that does not give anyone in that orga nisation the legal right of a ccess to the information in those rec ords. 8.3 The c lient can ask to see the ir rec ords, whether written or electronic. This is a result of the Data Protec tion A ct 1984, Ac cess Mo dification (Health) Order 1987 and the Ac cess to Health Rec ords Ac t 1990. A fee may be c harged to c over administrative costs. 8.4 The c ontrac ts of employment of a ll employees direc tly or indirec tly involved with clients but have a ccess to o r handle c onfidential reco rds (written a nd electronic) should contain c lauses which emphasise the principles of c onfidentiality and state the disciplinary ac tion which could result if these p rinciples are not met. 8.5 The methods used for rec ording electronic information must be secure. Local proc edures must include wa ys of checking that a record is authentic. All rec ords must clearly indica te the identity of the person who ma de the rec ord. Ensure that all persona l access codes are secure. 8.6 The C omputer Misuse Ac t 1990 came in force to secure computer programs and da ta a ga inst unauthorised access or alteration. Authorised users have permission to use
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certain programs and data. If those users go beyond what is permitted, this is a criminal offenc e. The A ct makes provision for ac cidentally excee ding p ermissions and covers fraud, extortion and blac kmail. 8.7 The AP must ensure that the storage and movement of records does not put the confide ntiality of c lient information a t risk.
9 CLINICAL PRACTICE 9.1 The A P will doc ument the c lient’s medica l history, take notes of individua l treatments for eac h c lient, and rec ord findings and clinical data methodic ally, without distortion. 9.2 AP’s must be aware of those diseases which are notifiable in their country of practice and take app ropriate action to c onform to the requirements of the loc al Health Authorities or laws. See Ap pendix 3. 9.3 AP’s as members of the A AI must not: 9.3.1 Use the title “d oc tor” before their name unless they are registered physicians with the Medical Assoc iation in the c ountry of prac tice. AP’s who a re not registered physicians but a re entitled to use the term “doctor” may state it after their name with appropriate qualification i.e. Doctor of Acupuncture, China. 9.3.2 Refer to or ad dress an assistant as “nurse” unless that assistant holds a nursing qualification in the country in which the prac tice is being op erated. 9.3.3 Co nduc t a genital examination of any client without a c hap eron being present unless written c onsent has been given. 9.3.4 Conduct a p hysical examination o f a child under 16 years of a ge except in the presence of a parent or guardian or other responsible adult. Written consent must also be given. 9.3.5 Make any claim, either oral or written, for the c ure o f any given disea se. 9.4 The A P should refer a client to another prac titione r if the following considerations apply: 9.4.1 If they consider the case is beyond their tec hnique, c apacity or skill, the c lient should be consulted / ad vised and introduced to the new prac titioner. 9.4.2 If they require advice from a more senior prac titioner. 9.4.3 Full details of the medica l history should be provide d, with the date and d etails of a ll trea tments given.
10 PRACTITIONERPREPARATION 10.1 AP’s rely on touc h so every care should b e taken with the condition of their hands. 10.1.1 In the event of a ny cut, abrasion or skin cond ition, latex gloves should be worn.
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10.1.2 If gloves are used they should be discarded a fter every trea tment of a c lient. 10.1.3 Hands must be washed thoroughly after every client, this app lies whether gloves have b een worn or not. 10.2 Any waterproof dressing must be changed after each individual treatment. 10.3 Attire should include washable or disposable clothing. 10.4 Hair should not come into contact with the client. 10.5 J ewellery should be removed or co vered. 10.6 Nails should be clean and short.
11 PRACTICE PREPARATION 11.1 AP’s must cond uct their prac tices at the highest professional stand ard in their personal appearanc e, hygiene and appropriate d ec orum. 11.2 Overall clea nliness of the clinic must be maintained on a da ily ba sis. 11.3 An appropriate dilution of disinfectant must be used after any suspected contamination. 11.4 The premises must be adequately furnished, heated when appropriate and provide hand washing facilities. 11.5 Where a pp rop riate c lean towels are to be made a vailab le for clients. 11.6 The consulting room should be fully insulated for sound from the waiting area . 11.7 Ensure the couc h is clea n and c overed by fresh pa per or other for eac h c lient. 11.8 Ensure there is an accident book to record any unusual incident. 11.9 All relevant Health and Safety at work procedures must be adhered to.
12 ADVERTISING AND ANNOUNCEMENTS 12.1 AP’s may ad vertise a prac tice or service, exercising c are that nothing is said or implied that would discredit Amatsu therapy. 12.2 The following guidelines must be ob served: 12.2.1 Stationary and nameplates should contain the minimal information needed to be descriptive but make no claims as to quality or effectiveness. 12.2.2 Professional announcements in the M edia shall contain name, profession,
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qua lifica tions, prac tice title, times of surgeries and addresses. 12.2.3 Practitioners are advised to use their first name or other indication of their gender with the surname/s. 12.2.4 Only professional qualifications from accepted organisations or Degrees conferred by estab lished Universities should b e displayed in practices. Qualifications from outside Ireland must be a ccompanied by the c ountry of origin i.e. Mr J oseph Bloggs, Doctor of Ac upuncture (Beijing), M BRC P (O steop athy). 12.2.5 Practitioners may add the letters AA I to their name. Prac titioners may print the title in full if they wish i.e. Ama tsu Association of Ireland .
13. PUBLIC STATEMENTS AND DEMONSTRATIONS 13.1 Practitioners are a dvised that they must exercise care in making any pub lic statement and should not present any facts or op inions purporting to represent the views of the A AI without obtaining written consent from The Ethics C ommittee. The AAI reserves the right to examine a ny material before giving such c onsent. 13.2 Practitioners may be c alled upo n to give a demonstration of Amatsu. In these cases, the modesty and dignity of the client must be preserved and they must not be brought into ridicule.
14. DEATH OR RETIREMENT OF A PRAC TITIONER 14.1 Practitioners should make arrangements for the c orrec t disposal of c ase records in the event of their death. Exec utors are ad vised to c ontact the AA I for advice. 14.2 Practitioners who sell or otherwise transfer their interest in a practice must inform all their clients of the change and give the name of the prac titioner to b e responsible for their treatment. 14.3 C lient information shall not be provided to the inco ming prac titioner without the permission of the c lient.
15. WORKING WITHIN ESTABLISHED MEDICAL PREMISES 15.1 The doctor in charge will usually retain overall charge of the client’s case and will give permission for the treatment to b e DELEGATED to the A P. 15.2 Where the prac titioner is a nurse, they must act within the current guidelines of the Ethics and Standards Co mmittee of A n Bord Altrana is and the Professional C od e o f C onduct Committee. They must also act only under the guidanc e of the ward management, observing a ny code of c onduc t that may have been devised within the Area Health Authority.
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15.3 Prac titioners who are not nurses but work at established medical premises must, at all times, act discreetly and conside rately, taking the g rea test care to consult with staff in charge a nd to a void any action or behaviour that could obstruct or conflict with the work of other health professionals.
16 DISCIPLINE AND COMPLAINTS 16.1 The a ccep tanc e of this C ode is the outward sign that prac titioners wish to estab lish the relationship between themselves and those to whom they have a professional responsibility. The ado ption of such a C od e is designed to establish the probity and competenc e o f the profession in the eyes of the p ublic and resolve any complaints in a transparent manner. See Appendix 4. 16.2 Practitioners are required to report any complaints or criminal convictions made ag ainst them to the BRC P and the AAI. 16.3 The Disciplinary Committee for the BRC P will be convened to investiga te c omplaints. 16.4 The Disciplinary Committee may determine the fitness or competenc e o f the prac titioner to c ontinue to p ractice. The AP may be removed from the Register if the C ommittee co nsiders they are unfit to rema in in registration. The AP may re-a pp ly at a later date for re-registration.
APPENDIX 1 STANDARDS, COMPETENCES AND SKILLS All fully qualified AP’s must be certified at the Anma and Seitai levels by teaching schools registered to the AAI and the ATA. APPENDIX 2 CONTINUING PROFESSIONAL DEVELOPMENTREQUIREMENTS Requirements are 4 days C PD. There must be a minimum of two da ys C PD in Amatsu training ea ch ca lendar year. Requirements also include up to date First Aid training. The full req uirements for this are at present work in prog ress
APPENDIX 3 NOTIFIABLE DISEASES The Department of Health from time to time issues guidelines to prac titioners. This is circulated by the IC M a s and when rec eived. Prac titioners are ad vised to chec k direc t with the Dep artment of Health to ensure that they have up to date information. C lients should b e asked if they have been in contact with or suffer from any notifiable disease. C ategories of Infection and Infec ting Agents:
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1 2 3 4 5 6
Open lesions or wounds Chronic skin conditions Hepatitis B and C virus. HIV MRSA CJ D
The AP should refrain from treating clients with the above co nditions unless they have been spec ifically trained in the relevant infection control proc edure.
APPENDIX 4 DISCIPLINARY PROCEDURE The AAI will have a proc edure to consider claimed infringements of this C ode. The IC M are currently determining policy.
APPENDIX 5 LEGAL STANDING OF THE AAI In the event that the AAI bec omes do rmant, or cea ses to exist in law. The treasurer will provide a ba lance sheet of the current financ ial co mmitments. Any outstanding monies will be transferred to a n Assoc iation that succeeds the AA I.
APPENDIX 6 ELECTION PROCEDURES Work in process. APPENDIX 7 ELECTED PERSONS AND COMMITTEE MEMBERS ROLES Work in process.
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