Terra Rosa E-Magazine Open information for massage therapy & bodywork No. 5, June 2010
Contents 02 Structural Integration—Michael Stanborough, MA 06 An interview with Shari Auth 08 Simulating Fascia & Injury— Maurizio Ronchi 09 Muscle Palpation Assessment and Orthopedic Massage by Dr. Joe Muscolino 14 High Heels and Back Pain by Erik Dalton PhD 16 The Danger of High Heels 18 Chronic Neck Pain & The Core 21 Myofascial Streching for the Arm & Shoulder - Walt Fritz, PT 22 Dorn Spinal Therapy & Breuss Massage - Barbara Simons 24 An Alternative Approach to Stretching - Whitney Lowe, LMT 27 Research Highlights 29 Six Questions to Michael Stanborough 30 Six Questions to Barbara Simon
www.terrarosa.com.au Welcome to our fifth issue of Terra Rosa emagazine, our free e-zine dedicated to bodyworkers. We got a range of great articles for you, starting with an introduction to Structural Integration (SI) by Michael Stanborough. More on fascia by our Italian bodyworker, Mau, showing a simple example how to simulate injury and trigger points. We have an interview with Shari Auth, the creator of the Auth Method of Forearm Massage and also the author of the best selling DVD. Erik Dalton gives an excellent article on high heels and back pain. And we also look into the hazard of high heels on the ankle, knee and foot. Dr. Muscolino, who will come to Australia next year, review the art & science of muscle palpation. Whitney Lowe shows you an alternative to stretching. Then we look at the neck and its core muscles. Walt Fritz will show you effective myofascial stretching for the arm, shoulder & neck. And don’t forget to read Six Questions to Michael Stanborough and Barbara Simon. We hope to keep you informed and entertained. Thanks for all of your support and enjoy reading. Stay healthy. Sydney, June 2010.
Disclaimer:
The publisher of this e-magazine disclaim any responsibility and liability for loss or damage that may result from articles in this publication.
Terra Rosa e-magazine No. 5, June 2010
1
Structural Integration
By Michael Stanborough, MA
Certified Advanced Rolfer Director, SI Australia Member of the IASI
sation techniques would lead in time to a realignment of the body so that it returned to its natural posture.
History Dr Ida Rolf originally called her unique form of bodywork therapy “Structural Integration” (SI) when she developed it over 60 years ago. For many decades her work was known most commonly by the nickname “Rolfing”, a term that arose during Dr Rolf’s development of the method at Esalen Institute in California. When the residents and visitors there received her treatments they described it as being “Rolfed” – saying they’d been Structurally Integrated somehow just didn’t do justice to the experience. However over the last fifteen years or so the term Structural Integration has returned to prominence as a number of schools throughout the world began to offer programs in the methodology and philosophies of Dr Rolf. In 2002 the International Association of Structural Integrators (IASI) was formed. Amongst its missions was the goal to provide a framework of curriculum standards for schools of SI that honoured both the original intent of Dr Rolf and the developments arising in the field that were being integrated in diverse ways into each of these schools. There are currently 18 certified programs in the world including SI Australia in Melbourne and the Australian School of Applied Structural Integration & Somatic Studies in the Gold Coast. The most recent IASI
symposium, held in Denver, attracted presenters from most of the member schools as well as important contributors to fascial research from outside of the SI community.
The Method So just what was it that the remarkable Dr Rolf conceived of? Through personal exploration and academic knowledge, she developed the insight that the earth’s gravity exerts a continuous influence on the balance of the body, locking into place any of the distortions caused by injury, poor posture or post-surgical scarring. Her PhD into biochemistry led her to the understanding that systematically manipulating the pliable connective tissue, known as fascia, held the key to structural rebalancing and from this a more aligned, energised person would emerge. These soft-tissue mobili-
Terra Rosa e-magazine No. 5, June 2010
This was accomplished through what become known as the Ten Series or “The Recipe”. Each session in the series works on a specific part of the body to systematically release the accumulated stiffness and stress in that area. The innate ability of the body to adapt skilfully and economically to gravity is progressively restored. As the series progresses the natural postural controls return and “standing up straight” and more importantly, moving freely, becomes the normal state. Balance between the inner core and the outer sleeve is reestablished with an accompanying increase in vitality and vigour. As the body moves away from the debilitating effects of muscular imbalances with their associated tension and pain, movement becomes more fluid and effortless. This ease in movement shows up in every day activities as well as in sports and the performing arts. In fact, a number of well-known sports people and dancers credit SI with enhancing or extending their careers. As well as being a manipulative therapy that restores natural movement and posture, SI has an educational component. Dr Rolf 2
Structural Integration realised quite early on that the changes that the therapist brought about in her clients would go deeper and last longer if they would change their habits of body use. These days SI practitioners frequently engage with a client’s movement habits during sessions. This is often done through deliberate and mindful client movement made during the manipulations as a way of taking advantage of neural plasticity. Imagery and increased awareness of weight, position and internal sensation will also be used to influence the internal body maps that control movement. The evidence is now strong that good connective tissue manipulation and movement education can make long lasting changes to posture, performance and pain reduction. Because of the consistency of these outcomes SI has moved from being an alternative therapy that enjoyed a reputation for helping people feel more balanced and grounded, particularly when other approaches had failed to provide a solution, to a recognised bodywork method that rehabilitates patients with long standing soft-tissue, postural and movement restrictions.
some who have chronic fatigue or fibromyalgia. He measured their balance before and after the Structural Integration using balance measurement tests. Everyone who had a balance problem improved.
Performance Implications If you ask a New Yorker how to get to Carnegie Hall they’ll most likely answer “practice, practice, practice”. Renowned concert pianist Leon Fleisher, who made his Carnegie Hall debut at 16 years of age, had done just that and through a gruelling schedule of practice and performance developed a debilitating over-use syndrome. This led to the loss of use of his right hand and a frustrating decade of teaching, conducting and performing pieces for the left hand. After exploring dozens of diagnostic and therapeutic avenues in an attempt to return to two-handed playing, Fleisher discovered SI. 10 months later, after receiving many treatments from Advanced RolferTM Tessie Brungart, Fleisher made a triumphant return to Carnegie Hall and has since returned to touring. In early 2009 he released to critical acclaim his first CD in twenty years. Brungart was subsequently invited to present her work to the National Institute of Health.
tion often produces the feel of immediate tissue release under the therapist’s hand. It was thought MFR altered the mechanical properties of fascia by permanently altering its length via alteration of the bind between the collagen fibres. Robert Schleip, a RolferTM, conducted a literature study and showed that this theory is not feasible as a much stronger force or longer durations of strain would be required for a permanent elastic Clinical Implications deformation of fascia. However he found that fascia and connective Tom Findley, MD, PhD and Certified Clinically, the largest group of peo- tissue in general is densely innerAdvanced RolferTM, is Associate Director for Research, War-Related ple to benefit from Structural Inte- vated by mechanoreceptors which gration has some type of myofascial are responsive to manual pressure. Illness and Injury Study Center, at Stimulation of these sensory recepthe East Orange VA Medical Center pain such as a bad back or neck, tors is responsible for a lowering of general stiffness or nonin New Jersey. This centre is designed to specifically serve veterans inflammatory arthritis. It’s also as- sympathetic tonus as well as a change in local tissue viscosity. with medically unexplained fatigue sociated with good outcomes for specific conditions such as scoliosis, and pains, and has highly specialRobert Schleip continued his study cerebral palsy and post-surgical ized equipment to measure baland research on fascia and obtained scarring. ance. Findley’s researchers have a PhD in 2005. Dr Findley (above) found subtle balance problems in and Dr Schleip thought it was due From Practice to Research many veterans with unexplained time that the scientists that were pains as well as in persons with Although SI is known to be effective studying fascia meet with the clinichronic fatigue and fibromyalgia. clinically, in the early days there cians that were treating it. They Dr. Findley did a case study with his was a lack of a physiological and planned a conference where the Structural Integration clients who scientific explanation of how it finest researchers in fascia were have myofascial pain, including works. Myofascial (MFR) manipulainvited to present their scientific Terra Rosa e-magazine No. 5, June 2010
3
Structural Integration research. The First International Fascia Congress on Facia was held on 4-5 October 2007 at Harvard University in Boston. In this congress, manual therapists learned new terminologies and theories on fascia. Among the new concepts: fascia is directly involved in force transmission from one tissue to another and this has major implications in explaining how the body functions; fascia’s ability to glide smoothly on other tissues can be altered, producing restrictions; manual treatments that address the fasciae can influence cells and molecules via mechano-transduction, producing changes in intracellular biochemistry and gene expression (this was one of the really startling presentations). The success of the congress led to the 2nd Congress of Fascia Research, two years later, held at the Free University, Amsterdam, 27-30 October 2009. This Congress included two sessions where therapists and researchers met. Manual therapists presented in brief a variety of manual and tool-assisted modalities, with the intention of informing scientists about their techniques and assumed theories behind them. In this congress, therapists learnt about the dynamic reconfiguration potential of the collagen network, which can occur within seconds. This suggests that the effect of manual therapy can be immediate and significant.
The future Where is SI going? The concepts, insights and methodology we inherited directly from Dr Rolf are all right there in the foreground, summarised in some sense by simply referring back to her seminal insights – for human well being, look to gravity, fascia and the whole body. However, the discussions we have about gravity, fascia and what we
mean when we say the “whole body” have expanded greatly. We’re continuing to look at the mechanical properties of fascia and it’s clear from the two Fascia Research Congresses that there’s still a lot to learn about what properties of fascia account for the changes brought about by SI. Other lines of questioning and concept formation are drawing on the fascinating advances in the understanding of neuroplasticity. Sandra and Mathew Blakeslee’s The Body Has a Mind of Its Own has captured the attention of many SI practitioners as has Norman Doidge’s The Brain That Changes Itself. Now we’re considering how the various “interventions” of SI – pressure, stretch, guided movement and selfsensing to name a few – affect body maps and sensory-motor connections. The insights of these books lend a new depth to the understanding of the work of French dancer, movement teacher and RolferTM, Hubert Godard. For Godard, perception, meaning and coordination create our gravity response perhaps even more than the fascia. This emphasis on the nervous system dovetails well with
Terra Rosa e-magazine No. 5, June 2010
Schleip’s ongoing research into the mechanoreceptors within connective tissue. Tom Myers continues to develop his anatomy trains concept with lots of engaging material in the latest and excellent edition of Anatomy Trains as well as on his website. The fascial dissections are particularly wonderful. The blending of SI with various schools of body-centered psychotherapy therapy continues. So too does the exploration of the spiritual dimensions of SI such as Will Johnson’s work with aspects of the awareness practices of Buddhism. Going forward we’ll be dancing, looking into microscopes, sensing into ourselves and others, heading to the dissection room, boning-up on the structures of the nervous system and looking on in awe at images of probes half the diameter of the wave length of light teasing the human genome out of fibroblasts. It should continue to be stimulating! Read also 6 questions to Michael on page 29. 4
Deep Tissue Massage & Myofascial Release Workshops with Art Riggs Sydney & New Zealand November 2011 FUNDAMENTALS OF TOUCH
Deep Tissue Massage Deep Tissue Massage is much more than just a “hard massage.” In contrast to just relaxing muscles, the specific lengthening of fascia and muscles and tendons offers many benefits such as freer joint movement, benefit for injuries, better posture, and feelings of well-being.
Sydney: 4, 5, 6 November 2010, New Zealand: 13,14,15 November 2010 This class covers all aspects of Deep Tissue and Myofascial Release work with nuts and bolts emphasis upon broad understanding and cultivating your touch and body mechanics.
INTEGRATED FULL BODY DEEP TISSUE MASSAGE
Art Riggs Art Riggs is a Certified Advanced Rolfer® and massage therapist who has been teaching bodywork since 1988. He is the author of the best selling Deep Tissue Massage and Myofascial Release book and DVDs. He also frequently authored articles for Massage and Bodywork Magazines in the US. He has conducted numerous workshops for health spas and for medical professionals, including physical therapists. He also teaches his work internationally including UK and Europe to bring them the knowledge and experience that he has gained with his work. He lives and practices in San Francisco bay area.
Sydney: 8, 9 November 2010 This workshop will provide you with the skills to smoothly integrate your specific deep tissue and myofascial release techniques into a fluid full body massage, and will be a great refresher if you feel you need some review.
ADVANCED DEEP TISSUE MASSAGE & MYOFASCIAL RELEASE Sydney: 25, 26, 27, 28 November 2010 This series expands the initial skills taught in “Fundamentals” workshop and offers a step by step movement up the entire body, offering more specific information, anatomy and strategies for all parts of the body.
Don’t miss this is a unique experience and rare opportunity to train with Art Riggs.
Book Now as Places are Filling Up.
Venue in Sydney: NatureCare College, 46 Nicholson st. St Leonards. NSW 2065.
Terra Rosa e-magazine No. 5, June 2010
5
5
An Interview with Shari Auth, Creator of the Auth Method of Forearm Massage More Leverage:
When and how did you decide to become a bodyworker?
By using your forearms you’ll have a steady, strong base of contact to lean onto.
I went to massage school almost by accident when I was 23. I was interested in going to medical school and went to massage school at night to get some education in alternative medicine, I discovered I had a gift and never left the profession.
Increased Career Longevity: Many massage therapists leave the profession because of wrist or hand injury. By using your forearms you’ll be able to protect the fragile joints of the hands.
How did you come up with the Auth method of forearm massage? Out of necessity. The Auth Method of Forearm massage developed naturally in my first several years of working full time as a massage therapist. I knew I wouldn't last long in this very laborious profession if I didn't learn to work efficiently and effectively. The Auth Method is effortless for the practitioner and feels wonderful for the client. The Auth Method takes the therapist's body into account, it is a way of working that is ergonomic, and when practiced correctly feels totally effortless, even when practicing deep tissue.
Greater Surface Area:
a bodywork experience that is deep but not painful. What are the benefits of Forearm Massage? Here is a list I complied recently on the benefits of Forearm Massage:
What makes Auth Method different from other bodywork? The Auth Method is different because it was developed by a massage therapist for massage therapists. It was designed with the therapist's health and longevity in mind. The Auth Method utilizes body weight not muscular force to engage the tissue. The Auth Method doesn't poke or prod; it's even, slow and patient. It's creates Terra Rosa e-magazine No. 5, June 2010
With an increased surface area of contact, you can work on more of your client in less time, making your practice more efficient. Your clients will feel like they are getting more for less. Increased Durability: A stronger tool lasts longer. The forearms are larger and less fragile than the fingers or thumbs, so your massage practice will thrive longer. Effortless Deep Tissue: Because you’ll have more leverage when working with your forearms, the deep tissue work you do on your clients will be less demanding. You’ll be able to work deeper on your clients, with less fatigue. Satisfy the Massage Needs of Larger Clients: The forearms are a big tool capable of doing bigger jobs. This makes them ideal for working the larger muscle groups of any of your clients, as well as addressing the 6
Interview with Shari Auth massage needs of your larger clients. More Contact: Clients come to massage therapists for contact. By using the forearms, you increase contact with your clients. This contact is comforting to your clients. It Feels Good: Forearm massage is just as soothing as massage with the hands. It might take time to develop sensitivity in the forearms, but the sensitivity is there. Listen to your client’s body, it will tell you how fast and how deep to go. Remember, massage isn’t something we do to our clients it’s something we do with them. Can you tell us about how Qi Gong practice can help in doing bodywork and massage? I teach simple Qi Gong exercises in my workshops and on my DVD, to help MT's develop better body mechanics while working. Qi Gong encourages a stance that is like a tree, grounded in the legs and relaxed in the upper body. This is perfect for bodyworkers. Qi Gong keeps the therapist grounded in
their own body. Qi Gong is a very slow martial art, so it slows the therapist down, which client's find very relaxing. What do you find most exciting about bodywork therapy? Watching people's lives transform for the better. What tips can you give to massage therapists to prolong their career? Get regular bodywork. Adopt a conscious movement practice, ie., martial arts, yoga, pilates, dance, gyrotonics etc. Use your forearms instead of your hands for the majority of your massage. Listen to your body and it's needs. Consciously breathe, both on and off the job. What are your interests these days? Cultivating a loving marriage....I'm getting married this summer!
Shari Auth, L.Ac., LMT, NCBTMB Shari Auth is the creator of the Auth Method of Forearm Massage and the instructional massage DVD, Auth Method: A Guide to Using the Forearms. She is a licensed massage therapist and acupuncturist, and is also certified in the Rolf Method of Structural Integration. Ms Auth teaches continuing education workshops for massage therapists, has a full-time practice in the healing arts in New York City, and has been practicing since 1995. For information on her practice in NYC, please visit shariauth.com.
Auth Method Instructional DVD Learn to massage without taxing the delicate joints of the hand and increase career longevity. Learn to give a full body massage using the forearms as the primary tool. These techniques can be used for both deep tissue work and light circulatory massage. This DVD teaches simple qi gong exercises for better body mechanics, as well as, how to use body weight to engage tissue, depth of pressure, speed of strokes and developing sensitivity in the forearms.
Terra Rosa e-magazine No. 5, June 2010
7
Simulating Fascia & Injury Maurizio Ronchi In this article, I will try to demonstrate using simple analogy, how injury and deformation on fascia can affect our body. I used a Glad Wrap (polyethylene) sheet to simulate a fascial sheet, a myofascial expansion, perimysium or thin aponeurosis. I simulated an injury or insult to the fascial sheet using a finger or a small ball that exerted pressure on the sheet and created deformation without a lesion. My question is, can an injury resulted from external condition (such as traumatic accident) or from internal condition (such as dislocation , oedema) can create this type of damage on the fascial structure? If yes, then is the deformation is temporary or permanent? My hypothesis is that the deformed fascia will arouse a repair or remodelling process e.g. stimulating the densification of collagen or the tensile forces of the adjacent muscles or tendons or fascial expansion will try to restore the damage. It may be that as a result of the deformation or repair process, can possibly create a myofascial trigger-point? And manual manipulation can help the process of restoration? In the event when the injury create a lesion, what will happen and as scar developed, similar to scar in the muscles, what kind of difference in its physical properties? I would love to hear your comments and opinions, please email me: ik2yxk@libero.it and I’d be happy to hear from you. Maurizio Ronchi is a bodyworker, sports athlete, and instructor. He likes to play extreme sports, including 100 m track and long jump, basketball, judo, and climbing. He was a track and field instructor since 1979, Climbing instructor since 1992. In the last 25 years, he has worked for athletes on various sports and at the moment working for SEREGNO RUGBY as a sports bodyworker.
Terra Rosa e-magazine No. 5, June 2010
8
Muscle Palpation Assessment and Orthopedic Massage by Dr. Joe Muscolino The Art and Science of Muscle Palpation When performing clinical orthopedic massage on a client, having an accurate assessment of the tone and health of each of the muscles is imperative. After all, with orthopedic massage, working to loosen tight muscles is usually our main objective. Probably the two most common presenting complaints of a client are stiffness, in other words loss of range of motion, and pain. By massaging tight muscles, we strive to relieve pain and restore range of motion. To make an accurate assessment and know which muscles need to be worked requires a number of assessment skills. Foremost among these is muscle palpation. Muscle palpation can be broken into two parts. The first part is locating the target muscle that we are looking to find. Once accurately located, the second part is to assess its health, in other words feeling for its tone by determining whether it is tight or loose. Although assessing the tone of the muscle is clearly the most important aspect of palpation, it cannot be performed unless we first determine with certainty where the target muscle is located. Effective massage usually requires working a muscle from attachment to attachment. But if we are not quite sure exactly where the borders of a muscle are, how do we know when we are working it and when we aren’t. Further, if a client presents with a tight area, and we cannot determine exactly what
Figure 1. A, Knowing the attachments of the deltoid allows us to accurately place our palpating fingers. B, Knowing the actions of the deltoid, we ask the client to abduct the arm at the glenohumeral joint, making it contract and become easier to palpate.
muscle or muscles are involved, then how can we counsel the client as to what activities likely caused their problem? So, the key to effective muscle palpation for orthopedic massage lies in being able to accurately locate each of the target muscles. And for each target muscle, there is a palpation protocol that can be performed to accomplish this. Unfortunately, muscle palpation is often not well learned by students and therapists alike. As a matter of course, it is often presented in textbooks and taught in the classroom as a series of protocols that are memorized instead of being understood. As with most things that are memorized, they are often forgot-
Terra Rosa e-magazine No. 5, June 2010
ten or become fuzzy in time, leaving us with weak palpation assessment skills. The art and science of muscle palpation lies in the fact that muscle palpation protocols do not need to memorized; rather they can be reasoned out by learning some basic common sense guidelines. Knowledge of these guidelines then allows us to figure out how to palpate each muscle of the body, equipping us to become powerful and effective clinical orthopedic therapists! The focus of this article is to discuss a few of the fundamental guidelines that are necessary when learning the art and science of muscle palpation. 9
Palpation The Art of Muscle Palpation:
Knowing how to choose the best action of the tarThe first two guidelines are what can be called the science of muscle get muscle can be reasoned out if we know the palpation because they are based on knowing the attachment and ac- actions of the target mustion information of the target mus- cle and we also know the actions of the adjacent cle that we learned in our science muscles. (anatomy and physiology/ kinesiology) classes. Guideline #1 is to use our knowledge of the attachments of the muscle to know where to place our palpating fingers. For example, if we are palpating the deltoid, then knowing that it attaches from the lateral clavicle, acromion process, and spine of the scapula, to the deltoid tubercle on the humerus allows us to place our palpating fingers on it (Figure 1a). However, as we explore this muscle, how do we know if at a certain point we have strayed off it and are now on a different muscle? Further, if instead of the deltoid our target muscle is deep instead of superficial, how do we know that we are palpating it and not adjacent musculature? In these cases, it is helpful to utilize Guideline #2 which is to know the action(s) of the muscle to have the client engage it and make it contract. In the case of the deltoid, we can ask her to abduct her arm at the glenohumeral joint (Figure 1b). The deltoid contracts and becomes palpably harder and we can easily feel the entirety of the muscle, discerning it from the adjacent soft tissues. These first two guidelines form the fundamental basis for locating a target muscle. They require that we either recall the attachments and actions that we have learned, or go back and look them up.
contraction of the target muscle to be as isolated as possible. For this reason, our goal is to have only the target muscle contract, and all the adjacent muscles remain relaxed. This brings us to Guideline #3, which is choosing the best action of the target muscle when we ask the client to engage and contract it. For example, if our target muscle is the flexor carpi radialis of the forearm/ wrist joint and we ask the client to flex the hand at the wrist joint, not only will the flexor carpi radialis contract, but so will the adjacent palmaris longus (Figure 2a). This will make it difficult to know when we are on the flexor carpi radialis versus the palmaris longus. The answer is to choose radial deviation as the action instead of flexion (Figure 2b). Now the flexor carpi radialis will engage and can be palpated, but the palmaris longus will remain relaxed. Knowing how to choose the best action of the target muscle can be reasoned out if we know the actions of the target muscle and we also know the actions of the adjacent muscles. Our goal is to find an action of the target muscle that is different from the actions of the adjacent musculature.
Figure 2. A, Adding resistance to flexion of the hand at the wrist joint causes the flexor carpi radialis (FCR) to contract, but it also causes the adjacent palmaris longus (PL), another wrist joint flexor, to contract. B, Adding resistance to radial deviation of the hand at the wrist joint causes the FCR to contract but the adjacent PL to remain relaxed.
Guideline #4, adding resistance to the client’s contraction, can be used. This was seen in Figure 1b; the therapist used his left hand to add resistance to abduction of the client’s arm. The optimal amount of resistance that should be added varies from muscle to muscle and client to client, so we need to be willing to be creative and experiment. If the muscle is not clearly felt with a little resistance, we add more; if the muscle is not clearly when adding a fair amount of resistance, we add less.
Perfecting the Art of Muscle PalpaAdding resistance is often the key tion to finding the target muscle. But it Beginning the Art of Muscle Palpa- In Guideline #2, we asked the client is where errors so often occur. Indeed, it is this step that is often tion to engage the target muscle so it inaccurately portrayed in many would be easier to palpate and The key to effective palpation is books and articles on palpation. would stand out. But sometimes, not just feeling the target muscle, simply asking the client to contract When resistance is added, it is imbut being able to clearly discern it the target muscle does not cause a perative that we do not add resisfrom the adjacent muscles and strong enough contraction to make tance across a joint that does not other soft tissues. This requires the need to be crossed. If our contact it palpably clear. In these cases, Terra Rosa e-magazine No. 5, June 2010
10
Palpation forearm pronation, it is important that our hand contacts the distal forearm, not the hand (Figure 3). Otherwise, adjacent wrist joint flexors (flexor carpi radialis, palmaris longus, flexor carpi ulnaris) will contract, making it impossible to be sure when we are on the pronator teres or when we have veered off onto these other muscles. Yet another example is the brachioradialis. When palpating this muscle, it is often recommended to resist flexion of the client’s forearm at the elbow joint by “shaking” their hand. However, doing this causes us to cross the client’s wrist joint to add resistance against their hand, Figure 3. When palpating the pronator teres which will cause adjacent muscles (extensors carpi radialis longus and and adding resistance to pronation of the forearm at the radioulnar joints, the resisbrevis) to contract as well, making tance should be added by contacting the it difficult to discern the brachioraclient’s distal forearm, not her hand. dialis from them. In this case, adding resistance properly requires When resistance is added, it contacting the client on the distal forearm as seen in Figure 4. is imperative that you do
not add resistance across a joint that does not need to be crossed!
Figure 4. When palpating the brachioradialis and adding resistance to flexion of the forearm at the elbow joint, the resistance should be added by contacting the client’s distal forearm, not her hand.
ABOUT THE AUTHOR: Dr. Joe Muscolino has been a massage therapy educator for 24 years. He is author of The Muscle and Bone Palpation Manual, with Trigger Points, Referral Patterns, and Stretching; The Muscular System Manual, the Skeletal Muscles of the Human Body, 3rd Edition; and Kinesiology, the Skeletal System and Muscle Function; as well as other publications by Mosby of Elsevier Science. His books are being translated into seven foreign languages. He also runs numerous continuing education workshops. He can be reached at www.learnmuscles.com.
Although many more guidelines exist to continue and perfect the art of muscle palpation, these first four on the client crosses another joint, guidelines form the fundamental basis for muscle palpation. When we will in effect ask the client to applying these guidelines, the key is contract other muscles, and this will cloud our ability to discern the to critically think through the paltarget muscle. Remember, our goal pation protocol by utilizing our knowledge of the attachments and is to isolate a contraction of the target muscle so that it can be dis- actions of the target muscle as well cerned from the adjacent muscula- as the attachments and actions of the adjacent muscles. Armed with ture. critical reasoning skills and accurate There are many examples that dem- palpation assessment, we can be CREDITS: onstrate this. In Figures 2a and 2b, effective clinical orthopedic therapists! note that the therapist contacted All illustrations reproduced from and added resistance to the palm The Muscle and Bone Palpation ManFor a thorough discussion of all 20 (body) of the client’s hand; he did ual, 2009, Elsevier. muscle palpation guidelines, along not cross over the finger joints to with illustrated palpation protocols Photography Yanik Chauvin / Elpress against the client’s fingers. sevier Doing so would have caused the cli- and video demonstration of the ent’s finger flexor muscles (flexors palpations protocols, see The Musdigitorum superficialis and profun- cle and Bone Palpation Manual, dus) to also contract, making it dif- with Trigger Points, Referral Patterns, and Stretching, by Joseph E. ficult to discern the flexor carpi radialis from them. Another exam- Muscolino, 2009, published by Mosby of Elsevier Science ple is palpation of the pronator (www.learnmuscles.com). teres. When adding resistance to Terra Rosa e-magazine No. 5, June 2010
11
Deep Tissue Massage, Stretching & Joint Mobilization Sydney & Brisbane July 2011 Intermediate & Advanced Techniques for the Neck Sydney: 2-3 July 2011, Brisbane: 9-10 July 2011
The first day will cover body mechanics for deep tissue work and stretching for the neck, including: How to use your core to easily perform deep work to the neck, How to safely massage the musculature of the anterior neck, and How to perform multiplane stretching of the neck. The second day covers Advanced Stretching Techniques and Joint Mobilization. Dr. Muscolino will describe and demonstrate: How and why CR (also known as PNF), AC, and CRAC stretching techniques work and advanced safe joint mobilization techniques.
Intermediate & Advanced Techniques for the Low Back & Pelvis Sydney: 4-5 July 2011
This workshop is structured similarly to the neck workshop. The first day will cover body mechanics for deep tissue work and stretching for the lower back & pelvis. The second day will focus on advanced stretching and how to safely perform joint mobilization.
Deep Tissue Massage, Stretching & Joint Mobilization The focus of these workshops is to learn how to work clinically utilizing deep pressure, basic and advanced stretching, and joint mobilization techniques; and to do so more efficiently by working from the core with less effort so you do not hurt yourself. In effect, how to work smarter instead of harder! Working clinically and efficiently can be done simply by learning a few basic guidelines of proper technique that Dr. Joe Muscolino will show you. An invaluable workshop for anyone who does sports, clinical, and/or rehab. work!
Dr. Joe Muscolino Dr. Joe Muscolino is a licensed chiropractic physician and has been a massage therapy educator for 24 years, with extensive experience in teaching kinesiology and musculoskeletal assessment and technique classes. Dr. Muscolino has authored 8 major publications with Mosby of Elsevier Science, including "The Muscle and Bone Palpation Manual, with Trigger Points, Referral Patterns, and Stretching" He also writes the column article "body mechanics" for the AMTA's massage therapy journal.
Don’t miss this unique experience to train with Dr. Joe Muscolino.
Book Early as Places are Limited
Terra Rosa e-magazine No. 5, June 2010
12
This book combines muscle & bone anatomy & palpation, trigger points & stretching all in one book! Available from www.terrarosa.com.au With more than 1,000 vibrant, full-colour illustrations and over 4 hours of detailed video demonstrations, THE MUSCLE AND BONE PALPATION MANUAL is the most visually engaging way to help you master and successfully apply palpation techniques in massage therapy. This innovative text uses unique, richly detailed photographic illustrations of muscles as they appear under the skin to give you a thorough understanding of effective palpation. This comprehensive guide provides unparalleled preparation for professional success.
To enhance muscle palpation illustrations and text in this book, a set of 2 DVDs (included free in the book) contains over 4 hours of video demonstrating the muscle palpations of the book. This DVD set also contains cameo presentations by some of the most prestigious names in the world of massage therapy education, including Tom Myers, Leon Chaitow, Whitney Lowe, Bob King, Gil Hedley, and many more. Additional free online resources are included on the companion Evolve website, including technique videos for the intrinsic muscles of the hands and feet, interactive review exercises, a massage research PowerPoint presentation, and joint motion information.
Key Features Full-colour musculoskeletal overlays depict muscles and
bones exactly as they appear when palpated to help you locate tissues and landmarks with confidence. Trigger points and referral patterns included for each muscle provide convenient access to guidelines for additional client assessment and treatment. Massage-specific treatment options guide you from palpation and assessment to practical treatment application. Stretching protocols and illustrations broaden your treatment capabilities. Comprehensive Body Mechanics chapter details 10 guidelines to help maximize efficiency during practice. A massage stroke atlas with information on draping techniques, massage strokes, and fundamental characteristics of touch helps you efficiently treat clients. Detailed explanations and full colour drawings for bone and bony landmark palpation provide a comprehensive resource for bone palpation.
Terra Rosa e-magazine No. 5, June 2010
13
High Heels and Back Pain by Erik Dalton PhD
For over a century, the biomechanical effects of heels in everything from running shoes to stilettos has puzzled researchers and fired controversy. When standing barefoot, the perpendicular line of the straight body column creates a ninety degree angle with the floor (Fig. 1A). On a two-inch heel, were the body a rigid column and forced to tilt forward, the angle would be reduced to seventy degrees, and to fifty-five degrees on a three-inch heel (Fig. 1B) Thus, for the body to maintain an erect position, a whole series of joint adjustments (ankle, knee, hip, spine, head) are required to regain and retain one's erect stance and equilibrium. The slope or slant of the heel, rear to front, is called the 'heel wedge angle'. The higher the heel, the greater the angle. On the bare foot there is no wedge angle. The bottom of the heel is on a level one hundred and eighty degrees, with body weight shared equally between heel and ball. Inside the heeled shoe, the wedge angle shifts body weight forward so that on a low heel, body weight is shared forty percent heel, sixty percent ball; and on a high heel ninety percent ball and ten percent heel. Under these conditions the step sequence is no longer heel-to-ballto toes and push-off, as with the bare foot. With heels two or more inches in height, little weight is borne by the heel of the foot causing the push-off phase to arise al-
most wholly from the ball (Fig. 2). In this reflex adjustment, scores of body parts - bones, ligaments and joints, muscles and tendons -- head to foot must instantly change position. If these adjustments are sustained over prolonged periods via habitual use of higher heels, the strains and stresses become chronic, causing or contributing to compensatory strain patterns ascending up the kinetic chain. In an article published in December 2009 at The Journal of Injury, Function and Rehabilitation, a research team compared the effects on knee, hip, and ankle joint motions of running barefoot versus modern running shoes. Sixtyeight healthy young adult runners who currently utilize modern running shoes for training were selected for participation. None of the participants had a history of musculoskeletal injury and they each ran an average of 15 miles per week. The experi-
Terra Rosa e-magazine No. 5, June 2010
14
High heels & back pain
ment was designed so participants ran on a treadmill linked to a motion analysis device. They each engaged in a short treadmill run session with running shoes, and in an identical short session barefoot. While some manual therapy techniques such as foot and ankle mobilization and structural alignment provide temporary relief from gaitinduced distress symptoms (Fig. 3), long-term, they are largely ineffectual in re-establishing natural gait. Why? Because natural gait is biomechanically impossible for any shoewearing person. The shoe's elevated heel shortens the Achilles tendon and tightens calf muscles sometimes leading to conditions such as plantar fasciitis and heel pain (Fig. 4). The heeled shoe "steals" much of the body's antigravity propulsive power by weakening the fascial
Figure 5 stirrup and leg muscles (Fig. 5). This not only places more stress on them to achieve needed propulsion (loss of ground reaction force), but power must be borrowed from elsewhere -- knees, thigh muscles, hips, and trunk. Both tendons, ligaments and muscles are, of course, vital to step propulsion and gait stamina -- which may help
Terra Rosa e-magazine No. 5, June 2010
Š 2010 www.erikdalton.com
explain the performance dominance of marathon runners from nations where the barefoot state is common from infancy to adulthood.
15
The Danger of High-Heels The idea that high heels can be hazardous to your health isn't new. Several research have found that high heels can contribute to the development of a variety of conditions from arthritis, chronic knee pain, sprained ankles, back problems, and development of corns and calluses to hammertoes. A research published in The Lancet Journal in 1998 and 2001 reported that the altered forces at the knee caused by walking in high heels may predispose to degenerative changes in the joint. Walking with wide-heeled and narrow-heeled shoes increased peak knee varus torque by 26% and 22%, respectively. These findings imply that wide-heeled shoes cause abnormal forces across the patellofemoral and medial compartments of the knee, which are the typical anatomical sites for degenerative joint changes or osteoarthritis. Recently, researchers at Boston University School of Public Health and the Institute for Aging Research in a study found that the types of shoes women wear, specifically high-heels, pumps and sandals, may cause future hindfoot (heel and ankle) pain. Nearly 64 percent of women who reported hind-foot pain regularly wore these types of shoes at some point in their life. Published in the October 2009 issue of the journal Arthritis Care & Research, the study examined the association between shoe wear— beyond just high-heel use—and foot pain. The researchers, who analyzed foot-examination data from more than 3,300 men and women in The Framingham Study from 2002-2008, say past shoe wear among women is a key factor for hind-foot pain. They found no significant link between foot pain and the types of shoes men wear. While foot pain is a common com-
plaint in the U.S. adult population—foot and toe symptoms are among the top 20 reasons for physician visits among those 65 to 74 years of age—relatively little is known about the causes of foot pain in older adults. Women are more likely than men to have foot pain; however, it is not known if this is due to a higher prevalence of foot deformities, underlying disease, shoe wear, or other lifestyle choices. From a list of 11 shoe types, study participants were asked about the one style of shoe they currently wear on a regular basis, what they regularly wore during five age periods in the past, and if they experience pain, aching or stiffness in either foot on most days. Nearly 30 percent of women and 20 percent of men reported generalized foot pain, which is in line with other foot-pain studies. Ms. Dufour’s team, however, found a significant association in women who reported hind-foot pain and past shoe wear that included high-heels and pumps. The shoe types were divided into three categories: 1. good (these shoes had firm nonflexible soles and good support at the back of the shoe, this included athletic shoes and casual sneakers) 2. bad (these shoes lacked support and structure such as high-heeled shoes, sandals, and slippers) 3. medium (shoes with an intermediate level of support including hard- or rubber-soled shoes and work boots). More than 60 percent of women reported wearing “poor” shoes in the past, compared to only 2 percent of men (13 percent of women said they currently wear “poor” shoes).
Terra Rosa e-magazine No. 5, June 2010
When we walk, a significant biomechanical shock is delivered to the foot each time our heel strikes the ground. “Good” shoes, such as sneakers and other athletic footwear, often have soles and other features that soften this shock and protect the foot. The heel and ankle take the brunt of this shock, which may be why women who wear high-heeled shoes often report pain in this part of the foot. In the UK, Rupert Evans, an accident and emergency doctor at University Hospital of Wales in Cardiff said that he has seen an increase in the number of women being admitted to hospital with injuries caused by high heels. Injuries ranged from sprained ankles to broken bones and dislocations – and in some cases caused permanent damage. He estimated that up to half a dozen women were now being admitted to his department with shoe-related injuries on weekend evenings. He advised that women should stick to shoes with heels less than 4 cm. He added that he was not advising that women should stop wearing high heels altogether, but advocating wearing them in moderation. References Alyssa B. Dufour, Kerry E. Broe, Anne H. Walker, Erin Kivell, Uyen-Sa D.T. Nguyen, Marian T. Hannan, David R. Gagnon, Howard J. Hillstrom. Foot Pain: Is Current or Past Shoewear a Factor? Arthritis Care & Research, 2009 D Casey Kerrigan , Jennifer L Lelas, Mark E Karvosky.Women's shoes and knee osteoarthritis. The Lancet Volume 357, Issue 9262, 7 April 2001, Pages 1097-1098.
16
The Hazard of High Heels Posture The knee The altered posture of walking in high heels places excess force on the inside of the knee, a common osteoarthritis site. A study found that women who wears high heels can increase the pressure on knee joint as much as 26%.
High heels push the centre of gravity in the body forward. taking the hips and spine out of alignment.
Pressure High heels may make legs look longer. But as the heel height goes up, so does the pressure on the forefoot.
Calf Gastrocnemius and soleus contract and adjust to the angle of the high heels creating shortened and tight muscles.
Achilles tendon When the front of the foot moves down in relation to the heel. the Achilles tendon tightens up. The higher the heel, the shorter the tendon becomes, creating heel pain.
Ankle injuries High heels impair balance: a wearer is at a greater risk of falling. which could lead to a sprained or broken ankle.
Pump bump The rigid backs or straps of high heels can irritate the heel, creating a bony enlargement also known as Haglund's deformity.
Metatarsalgia High heels force the body's weight to be redistributed. Prolonged wear can lead to joint pain in the ball of the foot.
Morton's neuroma
Bunions
Hammertoes
Heel height and a narrow toe box can create a thickening of tissue, around a nerve between the third arid fourth toes. which can lead to pain and numbness in the toes.
Tight fitting shoes can cause a bony growth of the joint at the base of the big toe, which forces the big toe to angle in toward the other toes, resulting in pain.
A narrow toe box pushes the smaller toes into a bent position at the middle joint. Eventually. the muscles in the second, third and fourth toes become unable to straighten, even when there is no confining shoe.
Neuroma
Terra Rosa e-magazine No. 5, June 2010
Chronic Neck Pain & The Core Chronic neck pain The human neck is a complex system of muscle, bone, joints and connective tissue. Chronic neck pain is increasingly becoming common in the modern society. The incidence of neck problem is reported to be greater in modernised, western society with the prevalence in the adult population being reported to be between 622%1. Another study in Canada indicates that 67% of individuals will suffer neck pain at some stage throughout life2. With an increasing reliance on computer, neck pain has become a great challenge in bodywork. Effective management of this condition is essential not only for symptoms relief, but more importantly, for the prevention of recurrent episodes of neck pain. Neck muscles predominately provide head stabilisation demands, it is estimated that neck muscles contribute about 80% to the mechanical stability of the cervical spine3. The other 20% is provided by the osseo-ligamentous system, which occurs mainly at end of range postures. Muscles provide dynamic support in activities around the neutral and mid-range postures, which are common during functional daily tasks. In a paper published in the European Spine Journal in 20074, Swiss researchers examined the correlation between the presence of neck pain and alterations of the normal cervical lordosis. They examined
using x-rays two groups of people: 54 people with a history of neck pain and 53 without. They found no significant difference between the two groups. The authors concluded that the presence of such structural abnormalities in the patient with neck pain must be considered coincidental, i.e. not necessarily indicative of the cause of pain.
raphy (EMG) to determine precisely abnormal muscle function. Results from their research demonstrated that people with chronic neck pain will show the following conditions:
Muscle weakness
deficits in muscle co-ordination which could result in poor support and potential overload on cervical structures,
Muscle weakness and impairment is a key feature of chronic neck pain5. Janda’s theory suggests the cervical flexor muscles become dysfunctional in the presence of neck pain. Simple clinical mechanical measures also demonstrated a reduction in the strength and endurance capabilities of the cervical flexor muscles in neck pain. New research from the University of Queensland by Deborah Falla & Paul Hodges analysed myoelectric signals using new sophisticated technology of surface electromyog-
Janda’s upper crossed syndrome is characterised by tightness of the upper trapezius, pectoralis major, and levator scapulae and weakness of the rhomboids, serratus anterior, middle and lower trapezius, and the deep neck flexors, the scalene muscles.
Terra Rosa e-magazine No. 5, June 2010
impairment in the deep cervical muscles, which are considered to be functionally important for joint support and control,
insufficiency in the preprogrammed activation of cervical muscles, inefficient neuromuscular activation, and greater fatigability of superficial cervical muscles. The core of the neck This research from Australia identified deficits in the motor control of the deep and superficial cervical flexors in people with chronic neck pain. This is characterised by a delay in onset of neck muscle contraction associated with movement of the upper limb. Studies also demonstrated a reduction in the strength and endurance capacity of the cervical flexor and extensor muscles in people with neck pain. Sternocleidomastoid (SCM) and anterior scalene (AS) muscles showed greater fatigability at moderate loads, and also during low load sustained contrac18
Chronic neck pain tions. The research also found that people with neck pain demonstrated an altered pattern of muscle activation characterised by reduced deep flexor muscle activity during a low load functional task and increased activity of the superficial cervical flexors.5 Whilst direct evidence of deep cervical extensor muscle dysfunction has been identified in people with neck pain, the new research showed evidence of the deep cervical flexor (DCF) muscles impairment in. The DCF muscles, including the longus colli, longus capitis, rectus capitis anterior and rectus capitis lateralis. The DCF muscles are histologically and morphologically designed to provide support to the cervical lordosis and the cervical joints. Now research has demonstrated reduced activation of the DCF muscles or the neck pain patient.5
Neck flexors (from Gray’s Anatomy)
amount of force as compared to normal person.
have an understanding of abnormalities in the muscular system associated with painful dysfunctional joints. Recent research have significantly advanced our understanding of the impairment in the deep and superficial cervical flexor muscles in people with neck pain syndromes. Based on the muscle deficits considered to occur in neck pain, two types of exercise programs have been proposed in the literature to address cervical flexor muscle impairment. These two types of exercise programs are focused on two different functional requirements.5
The first exercise regime consists of general strengthening and endurResearcher Deborah Falla suggest ance exercises for the neck flexor parallels between the deep core muscles. These exercises involve neck flexors in neck pain with trans- high load training and thus recruit verse abdominis and multifidus dys- all the muscle synergists that is, function in people with lower back both the deep and superficial muspain.5 cles. For example, strengthening the neck flexor muscles is achieved Chronic neck pain is a complex naby performing a head lift manoeuPeople with chronic neck pain have ture of muscle impairment as opvre which would recruit all muscles a disturbance in the neck flexor posed to simple weakness. capable of contributing to this acsynergy, where impairment in the tion including, SCM, AS, longus colli deep muscles is compensated for by Implications for rehabilitation and longus capitis. A typical exerincreased activity in the superficial Neck strengthening exercises have cise program would train the cervimuscles (SCM and AS). been shown to be beneficial in pre- cal flexors with the controlled head venting and treating work-related lift exercise and focus on training Reduced neuromuscular efficiency musculoskeletal disorders of the endurance and increasing the numindicates that people with neck neck. When developing exercises ber of repetitions. pain required greater muscular acfor treatment, it is necessary to tivity to produce an equivalent The second exercise regime has A Summary of the major neck muscles
Flexion
Extension
Lateral Bending
Rotation
Sternocleidomastoid
Splenius Capitis
Ipsilateral Sternocleidomastoid
Ipsilateral Splenius Capitis
Longus Capitis
Semispinalis Capitis
Ipsilateral Splenius Capitis
Ipsilateral Levator Scapulae
Longus Colli
Levator Scapulae
Ipsilateral Semispinalis Capitis
Ipsilateral Semipinalis Capitis
Longissimus Capitis
Terra Rosa e-magazine No. 5, June 2010
Contralateral Sternocleidomastoid, Contralateral Semipinalis Capitis
19
Chronic neck pain been designed to focus on the muscle control aspects and aims at improving control of the muscles within the neck flexor synergy. In contrast to more traditional high load strength and endurance exercises, low load exercise is used to train the coordination between the layers of neck flexor muscles. With this protocol, patients perform and hold progressively inner ranges of cranio-cervical flexion (C-CF) while trying to minimize activation of the superficial flexors. General strengthening exercises are not recommended in the early stages in this exercise approach as it is considered that general exercise will not necessarily address the dysfunction between the deep and superficial muscles. Thus specific
emphasis is first placed on reeducating the deep and postural muscles and general strengthening exercises are only introduced once the imbalance between the deep and superficial neck synergists has been addressed.5
neck pain and related disability in Saskatchewan adults. Spine 1998; 23:1689–98.
References
4
1
Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal 2006;15:834-48.
2
Cote P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey: the prevalence of
3
D. Grob, H. Frauenfelder, and A. F. Mannion The association between cervical spine curvature and neck pain. Eur Spine J. 2007; 16:669–678. Panjabi MM, Cholewicki J, Nibu K, Grauer J, Babat LB, Dvorak J. Critical load of the human cervical spine: an in vitro experimental study. Clinical Biomechanics 1998;13:11–7. 5 Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Manual Therapy 2004; 9:125–133
Advanced Myofascial Techniques Workshops in Australia 2011
Til Luchau
Larry Koliha
Join the Most Distinguished Teachers for workshops in Australia
Terra Rosa e-magazine No. 5, June 2010
20
Myofascial Stretching for the Arm and Shoulder By Walt Fritz, PT
Arm Pull In Myofascial Release, Arm Pull is a powerful technique used to release fascia in the wrist, arm, shoulder, thoracic, and cervical areas. Here we design a self arm pull technique which you can do yourself. Arrange a yoga belt so that the loop end is loosely enclosing the hands and wrist. Tie or secure the free end to a doorknob or similar sturdy object. Do not grip the belt tightly and pad the strap under the wrist if needed. Slowly lean away from the door, taking up the slack in the belt until you feel the first barrier. Allow the arm to telescope out from the neck and shoulder, allowing any three dimensional movement or
unwinding to occur. Hold the stretch for a minimum of three minutes or as directed by your therapist. Arm and Shoulder Stretch This is an effective way of using a yoga strap to stretch and release the arm, shoulder, and neck. Simply loop the end of the strap through the buckle and slide your hand through the loop. Keep the loop loose enough so that there is no excessive pressure. DO NOT GRASP the loop; instead let the hand hang loosely. If padding is needed, fold a washcloth or similar under the strap to avoid cutting into the wrist. Step on the loose end of the strap and lean in the other direction. Play with the amount of strap that hangs down to the side to assure that you are getting mild traction once you begin to lean. Explore different directions of body lean to isolate areas of tightness in your
Terra Rosa e-magazine No. 5, June 2010
body. Once you have found significant areas of restriction, remain in that position for 3-5 minutes. Allow your body to move in response to the releases. Repeat on both sides as needed.
Walt Fritz is a licensed physical therapist with a B.S. in Physical Therapy and B.A. in Community Mental Health from SUNY Buffalo. He’s been actively practicing Myofascial Release since 1992 and have instructed at over fifty Myofascial Release Seminars in the United States and Canada. He is the leader of the Foundations in Myofascial Release Seminars™ . With over 24 years experience as a physical therapist, he combines the best of traditional physical therapy interventions with the state of the art methods of Myofascial Release. His website is www.myofascialpainrelief.com
21
Dorn Spinal Therapy & Breuss Massage by Barbara Simon
Deviated vertebrae are brought back into place by the pressure of the thumb towards the spinous processes of the spine. For this procedure to take place it is essential for the client to move their arms or legs in a swinging motion, depending on which area he is being worked on. This movement relaxes the muscles and keeps the spine flexible so the vertebrae can slip back into position.
The Dorn Therapy The therapy of Dorn is a gentle treatment for the spine and all joints and is suitable to help clients presenting back and neck pain. It has been developed in Germany some 30 years ago from a farmer called Dieter Dorn. He himself had an accident which led him to a healer, a “bonesetter” as people called him, and he showed him the magical treatment which, after having seen many doctors and specialists, finally gave him relief after only 2 treatments. With this experience he decided that he himself wanted to go out and help other people with back pain, using this treatment and after his first successful treatment on his wife, she had been suffering from severe migraines for more than 10 years, word spread and the neighbours and friends came along to experience his “magic hands”. I know that many fabulous treatments and healing techniques started similarly, as a folk medicine and a secret, often kept by one person and lost after this persons death. But fortunately in this case, Dieter Dorn eventually became convinced that he had to share his secret and therefore there are now many Dorn practitioners around the world helping thousands of back pain sufferers every day. But how does Dorn Spinal Therapy work? It starts with the checking of the leg length, as 80% of people have a difference in their leg length, often without knowing it. Any differ-
Many problems such as headaches, dizziness, ear and/or eye problems can be the result of nerve pressure in the cervical area of the spine. By using this gentle massage technique these problems can be solved. To work on this area the head is gently turned whilst the therapist finds the deviated vertebra and then moves it back into position.
ence is balanced by easy exercises to bring back the joints of the lower limbs into their correct positions. These joints are the hip, knee and/or ankle and obviously work happens on the longer leg, not on the shorter like in most other modalities. Now that the legs are balanced, the coccyx, sacrum and ileum is the next area to check. It is examined for any twist and balanced with gentle pressure and movement. Once the persons 'base' is balanced, we can move on to the spine itself.
Terra Rosa e-magazine No. 5, June 2010
With this technique tendons and ligaments are not stretched or overstretched; they adapt after a very short time and support the muscles to keep the vertebrae in position. In case of sore or uneven joints there are some easy exercises to reduce pain and move the joints into their correct positions. The whole treatment is gentle and not dangerous, no cracking or abrupt movements are used, just the thumb on a specific area. The patient will not be surprised by sudden movements, the practitioner stays in communication with the patient and never goes beyond their pain threshold. To support 22
Dorn therapy & Breuss massage soak up the oil they expand and the distance between the vertebrae increases, allowing more flexibility for the spine. The secondary effect of the massage is its incredible relaxing effect. St. Johns wort oil is known as a nerve relaxant and that is what happens during the massage. Even the toughest people seem to melt under this massage procedure and finally allow themselves some relaxing moments. This massage can even be used as an add-on massage for just your normal massage procedure, particularly if you have done a very deep remedial massage.
the successful treatment there are very simple and quick exercises that help the client to keep the structure in place and also to take responsibility for their own getting better. They have to understand that it is not the practitioner who fixes them but it is their dealing with their body that improves their wellbeing. The spine is not only the central “support organ” of the body but more important the protective coating for the bone marrow, the higher “command organ” for all functions of the organs, tissues, even each cell in the body. Pain, malfunction and tissue changes – not only in the back but also in every other body region – are often caused by an irritation of the nerve that comes out of the bone marrow due to a displacement or blockage of one or more vertebrae. This means that e.g. a poor digestion can be related to a displaced vertebra in the corresponding area and therefore can be treated via the spine. So this means that it always is worth having your spine checked for any ailments that cannot be cured or before undergoing surgery. “sometimes it would be advisable to have the second thoracic vertebra checked before implanting a cardiac pacemaker” is one of Dieter Dorn’s humorous comments. And from my own experience I can say that yes there are cases where surgery could be avoided just because the client had the chance to see a Dorn Spinal Therapy practitioner.
Dorn Spinal Therapy is also a preventative treatment as it gives the opportunity to pick up developing problems in the spine and interrupt the process before serious problems start emerging. Therefore Dorn Spinal Therapy is also a fantastic treatment for children and teenagers, in fact for them it works the best as their body is still so adaptable and easy to move. Breuss massage The Breuss massage is a gentle and sensitive massage for the spine which is often combined with the Dorn Spinal Therapy. By gently stretching the spine the discs get decompressed which enables the St. John´s Wort oil, used in the massage, to penetrate. Breuss uses the image of a sponge to explain the process. A sponge under a 50kg weight becomes very thin. But by pouring water on the sponge it expands to its normal size. Similar happens to the discs. When they
Terra Rosa e-magazine No. 5, June 2010
This simple but effective treatment is now available in Sydney, Melbourne and Perth. Barbara Simon is running workshops to widen the accessibility for potential clients as well as for practitioners. It means an easy to learn skill that can add to the effectiveness of anyone working in body works: Massage therapists, Osteopaths, Chiropractors, Physios etc. For more information on the technique, testimonials and workshops go to www.backcaresolutions.net or call Barbara Simon on 0407946294 The Dorn Spinal Therapy DVD is available from www.terrarosa.com.au Read also 6 questions to Barbara on page 30.
23
An Alternative Approach to Stretching by Whitney Lowe, LMT
This article first appeared in the November 2009 issue of Massage Today, www.massagetoday.com. Clinicians, athletes and rehabilitation specialists advocate stretching as a means for injury prevention and treatment. The primary purpose of any stretching technique is to enhance pliability and flexibility in the soft tissues. It is also routinely incorporated with massage in the treatment of pain and injury conditions. There are many different stretching techniques, which all fall into one of three primary categories: static, ballistic or active-assisted stretching. Static stretching is the most common. In static stretching, you bring the target muscle into a lengthened position and hold it there until you have achieved the desired stretch. The ideal length of time to hold a static stretch is debated in the literature and the results appear inconclusive. Somewhere around 15 to 20 seconds is a common time frame that achieves good clinical results. Ballistic stretching is used most commonly in the athletic environment. During a ballistic stretch, you bob or bounce into a stretch to encourage tissue elongation in the muscle. Ballistic stretching works by using the momentum of the moving limb to extend past the initial limitation of range of motion. Many people oppose the use of ballistic stretching because the rapid elongation of muscle tissue
in the bouncing motion can activate the stretch reflex, which would be counterproductive to stretching. In active-assisted stretching, the client actively engages a specific muscle contraction prior to, or during, the stretching procedure. There is a variety of activeassisted techniques and they go by different names such as PNF, muscle-energy technique, active isolated stretching or facilitated stretching. There are slight variations in each of these methods, but they are all based on the neurological principles of postisometric relaxation (PIR) and reciprocal inhibition. Experiments that compare active-assisted methods with static or ballistic stretching show the greatest range of motion gains with activeassisted methods. Immediately following an isometric contraction, there is an increased degree of relaxation in that same muscle. This immediate reduction in neurological activity is called the post-isometric relaxation (PIR). The methods of active-assisted stretching use the window of reduced neurological activity during the PIR to engage a stretch of the target muscle after it has isometrically contracted. Stretching during the PIR is more effective than stretching without the prior isometric contraction.
assisted stretching methods is reciprocal inhibition. When an agonist (target) muscle contracts, there is a neurological inhibition of its antagonist (opposite) muscle. The reduction in neurological activity in the antagonist muscle is called reciprocal inhibition. Because reciprocal inhibition decreases neurological activity in muscles opposite the ones being contracted, it is helpful to use during stretching procedures. Stretching of the target muscle is enhanced when its opposite muscle is contracted at the same time (Fig. 1). The various techniques of activeassisted stretching advocate different lengths of time to hold the isometric contraction prior to stretch. Initial research has indicated that a relatively short period of nonmaximal isometric contraction (about 3 seconds) seems most effective for holding the contraction prior to stretch.1 These methods also vary in the length of time that the stretch is held. A study investigating active-assisted stretching compared stretch duration times of 3 seconds and 30 seconds and found no significant difference in the outcomes between the two time periods.2 More research is needed to determine the ideal stretching method(s). It may turn out that the optimum stretching method depends on the situation in which it is being used.
The other neurological principle that is of important in active-
Terra Rosa e-magazine No. 5, June 2010
24
Stretching muscle contraction is engaged to prevent overstretching. This immediate muscle contraction is called the myotatic (or stretch) reflex. Stretching procedures attempt to minimize any recruitment of the stretch reflex. Figure 1: Hamstring stretching with reciprocal inhibition. During this hamstring stretch the practitioner will engage the hip flexors concentrically by attempting to further flex the hip. Engaging the hip flexors causes reciprocal inhibition of the hamstring group
An Alternative Method
Manual-therapy practitioners have been excited by recent research studies enhancing our understanding of the physiological properties of fascia. We have recently learned that fascia contains contractile cells Effective Stretching Procedures and is capable of releasing its contraction and further elongating Each of the stretching procedures when a prolonged tensile load is mentioned above must take into applied to it.4 Armed with this new account the biomechanical and neuunderstanding, we can use the rological properties of the myofasphysiological properties of fascia to cial unit. Therefore, all stretching enhance stretching procedures. procedures engage two primary Combining active-assisted stretchcomponents: the physical stretch of ing methods with fascial-elongation muscle and connective tissue methods would address both the (mechanical effects) as well as the neuromuscular and connectivereduction in neurological resistance tissue components of the stretching to stretch (neuromuscular effects). process. Fascia is interwoven throughout Consider hamstring stretching as an muscles in an extensive network. It example of how this works. Engage has viscous properties that respond the hamstrings in a short 3-second better to slow, sustained tensile non-maximal contraction. Release loads and resist rapid elongation.3 the contraction and bring the hamThe process of connective tissue strings into a stretched position gradually lengthening when a sus(Fig. 2). Have the individual attained stretch is applied to it is tempt to further stretch the hamcalled creep. The extensive fascial strings by attempting to flex the hip network running through all muscles as far as possible (as they did in Fig. suggests greater benefit for longer1). This movement engages the reduration stretching methods to take ciprocal inhibition process and enadvantage of connective-tissue courages further lengthening. While creep. this position is held, apply a myofascial-stretch technique (with the The neurological resistance to hand or back side of the fist) to the stretch is primarily governed by a specialized proprioceptor called the hamstrings and hold it for about 30 to 60 seconds. Holding the myofasmuscle spindle. It is responsive to cial stretch encourages relaxation both the rate of muscle stretching of the fascial contractile cells and and the amount of stretch in the enhances connective tissue creep. tissue. If the muscle is stretched too fast or too far, the muscle spinBoth the neuromuscular and condle sends signals to the central nective-tissue components of the nervous system and an immediate Terra Rosa e-magazine No. 5, June 2010
Figure 2: Enhancing a hamstring stretch. The practitioner uses one hand to hold the limb in the stretched position and the other hand applies the fascial elongation technique to the target muscle group (hamstrings).
stretch are emphasized by combining these myofascial and activeassisted stretching techniques. I have found this stretching method helpful with a number of chronically tight muscles. In the future, it will be valuable to perform comparative studies with this and other stretching techniques to find out which ones are most effective under various clinical circumstances. References 1. Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular facilitation stretching: mechanisms and clinical implications. Sports Med 2006;36(11):929-39. 2. Smith M, Fryer G. A comparison of two muscle energy techniques for increasing flexibility of the hamstring muscle group. J Bodyw Mov Ther Oct 2008;12(4):312-7. 3. Taylor DC, Dalton JD, Jr., Seaber AV, Garrett WE, Jr. Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching. Am J Sports Med MayJun 1990;18(3):300-9. 4. Schleip R. Fascial plasticity: a new neurobiological explanation. J Bodyw Mov Ther 2003;7(1):11-9.
25
The Complete Collection of Orthopedic Assessment & Massage Available from www.terrarosa.com.au
Whitney Lowe’s Orthopedic Assessment & Massage
Learn classic assessment techniques! Lavishly produced and filled with beautiful 3-D animations that show exactly which structures are involved. Alan Edmundson, P.T. will walk you through a logical progression of testing that will reveal the underlying pathology with crystal clarity. Expand your assessment knowledge with this encyclopedic resource!
Terra Rosa e-magazine No. 5, June 2010
26
Research Highlights Massage therapy may help relieve symptoms of depression Depression is a huge public health problem, and treatment is often inadequate, Dr. Wen-Hsuan Hou of I-Shou University in Kaohsiung, Taiwan and colleagues note in their report. While massage can ease stress and tension and may have emotional benefits, the use of massage therapy in depressed patients is “controversial,” the investigators note, and “there is no qualitative review of the treatment effect of massage therapy in depressed patients.” To investigate further, they searched for randomized controlled trials of massage therapy in depressed patients. They identified 17 studies including 786 people in all. In 13 of the trials, massage therapy was compared to another active treatment such as Chinese herbs, relaxation exercises, or rest, while four compared massage to a “no treatment” control group. Investigators also used a range of methods for evaluating mood and depression in study participants. Overall, the studies, which were of “moderate” quality, showed that massage therapy had “potentially significant effects” in alleviating symptoms of depression, the researchers report in the American Journal of Psychiatry. It’s not clear from the analysis, they emphasize, whether a person would need to undergo regular massage therapy for benefits to persist. There are a number of ways through which massage could help people with depression, the researchers note, for example, by
reducing stress and inducing relaxation; building an “alliance” between the therapist and patient; and by causing the body to release the “trust hormone” oxytocin.
Hand and feet massages provide consolation for bereaved relatives Receiving soothing massages for eight weeks after the death of a loved one can provide muchneeded consolation during an intense, stressful period of grieving, according to a study in the April issue of the Journal of Clinical Nursing. Eighteen people who had lost a relative to cancer took part in the study. Participants ranged from 34 to 78 years of age and included widows, widowers, daughters and sisters. Nine chose foot massage, eight chose hand massage and one asked for both. Only three had previous experience of soft tissue massage. “Details about the massage study were included in an information pack provided by the palliative care team when people’s relatives died” says lead author Dr Berit S Cronfalk from the Stockholms Sjukhem Foundation, a Swedish palliative care provider. Relatives were offered a 25-minute hand or foot massage once a week for eight weeks and could choose whether the sessions took place at home, work or at the hospital. “Soft tissue massage is gentle, but firm” explains Dr Cronfalk, who carried out the research with colleagues from the Karolinska Institutet. “This activates touch receptors which then release oxytocin, a hormone known for its positive effects on well-being and relaxation. “In this study the hand or foot massage was done with slow
Terra Rosa e-magazine No. 5, June 2010
strokes, light pressure and circling movements using oil lightly scented with citrus or hawthorn. “The relatives were then encouraged to relax for a further 30 minutes.” Baseline data was collected on the participants during a 60-minute interview before the programme started and a further 60-minute interview was conducted a week after the massage programme finished. The interviews with the participants, which have been published in the Journal’s annual complementary therapy issue, showed that they derived considerable benefits from the programme. A follow-up six to eight months after the study showed that 17 of the relatives had moved forward with their lives, but one had suffered further emotional problems after the death of another close family member. “All the people we spoke to used the word consolation” says Dr Cronfalk. “The massages provide physical touch and closeness and helped to diminish the feelings of empty space and loneliness that people felt. “Study participants also told us that the massages helped them to balance the need to grieve and the need to adapt to life after the loss of their relative.”
Massage eases anxiety, but no better than simple relaxation does A new randomized trial shows that on average, three months after receiving a series of 10 massage sessions, patients had half the symptoms of anxiety. This improvement resembles that previously reported with psychotherapy, medications, or both. But the trial, published in the journal De27
Research Highlights pression and Anxiety, also found massage to be no more effective than simple relaxation in a room alone with soft, soothing music. “We were surprised to find that the benefits of massage were no greater than those of the same number of sessions of ‘thermotherapy’ or listening to relaxing music,” said Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. “This suggests that the benefits of massage may be due to a generalized relaxation response.” The trial randomly assigned 68 Group Health patients with generalized anxiety disorder to 10 onehour sessions in pleasant, relaxing environments, each presided over by a licensed massage therapists who delivered either massage or one of two control treatments: * Relaxation therapy: breathing deeply while lying down * Thermotherapy: having arms and legs wrapped intermittently with heating pads and warm towels All three treatments were provided while lying down on a massage table in a softly lighted room with quiet music. All participants received a handout on practicing deep breathing daily at home. Unlike the two control treatments, massage was specifically designed to enhance the function of the parasympathetic nervous system and relieve symptoms of anxiety including muscle tension. Using a standard rating scale in interviews, the researchers asked the patients about the psychological and physical effects of their anxiety right after the 12-week treatment period ended and three months later, Dr. Sherman said.
All three of the groups reported that their symptoms of anxiety had decreased by about 40 percent by the end of treatment—and by about 50 percent three months later. In addition to the decline in anxiety, the patients also reported fewer symptoms of depression and less worry and disability. The research team detected no differences among the three groups; but the trial did not include a control group that got no treatment at all.
Family members reduce stress in advanced cancer patients with 14 minute massages Advanced cancer patients who regularly received massages averaging 14 minutes or more by a partner or family member declined in stress scores over four weeks, according to results of a study reported at the 7th annual conference of the American Psychosocial Oncology Society. In the study, sponsored by the National Cancer Institute, 97 care partners followed the instruction of a DVD program to provide massage to patients at home. The multi-ethnic sample represented 21 types of cancer (nearly half with breast cancer), over half with either stage III or IV cancer. The study looked at the effects of massage by a care partner (spouse or family member) over four weeks. According to the principal investigator, William Collinge, PhD, president of Collinge and Associates, “The number of massages averaged about four per week across all patients, but the duration of massages was particularly important for stage IV patients. At four-week follow-up, 78% of those who averaged over 13.75 minutes
Terra Rosa e-magazine No. 5, June 2010
per massage had reduced stress scores, while only 15% of those receiving briefer massages did, a significant difference. It appears that 14 minutes is some kind of a ‘tipping point’ where the effects of massages by family members accumulate and reduce stress in these patients over time.” The study also looked at the immediate effects of massages by care partners and found significant reductions in stress/anxiety (44% reduction), (34%), fatigue (32%), depression (31%), and nausea (29%). These reductions are on a par with what might be expected from a professional massage therapist, Collinge said, and bode well for improved quality of life in cancer patients. According to Collinge, “It appears that care partners receiving video instruction can achieve some of the same results as professional practitioners. This has important implications for patient quality of life, but also for caregiver satisfaction. Caregivers are at risk of distress themselves – they can feel helpless and frustrated at not feeling able to help. This gives a way to help the patient feel better and increase their own effectiveness and satisfaction as a caregiver. It also appears to strengthen the relationship bond, which is important to both.”
28
6 Questions to Michael Stanborough 1. When and how did you decide to become a bodyworker? 1978. I was living in Sydney and thought about going to the osteopathic college that a friend of mine was teaching at. But I also wanted to travel and live where I could ski. So I ended up in Boulder, Colorado at the Boulder School of Massage. At that time it was one of the foremost schools in the world and attracted students from all over the place. It was a very exciting time – I think we all had a notion that massage was a path to “change the world” for the better. One body at a time. 2. What do you find most exciting about bodywork therapy? Getting to have authentic contact with people. 3. What is your favourite bodywork book? My own. And after that "Job’s Body" by Deane Juhan. Wow. What a great book. His writing style and the breadth of his wisdom are both inspiring. 4. What is the most challenging part of your work? Finding the pathways to the mind through the body – not so much challenging but it’s something that makes the work fascinating and at
times, profound. In some sessions there is whole symphony playing, not just a few nice instruments and this is simply delightful. 5. What advise you can give to fresh massage therapists who wish to make a career out of it? 1. Get an electric height adjustable table. Today! 2. Go to Pilates classes and get the core strength thing happening. 3. Work at about 50% of maximum output. No heroics trying to do the perfect, life-altering massage. 4. Charge more than enough – think rent, taxes, super, holidays and so on. Too many people charge too little. 6. How do you see the future of massage therapy? More evidence-based. Some of this will be good. I fear it’s going to come at the expense of the “heart and soul of massage”. Touch for healing and nurturance will be replaced in some measure by touch that is informed only by a scientific rationale. I’d like to see a blend of both these streams – evidence-based and the more humanistic approach - but the current climate seems pretty much oriented towards the former.
Michael Stanborough, M.A. (Communication Theory, Victoria University), is the director of SI Australia and the Stanborough Educational Group. He has practiced Structural Integration Rolfing®) for the past 25 years and was a full instructor at the Rolf® Institute in Boulder, Colorado. He is the first Australian to be certified to teach by the Rolf® Institute. Michael is the instructor of the best selling DVD series Direct Release Myofascial Technique. See Michael's website: http:// www.myo-fascial.com.au or www.siaustralia.org
SI Australia http://www.siaustralia.org Terra Rosa e-magazine No. 5, June 2010
29
6 Questions to Barbara Simon 1. When and how did you decide to become a bodyworker? I finished my studies to become a Natural Therapist in 1996 and after that I had enough of mind work and wanted to do something with my hands. So I looked into Dorn Spinal Therapy which back then was still very new even in Germany. I liked the simple and quick learning and that's how I started in bodyworks.
2. What do you find most exciting about bodywork therapy? The fast results I can get and the benefits I can create in clients. 3. What is your favourite bodywork book? Basic Clinical Massage by James Clay and David Pounds.
4. What is the most challenging part of your work? As I am now training other health care practitioners for me the most challenging part is to get students interested in learning Dorn Spinal Therapy.
5. What advise you can give to fresh massage therapists who wish to make a career out of it? Make sure you charge according to your services. Most massage therapists don’t value themselves enough and therefore don't charge enough money for the hard work they do. But it is important to set the value right - for yourself and for your clients, massage is very hard work and you want to be acknowledged for it. Also make sure you find your niche in which you specialise. I have seen so many massage therapists going from one training to another, trying to be everything to everyone. But reality is, clients are looking for specialised service and not for the Jack of all trades. 6. How do you see the future of massage therapy? Massage Therapy will always have a place especially now that more and more companies hire massage therapists to do work place massage and with that opening up an understanding about the benefits of massage therapy even for people who might have never thought about it. Also more and more people recognise that they need to distress from time to time and massage certainly can offer that too.
Barbara Simon is a Natural Therapist, trained in Germany, and specialising in Dorn Spinal Therapy. In 2000 Barbara moved to Australia with her family where she introduced Dorn Spinal Therapy not only as a therapist but also as a successful trainer in Dorn Spinal Therapy for health care practitioners. Apart from Dorn Spinal Therapy she also studied Remedial Massage, Reflexology, Ear acupuncture and Bach flowers.
http://www.backcaresolutions.net
Terra Rosa e-magazine No. 5, June 2010
30