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Terra Rosa

E-Magazine
Issue 4, December 2009 www.terrarosa.com.au

Contents Welcome to our fourth issue of Terra Rosa e


-magazine, our free e-zine dedicated to body-
02 Pain and relationships with workers.
your clients—Art Riggs
Earlier this year, we are a bit pessimistic on
06 All about pain the economical situation on our industry.
Things have turned out quite well for Austra-
09 An interview with Sean Riehl
lia, and I believe we will face a new year with
11 Compression with movement great hope.

14 Interview with Luigi Stecco And next year we will host a range of work-
and Julie Day shops by respected teachers Art Riggs and Til
Luchau. So watch out for this exciting work-
18 Myofascial Techniques for shops and a rare chance to have them in Aus-
the deeper structure of the tralia.
posterior neck —Til Luchau
We got a range of great articles starting about
22 Vertebral artery test —Colin pain. We have two great interviews, first with
Rossie Sean Riehl, the president and founder of Real
23 Form closure, force closure Bodywork. The second is an interview with
& myofascial slings respected bodyworkers from Italy Luigi Stecco
and Julie Day on Fascial Manipulation. We also
27 It’s not all about the piriformis review the soft tissue release technique. Til
—Marty Ryan Luchau on the myofascial techniques for the
neck, and Colin Rossie reminds us on the ver-
29 The myth about core training
tebral artery test. Nest we look at the SI joint
33 Research Highlights stability, and explaining what is force closure.
There‘s also an article about the myths of
35 Six Questions to Erik Dalton core training. Don‘t forget to read Six Ques-
36 Six Questions to Joe Mus- tions to Erik Dalton and Joe Muscolino.
colino We hope to keep you informed and enter-
37 Magic spots tained. Thanks for all of your support and en-
joy reading. Have a great holiday and hope to
see you again next year.

Sydney, December 2009.

Disclaimer: The publisher of this e-News disclaim any responsibility and liability for loss or damage that may result from articles in
this publication.

Terra Rosa E-mag No. 4, December 2009 1


Join the Most
Distinguished Teachers in
Myofascial Release
for workshops in Australia
Art Riggs Til Luchau Larry Koliha

Art Riggs is well-known for his passionate and sym-


pathetic teaching. He has been teaching bodywork
since 1988. The fulfilment he experienced in both
receiving and performing bodywork led him to a full
time career as a Rolfer and teacher of Deep Tissue
Massage. He has conducted numerous workshops in
US and Europe for health spas and medical profes-
sionals, including physical therapists, and has as-
sisted in Rolf Institute trainings.

Already a legend around the USA for their thorough,


learner-focused approach to training professionals in
their Advanced Myofascial Techniques trainings, the
Advanced-Trainings.com Faculty (featuring Certified
Advanced Rolfers and Rolf Institute® faculty Til Lu-
chau, Larry Koliha, and others) bring an unparalleled
depth of knowledge, talent and enthusiasm to their
very popular 1, 2, and 3-day workshops.

Workshops Down under:


- Fundamentals of Deep Tissue Massage & Myofascial Release
- Advanced Myofascial Techniques
- Advanced Myofascial Techniques Retreat in Bali/ Lombok.

Find out more on Art Riggs and Til Luchau workshops


2010 in Australia at www.terrarosa.com.au
Terra Rosa E-mag No. 4, December 2009 2
Pain & Relationships with Your Client
Art Riggs
Two years ago, Tom Myers wrote increasing discomfort from our
an interesting article about pain in work.
which he focused upon the subjec-
tive qualities of discomfort that Scientific literature is replete with
our clients experience in body- attempts to measure the specific
work. I particularly liked Tom‘s quantitative aspects of pain. I re-
distinction of three kinds of pain: cently had a physical therapist in a
workshop ask how many ounces of
- Pain entering the body—from in- pressure in a localized area of how
jury or other external causes, in- many square inches delivered at
cluding too aggressive work how many centimetres per minute
would elicit a pain response and
- Pain stored in the body‘s tissues the inevitable rebound of tissue?
- Pain leaving the body Teaching can indeed be a challeng-
ing experience at times! Such a
This subject is often neglected in over-zealous therapists who im- question ignores the intangibles of
articles and training--I think partly pose unnecessary discomfort (the touch and vast differences be-
because it is such a subjective sen- first of the three pains listed tween clients. Although our man-
sation but, also, because pain is a above), primarily from poorly de- ual skills are to a large extent spe-
bit like the black sheep relative veloped skills of touch, but also cific and measurable, our clients‘
that everyone in the family feels because of less than satisfactory perceptions of our touch are ex-
uncomfortable acknowledging. attention to the emotional aspects tremely varied, subjective, and in
of pain and the subjective connec- many ways contingent upon the
In this and an upcoming article I intangible aspects of our humanity
tion of trust one has with a client.
would like to focus upon our role and relationships with them.
as therapists to facilitate the re- Spend any time watching daytime
lease of pain stored in the body TV and you will see countless com- In this article, I will focus upon
and some practical ways of skill- mercials offering relief from pain. your connection with your clients
fully dealing with these sensations Pain is the enemy and is almost and how your relationship can af-
in our relationships with our cli- always looked at as a sign that fect the greatly varying subjective
ents. Even if our bodywork prac- something is wrong, so we are of- aspects of their perception. In a
tice is primarily relaxation and fered opiates to dull the sensations later article, I will discuss the
enjoyment based, the reality is rather than addressing the causes. physical skills of how to develop an
that virtually all people we see I prefer to look at symptoms of effective and powerful therapeutic
have areas of dysfunction, discom- discomfort as the ―canary in the touch that will ―feel good‖ to your
fort, or actual pain somewhere in mine shaft‖ alerting us of a poten- clients.
their body. If we fail to address tial problem. We all frequently
these issues, we do a disservice to have the experience of encounter-
our clients and limit the success of ing congested or fibrosed tissue YOUR RELATIONSHIP WITH YOUR
our practice. One of the most fre- that our clients express surprise at CLIENT
quent complaints I hear from peo- the tenderness and admiration for
ple asking for referrals is that our skills at discovering these se- Pain, either stored in the body or
overly conservative massage is in- crets. Finding these areas is the from your touch does not exist in a
effective in providing long-lasting preliminary skill, but the release vacuum. Most all of our perception
benefits and in dealing with of these patterns requires even of this sensation is influenced by
chronic pain in the body. Con- more finesse to mitigate the symp- context. Think of the difference in
versely, I also hear criticism of toms and their causes rather than perception between being stuck

Terra Rosa E-mag No. 4, December 2009 3


Pain
with a needle accidentally and the Give a feeling of empowerment to friends that they need to beware of
careful probing to remove a splin- your client. my enthusiasm as I try to give them
ter. The context of your relation- ―extra‖ work. I wish I could give
ship with your client and your inten- The most important gift of safety recall notices to my early clients as
tion can provide the confidence and you can give to your clients is the I watched them levitate off the ta-
caring that can make the difference knowledge that you will stop imme- ble as a result of my ―over-
between a tense and painful session diately if they ask you to. How- generous‖ attempts at being a mira-
or a relaxed and easy one as they ever, there is a delicate balance cle worker. Probably the single
realize the benefits from focused between being receptive to feed- largest cause of overworking or
work to solve problems. back and appearing to be under- causing discomfort is not the error
confident. Constantly asking your of working too deeply or applying
Since our bodies and minds are con- client if the work is too intense can too much pressure, but of working
ditioned to interpret pain as the too fast. Choose your goals before
messenger that ―something is wrong beginning work and don‘t get side-
here!‖ fear is often the primary tracked by trying to accomplish too
emotion that we deal with when much in limited time and working
working deeply with our clients. faster than the tissue can easily
The first few minutes of your ses- melt.
sion can be your major tool in allay-
ing fear and the tension in the body A friend once gave me some excel-
caused by this emotion. Following, lent advice from a Buddhist
are some suggestions for considera- teacher: ―In life, as in music, the
tion: rests are as important as the
notes.‖ I apply this wisdom to my
Establish rapport sessions. When performing intense
Taking just a few minutes to chat work, I give frequent breaks for my
with your clients, especially if it is clients to assimilate the changes
the first time you have seen them, and enjoy integrative and ―feel
can define the context of every- good‖ work. This allows for a rest
thing you do in the session. A few and the chance to appreciate and
minutes of relaxed conversation, call attention to the issues of pain. solidify the good work you have per-
and not necessarily only about The client should be able relax with formed.
―business,‖ can let your client feel confidence rather than having to be Consider Einstein‘s wisdom on the
like a person you actually care overly vigilant in giving feedback.
relativity of time. I learn a great
about on a personal level and begin We will discuss this in more detail deal when I go to yoga classes. As I
to establish a relationship based in the next article on this subject, look around the room, I see the
upon mutual trust. but suffice it to say that your ses- lithe young things who appear to be
Cultivate confidence in your skills sion will be much smoother and en- warming up for their primary jobs
joyable if you err towards the side as contortionists for Cirque du
Rather than immediately beginning of caution rather than overworking Soleil. In some poses, when I‘m
work on sensitive or troublesome and having to interrupt the flow of sweating bullets and considering
areas of complaint, address areas the session by frequently stopping crying out that I confess to uncom-
that will ―feel good‖ and let your work and having to regain the confi- mitted crimes, the teacher will
client become familiar and relaxed dence and relaxation of your clients sometimes let the class know that
with your touch in an area where after over-stimulation. Cultivate ―we only have 30 seconds left.‖
they feel safe. your sensitivity to the preliminary Suddenly, my perception of over-
signs of defensive withdrawal rather whelming pain dissipates as I realize
Explain the rationale behind your than crossing the threshold into that an end is in sight. I relax and
strategies, especially in areas that painful territory. move to a new level of release.
are sensitive. Intense therapy with When you feel that your clients are
a purpose will be perceived very Pace your sessions and clarify your working with you for important re-
differently from work that appears goals lease, let them know that you are
to be insensitive and without bene- aware and grateful for their coop-
fit. Good (overly ambitious) intentions
can lead to trouble. I joke with my eration and that relief is in sight.

Terra Rosa E-mag No. 4, December 2009 4


Pain
The very tension of conscious with- however, don‘t berate yourself if
holding is often the last obstacle in you very occasionally overstep the
the way of dramatic change. Of- limits of your clients‘ sensitivity.
ten, lightening up in force and As my Catholic friends remind me,
speed is all that is needed to ―It isn‘t a sin unless you enjoy it.‖
achieve that last release and true For pain held in the body, a careful
education to ―let go‖ of chronic dialogue--both with your touch and
tension. your unique relationship with each
person—of communication and ne-
This last point may be the most im- gotiation (rather than coercion) in Art Riggs is a Certified Advanced
portant of this article. The issue of intense work can spell the differ- Rolfer®, teacher of bodywork, and
pain is emotionally charged, both ence between a lost opportunity the author of Deep Tissue Massage:
for our clients and ourselves. It is and profound release. A Visual Guide to Techniques and
important to realize that pain, al- the acclaimed seven volume (11
beit with lots of very real variable hour) DVD series that accompanies
and personal emotional considera- the book. He will come to Australia
tions, also has a great deal of cul- in October 2010 and hold workshops
tural judgment. I see absolutely no on Deep Tissue Massage and Myo-
purpose or benefit from imposing fascial Release.
unnecessary discomfort in a session,

Art Riggs
Best Selling 7 Volume DVDs, 11 Hours
Encyclopedia of advanced massage DVD
and a visual guide manual

See also Art Riggs’ Workshops in Australia October 2010

Terra Rosa E-mag No. 4, December 2009 5


All About Pain

Australian clinician and researcher factures more sensors for excitatory


David Butler and Lorimer Moselely chemicals.
wrote an excellent book on
“Explain Pain”. This book explains - The brain starts activating neu-
pain from the neuroscience point rones that release excitatory chemi-
of view. Here are some summaries cals at the dorsal horn of the spinal
from the book. cord.

- Response systems become more


involved and start contributing to
Pain is Normal the problem.

- All pain experiences are a normal -Thoughts and beliefs become more
response to what your brain thinks involved and start contributing to
is a threat. the problem,

- The amount of pain you experi- -The brain adapts to become better
ence does not necessary relate to at producing the neurotag for pain
the amount of tissue damage. (the 'pain tune').
- The brain activates several sys-
- The construction of the pain ex- -Danger sensors in the tissues con-
tems that work together to get you
perience of the brain relies on many tribute less and less to the danger
out of danger.
sensory cues. message arriving at the brain.
Tissue Damage
Danger Alarm System Pain Management
- Tissue damage causes Inflamma-
- Danger sensors are scattered all -How you understand and cope with
tion, which directly activates dan-
over the body. pain affect your pain as well as your
ger sensors and makes neurones
life.
- When the excitement level within more sensitive.
a neurone reaches the critical level, -A key is to understand why your
Inflammation in the short term pro-
a message is sent towards the spinal hurts won't harm you and that your
motes healing.
cord. nervous system now uses pain to
- Tissue healing depends on the protect at all costs, not to inform
- When a danger message reaches you about damage.
blood supply and demands of the
the spinal cord it causes release of
tissue involved, but all tissues can
excitatory chemicals into the syn- -By being patient and persistent,
heal.
apse. you can use smart activities to
- The peripheral nerves themselves gradually increase your activities
- Sensors in the danger messenger and involvement in life.
and the dorsal root ganglion (DRG)
neurone are activated by those ex-
can stimulate danger receptors.
citatory chemicals and when the -Purposefully seek out activities
Normally, pain initiated by danger
excitement level of the danger mes- that produce danger-reducing
messages from the nerves and DRG
senger neurone reaches the critical chemicals.
follows a particular pattern.
level, a danger messages sent to
the brain. -By mastering your situation and
Altered CNS Alarms
then planning your return to normal
- The message is processed through- - When pain persists, the danger life, you will be able to do so .
out the brain and if the brain con- alarm system becomes more sensi-
cludes you are in danger and you tive.
need to take action, it will produce
pain. - The danger messenger neurone
becomes more excitable and manu-

Terra Rosa E-mag No. 4, December 2009 6


Deep Tissue Massage and Myofascial Release
Workshops with Art Riggs
Deep Tissue Massage is much more than just a ―hard mas-
sage.‖ In contrast to just relaxing muscles, the specific
lengthening of fascia and muscles and tendons offers
many benefits such as freer joint movement, benefit for
injuries, better posture, and feelings of well-being.

Part I. FUNDAMENTALS OF TOUCH


Sydney: 29, 30, 31 October 2010
New Zealand: 6,7,8 November 2010
Times: 9.00am – 6.00pm each day

This three-day class covers all aspects of Deep Tissue and


Myofascial Release work with nuts and bolts emphasis
upon broad understanding and cultivating your touch and
body mechanics. The material is designed to be appropriate for a wide range of therapeutic experience. Newly
certified massage therapists, but also advanced bodyworkers including physiotherapists and chiropractors have
commented on how beneficial the knowledge is and how it has transformed the way they work.
This workshop covers the entire body, with an emphasis upon the more subjective aspects of touch, biome-
chanics, use of tools (fingers, knuckles, fists, forearms/elbows), palpation skills, and body positioning.
You Will Learn:
 Techniques and tips for saving your thumbs and fingers
 Body mechanics
 Tools of Deep Tissue Massage-- Proper use of fingers, knuckles, fist, forearm, and elbow
 Introduction to spinal mechanics-- Understanding boney articulations and spinal mechanics to work for
better joint function
 Massage strokes and techniques -- Lengthening tissue, Anchor and stretch strokes, Freeing adhesions, and
Releasing holding patterns
 Positioning of clients to increase effectiveness of your work
This extensive training not only shows strokes and techniques, but, more importantly, will demonstrate the
qualitative art of working deeply in the body to affect profound change.

Part II. INTEGRATED FULL BODY DEEP TISSUE MASSAGE


Sydney: 2, 3 November 2010, Times: 9.00am – 6.00pm each day

Too often students leave upper level workshops excited about the new
material learned, only to find difficulties implementing the new knowl-
edge into their existing practices. This two-day workshop will provide you
with the skills to smoothly integrate your specific deep tissue and myofas-
cial release skills into a fluid full body massage, and will be a great re-
fresher if you feel you need some review.
You Will Learn:
 Communication skills to educate your clients on the advantages of
deep tissue massage and myofascial release to deal in detail with
specific areas of their bodies that need extra attention while still performing a full body massage instead
of spot work
 Evaluation techniques and session planning for a smooth and integrated massage to leave your clients
feeling the benefits of deep work while still being integrated
 Clear, anatomical and physiological protocols to connect all parts of the body into a fluid massage style
 Draping suggestions to utilize different body positioning options
 Options for tying together the massage to leave your clients feeling relaxed and energized

Terra Rosa E-mag No. 4, December 2009 7


Deep Tissue Massage and Myofascial Release
Workshops with Art Riggs
Part III. ADVANCED DEEP TISSUE MASSAGE &
MYOFASCIAL RELEASE
Sydney : 18, 19, 20, 21 November 2010

This four-day series expands the initial skills taught in ―Fundamentals‖


workshop and offers a step by step movement up the entire body, offering
more specific information, anatomy and strategies for all parts of the body.
The ―Fundamentals‖ class is strongly recommended as a prerequisite.

DAY #1: THE FEET AND LEGS


 Balancing the ankle and foot: Increasing mobility of the bones for freer
movement, normalizing imbalances in weight distribution for balanced
foot plant.
 The upper and lower leg including the knee, quadriceps, hamstrings, ad-
ductors and abductors.
 The Hips-improving flexion, extension, rotation

DAY #2: THE PELVIS AND HIPS


 Working with the posterior pelvis—balancing the deep rotators, sacrum and
coccyx
 Anterior pelvis --woking with the psoas and iliacus
 Abdomen

DAY #3: THE BACK AND CHEST


 Major muscles of the back--Quadratus lumborum, erectors, latissimus,
rhomboids, and small muscles of vertebral motion
 Spinal mechanics and mobilization of vertebrae and ribs
 Working with the Chest for improved breathing Art Riggs is a Certified Advanced
Rolfer® and massage therapist who
DAY #4: SHOULDER GIRDLE AND ARMS has been teaching bodywork since
 Shoulder girdle—Freeing the scapula, rotator cuff, chest, and first rib 1988.
 The arms—hand/wrist, forearm, elbow, and upper arm
 Thoracic outlet He is the author of the best selling
Deep Tissue Massage and Myofascial
 Improving the transition between the upper thoracic and neck, with some
release book and DVDs. He also fre-
techniques for working with the cervical spine. quently authored articles for Massage
and Bodywork Magazines in the US.

To register your interest


Visit www.terrarosa.com.au or e-mail: terrarosa@gmail.com
He has conducted numerous work-
shops for health spas and for medical
professionals, including physical
therapists, and has assisted in Rolf
Institute trainings. He also teaches his
work internationally including UK and
Europe to bring them the knowledge
and experience that he has gained
with his work. He lives and practices
in San Francisco bay area.

Terra Rosa E-mag No. 4, December 2009 8


An Interview with Sean Riehl,
President of Real Bodywork
How did Real Bodywork start How does Real Bodywork help
making massage videos? massage therapists meet those
challenges?
Sean and Geri Riehl taught mas-
sage in Santa Barbara, California. Our line of DVDs includes both
At the request of their students as clinical styles of massage and en-
a way to remember the informa- ergy-based styles of massage.
tion that was being taught, they
created a set of DVDs that mir-
rored the information shown in What opportunities are available
class. Their first DVD set, Deep to massage therapists that were-
Tissue and Neuromuscular Ther- n't available 25 years ago?
apy, shows all the techniques How do you see Real Bodywork
taught in a 100 hour NMT class. fitting into those trends? Twenty-five years ago massage
The next set, Myofascial Release therapists had to educate people
mirrors a 50 hour myofacial Real Bodywork is helping further that they weren't prostitutes. Now,
class. Although they fell in love therapists' education by providing massage is respected and people
with the video making process, training DVDs that focus on assess- understand the benefits without
they were surprised that each title ment and the benefits of specific the tie to sexuality. Almost every-
took 300-400 hours to create. As techniques. Many of our DVDs bring one I know has had a massage or
the business grew organi- techniques that have traditionally knows someone who regularly gets
cally, Sean and Geri began to been taught to physical therapists massage.
branch out and hire instructors to or osteopaths, such as nerve mobi-
teach various modalities. The suc- lization, positional release and Therapists now are making their
cessive 30 DVDs consist of master assessment techniques. Our DVDs way into hospitals and physical
therapists from all throughout the continue to help therapists learn therapy offices and gelling refer-
United States and Canada. Real new modalities at an affordable rals from doctors. Massage therapy
Bodywork continues to support price. has also become a mainstay at spas
massage excellence by bringing and retreat centers. Massage
quality DVDs to the massage com- What challenges do massage therapists are respected, and peo-
munity. therapists face now? ple see massage as a real career.

What is the most popular trend in How does Real Bodywork help
the massage industry at the mo- With an increase in training, as-
sessment techniques and under- massage therapists realize those
ment? opportunities?
standing of physical anatomy, the
A move to more clinical and thera- quality of energy and presence in a
session can decrease. As massage Real Bodywork helps therapists
peutic-style bodywork. It seems increase their skills by providing
massage has come a long way to therapy moves closer to the main-
stream medical model, therapists comprehensive training DVDs that
become quite mainstream and le- are clear and easy to understand.
gitimized in the eyes of the medi- will be challenged to hold onto the
valuable energy therapy tech- From our DVDs, therapists who al-
cal community. Therapists are ready have a good foundation in
trained better than ever before, niques and a spiritual basis – foun-
dation of presence, compassion fundamentals of massage can eas-
and treating clients with more in- ily learn new modalities. Knowing
telligence and skill than ever be- and calming touch – of massage as
healing. a variety of modalities can help
fore. the therapist compete when get-

Terra Rosa E-mag No. 4, December 2009 9


Interview with Sean Riehl
ting a job at a spa or doctor's of-
fice. By learning new types of mas- How will Real Bodywork meet the
sage, therapists can help their cli- future needs of the massage in-
ents heal more effectively. dustry?

Where do you think the massage Real Bodywork will continue to


field will be 25 years from now? create massage DVDs that are com-
prehensive and full of great tech-
Massage will be integrated into niques that therapists can apply in
standard medical treatment. It will their practices.
be commonplace for hospitals to
employ massage therapists. In doc-
tors' offices, you will be seen by
the nurse and doctor, and perhaps
be able to get a massage at the
same time.
recognized and respected. People
The connection between the emo- will get massage more regularly to
tional, spiritual, mental and physi- avoid injury and dysfunction be-
cal parts of our being will be more fore it manifests.

Learn classic assessment techniques! Lavishly produced and filled with beautiful 3-D
animations that show exactly which structures are involved. Alan Edmundson, P.T. will
walk you through a logical progression of testing that will reveal the underlying pathol-
ogy with crystal clarity.

Expand your assessment knowledge with this encyclopedic resource!

Terra Rosa E-mag No. 4, December 2009 10


Compression with
Movement
The basic concept of compression where it belongs and ask for move- area is sensitive. Active is when
with movement technique is cap- ment.‖ Robert Schleip generalized the client moves the structure/
tured by the generic name ―pin the idea into ―Active Movement joint him/herself. Some authors
and stretch‖ or ―anchor and Participation‖.2 also distinguished it if the move-
stretch‖. It involves applying deep ment or compression is assisted by
pressure to a muscle while simul- Chiropractor Jeff Rockwell devel- gravity.
taneously performing a controlled oped Active Myofascial Release or
muscle lengthening by moving the Chriropractic Myofascial Release. Concepts & Theories
corresponding joint either pas- In some places, it was also called
contractile myofascial release. According to Whitney Lowe4:
sively or actively.1 Unlike other
massage techniques, this provides Michael Leahy developed and mar- ―For muscles that are tight and
a method of manipulating deep keted, particularly to the medical very deep, it is hard to apply ef-
tissues throughout the full joint and physical therapy communities, fective pressure when doing a lon-
range of motion. codified application protocols for gitudinal stripping without using a
the technique as ―Active Release great deal of force. By having the
Imagine a rubber band with a knot
Technique®‖ or ART. Leahy‘s client actively engage the area,
tied in it. If you stretch the rubber
training is extensive and offers the cumulative effect of the pres-
band, the flexible areas will
many excellent protocols for treat- sure is magnified. This may also
stretch, while the knot will remain
ment of specific injuries or areas help mobilize some of the deep
unchanged. In the same way, mus-
of the body. In ART, the tissue is fascia surrounding these muscles.
cles become short and fibrous in
placed in a shortened position, the The effect of pressure is also mag-
isolated segments rather than uni-
―lesion‖ is trapped, then the tissue nified because the density of the
formly throughout the length of
is drawn under the contact while tissue is increased when muscle is
the muscle. This is the basis of the
the lesion is manipulated.3 engaged in active contraction.‖
idea, specific lengthening tech-
niques must be applied differently Whitney Lowe uses ―massage with According to Art Riggs and Keith
to these areas to affect release at active engagement‖ which uses Eric Grant1:
a very precise area. static compression, compression
When movement occurs, muscles,
broadening, and deep longitudinal
Variations tendons, fascia, and nerves also
stripping in combination with ac-
have to move. Some of this move-
There are variations of ―pin and tive movement of muscles. 4
ment will occur relative to other
stretch‖, distinctions among what fiber bundles in the same muscle,
British sports massage practitio-
is used and taught by various prac- some across other tissue struc-
ners, such as Mel Cash and Stuart
titioners involve whether the tures. If layers of tissue that need
Taws, called it ―soft tissue re-
movement is active or passive, and movement across each other are
lease‖ or STR.5
the direction and speed in which adhered to each other, movement
the compression is applied. There are mainly 2 types of tech- will be restricted. If tissues within
nique depending on how the prac- a muscles structure can‘t freely
Oblique pressure with active
titioner and client utilize the elongate, movement will be re-
movement has been a fundamental
movement: passive, and active. stricted. If, as a muscle shortens,
technique of structural integration
Passive is in the case where practi- fibers can broaden and separate
from its inception with Ida Rolf.
tioner moves client‘s structure/ laterally from each other (i.e. they
Over 50 years ago, Rolf instructed
joint. This is in case where the are cross-linked together), move-
her students to ―put the tissue

Terra Rosa E-mag No. 4, December 2009 11


Compression with movement
ment will be restricted. If nerve pist anchors restricted fascial or Techniques and be synchronized
tissue elongation is adhered or im- muscular areas, with the knuckles, with respiration to gain added re-
peded by other tissue, the nerve fist, forearm, elbow, or braced lease from this core human cycle.
tissue will either suffer impinge- fingers, while having the client Finally, having the client perform
ment (compression against an un- move an adjacent joint so that the active movements both is a very
derlying structure) or adverse neu- muscle, tendon, or fascia is slowly explicit reinforcement of working
ral tension (dysfunctional stretch- stretched from the anchor point. together and a form of gaining cli-
ing). This focuses the stretch at a pre- ent commitment.
cise point rather than having the
According to Jane Johnson6: ―Soft stretch dissipated over the entire As stated by Robert Schleip2:
tissue release localizes the length of the muscle. Muscle ―Active motor learning is the fast-
stretch; this is done by first to fix tightness is rarely equally distrib- est and most effective way of
part of the muscle against the un- uted over the entire length of a learning of our nervous sys-
derlying structure to create a false muscled, so focused anchoring tem‖ (Sir Charles Sherrington, a
insertion point. The fixing prevents eliminates the tendency of the famous neurologist, said ‗The mo-
some parts of the muscle from more flexible areas of the muscle tor act is the cradle of the mind.‘)
moving, and creating this false adapting to stretch while allowing
insertion points results in a more The efficacy of ‗pin and stretch‘ is
tight and fibrous areas to remain known clinically and anecdotally.
intense stretch.‖ short. The practitioner uses palpa- However, there is only a well
So how does compression with tion and visual observation to documented clinical study on the
movement help?1 evaluate adhesions restricting evaluation of soft tissue release
movement and anomalous tissue (STR) as an intervention for de-
It is hypothesized that as a muscle texture. Abnormal tissues are layed onset muscle soreness
lengthens, it has movement along treated by combining precisely (DOMS)7. This study showed that
its length (longitudinal) between directed tension with very specific STR intervention does not seem to
its own fibers and also relative to active or passive movements. improve the rate of recovery of
other tissue structures. Compres- DOMS. The author further sug-
sion along the muscle as it is According to Robert Schleip2: The
effect of this specific application gested that athletes or rehabilita-
lengthened (actively or passively), tion practitioners who are looking
localizes the stretch. Pressure ap- can be explained with the in-
creased stretching force on the for a quick fix to DOMS are there-
plied longitudinally against the fore unlikely to find STR any more
lengthening locally increases the mechanoreceptors of this tissue.
useful than more gentle massage
stretch within the muscle tissue. Finally, the addition of active cli- techniques.
Pressure applied longitudinally ent movements adds the elements
with the elongation increases the of neuromuscular re-education, Examples
shear stress on any adhesion bind- neurological reinforcement of
ing the lengthening muscle to ad- Here are some examples of com-
techniques, and making the practi-
jacent structures. Conversely, pression with movement tech-
tioner-client teamwork stronger
when a muscle shortens, it is also niques by Art Riggs from his book
and more explicit. Asking for ac-
forced to broaden. A direct or ―Deep Tissue Massage‖.
tive client movement may reveal
cross-fiber compression applied to aberrant movement patterns and Prone Hamstring Work
a broadening muscle will flatten it, fascial strain patterns not seen in
forcing fibers to spread trans- static or neutral positioning, ena- As shown in Figures above, flexing
versely apart, breaking adhesions bling the practitioner to ―track‖ the knee shortens and softens the
between fibers. The compression, muscles and fascia
properly directed, thus assists the into proper position
tissue movement required, allow- and length. Active
ing the tissue to free itself from movement against
adhesions. It is this latter property gentle practitioner
of self-tendency that also tends to resistance can en-
make compression with active able clients to re-
movements more effective than learn joint proprio-
passive movements. ception lost from
With these techniques, the thera- disuse or injury.

Terra Rosa E-mag No. 4, December 2009 12


Compression with movement
muscle, allowing for easy and pain- force to focus the stretch at the
free access to deep, fibrotic, and precise point of the anchor. This
specific areas of the hamstring. It is an excellent technique for iso-
is crucial to realize you are not lated tightness or adhesions. How-
sliding over the area with repeat ever, muscle restrictions often
strokes. Your intention will be involve neurological compensatory
similar in some ways to trigger or splinting adaptations covering
point work, but will have the the whole muscle's length that
added power of stretching the need to be retrained to lengthen
muscle at the specific area of ten- properly. In such cases, another
sion as you extend (straighten) the effective strategy is to direct force
knee, while anchoring at the pre- stretched by plantar flexing the in the direction of muscle length-
cise spot of tension. ankle. ening as opposed to the more com-
mon pin and stretch tech-
Envision grabbing and anchoring at Supine Trapezius Work niques. For example, directing
the specific area of tension and force distally on the hamstrings
slowly stretch the muscle away Anchoring and stretching anywhere
along the trapezius is extremely while asking the client to extend
from this anchor point by extend- the knee from a flexed posi-
ing the leg to either stretch tight effective, either to lengthen the
entire muscle or to release trigger tion. By paying attention to tor-
superficial fascia or release deeper sional factors such as adhesions to
muscle adhesions. points. By gently cradling the neck
and supporting the occiput, it is adjacent muscles, the therapist
The stretching of the muscle adds possible to side-bend and rotate can counter rotational restrictions
an element of neurological release the cervicals in many different and train the muscle to lengthen
missing in trigger point strokes angles to stretch the trapezius. and over-ride protective inhibi-
that simply hold the spot without You may also call for active motion tions due to injury. Another exam-
movement or that work in a neu- by instructing clients to extend ple would be to ask for knee flex-
tral position. As the muscle melts their arm down toward their feet ion while applying shearing force
and lengthens in the shortened or to rotate or side-bend their in the direction of the vastus later-
position, you may continue to ex- head away from the area where alis' lengthening while rolling it
tend the knee and stretch the you are working. away from the IT band to improve
muscle, always working within the patellar tracking.
comfort range of your client. You Although it certainly is acceptable,
especially in warming up the area, References
may exert steady lengthening pres-
sure on the muscle or do very short to use more flowing strokes moving 1 Art Riggs & Keith Eric Grant. Myofascial
repeat strokes from slightly differ- in the opposite direction, be sure Release. In: Modalities in Massage & Body-
to anchor on fibrous areas and work. (Elain Stillerman, Ed).
ent angles or depths. Depending on
your finger strength or the amount then very slowly manipulate the 2 Robert Schleip. Put more AMPs into your
of precision needed, you may util- head and neck to stretch the mus- sessions http://www.somatics.de/AMP.htm

ize either knuckles or fingers. cle at the precise area of restric-


3 Michael Leahy. Active Release Tech-
tion until you feel the area soften niques: Logical Soft Tissue Treatment In:
Anterior compartment of the leg or melt. Notice how in this Figure Functional Soft Tissue Examination and
the left hand is comfortably rest- Treatment by Manual (Warren Hammer Ed)
This picture shows a technique on ing on the table as the right hand
the anterior compartment of the 4 Whitney Lowe. Orthopedic Massage. El-
can rotate and side-bend the neck sevier (2009).
leg. The knuckles anchor the an- to stretch the muscles and mobi-
terior compartment, which is then lize vertebrae. This versatility will 5 Mary Sanderson. Soft Tissue Release,
Corpus Publishing, Lydney, Gloucestershire
not be possible if you always work (2002).
bilaterally with the head and neck
in a neutral position. 6 Jane Johnson. Soft Tissue Release, Human
Kinetics, Champaign, IL (2009).
Most descriptions of ―Compression
7 D. Micklewright. The effect of soft tissue
with Movement‖ describe anchor- release on delayed onset muscle soreness:
ing on restrictions and asking for A pilot study. Physical Therapy in Sport, 10
joint movement that elongates the (2008) 19-24.

muscle against the therapist's

Terra Rosa E-mag No. 4, December 2009 13


An Interview with Luigi Stecco &
Julie Ann Day
Fascial Manipulation© is a manual davers at the Renè Descartes Uni-
therapy that has been developed by versity. This was a fantastic oppor-
Luigi Stecco, an Italian physio- tunity because dissection of fresh
therapist from the north of Italy. cadavers is very limited here in
This method has evolved over the Italy and the fascia can only be
last 30 years through study and appreciated when the tissues are
practice in the treatment of a vast still fresh. She has been back sev-
caseload of musculoskeletal prob- eral times now, both with my son
lems. It focuses on the fascia, in Antonio and on another occasion, I
particular the deep muscular fascia, was able to assist her as well. Our
including the epimysium and the discoveries are mostly published in
retinacula and considers that the scientific journals whereas the
myofascial system is a three- photographs in the latest book
dimensional continuum. speak for themselves. It was en-
couraging to find that so much of
We are glad that we are able to have Julie Day and Luigi Stecco. what I had deduced from my stud-
an interview with Luigi, with the
ies really existed. The myotendi-
help of our fellow Australian, Julie- was a surprise to find these same nous expansions that link adjacent
Ann Day. points often corresponded with segments together and their con-
acupuncture points. There is a stancy confirmed the concept I had
definite overlapping of myofascial
sequences or myokinetic chains
Interview with Luigi Stecco and meridians. Study of Dr. Trav-
When and How did you decide to ell‘s trigger point work as well as
become a bodyworker? Ida Rolf‘s intuitions also contrib-
uted to the elaboration of the con-
I am actually a physiotherapist and cept of the Myofascial Unit, the
I studied in the North of Italy, basis of the myofascial system.
completing a Diploma in Physio-
therapy in 1975. I noticed that the Stecco family is
involved in the Fascial Manipula-
How did you come up with the tion work. Can you tell us about
fascial manipulation concept. the family involvement.

I was essentially unsatisfied with Carla, my daughter, is a medical


what physiotherapy treatments doctor and her thesis was about
were offering at the time, using a the fascia. She then went on to
lot of electrotherapy treatments, qualify as an Orthopaedic surgeon
whereas I was more interested in and is currently an Assistant pro-
manual techniques and movement. fessor at The Anatomy and Human
The local ―bone setters‖ working Movement Faculty at the Padova
in my area also fascinated me. University here in Italy. My son,
They were generally unqualified, Antonio, is also a medical doctor
with manual skills handed down and is currently specialising in
from generation to generation and Physiatry at the University of Pa-
I was curious about what they did dova.
and how it worked but they were
not able to give me any scientific In your book, there's lots of beau-
explanations. However, I had al- tiful dissection. Can you tell us
ready started applying connective about it. Who made the dissec-
tissue massage and I was convinced tion and what did you discover.
that the fascia was the key tissue.
In 2003, during Carla‘s Orthopae-
I then started to map out points
dic internship, she had the oppor-
that had been particularly effec-
tunity to spend six months in Paris
tive in resolving problems and it
dissecting unembalmed human ca-

Terra Rosa E-mag No. 4, December 2009 14


Interview with Luigi Stecco
formulated of myofascial se- the importance of the fascia is a
quences and the histological find- new paradigm for mainstream
ings have taught us about the won- groups. Carla and Antonio spend a
derful multilayered structure of lot time writing articles and, while
the deep fascia and also confirmed getting work published is arduous,
its rich innervation. over 30 indexed articles concern-
ing various aspects of fascia have
Did you formulate Fascial ma- been published so far. They are
nipulation after you have made also busy attending national and
the dissection or is it from your international anatomy symposiums
manual therapy experience. - the most recent in South Africa in
August, 2009 - and they receive a
The biomechanical model was well
lot of positive feedback. Courses in
established before the dissections Luigi Stecco.
Fascial Manipulation are being in-
started, so we can say it served as
creasingly requested by hospitals
a guide for the dissections. This
You won a poster presentation at with physiotherapists working in
model is fruit of 30 years of clini-
the First Fascia Congress share busy outpatient departments and
cal practice and study and courses
with about that work. You re- Physiotherapy associations organ-
in the Fascial manipulation tech-
ceived lost of attention at the ize some of our courses for their
nique started here in Italy in 1995.
Fascia congress, did you get members.
We did spend quite a lot on phone
many enquiries about your work
calls between Italy and France be- What is the most challenging part
after that. Does it have an impact
cause in the beginning it wasn‘t of your work?
on your work?
easy at all for Carla, besides, the
first time she was there all alone It was exciting get that recognition Each patient is a unique case that
and while her French colleagues and, certainly, it has contributed has to be studied as if it was the
were supportive they didn‘t really in increasing interest in general, first one - it is certainly not mo-
know what she was looking for! and our workload overall! A group notonous.
of Fascial Manipulation teachers is
Are there differences in human What is your most favourite
participating at the Second Fascia
anatomical study in Italy than the bodywork book?
Research Conference in October
one we received mostly in the
2009 in Amsterdam with four oral Leon Chaitow‘s book about neuro-
west, studying muscle as an indi-
presentations, a poster, and a full muscular massage is my favourite.
vidual rather than as a whole. day workshop. Carla is working on
I‘d say that anatomical studies are several new projects and has been You have an article in JBMT Ap-
the same here as the rest of the invited to teach fascial anatomy at plication of Fascial Manipulation
world although we are doing our the Ulm University in 2010 for a technique in chronic shoulder
best to introduce the importance course organized by Dr. Robert pain--anatomical basis and clini-
of the fascia especially in muscu- Schleip. cal implications. Can you tell us
loskeletal studies. about that research.
How is your work received by
Many of us in the English speak- mainstream medical and ortho- Carla and Antonio carried out this
ing world are more familiar with paedic groups in Italy? research in collaboration with Julie
Anatomy Trains by Tom Myers, Ann Day, an Australian physio-
It is always slow work changing therapist who works with us since
what is the relationship between
long established viewpoints and 1999. The focus was to provide
your concept and Anat-
omy Trains. an anatomical explanation for
the results obtained in applying
Briefly, they are two ideas the Fascial Manipulation tech-
that are parallel; however, nique in 30 patients with
they have been developed chronic shoulder pain.
in complete autonomy.
Now many people are talking
What do you find most about Evidence-based massage
exciting about bodywork? therapy or bodywork. In medi-
cine literature, massage and
I find it is very satisfying to bodywork are still being con-
be able to resolve muscu- sidered just as an alternative
loskeletal and visceral treatment with very little evi-
problems that other spe- dence-based research. This is
cialists have not been able of course, due to the nature
to help. of the research and what you
can measure as outcome.
Terra Rosa E-mag No. 4, December 2009 15
Interview with Luigi Stecco
Should bodywork move into the What advice you can give to fresh Seattle and I'll be talking at the
direction of evidence-based massage therapists who wish to World Massage on-line Confer-
medicine where everything has make a career out of it? ence in November.
to be research proven?
Study, listen to your patients, Luigi Stecco doesn't like travelling
We certainly need to strive to give study again, listen and go back and at all so we are also organizing a
plausible anatomical and physio- study again. course in Fascial Manipulation in
logical explanations about how our English for June 2010 at the Stecco
therapy may work. Medical Centre, in the north of
Italy, so people can meet him in
How did you see the blend be- Interview with Julie Day person! As you can tell, Fascial
tween research and manual ther- Manipulation helps to keep me
apy. busy.
At present, our research largely You translated 2 of Stecco's Fas-
involves the anatomical aspects of cial Manipulation book into Eng-
the fascia. By studying the anat- lish. It must take a lot of effort.
omy of the fascia, we can under-
stand more about how a wide It was a great learning process and
range of therapies may work. I am it certainly forced me to contem-
also working on a new volume plate all aspects of the model
about the treatment of the vis- elaborated by Stecco in great de-
ceral fasciae. I have been testing tail. The italian version of Fascial
out these theories concerning the Manipulation for Musculoskeletal
visceral fasciae for several years Pain was published in 2002 and the
now and so far have held two english edition in 2004. There is a
courses in this visceral technique new Italian edition of this volume
for therapists already qualified in at the publishers right now so I
Fascial Manipulation. hope to get the chance to do that
edition too so I can improve on the
Can you tell us about the Fascial You are originally from Australia, original translation! It was particu-
Manipulation Association in Italy. can you tell us how do you be- larly difficult because of the re-
come involved with Fascial ma- sponsibility of inventing new Eng-
The Association formed in 2008 nipulations? lish terms for the new terms that
and the founding members consist I studied physiotherapy in Ade- Stecco has coined.
in seven senior teachers of the laide, completing my Diploma in
Fascial Manipulation technique, my 1977 and I've been living and work-
son, my daughter, and myself. The ing in Italy since 1984. I have al- Fascial Manipulation - Practical
aim of the Association is to pro- ways used Connective Tissue Mas- Part was published in 2007 in ital-
mote research into the fascia and sage in my practice and I met Luigi ian and the english edition in 2009.
to monitor the quality of the Fas- Stecco in 1991 in Milan, at a con- This volume was easier because it
cial Manipulation courses. This gress about fascia. However, I did- has a lot of photographs and the
technique is currently taught in n't get around to doing a course terminology had already been es-
Italy, France, Portugal, Spain, Po- with him until 1999. On that occa- tablished.
land, Argentina, and Brazil by a sion he asked me if I could help
total of 12 qualified teachers and him translate a few lines. In the Fascial Manipulation the-
we are all working on rendering ory, it said that it is hypothesised
the educational process uniform. I've been collaborating with him that fascia is involved in proprio-
The Association held its first Na- ever since and have gone on to ception and peripheral motor
tional Congress in 2009 with almost become an instructor in the Fascial control in strict collaboration
a hundred participants. We are Manipulation technique. Together with the CNS. Can you elaborate
also organizing a course of Fascial with other instructors, I have more on the role of fascia in con-
Manipulation (in English) that will taught courses in Italy and Poland. nection with CNS.
be held in Italy at the Stecco Medi- In 2007, I was part of the group
cal Centre in June 2010. that won the best poster award at Great question!
the 1st Fascia Research Congress in The role of the CNS in motor con-
Our web site Boston and this year I'll be present- trol is well documented but not
www.fascialmanipulation.com has ing a one day workshop with Dr. that of the fascia. 70% of the
all the information. Carla Stecco at the 2nd Fascia Con- transmission of muscle tension is
gress in Amsterdam. In May 2010, directed through tendons, with a
I'm scheduled to give a talk and definite mechanical role, but 30%
mini workshop at the Massage of muscle force is transmitted
Therapy Foundation Conference, in throughout the connective tissue

Terra Rosa E-mag No. 4, December 2009 16


Interview with Julie Day
stretched and so it is possible to
recognize the precise direc-
tion and position of the limbs
through the spatial afferent infor-
mation received from the fascia
and integrated with other afferent
information being sent to the CNS.

You just came back from the 2nd


Fascia Congress in Amsterdam.
Can you share some of your ex-
periences.
Yes, there‘s a four-day program
full of high quality presentations
kept us busy. The latest trends
include new studies with evidence
surrounding the muscle, that is the cle contraction and so the activa- of fascial involvement in myofas-
deep fascia and intramuscular con- tion of specific pattern of recep- cial force transmission processes,
nective tissue. It is hypothesized tors is possible. Different portions and the role of fascia in motor
that fascia contributes to proprio- of muscular fibres are activated control. I found particularly inter-
ceptive information via its rich according to the degree of joint esting papers given by surgeons
innervation (mechanoreceptors movement, and so different pat- who are beginning to recognize the
and free nerve endings).The cap- terns of receptors are activated importance of fascia in plastic sur-
sules of these receptors are closely according to the ROM, and the spe- gery and tendon transpositions.
connected to the surrounding col- cific direction.
lagen fibres. These nerve endings At this Congress, our Fascial Ma-
could be stretched, and activated, nipulation group had a total of 3
each time the surrounding deep In the limbs, the deep fascia is presentations, 2 posters and a full-
fascia is stretched. However, it is relatively separate from underlying day workshop entitled "The Fascial
more probable that the ondulation muscles due to the epymisium and Manipulation© technique and its
of the collagen fibres inside the it has aponeurotic type character- biomechanical model - a guide to
deep fascia and the minor pres- istics. However, some muscles do the human fascial system". We
ence of elastic fibres infers an ini- have fascial insertions. In corre- were very busy networking all day
tial adaptation of the fascia, so spondence with these insertions, and were pleased to see that our
only when the collagen fibres have the deep fascia presents a thicken- workshop was sold out by the 2nd
lost their crimped conformation, ing, therefore these regions of the day of the Congress!
the receptors would be activated. fascia could easily perceive the
This mechanism could be consid- state of contraction of the under- The primary intent of the work-
ered a sort of "gate control" on the lying muscles. Nevertheless, the shop was to provide direct access
normal activation of the intrafas- most important connections are to new information about the
cial receptors. If the fascia is over- provided by myotendineous expan- anatomy of the human fascial sys-
stretched then these receptors sions into the fascia. The most fa- tem, considered to be potentially
could signal pain. mous expansion is surely the lacer- useful in the application of a vari-
Larger nerve fibres are often sur- tus fibrosus, an aponeurosis that ety of manual techniques. In fact,
rounded by different layers of originates from the biceps tendon this workshop attracted a wide
loose connective tissue that pre- and then merges with the ante- range of professionals from reme-
serves the nerve from traction to brachial fascia. Many other myo- dial massage, physiotherapy, chi-
which the fascia is subjected. If tendinous expansions have also ropractic, osteopathy, rolfing,
this mechanism is altered, we been recognized. When these mus- bodywork, and physiology.
could have a compressive syn- cles contract, not only do they
drome. move the bones, but thanks to
these fascial expansions they also
stretch the deep fascia and, con-
Regional differences in anatomy of sequently, with the activation of
deep fascia exist and therefore specific patterns of fascial pro-
proprioceptive activity differs prioceptors, permit the perception
somewhat. In the trunk, where the of the movement direction.
muscles and fascia have a very in-
timate reationship, the fascia is Every time that we move a limb,
immediately stretched by the mus- myofascial sequences are

Terra Rosa E-mag No. 4, December 2009 17


Working with the Cervical Core
Myofascial Techniques for the Deeper
Structures of the Posterior Neck

Til Luchau

Image 1: Cross-section of the neck at C5, from below. Shortened Image 2: When the soft-tissue structures around the atlanto-
―middle level‖ soft-tissue structures of the posterior neck, here occipital joint are free, small nodding motions will happen primarily
colored green, can contribute to limited flexion and increased cer- at the top of the neck, allowing the occiput to balance and move on
vical lordosis. These structures include the outer splenius and tra- the atlas like a seesaw.
pezius (medium green), the central nuchal ligament (dark green), Image courtesy Eric Franklin, originator of the Franklin Method
and the deeper transversospinalis group (bright green). Image (www.franklin-method.com), from his book Dynamic Alignment
©Primal Pictures Ltd. Used by permission. Through Imagery. Used by permission.

© 2008 Til Luchau, Advanced- and prepare the superficial fascial partment of the neck to lengthen;
Trainings.com. layers before attempting the tech- and,
Originally published in the USA in niques here. As in the first article, 3. The degree of participation of
Massage and Bodywork magazine I‘ll draw on the myofascial work as the ―prevertebral‖ muscles along
taught in Advanced-Trainings. the front of the cervical spine.
com‘s ―Advanced Myofascial Tech-
niques‖ workshop series. You can These each contribute to the align-
In our previous article (Preparing see video related to these tech- ment, flexibility, and stability of
the Neck and Shoulders for Deep niques and tests by visiting Ad- the neck, particularly in ―head
Work: Myofascial Techniques for vanced-Trainings.com‘s YouTube forward‖ positions (cervical lor-
the Superficial Fascia, I talked channel at: http:// dosis).
about how taking time to release www.youtube.com/user/
superficial restrictions, before AdvancedTrainings Begin with your client sitting or
working deeper structures, can standing. While looking at his or
increase your effectiveness and her profile, ask for small nodding
give longer-lasting results. In this 1. The Nod Test motions. We want just a little bit
article, we‘ll look at ways to as- The Nod Test allows us to assess of movement—too much will make
sess and release deeper neck re- three important things: the initiation of movement hard to
strictions. Since it is ―Part II‖ of 1. Freedom at the atlanto-occipital see. Ask yourself: Which neck joint
the earlier article, I‘ll assume (A/O) joint; moves first? Which joint or joints
you‘ve done some work to release 2. The ability of the posterior com- are flexing and extending in these

Terra Rosa E-mag No. 4, December 2009 18


Myofascial techniques for the neck
2. Cervical Transversospinalis
Technique

In a client that has limited neck


flexion, as in the person on the
right in Image 2, your next step will
be to lengthen and release the
strong, middle-level longitudinal
structures (listed in Image 1).

We‘ll use the knuckles of our proxi-


mal interphalangeal (PIP) joints to
anchor and lengthen these mid-
level layers (Image 4). Seated com-
fortably at the client‘s head, place
your right forearm and wrist on the
table for stability. With the PIP
knuckles of your first two fingers,
gently feel for longitudinal short-
Image 3: The Nod Test. When the deep structures of the posterior neck are able to
ness in the various layers of the
lengthen in the larger motions of cervical flexion, nodding happens primarily at the top of deeper neck structures, first on the
the neck (as on the left). When the posterior compartment cannot lengthen, cervical right side of the neck. Anchor these
flexion is limited, and the motion of nodding gets driven into the base of the neck (as on short tissues in a caudad or foot-
the right).
ward direction.

small nodding motions? If it is hard terior compartment of the neck to Once you‘ve comfortably placed
to see these things, ask your client lengthen in flexion. One way to see your right hand, you can slowly
to make even smaller motions, this is to look for evenness of flex- bring your client‘s neck into a bit of
while you look for the very first ion and extension throughout the flexion. With the left forearm
joints that move. You can also use cervical column. When the posterior braced against the edge of the ta-
your hands to feel for this initia- structures can‘t lengthen, larger ble for stability, lift the head to
tion, if it still isn‘t clear to your nodding motions are driven lower in slightly flex the neck. When you get
eyes. the neck, and the middle and upper your position and angles right, lift-
cervicals have less flexion (Image ing the head is relatively easy, even
This simple small-nodding test helps 2). if your client is bigger than you. If
you find where most of your client‘s lifting the head feels like a strain,
cervical flexion and extension typi- reposition until you find an easier
cally occurs. By implication, you
can determine if there is freedom
at the topmost joint of the neck,
the atlanto-occipital joint (A/O).
When the soft-tissue structures
around the A/O are free, small nod-
ding motions will happen primarily
here, allowing the head to balance
and rock on the atlas like a seesaw
(Image 1). When it is present, this
top-of-the-neck freedom gives a
sense of lightness and poise. If the
motion looks like it is happening
lower in the neck instead of at the
A/O, it could indicate restrictions in
the suboccipital or transversospi-
nalis muscles.

Once you‘ve assessed A/O freedom


with small motions, ask your client Image 4: In the Cervical Transversospinalis technique, you‘ll slowly lift the cli-
to do larger nodding, as in looking ent‘s head while gently anchoring shortened structures of the posterior neck.
up and down. With this larger mo- The knuckles provide a strong, sensitive, and stable tool. Be sure to keep your
tion, look for the ability of the pos- wrist as straight as possible.

Terra Rosa E-mag No. 4, December 2009 19


Myofascial techniques for the neck
―drive‖ the wedge in, like splitting
a piece of firewood. Rather than
forcing the joint open, let your fin-
gers be like a flashlight, showing
your client where new space and
length is possible. At each tight
space, wait for the client‘s tissues
and nervous system to respond as
you lift. Be sure to spend time at
the top joint of the neck, the A/O,
especially if your small-nodding test
showed movement restriction here.

In the passive version of this tech-


nique, simply find the shortened
spaces between the spinous proc-
esses of the neck, and in each
place, wait for the cervical joints to
open and release. In the active
variation, once you find a shortened
Image 5: In the Posterior Cervical Wedges technique, use the fingertips of both hands to
space between two cervical verte-
feel beside and between the spinous processes of each neck vertebra for any crowded or brae, ask for small, subtle nodding
shortened spaces. Wait for each joint to open and lengthen, rather than trying to ―drive‖ motions. Coach your client until you
the wedge of your fingers in. both feel the first movement of
nodding occurring right at the joint
way. Even though your right hand is returning. This technique can do space in question. In addition to
stationary on the table, lifting the both—it is an effective way to re- releasing shortened tissues, your
head has the effect of dragging the lease deep soft-tissue restrictions, client gains proprioceptive access
tissues out from under your knuck- right down to the deepest articula- to the joints that weren‘t opening
les. Keep your pace slow and tions of the cervical spinal column; as much as others.
steady, feeling for restrictions in and in the active-motion version, it
the posterior compartment of the will help your client find new move-
It may be difficult at first for your
neck, and waiting, rather than ment possibilities that will support
client to focus their nodding motion
pushing, for release. the structural work once the session
at the articulations that aren‘t ac-
is over. customed to moving. Some of the
verbal cues you can use include:
Once you‘ve made an initial pass or Use the fingertips of both hands to  “Use very small movements to
two, you can focus on very detailed feel the space and tissue texture let this space open.”
work into particularly tight or short beside and between the spinous
structures by incrementally lifting, processes of two vertebrae, begin-
 “Leave your head heavy on the
table. Let the movement begin
rotating, flexing, and extending the ning at the base of the neck with C6
right here.”
neck around the point of contact, and C7. Work head-ward, checking
all the while encouraging length up each articulation that you can pal-  “Let the back of your head
the back of the neck. Be thorough, pate. Gently lift with your finger- move upward on the table to gently
working deeper through the various tips into any restricted spaces be- open this space.”
layers you encounter, all the way tween the spinous processes (Image
from the occipital ridge into the 5). Keep your hands relaxed onto You may need to start with other
shoulders and base of the neck. By the table to avoid straining; lift joints, where there is already obvi-
switching your hand position, you with just the fingertips. ous flexion and extension with nod-
can work the left and right, as well ding; once you and your client can
as the central nuchal ligament When the neck flexes, the space both feel the motion at a mobile
(taking care not to apply an uncom- between these cervical spinous articulation, you can move up or
fortable level of pressure directly to processes opens. In a neck that has down into the more restriction
the spinous processes). lost flexion, like the one on the joints.
right in the Nod Test photo (Image
3. Posterior Cervical Wedges 2), some of these spaces between Another pointer: often, practitio-
Technique the spinous processes will be ners and clients start with move-
crowded and tight (most often be- ments that are too large to allow
It is one thing to release restricted tween the 3 rd
and 4 th
cervical verte- the needed specificity. We‘re
tissues; it is another to help our brae). Your fingertips are the teaching the ability to initiate flex-
clients find new ways of moving ―wedges‖ that can help invite more ion and extension at specific cervi-
that will keep the restrictions from space at each joint. However, don‘t cal joints, and this almost always

Terra Rosa E-mag No. 4, December 2009 20


Myofascial techniques for the neck
Incidentally, the back-of-the-neck alignment of the neck and head of-
lengthening that we‘re looking for ten involves more than just freeing
involves more than just releasing local restrictions. The neck reflects
the posterior joint spaces—it also what is happening in the rest of the
involves engaging the prevertebral body. Issues such as eyestrain, jaw
muscles along the anterior side of issues, shoulder patterns, rib or
the spine: the longus capitis, rectus pleural pulls, spinal rotations, hip
capitis and longus colli (Image 6). or pelvis asymmetries, or even sup-
These deep front-side antagonists port issues involving the lower
to the posterior neck extensors help limbs, will show up as neck align-
balance and coordinate cervical ment problems. Other neck struc-
flexion and extension. In a cervical tures, particularly the scalenes and
lordosis pattern, they are typically sternocleidomastoids may be in-
under-utilized. The active version volved. Habits of posture and body
of the ―wedge‖ technique auto- use can be slow to change. So,
matically engages these preverte- don‘t be discouraged if you find
bral muscles; you‘ll be increasing neck issues that don‘t seem to re-
their participation in movement and spond at first. Think bigger; learn
posture when you‘re helping your more; refer to a Rolfer or other
client find flexion at each restrictedcomplementary practitioner who
joint. specializes in big-picture, integra-
Image 6: The active version of the Posterior tive work, or in movement and pos-
Cervical Wedges technique engages the In a hyper-erect or ―military neck‖ ture reeducation. And don‘t be
prevertebral muscles along the front of the pattern, use the active wedge tech- afraid to experiment with these
spine (arrows) to help open any narrowed nique in reverse, encouraging more ideas and make them your own—
spaces between posterior spinous processes.
In a hyper-erect or ―military neck‖ pattern, extension (posterior closing) be- your clients and your own level of
the wedge technique can be reversed to tween cervical vertebrae. Find the satisfaction will undoubtedly bene-
encourage more extension (posterior clos- most open or flexed vertebral fit.
ing) between cervical vertebrae. spaces. Then, as you use your
Image from Kapandji, Physiology of the
Joints, Volume III. All rights owned by El- wedge to indicate these places to
sevier, Inc. Used by permission. your client, coach him or her to Til Luchau is the director and a
gently pinch or close right around lead instructor at Advanced-
your fingers. Go for subtlety, speci- Trainings.com Inc., which offers
involves asking our clients to slow ficity, and the ability to initiate continuing education seminars
down, and to make even smaller extension right at the joint in ques- throughout the United States and
movements than they‘re accus- tion. Of course, is it important to abroad. The originator of Skillful
tomed to. Be patient, stay in con- avoid over-extending the neck, so Touch Bodywork (the Rolf Insti-
versation with your client, and en- stay focused on local extension at tute’s own training and practice
courage him or her whenever you specific joints. modality), he is a Certified Ad-
feel movement at the restricted vanced Rolfer and a Rolf Institute
joint. Although subtle, the move- faculty member. He welcomes your
ment will be clear and tangible to The Big Picture comments or questions at
both of you when you‘ve estab- These techniques are quite effec- info@advanced-trainings.com.
lished it. tive, and you‘ll see satisfying re-
sults by using them. Of course,

Advanced Myofascial Techniques

DVDs and Manuals available from


www.terrarosa.com.au
Advanced Myofascial Workshops with
Til Luchau & Co. in Australia in 2010
For more info: info@advanced-trainings.com

Advanced-trainings.com
Terra Rosa E-mag No. 4, December 2009 21
Vertebral Artery Test (VAT)
Colin Rossie
Over the years I have heard all sorts of education. Perhaps the problem with tions and refer clients to them. They
stories about the efficacy and safety of the supine VAT arose through lack of now have a different attitude to pro-
the VAT. I've researched to find out all supervision: perhaps it was over- fessional massage therapy and body-
I can about it; some research indicates enthusiasm, the student possibly ap- work. Though I tend to err excessively
it's completely useless in indicating plying, however slight, an over- on the side of caution, these doctors
vertebral artery compromise. Nonethe- pressure in the extension, the lateral are no longer surprised by such refer-
less, I would do it each time before flexion, or the rotation component of rals and rather than dismiss them out
working on the cervical spine. In the the testing. I've always performed of hand will consider my concerns, test
absence of any alternative, I believe these tests gently as passive tests, their patient and respond to my con-
it's better to be safe than sorry. with no over pressure, and have never cerns.
had a problem with a client, other
I know at least two versions of it: than the occasional positive. Now, a not so happy story. As a gift to
One is the cervical quadrant test, her PA, one of my regular clients sent
which involves, while the client is su- In my clinical experience, there has her to see me. The PA was in her late
pine, bringing the head and neck into always been a higher incidence of cli- 20‘s, classic ―A‖ type, well organized,
extension and side-flexion, and holding ents recording a positive response to very bright, a fit, gym junkie. Her ma-
for 30 seconds, these tests than actually having vascu- jor complaint was ―sore neck & shoul-
lar compromise. Often the problem is ders‖. The first thing I did in the ses-
The other is the deKleyn Nieuwen- a middle ear/ balance issue. In any sion was a VAT. She came up positive
huyse Test, which is similar: with the one year, I'll have at least ten clients so we calmly discussed what a positive
client supine, the practitioner pas- test positive to the VAT. I always sug- result could mean and that before we
sively brings the client's head into ex- gest they go to their doctor for further could proceed with any work that I
tension, then passively rotates the testing. would need clearance from her doctor.
cervical spine instead of side-flexing I didn't work on her, and would not do
it. This test is performed bilaterally. Half do, half don't. I rigorously follow so until I had the all clear. She didn‘t
up and encourage them to. In most return, and answered my queries
There is also Hautant's Test, which cases it turns out that I am just being about whether she had seen to it yet
tests for the same but in the seated overly cautious - in the last ten years, with a casual ―I‘ll get around to it one
position, as well as Barre's Test, which most of those who have seen their day‖. Eight months later she died of a
is the same thing but done in the doctors have had nothing wrong. A few cerebral stroke while out running at 6
standing position. have recorded high cholesterol levels; a.m.
some have had vestibular compromise;
If dizziness, nausea, dipoplia or other one, a male amateur cricketer, 32 1) Magee, D. J. ―Orthopedic Physical
vision disturbance, disorientation, years old at the time, who otherwise Assessment‖ Saunders
ataxia, impairment of trigeminal sen- seemed perfectly healthy, had a berry 2) Petty N.J. & Moore A.P.
sation or nystagmus are provoked by aneurysm; another, a yoga-practicing ―Neuromusculoskeletal Examination &
any of these tests then your client is vegetarian in her late 40s, had an Assessment‖ Churchill Livingstone
recording a positive: testing should atheroma in her left carotid artery;
cease immediately and they should be and yet another had over the top hy-
referred to their primary care physi- pertension. A client last year had a
Originally published in AMT Journal "In
cian. condition known as Cerebral Arterio
Good Hands", September 2008.
Venous Malformation and after seeing
I would recommend all practitioners her GP had immediate surgery with Dr Colin Rossie is a Rolfer based in Syd-
familiarize themself with all of the Charlie Teo. None of these people ney. He has been a bodyworker for
above tests. These can all be found in would be walking on the planet today more than 20 years. Originally as a
a suitable examination and assessment had they not been made aware of a Shiatsu practitioner and later a Reme-
text.(1,2) possible problem via the VAT. dial and Sports Massage Therapist,
before becoming a Certified Rolfer®
After problems arising from it being All those clients were thankful that and Rolf® Movement practitioner.
done by a student in a college clinic, it such a thing was picked up. Several
is no longer taught at some massage local doctors initially found it amusing
training colleges. I think this attitude that a massage therapist would write
is a huge loss to massage or bodywork them a letter explaining their observa-
Terra Rosa E-mag No. 4, December 2009 22
Form Closure,
Force Closure &
Myofascial Slings
The sacroiliac (SI) joints are now these joints. It is both necessary can be increased in two ways.
well-known and become popular as and desirable that they move, so Firstly, by interlocking of the
the source of lower back pain. that they can act as shock absorb- ridges and grooves on the joint
Form Closure and Force Closure, ers between the lower limbs and surfaces (form closure); secondly,
which comes from the orthopaedic spine, and to act as a propriocep- by compressive forces of structures
and physiotherapy literature are tive feedback mechanism for coor- like muscles, ligaments and fascia
now quite popular in bodywork. dinated movement and control (force closure). Muscle weakness
This article attempts to describe between trunk and lower limbs. and insufficient tension of liga-
these terms and its relationship to ments can lead to diminished com-
SI joints stability and contribution As the SI Joints are capable of pression, influencing load transfer
to lower back problem. This article some movement, they must be negatively.
mainly comes from articles by controlled for effective force
Craig Liebenson1 and Diane Lee2. transfer to take place between For therapists, ‗force closure‘ is of
trunk and lower limbs. The muscle greater interest because we can
SI joints dysfunction has been system is able to provide a dy- influence this through exercise and
proven to cause not only lower namic way of stabilising the sacro- retraining.
back pain, but also groin and thigh iliac joint.
pain. For many decades clinicians FORM CLOSURE
have been convinced the SI joints The ability to effectively transfer The self-locking mechanism of the
were not mobile, but this notion is load through the pelvic girdle is pelvis is called form or force clo-
not based on research findings. dynamic and depends on optimal sure. Form closure is a feature of
Especially in the last two decades function of the bones, joints and the anatomy of the SI joints,
research has proven otherwise; ligaments (form closure) , optimal mainly their flat surfaces, and pro-
mobility in the SI joints is usual, function of the muscles and fascia motes stability. Unfortunately,
even in old age. (force closure), and appropriate these flat surfaces are vulnerable
neural function (motor control, to shear forces such as can occur
Movement in the SI joints and sym- emotional state). during walking.
physis pubis is made possible by
the fibrocartaligenous structure of The stabilization of the SI joints Since the SI joints have to transfer
large loads, the shape of the joints
is adapted to this task. The joint
surfaces are relatively flat which is
favourable for the transfer of com-
pressive forces and bending mo-
ments. However, a relatively flat
joint is vulnerable to shear forces.
The SI joints are protected from
these forces in three ways. Firstly,
due to its wedge-shape the sacrum
is stabilized by the innominates.
Secondly, in contrast to normal
synovial joints the articular carti-
lage is not smooth. Thirdly, the
presence of cartilage covered bone
extensions protruding into the
joint, the so called ridges and
Figure 1. Transversely oriented muscles press the sacrum between the hip bones. This deep grooves. They seem irregular, but
muscle corset forms lumbopelvic stability. (1) Sacoiliac joint. Muscles: transverse abdomi- are in fact complementary, which
nal (2), piriformis (3), internal oblique (4), and pelvic floor (5).
serves a functional purpose.

Terra Rosa E-mag No. 4, December 2009 23


Myofascial slings
This stable situation with closely
fitting joint surfaces, where no ex-
tra forces are needed to maintain
the state of the system, given the
actual load situation, is termed
'form closure'.

FORCE CLOSURE
If the sacrum could fit in the pelvis
with perfect form closure, mobility
would be practically impossible.
However, during walking, mobility
as well as stability in the pelvis
must be optimal. Extra forces may
be needed for equilibrium of the
sacrum and the ilium during loading Figure 2. Trunk, arm and leg muscles that compress sacroiliac joint. The crosslike sling
situations. How can this be indicates treatment and prevention of lower back pain with stretngthening & coordination
of trunk, arm and leg muscles in torsion & extension, rather tha flexion.
reached?
A. Posterior oblique sling Latissiumus dorsi (1), thoracolumbar fascia (2), gluteus maximus
(3), iliotibial tract (4).
The principle of a Roman arch of B. Anterior oblique sling Linea alba (5), external oblique (6), transverse abdominals (7),
stones resting on columns may be piriformis (8), rectus abdominis (9), internal oblique (10), ilioinguinal ligament (11). Pictures
applicable to the force equilibrium from Pool-Goudzwaard et al.3.
of the SI joints. Since the columns
of a Roman arch cannot move
apart, reaction forces in an almost
longitudinal direction of the respec-
tive stones lead to compression and
help to avoid shear. For the same
reason, ligament and muscle-forces
are needed to provide compression
of the SI joint. This mechanism of
compression of the SI joints due to
extra forces, to keep an equilib-
rium, is called 'force closure' (Figs.
1 & 2).

MYOFASCIAL SLINGS

Andry Vleeming and co. proposed


the concept of myofascial slings.
The term ‗sling‘ suggests, the myo-
fascial system is able to provide a
dynamic way of stabilising the SI
joint through force closure. There
are 3 slings that can provide force Figure 4. Anterior oblique sling, Pecto-
closure in the pelvic girdle include: rals, external oblique, transverse abdomi-
the posterior oblique sling, the an- Figure 3. Posterior oblique sling, Latis- nus and internal oblique.1
terior oblique sling and the poste- simus dorsi and contralateral gluteus
rior longitudinal sling. maximus, biceps femoris.1
cause closure of the SI Joints.

Posterior oblique sling: (Fig. 3) band (ITB). This sling system runs at
consists of the superficial fibres of a right angle to the joint plane of Anterior oblique sling: (Fig. 4) con-
the latissimus dorsi blending with the SIJ and in effect will cause clo- sists of the external oblique, inter-
the superficial fibres of the contra- sure of the joint when the latis- nal oblique and the transversus ab-
lateral gluteus maximus through the simus and contralateral gluteus dominis via the rectus sheath,
posterior layer of the thoraco- maximus contract. Furthermore, blending with the contralateral ad-
lumbar fascia. The superficial glu- the gluteus maximus and thora- ductor muscles via the adductor-
teus maximus then blends with the columbar fascia have investments abdominal fascia. This will cause
superficial fascia lata of the thigh, into the sacrotuberous ligament. force closure of the symphysis pubis
in particular the superficial iliotibial Tension in this ligament will also when contracted.

Terra Rosa E-mag No. 4, December 2009 24


Myofascial slings

Figure 5. Longitudinal slings, Deep multifidus


attaching to the sacrum with the deep layer of
the thoracolumbar fascia, blending with the long
dorsal sacroiliac ligament and continuing on into
the sacrotuberous ligament.

Longitudinal sling: (Figs. 5, 6) con-


sists of the deep multifidus attach-
ing to the sacrum with the deep
layer of the thoracolumbar fascia,
blending with the long dorsal sacro-
iliac joint ligament and continuing
on into the sacrotuberous ligament. Figure 6. Deep multifidus attaching to the sacrum with the deep layer of the thoracolum-
In a proportion of the population, bar fascia, blending with the long dorsal sacroiliac ligament and continuing on into the
the sacrotuberous ligament extends sacrotuberous ligament.
on to the biceps femoris muscle.
This causes compression of the L5/ They found that in dysfunction, above the couch for 20 cm without
S1 joint and compression of the SI there is a timing delay or absence bending the knee.‘‘
Joints. of contraction of these muscles and
consequently the system is not sta- When the lumbopelvic region is
Note that the anterior and posterior
oblique slings are similar to the bilized prior to loading. They also functioning optimally, the leg
Functional Front Line and Func- found that recovery is not sponta- should rise effortlessly from the
tional Back Line of Tom Myers‘ neous, in other words - the pain table and the pelvis should not
Anatomy Trains (Fig. 7). may go away but the dysfunction move (flex, extend, laterally bend
persists. or rotate) relative to the thorax
MOTOR CONTROL2 and/or lower extremity.
Another important component for
the stability of SI joints is motor The Active Straight Leg Raising The test is positive if
control. Motor control addresses Test1 - the leg cannot be raised up
the nervous system and is about the -Significant heaviness of the leg
co-ordination or co-activation of The active straightleg-raising test - Decreased strength (therapist add
these deep stabilizers. One of the (ASLR) can be used to test which SI resistance)
world's leading research teams from joint is unstable. It is useful for in- - Significant ipsilateral trunk rota-
the University of Queensland dicating effective load transfer be- tion
(Richardson, Jull, Hodges & Hides) tween the trunk and lower limbs.
have investigated the timing of Improvement should be noted:
these muscles in low back pain pa- The test is as follows: - Manual compression through the
tients. They found that normally, -Client lies supine with the legs ilia
these deep stabilizers should con- about 20 cm apart. - SI belt tightened around the pelvis
tract before load reaches the low -Actively lifts one leg 20 cm up fol- - Abdominal hollowing
back and pelvis so as to prepare the lowing the instruction, ‗‗Try to raise
system for the impending force. your legs, one after the other,

Terra Rosa E-mag No. 4, December 2009 25


Myofascial slings
Compression to the pelvis has been
shown to reduce the effort neces-
sary to lift the leg for patients with
pelvic girdle pain and instability.

Treatment of SI joint dysfunction


includes advice, soft tissue mobili-
zation and exercise. Offer advice
about lumbopelvic posture during
sitting, standing, walking, lifting
and carrying activities. In particu-
lar, give advice to avoid creep dur-
ing prolonged sitting. Also, a SI sta-
bilization belt may be indicated
until neuromuscular control of pos-
ture is reeducated subcortically.

Manual therapy to consider includes


myofascial release of the lumbodor-
sal fascia and postisometric relaxa-
Figure 7. The Functional Front Line and Functional Back Line of Tom Myers‘
tion of the adductors, piriformis, Anatomy Trains.
hamstrings, quadratus lumborum,
iliopsoas, latissimus doris, erector maximus and latissimus dorsi may Summary
spinae or tensor fascia lata. also require endurance training. In The SI joints are an important
particular, functional core exercises source of pain. Force closure of the
Exercise should focus on reactivat- training stability patterns in move- SI joints requires appropriate mus-
ing the deep intrinsic stabilizers ments and positions similar those of cular, ligamentous and fascial inter-
such as the transverse abdominus, daily life, recreation and sport, or action. The ASLR test can help to
internal oblique abdominals and occupational demands. determine if a specific treatment is
multifidus muscles. The quadratus For instance, squats, lunges, push- effective.
lumborum, gluteus medius, gluteus ing and pulling movements. Advice about posture and support,
manual therapy of related muscles
and fascia, and exercise of key sta-
bilizers are all important compo-
nents in re-establishing lumbo-
pelvic stability.

References
1
Craig Liebenson. The relationship
of the sacroiliac joint, stabilization
musculature, and lumbo-pelvic in-
stability. Journal of Bodywork and
Movement Therapies (2004) 8, 43–45
2
Diane Lee. Myths and Facts and
the Sacroiliac Joint. What does the
Evidence Tell Us?
3
A. Pool-Goudzwaard, A. Vleeming,
C. Stoeckart, C.J. Snijders and M.A.
Mens, Insufficient lumbopelvic sta-
bility: a clinical, anatomical and
biomechanical approach to ―a-
specific‖ low back pain. Manual
Therapy 3 (1998), pp. 12–20.

Terra Rosa E-mag No. 4, December 2009 26


It’s Not All About the Piriformis –
Considering the Abdominal Viscera in Lower Back
and Pelvic Pain
Marty Ryan
Different health care and manual may contribute to some of the
therapy modalities see lower back ―usual suspects‖ of low back and
and pelvis pain differently. Admit- pelvic pain - lumbar lordosis, low
tedly, the lower back region is a back muscle spasm, disk and facet
difficult area to define. Just ask issues, pelvic floor weakness, and
your clients to touch their own low anterior / posterior skeletal mus-
back pain and see what I mean. cle imbalance.
You may see answers anywhere
from the tip of the coccyx to T8. 4. The pelvic floor skeletal muscles
and related fascia is suspended
The lower back and pelvis is a between the coccyx, pubis, and
complicated confluence of the ischial tuberosities, and plays a
weight-bearing bony skeleton and large role in gait, posture, and
related soft tissues. This includes erect weight bearing responsibili-
the large postural muscles and re- ties. This area should not be
lated fascia, the digestive, elimi- missed!
native, and reproductive system
viscera, as well as large amounts 5. The quadratus lumborum, spinal
of blood / lymph / nerve tissues. rotators, erector group, hip rota-
tors (piriformis and its
Chiropractors, acupuncturists, neighbours), and gluteals are only
physiotherapists, orthopaedic sur- part of the lower back pain equa-
geons, medical doctors, movement low back and pelvic pain. tion. This is where most manual
therapists, and massage therapists Here are some reasons to consider therapists stop looking. At this
all have different ideas about how the guts when working with low point, only posterior tissues have
to optimize function and decrease back and pelvic pain – been considered. Braver therapists
pain here. Is it a joint issue? Is it a will also treat the iliopsoas mus-
soft tissue problem? Is there a 1. The abdominal viscera are bulky cle, which at least considers the
nerve being impingement? Does and substantial. This tissue in- other side of the spine.
the gut play a role? What pharma- cludes the fascial architecture and
ceutical interventions should be suspensory tissues + fluids + fat + 6. Myriad other factors can com-
used? Is surgery a possible answer? the abdominal and pelvic organs promise the function of the low
How do we get right with gravity themselves. back and pelvis including preg-
and the low back? How do patients nancy and labour, high velocity
maintain body awareness, proper 2. This weight is managed by the impact injuries, post-surgical ad-
nervous system messaging, and fascial suspension of the parietal hesion syndromes, scar tissue, in-
fluid dynamics to this region when peritoneum hanging from the res- flammation, and fluid return chal-
they leave our office? All of these piratory diaphragm, the spine, and lenges – just to name a few.
are terrific questions. the rest of the abdominal
―container.‖ This container also If working with the abdominal vis-
This short article proposes that holds back the expansion of the cera and pelvic floor is not a place
manual therapists also consider hollow abdominal organs which is of fluency for you, and your low
the abdominal viscera and pelvic quite a tricky balancing act. back and pelvis pain clients are not
floor when assessing and treating getting better; it may be time to
3. Improperly managing this weight increase your treatment skill sets.

Terra Rosa E-mag No. 4, December 2009 27


7 Goals for a Happy Belly
ing around in your life. 7. Ease and grace with your own
belly – instead of hating or fearing
4. Decreased cramping – both after your belly, you enjoy feeding it,
meals and during the entire day. looking at it, massaging it, hugging
5. Easy and efficient transit time it, and knowing that it serves you
and bowel movements –food should well. This is the broadest and most
move along the gut tube at a pace encompassing of all the goals here
that does not create cramping, and subsumes all of the above.
bloating, or gas and allows for 2 -3 Marty Ryan, LMP is a massage
easy bowel movements per day - therapist at the
usually after meals. Tummy Temple
6. Reproductive system ease – in Seattle, WA /
1. Decrease tension in the belly USA. His practice
wall – a chronically hard belly wall For females this means: specializes in
challenges posture, spinal support, digestive and
• regular and predictable men- reproductive sys-
and the proper mechanics of
strual cycles tem health care.
breathing. The hard belly wall - a
strange cultural goal to say the He is also the
• minimal abdominal cramping,
least - is a sign of anxiety, fear, founder and director of Love Your
breast tenderness, or headache
stress, inflammation, and de- Guts Seminars, currently a 3 week-
with ovulation or menses
creased abdominal organ function. end training series teaching palpa-
• minimal or no PMS / menopausal tory anatomy and treatment tech-
2. Easy penetration through the symptoms niques for the belly.
layers of belly organs – one should
be able to move through the belly • no cysts, masses, endometriosis, For more info on this work:
wall to all of the organs and front or fibroids in the pelvis www.loveyourguts.net
of the spine with little or no dis- Register for classes in the US
• easy access to sexual energy
comfort. Pain upon palpation at www.AdvancedEducators.com
various layers of the abdomen is a For males this means:
sign of tension, emotional or ener- Register for classes in the UK and
getic holding patterns, adhesion • no prostate swelling or nocturnal AU www.bodyworkcpd.co.uk
from inflammation or surgery, and urination
dysfunction on some level.
• easy erections without pain or
3. Decreased pain in the abdominal premature ejaculation
organs - both upon touch and walk-
• easy access to sexual energy

Available from www.terrarosa.com.au

Terra Rosa E-mag No. 4, December 2009 28


The Myth about Core Training
The origin of the core work these days much mythology out there about the
probably derived from the work done core,‖ maintains Stuart McGill, a
in a physiotherapy lab in University of highly regarded professor of spine bio-
Queensland during the mid-1990s. Re- mechanics at the University of Water-
searchers there (Paul Hodges, Carolyn loo in Canada and a back-pain clinician
Richardson, Julie Hides and co.), hop- who has been crusading against ab
ing to elucidate the underlying cause exercises that require hollowing your
of back pain, attached electrodes to belly. ―The idea has reached trainers
people‘s midsections and directed and through them the public that the
them to rapidly raise and lower their core means only the abs. There‘s no
arms. In those with healthy backs, the science behind that idea.‖
scientists found, transversus ab-
dominis, a deep abdominal muscle, ―If you hollow in your muscles as you
tensed several milliseconds before the are instructed in these exercises, you
arms rose. The brain apparently bring the muscles much closer to the
alerted the muscle, the transversus spine and you effectively reduce the
abdominis, to brace the spine in ad- stability of the back,‖ he says. ―Try it
vance of movement. In those with yourself by getting out of a chair with
lower back pain, however, the trans- a hollowed out stomach. Not only are
versus abdominis didn‘t fire early. The you weak and wobbly, it is very diffi-
spine wasn‘t ready for the flailing. It cult.‖
wobbled and ached. The researchers
The ―core‖ remains a somewhat nebu-
theorized, increasing abdominal comes to proof that core-stability
lous concept; but most researchers
strength could ease back pain. The lab workouts are helpful the ―evidence is
consider it the corset of muscles and
worked with patients in pain to isolate just not there‖. They cast doubt on
connective tissue that encircle and
and strengthen that particular deep the notion that back pain is linked to
hold the spine in place. If your core is
muscle, in part by sucking in their guts ―less than optimal core stability‖ and
stable, your spine remains upright
during exercises. The results, though suggest that it is linked to poor trunk
while your body swivels around it. But,
mixed, showed some promise against rotation and strength instead. What is
McGill says, the muscles forming the
back pain. more, the researchers say, the teach-
core must be balanced to allow the
ing of some core stability moves to
From that highly technical foray into spine to bear large loads. If you con-
people with or without back pain ―is at
rehabilitative medicine, a booming centrate on strengthening only one set
best controversial‖ since their own
industry of fitness classes was born. of muscles within the core, you can
review of evidence has shown that the
The idea leaked into gyms and Pilates destabilize your spine by pulling it out
exercises have little beneficial effect.
classes that core health was all about of alignment. Think of the spine as a
the transversus abdominis. Personal Professor Carolyn Richardson, of the fishing rod supported by muscular guy
trainers began directing clients to pull Department of Physiotherapy at the wires. If all of the wires are tensed
in their belly buttons during crunches University of Queensland, says: ―I have equally, the rod stays straight. ―If you
on Swiss balls or to press their backs found that for the fitness industry it is pull the wires closer to the spine,‖
against the floor during sit-ups, deeply often a poor instruction that is often McGill says, as you do when you pull in
hollowing their stomachs, then curl up misinterpreted or carried out badly. your stomach while trying to isolate
one spinal segment at a time. It‘s easily done incorrectly by people the transversus abdominis, ―what hap-
holding their breath or rounding their pens?‖ The rod buckles. So, too, he
But there‘s growing dissent among backs because they are sucking in their said, can your spine if you overly focus
scientists about whether all of this muscles so far.‖ on the deep abdominal muscles. ―In
attention to the deep abdominal mus- research at our lab,‖ he went on to
cles actually gives you a more power- Prof. Paul Hodges from University of say, ―the amount of load that the
ful core and a stronger back and Queensland agrees that clinical prac- spine can bear without injury was
whether it‘s even safe. A paper pub- tice often adopts research findings in a greatly reduced when subjects pulled
lished in July 2008 in the British Jour- simplified and hardline approach. in their belly buttons‖ during crunches
nal of Sports Medicine suggests that However he argued that motor control and other exercises.
the benefits of core-stability workouts interventions are effective. And we
have been wildly overplayed. Professor don‘t know yet if the effect is ex- Instead, he suggests, a core exercise
Garry Allison, of the school of physio- plained by increased stability of the program should emphasize all of the
therapy at the Curtin University of spine due to activation of transversus major muscles that girdle the spine,
Technology in Perth, Western Austra- abdominis and other deep muscles including but not concentrating on the
lia, and Sue Morris, a physiotherapy abs.
researcher at the University of West- Another school of core stability is by
Stuart McGill from Canada. ―There‘s so Side plank (lie on your side and raise
ern Australia, claim that when it
your upper body) and the ―bird dog‖
Terra Rosa E-mag No. 4, December 2009 29
The Myth about the Core
exercise (see below) the important Gently lift your head and shoulders, Source
muscles embedded along the back and hold briefly and relax back down.
sides of the core. ―Is Your Ab Workout Hurting Your
These three exercises, done regularly, Back?‖ By Gretchen Reynolds http://
As for the abdominals, no sit-ups, McGill said, can provide well-rounded, well.blogs.nytimes.com/2009/06/17/
McGill said; they place devastating thorough core stability. And they avoid core-myths/?apage=4
loads on the disks. An approved crunch the pitfalls of the all-abs core routine.
begins with you lying down, one knee ―I see too many people,‖ McGill told
bent, and hands positioned beneath me with a sigh, ―who have six-pack abs
your lower back for support. ―Do not and a ruined back.‖
hollow your stomach or press your
back against the floor,‖ McGill says.

Bird Dog Exercise (From Liebensen, 2009) opposite leg all the way behind you.
• Push with your support hand down into the floor so that
your head/neck and upper back push off the floor slightly.
Start
• Hold this position for a few seconds.
• Then return to the start position.
• Alternate arms and legs.

Avoid
• Poking your chin out
• Letting your shoulder blade stick out.
• Flattening or rounding your back
• Dropping your pelvis on one side
• Holding your breath

• Kneel on your hands on knees Sets/reps/frequency:


• Hands directly under your shoulders and knees directly • Perform 1 set with 8–12 repetitions
under your hips
• 1–2 times per day
• Round your back up and then let your spine relax down to
the floor into a natural slightly arched position.
• Hold this slightly arched down position and “brace” your Troubleshooting:
back by slightly tensing the muscles in 360° around your • If the Bird Dog is hard to control then perform the easier
back to stiffen your spine. Quad Arm Reach (Both legs on the floor, reach with 1 arm).
• Hold this “braced” position while breathing normally. This And progress to the Quad Leg Reach (Both hands on the
takes a little practice. floor , reach one leg behind).

Technique These exercises are now available in youtube, just search


• Keep your spine “braced” and reach with one arm all the for “bird dog exercise”.
way in front of you while simultaneously reaching with your

Source
Liebenson, C. The missing link in
protecting against back pain . Jour-
nal of Bodywork and Movement
Therapies (2009).

Terra Rosa E-mag No. 4, December 2009 30


Yoga Reduces Back Pain
Researchers from Boston University of Boston. They were randomly use in the control group did not
School of Medicine (BUSM) and Bos- assigned to either a standardized change, yoga participants' use of
ton Medical Center found that yoga 12-week series of hatha yoga pain medicines decreased by 80
may be more effective than stan- classes or standard treatment in- percent. Improvement in function
dard treatment for reducing cluding doctor's visits and medica- was also greater for yoga partici-
chronic low back pain in minority tions. As part of the trial, the re- pants but was not statistically sig-
populations. This study appears in searchers asked participants to nificant. "Few studies of comple-
the November 2009 issue of Alter- report their average pain intensity mentary therapies have targeted
native Therapies in Health and for the previous week, how their minority populations with low back
Medicine. function is limited due to back pain" explained lead author Robert
pain, and how much pain medica- B. Saper, MD, MPH, an assistant
Low back pain can result in sub- tion they are taking. The yoga professor of family medicine at
stantial disability and cost to soci- group participated in 12 weekly 75 BUSM and director of integrative
ety. Individuals from low-income, -minute classes that included pos- medicine at Boston Medical Cen-
minority backgrounds with chronic tures, breathing techniques, and ter. "Our pilot study showed that
low back pain (CLBP) may be more meditation. Classes were taught by yoga is well-received in these com-
affected due to disparities in ac- a team of registered yoga teachers munities and may be effective for
cess to treatment. Although many and were limited to eight partici- reducing pain and pain medication
CLBP patients seek relief from pants. Home practice for 30 min- use," said Saper.
complementary therapies such as utes daily was strongly encour-
yoga, use of these approaches are aged. Participants were provided
less common among minorities and with an audio CD of the class, a
individuals with lower incomes or handbook describing and depicting
less education. the exercises, a yoga mat, strap,
BUSM researchers recruited adults and block. Pain scores for the yoga
with CLBP from two community participants decreased by one-
health centers that serve racially third compared to the control
diverse, low-income neighborhoods group, which decreased by only 5
percent. Whereas pain medication

See Our Best


Yoga Collection
www.terrarosa.com.au/yoga

Terra Rosa E-mag No. 4, December 2009 31


ONSEN MUSCLE THERAPY
Everyone who deals with the treatment of pain must acknowledge the importance of structural imbalances in
the production of neuromusculoskeletal pain. The forces generated by these imbalances can be enormous and
every tissue in the body is affected when it is abnormally compressed or stretched due to these forces.

The nervous system receives pain signals from a variety of sources. The structural stresses placed on bones,
joint capsules, fascia, nerves bursae, cartilage, ligaments, tendons and muscles by the deviations we will be
assessing and treating can and do contribute enormously to patients pain.

This course is a must for the remedial and or sports therapist who wants a thorough understanding of the most
specific assessment criteria associated with exact palpatory skills to perform corrections to the musculoskeletal
system.

Onsen Muscle Therapy Volumes I, II, III & IV


Volume I - Structural Assessment and corrections of the Thoracolumbar, Sacral & Pelvic regions.
Volume II - Functional Assessment and corrections of the Thoracolumbar, Sacral & Pelvic regions.
Volume III - Structural Assessment and corrections of the Cervical & Thoracic Spinal regions
Volume IV - Functional Assessment and corrections of the Cervical & Thoracic regions

Course for Volume 1 will be held at:


Kotara Bowling Club, Howell Street Kotara.
Date: Friday 5th, Saturday 6th and Sunday 7th March 2010.
For all enquiries and bookings please contact Kristin Osborn 4920 70 10 or email osborntherapy@bigpond.com.
Numbers are limited so please book early.

Advanced Myofascial
Techniques Workshops
in Australia 2010

Art Riggs Til Luchau Larry Koliha

Join the Most


Distinguished Teachers
for workshops in Australia

Terra Rosa E-mag No. 4, December 2009 32


Research Highlights
Doubts over bracelet therapy they could work.‖ tated pictures and descriptions of
for arthritis various postures. They were later
Ideal Posture Questioned helped to achieve the positions by
―It appears that any perceived a physiotherapist.
Current recommendations for sit-
benefit obtained from wearing a Intriguingly, the men could not
ting posture and chair design are
magnetic or copper bracelet can achieve the much-recommended
based on limited evidence, says
be attributed to psychological pla- curved lower back posture unless
one researcher from the University
cebo effects‖ Stewart Richmond hands-on guidance was provided,
of Queensland. Questions are being
but were able to adopt the flat
The devices are used worldwide raised about the science used to
back and slump positions without
for helping to manage pain associ- support the sitting postures recom-
any help.
ated with chronic musculoskeletal mended as being good for our
Claus says that it suggests that if
disorders. The results of this trial backs and bodies.
such a posture is the ideal, people
conflict with those from previous
Researchers at the University of must be educated properly on how
studies, by showing that both mag-
Queensland‘s Centre of Clinical to achieve it and specially de-
netic and copper bracelets were
Research Excellence in Spinal Pain, signed chairs are unlikely to be
ineffective for managing pain,
Injury and Health, have found that enough.
stiffness and physical function in
the posture often recommended as
osteoarthritis. The research is pub- The work is part a growing cross-
ideal cannot be achieved without
lished in the latest issue of the disciplinary field – involving neuro-
assistance. More importantly, the
journal Complementary Therapies science, physiotherapy, biome-
‗ideal‘ curved lower back posture
in Medicine. chanics and psychology – to exam-
is not only difficult to achieve in a
ine how our spines operate. It is
The trial was led by Stewart Rich- sitting position, it also takes effort
expected to have future implica-
mond, a Research Fellow in the to maintain. Lead researcher Dr
tions for how we sit and how much
Department of Health Sciences at Andrew Claus says this is the first
sitting is healthy for us. Separate
the University of York, who said: time that researchers have accu-
research by the centre has already
―This is the first randomised con- rately measured how our spine and
shown that sitting is not linked to
trolled trial to indicate that cop- the muscles respond when manipu-
damaged spinal discs as had been
per bracelets are ineffective for lated in a range of postures.
previously thought.
relieving arthritis pain.‖
Theories surrounding good and bad ―There‘s reason for confidence
―It appears that any perceived postures have been based on that why we sit all day is partly
benefit obtained from wearing a measurements of the pressure ap- because it‘s not as bad as we used
magnetic or copper bracelet can plied to spinal discs in different to think,‖ says Claus.
be attributed to psychological pla- positions, says Claus.
cebo effects. People tend to buy He says the belief that slumped
postures are worse for your spine
Massage Helps Breast Cancer
them when they are in a lot of
pain, then when the pain eases off than upright ones is making as- Patients Relax
over time they attribute this to the sumptions based on this limited
Patients diagnosed with breast ab-
device. However, our findings sug- evidence. ―That‘s the thing that
normalities or cancer reported
gest that such devices have no real we‘re starting to redress,‖ says
that massage therapy helped them
advantage over placebo wrist Claus.
relax.
straps that are not magnetic and ―It may be that slumped postures
do not contain copper. are uncomfortable for the spine For ―Value of massage therapy for
and may cause people some prob- patients in a breast clinic,‖ surveys
―Although their use is generally lems, but the science to actually were mailed to 63 patients who
harmless, people with osteoarthri- test or prove that is really weak.‖ had a breast abnormality or a re-
tis should be especially cautious The research, published in the cent diagnosis of breast cancer and
about spending large sums of journal Manual Therapy, used sen- received complementary massage
money on magnet therapy. Mag- sors attached to the backs of ten therapy at Mayo Clinic in Roches-
nets removed from disused speak- male volunteers to monitor the ter, Minnesota, from February to
ers are much cheaper, but you angle of their backs as they imi- April 2005. The research was re-
would first have to believe that
Terra Rosa E-mag No. 4, December 2009 33
Research Highlights
ported by PubMed. potentially injurious responses, Again, the findings point to the
said Scott McLean, assistant pro- brain, McLean says.
Thirty-five patients responded (56 fessor with the U-M School of Kine-
percent response rate). All partici- siology. The fatigued subjects During testing, a flashing light
pants felt that massage therapy showed significant potentially cued the subjects to jump in a cer-
was effective in helping them re- harmful changes in lower body tain direction, and the more fa-
lax, and 34 felt that it was very or movements that, when preformed tigued the subjects became, the
somewhat effective in reducing improperly, can cause ACL tears. less likely they were able to react
muscle tension. quickly and safely to the unex-
―These findings suggest that train- pected command.
―More than 75 percent reported ing the central control process—
that massage therapy was effec- the brain and reflexive responses— The research suggests that training
tive in reducing fatigue, creating a may be necessary to counter the the brain to respond to unex-
general feeling of wellness, and fatigue induced ACL injury risk,‖ pected stimuli, thus sharpening
improving sleep quality and their said McLean, who also has an ap- their anticipatory skills when faced
ability to think clearly,‖ the au- pointment with the U-M Bone & with unexpected scenarios, may be
thors, from the Division of General Joint Injury Prevention Center. more beneficial than performing
Internal Medicine and the Breast rote training exercises in a con-
Clinic, Mayo Clinic, noted. McLean says that most research trolled lab setting, which is much
―Although this study was small, the and prevention of ACL injuries fo- less random than a true competi-
findings show that massage ther- cuses below the waist in a con- tive scenario. In this case, expand-
apy may help patients with breast trolled lab setting, but the U-M ing the anticipated training to in-
disease relax and feel better over- approach looks a bit north and at- clude shorter stimulus-response
all.‖ tempts to untangle the brain‘s role times could improve reaction time
in movements in a random, realis- in random sports settings.
tic and complex sports environ-
ments. ―If you expose them to more sce-
Knee Injuries May Start With narios, and train the brain to re-
Strain On The Brain The findings could have big impli- spond more rapidly, you can de-
cations for training programs, crease the likelihood of a danger-
New research shows that training
McLean said. Mental imagery or ous response,‖ he said. It‘s analo-
your brain may be just as effective
virtual reality technology can im- gous to how a seasoned stick shift
as training your muscles in pre-
merse athletes to very complex driver versus a novice learner
venting ACL knee injuries, and sug-
athletic scenarios, thus teaching might both respond to a sudden
gests a shift from performance-
rapid decision making. It might stall. The inexperienced driver
based to prevention-based athletic
also be possible to train ―hard might make a slow or even incor-
training programs.
wired‖ spinal control mechanisms rect decision.
The ACL, or anterior cruciate liga- to combat fatigue fallout.
ment, is one of the four major
In a related paper, McLean‘s group
ligaments of the knee, and ACL
again tested the single leg landings
injuries pose a rising public health
of 13 men and 13 women after
problem as well as an economic
working the legs to fatigue. While
strain on the medical system.
both men and women suffer an
University of Michigan researchers epidemic of ACL injuries, women
studying ACL injuries had subjects are two to eight times likelier to
perform one-legged squats to fa- tear this ligament than men while
tigue, then tested the reactions to playing the same sport. However,
various jumping and movement the study showed that men and
commands. Researchers found that women showed significant changes
both legs—not just the fatigued in lower limb mechanics during
leg—showed equally dangerous and unanticipated single leg landings.

Terra Rosa E-mag No. 4, December 2009 34


6 Questions to Erik Dalton
1. When and how did you decide to gins as we refine our ability to uncon-
become a bodyworker? sciously monitor and beautifully adjust
to our client‘s body rhythms. Our best
I had developed chronic shoulder/rib work takes place on a subconscious
pain playing drums in a ‗70‘s band level as our hands develop better lis-
called the ‗Flying Burrito Brothers‘. tening skills. We must remember that
Following a San Francisco concert, the innate wisdom of the body is the
Janis Joplin‘s drummer told me of a real healer… but I still like to take
eccentric older woman named Ida Rolf credit whenever possible.
who had fixed his problems. Well, the
Carmel Valley Inn was our next gig and 3. What is your most favourite body-
oddly, Dr. Rolf just happened to be a work book?
few miles away at the Esalen Institute.
Intrigued with the possibility of learn- From 1992 until 2002, I had the oppor-
ing more, I had to meet this amazing tunity to participate in post-graduate
woman. Her extraordinary lecture and continuing education workshops with
stunning demo was so motivating, I the legendary Philip Greenman at
was determined to have Rolfing® Michigan State College of Osteopathic
treatments upon my return to LA--but Medicine. Out of fond memories from
5. What advise you can give to fresh
sadly, in the 70's the Rolfer tribe was that exceptional learning experience,
massage therapists who wish to make
small due to the Rolf's high selectivity I‘d have to say Greenman‘s original
a career out of it?
of future students. A few years later, I little red textbook, ―Principles of Man-
took a job teaching biofeedback at the ual Medicine‖. However, following the Bodywork is a passion…not a profes-
Health Institute of San Diego and dur- death of my dear friend Robert Calvert sion. Love the work you do and you‘ll
ing my first workday, I heard a fellow (founder of Massage Magazine), his always be successful…and most of all…
colleague discussing a great Rolfer, wife Judi gifted me with an original never ever quit learning. I‘m a video
Victor, in Del Mar so I immediately textbook authored by the father of junkie with a collection of over 300
made an appointment. He not only osteopathy, Andrew Taylor Still. I'd manual therapy titles. Each morning
fixed my shoulder problem but encour- drooled over this textbook written in while running on the treadmill, I play
aged my interest and fascination with 1897 when my wife and I visited their something new or one of my old fa-
Rolfing and spurred me to follow my World Museum of Massage in Spokane, vourites and it always inspires me to
passion. In those days, the Rolf Insti- Washington, and it remains a crown try something new that day in my
tute required all applicants be gradu- jewel in my manual therapy library. practice. A favourite quote from my
ates from an approved massage col- We're privileged to stand on the shoul- first book sums it up beautifully: ― The
lege. In 1979, I enrolled in San Diego's ders of giants like Rolf, Greenman, Truly Educated Never Graduate‖…
Mueller College of Massage--three Still and others whose genius continues author unknown.
years later I was granted the distinc- to infiltrate every part of our indus-
tion of being accepted for training at try. 6. How do you see the future of mas-
the Rolf Institute. Initially, I found sage therapy?
4. What is the most challenging part
myself a little frustrated with the lack
of your work? On the upside, I see a more scientifi-
of structure in the Rolf training, but
cally based approach but on the down-
subsequently hooked up with some of My obsessive-compulsive personality side…more bureaucracy and less pas-
Ida‘s original instructors (Jim Asher, disorder keeps me working 70+ hours a sion for the work. As my 89 year-old
Emmett Hutchins and Jan Sultan). My week. Attempting to juggle a 30 year buddy Doc Atwater, a 32 year instruc-
fervour for structural integration be- full-time Myoskeletal Alignment pain- tor at the second chiropractic college
gan...and I haven't looked back. management practice while teaching founded in America used to say: ―Erik,
workshops, authoring books, articles & talk is cheap, research is rigged…so
2. What do you find most exciting
DVDs, leaves little time for a healthy what matters most is how well you
about bodywork therapy?
relationship with my wife, daughter perform ‗one-on-one‘ in the therapy
Hands-on therapy is special gift that and two lazy dogs. In an attempt to room‖.
always keeps giving. The more you redirect my OCD, we‘re building a
learn, the more you realize how little house in Costa Rica and hoping to soon
you know which inspires dedication. retire to a life of writing and thriving
With experience comes passion, and in a holistic self-sustaining community
passion develops intent. Soon that with like-minded friends.
wondrous inner mind/body dance be-

Terra Rosa E-mag No. 4, December 2009 35


6 Questions to Joe Muscolino
1. When and how did you decide to have." If you do the very best job you
become a bodyworker? can with them, they will refer others
to you and your practice will flourish.
I knew that I wanted to be a body- That was the best "marketing" advice I
worker when I was very young because ever heard. I will add one other thing.
I was influenced by three of my uncles Massage is largely about loosening taut
and a brother-in-law who were all chi- soft tissues. The other side of the coin
ropractors, as well as my mother was a is strengthening musculature. The best
medical technician and nutritional long-lasting relief your clients will find
consultant and my sister was an inten- is balancing strength with flexibility. If
sive care nurse. I grew up with the you train to become either a Pilates
health field all around me. instructor, athletic trainer, or perhaps
even a yoga instructor, then you will
2. What do you find most exciting
be equipped to take care of both of
about bodywork therapy?
your clients' needs for strength and
Hmm... I have to pick just one thing? I flexibility. Having a second skill set
will cheat and pick two. First, it is a such as this will also distinguish you
wonderful thing to help a patient/ from the other MTs in your area.
client return to good health. Good
6. How do you see the future of mas-
health is something that is so often
sage therapy?
taken for granted, but when someone
is in pain, especially chronic pain, it is numerous advanced study workshops,
I have been involved with massage
so hard to enjoy life. So, when I have including deep tissue, advanced
therapy education for over 23 years
the chance to help someone 'regain stretching, joint mobilization, and
now and have seen the profession blos-
their life,' it is so very gratifying. The palpation workshops, as well as ca-
som and explode. This is wonderful
second thing I will mention is that daver labs. He also runs in-services for
because it shows how the world is
writing textbooks on kinesiology af- instructors of massage therapy, cover-
awakening to the power of caring and
fords me the opportunity to constantly ing topics such as how to teach mus-
therapeutic touch. What is personally
read about and study the anatomy, cles, muscle palpation, kinesiology,
most exciting to me is the opportunity
physiology, and kinesiology of the hu- and more; as well as in-services for
for massage to be fully embraced into
man body. And, to an anatomy geek Pilates and yoga instructors and fit-
the health field. That opens the door
like me, that is so exciting. The human ness trainers on all subjects of muscu-
for people who are motivated to learn
body is such a marvel! loskeletal anatomy and physiology,
about and integrate kinesiology into
and kinesiology.
their practice, enabling them to criti-
3. What is your most favourite body-
cally think through the case studies Visit his website with lost of re-
work book?
that their clients present to them, so sources: www.learnmuscles.com
If I am allowed to pick one of my own, that they can be excellent clinical
it would be either my Muscle and Bone therapists!
Palpation Manual or my Kinesiology
Textbook. :) To choose someone
else's??? I would go with either Don Dr. Joe Muscolino is a licensed Chiro-
Neumann's Kinesiology textbook or practic Physician and has been an in-
Thieme's Atlas. Both are brilliant!! structor of kinesiology and muscu-
loskeletal and visceral anatomy, physi-
4. What is the most challenging part
ology, and pathology courses at the
of your work?
Connecticut Center for Massage Ther-
Finding the time to read, write, and apy (CCMT) since 1986. He is the au-
teach as much as I would like. thor of the Muscle and Bone Palpation
Manual & Kinesiology.
5. What advise you can give to fresh
massage therapists who wish to make Dr. Muscolino is also an approved pro-
a career out of it? vider by the National Certification
Board for Therapeutic Massage and
I remember something one of my in- Bodywork (NCBTMB) for continuing
structors in chiropractic school once education (CE) credit for massage
told us: "Take care of the people you therapists and bodyworkers and runs

Terra Rosa E-mag No. 4, December 2009 36


Terra Rosa E-mag No. 4, December 2009 37