July August 2021

P H A R M AC O LO G Y F O R B O DY WO R K E R S | K E E P I N G C L I E N T S S A F E , PA R T 2 : C L I E N T B O U N DA R I E S
JULY/AUGUST 2021
TECHNIQUE
PERSIS TENT IN JURIES p. 8 0
THE TIBIOTAL AR JOINT p. 8 2
SUBACROMIAL PAIN p. 8 6
FORE ARM AND FINGER WORK p.9 0
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Anatomy Trains and Laboratories of Anatomical Enlightenment
invite you to a unique, over-the-shoulder view:
Dissection with
Tom Myers and Todd Garcia
A Regional and Layered Journey Through the Human Body
5 Day in person Dissection
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5 Day Dissection Laboratory Massage & Bodywork readers –
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Vlada Yaneva, LMT
Visit: anatomytrains.com for details or email: info@anatomytrains.com

Live chat with us on anatomytrains.com
CONTENTS
44
features
44 62
TENDING TO OUR HANDS BURNOUT AND THE COMMITMENT TO SELF-CARE
As massage therapists, our hands are one of our most As we return to work, some of us—and a lot of our clients—are
valuable, powerful, and utilized tools. The exercises presented feeling burned out. Thomas Myers shares his thoughts and advice
here will help you tend to your hands, fingers, thumbs, on maintaining longevity, gleaned from his many years of practice
and wrists so you can prevent injury and sustain a thriving as a career therapist.
practice. By Thomas Myers
By Heath and Nicole Reed
70
52 KEEPING CLIENTS SAFE, PART TWO
FIND YOUR FLOPPY A successful practice is one where all participants—clients and
There is a terrible contradiction in the world of massage therapists—respect and value each other’s personal boundaries.
therapy and bodywork: We want our clients to feel floppy This article outlines clear guidelines and boundaries that will help
and full of ease after a session, yet, therapists can feel frozen create a safe, comfortable environment for clients.
and full of tension. This educator believes the best way to By Dr. Ben Benjamin
help clients get rid of unnecessary tension is for practitioners
to get rid of their own unnecessary tension. To do that, you
must find your floppy. 74
By David M. Lobenstine 10 STEPS TO SECURE YOUR PRACTICE
The public still struggles to tell the difference between a massage
therapy practice and a parlor. Here, we discuss 10 ways to keep
your practice safe—from making it clear you are a licensed
massage therapist to security methods and tools to keep
unwanted solicitors out of your practice.
By Joyce Gauthier
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 3
JULY/AUGUST 2021
THIS ISSUE
8 Editor’s Note
10 ABMP School Survey Results
12 Contributors
15 Speak Your Mind
17 On the Web
19 News Notes
94 ABMP Member Benefits
95 10-, 20-, and 30-Year Members
96 Meditate & Move
BEST PRACTICES
20 BLUEPRINT FOR SUCCESS
Keys to a Successful Business Partnership 
By Allissa Haines and Michael Reynolds
25 TABLE LESSONS
What’s In a Name?
By Douglas Nelson
26 MASSAGE AS HEALTH CARE

Harmful Stories
30
By Cal Cates
29 HEART OF BODYWORK
Ethical Boundaries 
By Laura Allen
EDUCATION TECHNIQUE
30 BACK TO BASICS 80 THE REBEL MT
The Case for Consistency  
32 80
Managing Intellectual and
Environment Boundaries By Allison Denney
By Cindy Williams 82 THE SOMATIC EDGE
32 PATHOLOGY PERSPECTIVES The Tibiotalar Joint
Pharmacology Basics for Massage By Til Luchau
Therapists
86 CLINICAL EXPLORATIONS
By Ruth Werner The Puzzling World of Subacromial Pain  Massage & Bodywork (ISSN 1544-8827; USPS 005-245) is
a bimonthly magazine published by Associated Bodywork
36 FUNCTIONAL ANATOMY By Whitney Lowe & Massage Professionals Inc., 25188 Genesee Trail Road,
Suite 200, Golden CO 80401. Periodicals rate postage
Coxal Joint
90 MYOSKELETAL ALIGNMENT paid at Golden, Colorado, and additional offices.
By Christy Cael TECHNIQUES POSTMASTER: Send address changes to ABMP, 25188
Forearm and Finger Work Genesee Trail Road, Suite 200, Golden CO 80401.
By Erik Dalton, PhD
4 massage & bodywork july/august 2021

Associated Bodywork
& Massage Professionals
Massage & Bodywork promotes professionalism among practitioners, stimulates

healthy dialogue, and expands the knowledge of those in the field to advance
their success—while remaining mindful of the breadth of bodywork backgrounds,
beliefs, and modalities.
EDITORIAL
Darren Buford
EDITOR-IN-CHIEF
darren@abmp.com
Karrie Osborn
SENIOR EDITOR, EDUCATION
AND PROJECT MANAGEMENT
karrie@abmp.com
Brandon Twyford
EDITOR, ONLINE AND DIGITAL STRATEGY
brandon@abmp.com
Mary Barthelme Abel

CONTRIBUTING EDITOR
marya@abmp.com
DESIGN & PRODUCTION Printed in the U.S.A. on recycled stock containing

Enviro/Tech inks, which Massage & Bodywork
has printed with since 2002, have a renewable
Amy Klein at least 10% postconsumer fiber.
resource content of 25.3%, which is much ART DIRECTOR

higher than the published 7% minimum soy amy@abmp.com
content required for soy inks. Enviro/Tech inks
include cottonseed, vernonia, sunflower, tung,
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GRAPHIC DESIGNER
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ADVERTISING
Angie Parris-Raney
DIRECTOR
angie@abmp.com
ABMP
800-458-2267
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Vol. #36, Issue #4 July/August 2021. All rights reserved © 2021.
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No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
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educational purposes only and is not intended as comprehensive modality training or medical advice. Massage & Bodywork encourages
practitioners and massage therapy clients to consult a qualified professional for individual diagnostic and health-care needs.

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EDITOR’S NOTE
of themselves, sometimes to the point of causing both

physical harm and mental exhaustion.
Is this now exacerbated by what we’ve lived through
this past year-plus? You betcha. The pandemic caused
both professional instability and the perception of lack
of control. We’re all feeling the effects of its mental
repercussions and likely will continue to do so for some
time to come.
As life and routines return to what we once knew,
people need massage—now more than ever. And they
need you to perform that massage. But to be there for
them, you fi rst need to be there for yourself.
Before we go back to “normal,” let’s take this time
to reset and reframe, to focus on both immediate and
long-term changes that can affect your profession, your
passion, and your livelihood. The pandemic forced a
break from our routines, a chance to reset. Let’s take
Beyond Burnout
advantage of that.
In this issue, we begin by addressing a massage
therapist’s primary professional tool: their hands. Heath
and Nicole Reed have been writing our Savvy Self-Care
My morning routine: column for years. In this issue, we elevate their words to
• Wake up lead feature (“Tending to Our Hands,” page 44), as a way
• Walk dogs (short walk) to say, This is important. Together, the two experts take
• Meditate us through a series of exercises to improve fi nger, thumb,
• Take vitamins and wrist activation as a way to prevent injury.
• Drink eight ounces of water Next, David Lobenstine’s “Find Your Floppy” offers
• Stretch new techniques to protect your body against unnecessary
• Eat breakfast rigidity while working. David has always been a
• Walk dogs (long walk) proponent of more efficient work, better results through
Every morning. less effort. I love his take here that fi nishing your day
I’ve been doing this regimen for so long that my body exhausted isn’t a badge of honor.
(and my dogs) knows something’s off if it doesn’t happen Finally, we close this theme with a think piece from
like clockwork. one of bodywork’s legendary voices. Thomas Myers
I see this ritual each morning as critical for my most offers his decades-in-practice perspective on maintaining
optimal day, setting the stage for what’s to come. And longevity through a commitment to self-care. Tom
though it’s not all I do (throw in an occasional run, hike, answers the question, what can you do as a bodyworker
bike ride, or paddle), it’s the start to maintaining a healthy to help restore an integrated purr in your clients’
body and mind. physiological motors? His series of approaches to framing
What do you do for self-care? Of course, the answer client homework is a must-read for MTs who have
to that question can be quite varied. Self-care means struggled with getting clients to see take-home exercises
so many different things: from reading a book, taking as valuable and an extension of the care brought about
a vacation, and checking out, to receiving bodywork, through the bodywork session.
strength training, and healthy eating. We hope you enjoy this issue and fi nd your own
Now, perhaps, a more pertinent question should be: healthful routines and new lifelong pathways inside.
What self-care do you do to protect your practice?
Massage therapy and bodywork are professions of DARREN BUFORD
passion. So much so that practitioners are notorious for Editor-in-Chief
giving their all to their clients and neglecting to take care darren@abmp.com

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ABMP SCHOOL SURVEY
Massage Schools Stay Resilient

During COVID-19 Pandemic
By Jed Heneberry, ABMP Senior Director, Marketing
Associated Bodywork & Massage Graduates per School

Professionals (ABMP) conducts a census 80
of all state-approved massage programs 71,272
every two years, and recently completed its 70
62,784
analysis of 2020 massage program results
58,207
and trends. 60
54,246
It is an understatement to say that 2020 48,271
50 47,940
was a year like no other, and while that
reality is reflected in the results we received, 39,251
Thousands
40 36,070
as well as the comments and stories we heard
directly from schools, the results show the 30
28,263
majority of massage therapy schools showed 23,877
20,598
impressive resilience in the midst of the 20
hardships of the past year.
ABMP’s census was conducted January 10
2021–March 2021, during which time 818 1,047 1,419 1,530 1,600 1,440 1,319 1,274 1,098 965 919
ABMP representatives attempted to contact 0
965 programs. Seventy percent of approved 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
programs responded to the survey, and Graduates Schools
nearly 50 programs were found to be closed.
Those who were reached (and still in
operation) were asked, “How many students data, we projected results for the segment of Types of Programs
graduated from your primary massage schools we did not receive an answer from.
ABMP categorizes massage programs
program in 2020?” Using state and program According to the results of the survey,
into six organizational types:
the number of massage therapy training
programs in the United States, and the Career School—multiprogram institutions
number of graduates from those programs, offering many career training programs
have declined from our 2018 survey (abmp. in addition to massage therapy, typically
com/updates/blog-posts/number-massage- medical and dental assisting, medical
Nea recordkeeping, etc. 150 programs
rly program-graduates-continues-decline).
5
Combining survey data and projections, College—massage program
0
ABMP estimates there were 20,598

Sc
offered at a community, junior, or

hoo
graduates from 919 programs in 2020, technical college. 144 programs

putting the average number of graduates per
919 Progra
ls Closed
Corporate School—massage therapy and spa

Average Graduates school at just over 22 students.
per School programs as part of a multicampus, multistate,
These are the lowest numbers we’ve
larger corporate entity. 44 programs
22
seen since 2000, and are down from 23,877
graduates from 965 schools in our 2018 Nonprofit—programs whose organization is
ms
survey. Given the environment for the incorporated as a nonprofit entity. 6 programs
Su
ve
ed country generally, and in-person education
r
ye 70 % Proprietary—traditionally and typically

d Respond specifically, these numbers are a testament “Mom & Pop” programs; single owner
to the hard work, perseverance, and passion at a single campus. 563 programs
displayed by the owners, faculty, and
ABMP Biennial Census 2020 Public—programs offered through the public
students at these schools.
education system/school district. 12 programs

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CONTRIBUTORS
Joyce Gauthier is
a New York State
licensed massage
therapist. She
owned a successful
medical massage
practice in a
chiropractic office
for seven years
before following her
dream of traveling
full time. Her current
residence is Gavia, a
42-foot sailing ketch,
accompanied by her
wonderful husband,
Matthew, and a lazy
74 shih tzu named Loki.
When Ben Benjamin, PhD, is not traveling

across the country teaching therapists how
to assess and treat injuries or giving expert
testimony, he’s studying something new,
whether it’s how to coach organizational
teams or a dance he loves called Casino.
70
62
With his passion for dancing between wind
and water, Thomas Myers compares a sailboat’s
rigging with the tensile structures that balance
the human body. He lives, writes, teaches,
and, when he can, sails the coast of Maine.
52 44
David M. Lobenstine is more Heath and Nicole Reed are co-founders of
grateful than ever, amid the Living Metta and want everyone in the world
pain of social distancing, for to enjoy the experience of befriending their
this community of massage body. The Reeds lead workshops and retreats
therapists. He says, “Let’s across the country and overseas and have
take care of ourselves, and been team-teaching touch and movement
each other, so that we can therapy for 16 years.
take even better care of our
clients when the time comes.”

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SPEAK YOUR MIND
You know you’re a massage

therapist or bodyworker when . . .
FROM FACEBOOK
You cringe anytime you read or hear You watch a guy walking down the street You hear, “I didn’t even know that was
“massage parlor” in reference to therapists and he catches you and winks, and you hurting until you touched it.”
in general. think, “Nah, don’t flatter yourself. I was @DANA.M.BRANDT.TINKER
SHANNON BOOTH checking out your jacked-up stride.”
MELINDA WOODARD You’ve mastered the 30-second snack break!
You have to be OK with total strangers @MASSAGEBYAM
cutting the cheese in close contact with you. You only eat “gassy” foods on your days off!
SERGIO FANDÓS AMY LEIGH You have enough laundry detergent on hand
for the entire block.
You analyze someone’s posture and gait at Your friends fight over who gets to sit in @INDYMASSAGES
the grocery store. front of you on the bleachers!
HOLLY HUNT G MASSAGE You have some sort of new age/spa music
playing in your head whenever you’re not
You have to do laundry after you do laundry. You do a full-body massage on your kid working.
FRANCHESCA LOVATO when applying sunscreen. @BEINTEGRATEDBODYWORK
DONNA POLITO JENKINS
Every hug becomes a bit of an upper back You can’t attend a family function without
palpation assessment. Your forearms are as big as your biceps. giving an impromptu “chair” massage.
SABRINA MERRITT KRISTY BROWN MEADE @JENNIFERHAGNER
You’re not really watching the sporting You can’t just apply something, you have You have nail clippers in every purse,
event, just fascinated by the body mechanics. to rub it in too. I’m an esthetician too and backpack, and multiple cubbies in your car.
KARA CALABRO struggle with this. @ALLISSAHAINES
KELLY K. MUELLER
You use shiatsu to pick up a broken fence. You're holding your wife’s hand and your
JESSICA HEFFERNAN LAPUT thumb goes into petrissage mode.
@SHIRE_MASSAGE
You have to line-item expense nail fi les on FROM INSTAGRAM
your taxes. You are always excited to go to work because
BERNADINE TALMADGE You watch gait patterns and think, “Damn, you know deep inside that this is your life’s
they must be in pain!” calling.
You wash up to the elbows in a public @CINDYEHRHARDT @BONNERUST
restroom.
KANDY KIGER You notice microscopic growth of your
fi ngernails.
People apologize to you for falling asleep or @DAVESHAHAN
not shaving.
LUKA SKYE
LOOKING FOR MORE THAN JUST CE HOURS?
Join us for education and fun in either sizzling Las Vegas or aboard a luxury cruise ship. Join the
LMT Success Group and massage therapists from all over the world on these exciting adventures.
WHAT HAPPENS IN VEGAS...

(can be very good for your massage practice)
Join us at our annual Success School!
Certification Programs In:
1 Medical Massage 7 LypossageTM
2 Medical Massage for Arthritis 8 Manual Lymphatic Drainage

3 Thai Yoga Massage 9 Advanced Sports Massage
4 Advanced Medical Massage 10 NMT for TMJ
5 Intro to Kinesiology Taping 11 Massage Cupping
6 Cranio-Sacral Therapy 12 Thai on the Table
Also scheduled: How to Throw a Massage Party
Now also and our famous LMT's Tax Workshop!
held in
L! Linq Hotel & Casino
Orlando, F
December 6-10, 2021
Pura Vida Spa Earn as many as

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September 4-11, 2021 October 17-23, 2021
This is me getting
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Details: lmtsuccessgroup.com • 800-201-2247
ON THE WEB
CONTINUING EDUCATION THE ABMP PODCAST

abmp.com/learn
abmp.com/podcasts
i a l s
ABMP CE
o c
YOU’RE INVITED! ABMP CE SOCIALS
S
Connect and engage with your massage
and bodywork community, experts in the
field, and ABMP as you learn and earn
CE! Join us live in our virtual classroom
to interact with course instructors and
learn valuable new tools for your practice.
If you couldn’t attend one of our past CE
Socials, you can still view past courses and
take quizzes to earn CE.
Previous ABMP CE Socials: • “Assessing and Treating Tennis and
“CANNABIS MASSAGE: CBD
• “Centering Diversity, Inclusion, and Golfer’s Elbow” with Dr. Joe Muscolino
101” WITH JORDAN PERSON
Equity in Our Practices” with • “A Website That Works” with Massage
Jordan Person wrote the book on
Shana Chivon  Business Blueprint and sponsored
cannabis massage—literally. Listen
• “Introduction to Oncology Massage: by Lokalyst
in as she tells us the difference
Part 1” with Healwell’s Cal Visit abmp.com/ce-socials to register for an
between CBD and THC, side
Cates and Kerry Jordan upcoming event!
effects and contraindications, and
incorporating CBD topicals into
your practice. Person breaks down
the common cannabis myths,
talks about the growing public
BLOG acceptance, and the possible future
abmp.com/updates/blog
of cannabis research.
WHAT THE CDC’S NEW MASK

RECOMMENDATIONS MEAN FOR MASSAGE
THERAPISTS
The Centers for Disease Control and Prevention
(CDC) issued new guidance about mask usage among
vaccinated people. But you may be wondering, what
does this mean about masks in my session room?
WHAT DO WE OWE OUR EMPLOYERS? OBESITY PRESSURES: “I

Allissa Haines of Massage Business Blueprint HAVE A CLIENT WHO . . .”
(massagebusinessblueprint.com) shares her thoughts PATHOLOGY CONVERSATIONS
on what massage therapists owe their employers in this WITH RUTH WERNER
exclusive blog post from ABMP. An obese client wants help with low-
back pain, but she can’t take deep
pressure. What to do? Werner gets
TOP 4 WAYS TO AVOID PROFESSIONAL a little strident in this discussion
LIABILITY ISSUES of weight, health, judgmental
Here are our thoughts on risk management and the language, and hands-on options.
best advice for the ways practitioners can protect their
livelihoods.
WITH ABMP
YOUR CE IS FREE!
650+ hours included with membership or available to purchase.
Learn more at abmp.com/learn
“I love everything about ABMP!

The CE classes cover interesting
and useful information, and they’re
all free. ABMP is awesome!”
— Meg

NEWS NOTES
NEW RESEARCH SHOWS PAIN-RELIEVING LOCAL VIBRATORY STIMULATION

EFFECTS OF CBD MAY HELP REDUCE LOW-BACK PAIN
A recent study evaluated the immediate
effects of a local vibratory stimulation
device on subjects with poor proprioception
in certain areas of their bodies. In their
rationale for conducting the study, the
researchers write, “Postural instability
owing to poor proprioception is considered
a main cause of low-back pain and falls.
However, the effect of local vibratory
stimulation on a poor proprioceptor on proprioceptive control
strategy has yet to be evaluated.”
The study was conducted by applying local vibratory stimulation
Researchers at Syracuse University recently conducted a to poor proprioceptors on six elderly patients with non-specific low-
study to determine the mechanisms behind CBD’s ability back pain (NSLBP). The researchers compared the proprioceptive
to reduce pain, as well as the impact the placebo effect may control strategy before and after applying the intervention.
have on pain outcomes. The authors write: “As our main finding in this study, patients
“For science, and the public at large, the question with NSLBP showed improvements in the proprioceptive control
remains: Is the pain relief that CBD users claim to strategy based on proprioceptive inputs from the muscle spindles
experience due to pharmacological effects or placebo that respond to a higher frequency. This improvement resulted
effects,” says study co-author Martin De Vita, a researcher from the activation of the poor proprioceptor after applying the
in the psychology department in the College of Arts and local vibratory stimulation for one minute.”
Sciences at Syracuse University. Future studies are planned that will address the limitations
“That’s a fair question,” De Vita continues, “because of this study, including increasing the sample size and evaluating
we know that simply telling someone that a substance whether improved proprioceptive control strategies can be
has the ability to relieve their pain can actually cause maintained long term.
robust changes in their pain sensitivity. These are called Read the full article online at https://doi.org/10.3390/
expectancy effects.” electronics10030341.
Using sophisticated equipment that safely induces
experimental heat pain, De Vita and the other researchers
were able to measure how the recipient’s nervous system
reacts and responds to pain. Afterward, “We administer a MASSAGE IMPROVES MOOD AND WELL-BEING IN
drug, like pure CBD or a placebo, and then reassess their CAREGIVERS OF PATIENTS WITH DEMENTIA
pain responses [to] see how they change based on which In a pilot study published in the International Journal of Environmental
substance was administered,” De Vita says. Research and Public Health, researchers sought to assess the impact
Some participants were told they received CBD when of different forms of therapy “in reducing the perceived burden and
they actually received a placebo, while some were told they improving the emotional status of caregivers of people with dementia
would be getting a placebo when they actually got CBD. and to determine which form of physical intervention is most effective.”
According to De Vita, “We hypothesized that we would For the study, 45 subjects were divided into three subgroups: the
primarily detect expectancy-induced placebo analgesia massage group, the relaxation group, and the control group. The
(pain relief). What we found, though, after measuring researchers found that massage led to both a reduction in perceived
several different pain outcomes, is that it’s actually a burden and an improvement in mood and well-being in the caregivers.
little bit of both. That is, we found improvements in pain The relaxation group experienced significant improvement in mood
measures caused by the pharmacological effects of CBD but no reduction in perceived burden. Massage and relaxation, however,
and the psychological effects of just expecting that they were found to be equally effective in improving the well-being of
had gotten CBD. It was pretty remarkable and surprising.” caregivers.
Read more at https://news.syr.edu/blog/2021/04/25/ The study concludes that while the results point to massage and
new-research-shows-pain-relieving-effects-of-cbd. And relaxation as low-cost, effective interventions, further studies are
to learn more about CBD and massage therapy, listen to necessary.
The ABMP Podcast, Episode 106 – Cannabis Massage with Read the abstract on PubMed.gov at https://pubmed.ncbi.nlm.nih.
Jordan Person at abmp.com/podcasts/ep-106-cannabis- gov/33302355.
massage-cbd-101-jordan-person.
best practices | BLUEPRINT FOR SUCCESS
Keys to a Successful
Business Partnership
By Allissa Haines and Michael Reynolds
While most massage practices operate as a solo

business, some have found success as a partnership
consisting of two or more people. Having a partner
to share both the successes and challenges of running
a business with can make the journey easier, more
fulfilling, and less lonely. And there are many things
to love about going into business with a partner.
Having a trusted partner to discuss ideas with can be a
great way to get outside perspective and run the business
with the best of both minds working together. Also,
sharing and splitting responsibilities can be a positive
benefit. If one of you loves working with accounting
and finances while the other loves marketing and client
communication, then a partnership allows you to align
your strengths more productively.
Like many arrangements, there can also be downsides
to partnerships. If partners don’t agree on major decisions
or philosophies, the conflict can have a negative impact
on the business or even lead to failure. In extreme cases,
an unethical partner can end up causing severe damage
through negligent or criminal actions, leaving the
remaining owner with a mess to clean up.
So how do you navigate partnerships in a way that
improves your chances of running a successful business
together?
BEFORE FINDING THE RIGHT PARTNER,

LEARN TO BE THE RIGHT PARTNER
Some people think partnerships are always a bad
idea, citing all the drawbacks and the failure rates of
partnerships (which is between 50 and 80 percent,
depending on the source). However, there are some steps
you can take to create an environment of success in a
business partnership. People often talk about how you have
to find the right partners and make sure you evaluate the
other person etc., but we contend it’s more important to be
the right person.
Your goal as a partner should be to bring the very best
in yourself to the partnership—to be someone who decides
to commit to having extreme respect for your partner and

Some of the best partnerships
finances, you’ll end up with neglected accounting. If you
are formed with people you’ve both love finances but hate doing marketing, you may
known for a long time as have accurate accounting, but you’ll never get clients.
Some of the best partnerships work because the two
friends and/or coworkers. partners complement each other in skills, philosophies,
and perspectives. You certainly don’t want to disagree
about everything, but it’s healthy to offer different
perspectives and bring different skills to the table. That
way, the business is served well on the foundation of the
trying to put their needs in the forefront of your mind. combined strengths of the partners.
As a partner, it’s important to have a serving attitude A lot of issues can be avoided by thoroughly thinking
and a constant goal to lift up your partner while being as through how well you know the other person and being
supportive as possible. honest about how good a fit there is. Some of the best
Partnership is kind of like a marriage. You can try partnerships are formed with people you’ve known for a
to find the right person, or you can be the right person. long time as friends and/or coworkers. It’s helpful to know
Both are important, but being the right person is the most how to work with them and how your personalities mesh.
important first step. Another factor is how seriously you each take
the business. If your business is a side hustle or an
experimental venture, and you both agree it’s not
DEFINE THE BASICS OF OPERATION necessarily your primary focus, then you can agree on
It can also be a good idea to set up a basic operating that and manage your vibe accordingly. If it’s a full-time,
agreement for your partnership using one of the all-in venture, then you both need to agree on that.
many online legal services available. For most micro-
businesses, like the ones we run, this is usually fine.
The operating agreement will help you outline the FINDING HAPPINESS
basic rules of what happens in various scenarios. For While partnerships are not for everyone—and
example, what happens if one partner decides to exit the can have downsides and risks—they can also be
business? Can that person sell their portion of ownership? incredibly rewarding if approached thoughtfully and
Does the remaining partner get the first right of refusal? with goodwill. By focusing on being a great partner,
Defining basic “what if” scenarios can ease the minds finding the right match, and understanding how
of both parties and offer some structure, should things to work together, you may find that a partnership
change. can bring a lot of joy to your business.
It can also be helpful to create an actual list of tasks
involved in running the business and note who will be Allissa Haines and Michael Reynolds are found at
responsible for certain tasks. This can help to measure and massagebusinessblueprint.com, a member-based
evaluate each partner’s workload, so no one feels they’re community designed to help you attract more clients,
doing more. These lists are dynamic and should evolve make more money, and improve your quality of life.
and change as the business grows. Having a tangible list
to discuss will facilitate open communication and clear
expectations.
FOR MORE LEARNING

DO YOUR DUE DILIGENCE
Catch Allissa and Michael on their
Partnerships are often started when two friends decide
weekly podcast, Massage Business
it would be fun to open a business together. While this
Blueprint, available on Apple Podcasts,
sounds great in theory, there is more to it. Being friends
Google Play, Spotify, and more.
and having fun together doesn’t mean you’ll make
great business partners. If you both hate numbers and
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best practices | TABLE LESSONS
What’s in a Name?
Undiagnosed Conditions Increase
Pain and Stress “While there is some undetermined
central mechanism driving all of this, it is
BY DOUGLAS NELSON clearly causing a hypersensitization in his
leg muscles.
“Let’s deal with the muscles directly
“This has been such an ordeal,” she activity always produces an undesirable through targeted hands-on therapy.
began, the exasperation in her voice audible approach, we can respond appropriately. Moreover, if we can decrease the overactive
over the phone. “My son has been struggling “When the same activity produces neurological firing in the periphery, it may
with this issue for about a year. He led a wildly variable responses, it is hard to know also have a beneficial effect on his central
highly active life until one day when he what to do. In that way, unpredictability nervous system.
developed flu-like symptoms. He was tested feels like complete loss of control.” “There is likely a self-sustaining
for COVID-19 but tested negative multiple “Exactly,” she affirmed. “If we knew feedback loop at play, where increased
times. Knowing it wasn’t COVID, we just what to do or what not to do, it would be so central nervous system activity is increasing
assumed it was a different viral infection much better.” sensitivity in the periphery. In response,
he would recover quickly from. After the “And then, there is the name, which the periphery is now sending increased
initial illness subsided, he still felt unusually is the second problem,” I said. “When we input back to the central nervous system,
tired. The longer this went on, the more name a pathology, we also assume we know restimulating it. Maybe we can interrupt
concerned we became. Moreover, he began something about its trajectory over time. that process.”
to experience multiple body aches in his If you fracture your arm, you know the I saw her son a few days later,
joints that prevented him from participating course of events over the next 6–8 weeks. addressing many of the muscles of his
in many of his previous activities. Every As difficult as it is to deal with the initial lower body, which were indeed very
spike in activity was followed by debilitating pain, there is a high likelihood things will hypersensitive. We worked slowly and
knee, hip, or ankle pain.” improve over time. carefully, and the sensitivity decreased
After asking her about what impressions “When a condition such as your son’s markedly during the session. The mother
the physicians had given them, she went on is undiagnosed, having a sense as to the and I agreed to communicate closely over
to describe the parade of doctors who had course of future events is impossible. Is the coming days.
seen her son. Many possible pathologies this a short-term struggle or will this go on Her son began increasing his activity
beyond a viral infection had been ruled out, indefinitely? It has been said that the brain after our session and continued to do so
but none of the doctors were able to pin is always asking three questions of each new with minimal discomfort. That process
down a reasonable diagnosis. They could say experience: What is it? What does it mean? continued, approaching levels he had not
what possible illnesses he did not have, but What do I do? accomplished in months. The mother
not what caused his symptoms. “Without a name, we don’t know the shared how relieved she and her husband
“Not knowing what’s wrong with him is meaning. Without meaning, we don’t were during our last phone conversation.
so stressful,” she said. “It’s been difficult for know what to do in response. That can feel “It’s kind of fitting that this all started
our whole family.” powerless and stressful. Is this at all helpful in 2020,” she said at the end of our call.
“I understand, and if I may, let me to you?” “Another uncertainty in a year filled with
elaborate on why,” I answered. “Research “Very much so,” she responded. “This uncertainty.”
in the area of both pain and stress gives an helps me understand why this whole Well said.
interesting insight into this dilemma, and experience has been so difficult. It also helps
there is a clear overlap between the two to know it isn’t unique to my family, that Douglas Nelson is the founder
conditions. there is a larger principle in play. and principal instructor for Precision
“Unpredictability makes the experience “I called you because several people have Neuromuscular Therapy Seminars, president
of both pain and stress far worse. One of the recommended we bring our son to you for of the 20-therapist clinic BodyWork Associates
most important factors in the management treatment. Would you be willing to see him, in Champaign, Illinois, and past president
of both is the feeling of a sense of control and if so, what would that look like?” of the Massage Therapy Foundation. His clinic,
over one’s circumstances. “Whatever this virus was seems to have seminars, and research endeavors explore the
“If there is a clear causal relationship affected muscles in his lower body,” I stated. science behind this work. Visit pnmt.org or
between two events, our brains figure out email him at doug@pnmt.org.
how to adapt and respond. If a specific
best practices | MASSAGE THERAPY AS HEALTH CARE
Harmful Stories
Awareness is Required to
Dismantle Poor Assumptions
By Cal Cates
When we consider our communication, I am deeply grateful to a colleague for

it’s easy to see that we don’t think much calling on me to reconsider the language
about how our assumptions and our culture I used in my March/April 2021 Massage
influence the stories that take shape in our & Bodywork column (“Moving Out of the
minds, that ultimately form the words we Fringes,” page 28) describing the cascade of
share, or how we hear words that are shared behaviors that can accompany stress. I wrote
with us. Consider these phrases: about “being sedentary,” “habitual eating,”
• “Until this person loses some weight, and a variety of other activities in which
there’s not much I can do for their joint humans engage. The words I chose exposed
pain.” my unconscious bias. I used some all-too-
• “If they’d eat better and exercise common phrases that paint our experience
more, they wouldn’t have this chronic in these bodies of ours as linear threads of
TARA WINSTEAD/PEXELS.COM
inflammation.” direct action and consequence. Presenting

• “I don’t know what this person expects health and dis-ease in this way skips
from me. They’re in a wheelchair.” around and glosses over the deepest, most
• “Of course, they have limited range of challenging issues of public health, which
motion/swelling/pain. Plastic surgery is means skipping around and glossing over
violent and totally unnecessary.” what it’s like to be a complex, multifaceted,
culturally shaped human.

I didn’t mean to simplify the incredibly complex issue of
stress. I didn’t mean to blame people who suffer from,
and with, stress. But what I meant to do is irrelevant.
I didn’t mean to simplify the incredibly complex issue stories in our heads about why and how our clients
of stress. I didn’t mean to blame people who suffer from, come to find themselves in need of what we do.
and with, stress. But what I meant to do is irrelevant. My We use our “stories” to decide who is worthy and who
intention and my impact are not related in the way I wish is going to “get better” because of us and our guidance.
they were. And often our clients “tell on themselves” and reinforce
Unfortunately, we all do this. Without noticing, we their failings to these cultural beliefs. That doesn’t make
miss the point and perpetuate harmful systems and ways of them true. It just proves how indoctrinated we all are into
thinking every day. When it is pointed out to us, we say, “I the false healthy/unhealthy binary.
didn’t mean it,” and we move on feeling absolved of impact Awareness is required to dismantle these systems.
because we did not intend the harm we caused. Turning the mirror on ourselves comes first. Notice,
The ways people are—the things I labeled in my does this make me uncomfortable? Am I justifying my
column last issue as “habits” and “behaviors” that lead our categorization of clients in terms of “likely to benefit” or
clients to seek out our care—are not the result of free will. “not for me”? Please just sit with that.
We are products of our culture and our privilege (or lack Awareness is an incredibly powerful start to this work.
thereof), supersized with a bonus of history, genetics, and Perhaps the greatest service we each can offer is to stop
public policy. telling these wrong, judgment-based, hierarchical stories to
We find our clients (and ourselves) in pain, ourselves so others can see there are better, more accurate,
discomfort, and disconnected from their bodies. Our more compassionate healing stories available.
ideas, and the so-called choices they inform related to
movement, food, or lifestyle, are inaccurately seen as Cal Cates is an educator, writer, and speaker on topics
each person’s fault. We dismiss and devalue the people ranging from massage therapy in the hospital setting
we have chosen to care for. We say that “poor choices” to end-of-life care and massage therapy policy and
are the problem, and we go on feeling “right,” as we regulation. A founding director of the Society for Oncology
provide insensitive care to people who are “wrong.” Massage from 2007–2014 and current executive director
These ideas are deeply, insidiously, and harmfully and founder of Healwell, Cates works within and
implanted and upheld by the culture in which we live. beyond the massage therapy community to elevate
We (often unconsciously) use these ideas to the level of practice and integration of massage overall
support a hierarchy of who “deserves” and will and in health care specifically. Cates also is the co-
“benefit” from our care. We use them when we think creator of the podcasts Massage Therapy Without
about our clients and what stands between them and Borders and Interdisciplinary.
the elusive experience of “wellness.” We believe we
know what’s necessary to be “healthy,” and we tell
Read our
Savvy Self-
EMBRACE A LOVING KINDNESS Care column
in Massage &
LIFESTYLE WITH SELF-CARE Bodywork
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best practices | HEART OF BODYWORK
Ethical Boundaries
Do They Exist for Employees?
By Laura Allen
A frequent complaint from therapists who work as

employees is that their employer is not supportive
when it comes to maintaining ethical boundaries.
When seeking a job, it’s vitally important that you
ask questions about company policies and how they’re
enforced. You should ask questions during the job
interview; you can’t make assumptions that an employer
agrees with you on ethical issues. Many workplace owners
are not massage therapists; they’re businesspeople. And
some may not be clear that massage therapists have a
code of ethics to follow. There are also employers who are
aware, but who don’t back that up with supportive actions.
Most employers require employees to sign a contract Most employers require
when they’re hired. Read it carefully before signing on the employees to sign a
dotted line, and question anything that isn’t clear to you. If
there are no policies in writing, that’s a red flag. contract when they’re hired.
One recurring complaint I hear is that some employers
expect employees to tolerate inappropriate sexual behavior
Read it carefully before
and/or comments from clients, or have the lax attitude of signing on the dotted line.
“just handle it yourself.” In reality, you are working in the
employer’s business, and management should not expect
employees to be the one to dismiss a client or tell them not
to come back. If management doesn’t handle a problem potential employer about whether you have the autonomy
client, and the therapist ends the session and asks them to to decide when or what type of massage is appropriate and
leave, there’s no guarantee the client won’t come back and safe for the client. Remember, the general public is not
behave inappropriately with another therapist next time. educated about massage contraindications and cautions,
Be sure you know how those situations are handled before which is why we must be.
agreeing to accept employment. There are both benefits and pitfalls to being
Another frequent issue is contraindications. an employee. In order to protect ourselves, we
Particularly in cases where the employer/business owner is have to be sure what we’re signing up for and
not a licensed therapist, they may lack knowledge of when be sure we’re a good fit for the business—and
there is a valid reason not to give a massage, to refuse deep that the business is a good fit for us.
work on a client who shouldn’t receive it, or to refuse hot
stone massage on a client who has peripheral neuropathy. Laura Allen has been a licensed massage therapist since
The business owner may have the expectation that all 1999 and an approved provider of continuing education since
customers are to receive what they want, whether it’s safe 2000. She is the author of Nina McIntosh’s The Educated
for them or not. Therapists have the right of refusal, and Heart, now in its fifth edition. Allen lives in the mountains
the obligation to first, do no harm. It’s wise to question the of Western North Carolina with her husband and their two
rescue dogs.
education | BACK TO BASICS
Managing
Intellectual and
Environment
Boundaries
By Cindy Williams
Boundaries —defining them, and often get to know

communicating them, and them well. Our role
guarding them—can be tricky. is to provide a client-
All humans have a right to choose centered, safe, and
their boundaries. Sometimes this is competent bodywork
easier said than done, especially when experience. Sometimes
it comes to intellectual boundaries that means our clients
in the therapeutic relationship. will express themselves,
Intellectual boundaries relate directly including their social
to a person’s thoughts, beliefs, values, frustrations.
and opinions. In school, we are taught to Client expressions
respect the thoughts, beliefs, values, and might include personal
opinions of others. We are also taught to opinions about politics,
keep our personal thoughts, beliefs, values, social or cultural groups,
and opinions to ourselves. In other words, social movements,
professionalism involves leaving one’s people who are different
personal life at the door. than they are, or
But what happens when a client stirs a someone whose opinion
reaction within you that promotes a feeling they strongly disagree
that an intellectual boundary is being with. Unfortunately,
violated? Or, what if you unintentionally sometimes you might
stir a client with something you say, do, hold opinions they
or display? We all carry past experiences disagree with.
that shape our perspectives. Added to this, It is highly likely
our culture is hot right now with opinion, you will have clients
expression, offense, and defense. What who are significantly
happens when these perspectives and different from you. It
emotions, be it ours or our clients’, filter into is important that these
the treatment room? differences do not
Here, we will explore how perspectives affect the therapeutic relationship. That system. This includes artwork that is
HUTOMO ABRIANTO/UNSPLASH.COM
might collide, how to avoid this occurrence, responsibility lies in your hands. philosophical, religious, or political
and how to respond when a boundary is in nature—or quotes that could
crossed. spawn disagreement. Ask yourself
HOW TO AVOID INTELLECTUAL what value and purpose your décor
BOUNDARY VIOLATIONS has on your professional work.
HOW DO PERSPECTIVES COLLIDE? The most effective way to avoid this type of • Always ask permission if energy work is
Our profession is unique. We spend a relational friction is to create a respectful, part of your therapeutic approach. It is
significant amount of time with our clients neutral environment. To do this: no different than asking if a client feels
• Avoid displaying items in your office comfortable having their glutes worked.
that might challenge a client’s belief

It is highly likely you
will have a client
who is significantly
It is a violation of a client’s intellectual different from you. It is client is greatly reduced if you follow the
boundaries to use any type of spiritual previously stated recommendations.
approach without permission. This important that these
would include praying, chanting, using differences do not Major Violations
crystals, telling clients about visions you Your safety is as important as your
had during the session, etc. It doesn’t affect the therapeutic clients’ safety, so if you feel threatened
mean to not do these things at all. It
means you should say to your client,
relationship. you can say, “I’m not comfortable with
the tone of this conversation. It is not
“I offer [energy work, crystal healing, supportive to our therapeutic goals, so
mantra chanting]. Is that something I’m going to end the session now.”
that interests you? If not, I can easily HOW TO RESPOND WHEN A You also have a right to not work with
forgo those approaches and still deliver BOUNDARY IS CROSSED that client further. If they try to rebook
quality work that meets your needs.” Intellectual boundary violations can be at any time, you can say you do not feel
• Wear a neutral, professional uniform. For genuinely unintentional. If a client is you can offer the quality of care they need
example, a plain-colored shirt instead expressing an opinion, even one that you or that you are not comfortable with the
of a shirt with words or images on it, agree with, you can simply not respond interpersonal dynamics, but you will gladly
even if they seem positive to you. and continue to do your work. If a client offer them contact information for two or
• Do not discuss your personal is really pushy or aggressive even after three other therapists they might choose
perspectives and opinions with you have attempted to dial down the from. Keep it simple. There is no need for
clients. A general rule of thumb: If it situation, you have every right to terminate argument from either side.
doesn’t directly relate to your client’s the session. Following are examples of
therapeutic goals, it is off limits. minor and major boundary violations
If a client makes a comment about and how you might handle them. CREATE A REFUGE
something that is not in alignment We all have varying histories, experiences,
with your perspectives, leave it be. Minor Violations triggers, and valid reasons for responding
Don’t comment or respond. Simply If a client is expressing a strong opinion, to stimulus in the ways we do. Ultimately,
roll right past it and redirect the you might say, “It sounds like that’s really our boundaries are ours to determine
conversation to the therapeutic goal. important to you. Where do you feel that and maintain. The most important part
• Last, but not least, get honest with yourself experience in your body? Can you take is for this to be done with purpose and
about your own biases. If you find yourself some deep breaths into that space and professionalism, which involves always
judging your client, it would be wise to release or disperse it just for this time so respectfully honoring boundaries—
address the bias in a safe and confidential you can allow yourself to retreat from it?” our clients’ as well as our own—and
environment. Journal about it, talk to a If they continue or ask you if they have remembering that the treatment room
trusted colleague, or talk to a therapist offended you, simply say, “My opinions, is not the place for social commentary.
(especially if it triggers posttraumatic both those that are similar and different It is, instead, a refuge.
stress in you). If you feel bias toward from yours, aren’t part of the session.
your client, it is highly unlikely you will It’s best if we stay focused on [insert the Since 2000, Cindy Williams, LMT, has been
offer work that has therapeutic value. therapeutic goal] and really allow your actively involved in the massage profession
These suggestions are not meant nervous system some space to shift into as a practitioner, school administrator,
to create a stale, cold, or impersonal healing mode.” instructor, curriculum developer, and
environment. You can offer a peaceful and Likewise, if a client reacts to something mentor. She maintains a private practice as
nurturing environment in which clients feel you say, you can respond with, “I genuinely a massage and yoga instructor. Contact her
your warmth and care without imposing did not intend to upset you. I apologize. Are at cynthialynn@massagetherapy.com.
belief systems. you comfortable continuing the session?”
However, the likelihood of upsetting a
education | PATHOLOGY PERSPECTIVES
Pharmacology Basics for Massage Therapists  

By Ruth Werner, BCTMB
When I entered the massage therapy field, it was

well accepted that practitioners needed to know at
least a little bit about contraindications: situations
in which massage therapy might cause damage. I felt
drastically underprepared to make good decisions about
contraindications at the beginning of my career, and
that led me to learn more (and then to teach and write)
about pathology in the context of massage therapy—
and this became an enduring passion for me.
But adjacent to pathology is the whole field of
pharmacologic interventions used to treat or manage
diseases and conditions, and, at least in my generation,
we received no education about that topic at all. In fact, I
learned that if a client needed medication to manage their
high blood pressure, then they were probably not a good
candidate for massage anyway. (How many clients would
you have if you followed this advice?)
Happily, that lack of any education about pharmacology
in massage school is no longer universally true—many
massage therapy programs now include information about
medications. Nonetheless, I continue to find that many
massage therapists seem eager to learn more about the
drugs their clients use and how massage might influence
those situations for better or worse. And because I teach
and write about pathology, I am often the person people
ask for this information.
This is highly ironic, given my lifelong avoidance
of learning anything—anything—about chemistry. But
in a way, that makes me a useful communicator about
this topic, because I find I am not alone in this attitude.
With that in mind, what follows is a chemistry-light
beginner’s introduction to the world of pharmacology,
with an emphasis on massage therapy accommodations and
adjustments.
WHAT IS A DRUG?
A well-accepted definition of drug is: a natural or synthetic ANNA SHVETS/PEXELS.COM
chemical substance that alters physiology when taken

into a living system. Under this definition, substances
like caffeine, alcohol, and even sugar could be considered
drugs.
Not all drugs are medications, however. A drug is a
medication when it is intended to improve health in some
way. Medications can be used to help diagnose, treat, or

Massage therapy is
most likely to have a
direct interface with
the medications our
prevent conditions, or manage them for find that a medication that has a history of
long-term maintenance. clients use in the safe use in one context can be effective in
Medications vary from dietary context of side effects. other situations as well, because it saves all
supplements in a couple of important ways. the safety testing that is necessary before a
Supplements are defined as substances taken Some side effects new drug is released to the market.
to complement the diet for full nutrition.
They are not strictly regulated, and as
are just accepted as
such, they are assumed to be safe unless part of medication HOW DO THEY WORK?
demonstrated otherwise. By contrast, To talk about where massage therapy fits
medications are carefully regulated and are
use, but some might in the context of our clients’ medication
assumed to be potentially dangerous until prompt people to use, we need to know a little bit about
safe limitations for use are established. how medications work. This is called
make an appointment pharmacotherapeutics, pharmacokinetics,
for massage. and pharmacodynamics. The video that
DRUG NOMENCLATURE accompanies this article will demonstrate
AND CLASSIFICATION how to read a complex drug guide and
The label on the container of an over-the- how these terms are used in that context.
counter or prescription medication may have ibuprofen (Advil) are fever reducers, but
multiple names for the drug inside. These their chemical structures are different. Pharmacotherapeutics (PT)
names typically include the following: a PT refers to what a medication is used
chemical name (e.g., acetylsalicylic acid), a Conditions Treated. Medications may for. In drug guides, this might be called
generic nonproprietary name (e.g., aspirin), also be classified by what conditions they “indications” or “uses.” As we saw in
and a trade name (e.g., Bayer or Bufferin). are used to treat. These classes include the discussion of classifications, many
Drugs are often classified by groups, anxiolytics (antianxiety medications), medications have multiple PTs.
but these groups can be arranged in many antihypertensives (drugs to treat high
different ways. For example: blood pressure), anticonvulsants (drugs Pharmacokinetics (PK)
to suppress seizures), and many others. Pharmacokinetics refers to how
Chemical Classes. Medications may be medications move through the body—
described by the chemical compounds A few other classification systems might from consumption, through metabolism,
they contain. Benzodiazepines are an be used by prescribing physicians and to excretion. The process of metabolism
example: This group of drugs is built pharmacists, but they aren’t relevant for this isn’t especially relevant for massage
on a particular chemical structure, discussion. therapy at this point (unless someday
and under this classification we find Drug classifications aren’t rigid, and we determine that receiving massage
diazepam (Valium), clonazepam many drugs are used for more than one changes the rate or process of how a
(Klonopin), and alprazolam (Xanax). purpose. Aspirin is an analgesic, but it is also client processes a drug), but the way
used as an antiplatelet drug. Amitriptyline medications are administered and excreted
Intended Mechanisms. Another way (Elavil) was developed as an antidepressant, may have some bearing on our choices.
to talk about medications is by what but it can be useful to control migraines or
they are intended to do. When we talk as a sleep aid. Gabapentin was designed to
about vasodilators or analgesics, this be an anticonvulsant drug, but it works well ADMINISTRATION
describes medications by their function. to manage neurogenic pain, so it is also an There are four main ways drugs can
Drugs grouped in this way may have analgesic. It is always good news when we enter the body to affect function:
different chemical structures, though. by mouth, by topical application, by
Both acetaminophen (Tylenol) and mucous membranes, and by injection.
By Mouth signs. More than one massage therapist has Injection sites are local contraindications
Most common medications are taken asked me whether they were inadvertently for massage for a few hours at least. In
orally (or “per os”— by mouth). This is dosed when working with clients who the case of botulinum toxin (Botox),
easy and convenient for many patients, didn’t tell them about their estrogen or which is injected into the subdermis
but the substance has to undergo filtration testosterone cream until after they had or intramuscularly, many physicians
and metabolism in the liver before it already touched the area. recommend waiting a few days before doing
enters the general bloodstream. Whatever Fortunately, the palms of the hands massage in that area.
makes it that far is called the bioavailable are among the least permeable parts of
fraction of the drug. This means a the body, and if our skin is intact—and we
person’s digestive and liver function may wash our hands frequently—our risk of EXCRETION
influence how much of a medication they significant exposure to medications in this Most drugs are excreted through urine
need to receive any benefit. Some drugs way is minimal. Still, if we know our client and feces, which typically happens
cannot withstand this process, and they has used a hormone cream or other topical within 48 hours of taking the dose.
degenerate before they are usable; this is application of a drug in some area, it is best Some drugs, notably some types of
why insulin cannot be taken orally. Because to avoid it, so we don’t have unintended chemotherapy, are excreted in sweat and
massage seems to boost digestive motility, influence on the dosage or uptake. sebum. MTs who specialize in working
our work may have an impact here. with cancer patients will need to know
Through Mucous Membranes the protocols for clients who are dealing
Topical Application Some medications are inhaled, absorbed with this situation—that is an issue to
In this context, we are referring to through the mucous membranes of the discuss with their health-care team.
medications that are intended to enter cheek or under the tongue, or absorbed
the bloodstream, rather than substances as suppositories in the rectum or vagina.
like pain-relieving gels or creams that are Like topically applied medications, this PHARMACODYNAMICS (PD)
meant for local impact only. In order to avoids filtration by the liver, giving almost Pharmacodynamics refers to the action
access the blood via the skin, drugs must instantaneous access of the drug to the of the drug: what it does to its target
be administered in high concentration, circulatory system. Nitroglycerin sublingual cells and tissues. Medications use
have duration of contact with an area of tablets (Nitrostat) for chest pain are an many strategies to achieve the goals of
skin with hair shafts, and be soluble with example of this kind of fast action. treatment, and more are in development
a molecular weight that allows it to pass One of the challenges with drugs given all the time. Here are some of the most
into the capillaries. Sometimes these by way of mucous membranes is that the common pharmacodynamics, with
medications are used with solvents to help uptake can be variable and unpredictable. examples of drugs that work in this way:
carry them across the epidermis and into This is why inhaled insulin didn’t work for
circulatory or lymphatic capillaries. most people: It is a drug that has to be given Cell membranes. Some drugs may act
Topical applications have some in the right dosage, at the right time, and on cell membranes to limit or promote the
advantages over orally taken doses of this was too hard to predict when it was used passage of substances into or out of the
medications: They bypass the filtration of as an inhalant. cell. For example, metformin (Glucophage)
the liver for direct access to the bloodstream makes cells more receptive to sugar.
and lymphatic system, and they can be By Injection
applied in multiple locations to avoid Injections of medications can happen Body fluids. Medications may alter
irritation. in a few ways. Drugs can be pushed the chemical properties of some
From the point of view of massage into the subcutaneous space (insulin is fluids. For example, proton pump
therapists, however, topical applications of an example) or into the intramuscular inhibitors (Prilosec, Prevacid) change
medications may carry some risks. If the space, like vaccines or antibiotics. In the pH of stomach secretions.
dose is in the form of a patch, like nicotine some situations, it is best for a drug to
or birth control patches, it is easy to identify access the bloodstream immediately. Enzyme systems. Some drugs change
and avoid (I suggest avoidance of several This is done with an intravenous (IV) the enzyme systems inside or outside
inches in every direction, because we don’t application. If this is an ongoing need, a cells. For example, selective serotonin
want to change the rate of uptake at the site). patient may have a port or a peripherally reuptake inhibitors (Prozac, Zoloft,
But some topical medications, especially inserted central catheter, or PICC line. Paxil) alter the activity of enzymes that
hormone creams, may not have any visible

PATHOLOGY PERSPECTIVES
would normally disable neurotransmitters Mitigation & Adjustments for

Medications Possible Side Effects
Underlying Conditions
left in synaptic gaps in the brain.
Antihypertensives, Vasodilation/parasympathetic More time to transition at the end
some anticonvulsants, response, hypotension, of the session, attendance during
Replication. Antibiotics prevent or antidepressants, dizziness, lethargy sitting up, conclude the session
inhibit replication of the targeted tranquilizers with active strokes
bacteria, and some kinds of chemotherapy
and other cancer drugs interfere
with the cell replication cycle.
Nonsteroidal anti- Analgesia, anti-inflammation Work conservatively to avoid
inflammatory drugs, overtreatment (normal signals
SIDE EFFECTS AND HOW steroidal anti- about pain tolerance will be
inflammatories, opioid impaired)
TO MITIGATE THEM analgesics
A drug side effect is an unintended and
often disagreeable effect of a medication. Glucose management Sudden drop in blood sugar Monitor carefully; adjust schedule,
While often mild, temporary, and annoying, (metformin, various forms if necessary, to work while blood
of insulin) sugar levels are steady; keep sugar
side effects can sometimes be severe. Very sources available
serious consequences of medication use are
called adverse drug events, and they include
things like allergic reactions, accidental Anticoagulants, antiplatelet Blood clotting inhibition Work conservatively to avoid
overdoses, and dangerous drug interactions. drugs bruising
Massage therapy is most likely to have

a direct interface with the medications our
Oral or topical steroids Thinned skin, thinned bones, Modify pressure to meet client
clients use in the context of side effects. connective tissue weakness; fragility; attention to hygienic
Some side effects are just accepted as part immune system compromise precautions and personal health
of medication use, but some might prompt
people to make an appointment for massage.
Atorvastatin (Lipitor) is associated with
muscle pain, for instance (a subject I covered Shown above is a table of side effects Ruth Werner is a former massage
in “Statin Use and Massage Therapy” in related to some commonly used medications, therapist, a writer, and an NCBTMB-
the January/February 2018 issue of Massage and how massage therapy might be adjusted approved continuing education provider.
& Bodywork, page 40). Some drugs used for to mitigate them, bearing in mind that She wrote A Massage Therapist’s Guide
symptoms of perimenopause or birth control further accommodations may be needed, to Pathology (available at booksofdiscovery.
can cause headaches. And sometimes drugs depending on the underlying conditions. com), now in its seventh edition, which is used
simply cause a feeling of fatigue or low This table is by no means comprehensive, in massage schools worldwide. Werner is
stamina—antihypertensives are especially and your clients’ medications, side effects, also the host of the podcast I Have a Client
likely to do this. and necessary accommodations may be quite Who . . . on The ABMP Podcast Network.
It can be appropriate to work with a different from what you fi nd here. Werner is available at ruthwerner.com or
client who wants relief from drug side This basic introduction to pharmacology wernerworkshops@ruthwerner.com.
effects, but it is important that we know is meant to provide enough guidance to
what drugs they’re using, and why. And if make safe choices in the short run and to get
the side effects have a profound, more-than- more information in the longer run. It is not
occasionally-annoying effect on a person’s enough to ask, “What medications do you
quality of life, then it is appropriate to refer use?” We must follow that up with questions
them back to their prescribing physician, about why they use those medications, and
who may be able to make some adjustments what side effects are present—because those
for a better result. are the answers that will inform clinical
decisions. SCAN AND WATCH
“Reading a Drug Guide”
1. Open your camera
2. Scan the code
3. Tap on notification
4. Watch!
education | FUNCTIONAL ANATOMY
Coxal Joint      
By Christy Cael The hip joint, and more specifically the
coxal joint, is formed by the articulation of
the head of the femur and the acetabulum
of the pelvis. This joint serves as a bridge
between the lower extremity and the
pelvic girdle, similar to the glenohumeral
joint of the shoulder. Both are ball-and-
socket joints that offer mobility in all
planes, but comparatively, the weight-
Iliac
bearing function of the coxal joint
crest
requires much greater stabilization.
Anatomy
Sacrum The acetabulum is a deep, cup-like
Acetabulum
depression located on the inferolateral
Head of femur aspect of the pelvis. This osseous socket
Ischium Pubis is formed where three bones (the ilium,
Greater trochanter
ischium, and pubis) fuse and provides a
Lesser stable seat for the rounded femoral head.
trochanter The depression of the acetabulum is further
deepened by the acetabular labrum—a
Shaft of femur fibrocartilaginous collar that snugs around
the femoral head and increases joint
stability.
Lateral View
The coxal joint is a ball-and-socket
synovial joint that has a thick, fibrous joint
capsule, as well as a complex network of
ligaments surrounding the joint. Within
the joint capsule, a relatively small ligament
(not pictured) connects the acetabular
Ilium fossa to the fovea of the femur and encloses
Sacrum the obturator artery. More relevant to
Pubofemoral movement are the iliofemoral, pubofemoral,
ligament and ischiofemoral ligamentous networks
Superior located outside of the joint capsule.
Ischiofemoral
pubic ramus
ligament The iliofemoral ligament joins the anterior
Greater trochanter inferior iliac spine and the intertrochanteric
Ischial
tuberosity
line of the femur. It is bifurcated and
Lesser
looks like an inverted Y with a primary
trochanter
function of restricting hip extension and
lateral rotation. The iliofemoral ligament is
Shaft of femur considered to be the strongest of the three
major ligament systems of the coxal joint.
Anterior View

The pubofemoral ligament joins
the superior pubic rami and the Ilium
intertrochanteric line of the femur. It is
shaped like a triangle and restricts both hip Sacrum
abduction and extension and reinforces the Ischium
joint capsule anteriorly and inferiorly. Ischiofemoral
The ischiofemoral ligament joins the body ligament
of the ischium and the greater trochanter of
the femur. It posteriorly reinforces the joint Greater trochanter
capsule and has a spiral orientation allowing Lesser trochanter
it to restrict hip flexion, adduction, and
medial rotation. Shaft of
femur
Mechanics
Because the coxal joint is a ball-and-socket
synovial joint, movement in all three planes
is possible, including hip flexion, extension, Posterior View
abduction, adduction, medial rotation, and

lateral rotation. This is also true of the
glenohumeral joint, but because the hip
Illiacus
functions as a weight-bearing structure
and is anatomically significantly more Psoas
stable, there is less range of motion possible Tensor fasciae
at the hip compared to the shoulder. latae
Another parallel between the hip and
shoulder is the presence of several deep Sartorius
muscles that help steer and dynamically Pectineus
stabilize the joint. The rotator cuff muscles,
including the supraspinatus, infraspinatus, Adductor
teres minor, and subscapularis, surround the longus
head of the humerus and control dynamic Gracilis
joint mechanics in the shoulder. Deep in
the hip, the piriformis, superior gemellus, Rectus
inferior gemellus, obturator internus, femoris
obturator externus, and quadratus femoris
Illiotibial
muscles serve a similar function. These are band
postural muscles and therefore functionally Vastus
better suited for endurance activity and lateralis
aerobic metabolism.
Vastus
Moving superficially, a multitude of medialis
large, prime mover muscles cross and affect
the hip, including the psoas, iliacus, rectus
femoris, tensor fasciae latae, adductor
longus and brevis, sartorius, and pectineus
anteriorly; adductor magnus and gracilis
medially; and the hamstrings and gluteals
posteriorly, with the gluteus maximus
extending laterally to the greater trochanter
Anterior View
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FUNCTIONAL ANATOMY
Gluteus medius (cut)
Gluteus minimus
Piriformis
where it joins the tensor fasciae latae
Obturator internus at the iliotibial band. All these muscles
Gemellus inferior serve both postural and force-generating
Quadratus femoris functions and, therefore, must be capable of
both strength and endurance activity and
anaerobic and aerobic energy production.
Semitendinosus
Pathology and Purpose of

Soft-Tissue Intervention
The coxal joint is vulnerable to excessive
compression, causing osteoarthritic changes
Biceps femoris (short head) due to high weight-bearing forces in this
area. This is also a common site of stubborn
postural deviations and compensatory
patterns associated with low-back pain
and other mechanical issues further down
the kinetic chain (foot, ankle, or knee
dysfunction). Poor mobility, joint stiffness,
and muscle hypertonicity are more likely
at the hip compared to the shoulder. Keep
in mind that genetic variation, history of
trauma, or surgical intervention can create
instability at the coxal joint, though it is less
common than at the glenohumeral joint.
Gluteus medius
Proper assessment of both joint mobility
and muscle length of stabilizers and prime
movers at the hip is useful as part of
postural assessment and movement analysis.
Gluteus maximus Ensuring optimal range in all motions
available and identifying specific movement
limitations is a critical part of treatment and
Adductor maintenance of optimal health for the lower
magnus extremities, pelvis, and spine.
Iliotibial band
Semitendinosus Christy Cael is a licensed massage
therapist and certified strength and
Gracilis conditioning specialist. Her private
Biceps femoris (long head)
practice focuses on injury treatment,
Semimembranosus biomechanical analysis, craniosacral therapy,

Biceps femoris (short head)
and massage for clients with neurological
issues. She is the author of Functional
Sartorius
Anatomy: Musculoskeletal Anatomy,
Kinesiology, and Palpation for
Manual Therapists (New York: Jones &
Bartlett Learning, 2010; jblearning.com).
Popliteus Contact her at christy_cael@hotmail.com.
Posterior View
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EDUCATION SPOTLIGHT
Upledger Instit�te Inter�ational

Q&A
Is it really necessary to learn different modalities?
Yes. The International Alliance of Healthcare
Educators (IAHE) (the global coalition comprised of
Upledger, Barral, D’Ambrogio Institutes, and many
others) encourages all therapists to incorporate
integrative therapies into their work with clients. By
understanding and utilizing the core essences of
different modalities and approaches, the therapist is
better equipped to create a plan for treatment.
When a therapist looks at treating the human

body, the complex anatomy has to be taken into
consideration, including bones, joints, muscles,
nerves, skin, superficial fascia, deep fascia
surrounding the muscles, visceral fascia that
surrounds organs, and the deepest level of fascia assess there is a problem in the shoulder, you need
of the craniosacral system. It’s important for the to determine whether the issue is indeed in the
therapist to learn many approaches and look at shoulder, or if it’s coming from somewhere else. A
different sources in the body to support the client’s thorough evaluation and an integrative approach is
needs. the only way you can tell which system or organ to
treat to alleviate the shoulder.
How will therapists benefit from a broader toolbox?
The more techniques you know, the more clients What’s the best way to find out about integrating
you can help. As a health-care practitioner, having a different modalities? IAHE is offering a free online
wider focus and different perspectives will help you program titled “Best Practices for Integrative
assess the source and better treat the client. The Evaluation and Treatment.” On August 7, 2021, join a
most challenging cases force us to learn more about panel of experts from three institutes to learn how
anatomy and physiology. Anything can go wrong to assess when and why an integrative treatment
with the body, so having more skills to address a approach is beneficial—and how to make the
wide scope of issues allows us to approach treatment most of the modalities you have studied. For more
with the technique that will be the best option. information or to register, visit Upledger.com.
How do we all determine where to begin—or

end—a treatment? The most important step in
treatment is evaluation. For example, once you
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EDUCATION SPOTLIGHT
specific needs of the client. This includes being able to
address certain areas of the body that other systems may
prohibit, such as the gluteal and pectoral muscles, all with
client informed consent.
In terms of employment benefits, some of the perks
individual studio owners may provide include health
insurance benefits, sick days, paid vacation, free monthly
massage, and a flexible schedule to meet their massage
therapists’ personal and professional needs.
How does the Elements Massage brand show appreciation

for massage therapists?
The Elements Massage brand understands appreciation
of the studios’ massage therapists is one of the most
important aspects of a happy, healthy studio team. This year,
we will be expanding our show of appreciation through a
“Summer Celebration” where massage therapists will be
Eric Stephenson automatically entered to win cash and prizes totaling nearly
$25,000, including Apple AirPods®, HyperVolt® massage
devices, and $500 gift certificates. To top it off, a grand prize
Chief Wellness Officer of $10,000 in cash will be given away the week of September
3 to any eligible studio employee hired on or before June
30, 2021. Appreciation is alive and well within the Elements
Q&A Massage franchise system!
What is Elements Massage’s philosophy toward the self-
What is on the horizon for the Elements Massage brand in
care and wellness of its massage therapists?
the coming years?
Since its inception, the intention of the Elements Massage®
As always, the brand will help studio owners continue to
brand boiled down to one sentence: “Taking the best care of
focus on the paramount concepts of safety and trust for
massage therapists so they can take the best care of clients.”
their team members and all the clients they touch in the
Wellness also includes maintaining a continual focus on the
250 studios across the country. This includes a focus on
emotional and mental well-being of massage therapists. The
the highest level of personalized, therapeutic massage
concept of psychological safety (the belief that you will not be
to promote the brand’s mission of “improving the lives of
punished or humiliated for speaking up with ideas, questions,
everyone we touch.”
concerns, or mistakes) is paramount for overall well-being and
I can also share something very exciting on the horizon
is alive and well in the studios. That intention is always front of
as well. Over the next year, Elements Massage studios will
mind, as we understand the importance of career longevity
continue to be the “Employer of Choice” in the massage
in a profession where research from the Entry Level Analysis
industry, with the brand unveiling a system-wide career
Project (ELAP) estimates 40 percent of massage therapists
advancement and development program unlike any
leave the profession within the first two years of practice.
program currently in the industry. It is an innovative game
What benefits does a massage therapist get from working changer! This will include increased financial compensation,
at an Elements Massage studio? increased leadership responsibilities, cutting-edge
The Elements Massage brand is focused solely on one thing: continuing education, and the ability to develop a unique,
providing therapeutic massage and bodywork. From a lifelong career path within the Elements Massage system.
day-to-day perspective, this singular focus allows massage We want Elements Massage studios to attract the best
therapists to focus on doing what they love, without having talent in the industry and help keep them happy for years
to sell required retail products to meet a monthly quota or to come!
recommend facials and other skin care services. In addition,
studio owners do not employ a cookie-cutter approach to
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TENDING TO
OUR HANDS
A
EXERCISES TO STRENGTHEN, STRETCH, AND ACTIVATE
By Heath and Nicole Reed
As massage therapists, our hands are one of our most valuable,

powerful, and utilized tools. Our hands are our emissaries of
touch as we press, pull, squeeze, discover, dissipate, and soothe.
In every touch, we have the potential to convey and circulate
kindness, care, trust, and hope. And with our hands, we can
embody our capacity to give and receive by infusing our breath
and mindful movements with every touch.
As touch therapists, hands are essential to not only our
livelihoods, but also to our lifestyle. How we eat, drink, dress,
wash, travel, text, and perform a multitude of other daily tasks
relies on the performance and versatility of our hands. If you’ve
ever gotten a paper cut or hangnail, you might recall how
distractingly uncomfortable basic tasks are and how much of
your day revolves around your hands.
Because our hands contain some of the highest proportion
of sensory neurons compared to other body parts, they are
highly sensitive to pain. Conversely, they are also a supersized
gateway to the relaxation response. Indeed, our hands are more
represented in our brain than any other single part of the body.
Likewise, behavioral researchers are finding that “using our
hands stimulates brain activity, promotes mental health, and “Your hand opens and
relieves stress.”1 closes and opens and closes
And yet, we often take our hands for granted, not giving them the attention . . . Your deepest presence is
and care they deserve and need. As therapists, it’s paramount that we lovingly tend in every small contracting
to our hands, fingers, thumbs, and wrists to prevent injury and sustain a thriving and expanding, the two as
practice. Here are some hand exercises to help you warm up before a session, beautifully balanced and
awaken your senses, tune into your energy, activate your coordination, release coordinated as bird wings.”
WENDY WEI/PEXELS.COM
tension, stretch your tools, and cool down post-session. —Rumi

IGOR MADJINCA/STOCKSY.COM
Pre-Session Warm-Ups
Shake It Off
Generate more blood flow and synovial fluid
circulation, and prepare your tools for hands-on
healing. Start by sitting, standing, or walking around.
Bend your elbows, and begin to vigorously shake
your hands, wrists, and fingers for 20–30 seconds.
SCAN AND WATCH

“Warm-Up Exercises”
1. Open your camera
2. Scan the code
4. Watch!
Get a Grip and Take a Bow

Start in a standing position and
interlace your fingers behind
your back. Stay here and enjoy a
few deep breaths to open your
chest and expand into your heart
space. If you like, you can take this
deeper with fingers still interlaced
Hands-On Hands
and begin to bend forward. To
Activate, awaken, and warm up your hands and brain with this quick exercise.
protect your spine, be sure to
For 30 seconds:
keep a bend in your knees so your
1. Rub the surfaces of your palms together.
belly or ribs are resting on your
2. Brush over the front, back, and sides of your hands.
thighs. For more intensity, reach
3. Massage, rub, or brush around the surface of every finger.
your interlaced fingers up to the
4. Finish by clapping your hands together several times and give your hands a
ceiling or wall in front of you. This
good shake.
encourages the thoracic outlet
5. Now pause and notice how you, your mind, and your hands feel.
to open, drains stored up tension
Use this technique to start your day awakened and refreshed or to reenergize
from the spine, and gives a
yourself in the middle of your day, as a way to drain away mental fatigue and
thorough head-to-toe activating
refine your sensory awareness.
stretch.
TOUCHING EMOTIONS
Touch is the first of the five senses to
develop in utero and is often the last of our
senses to diminish in old age. And, if we’re
lucky, our lives may be bookended by the
loving touch of another’s hands.
Touch can increase the release of
oxytocin (our feel-good hormones), and
holding hands has been shown to decrease
levels of cortisol (our stress hormone). At
the University of California, Berkeley,
research conducted by Dacher Keltner,
PhD, and his team found that humans can
convey emotions through touch alone—
more than half the time.2
It’s amazing that science demonstrates
emotions can be experienced and expressed
by touch. Take a moment to consider that
in a majority of cases, anyone from the
general population can nonverbally and
accurately interpret someone’s emotions
through touch. Now imagine what you,
as an experienced practitioner of touch,
could listen for and communicate with your
hands. One way to fine-tune this aspect of
your touch is to awaken your hands’ healing
energy.
2. Follow your breath, and apply your
Handy Acupressure pressure on the exhale and alternate by
Restore vitality in your body and activate releasing your pressure on the in-breath.
the healing energy in your hands by Repeat several times on both hands.
contacting a potent acupressure point called 3. Now create tiny circles in the center of
Lao Gong or Pericardium 8 (PC8). This your palm, circling 6–9 times in one
point is located in the center of your palm, direction and then reversing. Repeat on
where the tip of your middle finger touches both sides.
your palm when you make a fist. 4. Now bring your palms together, focusing
According to traditional Chinese your mind where the center of your palms
medicine, Lao Gong (translated as meet.
“Laborer’s Palace”) is the eighth point on 5. Breathe into the center of your palms,
the pericardium meridian and is considered and imagine a light growing brighter and
to be home to a minor chakra. Many brighter spreading to every finger with
energy healers use this point to sense or every breath in and out. Repeat until you
emit healing energy. Working with PC8 is feel calm, centered, and filled with light.
vital to allowing the flow of qi to circulate
through your hands and to spread to all the How do you experience energy in your
fingers. To get the energy and qi moving in hands? Can you sense light growing in
your healing hands: your palms, and if so, does it have a color?
1. Gently press the center of your palm with Explore, experiment, notice.
your opposite fingers, thumb, or knuckles.
HAND-BRAIN CONNECTION
Did you know that one quarter of the
brain’s motor cortex, which is the area
that controls all movement, is dedicated to
moving our hand muscles? And because the
left hemisphere of the brain controls the
right hand and vice versa, we recommend
people grow their ambidexterity by using
both hands equally in everyday life. This
will create an exponential impact on your
brain, allowing for clearer thinking, better
coordination, and lifelong performance
enhancements while doing the things you
love.
Hand-Brain Coordination Challenge

Do you work with both hands equally?
Play with the coordination challenge
below. You might be surprised how quickly
you can upgrade your entire brain-body
coordination.
1. Make two fists with your hands.
2. On your right hand, stick your thumb out.
3. On your left hand, stick your index finger
up.
4. Now, try to switch them so that your left
thumb is out, and your right index finger
is up. At the same time, your right thumb
needs to go in and your left index finger
needs to come down. Once you have it, try
switching them back.
5. Continue switching them to see how fast
you can do it. It won’t happen right away;
you have to think about and work on it.
These hand-brain coordination exercises
help build connections in your brain
that make it easier for you to think and
move. Giving your nervous system new
experiences keeps it healthy and actively
growing throughout your life.
Our hands
are like an
extension
of our brain,
and they are
such a highly
intelligent
sense organ,
they can
perceive and
communicate
without words,
interpret
others’
feelings,
and act as
superhighways
of neurological
awareness and
relaxation.
ELENA RABKINA/UNSPLASH
ListentotoThe
Listen TheABMP
ABMPPodcast
Podcastatatabmp.com/podcasts
abmp.com/podcastsororwherever
whereveryou
youaccess
accessyour
yourfavorite podcasts 49
favoritepodcasts
Post-Session Cool-Downs
Finger Flicks
In a standing position, bend your elbows and
bring your fingers into a soft fist, and then
swiftly flick your fingers toward the ground
as though you’re shaking off water. Be sure to
hear the sound of your fingernails flicking off
the heel of your palms (especially the ring and
pinkie fingers) and repeat a handful of times.
Repeat the same action on different planes of
movement: Extend and flick fingers out in front
of you, and then finger-flick laterally, superiorly,
anteriorly, and then back down inferiorly. This is
a great way to release stored energy and tension
from the upper body. Some people report
auto corrections in their elbow and/or carpals.
Practice between or after a day’s sessions.
Crane’s Beak Neck and Shoulder Release

This is an elegant healing move to open, stretch, and release accumulated tension from the
jaw all the way to your fingertips. You can do this standing or sitting. Reach your arms out
to the sides like wings. With the palms up, draw all your fingertips and thumbs together on
each hand to make a “crane’s beak.”
Now, externally rotate both arms so the creases of your elbows and your crane’s beaks
point up to the ceiling. Hold this position as you lower an ear to a shoulder and gently rock
your head forward and back to find the perfect stretch for you. When you feel complete, SCAN AND WATCH
repeat on the opposite side. Lower your arms, pause, and notice how you feel and where “Cool-Down Exercises”
you feel it. 1. Open your camera
Once again extend your arms straight out, but this time, internally rotate your arms so 2. Scan the code
the creases of your elbows and your crane’s beaks point toward the floor. Gently add the
4. Watch!
lateral cervical flexion with the gentle rocking on each side. Bask in all the new awareness,
blood, and energy circulating.
DYNAMIC STRETCHING
Studies show that preparing your body
daily with dynamic stretches can prevent
injury, increase blood flow to the muscles,
and improve muscle power and strength.3
Dynamic stretching is movement based and
uses active movements to create a stretch, as
in a walking lunge. We can do the same for
our hands and wrists.
Stretch to Strengthen
To perform this stretch:
1. Sit with your palms together in a prayer
position and rest your elbows on a table.
2. Engage and press into both palms.
Then press more firmly into one hand
as you stretch the back of the opposite
hand closer to the table. Then move
the opposite direction as you alternate
between wrist flexion on one hand and
wrist extension on the opposite.
3. Repeat back and forth several times until
you feel warmth building in your wrists
and hands.
Notes
Our hands are evolutionary marvels, 1. High Mowing School, “The Hand to Brain Connection,” accessed May 2021,
hosting 29 major joints, 123 ligaments, www.highmowing.org/using-your-hands.
34 muscles, 48 nerve branches, and 30 2. Dacher Keltner, “Hands On Research: The Science of Touch,” Greater Good
arteries, and they are complex and flexible Magazine (September 29, 2010), https://greatergood.berkeley.edu/article/
instruments evolved over 70 million years. item/hands_on_research.
Our hands are like an extension of our 3. J. Matt McCrary, Bronwen J. Ackermann, and Mark Halaki, “A Systematic
brain, and they are such a highly intelligent Review of the Effects of Upper Body Warm-Up on Performance and Injury,”
sense organ that they can perceive and British Journal of Sports Medicine 49, no. 14 (July 2015): 935–42, https://doi.
communicate without words, interpret org/10.1136/bjsports-2014-094228.
others’ feelings, and act as superhighways
of neurological awareness and relaxation.
Successful therapists understand the power Heath and Nicole Reed are co-founders of Living Metta (living “loving
of their hands in giving and receiving, kindness” ), a CE company now offering touch therapy tools and self-
emitting and sensing, and energizing and care practices in their online community. They also lead workshops
healing. Nurture, train, strengthen, and and retreats across the country and overseas, and have been team-
take care of your hands; treat them like the teaching touch and movement therapy for over 20 years. In addition
invaluable professional tools they are. to live classes, Heath and Nicole are life coaches offering home study,
bodywork and self-care videos, and online courses that nourish you. Try
their community free for 30 days at livingmetta.com/trial.
Find Your Floppy
GET RID
OF YOUR
OWN
TENSION
WHILE
YOU
WORK
By David M. Lobenstine
“The basic somatic task during our lifetime

is to gain greater and greater control over
ourselves, learning to flow with the stress
and trauma of life, like a cork floating on
top of the waves.”—Thomas Hanna1
T
hink about how you want
your client to feel at the
end of a session with you.
Floating? Floppy? Full of ease? Now
think about how you feel (more often
than you would like) after giving a
session. Frozen? Fixed? Full of tension?
This is a terrible contradiction.
Our client’s relaxation should
not require the opposite in us. In my
continuing education classes, therapists
often shrug off their own tension as part
of the job—as if feeling bad in our own
bodies is the seemingly inevitable result
of making our clients feel good in theirs.
Indeed, some therapists are even proud
of their tension, whether consciously
or not. That tension, we seem to tell
ourselves, is proof of how much we care
about our clients. Proof that we are real
therapists who are willing to sacrifice
ourselves to make others feel better.
I believe the inevitability of our own tension—and fist, or the heel of your hand; and hopefully sometimes
idealizing that tension—is a fallacy. This ingrained you’ll also be using your forearm or even your elbow.
idea is well-meaning, for sure, but it is wrong. You do Once you’ve acknowledged your point of contact,
not need to feel tense at the end of a session. And even observe each joint of your arm and hand that is distal
more importantly, the amount of tension you feel is not to your point of contact (in other words, the part of
proof you are a great therapist, and it is certainly not a your body after the point of contact, farther away from
prerequisite for a successful treatment. In fact, I think your shoulder and trunk). These distal joints are what
the opposite is true: You effect the most positive change I call “the area beyond the contact.” So, for example,
for your clients when you feel good during the session. if you are doing a beautiful effleurage stroke along the
The more relaxed we are while we work, the more paraspinal muscles and the heel of your hand is the
relaxed our clients will be. In other words, we help our point of contact, then the area beyond the contact would
clients as much as we are able when we help ourselves include your fingers and thumbs. (And specifically, all the
as much as we can. I believe the best way to help our joints therein: carpometacarpal, metacarpophalangeal,
clients get rid of unnecessary tension is to get rid of our and interphalangeal including distal and proximal.)
own unnecessary tension. Here, I want to offer a quick Once you’ve identified that area beyond the point
and specific way to do just that: As you work, make each of contact, you want to observe the amount of tension
joint in your arms as floppy as possible. Let me explain. in those joints that are beyond the contact. Once you
start to observe this area, I’m guessing you’ll start to
notice that they are holding more tension than you are
THE TIPS TELL US ABOUT TENSION aware of—particularly if you are determined to be really,
I have been writing in this magazine for close to a decade really good therapist and do really, really deep work.
about how we have to pay attention to our own bodies if Tension in the area beyond the contact should be an
we want to be successful and satisfied therapists.2 And I immediate red flag. Any time you see those joints are stiff,
teach multiple continuing education classes that vary in rigid, or tense, you are working harder than you need to,
their focus, but all emerge from the same idea: You will in two ways. First, contracting the muscles beyond where
be happier, and your clients will too, if you pour with you are contacting the client doesn’t make the stroke any
your body weight rather than push with your muscles. My better (and as we’ll explore further, might make the stroke
principle of pouring, rather than pushing, offers a way feel worse). Second, tension in this area beyond the contact
to assess the entirety of your body during your sessions is a sign there is excess tension elsewhere in your body too.
(not to mention the movement of your breath, and those Unnecessary muscle contraction beyond the contact is like
ever-present rumblings of your heart and your head), the warning light on your dashboard telling you there is a
so that you can attend to yourself while you take care of larger problem with your car. And just like with your car,
your clients. This kind of full-body self-awareness is very it is easy to ignore the warning light for a while. But the
simple, and with sufficient practice, very gratifying. But consequences are never good. Don’t ignore the warning
when you are just beginning to increase your own self- light. Your body—and your client’s body—will thank you.
awareness while you massage, paying attention to your The more you pay attention, the more you will notice
whole body all at once can feel overwhelming, so I have tension beyond the contact. It will feel like the warning
developed a shortcut. A simple way to get a glimpse of how light is constantly flashing! Luckily, the solution is easy
your whole body is doing is to just pay attention to one tiny (with apologies to Bobby McFerrin): Don’t worry. Be
part of your body. This is one way I monitor my own sense floppy. That’s it. Or another way to put it: Think floppy,
of ease in every session I give and is something you can not fixed. Let’s explore what this means in practice.
start practicing as soon as your next client is on the table.
TENSION-MONITORING EXERCISE LOOK FOR EXCESS, RETURN TO EASE

The practice is simple: With each stroke you give during In every continuing education class, I tell therapists my
a session, notice your point of contact—the part of your goal for every session: Do the minimum amount needed
body that is actually performing the stroke. For some to create the maximum benefit for the client. When I say
strokes, this will be the tips of your fingers or your this in class, everyone nods their heads. Who wouldn’t
thumbs; other times, you’ll be using your flat palm, a soft agree with this, after all? None of us want to work harder
than we need to, right? But then, what happens when those
participants go back to their tables and start to practice?

SOME TENSION,
WHETHER IN YOUR
FINGERTIPS OR
THUMBS OR WRISTS,
MAY NOT SEEM LIKE
A BIG DEAL. BUT IT
IS . . . THE NATURE
OF TENSION IS THAT
IT NEVER EXISTS
IN ISOLATION.
EXCESS EFFORT
IS CONTAGIOUS.
TATJANA ZLATKOVIC/STOCKSY.COM
Observing the Point of Contact and Beyond
If you make contact with your elbow or forearm, all the joints distal (wrist,
thumb, and fingers) are not contributing to the stroke. Therefore, they
should not be contracting at all. Instead, they should be as relaxed as
possible. They should be floppy. The same is true when you are using other,
more distal points of contact. For example:
• If you are making contact with the heel of your hand, your thumbs and
fingers should be floppy.
• If you are making contact with your thumbs, your fingers should be floppy.
• If you are making contact with your fingers, your thumbs should be floppy.
If any of those joints are tense or fixed or locked or rigid, then you are
working too hard.

You guessed it: They start working harder one part of the body is, in my experience,
than they need to. In other words, your an indication of tension elsewhere.
brain might agree with the idea of using Excess effort in the hands likely means
the minimum effort needed, but chances the muscles of the forearm, upper arm,
are your body is going to start working and shoulder are also working harder
harder as soon as you stop reading this. than they need to. There is a good
As always, I say this without judgment. chance the muscles of your trunk are REMOVING
Recognizing the disconnect between joining in with their own excess effort.
brain and body is a crucial aspect of our
longevity (or lack thereof) as therapists, and
Clients are a good reminder of how
excess tension spreads. Think about that
EXCESS EFFORT
it is something we are not very good at. The
longer I teach, the more obvious it becomes.
client who is glued to his computer. His
shoulders and neck are hunched and IS PROBABLY
THE SINGLE
Most therapists don’t have a clear sense of taut, obviously, but does the tension
how much effort they expend. stop there? Of course not. You can trace
We are bodyworkers. Our whole job the consequences of his keyboard over-
revolves around helping other people’s efforting all the way down the trunk and BEST THING
muscles. And yet, unless you have a well- even into the lower body. Your client is
developed practice of body awareness (tai
chi, Alexander technique, and Feldenkrais
probably carrying excess tension in his
gluteal muscles, his internal and external
YOU CAN DO—
are the ones that have been most helpful
for me), chances are you don’t have a clear
rotators, and even his hamstrings—even
though he is just sitting all day. The BETTER THAN
LEARNING A
sense of how much you are contracting nature of tension is that it never exists in
your own musculature! With practice, isolation. Excess effort is contagious.
however, you can learn to monitor your Because the body’s tension is so good at
muscles. And you can start in the next spreading, we should identify it wherever NEW MODALITY,
session you give, with the clue that is and whenever we can. You can use this tiny,
literally right in front of you: your arms.
If you are doing a stroke with your
and seemingly inconsequential, signal from
the end of your arms to become aware of
INCORPORATING
forearm, and you are trying really hard
to make that stroke great, chances are (at
the overwork that is happening along the
entirety of the kinetic chain. Even better, FANCY NEW
TECHNIQUES,
some point) one of two things will start to the signal itself contains the solution. It can
happen: Your hand will clench into a fist, or be daunting (even when we do recognize
your fingers will rise up toward the ceiling. the whole arm is working harder than
Either of these mean you are exerting more necessary) to actually try and reduce excess OR ADDING HOT
effort than needed. You are working with effort in the neck, shoulder, arm, and hand
more than the minimum effort necessary.
I often see the same counterproductive
all at once. But if you start just with the
most distal joints—that area beyond the
TOWELS AND
habit when a therapist uses the heel of
their hand as the point of contact. If you
contact—you’ll find a reflexive effect.
ESSENTIAL OILS
—TO MAKE YOUR
are pushing rather than pouring with the
heel of your hand, then your fingers will FLOPPINESS WORKS BOTH WAYS
begin to rise up toward the ceiling. The Once you get used to the idea of observing
same is true with our thumbs. When we the area beyond the contact, you can start SESSIONS MORE
are exerting more than the minimum expanding your awareness in the opposite
effort as we use our thumbs, then the
fingers tend to straighten and tense.
direction. Instead of only observing the
more distal joints of the body, you can
EFFECTIVE.
Some tension—whether in your also start to observe the more proximal
fingertips, thumbs, or wrists—may not joints—the joints before the contact.
seem like a big deal, but it is. Remember Start with your wrist, elbow, and
the warning light analogy from earlier? shoulder joints. Then, as you are ready, you
The problem is not the tension in your can spread your awareness even further
hands. The problem is that tension in any up through your cervical spine, down
along your thoracic and lumbar spine,
across and around your rib cage, and
eventually down into your pelvis. Indeed,
when using your fingertips or thumbs
to create a stroke, there is no part of the
body beyond the point of contact. In this
case, the point of contact is already the
most distal part of the arm. But the idea
of being floppy still applies. And in some
ways, it is more important than ever here.
When you start observing the larger part
of the body—the area before the contact—
things get a little trickier. Unlike our fingers
or wrists, we can’t simply let these more
proximal joints flop completely. If we did,
we would turn into the Scarecrow from The
Wizard of Oz, and we would fall over onto
our client on the table. Not a good idea.
So while we don’t want to just go
completely limp, we do want to use the
same essential concept: Identify excess
tension, and then let it go. That way, we
can do the same strokes but with just the
minimum amount of effort. A simple
exercise will help make this concept clear:
• Pick up a magazine or a thin book.
• Raise the magazine in front of
you, arm straight, until your arm
is parallel with the floor.
• Stay in that position for a minute, and
notice what happens in your body.
• Observe that your first instinct is to grip
Relax the Rigidity the magazine hard with your fingers
Each time you notice rigidity in your distal joints, try the following. so it doesn’t fall. And then your next
1. Notice this counterproductive habit, but try not to judge yourself for it. instinct is to clench various muscles in
Blame does nothing. Instead, think of that excess effort as a gift from your shoulder, back, and glutes to keep
your body, a reminder that you are working harder than is helpful. yourself in this awkward position.
2. Continue the stroke, but focus on lengthening your next exhalation. A Now, let’s examine holding the
breath out that is long, slow, and effortless is one of the best ways to magazine in this annoying position
overcome the over-efforting. without it being so annoying.
3. Think of those distal joints drooping, flopping, or sinking into a neutral • Experiment with loosening your
position as you exhale. grip on the magazine.
4. Feel the floppiness in the area beyond the contact, and imagine it • Try lengthening your exhalation slightly,
spreading up the kinetic chain. and with each slow, effortless exhale,
5. Feel yourself continue the stroke, but rather than pushing, pour the imagine your muscles are sinking as your
contact into the client. You’ll still be able to deliver just as much pressure breath empties. Doing this allows the
with the point of contact itself, but you will be using your whole body flexor muscles of your fingers, palm, and
more, and those specific muscles around the point of contact less. thumb to contract with a little less force.
Using these steps will allow your quality of contact to be different. It
will feel like less work for you, and it will feel less strained to the client.

• Allow the flexors and extensors of your forearm, Excess effort seems so obvious once I point it out, and
as well as your biceps and triceps, to soften just yet the therapist was, most likely, completely oblivious
slightly. You can still hold your arm parallel to the to it just a moment prior. Tension so easily creeps,
ground without your arm being quite so rigid. unnoticed, into the body—even when you are taking
• Let the muscles around your shoulder joint a CE class that is all about becoming aware of tension!
soften. Same with your glutes. Notice how your But the beautiful part happens next: Once they get over
body is still accomplishing its task but with their embarrassment, the awareness spreads elsewhere in
less tension throughout your body. The same their body. I see them soften a little, like they are settling
subtle shift is possible as you massage. into their stroke, able to contact their partner both with
While the concept of excess effort is easiest to greater ease and with a renewed sense of purpose. That is
see—and to feel—in the distal joints of the hand, the what your client wants. And that is also what you want.
same idea applies throughout your whole body. As you It is hard to let yourself work less hard. It is difficult
become more aware of excess tension in your hands, to let yourself fi nd ease. So start small. Just observe
expand that awareness further up the arms. Notice, as the joints beyond the contact. And then allow yourself
you work, how often the joints of your elbows, shoulders, the freedom that comes with being floppy.
or spine are locked and straining. Practice fi nding,
instead, a position for your upper body that is stable NOTES
but not rigid—you want to stabilize but not strain. 1. Thomas Hanna, Somatics: Reawakening the Mind’s Control
Throughout your client sessions, see if you can do of Movement, Flexibility, and Health (Cambridge: Da Capo Life
the same work with less effort, and gain the maximum Long, 1988), 15.
benefit with minimum effort. Your body will thank 2. Find all of Lobenstine’s articles in the digital editions of
you. And your client will thank you. They will feel the Massage & Bodywork magazine. “Under Pressure for More
difference, even though they won’t be able to articulate it. Pressure: The Client Who Demands Deeper,” May/June 2020,
The other problem with excess effort, as should be page 68; “Less is More: A More Effective Way to Use Lubricant,”
January/February 2020, page 80; “The Solution is the Sides:
obvious by now, is that it doesn’t do any good for the
Approach the Body from New Angles,” March/April 2017,
client, just as it doesn’t do any good for us. It is rare
page 58; “Breath: Your Most Powerful Tool,” May/June 2016,
that a client can actually identify when we are over-
page 74; “Pour, Don’t Push: How to Massage with Greater
efforting, and yet the client’s body can—consciously Depth and Ease,” November/December 2016, page 64.
or not—feel that excess tension. Any excess tension
in your body will feel to your client like you are
pushing or poking, instead of pouring and sinking. David M. Lobenstine, BA, LMT, BCTMB, has been
Excess effort causes clients to guard and hold rather massaging, teaching, writing, and editing for over 15
than sink and soften. Thus, removing excess effort years in New York City, with a focus on clients at all
is probably the single best thing you can do—better stages of childbearing. He is a co-author of Pre- and
than learning a new modality, incorporating fancy new Perinatal Massage Therapy (3rd ed.), and also designs
techniques, or adding hot towels and essential oils—to and teaches his own continuing education workshops,
make your sessions more effective. Create the possibility of both across the US and online at Body Brain Breath.
ease in your treatment room, starting with your own body, For more information, visit bodybrainbreath.com.
and your clients will embrace that possibility in theirs.
ADAPTING TO EASE
The idea of observing the joints beyond the point of
contact might seem laughably simple, but often the best
habits are the simplest. When therapists practice on
each other in my continuing education classes, one of
the most useful things I do is to walk from therapist to
therapist, without saying a word, and place my relaxed
hand atop their stiffened fi ngers, or around the shoulder SCAN AND WATCH
“Find Your Floppy”
that is climbing up toward the ear. Nearly always, the
1. Open your camera
therapist smiles, shakes their head, or rolls their eyes. 2. Scan the code
4. Watch!
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EDUCATION SPOTLIGHT
Are your courses offered in-person, online, or a
combination of both?
After 15 years of exclusively in-person teaching, we began
offering parts of our curriculum online five years ago. That
has proven very successful, and we now offer a Coaching
The Body® membership consisting of up to two years and
hundreds of hours of material covering the entire scope
of our work. Of course, palpation and techniques must
ultimately have an in-person element, but we’ve discovered
that there is a lot of critical knowledge that can be taught
online with testing. One thing I have learned is that the
greatest technique applied in the wrong place is far less
effective than a less-effective technique applied at the
source. This is a major reason why our online members are
seeing such success in their work, even without being able
to visit us for in-person study—although some do. I’ve also
been putting a lot of time over the last year into writing a
book on CTB that we expect to be published later in 2021.
What makes Coaching the Body’s® offerings new

and fresh, even for experienced practitioners?
Chuck Duff I came to manual therapy from a very unusual background,

so consequently our approach has many unique elements.
Experienced massage therapists, PTs, OTs, chiropractors,
Founder, Coaching The Body® and trigger point therapists come to us because Coaching
The Body® is a radically different method of analysis and
a unique combination of approaches that achieves a high
Q&A and consistent level of success. A big part of this is moving
How can Coaching the Body’s® trainings and from an “injury-centric” way of thinking to an understanding
webinars support massage therapists’ self-care? of how pain is generated in the brain as a response to
I’ve found that an important piece of learning for both nociceptive signals and neuroplastic changes that occur
my students and me has come from understanding how over time due to the body’s natural protective response. We
to deal with the challenges we face in our own bodies. employ movement-based techniques, many of them derived
The dominant belief in medicine seems to be that pain from traditional Thai poses, as a way to downregulate the
implies injury. For example, if you have anterior shoulder protective response, release trigger points, and regain
pain, you might be diagnosed with biceps tendinitis. But pain-free movement. Therapeutic vibration tools, including
trigger point therapists know that many muscles refer pain the Muscle Liberator™, which we designed, provide a
to the anterior shoulder, and most of them are situated powerful form of neurological distraction, amplifying the
elsewhere. Bottom line is, if you don’t resolve issues at rate and ease with which we can successfully resolve issues,
the true source, the pain will always return. So my work and also making it far easier on the therapist’s body.
has been devoted to uncovering the satellite referral
chains and functional relationships that reveal the true
source of most common pain complaints—shoulder pain,
sciatica, IT band pain, and so on. We’ve developed both
self-care and bodywork techniques for all our treatments.
The two go hand-in-hand, because our students can sponsored by
apply the techniques during therapy but also have a
good idea of what to recommend to their clients to keep
the pain away once they leave the treatment room.
BURNOUT
AND THE
COMMITMENT
TO SELF-CARE
By Thomas Myers
MARC BORDONS/ STOCKSY.COM

Like
“stressed” and “traumatized” before it,
“burnout” has become the new repository at how difficult this simple task might be.
for all manner of presenting symptoms, both Parents learn this lesson early (or don’t,
physical and mental. As we pick up our tools and then struggle with their children).
and get back to work, this particular time in Regardless, if you can find a harness
history calls us to our deepest motivations: to that fits your shoulders and a load you
set a straight course into an uncertain future. can bear—well, there are worse lives than
Your deepest purpose can often be found service. But we were talking about burnout
by rummaging around in your origins: What (I promise, we will come back to the part
got you involved in this work? No matter what about wounding again at the end).
form of manual or movement therapy you As we return to work (or maybe you
practice, 9 out of 10 of us arrived here through have been working full time all along,
our own wounding. In my own case, it was not but here comes a new world anyway),
a direct injury that was healed by bodywork, some of you—and a lot of your clients—
but rather the curse of being the awkward kid, are burned out. People often compare
never “fitting in my skin,” as the French say. this physiological state to running out
Deep touch brought me into myself, and (re) of gas, but the more proper analogy
started a long and joyful relationship with for burnout is lack of lubrication.
my movement and my emotional, sexual, For most of us this past year, parts of
and spiritual self these last 50 years. our motors have been running on overdrive,
After many years of practice, my mature while other parts have turned over only
work has returned me to my wounded roots: lethargically, so burnout is the screaming
As we come progressively out of the pandemic of those loose belts and ungreased gears
and back into touch with each other, I want turning too fast for long-term health. Is it
every child to get the kinesthetic life skills I fair to say that “tired” is low imbalance at
missed out on. I was stuck in a little metal desk the end of the day or the week, “stressed
in front of a blackboard. Our kids are jacked out” is the same deficit at the end of the
into a beanbag chair in front of a screen. month, and “burnout” is the same process
As a career therapist, I can say this with after a year? Depends on your innate
assurance: An updated version of physical resilience, and the words blur into each
education—a real education in how their body other, but it’s something like that.
works for our kids—would go far to alleviate
a lot of the problems we deal with daily.
Instead of a bright focus only on athletics, WHAT TO DO WITH CLIENT BURNOUT
we need a User’s Guide to the Human Body The rest of our discussion applies to
course for this generation of electronified clients, but hey, you are smart enough
children. Anyway, that’s my own personal to see where it might apply to you as
crusade based on my particular wounding. well. Beyond the usual bromides we’re
We all have wounds, and they are the key all doing our best with already—diet,
to healing—if not to full healing, at least to sleep, exercise, and personal connection
finding your true purpose in this lifetime. (tell me about it)—what can you do as a
“Freedom is resting easy in the harness,” said bodyworker to help restore an integrated
my teacher Peter, his little chuckle hinting purr in a client’s physiological motor?
To wring the last bit of fuel out of
this body-as-machine metaphor, we want
the engine to be capable of dropping to a low idle when pumping out extra signals down the motor nerves to the
there’s a chance to rest and repair, while still being muscles. The motor nerves are the only way “out” of
capable of revving up when power or speed are needed. the brain. You get input from eyes, ears, body, and the
Stress—or, more properly, continual unresolved rest, but all the output goes to your muscles—striated
stress, which science calls “distress”—revs our motors and smooth. Thus, we are all carrying a muscular “set”
up to a high idle, preventing parasympathetic self-repair with which we confront the world. It might be open
and the restoration our organism needs regularly to and easy, or it might be shut down and protected in
self-maintain. This past year has been a transparent the front and thus breathless. Or it may dramatize,
model of what continual stress does to us all. scampering away from the back with a sucked in and
Consider the balancing act your body performs—to pushed forward pelvis. Or the spine curls in on itself in
so many different rhythms. Your eyes recreate the visual grief—we all have a complex “set” built up over years.
world many times per second, constantly reconciling
what’s seen now with what’s been seen before. Your heart
rebalances, spinning out a gout of blood about once a THE NEUROMYOFASCIAL “SET”
second. A relaxed breath balances your blood every five AND HABITUAL RESPONSES
seconds. The fluid in your head waxes and wanes several The neuromotor set can be coupled with a lot of
times a minute. Peristalsis moves your food. Every few emotional force or only a little—it varies by person—
hours, your kidneys force you to find a place to pee. Once but we are all somewhat controlled by our habitual
or twice a day, you rebalance by defecating. Every 28 responses. This habitual response is “noise” in the
days, you shed the lining of your fruit. And so on, with motor output of the brain. Burnout increases the neural
a hundred fluctuating waves that constitute our minute- noise, and the resulting muscle tension leads to more
to-minute high-wire act. When the idle runs high, holding and more pain. Our job is to break that cycle.
repair runs low, and it is a matter of time until whatever So, our second job—and it is a higher calling than
part is weak starts to whine or just seizes and quits. simple awareness, as powerful as that can be—is to
The chemistry of stress is well documented, so follow facilitate client resolution of this noisy overdrive.
your own lights with supplements or medications or vagal Unfortunately, there is always some “noise”—the
stimulation—not my bailiwick. But can we change our anxiety that we’re not moving fast enough, that
chemistry by other than chemical means? Yes, with hands-
on work, by working in from the other end of the equation.
What do I mean? Instead of approaching burnout As you introduce any self-care practice
from an emotional or chemical vantage, what happens
to the movement system? First, sensory data from to a client, think ahead. What is your
the tissues—principally but not exclusively from the
fascia—up to the brain gets distorted. Any bodywork
or movement work can help return accurate reporting
goal? I look for a “We’ll be done with this
up the proprioceptive and interoceptive tracts—you
accomplish that every day. No matter how you practice, exercise when you can . . .” statement.
greater awareness is our most important offering. And
sure, getting into the sore places is great, but better yet, “somebody might be gaining,” as Satchel Paige
see if you can find a way to touch or move the silent but said, may produce constant underlying tension in
short areas that will free clients to resolve the strain the hamstrings, tension we are not aware of.
patterns that led to the pain patterns in the first place. These tensions accumulate over a lifetime, and
So, first, some places in the sensory body image get lost. gradually both mind (habit patterns) and body (your
Second—and this relates more to the burnout part— fascial fabric) take on that pattern as a permanent fixture
an anxious brain with unfulfilled needs (“You can never of your posture. The amount of change we all needed
get enough of what you don’t really need”) is constantly to adjust to this past year—and likely for more years
to come—has either temporarily or more seriously
overcome the habitual responses in some of us.

Burnout, on the other hand, denotes a particular
kind of tired. “I can’t go another step,” complained
my 8-year-old friend on a hike. Stop for a few
minutes, and she’s soon happily ranging on ahead
again. Tired—no matter how tired—can be fixed with
sleep or rest. Burnout, however, is still there in the
morning, or comes on quickly as the day progresses.
Burnout occurs when the requirements outstrip the
resources over a sustained period of time, and the
body switches to a defensive maintenance mode.
These days, I feel the fierce urgency of more touch
connection—just to sit down and laugh over a meal,
for crying out loud—as an ongoing tension in my low
belly and low back. This constant output into our
muscles costs energy, and in turn stifles sensation, Your Neuromyofascial
so opening up your clients to these neuromuscular
patterns becomes the doorway out of burnout.
“Set” of Posture in Action
Resilience—“things may be bad, but I can cope”— To feel how your neuromyofascial set works, lie on your back
implies more fuel in the spiritual tank, even if it comes on a floor or a mat, legs out straight. Put your attention in
from reserves. True burnout—what used to be called your spine. Notice where it touches the floor, where it doesn’t,
a nervous breakdown—implies all the usual spark is and note any tension you feel there. Everything I want you
gone. We’re all aware that we’re running faster than to notice is going to happen in the first half-second—I am
we are being restored, especially for anyone on the inviting you to look at what happens when you prepare to
front lines: nurses, mothers, and check-out clerks. move.
How do we restore resilience? When you feel Now lift one heel off the floor. An inch will suffice—your
resilient, you feel inside that you can muster the spinal muscles, joints, and fascia “set” themselves to handle
resources to stay centered, whether it is to keep the weight just before and just as you make the movement.
yourself safe or keep moving toward a goal. Increase Do this a number of times, relaxing in between and watching
your resilience and you’ll reduce your burnout. what happens when you just start to think about beginning
I will leave it to your own training and skill set to lift your leg. The “set” of your spine and hips as you take the
as to how you tackle this in a session of your chosen load is a combination—honed over many years—of neural
modality. All modalities, practiced with awareness, messages to muscles, the muscles strengthening as they
can be helpful in this regard. A coordinated program can, and the fascia providing the force transmission. Failure or
of deep-touch sessions can definitely help such a deficit in either the muscles or the coordinated messages will
“whole-person” event as burnout. Proceed with result in gradual densification and stiffening of the fascia to
confidence and be patient—results usually do not make up for the loss in stability.
appear until six sessions or so. The remainder of this For comparison, calm yourself and pay attention again as
piece discusses some global concerns in building a you lift the other leg an inch or so. Do that a few times. Can
self-care component into your clients’ daily activities. you feel a difference between how the two sides handle
the added strain? Remember to take a little rest between
changing sides, so you can perceive the differences clearly.
“HOMEWORK” FRAMEWORK If you are not feeling it, put a finger lightly on each anterior
No matter how good your work is, it will be more superior iliac spine on the front of your hip bone, and then do
effective if the clients live into the new space and make the test. It’s dollars to doughnuts that one side of your pelvis
it their own—we all know this. And the resources for twists more than the other, one finger moves up more than
generating a wide spectrum of self-care are legion, the other. Almost no one (but the most balanced athletes)
available all over the internet or indeed in recent have a bilaterally symmetrical response to load.
issues of this magazine. (See Heath and Nicole Reed’s Can you create one? Can you create a “set” that allows both
sides to remain in place (which a dancer would appreciate) or
at least move the same (which your low back will appreciate)?
feature article, “Tending to Our Hands,” on page 44 “Do these calf raises to strengthen your arches.” Be
of this issue, and their Savvy Self-Care column in past as specific as you can about how or when the project
issues of Massage & Bodywork magazine for more self- reaches its sell-by date. Set and monitor reachable
care practices for massage therapists and bodyworkers.) goals. Think about how much you like to hear, “Good,
Having made every frustrating mistake in the you got that, now let’s go on to the next thing.”
book trying to inspire my clients during my nearly
50-year career allows me to share some overarching
concepts I find useful, and I hope you will find START SMALL
them helpful too (but, please, interpret all of the Even with the athletes and everyday mat yogis, I start
following into your own practice as you see fit). small. “How many minutes a day will you give to this
With a few clients, especially if I have not started project?” If they answer an eager “15,” I give them
in on “homework” from our first session, broaching the something under five. If they say “five,” I give them
subject of support work is difficult. I usually go for the something under one minute.
direct approach: “You know, you’ll get more bang for your Also among my arsenal of homework assignments are
buck if you do a little support work between sessions.” items to be remembered moment-to-moment. Like, “Every
Regardless of the actual homework you assign hour you’re at work, I want you to drop those scapulae
your clients, you are inducting them into a self-care down your back about 80 times—any time you think of
routine, which is also an attitude. So many people it.” Or “Every time you’re waiting for something, take a
have lost this attribute—many in the pre-COVID, few seconds to center your pelvis back over your feet.”
“easy” days before the world shut down. Now, the If they come back and they haven’t done the homework
long-term lack is clear, and the need is urgent: (all too common), make the assignment smaller. No
Care for the self, from the self, is important, since shame, no blame—we’re all busy and distracted. Say,
outside stimulus has not been forthcoming this year. “Well, how about we try this then?” And then go for
Treat yourself as a person worth cultivating. something shorter and easier, which leads you to the
fruitful meditation: What is the minimum change
this client could make that would have the maximum
MAKE IT A PROJECT benefit? More is not better; more is much worse. If
As you introduce any homework/self-care practice your client doesn’t take it, all the good advice in the
to a client, think ahead. What is your goal? What is world you can think of is not just useless, it’s damaging.
your goal for your client? I look for a “We’ll be done It puts you in a parent position, which is a bad place
with this exercise when you can . . .” statement, and for a therapist to stand—and a hard one to get out
get the client’s agreement for the goal. If you hear the of once you have put yourself in it. Guard against
question, “How long should I do this?” you should “good” advice. Instead, look out for effective cueing.
have an answer ready—a definable state they can
achieve. Corrective homework that is open-ended
and does not have a specific goal tends to spend its CUE TO THE CHANGE*
energy and fade all too quickly in the client’s mind. *This is a phrase I believe I “stole” from Judith Aston
After that project is done, you may have another goal to (astonkinetics.com), but it is an especially important
set with them. Or the first project may have been in service concept when you want to change a common body habit
of a larger goal. Either way, keep the goals project-oriented that a client’s “set” makes them prone to. (Make sure
with an end in sight. Too many times I get an exercise they know the “bad” place, as well as the “good.”)
from a therapist without a goal, so the whole experience For the office worker prone to lifting her shoulders to
becomes endless and discouraging when I am at home. her ears when stressed, it is not a winning strategy to say,
A client can handle missing a benchmark, but without “OK, now your shoulders are down in a good place—keep
them, it’s harder to keep the inner child interested. them that way.” She won’t. It’s a habit. Despite your good
“OK, we’re going to try these deep calf raises for a work—especially at the beginning—those shoulders will
month—if we don’t see improvement in your arches by go up again as soon as the boss is around or she’s tired.
then, we’ll look for another strategy.” That statement A better way to approach this is as they are ready to
falls very differently on the ears of the client than: leave the session (after they’ve dressed), give homework.

This is the time when they are as close to the condition they already. The woman in the office likely needs to cue to
will be in when the habit strikes again. Discuss the process interactions: “Every time you listen to someone talk, take
of getting from A to B by saying, “Here’s what it feels like a second to drop those shoulders.” Does the guy with the
with your shoulders up—feel that? Now drop them down forward pelvis use the ATM a lot? Cue him to remember
your back, as if you’re putting them in your back pockets— about centering his pelvis every time he’s waiting in line.
feel that? Now up. Now down. What do you do to drop Find some concrete moment in their lives you can
them?” And so on, until they can easily go from their “bad” link to the cue that will make both your lives easier.
to your “better.” Take your clients through these homework Phrases like “When you get out of bed . . .” or “Last
thing before you sleep . . .” can be good cues to jog
their memory. Exception: Do not cue moms to their
Keep the goals project-oriented with kids’ behavior. Moms (OK, some dads too) have a
special state that is so totally unselfish, so focused on
their child, that this is not a time for them to think
an end in sight. Too many times and make a self-correction. Lots of my cues to parents
start with, “When you feel their breathing finally drop
I get an exercise from a therapist into sleep, and before you go clean up the mess, just
stand up for a minute and (insert body cue here).”
without a goal, so the whole
experience becomes endless and BUILD STRENGTH BY EXERCISING
THE MENTAL MUSCLE
These mental cues—however you couch them, and
discouraging when I am at home. however the client receives them—are the basis for
your clients to build a practice of self-attention and
exercises several times, so they really know the difference. self-care. In my own case, my mother’s attempt to teach
I do this commonly with shoulder position, or taking a me ethics—“You should think of other people”—got
breath for those who freeze, or centering the pelvis over the translated as “It’s a sin to pay attention to yourself.”
ankles for those who are “ahead of themselves,” and a bunch By the time I got to bodywork in my 20s, I could
of other little corrections that can be done to make deep feel almost nothing and had little control over my
pattern change more likely for your clients. Other times, I inner workings. It took a while to build up that skill
really am giving them a strengthening exercise to do, rather of being able to scan and read myself, a skill that is
than a postural awareness, but the same principles apply. second nature to some, but I had it bred out of me.
In each case, I reserve a few minutes before they True self-care is a muscle that most of us must
go out the door to cue to the change. “Here’s what exercise, or it gets lax. As we build strength in this
you feel like when you hold your breath. Got that? muscle, it can take heavier loads. So, just like training,
Not very fun, is it? When you feel like that—and you start small, do many reps, get some successes,
likely will—just swing into an inhale, letting your and then (and only then) increase the load.
upper ribs lift. Yup, just like that,” or whatever it is. Do not mistake self-care for self-regard, which is
Prepare to be patient. When the client comes in altogether less attractive. It is easy to tell the difference:
complaining they have to cue themselves multiple Self-care asks questions arising from inner feeling,
times an hour (or per day, depending on the cue), while self-regard asks questions about how things look
you’ve won. They are on the verge of dropping the from the outside. People with high self-regard are
compensatory pattern—persevere a little more, and often so empty in the middle, it is very hard for them
suddenly it is just gone, and they are not complaining to go there. Acts of service, if they ever get around to
anymore. You can then go on to the next challenge. it, are good cues for those narcissists like me. When
building a mental muscle of self-care, clients should
start small with doable projects and avoid “injury” (too
ANCHOR THE CUE much homework). Soon you will have a client capable of
For cueing the change to work well, you need to know a taking on the bigger issues in their lives and bodies.
little about your client’s activities. Some cues work well
anchored to exercise or another daily practice the client does
Self-care asks
inner feeling
questions arising from
,
while self-regard asks
questions about how things
look from the outside.
MARC BORDONS/ STOCKSY.COM

RESOLVE STRESSORS these knots have body components, and For many of us, faith in God or a
Much of our contemporary stress handling your bodywork can help expose them credo provides the matrix of meaning.
devolves into displacement behavior. My for resolution. In fact, I would say absent For some, the matrix has been transferred
older brother rags on me. He’s too big and a change in the body, psychological onto another spiritual path. For most
powerful for me to confront directly, so I rag insights and victories tend to fall flat. people, though, there is a middle
on my younger sister to disperse the feelings Without being a psychotherapist, you layer of personal meaning to their
and chemistry within me. Continued can point your client in the direction of the lives, which is there to be discovered
unresolved stress induces displacement on real stressor, the real disparity between how and then hopefully lived through.
the way to becoming endemic distress. they construct their inner world and how In my own case, finding Ida Rolf and
Displacement is often accompanied by the outer world appears to them. When the structural bodywork has given meaning
the words “So I . . .” as in, “Work is crazy, two coincide, you live happily. To the extent to my life, a meaning that was at first only
so I ease it off with a drink as soon as I get that they diverge—boy howdy, haven’t our sensed dimly (though firmly) but couldn’t
home,” or “School is stressful, so I smoke a expectations and reality parted company this be articulated. At this far end of my career,
bowl to make it bearable.” Of all the possible past year—there will be stress, the gears will with my dedication to a new program of
avenues to relieve mental pressure—like whine, and eventually something will break. somatic education, that meaning (which
drugging, overeating, playing for power— Some stress is resolvable; some is not. was present all along) is now coming to
physical exercise and truly consensual My mother could not bring her husband fruition. Maybe it will turn out well, maybe
sex are the least harmful to the body. back. We cannot wish COVID away. badly, but the meaning to me is clear:
Better to smash a squash ball than to What we can do—for ourselves and our Sensing + Doing = Meaning. Meaning is
yell or strike at your employees, as exercise clients—is expose the (minimum) two both the sensory side (getting accurate
dissipates most of that chemistry as well. conflicting urges inside the stress. One of signals from the body) and the doing side
On this planet, at least, no one gets all those urges is to move against the stressor, (being able to translate the sensory data
their wishes fulfilled. So we all have to deal and that movement is highly specific to to effective movement) that translates into
with at least some frustration of our id. each client. Another inner urge inhibits deep and emotionally satisfying meaning.
The only response that is not some form movement because the original move was Understanding “meaning” in itself does
of displacement is to resolve the stressor too risky. For most, once the two urges not spell success or failure in the outer
itself. Eventually I grew enough that my are exposed and cleared emotionally, the world. It is possible to understand your
older brother could not dominate me, and outer stress, whatever it is, can be borne inner meaning and still fail in an attempt
I stopped having to dominate my sister. more easily. Ultimately it comes down to to love, or to act on creativity or ambition.
Of course, not all stressors are so easily the old prayer, “God, grant me the serenity To return to our beginning, though,
resolved, and not all stressors are resolvable. to accept the things I cannot change, the is in the act of facing that inner wounding
When my dad died, I watched my mom like courage to change the things I can, and where we find the deepest resolution to
a hawk for the year after. They had been the wisdom to know the difference.” our human dilemma—win or lose. There
together 60 years, and there is no resolving is no great satisfaction to winning at the
the stress of a lost mate. She weathered it wrong thing—you just feel like you fooled
and lived a full life for another 20 years. MAKE MEANING ’em again. But it is surprisingly satisfying
If you get to a place with the client If we resolve all our stressors, will life make when we lose if we are barking up the
where they have built their inner sensing total sense? right tree. Building the muscle to face our
muscle, you can start moving them toward No, it will not. We humans are wounds is something we can build into
the resolution of the actual stressor. sense-makers, meaning-makers. It’s our our homework. It is a call to the self-care
This is not easy, and sometimes requires job as humans. And it’s never done. we so desperately need right now.
outside psychological expertise, since the Achieving a fully upright posture, or a
obvious stressor is not always the actual strong core, or a perfect wheel (backbend), Thomas Myers is the author of Anatomy
one. You know this: The problem with or a four-minute ice bath, or a fully Trains (Elsevier, 4th ed: 2020) and Fascial
the boss may be built on a much deeper open breath are not ends in themselves. Release for Structural Balance (North Atlantic,
original problem with the father figure, They are signposts on the way to a body 2nd ed: 2017). Myers studied with Ida Rolf
for example. The hunger for a mate is cleared of the “noise” that accompanies and has practiced integrative bodywork for
built on a hunger for attachment that was burnout. Finding meaning is a complicated more than 40 years. He directs Anatomy
thwarted starting on day one. No one is and subtle assessment that requires the Trains, which offers hundreds of continuing
asking you to be a psychologist, but all lack of noise to even get close to. education seminars worldwide and online. For
more information, visit anatomytrains.com.
PA R T T W O
KEEPING
CLIENTS
SAFE
By Dr. Ben Benjamin
How to Avoid Violating Client Boundaries
In Part One of “Keeping Clients Safe,” we discussed how to avoid WHO’S IN CHARGE?
injuring clients. In Part Two, we will look at another way we can During your intake, let the client know they are ultimately
protect clients by attending to their personal and emotional safety. the one in charge. At any point during the session, they
A successful practice is one where all participants—clients and inherently have the right to tell you to stop a particular
therapists—respect and value each other’s personal boundaries. technique, revisit an area where they would like more
C
attention paid, or adjust the level of pressure. To reaffirm
ultivating sensitivity and trust is essential to your commitment to their boundaries and increase their
keeping clients safe—especially as we are aware sense of safety and trust, remind the client they always
that many women and men have experienced have agency over their own body. Honoring this integral
physical or sexual trauma in their lives. According aspect of the client-therapist relationship requires that
to the National Council on Behavioral Health, 70 you let go of your ego or any false notions of control.
percent of adults in the US have experienced some type Most clients know what they like and what they
of traumatic event. That’s equal to 223.4 million people, want, and they will communicate it clearly when given
so it is highly likely you are working regularly with the chance. But always use your common sense and
individuals who have experienced trauma.1 avoid inappropriate touch that might cross a boundary
This article outlines some clear guidelines and or exacerbate an injury. Also, be mindful to not
boundaries that will help create a safe, comfortable injure yourself or disregard your own boundaries.
environment for clients, not just those for which trauma
is a factor. Safety is built on trust and trust takes time
to establish. Yet, trust can also be lost in an instant. It is PRESSURE LEVEL
worth taking the necessary time and care to establish a As detailed in Part 1, be sure you know the type of
therapeutic environment that feels both safe and respectful. session and the amount of pressure the client would like
before you begin. Work gently as you start, and build in
pressure based on the client’s expectations. If you find
ASK WHAT THE CLIENT WANTS that a different pressure not initially requested might be
As always, ask questions before you begin each session— more effective, always ask first before acting on impulse.
even with regular and returning clients. For example: Setting this intention reiterates that the client is in
• “Where would you like me to work today?” control of their own body and can accept or decline your
• “Is there anywhere you would like me to focus on in suggestion. One method used to empower the client is a
today’s session?” 1–5 pressure scale to communicate if you are using too
• “Is there anywhere you do not want me to work on much, too little, or just the right amount of pressure.
today?”
Additionally, when checking in with regular clients, be
sure to ask: “Is anything different since the last time I saw
you?”
Provide a space that upholds
PRIVACY BOUNDARIES
Always have the client change in private client safety to cultivate trust and
with the door closed or a curtain drawn.
Do this even if the client says they don’t maintain boundaries. Remember,
need privacy. Some clients will just walk
in and start undressing without you trust takes time to build, yet
saying anything. Stop them while you
gather whatever information you need can be damaged in seconds.
before the session starts; let them know
you will leave the room, at which point
they can change and get ready. This
establishes a professional boundary.
In the massage industry, the stock
phrase “Undress to your level of comfort” welcome. Begin to cultivate this awareness
is used frequently but doesn’t mean much during your intake by saying to the client: BUTTOCKS
to a person receiving massage or bodywork “Feel free to let me know at any point if you Permission from your client before engaging
for the first time. Be sure to follow up don’t like something or feel uncomfortable. in work on the buttock region is necessary,
this statement with examples like: “Some If you notice an internal dialogue that especially the middle and lower buttock.
people choose to leave their underwear questions what’s happening in the session, Most spas have restrictions on working in
on, and others remove it, while some take it’s time to say something. Remember, it’s this area, and some do not permit therapists
off their socks and some leave them on. your session, not mine, and I’m happy to to work on the gluteus muscles at all. Others
Do whatever is comfortable for you.” listen and change what I’m doing.” A client’s have therapists work only on the superior
When you set or reassert a clear comfort level in communicating openly with part of the buttock or on top of the drape.
boundary, you again increase the client’s a therapist will vary based on their familial, Conversely, many therapists who have
sense of safety and comfort. It’s especially social, cultural, and religious history. an independent, private practice do work
important to have this conversation with on the buttock area. There are important
a first-time client because it normalizes ligaments that are located at the medial and
their choice with regard to disrobing. Some DRAPE SECURELY superior border of the gluteus muscles and
people feel it’s expected to remove all their Secure draping is an important part of others that are deep to the gluteus muscles.
clothing. If they don’t, some clients feel establishing safety. Sloppy or loose draping The gluteal cleft is the groove between
it will impact the session, or they will be only makes the client feel uncomfortable the buttocks that runs from just below
viewed negatively. With all the sexual and and may create unnecessary issues for the sacrum and coccyx to the perineum.
physical trauma people (especially women) the therapist. As the client is naked (or If you work with clients who experience
experience in our society, safety and trust almost naked) on your table, they have low-back and hip pain, working on the
can only be facilitated when the client is to feel confident the drape will not slip, buttock can be an important area to treat,
free to make choices without judgment. fall off, or be compromised in any way. if done appropriately. Remember to always
Their confidence level rises if the drape undrape the buttock one side at a time,
is positioned professionally, which means and keep the gluteal cleft covered. Never
CHECK IN FREQUENTLY it is secured in the right place and only place your fingers into the gluteal cleft.
Due to the inherent power differential, exposes the area on which you are currently
many clients have difficulty speaking up working. Never work under the drape; this INNER UPPER THIGH
during a session when their expectations violates the implicit, agreed-upon boundary. The inner upper thigh is a very personal
are not being met, they feel disappointed, and sensitive area. It is often associated
or they don’t like what’s happening in the with touching only in an intimate, sexual
session. A client may fall silent or, worse, WORKING SENSITIVE AREAS relationship. Therefore, I discourage
choose not to return without explanation. Explicit permission is necessary before working the inner upper thigh unless
In creating an atmosphere of ease and safety, working on body regions that may be you work 3–4 inches below the groin.
remind clients that an open dialogue is sensitive areas for your clients. Use the
following tips for handling these delicate
areas, while also maintaining client trust.

There are exceptions, such as an injury abdomen on the psoas muscle attachments small circular motions. Work the upper
to the adductor muscle tendon units in to the spine, treating rectus abdominis pectoral muscle with moderate pressure.
the upper thigh, where the client has muscle strains, and working on menstrual In my opinion, if we lived in a
explicitly requested treatment. However, pain or alleviating constipation issues. different, more evolved time, it would be
only a therapist trained and confident Also, visceral manipulation techniques acceptable and beneficial to work on parts
in injury assessment and treatment can be effective if the therapist has the of the breast tissue, but not in the current
work should honor that request. appropriate training. Above all, abdominal social climate in the United States.
In this type of session, assessment is work should only be performed with an
crucial because a pain in the groin area explicit request or consent of the client.
might be coming from the low back. For CONCLUSION
example, an inflamed iliolumbar ligament PECTORAL MUSCLES Always treat the client and their body
or hip joint will often refer pain to the In the Unites States, working the pectoral with sensitivity and respect—the very
groin area. The therapist must be skilled muscles of a female client can also be same way you would wish and expect to
in assessment and able to differentiate an problematic. As an expert witness, I be treated. Always ask permission, and
adductor injury from other injuries that have seen many cases of sexual assault be especially aware and careful when
refer pain to that area. There are also a in a massage setting that start with the you work on more sensitive and personal
number of gynecological and urological therapist working the upper pectorals areas of the body. Provide a space that
issues that would refer pain to the upper and drifting onto the breast and beyond. upholds client safety to cultivate trust and
inner thigh as well, but these are beyond In the oversexualized cultural context maintain boundaries. Remember, trust
the scope of the massage therapist. of the United States, massage of breast takes time to build, yet can be damaged
Unless there is a specific injury tissue is not recommended. In most in seconds. If you follow these guidelines,
or pain to address, it is recommended states, in fact, breast massage is illegal. you will protect not only yourself and
to avoid the inner upper thigh area. In certain provinces of Canada, your clients, but also your employer and
Working on the area is not necessary in breast massage is an accepted technique. the massage industry as a whole.
a relaxation massage and often causes In massage school programs of 2,400-
the majority of clients to tighten up. plus hours of training, breast massage NOTE
is often taught and is performed 1. National Council for Behavioral Health,
ABDOMEN regularly on clients where there is a good “How to Manage Trauma,” May 2013, www.
The abdomen is also a very sensitive area reason. These provinces’ regulations thenationalcouncil.org/wp-content/
uploads/2013/05/Trauma-infographic.pdf.
for the majority of people. Many emotions are clear and strict; for instance, the
and feelings are held in that part of the client must consent in writing each
body. Working on the abdomen is often time a breast massage is performed. Ben E. Benjamin holds a PhD in sports
used as a gateway, along with the inner Women with certain conditions can medicine and owned and ran a massage
upper thigh and the pectoral muscles, definitely benefit from pectoral work and school for over 30 years. He has studied
therapists with sexual predatory tendencies (in some cases) work on, near, or under under James Cyriax, MD, widely known for
who are testing how far they can go without breast tissue. Cases of clogged milk ducts in his pioneering work in orthopedic medicine.
meeting resistance. Therefore, some of the nursing mothers, painful surgical scarring Dr. Benjamin has been teaching therapists
larger spa companies prohibit any work on the breast, and intercostal and lower how to work with injuries for over 35 years
on the abdominal muscles. Additionally, pectoral muscle strains are instances where and has been in private practice for over
launching into work on the abdomen manual therapy treatment is effective. 50 years. He works as an expert witness in
without a specific request can create a In the United States, I suggest two cases involving both musculoskeletal injury
scary, unsafe environment for the client. ways of working on the pectoral muscles of and sexual abuse in a massage therapy
There are certain instances where a female client. One: Carefully drape one setting. He is the author of dozens of articles
abdominal work can be very useful. side of the chest with just the very upper on working with injuries, as well as these
Examples include working through the pectoral muscle undraped on one side. widely used books in the field: Listen to Your
Work the upper segment of the muscle, Pain and The Ethics of Touch.
then redrape the client and undrape the
other side to continue the work. Two:
Work through the sheet or towel in
10 Steps to
Secure Your
Practice
By Joyce Gauthier

Respect Massage is a resource
to protect massage therapists
from sexual solicitors. The
Respect Massage mission
is to educate and empower
massage therapists so they
can easily spot, deter, and
escape from clients who
are looking for "happy
endings" or “extras.” For
more information, visit
respectmassage.com.
The public still struggles to tell the difference

between a massage therapy practice and a parlor.
Even in 2021, legitimate massage therapists are
lumped in with sex workers, which puts them at risk.
Here, we will discuss 10 ways to keep your practice
safe—from making it clear you are a licensed
massage therapist to security methods and tools to
keep unwanted solicitors out of your practice.
Gather personal information up front.
Someone looking to commit an illegal act may
want to avoid giving confidential information,
and this could keep them from booking. 2
SPOT THE RED FLAGS
Become adept at spotting any red flags, either
1
subtle or blatant, that a client may be looking for
a “happy ending.”
Be aware of code words, behaviors, and hints
SCREEN EVERY CLIENT that solicitors may use to “bait the hook” and
push boundaries to see how far they can go with
If you screen all your clients before scheduling
you. If a client is looking for an illegal service,
them, you will keep the majority of unwanted
they may not just come out and ask for it. They
customers from ever stepping foot in your office.
may hint at it in ways that could go over the head
Look at it this way: If you make the scheduling
of a therapist who does not know what to look
process a bit of a chore—as in having to take a
for. (Note: The Respect Massage Ethics Course
few steps to get on your schedule—it will attract
has a complete list of red flags, so you can spot a
serious, invested clients to your practice. Making
solicitor from a mile away and keep them from
the booking process a commitment attracts
even getting on your schedule.)
clients who are committed to working with you
and following your treatment plan.
3
• Ask screening questions before scheduling
a client. Ask them about their goals and
expectations for massage therapy. This
screening sets the tone that you have a MAKE MESSAGING CLEAR
medically based, therapeutic practice.
Be mindful of the words you use in your
• Gather personal information up front.
marketing. Never include words like sex, sexual,
Someone looking to commit an illegal act may
happy, or ending in your social media or on your
want to avoid giving confidential information,
website. Google does not know you are using
and this could keep them from booking. If a
those words as a deterrent, and you could end up
new client is hesitant to give you their address
in searches that include those words.
or last name, that should be a major red flag.
The Respect Massage Zero Tolerance logo
• Hold a credit card. Some therapists choose
is a simple, clear way to say your practice does
to hold a form of payment on file—or even a
not provide any sort of sexual experience. The
copy of the new client’s driver’s license—when
logo is available free of charge along with a free
booking a first-time appointment.
membership at respectmassage.com. Place the
• Pre-fill the intake form. Some therapists have
logo on your website as a deterrent for solicitors.
clients fill out an intake form online before
At respectmassage.com/clients, there is a
their first appointment. Use what works for
policy you are welcome to use to accompany
your specific practice and clients.
the logo. This policy describes what it means to
Keep in mind, most of your clients are well-
be a Respect Massage member and is carefully
meaning, so the barriers should be there to deter
worded to avoid any unwanted buzzwords that
and stop solicitors, not to make scheduling so
could potentially associate your practice with
cumbersome that you lose your dream clients.
sexual massage.


4
INCLUDE A LOCK WITH A VIEW
It is easy to keep the door locked and only let in

scheduled clients, but take this precaution a step
further to increase your safety tenfold. When
clients arrive at your door, first identify that
they are the client you are expecting by using a
doorbell with a camera and audio. You will have
control over who comes in, as well as the ability
to see and speak to anyone at your office door.
Using a doorbell with a camera and audio
helps you avoid letting in unwanted visitors, and
you can unlock your door with your phone from
anywhere in the office. Using a doorbell of this
type also eliminates the stress of waiting at the
front door to let clients in and alleviates concerns
if they arrive early (or late), or if you are with
a client, in the restroom, changing over the
treatment room, or eating your lunch.
Make sure the lock works in a way that lets
you get out quickly. Not letting in unwanted
people is important, but being able to get out of
your office is just as important—especially in an
emergency when seconds count.
5
PUSH THE BUTTON
One device I love is a panic button. These are

small, wireless, easily hidden buttons that can
be placed anywhere (under the massage table is
a favorite spot of mine). Using a panic button
is a discrete way to de-escalate a potentially
dangerous situation.
These devices can be programmed to alert
any contact you choose with the push of a
button. For example, you can alert your front
desk staff, who can then knock on the treatment
room door and say you have a family emergency.
You can also set the button to call police or
emergency services. Imagine how handy it would
be if you had a client with a medical emergency
and could quickly call for help without having to say you need to step out to blow your nose and
leave your client’s side. wash your hands. Whatever you need to do, get
out of the room and take the appropriate action
6
(run, get help, call the police, whatever you
deem appropriate and necessary to that specific
situation).
As soon as you identify a dangerous or
HAVE AN ESCAPE ROUTE
inappropriate situation unfolding, immediately
Make sure you have a clear path out of your remove yourself from the source of the danger.
office that you plan before you have an emergency
8
situation. Do not pile laundry or have décor in
the way of you getting out of the building safely
if you have to run away. Consider all doors and
windows fair game.
BE NEIGHBORLY
7
If you ever need help, having relationships
with your neighbors will make any interaction
smoother. Make sure the businesses and/
or homeowners near your office know you.
KNOW WHAT TO SAY
Introduce yourself, exchange phone numbers,
Prepare excuses to end a massage ahead of time. greet them when you arrive to work, and say
A concern I hear from massage therapists who goodbye when you leave. That way, if there is
are faced with a client who is being inappropriate an emergency and you have to run out of your
is they do not know how to end it. Or they are office, you will have somewhere to run to.
afraid if they call a client out on inappropriate Be active in your local massage community.
behavior, the client will get mad and possibly Know the other therapists work in the
become violent. surrounding area. That way, you can form a
If your intuition is telling you you’re local network of therapists who can warn the
in danger, trust it. Do not suffer through others if someone in your area is soliciting and/
uncomfortable and potentially dangerous or dangerous. Also, you will have the additional
situations for longer than you have to just benefit of knowing other massage therapists to
because you do not know how to end the session bounce ideas off, practice new techniques on, or
early. Get out as soon as you realize there is a to go to continuing education classes with.
problem.
Have excuses prepared beforehand. This
allows you to easily access them in a stressful
situation. You might say you are not feeling
well and leave the room. You could sniffle and
Respect Massage Policy

Massage therapists who are members of Respect Massage hold themselves to the highest
standards of an ethical, boundary-driven practice. Respect Massage members have a zero-
tolerance policy for solicitations of any kind. Jokes, innuendo, and inappropriate requests
are taken seriously and will result in the swift termination of the session. When choosing a
practice displaying the Respect Massage logo, you can have confidence in the safety and
professionalism you will experience as a client.

9 10
MARKET TO YOUR ADVANTAGE TRUST YOUR GUT
The way you market your business can attract I know, you hear it all the time, but it’s true.
your ideal client or the client of your nightmares. Your intuition is your best protector. If
Clarity surrounding who you want to work with something seems off, it probably is. Get out of
leaves less room for clients who do not fit your the situation safely.
criteria. Have a specialty, and home in on the The best way to protect yourself and
exact population you want to work with to deter your practice from dangerous people is to
inappropriate clients. avoid them altogether. If your gut instinct
Clarity includes images you use in your says something is off with a prospective
marketing too. Use pictures of you working client, do not schedule them. No amount
in your office on a client who resembles your of money is worth your safety.
ideal client. Stock photography is a gross
misinterpretation of what massage therapy truly Joyce Gauthier, LMT, is the creator and founder
is. Veer away from images of perfect-looking of Respect Massage, a campaign to protect
therapists. If you use images like this, it will massage therapists from sexual solicitations.
attract clients who are not necessarily looking Join the Respect Massage movement by visiting
for the therapeutic benefits of massage. respectmassage.com.
technique | THE REBEL MT
The Case for Consistency   

Treating Persistent Injuries
BY ALLISON DENNEY
There are about as many categories of

soft-tissue dysfunctions as there are types
of nut butters in the grocery store, so we
cannot expect to know them all when we
walk out the door of massage school—or
perhaps ever. It can get a tad overwhelming.
There is the sports injury, the car
accident injury, the work injury, the
overdoing it injury, the underdoing it
injury, the poor nutrition injury, the
under-hydrated injury, the no-sleep
injury, the yelling-at-kids injury, and,
most recently, the quarantine injury. (This
last one includes gray hair and wrinkles,
which I only wish could be treated with
massage.) Thankfully, though, we can
narrow this down a little and talk about
a subcategory that falls under all these it is theoretically treatable with the right screaming dysfunction, but the main focus
headings—the persistent injury. techniques. Why, then, does it persist? is that the muscles won’t stop yanking, and
As bodyworkers, we know our work is Like the skin from a clove of garlic the connective tissue won’t stop sticking.
not a one-visit-and-done type of situation; that insists on sticking to the garlic, then This is a good thing in the end—they are
the work we do involves changing the way the knife, and then to your finger, plantar doing what they are supposed to do—but
tissues operate, and this is no quick fix. fasciitis stays clinging to your client’s foot how do we deal with them when they just
Receiving bodywork is like going to the like it’s on a mission, with the tenacity don’t know when to stop? The answer
gym. You are not going to get buff after of a child on Christmas morning. Like lies in the simple truth that, to be good at
one visit. You are also not going to be a this child, when we are dealing with a anything in life, consistency is everything.
good artist or writer or musician or ostrich tenacious tormentor, it takes an equal In healing, this is especially true.
farmer after one attempt either. These amount of tenacity to confront it.
things take practice. And so does healing. If you think about it, plantar fasciitis
THE PRACTICE OF HEALING
is the combination of muscle tissue
We commonly talk about the importance of
pulling in one direction and connective
PLANTAR FASCIITIS, FOR EXAMPLE practice when learning a new skill, but we
tissue straining to give us some sort of
Let’s take a hard look at plantar fasciitis, don’t often experience this in how we heal.
stability—kind of like a magician trying
which is something we see quite often in our We are used to the quick fixes of modern
to yank a tablecloth out from under some
clinics and on our tables. Plantar fasciitis medicine—the shots and pills that numb
dishes, except we are the dishes, and the
is a soft-tissue injury that typically comes the pain. This makes learning how to move
tablecloth is glued to our feet. There are
from overuse or improper footwear, and through pain a little like trying to speak
a lot of things happening here that are
Russian after only watching a few Russian

As bodyworkers, we know our work
is not a one-visit-and-done type of
situation; the work we do involves
changing the way tissues operate,
and this is no quick fix. Lay out a regimen your clients can follow, including
how often, how long, times of day, and frequency.
Emphasize, in each of these layers, the importance of
consistency. And then, be sure to schedule a follow-up
TV shows. If we are given the tools but are not taught session. Make sure clients feel you are on this journey with
how to use them, giving up becomes awfully appealing. them—that you are as invested in their health as they are.
A massage therapist might be technically gifted and Once your client leaves your office, set a couple of
able to utilize incredible skills to work through plantar reminders to check in with them before they return.
fasciitis with a client. There might be intricate detail Exemplify what consistency means. This will reinforce all
in the muscles of the calf and steadfast patience when the work you ignited. Remind them that their practice and
manipulating the various elements of the foot. There energy are the missing elements in what it truly takes to
might even be fancy tools or soothing oils handled like a heal.
chef at a Japanese steak house. But, unless we teach that
client how to incorporate these tricks into their lives, they Dr. Strange: How do I get from here to there?
will just end up where they started—in pain and unhappy. Ancient One: How did you get to reattach severed nerves
Giving a client homework has never been a strong and put a human spine back together bone by bone?
suit for bodyworkers. The idea of telling someone what Dr. Strange: Study and practice. Years of it.
to do seems to go against the very grain of everything —Marvel’s Dr. Strange
holistic. The reality is, though, that we are responsible
for teaching self-care. Walking clients through the details Allison Denney is a certified massage therapist and
that will keep their tension at bay is more beneficial certified YouTuber. You can find her massage tutorials
than any extravagant technique. Assuming they know at YouTube.com/RebelMassage. She is also passionate
what to do—and they will actually do it—is on par with about creating products that are kind, simple, and
feeding your 8-year-old macaroni and cheese and then productive for therapists to use in their practices.
believing they can make it for themselves next time. Her products, along with access to her blog and CE
opportunities, can be found at rebelmassage.com.
CONSISTENCY CREATES RESULTS

Allow time at the end of every session to sit with your
client and walk them through exactly how to work on
their own calf and stretch their own foot. Offer them
options of how to stretch, like hanging their heel off a
step, and choices of how to self-massage, like using their
knuckles if it is too difficult with their thumbs. Be sure,
though, not to allow too much leeway when it comes
to how often—and how long—these stretches and self-
massages should take place. These need to be set in stone.
SCAN AND WATCH
“Foot Muscles Part II”
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2. Scan the code
4. Watch!
technique | THE SOMATIC EDGE
The Tibiotalar Joint

Hotline to the Brain
BY TIL LUCHAU
Balance isn’t easy. Whether in our life or in our body, finding the sweet
spot between life’s extremes can be complicated.
For example, simply standing upright is a tremendously complex
1
balancing act. In order to stand, our brain must constantly monitor and
respond to input from the environment via our eyes, from our movement
in space via our inner ears, and from our body itself via sensory nerve
endings (mechanoreceptors) in the soft tissues of the body.1 At the tibiotalar joint,
the concentrated
Concentrated around joints, these specialized neurons talk to our weight of the entire
central nervous system about mechanical force and position. In turn, the body balances on
brain (specifically, the brain stem, cerebellum, and cerebral cortex) uses the talus (blue).
Surrounding this
this information to orchestrate the reflexes, tension, and coordination we quarter-sized
need to balance, stand, and move. articulation,
mechanoreceptor-
rich structures
send a stream of
THE TIBIOTALAR JOINT information about
The lower in the body we look, the greater the forces of standing position, stresses,
and movement to
and balancing become. For example, the neck balances the head’s the brain, which
weight, and the pelvis bears and balances the entire weight of coordinates the
complex reflexes and
everything above it. But the foot modulates more force than any muscular activity of
other body part. This is especially true of the tibiotalar joint, where balancing, standing,
the tibia rests on the talus (the small, oddly shaped bone at the top and moving. (Purple:
toe flexor group.
of the foot). Here, the entire weight of the body is concentrated Brown: peroneal
into a slippery, domed joint surface about the size of a quarter.2, 3 group. Dark green:
Achilles and plantaris
Though the talus is unique in that no muscles directly attach to it, tendons. Orange:
it is surrounded on all sides by layers of soft tissue (Image 1), including extensor group.
Brown, tan, and green
joint capsules, ligaments, tendons and their sheaths, retinacula, deep wrappings: skin,
and superficial fascia, and skin. All these are richly embedded with superficial and deep
mechanoreceptors that monitor the enormous forces at this crucial joint fascia, and retinacula.)
Anatomy image
and rapidly communicate this information to the brain. It is thanks to courtesy Advanced-
this stream of sensory information that we’re able to balance on the Trainings.com.
relatively small tibiotalar platform. Without the mechanoreceptors
arrayed around the tibiotalar joint, the brain could not sense, prioritize,
or respond to changes of ankle angle, position, or load, and walking
would be impossible—often as not, we’d simply fall over.
HOTLINE TO THE BRAIN

As an analogy, a hotline was set up directly linking the Pentagon and
the Kremlin in 1963 at the height of the Cold War, so that crucial,
disaster-averting communication could be prioritized. The tibiotalar
joint can also be thought of as a kind of hotline to the brain because
of its key role in disaster-averting (that is, fall-averting) balance. As
hands-on therapists, we can imagine using this joint’s unique capacity

Key Points: The
Tibiotalar Technique
Indications
• Agitation, autonomic arousal, stress
• Balance or gait issues
• Limited or painful ankle
dorsiflexion
Purpose
• Autonomic calming via novel
sensory input
• Refine proprioceptive acuity of the
tibia-talus relationship
• Increase options for translation
(glide) at the tibiotalar joint
Instructions
• Posterior tibial glide: Gently lean
on the distal end of the tibia with
the flat of your forearm (Images
2 and 3, page 84) or open hand,
encouraging your client to relax,
breathe, and settle in.
• Posterior talar glide (see video):
Grip the talus between your
thumb (medially) and forefinger
(laterally). Use the web of your
hand to gently but firmly roll the
talus under the tibia, moving
the ankle into slight passive
dorsiflexion.
For More Learning

• Watch the “Leg, Knee & Foot”
(https://a-t.tv/legvideo) or
“Whiplash” (https://a-t.tv/
whiplashvideo) videos in the
Advanced Myofascial Techniques
series of workshops, live-online,
and recorded video courses.
• Tune in to the “Myofascial
Techniques: Working with
Whiplash” webinar featuring Til
Luchau in the ABMP Education
Center (abmp.com/learn).
2
In the Tibiotalar Technique, the

practitioner’s static pressure
encourages the tibia to glide
posteriorly (arrow, Image 4) on
the talus, sending unfamiliar
yet interesting sensory signals
to the brain’s balance centers.
When applied gently and
patiently, this technique
quiets, focuses, and calms the
client’s autonomic nervous
3
system. Anatomy image
Sebastian Kaulitzki/123rf.
Technique images courtesy
Advanced-Trainings.com.

THE SOMATIC EDGE
for sensing and prioritizing to focus the Notes

brain’s attention and bringing the deep 1. Todd S. Ellenbecker, George J. Davies, and Jake
brain centers involved in balance online. Bleacher, “Proprioception and Neuromuscular
In the Tibiotalar Technique (sidebar Control,” in Physical Rehabilitation of the
Injured Athlete, 4th ed., eds. James R.
page 83), we get the brain’s attention by
Andrews, Gary L. Harrelson, and Kevin E. Wilk
moving the tibiotalar joint in unfamiliar yet
(Philadelphia: Elsevier, 2012), 524–47, https://
nonthreatening ways. Then, we quiet the
doi.org/10.1016/B978-1-4377-2411-0.00024-1.
mind by waiting, relaxing, and breathing. To
2. Thanks to Jan Henry Sultan, Certified
do this, we can either posteriorly translate
Advanced Rolfer and senior faculty at the Dr.
(glide) the tibia on the talus (Images 2,
Ida Rolf Institute of Structural Integration,
3, and 4), or we can gently but fi rmly roll
for this concept and for the posterior-glide
it under the tibia with a slight passive version of the Tibiotalar Technique.
dorsiflexion by gripping the talus with the
3. The average width of the talar dome in a study
web of the hand and posteriorly translating
of 26 health adults was 28.4 mm, and a US
the talus in relationship to the tibia (shown
quarter-dollar coin has a diameter of 24.26
in the accompanying video). mm; Sorin Siegler et al., “New Observations
In either variation of the Tibiotalar on the Morphology of the Talar Dome and Its
Technique, we linger. And with sustained, Relationship to Ankle Kinematics,” Clinical
sensitive pressure, we stimulate the Biomechanics 29, no. 1 (January 2014): 1–6,
mechanoreceptors that seem to quiet, https://doi.org/10.1016/j.clinbiomech.2013.10.009.
focus, and calm the brain. This is why,
for example, in the Advanced Myofascial Til Luchau is the author of Advanced
Techniques series at Advanced-Trainings. Myofascial Techniques (Handspring
com, we begin our whiplash protocol with Publishing), a Certified Advanced Rolfer,
this technique. and a member of the Advanced-Trainings.
Understanding the Tibiotalar Technique com faculty, which offers online learning and
will open multiple possibilities in your work, in-person seminars throughout the United
whether your goal is increased options States and abroad. He and Whitney Lowe
for movement, refi ned proprioception, or host the Thinking Practitioner podcast. He
calming and quieting the client’s nervous invites questions or comments via info@
system. advanced-trainings.com and Advanced-
Trainings.com’s Facebook page.
Watch Til’s technique videos and read his past articles

in the Massage & Bodywork digital edition, available at
massageandbodyworkdigital.com, abmp.com, and on the
Advanced-Trainings.com YouTube channel.
SCAN AND WATCH

“The Tibiotalar Technique”
1. Open your camera
2. Scan the code
4. Watch!
technique | CLINICAL EXPLORATIONS
The Puzzling World of Subacromial Pain

BY WHITNEY LOWE
Acromion
process
Coracoacromial
ligament
Shoulder pain and stiffness are common

upper extremity complaints. Estimates Coracoid
process
are pain felt under the acromion process
(called subacromial pain) may encompass
somewhere between 44 and 66 percent
of all shoulder complaints seen by
orthopedists.1 For many years, shoulder
pathology in this region was called
subacromial impingement syndrome
(SIS), which indicates tissue compression
(impingement) as a primary cause.
Interestingly, recent research indicates
1
mechanical impingement may not be the
Coracoacromial arch. Image from 3D4Medical’s Complete Anatomy application.
primary cause of pain in some cases. Today,
researchers advise renaming this condition
subacromial pain syndrome (SAPS) to more
broadly include all the various pathological the coracoid process, which angles off in more likely to pinch soft tissues against the
causes for subacromial pain. an anterior direction. The coracoacromial underside of the acromion process. Often,
SAPS can include a spectrum of ligament spans between these two bony a nerve in the cervical region, the long
pathologies, such as partial thickness projections. The expanse, including thoracic nerve, may be responsible for these
rotator cuff tears, rotator cuff tendinosis, the acromion process, coracoacromial dysfunctional shoulder mechanics.
calcific tendinitis, and subacromial bursitis, ligament, and coracoid process, is referred The long thoracic nerve is a motor
as well as metabolic, inflammatory, and to as the coracoacromial arch (Image nerve that innervates the serratus anterior
degenerative changes in the tendon. In this 1). Subacromial pain is most commonly muscle. Compression of the long thoracic
column, we explore the multiple causes thought to arise from tissue irritation nerve (near the brachial plexus) may cause
of subacromial pain, look at a variety of under the acromion process but could weakness of the serratus anterior muscle.
treatment strategies, and explore where also occur from irritation under other Weakness in the serratus anterior leads to
massage therapy may play a role in reducing parts of the coracoacromial arch. inadequate upward scapular rotation during
this debilitating condition. The region under the coracoacromial abduction and the resulting subacromial
arch is anatomically unique. There are compression. This sequence of events is an
very few places in the body where soft example of how nerve compression near the
ANATOMY AND BIOMECHANICS
tissues get pinched between adjacent bones neck can lead to soft-tissue compression in
Our exploration of SAPS begins with a
or ligaments. The space underneath the the lateral shoulder.
review of key anatomical structures in
arch is relatively small and susceptible Another potential cause of subacromial
the region. The scapula plays a primary
for soft-tissue compression. In addition, impingement is excessive translation or
role in subacromial pain and has two
dysfunctional scapular mechanics can play movement of the glenohumeral head
prominent bony projections. The first is
a role in these problems. For example, the during shoulder motions. For example, the
the acromion process, which is out to the
scapula must move in upward rotation rotator cuff and biceps brachii muscles play
lateral edge of the shoulder. The second is
during shoulder abduction movements. If it
does not fully rotate upward, the humerus is

1 2 3
1 2
4 3
5
prominent roles in keeping the humeral

head partially depressed during overhead
shoulder motions. These muscles are critical
for ensuring the humerus doesn’t migrate in
2 3
a superior direction and pinch tissues under Tissues involved in subacromial pain: Tissues involved in subcoracoid pain:
1. Subacromial bursa; 2. Supraspinatus 1. Upper margin of subscapularis tendon;
the coracoacromial arch. Now that we have tendon; 3. Upper margin of the 2. Coracobrachialis bursa; and 3. Upper
explored the architecture and mechanics of glenohumeral joint capsule; margin of the glenohumeral joint capsule.
this region, let’s examine some of the main 4. Coracohumeral ligament; and Image from 3D4Medical’s Complete
5. Long head of the biceps brachii tendon. Anatomy application.
causes of SAPS. Image from 3D4Medical’s Complete
Anatomy application.
DESCRIPTION OF PATHOLOGY
There are two primary models of SAPS:
the mechanistic and the biological. We
not necessarily result from decreased glenohumeral joint capsule, coracohumeral
now realize many shoulder complaints are
subacromial space. ligament, and long head of the biceps brachii
a combination of both. The mechanical
The original description of subacromial tendon (Image 2).
has been the dominant model for
impingement was presented by Charles There is another region of potential
decades and is a bit more complex, so
Neer in a paper he wrote in the early impingement that does not get as much
we’ll take a detailed look at it first.
1970s.3 According to his classification, the attention as the subacromial space. Tissue
The mechanical model suggests there
pathology begins with edema and thickening compression under the coracoid process,
is a biomechanical problem leading to
of the bursa in the first stage. It progresses or the lower margin of the coracoacromial
the subacromial pain.2 As noted earlier,
to fibrosis and other inflammatory changes ligament, is called anterior or subcoracoid
this condition was previously referred to
within the supraspinatus in the second impingement. Possible causes of subcoracoid
as subacromial impingement syndrome.
stage. Eventually this can lead to a complete pain include entrapment of the superior
Subacromial impingement is usually
tear of the supraspinatus tendon in the third border of the subscapularis tendon, bursitis,
divided into two categories. The first is
stage. However, more recent findings have subscapularis tendon calcification, or
primary impingement, which results from
called into question this tissue progression, ossification and inflammatory enlargement
problematic architecture of the subacromial
so Neer’s classification is no longer of the glenohumeral ligaments.4 Pathology
region. For example, if there is very little
considered a standard sequence of events. of the bicep tendon may also be a cause
space between the acromion process and the
Most models of mechanical impingement (Image 3).
upper part of the humeral head, this narrow
now focus on the subacromial region, Some research also points toward
space would make impingement more likely
thus they’re being labeled as subacromial subcoracoid pain arising from the underside
and be considered a cause for primary
impingement syndrome. Pain is generally of the subscapularis where it comes in
impingement. Secondary impingement is
felt more in the lateral aspect of the shoulder contact with the glenohumeral joint. In
a result of biomechanical dysfunction or
and is most aggravated during shoulder some cases, excess friction can irritate the
overuse in the shoulder region but does
abduction movements but may be felt
during forward-flexion movements, as well.
The tissues most involved in subacromial
impingement include the subacromial bursa,
supraspinatus tendon, upper margin of the
underside of the subscapularis and lead to that may radiate to the lateral humerus as
muscle tears, producing pain that is often well. Subacromial impingement generally
mistaken for external impingement. produces more lateral shoulder pain,
Clearly there are various factors that while anterior impingement produces
lead to soft-tissue compression under the more pain on the front side of the
coracoacromial arch. Yet, recent research shoulder. It is common to hear reports
has shown us that there are some people of night pain, especially when lying on
with decreased space or significant soft- the affected side or sleeping with the
tissue degradation in the subacromial region arm overhead, as those positions further
who have no pain. There are also those compress the subacromial structures.
Recent research with significant pain complaints who don’t X-rays and MRIs are still used for
appear to have any evidence of impingement evaluation, but these methods may not
indicates damage that can be identified on imaging reveal crucial information about functional
mechanical studies. This has led researchers to look for
other potential causes of anterior and lateral
movements and mechanical stresses. A
truly thorough approach needs to include
impingement may shoulder pain. a comprehensive physical examination and
Our current understanding of tendon analysis of assessment patterns that suggest
not be the primary pathology helps shed some light on particular tissue involvement. This pattern
cause of pain in potential alternative explanations for analysis helps drive the most appropriate
shoulder pain that may not be caused solely treatment strategies.
some cases of by compression damage. Newer theories For example, suppose a client presents
shoulder pathology. suggest there may be a more complex
interaction between mechanical and
with lateral shoulder pain during active
abduction that is decreased but still present
biological factors in tendon pathologies near the end range of passive abduction and
around the shoulder. during resisted abduction. The presence of
The number of chronic overuse tendon pain during active and resisted abduction
disorders throughout the body increases movements strongly indicates contractile
as people age.5 Histological studies tissues such as the supraspinatus. In most
indicate changes occur at the cellular cases, we wouldn’t expect to see muscle-
level within these tendons. It looks as if oriented pain during passive movements
some subacromial pain complaints are a of that same motion. However, the
combination of mechanical irritation, along supraspinatus is susceptible to compression
with degenerative and metabolic change in under the coracoacromial arch during
the tendons. But the idea that metabolic and abduction, so this is one place in the body
degenerative changes within the tendons where pain during a passive movement could
are responsible for subacromial shoulder indicate muscle-tendon unit involvement.
pain has only recently become more Recognizing these patterns is more helpful
accepted within the research literature. It than any isolated orthopedic test or a single
remains likely that numerous shoulder pain image from a high-tech diagnostic study.
complaints involve both mechanical and As mentioned earlier, subacromial pain
metabolic/degenerative factors. will tend to be more significant during
active, passive, or resisted abduction
motions, while subcoracoid impingement is
ASSESSMENT
more likely to produce pain during active,
The best chance for identifying subacromial
passive, or resisted flexion motions. Because
pain starts with a detailed and thorough
subcoracoid impingement frequently
client history. Clients usually report pain
involves the subscapularis tendon, it is also
in the anterior/lateral shoulder region
common to see pain or discomfort during
resisted internal rotation because that
engages the subscapularis. There may also
be pain felt during either active or passive

CLINICAL EXPLORATIONS
external rotation of the shoulder where and gradually contributes to increasing Notes
the subscapularis is stretched. Sometimes available range of motion. A wide variety 1. Christina Garving et al., “Impingement Syndrome
there is a popping or snapping sensation of techniques can be used to help enhance of the Shoulder,” Deutsches Arzteblatt
associated with range of motion evaluations a greater sense of movement and pain International 114, no. 45 (November 2017):
765–76, https://doi.org/10.3238/arztebl.2017.0765.
in the shoulder, as well. reduction.
There are various special orthopedic Previously, we emphasized techniques 2. Teemu V. Karjalainen et al., “Subacromial
tests frequently used to identify such as deep transverse friction to the Decompression Surgery for Rotator Cuff
impingement problems, such as the Neer distal supraspinatus tendon to address scar Disease,” Cochrane Database of Systematic
Reviews 1, no. 1 (January 2019), https://doi.
impingement sign, empty can test, or tissue during the healing process. Friction
org/10.1002/14651858.CD005619.pub3.
Hawkins-Kennedy test, but they don’t techniques may still be beneficial, but we
always have a high degree of accuracy. They now find great benefit in techniques that are 3. Charles S. Neer, “Anterior Acromioplasty for
may also lead clinicians into more recipe- not as focused on a particular tissue. A wide the Chronic Impingement Syndrome in the
Shoulder: A Preliminary Report,” Journal of
oriented thinking about the evaluation array of methods used to treat the shoulder
Bone & Joint Surgery 54, no. 1 (January 1972):
process by prioritizing this test without girdle can help decrease apprehension
41–50, https://doi.org/10.2106/JBJS.8706.cl.
evaluating the other critical pattern and and restore a sensation of safe, increased
movement assessments. Rather than focus movement as the condition subsides. The 4. Gregory Cunningham and Alexandre
Lädermann, “Redefining Anterior Shoulder
on these special orthopedic tests, I find greater sense of pain-free movement can
Impingement: A Literature Review,” International
it far more valuable to explore the results encourage the person to perform gradually
Orthopaedics 42, no. 2 (June 2017): 359–66,
and patterns from the active, passive, and increasing activity levels that will provide
https://doi.org/10.1007/s00264-017-3515-1.
resisted motions in the shoulder. graded exposure and conditioning for
5. Teun Teunis et al., “A Systematic Review
the soft tissues so they can improve more
and Pooled Analysis of the Prevalence of
rapidly.
TREATMENT Rotator Cuff Disease with Increasing Age,”
Surgery may still be considered if
The primary goal of SAPS treatment is Journal of Shoulder and Elbow Surgery
conservative treatments are not initially 23, no. 12 (December 2014): 1913–21, https://
to eliminate pain and restore appropriate
effective. Common surgical approaches doi.org/10.1016/j.jse.2014.08.001.
function. What defines appropriate function
include increasing the subacromial space by
varies for each client. For example, it isn’t 6. R. Diercks et al., “Guideline for Diagnosis and
shaving off the underside of the acromion
always necessary to achieve a particular Treatment of Subacromial Pain Syndrome,”
process in a procedure called acromioplasty. Acta Orthopaedica 85, no. 4 (March 2014): 1–9,
numerical range of motion measurement.
However, recent research suggests treatment https://doi.org/10.3109/17453674.2014.920991.
It may be enough just to get the person to
outcomes from surgical procedures may
decrease pain for the essential things they
be similar to those from conservative
need to do as part of their daily activities. Whitney Lowe is the developer and
treatments, and this has led to a decreased
SAPS treatment generally begins instructor of one of the profession’s most
perception of the necessity for surgery.6 In
with conservative measures, such as popular orthopedic massage training
many cases, surgery is still effective, and
limiting aggravating movements along programs. His text and programs have
what becomes clear is there is no catchall
with moderate exercise. Any rehabilitative been used by professionals and schools
solution that works for everybody, in every
exercise is usually performed within a range for almost 30 years. Learn more at
situation.
that does not significantly aggravate the academyofclinicalmassage.com.
As we have seen, there are numerous
pain. Massage plays a great role at this stage,
causes of SAPS. It is a common occurrence
as it can help reduce irritation and increase
and a condition your clients are likely to
overall mobility in the shoulder region. We
present with. The more knowledgeable
shouldn’t think of massage as necessarily
you are about pathologies in this region,
making more space in the subacromial
the more helpful you can be for them. In
region. Instead, massage helps restore
addition, you may be working as part of a
overall shoulder movement, decreases
health-care team with other professionals.
apprehension in shoulder movements,
When you understand the nature of the
problem and how others may be approaching
it, you are a more valuable contributor.
technique | MYOSKELETAL ALIGNMENT TECHNIQUES
Stop Slipping and Sliding   

Get a Firm Grip on Finger and Forearm Techniques       
BY ERIK DALTON, PHD
Have you ever noticed your fingers

cramping or forearms slipping along the
surface of the client’s skin when attempting
to apply deep-tissue techniques? For several
years, I observed some class participants
struggling with this but was unsure how to
offer specific guidance. The answer came
unexpectedly one year at a workshop in
Costa Rica when a student asked if I would
slowly perform each of the extended finger
1
and forearm maneuvers in a step-by-step
fashion. Wow, what a novel and seemingly
obvious idea! Why had I not thought of The Nail Hook
this before? I realized I had been doing extended finger
technique.
these maneuvers so long I had simply
skipped over a few very basic principles.
Guided by this realization, I now
transferred the energy through my forearm and lock in my lumbar lordosis so I can
teach hand and forearm maneuvers in
extensor muscles instead of my flexors. have a good mechanical advantage as I
every workshop and online course to help
That was a big discovery I then applied to slowly glide down the transversospinalis
therapists deliver a deeper touch with less
all my hands-on techniques. Now when I muscles of the lamina groove.
effort and better body mechanics. Let’s
engage the tissues and get a good hook, I Typically, I ask my client to begin
deconstruct a few of them.
immediately firm up my forearm extensors performing slow anterior and posterior
to allow the energy to come through my pelvic tilts to help engage the brain in
NAIL HOOK TECHNIQUE body and down into the ground, making releasing any protective spasm in these
During my basic Rolf Institute training in my stroke more controllable and confident short rotator muscles. The goal is to restore
the early 1980s, I developed an odd routine (Image 2). proper spinal curves while decreasing
of performing finger push-ups after class to nervous system hyperexcitability.
improve my finger strength and stamina,
THE FLYING V
but it seemed to make little difference. I
The Flying V is one of my favorite extended ULNA HOOK
was never able to get a good, sturdy “hook”
finger techniques. It is performed using Forearm techniques are a favorite of mine.
in the connective tissues underlying the
the same principles as the Nail Hook For years, I experimented with ways of
skin. One day I discovered if I flexed my
technique, but is designed to add additional getting a better tissue hook to help prevent
fingers and engaged the tissues as if I
power and precision to areas that require slipping and sliding, and this is what I came
were digging in with fingernails and then
bilateral pressure to confined spaces. In up with. In Image 4, I begin the technique
extended my fingers, I was able to get a
Image 3, I begin by placing my index with my forearm supinated (palm up). As
much firmer lock that allowed me to lean
and middle fingers on each side of the I engage the lateral border of the erector
in with my body weight instead of sliding
client’s lamina groove and then reinforce spinae tissue in this supinated position,
along the skin with finger pads (Image 1).
by bracing with the index and middle I’m able to get a really good Ulna Hook,
As I practiced this Nail Hook technique,
fingers of my other hand. I firm up my
I noticed that as I extended my fingertips
forearm extensors, relax my shoulders,
at the distal interphalangeal joints, it

3
The Flying V with
index and middle
fingers on each side
of the lamina groove.
2 Engaging the forearm extensor muscles for

added control.
which allows me to sink to the tissue’s

fi rst restrictive barrier. Once I feel I’ve
achieved a sturdy tissue lock with energy
flowing through my legs, I slowly begin
pronating my entire forearm, moving
toward the spine at a 45-degree angle.
By starting the Ulna Hook technique
with the fi rmer surface of the ulna bone, my
hook is enhanced. As I pronate the forearm,
the softer surface of my flexor muscles can
maintain the fi rm hook without having to go
too deep.
Another way to creatively use this
Ulna Hook is with the Windshield Wiper
technique. In this variation, I fi rst place
my olecranon bone softly in the ipsilateral
4 The Ulna Hook forearm technique.
5 The Windshield Wiper variation.
lumbar lamina groove, then supinate and

hook with my ulna bone. As I traverse
to continue applying those strokes.
headward with my ulna at the lateral border
At the same time, I think you’ll fi nd it
of the ipsilateral erectors (Image 5), I begin
beneficial to incorporate the Nail Hook,
pronating my forearm so my flexor muscles
Flying V, and Ulna Hook into your
can sweep the erector spinae muscles back
bodywork practice to address the deeper
toward the midline to offer additional
neuromyofascial structures.
thoracic spine support. This is a powerful
nervous system stimulation technique that
Erik Dalton, PhD, is the executive SCAN AND WATCH
can be applied to a variety of connective “Balancing the T-Spine”
director of the Freedom from Pain Institute.
tissues. 1. Open your camera
Educated in massage, osteopathy, and
2. Scan the code
Rolfing, he has maintained a practice
DEEPEN YOUR PRACTICE in Oklahoma City, Oklahoma, for 4. Watch!
To be clear, some therapeutic massage more than three decades. For more
techniques are designed to glide on information, visit erikdalton.com.
the skin’s surface, and I encourage you
Connect and engage with your massage community
and experts in the field as you learn and earn CE!
Join ABMP virtually to interact with course instructors SCAN TO REGISTER!

and gain valuable new tools for your practice. 1. Open your camera
2. Scan the code
4. Watch!
abmp.com/ce-socials

Because LEGIT Matters
ABMP MEMBER BENEFITS
To view all you
r
discounts, log in
to A BMP.com
Take an active role in managing and reducing

ABMP members receive a deep discount on Purafil’s health-related out-of-pocket costs, become
PuraShield 500 air purifying system designed to remove a better consumer through increased
aerosols carrying harmful viruses and bacteria, odors, knowledge and advocacy, and increase
allergens, smoke, volatile organic compounds, and toxic overall health and well-being for yourself and
gases. Protect yourself and your clients by creating a your loved ones through the discount benefit
healthier indoor air environment. plan options (not insurance) offered by Direct
MedAccess. Choose from any one of five
plan options, including telemedicine, dental,
pharmacy, vision discounts, and more.
Pedestrian Shops offers ABMP members a discount Stay active at the gym or at home with flexible
on all shoes ordered online at ComfortableShoes.com. fitness options starting at just $25 a month.
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start shopping today. can even enroll your spouse or domestic partner.

PROUD ABMP MEMBERS
30 Years
Nanci Baldridge Sevyn Galambos Lynda Jones Grace Melby Mary Shideler
Jeannie Battagin Barry Giles Shana Kalaakea Marjorie Montrose Rosalba Villanueva
Robert Brodie Gary Hamann Gayle Kelly Jill Ring Dawn Wegenek
Diane Colligan Torbjorn Hanson Katherine Knowles Linda Rogers Sherryl Wood
Barbara Deppe Michelle Lee Harrity Katharine Lawrence Erna Schmidt
Teresa Edmonds Linda Heisserman Susan Levins Patricia Schoenstein
20 Years
Kristen Basinger Janet Erickson Rebecca Harrison Shawna Brook Miller- Teri Ann Schmitt Sandra Swanson
Donna Bills Kevin Evans Mary Ann Hawkins Radford Elisabeth Schock Rosalind Toomey
Apryl Elizabeth Richard Fancher Michael Jacobus Mari Ellan Minor Angela Schultz Tina Torres
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10 Years
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Renee Allen Diane Crowley Marsha Heath Alan Lopata Jeanne Phenany Christina Stitt
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Hannah Baker Coby Daniels Dianna Holland Peggy Luque Jonathan Pyndus Nicky Tsitouras
Gwennever Baldwin John Mark Davis Shannon Holmied Jan Luther Tanya Qually William Tweed
Renee Banks Rebecca DeMarco Wendy Howard Stephanie Lyons Joel Quezada Lisa Marie Twist
Robert Barnes Stephen Densmore Tessa Howiler Brian Madzey Tina Raburn Denise Utecht
Lynn Barnett Teresa Desmarais Irene Hsieh Dorothea Mahoney Sandra Randolph William Vallette
Lisa Bauer Garett Dickerson Michael Ingold Alexander Malo Tiffany Richards Laurie Vanderbilt
Cassandra Beck Brian Dorfman Shanthy Jayakumar Andrea Matson Joni Rimer Laurie Velez
Brenda Bernardin Kimberly Drewyor Kayla Johnson Jai May Karen Roberts Peta-Gaye Vernon
Daniel Blaisdell Katherine Dunn Meliza Jones Amy Jo McCarty Joyce Robison Elaine Villano
Jennifer Bloom Melanie Eggleston Erica Jones Heide McCoy Martha Rohrbaugh Patricia Waddey
Therese Boissonneault Tara Elias Greg Jones Jerry McDowell Marie Rose Newton
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Brigitte Boyea Sandy Erwin Nadia Kaley Sonia McNeil Genesis Margaret Roy Charlotta Wales
Laura Boyle Jamie Eversweet Brooke Kalmbach Huo Xia Mei Elizabeth Royce Matt Walker
Katherine Bradley Belmarez JoAnne Kenyon Rebekah Melzer Webster Saintpreux Katherine Walsh
Nicole Brandon Julia Fetter Robyn Kielsa Kelly Merriman Gayle Salisbury Diana Walter
Linda Broadhead Misha Forrester Evy Kimmell Michelle Michaud Carolyn Sandman Paul Weiss
Karleen Brown Joelle Fournier Kevin Kishida Heather Michet Paul Saxon Natalie White
Tara Brown Emily Fowler Jeanne Kitt Mary Misertino Crystal Schmidt Emily Whitechurch
Catina Browning Amber Fraga James Knott Bonnie Mohr Teri Ann Schmitt Cindy Wickert
Tina Bruglio Scott Francis Nancy Knott Jaclyn Moran Rickie Schmoyer Carmela Wiese
Dawn Byer Marie Freiss Chrystal Koch Pantip Moungkan Ursula Schneider Victoria Witalis
Joyce Calvitti Laura Gabel Brittany Kraly Nicole Murszewski John Schreiner Mark Wojtowicz
Alexandria Carroll Vanessa George Alison Kresge Martha Muzacz R.L. Schultz Ping Yan
Daniel Case Lara Gillease Stephani Kuntz Samantha Nadeau Jean Sefcovic Cody Yelton
Henry Chorro Jr. Marsha Glass S. Kathleen Latimer Tammy Nelson Leigh Seufert Julie Young-Nahmens
Pantip Elizabeth Glenn Renee LeBlanc Erik Nelson Phil Shenk Keiko Yumoto
Chumindrachak Lin Gong Angela Ledington- Rachael Nordquist Karen Beth Shubert Paola Zannini
Lori Churchfield Szaja Gottlieb Fischer Ellen O’Connell Laura Simpson Edmund Zebrowski
Robert Clary Lisa Gray Linda Lee Leigh Brian Ogden Frances Sivolella Guozhi Zhou
MEDITATE & MOVE
Guided Chair Yoga with Surya Bhedana

Pranayama Breath
BY ANGIE PARRIS-RANEY, LMT
In Sanskrit, surya bhedana means “sun piercing” (“surya” = sun and “bhedana” = piercing).
This yoga breathing technique activates a sluggish mind and moves energy throughout the
body. It also helps stimulate digestion, and is heating in nature. SCAN AND WATCH
“Guided Chair Yoga with Surya
In this exercise, we’re going to inhale only through the right nadi (representing the
Bhedana Pranayama Breath”
sun/masculine energy), which is more warming, and exhale only through the left nadi
1. Open your camera
(representing the moon/feminine energy), which is more cooling. 2. Scan the code
4. Watch!
SURYA BHEDANA PRANAYAMA Pigeon Pose
1. Begin by sitting comfortably with
your spine erect and your shoulders
relaxed. Let your left hand rest
comfortably in your lap. If you wear
glasses, remove them for this exercise.
2. With your right hand, rest the tips of
your index fi nger and middle fi nger
between your eyebrows. If this isn’t
comfortable, you may relax the fi ngers
toward the palm, gently tucking them in.
3. Close off your left nostril with your
ring fi nger. Inhale slowly through
your right nostril all the way to the
top of your breath. Then use your
thumb to close off your right nostril.
4. Release your ring fi nger and slowly exhale
through your left nostril all the way to
the bottom of your breath. Repeat this
sequence a couple more times. Let your
breathing be normal and rest a minute.
PIGEON POSE
1. Lift your left foot toward your right knee.
Make sure your left ankle, not your foot,
is placed on top of your right knee.
2. Flex your left foot. Inhale and lift tall.
3. Exhale and bend forward to your
comfort level over your left leg. Relax 6. Using your core strength, exhale, bend several deep breaths here. Release, and
your whole upper body. Breathe. in, and lift your right leg to center. place your palms together. Perform a
4. Come up and out of the position slowly, Inhale and stretch wide. Exhale, gentle twist to the left side, and then
then repeat on the opposite side, placing bend forward, and lift your left leg to the right, and come back to center.
your right ankle on top of your left knee. to center. Repeat two more times. 8. Sit up tall and rest your hands comfortably
5. Inhale, slowly coming out of the 7. If it feels comfortable, take your hands in your lap, with your palms up or down.
pose. Place your palms together back and toward the base of your chair. Take a few moments to connect to your
and inhale, lifting both arms out Extend your torso and neck, and look breath. Feel the natural rise of the breath
to the side like cactus arms. up. The head relaxes very gently. Take and the beating of your heart.

LISTEN.
LEARN.
MASSAGE.
REPEAT.
THE ABMP PODCAST
SPEAKING WITH
THE MASSAGE
& BODYWORK
PROFESSION
Exploring the issues and challenges unique to the massage and bodywork community.
Subscribe through Apple Podcasts | Google Podcasts | Spotify | and more.
abmp.com/podcasts
“We don’t
just graduate
practitioners.
We create
thought leaders.”
Ellen Freed – Faculty
2021-2022* Rolfing® Structional Integration Basic Training

Boulder, CO Campus
Program Start Dates
4 October 2021
10 January 2022
6 June 2022
3 October 2022
Regional Rolfing® SI Basic Training in Atlanta, GA

16 September 2021
2021/2022 Rolf Movement® Integration Certification

(Intensive)** Boulder, CO Campus
Course Start Dates
12 July 2021
20 September 2021
25 April 2022
11 July 2022
*All classes including CE can be found at rolf.org/courses

**The RMI classes listed are for our 30 Day Intensive Program and include three parts. We also offer a
Workshop Format that can be completed over time for added flexibility from various USA locations.
Apply now rolf.org/courses

T: 303.449.5903 Connect rolf.org

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26 MASSAGE AS HEALTH CARE

By Erik Dalton, PhD

4 massage & bodywork july/august 2021

Massage & Bodywork promotes professionalism among practitioners, stimulates

Mary Barthelme Abel

DESIGN & PRODUCTION Printed in the U.S.A. on recycled stock containing

resource content of 25.3%, which is much ART DIRECTOR

Vol. #36, Issue #4 July/August 2021. All rights reserved © 2021.

6 massage & bodywork july/august 2021

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