Terra Rosa E-mag #07

Terra Rosa E-Magazine

Open information for massage therapists & bodyworkers No. 7, March 2011 Contents 2 Fascia Fitness—Divo Müller & Robert Schleip 13

Tai Chi Coiling

18 Auth Method: A Guide to Using Forearms—Shari Auth 24 An Interview with Dr. Jean-Claude Guimberteau 28 Fundamentals ofClinical Orthopedic Massage—Dr. Joe Muscolino 30 The Massage Project— Joanne Schoenwald 31 Tai Chi for Fibromyalgia—Romel Rones 37 Transitioning Your Bodywork—Art Riggs 39

Research Highlights

40 6 Questions to Robert Schleip

www.terrarosa.com.au www.massage-research.com

Welcome to our special issue. Fascia research has attracted lots of attention among researchers and bodyworkers. Watch an introduction video on fascia here” http://www.youtube.com/watch?v=yj9NqWZ -0ik Fascia is important in muscular force transmission and an amazing sensory organ. Now it is time to put the research into practice. In our last issue, (No. 6, December 2010) Bethany Ward summarises the key findings from the fascia congress and what it means for bodyworkers. Now, we have the first application of fascia research in a new field called Fascial Fitness, a new way of training your body, pioneered by Robert Schleip, Divo Müller and Tom Myers. You have the first chance to read about it here. Also read about an ancient application of the fascia theory in Tai Chi coiling movement.

We also have an interview with Dr. Jean-Claude Guimberteau, a hand surgeon who for the first time, brings you the images of live fascia. A Massage Project by Joanne Schoenwald. Great massage articles

by Dr. Joe Muscolino on Clinical Orthopedic Massage, Shari Auth on Forearm Massage, and Art Riggs on How to make a transition in your bodywork practice.

Don’t forget to read 6 questions to Robert Schleip and Divo Müller.

Enjoy reading and Stay Healthy Sydney, March 2011

41 6 Questions to Divo Müller

Disclaimer: The publisher of this e-magazine disclaims any responsibility and liability for loss or damage that may result from articles in this publication.

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Fascial Fitness Fascia oriented training for bodywork and movement therapies Divo G. Müller, Robert Schleip Fascial Fitness

Fascial Remodelling

When a football player is not able to take the field because of a recurrent calf spasm, a tennis star gives up early on a match due to knee problems or a sprinter limps across the finish line with a torn Achilles tendon, the problem is most often neither in the musculature or the skeleton. Instead, it is the structure of the connective tissue – ligaments, tendons, joint capsules, etc. – which have been loaded beyond their present capacity (Renström & Johnson 1985, Counsel & Breidahl 2010).

A focused training of the fascial network could be of great importance for athletes, dancers and other movement advocates. If one’s fascial body is well trained, that is to say optimally elastic and resilient, then it can be relied on to perform effectively and at the same time to offer a high degree of injury prevention. Until now, most of the emphasis in sports training has been focused on the classical triad of muscular strength, cardiovascular conditioning, and neuromuscular coordination. Some alternative physical training activities such as Pilates, yoga, Continuum Movement, Tai Chi, Qi Gong and martial arts – are already taking the connective tissue network into account.

A unique characteristic of connective tissue is its impressive adaptability: when regularly put under increasing physiological strain, it changes its architectural properties to meet the demand. For example, through our everyday biped locomotion the fascia on the lateral side of the thigh develops a palpable firmness. If we were to instead spend that same amount of time with our legs straddling a horse, then the opposite would happen, i.e. after a few months the fascia on the inner side of the legs would become more developed and strong (El-Labban et al. 1993). The varied capacities of fibrous collagenous connective tissues make it possible for these materials to continuously adapt to the regularly occurring strain, particularly in relation to changes in length, strength and ability to shear. Not only the density of bone changes, as for example in astronauts who spend most time in zero gravity, their

The importance of fasciae is often specifically discussed; however the modern insights of fascia research have often not been specifically included in our work.

In this article, we suggest that in order to build up an injury resistant and elastic fascial body network, it is essential to translate current insights of fascia research into a practical training program. Our intention is to encourage massage, bodywork, and movement therapists, as well as sports trainers to incorporate the basic principles presented in this article, and to apply them to their specific context.

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Figure 1. Increased elastic storage capacity. Regular oscillatory exercise, such as daily rapid running, induces a higher storage capacity in the tendinous tissues of rats, compared with their nonrunning peers. This is expressed in a more spring-like recoil movement as shown on the left. The area between the respective loading versus unloading curves represents the amount of 'hysteresis': the smaller hysteresis of the trained animals (green) reveals their more 'elastic' tissue storage capacity; whereas the larger hysteresis of their peers signifies their more 'visco-elastic' tissue properties, also called inertia . Illustration modified after Reeves 2006.

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Fascial Fitness bones become more porous; fascial tissues also reacts to collagenous structures (Kubo et al. 2003). their dominant loading patterns. With the help of the The Catapult Mechanism: Elasfibroblasts, they react to everyday strain as well as to tic Recoil of Fascial Tissues specific training; steadily remodelling the arrangement of their collagenous fibre network. For example, with Kangaroos can hop much farther and each passing year half the collagen fibrils are replaced in faster than can be explained by the force a healthy body. of the contraction of their leg muscles.

Under closer scrutiny, scientists discovered that a spring The intention of fascial fitness is to influence this replacement via specific training activities which will, af- -like action is behind the unique ability: the so-called ter 6 to 24 months, result in a ‘silk-like bodysuit’ which catapult mechanism (Kram & Dawson 1998). Here the is not only strong but also allows for a smoothly gliding tendons and the fascia of the legs are tensioned like elastic bands. The release of this stored energy is what joint mobility over wide angular ranges. makes the amazing hops possible. Hardy surprising, Interestingly, the fascial tissues of young people show scientist thereafter found the same mechanism is also stronger undulations within their collagen fibres, remi- used by gazelles. These animals are also capable of perniscent of elastic springs; whereas in older people the forming impressive leaping as well as running, though collagen fibres appear as rather flattened (Staubesand et their musculature is not especially powerful. On the al. 1997). Research has confirmed the previously opticontrary, gazelles are generally considered to be rather mistic assumption that proper exercise loading – if ap- delicate, making the springy ease of their incredible plied regularly - can induce a more youthful collagen jumps all the more interesting. architecture, which shows a more wavy fibre arrangement (Wood et al. 1988, Jarniven et al. 2002) and which Through high resolution ultrasound examination, it is also expresses a significant increased elastic storage ca- now possible to discover similar orchestration of loadpacity (Figure 1) (Reeves et al. 2006). However, it seems ing between muscle and fascia in human movement.

Surprisingly it has been found that the fasciae of human to matter which kind of exercise movements are applied: a controlled exercise study using slow velocity and have a similar kinetic storage capacity to that of kangalow load contractions only demonstrated an increase in roos and gazelles (Sawicki et al. 2009). This is not only made use of when we jump or run but also with simple muscular strength and volume, however it failed to walking, as a significant part of the energy of the moveyield any change in the elastic storage capacity of the ment comes from the same springiness described above.

Figure 2. Length changes of fascial elements and muscle fibres in an oscillatory movement with elastic recoil properties (A) and in conventional muscle training (B). The elastic tendinous (or fascial) elements are shown as springs, the myo-fibres as straight lines above. Note that during a conventional movement (B) the fascial elements do not change their length significantly while the muscle fibres clearly change their length. During movements like hopping or jumping however the muscle fibres contract almost isometrically while the fascial elements lengthen and shorten like an elastic yoyo spring. Illustration adapted from Kawakami et al. 2002.

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Fascial Fitness

Figure 3. Collagen architecture responds to loading. Fasciae of young people express more often a clear two-directional (lattice) orientation of their collagen fibre network. In addition the individual collagen fibres show a stronger crimp formation. As evidenced by animal studies, application of proper exercise can induce an altered architecture with increased crimp-formation. Lack of exercise on the other hand, has been shown to induce a multidirectional fibre network and a decreased crimp formation.

This new discovery has led to an active revision of long accepted principles in the field of movement science.

energy transfer is still true for steady movements such as cycling. Here the muscle fibres actively change in length, while the tendons and aponeuroses barely grow In the past it was assumed that in a muscular joint longer (Figure 2). The fascial elements remain quite movement, the skeletal muscles involved shorten and passive. This is in contrast to oscillatory movements this energy passes through passive tendons which rewith an elastic spring quality in which the length of the sults in the movement of the joint. This classical form of muscle fibres changes slightly. Here, it is the muscle fibres contract in an almost isometric fashion (they stiffen temporarily without any significant change of their length) while the fascial elements function in an elastic way with a movement similar to that of a yoyo.

Here, it is the lengthening and shortening of the fascial elements that ‘produces’ the actual movement (Fukunaga et al. 2002, Kawakami et al. 2002).

Work by Staubesand et al. (1997) suggested that the elastic movement quality in young people is associated with a typical bi-directional lattice arrangement of their fasciae, similar to a woman’s stocking. In contrast, as we Figure 4. Loading of different fascial components.

A) Relaxed position: The myo-fibres are relaxed and the muscle is at normal length. None of the fascial elements is being stretched.

B) Usual muscle work: myo-fibres contracted and muscle at normal length range. Fascial tissues which are either arranged in series with the myo-fibres or transverse to them are loaded.

C) Classical stretching: myo-fibres relaxed and muscle elongated.

Fascial tissues oriented parallel to the myo-fibres are loaded as well as extra-muscular connections. However, fascial tissues oriented in series with the myo-fibres are not sufficiently loaded, since most of the elongation in that serially arranged force chain is taken up by the relaxed myo-fibres.

D) Actively loaded stretch: muscle active and loaded at long end range. Most of the fascial components are being stretched and stimulated in that loading pattern. Note that various mixtures and combinations between the four different fascial components exist. This simplified abstraction serves as a basic orientation only.

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Fascial Fitness A

B

Figure 5. Training example: The Flying Sword A) Tension the bow: the preparatory counter movement (pre-stretch) initiates the elastic-dynamic spring in an anterior and inferior direction. Free weights can also be used. B) To return to an upright position, the ‘catapulting back fascia’ is loaded as the upper body is briefly bounced dynamically downwards followed by an elastic swing back up. The attention of the person doing the exercise should be on the optimal timing and calibration of the movement in order to create the smoothest movement possible.

age and usually loose the springiness in our gait, the fascial architecture takes on a more haphazard and multidirectional arrangement. Animal experiments have also shown that lack of movement quickly fosters the development of additional cross links in fascial tissues.

The fibres lose their elasticity and do not glide against one another as they once did; instead they become stuck together and form tissue adhesions, and in the worst cases they actually become matted together (Figure 3) (Jarvinen et al. 2002).

transverse fibres across the muscular envelope are stimulated as well. However, little effect can be expected on extra-muscular fasciae as well as on those intramuscular fascial fibres that are arranged in parallel to the active muscle fibres (Huijing 1999).

Classical Hatha yoga stretches on the other side will show little effect on those fascial tissues which are arranged in series with the muscle fibres, since the relaxed myo-fibres are much softer than their serially arranged tendinous extensions and will therefore ‘swallow’ most The goal of the proposed fascial fitness training is to of the elongation (Jami 1992). However, such stretching stimulate fascial fibroblasts to lay down a more youthful provides good stimulation for fascial tissues which are and kangaroo-like fibre architecture. This is done hardly reached with classical muscle training, such as through movements that load the fascial tissues over the extra-muscular fasciae and the intramuscular fasmultiple extension ranges while utilizing their elastic ciae oriented in parallel to the myo-fibres. Finally, a dyspringiness. namic muscular loading pattern in which the muscle is both activated and extended promises a more compreFigure 4 illustrates different fascial elements affected by hensive stimulation of fascial tissues. This can be various loading regimes. Classical weight training loads achieved by muscular activation (e.g. against resistance) the muscle in its normal range of motion, thereby in a lengthened position while requiring small or mestrengthening the fascial tissues which are arranged in dium amounts of muscle force only. Soft elastic bounces series with the active muscle fibres. In addition the in the end ranges of available motion can also be utilized

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Figure 6. Training example: Elastic Wall Bounces. Imitating the elastic bounces of a kangaroo soft bouncing movements off a wall are explored in standing. Proper pre-tension in the whole body will avoid any collapsing into a ‘banana posture’. Making the least sound and avoiding any abrupt movement qualities are imperative. Only with the mastery of these qualities a progression into further load increases – e.g. bouncing off a table or window sill instead of a wall – can eventually be explored by stronger individuals. E.g. this person should not yet be permitted to progress to higher loads, as his neck and shoulder region already show slight compression on the left picture.

for that purpose. The following guidelines are developed as the weight is shifted in this direction. to make such training more efficient.

The opposite is true for straightening up – the mover activates the catapult capacity of the fascia through an Training Principles active pre-tensioning of the fascia of the back. When 1. Preparatory Counter-movement standing up from a forward bending position, the muscles on the front of the body are first briefly activated.

Here we make use of the catapult effect as described This momentarily pulls the body even further forward above. Before performing the actual movement, we start and down and at the same time the fascia on the postewith a slight pre-tensioning in the opposite direction. rior fascia is loaded with greater tension.

This is comparable with using a bow to shoot an arrow; just as the bow has to have sufficient tension in order The energy which is stored in the fascia is dynamically for the arrow to reach its goal, the fascia becomes acreleased via a passive recoil effect as the upper body tively pre-tensioned in the opposite direction. Using ‘swings’ back to the original position. To be sure that the one’s muscle power to “push the arrow” would then individual is not relying on muscle work, but rather on rightfully be seen as foolish, in this extreme example of dynamic recoil action of the fascia, requires a focus on an elastic recoil movement. In a sample exercise called timing – much the same as when playing with a yoyo. It the flying sword, the pre-tensioning is achieved as the is necessary to determine the ideal swing, which is apbody’s axis is slightly tilted backward for a brief moparent when the action is fluid and pleasurable. ment; while at the same time there is an upward lengthening (Figure 5). This increases the elastic tension in the 2. The Ninja Principle fascial bodysuit and as a result allows the upper body This principle is inspired by the legendary Japanese and the arms to spring forward and down like a catapult warriors who reputedly moved as silent as cats and left

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Fascial Fitness A

B

Figure 7. Training example: The Big Cat Stretch. A) This is a slow stretching movement of the long posterior chain, from the finger tips to the sit bones, from the coccyx to the top of the head and to the heels. The movement goes in opposing directions at the same time – think of a cat stretching its long body. By changing the angle slightly, different aspects of the fascial web are addressed with slow and steady movements. B) In the next step, we rotate and lengthen the pelvis or chest towards on side (here shown with the pelvis starting to rotate to the right). The intensity of the feeling of stretch on that entire side of the body is then gently reversed. Note the afterwards feeling of increased length .

no trace. When performing bouncy movements such as hopping, running and dancing, special attention needs to be paid to executing the movement as smoothly and softly as possible. A change in direction is preceded by a gradual deceleration of the movement before the turn and a gradual acceleration afterwards, each movement flowing from the last; any extraneous or jerky movements should therefore be avoided (see Figure 6).

ture of the connective tissue in that it becomes more elastic when correctly performed (Decoster et al. 2005).

Muscles and tissue should first be warmed up, and jerking or abrupt movements should be avoided. The motion should have a sinusoidal deceleration and acceleration shape each direction turn; this goes along with a smooth and ‘elegant’ movement quality perception. Dynamic, fast stretching has even more effect on the fascia when combined with a preparatory countermovement Normal stairs become training equipment when they as was previously described by Fukashiro et al. (2006). are used appropriately, employing gentle stepping. The For example, when stretching the hip flexors a brief production of ‘as little noise as possible’ provides the backward movement should be introduced before dymost useful feedback – the more the fascial spring effect namically lengthening and stretching forwards. is utilized, the quieter and gentler the process will be. It may be useful to reflect on the way a cat moves as it pre- The long myofascial chains are the preferred focus when pares to jump; the feline first sends a condensed imdoing slow dynamic stretches. Instead of stretching isopulse down through its paws in order to accelerate softly lated muscle groups, the aim is finding body movements and quietly, landing with precision. that engage the longest possible myofascial chains (Myers 1997). This is not done by passively waiting as 3. Dynamic Stretching in a lengthening classical Hatha yoga pose, or in a conventional isolated muscle stretch. Multidirectional Rather than a motionless waiting in a static stretch posimovements, with slight changes in angle are utilized; tion a more flowing stretch is suggested. In fascial fitthis might include sideways or diagonal movement ness there is a differentiation between two kinds of dyvariations as well as spiralling rotations. With this namic stretching: fast and slow. The fast variation may method, large areas of the fascial network are simultabe familiar to many people as it was part of the physical neously involved (Figure 7). training in the past. For the past several decades this bouncing stretch was considered to be generally harmful 4. Proprioceptive Refinement to the tissue, but the method’s merits have been conThe importance of proprioception for movement control firmed in contemporary research. Although stretching immediately before competition can be counterproduc- is made clear by the case of Ian Waterman, a man retive, it seems that long-term and regular use of such dy- peatedly mentioned in scientific literature. This impressive man contracted a viral infection at the age of 19 namic stretching can positively influence the architec-

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Figure 8. Training example: Octopus Tentacle. With the image of an octopus tentacle in mind, a multitude of extensional movements through the whole leg are explored in slow motion. Through creative changes in muscular activations patterns the tensional fascial proprioception is activated. This goes along with a deep myofascial stimulation that aims to reach not only the fascial envelopes but also into the septa between muscles. While avoiding any jerky movement quality, the action of these tentacle-like micro-movements leads to a feeling of flowing strength in the leg.

which resulted in a so-called ‘sensory neuropathy’. In this rare pathology, the sensory peripheral nerves which provide the somato-motor cortex with information about the movements of the body are destroyed, while the motor nerves remain completely intact. This means than Mr. Waterman can move, but he can’t ‘feel’ his movements. After some time, this giant of a man became virtually lifeless. Only with an iron will and years of practice did he finally succeed in making up for these normal physical sensations, a capacity that is commonly taken for granted. He did so with conscious control that primarily relies on visual feedback. He is currently the only person known with this affliction that is able to stand unaided, as well as being able to walk (Cole 1995).

Observation of the way Waterman moves is similar to the way patients with chronic back pain move. When in a public place if the lights unexpectedly go out, he clumsily falls to the ground (see BBC documentary: The man who lost his body http://video.google.com/videoplay? docid=-3032994272684681390#). Springy, swinging movements are possible for him only with obvious and jerky changes in direction. If doing a classical stretching program with static or active stretches, he would appear normal. As for the dynamic stretching that is part of our fascial training, he is clearly not capable, as he lacks the proprioception needed for fine coordination.

It is interesting to note here that the classical ‘joint receptors’ – located in joint capsules and associated ligaments - have been shown to be of lesser importance for normal proprioception, since they are usually stimulated at extreme joint ranges only, and not during physiological motions (Lu et al 1985). On the contrary,

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proprioceptive nerve endings located in the more superficial layers are more optimally situated as here even small angular joint movements lead to relatively distinct shearing motions. Recent findings indicate that the superficial fascial layers of the body are in fact more densely populated with mechano-receptive nerve endings than tissue situated more internally (Stecco et al.

2008).

For this reason a perceptual refinement of shear, gliding and tensioning motions in superficial fascial membranes is encouraged. In doing this, it is important to limit the filtering function of the reticular formation as it can markedly restrict the transfer of sensations from movements which are repetitive and predictable. To prevent such a sensory dampening, the idea of varied and creative experiencing becomes important. In addition to the slow and fast dynamic stretches noted above as well as utilizing elastic recoil properties an inclusion of ‘fascial refinement’ training is recommended in which various qualities of movement are experimented with, e.g. extreme slow-motion and very quick, micromovements which may not even be visible to an observer and large macro movements involving the whole body. Here it is common to place the body into unfamiliar positions while working with the awareness of gravity, or possibly through exploring the weight of a training partner.

The micro-movements are inspired by Emily Conrad’s Continuum Movement (Conrad 1997). Such movement is active and specific and can have effects which are not possible with larger movements. In doing these coordinated fascial movements, it appears possible to specifi-

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Figure 9. Training example: Fascial Release. The use of particular foam rollers may allow the application of localized tissue stimulations with similar forces and possibly similar benefits as in a manual myofascial release session. However the stiffness of the roller and application of the body weight needs to be adjusted and monitored for each person. To foster a sponge-like tissue dehydration with subsequent renewed local hydration, only slow-motion like subtle changes in the applied forces and vectors are recommended.

cally address adhesions, for example between muscle septa deep in the body. In addition such tiny and specific movements can be used to illuminate and bring awareness to perceptually neglected areas of the body (Figure 8). Thomas Hanna uses the label ‘sensory-motor amnesia’ for such places in the body (Hanna 1998).

5. Hydration and Renewal The video recordings of live fascia Strolling Under the Skin by Dr Jean-Claude Guimbertau have helped our understanding of the plasticity and changing elasticity of the water-filled fascia. This awareness has proven to be especially effective when incorporated into the slow dynamic stretching and the fascial refinement work. An essential basic principle of these exercises is the understanding that the fascial tissue is predominantly made up of free moving and bound water molecules. During the strain of stretching, the water is pushed out of the more stressed zones similarly to squeezing a sponge (Schleip & Klingler 2007).With the release that follows; this area is again filled with new fluid which comes from surrounding tissue as well as the lymphatic and vascular network. The sponge-like connective tissue can lack adequate hydration at neglected places. The goal of exercise is to refresh such places in the body with improved hydration through specific stretching to encourage fluid movement.

these begin to function less optimally as their elastic and springy resilience slowly decreases.

The short walking pauses then serve to re-hydrate the tissue as it is given a chance to take up nourishing fluid.

For an average beginning runner for example, the authors recommend walking pauses of one to three minutes every 10 minutes. More advanced runners with more developed body awareness can adjust the optimal timing and duration of those breaks based on the presence (or lack) of that youthful and dynamic rebound: if the running movement begins to be feel and look more dampened and less springy, it is likely time for a short pause. Similarly, if after a brief walking break there is a noticeable return of that gazelle-like rebound, then the rest period was adequate.

This cyclic training, with periods of more intense effort interspersed with purposeful breaks, is recommended in all facets of fascia training. The person training then learns to pay attention to the dynamic properties of their fascial “bodysuit” while exercising, and to adjust the exercises based on this new body awareness. This also carries over to an increased ‘fascial embodiment’ in everyday life. Preliminary anecdotal reports also indicate a preventative effect of a fascia oriented training in relation to connective tissue overuse injuries.

The use of special foam rollers can be useful tools for Here proper timing of the duration of individual loading inducing a localized ‘sponge-like’ temporary tissue deand release phases is very important. As part of modern hydration with resultant renewed hydration. However running training, it is often recommended to frequently firmness of the roller and application of the bodyweight needs to be individually monitored. If properly applied intercept the running with short walking intervals and including very slow and finely-tuned directional (Galloway 2002). There is good reason for this: under changes only, the tissue forces and potential benefits strain the fluid is pressed out of the fascial tissues and

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Fascial Fitness supple and resilient like a bamboo requires the devotion and regular care of the bamboo gardener. He nurtures his seeds over a long period of time without any visible positive result. Only after enduring care does the first bamboo seedling become visible as it pushes its way toward the sky. From then on it grows steadily upwards until it dwarfs its neighbours in height, flexibility and resistance to damage. It is therefore suggested that training should be consistent, and that only a few minutes of appropriate exercises, performed once or twice per week is sufficient for collagen remodelling. The related renewal process will take between six months and two years and will yield a lithe, flexible and resilient collagenous matrix.

Figure 10: Collagen turnover after exercise. The upper curve shows collagen synthesis in tendons is increasing after exercise.

However, the stimulated fibroblasts also increase their rate of collagen degradation. Interestingly, during the first 1-2 days following exercise, collagen degradation overweights the collagen synthesis; whereas afterwards this situation is reversed. To increase tendon strength, the proposed fascial fitness training therefore suggests an appropriate tissue stimulation 1 to 2 times per week only. While the increased tendon strength is not achieved by an increase in tendon diameter, recent examinations by Kjaer et al. (2009) indicated that it is probably the result of altered cross-link formations between collagen fibres. Illustration modified after Magnusson et al. 2010.

could be similar to those of manual myofascial release treatments (Chaudhry et al. 2008). In addition, the localized tissue stimulation may serve to stimulate and fine-tune possibly inhibited or de-sensitized fascial proprioceptors in more hidden tissue locations (Figure 9).

6. Sustainability: The Power of a Thousand Tiny Steps An additional and important aspect is the concept of the slow and long-term renewal of the fascial network. In contrast to muscular strength training in which big gains occur early on and then a plateau is quickly reached wherein only very small gains are possible, fascia changes more slowly and the results are more lasting. It is possible to work without a great deal of strain – so that consistent and regular training pays off. When training the fascia, improvements in the first few weeks may be small and less obvious on the outside. However, improvements have a lasting cumulative effect which after years can be expected to result in marked improvements in the strength and elasticity of the global facial net (Figure 10) (Kjaer et al. 2009). Improved coordination as the fascial proprioception becomes refined is probable.

For those who do yoga or martial arts, such a focus on a long-term goal is nothing new. For the person who is new to physical training, such analogies when combined with a little knowledge of modern fascia research can go a long way in convincing them to train their connective tissues. Of course fascial fitness training should not replace muscular strength work, cardiovascular training and coordination exercises; instead it should be thought of as an important addition to a comprehensive training program.

For more information on fascial fitness see: www.fascialfitness.de This article is adapted from: Fascia in Manual and Movement Therapies, Schleip et al., Elsevier Science 2011.

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Staubesand J, Baumbach KUK, Li Y (1997) La structure find de l’aponévrose jambiére. Phlebol 50: 105-113.

Stecco C, Porzionato A, Lancerotto L, Stecco A, Macchi V, Day JA, De Caro R 2008. Histological study of the deep fasciae of the limbs. J Bodyw Mov Ther 12(3): 225-230.

Wood TO, Cooke PH, Goodship AE (1988) The effect of exercise and anabolic steroids on the mechanical properties and crimp morphology of the rat tendon. Am J Sports Med 16 (2) 153-158.

About the authors Divo Müller is one of the first internationally authorized Continuum teachers in Europe since 1992. She is a Somatic Experience practitioner, author of a book, numerous articles and DVDs, all of which teach a specially designed movement approach for women, based on Continuum. Divo teaches regularly all over Europe as well as in Brazil and in New Zealand. She offers a unique movement program in her Studio Bodybliss in Munich www.bodybliss.de

Robert Schleip PhD, is an International Rolfing Instructor and Fascial Anatomy Teacher. Robert has been an Lu Y, Chen C, Kallakuri S, Patwardhan A, Cavanaugh JM enthusiastic certified Rolfer since 1978.

(2005) Neural response of cervical facet joint capsule to He holds on M.A. degree in psychology stretch: a study of whiplash pain mechanism. Stapp Car Crash and is a Certified Feldenkrais Teacher since 1988. He J 49: 49-65. earned his PhD with honours in 2006 at the age of 52, and shortly thereafter established the Fascia Research Mackey AL, Heinemeier KM, Koskinen SO, Kjaer M (2008) Dynamic adaptation of tendon and muscle connective tissue to Project at Ulm University and has a lab of his own. He mechanical loading. Connect Tissue Res 49(3): 165-168. was the co-initiator and organizer of the first Fascia Research Congress at the Harvard Medical School in Magnusson SP, Langberg H, Kjaer M (2010) The pathogenesis Boston, USA in 2007. See Robert’s website of tendinopathy: balancing the response to loading. Nat Rev www.somatics.de Rheumatol 6(5): 262-268.

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Tai Chi Coiling Movement One of the main principles in Fascial Fitness training is to use a preparatory counter-movement; before performing a movement, we start with a slight tensioning of the myofascia in the opposite direction. The intention is to exploit the catapult effect or elastic recoil property of the fascial tissues. Imagine using a bow; as the bow is drawn, energy is stored in the limbs of the bow and when the string is released the force is transferred to the arrow. For many years scientists were puzzled to explain how kangaroos and wallabies can hop at a speed of 20-25 km per hour and jump as high as 5 meters. The muscles of these animals simply don’t have that capacity. Later, it was found out that the high elastic storage capacity was held in the tendons and faciae, not in the muscles.

back of the body. This will create a smooth and efficient movement.

A specific routine called the Coiling Set is particularly useful to illustrate the principle; it was originally developed for martial arts training but now used as a health exercise. Practising the coiling set helps us to develop a fluid connection between the lower and upper body, between the left and right side, between the front and

Here are some examples taken from The Essence of TaiJi JiGong DVD by Dr. Yang Jwing-Ming (YMAA Publishing). These coiling exercises can be added to your fascia fitness routine.

In the book The Essence of Taiji Qigong: The Internal Foundation of Taijiquan by Dr. Jwing-Ming Yang (YMAA Publishing), he explained that the main purpose of the coiling set is to lead Qi to the skin and bone marrow through breathing and coiling motion. The principle is that we tense the muscles and fasciae by twisting the limbs and body in one direction and we relax the myofasciae when letting the limbs and body spring back to its starting position. This coincidentally is in line with the fascial fitness principle. This continuous coiling movement is believed to cause the Qi to be led to the skin and condensed to the bone marrow. Proper breathing and leading the Qi through the mind are the keys for Coiling movement, making use of the elasticity of fascia, a successful training. has been utilised in Tai Chi and Qi Gong for a long time.

Tai Chi and Qi Gong practitioners can move swiftly and The coiling movement should be first generated from smoothly thanks to the coiling principle. Martial artists the legs and then directed to the limbs of the body. The body should be soft like a whip. Stretch the arms to are able to generate powerful strike through coiling of energy. The coiling movement is embedded in many Tai open the joints, then twist. Imagine that you are moving Chi movement styles (e.g. Silk Reeling Tai Chi). Coiling against resistance, and that your feet are pushing against the floor. The movement is smooth and conprovides movements that are relaxed, fluid and baltinuous like an octopus. Correct breathing is the key: anced, this is due to a constant balancing of opposing forces with storing and releasing of energy in the move- slow, deep, long and not holding the breath. As you inhale, imagine that you are drawing energy in through ments. When all the muscles, tendons and joints are your hands and feet and condensing it in your Dan Tian linked, coiling can release a powerful energy. Coiling (center of gravity located in the abdomen) and spine. As through the waist can give massage to the internal oryou exhale move the Qi from you Dan Tian and spine gans, while coiling through the joints strengthen tenout through your hands and feet. dons and ligaments.

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(Pictures taken from The Essence of TaiJi JiGong DVD, courtesy of YMAA Publishing)

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Coiling Tai Chi Warming Up: Coiling forward and backward Lift the hand in front of the chest, slightly rounding the shoulder. Direct the hands to move towards the front of the body and tensioning the muscles, then and letting it return to the original position (front of the chest).

Coiling forward and backward

The Coiling Set The coiling set is composed of 12 movements that can be performed in stationary or moving. Each movement is to be performed 10 times.

1. Stand calmly to regulate the spirit & breathing Feet shoulder-width apart, arms hang naturally at sides.

2. White crane relaxes its wings Inhale while turning palms to the back, rounding the shoulders forward and slightly arching your chest. Exhale, turn palms to face front.

3. Drill forward and pull back Inhale, lift hands to mid chest with palms facing up. All fingers and both arms should be in a straight line. Exhale, pull in the elbows and extend arms in front of you, palms up while gently rounding the shoulders forward. Inhale, spread your elbows out to the sides and draw arms back to chest. Rotate your arms as they move so that they end up with palms facing your chest, arms and fingers in a straight line. Exhale, press arms down while keeping them in line, palms facing down, until arms are fully extended and fingers point downward.

Drill forward and pull back

4. Left and right Yin and Yang Hands in front of the abdomen. Exhale, drill your right hand forward, rotate the palm upwards and slightly turning your body. Inhale, recoil by pulling the right hand to the original position. Then continue by doing the same movement with the right hand.

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Coiling Tai Chi

Left and right Yin and Yang

5. Water and fire mutually interact Inhale, turn palms up and raise hands to the clavicle level as if you were lifting something. Exhale, turn palms down, then push them downward to your abdomen keeping the hands lined up in front of your body until arms are fully extended and fingers point straight to ground.

Water and fire mutually interact

6. Large bear encircles the moon Inhale, lift hands to clavicle level while turning palms faced up. Exhale, extend and rotate your arms forward so that your arms and chest form a large circle with palms facing forward. Inhale, turn palms to face inward as you move your hands back toward chest. Exhale, push both palms down to your abdomen keeping the hands in line.

Large bear encircles the moon

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Coiling Tai Chi 7. Living Buddha holds up the heaven Similar to movement no. 6 except that you push your hands up instead of forward.

Living Buddha holds up the heaven

8. Turn heaven and earth in front of the body Raise both hands in front of your chest, Turn palms upwards while inhaling, exhale push one hand up to the sky and push the other hand down the earth. Coil back to the original position and do the movement on the opposite hands.

Turn heaven and earth

9. Golden rooster twists its wings Similar to movement no. 8, except that the descending hand is threaded behind your back.

Golden rooster twists its wings

10. Turn head to look at the moon Continue from No. 9 but now twist your body to look directly behind you as you exhale. When right hand is up, twist to the left and vice versa.

Terra Rosa e-magazine, No. 7 (March 2011) Turn head to look at the moon

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Coiling Tai Chi 11. Big python turns its body Step your left leg to the left and squat down to put about 60% of your weight on it. Twist your body and move the arms. Exhale, twist your body to the left and twist your head to look to the back. Inhale, return to centre. Exhale, turn to the right. Toes point 45 degrees outward. Pivot feet as necessary to keep your stance stable.

Big phyton turns its body

12. Up and down coilings Turn your body to face forward and bring your hands to your waist. Next, exhale and stand upright and raise your hands straight up palms facing forward. Then inhale and lower your body as you twist it to the side and draw your hands into your chest turning the palms up. You should end up in the Sitting on Crossed Legs Stance. Pivot your feet as necessary to keep your stance stable. Then raise and twist your body into Horse Stance facing front. Repeat the movements to the opposite side.

Up and down coilings

For the complete description and demonstration of the coiling set, we refer to the book and DVD The Essence of Taiji Qigong by Dr. Yang Jwing-Ming, published by YMAA. Reference: Yang, J.M. 1998. The Essence of Taiji Qigong: The Internal Foundation of Taijiquan. Book and DVD. YMAA Publication Center.

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Auth Method: A Guide to Using Forearms My first massage job was at a spa. An average shift was six one-hour, full-body massages. Doing six massages a day, I quickly learned the importance of proper body mechanics and using the forearms to do massage. I began to rely on my forearms to work the entire body, reserving my hands for my client’s toes, fingers, and neck.

Fifteen years later, I am still seeing six clients a day (if not more), and I do not have—nor have I had—carpal tunnel, pain in my hands, lumbago, or any other massage-related injuries. I attribute this to using my forearms to perform the vast majority of massage work and practicing good body mechanics while giving a massage. Forearm massage wasn’t part of my massage curriculum in massage school and yet I use it more than the other methods I studied. I designed the Auth Method of Forearm Massage to help professional massage therapists enjoy longer, healthier careers. As MTs, it is imperative we keep work-related injuries to a minimum. The Auth Method is a massage technique that takes the practitioner’s wellbeing into account, as well as that of the client. It feels effortless to perform and great to receive.

Below are a few key concepts about the Auth Method, including some forearm massage techniques and a qigong exercise for better body mechanics.

Durability The forearms are a bodyworker’s most prized tool: they are more durable than the hands, fingers, or thumbs, so you can work longer on your clients with less wear and tear on your body. This means increased career productivity and longevity. Using the forearms as the primary tool in performing massage minimizes the risk of carpal tunnel, thenar problems, or pain anywhere in the hands, simply because you are asking less of your hands. Forearms are also less “pointy” than the elbows, so the massage work you do on your clients will be

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smoother and more relaxing.

Sensitivity With practice, the forearms are just as sensitive and agile as the hands, fingers, or thumbs. In my own experience as a massage client, I’ve often been snapped out of a state of total relaxation when the therapist roughly introduces an elbow and pokes around with too much pressure, bumping up against my spine or some other bony prominence. Many people immediately as-

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Forearm massage “Because the forearm surface area of contact is larger than using your fingers or thumb, you can work more of your client in less time.” sociate forearm massage with deep-tissue work. This is not a rule. Forearm massage is also good for light circulatory massage. Students of forearm massage should begin by using the forearms to do light work until they learn the nuances of this new tool. This is a safer, more practical way to develop sensitivity in the forearms. I recommend using a bit more oil than usual to account for the broader area of contact. The increased amount of oil helps to develop a relaxing glide with the forearms. With practice, the forearms can be just as sensitive as the hands, and offer an equally relaxing experience. Start out light and take it slow.

Leverage The forearms naturally lend themselves to doing deeptissue work and because the surface area of contact is larger Auth Method than using your fingers or thumb, you can work more of your client in less time. The forearms also provide more leverage for deep-tissue massage than the smaller, more fragile fingers, thumbs, and hands. When practicing the Auth Method, it is essential to lean into the tissue; it is not necessary to push, if you are using your body weight correctly. The forearms are perfect for leaning your body weight into your client. If the table is low enough, you can just drop your body weight down onto the tissue. Pushing is exhausting and you run the risk of applying too much pressure on your client. Instead, drop your body weight onto your client. Your body will naturally drop to the first layer of tight tissue; it’s like floating. As that layer of tissue releases, you will drop into the next layer of tight tissue. Practicing the Auth Method is effortless for the practitioner. The less energy you expend during a massage, the more massages you can do a day, and the more energy you have for your life. Just remember, when doing deep-tissue work use body weight, not force, and go slow. Feel for what your client is feeling; work the most superficial layer of tight tissue first. Your client will thank you for it.

Table Height For a medium-sized body, I recommend working with a table that comes to the height of the second or third metatarsal joint of the finger. If the client is overweight

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and tight, or excessively muscular, I might drop the table a little lower. If the client is petite, I might take the table a little higher. The table should be low enough that you can drop your body weight onto the client and high enough that your back is straight. It’s worth it to spend the extra couple of minutes before a session to adjust the table height. Better to spend the time to adjust the table height than spend the next hour uncomfortable or overexerting yourself.

Arm Glide Technique Position your prone client’s arm to a 90-degree angle so the elbow is just below the corner of the table and the forearm is hanging off the table. Stand below the raised arm in a lunge stance parallel to the table, facing the arm. Place the upper third of your left forearm onto the top of the right triceps and glide down the triceps toward the elbow. Slow down over tight spots in the triceps. Keep most of your weight in your feet at first and gradually drop more body weight onto your client’s triceps as you feel is needed. In general, the triceps do not need a lot of body weight to release when worked in this position. Your other hand is gently clasping the wrist (Figure 1). Repeat this stroke as necessary on both sides.

Still clasping at the wrist or hand, pull the arm onto the table and use your forearm to glide down the inner forearm from the elbow to the wrist. As you glide down the forearm, move your other hand to the elbow. Use the other hand to traction a slight stretch on the inner forearm (Figure 2). Lighten your pressure as you glide over your client’s wrist and drop your elbow into the palm (Figure 3). Make sure you are using enough oil to glide effortlessly. In my experience, the inner forearm and palm can withstand and enjoy a fair bit of pressure.

Just be mindful to lighten your pressure over the wrist.

Qigong for Better Body Mechanics Using my forearms has saved my hands, but what about the rest of me? Too many therapists quit the profession due to back pain. When I was getting my master’s degree in Chinese medicine, I was introduced to qigong. Qigong is an ancient Chinese exercise system that couples movement with breath. The movements are slow and relaxed—the ideal pace for massage. The qigong stance is grounded and strong in the lower body, like a tree trunk rooted to the earth, and relaxed and fluid in the upper body like tree branches flowing in the wind. The legs are spread wide with the knees bent. The back is straight and the shoulders relaxed.

The arms are loose like wet spaghetti. The Auth Method teaches the following simple qigong exercise for developing good body mechanics while working.

Prayer Wheel One of the main stances in the Auth Method is the lunge stance. To learn the lunge stance and to encour-

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Forearm massage

Figure 1

Figure 2 age a straighter back, relaxed upper body, and grounded lower body while working, try the qigong exercise Prayer Wheel.

Lower Body Find some empty space outside or in your home and put on some comfortable clothing. Stand with your feet hips-width apart and slightly bend your knees. Shift your body weight into your right leg and turn your left foot out to a 45-degree angle. Shift your body weight back into your left leg (left knee is bent) and step your right foot comfortably forward. Your stance will be about 75 cm wide. Inhaling, bend the right knee, straighten the left knee, and shift your body weight into your right leg. Keep your back straight and your hips low. As you move forward, keep your hips on the same horizontal line, not moving up and down. Exhaling, straighten the right leg, bend the left, and shift your body weight back into your left leg. Continue this backand-forth motion with the breath. Imagine growing roots out the bottom of your feet and inhaling up through the soles of your feet. This image will help keep you grounded in your lower body. When this motion feels comfortable, move on to incorporate the upper body.

Figure 3

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Forearm massage

Upper Body Inhaling forward, float the arms up with loose wrists until they are shoulder-height in front of you. Exhaling back, float the arms back toward your shoulders and down along your sides, keeping your shoulders relaxed through the entire movement. This makes a circular or wheel shape with the arms, hence the name Prayer Wheel. Keep your shoulders relaxed. Practice this exercise on both sides, making 10 or more Prayer Wheels.

This exercise is great for teaching therapists to stay grounded in the legs and relaxed in the upper body.

With time, it also slows the therapist down and reminds them to breathe.

Checking In When it comes to good body mechanics, it’s very important not to forget yourself and your needs while giving a massage. Check in with yourself while working.

Are you breathing? Is your back straight? Are your shoulders relaxed? Could you be doing less and getting the same or better results? This is your time, too. At the end of the massage, if our clients are more relaxed but we are more tense, we have only succeeded in transferring tension rather than reducing it.

conscious of your client’s breath. Relaxation happens with the breath. The breath moves and circulates. If our clients are not breathing freely, they are like a stagnant swamp, instead of a flowing river. Your massage will be much more effective if your client is consciously breathing. I know right away if my client isn’t breathing correctly because I start trying to breath for them. This obviously doesn’t work. We can’t do it for our clients.

Encourage your client to breathe—even if it means breaking a relaxing silence. It is essential. Encourage them to inhale through the nose and exhale through the mouth. Ask your client to breathe under your hands or into an area that you are working on that is blocked.

Use the client’s breath as a helpful and internal tool for deeper release.

Advantages It takes time to develop sensitivity in your forearms, but once achieved, there are so many advantages, including more durability for increased career longevity and productivity, better leverage for leaning into the tissue and saving you energy, and increased area of contact so you can work more of your client in less time.

Breath Happens The same way you are conscious of your breath, remain

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Forearm massage About the author Shari Auth is a licensed massage therapist and acupuncturist, and is certified in the Rolf method of structural integration. She is the creator of the Auth Method and has a fulltime practice in New York City. Auth teaches continuing education workshops and has a DVD, Auth Method of Therapeutic Massage: A Guide to Using the Forearms. For more information, please visit www.authmethod.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.

Treat yourself and spread the wealth: Get a massage before it's too late! (Photo by Gil Heldley).

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Advanced-Trainings.com’s

Advanced Myofascial Techniques Workshops Cairns, the Gold Coast, Melbourne, & Sydney. Throughout October 2011 The Advanced Myofascial Technique seminars present practicing manual therapists with highly effective and little-known techniques, tests, and procedures, which can be easily incorporated into your existing practice.

Drawing on a wide range of disciplines, the focus is on unusual, interesting, and fresh approaches that both expand your repertoire of techniques, as well as inspire creativity and innovation.

Two‐Day Workshops Neck, Jaw & Head Pelvis, Hip, & Sacrum Leg, Knee, & Foot

One‐Day Specialty Workshops TMJ; Headaches Sciatica & Disk Issues Advanced Knee Issues

Take 1, 2, or 3 days of training. Each event combines a 2-day training with an optional 1-day specialty class: Two-day workshops are highly recommended as prerequisites for the following 1-day specialty workshops. Alternatively, all 2-day workshops are available on DVD at a discount to registered participants.

What to expect Whether you have years of experience or come with fresh eyes, our workshops are designed to help you:  Learn specific techniques for common structural and functional complaints  Relieve pain, restore lost function, and get lasting results  Be more precise in working with specific tissue types and body layers  Combine more subtle indirect work with deeper direct work  Track subtle psycho-physiological and nervous system responses  Work more sensitively, safely, and comfortably at very deep levels.

Advanced-Trainings.com is associated with the Rolf Institute® of Structural Integration, Boulder Colorado, USA and is approved by the National Certification Board for Therapeutic Massage and Bodywork as a Continuing Education Provider in the USA. These workshops are pending approval for Continuing Education Credits by the AAMT and AMT in Australia.

All workshops combine:  In-person demonstrations and individualized hands-on supervision  State-of-the-art instructional materials, including 3D Interactive Anatomy software  A detailed course manual/note organizer with photos of techniques covered  Videos of instructor demonstrations available for postworkshop practice and review.

The Instructors Advanced.Trainings.com Faculty members Larry Koliha and Bethany Ward will be presenting on fascia research and myofascial therapy at the 2011 Association of Massage Therapists (AMT) national conference, as well as teaching workshops in Australia throughout October. Both Larry and Terra RosaAdvanced e-magazine, No.Rolf 7 (March 2011) Bethany are Certified Rolfers™, Movement® Practitioners, and teach at the Rolf Institute of Structural Integration.

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An Interview with Dr. Jean Jean--Claude Guimberteau Dr. Jean-Claude Guimberteau is a hand surgeon and the author of the famous film Strolling Under the Skin. The film shows for the first time the most fascinating images of living fascia. Using a special camera, Dr. Guimberteau showed that there is a unique architectural system in human and that the tissue continuity is global. He believes that sharing these discoveries will incite people to get into this scientific world exploring living matter organization. His work become well known in bodywork when his film was shown in The First Fascia Congress in Boston in 2007. He then realised a sequel Skin Excursion at the 2nd Fascia Congress in Amsterdam 2009, and his 3rd film Muscle Attitudes at the 7th Interdisciplinary World Congress on Low Back & Pelvic Pain in LA 2010. Now, we have a privilege to interview him for Terra Rosa e-mag.

Dr. Guimberteau, your work has provided brilliant images of living connective tissues that we haven't seen before, and inspired many of manual therapists who are closely working with the skin and manipulating connective tissues.

What led you to the discovery and study of the

architecture of the connective tissue. Can you give us a background?

I was seeking a technical procedure to reconstruct flexor tendons, when I came upon the sliding system that I termed the MVCAS (Multimicrovacuolar Collagenic Absorbing System). I first used a microscope to understand how it was working.

This tissue, which neatly ensures the efficacy of gliding structures and their independence, is composed of a network of collagen fibrils whose distribution seems to be totally disorganized and apparently illogical at a first sight. This impressed me because my Cartesian mind could not come to terms with the idea of chaos and efficiency co-exists perfectly. This was the starting point for an intellectual voyage that took me far from the beaten track and off into the largely unknown world of fractals and chaos. * Note: Fractal is a geometric pattern that is repeated at every scale. If you zoom in on a fractal pattern it will look similar or exactly like the original shape. This property is called self-similarity.

Chaos in mathematics is "the irregular, unpredictable behavior of deterministic, non-linear dynamical systems" which is used to describe objects that are apparently disordered, however there is an underlying order in apparently random pattern.

How do you start making film of live connective tissues? Why this is not done previously?

First we start taking pictures during surgical tendon reconstructive procedures. The photos were taken during a planned surgery, thus there is a time limit of 30 Pictures taken from Strolling under the Skin, courtesy of Endovivo.

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Interview with Dr. Guimberteau

Pictures taken from Muscle Attitudes, courtesy of Endovivo.

All the tissues observed were developed within the framework of multifibrillar architectures and resulting minutes so that the surgical team were not disturbed from the intertwining of fibrils : there are the miduring their work. Surgeries were performed either with crovacuoles which in fact are intra fibrillar micro vola garrot (a stick used for tightening a bandage, in order ume, and which are the basic elements combining a to compress the arteries of a limb), which allows rather polyhedral fibrillar frame enclosing multiple micro dull observation in terms of colour, or without a garrot vacuolar spaces of varying sizes between 10 μm and 100 which gives more lively images but is disturbed by blood μm, with a gel inside. extravasation (leakage). Then after, we extend to skin * Note: 1 μm or micro meter is a millionth of a meter. flaps and abdominal surgeries.

I don’t know why this has not been done previously but some of my experiences can explain that. For many years, I have performed microsurgery transplants and I have used microscope very often. Moreover, surgery is performed without bleeding using a tourniquet, so the observation is easier, and finally I love to understand the processes that have been going on.

What are the challenges in making these pictures using endoscopic camera?

The main challenge is to understand how tendon and skin are sliding, but also all these fascinating images have to be shared. They look so beautiful with their aesthetics, colours, varied and sparse shapes. Sharing them seems to be a good way to arouse the interest of people today.

These microfibrils have a diameter of about ten to twenty microns and are made up predominantly of collagen type I and III. By intertwining, in an irregular fractal manner, they determine the volume of the microvacuole, which is filled with a glycosaminoglycan gel. By accumulation and superposition, these multi microvacuolar polyhedral patterns will build an elaborate form.

In ‘Muscle Attitudes’, you proposed that there is a global tissue continuity around or inside the muscle. Can you tell us the implication of this.

The essential implications of these microsopic and endoscopic observations are the fibrillar continuity. There is no break in the tissue continuity, be it within muscle, tendons, or around the arterial and venous structures and the structures surrounding the adipocytes. All these What is the scale (magnification) we are looking structures are formed in the same manner and are continuous. at?

Generally magnification is 25 times.

In ‘Strolling Under the Skin’, you described the Sliding system and architecture of the connective tissue that looks chaotic in organisation composed of microvacuoles that are able to adapt itself to various stress. Can you briefly describe about this microvacuole form?

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We have discovered the same continuity of tissue within the sub-cutaneous tissue in Strolling Under the Skin, the epidermis and dermis and the muscles. The concept of the organisation of living matter into stratified layers, hierarchical layers of sheaths, lamellae and strata cannot satisfy an anatomist who studies precise, endoscopic, functional anatomy. Even though they may be of different colours, textures and shapes, they are all

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Interview with Dr. Guimberteau

Pictures taken from Muscle Attitudes, courtesy of Endovivo.

linked to each other. This is a global tissue concept.

covery and new technology will be the key point for this development.

Which part of your work would you suggest that could be the most important relevance for man- What are your current projects? ual therapists?

We continue to explore using HD (high definition) I think that our last movie Muscle Attitudes is the most technology and we will soon make a new movie on tenappropriate for manual therapists, however Skin Excur- dons anatomy and physiology. sion gives more detail on the intracutaneous connecBut for now, we want to show these films and images to tions. all people because we have to share the beauty of human The physical links between these contractile and conliving matter thanks to a book and new videos. nective fibrillar structures from the surface of the skin to the deep muscle can explain some of the effects of manual therapy in a rational physiological and noncontroversial manner.

How do you see new technology will bring to the understanding of connective tissues?

I am sure that in the future the intra-body exploration will be one of the new frontier in scientific medical dis-

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Fundamentals of Clinical Orthopedic Massage

By Joseph E. Muscolino, DC Fundamentals It might seem that the world of continuing professional education (CPE) for clinical orthopedic massage offers a dizzying array of treatment technique options. But when we look a little closer, we see that most of these techniques are variations of a few fundamental treatment approaches. The four fundamental treatment approaches that form the foundation of most every treatment technique in the world of CPE are hydrotherapy, soft tissue manipulation strokes, stretching, and joint mobilization. Following is a brief overview of these fundamental components of clinical orthopedic massage.

Hydrotherapy The term hydrotherapy literally means water therapy (hydro means water), and was named because water is used to apply hot and/or cold therapy to the client. Although water is not the only means of transferring heat and cold, the term hydrotherapy is generally used as a blanket term for all techniques that involve hot and cold. Cold hydrotherapy (also known as cryotherapy) usually involves the use of ice or ice packs and has antiinflammatory and analgesic effects (Figure 1). Ice is an anti-inflammatory that decreases swelling because it

“It might seem that the world of continuing professional education (CPE) for clinical orthopedic massage offers a dizzying array of treatment technique options. But when we look a little closer, we see that most of these techniques are variations of a few fundamental treatment approaches. ” causes vasoconstriction of local arteries; and it is an analgesic that decreases pain because it can numb pain receptors in the region of application. Heat hydrotherapy acts to relax and loosen musculature and other soft tissues where it is applied. Heat accomplishes this both by relaxing nervous system control of muscle tone and by loosening fascial tissues.

There are a number of options when it comes to hydrotherapy application for orthopedic work. Cold can be used to numb a region before deep tissue work is done.

By lessening sensitivity, the client will likely allow deeper pressure to be used than otherwise might have been comfortable or possible. Cold can also be used after deep tissue work to decrease swelling that might already have been present, or to prevent swelling from occurring that might result from the deep pressure. Although heat can be used to “soften” taut tissues before engaging in deep tissue work, it is especially valuable to use heat before stretching or joint mobilization is performed.

Soft Tissue Manipulation

Figure 1. A cryocup® is an excellent way to apply cold therapy (cryotherapy).

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The second fundamental treatment technique approach is soft tissue manipulation. Soft tissue manipulation is a broad term that can be used to incorporate most all

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Orthopedic massage types of hands-on massage strokes.

These include cross -fiber, compression, and deep stroking, to name a few. The benefits of each stroke vary depending upon the condition being treated and the individual preferences of the client receiving the work. What is common to all these strokes is the introduction of pressure into the client. AlFigure 2. The table needs to be low when though deep presapplying deep pressure to the client’s sure is not always back. the appropriate or best treatment option for every condition or every client, it is an extremely valuable tool for the clinical orthopedic massage therapist. When called for, it is critically important that we can generate deep pressure without excessive effort. Fundamental to this is the quality of our body mechanics.

There are many aspects to optimal body mechanics; however it is likely that the most important one is generating pressure from our core (trunk and pelvis). To accomplish this, our core must be positioned behind and in line with the stroke.

When we are standing and pressing into the “top” surface of the client (the body surface that is oriented toward the ceiling), we need to place our trunk over the client; this requires the height of the table to be low so

A

B

Figure 4. The sequence of steps for contract relax (CR) stretching protocol for the right lateral flexor functional group of the neck. A, The client contracts the target musculature against resistance by the therapist. B, The client then relaxes and the therapist stretches the client into left lateral flexion. Further repetitions are usually initiated from the position of stretch attained at the end of the previous repetition.

that the client is literally under us (Figure 2). A good guideline is to have the top of the table at the height of our knee. Of course, if we are using our elbow or forearm as a contact, the table can and should be higher.

Electric lift tables are not only convenient, they are extremely valuable because they allow us to optimize the table height by simply pressing on a foot pedal. This allows for optimal quality of work throughout the session, which translates into therapeutic success.

When we are seated and working the supine client’s neck, positioning our core behind the stroke involves laterally rotating the arm at the glenohumeral joint and placing our elbow inside our anterior superior iliac spine (ASIS). We then generate pressure by leaning in from our core. This core pressure translates through our forearm, hand, and then into the client (Figure 3).

Stretching

Figure 3. Placing the elbow inside the anterior superior iliac spine (ASIS) allows for pressure generated from the core to translate through the forearm and into the client.

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The third fundamental approach of orthopedic work is stretching. When appropriately applied, stretching is a critically important aspect of our orthopedic massage session. Because it is most effective when the client’s tissues are already warmed up, stretching is best performed after heat and/or massage are done. Logistically, this means that stretching is usually incorporated into the treatment toward the end of the session. There are a number of different stretching protocols that can be done. Common to all stretching techniques is that soft tissues are lengthened. This can aid in relaxing muscle tone and breaking up soft tissue fascial adhesions.

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Orthopedic massage

A

B

Figure 5. The sequence of steps for agonist contract (AC) stretching protocol for the right lateral flexor functional group of the neck. A, The client actively moves into left lateral flexion. B, The client relaxes and the therapist stretches the client farther into left lateral flexion. Further repetitions begin from the same starting position.

In addition to the physical lengthening component of stretching, advanced stretching techniques utilize an additional component; they add a neurologic inhibition that relaxes muscle tone. The generally accepted basis for contract relax (CR) stretching (also known as postisometric relaxation [PIR] stretching or proprioceptive neuromuscular facilitation [PNF] stretching) is inhibition of musculature due to the Golgi tendon organ reflex. Agonist contract (AC) stretching (the basis of Aaron Mattes’ active isolated stretching [AIS] technique) is based upon the reciprocal inhibition reflex (Figures 4 and 5).

Joint Mobilization The fourth fundamental treatment approach of clinical orthopedic massage therapy is joint mobilization. Joint mobilization is rarely utilized by massage therapists.

This is unfortunate because when appropriately applied, especially to the spine, it is such a powerful and effective treatment tool. In essence, joint mobilization can be looked at as a very specific and focused form of pin and stretch technique. Using the neck as an example, we pin (stabilize) one vertebra, and then we move the vertebra above (along with the rest of the cervical spine above and the head) relative to it. This directs the stretch to the specific segmental joint level that is located between them (Figure 6). Joint mobilization is extremely important because no other stretching protocol can target a specific joint level of the spine. All other stretching techniques (including neural inhibition stretches) apply their stretching force across the entire region of the spine where they are being employed. Consequently, if one joint level is tight (hypomobile), then adjacent joint levels usually compensate by increasing their motion

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Figure 6. Joint mobilization of the neck. One vertebra is pinned and the superior vertebra is moved relative to it. No thrust is ever applied with joint mobilization!

“Because joint mobilization is so precise and has such powerful effects, it is especially important to attend hands-on workshops when first learning this skill.� (becoming hypermobile). Because these hypermobile levels increase their motion, the tight joint level can avoid being stretched.

Joint mobilization stretching is very specific so we use only a very small range of motion to apply the stretching force; and we apply the mobilization stretch for only a second or less. It is critically important to point out that no thrust is introduced during joint mobilization. Doing so would constitute a high velocity joint manipulation that is not within the scope of massage therapy. Joint mobilization is always applied slowly and evenly.

Putting It All Together Competent clinical orthopedic massage therapy involves many things. First, it requires that we possess assessment skills and the critical thinking necessary to apply them to form an accurate assessment of the client. Next, we must have a tool box of treatment techniques that we can use to treat the client; along with the critical thinking needed to choose among these treatment tools. As a rule, our treatment should always be specific and tai-

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Orthopedic massage “The addition of these tools to your therapeutic tool box will increase not only your therapeutic success, but the success of your practice as well!” lored to the client who is on the table; treatment should never be applied in a cookbook manner. However, it is generally wise to follow the following guidelines: When we are looking to loosen taut soft tissues (including tight musculature) with orthopedic work, use a combination of heat, massage, stretching, and joint mobilization.

Further, the best order to apply these techniques is heat and/or massage first, followed by stretching and then joint mobilization.

Acquiring New Skills

at http://learnmuscles.com/Jt%20Mob%20of% 20Thor%20Region%20-% 20MTJWI09_BodyMechanics.pdf, and Joint Mobilization of the Low Back at http://learnmuscles.com/joint% 20mobilization%20of%20the%20low%20back%20-% 20WI%2009.pdf.

All articles cited can be found on the Articles page of the author’s website: www.learnmuscles.com.

Figure credits Figures 1, 3, and 6 are reprinted with permission from Muscolino, J. Advanced Treatment Techniques for the Manual Therapist: Neck. Baltimore, MD: Lippincott Williams & Wilkins (forthcoming) Figures 2, 4, and 5 are reprinted with permission of the massage therapy journal (mtj)

If you do not currently utilize stretching (especially advanced stretching techniques) and joint mobilization, you may want to consider adding them to your practice. About the author However, as with all new techniques, it is best to beDr. Joe Muscolino has been a massage therapy educator come proficient with them before trying them out on for 25 years. He is the author of eight your clients. Although these techniques can be learned major publications with Mosby of Elfrom books, journal articles, and video, in-person hands sevier, including The Muscle and Bone -on workshops with personal attention by a skilled inPalpation Manual, with Trigger structor is recommended for advanced stretching techPoints, Referral Patterns, and Stretchniques. Because joint mobilization is so precise and has ing. He is also the author of body mesuch powerful effects, it is especially important to attend chanics, a column article in mtj hands-on workshops when first learning this skill. The (massage therapy journal), as well as addition of these tools to your therapeutic tool box will an upcoming book on advanced neck increase not only your therapeutic success, but the suctreatment techniques for the manual therapist cess of your practice as well! (publishing Fall of 2011, Lippincott Williams Wilkins For more information on effective body mechanics for publisher). He runs numerous continuing education deep pressure, see Work Smarter, Not Harder at http:// workshops for therapists and instructors, including a learnmuscles.com/final%20CEcourse%20WI06.pdf.

Certification series on Clinical Orthopedic Massage Therapy (COMT). And he has a private chiropractic For more information on advanced stretching techpractice in Fairfield, CT., USA. For more information, niques, see Stretch Your Way to Better Health at http:// visit his website at www.learnmuscles.com. learnmuscles.com/stretch%20your%20way%20to% 20better%20health-%20FA06.pdf.

See also Advanced Stretching: Using Neural Inhibition to Enhance the Stretch, Parts 1 and 2 at http:// learnmuscles.com/MT_09_2010_Advanced_Stretching -1.pdf and http://learnmuscles.com/ MT_11_2010_Advanced_Stretching_2.pdf.

For more information on joint mobilization of the spine, see Joint Mobilization of the Neck at http:// learnmuscles.com/originals/body%20mechanics% 20FA07.pdf, Joint Mobilization of the Thoracic Region

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Deep Tissue Massage, Stretching & Joint Mobilization Sydney, Hobart & Brisbane — July 2011 Approved AAMT CPE & AMT CEU Intermediate & Advanced Techniques for the Neck Sydney: 2-3 July 2011, Hobart: 9-10 July 2011, Brisbane: 1213 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 25 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 best selling 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.

Approved AAMT CPE & AMT CEU Don’t miss this unique experience to train with Dr. Joe Muscolino.

Book Early as Places are Limited To register your interest & for more information, visit www.terrarosa.com.au Terra Rosa e-magazine, No. 7 (March 2011)

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The Massage Project 2011 www.massageproject.com

Joanne Schoenwald What started as a fanciful idea... (wouldn’t it be great to have a massage every day?)… quickly turned into The Massage Project. The concept is simple: have a massage every day with the hope and agenda that it will improve my health.

I was born anaemic, with serious food allergies and then began tearing ligaments in my ankle from 5 years of age. But things took a sharp downward turn for me at the age of 15, with crippling sciatica that seemed unsolvable and left me with a recommendation for surgery to have the sciatic nerve cut. This was followed by a diagnosis of Schumann’s disease in my thoracic spine.

All these spinal issues meant that my once very active life was changed forever. Skip forward another 20 years and the joyful day when I woke up to find myself ‘better’ hasn’t yet arrived. I’ve been diagnosed with hypothyroidism, fibromyalgia, rheumatism, sero-negative arthritis, chronic fatigue syndrome, and more. Now, I’m 35 and would like a baby with my husband and a recent test returned a ‘low egg count’. Time is definitely not on my side.

It was time to do something radical.

I am a former massage therapist and my husband, Alwyn Blayse, is a physiotherapist. We both have always been convinced of the value of massage but we haven’t found anything yet about anyone who’s had a massage every day for a prolonged period of time to study any changes. We are both equally as excited about the study of this experiment as we are about the health benefits for myself.

We began the project on January 1, 2011 and I’ve had at least 30 minutes of massage every day, either from a qualified massage therapist or from my husband (who’ll be the first to admit that physios aren’t trained in massage, but he does a pretty good job). And on one occasion, when I was stuck for a massage, I spent 32 minutes in a massage chair in a shopping centre, which I then reviewed on our website.

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So far, there have been two very exciting changes. The first relates to my thoracic spine and, by extension, my right arm (and occasionally the left one as well), which has been going numb for Joanne and Alwyn the past four years. It’s always been assumed that it was a structural issue to do with the degeneration in my thoracic spine, as it’s dependent on positions. For example, when lying in bed on my left side, often my (right) arm will go numb, but if I roll over onto my right side, it might release.

(Unless it’s really bad, in which case I have to get up out of bed and walk around to ‘unlock’ whatever is going on.) It will also go numb (at times) if I’m lying on my back, such as in the dentist’s chair. (Carpal tunnel syndrome was ruled out by electric tests.)

Prior to The Massage Project, my arm was going numb almost every night (say, 29 out of 31 days a month). In the first month of The Massage Project, that number dropped to just 9 nights in January. It’s looking slighter higher than that for February, but still a long way short of every night. This has been very exciting because no therapy that I’ve had to date has led to any sustained improvement.

The second exciting change that we’ve seen is that I lost 3 kilograms (6.6 pounds) in the first month. Fluid, assumedly, but a significant development nonetheless.

We’ve been keeping a blog about the project, including information on these sorts of changes, different massage styles and reviews at www.massageproject.com.

We hope that it will become a resource for those in the health care fields and especially to those training, studying and working in the massage profession.

Please do stop by and say hello or join our Facebook page

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Tai Chi Intervention for Fibromyalgia

Ramel Rones

"When you feel pain, MOVE it away." - Ancient Chinese proverb This article will give a basic overview of what I witnessed during the 12-week study, “Tai Chi Intervention for Fibromyalgia" at the Tufts School of Medicine.

Over the past eight years I was given the opportunity to collaborate with Tufts School of Medicine researching the philosophy of Tai Chi and its effects on both arthritis of the knee and Fibromyalgia. I was asked by one of the researchers at Tufts School of Medicine to design and implement an intervention for both debilitating diseases.

In this short article I will focus on the benefits, which were produced from these specific principles and techniques using Tai Chi philosophy.

About Fibromyalgia Fibromyalgia is a Rheumatic condition. Fibromyalgia is a disorder causing aching muscles, sleep disorders, and fatigue associated with raised levels of the brain chemicals that transmit nerve signals to the body. Fibromyalgia can lead to depression and to social isolation. The constant chronic pain affects people physically, mentally and socially. The disorder affects an estimated 10 million Americans, but it occurs most often in women.

Many of the individuals who suffer from Fibromyalgia experience debilitating pain, which immobilizes their daily physical abilities. When you lose physical independence, it often leads to depression. When people are depressed, they will often overeat and gain weight quickly. The stress resulting from the pain, depression, and isolation of Fibromyalgia will often cause the pa-

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tient’s health to spiral downward.

Benefits From Tai Chi—a 12 week Study The first benefit I witnessed was patients, one by one, coming out of their depression. Within three to four weeks into the 12-week study, I saw changes happening. Women start dressing up, using cosmetics, and getting their hair styled.

I understand from these patients that they started going out more, taking part in more social events. Over time and practice of the mind-body program, many patients actually started inspiring other people such as family and friends. This new mood is due to their achieving physical independence as well as being in a positive support group with emphasis on physical and

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Tai Chi for Fibromyalgia and a positive attitude.

The 12-week program Many people invest most of their time doing the Yang side of exercise such as resistant or cardiovascular work outs. But the program I designed mainly focuses on flexibility, deep breathing and meditation while evoking spirituality, which is more of the Yin side of exercise.

mental ability for two one-hour sessions for 12 weeks.

I half joke some times that we are a mind-body support group for Fibromyalgia, which is a little different from your typical support group which most of the time only talks. I am a strong believer in a “doing” support group with emphasis on physical activities and meditation, which I believe works better than only talk. I do think that a combination will actually give more individuals the best of both worlds.

Strength Benefits The second benefit that I witnessed is strength, in both the lower and upper body.

Strength is important for many reasons including daily tasks, supporting and nourishing the bones, and also as a mental booster. There are many practical examples for this strength theory. When you have strong legs and you know it, your self esteem and confidence is stronger. When your upper body is strong and you know it, you may need to change a shirt size, and when you look in the mirror you will see more defined shoulders. You will feel good about yourself. Your confidence and attitude will change to a more positive one.

Strength built up over the 12-week program allows individuals to start doing daily physical performance that we, healthy people, take for granted. Prime examples are: climbing stairs, carrying groceries, or holding your children or grandchildren.

It’s important to know that most patients could perform some exercises at the beginning of the study.

Some could do 10 up and down from a seating position on a chair or maybe 30 seconds standing in a horse stance against the wall. But at the end of 12 weeks, 90 percent of the patients could do 30 up and down two sets, legs together and legs apart, and three to five minutes stationery horse stance against a wall. This is a huge improvement and a symbol of very strong legs

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In the program, patients spend a lot of time in various postures to achieve better flexibility to free the skeleton from being a prisoner of the soft tissue. My goal was to move each individual at least two to three numbers down my scale of flexibility through the nine body markers, the ankles, quads, hamstrings, groin, outer hips, hips, lower back, shoulder girdle and neck.

“Having Power” Place To my surprise most patients moved three and more numbers down my flexibility scale. The improved flexibility allowed individuals to enjoy life even more because they were able to balance the new strength with flexibility. Patients were much better than they were before. They were in a new place, which I call “having power.” You can be strong and stiff or you can be flexible and weak, but if you find the balance between the two you will be powerful.

Our mind-body program was and still is unique in that the Qi Gong/Tai Chi movements are trained to both the left and right. Also, patients were able to do any of the exercises in a sitting position. These two facts alone allowed many individuals to stay with the class and not drop out. The idea that everybody can do something created an atmosphere of empowerment among all the patients.

It amazes me how far patients will go if you just give them a small task to make them part of the solution for their own disease. The intervention definitely empowered them. I have witnessed the positive chain reaction of this principle reaching great places, which I am almost sure would have been hard to achieve just through passive care.

Individuals started to take control and lose weight.

They were happy, looking for old hobbies, which the depression stopped them from doing or picking up new ones just to try new things. Some told me that the program helped them to cut back on medication because now they experience less pain and better physical performance. This new state of being allowed them to go play golf again or play the guitar, or for some even the

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Tai Chi for Fibromyalgia small act of being able to tie their own shoes.

I did not anticipate the results from this mind-body approach. I was thinking on a small scale, but I did not realize that what I considered small is huge for my patients/students. What I did not take into an account is the positive chain reaction and the power of empowering the patients/students.

A few years later, I still see at least five patients from the various groups of research, most of them, at this point, are my students. They are better than ever and most in some way will admit that they are addicted to this mind-body world. And they don’t do it every day, they will fall apart. I tell them that I am exactly the same.

Journey of Chi kung/Tai Chi program The Chi kung/ Mind Body/ Tai Chi program is a journey in which you strike a balance between external and internal work, developing the body and mind, while tapping into sources of abundant universal energy, such as the earth and sun. In doing so, you will be on the right path to developing a powerful fighting spirit, and a better quality of life for you and those around you.

The New York Times published an article based on the study. http://www.nytimes.com/2010/08/19/ health/19taichi.html The DVD, Sunset Tai Chi, which focuses on the short form in the Fibromyalgia study is available through http://www.terrarosa.com.au

About the author Ramel Rones moved to Boston from Israel in 1983 to study martial arts with renown traditional Chinese Master, Dr. Yang-Jwing Ming. After years of winning gold medals in China and in the United States, Ramel now focuses his efforts on helping people with situations such as cancer, arthritis, aging, injuries, and stress. He is a Scientific Consultant of Mind/Body Therapies at Dana Farber Cancer Institute, and Harvard and Tufts Medical Schools, as well as co-author of numerous scientific publications. He lectures and instructs the techniques of the eastern Internal Arts in hospitals, institutions, and schools around the world.

In addition to contributing articles to medical publications.

The New England Journal of Medicine published results of my 12-week study, A Randomized Trial of Tai Chi for Fibromyalgia, at Tufts School of Medicine concluding that regular Tai Chi practice can help patients with Fibromyalgia. The article can be downloaded here http://www.ramelrones.com/articles/fibromyalgia/ NEJM_RandomizedTrialTaiChiFibromyalgia.pdf

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Transitioning your Bodywork

Art Riggs

Dear Art “A few weeks ago, I took a great workshop on Orthopedic Massage and learned lots of new ways of working.

Now I find that I’m hesitant to try anything, because I work at a spa and am afraid that the clients will think the new work is strange and not like it. I’m already forgetting a lot from the workshop. How do I escape from this straightjacket?”

Answer Well, you certainly aren’t alone. Mark Twain once said, “I’ve had thousands of problems in my life, most of which never actually happened.” It is amazing how often I hear concern that trying new work will send clients scurrying to more conventional therapists. As a Rolfer, I had the same thing happen when I studied craniosacral techniques and more subtle work. I worried that people who expected sharpened elbows and knuckles would be disappointed and that my long-time regular clients would wonder if an imposter had taken over my practice. Nothing could be further from the truth; my clients loved the new skills, just as yours will appreciate your new techniques, in addition to the relaxation work you may normally do.

Just as some meat-and-potato people will never appreciate nouveau cuisine, some people might resist new bodywork. However, I think that the advantages of showing an increasingly discerning public your newfound skills far outweighs any downside; the rebooking from happy clients and word-of-mouth referrals will be evidence enough. It is far easier to draw clientele who return because they appreciate your work than to try to fit your work to your guesses about client tastes.

Many therapists project their own—sometimes incorrect—assumptions about what clients expect. Some therapists assume any work that approaches intensity may be considered strange. Many mistakenly assume that clients don’t want to be bothered in the midst of their headrest snooze to be moved for side-lying work,

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for example, or that a client will be unhappy if the session doesn’t leave all parts of the body equally covered with excess lubrication. In reality, almost all clients will be grateful for skilful work that pays attention to their particular needs, instead of conforming to cookiecutter convention.

The key to transitioning to a more creative bodywork style is communication with, and education of, your clients. A former student got in touch with me a few weeks after taking a deep-tissue class to say that after languishing for many months at a spa waiting for walkins, he is now booked every shift. The techniques he learned were certainly useful, but the main reason for his success was that he took the time before and during the massage to talk to clients to find out what they wanted to improve in their bodies. He went on to explain to them the benefits of spot work, working slowly and deeply in problematic areas, scheduling longer massages to get full-body coverage, and taking enough time to also focus on specific areas.

It is important to find your own sincere way of communicating and transitioning to the ways of working that excite you most. The following are a few suggestions: Gradually transition to your new way of working.

For regular clients, simply say you have some great new

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Bodywork transitioning "The key to transitioning to a more creative bodywork style is communication with, and education of, your clients” In the end, it’s important to remember that not every client will see you as the answer to his or her perfect massage. And that’s OK. But with good client communication and a desire to do the work you love, your practice will thrive with clients who see value in your more specialized work. Good luck, and let me know how it goes for you.

things you’d like to try to improve the massage. For new clients, build your confidence and communication skills with those whom you feel a good connection and suspect may be relaxed and open to expanding their experience, instead of on every newcomer who comes through the door.

Spend a few minutes getting to know your clients. Explain that the meter isn’t running until you start the bodywork. Educate them about how you work and learn about their needs. The session will be more rewarding for both of you because some connection will have been established, rather than abruptly diving into the massage.

Art Riggs is the author of Deep Tissue Massage: a Visual Guide to Techniques (North Atlantic Books, 2007), which has been translated into seven languages, and the seven-volume DVD series Deep Tissue Massage and Myofascial Release: A Video Guide to Techniques. Art has conducted numerous workshops for health spas and for medical professionals. He teaches deep tissue massage in the US and around the world, including Australia.

Develop your expertise slowly, instead of overnight.

Review your training and specialize on one technique with those clients who you feel may benefit most. When comfortable, introduce that technique to a broader array of clientele.

Find a peer therapist to trade with and refine your skills. A fear that clients won’t like your new work can be more than just projections about their preferences.

Sometimes the culprit is simply lack of confidence due to lack of practice.

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Research Highlights Massage therapy improves lives of people living with cancer

tions while standing on a rigid platform. Seven of these positions ranged from 15 degrees of foot eversion to 15 degrees of foot inversion and 11 positions ranged from A new study shows simple therapies, such as massage, 40 degrees of external foot rotation to 40 degrees of inboost the quality of life and reduce distress symptoms in ternal foot rotation. Pelvic tilt and lumbar lordosis were cancer patients. The study by the SolarisCare Foundaestimated using a 3D motion analysis system. tion, was presented at the Clinical Oncological Society of Australia Annual Scientific Meeting in Melbourne No- Foot pronation and supination did not have a significant vember 2010. relationship with pelvic tilt and lumbar lordosis. Internally rotating the legs caused the pelvis to tilt anteriorly The study found a 14 per cent reduction in symptom and externally rotating the legs caused the pelvis to tilt distress, with patients reporting improvements in pain, posteriorly. There was no relationship between leg rotafatigue, nausea, appetite, sleep, breathing and bowels. tion and lumbar lordosis.

Patients also reported an eight per cent increase per session in their quality of life, using a scale which meas- The authors concluded that since the effects of pelvic tilt ures empowerment, depression, anxiety, frustration, on the lumbar spine were only noticeable when pelvic confusion, coping and relaxation. tilt was exaggerated beyond values seen this study it seems unlikely that there is a link between induced foot The researchers measured the quality of life and symp- pronation and an increase in lumbar lordosis. tom distress of 1244 cancer patients receiving complementary therapies in addition to the mainstream cancer Placebos work — even without deception treatment. The therapies were based on: Touch: bowen For most of us, the “placebo effect” is synonymous with therapy, aromatherapy, reflexology, Energy: Reiki, the power of positive thinking. But a new study rattles pranic healing, Mind: meditation, chi breathing and this assumption. Researchers at Harvard Medical Support counselling School and Beth Israel Deaconess Medical Center According to lead researcher, Dr David Joske, the re(BIDMC) have found that placebos work even when adsearch demonstrates the positive impact complemenministered without the seemingly requisite deception. tary therapies can have on cancer patients. “It’s too Because such “deception” is ethically questionable, early to know whether these therapies have a real bioHMS associate professor of medicine Ted Kaptchuk logical impact or merely create a placebo effect,” Dr teamed up with colleagues at BIDMC to explore whether Joske said. or not the power of placebos can be harnessed honestly “In any case, there’s no doubt that there is an improved and respectfully. To do this, 80 patients suffering from outcome for cancer patients. I have seen my patients irritable bowel syndrome (IBS) were divided into two change their mentality to feel empowered about the groups: one group, the controls, received no treatment, management of their cancer. The research creates a while the other group received a regimen of placebos— compelling case for integrated medicine.” honestly described as “like sugar pills”—which they were instructed to take twice daily.

The mechanical relationship between the rearfoot, pelvis and low-back For a three-week period, the patients were monitored.

By the end of the trial, nearly twice as many patients There is a perception in bodywork that excessive prona- treated with the placebo reported adequate symptom tion of feet can result in bilateral foot flare. and in rerelief as compared to the control group (59 percent vs. sponse, the pelvis will tilt forward, causing an increase 35 percent). Also, on other outcome measures, patients in the lumbar lordosis. A study from University of Brit- taking the placebo doubled their rates of improvement ish Columbia, Canada published in Gait & Posture Jour- to a degree roughly equivalent to the effects of the most nal October 2010, investigated whether foot pronation powerful IBS medications. induced an anterior tilt of the pelvis and increased the degree of lumbar lordosis. The study also investigated The authors caution that this study is small and limited whether foot supination (measured as calcaneal inverin scope. “Nevertheless,” says Kaptchuk, “these findings sion) induced a posterior pelvic tilt and a decreased suggest that rather than mere positive thinking, there lumbar lordosis. may be significant benefit to the very performance of medical ritual. I’m excited about studying this further.

Participants placed their feet in 18 different foot posiPlacebo may work even if patients know it is a placebo.”

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6 Questions to Robert Schleip 1. When and how did you decide to become a bodyworker?

5. What advise you can give to fresh massage therapists who wish to make a career out of it?

In my twenties I was studying psychology at Heidelberg University, being fascinated by the way how mind, body and emotions interact. At that time Gestalt Therapy, Primal Scream, Transactional Analysis, Reichian Therapy and Encounter Groups were very popular. However, I became more and more impressed with the great impact of therapeutic approaches like Rolfing or Feldenkrais which addressed the body directly. Finally I received my first Rolfing series at the age of 23. It had such deep effects on my posture as well as my mental and emotional makeup, that I wanted to learn about that profound therapy as much as possible.

Don’t limit your curiosity. Join or start a collaborative study group in your area. Or start a Journal Club, where you discuss one or two important scientific papers per month. Invite other experts in your field to speak in your town, thereby learning a lot from them and also establishing yourself or your little group as an exchange knob for collaboration and new developments. At least once a year, go to an international conference in your field or a related field, best together with one or two colleagues, and afterwards dedicate a time to summarize your most important insights from that event to a group of local colleagues.

2. What do you find most exciting about bodywork therapy?

The exploration of the dynamics of the bodywide fascial network. Approximately 7 years ago, after over a decade of teaching Rolfing, I entered the field of academic science.

First as an avid spectator and interrogator. However soon I immersed myself like ‘Alice in Wonderland’ with total awe and wonder, even experimenting some laboratory tests with animal’s fascia in my home kitchen. Little did I know that this would lead to a fascinating and dynamic development, that now I only have 1 day left per week for my clinical bodywork practice, and being busy with laboratory and academic science developments during the remaining week. The scientific exploration of fascia as the ‘Cinderella tissue of orthopaedics’, coming from a bodyworker’s perspective, has proven to be such a goldmine, that it is immensely exciting to be part of the current scene of international ‘fascianados’ which are hunting and collaborating in this new field of fascia research.

3. What is your favourite bodywork book?

Sandra Blakeslee’s ‘The Body has a Mind of Its Own’ , being pretty equal in my esteem to Dean Juhan’s ‘Job’s body’.

4. What is the most challenging part of your work?

6. How do you see the future of massage therapy?

It is time we step forward from the current landscape of bodywork ‘schools’, which are oriented around a charismatic founder, and each has a vested interest in training students only the basic (and necessarily limited) viewpoints of that school, moreover attempt to selectively find scientific ‘evidence’ to support their theoretical assumptions as well as self confirming the relative superiority of their modality. While resembling the early developmental stages of many sciences several hundred years ago, this social and economic situation does not foster critical questioning and collaborative developments of new theoretical questions as well as practical approaches. Therefore more and more professional practitioners are currently taking on a more ‘rational’ attitude, and focusing less on (semi) spiritual concepts. They take on clinical reasoning and a more scientific approach of diagnosis and treatment. This is of course a very valuable and also necessary development. However, in my observation, it is often the less intellectual oriented practitioners that have the most refined touch skills, mindful presence, empathic intuition and therefore frequently deliver the most profound effects in their works. It would be a pity, if the increasing intellectualization of massage therapy results in massage practitioners that are more mechanistic, having similar personality like the typical white coat medical doctors who are full of knowledge, yet lack the ability to listen and to connect with their patients.

Having to learn to say ‘no’ . The increasing popularity of fascia research and our little group at Ulm university has resulted in much more collaboration requests than I can possibly handle.

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6 Questions to Divo Müller 1. When and how did you decide to become a bodyworker?

come successful in our practice and teaching.

I took my first training in neo-Reichian bodywork and massage at the tender age of 21 in 1982. That was the time, when I was deeply searching for something real, authentic and meaningful and all the other options like going to university and study medicine didn’t seem to meet that need. In 1992 I was introduced into Continuum Movement through its co-founder Susan Harper and fell completely in love with it. Being part of the first Continuum teachers training with founder Emilie Conrad, I became the first internationally authorized Continuum teacher in Europe. In cooperation with movement scientists and the recent findings on fascia research, I developed my own movement approach, called Bodybliss. In Germany, there are several DVDs published and a new book will be released in May 2011.

5. What advise you can give to fresh massage therapists who wish to make a career out of it?

2. What do you find most exciting about bodywork therapy?

Beside the values on the physical body of massage therapy in rehabilitation or health care, I believe that massage therapy will become even more important in these modern and stressful times, where the World Health Orgainsation predicts a threatening increase of psychological disorders like depression and burn out. The healing power of a sensitive touch and the loving presence of a practitioner are immensely needed qualities to ‘talk’ directly, yet non-verbally into the soft animal body. Whether it’s a deep tissue massage or the light touch of a cranio-sacral practitioner – the immediate effects on the mammalian nervous system are of enormous benefits and effective strategies for the modern, touch deprived and stressed out people.

To share the feel and somatic experience movement with my clients. The honesty about the expression of a body and the moving intelligence embedded in bones, soft tissues and fluids. I find it over and over exciting to be part of a healing process whether it’s primary taking place in the physical body or unfolds in the emotional or psychological process of a person. To facilitate the capacity to evolve into a mature human being through bodywork as an ongoing sensuous embodiment and foster the integrity of body mind and soul, makes my heart sing.

Beside the skills and techniques, follow the path of the ‘constant dripping wears away the stone’, - presenting or talking about your work wherever you can. Stay connected to your fellow colleagues and to those who trust your abilities and support your strengths. In times when the road is rough and bumpy remember what you love about the work and the qualities you have to offer, and feed that back into your own heart and soul and just keep going.

6. How do you see the future of massage therapy?

3. What is your favourite bodywork book?

Dean Juhan’s ‘Job’s body’ and Sandra and Matthew Blakeslee’s ‘The Body has a Mind of Its Own’.

4. What is the most challenging part of your work?

Together with Robert Schleip we teach a two year basic training in my method and we are into building a network and a community of bodybliss practitioners, going around the world to spread the news and the values of the work. Just to ‘stay the course’ in the daily demanding routine of an office and the organisational desk work is challenging, so that as the network be-

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