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 Y 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 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

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

touch: the forgotten sense

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,

https://drive.google.com/file/d/1XdjYP1BdnsG0mxtn1i-Oxi...touch: the forgotten sense

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 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. • 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 we are experiencing in society today? 26/03/2020 15:44

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.

Put your Muscles to the Test The Practice of Muscle Testing for Massage Therapists

By Earle Abrahamson and Jane Langston

O

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 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.

put your muscles to the test

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.

Table 3: Graded Manual Muscle Test

Kinesiology Muscle testing

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.

Graded manual muscle tests

Numeric Value Word Descriptor Clinical Description

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.

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.

5

4+

4

4-

3+

3 Normal

Good

Fair Completes ROM against gravity and maximal resistance

Completes ROM against gravity and against nearly maximal resistance

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

Completes ROM against gravity with no manual resistance

put your muscles to the test

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An example of muscle testing – Psoas Major

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.

Psoas Major Manual Muscle Test

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)

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.

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put your muscles to the test

Checklist for all 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

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

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/

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

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.

Without 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!

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

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

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 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.

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

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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BORN TO WALK: Myofascial Efficiency and the Body The revised edition of the definitive book on the mechanics, mysteries, and methods of upright walking in Movement Second Edition James Earls 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 providing a deeper insight into the physiology and mechanics of the walking process. 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. Updated information and research on myofascial continuities Chapters arranged according to planes of movement New, informative illustrations based on phases of gait with EMG readings Clear listing of the “Essential Events” The ability to walk upright on two legs is one of the major traits distinguishing 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 paleoanthropology, sports medicine, and anatomy, coupled with a functional understanding of the human form, to demonstrate how the whole body collaborates 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. 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. JAMES EARLS MSc. is a writer, lecturer, and bodywork practitioner 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 collaborated with many authors in the production of their titles.

Anatomy / Walking / Movement

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.

Chichester, England North Atlantic Books Berkeley, California

US $29.95 / $39.95 CAN ISBN 978-1-62317-443-9 www.northatlanticbooks.com BORN TO WALK Second Edition JAMES EARLS SECONDEDITION BORN TO WALK

Myofascial Efficiency and the Body in Movement JAMES EARLS Coauthor of Fascial Release for Structural Balance

North Atlantic Books

FOREWORD BY THOMAS MYERS

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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.

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