Terra Rosa

E-Magazine
Open information for massage therapists & bodyworkers
Terra Rosa e-magazine, No. 10 (June 2012) 1
No. 10, June 2012
www.terrarosa.com.au
www.massage-research.com
 Terra Rosa E-Magazine, No. 10, June 2012

3 Cover Feature 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
4 How Do We Know What We
continuously, as proven by our Massage News Update that
Know?Joe Muscolino
has continuously running the latest research on massage
and bodyworks since March 2007. Joe in his latest article
12 The Effectiveness of Massage discusses how we may acquire (new) knowledge. Most in the
TherapyAAMT Report 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
15 From the 3rd Fascia Congress proven not to be valid, e.g. flushing out toxins. Then we
David Lesondak have the research world, that recently becomes popular.
However we also not fall into the trap of the evidence-based
18 Pelvic Organ Prolapse medicine goes extreme and become a sceptic. Now there are
few blogs that supposedly provoke critical thinking in body-
Walt Fritz work, start to turn into sceptics and to attack on alternative
treatment: acupuncture is a sham, stretching is useless, fas-
21 What is Deep Tissue Massage cia research is overrated and so on. We should not forget
Art Riggs 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
24 Spontaneous Movement things; otherwise, it would not last very long in the world of
Body work manual and movement therapies. However, if every tech-
nique were as effective as its proponents state, why isnt
everyone doing that technique?
28 Tom Ockler on MET
An article posted in the Pain Treatment Topics by Stewart
30 Practitioner & Owner: Leavitt: ".. as with many other CAM approaches, the prob-
Straight Percentage Agreements lem of validity may be due to our lack of understanding
Work Best Don Dillon 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
33 Postural Assessment one way or another, it still appears premature to broadly
Jane Johnson 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-
38 3D Anatomy for Manual
ported on the third Fascia Congress in Vancouver. Art Riggs
Therapists answers What is Deep Tissue Massage. Walt Fritz on Pelvic
Organ Prolapse, Jane Johnson on Postural Assessment.
40 Research Highlights Thanks for reading and Stay Healthy

42 6 Questions to David Lesondak Sydney, June 2012

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) 2

 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) 3

 How Do We Know
What We Know?
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
Terra Rosa e-magazine, No. 10 (June 2012)
Joe Muscolino
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
4
 What We Know?
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
Terra Rosa e-magazine, No. 10 (June 2012)
...the day before the apple fell on New-
tons head, it did not mean that gravity
did not exist, we simply did not yet
have a scientific formula to explain it.
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 ones 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.
5
 What We Know?
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.
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, doesnt 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 elses conclusion about the study.
Terra Rosa e-magazine, No. 10 (June 2012)
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.
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 Newtons
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 Joes website
(www.learnmuscles.com)
6
 What We Know?
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.
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 clients 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, didnt
we just waste our clients 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;
Terra Rosa e-magazine, No. 10 (June 2012)
Be open-minded, but dont be so open-
minded that your brains fall out.
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 dont 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.
7
 What We Know?
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.
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 muscles 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-
Terra Rosa e-magazine, No. 10 (June 2012)
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. Wouldnt 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
8
 What We Know?

Figure 4A. When engaging the brachioradialis to palpate it, resistance should be placed against the clients 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.

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
wouldnt a stroking technique that increases local blood
supply be more efficient? Therefore, mightnt 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
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.
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-
ents hand, their radial deviators (extensors carpi ra-
dialis longus and brevis) will engage, making it harder

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

 What We Know?
...if every technique were as effective as
its proponents state, why isnt everyone
doing that technique?
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.
therapies. However, if every technique were as effective
as its proponents state, why isnt 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 Joes 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

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

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

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 (9am6pm).
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
Terra Rosa e-magazine, No. 10 (June 2012)
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 more11
information, visit www.terrarosa.com.au/joe
 The Effectiveness of
Massage Therapy
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-
Terra Rosa e-magazine, No. 10 (June 2012)
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
12
 The Effectiveness of Massage Therapy
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.
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

Subacute and chronic low back pain. Seven reviews

were in unison concluding that massage therapy for This is a summary of the research report The Effec-
subacute and chronic low back pain to be more ef- tiveness of Massage Therapy by Ng (2011), repro-
fective than placebo. duced with permission from AAMT.

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.

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

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

 The Effectiveness of Massage Therapy

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

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

 rd
From the 3
International Fascia
Research Congress
28
28--30 March 2012, Vancouver
David Lesondak
Its no lie, being behind First up in the panel was Wayne Diamond, MD from
the camera at the Third Wayne State University who presented data on the high
International Fascia incident of post-surgical adhesions following pelvic
Research Congress is a surgeries. Even with a relatively non-invasive proce-
pretty sweet gig. But its dure like a laparotomy or a laparoscopy the average of
also about multi- how many patients develop post-operative adhesions is
tasking, constantly tak- a very surprising 70%.
ing notes on each pre-
senter. Every time they Next up the Shaman/Showman of Bordeaux, France
change a slide writing tendon transplant surgeon Jean-Claude Guimberteau
down the exact time, wowed us with his latest endoscopic film. This time he
noting when the slide brought to life the reality of the stresses to the tissues
has an animation, when beneath the skin where scarring and adhesions are pre-
they skip a slide or acci- sent. It was actually a bit like a horror movie. Or if you
dentally jump ahead. prefer a different genre, as the narrator of the film put
When theres a technical failure and we have to wait. it, a fibular apocalypse. Graciously, Dr. Guimberteau
Adjusting for sudden volume changes or lighting is- has allowed us to use 3 minutes of this film in the final
sues. Fascia Congress DVD.

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.
Its 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.
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.

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

 3rd Fascia Congress

Think of these nerve impulses as cars on a superfast Dr. Gerald Pollack

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
its 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.
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 dont 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.

As bodyworkers, so much of our focus on fascia seems
to be on its 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
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.
Im 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

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

 3rd Fascia Congress
bringing it all home Friday morning with two stunning David Lesondak, BCSI, KMI, LMT is an Allied Health
back-to-back lectures on fascial anatomy and myofascial Member in the Department of Family and Community
trigger points respectively, but somehow I keep going Medicine at the University of Pittsburgh Medical Cen-
further back in time. ter (UPMC). He practices Structural Integration at
UPMCs Center for Integrative Medicine. Davids keen
I can remember being in the back of the room at the interest in the emerging science of fascia coupled with
first Fascia Congress at Harvard in 2007. No camera a previous career in the video arts led him to collabo-
that time, just feeling lucky to even be in the room, rate with Thomas Myerss to produce and direct the 3
amazed that it was even happening and trying not to get DVD set Anatomy Trains Revealed a video compan-
too geeky about meeting my heroes (look! Its Donald ion to Myers popular book. He has also worked on
Ingber!) whose work I had been inspired by for years. various video projects with Robert Schleip and a series
Move 4 years into the future to the Sheraton Wall of technique videos for the Gebauer company.
Center in Vancouver. A world-class hotel. A conference He is an NCBTMB approved continuing education pro-
room big enough hold over 800 people from 37 coun- vider and teaches fascially-oriented workshops inter-
tries. And everyone happy, connecting, confabbing, oc- nationally.
casionally contesting and setting new collaborations.
David is currently editing the videos from the Third
This is real. 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.

Will be Available Soon..

rd
The 3 International
Fascia Research Congress
on DVD

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

 Pelvic Organ Prolapse
Thorough Evaluation and
Myofascial Release
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
womens 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 30s and 40s have POP as well.
Although POP is not extremely common in women in
their 20s, 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-
Terra Rosa e-magazine, No. 10 (June 2012)
Walt Fritz
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
cant get it to come out).
Fecal incontinence.
Constipation.
Back/abdominal pain.
Lack of sexual sensation.
Painful intercourse.
Cant 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
18
 Pelvic Organ Prolapse
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
Terra Rosa e-magazine, No. 10 (June 2012)
Female reproductive organ anatomy. From: http://
commons.wikimedia.org/wiki/File:Female_anatomy.svg
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
19
 Pelvic Organ Prolapse
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.)
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.

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.

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

 What is
Deep Tissue Massage
Art Riggs
Question: My spa/clinic offers Deep Tissue Mas-
sage as a separate massage category and at a higher
price than regular massage, but I cant seem to get a
clear answer on what the difference is. Ive 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

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

 Deep Tissue Massage
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
Terra Rosa e-magazine, No. 10 (June 2012)
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.
22
 Therapeutic
Deep Tissue Massage
and
Myofascial Release

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.
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.
What is Deep Tissue Massage What to Expect
Most problems in tissue are caused by a buildup of tension
Not all of the work will be deeper than what you are used
and adhesions due to injury, overuse, or postural habits that
to in relaxation-based massage. Deep Tissue therapy can
are not specifically addressed in conventional massage. Rather
be performed in an integrated full body massage with spe-
than simply kneading muscles, your Deep Tissue bodyworker
cific deep focus upon a single or possibly several trouble-
places emphasis upon the therapeutic benefits of actually
some areas. However, you may choose a few particular
stretching and freeing short and fibrous restrictions.
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!
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.
 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) 23

 Spontaneous
Movement
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 bodys own inherent movement for therapy and
relieving pain. Usually these therapies initiate uncon-
scious or automatic movements in the clients 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-
tients 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-
Terra Rosa e-magazine, No. 10 (June 2012)
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-
24
 Spontaneous Movement
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
Terra Rosa e-magazine, No. 10 (June 2012)
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
25
 Spontaneous Movement
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 breathing technique stimulating a 'trance' state that
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-
Terra Rosa e-magazine, No. 10 (June 2012)
I cant 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
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
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-
26
 Spontaneous Movement
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-Yogas effortless straight back (uju-kaya)
meditation
Tibetan yogas 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 Andr 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 definitionnervous, muscular, and
skeletalmust 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-
Terra Rosa e-magazine, No. 10 (June 2012)
nizing the muscle
pattern, is respond-
ing to the clarity of
ones 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-
sagethat 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
27
 Tom Ockler
on MET
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.
Terra Rosa e-magazine, No. 10 (June 2012)
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.
28
 MET
What tips can you give to massage therapists to by several physiotherapists, oesteoplaths and massage
prolong their career? 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
No matter what type of body worker you are, your hands to Australia to teach. Who knows, It just might happen
and shoulders are your most important tools. some day soon.
Learn how to breathe; keep your core strong and keep
balance in your body's musculoskeletal system. Tom Ockler P.T. has extensive
teaching experience throughout the
United States, Canada, England
What are your interests these days? and Australia. As a teacher, Tom
Currently researching and writing two chapters for a has earned the nickname "The
textbook on chronic pain. One of the chapters is about Patch Adams of Physical Therapy"
MET, the other is about EFT. due to his unique style of injecting
humour into complicated subjects.
He has developed teaching methods that explain very
How and where can we learn more about MET? complicated subjects in easily understandable formats.
His two books and DVDs Muscle Energy Technique for
Taking a course from an experienced practitioner and
Lower Extremities, Pelvis, Sacrum, and Lumbar Spine
teacher is the best way. Buying the corresponding
and Muscle Energy Techniques for the Thoracic Spine,
manuals and DVDs is also a good start.
Ribs, Shoulder and Cervical Spine have been hailed by
Are you planning to come and teach in Austra- students as the most user friendly and useful Muscle
lia? Energy manuals ever.
I taught in Australia for a month way back in the late
80s and have not been back since. I have been contacted

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

Practitioner & Owner:
Straight Percentage
Agreements Work Best
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 contractors
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 associates suc-
cess.
Terra Rosa e-magazine, No. 10 (June 2012)
Don Dillon
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.
Its 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
30
 Straight Percentage
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
wont be home for two weeks. Can I call the mortgage
company and ask them to suspend my mortgage for
two weeks because I wont be using my house? Or the
phone, hydro and gas companies and ask for a reduc-
tion because Im not using their services for two weeks?
Terra Rosa e-magazine, No. 10 (June 2012)
What about the municipal government do I ask them
to scale back my property taxes? Of course not. I incur
expenses regardless of if Im 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-
31
 Straight Percentage
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 cant 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.
Don Dillon, RMT is the author of Massage Therapist
After examining my financial position and talking with
Practice: Start. Sustain. Succeed. and the self-study
my accountant, I put together a fact sheet with the ac-
workbook Charting Skills for Massage Therapists.
tual costs of the business and scheduled a meeting with
Don has lectured in seven Canadian provinces and
my associates to present the financial facts. The associ-
over 60 of his articles have appeared in massage in-
ates at first were apprehensive a natural response to
dustry publications in Canada, the United States and
being asked for more money. But after discussion and
Australia.
reflection, the associates fully accepted the new terms.
They were as reliant as I on seeing the business con- Don is the recipient of several awards from the On-
tinue. tario Massage Therapist Association, and is one of the
founding members of Massage Therapy Radio
While intuition is an important faculty for the practitio-
www.massagetherapyradio.com. His website,
ner providing care, do not forget to do the math when it
www.MTCoach.com, provides a variety of resources
comes to forming a contractual agreement. Make sure
for massage therapists.
your agreement is based on financial facts, not opinions
or unhelpful beliefs. This excerpt is reprinted from Massage Therapist
Practice: Start. Sustain. Succeed.

Available from Terra Rosa http://

www.terrarosa.com.au/book/

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

 Postural
Assessment
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
Terra Rosa e-magazine, No. 10 (June 2012)
Jane Johnson
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 clients 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-
33
 Postural Assessment
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
clients 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 clients
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.
Terra Rosa e-magazine, No. 10 (June 2012)
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.
34
 Postural Assessment

Factors affecting posture

Structural or Scoliosis in all or part of the spine.

anatomical 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 dowagers
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 People who grow up sitting cross-legged or squatting develop postures that are
cultural 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.

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

 Postural Assessment
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?
Examples of postural assessment Can you see also how her neck is also laterally flexed
and slightly rotated to the right?
Please note that these examples form just two parts of a
full body assessment and are for illustrative purposes
only.

Shoulder height
Abdomen
When looking at your clients shoulders, note whether
An area that
they are level, or if one appears higher than the other.
sometimes
What your findings mean gets over-
looked in pos-
Shortening in levator scapulae and the upper fibres of tural assess-
the trapezius may contribute to one shoulder appearing ment is the
higher than the other. If a scapula is elevated, you would abdomen.
expect the inferior angle of that scapula to be superior to How does the
the inferior angle of the scapula on the opposite side. abdomen of
your client
Here is an interesting question: How do you know
appear - is it
whether one shoulder is truly higher or the other is
flat or protrud-
lower? Ask the client to try this simple exercise: shrug
ing? In a nor-
their shoulders, elevating their scapulae; then relax.
mal, healthy
Now depress their shoulders; then relax. Which move-
person, the
ment did they find easier, elevation or depression? Most
abdomen
people find that shrugging the shoulders is easier than
should be flat.
depressing them. It seems reasonable to assume that if
your clients right shoulder appears higher, muscles on The photo-
the right are shorter and tighter than the corresponding graphs on the
muscles on the left. An exception to this might be if you opposite page demonstrate the variety in the shape and
were assessing someone with a neurological condition position of the abdomen when a person is viewed later-
(for example, having suffered a stroke) and she had a ally. Does an abdomen protrude because the person is
dropped shoulder as a result of low tone on one side of overweight or pregnant, or it is the result of the persons
her body. overall standing posture and an anteriorly tilted pelvis?
Is there increased tension in the abdomen perhaps cor-
Therapists have observed that, for many people, the
responding to a posteriorly tilted pelvis and a decreased
dominant shoulder is naturally depressed and slightly
curve in the lumbar spine?
protracted. If right-handed, the right shoulder may be
slightly lower and more protracted than the left. Clients

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

 Postural Assessment

What your findings mean Postural Assessment is available from

www..terrarosa.com.au
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-
Jane Johnson MSc, is co-director of the London Mas-
cause the client is overweight. Clients with restrictions
in the muscles and fascia of the chest sometimes appear sage Company, England. As a chartered physiothera-
to have a protruding abdomen, quite a distinct change pist and sport massage therapist, she has been carry-
in shape from the chest area, which is tight and de- ing out postural assessments for many years. She is
pressed. renowned for her teaching, enthusiasm and dynamism.
Her track record in the industry spans over 17 years
References working both as a practitioner/instructor and as
course director of her own company and other success-
Hanchard N, Goodchild L, Thompson J, OBrien T, ful massage schools. She has a deep interest in muscu-
Richardson C, Davison D, Watson H, Wragg M, Mtopo S loskeletal anatomy and how newly qualified therapists
and Scott M (2011). Evidence-based clinical guidelines can be better educated in this subject. She also is inter-
for the diagnosis, assessment and physiotherapy man- ested in the relationship between emotions and pos-
agement of contracted (frozen) shoulder, Standard ture. In her spare time, Johnson enjoys taking her dog
Physiotherapy 1:3. Endorsed by the Chartered Society of for long walks, practicing wing chun kung fu, and vis-
Physiotherapy. iting museums. She resides in London. Read also 6
questions to Jane on page 43

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.

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

 3D Anatomy for
Manual Therapies
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
Terra Rosa e-magazine, No. 10 (June 2012)
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-
38
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) 39

 Research Highlights
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-
Terra Rosa e-magazine, No. 10 (June 2012)
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.
40
 Research Highlights
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
Terra Rosa e-magazine, No. 10 (June 2012)
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.
41
 6 Questions to
David Lesondak
1. When and how did you decide to become a body- 5. What advise you can give to fresh massage therapists
worker? who wish to make a career out of it?

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.
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.

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.

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

 6 Questions to
Jane Johnson
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
thingsshells, 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,
Terra Rosa e-magazine, No. 10 (June 2012)
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.
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 6 Questions to
Walt Fritz
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?
Netters 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.
Terra Rosa e-magazine, No. 10 (June 2012)
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.
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