Massage World - Issue 112 by mwcommsltd

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Temporary Work in the EU

I S S U E 112 2 02 1

Myofascia & Real-Life Movement Part 2

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An Introduction to...

Tissue Mechanics Touchdown in Corporate Space

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M A S S AG E T H E R A P Y ◆ R E F L E XO LO GY ◆ B U S I N E S S T O O L S

editorial by Wendy Kavanagh

Wendy Kavanagh

TURES

Earle Abrahamson Pauline Baxter Kate Browne Ruth Duncan Rachel Fairweather EDITOR Madelaine Winzer EDITOR Susan Findlay Wendy Kavanagh FEATURES Julian Baker Emma Gilmore FEATURES Pauline Baxter Pauline Baxter Jane Langston Kate Browne Rachel Beider Ruth Duncan Meghan Mari Greg Coughlan James Earls Nana Mensah Ruth Duncan Rachel Fairweather Greg Morning James Earls Susan Findlay Rachel Fairweather Giacomo Sandri Til Luchau Susan Findlay Sarah Jane Meghan Tepper Mari Emma NanaGilmore Mensah Ian Tennant Claire Squire Nicole Madelaine WinzerPerez Amanda GiacomoWhite Sandri Mark Woollard Simon Wellsted Madelaine Winzer Marina Young Madelaine Winzer

GRAPHICVictoria DESIGN Osborne Victoria Osborne PHIC DESIGN

Victoria Osborne

GRAPHIC DESIGN

welcome welcome M

illions of people have been staying inside and working from home, highlighting the huge impact our living space has on our lives as we interact editorial by Wendy Kavanagh with clients, friends, and families through the likes of Zoom and Skype. COVID-19 has caused a mass of anxiety throughout the world, especially for massage therapists as caring What a great time to see everything slowly s the colour ofindustry. the leaves change, there return is one back to touch is integral to our normal. Spring is here and themind cafes are filled smiles question on everyone’s – what’s next?with We have again as people and coffee. been enjoy living asome week atbrunch a time as we a wait to seeThe what guidelines set us outBritish by the Government. It weather isn’tnew quite there will yet,bebut are relentless Massage therapists have had toaffected think outside the box when it work has come to remote working. has everything from the way we to our relationships when it comes to the small things which make life more Emma Gilmore talks about the different ways you can work from home as a massage and mental health. Therefore, it is more important than ever to find enjoyable, and yes, that includes a good massage. routine works for you, stay connected ones, eat therapist and what you needa to takethat in consideration when doing to so.loved Some massage wellto and exercise.their websites and social media platforms, while therapists have taken this time improve Fascia steals the spotlight in this issue of Massage World with Julian Baker others have taken this time to expand their knowledge through research anddo online courses. focusing onthe what actually is and what manual therapists In this issue, FHTFascia talks about alternative approaches to support health and can wellbeingto affect In this issue Greg Morling gives some new perspectives on research designs thatJames might truly or change it with theirarehands. You also the second article when hands-on therapies sadly not an can option. As find bodyworkers, it is our goal tofrom provide reflect the way we work and the wellbeing we hope to foster in out clients, while Kate Browne clients on withMyofascia the supportand they Real-Life need to feel Movement better, so they– won’t need to rely us moving to feel Earls and he will geton you while better. Giacomo Sandri explains how to manage inflammation by integrating medicinal herbs explains the ways which art can can go be far used anatomical you read. It’s in not like we at to thelearn moment, but if terms. you are lucky enough intowork the massage treatment. you can check out the things you will need to take into to internationally, It is an uncertain time so try to stay positive and enjoy the summer! consideration surrounding Brexit.

Our situations are unique, and we face a lot of uncertainty and challenge going forward. It is essential to take pleasure in the small things and be grateful for what is good in life. Make Asure lotyou of patience is required we wait for issue business to pick up again, but I am wrap up warm and enjoy as reading this new of Massage World!

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contents

issue 112 2021

8 ◆

F E AT U R E S

8 Massage Mentor: How to Best Handle COVID Cancellations

Susan Findlay looks at fears and anxiety regards opening up your clinic after lock periods of lockdown

12 Touchdown in Corporate Space

Pauline Baxter looks at the ways massage treatments will be different in a post-Covid world.

16 Myofascia & Real-Life Movement (part 2)

James Earls continues his series on Myofascia and Real-Life Movement.

21 WTF (What’s this fascia?)

In complementary health over the past few years the word fascia keeps popping up. Julian Baker looks at what fascia is and the role it plays in the body.

24 Myofascial Pain & Hormones

Ruth Duncan asks. Do women experience more pain than men? Does this suggest that female physiology is different and if so, what factors influence the pain experience?

34 Temporary Work in the EU

With so much uncertainty in the air, who knows what will happen? Claire Squire lists the considerations that people will need to take on board if working internationally.

38 When Chest Pain Is Not Due to Heart Problems

Amanda White explains what can cause chest pain and how SKART can be used to treat it effectively.

40 An Introduction to Tissue Mechanics – The Missing Link

Simon Wellsted takes you through the steps to help you further your understanding of tissue mechanics and what various tissue mechanics signatures mean.

◆

R EG U L A R S

3 6 32 54

Editor’s Welcome News & Views Reviews Course Listings

44 Is Your Treatment Table a Liability?

Greg Coughlan & Maria Griffin from Massage Warehouse looks into a rise in claims with industry insurance companies and massage equipment and in particular Treatment tables.

48 How to Brand Your Business to Stand Out from the Crowd

There are so many businesses that offer the same service. In this article, Rachel Beider proposes different ways to help you discover your brand.

16 ISSUE 112 2021

news & views ◆

S P EC IA L R E A D E R D I S CO U N T

Thinking of Entering the NMC This Year? Well, if you do MW has a Special 20% discount for it’s readers and contributors. Just visit the entry page fill out your application and make sure you use code MW2021 for your discount. This code will expire on 31.08.21. The FHT and Massage Warehouse are sponsoring the National Massage Championship again this year when it returns to Olympia Beauty on Sunday 3 and Monday 4 October 2021. Now in its third year, the NMC will be welcoming international competitors for the first time, across the entire competition. Taking place on the Gallery level at Olympia London, qualified therapists are invited to showcase their technique and bodywork skills in six different categories: Here are the categories to Enter and remember you can enter more than one.

A DVA N C E D M AS SAG E

1 hour massage. This includes any advance massage techniques such as deep tissue, remedial/sports techniques, MFR, NMT, trigger points, mobilisation or any other advanced massage technique including Swedish Massage technique and tools allowed.

F R E E S T Y LE M AS SAG E

1 hour massage. This category will include a rich mix of massage and bodywork skills that are inspired by western /eastern modalities- your own unique set of skills.

S PA/ W E LLN E S S M AS SAG E

1 hour massage. Classical Swedish, Beauty and Spa style massage techniques. No advanced massage techniques allowed (see Advance Massage category).

S PA S I G N AT U R E M AS SAG E

1 hour massage. This brand new category is open to all SPA’s and Brands to represent their signature Massage Treatment. You can enter 1x massage therapist to represent your SPA/Brand/Product and will have 30 minutes of setup time to present and showcase your signature massage in the best possible way.

E AS T E R N M AS SAG E

1 hour massage. This category will be based on eastern medical system including Traditional Thai Massage, Thai Yoga massage, Shiatsu, Ayurveda, and Indonesian and Polynesian techniques amongst others. Tools are allowed.

C H A I R M AS SAG E

40 mins massage. This massage should be implemented on an industry standard professional massage chair and the model must be fully clothed. You can be creative in the technique in this category. Please supply your own chair. No chair? Please request a chair when registering.

Enter here www.olympiabeauty.co.uk/thenmc

THE BIG WELL , TENERIFE RETREAT 2021 Tuesday 14 September - Sunday 19 September 2021

TENERIFE SP ORTS &

WELLNESS RETREAT

14th - 20 th SE PT Tenerife Top EMBER Tenerife - Can Training ary Islands

Kush Kumar from Think Tree Hub the, international professional association for complementary therapy has organised The Big Well for therapists and healthcare workers alike. This is a unique event on the Wonderful Island of Tenerife where therapists can give and also receive treatments as well as attend talks and workshops from industry professionals. The Resort is called Tenerife Top Training and regularly hosts top premiership Football teams, Olympic teams and other elite athletes from across the globe. With more than 340 days of Sunshine and one of the Worlds healthiest climates, Europe’s best sports centre ensures 1st-class conditions for your retreat. MASSAGE COURS ES EUROPE

Spaces for course providers to come on board the first event are already full, but get ready to book your space as a participant! More details from elainewhillock@gmail.com. To get involved in the ground breaking retreat for therapists email admin@thinktreehub.com 6

ISSUE 112 2021

news & views HYBRID INTERNATIONAL COMPETITION IN DENMARK The International Massage Association has decided that the 2021 World Championship in Massage event will be held as a Hybrid for the first time.

What does Hybrid event mean? The Championship will be split into two simultaneous parts. One part physically in Denmark and One part online. 1. The physically part is like former years/Championships in Copenhagen. 2. The online part where the participants will be going live (most likely Zoom) with their massage treatments from a place of their own choice. There will be judges live watching and judging these treatments on same terms as the physical part. The online part is as of now scheduled for Friday June 18th, 2021 in the hours between 9am to 6pm (Central European Summer Time (CEST), UTC +2).

Please email contact@worldchampionshipmassage.com if you would like to get involved as a Judge or a Competitor

FHT Goes Online this Summer 13–14 June 21 The FHT is delighted to announce that, for the first time, this year’s annual training event will be hosted virtually so that you can join in, wherever you are! Your ticket gains you access to the whole event, including every single ‘access anytime’ seminar for the duration of the Congress! Your ticket also gives you the opportunity to attend live webinars from industry experts and access show offers and discounts. The flexible style of this event allows you to tailor the Virtual Congress to suit you and your interests.

We are delighted to inform you that National Massage Day and Pro-Touch Awareness Month will be back in business this October 21. We’ve caught up with the current co-ordinator, Liz Badger, who says “The announcement today that hugging will soon be a part of our lives again, coupled with the return of the National Massage Championships at Olympia Beauty this October is brilliant! I’m beyond excited and hugely honoured to have been invited to be a guest judge this year – and so will be bringing National Massage Day and the Hands-on Revolution to London with me. Watch this space!”

We will be bringing you the latest news on how you can get involved this year, plus you can also contact Liz directly at liz@face-the-world. co.uk if you’ve any spare time to help support the Steering Group and get involved.

Well Done Juan!! Massage World recently teamed up with Certikin with an online competition to celebrate the launch of their brand new website affinityequipment.co.uk. The Winner of the competition was Juan Martinez who received a selection of Affinity goodies worth over £300.

Juan said this “OMG! Thanks for email and the great news. classifiedsclassifiedsclassifiedsclassifiedsclassified It is the first time in my life that I won anything like this!

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assifiedsclassifiedsclassifieds Don’t miss out and book yourHelen ticket Mary www.fht.org.uk Perkins

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ISSUE 112 2021

◆

Mas is ch

MASSAGE MENTOR

◆

How to Best Handle COVID Cancellations

s first lov e is danc e, nything BY S U SA N F I N D L AY to do wit h of movem ent. She as a nur se in Ca nada left the p rofession when sh the UK a e s she wa nted a d on with I have previously eeper how I am seeing an increase in the level of anxiety discussed her clien t s . For man There are many reasons for it: some therapists are feeling worksurrounding re-opening. ed in bot y h healt achinso h rusty, having not massaged anyone for the past year, they’re also overwhelmed by a n d g 20+ cla s s e s a week that need to be taken, and finally some do not know how to allr the extra precautions ng GP • Advice a eferral s chemes. should they be related to Covid. ndbetuato cancellations This can tricky subject. As makehandle She r i better us a l s on how to eweofwant line self-limit to be fair but there has to be o an reasonable to our flexibility. a l l di h whictherapists, e r c h led her are team a t o r n e d one to train as assage a • nd Reme A d v i c e dial Soft and help o apist. Cu n both han rrently s h e ds-on NLSS8M i s the SSUE 112 2021 • Up to da anId specialis te informa es in ncolog

JOIN the JING o n and business going suppor

massagementor H O W T O B E S T H A N D L E C OV I D CA N C E L L AT I O N S

assage therapy is a vocation; therefore, we are extremely attached to our professions. Being self-employed or part of a small business will have made this last year of closures especially tough and, although faced with concerns, I expect we are all excited to see our businesses thriving once again. Currently, issues around cancellations due to COVID are abound. None of us want to lose money or lose an appointment slot another client could benefit from. Thankfully, my clients have all been so desperate to be seen after so many months of aches and pains that I am not witnessing many cancellations. However, I am aware that this is likely a temporary situation and as COVID seems to be here to stay, for this year at least, and so we will all need to have a process in place by which to deal with them. The way you manage cancellations or noshows is very personal to you and your business. However, I would suggest that a minimum of 24 hours’ notice is given. My rule is 48 hours 50% cancellation fee, anything less, full payment is required.

Be consistent in upholding the policy, clients who frequently chop and change their appointments soon learn there are consequences to this type of behaviour and find themselves unable to book another appointment that is as convenient. even if they are a regular client, and send a confirmation email which links to the policy on the website. Be consistent in upholding the policy, clients who frequently chop and change their appointments soon learn there are consequences to this type of behaviour and find themselves unable to book another appointment that is as convenient. I believe we set the precedent for how we should be treated, hence do not be shy, stick to your guns about your cancellation policy. When taking a booking over the phone or by email I will not only point out the cancellation policy but the COVID-19 Policy as well. By encouraging them to remind themselves of current government legislation as well as how you are following it for their safety and well-being, they are less likely to cancel at short notice. If uncomfortable they are more likely to cancel there and then.

Here are a few key pointers of mine:

Cancellation Policy

The integral starting point is a robust cancellation policy! This will be up to you, your values and your business needs. It is essential that the policy anticipates the unique difficulties your business may face, by pre-empting these in a policy you can avoid the majority of uncomfortable client conversations by simply pointing them in its’ direction. Once created you need to ensure that the cancellation policy is displayed clearly on your website and direct customers to it upon booking. Remind clients of your policy if they are booking over the phone,

Taking a Deposit

If you have a booking system which allows for a small, even £1, deposit to be taken then it is an added security measure if faced with no-shows. Therapists have said that the number of no shows diminished when they implemented this booking system, my thoughts are it probably eliminates the casualness when someone books an appointment, especially if they are aware that full payment will be taken if they do not give enough notice. Even if no deposit is taken, simply by obtaining a copy of their credit card details you are adding an extra layer of security. However, I am not at all high-tech and take most

of my bookings over the phone! But I do appreciate that this is a beneficial measure.

High Risk Clients

I have a naughty list! This is a list made up of clients who were no-shows or cancelled inside of the cancellation window. This lets me know that they are at risk of cancelling short notice and I will take measures to reduce negative impact. Firstly, I tend to book them in at the end of the day as this potentially allows me to refill the slot if they cancel earlier that day. If I do not refill the slot, then I can enjoy a shorter workday and go for a walk in nature instead of losing a random hour in the middle of the day which is likely to be largely unproductive. If the client has not paid for a missed appointment, then I will remind them of this when they contact me to rebook. This can be a difficult conversation, but most clients are understanding, if not embarrassed, and pay for the missed appointment. There is one group of clients I tend to offer more flexibility when it comes to cancellations, they’re my oncology clients, especially those undergoing treatment. I make sure I know the schedule of their appointments and generally book each of their sessions based on the timing of their sessions (the same considerations can go for other medical conditions). If they are midway through their chemotherapy I will check in with them the night before to see how they are faring, or ask them to call me first thing in the morning so we can decide if this is a good day for ISSUE 112 2021

massagementor massagementor today’s challenges H O W T O B E S T H A N D L E C OV I D CA N C E L L AT I O N S

Covid-19 Protocols

Prior to their appointment I will carry out a covid assessment over the phone or by email. This will reiterate my cancellation policies, my Covid-19 policies, as well as the Covid-19 health assessment questions.

we can to ensure they are fully aware of our policies and have had enough opportunity to cancel.

Conclusion

Covid is not the easy option for cancelling, it follows the same principles This is a key reminder to them to cancel of any condition that entails poor health. them to come in. Some situations are before fees come into place. It may not If you clearly lay out your policies from unpredictable and require flexibility. be illness that causes them to cancel, the start it will pre-empt future hassles but discomfort and concern around and minimise the time you spend date about all the current policies, procedures. I cannot say this for every PA, but I Covid-19 itself. There are numerous negotiating cancellations. Your clients Covid Assessment do know that those sitting as board members of the GCMT (The General Council Susan’s first love is dance, anxieties a client may have about coming should respect time and value the This is essential. Prior to their of Massage Therapies) played a significant role in getting information out to all their sport, anything toyour do with to your clinic for treatment such as treatments that you offer. appointment I will carry out a covid members. the joy of movement. She If they don’t – contagion, vaccines, physical shyness add as them to thatin naughty list! assessment over the phone or by email. I was heartened to see that so many therapists joined in on the conversation, trained a nurse Canada and social anxiety. (Please see my blog but soon left the profession when she This will reiterate my cancellation how the profession started talking as a unified body, and how we got behind our ‘Back to Normality’). However, whilst came to the UK as she wanted a deeper policies, my Covid-19 policies, as well professional associations, with GCMT emerged as a body with influence. It is now we the cangovernment empathisetowith these concerns connection with her clients. For many as Covid-19 health assessment upthe to us to support our PA’s in their efforts to petition recognise questions. the value of higher education within the profession.we have, by this point, done everything years she worked in both health and So, what can you do? The good news is, the more education and experience fitness, teaching 20+ classes a week you have the easier it will be for you to re-establish yourself. For those therapists and running S U S A NGP F I Nreferral D L AY schemes. She first love is dance, that are new to the profession, it is important that you have a niche, a specialism wantedSusan’s to make better usesport, of allanything her to dowhich with the of to movement. that places you in a position of greater value. Your expert skills will establish you knowledge ledjoyher retrainShe as as a nurse in Canada but soon left firmly and increase the need for your services. a Sportstrained Massage and Remedial Soft the profession when she came to the UK as I want to leave you with thoughts of encouragement; we all know how Tissue Therapist. Currently she is the she wanted a deeper connection with her important massage is and the thought of a future without it is daunting, both for director of NLSSM and specialises in clients. For many years she worked in both our clients and ourselves as professionals. I cannot see massage stopping; whilst teaching Oncology Massage. She is the health and fitness, teaching 20+ classes we may have to improvise and adapt, we will certainly survive. author of Sports Massage: Hands on a week and running GP referral schemes. Guide for Therapists and is the Sports She wanted to make better use of all her Massage featurewhich writer Massage knowledge led for her to retrain as a Sportsvolunteers Massage and her Remedial Soft World. She time asTissue a Therapist. of Currently she is the director board member GCMT. References of NLSSM and specialises in teaching “Coronavirus And The Impact On Output In The UK Economy - Office For Oncology Massage. She is the author You can join her on Massage Mondays National Statistics”. Ons.Gov.Uk, 2020, https://www.ons.gov.uk/economy/ of Sports Massage: Hands on Guide for for free weekly massage videos grossdomesticproductgdp/articles Therapists and is the Sports Massage www.susanfindlay.co.uk coronavirusandtheimpactonoutputintheukeconomy/june2020#:~:text=It%20 feature writer for Massage World. She is%20clear%2C%20that%20the,the%20largest%20recession%20on%20 volunteers her time as a board member record.&text=Furthermore%2C%20Quarter%202%202020%20is,downturn%of GCMT. 20of%202008%20to%202009. You can join her on Massage Mondays “Set Up A Business”. GOV.UK, 2020, https://www.gov.uk/set-up-business. for free weekly massage videos Hellicar, Lauren. “Coronavirus: What Support Is Available For Small Businesses And www.susanfindlay.co.uk 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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BY PAU LI N E B A X T E R

Everyone has had the experience of things not going quite according to plan, the last year being case in point. The devastating impact of Covid-19 has by far been the furthest reaching disaster in so many different ways.

ISSUE 112 2021

rom a business perspective the future will be a challenge, but then running a business is always a challenge. It’s the nature of the challenge which changes and so your approach has to change. If you sit back and wait for work to come to you or you stick with the business plan you wrote at the beginning of 2020 then you are likely to be disappointed.

As stated by Charles Darwin; It is not the strongest of the species that survives nor the most intelligent that survives. It is the one that is most adaptable to change.

massagefeature T O U C H D O W N I N C O R P O R AT E S PAC E

Corporate massage is no different in that everything has changed from how things used to run. You have to look at the logistical processes involved in providing corporate massage, but you also have to look at the massage itself. Although you are not completely ‘re-inventing the wheel’, you are updating the structure to allow for the new terrain in which we all find ourselves.

We are already thoroughly cleaning equipment, the room and ourselves between each client so do we need to do anything else?

Please bear in mind these are my thoughts on the situation at the time of writing. With regard to massage I am neither saying what you should/should not do, nor am I saying what is right or wrong. However, the points I raise are ones which you need to consider in order to:

Perhaps one option 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.

◆ ensure your decisions are reflected in your risk assessment

◆ ensure your actions comply with your decisions The risk assessment is not simply a paperwork exercise that you complete and then ignore. Let’s look at the massage itself (in this case Seated Acupressure), as this is the part over which you have control. The area considered to be in the ‘higher risk zone’ is the area close to your client’s face. Seated Acupressure is applied over clothes with you working from behind, to the side, and in front of, your client. Are any of these areas putting you in the high risk zone? Your client may well be facing away from you when sitting on the chair but, where does their breath go as they breathe out? Directly down onto the arm rest, their hands and arms and possibly deflected forwards. Currently, every client is required to wear a face covering from the moment they enter your clinic. There are exceptions to this so you do need to be aware of this and record in your risk assessment what actions you would take. Although a face covering may reduce the potential risk of infection, it does not completely eliminate it. As a practitioner, you are required to wear a level of PPE (personal protective equipment). You must ensure you follow guidelines provided by the Government, your professional body, insurance provider and local council. As you will be aware, things can change rapidly and so you must ensure you keep up to date. There will be a level of PPE that is a must, but you may also choose to adopt a higher level of precaution. Some practitioners I know change their own clothes before each client, in addition to the necessary fresh PPE. Others I know will be wearing an apron and gloves in addition to the mask and visor.

What about your client and their clothing? They may have travelled on public transport in those clothes which may increase the potential for transfer of infection.

Then there is the massage itself. Do you now change how you carry out the massage and adjust some of the techniques to reduce or remove the time you would normally spend standing in front of the client? You would have asked your client to sanitise their hands upon arrival so you may decide this is sufficient for you to carry out the normal hand massage. Perhaps you would choose to do this with the client’s arm at their side, thus reducing the time you may spend directly in front of your client. What about when the client is sitting upright? Some stretches are usually completed in the upright position and applied as the client exhales. If their face covering is ill-fitting then their out breath is likely to be directed through the areas of least contact, often backwards through the gap at the side of the face towards you. 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 thoroughly clean your equipment and ventilate the room etc after every client, completing your Covid-19 questions the day before their appointment, in addition to the consultation at the time of the appointment.

LOG I S T I C S

Having re-evaluated the legal requirements, up to date guidance, the massage style (in this case Seated Acupressure) and any necessary adjustments you need to make, you can review the logistics relating to where you will be working. In corporate massage, every office is different. Because of this, you will need an additional Covid-19 related Risk Assessment for providing massage which is specific to each location. You will need to consider the access to the building, the area in which you work (a dedicated room is preferable), the number and length of appointments (allowing for cleaning and ventilation), health questionnaires and obviously taking into account the Company regulations and procedures. ISSUE 112 2021

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By liaising with your company contact you should be able to ensure both parties agree on how the service will recommence. Which brings me to possible alternatives to visiting the office itself? Because of obvious complications to going to site, both for the practitioner and the company, there may be ways to adapt. One option may be being mobile. If you and the employees of the company live locally then perhaps you can encourage the company to pay for you to visit individuals. If you have your own clinic/treatment room then perhaps employees can come to you individually but the company pays for the service. In either case, you would need to complete a specific Risk Assessment.

Possible solutions will be different for everyone but if you haven’t already done so, now is the time to get in touch with your contacts. Possible solutions will be different for everyone but if you haven’t already done so, now is the time to get in touch with your contacts. Find out how they are, what changes they have made, what the future looks like. Nurture your relationship in preparation for the future. Be positive and be prepared. If you work on behalf of another massage company, they should provide you with the relevant information regarding the precautions they have in place. It may be wise to ask to see a copy of their Risk Assessment, as they may ask to see yours. It may seem like an awful lot to think about but don’t be put off. Instead, be prepared. Corporate massage will return but in a more restricted environment.

Stay well and massage safely. PA U L I N E B A X T E R 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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Myofascia & Real-Life Movement Part Two

BY JA M E S E A R LS

The first article in this series investigated the influence of movement through our whole body. By moving our arms in each of the three planes we found that the body reacts in quite predictable ways – movement in the sagittal plane causes the body to flex and extend; movement in the frontal plane causes side flexions, abductions and adductions; and, of course, transverse plane movement will create a series of rotations.

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ut why is this useful? As we emphasised in the article, there is no such thing as single-plane motion, any movement in the body will have an element of each three – we live and move in a 3-dimensional world after all. Just as the 3-D printer can plot any position and create complex, beautiful objects by joining a series of X-Y-Z coordinates, we can also use the same system to describe and movement. Of course, most of us will not need to describe any movement in the amount of detail required by the 3D printer but by becoming familiar with the ideas contained in this series, you will gain the ability to see how anatomy and movement overlap in ways that make sense – more than any standard anatomy text will give you. If you missed the last article, or if you’re struggling to recall it, revise by standing up now and go through the same exercises again. Bring your hands overhead and swing them forward and back (sagittal plane), then side-to-side (frontal), and then bring them in front of you and swing them around to the left and right. Make the movements large but within your comfort range and let your whole body respond to the movements (i.e. don’t try to stabilise against the movement), and pause at the end of each comfortable range and check the reactions that happened through your joints. The reactions should match the descriptions above – flexion/extension; then side flexion, and abduction/ adduction; then rotations with each of the three planes. We can now explore a number of important principles from this simple exercise that help us build the complex picture of the moving body.

Principle 1. There is a direct relationship between the direction of movement and how our joints react to it. For example, swinging the arms forward and back caused a series of flexions and extensions and greater movement occurs in the joints that have larger flexion and

Figure 1 – Letting your body respond as you swing the arms back and down causes your ankles, knees and hips to respond. The sagittal plane movement through the shoulder girdles encourages and uses the sagittal plane range in many of the other joints through the body.

Figure 2- Movement through the ‘hinge’ joint of the knee is controlled by the hamstrings (not shown) and quadriceps. Although both muscle groups have a range of fibre directions and can control the smaller movements in the other planes, the predominant line of muscle force is aligned with the predominant axis of joint movement.

extension ranges. The knee joints can contribute significantly to sagittal plane movement but have much less freedom to offer to frontal and transverse plane movements. The correlation between movement direction and joint alignment is almost too obvious to point out which is why most trainings fail to mention it. However, when combined with our second principle, it gives us an essential foundation for the visualisation of anatomy in motion.

‘hinge’ joints of the elbow and knee (Fig. 2). Although there is some angulation to the fibres of the triceps and the quadriceps, the fibres conjoin at a tendon to produce one predominant line of pull. It is important to reiterate that we are not talking about either joints that only ‘hinge’ or muscles that only pull in the sagittal plane. Although ‘hinge joints’ and ‘planes of motion’ are commonly mentioned concepts in anatomy texts I have never met an anatomist who actually thinks of anatomy in those limited terms. The common vocabulary of anatomy has been strongly critiqued by many ‘biotensegrity’ teachers and while it may get criticised (and it should be as we can learn better vocabularies once they are available), the word I choose to use here are to help us build our vision. I ask you to hold the vocabulary loosely, use your body to learn and experience the reality of movement and its interplay with anatomy – after all, no one complains that the streets of Manhattan are not perfectly aligned to the compass when everyone uses north, east, south and west to give directions. What we are exploring in this series is the relationship between form (our anatomy) and function (our movement ability). These two

Principle 2. Joint movement and muscle fibres have to be aligned. Once again, this second principle is overlooked, and I have never seen it stated in any text. If a movement is available at a joint, there has to be some degree of protection and control of that motion. Many joints have a range of ‘play’ (the small motion that is possible in every joint in any direction), but these have a number of other protective mechanisms, most commonly strong ligamentous strapping. Larger ranges of motion require stabilising (and mobilising) force provided by the contractile muscles rather than passive ligaments. The easiest places to see this relationship is in the body’s two main

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dynamics are in a constant relationship with one another as our anatomical form dictates much of our normal movement range – we saw this above with how joint alignment directed movement through the tissues – and also how we use our body will affect our form in terms of strength and alignment. The bidirectional relationship between form and function is also reflected in our third principle.

Principle 3. Muscles can create movement across joints, and importantly, muscles react to movement across joints. The fact that muscles can create motion across joints is the lesson we all had to learn for our exams. Each muscle has a list of ‘actions’ that must be regurgitated on command if we want to pass the various tests thrown at us. Unfortunately, as useful as the actions might be, the bias toward always learning the concentric action of a muscle also set up an unconscious bias for many of us. It is a very common mistake to think that concentric contractions are the main drivers of human movement. Concentric contractions are hugely important for movement, but other forces are at play as well. Take the example of the forward arm swing you performed earlier. As one swings forward, the normal response is to flex at the hips and knees. Did you contract your hip and knee flexors to create those actions? No, the joint movement happened in response to the momentum of your arm swing along with gravity acting through your various joint and tissue alignments. If you hold the forward and down position of the sagittal plane swing for a moment can you feel which muscles are working? If your hips and knees are flexed, it will be the ‘extensors’ that are controlling the movement and preventing you from falling further forward under the influence of gravity (see fig. 1 – it is the soleus and gastrocnemius that controls ankle dorsiflexion and the quadriceps that control knee flexion). The third of our principles gives us an 18

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Figure 3 – Balancing on foot during gait requires the hip abductors to work to prevent adduction. A - In this case, the person’s right abductors have to tension to prevent the pelvis from tilting too much to the left. B – Weakness of the hip abductors cause instability of the pelvis which can lead to the upper body leaning over to compensate, a common pattern of Tredelenburg gait.

Figure 4 – The deep ball and socket of the hip provides movement in each plane – sagittal (flexion/extension), frontal (abduction/adduction) and transverse (internal/external rotation). But, no movement is limited in any one of those planes and the combination of muscle fibre directions (see fig. 5) allows the hip to circumduct - i.e. move in any combination of directions.

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Figure 5 – The circumduction of the hip is made possible by the sweeps of muscle fibre directions surrounding the joint. Although confusing at first sight, the muscle groups can be easily divided into functional groups for quicker understanding.

important lesson for our visualisation – motion through the body has to be controlled. This is easily seen in the common example of our hip joints. The triangular arrangement of the so-called abductors provides the ability to lift our leg out to the side, i.e. to abduct the hip. But, every time we take a step, we support ourselves on one leg and the role of the ‘abductors’ changes to ‘preventors of adduction’ (see fig. 3). The hip abductors do not have to provide abduction for each step, they have to supply enough stability to the pelvis to prevent it tilting too far into adduction (as in a Trendelenburg gait). To immediately feel another example, stand in a comfortable position with your feet about hip-width apart and, without moving your feet, lean as far forward as you can. Try to hold the new position for as long as you can. Which muscles do you feel burning? For most of us, it will be the ‘plantarflexors’ at the back of the leg – gastrocnemius, soleus and a few others with longer names. As you leaned forward your plantarflexors (gastrocnemius and soleus etc.) contracted to control dorsiflexion. Ankle dorsiflexion was not caused by a contraction of the ‘dorsiflexors’ (e.g. tibialis anterior), for most people the movement came from a simple lean forward that shifted your bodyweight and gravity started to take over.

The offset between your centre of mass and centre of support as you lean forward increases the demand for stabilisation. Stability, or ‘resistance to falling’, is then provided by increasing muscle tension, a fact used as justification by many movement and bodywork schools’ attention to postural balance. Being ‘off-centre’ increases the load on muscles as they work to resist the effects of gravity – we will continue to explore the effects of offset forces through this series as off-set forces influence a lot of dynamics and our ability to move efficiently or not.

Principle 4. Our fourth and final principle for this instalment is to appreciate the correlation between joint type and muscle fibre arrangement. This last principle is really just another exploration of our second principle above – the relationship between fibre direction and joint alignment but it is a point worth repeating in a different way as it brings each of the principles together. The knee and elbow joints were used as examples when looking at the second principle above. Both considered ‘hinge’ joints by the textbooks with one primary direction of movement and muscles placed on either side of them to control flexion and extension. As we know there are other types of joints with wider

ranges of motion, the most obvious is the ‘ball and socket’ joints of the shoulder and hip. The spherical arrangement of ball and socket joints provides movement in each direction – ball and socket joints can achieve varying degrees of flexion/ extension, abduction/adduction, and internal/external rotation (fig. 4). While the range in each direction might not be equal, the joints, and therefore the muscle tissues, can provide movement and control for every combination of those motions. When we apply the other principles to that fact, we then know that the joint can respond to any movement through the body (principle 1); direction of muscle force must be aligned to each significant joint movement (principle 2, please note – direction of pull does not always match fibre direction due to possible combinations of fibre angles); and that the joint could be moved in any direction by concentric contraction of surrounding muscles and those same muscle fibres can react eccentrically to control the joint motion as it responds to momentum (principle 3). If we return to the example of the hip joint, the deep ball and socket arrangement is surrounded by a series of muscles that control motion in each direction (fig. 5). The hip joint is encircled by muscles classified ISSUE 112 2021

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Figure 7 – The hip ‘abductors’ have to stabilise the pelvis when the hip is in flexion (a), ‘neutral’ (b) and extension (c). The triangular arrangement of the hip abductors supports the joint’s progression by first contracting the gluteus maximus (purple in ‘A’), all of the abductors together (purple in ‘B’), and then the tensor fascia lata (purple in ‘C’).

Figure 6 – Note the different orientation of the blades of the pelvis between the chimp and human (A). Although both species have very similar muscles, the orientation of the bones changes the angle at which the muscles cross the hip joints. As less muscle bulk crosses the outside of the chimp’s hip, they are less able to stabilise the pelvis in the frontal plane (B) which is an essential portion of human gait as we stand on one leg and swing the other forward (C).

as hip flexors, extensors, abductors, adductors, internal and external rotators. We can choose to either classify each muscle in that way or see the hip muscles as a continuous group that surrounds and encompasses the ball and socket from every angle to provide 3D movement and control. The implication of the correlation between muscle fibre and joint alignment is illustrated by the human ability to walk. The different orientation of the human ilium is a well-used example of one evolutionary change that helped Homo sapiens develop bipedal gait (fig. 6). Changing the orientation of the pelvis from facing straight back (as in the chimp) to face laterally (as ours does), changes the 20

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direction at which the muscle fibres cross the hip joint. If muscle fibres cross the back of the joint (as in the chimp), they can only extend the hip or prevent it from flexing. By coming over the outside of the joint (as in the human condition), muscle fibres can now act as abductors and help prevent the hip from adducting as we stand on one leg. The ability to stand on one leg is an essential part of our upright gait and it requires the control of adduction due to the offset between the point of support and our centre of gravity. During gait, our hip has to pass through flexion and extension as it supports us and if we look at the arrangement of ‘abductor’ fibres around the hip we see that they form a triangle from the flexor abductor (tensor fascia lata) at the front, to the extensor abductor (gluteus maximus) at the back (fig. 7).

S U M M A RY

By seeing the interplay between movement direction, joint and muscle alignments we can build our understanding of movement in the real-world. Form and function are entwined – humans move in certain patterns because of our tissue alignment and those tissues become aligned partly in response to movement. Being able to see the muscular and skeletal systems together helps us make sense of movement patterns. Muscle fibres are positioned to create and control movement across joints. But that movement is not always created or driven by the concentric contraction of the local muscle. To understand movement, we need to see how gravity and momentum have roles to play and, as we saw in our first article, we need to understand how movement will travel through a sequence of joints, particularly when an area has an injury or restriction. Perhaps we’ll explore that in the next exciting instalment.

JA M E S E A R L S James has been a dedicated manual therapist for almost 30 years. During the last 20 years he has have specialized in myofascial approaches to bodywork and co-authored ‘Fascial Release for Structural Balance’ and ‘Born to Walk’. While teaching myofascial anatomy around the world he encountered many interesting models and became especially interested in the functional movement work of Gary Gray. After being awarded the highly regarded GIFT Fellowship from the Gray Institute he managed to blend my understanding of myofascial anatomy and functional movement into his second book – ‘Born to Walk’ – which has been translated into numerous languages with an updated second edition released in 2020. His work combines my interests in functional, evolutionary and comparative anatomy to explore the ‘truths of movement’. He firmly believes that by understanding normal, everyday movement we are better able to understand the limitations our clients may experience and thereby develop appropriate, fun and individualised movement practices for them.

FASCIAL ANATOMY FOR MOVEMENT • A series of fascial anatomy online and in-person courses and lectures • Online fascial based movement classes • Fascial focused yoga classes and workshops • Short fascial anatomy workshops for movement and manual therapists Fascial focused dissection courses in Winter 2021 and throughout 2022 at the Plastinarium in Germany with Gary Carter (lead dissector and designer for the Fascial Net Plastination Project). Gary Carter brings the very latest in Fascial research including new groundbreaking information. Collaborations with leaders in the field of Fascial research, movement practices and so much more.

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What’s this fascia? BY J U LI A N B A K E R

ascial release, fascial stretching, fascia blasting, myofascial meridians. Everywhere you look over the last few years in the complementary health industry the word fascia keeps coming up. The claims surrounding fascia and the varying treatments and approaches that address it, all seem to start from the premise that fascia is something that needs working on or treating and thereby is the root of many problems. There’s very little evidence to support these ideas and much of what is suggested or discussed is often based on a lot of misunderstanding and misinformation. Can we ‘release’ fascia and do we need to and what exactly is it that we’re doing when we try? The absence of much information about fascia for many years, has created something of an information vacuum and with the lack of certainty many speculative ideas have cropped up. Recently there has been a more concerted effort to raise the fascial profile and superstars of the fascial world like Robert Schleip and Carla Stecco have become familiar faces to many. But what exactly is the interface we call fascia and what can we really do as manual therapists to affect or change it with our hands. The answer seems to be that in spite of the plethora of treatments available, there is very little direct change 22

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that is likely to be happening during any kind of fascial treatment. It’s worth however having a closer look to see if we can find the thing that really is fascia and whether anything we do can influence or impact on it. Fascia falls into the category of connective tissues, which include bone, skin, adipose, and even blood, although this is disputed by some as it lacks the fibres one would normally associate with connective tissues. These categories then in turn get broken down into further sub sections and can be quite confusing. Simply put, all fascia is connective tissue, but not all connective tissue is fascia. It’s collagen that we need to turn to next, as this is the thread that quite literally holds us together. Collagen is the most common protein in the body, accounting for around 35% of all our

proteins. Collagen is to humans what cellulose is to plants, and without it, we’d be soggy puddles lying on the floor. Produced by fibroblast cells, the collagen fibres form a hugely strong triple helix, that twists itself into a rope like structure that has the relative strength of steel rope. These collagen fibres develop to form different structures around the body, but they are abundant at every level in our system and are created every day that we’re alive. The fibroblasts respond to all kinds of signals. Loading, injury, inflammation and even stillness will all trigger the laydown of collagen fibres. Although we find collagen in the skin, the first port of call for us as manual therapists in the search for fascia, lies a little deeper. Adipose tissue or fat is another type of connective tissue and although, in our endless and complicated

fasciarealised W H AT ’ S T H I S FA S C I A?

relationship with fat we are wary of it, it’s a vitally important tissue. The cells that make up the adipose are unusual in as much as they don’t proliferate that much, but instead just get bigger. Making cells is very energy intensive and energy that we take in needs to be stored quickly. As a result, the adipose cells, adipocytes, are able to expand rapidly to accommodate the nutrients we take on board, especially those in the form of sugar. Fat cells however can’t just float around but need something to hold them in place and its collagen that does this, forming a strong network that attaches strongly between the underside of the skin and the deep fascia, blending into both and able to expand rapidly according to the rate of expansion of the adipocytes. This highly mobile and flexible connective tissue layer forms the structure that is generally referred to as superficial fascia and is the interface for all manual therapy. We may think we’re working on and feeling muscle, but everything we work on, everywhere in the body, has the superficial fascia in the front of it. It’s this layer that defines our shape and the way we present ourselves and respond to the world. The tissues that make up this structure have an enormous range of sensory nerve endings and respond rapidly to hormones, heat, touch and movement. The collagen fibres that make up the superficial fascia, aren’t just isolated into the fatty layer, but continue deeper into the body and become the tissue that many go straight to when thinking of fascia. The white, sheet-like wrappings that sit beneath the adipose layer are, for many people what fascia is all about. However, if anything, this is the middleman of the fascial network. From these strong fibrous wrappings, the fascia changes and becomes thinner and more delicate as it drops down into the muscular layer. Here it invests around the inner structure of the muscle, creating a wet, sliding and mobile environment, ensuring the smooth functioning of the muscle and effective communication between muscles and other organs and cells.

Two dissected layers of superficial fascia, reveal the enormous variation that is possible in this tissue.

The key component for all of this function is fluid. The cells produce an abundance of fibres and fluid that allow for this communication and function to take place and this tissue, the extra cellular matrix is the most diverse, abundant and perhaps most important tissue in the body. It’s also where every aspect of therapy and movement can be sure that it is having an effect. Whilst we can speculate and discuss what it is we are doing when we work on someone, we can be certain that whatever type of bodywork we apply, we are working primarily on superficial tissues, and almost certainly affecting the extra cellular matrix to some degree. The superficial fascia is not just all about the storage of energy though. It is the tissue that is likely to be disproportionately affected by scarring arising from surgery or injury and the pinning down or restriction of it will have body wide consequences. Any degree of movement through joints anywhere on the body is dependent on these tissues being mobile. Any degree of restriction

The fibres that hold the fatty tissues of the superficial fascia in place, also become the structures that will form the more familiar tissues of the deep fascia. Here the iliotibial tract is seen with the superficial fascia still attached.

has the capacity to limit normal ranges elsewhere and the simple mobilisation of this interface in restricted areas is often surprisingly effective and the subject of many courses labelled ‘scar tissue release!’ By contrast, the deep, fibrous layers of white fascia that wraps around muscles and tissues, particularly in the lower body, is pretty impervious to the touch. The amount of force and time required to change this type of fascia is enormous and we would damage ourselves and rip our clients to shreds long before we got close to changing deep fascia. However by understanding that we are not accessing deeper layers when applying pressure, but instead assisting the flow of fluid, we can accept the vital role that hands on treatment has to play in restoring and or helping to maintain flow to a liquid medium. It should be noted that in order to reveal the familiar shape of the ITB, most of the fascia attached to it on either side, needs to be dissected and discarded.

J U LIAN BAKER Julian has worked in the top medical schools and universities around the UK, gaining plaudits and praise wherever he has run a class. His approach of shaking up traditional anatomy and reframing it in ways that relate to the field of manual and movement therapies has brought him a world wide following and plaudits from every corner of the anatomical and manual therapy field. His work combines my interests in functional, evolutionary and comparative anatomy to explore the ‘truths of movement’. He firmly believe that by understanding normal, everyday movement we are better able to understand the limitations our clients may experience and thereby develop appropriate, fun and individualised movement practices for them. functionalfascia.com

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Myofascial Pain & Hormones BY R U T H D U N CA N

Do women experience more pain than men? Does this suggest that female physiology is different and if so, what factors influence the pain experience?

n the UK in 2019, 50% more women lived with chronic low back pain than men(1). The NHS report that seven times more women experience Fibromyalgia than me (2). While consideration must be made to various other factors such as socioeconomic (education, income and occupation), comorbidity (other health issues), culture, beliefs, and family life, could sex hormones contribute to the experience of pain? Recent studies have eluded to the role that the fascial system may play in the experience of pain as it is influenced by female sex hormones, specifically relaxin and oestrogen. When hormone levels change, the fascial tissue can become less or more dense accordingly. Dense fascia can compress the nervous system increasing the pain experience. Less dense fascia, which is less supportive, increases ligament laxity and decreases control and coordination of movement, often resulting in injury. The hormone relaxin is released during menstruation and is at its peak during the first trimester of pregnancy. Relaxin prepares the uterus for accepting

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embryonic implantation and continues to support foetal development via the placenta. Relaxin also supports soft tissue and bone remodelling and plays a role in tissue inflammation and fibrosis(3). Like relaxin, oestrogen is involved in tissue remodelling but also plays an important role in female development, cardiovascular health and metabolism. Pregnancy, for many women, reduces their everyday daily pain experience. This is due to an increased release of relaxin which prepares the body for birth, eventually allowing the pelvis and cervix to widen during labour. However, relaxin doesn’t discriminate. While some historical pain may be reduced during pregnancy, some women may experience unfamiliar pain as their body becomes more mobile than usual carrying the weight of their unborn child(4). As relaxin is also released during menstruation, it is thought that women could experience more sporting injuries during certain phases of their menstrual cycle. For this reason, menstrual cycles are commonly factored into female elite athlete training programmes where

some clubs and teams use apps to assess training, load, performance and recovery. A female athlete can record her menstrual cycle and moderate her training to consider muscle and joint loading avoiding potential injury and maintaining performance(4). Additionally, many women experience an increase in pain levels during menopause and post-menopause. Menopause is considered the 12 month time period where a woman finishes menstruating. Post-menopause is the time period after a consecutive 12 month period without menstruation. Commonly, it was thought that menopausal and post-menopausal pain was age-related stiffness. However, recent research suggests that a reduction in oestrogen levels increases fascial density resulting in increased stiffness and an increase in the experience of pain(5). Fascia is a ubiquitous tissue. It exists everywhere in the human body and has been described as the ‘Cinderella of the orthopaedic tissues’ (6). It is also thought to be the largest human body system because it touches all other structures (7). Robert

femalephysiology MYO FA S C I A L PA I N & H O R M O N E S

Schleip, a well-known fascial researcher and bodyworker, discusses the entire fascial network as having 50 million more nerve endings than the skin and over 120 million more sensory nerve endings than the eye (8). The fascial system is totally integrated and is the immediate environment of every cell in the body. This tensional network can also adapt its fibre arrangement and density according to the local and tensional demands (9). The fascia is comprised of two main types of collagen, collagen I and collagen III. Type I collagen is the most abundant collagen in the body. It is found in tendons, skin, artery walls, cornea, the endomysium surrounding muscle fibres, fibrocartilage, the organic part of bones and teeth and scar tissue. Type III collagen is found in artery walls, skin, intestines and the uterus. It is also found in granulation tissue, the immature tissue that helps heal a wound. Collagen I provides the fascial tissue with strength and resistance to tensile stressors. In contrast, collagen III provides a degree of elasticity. The extracellular matrix (ECM) comprises collagen fibres, proteoglycans, glycosaminoglycans, elastin and fibronectin all creating a dynamic tissue environment. Fascia supports, protects, separates and binds all other body structures. The ECM also plays a contributing role in movement, coordination and function. The most simple analogy is to view the fibres and the ECM as a casserole dish of meat and vegetable stew in gravy. The meat is the collagen, the vegetables are the other fibres, such as elastin and fibronectin and, the gravy is the gel-like ground substance. The gravy connects all the components but, at the same time, creates separation. Fibroblasts, specialised cells, produce collagen within the fascial

tissues. Fibroblasts also produce glycosaminoglycans and proteoglycans for the ECM. You may know the ECM as the ‘ground substance’. Fibroblasts have receptors on their cell surface, allowing them to respond to their environment. Some receptors respond to hormone levels, including oestrogen and relaxin. Cell receptor signalling causes a cell to function in a particular way. Hormone levels within the fascial tissue will cause fibroblasts to produce more or less collagen, glycosaminoglycans and proteoglycans. In vitro (tissue specimens in a lab) research by Fede et al., (4) and (5), discovered that sex hormone levels did affect the composition of fascial tissues. They found that when sex hormone levels were decreased, collagen type I levels increased. Since collagen type I is involved in tissue stiffness, this research suggests that when women experience decreased sex hormones during menopause, the fascia becomes more dense. When fascia is dense, it compresses nerves, specifically nociceptors. When compressed, nociceptors respond to tissue damage and send action potentials via the dorsal horn to the brain that is recognised as pain. Additionally, dense fascia also increases the inflammatory response resulting in a chemical exchange

at cellular level where inflammatory cytokines stimulate and activate the same nociceptors sending a cascade of information to the brain resulting in pain. Further, when the nociceptors are continually bombarded with information, they experience an increased sensitivity which, over time, results in peripheral and central sensitisation. Both peripheral and central sensitisation are considered to be a major mechanism in chronic pain in the absence of tissue injury. Conversely, Fede et al., (4) and (5) also concluded that when sex hormone levels increased, the fascial tissues became more lax and elastic. Laxity was due to the resultant increased production of collagen type III and less collagen type I. However, it’s thought that collagen type I and III are not the only fascia related factors influencing pain in the fascial system. Increased production of glycosaminoglycans can also increase pressure on nociceptors. Glycosaminoglycans are large molecules produced by fibroblasts that attract water; as such, they are hydrophilic. When there is an increase in collagen type I, the glycosaminoglycans aggregate and mass together. A major role of glycosaminoglycans is to promote tissue glide. When the

Microfilaments (green), mitochondria (red), and nuclei (blue) in fibroblast cells

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femalephysiology MYO FA S C I A L PA I N & H O R M O N E S

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glycosaminoglycans are aggregated, they can no longer attract water molecules, resulting in tissue dehydration and less tissue glide. Less tissue glide and tissue dehydration are thought to play a significant role in Myofascial pain (10). Chronic pain is multifactorial. However, when hormone levels influence fascia, it does look possible that the resultant effect may influence the pain experience. Could this knowledge contribute to our treatments? Perhaps a pre-menopausal woman, including athletes, experiencing chronic pain could benefit from fascia orientated manual therapy when she is treated during her menstrual cycle. The positive effect may be an increased treatment outcome as her tissue may respond better, as it is suggested that the tissues are less dense during the menstrual cycle. The downside may be that some women experience more emotional strain during menstruation and suffer from menstrual pain that they may simply not be able to tolerate bodywork at that time. While these treatment considerations are plausible, individual assessment and communication is required as some women simply don’t like being treated when they are menstruating. Menopausal and post-menopausal women may benefit from more regular fascia orientated manual therapy treatments due to potential tissue density from a reduction in oestrogen levels. As 1 the fascial system is highly sensory in nature, chronic pain, including low back 2 and Fibromyalgia in menopausal and pain post-menopausal women, may be due to a decrease in oestrogen levels. However, 3 as osteoporosis is common in menopause

due to a reduction in oestrogen, local contraindications should be considered. Myofascial release (MFR) is an advanced manual hands-on therapy employing techniques thought to treat the fascial fibres and the ground substance. MFR doesn’t stretch the tissues. A low load pressure influence tissue change via the nervous system applying the Arndt Shultz Law, where less pressure results in increased tissue change. MFR also utilises fluid dynamics where gentle and sustained pressure exudes water (tissue fluids) from the treated tissue, somewhat like gently squeezing water from a sponge. It is thought that this fluid movement helps the tissue to reorganise encouraging cellular communication and tissue rehydration eventually reducing pain (9). Additionally, MFR also encourages a downregulation of the pain experienced by reducing the influence of the stress hormone cortisol thereby helping to regulate the Hypothalamic–pituitary–adrenal axis. There is still much that we don’t yet understand about hormones and their effects on the body. Fascial research has increased dramatically in recent years. However, to study fascia means that tissue is researched in vitro in a laboratory. As the fascial system communicates with every other body tissue, to research only one small part will only provide a hypothesis of the whole. Despite limited research, it is worth considering the role that hormones may play in Myofascial pain. It may provide answers as to why some female clients don’t respond as expected and how treatments may be adapted during menstruation, menopause and post-menopause.

1 IHME (2021) https://vizhub.healthdata.org/gbdcompare/patterns

2 NHS (2019) Fibromyalgia https://www.nhs.uk/ conditions/fibromyalgia/

3 Dehghan, F., Haerian, B. S., Muniandy, S., Yusof, A., Dragoo, J. L., & Salleh, N. (2014). The effect of relaxin on the musculoskeletal system. Scandinavian journal of medicine & science in sports, 24(4), e220–e229.

https://doi.org/10.1111/sms.12149 Our latest step in our mission to reduce plastic waste. 4 Fede, C., Albertin, G., Petrelli, L., Sfriso, M., Biz, C., De Caro, R., Stecco, C. (2016) ‘Hormone Receptor Either recycle or compost when empty, no more plastic to throw away! Expression in Human Fascial Tissue’, European

Journal of Histochemistry , vol. 60, nbr, 4, p. 2710. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5134680/. 5 Fede, C., Pirri, C., Fan, C., Albertin, G., Porzionato, A., Macchi, V., De Caro, R., Stecco, C. (2019) ‘Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production’, PLOS ONE,vol, 14, nbr. 9. https://journals.plos.org/plosone/ article?id=10.1371/journal.pone.0223195. 6 Schleip, R., Zorn, A. and Klingler, W. (2010) “Biomechanical properties of fascial tissues and their role as pain generators,” Journal of Musculoskeletal Pain, 18(4), pp. 393–395. doi: 10.3109/10582452.2010.502628. 7 Pischinger, A. 2007. The extracellular matrix and ground regulations: Basis for a holistic biological medicine. Berkeley, CA: North Atlantic Books 8 Lesondak, D, Akey, A. M. 2021. Fascia, function and medical applications. P. 61. Boca Raton, FL : Taylor Francis Group LLC. 9 Schleip, R., Findley, T.W., Chaitow, L., and Huijing, P., eds. 2012. Fascia: The tensional network of the human body. Philadelphia: Churchill Livingstone. 10.Stecco, C., Stern, R., Porzionato, A., MacChi, V., Masiero, S., Stecco, A., & de Caro, R. (2011).

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Eastern Massage Approaches BY R AC H E L FA I R W E AT H E R

This month in Massage World’s CPD section we will explore the exciting world of Eastern massage techniques with not one but 2 articles! Using principles of balancing energy through the meridians, Amma Fusion and Table Thai are 2 dynamic massage techniques that can be easily integrated with your existing body work for an effective and unusual treatment. The techniques are a lot of fun and clients love the deep but gentle pressure, balancing point work and exhilarating passive stretches of these approaches.

Meridian Magic! Using meridians & acupressure points in massage Why Use Meridians and Acupressure Points in Massage? Anna, one of my regular clients, staggered into my clinic looking tired and drained. Her new job involved a gruelling commute and long hours, leaving her with a sinus infection she couldn’t shift. An hour later, after a thorough treatment working her Lung meridian and relevant acupressure points on her face, she was bright eyed, decongested and relieved. “ I never cease to be amazed at what massage can do” she said- a great advert for me and for massage in general. John, a Jing trained massage therapist, does on site massage for a local company. Because of his knowledge of meridians and acupressure points he is able to provide not just chair massage, but bodywork on a massage table over clothes. His clients love being able to actually lie down and this enables John to do serious therapeutic work in the 20 minute treatments. Amma Fusion Meridian techniques as taught by Jing involve no oil and can be performed over clothes. This makes them perfect for on site situations or for clients who are uncomfortable removing their clothing. Vivian suffers from Chronic Fatigue Syndrome. She finds life a struggle and previous Swedish massage treatments have left her even more tired and drained. In 28

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contrast, treatments utilising Amma Fusion meridian techniques give her more energy and leave her feeling energetically balanced and able to cope with life. Again my knowledge of acupressure has enabled me to gain a regular client where I may have lost one. The above examples give you a few ideas of how Amma Fusion (meridian and acupressure massage) as taught by Jing is not just good for you but good for your clients and, above all, good for your business. As a bodyworker with 20 years experience in the industry, I know how hard it can be to build up a thriving practice. To do this successfully you need a toolbox of techniques and approaches that can help clients in many diverse situations. Amma Fusion has several benefits for you and your clients that can help you build the practice you desire:

◆ Amma is often successful in treating conditions that do not traditionally respond to

Swedish or other standard massage techniques. These include digestive complaints, colds, headaches, sleep disturbances, chronic fatigue, neck or back pain that does not respond to a muscular based approach.

◆ Amma can be performed over light clothing which is preferable for some clients. ◆ Learning to use your own body energy enables you to give a more effective massage with less work, saving your body and your career.

◆ Adding Amma fusion to your toolbox of techniques enables you to attract more clients and adds an extra dimension to treatment of existing clientele.

So what are meridians and acupressure points? Put quite simply, meridians are like the energy “super highways” of the body. The core principle of Traditional Chinese Medicine (TCM) is that health and illness are directly related to the flow of qi (energy) in the body. If qi (pronounced “chee”) becomes imbalanced in some way (ie: by becoming deficient, excessive or stagnant) dis-ease may result. From a TCM point of view, energy flows in channels known as “meridians”; traditionally there are 72 channels with 12 major ones used in acupuncture and bodywork. Amma Fusion techniques focus on balancing energy in the body by working these channels through palming/thumbing techniques and a series of dynamic stretches.

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What is Amma Fusion Amma fusion massage uses an exciting blend of the most effective Eastern massage techniques and draws from disciplines such as acupressure, table shiatsu and tuina. Utilizing the model of meridians, Amma is similar to acupuncture but uses the firm gentle pressure of hands. Amma can be used to treat conditions such as migraines, neck and back pain, sinus problems, digestive complaints, chronic fatigue, and in preventive health care. Systemic conditions may also be eased with this subtle and powerful technique. Amma is based on concepts of traditional Chinese Medicine (TCM); TCM is based firmly in philosophy and ones relationship to the universe. Amma focuses on the movement of qi; strokes take energy form the centre of the body out to the extremities. This in combination with pressure on certain acupressure points unblocks stagnant qi and increases health and vitality. Amma can be used as a stand alone technique or blended with other bodywork styles including myofascial release, stretching, other energy work and trigger point therapy. Amma Fusion also uses knowledge of recognisable points along the meridians where the energy can be easily accessed and balanced. These are known as acu-points or more commonly, acupressure points (“tsubos” in Shiatsu)

Try this! Sensing Energy Meridians are like magical underground energy rivers in the body. It can take time and patience to be able to feel them but if you try and tune into the meridians on every client you put your hands on you will soon start to get a sense of the presence of qi in the body.

◆ Sit quietly with your feet on the ground and tune into the sensation of your breath.

Follow your breath for several cycles as you feel your mind and body start to become still. Have your hands palm up in your lap. Imagine you are breathing energy up from the ground into your feet then into your belly. On the out breath imagine you are shooting this breath up the spine and out of the arms and hands. When you have got used to this sensation you may feel that your hands have started to get warmer or more tingly.

Principles used in Amma Fusion There are certain principles used in Amma Fusion that are common to all good bodywork. These include:

◆ Importance of grounding: To practise Amma

well you must understand what it means to be in touch with the ground, to be working from your ‘hara’ or centre of your body rather than your head.

◆ Principles of pressure: Good therapists always

use their body weight to apply pressure rather than muscular strength. This allows the qi of the giver and receiver to interact. Remember - “lean don’t press.”

◆ Bring your hands out in front of you as if you are holding a small tennis ball at the

level of your belly and see if you notice any sensations between your hands. Practice moving your hands different distances apart so the size of your “energy ball” changes from a tennis ball to a football to a beach ball. You may find with time that you feel a warmth or an attraction or a repulsion between your hands. This is what energy feels like.

Now see if you can feel energy in the body. Place the palm of one hand over the wrist (soft side) of your other hand and tune in. You may start to feel underground “rivers” of energy- these are the meridians. If you feel this, follow a channel along up the arm and see where it goes. Congratulations! You are entering the marvellous magical world of meridian massage!

◆ Listening to your client: Allow your hands and

whole being to tune into your partner. Connect with the heart and listen with your hands.

◆ Body Mechanics: Using the principles of tai chi move from your belly; let your legs and hips do the work. Focus your hara on where you are working. Learn the dance of massage, moving with fluidity and grace.

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◆ Bladder 2: This point is at the medial end of the eyebrow. Press up into the bone above the eye into a small depression.

Point for emotional balancing and release

◆ CV 17: This point is found on the breast bone at the level of the 4th intercostal space. It is great to finish a session by holding this point and with one hand and the other on the forehead.

Table Thai Massage– A Dynamic Fusion of East and West Why Table Thai?

Acupressure Party Tricks! Here are a few acupressure “party tricks” you can try out with your clients or family. These are effective points that can be used as “shotgun” techniques to achieve a certain effect. Great for convincing potential clients about the power of acupressure and bodywork!

Point for headaches, face and toothache pain A great point for any type of pain in the head or face is Colon 4 . To find this point work into the webbing between your thumb and first finger until you find a sore spot. Hold the point until the pain starts to ease. Co 4 is also known as “The great eliminator” so is also a great point for constipation!

Points for sinus problems or nasal congestion Try these points the next time you have a stuffy nose. ◆ Colon 20: Find the part of your nose that flares out and with your little finger find a hollow in the bone right next to the nostril. Hold the other side of the head with your other head and wait until the congestion eases.

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“Table “ and “Thai” – the 2 words don’t really seem to go together; Thai massage, like many Eastern techniques such as Shiatsu, is traditionally carried out on the floor on a futon enabling the massage therapist to optimally use their body weight to apply wonderful palming compression strokes and deep stretches. This contrasts with techniques such as Swedish massage, sports massage or remedial massage, which again for reasons of body mechanics, tend to work better with the use of a massage table. This often leads to a rather arbitrary division where massage therapists tend to practise one or the other of these massage styles without integration, even if they have training in both. there are occasions where pure technique is appropriate for but we can lose out on the potential benefits to our clients of combining different styles. This is one of the hallmarks of the “Jing” approach – a form of integrated bodywork where the practitioner is able to draw from a wide “toolbox” of techniques. We encourage combining styles in a creative way to give the client the best possible treatment for them. This is how you build a practice; this is how you retain clients week in week in out, year after year, and most of all this is how you stop yourself getting bored with your work. You can constantly reinvent the passion that drew you to bodywork in the first place.

Traditional Thai Massage vs Swedish Massage The casual observer of Thai massage may be surprised to learn that it is in fact an energy based technique. Traditional Thai massage is based on a very different “map “ of the body than Swedish based massage styles, taking as its starting point

a view of the body that is based on energy lines known as “sen”. It is important to note that, although there are similarities, these lines are different than the Chinese meridian lines used in shiatsu, acupuncture , tuina and amma. The aim of a Thai massage session is to balance energies throughout the body by working these lines through palming/thumbing techniques and a series of powerful stretches that resemble a kind of assisted yoga. In contrast the “map” employed by Swedish based massage styles is based on more familiar notions of soft tissue; our goal is to affect the muscles, fascia, tendons and ligaments. Swedish based strokes such as effleurage work to assist the circulation, the blood and the lymph flow, and are traditionally carried out in a direction towards the heart – exactly the opposite way to many Eastern based styles.

“The map is not the territory”- integration of East and West If you truly understand the essence of the different styles, East and West can easily be integrated to create a truly powerful bodywork that is unique in its own right. Although Swedish and Eastern styles are looking at the body in a very different and seemingly mutually exclusive way, they are only maps” of the body. As the great quote goes “ the map is not the territory’, here, the body itself is the “territory “. Once we develop our bodywork and knowledge skills we can understand our way around it with less need for “maps”. It’s a bit like trying to find your way around London, there are many different “maps of the city for different modes of transport, for example the A-Z which shows you how you can get around by foot or car; the bus map, or the map for the tube. If you don’t know the city its much easier to use only one “map” to navigate your way around. But when you know the territory itself, you can start to integrate different maps. You can get to where you want in the most enjoyable and efficient way; hopping from the bus to the tube; or deciding to get out and walk between tube and bus. Its no different with the body. This is the essence of true bodywork mastery. If you are well versed in different bodywork styles

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and understand their “essence” you can use whichever style will help that client most at that particular time and in most cases, blend styles appropriately. In relation to Table Thai this is exactly what we have developed at Jing. For the eclectic bodyworker. the wonderful techniques of Thai massage can be adapted quite easily into a Western system – the compression, and thumbing can be used to work muscles rather than energy lines and the fantastic yoga type stretches can used to increase flexibility and re-vitalise the body. More than anything, Table Thai is really a great excuse to have FUN with the body and we all need to have fun to prevent our practice getting stale.

Table Thai techniques One of the most basic Table Thai techniques is palming. Palming is a very versatile technique that can be used in many places on the body such as the back, buttocks or legs.

Palming Palming is used to warm up the body and open the energy channels. When palming, relax your hands and fingers, use the palm and heel of the hand and “fall” into your client’s body with your body weight. The amount of pressure that is needed will differ from person to person, body part to body part and with the same person at different times. At Jing we put a lot of emphasis on developing what we call “listening touch” – that is the ability to sense phenomena about the body, from the touch alone. The first step in developing your listening touch is the ability to sense how far the body will let you in, both physically and emotionally, without tensing up or registering pain. In Thai massage this is used to feel the energy and where it is blocked in the body. Imagine sinking down into your clients body, millimetre by millimetre, through layers of the skin, fascia , muscles and energy until you feel a barrier. If you wait patiently at this barrier you may feel the client let you in even further. This is the essence of working deeply without causing your client pain or expending too much of your own energy in the process –“work deeper not harder”. Remember that until you have developed your listening touch to a high level you should always check in verbally with your client about the pressure you are using.

Variations on palming There are 2 ways that you can use palming techniques while working on the table. One is to stand by the side of the table; the other is to actually climb on the table itself! The latter can seem scary at first but is actually a good way of working deeper with clients who require a lot of pressure. Palming from side of table: Client prone: Stand face on to the side of the table and place your hands on the opposite erector spinae making sure you are on the soft tissue and not on the spine. Lean in with your “listening touch” and sink down with both hands. Slowly “walk”down the muscles with your hands – you can take this stroke all the way into the buttocks and all the way down the hamstrings if you choose. Then move to the other side of the table and work the other side of the body in the same way. Palming while kneeling on side of table: Please note that although this technique is safe if done properly you should always follow any general health and safety precautions that may be operating at your place of work. Also always use your common sense as there may be some situations where clients may find this inappropriate. To palm from the side of the table simply kneel on the edge and in a “table top” body position, lean into the erector spinae with your listening touch as before. Keep your arms straight but not locked and slowly walk your hands down the back. If appropriate you can also straddle your clients body in a “lunge” position and do double palming down both erector spinae at once.

Want to learn more?

If you are interested in the integration of Eastern and Western techniques come along to our 4 day Amma Fusion course ( 2 x 2 day modules) or one day Table Thai course . These exciting classes will enable you to incorporate the wonderful dynamics of Eastern acupressure, meridian work and stretches into your existing massage work. East meets West – you know it’s the best!

About Jing

The Jing Institute of Advanced Massage Training is an organisation dedicated to excellence in all aspects of postgraduate massage training. Based in Brighton, we offer courses around the country. Our courses include longer qualifications in advanced massage including our revolutionary BTEC Level 6 (degree level) in Advanced Clinical and Sports massage and 1-2 day CPD courses in Hot Stone Fusion, trigger point, myofascial release, stretching, pregnancy, on site, living anatomy and many others. You can also check out the approaches discussed in this article in our DVD in advanced clinical massage techniques, downloadable from the website. Please call or check our website for further information and course dates. www. jingmassage.com  info@jingmassage.com  Tel: 01273 628942 You can also follow us on Facebook: Jing Institute of Advanced Massage Training or Twitter! @JingInstitute

R AC H E L FA I R W E AT H E R Rachel 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

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productreviews Thai Massage Dissected By Natasha de Grunwald Written by the UK’s leading teacher and practitioner Natasha de Grunwald, a pioneer of Thai massage and bodywork for 30 years. Thai Massage Dissected is a book aimed at massage therapists, yoga teachers, physiotherapists, osteopaths and all manual therapists who want to expand their therapeutic approach and are curious to learn about the body from a Thai anatomy and dissection perspective. Therapeutic Thai massage and bodywork is a rich and diverse modality, so much more than the stretching and deep tissue work for which it is known. The book provides a richly curated combination of tools, techniques and protocols that will enhance all practitioners’ skill sets. Natasha discusses the roots of this modality as Buddhist medicine, the five element system, the use of therapeutic herbs and Thai anatomy, whilst also writing about concepts such as proprioception and interoception. There is an additional chapter looking at traditional healthcare practices for women, informed by her time spent with village midwives on the Thai/Burmese border.

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Natasha de Grunwald uses imagery from many hours spent in a cadaver lab to describe anatomical, textural layers and structures, bringing human form to life. She consolidates this with a therapeutic perspective on Thai medical theory and how Thai massage and bodywork can be carried out in a clinical setting. This comes from her extensive research, studies and knowledge spanning over three decades.

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Temporary Work in the EU? BY C L A I R E S Q U I R E

In the heady days of 2019, a UK massage therapist who wished to do a summer season working at a spa in Greece, a yoga teacher wanting to take a group to Spain or a bodywork practitioner wishing to provide treatments combined with extra study in France could more or less just jump on a plane and go. Whether they could legally work within the EU, wasn’t something that needed to be thought about. Today, Covid aside, Brexit has changed that landscape entirely.

hilst the global pandemic has rightly taken the focus over the last 12 months, negotiations regarding the UK’s exit from the European Union (EU), fell out of the spotlight. The consequences of this are that many may not be fully aware of how the changes will impact until they have to deal with them.

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This article aims to shed light on some of the areas that UK health and wellbeing practitioners who wish to work for temporary periods within the EU now need to consider. It is intended for guidance only, rather than as definitive advice. The situation is complex, and many matters are still evolving as the relationship between the UK and EU develops.

WORKING IN THE EU

The UK / EU Brexit negotiations that concluded in December 2020 focused on trade between the two parties rather than services. The free movement of people, which is one of the four pillars that the EU stands on, is something that the UK specifically wished to opt-out of. As a result anyone from the UK wishing

businesstools T E M P O R A RY W O R K I N T H E E U ?

to work in the EU, even for temporary periods, now falls into third country status. Essentially this means if you wish to work in the EU, you need to follow the regulations of the individual Member State you’re aiming for. The European Federation for Complementary & Alternative Medicine (EFCAM), have been seeking EU wide recognition for the provision of Holistic Therapies by properly qualified practitioners, however this has yet to happen. In addition, a number of EU Associations for specific modalities are working to have training for their therapy recognised under the European Qualifications Framework, although again none have yet been finalised or agreed. As a result, most health and wellbeing professionals who wish to work in the EU on a temporary basis, must check if their professional qualification will need to be specifically recognised and if they require a work permit or visa, for every individual EU country that they wish to work in. In addition, it will be essential to keep this under review, as the situation may change from one visit to the next.

R EG U L AT E D PROFESSIONS

As the UK is now considered a ‘third country’ to the EU, it is a requirement for anyone who holds a regulated professional qualification, to get this recognised by the individual member state they wish to work in, before they are able to practice that profession within the EU. Details may be checked in the EUs Regulated Professions Database (see links below). Although UK information is no longer updated, it will give an indication as to whether specific qualifications are required for a particular trade or not. Please also note, that individual Member States may have different criteria to the UK for what is a ‘regulated profession’, and it will be for the therapist to check this prior to travel. For those health and wellbeing professionals that are regulated within the UK, the situation is complicated in that there are no pan European regulations for such therapies. Indeed, in certain EU countries, the practice of therapies such as

Homeopathy, Acupuncture, Chiropractic, Osteopathy and Physiotherapy can only be performed by medically qualified doctors, whilst in others, there is no requirement for regulation. It will therefore be a matter of checking the regulations for the Member State you wish to work in and gaining recognition, where relevant, before you are able to practice. Do you need a work permit/visa? According to the Foreign Travel advice on gov.co.uk UK Citizens who are providing services in another country as a self-employed person may need a visa, work permit or other documentation, regardless of their length of stay. Again, the rules of this in the EU are determined by the individual Member State, and although there is a link available on the UK Government site, as one may imagine, it doesn’t give a simple yes / no answer. Time and research will be required, ideally with the embassy of the country you wish to work in, as they will have the most up to date information regarding requirements. Where visas / work permits are necessary, these will likely be the responsibility of the employer when an offer of temporary paid employment has been made, or up to the individual when working on a self-employed basis. Either way, they may take time to organise, and this should be factored into the planning process for any trip.

OT H E R CO N S I D E R AT I O N S

Professional Liability Insurance and Retreats Insurance Does your Professional Liability Insurance provide cover for temporary work abroad? Most are likely to include this as part of the standard terms of the policy, but it is worth checking if you will be relying upon the protection for any claims brought by EU citizens. Where cover is not included as standard, it may be available as an added extension for an additional premium. These policies will however include a criminal acts exclusion, which is likely to be invoked if you are not legally allowed to work within the country.

If you are organising a trip for feepaying clients that involve two or more elements organised by yourself (i.e. accommodation and treatments), you may incur additional liabilities as you are considered to be acting as a tour operator under the 2018 travel package regulations. As such, it is worth considering specialist insurance cover to meet this need. This has perhaps been brought home to us all over the last 12 months, with the impact of the global pandemic on travel and events. Your Insurance Broker should be able to assist with this cover. Data Protection For most UK based therapists there is a condition within their Professional Liability Insurance policy for them to take records of any treatment they perform, this requires the holding of personal information, potentially including special category health data. Whilst the UK was part of Europe, the data could be transferred between member states without issue. The aim is for this to continue but has yet to be confirmed. The UK Government enacted the General Data Protection Regulations (GDPR) into UK Law with the 2018 Data Protection Act. A temporary bridging mechanism came into place on 1st January 2021 to allow for the continue flow of data post-Brexit. Currently, we are awaiting a confirmation that a draft adequacy decision will be accepted by the EU parliament, that, subject to the two regimes staying aligned, things will continue unchanged. This is one to watch as the ICO note If adequacy decisions are not adopted at the end of the bridge, transfers from the European Economic Area (EEA) to the UK will need to comply with EU GDPR transfer restrictions. Legacy Data i.e. data from any EU citizens that may have been taken prior to 31st December 2020 will be processed under the rules of the ‘Frozen GDPR’ or regulations as they were at that time. For therapists, this will give comfort that they are able to legitimately hold records from previous EU clients without having to do anything further. ISSUE 112 2021

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C H EC K LI S T ◆ Do you have a professional qualification that needs recognition?

Your Healthcare Your own health care when working in the EU is equally important to that of your clients. EHIC – European Health Insurance Cards that are within date are still valid to cover state-run health care, typically emergency health care for UK citizens who are visiting/travelling in the EU. The EHIC card has been replaced by the GHIC (Global Health Insurance Card), which is available for all UK residents. Whilst an E/GHIC will cover you for emergency healthcare matters, it is also worth considering a travel insurance policy if you will be working in the EU. These are useful, particularly when considering larger expenses, e.g. repatriation as a result of missed flights due to medical stays etc. Please be aware that as a result of the global pandemic it is likely that Covid exclusions will become commonplace in these types of insurance policies. Driving Although some exceptions may apply, typically you will not need an international driving licence whilst driving in the EU post-Brexit. You will need your driving licence with you, together with a hard copy ‘green card’ for the vehicle you are driving. The green card is proof that you have motor insurance and can be obtained from your insurance provider if using your own vehicle. Passport And finally, remember to check your passport is in date with at least 6 months left before you go, the last thing you will want is to arrive at the airport and discover you won’t be able to travel as your passport has run out! In summary, whilst there are many additional hurdles that health and wellbeing professionals will need to manage when working in the EU postBrexit, the option is definitely still there. A summer season at a Greek spa resort, or organised trip to Spain are definitely still options, for the health and wellbeing professional willing to put in the extra effort to achieve them. 36

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◆ Do you need a visa or work permit? ◆ Does your Professional Liability Insurance cover you for

temporary work abroad and/or do you need retreats insurance or similar?

◆ Have you double checked data protection legislation? ◆ Have you got an E/GHIC and relevant travel insurance? ◆ Have you got your driving licence and green card if relevant? ◆ Is your passport in date?

LI N KS A N D F U R T H E R I N FO R M AT I O N : Regulated Professions: Regulated professions database - European Commission (europa.eu) - https:// ec.europa.eu/growth/tools-databases/regprof/ – Osteopaths see: Home - General Osteopathic Council (osteopathy.org.uk) and Regulation in Europe | EFFO – Chiropractors see: General Chiropractic Council | GCC (gcc-uk.org) – EFCAM - Welcome by the EFCAM President - EFCAM Brexit Transition Checklist: Brexit - GOV.UK (www.gov.uk) https://www.gov.uk/transition Brexit checker results: what you need to do - GOV.UK (www.gov.uk) Do you need a visa to work in country: Foreign travel advice - GOV.UK (www.gov.uk) https://www.gov.uk/foreign-travel-advice Business Travel requirements: Visit Europe from 1 January 2021: Business travel: extra requirements GOV.UK (www.gov.uk) https://www.gov.uk/visit-eu-switzerland-norway-iceland-liechtenstein/businesstravel-extra-requirements Data Protection: UK businesses and organisations with a European presence or European customers | ICO www.ico.org.uk/dpbrexit

CLAIRE SQUIRE Claire is the Business Services Manager at Balens, with oversight responsibility for areas as varied as Marketing, Events, Facilities Management and Training. Claire has been with Balens since 2009 and has an Honours Degree in Hospitality Business Management. She has a background and personal interest in Health and Wellbeing, completing various courses and training in the sector. balens.co.uk

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When Chest Pain Is Not Due to Heart Problems BY A M A N DA W H I T E

“As I clutched my chest, as the pain shot around my ribs and into my shoulder, I thought Oh God! I took myself to the emergency clinic, as every sensible person would. The Accident and Emergency department did a full heart screen on me and said that my heart looked fine, which was a great relief. So, I asked why am I getting this pain and they said it might be muscular and stress-related. I had been gardening when it started, so they asked if I had moved awkwardly? I thought about it and it was possible. I left with painkillers, but I was still in pain!

uckily, I had learnt a back technique called SKART. I got my husband to help me test my back and discovered that my thoracic area was showing that the vertebra was out of place in a couple of areas. So, we treated this area putting the vertebra back into place, then we checked it again and showed the correction had held. We also used some magnet plasters on either side of the spine to ease the spasm. I instantly started getting some relief as the pain spasming around my ribs went down to a dull ache and then by the late evening had gone completely. What a relief this was.” Muscular chest pain or chest-wall pain is quite a common issue in the thoracic area of the back, which can cause referred pain to the chest area. Chest muscles can get

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strained or sprained. It can be made worse by coughing, sneezing and moving. The spinal cord supplies nerves to and from the body where signals meet.

Does having chest pain mean I am having a heart attack? Thousands of people have received relief and alleviation of symptoms of chest pain by a correction of neck and back adjustments. Yes, always get checked out by your GP or A&E but if your heart is fine consider it coming from your spine and radiating round.

Can indigestion be mistaken for a heart attack? Yes, but a heart attack can also be mistaken for indigestion so always get checked out! Seek medical help if you experience severe

pathologyinsight W H E N C H E S T PA I N I S N O T D U E T O H E A R T P R O B L E M S

chest pain or you have vomited with specks of blood or blood that has the appearance of coffee grains.

upright position. Get checked out for food allergies and cut down on spicy, fatty food, alcohol and stimulants.

What is indigestion?

Is my chest pain coming from my heart?

Indigestion is the term used to describe pain and discomfort in the upper abdomen or chest area, most common after a meal but can occur any time during the day. Heartburn is a burning sensation that can be felt in the ribs and chest area behind the breastbone and is due to the stomach contents coming back up the gullet. With indigestion you can also have wind, bloating, belching, burping, nausea, vomiting and loss of appetite.

◆ Stomach ulcers

Heart pain, known as angina, occurs in the middle of the chest, where the breastbone is and then spreads out. It can feel like a heaviness or a tight band around your chest. It can radiate to your neck, jaw and arms. Angina is typically worse with exercise and improves with rest. In first aid they recommend you chew an aspirin. This can make the blood less sticky as long as you are not allergic to it and it does not counteract with any medication you are on. Always get checked out by a Dr or A&E once given the clear then check other causes.

◆ Dietary factors

What is the difference between angina and a heart attack?

What are the causes of indigestion? ◆ Structural problems of the neck & diaphragm ◆ Stress and anxiety ◆ Some drugs

◆ Rib fracture

◆ Chest pain can also come from the liver, gallbladder, breasts or even bowels ◆ Chest infection such as pneumonia or flu can give you pleuritic chest pain

Pleuritic chest pain is localised to one side and feels sharp. It is made worse by taking a deep breath. It also occurs when you get a clot on the lung known as a pulmonary embolus, which would be accompanied by breathlessness. The vertebra that connects to the phrenic nerve is in the neck area between the shoulders. This nerve connects to and controls the diaphragm. If the neck is out of balance it can trap the nerve. The weakening of the nerve can lead to a weakening of the diaphragm. If this is weak it allows the stomach to push up into it. If nothing is holding the stomach down, it allows food back up causing symptoms of indigestion and in extreme cases nausea.

What can I do to avoid getting indigestion? It is important to have your back and neck checked regularly. It also helps to eat regular meals and slowly chew your food. If indigestion occurs at night, sleep in a more

A heart attack is not relieved by rest or aspirin. The symptoms are similar, but you feel worse and may also feel sick, cold and sweaty. If you experience these symptoms you must call 999. “I experienced chest pain for many years. I did the normal thing and went to my Doctor who performed all the tests on my heart, and they came back clear. It used to come and go but it was worse when I wore a bra and I found deep breathing uncomfortable. I tried treating myself for indigestion with tablets that my pharmacist recommended but I had no improvement.

So, what was causing my chest pain?

I chose to visit a SKART Therapist who suggested my chest pain could be referred pain from my spine. I was sceptical but accepted treatment. She said the referred pain was where the pain is felt in an area that is distant from the underlying cause, such as the spine. I was amazed at how quickly I recovered after having the pain for so long. After three treatments I was completely pain-free, and even after the first treatment I noticed a difference.” Structural Kinesiology Acupressure Release Technique (SKART) is a cuttingedge new diagnostic and therapeutic technique that is designed, trialled and used for the efficient management of back, neck, hip, and leg pain. It is a gentle, non-

invasive, safe and effective approach. Through this course, you will learn to solve muscular and nerve-related chest pain issues using effective, practical, safe, non-forceful and gentle correction techniques. SKART enlightens you in using the muscles as diagnostic tools to access the most appropriate treatment for the body. This is accomplished by finding the exact pain site and then being able to treat it effectively so that the pain is cleared. Using SKART to find imbalances and issues through muscle testing helps to remove any doubt, guesswork and the hard work of subjective diagnostics. SKART is a bespoke online course that has been designed for those of you who are looking for an exciting and rewarding new career in healthcare. As well as those who are already treating patients and wish to add a new therapeutic and diagnostic tool to their skill set.

A M A N DA W H I T E Amanda is a Registered General Nurse, Licenced Acupuncturist, Cert Education, Health Consultant, and the founder and CEO of SKART International Ltd. Structural Kinesiology Acupressure Release Technique (SKART) is a cutting-edge new diagnostic and therapeutic technique that is designed, trailed, and used for the efficient management of back, neck, hip, and leg pain. During her career in nursing (RGN 1989), Amanda developed ME & back problems. This sent her on a journey of discovery. From there, she travelled to China to study basic acupuncture with a group of trainee doctors. When Amanda returned, she completed 3 years of training to become a qualified acupuncturist (British Acupuncture Association) in London. Amanda has been on a lifelong journey into complementary therapy, searching for answers and cures. She has also trained as an Advanced Kinesiologist, Reiki Master, NLP master practitioner and EFT therapist, whilst curing herself of several issues along the way. To share her passion and knowledge, she chose to qualify as a certified teacher (Cert Ed) so that she could start training other individuals in these subjects, that she feels passionate about. Want more information and inspiration on anything discussed? www.myskart.org | info@myskart.org

ISSUE 112 2021

An Introduction to Tissue Mechanics

The Missing Link! BY S I M O N W E LLS T E D

Tissue mechanics is a term you probably haven’t heard previously, but it is fundamental to what we all do as soft tissue therapists. My name is Simon Wellsted, and I am a sports therapy professional specialising in the systemic relationship between tissues, movement systems and injury. I do this through the lens of 3 very closely integrated and fully evidenced sciences called tissue mechanics, clinical biomechanics and pathomechanics, which together, deliver a 100% modality- and discipline-neutral perspective of the human body.

e need all 3 sciences, but this article introduces the first of these - tissue mechanics, without which the other 2 are meaningless. You might recall I wrote an article in Issue 106 of Massage World Magazine back in 2019 all about integrated thinking and working? The science of tissue mechanics is central to the delivery of the integrated thinking and working I discussed in that article, as well as significantly increasing our clarity and understanding about what is going on, why things are happening and what needs to happen next.

S O, W H AT I S T I S S U E M E C H A N I C S?

Looking at Diagram A, you’ll see that tissue mechanics is a science that explains what is going on inside muscles. It is a great deal more than this, but at a fundamental level, this is what it is. And, as the diagram shows, the other allied sciences take what tissue mechanics is telling us, going deeper and further to explain what is happening inside the wider body to deliver the tissue mechanics information we are finding. 40

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I’m already hearing you shout out “I already know what’s going on inside muscles”! Here’s the rub: There is no such thing as “just tight” or “just weak”. The adjectives we typically use to describe what is going on inside muscles e.g., “tight”, “weak”, “stiff”, “over-active”, “under-active”, “strong” and many others, are, without context, completely meaningless. Why? Because the science of tissue mechanics

tells us that there are multiple “types” of tightness and weakness. Moreover, each of these different types indicates a different intervention strategy. So, just because it’s “tight” doesn’t mean we should automatically dive in to stretch or release it and just because it’s “weak” doesn’t mean we should automatically dive in to activate, strengthen or condition it. Indeed, there is NO issue for which the

tissuematters AN INTRODUCTION TO TISSU E M ECHAN ICS

correct initial intervention is stretching, releasing, activating, strengthening or conditioning. We need a lot more information about what is going on inside tissues before we can be certain what the correct intervention is for the “type” of tightness or weakness we are seeing or feeling. And it’s the science of tissue mechanics that gives us this crucial information.

W H AT D O I M E A N BY “A LOT M O R E I N FO R M AT I O N ”?

Let me ask you a question … when we palpate tissues and feel tightness, what exactly are we feeling that is delivering the sensation of tightness? Let’s take a step back. What does soft tissue therapy such as massage DO? … we create tissue change, yes? But what tissue changes are we delivering with the various massage techniques we use? Remember, tissue mechanics tells us that there are numerous “types” of tightness, weakness and other tissue “states”, with each type presenting for a different reason and each requiring a different intervention. These different tissue mechanics “types” tell us what changes have occurred inside tissues and consequently what changes need to be applied to any given tissue to rectify what has happened. Each client situation will be unique because each client we see will potentially be presenting with different combinations of “types” of tightness and weakness across their body. So, we need this “tissue change” information, and tissue mechanics provides this.

W H AT D O I M E A N BY D I F F E R E N T “ T Y P E S ”?

To understand this, we have to dive a bit deeper. When we massage any tissue, we are delivering physiological change, biomechanical change and neurological (neuro-signalling) change. But what combination of physiological change, biomechanical change and neurological change is needed for any given tissue, on any given day, for any given client?

Each “type” that tissue mechanics tells us about comprises a different mix of physiology, biomechanics and neurological patterning (the tissue mechanics signature). Can you now see that simply saying “it’s tight” or “it’s weak” doesn’t go anywhere near deep enough? We need to know the tissue mechanics signature for each individual tissue we are looking at.

W H AT D O E S T H I S M E A N FO R CO M M O N TOO LS W E A LL U S E?

Tissue mechanics puts rather a different perspective on common concepts and tools upon which we all routinely rely, such as: ◆ Postural assessment and analysis ◆ Movement assessment and analysis ◆ Clinical “special tests” ◆ Various models describing muscle ‘syndromes’ (e.g., upper cross or lower cross syndromes) The above tools and concepts all reside in the bottom layer of the pyramid in Diagram A. We can “see” what is happening for sure, but without tissue mechanics (and the layers above), we lack clarity or certainty about what is going on. We cannot, for example, observe somebody’s posture and make any assumptions about: a) What is going on physiologically, biomechanically or neurologically inside tissues, b) Why this is happening, and hence c) What needs to happen to those tissues. A classic example is protracted (rounded) shoulders which are often attributed to “tight pecs”. Before we tell somebody to stretch their pecs back by rolling their shoulders (or dive in to release the pecs with manual therapy) we need to understand what combination of physiological change, biomechanical change and neurological change is taking place inside these pecs. Also, we cannot generalise about muscles that are often combined through some of the muscle syndrome models we are taught to use, where we may say “X

and Y are tight” and therefore “A and B are weak”. We just don’t have sufficient information to formulate any clinical reasoning here. This applies just as equally to exercise and movement disciplines as it does to soft tissue and manual therapy disciplines. Tissue mechanics gives us the crucial additional information we need, whether we are a personal trainer, a Pilates teacher, a sports massage therapist or any other manual or physical therapist. I coach ALL of my clients (exercise, movement, manual therapy or physical therapy) to understand tissue mechanics, how to read what tissues are telling us, what various tissue mechanics signatures mean and hence what interventions, whether exercise, movement or manual therapy, are indicated.

O K , S O LE T M E T H R O W A N OT H E R C U RV E B A LL I N TO T H I S D I S C U S S I O N .

Tissue mechanics signatures almost always differ from left to right! So, with the pecs example, the left pecs are very likely to present with a different tissue mechanics signature to the right. And similarly, with every other muscle in the body. Therefore, the required intervention is going to be different on each side, for any given tissue. If the tissue mechanics signatures are different on left and right, each requiring different intervention strategies, do you think exercises such as squatting, lunging, stepping or bridging or doing the same type of manual therapy intervention on each side is going to get the best results for clients? This was the root of my problem when I sustained my back injury during a Badminton match ~30 years ago. I knew nothing about all this; indeed, I wasn’t even in the industry at that time. But neither did any of the professionals I consulted either. None of these professionals understood that coming in at the bottom of the pyramid, starting from a position of “not knowing”, and taking the time to systematically work out what was actually happening inside my body – starting with tissue mechanics – would enable them to better understand the environment that resulted in my injury. I now know precisely what that environment was, and hence exactly ISSUE 112 2021

tissuematters AN INTRODUCTION TO TISSU E M ECHAN ICS

why my injury occurred. Contrary to popular belief, injury doesn’t “just happen”! It is the environment inside the body that ‘choreographs’ an injury over a period of time. If the tissue mechanics signatures in my own body had been picked up and understood long before I sustained my injury and addressed with the correct exercises and manual therapy interventions, the environment inside my body would have been totally different and the likelihood of me sustaining my back injury would have been significantly reduced.

What’s really interesting is trying the above, intervening with your normal massage therapy technique, and then repeating the listening procedure. Do you pick up any changes in tissue mechanics signature response before and after?

LE T M E G I V E YO U S O M E T H I N G TO T RY

LE T ’S W R A P U P

I can’t teach you to understand tissue mechanics, what various tissue mechanics signatures mean and what to do about all these in a 2000-word article. What I can do is give you something to go and play with that will hopefully demonstrate what I am talking about. We’ve all learned to palpate tissues, but earlier in this article I mentioned that I teach all of my clients how to read what tissues are telling us, and this ‘listening to tissues’ is the key here. 1. Place a single hand on a specific muscle. Pectoralis major (or minor) or Gluteus Maximus are great starting points. 2. Orientate your hand along the muscle body fibres of the chosen muscle. 3. Very light contact is required. 4. Ask the client to “recruit” the specific muscle under your hand, very lightly, with no more that 10% effort (you might need to coach the client how to do this, as they might not know how and will almost certainly want to give you far more than 10% effort). 5. Focus your attention and listen through your hand. 6. Ask them to hold the 10% recruitment for about 4 – 5 seconds and then let the contraction go. 7. What do you feel at the precise point the client tries to recruit the muscle? 8. What do you feel during the 4 – 5 second recruitment 9. What do you feel when they release the recruitment? 10. Perform exactly the same procedure on the left and on the right. 11. What differences do you pick up? It takes practice to pick up really subtle differences BUT don’t keep repeating it on the same muscles over and over, move to a different muscle or try again tomorrow. 12. If you picked up differences at this really low level of contraction then you are picking up different tissue mechanics signatures; differences in physiology, differences in biomechanics and differences in neurological patterning.

When dealing with what are generally considered niggles, such as persistent tightness, persistent weakness and many other muscle misbehaviours, understanding the tissue mechanics signature of muscles gives us crucial information regarding what is going on and what we need to be doing to address these issues. Also, returning to my article I wrote in Issue 106 of Massage World, helping exercise professionals to understand the tissue mechanics signatures in their clients’ tissues helps them better understand why clients might be struggling with certain exercises or why they are regularly returning with the same muscle misbehaviour issues. If clients keep returning to you with the same muscle misbehaviour issues over and over again, ask yourself the question, “What tissue mechanics might be at play here?”. I invite you to get much more proactive, analytical, strategic and ‘diagnostic’ in understanding the tissue problems your clients present with. Tissue mechanics gives you the understanding, skills and tools to achieve this.

13. These differences tell us that different interventions are needed to address what is happening within these muscles.

If this has resonated with you and you’d like to have a chat about what I’ve opened your eyes to in this article, then please do contact me – my details are below. I also run a private Facebook Group where I regularly discuss these topics https://www.facebook.com/groups/ TheIntegratedFitpro. And other learning resources are available at https://learning.theintegratedfitpro.com 42

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light. Being rechargeable and portable, photizo is another tool for a therapist to enhance a treatment session. Photizo is even small enough to tuck in your therapy bag.

What therapists love about Photizo is that it is a truly holistic tool as photobiomodulation is wonderfully free of side effects. Photobiomodulation utilises the healing power of red and near-infrared light which has proven to be effective in accelerating the natural healing processes. One primary mechanism with PBM is stimulating the receptor Cytochrome C Oxidase which leads to increased ATP production in the mitochondria. It became officially classified by MeSH as Photobiomodulation (PBM) in 2015. Restoring ATP production in compromised cells throughout the body helps every cell to recover and function at their best, encouraging the body to achieve optimum health naturally. PBM is currently the most studied area of photomedicine. In addition to enhanced healing of tissue trauma, empirical studies show amazing improvements in skin health, collagen production, physical performance and muscle recovery. Emerging studies are showing there is now valid consideration for using PBM proactively which means if you are treating athletes, this modality could help to minimise delayed onset muscle soreness when used prior to training sessions There’s also plenty of clinical evidence and real-world proof that red light therapy is extremely effective in relieving pain caused by underlying health conditions or injuries.

The undeniable effects show PBM can help enhance any massage technique to penetrate deeper into tissue by improving blood circulation, lymphatic flow and fascia release. The effects of PBM accelerate the natural repair process throughout all stages of tissue healing. More recent research shows integrating red and near-infrared light at the right dose can also help with hair regrowth, sleep, stress, cognitive function and mental health. Unlike laser light devices, LED technology is not harmful to the skin or the eyes, and there’s no need for cumbersome protective eye wear. The Photizo Sport model dosing is appropriately configured for application on acute injuries to help in any musculoskeletal sports injury rehabilitation programme. The Pain Relief model emits a stronger dose of light for chronic pain conditions. There is also the Skincare version for wound healing and the anti-ageing beauty device, Blush. The Photizo Homecare range lights the way for the use of this amazing holistic modality in an affordable tool for everyone.

Find out more about Photizo and reseller opportunities: www.danetrehealthproducts.com

ISSUE 112 2021

Is Your Treatment Table a Liability? BY G R EG CO U G H L A N & M A R IA G R I F F I N

Treatment table accidents have been on the rise in recent years according to insurance companies. Thankfully at Massage Warehouse, we haven’t had direct experience of claims but after hearing about the problem, we wanted to help the industry overcome it. To get an idea of what is happening we spoke to insurance companies and we also reached out on social media to ask the community if they have had any insurance claims due to accidents.

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What is happening?

Mel, a mobile therapist from London had an accident with her table after only the fourth use. “The fourth time I went to use the couch, my patient was getting off after the treatment finished and it went down on the side she was getting off on with a loud bang. The corner of the frame had cracked and the table and the client fell to the floor. There was an umbrella stand which the table crashed into, tearing a hole in the couch. My client also hurt her shoulder as she tried to break her fall to the floor. As well as possibly losing her as a client I was without a table for 5 days and had to cancel all my clients costing me over £500 in lost treatments. For months, I was worried my client would make a claim against me but thankfully she didn’t. I offered her a month worth of free treatments which may have prevented that happening. As well as the lost cost of my table, the cancelled clients and the free treatments, the incident cost me over £800 and if I had just spent half of that on a proper table, all this could have been prevented. It was a very stressful time” Mel told us she bought her table online for under £100. She liked how light it was and couldn’t find a lightweight mobile table with a low price. After this experience, she replaced the table and choose to pay close to £400 for a professional table with a good back up guarantee.

theindustry I S YO U R T R E ATM E N T TA B L E A L I A B I L I T Y ?

Doing some research on the topic, and from speaking with the insurance companies to gather more info on the problem, it seems the accidents are occurring on the cheap budget tables you typically find on large e-commerce websites that sell anything and everything and are not specialists in any area. And with the population as a whole getting heavier, there also seems to be a trend towards accidents happening with heavier clients and, more often than not, the accident happens at the end of the treatment when they are getting off the table. After researching budget tables on the market (we classed budget tables as tables up to £100 and professional grade tables over £250), the reviews seem to back the findings up with numerous complaints of tables collapsing not long after purchase.

The Consequences of not paying enough!

Cutting corners and choosing the wrong treatment table will save you money initially but in the long run, it is actually a false economy and may well cost you multiples of what you saved. We like to say buying a table is like buying a pair of shoes, the fit must be right! You can buy a cheap pair of shoes or a high-quality pair with a higher price tag. They will both get you from A to B walking, just like you can give a treatment on any treatment table. But the journey will be very different with the more comfortable shoes and the treatment experience will be very different for both the client and therapist with a high end professional table. If your client has visited a therapist owning a very comfortable table with excellent foam comfort and stability,

they will notice the difference if your table lacks in these areas and they may well have a different experience during your treatment. From my own experience, I once went to a new therapist in Cardiff and they were using a cheap bed and it was very narrow (non-specialist retailers like to reduce manufacturing costs by reducing the table size). For the entire hour I couldn’t relax, both with my shoulders hanging off the edges and the instability of the table. He was a good therapist but I didn’t book again because of the table. Besides of the inferior treatment experiences a cheap table will offer, if things do go wrong and it breaks you will most likely need to cancel your bookings for the following days unless you have a backup table or can borrow one quickly. Researching options for a new table and getting a table delivered could take up to

securely with a hinge across the middle of the table. There are different types of hinges such as flat hinges which you find on a normal door in your home –these are normally the ones used on budget tables and are the most likely to allow the table to collapse if overloaded. Then there are piano hinges, which run the entire length of the middle of the table, and finally there are U - shaped hinges which wrap around the frames of the table to make it join in the middle and make it very difficult to collapse. Even if the price difference between the different types hinges is only 20p, to a factory producing hundreds of thousands of tables a year for retailers around the world, that amounts to a considerable saving of £10,000s in just one component alone! Manufacturers want to keep costs down on their end, and unless the retailer you buy from is a specialist with experience and a good reputation on the selling side, they won’t know the importance of using the proper components for the tables they

a week. That is a lot of income lost. That is the best-case scenario. If your client gets injured you face a loss of reputation, bad reviews which are publicly available for the life of your business and the possibility of an injury claim. I think any therapist who has gone through a table breaking or collapsing would gladly go back in time and spend more money on the best table they can get. In hindsight, everything is much clearer!

sell and they won’t have the many years of experience in knowing what to look for when choosing which tables to sell. To join legs to a wooden frame, you need good quality components so there is no noise or squeaking and very robust stability. The wood on different tables may look the same to a therapist but there are different grades and strengths of wood. Good brands choose the best wood so tables are less likely to break. All these higher quality components cost extra which essentially makes for a higher priced table along with the better-quality upholstery, foam and all-round build quality. The cheaper tables tend to have very thin wood which can’t withstand much force being pushed into it and splits over time.

Table basics

The two areas of a table which are most likely to break on a budget table are the middle of the table where the two halves are joined and each of the four corners where the leg joins the frame. To make a portable table, two wooden or aluminium frames need to be attached together

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theindustry I S YO U R T R E ATM E N T TA B L E A L I A B I L I T Y ?

I think we are seeing a rise in accidents because more student and newly qualified therapists are choosing budget tables from nonspecialist retailers, the population as a whole is getting heavier and the increase in popularity of mobile treatments which require lighter treatment tables.

Why is it on the increase?

I think we are seeing a rise in accidents because more student and newly qualified therapists are choosing budget tables from non-specialist retailers, the population as a whole is getting heavier and the increase in popularity of mobile treatments which require lighter treatment tables. The combination has created a situation that needs to be addressed. Treatment tables do have weight limits, and it’s important that therapists can find a way of discussing this with their clients, should they have concerns that the limits may be exceeded. Also, an important thing to note here is that a weight limit is not necessarily about the weight of the client. Most treatment tables can take a lot of weight – up to 300kg or 25 stone. But this weight needs to be evenly distributed. 46

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So, you could have an average weight person on your table who can still end up breaking it because the weight has to be distributed evenly across the whole bed and not all of the weight put into one point of the table. Heavier clients can be less agile so their movements on and off the bed use more force or they just don’t know any better. Over time, all these movements of force in one point of your table can put extra loading on these areas and weaken the underlying structure. It is definitely worth it a as therapist to help instruct your client how best to get on and off the table and turn over during a treatment. With the rise of mobile treatments to client’s homes, therapists need lighter tables to carry. Professional lightweight tables can cost 3-4 times that of a budget lightweight table.

And with many mobile therapists being recently qualified, they tend to lean towards buying the budget table as they start out on their career yet it is these lightweight aluminium tables that especially need to be of the highest quality and strength. Many non-specialist retailers want to sell the cheapest tables they can make for the most profit they can get. They don’t care about long term quality or any after sales customer service. They are not involved in the massage industry and do not use the products themselves so they don’t know what good quality means. What is important to them is the margins - with a “stack them high, sell them cheap” sales approach to treatment tables.

How can we solve this?

As professional therapists, we offer the client a package of our personality, our skills, how we present ourselves, our equipment and our customer service. It would be great if therapists, as professionals, only used professional equipment. Not only will it give the clients a better experience on the table, it will eliminate any problems with accidents and injuries as these table can never collapse. 1. Therapists need to take responsibility for their equipment and not take chances with budget tables. A professional cyclist wouldn’t buy a bicycle from the department store! Nor should a therapist buy a table from a retailer who sells anything from toothbrushes to mobile phone accessories! The professional cyclist would go to a speciality retailer just like the professional therapist should. The best quality table should be sought which will last ten plus years. Buying from reputable and experienced companies who you can actually pick up the phone and speak with will not only get you the specialist advice required but this way you know you will have some recourse if anything goes wrong. With large

theindustry I S YO U R T R E ATM E N T TA B L E A L I A B I L I T Y ?

platforms such as Amazon, you have 30 days to return an item but trying to contact an amazon retailer after the first month can be an impossible endeavour as they are usually based in China and are often uncontactable. It is understandable that a student at the beginning of their course would choose a budget table. They may not know if they will progress and maybe the funds are tight. But the problem is when they then continue as a qualified professional with the same table not knowing they can and should be using better equipment to represent them and their industry as professionals. One great way to think of justifying that extra upfront cost is it only takes an extra 3-4 treatments to cover the extra cost yet you will have a far superior table that should last you at least 10 years from the beginning of your career! Once you have the table, maintain it like you would your car. Check all the moving parts every 6 weeks or so. Check all the hinges are still strong and moving ok, check all the screws, nuts and bolts are tight and oil any parts of the table that move. Also, therapists need to be careful where they store table. Coming out of lockdown there has been an increase in problems because therapists had their table stored in the garage or attic where it has been affected by dampness and fluctuating temperatures. 2. Therapists, especially for new clients, need to educate the client how to get on and off the table on their first visit. And with insurance companies saying most accidents happen at the end of the treatment, therapists need to support the client when getting off the table after the treatment when they may be slightly woozy or unstable on their own. 3. Retailers need to make sure they are only selling quality equipment. Choose a specialist who truly cares about the customer and the industry. They will want you to have the best table possible, not just because it is best for

It is understandable that a student at the beginning of their course would choose a budget table. They may not know if they will progress and maybe the funds are tight. But the problem is when they then continue as a qualified professional with the same table not knowing they can and should be using better equipment to represent them and their industry as professionals.

you or for the industry but also so you can go and tell your therapists friends how great it is! 4. Better training in the colleges and schools is also necessary. Many colleges already provide the necessary training on how to choose a table and how to maintain it throughout its lifetime.

channel at youtube.com/ MassageWarehouse where we have an upcoming series on how to maintain your table and how to instruct your client on and off the bed to prevent accidents happening.

5. We would like to see professional associations and governing bodies join with training providers and retailers to make a standard set of guidelines for students on how to choose a table, how to maintain the table and how to manage clients on and off the table. We can solve the problem together as an industry with a renewed approach to the way we view our equipment.

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MARIA GRIFFIN Maria, a former sports massage therapist and one of the founders of Massage Warehouse is heavily involved in the design of treatment tables. She has helped thousands of therapists choose the right table for their practice and is involved in bringing about higher standards in the industry. www.massagewarehouse.co.uk – sales@massagewarehouse.co.uk

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How to Brand Your Business to Stand Out from the Crowd BY R AC H E L B E I D E R

Today’s business landscape is a crowded one. Even if your services are different from the rest, you still have to find ways to stand out and be noticed. Sometimes you may find it challenging to even identify what makes your brand unique, especially when you’re offering similar services to other businesses. Having a strong brand helps clients resonate with the services and products that you are offering, and makes them more likely to purchase from you. Clear and consistent branding makes it easy to find you and even easier to tell others about you. To build a brand, you need to understand what your strengths are, and then you need to communicate those strengths to potential clients.

tart by observing other businesses that offer anything similar to you in your neighbourhood. You should know inside and out what your competition is offering so that you can build upon what’s already out there, or offer something different or better or more unique. It’s not necessary to reinvent the wheel, but when you bring your unique value or take on something, it sets you

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apart. You must know your competition so that you’ll even more thoroughly understand your differences, and how to market that fact. At my massage practice, for example, we don’t offer wraps or scrubs or aesthetic services—we just do clinical style therapeutic massage. Our competition offers a wider variety of services at various price points, but we specialize in a particular style of massage that resonates with our clients. Clients don’t just come to us to have oil rubbed on them

to relax, they come to us because they know that they will have a deeply healing experience where whatever was ailing them will be addressed with specificity, care and detail. A quick note on visual branding and identity Trust me on this one: do not use a lotus or stack of hot stones in your visual branding, they are the most obvious and overused symbols in wellness, and will not

businesstools B R A N D I N G YO U R B U S I N E S S

help your business to stand out. Remember, a great brand is consistent, memorable, and simple. Don’t overcomplicate things. If you can find someone locally whose branding you love, see if that artist might consider a trade with you for massage! You should also check out inspiration on sites like Pinterest and Canva. I love using 99 Designs for logo design. Try to get inspired by industries outside of your own, and see if anything connects.

Make your brand unforgettable by infusing it with what makes you unique! This could be your background, illnesses, family stuff, history or something else. with my shoulders frequently up near my ears. This terrible posture, coupled with the curves of my spine, resulted in

H E R E A R E S E V E R A L WAYS TO H E LP YO U D I S COV E R YO U R B R A N D: ◆ Ask a friend or client to describe exactly what it is you do. Their

description should be enlightening: If it’s inaccurate, that means you have work to do. If it’s on point, you know you’re on the right path.

◆ Scan your online reviews on Google or Yelp for words that come up repeatedly. These words and phrases will help you have a greater understanding of your strengths, through the lens of your clients.

◆ Consider your personal history: People don’t buy from companies, they buy from people.

◆ Ask yourself this question: If you stopped offering your services,

what would clients miss the most about working with you? For example, if your very favourite restaurant closed forever, maybe you’d miss the food, or the way the waiter always knew your order, or the convenience, or the ambience. Think about what clients would miss the most about you, and be sure to lead with that!

YO U R M E S S I S YO U R M E S SAG E

Make your brand unforgettable by infusing it with what makes you unique! This could be your background, illnesses, family stuff, history or something else. Don’t be afraid to be controversial. Stories make your brand unique. These are the life experiences that will resonate with people. Clients don’t want to see some “perfect” business: it reads as inauthentic and fake. We don’t feel close to something that feels like a huge corporation, we want genuine connections with real people. For example, I grew up with scoliosis, which caused me constant back pain as a child, especially carrying around a lot of heavy textbooks. I’ve also often been anxious,

near-constant chronic pain. The chronic pain I experienced from scoliosis makes me unique, and it’s something that has resonated with my clients. Because I have a deep understanding of physical chronic back pain, I’ve attracted quite a few clients who also suffer from scoliosis and chronic pain. I enjoy working with them—I get it. There’s something from your own life experience that defines you, whether it’s personally or in your family. Something from your past that made an impact on you. There’s a reason you chose this profession. Lead with that. Tailor your services to what you love to do, and what resonates with you. Look for other examples in your own life that have coloured your experience. Maybe you’ve been injured, or cared for a loved one with an illness, or watched a friend

go through something in their lives. Take whatever experiences you’ve had that have shaped your views, and start there. You might think that having a niche would limit you from seeing clients, but this is a common misconception. Everyone loves a specialist! For example, my dentist in NYC loves treating jazz musicians—he loves jazz music, has posters and black and white photographs of the greats all over the walls of his dental practice, plays seriously good jazz music over the speakers, and on his website talks about the specific dental issues that some jazz players face from using their instruments. He calls himself the Jazz Dentist. I found this seriously cool—most dentists don’t distinguish or brand themselves in a unique way like that. And his branding seriously stood out to me. Am I a jazz musician? Absolutely not—and I’m guessing many of his clients aren’t either. But his brand made a memorable impression on me and I became a very loyal patient! Remember, everything that you do is a branding opportunity: from the tone and copy on your website, to your Instagram, to your printed business cards and any freebies you offer. How you communicate directly impacts how clients experience your brand. Lead with what makes you uniquely you, and you’ll gain the favour of lifelong customers who are thrilled to do business with you.

R AC H E L B E I D E R Rachel is a multi-passionate entrepreneur and best-selling author who bootstrapped her massage business from a solo practice to over $10m in sales. She is currently an Entrepreneur in Residence at Harvard University, working with their students on starting businesses. Her work has been featured in the WSJ, Entrepreneur, Forbes, and “O” Oprah Magazine.

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COLLEGE PROFILE

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School of Bodywork THE VAGUS NERVE SERIES: The Vagus is arguably the most important and certainly the most complex nerve in the human body. Stephen Porges “Poly Vagal Theory” radically changed the understanding how the body and mind work in conditions of safety, danger and life-threat. It forms the foundation of the contemporary comprehension of trauma and traumatization.

M I S S I O N S TAT E M E N T: Here at SCHOOL OF BODYWORK we are passionate about bringing you specialist training at affordable prices. We are so proud of our webinars and have collaborated with experts in their field to bring you up to date, topical information to help fill the gaps in your education and to help you support your clients. We specialise in taking complex information, making it accessible and relevant to your clinical work. “Your teaching and facilitating of learning emerges from a place of passion, empathy, intuition and sound knowledge. Learning with you is effortless and immersive, inspiring and natural.” Lucinda

W E B I N A R S:

TRAUMA SERIES The ability to support clients who present with trauma, stress and anxiety is an important part of any therapist’s work, this in depth, yet accessible series is a must for those who wish to take their practice deeper. Understand how trauma is held in the body physiology and how you can support your clients with a trauma past. FASCIA SERIES: Everything you need to know about the fabulous fascial system. Delivered in an informative, accessible way. These webinars will change your approach to bodywork & improve your clinical results, ensuring more repeat clients

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WOMEN’S HEALTH SERIES: “For much of documented history, women have been excluded from medical and science knowledge production, so essentially we’ve ended up with a healthcare system, among other things in society, that has been made by men for men,” Dr Kate Young. • Menopause: this seminar will explain the physiological changes that impact women’s lives during this crucial life-stage and give you some strategies to support your clients through this time of transition • Pelvic floor health and dysfunction encompasses so many things, it is absolutely vital to our physical and emotional wellbeing. In this webinar your questions about pelvic floor health will be answered, leave empowered to change the way you think about your pelvic floor. • Beyond the scar how complications from surgery or internal scaring can affect bladder & womb health as well as fertility “Around 40% of women have mechanical causes for their infertility, eg scar tissue in the abdomen and uterus etc. These women often have a very good and healthy egg supply, but experience complications when trying to conceive.” Anne Marie Jensen Author of Fertility and Physical Therapy

PAT H O LOG I E S:

Chronic pathologies we will explore common chronic pathologies and how to treat them, dates coming soon.

T U TO R S:

We have teamed up with experts in their field to bring you up to date knowledge that will transform your clinical practice and you understanding Emma Gilmore is Founder and Director of School of Bodywork. A bodywork therapist for almost 30 years, she is passionate about collaborations, sharing her knowledge on fascia informed bodywork and women’s health including post-partum scarring. She is so proud to be collaborating with experts to share current knowledge on-line and in-person. Emma’s passion for the benefits of bodywork are enthusiastically transmitted through her national and international teaching. She has been selected by the International Massage Association as an Educational Ambassador, recognising her as one of the key players in the International Massage Profession. She has judged the National Massage championships, is a founding member of the Fascia Research Society (FRS) and is currently researching a book on fascia and the body-mind complex.

W H Y T R A I N W I T H U S?

Our online programme offers an exciting range of new courses. For up to date information & inspirational news please join our mail list info@schoolofbodywork.com Follow us on Instagram @schoolofbodywork Facebook @SOB2000 07711 656 011

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point therapy, myofascial release, soft tissue release, sports techniques, stretching (passive, PNF and AIS), hydrotherapy and shiatsu. You will also gain an in-depth understanding of the treatment of common musculoskeletal pathologies. HANDS-ON AND ONLINE COURSE OPTIONS AVAILABLE.

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Affordable training with the very best from the industry Sunday 13 - Monday 14 June 2021 The FHT is delighted to announce that, for the first time, this year’s annual training event will be hosted virtually so you can join us, wherever you are! Don’t miss this affordable and flexible two-day CPD event which will allow you to: • • • •

Develop your therapy knowledge Discover the next step in your career Unlock show discounts and offers Gain valuable CPD points

Visit fht.org.uk/virtualcongress to find out more and book your ticket!

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

The perfect textbook for students of complementary therapy up to Levels 2 and 3, nursing, physical therapy, or those studying any course requiring a detailed knowledge of anatomy, physiology and pathology. Designed for use both in the classroom and as a home study resource, it provides all the information necessary to meet or exceed the curriculum requirements of all the major international awarding bodies and incorporates many unique features not found in other texts, including being interspersed throughout with ‘study tips’, ‘in the classroom’, ‘…in a nutshell’, ‘did you know?’ and ‘infoboxes’. ISBN 978 1 913088 05 7, £21.99, 440 pages, 275mm x 212mm, 450 colour illustrations and photographs

Fully illustrated, easy-to-learn fascial exercises for improving mobility and flexibility, treating pain and enhancing sports performance—a newly updated bestseller In this second edition, fascia researcher and Rolfing therapist Dr. Robert Schleip offers readers a series of practical exercises for energetic, pain-free living—and shows how to train your fascia in just 10 minutes twice a week. You can do these exercises at home, squeeze them in between meetings and fit them into the existing fitness regimens. ISBN 978 1 913088 21 7, £18.99, 304 pages, 240mm x 170mm, paperback, 200 colour illustrations and photographs

Written in a clear, no-nonsense style, this is the ideal textbook for students of reflexology up to Levels 2 and 3. Designed for use both in the classroom and as a home study resource, it provides all the information necessary to meet or exceed the curriculum requirements of all the major awarding bodies. The book outlines each body system; includes chapters on hand reflexology and meridian therapy; has revision and multiple choice questions for each chapter; has a study outline at the end of each chapter; features case studies, etc. ISBN 978 1 913088 11 8, £19.99, 312 pages, 275mm x 212mm, paperback, 350 colour illustrations and photographs

Better regulate your own stress response through vagus nerve stimulation and experience a greater zest for life! These simple exercises work by improving the quality of stimulation the vagus nerve receives, enabling the brain to function with a greater level of predictability, safety and protection. This is the first book to present the subject so comprehensively and in a way that is accessible to a general audience. Explore a variety of balance, hearing, sight, breathing and touch exercises and experience for yourself the positive impact of vagal stimulation! ISBN 978 1 913088 17 0, £14.99, 320 pages, 240mm x 170mm, paperback, 200 black and white illustrations and photographs

For more information on these and all other titles published by Lotus Publishing, please see: www.lotuspublishing.co.uk

“An amazing learning journey that has transformed my life.” The Bowen Technique is rapidly becoming the therapy of choice for

both clients and therapists alike. Since it is appearing in more and more therapy rooms every day, it is worth giving it some consideration. Bowen is a suitable therapy for most of your existing clients - from newborns to athletes, the elderly and disabled.

“When a 14 year-old boy with asthma tells you they have ‘never been able to take a deep breath like that, ever’. Peak flow goes from average of 250 to just over 400 in 2 treatments.” Whilst some modalities can create joint soreness and muscular aches in the therapist over time, Bowen does not. Bowen is administered without deep or forceful manipulation, meaning that therapists can book more clients per day and continue to work for many years to come.

The College of Bowen Studies are world leaders in Bowen training,

and their training courses and one-day introductions to the technique are taking place across the UK now.

“I love that I’ve never advertised Bowen – the people I’ve treated successfully are doing that job for me!” So give your hands a break. Make Bowen one of your “must-do” courses this coming year.

Reserve your place online NOW.

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Give your hands a break. Learning Bowen allows you to do the work you love without it taking a toll on your hands. Register your interest for our 2021 intake

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Training Specialists in

Seated Acupressure Diploma Seated Acupressure Refresher Massage At The Desk A mixture of home & on line study, plus essential classroom practical work, all combine to provide thorough training to the highest standards. All sections must be completed for the relevant course. Courses take place in March and September 2021.

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

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