Vous êtes sur la page 1sur 49

Terra Rosa

Bodywork e-News
Issue 2, December 2008 www.terrarosa.com.au

Welcome to the second issue of Terra Rosa Bodywork e-


Contents news, our new free electronic news magazine dedicated to
bodyworkers. It has been a great year in 2008, beginning
01 Editorial with a great start, economy is strong and flowing. However at
02 Integrating Diagnosis and Treat- the end of this year, we see the drop in the world's economy
ment for Bodywork—Kit Laughlin and our Australian dollar is falling sharply. Inevitably we have
to readjust our prices several times. We hope that the market
05 The Spinal Engine — Erik Dalton will pick up again and your business will be steady. Be positive.
09 An Integrated Approach to Re-
habilitation of Leg Injuries. Part In this issue, we got great articles for you. We focus on the legs
1.—Art Riggs and lower extremities. Art Riggs give us a complete range of
techniques for leg injuries. This is the firt of a two parts article.
18 Unravelling the Mysteries of Un-
Watch out for the next part on our next issue. Our colleague
winding
from Italy, Mau shows us his innovative passivattiva tech-
27 Lipoedema —Kristin Osborn nique. Check it out. On the foot, we look at the history of Chi-
nese reflexology and stretching for plantar fasciitis. There’s
31 Stretching for Plantar Fasciitis
also great articles by Kit Laughlin, and Erik Dalton. Kristin
33 Rwo Shur, Chinese Foot Reflex- Osborn shares her passion with us on Lipoedema, a condition
ology little known. And we look at the mysteries of unwinding.
36 The Passivattiva Technqiue for Don’t forget to read our 6 questions to Whitney Lowe and
the Legs—Maurizio Ronchi Diana Haynes.
46 Research Highlights We hope to keep you informed and entertained. This e-News
47 Six Questions to Whitney Lowe is dedicated to all of you. If you have something you wish to
contribute, drop us an email: terrarosa@gmail.com. We be-
48 Six Questions to Diana Haynes lieve that therapists like you have lots of experiences to share
around. Thanks for all of your support, wishing you have a
Great Christmas, Happy Holiday and enjoy reading.

Sydney, December 2008.

Terra Rosa
www.terrarosa.com.au
The Source for Massage Information

Bodywork e-News 1
Disclaimer: The publisher of this e-News disclaim any responsibility and liability for loss or damage that may result from
articles in this publication.
Integrating diagnosis
and treatment for
Bodywork
by Kit Laughlin

The question of how a therapist doing a structural and functional


can incorporate diagnostic tech- What are the expec- analysis some time in the future
niques (assessment of structural as a means of making concrete
and functional considerations tations of the client? some possible causes of their
deemed relevant to the client's How may they be problem. The initial consultation
problem) into a standard mas- then proceeds as normal, with a
sage treatment is not an easy one changed for the standard massage being per-
to answer. This question give client's ultimate formed. During the massage, the
rise to two additional questions: practitioner is gaining a much
What are the expectations of the benefit? clearer idea of where the client
client, and how may they be holds tension, and possibly
changed for the client's ultimate perfectly reasonable matter, then, where the client lacks strength as
benefit? to offer to teach the client a well. For example, in the case of
number of such exercises at the neck pain, levator scapulae can
What is the reason for treat- conclusion of the session. One explicitly palpated and its ten-
ment? could shorten the actual massage sion in relation to surrounding
The first question may be re- part of the session by 10 or 15 tissues assessed. In the case of
worded: for what apparent rea- minutes explicitly for this pur- back pain, erector spinae (or
son is the client coming to see pose. If the use of the exercises even quadratus lumborum) may
you? The reasons are many and by the client makes a difference be palpated, assessed and
varied, but chief among them are to this very common problem, treated. Comparisons of left/
stress management, neck, mid- you can be sure the client will right development of muscles
dle or lower back pain, optimisa- ask you for additional stretching articulating the spine can be
tion of well-being, or some spe- exercises at a future consultation. made.
cific musculoskeletal problem. If
stress management is the reason, Neck or back pain Specific conditions
then the practitioner can explain One of the most common rea- If the client is coming to see you
during the treatment that the sons for a client to come to a for a specific musculoskeletal
tension that is being explicitly massage practitioner is for the problem, it is an easy matter for
dealt with in the massage session treatment of the neck or back the practitioner to suggest
is in fact the body's most funda- pain. The practitioner needs to stretching or strengthening exer-
mental reaction to stress. Ac- realise that a client has a specific cises as the client's homework,
cordingly, any one of the ortho- idea of what it is they want from and be certain that this course of
dox approaches to reducing you, but often lacks the language action is very likely to yield
stress is then a natural subject to or concepts with which to articu- much faster results than simply
which the conversations can turn. late their concerns. In the case of being treated by massage. This is
So, for example, one might talk neck and back pain, during the because dysfunctional patterns
about relaxation techniques, or taking of the client history before of flexibility or dysfunctional
the use of stretching exercises to the massage commences, the motor patterns are the main rea-
change tension patterns. It is a practitioner can float the idea of son for these kinds of problems.

Bodywork e-News 2
Diagnosis & Treatment
suming a treatment hour, the
remainder of the time can be
used in the teaching what the
analysis reveals to be the most
likely significant two or three
exercises. At a future consulta-
tion, you will be able to concen-
The vast majority of muscu- trate on whichever muscles the
loskeletal problems (including, treatment being practised. In analysis has revealed to be exces-
of course, neck and back prob- other words, the practitioner is sively tight, in addition to the
lems) may be said to be the re- put forward implicitly as the massage process that you usually
sult of inefficient biomechanics, fount of wisdom, and the client use. At the conclusion of the
but so saying does not indicate the vessel. Apart from being pa- massage, spend 10 minutes re-
specific treatment directions. To tronising, a great deal of recent viewing the previously-taught
move beyond a mere description research in medical anthropol- exercises with the client. Experi-
of the problem (even though ogy suggests strongly that the ence has shown that no matter
'biomechanical' does have a nice likelihood of successful resolu- how well these exercises are
scientific ring about it!) to a tion of any problem is lessened taught the first time, reviewing
treatment of its cause(s) requires considerably if the client is not them a week or a couple of weeks
that some analytical process be actively involved in his or her later will reveal practise errors;
used. As I have published else- treatment. we are all human, after all, and
where, one such specific and re- clients (and practitioners) alter
peatable process is the assess- States of mind the form of an exercise to make
ment of physical functions in So we might say that one could it more comfortable, and often
terms of insufficient flexibility or have a process reason for recom- avoid the target area as a result.
lack of strength. This relatively mending stretching or strength-
simple analysis yields specific ening exercises (that your analy- Progressing the intensity of
treatment recommendations: sis has yielded an understanding the exercises
stretching exercises for areas of specific biomechanical prob- I have found that once the pain
that testing reveals to be tight in lems in the client's system) and a of the initial problem has re-
comparison with what is psychological reason. This latter ceded, it is usually necessary to
'normal' for that client and reason is simply (and very im- teach some strengthening exer-
strengthening exercises for areas portantly) the creation of an op- cises in order that the client re-
shown to be weak. This latter timistic state of mind in the cli- turned to full normal (or, desir-
assessment will require an un- ent, and the passing on of spe- able) function. We might say
derstanding of which muscles cific tools for the client to use to that in order for rehabilitation to
need to be activated and how resolve his or the problem. This be considered complete, the cli-
strong they need to be in relation gives the control of the problem ent must move beyond the pre-
to other muscles. largely to the client---in my view injury state of fitness that led to
an essential first step up for full, the initial problem. In respect of
Going beyond a 'condition' permanent resolution of the neck pain, the anterior neck
or 'problem' problem. Until the client takes muscles usually need strength-
There is a further consideration responsibility for his or her own ening. Any tendency to carry the
in recommending specific problem, the problem is likely to head forward of the ideal posi-
stretching and strengthening ex- recur regardless of how effective tion will also need to be cor-
ercises, and that is the notion of your treatment is. rected, and this usually requires
empowerment. Far too many the strengthening of muscles in
practitioners---deliberately or Integration of treatment the lower abdominal area. In ad-
inadvertently---disempowered elements dition, it will be necessary to
their clients. That is, from the If the practitioner embraces an check the flexibility of the hip
very first consultation, an atmos- analytic protocol as, for example, flexors, ilio-psoas and rectus
phere can be created wherein the outlined in the book Overcome femoris, in particular. This is
practitioner and the client both neck & back pain, the structural because the research has shown
regard the client as the more-or- and functional analysis will take that an anterior pelvic tilt can be
less passive recipient of the about 30 minutes in total. As-

Bodywork e-News 3
Diagnosis & Treatment
the main cause of the forward- worsen one's posture. Exercising is with friendly and supportive.
head posture. over the Swiss ball, an extremely The atmosphere created in the
unstable environment (especially treatment facilitates a deep ex-
Unstable exercises for those people who have never ploration of the causes of any
If lower back pain is the initial done any strengthening exercises particular problem---
consultation problem, it is usu- before) wakes up the fundamen- psychological and emotional as
ally necessary to teach effective tal reflexes and allows the client well as physical. It is also no ac-
strengthening exercises for par- to re-establish desirable patterns. cident that massage practitio-
ticular muscle groups once the I am happy to report here that ners form the bulk of those who
pain has settled down. Without results come extremely quickly, attend my workshops---and oth-
wanting to preempt your testing especially with clients to have no ers who teach similar tech-
procedures, experience has experience with exercise. niques---and are among the
shown that the lower abdominal most open minded of practitio-
muscles, transversus abdominis, In conclusion ners, too.
and the relationship between the Speaking generally, massage
strengths of the internal and ex- practitioners are uniquely poised
ternal obliques usually needs to take advantage of recent Kit Laughlin is one of the
attention. Recent work I have breakthroughs in rehabilitation world’s authorities
done with Paul Chek confirms medicine techniques. Because of on the subject of
the claim that strengthening ex- the physical basis of the massage stretching. Kit
ercises are most efficiently done practice, many practitioners al- studied oriental
using an exercise ball. All of the ready have a deep intuitive un- traditional Japa-
abdominal strength the exercises derstanding of how the parts of nese medicine dur-
in my book Overcome neck & the body work together. To make ing a four-year
back pain can be done this way. massage practitioners the pre- stay in Japan. Kit
I believe the usefulness of the eminent rehabilitation practitio- developed the principles of Pos-
exercise ball lies in the elicitation ners in the new millennium, all ture & Flexibility over 24 years,
of some primitive reflex arcs, that is needed in my view is to and has been teaching them for
which in turn reactivate the acquire an effective understand- 21 years at the Australian Na-
righting and tilting reflexes. The ing of efficient stretching and tional University Sports and
reason this is important is that strengthening exercise tech- Recreation Association.
life, and inefficient exercise pat- niques in addition to the specific
Kit teaches P&F to practitioners
terns, tends to worsen existing massage modality one uses.
and to people everywhere who
imbalances and frequently It is no accident that massage
want to rehabilitate or avoid
strengthens the upper abdomi- practitioners are very often the
injury, enhance performance or
nals preferentially. As these at- first recourse in people's daily
maximise wellbeing, in Austra-
tach to the ribs, increasing their life problems. This is because
lia and around the world.
strength without attention to massage therapy has a very low
how the body uses the other ab- incidence of unwanted side ef-
dominal muscles can actually fects and because the treatment

Stretching & Strengthening


with Kit Laughlin
Stretching Books & DVDs by Kit Laughlin with specific pro-
grams for Back Pain, Neck & Shoulder Pain & RSI.

Available from: www.terrarosa.com.au

Bodywork e-News 4
The Spinal Engine
by Erik Dalton PhD

Most manual therapists perform Those of us who’ve experienced responsible for gait but merely
gait analysis based on observa- body braces or casts will tell you “instruments of expression”. He
tion of leg movement as it relates that normal cross-patterned gait theorized that during heel strike,
to the pelvis (pedestrian theory with reciprocal hip rotation is kinetic energy was not displaced
of locomotion). Although the almost impossible. We tend to into the earth as in the pedes-
legs are obviously important fac- walk with an awkward ‘block- trian model, but efficiently
tors in efficient locomotive ac- type’ stride where the QL is re- transmitted up through the myo-
tivities…are they really the pri- cruited to lift the ipsilateral leg fascial system causing the spine
mary driving force behind body to keep it from dragging the to resonate in the gravitational
movement? It makes no sense ground during the swing phase. field.
that the torso, arms and head This aberrant gait is also seen in
would not somehow contribute our lumbar-fused and ankylosed Therefore, during right legged
to gait. Since the body strives on clients…and even in infants weight bearing, the lumbar spine
energy conservation, the idea of who’ve yet to develop a stable is pulled into right sidebending
dragging a heavy torso around lumbar curve. Try experimenting (left rotation) by the multifidus,
while walking or running seems with this concept by placing longissimus, iliocostalis and tho-
like a terrible waste of muscular some kind of elastic or leather racolumbar fascia. This action
mass. support around your lower rib- counter-rotates the pelvis as the
cage or lumbar spine. Can you sacrum is forced into left side-
Using the feel your thorax and pelvis trying bending and right rotation
pedestrian to rotate against resistance from (Figure 2).
theory of the strap?
locomotion, This dynamic coupling at L5-S1
try to imag- is essential to efficient gait and
ine what a lumbar longevity. When
100 meter Spinal Engine Model counter-rotation of pelvis and
Olympic lumbar spine is lost, the spinal
In the early 1900’s, Robert engine runs out of gas allowing
sprinter’s
Lovett, MD, developed theories compressive forces to squash the
body might
based on the assumption that a L5-S1 intervertebral disc with
look like
rotational component was essen- each step. No wonder the L5 disc
(Figure 1).
tial to human movement. His suffers the most herniations and
research concluded that in the is the most operated on of all
presence of normal lumbar lor- spinal segments.
dosis, sidebending produced an
axial torque (sidebending to one
side and rotation to the other)
One would expect to see a tiny which he labeled ‘coupled mo-
upper torso driven by huge pow- tion’.
erful legs. Any added upper body In 1988, Serge Gracovetsky,
weight would only serve to slow Ph.D. expounded on this idea in
the runner down. his book titled ‘Spinal Engine’ by
declaring that the legs were not

Bodywork e-News 5
Spinal Engine
In his presentations and writings, reach maximum stretch as the
Gracovetsky offers a counterin- latissimus dorsi also is being
tuitive, but seductive, argument stretched by the forward swing
that the legs are not responsible of the opposite arm.
for gait, but merely “instruments
of expression.” He expounds on Heel strike signifies transition
this concept by showing video of into the propulsive gait phase. At
a man born with no legs walking this time, biceps femoris and
(perfectly balanced) only on his gluteus maximus join forces, cre-
ischial tuberosities (Fig. 3). With ating antagonistic resistance
the use of a high-resolution with the contralateral latissimus
opto-electronic tracking system, dorsi, which is now extending
Gracovetsky was able to study the arm in concert with the pro-
and organize evolutionary details pelling leg. The synergistic con-
concerning functional adapta- traction of the gluteus maximus
Figure 2. Spinal engine is tions as they apply to the body’s and latissimus dorsi creates ten-
revved-up by counter rotation of spinal engine. sion in the thoracolumbar (and
the pelvis and trunk. lumbodorsal) fascia, which soon
releases in an energy pulse
which assists deeper muscles of
locomotion, thus reducing the
Are legs really necessary? metabolic cost of gait.
Due to the natural counter-
rotation of the right leg and left
shoulder, an efficient myofascial
Figure 3: spring system develops. Pull of
Balanced Figure 4: the lats creates a strong ten-
walking on Lats are sional force that travels through
ischial tu- stretched the thoracolumbar fascia, long
berosities. by the for- dorsal SI ligaments and contin-
Adapted ward ues through the contralateral
from swing of gluteus maximus, sacrotuberous
Serge Gra- the oppo- ligament and biceps femoris. At
covetsky site arm. this point, spiraling tensional
with per- forces increase in these posterior
mission. global structures and begin to
dig tentacles deep into the osteo-
ligamentous spring system.
Fig. 4 demonstrates what I refer-
At a Rolf Institute® annual con- Before delving into the biome-
ence as the posterior spiral
vention in the mid 1980s and chanical intricacies of the core’s
spring system (PSSS) – a slightly
again at the International Fascial disc/facet spring system which
altered version of Gracovetsky’s
Congress at Harvard University, powers the spinal engine, let’s
model. I like to include biceps
I was blessed with the opportu- look briefly at global muscles
femoris in this pattern, not only
nity to share discussion and in- driving the anterior torso’s ro-
because of its intimate co-
sights with a delightful and pro- tary spring system.
contracting relationship with
vocative nuclear physicist (and
gluteus maximus during heel
fellow musician) named Serge
strike but also because of the in-
Gracovetsky. His unusual biome-
fluence this complex lateral The Anterior Spiraling
chanical approach to movement,
hamstring muscle has on pelvic Spring System
which he calls the “Spinal En-
mechanics in force closure of the
gine,” continues to dramatically So, what does it look like from
sacroiliac joint during the stance
alter my ingrained view of body the front? In our discussion
phase. Notice in Fig. 4 that just
locomotion and lifting. above, we saw how one leg
prior to heel strike, the biceps
femoris and gluteus maximus swings in opposition to the op-

Bodywork e-News 6
Spinal Engine
posite arm causing trunk as the leg is pulled through dur- strong forces are transmitted to
counter-rotation. To aid the ing the swing phase of gait. As the intervertebral joints where
latissimus/gluteal spring system the speed of walking progresses the combined action of discs and
in trunk rotation, we have an an- to running, activation of the facets counter-rotate the pelvis
terior spiraling spring system ASSS becomes more prominent. (Fig. 6).
(ASSS). When working together harmo-
niously, these global muscles en-
hance the power of the posterior
Figure 6:
Figure 5: spiraling spring system by pro-
Forces
ASSS: viding greater rotary torque at
transmit-
Oblique the osteoligamentous level dis-
ted to the
abdominal cussed below. Bottom line: Ad-
interverte-
contrac- aptations of the trunk in locomo-
bral joints
tion cre- tion primarily serve three goals:
where the
ates a con- * Rotation of the pelvis; combined
tralateral action of
fascial pull * Counter-rotation of the discs and
through shoulders; and facets counter-rotate the pelvis.
the lower
torso to * Stabilization of the head.
the adduc-
Note: It’s important to recall that The process is repeated as the
tors.
the primary afferent feeding left heel strikes the ground re-
neurological information for the sulting in an oscillatory motion
gait cycle arises from a stretch of that efficiently moves the body
Fig. 5 demonstrates an anterior the hip flexors (primarily the ili- with minimal energy expendi-
firing-order model where opsoas). Therefore, as the iliop- ture. At the deepest osteoliga-
oblique abdominal contraction soas cross the hip, sacroiliac and mentous level, this interlocking
forces a contralateral fascial pull lumbar spine, any joint restric- of facets and discs transmits vir-
through the lower torso to the tions will hinder excursion, thus tually all the available counter-
adductors. The ASSS concept minimizing the stretch. Thera- rotational pelvic torque needed
describes a nice working rela- pists must restore movement to aid core and global muscles in
tionship between the oblique ab- and alignment to all myoskeletal locomotion efforts.
dominals and the contralateral structures to maximize normal
adductor musculature via the neurological feedback and opti-
intervening anterior abdominal mum muscle sequencing.
Summary
fascia. Notice in Fig. 5 how the
left thigh adductors work in per- The elegance of Gracovetsky’s
fect harmony with the ipsilateral spinal engine system can be felt
Disc and Facet Rotary
internal obliques, as well as the in your own body during gait.
Torque
contralateral external obliques, Practice propelling yourself for-
to stabilize the body on top of Gracovetsky doesn’t view the ward by allowing the right arm
the stance leg and to right-rotate spine as a compressive loading and shoulder to swing forward
the pelvis. This firing-order pat- system where intervertebral and the left back.
tern positions the pelvis and hip discs perform as shock absorbers.
so they are prepared for the suc- He imagines the outer annulus One should feel the torso rotate
ceeding heel strike. (tree-ring) disc fibers and their left as the pelvis counter-rotates
accompanying facet joints as dy- right. As the trunk and hip mus-
namic antigravity “torsional” cles concentrically and eccentri-
springs that store and unload cally co-contract, stored energy
Internal/external obliques, like is transmitted through the in-
the adductors, provide stability tensional forces to lift and propel
the body in space. tervertebral discs, ligaments and
and mobility during the initia- facet joints. Do you feel your pel-
tion of the stance phase of gait. vis counter-rotate with each
During toe-off, as the spiraling
This ASSS system also works step? Try contracting the ipsilat-
spring system begins to recoil,
with the PSSS to rotate the pelvis

Bodywork e-News 7
Spinal Engine
eral gluteus maximus on heel down? The more you practice in Walking” with Gracovetsky’s
strike as you rotate from the top working with dysfunctional Spinal Engine, I’ve come up with
down. As the gluteals co-contract ASSS and the PSSS patterns, the some practical strategies for
with the lats, more kinetic en- more effective your therapeutic tackling painful compensatory
ergy is stored in the posterior outcomes. patterns seen daily in our man-
spring system. This exercise also ual therapy practices. We expect
helps bring tone to typically Ten years ago, Volume One of to have the DVD’s and accompa-
weak butt muscles. the Myoskeletal Alignment Tech- nying book ready for release
niques® was released. In that soon.
Many individuals in our practice book and video program, I had
who complain of back pain may the pleasure of introducing
not feel the pelvis rotate. Typi- Vladimir Janda’s upper and
cally, these clients are suffering lower crossed syndrome to the Erik Dalton, Ph.D.,
from such things as joint fixa- massage therapy community. earned his phi-
tions, lack of proper spinal With inspiration from other losophy and clini-
curves, altered firing-order pat- mentors such as Ida Rolf and cal psychology
terns (in the deep inner unit) Philip Greenman, I set about to degrees from the
and/or imbalances between develop techniques to comple- University of
global and core muscles due to ment Janda’s wonderful postural Oklahoma. An in-
improper strength training. assessment model. spiring presentation by Dr. Ida
Structurally oriented pain thera- Rolf in 1972 sparked a passion-
pists trained in this method For the past few months, I’ve ate mind-body adventure lead-
seem to be successful in relieving been grinding it out in ing Dalton through a maze of
many chronic back conditions. preparationȠfor release of my learning institutions including
new Advanced Myoskeletal the Menninger Foundation,
Closely observe your clients as Alignment for Low Back, Hip & Mueller College of Holistic Stud-
they walk. Do the arms swing Leg Pain DVD series. By combin- ies, Michigan State College of
evenly? Is there a nice cross- ing spinal/pelvic biomechanical Osteopathic Medicine, and the
patterned gait? Does the energy principles from Greenman’s Rolf® Institute of Structural
appear to travel from the top “Clinical Aspects of the SI joint Integration.

Advanced Myoskeletal Alignment Techniques


With Erik Dalton
Learn innovative Bodywork deep tissue technique for chronic
reflex muscle spasms caused by joint dysfunction, including
Myofascial Mobilization, Structural Integration, Manipulative
Osteopathy, and Muscle Energy Techniques (MET).

The Myoskeletal Alignment Techniques program was developed


by Dr. Erik Dalton as a tool to help relieve neck/ back pain epi-
demic. By incorporating muscle-balancing techniques with
joint-mobilization maneuvers, manual therapists learn to
quickly identify and correct dysfunctional strain patterns be-
fore they become pain patterns. Combining muscle and joint
modalities offers busy bodyworkers short-cuts that help shorten assessment/hands-on
time, increase therapeutic efficiency; and provide clients with pain relief.

Available from: www.terrarosa.com.au

Bodywork e-News 8
AN INTEGRATED APPROACH
TO REHABILITATION OF
LEG
INJURIES
Part 1
by Art Riggs
“The foot bone connected to the ankle bone, The ankle bone connected to the shin
bone, The shin bone connected to the knee bone, The knee bone connected to the
thigh bone, The thigh bone connected to the hip bone, the hip bone connected to the
back bone.”…Spiritual “Dry Bones”

As a veteran of seven knee sur- the legs and how to work with freak of nature” because of the
geries resulting from my genetic compensatory limping patterns speed and quality of his recovery
roots of extremely bowlegged that occur after injury. compared to other patients of
peasant (Neanderthal?) ancestry, the surgeon.
After my third knee arthroscopy
combined with excessive and,
I was highly motivated in my re- Today, with the current health
some might say, obsessive ath-
habilitation but had considerable insurance restrictions, many pa-
letic over-indulgence, I have a
problems with recovery in spite tients rarely see their doctors for
virtual PhD of personal research
of extensive conventional physi- follow up or for more than per-
in acute and chronic injuries to
cal therapy treatment of functory physical therapy after
the legs and recovery from sur-
strengthening, stretching, ultra- acute knee injuries or after the
geries. Through my own experi-
sound, electrical stimulation, scars from surgery have healed.
ence and the treatment of fellow
and various anti-inflammatory I had essentially resolved myself
sufferers, I’ve learned that the
modalities. I had experienced that my surgeries just didn’t
best treatment should include a
the all-too-common plight of work well and that I must accept
wide range of approaches from
many patients who are told by my fate when a friend twisted my
soft tissue muscular and fascial
their doctors, “A certain percent arm to see a physical therapist
work, joint mobilization, stretch-
of these cases just aren’t success- (or physiotherapist, PT) who es-
ing, strengthening, and neuro-
ful.” (as if it is the patient’s fault chewed many of the conven-
muscular re-education. Injury to
or he loses by a toss of the dice). tional PT modalities and concen-
any joint of the leg will necessar-
Conversely, one client whom I trated upon soft tissue manual
ily impact the joints above and
recently treated with a broad ap- therapy. I had never before ex-
below. In addition to offering
proach of soft tissue work to the perienced “bodywork,” but after
specific treatment strategies for
knee and attention to compensa- one treatment of manual work to
the knee, this article will also
tory walking patterns in the feet free up restrictions in the mus-
discuss the complex interplay
and hips was complimented by cles and fascia around the knee
and feedback loops between
his surgeon that, “…he was a and some attention to compen-
muscles and all major joints in
Note: This article will use the more common usage of the term “leg” to refer to the entire lower extremity as opposed to
strict medical terminology where “leg” specifically refers to the portion of the lower extremity between the knee and ankle.

Bodywork e-News 9
Treatment for the Legs
satory holding in my hip and an- good manual skills and an un- the specific injury site. The suc-
kle, I felt that I had a new knee. derstanding of the complex in- cess of movement therapies is
So I suppose that terplay of the joints from the foot due to their understanding of the
I was actually to the hip, any massage therapist kinesiology and neurological
lucky to have ex- can provide great benefit to their patterns of how limping becomes
perienced my clients. We will focus on the established and hampers healing.
knee problems knees, but since injuries to the It is short-changing your client
because my as- foot, ankle, and hip often present to focus your attention on just
tonishment at the the same compensatory move- the muscular issues at the injury
benefits is what ment patterns as knees, the site without considering joint
led me into the strategies in this article will be compensations above and below
bodywork field! just as helpful for treating these the site of dysfunction and work-
injuries in a holistic manner to ing to mobilize them.
Although my in-
return normal gait.
juries were exten- The movement of the knee
sive and have re- There are no magic bullets or through extension and flexion is
quired additional simple strategies for treatment a sophisticated combination of
surgeries (finally of leg injury, and clients must be spinal cord reflexes and con-
requiring very treated as unique individuals scious higher order brain func-
successful knee based upon their particular in- tion. To greatly simplify: When
replacements be- jury or surgery, their experience the quadriceps (the agonists in
cause of arthritis), of pain or dysfunction, and their this case) contract, they extend
the amazing adaptive compensations in gait. the knee (the rectus femoris,
benefits that I As tempting as it is to move into along with the psoas, can also
continue to reap specific techniques, it is essential flex the hip, and will need to be
from manual to develop an understanding of addressed to return normal hip
therapy are not the complex relationship be- function in the later stages of
the proprietary tween all the joints of the leg and recovery). In order to facilitate
domain of sophis- how they influence recovery this action, the hamstrings
ticated physical from injury so that therapists (antagonists) must relax so the
therapy. Unfortu- can have a logical plan for treat- two muscle groups aren’t com-
nately, many mas- ment, rather than just trying to peting with each other. Con-
sage therapists are work where it hurts or using versely, in knee flexion the ham-
hesitant to work some technique that looked good strings contract to flex the knee
with injuries be- in a class or book. (or extend the hip if the knee is
cause they are fixated) while at the same time,
given little in- the quadriceps must relax. This
struction on deal- NEUROLOGICAL FACTORS process of contraction/
ing with post- relaxation of opposing muscles is
injury or surgery When manual therapy and con- called reciprocal inhibition and
cases except for ventional western medical meth- occurs at an unconscious reflex
caveats that instill ods prove to be less than satis- level in all parts of the body.
trepidation. I re- factory, the success of Pilates
and somatic therapies like Fel- If there is pain or soft tissue re-
late my personal
denkrais® demonstrates the im- striction in the knee joint, a com-
From Gray’s anatomy story to empha-
portance of treating more than plex series of protective reflexes
size that with

Bodywork e-News 10
Treatment for the Legs
occurs that overrides the smooth
function of reciprocal inhibition
to compensate for the restriction
or prevent the joint from moving
into painful positions. This reac-
tion may be useful in the early
stage of recovery to prevent pain
or protect the joint, but if the
joint does not quickly return to
normal pain-free movement,
there is a likelihood of limping
patterns being established that
disrupt function above and be-
low the knee. These global feed-
back loops tend to exacerbate
and fixate the original injury.
(Possible side-bar) Understand-
ing how the foot, ankle and hip
at first respond to and later con-
tinue to affect the knee is often
the key to rehabilitation, not
only of acute problems but long-
standing chronic ones.

Although there are many differ-


ent patterns for compensation in
walking, sidebar #1 demon-
strates the most common limp-
ing patterns for knee pain. In
part two of this article we will go
into a deeper analysis of gait,
techniques for joint mobilization,
and some strategies for return- Box 1: In varying degrees, limited knee extension will have the following results in gait,
including a short stride. If you can return normal extension to the knee (the primary
ing normal function to the feet
restriction), then most of the secondary compensations in the foot and hip will improve
and hips. For now, this chart will with minimal intervention. Muscles that are inhibited will need to be strengthened, and
give you a map of short muscles any good sports medicine book will have suggestions. These images confine themselves
that you can begin working with to the pelvis and below, but notice how pelvic tilt is also affected and will have effects up
to improve knee function. the spine and beyond. If you consider how a tight psoas on the affected side will present
side-bending and rotational strain on the lower back, it becomes clear how the effects of
injury radiate globally.

TREATMENT STRATEGIES terproductive if performed with- early, thereby increasing inflam-


FOR THE KNEE out considering the progress of mation. It is understandable that
your client in his or her healing both therapists and clients are
Even ideal techniques or soft tis-
process. We all walk a fine line of anxious to progress as quickly as
sue strategies may prove less
providing effective work or occa- possible with recovery, but I feel
than effective or possibly coun-
sionally working too hard or too that too early or aggressive inter-
Bodywork e-News 11
Treatment for the Legs
vention may disrupt the amazing ion, the primary culprit in limp- either surgical or accidental, and
ability of the human body to di- ing is a lack of knee extension, should be the first issue ad-
rect its own healing. Often, cli- even if it just a matter of a few dressed. The client will probably
ents are hoping be quickly degrees. Certainly you should have some residual pain and fear,
“fixed” by outside intervention work to improve flexion, but in so it is crucial to move slowly
or magic bullets. I prefer to look most normal, relatively level
at my work as returning balance, walking and level running condi-
thereby opening the door for my tions, it is possible to navigate
clients’ bodies to heal themselves. without limping even with re-
Giving them the confidence and stricted flexion. Once you un-
trust in their body’s recuperative derstand how the ankle, knee
powers is another gift that you and hip are related, you can be-
can provide in addition to your gin to work with a rational strat-
work. egy to return normal movement
to the whole leg. (last sentence is
After surgery most orthopedists
redundant…...repeat for empha- and within their pain threshold.
and physical therapists feel that
sis or delete?)
if the incision is healing properly, Photo #1—Sleeve Work
after approximately seven days it Treatment #1: Freeing the
With your fingers softly curved,
is safe to perform superficial Superficial “Sleeve” around
take a hold of as broad an area of
work to reduce swelling, prevent the Knee Joint
tissue as you can with the soft
adhesions from forming, and
This is really quite easy and pads of your fingers and the
improve mobility. To play it safe,
gratifying work once you have a palms of your hands. Your in-
I recommend waiting for at least
feeling for it, but it is quite dif- tention should be very superfi-
10 days, and always proceeding
ferent from typical kneading, cial, no more than ½ inch deep,
with authorization from the sur-
effleurage, or deep muscular as you visualize VERY slowly be-
geon. The tissue will most likely
work of conventional massage. ginning to first soften tissue and
be very warm from natural in-
This work will facilitate improve- then unwind and separate this
flammation processes; it is
ment in both flexion and exten- outer sleeve from deeper tissue
strongly recommended that
sion and the feeling of tightness and the joint. If performed
whenever working on injuries
surrounding the knee. The su- properly, the client usually com-
you apply ice packs for 10 min-
perficial tissue around an in- ments that it feels quite enjoy-
utes after the session and have
jured or surgically repaired knee able (in an intense way) and
your client apply ice later in the
will usually lack the resilience freeing. The softening of tissue
day. “Hot” or very red, irritated
and mobility of normal tissue might feel like you are slowly
tissue, especially if the client has
and feel leathery. This is a dif- letting your fingers test the ripe-
a fever, is a serious problem after
ferent quality from softer puffi- ness of an apple while being
surgery, and they should imme-
ness of deeper joint swelling careful to not bruise it. Gently
diately contact their surgeon to
which may also be present, but grabbing the incision and lifting
rule out an infection in the joint.
will “give” more easily because of it and slowly moving back and
That said, what do you do when
the additional fluid in the joint forth similar to skin rolling is
you first see a client after surgery
capsule. It is almost as if a tight very helpful, but again, with the
or an acute knee problem?
sleeve has been wrapped around doctor’s permission soon after
Although clients may be con- the joint. This is the body’s at- surgery. After softening the tis-
cerned with the lack of knee flex- tempt to stabilize after trauma, sue, then visualize that you are

Bodywork e-News 12
Treatment for the Legs
sliding this superficial layer and mobility at the end range tation.
around the joint in whatever di- restriction of tissue. Working in
rection it wants to stretch, un- the neutral position is of mini-
wind, and release—almost like mal benefit. Take the joint to the
very slowly wringing out a wet end range of comfortable flexion
towel--being careful that you are and work to extend that end
grabbing and stretching tissue range either passively or by hav-
rather than sliding over it. There ing your client actively flex the
is little or no need for lubrication, knee while you work on any soft
which makes the skin slippery tissue areas that are resisting.
and requires more pressure to Your client can tell you where
Photo #3—Supine Knee Flexion
grab the sensitive tissue. the tissue is tight and resisting
movement. This approach affords more con-
The release happens at the end
tact with the anterior knee and
range of restricted motion and at
patella as well as the quadriceps.
a very oblique angle, not from
Stretch the knee into flexion and
jostling tissue back and forth or
ask where any restrictions are
working on deeper tissue…
felt. You can use anchor and
almost as if you trying to free the
stretch strokes applying pressure
lid from a jar by slowly applying
proximally as you flex the knee
steady pressure and waiting
against adhesions, or you can
(hoping) that it will eventually
work in the direction of length-
release and move. You want that
ening by grabbing tissue and
leathery superficial tissue to be Photo #2-- Prone Knee Flexion
pulling it in that direction. To
able to slide over the joint in all Technique
allow both hands to work, you
directions so it does not disrupt
To insure that you are not stress- may instruct the client to flex her
joint function. A very effective
ing the knee capsule, be sure to knee by using her hands to pull
technique is to rotate the outer
have your client inform you if the knee towards her chest, or
sleeve of tissue as far as it will go
the restriction feels like it is deep use your own body to apply flex-
and then ask your client to very
in the joint rather than in the ion pressure to the lower leg.
slowly flex and extend the knee
soft tissue you are addressing.
so that the joint moves under the
Also make sure that the patella is
sleeve that you are stabilizing.
not compressed against the table.
Slowly flex the knee with your
other hand and address any ar-
Treatment #2: Improving
eas distal to the knee that are
Flexion.
restricting movement. The fist,
As mentioned earlier, flexion is fingers, or even the forearm are
rarely a lasting problem, and re- effective tools. In addition to
turning full extension should be freeing localized tissue where
a higher priority. However, most you are working, this will also
Photo #4—Seated Quadriceps
clients seem quite concerned stretch the quadriceps. This is
Work
with flexion and it is relatively the perfect time to offer your cli-
easy to improve. Your goal is to ent suggestions about a home Good old-fashioned softening of
increase joint range of motion stretching program for rehabili- the quadriceps with the forearm

Bodywork e-News 13
Treatment for the Legs
is always helpful. Of course
working with your client in su-
pine position is also acceptable,
but does not stretch the tissue.
Having the client sitting and ac-
tively flexing the knee as you ap-
ply force in a distal direction to
expedite lengthening is more ef-
ficient for biomechanical use of
your weight and also assists with Photo #5—Patellar Mobilization Photo #6—Soft Tissue Patellar
joint tracking and other neuro- Work
The patella will only glide freely
logical movement patterns. An-
when the knee is fully extended In addition to mobilizing the pa-
chor and stretch strokes apply-
(another reason to return full tella by working directly with the
ing force proximally while
extension to the knee joint as bone as a lever, it is very impor-
stretching the tissue by increas-
soon as possible). Palpate the tant to soften tissue around the
ing flexion are also very effective
difference on yourself by at- perimeter of the patella that can
for freeing more superficial ad-
tempting to slide your patella interfere with tracking. Work
hesions around the knee joint.
back and forth with the knee just slowly in all directions with fin-
slightly bent, as it would be if gers or knuckles and wait for the
supported by a bolster in supine melt of tissue.
Treatment #3: Freeing the
position. Now let your knee rest
Patella
in full extension (without con-
Even with deep joint injury or tracting the quadriceps) and no- Treatment #4—Freeing the
surgery, the patella often be- tice how much easier the patella Iliotibial Band
comes restricted and can cause moves. To mobilize the patella,
the knee should be extended as With virtually every knee injury,
tendinitis and secondary pain. It
straight as is comfortable with- the I.T. band will become tight
is unfortunate that many early
out a bolster. and hard. Not only is this un-
massage trainings instill fear of
comfortable or painful for the
working in this important area.
With the soft, flat border of your client, but the tightness causes
Be careful to not compress the
thumb, gently lift the patella and torsion (strain?) on the knee,
patella against the femur when
slowly mobilize in all directions, pulls the patella laterally, and
working, but do work for more
waiting at end range of restric- prevents smooth flexion and ex-
ease in proximal/distal and lat-
tion for a softening of resistance. tension. The biggest complaint
eral/medial movement. Tight
In this case, I am actually lifting that some clients express for
tissue and tension in the I.T.
and tilting the patella with my work in this area is that the
band and vastus lateralis most
thumbs slightly below the ante- therapist moves too fast and ex-
often will cause the patella to
rior surface so it is not com- erts pressure directly into the
deviate laterally, so although not
pressed against the femur. You femur rather than obliquely.
shown in this example, any work
can even rotate the patella clock-
to lengthen and soften the I.T. Just softening the tissue will be
wise and counterclockwise.
band is very helpful. Don’t try to of substantial benefit, but put-
accomplish too much in one ses- ting the I.T. band on as much as
sion, but a little work each time
will be helpful.

Bodywork e-News 14
Treatment for the Legs
this work. In addition to stretch- fingers is very effective to allow
ing in a distal direction with the the band to stretch in a straight
soft underside of your forearm, line and also to allow the patella
grabbing the I.T. band and rotat- to track correctly instead of be-
ing it around the leg to free it ing pulled too far laterally.
from deeper adhesions is also
very helpful
Conclusion

I hope that this first of two arti-


cles provides some helpful
strategies for working with knee
injuries, and more important,
stimulates some thought about
the interconnectedness and
global issues involved in treating
not only injuries to the legs, but
in treating any other injuries.
Photo #9---Compartment Sepa- The forthcoming article will offer
ration specific tools for returning full
Photos # 7 & 8 ---Working with
the Iliotibial Band in Side-Lying range of motion to the knee in
With immobility after injury or
extension and in working with
surgery, adhesions may form
a stretch as possible by having joints.
along the anterior or posterior
the leg extended in the side-lying
border of the I.T. band. Precise
position will add to the benefit of
work along either border with

Art Riggs
Deep Tissue Massage & Myofascial Release

This seven volume (over 11 hours) encyclopaedia of bodywork gives


clear demonstrations of virtually every tissue technique any therapist
will need. Seeing them performed live, in real time, offers an educa-
tional experience that is impossible to achieve in books alone.

Many massage training videos just show "strokes" without delving


into the complex issues of soft tissue restrictions, osseous articula-
tions and strategies for working with the multitude of different issues
we face as therapists. This extensive series is designed to stimulate
creativity and problem solving skills. This valuable resource not only shows countless strokes and
strategies, but will, more importantly, demonstrate the art of working with fascia to affect profound
change.

“Riggs is to be congratulated for putting together a pleasing and professional set of programs, which I predict will
be strewn on the desk of many a therapist —being used, rather than up on a shelf gathering dust. “ Thomas Myers

Available from: www.terrarosa.com.au

Bodywork e-News 15
The most comprehensive DVD on
Positional Release Techniques
Positional Release therapy is an excellent
way to release hyper-sensitive tissue easily
and quickly. Similar to Ortho-bionomy, strain
counter strain, and neuromuscular re-
education, this technique uses the body’s
nervous system to remind the muscles to re-
lax. This comprehensive DVD shows how to
release the most common dysfunctions with
ease and skill This DVD contains 33 chapters,
59 releases, almost 3 hours of information,
and great for hyper sensitive areas.

Featured in AMT Newsletter "In Good Hands" March 2008 ***** Five stars, Valuable resource,
highly recommended! (Review by Tyraus Farrelly) * Excellent quality * Good value for money * 3
hours of information & techniques * Covers positional release for the entire body * Easily inte-
grated into any practice

Anyone for a Stone massage?

Bodywork e-News 16
Lomi Lomi Massage
Workshop
Down Under

With
Carrie Rowell

Join Carrie Rowell for a 4-day Workshop, Hawaiian Lomi Lomi Massage, covering an introduction
to the principles, and a full body massage routine, complete with joint mobilization and passive
stretching.

Carrie will travel to Australia in November 2009 and hold workshops in various places, including:
Sydney, Byron Bay, and Brisbane. For over 20 years, she has studied various forms of sacred dance
and movement. She applies the beneficial techniques learned from these arts into her bodywork
therapy. Carrie practices and teaches bodywork in the US and traveled all over the world teaching
Lomi Lomi massage, sacred dance and healing and empowerment workshops for women.

For centuries the ancient art of Hawaiian Lomi Lomi massage has been used as a powerful tool for
maintaining a healthy way of life. The strokes are long and flowing, using forearms and elbows, and
giving the feeling of many hands on the body at once. All seminars incorporate movement and
breath exercises, specific Hawaiian Massage techniques and exercises for self care.

Practitioners work on each other and switch partners to learn how to apply the techniques to differ-
ent body types. Individual attention is given by the instructor so that the students learn how utilize
their body mechanics in the most efficient way for them. Each day you will learn new exercises and
massage techniques designed to harness the power of the elements earth, air, water and fire.

To register your interest and get more details


email: terrarosa@gmail.com or carrie@carrierowell.com

Bodywork e-News 17
Unraveling the mysteries of

Unwinding
What is unwinding? work that needs to be experi- gentle touch with a clear inten-
enced to be appreciated. This tion of restoring balance and be-
The term “unwind” is generally
article will take a look at some ing aware of client’s body can
used with a meaning to relax,
aspects of physical unwinding, stimulate unwinding. Unwinding
become less tense, or take an
and also presents some theories can happen automatically when
ease. “Unwind your body” is a
on why and how it occurs. a therapist is working on a cli-
common phrase used to promote
ent’s soft tissues. The client gen-
relaxation bodywork. This technique is usually offered
erally moves in response to
in classes and workshops in
But Fascial or Myofascial Un- therapist’s touch and inner feel-
myofascial release (the John
winding is a type of bodywork ing. The movement can be large
Barnes MFR). Unwinding can be
that has a goal to “release” fas- or small, involving some parts of
thought as an expression of in-
cial restriction by encouraging the body or the whole body. It
ner movement. Sometimes just a
the body or parts of can happen when a client feels
the body to move to safe and secure in the hand
areas of ease. Unwind- of the therapist and this
ing usually involves a allows the expression of
therapist that induced movements. In some cases,
the process to a client, emotional release can oc-
and this is followed by cur during unwinding,
spontaneous reaction: therefore it is important to
bending, rotating, and distinguish between pure
twisting of the parts of physical unwinding and
the body in a rhythmic emotional release. Here we
pattern. only discuss physical un-
winding which has a pro-
Unwinding is a gentle found therapeutic benefit
and non-invasive in releasing chronic mus-
treatment which re- culoskeletal pain.
sponds to body’s inner
potential, not forcing In craniosacral therapy
the tissue in some di- there’s a technique called
rections. The goal is to sometoemotional release
facilitate the body’s which used fascia unwind-
own physical release ing to access client’s emo-
potential. It is a body- tion; it mostly deals with
the physical manifesta-

Bodywork e-News 18
Unwinding
tions of emotional trauma with strain pattern of the tissues is
the aim to release residual nega- holding may become more easily
tive energies from past traumatic clarified. Alternatively the thera-
experiences. Again, here we only pist can add compression to
deal with physical unwinding. main joints in the area, or hold-
ing part of a body in certain re-
The technique is originated in
laxed position.
indirect osteopathic techniques.
Robert C. Ward in Foundations The unwinding process can be
of Osteopathic Medicine, said carried out on any parts of the
that its origins are not clear; body such as arm, leg, neck or
however the procedures have even jaw. It can also be carried
been described for decades by out for the whole body. The fol-
scientific descriptions for the
many osteopathic practitioners. lowing are some examples:
events are lacking.”
The term “unwinding” was Arm and shoulder unwinding,
How to unwind?
coined by Dr. Viola Frymann in client is supine, and lifting an
1963. The technique was mainly To introduce an unwinding ther- arm supporting it under the
developed by Dr. Frymann, who apy, the therapist must be cen- therapist’s elbow and wrist, a
was a student of Dr. Sutherland. tered and grounded, acting as a light compression towards the
The physical unwinding compo- catalyst or facilitator, with a shoulder joint can be added. Af-
nent of Somatoemotional Re- compassionate attitude, and be ter a while, the therapist will
lease is based on Dr. Frymann’s aware of client’s inherent wis- sense movements.
work. However, unwinding was dom.
Leg unwinding 1, client is su-
never intended nor used by her
The techniques for unwinding pine, therapist lifts the client’s
to provoke emotional release.
can be found in craniosacral leg with flexed knees, and sup-
According to Dr. Frymann the therapy books such as by ports it by holding at the knee
principle of unwinding is to Upledger and Vredevoogd (1983) and ankle. Gentle compression
place the body in the position and Milne (1998). In unwinding, of the leg towards the hip joint
that permit the fascia to go the therapist act as a catalyst, can be added. After a while, the
through whatever motions are placing the client’s body or body therapist will sense some move-
necessary to eliminate the forces parts in certain configurations, ments.
causing the injury. and let it “unwind”. The tech-
Leg unwinding 2. Client su-
nique begins quite simply from
The phenomenon of unwinding pine, standing at the foot of the
the therapist’s touch and the cli-
where parts of the body move table, gently hold client’s heels in
ent takes over quickly.
spontaneously and involuntarily cupped hands, lift the fully ex-
is fascinating and mystical. Therapist initially induces the tended legs. Gentle compression
Robert Ward recognized that motion in the body, usually by
these seemingly random move- lifting and holding certain part
ments reflect a variety of inter- of the body so that it removes
acting electromechanical events the influence of gravity. This
affecting central, peripheral, technique is often used when
autonomic, and even physiologic working with the limbs. Accord-
functions. He added that “amid ing to Kern, when the gravity
much speculation, satisfactory effect has been removed, any

Bodywork e-News 19
Unwinding
towards the hip joint or traction that the movement is not di-
can be added, feel and listen to rected by practitioner, but rather
the inherent motion. Ankle and is followed as the body “unwind”.
feet can also unwind in this tech- Great sensitivity and fine palpa-
nique. tion skills are required to carry
out this process. The first re-
Hip joint unwinding, client is
quirement is the therapist’s
supine with knees flexed. Thera-
touch, a client must feel safe un-
pist lifts both legs by the knees
happen spontaneously when the der the caring hand, otherwise
so the thighs form about ninety
performing myofascial tech- unwinding would never happen.
degree angle with the hip. Intro-
niques such as: suboccipital de- It can begin with observations
duce a gentle compression of the
compression, or stretching of such as muscles twitching, and
knees towards the hip joint, and
neck flexors (neck under exten- gentle movement: head rocking
release. Wait and sense for
sion, and rotation). from side to side. If allowed to
movement on the legs, and
build up momentum, the move-
thighs around the hip joint. The following techniques can be
ment can be stronger and the
used to induce Whole body
therapist just need to hold the
unwinding (Upledger and Vre-
body lightly or even moves the
devoogd, 1983):
hands away and the movement
- client seated, will still continue. Sometimes
with one hand unwinding can get very active
on the parietal and aggressive involving the
and the other whole body, looking like “getting
on the poste- the demon out of the body”.
rior upper
In the first experience, client
thoracic re-
usually assumed the therapist is
gions. A slight,
guiding the movement, and
inferiorly-directed compressive
sometimes when made aware of
force exerted on the parietal so
Neck un- it can stop the movement as it
that the cervical and upper tho-
winding, feels weird that the body is mov-
racic regions are gently com-
therapist is ing unconsciously.
pressed caudally.
standing
Upledger suggested that client
behind a - client
will ultimately resume to the
sitting client. standing fac-
body posture in which the injury
Place one ing the
occurred. Many people feel
hand on top therapist,
drawn to unwinding with the
of the head, gently com-
intention of relieving trauma
and the pressing
patterns. The pattern of move-
other hand medially the
ment can be rhythmic but some-
on the anterior ilia, feel and listen to the
times can be random as well. Af-
shoulder. Introduce a gentle inherent motion.
ter a period of time, the move-
compression to the head, and
The practitioner senses and fol- ment ceases and the unwinding
release. The therapist will sense
lows the inherent motion arising is said to have reached a still
movement on the neck and fol-
from the body. It is important point.
low it. Neck unwinding can also

Bodywork e-News 20
Unwinding
In practice, the unwinding pat- diminish and range of motion McCarthy and colleagues (2007)
terns are unpredictable. Some will return”. The process is al- documented the use of unwind-
will only show subtle motion, ways gentle, always following the ing in the treatment of a patient
while others can move vigor- body’s own demands and is usu- with chronic neck pain. They
ously through space. Some sensi- ally experienced as a very relax- evaluated the outcome of short-
tive therapists can induce, and ing, soothing, and pleasant ex- term pain and disability in a pa-
expect unwinding from their pa- perience. Even in painful neck or tient with chronic neck and
tients, while others never experi- frozen shoulder conditions, the shoulder girdle pain treated with
enced it. gentle process of unwinding can just unwinding. Treatment
be carried out, to encourage and shows a reduction in pain inten-
If the client suddenly starts to
discover pain-free movement to sity and perceived disability.
unwind, without your
intention, you could
just to support the cli-
Tissue memory
ent, and stay out of the
way. When the body The metaphors used to ex-
starts unwinding rigor- plain fascial unwinding in-
ously, it can take over clude: unwinding tangled
the session. Clients telephone wires or twisted
usually unwind when rubber bands. Most com-
they feel secured and mon explanation is that our
supported. It is impor- tissues hold memory of
tant not trying to ana- trauma, and unwinding will
lyze and figuring out allow the client’s body to
and judging what is move to self correction.
happening. Remember, Fascia may become short
it is natural process, and tight due to trauma,
and let it flows. Taking poor posture, and physical
a seminar on unwind- stress. Upledger and Vrede-
ing would certainly be voogd (1983) described it as
helpful. follows:
the area and restore mobility.
“When an injuring force occurs,
Barret Dorko (2003) character- the tissue which receives the
Benefits
ised it with four attributes: ef- force is changes. Perhaps it re-
Unwinding techniques can be fortless, warmth, muscular sof- tains the energy of the impact.
used in conjunction with other tening, and surprise. The muscu- The human body the either dissi-
modalities is to release pain or lar softening is attributed to the pates that energy and returns to
movement restriction of clients full expression of muscles, and normal; or the body somehow
(not for releasing emotional the warmth to an increase of localizes the impact energy and
problems). Barnes (2000) sug- blood flow. The effortless and walls it off.” Unwinding at-
gested that myofascial release surprising qualities of this mo- tempts to free these stored en-
and unwinding are the best thing tion are both characteristic of ergy. (Upledger, 1987)
for anyone with acute injuries, instinctive and unconsciously
There are also various theories
“spasms will lessen, pain will motivated movement.
regarding memory for traumatic

Bodywork e-News 21
Unwinding
events maybe encoded differ- client supine and head off the
ently from other events. The first table, neck supported and under
is called state-dependent mem- extension). These techniques are
ory which comes from observa- also known clinically can trigger
tion that memory in one state of unwinding of the neck. Anxiety
consciousness cannot be recalled levels significantly decreased af-
until the person returns to the ter the application of the three
same state. Another idea is sug- techniques. Heart rate and sys-
gested by Sigmund Freud who tolic blood pressure were modu-
proposed that unwanted memo- lated during the course of the
ries can be excluded from aware- ered tonus of intrafascial smooth myofascial techniques, and the
ness, a process called repression. muscle cells. effects were observed up to 20
Recent studies show that a bio- minutes after the therapy.
Gentler types of myofascial
logical mechanism exists in the
stretching and cranial tech-
human brain to block unwanted
niques also have been shown to
memories. Unwinding as an ideomotor
affect autonomic nervous system.
action
Clinical observations show that
gentle myofascial techniques can First, let us review the idea and
Neurobiological fascia the-
stimulate clients’ involuntary process movement. Andre Ber-
ory
motor reactions such as rapid nard in Ideokinesis summarized
Robert Schleip in a fascianating eye movements or muscles it beautifully:
series of paper (2003a, 2003b) twitching. Study by Zullow and
Reisman (1997) indicated an in- “Movement may be defined as a
presented a comprehensive re-
crease in parasympathetic activ- neuromusculoskeletal event.
view on the neurobiology of fas-
ity as a result of application of This means that in order for
cia and provide a theory on how
cranial techniques called com- movement to take place, all three
myofascial release works. Fascia
pression of fourth intracranial of the systems alluded to in this
and the autonomic nervous sys-
ventricle (CV4) and sacral hold definition—nervous, muscular,
tem appear to be intimately con-
as measured by heart rate vari- and skeletal—must be involved.
nected. Fascia is densely inner-
vated by mechanoreceptors ability. Fernandez Perez and col- Each system has its own specific
leagues (2008) recently exam- role to play; the nervous system
which are responsive to manual
pressure. Myofascial manipula- ined the effect of
tion involves a stimulation of introducing
intrafascial mechanoreceptors three myofascial
which are then processed by the and craniosacral
central nervous system and auto- techniques on Spa &
nomic nervous system. The re- the physiologic Massage
sponse of the central nervous changes. The Unwind
system changes the tonus of three techniques
some related striated muscle fi- are suboccipital
bers. The autonomic nervous muscle decom-
system response includes an al- pression, CV4,
tered global muscle tonus, a and deep cervi-
change in local vasodilatation cal fascia
Unwinding? No, Thanks ..
and tissue viscosity, and a low- stretching (with
David will wind me up again when I get home

Bodywork e-News 22
Unwinding
is the messenger, that is, it trans- anticipation of the required
mits impulses or messages to the movement directly triggers the
muscles to contract or release; actions that have been learned to
the muscle system is the work- produce those. This is the differ-
horse or the motor system; the ence between normal sensorimo-
skeletal system is the support tor and ideomotor learning. It is
system that is moved by the easier to illustrate it with an ex-
work of the muscles. However, ample, when playing the piano,
the nervous system is more than both types of learning may be
just a simple messenger. It also present, but sensorimotor map-
organizes the muscle pattern, ping would associate the finger
and it does this on a sub-cortical movement to the sight of the
level, that is, the level below con- musical note, whereas ideomotor
sciousness. Muscle pattern is the learning would associate the fin-
complex of muscles that perform ger movement to the hearing of
a desired movement: organizing the tone. Similarly in unwinding,
the muscle pattern is a highly when it is initiated, the move-
complex and sophisticated task. intervention, or other supernatu- ment is guided and associated by
… If the movement is not done ral causes. Carpenter argued that the stretching sensation, finding
well, it means the muscle pattern muscular movement can be initi- areas of ease of movement and
is poor, and the muscle pattern ated by the mind independently free from pain. Meanwhile in
is poor because the “wrong” of our will or emotions. We may stretching, the movement is
message (a faulty concept of the not be aware of it, but sugges- guided by the therapist’s hand or
movement) has been sent to the tions can be made to the mind by cue.
muscles. This wrong message is others or by observations. Mus-
Dorko hypothesized the mecha-
the result of either a lack of clar- cles can be involuntarily acti-
nism of unwinding as follows:
ity about what the movement is vated by thoughts. Involuntary
“Muscular pain can arise from
or a previously established poor muscle movement can manifest
mechanical deformation of vari-
muscle pattern associated with in various ways, for example ask-
ous tissues. If the movement re-
the movement.” ing a subject to think of an activ-
quired for reducing that injury is
ity is enough to set the muscles
Barret Dorko (2003) suggested not permitted because of cultural
required for that activity into
that fascial unwinding can be norms, the body would respond
action.
explained as ideomotor move- with an array of isometric con-
ment (ideomotion). Ideomotor According to ideomotor theory, traction of muscular activity.” He
action or ideomotion is the typical reason for performing further assumed that this muscle
“influence of suggestion in modi- a movement is to produce an ef- activity is commonly misinter-
fying and directing muscular fect in the environment. The preted as a lack of appropriate
movement, independently of vo- ideomotor principle is based on relaxation, and subjected to vari-
lition”, a definition given by psy- two conditions. First, it is re- ous forms of stretching, manipu-
chologist and physiologist Wil- quired that movements and their lation or exercise. Manual tech-
liam B. Carpenter in 1852. Car- resulting effects become associ- niques elicit ideomeotor activity
penter used ideomotor action as ated, it is possible to predict an (unwinding) allows full expres-
an explanation for various phe- effect or outcome given a move- sion of the muscles and encour-
nomena that were being credited ment. Second, this association age to complete the motor re-
to new physical forces, spiritual works in two ways, so that the sponse for which the contraction

Bodywork e-News 23
Unwinding
was activated. The touch by the Central nervous system
therapist is gentle and non-
coercive, with a goal to make the Ideomotor action
client aware of internal motor Sensory input
activity and then get out of the
way of that movement.

Consciousness theory Tissue response Tissue manipulation, Touch, Stimulation of


Stretching, Unwinding mechanoreceptors
Research conducted by Halligan
and Oakley (2000) suggested
that all the thoughts, activities,
ideas, feelings, attitudes and be-
liefs traditionally considered be- Autonomic nervous system
ing the contents of conscious-
ness are produced by uncon- Figure 1. A hypothetical model for fascial unwinding (based on Schleip, 2003b).

scious processes—just like ac-


tions and perceptions. It's only scious experience close to that of introduction of stretching or
later that we become aware of a passive movement. Unwinding movement to areas of ease. This
them as outputs when they enter or ideomotor process thus repre- is under unconscious state and
our consciousness. sents dissociation between vol- client remains unaware, indicat-
untary action and conscious ex- ing dissociation between volun-
In their model, all of the brain’s perience. tary action and conscious experi-
information processing activities ence. This stretching sensation
are referred to “unconscious” in turn stimulates a response in
parts of the brain as Level 2. the tissue, providing a feedback
A hypothetical model
Within this level, there must be to the central nervous system as
some kind of decision-making A hypothetical model employing outlined by the theory of ideo-
device, a central executive struc- the neurobiological and ideomo- motor action. The process is re-
ture (CES). The CES identifies tor action theories was recently peated until the client is relaxed
the most important task the proposed. In the first stage, the or reached a “still point”.
brain is carrying out at any mo- induction process, the therapist
ment, and selects the informa- working on a client introduces
tion that best describes the cur- gentle touch or stretching onto
Summary
rent state of the brain in relation the tissue. When client feels safe
to the chosen task. Only this in- and supported, the process is Unwinding is a gentle form of
formation would be allowed to initiated. The touch stimulates therapy which can be incorpo-
enter Level 1, to produce con- mechanoreceptors of fascia and rated in other form of bodywork.
scious experience. in turn arouses parasympathetic It is a non-invasive treatment
nervous system response. The which responds to the body’s in-
In a hypnosis trial, Haggard and
result is that client is in a state of ner demands to release, never
colleagues (2004) demonstrated
relaxation and calm, which imposing any stress on the tis-
that an ideomotor response pro-
sometimes is followed with rapid sues. It is generally painless and
duced by suggestion is generated
eye movement, twitching or deep brings about a much appreciated
via normal voluntary motor con-
breathing. The stimulation also sense of relief, ease, and relaxa-
trol systems but experienced as
influences the central nervous tion, as well as the more pro-
involuntary, resulting in a con-
system, which responds with the found therapeutic release of un-

Bodywork e-News 24
Unwinding
derlying chronic conditions. Paoli, PA.

The effect of myofascial manipu- Barnes, J.F.,


lation has been studied from cel- 2000. Healing
lular, tissue to whole body level. Ancient
Studies have shown that it is im- Wounds: The
possible to generate immediate Renegade's
and permanent lengthening or Wisdom. MFR
unwinding of the fascia with me- Treatment
chanical means. Creating such Centers &
changes require a huge amount Seminars,
of force with longer durations of Paoli, PA.
John just like to unwind at the end of a busy day
stretching. Stimulation of mech-
Dorko, B.L.,
anoreceptors is the most likely tional Journal of Osteopathic
2003. The analgesia of move-
trigger of such release. Medicine 10(4), 104-112.
ment: ideomotor activity and
As a bodywork, we can view un- manual care. Journal of Osteo- Schleip R., 2003a. Fascial plas-
winding as an application of the pathic Medicine 6(2), 93-95. ticity – a new neurobiological
neurobiological concept employ- explanation. Part 1. Journal of
Haggard, P., Cartledge, P.,
ing the self-regulation dynamic Bodywork and Movement Thera-
Dafydd, M., Oakley, D.A., 2004.
system (Schleip, 2003b). The pies 7(1), 11-19
Anomalous control: When ‘free-
therapist working as a facilitator
will’ is not conscious. Conscious- Schleip R., 2003b. Fascial plas-
inducing parasympathetic sys-
ness and Cognition 13(3), 646- ticity – a new neurobiological
tem, paying attention to the state
654. explanation. Part 2. Journal of
of autonomic nervous system,
creating unusual sensations with Bodywork and Movement Thera-
Halligan, P.W., Oakley, D.A.,
subtle stimulation, including im- pies 7(2), 104-116.
2000. Greatest myth of all. New
mediate feedback, and involving Scientist 168 (2265), 35-39. Shea, M.J. Autonomic nervous
active macro-movement partici- system. http://ww.cathysheaschool.com/
pation. Milne, H., 1998. The Heart of
articles_15.asp
Listening: A Visionary Approach
As John Upledger (1987) said: to Craniosacral Work: Anatomy, Upledger, J.E., Vredevoogd, J.,
Technique, Transcendence. 1983. Craniosacral Therapy.
“ I can’t tell you how it works. I
North Atlantic Books. Eastland Press, Seattle, WA.
know that the intention of the
therapists has a lot to do with it. Kern, M., 2005. Wisdom in the Upledger, J.E., 1987. Craniosac-
Also the less guarded the patient Body: The Craniosacral Ap- ral Therapy II. Beyond the Dura.
is, the quicker it will work.” proach to Essential Health. Eastland Press, Seattle, WA.
North Atlantic Books, Berkeley,
Ward, R.C., 2002. Integrated
CA.
Neuromusculoskeletal release
References
McCarthy, S., Rickards, L.D., and myofascial release In: Foun-
Barnes, J.F., 1990. Myofascial Lucas, N., 2007. Using the con- dations for Osteopathic Medi-
Release: The Search for Excel- cept of ideomotor therapy in the cine. 2nd ed. Lippincott Wil-
lence. A Comprehensive Evalua- treatment of a patient with liams & Wilkins, Philadelphia,
tory and Treatment Approach. chronic neck pain: A single sys- PA, pp. 931-965.
Rehabilitation Services, Inc., tem research design. Interna-

Bodywork e-News 25
Myofascial Release &
Craniosacral Therapy
at
www.terrarosa.com.au

Bodywork e-News 26
Lipoedema
By Kristin Osborn Dip. R.M., Dip. M.Sc., T.A.A.

Lipoedema is a form of lipodys- sive diet or exercise, often this Stages of Lipoe-
trophy (pseudo edema), involv- makes the condition worse dema
ing the accumulation of abnor-
• Is usually triggered around Stage 1: Visual inspec-
mal deposits of adipose (fatty)
Puberty, Pregnancy, Pre- tion is normal. The
tissue in the subcutaneous layer
Menopause and following Gy- surface of the skin is soft and
of the skin. This is a continuous
necological Surgery smooth.
process.
• Patient’s will gain weight in Stage 2: Large fatty lobules are
History
lipoedemic areas and lose it in seen when the skin is squeezed
First identified at the Mayo non-lipoedemic areas between two fingers. There are
Clinic in the United States in small skin deformities and un-
• The basic profile of sufferers
1940, Lipoedema is barely even skin surface.
look like a size 8 from the
known to physicians or to pa-
waist up and a size 16 from Stage 3: Inspection reveals sig-
tients that have the disease.
the waist down nificant deformation of the pro-
Estimates vary widely but range file. Very large, excessive fatty
as high as 11% of the post- lobules are present.
puberty female popula-
tion has the disease.

Main Characteristics

• It usually is inherited

• It occurs almost pre-


dominately in women

• It occurs from the ano-


rexic – morbidly obese

• It occurs bilateral and


symmetrical from the
waist to the ankles,
Stemmer’s Sign
(edema of the forefoot
and toes) is negative

• Lipoedemic fat cannot Anterior View Posterior View


be lost through exces-

Bodywork e-News 27
Lipoedema
Comparisons: Lower Lymphoedema Versus Lipoedema

Lower Lymphoedema Lipoedema

Pre-Lymphatic Channels Usually Normal

Sex Commonly Female Always Female

Laterality Uni- or Bilateral Bilateral

Symmetry Unusual Yes

Skin Deposits Firm Soft

Skin Temperature Warm Cold

Edema Present Minimal

Pitting Common Rare

Pain on Pressure Varies Yes

Fragility of Blood Vessels Rare Typical

Foot Involved Spared

Cellulitis Yes Rare

Response to Bandaging Tolerated Not Tolerated

but not in bed

Symptoms Treatment • Biker Shorts or Control Briefs


are also good to use during
• Sufferers complain of heavy • Surgery involving Liposuction
the day
legs. is highly controversial as with
sclerosing injections as this • Manuel Lymphatic Drainage
• They find it hard to tolerate
may cause Secondary Lym- Therapy is the most com-
compression garments associ-
phoedema monly used technique and
ated with conventional lym-
mapping is normal in pure
phoedema treatment because • Dieting for weight loss is un-
Lipoedema. MLD is also an
the underlying lipoedemic fat warranted for these patients
anti-spasmodic which makes
is very painful.
• Light physical exercise is nec- it the perfect treatment for
• Palpation is painful essary to avoid recurring these patients who may have
blood infections, fibrosis and some muscular trouble as well.
• Bruising is easy because of Please note that MLD
developing morbid obesity
the fragility of vascular walls should not be longer than
making them immobile
a 1 hour session in any 1
• Spider or Varicose Veins usu-
• Class 2 or 3 stockings are to day.
ally come hand in hand
be worn during the day and a
compression garment at night • Some Herbs such as Horse

Bodywork e-News 28
Lipoedema
chestnut help with aching legs early, which currently is rare, it Therapy An Osteopathic Lym-
and support of the Venous is possible to prevent a signifi- phatic Technique 2nd Edition by
System cant expansion of fat cells and Bruno Chickly.
alert patients to their heightened
• No remedial, trigger
risk for obesity, if they become
point or deep tissue mas-
progressively less mobile, so they Kristin Osborn Dip. R.M., Dip.
sage is to be performed on
can take appropriate action. M.Sc., T.A.A., Lymphologist, Cli-
the limb/s of any patient with
nician, Writer, Member Austral-
Lipoedema or Lymphoedema These patients often sit in other
asian Lymphology Association
as this could result in increas- categories of Obesity, Eating
& Lymphoedma Association of
ing the initial problem and Disorders, and Depression due
Victoria. Newcastle Lymphoe-
risk of developing clots. to lack of proper diagnosis.
dema Clinic, 28 Cathrine Street,
These patients come to me often
Patient Precautions Kotara South, NSW 2289, Ph.
confused about their condition;
(02) 49207010.
• Keep skin moisturized exclud- they develop low self esteem and
ing products containing Min- are generally depressed as to the
eral Oils and Lanolin lack of answers they seek.

• Use Antiseptic on any cuts or The true term Lipoedema is ac-


bites tually incorrect because in sim-
ple cases, true edema is absent.
• Keep toes dry In advanced stages of develop-
ment, Lipoedematous tissue may
• Use an anti-fungal powder on
sometimes develop true edema.
toes
The resulting condition is called
• Do not overheat or get sun Lipo-Lymphoedema. The edema
burnt on legs associated with Lipoedema has
no pitting and there is no rise in
• Don’t overload on proteins
temperature.
and avoid food containing
saturated fats There is no cure for Lipoedema,
so early diagnosis and education
• Keep hydrated
to pre-pubescent females and
• Elevate limbs regularly GP’s is crucial. Empowering
these women with knowledge
• Shave legs with an electric and understanding of their dis-
razor to avoid cuts ease enables them to manage
their problem more easily, gain
self confidence and live a rea-
Conclusions sonably normal life. I am cur-
rently trying to organize public
Lipoedema is often confused
seminars for education purposes
with obesity and patients are in-
in this field for awareness and
formed to diet and exercise
understanding of this disease.
which often leads to an increase
in the problem. Resources: Silent Waves Theory
and Practice of Lymph Drainage
If Lipoedema was diagnosed
Bodywork e-News 29
If you like this map, we sell a poster version 46 cm x 40 cm. If you don't need it so big, just print the above picture
on your printer with some nice photo paper!

Bodywork e-News 30
Stretching for
Plantar Fasciitis
Chronic plantar heel pain while, e.g. sitting. After inactivity tion, patients have about a 75
(CPHP) is one of the most com- and when they start to walk percent chance of needing no
mon conditions affecting the foot. again they get the pain. When it further treatment.
CPHP has become a generalised becomes more of a chronic prob-
term encompassing a broad lem it's going on for months, The study is a two-year follow-
spectrum of conditions affecting typically start to have pain when up on 82 patients with plantar
the heel, including subcalcaneal standing and at the end of the fasciitis, all of whom were part of
bursitis, neuritis, plantar fasciitis day it becomes worse. an original clinical trial of 101
and subcalcaneal spur, usually patients in 2003. The patients
the true pathology is unclear. A heel spur is often seen in those were taught a stretch that spe-
suffering from plantar fasciitis. cifically targets the plantar fascia.
However, plantar fasciitis is con- It consists of a thin spike of cal-
sidered to be the most common cification, which lies within the The stretch requires patients to
cause of pain and the terms are plantar fascia at the point of its sit with one leg crossed over the
used interchangeably in the lit- attachment to the calcaneus, or other, and stretch the arch of the
erature. CHCP has been reported heel bone. While this condition foot by taking one hand and
to account for 15% of all adult is commonly present in plantar pulling the toes back toward the
foot complaints requiring profes- fasciitis, heel spur is not causing shin for a count of 10. The exer-
sional care. It is usually observed the problem, it's the micro tear- cise must be repeated 10 times,
in the 40 to 60 year old age ing of the plantar fascia. and performed at least three
bracket, but has been reported in times a day, including before
people from 7 to 85 years and A study conducted at LaTrobe taking the first step in the morn-
appears to be more common in University showed the people ing and before standing after a
females. Symptoms typically in- with CPHP had significantly prolonged period of sitting. More
clude pain under the medial heel greater Body Mass Index, a more than 90 percent of the patients
during weight bearing, especially pronated foot posture and were totally satisfied or satisfied
in the morning and at the begin- greater ankle dorsiflexion ROM. with minor reservations, and
ning of weight-bearing activities. The authors concluded that peo- noted distinct decrease in pain
ple with CPHP were more likely and activity limitations.
Plantar fasciitis occurs when the to be obese and to have a pro-
plantar fascia, the flat band of nated foot posture.
tissue that connects your heel
bone to your toes, is strained, A study in the U.S. led by Dr.
causing weakness, inflammation Ben DiGiovanni from University
and irritation. Plantar fasciitis of Rochester suggest that a plan-
can be a frustrating experience, tar fascia-specific stretching ex-
as the chronic cycle of re-injury ercise is proving quite effective
and pain can last for up to one to help treat and potentially cure
year. plantar fasciitis. The study pub-
lished in Journal of Bone and
The classic symptom is the first Joint Surgery, found that pa-
step in the morning pain, when tients suffering from the painful
a patient stands in the morning heel spur syndrome had a 75
and has severe heel pain, there's percent chance of having no pain
a high chance it's plantar fasciitis. and returning to full activity
Heel pain can also occur when a within three to six months of
patient is off their feet for a performing the stretch. In addi-

Bodywork e-News 31
Plantar Fasciitis
Most physicians will recommend The Journal of Bone and Joint
a non-surgical approach to treat- Surgery, 2006;88(8):1775-1781.
ing plantar fasciitis, advising
anti-inflammatory, foot inserts Irving, DB, Cook, JL, Young,
and stretches. Surgery occurs in MA, Menz, HB. Obesity and Pro-
about five percent of all cases, nated Foot Type May Increase
and has a 50 percent success rate the Risk of Chronic Plantar Heel
of eliminating pain and allowing Pain: A Matched Case-Control
for full activity. Study. BMC Musculoskeletal
Disorders. July 2007.
“Plantar fasciitis is everywhere,
http://www.abc.net.au/rn/
but we really haven’t had a good healthreport/stories/2006/
handle on it,” said DiGiovanni. 1784908.htm
“The condition often causes
chronic symptoms and typically http://www.urmc.rochester.edu/pr/
news/story.cfm?id=1275
takes about nine to 10 months to References
burn itself out, and for people
experiencing this pain, that’s DiGiovanni BF et al. Plantar Fas-
way too long to suffer through cia-Specific Stretching Exercise
it.” Improves Outcomes in Patients
with Chronic Plantar Fasciitis.

Thumbsavers(R) is an effective tool that assists therapists by providing support and reducing the stress on
your joints and wrists from deeper tissue massages, while protecting your most valuable commodity: your
thumbs & hands! Thumbsavers is so unique that it cannot be called a "tool" because your thumbs and fingers
are actually inside them. Has been used by many Therapists in Australia with great results.

Thumbsavers can be used for: Trigger Point therapy, Deep tissue massage/ neuromuscular therapy, Chair
Massage, Acupressure, Shiatsu, Thai Massage, Reflexology, Equine Massage.

With Thumbsavers, you can: Massage deeper and work longer, Reduce fatigue and joint Pain, Reduce carpal
tunnel syndrome, Alleviate wrist, thumb and joint fatigue and pain.

Available at: www.terrarosa.com.au

Bodywork e-News 32
Rwo
Rwo--Shur
Chinese Foot Reflexology
On 1st July 2008, 1008 reflex- leaving the church follow-
ologists set a new Guinness ing mass, he looked unin-
World Record in Taiwan for hav- terested in my sermon and com-
ing the “most people receiving plained of a headache. "I
foot massage (reflexology) si- grabbed his feet, saying, please
multaneously.” give me five minutes”, Fr. Josef
said. "I showed him, here is a
The record was organised by Tai-
reflex area for your headache
wan Tourism Bureau to promote
"the cross you have to carry." A and began massaging it for him."
health tourism. Reflexology is a
fellow missionary Brother Law- Fr. Josef found his new method
popular practice in Taiwan for
rence massaged his foot and of preaching. Unlike other West-
relaxation and improving gen-
gave him a reflexology treatment. ern priests, who often bring rice
eral health; the activity is gaining
Few treatments and his arthritis or flour to remote villages, Fa-
popularity among foreign tour-
pain was reduced. He was then ther Josef brings his hands.
ists in recent years.
given a book on foot reflexology
Though he worked quietly and
It is known that Traditional Chi- "Good Health for the Future," by
locally, word of his success
nese Medicine includes foot re- Swiss nurse Hedi Masafret.
spread. Eventually he taught
flexology from about 2000 years When he first used reflexology
what he knew to 10 Taiwanese
ago, but do you know that Chi- on himself he could barely stand
people, who helped him give re-
nese foot reflexology only comes the pain, but he kept at it.
flexology sessions. Ninety per-
to light in the 1980s and is intro- Within two weeks, to his amaze-
cent of the people came to the
duced by a Swiss Priest? Foot ment, the arthritis disappeared,
church just for their health prob-
reflexology was not really prac- never to return.
lems, only 10 percent were inter-
ticed and virtually unknown in
Soon after his own healing, Fr. ested in the spiritual. But he
Taiwan and South East Asia un-
Josef offered to work on parish- never gives up hope.
til the 1980s.
ioners with chronic diseases,
A drama unfolded when, in 1981,
It began in 1977 when Father people on whom doctors had
a woman with hyperthyroidism,
Josef Eugster, who goes by the given up. When an old man was
signified by her bulging eyes,
Chinese name Wu Ro-shih (吳若 came to him. After receiving
石), from the Swiss village of daily sessions for two weeks, her
Berneck came to Taiwan's east eyes slowly moved back into
coast town of Taitung, where their cavities. After three weeks,
people pray in shrines and hold she had recovered. The woman
ceremonies by the sea. He was was Li Wen, a well-known Taipei
suffering from severe rheuma- broadcaster, and she taped a ra-
toid arthritis in his knees. Medi- dio interview with Fr. Josef,
cine was of no help, and his phy- which led to a television inter-
sicians piously told him, a young view. The programs received a
man of 37, that the disease was tremendous response in Taiwan,

Bodywork e-News 33
Rwo
Rwo--Shur

own health. "This must be taken


seriously," he says. "We can only
do as much work for others as
the amount of good health we
and soon thousands of people public, angry with the govern- are in." Secondly, he decided
were streaming into Fr. Josef’s ment for banning reflexology, that the future of reflexology in
small parish near Taitung, lo- poured into the offices of the Taiwan would be best served by
cated in the southern part of the president and vice president of placing his work into the hands
country. There are often even Taiwan. The controversy came to of others. He turned to his
hundreds of people lined up at somewhat of a conclusion when "adoptive" brothers, Josef and
the door of the church at mid- Fr. Josef was invited to speak to Thonet Tschen to establish the
night. One time, he was too ex- the vice president in Taipei and International Institute for Rwo
hausted from doing massage and explain what was going on. With Shur Health in April 1982. Re-
fell ill with nephritis. I was hos- the reluctant cooperation of the flexology theory is then com-
pitalized and couldn't do any health minister, Fr. Josef was bined with Chinese medicine's
massage, so I asked them to go subsequently allowed to con- five-elements concept. Gradually,
to the beach to find pebbles to tinue his work in a hospital set- Fr. Josef’s technique has become
step on. This became the origin ting for two years, not as an en- widely known in Asia as the Rwo
of "pebble paths" meandering dorsement of reflexology but as a Shur Health Method or Fr.
through many of Taiwan's parks. way to contain it. Josef’s reflexology. The Rwo-
Shur technique is now practiced
Fame has brought its share of
At about the same time, the in Singapore, Malaysia, Japan,
trouble. In 1980, people abusing
Church was also pressuring Fr. South Korea, Indonesia, and
his name began prescribing
Josef to stop, saying that reflex- Mainland China.
medicine. His taxes were
ology was not his proper work.
checked and the Department of There are more than 1,000 foot
Though he firmly believed that
Health charged him with practic- massage parlors in Taiwan, Fr.
he was simply doing what Jesus
ing medicine without a doctor's Josef estimates that 20 percent
did in helping people, the strain
certificate. "I even received calls of Taiwan's population receives
was great. He finally took a leave
threatening to kill me," he said. reflexology sessions regularly.
of absence, resting, praying and
During this intense period, still meditating at a Benedictine con- So what is the difference with
in 1981, he and his workers were vent in Israel. There, he came to Western Reflexology? According
forced to quit their practice. some important realizations. to Fr. Josef, reflexology theory
Thousands of letters from the One was that every reflexologist divides the foot into 26 bones
must first take care of his or her
Bodywork e-News 34
Rwo
Rwo--Shur
and five major re- ond phalanges joint to "rub" and
flex areas. To mas- stimulate the reflex point. Some-
sage the foot is to times it can be very aggressive
stimulate the prob- and painful (as with other Chi-
lematic organs or nese bodyworks). The treatment
push away the generally starts with a warm foot
pathological sedi- bath, dipping your foot in a warm
ments. water with salt. Then the pain be- Fr. Josef Eugster in the 1980s
gins, with rigorous reflex points
The reflex point is
Fr. Josef Eugster stimulated from the base, side, flexology Throughout Asia ... And
mainly the same
front and lower part of the legs. Beyond. Massage Magazine, Issue
with the Western chart, but there
Then finishes with warm towel 93, September/October 2001.
maybe few extra or different
wrapping over the feet.
points (see chart). Chinese Re- Taipei Times. Sep 15, 2002.
flexology is more dynamic, rigor- References
ous, and painful. The therapist
Kathryn Treece. Soul Work. How
used their knuckles and the sec-
A Swiss Priest Popularized Re-

Check out our Reflexology Collection


www.terrarosa.com.au/reflexology

Bodywork e-News 35
The Passivattiva Technique
for the Legs
by Maurizio Ronchi
Editor’s note: The following article is from our fellow and experiences contributed to the development of my
bodyworker from Italy, Mau. Mau has developed the methodology.
passivattiva technique, a type of myofascial release
with application in sports bodywork. This is a rough e- Basically I want to explain how this technique engaging
translation of the original article in Italian. Sorry for active movement by the client with stretching, twisting
the bad English. But I think you will get the idea, Mau and muscle contraction for releasing myofascial adhe-
has kindly shared a range of techniques. If you can sions.
speak Italian, you can view the complete article here: TREATMENT IN SPORTS MASSAGE
http://massaggiosport-bodyworks.spaces.live.com/
The passivattiva myofascial release technique helps to
restore the proper glide between various tissues and
INTRODUCTION thus mobility of joints. This technique, in some cases, is
combined with cross fiber friction or the Cyriax tech-
In this article, I will try to explain how the passivattiva nique.
technique applied in sports massage as an effective
method for releasing fascial adhesions, which can im- When collagen fibers are subjected to trauma, or stress
prove the biomechanics of the body and optimize per- overload, they tend to thicken and become even more
formance in sports. This work is the result of my long random and disorder. It will start to form adhesiveness
experience as an instructor, physical trainer and body- and subsequent retraction of myofascial-linking the
worker for various sports groups. normal dynamic muscle / joints – and limited Range of
First, a clarification: I am neither a medical practitioner Motion.
nor a physiotherapist, but a technical researcher in this All manual bodywork techniques shown in this article
field. This is due to my training in chemical analysis required an active participation by the athlete. Athlete
with experience in biochemistry, trying to identify and involved in active participation in moving, stretching,
understand some of the physiological phenomena that applying torque, contracting, relaxing the muscle or
occur in the myofascial fabric during the application of body parts while the therapist sustain, hold, moves pas-
massage techniques. sively the same
For all these years I had the good fortune to work with muscle or body
biologists, doctors and sports physiotherapists as a part. This is essen-
source of my education, which I continue to revise and / tial to get the best
or develop new techniques for specific sports and ath- treatment result.
letes, or as we called it "Sports-bodyworks".
The passivattiva
To validate the passivattiva technique, a methodology technique can
which I developed for the separation of fascial adhesion, change the visco-
I refer to an excellent study by Robert Schleip, with par- elasticity of the
ticular reference to his article "Fascial plasticity - a new myofascial tissue
neurobiological explanation" where I found a significant (collagen). This
explanation of the biomechanical and biochemical not only due to the
mechanisms involved in the tissue when applying the physical mechan-
passivattiva technique. ics, but also due to
the effects the re-
I want to acknowledge Art Riggs, a highly respected
sponse of stimula-
bodyworker, thanks to his fruitful exchange of views
tion performed on

Bodywork e-News 36
Passivattiva
mechanoreceptors: corpuscles and Golgi bodies, and nique reduces the time needed to free the adhesions and
Ruffini Pacini. maintain this new state of freedom longer.

We won’t go into too much detail (I recommend reading The following picture shows performing an initial sepa-
the work by Robert Schleip), but it is clear how impor- ration, each muscle is treated with manual twist and roll
tant to respect this kinetic separation condition during for further separation of muscle-fascia-muscle, high-
myofascial release, more so on the basis of we got posi- lighting the degree of release from adhesions.
tive results using this technique. From my experience, Before moving to read the techniques, it is good to re-
techniques that include passivattiva with manual sepa- member that once chronic adhesions in a muscle, that
ration of adjacent muscles during the sports massage, doesn’t allow a proper ROM, for a more effective treat-
will provide great help to athletes to achieve good ath- ment, we must also treat other muscles in the myofas-
letics performance. cial chain.

The passivattiva technique is very effective for the types It is worth a while
of muscle spindle or elongated form with a small belly in working exclu-
and long tendons, which often experience stress because sively on a muscle,
of fascial restriction around the related bone structure, but bear in mind
or are subject to a rotation-tension along their axis be- the interaction it
cause of adhesions with adjacent muscles or the within carries in relation
itself. In addition on working the muscles, it is also es- to the fascia and
sential to work on the tendons to break the fibrous ad- its kinetic chain.
hesions. Fascia wrap and
fill all areas of the
"Even before the symptoms appear in troubled tendoni- muscle, both in bundles fibrils and in sheets, fascia tend
tis, collagen tends to degenerate initiating a local in- to shorten in these hotspots - critical points - causing
flammation. The friction massage on tendon-sheath the well-known problems of mobility in myofascial ar-
plays an important role on the preventive work of in- ticulation.
flammation caused by excessive workload or fibrous
sheath, because it stimulates the reproduction of colla- So to perform a work on functional separation , it is nec-
gen to replace the degraded by arranging orderly. So essary to relax as much as possible the muscle taut, con-
massage with its specific technical manuals for the sepa- tract or tighten, so that the fascial adhesion can be effec-
ration of fibrous adhesions between muscle-fascia- tively removed or relaxed. In the event of excessive
tendon is a good way for the prevention of accidents muscle tension, it is good to try to reduce this by treat-
and benefits to the sports" (Whitney Lowe). ing first the whole myofascial chain, with the intent to
induce a better relax. Then we can treat the muscle
"... A well-stretched muscle is able to perform the more easily.
broader movement with less stress on its joints. Mobil-
ity studies confirm that perform stretching exercises at For example if you want to treat thigh muscle Biceps
the end of the workout accelerates the recovery ..." (M. Femoris, test its entire fascial chain, or by starting with
Scuderi, massage therapist). the lower muscles Peroneus, Gastrocnemius and Soleus,
"Moreover, these adhesions carrying both lateral trac- then the Biceps Femoris, sacral ligaments, Erector Spi-
tion forces, destabilize the associated fascial compart- nae, occipitals and the whole chain on this path.
ment, which forces to establish a self muscles -torsion
around its own axis " (Art Riggs). Or in the case of Tensor of Fascia Lata, begin testing the
Tibialis muscle, the TFL, the interior Oblique, and be-
PRINCIPLES OF THE PASSIVATTIVA TECH- cause in this case, the chain is a spiral, we will continue
NIQUE the external Oblique and then go back and towards the
The technique consists of one hand moving, stretching Serratus, Romboids, and ending with the Levator Scap-
the body part, while the other statically holding the ula and Splenius, including the fascia around it. Per-
muscles. Through specific positions, with a little help sonally I follow the myofascial chains from Tom Myers’
from the movement by the athlete, the passivattiva tech- Anatomy Trains.

Bodywork e-News 37
Passivattiva
We will see in detail how to perform such maneuvers. tion should be performed on hypertonia, tight or tense
The key point is to get a cooperation from the athlete, muscle. All movements of the body are made for agree-
making aware of the techniques that you are using, ex- ment of muscle co-activation, or synchronicity between
plaining the purpose and the expected results. As you opposing muscle groups during the contraction-
know, the more it lowers the stiffness or muscle tension, relaxation-stretch, the penalty of static body, not mov-
will enter more in sync with the athlete and the more ing. So the activation of a muscle - agonist - follows a
effective passivattiva technique will be. relaxation of the muscle opposite - antagonist - which
can stretch more. Carryover the classic example, used in
All manual separation and stretching should be per- the elongation method of PNF - Proprioceptive Neuro-
formed very slowly, and can be stopped for any reason. muscular Facilitation - how to facilitate the stretching of
This is because, when we are working deeply on myofas- the rear thigh muscles, it requires the help by athlete
cial contractures, adhesions and fibrosis, we must al- that must first take the Quadriceps muscle, which in-
ways have control of the situation, pointing out that you nervations result in a mutual relaxation of Hamstring so
are not just smearing oil to the body but working with it can be easily stretched.
pressure to release the muscles and tendons.
The ultimate purpose of the passivattiva technique is to
Based on this consideration, it is better not to put too have a muscle biomechanically freer in its ROM and
much lubrication to the area with oil or creams so we have rebalanced forces related stabilization of the ar-
can keep a good control. As Art Riggs said, if we wanted ticulation.
to unscrew the cap of a jar of marmalade with your
hands full of oil, you can do that, but ... how much en- We can say that the classic myofascial release as a static
ergy you would waste to unscrew the lid! That is also camera, while the passivattiva technique is a dynamic
translated against athlete; you can also cause excessive camera - now we shall see in detail.
pain for nothing, while the therapist wastes lots of en-
ergy and an excessive load on the joints of the fingers. THE PASSIVATTIVA TECHNIQUE

Now in order to enter passivattiva technique, let me The first step in passivattiva technique is to warm-up
first explain the concept with an example: imagine hav- the area to be treated, or to get a good warm-up for the
ing to shoot an object with a camera and try to be as fascia, thereby exploiting its thixotropic properties
clear as possible and recognizable from the background. (viscosity reduction induced by mechanical action) to
To get a good detail, we take the picture from different obtain the first instance of the first issue of work the
angles, the more points of view, the more precise will be depths. So you start with light touch with the palm of
the resolution and the end result is a very good picture the hand or forearm to the area. This manual, working
after considering many angles. If instead we use a video in the development of muscular strength, is not separa-
camera, the shooting on the move - kinetic - around, tion but to prepare for it since it stretches, and flattens
above and below the item will be even more detailed the fascial "wrinkles" and in order for the longitudinal
and more comprehensive, or the best resolution of de- fibers of collagen that have been tangled while shorten-
tail and emphasis on the subject . ing, make adjustment following a state of mechanical
stress.
An example by relating to passivattiva technical, the
therapist who passively supports the motion and muscle This initial phase of myofascial release, is characterized
activation by athlete, can work the muscle and fascia by slowness and gentle pressure applied, the therapist is
adjacent to almost 360 degrees, while they stretch, relax testing the area of the body of the athlete in order to
and contract. Thus, particularly the muscles, to be able gain as much information and formulate what is best
to have movement during all the various changes and target for the continuation of treatment.
position will provide a great benefit to the morphologi-
cal structure. As Erik Dalton said "palpation is an art to obtain infor-
All this is made even more effective since it will use the mation."
mechanism of “mutual innervations “ between agonist- The surface stroke at the beginning of treatment, you
antagonist muscles, especially when the work of separa- warm-up, soften and release the muscles, they also di-

Bodywork e-News 38
Passivattiva
rectly become the primary source of information. This It seems even
slow pace and accuracy in work allows our sensors and clearer now why
skin – tactile mechanoceptors - to be in the best condi- we must main-
tion of sensitivity to detect and we know the condition tain a certain
fascial of the athletes. In doing so, the therapist will get slowness in the
lots of the information useful to develop the most effec- implementation
tive strategy to be executed on the athlete. It would be of these deep
frustrated if the technique was applied quickly and too techniques.
sharp. Speed reduces
our tactile sensi-
To complete the image information, please note that tivity, and it is also difficult to immediately stop the
each muscle is part of a joint compartment, and there- stroke in case of problems and, can be quite unpleasant.
fore is useful to test the ROM, which is active-passive, to
highlight any restriction, pain or anything physiological, TOOLS
caused by adhesions and muscle tension induced by the To release adhesions between the muscle to muscle and
same or adjacent muscles. After the manual stroke of muscle to fascia, you can use different tools, depending
the muscles you run the deep stripping strokes, in order on the type of work or the anatomical structure of mus-
to begin to break or release the superficial fascial adhe- cles to be treated. Here are some examples of those
sions. This technique is more of a "friction" than a deep most used. Note once again as for greater effectiveness
stroke, a kind of short duration intense passive stretch- of the passivattiva technique you always start with the
ing. manual of stroke for warming-up and the need for tac-
tile perception by the therapist for understanding the
From this moment onwards, we will apply main pres- real body -muscles- situations.
sure stroke, it is essential that all the techniques of sepa-
ration of deep myofascial run with the tension or -
stretch - or twist - spin stretch - or through a contrac-
tion of various muscles.
This condition is applied both by
passively, that the athlete that acti-
vates isometric muscle contraction.

This is essential for two reasons: the Fig.11 shows strokes using the palm of the hand and
first is to lengthen the muscle fibers forearm.
and fascial bundles towards the
physiologically muscle line forces;
the second is for prevention, the use
heavy deep pressure on the myo-
tendon belly when isn’t contracting,
not only can be painful but also harmful for the athlete.
So as I described for greater effectiveness of the pas-
sivattiva technique, according to the structure and ana-
tomical location of the muscle to handle, not to restrict
the work of separation to a fixed position or static, but
apply the work while the muscle is activated by a grad- Thumbs, fingers and knuckles are generally excellent
ual contraction movement or by stretching. tool for separation of tendons, as in this case by the ex-
tensors tendon of the toes. You run a deep curvilinear
In the case that for some reasons we can not apply the “smiley” technique. This technique is very effective for
technique dynamically, e.g. biomechanical impediment athletes who wear narrow shoes (sprinters, football
or pain, treat muscle by varying as much as possible the players, skaters, climbers etc.).
angle of the associated joint.
The use of knuckles need to increase the pressure or

Bodywork e-News 39
Passivattiva
In fig.16 we show the use of the thumbs and elbow for
separation of hamstring muscles, and finalized by the
roll and twist technique to the Biceps femoris.

Once a good position myofascial release with emphasis


on muscle, you proceed with the deep transverse fric-
force with respect to the fingers and thumbs when re- tion for large muscle mass in order to realign muscle
quired, saving its overload. For example the Tibialis- fibers and fascia in line of force. (fig.17)
Peroneus treatment (fig.14) if needed a deep work is
much better (last picture) to use knuckles for saving
your fingers from excessive stress on the joints and pha-
langes.

The use of forearm, fist or elbow is necessary for some


type of anatomical muscles or when you need to run a
deep, that is not painful, but more effective and decisive
- not in a rush.
The purpose of the twist & roll technique, preferably to
the medium / small size muscles, is to highlight the
muscle throughout its length: its origin, belly-listing
myotendon and periosteum as the anatomical structure
allows us to run (fig.18).

In fig.15, we see a passivattiva technique for separating


the Iliotibial band from Fascia Lata and Vastus Lateralis.
The use of fist and forearm for stripping, followed by
separation with the use of the elbow and finally empha- This type of work is needed, in addition to the realign-
size the TFL with twist & roll, a series of twists-turns- ment of myofascial fibers, to release the muscle from
elevation-friction to mobilize all single released from deep adhesions so that they can be free to glide between
muscle tension and adhesions. the tissues layers and bones, completing the initial
For the best effectiveness in achieving the purpose of warm-up. This is the real goal of passivattiva technique:
the manual of separation, it is even more important to to restore the myofascial imbalances and reach the pos-
put an image the action of myofascial release, the fin- sible full ROM, for let to athlete the best sports per-
gers, the knuckles or other exercise tools on the edges of formance.
the muscle or Fascial area that we are dealing with.

Bodywork e-News 40
Techniques for the Lower Extremities
TECHNIQUES FOR THE LOWER EX-
TREMITIES

The following are some examples of techniques for the


separation of muscles of the lower extremities.

Separation for the Anterior Tibialis and Peroneus from


Gastrocnemius. This technique must be performed with
the therapist passively pressing on the leg while the ath-
lete maintains a slight push isometric against the thera-
pist as to stretch the leg.

Stripping of Tibialis-Peroneus muscles for a first break


of adhesions with the superficial subcutaneous fascia,
the athlete keeps the limb in slight abduction by push-
ing the knee against the outside of his hand.

Fingers for releasing the adhesion between lateral and


medial Gastrocnemius muscle, and Soleus, then freeing
the Peroneus tendons. Run the manual to different an-
gles of knee and a slight foot dorsiflexion hold by athlete.

A different position for the stripping the Tibial and Per-


oneus muscles. The athlete applies a slight isometric
contraction by pushing against the therapist.

This technique is required for myofascial retractions


that inhibit the related joint. That explain the reason we
are going to extend a shortening hypertonia against the
direction of myofascial narrowing, so beside obtaining a
release of fibrous adhesions, it is also stretching the
muscle articulation, relieving it from excessive tension/
traction often due to postural imbalances.

Stages of releasing surfaces myofascial adhesion, a


thumb is separating the two muscle bellies of Gas-
trocnemius , while fingers are releasing it from the So-
leus. Note the excursion of the athlete leg which can be
either passive or active.

Bodywork e-News 41
Techniques for the Legs

Separation with the thumb for muscles Gastrocnemius


lateral and medial, with the leg in motion. Run or take Stripping technique with the fist for the surface adhe-
up to the dorsi foot flexion and plantar foot flexion. sions of Gastrocnemius and Peroneus. Therapist on a
passive mode while the athlete actively stretching.

Deep muscle release for Gastrocnemius with the elbow.


All these examples for calf muscles show the choice of Twist & Roll technique to stretch the Achilles tendon sheath.
using the best tools to adapt to different types of struc-
ture and muscle mass which may different from one
athlete to the other. Twist & Roll technique
for Gastrocnemius ten-
don. Ask the athlete to
press down lightly to-
wards the ball.

Stroke with the forearm for warming up, required for a


change after achieve viscoelasticity and “ironing” the
fascial wrinkles responsible for shortening and rigidity -
stiffness - the Gastrocnemius-Soleus

Stroke for warming and stretching the Quadriceps and ad-


ductor muscles. Ask for a minimum active contraction.

Following on, with thumbs release/separation. Use dif-


ferent knee angles.

Bodywork e-News 42
Techniques for the Legs

The stroke becomes more vigorous using fist for stripping


the ITB. Therapist can modulate the pressure by support-
ing the own body weight.

Stages of separation for muscle Rectus Femoris from other


adjacent Quadriceps muscles, moving the leg in passivat-
tiva mode. Is clearly evident here the kinetic contribution
given by athlete.

Stripping the ITB by varying the leg position.

Separation of Rectus femoris from other muscles of the


Quadriceps. Light muscle activation while the athlete
pushes towards the therapist’s hand.

Using the elbow for the separation of ITB from Vastus Lat-
eralis muscle, with different leg positions and always in
passivattiva mode.

Cross muscle friction for the realignment of fibers bundles


of the Quadriceps bellies. Athlete maintains a slight iso-
metric contraction pushing the ball. Change the hip open-
ing angle.

ITB release from subcutaneous connective tissue.


Various leg positions for stroke technique for Tensor Fas-
cia Lata and Iliotibial tract.

Bodywork e-News 43
Techniques for the Legs

Stroke with stabilizing the pelvic. Initial separation of


the Adductor muscles from subcutaneous fascia.

Forearm stroke for Hamstring muscles, stripping tech-


nique while therapist and athlete moving the leg, in ac-
cordance with passivattiva technique.

Another techniques for the separation of the Adductor


muscles using the forearm and the palm of the hand,
changing the knee and hip angle, and asking to athlete
to hold a slight adduction by the leg. In case of excessive
pelvic rotation, stabilize it with the hand.

Hamstring separation/release with the palm of hand


holding the thigh while the knee is moved internal-
external rotation.

Treatment for the Adductor muscles with thumbs and


fingers, elbow for deeper release if required. In the last
picture, the twist & roll technique.

Twist & roll technique for Hamstring release from sub-


cutaneous connective tissue, with varying the hip angles.

Twist & roll technique for the Adductor muscles, the


therapist moves the leg forward and back supported by
his pelvis, or asking the athlete to hold a slight contrac-
tion by pushing the foot against the therapist ‘s pelvis.

Bodywork e-News 44
Techniques for the Legs

Maurizio Ronchi is a bodyworker, sports athlete, and instruc-


tor. He is 47 years old, and enjoys extreme sports: 100 m
First adhesion release for Hamstring. Ask the athlete to track and long jump, basketball, judo, and climbing. He is a
slightly push the leg against the therapist’s shoulder. track and field instructor since 1979, and climbing instructor
since 1992. He is an instructor in wellness massage at AS-
SOTIB school since 2005. Co-teacher in sports massage at
ASSOTIB school since 2006. Sports bodyworker for Vedano
Soccer and Seregno Rugby. In the last 25 years, he has
worked with athletes in various sports. He lived in Monza,
northern Italy. You can contact him at: ik2yxk@libero.it, or
visit his blog (in Italian): http://massaggiosport-
bodyworks.spaces.live.com/

Athlete holding the leg, and therapist performing a deep


Hamstring separation.

Several
techniques
for hip
external
rotators.

Bodywork e-News 45
Research Highlight
Alexander Technique In addition, patients receiving Division of General Internal
Alexander technique lessons re- Medicine at the University of
offers long-term relief ported improved quality of life. Colorado Denver School of
for back pain Medicine. "This study is impor-
Interestingly, six one-to-one les- tant because it shows massage is
Alexander technique lessons in sons in the Alexander technique a safe and effective way to pro-
combination with an exercise followed by exercise had nearly vide immediate relief to patients
programme offer long-term ef- as much benefit (72%) as 24 les- with advanced cancer."
fective treatment for chronic sons in the Alexander technique
back pain, according to a study alone. Pain and depressed mood are
published on the British Medical common problems for patients
Journal. The researchers conclude that: with advanced cancer. While
“Massage is helpful in the short drug therapies can reduce symp-
A team of researchers from the term…[but] the Alexander tech- toms, they don't always work
University of Southampton and nique retained effectiveness at and often have troublesome side
the University of Bristol com- one year…the results should ap- effects. Researchers think that
pared the effectiveness of mas- ply to most patients with chronic massage may interrupt the cycle
sage, exercise and the Alexander or recurrent back pain.” of distress, offering brief physi-
technique for the relief of back cal and psychological benefits.
pain over one year. Physically, massage may de-
Massage therapy im- crease inflammation and edema,
Professor Little and colleagues proves pain and mood increase blood and lymphatic
recruited 579 patients with for advanced cancer pa- circulation, and relax muscle
chronic or recurrent back pain tients spasms. Psychologically, mas-
from 64 general practices in the sage may promote relaxation,
south and west of England. Pa- release endorphins, and create a
A new study from the National
tients were randomised to re- positive experience that distracts
Institutes of Health finds that
ceive normal care, massage, six temporarily from pain and de-
massage therapy may have im-
Alexander technique lessons, or pression.
mediate benefits on pain and
24 Alexander technique lessons. mood among patients with ad-
Half of the patients from each of vanced cancer. The study ap- Researchers caution that while
the groups were also prescribed pears in the September 16, 2008 massage may offer some imme-
an exercise programme (brisk issue of Annals of Internal Medi- diate relief for patients with ad-
walking for 30 minutes per day cine. vanced cancer, the effects do not
five times a week). last over time, demonstrating the
need for more effective strategies
In a randomized trial of 380 ad-
After one year of Alexander tech- to manage pain at the end of life.
vanced cancer patients at 15 U.S.
nique lessons, patients reported hospices, improvement in pain
fewer days with back pain over and mood immediately following
the past four weeks. Patients re- treatment was greater with mas-
ceiving normal care reported 21 sage than with simple touch.
days of back pain, compared to
those who received 24 lessons of
"When patients near the end of
Alexander technique who experi-
life, the goals of medical care
enced 18 fewer days of pain.
change from trying to cure dis-
Those who had six lessons re-
ease to making the patient as
ported 10 fewer days of pain and
comfortable as possible," said
those having massage said they
Jean S. Kutner, MD, MSPH, As-
had seven fewer days of pain.
sociate Professor of Medicine,

Bodywork e-News 46
6 Questions to Whitney Lowe
1. When and how did you decide to become a Whitney Lowe has been a mas-
bodyworker? sage educator for over 17 years.
He is the author of the book,
I was in graduate school studying psychology and get- Orthopedic Massage: Theory
ting kind of burned out at it. I was introduced to mas- and Technique. He researches
sage and thought it would be a great way to integrate and authors articles on pain
with some of the things. I was learning and help me pay and injury assessment tech-
my way through the rest of graduate school. However, I niques in numerous publica-
got so interested in the field, I never went back to finish tions.. Whitney is frequently a
my graduate program and have been in massage ever featured author in Massage
since. Magazine, Massage Today,
2. What do you find most exciting about body- Massage & Bodywork, and
work therapy? Journal of Bodywork and
Movement Therapies.
The incredible diversity of practitioners, perspectives,
and treatment strategies that are effective in gaining After years of clinical research and practice in the
great change for people. healthcare setting, Lowe developed his Orthopedic Mas-
sage approach for massage therapists who treat pain
3. What is your most favourite bodywork book? and injuries with massage therapy. Wanting to help
practitioners challenged with the demands of today's
I'd have to say it's a tie between Donald Neumann's
clients, Lowe spent years in research. His programs and
Kinesiology of the Musculoskeletal system and Andry
books demonstrate his dedication to research-based
Vleeming's Movement, Stability, & Lumbopelvic Pain.
approaches. See his website for more information
4. Which is the most challenging part of your http://www.omeri.com/
work?

Finding time to do all the fascinating things I am inter-


ested in.

5. What advise you can give to fresh massage


therapists who wish to make a career out of it?

Take care of yourself physically and emotionally and


make sure you continue learning. That's what helps
keep it fresh and interesting after many years.

6. How do you see the future of massage ther-


apy?

Growing in a wide variety of directions with spa work,


personal care massage, and the medical applications. I
think our great diversity is one of our wonderful
strengths as a profession.

Bodywork e-News 47
6 Questions to Diana Haynes
1. When and how did you decide to become a body- but expect it to take a 50% bite out of your paycheck. If you
worker? really want the rewards and challenges of running your own
business, get business training and find a good mentor. It
I took my first certification in 1972 but it wasn't until I got a takes incredible persistence, creativity and good planning to
job in a physical therapy office some years later that I really succeed at any business and massage is no different. I have
saw the power of massage to help people heal on multiple seen brand new practitioners succeed and more seasoned
levels. In that office, I worked 30 minute sessions 8 hours a therapists fail depending on their commitment to the busi-
day on patients with every type of injury, disability or disease. ness end of their business. Know what's right for you and
I discovered that massage dramatically improved their recov- then give it 100%
ery process, eased their pain and gave them a sense of em-
powerment in the journey of getting well. I was hooked and 6. How do you see the future of massage therapy?
started taking every advanced class I could find to further my
ability to help these patients. One of the things that I've always loved about massage ther-
apy is that it keeps evolving and has so many facets that
2. What do you find most exciting about bodywork there's literally something relevant to every body. In the 60's
therapy? massage exploded on the scene as an off shoot of the human
potential movement and was largely focused on overcoming
The fact that the gift can go so far beyond the technique that inhibitions and developing safe sensuality. In the 70's Gestalt
a person is applying. There is something so profound about therapy, Alexander technique, Rolfing and Deep Tissue
the simple act of caring, the honoring of our hurts that goes emerged and dominated the Esalen community. In the 80's
straight from the physical to our deepest spiritual need. Mas- more scientifically based modalities like Neuro-Muscular
sage can dissolve isolation as well as scar tissue and heal Technique, Muscle Energy Technique, CranioSacral, Myofas-
wounds that never left a mark. It's this psychospiritual di- cial Release and several other osteopathic spin offs became
mension that excites me most because it doesn't even require popular along with Reiki and purely energetic approaches to
words and yet can transform a person from the inside out. healing. While the scientific & structural techniques remain
strong, in the 90's I saw a blossoming of the Spa modalities -
3. What is your most favourite bodywork book?
lymphatic, hot stone massage, peels and wraps along with
There are so many it's really hard to choose. I'd have to ad- the more exotic Thai massage, Barefoot Shiatsu and Watsu.
mit the 2 books that I've used most often over the years
Today the massage schools are covering it all and more prac-
(other than anatomy texts) has been Ben Benjamin's "Listen
tices advertise a plethora of services. The challenge I see,
to your Pain" and "Functional Assessment in Massage Ther-
when you have a 1000 hours of training in multiple modali-
apy" by Whitney Lowe. These books helped me when clients
ties, is how to choose what's best for this client today. Unlike
described symptoms that I wasn't familiar with and wasn't
the Starbucks client, who can clearly order exactly what they
sure if they needed a referral or if I could help them. They're
want, we don't have a clientele that typically asks for mostly
both very user friendly and have good illustrations unlike
neuro muscular with a little cranial work, foot reflexology,
some more medical text books.
some energy balancing and - hold the foam. But that is the
4. Which part of the body do you find the most chal- direction that I see - more choices, more sophistication and
lenging to work on? more broad appreciation of the manifold benefits of this art.

Knees have long been my nemesis, In part because some of Diana Haynes has been practicing
the critical structures aren't reachable without a knife and various forms of bodywork for over
the symptoms associated with knee injuries can be so vari- 30 years. Beside owning her own
able. massage school, she also developed
Yogassage, a blend of yoga and
5. What advise you can give to fresh massage thera- bodywork. Out of her vast knowl-
pists who wish to make a career out of it? edge of massage, she has a special love for Positional Release.
She is the author of the best selling DVDs Positional Release
Know yourself and what skills you bring to a business be-
and Chair Massage.
sides your hands. If you don't like marketing or responsibil-
ity, you'll need to find a position where that is done for you,

Bodywork e-News 48
YOGA
Real Bodywork presents a series of yoga DVD from Gentle Beginner, Rejuve-
nating Restorative, Flowing Intermediate, and Invigorating Advanced. Each
DVD includes more than 3 hours of practice, plus unique pose guide section
that focuses on alignment, variations, benefits and cautions for over 20 yoga
poses! Each Yoga DVD is filmed in beautiful high definition, and includes a
compelling soundtrack and inspiring instruction!

Bodywork e-News 49