Written by Lee Jarvis. Proofreading and editing by Genevieve Sauviat.
Kristen Jarvis is a graduate of the Canadian Academy of Osteopathy (CAO) and an Osteopathic Manual Therapist. Kristen graduated the CAO in 2017 after a 16-year career as a Registered Massage Therapist. Currently, Kristen is a professor at the CAO and has taught the courses Professionalism and Ethics, as well as Practice and Development. At the time of this article Kristen is also the Director of Clinics at the academy.
In November of 2024, I interviewed Kristen at her office in Welland Ontario. She was (and is) very passionate about her Osteopathic Manual Therapy career and this comes through in her continuous study and research into anatomy and physiology. This passion for research is well applied in the better understanding of diseases and conditions of the patients she sees daily, in her private practice. During the interview, so many great ideas and concepts were discussed, and the pace was so quick, that there were times I could barely keep up. It was without a doubt, a truly enjoyable experience (that also reminded me that I need to keep up my own studies).
Kristen and I talked about many subjects but eventually came around to the idea of Collective Mechanics. For those who don’t know the term, “Collective Mechanics” is a CAO concept originally coined by Robert Johnston, the Head Instructor and Principal at the CAO. For a complete explanation of collective mechanics, consider reading the book “Osteopathic Principles: Applied in Mechanics and Treatment.” One of the most notable principles of Osteopathy, its first principle, is that all the structures of the body work together. The exact statement by the founder of Osteopathy Dr. Andrew Taylor Still, is that “The body is a dynamic unit of function” and this statement appears to become more and more true with each modern discovery in the study of the body. It is clearer than ever that every small and large part of the body must work together if there is any chance at health. Interconnectivity is certainly not limited to movement of the body and any system-to-system interaction is just as good of an example. Although movement is still a great example of integrated function.
Collective Mechanics builds upon the Osteopathic principles is a topic we aim to explore in greater depth through future articles in the CJO. For the purposes of this specific article and as a summary of this broader concept, Collective Mechanics can be understood as:
- The human body prefers to/is made to work together
- The body works together in its physiologic processes as well as in movement (which are two things that are becoming increasingly difficult to separate)
- All movement is distributed throughout the body, though to varying degrees
- A change in movement in one area necessitates adjustments in others (whether in a significant amount, or in subtle ways as well)
- Muscular and connective tissue movement directly influences fluid dynamics within the body
- When one part of the body moves less effectively in the body, other parts consequently move less effectively
- These compensatory changes occur across multiple areas, sometimes at significant distances, and involve multiple layers of tissue
- When treatment is aimed at improving movement, considering as much of the body as possible enhances outcomes
- And, this point being more specifically applicable to treatment setup, engaging more of the body in the leverage setup reduces the force required by both the patient and practitioner, making the process safer and more efficient
Kristen demonstrated several high-quality applications of these concepts in practice, one of which I will detail below. I must say that while many practitioners can implement full-body leverage applications, Kristen not only executed them skillfully but also provided a thorough and comprehensive explanation. This combination of expertise and clear instruction is rare and greatly appreciated.
Supine leg pull with patient active head twist
Before demonstrating the following method, Kristen had already performed several other applications with me as the patient. During this process, she identified a restriction in my anterior thoracic region, affecting structures such as the ribs, sternum, and costal chondral cartilages.
Kristen explained that addressing this restriction within the framework of Collective Mechanics would require working through multiple regions of the body. She further clarified that the corrective method she was about to demonstrate could be approached in smaller, sequential steps or performed as a single, integrated method. The choice between these approaches was patient dependant, but in this case, either method was viable.
I requested that she perform the correction all at once, as I believed it would provide an excellent explanation—and make for a great picture, and she agreed to my request. Throughout this setup and process, Kristen also explained she would be setting up the positions of correction for both direct and indirect applications, as needed based on her findings and how the body actively responded to positioning.
To save time in explanation, understand that in Osteopathic terms, the “anterior thoracic region” refers not only to the skeletal components but also to the surrounding and attached connective tissues. In this context, the term “fascia” is used in its broadest sense to encompass these structures. Kristen identified this region as a pathologic pivot, meaning it served as a focal point for dysfunctional movement patterns. Because of its role in a larger, detrimental movement tendency, it was important to address the area as a whole.
The setup for the process began with an exceptionally well-executed hold on my right leg. I sincerely mean this as a compliment, as the position was not only highly effective but also ergonomically efficient for the practitioner. Kristen had her knee up on table, to create a base for the leg closest to her. The right leg was lifted up, abducted, and then placed overtop Kristen’s bent leg.
The leg was positioned over Kristen’s leg and left partially suspended, as the abduction used meant there was no table surface beneath it to rest the foot on. This suspension created a slight traction effect on the hip joint.
Kristen stated that internal or external rotation can also be used if needed to further address the restriction (but was not needed this time). Kristen then secured my leg with her down-table hand and applied her body weight into the leg with a bit of a backward lean. This application generated much more significant traction at the hip joint with minimal physical effort on her part. The traction was distributed evenly and safely through the leg and into the hip joint (it was completely painless and actually felt like a deep, effective stretch).
This leg setup allowed Kristen to keep her up-table hand free to work on the previously mentioned thoracic restriction. Using her up-table hand, Kristen found the point of restriction in the anterior thoracic region. By leaning into it with a straight arm (specifically shifting her weight to her left) she was able to apply controlled pressure to the area.
The lower body, already positioned for traction from the lower to upper regions, connected effectively to the newly established fixed point of the hand and thorax. Already this is a long use of leverage by anyone’s standards, but the process did not stop there. Kristen then instructed me to begin turning my head to the left (as in my left or the left side of the table). At a certain point when the tension/building leverage increased within a certain range of head movement, I was instructed to stop and hold the position.
This head position was explained as a further connection, from the head downward to the thoracic fixed point. Kristen noted that she could feel a significant pull extending from bottom to top, a long line of leverage spanning most of the body’s length. This leverage, or the sensation of a long pull/stretch, was something that I experienced as well.
Kristen then instructed me to engage additional muscles and planes of motion by pressing my head straight back into the table. Due to the resistance provided by the table, this component of the application could be considered Post-Isometric Relaxation (PIR). However, the added muscle activation significantly contributed to the overall leverage effect (which might alter the naming of the maneuver, although that distinction is not particularly relevant in this context). Kristen then instructed me to lift my chin up (Atlantooccipital extension), to further increase tension in the lever. At that point, unless someone had physically pinched my scalp, it would have been nearly impossible to create a longer lever.
Since this application required some time to set up, the release itself occurred quickly. Once it happened, Kristen allowed the hold to return to a comfortable resting position. This rapid release of the larger leverage could have been due to the time spent establishing the full setup and the associated myofascial release, as time is traditionally a key factor in tissue release. Conversely, a sufficient neurologic stimulus and/or input change, may have altered the tone of the involved tissues. Nonetheless, a noticeable relaxation of both the tissues and the patient took place. It should also be mentioned despite the length of this write-up, the entire process—including a full explanation—took only about 1 minute and 45 seconds and required minimal physical effort on Kristen’s part. Whether from the standpoint of effective treatment or a very well constructed setup, I couldn’t have been more pleased with the result.
I would like to thank Kristen for this demonstration and for taking the time to speak with me. In our upcoming articles, we will explore additional topics, including skill development in practice and further manual applications.
Dig on!