Massage World Issue 120 - Winter

editorial by Wendy Kavanagh

MEDITOR Ruth Duncan

EDITOR Madelaine Winzer

EDITOR Ruth Duncan

FEATURES

FEATURES

FEATURES

Earle Abrahamson

Julian Baker

Earle Abrahamson

Sue Burgess

James Earls

Ruth Duncan

Sue Burgess

Rachel Fairweather

James Earls

Ruth Duncan

Su Fox

James Earls

Rachel Fairweather

Susan Findlay

Natalie Lenton

Rachel Fairweather

Owen Lewis

Owen Lewis

Susan Findlay

Chloe Milton

Owen Lewis

Natalie Lenton

Sunita Passi

Natalie Lenton

Colleen O’Flaherty-Hilder

Sunita Passi

Darien Pritchard

Colleen O’Flaherty-Hilder

Gina Sanki

Sunita Passi

Mary Sanderson

Madelaine Winzer

Gina Sanki

Claire Squire

Claire Squire

GRAPHIC DESIGN Victoria Osborne

Madelaine Winzer

Madelaine Winzer

SOCIAL MEDIA Pia Singleton

MEDIA

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MThe clocks have changed, and we are slowly moving towards the longer and warmer days. Spring often feels like a time to renewal and growth and this edition of Massage World will certainly help you grow your knowledge and skills. There is an abundance of thought-provoking articles aiming to inspire and engage your critical thinking skills and offer insight into different ways that we can promote health.

TIcan’t believe the year has gone by so quickly as we recently experienced one year meeting another. Time seems to get faster as I get older, but maybe as I get older, I realise the value of time. The beginning of the year is a good time to plan what goals you would like to achieve in the coming year along with steps you are going to take to reach those goals.

he clocks have changed, and we are slowly moving towards the longer and warmer days. Spring often feels like a time to renewal and growth and this edition of Massage World will certainly help you grow your knowledge and skills. There is an abundance of thought-provoking articles aiming to inspire and engage your critical thinking skills and offer insight into different ways that we can promote health.

Owen Lewis explains how our social context alters our perception and our understanding of anatomy by looking at the history of hierarchy and its role in the modern economic and political system. Is our current environment stopping us from moving?

Colleen O’Flaherty-Hilder discusses aromatherapy and stress while Sue Burges delves into Kinesthetic Optimum Recovery & Enhancement (K.O.R.E) muscle testing. Owen Lewis discusses uncertainty, postural evaluation and the neural/ dural system while Earle Abrahamson’s article looks at what we consider what matters most in Massage Therapy Education.

Colleen O’Flaherty-Hilder discusses aromatherapy and stress while Sue Burges delves into Kinesthetic Optimum Recovery & Enhancement (K.O.R.E) muscle testing. Owen Lewis discusses uncertainty, postural evaluation and the neural/ dural system while Earle Abrahamson’s article looks at what we consider what matters most in Massage Therapy Education.

James Earls discusses fascia, movement and the important aspect of interdependency of body systems then we have our therapist spotlight interview with Tamer Morsy titled ‘Inspired by Change’. Ruth Duncan looks at the fascial system and historical thinking that it stores memories.

James Earls discusses fascia, movement and the important aspect of interdependency of body systems then we have our therapist spotlight interview with Tamer Morsy titled ‘Inspired by Change’. Ruth Duncan looks at the fascial system and historical thinking that it stores memories.

If clients are looking for alternative therapies to aid their recovery from injuries alongside massage, AquaStretch UK may be the answer with its clinically proven, lowimpact technique that restores mobility, decreases pain, increases exercise training efficiency, and improves general wellbeing. Read about more benefits that this therapy provides as it may be a great recommendation to clients who are wanting new ways to find solutions to their problems.

For now, it’s time to chill quite literally!

For now, it’s time to chill quite literally!

Here at Massage World, we are excited for the year as lots of exciting events fill our calendar giving our readers the perfect opportunity to network and get inspired.

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I am sure it will be a fabulous year and we can’t wait to see what it has in store.

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DISCLAIMERS

DISCLAIMERS

The publisher has taken all reasonable measures to ensure the accuracy of the information in Massage World and cannot accept responsibility for errors in or omissions from any information given in this or previous editions or for any consequences arising thereof. The Editor may not always agree with opinions expressed in Massage World but allow publication as a matter of interest, nothing printed should be construed as Policy or an Official Announcement unless stated. No part of this publication may be reproduced in any form or by any means whether electronic, mechanical and/or optical without the express prior written permission of the publisher.

The publisher has taken all reasonable measures to ensure the accuracy of the information in Massage World and cannot accept responsibility for errors in or omissions from any information given in this or previous editions or for any consequences arising thereof. The Editor may not always agree with opinions expressed in Massage World but allow publication as a matter of interest, nothing printed should be construed as Policy or an Official Announcement unless stated. No part of this publication may be reproduced in any form or by any means whether electronic, mechanical and/or optical without the express prior written permission of the publisher.

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RUTH DUNCAN Guest Editor

RUTH DUNCAN Guest Editor

12 Clinical Canine Massage

Therapy

Part 2

Canine massage therapy has surged in popularity as a way of giving back to our four-legged friends by helping their mobility and their mood. In part two of this series, Natalie Lenton looks at how we can identify signs of pain in non-verbal animal communication.

16

Upper Limb: The Shoulder Girdle

An extract from Mary Sanderson’s book Soft Tissue Release: A Practical Handbook for Physical Therapists that focuses on treating injuries in the shoulder girdle.

20

Functional, not Textbook, Anatomy

Learning anatomy can be formulaic and frankly quite disappointing as what we read in textbooks doesn’t quite translate to the physical world. James Earls provides languages, exercises and images to help you understand anatomy more clearly, while allowing you to deepen your appreciation of vocabulary in new ways.

24

Hierarchy and Heterarchy in Care and Understanding

Our environment influences what we do, how we do it and how we think. Owen Lewis explores how distant social and political systems influence our perception of the body and clinical work.

28

Guidance on what to do in the event of a complaint or claim made against you

When it comes to our business plans, insurance can sometimes not be a priority, especially when it is not a legal requirement. Chloe Milton tells us why insurance is important when working as a therapist while listing a few things you can incorporate into your practice to reduce the chance of a claim being made against you.

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The Tri-Dosha Method

Sunita Passi talks about the evolution of yurvedic massage and how it can be used to nurture the body, mind and soul to help people on their journey towards ejuvenation and inner harmony.

news & views

Italy Hosts the EMC 2024

From May 24th to 26th, 2024, in Rome, the European Massage Championship (EMC), organized by the New Massage Association (NewMA), will take place. The history of this event began in 2019 with its first edition in Spilamberto, near Bologna, Italy. After the initial significant success, the second edition moved to Nice, France, followed by the third edition hosted in Sibiu, Romania, in the heart of Transylvania. To continue this series of prestigious events, the fourth edition will be held in the captivating setting of the “Sala delle Colonne,” right in front of the EUR obelisk of Rome.

The program includes an inaugural day dedicated to workshops led by renowned therapists, followed by two days of competition. This unique event will attract participants from thirty European and international countries united by a common passion for massage. In addition to showcasing their skills, participants will have the opportunity to learn and develop new techniques in an international context, creating new professional connections with therapists from different nations.

The EMC goes beyond mere competition, pursuing the broader mission of promoting higher standards of quality in the massage profession. In an industry where international standards are often overlooked, the championship aims to make a tangible contribution to their affirmation. The organization of workshops by NewMA also emphasizes its educational commitment, providing a significant contribution to the professional development of therapists.

NewMA is committed to identifying talented and qualified massage therapists who have remained in the shadows in Europe and around the world, thereby shedding light on those who best represent the highest standards of the profession. The EMC thus becomes a public opportunity to highlight these professionals and recognize their value.

NewMa is also known for giving the highest importance to fair and transparent evaluation. Over time, they have improved their entire process, from Jury recruitment to evaluation criteria and timely and accurate reporting. They hold the very firm belief that an airtight evaluation process is not only important, it is the cornerstone of a successful event.

Participants in the championship not only compete for titles and prizes but also leverage valuable opportunities for personal and professional growth. Winning a title at the EMC goes beyond simple immediate recognition and prestige, it also contributes to propelling a therapist’s career to new heights. The success stories of past champions attest to this, with many of them opening schools to share their techniques with the next generation of therapists or becoming sought-after experts, traveling worldwide to offer their unique skills.

The founders of the New Massage Association - Ana-Daliana Sandu, Antonius Vlad Sandu, Daniele Mattarelli, Elvira Gentile, Nicoletta Casartelli, and Julien Elis - are already working to ensure that the 2024 event is unforgettable. If you were to ask any of them “Why come to the European Massage Championship?”, they would all answer that even though the trophies are an important part of it, the real reasons to come are passion for massage, camaraderie and a shared taste for learning and sharing within a highly professional environment.

Video: https://www.youtube.com/watch?v=8ABXBvKgENs Website: https://www.newmassageassociation.com/

The Big One is back in Copenhagen Denmark 2024

The International Massage Association aim to develop and promote the various massage techniques which are practiced by experienced Massage Therapists worldwide.

The World Championship in Massage is primarily a competition, but at the same time an opportunity for Massage Therapists to find professional inspiration and networking.

By participating in the World Championship, the Massage Therapists will get the opportunity to strengthen and improve their skills. A Diploma will be issued for each participant, enabling the Massage Therapists to brand their business in a new way.

Date and Location: The 7th World Championship in Massage will be held in Copenhagen on J une 28 – / June 30, 2024 at: Sigurdsgade 26 DK 2200 Copenhagen N Denmark Enter here https://worldchampionship-massage.com/registration/

IT’S BACK! PROFESSIONAL BEAUTY LONDON RETURNS IN MARCH

Professional Beauty London is the UK’s leading event for spa, salon and nail professionals. Taking place at ExCeL London on Sunday 3rd and Monday 4th March, this year’s theme is elevate your business with treatments, trends and training.

The show floor is divided into

6 key zones nails, lashes, make-up, waxing and brows, Advanced Treatments, Spa and Skincare, International Brands Pavillion, Organic and Natural and Training, recruitment and retail sales. The show provides the opportunity to meet hundreds of leading brands, test and compare the latest products and benefit from exclusive show offers.

There will also be 3 live stages of education Business and Trends, Skin and Advanced Treatments and The Beauty Workshops. The education is aimed to support professional development and business growth.

Also taking place alongside Professional Beauty London is The World Spa and Wellness Convention. This global networking event is for both independently run and group spas and hotels taking place at Professional Beauty London. Delivering a dedicated two-and-ahalf-day programme which provides practical solutions to the most pressing issues facing the industry; delivering fresh insight on trends and challenges all designed to help grow skills and talents of the top spa leaders and teams in the industry.

World Spa & Wellness Convention ExCeL, London

The World Spa and Wellness Convention is coming back to London as on 3-4th March 2024 as part of Professional Beauty giving professionals in the industry the perfect opportunity to network, keep up to date with industry news and recruit for your business. It is an event with a 360-approach incorporating skincare, nutrition, wellness and fitness. Talks will be held over the two days by leading experts in the industry who will explore the challenges within the industry today and the best ways to overcome them. Here is the line-up of sessions along with some of the speakers:

• Amanda Al Masri - Global Director Wellness Hilton

• Amy McDonald - Principal Under a Tree (Best Practices in Community Living)

• Emmanuel Arroyo - Senior Corporate Director of WellnessRosewood Hotel Group

• Virginie Fliegans - Senior Spa Director Four Seasons Paris George V

• Sonal Uberoi- author of The Wellness Asset

• At tracting and retaining staff with career opportunities and a culture of wellness

• Simon Marxer - VP Spa & Wellbeing HYATT and Miraval Resorts

• Teresa O’Farrell - Global Head of Wellness and Spa - Dorchester Collection

• Erica D’Angelo, Chief Wellness Officer and WSW Spa Leader of the year 2023

Register for your free ticket to Professional Beauty London at professionalbeauty.co.uk/London you can also book your ticket to the World Spa and Wellness Convention, navigate to what’s on and book prices start at £195).

• Michael Newcombe - Vice President Wellness Global Four Seasons Hotels & Resorts

Register for your free ticket to Professional Beauty today at https://pblondon24.showhub.live

Bowen Technique The Knee

No Such Thing As a Knee?

BY JULIAN BAKER

BY JULIAN BAKER

<CAP 51>Location of the knee procedure – moves 1–3.

One of my favourite podcasts is called ‘No Such Thing as a Fish.’ Hugely entertaining, it explores the natural and scientific world and comes up some of the most amazing facts you can ever imagine and lots that will blow your mind. And yes, it’s true, there is no such thing as a fish!

The knee can be considered to be similar to the hamstrings in terms of the effects we are going to achieve. The knee itself is a joint made up of, and dependent on, the relationships around it. The muscles of the hamstrings reach down over the joint to grasp the tibia and fibula, and in like manner the muscles of the calf reach up to grab hold of the femur, in the catching-style wrist grip of a pair of trapeze artistes.

FThere are so many things that we have accepted as undisputable facts in our minds, that when they are challenged or broken down, the result can make us feel quite uncomfortable or defensive. Changing ideas and challenging certainties that people have around the human body, manual therapy and particularly anatomy is something that I actually quite enjoy. I’ve been running human dissection

rom a connective tissue perspective, the knee can be seen as being heavily influenced, from the outside and inside, by pressures and tensions placed on it by these various muscle and fascial connections. For example, a slightly inverted ankle will create a little more tensional strain along the lateral side of the leg, and therefore place more tension and potential strain on the knee as a result. Similarly, if we look at the lower back and

classes for manual therapists for over a decade, looking at the body in ways that the anatomy books tend to overlook. One thing I ask of those attending is to be prepared to dissect their own deeply held truths and understanding of the human form and to look for what is really there rather than what they want or hope to see. It’s interesting to see what approaches or ideas really hold up under such scrutiny. Seeing

bodywork perspective, the relationships to and from the knee are as important as the knee itself. We need to find out why it is that the problem has arisen and why the injury has occurred.

A common presentation will be a client who has experienced back trouble for years, and who has modified their weight bearing and movement patterns in order to adjust to the pain levels they experience. It is this compensation that causes conflict: uneven

people’s quite opposing is really in someone body from Sometimes so often validity

massagetechnique

An argument often put to me is that it is impossible to avoid contact injuries in sports such as rugby and football. Of course, a violent tackle is highly likely to result in an injury to a specific area. Yet the level of injury, and therefore the speed of recovery, are going to depend a lot on the level of tension that was present at the site prior to the injury. A joint which is highly stressed as a result of a previous injury, or from tensions in other areas of the body above or below the site, will mean that any injury to the area will be potentially more serious. If the tensions in these areas are left unaddressed and only the injury site treated, then full recovery is unlikely. This in simple form is the case for preventative treatment of the whole body, and for full history taking to establish prior injuries. Moreover, a good therapist will be skilled in reading how a client holds their body and the patterns they use to move around.

Contributing Factors

A knee might eventually even need replacing. However, it seems completely illogical to ignore the possible causative contributing factors at the same time as the knee is surgically addressed. Knees wear out for various reasons, but the human knee is more than capable of lasting 120 years without wearing out. However good the surgery, if it is being performed in the middle of an existing problem, the problem isn’t going to go away.

It is vital to start by comparing one knee to the other and make as many observations as possible. How does the client stand, sit, cross their legs and take their shoes off? Ideally you would make these observations without the client being aware of it: a selfconscious client makes for very unreliable body-reading!

The influence of the ITB cannot be underestimated as far as the knee is concerned: ITB syndrome has been well established as a cause of knee pain, both in orthopaedic medicine and in the field of sports injury. However, as dissective evidence shows, the ITB is part of a wider

structure of fascial covering around the leg, and palpation to determine other areas of tension can be useful in pinning down any other regions where the knee is being affected. Areas to palpate include the anterior compartment of the leg, where in many cases the fibres of the ITB extend down and seem to create a string-tension relationship between the foot and the thigh.

The patella can be seen as floating in a sea of connective tissue; it is embedded in a soft pad all the way around the knee and held in place by a ligament which also blends into the rest of the knee fascia. The knee influences a lot of other movement patterns throughout the body, acting as a mechanism for diverting forces through the back and into the upper body from the ankle, as well as acting as a feed-forward point for functional movement. It can be thought of as a barometer for the tensional environment of the lower leg, and worked as part of addressing the ankles, hamstrings and lower back. Any swellings or inflammations can be addressed with traditional remedies – refer to the remedies section for more information.

The first move of the knee, commonly referred to as ‘hit the lat’ (HTL), works the lateral inferior border of the vastus lateralis tendon, also known as the tendon of the quadriceps femoris. The move can be thought of as a complete treatment, as this point for the knee is very similar to the junction point of the superior medial angle of the shoulder (moves 6 and 8 of Page Two). At this point for working the knee, the ITB joins together with the vastus

lateralis, the patella ligament and the tendon of the quadriceps to become one large, tense and highly energetic covering around the knee. When dissecting this area, it is very difficult to single out where one structure begins and another ends, making the HTL a move that encompasses the whole of the knee. Many practitioners will also attest to the noise that is heard in the stomach when making this move, although it is not entirely established as to why this happens.

Moves 2 and 3, which can be performed in any order, aim to lift the fatty pad that sits under and around the patella, which in turn floats over the joint and takes pressure off the vastus intermedius, which is attached to the femur. The patella ligaments are very deep under this structure, and once again the hammock analogy is dragged out to illustrate the moving aspect of the patella, held under tension by the ligaments at either end. The patella almost floats in the fatty tissue around the knee, which needs to have an appropriate degree of tension to keep the movements of the joint under control.

It is always worth moving the patella around to check its mobility. If it is stuck, the HTL will generally give it a degree of freedom quite quickly. If it remains stuck, and the ‘lat’ is sticky and hard to feel, gentle mobilisation of the patella will be helpful.

Moves 5 and 6, again in any order, roll around the lateral and medial heads of the gastrocnemius and soleus. These moves create a release for

Location and direction of the knee procedure –moves 5–10.

massagetechnique

the posterior compartment of the leg, but also act strongly on the ankle joint where the gastrocnemius muscles join with the Achilles tendon and continue around the heel bone into the plantar fascia of the foot. The teasing moves along the back edge of the calf need to be done very gently for the best effect. These are not pulling or rolling moves, but a very gentle teasing action using the tips of the fingers.

In my experience a tender, swollen or inflamed calf responds to this gentle teasing much more quickly than any attempt to go in with depth and separate the muscles. Many exceedingly swollen legs have responded remarkably to these gentle teasing moves down the leg. Patience and plenty of breaks are the key to reducing any swelling; using force, or even much more than moderate pressure, is both counterproductive and potentially very harmful. We still have to bear in mind the sock-like aspect of the fascia underneath our fingers, which seems to be very responsive and sensitive to gentle touch. A swollen knee will also respond well to this teasing, and the three medial moves across the Achilles will help to release excess fluid into the medial side of the ankle to promote lymphatic movement.

A word here on the sciatic nerve, which is made up of two nerves – the tibial and common peroneal. As thick as your thumb and very sinewy, the nerve separates into its component parts around the back of the knee and travels down either side of

the leg, sending off branches along the way. When the tibial nerve reaches the back of the medial malleolus, it divides into the medial and lateral plantar nerves. These nerves are responsible for quite a lot of innervation in the foot, and in turn can be indicated in a fair number of problems, including plantar fasciitis or pain in the sole of the foot.

The small move at the back of the malleolus can therefore be quite a useful addition to the knee procedure, especially if the ankle procedure is to follow or if there is any presentation of sciatic-type symptoms radiating into the ankle or foot. Although appearing somewhat complicated and fiddly, the knee procedure can be performed straight through with no break in cases where a preventative treatment is being given, and where there is no immediate or obvious problem.

JULIAN BAKER

Julian has worked in the top medical schools and universities around the UK, gaining plaudits and praise wherever he has run a class. His approach of shaking up traditional anatomy and reframing it in ways that relate to the field of manual and movement therapies has brought him a world wide following and plaudits from every corner of the anatomical and manual therapy field.

His work combines my interests in functional, evolutionary and comparative anatomy to explore the ‘truths of movement’. He firmly believe that by understanding normal, everyday movement we are better able to understand the limitations our clients may experience and thereby develop appropriate, fun and individualised movement practices for them. functionalfascia.com

<CAP 53>The sciatic nerve in dissection, in relation to the piriformis and hamstrings.

<CAP 54>Knee procedure – moves 1–4 (bilaterally).<CAP 55>Location of the knee procedure – move 12 (tibial nerve).

has

the

and is very much appreciated by the clients”

Clinical Canine Massage Therapy Part tw0

BY NATALIE LENTON

Dog ownership is proven to benefit the health of owners in so many ways. From encouraging exercise and improving cardiovascular health to reducing stress, depression and anxiety, dog ownership is proven to have phenomenal effects on our mood and general wellbeing.

According to Marshall-Pescini et al. (2009), “A number of studies have shown that when dogs and humans interact with each other in a positive way (for example cuddling) both partners exhibit a surge in oxytocin, a hormone which has been linked to positive emotional states.”

Canine massage therapy has surged in popularity as a way of giving back to our four legged friends by helping their mobility and their mood. Unfortunately, it’s not as simple as adding canine treatment to your clinic offerings as working with dogs requires the correct training, animal handling skills and insurance as well as veterinary consent and a whole litany of other requirments. So where do you start? In Part 2 of this feature on canine massage therapy, you can investigate further a review of the world’s first ground breaking clinical trials on canine massage therapy which were puåblished in 2021 in the ‘Vet Record’ published by the British Veterinary Journal with a pioneering study by Winchester University.

In Part 1 we looked at the respected ‘Lenton Method®’ of Clinical Canine Massage Therapy , now lets take a look at how we can identify signs of pain in the non verbal animal client…

Five principles of pain

Clinical canine massage practitioners utilise the ‘five principles of pain’ in their assessment of their patients prior to treatment: gait, posture, activities of daily life, behaviour and performance.

massagetechnique

Gait & Posture

A mild presentation of lameness may not be detected if a dog’s gait is observed at a “walk” when assessing for abnormalities. A dog’s “trot” has been reported to be the better gait for detection of any lameness as it is the only gait where the “forelimbs and hindlimbs never receive assistance from the contralateral limb in bearing weight” (Carr and Dycus, 2016). Identification of affected joints and irregularities during gait analysis can then be correlated with palpation to help better understand the underlying condition (Lenton, 2017:3). The initial palpatory assessment by the guild practitioner looks at a minimum of sixty pairs of muscles and regions of fascia to locate commonly observed issues. (Riley et al, 2021).

Below are examples of some of the indications of lameness that can be seen during gait analysis (Carr and Dycus, 2016).:

• In dogs with forelimb lameness, weight is generally shifted caudally, with the head “going down on the sound limb”. The hindlimbs may seem to tuck under with arching of the back, and they may take shorter strides with their hindlimbs.

• Dogs that have a shoulder injury usually present with short strides, in comparison to dogs with an elbow injury who can appear to “circumduct the limb to ease pressure on the medial aspect of the elbow” (Carr and Dycus, 2016).

• In dogs with lameness in their hindlimbs, their weight is generally shifted cranially. Their forelimbs may be positioned more caudally, their head and neck may be lowered and extended to help them to relieve some of the weight from their rear end. The dog’s tail may lift as the lame hindlimb makes contact with the ground. When a massage guild practitioner is carrying out gait and posture analysis, there are four main points that they take into consideration:

• Subjective analysis Discussion with owner as to presenting symptoms, what they think may be the issue, what they think the cause may be (e.g. injury occurred during particular movement at agility)

• Objective analysis Gait and posture analysis by therapist prior to treatment and also palpation.

• Primary area of issue Look to identify any soft tissue injuries e.g. spasms and strains, and common orthopaedic complaints.

• Any secondary areas Including areas of compensation

Activities of Daily Living

Certain activities of daily living (ADLs) can contribute to and exacerbate muscular injuries and lead to irregularities being seen in gait analysis. Examples of these ADLs which the massage therapists will discuss with the owners include:

• Height of feeding bowls

• Pulling on the lead when walking

• Excessive play with tug toys

• Climbing up and down stairs

• Jumping in and out of a car

• Inadequate/unsupportive bedding

• St anding on hind legs

• Chase games, such as use of a tennis ball thrower

• Jumping on and off furniture

• Slippery flooring e.g. laminate

Benefits of massage

4

Behaviour

• Deterioration/change in a dog’s behaviour can be an indication of acute or chronic pain. No dog will receive massage therapy without signed veterinary consent in accordance with the Veterinary Act 1966 and the Veterinary Exemption Order 2015.

3 5 1

• There are a number of behavioural manifestations of pain in a dog, one example is an exaggerated fear response to strangers or other dogs (Heath, 2016). Canine massage therapists provide a ninety minute session for initial consultation and treatment, which allows for a comprehensive assessment including detailed history taking. The therapists are then able to refer back to the referring veterinary professional about any presentations that require further intervention or assessment.

Performance

Change in performance such as measuring or knocking poles in agility can be an indicator of a muscular injury.

Below are some examples of how massage benefits the patient (this is not an exhaustive list) and is summarised in figure 1.

Riley et al , 2021)

Anatomical

Reduced muscle stiffness and soreness

Increased mobility and motility of muscle

Restored/improved fascial plasticity

Improved joint range of motion

Restored tissue movement and functionality

Physiological

Increased interstitial pressure, venous and lymphatic flow

Increased fluid exchange between vascular system and peripheral tissues

Decreased inflammation, pain, muscle fatigue

Parasympathetic activation, including reduced cortisol and increased serotonin

Psychological

Reduced depression

Reduced fear and anxiety

Reduced stress

Improved mood and demeanour

Improved motivation

Improved range of joint motion

The range of motion of a joint describes the movement from full flexion to full extension

Brachialis

Figure 3. Benefits of Massage; Effect of massage therapy on pain and quality of life in dogs: A cross sectional study, Riley et al 2021)

Figure 1. Benefits of Massage; Effect of massage therapy on pain and quality of life in dogs: A cross sectional study, Riley et al 2021)

massagetechnique

CANINE MASSAGE

Improved range of joint motion

Improved range of joint motion

The range of motion of a joint describes the movement from full flexion to full extension and is dependent on several factors including the surrounding muscles and the bony configuration of the joint. One example would be full flexion of the elbow joint, which is limited by the biceps brachii as illustrated in figure 2. Any tightening or hypertrophy of the biceps brachii from excessive training could result in decreased range of motion of the elbow joint (Davies, 2018;119).

The range of motion of a joint describes the movement from full flexion to full extension and is dependent on several factors including the surrounding muscles and the bony configuration of the joint. One example would be full flexion of the elbow joint, which is limited by the biceps brachii as illustrated in figure 4. Any tightening or hypertrophy of the biceps brachii from excessive training could result in decreased range of motion of the elbow joint (Davies, 2018;119).

Biceps brachii M.

Brachialis M.

M.

Below are some of the ways in the which canine massage can benefit the muscular system (Weerapong, Hume and Kolt, 2005; Rasch, 2013; Corti, 2014):

• Increased blood flow

• Increased muscle temperature

• Increased interstitial pressure, improving venous return

• Increased local circulation

• Mobilise deep muscle tissue

• Treat muscle spasm or break up adhesions from old injuries

Parasympathetic activation, including reduced cortisol and increased serotonin

Massage has been reported in humans to increase parasympathetic activity: reducing heart rate and blood pressure and increasing endorphins (Weerapong et al, 2005). Serotonin and

Parasympathetic activation, including reduced cortisol and increased serotonin Massage has been reported in humans to increase parasympathetic activity: reducing heart rate and blood pressure and increasing endorphins (Weerapong et al, 2005). Serotonin and dopamine levels have been shown to increase during massage therapy (Field, 2014; Field et al, 2005)); it has been suggested that serotonin may both promote and inhibit pain perception utilising different physiological pathways (Marks et al, 2009). A study by Morhenn et al on 95 human participants showed that massage increased levels

of oxytocin and reduced levels of adrenocorticotropic hormone (ACTH) (Morhenn, Beavin-Yates and Zak, 2012). Massage therapy is increasingly being used in canine sports medicine, not just for rehabilitation of injuries, but also to help improve recovery. There have been a number of publications about how massage therapy in humans helps to reduce delayed onset muscle soreness (DOMS) with a proposed theory for the physiological mechanism shown in figure 3 (Hilbert, 2003; Zainuddin et al, 2005).

• Increased range of motion

dopamine levels have been shown to increase during massage therapy (Field, 2014; Field et al, 2005)); it has been suggested that serotonin may both promote and inhibit pain perception utilising different physiological pathways (Marks et al, 2009). A study by Morhenn et al on 95 human participants showed that massage increased levels of oxytocin and reduced levels of adrenocorticotropic hormone (ACTH) (Morhenn, Beavin-Yates and Zak, 2012). Massage therapy is increasingly being used in canine sports medicine, not just for rehabilitation of injuries, but also to help improve recovery. There have been a number of publications about how massage therapy in humans helps to reduce delayed onset muscle soreness (DOMS) with a proposed theory for the physiological mechanism shown in figure 4 (Hilbert, 2003; Zainuddin et al, 2005).

• Stimulate sensory receptors and decrease muscle tension by reducing neuromuscular excitability

• Realignment of muscle fibres

• Reduction in delayed-onset muscle soreness (DOMS)

• Reduce atrophy

• Improve muscle tone

• Reduce inflammation, strain

• Reduce pain

Massage

Decrease

● Increased blood flow

● Increased muscle temperature

Below are some of the ways in the which canine massage can benefit the muscular system (Weerapong, Hume and Kolt, 2005; Rasch, 2013; Corti, 2014):

Although the majority of the Canine Massage Guild practitioners are based in the UK, there are a number that are based internationally including Australia, Europe and Malaysia and can be found on the online register at https://www.k9-massageguild.co.uk/therapistregister/. In 2019, the canine massage guild published the Integrated Veterinary Care Initiative which described how clinical canine massage delivered by a guild member could be used by vets as a component of a multi-disciplinary practice. It explains how the guild practitioners work with vets and more information can be found on their website https://www.k9-massageguild.co.uk/veterinary-information-zone/. If you are considering offering canine massage therapy then look into the 2 year Clinical Canine Massage Practitioner Programme externally accredited by LANTRA and provided by the Canine Massage Therapy Centre www.k9-massage.co.uk

● Increased interstitial pressure, improving venous return

● Increased local circulation

● Mobilise deep muscle tissue

● Treat muscle spasm or break up adhesions from old injuries

● Increased range of motion

Figure 5. Theoretical model of how massage may reduce the severity of muscle soreness (Weerapong et al , 2005)

Figure 4. Medial dog elbow (Constantinescu and Constantinescu, 2009)

Medial collateral ligament

Bicipitoradial bursa Tendon of brachialis

Figure 2. Medial dog elbow (Constantinescu and Constantinescu, 2009)

Figure 3. Theoretical model of how massage may reduce the severity of muscle soreness (Weerapong et al, 2005)

Soft Tissue Release Upper Limb

BY MARY SANDERSON

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

The Shoulder Girdle

The scapula is embedded in muscles that attach it to the posterior thorax, thoracic spine, neck and head; its only bony connection is to the sternum via the clavicle. This arrangement allows the shoulder girdle to stabilise shoulder movement and facilitate considerable shoulder mobility (fig. 5.1). Being held within the pull of so many muscles makes for very interesting treatment plans to resolve muscle balance and faulty movement. The scapulo-humeral rhythm is the pattern of movement between the scapula and the shoulder joint. Overall, the scapula

should move in an approximately 1:2 ratio, with the humerus in the lateral plane. Muscle balance, timing and coordination control this rhythm.

Muscular imbalance may occur in this area with hypertonic over-used muscles altering the scapulo-humeral rhythm, causing impaired shoulder movement and pain. Addressing tightness prior to strengthening inhibited muscles in an array of possible altered biomechanics is necessary.

Commonly, poor scapula stability causes the acromion to tip down. Releasing

the upper, particularly the lateral and anterior upper trapezius fibres, and serratus anterior, will help stabilise the scapula for strengthening, in this case the lower fibres of the trapezius.

The pectoralis minor is a powerful muscle that will also be tight with underactive lower trapezius fibres, causing the scapula to tilt anteriorly and laterally. If in good health, the pectoralis minor balances out the pull of the levator scapulae and rhomboids.

A common trunk defect occurring here is thoracic kyphosis. In this condition, the shoulder girdle protractors tend towards hypertonicity as activities draw the shoulders forward; the girdle retractors and trunk extensors become inhibited. Many activities encourage the development of this position, for example sitting at a computer or driving. Often it is the rhomboids (retractors) and the lower fibres of the trapezius (girdle depression) that need strengthening but soft tissue release prior to this is necessary because they will probably contain trigger points and fascial distortion.

Conversely, if the rhomboids are hypertonic, the serratus anterior will be locked long; this often accompanies a flat thoracic spine.

Figure .1. The shoulder girdle.

The sternoclavicular and, more frequently, the acromioclavicular joints can be injured traumatically, particularly in falls. Injury here can lead to future problems with hypermobility, instability and loss of strength.

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STR around these joints can break adhesive tissue and contribute to healing, reducing the development of chronic weakness. Maintenance work around the joints, such as STR to the subclavius, to minimise the possibility of an individual developing degenerative conditions from overuse is advantageous for anyone involved in throwing or heavy lifting.

MUSCLE EFFECTS OF MUSCLE RESTRICTIONS

Suboccipitals

Shoulder Retraction

Major Muscles: Rhomboids and trapezius (middle fibres).

The rhomboids and the trapezius work together to produce retraction. The trapezius also assists in lateral rotation of the scapulae, and the rhomboids in medial rotation. Both muscles are important in stabilising the scapulae during shoulder abduction and adduction. The trapezius has many functions and therefore plays a crucial role in the overall action of the upper limb.

Shoulder Retractors – Treatment

With the subject in a prone position, apply pressure, working from the lower to the middle fibres. Lock at points away from the vertebrae, and locate points away from the outer edges of the muscle and its insertion points on the spine of the scapula. Instruct the subject to push the shoulder into the table to produce protraction.

As the trapezius is softened, progress to the rhomboids (fig.3). Provided that there is sufficient flexibility in the muscles and range of movement in the shoulder joint, support the anterior shoulder and move it into medial rotation, placing the subject’s arm behind

Pectoralis minor Impact on the combined motions that result from its relationship with the levator scapulae and rhomboids. Can also lead to thoracic outlet syndrome by compression of the brachial plexus, which runs beneath it. Postural changes associated with ‘rounded shoulders’.

Trapezius

Upper: elevated shoulders and reduced ROM head and neck.

Middle: scapula abduction (although rare).

Lower: thoracic spine curve at insertion and impact on its relationship with the upper trapezius and serratus anterior.

Serratus anterior Reduced upward rotation of scapula, inability to raise arms fully above head in frontal plane, abnormal scapulo-humeral motion and increased stress on glenohumeral joint.

Levator scapulae

Levator scapulae

Rhomboids

Subclavius

Reduced cervical rotation, elevation of medial section upper scapula (appearance of elevated shoulder), and head tilt with lateral flexion of humerus. In conjunction with rhomboids contributes to ‘round-shouldered’ posture.

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

Impact on scapulo-humeral rhythm and, along with levator scapulae, development of ‘roundshouldered’ posture is influenced.

Reduced sternoclavicular joint elevation, impacting on scapulo-humeral rhythm.

Figure 2. Posterior back and shoulder muscles.

Table 1. Effects of muscle restrictions on shoulder girdle movement.

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the back. This draws the scapula up so that the rhomboid attachments can be easily located along the vertical border.

Pressure near to the vertebral attachments must also be administered. After each new lock has been applied, the subject actively protracts by pushing the shoulder into the supporting hand.

The rhomboids and trapezius (fig. 4) can be targeted effectively from a seated position using passive or active STR.

produce neck extension when both sides contract. When one side contracts, side flexion occurs. The levator scapulae also assists in medially rotating the scapula.

Shoulder Elevators – Treatment

With the subject in a prone position, support the anterior shoulder under one hand and hook over and into the upper fibres of the trapezius with the other (figs. 5 & 6) maintain the lock and depress the shoulder with the supporting hand.

The levator scapulae may be treated in a similar way; the insertion can be located at the superior angle of the scapula by directing the pressure under the upper trapezius fibres. It may prove easier for the subject to actively depress the shoulder so that the lock can be maintained; lock in with a reinforced thumb and

ask the subject to slide the hand down the side of the leg. This will generally cause considerable release in the area.

Shoulder Depression

Major Muscles: Subclavius, pectorals and trapezius (lower fibres).

The subclavius prevents elevation and protraction of the shoulder girdle and contributes to acromiclavicular joint stabilisation.

Shoulder Protraction

Major Muscles: Serratus anterior and pectoralis minor.

The serratus anterior is a girdle protractor and is therefore highly developed in athletes such as boxers and throwers, for whom punching and throwing require a powerful forward movement of the scapula. The muscle also plays an important role, along with the rhomboids and the middle fibres of the trapezius, in stabilising the scapula against the thorax during arm movements. It assists the trapezius in lateral rotation of the scapula. Weakness or inhibition of this muscle can cause medial winging of the scapula. The serratus anterior requires particular attention following shoulder dislocation, as it is susceptible to the formation of adhesions.

The pectoralis minor assists the serratus anterior in protraction, and also raises the ribs to assist in forced inspiration.

Figure 5. Passive STR to upper fibres of the trapezius.

Figure 7. Passive STR to the serratus anterior.

Figure.6. Working from the head, the trapezius fibres can be targeted as the therapist cups the shoulder with the other hand and pushes it down into depression.

Figure 3. Active STR to the rhomboids

Figure 4. STR to the middle fibres of the trapezius

Shoulder Protractors – Treatment

STR to the serratus anterior is most easily administered with the subject in a side-lying position (see fig. 7). The muscle may be targeted using fingers to lock in across the muscle, so as to avoid crushing tissue between the ribs. Gently pull the arm back to extend the shoulder and produce retraction of the shoulder girdle; alternatively, lock in and instruct the subject to perform active retraction (see fig. 8).

Prior to addressing pectoralis minor, ensure that pectoralis major has been released. Use fingers or a reinforced phalange to target pectoralis minor away from the coracoid process; instruct the subject to retract the scapula into the couch.

With the subject in a supine position, pectoralis minor can be reached specifically by abducting the arm to 90 degrees and gently delving under pectoralis major, towards the coracoid process and the origin of the muscle (fig. 9a). Once reached, the depth should be maintained while the subject raises the arm to draw the scapula upwards (fig. 9b).

Alternatively, a retraction movement can be achieved by the subject pushing the posterior shoulder or arm down into the table. Either way, the pressure needs to be released promptly, as it can be uncomfortable.

massagetechnique

Shoulder Girdle in Side-lying and Seated Positions – Treatment

With the subject in a side-lying position and the shoulder medially rotated, secure the anterior shoulder and use both your hands to move the scapula. It is important not to force this position if the subject has any restriction; treatment should continue by allowing the arm to relax in front. Once in position, focused locks and small precise active movements of retraction, protraction, elevation and depression, together with appropriate locks, may be highly effective in freeing the girdle as a whole. Scapula movement, or lack thereof, can be accurately assessed in this position, so treatment can have rapid results.

With the subject seated, active STR can be easily administered to the trapezius and rhomboids as the subject protracts by pushing the shoulder forwards. A resistance can be supplied here to enhance the release. The lower fibres can be located as the subject elevates the girdle by shrugging the shoulders. Very dynamic active STR can be conducted using broad active arm movements to produce the required shoulder girdle action.

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 8. Active STR to the serratus anterior.

Figure 9. Active STR to the pectoralis minor.

MFunctional, Not Textbook, Anatomy

BY JAMES EARLS

Extracted from upcoming publication: Functional Anatomy of Movement

Everybody got mixed feelings About the function and the form. Everybody got to deviate From the norm

Geddy Lee, Alex Lifeson, Neil Peart, “Vital Signs”

y guess is that you are reading this book because, like me, you are searching for new and improved ways to see and understand movement. Perhaps you have suffered through traditional anatomy textbooks and been somewhat confused and disappointed with the world of anatomy because what we read in the books and what we experience in the real world just don’t match up. If that is the case you will be glad to know the language, exercises, and images included in this book will guide you to a new, deeper appreciation of vocabulary in ways that will help you see anatomy in movement more clearly.

Time and exposure to numerous approaches to anatomy of movement have helped me appreciate many reasons why musculoskeletal anatomy is taught in its usual limited and dry manner. Most of the problems are due to the complexity of normal movement, and our anatomy resources cannot cope with the sheer number of variables. Have a look at the variations in the main image and figure 1. The people are making different movements, in different environments, probably at different speeds and in a range of angles; their feet or pelves have different points of contact with that environment, and they are each using

their body with its own unique history of physical training (or lack of), alongside a list of injuries. Talk about complex!

Not only do we each have a physical history but each of us also moves in keeping with our expectations and beliefs around our body and its ability. Those expectations come alongside a wide range of other psychological and emotional considerations that alter the movement strategies we use. Being able to put all those variables and variations into a textbook would not be easy. Thankfully, there are ways in which we can come close to appreciating what is really happening if we understand several principles.

Most of those principles have been omitted from the anatomy model presented in textbooks but will be included for you here. Importantly, one of the first things we will do is to break away from the dull and frustrating “anatomical position,” with its precise origins and insertions, that gives us those hard-to-remember and limited muscle actions. We will come back to that soon.

Learning Anatomy, the Slow and Hard Way

Textbook anatomy is often taught by people who are older than us, have read more books than us, have been put in positions of authority, and are (too often!) men and, commonly, bearded. They like to use books, large and heavy tomes, with long strange words and terminology that is esoteric and confusing. As students, we are often in awe of these “holders of arcane knowledge,” the ones who can speak this strange language with fluency and gravitas. All of this—just like internet conspiracy theories—gives the impression of authority and truth-holding.

We want to be like those professors,1 but we struggle. Anatomy texts are presented to us as if they carry “The Truth,” and we are given the impression that we will be successful if we diligently learn every structure, every attachment, nerve supply, and action. Too often, we become disillusioned before reaching the end of the book.

Well, just as with internet conspiracy theories, you can relax in the knowledge that quite often those professors and the

tomes they work from are based on limited understanding of real life.2 However, many anatomy teachers do have a much greater vision of anatomy than the books they use, but that vision comes through time with the material. We do not want to take that time—nor is it necessary—and using many of the principles in this text will help you rapidly expand your anatomy. The problem with traditional anatomy is that its standardized ideas about how anatomy should be taught in the first instance come with simplifications, abbreviations, and conventions, which serve us well for the short term but actually create issues as we try to go further into the discipline.

Our anatomy teachers are following a tradition—they are using tools that they are familiar with, tools that have been tried and tested and been found to be …, well, “good enough.” Sadly, that “good enough” leaves us with all manner of confusion and frustration. We thought we were getting “The Truth,” but in reality it was the “it’ll do for now and it’s enough to get them through the exam” version.

Reducing the information to the basics, the “just enough to pass the exam” version, instils many unconscious biases and prejudices, which limit and inhibit learning. Unknowingly, traditional anatomy often gets in the way of true understanding. 3

The Problems with Anatomical Position

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. They are considered an inherent part of the anatomy story and its normal presentation, but each story-telling tradition has a style that prepares the reader for the world they are about to enter. Whether it be the “far away land” of fairy tales or the alcoholfueled, smoke-heavy scenes of detective noir, the reader is prepared for the world they are about to enter. Anatomy texts don’t provide that preparation for us.

1 Real life requires movement in different positions, at multiple angles, with various speeds. Anatomical position removes many of those variables to give us a simplified story that doesn’t fully prepare us for reality.

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. My eyes were opened to this by the “father of function,” Doctor Gary Gray, and his collaborator Professor David Tiberio. I had been teaching anatomy and approaches to anatomy for many years, but it was only when I heard Gray and Tiberio speak of the “Truth of Movement” that I realized how often we try to impose a model of anatomy onto what we see.

I do not want to waste your time with unnecessary introductions to this and that theory. We will get stuck into the nitty gritty and set the scene for you as quickly as possible

Figure

anatomyrefocused

the

Careful observation of the

sky led Copernicus to develop a better, more accurate model, which held the sun at its center. Copernicus’s new model was counter to the teachings of the Church, which believed God had placed humanity at the center of creation. The Catholic Church’s strong resistance to the new model is a warning to us that observation, not dogma, should be our starting point for the development of understanding.

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. As M r. Rumsfeld famously said, though with less clarity, “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.

1 But with better dress sense and less facial hair.

Without knowing it, the textbooks have handicapped our ability to grasp the anatomy of movement. This first chapter will expose some of those limitations to help clear the path as we move forward.

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 through this text. As parents were so fond of telling their kids, we “need to use our words,” and we

2 Please don’t mistake my flippancy with disrespect for your wonderful favorite teacher or indeed any other.

need to use them correctly. 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.

Science has a long history of imposing ideas, beliefs, faiths, and models onto reality. For example, reluctance to accept reality over faith hindered the transition from an earth-centered view of the universe to the more accurate sun-centered version (figure 1.2). That new and improved model relied on the principle of parsimony (finding the best-fit explanation for the observations) and underpins scientific development, and we will follow that rule as closely as possible within this short text.

We will fit the 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.

So, rather than learning yet another expensive and branded story of movement, let’s set off on our ecumenical journey toward the truth of movement and see how anatomy fits to it.

3 The point I am making is that we hold the watered-down story of textbook anatomy too tightly, and our grip on it should be relaxed.

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.

Figure 2. Our first observations of the movement of the stars and planets created the illusion of the earth being at the center of

universe.

night

Hierarchy & Heterarchy in Care and Understanding

BY OWEN LEWIS

We have long known that our environment influences what we do, how we do it and even how we think. We are beginning to realise how are current environment seems intent on stopping us moving. We use cars for travel, chairs for work and our hunter gather bodies have calorie rich meals delivered to the front door. But what about the way we think? Can our social context alter perception? How then does the environment influence our perception, even our understanding of anatomy? And how does this affect the way we work?

In this article we probe further to discover how seemingly distant social and political systems influence our perception of the body and our clinical work.

Our current medical system is another example of a hierarchical system, with the surgeon at the top. Unfortunately, it is the system itself that creates barriers, meaning it is rare to talk to many surgeons or other people at this perceived ‘top’. However, many of the surgeons I have spoken too are not the know-all egos one might expect, many are all too willing to embrace other ideas. Often surgeons are imaginative people with a great knowledge that they too don’t know everything.

Hierarchies have existed in political, religions and pervade society throughout history. It was into this variety of strong social hierarchical systems that our early anatomical knowledge was born.

Hierarchical systems are not confined to the organisation of people in society. A hierarchy can exist as a knowledge hierarchy, where facts, rather than people, are ordered by perceived importance. It is this hierarchical system of knowledge that places anatomical parts in order of higher or lower importance. The earliest anatomists show their perceived importance of particular structures by the names they were given: The iris, the coloured part of the eye named after the goddess of the rainbow in Greek mythology; the cartilage that covers the front of the larynx was a piece of forbidden fruit caught in Adam’s throat, the Adams apple; the soul was thought to reside in the sacred bone, the sacrum; whereas, the word ‘muscle’ translate to little mouse; and Patella, simply means small plate; the sole of the foot is derived from the Latin solum, just meaning “bottom”, and certainly not the grandiosity of Atlas who holds up the world and resides at the top of our hierarchical spine.

Today the tradition of hierarchical anatomy continues to influence our understanding and possibly our clinical application. Consider which you perceive as more important: the brain or the

knee; pic.2 & pic.3 the psoas or flexor digitorum profundus; gluteus maximus or levator palpebrae superioris. Attempting to pick the most important structure will likely create dissonance and debate. The ultimate answer is, it depends. Shall I open my eyes (levator palpebrae superioris) or run up hill (gluteus maximus)? Play the piano (flexor digitorum profundus) or bow at the end of my performance (psoas)? Sit and think (brain) or play football (knee)? Sorry, this last one does a disservice to footballers! Such fragmentised thinking is quite different from the unbroken whole that is the true reality of each human being.

Attempting to place parts into an order of importance may also skew our interpretation of a client’s case history. One might perceive a client back pain of two weeks to be of more importance than the ankle sprained twenty years ago. However, if the sub-optimal biomechanics of the ankle is the root cause of the back pain, then the perceived importance needs to be reversed.

On a bigger scale, clinics are often organised in a hierarchical system. This may allow the lead practitioner to dictate their own elevated level of importance. This is often a sign of insecurity, nervousness, and the need to prove their worth to the client. In this way a practitioner’s deep seated inferiority complex maybe interfering with the therapeutic appliance. The overuse of complex anatomical terms may put

Today the tradition of hierarchical anatomy continues to influence our understanding and possibly our clinical application.

the client in a lower state, a position of awe at the practitioner’s amazing knowledge. What is reenforced is the hierarchical idea that the practitioner knows more than the client. My concern with adopting this approach is that the practitioner would now be expected, not just to know more, but to know everything. In this situation the practitioner fails if they consult a book, ask a colleague or turn to the ‘font of knowledge’ we call google. My argument here is that knowledge is not a moral compass. Knowledge does not make me better than, or of higher status than another human being.

bodyworkerinsights

Unfortunately, a hierarchical approach often ends up positioning us as master and slave, knower, and non-knower. The result is to create a situation where client and practitioner are vying for supremacy. A lack of client compliance with exercises is often a clear example of such dissonance.

The philosopher and economist, Karl Marx explains how it will be slaves or workers that will transform the world. The masters, says Marx, are imprisoned in the world made by the workers. The biggest changes come about; not though political ideology cast down from on high. It’s not the person with the microphone or at the pulpit that will make the change, the biggest changes come from the masses. And while Marx is talking about a political rather than a clinical ideology, I see certain overlaps. “Workers of the world unite: you have nothing to lose but your chains” (Marx). Perhaps it is time for us working clinicians to unite and loose our chains of hierarchical knowledge and change our clinics! Pic.3

But this is not a call to arms, I am no revolutionary, but a quiet advocate for an alternative. The alternative is a systemic change towards nature. The natural system of things is closer to that of a heterarchy than a hierarchy. In a heterachical system no one person and no one structure dominates the others. In this way authority is distributed.

If government took on a heterachical approach, anyone could govern or be governed by others (and with the number of prime ministers we’ve had recently, perhaps this really is the governments approach!). This may all seem like nothing more than theoretical ideology, however this heterarchical system describes our environment. An environment that can mold and alter our perception of the body.

Nature does not have a clue about hierarchies. Ask a daffodil which is more important, its stem or its petals and the daffodil will give you a quizzical look of incomprehension. Sorry to tell you but fairy tales lie, the lion is not really the king of the beasts. The psoas is not more or less important than any other structure. And our clients are not more or less important than the practitioner. Different, yes, different skills, different ideas, different understanding, but not more or less important. I am only as good as my clients; we succeed or fail together.

If we took a heterachical approach, would we listen to our clients in a slightly different way? Listen to an insider’s view of the body which only the client can perceive. This change in approach would allow the client to be the expert and the practitioner, the student. And a student is not expected to know everything. Taking on the role of a student means you are now expected

to ask questions. Not the usual ‘what’ question but the higher level ‘why’ questions. Moving on from finding out what’s wrong, towards understanding the why that underpins injury and pain.

In this heterarchy the fact that an old ankle sprain could create back pain would be obvious. The idea that fitting a shoe orthotic could give a client headache becomes a simple and obvious concept. The result of this change in viewpoint would be the clear necessity to assess the whole system the whole of the time.

Assessing the whole system is a complex and necessary challenge in our daily work. Thankfully there are methods to allows clinicians to assess the whole system within the confines of the time and space available in clinic. It will be of no great surprise to learn that Born to Move is one such heterachical system. A system of assessment and appreciation of the whole heterachical system. We learn to listen to the whole system, the whole story, to find the cause that underpins the reasons that an individual made the appointment in the first place. The Born to Move system is organised to embrace this heterachical approach to learning and educating. Teachers remain students, students evolve into higher level questioners and so, as a founder of Born to Move, perhaps I am a revolutionary.

OWEN LEWIS is a highly experienced and educated clinician. An accomplished teacher of many years he has recently teamed up with James Earls to create Born to Move. Born to Move is a comprehensive set of courses that are not confined to any one doctrine but blends and utilises James and Owen’s varied and extensive understanding of the body in movement. Being taught by Owen is to experience simplicity within the complex. Seeds of knowledge watered by a wealth of clinical relevance.

Clinically Owen has gained a distinguished reputation. Grounded in his extensive anatomical and biomechancial understanding he works alongside his clients. Taking a principle based framework that allows the discovery of individually tailored, effective solutions to problems and empower change. His diverse interests in art, anatomy, philosophy and movement to ensure his workshops are a pleasurable part of your training. borntomove.com

Guidance on what to do in the event of a complaint or claim made against you

BY CHLOE MILTON, BALENS LTD, SPECIALIST INSURANCE BROKERS

Established in 1950 Balens have been offering specialist insurance across the Health, Well-being, Fitness and Beauty sectors since the early 1990s and now insure over 100,000 clients. Our insurance solutions are available for individuals and their businesses as well as organisations, charities and the not-for-profit sectors. Our teams have considerable experience in these fields enabling them to focus on guidance, support and service to our clients.

As an individual Health and Wellbeing practitioner you can be held legally liable for loss or damage to other people’s property, injury, harm or financial loss alleged to have been caused to your clients, patients or other parties as a result of your actions or advice that you have given. Let’s be honest, insurance is a task that we put to the bottom of our ‘to do list’, we know we need it, we understand the importance of it, however, it is not something we enjoy purchasing or necessarily even budget for, it certainly isn’t something we choose to talk about. However, insurance has become vital, whether this be home insurance, car insurance or business insurance. Some of us purchase insurance because it is a legal requirement, others purchase it because they know it is good practice and others purchase it for the comfort blanket and safety net that it gives. Insurance allows you to focus on your day-to-day tasks, and clients without having to worry about the ‘what if’s’.

None of us know when we may find ourselves in a potential claim situation. In your line of work, you may take all the necessary precautions and may have worked for years without having a claim so may feel as though it will not happen to you, but unfortunately it can happen and many of our clients are shocked when it does. The reality is that regardless of the insurance, a complaint or claim against you or

your business can be very stressful, time consuming and costly, with potential unexpected knock-on effects that are hard to quantify but may include such areas as harm to your personal or business reputation. However, as we are all aware, prevention is better than cure, and whilst you will never be able to completely eradicate the risk, there is much you can do to mitigate the potential of a complaint or claim being made against you.

◆ Good quality communication (especially listening skills) and developing a quality therapeutic relationship is key.

◆ Keep your boundaries; respect your patient’s autonomy.

◆ Please remember that you have a patient practitioner relationship with your client, and keep your communication style professional. Familiarity could become a double-edged sword.

◆ Try to keep personal relationships away from professional ones - don’t get intimate with your patients - it still happens and inevitably can cause problems.

◆ If you are asking someone to remove their clothes for your therapy, remember to ensure they are comfortable to do so. Vacate the room or provide a screen for them to get changed behind. Provide a robe and/or offer a chaperone if possible.

◆ Towels and discretion should be always used to maintain dignity.

◆ Gain consent before you touch your client, and throughout the treatment, and note this in your treatment records.

In the unfortunate event of someone making a complaint against you, please contact your Insurance Broker in the first instance, Don’t wait for situations to escalate, your Broker is there for you, not to judge, but to

provide the benefit that you purchase your insurance for. A complaint handled well may lead to a happy client for years to come, if handled badly, it could lead to a potentially stressful and time-consuming claim. All Insurance Brokers will have their own systems and procedures. At Balens policyholders must notify us of a claim or an incident which could give to a claim, this can be done through phone or email. We will give guidance when speaking to the policyholder about what information/ documentation is required. This will normally be a copy of the treatment records, qualifications of the therapist and any communication between the therapist and the claimant.

None of us are perfect, and clients will inevitably be dissatisfied at some point, however the key in managing this is knowing how to resolve the issue. For more information on this please see the relevant page on our website that highlights the do’s and don’ts in a complaint situation. https://www.balens.co.uk/claims/ dos-and-don-ts-in-a-complaintsituation/

We hope that the above has been a useful reminder of what to do, should the unfortunate ever occur. At Balens we believe we are more than just insurance; we have witnessed many of our clients businesses grow and have been there throughout their journey offering insurance solutions along the way. Our focus is on supporting you and your business so you can focus on your specialist area whilst caring for your clients. As well as our individual cover we also offer a range of other policies which may be suitable for you and your business, including: Therapy/Treatment Room cover; Income protection solutions; Schools and Clinics packages; Health Products Insurance and more.

To learn more about the policies we have on offer please visit our website.

www.balens.co.uk

Rockin’ all over the world!

Hot Stone Fusion for the Treatment of Pain

Hands up if you thought hot stone massage was just a bit of luxury with no therapeutic effects - great for relaxation but not the domain of serious massage therapists aiming to alleviate and prevent musculoskeletal pain. If so, cast your eye over the following comments from therapists and clients who have experienced the true power of Hot Stone massage taught the Jing way – a blend of creative and effective stone work known as Hot Stone Fusion.

One of my clients had been in chronic pain with his neck after whiplash in two consecutive car crashes EIGHT years ago. He had never felt safe or comfortable enough to have anyone touch his neck. He came to me and we worked gently on the area with the heat of the stones. He was so relaxed by the use of the stones but tensed up as soon as I put my (loving!) hands on his neck. We worked very deeply into trigger points and stretching with the stones and the results were incredible - after only two sessions he was pain free”

I have had massages with a therapist who did the stone course with you. I suffer from back pain that ranges from dull to piercing. Normally I would go for a purely therapeutic massage, but wanted to try the stones. Not only was the treatment amazing, but I had more pain relief from the use of placement stones and heated stones used to strip the muscles than I have had from any massage in a long time. While I adore just about every type of massage, the therapeutic qualities of Hot Stone Fusion massage outstrips them all. I got a relaxation massage and a pain relief massage all in the same 85 minute session!”

As a writer I spend long periods sitting at my PC, and have experienced a succession of different types of pain in my back and shoulders. After just one session of Hot Stone Fusion Massage, my back has improved and my shoulders haven’t felt so good in years. Fantastic!

These results are not unusual. If you are taught to use the stones effectively and specifically, you have at your disposal an amazing tool that will help you to:

• Al leviate both acute and chronic pain

• Effectively address i njury r ehabilitation

• Save your hands

• Work deeply i n a gentle a nd more effective way

• Del ight your clients

• Bu ild your practice

• Ea rn more money

BACK TO BASICS- THE POWER OF HOT AND COLD IN THERAPEUTIC TREATMENT

Why should using the stones be so helpful in the treatment of pain? The answer lies in the age old use of hot and cold as a therapeutic modalityphysiotherapists, naturopaths and osteopaths are well aware of the efficacy of thermal modalities in bodywork, as was your mother who gave you a hot

water bottle to soothe your sore belly when you were a child. Yet we find that massage therapists tend to be less informed about the therapeutic effects of using hot and cold in bodywork. This can give you great results with less effort from yourself.

THE HELPING HAND OF HEAT IN THE CHRONIC PAIN CONUNDRUM

Heat can be used very effectively in cases of CHRONIC pain. This is pain that has lasted for longer than 72 hours and is characterised by being dull, achy or long standing. In our experience this is a common phenomenen in the massage therapist’s clinic and we are much more often confronted with the conundrum of chronic pain than dealing with recent acute issues. If you have a busy clinic you are probably well acquainted with obstinate back pain, neck pain, RSI, plantar fascitis and other conditions that have persisted beyond an expected healing time.

It is fair to say that chronic pain is much more complex to treat than acute pain and usually requires a multi-faceted approach. Adding heat into the mix through the medium of hot stones can enhance your outcome significantly.

The positive effects for heat in chronic pain cases can be summarised as follows:

• Ps ychological effects: Heat makes us feel nurtured, relaxed, cared for and positive – attributes we want our clients to associate with our treatments. If our clients feel safe under our hands, their bodies relax and let us in to do vital therapeutic work without resistance. We instinctively feel that heat has a “feel good” factor – my best friend said to me once that if she ever feels out of sorts she just has a bath and it always makes her feel better!

Following her advice has stood me in good stead and likewise applying heat in a clinical situation invariably has a postive effect.

• De creased muscle tightness and trigger point activity: Heat seems to have a direct effect on reducing tight muscles- often the primary cause of common pain conditions. Tight muscles also harbour pain referring trigger points – the bad boys of musculoskeletal pain. There is evidence that heat applications may reduce the firing rate of muscle spindle cells and decrease activity in the gamma efferent system of the spindles. This reduction in muscle spindle activity will have a direct impact on reducing muscle tightness.

• Increased circulation and reduction of rehabilitation time: The local increase in circulation caused by heat application is beneficial in healing numerous injuries. Bringing fresh blood and nutrients to the areas helps maintain the optimum health of the tissues for injury repair.

• Increased pliability of connective tissues: Heat applications help to improve the elasticity of fascia

(connective tissue) therefore myofascial and therapeutic stretching procedures are much more effective if heat is applied beforehand. Research has shown that temperature increase in fascia of up to 40 degrees C leads to reduced stiffness and more rapid elongation of tissue which in part can be attributed to higher extensibility of collagen (Lehman et al 1970, Warren et al 1971). Therapists interested in the benefits of fascial work would do well to apply heat to the tissues first for even better and quicker results in fascial release.

• De crease in perception of pain: We natually turn to the healing properties of heat when in pain –hot water bottles, baths, jacuzzis and hot compresses are common self care measures for everything from sore backs to period pains. Heat can help to decrease the individual perception of pain and enable us to feel in control of our pain responses

ICE FOR INJURY – THE USE OF COLD STONES

Cold is an ideal treatment for ACUTE injuries i.e: those where the injury is recent (less than 72 hours) and characterized by inflammation, swelling, lack of mobility and pain. A recently sprained ankle is a classic example of an acute injury.

Massage therapists often get confused about which injuries are acute and sometimes use ice or cold inappropriately. A good example is low back pain where therapists are often terrified of mysterious “inflammation” that is not obvious but they are convinced must be there. Approximately 85% of low back pain is actually known as “non specific” –in other words we have no idea what the cause is – there is no injury and therefore no inflammation!

Clinical experience suggests that trigger points and myofascial restrictions are key components of this type of pain – such soft tissue restrictions actually respond much better to heat. In these cases ice may not be useful as it can trigger spasm of already overly tight muscles and cause those trigger points to start a-firing.

When used appropriately in acute

pain, cold has highly beneficial effects in helping acute injuries to heal quicker:

• Reduction in muscle soreness: Cold is of benefit in reducing certain types of muscles soreness, especially that associated with increased levels of unaccustomed exercise.

• Cold slows down the cellular metabolic activity. In acute injuries, the increase in cellular metabolic activity is one factor that prolongs the healing process. Using cold immediately after injury shortens the recovery period.

• De creased nerve conduction velocity: This can be very beneficial in reducing pain sensations and increasing the pain threshold thereby providing pain relief

• De creased oedema: Oedema is one of the primary causative factors in the perpetuation of acute pain. Cold is very effective in reducing oedema.

BEST OF BOTH WORLDSHOT AND COLD CONTRAST APPLICATIONS

To get both the beneficial aspects of hot and cold, the technique of “contrast bathing” is applied. The use of hot and cold is alternated to a particular area. This is believed to cause a flushing of the tissue fluids and improve many of the neurological responses that will create the best environment for healing.

There are many ways to apply hot and cold to the body during bodywork, including hot and cold packs, infra red lamps, hydroculator packs etc. However, few have the unique advantage of the stones - namely that you can actually WORK with the stones while simultaneously applying wet heat/ cold, thus enhancing greatly the time effectiveness of your treatment. It is important to note that there

are many hot/cold stone massages where hot and cold stones are run up and down the body quickly, often causing discomfort for the client. This is completely different, -here we are specifically treating an area of pain, tension, or injury to create a positive outcome for our clients.

WHAT DOES THE RESEARCH TELL US ABOUT USE OF HOT AND COLD?

Although hot and cold has been used for decades as an important adjunct modality in the treatment of pain, supporting evidence from research ( as ever!) is divided.

Some research trials have been overwhelmingly positive in the support of the use of heat for pain reduction. In two trials of 258 participants with a mix of acute and sub acute low back pain, heat wrap therapy significantly reduced pain after 5 days compared with oral placebo.

In common with experiences in clinic where effects on pain reduction can in some cases be instantaneous, one trial of 90 participants with acute low back pain found that a heated blanket significantly decreased pain immediately after application (Both studies in French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006. Review. PubMed PMID: 16641776.)

Excitingly there is also some support for fans of the Jing approach to combining different approaches within a treatment to gain maximum results. One trial of 100 participants with a mix of acute and sub acute low back pain found that using heat in conjunction with exercise significantly increased pain relief compared to heat alone. This is an important finding and confirms our belief in the value of self- care suggestions for clients as an important part of the clienttherapist interaction. Both local heat

application and encouraging exercise and movement are easy and safe suggestions for the client in pain.

In conclusion, evidence is limited but encouraging as to using heat in treatment. The Cochrane review concludes

“There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and sub acute low back pain, and that the addition of exercise further reduces pain and improves function. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain”

USING THE STONES IN REMEDIAL MASSAGE WORK

At Jing we teach you the skills to understand when hot and cold stone work should be used to treat different pain conditions and the confidence and creativity to design unique and luxurious treatments for all your clients. Some great techniques to play with

• La rge hot stones can be used over the drape to warm and relax the fascia and muscles in the area of pain for up to 20 minutes before treating the area directly.

• Pl acing stones is a lovely part of the work we do, but it is only 10% of it. Most of the work is done by dynamically and specifically massaging the body with the stones as extensions of the therapist’s hands.

• Broad effleurage strokes are used to warm the area, before using smaller specific stones to strip and elongate the muscles fibres, searching for trigger points. This saves your precious thumbs and gives great relief to your client. For example to alleviate low back pain we could treat Erector Spinae, Quadratus Lumborum, Gluteal muscles and the lateral rotators with these techniques.

• Cold stones can be used in a similar way for acute pain to decrease pain and swelling. Cold stones used in conjunction with deep transverse friction can be very effective.

• Cold stones are usually not used longer than five minutes in any one area.

CREATIVITY AND SPECIFIC TREATMENTS

Jing therapists are trained to use the stones creatively. On our courses. you will learn a fabulous head to toe full body massage, plus the freedom to blend remedial techniques such as trigger point therapy, myofascial work and clinical stretching to produce great results. Our students are given the confidence to combine the stones with existing techniques as diverse as energy work, reflexology, sports massage or aromatherapy. This leads to a confident and creative practice as outlined by the comments below from students who have worked with us:

Using Hot stone Fusion in:

• Reflexology: “I’ve only used stones with reflexology, but even in this small area they are great. I’ve used them on pregnant mums up the arms to remove tension and relax them. I place them between the toes and under calves, clients love this”

• Myofascial Work: “I feel results are much faster with the stones than with the hands alone… There is no getting away from HOW THE CLIENT FEELS with the warmth of the smooth stones gliding over them. They can be used without oil... just wet and then you can put a warm towel over the area to dry it and away you go with some myofascial techniques”

• A romatherapy: “Since doing the hot stone course with Jing and using it in my clinic alongside my aromatherapy practice, I have found in treating people with severe painful muscular complaints that the analgesic and muscle relaxant aromatherapy oils get in to the client’s blood stream quicker when using hot stones as opposed to traditional massage. The benefit is that I can work deeper into the muscle tissue with the stones within 10 minutes, whereas with handwork I would have to take 30 minutes. So basically hot stones deliver better quality massage time for the client”

About Rachel Fairweather and the Jing Institute of Advanced Massage

Rachel Fairweather is co-founder and director of the Jing Institute of Advanced Massage. Based In Brighton, London and Edinburgh we run a variety of courses in advanced techniques to help you build the career you desire.

Our short CPD courses include excellent hands on learning in a variety of techniques including hot stone fusion, trigger point therapy, myofascial release and stretching. For the first time you are now able to learn these techniques at your own time and pace with our revolutionary online low back pain course aimed at giving qualified bodyworkers the skills they desire.

For the therapist who wants to be the best they can possibly be, we offer a BTEC level 6 (degree level) in advanced clinical and sports massage – the highest level of massage training in the UK.

Want to find out more? Please contact The JING Institute!

Tel: 01273 628942 Email: info@jingmassage.com

Website: www.jingmassage.com

Copyright Jing Advanced Massage November

Rachel Fairweather and Meghan Mari with thanks to Jing students Susky Hashemi, Christina Hitchins, Carmen O’Connor, Tara Hunt and Victoria Hayden. Photos Meghan Mari

2013. Text

bookreview

Functional Anatomy of Movement

An Illustrated Guide to Joint Movement, Soft Tissue Control, and Myofascial Anatomy

James Earls

ACritical Thinking and Practical Application

Ruth Werner

uth Werner’s best-selling A Massage Therapist’s Guide to Pathology is a highly regarded, comprehensive resource that sets the standard for pathology instruction.

Runique and comprehensive approach to functional anatomy through the lens of myofascia, from the author of Born to Walk

Countering the oversimplified teaching of musculoskeletal anatomy via static positions, James Earls argues for a novel approach. He calls for new tools and vocabulary to observe and articulate anatomy in motion and posits that observing varied bodies in different environments should refine our anatomy understanding.

Earls explores the profound effects of understanding fascial tissue interconnectedness—described as anatomy trains, myofascial chains, meridians, or slings—on our anatomical knowledge. He delves into the concept of tensegrity, emphasizing its contribution to our appreciation of the intricacy and interdependence of realworld body movements.

By situating the different theories and metaphors of myofascial continuities against the context of common real-life movements such as sports exercises and yoga asanas, Earls describes the utility and application of each theoretical system to many different situations and issues.

Using up-to-date research, Earls digs into important questions for physical and manual therapists: which tissues really are contiguous? Does continuity of tissue actually show or demonstrate transmission of force and communication along those lines? And does fascial tissue have to be continuous for the body to actually transfer force?

Accessibly written and fully illustrated, Functional Anatomy of Movement offers practical applications for physical therapists, chiropractors, and bodyworkers, as well as new tools for teachers of yoga and Pilates to develop a deeper understanding of anatomy and movement.

ISBN 978 1 913088 38 5

£19.99

Both books available at www.massagebooks.co.uk

Written for massage therapy students, this ground-breaking textbook serves up a comprehensive review of the etiology, signs, symptoms, and treatment of more than 500 diseases and disorders.

Focusing on evidence-informed massage therapy, this book will:

• Prepare students to make treatment choices that result in optimal outcomes for clients living with a wide range of conditions.

• Help students acquire the knowledge and develop the critical-thinking skills needed to positively impact healing processes.

• Re ady students to work independently or on a health care team.

• Ma ke pathology relatable, fascinating, and understandable.

Organized by body system, this indispensable classic includes compare-and-contrast charts that list similar conditions side-byside, allowing students to easily discern the differences.

Practical reference tables summarize the benefits, risks, and massage therapy options for each condition. ISBN

Achedaway Scraper - The World’s First Heated Muscle Scraper Made for Pain Relief and Muscle Recovery

Achedaway Scraper derives its concept from the Chinese traditional Gua Sha techniques. Using traditional stainless steel and stone muscle scrapers are cold and difficult to use. They have to use hot stones and heated towels to heat up the clients tissue then use cold scraping tools. That’s why Achedaway made the world’s first heated muscle scraper.

Heats Up in Seconds

It heats up to 50 Celsius degree (122 Fahrenheit degree) in seconds, has three adjustable temperatures. Heat and scraping together provide increased blood flow which promotes healing.

Ergonomic Design

The ergonomic design allows you to use both hands or a single hand for clients and is even great for self-care and self-use. Three different edge choices allows you to reach all the muscle groups.

Easy Clean

To clean, just use your favourite cleaner, wipe down and you are good to go.

Price £209.00

https://achedaway.uk

Excellence in Therapy FHT Excellence Awards 2023 Winners

In it’s 13th year, the FHT Excellence Awards showcase our leading holistic practitioners and how they are making a difference to people living in their local community – from helping clients improve their health and wellbeing to providing tailored learning and support to students and qualified therapists. The FHT is proud to announce the winners of this year’s FHT Excellence Awards 2023.

FHT COMPLEMENTARY THERAPIST OF THE YEAR 2023 – JANE EATON

Jane has been recognised for her outstanding dedication, expertise and unwavering commitment to the holistic therapy industry and the wellbeing of her clients for over 20 years.

FHT BEAUTY THERAPIST OF THE YEAR – WENDY WYATT

Wendy has demonstrated excellence in the beauty therapy sector, going above and beyond for the industry and her clients. Her long-standing commitment is truly commendable.

FHT SPORTS THERAPIST OF THE YEAR – HELEN SWEENEY

Helen’s passion for sports therapy shines through her work, making her a well-deserving winner in this category. Her dedication in supporting clients to become and stay physically active is truly exceptional.

FHT STUDENT OF THE YEAR – LOTTIE MAY MORPHEW-HEDGES

Lottie exemplifies excellence in her studies, promoting the integration of holistic therapy into her local community and healthcare system. Her commitment to learning and growth sets a high standard for aspiring therapists and she is an inspiration to many.

FHT TUTOR OF THE YEAR – VICTORIA

SALOMON

Victoria’s dedication to educating and nurturing future therapists has earned her this well-deserved accolade. Her continued focus on supporting the nation’s wellbeing by educating students in self-treatment programmes and techniques has a great impact on the future of the therapy industry.

FHT COORDINATOR OF THE YEAR – WENDY WYATT AND ANGELA PAVLOVIC

Wendy and Angela have been instrumental in coordinating the Waterlooville Local Support Group, bringing together like-minded individuals and fostering a sense of unity among members.

FHT VOLUNTEER SERVICE AWARD – LEONNA SPEIRS

Leonna has dedicated her time and effort to selflessly serve her local community, exemplifying the spirit of volunteerism that is essential to the therapy sector.

FHT LIFETIME ACHIEVEMENT AWARD – ANGELA

WHEAT

SPONSORED BY SPABREAKS.COM

Angela has made an enduring impact on the field of therapy, and her lifetime of achievements and contributions to the community has earned her this prestigious award. www.fht.org.uk

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Tri-Dosha: Nurturing Mind, Body, & Soul through Ayurvedic Massage, Breathwork & Guided Meditation

BY SUNITA PASSI

In the hustle and bustle of today’s world, finding true balance and centeredness can often feel like an elusive goal. How can one maintain a positive outlook while managing a bustling training academy, overseeing product brands, and tending to be aging parents? This question led me on a journey that culminated in the creation of the Tri-Dosha Method, a holistic approach to well-being rooted in the ancient wisdom of Ayurvedic Massage.

The Tri-Dosha Method, as detailed in my new book, is a voyage into Ayurvedic Massage, Healing, and Self-care Advocacy. It’s a comprehensive guide that will not only uplift you but also equip you to uplift others - your friends, your family, your clients - every step of the way.

Ayurvedic Massage: Nurturing Mind, Body, and Soul

Massage is more than a physical practice; it’s an art that touches the very essence of our being. Ayurvedic massage, in particular, transcends the physical realm, delving into the realms of the mind and emotions. Beyond the soothing of muscles and softening of skin, it’s a journey towards rejuvenation and inner harmony.

Ayurvedic massage is an integral part of the ancient science of Ayurveda, offering a holistic approach to wellbeing. It addresses a wide array of conditions, providing relief from migraines to anxiety and fatigue to circulation issues. At its heart lies the vital technique of oleation, or oiling, a practice deeply rooted in ancient texts.

The Evolution of Ayurvedic Massage: A Massage Through Time

The practice of Ayurvedic massage has woven itself into the tapestry of human history, spanning epochs and cultures. From the earliest days, when humanity lived in harmony with nature, touch was recognized for its profound impact on body, mind, and spirit. This wisdom has been preserved through rich oral traditions and cultural heritage, particularly in regions like Kerala, India.

Families played a crucial role in transmitting Ayurvedic knowledge, with experienced practitioners passing down their wisdom to the next generation. Home-based therapies, practiced within families, were once the norm. Local healers, recognized as authorities on Ayurveda, were invaluable resources for healthcare within their communities.

While written texts like the Charaka Samhita and Susruta Samhita have codified Ayurvedic principles, much of the wisdom was originally transmitted orally within families. This familial transmission played a crucial role in preserving and perpetuating the practice of Ayurvedic massage through the ages.

An Ancient Tradition

Dhanvantari, the God of Ayurveda, stands as a symbol of the profound history and mythology of Ayurvedic medicine, including Ayurvedic massage. According to Hindu mythology, Dhanvantari emerged from the cosmic ocean holding a pot of nectar, symbolizing health and immortality. He is revered as the divine physician, credited with imparting the knowledge of Ayurveda to ancient sages.

The practice of Ayurvedic massage has woven itself into the tapestry of human history, spanning epochs and cultures.

In the context of Ayurvedic massage, Dhanvantari is considered the archetype of the ultimate healer, laying the foundation for the comprehensive system of healthcare now known as Ayurveda. His association underscores the sacred and divine nature of this healing art, emphasizing that it is not merely physical, but deeply spiritual and holistic.

A Resurgence of Holistic Well-being

In today’s world, Ayurvedic Massage is experiencing a renaissance, both in its birthplace of India and across the globe. Western countries, including the UK, are witnessing a surge of interest in natural, comprehensive approaches to well-being. Ayurvedic massage, with its focus on harmonizing the body, mind, and spirit, is gaining prominence as an alternative to conventional medicine.

Tri-Dosha’s contribution has been instrumental in disseminating this ancient practice, training over 2000 independent therapists. Collaborations with wellness centers, clinics, and spas have widened access to Ayurvedic massage. To further advance and propagate this form of healing, we are exploring avenues such as ongoing education, research, and partnerships with healthcare professionals.

As the founder of the Tri-Dosha Academy, I invite you to delve into the profound wisdom of Ayurvedic Massage through the pages of my book, “The Tri-Dosha Method.” Discover a comprehensive guide that not only uplifts you but empowers you to uplift others. For more information, visit my website at www.sunitapassi.com.

Note: The content of this article is based on the forthcoming book “The TriDosha Method” by Sunita Passi.

Sunita is the founder of Tri-Dosha, is an Ayurvedic practitioner, author, and holistic therapist educator. Her vision is to help anchor a deeper connection to our inner selves and the world around us. Sunita believes that well-being is ours if we unlearn some of the things we’ve been brought up to believe and begin treating ourselves and others with joyful respect. At the heart of everything she does at Tri-Dosha is a foundation based on learning from the natural rhythms of Mother Earth and the universe.

For registration: 3 Day Spa Guided Meditation Treatment and Training | Tri-Dosha

Tri-Dosha Academy

Tel: +44 (0) 115 752 2425

Email: info@tri-dosha.co.uk

SUNITA PASSI

Hands Free Massage Using the Forearms & Elbows to Save the Practitioner’s Hands

DBY DARIAN PRITCHARD

oing massage is a demanding physical and hand-intensive activity, especially when we are applying pressure. It’s important to take care of the tools of the trade - your body and your hands. Massage practitioners can fatigue or strain their hands, most often in the thumbs or wrists. Stiffness and soreness in the shoulders and back are also common. This series of articles focus on how to look after your body and use it most effectively to support your hands (and forearm and elbow) in massage sessions.

This article focuses on Hands Free Massage (using your forearm and elbows) which significantly reduces the physical demands on your hands and extends your career.

Although the idea of using other body parts than the hands is relatively new in Western massage, it’s common practice in most other massage traditions. Around the world, people often use the lower body (particularly the feet and knees) for working on a client on a mat or futon on the floor. And mostly use the upper body for table techniques or with a seated client. You can sometimes use your knees and feet when the client is on the table, if your hips are flexible enough.

THE TOOLS OF HANDS FREE MASSAGE

In UK, ’Hands Free Massage’ has primarily come to mean using the forearm and elbow with the client on a massage table or chair. We’ll look at the three main HF ‘tools’ in this article. These ‘tools’ are good substitutes for your thumbs and fingers which are the most vulnerable area

Figure 1- Using the soft forearms

Although the idea of using other body parts than the hands is relatively new in Western massage, it’s common practice in most other massage traditions.

for massage practitioners. By using your forearms/elbows, you are saving your hands, particularly your vulnerable thumbs and wrists. Note: Bear in mind that, even with such tools, there are limits to everyone’s ability to apply pressure, which depends on your build and fitness.

The forearms can be used for applying light pressure in order to rest your hands, and are essential when you are using firm pressure This is especially important for practitioners with small or slender hands or hyper-mobile joints, and those with a clientele who require a very firm massage.

The ‘soft’ forearm (the bellies of the flexors muscles - at the front of the forearm) can be used for pressures ranging from relatively light to quite firm. This area is especially useful as a larger,

stronger substitute for the palm and heel of the hand when you are applying pressure over a wide areaeither stationary pressure or in sliding strokes. The ‘hard’ forearm (the ulna) is a stronger tool which can replace the fist for working on large, tight or well-used muscles. It provides a stronger, more specific pressure surface than the soft forearm.

There’s various useful parts of the elbow, which enable you to focus pressure on small tight areas (saving your thumbs, knuckles and fist). The most commonly used is the point of the elbow (the olecranon of the ulna).

Using the elbow needs the greatest care as its very easy to bruise the client. It has a poor reputation because it’s often used in the most extreme way - with the elbow fully bent so that it is sharpest and most dagger-like. And it’s often also used in an overzealous way - too abruptly, too forcefully, and too early in a massage.

The client/’s body needs preparation before elbow work, so that the tissues are acclimatised to a gradual increase in the pressure and depth of working. It should only be used for applying pressure AFTER PREPARING THE CLIENT’S TISSUES, and NOT as the first tool of choice.

Figure 2 - Using the elbow

bodymechanics

And it’s crucial to have experience in palpating muscles and tensions and monitoring the microresponses in the client’s soft tissue BEFORE you start to use these strong tools.

Working carefully when going deep:

When they’ve mastered using the forearm, the massage practitioner can work quite firmly and deeply. Don’t try to force the tissues into submission, which is likely to cause the client to tense against you. The deeper that you work, the more slowly you’ll need to slide - to give the client’s tissues time to ‘trust’ your pressure and accommodate to it.

Monitor the client’s responses and adjust the pressure:

We cannot emphasise strongly enough that the pressure that you apply needs to be appropriate for the client at that time, and for each area of their body. These are strong tools, which need to be used sensitively, with feedback from the client about the level of pressure that they find manageable.

Involving your body:

It’s easy to strain your shoulders, particularly the rotator cuff muscles, by working stiffly when applying pressure. So it’s important to involve your body:

And it’s crucial to have experience in palpating muscles and tensions and monitoring the microresponses in the client’s soft tissue BEFORE you start to use these strong tools - in order to begin using them in a skilled way with appropriate sensitivity.

SOME PRINCIPLES OF HANDS FREE WORKING

Supporting the Hands Free tools:

There’s a number of ways of supporting and controlling these tools in action. One of the most important is to use your other hand to support and guide your working forearm/elbow whenever you can.

Relaxing your hands:

We are so accustomed to using our hands for massage that it takes time and quite some attention to monitor the instinctive tensing of your hands, and to cultivate the habit of relaxing them when using the forearm. However, it’s crucial to keep the hand of your working arm as relaxed as possible.

Sensing with the forearm:

People often mistakenly assume that they will be unable to sense through their forearm. Of course this area will never be as sensitive as your fingertips, but you can learn to palpate the client’s tissues and responses with it. And this is essential if you are aiming to work skilfully, rather than just ‘mash’ the client with these strong tools.

• leaning forward to increase the pressure that you’re delivering (when appropriate)

• swaying your body forward and back for sliding strokes

• repositioning your body to stay comfortably behind and close to your forearm/elbow.

Working ‘like a chimp’:

In switching from your hands to your forearm/elbow, you need to get closer to the table. Be careful not to strain your back by hunching over or by leaning too far over the table. Instead, widen your stance and bend your knees in order to lower your trunk. Some people liken this to the way that chimpanzees move. Initially, this working position may feel awkward, and it may take time for your leg muscles to get used to the unfamiliar demands you’re making on them.

mechanics

You may need to adjust your table height for Hands Free working if you have knee problems.

CONCLUSION

The forearms and elbows are strong tools to use in massage, which allow the application of firm pressure over a wide area, with ease. When used intelligently and sensitively, these tools can save a practitioner’s hands, and expand the range of pressure that you can comfortably apply - for your client and for yourself.

This article offers a brief introduction to Hands Free working, which can extend the practitioner’s working life. It points out some of the many elements that you need to incorporate to make it work well - for the client’s comfort and for you to avoid straining your body. It takes time, practice and practical training to master and co-ordinate the elements that make forearm and elbow work easy and effective.

AN IMPORTANT CAUTION

Unfortunately, many people begin using these strong tools to ‘mash’ the client - like using a sledgehammer to crack nuts (e.g. sliding them along like an unyielding steamroller in deep pressure strokes). So, please bear in mind that this article can only offer an overview of Hands Free Massage, and does NOT provide any kind of INSTRUCTION. This aspect of massage requires personal training in using these strong tools skilfully -

• to avoid bruising clients,

• to learn how to monitor and adapt to the client’s build, tensions and responses,

• and to use your body well to support working hands free (to avoid straining yourself).

3

Figure 3 - Relaxing the hands when using the forearms

Darien has over thirty years of experience as a bodyworker, including twenty five training massage professionals, and over twenty of teaching a range of professional development courses for massage practitioners. He pioneered a focus on the practitioner’s bodyuse as an integral part of massage training in the UK, including ‘Hands Free’ Massage (using the forearm and elbow to save the practitioner’s hands). He also teaches RhythmMobility® (rhythmical techniques for release, energising and rebalancing the body). He coauthored Anatomy, Physiology and Pathology for the Massage Therapist (2001), a textbook for massage students and practitioners in their early years. This article is an extract from the career-maintenance reference book Dynamic Bodyuse for Effective Strain-Free Massage (2007).

Contact details:

DARIEN PRITCHARD

Practical Pathology for the Massage Therapist

BY SU FOX

Why do we need to know about pathology, the branch of medicine that studies the things that go wrong with the tissues and workings of the body? Because hardly anyone that we massage is 100% fit and healthy;  we all have some sort of pathology, whether it’s a serious chronic condition, hayfever snuffles or a strained muscle. Increasing numbers of massage therapists work in medical settings or with client groups with particular diagnoses, such as cancer. These professionals know how to massage safely, taking into account all the relevant aspects of someone’s medical condition. This is the first in a series of articles that address the issues facing the rest of us.

It is important for the massage practitioner to understand the theoretical basis of the medical model, and to be familiar with medical terminology, not just for those clients who have a diagnosed condition, or are unwell, but also for the people who are certainly not ‘diseased’ but require particular consideration, such as pregnant women or elderly people. Just as a solid grounding in anatomy, particularly musculo-skeletal, enables the practitioner to massage more effectively, and an understanding of physiology helps the practitioner to recognise the

pathologymatters

connection between stress, arousal, relaxation and the functioning of the nervous system, so a basic knowledge of pathology is essential for understanding the rationale behind contraindications, and how to massage safely.

Indications and contraindications

These  terms from medical practice  refer to whether a particular treatment is ‘indicated’, meaning ‘good for’ a particular condition, or harmful (or may cause harmful side effects), in which case it is contra (against) indicated. Surgery is the indicated treatment for appendicitis, but not for bronchitis. Many medications are contraindicated in pregnancy, because of possible harm to the foetus. Massage could be said to be ‘indicated’ for muscular tension and stiffness, for stress and associated conditions, and for temporary pain relief.

But what about contraindications?

A list of conditions that are contraindications, conditions that we don’t massage, isn’t very helpful. We need to be able to think much more flexibly, with different categories of contraindications, and even then, to be able to know when something is a hard•and-fast rule, such as avoiding abdominal massage in the first trimester of pregnancy, and when something is a recommendation and your decision depends on a number of factors, including your own common sense. For example, it is generally not recommended to massage a person with an infectious airborne condition that you could catch yourself. Usually someone with such a condition would be feeling too unwell to have a massage, but supposing a client turns up with a bad cold. What do you do? Send him home or have an extra box of tissues to hand?

Total contraindications

There are very few medical conditions that are total contraindications,

where massage is not recommended at all, and they fall into two categories.

There are the conditions that are infectious, and could be transmitted to the practitioner, or, in some cases, spread to other parts of the client’s body, and there are the potentially life-threatening conditions that carry a high risk of reoccurrence. Both of these total contraindications are to protect the practitioner, the first from catching infection and the second from the accusation that a massage treatment could have triggered another, possibly fatal, episode. In the weeks immediately following a heart attack or a stroke, there is a high probability of reoccurrence, which fades over time and with medical treatment.

Deep vein thrombosis is also a total contraindication in the initial stage before medication dissolves the clot, and the risk of it detaching from the wall of the blood vessel where it has formed, and travelling around the system where it could lodge in the lungs or brain, has been reduced. During these periods, massage is a total contraindication and thereafter given only in consultation with the client’s doctor until a safe period has elapsed.

Local contraindications

These are the obvious ‘massage is okay but avoid the area’ conditions. We all know not to massage over open, weeping

or cut skin, and to avoid areas of fungal infection on the skin, such as athlete’s foot. We know that inflammation, bruising and recent fractures are also local contraindications, but if we omit these parts of the body in the same way as an open sore on the skin, and massage the rest of the body as normal then we are doing that body a disservice.

Many local contraindications require that we know how to work with them. An area of inflammation, for example, will benefit from massage techniques in adjacent areas that improve the circulation, and increase the supply of food and oxygen to the damaged tissues while removing wastes. If the bone that is fractured is in the leg, it is likely that the other leg will be compensating and the muscles could do with extra attention.

When we know the names of common medical conditions, their cause, and which system of the body is mainly affected, we are in a better position to make good treatment decisions.

Following articles will explore the factors that cause disease, commonly used medications, their effect on the body and how this might be relevant to massage treatment decisions, and how, when and why to liaise with a medical practitioner.

Su Fox BSc PGCE UKCP Reg MTI Reg CSTA Reg has worked as a complementary therapist and psychotherapist since 1988. For over twenty years she taught massage and related skills in day care centres for the elderly, people with learning difficulties, and mental health issues as well as professional massage qualifications at Hackney Community College. She was director and chair of The Massage Training Institute between 1991 – 2000 and during that time co-authored, with Darien Pritchard, of Anatomy, Physiology and Pathology for Massage and authored The Massage Therapist's Pocketbook of Pathology, which has just been revised and reissued as The Massage Therapist’s Pocketbook of Pathology, by Lotus Publishing. During this time she was also running a successful private practice in psychotherapy at The Burma Road Practice in North London, focusing particularly on trauma work. Su has always believed that the talking therapies need to address the body, and that alternative therapies often failed to consider mental and emotional health, and this led her to write Relating to Clients. The Therapeutic Relationship for Complementary Therapists, published in 2009. In 1993 she added Craniosacral therapy to her qualifications and is a regular contributor to Fulcrum, the journal for the Craniosacral Therapy. She can be contacted at viasufox56@gmail.com

www.burmardpractice.co.uk/therapist-counsellor-london-n16/13-su-fox-therapist-n16

AquaStretch UK

A low-impact therapy for a large impact on your life!

BY HAYLEY PITTAM

AquaStretch is a form of Watsu® otherwise known as hydrotherapy which comprises of stretches, massages, and acupressure. It was invented by Harold Dull in 1980 who taught Zen Shiatsu. He came to the realisation that his shiatsu was more effective for his clients when performed in water; muscles and tissues relaxed easier. He combined the words “water’ and “shiatsu” to form Watsu®. Watsu is now used as a healing method where the water helps relieve physical tension while promoting relaxing which in turn supports overall health and wellbeing.

AquaStretch UK will put you in the right lane to recovery. This clinically proven, ground-breaking technique restores mobility, decreases pain, increases exercise training efficiency, and improves sports performance and general overall well-being. Whether you are having the treatment yourself or you’re the facilitator providing treatment you will notice the benefits. AquaStretch UK

are often more effective than massage and benefits can last up to three to four times longer than many conventional treatments.

AquaStretch UK is a type of assisted/ guided myofascial stretching that is only possible in the water. You can stretch into more comprehensive positions not possible on land and hold stretches much longer, allowing you to identify and stretch fascial restrictions more effectively.

Fascia is connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fibre and muscle in place. This connective tissue does more than provide internal structure and has more nerve endings than muscle, making it almost as sensitive as skin.

AquaStretch UK myofascial release therapy eliminates pain caused by muscles or other connective tissues that are tied down by tight fascia. Damaged

fascial tissue can contribute to pain at trigger points that restrict blood flow to nearby areas, causing the damage to spread. When stressed, traumatised or emotionally charged, fascia tightens up which can take a while to release on a massage bed and can especially have a negative effect if they are also in pain. Being in the water has a relaxing effect on the body, allowing it to rest and restore as it calms the nervous system down. The buoyancy supporting the body allows for a greater freedom of movement. This will enable to facilitator to help the body unravel, reorganise, and lengthen the underlying connective tissue allowing for better movement, flexibility, and health.

Unlike other manual therapies that employ deep vertical 2D pressure to the adhesions, AquaStretch UK focuses on dynamic 3D movement with pressure and traction stretching the entire fascial chain. Research has shown that AquaStretch helps with a variety of conditions such as chronic pain, lower back, neck, joint or muscle pain (such as arthritis, fibromyalgia and headaches), pain from injuries and accidents, as well as pre-operative and post-operative.

When you have a client who is alleviated from the daily pain they are suffering, with their movement becoming smooth and controlled and with adhesions released restoring the body to its optimal length, it is an amazing

massagetechnique

profession. Our AquaStretch UK facilitator is a four-day course, learning the science and anatomical theory behind this brilliant technique, as well as being in the water to feel and learn the specific movement patterns required to deliver the treatment.

AquaStretch Benefits

• Pain-free treatment

• Relaxes the body & mind

• Releases trigger points & breaks up knots

• Cor rects body imbalances

• Improves flexibility & joint range of motion

• Improves neuromuscular efficiency

• Increases lymphatic & vascular efficiency

• En hances performance & muscle function

• En hances circulation in areas where blood flow may become restricted

• AquaStretch is generally more effective than massage (and OMT) and benefits last 3 to 4 times longer

Pre-cautions should be taken when embarking on any new therapy to ensure your health remains the number one priority. Hydrotherapy does have some potential drawbacks that you should be aware of. As a passive form of therapy, a therapist will assist you with movement throughout your treatment meaning there will be close contact which may be uncomfortable for some individuals. People with certain medical conditions including fever, uncontrolled epilepsy, serious cardiac problems, open wounds, skin infections, serious UTIs, bowel incontinence, respiratory disease or allergies to pool chemicals should avoid Watsu as these could be worsened by Watsu. If you have osteoporosis, spinal problems, balance problems or are pregnant it is a good idea to inform your therapist so they are aware of your condition and can tailor your session to suit your individual needs. Like always, it is a good idea to check with your doctor to make sure that AquaStretch will be safe for you.

For more information about AquaStretch visit their socials or aquaticacademy.co.uk/ aquastretch

Haylley Pittam Co-Founder of A.R.E.A

Aquatic specialist with over 18 years expertise in the health and fitness industry

Haylley is highly experienced and covers a wide variety across the health and fitness industry. Haylley is a qualified personal trainer, aquatic fitness instructor, educator, masseuse, swimming coach, GP referral consultant and is also a Vibration Training Specialist. Highly qualified, Haylley’s main areas of focus include Pre & Post Natal and Pelvic Care. This is a subject Haylley offers extensive knowledge on, her Aqua Natal course being evidence of this along with her Pool floor to Pelvic floor workshop. Haylley teaches both swimming and aqua aerobics to elite and recreational athletes, also providing massages for any clientele.

In addition, Haylley has written and delivered specialist workshops, accredited by CIMSPA all around the UK and internationally for AREA.

Spa Business

BY MADELAINE WINZER

This article is about how to best run a spa business and assumes that it is already set up and established. The investment in and set up of a spa is a big topic and we plan to cover more in a subsequent article.

In essence, running a spa business is no different to running most businesses. It needs to follow the principles of economics and have people believe in its benefit and give their time and skills to it so that customers see their genuine enthusiasm for what they are doing.

In common with other personal customer care businesses, it needs to be done with care, consistency, clear communication, and calmness.

Successful businesses benefit their customers such that they want to come back, pay a fair price for the products and services that they receive and recommend to others, and we will explore this further in this article. Let us look at some of the key business questions for a spa manager or owner. These fall into two groups:

1. Customers and spa offering

Who are my customers? What do I offer them? What distinguishes my spa offering from others? How do we ensure that our customers go home feeling rejuvenated and recommend us?

2. Economics and making it a viable business

What is a fair price to charge customers? What are my costs and how do I make a profit? What risks do we need to think about? What about administration, booking systems, treatment records and customer information?

businesstools

CUSTOMERS AND SPA OFFERING

You are responsible for finding customers, retaining them, and marketing your business to new customers.

To attract customers, you need a 'hook' for them to choose your spa and this will be such things as an advertised spa package, a personal recommendation, a review they have read, distinctive treatments, the quality of the products used, the atmosphere of the spa or the attentiveness of staff...some of the many reasons.

Our research shows that customers usually come as part of a group or as a couple by invitation and spa is an experience they love to share and tell others about. Groups add a vibrancy to your spa and inspire a feeling of exploration, so it is always a good idea to have a continual flow of groups and couples visiting.

Reviews of spas often mention words like 'escape', 'relaxation', 'rejuvenation', 'cleansing' and 'detox'. Customers value the feeling that a spa day or treatment gives them and will most likely share their experience with others.

The majority of spa customers are women and that will likely continue to be so, but we suggest finding an appeal to men who are very enthused when they first discover the joys of spa. Men's facials, massage and hand and foot treatments are beginning to regularly appear on menus of spa treatments.

The average age of spa goers is gradually increasing and there is a big market and appeal to those who have the time, money, and inclination to go. Tailor your marketing to recognise this.

Customers remember little details that make the spa different and perhaps more luxurious than they have at home. Think about those as they will talk about them and more likely come back. This can be the scents used, the quality of the robes, cleanliness of the changing rooms etc.

We also recommend investing in high-quality treatment menus, descriptions, and photos. People love to browse online, and you can whet their appetite to book treatments. A quality spa will generate at least 50% of its income from the treatments given.

Remember that customers do need refreshing drinks to rehydrate and enjoy and are looking for healthy and cleansing options when in the spa. Iced, fruit-infused drinks and some luxury fizz need to be offered.

Customers need to have feel refreshed and hydrated.

This is true to a lesser extent for some simple nutritious food which can be ordered, and you can be creative on that and what you are capable of offering.

ECONOMICS AND MAKING IT A VIABLE BUSINESS

Deciding a fair price to charge is one of the biggest questions for any business. The level that you pitch this at says something about your spa, your target customers and determines the viability of your business.

You need to spend time and research to look at price ranges and what the 'market' rate is. It is not rocket science and you will want to consider affiliation to discount schemes like Groupon, membership deals, preferential rates for hotel guests, rates for a series of treatments etc.

Bear in mind that you want to make the maximum use of the facilities that you have so they do not lie idle nor are staff underused when on duty.

We advise not to underprice your products to allow some flexibility to discount for group bookings or for having two or more treatments.

The general business rule is that one-third of your price should cover the cost of your product and staff, one-

third for overhead (energy, the use of the building, insurance, marketing, taxes, cleaning, maintenance etc.) and one-third is profit. You can then safely offer discounts or deals of up to 15% without losing money and cover times when the spa is quiet.

Always leave scope and money for things going wrong and contingencies and think of what a business impact could have; these may include accidents, infections, damage from treatments not being properly done, and loss of key staff.

Think also and regularly check facilities for accessibility, health and safety and train your staff in these areas.

Information systems containing accounting data, customer information, and records of treatments taken are a vital tool for you not only as a responsible and compliant business owner but also to have data which is extremely valuable to understand the flow and nature of the business and what sells and how to then adapt your business for best success and service.

This article only scratches the surface but gives you an insight into the business of running a spa and some important questions to think about. We wish you luck and please take advice if not sure and you will have a business which brings enjoyment, wellbeing and escape to your customers.

Image by cookie_studio on Freepik

CranioSacral Therapy Training

www.accreditedmassagecourses.co.uk

info@accreditedmassagecourses.co.uk

Tel: 020 8340 7041

You’re a hands-on therapist.

1 day CPD courses:

And you’re good.

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

And you want to keep getting better...

Do more for your clients.

Myofascial Release

Deep Tissue Massage

Like get to the root of what’s causing their body to be in pain, help them release & recover from trauma, feel more vibrant...

Trigger Point Massage Sports Massage Techniques

Pregnancy Massage

Cupping Massage

CranioSacral Therapy can help you go deeper... and help clients heal quicker.

Even with long held issues.

ITEC courses in Spring 2017:

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

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

FREE Brochure + Colour Swatch set to help with their decision. Futon Pacifika have increased their Standard Range and can now offer Extra Long Futons (@ 240cm the increase in Platform length enables work on Head / Feet while on the Futon with the Client - replacing the need for an extension)... Futons can also now be manufactured using fully Vegan materials.

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

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

Sat 8 April ITEC Sports Massage Level4 (Run over a series of weekends. Exam in December 2017)

Courses will start again in September 2017.

Weekend

Use light pressure to dramatically reduce body restriction, tension & pain

The EMMETT Technique is a non-invasive & simple to apply hands-on body therapy. It acts like ‘first aid’ to release muscle related issues. Through the light touch application on specific points around the body we can help to relieve discomfort, create postural changes, and improve movement, flexibility and overall well-being.

This internationally recognised technique is now taught and practiced in over 40 countries and is equally effective on both people and animals.

The EMMETT Technique is easy to learn and blends beautifully with other modalities but best of all its easy on your hands and back!

Curious? Why not scan the QR code to hear more about the technique and try 2 releases for yourself. Courses held all over UK & Ireland.

For enrolment details, and further information about the EMMETT Technique and training: emmett-uk.co.uk

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 www.ALBT.co.uk

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?

If you answer yes to any of these please check out our website to read about the details.

Precise Assessment; Targeted Intervention; Outstanding results.

Check website for dates.

Email: phil@handsonclinic.co.uk

Tel: 01271812998 / 07788502023

courselistings

Be More Jedi...

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

So adding an additional set of powerful skills will simply up the ante.

CranioSacral Therapy (CST) is a Jedi power.

(Not a Star Wars fan? Sorry! Anyway, what I’m getting to is...)

Most of us want to keep becoming the best therapist we can be.

CranioSacral Therapy (CST) will evolve your skills and help you go deeper, more quickly, with those clients that are ready.

You will love every session, because every session is different and you never know what is going to happen. (Why? Because every client is different and each time they come is a different time!)

The results your clients will get will show you more magic than you may have thought possible.

Your hands will transform. So will your clients. Curious? Find out if it is for you.

Click here for our FREE ONLINE INTRO <www.upledger.co.uk/free-online-intro> to see if this feels like a good next step for you.

www.upledger.co.uk | 0800 690 6966 | mail@upledger.co.uk

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

◆ Level 4 Diploma in Advanced Remedial Massage

◆ Diploma in Fascia Informed Bodywork

◆ Adva nced Techniques

◆ Pregnancy Massage

◆ Indian Head Massage

◆ Rejuvenating Facelift Massage

◆ Sk ills 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

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

For more info and to book:

www.schoolofbodywork.com

07599 985648

courselistings

info@theuklc.com

www.gatewayworkshops.com

www.theuklc.com

Bristol College of Massage and Bodywork

Bristol College of Massage and Bodywork

Bowen Technique

Bristol College of Massage and Bodywork offers Diplomas in Holistic Massage (Level 4), Remedial and Sports Massage (Level 5) and Indian Head Massage (Level 3 Certificate) in Bristol and Worcester. Set in our spacious, cool premises in the heart of Bristol and The Fold, Bransford, we also provide an extensive CPD programme for qualified therapists taught by national and international tutors including:

Bristol College of Massage and Bodywork offers Diplomas in Holistic Massage (Level 4), Remedial and Sports Massage (Level 5) and Indian Head Massage (Level 3 Certificate) in Bristol and Worcester. Set in our spacious, cool premises in the heart of Bristol and The Fold, Bransford, we also provide an extensive CPD programme for qualified therapists taught by national and international tutors including:

◆ Ma ssage for Womens' Health

◆ Ma ssage and Pregnancy

◆ Vi sceral Massage

◆ Acupressure for Facial Release

◆ Massage for Womens' Health

◆ Cupping Therapy

Details:

Lomi Lomi Introductory Workshop

Lomi Lomi Introductory Workshop

Practitioner Training in Hawaiian Lomi Lomi Massage

Introductory Hawaiian Lomi Lomi Workshops are held on the first day of every full Practitioner Training as both share the same syllabus.

Introductory Hawaiian Lomi Lomi Workshops are held on the fi rst day of every full Practitioner Training as both share the same syllabus.

In this Workshop you will:

In this Workshop you will:

◆ Ex perience the wisdom and paradise of Hawaii through guided visualization

◆ Experience the wisdom and paradise of Hawaii through guided visualization

◆ Receive and give basic back of the body Hawaiian Massage strokes

◆ Receive and give basic back of the body Hawaiian Massage strokes

◆ Sense the dance-like grace, ease, and alignment of your body flowing with the rhythm of the ocean waves

Details:

◆ Massage and Pregnancy

◆ Cha ir Massage

◆ Visceral Massage

◆ Oncology Massage with Susan Findlay

◆ Acupressure for Facial Release

◆ Myofascial Release with Ruth Duncan

◆ Cupping Therapy

◆ Al leviating Headaches

◆ Chair Massage

◆ Deep Tissue Massage

01373 461812

◆ He at as Medicine

◆ Oncology Massage with Susan Findlay

◆ Ba linese Massage

info@thebowentechnique.com

◆ Sense the dance-like grace, ease, and alignment of your body flowing with the rhythm of the ocean waves

◆ Use hands, forearms and body weight to create the long, flowing, continuous and beautiful strokes unique to Lomi Lomi

◆ Advance your bodywork to new levels of depth and connection

◆ Use hands, forearms and body weight to create the long, flowing, continuous and beautiful strokes unique to Lomi Lomi

◆ Br ing the Spirit of Aloha into your hands to give your clients more meaningful nourishment, revitalisation, inner calm, and relaxation

◆ Advance your bodywork to new levels of depth and connection

◆ Myofascial Release with Ruth Duncan

◆ Hot Stones

◆ Alleviating Headaches

www.thebowentechnique.com

◆ Adva nced Hands Free Massage

◆ Deep Tissue Massage

◆ Ea stern Foot Massage

◆ Heat as Medicine

◆ Intro to Remedial and Sports Massage

◆ Balinese Massage

Prenatal Massage Training

◆ Hot Stones

For more info and to book: www.bristolmassage.co.uk

◆ Advanced Hands Free Massage

◆ Eastern Foot Massage

◆ Intro to Remedial and Sports Massage

For more info and to book: www.bristolmassage.co.uk

Acupuncture and dry needling foundation course

Details:

Looking for another tool to your toolbox, or another string to your bow?

Your clients are looking for acupuncture and dry needling, and we can train you to become safe, confident and effective in needling skills.

Breeze Academy are the UK’s leading Needling education provider.

Acupuncture and dry needling foundation course

01782 285545 or 01782 639777

Looking for another tool to your toolbox, or another string to your bow?

carol@comfyspatraining.co.uk

Our courses are triple-locked quality assured, and consistently rated 5-star – a unique blend of online and faceto-face teaching, meaning less time away from home and work, and less cost!

www.comfyspatraining.co.uk

Your clients are looking for acupuncture and dry needling, and we can train you to become safe, confident and effective in needling skills.

The face-to-face workshops are fun, practical and engaging, meaning that you’ll be able to apply your learning into practice immediately.

Gladwell School of Massage

Breeze Academy are the UK’s leading Needling education provider.

E: breeze.academy/locations/acupuncturecourse-locations

Our courses are triple-locked quality assured, and consistently rated 5-star – a unique blend of online and faceto-face teaching, meaning less time away from home and work, and less cost!

W: enquiries@breeze.academy

Sports Massage

Accredited by the CThA, FHT, Think Tree Hub

◆ Bring the Spirit of Aloha into your hands to give your clients more meaningful nourishment, revitalisation, inner calm, and relaxation

T: 01273 730508

Number of CPD Points gained varies per Practitioner Association

Cost: £135

E: info@hawaiianmassage.co.uk

Introductory Workshop Dates 2022

Accredited by the CThA, FHT, Think Tree Hub

www.huna-massage.com

July 7th, October 1st, October 6th

Number of CPD Points gained varies per Practitioner Association

Cost: £135

2023

Introductory Workshop Dates 2022

July 13, October 7, October 12

July 7th, October 1st, October 6th

McTimoney College of Chiropractic

2024

July 18, October 10

2023

T: 01273 730508

July 13, October 7, October 12

E: info@hawaiianmassage.co.uk

2024

www.huna-massage.com

July 18, October 10

RockBlades Education

T: 01273 730508

E: info@hawaiianmassage.co.uk

Instrument Assisted Soft Tissue Mobilisation (IASTM)

www.huna-massage.com

Add the RockBlades (IASTM) method to your skillset to enhance your treatments and reduce hand fatigue. The ergonomically designed smooth edged RockBlade and Mohawk tools combine with cutting edge education to produce this internationally acclaimed course run throughout the UK.

RockBlades Education

We also have a popular triple evening live stream course with a unique assessment and certification process.

Instrument Assisted Soft Tissue Mobilisation (IASTM)

Dates: Courses available throughout the UK and via Live Stream Visit: www.RockTape.co.uk

Details:

London | Bristol | Birmingham | Nottingham | Brighton | Liverpool

Add the RockBlades (IASTM) method to your skillset to enhance your treatments and reduce hand fatigue. The ergonomically designed smooth edged RockBlade and Mohawk tools combine cutting edge education to produce this internationally acclaimed course run throughout the UK.

E: breeze.academy/locations/acupuncturecourse-locations

Take your Sports Massage skills to the next level, and gain your level 4 qualification in Sports Massage Therapy. Offer way more to your clients, through detailed assessment skills, advanced massage techniques, which you can apply to common musculoskeletal injuries.

The face-to-face workshops are fun, practical and engaging, meaning that you’ll be able to apply your learning into practice immediately.

www.gladwellschoolofmassage.com

W: enquiries@breeze.academy

Our courses are fun, interactive, and delivered by experienced tutors who have your learning experience at the heart of every course.

RockPods Cupping EducationMyofascial Dry Cupping

We also have a popular triple evening live stream course with a unique assessment and certification process.

www.mctimoney-college.ac.uk

The RockPods cupping course was our most popular course of 2020 and 2021. Join us to find out why this modern and unique approach to cupping is proving so popular. Through a combination of soft tissue mobilisation and movement you will discover new possibilities for cupping in modern manual therapy.

Dates: Courses available throughout the UK and via Live Stream

Visit: www.RockTape.co.uk

London | Bristol | Birmingham | Nottingham | Brighton | Liverpool

Sports Massage

Not only is the Sports Therapy industry moving towards Level 4 as the standard qualification, a Breeze Academy level 4 Sports Massage course provides eligibility to our acupuncture and dry needling courses.

Take your Sports Massage skills to the next level, and gain your level 4 qualification in Sports Massage Therapy.

E: breeze.academy/locations/sportsmassage-course-locations

T: enquiries@breeze.academy

Offer way more to your clients, through detailed assessment skills, advanced massage techniques, which you can apply to common musculoskeletal injuries.

Our courses are fun, interactive, and delivered by experienced tutors who have your learning experience at the heart of every course.

Not only is the Sports Therapy industry moving towards Level 4 as the standard qualification, a Breeze Academy level 4 Sports Massage course provides eligibility to our acupuncture and dry needling courses.

E:

RockTape Kinesiology Taping Education

The worlds leading Kinesiology Taping Education from RockTape UK will teach you everything you need to know to get the best results from this fantastic treatment and rehabilitation tool. Join us for one or two days for an evidence informed highly practical and fun course. We also have a popular evening live stream course with a unique assessment and certification process.

Issue 109 2020

RockPods Cupping EducationMyofascial Dry Cupping

E: Daniel@RockTape.co.uk

The RockPods cupping course was our most popular course of 2020 and 2021. Join us to fi nd out why this modern and unique approach to cupping is proving so popular. Through a combination of soft tissue mobilisation and movement you will discover new possibilities for cupping in modern manual therapy.

T: 01206 615464

RockTape Kinesiology Taping Education

The worlds leading Kinesiology Taping Education from RockTape UK will teach you everything you need to know to get the best results from this fantastic treatment and rehabilitation tool. Join for one or two days for an evidence informed highly practical and fun course. We also have a popular evening live stream course with