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Combining Medicinal Herbs with MT

Issue 110 2020

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The Fascia Issue

Visualisation to Enhance Dynamic Touch Â£5.00

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The Role of Fascia in Pain The Thoracolumbar Fascia

Fascial Membranes MASSAGE THERAPY | REFLEXOLOGY | BUSINESS TOOLS

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welcome editorial by Wendy Kavanagh

EDITOR

Wendy Kavanagh

FEATURES

Pauline Baxter Kate Browne Ruth Duncan James Earls Rachel Fairweather Susan Findlay Til Luchau Meghan Mari Nana Mensah Nicole Perez Giacomo Sandri Madelaine Winzer

GRAPHIC DESIGN

s the colour of the leaves change, there is one question on everyone’s mind – what’s next? We have been living a week at a time as we wait to see what new guidelines will be set out by the Government. It has affected everything from the way we work to our relationships and mental health. Therefore, it is more important than ever to find a routine that works for you, stay connected to loved ones, eat well and exercise.

In this issue, the FHT talks about alternative approaches to support health and wellbeing when hands-on therapies are sadly not an option. As bodyworkers, it is our goal to provide clients with the support they need to feel better, so they won’t need to rely on us to feel better. Giacomo Sandri explains how to manage inflammation by integrating medicinal herbs into the massage treatment.

Victoria Osborne

MEDIA COMMUNICATION

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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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â&#x20AC;&#x153;As a result of the advert, on the CThA Members Forum, I have one new holistic massage therapist who has joined the team and is very much appreciated by the clientsâ&#x20AC;? Donna Woodcock Massage Therapist

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contents

issue 110 2020 Features 8 Massage World Mentor

If you have been subscribing to MW for a while you will know that Susan Findlay has been our Sports Massage writer for many years and we thank her for that. Susan has now adopted a new and exciting role, that of our readers Massage Mentor. Please feel free to send any questions into MW that you would like Susan to discuss.

12 How do we Regain the Confidence of Businesses in a Covid-19 World? t’s a simple enough question, but definitely not a simple answer. There are so many things to consider and change in order to work as safely as possible, whilst still adhering to Government, industry and insurance provider guidelines. Pauline Baxter guides us on the answers.

16 Combining Medicinal Herbs with Massage Therapy Giacomo Sandri provides tips on how to integrate medicinal herbs into the massage practice, specifically focusing on managing inflammation.

Rethinking Hands-On Therapy The FHT puts a spotlight on some therapeutic approaches to support clients’ health and wellbeing that may help to reduce the risk of COVID-19 transmission.

20 Using Visualisation to Enhance Dynamic Touch Kate Browne shares some of the visualisation imagery that she uses that has enhanced both her quality of touch and body-integrated movement.

34 Fascia Pages This issue we have a focus on Fascia with articles from James Earls writer, lecturer and bodyworker, specialising in Myofascial Release and Structural Integration, Ruth Duncan Director Myofascial Release UK and author of A Hands on Guide to Myofascial Release. Til Luchau instructor and the Director of Advanced-Trainings.com. also contributes Til, has a diverse background that includes manual therapy, somatic psychology, transformative education, as well as organizational and leadership development.

46 Essential Oils, Coronavirus &amp; COVID19 Essential oils or their constituents are widely used in pharmaceutical preparations and in traditional and complementary medicine, in aromatherapy and in the spa industry. Nicole Perez from the IFA looks at essential oils in mconjunction with the current Pandemic.

Regulars 3 6 32 56

Editor’s Welcome News & Views Reviews Course Listings

news&viewsnews&viewsn FHT announces 2020 Excellence Awards finalists The FHT was thrilled to receive a high volume of excellent entries to its 2020 FHT Excellence Awards. And with COVID-19 still very much impacting our local communities, it’s never been more important to showcase the many ways professional therapists can make a real difference to the health and wellbeing of others. FHT were delighted to announce this year’s finalists… FHT Complementary Therapist of the Year • Mary Atkinson • Malminder Gill • Sal Hanvey • Andrea Lambell • Joy Shaw • Alexandra Skanderowicz FHT Sports Therapist of the Year • Leigh Edwards • John Molyneux FHT Beauty Therapist of the Year • Stephanie Chaytor • Geraldine Flynn FHT Student of the Year • Anya Rae • Tina Wilkinson FHT Tutor of the Year • Caroline Bradley • Marie Duggan • Dawn Morse • Jennifer Young FHT Local Group Coordinator of the Year • Tim Djossou • Jackie Hamilton NEW category! FHT Green Therapy Business of the Year • Anne Bramley and Helen Saunders • Tina Kent • Mani Kohli • Lucy Stevens The winners will be announced in November and celebrated across FHT’s online platforms and in future issues of International Therapist magazine.

We wish you all the best of luck! 6

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FHT support for therapists during COVID-19 Throughout the COVID-19 pandemic, the FHT has worked hard to provide regular updates and useful resources to support and represent the professional interests of its members, many of which have also been available to non-members. These include: • Coronavirus statement and FAQs - providing FHT members and other therapists with new and relevant information as the situation evolves and sector-specific government guidelines are published and updated. • ‘Preparing to return to practice’ guidelines – outlining key things to consider that will help minimise the risk spreading coronavirus when working with clients during COVID-19. • Special FHT member e-newsletters – highlighting significant changes to our statement and guidelines, and providing links to online articles and resources to support members, their clients, friends and family. • A COVID-19 ‘FHT members return to work pack’ – including an email template; a multi-purpose resource that can be used as a poster, information leaflet or checklist; a social media graphic; pre-treatment questions; and a COVID-19 policy template. • Preferential prices on PPE – through FHT Partner Brand, Physique Management, and Medisave, covering a range of PPE including face masks, visors, goggles, gloves and hygiene/cleaning products. • Access to infection control courses – provided by FHT accredited course providers, Brighton Holistics, Gateway Workshops, and Jennifer Young’s FREE FHT-accredited and certified course, Control of Cross Infection in a Post-Covid World. • A ‘Stay at Home’ video series – providing therapists with a free source of CPD, with more than 20 videos to choose from, all kindly supplied by FHT speakers and accredited course providers. • Working with the government – throughout the pandemic, the FHT has been in direct contact with the English, Welsh and Scottish governments, supporting them with information and feedback on their guidelines and to answer their members’ queries. • Lobbying the government – as part of the Integrative Healthcare Collaborative, FHT has supported various petitions and letters to government, with the latest asking for clearer guidance for therapists when local restrictions are announced.

To access these resources, visit fht.org.uk/coronavirus

snews&viewsnews&views The National Massage Championship The National Massage Championship will be returning to Olympia Beauty on Sun 3 - Mon 4 October 2021 for the third year and opens for the first time to international competitors across the entire competition! This incredible event welcomes all qualified massage therapists and bodyworkers to compete for a trophy or two in 6 competition categories! The competition will be taking place on the Gallery level at Olympia London. Qualified therapists are invited to showcase their technique and bodywork skills in six different categories including Advanced Massage, SPA/Wellness Massage, Freestyle Massage, Eastern Massage, Chair Massage and Clinical Massage. Bringing together qualified massage therapists of all backgrounds, The National Massage Championship is run by therapists for therapists and judged by our panel of international judges with extensive professional massage therapy experience.

We look forward to seeing you there! Enter here: www.olympiabeauty.co.uk/thenmc

World Massage Festival The International Massage Association has teamed up with the World Massage Festival and introduce the World Massage Hall of Fame.

Two of our Favourite Things!

They want to honor those who built the bridges for our profession, to educate the general public about massage, to educate therapists about different types of massage and to have fun.

The Baan Thai Spa in Hull City Centre is offering a meal deal but, not just a Free Fizzy drink. The innovative Spa is offering Thai massage therapy and a Thai meal for ÂŁ50. Interested? Well we are at MW.

August 1-5, 2021 Planet Hollywood Las Vegas, Nevada

Search Baan Thai Spa Hull

www.worldmassagefestival.com

Susan Findlay: Massage Mentor

What Are The Challenges Facing Us Today? I am going to begin this by stating the obvious: the spread of any infection, past, present, and future is going to be measured against the severity of this pandemic. It has awakened us to what our future may look like; a new normal has emerged. I would love to know how much of this will remain, but your guess is as good as mine. I want to discuss what we can take away from this experience, what might our new normal look like, and what we can do to ensure we have a vibrant future.

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massagementor today’s challenges

e have already begun to work differently; our existing cleanliness practices have been magnified. I have always wiped down the couch, cleaned the room, and changed the bedding, but now I find myself changing my working clothes after each client, stripping everything down (my over-worked washing machine is the real hero in this story), and sterilizing the room. The work has not stopped with just the practical side; I have had to take on extra administration such sending out an online Covid appointment questionnaire which must be completed 24 hours before attendance, doing a phone assessment, sending out informational packs to clients, updating my website with the appropriate information, and the list goes on… All of these extra precautions have meant that expenses have increased, whilst the number of clients I get to see has reduced. Appointments are no longer an hour with all of the cleaning and formfilling I have to do. This means that there are no longer the hours in the day to see

all of the clients who used to walk through the door. So, with this expense increase and client number decrease, is there anyone out there who has not considered changing their pricing structure? I know many people will be uneasy about this, for fear of losing clients. Honestly, I believe that your clients will understand the increase in price, as long as you give enough notice and clearly explain why the price has had to rise. When I first started out, I charged £25, which was a fair price for an inexperienced therapist. For years I didn’t increase this, despite having much more experience under my belt and having attended extra training, which all contributed to an improved service. It wasn’t until one of my clients actually told me to raise my prices that I considered it, but I still hemmed and hawed about doing so, for fear of losing clients. Instead of going all out I tentatively increased it by £5, which I thought was reasonable, even though I was nervous about it! My client actually laughed at me and said: “not enough” and told me what she would happily expect to pay. I gave my clients enough notice and took the plunge and increased my prices up to what I thought was a jaw-dropping amount: £40 for a session! I fully expected to lose some clients over this, however not one of them was unhappy with this increase. I actually found that my client numbers started to increase after this! So, what is the lesson? Do not underestimate your clients, they do value your service and will understand the reason for raising your prices. People are happy to pay money for quality. With the recent global economic downturn , many people have found that their employers have gone out of business. This can be scary but is also a fantastic opportunity to strive out on your own, be your own boss, and ultimately take charge of your own destiny. This frightening feeling has chased me all of my life, and still catches up with me even now. You might be asking yourself “where do I begin? What do I need to do to stand out from the crowd and attract clients?” There is no simple answer to these questions, it is something which is learned incrementally. Work with your best asset; yourself. There are many

available resources online for starting your own business ; it’s important to devise a business plan and research how to organize and execute it. You may also be eligible for financial help, as there are plenty of government grants to take advantage of . Realise that running a business is a learned skill, so be gentle with yourself; it is a steep learning curve, and no one gets it right 100% of the time. I have written a few articles about business skills that will help you, they are in the blog section of my website: www. susanfindlay.co.uk/blog . Further business videos and articles are within the Online Massage Coaching Program. Now that I have shamelessly plugged my wares let us move on, let’s talk about where might our future lie? You might have been one of the many therapists who felt demeaned to be put in the government classification of “massage parlors”, with the connotations of relaxation and pampering. However, once I had gotten past my initial rant, I realized that I had to take some responsibility for this perception. Although I, and many of you, have undergone specialist training in many areas, we cannot expect the general public to be aware of this via osmosis. The phrase “massage therapist” already has its associations with the general public; it is up to me to define what it entails. I attempted to remedy this by referring to myself as a “Remedial Soft Tissue Therapist”, hoping that this would offer a better explanation, but the simple fact is that the general public are not aware of the wide range of practices we can specialize in. As a profession, we have not done ourselves any favors by working in isolation or in small groups, which has served to create a disunified profession. It comes down to us, the individual, as well as our Professional Associations (PA) to work towards changing this. If anyone has not been a part of a PA, this pandemic should have given you enough reasons about why it is important to be a member of a reputable one. People often say, “I do not belong to a PA, what do they do for me?” Unless you have been living on another planet, during this period of uncertainty PA’s really demonstrated their value: they offered excellent support and kept us up to Issue 110 2020

massagementor today’s challenges

Covid-19 Protocols

date about all the current policies, procedures. I cannot say this for every PA, but I do know that those sitting as board members of the GCMT (The General Council of Massage Therapies) played a significant role in getting information out to all their members. I was heartened to see that so many therapists joined in on the conversation, how the profession started talking as a unified body, and how we got behind our professional associations, with GCMT emerged as a body with influence. It is now up to us to support our PA’s in their efforts to petition the government to recognise the value of higher education within the profession. So, what can you do? The good news is, the more education and experience you have the easier it will be for you to re-establish yourself. For those therapists that are new to the profession, it is important that you have a niche, a specialism that places you in a position of greater value. Your expert skills will establish you firmly and increase the need for your services. I want to leave you with thoughts of encouragement; we all know how important massage is and the thought of a future without it is daunting, both for our clients and ourselves as professionals. I cannot see massage stopping; whilst we may have to improvise and adapt, we will certainly survive.

References “Coronavirus And The Impact On Output In The UK Economy - Office For National Statistics”. Ons.Gov.Uk, 2020, https://www.ons.gov.uk/economy/ grossdomesticproductgdp/articles coronavirusandtheimpactonoutputintheukeconomy/june2020#:~:text=It%20 is%20clear%2C%20that%20the,the%20largest%20recession%20on%20 record.&text=Furthermore%2C%20Quarter%202%202020%20is,downturn%20of%202008%20to%202009. “Set Up A Business”. GOV.UK, 2020, https://www.gov.uk/set-up-business. Hellicar, Lauren. “Coronavirus: What Support Is Available For Small Businesses And The Self-Employed?”. Simplybusiness.Co.Uk, 2020, https://www.simplybusiness. co.uk/knowledge/articles/2020/06/coronavirus-support-for-small-business/.

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Susan’s first love is dance, sport, anything to do with the joy of movement. She trained as a nurse in Canada but soon left the profession when she came to the UK as she wanted a deeper connection with her clients. For many years she worked in both health and fitness, teaching 20+ classes a week and running GP referral schemes. She wanted to make better use of all her knowledge which led her to retrain as a Sports Massage and Remedial Soft Tissue Therapist. Currently she is the director of NLSSM and specialises in teaching Oncology Massage. She is the author of Sports Massage: Hands on Guide for Therapists and is the Sports Massage feature writer for Massage World. She volunteers her time as a board member of GCMT. You can join her on Massage Mondays for free weekly massage videos www.susanfindlay.co.uk

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Corporate Massage and Covid-19: How do we regain the confidence of businesses in a Covid-19 world? By Pauline Baxter t’s a simple enough question, but definitely not a simple answer. There are so many things to consider and change in order to work as safely as possible, whilst still adhering to Government, industry and insurance provider guidelines. As we have seen a number of times, adhering to guidelines can be pretty challenging. The situation can change in an instant, consequently leading to altered guidelines at very short notice! As I write this, the threat of more local lockdowns is increasing across the UK. Chaos seems to be thriving wherever you look;

The list is endless. Throw into the mix the return to school and return to work for many, and the question of whether there will be a ‘second wave’ pops up. The answer to which is simply, ‘nobody knows’. (Anyone else immediately think of the insurance advert where the man is asked if his door lock conforms to British Standard BS3621?). By the time this article goes to print things will have changed again, with further updates from the Government. What of the return to work within the complementary therapy industry? Many will have returned to work a few weeks ago, others choosing to delay their return for a variety of reasons.

• travel plans • exam results • evictions • business closures • job losses • the lack of unity between the UK nations and so many other areas 12

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For the moment, let’s consider the complementary therapy industry as a whole. The situation arising from Covid-19 has led to some practitioners deciding to no longer offer any hands-on therapies. This may have resulted in a change of direction and in some situations, a complete

massagefeature corporate massage and covid-19

Your client may well be facing away from you when sitting in the chair but, where does their breath go as they breathe out? Without a mask it flows down onto the arm rest, their hands and arms and is possibly deflected forwards. If you are working from the front on shoulders, neck or arms, this puts you in close proximity or contact with potentially high risk areas. You have to assess the risk and decide if, and how, you can minimise it. One option may be simply to not work on the client whilst standing in front of them. What about working from the side? When working on the arm at the side of the client, it is usual to bring the forearm down from the arm rest. Do you consider the forearms to have been too close to the high risk area?

Are there any other specific acupressure massage techniques you need to consider?

change of career. Others are happy to continue with hands-on therapies. Whatever path you have taken, it is vital that that you keep up to date with the guidelines provided by the Government, professional associations, industry and your insurance provider. Not an easy task as I am sure you are aware. The initial influx of information and questions as to what the guidelines actually meant for different situations was mind boggling. Less so now but you need to remember, there is no ‘one size fits all’ scenario. It should be clear that the Government and your insurance provider guidelines have the ‘must do’ guidelines. Within the complementary therapy industry, there are several professional associations (PA), all of whom have a list of guidelines and recommendations. Each association has slightly differing recommendations which may be partly due to the range of therapies with which they deal or represent. Before I proceed further, I want to remind you that the following thoughts are MY thoughts only. As a professional practitioner, YOU must do your own research relating to the Government, your industry, PA’s and insurance provider, guidelines and regulations. Based on this information you should then be able to determine which are your ‘must do’ actions, and which are recommendations for the therapies you offer. Follow this with your own risk assessments, the results of which will help you decide how you proceed. Several of you have asked about corporate massage, specifically Seated Acupressure. Can this now be offered? A very good question. For Seated Acupressure/On Site Massage, think about the different techniques involved. The massage is applied through clothes and you work from behind the client, to their sides and in front. Are any of these areas putting you in the high risk zone? Although currently we require the client to wear a face mask throughout the massage, there will be exceptions to this so your risk assessment should reflect this.

Moving on to PPE, there still remains confusion about what you should wear and what may be optional. Just to make it more confusing, it can vary depending on where you live. Personally, I would wear a mob cap over my (very long) hair, a mask, a visor and apron. Gloves are a possibility, and I will discuss the options later. Clients are required to wear their own mask throughout the massage (possible exceptions for health reasons). Once you have figured out what you are going to do for yourself, turn your thoughts to your client. For Seated Acupressure you will be working on the clothes of many different clients, some of whom may have travelled on public transport whilst wearing those clothes. This creates a risk of your client picking up and transferring Covid-19. The Company should have completed a risk assessment relating to this and you will be required to follow their procedures as a visitor to their office.

Is there anything else you can do as a practitioner? We are already thoroughly cleaning equipment, the room and ourselves between each client so do we need to do anything else? Wearing disposable gloves as part of your PPE could be an option. However, Seated Acupressure includes the use of forearms too. Does this mean you need to wear PPE that includes sleeves? Perhaps one solution is to provide a light towel or cloth that is big enough to drape over the client (one for each client), thus providing a clean surface on which you can work. There may be a disposable option for this so you would need to carry out your own research. Once you start to break down the different aspects of Seated Acupressure, you realise in a Covid-19 situation, there is a lot to consider. That’s without even looking at the appointment situation where you have to leave enough time to thoroughly clean your equipment and ventilate the room etc before/after every client, completing your Covid-19 questions the day before their appointment, as well as the consultation on the day. That is a lot to consider. As a practitioner of Seated Acupressure, I did put considerable thought into where I go from here. Note that I am not telling you what you should, or should not, do. Nor am I saying what is right or wrong. I am merely offering my own thoughts on how I choose Issue 110 2020

massagefeature corporate massage and covid-19

to proceed at this moment in time. After ensuring up to date Government guidelines allow massage to continue, my next port of call is my insurance provider. If they say no to Seated Acupressure for now, then I have my answer. If they say yes, then as long as I follow all relevant guidelines, the ball is back in my court. I would still always check with them if they have any additional requirements for any other therapies which I may be offering.

mentally. The need for massage and other complementary therapies is essential, but they must be provided in the safest way possible to minimise the risk of spreading Covid-19. It is important to liaise with my contact within each company as they will have their own regulations and procedures to which I will need to adhere. Consequently, there will be discussions between both parties, to ensure we agree on how, and when, the service will recommence.

The next step is to update my existing risk assessment (RA). My RA breaks down into three categories each of which needs an additional Covid-19 section. My RA categories are:

What if there is a vaccine? Would that mean it is safer to return?

• RA1 - includes each of the therapies I offer • RA2 - deals with any personal health concerns • RA3 – relates to the individual places where I work. No two companies and locations are the same, so this must be taken into account

RA1 At the time of writing this, the restriction to working in the highest risk zone (directly in front of the face) has been eased in some areas and re-instated in others, just to add to the confusion!

This is also a very good question, to which there is no definite answer. If, as and when, a vaccine becomes available, you would need to consider this in your risk assessment. Although finding a vaccine is obviously of high importance, it would not be available for some time. You have to assess the risks in the current situation, not try and ‘second guess’ what might happen. I know some of you have already gone back to corporate massage, having completed your risk assessments and feeling comfortable to return. Personally, I have decided to delay my return for the moment, but will continue to monitor and reassess the situation. Whatever you decide, keep up to date with the guidelines, continue to update your RA and if you decide to return to massage, do so responsibly and as safely as possible.

RA2 This section of my risk assessment relates purely to me and my own health. As a Type 1 Diabetic, this puts me into the NHS ‘vulnerable category’. I have to assess the risks involved with me returning to providing corporate massage and how I can either eliminate, or minimise, these risks. RA3 Many companies are only just returning to the office themselves. Some have taken the decision to keep their employees working from home until next year. Others have been working throughout the pandemic. Each company is different, each location is different. They all have their own new working procedures to action and adapt them as required. The past few months have also highlighted the importance of individual health and wellbeing, both physically and

Pauline Baxter A 10 year background in Health & Fitness Club Management laid the foundation for Pauline’s venture into the world of complementary therapies. Over 22 years later, that journey has been, and continues to be exciting, rewarding and ever-evolving. Notable events include becoming a tutor for Academy of On Site Massage (AOSM) in 2000, director and owner of AOSM in 2006, a regular contributor to industry magazines since 2010, development and growth of additional On Site Massage training, and a judge at the National Massage Championships in 2018 & 2019. www.aosm.co.uk | 0118 391 4313

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Combining Medicinal Herbs with Massage Therapy: Chronic Inflammation Management By Giacomo Sandri

In our work as bodyworkers, we mostly use the tools that Mother Nature gave us, including our hands, forearms, elbows and even our knees. And ultimately, our goal is to empower the individuals who seek us by supporting them to take good care of themselves, so they wonâ&#x20AC;&#x2122;t need to rely on us to feel better. So, as dedicated soft tissue specialists, it could be said that part of our mission is to acquire fresh knowledge and develop new skills to increase the quality of the treatment that we offer. As a qualified herbal medicine practitioner and bodyworker, I have witnessed how herbs and herbal extracts can work synergistically with intentioned touch to support the client in achieving a deeper state of wellbeing. This article aims to provide tips on how to integrate medicinal herbs into the massage practice and will specifically focus on managing inflammation.

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thebodyworker chronic inflammation management

Musculoskeletal Inflammatory Conditions and the Bodyworker Perspective Swelling, redness, heat and tenderness are the notorious four for diagnosing an inflammation. Inflammation is like stress: it occurs for a short period, and with the right timing is immensely beneficial, but when it lingers for too long, it can be detrimental (1). When signs and symptoms of inflammation show up and remain for a long time in one or more joints, the suspect is usually arthritis, being this osteo, rheumatoid or psoriatic depending on the presentation. If these symptoms are experienced around soft tissues such as muscle attachments and bursae, they can be referred to as Soft Tissue Rheumatisms (STR). The most common STR are subacromial bursitis, epicondylitis, trochanteric bursitis, anserine bursitis, and fibromyalgia, which are medically treated with painkillers and non-steroidal antiinflammatory drugs (NSAIDs) (2). From the bodyworker perspective, the help that we can offer in chronic (but also acute) inflammatory conditions include manual lymphatic drainage, gentle mobilisation, and the correction of musculoskeletal imbalances. We might as well terminate our session by suggesting to our client some stretching or strengthening exercises in combination with rest or other lifestyle adaptations.

The Role of Herbs in Regulating Inflammation Medicinal herbs contain compounds termed bioactive phytochemicals which, when absorbed, positively interact with the physiological processes of the body. Usually, most herbs have a few main compounds that are accountable for their properties; nevertheless, they may have dozens to hundreds of less bioactive phytochemicals that work synergistically to increase bioavailability, enhance potency or minimise toxicity of the most

2 bioactive compounds (3). That is why often herbs have little to no side effects, while unfortunately there is plenty of evidence that the most commonly prescribed NSAIDs can have detrimental consequences on the digestive system (4) and even impair the growth of articular cartilage (5). In regard to inflammation, herbs work by directly inhibiting inflammatory factors, by promoting lymphatic flow and supporting the bodyâ&#x20AC;&#x2122;s excretory channels in removing pro-inflammatory agents. To target an inflammatory condition, herbalists would probably prescribe a blend of herbs which have the three properties above.

Popular AntiInflammatory Herbs Tumeric Rhizome (Curcuma longa radix) (main pic) Turmeric has gained such an outstanding popularity in recent times to the point that the Western market has put this yellow rhizome in the hall of fame of the cure-all herbs. Specific to inflammation, the medical literature is mostly focused on studying its yellow pigments, called curcuminoids. Curcuminoids have been shown to be potent anti-inflammatory in vitro, both in animal studies and human trials (6); their mechanism of action involves the inhibition of several cytokines and enzymes which exert a pro-inflammatory action.

How to take it: The easiest and most common way to have turmeric is through food. Turmeric can be found on the shelves of the local supermarket in both fresh and powdered forms. Using turmeric in combination with black pepper to enhance its absorption in recipes such as golden milk, Indian curries, and Summer juices is a great way to keep chronic inflammation under control in the long run. Still, it probably wonâ&#x20AC;&#x2122;t be enough to exert a noticeable change in the short-term. The website Examine.com shows that standardised turmeric extracts with high curcuminoids (esp. curcumin) concentration works faster and more efficiently than turmeric by itself (7). How to take it: Take turmeric regularly in combination with black pepper for prevention and long-term inflammation management, and take a high curcumin concentration supplement (500-1000mg and still in combination with black pepper) for fast-acting relief. Frankincense Resin (Boswellia serrata) (pic.2) The medicinal use of frankincense resin for rheumatic and arthritic conditions is described in Ayurvedic (traditional Indian medicine) manuals dated 700BC. These properties are now more consolidated by studies showing what a potent antiinflammatory frankincense resin Issue 110 2020

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is. The most active family of compounds identified in frankincense are called boswellic acids, and they have shown to be strong inhibitors of pro-inflammatory enzymes like 5-lipoxygenase and COX-2 (8). There are few studies on frankincense relevant for us bodyworkers: a study from 2007 evaluated the efficacy of frankincense for knee OA in a dosage of 333mg a day; it resulted that most participants started experiencing a significant decrease in inflammation symptoms after just 2 months (9). The remarkable finding from this study is that the anti-inflammatory effects persisted for a month after the administration of frankincense was over. A review from 2017 on the anti-inflammatory properties of boswellic acids showed a remarkable improvement of tendinopathies, arthritis, ankle sprains and sports injuries in several clinical studies just after a month of oral administration in combination with rehabilitation and bodywork (10). Frankincense is therefore a safe, reasonably fast-acting anti-inflammatory for joint and tendon medical conditions. How to take it: Tablets. They can be found easily at the local health food shop or online. Although a standard dosage has not been established, it is suggested to simply follow the manufacturer instructions. Devil’s Claw (Harpagophytum procumbens) (pic.3) Devil’s claw is native to the Kalahari Desert in the African continent, and its name comes from the peculiar shape of its hooked fruits. In herbal

medicine, the root is the part used to treat rheumatic conditions of the musculoskeletal system, as it contains a high concentration of its main bioactive compounds, rightly called harpagosides and procumbides. One of the most indepth reviews on devil’s claw has been published by McGregor et al. in 2005 who collected evidence on the inhibitory action harpagosides and procumbides have on inflammation mediators such as TNF and thromboxane. The review states that daily supplements of devil’s claw can be a promising side-effects free long-term treatment for managing arthritis and rheumatisms (11). How to take it: devil’s claw root extract can be easily found in tablet form on the internet or at local health food stores. It is suggested to take 1000mg of powdered root up to three times a day (12). It can also be taken as a tincture (alcoholic extract) probably available at your local herb shop. Celery Seeds (Apium graveolens fruct) (pic.4) Celery seeds have been used traditionally since the middle ages as a remedy for rheumatisms, gout and water retention. Celery seed extract is not a strong inflammatory, but it is a diuretic and detoxifier, promoting the removal of uric acid and other toxic by-products from joints and soft tissues (13). Because of these cleansing properties, celery seeds are a wonderful remedy to combine with traditional anti-inflammatory herbs. They can be suggested to those clients suffering from arthritis, tendonitis or

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4 gout with fluid retention characterised by swollen/’boggy’ at touch tissues. How to take it: Celery seeds can be sourced in any large supermarket or in shops specialising in spices and culinary herbs. The best way to take them is through a strong water extract (decoction). To make a decoction, boil a teaspoon of crushed seeds and leave them to simmer for 10 minutes before straining and drinking. Burdock Root (Arctium lappa) (pic.5) Burdock has been listed in Western Herbal Medicine and Traditional Chinese Medicine pharmacopoeia for millennia and is classified as a tissue depurative and a blood tonic. It is indeed one of the remedies of choice when a client presents symptoms of toxic build-up and chronic inflammation. Different from other remedies, it is not clear which pharmacologically active compounds burdock manufactures, but from a nutritional point of view it is like a chemical minestrone: it has a little bit of everything including vitamins, minerals, bitter compounds, prebiotics and more (14). What we can be sure of is that burdock works very well in clearing toxic pro-inflammatory compounds out of the tissues. One study on 36 patients diagnosed with knee osteoarthritis showed that consuming burdock root tea for 6 weeks significantly reduced inflammatory markers and remarkably increased endogenous antioxidants (15). So, from the herbalist perspective, the client-type who will benefit from taking burdock will present soft tissue

thebodyworker chronic inflammation management

inflammation/arthritis alongside severe acne and fluid retention. How to take it: Ideally as a tincture or tablets. Available at most herb and health food shops.

Conclusion Discovering new and effective ways to empower our clients to get better can be considered part of our homework as bodyworkers. As we deal with more complex cases like chronic inflammatory conditions, it is important to have some extra arrows in our quiver. The purpose of this article then is to shape some of these arrows into well-researched herbal remedies that will provide our clients with the opportunity to climb one step further on the stairway of health.

References

1. Goodman, Stuart B., and Ling Qin. “Inflammation and the Musculoskeletal System.” Journal of Orthopaedic Translation, vol. 10, July 2017, pp. A1–A2, 10.1016/j.jot.2017.07.001. Accessed 24 Aug. 2020. 2. Reveille, John D. “Soft-Tissue Rheumatism: Diagnosis and Treatment.” The American Journal of Medicine, vol. 102, no. 1, Jan. 1997, pp. 23S-29S, 10.1016/s0002-9343(97)00413-0. Accessed 24 Aug. 2020. 3. Zhang, Lijuan, et al. “Synergistic Anti-Inflammatory Effects and Mechanisms of Combined Phytochemicals.” The Journal of Nutritional Biochemistry, vol. 69, July 2019, pp. 19–30, 10.1016/j.jnutbio.2019.03.009. Accessed 24 Aug. 2020. 4. Scheiman, James M. “NSAIDS, GASTROINTESTINAL INJURY, AND CYTOPROTECTION.” Gastroenterology Clinics of North America, vol. 25, no. 2, June 1996, pp. 279–298, 10.1016/s0889-8553(05)70247-8. Accessed 27 Dec. 2019. 5. Brandt, Kenneth D., and Marshall J. Palmoski. “Effects of Salicylates and Other Non-steroidal Anti-Inflammatory Drugs on Articular Cartilage.” The American Journal of Medicine, vol. 77, no. 1, July 1984, pp. 65–69, 10.1016/s0002-9343(84)80021-2. Accessed 26 Aug. 2020. 6. Chainani-Wu, Nita. “Safety and Anti-Inflammatory Activity of Curcumin: A Component of Tumeric (Curcuma Longa).” The Journal of Alternative and Complementary Medicine, vol. 9, no. 1, Feb. 2003, pp. 161–168, 10.1089/107555303321223035. Accessed 20 June 2019. 7. Patel, Kamal. “Curcumin UPDATE for 2019: Benefits, Dosage, Side Effects.” Examine.Com, Examine.com, 5 Feb. 2015, examine.com/supplements/curcumin/. Accessed 1 Mar. 2019. 8. Siddiqui, MZ. “Boswellia Serrata, A Potential Anti-inflammatory Agent: An Overview.” Indian J Pharm Sci, vol. 73, no. 3, 2011, pp. 255–261. 9. Thawani, V, et al. “Open, Randomised, Controlled Clinical Trial of Boswellia Serrata Extract as Compared to Valdecoxib in Osteoarthritis of Knee.” Indian Journal of Pharmacology, vol. 39, no. 1, 2007, p. 27, 10.4103/0253-7613.30759. Accessed 17 Mar. 2020. 10. Riva, A, et al. “A Novel Boswellic Acids Delivery Form (Casperome®) in the Management of Musculoskeletal Disorders: A Review.” European Review for Medical and Pharmacological Sciences, vol. 21, 2017, pp. 5258–5263. 11. McGregor, Gerard, et al. “Devil’s Claw (Harpagophytum Procumbens): An AntiInflammatory Herb with Therapeutic Potential.” Phytochemistry Reviews, vol. 4, no. 1, Jan. 2005, pp. 47–53, 10.1007/s11101-004-2374-8. Accessed 2 Sept. 2019. 12. Bartram, Thomas. Encyclopaedia of Herbal Medicine. First ed., Dorset, Grace Publishers, 2007. 13. Fazal, Syed Sufiyan. “Review on the Pharmacognostical & Pharmacological Characterization of Apium Graveolens Linn.” Indo Global Journal of Pharmaceutical Sciences, vol. 2, no. 1, 2012, pp. 36–42. 14. Light, Marylin. “Chemical Constituent of Burdock.” Www.Herballegacy.Com, 2020, www.herballegacy. com/Light _ Chemical.html#:~:text=Chemical%20Constituent%20of%20Burdock&text= 15. Maghsoumi-Norouzabad, Leila, et al. “Effects OfArctium LappaL. (Burdock) Root Tea on Inflammatory Status and Oxidative Stress in Patients with Knee Osteoarthritis.” International Journal of Rheumatic Diseases, vol. 19, no. 3, 28 Oct. 2014, pp. 255–261, 10.1111/1756-185x.12477. Accessed 29 June 2020.

Giacomo Sandri graduated in Herbal Medicine (BSc Hons) at the University of Lincoln in 2017, and attained a diploma in Holistic massage at the Bristol College of Massage and Bodywork in 2018. He holds certificates in Facial Acupressure, Complete Manual Therapy and FREC3 First Aid. He is also a member of the National Institute of Medical Herbalist (NIMH) and Massage Training Institute (MTI). In 2019, he coined the term Naturopathic Massage Therapy, a discipline which combines herbal medicine, nutrition and bodywork to provide a clearer understanding and a tailored deeper treatment to individual suffering from musculoskeletal and neurological disorders. Giacomo currently practices as a herbalist and massage therapist in Bristol under the business name of Blue Ginkgo offering consultations at the Easton Business Centre and online.

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Using Visualisation to Enhance Dynamic Touch By Kate Browne

Exploring Visualisation Many movement-based art forms, from dance to Tai Chi, Kung Fu to yoga, are inspired by elements of the natural world. From animal movements to the flight of birds, trees swaying, grasses rippling, or wind on the water. Not only do the physical movements reflect the environment, but they also spiritually connect the practitioner to the art form more closely. It’s a technique that massage, as another uniquely movement-based practice, can make good use of. In this article, I’ll be sharing with you some of the personal visualisation imagery that I use. These visualisation techniques have enhanced both my quality of touch and bodyintegrated movement. They feel intuitive; they ‘ground me’ and foster a deeper connection between myself and my client. Let’s start at the beginning with the technique of grounding.

Ground Yourself I encourage you to practice some kind of grounding exercise before every massage treatment and make it part of your routine. This can be as easy as taking a few deep breaths or softening your knees and relaxing your stance. It can be helpful to do a quick ‘body scan’ to ensure your spine is aligned vertically, your weight is centred, and your knees, shoulders, arms and wrists are relaxed. As you breathe in and out, visualise the earth’s energy grounding you through your feet and root chakra, whilst the energy above draws you up through the crown of your head, like a puppet string. Think long through the back and take this moment to check in with yourself. Engaging with your own breathing is a really important stage in using visualisation in massage. It will help you feel better connected to yourself and enable you to move in a way that feels more fluent. It’s also a good time to ask your client to take some long, deep breaths. This will help the transition from consultation chatter to treatment and will give you the opportunity to complete your own grounding. 20

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First Contact – The Ripple Effect Now that you’re feeling grounded and your client has taken some deep breaths, it’s time to make first contact. This is one of my favourite moments in a massage, but I feel as though it’s one that is often overlooked or rushed. Your client, if seeing you for the first time, may also feel apprehensive, so this is a great opportunity to put them at ease and let them know that they are in good hands. You may like to close your eyes for this exercise to focus your attention inward. From your grounded state, standing to the side of your client, take a slow, deep breath in and lift your hands, ready to place them on the body. Your hands should feel relaxed, leading with the tops of your wrists. Now visualise the body as a pool of still water. As you exhale, allow your relaxed hands to float down onto the body as though they are weightless. As your hands make first contact, imagine them making contact with the water, sending ripples radiating across the surface. These gentle ripples travel the length of the whole body, down the spine, along the

therapistinsight using visualisation

Build the Rhythm This next visualisation is inspired by the ebb and flow of tides along the seashore. It has the added benefit of helping those who feel a little stiff in their lower body when massaging. It encourages you to loosen your legs and lower limbs so that you can integrate your whole body into the massage. Again, take a moment to centre yourself. Imagine a beach with the sea rushing up onto the shore. Observe how the water glides across the sand, lightly skimming the shoreline. As it reaches the highwater mark, the wave loses momentum; suspended for a moment; before falling away and being drawn back into the sea.

arms and legs, through the fingertips and toes, up through the crown of the head, conveying a calm and restful energy.

What do you see in your ‘mind’s eye?’ Firstly, the steady, fluid momentum as the water dashes up the shore. Secondly, a fermata - the ‘pause’ as the water is suspended for a moment upon the sand. And thirdly, the ebbing away of the water as it’s dragged back into the ocean. Imagine this scene for a few moments, focusing on the rhythm of the waves and the different behaviours of the water.

Engaging with your own breathing is a really important stage in using visualisation in massage.

When you’re ready, coordinate your own breathing rhythm with the visualisation. As the water rushes towards the shore, inhale. Hold your breath for a moment as the water reaches the high tide line, then exhale as the water is drawn back into the sea. Now transfer this to your touch. For me, this visualisation is particularly effective – and beautiful, when used in conjunction with long, flowing effleurage. Let’s take the backs of the legs as an

With your hands now in contact, ask your client to take several deep breaths. As they do, synchronise your breathing with theirs. As they breathe in, allow your hands to ‘float’ for a moment. As they breathe out, do the same, this time allowing your knees to soften and hands to ‘drop.’ With every breath, you send more ‘ripples’ throughout the body. Repeat this for a few breath cycles, allowing the pressure in your hands to rise and fall with the rhythm of their breathing. I find the imagery of ripples particularly powerful, since it makes a connection with the whole body, right from that first moment of contact. Although this exercise is very simple in essence, the beauty comes in the way that it’s delivered and the sensitivity of your touch. As you practice this, you may find that you’re able to tune into their energy field and pick up information that might be relevant to the treatment later on. Issue 110 2020

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example. Begin by grounding yourself, making sure that your knees, shoulders, elbows and hands are relaxed. Ensure that you have a staggered stance and have applied enough oil to enable long gliding strokes. You may like to introduce your touch using the first exercise. Let your knees gently bend and slowly transfer your weight to your leading leg. As you do this, inhale and glide your hands upwards along the client’s leg. Visualise the water as it rushes up the shore and let this feeling transfer into your touch. As you reach the top of their leg, you should be finishing your inhalation. Your momentum will naturally slow. Think of the wave suspended upon the shoreline and see if you can feel that moment, that pause, with your whole body.

areas that you want to come back to later. You should find that your relaxed hands will pick up more information if they are softer. Keep your body soft, and you’ll be able to feel more.

A Powerful Tool in the Right Hands Being led by a feeling or idea can free your touch so that you’re not bound by a technique or specific stroke. Visualisations are just one way of enhancing the dynamics of your touch. I’ve shared my personal imagery, but I encourage you to give it a try and see what you come up with. It can add a new dimension to your practice.

Amazing things can happen when you give yourself a creative space to explore!

And Release As you exhale, let your weight transfer, through your knees, to your back foot whilst drawing your hands back down the leg to your centre, ready to repeat. It should be one rhythmic, fluent motion, uniting the rhythm of the wave, your breathing and the movement of your hands. Imagine the gravitational power of the ocean in this stroke, as it pulls the water back into the sea. The visualisation will make your touch more dynamic and powerful. As you repeat this sequence, you’ll start to develop a natural rhythm, just like that of the tide. Let your legs lead the movement, and your body will follow. You can experiment with the pressure and speed, allowing your hands to explore the landscape of the body, detecting any

Kate began her therapy journey in 2014, training in Holistic Massage at the Bristol College of Massage and Bodyworks. Eager to expand her understanding, Kate returned two years later to complete her level 5 Remedial and Sports Massage Diploma. Her interest in anatomy and passion for delivering a higher standard of massage has always been at the forefront of her work. In 2019, Kate gained recognition after she entered the National Massage Championship in London and took first place in her category of Advanced Massage Therapy. She also went on to win the overall competition and was awarded the Judges Choice Excellence Award. Kate was due to compete in the 2020 World and European Championships which will now likely take place next year. www.cotswoldmobilemassage.com

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Rethinking Hands-on Therapy The FHT puts a spotlight on some therapeutic approaches to support clients’ health and wellbeing that may help to reduce the risk of COVID-19 transmission

s therapists, we all understand the benefits of positive touch. However, one thing COVID-19 has brought home to many of us is the need to find alternative approaches to support health and wellbeing when hands-on therapies are sadly not an option.

Dr Peter Mackereth, a qualified nurse and former complementary therapy lead at The Christie, Manchester, told the FHT, ‘Now, more than ever, we need to communicate and collaborate with other complementary therapists in exploring new ways to learn, adapt and grow from this pandemic. As we contemplate booking in clients or going back to providing volunteer or paid services in hospices and healthcare settings, how do we manage our risk and bring comfort to others? Perhaps we need to look at our toolbox and think creatively; some options include using gentle touch over textures, investing in the therapeutic use of the voice, and teaching self-soothing 24

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techniques to our clients and their partners/family members.’ Needless to say, as therapists we will need to continue following government guidelines and be particularly cautious before treating anyone while COVID-19 is still in general circulation. Among other things, we will need to continue screening the health status and vulnerability of both ourselves and our clients, follow enhanced hygiene measures, and wear appropriate personal protective equipment. Below we take a look at some therapeutic approaches that can also help to reduce the risk of transmission, both now and in the future, should COVID-19 peak again or we are faced with another health crises that forces us to rethink the way work. Of course, there will be lots of other therapies and techniques that would be worthy of a mention, that we unfortunately didn’t have the space to include. Please bear in mind that the purpose of this article is to simply encourage you to think about

covidmatters rethinking hands-on therapy

how you might adapt your toolkit so that you can continue supporting others and earn an income if a more ‘hands-off’ approach is needed.

flower remedies, nutritional therapy and even aromatherapy and skincare, for which tailored products could then be posted out or safely collected from a drop-off point.

Exercise, movement and mindfulness

And of course, once it is safe to carry out ‘in person’ treatment, and particularly indoors, none of these modalities involve working in close proximity to the client, which means social distancing measures can be maintained throughout the entire session.

It was interesting to note that as the various countries started to ease their way out of lockdown, business activities that could be conducted outside (where the risk of transmission is lower) and without the need for physical contact (to ensure social distancing was possible) were among the first to get the ‘green light’. This included modalities such as personal training, sports coaching, aerobics, kettle bell training, Nordic walking, yoga, tai chi, mindfulness and meditation.

It’s good to talk Talking therapies, such as counselling and cognitive behavioural therapy (CBT), were able to continue throughout the lockdown period, when provided over the phone or via a video communication platform, such as Zoom, Skype or Facetime. Similarly, members have been able to provide remote consultations for therapies such as homeopathy,

…we will need to continue following government guidelines and be particularly cautious before treating anyone…

Optimal positioning With viruses such as COVID-19, the risk of transmission is higher when in close proximity to an infected person, and particularly when face to face. This is because the virus is primarily spread from person to person through droplets that come from the nose or mouth of someone infected, usually when they cough, sneeze or speak. A number of close contact therapies can be conducted further away from the face, which will carry a slightly lower risk of infection. These might include reflexology, pedicures and other foot treatments. Similarly, treatments that involve the therapist working from behind the client will carry a slightly lower risk, such as

back massage, seated acupressure and Indian head massage.

Working through textiles Some therapies can be conducted through clothing or other textiles, which means having limited or no direct contact with the client’s skin. These might include shiatsu, seated acupressure and Indian head massage. Those working in a hospice or hospital environment may also be familiar with the HEARTS Process Issue 110 2020

covidmatters rethinking hands-on therapy

developed by Ann Carter, which is a gentle, sensory experience that draws on hands-on contact (which can be done through clothing, sheet or blanket), empathy, aromas, relaxation, textures and sound.

Energy and being present Reiki and healing are very gentle treatments that can also be done through textiles, by holding the hands a short distance away from the client, or even remotely. Sometimes, simply placing your hands on a client’s back, arm or feet and maintaining a ‘holding position’ can be incredibly therapeutic and comforting. This can be combined with a guided visualisation, to help calm the body and mind.

Reducing treatment times Throughout COVID-19, the scientific advisors have made it clear that the nearer you are to a person and the longer you are in close proximity to them, the higher the risk of transmission. Government guidance for those providing close contact services therapies in England also state, ‘Businesses should consider providing shorter, more basic treatments to keep the time to a minimum’ and ‘Where extended treatments are undertaken, such as […] massages, consider how the length of the appointment could be minimised.’

Whether you are looking to train in person when hands-on training resumes or online, before you book on a course, please check that it will be accepted by your professional association for membership and insurance purposes. This article first appeared in the Summer (July 2020) issue of International Therapist, the membership magazine of the Federation of Holistic Therapists. Founded in 1962, the FHT is the UK’s leading professional association for complementary, holistic beauty and sports therapists, and runs the largest Accredited Register of complementary therapists, as part of a government-backed programme, overseen by the Professional Standards Authority for Health and Social Care. For more information or to find out the many benefits of being an FHT member, visit www.fht.org.uk

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Welcome to

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

advancedcpdadvancedcpda Clinical and Orthopaedic Assessment for Massage Therapists Assessment is often poorly taught to massage therapists and as a result many of us end up terrified of treating pain conditions. Is the tingling down our client’s hand and arm a result of a nerve compressed by soft tissue (well within our scope of treatment) or something more serious? Is our client’s bad back a muscular problem or should they be referred back to their GP? Precise and targeted clinical assessment should be a vital tool in any therapist’s toolbox and will not only gain you better outcomes but increase your professional standing with the medical profession, physios, chiropractors and osteopaths. Knowing when to refer to these other professionals or when a condition is best treated by yourself is a key component to making our profession more professional. What is Orthopedic Assessment? “ An assessment is an educated evaluation of a clients condition and physical basis for his/her symptoms in order to determine a course of treatment”(Clinical Massage Therapy: Rattray and Ludwig) “ A judgement about something based on an understanding of the situation” (Encarta world English dictionary”)

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Assessment, Diagnosis and working within your scope of practice It is firstly important to understand the difference between assessment and diagnosis with respect to your role and scope of practice as a massage therapist. Massage therapists use the word assessment when evaluating the nature of a condition. This is not a diagnosis which is a term used by the medical profession. It is the difference between investigating the nature of a condition (assessment) and naming that a certain condition is present (diagnosis)

GPS have a much wider scope of knowledge and potential sources of pain – for example, tingling down the legs could be result of a tumour pressing on the spine. However if other causes of pain have been ruled out by the GP, your consultation and assessment can focus on whether the condition is being caused by soft tissue issues, emotional stress or other factors that lie within your scope of practice. For example if other causes have been ruled out the tingling down the legs could be result of the sciatic nerve being compressed by the piriformis which is easily treatable through massage therapy

dadvancedcpdadvancedcpd Why do an assessment Quite simply, a good assessment enables us to plan effective treatments that achieve the goals or outcomes that the client desires. From a business point of view, achieving good outcomes leads to satisfied customers, which leads to a thriving and interesting practice. Doing an assessment enables you to be the equivalent of a massage Sherlock Holmes, picking up clues from your client in various different ways to help you figure out what is going on and how you can best help. A good assessment enables you to see whether your treatment is working and gives you measurable benchmarks so both you and your client are able to assess progress.

HOPRS Clinical assessment for massage therapists is usually divided into 5 components, which you can remember, by the acronym “HOPRS”: • H - Health history questions (usually known as your case history or medical intake) • O - Observations (i.e.: of posture) • P - Palpation (of soft tissues including muscles and fascia) • R - Range of motion testing (of movements at joints) • S - Special Orthopaedic Tests (specific tests that help us to identify problems more precisely) Your skill set may also mean that you carry out other forms of assessment to help determine the nature of the problem- for example the local or general listening techniques used in visceral manipulation; arcing used in cranial work or scanning the chakras for imbalances. Depending on your skill, knowledge and scope of practice you may focus more on some areas of the above than others. However whether you are doing relaxation massage, sports massage, energy work or pregnancy massage, some form of assessment is vital. You always need to know why your client has come to you, what they are expecting from the treatment and a baseline for any changes you make.

Health History “A good listener is not only popular everywhere, but after a while he knows something” (Wilson Mizner) Taking a case history is often the first real contact you have with your client. This is the point where you can really start to hear your client’s story, make a connection with them as a human being, and start your detective journey gathering clues as to their physical, emotional and spiritual make up. It is also the point where your client will start to make judgements about you; your level of skills and professionalism, and ultimately whether they will come back to you. Taking time to do a thorough case history is an investment not only in your client’s welfare but your business. Your job at this point is to draw out the information that you need to make an assessment of your clients needs and, most importantly, what outcome they would like to see from this treatment or series of treatments. It is your job as a professional to figure out how you can achieve this outcome and realistically how many sessions this may take. A great simple question to ask is “How would you like to feel after the treatment”. This focuses the client onto their expectations- if they don’t know what they want from the treatment, it will be very difficult for you to meet their needs. Once you get an answer, try and narrow this down even further.

For example, your client may say they just wish to “relax”. This may seem like a simple goal but the more precise you can be, the better you will be able to achieve your outcome. Through careful questioning and listening, try to ascertain what relaxation feels like for the client- a useful question to ask is “How will that feel in your body that is different from now”. This more precise questioning will often get to the nub of what is needed – for example your client may then say, “ my shoulders will feel looser”. Great! Now you have something concrete you can do – any wonderful techniques you know to release shoulders (trigger point work, general Swedish techniques, hot stone work, stretching, range of motion). You also have a measurable outcome that you can refer back to at the end of the session; afterwards you can ask your client “how do your shoulders feel now”. If the answer is “looser” you both know you have done a good job! If your client is presenting with some kind of pain problem you will need to focus in further with your questioning to give you the information you need to treat effectively. Use the mnemonic OPQRS to help: O Origin of the pain. When did the pain begin? Was there a precipitating factor – accident, fall, emotional trauma? P Provocation: Does anything make the pain worse? i.e.: cold, Issue 110 2020

advancedcpdadvancedcpda movement, getting stressed. Conversely does anything make the pain better? Ie: warm bath, moving around etc. Q Quality of the pain. This can help you identify the source of the problem. Nerve pain tends to be tingling or electric. Chronic soft tissue pain can be dull and achy whereas more recent acute muscle pain can be sharp and stabbing. Pain of a muscular origin is often aggravated or relieved by movement. Beware of pain that is deep and unrelenting, even in sleep, and make sure that other causes have been ruled out. This type of pain can often be a sign of a more organic problem such as a tumour. R Radiate: Does the pain stay in one place or does it radiate to different parts of the body? S Site: Where is the pain exactly? Get your client to point to it. It can also be helpful to have a picture of a body on your case history form where the client can draw in the areas of pain.

Observation This part of the assessment process begins the minute you see your client. How do they walk, take their coat off, are they easy in their body or are there areas of apparent restriction? How do they seem emotionally – do they have a good vital energy or do they seem tired and low? The more you use your powers of observation, the more you are able to develop this sense to your advantage. Ida Rolf, the founder of Rolfing, famously was able to assess the exact location of a lumbar herniation of an unknown client walking through the door in a heavy overcoat. It is also useful to carry out a more structured process of body reading- the exact way you do this often depends on your training or particular bodywork discipline. Physios, osteopaths and other bodyworkers will often observe the body in a systematic fashion – noting for example, relative heights of the shoulders, tilts to the pelvis, rotations of the legs etc. This gives us clues as to what areas of soft tissue may be tight or restricted. For example a laterally rotated leg could indicate a tight piriformis muscle that may be the cause of a client’s sciatica by entrapping the sciatic nerve. A quick way of assessing visually is simply to look at your client while they are 30

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standing and notice any gross, observable differences between the 2 sides of the body (left to right and front to back) Which areas seem tight or drawn together? These may well be areas you need to work to free up muscular or fascial adhesions.

Of course our palpation skills need not be limited to muscle and fascia- a skilled therapist will learn to appreciate subtle movements such as the cranial or visceral rhythm or subtle energies such as the chakras and the meridians. This is what makes massage so magical!

Palpation

Range of motion and Special Orthopaedic Testing

“Palpation cannot be learned by reading or listening; it can only be learned by palpation” (Frymann 1962) “There are no limits to sensitivity” Jean Pierre Barral Palpation is truly one of the most wonderful tools in our repertoire and is a skill that we develop constantly in our work. There are no limits to palpation as an assessment tool - as we develop our sensitivity as bodyworkers, we find that we are able to feel more and more subtle differences in tissues and energy fields. Developing palpation skills relies on you touching the body with intent and focus; Neuman (1989) states “ The three most common errors made while palpating to assess tissue are: • Lack of concentration on what is being touched • Too much movement of the palpating fingers • Using excessive pressure” If you are focussing on soft tissue, the information gathered from palpation can be organised into 4 categories – the 4 “T’s” of palpation: Temperature: Tissue may be hot, indicating inflammation, or cool, indicating ischemia. Texture: Healthy tissue has an even texture throughout. Adhesions feel as if the muscle is stuck together. Trigger points can feel like a small pea or as big as an olive. Tenderness: Pain can be indicated if the client winces with compression Tone: Tissues can be hypertonic (increase in tone relative to nearby muscles) or hypotonic (decrease in tone)

These can be subdivided into: • Active range of motion test: These focus on the contractile tissues i.e.: the muscle tendon unit. • Passive Range of Motion test: These focus on the inert tissues i.e.: ligaments or the joint capsule • Manual Resistive Tests: These assess contractile tissue for pain and weakness with muscle, tendon or peripheral nerve injury. • Special Regional Orthopaedic Tests: These are used to isolate a specific condition.

Eastern Methods of Assessment I have also found it useful to bring in ideas from other approaches to inform the assessment process. Traditional Chinese medicine (TCM) has an extremely thorough assessment process based on the following 4 traditional areas: 1. Looking: appearance; facial colour; tongue diagnosis 2. Listening and smelling: voice and respiration 3. Asking: The practitioner will do a thorough case history including preference for hot and cold (relates to TCM principles of Yin and Yang); headaches; pain; urine; thirst; sleep; family history 4. Touching: The practitioner will assess through taking the pulse (there are hundreds of different pulse qualities in TCM representing different states – for example a shallow and weak pulse indicates deficiency of qi (life force)

dadvancedcpdadvancedcpd

Bringing it all together When you have gathered all your information from the various aspects of your assessment process you are in a position to make an informed judgement about a treatment plan. Make sure you have really listened to your client, not just with your ears but your informed touch and that your assessment is not based on snap judgements. Be prepared to modify your treatment plan as you go along depending on what you find with further exploration of the tissues and how your client responds. Bringing assessment skills into your work will enhance your practice tremendously; try some ideas out bearing in mind the words of Socrates: “ Four things belong to a judge, to hear courteously, to answer wisely, to consider soberly and to decide impartially.”

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

TREATMENT TABLE SANITARY PROTECTIVE BARRIER (Fitted & Washable) Massage Warehouse With our new hygiene guidelines in place, Massage Warehouse have come up with a sanitary protective barrier for your treatment table that can be disinfected after each treatment which prevents you having to use harsh chemical or alcohol based cleaners directly on your treatment table. These cleaners can damage and deteriorate the table upholstery over time.

FEATURES:

The protective cover offers the perfect solution to maintain a sanitary protective barrier between your treatment table and everything that is going on above it!

• Waterproof

• Moisture barrier

• Wipeable and disinfect-able The cover is elasticated to fit around and underneath the edges of your table and is made of Polyurethane Laminate (PUL). PUL is water resistant and acts as a moisture barrier preventing materials from getting through to the table, avoiding cross-contamination.

• Machine washable up to 70 degrees • No noise from material

Available in a ‘with’ and ‘without’ breath hole option and the with breath hole option also extends downwards inside the breath hole so the entire table is covered and protected which you can see in the photo. A separate face cushion cover is also available so no matter what your table type, Massage Warehouse has you covered!!

• Protects massage table so you do not have to disinfect the table and risk ruining the massage table upholstery over time • Protect non-washables such as fleece pads and table warmers which cannot be washed. They fit securely and neatly under the sanitary cover and do not come into contact with anyone. • Very lightweight for carrying to mobile treatments • Hypoallergenic • Colour: White

massagewarehouse.co.uk

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bookreviews

Talia Stiles

Everything Moves: How Biotensegrity Informs Human Movement Susan Lowell de Solórzano MA Susan Lowell de Solórzano MA is a Level 3 T’ai Chi instructor (American T’ai Chi & Qi Gong Association); certified FlexAware teacher. Assistant to Dr. Steven M Levin; Founder and Head Organizer DC BIG (Washington DC Biotensegrity Interest Group) Susan Lowell’s fascinating new book Everything Moves looks at he emerging science of biotensegrity and provides a fresh context for rethinking our understanding of human movement but its complexities can be formidable. In Everything Moves the author shares her understanding of biotensegrity as developed over years of direct study with the concept’s originator, Stephen M Levin MD. The book includes contributions from movement professionals from different philosophies, including T’ai Chi, Yoga, Pilates, Craniosacral therapy, Alexander Technique, massage therapy and others. Each expert considers how biotensegrity applies to their work. It also includes exercises and activities to facilitate sub-verbal, experiential access to the concepts. It seeks to make biotensegrity accessible to a variety of movement and bodywork professionals through experiential activities and exercises.

handspringpublishing.com

The Vital Nerves: A Practical Guide for Physical Therapists John Gibbons

The Vital Nerves is a comprehensive, must-have roadmap to the functional anatomy of the nervous system. Enriched with anatomical drawings and detailed explanations, it explains neurological testing, common neuropathies, and differential diagnoses, and is an indispensable resource for physical therapists and bodyworkers. Osteopath, lecturer and author John Gibbons offers an accessible introduction to the peripheral nervous system (PNS). Alongside real case studies and guidelines for hands-on work with clients and patients, The Vital Nerves demystifies and makes accessible everything from how to diagnose nerve conditions to understanding how our cells communicate. Gibbons provides critical insights into the structure and functions of the PNS; the body’s response to stimuli and how it knows what to do; the sympathetic and parasympathetic nervous systems; understanding the stress response; and how reflex testing can aid in diagnosing conditions like Multiple Sclerosis, Parkinson’s Disease, and paresthesias. The Vital Nerves addresses practical, common considerations like how to: • Assess the nervous system using a patella (reflex) hammer, myotome (muscle) testing and dermatome (sensory) testing • Determine whether pain in the posterior part of the thigh is caused by the sciatic nerve, piriformis or simply a hamstring strain • Decide at what level a disc may have herniated • Differentiate between upper and lower motor neurone disorders • Know what to do with the findings of your neurological assessment and the circumstances under which to refer patients for more specialist care.

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Fascial Membranes By James Earles

Each and every part of the body is wrapped within the fibrous fascial web of connective tissue, which consists predominantly of collagen, elastin, and ground substance (a gel-like fluid consisting of water along with various sugars and proteins). The fascia holds every single part of our body together and it provides us with protection, both mechanical and chemical—the fascia forms a physical barrier, and the fluid within the fascia contains many lymphocytes. The fibrous elements allow the transfer of force (created either by muscle contractions or by external forces), but they do so with an element of elasticity, which gives us the “spring in our step.” This pliability is enhanced through the engagement of longer lines of tissue.

Force is most often considered in terms of straight lines, along muscle fibers and out into tendons and ligaments. This bias is inherent within most anatomy presentations, but it is a misunderstanding, as we need a further appreciation of fascial aponeuroses. Many of the fascial wrapping sheaths in the body are extensions of muscular tissue. These often play an important role in dispersing force by acting as “hydraulic amplifiers” (Gracovetsky 2008; DeRosa and Porterfield, in Vleeming et al. 2007). To understand a “hydraulic amplifier,” imagine the example of a balloon. The tension of the outer rubber membrane and the compression of the air inside it create a circumferential “stiffening” dynamic within the structure. If the balloon is not fully inflated, however, there will be little tension created on the outside. The balloon will be less resilient and will mold itself to the surface it is resting on, rather than being independently buoyant on it. Conversely, if the balloon is overinflated, the elastic will fatigue and lose its ability to adapt to the tension—eventually, it will burst. In the fascia, the body’s encasing material, similar events can occur.

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This has been studied primarily in the thoracolumbar and thigh areas, where the muscles of the pelvis and the lower back are dealing with high stress loads in various vectors of force and at different anatomical depths (see fig. 1.24). In cross section, we can see the continuity of the posterior and middle layers of the thoracolumbar fascia wrapping around the muscles—stabilizing, supporting, or moving the lower back. Figure 1.24. In walking, the thoracolumbar fascia will be tensioned by the contralateral contraction of the gluteus maximus and latissimus dorsi. This creates tension in the supporting fascia around the lower back muscles, which in turn “pump up” the fascia by pushing out against it when they contract to support the spine (A). This creates a force-dispersal system and is a mechanism used in various parts of the body, including the thigh (B). The enveloping fascia of the thigh, the fascia lata, is tensioned by the appropriately named tensor fasciae latae (TFL) and by the gluteus maximus. Both of those muscles are, in fact, encased within that layer of fascial tissue. This inward force is then met by the outward expansion of the underlying muscles, which will be contracting to support the knee and hip. The contralateral pattern of walking creates tensioning across the diagonal line of the gluteus maximus to the opposite latissimus dorsi muscles via the thoracolumbar fascia (TLF, Willard et al. 2012). The fascial sheet of the TLF and its deeper connections will therefore be tensioned, like the skin of a balloon, and this “shrink wrapping” force will meet the expansion of the muscles within it, creating a taut “balloon” capable of easy force transfer and recoil. It is estimated that this form of hydraulic amplifier can increase the efficiency of muscle contractions by up to 30 percent, though if the fascial sheets are challenged, as in a fasciotomy (the cutting of the fascia to relieve underlying pressure), efficiency can be decreased by 10 to 16 percent (Parker and Briggs 2007).

Figure 1.25. The very fluid areolar tissue contains collagen and elastin fibers, like fascia, but within a much higher concentration of ground substance. This compliant tissue connects fascial layers and facilitates movement by adapting its orientation to the vector of forces involved. (Reproduced with the kind permission of Dr. J. C. Guimberteau and Endovivo Productions.) All of these myofascial layers, while separate in terms of depth and the forces they carry, are connected to one another by a different kind of fluid-rich fascial tissue, known as areolar or loose connective tissue (fig. 1.25); it provides the lubrication within the system that enables each plane to glide on its neighbor. This tissue, however, is prone to changes in local hydration, creating adhesions which inhibit the relative movement between the different planes. 36

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Figure 1.24

Figure 1.25

James Earls is a writer, lecturer and bodyworker specialising in Myofascial Release and Structural Integration. James trained with and taught for Tom Myers, the originator of the Anatomy Trains model. James also studied movement principles with Gary Gray and David Tiberio of the Gray Institute. To further explore comparative anatomy, James is a patron of both the Zoological Society of London and the Natural History museum. He has published numerous articles and released two books - Fascial Release for Structural Balance and, more recently, ‘Born to Walk’, an exploration of myofasciae and its relation to movement. E: jearls35@yahoo.com

Cross hand release lateral lumbar

The Role of Fascia in Pain By Ruth Duncan

Why is there so much discussion about fascia and pain and how can we as therapists use this information to treat pain? Fascia has been described as the largest sensory system in the human body because it touches all other body structures (1). It is now estimated that the fascial tissues have 250 million sensory nerve endings. That’s 50 million more nerve endings than the skin and over 120 million more than the eye (2). Sensory nerve endings, called receptors, are all over your body and convey messages from your senses via your nervous system to the brain for processing. Sensory reception comes from your visual, auditory, olfaction and gustatory systems as well as the sense of touch. It was previously thought that the skin was the largest touch sensory organ, having a variety of sensory receptors able to discriminate different types of touch. However, through research, knowledge of fascia’s own sensory innervation is providing a greater insight into body function and dysfunction.

It is estimated that 43% of fascial innervation is sensory (3) The sensory receptors in fascia respond to the following stimuli: • different types of touch, pressure and load mechanoreception • the position and movement of the body in space proprioception • different tissue temperatures - thermoreception • different chemicals in the tissues - chemoreception • the sense of potential or actual tissue damage (noxious stimuli) - nociception • the sense of self – interoception. One of the biggest areas of fascial research is the role which fascia plays in pain. The experience of pain Is attributed to specialised sensory nerves called nociceptors and fascial research has been trying to establish which fascial tissues contain these nociceptors and their quantity. However, the sense of touch and the experience of pain is not singularly dependant on the presence and suggested quantity of sensory Issue 110 2020

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Dorsal Horn

receptors including nociceptors in fascia. Instead however, research has focused on what factors causes these receptors to send action potentials to the brain. As we all know, certain body parts are more sensitive than others. For example your fingertips, face and ears are far more sensitive to touch than the side of your arm or your low back. Every sensory nerve, including nociceptors, have receptive fields which are discrete areas in the tissue from which receptors receive stimuli. The receptive fields in the fingertips are tiny compared to the larger receptive fields in the low back. This means that you can discriminate touch and injury with a higher refinement and sensory awareness in your fingers compared to your low back. If there are more receptive fields in your fingertips, why then is low back pain one of the most common conditions that we treat as manual therapists? The experience of pain is a result of a combination of factors including the chemicals, oxygen levels, blood supply and nutrients in the tissue environment, tissue tension and glide, correct functioning of the nervous system, age, gender, resilience and belief, as well as psychological stress levels. Traditionally, back pain was thought to be the result of issues with the vertebrae, intervertebral discs, the facet joints, nerve compression and with the ligaments. However, over the last few years fascial research has offered a very plausible explanation for 38

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Erector spinae MFR technique

unresolved, and often chronic, low back pain originating from the lumbar fascia, in particular the thoracolumbar fascia (TLF). Research has shown that the dorsal horn of the spinal cord receives afferent nociceptive information from the TLF transmitting it to the brain for processing (4). This means that the TLF nociceptors detects actual or potential tissue damage which could be the source of chronic low back pain. The TLF, sometimes called the lumbodorsal fascia, spans a huge body area and assists with load transfer between the spine, pelvis, legs and the arms. Crucially, the TLF spans the sacroiliac joints, a common area of pain. It also travels as far down as the sacrotuberous ligament, which itself fuses with the biceps femoris fascia of the posterior thigh, and as high up the trunk so that it connects with the fascia of the trapezius and latissimus dorsi muscles. It also reaches as high as the nuchal ligament at the occiput.

The TLF fuses with the fascia connecting with and surrounding the following muscles: • Gluteus maximus and medius and their connections with the fascia lata • Latissimus dorsi • Trapezius • Erector spinae • External and internal obliques • Serratus posterior inferior(5) and (6).

Any dysfunction of the TLF can therefore directly affect the function of these muscles with which it connects and their associated joint range of motion. Additionally, dysfunction or injury in one of the these muscles could transmit an imbalance of load via the TLF to other body areas with which it connects. This is a common scenario between the hip and contralateral shoulder (7). However, let’s go back to the experience of pain. The majority of TLF lies superficial to the erector spinae muscles but has deeper fibres which attach to the spinal ligaments, iliac crest and to the posterior superior iliac spines. It is considered part of the deep fascia lying below the fascia superficialis. The TLF has many different fibre directions connecting the trunk with the pelvis and legs, and with the upper body directing the transfer of load both longitudinally and contralaterally. A ground breaking study by Schilder et al. in 2013 (8) showed that the TLF was involved in the pain experience. Participants who already had a degree of low back pain were injected with hypertonic saline solution (salt solution), a nociceptive irritant, into their TLF, their erector spinae muscle and their fascia superficialis. The results showed that the participants experienced an increased and longer lasting pain from the injection into their TLF than to their erector spinae muscle and to their fascia superficialis of their low back. This study therefore showed that the TLF was

fasciapages the role of fascia in pain

Here are two valuable and effective techniques for your clinical practice. These are both taught in the MFR UK Certificate in Integrated Myofascial Therapy for the treatment of the thoracolumbar fascia. Myofascial Release for the erector spinae muscles – a myofascial mobilisation technique.

innervated with nociceptors responding to the hypertonic saline solution that had created a toxic tissue environment. This environment resulted in the nociceptors firing an action potential towards the dorsal horn in the spine, resulting in pain. Of all the sensory receptors in the fascia, it is estimated that 20% are myelinated mechanoreceptors specifically sensing proprioception by means of the muscle spindles and Golgi receptors, sending signals to the spinal cord via type I, Aα neurons. The Ruffini and Pacini receptors respond to both mechanoreception, touch pressure and load, and to proprioception transmitting that information via type II, Aβ neurons (9). The other 80% are called interstitial free nerve endings (FNEs) which are also wide dynamic range or polymodal neurons capable of sensing multiple different sensations. They are classified into the group III, or Aδ (A delta) thin myelinated neurons and group IV, or C unmyelinated neurons conveying mechanoreception, thermoreception, chemoreception, interoception and, more importantly, nociception to the spinal cord (9). The dorsal horn in the spinal cord has specific areas where the polymodal FNEs synapse. When these areas receive adequate stimuli from the FNEs, such as information regarding touch, proprioception, temperature and the chemical environment of the tissues, they deliver this information to the brain as normal function. However,

• Position your client seated on a stool or chair, their feet flat on the floor and their arms by their sides • Stand behind your client and position yourself in a lunge stance with one foot in front of the other • Loosely clench your fists and place the flat part of the backs of your fingers (proximal phalanges) onto the erector spinae musculature either side of the client’s spine at C7/T1 and lean gently and slowly into their tissue with an oblique pressure • Ask the client to slowly drop their chin to chest and to begin to roll and flex forward, not flexing at the hips but flexing their spine, vertebrae by vertebrae • The client should keep their arms at their sides and create a subtle counter pressure through their feet up their body to meet the pressure from your hands and your own body • It is important not to push the client forwards but to lean into them allowing your body weight to supply the technique • As the client rolls and flexes forward and down, allow your hands to slowly glide down their back either side of their spine • Don’t be tempted to force an inferior drag. Instead, allow the clients position to permit your movement over and through the tissues • Once you have reached their iliac crest, slowly remove your hands and ask the client to sit up. Repeat the process 2-3 times • This technique must be performed slowly and diligently to maintain control of the movement.

Myofascial Release for the lateral lumbar – a cross hand release • Position your client in a side-lying position with the area to be treated uppermost • Ask the client to lie in a slight diagonal position across your treatment table • Their top leg should lie in a straight line with their body and the lower leg can be flexed at the knee and hip • A pillow may be placed under the lateral waist to keep the lumbar neutral. If the client can tolerate it, place their top leg slightly behind them and off the treatment table to allow gravity to enhance the technique. • With crossed hands, contact the iliac crest with one hand and the lateral lower ribs with the other hand. • Allow your hands to sink slowly and gently down into the tissues until you meet resistance (barrier or end feel) • 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 • 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 • Go with the motion to the next barrier which may feel like a twist or shear • Continue to hold these 3 components for 3-5 minutes or longer • Always be subtle and sensitive with your hands and never force the barrier • Allow the tissue to reorganise when it is ready rather that making it change • Disengage from the tissues by gently reducing pressure and removing your hands. • Apply to both sides of their body. Issue 110 2020

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Also here is a self-myofascial release technique which forms part of the technique programme from the MFR UK new Self Myofascial Release Therapy (SMFRTherapy) online course. Self-Myofascial Release Therapy using a foam roll • Sit at the very end of the foam roll and slowly lie backwards onto it so that your head is resting at the other end • Keep your knees bent and your feet flat on the floor with a wide enough stance so that you are balanced on the foam roll • Allow your arms to drop onto the floor either side of you with the palms of your hands facing the ceiling, your arms should be in no more than 45 degrees of abduction • Take some deep breaths and every time you breathe out concentrate and soften your body paying particular attention to softening your low back so that it is resting on the foam roll • Imagine that your body can soften and melt over the foam roll • Concentrate and keep allowing your body to soften • Once this position becomes comfortable, slowly move your arms higher towards 90 degrees of abduction and wait for your body to soften • If there is any resistance or discomfort, lower your arms again • You should be able to maintain a comfortable position on the foam roll for approximately 8 minutes • Perform this self-myofascial technique slowly every day until you can comfortably place your arms at 90 degrees of abduction with your lower arms and hands resting on the floor.

SMFRTherapy Foam roll low back

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the dorsal horn is constantly greedy for sensory input. When there is insufficient proprioceptive or mechanoreceptive sensory input, from a sedentary lifestyle, age or immobilisation from an injury, it lowers the FNEs threshold responsiveness to nociception which actually increases nociceptive activity, resulting in pain (10). From the Schilder et al study, we know that fascia is highly innervated with sensory nerve receptors. A further study by Tesarz et al in 2011 (11) discusses the presence of sensory receptors in the TLF but they also found that the adjacent subcutaneous fascia (fascia superficialis) had sensory nerve receptors and in particular these tissues were highly innervated by FNEs, capable of responding to nociception. It is hypothesised that the reason that the TLF and the subcutaneous tissues are innervated by nociceptors is due to the global responsibility for functional movement and load distribution. In the study by Schilder et al., the participants in the study already had low back pain. Therefore the FNEs were already sending signals of nociception before the hypertonic saline solution was injected. Additionally, further investigations of the thickness of the participants’ TLF, compared to healthy subjects, showed that their TLF was thicker and more dense. When fascia becomes dense, or thicker, it loses its ability to permit glide between neighbouring structures and becomes adhered, limiting function. The densification of the TLF affects tissue blood flow, oxygen exchange (ischaemia and hypoxia) and nutrient delivery. As a result, the tissue become acidic with a decrease in blood pH levels (12). This densification compresses and damages the FNEs causing them to release a chemical called Substance P. at their tips which sensitises them to their environment (12). Tissue damage also causes the release of calcitonin gene-related peptide (CGRP) which also sensitises FNEs (12). The toxic tissue environment and sensitising chemicals, stimulate the FNEs to bombard the central nervous system with nociceptive signals, resulting in pain. Adding hypertonic saline solution to this already compromised tissue, increased pain intensity and duration. If the FNEs have defaulted to transmitting nociceptive input, they are not transmitting other sensory information such as proprioception, mechanoreception and

fasciapages the role of fascia in pain

interoception. The role of any therapeutic intervention then becomes far more clear. The environment of the FNEs needs to be addressed using manual therapy that will improve tissue glide, reducing tissue hypoxia and ischaemia. The entire TLF should be treated with myofascial approaches, varying techniques to include lighter touch to downregulate the pain experience, and with deeper slower techniques to address areas of fascial densification and dysfunction. Movement therapy such as Yoga, Feldenkrais and Pilates, as well as focused slow stretching, will also increase proprioception. Mindfulness, self-hypnosis and meditation will also increase interoception, taking the focus of the FNEs away from nociception. Since low back pain is often attributed to lack of mobility, sedentary lifestyle and habitual postural patterns, exercise therapy will also play a valuable role in rehabilitation. As you can see, extensive research on sensation and in particular the sensation of pain and the role which fascia plays, is presenting a greater insight into how we, as therapists, can effectively treat low back fascial dysfunction and restore pain free movement.

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 handson 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

References

1.Oschman, J. (2012) ‘Fascia as a body-wide communication system’ in Schleip, R., Findley, T.W., Chaitow, L., and Huijing, P. (eds) Fascia: The Tensional Network of the Human Body. Pennsylvania, Churchill Livingstone, p. 104. 2.Schleip, R. (2020) ‘Innervation of fascia’ in Lesondak, D. and Akey, A. (eds) Fascia, Function and Medical Applications, Boca Raton, CRC Press, p61. 3.Schleip, R. (2020) ‘Innervation of fascia’ in Lesondak, D. and Akey, A. (eds) Fascia, Function and Medical Applications, Boca Raton, CRC Press, p62. 4.Hoheisel, U., Taguchi, T., Treede, R. and Mense, S. (2011) ‘Nociceptive input from the rat thoracolumbar fascia to lumbar dorsal horn neurones’. Eur J Pain. 2011;15(8):810-815. [Online] doi:10.1016/j.ejpain.2011.01.007 (Accessed 31 August 2020). 5.Vleeming, A. (2012) ‘The thoracolumbar fascia’ in Schleip, R., Findley, T.W., Chaitow, L., and Huijing, P. (eds) Fascia: The Tensional Network of the Human Body. Pennsylvania, Churchill Livingstone, pp 36-40. 6.Casato, G., Stecco, C. and Busin, R. (2019) ‘Role of fascia in nonspecific low back pain’. Eur J Transl Myol. 2019;29(3):8330. [Online] doi:10.4081/ejtm.2019.8330 (Accessed 31 August 2020). 7.Lee, D. (2010) ‘The Pelvic Girdle’ (4th eds), Edinburgh, Churchill Livingston. 8.Schilder, A., Hoheisel, U., Magerl, W., Benrath, J., Klein, T. and Treede, R. (2013) ‘Sensory findings after stimulation of the thoracolumbar fascia with hypertonic saline suggest its contribution to low back pain’. Pain. 2014;155(2):222-231. [Online] doi:10.1016/j.pain.2013.09.025 (Accessed 31 August 2020). 9.Schleip, R. (2020) ‘Innervation of fascia’ in Lesondak, D. and Akey, A. (eds) Fascia, Function and Medical Applications, Boca Raton, CRC Press, p63. 10.Schleip, R. (2017) ‘Fascia as a Sensory Organ’ in Liem, T., Tozzi, P. and Chila, A. (eds) ‘Fascia in the Osteopathic Field’, Edinburgh, Handspring Publishing, pp 66-67. 11.Tesarz, J., Hoheisel, U., Wiedenhöfer, B. and Mense, S. (2011) ‘Sensory innervation of the thoracolumbar fascia in rats and humans’. Neuroscience. 2011;194:302-308. [Online] doi:10.1016/j.neuroscience.2011.07.066 (Accessed 31 August 2020). 12.Langevin, H. and Sherman, K. (2007) ‘Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms’. Med Hypotheses. 2007;68(1):7480. [Online] doi:10.1016/j.mehy.2006.06.033 (Accessed 31 August 2020).

More research on fascia and pain Hormone Receptor Expression in Human Fascial Tissue Fede et al. (2016). This research discusses the role that hormones may play in fascial densification. It is suggested that fascia has specific hormone receptors affected by menopause. This could explain why some women going through menopause experience stiffness and discomfort that may be attributed to fascial densification. Fascia: A missing link in our understanding of the pathology of Fibromyalgia Liptan, (2010). This article discusses the hypothesis of how fascia, which has become thick and densified, may be a contributing factor that causes peripheral and central sensitisation. Both peripheral and central sensitisation are known to be involved in Fibromyalgia. Fascia and soft tissue innervation in the human hip and their possible role in post-surgical pain. Fede, (2020) This research study shows that nociceptors have been found in the fascia and soft tissues of the human hip. We know that nociceptors respond to noxious stimuli (tissue toxicity, densification etc) however, it was previous thought that the fascia was inert without sensory innervation. Thus study contradicts that paradigm and shows that fascia has the ability to the dorsal horn with sensory information from the tissues resulting in pain. The sympathetic nervous system modulates CD4+FoxP3+ regulatory T cells via a TGF-β-dependent mechanism Bhowmick, (2009). TGFβ (TGFbeta) is a cytokine involved in the inflammatory response, fibroblast activity, scar tissue healing and pathologies as well as cancer metastasis. As TGFβ activates fibroblasts that help fascia maintain its integrity, this study suggests how the stress response (flight and fight) may increase fascial tone resulting in pain. Hyaluronan within fascia in the etiology of myofascial pain Stecco, (2011). This study discusses the molecule hyaluronan (HA) which plays a vital role in the fascial ground substance (ECM) that permits tissue glide. When tissues become dysfunctional (densification) the ground substance containing the HA become more viscous (thicker). Tissue strain and a more viscous ground substance are co-contributors to myofascial pain. The study presents a hypothesis as to the reason why trigger points form. A trigger point is a discrete hyperirritable spot on (predominantly) muscle. It is thought that the increased viscosity of the ground substance and change of concentration to HA contributes to tissue ischaemia and hypoxia resulting in trigger point formation. Pathophysiological model from chronic low back pain integrating connective tissue and nervous system mechanisms Langevin, (2006). This study looks at more than just the biology of pain but of the biopsychosocial interaction between the connective tissue (fascia) and the nervous system. It discusses the movement pattern dysfunction, stress, hypomobility and hypermobility, fascial remodelling as well as nociceptive innervation.

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The Thoracolumbar Fascia Extract from Advanced Myofascial Techniques By Til Luchau

To be human is to have back pain. Back pain is one of the most common physical disorders that humans endure. It affects about 90 percent of people at some point in their lives (1), and ranks as the leading cause of disability worldwide (2). Low back pain (LBP) has been with us for as long as we have had backs, and for just as long, humans have been seeking to understand and relieve back pain. The oldest known writings on surgery—the 3500-year-old Edwin Smith Papyrus from Ancient Egypt—include tests and treatments for back sprain. In more recent medical history, different mechanisms have been thought to be the primary source of back pain at different times. The changing theories about LBP’s primary cause have included referred sacroiliac joint pain (3) and nerve inflammation (a popular explanation in the early 1900s); “muscular rheumatism” (fibromyalgia) (4) and psychological issues such as “hysteria” (5) (1920s–1930s); quadratus lumborum (QL) spasm (until the 1950s); disc issues (1930s–1990s; discussed in more detail later in this chapter); transversus abdominis strength (1990s) (6); multifidus size (2000s) (7); and the more recent emphasis on “core stability” (in the last decade). While many of these theories have proven to be important pieces of the back pain puzzle, up to 85 percent of back pain cases still have no known cause (8), and the search for understanding and effective treatment continues. Recently, a number of researchers have identified another contributor to many kinds of previously unexplained LBP: the highly innervated thoracolumbar fascia (TLF); we’ll discuss the specifics below.

The thoracolumbar fascia’s role in LBP The sensitive TLF (also known as the lumbodorsal fascia) covers and separates many of the muscle groupings that lie posterior to the spine. From behind, anatomy texts often depict it as a diamond-shaped connective tissue structure lying over the lower back, connecting 42

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the gluteal fascia to the latissimus dorsi (Figure 2.1). H owever, from other angles, it becomes clear that this structure is much more complex. Multiple layers wrap three-dimensionally around the various structures of the low back (Figures 2.2 and 2.3), and extend from the base of the neck (where it is contiguous with the deep cervical fascia) to the sacrum and iliac crests of the pelvis. Its different layers adhere to the processes of the lumbar vertebrae and spinal ligaments along the midline of the back, and it adheres to the ribs laterally. The TLF wraps around and connects several of the structures thought to be responsible for LBP, such as the spinal ligaments, the QL, and the transversospinalis muscles (including the erectors and multifidi). It also interconnects other key muscles involved in back pain such as the transverse abdominis, the obliques and, via its upper end, the diaphragm. The recent increase in the awareness of fascia’s role in sensation and pain perception has stimulated research showing that pain-signaling free nerve endings and mechanoreceptors in the back’s TLF are more abundant than previously thought, and that the TLF is significantly thicker in those with LBP than in those without (9). Other research has shown that there is less gliding between the deeper layers of the TLF in people with LBP (10). This suggests that our method’s goals of increased fascial elasticity and layer differentiation (see Volume I: Chapter 2, Understanding Fascial Change) may be part of why manual therapy has been observed to help LBP, both anecdotally in the practice room, and statistically in back-pain research (11). Because the sensitive yet strong TLF diagonally joins each leg to its oppositeside arm, it is an important structure in the mechanical and proprioceptive control of walking, running, throwing, and all contralateral motions. As a whole-body connector, it can be directly involved in many client conditions, including: • Low- and mid-back pain • Recurring tightness in the thoracic spine or low back • Spinal stiffness and restricted rotation or flexion • Inhibited contralateral arm/leg motion, and • Limited rib or back motion in diaphragmatic breathing.

The TLF is also indirectly implicated in many other conditions, including hip or sacroiliac pain (12), as well as in suboccipital headaches or plantar fasciitis, via its indirect fascial connections to those regions (13).

Iliac Crest Technique We will prepare for our work with the low back’s fascia by starting with the iliac crests. It is along these thin, bony ridges that the layers of the TLF find their inferolateral attachments to bone; so when we work these attachments, we are also working the conjoined fascial attachments of the transverse abdominis, the internal and external obliques, as well as the iliocostalis, the largest and most lateral of the spinal erectors. The iliac crests are the stopover place for these and many other soft tissue connections, from both above and below. Since our focus is on preparing for low back work, we will emphasize the superior aspect of these bony ridges where the low back structures attach. Using a soft fist, feel for the bony ridge of the iliac crest. Use the furrow between two of your knuckles as a way to wrap around the crest’s ridge slightly (Figures 2.4 and 2.5). On many clients with long-term low back pain or strain, you will find thick, dense fascial buildup here. Starting at the lateral-most part of the hip crest, sink in slowly, feeling for the tissue to soften in response. By waiting for this response, we are evoking a reduction in the resting tone of the fascia’s associated muscles via a Golgi tendon organ reflex (14). This allows our work to have a much greater effect, as by waiting, we affect much more than the small area we are contacting with our soft fist. This reduction in tone is therapeutic in and of itself; it also serves to prepare the body for the more direct work with the lumbar sections of the TLF (which will be addressed in the next technique). Once you have felt the tissue here soften slightly in response to your static, patient pressure, you can begin to slowly glide along the crest to a new area. Wait here for a tissue response; its softening will allow you to glide to the next area. As you glide medially along the crest, you will encounter the more muscular attachments of the QL and the iliocostalis. Slow down even more. Perhaps take a more superficial layer, at least for your first pass. Continue this process of waiting for a response

fasciapages the thoracolumbar fascia

in each place, until you have reached the posterior superior iliac spine—the posterior terminus of the iliac crest. Repeat at a slightly deeper level; or, move on to the next technique.

Thoracolumbar Fascia Technique Your work along the iliac crests addressed the inferior attachments of the TLF, which will make your work with the rest of the low back easier and more effective. The TLF is composed of dense, fibrous connective tissue layers that are separated by thin layers of loose connective tissue; these thin layers normally allow the dense layers to glide against one another during trunk and limb motion. As mentioned, less gliding between the layers here has been correlated with lower back pain (15). We will address each layer of the TLF in turn, restoring differentiation and elasticity as we go. Superficial and Posterior Layers There are several outer layers in the low back— the skin, the various layers of superficial fascia, and several layers of deeper fascia underneath. These include the posterior (outermost) layer of the TLF, which covers the erector/multifidus group, and gives rise to the latissimus dorsi that connects the back to the arm (Figures 2.1 and 2.3). Using a soft fist, sink into the space between the iliac crest and the 12th rib. Use a light enough touch that you can easily glide from the lateral to medial aspects of this space, using your slow, patient friction to move each layer in turn. Do not use lubricant. The friction itself is the therapeutic tool that increases layer differentiation. Make sure your pressure is comfortable for the client; the TLF sublayers here are all richly innervated, and are sometimes even more sensitive than the deeper layers underneath. Feel for an increase in tissue elasticity and easier gliding of one layer upon another. Repeat this process until you have worked the surface tissues of the entire span between the pelvis and the ribs. Once you have prepared the outer layers with several lighter passes, you can engage your client’s active movement. Ask f or slow, active motions from the participant— for example, “Let your knee slowly come towards your chest,” or “Very slowly, reach up above your head.” Make sure your client is breathing easily. Engaging the limbs and breath in this way will broaden the effects of your work, and evoke more powerful Golgi and nervous system responses.

Erector and Multifidus Layer The spinal erectors and multifidi lie between the TLF’s posterior and middle layers. Many practitioners are accustomed to addressing the erectors from their posterior aspect in a prone client, which is how these large, thick muscles are depicted in most anatomy illustrations. However, with your client in a side-lying position, gravity enables a different approach. Begin with a soft fist to feel for the lateral edge of this large group of muscles (Figure 2.6). The entire muscle group will be several inches thick, and it constitutes the bulk of the muscle mass next to the lumbar spine (Figures 2.7 and 2.9). Rather than sliding on the surface, as we did with the previous fascial layers, sink in to the thick lateral aspect of the erector group (Figure 2.7). You will need to be positioned above your client in order to use gravity, so your table will be quite low, or you may need to kneel on your table. If there is enough space between your client’s ribs and pelvis, instead of using a soft fist, you can carefully use your forearm to work the erectors’ lateral aspects (Figure 2.8). Be extremely gentle and cautious with the forearm—avoid using the point of your elbow;

Transverse abdominis Internal oblique

Quadratus lumborum

Psoas major

Vertebra

External oblique

Latissimus dorsi

Erector spinae Thoracolumbar fascia

Figures 2.1/2.2/2.3 The multi-layered thoracolumbar fascia (TLF, also known as the lumbodorsal fascia), shown in green in Figures 2.2 and 2.3. A tough, fibrous, and multilayered confluence of fascial sheets connecting the lower limbs to their upper limb counterparts on the opposite side, it is highly innervated and plays a role in many cases of back pain. The TLF wraps and connects many of the low back structures involved in low back pain, including those labeled here, and attaches to the psoas major fascia as well as the spinous and transverse processes of the vertebrae.

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Figures 2.4/2.5 The Iliac Crest Technique. Gently use the knuckles of a soft fist to work the attachments of the TLF and other structures along the length of the iliac crests. Glide slowly to prepare the outer layers; use static pressure on deeper layers.

instead, use the broad, flat surface of your ulna. Avoid any pain—if your client is not comfortable with your pressure or pace, more preparation and a slower approach are indicated. Use your forearm to feel, more than to manipulate. Wait for a softening of this thick muscular layer. Your touch is static, deep, and perceptive. You do not need to glide or move to affect the TLF here—your static pressure is quite effective at evoking sensation and change, both within the muscles and in their enveloping fasciae. As a variation, you can ask your client for slow active client movement, as you did with the outer layers. This will move the fascia under your static touch and help with neuromuscular re-education as you coach your client to find new, more refined ways to initiate movement. At this deeper level, the movements must be very slow and deliberate since they will intensify your client’s sensations. Be extra sensitive. Cue your client to make minute movements, as you work very slowly. Motions might include slow hip flexion or extension; reaching with arms; or pelvic tucking and rocking. If you are patient and sensitive, you can work very deeply here, as your client’s slow, d eliberate movements both free fascial layers and increase proprioception of the limbs’ connection to the spine. Quadratus Lumborum Layer Just anterior to the erectors, or deeper into the body, you will find the QL between the middle and anterior layers of the TLF (Figures 2.3 and 2.9). The QL is a key stabilizer of the trunk/pelvis relationship; as a postural muscle, it is active in bending, balancing, walking, and breathing. Well known to manual therapy practitioners as a crucial structure to include when addressing back pain, the QL and the fascia around it (on average, the fascia around a muscle has about six times more nerve endings 44

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than muscle tissue itself) (16) can be a source of many kinds of back discomfort. To find the QL and its fascia, use the Iliac Crest Technique to follow the crest medially until you encounter the attachments of the QL. From here, you can begin to use your two thumbs together (Figure 2.10) to isolate the QL layer. Do not hyperextend your thumbs or apply excessive pressure with them. Use static pressure and active client movements, as you did with the other layers. Work the QL from its attachments in the iliac crest to its insertion on the 12th rib. Breathing and hip motions will be particularly relevant.

Considerations When properly applied, the work described here has proven to be very safe and effective. It has been taught to thousands of practitioners on several continents over the last two decades in our continuing education trainings. However, some important considerations apply: • In the side-lying work, be mindful of the ends of the floating ribs and the transverse processes of the vertebrae, both of which are sensitive, and could be injured by incautious work. Avoid putting pressure directly on the transverse processes— there are stories of overly aggressive lumbar work bruising the tissue here by pushing it against the pointed processes. Stay in touch with your client’s comfort level; do not try to “rub away” any bumps or apparent knots that you might find— they might be bone. • These techniques are most effective on mild to moderate chronic back pain. Recent back injuries or surgery are usually contraindications to the direct approach described here, at least until the tissues have healed (although with

care, experienced practitioners can often adapt these ideas for recent back injuries. One key is to apply the techniques gently and gradually, noting responses between sessions). Older, healed injuries and surgeries often respond very favorably to these techniques. • Strong LBP of sudden or frequent onset is probably cause for referral to rehabilitation or complementary specialists, such as a physical therapist, chiropractor, or physician, since LBP may need more care than most manual therapists can typically provide, as LBP can sometimes signal serious medical issues. • Disc issues: until recently, intervertebral disc issues (bulging, herniation, degeneration, and so on) were the favored explanation for many types of LBP, with discectomy surgery increasing in popularity tremendously after its introduction in the 1930s (leading some authors to refer to the decades that followed as the “dynasty of the disc” (17)). However, since the 1980s, there has been less emphasis on disc issues as a major cause of LBP, as more recent research has shown that most disc issues are a relatively uncommon cause of pain. Most disc issues are asymptomatic, and while more than 60 percent of people over age 40 show evidence of disc degeneration, a much lower percentage have any related pain (18). Nevertheless, I do not recommend using these techniques with disc issues until you are very familiar with their application and can reliably gauge the appropriate pressure, duration, and response. The danger in working with disc issue patients is that releasing their compensatory muscular and fascial tension too quickly, or in an unbalanced way, could aggravate or further destabilize a fragile pattern. Play it safe and refer these clients to a specialist, or work under a specialist’s close supervision until you have gained enough experience to competently address the trickier situation of disc issues and unstable LBP.

Summary At the beginning of this chapter, we listed some of the many mechanisms that have been thought to be responsible for back pain through the ages. While all of these factors may contribute to LBP, and treatments based on them may all give relief in individual cases, none of these theories have proven to be a silver bullet cure-all, nor has any one approach been consistently effective with a majority of LBP suffers. In a survey of the leading back pain theories published over the last 100 years, the authors conclude that “today we know that for the majority of low back pain cases, a specific etiology [cause] cannot be

determined” (19). In spite of this, many back pain sufferers do find relief in hands-on work (as well as other approaches). Our increased understanding of the TLF’s sensitivity and role in back pain is a significant addition to our knowledge base, and this gives manual therapists new tools to help many clients’ back pain that has not responded to other treatments. Like most of the LBP theories discussed earlier, the ideas discussed in this chapter add a piece to our overall understanding—even if none of these theories have yet proven that they are sufficiently effective to make back pain completely obsolete.

References

[1] Frymoyer, J.D. (1988) Back pain and sciatica. New edicine. 318. p. 291–300. England Journal of M [2] Institute for Health Metrics and Evaluation (2010) Global Burden of Disease Study. [3] Don Tigney, R. The Sacroiliac Joint. http://www. thelowback.com/history.htm. [Accessed December 2015] [4] Lutz, G.K. et al. (2003) Looking back on back pain: Trial and error of diagnoses in the 20th Century. Spine. 28(16). p. 1899–1905. [5] Maharty, D.C. (2012) The history of lower back pain: A look back through the centuries. Primary Care. 39(3). p. 463–470. [6] Hodges, P.W. and Richardson, C.A. (1996) Inefficient muscular stabilisation of the lumbar spine associated with low back pain: A motor control evaluation of Transversus Abdominis. Spine. 21(22). p. 2640–2650. [7] Danneels L.A. et al. (2000) CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. European Spine Journal. 9(4). p. 266–272. [8] Deyo, R. and Weinstein, J. (2001) Low back pain. New England Journal of Medicine. 344. p. 363–370. [9] Langevin H.M. et al. (2009) Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskeletal Disorders. 10. p. 151. [10] Langevin H.M. et al. (2011) Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskeletal Disorders. 12. p. 203. [11] Furlan, A.D. et al. (2008) Massage for low-back pain, Cochrane Database of Systematic Reviews. 4 CD001929. [12] Nickelston, P. (2013) Thoracolumbar fascia: The chronic pain linchpin. Dynamic Chiropractic. 31(21). http://www.dynamicchiropractic.com/mpacms/dc/article. php?id=56728. [Accessed December 2015] [13] Myers, T. (2009) Anatomy Trains. Churchill Livingstone. [14] Schleip, R. (2003) Fascial plasticity: A new neurobiological explanation, Part I. Journal of Bodywork and Movement Therapies. 7(1). p. 14. [15] Langevin, H.M. et al. (2011). ibid. p. 203. [16] Mitchell, J.H. and Schmidt, R.F. (1977) Cardiovascular reflex control by afferent fibers from skeletal muscle receptors. In: Shepherd, J.T. et al. (eds). Handbook of Physiology, Sect. 2, Vol. III, Part 2. Bethesda, MA: American Physiological Society. p. 623–658. [17] Parisien, R.C. et al. (1998). Ushering in the “dynasty of the disc”. Spine. 1. 23(21). p. 2363–2366. [18] MDGuidelines. Intervertebral Disc Disorders. Reed Group. (December 2012.) [19] Lutz, G.K. et al. (August 2003). ibid.

Picture credits

Figure 2.1 Robert Schleip, copyright fascialnet.com, used by permission. Figures 2.2, 2.7, and 2.9 Primal Pictures, used by permission. Figures 2.3 based on de Rosa and Porterfield, AdvancedTrainings.com. Figures 2.4, 2.5, 2.6, 2.8, and 2.10 Advanced-Trainings.com.

Figures 2.6/2.7/2.8 The Thoracolumbar Fascia Technique works three-dimensionally to differentiate the various layers of the TLF, from superficial to deep, as to wraps around the thick muscle mass of the erectors (Figure 2.7). Figure 2.8 shows very gentle work with the ulna on the erector layers. Use caution around the sharp and sensitive transverse processes of the spine, as well as the ends of the floating ribs.

Figure 2.9 The deepest layers of the TLF (green) wrap the quadratus lumborum (QL), which is anterior or deep to the erector spinae (ES). The multifidi (M) and psoas major (PM) are also shown.

Til Luchau is the author of the Advanced Myofascial Techniques series of trainings and books (Handspring Publishing) He is also the co-host of The Thinking Practitioner podcast; a Certified Advanced Rolfer; and a member of the AdvancedTrainings.com faculty, which offers online learning and in-person seminars in the UK and worldwide. He invites your questions or comments at info@advanced-trainings.com or via social @TilLuchau.

Figure 2.10 Careful use of the thumbs is one option when working with the deep quadratus lumborum layer. Keep your two thumbs together, avoid hyperextending any joints, and check with your client about comfort. Adding breath and slow hip movement can increase effectiveness of this and the other TLF techniques.

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Essential Oils, Coronavirus & COVID19 By Nicole Perez

ince the beginning of the coronavirus pandemic, many people have been faced with severe challenges both physical and emotional, which may have had a profound impact on their life and their state of mind. The International Federation of Aromatherapists (IFA), as a complementary health organization, wishes to extend its heartfelt sympathy to all those affected and its sincere thanks to all those who are putting the safety and welfare of others before their own. 46

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How Can Essential Oils Help During this Serious Health Crisis? Poor sleep affects as many as a third of us and in recent years, it has been linked to various health conditions including diabetes, heart disease, obesity and mental health problems. Clary sage and marjoram both have sedative qualities, which can help promote sleep, while lavender, chamomile and neroli are calming and soothing oils, which are great for relieving anxiety if this is the underlying problem. Where depression is linked to poor sleep, an uplifting oil like bergamot could be beneficial. Essential oils or their constituents are widely used in pharmaceutical preparations, in cosmeceuticals (skin-care products with the combined benefits of cosmetics and pharmaceuticals), as food preservatives, flavour enhancers, in traditional and complementary medicine, in aromatherapy and in the spa industry. Essential oils are very popular with the public too, not only because their fragrant odours are pleasant and invigorating but also because they offer so many health benefits and are considered safe to use in the home when used within safety guidelines. Also, the simple action of smelling an essential oil can have a number of measurable physiological effects on the body such as change in heart rate or blood pressure, change in brainwaves activity, change in eye

movement, etc. In fact, a number of studies have shown that the fragrant odours of essential oils have psychophysiological effects and proved that they can bring fast relief from stress and ease emotional difficulties.

Antimicrobial and Antiviral Activities of Essential Oils The immune system is a highly complex system that contributes both to the maintenance of a healthy body and defence against harmful pathogens. Certain existing health factors and mental states can make it difficult for the immune system to be fully effective. Natural remedies such as essential oils can support the body’s immune response and, more generally, can offer support to the ‘whole person’ as well. Essential oils have a long list of therapeutic properties, but not all essential oils act in the same way. For example, some essential oils work in a wide-ranging way, while others work on more specific areas. Some essential oils can produce a quick response, while others may have a much slower cumulative action. These differences are determined by the constituents present in an essential oil, the dosage used and the method of application. Many essential

oils can work in synergy with each other and can address more than one aspect of health at the same time. During a serious infection such as Covid19, to obtain maximum benefits from essential oils, it is important to choose a small number of essential oils that offer both holistic benefits and physiological benefits, in order to increase physical and mental wellbeing which in turn may stimulate immunological stamina. The contribution of essential oils as natural antivirals is promising, as some essential oil constituents have been found to inhibit virus replication in clinical studies, but the mechanisms by which essential oils can undermine viruses is still not clear. In contrast, there are a number of verified antimicrobial and antibacterial essential oils to choose from. So far, most essential oils tested for antiviral properties have mainly been tested against herpes viruses, so it cannot be assumed that those essential oils labeled as antivirals will automatically help in the fight against Covid19, but they can offer some indirect support to the immune system. Other essential oils with therapeutic properties that can ease different symptoms and potentially help during a Covid19 infection should also

be considered: respiratory antiseptics, anti-inflammatories, mucolytics, febrifuges, antitussives, expectorants, decongestants, cytophylactics, antioxidants and prophylactics. All essential oils with these properties can help make the ‘terrain’ in the body less welcoming to infectious organisms and can decrease the acuteness of symptoms. For example, respiratory oils like Peppermint, Eucalyptus, Pine needle and Juniper berry can help keep respiratory passages open and improve breathing capacity but they can also work as mucous expectorants, as antivirals and antimicrobials, and help ‘sanitize’ the ambient air in confined spaces, thus offering general support to the body or to any other treatments in a number of ways. While it certainly cannot be claimed that essential oils are a cure for this current serious illness, nonetheless, they can be useful for people who have milder symptoms of Covid19 and who have not needed to be hospitalized. Finally, one more good reason for using essential oils in the fight against pathogens is that pathogens are Issue 110 2020

adversely affected by aromatic molecules. Also, viruses have been observed to only be able to resist one type of aromatic molecule at a time, and essential oils offer such an array of aromatic molecules that can damage viruses. So again, although, essential oils are not a cure, certain essential oils can interfere with the cycle of infection/replication of pathogens. After all, plants produce essential oils as part of their arsenal of defensive weapons against the myriads of microorganisms and parasites that inhabit the environment. Is not Nature amazing?!

The Neuro-Psycho-Immune Connection As already mentioned, good immunity is directly related to mental wellbeing because any negative psychological state or emotional upset can impact the immune systemâ&#x20AC;&#x2122;s ability to detect pathogens. Stress levels are also a factor in efficient immune response, as changes in stress hormone levels can also lower immunity. Therefore, improving mental wellbeing can help our chances of fighting infections and diseases and help optimise biological function. Regularly smelling those essential oils that are uplifting, mood enhancing, calming, relaxing, anti-depressive, stimulating and tonic, can give body and mind a boost and can indirectly contribute to the fight against Covid19.

For example, Rosemary essential oil can counter mental apathy and improve both the immune response and respiration; Lavender (Alpine and English) can lower anxiety, regulate stress hormone levels and help various respiratory complaints; Lemon is an antioxidant, can sharpen the senses and mental functions, and regulate cardiac and respiratory rhythm: and Rose Geranium is an adaptogen, an antiinflammatory, cicatrisant, and it can modulate stress hormones. Essential oils can also help the family and helpersâ&#x20AC;&#x2122; mental and emotional health around frail and sick people. Examples of beneficial essential oils for the mind and emotions are Cardamom, Basil, Champaca, Clary Sage, Grapefruit, Jasmine, Mandarin, May Chang Patchouli, Petitgrain, Rose, Spikenard, Tuberose, Vetivert, YlangYlang. Synergetic Activities of Essential Oils Synergy means working together. Synergy occurs naturally between the different constituents of an essential oil and gives the oil unique therapeutic benefits. The concentration of each constituent in an essential oil also affects its therapeutic value. Essential oils with similar constituents and properties can be added together to make more potent aromatherapeutic remedies. The only draw-back with such synergetic blends is that some constituents may have adverse effects, so checking suitability of recipient and potential toxicity of the essential oils or constituents is important.

Some useful air cleanser essential oils: Name of Essential Oil

Benefits

Bergamot Citrus bergamia Risso & Poit.

antiinfectious, antiviral, deodorant

Cinnamon leaf Cinnamomum zeylanicum Nees

a powerful antimicrobial and air disinfectant

Eucalyptus (all) Eucalyptus globulus labill. Eucalyptus radiata Seiber ex DC Eucalyptus smithii RT Baker

antimicrobial can help prevent further infections

(Spike) Lavender Lavendula

antiinfectiou, immunostimulant, mucolytic

May Chang CT Citral - Litsea cubeba

antimicrobial and refreshes the air

Peppermint Mintha piperata

antimicrobial, antiviral, purifies the air.

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Which Methods of application: Before using essential oils, for oneself or others, be aware that certain essential oils have particularly strong, penetrating, pungent and tenacious odours and are not necessarily suited for children, pregnant women (whose sense of smell is often heightened) or frail people. 1. Direct inhalation using a smelling strip or nasal inhaler can improve breathing or help maintain a clear mind. This method can help ease upper respiratory symptoms such as a blocked nose, sneezing, coughing, a sore throat, or mild respiratory difficulty caused by sinusitis, hay fever or a cold. Useful essential oils include Lavender, Eucalyptus, Peppermint, Pine Needle and Tea-tree. Essential oils that have been proven efficient for reducing stress, anxiety, irritability, mental dullness, tiredness, or for use for general relaxation include Geranium, Lavender, Mandarin, Orange, Rose and Vetivert. 2. Diffusers and sprays are most suitable not only for maintaining a pleasant environment but also as an air cleanser, as many essential oils have antiseptic and antimicrobial properties, e.g. Cinnamon Leaf, Eucalyptus, Peppermint, Tea-Tree. Essential oils that increase mental alertness, improve memory and increase autonomic functions are Bergamot, Lemon, Peppermint and Rosemary. 3. Topical applications to boost the body system and organs through transdermal absorption of essential oils. (See at the end for useful recipes).

Which Essential Oils? Air cleansers against airborne microbes â&#x20AC;&#x201C; used in a diffuser, a spray bottle, or aerosols When an airborne infection is around, it is important to keep the ambient air around as clear as possible from infectious organisms. Spraying the air with essential oils to maintain air quality helps keep the environment healthy for all. Also, air diffusion of essential oils can stimulate the immune system.

Immuno-stimulants/Antimicrobials/ Antivirals These are essential oils that can either strengthen immunity or directly fight infectious organisms. Name of Essential Oil

Benefits

Bergamot Citrus bergamia Risso & Poit.

antiviral, antimicrobial

Cajeput Melaleuca leucadendron

antiviral, antimicrobial, expectorant, immunostimulant

Eucalyptus (all) Eucalyptus globulus labill. Eucalyptus radiata Seiber ex DC Eucalyptus smithii RT Baker

antiviral, antiinfectious, antimicrobial, febrifuge, immunostimulant, expectorant

Lavandin Lavendula latifolia Medik

antiviral, antimicrobial, expectorant, antiinfectious

Lemongrass Cymbopogon citratus DC Stapf

antiviral, antifungal, antiinfectious

Manuka Leptospermum scoparium Forst & Forst

antiviral, antimicrobial, immunostimulant, antitussive, expectorant

Melissa Melissa officinalis

immunostimulant, expectorant, antitussive

Niaouli CT Cineole Melaleuca quinquinervia or Viridiflorol

antiviral, antimicrobial, expectorant, immunostimulant,

Ravintsara Cinnamomum camphora

antiviral, antimicrobial, antiinfectious, immunostimulant,

Rosemary CT Cineole Rosmarinus officinalis

antimicrobial, expectorant

Tea-Tree Melaleuca alternifolia

antiviral, antimicrobial, antiinfectious, immunostimulant

Thyme CT Thymol Thymus vulgaris

antimicrobial, antiinfectious, immunostimulant

Adaptogens and Antioxidant Essential Oils Adaptogens: Some essential oils are classified as adaptogens because they are known to have a ‘normalising’ effect on body processes, hormone release and stress, meaning their action can either be energising, stimulating, tonic or decreasing, calming, sedative depending on what is needed. Adaptogens essential oils can help regulate stress hormone levels, increase stamina, improve the immune response, regularise blood pressure, cardiac and respiratory rate, lower inflammation, are prophylactic and contribute to the prevention of and the recovery from illness.

Antioxidants maintain balance, help keep oxidative stress in check, help improve immunity and keep the body healthy. Antioxidant essential oils examples: Citrus essential oils, Black Pepper, Ginger, Ho Wood, Oregano. Essential Oils to Appease Spasmodic Coughs – best application methods are steam inhalation or a chest rub. Examples of antitussive and respiratory antispasmodic essential oils are Benzoin, Cypress, R Chamomile, Fennel, Fragonia, Inula, Lavender, Myrtle (Green), Manuka, Marjoram. Note: Benzoin, R. Chamomile, Fragonia, Lavender, Manuka essential oils are suitable for children or vulnerable people in a diffuser or in a 0.5% to 1% diluted blend and applied to soles of feet. Pneumonia is a serious and lifethreatening infection of the lungs caused by bacteria, a virus or fungi. Pneumonia caused by bacteria and a virus is contracted from airborne droplets projected out when sneezing and coughing, and fungal pneumonia is contracted from the environment, i.e. skin contact with surfaces. Chest rubs and inhalation in the recovery phase can be useful up to 6 months after the illness: Respiratory anti-inflammatory and tissue repair: Benzoin, Cedarwood, Frankincense, Niaouli CT Linalol and CT Nerolidol, Blue Tansy, Thyme CT Linalol.

Adaptogen essential oils examples: Bergamot, Frankincense, Rose Geranium, Lavender, Lemon, Melissa, Rose, Neroli, Turmeric Root, Ylang-ylang. Nicole Perez, Fellow IFA Member and Principal Tutor of the School of Holistic Aromatherapy If you would like to learn more about essential oils please view our website for information regarding courses and training. Caution must be exercised when using essential oils and where there is doubt, always contact an IFA Registered Aromatherapist who will offer guidance on the oils that are suitable for individual needs. Our Register is approved by the Professional Standards Authority (PSA), a UK body accountable to Parliament which gives additional external reassurance as to the competence, professionalism and safety of our practitioners that meet that high standard. www.ifaroma.org | office@ifaroma.org

Issue 110 2020

OIL PROFILE

Peppermint Peppermint is a perennial herb that grows in the USA, Argentina, Brazil, Morocco, India, Australia and several countries in Europe including England. The essential oil is pale yellow or green. It has a fresh, cool, characteristic minty odour that is penetrating and strong but volatile. LATIN NAME: Mentha x piperita L. FAMILY: Lamiaceae METHOD OF EXTRACTION: Steam distillation of partially dried flowering herbs. HISTORICAL USE: Peppermint herbs have long been used in cooking. It alleviates many digestive issues,

including dyspepsia, flatulence, nausea and cramps. FOR MASSAGE: Peppermint essential oil can be blended with a carrier oil such as sweet almond oil.

However, care should be taken as it has a very potent aroma. The correct dosage guidelines should be followed when using Peppermint essential oil. As usual, this oil should only be used for massage by qualified therapists. THERAPEUTIC PROPERTIES: Peppermint essential oil has been shown to be analgesic, antibacterial,

and antiviral. It is digestive, stimulant and stomachic. Peppermint is also effective in treating headaches, migraines, colds and fevers. OTHER USES: Peppermint essential oil is commonly used as a flavour in oral care mouthwashes and

toothpastes. CONTRA-INDICATIONS: Peppermint essential oil is generally non-toxic and non-irritating,

although it may be sensitising. It is contra-indicated for anyone suffering from cardiac fibrillation or a very specific condition called G6PD deficiency. Peppermint essential oil should not be directly applied on to faces of children or infants, due to the levels of menthone. Avoid using peppermint essential oil during pregnancy and whilst breastfeeding. Avoid using old or oxidised oils.

OIL PROFILE WRITTEN BY NANA MENSAH

Issue 110 2020

Kneads Must have put their awardwinning Kneader Chair Massage routine into an accredited and insurable online course so that therapists can: • learn hand-saving techniques using the Kneader massage tool • learn a new and exciting chair routine • grow their business • earn 15 CPD points

Our introductory course offer is just £149.99 (which includes 2 Kneader massage tools). Visit www.kneadsmust.com and the ‘book a course’ option to access the course information page link and view course clips.

Hawaiian Lomi Lomi This is a dynamic, spiritually rich and life-changing Practitioner Training of the highest UK standard in authentic Hawaiian Lomi Lomi Massage that seamlessly synthesizes ancient principles with modern practice The aim of the Course is to teach students to give a complete therapy session to the highest possible standard and is offered in three learning options: Progressive, Fast Track and Immersion. The Training experience recreates the gracious life-affirming atmosphere of loving kindness reminiscent of old Hawaii and its wise culture of Aloha where this exquisite massage was first developed. Classes celebrate the joy of learning in a relaxed yet stimulating and supportive environment that naturally allows students to fully engage with their own personal inspirational journey of discovery. Students work in pairs, giving and receiving Hawaiian Lomi lomi Massage to experience its wonderful essence, beauty and benefits in all capacities as giver, receiver and observer while learning to blend fulsome and flowing unique massage strokes, focused energy techniques and Huna wisdom with an ever-deepening understanding of the gentle all-embracing healing power of Aloha. Each student works comfortably within their own ability and pace while ultimately completing the full syllabus.

Hawaiian Massage UK Training Center www.huna-massage.com E: info@hawaiianmassage.co.uk T: 01273 730508 / 07974 083432

Issue 110 2020

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 Vital Nerves

PRICE:

£19.99

This second and revised edition provides new research on assessment, diagnosis, and treatment approaches to enhance gait efficiency. Changes include: • Updated information and research on myofascial continuities • More clearly arranged according to planes of movement • New informative illustrations based on phases of gait with EMG readings • Clear listing of the ‘Essential Events’ James Earls explores the mystery of walking’s evolution 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.

PRICE:

£19.99

is a comprehensive, must-have roadmap to the functional anatomy of the nervous system. Enriched with anatomical drawings and detailed explanations, it explains neurological testing, common neuropathies, and differential diagnoses, and is an indispensable resource for physical therapists and bodyworkers.

Gibbons provides critical insights into the structure and functions of the PNS; the body’s response to stimuli and how it knows what to do; the sympathetic and parasympathetic nervous systems; understanding the stress response; and how reflex testing can aid in diagnosing conditions like Multiple Sclerosis, Parkinson’s Disease, and paresthesias. • Assess the nervous system using a patella (reflex) hammer, myotome (muscle) testing and dermatome (sensory) testing • Determine whether pain in the posterior part of the thigh is caused by the sciatic nerve, piriformis or simply a hamstring strain • Decide at what level a disc may have herniated • Differentiate between upper and lower motor neurone disorders • Know what to do with the findings of your neurological assessment and the circumstances under which to refer patients for more specialist care.

978 1 913088 10 1

978 1 913088 18 7

208 pages, 275mm x 212mm, 250 colour photos and images, paperback

184 pages, 275mm x 212mm, 300 colour photos and images, paperback

Both James Earls and John Gibbons are well-known to Massage World readers through their series of articles and books. James is the director of Born to Move, an education platform teaching real-life anatomy for movement and manual therapists, and has coauthored, with Thomas Myers, Fascial Release for Structural Balance. John specialises in the assessment, treatment, and rehabilitation of sports injuries and supports over 75 sports teams from Oxford University, as well as teaching his acclaimed Bodymaster Method® to physical therapists. He is the author of 6 books, with more planned.

See more about Lotus Publishing and their range of books at: lotuspublishing.co.uk

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• 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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Visit our website to see our great multibuy offers and for more information on our product range 倀氀攀愀猀攀挀漀渀琀愀挀琀甀猀愀琀攀猀猀攀渀琀椀愀氀漀椀氀欀渀漀眀栀漀眀䀀最洀愀椀氀⸀挀漀洀昀漀爀昀甀爀琀栀攀爀椀渀昀漀爀洀愀琀椀漀渀

www.highlandwax.co.uk Highland Wax Company, Foynesfield Cottage, Nairn IV1 2 5SA 01 667 451 736 info@highlandwax.co.uk

Academy of On Site Massage

T: 0118 391 4313 info@aosm.co.uk www.aosm.co.uk M: 07930 266 427

Training Specialists in

Seated Acupressure (On Site) Massage As we all adapt to the new ways of working we are pleased to announce that our training schedule is now available. Our courses combine both classroom work and home study to provide thorough training to the highest standards. Hands on massage training is vital to provide essential experience of, guidance for, and practise in, the execution of the diﬀerent techniques involved. All practical training takes place at Kingsmoor Clinic in Oxfordshire.

£395

£260

Diploma & Post Graduate course details can be found on our website www.aosm.co.uk Please note our new contact no: o118 391 4313 “Probably the best taught course I have been on” Justine Thornton

£295

0208 450 7999

Issue 110 2020

£475

All practical training will take place at Kingsmoor Clinic, Oxfordshire www.kingsmoorclinic.co.uk

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Issue 110 2020

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 Training: Seated Acupressure (On Site) Massage Diploma Post-Graduate Training includes: • Massage At Your Desk • Massage Tools Course • Advanced Seated Acupressure • Seated Therapeutic Massage • Hands Free Seated Acupressure • Seated Acupressure Refresher

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

T: 01727 768559 /07796268782 E: enquiry@ftt-beautyandtraining.co.uk www.fttbeautyandtraining.co.uk

ISRM/BTEC (Level 5) Diploma in Sports & Remedial Massage Courses

T: 0118 927 2750 E: info@aosm.co.uk www.aosm.co.uk

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

T: 01509 551513 E: admin@ukmassagecourses.com www.ukmassagecourses.com

Amanda Hermitage: Anatomy Courses on Cadavers and Dissections with Julian Baker

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.

Training will take place at KINGSMOOR CLINIC in OXFORDSHIRE www.kingsmoorclinic.co.uk

UKCP Accredited Diploma

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

E: amandyh@aol.com

Details: See website

T: 0207 263 4290 E: admin@lsbp.org.uk www.centreforbodypsychotherapy.com

Issue 110 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.

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.

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

www.gladwellschoolofmassage.com Issue 110 2020

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BALENS HEALTH PROFESSIONALS INSURANCE PACKAGES » Professional, Public and Products Liability Cover » Limit of Liability of £4,000,000 or £6,000,000 » Multi Therapy cover for over 3,500 activities (subject to qualifications)

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MEMBERSHIP AND INSURANCE

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The Federation of Holistic Therapists (FHT) is here to help you and your therapy career ﬂourish, with tailor-made insurance policies, our exclusive members’ magazine, International Therapist, as well as training courses, local support group meetings, special events and the professional recognition that comes from being a member. We also hold the largest Accredited Register of complementary healthcare therapists independently approved

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