Terra Rosa E-magazine Issue #12

Terra Rosa E-Magazine

Open information for massage therapists & bodyworkers No. 12, June 2013 www.terrarosa.com.au www.massage-research.com

Terra Rosa e-magazine, No. 12 (June 2013)

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Terra Rosa E-Magazine, No. 12, June 2013

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Heart Support, Heart Opening — Mary Bond

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Case Puzzler: Anterior/lateral Hip — Whitney Lowe

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An Interview with Susan Chapelle

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A Journey into Fascia Wonderland

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Venolymphatic Drainage Therapy — Guido Meert

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Emotional Release — Art Riggs

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Borborygmous — Walt Fritz

Welcome to our 12th issue of Terra Rosa Emagazine. We continue bring you latest news and articles on manual therapy and bodywork. We are proud to bring you a range of articles, starting with Mary Bond on a healthy posture. Whitney Lowe presents an orthopaedic assessment and massage treatment for the hip. Susan Chapelle talked about her research work in the role of massage in postoperative patents. Then take a journey into the world of fascia research. Guido Meert introduced Venolymphatic Drainage Therapy. Art Riggs addressed the sensitive issue of emotional release. Walt Fritz talked about borborygmous? Then we look at the possible relation between reflexology and fascia. Finally what is pseudoscience and pseudoskeptics?

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Fascia and Reflexology

Don’t miss 6 questions to Mary Bond and Guido Meert.

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Pseudoscience & Pseudoskpetic

Enjoy and Happy Reading.

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Research Highlights

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6 Questions to Mary Bond

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6 Questions to Guido Meert

Sydney, June 2013

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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Heart Support Heart Opening Mary Bond How does it work in your life in general—the relationship between support and openness? Recall a situation in which you were vulnerable—your metaphorical heart opened--but you lacked backing. My guess is that it wasn’t your favorite experience.

Shoulder Support for Your Heart Our physical hearts, too, need support. In my book, The New Rules of Posture (pp. 114-124), I describe the partnership of serratus anterior, lower trapezius and latissimus dorsi as the best strategy for stabilizing the scapulas. When “serratus and company” are engaged, the back appears—and feels—broad. This breadth provides backing for the heart as well as support for efficient shoulder stabilization and for graceful and efficient movements of the arms.

The “Corocoid Corners” With broad back support for the scapulas, the back of the armpit feels active and alive and the clavicles seem to widen apart from one another. The resulting spaciousness under the lateral clavicles makes it easy to palpate the corocoid processes. If pectoralis minor has been overused in shoulder stabilization this front “corner” of the shoulder girdle appears deeply indented, a sure sign that back support for the shoulder blade is under active.

I like thinking of the corocoid “crows beaks” as the eyes of the shoulder blades. Visualizing the “eyes” widening and looking forward can become a short cut to healthy shoulder stabilization.

Breath Support for the Heart Consider this illustration of heart and lungs (Figure 1).

Notice there is more lung tissue in the back of the ribcage than in front; more lung in the lower than upper ribcage. (The lower lungs are richest in capillaries too— that means they are best equipped for oxygen exchange. For more about respiration, see Chapter 4 of The New Rules) Notice how the lungs appear to wrap around the heart. When you inhale that actually happens: the lungs swell to embrace and massage the

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heart with each breath. Take a moment now to feel or imagine that (remember: imagined sensation is as pertinent to your brain re-mapping process as “real” sensation). Sit upright in your pelvis, weight slightly forward of your sit bones. Breathe in through your nose, asking your lower back ribs to open like venetian blinds (or like fish gills). During the out-breath, bring your awareness to the weight of your body—feel the pressure of your thighs on the chair, your feet on the ground.

Continue with this, while imagining your lungs caressing your heart.

Now consider the photo of a woman in standing in mountain pose. Notice the lifted front chest, and pinched back ribcage. She is thrusting her chest forward and shoulders back with her rhomboids. Imagine her breathing into the lower back ribcage. Can she do it?

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Heart Opening This posture may be touted as “heart opening”, but without the support of breath, it’s necessarily an unresponsive posture. How sustainable can any opening be without support?

Many approaches to fitness and posture emphasize lifting the ribcage—it’s not exclusively a yoga teaching. For most people, lifting the ribcage means lifting the front of it because they have not yet become aware of the back of the body. I’m hoping that the information about how the lungs work can provide incentive for you to revise this posture in whatever workouts you may be doing.

Arm Support for the Heart In this illustration you see the arm buds of a human fetus developing from the same embryological tissue as the heart. Amazing, right?

From our very inceptions, our arms make gestures of our hearts’ intentions. For carrying out those intentions, our hearts require that our arms be well supported.

And here’s where your “corocoid corner” awareness comes in.

When you have the supportive band of “serratus and company” across your mid-back and your corocoid corners are spacious, your humeral heads will roll back into the shoulder socket when you raise your arms. That’s a secure way for your arm to connect into your trunk, and with support from the spine, for your arms to securely and openly express your heart’s intent.

If, however, you lift your chest by retracting the shoulder blades that only appears to widen the corocoid area, masking tightness there. When the scapula retracts like that the humeral head is forced forward in the shoulder socket. In this position it’s much more difficult for arm movements to find support from the shoulder blade and secure connection to the spine.

Body Fashion and the Heart Consider the star of the moment. I’m not commenting on Beyoncé’s structural organization, though judging by her performance in the American Super Bowl extravaganza, it’s clear she’s super fit and well coordinated. I’m submitting this image as our culture’s current expression of an ideal woman’s body. Note that while the heart area appears open, the corocoid area is withdrawn. This postural pattern is indicative of lack of arm support for the heart. While provocative, it’s not

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really a generous posture. You’ll see it everywhere in western media—Beyoncé is not alone. Such shoulders seem to embody confusion about women’s hearts and women’s identities.

Watch also The Secrets of Shoulder video at: http://youtu.be/ hJmXNay-n7s

Mary Bond has been a student of the human body since donned with her first dancing shoes at age six. After receiving an MA degree in Dance from UCLA, she studied with Ida Rolf, originator of a type of body therapy known as Structural Integration. Mary began teaching movement and bodywork courses in 1994 and currently the Chair of the Movement Faculty of The Rolf Institute® of Structural Integration in Boulder, CO. Her book, The New Rules of Posture, presents new developments in movement education. It evolved out of her wish to share the legacy of Ida Rolf with the general public.

While this legacy includes the understanding of posture and movement, it also has philosophical implications.

The deeper message is that the way we inhabit our bodies affects the ways in which we perceive the world and behave toward one another. Her 2012 DVD, Heal Your Posture, further elucidates this message. See her website http://healyourposture.com/ Mary will travel and teach in Melbourne and Perth, July 12-14th & July 20-22nd.

“Eyes Within Your Spine”: Using The New Rules of Posture as a template for posture and movement analysis, Mary shares a sensory approach to movement education that can be tailored to any somatic discipline.

For more details visit: http:// www.bodyworkeducationaustralia.com.au

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“Unlike posture improvement programs that promise instant results, HEAL YOUR POSTURE: A 7-Week Workshop with Mary Bond, author of "The New Rules of Posture", helps you understand the interrelated habits that underlie poor posture. By spending a week with each of 7 lessons, viewers will learn to re -map long-standing habits of walking, standing, sitting, and breathing that contribute to unhealthy and unattractive posture, as well as to back, neck, jaw and shoulder pain.

Lesson topics include pelvis and hip awareness, healthy breathing, core support, help for flat or rigid feet, shoulder support, jaw and eye tension, spine mobility, and fluid walking. Rather than training muscles into an ideal shape, Mary's approach helps you recreate your best body from within, though awareness.

How we use our bodies in daily life-how we sit, stand, walk move, bend and carry out domestic, leisure and work-related tasks-has profound implications in terms of comfort, energy and avoidance of mechanical stress. Teaching is an art, and Mary Bond displays great skill, knowledge and art as she gracefully leads us through a process of learning new ways of functioning. This highly informative video is a wonderful resource."

Available at www.terrarosa.com.au

Mary Bond “Eyes Within Your Spine” workshop July 12-14th & July 20-22nd, 2013 Melbourne and Perth, Australia Using The New Rules of Posture as a template for posture and movement analysis, Mary shares a sensory approach to movement education that can be tailored to any somatic discipline.

For more information, see http://www.bodyworkeducationaustralia.com.au

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Anatomy in Clay®

Sydney

Dr. Joe Muscolino is presenting this workshop for learning muscles by building them in clay, which is the ultimate kinaesthetic experience for deepening the knowledge of the skeletal muscles of pelvic tilt and shoulder girdle.

14 February 2014, Muscle Palpation as an assessment tool for Orthopedic Massage 15-16 February 2014, COMT: Neck 17-18 February 2014, COMT: Lower Back & Pelvis

Sydney

Gold Coast

8 February 2014, Anatomy in Clay® Muscles of the Pelvic Girdle/ Powerhouse 9 February 2014, Anatomy in Clay® Muscles of the Shoulder Girdle

Clinical Orthopedic Massage Therapy (COMT) The focus of these workshops is to learn how to work clinically utilising deep pressure, basic and advanced stretching, and joint mobilisation 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!

The workshop will cover body mechanics for deep tissue work, muscle palpation assessment, orthopaedic assessment testing , and stretching. It will also has focuses on advanced stretching (CR, AC, and CRAC stretching), motion palpation and assessment of joint, and how to safely perform joint mobilisation.

21-22 February 2014,COMT: Lower Back & Pelvis 23 February 2014 , Advanced Joint Mobilisation

About Dr. Joe Muscolino Dr. Joe Muscolino is a licensed chiropractic physician and has been a massage therapy educator for more than 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 Muscle and Bone Palpation Manual, with Trigger Points, Referral Patterns, and Stretching" "Joe has inspired me to dig deeper into the knowledge I already have and to pursue more information about the body in further study. I have been to many courses in the past which were unable to do more than pass on a few interesting techniques, many of which were not easy for the therapist to perform unless they were a 6 foot male with arms twice the length of mine. It is a true gift to be able to inspire your students, especially those who have been in the field for a few years and are unaccustomed to learning.” Anita S., Hornsby.

"Joe Muscolino is a master of his profession! His broad knowledge on the human body and extensive experience made the workshops interesting and engaging. I would highly recommend his workshops to any body-worker. I, myself, can't wait for the next one!" Zuzana G, North Sydney.

Terra Rosa e-magazine, No. 11 12 (December (June 2013)2012) 6

Book Early as Places are Limited 6 6

To register your interest & for more information, visit www.terrarosa.com.au/joe

Case Puzzler: Posterior/lateral thigh pain Whitney Lowe Background I had an interesting client case recently that emphasizes the crucial importance of accurate and comprehensive assessment. The client (we will call him Mark) was reporting a sharp pain on the posterior/lateral aspect of the left thigh (Figure 1). Mark reported the pain as coming on gradually over the course of several months, but was exacerbated one day when he adducted the left thigh while sitting and heard a popping sensation. The pain seemed to get much worse after that and has been ongoing for close to a year.

Mark’s job requires sitting and his pain is worse after long periods of sitting, but is relieved when he gets up and moves around. He had seen several other practitioners (physical therapist, massage therapist, and orthopedist). He had gotten partial relief from these other approaches, which had all focused on the iliotibial band with suspected adhesions as the root of the problem.

Previous therapeutic approaches included deep friction massage, strain-counterstrain, and three rounds of cortisone injections into the lateral thigh and iliotibial band regions. None of these solutions worked for any length of time and Mark continued to have the same pain and problem.

Case Analysis If the ITB had been the problem, prior treatment approaches focusing on the iliotibial band should have provided relief. Mark’s case demonstrates how important it is to conduct your own assessment even if a client comes in with other healthcare professionals’ assessments. Similarly, this case shows that it is valuable to reassess a pain complaint and not to continue down a treatment path when results are elusive.

To explore other possibilities with Mark, a very detailed history was taken of exactly how the pain had come about and how it was perpetuating on a daily basis.

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Also he was asked to try to pinpoint exactly where he was feeling the most pain. Mark’s long periods of sitting appeared directly related to how the condition was being aggravated. He said it felt better almost immediately when he got up and walked around, but then gradually started hurting again after sitting. That notion stuck with me because that pain pattern is not typical of conditions when fibrous adhesions, such as might occur with ITB problems, are the root of the problem.

Key factors in the physical examination pointed in a different direction than ITB issues. He didn’t have pain when attempting to actively abduct the thigh against resistance, nor when his primary tender spot was palpated during resisted abduction. If the ITB was the major culprit, this test should have greatly exaggerated his pain.

Next, the reported primary tender area was palpated as he attempted to actively extend the hip and flex the knee while in a prone position. This test caused a significant reproduction of the primary pain. Further testing, involving palpation during the same two movements but with increased resistance, reproduced the same pain with greater intensity. These test procedures strongly recruited the hamstring muscles.

When these test results were combined with information from the history, it became clear that the biceps femoris was the primary tissue involved in his pain complaint. Further, exploratory palpation found hypertonicity and pain in a deep band within the biceps femoris; this finding provided further evidence that the problem was not in the ITB, but in the hamstrings.

Anatomy of the Problem The hamstring muscle group is composed of three posterior thigh muscles: the semitendinosus and semimembranosus on the medial side, and the biceps

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Posterior/lateral thigh pain

Figure 1: Primary site of pain right adjacent to ITB

femoris on the lateral side. The biceps femoris has two heads. The long head of the biceps femoris originates on the ischial tuberosity and the short head originates along the linea aspera on the posterior side of the femur. Both heads of the biceps femoris share a common insertion on the lateral aspect of the fibular head.

When contracting concentrically, the hamstrings produce knee flexion. The semitendinosus, semimembranosus, and long head of biceps femoris also contribute to hip extension. The short head of the biceps femoris is not involved in hip extension as it doesn’t cross the hip joint. The hamstrings also act on knee rotation when the knee is in a flexed position. The semimembranosus and semitendinosus medially rotate the knee, while lateral rotation is produced by the biceps femoris.

Mark’s long hours of sitting put the hamstrings in a chronically shortened position. In addition Mark is an avid hiker, so on weekends his hamstrings get a good workout. Both activities produce hypertonicity in the hamstrings generally. In Mark’s case, the biceps femoris became chronically hypertonic and there was a small localized spasm of a portion of the muscle, though not a trigger point.

Treatment Protocol

Figure 2: lengthening strokes of active engagement performed during eccentric knee extension

to directly address the spasm and trigger point. There were immediate and positive results from this therapy.

Treatment requires counteracting the effects of the problem with activities such as stretching, self massage, and hot baths or applications to help the muscle begin to relax. Mark was also instructed to alter his activity patterns at work and on the weekend. While he cannot help but sit at his work, he can get up more frequently. During these breaks it would be best if he walks around, but also takes a few minutes to do some simple stretching of the hamstrings and back of the leg and hips. There are useful home massage tools for Mark to employ, such as rolling on top of a tennis ball or other type of roller under his thigh, or other self massage tools widely available now.

Conclusions Many times things are not what they initially seem. The other manual soft-tissue technique approaches had limited success, but no lingering adverse effects. However, there could be detrimental long-term effects from continued cortisone injections. The key takeaway here is that doing additional assessment is highly valuable, especially if the condition is not blatantly obvious or unresponsive to initial treatment.

Mark was treated using soft-tissue treatments aimed at reducing general hypertonicity as well as specific, targeted treatment for the spasm. Active engagement techniques – deep stripping with active eccentric knee flexion - in particular were used to encourage elongation of the muscle (Figure 2). These techniques enable easier access to the deeper muscles of the hamstrings and intensify the treatment (notably with less effort on the part of the therapist). Static compression was used

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An Interview with Susan Chapelle When and how did you become a massage therapist?

In 1987 I started doing treatments while working as a technician for IATSE (International Alliance of Theatrical Stage Employees). I worked on musicians and crew.

I had no idea it was a profession I could choose, and become educated in. I started school at Sutherland and Chan College in Ontario Canada, graduated and started doing research.

Can you tell us about the place where you come from, Squamish, which you called the epicentre of orthopedic injuries. How did you get involved in treating people with orthopaedic injuries?

Squamish IS the epicentre of orthopaedic care. We have Whistler just north of us, skiing and downhill biking. We have Squamish that produces a bizarre amount of fractures and scar tissue. We have the youngest demographic in Canada. We attract people because of our title “Outdoor Capital of Canada”. We are in the mountains, on an ocean. Every sport imaginable is available in a range from extreme to modest. Rock climbing, mountain biking, kayaking, skiing etc. We have Olympic athletes that live and train here all year.

That makes for lots of scar tissue. Good thing we have surgeons and great GP’s to work along side. It is a privilege to work in such a young and vibrant community that is willing to push all the envelopes.

You have worked with people on postoperative care.

Research into wound healing has shown that adhesion formation happens within 6-12 hours of surgery. The collaboration with medical practice is exceptional in Squamish. My practice had many post-surgical patients, mostly cancer/orthopedic. Once scar tissue is formed it is impossible to change. The best effect is while tissue is forming. Research has helped move massage therapy forward in post-surgical care. I have always had my practice in difficult, chronic pain and

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surgery patients that have been through much health care.

How did you get involved in research?

I have always been involved in research. I grew up reading anatomy and physiology books obsessively.

The paradigm and dogma introduced to me at massage school often didn’t jive with what I had learned. I had been in anatomy labs, and going to University of Toronto medical open houses since I was 6. Research gives us a better understanding of the mechanisms involved with our work. I put together a few projects while in Toronto, but for various reasons did not finish the projects. Tools were not available, resources were slim, collaboration was difficult with under-educated therapist (like ME). I went to the Amsterdam Fascia Research Congress trying to find a tool to measure scar tissue extensibility. No luck, but met a scientist (Dr. Geoff Bove). We collaborated on a breast cancer project I was trying to get data on, and started to look deeper at the mechanisms, as well as examination of the tools available to collect quantitative data.

You worked with people having adhesions developed from surgical procedures. What did you do and how massage can help.

Massage is of great benefit to post-surgical patients.

The statistics in many surgeries show that women get more surgery than men. This is anything from obstetric/gynecology, heart, kidney, and cancer surgeries. I observed fresh breast cancer scarring often, with immediate ROM problems as well as developing lymphedema. Little is known about the effects of manual therapy on wound healing, including in allopathic care. It is a very simple mechanism, complex cellular. Tissue heals quickly, adhesions form quickly. It is impossible to affect a scar once it has formed, but very possible to prevent adhesion formation during the post-operative healing process. From immediately following surgery

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Susan Chapelle (keep cells moving, decrease inflammatory response – See the paper Chapelle, Bove, JBMT) and keep things moving so they don’t stick together. Gentle postsurgical mobilization is excellent for reduction of adhesions. Newly formed adhesions can be manually lysed.

But not so successful with bigger, and older adhesions.

Then the question is, what we can access and affect.

Human studies on ischemia are being looked at, as well as other new information that is all good for our profession.

Can you briefly explain the research behind the article “Visceral Mobilization can Lyse and Prevent Peritoneal Adhesions in a Rat Model” published in the Journal of Bodywork and Movement Therapies (JBMT).

As most therapists who were taught visceral mobilization, I found much hypothesis and no didactic, scientific, evidence-based or informed information. I work with many patients and had a great story, but was “hallucinate along with me”. I had no idea if I could or could not affect adhesions. Or move organs, affect fascia, integrate with nerves. This project gave me some very clear guidelines as to what we can affect. As well, the questions raised and observations spawned our second study on post-operative ileus. (Which spawned another hypothesis on neural involvement in the formation of adhesions, in review with the NIH for funding). Science should always spawn more questions.

Thank goodness.

There are many studies looking the efficacy of massage for a particular condition. Meanwhile there is not much research that specifically looked into the mechanism of how massage works.

I dislike case studies. They are perhaps interesting but nothing other than. It can spark good conversation with no data. I am an evidence driven person, and one that does not like the A-C method of research. This is where you say, because of this, therefore that. With no data or information to inform the leap. I see the value in examination of the effect of a treatment, but hopefully on 15 people, not just “I worked on this person, and this happened”. We must look to inform mechanism, not just “this, therefore that”.

There are now many research studies coming out, not in massage therapy but other manual therapies. Essentially, manual therapy has the same mechanism of change, it doesn’t matter what title you are called. As a (massage) profession we are debilitatingly undereducated. It doesn’t spark a ton of confidence in giving money to our profession to work in labs. There are

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Susan presented her work at the AAMT conference in Adelaide, May 2013.

treatments out there that work, but have anecdotal mechanisms. We need better collaboration on preexisting models of disease. Or a really rich person who likes massage therapy and can fund a therapist to work in a lab ;-).

Do you think massage therapists should be more research orientated? Or should treatments be evidencebased?

I think everyone should be better informed as to the evidence available. I speak as a politician and therapist.

We should not be afraid to say that we don’t know or understand an area, and absolutely should not make up mechanisms that have no anatomical or physiological truth in them. It is ok to rub and say, “so happy you feel better” without saying what you are affecting. Most of the time we guess, based on intuition, or poor information. Being wrong can affect the public’s health care, and the view of our profession. Better to be informed.

Evidence informed is the best we have right now. We do not need to be research oriented to do our work. We should use our natural curiosity on why a person is getting better with treatment to look into the basic anatomy of the structures involved. Then we need to look at what research has been done in the area. Then we can be better informed for our patients, other professionals, and ourselves.

What are you working at the moment?

Various projects:  A software that has a research oriented search engine for record keeping. Every clinic is a wealth of

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Susan Chapelle data.  How massage therapy affects neural regeneration (Funded by BCMTA).  The continuation of the work on visceral adhesions (if we get NIH funding, in review)  Building better education systems and regulatory bodies for massage therapy  Collaborative health care and funding for preventative health care in politics. Canada (everywhere) needs better funding for research into prevention. We are all going broke paying for healthcare.

What are your favourite manual therapy books?

Thieme Atlas of Anatomy: Neck and Internal Organs (or any of Thieme anatomy books) and Wall and Melzack’s Textbook of pain, 6th edition.

Manual therapy books are a wealth of subjective conjecture. I derive my rubbing skills from my clinic, my knowledge of what I am doing from science, anatomy and physiology. We are all capable of the same skills and level. It’s the deeper understanding of the mechanisms that we lack.

Susan Chapelle has been a practicing therapist for over 18 years. Susan worked in the entertainment industry backstage for 15 years before deciding to become a massage therapist. This led her to treating people in the industry and opening a clinic that specialized in the quick assessment and treatment of performing artists. In 2012, Susan accepted the award from the Massage Therapists Association of “BC RMT of the Year”. Susan has been working with palliative care patients for over 10 years, and recently embarked on a research study to deepen the understanding of how massage therapy effects post surgical complications in breast cancer patients. Susan enjoys living in Squamish for the outdoors. She is an avid climber, skier and mountain biker. Susan is one of the presenters at the 2013 AAMT Conference in Adelaide.

References Geoffrey M. Bove, DC, PhD, Susan L. Chapelle, RMT. 2011. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. Journal of Bodywork & Movement Therapies. Available from: http:// www.squamishintegratedhealth.com/wp-content/ uploads/Bove_Chapelle_11_Adhesions.pdf

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A Journey in Fascia Wonderland This article is based on Robert Schlep’s talk at the 3rd World Fascia Congress in Vancouver 2012 titled: Alice in Wonderland- Getting curioser and curioser.

The scientific world and the clinician world rarely meet, and the fascia congress is one of the important events that tried to make scientists and manual therapists meet and started to talk to each other. Most manual therapists or bodyworkers choose to be in the complementary and alternative groups. The field is usually dominated by different schools, where the teachers or charismatic founders are regarded as the ‘knowledge’ authority. (Whitney Lowe called this The Sage on the Stage). The teachers are quite skilful but sometimes the concepts they proposed stretch a bit beyond from the scientific reality. For example Dr. Andrew Taylor Still, the founder of Osteopathy, and Dr. Ida Rolf, the founder of Rolfing. They have very profound clinical knowledge, and they tried to explain what they are doing based on their knowledge at that time. Myofascial release was thought to be able to change the state of the ground substance from gel to sol, or able to loosen the cross links of the collagen fibre. But most of these theories or hypotheses came from their own intuition without solid scientific proof.

The first fascia congress held in Boston, in 2007, and covered by the prestigious Science magazine with an article titled “Cell Biology Meets Rolfing”. The article described the opportunity but also the challenges of how scientists and clinician can meet and talk to each other. The two groups reach out to each other, with a hope to provide fruitful exchanges of ideas and experiences. Clinicians such as Schleip have travelled from the ‘alternative world’ to the scientific world by doing a PhD degree in fascia biology. Meanwhile scientists such as Tom Findley, a medical researcher, travelled to the clinician world by studying Rolfing for several years.

Robert compared himself as Alice in Wonderland, he has travelled in the Scientific Wonderland, and came back telling stories about strange scientists he met to his fellow clinicians.

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A therapist waiting to be enlightened by researchers.

Robert gave three specific examples of what he as a clinician had been able to learn from the scientific world.

(1) Fluid dynamics Water constitutes around 68% of the fascial tissuesvolume . Fascia regulates the flow of fluid in the extracellular matrix, and fluid flow can causes fascial remodelling. A study conducted by Schleip and coworkers at the University of Ulm (Figure 1) showed that, in an in vitro study using fascia from animal, that during the tissue loading (fascia stretch) water is extruded from the tissue and this tends to contribute to a temporary decrease in tissue stiffness (i.e. tissue softening) immediately after the stretch. The findings also found that that after the stretch, the stiffness of the tissue increases and it also regains a gradual rehydration.

This phenomenon is due to the behaviour of the ground substance in the extracellular matrix which prevented from absorbing fluid by tension that fibroblast cells put on extracellular matrix fibres. When this tension is relaxed, the extracellular matrix can absorb fluid rapidly.

The implication is that when Robert applied pressure through his elbow to the thoracolumbar fascia, he now paid more attention to the fluid dynamics, rather than only trying to melt the tissue or breaking up the fibrous tissues, or stimulating the mechanoreceptors. Now Robert works more gently and more slowly. We should

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A Journey in Fascia Land 72

Mean fibre length (μm)

(a)

Moisture Content (%)

70 68 66

64 62

75

400

Subcutaneous tissue Outer layer

50

Inner layer

200 25 0

0 CGRP

60 Before

After

After 30 After 1 hr After 2 mins hrs

After 3 hrs

Figure 1. Changes in the mean water content of a porcine lumbar fascia before and following a 15 minutes stretch with a 4% strain (After Schleip et al., 2012)

Another research by Melody Swartz (from Lausanne, Switzerland) described how subtle change in fluid shear on cell culture has a profound change in the fibroblasts. Fibroblasts are most responsive to the detection of fluid shear - i.e. to the slow motions of the water around them - as sensed through their antenna-like cilia (soft tentacle). It is indicated that a large portion of the impact of collagen stretch is less due to the direct effect of transmission of that stretch to the cell membrane, but rather to the sensation of the fluid shear which is induced by the collagen fibre reorientation which is then sensed by the hair-like cilia.

This idea can be illustrated as follow: imagine how much the hairy tip of a painter's brush would bend if you move it at a steady speed through a fluid medium.

Or imagine moving a finger through yoghurt. Both the speed as well as the viscosity of the fluid medium will influence the amount of shear. The clinical implication is that if you move very slowly at a constant speed through a dense tissue area (e.g. with the therapist's knuckle or a foam roll), then the tiny cilia of the fibroblasts will be bent only very gently by the resulting fluid shear, and this seems to stimulate them to produce an enzyme (MMP-1) which starts to break down excessive collagen in the next few hours.

(2) A tool for evaluating the stiffness of tissue Most palpation that we do is subjective, and therapists cannot remember how ‘stiff’ is the tissue before and after treatment (or even a week after treatment).

Therapists should have a more objective tool to measure the therapeutic response. Robert suggested Myoton Pro, a tool recently developed to measure the tissue stiffness. The quantitative digital measurement provided by this ‘myometer’ proved to be reliable and useful for assessing biomechanical properties of myofascial tissues. This tool works by creating a constant pre-load of the soft tissue via a movable indentation probe, which is then rapidly released and the tissue response

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Substance P

(b) Percentage containing receptive free nerve endings 65% 72% 0% 33%

now thinking not only about stimulating the mechanoreceptors or golgi tendon organ, but be aware of how the fluid moves.

Middle layer

CGRP

Subcutaneous tissue

69%

Outer layer

95%

Middle layer

0%

Inner layer

0% Substance P

Figure 2. The distribution of CGRP and Substance P (SP)immunoreactive nerve fibers in the Thoracolumbar Fascia (redrawn from Tesarz et al., 2011). (a) Mean nerve fibre length of CGRP and SP. Almost all fibres were found in the outer layer of the fascia and the subcutaneous tissue. The middle layer was free of SP-positive fibres. (b) Distribution of CGRP and SP-containing receptive free nerve endings expressed as percent of the total number of CGRP- or SPcontaining fibres in each fascia layer. SP-containing free nerve endings were restricted to the outer layer of the thoracolumbar fascia and the subcutaneous connective tissue while CGRP-containing free nerve endings were also found in the inner layer of the thoracolumbar fascia.

(damping oscillation) of the tissue is measured. This kind of tool could provide a more objective measurement on the effectiveness of our treatment.

(3) Innervations of the lumbar fascia Prof. Siegfried Mense, in his lab. in Heidelberg, Germany, showed that the thoracolumbar fascia is densely innervated. Another recent study also from Heidelberg led by Jonas Tesarz et al. (2011), and published in Neuroscience journal, quantified the amount of innervation of the thoracolumbar fascia (TLF). Using calcitonin gene-related peptide (CGRP) and substance P (SP)containing free nerve endings, they quantified the amount of nerve endings in the TLF of rat. They showed that the TLF is a densely innervated tissue with marked differences in the distribution of the nerve endings over the fascial layers (Figure 2). They distinguished three layers: (1) outer layer (transversely oriented collagen fibers adjacent to the subcutaneous tissue), (2) middle layer (massive collagen fiber bundles oriented obliquely to the animal's long axis), and (3) inner layer (loose connective tissue covering the paraspinal muscles).

It is the subcutaneous tissue and the outer layer that showed a particularly dense innervation with sensory fibres. SP-positive free nerve endings-which are as-

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A Journey in Fascia Land

Autonomic Nervous System

Fascial tonicity

Fluorescent ratio

Cytokines, pH

Mechano-stimulation Figure 3. Proposed interaction between the autonomic nervous system and fascial tonicity. Sympathetic activation tends to activate TGF -β1 expression (as well as probably other cytokines) in the body, which has a stimulatory effect on myofibroblast contraction, thereby leading to an increase of fascial stiffness. In addition, shifts in the autonomic nervous system state can induce changes in pH, which affects myofibroblast contraction as well. Skilful therapeutic stimulation of mechanoreceptors in fascia - particularly of Ruffini or free nerve endings - can induce changes in the autonomic nervous system.

Redrawn from Schleip et al. (2012).

Oscillating Fibroblasts (%)

0

200

400 Time (s)

600

20

10

0 sumed to be nociceptive-were exclusively found in these layers.

Because of its dense sensory innervation, including nociceptive fibres, the TLF may play an important role in lower back pain. Most of the myofascial pain may come from the superficial layer. This suggests that it may be most effective to work more superficially, stimulating proprioceptive nerve endings and reaching to the nociceptor. For many years Robert taught his students to work deeper for more profound change, but now based on this new finding, he often works more superficially to be more effective.

In addition, Robert also suggested three areas of consideration that scientists can learn from therapists: (1) The influence of sympathetic activation on and fascial tonicity Vladimir Janda, suggested a close relationship between the autonomic nervous system (ANS) and fascial tonicity, implying that sympathetic activation may lead to an increased cellular contraction within fascial tissues.

However it was not until recent findings that suggests that sympathetic activation induces an increased TGFβ1 expression; and- since this cytokine is known as the most potent stimulator of myofibroblasts contractionthat this may also lead towards an increased fascial contractility.

Figure 3 illustrates a possible two-way interaction between ANS activation and fascial tonicity. Besides the influence of the ANS on cellular contractility in fascia, this diagram also emphasizes the potential influence of

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50

100

150

200

250

Ca2+ Oscillation period (s) Figure 4. Myofibroblasts expressed rhythmic calcium oscillations.

The graph on the left showed recording of fluorescence activity of five individual cells, which were previously stained with Flura-2. The analysis revealed a common peak around 99 ± 32 seconds of the cells, as well as asecond maximumof 221 ± 21 s. Graphics based on Follonier et al. (201 0).

therapeutic fascial stimulation on ANS tuning. Stimulation of non-nociceptive mechanosensory free nerve endings can influence ANS tuning. In addition, stimulation of Ruffini corpuscles- which are reportedly particularly sensitive to slow shear application - tends to inhibit sympathetic activation.

(2) The Rhythmic oscillations of fascial tissues When connective tissue cells were put together in a cell culture medium with a collagen grid, they tend to show periodic oscillations. In particular, it has been shown that they expressed rhythmic calcium oscillations which were accompanied by contractions of the cells. A study by Follonier et al. (2010) demonstrated that myofibroblasts tend to oscillate in such an environment in synchronicity, when they were in close contact with each other (Fig. 4). The observed oscillations had a mean period length of 100 second. It is an intriguing question whether this very slow rhythm observed in these cell cultures - with one cycle taking more than one and a half minutes- could be related to the socalled “long tide” oscillations in biodynamic craniosacral therapy. The so-called “breath of life” has a deep and slow rhythmic impulse expressed about once every 100 seconds. This needs to be tested in real-

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A Journey in Fascia Land world, whether myofibroblasts can express this behaviour, and related to the "breath of life". Or this is just a palpatory illusion of the therapist.

(3) Fascia research networking Finally, scientists should collaborate more following the network properties of the connective tissues. Competition in the scientific world is very strong (sometimes can be ruthless), researchers compete to publish first, therefore they usually never share their findings or data. This is also instigated by competition for funding. Scientists should be more open to their work and collaborate more, without the fear of other people trying to steal their ideas. They should imitate the network tissues they are working on by forming a network of exchange of information.

References Follonier, C.L., Buscemi, L.,Godbout, C., et al., 20 I 0.A new lock step mechanism of matrix remodeling based on subcellular contractile events. J. Cell Sci. 123, 17511760.

Schleip R, Duerselen L, Vleeming A, Naylor IL, Lehmann-Horn F, Zorn A, Jaeger H, Klingler W. Strain hardening of fascia: static stretching of dense fibrous connective tissues can induce a temporary stiffness increase accompanied by enhanced matrix hydration. J Bodyw Mov Ther. 2012 Jan;16(1):94-100. doi: 10.1016/ j.jbmt.2011.09.003.

Tesarz J, Hoheisel U, Wiedenhรถfer B, Mense S. Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience. 2011 Oct 27;194:302-8. doi: 10.1016/j.neuroscience.

Schleip, R., Jager, H., Klinger, W. 2012. Fascia is Alive.

In: Fascia: The Tensional Network of the Human Body.

Churchill Livingstone.

This book is the product of an important collaboration between clinicians of the manual therapies and scientists in several disciplines that grew out of the three recent International Fascia Research Congresses (Boston, Amsterdam, and Vancouver).

The book editors, Thomas Findley MD PhD, Robert Schleip PhD, Peter Huijing PhD and Leon Chaitow DO, were major organizers of these congresses and used their extensive experience to select chapters and contributors for this book. This volume therefore brings together contributors from diverse backgrounds who share the desire to bridge the gap between theory and practice in our current knowledge of the fascia and goes beyond the 2007, 2009 and 2012 congresses to define the state-of-the-art, from both the clinical and scientific perspective. Prepared by over 100 specialists and researchers from throughout the world.

Available at www.terrarosa.com.au

Terra Rosa e-magazine, No. 12 (June 2013)

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Based on the Latest Research in Fascia, A new approach to train your fascial web.

Conventional training has been emphasizing on muscles, cardiovascular fitness and coordination. However, most of the sports injuries occur in the connective tissues. Fascial Fitness will show you how to train the connective tissues, to prevent and repair damage, and to build elasticity and resilience into the body.

This workshop is the only training program for the development of supple, flexible and strong connective tissue!

Learn the latest findings in Fascia Research and put it into practice.

Fascial Fitness complements conventional sports training with recommendations for specific loading exercises, dynamic stretching as well as 'bouncing' movements that utilise and strengthen the elastic recoil inherent in collagenous tissues.

Watch our for Introductory and Certification Courses in 2014 www.terrarosa.com.au/ff

If the 'fascial' body is well trained – optimally elastic and resilient – it can be relied on to perform effectively, to allow peak performance, to foster the coordination of supple, elegant movement and to offer a higher potential for injury prevention.

About the Instructors Divo Muller 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, which teaches 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.

She is one of the original developer of Fascial Fitness program.

Robert Schleip PhD is an International Rolfing Instructor and Fascial Anatomy Teacher. Robert has been an enthusiastic certified Rolfer since 1978. He holds on M.A. degree in psychology and is a Certified Feldenkrais Teacher since 1988. He earned his Ph.D. with honours in 2006 at the age of 52, and shortly thereafter established the Fascia Research Project at Ulm University and has a lab of his own. He was co-initiator and organizer Terra Rosa e-magazine, No. 12 (June 2013) of the first Fascia Research Congress at the Harvard Medical School in Boston, USA in 2007.

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Venolymphatic Drainage Therapy Guido F. Meert We often forget that our cells are, in a matter of speaking, swimming gel-like living structures in an ocean of interstitial fluids. The concentration quotients of salts (NaCl, KCl, CaCl2) in the interstitial fluid and in the water of an ocean are astonishingly nearly identical. In our body, we are quasi carrying an ocean around with us and actually we have to keep the chemical composition of the oceans fluid constant (5).

Anyone who owns an aquarium knows that if one wants to keep the fish healthy, one has to clean the tank, to clear out the drain and to filter and drain the water regularly. Just as the fishes, the cells of a living being need those cleaning arrangements. Furthermore they need food and oxygen and have to get rid of waste products. For example many proteins are too large to simply diffuse, therefore flow in the interstitial space is necessary for the transport of those proteins from the blood to the cells, and vice versa.

Both cleaning and nutrimental processes proceed logistically by the venous and lymphatic fluids. The lymph nodes, the spleen, the liver and the macrophages (leucocytes) try to fish out the waste materials and antigens out of the body fluids. Unfortunately, the connective tissue is often being abused as storage for waste products or to make things even worse used as a dumpsite. It is absolutely necessary that one needs to readjust his/her life-style and looks after a balanced diet, moderate sport and exercise and a reasonable stressmanagement.

The battle between infections and the body´s defenses is mostly fought in the connective tissue, leaving behind remains and fragments (5). It is not for nothing that Andrew Taylor Still instructed us: “Let the lymphatics always receive and discharge naturally. If so we have no substance detained long enough to produce fermentation, fever, sickness and death” (11).

To enable the defence cells to attack antigens and to start the immunologic communication, it is useful to loosen and to soak through the connective tissue. After

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all, leucocytes have to crawl out of the vessels and penetrate the collagenous network to find the battlefield. Myofascial techniques allow us to break up fascial adhesions. Subsequently, it makes sense to irrigate and purify the connective tissue by some venolymphatic drainage techniques. By stretching or compressing the tissue, water is being extruded out of the connective tissue and makes the tissue more pliable and supple.

Afterwards water is re-adsorbed and the tissue search for new equilibrium. In connective tissue we are dealing with interfascial and bulk water. Via hydrogen bonds, the interfascial water molecules seem to interact with the folding and therefore also with the function of the proteins (1). Water in bulk seems to behave differently from water in confined spaces (f.e. in interfascial spaces), but more research is needed into this (13). The extracellular matrix builds a gelatinous network, containing collagenous and elastic fibers and matrixmolecules (proteoglycans, glycoproteins, glycosaminoglycans), who bind the containing water. In fact, we can make out three “populations” of water molecules in the connective tissue (9): - water molecules, bound within the triple helix of the collagen molecules, - water molecules, bound on the surface of the triple helix or bound with matrix molecules - water molecules, free-running in the space between the fibrils and fibers.

Biochemical reactions take place in the confined spaces with interfascial water and bigger and smaller interfaces are built, with a hydrophobic or hydrophilic character for the interstitial fluids. It is fascinating to study the mechanical properties of the connective tissues in combination with the dynamics of the water molecules and hydrogen bonds (2). But more research is certainly needed into this.

Therapists can first try to “dissolve” adhesions of the collagen network and thereafter they try to “wash out” pro-inflammatory substances and waste products by venolymphatic pump-techniques. However it is absolutely necessary – before starting a venolymphatic

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Venolymphatic Drainage Therapy

fluids and react to it by secreting chemokines and several cytoykines (8). The vessels are even able to regulate the frequency and amplitude of their pumping activities and in a manner of speaking to interact with their environment.

drainage - to be aware of some contraindications: acute inflammation, heart failure, infectious diseases, thrombosis, embolisms, malignant diseases and other acute diseases (5)!

Unlike the blood circulation, the lymphatic system has no cardiac pump to make the fluid circulate. However, the mechanisms responsible for keeping the interstitial fluid in motion include the intrinsic pumping movements of the lymphatics and vessels (vasomotion) as well as the intrinsic mobility of the tissue (3).

Fibroblasts exert tensile forces on collagen fibers of the extracellular matrix (ECM) via integrins and thereby squeeze the ground substance. Afterwards they decrease their tension upon the collagen fibers and allow the ECM to take up fluids and swell up (10). Proinflammatory cytokines (prostaglandin E1, interleukin1, interleukin-6, TNF-α) seem to trigger the relaxation of the fibroblast-collagen network and lower the interstitial fluid pressure. Substances that provoke the squeezing of the ECM and increase the interstitial fluid pressure are for example platelet-derived growth factor or β1-integrins (4).

There are several body-rhythms (rhythm of the heart, respiration, peristalsis…), which interfere with each other and ultimately produce a slow rhythm in the human body, unique for that person and that moment.

Beside the pumping activity of the fibroblastcollagenous network, one of the most interesting rhythms that promote this body- or tissue-rhythm, is the active vasomotion of lymphatics and vessels (7).

Thereby the endothelial cells seem to be able to “feel out” the flow or the absence of flow of the interstitial

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It is a fascinating experience to learn to palpate, stimulate and channel those individual and subtle waves of “swelling, straightening oneself and exorotation of the extremities” and “detumescing, slumping down and endorotation of the extremities” through the tissues of the patient. I prefer to call those waves, “inspiration-” and “expiration-waves” of the “breathing” of the tissue rhythm. If we are able to manage it to reinforce those body waves, we can amplify the milking and nourishing effects of the ground substance, without exerting any aggressive force on the tissues. Therefore it is helpful to apply some pumping drainage-techniques first, which complement a lymphatic drainage. I am grateful, to be able to develop some venolymphatic drainagetechniques and a general treatment schedule (6): 1. Myofascial release 2. Treatment and stimulation of the organs responsible for excretion and detoxification 3. Lymphatic + venous + intraosseous pumping (perfusion of the tissue) 4. Treatment and stimulation of the diaphragms 5. Release of articular restrictions 6. Active exercises and general lifestyle/attitude changes For more information on venolymphatic drainage, may I invite you to read my book “Venolymphatic Drainage Therapy” (Churchill Livingstone, 2012), and my book “Venolymphatic craniosacral osteopathy”, which unfortunately is only available in German at the moment.

Perhaps, we will meet each other between the lines…

References (1) Bellisent-Funel M.C.: Hydrophylic-hydrophobic interplay: from model systems to living systems. 2005 – Comptes Rendus Geosciences, 337, 1, 173 – 179.

(2) Fenn E.E., Wong D.B., Fayer M.D.: Water dynamics at neutral and ionic interfaces. 2009 – Proc. Natl.

Acad. Sci. U.S.A., 106, 36, 15243 – 15248.

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Venolymphatic Drainage Therapy (3) Gashev A.A., Davis M.J., Zawieja D.C.: Inhibition of the active lymph pump by flow in rat mesenteric lymphatics and thoracic duct. 2002 – J. Physiol., 540, 3, 1023 – 1037.

(4) Martin M., Resch K.: Immunologie. 2009 – Verlag Eugen Ulmer, Stuttgart.

(5) Meert G. F.: Fluid dynamics in fascial tissues. In Schleip R. et al: Fascia – The Tensional Network of the Human Body. 2012 – Churchill Livingstone, Elsevier, Edingburgh.

(6) Meert G. F.: Venolymphatic Drainage Therapy. An osteopathic and Manual Therapy Approach. 2012 – Churchill Livingstone Elsevier, Edingburgh.

(7) Meert G. F.: Venolymphatische kraniosakrale Osteopathie. 2012 – Elsevier, München.

(8) Ng C.P., Helm C.L., Swartz M.A.: Interstitial flow differentially stimulates blood and lymphatic endothelial cell morphogenesis in vitro. 2004 – Microvasc Res. 68, 3, 258 – 264.

(9) Peto S., Gillis P.: Fiber-to field angle dependence of proton nuclear magnetic relaxation in collagen. 1990 – Magn. Reson. Imaging, 8, 6, 703 – 712.

(10) Reed R.K., Liden A., Rubin K.: Edema and fluid dynamics in connective tissue remodeling. 2010 – J. Mol. Cell. Cardiol., 48, 518 – 523.

(12) Still A. T.: Philosophy of Osteopathy. 1992 – Eastland Press, Seattle.

(13) Ye H., Naguib N., Gogotsi Y.: TEM Study of water in carbon nanotubes. 2004 – JOEL News Magazine, 39, 2, 2 – 7.

About the author Guido F. Meert (physiotherapist and osteopath) was born in Aalst, Belgium: in 1963. He is currently working in practice in Roding, Bavaria, Germany. Guido is the Founder, Technical Director and Lecturer of the German Osteopathic Skill Centre (Deutsches Fortbildungsinstitut für Osteopathie) in Neutraubling (Germany), Waldenburg (Germany) and Plauen (Germany). He regularly gives lectures on theoretical and hands-on seminars in Germany and Switzerland. He has authored 3nbooks: "Das Becken aus osteopathischer Sicht" (The pelvis from an osteopathic view), "Das venöse und lymphatische System aus osteopathischer Sicht". Translation in English: "Venolymphatic Drainage Therapy" and "Veno-lymphatische kraniosakrale Osteopathie” (Venolymphatic craniosacral osteopathy).

(11) Schleip R. et al: Fascia – The Tensional Network of the Human Body. 2012 – Churchill Livingstone Elsevier, Edingburgh.

Prepared in an easy-to-follow, practical format, Venolymphatic Drainage Therapy: an Osteopathic and Manual Therapy Approach explores the anatomy, physiology, embryology and biomechanics of the venolymphatic system and also presents a variety of effective treatment options which range from the treatment of functional disorders of the diaphragm, the intraosseous fluid system, the spleen, liver and gallbladder, kidneys and ureters to the management of problems connected with the abdominal mesenteries and abdominal organs.

Richly illustrated with an abundance of artworks and photographs throughout, this volume will be ideal for osteopaths, chiropractors, physical therapists, physiotherapists and massage therapists worldwide.

Available from www.terrarosa.com.au

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Terra Rosa proudly brings you

CORE Myofascial Therapy with George Kousaleos CORE Myofascial Therapy Certification program Sydney, 26,27,28 September 2014: CORE Myofascial Therapy 1 29,30 Sept- 1 Oct 2014: CORE Myofascial Therapy 2 An advanced, six-day workshop designed to give practicing massage therapists in-depth knowledge and hands-on experience in full-body Myofascial treatment protocols. With this knowledge and skill, you will be able to improve your clients’ structural body alignment and increase their physical performance.

CORE Myofascial Therapy was used as the premier treatment for the British Olympic Team at their 1995 and 1996 Olympic Training Camps held at Florida State University.

Techniques and Skills you will learn and be able to apply to your practice immediately:  Myofascial Spreading- the foundation technique for full-body treatment  Back Specific- a comprehensive routine for the deep musculature of the Para spinal, shoulder, and hip regions.  CORE Release- intrinsic techniques for balancing the pelvic structures  Arthrokinetics- arm and leg joint techniques that reduce ligament tension and holding  End Work- a series of techniques that stimulate the parasympathetic response at the close of a session  Neurosomatic Awareness Exercises  How to combine both passive and active movements into your session for greater results  Specific techniques to address and theories of common structural and functional client issues.  Ultimately how to eliminate pain, restore movement and limited function, and get long term results.

CORE Sports and Performance Bodywork Sydney, 3,4,5 October 2014 This 2-day seminar will examine the four basic styles of performance inherent in all athletic disciplines. Utilizing structural integration and myofascial therapy theories and techniques that are appropriate for each style of performance, participants will focus on developing training and event protocols for endurance, sprint, power, and multi-skilled athletes. Presentations on performance mechanics, somatotypes, and the balancing of the autonomic nervous system will highlight a comprehensive study of advanced therapies for the athletic performer.

George Kousaleos, LMT is the founder and director of the Core Institute, a school of massage therapy and structural bodywork in Tallahassee, FL. He is a graduate of Harvard University, and has been a leader in the massage therapy field over his 30-year career. He helped bring sports massage to the 2000 and 2004 Summer Olympic Games, and is a past president of the Massage Therapy Foundation.

He is the General Manager of the 1996 British Olympic Preparation Camp Sports Massage Team and as Co-Director of the 2004 Athens Health Services Sports Massage Team he has supported the inclusion of massage therapy at the highest levels of international sports.

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George teaches throughout the world and has given keynote and motivational presentations to national and international organisations. His website is at www.coreinstitute.com

Emotional Release Q&A with Art Riggs

Q

DEAR ART, I’m taking an advanced continuing education class and the instructors are trying hard to elicit a strong emotional release when demonstrating on models. This upsets me. I feel this is unethical and potentially harmful, and it conflicts with my previous training.

What is your opinion? —FRANK

DEAR FRANK, I can empathize with your feelings—or rather, “I feel your pain.” Some teachers in my CE classes over the years appeared to be trying to impress practitioners with the power of their work by demonstrating their ability to initiate emotional release. Some therapists in the class reserved their spots in queue for a meltdown virtually every day so they could have their 15 minutes of fame in the centre of the healing circle. My opinion is that expanding our skills is an important part of the profession, but it should be limited to our professional parameters. You’re correct: playing amateur psychologist is in conflict with our scope of practice as bodyworkers. I know several clients who expressed their distaste for what they consider to be intrusive and leading questions by some therapists attempting to steer the session into psychological encounters. If one wants to be a psychologist, then by all

A

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means pursue that goal with accredited academic training and a long period of supervision. But how would we bodyworkers feel if psychologists began offering massages without proper training? The mind-body relationship is very real, though, and one of the wonderful gifts we can give our clients is the ability to feel and express their emotions within proper boundaries and in a safe environment.

Spontaneous emotional reactions do happen during bodywork, and I will offer a few suggestions for dealing with them. However, there is a huge difference between allowing emotions to naturally occur and the manipulation of those emotions, either verbally or physically. In the early days of the Human Potential Movement1 , some therapists would perform painful work, exhausting clients until they would finally break down in tears or yell in anger, knowing that the therapist would be satisfied and lighten up. An important principle in our work is to never attempt to induce any emotional response—sadness, anger, contact with an “inner child,” or repressed memories. When potential clients ask me if I do emotional bodywork, I tell them that I am very comfortable with anything that comes up in a session, but I do not consider myself to be an evocative therapist that attempts to manipulate the session. Some clients will, of course, be looking for just such a relationship, and there will always be some well-meaning therapists who will serve these peoples’ needs. However, these practitioners are treading on thin ice. Often, the cathartic releases really aren’t therapeutic and can simply be unconscious reactions to play along with the therapist’s agenda, or a repeating drama without any

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Emotional Release you feel that the reaction is escalating in an unhealthy manner, ask the client to sit up and offer water and a tissue. 

It is our job to maintain the safe shape of the session at all times. Avoid asking, “What would you like to do?” This may allow for some options that are not appropriate, such as the client asking you to leave the room or for close physical contact.

Don’t give the perception that you are uncomfortable or that the response is inappropriate. After an appropriate amount of time, check in on the client and offer specific options, such as working in a different area, sitting quietly, working with the breath to return to normal patterns, or winding down the session.

Frank, it is gratifying to see your ability to not look at everything that teachers say as written in stone. I hope you glean some useful techniques from the class, and I’m confident you can maintain your professionalism.

Note real connections to deep emotions. Some clients practice a repeating cycle of several emotional release sessions until the routine seems repetitive, then move on to another therapist to start the cycle anew. Superficial reactions are usually not problematic and may well serve a purpose for some clients, but amateur attempts to initiate emotional catharsis can amplify serious consequences such as transference, projection, and other quagmires. There is also the danger of releasing deeply held emotional trauma that the massage therapist is unable to deal with.

1 The Human Potential Movement arose in the 1960s with the goal of cultivating what its advocates believed was the untapped potential for growth and change lying dormant in all people. Some examples include Werner Erhard’s EST training, Abraham Maslow’s theories of self-actualization, Transcendental Meditation, primal scream therapy, walking on hot coals, rebirthing, intense bodywork, and many other psychological and bodywork philosophies aimed at uniting the mind, body, and soul.

Guidelines A respected teacher and good friend, Lucy Rush, offers the following advice for dealing with clients who have an emotional reaction to your bodywork: 

Never try to create emotional release.



Support a spontaneous release if it arises—whether it’s sadness, anger, or physical reactions like changes in breathing or muscle movements—by simply observing and allowing it to happen. Do not attempt to intensify or prolong reactions by saying “Let it all out,” or engage in dialogue asking them to explain their feelings.



Always have a glass of water or a box of tissues nearby. Some reactions may build on themselves. If

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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. Visit his website at ww.deeptissuemassagemanual.com.

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Borborygmous Walt Fritz, PT. Borborygmus (plural borborygmi) (from Greek βορβορυγμός) also known as stomach growling, or rumbling, is the rumbling sound produced by the movement of gas through the intestines of animals, including humans. (from Wikipedia) It is viewed as a common and natural occurrence that happens as fluids and gasses pass through the gastrointestinal tract. But I learned this word in a slightly different context.

A number of years ago, as I lay on an acupuncture table, my stomach started to rumble. It happened 10-15 minutes into the session and I did what I think many of us do in a similar situation; I apologized for the untimely noises that my stomach was making. The acupuncturist, who was also a nurse, put me at ease. First she informed me that in Eastern Medicine, such sounds are considered a compliment. In Western Medicine, such sounds are known as borborygmus. I think many of us can relate to my experience, both as a practitioner, who hear the sound begin a short while after a session begins, as well as the client who experiences borborygmus. I loved this concept, as well as the word borborygmus.

It is well established that during the fight or flight response there is an inhibition in stomach and upper digestive tract action. This is a function of the autonomic nervous system and is, in essence, a stress response.

Essentially, all energy is sent to the parts of the body that are needed most for action (for fight or flight), such as the heart, lungs, and skeletal musculature. This action is triggered by the sympathetic nervous system.

When the stress is gone, stomach motility, as well as other functions, resume (triggered by the parasympathetic nervous system). With humans, the fight or flight response may have played a stronger role earlier in our evolution. The need to respond/react to attack may have been daily occurrences. As we moved into more modern times the emergency responses that require

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huge amounts of physical effort and our need for fullfledged fight or flight responses lessened, but the tendency for our bodies to act (or over react) continued.

The stress response halts or slows down various processes such as sexual responses and digestive systems in order to focus on the stress situation, typically causes negative effects like, constipation, anorexia, erectile dysfunction, difficulty urinating, and difficulty maintaining sexual arousal. Prolonged exposure to stress responses can cause a chronic suppression of immune system function. I believe that many are walking around each day in a partial or full state of fight or flight. Clients arrive daily at my office after fighting traffic, fearing of being late for their appointment, bad news on the radio, etc. It is only after they have softened into the treatment table and the treatment begins that they come down from the perceived stress of the outside world. Good hands-on manual care can allow the feeling of threat and stress to diminish. It is then that their digestion restarts. It is then that the borborygmus kicks in.

Enjoy the compliment!

Copyright Walt Fritz, PT and Foundations in Myofascial Release Seminars 2009-2013

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Fascia and Reflexology Fascia, as we all now know, is a seamless web of connective tissue that covers, connects, and holds the muscles, organs, and skeletal structures in our body. Fascia envelopes every structure in the body, each nerve, bone, muscle, organ of the body is surrounded by fascia. Fascia can be found superficially and deep within our body. Superficially, a layer of fascia can be found just under the skin sandwiched between two layers of a honeycomb-like structure that contains fat tissue (See Figure 1. Cross-section from the skin to musculature, showing fascial membranes and rtetinacula Figure 1). Deeper within the cutis fibres. Illustration by Giovanni Rimasti, modelled from an illustration by Luigi Stecco. (From Muscolino, 2012, Used with permission). body, fascial planes wrap around the muscles (Muscolino, 2012).

A significant layer of fat in the superficial fascia is distinctive to human, compensating for the lack of thick Generally fascia is distinguished into superficial and body hair, and plays an important role in heat insuladeep fascia. The superficial fascia is located just undertion. The superficial fascia also conveys blood, lymneath the skin. According to the Stecco studies, the suphatic vessels and nerves to and from the skin and ofperficial fascia is a bilaminar membranous layer rich in ten promotes movement (gliding) between the skin and elastic fibres lying within two layers of what is called underlying structures. It will be mostly affected by the “retinacula cutis”. The superficial fascia together light touch techniques (e.g. lymphatic drainage, Bowen with the superficial and deep retinacula cutis layers is therapy, myofascial release). By contrast, the deep fascommonly known as the hypodermis. Deep fascia is a ciae in the limbs and back are typically dense connectough dense connective tissue below the superficial fastive tissue sheets that have large numbers of closely cia, and it envelops the underlying muscles that are packed collagen fibres (Benjamin, 2009). The deep fasdeep to the skin or envelops periosteum of the bone in cia in contrast to the superficial fascia has a robust, regions. For a more thorough explanation on the differ- multilayer collagen fibre structure and relatively fewer ent layers of fascia, read Joe Muscolino’s article Fascial elastic fibres. The deep fascia is responsible for meStructure (originally published in the Massage Therapy chanical function of force transmission and a possible Journal of the American Massage Therapy Associaproprioceptive role which is due to the large numbers tion). of embedded mechanoreceptors. It is more probable that this layer can be affected by deep massage tech-

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Fascia and Reflexology niques, such as deep tissue work or friction concentrated in limited areas.

In most parts of the body, the superficial fascia is an elastic connective tissue layer surrounded above and below by adipose tissue. However at the palm and sole of the foot, the skin is tightly bound to the underlying tissues to prevent or restrict movement (Figure 2) . If movements were allowed to occur here within fascial planes, then the hands or feet would not been able to have a firm grip. The retinacula of the retinacula cutis layers in the palms and soles are much thicker. They bind the superficial fascia to the deep fascia and adipose tissue is sparse beneath the skin. It is even absent at the finger creases on the palmar sides of the interphalangeal joints, so that the skin immediately covers fascial tendon sheaths (Benjamin, 2009). See also Figure 2 and Figure 3 of Mike Benjamin’s article The fascia of the limbs and back . (The article also provides a thorough anatomical view of the fascia of the hands and feet.) Pavan et al. (2011) studied the mechanical properties of the plantar aponeurosis.

According to Julie Day, a physiotherapist working with the Stecco group in Italy: “The fact that the superficial fascia and the deep fascia almost fuse together in the soles of the feet and the palms of the hand could be an explanation for why working deeply in these areas, as in reflexology, can affect areas that are distant from the area we work on.” Julie who presented Fascial Manipulation at the AAMT conference said that she had often used plantar reflexology in the past and but, at that time, had not found any plausible anatomical explanations for its effectiveness. Reflexology is a relatively easy technique to learn and it can either be incorporated within a massage session or as a specific session apart.

The general belief in reflexology is that each part of the body is interconnected through the nervous system to the hands and feet. Stimulating specific reflex points in the feet is believed to be able to bring relieve to poorly functioning areas of the body. However there is no evidence of such connections between certain parts of the feet and hands and the various organs in the body.

According to Dr. Ida Rolf in “Rolfing and Physical Reality”: "The meridian points and reflex points in the feet are most likely end-points of myofascial strain, the result of imbalance which transmits its difficulty in compensating pattern through the body to the surface. Fascial planes may be the route of mechanical transmission of pain." She also mentioned "Foot reflexes are peaks of strains. They are nothing mystical; they are

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Figure 2. View of the plantar aponeurosis (Photo by Carla Stecco, Used with permission).

where strain goes in the foot. If you are relieving strain above the reflex points (for example in the ankle and shin) you will relieve those points of strain in the sole of the foot. When a weight goes down and dies in some place, it becomes a reflex point." And "I think that many if not all reflex points in the foot are simply points where gravitational strain inserts and comes together. They are the end of the line we call balance" So next time we work on reflexology think of the connective tissue!

References Mike Benjamin. The fascia of the limbs and back – a review. J Anat. 2009 January; 214(1): 1–18. doi: 10.1111/j.1469-7580.2008.01011.x http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC2667913/ Julie Day. What’s New in Fascial Anatomy. Terra Rosa E-magazine No. 8, July 2011. http://www.scribd.com/ doc/60058449/Terra-Rosa-E-magazine-Issue-8-July2011 Joe Muscolino. Fascial Structure. Massage Therapy Journal, Spring 2012. http://www.learnmuscles.com/ MTJ_SP12_BodyMechanics%20copy.pdf Pavan PG, Stecco C, Darwish S, Natali AN, De Caro R. Investigation of the mechanical properties of the plantar aponeurosis. Surg Radiol Anat. 2011 Dec;33 (10):905-11. doi: 10.1007/s00276-011-0873-z.

Ida Rolf. Rolfing and Physical Reality. Edited by Rosemary Feitis. Healing Arts Press, 1978, 1990.

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Pseudoscience & Pseudoskeptics Early knowledge on massage therapy has been mostly based on what therapists observed or experienced. As with other health disciplines, early therapists present their hypothesis based on what they believed is happening. Nothing scientific, but some become myths that are still being passed on. For example, massage can expel toxins out of the body. It turns out some of these myths are completely wrong.

Some of massage teachers then become the ‘authorities’ and start to develop their own modalities and schools, and frequently used pseudoscience to describe what they are doing. Pseudoscience is a claim, belief, or practice which is presented as scientific, but does not adhere to a valid scientific method. It lacks supporting evidence or plausibility, cannot be reliably tested, or otherwise lacks scientific status (http:// en.wikipedia.org/wiki/Pseudoscience). A typical example is linking a modality with quantum physics, the authority would quote something about the efficacy of the technique is due to the reduction in entropy, engaging fractal structure, based on relativity, uncertainty principle, and so on that all sound scientific but got no scientific grounds at all. Pseudoscience holds back the progress in massage therapy.

However many great researchers have contributed to the better understanding of what is happening with massage. Much research has been conducted for the past 20 years to show the efficacy of massage through clinical trials and also trying to figure out the mechanisms on what’s happening. For example, in the field of fascia research there has been tremendous research on the basic understanding on the anatomy and physiology of fascia.

But, there are another group of people who claimed they understand science and started to discredit massage therapy research. E.g. massage has no benefit at all except for relaxation, most research studies on the efficacy were flawed, fascia research is overrated and of no use, stretching is no use, palpation is just an illu-

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sion, etc. Unfortunately many therapists buy into those arguments, some believed they liked to be challenged, and encouraged critical thinking as they dare to disagree. However most of this ‘critical thinking’ is just another presentation of a biased view.

What seems to be a skeptic turn out to be pseudoskeptic, which usually made negative claims without bearing the burden of proof of those claims. Pseudoskepticism (or pseudoscepticism) refers to arguments which use scientific-sounding language to disparage or refute given beliefs, theories, or claims, but which in fact fail to follow the precepts of conventional scientific principles. What you can see directly is that pseudoskepticism usually involves "negative hypotheses" - theoretical assertions that some belief, theory, or claim is factually wrong - without satisfying the burden of proof that such negative theoretical assertions would require.

Some of the characteristics include double standards in the application of criticism, tendency to discredit, rather than investigate, and suggesting that unconvincing evidence is grounds for completely dismissing a claim. (http://en.wikipedia.org/wiki/ Pseudoskepticism) Pseudoskepticism is related to pseudoscience as both advocate poor scientific reasoning. They are impediment to growth and progress. Some like to be challenged, however one should also understand that doesn’t mean it follows any scientific principle. Just as much of it needs science, massage is more as an art as well. Joe Muscolino said “Be open-minded, but don‘t be so open that your brains fall out”.

A quote from Zhiangzu illustrates this: “Life is finite, but knowledge is infinite. To pursue the infinite with the finite, how dangerous that is! To believe that one truly knows, how extremely more dangerous that is “

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Research Highlights Compiled by Jeff Tan The Chemistry of Massage Therapy Do animals enjoy massage? Mice seem to, according to new research from the California Institute of Technology, where scientists picked out the neurons that fire when a mouse is stroked. There are hopes that identifying similar neurons in humans could help develop new pain or stress-relieving drugs. In a study published in Nature, researchers identified the nerves that respond to pleasant, massaging stroking in mice. The nerves, found under hairy skin, are called C-tactile fibres in humans, and they're why we enjoy cuddling and massages.

Researchers found the corresponding nerves by injecting mouse embryos with a gene that caused the neurons to light up when active. They found that the Ctactile-like neurons were activated by stroking the mouse's hindfoot with a paintbrush, but not by pinching it with tweezers. Once they identified what was activating the sensation, scientists genetically modified other mice so their neurons would respond to a chemical stimulus that mimicked the feeling of stroking or grooming.

To test whether the mice actually liked this feeling, they were put in two different chambers after being exposed to either the chemical massage or to simple saline. Before the test, most of the mice exhibited a preference for one chamber or the other, so the chemical massage was set up in the non-preferred chamber. After four days of conditioning, the mice increased the time they spent in the chamber that they associated with the massage - the chamber they initially didn't care for.

This suggests that activating these neurons provided a positive or anxiety-relieving experience.

Visceral massage reduces postoperative ileus in a rat model Abdominal surgery usually causes a temporary reduction of normal intestinal motility, called postoperative ileus. Postoperative ileus extends hospital stays, increases the costs of hospitalization, and may contribute to the formation of postoperative adhesions. Massage therapist from Canada Susan Chapelle together with scientist Dr. Geoffrey Bove designed experiments to determine if visceral massage affects postoperative ileus in a rat model.

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They used forty female Long Evans rats, they were assigned to 4 groups in a 2 (surgery) Ă— 2 (treatment) factorial design. Twenty rats were subjected to a small intestinal manipulation designed to emulate "running of the bowel." Transabdominal massage was performed upon 10 operated and 10 control rats in the first 12 h following surgery. Ileus was assayed after 24 h using fecal pellet discharge and gastrointestinal transit. Intraperitoneal inflammation was assayed using total intraperitoneal protein and inflammatory cell concentrations.

The results showed that surgery consistently caused ileus. Compared to the operated group with no treatment, the operated with treatment group showed increased gastrointestinal transit and reduced time to first fecal pellet discharge. Similar group comparisons revealed that the treatment decreased total intraperitoneal protein and numbers of intraperitoneal inflammatory cells.

The authors concluded that in this rat model, visceral massage reduced experimental postoperative ileus. The data suggest that the effect was through the attenuation of inflammation. A similar study could be designed and performed in a hospital setting to assess the potential role of visceral massage as part of the integrated care for postoperative ileus. The study was published in Journal of Bodywork and Movement Therapy in 2013.

Impact of massage therapy on the levels of distress in brain tumour patients Massage Therapy for Decreasing Stress in Cancer Patients Research was published in British Medical Journal on Supportive and Palliative Care. The research indicates that massage therapy can have a positive influence on the quality of life of people suffering serious illnesses such as brain cancer. Patients with brain tumours report elevated levels of distress across the disease course. Massage therapy is a commonly used complementary therapy and is employed in cancer care to reduce psychological stress and to improve quality of life (QoL). A pilot study was conducted to obtain a preliminary assessment of the effect of massage therapy on patient-reported psychological outcomes and QoL. The study was a prospective, single-arm intervention.

Participants were newly diagnosed primary brain tu-

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Research Highlights mour patients who reported experiencing distress and who received a total of eight massages over a period of 4 weeks. Participants completed the National Comprehensive Cancer Network's Distress Thermometer (DT) six times over a 5-week period.

The results showed that as a group, levels of distress dropped significantly between baseline and week 3, with a further significant reduction in distress between week 3 and week 4. At the end of week 4, the DT scores of all participants were below the threshold for being considered distressed. By the end of the intervention, participants reported significant improvements in one test domain focused on emotional well-being.

Massage on Experimental Pain in Healthy Females A randomized controlled study conducted by researchers form University of Mississippi Medical Center, evaluated the effect of massage on affect, relaxation, and experimental pain induced by electrical stimulation. Published in Journal of Health Psychology, the authors hypothesised that there are 3 mechanisms of massage in reducing pain: through the gate control theory (pain signals can be modified by competing tactile stimuli, such as touch and pressure (counter-pressure) from massage), relaxation (cognitive relaxation induces physiological relaxation and a reduction in pain), and affect (Massage reduces negative affect and increases positive affect).

Participants were 96 healthy women (mean age = 20 ± 6 years) randomly assigned to a 15-minute notreatment control, guided imagery, massage or massage plus guided imagery condition. Guided imagery is a non-tactile cognitive relaxation intervention used to minimize response to acute and chronic pain, which has been shown to work relaxation process. The statistical analysis revealed no group differences in pain intensity, threshold, or tolerance. The two massage conditions generally reported decreased pain unpleasantness, lower unpleasant affect, maintenance of pleasant affect, and increased relaxation compared to the notreatment condition.

The results do not support the hypothesis that massage works by interrupting ascending pain messages. However the most likely mechanisms are: Massage works via increased relaxation (Massage was found to be superior to guided imagery) and Massage works via affective pathway (Massage superior to guided imagery in

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Reduced unpleasant and Maintenance of pleasant). The results suggest that massage may alter immediate affective qualities in the context of pain.

Static Stretch doesn't enhance Sports Performance Researchers recently have discovered that static stretching can lessen jumpers’ heights and sprinters’ speeds. In addition static stretching also does not reduce people’s chances of hurting themselves.

Two recent studies provide reasons not to stretch. A study published in the April 2013 issue of The Journal of Strength and Conditioning Research by Dr. Jeffrey Gerlgley from Stephen F. Austin University, concluded that if you stretch before you lift weights, you may find yourself feeling weaker and wobblier than you expect during your workout. Another new study from Croatia, published in The Scandinavian Journal of Medicine and Science in Sports, provide a comprehensive reanalysis of data from previously conducted experiments. The two studies boost a growing scientific consensus that pre-exercise stretching is generally unnecessary and likely to be counterproductive.

Researchers at the University of Zagreb began examined hundreds of earlier experiments in which volunteers stretched and then jumped, dunked, sprinted, lifted or otherwise had their muscular strength and power tested. For their purposes, the Croatian researchers wanted studies that used only static stretching as an exclusive warm-up. The scientists found 104 past studies that met their criteria. They amalgamated those studies’ results and using statistical calculations determined how much stretching impeded subsequent performance. The numbers, especially for competitive athletes, are sobering. According to their calculations, static stretching reduces strength in the stretched muscles by almost 5.5 percent, with the impact increasing in people who hold individual stretches for 90 seconds or more. While the effect is reduced somewhat when people’s stretches last less than 45 seconds, stretched muscles are, in general, substantially less strong.

They also are less powerful, with power being a measure of the muscle’s ability to produce force during contractions, according to Goran Markovic, a professor of kinesiology at the University of Zagreb and the study’s senior author. From the they determined that muscle power generally falls by about 2 percent after stretching. And as a result, they found that explosive muscular

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Research Highlights performance also drops off significantly, by as much as 2.8 percent.

A similar conclusion was reached by Dr. Jeffrey Gergley in another study, in which young, fit men performed standard squats with barbells after either first stretching or not. The volunteers could manage 8.3 percent less weight after the static stretching. But even more interesting, they also reported that they felt less stable and more unbalanced after the stretching than when they didn’t stretch.

Just why stretching hampers performance is not fully understood yet, although the authors of both of the new studies write that they suspect the problem is in part that stretching does exactly what we expect it to do. It loosens muscles and their accompanying tendons. But in the process, it makes them less able to store energy and spring into action, like lax elastic waistbands in old shorts, which I’m certain have added significantly to the pokiness of some of my past race times by requiring me manually to hold up the garment.

Static stretching alone is not recommended as an appropriate form of warm-up. A better choice is to warm-up dynamically, by moving the muscles that will be called upon in your workout. Jumping jacks and toy-soldierlike high leg kicks, for instance, prepare muscles for additional exercise better than stretching.

From: Reasons Not to Stretch. http:// well.blogs.nytimes.com/2013/04/03/reasons-not-tostretch/ Exercise is as effective as massage for sore muscles It’s a common belief that massage is the best for treating post-workout pain. However a new research published in the Journal of Strength and Conditioning Research has found that massage and exercise had the same benefits. Lars Andersen, the lead author of the study and a professor at the National Research Center for the Working Environment in Copenhagen, and his colleagues asked 20 women to do a shoulder exercise while hooked up to a resistance machine. The women shrugged their shoulders while the machine applied resistance, which engaged the trapezius muscle between the neck and shoulders. Two days later, the women came back to the lab with aching trapezius muscles. On average they rated their achiness as a five on a 10 point scale, up from 0.8 before they had done the shoulder work out.

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Then the women received a 10-minute massage on one shoulder and did a 10-minute exercise on the other shoulder. Some women got the massage first, while others did the exercise first. The exercise again involved shoulder shrugs; this time the women gripped an elastic tube held down by their foot to give some resistance.

(Hygenic Corporation, which makes the tubing used in the study, supported the study.) Andersen’s group found that, compared to the shoulder that wasn’t getting any attention, massage and exercise each helped diminish muscle soreness. The effect peaked 10 minutes after each treatment, with women reporting a reduction in their pain of 0.8 points after the warm up exercise and 0.7 points after the massage. “It’s a moderate change,” said Andersen. He said he expects that athletes would notice a difference in having their soreness reduced by this amount. “I think that for athletes…by reducing soreness then they’re able to perform better, but we didn’t measure this. But if you are sore your movements are very stiff and it’s difficult to perform,” he said. Andersen said he’d like to see future studies track whether warming up the muscles to relieve soreness does indeed impact how well athletes perform. The study suggests that “maybe (massage or exercise) has some benefit for individuals prior to an activity, even though the benefit may be short-lasting,” said Jason Brumitt, of the School of Physical Therapy at Pacific University, who was not involved in the research. It’s not clear how massage or exercise would relieve soreness, but Brumitt said that it’s thought that they help to clear out metabolic byproducts associated with tissue damage. Andersen recommends that people try light exercise to ease their pain.

The effect is moderate, and only offers temporary relief, but the benefit of using exercise, Andersen said, is that it doesn’t require a trained therapist or travel time. “If people go out and exercise and get sore they can find some relief in just warming up the muscles,” he said.

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6 Questions to Mary Bond 1. When and how did you decide to become a bodyworker?

I watched Ida Rolf give a demonstration in 1969 and that was it! I begged her to let me join the class she was to begin the following week. I had no background in massage or anatomy, and no interest, really, in touch therapy. I was a dancer at that time, and what Dr. Rolf spoke about in terms of human movement and gravity was something I just had to understand. At that time, this idea was new, as was Rolf’s insistence that the medium of structure is fascia.

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

I used to have a hard time saying “no” to someone who had pinned their hopes on Rolfing®, but who presented a problem I didn’t believe my work would address. I’ve learned to acknowledge the limitations of my interests and abilities, so these days I can avoid accepting such people into my practice in the first place. In the past, I had to go through the awkwardness of our mutual disappointment.

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

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

I am thrilled by my clients’ amazement when they stand up from the table with new awareness of support and mobility in their bodies. The fun part, for me, is helping them find their own way of describing (and therefore of taking responsibility for) the restored lift through their central line, for example, the settled sensations through their legs, or the articulation in their feet.

3. What are your most favourite bodywork books?

I go back again and again to Calais-Germain’s anatomy books. Also Schultz and Feitis, The Endless Web, and Jeffrey Maitland, Spinal Manipulation Made Simple.

Sandra Blakeslee’s book, The Body Has a Mind of Its Own, explains the neuroscience behind body organization and movement. So much of the healing we hope to deliver must take place in the brain.

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You will never, ever be finished learning about the body, or about how best to be of service. Your education will come at you in waves and sometimes from unexpected sources. Be patient as you accumulate the layers of your own unique approach.

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

The increasingly non-physical character of work and recreation generates physical dysfunctions related to sedentary lifestyle, while the ease and speed of electronic communication fosters detachment from our bodies. Furthering the disembodied state is the subconscious threat of traumatizing ecological and manmade disasters. Living in our bodies, feeling our feelings—taking time for that—becomes less and less comfortable. The potency of touch summons our clients back into their bodies and into the felt sense of their experience. This is what we are doing when we touch— stemming the tide of dehumanization.

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6 Questions to Guido Meert 1. When and how did you decide to become a bodyworker?

I have always been fascinated by sports and movements of the human body. The way to the profession of the body worker was easy and once I got my first anatomy course, I was fully "infected". But I also love it, to communicate with people and a human being, to me is a "quadri-unity", being constituted of the body, the spirit, the mind and the social setting. I think, it is important to emphasize, that by treating the human body, we are always dealing with the quadri-unity of this individual person. Therefore I would prefer the terminology "unityworker" instead of bodyworker...

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

To be able to feel the "breathing" and those small movements (swinging between contraction and relaxation) of the living tissues and of the body fluids, and those vasomotion-rhythm or tissue-rhythm (so-called "primary respiration"). When the patient is relaxing and is giving the "unityworker" the opportunity to feel his tissue-rhythm, it is truly a privilege...

It is every time a new fascinating and surprising, if the tissues of the patient are giving you some information, you can work with to help the patient. But, unfortunately, the transfer of information through the tissues is not working always... Nevertheless, the first time I saw the intrinsic movements of the lymphatics and the blood vessels in the lab, which we know now as "vasomotion" (spontaneous oscillation in tone of blood vessels, fully independent of heart rate, innervation or respiration) I was being carried away by enthusiasm for this magnificent quality of living tissue. I am thankful to be able to learn to work sometimes with those rhythms of the living being. But, of course you have to combine this rhythmic work with myofascial techniques, stabilizing exercise and many other therapeutic work.

3. What is your most favourite bodywork book?

A very difficult question. Perhaps several: "Energy Medicine in Therapeutics and human performance"

by James Oschman "Anatomy Trains" by Thomas Myers "Common vertebral joint problems" by Gregory P. Grieve "Fascia. The tensional network of the human body" edited by Robert Schleip et al.

"Handbook of physiology. Microcirculation" by Tuma R. F. et al.

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

To transfer the thrill of osteopathic work, both to the student and also to the patient. In our civilized and fast-moving world, our body is flying, diving, carting... and at the very moment our mind is thinking about, how we could make it possible to be even more quickly. Unfortunately, often we have no time left to "arrive". Even worse, sometimes we forget our soul along the way... I see it as an important challenge, to decelerate and to have time for my patients and students. It can be exciting to pick up the patient, where he lost himself an to find back some pieces of the quadri-unity of the patient...

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

Get fascinated as soon as you can, from the ingenuity of the human quadri-unity. That is the best motivator you can get...!

Therefore an intensive study of anatomy-physiology and a good training, education of your palpatory and empathyskills is very important. For example, It is very important to steer a middle course between (1) refining your palptoryempathy-skills, (2) understanding the linking elements in the network of the human quadri-unity, (3) elaborating your scientific approach and (4) bolstering a respectful humility for the suffering human being. That also seems to be a middle course as a "quadri-unity"... :-) 6. How do you see the future of massage therapy?

I think, that the science of the connective tissue is exponentially expanding at the moment, due to the "fascianating" work of Robert Schleip et al. But we also need more “unityworkers", who write and publish some exciting and scientific work on massage therapy and carry out scientific research, because the biochemics and genetics seem to extrude the "bodywork"... We need a more linking cooperation between mechanics, biochemics, genetics, psychology, soul-caring... As unityworker, we have the possibility to see the patient earlier and more frequently as the MD and also we are investing more time in the patient. Perhaps we can also play a more vital role in preventive care...

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