Massage World issue - 119 Summer

◆ FEATURES

8 Massage Mentor: Clear Communication

As an oncology massage therapist, Susan Findlay consistently face trials that test communication skills. Over the years, she has assessed what strategies have proven effective and what hasn’t. She shares insights into navigating discussions that demand exceptional proficiency.

12 Does fascia hold memories? Part 2

Ruth Duncan delves deeper into the role of the sympathetic nervous system and its relationship with certain brain areas, looking at how these may play a role in the unwinding process.

16

Soft Tissue Release

An extract about the next from the recently published fourth edition A Practical Handbook for Physical Therapists

by Mary Sanderson.

20 Getting it write – Writing and Publishing for the Soft Tissue Therapy Sector

Writing and publishing for the soft tissue industry can be an exciting opportunity to present new ideas, concepts and practices but could equally be difficult and lonely for

the writer. Earle Abrahamson offers tips to those looking to write for the industry.

24 How to Use VacuumCupping Techniques in the Management of Lower Back Pain

For thousands of years, practitioners of different medical disciplines have attempted to treat lower back pain using different theories and methods. Explore why Daniel Lawrence believes cupping, when utilised correctly, can be incorporated with Western medicine to treat lower back pain.

28 Relieving Back Pain with Massage: A Therapeutic Path to Wellness

Madelaine Winzer discusses different ways massage can be used to alleviate and manage back pain.

44 Hawaiian Lomi Lomi Massage

An interview with Rosalie Samet where she shares the history of Hawaiian Lomi Lomi and the influence it has and continues to have on her life.

44

50 Spotlight

The spotlight is on Vanessa Passarella Read about her journey into the industry and discover what inspires her to be the therapist she is today.

50% off entrance tickets for Massage World readers at omyogashow.com

Use code: MASSAGEWORLD

Offer ends 16th Sep 23

The biggest yoga event in Europe is back in London’s Alexandra Palace for its annual three day show. Everything you need to know about yoga all under one roof, from free yoga sessions, workshops, lectures and shopping.

Over 170 free yoga sessions are taking place across five class areas over the three days. Open classes are suitable for all age groups and abilities, it is the perfect opportunity to try something new including Ashtanga, Hatha, Vinyasa Flow, Yin, Sound and Inversions.

New to OM Yoga Show this year is a whole new open class area dedicated to sound healing, meditation and mantra. Join teachers offering sound bowl healings, shamanic ceremonies, kirtan and devotional chanting to heal your body and soul. Free admission included in your entrance ticket.

Leading teachers from around the world are sharing their wisdom and expertise in 24 different workshops, all bookable in advance. These longer session workshops give visitors the chance to focus on specific disciplines including Chair Yoga, Hip Love and Hip Hate, Sleep Yoga, Yogabeats, Elemental Flow, Authentic Indian Yoga, Anxiety Connection and much, much more. Workshop tickets start from £10.

Another exciting addition this year are hot yoga sessions, held in a portable hot pod yoga studio. Step into an immersive pod filled with calming scents and move to relaxing beats in 37 degree heat. Pre bookable at £10 a session, tickets available at omyogashow.com.

The OM Yoga Show provides an unrivalled shopping experience for any yoga enthusiast, with 250 exhibitors there is something for everyone, find yourself some new workout gear, yoga mat, equipment, aromatherapy oils, organic toiletries or healthy superfoods. Register for your FREE show guide at omyogashow.com. Entrance tickets to the OM Yoga Show are now available to book online at omyogashow.com. All OM Yoga Show tickets include entry to the Mind Body Soul Experience which is running side by side in the hall next door.

Caroline Larissey Joins FHT Board as Vice President Following AGM Meeting

The FHT are delighted to announce the appointment of Caroline Larissey as the newest member of the FHT Governing Council, assuming the esteemed role of Vice President. Caroline’s appointment was confirmed during this year’s Annual General Meeting, where her extensive experience and remarkable accomplishments in the industry stood out.

Caroline is a highly respected and accomplished professional, currently serving as the Director of Quality and Standards at the National Hair and Beauty Federation (NHBF) where she is a driving force behind championing the employer voice and ensuring uncompromising quality, standards and education throughout the sector.

Acting as a pivotal liaison between government and industry, Caroline collaborates with employers, industry stakeholders, awarding organisations, professional bodies, government agencies, departments and ministers. Her expertise spans diverse areas, including training, apprenticeships, standards, qualifications, codes of practice, quality assurance, funding and business practices. She also serves as a chairperson, ambassador, advisor and board member of various influential groups involved in industry.

On the news of her appointment, Caroline says: “I am truly honoured to have been elected as a member of the Governing Council for the Federation of Holistic Therapists, serving as the Vice President.

“The FHT’s unwavering dedication in supporting, representing and championing therapists within the complementary, beauty and sports sectors resonates deeply with my own goals and values. I am excited about the opportunities that lie ahead and look forward to supporting the FHT over the coming year.”

Caroline’s passion for excellence and her impressive track record makes her a valuable addition to the FHT board, and her insights are expected to contribute significantly to the FHT’s future success.

www.omyogashow.com

As Vice President, she will play a pivotal role in guiding the FHT’s mission to raise standards, promote good practice and provide unwavering support to therapists across various holistic disciplines. Her expertise and dedication are poised to further strengthen the FHT’s commitment to excellence and advancement within the health and beauty therapy industry. Please join us in extending a warm welcome to Caroline Larissey as she embarks on this exciting new chapter with the FHT.

Photo: Alexandra-Palace-Sophie-Harbinson-@yourallypally@sharbinson

National Massage Championships 2023

The National Massage Championship (The NMC) will be returning to Olympia Beauty in 2023 for the fifth year! This incredible event welcomes all qualified massage therapists and bodyworkers to compete for a trophy or two in 6 competition categories! Each category costs £129 and you can receive a discount if booking multiple categories. The competition will be taking place on Sunday 15 and Monday 16 October 2023 at ExCeL London and is open to all qualified massage therapists! The NMC 2022 attracted over 100 competitors representing eight countries across six categories and received sponsored entries by over 15 massage and spa companies, making it our biggest to date. The NMC is created in partnership with Kate Tora of CityLux Massage and Carl Newbury of Massage World Magazine and sponsored by the IMA and Massage Warehouse. We can’t wait to welcome you back in 2023 and we are also open to spectators!

Use Code MWM20 at Check Out to get a 20% on Entry

Enter here www.olympiabeauty.co.uk/thenmc-2023/

Professional Beauty

North 2023 is back on 24-25 September 2023 at Manchester Central!

Register to see what’s shaping the profession, test and compare 100s of new products and take advantage of exclusive offers. Make the most of the three live stages available to learn new skills and update your treatment menu.

Register here

www.professionalbeauty.co.uk/e/pbnorth/site/Home

BUSINESS EXCHANGE OPPORTUNITY

Cosmoprof Asia, the leading b2b international beauty trade show in Asia, is where global beauty trendsetters gather to introduce their cuttingedge technologies, product innovations and new solutions. The show serves as an ideal platform for the entire beauty industry to unveil the latest trends, enable partnerships and business opportunities.

www.cosmoprof-asia.com

The Natural Health & Movement Summit

BEST IN THE WORLD 2023

Luisa Vargas from the Dominican Republic

Overall Gold Medal at the 2023 World Massage Championship in Copenhagen, Denmark in June 2023. Luisa is a licensed massage therapists in the USA and also inventor of her own method called LUVA LV7 massage inspired by a multicultural vision and ancient techniques combined with her passion for human anatomy and the synchronization of body and mind.

Congratulations Luisa!

Enter the World Massage Championship 2024 here www.worldchampionship-massage.com

This event is designed for dedicated personal trainers, movement therapists, and manual therapists of any form who want the best ways to update and reinvigorate their vision.

It will be full of fun, evidence-based information with usable tried and tested strategies and techniques that you can implement for your clients right away.

Register Here: www.eventbrite.co.uk/e/543257908027

Clear Communication

Susan’s first love is dance, anything to do with of movement. She as a nurse in Canada soon left the profession when she the UK as she wanted a deeper connection with her clients. For many she worked in both health and teaching 20+ classes a week running GP referral schemes. She make better use of all her knowledge which led her to retrain as Massage and Remedial Soft Therapist. Currently she is the NLSSM and specialises in Oncology Massage. She is the Sports Massage: Hands on Therapists and is the Sports feature writer for Massage volunteers her time as a member of GCMT. her on Massage Mondays weekly massage videos

BY SUSAN FINDLAY

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Communication is akin to breath, both functioning as automatic behaviours until placed under extra demand. Just as we notice the absence of oxygen when breathless and become aware of shallow breathing under stress, communication too gains attention when confronted with challenging situations. In these moments, we may find ourselves at a loss for words.

• Advice and tutorials on how to diversify online self-care team and one to

Much like a therapist’s personality can manifest through communication – be it shy, bold, confident, thoughtful, or kind – our true behaviour often surfaces during touch conversations. The struggle to find the right words, the instinct to avoid or downplay the issue, or the attempt to patch things up hastily mirrors this reality. As an oncology massage therapist, I consistently face trials that test my communication skills. Over the years, I’ve assessed what strategies have proven effective and what hasn’t. Here, I share insights into navigating discussions that demand exceptional proficiency.

In my view, communication extends beyond mere words to encompass gestures and touch. However, let us start with our verbal skills.

• Advice and help on both hands-on

In my role as an oncology soft tissue therapist, I often find myself engaged in challenging conversations. However, even during my previous career in remedial massage, I realized that my training hadn’t adequately equipped me to be an attentive listener or an adept communicator.

Approaching Delicate Dialogues:

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Delicate conversations, those requiring a tender touch, demand the right words. Such conversations require a blend of tenderness and inner strength, as exemplified by Kathryn Mannix, in her book “Listen , How to Find the Words for Tender Conversations”.

• Exclusive community Zoom sessions and Rachel of Jing advanced massage.

Drawing from both my experience as a remedial massage therapist and nursing, I’ve learned that effective communication involves a few key skills.

• A welcoming and inspiring online community.

Respecting Differing Perspectives:

While we may firmly hold our own beliefs about what’s in the best interest of our client, it’s crucial to maintain an openminded approach to the validity of their viewpoints. Even when we’re convinced

that alternative paths could be more appropriate, it remains paramount to listen with respect. For instance, if I have a client undergoing breast cancer treatment and they’ve opted for a plan that I deem insufficiently robust, it’s not for me to “correct” them and impose my viewpoint. If they seek my insights or inquire about my stance on their choices, it’s not for me to endorse or dismiss their chosen treatment. Instead, my approach often involves posing thoughtful questions that foster clarity and stimulate curiosity. It’s imperative that they feel a sense of ownership over their decisions, unaffected by any sway from me.

The Power of Not Knowing:

It’s crucial to accept that we don’t need all the answers. Giving clients the space to explore their thoughts, options, and choices is more valuable than filling gaps for them. Through my experience, I’ve also come to understand that there isn’t a singular approach to every situation, particularly within the realm of cancer treatment. Each consultant has developed protocols grounded in experience, the latest research, and the unique circumstances of the client. I appreciate these variations, understanding that while not all approaches may be flawless, it’s imperative to honour the evolving process. I’ve adopted a stance of openness to diverse perspectives, all the while being mindful not to impose a singular “correct” path. Instead, I provide suggestions that respect the individual journey and add to the ongoing conversation.

Silence as a Powerful Tool: Do you find silence uncomfortable?

Whatever the reason, embracing this skill as part of your listening repertoire is essential. Silence fosters trust, providing individuals the space to delve into their thoughts, introspect and convey profound reflections.

A key observation is to look out for their eye movements, when someone is trying to access deeper thoughts they will look away or down, give them time to complete this action.

If you tend to speak before someone completes their sentence, consider waiting

for about 2 seconds after they’ve finished speaking before you contribute to the conversation. You might be amazed by the additional information they spontaneously provide when they sense they have the room to express themselves.

Shifting the Balance of Control:

In conversations, allowing clients to take the lead can uncover suppressed thoughts and lead to clarity. Openended questions, such as “What does that look like for you?” or “How do you envision it going?” encourage detailed responses and minimize assumptions.

Speaking Their Language:

Summarizing using the client’s words helps them feel heard and promotes self-reflection. This technique aids in accuracy and demonstrates respect for their expressions. Hence, I tend to use their exact wording and reflect it back to them as well as integrating it into the session, for instance if they refer to something that clearly gives them “discomfort” I will not use the word pain unless they have already done so, if they refer to it as stiffness or an ache that is what I will use to describe it.

Empowering Through Familiar Language:

Using accessible language while offering advice or instructions helps clients grasp and implement suggestions more effectively. Technical jargon can be alienating, hindering their confidence. It’s worth noting that a term we consider routine might seem foreign to our clients. Words like “posterior” or “lateral line”, mentioning specific muscles or delving into intricate details about the nervous system can lead to confusion for them. I am not trying to dumb down the session but rather striving to meet my client at a level where they can derive the maximum benefit from the treatment.

Guiding Without Dictating:

Rather than providing direct solutions, asking questions encourages clients to find answers themselves. This empowers them to take charge of their well-being. It is amazing what a client will come out with that is a proper solution.

A significant aspect of oncology treatment involves being directed towards necessary steps, creating a sensation of being shuffled from one point to another. Unfortunately, this process often occurs with limited comprehension. The fear of inquiring or challenging prescribed treatments is prevalent among individuals. Therefore, I actively seek opportunities to restore control to their hands. My goal is for cleints to rely less on my guidance and cultivate their independent thinking. I prioritize empowering them, ensuring that they leave each session not only with newfound hope but also with a heightened sense of control over their own health journey.

Beyond Words:

Effective communication isn’t solely verbal; touch plays a role. As therapists, we should listen to what our touch conveys. Guided by intuition rather than analysis, we connect on a deeper level. Clients have a keen perception of whether you are genuinely engaged or merely going through the motions, whether you’re authentically responding to what they’re experiencing or simply carrying out a procedure.

I am referring to what I call a Mindful Touch, it is the ability to palpate, relax into the tissue and react to what your hands are feeling. It is a response to an experience. It might be deep, it might be very superficial, the skill is to be able to reach a comfortable depth that feels as if you have reached that ‘satisfying and connected’ depth. It requires the ability to react to the feedback being felt within the connective tissue, developing the skill to move at a suitably rhythmic speed, choosing techniques that would benefit the situation, and responding to what your hands are feeling.

Oncology Massage: Being Present:

Oncology massage isn’t about “doing” but about “being.” Sensing and responding to the body’s cues, rather than imposing fixes, fosters a more meaningful connection.

Oncology massage is neither light, fluffy or insubstantial, it addresses the needs of the client and how the tissue responds, the most descriptive word I use when teaching this method

massagementor

massagementor

today’s challenges

Key Takeaways:

Covid-19 Protocols

is to feel what is happening underneath your hands, to be led by the tissue and respond to it, not force your way through in an unthinking way, but to ‘melt’ into the soft tissue in a considered way. This form of massage is not exclusive to Oncology but it is less demanding on those who are suffering with cancer or any condition that is placing a greater stress on the body’s systems, the intention of this approach is to assist the client’s recovery rather than causing them to recover from the massage.

Storytelling as Therapy:

instance, if they struggle to pinpoint the location of discomfort, their hands come to the rescue, sketching motions, forming circles or enacting pulling gestures. Each imparts a distinct facet that words alone might struggle to convey. However, they aid in comprehending their intended message even when left unspoken.

• Active Listening: Patiently listen and wait before responding.

• Mirroring: Repeat their words to ensure understanding.

• Open-Ended Questions: Encourage elaboration and avoid assumptions.

• Silence: Let it fill the gaps to allow reflection.

• Actively listening to their story

• Be present and let your hands feel and respond

date about all the current policies, procedures. I cannot say this for every PA, but I do know that those sitting as board members of the GCMT (The General Council of Massage Therapies) played a significant role in getting information out to all their members.

I was heartened to see that so many therapists joined in on the conversation, how the profession started talking as a unified body, and how we got behind our professional associations, with GCMT emerged as a body with influence. It is now up to us to support our PA’s in their efforts to petition the government to recognise the value of higher education within the profession.

Gestures can fulfil a spectrum of vital roles, beyond enhancing communication, they serve as a conduit for clients to articulate themselves then verbal expression falls short, especially when emotions are woven into the narrative. Furthermore, I use gestures strategically to grant clients a heightened sense of agency, for instance I let my client guide my hand to the precise ‘point of concern’, not only does this help in discerning the underlying issues but also empowers the client by granting them a degree of influence over the process.

• Recognize an integrative approach to cancer care

• The importance of gestures as a form of communication

In Conclusion:

So, what can you do? The good news is, the more education and experience you have the easier it will be for you to re-establish yourself. For those therapists that are new to the profession, it is important that you have a niche, a specialism that places you in a position of greater value. Your expert skills will establish you firmly and increase the need for your services.

I want to leave you with thoughts of encouragement; we all know how important massage is and the thought of a future without it is daunting, both for our clients and ourselves as professionals. I cannot see massage stopping; whilst we may have to improvise and adapt, we will certainly survive.

References

Sharing their narrative verbally holds therapeutic value. Offering attentive listening devoid of premature solutions, amplifies the healing essence. During the storytelling phase, I abstain from jotting down notes (unless it is a medication I am not familiar with) positioning myself directly across from the client to foster an open connection without the barrier of a desk or table. Amidst our hurried lives, everything seems rushed, yet I dedicate my complete focus to them. In the lives of my oncology clients, the need to retell their story often arises, but over time, it tends to lose its emotional touch and becomes more factual as they repeat it from one medical practitioner to another. An integral aspect of my therapy involves encouraging clients to express their narrative. This leaves them with a sense of being listened to and truly heard.

“Coronavirus And The Impact On Output In The UK Economy - Office For National Statistics”. Ons.Gov.Uk, 2020, https://www.ons.gov.uk/economy/ grossdomesticproductgdp/articles

Gestures – the Silent Communicator:

coronavirusandtheimpactonoutputintheukeconomy/june2020#:~:text=It%20 is%20clear%2C%20that%20the,the%20largest%20recession%20on%20 record.&text=Furthermore%2C%20Quarter%202%202020%20is,downturn%20of%202008%20to%202009.

“Set Up A Business”. GOV.UK, 2020, https://www.gov.uk/set-up-business. Hellicar, Lauren. “Coronavirus: What Support Is Available For Small Businesses And The Self-Employed?”. Simplybusiness.Co.Uk, 2020, https://www.simplybusiness. co.uk/knowledge/articles/2020/06/coronavirus-support-for-small-business/.

I have touched only briefly on the topic of gestures, a facet of communication utilized by both the therapist and the client. These subtle yet impactful movements introduce an additional layer to the conversation. We become acutely aware of this when observing a client grappling to articulate something intricate. For

Enhancing communication involves embodying the skills reflected in touch: patience, listening, and responding at the right moment. This facilitates ease of expression and openness, leading to transformative conversations. Remember, being a proficient therapist also means recognizing when external expertise is required. While we aim to help, some conversations may require professional intervention beyond our scope. Offering support without carrying the burden alone is crucial. It is important that an integrative approach includes other modalities like counselling, nutrition, movement etc. You can find a number of articles on the subject of touch i.e. ‘A Mindful Touch’, ‘What is Oncology Massage’, and some research on the effects of touch, of course I ‘touch’ on other subjects that might be of interest to you.

SUSAN FINDLAY

Susan Findlay specialises in Oncology Massage, she is the Director of NLSSM and is a board member of GCMT as well is a Trustee for Circle of Comfort Cancer Care.

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

You can join her on Massage Mondays for free weekly massage videos

She is passionate about providing the highest quality of massage training in both soft tissue therapy and Oncology Massage, with workshops around the UK and Ireland including online! Susan runs her own clinic from her home in Wales and the school in North London, and is also the author of Sports Massage, A Hands-on Guide for Therapists.

www.susanfindlay.co.uk

You can find out more about Susan at www.susanfindlay.co.uk, or on Instagram @susanfindlaymassage, and you can contact her directly at info@susanfindlay.co.uk.

Woodcock Massage Therapist

“As a result of the

on the CThA Members Forum, I have one new holistic massage therapist who has joined the team and is very much appreciated by the clients”

Does Fascia Hold Memories? Part 2

BY RUTH DUNCAN

In my previous article, ‘Does fascia hold memories?’ Part one, I discussed what is commonly thought of playing a role in an unwinding process as well as a brief history of the origins of unwinding and how it relates to trauma. In this edition, I will go a little more in depth with the role of the sympathetic nervous system (SNS) and its relationship with certain brain areas and look at how these may play a role in the unwinding process.

SNS activation creates a myriad of changes within the body in readiness to fight or flight. This includes, widening the eyes, increasing heart rate and respiration. This is a normal process and should be relatively short lived with a return to parasympathetic tone once the threat is over. However, prolonged stress and anxiety for any reason sensitises the SNS meaning that it produces the flight and flight response at a lowered threshold. This results in what is called Hebbian learning, a common neuroplastic process of nerves that wire together, fire together (Keysers and Gazzola 2014). Think of playing a chord involving several keys on a piano that all respond together. That one chord, or output,

have multiple firing nerves to produce one sound. When played over and over again, the reptation creates learning and you can play that chord and entire piece of music without looking and even thinking. This is what it meant when nerves wire together, they fire together. It becomes unconscious and, as we don’t know we are doing it, we don’t know how to turn them off. This is especially true in chronic pain and a sensitised nervous system.

Due to this neuroplastic process, it takes far less stimulus to create activation of the SNS (Alshak and Das 2022). The SNS sensitivity increases the allostatic load which is the constant adaptation of the body systems in response to the cumulative burden of chronic stress and life events (Guidi 2020). SNS activation is

controlled by some of the oldest, or reptilian, parts of the brain and are part of our survival mechanism. In the fight and flight response, information processing is restricted to these older brain areas. However the cortex, the newest and outermost part of the brain, goes into quiet mode. What’s also important is that the reptilian brain can’t tell time. That is a cortical process along with problem-solving, reasoning and consciousness amongst others (Jawabri and Sharma 2022) and (Raccah et al. 2021). This would seem to correlate with the feeling that people describe as ‘right back there’ when they experience SNS activation. Also, as the cortex is in sleep mode during heightened SNS activation,

rational thoughts, processing and judgment of the current event are unavailable to consciousness. This is what’s commonly called dissociation and is a naturally occurring phenomenon as a protective mechanism. This mechanism allows us to fight or flight even when we may have been injured in order to escape as there is no time for logic and cognitive processing. This same process inhibits the pain response and is thought to be the reason why some people walk for miles to escape trauma and only when they reach safety do they realise they have a broken ankle. Here though, historical thinking is that the trauma memory is frozen in time in the fascia. Further popular thinking also correlates with Stephen Porges Polyvagal Theory with this person being stuck in dorsal vagal tone or what’s commonly known as the freeze response. Rather, a better description and one that avoids catastrophising and potential to reinforce trauma would be to describe the process of the neuroplasticity of the sensitised SNS as all it is trying to do it offer protection. I hope that it is becoming clearer that while the fascia responds to the fight and flight response, it is an unlikely candidate to be the originator of this response or a storage container for the replay of movie-like trauma events.

It is much more plausible, and realistic, to attribute responses and behaviours that become actions and reactions with the lowered threshold response of the SNS. Also, according to Trauma Neuroscientist Dr Bruce Perry, memories are recreated, they are not replayed. This falls in line with the neuroplastic model in that nerves that wire together, fire together. When events, context and meaning all come together in the right amount and order, the sensitised SNS springs into action and plays out a story in the body. Unfortunately, for some people this is a daily event perhaps from an abusive partner. For others its episodic such as a car backfiring sounding

like gunshot to a veteran with PTSD. These reactions and actions are what are seen in an unwinding. The process of how MFR triggers the sensitised SNS is the next thing to consider. During treatment, the client is relaxed and calm. As the therapist engages the client into the therapeutic relationship through effective dialoguing, interoception or the sense of self is heightened. This is a quality of the nervous system where specialised nerves deliver this sense of your inner self to the limbic system in the brain where emotional regulation occurs. In relaxation mode, unconscious cortical control mechanisms, natural and learned inhibition and antagonistic processes usually employed to compensate for a sensitised SNS are reduced. This potentially means that

of suggestion in modifying and directing muscular movement independently of volition.’

Minasny (2009) goes further with describing that specific elements of sensory input, or afferent signalling, along with context and the relaxation response being divided into certain brain regions. This correlates with current thinking on mechanosensation by Bialosky (2018) in that touch stimulates the cutaneous sensory endings sending message via the spinal cord to the brain that creates physiological body changes. Additionally, Brandi et al. (2023) also suggests that touch could stimulate the deeper fascial mechanoreceptors which also result in physiological and psychological changes.

these gatekeepers are turned off allowing the sensitised SNS to spring into action from even the smallest sensory input. This is not a negative response as the client is well aware that they are in a therapeutic environment, but it can take a client by surprise as their normal hypervigilance keeps sensitised SNS reactions and actions under wraps. Here, the skill of the therapist is to support the client, reassure them and facilitate the process.

The unwind, the physical movement, is thought to be what Carpenter (1852) describes as an ideomotor response. There is not enough evidence that supports the unwind solely being the domain of the fascial system. Instead, consider that all movement is the domain of the nervous system as motor output. Carpenter (1852) described ideomotor to be ‘influence

Once a threshold of sensory information is reached, the body begins to complete the normal and natural process of self-regulation. Self-regulation is conducted in many ways but the most well know are tears, rocking, shivering and even vocalising (Gračanin 2014). This is where the ideomotor movement, or unwinding, can also be considered as a form of self-regulation.

Ultimately, the self-regulatory process of unwinding is a valuable process as a response to affective contextual touch. It can also be considered as graded exposure delivering post-event wisdom and can play an important role in helping people reclaim their health and wellness.

Once a threshold of sensory information is reached, the body begins to complete the normal and natural process of self-regulation.

massagemodalities

DOES FASCIA HOLD MEMORIES? PART 2

Part 1 references.

Barnes JF. (2020) ‘Myofascial Unwinding’, Massage Magazine April 2020. Available at https://www. massagetoday.com/articles/1588026401859/ Myofascial-Unwinding-Part-I

Darby, I. A., Laverdet, B., Bonté, F., & Desmoulière, A. (2014). Fibroblasts and myofibroblasts in wound healing. Clinical, cosmetic and investigational dermatology, 7, 301–311. https://doi.org/10.2147/CCID.S50046

França et al. (2020) Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Frontiers in Physiology, vol 11. Available at, https://www.frontiersin. org/articles/10.3389/fphys.2020.587373

Minasny B. (2009). Understanding the process of fascial unwinding. International journal of therapeutic massage & bodywork, 2(3), pp. 10–17. Available at https://doi.org/10.3822/ijtmb.v2i3.43

Pavan, P. G., Stecco, A., Stern, R., & Stecco, C. (2014). Painful connections: densification versus fibrosis of fascia. Current pain and headache reports, 18(8), 441. https://doi.org/10.1007/s11916-014-0441-4

Schleip, R., Gabbiani, G., Wilke, J., Naylor, I., Hinz, B., Zorn, A., Jäger, H., Breul, R., Schreiner, S., & Klingler, W. (2019). Fascia Is Able to Actively Contract and May Thereby Influence Musculoskeletal Dynamics: A Histochemical and Mechanographic Investigation. Frontiers in physiology, 10, 336. https://doi.org/10.3389/fphys.2019.00336

Tozzi P. (2014) Does fascia hold memories?, Journal of Bodywork and Movement Therapies, Volume 18, Issue 2, pp. 259-265, ISSN 1360-8592. Available at https://doi.org/10.1016/j.jbmt.2013.11.010

Wipff, P. J., & Hinz, B. (2009). Myofibroblasts work best under stress. Journal of bodywork and movement therapies, 13(2), 121–127. https:// doi.org/10.1016/j.jbmt.2008.04.031

Zullo et al. (2017) The interplay between fascia, skeletal muscle, nerves, adipose tissue, inflammation and mechanical stress in musculofascial regeneration. Journal of Gerontology and Geriatrics, 65(4), pp. 271-283. Available at https://eprints.qut.edu.au/118615/13/118615.pdf

Part 2 references

Alshak MN, M Das J. (2022) Neuroanatomy, Sympathetic Nervous System. [Updated 2022 May 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK542195/

Bialosky, J. E., Beneciuk, J. M., Bishop, M. D., Coronado, R. A., Penza, C. W., Simon, C. B., & George, S. Z. (2018). Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. The Journal of orthopaedic and sports physical therapy, 48(1), 8–18. https://www.jospt.org/doi/10.2519/jospt.2018.7476

Brandl, A., Egner, C., Schwarze, M., Reer, R., Schmidt, T., & Schleip, R. (2023). Immediate Effects of Instrument-Assisted Soft Tissue Mobilization on Hydration Content in Lumbar Myofascial Tissues: A Quasi-Experiment. Journal of clinical medicine, 12(3), 1009. https://doi.org/10.3390/jcm12031009

Carpenter W. (1852) On the ‘Influence of Suggestion in Modifying and directing Muscular Movement, independently of Volition’. Royal Institute of Great Britain, weekly evening meeting. Available at https://ia801305.us.archive. org/5/items/b22377074/b22377074.pdf.

Neuroplasticity

Gračanin, A., Bylsma, L. M., & Vingerhoets, A. J. (2014). Is crying a self-soothing behavior?. Frontiers in psychology, 5, 502. https://doi.org/10.3389/fpsyg.2014.00502

Guidi, J., Lucente, M., Sonino, N., & Fava, G. A. (2021). Allostatic Load and Its Impact on Health: A Systematic Review. Psychotherapy and psychosomatics, 90(1), 11–27. https://doi.org/10.1159/000510696

Jawabri KH, Sharma S. Physiology, Cerebral Cortex Functions. [Updated 2022 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi. nlm.nih.gov/books/NBK538496/

Keysers, C., & Gazzola, V. (2014). Hebbian learning and predictive mirror neurons for actions, sensations and emotions. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 369(1644), 20130175. https://doi.org/10.1098/rstb.2013.0175

Minasny B. (2009). Understanding the process of fascial unwinding. International journal of therapeutic massage & bodywork, 2(3), pp. 10–17. Available at https://doi.org/10.3822/ijtmb.v2i3.43

Raccah, O., Block, N., & Fox, K. C. R. (2021). Does the Prefrontal Cortex Play an Essential Role in Consciousness? Insights from Intracranial Electrical Stimulation of the Human Brain. The Journal of neuroscience : the official journal of the Society for Neuroscience, 41(10), 2076–2087. https://doi.org/10.1523/JNEUROSCI.1141-20.2020

RUTH DUNCAN

MFR UK also runs regular MFR workshops. Visit our website for further information. You can also attend our unwinding workshop if you have prior MFR training from another training provider. See our website for full details. workshop if you have prior MFR training from another training provider. See our website for full details.

Ruth has been teaching Myofascial Release for over 20 years in the UK and internationally. She is the author of ‘A Hands On Guide To Myofascial Release’ now in its second edition. She completed a BSc (Hons) in Health Sciences and a PGCert in Pain Science and Theory and has a keen interest in research and evidence based practice. Contact her on:

If you want to learn more about unwinding, have a look at a recent master session I did online.

Soft Tissue Release Trunk & Neck - part tw0

BY MARY SANDERSON

Extract from Soft Tissue Release - A Practical Handbook for Physical Therapists

for long periods, painting a ceiling or engaging in sports such as cycling. The soft tissues can become micro-torn and tense; as the activity persists, holding patterns and imbalances prevail. An increase in the cervical curve, forcing the head forwards, is a common result.

The Neck

The neck flexors are generally weaker than the extensors, which have to hold the heavy head in an upright position, against gravity. The extensors are constantly under tension, contracting statically and eccentrically to maintain posture. Postural deficiencies can especially occur with repetitive activities or positions, for example sitting, writing

Problems manifest as movement restrictions, headaches, vertigo, tinnitus, and muscle, joint and nerve pain. Impingement of vertebral arteries and nerves can occur, which may not necessarily have a muscular cause, and medical advice needs to be sought if a subject presents with dizziness or referred pain that is not clearly muscular in origin.

As well as controlling specific movements, many of the small neck muscles are involved in maintaining the balance and stability of the head on the neck; these cannot be palpated, so they will not be discussed. The platysma is the most superficial anterior muscle and is a thin, flat muscle that adheres to the skin.

Seated STR is a good way to start an assessment and treatment, and the neck flexors can be generally addressed if the head and neck are protracted. Then, systematically working the agonists and antagonists will ensure good recovery of chronic neck tension and side-effects such as tension-type headaches (TTHs). This will also facilitate a return to good posture and an enhanced functional capacity. Because of its extreme mobility, the neck is also vulnerable to traumatic injury, an example being whiplash. Following such injury, there will be ligamentous damage, and the neck muscles will present with extreme tension. This is due to fierce reflex muscle contractions that protect the head against rapid movement. Provided that the results of a medical screening are satisfactory, STR is an indispensable therapy. Degenerative conditions, such as spondylosis, can also benefit from STR; use of active STR will ensure that the subject only moves through a range that can be performed comfortably. Improving movement and posture will relieve pressure on the facet joints and discs (fig.1).

Neck Flexion

Major Muscles: SCM, scalenus anterior and longus colli (flex the neck); longus capitis and SCM (flex the neck and head); rectus capitis anterior (flexes the head on the neck and stabilises the atlanto-occipital joint).

Figure 1. Anatomy of the cervical spine).

Figure 2. Active STR to the SCM.

Neck Side Flexion

Major Muscles: Scalenes, splenius cervicis, levator scapulae and SCM (side flex the neck); SCM, splenius capitis, trapezius and erector spinae (side flex the head and neck); rectus capitis lateralis (side flexes the head on the neck).

Neck flexion occurs when the SCM muscles on both sides contract; side flexion to the same side or rotation to the opposite side occurs when the SCM on one side contracts. When the head and neck are fixed, the SCM muscles

can raise the clavicles and sternum, thus assisting inspiration. The scalenes, when contracting bilaterally, also assist in neck flexion; if only one side contracts, they assist in side flexion to the same side. The brachial plexus runs between the scalenus anterior and the scalenus medius.

Neck Flexors and Side Flexors –Treatment

With the subject in a supine position, support the head with one hand and gently grasp the SCM with the other hand (fig. 2). Maintain this hold and instruct the subject to extend the neck. Alternatively, gently grasp the muscle and passively move the neck away from this lock into side flexion; or instruct the subject to rotate the neck to the same side for a stretch. It is vital not to move too quickly. If the area is particularly congested, apply pressure to one side of the muscle at a time. Lock into the muscle origin, moving to two or three new points to free the

MUSCLE EFFECTS OF MUSCLE RESTRICTIONS

Suboccipitals

Rectus capitis posterior minor

Rectus capitis posterior major Superior oblique Inferior oblique

Limited studies exist on the effects of tightness in these muscles, although connections to dura are found in rectus capitis posterior minor, which is associated with headaches. There is also a suggestion that tightness may affect positioning of head, increasing upper cervical extension.

Semispinalis capitis Reduced flexion of head and cervical spine. Entrapment of greater occipital nerve.

Splenius cervicis Reduced flexion of head and cervical spine. Limited studies exist on these muscles.

Longissimus capitis Increased lateral flexion of head on neck when observed in frontal plane, and posterior rotation of cervical spine.

Levator scapulae Pain in medial scapula and neck. Increased ipsilateral neck flexion and/or raised scapula.

Trapezius Reduced head and cervical spine flexion and ipsilateral rotation of head. Head pain is thought to be linked to trigger points in tight upper fibres.

Sternocleidomastoid Torticollis, both spasmodic and congenital. Head-forward posture. Increased extension of upper cervical spine.

Scalenes Sensation changes in arms and hands as the brachial plexus is compressed. Reduced rotation and increased lateral flexion of cervical spine.

Figure 3. Passive STR to the posterior scalenes.

Figure 5. Active STR to the splenius capitis.

Figure 6. Active STR to the neck extensors.

Figure 5. Active STR to the splenius capitis.

Figure 4. Muscles of the neck.

clavicular and sternal fibres. STR at the insertion points of the SCM, on the skull, is necessary, and an MFR lock will prove highly successful where fascial thickening is often evident; use of the knuckle away from the bone is helpful in attaining a lock, but move carefully into position.

The scalenes assist with inspiration, so incorporating breathing will not only help to relax the subject, but also directly assist with the release. The scalenes can be treated by first side flexing the neck to the same side during inhalation, then gliding away from the clavicle with the lock and moving the head into side flexion to the opposite side during exhalation (fig. 3). For scalenus anterior, lock in just laterally to the SCM; for the scalenus medius, lock in away from the mid-portion of the clavicle; and for the scalenus posterior, lock in away from the most lateral point of the clavicle.

Because this whole area can be highly sensitive, treatment should always be slow.

Neck Extension

Major Muscles: Levator scapulae and splenius cervicis (extend the neck); trapezius, splenius capitis and erector spinae (extend the head and the neck); rectus capitis posterior major and minor, and superior oblique (extend the head on the neck).

Neck Rotation

Major Muscles: Semispinalis cervicis, multifidus, scalenus anterior and splenius cervicis (rotate the neck); splenius capitis and SCM (rotate the head and the neck); inferior oblique and rectus capitis posterior major (rotate the head on the neck).

Neck Extensors and Rotators – Treatment

There are two main ways to work this area. Firstly, with the subject in a supine position, support the head with one hand and lock into the extensor muscles with the other hand as the neck is flexed, side flexed or rotated. Systematically release the superficial layers of the whole of the back and side of the neck; often, only minimal movement is required for an effective result.

Congestion frequently occurs between the trapezius and the SCM, within the splenius muscles (fig. 5) and

levator scapulae. These muscles may be reached by locking in deep to the lateral border of the SCM as the neck is side flexed to the opposite side, or as the subject is instructed to flex the head.

The upper fibres of the trapezius can be addressed using an index finger reinforced with the middle finger as the neck is flexed or side flexed to the opposite side. The deeper extensors can be engaged as the chin is tucked in for a stretch (fig. 6).

Use an MFR lock to engage the suboccipital muscles as the subject is instructed to tuck the chin in (fig. 7).

Secondly, in a seated position the subject can perform a variety of movements of side flexion, flexion and rotation as the therapist provides a specific lock (figs. 8 & 9). This is a highly effective way of introducing functional awareness as the subject is guided into a stretch.

It is important to achieve the pressure gently and precisely or movement will be difficult. The trapezius and levator scapulae can be treated highly effectively this way. The insertion point of the levator scapulae can be targeted by curling under the anterior fibres of the trapezius, towards the medial border of the scapula; the subject can then side flex and flex the neck.

MUSCLE EFFECTS OF MUSCLE RESTRICTIONS

Masseter Restricted jaw depression, lateral deviation of mandible (unilateral) with impact on bite mechanics. Compression of disc and tissue.

Temporalis Similar to those of masseter but with greater effect. Static retraction of jaw and concomitant reduction in mandible protraction. Linked to headaches and pain.

Lateral pterygoid Subluxation of mandible and dysfunctional movement between disc and mandible, resulting in clicks and possible locking of jaw. Linked to headaches.

Medial pterygoid Compression of disc and if unilateral, an increased contralateral deviation of jaw, affecting bite mechanics.

Figure 7. Active STR to the suboccipital muscles.

Figure 8. STR to the upper fibres of the trapeziuss.

Temporomandibular Joint (TMJ)

There are four main muscles associated with this joint: temporalis, masseter and the medial and lateral pterygoid (fig. 10).

Problems present as a general aching in the area, restricted or asymmetrical movement, and clicking. Dysfunction can occur due to trauma, for example a whiplash injury or a direct blow in a contact sport. Tissue congestion can develop from a jaw fracture or loss of teeth, or after major dental surgery during which the mouth has been forced open for long periods. Chewing on one side of the mouth or clenching the teeth may cause an overuse injury to develop, which can lead to pain and headaches.

TMJ – Treatment

With problems in this area it may be necessary to seek specialist advice, particularly from a dentist, who will check the bite.

STR treatment should initially consist of a general treatment to the neck. STR to the muscles which move the joint will help reduce pain and contribute to the re-education of faulty movement patterns; often a dentist will suggest a set of exercises, such as placing the tongue on the upper palate as the mandible is opened.

Apply an MFR lock to the temporalis (fig. 11) and ask the subject to open the mouth. Then apply a lock to the masseter and again ask the subject to open the mouth. Reinforce the index finger with the middle finger to work more deeply and close to the TMJ to target the pterygoids. Both sides can be treated at the same time initially; observe carefully how wide the mouth opens and note any deviation while palpating the tissues. For more specific STR, perform the lock to one side at a time but avoid over-treating.

Soft Tissue Release: A Practical Handbook for Physical Therapists is a complete reference guide for students embarking on clinical practice, therapists from all backgrounds wanting to understand more about pain management, or any individual wishing to harness the power of soft tissue release to treat their own pain.

MARY SANDERSON

Mary is a specialist in soft tissue therapy and has been a senior tutor for the London School of Sports Massage (LSSM) since 1994. She has run her own private practice in St Leonards on Sea, East Sussex, for over 25 years, treating a wide range of clients including elite sports people, musicians and performers. Mary also regularly presents on CPD programmes for manual therapists, personal trainers and coaches.

Figure 9. STR to the upper fibres of the trapezius using the elbow.

Figure 11. Active STR to the temporalis.

Figure 10. Temporomandibular joint.

Getting It Write Writing & Publishing for the Soft Tissue Therapy Sector

BY EARLE ABRAHAMSON

“A writer only begins a book, a reader finishes it.”

Samuel Johnson

Writing and publishing for the soft tissue industry can be an exciting opportunity to present new ideas, concepts and practices but could equally be difficult and lonely for the writer. How best do we design and develop publications that engage the reader with the content? What makes a good publication? How do we get started and build knowledge and content? These are just a few questions that continue to highlight the challenges within the writing process.

This article reflects on the process of writing and how best to develop ideas into publications. It further serves to connect ideas, the individual, and the industry through understanding what matters most in terms of scholarly and practiceoriented outputs. The article is punctuated with questions that will hopefully be useful in reflecting upon a range of challenging and important questions.

I initially use the term publication to capture a plethora of written outputs but then narrow the content to consider the writing and publication of books.

As an author and practitioner, I have always marvelled at publications that are well written, accessible, and present information in innovative ways. These publications (be they books, articles, blogs or information guides) make learning interesting and invite the reader into the writer’s world. However, bringing a publication to life requires dedication, understanding and commitment to what matters most within the industry. It is not about repeating what exists, but rather finding unique ways to advance knowledge and disrupt current thinking. In doing so the reader is invited to think and apply knowledge in different ways as opposed to simply absorbing the words of the writer.

Recently, I was invited to lead an on-line writing symposium for an international soft tissue therapy publisher. The idea was to create a common space for connecting international writers. The symposium was about different writing journeys, different destinations, and different starting points. By connecting

a range of writers in a common on-line space, the community of writers could engage with a series of questions as identified above and provide critical insights into their personal and collective experiences within the writing process. It further enabled the sharing of ideas and the probing of difficult questions to build publications that are not only useful for the writer but more importantly used by the industry.

I began the symposium by asking – “Who gets to write?”. This question triggered a range of responses that delved into the heart of inclusion, diversity and equality within the writing process. It exposed the examples we use, the choice of text we develop and the potential audience that could or would use and/or benefit from the work.

To develop the industry, we must begin to recognise knowledge in multiple ways. We must build a community that embraces and celebrates difference and recognises the true value of differing perspectives. The writing process is predicated on building and sharing knowledge in a range of ways. What we come to believe as truth is often engrained through exposure to specific ways of learning and doing. Collectively these are known as epistemologies and ontologies. Our knowledge systems inform the way we work and use knowledge to develop our skills. We may choose to exclude or ignore certain ways of working without fully appreciating why.

Take a moment to reflect upon how you have developed your knowledge? Who has been instrumental in designing

your thinking and thought processes? What publications do you read and why? By only focussing on certain ways of working, thinking and doing, you may subconsciously be destroying other forms of knowing and knowledge (epistemicides). Do you read publications written by authors from different cultural backgrounds? If so, how have these perspectives influenced your practice?

Publishing Books

Whilst some of the above questions may appear rhetorical, they provide a landscape into designing a publication. The writing process often begins with a mind map of ideas which enables the writer to systematically consider sequence, impact, value and reach of the work. If we take the example of a book, the first hurdle is convincing a publisher that the text is worth publishing. Here the focus is on audience, content, context, comparison, marketing and future value. For example, would the text gain value if translated into different languages or could innovation be used to support the reading of the content such as embedded videos and links to resources. Writing well is often beyond words and includes a sound knowledge of the industry, coupled with current debates and resources that are used across learning and practice abilities.

During the symposium, many writers identified the volume of ideas that could enhance but equally hinder the writing process. How much should a writer pack into a book? Is the book useful as a series of volumes? How will the book be read, used or understood? These seemingly simple questions need to be unpacked and considered when writing the initial proposal. Bringing ideas to life needs focus and review. Many writers at the symposium spoke passionately about having a critical friend, a colleague with experience who could cast a sensitive eye over the text, provide insight and understanding of how the text could be shaped, and support the development of the proposal and final text. This means actively seeking out colleagues, not necessarily family

By only focussing on certain ways of working, thinking and doing, you may subconsciously be destroying other forms of knowing and knowledge (epistemicides).

members, to be readers of the text who can direct meaningful feedback into developmental actions. Some writers appear to write at certain times and need space and place to collate ideas, consolidate thinking and block write key components of the text. Others may need to write a little each day. What became evident is that writing means different things to different writers. Some attempt to share years of experience and challenge within a single text, whilst others choose to focus on a specific skill or concept. It is important to define what writing a book means within the context you work. Writing is not about fame but more about focus. It is a journey with challenges, frustrations, distractions, and despair but in return often yields opportunity, enterprise and a firm sense of accomplishment.

I conclude this article by focussing on lessons learned and provide guidance to develop writing skills and opportunities for publications. I return to the question that triggered conversation within the symposium – “Who gets to write”. This question remains a catalyst for reflecting on what writing means and how writing is valued. Over many years I have been fortunate to write and support writing in multiple forms. I become excited at witnessing the conversion of ideas into publications and how through communities of practice new ideas and publications emerge. I equally worry about the silence or absence of writing in some communities due to fear of writing or feelings of not good enough or skilled enough to write. These individuals may have a lot to offer yet opt to read what is written (consumers of knowledge) at the expense of contributing to or producing of new knowledge.

Below I offer advice on navigating the writing process:

1. Research your topic and audience – know what and for whom you are writing,

2. Identify your community of critical friends – colleagues who will support your writing journey,

3. Research the publisher you wish to write for. In doing so, read publications from the publisher to better understand and familiarise yourself with the format, style and content.

4. Think carefully about individual or collaborative writing i.e. are you writing alone or with others? What are the benefits and barriers in doing so?

5. Plan your writing experience from proposal to publication,

6. Consider the context and supporting content carefully i.e. number of images, diagrams, tables etc…

7. Do your market research – who are the competitors? What books already exist? How will your publication differ? How will your publication stand out?

8. How long will it take to complete? Plan your timeline based on your writing habits

9. Connect your lived with your learned experiences – who could review your proposal professional and add value to the final publication? Who would be useful in writing a foreword?

10. Consider innovation in the design of the work – would videos be useful?

11. Plan for inclusion – this requires thoughtful consideration of images and content

12. Who will read, use, and recommend your text? Are you writing for a specific audience?

13. Plan a focus group to receive guidance and feedback on initial ideas and writing plan?

14. Consider opportunities for promoting your work –conferences, podcasts, events, tradeshows, blogs etc

15. Be brave and begin writing. Remember your initial plan may be miles away from the finished product – but at least you are making a start.

Getting it write is difficult. The process dictates commitment and time. Apart from the guidance above, remember to be bold, brave, curious and creative. Think about long term value and how through an initial text, you could generate additional ones. There is no write way, but there is a way that will work for you. The soft tissue therapy sector needs new writers, new ideas and new ways of working. As the sector reshapes its future, opportunities arise to design publications that serve to promote the values and practices we need to uphold.

EARLE ABRAHAMSON is an Associate Professor at the University of Hertfordshire. He is an international author, scholar and practitioner. He has published a range of texts for the soft tissue therapy sector and continues to write and supporting writing initiatives. Earle has been nationally and internationally recognising for his work on leading scholarship and writing. He is chair of the GCMT and elected board member to the CNHC.

Cupping for Back Pain

BY DANIEL LAWRENCE

Author of ‘A Practitioner’s Guide to Clinical Cupping’, Lotus Publishing, 978-1-913088-33-0, £14.99.

Available from Amazon and other online retailers

Introduction

The incidence of lower-back pain varies within different societies and cultures around the world. For thousands of years, practitioners of different medical disciplines have attempted to treat back pain using different theories and methods. Massage, manipulation, acupuncture, and cupping have all received regular mention in historical medical texts. In the West, cupping became overshadowed by Western medicine and the rise of the evidencebased pharmaceutical industry. Vacuum cupping does not feature in any national back-pain guidelines either in the UK or USA and has until recently been overlooked by many physical therapists. In contrast, acupuncture, which could be considered a similar intervention with similar origins, has been widely integrated into Western pain management. I believe that cupping, when utilized correctly, may just require

the opportunity to integrate with modern back-pain treatment approaches.

Placing a cup over the patient’s perceived painful area provides a handle for mobilizing the soft tissue without the need to apply downward pressure, something that can be unduly painful in the case of lower-back pain. If you are fortunate enough to have received cupping therapy over your lower back, you will likely appreciate why it has become so popular. The feeling is so unique it is often said to be “indescribable,” as it is not comparable to any other form of manual therapy.

Lower-back-pain treatment can be significantly aided with cupping, and so much more can be achieved beyond the traditional passive and static application methods. Cupping can transcend standard manual therapy and support the restoration of spinal movement and motor control. We will explore this further within this chapter.

Contraindications

While it is beyond the scope of this book to offer a full lumbar-spine assessment plan, this chapter does provide an opportunity to raise awareness of the spinal red flags, including cauda equina syndrome (CES).

CES is a rare but serious condition that if left untreated can lead to permanent loss of bladder and bowel control and sexual function. It is a condition that can be successfully treated if suspected and detected early. If your patient is experiencing any of the symptoms listed in box 1, instruct them to speak to a doctor or visit an emergency department on that same day. It is better to be overcautious if CES is suspected.

Cauda Equina Syndrome Warning Signs

• Loss of feeling or pins and needles between the inner thighs or the groin

• Numbness around the genitals, buttocks, or anus

• Increased difficulty urinating, leaking, or loss of sensation

• Not knowing when your bladder is full or empty

• Loss of sensation in the genitals

If a patient reports any combination of the above, they should seek medical help immediately from a doctor or an emergency medical department.

Box 2 lists other signs of serious spinal pathology, which are therefore contraindications to treatment. Any patients suffering from or reporting any of these symptoms should report them to their doctor. 2

Serious Spinal Pathology Warning Signs

• History of trauma, including falls, collisions, and impacts

•

• History of cancer

• Known or suspected

osteoporosis

• High temperature or feeling generally unwell

Stages of Nonspecific Back Pain

There are many causes of lower-back pain, and it remains a very unique experience for each individual.

This chapter will focus on techniques for nonspecific lower-back pain—this is the most common back-pain patient category. Patients with nonspecific lower-back pain have no history of spinal trauma and no symptoms of sciatic or other peripheral nerve involvement. The techniques will be most effective for acute back pain of less than six weeks duration but may also be utilized for more-persistent lower-back pain, while appreciating that longerterm back pain is often much more resistant to manual interventions.

Physiotherapist Dr. C. M. Norris (2020) described the back-pain recovery and rehabilitation process as passing through three distinct phases: reactive, recovery, and resilience. I am very much in favor of his approach.

When an episode of lower-back pain initially occurs, the patient is very reactive to the pain, often limiting movement and seeking to rest and immobilize as much as possible—this type of patient behavior is initially helpful to allow pain reduction and recovery. During this first phase, passive

interventions, which could include cupping, are well received and appreciated by most patients. Once the patient feels the back pain has “settled,” they should be guided to recover and restore normal spinal movement patterns. Cups can be used to augment the recovery phase, but not in the same manner they were used during the reactive phase. This is where we see the use of cups progressing from the constraints of traditional treatment to the innovative methods described later in this chapter.

The final phase, resilience, is the most exciting phase of rehabilitation. Sadly, it is one that is often ignored by bodyworkers and their patients, owing to the typically satisfactory reduction of pain and a lack of patient motivation to continue rehabilitation if no longer experiencing pain. In the resilience phase, as the name suggests, patients can build a resilience to the pain and dysfunction that come from the demands of normal daily life. This is often described as creating a functional buffer zone.

As mentioned previously, using cups for the treatment of lower-back pain requires a lot more than vacuuming the sore spots. The following treatment options are presented in a progressive order. You may be able to take a patient through the full regime in one session, or it may take multiple sessions to progress to the more advanced techniques.

The techniques will be most effective for acute back pain of less than six weeks duration but may also be utilized for morepersistent lower-back pain, while appreciating that longer-term back pain is often much more resistant to manual interventions.

Worsening pain that continues without movement and at rest

If a patient reports any of the above, they will need to be assessed by a medical professional before any treatment, including cupping, is considered.

Getting Started

Using the standard application principles outlined in chapter 2, begin with the patient in a resting position. This could be seated, prone lying, or side lying, depending on the patient’s mobility and preference (figure 9.1).

Passive Cupping

The starting position should be as comfortable as possible for the patient before the cups are applied. You may wish to start with just one cup applied with a low-to-moderate level of vacuum. This will allow the patient to familiarize themselves with the sensation, ask any questions regarding cupping, and begin to relax.

Following the introduction of one cup, the treatment can then progress by adding a second cup and mobilizing the soft tissue using the cups as handles, continuing this for 1 minute and then relocating the cups to avoid excessive skin marking (ecchymosis). Figure 9.2 shows an example of soft-tissue mobilization with two cups.

Active Cupping

Active cupping over the spine provides therapeutic movement in combination with the sensory stimulus of cupping. To achieve this, begin with the cups over the lower back, and then guide the patient to move through a specified range of motion. Figure 9.3 provides examples of active flexion (figure 9.3a–c) and rotation (figure 9.3d) progressions. Large ranges of motion can lead to a loss of vacuum as the skin movement breaks the seal around the cup. For this reason, make sure you are not using glass or other breakable cups.

Advanced Techniques

Active cupping techniques can be enhanced with passive soft-tissue mobilization to create an enhanced tissue shear during an identified movement restriction. The tissue shear can be applied to either assist or resist the movement or may alternate between the two. Advanced technique examples for spinal rotation, lumbar flexion, and side flexion are shown below.

Advanced Lumbar Rotation Technique

Begin with the patient seated, with their back accessible. Assess the direction of rotation restriction—i.e., right or left. Then place two cups on or just above the glutes on the same side as the rotation restriction, at an oblique angle (figure 9.4a). The aim is to place the cups along one of the myofascial lines that run across the spine. The cups can then be gently mobilized in the opposite direction to the active rotation to create tissue resistance and a tolerable level of shear strain (figure 9.4b).

An alternative method would be to assist the soft-tissue glide by mobilizing the cups in the same direction as the rotation (figure 9.4c). Following three or four endrange rotations coupled with the assisted or resisted soft-tissue mobilization, the patient should experience less resistance into rotation. If required, the treatment can be repeated and the cups can be reapplied further up the myofascial line (figure 9.4d).

Advanced Lumbar Flexion Technique

Begin with the patient seated, with the feet raised to flex the hips. The patient should then bend forward into pain-free lumbar flexion (figure 9.5a). Apply two cups over the paraspinal muscles at the level of the

Figure 1. The three starting-position options: (a) seated, (b) prone lying, and (c) side lying

Figure 2. Seated cupping up the spine using two cups, one in each hand

Figure 3. Active cupping into flexion from (a) seated, (b) side lying, and (c) prone position, plus (d) seated rotation

Figure 4. (a) Start with two cups on or just above the glutes on the same side as the rotation restriction at an oblique angle; (b) mobilize in the opposite direction or (c) in the same direction; (d) cups can be reapplied further up the myofascial line

upper lumbar spine. Apply a shearing force through the cups by resisting the forward flexion with a downward counter-tension by pulling the cups gently downward (figure 9.5b). Repeat this maneuver as the cups are relocated at intervals down the lumbar spine and over the upper sacroiliac-joint region (SIJ) (figure 9.5d).

Advanced Lumbar SideFlexion Technique

Begin with the patient in a neutral sitting position with approximately 90 degrees of flexion at the hips. Place one large cup over the region of the quadratus lumborum on the side you wish to stretch. Instruct the patient to reach up above their head and side flex in the opposite direction, while opposing the side flexion with downward counter-pressure using the cup (figure 9.6). Repeat this maneuver three to four times before retesting the patient’s side flexion.

Bringing It All Together

Once a patient becomes familiar with cupping therapy and regains confidence in their spinal motion, then the methods presented in this chapter can be delivered progressively during a single treatment session, with some potential customization to suit individual patients.

Figure 9.7 shows a series of photographs taken during a progressive lumbar-spine

cupping treatment. You will note that figure 9.7d shows the use of a deep squat to achieve the full range of lumbar flexion.

Cupping for BackPain Rehabilitation

The sensory experience of vacuum cupping can offer more than just a pleasant sensation. The lumbar spine is a region that lacks the ability to calibrate its movement with simple visual feedback. As a result, educating back-pain patients in the performance of restorative movement patterns can be challenging. Movement performance can be enhanced with increased sensory input, and this is often achieved with careful hand placement, also known as tactile facilitation, but it can also be achieved with vacuum cups, which have the advantage of being able to cover a larger area and provide a more intense and novel sensory input when compared with the touch of a hand.

For example, if you are teaching a patient to flex the lumbar spine, they may struggle to feel whether the spine is indeed flexing. However, with strategically placed cups (main pic), an intense stretching under the cups will be felt on flexion of the lumbar spine, which will provide the feedback and sensory reference to perform the flexion action correctly and to learn a new movement pattern.

Conclusion

The many different ways in which cupping can be incorporated into lower-back pain management highlights how versatile this treatment modality has the potential to be. You may wish to follow the guidance set out in this chapter or use the concepts to improve your current approaches to back pain. Whichever route you decide to take, the intention of this chapter was to present a modern methodology that allows practitioners to break away from the limitations of traditional cupping and begin an integration with the modern evidence-based approaches to back pain.

References

Myers, T. W. 2013. Anatomy Trains E-Book: Myofascial Meridians for Manual and Movement Therapists. Elsevier Health Sciences.

Norris, C. M. 2020. “Back rehabilitation: The 3R’s approach.” Journal of Bodywork and Movement Therapies 24(1): 289–99.

DANIEL LAWRENCE is a UK chartered physiotherapist, multi-published author, YouTube creator - @ThePhysioChanneland International lecturer. Daniel holds separate post-graduate qualifications in musculoskeletal medicine and education. Having completed 10 years as a university lecturer, Daniel now combines teaching, creating, travelling and clinical work alongside his role as European Education Director for RockTape.

Figure 5. (a) Patient seated with feet raised to create a squat position and then flexed forward; (b) two cups over the paraspinal muscles with a shearing force to resist the forward flexion by pulling the cups gently downward; (c) example using rigid plastic cups; (d) pods over the SIJ region

Figure 6. With one large cup over the quadratus lumborum, the patient reaches up and side flexes in the opposite direction, while you oppose the side flexion with downward pressure through the cup

Figure 7. (a) Passive lumbar cupping (two cups) in prone position; (b) Balasana yoga stretch (four pods); (c) Balasana plus shearing; (d) deep squat (six pods)

Relieving Back Pain with Massage: A Therapeutic Path to Wellness

BY MADELAINE WINZER

Although most jobs are physical and naturally can put strain on the back, those who spend most of their working day seated at a desk are also at risk of developing back pain. Sitting for a prolonged period of time without regular intervals can place a lot of strain on the muscles, joints and disks of both the back and neck. Less movement equates to weaker muscles causing the surrounding tissues to become inflexible making simple movements in everyday life such as carrying groceries or gardening more challenging. Chronic stress and anxiety experienced through the faster pace of living don’t help as our bodies hold all that extra tension too, which can lead to further issues including inflammation of soft tissues. In many cases the back pain has a resolution, however, if back pain

has built up over time it can be more difficult to fix. Therefore, it must be managed through a combination of medications, lifestyle changes and alternative therapies to enhance quality of life and help prevent further issues.

Benefits of Massage Therapy

Massage therapy can be an effective way to help alleviate back pain, offering individuals many benefits that can reduce both short-term and chronic pain. Sometimes the problem is in the back itself, however, a lot of the time, back pain is a signal that something elsewhere in the body is off balance. As a therapist, it is important to get to the route of the client’s issue, by asking questions and then asking some more questions. Generally, a client doesn’t know what

Modern lifestyles involve a significant lack of physical activity, which can lead to adverse consequences for both the body and the mind. A common complaint that presents itself time and time again, not just among clients, but in the general public is back pain.

type of massage or focus area within the massage will help their case, so by digger deeper, you will grasp what type of lifestyle your client lives and the effect it has on their body.

Just by looking at somebody, you can tell they are carrying ‘the weight of the world on their shoulders’. It is no coincidence as the body operates as a single unit, and stress and emotions can accumulate in the body causing muscles supporting the spine to tighten. When this happens, bones can become misaligned affecting the spinal cord and adjacent nerves. Therefore, self-awareness is important, so a minor stressor doesn’t become a major stressor.

Massage can help to alleviate back pain, while also providing other wonderful benefits that will most definitely add to quality of life. Some of them include:

◆ Stress management: Massage will help relieve tension that has built up in the muscles over time and lower stress levels by promoting relaxation and releasing endorphins. When stress levels are decreased, it is likely that emotions such as depression and anxiety will also decrease.

◆ Increased circulation: Massage encourages blood flow, delivering more oxygen and nutrients to muscles and tissues. This helps to rid the body of toxins and reduce inflammation, therefore promoting healing and speeding up the recovery process.

◆ Improved flexibility: Massage will reduce stiffness and tension in muscles surrounding bones and joints, while also stimulating the production of synovial fluid, improving the range of motion. What’s more, regular massage will help joint mobility and the maintenance of muscle elasticity.

◆ Better posture: Regular massage helps promote relaxation and therefore reinforces healthy and natural movements. Massage can free the muscles that have shortened or become weak because of bad posture, giving the body a chance to move with less pain and more fluidity.

◆ Deeper Sleep: Massage can shift the body from a sympathetic state (fight or flight) to a parasympathetic state (rest and digest). This makes it easier to drift off and enjoy a quality night of sleep.

Which Massage Is Best for Back Pain?

There are several types of massage and techniques that can be effective for treating back pain. It depends on the root cause of the pain, the intensity of the pain and the client’s preferences. Differentiating between Eastern and Western approaches to massage is important as in the West, the mind and body are viewed as two separate entities whereas, in the East, the body is focused on as one entity. Popular forms of Western massage are Swedish massage and deep tissue massage. Swedish massage utilises five strokes to treat superficial muscles, promoting relaxation and increasing circulation. It is perfect for individuals who have tension in their back through to those suffering from pain caused by arthritis. Deep tissue massage uses a firmer pressure reaching deeper layers of muscle and fascia to break down knots that contribute to inflammation. Deep tissue is great for treating people who have sports-related injuries and for treating the majority of those with arthritis.

Eastern massage emphasises holistic health and its influence continues to grow in the Western world as more principles

RELIEVING BACK PAIN WITH MASSAGE

and techniques have become commonplace in the West. A popular massage that is used in the West to address back pain and other health conditions is Shiatsu–a form of Japanese bodywork that uses pressing, kneading, soothing, tapping and stretches. It is based on the traditional Chinese medicine of ‘qi’ which is a vital life force. When this is blocked, it is believed to cause issues in the body that leads to disease, and shiatsu is used to help resolve these blockages so energy can flow freely. Shiatsu massage is often used in corporate environments to give workers a rest bite from their desks and relieve some stress. It is convenient as it can be performed through the body and is oil-free.

Conclusion

The spine is central to most things we do with our body, and yet is often neglected. We all experience back and neck ache to varying degrees without knowing the cause or how we can alleviate and prevent it. Stress, tension and knotting of muscles is what massage therapists feel and work on. The effects of massage are quickly felt, and we can all benefit from this regular back care whether a nurse, driver, office worker, construction worker or in hospitality. The differing stresses and pressures on our spines and backs are added in the gym, practising sports and at home. It sounds like an expense as it is usually not provided by the NHS, however, it will reap big benefits for you, your longevity, mobility, provide you with advice from a therapist and result in a happier you.

Massage may not fix all our problems, but it can make a big difference for those experiencing back pain – a positive step in the right direction.

The Seven Secrets of Highly Successful Bodyworkers

With acknowledgements to Steven Covey for his inspirational book: The Seven habits of Highly successful people.

What makes a really GREAT bodyworker?

During my twenty five year love affair with bodywork I have practised, taught, studied and received massage in many diverse parts of the world including the UK, USA, Europe and Thailand. I have known bodyworkers from many different disciplines and walks of life, from the extreme ends of the “New Age” to the resolutely

scientific. I have experienced people working with muscles, bones, auras, Qi, cranial rhythms, Sen lines, meridian lines, manipulating organs, fascia, using movement and stillness. I have seen healing happen through working on the body, off the body and in the deepest layers of the body.

From all of this it has become apparent to me that some bodyworkers “make it” – they are successful, happy, have the practice

they desire, feel like they are travelling their life path, and are financially content in whatever way that means to them. Others never quite seem to get there, their practises don’t flourish, clients don’t come back to them, they are scraping a living emotionally and financially.

So what is the difference? What makes a truly great bodyworker? It seems no single quality alone will suffice. I have seen highly gifted and

intuitive therapists burn out rapidly as they become overwhelmed with the practicalities of running a business. I have seen therapists who are successful business people and know their anatomy inside and out but who have no sensitivity of touch or ability to relate to clients.

This article attempts to distill the essence of some of those qualities I have observed in the therapists who are living and loving their life and work to the full - the Seven Secrets of Highly Successful Bodyworkers.

Secret One: Enthusiasm

“Nothing great was ever achieved without enthusiasm” Emerson

“Nothing is so contagious as enthusiasm; it moves stones, it charms brutes. Enthusiasm is the genius of sincerity and truth accomplishes no victories without it” Bulwer-Lytton

Great bodyworkers LOVE what they do. They are excited, animated and energised by their work. They love to talk about it, read about it and let others know how great bodywork is. And their enthusiasm doesn’t just stop at the bodywork; they are energetic about all aspects of their practice; how they can make their clinic room the most restful and appealing to their clients, how they can design a great business card or leaflet, how they can find the best clinic or colleagues to work with. Enthusiasm is contagious, your clients want to know that you believe in what you do, they want a piece of what makes you buzz. If you are bored by your work, your clients will know and, lets face it, who wants to be around someone who is jaded .

One of my first teachers said to me “I have to constantly find ways to stop myself getting bored with massage”. That is what good massage therapists do- they are fascinated by the body, always finding new ways to achieve better results with their clients, looking for new techniques. If you

are still doing the same routine you learned five years ago, chances are you will be bored.

So if you are jaded with your treatments, go and get some training, find new ways to work and break out of the box. Find a colleague to swap with and learn some new techniques. Read a great bodywork book. Surf the internet for inspiring bodywork sites. Rediscover your passion for your work and watch your practice grow.

Secret Two: Perseverance

“Victory belongs to the most persevering” Napoleon

“I never did anything worth doing by accident, nor did any of my inventions come by accident, they came by work” Edison

“If people knew how hard I worked to get my mastery, it wouldn’t seem so wonderful after all” Michelangelo

Like these famous characters, successful bodyworkers know the value of hard work and perseverance. Great therapists “keep on keeping on” when things are not going their way, pick themselves back up after mistakes and failures. No matter how talented you are, building a successful practice takes time, work and perseverance. Don’t expect the phone to just start ringing when you qualify; you need to put in effort and good old fashioned elbow grease to get those clients. Remember the old adage “If you love what you do you’ll never work another day in your life”. So love your vocation, work hard at it and enjoy the journey.

Secret Three: Be open to new learning

“As for me all I know is that I know nothing” Socrates

“To be conscious that you are ignorant is a great step to knowledge” Disraeli

The fascinating paradox is that great bodyworkers “know their stuff” yet at the same time are comfortable with “not knowing” and are always striving to learn more. Taoist sages claim that “one who does not know actually knows, and one who knows really does not know”. To be empty, to recognize how little we know is to be abundant. Successful bodyworkers are always open to new learning, and recognise we are always beginners with so much to learn. As the great Tom Myers, author of “Anatomy Trains” said once in class “The higher the mountain of my knowledge, the broader the horizon of my ignorance”. Knowing more helps us realise how much more there is to know. In this way, bodywork becomes a precious jewel that will sustain our interest for life.

There is a wonderful story in the book “ Beyond Shiatsu” by the inspirational bodyworker and teacher Ohashi that helps us to understand the importance of always keeping a “beginner’s mind set”

“In the 1970s I gave some sessions to the late prima ballerina Margot Fonteyn. After one of them she said she was attending ballet classes for beginners. I asked her “ Why are you- a famous, top ballerina- taking a beginners basic course with 18 year old kids. She said “If I don’t take this class every day, I can tell it in my performance; and if I don’t take this class for 2 days my choreographer can tell and if I don’t take it for 3 days, an experienced audience can tell”.

This is the essence of mastery – to always be open to new learning, to seek out inspirational teachers and mentors, to use their experience to give you shortcuts to the success you desire.

THE SEVEN SECRETS OF HIGHLY SUCCESSFUL BODYWORKERS

advancedcpd

THE SEVEN SECRETS OF HIGHLY SUCCESSFUL BODYWORKERS

entirely different from what will be needed to enable the next client to achieve deep relaxation.

Secret Four: Great Touch

“Good bodywork is 90% perception and 10% technique: (Christophe Somer; Rolfer)

Successful bodyworkers have great touch. Their work has focus, sensitivity and connection. The term “listening touch” coined by Rollin Becker describes this perfectly. Good listening touch is different than knowing lots of techniques- skills are important but if they are carried out with lack of focus and feeling, your work will be ineffective. It doesn’t matter whether you are doing sports massage, relaxation massage, aromatherapy, shiatsu, craniosacral work or Thai massage, the therapists who get good results and retain clients have great touch. This doesn’t mean they were just born with it: like everything else, good touch and sensitivity comes from application, focus and experience.

Good teachers will teach you not just technique but how to touch –how it feels to palpate a tight muscle, restricted fascia, stagnant energy or the gentle tide of the cranial rhythm. Receiving bodywork yourself will teach you what feels good and what doesn’t. Cultivate your sense of touch by being fascinated by the body and its hidden rhythms and find yourself a good teacher whose own touch thrills your senses.

Secret Five: Outcome orientated treatments

Successful bodyworkers are focussed on the outcome of their treatments not just what style or techniques they offer. If a client wants to relax, a good therapist doesn’t just launch into the same old tired routine but digs into their toolbox of techniques and finds what they can use to make this unique individual relax. This may well be

At Jing, our advanced clinical massage courses look at how to reduce pain within 1-6 treatments from a combination of advanced techniques including trigger point, myofascial release and stretching. Being outcome orientated builds practices and retains clients as they know exactly what they can expect to achieve from the treatment or series of treatments. Being outcome orientated also relies on good consultation and assessment skills so you know what your client needs and expects.

Secret Six: Beautiful Body mechanics

“The energy is rooted in the feet, developed in the legs, directed by the waist and expressed through the fingers” (Tai chi classics)

Employing good body mechanics while you work not only helps you to avoid injury but also enables you to use more sensitive and powerful touch. The equivalent of a secret handshake, we like to joke that good massage therapists are able to spot each other across a crowded room by the grace, composure and sense of focus of their body mechanics. A good massage therapist moves with ease and fluidity, avoiding techniques that place strain on hands, wrists, necks and back. In this way massage becomes a dance and moving meditation, following the principles of tai chi, using breath and energy and from a firm rooted foundation.

Good body mechanics relies on several basic principles:

• Power of grounding: As expressed in the quote above, Tai Chi Masters understand that power, strength and grace comes ultimately from the connection with the earth. Before you start working, take time to establish a strong energetic connection with the ground through your feet, legs and belly (known as the Hara or Tan Tien in the East). In Traditional Chinese medicine the Hara is the “centre of being” and martial arts emphasise moving from this place to achieve graceful power and strength.

A good visual to help establish a strong connection with the ground is by imagining roots extending from the soles of your feet and penetrating all the way down into the centre of the earth. On the in- breath imagine you are drawing up light, warmth and energy into your belly. On the out -breath imagine that energy is shooting up your spine, down your arms and out of your hands. This is a great visualisation to help you work deeper without working harder and encourages you to operate from your legs and belly rather than the upper body and arms. In this way you are able to give a deeper and more sensitive massage without strain. It does however mean that you will develop muscular horse riding thighs from doing massage rather than buff Madonna arms!

• Use of the Hara: A good principle of body mechanics is to ensure that your hara points in the direction you are working. Imagine your hara as a strong light attached to your belly that functions to illuminate your workspace. This helps you to avoid twisting your body into uncomfortable positions while massaging.

THE SEVEN SECRETS OF HIGHLY SUCCESSFUL BODYWORKERS

• Use your body weight not muscular strength to work deeper. If your table is at the correct height you should be able to lean into the body to achieve depth rather than pressing and straining with the hands and arms. As Ida Rolf, founder of the deep fascial technique known as Structural Integration said “Strength that has effort in it is not what you need; you need the strength that is the result of ease.(Rolfresearchfoundation.org, 2014)

• If your client needs deeper work, avoid the temptation to strain and instead bring yourself back to your breath and hara. Soften your body, shoulders and arms, breathe out and imagine the breath flowing down your arms as you lean into your clients body to achieve depth. This approach also keeps your body in a sate of receptivity where you can sense changes in the tissues. Tight muscles and locked arms reduce our ability to actually feel.

• Keep your joints stacked but soft. Avoid techniques that place the hands or wrists in ulnar or radial deviation or cause the elbows to bend excessively. The wrists should be in line with the elbows and the elbows in line with the shoulders. However at the same time, ensure your joints are not locked but have a slight softness within them.

• Feet, Breath, Belly: When we work it is easy to get completely caught up in the task at hand both psychologically and physically. This can lead to us working harder or faster than we need to and lessen our capacity for listening to the body and using the principle of less is more. Using your own breath as an anchor is a good way to avoid this. Always find the quiet part within yourself by re-connecting with the breath flowing in and out of your belly and by noticing the sensation of the feet against the floor. Keep checking back into your own body and noticing how you feel. A good mantra while you work is “Feet, breath, belly” . This really helps you to remain grounded at all times

• Keep your chest and heart area open and avoid the temptation of hunching over or staring at your client’s body. The massage therapist’s quest for X- ray eyes doesn’t help- honest!

Secret Seven: Good interpersonal and listening skills

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”

Leo Buscaglia

Whether you are a medical doctor, massage therapist, talk therapist or acupuncturist, a key component of facilitating wellness in your client is this therapeutic relationship or alliance. This refers to the sense of “collaboration, warmth, and support between the client and therapist”.

In other words that warm fuzzy glow you get when you think about a professional who has shown kindness and concern for your wellbeing.

Research shows that if you have a good relationship with your doctor for example, this in itself means that you are likely to have an improved healthcare outcome regardless of what treatment you receive. This is just as true for our work with musculo-skeletal pain- studies have shown that positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in low back pain and increased treatment satisfaction for clients

with musculoskeletal problems. Really? Can our client’s bad back be improving just because they like us? Is being smiley more important than soft tissue release? Research suggests that the interpersonal dynamic is certainly a factor and points to the importance of the practitioner- client bond as part of a competent and truly holistic healing process.

Good bodyworkers have a kindness and concern for their clients and excellent interpersonal and listening skills. Take time to develop these and your treatment outcomes will improve considerably.

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

RACHEL FAIRWEATHER

The Pocket Atlas Of Trigger Points

Written by Simeon Neil-Asher

A simple, go-to guide to treating chronic pain with trigger point therapy for physical therapists, bodyworkers, and patients.

From the bestselling author of The Concise Book of Trigger Points.

This pocket-sized guide covers practical information about the trigger points— the painful knots that can form in tissues like muscles and fascia— that are central to addressing acute and chronic pain with massage, bodywork, and physical therapy. Fullcolor illustrations and charts help practitioners, students, and patients identify trigger points and address referred pain pat- terns with ease. The first chapter introduces relevant information on fascia and myofascial meridians and provides an overview of trigger point symptoms, classification, and formation. Subsequent chapters are organized by muscle group and feature concise—yet comprehensive— sections on each of the main skeletal muscles and their trigger points. Common conditions, such as headaches and back pain, are explored for all of the muscle groups, including the muscles of the:

• Face, head, and neck

• Trunk and spine

• Shoulder and arm

• Forearm and hand

• Hip and thigh

• Leg and foot

Written in clear, accessible language, this essential guide offers a wealth of knowledge to the lay reader, the student, or the practitioner.

ISBN: 978 1 913088 12 5

PRICE: £12.99

Available www.massagebooks.co.uk

Evya London Review by Madelaine Winzer

Iam excited to share this exciting new brand with the massage community. Evya London is a 100% organic and vegan-friendly oil brand. They ethically source their ingredients from certified organic farms throughout the world and bottle them in the United Kingdom to bring you products that make you feel good from the inside out.

Jojoba and Lavender Essential Oil

Evya stocks a variety of carrier oils that are extracted from nuts, kernels, or seeds of plants that are mixed with essential oils to reduce the potency to avoid irritation or burning to the skin. The client’s needs will determine what carrier oil and essential oil you will use during your massage.

I most recently blended Evya Jojoba Oil with a few drops of Evya Lavender Essential Oil sourced from France for a client who mentioned they held a lot of tension in their upper back and neck. Lavender is known for its ability to calm the nervous system, lift mood and reduce pain and inflammation, while jojoba oil is deeply hydrating and moisturising for the skin.

It was my first time mixing my own oil and the instructions provided by Evya made sure it was safe and effective for my massage. The scent was wonderful, and the consistency of the oil made the strokes of my massage flow smoothly.

Muscle Ease Oil

Lavender, peppermint and eucalyptus are the three essential oils mixed with grapeseed carrier oil to create this blend which I absolutely love. The essential oils complement each other well to create a scent that is warm and soothing while the consistency makes it an enjoyable blend to use for massage. It is my favourite blended oil from the Evya collection that I have tried so far and ensures a relaxing and rejuvenating massage for the client.

Credit for photos:

Photographer: Mert Can Dogan Insta: @agrobacter

St Mary’s University - School of Massage

WORKING TEAM

Our friendly and supportive team of expert tutors includes Naomi, Cathy, Vicky (main pic left to right) and Amanda. The team has a wide range of specialities and is very experienced in teaching massage qualifications.

Naomi delivers the Level 3 and Level 4 Sports Massage qualifications, including our intensive courses and our popular one-day Pregnancy Massage course.

Cathy teaches the Diploma in Sports Massage for Massage Therapists, the Level 3 Extended Diploma in Sports Massage and also our advanced Level 4 and 5 Sports Massage courses.

In addition, Cathy delivers a number of focused one-day courses including Taping and Strapping, Muscle Energy Techniques (MET) and Soft Tissue Release (STR).

Vicky is our expert teacher in Anatomy and Physiology theory which is the foundation of all our entry level massage diplomas. Vicky also teaches our Level 3 Diploma in Body Massage.

Amanda is our Reflexology specialist and teaches the Level 3 Diploma in Reflexology.

The team also includes Cindy, Liz and Helen who are always on hand to help with any questions and organise volunteers for students to practise on.

BACKGROUND

This September we are delighted to be celebrating our 25th anniversary of delivering professional massage qualifications. We are proud to be one of the longest established and most experienced providers in the sector, offering not only entry level qualifications but also qualifications which allow you to advance and develop your skills and client portfolio as your career progresses.

We have a rich heritage as part of St Mary’s University, Twickenham and our students enjoy learning in state-of-the-art facilities which are fully equipped with high spec hydraulic massage couches at our specially developed unit, which is also home to our Sports Rehabilitation and Physiotherapy students.

OUR COURSES

A full range of ITEC qualifications for every part of your career journey - from the Level 3 Diploma in Massage and Sports Massage to the advanced Level 4 and 5 Diploma in Sports Massage.

Also, qualifications such as the Level 3 Diploma in Reflexology which is an excellent way to develop your skill set and client base. Plus, specialist courses that continue your career development such as Pregnancy Massage, Taping and Strapping, MET and STR.

Our next courses start in September 2023.

WHY TRAIN WITH US?

Our extensive experience, our expert teachers, our state-of-the-art teaching facilities and the range of courses on offer!

We offer plenty of flexibility with course dates allowing you to fit your studies around childcare and work commitments.

Our courses also have a very high level of in-person, hands-on-teaching which and allows our tutors to give plenty of guidance and feedback.

We also offer you the option to pay for your course flexibly.

Finally, we have an excellent success rate and hope to welcome you soon!

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BOOST! The science of vitality

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Stress: A Physiological Perspective

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Our brains and bodies are physically entangled and co-dependent. Connecting the visual and vestibular systems with movement could be the missing link in improving physical performance

Fascia & Movement

The Problems with Anatomical Position

BY JAMES EARLS

Extracted from upcoming publication: Functional Anatomy of Movement

Life is a continuous exercise in creative problem solving.

Michael J. Gelb, Brain Power: Improve Your Mind as You Age

The use of anatomical position is probably one of the biggest barriers to understanding functional anatomy. Anatomy books rarely, if ever, tell us that they are presenting us with a model based on several conventions. The conventions used by the books have become so endemic that they are passed down from one author or teacher to the next without question.

One of the problems is the lack of an introductory disclaimer that puts the many assumptions and conventions of the anatomical model into context. By omitting a statement listing those assumptions, the texts are setting us up to experience failure and confusion, as the assumptions are like weeds that grow and get in the way of our path to understanding.

The use of “anatomical position” and its trusty companion, rote memorization of muscles, presents immediate barriers to understanding when we attempt to interpret everyday movement. Our starting point for the anatomy of movement should not be the textbooks, it should be movement. Movement should inform our interpretation of anatomy, not the other way around. Straight away, there are two major challenges with this new approach—but they exist only because of our previous teachings:

1. We should be aware that sometimes “We do not know what we do not know.” In our case it is the prejudices, the biases, and the unconscious confusions that have been drilled into us through textbook anatomy. Without knowing it, the textbooks have handicapped our ability to grasp the anatomy of movement.

2. Because textbook anatomy uses such a small frame of reference, we have not been given the language to describe what we see when people move. Vocabulary and the clarity of language will be an ongoing theme. It might seem pedantic, and you may find it a little difficult to grasp initially, but my guarantee to you is, if you practice the language and become fluent in it, you will start to see anatomy as it moves.

We will fit anatomy to human movement, not the other way round, which has been the case for too long. It is human movement that should be our starting point for understanding. There are many schools of thought in movement therapies, often with too much dogma and not enough understanding. There are too many trademarked approaches trying to teach us to move in “their” way, with “their” repertoire, and “their” interpretation of anatomy. But there is no “their” anatomy, there is just the anatomy that fits your movement in the context of your body.

Announcing the Unannounced Rules of Anatomical Position

1. Position

Every listed action in anatomy books begins from anatomical position, but few of us ever find ourselves in that position at any point during the day. The main picture only gives us a taste of the almost endless variations on body orientation and position from which we must control or create movement.

We will pay a lot of attention to vocabulary and language skills. The anatomical language for movement is more highly developed than most of us realize. The problem has been the way it has been handed down and diluted over time, with the emphasis being placed on learning location and action rather than the effects of tissues on, and during, movement. Learning that language will take just a little time, and practicing it can be done anytime, anywhere, by simply taking a quiet moment and watching someone as they move.

Each article will build your skills of seeing and verbalizing movement. The old saying “Give a man a fish and you feed him for a day, but teach a man to fish and you feed him for a lifetime” is perfect for our approach here. Textbook anatomy gives us fish—lots of them—and because those fish are all in anatomical position, it does not really tell us much about the qualities of

fish, their ecology, the ways they like to move, or the best ways to catch them. By the time you have worked through this text, you will be sufficiently prepared to recognize, describe, or design most movements you come across in real life, in the studio, or in clinical practice.

The pressure to be precise and accurate is part of the illusion delivered within the detail of textbook anatomy. It is almost as if there is a conspiracy to provide us with limited tools to give the impression of exact answers, so that we can perform examinations in ways that can be graded, so that we can apply exact orthopedic tests, so that we can then perform random double-blind controlled tests, so that we can ultimately create standard protocol approaches for each pathology. Thankfully the world is much more interesting and random and far more exciting than that. However, to embrace it we must be content to go to the place of not knowing the final answer.

2. Environment

Our movement environment is probably the biggest movement variable with which we must contend. Part of the excitement and interest of the real world is our constantly changing surroundings. We might be slogging away at the computer desk one day and climbing mountains the next. We make movements while we are sitting, we can swim, and swing from branches, but poor old “anatomy man” only ever gets to float in one place (Figure 1).

The anatomy of movement requires an appreciation of how the environment alters the way forces are dealt with by the body. We will cover

many of those variables, but the ability to understand the switch between open- and closed-chain movement and how it affects muscle action is perhaps the biggest breakthrough you can make to help along the way. If these concepts are not familiar to you, don’t worry—we will deal with each topic from a range of directions with slightly different vocabulary and images, as it is impossible to explore every possibility up front. We have to present the overriding principles first and then you can practice applying them in your own discipline. Learning the principles of movement is essential. We cannot take the rote memorization approach used in textbook anatomy. There are an infinite number of ways in which we can change our movement environment. We can have different parts of our body in contact with a surface; the surface could have different properties (think sand versus concrete), it could also be at different angles, or different temperatures, and so on.

3. The Missing Forces

Somehow “anatomy man” lives in a world with no gravity, ground reaction force, friction, or momentum present. To “see” anatomy in action, we must understand the effect each force has on the body. We will address each of

them through the text, but don’t panic—there will be very few graphs and even fewer equations, I promise. This is not a standard biomechanics text. My intention is to develop the language and therefore the vision to “see” anatomy, not to pass college tests.

Jargon, unnecessarily complicated equations, and questionable science have all hindered our understanding of normal, real-life movement. The aim here is to give you a working appreciation to see how the forces interact to change how our tissue reacts. The reality is that most of us don’t really care or need to know how to measure the forces acting on and through the body, we just want to understand how it moves (or doesn’t), and so we can leave the kinetic side of biomechanics to those who are inclined that way.

Figure 2 shows the different actions of the hip abductors during open- and closed-chain movements, but it also presents the effects of gravity, momentum, and ground reaction forces. We will explore the forces of gravity, ground reaction force, and momentum, but it is worth defining them briefly here first. We will consider gravity to be constant in both direction and the amount of force it applies to the body. Gravity does change slightly with altitude but not to such a degree that it really affects our movement, and if you are that high, the lack of oxygen will be more of a concern than how your “glutes” might be working.

While gravity might be constant, ground reaction force is highly variable and, just to confuse us a little, it is not always a ground reaction force. Reaction forces result from any interaction with a surface, but the most discussed reaction force is the one we feel from the ground with every step. If you are sitting to read this text, your chair or sofa is supporting you by providing a reaction force. Move slightly in the

chair and you can sense the change in pressure under your pelvis as the angle of that pressure alters accordingly. Different ground surfaces also affect reaction forces - this is why running on sand is harder work than running on a road (because the softer/ more dispersible surface absorbs a larger percentage of the impact force), and why running on a road can be more jarring to our system (because the harder surface absorbs less of the impact force, which is why we try to change the environment for our feet and purchase “cushioning” trainers).

Momentum is a major factor in real-life movement. Muscle-actionbased anatomy assumes it is muscles that create the force to move us, but that is not always the case. Think about what happens after you throw a ball— your body responds to the momentum of your arm, and your spine and hips will probably flex, but not necessarily because of contractions from the flexor muscles. We will see many examples of how, because it is completely connected, the body transfers movement through itself—movement in one body part should create movement elsewhere.

4. Joint-Specific Movement

Anatomical-position anatomy assumes only the joints crossed by the muscle tissue are the ones affected by the muscle’s contraction. This is a strong prejudice and is even embedded in how

we name many muscles. Using their anatomical-model “actions,” we name muscles directly according to their actions (e.g., flexor hallucis longus and adductor brevis), and we group muscles together according to their common actions (e.g., the abductors, the plantar flexors). The language is so ingrained that when we hear the “abductors” being talked about, we know it is the hips under discussion. As we will see, this common language can be very useful as a shorthand—it allows us to know exactly where we are, and which tissues are being addressed—but it harbors unseen prejudices that limit our thinking. Do the “abductors” only abduct? No, they also control adduction and can produce and control medial and lateral rotation, as well as flexion and extension of the hip, so why do we insist on lumping them together, and thereby limiting them, as “abductors?”

As every muscle will affect joints and tissues beyond its defined span of

“origin and insertion,” we will build toward a full-body, interactive, and interrelated vision and see how changes in tone of a muscle can ripple outward beyond its attachment sites. For example, stand up and balance on your right leg, but let your hip drop (figure 3), and then use your hip abductors to bring your pelvis back to horizontal again.

Of course, other muscles were involved, and we need to appreciate how other muscles play supporting roles during movement, as no muscle—nor group of muscles—works independently. For example, in the exercise in figure 4 our need to stay relatively aligned to gravity (i.e., to remain upright) requires the spine to bend as the pelvis tilts away. The bend of the spine helps the head stay in place, but then try keeping your head, spine, and pelvis neutral to one another as the right hip adducts to see what would happen—it can’t be done without falling over (see figure 4). Although this simple movement is something we do with every step, anatomical position and its associated language makes it confusing because of its failure to appreciate the influence of gravity and the interconnectedness of the body.

5. Muscle Action—Not Function

In contrast to the reality of the body’s interconnectedness, anatomical position allows only the distal bone

to move in response to a muscle contraction, but in the real world that is rarely the case. It is only when confined by exercise equipment, or the instructions of certain disciplines such as Pilates or yoga, or by other environmental factors, that movement is limited to one or two joints. That is not to say that any of those restrictions are necessarily bad things—they add precision and control to a discipline, focusing strength or motor control into specific areas.

Anatomical-position-based anatomy has given us the impression that we can use isolated muscle actions to create exercises. The ability to focus strength and control into precise areas for a client can be an extremely useful tool for any therapist—movement or manual—but it has generally been done in a shotgun manner.

There are many books to show what curls, squats, and lunges do for your “glutes,” or how various asanas or other repertoires can “improve your core.” Few books exist to show how any of that relates to real-life movement and why you might want to use precise exercises for the client in front of you at that time. An aim of this book is to give you the tools to provide a truly holistic, individual program to match the needs of your client in that moment. However, this book does not aim to give you prescriptions. It is not embedded within any one philosophy, dogma, or aesthetic, it just wants to promote good understanding.

JAMES EARLS

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.

Finding Purpose Hawaiian Lomi Lomi Massage

INTERVIEW WITH ROSALIE SAMET BY MADELAINE WINZER

The story of Hawaii is essentially a sacred love story about the people’s deep reverence for nature, their beliefs, and customs for their people. The people were in love with the beauty, power, and magic, and in return, they felt truly loved by life. Lomi lomi is an ancient massage that had been practised for over 1000 years and was a sacred part of healing affecting the body, mind, and spirit. This style of massage differs from other types of massage with its use of smooth therapeutic strokes to massage the whole body to release trapped memories and tensions, so that balance and harmony can be restored throughout the body.

Itravelled two hours by train from my family home in Essex to Brighton to meet this lovely lady. We chatted for a couple of hours by the fire where Rosalie asked me “Can you write?” before I proceeded to ask her about her journey into massage and what continues to inspire her to share her passion with others in the Western world. And like any interview I do, I ask one question and the answer tails off to the point where I intervene with a style that could compete with Amelia Dims on Chicken Shop Date. For me, writing means being able to put myself out there and communicate how somebody else sees the world by giving them a voice while being a good massage therapist means creating a place of trust and helping somebody feel good, by relieving some of their pain, whether that is physical or mental.

Rosalie first discovered the sacred art of Hawaiian massage when she was in London in 1990. It was an experience that allowed her to reach a state of mind that made her feel at peace, reminding her that she had everything she needed within her – you could call it an ‘aha’ moment. It was the beginning of a new journey that led her to study in Hawaii where she discovered a whole new way of seeing the world.

After being influenced by the rituals of Hawaii, Rosalie transformed her life by integrating Aloha into her own life to generate positivity. She has been sharing the benefits of lomi lomi with others for over thirty years through her work as a massage therapist and shares her knowledge with the next generation through the courses she runs. Her passion is obvious as she ensures her students are connected to their life force to facilitate healing in clients before they become certified in lomi lomi massage.

There is no better way to understand something than to try it and I had the pleasure of receiving my first ever lomi lomi massage from Rosalie. In preparation, we discussed the expectations of the massage before Rosalie went ahead and prepared the room, so it was warm and relaxed. She then went on to cleanse the room of all frequencies less than love and harmony so they could be replaced by love and light. She then left the room, and I got ready for the massage.

And unlike most other types of massage, I removed all my clothes and was covered with a sarong to protect my modesty as I lay face down on an oil-resistant table rather than on a towel. This allowed for an uninterrupted continuous flow of the massage techniques with oil that traversed along the sides of the body, giving access to the gluteal muscle group that holds so much tension. Rosalie made sure only the area being massaged was uncovered so I was never exposed.

With soft music lingering in the background and Rosalie checking in to make sure everything was okay, I switched off soon after the massage began as my mind lost its trail of thought. It was a ninetyminute massage which allowed me to fully reap the benefits of the

massage with me turning over at the midway point so my front including the face could be massaged.

Hawaiians believe that massaging the back of the body clears the path towards the future and by working on the front of the body issues of the past are resolved.

The benefits of lomi lomi that stood out to me as my massage came to an end after Rosalie performed some grounding techniques was the total state of relaxation. When Rosalie finished the massage, I continued to lie on the massage table for a further ten minutes feeling like I could fall asleep there and then. I couldn’t think of a better way to experience this Hawaiian massage than from Rosalie down in Brighton.

The benefits are vaster than what I felt at that moment and contribute to an overall feeling of vitality by positively impacting the physical body, mind, heart and soul. From improving posture and helping detox systems and organs to calming the mind and restoring wellbeing, a safe space is created for individuals to reach a state of mind where they feel at peace in a trusting environment. It was my first Hawaiian style of massage, and it certainly won’t be the last.

ROSALIE SAMET

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

ROSALIE SAMET

Student Q & A WITH ANITA SNOWBALL

Question 1:

I am returning to massage having qualified sometime ago. I have recently been made redundant and now feel it is time to launch my business. However, I feel that I may be rusty with techniques can you advise me as to how to build my confidence again, how will I know that my massage is good enough?

A. Welcome back. All you need to do initially is get hold of some friends; get them on the couch and massage. Ask them for their honest opinion, re-read your course notes if you still have them remember how it felt when you were using your skills. I would also look for some refresher courses it is worth attending a workshop or two just to get you back in the swing of things. Get yourself insured, look at your anatomy again, revise muscles and the benefits of massage to the whole body and obviously check contra-indications. Once you start again you will find that it all comes back to you. Enjoy.

Question 2:

I have recently qualified in massage and Indian head massage, my concern is that I do not have enough to offer my clients to launch a real business do I need to have more therapies or do I start then add them later?

A. This is a common concern for new therapists. My advice is to get going with what you have, learn your trade. Work with clients you will then be in a better position to see if your skill base is in need of a boost. Look at CPD courses for different techniques such as Trigger Points, Deep Tissues techniques, etc., if you are interested in a more remedial application. You could ask your clients what they want from a massage as a form of market research. Choose the course that will help you address the needs of your client base. Trust yourself and you will develop as you should.

Question 3:

I have recently been working with a new client and when they pay they always give me a tip, is this OK? It does make me feel a little uncomfortable and I have explained that they do not need to do this but they said that they want to. What should I do?

A. It always makes me feel uncomfortable when it happens, however I feel happy that they appreciate what I am doing. If I am asked I have always said that it is not required that they tip me, after all I set my prices. If they do insist that I take it I make sure they know how I appreciate their gesture. You could always donate it to a charity if that sits well with you.

Question 4:

Could you please tell me what it means if a course has CPD points. No one mentioned them on my course.

A. CPD means continual professional development. Most memberships organisations ask their members to attend some professional training throughout the year. It ensures that working therapists keep up to date with their knowledge. Check with your organisation as to what they require.

Anita is a Senior Tutor at the Middlesex School of Complementary Medicine in London, established since 1992. As a Senior Tutor she has had to deal with a wide variety of queries from both students and graduates. So go ahead, send in your questions to Anita at info@ massageworld.co.uk and test her knowledge!

ANITA SNOWBALL

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Vanessa was born in Colombia and grew up in Northern Italy near Verona before moving to London in 2005. Her journey provided many challenges along the way as her English was limited and she had to balance long hours waitressing then as a commis chef at the Shard with being a single mum. Over the years, she had somehow lost touch with her passions and became frustrated and drained working at a job that gave her nothing in return. Therefore, she began researching courses, deciding to enrol at the London School of Health and Beauty.

Leidy Vanessa Passarella

BY MADELAINE WINZER

It was a turning point for Vanessa as she became excited about what the future held for both her and her daughter. Her biggest inspiration during this time was her first teacher, Angelica Skoberla, who was tough on her but taught her to believe in herself. Angelica emphasised with Vanessa’s situation and allowed her to bring her daughter to the courses where she acted as a model. Vanessa enjoyed her studies and qualified in a range of beauty treatments, with massage being the treatment she resonates with the most today. She now holds qualifications in aromatherapy, reflexology, hot stone/ hot bamboo, baby massage, and chair massage to name a few. Devoted to being the best massage therapist she can be, Vanessa continuously educates herself by attending courses while perfecting her own style. She loves to help people, and the best way she knows how to do that is through massage.

Currently, Vanessa works throughout London for businesses, agencies, and private clients, while travelling to the odd festival here and there to share her talents. She occasionally competes in massage competitions, with her most notable achievements including winning a silver medal in the chair category at the National Massage Championships 2018. Following in her father’s footsteps, she also works as a teacher at International Massage Education where her role is to share her knowledge and inspire the next generation of massage therapists. She is a lady who puts everything into her work, and it will be interesting to see what she does next.

Website: wellnessbyvanessa.com

Instagram: wellness_byvanessa

Vanessa loves to help people, and the best way she knows how to do that is through massage.

I had the pleasure of meeting this beautiful lady last year at the World Massage Championships in Copenhagen where she acted as a judge in the chair massage category. Her passion for massage is obvious and over the past year, I can safely say Vanessa is my go-to if I want a quality massage to relieve the stress of London living.

Safety, Security, Stability & Support!

For over 100 years we have provided our members with the stability and security they need! You can be assured we will walk alongside you throughout your career – from student to practicing member and in to retirement, we will be there for you. Look at what we o er...

Discounts – membership of the LCSP Register gives you signi cant discounts at major UK clinic suppliers – essential during a cost of living crisis!

Free access to the highest quality CPD – we regularly run free online Tutorials with experts in our eld and our website is a treasure trove of the latest industry research, articles, blogs and news. Your membership also includes access to CPD courses at discounted prices with industry leading providers.

Competitive membership fees - when the price of everything around you seems to be going up – we hold our membership fees! For the 5th year we have decided not to increase our membership fees because we understand how challenging it is to run a business through di cult times.

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working closely with patients day in day out. We endorse Mental Health First Aid training and advise that members consider this training for their own wellbeing, and so that they can give their best to each patient at all times.

Regulation –the LCSP Register has for many years been at the forefront of setting standards and regulations within our industry, working closely with the GCMT and CNHC to protect the public and promote therapists interests. Communication – you won’t only hear from us when your renewals are due! We issue a quarterly newsletter and are in touch with members regularly to keep you abreast of any news, regulatory changes or requirements. Our social media feeds are updated weekly with the latest CPD opportunities, news and o ers.

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We have a dedicated Admin O ce and Secretary – call us and you’ll nd a real person on the end of the phone! If you need advice or support, we are here for you! Our Board members have a wealth of experience which you can call upon if needed, including a nominated Welfare O cer and Benevolent Scheme for members who nd themselves in distressed circumstances.

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1 day CPD courses: We run a selection of 1-day CPD courses throughout the year, aimed at qualified therapists wanting to extend their range of therapies.

You’re a hands-on therapist. And you’re good. And you want to keep getting better... Do more for your clients.

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Discover the magic of this modality so your hands become more potent conduits for transformation.

ITEC courses in Spring 2017:

We run our ITEC courses twice a year. The next intake is in March/April 2017

Mon 27 March ITEC Massage Level 3 (Fast-track, exam in Jul 2017)

Try our free online intro to see if this is your next step:

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St Mary’s University – School of Massage

Offering a comprehensive range of ITEC qualifications for every part of your career journey.

Qualify as a Massage or Sports Massage Therapist, a Reflexologist, or study a qualification or specialist course to advance and develop your skills and client portfolio.

We are proud to be one of the longest established and most experienced providers of professional massage qualifications and celebrate our 25th anniversary this year.

Located in Twickenham, London you can enjoy learning with our team of expert tutors in state-of-the-art facilities which are fully equipped with high spec hydraulic massage couches.

Courses dates start in September 2023 and run throughout the year on an ongoing basis.

For more information and booking links visit:

www.stmarys.ac.uk/short-courses/massage

Assessment Led Bowen

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Are you looking for the next step in your career? Do yo want to take your body work to the next level? Get amazing results? See more clients? Have shorter treatment times? Be kinder on your body?

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Be More Jedi...

If you work with your hands and treat people with ‘the force’ you are already Jedi right?

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School of Bodywork

The School of Bodywork offers fully accredited unique training from Beginner to Advanced in Massage and Myofascial Release. We encourage students to develop their own personal style with emphasis on body mechanics and practitioner longevity in all our training. All our tutors are passionate about sharing their knowledge and experience in an accessible way, both in class and online.

Join us for the following courses:

◆ Level 3 Diploma in Therapeutic Massage

◆ Level 3 Diploma in Anatomy, Physiology & Pathology

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◆ Advanced Techniques

◆ Pregnancy Massage

◆ Indian Head Massage

◆ Rejuvenating Facelift Massage

◆ Skills Sharing Days

◆ Working with TMJ/The Jaw Disorders / TMJ Therapy Techniques

◆ Working with the Cranium / Cranial Therapy Techniques

◆ Working with the Abdomen / Abdominal Therapy Techniques

◆ Online Modules on Pain, Fascia, Business, The Vagus Nerve, Trauma and more

For more info and to book: www.schoolofbodywork.com

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The Federation of Holistic Therapists is here to support, protect and promote you with our comprehensive membership and insurance packages.

One of the many benefits you get, as an FHT Full Member, is to promote yourself on the UK’s largest and most trusted register – the FHT Therapist Register.

To join today and list yourself on the FHT Therapist Register, visit www.fht.org.uk/join-us or call 023 8062 4350