Terra Rosa e-magazine, No. 10 (June 2012) 1

Terra Rosa Terra Rosa Terra Rosa

E-Magazine

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

Open information for massage therapists & bodyworkers

No. 10, June 2012

Terra Rosa e-magazine, No. 10 (June 2012) 2

Terra Rosa E-Magazine, No. 10, June 2012

Welcome to our tenth issue of Terra Rosa e-magazine. In

this issue, we have some focus on research and what it can

do for us. We are quite fond of new research that came out

continuously, as proven by our Massage News Update that

has continuously running the latest research on massage

and bodyworks since March 2007. Joe in his latest article

discusses how we may acquire (new) knowledge. Most in the

massage world would fall into the authority model, where

we believe in what the teacher said. We must be aware that

most of the knowledge in early massage teaching is now

proven not to be valid, e.g. flushing out toxins. Then we

have the research world, that recently becomes popular.

However we also not fall into the trap of the evidence-based

medicine goes extreme and become a sceptic. Now there are

few blogs that supposedly provoke critical thinking in body-

work, start to turn into sceptics and to attack on alternative

treatment: acupuncture is a sham, stretching is useless, fas-

cia research is overrated and so on. We should not forget

that bodywork is much of an art than science, that's why

people are enjoying massage. As Joe stated that ‗most every

technique must have something valid within it, if not many

things; otherwise, it would not last very long in the world of

manual and movement therapies. However, if every tech-

nique were as effective as its proponents state, why isn‘t

everyone doing that technique?‘

An article posted in the Pain Treatment Topics by Stewart

Leavitt: ".. as with many other CAM approaches, the prob-

lem of validity may be due to our lack of understanding

and/or ability to adequately assess effectiveness, rather than

with the modality itself. Considering the multitude of pa-

tients worldwide who have benefitted from acupuncture in

one way or another, it still appears premature to broadly

dismiss it as being of little or no value for pain relief."

In this issue, we also cover other exciting articles from a se-

lection of well-known bodyworkers. David Lesondak re-

ported on the third Fascia Congress in Vancouver. Art Riggs

answers What is Deep Tissue Massage. Walt Fritz on Pelvic

Organ Prolapse, Jane Johnson on Postural Assessment.

Thanks for reading and Stay Healthy

Sydney, June 2012

3 Cover Feature

4 How Do We Know What We Know?—Joe Muscolino

12 The Effectiveness of Massage

Therapy—AAMT Report

15 From the 3rd Fascia Congress — David Lesondak

18 Pelvic Organ Prolapse—

Walt Fritz

21 What is Deep Tissue Massage —

Art Riggs

24 Spontaneous Movement

Body work

28 Tom Ockler on MET

30 Practitioner & Owner:

―Straight Percentage Agreements Work Best‖ —Don Dillon

33 Postural Assessment—

Jane Johnson

38 3D Anatomy for Manual Therapists

40 Research Highlights

42 6 Questions to David Lesondak

43 6 Questions to Jane Johnson

44 6 Questions to Walt Fritz

Disclaimer: The publisher of this e-magazine disclaims any responsibility and liability for loss or damage that may

result from articles in this publication.

Terra Rosa e-magazine, No. 10 (June 2012) 3

Cover Feature

The cover of this magazine features a picture of lum-

bodorsal and gluteal fascia. (Thanks to Robert Schleip

for permission to use.) The picture is part of the Fas-

cia Posters produced by Robert Schleip. The project of

illustrating fascia took more than 3 years to complete.

The idea of illustrating fascia comes from the demand

from bodyworkers who got tired of seeing the same

muscular or skeletal posters hanging on their wall.

There is also never an illustration of connective tissue

as a whole in the body. Robert and colleagues col-

lected hundreds of illustrations and photographs of

fascia and connective tissues from old and new litera-

tures. They fed those pictures into a computer pro-

gram to recreate a 3-D illustration. With hours and

days of trial and error they try to provide not only an

anatomically correct representation but also convey a

sense of the unified harmony. Finally with consulta-

tions with anatomy experts, they produced these set of

posters that beautifully convey without words the

unity of the fascial net from the most superficial layers

all the way to the endomysium. More than just another

anatomical chart, they are also fine art in their own

right. Robert hoped that future development will cre-

ate a 3-D computer model showing the layers and

connectivity of fascia.

Watch Robert Schleip talking about the challenge of

illustrating fascia http://youtu.be/I8H0MwyQIi0

These posters are available from

www.terrarosa.com.au

Terra Rosa e-magazine, No. 10 (June 2012) 4

This may seem like a strange question. After all, most of us are probably more concerned with the knowledge that we acquire rather than how we acquire it. But, examining this question is not just an exercise in abstraction; it can improve our cli-ent practice skills because it helps us choose what techniques we want to learn and place into our toolbox of treatment techniques.

Our approaches to acquiring knowledge can be divided into four models. They are: 1. knowledge imparted by an authority, 2. gleaning knowledge from research, 3. testing the new knowledge in our practice, and 4. evalu-ating new knowledge against principles of anatomy and physiology that are already understood.

Authority model

The authority model rests upon knowledge being im-parted by an individual who we respect and place in a position of authority. This is probably the most com-mon approach to learning. It begins in school, where as empty vessels, we sit and try to absorb as much as pos-sible of the knowledge of the teachers who are assigned to our classes. This method of learning is often called sage on the stage because the teacher is the sage stand-ing on the stage in front of us. We also place the au-thors of our textbooks as sages that we learn from. The authority model of learning usually continues after graduation. As practicing therapists, we subscribe to magazines devoted to our field and read articles by more sages. And we further our knowledge base by at-tending continuing education workshops where con-tinuing education instructors are sages who present their techniques for us to learn.

The authority model rests upon the idea that wisdom is passed from mentor to pupil and we are enriched. However, there is a three-fold danger to this model. First, this model assumes that each authority is truly a knowledgeable and wise expert; this is not always the

case. As brilliant as some sages might be, there might be some aspects to their knowledge base that are lack-ing; or the perspective they present might not fully en-compass the entirety of the knowledge area that is be-ing taught. They might even hold some beliefs that sim-ply are not true, and therefore present some incorrect information. But how are we to know? How do we choose which pieces of information are pearls of wis-dom that we should hold onto and use with our clients, and which pieces would best be discarded?

This dilemma lies at the heart of the second problem, which is that the authority model often discourages independent and creative thought. Instead of critically thinking through the information given to us, the au-thority model often presents cookbook recipes that are to be followed. We trust the information because we believe in the infallibility of the authority. This is espe-cially true in the world of continuing education where charismatic instructors might not explain the anatomic and physiologic basis for their technique protocols and might offer only their successful case studies as validity of their technique. A good maxim might be: Beware of case studies. Anyone who has been in practice for a few years can cherry pick out a handful of miracle case study success stories from all the clients they have seen.

And the third problem is likely the most vexing of all. What do we do when two (or more) authorities we trust disagree with each other? And looking at the world of continuing education, it does seem that many authori-ties are convinced of the superiority of his/her own technique over the techniques of others. Who do we choose to trust more when this occurs?

Research model

The second approach to learning is to look to research for our answers. Research is based on the scientific method, which relies on a very simple and logical con-cept: if something works, it should be reproducible. It would seem that the research model might be the solu-tion to the problem with the authority model. For ex-ample, if an authority states that a certain treatment

How Do We Know How Do We Know How Do We Know What We Know?What We Know?What We Know?

Joe Muscolino

Terra Rosa e-magazine, No. 10 (June 2012) 5

technique helps low back pain, and they back this up by describing two or three case studies, scientific research applies their treatment technique to a large group of people who have low back pain, to see if their treatment is as effective as they state. The results for this treat-ment group are compared to a large control group which did not receive the treatment (usually the control group receives what is called a placebo or sham treat-ment that is known/considered to be ineffective). A comparison is then made to see if the clients in the treatment group fared better than those in the control group. If they did, then the proposed treatment is effec-tive and valid. Alternatively, the proposed treatment could be compared to another treatment that is recog-nized and accepted to see which one is more effective.

Certainly, trusting research is a lot safer than blindly trusting an authority. The very essence of research is to put the ideas of authorities to the test. But relying too much on research can also have its dangers. The effi-cacy of a research study depends upon it being de-signed and carried out correctly, which is not always the case. Research study design can be complicated, and errors are sometimes made. Further, incorrect in-terpretations and conclusions of the research data can occur.

Study population

First of all, an effective research study involves working with a large number of people (the number of people in a study is referred to as ―n‖). Whereas a single case study (n of 1) or a few case studies (an n of 2 or 3) might make the proposed treatment technique seem effective, perhaps these results are not reflective of the entire client population. If n is large enough, we can better trust that the technique is representative of the entire client population that we might treat, and there-fore will work for us with our clients. For a research study to be effective it usually means that that tens, if not hundreds or thousands, of people need to be in-volved. This can be expensive and these types of large studies are not always available.

Inclusion and exclusion factors

Next, we have to make sure that the inclusion and ex-clusion factors are carefully chosen. As these names imply, inclusion factors are those factors/parameters that we want included in the study; exclusion factors are those that we want excluded. Continuing with our example, if the study is evaluating the effectiveness of the proposed treatment on clients with low back pain, do we include all people with low back pain, or do we pick and choose which ones are to be part of the study? For example, we might want to include all people with muscle spasms, strains, and strains; but exclude all people with herniated discs or severe degenerative joint disease. The idea of inclusion and exclusion factors be-comes more complicated when we start to consider all the other parameters that might affect the study. Are

people included who also exercise or meditate or en-gage in some other activity that might affect the study? The very essence of a research study is that we try to study just one parameter, the proposed treatment. But so many factors affect health that it is virtually impossi-ble to do this. Therefore, we try our best to identify all of these factors and then make sure that they are equally represented in both the treatment and control groups. If this is achieved, then we assume that any difference between the two groups is due to the pro-posed treatment technique. However, accounting for all of these factors and then distributing them evenly is not always successfully achieved.

Isolation versus wholistic approach

In fact, this points to the larger conceptual difficulty of research. A research study, by design, is meant to evaluate the effectiveness of just one parameter. In other words, a research study, to be valid, must isolate this one parameter and then decide it is effective in im-proving one‘s health. However, the concept of wholistic health involves the realization that no one parameter works in a vacuum. Good health is often attained only when a number of treatments are administered in con-junction with each other. For example, the best treat-ment for a client with low back pain might be to use massage, heat, and stretching together, not to mention advising the client about postures, stress, and diet amongst other things. These multi-faceted treatment approaches are inherently difficult to evaluate with sci-entific research models.

Treatment administration: validity and bias

Another consideration is whether the treatment was administered correctly. This may seem to be a given, but is not always the case. It is not uncommon for treatment to be administered by people who are not experts in that technique. This is especially true with touch/massage research where the people administer-ing the care are often nurses or family members. A valid question is: If the treatment was not administered by experts, can we trust the results? Ironically, if ex-perts are used to administer the treatment, because of their interest in seeing their technique succeed, bias may creep in. To prevent bias, it is important that the therapists are not the same people who chart the pro-gress of the participants in the study. In this way, the people who chart the progress are blinded in their knowledge of who is in each group.

―...the day before the apple fell on New-

ton‘s head, it did not mean that gravity

did not exist, we simply did not yet

have a scientific formula to explain it.‖

What We Know?

Terra Rosa e-magazine, No. 10 (June 2012) 6

Client bias and hands-on placebo treatment

In fact, even the participants may be biased and want so much to improve that they bias the study. This is why it is important to design the study to include a sham placebo treatment so that the participants do now know whether they are in the treatment group or the control group that received the placebo; in other words, they are also blinded. This brings up a problem that is particularly challenging when conducting re-search in the world of manual therapy: it is difficult if not impossible to create a valid hands-on placebo treat-ment for the control group. In the world of prescription drug research, both groups receive the same little white pill so they cannot know which group they are in. But in the world of massage and other manual therapies, clients know whether hands-on massage is being given to them. Therefore, an ineffective placebo hands-on treatment must be devised. But this is extremely diffi-cult. After all, doesn‘t all touch involve some therapeu-tic healing?

Interpretations and conclusions

And on top of all this, the final conclusions at the end of a research study may be open to interpretation, so it is important to read carefully the entire paper to see if you agree with the conclusions drawn by the authors of the study. Yet, most therapists do not read the entire research paper that is published; rather they read only the short abstract or conclusion; or worse yet, read or listen to someone else‘s conclusion about the study.

Not all research is in

Which brings us to our last challenge when relying on the research model for what we know. Because valid research is expensive and takes time, there are not al-ways research studies available to prove or disprove the value of every treatment technique. However, we can-not always wait for all the studies to be conclusively done; our clients need treatment now. In the mean-time, it is important to remember that the absence of research does not prove that a technique is not valid. When someone states: ―There is no proof that treat-ment X works,‖ it does not necessarily mean that there is proof that treatment X does not work. To make a comparison, the day before the apple fell on Newton‘s head, it did not mean that gravity did not exist, we sim-ply did not yet have a scientific formula to explain it. In the absence of definitive proof, we need to be open-minded.

For more information on reading and understanding

research papers, see Anatomy of a Research Article on

the Articles page on Joe‘s website

(www.learnmuscles.com)

FIGURE 1A. Ulnar deviating the hand at the wrist joint has little or no effect at stretching the brachioradialis because it does

not cross the wrist joint. 1B. Placing the forearm in full extension at the elbow joint and full pronation at the radioulnar

joints are the most effective forearm positions to stretch the brachioradialis.

―Our client did not sign up to be part of a research study; he or she came for ef-fective treatment and it is our responsi-bility to administer it.‖

What We Know?

Terra Rosa e-magazine, No. 10 (June 2012) 7

Testing New Knowledge Model

In the face of not blindly trusting an authority, and also not having conclusive valid research upon which to rely, we can always try testing the knowledge/technique in our own practice. For example, on Mon-day morning, we can practice on our clients whatever we learn in a continuing education workshop over the weekend. However, this can also be problematic for many reasons. In effect, we would be conducting our own limited research study; and we might not be de-signing and executing it very well. We might not yet be proficient with the treatment technique to implement it correctly; we might not have enough clients to test it on to determine if it is effective; and if we are administer-ing other techniques at the same time, how do we know which one was responsible for a client‘s improvement, if any? Beyond all this, there are literally tens if not hundreds of techniques being marketed to manual and movement therapists. Do we need to test them all? And if we did just try out a technique for a reasonable pe-riod of time, and it did not prove to be effective, didn‘t we just waste our client‘s time and money? Our client did not sign up to be part of a research study; he or she came for effective treatment and it is our responsibility to administer it.

Evaluating new knowledge against anatomy and physiology principles

We can see that the authority model of learning re-quires trust that the authority is infallible; definitely problematic. Relying on the research model requires clear and conclusive valid research to already be done;

often problematic. And relying upon the model of test-ing all new knowledge in our practice is logistically problematic, as well as potentially unfair to our clients.

Where does this leave us? Are we back to being open-minded and trusting our sages on the stage? We usually think of being open-minded as being a good thing, but there is another old saying that goes: ―Be open-minded, but don‘t be so open-minded that your brains fall out.‖ This is where our fourth model of learning, that is, evaluating new knowledge against principles of anat-omy and physiology, is so valuable.

Essentially, evaluating new knowledge against princi-ples of anatomy and physiology allows us to critically think through the mechanics of a new technique that is being proposed, and determine for ourselves if the ba-sis for this technique makes sense given what we know about anatomy and physiology. Certainly, not all of anatomy and physiology is known and understood, but we do have some very well established principles about how the human body functions. And if we apply that knowledge to a new technique, we are empowered to critically think through the likelihood of how effective that technique will be. It also empowers us to deter-mine when to apply the technique.

Figure 2A. Stretching the vastus musculature of the quadriceps femoris group is accomplished by flexing the knee joint. B and C, the thigh is laterally rotated and medially rotated at the hip joint respectively. These motions do not

stretch the vastus musculature because the vastus muscles do not cross the hip joint.

―Be open-minded, but don‘t be so open-

minded that your brains fall out.‖

What We Know?

Terra Rosa e-magazine, No. 10 (June 2012) 8

For example, by knowing anatomy and physiology, we can reason what stretches for a muscle would and would not be correct. We do not need to trust an au-thority; we do not need to wait for a research study to be done; and we do not have to subject our clients to be guinea pigs as we test every stretch that is proposed.

We understand that stretching a muscle involves mak-ing it longer, which is accomplished by simply doing the opposite of the muscle‘s joint actions. This makes sense because if the actions of a muscle bring it to its shortened state, then doing the opposite of the actions would make the muscle longer, thereby stretching it. (One addendum to this idea is that it might be ex-

panded to include actions at other joints if myofascial continuity across these other joints is considered.) So, we think of the joint actions that the target muscle to be stretched can do and we compare that knowledge to the stretch that is offered by the authority. If the knowledge matches, we can trust that the stretch will, in fact, be effective and we can begin employing it in our practice; if it does not, we can choose to not embrace it.

For example, given that the brachioradialis does not cross the wrist joint, why would moving the hand into ulnar deviation at the wrist joint add to its stretch as is often recommended by authorities (Figure 1a)? Could it be that the increased stretch that is felt by the client is occurring in the nearby extensors carpi radialis longus and brevis, which do cross the wrist joint and are stretched with ulnar deviation of the hand? And given that the end forearm position when the brachioradialis is maximally contracted and shortened is halfway be-tween full pronation and full supination (at the radioul-nar joints), why would we want to place the forearm in that position as is often recommended? Making a mus-cle longer to stretch it is not accomplished by placing it in the position of its actions, it is accomplished by do-ing the opposite of its actions. Wouldn‘t full pronation (or even full supination) of the forearm make more sense because this position brings the attachments far-ther apart, therefore the muscle is lengthened (Figure 1b)?

Looking at a stretching example in the lower extremity, why is it recommended by many authorities to change the position of the hip joint when stretching the vastus musculature of the quadriceps femoris group? If the

FIGURE 3. Deep stroking massage functions to increase arterial blood circulation to the trigger point (TrP). If done along the direction of the taut band of the TrP, it also helps to stretch and physically break the cross-bridges

of the TrP.

―...if the time is spent to learn and understand

anatomy, physiology can be figured out. If

physiology is understood, then pathophysiol-

ogy can be figured out. If the mechanics of

pathophysiology are understood, then assess-

ment can be figured out. And if assessment is

known, then treatment can be figured out. It

all stems from spending the time to first truly

learn anatomy.‖

What We Know?

Terra Rosa e-magazine, No. 10 (June 2012) 9

vastus muscles do not cross the hip joint, then other than flexing the hip joint to slacken the rectus femoris and knock it out of the stretch (so it does not limit stretching the vastus musculature), what are we trying to accomplish by altering the position of the hip joint (Figure 2)? If it has to do with myofascial meridian continuity, then a specific position should be deter-mined based on the adjacent muscle/myofascial units that are in the meridian; does the recommended change in the hip joint make sense when compared with this information?

Using trigger point (TrP) treatment as another exam-ple, if a TrP is understood to be due to local ischemia in the tissues, does it make sense to create any further ischemia with prolonged pressure? And if deep pres-sure is administered, does it make sense to hold it for a prolonged time? What are we trying to accomplish and are we accomplishing it as effectively as possible? Given that ischemia is the problem (because it causes a decrease in blood supply that then causes a decrease in ATP molecules that are needed to break the actin-myosin cross-bridges that create the contraction), then wouldn‘t a stroking technique that increases local blood supply be more efficient? Therefore, mightn‘t multiple short deep effleurage strokes be more effective when treating TrPs than holding sustained compression? These are the kinds of questions that can be asked and answered without benefit of authority, research studies, and months of testing in your practice (Figure 3).

Evaluating new knowledge against principles of anat-omy and physiology can also improve our assessment skills as well. Continuing with the brachioradialis as the

example, if we want to assess it through palpation and we need to make it contract to engage it and locate it, it makes sense that we want to contract the brachiora-dialis and only the brachioradialis if we want to discern it from the adjacent musculature. This requires an iso-lated contraction. So we ask the client to place their forearm in a position that is halfway between full pro-nation and full supination (the best position for it to effectively contract, given its actions), and then flex the forearm against our resistance. It is crucially important that our resistance is placed against their distal fore-arm, not their hand. If we add our resistance to the cli-ent‘s hand, their radial deviators (extensors carpi ra-dialis longus and brevis) will engage, making it harder

Figure 4A. When engaging the brachioradialis to palpate it, resistance should be placed against the client‘s distal forearm, not hand. 4B, If the client attempts to radially deviate the hand at the wrist joint, the extensors carpi ra-

dialis longus and brevis would contract, making it difficult to palpate and discern the brachioradialis from these muscles.

Perhaps the most effective way to become a more effective clinical orthopedic massage therapist is not to continually frequent con-tinuing education workshops, not to continu-ally read every research study that is pub-lished, and not to spend hundreds of hours testing new techniques on our clients, but to spend more time going over the basics of anatomy and then critically thinking from there.

What We Know?

Terra Rosa e-magazine, No. 10 (June 2012) 10

to discern the brachioradialis from these adjacent mus-cles (Figure 4). By understanding basic principles of anatomy and physiology, we can reason through how to most effectively palpate and assess our clients.

The essence of evaluating new knowledge against es-tablished principles of anatomy and physiology is that we are empowered by critical thinking. Of course, this requires first learning anatomy, which is often not as well taught and learned as might be desirable. But, if the time is spent to learn and understand anatomy, physiology can be figured out. If physiology is under-stood, then pathophysiology can be figured out. If the mechanics of pathophysiology are understood, then assessment can be figured out. And if assessment is known, then treatment can be figured out. It all stems from spending the time to first truly learn anatomy. Perhaps the most effective way to become a more effec-tive clinical orthopedic massage therapist is not to con-tinually frequent continuing education workshops, not to continually read every research study that is pub-lished, and not to spend hundreds of hours testing new techniques on our clients, but to spend more time going over the basics of anatomy and then critically thinking from there.

Conclusion

This article could be construed as being negative on educators and authors, given their role as authorities. I as the author of this article am fully aware of the irony of being the authority as you read this. However, it is not the knowledge or the authority that is the danger; most authorities fervently believe in what they are teaching and have an extensive knowledge base. The danger comes when we place blind trust in them. When we treat them as a sage on the stage, or perhaps a sage on the page. Similarly, this article should not be con-strued as being against scientific research; I am also a firm advocate for research. But we need to be aware of the limitations of relying too heavily on research when making treatment choices; if for no other reason be-cause research is rarely complete. And certainly, there is nothing wrong with being creative in our practice by introducing and trying new treatment techniques, we just need to be mindful to not constantly subject our clients to the newest technique that is the flavor of the month.

Most every technique must have something valid within it, if not many things; otherwise, it would not last very long in the world of manual and movement

therapies. However, if every technique were as effective as its proponents state, why isn‘t everyone doing that technique? A logical conclusion might be that each technique has something to offer, but does not offer the solution to every problem for every client. Therefore, our role is to learn as many techniques as possible, adding the elements of each one to our tool box of therapies. Then, with the wise judgment that comes from experience, we can learn how to reason through which combination of assessment and treatment tools to use in each case for the best improvement of the cli-ent who is on our table. This Article is reprinted with permission from AMTA

Massage Therapy Journal, Summer 2011

www.amtamassage.org/mtj

―For more information on reading and understanding

research papers, see Anatomy of a Research Article on

the Articles page on Joe‘s website

(www.learnmuscles.com)

FIGURE CREDITS: Figures 1a, 2b and 2c: Illustrated by Giovanni Rimasti Figures 1b, 2a, 4a, and 4b from Muscolino JE: The Muscle and Bone Palpation Manual, with Trigger Points, Referral Patterns, and Stretching. 2009, St. Louis, Elsevier / Photography by Yanik Chauvin. Figure 3 reprinted from understanding and working with myofascial trigger points, body mechanics column article, mtj, spring 2008 issue. Illustrated by Jeannie Robertson

―...if every technique were as effective as its proponents state, why isn‘t everyone doing that technique?‖

What We Know?

Terra Rosa e-magazine, No. 10 (June 2012) 11

Clinical Orthopedic Massage Therapy (COMT) The focus of these workshops is to learn how to work clinically utilis-ing deep pressure, basic and advanced stretching, and joint mobili-sation 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, clini-cal, and/or rehab. work! Each workshop delivers 8 hours of instruc-tion every day (9am—6pm). The workshop will cover body mechanics for deep tissue work, mus-cle 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.

Sydney

1-2 May 2013, COMT: Upper Extremity 6-7 May 2013, COMT: Lower Extremiy

Gold Coast

11-12 May 2013, COMT: Neck

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 publica-tions 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 unaccus-tomed to learning. The class challenged me and my way of think-ing without belittling the areas I am weak in. The content was thorough yet simple to understand with Joe's wonderful way of teaching. His immense technical knowledge of the body has shown me how effective we can be as therapists if we apply all of the resources that are available to us.”

Anita Schmidt, Hornsby

"Joe Muscolino is a master of his profession! His broad knowl-edge 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 Gaalova, Queenscliff, NSW.

Book Early as Places are Limited To register your interest & for more information, visit www.terrarosa.com.au/joe

Terra Rosa e-magazine, No. 10 (June 2012) 12

The Australian Association of Massage Therapists

(AAMT) in 2008 commissioned a research report into

finding the research evidence on the effectiveness of

Massage Therapy. The research report was conducted

Dr Kenny CW Ng, a Member Australian Association of

Massage Therapy in collaboration with Professor Marc

Cohen, School of Health Sciences, RMIT University.

This article is a summary of The Effectiveness of Mas-

sage Therapy Report which was first published in Octo-

ber 2011.

Massage here was defined as ―manual soft tissue ma-

nipulation, and includes holding, causing movement,

and/or applying pressure to the body. Massage therapy

is the practice of massage by accredited professionals to

achieve positive health and well-being (physical, func-

tional, and psychological outcomes) in clients.

The research reviewed includes systematic reviews,

randomised controlled trials, comparative studies, case

-series/studies and cross-sectional studies in academic

research papers, published between 1978 and 2008. It

covers a range of massage therapy techniques , include

acupressure, Bowen therapy, lymphatic drainage, myo-

fascial release, reflexology, Rolfing, shiatsu, Swedish

massage, sports massage, infant massage, tuina and

trigger point therapies/modalities. More than 740

studies from 5 reputable databases were reviewed.

The studies were grouped into 5 categories based on

their study quality and clinical significance. (see table

below). The grades of recommendation are:

A Body of evidence can be trusted to guide practice

B Body of evidence provides moderate support to guide

practice in most situations

C Body of evidence provides limited support for recom-

mendation(s) and care should be taken in its applica-

tion

D Body of evidence is weak and any recommendation

must be applied with caution

E Body of evidence is insufficient to provide recom-

mendation

The Effectiveness of The Effectiveness of The Effectiveness of Massage TherapyMassage TherapyMassage Therapy

Terra Rosa e-magazine, No. 10 (June 2012) 13

The report found a growing research studies in the ef-

fectiveness of massage therapy (Figure 1). There is also

a growing body of research supports massage therapy

as being an evidence-based therapeutic modality,

which is summarised in Figure 2.

In particular, massage has been found effective for:

Acupressure Management of Nausea and Vomit-

ing. There is strong evidence supporting acupres-

sure management of nausea and vomiting

Managing anxiety, stress and promoting relaxa-

tion. Multiple studies provided good evidence sup-

porting the effectiveness of massage therapy in

managing anxiety, stress and promoting relaxation.

Subacute and chronic low back pain. Seven reviews

were in unison concluding that massage therapy for

subacute and chronic low back pain to be more ef-

fective than placebo.

Pain reduction, quality of life, improved sleep, re-

duced depressive symptoms. Positive outcomes re-

ported following massage therapy include pain re-

duction, better quality of life, improved sleep and

function as well as reduced depressive symptoms.

Infant distress, newborn growth, mother-infant

interaction, post-natal depression. Studies into the

benefits of massage therapy for maternal and infant

care reported a reduction in infant distress, signifi-

cant newborn growth and development, improved

mother-infant interaction and reduced symptoms of

post-natal depression.

The report concluded Massage Therapy as a safe and

effective treatment option. The report reinforces that:

There is consistent and conclusive evidence that mas-

sage therapy is safe. However, the importance of quali-

fied massage therapists adhering to appropriate scopes

of practice, safety guidelines and ethical procedures is

stressed. There is a growing evidence base to aid clini-

cians in recommending massage as an evidence-based

therapeutic modality. Clinicians are encouraged to col-

laborate with professional massage practitioners for

best practice management of patients who may benefit

from massage therapy.

The full report can be downloaded at

www.aamt.com.au

This is a summary of the research report „The Effec-

tiveness of Massage Therapy‟ by Ng (2011), repro-

duced with permission from AAMT.

Figure 1. Growth of published studies on the effectiveness of massage. therapy . After Ng (2011) TEMT Report, AAMT.

The Effectiveness of Massage Therapy

Terra Rosa e-magazine, No. 10 (June 2012) 14

Figure 2. Summary of systematic reviews on the effectiveness of massage therapy. After Ng (2011) TEMT Report, AAMT.

The Effectiveness of Massage Therapy

Terra Rosa e-magazine, No. 10 (June 2012) 15

It‘s no lie, being behind

the camera at the Third

International Fascia

Research Congress is a

pretty sweet gig. But it‘s

also about multi-

tasking, constantly tak-

ing notes on each pre-

senter. Every time they

change a slide writing

down the exact time,

noting when the slide

has an animation, when

they skip a slide or acci-

dentally jump ahead.

When there‘s a technical failure and we have to wait.

Adjusting for sudden volume changes or lighting is-

sues.

All of this gets written down so that when I am editing

this footage (which I am doing now) – it goes a lot

smoother and faster.

It‘s all very multi-tasking, and makes it hard to absorb

all of the information being presented. I left the Con-

gress my head aswirl and agoggle with so many things

but overall I was left with the strong, unshakable sense

that: This is real. There was a lot here to be real about.

The first day began with keynotes involving repetitive

motion disorders and ended with a panel discussion on

scar tissue and adhesions that played like a superb four

movement symphony.

First up in the panel was Wayne Diamond, MD from

Wayne State University who presented data on the high

incident of post-surgical adhesions following pelvic

surgeries. Even with a relatively non-invasive proce-

dure like a laparotomy or a laparoscopy the average of

how many patients develop post-operative adhesions is

a very surprising 70%.

Next up – the Shaman/Showman of Bordeaux, France

– tendon transplant surgeon Jean-Claude Guimberteau

wowed us with his latest endoscopic film. This time he

brought to life the reality of the stresses to the tissues

beneath the skin where scarring and adhesions are pre-

sent. It was actually a bit like a horror movie. Or if you

prefer a different genre, as the narrator of the film put

it, ―a fibular apocalypse‖. Graciously, Dr. Guimberteau

has allowed us to use 3 minutes of this film in the final

Fascia Congress DVD.

Following the film was Hal Brown, a DO from Vancou-

ver who presented an overview of prolotherapy to treat

scars and adhesions. He uses a neural therapy model,

injecting local anaesthetic to depolarize the nerve tissue

around the scars. In the skin there are billions of sym-

pathetic nerve fibres, all tightly packed together. The

signals from these nerves travel at about 400 kilome-

tres per hour making for instantaneous communication

throughout the body. Anytime there is a cut, tear, sur-

gery or sufficient trauma, these fibres are torn asun-

der. Without intervention the repair is very chaotic to

the nerves near the affected area, which will fire in ab-

errant and send signals to other parts of the body with

no rhyme or reason.

From the 3From the 3From the 3rdrdrd International Fascia International Fascia International Fascia Research CongressResearch CongressResearch Congress 282828---30 March 2012, Vancouver30 March 2012, Vancouver30 March 2012, Vancouver

David Lesondak

Terra Rosa e-magazine, No. 10 (June 2012) 16

Think of these nerve impulses as cars on a superfast

highway who have to detour around an accident, but in

this case the accident is never cleared from the road-

way.

So back to the injections. When the anaesthetic wears

off in the injected areas, the nerve repolarizes and the

nerves membrane potential is restored to normal

around the area and functionality returns. Dr. Brown

presented several compelling case studies dramatically

showing the success of this approach.

The panel ended with the dynamic Susan Chapelle,

RMT from Squamish, British Columbia. Squamish is a

community of about 17,000 people , unique because of

it‘s climate which allows you to both ski and mountain

bike in same day, not to mention kayak and rock climb.

Many Olympic athletes train there. She described it as

an ―epicentre of orthopaedic injuries‖. In this environ-

ment, people get their surgeries and need to get back to

their sports before the injury fully heals. This has lead

to an environment where complementary therapists

communicate freely with allopathic doctors and where

early manual interventions are showing beneficial re-

sults.

Susan was also involved in a ground-breaking adhesion

study, partnering with Geoffrey Bove DC, PhD from

Maine to study the effects of manual therapy of adhe-

sions.

Now, I need a drink of water because Day 2 was all

about fluid flow.

As bodyworkers, so much of our focus on fascia seems

to be on it‘s load bearing, structural component. Dr.

Rolf K Reed challenged us to think about its role as a

regulator of fluid flow and Gerald Pollack challenged us

to rethink what we know about water itself.

It seems that Dr Pollack has discovered a 4th state of

water. The defining characteristic of this fourth state of

water, which has been heavily researched, is that it is a

liquid crystal. It is a thicker, more viscous water that

also seems to have a energy-producing capacity. And

what unlocks this capacity? Radiant energy – the sun!

E=H2O according to Pollack, claiming that radiant en-

ergy drives blood, lymph and fluid flow throughout the

body. And don‘t quote me on this yet, but I believe that

in the Fluid Dynamics Panel that ensued it was posited

that the water content of our fascia may be about 50%

this ―fourth state‖ water.

All of this points to possible explanations for everything

from cold lasers to energy work, not to mention a walk

on a sunny day, but as always – more research is

needed.

And speaking of research I need to go research that

mention about the amount of fourth state water in our

fascia. That means I need to get back to editing video.

I‘m on a deadline you see, to get those videos finished

and get this article finished for your enjoyment before I

get on a plane to shoot more video at the BodyWisdom

Spain Congress. Which I will surely write about too.

There was so much more that happened in Vancouver:

the multi-media night, Carla Stecco and Jay Shah just

3rd Fascia Congress

Dr. Gerald Pollack

Terra Rosa e-magazine, No. 10 (June 2012) 17

bringing it all home Friday morning with two stunning

back-to-back lectures on fascial anatomy and myofascial

trigger points respectively, but somehow I keep going

further back in time.

I can remember being in the back of the room at the

first Fascia Congress at Harvard in 2007. No camera

that time, just feeling lucky to even be in the room,

amazed that it was even happening and trying not to get

too geeky about meeting my heroes (look! It‘s Donald

Ingber!) whose work I had been inspired by for years.

Move 4½ years into the future to the Sheraton Wall

Center in Vancouver. A world-class hotel. A conference

room big enough hold over 800 people from 37 coun-

tries. And everyone happy, connecting, confabbing, oc-

casionally contesting and setting new collaborations.

This is real.

David Lesondak, BCSI, KMI, LMT is an Allied Health

Member in the Department of Family and Community

Medicine at the University of Pittsburgh Medical Cen-

ter (UPMC). He practices Structural Integration at

UPMC‟s Center for Integrative Medicine. David‟s keen

interest in the emerging science of fascia coupled with

a previous career in the video arts led him to collabo-

rate with Thomas Myers‟s to produce and direct the 3 –

DVD set “Anatomy Trains Revealed” a video compan-

ion to Myers‟ popular book. He has also worked on

various video projects with Robert Schleip and a series

of technique videos for the Gebauer company.

He is an NCBTMB approved continuing education pro-

vider and teaches fascially-oriented workshops inter-

nationally.

David is currently editing the videos from the Third

International Fascia Research Congress, which will be

made into a DVD set available in July 2012.

In his spare time, he tries to find spare time. David can

be reached at lesondakda@upmc.edu. Read also 6

questions to David on page 42.

3rd Fascia Congress

Will be Available Soon.. The 3rd International

Fascia Research Congress on DVD

Terra Rosa e-magazine, No. 10 (June 2012) 18

Referrals for myofascial release treatment can come

from a wide variety of sources for an even wider variety

of conditions. When questions come in regarding if I

can help with a certain condition, I am optimistic .

Therapists may have their comfort level, depending on

their training and licensure, which can actually limit

the referrals that come their way. Treatment of

women‘s health conditions has always been a strong

part of my practice. Even for common conditions, such

as lower back pain, women are often faced with a dif-

ferent set of causative factors than men, especially in

the United States, where pelvic surgeries are all too

common. The role that scar tissue can play with pelvic

pain/dysfunction is huge, and we can play a significant

role in helping this population.

Pelvic organ prolapse is a common referral to a physi-

cal therapist, with pelvic floor musculature strengthen-

ing the most common intervention. But there are other

views on causative factors, as well as treatment ap-

proaches. I recently connected with Sherrie Palm, who

heads the Association for Pelvic Organ Prolapse Sup-

port, Inc. Sherrie has recognized the role that myofas-

cial release treatment can play in pelvic organ prolapse.

While pelvic organ prolapse may seem an obscure dis-

order, consider the following:

POP SYMPTOMS AND CAUSES

Half of all women over the age of 50 suffer from at least

one type of pelvic organ prolapse (there are 5 types),

many women in their 30‘s and 40‘s have POP as well.

Although POP is not extremely common in women in

their 20‘s, it can occur in this age bracket. The 5 types

of pelvic organ prolapse are cystyocele (bladder), recto-

cele (large bowel), enterocele (intestines), vaginal vault

(vagina caves in on itself after uterus is removed-

hysterectomy), and uterine (uterus). When the PC or

pelvic floor muscles weaken or become damaged, one

or more of these organ/tissue areas shift in the pelvic

cavity beyond their normal positions.

Each of these 5 types of POP has its own symptoms, but

in general symptoms can include:

(Use with permission from Sherrie Palm. http://

pelvicorganprolapsesupport.org/pop_basics/

pop_symptoms_and_causes)

Pressure, pain, or fullness in vagina, rectum, or both.

Feeling like your ―insides are falling out‖ or like you are sitting on a ball.

Urinary incontinence.

Urine retention (you have to (urinate), you just can‘t get it to come out).

Fecal incontinence.

Constipation.

Back/abdominal pain.

Lack of sexual sensation.

Painful intercourse.

Can‘t keep a tampon in.

There are multiple causes of POP; it is likely that most

women have more than one cause that fits their health

pocket and lifestyle. The most common causes of POP

are:

Vaginal childbirth - complications from large birth

weight babies, forceps or suction deliveries, multiple

childbirths, improperly repaired episiotomies. (It is

also possible for women who have never given birth to

have POP; there are many non-childbirth related

causes.)

Menopause - age related muscle loss due to drop in

estrogen level; this impacts strength, elasticity, and

Pelvic Organ Prolapse Pelvic Organ Prolapse Pelvic Organ Prolapse Thorough Evaluation and

Myofascial Release

Walt Fritz

Terra Rosa e-magazine, No. 10 (June 2012) 19

density of muscle tissue.

Chronic constipation - IBS (irritable bowel syn-

drome), poor diet, lack of exercise can all cause consti-

pation.

Chronic coughing - smoking, allergies, bronchitis,

and emphysema can create chronic coughing.

Heavy lifting - lifting children, repetitive heavy lifting

at work, weight trainers.

Joggers, marathon runners - constant downward

pounding of internal structures

Abdominal surgeries - structural weakness from

surgery or myofascial restrictions and scar tissue can

lead to POP

Diastasis Rectus Abdominus (DRA) - a separation

in the two bellies of the rectus abominus muscle during

pregnancy may predispose women to a weakness in

core support which can lead to POP issues.

When one researches pelvic organ prolapse on the ma-

jor Internet medical sites, muscular weakness is an oft

repeated cause for many prolapse issues. Weakness of

the musculature or overstretching of lower pelvis soft

tissue can certainly be at the root of prolapse and

should not be discounted. Weakness is said to result

from childbirth, including cesarean section, as well as a

myriad of other pelvic surgeries. What is missing from

these explanations is the profound tightness that can

develop secondary to surgeries and childbirth, espe-

cially scar tissue tightness. It can be this tightness that

FORCES an organ to move from its original position.

While traditional strengthening, including various

types of electrical stimulation, can improve certain is-

sues, often the treatment is incomplete. Unless the

tightness is addressed, an increase in tightness may be

the result.

Myofascial release is an accepted therapeutic modality

practiced by physical therapist, occupational therapists,

and massage therapists. Having a bit of an education

regarding the most effective types of myofascial release

is in order, as there are many variations. Both direct

and indirect myofascial release have been used for dec-

ades, first by osteopaths and eventually therapists. Di-

rect myofascial release involves a deeper, more forceful

type of pressure that is typically short in duration. Indi-

rect myofascial release is gentler and is typically sus-

tained for a longer time period. While I was trained in

both methods, I find that the indirect approach is both

better tolerated and also provides more lasting results.

A trained myofascial release therapist will be proficient

in evaluating and treating a wide variety of pelvic pain

and dysfunction syndromes. A GoogleScholar.com

search will give you a large number of examples of

myofascial release being used effectively in the treat-

ment of pelvic organ prolapse.

Particular attention should be paid to any and all scar

tissue in the lower abdominal and pelvic regions. Scar

tissue evaluation should be a regular part of all thera-

peutic treatments. Assessing the tissue quality of super-

ficial to deep soft tissue of the lower abdomen/pelvis,

as well as the lumbosacral regions, and connecting that

tightness to their pain or dysfunction, closes the loop.

This loop is an important part of our role. If, during

evaluation, we can reproduce their pain/dysfunction,

whether local or distant to the pain, this creates a posi-

tive feedback loop between what we feel may be at

fault, connects it to their pain, and feeds back the infor-

mation to the therapist. The therapist now has a firm

place to begin treatment and the client has trust that

the therapist understands and acknowledges their

pain/dysfunction. As I travel, teaching my Founda-

tions in Myofascial Release Seminars, I find that many

therapists feel that evaluation time is time wasted from

the session. They relate an assumption from their cli-

ents that they expect the full amount of hands-on time.

Here is where education, of both the therapist-in-

training as well as their clients, is crucial. Without a

thorough evaluation, one is really treating blindly.

As a physical therapist, clients are often confused when

they walk into my office for the first time. They expect

to see the typical array of exercise machines, modalities

machines, etc. But what they find is a simple treatment

Pelvic Organ Prolapse

Female reproductive organ anatomy. From: http://

commons.wikimedia.org/wiki/File:Female_anatomy.svg

Terra Rosa e-magazine, No. 10 (June 2012) 20

table. I explain to them that the weakness model of

pain or dysfunction has its place, but I find that not

everyone responds to the traditional sort of interven-

tion. We then proceed with the evaluation where, hope-

fully, I am able to connect their symptoms with my

findings.

Clients may wonder what myofascial release treatment

is like? While all therapists evaluate and treat in differ-

ent ways, there should be some commonality. After a

thorough history taking, your therapist may perform a

head to toe evaluation, in standing, sitting face up and

face down. This is an important aspect of myofascial

release, as tightness, injury, or surgery in other areas of

the body can influence the pelvis. They will then nar-

row the scope of their evaluation to the area of dysfunc-

tion. Gentle pressure into the lower abdomen will often

reveal a great deal of information to both the therapist

as well as to you. You may be surprised as to how easily

your therapist can reproduce familiar sensations of

tightness, pain, or pelvic organ dysfunction with just a

small amount of pressure placed into very specific area.

(It is important to note that in certain circumstances it

may be necessary for your therapist to perform evalua-

tion and/or treatment vaginally or rectally. Individual

regional licensure laws vary. Physical therapists are

often permitted to perform internal examination and

treatment. It is important to note that internal treat-

ment is NOT always needed to successfully resolve pel-

vic organ prolapse issues. Your therapist should ex-

haust external treatment before proceeding further and

only with your consent. In my experience it is only oc-

casionally necessary to treat internally. If you feel pres-

sured by your therapist in any way, find another thera-

pist.)

Treatment with indirect myofascial release involves the

therapist placing mild to moderate pressure into an

area of tightness and maintaining that pressure for

time frames up to or exceeding five minutes per tech-

nique. Typical sessions last an hour. Frequency of

treatment can vary, but your therapist may wish to see

you more often for the first few sessions. Trying to pre-

dict the necessary length of treatment is difficult, but

when working with a well-trained and experienced

myofascial release therapist, one can expect to notice

lasting, positive changes in as little as three sessions.

While it may take longer than three sessions to find full

relief, you should be able to determine in a short length

of time whether myofascial release is working for you.

Your therapist will also recommend home stretching to

allow you to continue to progress.

To find a qualified myofascial release therapist near

you, please refer to the Myofascial Release Therapist

page on this website:

http://pelvicorganprolapsesupport.org/

health_care_connections/

myofascial_release_therapists

You may also email me at

walt@myofascialpainrelief.com or check the therapist

listings at www.FoundationsinMFR.com.

© 2012 Walt Fritz, PT

Walt Fritz, PT has been a physical therapist since 1985

and has been teaching Myofascial Release to physical

therapists, massage therapists, and occupational

therapists since 1995. His Foundations in Myofascial

Release Seminars were developed in 2006 and have

been taught across the United States. Working from

the strengths of his predecessors, Walt emphasizes the

straightforward effectiveness of Myofascial Release

without the hype. In his Foundations in Myofascial

Release Seminars, Walt brings an approachable, easy

to understand style of teaching, one that can easily be

assimilated into your treatment regime. Evaluation is

a strong component of his teaching style, in order to

create a logical progression from evaluation to treat-

ment. Read 6 questions to Walt on page 44.

Look for his videos on the WaltFritzPT YouTube

Channel. Walt also owns the Pain Relief Center, a

physical therapy private practice in Rochester, NY,

with a specialty in treating pain conditions.

Pelvic Organ Prolapse

Terra Rosa e-magazine, No. 10 (June 2012) 21

Question: “My spa/clinic offers “Deep Tissue Mas-

sage” as a separate massage category and at a higher

price than regular massage, but I can‟t seem to get a

clear answer on what the difference is. I‟ve also heard

that it can be painful. Can you explain why it costs

more and how it is different?”

Answer: Although I think there is a perception that

the increased charge is because the therapist is working

―harder,‖ any extra charge for deep tissue massage

should be because the practitioner has taken advanced

courses to learn new skills. We will get into some spe-

cifics of the differences between deep tissue and

―regular‖ massage in a bit, but it is helpful to first dispel

some misconceptions:

Deep Tissue Massage is painful: This comes from the

―No Pain, No Gain‖ fallacy, and there is a big difference

between working deeply and working hard. The em-

phasis is simply on sinking to deeper levels of stress in

the layers of the body with a bit more emphasis upon

therapeutic results while using some of the tools that I

will explain later.

Relaxation massage is for enjoyment while deep tissue

work is for specific problems: There are two miscon-

ceptions here: Relaxation massage is much more than

just ―enjoyment‖ or ―feel good‖ and is very therapeutic

for many reasons, including specific benefits to the

muscles themselves through increased circulation, and

many health benefits that result from releasing general

tension levels in the body due to the stresses of life.

Conversely, many people find deep work extremely

gratifying and enjoyable, not just for the long lasting

benefits or improvement of performance in activities or

sports, but because it actually feels good!

Deep Tissue Massage can be risky because of overwork,

not only being unpleasant but not entirely safe: Actu-

ally, proper training in deep tissue skills goes into

much more detail about contraindications and safely

working than initial trainings and is quite safe.

There are many different variations in how practitio-

ners perform Deep Tissue Massage with the therapeutic

goals for the work and also with how it is practiced:

GOALS

Treatment of injuries or conditions: Both for treat-

ment and prevention of soft tissue problems, deep tis-

sue massage releases adhesions, improves muscle

function for better alignment of muscles to help im-

prove joint mobility or proper function.

Improvement of performance in activities: Whether in

sports, dance, yoga and everyday activities, the stresses

of life result in short and tight muscles that limit mobil-

ity and cause pain or discomfort. Deep Tissue Massage

places more emphasis upon grabbing and stretching

What is What is What is Deep Tissue MassageDeep Tissue MassageDeep Tissue Massage

Art Riggs

Terra Rosa e-magazine, No. 10 (June 2012) 22

short muscles and fascia that hinder performance in-

stead of sliding over and compressing tissue as more

general massage that uses a lot of lubrication.

Improved posture: This particular facet of Deep Tissue

Massage, sometimes called structural integration, focus

upon careful analysis and a systematic and structured

plan to lengthen short muscles and fascia that ad-

versely affect posture so that people can stand or sit

erect and move more freely.

Emotional/psychological freedom: Some theories of

the personality emphasize the integration of the physi-

cal and emotional components of health. Under stress

or when not feeling safe, many people tighten or ar-

mour their muscles into habitual patterns that rein-

force emotional patterns. As these physical restraints

are released, many people report a profound emotional

response.

THE TOOLS

The proper application of pressure necessitates a

broader range of tools than those used in conventional

relaxation massage. Some people assume that if an el-

bow is used, that it must be intense, but the elbow often

allows your therapist to use proper mechanics in her

body so she is not straining and is relaxed which allows

for much more enjoyable sensations instead of strain-

ing. To sink through superficial layers to deeper ten-

sion, she may use focused and precise tools such as

knuckles or an elbow. For large muscles that require

more pressure, she may choose to use the forearm or a

fist to focus attention on a broader surface.

HOW DEEP TISSUE MASSAGE IS PRACTICED

The first thing you may notice will be that much less

lubrication is used. Just as trying to turn a doorknob

with slippery hands is difficult, it is difficult to grab and

stretch short tissue if too much lubrication is used.

This may be the biggest distinction between ―regular‖

and deep tissue massage. Light lubrication requires less

pressure to grip tissue, so profound work may actually

be less intense than when the therapist works too hard

to overcome the slipperyness of excess lubrication.

Deep tissue massage does, indeed, work with deeper

layers of the body by sinking though superficial layers.

This does not mean that substantially more pressure is

needed as the therapist sinks vertically until she senses

the layer of tension and then moves obliquely to

lengthen short muscles and fascia at this layer.

Strokes will be considerably slower and possibly

shorter as the therapist waits for a slow release of ten-

sion and may move quickly or even skip some areas so

that more time can be spent on specific areas of need.

Clients are often asked to be actively engaged in the

process by moving to positions that stretch muscles

and joints to affect a release.

A session may not cover the entire body. Doing ―spot

work‖ allows for meticulous and careful attention to

problem areas rather than spreading the work ―too

thin.‖

Although it should not be painful, work may be more

intense and utilize active cooperation of the client to

consciously release areas of holding. However, a deep

tissue massage, whether full body or for spot work

should not attempt to coerce the body into submission.

The line between a deep tissue massage and relaxation

massage is not a sharp one. A good relaxation massage

should slow down and pay particular attention to spe-

cific areas of restriction, and a good deep tissue mas-

sage should also have relaxation and pleasure as a ma-

jor goal. As in all bodywork, the key to a gratifying ex-

perience is largely a function of good communication

and clarification of objectives.

The following pages is an example of a brochure made

by Art explaining what is deep tissue massage, you

can print and use as an information for your client .

International presenter Art Riggs became enthralled

with bodywork after a meandering career in acade-

mia. He was certified by the Rolf Institute in 1987 and

teaches deep tissue massage, myofascial release and

Rolf workshops in the US and abroad. He also main-

tains a private bodywork practice in Oakland. Art is

the author of the textbook, Deep Tissue Massage: a

Visual Guide to Techniques and the acclaimed seven

volume DVD series, Deep Tissue Massage and Myofas-

cial Release: A Video Guide to Techniques.

Deep Tissue Massage

Deep Tissue Massage offers the same relaxing and

enjoyable experience as conventional massage, but

with the added emphasis of releasing deeply held

tension in muscles and fascia to provide a more

therapeutic release to troublesome or painful

areas of your body.

Our therapists are specially trained in therapeutic

Deep Tissue Massage and Myofascial Release to

offer you profound, long-lasting benefits that are specially tailored to your individual needs.

Your therapist has taken extensive continuing edu-

cation training in Deep Tissue Massage and Myofas-

cial Release. The fee for this bodywork is based

upon the expertise required to provide the most

enjoyable, effective, and safe experience for you--

not because more effort is required.

Because the work is performed much more slowly

and often requires additional time to release hold-

ing in certain areas, it is highly recommended that you choose a longer time period to enable you to

integrate the work at a pace that is easy for your

body. Longer sessions allow proper time to address

your needs and will provide a more enjoyable, pro-

found, and longerlasting improvements to your well

-being.

Therapeutic

Deep Tissue Massage

and

Myofascial Release

What is Deep Tissue Massage

Most problems in tissue are caused by a buildup of tension

and adhesions due to injury, overuse, or postural habits that

are not specifically addressed in conventional massage. Rather

than simply kneading muscles, your Deep Tissue bodyworker

places emphasis upon the therapeutic benefits of actually

stretching and freeing short and fibrous restrictions.

How is Deep Tissue Performed?

While carefully sinking to deeper layers of the body, your

therapist will work with slow and relaxing strokes to actually

lengthen muscles, and free them where they are "stuck.' Most

of the massage will be performed with the hands, but in cer-

tain areas, the use of more broad and powerful tools such as

knuckles, forearms, fists, and elbows will prevent the discom-

fort that is sometimes felt if too much pressure is applied

with fingers. Body positioning to stretch muscles will provide

more flexibility of joints, release of painful restrictions, and a

gratifying sense of deep relaxation.

What to Expect

Not all of the work will be deeper than what you are used

to in relaxation-based massage. Deep Tissue therapy can

be performed in an integrated full body massage with spe-

cific deep focus upon a single or possibly several trouble-

some areas. However, you may choose a few particular

areas without covering the entire body.

Your Role in the Session

Your therapist is trained to locate areas of tension, but it

is recommended that you take a few minutes to discuss

your needs so that the session will provide you with an

integrated, therapeutic, and pleasant experience. Although

more pressure may be applied, the release of tension

should not be painful, and you may want to be more in-

volved in communicating your experience and needs than

in conventional relaxation massage.

Please feel free to ask our staff if you have any additional

questions ... and enjoy your massage!

Terra Rosa e-magazine, No. 10 (June 2012) 23

Join Art Riggs

for a unique experience

in Deep Tissue Massage

Workshop

Sydney,

October 2012

Register now at

www.terrarosa.com.au/art

Cultivating a powerful and soft touch: Strategies for Treatment with

Deep Tissue Massage and Myofascial Release

27-28 October, Sydney

This 2-day workshop focuses on proper use of biomechanics to allow therapists to remain healthy and conserve en-

ergy, and refine skills for deep tissue massage and myofascial release. We will learn how to work with a powerful but

soft touch, with proper use of knuckles, fists, elbows and forearms. The emphasis is on the layers of the body and myo-

fascial skills to stretch and release tissue restrictions rather than just sliding over superficial layers.

Working with Common Injuries and Complaints in a Bodywork Practice

30-31 October, Sydney

This workshop covers most all of the injuries and complaints that are encountered in a therapeutic bodywork practice.

In addition to therapeutic techniques to help resolve problems, we will also provide information to work safely around

injured areas and what not to do, so both the client and practitioner can feel confident and safe. We will cover:

• The feet and lower leg: plantar fasciitis, Achilles tendinitis, sprains

• The knee: patella-femoral pain, surgery rehabilitation, providing proper function of the joint from an holistic viewpoint

• Back pain, sciatica including piriformis syndrome (psoas work if time permits) and mobilising ‘stuck’ ribs

• Shoulder girdle and rotator cuff

• Arm and wrist problems including RSI

• Whiplash

Terra Rosa e-magazine, No. 10 (June 2012) 24

Most bodywork and movement therapy instructed the

client to perform movement which can facilitate sim-

ple patterns of activation and release. However there

are various bodywork and movement therapy that util-

ise the body‘s own inherent movement for therapy and

relieving pain. Usually these therapies initiate uncon-

scious or automatic movements in the client‘s body.

Here we listed several bodywork and movement works

that used these approaches. And we try to explain ra-

tionally how these spontaneous movements can occur.

We can classify them broadly as bodywork, movement

therapy, and spiritual movements.

Bodywork

Fascial Unwinding

Fascial or myofascial unwinding is a specific technique

of bodywork that is used to release fascial restriction by

encouraging the body or parts of the body to move into

areas of ease. It involves constant feedback to the prac-

titioner who is passively moving a portion of the pa-

tient‘s body in response to the sensation of movement.

The unwinding process usually involves a therapist in-

ducing the movement to a client, and is followed by a

spontaneous reaction: parts of the body bend, rotate,

twitch or twist, sometimes in a rhythmic or chaotic pat-

tern. It is taught and used in myofascial release and

craniosacral therapy. Although unwinding is usually

induced by a therapist, the client can also experience

self unwinding.

Simple Contact

Created by Barrett Dorko, a physical therapist from the

USA in the early 2000s. The basis is that the body

naturally and perpetually moves in a way that promotes

health and optimal function (called inherent move-

ment). The practitioners use their hands not in an ef-

fort to impose forces, but to listen and follow this in-

herent movement, and encourage its greater expres-

sion. This technique explicitly uses ideomotor action

(ideomotion) as a form of therapy.

Non-Directed Body Movements http://

marvinsolit.site.aplus.net/pgs/health/ndbm_mb.htm

Non-Directed Body Movement (NDBM) is a method

developed by Dr. Marvin Solit for unwinding defense

and control patterns that have accumulated in the

body's tissues. Dr. Solit was one of the earliest Rolfers

trained by Dr. Rolf. NDBM is based on an idea that is

diametrically opposed to the common sense dictates of

our culture - that pain, illness, negative emotions and

injury are not bad things to be avoided or fixed.

NDBM started by asking the client to stand and focus

on what you feel in your body without any intention to

understand, change or fix anything. When these feel-

ings, emotions and thoughts arise, it is important not to

act on them, but just to continue to pay attention to

them, most particularly attending to what they feel like

as a physical sensation. Then, just track the sensations,

where they go, how they change, how your body re-

sponds. They are usually slow and subtle, taking a part

or the whole of the body into a rotation, a bend, lifting

up or pulling down. By staying with it long enough, it

eventually releases and the pattern that was under it,

which I was defending myself against, comes to con-

sciousness in some way.

Muscle repositioning (http://

musclerepositioning.blogspot.com/)

A contemporary technique created by Luiz Fernando

Bertolucci, a physician and Rolfer from San Paolo, Bra-

zil. It is a type of myofascial release characterized by

integrating body segments during touch, condition as-

Spontaneous Spontaneous Spontaneous Movement Movement Movement

Terra Rosa e-magazine, No. 10 (June 2012) 25

sociated with the occurrence of various sorts of motor

reflexes. Luiz explained this spontaneous movement as

a form of pandiculation, the involuntary stretching of

the soft tissues, which occurs in most animals and is

associated with transitions between cyclic biological

behaviours, especially the sleep-wake rhythm.

Movement Therapy

Movement therapy refers to a broad range of move-

ment approaches used to promote physical, mental,

emotional, and spiritual well-being. There are various

approaches to movement therapy, and there are some

approaches encourage spontaneous movement. Some

approaches emphasize alignment with gravity and spe-

cific movement sequences, some approaches are pri-

marily concerned with increasing the ease and effi-

ciency of bodily movement. Some approaches empha-

size awareness and attention to inner sensations. Other

approaches use movement as a form of psychotherapy,

expressing and working through deep emotional issues.

The following are some movement works that encour-

age spontaneous movements.

Hanna Somatic Education (http://www.somatics.com)

also known as Hanna Somatics, founded by Thomas

Hanna in the 1970s. Hanna Somatics is a system of

neuromuscular education which helps one to enjoy

freedom from pain and more comfortable movement. It

teaches one to recognize, release, and reverse chronic

pain patterns resulting from injury, stress, repetitive

motion strain, or habituated postures. The experience

of ―conscious embodiment‖ can be developed through a

process of movement exercises, direct touch from a

skilled teacher or therapist, and the study of the body

itself through the life cycle.

One of the forms of somatic education used in Hanna

somatics is pandiculation. Pandiculation is the act of

yawning and stretching simultaneously, it is an instinc-

tual behaviour that cleanses residual tension from the

neuromuscular system and arouses the sensory-motor

nervous system. Pandiculation is found among all ver-

tebrates, the action commonly precedes moving from

rest into activity, commonly manifested as stretching.

The practitioner helps the beginner through a process

called assisted pandiculation, which involves the client

contracting the affected area while the therapist pro-

vides resistance. This teaches the body how to correctly

perform the action. Afterward, the therapist instructs

the client on self-pandiculation to obtain relief from

pain and stress. See also an article on Pandiculation

from Issue 8 of this e-magazine.

Continuum (http://www.continuummovement.com)

Founded by Emily Conrad, a dancer who studied Afro-

Haitian dance and ballet, in the late 1960s. After wit-

nessing and experiencing undulating wave movements

Spontaneous Movement

Terra Rosa e-magazine, No. 10 (June 2012) 26

prayer rituals in Haiti, she found that fluid undulating

movements are the essentials for human being. Emily

developed Continuum Movement as a form of move-

ment education that is based in the concept of the body

being made up of mostly fluids. This gentle therapy

includes breathing techniques, sound, and imagery to

create subtle (mircro) and dynamic movements. The

emphasis is upon unpredictable, spontaneous or spiral

movements rather than a linear movement pattern.

Authentic movement (AM) http://

www.authenticmovementcommunity.org/

Started in 1950s by Mary Starks Whitehouse as

"movement in depth". AM is based on her understand-

ing of dance, movement, and depth psychology. There

is no movement instruction in AM, simply a mover and

a witness. The mover waits and listens for an impulse

to move and then follows or "moves with" the sponta-

neous movements that arise. These movements may or

may not be visible to the witness. The movements may

be in response to an emotion, a dream, a thought, pain,

joy, or whatever is being experienced in the moment.

The witness serves as a compassionate, non judgmental

mirror and brings a "special quality of attention or

presence." At the end of the session the mover and wit-

ness speak about their experiences together.

Subud (http://www.subud.org/)

A spiritual movement developed in Java, Indonesia in

the 1920s founded by Muhammad Subuh Sumohadi-

widjojo. The basis of Subud is a spiritual exercise called

―latihan kejiwaan‖ or simply ―latihan‖ which was said

to represent guidance from "the Power of God" or "the

Great Life Force". This exercise is not thought about,

learned or trained for; it is totally unique for each per-

son and the ability to 'receive' it is passed on by formal

contact with another practicing member at the

'opening'. The experience takes place in a room or a

hall with open space, after a period of sitting quietly,

the members are typically asked to stand and relax.

Members are advised to surrender to the Divine and

follow what arises from within, not expecting anything

in advance. They will find themselves making involun-

tarily movement, walking around, dancing, jumping,

laughing, crying or whatever. The experience varies for

different people, but the practitioner is wholly con-

scious throughout and frees to stop the exercise at any

time.

Taiji wuxi gong (http://www.taijiwuxigong.com/)

Is a type of Tai Chi movement which has a goal to

achieve self-healing and self-regulation using sponta-

neous movement. Spontaneous movement can be in-

duced using a special body posture. The practitioners

stand in a certain position so that the centre of gravity

becomes more central in the body, in the ―Dantian‖, the

energy centre in the lower abdomen. After a while prac-

titioners start moving by themselves in standing posi-

tion. It is about letting the body decide itself what

movement it needs to restore inner movement in an

area that is blocked. It is believed that this posture al-

lows the practitioner to connect to a vibrational force

from the earth, and this force is used to activate the

Dantian, and the activated Dantian creates spontane-

ous movements.

There are also other more rigorous spontaneous

QiGong exercise of Five Animal System (http://

dangerofchi.org/videos/videos.html)

Trance dance (http://www.trancedance.com/)

is a contemporary blend of body movement, healing

sounds, dynamic percussive rhythms, transformational

breathing technique stimulating a 'trance' state that

promotes spiritual awakenings, mental clarity, physical

stamina and emotional well-being.

Spiritual Spontaneous Body Movements

Spontaneous body movements can also occur in many

forms with spiritual connotation. In meditation, spon-

taneous movement can occur as shaking, the head

moving, twitches and all sorts of other body move-

ments.

Kundalini yoga, an active form of yoga designed to

awaken the kundalini (spiritual energy located at the

base of the spine). The main work is called a kriya,

which is a prescribed sequence of poses that focuses on

a specific area of the body. Kriya may consist of rapid,

repetitive movements done with breath or holding a

pose while breathing in a particular way. It can involve

intense involuntary, jerking movements of the body,

including shaking, vibrations, spasm and contraction.

It is believed that this happened when an intense en-

Spontaneous Movement

“I can‟t tell you how it works. I know that the

intention of the therapist has a lot to do with

it. Also the less guarded the patient is, the

quicker it will work. “

John E. Upledger, 1987

Terra Rosa e-magazine, No. 10 (June 2012) 27

ergy moves through the body and clears out physiologi-

cal blocks. As deeply held armouring and blockages to

the smooth flow of energy are released, the person may

re-access memories and emotions associated with past

trauma and injury. (From: http://www.life-

enthusiast.com/ormus/orm_kundalini.htm)

See examples video: http://www.youtube.com/watch?

v=z2NifkVq5RE, or http://www.youtube.com/watch?

v=zCQFSwkvwUc

Spontaneous movement or Ideomotor action is also

part of some spiritual practices, which is called a class

of innate bodily manifestations of spirit: (after Stuart

Sovatsky http://www.cit-sakti.com/kundalini/sahaja-

spontaneous-yoga.htm). The examples are:

Spontaneous spinal rockings prayer in Judaism as davening and Islam as zikr

Autonomic quaking and shaking or ‗Quaker‖ and ―Shaker‖ or the "taken-over" gyrations of gospel ―holy ghost‖ shaking and dancing and charis-matic/pentacostal ―mani-festations‖

Dionysian "revel"

Shamanic trance-dance

Raja-Yoga‘s effortless ―straight back‖ (uju-kaya) meditation

Tibetan yoga‘s Tumo heat

Reichian full-bodied, spontaneous ―orgasm re-flex‖

Yoga kriyas

Spontaneous QiGong No doubt there are other bodywork and movement

works that share similar characteristics. To understand

how spontaneous movement occurs, first we need to

understand about movement. According to André Ber-

nard in Ideokinesis, movement may be defined as a

neuromusculoskeletal event. This means that in order

for movement to take place, all three of the systems

alluded to in this definition—nervous, muscular, and

skeletal—must be involved. Each system has its own

specific role to play; the nervous system is the messen-

ger, that is, it transmits impulses or messages to the

muscles to contract or release; the muscle system is the

workhorse or the motor system; the skeletal system is

the support system that is moved by the work of the

muscles.

The nervous system is more than just a simple messen-

ger. It also organizes the muscle pattern, and it does

this on a level below consciousness. It is the complex of

muscles that perform a desired movement: organizing

the muscle pattern is a highly complex and sophisti-

cated task. Our conscious role in movement is to focus

on the movement, because the nervous system, in orga-

nizing the muscle

pattern, is respond-

ing to the clarity of

one‘s concept of

what the movement

is. If the movement

is not done well, it

means the muscle

pattern is poor, and

the muscle pattern is

poor because the

―wrong‖ message (a

faulty concept of the

movement) has been

sent to the muscles.

This wrong message

is the result of either

a lack of clarity

about what the

movement is or a

previously estab-

lished poor muscle pattern associated with the move-

ment.

The objective of movement work is to change the mes-

sage—that is, to rethink the movement in order to

change the poor muscle pattern. This rethinking the

movement can be formed into an image and used as a

means to change the muscle pattern.

However in spontaneous movement, the inherent

subconscious movement is used to correct the muscle

pattern. The whole class of involuntary and automatic

movement, can be considered as ideomotor action or

ideomotion. Ideomotion is a movement that occurs as a

result of mental activity, but independently of con-

scious volition. These involuntary movements can hap-

pen spontaneously or can be stimulated by various

ways. The stimulus can be tactile and proprioceptive

stimuli, or simply by thought, emotion, verbal sugges-

tion. Barrett Dorko argued that ideomotor movements

that accompany pain can be corrective. When pain of

mechanical origin occurs, our brain automatically pro-

duce motor commands to reduce pain . However the

corrective movements produced by pain are often in-

hibited by other mental activity. Thus ideomotion can

be used as corrective movements that have become in-

hibited. (See also http://

www.bettermovement.org/2011/ideomotion-part-three

-how-to-elicit-corrective-movement/)

This is a work in progress. Feel free to provide com-

ments by emailing terrarosa@gmail.com

Spontaneous Movement

Terra Rosa e-magazine, No. 10 (June 2012) 28

Tom, can you briefly explain what is MET?

What is the difference with stretching.

MET stands for Muscle Energy Technique. It is an Os-

teopathic-based method that does not use manipula-

tion to correct asymmetry and hypo-mobilities in the

body. Since it relies on the muscle spindles, it actually

has advantages over stretching because it is theorized

to reset the muscle spindle to actually lengthen the

muscle and not just stretch it.

Usually we learn MET for lengthening muscles,

but in your books and DVDs you also focused

on joints, ribs and vertebrae. Why and what's

the benefit for bodyworkers to learn these tech-

niques

There are two main types of Muscle Energy Tech-

niques: One technique for large muscle groups and one

for articular restrictions / hypo-mobility. So often,

smaller muscles can get reset and pull / restrict bones

and joints, thus creating pain and lack of range of mo-

tion. Having these two techniques in your "bag of tools"

can effectively treat just about any somatic asymmetry

and hypo-mobility you find.

In your book, you mentioned 'Bone is the Slave

to Muscle'?

Yes, this is an Osteopathic phrase to remind us that the

bones / joints are not stuck out of place by some physi-

ologic glue but rather, held out of place by muscles that

have too much tone and have been "re-set" to be too

short and too sensitive to stretch. Therefore, since a

manipulation may produce an analgesic effect to tem-

porarily reduce pain, Muscle Energy, when done prop-

erly, is designed to correct the problem and not just

cover up the pain. In other words, since the problem is

in the muscle, why spend your time treating the joint.

You also stressed a lot on breathing in your

work, can you tell us the importance of correct

breathing, and how bodywork can help.

It takes about 3-4 full seconds to reset the muscle spin-

dle back to normal. That is just about the amount of

time it takes to take a nice breath in and out. Also, and

perhaps even more importantly, deep breathing is

known to have a direct synaptic connection to inhibit

the gamma motor neuron cell body that is located in

the anterior horn of the spinal cord. Therefore the deep

breath assists in the actual resetting of the muscle spin-

dle by inhibiting firing of the gamma motor neuron and

thus the interfusal fibres of the muscle spindle itself.

One more thing, we don't breathe well and good deep

breaths are very healthy for all of us.

Why do you need to 'treat' the ribs?

Since deep breathing is such a big help to doing muscle

energy as well as reversing and preventing so many

diseases, if the ribs are painful and don't expand well,

you have difficulty breathing. Once a pattern of shallow

or belly breathing is learned and maintained, we begin

our slow downward spiral of ill health and hasten our

death. As you may know, Joseph Pilates was very big

on breathing. So by treating rib restrictions you can get

proper breathing back on track and really improve the

life expectancy or what I like to call the "thrife expec-

tancy." In other words, how long you actually thrive,

not just how long you live.

You also have a passion on Alternative Medi-

cine, we obviously don't feel that Alternative

Medicine should only be used as a last resort.

I'm in favour of anything natural and simple that keeps

us healthy. In most cases, that is in direct opposition to

our current, income-based conveyor belt form of medi-

cine. Unfortunately, in the USA, our health care system

is the number one cause of death. Time to change that

system.

Tom OcklerTom OcklerTom Ockler on METon METon MET

Terra Rosa e-magazine, No. 10 (June 2012) 29

What tips can you give to massage therapists to

prolong their career?

No matter what type of body worker you are, your hands

and shoulders are your most important tools.

Learn how to breathe; keep your core strong and keep

balance in your body's musculoskeletal system.

What are your interests these days?

Currently researching and writing two chapters for a

textbook on chronic pain. One of the chapters is about

MET, the other is about EFT.

How and where can we learn more about MET?

Taking a course from an experienced practitioner and

teacher is the best way. Buying the corresponding

manuals and DVDs is also a good start.

Are you planning to come and teach in Austra-

lia?

I taught in Australia for a month way back in the late

80s and have not been back since. I have been contacted

by several physiotherapists, oesteoplaths and massage

therapists to come over and teach but so far, no one has

taken the lead to get it done. I would love to come over

to Australia to teach. Who knows, It just might happen

some day soon.

Tom Ockler P.T. has extensive

teaching experience throughout the

United States, Canada, England

and Australia. As a teacher, Tom

has earned the nickname "The

Patch Adams of Physical Therapy"

due to his unique style of injecting

humour into complicated subjects.

He has developed teaching methods that explain very

complicated subjects in easily understandable formats.

His two books and DVDs Muscle Energy Technique for

Lower Extremities, Pelvis, Sacrum, and Lumbar Spine

and Muscle Energy Techniques for the Thoracic Spine,

Ribs, Shoulder and Cervical Spine have been hailed by

students as the most user friendly and useful Muscle

Energy manuals ever.

MET

Terra Rosa e-magazine, No. 10 (June 2012) 30

Massage practitioner agreement terms frequently fea-

ture a straight percentage of earnings. The contracting

practitioner receives fee for service then remits a per-

centage of those fees to the business owner or manager.

For short-term locum (maternity leave/limited-time)

or as a trial to ensure practitioner and workplace are a

good fit, straight percentage agreements work well. For

long-term relationships built on trust, loyalty and re-

spect, they are problematic.

A straight percentage creates a variable rent, typically

covering operating expenses incurred in some, but not

all, months. Early in the working relationship, the busi-

ness owner frequently supplements the contractor‘s

expenses in the hope the investment will result in a

long-term relationship and eventually a profit. In ef-

fect, the owner shoulders the risk of the associate‘s suc-

cess.

The above illustration depicts the rent a business

owner receives from a contracting practitioner over six

months in a straight percentage agreement. Operating

expenses are estimated by the business owner to be

$950 / month. Note the variance of the rent paid to the

clinic. In only two months does the business make a

profit above operating expenses in exchange for bro-

kering a work opportunity for the associate. In the

other four months, the business does not receive ade-

quate rent to cover operating expenses incurred by the

associate. In those four months, the business owner

must cover the shortfall with her or his own money.

It‘s worth re-stating the obvious. With a percentage

agreement, whenever the associate does not work at

adequate capacity to meet expenses, the business

owner dips into his or her own pocket to make up the

difference.

Percentage-only agreements are not good for contract-

ing practitioners either. When starting out, paying a

portion seems reasonable. However, when the contrac-

tor's practice is booming, the rent can seem dispropor-

tionately high. A straight percentage agreement pro-

vides a disincentive to long-term working relationships

because it penalizes the associating practitioner for

working more! Having to relocate because the rent be-

comes too high is expensive and practice-killing. For

long-term relationships, we need accountability and

opportunity for financial reward on both sides.

I suggest a model that encourages fairness and ac-

countability for both parties - a percentage agreement

with a base and cap rate. The base rate guarantees cash

-flow for the business owner to offset business expenses

borne on behalf of the associate. The cap rate creates

incentive for the associate to work hard and maximize

Practitioner & Owner: Practitioner & Owner: Practitioner & Owner: “Straight Percentage “Straight Percentage “Straight Percentage

Agreements Work Best”Agreements Work Best”Agreements Work Best”

Don Dillon

Terra Rosa e-magazine, No. 10 (June 2012) 31

her/his yield. In my experience, the base rate motivates

contracting practitioners to try harder, to focus their

efforts and challenge themselves. The cap rate assures

them the rent will not become unreachable.

In my dealings with associates, I found it effective to set

a base rate for the first six months, then raise the base

rate for the second six months, followed by a move to a

flat rent (set at the cap rate) at one year. It allowed the

associates time to get their practice up and running

without excessive financial pressure. And, it ensured

that, as business manager, I could expect a progressive

return on investment in my budding associate. It also

pushed me to get my associates as productive as possi-

ble quickly.

"I'm away....why should I pay?"

Some contracting practitioners argue they shouldn't

bear expense when on vacation or away from the office.

Their logic, "I'm not working or using any re-

sources...why should I pay?" I recall a month when

both my associates were away for a good portion, one

married and the other on a training course. Because we

had straight percentage terms, their low productivity

that month meant low cash flow for me. I had to cover

much of the operating expenses myself which meant I

didn't have enough take-home pay for myself. As a re-

sult, I incurred debt.

Consider this analogy. I am going on vacation and

won‘t be home for two weeks. Can I call the mortgage

company and ask them to suspend my mortgage for

two weeks because I won‘t be using my house? Or the

phone, hydro and gas companies and ask for a reduc-

tion because I‘m not using their services for two weeks?

What about the municipal government – do I ask them

to scale back my property taxes? Of course not. I incur

expenses regardless of if I‘m home or not. Businesses

do, too.

Caveat: As a business owner and manager, make sure

you know your average monthly and seasonal business

expenses before you set the terms of your agreement.

Don't forget to build in a profit margin for contingency,

expansion and reward for shouldering the risk and re-

sponsibility of running the business. In my opinion,

straight percentage agreements have some benefits, but

have unacceptable disadvantages in long-term working

relationships.

Partners in Profit But Without Risk Are Not

Partners!

Sometimes, practitioners-turned-business managers

allow an associate under their wing in a collective part-

nership. True partners share the potential for profit as

well as risk of loss. Partnerships are problematic when

risk is not borne equally by all partners. Consider a

business owner who agrees to divide the expenses for

business operation equally between herself or himself

and three associates, without incorporating any profit

margin.

The business owner is wearing two hats - practitioner

and manager - but did not factor in a salary for the ex-

tra administrative work required. If two associates

leave, the owner and the remaining associate must now

double their rent (and their business duties) to cover all

expenses until they find two more ―partners.‖ Are all

partners willing to bear the risk of loss as the business

owner must? If not, don't make them partners! Part-

ners should buy in/invest with their own capital and

have the responsibility of finding a replacement or sell-

ing their share should they wish to leave the partner-

ship.

A business manager who bears the operating expenses

and risk of loss should be paid for it.

"Without a straight percentage agreement,

will I fail to attract candidates?"

If you have an established location and reputation you

have a valuable asset. Associates will jockey for the op-

portunity to be part of your business.

During prospective associate interviews, I openly dis-

Straight Percentage

Terra Rosa e-magazine, No. 10 (June 2012) 32

close what it costs to run my business (profit margin

in), and clearly set my expectations for the candidate.

In setting up expectations in advance, I am less likely to

encounter problems with the associate later on. If your

business has high value – a well-established reputation

and location – you will attract better candidates.

Intuition versus Doing the Math

In my seminars, I ask business owners, ―How did you

arrive at the financial terms for your agreement?‖ The

typical response: The terms ―seemed fair,‖ or ―felt

right.‖ Further, ―If I figure my actual expenses and a

profit margin into my terms, my associates will leave

and take all the business with them. I can‘t raise the

rent!‖ This is what I believed as a business owner and

manager and for years tried to increase my income

through other means before I finally questioned my

own beliefs. I had allowed professional myths and mis-

information to determine my terms, rather than basic

math. I had paid handily for these beliefs and not until

I admitted the reality of my business costs and lack of

business experience did I resolve my dilemma.

After examining my financial position and talking with

my accountant, I put together a fact sheet with the ac-

tual costs of the business and scheduled a meeting with

my associates to present the financial facts. The associ-

ates at first were apprehensive – a natural response to

being asked for more money. But after discussion and

reflection, the associates fully accepted the new terms.

They were as reliant as I on seeing the business con-

tinue.

While intuition is an important faculty for the practitio-

ner providing care, do not forget to do the math when it

comes to forming a contractual agreement. Make sure

your agreement is based on financial facts, not opinions

or unhelpful beliefs.

Don Dillon, RMT is the author of Massage Therapist

Practice: Start. Sustain. Succeed. and the self-study

workbook Charting Skills for Massage Therapists.

Don has lectured in seven Canadian provinces and

over 60 of his articles have appeared in massage in-

dustry publications in Canada, the United States and

Australia.

Don is the recipient of several awards from the On-

tario Massage Therapist Association, and is one of the

founding members of Massage Therapy Radio

www.massagetherapyradio.com. His website,

www.MTCoach.com, provides a variety of resources

for massage therapists.

This excerpt is reprinted from Massage Therapist

Practice: Start. Sustain. Succeed.

Available from Terra Rosa http://

www.terrarosa.com.au/book/

Straight Percentage

Terra Rosa e-magazine, No. 10 (June 2012) 33

When used in the context of therapy –

physiotherapy, massage therapy, oste-

opathy or chiropractic, for example –

the term posture more precisely de-

scribes the relationships among various

parts of the body, their anatomical ar-

rangement and how well they do or do

not fit together. Bodyworkers have be-

come familiar with postural terms such

as scoliosis and genu valgum, which are

used to describe a congenital, inherited

position, plus used to describe a posi-

tion assumed through habit, such as

increased thoracic kyphosis resulting

from prolonged sitting in a hunched

position. Of course, the postures we

assume provide clues to not only the

condition of our bodies – traumas and

injuries old and new, and mild or more

serious pathologies – but also how we

feel about ourselves – our confidence

(or lack of it), how much energy we

have (or are lacking), how enthusiastic

(or unenthusiastic) we feel, or whether we feel certain

and relaxed (or anxious and tense). Intriguingly, we all

almost always adopt the same postures in response to

the same emotions.

Why should I perform a postural assess-

ment?

The main reasons for carrying out a postural assess-

ment are to acquire information, save time, establish a

baseline, and treat holistically.

i) Acquire information

First, and most important, performing a postural as-

sessment gives you more information about your client.

Here are two examples to illustrate this point:

Example 1

Working with the general popula-

tion, you have your fair share of cli-

ents suffering from back and neck

pain. Many clients believe that their

‗terrible posture‘ is due to the seden-

tary nature of their work, the long

hours they spend slumped at a desk

or driving. It would be helpful to

know whether a client‘s pain does

indeed stem from the adoption of

habitual postures, or whether it

might be due to something else. By

distinguishing among various

causes, you are more likely to be

able to determine whether a change

in working posture might be benefi-

cial.

Example 2

Assessing a 49-year-old woman for

worsening shoulder pain, you notice

a decrease in shoulder muscle bulk

during the postural assessment. One

possible explanation for atrophy of the shoulder mus-

cles (accompanied by a progressive decrease in range of

movement) in a client with no history of trauma is ad-

hesive capsulitis. The information you have gained

from your observation has contributed to the formula-

tion of your diagnosis, which may later be substanti-

ated or refuted with the appropriate tests.

It is important to remember that postural assessment is

only one component of the assessment procedure, and

that to make a diagnosis of any condition, all compo-

nents of the assessment procedure need to be consid-

ered, along with current guidelines. For example, to

support a diagnosis of adhesive capsulitis, you may fol-

low guidelines such as those set out by Hanchard and

colleagues (2011).

The postural assessment is also an opportunity to clar-

Postural Postural Postural AssessmentAssessmentAssessment

Jane Johnson

Terra Rosa e-magazine, No. 10 (June 2012) 34

ify observations about marks on the skin such as

scars from significant operations (such as appen-

dectomies or treatment for fractures in child-

hood) that clients may have forgotten to men-

tion.

ii) Save time

A postural assessment may save time in the long

run by revealing facts that are pertinent to the

client‘s problem that might otherwise have taken

longer to establish. The relationships among

body parts are more difficult to assess when

someone is lying down to receive a treatment,

but suddenly become obvious when they stand.

Example

You are a sports massage therapist treating a typist

who is normally fit and healthy. She is complaining of

right-side anterior shoulder pain. Performing both the

standing and sitting postural assessments, you observe

that your client has a considerably protracted right

scapula, something you had not noticed when your cli-

ent was in the prone position, a position in which both

scapulae naturally protract.

iii) Establish a baseline

A postural assessment helps you to establish a baseline

– a marker by which you might judge the effectiveness

of your treatment. If your client has muscular pain in

the low back resulting from the position of the pelvis,

and you prescribe exercises and stretches to correct this

posture, you will no doubt need to reassess the client at

some stage to determine whether there has been any

change in the pain and whether this can be attributed

to an alteration in the position of the pelvis. If we sus-

pect that a problem is the result of poor posture, we

need to identify whether we have made any impact

(directly with massage and movement, or indirectly

with prescribed exercises and stretches) on the client‘s

upper body posture.

iv) Treat holistically

Finally, it could be argued that by including an analysis

of posture as part of our assessment, we are offering a

more complete service, in keeping with the idea of

treating people holistically, not compartmentalising

them as a bad knee, a frozen shoulder, or whiplash. We

keep records of clients‘ states of health and physical

activities, so it seems logical that we also keep a record

of their postures.

Who should have a postural assess-

ment?

Ideally, you should perform a postural assess-

ment on all clients presenting for sports or reme-

dial massage, physiotherapy or osteopathy treat-

ments. If you are working as a fitness profes-

sional with one of your aims being to strengthen

weak muscles, or as a teacher of yoga aiming per-

haps to lengthen muscles, you too will find pos-

tural assessment beneficial because it will help

you identify muscle imbalances and you can

therefore design the most effective exercises and

postures for your clients. However, with some

clients, a postural assessment may not be appro-

priate, such as the following:

An anxious client

A client unable to stand because of pain or illness

A client who is unstable when standing or when get-

ting to or from the standing position

A client who does not understand the purpose of the

assessment or who does not give consent to having

one performed

A client with a condition that would benefit from a

different form of assessment

When working with an anxious client, you may want to

postpone a postural assessment while you develop a

rapport. Once that is established, you can carry out a

more thorough assessment, including that of posture. It

would be inappropriate to assess the posture of a client

who is unable to stand because of pain or illness. Re-

member, you can still assess a client in a seated posi-

tion. In some cases a postural assessment is warranted

but must be performed with care. For example, you

may want to assess an elderly person who has suddenly

become unbalanced when using a regular walking aid.

In this case you need to assess the patient standing

with the aid, yet you must also ensure safety. Similar

caution needs to be taken when assessing a client with

a recent injury. With such patients – particularly those

with injury in the lumbar spine, pelvis or lower limbs –

weight bearing or a change in posture may aggravate

discomfort. Some clients may be unsettled by how close

you are to them during a postural assessment; with

such clients, you should clearly explain your intention

and the purpose behind the assessment.

Postural Assessment

Terra Rosa e-magazine, No. 10 (June 2012) 35

Structural or anatomical

Scoliosis in all or part of the spine. Discrepancy in the length of the long bones in the upper or lower limbs. Extra ribs. Extra vertebrae. Increased elastin in tissues (decreasing the rigidity of ligaments).

Age Posture changes considerably as we grow into our adult forms, with postures in children being markedly different at different ages.

Physiological Posture changes temporarily in a minor way when we feel alert and energised compared to when we feel subdued and tired.

Pain or discomfort may affect posture as we adopt positions to minimise discom-fort. This may be temporary or could result in long-term postural change if the position is maintained.

Physiological changes that accompany pregnancy are temporary (e.g., low back-ache before or after childbirth), but sometimes result in more permanent, compensatory postural change.

Pathological Illness and disease affect our postures especially when bones and joints are in-volved. Osteomalacia may show up as genu varum; arthritic changes are often revealed when joints in the limbs are observed.

Pain can lead to altered postures as we attempt to minimise discomfort (for exam-ple, following a whiplash injury a client may hunch the shoulders protectively; abdominal pain may lead to spinal flexion).

Malalignment in the healing of fractures may sometimes be observed as a change in bone contour.

Certain conditions may lead to an increase or a decrease in muscle tone. For ex-ample, someone who has suffered a stroke may have increased tone in some limbs but decreased tone in others.

As elderly adults, we tend to lose height as a result of osteoporotic changes and so develop stooped postures; postmenopausal women may develop a dowager‘s hump.

Occupational Consider the postural differences between a manual worker and an office worker, and between someone active and someone sedentary.

Recreational Consider the postural differences between someone who plays regular racket sports and someone who is a committed cyclist.

Environmental When people feel cold they adopt a different posture to that when they feel warm.

Social and cultural

People who grow up sitting cross-legged or squatting develop postures that are different from those of people who grow up sitting on chairs.

Emotional Usually, the posture we subconsciously adopt to match certain moods is tempo-rary, but in some cases it persists if the emotional state is habitual. Consider the posture of a person who is grieving, or the muscle tone of a person who is angry.

Clients who fear pain may adopt protective postures.

Factors affecting posture

Postural Assessment

Terra Rosa e-magazine, No. 10 (June 2012) 36

Examples of postural assessment

Please note that these examples form just two parts of a

full body assessment and are for illustrative purposes

only.

Shoulder height

When looking at your client‘s shoulders, note whether

they are level, or if one appears higher than the other.

What your findings mean

Shortening in levator scapulae and the upper fibres of

the trapezius may contribute to one shoulder appearing

higher than the other. If a scapula is elevated, you would

expect the inferior angle of that scapula to be superior to

the inferior angle of the scapula on the opposite side.

Here is an interesting question: How do you know

whether one shoulder is truly higher or the other is

lower? Ask the client to try this simple exercise: shrug

their shoulders, elevating their scapulae; then relax.

Now depress their shoulders; then relax. Which move-

ment did they find easier, elevation or depression? Most

people find that shrugging the shoulders is easier than

depressing them. It seems reasonable to assume that if

your client‘s right shoulder appears higher, muscles on

the right are shorter and tighter than the corresponding

muscles on the left. An exception to this might be if you

were assessing someone with a neurological condition

(for example, having suffered a stroke) and she had a

dropped shoulder as a result of low tone on one side of

her body.

Therapists have observed that, for many people, the

dominant shoulder is naturally depressed and slightly

protracted. If right-handed, the right shoulder may be

slightly lower and more protracted than the left. Clients

with neck pain may subcon-

sciously elevate their shoul-

der protectively in an at-

tempt to reduce their dis-

comfort.

This woman is standing

‗relaxed‘. Observe how she

holds her right arm. She has

suffered neck pain in the

past, but at the time this

photograph was taken, and

for many months previous to

that, she was pain free.

Would you agree that her

right shoulder is elevated?

Can you see also how her neck is also laterally flexed

and slightly rotated to the right?

Abdomen

An area that

sometimes

gets over-

looked in pos-

tural assess-

ment is the

abdomen.

How does the

abdomen of

your client

appear - is it

flat or protrud-

ing? In a nor-

mal, healthy

person, the

abdomen

should be flat.

The photo-

graphs on the

opposite page demonstrate the variety in the shape and

position of the abdomen when a person is viewed later-

ally. Does an abdomen protrude because the person is

overweight or pregnant, or it is the result of the person‘s

overall standing posture and an anteriorly tilted pelvis?

Is there increased tension in the abdomen perhaps cor-

responding to a posteriorly tilted pelvis and a decreased

curve in the lumbar spine?

Postural Assessment

Terra Rosa e-magazine, No. 10 (June 2012) 37

What your findings mean

Protrusion of the abdomen could be a natural conse-

quence of pregnancy or the result of increased lumbar

lordosis, or it could simply be excess adipose tissue be-

cause the client is overweight. Clients with restrictions

in the muscles and fascia of the chest sometimes appear

to have a protruding abdomen, quite a distinct change

in shape from the chest area, which is tight and de-

pressed.

References

Hanchard N, Goodchild L, Thompson J, O‘Brien T,

Richardson C, Davison D, Watson H, Wragg M, Mtopo S

and Scott M (2011). Evidence-based clinical guidelines

for the diagnosis, assessment and physiotherapy man-

agement of contracted (frozen) shoulder, Standard

Physiotherapy 1:3. Endorsed by the Chartered Society of

Physiotherapy.

This excerpt is based on excerpts from Postural Assess-

ment, by Jane Johnson, published in December 2011 by

Human Kinetics. This article was first published in

International Therapist (Issue 99, January 2012), the

membership journal of the Federation of Holistic

Therapists.

Postural Assessment is available from

www..terrarosa.com.au

Jane Johnson MSc, is co-director of the London Mas-

sage Company, England. As a chartered physiothera-

pist and sport massage therapist, she has been carry-

ing out postural assessments for many years. She is

renowned for her teaching, enthusiasm and dynamism.

Her track record in the industry spans over 17 years

working both as a practitioner/instructor and as

course director of her own company and other success-

ful massage schools. She has a deep interest in muscu-

loskeletal anatomy and how newly qualified therapists

can be better educated in this subject. She also is inter-

ested in the relationship between emotions and pos-

ture. In her spare time, Johnson enjoys taking her dog

for long walks, practicing wing chun kung fu, and vis-

iting museums. She resides in London. Read also 6

questions to Jane on page 43

Postural Assessment

Terra Rosa e-magazine, No. 10 (June 2012) 38

Having used Primal software for many years in her

teaching, renowned massage therapist and educator

Judith DeLany proposed a new Primal Pictures product

specifically designed for manual practitioners, with a

focus on massage techniques. This proposal became a

reality in 2012 with the publication of 3D Anatomy for

Manual Therapies.

The aims of the product are to introduce the students,

as well as professional practitioners, to a wide range of

techniques and modalities, to clarify anatomy and func-

tional movements, and to provide instructors with ex-

ceptional, easy to use tool, to guarantee success within

this substantial, worldwide market.

Manual therapy practitioners use their hands to locate,

assess and treat myofascial tissues. The clearer the

anatomy knowledge, the more precisely placed and

safely executed the treatment. Knowledge of neurovas-

cular and lymphatic structures is necessary in order to

avoid endangerment sites and to focus treatment to-

ward relieving muscular impingement of those struc-

tures. Using clear anatomy visuals, created by Primal

Pictures, provides the level of detail needed in an en-

gaging and easy to use format.

The 3D anatomy models were accurately built using

MRI and CT scan data and cadaveric material. For

many of our 3D models we used the Visible Human

Project data produced by University of Michigan. The

imaging data is delivered as 2D cross-sectional slices,

and then each slice goes through a segmentation proc-

ess. This involves outlining individual tissue, by hand,

and tracking the contours of each anatomical feature

through successive slices, which are then built into a

3D model using advanced graphics techniques. All Pri-

mal anatomy models are verified by an in house team

of qualified anatomists and by a team of external ex-

perts.

Judith DeLany and Primal Pictures worked with a team

of the top names in massage and manual therapy, in-

cluding: Timothy Agnew, Sandra K Anderson, Jean-

Pierre Barral DO MRO(F) PT, Leon K Chaitow ND DO,

Bruno Chikly MD DO, Alain Croibier DO MRO(F),

Johnette du Rand ,Sandy Friedland, Richard M Gold

PhD L.Ac, Alison Harvey DC CST-D, Dawn Langnes BS

LMT, Whitney W Lowe, Vimala McClure, Mike McGil-

licuddy, Joseph E Muscolino DC, Thomas Myers,

Carole Osborne, Sharon Puszko PhD LMT, Susan G

Salvo B Ed LMT NTS CI NCTMB, John E Upledger DO

OMM John M Upledger CEO, Ed Wilson LMT, Cert

Reflexology, Robert A Wuttke LMT NSCA-CPT BMO,

James Waslaski AA LMT CPT (NASM), Linda Beach,

Iris Burman LMT CNMT, Susan Kay Hillman, ATC, PT

Beside anatomy, the DVD-ROM also covered 27 man-

ual therapy techniques, include: Active isolated stretch-

3D Anatomy for3D Anatomy for3D Anatomy for Manual TherapiesManual TherapiesManual Therapies

Terra Rosa e-magazine, No. 10 (June 2012) 39

ing, Orthopedic massage, Aquatic bodywork, PNF

stretching, Body wraps and scrubs, Positional release,

Craniosacral therapy, Prenatal massage, Hospice-based

massage therapy, Reflexology, Hot/cold stone therapy,

Shiatsu/acupressure, Infant massage, Sports massage,

Kinesiotaping, Spray and stretch, Lymph drainage

therapy, Structural integration, Massage for the elderly,

Swedish massage, Muscle energy techniques, Thai mas-

sage, Neural manipulation, Trigger point release, Neu-

romuscular therapy (NMT), Visceral manipulation,

Oncology massage.

3D Anatomy for Manual Therapies is now available

from www.terrarosa.com.au

Postural Assessment offers students and

practitioners of massage therapy, physi-

cal therapy, osteopathy, chiropractic,

sports medicine, athletic training, and

fitness instruction a guide to determin-

ing muscular or fascial imbalance and

whether that imbalance contributes to

pain or dysfunction.

Now available at www.terrarosa.com.au

Terra Rosa e-magazine, No. 10 (June 2012) 40

Massage Therapy Attenuates Inflammatory Sig-

nalling After Exercise-Induced Muscle Damage

Although there is evidence that massage may relieve

pain in injured muscle, how massage affects cellular

function remains unknown. The discovery provides

strong evidence that massage merits further study as a

treatment for injuries and chronic disorders, said Dr.

Mark Tarnopolsky, a researcher at McMaster Univer-

sity in Ontario, Canada. The authors administered ei-

ther massage therapy or no treatment to separate

quadriceps of 11 young male participants after

exercise-induced muscle damage. Tarnopolsky, who

has studied the cellular effects of exercise for decades,

performed muscle biopsies in both quadriceps (vastus

lateralis) of healthy young men before and after they'd

undergone strenuous exercise, and then a third time

after massaging just one leg in each individual. Com-

paring tissues from each subject's massaged leg with

tissues from his unmassaged leg, Tarnopolsky and his

team found that massage therapy reduced exercise-

related inflammation by dampening activity of a pro-

tein called NF-kB. Massage also seemed to help cells

recover by boosting amounts of another protein called

PGC-1alpha, which spurs production of new mitochon-

dria — tiny organelles inside cells that are crucial for

muscle energy generation and adaptation to endurance

exercise. Other proteins with similar roles were influ-

enced by massage as well.

The study was published in the journal Science Trans-

lational Medicine.

Pleasant Human Touch is Represented in the

Brain

Touch massage (TM) is a form of pleasant touch stimu-

lation used as treatment in clinical settings and found

to improve well-being and decrease anxiety, stress, and

pain. Emotional responses reported during and after

TM have been studied, but the underlying mechanisms

are still largely unexplored. In the study conduced by

Swedish scientists, the authors used functional mag-

netic resonance (fMRI) to test the hypothesis that the

combination of human touch (i.e. skin-to-skin contact)

with movement is eliciting a specific response in brain

areas coding for pleasant sensations. The design in-

cluded four different touch conditions; human touch

with or without movement and rubber glove with or

without movement. The pleasantness of the four differ-

ent touch stimulations was rated on a visual analog

scale (VAS-scale) and human touch was rated as most

pleasant, particularly in combination with movement.

The fMRI results revealed that TM stimulation most

strongly activated the pregenual anterior cingulate cor-

tex (pgACC.) These results are consistent with findings

showing pgACC activation during various rewarding

pleasant stimulations. This area is also known to be

activated by both opioid analgesia and placebo. To-

gether with these prior results, the finding furthers the

understanding of the basis for positive TM treatment

effects. The study was published in Neuroimage.

Massage Therapy for Osteoarthritis of the Knee

A group of medical scientists from the US in 2006, re-

ported results of a pilot study of massage therapy for

osteoarthritis (OA) of the knee. Subjects with OA of the

knee were randomized to biweekly (4 weeks), then

weekly (4 weeks) Swedish massage (1 hour sessions) or

wait list. Subjects receiving massage therapy demon-

strated significant improvements in the Western On-

tario and McMaster Universities Osteoarthritis Index

(WOMAC), pain, stiffness, and physical functional

disability domains and visual analog pain scale, com-

pared to usual care. Notably, the benefits persisted up

to 8 weeks following the cessation of massage.

In a new trial, the scientists now want to identify the

optimal dose of massage within an 8-week treatment

regimen and to further examine durability of response.

Participants were 125 adults with OA of the knee, ran-

domized to one of four 8-week regimens of a standard-

ized Swedish massage regimen (30 or 60 min weekly or

biweekly) or to a Usual Care control.

Their results showed that the WOMAC Global scores

improved significantly in the 60-minute massage

groups compared to Usual Care at the primary end-

point of 8-weeks. WOMAC subscales of pain and

functionality, as well as the visual analog pain scale also

demonstrated significant improvements in the 60-

minute doses compared to usual care. No significant

differences were seen in range of motion at 8-weeks,

and no significant effects were seen in any outcome

measure at 24-weeks compared to usual care. A dose-

response curve based on WOMAC Global scores shows

increasing effect with greater total time of massage, but

with a plateau at the 60-minute/week dose.

The authors concluded that Given the superior conven-

ience of a once-weekly protocol, cost savings, and con-

sistency with a typical real-world massage protocol, the

60-minute once weekly dose was determined to be op-

timal, establishing a standard for future trials.

The research was published in PLoS.

Research Highlights

Terra Rosa e-magazine, No. 10 (June 2012) 41

The Role of Massage in Scar Management

Many surgeons recommend postoperative scar massage

to improve aesthetic outcome, although scar massage

regimens vary greatly. Scientists from Ohio conducted a

review on the efficacy of scar massage. The review was

published in Dermatology Surgery Journal.

After searching through a large scientific database, ten

studies including 144 patients who received scar mas-

sage were examined in the review. Time to treatment

onset ranged from after suture removal to longer than 2

years. Treatment protocols ranged from 10 minutes

twice daily to 30 minutes twice weekly. Treatment dura-

tion varied from one treatment to 6 months. Overall, 65

patients (45.7%) experienced clinical improvement

based on Patient Observer Scar Assessment Scale

score, Vancouver Scar Scale score, range of motion, pru-

ritus, pain, mood, depression, or anxiety. Of 30 surgical

scars treated with massage, 27 (90%) had improved ap-

pearance or Patient Observer Scar Assessment Scale

score. However the authors concluded that although

there are several studies showing the effectiveness, the

evidence for the use of scar massage is weak, regimens

used are varied, and outcomes measured are neither

standardized nor reliably objective, although its efficacy

appears to be greater in postsurgical scars than trau-

matic or postburn scars. Although scar massage is anec-

dotally effective, there is scarce scientific data in the

literature to support it.

Neural Correlates of a Single-session Massage

Treatment

A recent study from Canada investigated the immediate

neurophysiological effects of different types of massage

in healthy adults using functional magnetic resonance

imaging (fMRI). The study suggested that that qualita-

tively different aspects of massage, such as the nature of

human touch, can selectively modulate the activity of

certain brain regions.

The researchers looked at the problem from, the resting

state of the brain, which has been referred to as the de-

fault mode network and has received much attention for

its importance in the generation of consciousness. These

regions (i.e. insula, posterior and anterior cingulate,

inferior parietal and medial prefrontal cortices) have

been postulated to be involved in the neural correlates

of consciousness, specifically in arousal and awareness.

The researchers posit that massage would modulate

these same regions given the benefits and pleasant af-

fective properties of touch. Healthy participants were

randomly assigned to one of four conditions:

1. Swedish massage, 2. reflexology, 3. massage with an

object or 4. a resting control condition. The right foot

was massaged while each participant performed a cog-

nitive association task in the scanner.

They found that the Swedish massage treatment acti-

vated the subgenual anterior and retrosplenial/ poste-

rior cingulate cortices. This increased blood oxygen level

dependent (BOLD) signal was maintained only in the

former brain region during performance of the cognitive

task. Interestingly, the reflexology massage condition

selectively affected the retrosplenial/posterior cingulate

in the resting state, whereas massage with the object

augmented the BOLD response in this region during the

cognitive task performance.

The most robust fMRI changes were observed with the

Swedish massage treatment, which involves long and

smooth strokes with an applied pressure geared towards

relaxation. The impact of reflexology, which is focused

upon applying pressure to specific reflex points to in-

voke a beneficial response at distant body regions, was

restricted to the RSC/PCC brain region. In contrast, the

massage with a wooden object, which involved pressure

and strokes along the same areas of the foot as applied

in the Swedish massage, had no significant effect on the

BOLD signal in either of the brain regions. This latter

finding is particularly noteworthy since it suggests the

possibility that the human touch component (as op-

posed to the same pattern of massage with an object)

had a profound influence upon the impact of the treat-

ment. These findings should have implications for bet-

ter understanding how alternative treatments might

affect resting state neural activity and could ultimately

be important for devising new targets in the

management of mood disorders.

The study was published in Brain Imaging and Behav-

ior.

Research Highlights

Terra Rosa e-magazine, No. 10 (June 2012) 42

1. When and how did you decide to become a body-

worker?

It was in 1989. Bodywork and massage were always

something I had been doing since my early teens and

into my young adulthood. I had tried a number of dif-

ferent careers but nothing really took off. Putting my

hands on people and affecting them was the one con-

stant in my life. It seemed like a good way to earn a liv-

ing while I was figuring out what I wanted to do with

my life – and here I am 23 years later so I guess I fig-

ured it out.

2. What do you find most exciting about bodywork

therapy?

That here is so much to discover. That there are so

many potential applications that haven't been tried.

That after 20 years my patients are still surprising me

about what they're capable of doing. And if it doesn't

sound too grandiose, helping the disenfranchised find

hope.

3. What is your most favourite bodywork book?

Well, It' s not exactly a bodywork book per se, but

"Energy Medicine – The Scientific Basis" by Jim Osch-

man gets read every year for continued inspiration. I

am also a big fan of Dr. Atul Gawande and his book

"Complications: A Surgeon's Notes of an Imperfect Sci-

ence." It's just a beautiful book that I recommend to all

my students and surprisingly applicable to our field.

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

Having to tell somebody "I can't help you," and taking

time for myself to rest, recharge and revitalize – but as

I approach 50 I'm getting better at this.

5. What advise you can give to fresh massage therapists

who wish to make a career out of it?

Follow your passion and shape your practice in a way

that feeds you, and by that I mean not physically, but in

a way that feeds your soul. Stay curious, keep learning

new things, keep your sense of wonder alive and never,

ever tell a client or patient that they're "a mess" or "you

have the tightest traps in the universe" – give them

information about their bodies that they can use to

make a difference.

6. How do you see the future of bodywork and massage

therapy?

I think the sky's the limit. The research is finally start-

ing to prove what we've seen clinically for a very, very

long time. It's vindicating and opening new doors to

us. As we walk through them we must remember to be

humble and learn from everyone we meet. And to look

for opportunities to teach what we know. And do both

these things in a spirit of collaboration and openness.

6 Questions to David Lesondak

Terra Rosa e-magazine, No. 10 (June 2012) 43

1. When and how did you decide to become a body-

worker?

It wasn't a conscious decision at all. At school I liked to sort

things—shells, seeds, stones, whatever I could get my hands on—

and so studying the human body came naturally as I viewed it

simply as something that could be sorted. It could be sorted into

systems (respiratory, digestive, nervous, etc.), and aspects of

those systems could themselves be categorized (flexor muscles/

extensor muscles, arteries/veins, etc). Of course we all appreciate

the interrelationship between systems and between these and the

mind, but back then it seemed an easy way to help me learn hu-

man anatomy when I was studying biology. The more I learned

the more I became interested. From training as a fitness instruc-

tor I moved into massage, sports massage, exercise physiology,

exercise psychology, and physiotherapy. I'm a lifelong learner and

so forget to see myself as a 'bodyworker' because I continue on the

journey of learning and understanding so have not yet

'become'anything!

2. What do you find most exciting about bodywork ther-

apy?

The fact that I pretty much learn something new on a daily basis.

Within the last two days I've come across three people each with

unusual presentations: paralysis of the long thoracic nerve due to

a single cough whilst resting, oedema to the face with no apparent

cause, and an unusual hip pathology. I find it fascinating and in-

triguing to find the best ways to help each client, knowing that all

treatments need to be tailored. So because every client is different

I feel that I am myself always growing and expanding in knowl-

edge and awareness and that's a very satisfying feeling. I'm actu-

ally also really excited by the fact they the profession attracts new

people all of the time, who come bringing their own ideas and

experiences. I'm a total fan of diversity and the more people who

join the profession the better it becomes.

3. What is your most favourite bodywork book?

Well, its not actually a book for bodyworkers, its one of the

Thieme Flexibooks called Colour Atlas and Textbook of Human

Anatomy, Volume 1: Locomotor System by Werner Platzer. Its a

superb anatomy book, small, compact, with fantastically clear

illustrations. I discovered it years ago when working for a publish-

ing company and return to it time and time again.

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

Ensuring that the last treatment of the day is as good as the first.

This may sound obvious but I often work as a locum physiothera-

pist, in roles that require massage. I recently completed a contract

with a clinic specializing in whiplash and saw 17 patients day,

each of 30 minutes, all of whom had various whiplash associated

disorders. Its a real skill to make every client feel special and not

simply like a number on a conveyor belt and whilst longer treat-

ment times and fewer patients are preferable, this is not always

possible when working for other people. I actually enjoy the chal-

lenge of working this way and endeavour to be absolutely the best

bodyworker I can possibly be to each and every client, to help

them manage their condition effectively so that they leave feeling

positive and uplifted. It also requires considerable diagnostic and

treatment skill to be able to work in this manner, which I truly

believe can be done with experience.

5. What advise you can give to fresh massage therapists

who wish to make a career out of it?

Be yourself. Explore different ways of working and, more than

anything, follow your instincts. There is no one way to do any-

thing. There is no one therapy that should be employed. Different

techniques work for different clients with the same conditions,

and different types of bodywork suit different therapists. All body-

workers have something to contribute to the field. All bodywork-

ers have the opportunity to make a difference. If you help but one

client to feel better about themselves, to help reduce their pain or

anxiety or to improve their function, it has all been worth it.

Though not necessarily advice, one thing I would wish for is for

any therapist to find ways to share their experiences. The value of

sharing cannot be overstated. It's not just useful its crucial. Maga-

zines, conferences, workshops, chat rooms, books, newsletters,

these are all superb ways to gain knowledge and skills and also to

share knowledge and skills. Continue to ask questions. I owe a

tremendous debt of gratitude to the hundreds of therapists I have

helped to train because they have asked questions which have

kept me on my toes for many years. Sharing is everything.

6. How do you see the future of bodywork and massage

therapy?

I'm not sure of the situation in other countries, but I can tell you

that in the UK I'm sensing more and more physiotherapists and

osteopaths exploring massage as postgraduate training. At the

same time, after training and working as bodyworkers, some

therapists crave additional stimulation so go on to study physio-

therapy or osteopathy. There is definitely a growth in our appre-

ciation of fascia and the role that it plays. There are also a growing

number of therapists wanting access to cadaveric specimens so

that they can view the body structures they have learnt about and

work with. Having some physiotherapists provide massage has

helped this therapy to become more acceptable to some people

and this is a good thing because people who have received mas-

sage and benefited from it are more likely to seek out practitio-

ners whether these practitioners are physiotherapists or not.

6 Questions to Jane Johnson

Terra Rosa e-magazine, No. 10 (June 2012) 44

1. When and how did you decide to become a body-

worker?

After failing miserably as an engineering major in col-

lege, I shifted my sights toward physical therapy.

While in theory, physical therapy is bodywork; there

was often little resemblance to what I do now. After

moving through a variety of job situations for 10 years,

I began my first few continuing education seminars in

MFR and CST and I was hooked. I was so impressed at

the changes that I could make in my clients, even after

only one weekend seminar. I took all of the classes I

could and spent the next ten years instructing at myo-

fascial release seminars for another teacher. After a

parting of ways, I began my own line of myofascial re-

lease seminars (Foundations in Myofascial Release

Seminars) in 2006.

2. What do you find most exciting about bodywork

therapy?

Simply put, it is being able to help those who others

were not able to help. I love being able to positively in-

fluence the lives of others, whether it is my clients or

the therapists that I teach.

3. What is your most favourite bodywork book?

Netter‘s Atlas of Human Anatomy. The artistry is mag-

nificent and every time I pick it up I am amazed just

how well we function. It is also my favorite teaching

tool for clients.

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

Two things come to mind. One is trying to ignore the

garbage that continues to exist in the therapy commu-

nity when it comes to myofascial release. The science is

quickly emerging and evolving, thanks in no small part

to the Fascia Research Congress. There is no need to

continue pursuing alternative explanations that bring

no credence to our field. However, there is money to be

made in continuing to push this agenda onto unsus-

pecting therapists.

Second, as a physical therapist I have many obstacles to

overcome in dealing with stereotypes of just what

physical therapy is. In many ways, massage therapists

have it easier. A bodywork-centered approach is what

new clients expect, even though the modality may vary.

Mention physical therapy to the average person and

their vision of that is very different than the way I prac-

tice. It is a pleasant surprise to most new clients, as

they are not used to being touched and given so much

one-on-one treatment by their physical therapist.

5. What advise you can give to fresh massage therapists

who wish to make a career out of it?

Find your passion. I discovered mine 20 years ago and

continue to love what I do to this day. How many peo-

ple can say this? Whether it is my choice, myofascial

release, or any of the other excellent modalities avail-

able, find a teacher who matches your style and pursue

the work. Fill your toolbox with skills that will allow

you to meet the needs of your dream client. I believe

specialization is key to success in our professions. Be

very good at something and word will spread.

6. How do you see the future of bodywork and massage

therapy?

I believe that the science-based approach to bodywork

will continue to spread, replacing unfounded modali-

ties and approaches. Therapists will need to keep up

with the changes or get left behind. Massage schools

will need to better address this science and continuing

education will need to keep pace as well. ―Because it

works‖ will no longer be good enough.

6 Questions to Walt Fritz