Developed by Edward G. Stiles, D.O., F.A.A.O., sequencing is a method of locating the key area in which to treat in the body. The sequencing is a principles-based approach that can be applied in any patient position (standing, sitting, supine or prone) and can lead you to the key area to treat. By locating the key area (called the Area of Greatest Restriction or AGR or Area of Greatest Hinderance) the practitioner can more effectively and efficiently treat the patient. The principles then allow the practitioner to get as specific as necessary in locating the AGR before treatment commences. By treating the areas that are most restricted in the body and then after each change re-evaluating the patient to find the next AGR, each patient treatment becomes unique. The potential for change in each treatment is maximized. Each treatment AND each visit are unique and tailored specifically to that patient and that day. The patient’s complaints resolve more rapidly and with much less effort on the part of the practitioner. Sequencing also allows the practitioner to utilize the patient’s body as a “measuring stick” for progress between treatments (i.e. if different areas are located as the AGR in successive treatments - the body is changing). Sequencing is unique to Dr. Stiles and his students. Luckily, I had the opportunity to be one of the first undergraduate fellows to study under his mentorship. I spent an extra year in medical school learning more about osteopathic manipulation and Dr. Stiles’ unique approach to treatment. That year has paid huge dividends in my practice and in patient outcomes. Ed and I have taught numerous courses together over the ensuing years since graduation and I continue to learn from him today.
Treating a patient can be compared to trying to open a wall safe. The patient walks into the office and hands the practitioner the numbers to the combination, but unless the practitioner knows the order in which to enter them, the patient does not get the prize (improved, optimized health). Sequencing allows the practitioner to ask the patient’s body the order in which that treatment should be performed - this makes every treatment (even with the same patient) unique. This approach to treatment differs vastly from the allopathic approach (your wrist hurts, so we only treat your wrist), an evidence-based approach (the evidence says your should pain most likely comes from this spot), or a top-down or bottom-up approach ("I was taught to always start at the feet and work up” for example).
I have taken Dr. Stiles’ principles and expanded sequencing in many ways in my 20 plus years of using sequencing as an approach to the patient. Each new piece that I learn from treating a patient has a place in sequencing. Each new course I take is added to the paradigm (Barral’s work with nerves, viscera and emotion, Chikly’s work with the brain and lymphatics, Arbuckle’s dural restrictions, Hiss’s foot treatments, retained primitive reflexes, etc.) - all of these represent a specific finding when sequencing the body that will lead to an area to treat. New levels have been added and that has led to more course offerings. The Sequencing 1 course is nearly identical to what Dr. Stiles’ taught us in medical school and it is the recommended place to start your education. The new knowledge that has been gleaned from using the methods from multiple practitioners has been distilled into other courses. They can jump start you on your learning and palpation journey. We currently offer:
Sequencing 1: The ART of Finding the Key. Sequencing is a road map for how to treat the body - it tells you where in the body to start (and gives you a rationale for why), and then where to advance next, and when to end the treatment. In this introductory course, you will learn the principles behind sequencing and how to apply them. We will cover eye dominance, how to blend with the tissue while palpating (blended palpation) in order to get the best feedback, how to move the patient utilizing the principles of tensegrity, and how to choose the treatment type. Examinations of each area of the body will be explored using the “ART” - Assess, Rank and Treat. Additionally, we will learn how to sequence the pelvis utilizing Fred Mitchell, Sr.’s model of pelvic mechanics and tie that in with the rest of the body. Sequencing makes each treatment unique for every patient at every visit. The key area is potentially different for every patient at every visit - so you may never treat in the same order or the same way twice. Sequencing makes you EFFECTIVE - without learning new techniques every few months.
Sequencing 2: The Pelvis in Depth. Following Mitchell’s model of the pelvis, we explore the mechanical movements that occur during breathing, walking and the cranial rhythm and how they influence the pelvis. After examining and treating the pelvis following Mitchell’s model, we will teach how gait influences the pelvis and cover how to diagnose and treat gait dysfunctions. We then add to Mitchell’s model by exploring two new axes. We also explore the sacrum from its adult form of one solid piece backwards through its development and cover what a lesion at each stage feels like and how it is treated. Traumatic lesions of the pelvis and sacrum as well as bilateral lesions will also be examined. The bilateral lesions are not explored in depth in any other class/school I have ever seen or heard of. They are present in many people and are a vital part of relieving their chronic conditions.
Sequencing 3: The Midline Structures (the Bow and the Bowstring). This course adds onto the principles taught in Sequencing 1. With a small change in hand position, the sequencing screen can give you feedback about the midline structures of the body and how they function (or are restricted). Because the body is normally tested in standing and/or seated position - and not under load, many structures that do not show up in any other practitioners' approach can be isolated and localized using this method. (this would include Barral’s global and local listening, myofascial testing, mechanical link, thermal diagnosis, the mechanism/cranial diagnosis, visual diagnosis, etc. - none of these approaches are bad at all, they just don’t isolate what this method does). This course is helpful to locate the mechanical issues in your problem patients that may have been hard/impossible to find otherwise.
Sequencing 4: Sequencing Hospitalized Patients. This course builds on the others by showing how to safely and efficiently treat the hospitalized patient. A minimum amount of hand positions are utilized to get a maximal amount of diagnostic feedback from the patient's body. This course details how to sequence/treat the patient in the hospital bed without having to move the bed or contort your body. Diagnosing/treating the body through the feet will be covered. How to diagnose and treat all of the cranial strain patterns through the pelvis will also be explored. This method is invaluable as a time saver and back saver for the practitioner and is a vital addition to anyone treating patients in a hospital setting.
Sequencing 5: Locating and Treating Shock in the Body. When a patient comes to see us that has already been to see more than one other qualified practitioner, they are likely telling you that their body is in shock. This shock is different than hypovolemic, neurogenic or septic shock that is typically treated in the Emergency Room. This shock restricts movement in planes of motion (and thus affects the whole body). This shock prevents treatments (even good osteopathic ones) and medications from working effectively. This is one of the reasons why patients keep returning for the same issue. Learn how to identify the five different types of shock (including the one that Dr. Fulford described) and how to rapidly treat them. Previous knowledge of the sequencing method of screening the patient is required.