THE TOP 15

MASSAGE
TECHNIQUES
2019 EDITION

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TABLE OF
CONTENTS
AROMATHERAPY
PG 5

ASSISTED STRETCHING
PG 9

CHAIR MASSAGE
PG 14

CRANIOSACRAL
PG 19

THERAPY CUPPING
PG 24

ENERGY THERAPY
PG 33

FACE-LIFT, OR FACIAL, MASSAGE

PG 44

GERIATRIC, OR SENIOR, MASSAGE

PG 52
TABLE OF
CONTENTS
INSTRUMENT ASSISTED SOFT
TISSUE MOBILIZATION
pg 58

LIGHT AND LASER THERAPIES

pg 63

MEDICAL MASSAGE
pg 67

MYOFASCIAL RELEASE
pg 70

ORTHOPEDIC MASSAGE
pg 76

STONE & SHELL THERAPY

pg 83

TAPING
pg 89
AROMATHERAPY
4 Ways to Use
Aromatherapy in
Your Spa Practice
By Debora Bogart

E
ssential oils can be a
beneficial addition to any
massage, but before using
them you must be properly
trained and aware of your clients’
health issues, allergies and
scent dislikes.
Further, with aromatherapy you will be adding
something to the massage medium that will be
absorbed through the skin, affect your client’s
metabolism and interact with their limbic system.

As massage therapists, we must understand

the importance of proper training before using
something as potent as essential oils, because
not everyone’s massage education includes this
important information. After you’re educated, by
doing a thorough intake and assessment you can
determine how you want to proceed with your
aromatherapy add-on to a massage session.

EMPLOY A DIFFUSER
Diffusers distribute essential oil molecules into
the air, which gives anyone walking into the space
beneficial exposure. A diffuser that allows you to
change oils quickly is ideal.

5
 Diffusers driven by an electric fan use a pad to apply
a few drops of oil, and the pad is placed beneath the
fan compartment.

This type of diffuser allows for a quick change of

oils if a therapist encounters a client who finds the
current oil offensive to their senses.There are many
diffusers on the market, enabling a therapist to
purchase one that meets their specific needs.

USE SINGLE-NOTE ESSENTIAL OIL

ADDED TO MASSAGE CARRIER OIL
Have a variety of oils on hand so the single oil can
be added as needed. Single-note essential oils, such
as lavender or Roman chamomile, can be used to
enhance relaxation or alleviate a depressive mood.
A couple drops of the essential oil added to 1 ounce
Single-note essential of carrier oil is all that is needed to complete a full,
relaxing, therapeutic session.
oils, such as lavender
or Roman chamomile, INTENSIFY MASSAGE’S BENEFITS
WITH CUSTOM BLENDS
can be used to enhance Use blends the same way you use a single-note
relaxation or alleviate a essential oil. Just place a few drops of the ready-
made blend into 1 ounce of a massage carrier oil.
depressive mood. Massage the oil into the client’s trouble areas or use
it on the whole body.

A great example would be using a muscle blend of

Helichrysum and Wintergreen on an athlete who is
complaining of muscle aches.

Blends are a group of essential oils that usually have

the same chemical components, thus creating a
stronger blend.

Some common blends to keep on hand would be

muscle blends, relaxation blends and rejuvenating
blends.

It would also be helpful to have special blends on

hand for fibromyalgia, sinus pain, and tension and
migraine headaches.

6
For therapists who don’t have ample training or
knowledge of blending, there are many massage
mediums on the market that have essential oils
already added for you.

Even though these products are available to all

therapists, a therapist still needs to be aware of
indications and contraindications, as well as, the
properties of the pre-added essential oils to prevent
allergic reactions with clients. Most of the products
will list the beneficial effects of use on the product
labels.

OFFER RETAIL SALES OF

CUSTOM BLENDS
Therapists who have ample training can pre-
blend massage creams for clients to purchase and
continue self-care aromatherapy treatments at
home between their therapeutic sessions.
This allows them to get the most complete results
from their aromatherapy.

Therapists who are not trained in blending

can purchase pre-blended creams from an
aromatherapy company or another local
aromatherapist at wholesale cost.

Some common retail products that clients may

enjoy include diffuser single-note essential oils or
diffuser blends, fibromyalgia creams, muscle relief
creams and headache or sinus roll-ons.

Self-massage lotion that has essential oils blended

for relaxation and better sleep is a wonderful
product to have on hand for most clients.

7
Even though such products are commonly found
at department or health-food stores, clients prefer
to purchase such products from knowledgeable
therapists who can help them choose the best
products for their needs.

About the Author: Debora L. Bogart, LMT,

is a certified aromatherapist and the medical
massage therapist at Ellerbrock Spine and Soft
Tissue in Bluffton, Ohio, instructor of an NCBTMB
continuing education aromatherapy course for
massage therapists and former massage theory
and advanced massage modality instructor at the
Institute of Therapeutic Massage in Lima, Ohio.

8
ASSISTED STRETCHING
How to Get Even the Most
Inflexible Client to Say Yes
to Being Stretched
By Judy Stowers

I
n 2004, I watched my swim coach
experiencing a stretch session. He
was a high-level athlete and used
stretching as a way to stay on top of
his game.
Having been in the massage industry for four years at that
time, I was immediately drawn in to the benefits he was
experiencing and wanted to be trained to provide stretch
sessions to my clients.

Fast-forward 14 years, having gone through certification

in a few different stretching methods, it is now over 60
percent of my practice. A constant curiosity of the human
body and how the fascial relationships affect different
conditions has led me down a path I never imagined.

Early on in my career, I wanted to focus on professional

athletes. I found myself doing just that.

From Olympians to the NFL, and from the Major League

Baseball to collegiate sports, I was providing an increased
number of stretch sessions to athletes.

After taking courses, I quickly integrated stretch therapy

into my practice and soon found that working with the
everyday athletes, the ones who are out there having fun
and staying fit, was the most rewarding.

Helping them achieve their goals and stay injury free

through stretching has been just the niche that has taken
my practice to a new level.

9
 It is what people are finding they need help with, and
need the benefits of, in order to stay active and healthy.
With need comes an incredible opportunity for growth.

8 WAYS TO MARKET
ASSISTED STRETCHING
Finding ways to market assisted stretching sessions has
been challenging when it isn’t the first thing that people
think of as something that will help them to perform at
their best and to feel better in their everyday lives.

Through the years, I have found some ways to bring

attention to the general public on the benefits of
stretching. Here are a few marketing strategies that
have helped me build a clientele that comes specifically
for stretch therapy sessions. Rest assured, if you have
a Massage Magazine Insurance Plus policy, assisted
...first thing that stretching is included in the 350 services you’re already
covered for.
people think of as
something that will
help them to perform
1 Donate time to local gyms, running stores or triathlon
stores to speak about the benefits of stretching
and how it can help them perform at a higher level.
Education is the key to helping people understand how
at their best and to your services can benefit them.
feel better in their
everyday lives. 2 Encourage everyone to bring a yoga mat and take
the attendees through a few stretches that target
the needs of the group you’re presenting to. This allows
them to FEEL how good stretching feels in their bodies
and encourages them to come in for a stretch session.

Words rarely sell the service by themselves, although the

words can create some initial intrigue. For the potential
client to feel the effects will create a strong desire for
them to schedule an assisted stretching session.

3 Ensure your website has information on the benefits

of assisted stretching so that potential clients can
learn about your services. Answer questions that are
relevant to the benefits of stretching and the conditions
it can help overcome. A large percentage of the
population does their research online before scheduling.

10
When you provide information, as well as a platform
for scheduling, your appointments will increase.
Booking online makes it easy for the consumer,
which means they are more likely to book than if
they have to call or email.

4 Create a social media presence. Offer stretching

recommendations on a consistent basis to draw
potential clients in. Several clients have decided to
come in and try stretching after they have seen a
post on a social media page.

Ensure the post is engaging and that it identifies

what the stretch can help with, such as low back
pain, shoulder pain and plantar fasciitis.

As much as we want them to come in the door,

allowing the consumer to see what you’re all about
and what you offer helps them choose you over
other practitioners.

Designing posts that trigger the “I need that”

thoughts from the consumers lead to scheduling
appointments. The need for a social media presence
isn’t going away any time soon so this is an
important piece of the marketing puzzle.

5 When clients are in your office for another

modality, encourage they try a stretch for
whatever they are in for. Ease them in with one
stretch and build on that in subsequent visits. When
they come in again, be sure to ask them how they
felt after assisted stretching and then build on that.

Offer an additional stretch at the end of their session

so they begin building a toolbox of stretches that
they can do on their own.

Helping a client learn to help themselves goes far

beyond requiring them to experience the results
only from coming in to see you. They always
appreciate learning and although they may not
start doing stretches on their own right away, by
providing the education, you give them the option
of helping themselves.

11
 I have had several stretch cards printed with the
home versions of each stretch. Before the client
leaves, I give them the cards of the stretches we
covered so they have a reference and don’t have
to try to remember everything we covered. They
always appreciate this and comment on how much
it helps them.

6 Attend local events and provide stretch services

free of charge to the participants. Most event
organizers will welcome services that complement
the athlete experience.

Whether the event is for the weekend warrior or

experienced athletes, a post-race stretch session can
help them recover faster. Set up a booth and offer
your services for free. Have business cards and fliers
available so that the participant has an easy way to
contact you after the event.
Give them an
incentive that makes
sense to your business
7 Consider adding a coupon or discount code
to event participants when possible. This
incentivizes them to schedule an assisted stretching
and also that helps session after their event. When people are trying
something new, they look for a way to get it with a
the client experience small discount.
what you have to offer Once they are in the door, you can further
with stretch. incentivize them with package offers to keep them
coming in. This would be the equivalent to a first-
time client offer that you may already offer.

I would caution to not discount it so much that

you only get them in the door once. That will only
devalue your services and create a lot of one-time
clients rather than the long-term client that you are
seeking.

Give them an incentive that makes sense to your

business and also that helps the client experience
what you have to offer with stretch.

8 Ask clients to leave reviews. When you have a

Yelp.com or google.com page, the reviews are
what help drive people to your business. These
services are free of charge and can help potential
clients find you more easily.

12
ADD ASSISTED STRETCHING
TO YOUR MENU
With the number of people who are working hard
to stay active and fit, adding stretch therapy to your
menu of services will certainly help your business
grow. It may take a few tries to figure out what works
best for you to draw these athletes into your office.

However, once you do find what works, there will be

no turning back. Stretching, flexibility, and mobility
fills in the gaps of other modalities and makes any
movement available to any body.

With its high level of safety and effectiveness, clients

will not see any other option to helping them achieve
their goals. Stretching will become their
way of life!

Judy Stowers, LMT, CST, is an educator, and

an expert in exercise, massage, flexibility and
stretching. She owns Apex Bodyworx in Scottsdale,
Arizona. Stowers is a National Certification Board
for Therapeutic Massage & Bodywork-approved
continuing education provider. She wrote “Take
Your Massage Results to New Heights with Assisted
Stretching” for MASSAGE Magazine’s June 2018 issue.

13
CHAIR MASSAGE
15 Tips
from Chair
Massage Pros
By Allison Payne

W
ith a quality massage chair
and your imagination, you
can expand your practice,
build clientele, make extra money
and support clients’ health.

THREE EXPERTS SHARE THEIR TIPS FOR

CHAIR MASSAGE SUCCESS.

1 Use a chair massage as a marketing tool—or your

primary means of income. “[It’s] a way to build a
table practice, or to create a chair practice that’s part of
a table practice,” says David Palmer, founder of Touchpro
International and developer of the first massage chair.
“And some people choose to make chair massage their
primary, exclusive way to [provide] skilled touch in the
world.”

Depending on your personality, you may prefer to build

longer-term relationships with clients; or you may value
the chance to meet lots of new people and make an
improvement in their day, meaning you would take your
massage chair to many different locations.

“Some therapists enjoy [chair massage] for the variety,”

says Dan Melmed, L.M.T., owner of Body Well Mobile
Massage Professionals. “The money can definitely add
up, because in a lot of cases, we’ll be going for several
hours of guaranteed work. I know many therapists, myself
included, appreciate the opportunity to be able to have a
positive impact on so many people, in such a short period
of time.”

Also, Melmed adds, “there’s no laundry involved!”

14
 2 Highlight the benefits of chair massage.
While you may not be able to effect long-term
health benefits from a single chair massage session,
you will help that client feel better right there,
right then. “It’s an instant attitude adjustment,”
says Palmer. “It does make people feel better
immediately thanks to oxytocin and a couple
of other hormones that get released as soon as
positive touch is encountered.”

Ralph R. Stephens, L.M.T., C.N.R.T., founder of Ralph

Stephens Seminars and creator of the video series
Seated Therapeutic Massage, says, “There is a
therapeutic paradigm for the chair. I’ve found that
even if I was in a relaxation setting, like out in public
somewhere, almost everybody that got in the chair
had some specific complaint.”
...improving
employee morale, 3 Reframe the idea of stress relief.
“Instead of selling [massage] in the negative,
reducing stress, sell it in the positive. [It’s] health promotion, not
just stress reduction,” Palmer says. “Everybody is
decreasing the comfortable with the concept of health promotion: I
chances of injury, want better health.”

and other benefits.

4 Give management what they want.
When you’re marketing in-office chair massage
to corporate clients, make sure you explain how
chair massage techniques will help their bottom
line—by improving employee morale, reducing
stress, decreasing the chances of injury, and other
benefits. Stephens says, “Approach employers with
how this is going to benefit [their] company, not just
cost [their] company.”

5 Optimize your website for local search.

According to Palmer, “We really don’t find the
customer. The customers for chair massage in
the workplace find us. When people want chair
massage, they’ll type it into their browser … and it
pops up in their geographical location.”

15
6 Nurture corporate relationships.
Keep in touch with managers who have booked
your chair massage services, even if they change
jobs. “We’ve many times seen where a manager
who’s brought in chair massage at one company
leaves, goes to another company and then brings it
in over there,” Palmer says.

7 Promote yourself—if you can.

Check with the person who hired you to do chair
massage, and make sure it’s OK to have business
cards or brochures available. One short seated
session might be someone’s first massage—and
might convince that person to get table massage on
a regular basis.

Stephens recommends carrying business cards

with you at all times, even when you are not doing
massage. “Don’t go to the grocery store without
cards; don’t go to the gas station without cards,
because everybody needs a massage. They just
don’t know it yet.”

8 Pack a toolkit.
Palmer recommends disinfecting wipes, face
cradle covers, and elastic bands for clients with long
hair. You should also make sure there’s a small trash
can nearby to throw away disposable items.

9 Make payment terms clear.

Make sure the client understands whether
you are charging per minute or per session, and
what types of payment you accept. In a corporate
setting, says Melmed, a good method is to charge
a guaranteed set hourly rate, and agree on the
number of hours you’ll be available to provide
massage. “That way we know what we’re going to
be making and we can also guarantee [that] for the
therapists performing the services.”

10 Bring the guys.

Melmed feels there’s less gender
discrimination surrounding chair massage. “For male
therapists looking to get more work, I’ve always
recommended chair massage because most of our
corporate clients are really not as concerned with
gender. If we’re sending a team of therapists, they’ll
often request some balance of male and female.”

16
 11 Make your needs known.
Have a conversation with the manager who
booked your services, explaining what you will need
to do your best work possible, or even provide a
list in writing. Discuss details such as how long you
will work, when you will need bathroom, lunch or
stretch breaks, and how many clients you will see.
“There can be misunderstandings, because the
person coordinating it at the company may not fully
respect the therapist’s needs or how hard they’re
working, and the fact that they actually need a
break,” Melmed says.

12 Be legal.
Generally, says Melmed, you don’t need
permits for events that take place on private
property, such as within a company’s offices, but
you may need a permit to provide massage at
festivals or other outdoor venues. Some places, such
Discuss details such as public parks, may also require proof of insurance.

as how long you will

work, when you will 13 Don’t settle for low rates.
“You want to find places with people who
can afford you,” says Stephens. He also recommends
need bathroom, lunch or watching your overhead, especially in places where
you rent a kiosk, like malls or airports. “Make sure
stretch breaks, and how that space isn’t so expensive that you wind up not
many clients you will see. making much money.”

14 Keep your massage chair ready.

“Don’t fold your chair up every time you bring
it back to your office,” says Stephens. “If somebody
comes in [with] very acute back pain, one of the
most painful things for them to do is lie down on
the table and get back up off of it. You can have
them straddle that chair, sit down and calm that
low back down in the first 10 or 15 minutes of
your treatment, and either move on to the table or
maybe you can resolve their complaint in the chair.”

15 Set realistic intentions and expectations.

“Making sure that the expectations of the
customer are in alignment with the intention of the
practitioner is crucially important to the massage
transaction,” says Palmer. “If they think you’re doing
therapy, and you’re only doing relaxation massage,
you might have a problem.”

17
That’s why Palmer always makes chair massage
clients a promise he can keep: “No matter what you
feel like when you sit down in the chair, you’ll feel
better by the time you get up. I think that’s a very
powerful and appropriate guarantee.”

Allison Payne is associate editor of MASSAGE

Magazine and managing editor of futureLMT.com,
MASSAGE’s publication for student and beginning
massage therapists. She wrote “The Top 3 Ways to
Make Money with Your Massage Chair” for MASSAGE
Magazine’s November 2015 issue.

18
CRANIOSACRAL THERAPY
Craniosacral Therapy: An
Ideal Modality for Treating
Inflammation
By Tim Hutton, PhD, LMP, CST-D

C
ranioSacral Therapy (CST),
because of its ability to engage
specific tissues in the body with
great precision, is an ideal modality
with which to address the immune
system. Using CST it is possible to
directly map inflammation in the
body, on a micro level.
One can tell exactly which tissues are inflamed, what
aspects of the immune system are involved in that inflam-
matory process, and to some extent to what the immune
system is reacting, all simply by palpating the movement
of the immune system in response to the craniosacral
rhythm.

The immune system, which consists of a loose network

of 10 to 50 billion cells of various kinds, all acting togeth-
er and communicating with each other chemically and
energetically, can often seem a bit esoteric. Tissue is easy
to palpate and is easily affected by manual therapy. It is
less obvious that this is true of the immune system. The
immune system, however, is involved in every issue that
we treat as manual therapists. If the client is experiencing
a symptom, there is some degree of inflammation, and
the immune system is involved.

This involvement may be primary, as in the case of

an infection or an autoimmune condition, or it may
be secondary, in which case simply releasing fascial
restrictions may be enough to allow the inflammatory
response to completely abate. Most often, the situation
is somewhere between these two extremes, however,

19
 and simply releasing fascial restrictions does not
completely eliminate the inflammation. Thus it
is critical that we as manual therapists be able to
address this important system of the body. These
types of white blood cells help the immune system.

A BRIEF HISTORY OF
CRANIOSACRAL THERAPY
CranioSacral Therapy was developed by John
Upledger, D.O., O.M.M., in the mid-1970s and derives
out of the osteopathic tradition. Andrew Taylor
Still developed osteopathy itself in the late 1800s.
Osteopathy is based upon the principle that the
body possesses its own Inner Wisdom and ability to
heal, though sometimes the body needs additional
resources to do so. The role of the therapist is to
provide those additional resources to the Inner
Wisdom. The therapist does not directly make
changes to the tissue; the therapist supports the
While there are some Inner Wisdom and the Inner Wisdom makes the
changes the Inner Wisdom deems to be important.
similarities between Thus, the role of the therapist becomes that of a
Cranial Osteopathy facilitator. Andrew Still had a student in the 1920s
named William Sutherland, D.O. Sutherland was
and CST, there are also intrigued with the movements of the bones of the
skull and developed an approach to therapy he
major differences. called Cranial Osteopathy. While there are some
similarities between Cranial Osteopathy and CST,
there are also major differences. In the early 1970s,
Upledger had the opportunity to assist a surgical
procedure that involved exposing the dural tube
of the patient (the membrane which surrounds the
spinal cord).

During this surgery, Upledger directly witnessed a

rhythmic expansion and contraction of that tube.
Intrigued, he initially went and studied Cranial
Osteopathy. His research led him in a different
direction, however, and ultimately, he developed
CST. Cranial Osteopathy focuses primarily on the
bones of the skull. Practitioners have a very detailed
understanding of the sutures of the cranium, and
many subtle techniques to free up those bones.
Upledger felt that while the sutures were important,
problems were most often caused by tensions
in the membrane system to which those bones

20
attach. These membranes line the cranium and
attach strongly to the sacrum, hence the name
CranioSacral. (Tensions may come from anywhere.
It is not uncommon for a sprained ankle or twisted
knee, for example, to produce a tension that pulls
up into the cranium.

In such a case, treating the membranes in the

cranium can be helpful, but if the twist in the knee
or ankle is not addressed the results will often
only be temporary. Thus, despite the name, a
CranioSacral therapist will address the entire body,
not just the head and tailbone.) Addressing these
membranes requires that very light force be used.
Too much force and the body will guard. Typical
force used in CST at the site of the tension is about 5
grams, or the weight of a nickel. (The therapist may
need to apply more force than that to the tissue, in
order to apply just the right force at the depth of the
restriction.)

CRANIOSACRAL THERAPY AND

MUSCULOSKELETAL PAIN
Life is about compensation. We all have tension and
internal conflicts due to various traumas that we
have experienced. So long as we can compensate
around those internal tension patterns, there will be
no symptoms. Absent direct palpation of a tension
pattern, one would not even know it is there. It
is only when the tension overwhelms the body’s
ability to compensate that these symptoms occur.
However, symptoms show up at the weak link—not
necessarily where the tension is. Symptoms are not
a reliable indicator of where the origin of a problem
lies, and simply treating symptoms often will yield
only temporary results. CST directly addresses
those internal tension patterns. Reducing internal
tensions gives the body back room to compensate,
often resulting in a reduction of symptoms. This is
true even in cases where the proximal cause of the
symptoms was not directly addressed.

21
 Give the body enough room to compensate and
the symptoms may abate anyway. Thus, CST is
potentially beneficial for just about any condition.
Reducing internal tension and conflict allows the
body to function better no matter what is going
on. CranioSacral Therapy can be used to treat, often
in conjunction with other therapies, a wide variety
of pain conditions, particularly headaches and
musculoskeletal pain. It can be useful in treating
neurological and circulatory issues, digestive issues
as well as problems with other internal organs.
Any condition may respond positively to CST if the
internal tension in the body can be reduced.

Because CST employs very light force, typically

about 5 grams, there are very few contraindications
to its use. Contraindications generally fall into two
major categories: compromise to the structure
of the membrane system around the brain and
spinal cord, and anytime a small transient increase
Upledger Institute in intracranial pressure could conceivably cause a
problem. Examples of the former are epidural leaks
International (UII) from lumbar puncture and open cavity head wound.
teaches CST through Examples of the latter include acute stroke, severe
concussion with consequent swelling of the brain
a series of four-day and unstable cerebral aneurism. (Chronic stroke,
seminars. where there is no longer a danger of causing a clot
or bleed to recur, is very much an indication for CST.)

BECOMING A CRANIOSACRAL
THERAPIST
Upledger Institute International (UII) teaches
CST through a series of four-day seminars.
There are four seminars in the core curriculum:
CranioSacral Therapy 1, CranioSacral Therapy 2,
SomatoEmotional Release 1, and SomatoEmotional
Release 2. In addition to these four courses, UII
teaches numerous seminars on more specialized
topics in CST, such as pediatrics and obstetrics,
working directly on the brain, and as discussed,
working directly with the immune system. UII
also has a certification process that is available
to students. There are two levels of certification,
the first of which can be undertaken after having
complete CranioSacral Therapy 2, although the

22
certification process is really meant for students
who have been in practice for several years and
have a lot of experience doing CST.

To become certified, students must pass an open

book essay exam, and they must demonstrate
competency in CST during a hands-on practical
examination. (Certification does not provide a
legal right to practice. Certification can, however,
demonstrate to clients the competency of the
therapist, and is meant to be a learning experience.)

Tim Hutton is a licensed massage practitioner in

the state of Washington and has been in private
practice at the Natural Health Clinic in Bellingham,
Washington, doing CranioSacral Therapy, since
1994. He is also certified in CranioSacral Therapy at
the Diplomate level (C.S.T.-D.) and teaches a variety
of courses in CranioSacral Therapy for Upledger
Institute International.

23
CUPPING
Cupping
as Manual
Therapy
By Anita Shannon, L.M.T.

J
ust as there are many different
approaches to massage, there
are many types of cupping
therapy. A cup replaces the hand in
vacuum manual therapies, where a
machine is used to create a sucking
effect.

We cannot create suction with our hands. The cup is held

in the hand and the practitioner performs movements as
they would with massage, except it is done with suction.

A cup may also be used for meridian and point work

in traditional cupping therapies. Hybrids of these two
approaches are coming into use as well. The beauty of
adding cups into bodywork is the synergistic aspect of an
integrated treatment.

Synergy means “made up of aspects or parts that work

well together” (Encarta Dictionary). Traditional Chinese
Medicine, for example, features the concept of yin
and yang as synergistic forces. We have all noticed
more impressive results as we learn and integrate new
modalities into our work, because synergy increases the
benefits of our treatment.

Massage cupping combines well with other modalities, is

easy to integrate into a massage session, and is valuable
as an assessment tool. The vacuum creates a lift and
separation in tissue that complements the compression
of most manual therapies.

24
 You can add cupping to other techniques you have
learned and use in your practice. For example, with
a pin-and-stretch technique you could try using the
cup to pin, or place it on a trouble spot along the
muscle and perform the movement as you usually
do.

BENEFITS OF CUPPING
Cupping affects several areas, including circulation,
fascia, lymph and muscle tissue.

Circulation: The vacuum creates vasodilation,

which draws blood flow into the tissue. The
expansion of blood vessels also offers a vehicle for
release of deep inflammation to the skin surface. (If
the skin becomes hot during vacuum therapy, it is
usually a good time to move on to another area of
the body.)
Cupping affects
several areas, Fascia: Separation of strands of fascia is profound
when tissue is stretched in multiple directions
including circulation, by the cup. Observe the tissue in and around the
fascia, lymph and cup to see that the stretch often extends into the
surrounding tissue. Separation of the strands and
muscle tissue. structures creates space for fascia to move properly.
(View Strolling Under the Skin, a video presentation
on fascia by Jean-Claude Guimberteau, MD.)

Lymph: The vacuum is used to release adhesions

that can block drainage and create congestion and
vascular stress in the affected area. Adhesions are
defined as “the joining of normally unconnected
body parts by bands of fibrous tissue” (Encarta
Dictionary).

This can be scar tissue; tangled and torqued fascia;

and even a compression mark from such clothing as
bras, tight bike shorts or socks; or marks from a chair
where the person sat and worked for years. (Apply
moist heat prior to treatment for better drainage of
congestion, scar tissue release, and hydration of stiff,
hard tissue.)

25
 Once the restriction of flow is removed, congestion
can be liquefied and directed to the nodes using
a combination of manual and vacuum therapies.
Vacuum therapies also work well in combination
with lymphatic taping techniques and manual
lymph drainage.

Muscle tissue: Using the vacuum cup on all types

of muscle tissue produces effective results. The
tissue visibly softens, feeling plump with hydration
and blood flow when palpated. Attachments can
be toned or released depending on the techniques
used. The park-and-manipulate technique, for
example, enables the practitioner to lift attachments
as the joint is slowly moved through its range.
Vacuum therapies also
AN OVERVIEW OF CUPPING
work well in combination Cup size matters. A larger cup will provide the best
with lymphatic taping evaluation of the tissue in and around the cup, and
also disperse a stronger suction over a larger area
techniques and manual for more comfort. Smaller cups allow for precise
lymph drainage. work in challenging areas such as the face, neck,
hands and feet.

When working on a muscular athlete, using extra-

large cups that can cover a large portion of the
muscle or muscle group has benefits that cannot be
produced with the hands. Pre-treating with vacuum
therapy prior to deep tissue techniques significantly
increases the effectiveness of manual methods,
along with less strain on both therapist and client.

Softening and decompressing the lateral leg

structures is crucial when working with lower back
and gait issues or athletic performance regimens,
and the vacuum cups can do this very comfortably.

26
Pumping modes and continuous suction are
effective in different ways:

• Pumping, which creates a vacuum effect inside

the cup, begins the gentle separation of fascia
strands without the stress of continuous suction.
Pumping is a technique that creates suction
and then releases the tissue. Pumping can
be very superficial, using a fast timing on the
suction and release, or deeper if the suction is
held longer. Static, or constant, suction is used
to glide across the tissue or perform other
movement that requires the cup to maintain
suction until manually released.
• Pumping can encourage tone in hypotonic
tissue, while long, gliding movements or traction
are beneficial for loosening hypertonic tissue.
• Pumping is best for gentle work, while
continuous suction techniques work well
for those who have limited sensation due to
congested or dense tissue.
• Pumping is useful for working lightly over
lymph nodes, and continuous suction is used to
separate and decongest tissue.
• Pumping is often used to stimulate tissue and
is especially beneficial for organs and weak
vascular walls.

ZONE BY ZONE
Abdominal work: Cupping therapies combine well
with colon therapies and are used to release the
diaphragm and intercostals. These techniques are
always an important part of working with scoliosis.

Head and neck: Vacuum therapy techniques

merge with chiropractic and a variety of manual
therapy techniques by releasing tissue prior to the
adjustment or movement, allowing free realignment
of the skeletal system.

Small cups and pumping modes can be used to

address a variety of issues in the face, head and
neck. Sinus and ear congestion and headaches
are some of the conditions that benefit from such
applications.

27
 Research on 50 subjects with chronic, nonspecific
neck pain, published in Complementary Medicine
Research in 2017, found those who received
cupping massage “reported significantly less neck
pain post intervention” than those assigned to a
wait list. “Cupping massage appears to be effective
in reducing pain and increasing function and quality
of life in patients with chronic non-specific neck
pain,” the authors noted. “More rigorous studies are
needed to confirm and extend these results.”

Shoulders and back: Once the neck structures are

released, the anterior and posterior muscle groups
of the upper trunk must be addressed. Pectoral
hypertonicity with trapezius hypotonicity is a
common problem that pulls the shoulders forward.

One of the most effective parts of anterior release

techniques is working along the sternum and
pectoral attachments, moving into the muscle mass
The most familiar and then up to the shoulder attachments. The cups
also make it very easy to work deep in the axilla to
application of liberate the joint from restriction of movement.
cupping therapies is
The most familiar application of cupping therapies
on the back. is on the back. The goal of long, gliding movements
along the erector spinae and intervertebral
structures is to create space for the discs and relieve
pressure or compression. Another favorite area
on which to use vacuum cups is the typically stiff
thoracolumbar fascia of the lower back.

Arms and legs: If there is a complaint of carpal

tunnel syndrome, the work begins with the head,
neck, shoulders and back, and then continues into
the arm and hand to identify and release chronic
issues resulting from repetitive movement patterns
or old injury. Small cups and strong suction used on
the wrist and hand after the other areas have been
addressed can then produce effective results.

Results of a randomized controlled trial on 52

outpatients published in 2009 in the Journal of
Pain indicated, the authors noted, that “[c]upping
of segmentally related shoulder zones appears to
alleviate the symptoms of carpal tunnel syndrome.”

28
 Plantar fasciitis is very similar in that the treatment
begins with the back and hips and works down to
the feet to discover the true origin of the imbalance.
Many people with lymphatic challenges in the legs
experience loss of sensation or pain in their feet,
and vacuum drainage of lymphatic congestion
combined with taping works well to relieve pressure
on the nerves and blood vessels.

Skin: The skin is often overlooked in bodywork, but

observation of this tissue in and around the cup can
reveal clues to client conditions. Restrictive patterns
can be seen and traced, tissue inflammation can be
detected if the skin becomes hot, and old debris
from life experiences can be seen and sometimes
smelled coming through the skin. (Read more about
this in the section titled “Debris in the Tissues?”
below.)
The skin is often The skin can also be tightened and toned using
overlooked in bodywork, vacuum therapies, providing a great preparation
or even alternative to surgical treatments. (Note,
but observation of this however, that the information in this article does
tissue in and around the not replace medical advice.)

cup can reveal clues to Facials and other skin care procedures such as
dermabrasion have included vacuum therapy
client conditions. for decades, well before the recent resurgence of
interest. If you hold a certification or credential
that puts skin care within your scope of practice,
cupping could be a valuable addition to your clients’
care.

DEBRIS IN THE TISSUES?

There is much dissension on the subject of toxins
and debris in the tissues of the body. Toxins are
defined as “a substance that accumulates in the
body and causes it harm” (Encarta Dictionary) and
are usually associated with slow poisoning. We are
exposed to quite a few substances in our daily lives,
from the cacophony of synthetic scents we are
assaulted by to fuel exhaust and other pollutants.

The experiences we have had in classes and at trade

shows are puzzling. During one demonstration,
a student being treated had worked in baggage

29

It appears that the body is
not able to eliminate the
residue from medications,
pollutants, injuries,
surgeries and other life
events, and it finds a safe
place to store the material.
handling for over 10 years before becoming a
therapist nine years prior to the class. During the
cupping therapy, we had to have everyone leave
the classroom after the smell of jet fuel became
overwhelming. While there may not be an easy
explanation, the experience left a vivid memory and
many questions.
The discolorations under the skin that we often see
from cupping therapies might provide perspective
on this therapy’s effect on pollutants in the body.
My opinion is that many people have compromised
immune function and are not able to effectively
eliminate all of the residue from surgeries or injuries
that could not be eliminated by the immune and
lymphatic systems.
Based on in-session experiences, I believe that a
dark purple or black color can indicate a very old
injury, graduating to brown colors and then red
tones from more recent issues.
When working on the upper back over the lungs
of smokers, a yellow-and-gray discoloration will
often appear. People exposed to things such as
secondhand cigarette smoke, campfires, fireplaces,
and wood or pellet stoves often present a gray color
in the skin on their back during cupping therapies.
We see these things when we work with vacuum
cups, but without a body of research into this
therapy we don’t have substantiated explanations
for them. It appears that the body is not able to
eliminate the residue from medications, pollutants,
injuries, surgeries and other life events, and it finds a
safe place to store the material.
It would seem that the vacuum will often pull
that material from storage and the body will then
eliminate it via the lymphatic and eliminatory
systems, just as it would be eliminated at the time of
injury.
30
 THE FUTURE OF CUPPING
There are a plethora of classes available today, but
nothing replaces a live workshop. Because it can
be difficult to travel to a class or you are not sure
if this modality fits into your work, there are also
online classes that will provide a vast amount of
information.

Begin with an online course and practice on willing

volunteers, and then attend a workshop to study
with an experienced instructor, as well as hear
questions and experiences from other students.
Cupping is an ancient art that is finding a new place
in modern health care. However, research into
cupping is lacking.

One review of cupping in athletes, published in

the Journal of Alternative and Complementary
Medicine in March 2018, looked at 11 trials—and
Massage cupping is while the authors found that “cupping was reported
as beneficial for perceptions of pain and disability,
an effective tool and increased range of motion, and reductions in
vacuum therapy is a creatine kinase when compared to mostly untreated
control groups,” they also noted that most of the
modern technique. trials had “an unclear or high risk of bias” and that
further research is needed.

Vacuum therapies, or massage cupping with

vacuum action, do combine with current medical
practices as an integral part of surgical preparation
and recovery, along with injury rehabilitation,
functional medicine and wellness.

Medical professionals refer to practitioners, often

after a patient or two comes in and shows them a
big shift in their issue, such as a change in dense
breast tissue or in post-surgical scarring.

Massage cupping is an effective tool and vacuum

therapy is a modern technique. Both may benefit
your clients in ways your hands alone cannot. As
research into cupping matures, so too will the
opportunities to practice it in a variety of venues.

31
Take this quiz to determine if contemporary vacuum
therapies would be an added asset to your business!
The quiz is appropriate for all health care providers,
including nursing, PT, OT, chiropractic, and massage
therapy.

About the Author: Anita Shannon, LMT,

(massagecupping.com) has been licensed in
massage therapy and cosmetology since 1983.
An educator since 1990, she appears at national
chiropractic, massage, and spa conventions and
currently presents workshops on ACE Massage
Cupping and MediCupping at international
locations since developing these brands of
bodywork in 2002. She has created five educational
videos on vacuum therapies. She was inducted
into the Massage Therapy Hall of Fame in 2011. Her
articles for MASSAGE Magazine include “Conquer
Clients’ Confusion About Massage Cupping.”

32
ENERGY THERAPY
The Massage
Therapist’s
Guide to Reiki
By Allison Payne

W
hat Is Reiki? Reiki, which
originated in Japan, is
a form of energy work
administered with very light or no
touching of the body; the word Reiki
comes from the Japanese words “rei”
(life force) and ki (energy).

Reiki is based on the idea that a life force energy flows

through us, and that fluctuations in this energy affect our
physical health, according to the International Center for
Reiki Training (ICRT).

In a typical Reiki healing session, the client remains fully

clothed and either lies down on a massage table or sits
comfortably in a chair. As in a massage session, a serene,
peaceful environment is created for the session, often
with quiet music.

The Reiki practitioner, employing either very light hands-

on touch or holding his or her hands close to the client’s
body, then moves the hands systematically through
different positions, with the intention of discharging
negative energy and replacing it with positive energy.

The Reiki practitioner may spend more time in certain

areas, depending on the clients’ needs or goals for the
session. Because Reiki derives its benefits from an energy
that is universally accessible to anyone, anywhere,
proponents of Reiki may also offer what are called distant
sessions, in which the receiver is not physically in the
practitioner’s presence.

33
 Recipients of Reiki say receiving it feels “like a
wonderful glowing radiance,” according to the ICRT.
Proponents of Reiki say sessions can be helpful in
improving the condition of those suffering from
a variety of physical issues, from chronic, serious
illnesses such as cancer to more minor conditions
like insomnia.

“Professional massage therapists are naturally

in tune with the human body and its energy,
blockages and flow. Adding an energy healing
technique such as Reiki is a perfect complement to
expand their offerings,” reiki expert Linda LaFlamme
told MASSAGE Magazine via email.

“Becoming trained and certified in Reiki and a

registered Reiki professional can help expand a
massage business and will expand the therapist’s
range of offerings,” she added.

You can actually... be William Rand, a senior Reiki master and teacher
and president of the Center for Reiki Research,
giving Reiki at the told MASSAGE Magazine that the healthy touch of
massage therapy and the energy of Reiki healing
same time you’re doing complement each other well, and that about
a massage... 10 percent of students in his Reiki trainings are
professional massage therapists.

“You can actually ... be giving Reiki at the same time

you’re doing a massage,” he said.

A BRIEF HISTORY OF REIKI

According to Rand’s book, Reiki: The Healing Touch,
Reiki began in Japan, where it was practiced in
several different styles; however, Mikao Usui is
regarded as the founder of the typical style of Reiki
with which most people are familiar, now known as
Usui Reiki.

In Tokyo in 1922, he established a school of Reiki, to

which many people came seeking guidance as well
as help with their ailments.

Mikao Usui also developed teaching methods with

which to pass along his knowledge and taught more
than 2,000 students before his death in 1926.

34
 A succession of several students in turn led his
organization after he died. Hawayo Takata is the
woman credited with bringing the practice of
Reiki to the U.S. in 1937, and she developed and
adapted it in a number of ways for American Reiki
practitioners.

The Reiki healing method by which a student of

Reiki is initially introduced to the energy by a Reiki
master is called an attunement.

The history of a person’s Reiki instruction, because

it is passed down from teacher to student and
then to that student’s students, is referred to as a
practitioner’s lineage.

THE DIFFERENT KINDS OF REIKI

There are several different kinds of Reiki—and every
Karuna Reiki was practitioner brings his or her own style to bear on
developed with the what he or she was taught—but there are two main
types most commonly used in the U.S.: Usui and
intention of relieving Karuna.
suffering... Usui Reiki, the style which is most familiar in
the West, began in Japan with Mikao Usui and
eventually came to the U.S. with Hawayo Takata
in 1937. It is typically used to promote relaxation,
stress reduction and balance, which can in turn
promote healing.

Karuna Reiki was developed with the intention of

relieving suffering; the word karuna is Sanskrit for
“any action that is taken to diminish the suffering of
others” and can also be translated as “compassionate
action,” according to the International Center for
Reiki Training.

Karuna Reiki was developed by William Lee Rand,

from the Usui Reiki in which he was originally
trained. (Rand and the ICRT introduced another
variety, Holy Fire Reiki, in 2014.)

35
REIKI SYMBOLS AND
WHAT THEY MEAN
Usui and Karuna Reiki both use a number of special
symbols to help practitioners’ access and channel
the energy on which the practice of Reiki is based;
these are introduced to the Reiki student during
his or her attunement, when the student learns
to associate each symbol with the specific type of
energy it represents.

By recalling a symbol, the practitioner can also tap

into that energy when needed during a session.
The Reiki symbols themselves are derived from the
Japanese kanji system of writing, and also Sanskrit
in some cases, according to the ICRT.

Usui Reiki uses these symbols:

• Power (Choku Rei);

• Mental/Emotional Harmony (Sei Hei Ki);
• Distance/Connection (Hon Sha Ze Sho Nen);
• Reiki Master (Dai Ko Myo);
• Completion (Raku).

Karuna Reiki uses these symbols:

• Om/Aum (the sound of eternal oneness,

typically associated with meditation);
• Zonar (karmic issues);
• Halu (a deeper form of Zonar);
• Harth (heart issues);
• Rama (male/female energy);
• Gnosa (mind/higher self );
• Kriya (healing);
• Iava (personal power);
• Shanti (peace).

WHAT ARE SOME REIKI BENEFITS?

“Some of the many benefits of Reiki may include
stress reduction, comfort and sheer relaxation,”
said LaFlamme. “Many clients report a feeling
of enhanced well-being, peace and of feeling
grounded after a session or series of sessions.”

36
 In addition to the benefits to the client who
receives Reiki, giving a Reiki session can benefit the
practitioner as well. Because Reiki is believed to
balance life energy, being an active participant in
that process helps both you and your client.

“A Reiki practitioner also receives some of the

healing benefits of Reiki while giving Reiki, as
an added wonderful bonus,” LaFlamme said.
“Professional massage therapists [who perform
Reiki massage] give so much of themselves in their
beneficial and loving practices.

“Offering Reiki to clients ... is a refilling of the

well while providing value at the same time,” she
continued. “Everyone benefits, sometimes in
profound ways.”

Whether you offer just Reiki or decide to work as a

Reiki massage therapist, both you and your clients
will reap rewards from this energy work.
...the results can
be measured, and WHAT DOES SCIENCE SAY
there’s extensive ABOUT REIKI?
Rand said no “solid evidence” for Reiki’s effectiveness
research on that. yet exists, though practitioners and clients often
cite anecdotal evidence to back up Reiki’s various
benefits.

“In terms of the energy itself, it seems to beyond

scientific measurement,” Rand said, “but the results
can be measured, and there’s extensive research on
that.”

He described one study in which 45 participants

with health issues were divided into three groups:
the first received no intervention; the second
received what he called “sham Reiki,” in which a
person posing as a Reiki practitioner went through
the motions of providing Reiki; and the third
received authentic Reiki from a trained practitioner.

(The sham Reiki group was used to control for the

placebo effect, in which people experience benefits
purely because they believe an intervention will be
effective.)

37
 During the study, standard care and sham Reiki “had
some effect, but it was very marginal,” Rand said. In
the Reiki group, the subjects experienced significant
decreases in heart rate and diastolic blood pressure,
according to the study’s abstract.

Write-ups of this study, along with a number of

others, are available to read on Rand’s research
website. While research into this modality is
challenging for many reasons, Rand recognizes
the importance of achieving scientific validation of
Reiki’s benefits through formal research.

“We want to do a large-scale study with 300 patients

... that science [would] consider as an adequate,
large-scale study,” he said.

IS REIKI RIGHT FOR YOU?

...by its nature it To be an effective, sought-after Reiki practitioner,
“being honest and having a sincere desire to help
often touches the others” is essential, Rand said.
spiritual side of both He also notes that good organization and business
practitioners and skills are important, just as they are in massage
therapy, especially if you are a sole practitioner who
clients. is self-employed.

While Reiki is not a religious belief system and does

not require any particular faith, by its nature it often
touches the spiritual side of both practitioners
and clients. For that reason, Rand said, a certain
openness of mind and heart is critical to being a
practitioner of this modality.

“You have to at least be open to that, the spiritual

ideas—that there are energies available that you
can tap into,” he said.

WHAT YOU NEED TO GET STARTED

PRACTICING REIKI
Getting started with Reiki is fairly simple; Rand notes
you can begin using it almost immediately after
your first class.

38
 “You don’t have to study for a long time to learn
Reiki; you receive what’s called an attunement,” he
said. The attunement gives you the ability to use
the technique on yourself and others, though you
should be honest about your skill level and not offer
it professionally until you receive further training.

“You can take a class in a weekend and actually

doing Reiki on yourself and others that is effective,”
Rand said.

“It’s not based on skill so much as it’s simply the

energy that you receive during the attunement;
there is some skill involved, of course, and that
comes with experience, but immediately, as soon as
you have taken the class and you put your hands on
someone, the energy starts flowing.”

Because Reiki is simple to learn and begin using,

practitioners often begin offering it even with only
Rand recommends level one certification, which typically involves a
waiting until you’ve one- or two-day class. Rand recommends waiting
until you’ve achieved at least level two before you
achieved at least begin using it professionally.
level two before “I would say at level two, you could start a business
you begin using it and start giving sessions, and you would be
effective and your sessions would be worthwhile,”
professionally. he said.

Some people then learn beyond level two to the

advanced and master levels and, if they want to
teach, can train to become Licensed Reiki Master
Teachers (LRMT), a credential offered by ICRT.
According to the ICRT’s website, that credential
takes three or four years and about 1,000 hours of
study to achieve.

DO YOU NEED A CREDENTIAL TO

PRACTICE REIKI?
Whether or not you need a Reiki credential depends
on where you live. “Most of the states in the U.S.
do not require one to be licensed to do Reiki,”
said Rand. Because Reiki does not require the
practitioner to manipulate tissue, it typically does
not fall under the definition of massage.

39
 Among states that do require licensure or impose
other restrictions on Reiki practice, the rules vary
widely. Laws about the practice of Reiki usually exist
under the umbrella of massage therapy.

That means you’ll probably be able to get

information on regulations concerning its practice
by contacting your state’s massage therapy board or
other governing body in charge of massage therapy
licensure.

The states of Florida and Texas, for example, require

a person to have a massage therapy license in order
to perform Reiki.

States such as Colorado and California do not

require a license but do require giving clients certain
disclosures about the service you provide.

In states such as Mississippi, you can perform Reiki

Laws about the without a massage therapy license as long as you
practice of Reiki do not touch or manipulate tissue or perform it
while doing a tissue-manipulating modality such as
usually exist under massage.
the umbrella of In addition to becoming familiar with your state’s
massage therapy. requirements for Reiki practice, it is also a good idea
to inquire about any local ordinances that might
apply.

“When starting a Reiki practice, one should become

familiar with local, city, and state or province laws, if
any, regarding the practice of Reiki,” said LaFlamme.

HOW MUCH DOES REIKI

CERTIFICATION COST?
The costs of Reiki training and certification vary
widely, Rand said, and those variations may or may
not reflect the quality of the education provided.

For example, he said when he first started looking

into training beyond level one, in the 1980s, a few
programs cost $10,000; while another, the one he
eventually took, only cost $500. (That $500 in the
1980s equates to about $2500 today, he said.)

40
 Because of the wide variation in costs and
curriculum quality, Rand recommends researching
what content is included in the course, as well as
several other factors, before deciding on a program.
“I would look at their background ... the lineage of
the teacher,” he said. How long has that person been
teaching?

“Get a feel for their level of spiritual development,”

he continued. Talk to the teacher, and others who
have taken the program if possible. If it seems like
the instruction being provided is “ego-based,” Rand
said, keep looking.

“Does it sound like they want people to come to

them because they project themselves as being the
center of Reiki ... better than anyone?” he said.
This kind of attitude runs counter to a core principle
Rand recommends of Reiki, that the life energy being worked with is
universally available and that anyone is qualified to
researching what learn to channel and use it.
content is included in
Finally, trust yourself.
the course, as well as
“I tell people to follow their own inner guidance,
several other factors, their intuition, in terms of [choosing] a teacher to
before deciding on a study with,” Rand added.
program. DO I NEED REIKI INSURANCE?
Reiki liability insurance is essential. No matter how
careful you are, accidents happen; and getting sued
can easily bankrupt your business. Many entities
offer Reiki insurance, including Massage Magazine
Insurance Plus.

When shopping for Reiki insurance, it’s important

to look for a plan that offers professional liability
coverage (for claims of malpractice); general liability
coverage (for accidents, such as when someone
trips and falls); and product coverage (for damages
resulting from products used during sessions).

Some Reiki insurance policies may also offer

benefits such as rental damage coverage, identity
protection, or reimbursement for stolen equipment.

41
 You should also know the coverage limits of your
policy, and whether it is occurrence-form or claims-
made.

In occurrence-form coverage, an incident is covered

as long as you were covered on the date the
incident occurred; in claims-made, you must be
covered at the time the claim is filed, regardless of
when the incident took place.

WHAT TO CHARGE FOR

A REIKI SESSION
How much should you charge clients for a Reiki
session? Rand recommends using your rate for a
massage as your reference point, while taking into
account such factors as where you live and what
your competitors charge.

“Look around in your area and see how much

Reiki can provide people are charging for a massage session and
added value and an charge a similar amount,” he said, noting that could
mean anywhere from $35 to $150, depending on
added dimension your location.
to existing massage If you offer Reiki in conjunction with massage,
sessions or as a or blended into a Reiki massage therapy session,
you can also think about pricing it as an add-on or
standalone service. charging a higher rate for the combined session.

ADDING REIKI TO YOUR

MASSAGE PRACTICE
“Reiki can provide added value and an added
dimension to existing massage sessions or as a
standalone service,” said LaFlamme.

You probably already discuss with clients some

of the positive effects regular massage therapy
can have on their well-being. Energy work such as
Reiki also has a place in a person’s wellness routine,
alongside other healthy habits.

“Reiki is one part of a general wellness program that

may include diet, exercise and self-care,” LaFlamme
said. “Receiving regular massage and Reiki sessions
can benefit the body, calm the mind and soothe the
soul.”

42
Apart from the benefits it offers clients, Reiki
sessions also offer the practitioner a chance to
provide a valuable service that isn’t as physically
taxing as massage therapy, at a comparable price
per session.

“Reiki is done with a gentle, static touch, which

provides a break for the professional therapist in
contrast to techniques that require greater pressure,”
LaFlamme said.

CAREERS IN REIKI
Many practitioners offer Reiki sessions in private
practice and are either in business for themselves
or working in a multidisciplinary setting with other
providers, such as massage therapists, chiropractors,
reflexologists, or practitioners of other types of
energy work.

Due to the increasingly wide acceptance of

integrative therapies as an adjunct to traditional
medical care, many hospitals and other health care
facilities now need Reiki practitioners, as well.

Once you have enough experience and training, you

may also choose to teach Reiki.

43
FACE-LIFT, OR FACIAL, MASSAGE
Bamboo Facial Massage
Improves Clients’ Health
with All-Natural Elements
By Michelle Mace

T
he face is a truly complex
creation of skin, muscles and
sinew—so why do we ignore
it most of the time, suggesting
a massage session that focuses
on desk-ravaged shoulders or a
treatment for overworked feet rather
than a facial massage?
Over the years, I’ve noticed that clients often claim facial
massages are messy, and sometimes simply unnecessary.
My response is, “A face is just as important as your hands,
hips and back, is it not?”

Indeed, it is, and it’s about time we acknowledge its

importance. While the hunch of your shoulders and
noticeable limp speak volumes, so do the lines on your
face and the dryness of your skin. When someone is sleep
deprived, in pain, stressed or unwell, their face presents
these issues like an open book.

The solution is simple: a facial massage.

Taking into account the structures of the visage,

therapists can reduce tension, improve health and
brighten overall appearance, along with a myriad of other
advantages that are linked to the basic concept of hands-
on therapy.

But coupled with all-natural elements of bamboo

massage tools, and we suddenly see more than merely an
improved completion.

44
 With a small dab of rice oil and heated bamboo
massage tools, clients will be relaxed into a whole
new state of nirvana.

Even though this approach is a blending of these

two techniques, it is considered to be primarily
a massage and does not require the use of facial
products.

A bamboo massage facial session is a unique add-

on for massage therapists and estheticians alike.

LET’S GET TO KNOW THE MUSCLES

OF THE FACE
Before applying bamboo facial massage techniques,
it’s essential to understand the various muscles
you’ll be working on, as well as their specific
function.

Each muscle has a Under the facial skin, there is a group of

approximately 20 flat skeletal muscles. These facial
different role to play muscles are positioned around facial openings, such
in facial movement as the ears, nose, eyes and mouth, or stretch across
the skull and neck.
and control facial
Each muscle has a different role to play in facial
expressions. movement and control facial expressions.
Depending on their position, these muscles can be
grouped into different categories. Now, let’s do a
quick review of the primary muscles affected by a
facial massage, as well as their various functions.

Orbicularis Oris: This muscle of the face encircles

the mouth and helps to pucker the lips and close
the mouth.
Depressor Labii Inferioris: Situated beneath the
lower lip, this facial muscle assists in depressing the
lower lip.
Levator Labii Superioris: Located above the upper
lip, this muscle of the face helps to elevate the
upper lip.
Buccinator: This muscle forms the anterior part
of the cheek, the wall of the oral cavity, and the
muscular base of the cheek. The Buccinator muscle
aids in chewing and helps to hold food in the proper
position, inside the mouth.

45
 Mentalis: Between the chin and lower lip is a
groove, and that’s the location of the mentalis
muscle. Also known as the pouting muscle, Mentalis
helps in contracting the chin.
Risorius: Known as the laughing muscle, Risorius
forms the depression of the cheek, in the angle of
the mouth. Unsurprisingly, this muscle helps one
to smile. Zygomatic major and minor: Beneath the
cheekbones is the zygomatic arch, formed by the
zygomatic major and zygomatic minor muscles.
While the major help in smiling, the minor aids in
frowning.
Frontalis: This muscle of the face is also known as
the epicranius muscle as it covers parts of the skull.
Found near the frontal belly and occipital bone, this
muscle helps in facial expression.

THE BENEFITS OF BAMBOO

The truth is, there’s a FACIAL MASSAGE
Many clients aren’t aware of the benefits of a
lot more to a bamboo bamboo massage treatment. If they were, they’d
facial massage make sure to ask their therapist for one at every
appointment.
session than just a
calming muscle rub. The truth is, there’s a lot more to a bamboo facial
massage session than just a calming muscle rub.

Aside from that blissful state of relaxation, your

clients are also profiting from rejuvenation benefits.
Additionally, as with the rest of their body, facial
muscles need movement and exercise to maintain
health and keep them looking youthful.

Relieves Face and Neck Tension

As massage therapists, we’re well aware that
muscles hold tension, and that includes the facial
muscles. In fact, some clients keep the majority
of their stress in their head and neck, making
them prone to headaches, migraines and vertigo.
Esthetically-speaking, more facial tension means
more facial wrinkles. Bamboo massage techniques
reduce tough tension while smoothing out and
moisturizing skin.

46
 Boosts And Improves Circulation
Facial muscles require the same amount of TLC
as the rest of the body. After all, they’re just as
important as any other muscle, yet they’re often
neglected. Increase oxygen and blood flow to the
face by using specialized bamboo facial massage
maneuvers that address the entire face, forehead
and neck.

Yubi sticks create effleurage strokes on the cheeks

and forehead. This stick increases blood flow to the
facial tissues.

Provides A Natural Facelift

Stimulating the face muscles with regular massage
helps to bring oxygen to that area, which is a natural
form of anti-aging skincare.

Enhanced blood flow to the locale increases

collagen production, giving a healthy and natural
There is nothing glow to the complexion. It also helps tighten
as soothing as a muscles, improve muscular strength and enhance
tone.
professional bamboo
facial massage. Induces The State Of Nirvana
There is nothing as soothing as a professional
bamboo facial massage. Since there are many nerve
endings in the head, a facial massage produces a
state of sheer relaxation.

During this deep state of tranquility, dopamine and

serotonin—the “feel good” hormones—are released
into the bloodstream.

In essence, bamboo facial massage doesn’t just

affect your facial muscles; it also affects your mind,
energy and consciousness.

AN OVERVIEW OF THE PHYSICAL

AND MENTAL BENEFITS OF
MASSAGE THERAPY
As therapists, we see a multitude of health benefits
firsthand every time we treat clients.

47
Some claim this natural therapy has improved their
sleep while others insist it has lowered their blood
pressure.

Sure, we’ve learned about the many positive results

of massage on the body in school, but how many
therapists can name each and every health and
mental benefit as they’re reading this article?

Do you realize how many changes take place in

your client’s body during a one-hour session? In
merely 60 minutes, the person on your mat or table
will experience improved sleep, reduced stress, a
stronger immune system, less headaches, lower
blood pressure—and the list goes on and on.

The truth is, relaxing tense muscles is just the tip of

the iceberg, it’s merely the superficial label attached
to massage therapists everywhere.

In the end, our clients are in for so much more

during their appointment than merely less tension
in their upper traps.

Relieves Muscle Pain

If there’s one thing that massage therapy is known
for, it’s muscle pain relief. Often, the vast majority of
clients that seek out massage are looking for help
with their muscle tension and pain.

By stimulating the release of the body’s “feel-good”

hormones—endorphins—muscle manipulation
helps with conditions such as neck and back pain,
persistent headaches and migraines, chronic fatigue
syndrome and fibromyalgia, to name just a few.

The wonderful thing about massage treatments is, it

decreases the need for certain pain medication as it
naturally relieves pain, regardless of its root cause.

Promotes Flexibility and Relieves Inflammatory

Conditions
Massage can treat inflammatory conditions such
as bursitis and arthritis by relaxing and loosening
muscles.

48
 With frequent therapy, clients gain a wider range
of motion and increased joint flexibility. Thanks to
regular massage, clients see a marked improvement
in movement, a physical fluidity that decreases the
likelihood of muscle injuries.

Improves the Lymphatic System

A healthy lymphatic system results in lower
susceptibility to various illnesses. But that’s now all,
your body also benefits from a heightened ability
to heal itself due to a healthy lymphatic system.
Massage therapy sessions stimulate this system,
enhancing the body’s natural defense mechanisms
and immunity.

Improves Circulation
Massage therapy improves blood circulation, thus
resulting in a better supply of nutrients to cells
throughout the body, as well as better cell waste
material transport.
During a massage Additionally, this circulatory improvement
session, cortisol is encourages healthier, softer and clearer skin, and
that’s because skin cells are more nourished with
released into the oxygen and nutrients.
system.
Therapeutic Abilities
In hospital and clinic settings, massage therapy is
regularly used to treat surgery and trauma patients
to help them rehabilitate and recover. In some
states, post-operative massage is employed to
reduce in-hospital stays.

Relieves Stress
During a massage session, cortisol is released into
the system. This different kind of hormone is in
charge of lowering the body’s stress levels.

The great thing about lower stress levels is, the body
has an easier time to heal itself. Furthermore, this
relaxed state decreases anxiety, makes it easier to
breathe and lowers blood pressure levels.

49
 On top of all these advantages, massage also
satisfies the body’s inherent need for touch. As such,
regular sessions promote the sensation of being
nurtured thus improving emotional well-being. The
end result is lowered anxiety and stress levels.

Improves Concentration
Concentration and focus are promoted via the
calm and relaxed state that massage induces. This
tranquil frame of mind perpetuates productivity
and creatively. Also, massage therapy makes people
more mindful of their body, which assists them in
identifying what their body needs.

Promotes Better Sleep

For some individuals, sleep is unattainable, and
those who suffer from depression, anxiety or other
issues that result in nighttime tossing and turning
this problem can seem like it takes over your life.
...massage also
As massage promotes the relaxation of both
satisfies the body’s body and mind, it’s a great way to help the body
inherent need for learn to “switch off” for the night. Fatigue, lack of
concentration, and irritability are all results of lack
touch. of sleep, since our nightly rest is the time where the
body refreshes, rebuilds and heals itself.

BAMBOO MASSAGE CAN SAVE

YOUR HANDS
Injury is a common occurrence among massage
practitioners and other manual therapies, but it can
be prevented. Without a doubt, massage therapy is
physically demanding.

We’re in a field that promotes health and well-being

to clients, only to ignore our own physical ailments
and emotional issues.

Even if you’ve been a bodyworker for years, that

doesn’t mean you can’t enjoy a nice, long, lucrative
career. That’s why it’s vital that massage therapists
not underestimate the risks involved in pursuing
such a physically demanding vocation.

50
At some juncture in your career, you’re likely to
suffer an injury, be it a work-related incident or
burnout.

If you haven’t considered the importance of self-

care, then you’re walking a dangerous road.
When you learn bamboo massage for the face—a
technique that is not demanding on the body—
you’re adding to your repertoire of massage
knowledge, all while saving your precious hands.

Michelle Mace-Lambert, LMT, is founder of

Barefoot Masters, and has been instructing
courses in barefoot techniques for several years.
She has traveled to Asia and studied chavutti
thirummaltechniques with the master himself,
Prabhat Menon. She offers nine different hand-
saving techniques and over a dozen CE classes
for massage. As a 20-year veteran of massage,
her passion is to create career-saving options for
massage therapists. She wrote “With Ashiatsu,
You Hold Your Client in Your Two Feet” for­
massagemag.com.

51
GERIATRIC, OR SENIOR, MASSAGE
The Future Will Be
Filled with Seniors­—
And Senior Massage
By Seraine Page

B
y 2050, America’s 65-and-
over population is projected to
nearly double from 48 million to
88 million, according to the National
Institutes of Health.

“Older people are a rapidly growing proportion of the

world’s population,” said National Institute on Aging (NIA)
Director Richard J. Hodes, M.D., in a 2016 NIA statement.

“People are living longer, but that does not necessarily

mean that they are living healthier,” he added. “The
increase in our aging population presents many
opportunities and also several public health challenges
that we need to prepare for.”

BATTLING LONELINESS
With such a significant increase in that particular
demographic come challenges of finding long-term
care solutions. Many people will end up in assisted living
facilities where loneliness and depression can often
plague even the most sociable of people.

Between 1 and 5 percent of elderly living in community

are depressed, while that figure rises to 11.5 percent in
hospitalized elderly, for example.

Marc Silverstein saw it with his own mother. A normally

talkative and personable woman, she shrank into herself
when she moved into assisted living, Silverstein said.
There were plenty of regular activities, such as bingo and
social events, but his mother wasn’t having any of it.

52
 As someone who personally received plenty of
massages, he noticed that geriatric massage wasn’t
available at his mother’s facility.

“With all the services and amenities that were

offered, the one thing they never offered her was
massage therapy,” he said. “I thought odd that the
one thing that could help her wasn’t offered, so I
decided to do something about it.”

In 2010, he founded Tender Touch For All, a

nonprofit that provides on-site massage therapy
services to seniors, veterans, and those with
disabilities or chronic conditions at their residential
or treatment centers.

Tender Touch For All also offers massages to support

staff and families on site, usually in a chair or
massage desktop portal.
Tender Touch For All
also offers massages “Nurses, social workers, they have very physically
and emotionally demanding jobs,” said Silverstein.
to support staff and “We do a lot of staff appreciation events for people
in nursing homes and assisted living facilities, built
families on site, usually around holidays like National Nurses Week.”
in a chair or massage Tender Touch For All services reach 7,500 people
annually. Seniors are the largest demographic of
desktop portal. massage recipients in the program, but staff reach
clients at hospice centers and wellness events, too.

BENEFITS OF MASSAGE
Multiple studies indicate the physical benefits
of massage therapy in those suffering with
osteoarthritis. One particular pilot study done by the
Department of Veterans Affairs showed significant
improvements in self-reported osteoarthritis-related
pain with regular use of Swedish massage.

A 2016 published study also reported knee

osteoarthritis pain in elderly reduced with a
combination of modalities including massage, yoga,
and tai chi.

Aside from alleviating physical pain, massage is

thought to reduce symptoms of depression and
anxiety as well.

53
 Facility administrators at sites where Tender Touch
For All therapists visit attest to it on a regular basis.

For the last three years, CareRite Centers Network

has employed Tender Touch For All therapists
at six of its locations. The nursing center’s
mission statement embodies the idea of holistic
opportunities for its rehab facilities and liked the
philosophy behind Tender Touch For All.

Most of all, the stories of healing have cemented

the company’s decision to work with the nonprofit,
said Ashley Romano, national director of patient
experience and research development at CareRite
Centers.

“The residents have expressed a reduction in

stress and anxiety and enjoy the opportunity to
receive non-pharm interventions as part of their
regular routine,” said Romano. “Additional benefits
Additional benefits have included an increase in appetite and positive
have included an displays of behavior.”

increase in appetite Above all, residents always request return visits,

and positive displays said Bonnie Nogin, director of community affairs at
CareRite Centers.
of behavior.
“A female resident who was a participant in the
spa program and signed up for monthly visits told
our recreation therapist that she was going to put
on a wig and glasses so she could pretend to be a
different person and get two massages that day,”
Nogin said.

Other massage recipients can often be moved

to tears. “One family member had been sleeping
bed side with her spouse who was terminally ill
on hospice care,” said Nogin. “The Tender Touch
therapist was spending time with the patient and
took the family member aside and said, “I’ve noticed
that you’ve been here for the last month and I’d like
to offer you a massage to ease your mind.”’

It isn’t uncommon to see interactions like that with

therapists and residents, Nogin said, and is one of
the joys of working with Tender Touch For All.

54
TRUST MATTERS
When massage therapist Lauren Jill Morett-
Vij, L.M.T., worked at an adult day care for
developmentally disabled adults, she remembers
one 70-year-old client who would yell at her to leave
the moment she saw Morett-Vij.

Now, she offers hugs and insists on being Morett-

Vij’s first massage client of the day. Another client,
who has been wheelchair-bound for 40 years, never
wants to let go of Morett-Vij’s hands.

For nearly three years, Morett-Vij has worked with

the elderly and blind in the Long Island and Queens
areas on behalf of Tender Touch For All. She’s
also worked wellness events and at a facility for
traumatic brain injuries.

“The Tender Touch For All organization is unique,

it offers compromised and confined people who
would not ordinarily be able to go out and receive
this care a personal hands-on experience that
benefits their body and soul,” she explained.

Trust, she said, is a big part of that whole-body

benefit. Offering a hand massage first allows her
clients to ease into the idea of being touched.
Once trust is established, she’s able to work on other
parts of the body more easily.

Witnessing her clients immediately benefit—such

as seeing a relaxed smile at the end of a session—is
one of Morett-Vij’s favorite parts of the job.

With many clients in wheelchairs or with walkers, it

can be hard to imagine a different, younger person.
But part of her job is to see the whole person, past
and present, which allows her to connect more
personally to clients, she said.

One client, an 86-year-old retired librarian once told

her: “Every time you massage me you know exactly
how to renew me. Your hands are intuitive.”

Responses like that are why Morett-Vij said she is

proud to be a part of Tender Touch For All.

55
 “It allows me to be a positive change and benefit in
their daily, present life,” she said. “ I enjoy knowing
that when I leave my Tender Touch For All patients,
I have been instrumental that day in giving them
quality of life.”

NATIONAL EXPANSION
Silverstein believes massage is good for everybody.
He’s seen it personally, and now with his program,
he’s witnessed positive changes in thousands of
lives.

With that evidence in hand, he hopes to expand the

program nationally to reach more people in need of
healing human touch.

“My vision is for this to be a national organization,”

remarked Silverstein. “We would love to work more
It allows me to be a with veterans.”

positive change and While passion and great therapists drive the
benefit in their daily, program, time and resources also play a factor. The
nonprofit survives on grants, program fees and
present life. occasional fundraisers, Silverstein said.

The facilities where the therapists visit pay for the

program to be brought in, which in turn usually
makes the program free to recipients. Sometimes
there is a low fee associated with it, but more often
than not it is a free service, Silverstein said.

Stress Relief for a Cause is one ingenious fundraiser

his marketing team developed.

Tender Touch For All therapists visit a location,

such as a college campus during finals week, and
offer 10- to 15-minute chair massages. All proceeds
benefit Tender Touch For All, and if a location signs
up for a minimal monthly program—one therapist
for three hours—for 12 months, it can fund a
program at a senior care or veterans facility for an
entire year.

56
For Silverstein, offering a holistic option at reduced-
rates for vulnerable populations is something he
hopes catches on and grows far and wide. While
not a massage therapist, he greatly respects the
profession.

“I’m just someone who sees the benefits,” he said.

“It’s a hands-on approach that makes people
healthier physically, mentally and emotionally.”

Seraine Page is an award-winning journalist

based out of Southwest Florida. She enjoys writing
about health, wellness and travel. Her work has
been published in Discover Kitsap, A AA Journey
Magazine, DAYSPA Magazine, Bainbridge Island
Review, and others. She has written many articles for
massagemag.com, including “A Whole-Family Model
of Massage” and “This is How to Get a Job Working
on Olympic Athletes.”

57
IASTM
Your New Massage Tool:
Instrument Assisted Soft
Tissue Manipulation
By Jill Magee

M
any massage therapists
use tools in their massage
sessions. Instrument Assisted
Soft Tissue Manipulation (IASTM) is
rapidly becoming a popular tool and
something for massage therapists to
look into for use in their practices.

IASTM is a manual therapy approach to musculoskeletal

injuries using tools. IASTM tools can be used to address
fascial restrictions as well as areas of the body that exhibit
soft tissue fibrosis, chronic inflammation or degeneration.
As a rehab tool, IASTM reduces pain and increases range
of motion.

There are many things to consider when purchasing and

using IASTM tools in your practice, including: how the
tool feels to you and the client you are working with; how
it fits into your practice; and the type of massage you do.
The price of the tool and how much you want to use the
tool in your work should also be considered.

IASTM IN SESSION
Understanding how the body responds to the different
uses of IASTM tools will help you utilize the tool to its full
potential with your clients. Methods and uses of IASTM
tools differ widely among practitioners. This is for you to
decide and educate yourself on.

One of the ways IASTM tools work is by causing

stimulation to an area of work, which initiates a local
inflammatory response. The controlled microtrauma
facilitates the body’s healing.

58
 How the client responds to the tool is a big part of
why it’s a good idea to have multiple tools on hand.
Different tools work better on different parts of
the body. Some tools offer varied sides and edges,
so they are multi-use. Different tools also provide
different session outcomes. Open communication
with your client on feel is key. Talk to your clients
and get their feedback. Some clients prefer a lighter-
weighted tool with blunt edges or a longer tool with
a sharper edge.

Some massage therapists feel they aren’t interested

in tools because they do more “soft tissue and
relaxing massage”—but taking a tool course or
diving into how adding a tool to your practice can
help your clients will support your understanding
of tools, and aid you in communicating a tool’s
benefits. It’s all in how you use the tool. IASTM isn’t
just for deep tissue or sports massage. Bamboo
You can use a tool that sticks can provide a nice, even glide to relax the
lets you feel the body body, for example. Look into adding tools to your
relaxation massage as well.
more and therefore
acts as an extension of You can use a tool that lets you feel the body more
and therefore acts as an extension of your hand
your hand... so that you can feel what it is doing to the tissue
underneath. You can use tools for varying reasons
and outcomes desired for clients.

Oftentimes I use an IASTM tool to locate issues on

my clients. I’ll run the tool lightly over the muscles
and feel if there is any congestion in the tissue. Then
I’ll use the tool to address the problem area. I think
the old notion that tools are only for aggressive
work is finally fading, and the new science on how
therapists can utilize tools is coming out.

I encourage you to map out why you want to add

IASTM tools to your practice and then look up the
varying educational courses that correspond with
the outcomes you want for your clients. Taking
courses on multiple methods is always a good
option and keeps you updated on continuing
education and new methods.

59
I’ve taken courses and talked with educators of
most of the IASTM methods, so I can easily talk to
clients about their options and how tools added to a
session can help them.

Using outdated methods or unproven science with

IASTM tools damages the reputation of massage
therapists, so keeping updated and educated is a
must. Some clients don’t understand the varying
options, and when you pull out tools they might
get a little nervous. In my practice, I talk with them
about options and how the tools work and feel—
and I have yet to have any clients not want me to
use tools with them.

PROPER CARE
Hygiene is a big factor when you use tools. Use
alcohol to wipe tools off and regularly clean all of
your tools thoroughly. I have a sports performance
business, and staph infections are something clients
deal with in the locker room—and if tools aren’t
cleaned properly, it can easily be spread. If you
use the tools on feet, you must either wipe off the
tool or have multiple tools available so when you
work on other parts of the body you won’t spread
bacteria or germs.

Keep alcohol wipes close by and also soak or spray

tools with 91 percent isopropyl alcohol after every
use to keep them clean. Keep your tools in a clean
carrying case so they don’t get nicked up or dirty
when you travel.

You can use an emollient like a beeswax mix or

coconut oil for better glide for the client. Take out
what you need or apply it to the clean tool so that
cross contamination between clients doesn’t occur.

TOOLS FOR LONGEVITY

Many massage therapists have added tools to their
practices because doing so will help keep them
working longer with less stress on their hands and
bodies.

60
 When incorporating tools into massage work,
ergonomics is one of the first things to look at. How
a tool feels to you and the client is a big part of
finding the right tools for your practice. Many of the
massage therapists I talk with say how the tool fits in
their hand and its workability over the course of the
day is a big part of why they choose the tools they
do.

In my massage therapy education, we learned about

tools and how to use them and were encouraged
to try everything from the expensive, professionally
made stainless steel tools to the blunt end of
a butter knife and a thick plastic soup spoon. I
encourage you to try multiple tools and have a few
on hand in your practice.

I own both stainless steel and plastic tools. I

personally like the feel of the stainless steel over
plastic, but I travel quite a bit with my athlete
IASTM tools can clients and having a plastic tool is necessary for
be expensive, but TSA compliance when I have a tool in my carry-on
luggage. I also work with tools in different sizes. I see
are well worth the multiple clients a day and work long hours, so grip is
investment. important for me because my hands will hurt if the
grip isn’t right for my hand. I also change up how
I hold a tool and how much pressure I use during
sessions.

CHOOSING TOOLS
IASTM tools can be expensive, but are well worth
the investment. I suggest choosing a tool company
that you can have ongoing communication with
and that has education and support associated with
their tool. Then you can be a part of a community,
and stay up-to-date on new science and in contact
with others using the same tools. Talking to people
who utilize tools in their practice and have similar
backgrounds and work is another great way to learn
various ways to use tools and options in client care.

The great thing is, as the popularity of IASTM use in

massage practices increases, affordable options and
education will also increase with demand.

61
Many popular product companies have now
introduced IASTM tool options and education into
their product lines. Make sure the IASTM tools and
education you are considering are high-quality
products by looking at reviews and what other
reputable massage therapists are using in their
practices. Be diligent in looking at the quality of the
product and how you can use it.

Overall, education and experience with IASTM goes

a long way toward having a positive outcome with
your clients. It took me awhile to feel comfortable
using tools in my practice because I rely so much
on the feel of the tissue when working with my
clients, but after much practice and trying different
methods and education, I can’t imagine not utilizing
IASTM in my work.

My clients have been great with feedback and even

have their favorite tools for use in their sessions. The
use of IASTM tools in massage therapy is growing,
and it is time to look into it for yourself and for your
clients.

Jill Magee, CMT, is an expert in the field of body

mechanics and muscle balance with specialization
in athletic assessment and corrective training. She
is a RockTape ambassador and RockFit instructor,
holds a bachelor’s degree in exercise science and
sports coaching, and is a certified personal trainer.

62
LIGHT AND LASER THERAPIES
The Return of
Color Light
Therapy
By Ronel Corbin

C
olor light therapy, also
called chromotherapy, is the
therapeutic use of light to
improve health and is re-emerging as
an “old new age” therapeutic option
embraced by some health care
practitioners.

Proponents of color light therapy healing say it can

help prepare a client’s body for massage, achieve more
profound results and induce deeper levels of relaxation.

A COLORFUL HISTORY
In 1903, Niels Ryberg Finsen, the developer of a device
that produced synthesized light, was awarded the Nobel
Price in Medicine for this discovery. Since that time, the
health benefits of color have been studied but not in
depth.

For one study on the effect of color on the body, see

“The Effects of Baker-Miller Pink on Biological, Physical
and Cognitive Behaviour,” published in the Journal of
Orthomolecular Medicine.

Additionally, according to color therapist Constance Hart,

“In 1938, the Worchester State Hospital in Massachusetts
did effective testing on patients with colored lights,
revealing that red had a stimulating effect while blue had
a soothing effect.”

In 1958, Robert Gerard, Ph.D., of UCLA, did substantial

testing to [indicate] that blood pressure increases
under red light and decreases under blue light. (Color
Psychology and Color Therapy, Birren, 1950.)
63
 And in the article “Let There Be Light; The Healing
Art of Spectro-Chrome,” Steven Ross, Ph.D., wrote,
“The effects of color and light on the human
system are subjects of scientific investigation …
An example of this effect is found in the medical
practice of treating premature babies with Bilirubin
Syndrome (jaundice) by exposing them to blue
light.”

BATHE THE BODY WITH COLOR

LIGHT THERAPY
Meanwhile, some health care practitioners are
turning toward light and color therapies. Vanessa
Cisneros, a doctor of Chinese Medicine practicing
at the Healing Elephant Clinic in Miami, Florida, has
dedicated her professional life to the combined
learning of color, light and sound therapies, which
...some health care can transform the mind and deeply heal the body.
Cisneros serves on the board of the International
practitioners are Light Association and was invited to represent it at
turning toward light the recent Nobel Peace Prize concert in 2016.

and color therapies. “I can produce quicker and more accurate results
with color and sound than with any other therapy,”
Cisneros said.

Cisneros says she takes color light therapy very

seriously and uses only authentic color therapy tools
that have the correct healing frequency.

She bathes the body in light with the Spectro-

Chrome system, which dates back to the late 19th
century and uses the best source of light from an
incandescent bulb that emits a selected continuous
light spectrum. When combined with specific color
filters, this spectrum supports healing.

Some of the other color tools she uses to apply color

to smaller areas are the Bioptron and the Molimed
color-light system. The Bioptcron, in particular, she
says, reduces swelling and inflammation.

64
Directing focused colored lights on acupressure
points stimulates the healing energy that “naturally
occurs in our bodies,” according to text on the
business page of Sound Color Acupuncture. “Color
can assist with emotional releases, a deeper sense
of self, which brings about insight, clarity and
harmony. It is very useful in relieving stress and
anxiety,” that site said.

Cisneros says she has learned much of what she

knows from attending educational conferences
where she is exposed to the latest therapeutic
uses of color light therapy as well as the latest
equipment.

As Darius Dinshah noted in the article, “Color

Therapy: An Old New Age Therapeutic Option,” there
is “a difficult point for many to understand: How
can colored light possibly cause a physiologic effect
inside a human (or animal) body?”

TWO RECEPTOR ORGANS

Color light therapy can establish or improve health
in a gentle, biophysical way. In the human body,
there are two receptor organs for light, which are
formed during embryonic development: the eyes
and skin. Besides what we see through the eyes,
colors do not in fact exist as such; they exist only as
wavelengths that also contact the skin.

An example of this effect is found in the medical

practice of treating premature babies with Bilirubin
Syndrome (jaundice) by exposing them to blue
light.“Light applied to the skin causes a chemical
reaction (photo-oxidation) in blood circulating
under the skin, effectively lessening bilirubin levels
with the aid of the liver,” Dinshah said.

Color combines both physiological and physical

characteristics. The two most studied colors for
treatment are blue and red light, and it has been
established that red corresponds to the stimulating
effect of the sympathetic nervous system, while
blue affects the regenerating and relaxation of
parasympathetic nervous system.

65
“Additional light exposure is well-known to cause
a beneficial change in seasonal affective disorder
(SAD), a condition believed to be caused by
insufficient light energization through the eyes to
the hypothalamus thence to the pituitary gland,
which controls the endocrine system,” said Dinshah.
There is no question that light, color (and sound)
can be an important therapeutic tool that aid
everyone. They will allow for deeper relaxation and
improve the healing response from the body after a
massage.

Ronel Corbin is a physician of Chinese medicine

who has been in the holistic health and wellness
field for more than 24 years. She wrote this article
on behalf of The International Light Association,
which will hold its 14th Annual Conference April
30 to May 3 in Fort Lauderdale, Florida. Hosted
in North America for the first time in six years,
the conference, themed “The Power of Light,” will
feature presentations from 17 of the most renowned
light therapists and researchers from across North
America, Europe and Asia.

66
MEDICAL MASSAGE
New York Hospital
Makes Medical Massage
Therapy a Priority
By Christina DeBusk

S
isters of Charity Hospital in
Western New York State is
a health care institution that
offers hospital-based medical
massage therapy.This program
gives patients access to a variety of
massage services, including deep
tissue, orthopedic and Swedish
massage.

Founded in 1848 by the Daughters of Charity of St.

Vincent de Paul, Sisters of Charity Hospital reports that it
is Buffalo’s first hospital.

Massage therapist and massage department manager

Susan Hanlon has been with Sisters of Charity for nine
years in April, with 18 years’ experience as a massage
therapist in general.

Hanlon says that roughly 80 percent of Sisters of Charity

Hospital’s medical massage therapy clients are seen on
an outpatient basis, mainly due to no-fault (auto accident
injuries) or workers’ compensation claims.

The massage therapists at the hospital also receive

orders from physicians to see patients in the hospital.
For instance, on Wednesdays, Hanlon and her team can
often be found providing services to patients with cancer.
“We do 10 to 15-minute massages on them while they’re
getting chemo,” she says.

67
The National Center for Complementary and
Integrative Health (NCCIH) shares that this can be
beneficial, as many reviews and studies have found
that, “at least for the short term, massage therapy
for cancer patients may reduce pain, promote
relaxation, and boost mood.”

The NCCIH also adds that special precautions must

be taken with patients with this type of medical
condition, such as not massaging directly over
tumors and avoiding areas that could be sensitive
due to radiation therapy.

HOSPITAL-BASED MEDICAL
MASSAGE THERAPY
In fact, it is these types of situations that Hanlon
says drew her to providing massages in this type
of setting. It’s more of challenge, she says, because
each patient is different in regard to his or her
massage needs based on the injuries sustained.

This gives her the opportunity to practice different

techniques, a factor that Hanlon also enjoys. “I
like the variety,” she says, “and not doing the same
technique over and over again.”

Increasing the challenge and the variety even more,

Hanlon shares that, many times, what works for a
patient one time may not work for them the next
time.

It takes “a lot of communication,” she says, to ensure

patients are receiving the hospital-based medical
massage therapy they need.

Of course, the main difference between seeing

massage therapy patients in a hospital setting is
that there are more physical medical issues to deal
with says Hanlon, whereas at a spa the focus is often
on relaxation.

TRAINING REQUIREMENTS
To work in this type of setting in New York, massage
therapists must be licensed by the state, says
Hanlon.

68
These license requirements include receiving more
than 1,000 hours of instruction in massage-related
subjects and passing the New York State Massage
Therapy Examination.

Alternatively, if massage therapists are licensed

elsewhere and want to transfer to New York, they
may be eligible for licensure by endorsement,
which also carries the requirement of 1,000 hours of
education and passing a comparable exam.
Massage therapists employed by a hospital should
possess a liability insurance policy that covers
many modalities and protects them in case of client
accident or injury.

Although no special training is mandated to provide

massage services within a hospital setting, Hanlon
says that massage therapists interested in providing
services to hospital patients should take some
classes in myofascial release, specifically. She also
advises that flexibility is required, as methodologies
used vary tremendously.

Christina DeBusk is a freelance writer dedicated

to providing readers relevant, research-backed
content related to health and wellness, personal
development, safety and small business ownership.

69
MYOFASCIAL RELEASE
Thumb Pain and The
Therapist: Advanced
Myofascial Techniques
By Til Luchau

T
hank goodness for the thumb.
Its unique opposability allows
us to grasp, hold, squeeze
manipulate; its enormous strength
gives power to our grip; and its
unmatched sensitivity (matched
by an colossal portion of the brain
dedicated to its sensations) helps us
feel the most minute differences in
texture, size or pressure.
Thumbs are good at so many things that they are
commonly overused, causing tissue and joint irritation,
pain, and eventual damage. For example, the increasing
use of small-device keyboards means that thumbs are
more active than ever in awkward, repetitive movement
patterns that are needed to type out texts, posts, and
tweets.

Massage and manual therapists are vulnerable to thumb

over-reliance. In our Advanced Myofascial Techniques
seminars, we see practitioners in most every workshop
suffering from the effects of thumb overuse; sometimes
the symptoms are severe.

The structure of the thumb gives it special qualities but

predisposes it to unique vulnerabilities. The thumb’s joints
are the most mobile of all the digits, allowing the thumb
its distinctive opposability and adaptability.

70
 As with the fingers, the articular ligaments provide
some stability, but because of its highly mobile
joints, the thumb gets most of its stability from
coordinated active muscular tension. The muscles
of the thumb are arrayed in all directions around it,
much like guy-wires around a pole or mast.

Moreover, these muscles stay busy; given that

so much of the thumb’s stability comes from the
tension of these muscles, most thumb muscles are
active during most thumb movements.1 It is no
wonder our thumbs get tired.

The origins of the word “thumb” go back to the Old

English word thūma, from the Indo-European word
tum or “swelling” (which also gave us “tumor” and
“thigh”). The swelling in the thumb’s case is thought
to be its round shape, or the thumb’s rounded
...the thumb gets most thenar eminence (the muscular portion of the palm
of its stability from at the base of the thumb).

coordinated active The thenar eminence often takes the brunt of

thumb overuse and repetitive strain. There are at
muscular tension. least two reasons for this:

1 Since the thenar eminence contains the primary

muscles involved in finger-to-thumb gripping,
activities or occupations that involve repeated or
prolonged use of small instruments or fine tools
(dentistry, electronic manufacturing, handwriting
and so on) can be associated with thenar eminence
overdevelopment, fatigue and pain.

2 Since its three constituent muscles (abductor

pollicis brevis, flexor pollicis brevis and
opponens pollicis) are some of the thumb’s bulkiest,
the thenar eminence also provides the lion’s share
of palm-to-thumb grip strength. (For example, when
using large tools such as hammers, shovels, or in
manual therapy techniques involving squeezing or
kneading.)

71
THE CARPAL TUNNEL CONNECTION
Overuse of the thenar eminence is also intimately
connected to neurovascular compression,
inflammation, and the symptoms of carpal tunnel
syndrome (such as hand, palm or wrist pain;
numbness; and tingling).

Because all three of its muscles have direct

connective tissue continuity with the carpal tunnel’s
flexor retinaculum, repeated or heavy use of the
thenar muscles can contribute to tension, strain
or thickening of this carpal ligament, which could
narrow the carpal tunnel space and compress its
contents.

This thenar eminence/carpal tunnel connection

works in both directions—the thenar muscles
can contribute to tunnel compression, and tunnel
compression can cause thenar pain. While the ulnar
nerve, which does not pass through the carpal
tunnel, innervated most palm muscles, the thenar
eminence is typically innervated by the median
nerve, which does pass through the carpal tunnel.

Compression and irritation of the median nerve

is most often responsible for the pain of carpal
tunnel syndrome. In fact, thenar eminence pain is
one of the most common effects of median nerve
compression and atrophy of these muscles is a
possible long-term result of unresolved carpal
tunnel neurovascular compression.

Direct myofascial manipulation of the thenar

eminence has been observed to lessen carpal tunnel
compression symptoms, but if you suspect that your
client has muscle atrophy accompanied by thenar
or wrist pain, referral to a rehabilitative specialist is
clearly indicated.2

It is also important to remember that median nerve

symptoms can be related to irritation anywhere
along the median nerve’s length, from the cervical
nerve roots, distally through the brachial plexus, or
in the arm, elbow or forearm—not just in the wrist
or hand.

72
 THENAR EMINENCE TECHNIQUE
Carpal tunnel symptoms are not the only reason
why we would work the thenar eminence. Anyone
who uses his or her hands will truly appreciate
focused local work with the structures of the
thumb’s base.
The Thenar Eminence Technique uses the knuckles
of the practitioner’s soft fist. Note that a soft fist is
open, which makes it more sensitive and adaptable
than a hard, closed fist. In this position, hand
stability is achieved by aligning the arm, carpal and
metacarpal bones, rather than by contracting the
muscles.

This means that the wrist must be in a neutral or

slightly flexed position. As with the thumb joints,
avoid wrist hyperextension
The Thenar Eminence
Technique uses With your non-working hand, cradle your client’s
hand from below. This will provide you with extra
the knuckles of the sensitivity and control, as you can tune the position
practitioner’s soft fist. of your client’s hand to allow the soft fist to engage
just the right layer.

Use your soft fist’s MPJ joints (the proximal

metacarpal phalangeal joints at the base of the
fingers, or the first knuckle) to feel into the hand’s
layers. With the broad tool of the fist, you can anchor
larger sheets of palmar fascia.

Once engaged, ask for slow, active client movement:

“Let your hand open and close”; or “Open your
thumb.” This will slide and differentiate the tissue
layers under your pressure, and give clients control
over the technique’s intensity.

Work from the center of the palm outwards, starting

superficially with the palmar fascia and then
working deeper, layer-by-layer, until you are deep
within the thenar eminence.

73

If your client’s thumb
symptoms continue to
be troublesome, a shift in
your approach or in the
client’s habits is indicated.
Although there is some sliding involved, I suggest
not using oil or lotion, as the friction will provide
a therapeutic tension to the palmar and muscular
fascias; it should not be uncomfortable if you work
slowly enough.
As always, be sure your pressure is not too painful
for your client. If he or she is gripping or contracting
elsewhere in the body as a result of your pressure
or speed, you are working against yourself. Slow
down and let the layers melt away. Think about how
much of the brain’s sensory cortex this little area
occupies—so why rush it?
If your client’s thumb symptoms continue to be
troublesome, a shift in your approach or in the
client’s habits is indicated. Given that the thumbs
are so active, you may find that clients with high-
demand occupations or activities may need this
kind of work on a regular basis in a maintenance
and prevention capacity.
THANK YOU, THUMBS
Of course, the Thenar Eminence Technique is
especially suited to bodyworker self-care; just lay
your own hand down on the table at the end of your
day and lean into your thenar eminence with the
knuckles of your soft fist (or your elbow).
Slowly open and close your “client” hand, releasing
any thumb tension and fatigue. This would be a
great time to say a silent “thank you” for the wonder
of thumbs—thank goodness we have them.
74
Excerpted from Til Luchau’s Advanced Myofascial
Techniques, Volume 1: Shoulder, Pelvis, Leg and
Foot, Chapter 12: The Thenar Eminence. Handspring
Publishers, 2015.

Footnotes

1. Austin, NM, (2005). “Chapter 9: The Wrist and

Hand Complex.” Levangie PK, Norkin CC,
eds. (2011) Joint Structure and Function: A
Comprehensive Analysis (4th ed.). Philadelphia: F.
A. Davis Company.
2. Goodwin, S. (2003, December/January). Carpal
Tunnel Syndrome and Repetitive Stress Injuries.
Massage & Bodywork, 66-78.

Til Luchau is the author of the Advanced Myofascial

Techniques DVDs and books (Handspring Publish-
ing, 2016), a Certified Advanced Rolfer and lead
instructor in the Advanced-Trainings.com faculty,
which offers online learning and in-person seminars
throughout the United States and abroad.

75
ORTHOPEDIC MASSAGE
Orthopedic Perspectives
on Tendon Pathology
and Treatment
By Whitney Lowe

M
assage therapy is used with
much success for treating
chronic overuse tendon pain,
which is one of the most common
soft-tissue disorders.

However, there are also situations in which the treatment

seems less effective. Current research is helping us learn
more about tendon structure, function and what is
behind painful tendon disorders. A better understanding
of these common tendon disorders helps us be more
effective in the treatment room.

Tendons are composed of multiple strands of collagen

fibers primarily oriented in a parallel direction. This
parallel fiber orientation provides the greatest tensile
strength in a longitudinal direction.

The primary mechanical load on tendons is the pulling

force of muscle, so longitudinal tensile strength is very
important.

The main function of tendons is to connect muscle to

bone and thereby transmit the pulling force of muscle
contraction to the bone. The shape and size of the
tendons are dictated by the muscles they are attached to
and the force loads those muscles generate.

Some tendons are small and rounded, such as the distal

wrist flexor tendons. Others, such as the iliotibial band,
are large and sheet-like, so there is much more surface
area for muscle attachment.

76
 TENDON PATHOLOGIES
The main pathology involving tendons is pain from
chronic overuse or repetitive loading. Previously this
condition was called tendinitis as it was believed to
be an inflammatory reaction to excessive loading.

Once research studies established the absence of

inflammatory activity in many tendon disorders,
these problems were more commonly referred to as
tendinosisor tendinopathy simply indicating some
type of pathology in the tendon.

The primary clinical symptoms of tendinopathy

included localized tendon pain (especially with
loading), tenderness to palpation (usually increased
when the tendon is loaded) and impaired function.

Tendinopathy can usually be traced back to one or

more key factors:
Similar to compression
• Chronic tensile loading (excess pulling from
pathology excessive muscles). The chronic tensile load frequently
friction during repetitive occurs with repetitive motion disorders, such
as those present in many occupations or
movement plays a part recreational activities.
in tendon pathology. • Compressive loading. While tensile
loading from repeated muscle pulling is the
most common cause of tendon disorder,
repeated tendon compression can also cause
tendinopathy.

There are numerous locations where tendons are

compressed against a nearby bony prominence. An
example is the insertion of the Achilles tendon at
the calcaneus (Figure 1). The repeated compression
of the tendon can lead to degenerative changes in
tendon structure.1

• Friction. Similar to compression pathology

excessive friction during repetitive movement
plays a part in tendon pathology. Tenosynovitis
(inflammatory reaction between the tendon and
surrounding synovial sheath under retinacula
in the distal extremities) is a good example of
friction stress on the tendon.

77
 • Medications. We have known for some time
that corticosteroids (cortisone injections) and a
family of antibiotics called fluoroquinolones are
associated with tendinopathy.

Medication induced tendinopathy appears to affect

large tendons (those attached to powerful muscles
and significant tensile loads) the most. However,
smaller tendons such as the wrist and hand may be
affected as well.2

Despite our understanding of these common causes

of tendinopathy, there are still some mysteries of
its presentation. It is baffling why tendon pain is so
prevalent, persistent and why it comes and goes
with little reason in many cases.

Starting in the 1980s high-tech imaging studies

caught many clinicians and researchers by surprise
when they showed an absence of inflammatory
Medication induced cells in many overuse tendon disorders. Since that
time there has been a consistent move away from
tendinopathy appears focusing on an inflammatory component of these
to affect large problems.

tendons the most. However, more recent research has suggested that
there may actually be inflammatory activity going
on in some cases and at certain stages, so the idea
of an inflammatory component should not be
abandoned.

The model of the tendon pathology continuum

described by Cook and Purdam (described later in
this article) gives a good explanation for why we
may sometimes encounter inflammation and other
times not.3

WHAT MAKES TENDONS HURT?

Formerly the primary idea behind the pain of
tendinopathy was that the pain was a direct result of
tissue damage within the tendon.

The presence of localized pain that is persistent with

palpation and specific tendon loading reinforce this
idea.

78
 However, recent imaging studies have called that
idea into question as there are numerous cases of
tendon damage evident on imaging with no pain
at all. This would suggest other factors may also be
involved in chronic tendon pain.

So, what causes a tendon to be painful? It is clear

that excess tendon loading is a primary factor
in most painful tendon disorders. However,
dysfunctional signal processing in the nervous
system is now recognized as a likely cause for pain
in many of these conditions, and this has important
ramifications for treatment.4

Another interesting pattern with tendinopathy is

that there seems to be a warm-up effect. Patients
frequently report symptoms gradually diminish with
activity, but often recur with great intensity after the
It is clear that excess activity has ceased. It is likely that there is some type
tendon loading is of neurological gating or nociception inhibition
during activity that is involved in this process.
a primary factor in
Current research suggests a role for the central
most painful tendon nervous system in ramping up the alarm of the
disorders. body’s pain system. Essentially this occurs when the
central nervous system gets out of calibration and
sets off the pain alarm when it shouldn’t.

This is a process called central sensitization and

it appears to be linked with many chronic pain
conditions. It is likely that long-duration tendon
disorders may have some degree of central
sensitization as a primary cause of the persistent
pain.

One possible suggestion for the cause of tendon

pain is a ‘mis-regulation’ of tendon load and the
perception of potential damage which then leads
to persistent pain. If this type of central neurological
processing error is occurring, then local tissue-based
interventions aimed directly at the tendon may have
limited effectiveness.

79
A NEW MODEL OF TENDON
PATHOLOGY
Cook and Purdam suggest that common overuse
tendon disorders may not be just one type of
pathology, but instead lie on a continuum. This
could be one reason that various symptoms are
inconsistent and treatments are inconsistent in their
effectiveness. Treatment success is more dependent
on what stage of the continuum the condition is
at.(3)

Cook and Purdam’s three stages of the

continuum(3):

• Stage 1: Reactive Tendinopathy: non-

inflammatory phase with tendon thickening—
often from a burst of physical activity. May
be either excessive compressive or tensile
loading—often seen in younger individuals.

• Stage 2: Tendon Dysrepair: similar to

reactive tendinopathy but with greater matrix
breakdown. Hard to identify this stage, but there
may be some focal tendon thickening and some
more significant changes visible on imaging
studies. An older person with less tendon
adaptability may move more quickly into this
stage of degeneration.

• Stage 3: Degenerative Tendinopathy: seen

more common in elderly people, but also
present in younger individuals with chronically
loaded tendons that have not been able to
adapt. Typical presentation is middle aged
athlete (the weekend warrior) with Achilles
tendon pain and thickening.

There are often repeated bouts of tendon pain that

seem to occur as the person is gradually working
toward some degree of adaptation. If extensive,
degenerative tendinopathy can lead to rupture.
It is much harder to rebound from degenerative
tendinopathy once it has reached this stage.

80
 There is a strong suggestion that tendon loading
and soft-tissue treatments like massage are
beneficial in the healing process, especially at
specific stages along this continuum. Some of
the benefits may be related to actual mechanical
loading of the tendon and in other cases it may be
related to regulation of neurological processes that
help decrease pain.5

KEY TAKEAWAYS FOR ASSESSMENT

AND TREATMENT
• Physical examination is still very important
to identify potential tendon pathology and
evaluate if there is consistency with diagnostic
imaging results that may have been performed.
Presentation clinical factors are very important,
so comprehensive physical assessment is crucial.
Tendon disorders
• Consider that the tendon pathology may be at
are very common varying stages depending on your client’s age
in clients seeking and activity levels, for example.

massage therapy. • Treatment approaches should focus on methods

that are not just tissue oriented (like friction).
Those that engage higher-order neurological
processes (like active engagement techniques)
may have added benefit for tendinopathy.

• The more frequently treatment, loading and

movement strategies are reinforced, the better
and more long-lasting those effects are likely to
be.

• Tendon disorders are very common in clients

seeking massage therapy. Keeping up with
current research, such as that presented in
this article, helps us better understand these
conditions, which helps us deliver the most
effective treatment strategies for our clients.

81
Footnotes

1. Cook JL, Purdam C. Is compressive load a factor

in the development of tendinopathy? Br J Sports
Med. 2012;46(3):163–8.
2. Berger I, Goodwin I, Buncke GM.
Fluoroquinolone-Associated Tendinopathy of
the Hand and Wrist: A Systematic Review and
Case Report. Hand. 2017;12(5):NP121-NP126.
3. Cook JL, Purdam CR. Is tendon pathology a
continuum? A pathology model to explain
the clinical presentation of load-induced
tendinopathy. Br J Sports Med. 2009;43(6):409–
16.
4. Rio E, Moseley L, Purdam C, Samiric T, Kidgell
D, Pearce AJ, et al. The pain of tendinopathy:
Physiological or pathophysiological? Sport Med.
2014;44(1):9–23.
5. Rio E, Kidgell D, Moseley GL, Gaida J, Docking
S, Purdam C, et al. Tendon neuroplastic
training: changing the way we think about
tendon rehabilitation: a narrative review. Br J
Sports Med[Internet]. 2016 Feb [cited 2016 Feb
8];50(4):209–15. Available here.

Whitney Lowe, LMT, directs the Academy of Clinical

Massage. He teaches continuing education in
advanced clinical massage through the academy,
and offers an online training program in orthopedic
massage. He is a regular contributor to MASSAGE
Magazine. His articles include “Clinical Reasoning as
a Component of Orthopedic Massage.” This article
was excerpted from Lowe’s upcoming new edition
of Orthopedic Assessment in Massage Therapy, due
out in 2019.

82
STONE & SHELL THERAPY
How to Use Hot
Stone Meridian
Technique
By Patricia Mayrhofer

T
he Hot Stone Meridian
technique involves the artful
application of pressure via
warmed stones along the body’s
energetic pathways, or meridians.
The value of working with massage stones has been
misunderstood. Many therapists and clients alike
think massage stones constitute more of a pampering
treatment than a therapeutic session; however, there are
tangible benefits of working with the heat and energy of
stones.

Heated stones make deep penetration into the tissue

easy to achieve. In addition, a greater release of muscle
stress and strain helps to release toxins. Pain reduction is
an additional benefit of this technique.

M. Cathy Calabria-Kane practices several touch

techniques, including massage therapy, shiatsu and hot-
and-cold stone techniques.

After working as a therapist for 10 years, she decided to

incorporate stone therapy into her shiatsu sessions—
and the benefits, she says, are evident.“It has been a
tremendous assist in speeding up the healing of my
clients, not just physically but also emotionally,” she says.

SHIATSU’S PATH
Tokujiro Namikoshi is credited with the development
of shiatsu, which is based on Western anatomy and
physiology. (The word shiatsu means “finger pressure” in
Japanese.)

83
 At age 7, Namikoshi wanted to help his mother, who
was suffering from rheumatoid arthritis, and began
using pressure with his thumbs and palms to give
his mother some relief from pain.

Namikoshi went on, as an adult, to found the

Japan Shiatsu College in 1940. A student, Shizuto
Masunaga, created the zen style of shiatsu, which is
based on traditional Chinese medicine.

Another practitioner, Tadashi Izawa, established

meridian shiatsu, which incorporates the meridian
theory of traditional Chinese medicine into shiatsu.

This Japanese technique has evolved into yet

another healing modality: the Hot Stone Meridian
technique, which draws upon both shiatsu and
Swedish massage to offer clients a potent means of
Each of the 12 meridians effecting positive physiological change.
mirrors a particular RELEASE ENERGY BLOCKAGES
organ or function of the Each of the 12 meridians mirrors a particular organ
or function of the body, and each is an energy
body, and each is an channel related to acupuncture points.
energy channel related
Practitioners of Asian healing arts believe meridians
to acupuncture points. connect all body parts. The Hot Stone Meridian
technique was developed for Nature’s Stones by
massage therapist and shiatsu practitioner Elisabeth
Ott, in cooperation with shiatsu practitioner Carol
Livesay, and is based on the principles of meridian
shiatsu.

In shiatsu, disease is regarded as the result of an

energy blockage or imbalance. Therefore, shiatsu
is about balancing the body by directly addressing
points along the meridians. Shiatsu points are
located along meridians, and are related to the
central and autonomic nervous systems. Treatment
involves the whole body.

In the Hot Stone Meridian technique, heat from the

stones can release stagnation in the meridians more
easily than just the fingers, thumbs and palms.

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 The energy held by the stones is undeniably
important in affecting the movement of stagnation
in the meridians. Stones have developed a powerful
energy after thousands of years of being tumbled
in oceans and rivers and being exposed to the sun,
moon, winds and tides.The energy of the stones
combined with the energy of the practitioner allows
the meridians to release their stagnation with
more ease.

A focused practitioner who is sensitive to energy

provides an extra dimension by connecting to the
body with both hands; one hand works and one
hand feels the pulse of the body.

“After determining which meridian to begin

treating, the giver places the stones along the
pathway, gently supporting the opening of the
The therapist works with channels and assisting the chi to move freely,”
no oils or lotions, and Calabria-Kane explains.

applies pressure with “The stones allow the giver the freedom to move
her fingers, thumbs and to other pressure points on that meridian while
supporting the receiver throughout the entire cycle,
palms to release the no matter where the giver is working.” Releasing
the shiatsu points will unblock and rejuvenate the
stagnation in points on meridians that run throughout the entire body,
the meridians. aiding in healing mind, body and spirit.

“Once the giver gently removes the stones from the

specific points along the meridian, the giver can
begin thumbing and palming over these pathways,”
Calabria-Kane says. “The heat from the stones
stimulates circulation of chi to flow freely through
the channel, and the stones support me, as the
giver, in assisting the opening of blocked meridians
so the physical body can begin the process of
healing itself.”

Shiatsu is usually performed on a floor mat, and the

client is always clothed. The therapist works with
no oils or lotions, and applies pressure with her
fingers, thumbs and palms to release the stagnation
in points on the meridians. Stretching is also
incorporated.

85
The Hot Stone Meridian technique is performed
on a table rather than on a floor mat, for several
reasons: Because hot stones need to be repeatedly
replaced during a session, the practitioner would
have to interrupt his rhythm to stand up to get
fresh stones. He would also have to be aware of the
placement of the heater so as not trip on it. Also, it
would be tiring for the practitioner to repeatedly
get up and down.

It was determined, after much consideration and

trial and error, the best and safest method was to
practice on a massage table. Shiatsu practitioners
will have to adjust to working on a table instead
of the floor. They may find it will take some time to
overcome their uncertainties, but they will soon see
they can connect effectively when their client is on
the table.

STRESS RELIEF
Western massage uses long, smooth strokes,
kneading and palpating layers of muscle tissue
using massage oil, cream or lotion. As you know,
this technique is most commonly performed on a
massage table with the client unclothed.

There are extensive benefits to massage therapy,

including increased circulation, stress relief, pain
relief, reduced muscle spasms and cramps, an
enhanced immune system, reduced postsurgical
adhesions and swelling, releasing of endorphins,
reduced migraine pain, and lessened depression
and anxiety.

Stress relief is one of the most profound benefits of

massage therapy. The American Medical Association
estimates stress is a factor in more than 75 percent
of all illness and disease today.

Shiatsu is said to be a natural way to help people

relax and cope with such issues as stress, muscle
pain, nausea, anxiety and depression. Some say it
contributes to healing specific illnesses, although
this has not been scientifically proven. There are
many clients who attribute their well-being to
shiatsu sessions.

86
 Calabria-Kane recalls one client who commented on
a Hot Stone Meridian technique session by saying,
“‘The floodgates have opened.’

“The stones support my clients to deeply relax and

release on an emotional level, letting go of stored-
up tension and anxiety deep within the connective
tissue,” Calabria-Kane adds.

EAST MEETS WEST

Shiatsu and hot stones are a great combination.
Through the combination of Eastern and Western
modalities, the practice of the Hot Stone Meridian
technique brings a new dimension to shiatsu and
hot stone massage.

Energy and heat combine to achieve a path of good

health. Stretching aids in releasing stagnation in
The ultimate objective the meridians, and heat relaxes the body efficiently,
allowing for a greater stretch.
is to have energy
and blood flow freely The heat from the stones also releases toxins that
in turn help the client to feel less pain. Working the
with no restrictions or meridians that run through each constricted muscle
stagnation. improves the flow of the body’s energy, allowing the
body to heal. The increased flow of energy makes
a person less susceptible to disease and illness,
according to the shiatsu philosophy.

The ultimate objective is to have energy and blood

flow freely with no restrictions or stagnation.
A few shiatsu practitioners have asked whether or
not a Hot Stone Meridian technique practitioner can
really feel the pulse of a meridian through a stone.
This sensation is entirely possible to experience after
studying with an instructor and learning to properly
work with the stones.

The combination of energy from the practitioner

and the stones allows the meridians to release
stagnation more freely. The practitioner will notice
a sensation similar to a hammer pounding as
stagnation releases.

87
PRACTICE SUCCESS
I believe one massage stroke with a hot stone is
equivalent to 10 strokes by hand. The Hot Stone
Meridian technique is a breakthrough for shiatsu
practitioners and massage therapists trained in
working with the meridians.

It offers variety and intensity to a practice, along

with healthy results that keep clients returning.
Education on properly handling the stones is most
important. There are many safety issues that need
to be addressed, such as temperature, pressure and
the care and cleaning of the stones and equipment.
Proper education will produce excellent treatments;
excellent treatments mean happier clients; happier
clients mean a successful practice.

“With all my clients, I encourage sequential

treatments until both the receiver and the giver
feel the balance and harmony of the body, mind
and spirit,” says Calabria-Kane. “In most cases, my
clients have asked to continue stone therapy in their
treatments because of the initial results of feeling
more open and the duration of how well they feel
after a treatment.”

As interest in Asian healing methods grows, by

both consumers and therapists, shiatsu will also
continue to grow in popularity. In today’s economic
environment, therapists need that extra edge to
help them stay successful. The Hot Stone Meridian
technique gives the therapist that needed edge.

Pat Mayrhofer is the founder and president of

Nature’s Stones Inc., a massage-stone training
company offering seminars internationally in many
modalities for massage therapists, estheticians,
shiatsu practitioners, reflexologists, nail technicians,
physical therapists and chiropractors.

88
TAPING
Why You Need to Be
Taping Movement,
Not Muscles
By Adam Wolf

O
ver the course of my 12-year
career as a massage therapist
and physical therapist, my
thought processes have evolved,
compelling my treatments to become
more effective.
For example, by placing more emphasis on the nervous
system than the musculoskeletal system, I have learned
we can create neurological opportunities for change
through touch and movement; kinesiology tape can help
lengthen the opportunity while also helping to guide
movement.

Movement therapies have customarily focused on

isolated muscles rather than motion for treatment
outcomes. However, in reality, the body knows movement
not muscles. Knowledge of isolated muscle is necessary
and yet it doesn’t reflect integrated movement, as
tradition dictates muscles are named for the isolated,
shortening action rather than the lengthening action.

For example, the quadricep can extend the knee and

often does, yet in upright function, the quadricep (along
with tissue above and below) controls knee flexion and
simultaneous frontal and transverse motions. The body
controls and reacts to gravity, ground reaction forces,
mass and momentum, and injury often occurs at the
hypermobile region(s) when it is unable to. (For more
information on this topic, see my book, REAL Movement:
Perspective on Integrated Motion & Motor Control.)

89
 Prior to my introduction to the concept of taping
movement, not muscles, kinesiology taping didn’t
fit into my thought process or treatment paradigm.
I couldn’t rationalize why I’d tape an individual
muscle, let alone distal-proximal or proximal-distal
to facilitate or inhibit it.

Nonetheless, after my introduction to this new

framework of taping motions instead of muscles,
lengthening the skin (not the tape) made sense.
This taping method fits into my philosophy of
modulating the nervous system more than the
musculoskeletal system, recognizing the two
systems are interrelated and interconnected via a
neuromusculoskeletal system.

Fundamentals of my practice include understanding

the principles of anatomy, physiology,
biomechanics, neurology, the mechanisms of pain,
and an ability to apply my understanding logically.
The body knows
A working knowledge of anatomy is important as
motions and how to it allows for easier communication regarding the
control them, while region, and also when tissue needs to be worked in
isolation—similar to how a map provides an idea
the brain knows of where you are. Real life is different from a map—
similar to how a movement paradigm recognizes
individual muscles. individual muscles and isn’t limited to the construct
that they solely produce motion instead of
controlling the presented forces. The body knows
motions and how to control them, while the brain
knows individual muscles.

NEGATIVE FEEDBACK LOOP

Understanding biomechanics is important, because
whether pain is biomechanically driven or not, it
becomes biomechanical if not addressed because
people move around pain, not through it.

In these situations, combinations of tissue on

one side of a joint and body stay short relative to
the other longer side, which remains relatively
lengthened. This leads to tissue not getting fully
long or fully short or experiencing the pressure
changes necessary to pump fluid through the
tissue, resulting in lack of oxygenated fluid moving
through it.

90
 Due to the lack of both pressure change and oxygen
to the tissue, physiological and neurochemical
processes occur, resulting in acidic responses that
can sensitize the nerve peripherally and progress
centrally. In these situations, a concurrent cross-
linking of the tissue- layer interfaces also occur,
limiting the ability to slide past other tissue and
creating a negative feedback loop.

Improving biomechanics even temporarily, what

current research demonstrates occurs with joint-
and most soft-tissue mobilizations, is still valuable,
because changing input provides an opportunity to
create, temporarily, moments of easier movement.
Pain-free movement creates a feed-forward
mechanism, leading to more pain-free movement
and less anxiety around movement.

In other words, changing biomechanics temporarily

opens a neurological window of opportunity that
...tape affects the can be helpful in changing input, recognizing pain is
an output. Kinesiology tape can help the window to
nervous system stay open longer.
more than the For me, an important revelation in practice was
musculoskeletal that tape affects the nervous system more than the
musculoskeletal system. Research demonstrates
system. that various sympathetic processes occur with pain,
including inhibitions and reduced somatosensory
representation in the painful region.1,2Therefore,
early interventions should be geared toward
creating parasympathetic responses and
concurrently driving nonthreatening input to the
affected region.

Put another way, there’s a predictive process

associated with pain, including decreased
proprioception to the painful region and
contributing behaviors to the painful experience.

PAIN IS AN OUTPUT
For someone in pain, changing input is important
because pain is an output. Touch and interaction
with the skin are two effective strategies because
the skin is the body’s largest organ and an extension
of the brain.2,3 Embryologically, skin develops
alongside the brain.

91
In painful situations, often the surrounding skin
has a limited gliding ability in specific directions,
compared to the other side, while also being more
sensitive and more difficult to lift.

Movement—specifically, nonthreatening, controlled

movement that lengthens combinations of tissue
and is based on quality and thresholds—is another
strategy to alter input. Combining movement
with touch stimulates proprioceptors, improving
awareness in space, and also creates input change,
which are all important for behavior change and
improving movement.

TAPING APPLICATIONS
While numerous rationales for kinesiology tape
exist, the primarily applications are for pain,
decompression and neurological re-education,
focusing on the nervous system more than the
musculoskeletal system.

Research demonstrates that those in pain have

limited awareness of the painful body parts in space,
while other research shows that in a functional
MRI, putting a piece of adhesive elastic tape on the
vastus medialis oblique lit up the part of the brain
responsible for the vastus medialis oblique.2

This means that tape can improve tactile acuity and

somatosensory cortex representation, which are
both important for changing output. Research also
indicates that kinesiology tape pulls toward middle,
creating a lifting and decompression effect on the
tissue underneath compared with what’s around it.

Recall that lack of motion results in lack of fluid

being pumped around the body, resulting in less
blood and oxygen reaching the tissue. When this
happens, there’s a cascade of effects that results in
a cascade of events that ultimately limit the slide of
tissue.

92
 Therefore, due to the lifting effect the tape has on
the superficial skin, it can assist in increasing blood
and oxygen to tissue, in addition of providing
a reminder about where someone is or is not
positioned in space, which is important for the
process of learning something new.4

For example, I often see people with cervical,

shoulder or low-back pain who happen to sit for
long periods of time in the same position at their
desk. The behavior of extended sitting is a behavior
to change, and helping people become aware of
pain when in that position will create the awareness
necessary to influence change.

Simple vertical stability strips along the mid-back

can help bring awareness to position, especially
Oftentimes runners when sitting in a bad position that will tension the
tape, alter sensation and bring awareness to poor
experience pain from positioning.
a lack of appropriate
Another example of how tape can assist in creating
stride, including behavior is with runners. Oftentimes runners
cross-over striding or experience pain from a lack of appropriate stride,
including cross-over striding or over-striding. The
over-striding. behavior of inappropriate stride contributes to
overloaded tissue and possibly a pain response, and
so awareness of undesirable running mechanics is
beneficial.

A piece of tape on the posterior thigh (hamstring) or

a piece running down the lateral line when crossing
the midline bring awareness when over-striding.
In both instances, the tape brings awareness to
a movement or behavior that could potentially
contribute to pain.

INPUT CHANGES
The paradigm of taping movement instead of
muscles is consistent with the concept of affecting
the nervous system more than the musculoskeletal
system, although it is an interrelated spectrum.

93
 When working with people in pain, it’s important to
change input, including touch, vibration, pressure,
tension, temperature, words and emotions, because
pain is an output. Therefore, creating strategies
that include as many input changes as possible
is a good way to deal with pain in initial stages of
intervention.

Using kinesiology tape for movement is a great

adjunct for manual therapy, because the framework
of application is grounded in an understanding that
the body knows movement.

References

1. Nijs J, Daenen L, Cras P, Struyf F, Roussel N,

Using kinesiology Oostendorp RA. Nociception affects motor
output: a review on sensory-motor interaction
tape for movement with focus on clinical implications. Clin J. Pain.
February 2002. 28(2);175-81.
is a great adjunct for 2. Callaghan MJ, McKie S, Richardson P, Oldham JA.
manual therapy... Effects of patellar taping on brain activity during
knee joint proprioception tests using functional
magnetic resonance imaging. Phys. Ther. June
2012. 92(6); 821-30. Doi: 10.2522Epub 2012 Jan
26.
3. Di Pietro F, George P, O’Connell NE. “Tactile
thresholds are preserved yet complex sensory
function is impaired over the lumbar spine of
chronic non-specific low back pain patients:
a preliminary investigation.” Physiotherapy.
December 2010. 96(4); 317-23.
4. Macefield VG, Norcliffe-Kaufmann L, Goulding
N, Palma JA, Fuente Mora C, Kaufmann H.
“Increasing cutaneous afferent feedback
improves proprioceptive accuracy at the knee
in patients with sensory ataxia.” J Neurophysiol.
Feb. 1, 2016; 115(2) 711-6.

94
Additional references: “Short term effects of
kinesiotaping on acromiohumeral distance in
asymptomatic subjects: a randomised controlled
trial” (Manual Therapy, 2013). “The effect of applied
direction of kinesio taping in ankle strength and
flexibility” (30th Annual Conference of Biomechanics
in Sports, 2012). “Initial effects of kinesio taping
in patients with patellofemoral pain syndrome: A
randomized, double blind study” (Journal of Sport
Rehabilitation, 2011).

Adam Wolf, PT, LMT, FAFS, is co-owner of REAL

pt in Chicago, Illinois. His professional career
spans nearly two decades and includes clinical,
management, consulting, education, performance/
strength and conditioning, as well as ownership
roles. He is the author of REAL Movement:
Perspective on Integrated Motion & Motor Control.
Wolf is also a RockTape Functional Movement
Techniques instructor who presents to fitness and
rehabilitation professionals internationally.

95
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