Ebook-MM 2021 Techniques r2

The Top 8
Massage
Techniques
for 2021
• Massage Cupping • Reflexology
• Assisted Stretching • Oncology Massage
• Trauma Release • Assessment
• Kinesiology Taping • Reiki
SPECIAL: How to Market a Technique

BROUGHT TO YOU BY
1 Massage Cupping
Massage cupping reduces clients’ pain, increases
flexibility and decreases inflammation, and can be used
3
for a wide variety of clients.

By Danny Porcelli, Shannon Gilmartin and Anita Shannon
2 Assisted Stretching: PNF

Proprioceptive Neuromuscular Facilitation
encompasses a broad treatment approach to facilitating
7
proper muscular function.

By Jimmy Gialelis
3 Trauma Release
Traumatization can occur when any individual—
any client—experiences a very negative event that can
11
create a lasting impact on the person’s emotional and

mental stability.
By Jimmy Gialelis
4 Kinesiology Taping
Three kinesiology taping experts weigh in on
its benefits for the athletic population, the general
17
population and pregnant clients.

By Holley J. Deshaw, Alexander Bailey and Jessica Hill
5 Reflexology
Reflexology focuses on the reflex points that
correspond to the glands, organs and various other parts
21
of the body.
By Debbie Hitt
6 Oncology Massage
Massage services in cancer treatment and recovery
are individualized and differ in emotional intensity.
25
By Jacqueline Algaier
7 Assessment
Research has shown that there can be a weak
correlation between structural or postural challenges
29
and corresponding pain complaints.

By Whitney Lowe
8 4 Questions about Reiki

Reiki is based on the idea that life force energy flows
through us, and that fluctuations in this energy affect our
34
physical health.
9 Market a Technique
You’ve mastered a modality — now let clients know.
By Coach Cary Bayer
36
THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 2

All photos: stock.adobe.com unless otherwise noted.
Massage Cupping
Massage cupping reduces clients’ pain, increases flexibility and decreases
inflammation, and can be used for a wide variety of clients. Have you
considered which of your clientele could benefit from this technique?
Cupping found it footing as a technique for athletes. It still holds great

benefit for that clientele, while over the years uses for this tool have evolved.
Technique names have developed as well.
Here, three educators—Danny Porcelli, DC, Shannon Gilmartin, CMT, and

Anita Shannon, LMT—describe myofascial cupping, relaxation cupping
and lymphatic cupping for athletes, clients seeking relaxation, and women
diagnosed with dense breast tissue, respectively. Get a feel for how this
therapy might be incorporated into your practice.
Athletic Clients
I recently taught a myofascial cupping class to a group of highly skilled
PHOTO COURTESY OF ROCKTAPE
therapists who were eager to learn the benefits of cupping. Why is this
technique making a resurgence with massage therapists, doctors and
trainers? Is it because it is effective, safe, or because the tools are inexpensive
or because it’s trendy? I say all of the above.
If anyone glimpsed into my treatment room at a given time they may think I was
a massage therapist, a chiropractor, a personal trainer or a physical therapist.
Athletic clients have I start my sessions with manual therapy, which usually includes cupping.
healthy robust skin My office is inside a Crossfit gym; I attract athletes and people who value
movement. In my experience, cupping is a highly effective treatment for my
(which is optimal athletic population.
for cupping) and
Athletic clients have healthy robust skin (which is optimal for cupping)
are susceptible
and are susceptible to repetitive use injuries that respond well to this type
to repetitive use of treatment. Myofascial cupping lifts the skin, fascia and muscles apart
injuries that respond (decompressive effect) which creates more space for tissue mobility. This
effect also assists in breaking down small adhesions and kick-starts the
well to this type of healing process by drawing fluids and healing molecules into the area.
treatment.
Cupping can be used for passive recovery as well as active treatments. I
use passive cupping to enhance the effects of different types of stretching.
Cups are applied to the target tissues (space acquisition) and improve
interlayer gliding—a much-needed effect to enhance tissue mobility and
range of motion. They can also be applied statically for a period of time to

relax the area. Cupping with movement can reduce pain or assist in retraining
a movement pattern. With cups on, adding movement patterns that were
painful or dysfunctional can reduce threat, decrease pain and improve body
awareness.
A final reason I prefer cupping athletes to other treatments is their belief

systems play a critical role in how they perform. They pay attention to trends,
new treatments and cutting edge therapies. When they see Michael Phelps,
Kelly Slater or another athlete in their sport receiving cupping therapy, they
seek it out for themselves. If the client believes it will help then we will be more
successful with the intervention. The perception of the client matters and will
always have an effect on the outcome.
Cupping is generally regarded as safe, effective and inexpensive. It is one of

the oldest treatments we know of and as research continues to build, we will
see the use of myofascial cupping continue to grow.
Danny Porcelli, DC, wrote this article on behalf of ROCKTAPE (rocktape.com), as primary
chiropractic physician and owner of XOC Chiropractic in Naples, Florida.
Relaxation Clients
Cupping massage for stress relief is a wonderfully unique adaptation of
PHOTO COURTESY OF MODERN CUPPING THERAPY
cupping—and different from the more common or traditional cupping

therapies. While most people are familiar with stronger, often less-than-
relaxing cupping applications that commonly leave cupping marks, cups
can also be employed in a variety of ways to address a multitude of ailments,
including stress and anxiety. Just like the hands of a skilled massage therapist
can induce relaxation, cups can be used to facilitate stress relief, oftentimes
not leaving any cupping marks to achieve benefit.
Therapeutic cupping employs negative pressure to approach the body for

Therapeutic cupping treatment, which is something unique only to cups. Considering most manual
therapies employ positive pressure, this concept of administering bodywork
employs negative that creates space can be quite the welcome sensation.
pressure to approach
Rather than using strong pressure and vigorous movements, non-aggressive
the body for
cupping techniques can offer universally calming results to the entire central
treatment, which is nervous system due to its relaxing effect on all sensory receptors. Similar to
something unique how the relaxing, light pressure strokes done by hand – often called nerve
strokes—can calm someone, using cups with various soothing applications
only to cups. can evoke a tranquil response in the central nervous system. Once cupping
begins to take effect, the peripheral repercussions can have a profound effect
on the entire central nervous system, thereby inducing deep relaxation.

One of the most common areas to work with cups for stress relief is over
the back along the paraspinals, and across the shoulders. The naturally
decompressive sensation of cups can be disorienting to tight areas stuck
in a state of contraction; this altered sense of manipulation can ultimately
promote some much-needed muscle relaxation (without added, positive
pressure). Applying non-aggressive cup placements that progressively
soften and hydrate tissues, moving cups slowly with lighter pressure along
these common lines of tension, even lightly sliding over the rib cage to create
expansion and induce a deeper sense of breath, all collectively can be a great
stress-relieving treatment.
Whether cups are used to address areas of muscle tension, as a more holistic
application for the whole body, or gently across the face with specific micro-
cupping techniques, the feedback is consistently one of positive, therapeutic
relief. Some people have given the feedback that they have more breathing
room in their bodies. One of my favorite client testimonials about face cupping
leaves a relaxing, lasting impression: “It feels like you just drained the stress out
of my face, thank you.”
Shannon Gilmartin, CMT (moderncuppingtherapy.com), started her massage therapy

career in 2000, and began cupping practices in 2004, teaching cupping internationally soon
thereafter.
Dense-Breast-Tissue Clients
According to the National Institute of Health (NIH), nearly half of all women
over 40 in the USA are found to have dense breast tissue. Dense breasts
have a high amount of fibrous and glandular tissues and low amounts of fatty
PHOTO COURTESY OF ACE MASSAGE CUPPING
tissue. The NIH also reported 268,600 new cases of breast cancer in 2019
in the USA. Women’s breast health and surgical recovery has become all
important and massage therapists, physical therapists and other health care
professionals can help.
Using vacuum therapies for lymphatic liquefaction and drainage of the breasts
has resulted in diagnosis changes for some women who were originally told
they have dense breast tissue. Could it be that many of these women had
such congested lymph that it appeared in the mammogram or other testing as
dense fibrous and glandular tissue? And these breasts become very heavy,
putting strain on the entire body.
Normal lymphatic drainage of the breast is often impeded by tight-fitting

bras and other garments that compress tissue. Many women truly need the
support and using a silicone vacuum cup in the shower just a few times a week
can offset the consequences of wearing a support or athletic bra. A short

series of treatments by a trained professional to clear and support normal
drainage is often necessary prior to this type of home maintenance, and the
professional can also instruct their client or patient in the proper techniques
used with the cup.
So many women Dense breast tissue is considered a marker for high risk of breast cancer.
No wonder, since the congestion contains years of cellular debris and the
are diagnosed with tissue has not received adequate nutrition. This creates the perfect acidic and
a genetic form of hypoxic (low oxygen levels) environment for cancer to proliferate. Healthy
breast tissue that is alkaline and hyperoxic does not provide cancer with much
breast cancer and
opportunity to thrive.
receive treatment
or surgery, and So many women are diagnosed with a genetic form of breast cancer and
receive treatment or surgery, and some women with a genetic predisposition
some women are opting for surgery as a prophylactic measure. Vacuum therapies can
with a genetic significantly change the issues that often arise from these surgeries and has
also been used to create space for implants in reconstructive surgery.
predisposition are
opting for surgery Scar tissue, including radiated tissue, responds quickly to soften and become
as a prophylactic more pliable, enabling women to do basic daily movements and tasks that
we all take for granted. Pain levels decrease and a simple hug becomes
measure. Vacuum a joy again. Breathing becomes easier and energy levels can normalize.
therapies can Contractures are also a serious side effect of reconstructive and elective
breast surgeries and these can quickly be released without discomfort.
significantly change
the issues that These gentle techniques are often done with extra-large rigid or soft cups
often arise from to encompass the entire breast area, and smaller cups to address scars and
restrictions. Training is essential, and the techniques can easily be added into
these surgeries another service or become a single half-hour specialized treatment.
and has also been
used to create Anita Shannon, LMT (massagecupping.com), is licensed in massage therapy and
cosmetology since 1983, and an educator since 1990. She presents workshops on ACE
space for implants Massage Cupping and MediCupping since developing these methods in 2002.
in reconstructive
surgery.

Assisted Stretching
Proprioceptive Neuromuscular Facilitation (PNF) encompasses a broad
treatment approach to facilitating proper muscular function. There are many
methods within this umbrella term, with some methods designed to strengthen
muscles whereas other methods are designed to free restricted neuromuscular
patterns. Many physical therapists learn the former methods mentioned,
whereas massage therapists may be trained on the latter methods.
PNF methods were first devised by Herman Kabat, MD, PhD, Margaret Knott,
PT, and Dorothy Voss during the 1940s and 1950s, and were based upon the
neuromuscular theories of Sir Charles Sherrington from earlier in the century.
Sherrington’s laws of neurology, including irradiation, successive induction and
reciprocal inhibition, became the foundation for early PNF treatment methods.
Initially, PNF was employed to assist paralysis patients due to polio and related
injuries. Years later, PNF methods were utilized by physical therapists as a
supportive treatment option in movement and therapeutic exercises.
Benefits of Stretching
PNF methods complement traditional stretching performed by massage
Initially, PNF was therapists. According to the Mayo Clinic, the top five benefits of stretching
employed to assist include:
paralysis patients due • Increased flexibility and joint range of motion. Flexible muscles can
to polio and related improve your daily performance. Daily functional tasks become easier and
less tiring. Flexibility tends to diminish with age but can be regained and
injuries. Years later,
maintained.
PNF methods were
utilized by physical • Improved circulation. Stretching increases blood flow to your
muscles. Improved blood flow brings more nourishment, rids metabolic
therapists as a waste out of tissues and shortens injury recovery time.
supportive treatment
• Better posture. Good posture alleviates painful discomfort and chronic
option in movement
holding patterns within the body. When long-held chronic tension has
and therapeutic alleviated, the body’s parasympathetic mode can restore homeostasis.
exercises.
• Stress relief. Stretching relaxes tight, tense muscles that often
accompany stress.
• Enhanced coordination. Maintaining full range of motion through joints

keeps you in better balance. Coordination and balance will keep you
mobile and less prone to injury from falls, especially as you age.

2
The Stretch Reflex
1. The muscle is initially
stretched.
2. Afferent signals are sent
to the spinal cord.
1 3 3. The interneuron
connects the afferent
and efferent fibers.
4. Efferent signals are sent
to the muscle to cause
contraction.
Examining the anatomy and physiology involved with PNF methods answers
how using PNF will accomplish these benefits. There are two key principles
working in conjunction with PNF style stretching: reciprocal inhibition and post
isometric relaxation. These principles allow PNF style stretching to utilize the
effectiveness of the nervous system to augment the effects of traditional simple
stretching. Any stretch may be enhanced with the PNF methodology applied.
Reciprocal inhibition: This principle describes how a muscle relaxes when

When one first its antagonist contracts. Neurologically, an afferent (sensory) message from
a muscle is brought into an interneuron within the spinal column. Because
stretches a muscle, interneurons are inhibitory by nature, the efferent (motor) signal from the
not all fibers stretch spinal column will cease contraction of the muscle’s antagonist.
simultaneously.
Example: The anterior deltoid muscle, a shoulder flexor, will relax when the
Some remain at posterior deltoid, a shoulder extensor, contracts.
rest. The length of
Post isometric relaxation: This principle describes the three- to five-second
an entire muscle window of time in which a muscle fully relaxes after its contraction ceases
depends on the before the muscle’s tonus is restored. This allows the body to reset its
number of stretched proprioception.
fibers. What Happens During a PNF Stretch?

When one first stretches a muscle, not all fibers stretch simultaneously. Some
remain at rest. The length of an entire muscle depends on the number of
stretched fibers.
When a stretch occurs, there are two types of mechanoreceptor cells at work:
Golgi tendon organs and muscle spindle cells. These cells perceive one’s own
body position and movement by detecting changes in tension placed upon
joints and muscles.

Golgi tendon organs are effective at ensuring a muscle does not have too
much load placed upon it. These cells communicate within spinal gray matter.
When gray cells perceive a muscle may be damaged due to excessive load,
the spinal cord sends a message to the muscle to relax. This is termed an
inverse stretch reflex.
Muscle spindle cells aid in maintaining muscle tone and ensuring our muscles
never over-stretch. These cells also communicate with the spinal gray matter.
When gray cells perceive a muscle is stretching beyond its limit, the spinal
Muscle spindle cells cord sends a message to the muscle to contract slightly. This is termed a
myotatic stretch reflex.
aid in maintaining
muscle tone and In addition, the Pacinian and Ruffini joint nervous organs impact the ability
of joints to remain steady and static during stretches. Pacinian organs are
ensuring our muscles
active with rapid, quick joint movements. Ruffini organs are active with slower,
never over-stretch. measured joint movements. If these organs cannot facilitate proper signaling,
These cells also the joints stretched may exhibit an abrupt or interrupted end-feel, the
sensation felt when a limb is stretched to its limit.
communicate with
the spinal gray If stretching is performed slowly on a daily basis, the mechanoreceptor cells
matter. When gray become accustomed to the new proportions of length within muscles. This is
why daily stretching is key in achieving maximum results of improved flexibility
cells perceive a and range of motion.
muscle is stretching
Assisted Stretching
beyond its limit, the Depending on the PNF method utilized, a practitioner may choose to engage
spinal cord sends a muscle with either an isometric or concentric muscle contraction. An
a message to the isometric contraction involves a muscle held in a fixed position as it contracts.
A concentric contraction involves a muscle shortening upon its contraction.
muscle to contract Whether the contraction is isometric or concentric, only a slight contraction
slightly. This is (about 10% of strength offered) is enough to engage the nerve cells involved to
make PNF methods effective.
termed a myotatic
stretch reflex. Full-force contractions may easily lead to injuries during the treatments and
are unnecessary to accomplish the goals of PNF methods. Advising a client to
exert a slight contraction at most will avoid injuries during PNF stretching.
There are many different types of PNF methods that can be learned. Physical
therapists will learn methods to strengthen muscles adversely affected by
injury, trauma and/or medical conditions.
These strengthening methods will help clients who need greater range of
motion develop muscle strength and endurance, and better continuity between
agonist and antagonist muscles. Clients rehabilitating from injuries will greatly
benefit from improved muscle strength after muscle atrophy has occurred.

Both physical and massage therapists may learn PNF methods to relax certain
muscle regions for similar benefits. Clients experiencing chronic pain will benefit
from the relaxation effects provided. Functional improvements in daily tasks will
be witnessed as muscles have improved efficiency. Better flexibility of joints and
muscles will aid proprioception and movement patterns, especially in people
who are relearning how to walk and use their bodies after accidents.
Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education
(advancedmassagece.com) in Tempe, Arizona.
References:
• “Facilitated Stretching”, McAtee, Robert & Charland Jeff, 1999, second edition.
• Mayo Clinic: mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931,
Staff, January 2020.

Trauma Release
When considering massage for trauma, examples of veterans of battle or
crime survivors might come to mind. We forget that traumatization can occur
when any individual—any client—experiences a very negative event that can
Before working with create a lasting impact on the person’s emotional and mental stability.
trauma patients, a
Be ready to expand your practice of holding professional space for trauma
massage therapist patients. How the therapist shows up within the treatment room will make a
needs to do an world of difference in the effectiveness of the session.
honest introspection
This article will present two aspects of this topic. First, many facets of how
on their level trauma presents within the body will be examined. Second, considerations
of training and when creating massage treatment planning will be appraised.
understanding of How Trauma Expresses

trauma. Merriam-Webster’s medical dictionary defines trauma as “1. Injury; 2.
Psychological or emotional damage.” All massage schools hold discussion
in courses around healing the physical nature of trauma. Not every school
discusses the psychological or emotional natures of trauma. Before working
with trauma patients, a massage therapist needs to do an honest introspection
on their level of training and understanding of trauma.
Everyone’s experience and comfort level with the subject will vary. As a

massage therapist learns more about how trauma processes within the
mind and expresses through the body, the nuances of the topic will demand
heightened awareness and sensitivity.
Trauma is processed in the mind in a fascinating manner. Neuroscientist and

psychiatrist Paul MacLean (1913–2007) described how the brain processes
trauma via the Triune Brain Model.
This model devises three brain aspects at work to help the body process
stress: the brain stem (primitive brain); the limbic system (paleomammalian
complex); and the neocortex (neomammalian complex). Essentially, the brain
stem activates the other two complex portions to facilitate a stress response.
Primitive instincts and protective measures learned early in life will initiate to
protect the person from the pain of trauma.1
The Stress Response Cycle

Trauma expresses through the body in many fashions. There are many
manifestations of physical expression of trauma. Sympathetic responses,
Sympathetic also referred to as fight, flight or freeze responses, can grip a person recalling
trauma. Heart and breathing rates increase, nerves become hyperactive, eye
responses, also pupils dilate, digestion shuts down and muscles activate.
referred to as fight,
The body’s HPA axis is involved within the trauma response. HPA stands for
flight or freeze three glands communicating hormones in response to trauma: hypothalamus,
responses, can grip pituitary and adrenal glands. The communication amongst these three glands
a person recalling is the same regardless of the type of trauma experienced.
trauma. Heart and When the body experiences stress, the hypothalamus sends corticotropin-
breathing rates releasing hormone to the pituitary gland. This induces the pituitary to release
adrenocorticotropic hormone to the adrenal glands. This facilitates a release
increase, nerves
of adrenaline hormones (epinephrine and norepinephrine) as well as cortisol
become hyperactive, into the bloodstream to create a sympathetic stress response.
eye pupils dilate,
Elevated levels of cortisol indicate long-term stress experienced. Cortisol in
digestion shuts down significant quantity can signal to the hypothalamus and pituitary to continue
and muscles activate. producing corticotropin-releasing hormone and adrenocorticotropic
hormone, perpetuating the stress response cycle. This constant positive
feedback can create a condition called HPA axis dysfunction.2
1. Rosenthal, M. The Science Behind PTSD Symptoms: How Trauma Changes the Brain.
June 2019; psychcentral.com/blog/the-science-behind-ptsd-symptoms-how-trauma-
changes-the-brain. Accessed July 2020.
2. Patel, R. HPA Axis Dysfunction Explained: The Facts You Need to November 2019;
webfmd.com/hpa-axis-dysfunction. Accessed July 2020.

This condition results in lessened cortisol levels in the long run, making the
body rely on adrenaline hormones for stress response. Common symptoms
of HPA axis dysfunction include waking up feeling tired, insomnia, cognitive
challenges, weight gain and irritability.
Massage for Trauma: Emotional Release

On the massage table, the sympathetic response can present in many
ways. The client’s breath rate may increase enough to make a session feel
uncomfortable. Their body may twitch with many muscle spasms.
On the massage
Their body may also become rigid. Muscles may be too difficult to apply
table, the
pressure upon. When receiving massage for trauma, the client may ask you to
sympathetic avoid a certain region of the body. We must respect client requests and steer
response can present away from bodywork that overstimulates their body.
in many ways. The The client may also verbally recall events, sharing deeply personal and
client’s breath rate intimate information. The ability to listen without offering counseling is
may increase enough paramount. Remain within scope of practice which is to mindfully listen, hold
professional space and refer the client to appropriate professionals.
to make a session
feel uncomfortable. The potential for somato-emotional releasing during massage for trauma is
quite likely with trauma patients. Different schools describe varying methods
Their body may and perspectives of interacting with clients experiencing these responses.
twitch with many What I present in my continuing education courses is a three-step approach:
muscle spasms.
1. Acknowledge the energetic shift in the room. When a somato-
emotional response is occurring (or soon to occur), there can be
a palpable shift in energetic feel of the client. When this occurs,
immediately stop performing massage and check in with client. Their
response will inform you of how to proceed next.
2. Validate the client’s feelings. Some clients may not want to share
their feelings or allow feelings to be felt while lying upon the table.
Saying statements to validate that feelings are valid such as “It’s OK
to have this feeling” and “This is a safe space to feel what you need to
feel” can provide permission for a client to feel appropriately.
3. Continue as directed by the client. We hold space for clients and

wait for them to provide a directive on how to next proceed. Some
clients may request a simple touch gesture such as holding their hand.
Other clients may want you to back away or leave the room. Many
clients may ask you to wait a few minutes before proceeding with the
massage while others may end the session entirely. We simply respect
their wishes for this step.

Massage for Trauma: Treatment Plans
There are many considerations for massage therapists to review as massage-
for-trauma treatment plans are devised and a client is expressing their
trauma upon the table. The first question to consider is if the therapist is able
to maintain poise during a session. Poise refers to the ability to gracefully
maintain focus and balance of a situation when it becomes uncomfortable. A
therapist needs to refer a client to another practitioner if they cannot maintain
poise with a client.
Also, deducing myofascial patterns of tension and determining where a client

holds tension can be valuable. The Fascial Research Congress has confirmed
in numerous studies that fascia possesses gray matter nerve tissue. This
tissue stores memories and data.3 This explains why many clients experience
a recollection of a memory when a person touches a certain region.4
If the therapist feels Activating the neuronal tissue of fascia can literally activate memories stored
within a body region. This will facilitate a physical response of myofascial
the client’s trauma tightening and restrictions. A therapist can seek the patterns of tight and
response upon taut muscle tissue the body holds with this trauma response. Modalities to
assist in the softening of these restrictions include myofascial release, cranial
the table is to an sacral therapy, reflexology and facilitated stretching. A classic Swedish-style
unmanageable point, approach can also be effective when performed mindfully.
ending a session and
When to End a Session
offering a referral to a Right of refusal is an often overlooked aspect of the therapeutic relationship.
medical professional Clients have the right to refuse services for any reason at any time. If they
determine that the session should be stopped mid-session, their request must
is appropriate.
be respected. Allow the client grace and dignity in this decision.
This same right also applies to the practitioner. You can end a session at any
time with just and reasonable cause. Consider the nature of the therapist-
client relationship with these decisions.
Also, if the therapist feels the client’s trauma response upon the table is to
an unmanageable point, ending a session and offering a referral to a medical
professional is appropriate. Document any session that ends prematurely,
either by the client or the therapist’s discretion.
A final note on massage for trauma is for massage therapists to seek

additional resources for learning more about the effects and manifestations of
3. Gunther, et al. Fascia as a Sensory Organ: A Literature Review of the Sensory Organ
Innervation of Muscular Fascia. Fascia Research Congress, September 2012.
4. van der Kolk, B. The Body Keeps the Score, Penguin Books. 2015.

trauma. Our industry is quite limited in what is presented in schools; therefore,
further training is imperative. The ability to hold professional space with
someone experiencing trauma can be tricky, yet methods can be learned and
practiced as we become cognizant of our communication tendencies and
sensitivity of awareness.
Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education
(advancedmassagece.com) in Tempe, Arizona.

Grounding Techniques for the
Trauma Massage Therapist
The mental demand and energy to maintain poise can become taxing for
a massage therapist working with this population. As massage therapists
experience working with traumatized clients, it’s important to perform
grounding and self-care techniques upon day’s end. Practicing healthy habits
after seeing trauma patients will help avoid therapist burnout, either physically
or emotionally.
Grounding techniques I’ve found effective include breath work. Here are two
examples of easy breath work a therapist can do to maintain centeredness.
Three Part Breath
• Imagine three sections of your torso: the lower belly below the umbilicus,
the upper belly between umbilicus and rib cage, and the chest region.
• Imagine a color to your breath. As you inhale, draw this color to your lower
belly, then upper belly, then chest. Pause briefly. Exhale emptying color
breath from chest, then upper belly, then lower belly squeezing your core
tightly as you complete this breath.
Beginner’s Note: Start with small interval of only 4–5 seconds per inhale
/ exhale to avoid becoming lightheaded. As you feel this breathing method
become easier, strive for 10 seconds or more per inhale / exhale.
Ocean’s Breath
• Inhale through your nose, then slightly constrict your throat as you slowly
exhale, creating an ocean’s wave sound to the exhaled air. Imagine a mirror
in front of your face that your breath fogs upon exhalation. Continue with a
slow rhythmic pace.
Beginner’s Note: Make your exhale last longer than the inhale as you
practice.
Other self-care tips that can become healthy habits include being mindful of
your dietary food choices, creating a stretching or yoga routine, taking a walk,
unwinding your mind with a good book, taking baths to soothe your body and
inhaling relaxing essential oil scents.

Kinesiology Taping
Kinesiology tape has become a staple for massage therapists, physical
therapists and other practitioners who work with sports teams—but these
brightly colored strips of tape aren’t just useful for athletes. Here, three
kinesiology taping experts weigh in on its benefits for the athletic population,
the general population and pregnant clients.
Taping for Athletes

By Holley J. DeShaw, LMT, CKTP
I first began my integration of kinesiology taping

applications in my work with elite-level track and field
athletes. I was working at the Olympic Trials in Eugene,
Oregon, when this method of taping really exploded onto
the scene as a tool in sports performance and recovery.
NEIL NOURIGAT
For myself and so many other massage therapists as well as

Holley J. DeShaw
other health care practitioners, it was an incredible modality
to utilize that was drug-free, pain-free, and that athletes felt supported by. In
the following years, cutting-edge applications have grown, which everyone
from the most seasoned athlete to a casual weekend runner or gym
enthusiast can use with ease.
One of the greatest benefits in using this method of taping is there isn’t
One of the greatest restriction to joints or of blood or lymphatic flow—only support and facilitation
benefits in using of movement. I have used it extensively at the end of a session to facilitate
optimal results from the massage session.
this method of
taping is there isn’t Also, I have witnessed the most seasoned athletes in the NFL, NBA, soccer,
and track and field using it, and the running community extensively utilizes
restriction to joints or
taping products and applications in both their recovery and performance
of blood or lymphatic goals. The fact that kinesiology taping can be used to help facilitate pain
flow—only support relief as well as be applied with ease to so many areas of the body makes it
an incredible addition to the way massage therapists or athletes can recover
and facilitation of better, faster, and perform at their best.
movement.
Taping for the General Population
By Alexander Bailey, PhD, LMT, NASM CPT-CES-PES-FNS
Kinesiology taping is great for the general population, specifically those with
posture and chronic pain issues. Common complaints of neck, shoulder and
back pain are due to day-to-day repetitive activities both at home and work.

The average person sits in front of their computer or uses
an electronic device for hours on end with poor posture.
Others may be standing behind a counter slumped over
all day or stuck in a car with a long commute to and from
work. Or maybe they have small children at home they are
constantly picking up.
Alexander Bailey
For many people, an application called posture taping can
be beneficial because it helps retrain the muscles and restore balance. This is
done by applying the tape on the back of the body while the client is standing
in their ideal posture. The tape acts like a mini feedback system because when
the client goes back to their original posture, they will feel the tape pulling or
tugging against their body; this will remind them to correct themselves back
to their ideal posture. Over time this will help retrain their muscles and restore
balance, alleviating a lot of their chronic pain issues.
One popular application is applying the tape in an X pattern, covering the

upper back with two strips. This is ideal for people who are constantly
hunched over as this will remind them to bring their shoulders back, thus
One popular reducing strain on the upper body.
application is Another application which is helpful for those suffering with low-back pain is to
applying the tape take three strips of the tape, then apply two strips vertically along each side of
in an X pattern, the spine over the low back. The third piece will be applied horizontally across
the two, making an H. This will remind the person not to use their low back
covering the upper when picking things up.
back with two
Taping for Pregnant Women
strips. This is ideal
By Jessica Hill, DPT, CSCS, SFMA, FMS, FRC
for people who are
constantly hunched Women experience a myriad of discomforts and
pains associated with the hormonal, physiological and
over as this will biomechanical changes that occur during pregnancy;
remind them to bring there are common reports of back pain, pelvic pain, neck
pain, sciatica, swelling in the feet and ankles, carpal tunnel
their shoulders back,
syndrome, and other issues. Because pregnant women
thus reducing strain tend to avoid pharmacological intervention due to concerns
Jessica Hill
on the upper body. about the safety of the baby, strategies for pain may include
massage, instrument-assisted soft tissue mobilization (IASTM), exercise,
adjustments, supportive garments and kinesiology tape.
Kinesiology tape is a drug-free, safe, non-invasive, low-cost intervention that

may markedly improve pregnant women’s comfort and movement capability.
The tape is lightweight with a consistency similar to that of skin, allowing for

improved comfort on hot days and for use in conjunction with other supportive
garments. It can be worn sleeping, showering and exercising. The tape is
made from cotton with medical-grade acrylic adhesive that does not seep into
the skin or bloodstream.
Studies concerning the efficacy of kinesiology tape for treating pain

are prevalent in the literature; however, there are few studies pertaining
specifically to kinesiology tape used during and after pregnancy. Some
notable research in this area includes:
• A 2017 article in the Medical Science Monitor, “Kinesio Taping vs Placebo

in Reducing Pregnancy-Related Low Back Pain,” demonstrated a
significant decrease in low-back pain in pregnant women compared to
placebo. The authors noted the analgesic effect peaked at two days.
• “Short-Term Effects of Kinesiology Taping in Women with Pregnancy-

Related Low Back Pain,” a 2016 study in the same journal, concluded that
kinesiology tape may be used as an effective complementary treatment to
help relieve pregnancy-related low-back pain.
• A study published in 2017 in Ginekologia Polska, “Impact of Kinesio Taping

Application on Pregnant Women Suffering from Pregnancy-Related Pelvic
Girdle Pain,” noted significant reduction in pain related to pelvic girdle pain
(PGP) that peaked at three days and continued for five days following
removal of tape.
Kinesiology tape is an
incredibly versatile • Research in 2019 in the Journal of the Canadian Chiropractic Association,
“Taping Protocol for Two Presentations of Pregnancy-Related Back Pain,”
tool that may be used is a case series following two pregnant women: one with lumbosacral
in conjunction with pain and the other with PGP, throughout their course of care, including
successful applications of kinesiology tape in helping mitigate their pain
massage therapy
and improve function.
and IASTM to further
promote comfort and Kinesiology tape is an incredibly versatile tool that may be used in
conjunction with massage therapy and IASTM to further promote comfort
wellness for pregnant and wellness for pregnant women. Taping applications may be stacked with
women. other modalities and be combined and modified to best serve each woman’s
individual needs.
Taping is for Everyone

Kinesiology taping is a versatile, effective strategy to address pain and
dysfunction, whether your clients are top-level athletes or office workers.
If you are interested in adding this technique to your repertoire of bodywork

tools, several companies that manufacture the tape offer training; the website
of the National Certification Board for Therapeutic Massage & Bodywork
(ncbtmb.org) also lists a number of online and in-person taping workshops
from various continuing education providers.
Holley J. Deshaw, LMT, CKTP (holleydeshaw.com), has an extensive history in the sports
medical performance and recovery field. She is a KT Health spokesperson (kthealth.com)
and has worked with some of the most elite athletes in the NFL, NBA and Track & Field.
Alexander Bailey, PhD, LMT, NASM CPT-CES-PES-FNS, who holds a PhD in kinesiology and
an MS in exercise science, maintains a private practice specializing in sports performance
and pain management (bodyaligntherapy.com).
Jessica Hill, DPT, CSCS, SFMA, FMS, FRC, is a doctor of physical therapy with 18 years of
clinical experience, and a Functional Movement Techniques instructor for RockTape USA
(rocktape.com).

Reflexology
While a foot massage can be very enjoyable, foot massage and reflexology
are vastly different in many aspects, including definition, scope of practice and
purpose. The public is oftentimes unaware of these differences—and many
massage therapists are unaware as well.
I am continually asked by prospective clients if my services are a foot

massage or reflexology. One prospective client asked, “Please describe your
reflexology service in detail, as I’m looking for a true reflexologist. I’ve had
reflexology before and that is what I want. I don’t want a foot massage.” She
went on to share her story of how she’d paid for reflexology sessions and was
very disappointed that she ended up receiving a foot rub with lots of lotion.
On the opposite end of the spectrum, I remember a gentleman who came in

for a session, and at the end of the session he said, “I thought I was getting
a foot massage and thought you would be using lotion.” I explained what
Foot Reflexology Chart
Medial side of the foot
Right sole Left sole Superior of the foot Lateral side of the foot
1. Frontal sinus 15. Stomach 29. Descending colon 41. Vocal cords 51. Pelvis
2. Nose 16. Suprarenal gland 30. Ascending colon 42. Rib cage, ribs 52. Uterus, prostate
3. Pituitary 17. Kidneys 31. Sigmoid colon, rectum 43. Mid back 53. Penis, vagina
4. Trigeminal nerve 18. Heart 32. Ileocecal valve 44. Breast, mammary 54. Sacrum, coccyx
5. Cerebrum 19. Liver 33. Caecum, appendix gland 55. Lumbar spine
6. Cerebellum brain stem 20. Gallbladder 34. Anus 45. Lymph of the head, 56. Thoracic spine
7. Neck 21. Pancreas 35. Insomnia point brain 57. Cervical spine
8. Eyes 22. Duodenum 36. Gonads 46. Lymph of chest, lungs 58. Hip
9. Hypertension point 23. Celiac plexus 37. Sciatic nerve 47. Pelvis lymph 59. Ovary, testes
10. Ears 24. Spleen 38. Upper jaw, teeth, 48. Lymph of groin 60. Leg, knee, hip
11. Parathyroid gland 25. Ureters gums 49. Fallopian tube, vas 61. Shoulder, arm
12. Thyroid gland 26. Bladder 39. Lower jaw, teeth, deferens, seminal
13. Trapezius muscle 27. Transverse colon gums vesicle
14. Right lung, bronchi 28. Small Intestine 40. Neck, throat, tonsils 50. Rectum
reflexology was and the science behind reflexology and how it is different from
a foot massage. Interestingly enough, the gentleman came to see me the next
day for a reflexology session.
Definition
In 2016, the three national reflexology organizations—the Reflexology
Association of America, the American Reflexology Certification Board and the
National Council of Reflexology Educators—worked together to create one
definition to describe the discipline:
Reflexology is “Reflexology is a protocol of manual techniques, such as thumb and finger

a noninvasive walking, hook and backup and rotating on a point, applied to specific reflex
areas predominantly on the hands and feet. These techniques stimulate the
discipline and clients complex neural pathways linking body systems, supporting the body’s efforts
remove only their to functional optimally.”
socks and shoes to
Scope
receive it. Reflexology is a noninvasive discipline and clients remove only their socks
and shoes to receive it. Reflexology is limited primarily to the hands and feet,
while in some states practitioners may also be able to include the outer ears.
Reflexologists use specific techniques that are very different from massage
techniques.
Purpose and Benefits

Reflexology focuses on the reflex points that correspond to the glands, organs
and various other parts of the body. Theory suggests that the specific manual
techniques that are used in reflexology stimulate the complex neural pathways
linking body systems, supporting the body’s efforts to function optimally, by
promoting a relaxation response via the nervous system that encourages
the body to seek balance and, in so doing, assists the body to function more
efficiently.
The effectiveness of reflexology is recognized worldwide by various

national health institutions, including the National Institutes of Health and
the National Center for Complementary and Integrative Health, as a distinct
complementary practice within the holistic health field. Our understanding of
reflexology is informed by over 300 research studies.
The first-ever reflexology research study to be published in a peer-reviewed

journal, Obstetrics and Gynecology, in 1993, demonstrated that ear, hand
and foot reflexology were useful in the treatment of both psychological and
physical symptoms associated with PMS. More recently, three longitudinal,
randomized, controlled studies funded by grants through the National Cancer
Institute studied the effects of reflexology on breast cancer patients.

While one study is ongoing, results from the first two studies found reflexology
to be safe and of benefit to breast cancer patients in improving their ability to
function in everyday activities, such as walking up a flight of stairs or carrying a
bag of groceries, and in reducing pain and fatigue, among other symptoms.
Equally important, these studies indicated that reflexology is fundamentally

different from massage in that the individuals assigned to the control group
who received “lay foot manipulation” (in other words, massage) did not
see considerable improvement in their symptoms versus those individuals
assigned to the reflexology group.
A one- or two-day
class does not qualify In my practice, numerous clients have shared the benefits of receiving
reflexology. One young female in her mid-20s had suffered from migraines
a practitioner to since her early teen years and was on medication to prevent the migraines.
consider themselves After two sessions of reflexology, she shared she was having fewer migraines
as a reflexologist. and she was not taking as much medication. Other clients have reported
benefits that range from relaxation and increased energy to deeper sleep, and
they had been able to manage their pain better. Each person is in a different
situation, so the benefits for each client may vary.
Training
Reflexology training can range from a few hours to certification. The
interested individual should consider state laws and how they intend to
include reflexology in their practice. A one- or two-day class does not qualify
a practitioner to consider themselves as a reflexologist. Individuals looking for
a reflexologist should inquire as to the training and experience in reflexology
specifically. The Reflexology Association of America (reflexology-usa.org)
and the American Reflexology Certification Board (arcb.net) are valuable
resources for finding a qualified reflexologist.
The American Reflexology Certification Board (ARCB) offers the opportunity

for eligible applicants to take the national board exam, a 300-question
written exam based on psychometric standards, a hands-on practical and
the submission of documented sessions. Upon successfully completing
the national exam, the reflexologist would earn the designation of National
Board Certified Reflexologist (NBCR). To maintain the NBCR designation,
a reflexologist will need to complete required continuing education
requirements.
Statutory Requirements
It is important to understand that every state has different requirements
related to massage and related bodywork therapies. Five states require
registration or licensure to practice reflexology: Nevada, New Hampshire,
North Dakota, Tennessee and Washington. Thirty-four states have laws
exempting reflexology from massage. Some states, including Florida,

Arkansas and New York, require reflexologists to be licensed in massage
therapy.
Many reflexologists work independently, and there are a variety of business

models, including corporate, wellness centers and sole proprietorship.
Reflexologists should represent themselves based on their education and
should also make the details of their training available to clients.
Furthermore, reflexologists don’t present themselves as massage

therapists—and massage therapists should not present themselves as
reflexologists without the proper training.
Debbie Hitt, NBCR, is a nationally certified reflexologist and has been sharing reflexology since
2001. Certified reflexologist Adrianne Fahey contributed to this article.

Oncology Massage
When I consider how I became an oncology massage therapist, I am always
reminded of my mother, who had cancer.
When I was growing up, cancer was referred to in my family as the “C” word.
We did not have an awareness of how to deal with her cancer diagnosis and
its effect on her, my father and us, their eight children. Though we were in
the trenches with the enemy, our family approached the subject with stealth
silence. Cancer came in and altered our world, leaving me, all of us, to figure
PHOTOS COURTESY OF JACQUELINE ALGAIER
it out.
During one of her few visits home from treatments she was receiving at Sloan
Kettering in New York, I remember my mother sitting next to me on the couch
in the living room. Her beautiful brown eyes and painted red lips were in the
forefront of my mind. I asked about her funny balding head. She placed my
hands on the growing sprouts of soft, baby-fine hair. I smoothly and lovingly
glided my hands, gently feeling the silky newness. Feelings of peace and
connection ensued.
Little did I know or begin to understand, until years later, how this experience in
After gaining childhood would be an unconscious thread of motivation behind my desire to
knowledge of how take my massage practice into the direction of oncology.
the lymph system What’s Your Motivation?

can be compromised, What is the value appropriated to becoming a massage therapist who
specializes in services for those living with cancer? The desire may grow out
this therapist is able
of a deep longing to reduce suffering for individuals. Others may find that it is a
to determine the way of giving back after healing from the loss of someone who had cancer. For
best way to massage, others it may simply be another skill set to pursue.
proximal to distal, away Whatever the reason, a conscious and deliberate evaluation of one’s motives
from a node removal and skills is needed in order to maintain healthy boundaries and move forward
in the direction of “do no harm.” To provide safe and effective massage, a
surgical site.
therapist must have the confidence and clinical skill to serve a population of
individuals who are at risk for blood clots, lymphedema, infection, and poor
reaction to inappropriate levels of pressure.
Research Results
Oncology massage is a term and service that is often undervalued
and misunderstood by massage therapists, clients, spas and hospital
administrators. Massage looks very different in the arena of treatment, early
recovery and long-term recovery.

In other words, massage services are different for different stages of
treatment and recovery, as well as for each individual. This means there are
ongoing assessment and adjustments made to fit the client.
Oncology massage research results are as varied as approaches to massage

therapy. Qualitative and quantitative research has demonstrated the efficacy
of massage in reducing anxiety and pain; increasing clients’ esteem for their
bodies; and supporting other quality-of-life areas often diminished with
cancer, such as poor sleep, fatigue and depression.
Competent oncology massage therapists offer a depth of support and relief

to those who are experiencing negative side effects from chemotherapy,
radiation, surgery and other treatments for cancer. Through education and
experience, therapists must learn a specific body of knowledge and develop
critical thinking skills that will be needed in order to ask clients the right
questions and listen for specific answers.
Understanding the significant side effects of cancer treatment such as low

blood counts, pain syndromes and mobilization issues that occur as a result of
treatment are just a few issues that have to be addressed clinically.
Practitioners, especially Education

Currently, those who attempt to elevate the practice of oncology massage to
those who are a level of professionalism that is respected and appreciated cannot enforce
seasoned professionals, standards of education, as there is no one unifying entity or licensing body
often find they need to comparable to that of nursing or physical therapy. Those seeking oncology
massage are left to the discretion of the therapist’s own understanding of their
dial back on their level level of competence.
of pressure, utilizing a
It is unclear what demonstrated level of skill is needed to be able to include
“whole hand” surface
oncology massage in one’s scope of practice as a massage therapist.
approach. This can Untrained therapists or those with little training in oncology massage, hired
be difficult for those into hospitals, clinics or spas where there isn’t a clear understanding of the
knowledge base needed to provide safe massage, may unknowingly take on
who are used to more than they can clinically handle, leaving clients at risk and therapists in a
using heavy-handed constant state of uncertainty.
techniques. Even the
Despite these challenges, many educators in the field of oncology
pressure of gentle, have followed the leadership and teaching of authors and oncology
general Swedish massage therapist pioneers. These professionals have put forth the basic
understanding that all people living with cancer may experience massage
massage may be too or therapeutic touch when thorough assessment reveals the parameters
much for someone needed to provide the right pressure, positioning and site provisions
in active cancer necessary. They also posit that those who have been in ongoing recovery
continue to need special clinical considerations.
treatment.
Developing clinical skills and ongoing training in the nuances of oncology
massage can start by attending an Introduction to Oncology Massage
weekend training. These courses offer a springboard from which a therapist
can gain the initial understanding of types of cancer, cancer treatments, side
effects and the cautious approaches needed.
A therapist who has the desire to continue to learn and grow in oncology
massage can receive further education, supervision and connection to
a mentoring body of educators and experienced therapists. Mentoring
educators Tracy Walton and Associates (tracywalton.com); Gayle McDonald
and Associates (oncologymassageeducationassociates.com); and Healwell
(healwell.org), to name a few, can provide further study and support beyond
introduction courses in oncology massage. Such organizations are able to
provide answers to concerns and questions that inevitably arise as services
are rendered.
The emotional experience of working with those living with cancer requires
empathy and an ability to listen to clients without personal bias or unresolved
losses that could muddy the therapeutic waters. Senior therapists can assist in
providing awareness and the much-needed process of unwinding issues that
may interfere with a newbie’s ability to be in the present moment with a client.
The emotional
Furthermore, there are supportive institutions that provide resources and
experience of working credibility to oncology massage, including the Society for Oncology Massage
with those living (s4om.org). Also, the National Certification Board for Therapeutic Massage &
with cancer requires Bodywork (NCBTMB) offers a new certification course in oncology massage.
empathy and an ability Bodies of professional volunteers, who strive to support the safe delivery
to listen to clients of massage to people who have been diagnosed with cancer by promoting
education standards, engaging in research and vetting massage therapists
without personal bias
who want to be recognized in their oncology massage therapist directories,
or unresolved losses regard the profession in a serious and thoughtful manner. There are long-
that could muddy the standing professional educational resources that provide training and
education within hospital settings, chemo infusion labs and hospice.
therapeutic waters.
Therapeutic Relationship
Massage services in cancer treatment and recovery are individualized and
differ in emotional intensity. Massage therapists who are present and aware
of issues related to a client’s acute trauma, resulting from a single incident
or chronic trauma from repeated and prolonged negative experiences, can
better facilitate providing a safe and comforting environment.
Proper training, engagement in self-care and supervision are key to

awareness development. Those on the cancer journey need massage

therapists who are able to provide services, with the acumen to keenly
observe and ask pertinent questions for treatment planning and ongoing care.
A therapeutic relationship that is saturated with healthy boundaries and

services provided within the therapist’s scope of practice, in a nonjudgmental
approach, adds to the effectiveness and quality of services provided. A client
who is able to rest assured that the focus of “do no harm” is at the basis of the
oncology massage service increases the client’s ability to let go and retreat
into the massage and the moment at hand, unfettered.
Jacqueline Algaier, LMT, is a nutrition and essential oils educator and oncology massage
therapist with 22 years of massage therapy experience.

Assessment
Models of dysfunctional posture and structure have evolved because they
make sense within the dominant biomedical and biomechanical framework
that is most pervasive in musculoskeletal medicine. In any mechanical
system, if the coordinated moving parts are not correctly aligned, the moving
system is not working most efficiently. This inefficiency may eventually lead to
breakdown. That concept makes sense and has been applied extensively in
most disciplines that address musculoskeletal pain complaints.
However, the human body is much more complicated than a simple machine.
Research has shown that there can be a weak correlation between structural
Assessment helps or postural challenges and corresponding pain complaints. For example,
just because someone has forward head posture doesn’t mean they are
the therapist better destined to have back or neck pain. This weak correlation has become a
understand the context primary argument for those who critique postural or mechanical treatment
approaches. However, this critique can also be misleading.
of postural or structural
problems, their A weak correlation means you can’t assume there is a direct cause-effect
physiological impact, relationship. Just because a postural or structural challenge exists, doesn’t
mean it is the cause of someone’s pain. Yet, that doesn’t mean the postural
and how relevant they problem is irrelevant and you should ignore it. There are numerous instances
are for the client’s when posture and structure definitely play a role in a client’s complaint. So,
current complaint. how do we know when a particular postural or structural problem is relevant?
The Role of Assessment

There are important guidelines that can help determine if a postural or
structural issue is a contributing factor. For decades I have been a strong
advocate of using comprehensive assessment with our clients, with the
degree of assessment depending on the complexity of the issue. Assessment
helps the therapist better understand the context of postural or structural
problems, their physiological impact, and how relevant they are for the client’s
current complaint.
The relevance of postural challenges depends on each client’s unique

situation. Whether or not a particular postural problem might be pertinent
is highly dependent on what factors might be exaggerating the mechanical
loads from that postural challenge. For example, a client might have lived their
entire life with a lateral pelvic tilt and a leg length discrepancy and never had
any problem. If you happen to identify those postural or structural challenges
during your treatment session, it may be erroneous to introduce the idea that
this is something the client needs to fix or change, because it has not caused
any significant problem to begin with.

On the other hand, if that same client just started a new running regimen and
is now having sacroiliac and low-back pain, the relevance of the postural
challenge is very worthy of investigation. The pelvic tilt and leg length
discrepancy exaggerates the constant and repetitive load on this region from
the new running routine.
In this article, we’ll look at a couple of common postural and structural

disorders and explore how we can best approach them. We take into
consideration current biomechanical research, but also consider the
limitations of what we still have yet to learn.
Ideally, if 10 different
practitioners evaluate Posture and Pain
the same client when Let’s look at two common postures that are often identified as contributing to
client pain complaints. The first example looks at a pain complaint that cannot
assessing for a pelvic really be addressed via the mechanical model because changing structure is
alignment problem, very unlikely. Adaptation is key here. In the second example, we actually can
they should all come use some of the mechanical model idea in order to address pain.
up with the same

determination. 1 Tilted pelvis. The pelvis is not a highly mobile region, but it certainly has
garnered its fair share of attention as a postural challenge. The literature
in our field and other manual therapy fields is rife with references to anterior,
posterior, and lateral pelvic tilts, upslips, torsions, and other structural and
postural misalignments of the pelvic region. Unfortunately, the biomechanical
literature does not support many of the assessment or treatment strategies to
address these pelvic anomalies.
Interrater reliability is a measure of how accurate an assessment procedure

is when multiple people perform it. Ideally, if 10 different practitioners evaluate
the same client when assessing for a pelvic alignment problem, they should all
come up with the same determination.
Unfortunately, a good number of the sacroiliac joint and pelvic position

assessment tests have poor interrater reliability. Does that mean these
conditions don’t exist and are not important? Not necessarily.
Numerous factors may lead to sacroiliac joint pain. Pelvic alignment is

undoubtedly one of those factors. Yet, we do know accurately measuring
position or alignment is difficult. Biomechanical research has also suggested
that it is difficult to change structure and position of the pelvis through soft-
tissue treatment interventions.
Yet, we also know that soft-tissue treatment of pain conditions in this region
are often very effective in restoring pain-free movement. So, what is occurring
here in these conditions?

Accurate assessment may help us pinpoint what seems to be the primary
culprit in some of these pain complaints. By selectively stressing various
tissues in this region during the assessment, we may be able to determine if
pain is primarily originating from irritation of sacroiliac ligaments, myofascial
trigger points, entrapment of cluneal nerves, irritation of sacroiliac joint
surfaces, tightness in distal lumbosacral muscles, or other factors. Specific
treatments can target the primary tissues that appear to be driving the pain
complaint.
In this instance, massage isn’t being used with the primary intention of
Forward head posture
changing a pelvic alignment—which is quite difficult. Instead we are
is probably one of the focusing attention on what is called the nociceptive driver, the primary tissue
most common postural responsible for generating the neurological signals that are producing pain.
challenges in our Nociception is the chemical, thermal or mechanical sensory signal that the
culture. brain interprets as pain. Massage is an excellent strategy for reducing excess
nociceptive input to reduce pain.
In this instance, our treatment goal is not necessarily to change a pelvic

alignment position, but instead to help manage nociception. The eventual end
goal is likely to be reduced pain even if the postural alignment challenge still
exists.
Yet, just as described above, it will be crucial to work with the client to help
reduce mechanical factors that put increased mechanical load on the region
that will further drive tissue irritation or injury and increase nociceptive input.
In a case like this it is best to advise the client on alterations in movement

or postures that they know contribute to their pain. Keeping a journal is an
excellent way for a client to help correlate their pain to their daily activities.
2 Forward head posture. This is probably one of the most common

postural challenges in our culture. The rise of occupations with sedentary
body positions and focus on computer, mobile phone and tablet screens
appears to exaggerate this posture even further.
Other factors may also play an essential role in developing forward head
posture. For example, I played tenor saxophone in the school band when
growing up, and as a result I developed a significant forward head posture from
spending hours each day with the weight of the saxophone hanging on my neck.
Today, I frequently have low-back pain, and after extensive evaluation, I can
correlate that pain with my forward head posture in a particular way. There are
many days when this posture doesn’t bother me at all. However, if I stand in

relatively static positions for long periods with the forward head posture, such
as in the classroom when teaching or in the kitchen while cooking, my low
back will hurt as a result.
Ironically, it rarely bothers me when I sit at my desk all day working on the
computer. This is because I have found a chair-and-desk position that
decreases the mechanical load even when I am at the computer for long hours
at a stretch.
Constant movement, I’ve learned, is the best antidote to prevent my back

It is tempting to look at
pain. I have often tried to address the problem with massage alone, only to
the postural challenge have it recur at the next instance of sedentary standing. Massage is helpful to
primarily from a address the symptoms of back pain and the resultant muscle tightness, but
movement and changes in how I stand or hold my body are the essential keys
massage perspective to prevent the problem in the first place.
and focus attention
on the short-and-tight This is an example where a postural/structural challenge is relevant to the
existing pain complaint. However, more extensive evaluation and assessment
muscles on the anterior were necessary to identify when and how this problem was manifesting.
side with the idea
It is tempting to look at the postural challenge primarily from a massage
that merely working perspective and focus attention on the short-and-tight muscles on the
these will change the anterior side with the idea that merely working these will change the postural
postural condition; condition; however, our more current understanding of motor learning and
neuromuscular patterns reminds us it is not that simple. Movement and
however, our more continual reinforcement of new motor patterns are necessary to alter habitual
current understanding postures and motor patterns that we have learned and reinforced over time.
of motor learning
Important Treatment Considerations
and neuromuscular What is most helpful is if we approach each of these problems in a
patterns reminds us it constructive way with our clients and remember that we play two separate
roles in each therapeutic encounter. We are a practitioner who performs
is not that simple. soft-tissue manipulation, and we are an educator who helps them learn more
about their body and how to live a more pain-free life. Here are some essential
guidelines to remember as we look at various postural and structural problems
with our clients:
• Don’t pathologize every postural challenge. Not everything needs to be

corrected. The body is highly adaptable to asymmetry.
• Use language and descriptions that are more positively oriented, such as
letting the client know that you think massage is likely to help them move
more freely and with less pain, regardless of their postural or structural
challenge.

• Steer clear of narratives that focus on postural or structural challenges
in a negative light, such as “Look at that overpronation in your foot. It’s no
wonder your knee hurts.”
• Remember that each person is an individual, and we don’t have to get

everyone to fit into some ideal postural alignment—such as having
anatomical landmarks perfectly lined up with a plumb line, for example.
• When looking at any postural condition, consider the context of how that
person is using their body and any other biomechanical factors that may
Massage is very helpful
either offset or exaggerate the postural challenge.
in reducing prolonged
tightness in muscles Enhance Positive Responses
Postural challenges involve a complex interplay of biomechanical, biological,
and helping reduce psychological and social factors. Merely attempting to address a soft tissue
pain in numerous pain complaint only from the mechanical lens of changing structure or posture
conditions; however, might address only a limited part of the problem. When we move our attention
away from posture and structure purely as a mechanical distortion that needs
it’s less clear that to be fixed, it lets us view each client more as a whole person.
massage can actually
Massage is very helpful in reducing prolonged tightness in muscles and
change posture in helping reduce pain in numerous conditions; however, it’s less clear that
many instances. massage can actually change posture in many instances. Postural change
seems to be strongly driven by motor learning and repeated neuromuscular
patterns.
Despite the very best massage treatment in the world, a person can easily
slip back into their stooped postural pattern on the way home. Some pain
complaints in which a posture is a factor are better addressed after assessing
the client more wholistically, and making subtle changes in movement patterns
and treating for pain reduction.
In other cases, focusing more attention on helping to enhance positive

responses through the neurological system may be more important than
potential changes we might have thought we were making by changing
posture or movement patterns. This shift in perspective might help emphasize
some of the most powerful aspects of what happens in the treatment
room: namely, neurological responses and the power of the client-therapist
relationship.
Whitney Lowe, LMT, directs the Academy of Clinical Massage (academyofclinicalmassage.

com). He teaches continuing education in advanced clinical massage through the academy,
and offers an online training program in orthopedic massage.

4 Questions about
Reiki, Answered
Reiki is a technique that originated in Japan. It is a form of energy work that is
administered with light tough or no touching of the body. Reiki is based on the
idea that life force energy flows through us, and that fluctuations in this energy
affect our physical health, according to the International Center for Reiki.
Here we have answered four questions about Reiki with information

excerpted from The Massage Therapist’s Guide to Reiki at massagemag.com/
reikiguide. Visit the guide to learn if Reiki is right for your practice, what the
science says about Reiki, how much a Reiki certification costs, and more.
1 What Does a Typical Reiki Session Look Like?

In a Reiki healing session, the client will remain fully clothed and either lies
on a massage table or sits in a chair. In a massage session, a serene, peaceful
environment is created for the session, often with quiet music. The Reiki
practitioner will either use light hands-on touch or hold their hands close to
Karuna Reiki was
the client’s body, moving their hands systematically through different positions
developed with the with the intention of discharging negative energy and replacing it with positive
intention of relieving energy.
suffering; the word

karuna is Sanskrit for 2 Where Does Reiki Energy Come From?
The energy from Reiki is universally available to anyone, anywhere, and
proponents of Reiki may also offer what are called distant sessions, in which
“any action that is
the receiver is not physically in the practitioner’s presence.
taken to diminish the
suffering of others” and
can also be translated
3 What are the Different Types of Reiki?
There are several different kinds of Reiki—and every practitioner brings
their own style to bear on what they were taught—but there are two main
as “compassionate types most commonly used in the U.S.: Usui and Karuna.
action,” according
Usui Reiki, the style that is most familiar in the West, began in Japan with Mikao
to the International Usui and eventually came to the U.S. with Hawayo Takata in 1937. It is typically
Center for Reiki used to promote relaxation, stress reduction and balance, which can in turn
promote healing.
Training.
Karuna Reiki was developed with the intention of relieving suffering; the word
karuna is Sanskrit for “any action that is taken to diminish the suffering of
others” and can also be translated as “compassionate action,” according to
the International Center for Reiki Training.

4 What are Some of Reiki’s Benefits?
Reiki has many benefits. Some of them include stress reduction, comfort
and relaxation, according to Reiki expert Linda LaFlamme.
In addition to the “Many clients report a feeling of enhanced well-being, peace and of feeling
benefits to the client grounded after a session or series of sessions,” she said.
who receives Reiki,
In addition to the benefits to the client who receives Reiki, giving a Reiki
giving a Reiki session session can also benefit the practitioner. Because Reiki is believed to balance
can also benefit the life energy, being an active participant in that process helps both you and your
client.
practitioner.
“A Reiki practitioner also receives some of the healing benefits of Reiki while
giving Reiki, as an added wonderful bonus,” LaFlamme said. “Professional
massage therapists [who perform Reiki massage] give so much of themselves
in their beneficial and loving practices.
“Offering Reiki to clients ... is a refilling of the well while providing value at the
same time,” she continued. “Everyone benefits, sometimes in profound ways.”
Whether you offer just Reiki or decide to work as a Reiki massage therapist,
both you and your clients will reap rewards from this energy work.

Market a Technique
You’ve Mastered a Modality—Now Let Clients Know
It’s more important than ever to keep lines of communication open with clients,
especially as your massage practice has no doubt been closed for weeks—or
months—due to the coronavirus pandemic. Whether you have reopened yet
or not, keeping on top of your marketing is key in order to make sure clients
know you intend to be a health resource for them when the time is right.
Your clients will need massage more than ever to cope with the stress
and isolation this situation has caused. Let’s dive into communication best
practices that will help you help your clients understand how the techniques
you are skilled in will provide relief.
New Things Matter

I often get emails from local south-Florida restaurants that inform me they’re
For many of the many introducing an entrée from the kitchen, a dessert from the pastry chef, or a
hundreds of MTs I’ve drink from the bartender. Frequently they’ll discount these offerings, so I try
met at countless CE them. It’s effective marketing, especially when products are good and price is
inviting. If this works for restaurants why can’t it work for massage therapists?
classes and in private The answer is it can work for massage therapists, and it does work for many of
sessions, I’ve seen how the 325 massage therapists whom I’ve privately coached.
difficult it is for many Let’s suppose you practice Swedish massage and have just been trained in
of them to market. myofascial release. How do you let clients know you’re offering more than just
relaxation? For many of the many hundreds of MTs I’ve met at countless CE
classes and in private sessions, I’ve seen how difficult it is for many of them to
market. Far too many body workers—even highly talented ones—see selling
what they do as an anathema. It’s for usually one or two reasons or both—
marketing and selling are dirty, nothing a massage therapist, doctor or hospital
would do. (Even though hospitals advertise all the time.) The other reason:
fear. Consequently, for many therapists introducing a modality, there’d be no
marketing whatsoever, no announcement to tout their availability.
Fear aside, what’s a good way to communicate this availability? There are
many answers. As Shakespeare wrote, let me count the ways. What follows is
an 11-point integrated marketing program.
1 All the newsletter that’s fit to print. You have one, don’t you? I’ll assume you
do. With email marketing companies like Constant Contact and Mailchimp,
it’s easy to let clients know what you’re doing—even if it’s just quarterly.

When introducing a modality, it should kick off your newsletter. You can donate
a free session to the first person who calls to collect it. I offer a coaching
session in both my general newsletter and massage therapist newsletter, and I
find it inspires people to read them carefully to win the freebie. Those who win
sessions who’ve never had one before often wind up becoming clients.
If your clients pass your newsletters on to those in their lives who are not
clients of yours might become winners of your free session and become
clients, too.
You wouldn’t dream Plus, email makes communication free. Create a mailing that announces your
of going into business new modality and send it to your entire professional and personal mailing lists.
without a business
card; the time is rapidly 2 BOGO. Supermarkets, bookstores and other retail businesses have found
buy-one-get-one-free offers have been very popular with customers. Yet,
only a tiny percentage of massage therapists have employed this strategy—
coming when you even though I’ve been telling them for decades how effective it can be.
wouldn’t dream of
going into business Why not make your myofascial release treatment available on a buy-one-get-
one-free basis? This strategy gives clients the opportunity to experience not
without a website just one, but two sessions.
either.
Considering the more thorough healing that could come from myofascial
release versus its Swedish counterpart, it’s likely clients will be enamored of
the method even if it’s likely to cost more than their Swedish sessions. If you
decide to adopt this BOGO approach, make sure you let clients know about it
in all your communications and platforms.
3 Caught in the web. I’m afraid to ask, but, you do have a website, don’t you?
If you don’t, what are you waiting for? Please don’t tell me—as I’ve heard
far too many massage therapists say in the past—“I’m not a computer person.”
If you’re not a computer person and you’re a massage therapist, you’re rapidly
approaching the time when you won’t be a massage person either.
You wouldn’t dream of going into business without a business card; the time
is rapidly coming when you wouldn’t dream of going into business without a
website either. I’ll assume you have a site. Make certain myofascial release is
described in great detail, including its many benefits.
If you’ve done some treatments already, ask those who’ve received them if
they’d kindly give you a testimonial. Don’t be shy! Your shyness could cost
people the opportunity of receiving its healing influences. (The website should
also contain your newsletter with the free session offer and the BOGO offer.)

4 Tweet, link and post. I’m still afraid to ask, but, you do use social media,
don’t you? If you’re on Twitter, tweet the news of your new method for
helping clients heal. If you’re on Linkedin, link in and let contacts know of your
development. If you’re on Facebook—you gotta be on Facebook, at least—
then, let’s face it, it’s time to start posting about your new technique.
If you don’t have a separate Facebook business page for your massage
business, it’s time to set one up. Don’t mix up news about massage or
myofascial release with news of your family, your vacation and the delicious
entrée you just ate at your favorite bistro.
5 Seeing is believing. We live in a very video culture, and one of the most-
watched channels these days is YouTube. Make a short video explaining
the benefits of your work, and feature you doing a myofascial release
treatment for a minute or two. Then cut to a client giving a testimonial, or
information about your free-session offer or BOGO plan.
6 Read the signs. Put up a sign in your office that lets your clients know the
new technique is available. Say something very positive about it, and put
the sign on your desk in a very prominent place, so they see it very easily when
they pay for their massages and schedule new ones.
If you don’t have a
separate Facebook
business page for your
7 Press on. Publicizing massage work is almost never done by massage
therapists. (That, of course, is a big missed opportunity, so don’t get me
started on it; it’s another article.) While only a community-minded newspaper
massage business, it’s is likely to give any coverage to the addition of a new modality, it’s certainly
worth the few minutes it takes to write a press release and find out the contact
time to set one up. information of that newspaper, because it might carry the item.
In one paragraph you can tell the story of your new technique. Be sure to
indicate what client or condition—Athlete? Headache?—the technique
best serves. In the closing paragraph you can summarize your career as a
professional massage therapist, indicating how long you’ve worked in the area.
What’s great about this is everyone who reads the story lives or works close to
where you work. Hence, they’re potential clients. If the piece runs, make sure
to mention it on your website, in your office, and in your next newsletter.
8 It adds up. I’m not a big fan of massage therapist advertising because
much of it is a total waste of money the way it’s usually done. But an ad
that promotes the healing nature of massage can help bring in new clients
and more than pay for itself—just make sure the ad speaks to the benefits the
technique brings about.

9 Talk is anything but cheap. Massage therapists are extremely talented
with their hands but not so much with their voices. But this is no time to be
shy—let everyone know you’re now making available deep healing work. All
you have to do when your client is off your table, out of your room, and about
to set up their next appointment is to ask if they’d like to book a myofascial
release session. It’s no more complicated than that.
If you’re doing a BOGO offer you can ask them if they’d like to get a free deep
If you’re doing a BOGO tissue massage. All they have to do is buy one and the second one is on the
offer you can ask house.
them if they’d like to

get a free deep tissue 10 Party! I’m not saying you need to throw a party to celebrate your new
offering—but, hey, it wouldn’t hurt. Some stores celebrate their grand
openings by decorating with bunting and streamers. It’s not needed to go this
massage. All they have
far but a little gathering could be just what the therapist ordered. Perhaps a
to do is buy one and get-together for a few hours with snacks like fruit, cheese and crackers, water
the second one is on and juice, even wine if you want to splurge.
the house. You could give a brief talk to explain the value of myofascial release. You could
even give a few short demonstrations of five minutes apiece, so people can
feel the advantages in their bones—or at least in their muscles.
Coach Cary Bayer (themassagemarketingcoach.com) has created 14 NCBTMB-accredited

workshops, two DVDs for MTs, wrote for 15 massage newsletters, and authored the Grow a
Rich Massage Business trilogy of full-length books.

NEW Free Massage Intake Form
MASSAGE Magazine Insurance Plus wants to ensure you have

all of the tools necessary to get back to work and practice safely.
Screen for COVID-19 with our free massage intake form.
Download Your Free Intake Form Here
(800) 421-5577

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The Top 8

SPECIAL: How to Market a Technique

for a wide variety of clients.

2 Assisted Stretching: PNF

proper muscular function.

create a lasting impact on the person’s emotional and

population and pregnant clients.

and corresponding pain complaints.

8 4 Questions about Reiki

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 2

Cupping found it footing as a technique for athletes. It still holds great

Here, three educators—Danny Porcelli, DC, Shannon Gilmartin, CMT, and

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 3

A final reason I prefer cupping athletes to other treatments is their belief

Cupping is generally regarded as safe, effective and inexpensive. It is one of

cupping—and different from the more common or traditional cupping

Therapeutic cupping employs negative pressure to approach the body for

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 4

Shannon Gilmartin, CMT (moderncuppingtherapy.com), started her massage therapy

Normal lymphatic drainage of the breast is often impeded by tight-fitting

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 5

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 6

• Enhanced coordination. Maintaining full range of motion through joints

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 7

Reciprocal inhibition: This principle describes how a muscle relaxes when

fibers. What Happens During a PNF Stretch?

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 8

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 9

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 10

understanding of How Trauma Expresses

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 11

Trauma is processed in the mind in a fascinating manner. Neuroscientist and

The Stress Response Cycle

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 12

Massage for Trauma: Emotional Release

3. Continue as directed by the client. We hold space for clients and

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 13

Also, deducing myofascial patterns of tension and determining where a client

A final note on massage for trauma is for massage therapists to seek

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 14

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 15

Three Part Breath

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 16

Taping for Athletes

I first began my integration of kinesiology taping

For myself and so many other massage therapists as well as

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 17

One popular application is applying the tape in an X pattern, covering the

Kinesiology tape is a drug-free, safe, non-invasive, low-cost intervention that

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 18

Studies concerning the efficacy of kinesiology tape for treating pain

• A 2017 article in the Medical Science Monitor, “Kinesio Taping vs Placebo

• “Short-Term Effects of Kinesiology Taping in Women with Pregnancy-

• A study published in 2017 in Ginekologia Polska, “Impact of Kinesio Taping

Taping is for Everyone

If you are interested in adding this technique to your repertoire of bodywork

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 19

THE TOP 8 MASSAGE TECHNIQUES FOR 2021 | 20

I am continually asked by prospective clients if my services are a foot

On the opposite end of the spectrum, I remember a gentleman who came in

Foot Reflexology Chart

Medial side of the foot

Reflexology is “Reflexology is a protocol of manual techniques, such as thumb and finger