Massage World - Issue 108 by mwcommsltd

MASSAGE WORLD

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Sports Massage: Top Tips Deep Tissue Massage Marketing to Customers Today

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Issue 108 2020

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Case Study: Post-Concussion Syndrome

Touch: The Forgotten Sense Are You Sitting Comfortably? Buying Massage Chairs £5.00

MASSAGE THERAPY | REFLEXOLOGY | BUSINESS TOOLS

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welcome editorial by Wendy Kavanagh

EDITOR

Wendy Kavanagh

FEATURES

Wendy Kavanagh Earle Abrahamson Pauline Baxter Conor Collins Ruth Duncan Rachel Fairweather Susan Findlay Emma Gilmore Ruth Hull Jane Langston Meghan Mari Nana Mensah Charlie Thompson Amanda White Madelaine Winzer Mark Woollard

GRAPHIC DESIGN

Victoria Osborne

MEDIA COMMUNICATION

C J Newbury

PUBLISHERS

NK Publishing

ADVERTISING

Please call the Massage World office T 020 7387 2308

his year will be one we never forget as mother nature has the upper hand! Covid-19 has killed tens of thousands of people throughout the world in a short space of time, and all we can do is wait to see what happens next. A lot of events have been cancelled, but there will be many more to look forward to in the future. It is a terrible situation we are in, which may mean we have to change our perspective. Now could be a great time to brush up on skills, read more and think about ways that you could improve your business. Charlie Thompson highlights different ways you can market your business in order to gain new customers and keep them. Many societies throughout the world are touch-deprived and massage can be a great way to treat the problem. In this issue, Emma Gilmore explains the power that nurturing ‘touch’ has on people’s health and wellbeing. Massage therapists are at the forefront of patient’s recovery when it comes to concussion. Conor Collins talks us through what post-concussion syndrome is and how to manage patient’s recovery so they have the best opportunity for recovery. There are many more fantastic articles in this issue to keep you informed. Thank you to all of our readers and contributors. Stay safe and look after yourselves!

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Massage World, The Crypt Centre St Mary Magdalene Church Munster Sq, London, NW1 3PL T/F 020 7387 2308 E info@massageworld.co.uk W www.massageworld.co.uk DISCLAIMERS The publisher has taken all reasonable measures to ensure the accuracy of the information in Massage World and cannot accept responsibility for errors in or omissions from any information given in this or previous editions or for any consequences arising thereof. The Editor may not always agree with opinions expressed in Massage World but allow publication as a matter of interest, nothing printed should be construed as Policy or an Official Announcement unless stated. No part of this publication may be reproduced in any form or by any means whether electronic, mechanical and/or optical without the express prior written permission of the publisher.

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contents

issue 108 2020 Features

12 Why is SKART Part of the 21st Century of Health? SKART (Structural Kinesiology Acupressure Release Technique) is a cutting-edge new diagnostic and therapeutic technique designed, trialled and used for the efficient management of back, neck, hip and leg pain. Amanda White explains what SKART can help you with, what areas it helps to treat and how embarking on the course will help develop new skills that have the potential to benefit practice and client health.

20 Touch - The Forgotten Sense In this digital age when we are more than ever connected via technology, research shows we are decreasingly connected in a true, meaningful human way, we are currently experiencing less touch than ever before with less time spent engaging in positive face to face interactions. In this article Emma Gilmore discusses the importance of touch and the consequences that are associated with lack of nurturing touch.

34 Are You Sitting Comfortably? There are choices everywhere and it can be confusing when it comes to making a final decision regarding which massage chair will be the best option for you and your clients. Pauline Baxter talks us through what you need to consider when buying a massage chair.

36 Post-Concussion Syndrome As the field of concussion continues to evolve, massage therapists are becoming an integral part of the health care team managing this often complicated injury. In this case study, Conor Collins explains what Post-Concussion Syndrome is and the importance of the massage therapist’s role in managing a patient’s symptoms.

40 Reflexology For Mental Health Mark Woollard explains how reflexology can be used to help treat patients who have mental health conditions, concentrating on what he calls the Spirit, Emotion, Mind and Stress reflexes.

45 Marketing Today How do you market yourself effectively without wasting your time and money? Charlie Thompson looks at different ways of marketing and how they can be used effectively to increase your customer base and get your company the exposure it needs to thrive.

45 Regulars 3 6 33 40 45 56

Editor’s Welcome News & Views Book Reviews Reflexology Business Tools Course Listings

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news&viewsnews&viewsn

FHT blog supports therapists and clients during social distancing measures It’s incredibly sad that at a time when positive touch has never been more needed by those in our local community, we are faced with an unprecedented situation where social distancing has become an imperative to protect everyone, and not just the people we treat, from COVID-19.

Online tools to help you support your clients remotely New to live video and voice apps? FHT’s deputy editor, Leanne Sheill, provides a ‘one-stop-shop’ with links to the most popular online tools to stay in touch with your clients.

In an effort to help its members and their clients stay well at home, the FHT is offering lots of articles and advice on its blog, which are freely available to all. Recent items published include:

Five heart-warming stories since the coronavirus outbreak Here we share five uplifting stories that appeared on our social media feed, from three elderly women self-isolating together, to penguins making the most of human social distancing at a zoo.

Self-help techniques to boost your health and wellbeing at home FHT Vice President Mary Dalgleish gives five top tips to help reduce anxiety and boost health and wellbeing. Feel free to share the link with your clients and on social media.

The FHT is happy to advise or comment to the media on any matters relating to complementary, holistic beauty and sports therapy, including training standards, safe and responsible practice, and regulation.

Working remotely with clients FHT looks at how therapists can support clients remotely through the telephone, email, messaging and online technology.

Find all the above and more at www.fht.org.uk/blog. You can also read FHT’s coronavirus at PLACE ON TAKING statement 2020 SUN 4 & MON 5 OCTOBER www.fht.org.uk/coronavirus The W14 !"#"$"%&'"()()

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TAKING PLACE ON SUN 4 & MON 5 OCTOBER 2020 AT OLYMPIA LONDON W14

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The National Massage Championship

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The National Massage Championship will be returning to Olympia Beauty on Sun 4 - Mon 5 October for the third year! This incredible event welcomes all qualified massage therapists and bodyworkers to challenge themselves and receive professional feedback on their techniques! Every competitor receives a certificate of participation and is invited to the networking reception taking place after the Awards Ceremony on Monday. We can’t wait to see you there!

Are you ready? ENTER ANY OF THESE CATEGORIES

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Issue 108 2020

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ENTER ANY OF THESE CAT

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snews&viewsnews&views The Jing Method is now online! As the world is shifting and changing on what seems to be a daily basis, Jing Advanced Massage (www. jingmassage.com) is adapting. They are responding to the call for help from the massage therapist community worldwide in the only way they know how – with connection – virtual connection! Hands on has become hands on-line! In this uncertain time, Jing is offering 3, totally free, weekly webinars to the Massage World community. Each episode offers tried and tested top tips for reaching out to your massage clients in our new virtual world. Learn a step by step method for helping your clients with self-care, self myofascial release, stretches and self trigger point work for their chronic pain conditions. You will learn everything you need to keep your practice going until we can get back to business as usual. Of course, the trademark positivity and inspiration Jing is known for is all given straight from the heart for free! Jing are also offering a range of self-care sheets for clients that are free to download. Covering everything from helpful visualisations for pain relief, to self-trigger point treatment and exercises for Temporomandibular Joint (TMJ) Pain, these helpful resources are perfect for emailing to your clients to give them a reminder to keep them helping themselves whilst reminding them that you are still here for them. If you are looking for a little more to get involved with, Jing is also offering an immersive online adventure. They have taken 6 modules from their award-winning BTEC level 6 Professional Diploma in advanced clinical and sports massage – and whisked them into the online world. This allows therapists to get the best of the Jing vibe at home. And I promise you –even for the most technophobic therapist, it is super easy to use. Much more than your standard online course – they really do give you the full experience of the Jing flagship hands-on workshops without leaving your seat. They include engaging and funny TV-style commentary by Meghan and Rachel (Jing Directors), films and close-ups of all techniques, hands-out, quizzes and all the rest you would expect to find in an online course – but the best bit – is what you learn. Really powerful easy to follow protocols that get your clients out of pain and moving again. So however you want to get involved – Jing has something for you. Stay connected

Standard Authority for Touch in Cancer Care (SATCC) Founder of ESPA, Susan Harmsworth MBE is collaborating with spa industry leaders to create the Standard Authority for Touch in Cancer Care (SATCC), a recognised standard of training for providing spa treatments to those living with cancer. SATCC will launch soon. SATCC will provide those affected by cancer with access to appropriately qualified spa therapists and support the industry with an accredited platform signposting training courses for staff. One in two people in the UK is expected to experience cancer in their lifetime*, and SATCC will ensure individual therapists and spas will provide safe and inclusive treatments, from diagnosis to remission. Susan Harmsworth MBE, SATCC founder, said: “Hearing you have cancer can evoke a range of emotions from anger and disbelief to shock and sorrow, all of which compound the physical toll of the disease and its treatments. Every person diagnosed with cancer copes in their own way and our aim at SATCC is to ensure that spas and wellness therapies remain an option for those dealing with what will possibly be one of the greatest challenges they’ll face. Together, as the spa industry, we have a duty to embrace those living with cancer and help enhance their lives.”

Over fifty years’ of holistic wellness and spa experience have brought Susan, who founded ESPA in 1992 and has designed over 600 spas worldwide, to establish SATCC with accredited UK spa industry partners including Spabreaks.com and Think Tree Hub. Think Tree Hub is an online professional association for complementary therapists, practitioners, courses providers and the public seeking professional health treatments, CPD and accredited courses. Think Tree Hub displays a register of professionals and their accreditations, making them discoverable by spas and consumers. Individual therapists, practitioners and small business spas will be able to apply to Think Tree Hub and be registered as SATCC-approved once their licence, certificates and insurance information have been successfully approved. Any therapist who is already trained by one of the SATCC advisory board’s training providers will automatically be SATCC-approved and eligible to register online. The website will also launch an SATCC web page directing visitors to SATCC- approved and accredited training providers and courses.

thinktreehub.com

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Top Tips in..

Delivering Deep Tissue Massage By Susan Findlay

Sports Massage is rightly known for the way it addresses deep tissue problems, this form of massage is very popular but the delivery for many therapists can present some real challenges, one of those being able to provide the right amount of depth without injuring themselves.

Issue 108 2020

sportsmassage top tips in delivering deep tissue massage

Here are some examples of good body mechanics and technique. Photo A shows the therapist using her thumb in a passive manner, the bottom hand is relaxed while the top hand creates the pressure making the connection between the client and the therapists solid rather than rigid. This minimizes any stress being placed on the thumb and as an added feature there is much better depth control. What makes this even more effective is her body alignment and arm placement, both are well placed, this sets things up for the movement to come from the back leg keeping the stress away from the contact hand.

After setting yourself up with the couch at the right height consider the following principles:(2) • Keep your hips and shoulders squared. • Adopt a wide stance. (3 feet approx.) • Place your arms away from your body. (30 degrees) • Maintain long levers. • Create a circle with your arms. • Do not lock your elbows. • Generate movement from your legs.

study done by Greene and Goggins reported that 77% of those that took part in their survey demonstrated some form of musculoskeletal symptoms occurred during and following massage work, these included pain, discomfort, soreness, numbness and tingling. I believe a majority of these can be attributed to poor body mechanics and there is a need for formal study to determine the reasons because from my experience as a tutor, I have seen a very high proportion of therapists with inadequate working methods. Common areas of injury include the shoulders, thumbs, low back, neck, wrists and thumbs. Overuse syndrome is at the top of the list followed by tendinitis/tenosynovitis and low-back strain.(1) If compared to the general working population the difference seems to indicate that the injuries we incur are unique to the type of work we do.

How to Avoid Becoming a Statistic In order to get it right you need to start at the beginning, consider the following: If you are determining the height of your couch by using an extended arm to the fingertips or fist to the top of the couch, it does not take into consideration the size and position of your client, your stance, the area of the body you’re working on and the technique you’re using. You can go to Top Tips N’ Touch on www. susanfindlay.co.uk and follow the links to watch a free video demonstration.

Do the following exercise to help you evaluate how well you are applying the principles of good body mechanics. The easiest way to do this is to ask someone to observe you and help you answer the questions. Is your back in line with your hips and legs?

Yes

Are you bending at the waist?

Yes

Are you looking straight ahead?

Yes

Are you looking at what you are doing?

Yes

Are your shoulders relaxed?

Yes

Are your shoulders elevated?

Yes

Are your arms in front of you?

Yes

Are your arms at your side or close to the body?

Yes

Is your breath easy and relaxed?

Yes

Are you holding your breath or sweating?

Yes

Are you pushing from your legs?

Yes

Is the momentum coming from your upper body?

Yes

Are your arms relaxed?

Yes

Are your arms shaking?

Yes

Are you able to physically cope?

Yes

Are your joints or muscles showing signs of discomfort?

Yes

The aim is to set yourself up so that you can work deeply but in a position of ease, with it being both safe and effective. If you answered yes to all of the questions in the left column, well done! You are practising good body mechanics. If you answered yes to any of the questions in the right column, you need to revisit the principles of application. This is not a complete assessment of your skills, so if you are suffering with discomfort despite answering yes in the left hand column, then further assessment of your technical application is needed. Issue 108 2020

sportsmassage

3 top tips:

top tips in delivering deep tissue massage

2. e

d In Photos B, C, D and E are other examples of how to distribute the stress away from the bottom hand and use the top one to apply the power, it also demonstrates how the therapists body mechanics can make it deeper and more controlled. What you cannot see is the speed at which they move, the rule of thumb is the deeper you go the slower you should move, otherwise if you rush you will feel your fingers ‘flip over’ the muscle rather than softening and pulling through it. In both examples they’re using their bodies to control the movement keeping their arms extended while pulling back. As previously mentioned it minimizes the stiffness of the contact hand by using the top hand to apply more pressure and directing the movement from the torso and legs. In all the examples the effort was not in the contact hand, but was the result of the whole body working together to produce the movement. I have followed this principle throughout my career and it has given me almost 20 years of injury free work. I do not believe our work should be physically hard, nowhere in the job description does it read I must feel worn out at the end of my

Keep the bottom hand relaxed Generate the power from the top hand Use your body to move

day or suffer pain or any sort of discomfort because I have a physical job. It should be effortless, easy, flowing, the only part of me that is tired at the end of the day is from the amount of thinking and interaction I have had with my clients. It is always a challenge to convey the correct method of movement and application of a technique on paper, so to help you there are videos on my Susan Findlay Youtube channel, under the Massage Mondays playlist. If you have any questions or would like to see some instructional videos of a particular sort, please drop me a line a susan@nlssm.com or post on my forum.

Susan Findlay is the Director of NLSSM and Chair of GCMT Communications. She keeps her hands in as a Sport and Remedial Massage Therapist in north London. She is also the author of Sports Massage, a practical book for all massage professionals wanting to work more effectively as a sensitive and deep tissue therapist.

References:

Susan can be contacted at www.nlssm.com or email her at susan@nlssm.com

1. Greene, L., Goggins, R. Musculoskeletal Symptoms and Injuries Among Experienced Massage and Bodywork Professionals, www.massagetherapy.com 2. S.Findlay, 2010, Sports Massage (Champaign, IL: Human Kinetics). (This book is dedicated to teaching good body mechanics and being an effective therapist).

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Why is SKART part of the 21st century of health? By Amanda White

SKART (Structural Kinesiology Acupressure Release Technique) is a cutting-edge new diagnostic and therapeutic technique designed, trialled and used for the efficient management of back, neck, hip and leg pain. The online course teaches safe and simple techniques which, when applied to the body, can identify and treat a spectrum of conditions.

Issue 108 2020

hrough my work at the Centre for the study of Complementary Medicine, I was approached to run a Chronic Pain research trial for the NHS. This developed into an NHS Chronic Pain Clinic which I ran for 18 years. It was here that SKART was developed, researched and used to help thousands of patients. I had over 80 GPs referring patients to me for a wide spectrum of pain-based issues, in which SKART was fundamental in my ability to locate, identify and treat these skeletal and muscular conditions successfully. After leaving the NHS, I spent time teaching the technique I used to

bodyworker structural kinesiology acupressure release technique (SKART)

practitioners and some doctors before taking time to have a family. With my daughter now grown and at university I want to continue the work I started, by getting the message and power of SKART back out into the world. Over the last year I have written a full qualification specification which has been approved, accredited and endorsed by the International Institute for Complementary Therapists (IICT). And now, been accredited worldwide in Europe, Asia, Australia, New Zealand and the USA as an approved and recognised technique. We are delighted to be a Platinum Training Provider for them and through the e-learning platform are spreading the word throughout the world. The foundations of SKART are based on the principals of Meridian therapies which have their roots in the practice of Acupressure and Kinesiology, dating back to B.C. The Great philosopher Aristotle termed the word kinesiology and is often referred to as the “Father of Kinesiology”. Over the years knowledge has been developed on this subject, but most articles and research start from the early 1900s. In 1964 Dr George Goodheart, an American Chiropractor, extended on this knowledge by discovering that specific muscles of the body when tested could reveal a great deal about a person’s state of health. He concluded that it was not muscle spasms that pulled the spine out of place, but more likely a weak muscle on one side of the

body causing a normal muscle opposing it to become or seem tight. Working on just releasing the tight muscle will therefore usually only give short-term relief. Our bodies are balanced mechanisms with the skeleton being the frame that everything is attached to, including muscles, tendons and ligaments. Each muscle relies on many things to keep it balanced. These include, a nerve to activate it, a blood supply to oxygenate it, lymphatics to clear it and the acupressure meridian to energise. Kinesiology is taught in over 200 Universities in America as a ‘Kinesiology & Exercise Science Course’. This course looks at sports management, athletic training and physical education at degree, bachelor’s and master’s level. In the UK however, Kinesiology is relatively unknown as the practitioners who use it integrate it into their therapies but often don’t use it by name directly.

What can SKART help you with? It is clear that back pain is a common problem within our society. It is the most common symptom presented to a GP in the UK. Recent back pain figures from the Office for National Statistics show that nearly 31 million days of work are lost every year due to back pain. The National Institute for Health and Clinical Excellence (NICE) says that lower back pain results in many problems. Whilst back pain can be seen as a universal problem, the effects on an individual level can be great. Reduced mobility can greatly affect quality of life, the ability to work and can cause isolation. The treatment of back pain costs the NHS more than £1 billion a year and the UK economy £3.5 billion a year in lost production. Therefore, the expertise to effectively prevent and treat back pain can be a crucial part of a clinician’s toolkit. There is now a huge body of research on Kinesiology, which has been developed by physicians. Research has found that kinesiology is a tool that enables unbiased and non-intrusive assessments to be made of many aspects of life’s functions and dysfunctions. Research has also shown that one of the most under-recognised causes of chronic back pain is due to misalignments. Misalignments can occur due to twisting

awkwardly, poor sleeping facilities, injury or pregnancy. Misalignments of the vertebrae in the spinal column puts pressure on nerves, causing shooting pain, weakness, numbness, tingling and different leg lengths if the pelvis is involved.

What are some of the areas SKART treats? Back & Neck Problems that can cause pain, headaches, dizziness, leg pains and restless legs.

“For about 18 months I had been feeling quite unwell with headaches and neck ache. These symptoms were quite severe before treatment. Results showed after just two weeks, and after six weeks I felt totally different. I felt well, and nine months later there has been no relapse.” Debbie Gifford

The Symphysis Pubis is the joint at the front of the pelvis between the pubic bones. This is held together by fibrocartilage, which is supposed to minimise movement and make the structure rigid. But unfortunately, it can become misaligned leading to pain in the groin, hip area, leg length imbalance, leg weakness or giving way, and pain radiating down the outside of the leg. It can also contribute to the destabilisation of the back, causing general back pain as a secondary problem.

“I had been suffering from groin pain and pain down the side of my leg. It was severe, and my mobility was decreasing. After three treatments, the general pain had reduced from level nine to zero. After treatment I’m able to enjoy my gardening much more and no longer use a walking stick.” Joan Adkins Issue 108 2020

bodyworker structural kinesiology acupressure release technique (SKART)

SKART also helps with pain location and treats: • Cranial issues which can cause headaches, pressure pain and excess crying in babies. • Lymphatic problems leading to feelings of sluggishness, toxic build up and reduced energy. • Jaw issues leading to pain. • Shoulder problems causing pain, tingling and numbness down the arm and in the fingers. • Ileocecal valve problems causing pains in lower right abdominal area and gut spasms. • Hiatus Hernia issues linked to pain and discomfort under the left ribs, indigestion and nausea.

References

How to Treat and Avoid Low Back Pain by Oliver Eaton listed in back pain, originally published in issue 249 - October 2018 In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counselling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care. - Korthals-de Bos et al (2003), BMJ “Manual-thrust manipulation provides greater shortterm reductions in self-reported disability and pain compared with usual medical care. 94% of the manualthrust manipulation group achieved greater than 30% reduction in pain compared with 69% of usual medical care.” - Schneider et al (2015), Spine “Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.” - McCrory, Penzlen, Hasselblad, Gray (2001), Duke Evidence Report

The Course SKART is a bespoke online course that has been designed for those who are looking for an exciting and rewarding new career in healthcare. Similarly, for those who are already treating patients and wish to add a new therapeutic and diagnostic tool to their skill set. The SKART qualification can be done at your own pace anywhere in the world. It is a perfect tool for practitioners to be able to help their clients more. It gives you quick diagnostic tools, treatment methods and a client feedback system so that you and your client can see that the treatment has worked.

What are the benefits of SKART to me? • You will learn to solve back issues using effective, practical, safe, non-force and gentle correction techniques. • The course’s design means that it is easy to learn and understand, bringing you to the forefront of your profession with these new skills to benefit practice and client health. • With millions of people suffering from pain conditions, you can be the solution. • Learn to use SKART to study the body’s energy systems. To use the muscles as diagnostic tools to access the most appropriate treatment for the body, to find the exact pain site and to be able to treat it so you can clear the pain. • This course is heavily discounted at the moment, as we believe it is a skill that should be open to all. At £199 reduced from £450, now is a great time to learn. • SKART muscle testing is a way to communicate with the body. It is a biofeedback system that talks to the body in a language which the body understands and can respond to and gives real time feedback. It allows us to use the patient’s own body as the research tool to find out what it needs, where to treat, how to treat and gives feedback on whether the correction has held and corrected the problem area, giving patient reassurance, as it is easy to see the difference. • Using SKART to find imbalances and issues through muscle testing helps remove the doubt, guesswork and the hard work of subjective diagnostics. • SKART is non-force and gentler than many other manipulative therapies. It is quick to locate the problem area, needing no gadgets and it can be done anywhere. I have corrected people’s neck problems on trains, planes and by the beach. Do you want to be part of the 21st century health developments? Be free of pain and change the way you see health, and help others by embarking in a new and rewarding career in the SKART health system?

Amanda White is the founder and CEO of SKART International. Amanda qualified as a nurse (RGN) back in 1989 and shortly after developed back problems due to lifting patients in addition to contracting ME. This subsequently sent her on a journey of discovery. She travelled to China to study basic acupuncture with a group of trainee doctors. On her return, she completed 3 years of training at the British Acupuncture Association in London to become a qualified acupuncturist. Whilst training, Amanda was employed at the Centre for the Study of Complementary Medicine (CSCM) in Southampton, where she worked as a practice nurse, before she moved on to run an NHS Chronic pain clinic for 18 years. Amanda has been on a lifelong journey into complementary therapy searching for answers and cures. This led her to train as an advanced Kinesiologist, Reiki master, NLP master practitioner and EFT therapist, whereby she cured herself of a number of issues along the way. In order to share her passion and knowledge, she also qualified as a Certified teacher (Cert Ed) so she could start training people in the subjects that she is passionate about. Amanda continues to run a busy private clinic in the heart of the New Forest.

Issue 108 2020

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Myofascial Release

Treating Leg-length Discrepancies By Ruth Duncan MFR UK here are two general physical reasons that a pelvic imbalance occurs. One is direct trauma or injury such as a fracture or tissue injury to the pelvis, leg or ankle. The other is caused by tissue dysfunction from overuse, misuse disuse or underuse. This is where the client has continually loaded a specific area of their body for too long and created an imbalance or they have not used that area of their body and it has now become weak and dysfunctional both of which can be viewed as an adaptive pattern. Overuse, misuse, disuse and underuse are the most common issues that manual therapy practitioners see where the client complains of back and gluteal pain, piriformis syndrome or sciatic like symptoms.

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The Pelvis The pelvis is a basin-shaped structure at the lower end of the spine and is attached to the sacrum and the coccyx. The pelvis protects the internal abdominal contents including the bladder, rectum and, in women, the uterus. The pelvis is made up of three hip bones, which are joined posteriorly by sacroiliac joints to the sacrum and anteriorly by the cartilaginous pubic symphysis. Attached to the pelvis are muscles of the abdominal wall, the buttocks, the lower back, and the thighs. Each side of the pelvis, called the right and left innominate

bone, is made up of three fused bones: the ilium, the ischium, and the pubis. Together they form the acetabulum, which is a cup-like depression ‘ball and socket’ joint for the femur.

Postural assessment The easiest way to approach an assessment for the pelvis is to first assess the client in standing, without shoes and on a level floor. The landmarks we will assess are: • Anterior superior iliac spine (ASIS) • Posterior superior iliac spine (PSIS)

Overuse, misuse, disuse and underuse are the most common issues that manual therapy practitioners see where the client complains of back and gluteal pain, piriformis syndrome or sciatic like symptoms.

bodyworker treating leg-length discrepancies

1 Standing assessment Kneel down in front of the client and palpate to locate the ASIS using your thumbs. Move to the back of the client and palpate to locate the PSIS. Look for: • The heights on the anterior superior iliac spines in the anterior view, these should be level on the horizontal plane • The heights on the posterior superior iliac spines in the posterior view, these should be level on the horizontal plane Write down what you see on a body chart or a piece of paper. From the anterior view, do you see their right ASIS lower or higher than their left ASIS? Take care to make sure that you note their right and left side and not

yours. From the posterior view, do you see their right PSIS lower or higher than their left PSIS? If you see the right ASIS lower than the left ASIS, then you should see the right PSIS higher than the left PSIS. If you see the left ASIS lower than the right ASIS, then you should see the left PSIS higher than the right PSIS. If you do see either of these two scenarios, then you have what’s called a pelvic rotation or pelvic obliquity. If you imagine the sides of the pelvis as two wheels, when you walk, your leg goes forward but the pelvis on that side must roll backwards. When your leg is backwards, your pelvis on that side must roll forwards. So, the two wheels on either side of your body move in opposite rotations to each other in a forward and backward motion as you walk or run. So ideally, when you assess the body in standing, the two ASIS and the two

PSIS should be level on the horizontal plane. However, we don’t just run and walk all day. We sit for extended periods of time, we sleep curled up and we do lots of sports and activities where we use certain parts of our bodies more than others and this can create an imbalance to the movement of the pelvis positioning it in a pelvic obliquity where one side has a propensity to be more anterior and the opposite side be more posterior position. It’s not uncommon to assess the pelvis in standing and find a reasonable discrepancy in the heights of the PSIS and ASIS but the client doesn’t have any pain. No one is perfectly balanced and we all have a body that is functional to our daily needs. However, sometimes the smallest discrepancy can cause excruciating pain and this is something that we as manual therapists can help with. When one side of the pelvis is stuck in a more anterior rotation than its counterpart, the positioning of the femur changes which is what creates what looks like a leg length discrepancy. The femur is not in the middle of the side of the pelvis, it sits more anterior. When the pelvis is anteriorly rotated, the femur drops down. When the pelvis is more posteriorly rotated, the femur gets pulled upwards. Effectively, an anterior pelvis presents what looks like a longer leg and a posterior pelvis presents what looks like a shorter leg. Of course, the legs haven’t changed lengths but it’s their positioning in the pelvis which makes them look like one is shorter than the other. Additionally, the pelvis is also dependant on the position of the lumbar and vice versa. Often, when a client complains of back pain, they will also have a leg length discrepancy. Issue 108 2020

bodyworker treating leg-length discrepancies

The pelvis can also tilt upwards or downwards on either side like a seesaw which can also present in a leg length discrepancy. If one side of the pelvis is pulled up higher, the leg also comes with the pelvis effectively shortening the leg on that side. Conversely, the other side of the pelvis must drop down effectively lengthening the leg on that side. Some therapists call this an up slip and a down slip and others call it a pelvic tilt. Often, you see both a pelvic obliquity with an up slip and down slip as the pelvis can move in multiple directions at the same time. When you see an imbalance in the pelvis, you often see other imbalances associated with it such as: • One hip higher than the other • A lateral shift in the pelvis where they don’t look like they stand evenly on their legs • They stand with one knee slightly bent and the other hyperextended • One foot turns out more than the other • Their body leans forward with a lumbar lordosis

Cross hand release techniques for the pelvis and lumbar. Assess the pelvis to establish the ASIS which is lower to the floor, this is the functionally longer leg and this is the side we will treat as this side of the pelvis in in an anterior rotation where treating this side will help us remove the tissue strain allowing the pelvis to move back into a more neutral position. With the client laying supine, we will do a cross hand release technique for the anterior hip to remove tissue dysfunction. Place one hand on the client’s upper thigh with your fingers pointing to their feet, skin on skin. Place you other hand, crossed over or under your other hand, on the client’s lower abdomen, medial to their ASIS with your fingers pointing to their opposite shoulder, again skin on skin.

• They may wear an orthotic and have or have had foot and ankle problems • They also have one shoulder higher than the other

• with hands crossed, gently contact the tissue.

• And obviously pain in the sacroiliac area, gluteal area and low back.

• allow your hands to sink slowly and gently down into the tissues until you meet resistance (barrier or end feel) - this is the first dimension

There are many techniques that we can do to balance the pelvis but here is one simple technique that you can use to remove some of the strain.

• wait at this barrier until you feel a yielding or melting sensation allowing you to lean a little more to the floor. There may be numerous sensations of tissue melting which feel soft and somewhat bouncy • continue with your downward pressure following each tissue change until you feel that your hands have met a firmer resistance, this will be the deeper layers of fascia

• maintaining your pressure to the floor, slowly separate your hands until you meet resistance - this is the second dimension. Wait at these 2 barriers for the tissue to yield under and between your hands • as the fascia yields to your touch, you will feel motion under your hands - this is the third dimension • go with the motion to the next barrier which may feel like a twist, shear or unwinding • continue to hold these 3 components for at least 5 minutes or longer • always be subtle and sensitive with your hands and never force the barrier • allow the tissue to reorganise without force. Disengage from the tissues by gently reducing pressure and removing your hands. (Fig. 3)

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bodyworker treating leg-length discrepancies

Now ask the client to lie on their side with the side your just treated uppermost. Place a small pillow under their waist to keep their lumbar spine neutral. Straighten their upper leg and position it in line with their spine. Place one hand, skin on skin on their lower lateral ribcage with your fingers pointing to their shoulder. Place your other hand, skin on skin on their iliac crest either over or under your ether hand and perform the cross hand release again. (Fig. 4)

4 What these techniques do is help remove the strain pattern from one of the sides of the pelvis to create balance. We do these techniques on the anterior rotated innominate as it’s easier to push the anterior innominate backwards. The right side of the pelvis is usually the anterior rotated side due most things being right side dominant however, always check to see what ASIS looks lower than its counterpart and do these two techniques on the lower ASIS side. Cross hand release techniques form the main component of a myofascial release treatment session. The pressure used to apply the technique varies from person to person as everyone’s tissue tension is

different. The skill of the technique is not how much pressure is used, but how much resistance is felt in the patient’s body. The practitioner applies the technique to tissue tension and waits for the myofascial tissue and ground substance (gel fascia) to reorganise which can be felt as a yielding or ‘release’ of tissue tension under their hands. These two techniques are part of a series of techniques used to balance the pelvis. While they are usually very effective sometimes, tissue tension is more complex than the anterior hip or lateral lumbar and further technique application is necessary. There are

also a few different assessments that can be done to maximise on treatment efficacy. Always re-assess their ASIS and PSIS after applying these techniques to see what changes you have made. Leg length discrepancies are not always about the pelvis. They can be caused by the lumbar, knees, feet and ankles and indeed, there can be dysfunction with all of or some of these structures when viewing the body from a biotensegrity point of view. Pelvic assessment and balancing and treatment for leg length discrepancy is taught in the Structure Series Part 2 of Integrated Myofascial Therapy presented by Myofascial Release UK in workshops around the UK.

Myofascial Release UK (MFR UK) teaches a variety of myofascial approaches including sustained myofascial techniques, compression and traction techniques, position of ease techniques, direct soft tissue mobilisation, rebounding, unwinding and fascial self-care and rehabilitation approaches. MFR UK also teaches fascial assessment, pelvic, sacrum and spinal evaluation and pelvic balancing techniques using pelvic positioning wedges in part 2 of the structural series. MFR UK welcomes those with a minimum of a level 3 hands-on qualification such as sports massage, holistic massage, Bowen, Shiatsu, Craniosacral therapy, Thai massage and similar. Also welcome are osteopaths, sports therapists, physiotherapists and chiropractors. Further details can be found on www.myofascialrelease.co.uk. Email: info@myofascialrelease.co.uk | Tel: 0333 006 4555

Issue 108 2020

Touch: The Forgotten Sense By Emma Gilmore

Having been working with touch modalities for 25 years, I witness constantly the power of positive, nurturing touch. At the end of just a single session, a client seems not just relaxed, but in a better place. When they return for a second session they are very often less awkward and agitated, and are more “themselves”.

et in this digital age when we are more than ever connected via technology, research shows we are decreasingly connected in a true, meaningful human way, we are currently experiencing less touch than ever before with less time spent engaging in positive face to face interactions. Research shows we are hard wired to receive nurturing touch, we have evolved in such a way that we are programmed to want, to need touch, yet in today’s world many of us are touch-deprived. So what are the

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implications to our touch-deprived on society? Professor Richard McGlone, a neuroscientist interested in the fundamental importance of touch, explains that there are two types of nerve cells through which we experience touch, to simplify things, these can be termed ‘fast’ and ‘slow’. I am going to explore the ‘slow’ sensory nerve fibres in more detail, these are found in skin with hairs - all skin except for palms of the hands, soles of the feet and lips - these afferent touch receptors directly impact on how we feel - their major

property is to help regulate our emotional states. They are considered slow as they take 1-2 seconds to deliver messages to the brain and are stimulated by pleasant slow stroking. Interesting that they are not in the hand, the “tool” which delivers touch. The ‘fast’ nerve cells found in the skin receptors in palms of hands, soles of the feet and lips - are involved with delivering the message of touch from the outside world sending quick signals to the brain in order to protect us, if for example we pick up a hot pan the fast cells carry a message to alert us

massagefeature touch: the forgotten sense

and we immediately let go. This sensation of pain is transitory and there is no emotion attached. There are also many fast cells in muscles and joints that play an important role in proprioception. Fascinatingly blind people can interpret brail, with messages from “fast” receptors in their fingertips, faster than we can read text, which demonstrates the efficiency of the “fast” nerve cells. The ‘slow’ touch nerves, known as C afferent nerves, kick in a few seconds later and have an emotional aspect – they let us know how we feel - their major function is to help regulate our emotional states. Through gentle stroking these are stimulated to let us know we are safe. In fact research shows that our sense of self, our identity is imprinted on the developing brain through touch. The first two years of life are fundamental to brain development, and close physical contact is essential for optimal brain development. The importance of touch for new-born babies is widely recognised, with skin-to-skin contact encouraged immediately after birth, to help regulate the babies’ breathing, heartbeat and blood sugar levels as well as forging bonds between parents and their child. Professor McGlones, research looks at pre-term infants. The medical professional can now keep pre-term infants alive from 23 weeks, intervention keeps the heart ticking and lungs clear, but what has not been recognised “is that 25% of these babies develop full blown autism, and all pre-term babies will have some cognitive deficit throughout their life” – what do all these babies share? They have little or no touch while in the incubator which could be up to 2-3 months. New research from Milan shows that the babies who are in-fact touched while in the incubator are discharged earlier than those not touched. Link between touch and autism is highly contentious, however Professor McGlone believes there is a link. The pre-term babies are physically alive and well, but the little person without touch is going to suffer, they are going to experience a sense of neglect and lack of safety as touch is a fundamental requirement of life, and plays a fundamental role in the development of the social brain. Premature babies miss out on the sensory experiences of late gestation, the amniotic fluid washing over them, being rubbed against womb wall, as well as being stroked through the abdomen. All of this touch is removed in the pre-term baby when placed in the incubator, as well as the mothers nurturing touch, this has adverse

effects on the development of the social brain. The emergence and increased understanding of Epigenetics in some ways replaces the nature, nurture debate. Are we our just the expression of our genes or does nurture play a part? Are we in fact the sum of our life experiences? Epigenetics, gives recognition to how the environment affects us and how certain genes are turned on or off, depending on experiences. Research with rats, which is also relevant to humans demonstrates the importance of touch to create a calm, socially balanced, happy adult (rat or human). Further research into touch by Michael Meany took place on 2 populations of rat mothers: one group were “high lick” mothers who frequently groomed their pups, one group were “low lick” mothers. In the rat population, to lick and groom is the equivalent of nurturing touch. What the researched showed is that “high lick” rat pups had a well-developed stress regulatory system in their brain, they could withstand every day stress and could self-regulate. On the other hand, “low lick” rat pups had a red alert stress system, unable to self-regulate in stressful situations. This suggests the seeding bases for many psychological & psychiatric disorders that develop through life stem from early life adversity, or lack of touch. In essence lack of touch, which is perceived as neglect impacts on genes which regulate stress: if we are not touched enough in a loving way as infants, our stress response will be adversely affected throughout life. Simply put, without loving touch as a child we will be less resilient to stress for the

rest of our life. The implications are huge. Conversely a child who receives positive, caring nurturing touch, becomes a happy, balanced self-regulating adult. These “slow” C tactile nerve fibres evolved to provide reward signals that build relationships between primates – historically we were safer in groups, communities or tribes of people; the best way to protect the species was as part of a community, not as an individual. Therefore those who do not get enough touch during development – will experience negative consequences on the social brain, find it hard to build relationships as is seen in those with Autism or Asperger’s. The lack of touch – or reward - is interpreted as being unsafe, putting infants (and eventually adults) on high alert, and seeking reward in other places. This where addictive behaviours come in to play - in order to block out our suffering and pain. Addiction comes in so many forms, anything from screen and sugar addiction to workaholics, shopaholics or obsessive compulsive behaviour, to name a few. These addictive behaviours are on the rise, perhaps in part, due to the current lack of positive societal touch. The last part of Professor McGlones research which is fascinating, is that these C tactile afferent nerve fibres which innovate the skin, respond to gentle touch. They are attuned to the exact speed that we instinctively stroke or massage each other. Which is 3-5cm per second. Experiments done to compare stroking rates on skin to other inanimate objects like a table top vary enormously. When stroking inanimate objects our rate of stroking is erratic, Issue 108 2020

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massagefeature touch: the forgotten sensehttps://drive.google.com/ﬁle/d/1XdjYP1BdnsG0mxtn1i-Oxi...

mental health of our society, as touch is a fundamental human requirement. Although the negative touch episodes are clearly taking place, perhaps there is also a place to report on positive touch experience, to keep things in balance. Professor Frances McGlone research demonstrates how simple every-day touch impacts our life: • If a waiter taps you on the shoulder when they give you the bill – you tip more – just from that touch.

however when working skin on skin, we naturally attune to the pace that the C tactile neurons respond to - 3-5cm per second. Amazing – yet reassuring that we still have the innate capacity to attune to others in this high-tech world. Sadly we are currently living in a climate where society demonises touch, a lot of negative touch is reported in the media, which adversely affects our relationship to touch. Fear of touch has entered our society, both the teaching and medical fraternity report being scared of physical contact in case of the touch being misconstrued. Our brain is consciously reacting to input, if we constantly receive info – for example through negative reporting in the media –that touch is risky and contentious, or even dangerous, we will believe that. Sadly this will adversely affect the

• Basketball teams who have more hands on interaction in a match, work better as a team, perform better and move higher up the league table. • Those who are touched when they visit a library, reported a more positive experience.

We are hard wired to receive human touch, we touch technology all the time, we know the texture and shape of our phone, we know where the letters are on the keyboard, but do we still know what nurturing touch feels like? Do we still recognise its benefit? Research shows we are currently experiencing less touch than ever before, which will have implications on our society, is this perhaps one reason for the mental health epidemic 15:44 we are 26/03/2020 experiencing in society today?

Professor McGlone suggests the seeding bases for many psychological & psychiatric disorders that develop through life stem from early life adversity, due to lack of nurturing touch, which affects our neurophysiology. Are we having a mental health crisis in the younger generation because they simple were not touched enough? If so, the larger implications on society are potentially devastating. In our highly sophisticated “developed- world” the basic human need of touch is frequently not being met. Women are sometimes returning to work within days or weeks after giving birth, either to protect their career or because they cannot afford not to work. Infants are put into care, perhaps with lack of close physical contact, which will adversely affect the development of the social brain. The take home intervention for society and individuals is we need to prioritise touch. We as bodywork therapists are in a prime position to spread the word on the importance of touch and to help others; clients as well as friends and family. The good news is, if we look at neuroplasticity we know that the brain can change throughout life – so regular positive touch – through massage, can help clients self-regulate more effectively and make improvements in people’s stress response. As Professor McGlone says: “Touch is not just a sentimental human indulgence, it’s a biological necessity”. Perhaps many of us have come to see touch as something additional, something extra, something we’ll make space for ‘if we have time’ rather than an element of our lives, that is fundamental to wellbeing.

Emma Gilmore APNT, iMFT, BCMAis Director of School of Bodywork, which she established in 2009. Emma’s passion for the benefits of bodywork are enthusiastically transmitted through her national and international teaching. An advanced bodywork therapist specializing in Myofascial Release, with a deep knowledge of human anatomy, fascia and the delicacy of the human condition. Emma shares her knowledge of how physical and emotional trauma manifests in our physiology causing pain, discomfort and pathologies, as well as the potential for its release through bodywork. Emma was a judge at the National Massage Championships, is a founding member of the Fascia Research Society (FRS), and is currently writing a book on fascia and the body-mind complex. Having been a bodywork therapist for 25 years, Emma shares her detailed knowledge in an accessible and engaging way. She encourages all students to develop their own style, drawing on their personal knowledge and experience when dealing with clients. Emma’s journey through the world of bodywork has been a very personal one of self-development and healing and it is with this understanding and sensitivity she shares her knowledge.

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Put your Muscles to the Test

The Practice of Muscle Testing for Massage Therapists By Earle Abrahamson and Jane Langston

ur last article examined the value of muscle testing in assessment and correction of musculoskeletal problems, and we discussed how muscle testing provides meaningful metrics and information to help understand underlying causes of why clients present with different complaints. This article will explore several methods of muscle testing and explain their clinical use. Muscle testing techniques can range from a gentle hold to assess muscle firing and activation, positioning a limb to see if the muscles can cope with the effects of gravity, through to a resistive force being applied in the opposite direction to the muscle action. Different information and meanings are obtained from each of these types of tests, the techniques for performing them differ and the individual advantages and disadvantages of each need careful consideration when choosing the appropriate assessment method. A quick reminder of the overview of a muscle

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test – the muscle is activated by bringing the origin and insertion of the muscle closer and then either applying pressure to the limb whilst the client attempts to maintain position, or by seeing if the client and maintain position against the force of gravity. Let’s examine each method in turn.

Manual Muscle Tests This group of tests includes any strength test evaluation where the practitioner with or without the assistance of gravity applies a resistance. This is appropriate for on-site and acute evaluations as no equipment is required apart from the practitioner. Research has shown that being able to control and adjust the resistance being applied in response to the client’s efforts is useful (Kisner and Colby 2002). Resistance can further be altered through the range of motion to allow the client to achieve maximal effort throughout the test. Manual muscle tests include isometric break

tests and graded manual muscle tests. A potential disadvantage to these tests is that all findings rely on subjective information and the practitioner’s ability to discern effective contraction from possible dysfunction. The practitioner’s own strength, posture and morphology could negatively impact test findings so each practitioner should calibrate their own movements

Isometric Break Test This form of muscle test is relatively quick and efficient. The limb is placed into a neutral and mid-range joint position and the client is instructed to hold the possible whilst the practitioner attempts to “break” the position by attempting to move the joint by applying a matching resistance to the distal segment. The proximal segment of the limb is supported or stabilised by the practitioner. In a “strong” test, the resistive force is equal and opposite to the client’s effort.

industryworks put your muscles to the test

Kinesiology Muscle testing

Table 1: Isometric Break Test

Reaction

Indications

Strong and pain free

Normal response

Strong and painful

Potentially indicates a lesion in the musculotendinous junction or muscle. This is more common in acute injuries

Weak and pain free

Indicative of a nerve-related injury or musculotendinous rupture. Important to note that contractile function could be lost without eliciting pain, depending on rupture type and fibre damage

Weak and painful

Indicative of a serious injury that could range from a bone trauma such as a fracture through to an unstable joint.

Table 2: Isometric Break Test Grading Scale

Grade

Description

Maintains test positive against gravity and maximal resistance

Maintains test position against gravity and moderate resistance

Maintains test position against gravity and less than moderate resistance

Maintains test position against gravity and minimal resistance

Maintains test position against gravity with no resistance

It is important for the practitioner to note the presence of pain during the isometric break test as there may be underlying injuries or lesions present. To further confirm a strength test finding, it may be useful to stretch the muscle in the opposite direction to its motion. If one has a positive result of pain and some weakness from leg extensors, one may also not pain when stretching the leg extensors (see Table 1). When grading a break test, it is important to grade the muscle according to the maximum resistance against which it holds. Isometric break tests results can be documented according to table 2.

These tests are best performed by carefully positioning the client in such a way that they muscle being tested is easily isolated. The practitioner stabilises the proximal segment with one hand and applies a resistance to the distal segment with the other. Anatomically speaking, this means the origin of the muscle is stabilised and supported, with the resistance being applied at the insertion of the muscle. The direction of resistance should be applied in line with the orientation of the muscle fibres being tested. Graded manual muscle tests can be assessed according to the criteria in table 3.

This method of muscle testing was introduced by Dr George Goodheart DC and used in applied kinesiology, chiropractic and by other soft tissue practitioners (Cuthbert, S.C. & Goodheart, G. J, 2007). The client is passively placed into a position which brings the muscle’s attachments (origin and insertion) closer together in the midpoint of the range, then asked to hold this position whilst the practitioner uses good, natural body movement, rocking their body slightly to place a small amount of pressure on the limb. If the muscle responds by activating contraction to match the light pressure, the muscle is deemed to be “strong”. A “weak” test occurs when the client is unable to respond to this light movement and subsequent pressure. Body movement is key to reliable testing. Practitioners should use excellent manual handling techniques and use swift and flowing movements to place the limb. Moving too slowly and ponderously will cause the client to recruit compensatory muscles. Applied kinesiologists assign associations to certain muscles. They link muscles to acupuncture meridians and organs. This is widely seen in a branch of Kinesiology called Touch for Health. Some applied kinesiologists have recognised that certain emotional states can appear to weaken a muscle or groups of muscles. Being aware of the anatomical reasons and possible energetical reasons for a muscle weakness means that practitioners can have an holistic appreciation of their client’s wellbeing. The combination of the weak muscle tests will help to form a picture, both postural and energetic, and this will guide the practitioner towards appropriate interventions, depending on the modality of the therapy being practiced.

Table 3: Graded Manual Muscle Test

Graded manual muscle tests These tests examine strength using applied resistance against gravity through a full or partial range of motion. They provide more information than break tests as their examine and monitor the muscle function through the range of motion, not simple in the midrange. This better assesses the individual muscle contributions to the motion and provide more reliable information regarding location and possible reason for muscle weakness and pain.

Numeric Value

Word Descriptor

Clinical Description

Normal

Completes ROM against gravity and maximal resistance Completes ROM against gravity and against nearly maximal resistance

4+ 4

Good

Completes ROM against gravity and against moderate resistance

Completes ROM against gravity and against minimal resistance >50% range

Completes ROM against gravity and against minimal resistance <50% range

3 3-

Fair

Completes ROM against gravity with no manual resistance Does not complete ROM against gravity but does complete more than half the range Issue 108 2020

industryworks put your muscles to the test

1 An example of muscle testing – Psoas Major

Psoas Major Manual Muscle Test

Psoas major is a hip flexor muscle, which originates at the transverse processes and vertebral bodies of L1 to L4/5 and their associated intervertebral discs. It inserts into the lessor trochanter of the femur. As well as flexing the hip, it helps produce external (lateral) rotation of the hip. It also works to produce anterior pelvic tilt through the hip joint and maintains lumbar curve by producing flexion and lateral flexion of the spinal joints at the lumbar vertebrae. When contracted eccentrically, it helps to control extension of the hip. It works synergistically with iliacus, rectus femoris and pectineus, so these muscles should be tested alongside the psoas major to give a fuller picture. The postural picture exhibited when the psoas major muscle tests weak is profound. Bilateral weakness of psoas major causes a loss of lumbar curve and rounder shoulders (kyphosis), and unilateral weakness causes a lumbar scoliosis. Such whole-body changes highlight the importance of testing this muscle.

This is performed supine, with the hip flexed to 60°, and leg abducted to approximately shoulder width and laterally rotated. Practitioner applies a resistance force diagonally, medial to lateral, trying to encourage hip extension. Use an appropriate grading scale to record the findings, noting any presence of pain on testing. Remember to test through the range. Practitioner can stabilise the movement by placing a supporting hand on the client’s opposite anterior superior iliac spine (ASIS). It is good practice to ask the client to cover ASIS with their free hand to avoid any inappropriate or sensitive contact. (See pic.1)

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Psoas Major Kinesiology Muscle Test This is performed supine. The leg is passively placed by the practitioner by picking up the straight leg from the medial side of foot thus flexing the hip to 60° with leg abducted to shoulder width and laterally rotated. Client is instructed to hold this position, whilst the practitioner slightly rocks their body,

exerting a light pressure on the foot in the direction of extension and slight abduction. Stabilisation is performed by the practitioner supporting themselves by placing the side of the hand on the opposite ASIS to prevent trunk rotation of the client. (see pic. 2) The kinesiology test differs from the graded manual muscle test in that the limb is placed passively by the practitioner, rather than the client actively moving it there. Good body dynamics are required here. The amount of pressure used to activate the muscle fibres is different too. In the graded manual muscle test, the practitioner exerts an amount of resistance, where in the kinesiology test, the amount of pressure is much less – in fact it is only applied by the practitioner rocking their body slightly, thus activating a small proportion of the muscle fibres. The kinesiological associations of the psoas major are linked to the kidney and its energetics, including the kidney acupuncture meridian. This is also linked with the emotions of fear and fright. Points to bear in mind if there appears to be no physical reason for the psoas to test weak. Muscle testing is a valuable assessment and treatment technique. In assessing function and often dysfunction, muscle tests, together with other musculoskeletal screening tests such as range of motion, ligamentous, neurological and special tests, can help provide a map to identifying and then isolating specific tissues injuries or pathologies. It is important to recognise that muscle testing alone may not be sufficient to evidence pathological conditions. Musculoskeletal conditions are often difficult to understand and treat. By integrating muscle testing into soft tissue therapeutic interventions, the practitioner may be better equipped to assess impact and effectiveness of treatment and develop clinical metrics to gauge intervention value. Put simply, muscle testing enables the practitioner to systematically develop a battery of tests to assess, treat, and evaluate the process. This will form the focus of the next article that will specifically examine how tests inform treatment choices and outcomes. The success to muscle testing is understanding the anatomical landscape. Once the anatomy is mastered the testing should make sense as it flows along the natural anatomical lines and matrices. When in doubt challenge and test your thinking by putting your muscles to the test.

industryworks put your muscles to the test

Checklist for a ll muscle tests

Provide clear communication and instruction to the client, including consent

Identify origin, insertion, and motion of muscle or muscle group to be tested Observe and monitor possible compensatory movements and muscles, including breath-holding Position client for maximal support and stabilisation Position self for best mechanical advantage and appropriate line of resistance

Muscle Testing – A Concise Manual is a clinical resource for muscle attachments, actions and orientation and the safe and effective administration of the tests. The book is written in an accessible manner and provides a map for learning, practice, reflection and advancement of knowledge and skills. Supplemented by videos. Published by Handspring Publishing: handspringpublishing.com/product/muscle-testing-aconcise-manual/

Stabilise proximal segment Apply resistance to distal segment in direct line of pull with muscle function Complete the motion by monitoring any compensatory or substitution movements Reposition client to test with gravity minimised or eliminated if unable to complete the movement Use appropriate grading scale to document findings Record findings on clinical notes

Earle Abrahamson Abrahamson is the Chair of the Massage Training Institution (MTI), elected member of the massage therapy PSB on the CNHC, Vice-Chair of the GCMT, and director at Hands-on Training, a specialist massage training school in North London. Together with Jane Langston he authored “Making Sense of Learning Human Anatomy and Physiology” (Lotus Publishing), Muscle Testing: A Concise Manual (Handspring Publishers) and runs an anatomy company called Learn Anatomy Ltd. He holds the role of senior lecturer in Sports Therapy at the University of East London. He was part of the medical team for the London 2012 Olympic and Paralympic Games, and London 2017 Athletics. Earle has received several awards for his teaching and clinical work. Earle has judged the National Massage Championships for the past 2 years. Jane Langston worked for over 20 years in haematology and blood transfusion laboratories within the UK National Health Service and is Fellow of the Institute of Biomedical Science. She went on to develop her skills as an Amatsu practitioner in a busy clinic in Hertfordshire for another 20 years. Jane is a teacher of Amatsu soft tissue therapy and anatomy & physiology and is a director of Amatsu Training School Ltd and Learn Anatomy Ltd. As a result of many years of teaching, she understands that students needed good strategies to help them learn, retain, and apply anatomical studies. Jane is an Amatsu therapy representative on the General Council for Soft Tissue Therapies and is an Amatsu advisor to the British Register for Complementary Therapies. Together Earle and Jane wrote Making Sense of Learning Human Anatomy and Physiology, a text that focuses on teaching and learning strategies for anatomy and physiology. Their latest book Muscle Testing: A Concise Manual (Handspring Publishing) was published in November 2019. Muscle testing workshops are available via learnanatomy.uk. Both Jane and Earle are “Muscle Whisperers” for Massage Warehouse. www.learnatomy.uk | www.massagetraining.co.uk | www.hands-on-training.co.uk | www.amatsutrainingschool.com | www.handspringpublishing.com www.gcmt.org.uk

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Dedicated Followers of Fascia! Unravelling the Mystery of Myofascial Approaches Are you fascinated by fascia? Marvelling at the magic of myofascial release? Crazy about craniosacral therapy? Then you are not alone. Interest in myofascial and fascial related therapies has risen exponentially in the bodywork field over the last 10 years, paralleled by a similar rise in interest in the medical and scientific arena. Just as with it’s location in the body, the ubiquitous tissue of fascia literally seems to be found everywhere at the moment more articles, more training courses, more clients asking about this work.

ithout a doubt adding fascial techniques to your toolbox will enhance your ability to address puzzling pain issues, including those where emotional problems have literally lodged in the tissues. Understanding the nature of fascia can help to unlock the unique mind-body connections that can contribute to complex hurts that have been resistant to other therapeutic interventions. Yet if you are interested in further CPD training, finding your way around the maze of different types of fascia work can be really confusing. What is the difference between direct and indirect fascial work? Is myofascial release different than other types of fascial work? What on earth is Rolfing - was Rolf Harris a bodyworker before he moved onto Pet Rescue!? What has craniosacral therapy got to do with fascia? Read on and your burning questions will be answered!

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Let’s start at the very beginning -What is fascia? To understand fascial related therapies we first have to understand the nature of fascia itself. Most of us who studied Anatomy and Physiology on our qualifying level courses dutifully learned about all the different body systems such as the cardio vascular system, lymph system, digestive system and of course the musculo-skeletal system. Yet very few of us were given more than a passing reference to one of the most important and prevalent interconnected systems in the body– the fascial system. Indeed fascia has traditionally been so ignored in mainstream anatomical and medical thinking (which has then been reflected in bodywork) that prominent fascial researcher and bodyworker, Robert Schleip, has coined it the “Cinderella tissue”. Yet as we all know, Cinderella finally got out of her dank basement and dazzled at the ball – and currently interest in fascia is rising to such an extent that

hopefully over the years to come, a detailed knowledge of the fascial system will be a necessary part of both mainstream medical and complementary therapy anatomical knowledge.

Fascia – the boffin’s definition For a nerdy definition of fascia lets turn to the International Fascial Research Congress – a wonderful initiative set up by pioneers in the field who have brought together manual therapists and scientists to give us a more full understanding of how fascial therapies work: “Fascia is the soft tissue component of the connective tissue system that permeates the human body. It forms a whole-body continuous three-dimensional matrix of structural support. Fascia interpenetrates and surrounds all organs, muscles, bones and nerve fibers, creating a unique environment for body systems functioning. The scope of our definition of

dadvancedcpdadvancedcpd and interest in fascia extends to all fibrous connective tissues, including aponeuroses, ligaments, tendons, retinaculae, joint capsules, organ and vessel tunics, the epineurium, the meninges, the periostea, and all the endomysial and intermuscular fibers of the myofasciae.” http://www.fasciacongress.org/about.htm

Fascia – the cheat sheet definition If that definition made your eyes glaze over lets give you the translated “cheat sheet”. The key phrase in the above definition is “the soft tissue component of the connective tissue system”. Although it is true that all fascia is connective tissue, not all connective tissue is fascia – if you hit your anatomy books for a refresher you will find that for example blood is a form of connective tissue, yet is clearly not fascia. So, in other words fascia is the “soft tissue stuff” that is literally found everywhere in the body – around the brain (meninges); around every muscle fibre (endomysium), around the nerves (epineurium), in the ligaments, tendons and around muscles and bundles of muscles (myofasciae). The mind boggling truth is that all these structures can be considered fascia and furthermore are all interconnected in a gigantic silken spider’s web. The easiest way of understanding fascia is with the idea that if we had a magical substance that could dissolve everything in the body EXCEPT fascia, we would still be left with a complete 3D representation of the body. Once you have this perspective of a tough silken fascia “body suit” that permeates every structure in the body you can start to appreciate the relevance of fascia to massage. Because fascia is an interconnected system, then strain or tension in one part of the system can cause pain, lack of mobility or other dysfunction elsewhere.

Fascial Work in Massage The average massage therapist in the UK generally learns no or very little fascial work on their qualifying course; instead most of us are taught a Swedish massage routine which is designed primarily for relaxation and to enhance blood and lymph flow. Although these techniques are a great basis for starting out as a massage therapist, the addition of myofascial techniques will without a doubt enable you to get better results, more clients through the door and a greater satisfaction in your work. Doing effective fascial work requires sensitivity, willingness to follow

your intuition, a sense of connection with the body and the development of what we call “listening touch”. I find these qualities usually come easily to massage therapists with good teaching and a little practice – indeed as we often work first with our hands and our heart and our head it can be easier for us to adopt this approach than physios or osteopaths whose training may have been more intellectually driven. Fascial techniques can be used a treatment in themselves or integrated with other modalities such as trigger point, Swedish massage and stretching. At Jing we definitely favour the integration of techniques in a whole body treatment as we believe in the principle of the “gestalt” – the whole being greater than the sum of the parts. So integrating myofascial work with trigger point and other techniques will often get more effective results than just fascial work alone. In my own clinic I have successfully used fascial techniques to treat pain issues such as low back pain, sciatica, carpal tunnel syndrome, RSI, sporting injuries, rotator cuff problems, fibromyalgia, pelvic and menstrual problems, IBS, and headaches. I have also used my knowledge of fascial skills in conjunction with therapeutic talk skills to facilitate my client’s ability to identify and work with emotional holding patterns in their bodies which were contributing to their pain patterns. Fascial work is an integral part of every single treatment I do – without a doubt learning fascial release techniques has been the biggest single investment of my career.

Why do fascial release techniques work? All the approaches to working with fascia believe that the manual forces applied during hands on therapy change the “density, tonus, viscosity or arrangement of fascia” in a permanent or semi- permanent way. There are several theories about why this happens: Thixotrophy – or the gel to sol theory Ida Rolf first proposed the theory that connective tissue is a colloid substance in which the ground substance can be influenced by the application of energy (heat/ mechanical pressure) to change from a more dense gel state to a more fluid sol state. This characteristic is called thixotrophy. The type of movement required to produce this change is crucial, as it needs to be SLOW. If quick movement is applied to a thixotrophic substance it will remain solid; if slow movement is applied the substance will literally melt under your fingers. The thixotrophic nature of fascia is important when doing myofascial bodywork as with the correct application of technique we can enable this change from a solid to gel state thus releasing long held myofascial restrictions that are causing pain and dysfunction. Although the thixotrophic nature of fascia has long been believed to be the reason for the efficacy of fascial techniques and the “melting” sensation we feel beneath our hands as practitioners, recent research by Robert Schleip and others has Issue 108 2020

advancedcpdadvancedcpda to conduct bioelectricity, thus creating the environment for enhanced healing. They can also structurally eliminate the enormous pressures that fascial restrictions exert on nerves, blood vessels and muscles. Myofascial release can restore the fascia’s integrity and proper alignment and, similar to the copper wire effect, can enhance the transmission of our important healing bioelectrical currents.” Schleip points out that the time cycle involved is again too slow to account for the immediate tissue changes felt by the practitioner. The Role of the nervous system A newer explanation proposed by Robert Schleip focuses on the mechano receptors found in the fascia – manual stimulation of these leads to changes in tonus of the motor units under the practitioner’s hand. The fascial system and autonomic nervous system are closely linked leading to changes in fascial tonus and ground substance viscosity. This would explain the short-term changes that are felt beneath the practitioner’s hands.

questioned this assumption. Schleip points out that the thixotrophic effect is reversible (think of melted butter going back to hard) and therefore doesn’t account for permanent tissue changes. Also research suggests thatthe amount of force and time required to produce permanent changes in fascia are much greater than that applied during manual therapy. Piezoelectric Force James Oschman and others have suggested that the way in which fascia can change its shape is due to a phenomenon known as piezoelectricity. Basically the idea is that pressure creates an electrical current through the tissue – the fascia behaves like a “liquid crystal”. The suggestion is that the electric current stimulates the fibroblasts to alter their activity in the area. John F. Barnes describes it in the following way (Myofascial Release, the Search for Excellence): “Piezoelectric behaviour is an inherent property of bone and other mineralized and nonmineralized connective tissues. Compressional stress has been suggested to create minute quantities of electrical current flow. Like untwisting a copper wire, the techniques can restore the fascia’s ability 30

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Overview of different Fascial approaches A “full fascial toolbox” would really encompass techniques not just for the myofascia (fascia around and within the muscles) but also the cranial fascia and the visceral fascia. Newer techniques also work on the fascia around the nerves and blood vessels. Approaches that work on the myofascia – Structural Integration and Myofascial release (MFR) Techniques are often referred to as “direct” or “indirect”. In the direct method we have a clear concept of where we want the tissue to go to produce a certain effect. This is used in Rolfing and Structural Integration techniques where we wish to produce optimal alignment in the body. Indirect release is the term applied to releases in which the practitioner follows the direction of ease in the client’s tissues rather than working directly on the restriction first. This is similar to releasing a stuck drawer by pushing it in first. Myofascial release (MFR) uses this approach. In the indirect approach the fascia is put on a stretch or given slight pressure to initiate a response in the tissues. The therapist then literally “follows” where the tissue wants to go with their hands whilst keeping the stretch. After holding the stretch

for between 3-5 minutes the tissue will eventually release in the place where it needs to. This sensation can feel literally magical and can require a level of practice to master. Some of the most well known fascial approaches are: • Rolfing or Structural Integration (SI) as developed by Ida Rolf in the 1960s. Rolfing seeks to re-establish proper vertical alignment in the body by manipulating the myofascial tissue so that the fascia elongates and glides rather than shortens and adheres. SI work aims to literally change the shape of the body into more optimal alignment thereby easing pain and dysfunction caused by fascial restrictions. SI work typically takes the body through a series of sessions – 10 in the original “Rolfing recipe”; starting at the feet and working the way up the body to achieve balance and ease. SI approaches incorporate: • Systematic “body reading” to identify imbalances • A series of deep direct fascial techniques that incorporate work with fists, fingers, forearms together with active movement by the client. This follows one of Ida Rolf’s great dictums “Put it where it belongs and call for movement.” Other Structural Integration approaches Other SI approaches include KMI (Kinesis Movement Integration) as developed by Tom Myers; Hellerwork (includes dialoguing and emotional work) and many others. All of these approaches are based heavily on Rolf’s original work and retain most of her original concepts and techniques. For example, KMI uses 12 sessions rather than 10 to incorporate Tom Myers new ideas around the way fascia links together (“Anatomy Trains”). However the techniques are broadly identical to those used by Rolfers and SI practitioners from different schools share more similarities than differences in the way they work. • Myofascial Release (MFR): originally coined by the osteopath Robert Ward, in the 1980s the term MFR was adopted by a physical therapist John Barnes to describe his method of freeing restrictions in the myofascial system. The overall intention of MFR is to relieve pain, resolve

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structural dysfunction, restore function and mobility and release emotional trauma. MFR techniques rely heavily on the ability of the practitioner to use the “listening touch”; tune into the tissues and follow the fascia to where restrictions are held. Techniques taught in this approach usually include cross hand stretches, arm and leg pulls and many others. Some of the techniques taught have a cross over with those from craniosacral therapy (ie: transverse fascial plane releases) or in some cases more direct approaches. Craniosacral therapy and Visceral Manipulation Both MFR and structural integration approaches focus mainly on the myofascia – the fascia running through and around the muscles (“myo”). An all round fascial practitioner would also be proficient at techniques that seek to identify and release deeper fascial restrictions ie: that found in the cranium and around the organs.

• Visceral Manipulation: developed by the visionary French osteopath Jean- Pierre Barrall, sees restrictions in the viscera (organs) as primary to other types of pain including musculo skeletal restrictions. Through tuning into the fascial restrictions around the organs with a sophisticated sense of “listening touch”, excellent results can be gained. • Craniosacral Therapy: Works on the deepest layers of the fascia: the dura mater surrounding the brain and spinal cord. William Sutherland was the osteopath who pioneered this approach to healing by recognising the potential of the cranial bones to move; John Upledger has popularised craniosacral therapy in the last few decades. There’s all so much exciting stuff!

Where should I start? With all the exciting fascial CPD training around the UK at the moment it’s easy to feel like a kid in a sweetshop – just where should I start with this fascial feast? As a general rule, from my own perspective, I would recommend learning direct or indirect myofascial techniques first then progressing to cranial then visceral work. This is because in my view, the latter techniques require increasing levels of sophistication and refinement of touch and ability to connect with the body tissues. Splash out for a longer training rather than a 1 day workshop as this will not really give you enough experience with the techniques to get results (although can be good as a taster)

I hope this has given you some ideas and confidence to play with training in different fascial approaches. Fascia work is fun, fun, fun and gets astounding results. Keep your work fresh and exciting and you will always have clients coming back for more.

Rachel Fairweather is author of the best selling book for passionate massage therapists – ‘Massage Fusion: The Jing Method for the treatment of chronic pain”. She is also the dynamic co-founder and Director of Jing Advanced Massage Training (www. jingmassage.com), a company providing degree level, hands-on and online training for all who are passionate about massage. Come and take part in one of our fun and informative short CPD courses to check out the Jing vibe for yourself! Rachel has over 25 years experience in the industry working as an advanced therapist and trainer, first in New York and now throughout the UK. Due to her extensive experience, undeniable passion and intense dedication, Rachel is a sought after international guest lecturer, writes regularly for professional trade magazines, and has twice received awards for outstanding achievement in her field. Rachel holds a degree in Psychology, a Postgraduate Diploma in Social Work, an AOS in Massage Therapy and is a New York licensed massage therapist. jingmassage.com | 01273 628942 | © Jing Advanced Massage April 2019 | Photos: all © Jing Advanced Massage; except 3 & 4 ©Handspring Publishing

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productreviews Porta-lite Advantage with wheeled case RRP £239.99 (current site offer £194.97) Owning an on-site massage chair is a great way to break into new markets and add more office based clientele or casual shoppers to your customer list. When choosing an on-site massage chair you need to make sure you select a model based on its strength & robustness, ergonomics for different sized clients and yourself, comfort and padding and of course the best quality/price ratio for your budget.

Offer just for Massage World Readers :

Free 6 piece 10 0% cotton fitte d washable chai r cover set to co ver al l the areas of your chair whe n you become th e luck y ow ner of the Porta-lite advantage unt il 30th June. Sim ply quote th is offer at time of purchase.

The Porta-lite Advantage with wheeled case is a professional grade on-site chair with 3 inch foam padding, fantastic build quality and adjustable in 4 different areas to fit clients up to 6’4” conformably. It is priced mid-range and is the only model on the market that comes with a handy wheeled suitcase to easily move around with.

There are many videos on youtube going into more detail, some from us and some from therapists who have reviewed the chair. To see a quick 5 minute review, type this URL into your browser https://youtu.be/2n0vgSZ7Z _ s and check out some photos from other therapists using the chair on Instagram like the image below! https://www.instagram.com/massagewarehouse/ If you have any questions feel free to give our customer support who are all therapists themselves a call on 01443 806590 or email customersupport@massagewarehouse.co.uk Product link: https://www.massagewarehouse.co.uk/collections/on-sitemassage-chairs/products/portalite-advantage-wheeled-massage-chair

"I bought both my massage chair and table from Massage Warehouse because I only wanted professional tools for my business. I hope you like my unique pictures!" Endre - Weybridge

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bookreviews

Talia Stiles

This second and revised edition provides new research on assessment , diagnosis, and treatment approaches to enhance gait efficiency. Changes include:

Born to Walk is designed to help movement therapists, physiotherapists, osteopaths, chiropractors, massage therapists, and bodyworkers understand gait and its mechanics, and will appeal to anyone with an interest in evolution and movement. It offers a concise model for understanding the complexity of movement while gaining a deeper insight into the physiology and mechanics of the walking process. The ability to walk upright on two legs is one of the major traits distinguish- ing us as humans, In Born to Walk, author James Earls explores the mystery of walking’s evolution by describing the complex mechanisms enabling us to be efficient in bipedal gait.

BORN TO WALK

Myofascial Efficiency and the Body in Movement

JAMES EARLS

Coauthor of Fascial Release for Structura

l Balance

JAMES EARLS

The ability to walk upright on two legs is one of the major traits distinguish ing us as humans. Author James Earls explores the mystery of the evolution of walking by describing the complex mechanisms enabling us to be efficient in bipedal gait. His model uses the latest research in paleoanthr opology, sports medicine, and anatomy, coupled with a functional understanding of the human form, to demonstrate how the whole body collaborate s as an interconnected unit in walking. Earls explains the efficiency that is part of our natural design, distilling the complex actions into a simple sequence of “essential events” that engages the myofascia and utilizes its full potential. Born to Walk helps identify areas of the body that, if dysfunctional, may reduce efficiency of gait. With this knowledge we can help ourselves and our clients regain a flowing elasticity within gait. JAMES EARLS MSc. is a writer, lecturer, and bodywork practitione r specializing in functional movement and structural integration He is the director of Born to Move, an education platform teaching real-life anatomy for movement and manual therapists, and he is a popular presenter at conferences and workshops around the world. Earls is the coauthor, with Thomas Myers, of Fascial Release for Structural Balance. He also writes regularly for professional magazines and journals, and has collaborate d with many authors in the production of their titles.

Second Edition

U Updated information and research on myofascial continuities U Chapters arranged according to planes of movement U New, informative illustrations based on phases of gait with EMG readings U Clear listing of the “Essential Events”

D N O N C IO SE DIT E

The revised edition of the definitive book on the mechanics, mysteries, and methods of upright walking

Born to Walk is designed to help movement therapists, physiother apists, osteopaths, chiropractors, massage therapists, and bodyworkers understand gait and its mechanics and will appeal to anyone with an interest in evolution and movement. It offers a concise model for understanding the complexity of movement while providing a deeper insight into the physiology and mechanics of the walking process.

BORN TO WALK

BORN TO WALK: Myofascial Efficiency and the Body in Movement Second Edition James Earls

Anatomy / Walking / Movement

www.northatlanticbooks.com US $29.95 / $39.95 CAN

Chichester, England

ISBN 978-1-62317-443-9

Born to Walk helps identify areas of the body that, if dysfunctional, may reduce efficiency of gait. With this knowledge the therapist can help themselves and their clients regain a flowing elasticity within gait. North Atlantic Books Berkeley, California

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Movement Integration: The Systematic Approach to Human Movement Martin Lundgren & Linus Johansson The ability to move with efficiency and agility has been an essential component to our evolution and survival as a species. It has enabled us to find food, fight threats, flee danger, and flourish both individually and collectively. Our body’s intricate network of bones, muscles, tissues, and organs moves with great complexity. While traditional anatomy has relied on a reductionist frame for understanding these mechanisms in isolation, the contributors to movement integration take a more systematic, integrative approach.

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There is quite a difference between movement and movement, and this is the reason for this book. With over 150 images, the colour illustration model provides a visual tool for understanding how joints interact with surrounding structures. It’s the ideal book for physiotherapists, massage therapists, structural integrators, coaches, as well as Pilates and yoga instructors.

£24.99 Published by Lotus Publishing ISBN: 9781905367955

Our new website is launching soon! Follow us on Twitter to keep up to date on the launch @massageworlduk Issue 108 2020

To help you with this, consider the following; • framework • weight • ease of transport • upholstery • adjustability • durability • protective carry bag • cost • new versus second hand • warranty • maintenance • you!

Are you sitting comfortably?

What to Consider When Buying Your First Massage Chair By Pauline Baxter earning a new skill such as Seated Acupressure (On Site) Massage is exciting. You can hardly wait to qualify, get out into the ‘big, bad corporate world’ and secure those contracts that are just waiting for your expertise. It is also a little bit scary as you try and figure out how to approach companies, what length of appointment to offer and not forgetting what to charge! One thing you will definitely need is a massage chair. This brings with it a whole new set of dilemmas. Which make of chair should you buy? What should you pay for a chair?

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Should you buy brand new or second hand? How do you know which is best? So many questions and so many options! The important thing is not to rush into buying the first chair you come across or to buy the cheapest just because it is the cheapest. You need to try out different makes of chair to help you work out what suits your requirements. Your training provider should be able to provide the use of at least two different makes of chair to use during the course for comparison purposes.

Framework / Weight / Ease of transport Most massage chairs fold down to a certain degree and are usually reasonably portable. However, if the framework is heavy then this can potentially cause issues. Will you be carrying the chair on the bus, train or tube? If so, a heavy or large chair could be a problem. You would probably need a massage yourself when you get to your destination! To try and counter this problem, many chairs have wheels or the bag in which the chair sits has wheels. Another alternative is to use a small luggage trolley. This can work reasonably well where the ground is relatively flat and smooth, but can be a challenge on bumpy pavements as the chair can slip to one side. You would just need to ensure the chair is securely tied onto the trolley. If driving, will the chair fit in your car? Perhaps you are able to leave the chair in the company so you don’t need to transport it each time. In which case, a number of additional questions arise: Is the chair kept in a locked store? Who has access to the cupboard? Is your chair insured and if so, under whose insurance? If you decide to leave the chair at the company then ensure you work out an agreement with that company.

massagefeature are you sitting comfortably?

Upholstery / Adjustability / Durability It may seem an odd thing to say that the upholstery is something to consider when buying a chair. Surely the upholstery is just some sort of vinyl covering? The chair needs to be comfortable for the client. It also needs to be durable to allow for the usage and the cleaning that will take place. With regard to you, the practitioner, you need to consider how much you plan to use the chair. The durability is more important if you are looking to use it every day than if you use it once per month. Adjustability: The main areas of the chair which should adjust are the seat, chest pad, headrest and armrest. Seat: The seat of the chair is adjustable height wise, according to the practitioner requirements. For example, if the client is 5’10” and the practitioner is 5’2”, then the seat will need to be lowered. This is to allow the practitioner to work comfortably on the client’s shoulders, in particular when the client is upright. If the client is 4’10” and the practitioner is 5’8” then the seat needs to be raised. In making the height adjustment, it is important that the angle between the chest pad and the seat is as close to 90° as possible. This is to provide the most comfortable position for the client and the most efficient position for the practitioner. Chest Pad: On some chairs the chest pad can be moved up or down the main frame of the chair. Others have a pad which is attached to the chair by velcro and can also be moved up or down as required. An additional feature of the second type is that this pad can be turned 90° to provide wider support (sometimes required for a slightly larger client). Head Rest: People come in all sorts of shapes and sizes so there needs to be good adjustability of the head rest to enable the client to remain as comfortable as possible

throughout the massage. The most adjustable headrests tend to have two quick locks and the ability to slide the frame of the head rest up and down to adjust the height.

timeframe guarantee. If buying from another practitioner there is unlikely to be a guarantee. This is why it is important to try the chair first.

Arm Rest: This should be adjustable from both a height and an angle perspective. Whilst the above may seem like there a lot of adjustability is required, it is worth it. A chair with few adjustments may limit the comfort of the client. An uncomfortable client is less likely to come back for another massage. Think of it this way; ‘the chair should adjust to fit the client rather than the client fit the chair’.

All equipment should be regularly checked and maintained. How easy is it to maintain the chair? What about availability of parts if you need a replacement?

Durability: We have already briefly mentioned durability. Put simply, this is the ability of the chair to withstand wear, pressure and possibly damage. When using the chair, it is important to remain within the usage guidance of the manufacturer.

Protective Carry Bag This pretty much speaks for itself. A carry bag will help prolong the life of the chair and may make it easier to transport. Usually, the manufacturer will make a bag that fits the chair.

Cost This is a major topic. The price of a massage chair can vary enormously according to make and whether the chair is new or second hand. Your budget will certainly be a factor to consider.

New versus second hand / Warranty When buying a new chair the manufacturer should provide a warranty which is a written guarantee promising to replace or repair the item within a specified period of time. This warranty will have terms and conditions so make sure you read them before purchasing. Second hand massage chairs can often be found advertised on social media. A word of caution: always try the chair before you buy it. Trying the chair includes; • you sitting on the chair • having someone else sit on the chair whilst you apply one or two massage techniques • checking there is no damage to the upholstery, framework or adjustments • all nuts and bolts etc are present and correct Always ask if there is any guarantee with the chair. If bought via eBay there may be a short

Maintenance

You! This one is fairly obvious. It makes sense for you to like the chair if you are going to buy it so make sure you do your research. A great way to do this is at relevant events/exhibitions and visit the stands of the suppliers. Speak with other practitioners. See what make/ model chair they have and what they think of it (good and bad). Speak to your training school and see what they recommend and why.

Final thoughts It may seem a little confusing when you consider the above. But all the points are valid. You are investing in your business and want to ensure the equipment is ‘fit for purpose’. Whatever chair you decide to buy, think in terms of what work you will get as a result of practicing on site massage. You will very soon recoup the money spent on the chair itself.

Happy chair research! Pauline Baxter A 10 year background in Health & Fitness Club Management laid the foundations for Pauline’s venture into the world of complementary therapies, which began in 1994. A year out to travel in 1996 provided an amazing range of new challenges and experiences before settling back in the UK to begin her full time journey into life as a massage practitioner. Over 20 years later that journey has been, and continues to be, exciting, rewarding and ever evolving. Most notable events include becoming a tutor for Academy of On Site Massage (AOSM) in 2000, director and owner of AOSM in 2006, development of the AOSM corporate services division and in particular, the growth of On Site Massage Association (OSMA). Away from massage Pauline is a hockey fanatic (the field variety, not on ice!) and continues to play today. Whilst she can still run she will still play (she just doesn’t run as fast as she used to!).

Issue 108 2020

Case Study

Post-Concussion Syndrome By Conor Collins

I sit across from a young lady who has been struggling for months with the symptoms of post-concussion syndrome. She is frustrated and tears up as she explains how she feels lost, helpless and has received little guidance on how to get better. She’s been told to sit in a dark room, not exercise and “rest”. When her symptoms don’t get any better, she’s told to rest more and the cycle repeats itself.

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casestudy post-concussion syndrome

have heard this story plenty of times. As the field of concussion continues to evolve, massage therapists are becoming an integral part of the health care team managing this often complicated injury. Years ago, I had a very poor understanding of this injury when I began to see more concussions in practice. What I discovered is that I was not alone, the entire medical community was struggling to manage patients appropriately. This has caused practitioners of all disciplines to learn more about the role they play in managing a concussion, whether they are a sole provider treating a patient or part of a complementary medical care team.

A concussion is defined as “any transient neurological dysfunction resulting from a biomechanical force” (Giza C., Hovda D., 2001). In simplest terms, the brain gets injured at a microscopic level which can lead to a host of symptoms. The vast majority of these symptoms resolve within 30 days. A small percentage of patients will have symptoms between 30-90 days (known as “post-concussive syndrome”) and an even smaller group will experience symptoms lasting over 90 days, placing them into the persistent symptom category. As with anything overwhelming, establishing a process can help simplify things. The more thorough an exam the more time the massage therapist will save in treatment. A thorough health history should be performed in order to identify “red flags” before beginning any physical exam. Red flags can include, but are not isolated to: persistent vertigo, resting double vision, unrelenting severe headache, persistent vomiting or continued neurological decline. These symptoms require immediate attention by a physician. Depending on the therapist’s experience, a full neurological exam should be performed, including assessment of the central and peripheral nervous systems as well as the cranial nerves. This allows the therapist to catch discrete symptoms that might go overlooked during initial health history intake. The assumption should also be made that none of these assessments have been done by any other practitioner. In my experience, many massage therapists

Pay close attention to the symptoms felt by the patient during the assessment and whether or not the evaluation recreates any familiar symptoms.

expect that another discipline has performed these exams which is not always the case. Approach each patient with a clean slate and it will allow you to understand them more thoroughly. Following a neurological exam, assessment of the cervical spine should be performed and include: range of motion, strength, proprioception and indicated special orthopaedic tests. Pay close attention to the symptoms felt by the patient during the assessment and whether or not the evaluation re-creates any familiar symptoms. If a patient has suffered a concussion, there is almost always a concurrent whiplash-associated injury. The force by which a whiplash injury occurs is substantially less than that of a concussion. If a patient is coming into a clinic with a previously diagnosed concussion, it is safe to assume that they have exceeded the force required for a whiplash-associated disorder. In particular, the massage therapist should address the sub-occipital, scalene, and sternocleidomastoid muscles. Injuries to the ligaments and joint capsules of the cervical and upper thoracic spine are also very common, depending on the mechanism of injury. The massage therapist is often asked to field a number of questions regarding concussion following treatment. This is mainly due to the frustration of the patient, as well as the significant amount of misinformation being communicated about the injury. Having a baseline understanding of the current evidence

surrounding concussion injuries assists the massage therapist in communicating with the patient effectively. Some of these topics include appropriate rest, exercise and screen use. Gone are the days of pure rest and sitting in a dark room. The evidence is very clear that total rest beyond 4872 hours is not favourable to recovery in concussion patients. In fact, cardiovascular training that is heart rate guided and within sub-symptom threshold has been shown to be very beneficial for the healing process (Leddy et al., 2018). With respect to screens, patients may want to monitor their symptoms during screen use and limit themselves accordingly, but do not need to remove screens entirely. The most important thing during the healing process is that the patients try to remain at or below their symptom threshold for the day. Of the symptoms requiring management following a concussion, there are three that are considered a priority. It’s important for the massage therapist to understand these symptoms thoroughly and provide sound evidence-based advice to ensure patients are making appropriate progress through each stage of the injury. Sleep helps assist in breaking the acute cycle of injury, is brain saving, and helps regulate the stress response of the autonomic nervous system following a concussion. Structured sleep hygiene practices will help manage symptoms. This is done by developing a fixed bedtime, minimizing sleep-altering substances 2 hours before bed (caffeine, sugar, and alcohol) and removing all electronics from the bedroom. Regulating sleep can also help with the second priority symptom following a concussion, which is headache. The massage therapist should begin by classifying headache symptoms as there are many types of headache, each requiring its own treatment. Many therapists assume that the majority of headaches are cervicogenic in nature. Cervicogenic headaches arise from the muscles, joints and/or ligaments of the cervical spine and are often recreated through movement of the neck, or palpation of the structures in the cervical spine. While these headaches are prominent there are also several other types of headaches commonly suffered post-concussion.

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casestudy post-concussion syndrome

The massage therapist should have a thorough understanding of a patient’s headache history to better predict outcomes following injury. For example, if a patient has a prior history of migraines, they may experience an increase in frequency of migraine headache following a concussion. Tension headaches are the most common type of headache suffered during the acute phase of concussion. These headaches are driven by an imbalance in the autonomic nervous system as it tries to manage the metabolic changes occurring within the brain. Understanding that these headaches are driven by the nervous system rather than the soft tissue can help the massage

therapist develop treatment plans that provide the patient with relief during these periods. Lastly, medication overuse headaches are common as patients struggle to manage symptoms. Overuse of medication can perpetuate symptoms without the patient’s knowledge. Patients should be questioned regarding the frequency of medication use. Those patients using medication for 15+ days out of the month should be referred to a physician to help progressively reduce medication use under medical guidance (International Headache Society, 2018). Lastly, the development or resurgence

of mood disorder is also of high importance following a concussion. Understanding a patient’s mental health history prior to injury will help determine the need for a referral. Validated questionnaires can be used to help quantify often ambiguous symptoms of anxiety and/or depression. Those patients suffering from mental health concerns following a concussion should be referred back to a physician. While it’s important for the massage therapist to recognize when patients need help managing their mental health, it is not within their scope of practice to manage them directly. Resources that may help manage a patient’s mental health symptoms include, but are not isolated to: medication, cognitive behavioral therapy, sleep, and exercise. Those patients resorting to self-medicating are at increased risk of developing persistent mental health disorders and should take immediate action to avoid such an outcome. A concussion is often a scary diagnosis to receive. As research continues, it is becoming increasingly evident that active care programs are of benefit to patient progress. As is true for many medical conditions today, gone are the days of sitting and waiting. Scarier than the diagnosis itself are practitioners that provide advice to patients based on theory rather than evidence. As massage therapists are becoming an integral part of the patient management team, being at the forefront of the concussion research allows them to provide patients with the best opportunity for recovery.

Conor Collins is a Canadian massage therapist and has been practicing and teaching in Ontario for 13 years. As both a massage therapist and sports injury therapist, Conor provides a unique approach to clinical practice by combining disciplines of manual therapy and movement-based rehabilitation strategies. Conor shares a special interest in concussion management. His passion is to help massage therapists better understand the nervous system and its role following a concussion injury. Conor’s goal is to help educate massage therapists worldwide and help them to become leaders in the concussion management space. Conor is the owner of a private multidisciplinary clinic just outside of Toronto, Ontario. While not in clinical practice, he is on faculty at Mohawk College in the massage therapy program. He is also the producer of the podcast, “The Concast”, where he discusses the manual therapy industry from an evidence-based perspective. Throughout his career, Conor has had the pleasure of working major sporting events such as the Pan Am games, as well as managing athletes and consulting for national-level and club teams in both the NHL and NCAA. Website - www.conorpcollins.com Facebook - www.facebook.com/conorpaulcollins Instagram - www.instagram.com/conorpaulcollins Podcast - www.anchor.fm/concast

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e l i m o m a h C n Roma

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Oil profile written by Nana Mensah IMage from WIki: Oceancetaceen - Alice Chodura - Vogtherr, M. (1898) Köhler’s Medizinal-Pflanzen 3. Band. Fr. Eugen Köhler, Gera-Untermhaus. Tafel 9. (als Anthemis nobilis) Issue 108 2020

Reflexology

Reflexology for Mental Health Mark Woollard

ental health conditions are varied, and many with a broad spectrum of disorders to consider. It’s important to remember that as Reflexologists we are not Doctors or Psychologists. Therefore, when treating a client who presents themselves with a mental health concern, I will concentrate on what I call the Spirit, Emotion, Mind and Stress reflexes. When presented with a client with mental health issues, I find this list of questions invaluable in ascertaining their wants, needs and hopes. As I’ve said previously, these questions are by no means exhaustive:

• Have you seen a doctor? • What is their diagnosis? • Have you been prescribed medication? • How are your sleep patterns? • On a scale of 1-10, what would you say are your stress levels? • Do you practice any relaxation techniques? 40

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• Are you anxious or prone to panic attacks? • Do you suffer from headaches or mood swings? • How are your bowel movements? (I often find a client with mental health concerns will have a reactive bowel, be it diarrhoea or constipation.)

As always, I will double thumb walk the specific areas I like to concentrate on. By double thumb walk, I mean six times instead of the usual three. The digestive system as a whole is my first port of call when re-working. This system of the body is sensitive to emotion, including anger, anxiety and sadness. Stress, depression and other psychological factors can put the brain-gut connection out of sync. Re-working the head reflex may seem obvious, but don’t underestimate its importance. Many clients complain of headaches so to soothe the head is a vital contribution in improving your client’s mental health. Panic attacks, anxiety and breathing troubles are common complaints in mental health so paying attention to and reworking the lungs, diaphragm and solar plexus is

reflexology mental health

invaluable. Encourage your client to practice diaphragmatic breathing as you work these reflexes. I would even go as far as to tell your client to practice this technique on a daily basis as diaphragmatic breathing is known for helping to manage the symptoms of conditions as wide ranging as irritable bowel syndrome, depression, anxiety and sleeplessness. Never be scared of ‘overworking’ the solar plexus either as this helps immensely with stress and balance. We all know the endocrine system is the collection of glands that produce hormones that regulate metabolism, growth, development, sexual function, sleep and mood, among other things. Hence being one of the major areas/systems that should be re-worked in this client scenario. Pay particular attention to these glands: • Pineal- produces melatonin which modulates sleep patterns. • Thyroid- produces hormones which regulate brain development and mood. • Adrenals- produces cortisol which helps you respond to stress. • Pituitary- it goes without saying that this master gland should get extra attention. It controls many other hormone glands in the body and many bodily functions just wouldn’t function without it. I always end the session with three deep thumb pressures on the solar plexus, encouraging my client to engage in some diaphragmatic breathing to calm and ensure they end the session relaxed. I also like to perform this Reflexology/Massage relaxation technique at the beginning AND the end of the session. • Feel the aura all around the foot. Without touching, slowly move your hands around the feet, about 1-2 cm away so you and the client can feel the heat and energy. • Stroke the feet with both hands. • Effleurage movement, up and down the feet and ankles. • Windscreen wipers with alternate thumbs down the sole of the feet.

Case Study Sarah, 36 came to me after suffering from depression and anxiety since her early teens. The doctor had prescribed her anti-depressants which she had been taking for twenty years. After a particularly bad spell of anxiety and panic attacks, she started to worry that her medication was no longer effective. Worried that the doctor would simply increase her dose, I advised her to see me for monthly sessions. Within three months of sessions, her anxiety levels had dropped to the lowest levels she could ever remember. And she was delighted that she had suffered from no panic attacks. Nine months on and she has now had her dose of anti-depressants reduced. I also advised her to alternate her Reflexology sessions with some Reiki treatments and she is the happiest she has been in her adult life.

• Make a fist and push into the sole of the foot, push and release all the way down. • Cup the ankle bones either side of one foot firmly. Rock the ankle gently to and fro for 10 seconds each foot. • Cup and squeeze the leg up to the mid-calf, first one leg, then the other. • Spinal stretch from heel to big toe with thumbs. • Push the flat of your hand against the sole of the foot (solar plexus on foot to solar plexus on hand). Hold for a minute on each side with deep breaths. • Rotate each ankle clockwise x3. And anti-clockwise x3. • Hold foot with fingers over top of foot and thumbs on solar plexus. Pull them towards you, lift and push down on solar plexus. Repeat both feet. • Pull toes, holding base of each toe whilst pulling. • Rotate each toe, clockwise and anti-clockwise x3. • Another spinal stretch. • Stroke the feet. • Final effleurage movement, up and down the feet and ankles.

Mark David Woollard has fifteen years of experience working as a Reflexologist and Massage Therapist. Based in South West London, he worked in salons for ten years before becoming a freelance mobile therapist. As well as Reflexology and Swedish Massage, he also offers Reiki, Indian Head Massage and Holistic facials. He is a qualified teacher and enjoys passing on his passion and knowledge to the ‘therapists of the future’. For any questions, tips or information email markdavidwoollard@live.co.uk

• Hold solar plexus on both sides at the same time with three deep breaths. Issue 108 2020

Reflexology

Diseases and Disorders of the nervous system Part 2 By Ruth Hull Reflexology is a holistic therapy that treats a person rather than a disease and every treatment should involve a thorough working of all the reflexes of the body as well as the reworking of any reflexes that are found to be out of balance or congested.

Motor Neurone Disease (MND) Degeneration of the motor system. Characterised by progressive weakness and wasting away of muscles and eventual paralysis. Affects both skeletal and smooth muscles but does not affect the senses. Direct reflex • Brain • Spine Associated reflexes • Entire musculo-skeletal system • All endocrine glands • Solar plexus Multiple Sclerosis (MS) Autoimmune disorder in which patches of myelin sheaths and underlying nerve fibres of the eyes, brain and spinal cord are damaged or destroyed. Nerve transmission is disrupted and symptoms include weakness, numbness, tremors, loss of vision, pain, fatigue, paralysis, loss of balance and loss of bladder and bowel function. Occurs in periods of relapses and remissions. Direct reflex • Brain • Spine

owever, sometimes it helps to have a basic understanding of certain diseases and disorders so that you can, in addition to giving a full treatment, spend some extra time focusing on reflexes that will deepen the effects of your treatment. In this chapter you will find suggestions for reflexes that can be worked for some specific diseases and disorders. Please be aware that these are only suggestions and that there are many different approaches to treatments.

Associated reflexes • Entire musculo-skeletal system • Thymus • Adrenals • Solar plexus • Reflexes of areas affected (e.g. eyes, bladder or bowels)

Please also be aware that the following information should not, in any way, be used. to diagnose a condition. Reflexologists are not medically trained and should not diagnose conditions or attempt to treat them in the place of conventional medical treatment.

Muscular Dystrophies Group of inherited muscle-destroying diseases that lead to muscular weakness. Characterised by progressive atrophy of skeletal muscle due to degeneration of individual muscle fibres.

Study tip If you forget everything else, try to remember the following: • If there is pain, work the brain • If there is inflammation, work the adrenals • If there is mucous, work the ileocaecal valve • If there is stress, work the solar plexus and diaphragm • If there are toxins or waste, work the organs of elimination (lungs, liver, kidneys, large intestine, lymphatics and skin) • If there is infection, work the lymphatics, liver and spleen

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Direct reflex Entire musculo-skeletal system Associated reflexes • Brain • Spine • Solar plexus • Sciatic nerve • Relaxation techniques to improve circulation

reflexology diseases and disorders of the nervous system - part 2

Neuralgia Severe pain along nerve pathway. Generally characterised by stabbing or burning pains. Direct reflex Reflex area for nerve affected (e.g. work sciatic nerve if neuralgia is in legs or feet, arm reflex if it is in arms or hands, face reflex if it is in face, etc) Associated reflexes • Brain • Spine • Entire musculo-skeletal system • Relaxation techniques to improve circulation Pain and Referred Pain (Synalgia) Pain is an unpleasant bodily sensation and is a reaction to injury, illness or harmful bodily contact such as heat. Referred pain is pain that is felt in a different part of the body to where it is produced. It arises because sensory nerves from different parts of the body often share nerve pathways in the spinal cord. Direct reflex Reflex for area affected Associated reflexes • Brain • Adrenals • Solar plexus

Associated reflexes • Brain • Cranial nerve • Spine • Sciatic nerve if legs affected • Relaxation techniques to improve circulation Parkinson’s Disease (PD) Progressive disorder of the CNS thought to be due to an imbalance in neurotransmitter activity. Symptoms include tremors, rigidity, impaired motor performance and slow muscular movements. Direct reflex Brain Associated reflexes • Cranial nerves • Spinal cord • Entire musculo-skeletal system • All endocrine glands • Solar plexus • Diaphragm Sciatica Inflammation of the sciatic nerve. Symptoms include pain, numbness or pins-and-needles down back of leg. Can be caused by lower back tension, herniated disc, osteoarthritis, diabetes or pregnancy.

Comment Refer your client to a doctor for a medical diagnosis of their pain. Paralysis Impairment or loss of motor nerve function. Symptoms vary from muscle weakness, spasticity or flaccidity to complete loss of function. Has many different causes. Direct reflex Reflex for area affected

Direct reflex Sciatic nerve Associated reflexes • Brain • Spine (especially lumbar and sacral) • Entire musculo-skeletal system • Relaxation techniques to improve circulation adequately. Stress can break down the body’s defences, making it more susceptible to illness. Direct reflex Solar plexus Associated reflexes • Diaphragm • Brain • Cranial nerves • Spine • All endocrine glands • Entire musculo-skeletal system • HP-6 acupoint on wrist Stroke (Cerebrovascular Accident/CVA) Occurs when the arteries to the brain become blocked or rupture and brain tissue dies. Symptoms can include sudden weakness or paralysis of face and leg on one side of body, slurred speech, confusion, loss of balance and coordination and sudden severe headaches. Risk factors include old age, narrowing of arteries (artherosclerosis), high blood pressure, diabetes and smoking. Direct reflex Brain Associated reflexes • Cranial Nerves • Spine • Reflexes to areas affected • Entire musculo-skeletal system • Relaxation techniques to improve circulation

This extract is from Ruth Hull’s ‘The Complete Guide to Reflexology’ Available from massagebooks.co.uk Ruth Hull is a freelance writer who specialises in natural health. Born and educated in Zimbabwe, she completed a degree in Philosophy and Literature before studying and practising complementary therapies in London. She now lives in South Africa and is married with two children.

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Online CPD massage training courses TAKE YOUR MASSAGE THERAPY BUSINESS ONLINE WITH SIX DYNAMIC ONLINE CPD COURSES TO INCREASE RANGE OF MOTION AND REDUCE PAIN FOR YOUR CLIENTS. LEARN TRIGGER POINT THERAPY, MYOFASCIAL RELEASE, SOFT TISSUE RELEASE, SPORTS TECHNIQUES, STRETCHING (PASSIVE, PNF & AIS), HYDROTHERAPY AND TABLE SHIATSU. GAIN AN IN-DEPTH UNDERSTANDING OF THE TREATMENT OF COMMON PAIN CONDITIONS SUCH AS BACK PROBLEMS, SCIATICA, HERNIATED DISC, FROZEN SHOULDER, SPORTING INJURY, HEADACHES, RSI AND OSTEOARTHRITIS.

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Marketing to the Customer of Today By Charlie Thompson

Small businesses fail because they don’t have enough customers. Spas and salons fail because the don’t have enough customers. Massage therapists, in my experience also fail because they don’t have enough customers! The big questions are how to prioritise finding new customers, being able to retain the new customers, and delivering the best quality massage therapy you can. Let’s assume the third part of this is in place – your massage therapy work is good, otherwise do not read on!

hen looking for the solution, it is important to draw together the most important and lucrative sales and marketing techniques, that will ultimately drive more new customers to your business than you can handle. That’s the type of problem you want! It is important to allocate a certain amount of money to spend on marketing. If you try to rely on referrals, this will be extremely slow, and without reputation you have little chance of long-term or rapid success. This brings about the question of reputation which I will address later. Think of yourself as a hyperlocal business, identifying the catchment area your customers will come from (normally within 10miles), and not dream that regular customers will drive a long way for your services because they won’t in big numbers. It’s crucial to forget about those one or two customers that will do things out of the norm, because by very definition they are not the norm and it is crucial to focus on the norm to be able to do this well. I always like to think of my old maths lessons and the normal distribution curve (my teams have heard this many times!). Where are the biggest group of customers making the biggest difference to my business?

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businesstools This could be age group, gender grouping or distance travelled – see below: Normal distribution: focus your time where there are the most people and do not be distracted by the noisy minority! Identify the main screen target audience for your massage therapy business. If you take a simple age category, you will see that most customers will fall into a certain age bracket, with very few being very young or very old. There are good reasons for this; the young being very price sensitive, and the older clientele being on and off fixed incomes and less prone to investing money into their future. As ever, you will know a few exceptions to this, but if you are honest with yourself there won’t be many.

The digital world of today: How do I do any of this without wasting my time and money? Everyone is aware that Facebook and Google dominate the digital space, but how do I, as a standalone massage therapist or small massage therapy business make my business heard amongst the others? Let me share a plan with you. If you identify the cost of delivering your first massage, and how much you would be prepared to pay for that customer to become a regular customer with you, what would it be? I would estimate that this will be at least £20-£30, which gives you a great starting point for spending money to acquire that customer. You should look at the number of customers you need. For example, The Massage Company requires 300 new customers per month, but your business may only need 20 customers in total in order to meet the lifestyle or business demands that you’re looking for. The process is the same! For 20 customers equals £400-£600 of spend, that you should allocate within a period that you can handle the new enquiries (I suggest 3 months is a good timeline). In time, the good news is that this will reduce because your reputation will grow, and the internet and online reviews will significantly enhance this. It is all about you creating your own hyperlocal business environment. So, where do I spend the money, as it might sound rather a lot? Let’s start with Facebook. Creating a business page is essential, and this will be “attached” into your own personal Facebook profile (do not use your own profile itself to advertise within, as Facebook keeps you 46

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secret from your business in the eyes of the public). You should then create a Facebook business manager account, which might take a little learning but that’s new business, and if you’d like to be successful here is where you start learning. Allocate your payment method to this which should be either your business bank account card or even a credit card. Facebook is brilliant at finding people who are interested in massage therapy, but very few of those are actively looking for a massage right now! So, the secret is to generate new leads and use the Facebook system to acquire new customers that you can target in the future with offers and promotions. In Facebook it’s called ‘lead generation’, so learn how to do it, or pay someone to do this. Think now about your cost of acquisition and monitor your campaigns and promotions.

Top ti p: Facebook loves videos, and they don’t have to be super high quality, as customers are savvy and they understand genuine passion. Put yourself or one of your team in front of the camera and share your plans!

What about Google? It’s a big scary monster, but is perfect to help the individual massage therapist and a small business. The crucial point is to play Google within its own rules. Set yourself up a ‘Google My Business’ listing and claim it so you can verify it (which is done by an old-fashioned post card to your address). Once you have done this, take time to set up the listing properly, adding good photos, descriptions and opening hours, and expect this to take three or four hours. Google the confidence that this is real and relevant.

Top ti p:

Always write your address and phone number in EXACTLY the same format in every place you list your business. The Internet is not a person so recognises complete consistency. If you provide this consistency with your massage therapy, then everyone gets a great customer journey!

In order to place adverts on Google, my recommendation is to find the help of a ‘Google AdWords’ specialist (this is different to what is called SEO – Search Engine Optimisation, which I will come to later). Talk to three to five of them before choosing your favourite one. In my experience there are many, many “AdWords experts” out there, but very few who will actively look after your business. Remember, “where there’s mystery, there’s margin”, so trust the person you choose. Expect to pay around 20% of a small advertising budget to an expert. In my experience those businesses who say they will be doing the work for 10% will really care once your business is

businesstools set up, and you will be left three months from opening with little relationship and little chance of improving your online presence.

Top ti p:

Ask your Google AdWords expert which are the most searched terms before committing your money. It might be that ‘Sports Massage’ is the most searched term, and therefore the most expensive, but you don’t have to advertise 24 hours a day and seven days a week? Adverts can be turned off at certain times of day and night. The word “massage” gets searched for ‘shady’ reasons after 10pm, so why would you want to be advertising at that time anyway?

Local activity and partnerships This area is often overlooked. When you meet people in the local community, they will form a level of trust and judgement on you as a person that will form part of their decision-making, especially in a business where we are asking people to remove most of their clothes and feel vulnerable. Running a large business, I am always staggered by the number of massage therapists and small businesses owners who forget that many, many, customers are worried about being one-on-one with another individual, and we have to break down these barriers as early as possible. Find yourself local events within your catchment area, and again be prepared to pay to attend them. While at these events you should be selling, not just promoting – if possible, take someone with you, as it is always better than being on your own.

Top ti p:

Run a competition for a free massage, covering yourself in the GDPR world by asking people if you can then send them an offer for a massage afterwards. The key here is of course the email address, and you should not be afraid to email people directly with an offer to book with you. Every now and again someone might want to unsubscribe which is fine.

SEO than anything else. As a test, try being a customer in your own area – search ‘massage near me’ and you will see the listings with good reviews come just below those who are advertising.

Creating a hyperlocal environment The beauty about Facebook and Google marketing, combined with local activity and online reviews, is that you are creating a hyperlocal presence for yourself within your chosen catchment area. You then become more relevant, and this relevancy score is something that Google and Facebook will then learn through their own internal “AI” (artificial intelligence), and naturally push your business at no cost into more and more homes, and more and more searches. Be hyperlocal with your social media. Social media is news and information, and it runs alongside Facebook and Google marketing, but it is not the same. Social media is exactly that, social - it could be competitions, pictures of you at a local event, or simply useful information about lower back pain (did you know the NHS recommends massage therapy for lower back pain, but does not recommend a massage therapist to provide it - how crazy is that?)

Today and the future The crucial power of local partnerships is the conversion to long-term customers, which is very strong. People arrive in your business knowing already a little more about you and have often had the chance to talk about their area of need. The trust is established earlier.

Referrals? How do I get them? Another mistake I see people rely on, is that they hope and expect their current customers to refer new customers to them easily! It will happen, especially if you’re good as people will naturally recommend good businesses, but it will be slow. When starting a new business, do not expect referrals, and treat any referrals as a bit of a bonus. As your business matures this could easily become 20% to 50% of your business, depending on the size of what you do, but it simply doesn’t happen very much in the first 3 to 6 months. The reality is that only a certain number of people are ever looking for massage therapy at any given time, and you should use online reviews particularly with Google, Facebook and TripAdvisor to really push your business forward. These will be more powerful in generating good

Let’s change our industry, to make it far easier for people to access regular and consistently high-quality massage therapy. If you’re reading this, you’re already halfway there because you are a great massage therapist, and you’re investing your own time to read Massage World and other trade press. It must be easier for the customer to find us and book us, and make massage part of an everyday lifestyle choice! Allocate a good portion of your business life to generate new customers each month, as things do not happen by chance, they happen by choice. Good luck!

Charlie Thompson is using his experience of running large multi-site spa businesses for Virgin Active and Q Hotels, together with opening 18-20 new spas with ESPA, to be the Founder and Managing Director of the fast-growing new concept The Massage Company. He was also Chairman of the UK Spa Association for 7 years until 2019. For further information: massagecompanyfranchise.co.uk

Issue 108 2020

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on the catwalk

Surviving as a vegan business I Animal rescue in Bali

Understanding your body better

lessons to your younger self

Kindness How to veganise your wardrobe

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OM Meets – Kat Pither Born and bread – Better baking 360° Yoga – Anatomy academy OMFM – Richard-Hubert Clarke

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Welcome to

The International Professional Association with a difference For complementary, beauty/SPA, alternative and integrated healthcare and wellbeing

Why be part of a professional association?

A professional association is there to look after your interests. No one else is. Many people within our industry work individually. Being part of a professional association gives you support, a network of colleagues, access to career development and industry updates, security in your work and helps you ensure you are up to date with legal changes.

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We are ThinkTree. We are founded and run by practising therapists and experts in training. We care about the industry and we know about it because we’re part of it. This gives us a unique edge.

What you will get

• Recognition from belonging to a Professional Association • Free online CPD from industry experts • Support for new and existing trainers • Course and Centre approval and accreditation • Monthly newsletter and free access to industry leading Holistic Health Magazine • Special Treatment Licence exemption (which could cost up to £2,500) • Save money on insurance, clinic supplies and other products • Free session with a wellness coach and more

• Free social media resources • Use of our logo for your marketing • Your own mini web page on our site in our directory • Free legal and business support helplines • Highly competitive joining fee.

Who can join • Massage and Bodywork practitioners of all kinds • Beauty Therapists • Health and Fitness Professionals • Medical Professionals • Energy Therapists • Mindfulness, Hypnosis, CBT practitioners • Teachers, Coaches and Course Providers • Students (Free membership) Not listed here? Just ask us

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OSMA

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We are delighted to announce that Kingsmoor Clinic (nr Oxford) will be the premier training base for AOSM (south) in 2020 Www.kingsmoorclinic.co.uk

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Please note our new contact number: 0118 391 4313 Seated Acupressure (On Site) Massage Diploma & all Post Graduate courses details can be found on our website www.aosm.co.uk

“Probably the best taught course I have been on” Justine Thornton

Þ  Member forum & message board Þ  OSMA Facebook group Þ  Þ  Discount on AOSM courses Þ  and more.. (see website)

Membership runs annually from 1 Apr to 31 Mar. To join simply go to www.osma.org.uk and click on ‘Join Now ’. A division of Academy of On Site Massage

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A family run business developing and producing 1 00% natural Beeswax based products. • Our Massage Wax range offers professional therapists a variety of delicately formulated aromatic blends - one to suit every client! • A fantastic alternative to massage oil - with no spills! • Leaves skin nourished and hydrated without feeling oily • Protects delicate skin, perfect for Baby massage (Be Sensitive) • Recyclable packaging • 1 00% Natural Ingredients.

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courselistingscourselistingscourselistings Academy of On Site Massage – Seated Acupressure Diploma and CPD Post Grad Courses Ever thought about offering massage in companies but not sure where to train? We have the answer. As specialist trainers in Seated Acupressure since 1989 you can be confident you will receive the most thorough training and support available. Further training is available via our range of post graduate courses to enhance your skills. Details: For a quick view of course dates please go to our new website at www.aosm.co.uk and check out the CALENDAR Post graduate training includes; • Massage At Your Desk • Massage Tools Course • Advanced Seated Acupressure • Seated Therapeutic Massage • Hands Free Seated Acupressure • Seated Acupressure Refresher Training locations include; • Oxfordshire • Sheffield • Reading

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Anatomy Trains UK Learn from the people who wrote the books! Expand your understanding of myofascial connections through body and gain new skills directly from the experts. Learn to address postural and functional patterns by combining manual and movement skills.

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Amanda Hermitage: Anatomy Courses on Cadavers and Dissections with Julian Baker Hands-on experience, these workshops will change the way you view the body and enhance your understanding of anatomy. Open only to therapists and body workers, including students. Details: London venue

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FTT Beauty and Training Centre Well established training centre since 2000, Warm and friendly environment based in Hertfordshire. Close to the M25 and M1. Offering a wide range of both Complementary and Beauty Courses, whether it’s an NVQ Level 2, 3, 4 or CPD Fast Track Accredited Diploma. Small groups (Max. 4) allowing for more personal attention to the individuals. Courses are tailored to meet individual needs, suitable for beginners and qualified therapists. Details: Call office for full details on dates and times

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ISRM/BTEC (Level 5) Diploma in Sports & Remedial Massage Courses On this intensive 12-month Course you will: Revise and consolidate general massage techniques • Learn advanced soft tissue techniques • Analyse touch /connection /palpation • Explore injury and recovery - analysis and treatment • Discover the how to massage in non-clinical settings • Investigate Posture and Core Stability • Examine Flexibility/ Stretching/Relaxation • Gain knowledge of Nutrition & Sports Psychology • And MORE. Details: CPD Workshops; Muscle Energy Technique; Myofascial Release; Soft Tissue Release

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UKCP Accredited Diploma The London School of Biodynamic Psychotherapy (LSBP) was established in 2000, at Gerda Boyesen’s request, to carry forward the professional training in Biodynamic Body Psychotherapy previously taught at the Gerda Boyesen Centre. LSBP offer a four year UKCP accredited diploma training in Biodynamic Body Psychotherapy, along with CPD workshops throughout the year. LSBP provides professional practitioner Biodynamic Body Psychotherapy courses, promotes research in the field and serves as a professional body for Biodynamic Body Psychotherapists. LSBP is a member of the Humanistic and Integrative Psychotherapy section of the United Kingdom Council for Psychotherapy (UKCP) and also of the British Massage Therapy Council (BMTC) and the Association of Humanistic Biodynamic Massage Therapists (AHBMT). Through its membership of UKCP/HIPS, LSBP is directly involved in maintaining the standards of the psychotherapy profession, having a seat on the UKCP registration board. Details: See website

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Issue 108 2020

courselistingscourselistingscourselistings UK Lymphology Clinics Lymphatic Healthcare and Education Advancing training in our ground-breaking therapies to give knowledge and understanding of the lymphatic system for those who want to confidently expand their careers in a new dimension! Details: Breast Cancer Aftercare - Lymphatic Pressure Therapy - Six Months Training - 55 CPD points New and unique, this advanced training offers maximum beneficial aftercare for breast cancer clients. Encouraging five elements of recovery for range of motion to restore muscle connection for mobility and balance, whilst stimulating lymphatic return for an overall post-operative improvement. VTCT Approved. For caring, empathetic therapists confident in their own ability to provide excellent standards of UKLC aftercare! Must have six months massage training and six months practice. Lymphatic Integrated Massage - One Day Attended Course - 12 CPD points Encouraging a new approach towards effective lymphatic stimulation. This two-part course of three weeks home study theory and one day practical results in a short powerful therapy application to be integrated into everyday massage. “Thank you so much for excellent training, I thoroughly enjoyed all aspects of the course and the LIM benefits. You are an inspirational teacher.” Please see more details on our website.

T: 07599 985648 E: info@theuklc.com www.theuklc.com Bowen Technique A soft tissue remedial therapy which is gentle on both practitioner and client while still being powerfully effective. Add Bowen to your existing practice, offering it as an alternative to new and existing clients. Training is rigorous but fun with an emphasi s on your practical skills. Download our prospectus one from the website. Join one of the many Part 1 courses on offer across the UK. Details: Contact us for course dates.

T: 01373 461812 E: info@thebowentechnique.com www.thebowentechnique.com Prenatal Massage Training Training with Comfy Spa Training Company enables you to specialise in pregnancy massage. Our Post Graduate course will teach you all the important do’s and don’ts along with practical skills of how to deliver a beautiful ritual spa treat for mum to be and baby bump. To qualify for training in this unique & beautiful course all you need is a certificate in A&P and massage. Free belly casting is included with this course. Details: Courses are run throughout the year. 1 Day Course with pre-course study £160 + vat

T: 01782 285545 or 01782 639777 E: carol@comfyspatraining.co.uk www.comfyspatraining.co.uk Gladwell School of Massage Gladwell School of Massage is open to everyone who has an interest in the healing arts, whether you are a practitioner or a complete beginner. Our courses include Thai Yoga Massage - the latest and most effective table massage techniques, Postural Assessment - muscle testing and rehabilitation, Chair Massage, and much more. Expert tuition is provided by Daniel and his daughter Lila (see below), at popular locations in the UK or at their retreat home in Greece.

www.gladwellschoolofmassage.com

Womb & Fertility Massage Therapy A 4 day Spiritual, Practical & Theory course for therapists who’s passion is to nourish and nurture every women through any stage of their reproductive life. A unique blend of ancient, intuitive and sacred techniques. Details: 2018 National and International Courses: Belgium, Belfast, Ireland, Brighton, Manchester, Bristol, London

T: 07713 477511 E: info@fertilitymassage.co.uk www.fertilitymassage.co.uk Gateway Workshops™ Gateway Workshops™ offering recognised one day diploma massage, beauty and also on-line complementary therapy qualifications. Courses for all levels, CPD courses for therapists, courses for complete beginners looking to learn massage or beauty, gain a qualification or a total career change. Recognised, affordable and insurable training allowing you to use these therapies professionally to gain an extra income, in a clinic or as a mobile therapist. Details: Please check our web site for all the courses we offer - regular monthly weekday and weekend options in London, UK and Ireland.

www.gatewayworkshops.com Practitioner Training in Hawaiian Lomi Lomi Massage With Rosalie Samet. Dynamic, spiritually rich and life-changing authentic massage from Hawaii synthesizes ancient with modern in exceptional 12 Day Practitioner Training of highest UK standard. Intensive, Fast Track and Progressive options. CPD Workshops. Blend powerful massage skills, energy techniques, Huna wisdom and Aloha. Daily massage exchanges, small happy classes. Accredited by FHT and CThA with 2-day Assessment for Certification Details: FAST TRACK One Module of 4 days each – every month over 3 months. Autumn: Oct 10*– 13, Nov 07–10, Dec 05 – 08 INTENSIVE Three Modules of 4 days with one day off between each. Course Dates 2020 Spring: Feb 22* – Mar 02 or 07 Feb 22*– 25, Feb 27 – Mar 02, and 04 – 07 (or may be taken later)

T: 01273 730508 E: info@hawaiianmassage.co.uk www.huna-massage.com McTimoney College of Chiropractic We have been training chiropractors for over 45 years and have graduated many massage therapists who recognised that they needed additional skills and knowledge to enable them to help more clients. We deliver two programmes providing a Masters in Chiropractic. One is suitable for school leavers and is taught during the week and one is specifically designed for mature learners wishing to change their career. This programme is taught over one weekend a month and through summer schools in each year which allows students to continue to work whilst training. Both programmes are registerable qualifications with the General Chiropractic Council. This is a perfect way to upskill, building on your knowledge of anatomy and physiology to learn more about clinical conditions and the practical adjustment skills you need to make a difference. ‘I always wanted to be a chiropractor – I just never knew it would be this good!’ Details: Intakes in January (Manchester and Abingdon) and September (Abingdon)

www.mctimoney-college.ac.uk Issue 108 2020

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Massage World - Issue 108

Articles inside

Post-Concussion Syndrome

Touch - The Forgotten Sense

Why is SKART Part of the 21st Century of Health?

Reflexology For Mental Health

Are You Sitting Comfortably?