Terra Rosa eMagazine Issue 6

Terra Rosa e-magazine No. 6, December 2010 1

Terra Rosa Terra Rosa EEE---MagazineMagazineMagazine

No. 6, December 2010

Contents

02 Myofascial manipulation— Mau Ronchi

11 Passivattiva technique for the torso & upper extremities — Mau Ronchi

19 The Trendelenburg test —John Garfield

20 Learning massage through videos—Video killed massage books?

24 Art Riggs Deep Tissue Massage workshops in Sydney

27 Fascia science made simple—Bethany Ward

33 Interview with Gil Hedley

36 Myofascial stretching for hip flexors - Walt Fritz, PT

37 Fibromyalgia: New perspec-tives—Steve Goldstein

44 Relieve computer neck & shoulder tension— Anita Boser

46 Spock massage

47 Research highlights

49 Six questions to Steve Goldstein

50 Six questions to Bethany Ward

Disclaimer: The publisher of this e-magazine disclaim any responsibility and liability for loss or damage that may re-

sult from articles in this publication.

Greetings for the festive and holiday sea-

son. And this is our sixth issue of our free e-magazine dedicated to bodyworkers.

In this issue we have a full 50 pages of informa-tion crafted by our distinguished authors with a special focus on fascia. This issue started with a thesis on Myofascial Manipulation by Mau from Italy, and followed by a demonstration of his techniques. The Trendelenburg test by John from the Gold Coast. We look at the history of massage videos. Video killed massage books? Read a report form our recent workshops by Art Riggs, a great teacher.

Bethany Ward attempts to explain science be-hind fascia in plain terms so it understandable and applicable to bodyworkers . Followed by an interview with Gil Hedley on Integral Anatomy. Myofascial stretching by Walt Fritz.

Our own Aussie-American Steve Goldstein ore-sents a new perspective Fibromyalgia. Anita Boser gives you some tips on Undulation. Check out also when Dr. Spock becomes a mas-sage therapist.

We’d like to thank all the authors who have contributed to our magazine. Thanks for all of your support and enjoy reading. May you have a successful new year, continue to grow both in your business and therapeutic skills. Have a great holiday and hope to see you again next year.

Sydney, December 2010.

Open information for massage therapists & bodyworkers


This article aims to connect some of my experi-ences as a sports bodyworker with the technical and scientific aspects of research studies. It high-lights the essential the use of myofascial manipu-lation in order to improve athletes sports per-formances. In particular, I want to validate pas-sivattiva technique, a myofascial release tech-nique which I have developed (see Terra Rosa Bodywork magazine, Issue no. 2)

First, I will discuss about connective tissue and make just a brief introduction to the meaning of “connectivity” of the connective tissues which we will treat using manual techniques. There are two different types of connectivity: a mechanical one and a functional one.

The first one is characteristic of the more resis-tant and fibrous tissues, and is needed to protect and sustain various organs and to connect and settle between themselves various tissues. The second one is exclusive to tissues with a higher content of water, more ground substance, less dense and robust, therefore more fluid and adapt to the transport of nutrients and to the defense from external agents.

The connective system can be seen as fascial chains or fascial trains, as the distributor and harmonization of all forces expressed by the tis-sues – contractile system. The fascia under the athletic-sports aspect, act as an orchestra direc-tor of our body, able to manage all the movement parts, Central Nervous System – Muscles – Skeleton. Without it our movements would be like a robot-man, without harmony and the flu-idity human gesture.

If we simply compare the human body to a vio-

lin, we could think of the chassis as the skeleton, the violin bow as the muscular strength, the subject that plays it as the central nervous sys-tem (CNS), and the cords as the fascial chains. The cords evenly transmit on themselves all the muscular strength produced by the violin bow and they induce also the vibration (strength) to the whole instrument.

The player’s fingers pressing on various part of the violin handle are like the intersection points or variation of tissue mass-dimension-density, where is discharged part of the force transmitted from the fascia.

If the above all happens with harmony and syn-ergy between the parts we will obtain a nice sound, therefore if the body is well trained, har-monic and synergic in all its components we will obtain a good athletic-sportive performance.

I believe the fascia system is the most relevant part of this concert of components, throughout all its fascial chains, it directs and transmits with harmony all muscular strength through the whole body. The main thing needed now is that the instrument should always be well maintained if we ask it to give a good performance.

It is understood that the manipulation and the sports bodyworks along with the athletic prepa-ration are very important means to maintain the body tuned and equilibrated, also the importance of routine maintenance to correct all anomalies due to overuse and overload.

Myofascial Manipulation: Myofascial Manipulation: Myofascial Manipulation: Relating practice to theoryRelating practice to theoryRelating practice to theory

Maurizio Ronchi


It is clear that the inactivity, repetition and over-working affect negatively the muscle functional-ity and the connective tissue in all its forms from myotendon-aponeuroses and capsulae-ligament, until the inner connection fascia-muscle and nervous fibers, due to the well recognized strict connection between muscle and fascia. What can cause, at a practical level, these thickening situations with an increase of the connective tis-sue fibers covering (or close by) a muscle? Due to the loss of elasticity of fascial glide or of the near CT, follows up an increase of muscle length pas-sive resistance force; therefore less myofascial escursion, ensuing stiffness and retraction and finally a sensible deduction of muscle – joint bio-mechanics functionality. This condition is appre-ciated from the athlete who feels compelled to make an athletic gesture, as well as the operator during the execution of simple muscular tests and joint ROM.

Please find here below a scheme by Mauro Las-trico (1) (who kindly gave me permission to pub-lish it here) which easily express the mechanics of myofascial retraction.

Comments to picture. “ The causes of the muscu-lar shortening”

The muscular fiber is composed from a sequence of parts which are contractive (elastic, repre-sented as yellow ellipse) and the non contractile parts (plastic connective tissue, red rectangular). With reference to the physical laws on the defor-mations of the elastic bodies, it turns out that the members that are contractive, the muscular fi-bers behave like elastic elements; consequently

after deformation by compression (contraction) they can return to their initial condition. On the contrary the ones that do not have contractive components (such as connective tissues) behave like plastic materials, so if a deformation (compression) occurs with a force and for a suffi-cient time to exceed the threshold of the curve of the elastic deformations, it will enter the area of permanent deformation, the connective tissue will remain shortened.

“As a matter of fact, a muscle with fibers of actin and myosin more closely connected, with a thick-ening of connective tissue, which becomes more fibrous, lead to an increase of passive resistance force with a decrease of elastic capacity and func-tional resistance of the muscle itself ”( U. Mo-relli )(2).

Here I will show you a simple and empirical ex-ample illustrating the above theories.

The first picture is an example of a relaxed mus-cle , where the violet net represents a portion of densified and highly fibrous fascial tissue. The second picture simulates the contraction of the muscle, which highlights the low elasticity of the

Myofascial manipulation


fibrotic fascia, which cannot allow the physio-logical dimensional change of the muscular belly, and such deformation lead against the natural biomechanic joint movement to which the mus-cle is connected.

Therefore this collagen and fiber thickening, are areas that need manual treatments in order to maintain a physiological elasticity/flexibility es-pecially after a trauma-injury or an intensive/repetitive work/training cycle aimed to a specific joint muscle district.

During my research and close examination of this topic, I was drawn by a dissection made by the Department of Anatomy and Human Physi-ology of Padova University by Carla Stecco which compares “nude” and fascial muscles. This study “Studio anatomico della continuità miofasciale ” ( C. e A. Stecco)(3), was presented at the First Fascial Congress 2007 in Boston USA.

I also found an interestinge definition of myofas-cial expansion of the muscles, which is the main subject of their research. Luigi Stecco, one of the first scientists and bodyworker in the fascia field, gave me precious help in order to deepen my knowledge of physiology and all mechanisms of various forms of connective tissues.

It also brought me to better comprehend and

clarify the way all myofascial ma-nipulation, like passivattiva tech-nique, improve a poor physical-athletic condition. When we ap-ply manipulation technique to treat a fibrous CT, the pressure and induced heat are able to sof-ten the fascia’s Ground Sub-stance*. Therefore we can change from a dense gel physical state to a sol more soluble state, allowing also the rupture of eventual tis-sue adhesion and linkages. Colla-gen and Elastin proteins are of-ten found together, their interac-tion generates viscoelastic prop-erties of the connective tissue.

The viscoelasticity depends on collagen, elastin and ground substance quantities (Arti Ahlu-walia)(5).

* The gelatine Ground Substance that consti-tutes together with collagen and elastin the “extracellular substance” – ECM- on both soft and hard/mineralized tissues. It is mainly made of proteins PolySaccharids or Glycoaminoglycans (GAGs), which act as cement between fibers of collagen and elastin (6).

“Mature collagen is susceptible to no enzymatic glycaction and the substances produced can be transformed in a cross-links able to inhibit the natural collagen turn-over. " ( A. Scherillo ) (7).

I should highlight the fact that only CT is plastic and malleable due to the thixotropic property of collagen, meanwhile muscular tissue doesn’t have this property. Often when thinking about fascia, we think about only the aponeuroses layer around limbs but we should think also about epi-mysium-perimysium-endomysium. This colla-genic skeleton of the muscle is what gets over-load or repetitive strain syndrome and acute damage.

I always like to highlight the importance of colla-gen for our body using this quote: “Collagen is one of the most ubiquitous proteins of our body.

Images from: " Histological study of the deep fascia of the limbs" (4)



It is the structural element that supports every-thing under the skin, veins, tendons, ligaments, cornea, bones etc. It has the same importance for our body as the steel in a technological world” (5).

Myofascial manipulation brings a hard and fi-brous CT to a normal elasticity due to its viscoe-lastic property of the Ground Substance as well as breaks all cross-links tightness with adjacent tissues returning to the physiological movement to permit a more free joint ROM .

Here I will show you a simple empirical example of viscoelastic change induced by a myofascial manipulation technique:

The picture on the left shows an aluminium sheet as the fascial sheet, normal fascial sheet and on the right I simulate overuse of the fascial sheet.

As a result, here the col-lagen fibers are ran-domly positioned and the layer is crumpled.

However using myofascial manipulation tech-nique, we can induce viscoelastic change with realignment of collagen fibers and reinstating the natural sliding layer due to the mechanical ac-tion and heat induced by the technique.

Obviously it is not possible to have a myofascial release on all human body CT’s structures. As indicated by Robert Scheilp in the article “Three-

dimensional mathematical model for deforma-tion of human fasciae in manual therapy" (8), in order to have an evident viscolelastic change of Iliotibialband ( ITB ) several tens of kilos of force-weight induced by manipulation are needed and therefore it is impossible to apply. But it is not a lost cause!

In fact, from my experi-ence, and I believe not only my experience, treating the ITB tract (as seen in my first part of passivattiva technique) with stripping using the fist, it is not difficult for both the practitioner and athlete can feel and hear the creeping or the pop-ping sound of a myofascial release.

What did our manipulation induce? Speaking with Robert Schleip (an international acclaimed fascia expert), we agree that probably the ITB aponeuroses external part is structured in a dif-ferent way from the core, with a possible differ-ence in density and order of collagen fibers. Probably, because for the time being we haven’t got a detailed histological studies yet. Therefore the release we feel is due to the breaking of myo-fascial adhesions, such as those links that form between the different layers of tissues made by weak hydrogen bonds and van der Waals forces which determine the tissue tightness.

In accordance with the viscoelastic property of Extracellular Matrix (ECM) we can come to the conclusion that all effects induced by manipula-tion brings sensible changes like breaking the layers linkages and ECM hydration changes that allow the practitioner to feel the myofascial re-lease which also apply for dense connective tis-sues like the Iliotibial tract. We will not be able to modify the dense fibrous structure but we will definitely be able to modify its tightness and the gelatin matrix to which it is dispersed and wrapped.



Several studies show the differ-ence of a cross-link holding force between a tissue with a higher per-

centage of elastin and one with less. The force of elastin links is much lower compared to the one of collagen fibers therefore it is much easier to manipulate (Rizzuto, Del Prete) (9) .

Meanwhile, always simplifying, in the case of a viscoelastic change during a myofascial manipu-lation, we already know based on the latest stud-ies, that between 2 – 3 minutes with a load of a few kg of force-weight applied, we observed a change of the physical state of the Ground Sub-stance.

But that is not all! The fascial manipulation, as passivattiva, can affect the proprioceptive re-store.

To highlight these considerations and the precise scientific basis, I have to go back to the marvel-lous research work "Histological study of deep fascia of the limbs " (4) which is the source of some interesting aspects of myofascial system and valuable knowledge to the know-how of a sports bodyworker in order to arrange his own manipulation techniques. I will give an account of some aspects of the study. First I would like to talk about the morphology of the deep fascia, the layer where CT is tightly connected to the mus-cles. The layers we are talking about are from the brachial and crural fasciae. These layers of fascia are not uniform; they have different types of den-sity.

The deep fascia of the limbs is a sheath present-ing a mean thickness of 1mm, formed by two to three layers of parallel collagen fibre bundles. In the adjacent layers, they show different orienta-tions. Each layer is separated from the adjacent one by loose connective tissue, permitting the sliding of the collagen layers. Nerve fibres were found in all specimens, while muscular fibres were evidenced only in one specimen.

The structure permits the fasciae of the limbs to have a strong resistance to traction, even when exercised in different directions. The capacity of the different collagen layers to glide one on the other could be altered in cases of overuse syn-drome, or trauma.

This study on the deep fascia is of great help to practitioner to evaluate how to arrange the pres-sures of a manipulative myofascial to normalize an excessive densification in a muscle due to overuse, overload or high repetition of an athletic performance. I think it is extremely useful know-ing how and where the CT collagen fibers den-sity, changes in order to obtain better results from our techniques and a noticeable energy sav-ing from the operator.

Another aspect ex-tremely useful for sports therapist and highlighted from the research results is how the deep fascia is structurally or-ganized. Some im-ages explain and show how the vari-ous collagen fiber bundles cross themselves up to obtaining a very resistant structure to traction and very adaptable to lengthening even though it has a low presence of elastic fibers (1%) assum-ing a characteristic wave shape which increases elasticity and flexibility.

Another study of research made by Carla Stecco “Modello per la misura dei parametri della fascia profonda” (10), explains once more how excep-tional it is the potentiality and adaptability of the fascia. This resistant and elastic property seems to be caused by the orientation/direction of the collagen fibers in the various layers of the fasciae of about 78°. This exact positioning, explains why the fasciae has an excellent biomechanical property, with an elastic capacity in all direc-tions. Thanks to this angular structuring, the tractional, compressive and direct force applied to the muscle, are directly transferred to the deep



fascia without creat-ing too much negative resistance, even with the presence of nu-merous elastic fibers.

This kind of elastic structuring allows for an excellent transfer-ability between the various fascial layers. This helps us explain the different approach (planning /execution), between a myofascial sports massage and a

traditional one (which is based on effleurage and petrisage has little results). What is really needed is precise and specific manipulation, to diversify the viscoelastic property, and try to normalize the fibers density created by tension, injury, overload or scars.

At this point, I would like back to the exchanges point of view about the passivattiva with Robert Schleip. He agrees that for a better results in a myofascial release, one of the prerequisites is to manipulate as much as possible the entire mus-cle and its surrounding myofascial expansion, as explained in the first part of my technique.

The manipulation should be applied at 360 de-grees in an ample wrapping manner: under, over, sides, for surrounds all muscle mass and fascial expansions during its changes, contrac-tion, stretching and relaxation phases, both ac-tively by the athlete and passively with the help of the operator during the muscle/joint range of motion.

That’s the mechanics of passivattiva technique. This way, not only is it possible to help/increase the fluids circulation into the Ground Substance, of which we know still very little, even though we are now more sure than ever about the impor-tance of the dynamic hydration effect created by proper myofascial manipulation.

After the myofascial manipulation that created a

plastic or permanent change, and if we asked the athlete to do some exercises for the interested area or we do them passively, we can feel the re-sult is more durable, also increased GAGs regen-eration and stimulating the physiological colla-gen turnover (Brad Hiskins) (11).

This passivattiva technique for sports bodywork is also able to stimulate various mechanoceptors present in the deep and adjacent tissues (myofascial expansions) and considering the dy-namic and wide myofascial surface treated, im-proving the proprioceptive system for a more or better muscle-joint stability and gesture in the sport performance, and during the rehab ath-letic route.

I borrow the term Myofascial Induction (Induzione Miofasciale) by Maurizio Cosciotti, who works alongside Prof. A. Pilat and co-author of this great book, which is useful to finalize all consideration made until now along with one of my recent experiences. It is curious how all these inductions produced by a myofascial manipula-tion, especially for the proprioceptive input ap-plied, I directly encountered them studying deeply, even before knowing the physiological mechanism of the chemical-physical change which happens in the manipulated areas. It has been less appreciated in the experience I had fol-lowing the evolution of shoulder dislocation to some of my rugby players. Six shoulders gone in the first months of the season. One fracture of the Clavicula meanwhile the other five weren’t so bad.

Obviously started the normal hospital emergency room, immobilization and orthopedic visit, out



of the system of con-ventional rehab, the athlete is given a classi-cal self-made home program : elastics, stretching, Codman’s exercises and various auto-mobilization tech-niques.

As seen and confirmed by my experience, 60% of the athletes (for the longing of the sport and the need of physi-cal fulfilment) will only exert themselves and ex-ercise for one week/ten days. Half of the re-mained will work at home on their problem for about two weeks, and the other half (remaining 20%) will complete the entire program as pre-scribed by the therapist or sports doctor.

Based on these statistics, we all know the length of the rehab route, but most of all the poor qual-ity of the athlete once back in sport-action or trainings after a rushed “do it yourself ” therapy. Without digging to deep about the “why” or “how” one ends up with so many injured ath-letes, we do know that a rehabilitation program based on “do it yourself at home” therapy, can and most probably will add to the numbers of re-injured athletes, as expressed by the Director Dr. Claudio Manzini of Orthopedic-Traumatological department of Giussano Hospital, Italy.

For this reason, we know and see why it is so im-portant for us to use our techniques on the ath-letes, for their sporting future, and to prevent possible regression.

“When a joint is immobilized, the least loading and unloading mechanically of the cartilage and surrounding tissues interferes with a normal ex-change of the cells and the matrix substance (ECM). The consequence, the loss of matrix adds to the vulnerability of the injured tissue, and a higher risk of injury to the same tissue once the athlete resumes a normal sports activity (Elzi

Volk)(13).

Well, now I going back to the my rugby players injured shoulders. Adding to the usual “work at home” therapy, I have been seeing the athletes on a weekly basis, to improve the articulation and mobility of the limbs, and to test the muscle capacity. Massage to increase the micro circula-tion and drainage, to eliminate rigidity, contrac-ture, adhesion or loss in the affected areas, and to resolve the problem of balance compensation in other parts of the body.

But the most beneficial work done according to me, was not the manipulation of the Rotary Cuff muscles belly, but the CT in that area in all of its variations, ligaments, tendons and myofascial expansions included. Therefore, a massage and manipulation more widest and deepest, keeping in consideration the ties between dense and lax CT, rich of Ground substances, where one creates important zones of transition (15) .

Seen in this light, I have manipulated the various aspects of the available CT form, tendons, liga-ments, joint capsule, the entire muscle and sur-rounding, intersecting, joining and overlaying areas.

That treatment is necessary to restore the right bio-mechanics balance, and must to do it as soon as possible, or the continuos overload can light an anatomic changes that driving to a not syn-chrony of myofascial chain, then in a bad quality athletic performance ( G. Di Giacomo ) (16).

Within a few weeks I was told by my athletes that compared to a similar earlier injury and “home made rehab”, the shoulder feels more attached, more secure, and felt the need to increase the repetition and resistance of the exercises, after my support. Now, after having studied these problems, and after a lot of research and vast lit-erature, I understand and can say (without in-venting hot water) how important it is for a bodyworker to address all parts and aspects of CT in the area to be treated, also under the as-pect of proprioceptive input induced. The pro-prioceptive stimulation is more important, its



signal running more fast than the nociceptor sig-nal, because is one of the best prevention for joint injuries (M. Cesena ) (17).

This obviously makes me think that my experi-ence is not a singular case, but fruit of a precise and now well known to work efficient myofascial manipulation – sports bodyworks - where also the passivattiva technique is a reference.

The experience leaves me satisfied and happy in the role of sports bodyworker, given the work and assistance together with the athletes in their final stage of therapy, no longer delicate, but es-sential and never to undervalue.

Our treatment and support, can give to the ath-lete a reasonable range of mind tranquillize due to proprioceptive recovering, improving to per-mit him a safe “back in action”. Now more than ever I am convinced that the know how of a sports bodyworker is a mix of experience and sci-entific research to obtain the most efficient tech-nique to help the athlete improve or regain after injury the best performance possible, remaining always within the boundaries and limits oper-able.

I would like to finish this, which has cost me a lot of pleasurable sleepless nights, with the consid-eration of the fascia movement in Italy which is timidly but with great determination trying to come to light of day in Sports & Medicine.

Timidly only because it is truly difficult to find space, resources and help to be able to research and experiment in the fascinating fascia world (or fascianating, used by Robert Schleip).

I am certain, I am not a doctor nor am I a thera-pist, only a simple sports bodyworker, and it is hard to get any answers here in Italy, with many doors being closed in face, while at the same time, for years I have collaborated with illustri-ous scientist, researchers and bodyworkers from around the world, among which the famous & extraordinary Doctor David Simons, he always ready to answer and aid me to explain and un-derstand some technical dubs.

But we of the fascia movement are determined and optimistic and seeing what is happening in these last few years in the fascial world commu-nity we are hoping that also our country will con-tribute to the process of research and develop-ment in this field.

Here below you can find a quote by Luigi Stecco:

“.....only a hand guided by deep scientific knowhow can solve well and quickly a muscle-skeletal problem. The more knowledge you have, the more easily you can find the cause of pain and of a joint dysfunction. It has nothing related to magic.” (18)

Therefore the approach with various techniques must keep into consideration of this structural specific situation in order to obtain the maxi-mum results and especially avoid an useless te-nacity in the low density and thickness areas. I’m always happy to remember a step of Tom Myers paper, where he remarks the importance of find-ing-feeling the resilient areas and the adaptabil-ity of the fascia superficially before untangling the deeper mass. By going deeper too quickly you risk to bury even more the problem instead of resolving it as quickly as possible. You need a precise approach plan and the help of the athlete which by the aim of the passivattiva technique; “he is involved in the process increasing the pro-prioceptive by mechanoceptors stimulus, allow-ing to the operator to easily feel which level of myofascia has been approached.” ( T. Myers ) (19).

THANKS to…

Really I must thanks these extraordinary per-sons: Bellia Rosario, Casciotti Maurizio, Chetta Giovanni, Crippa Lorenzo, Dalton Erik, Polimene Federico, Riggs Art, Stecco Luigi and Antonio. Also to Piera and Massimo Terragni, owner and trainers of COBRAGYM for their availability and support during my tests. Mrs Cristina van Hal for helping with the translation.

...and DEDICATION



This article is a personal dedication and huge thanks for the scientists and researcher in the various fields as human physiology, anatomy, and biomechanic. Their contribution, for us sports bodyworkers, is the ground where we build our techniques, and thanks to their publications we can give a scientific validate to our works. But also for better understand what we can induce with manipulation, and to be even more efficient to aid athletes in own sports performances. After big sport events, is usually thanks the medical, technical and training staff, but very few time are mentioned who made the obscure ground re-search work. I want to mention some of these ex-traordinary scientists as

Dal Monte Antonio, Gibson William, Gracovetsky Serge, Schleip Robert, Simons David, Stecco Carla and many others.

Grazie,

Maurizio Ronchi

References

1. M. Lastrico: Il trattamento delle lombalgie secondo il me-todo Mézieres - www.aifimm.it/

2. U. Morelli: Rieducazione posturale metodo Le TRE Squadre - www.tresquadre.com/

3. C. Stecco, A. Stecco: Studio anatomico della continuità mio-fasciale - abstract dei lavori del FIRST INTERNATIONAL FASCIA RESEARCH CONGRESS, Harvard Boston USA 2007 - www.fascialmanipulation.com/

4. C. Stecco, A. Porzionato, A. Stecco, R. Aldeghieri, R. De Caro: Histiological study of the deep fascia of the limbs - Uni-versità di Padova - FIRST INTERNATIONAL FASCIA RE-SEARCH CONGRESS, Harvard Boston USA 2007 - www.fascialmanipulation.com/

5. A. Ahluwalia: Biomechanics of Soft Tissue: An introduction - Centro Interdipartimentale di Ricerca "E. Piaggio", Facoltà di Ingegneria, Università di Pisa - www.dionisio.ing.unipi.it/

6. U. Andreaus: Resistenza dei BioMateriali - BioMateriali naturali Parte 1ª - www.clinicaebiomedica.ing.uniroma1.it/, Roma

7. A. Scherillo: Riproduzione, sviluppo e accrescimento dell'uomo XVIII ciclo - Università di Napoli - www.fedoa.unina.it/

8. R. Schleip et al.: Three-dimensional mathematical model

for deformation of human fasciae in manual therapy -JAAO - vol 18 - N° 8 - August 2008 - 379-390

9. Z. Del Prete (dispensa a cura dell'Ing. Emanuele Rizzuto): Misure in vitro delle proprietà viscoelastiche di tessuti connet-tivi - Corso di Misure Industriali II Università degli studi di Roma "La Sapienza"

10. C. Stecco: Modello per la misura dei parametri della fascia profonda - Atti I Convegno sulla Manipolazione Fasciale, CMS, Vicenza, 2009

11. B. Hiskins: Tissue Tension Techniques -www.softtissuetherapy.com.au

12. C. Manzini ed equipe: Patologia traumatica e da sovrac-carico nello sport: nuovi percorsi terapeutici - Corso organiz-zato dall'U.O. di Ortopedia-Traumatologia del Presidio Osped-aliero di Giussano (MB), 2008

13. E. Volk: Connective tissue: the good, the bad and the ugly - www.thinkmuscle.com

14. D. Amiel, S. L-Y. Woo, F.L. Hardwood & W.H. Akeson: The effect of immobilization on collagen turnover in connective tissue: a biomechamical correlation - Acta Orthop Scand, 53, 325-332, 1982

15. Appunti di Medicina per studenti: Connettivi propria-mente detti - http://doc.studenti.it/

16. G. Di Giacomo: Inquadramento clinico diagnostico della spalla: patologie più frequenti – Etiopatogenesi - www.laspalla.it/

17. M. Cesena, M. Baldo, A. Chiffi: Distorsione tibiotarsica nella pratica del rugby: dall'incidenza al recupero funzionale ad una proposta di prevenzione - BLUWELLNESS periodico di informazione sanitaria, ottobre 2003, n. 3 - www.blucenter.net/

18. L. Stecco: La cura della fascia - Intervista pubblicata su Vita&Salute, aprile 2003 - www.fascialmanipulation.com/

19. T. Myers: Appendice 2 - principi di trattamento - linee guida - da Meridiani Miofasciali - www.anatomytrains.it/

20. V. Rucco e F. Genco: Il massaggio trasversale profondo secondo Cyriax nella lega mentite ileio-lombare - Ospedale di Medicina Fisica e Riabilitazione Servizio Terapie Fisiche, Spilimbergo (UDINE)



Here I present the passivattiva techniques for the Trunk and Upper Limbs. I recommend to be always slow during your work to achieve a good result.

Myofascial release for Levator Scapulae and Rhomboids. The release direction follows the Spine of scapula. The best efficacy is by asking to athlete to push his head towards the therapists chest. This technique will allow some popping , the typical sound of some manipulations, and for mo-bilization of the muscle ( with kind permission by Lorenzo Crippa ).

These techniques have the same aim as the previous one, here using a different tool for more or less “deep”. Therapist change the Scapula position to get more available muscle sur-face, and at the same time he asked the athlete to aid with shoulder motion.

Passivattiva Technique Passivattiva Technique for the Torso & Upper Extremities

Maurizio Ronchi


Passive stretching for Rombhoids and treatment of the fascia at the border of Scapula, with passive movement .

The same technique but with active arm movement by the athlete.

Deep work for Scapula border fascia and Subscapularis from Serratus to restore the physio-logical Scapula glide on the chest.

Passivattiva technique


Fascia around Clavicle

Twist &roll for the several myofascial expansion at the Clavicle. Ask to athlete to move the shoulder forward and backwards, and treat both in static position and in movement for get the best result.

Supine variation, in this case we ask to athlete to glide up& down the shoulder over the massage table.

Twist & roll manipulation for Sternocleidomastoid. Athlete turning with head torsion for muscle contraction or stretching.

Pectoralis

Myofascial release for Pectoralis Major and Minor, and manipulation of the Axillary fascia. Ask for a slow arm movement while the gentle finger to go inside and slid-ing over the chest.


Terra Rosa e-magazine No. 6, December 2010 14 14

Latissimus Dorsi

Release for Latissimus dorsi, Teres and Infraspinatus, change or ask for change in the arm position.



The Pelvic area

Warming up. A slow and deep fiction for some minutes, so we can induce a better tissue plasticity , good for following manipulation.

After the warm-up, we can treat the posterior Iliac crest, where a lot of fascial tissue are attached. On the right, let the leg hanging down for a joint relax, then pull the Iliac crest. In case of a big athlete for better stability, ask him to hold with the hand on the edge of the massage table.

Side thrust to slacken the SacroIliac joint, and same technique to release the Piriformis ( with kind permission by Lorenzo Crippa ).



To complete the SI joint release, therapist use own Ulnar forearm side inside the two joint bone. The movement forward/back the spine direction is in synchronicity with leg motion anchored to therapist’s arm ( with kind permission by Erik Dalton).

Deep friction to treat the Iliolumbar ligament (ILL). Often the pain to the lumbar area is cause by a functional overload of ILL. The choice of the tool is related how deepest we want to go. These techniques mobilize the cutaneus and undercutaneus layers over the tendons, fascial and aponeuroses layers.

The Forearm

Twist& roll for Biceps Brachii. In passivattiva with the arm motion we got the best result.



Twist & Roll for release between Biceps and Triceps Brachii

Here with this technique, the therapist can tune the muscle to release and stretch. (with kind permission by Giovanni Chetta).

Release techniques for wrist and fingers flexor tendons. The thumbs works the tendons while the fingers treats the ex-tensor muscles on the back side of forearm.

Therapist tuning the muscle-tendons stretch, changing the knee pressure versus the athlete palm. (with kind permission by Giovanni Chetta).

The last two pictures show the stripping technique to decompress the forearm tight fascia. A good one for sports involving weight, e.g. javelin, hammer ect, or judo, gym-ring, tennis, rowing.



The “Third finger test” for check how freely is the motion degree of extensor muscles. In the case of negative result, therapist can perform a full compartmental myofascial release

The “Smiley” manipulation for extensor tendons and muscles release and mobilization. The same work for Brevis and Longus tendons of the thumb. These manipulation made the typical popping sound release ( with kind permission by Lorenzo Crippa).

Please Note: This article is obviously not substitute of medical procedure, ask to a specialist before use the advises show here. Paper is free to use, just quote the author and source.

Maurizio Ronchi email [email protected]

Sports bodyworker member of Seregno Rugby Medical Staff

Associazione Manipolazione Fasciale® -Fascial Manipulation Asso-ciation®

Associazione Italiana Taping Kinesiologico®

Teacher of Passivattiva Technique



It is my observation that although many body workers have learnt the Trendelensberg Test they are often not taught an effective method of correction. Without such knowledge this valuable test is sadly dropped from their repertoire of assessments.

REASON FOR TESTING: To determine if there is a muscle firing dysfunction and/or weakness of the glu-teus medius which can lead to a chain reaction of wide spread muscle dysfunction. Especially the piriformis muscle which is forced to take on an increased pelvic stabilizing role, which in turn creates a chronic hyper-contraction of the piriformis & contributes to sciatic nerve pain. Gluteus medius can contribute to, amongst other things, neck & back pain, sacroiliac joint dysfunc-tion, pelvic rotation along with leg length discrepancy.

THE TEST:

Client: Standing with back to you (best to have a wall or back of chair in front of them for balance, especially if injured or elderly)

Therapist: Squatting behind client with hands on top of each iliac crest laterally

Ask client to raise (flex) his/her left knee to 45 degrees if capable and hold for approximately 30 seconds. Ob-viously if someone experiences pain on lifting the leg it would be a contraindication until improved. Test for both sides.

Negative Test: If the unsupported pelvis (opposite to one standing on) stays at same height or goes slightly superior. (Left on the picture)

Positive Test (dysfunction): If the unsupported pelvis drops inferiorly making it lower than the supporting leg side. (Right on the picture)

IMPORTANCE OF CORRECTION: If left uncor-rected it will interfere with gait and can have multiple chain reactions throughout the body. It is often the cause for a hypertonic piriformis. CORRECTION: If positive test. (A take home exercise is shown to your client after your usual pelvic treat-ment which has addressed any gluteus medius dysfunc-tion. The exercise will re- program the gluteus medius

to fire correctly and maintain appropriate muscle tone.)

THE EXERCISE: Have client stand facing a wall or back of chair (for balance) supporting themselves with their hands. If left leg was positive start by putting all your weight on the right leg (by slightly lifting left leg off the ground). Tighten (contract) the gluteal muscles strongly of the left unsupported leg and maintain that continuous tension while you now transfer all your weight onto that leg and lift the other (R) into the Trendelenburg Test position. The iliac crest should now be level. Make sure they are standing upright. Hold position for 30 secs. REPEAT 2 more times. Only need to do it on the positive test side/s. There can be a bilat-eral dysfunction also which warrants doing the exercise on both sides.

Perform the exercise daily. You can do it 2 or 3 times a day for faster results. Train your client in the correct execution and check their technique every treatment as many people find it difficult to understand. Within 3 or 4 weeks of exercise the gluteus medius should be re- trained.

Usually within 2 - 3 weeks muscle memory has kicked in and the body now accepts its new muscle length. It is still beneficial to do the exercise occasionally after it has corrected.

The Trendelenburg TestThe Trendelenburg TestThe Trendelenburg Test John Garfield Dip Bowen Therapy/

Soft Tissue Therapist

The Trendelenburg test. Left: Negative test (normal hip abductor). Right: Positive test (weak left gluteus medius). Trunk also shifts left as the client attempts to decrease stresses across involved hip to maintain balance.


History

People have been making videos or movies demonstrating massage tech-niques and manoeuvre since the advent of portable cameras. Early videos were made mainly to document workshops or classes by legendary instructors. For example, in YouTube there are several video footages from 1970s showing Dr. Ida Rolf talking and demonstrating Structural Integration.

Since the advent of home videos or VHS in the late 1970s, initially videos were made mainly just as a demonstra-tion. It probably started in the early 1980s. There were various video tapes produced with the target audience of general public, mainly general routine, such as Swedish massage, Healing Massage, Massage for relaxation, Massage for couples etc.

Late 1980s begin the release of videos that were more technical for massage professionals, they mainly focussed on sports massage. Notably, Therapeutic Massage for Sports and Fitness by Rich Phaigh (1988). Another series that appeared in 1992-1993 are Clinical Sports Massage by Benny Vaughn. Here massage videos are not just showing techniques for relaxation, but more spe-cific for massage professions, and particular tech-niques, e.g. massage to enhance sports perform-ance. Due to the expense of filming (before the advent of desktop video publishing), there were only a few videos on these specific massage topics, and they were fairly short in length, usually about 30-45 minutes each.

In 1995 several videos for massage professionals

started to be produced, notably Step by Step Tuina by Maria Mercati in the UK, Ralph Stephens’ Therapeutic Massage in the US.

The Video Atlas of Human Anatomy by Robert Acland was released in 1996. This is one of the first 3-D live look at human anatomy: bones & muscles. The amazing picture enhanced the learn-ing experience of anatomy. This was quickly adopted by many schools, books & videos.

In the late 1990s to 2000 there were more videos produced specific for massage professionals, and became popular at that time. This also coincided with the wide availability various massage modali-ties. These techniques used to be taught restricted in some schools, now they are becoming more available for general massage practitioners. For example, Deep Tissue & Neuromuscular Therapy by Real Bodywork, Erik Dalton’s Myoskeletal Alignment Technique, Tom Myers’ Anatomy

Learning MassageLearning MassageLearning Massage Through VideosThrough VideosThrough Videos


Trains videos, Art Riggs’ Deep Tissue & Myofascial Release.

Videos in DVD format start to appear in mid 2000. Initially videos from VHS were converted to digital format. However, now most new videos were made in digital format.

Real Bodywork produced its first massage video on Deep tissue and Neuromuscular Therapy as a responds to the request of their students as a way to remember the information that was being taught in a 100 hour NMT class. The information in these DVDs is great, and they even made mus-cles out of clay and had some computer graphics. The first videos were also a bit shorter, usually about 75 minutes. This is in contrast with recent DVDs that are more animated with 3D models, and filmed digitally in wide screen format to fit modern TVs. Recent DVDs are usually over 2 hours and sometimes approach 4 hours in length. Sean said that each title took 300-400 hours to create.

Many DVDs are now available bringing techniques that have traditionally been taught to physical therapists or osteopaths as in-house training, such as craniosacral therapy, myofascial release, nerve mobilization, positional release and orthopaedic assessment techniques. Nowadays we are fortu-nate that we can find most of the modalities avail-able on DVDs.

Advantages

Sean Riehl, the president and founder of Real Bodywork, believes that learning techniques through a DVD is a much better way as compared to a book because you can actually see the instruc-tor doing the moves. In a book all you have are static images and descriptions which can some-time hard to follow or imagine. Of course a book can offer a lot more encyclopaedic information, but yet when it comes to learning a technique; it really helps to see the instructor doing the moves, because a lot of information that is not spoken is transmitted when you watch someone who is mas-terful practice their craft.

Viewing the muscular and bone structure involved

while the in-structor is demonstrat-ing on a cli-ent makes learning more inter-esting and easy to grasp. The “x-ray eye” allows us to see the muscle groups in-volved while the practitio-ner is mas-saging. In-structors used different ways to convey this information. For example, in the early days, artist drew the muscles on the skin of a model to depict the mus-cles involved in massage. This actually works quite well, another trick is having the model wearing a body suit that has muscles drawn to it. This is less successful. The availability of modern computer graphics now enabled us to see clearly the muscles and skeletal parts involved in particular move-ment.

Cameras placed at the best angle allow us to see the technique demonstrated from the best possi-ble viewing positions and you can view it again and again.

Instructors also come up with various ways to en-hance the learning process. For example, Tom Myers in his Anatomy Trains techniques DVD showed the techniques as taught in a small class mentoring situation. Tom demonstrated a tech-nique, and this is followed by the student. The comments from the clients, Tom’s corrections concerning application and the student’s body use, and the student’s responses, all become part of your learning process.

You can learn new techniques from watching and

Brilliant graphics showing anatomical structure from Real Bodywork make learning anatomy interesting. (Pictures courtesy of Real Bodywork.

Massage videos


practising from videos, although you cannot feel the sense of touch from watching DVD, the experi-ence can be made equivalent to a class/ workshop. You can gain new knowledge from renowned in-structors. Although it is best to experience a hands-on workshop, when you have limited budget, travelling to other towns can escalate the cost quickly. The best is to watch and practice it with a fellow therapist. You learn the same technique from a reputable instructor in your living room, at your own time. It is a reference that can be con-sulted at any the time. Seeing the techniques per-formed live is the key, more than a just a book with pictures.

Is it really possible to learn techniques from video?

Erik Dalton wrote: “During the past 30 years in the touch-therapy business, I’ve personally wit-nessed that everyone learns uniquely and at differ-ent paces. Some possess an “innate kinaesthetic palpatory awareness,” while others prefer repeti-tive observation of the techniques to ensure their understanding of inherent subtleties. Regardless of individual differences in learning, it seems that when dealing with hands-on modalities, following along with a hands-on video (whether online or DVD) does more to enhance the learning experi-ence than simply reading theory from a book or manual; although, both ingredients are essential to the successful outcome of any comprehensive home-study program. “

Since 1999, Erik Dalton’s the Freedom From Pain Institute® has produced high-quality reading and video programs that provide a much-needed ser-

vice to the community. Erik found that well-designed home-study programs often spark a pas-sion that encourages therapists to further enhance their skills by attending live presentations---if their physical and/or financial condition permits.

However many still believe that massage or man-ual therapy can’t be learnt from watching videos, they argued that massage can only be learnt by hands-on workshops. The sceptics claim that manual therapists are not visual learners and lack the ability to observe and duplicate the instructors demonstrating techniques. The idea that thera-pists cannot view a hands-on manoeuvre and du-plicate it may hold true for those students still in training who’ve not yet mastered basic hands-on skills and anatomical astuteness.

Whitney Lowe believes that when a therapist has mastered the basic techniques of massage, that individual should have gathered sufficient skills to further that learning through high quality instruc-tional materials that are delivered in a wide vari-ety of methods e.g. video, or online.

Erik Dalton admitted that he has been a compul-sive video-junkie for many years and host a collec-tion of more than 300 VHS and DVDs from every country. Admittedly, some languages he does not understand, but visual learning from great hands-on practitioners in every field of bodywork truly inspires and challenges his quest for greater knowledge. Each morning while running on the treadmill, he grabs something newly purchased or perhaps watch one of his favourites. “Even if I’ve seen the video dozens of times, I’m always able to pick up some little titbits that pique my interest

Massage videos


and boost my motivation to get into the therapy room and share what I’ve learned with my cli-ents”.

What makes a good massage DVD?

Sean Riehl advises that a good massage DVD should be easy to understand and well organized. It should also quickly get to the point of the tech-nique and offer information that the therapist can apply immediately in their practice. A good mas-

sage DVD should include some assessment along with treatment, so it not just a bunch of tech-niques by themselves, but an entire treatment pro-tocol.

In addition, Whitney Lowe said that a good DVD should take into account contents that common practitioner would really want and need to see and hear.

Sean believes that the information is the impor-tant part, not the instructor. Instead of trying to trademark a type of massage, or create yet another name of a new modality, instructors should just focus on teaching students how to perform assess-ments on their clients and effective techniques to address what is going on. The assessment tech-niques are fairly standardised, and there are only so many ways to touch the body, and good body-work does not need to be very complicated. New trademarked modalities are just a rehashing of techniques that people have even doing for years anyway. In Real Bodywork products, Sean tries to separate the DVD names based on how a type of massage works, or which condition it addresses.

Massage videos


Art Riggs’ Deep Tissue Massage workshops organised by Terra Rosa started 4th November 2010 at Nature-Care College, St Leonards, Sydney. It is a 3 day Funda-mentals of Touch. Art’s approach is a relaxed and fun learning environment. This workshop gave an under-standing of touch, depth of layers and the ability to di-rect intention. It covered proper use of biomechanics and tools—Say no to thumbs, Use fingers, knuckles, fists, forearms, and elbows. Art showed how to utilize body positioning to facilitate release of restrictions, and increased knowledge of therapeutic strategies. In addi-tion to muscles, he showed how to cultivate an under-standing of the osseous component for effective body-work, including vertebral articulation and mobilization, and working to create freer ribs movement.

Art’s teaching approach is unique, instead of showing a stroke that you would copy, Art will give you a dozen of approaches that you can adapt and make it your own. Cultivate an effortless, pleasing and effective touch!

All participants are amazed with Art’s style of teaching, knowledge and kindness. The comments are:

“One of the best teachers I have come across”

“What a generous, patient and humble teacher Art Riggs is, what a pleasure and privilege it was to be in his class.”

“Art is just great at being the humble expert! He had the perfect balance of theory and hands-on and is flexible enough to adapt the content to suit the class dynamics and yet still meet the course objectives.”

“Art Riggs is an amazing teacher. So generous and knowledgeable as well as being very approachable.”

“Fun, warm, unflappable, generous with time. great at correcting bad habits. kept things simple & on track”

The second part of the workshop, Integrated Deep Tis-sue Massage, continued 8th-9th November. Art started with strategies on how to market yourself, communi-cate with clients, and distinguishing deep tissue from relaxation massage. The Humanity side of massage that is rarely discussed in any workshop is really empha-sized. Art demonstrated how to do the structural evaluation while doing your massage work – how to get the soft tissue feel, joint function, where is obstruction or problem?

“Very hands-on, plenty of chances to ask questions”

“Enjoyed every minute “

“Art Riggs is generous, open, relaxed, very engaging, informative, interesting and an excellent communica-tor. Art is able to adjust the programme to the specific need of the group so everyone went away with things relevant to them.”

Report from Report from Report from Art Riggs’ Art Riggs’ Art Riggs’ Deep Tissue MassageDeep Tissue MassageDeep Tissue Massage Sydney WorkshopSydney WorkshopSydney Workshop


The final Advanced Deep Tissue Massage was on 25th-28th November. It goes into more details covering the whole body. First, the quality of touch is again revis-ited. Then Art covered body reading of strain patterns on the feet. Anatomy, demonstration is all covered for the ankle, knees, hips, back, pelvis, abdominal area, vertebral column, chest, arm, shoulder, and neck.

The class run the full day from 9 am to 6 pm. You get what your money worth, full 8 hours per day. You’d never experience this in any workshop. Comments in-clude:

“Art is generous with his knowledge and time and is clearly passionate about bodywork. His enthusiasm is infectious.”

“Never seen so committed instructor to spare his break to provide extra information.”

“ I would have to say that this is one of THE BEST workshops I have attended.”

Comments on the workshops include:

“This workshop was excellent, Art is the best instructor I've seen, he is the most humble, patient, generous, easy going in addition to teaching in an easy to follow manner, mixing the theory and practical perfectly.

People would have walked away with a lot more knowledge whether they were new therapists or therapists that have been practicing for years.”

“The series of workshops were facilitated in a way which allowed attendees to interact, while learning skills and knowledge which can be applied to our indi-vidual practices. Art managed to get excellent group interaction right from the beginning; the course was interesting, informative, extremely well presented and very relevant to our work.”

“I've really enjoyed Art's workshop and found his way of working very inspiring. It has been a privilege to see him demonstrate his work and show us much more than a really useful, clever and comprehensive collec-tion of bodywork techniques. What is also great it's the humanity and compassion Art is channelling through his work and the deep connection he is able to achieve through his hands. I am very grateful to have been able to learn with all the other participants to the workshops, the atmosphere has been really supportive and encouraging.”

Art Riggs’ Workshop


Personal testimonials include:

“Thank you Terra Rosa for organizing Art Riggs workshops in Sydney. It's been an incredible experi-ence and the best investment in my profession I've ever made! Art's extensive knowledge and genuine personality made these workshops very inspirational. Thank you Art for being such an amazing mentor!” Zuzana Gaalova, Queenscliff, NSW.

“I am very happy to had the opportunity to meet Art Riggs. As a Massage Therapist he is the best experi-ence since I left TAFE college. I am very lucky to have him as a mentor. You cannot imagine. He taught me to "sink and slow”, he put his hand on my hand and told me to let him take the movements. He taught me to feel like how I can change the body's structures. I did it, I felt it. I had been practicing his work and I am improving every moment. His approach is great. He is not just a teacher, he is a master. His passion, pa-tient and charisma are just amazing. ” Juliana Osorio-Ramirez, Sydney.

“Excellent practical advice, excellently delivered that will be of major benefit to me in my day to day work. It has provided me with the perfect grounding and structure to achieving and delivering several different ways to work effectively on soft tissue. I really got a great amount out of the series, it covered all my objec-tives and more. The one to one training was excellent, I would highly recommend to others. Overall – excel-lent. Would love to do it again!!” Tracey Langham, Anglesea, VIC.

“ Art Riggs is a great educator - knowledgeable, car-ing and willing to share his information. Two assis-tants(Colin Rossie and Tom Shand were great) made it very easy to get feedback and help during practical sessions. I feel the information and techniques learned will be able to fit very easily into my massage treat-ments.” Margaret Markus, TAFE lecturer, Sydney.

Art Riggs’ Workshop

Readers of the Terra Rosa E-Magazine are well ac-quainted with Rolfers and their love affair with connec-tive tissue. In recent years, we’ve gotten really excited as serious scientists and academics have caught our enthusiasm for the stuff. Every three years, clinicians like you and me gather with pre-eminent fascia scien-tists at the International Fascia Research Congress, to share our insights and further each other’s work. These conferences exhibit a passion for learning that is unfor-tunately all too rare these days; I highly recommend you attend one if you can. You’ll have fun and your brain will get a workout!

But let’s admit it — all that scientific terminology can get a bit daunting. So, I wrote this article to summarize and make sense of the latest fascia research and explain how it applies to massage and bodywork therapists. I hope this discussion puts the latest information about fascia in a context you can use: 1) influencing your work with clients right away; and 2) cluing you in to areas and resources that you may want to explore more in depth on your own.

A brief history of fascia science

The Fascia Research Congress is the brain child of a dear friend of mine, Dr. Thomas Findley—who is a medical doctor, a PhD, and a Certified Advanced Rolfer, Tom tells a story about researching fascia 30 years ago and finding a dearth of information. He ex-plains, “When it came to connective tissue, all we knew was that when you heated a rat tail you could stretch it. There was no other relevant research that I could find.” A scientific discipline couldn’t ask for more humble beginnings. Tom says it was at that moment that he started dreaming of a fascia congress that would “bring

together widely separate research disciplines in the ser-vice of the clinician.”

Until recently, doctors and scientists alike treated fas-cia as the webby material you cleared away during a dissection to get to the really interesting parts — the bones, muscles and organs. Fascia was considered pretty much inert stuffing that didn’t do anything. And because connective tissue is everywhere that other stuff is not, it only got named where it was particularly thick, like the plantar or thoracolumbar fasciae.

Watching a positive trend toward fascia research (during three decades, the number of published articles increased over six-fold), Tom organized the first re-search congress on the Harvard University campus. It was only meant to be one-time event but was so suc-cessful that another was held in Amsterdam in 2009, with the next one planned for Vancouver in 2012. Fi-nally, we have a forum to help clinicians understand why myofascial work is so powerful and develop ways to further the work.

Latest research

A lot of fascia research is still answering basic ques-tions: “What is it?” “What are its properties?” and of particular importance to you and me, “How do we af-fect it?” At the 2009 congress, Jaap van der Waal, MD, PhD spoke about his anatomical studies and explained that a lot of what we take as gospel about the body is just plain wrong (van der Wal, 2009).

Say it isn’t so…

1) Ligaments don’t exist. True ligaments are almost nonexistent; in most cases, ligaments are only “made” with dissection.

Fascia Science Made SimpleFascia Science Made SimpleFascia Science Made Simple——— and Applicable to your Practiceand Applicable to your Practiceand Applicable to your Practice

Bethany Ward, MBA, Certified Advanced RolferFaculty member of Advanced-Trainings.com and

the Rolf Institute® of Structural IntegrationPresident of the Ida P. Rolf Research Foundation


2) Tendons don’t insert into bone. There are no discrete tendon attachments as pictured in anatomical drawings. Rather, tendons insert into a connective tis-sue apparatus, which transmits force across joints. In fact, 15-80% of connective tissue fibres extend past the designated tendon insertion (Stecco, 2009).

3) Muscles are not the prime players. Tradition-ally, muscles were thought to be active while tendons remained static. Actually, muscles and tendons work as a dynamic system in function, as well as in each other’s development. As it turns out, the term “myofascial” is particularly apt because it communicates this intercon-nectedness of muscle and fasciae.

You can read the full article at http://www.ijtmb.org/index.php/ijtmb/article/viewArticle/62/82.

A system — greater than the sum of its parts

Connective tissue doesn’t lend itself to reductionism. Although it’s true that anatomists have named fascial structures where the matrix becomes particularly thick, as in tendons or ligaments, these tissues are continuous with different fascial types, which all meld into each other. Perhaps more than any other system in the body, the fascial matrix must be addressed as a complex whole.

And here is the rub: connective tissue’s incompatibility with anatomical separation seems to be at the heart of its incredible ability to simultaneously provide support, containment and freedom of movement.

Connective tissue performs seemingly diametric functions

1) Fascia provides both separation and connec-tion of structures (van der Wal, 2009). By enveloping structures (everything from single muscle and nerve cells, to bundles of cells, to muscle bodies and bones), fascia allows for glide between structures while binding them together and providing form. If we understand this dual role, we can address adhesions to improve glide between structures while also affecting the larger system.

2) Fascia contributes to both support and force transmission in the body. Researchers observed that in most muscles, single muscle fibres do not span the entire length between tendons (Purslow, 2009). So how are forces transmitted through these structures? The connective tissue endomysium keeps fibres tightly in register within the fascicle, which makes it possible to transmit forces between muscle fibres by shear forces.

Fascial tension plays a critical role in low back stability. Fascia needs to bear load and the carrying of load needs to vary between muscles and back fascia for healthy function of the low back (Hodges, 2009). Additionally, crural fascia strongly links the thigh muscles and cal-caneus, contributing to propulsion, stability and motor coordination (Nichols, 2009). Crural fascia enhances propulsion by increasing retraction and ankle plantar flexion, while limiting movement of lower limb, provid-ing stability.

3) And now for something really unexpected: Fascia both limits movement and contributes to the fluidity of movement! A study of calf muscles found that as muscle contracts, its tendons actually lengthen a bit, storing energy that is released when the muscle relaxes, which makes gait more efficient (Kawakami, 2009). Does this happen elsewhere? Proba-bly. If so, the interplay between fascia and muscle is im-portant in energy transfer between tissues. Fascia sof-tens the beginning and the end of the muscle move-ment. It also stores kinetic energy of movement, much as a hybrid car uses regenerative braking to store energy in its batteries.

So fascia separates and unites; supports and communi-cates; and stores energy and releases it. How is fascia able to possess such inconsistent properties? The an-swer may be the results of its interconnected system. In addition to enveloping all the structures we can see, fas-cia extends from the surface of muscle to the interior of the muscle cell. Dr. Ingber at the 2007 congress showed how these connections within the cell extend to the nu-cleus, with tension of the intracellular fibres directly affecting gene transcription (Ingber, 2007). The fascial matrix reaches even farther than we thought.

So when you work with connective tissue, you need to be thinking about these connections. Even when ad-

Jap Van Der Wall at the 2nd Fascia Congress. Picture taken from Fascia Congress DVD.

Fascia science made simple


dressing a specific area of adhesion, your hands and intention must be connecting with the fasciae as a sys-tem that crosses all boundaries.

How to address fascia layers

Based on our current knowledge, it is likely that myofas-cial techniques can restore glide between structures. To do this, we identify places where fascial layers have be-come stuck together — either due to adhesions or scar tissue —and work to free them up. Assessing range of motion and comfort level during movement, before and after your intervention, can tell you if you’re being effec-tive.

In classes and workshops, I teach students how to “hook into” tissue to create a directed stretch and wait for the tissues to release. From Rolfer-researcher Robert Schleip’s work, we’re understanding that angle of con-nection really matters. Schleip likens the fascial layers to a layered dessert, the tiramisu, to show how layers are both distinct and interconnected. He proposes that rather than getting tissues to slide, which suggests movement between separate layers, we’re actually at-tempting to “shear,” or create lateral movement be-tween interconnected strata. To achieve lateral move-ment, you need to make sure your angle of force is simi-lar to the angle of the layers. Rather than working per-pendicularly to the facia layer, you want to hook into the layer and take it in a direction that shears it with respect to the adjacent layer. Robert Schleip has created a li-brary of fascia-related articles for somatic practitioners at http://www.somatics.de/, a treasure trove of infor-mation.

In a related study, scientists identified three layers of crural fascial. Collagen fibres within each layer lay par-allel, while fibres of different layers form 78-degree an-gles with other layers. This pattern has been found in thoracolumbar fascia (Stecco, 2009), as well as in bo-vine neck muscle (Purslow, 2009). While this orienta-tion of collagen fibres within layers makes fascia highly resistant to traction, the oblique fibre orientation be-tween layers makes shearing a viable therapeutic ap-proach.

Using myofascial techniques to relieve pain and restore function

Based on what we currently know about connective tis-sue, your myofascial interventions should:

1. Target areas that cause tension in fasciae. A study looking at the effects of stretch on areolar (or “loose”) connective tissue found significant remodelling of the fibroblast cells, which make up fascia, in response to only twenty minutes of tension (Langevin, 2009). Based on this work, it makes sense to direct myofascial therapy at areas (scars, fibrosis, inflammation, etc.) that may be causing chronic tension in the fascia. Areolar connective tissue is the most widespread connective tissue in the body. In addition to filling the spaces between organs and surrounding and supporting blood vessels, this tis-sue attaches the skin to the underlying tissue. As such, fibrosis can cause strain patterns in the body the same way a seam changes the pull through a piece of cloth. After appropriate preparation, address fibroses and scar tissue early in your sessions, leaving time to integrate these changes throughout the system.

2. Don’t forget the nerves. Dysfunctional fascial tension can affect every structure in the body, including nerves. It is common to find intra-fascial nerves oriented per-pendicularly to collagen fibres, suggesting that fascial stretch may stimulate nerves and contribute to certain pain conditions (Stecco, 2009). Like other structures, nerves are sheathed in fascia to allow for glide during movement. Like other structures, nerves can be im-peded by adhesions, or “tethered,” causing pain and dysfunction. Learning to feel for nerves and freeing them from surrounding tissues is an important skill for myofascial therapists. If you haven’t explored this area of the work, I strongly encourage it. Just learning to free up the sciatic nerve as it makes its way from the spine down the leg will make you much more effective with common piriformis and sciatic dysfunctions.

3. Work superficial and deep layers. Although it is often tempting to skip superficial layers when you work, don’t. The superficial layers of the thoracolumbar fascia appear to be highly innervated — with over 90% of no-ciceptive fibres in the superficial fascia and subcutane-



ous layer, few fibers in the inner layer, and none in the middle layer study (Tesarz, 2009). Nociceptors (pain sensors) are also likely to be found in these tissues as well.

At the 2010 Interdisciplinary World Congress on Low Back and Pelvic Pain in Los Angeles, the role of fascia was described as a very promising area for future re-search dealing with low back pain. When you address superficial layers, you may be able to affect the remodel-ling of these tissues, which appear to be caught in chronic pain patterns. When you work deeply, in tendon attachments, where golgi tendon organs are abundant, you may also be influencing muscle patterns. So, con-sciously working at both superficial and deep levels is warranted when dealing with chronic pain.

A word about terminology

The tendency to use the terms “fascia” and “connective tissue” interchangeably is actually incorrect. It can be confusing because we’re talking about a matrix of mate-rial that wraps around every muscle cell and creates en-velopes, which compartmentalize and wrap around other structures. There are different fascial layers, which, are interconnected. The more we learn, the more we appreciate fasciae’s different densities, composi-tions, and unique properties. As such, it’s actually incor-rect to lump all these tissues together as “fascia.” Cur-rently, researchers (Langevin and Huijing, 2009) distin-guish between a dozen types of fascia: dense connective tissue, areolar (loose) connective tissue, superficial fas-cia, deep fascia, intermuscular septa, interosseal mem-brane, periost, neurovascular tract, epimysium, intra- and extramuscular aponeurosis, perimysium, and endo-mysium. You can read the full article online at http://www.ijtmb.org/index.php/ijtmb/article/view/63/80.

Conclusion

Myofascial therapists know we can create change — we see it everyday when clients experience increased range of motion, reduced pain, and/or smoother, more coordi-nated movement. But until recently, we didn’t have a lot of places to look to understand the mechanisms for these changes. Fascia has been ignored for a long time so there’s a lot of catching up to do in the research lab. But the latest findings strongly suggest that myofascial therapy is effective because it:

• Improves the glide between the enveloping septa;

• Affects mechanoreceptors (golgi tendon organs); and

• Works with the body as a system, addressing muscle and connective tissue as functional units.

Fascia brings together seemingly opposing functions in the body; working with these tissues demands that we exhibit a similar sophistication. We must be able to sense with our hands and bodies on both a micro- and macro-level. We must be able to identify and address adhesions, scar tissue, and fibroses, which can create tensions through surrounding tissues leading to dys-function. But at the same time, it is essential that we track how force transmits through larger areas and, ulti-mately, the entire system.

Empirical studies are confirming what we suspected — bodywork remains an art, as well as a science. In a study involving tendon transfer surgery for patients with cerebral palsy, researchers found the locations of fascia connections varied significantly among subjects (Kreulen, 2009). Every person who walks in your office is as different at his or her fingerprint. Anatomy books, your teachers, and even your own experience can only give you a general sense of where you need to work. Re-search can inform you of new things to try and new pat-terns to notice, but the most important skill you have is your touch and your openness to sense what’s there. Only the sensitivity of our hands will tell us what to do and what to do next.

Luckily, the fasciae, once considered inert, replaceable packing material, are turning out to be one pretty smart interconnected cookie. Acupuncture research by Helene Langevin, MD showed that although inserting needles created measurable changes in the fascia, the change was not appreciably different if the needles were placed in traditional points or nearby (Langevin, 2006), intro-ducing the question: “Is the connective tissue a body-



wide signalling network?” If so, are we just facilitating healing that the body is trying to do anyway? (Seems plausible to me.) Since fascia connections extend to the nucleus and influence gene transcriptions, what else is possible?

I don’t know, but I’m looking forward to find out.

About the Author: Bethany Ward, MBA is a Certified Advanced Rolfer, Rolf Movement® Practitioner, and faculty member of the Rolf Institute® of Structural Integration. She is President of the Ida P. Rolf Research Foundation and a member of the faculty of Advanced-Trainings.com. She and fellow Rolfing Instructor Larry Koliha will be presenting at the October 2011 Association of Massage Therapists Conference in Syd-ney as well as co-teaching Advanced-Trainings.com’s “Advanced Myofascial Techniques” workshops throughout Australia in the weeks following. To learn more about classes and dates, go to http://www.advanced-trainings.com. Read also 6 questions to Bethany on page 50.

Sources

All 2009 findings by Hodges, Ingber, Kreulen, Langevin, Nich-ols, Purslow, Stecco, Tesarz, and van der Wal reference their presentations at the 2009 Fascia Research Congress and are available on DVD, available at http://www.fasciacongress.org.

Hodges P. Fascial aspects of motor control of the trunk and the effect of pain. In: Huijing PA, Hollander P, Findley TW, eds. Second International Fascial Research Congress [DVD]. Vol. 2. Boulder, CO: Ida P. Rolf Research Foundation; 2009.

Ingber D. Tensegrity and mechanoregulation. In: Findley TW, ed. First International Fascial Research Congress [DVD]. Vol. 1. Boulder, CO: Ida P. Rolf Research Foundation; 2007.

Kawakami Y. In vivo ultrasound imaging of fascia. In: Huijing PA, Hollander P, Findley TW, eds. Second International Fas-cial Research Congress [DVD]. Vol. 4. Boulder, CO: Ida P. Rolf Research Foundation; 2009.

Kreulen M. Myofascial force transmission and reconstructive surgery. In: Huijing PA, Hollander P, Findley TW, eds. Second International Fascial Research Congress [DVD]. Vol. 3. Boul-der, CO: Ida P. Rolf Research Foundation; 2009.

Langevin HM. Bouffard NA. Badger GJ. Churchill DL. Howe AK. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. Journal of Cellular Physiology. 207(3):767-74, 2006.

Langevin HM, Bouffard NA, Fox JR, Barnes WD, Wu J, Palmer BM. Fibroblast cytoskeletal remodeling contributes to viscoelastic response of areolar connective tissue under uniax-ial tension. In: Huijing PA, Hollander P, Findley TW, eds. Sec-ond International Fascial Research Congress [DVD]. Vol. 1. Boulder, CO: Ida P. Rolf Research Foundation; 2009.

Langevin MH, Huijing PA. Communicating about fascia: his-tory, pitfalls, and recommendations. International Journal of Therapeutic Massage and Bodywork. 2009;2(4):3-8.

Nichols R. Systems for force distribution in motor coordina-tion: fascia and force feedback. In: Huijing PA, Hollander P, Findley TW, eds. Second International Fascial Research Con-gress [DVD]. Vol. 4. Boulder, CO: Ida P. Rolf Research Foun-dation; 2009.

Purslow P. Fascia and force transmission: structure and func-tion of the intramuscular extracellular matrix. In: Huijing PA, Hollander P, Findley TW, eds. Second International Fascial Research Congress [DVD]. Vol. 2. Boulder, CO: Ida P. Rolf Research Foundation; 2009.

Stecco C. Anatomical study and tridimensional model of the crural fascia. In: Huijing PA, Hollander P, Findley TW, eds. Second International Fascial Research Congress [DVD]. Vol. 2. Boulder, CO: Ida P. Rolf Research Foundation; 2009.

Tesarz, J. The innervation of the fascia thoracolumbalis. In: Huijing PA, Hollander P, Findley TW, eds. Second Interna-tional Fascial Research Congress [DVD]. Vol. 2. Boulder, CO: Ida P. Rolf Research Foundation; 2009.

van der Wal JC. The architecture of the connective tissue in the musculoskeletal system – An often overlooked functional parameter as to proprioception in the locomotor system. In: Huijing PA, Hollander P, Findley TW, eds. Second Interna-tional Fascial Research Congress [DVD]. Vol. 2. Boulder, CO: Ida P. Rolf Research Foundation; 2009.




Advanced-Trainings.com’s

Advanced Myofascial Techniques Workshops

Cairns, the Gold Coast, Melbourne, & Sydney. Throughout October 2011

What to expect Whether you have years of experience or come with fresh eyes, our workshops are designed to help you: • Learn specific techniques for common structural and

functional complaints • Relieve pain, restore lost function, and get lasting re-

sults • Be more precise in working with specific tissue types

and body layers • Combine more subtle indirect work with deeper direct

work • Track subtle psycho-physiological and nervous system

responses • Work more sensitively, safely, and comfortably at very

deep levels. Advanced-Trainings.com is associated with the Rolf In-stitute® of Structural Integration, Boulder Colorado, USA and is approved by the National Certification Board for Therapeutic Massage and Bodywork as a Continuing Edu-cation Provider in the USA. These workshops are pending approval for Continuing Education Credits by the AAMT and AMT in Australia.

The Advanced Myofascial Technique seminars present practicing manual therapists with highly effective and little-known techniques, tests, and procedures, which can be easily incorporated into your existing practice. Drawing on a wide range of disciplines, the focus is on unusual, interesting, and fresh approaches that both expand your repertoire of techniques, as well as inspire creativity and innovation.

Take 1, 2, or 3 days of training. Each event combines a 2-day training with an optional 1-day specialty class: Two-day workshops are highly recommended as prereq-uisites for the following 1-day specialty workshops. Al-ternatively, all 2-day workshops are available on DVD at a discount to registered participants.

All workshops combine: • In-person demonstrations and individualized hands-on

supervision • State-of-the-art instructional materials, including 3D

Interactive Anatomy software • A detailed course manual/note organizer with photos of

techniques covered • Videos of instructor demonstrations available for post-

workshop practice and review. The Instructors Advanced.Trainings.com Faculty members Larry Koliha and Bethany Ward will be presenting on fascia research and myofascial therapy at the 2011 Association of Massage Therapists (AMT) national conference, as well as teaching workshops in Australia throughout October. Both Larry and Bethany are Certified Advanced Rolfers™, Rolf Movement® Practitioners, and teach at the Rolf Institute of Structural Integration.

Two‐Day Workshops One‐Day Specialty Workshops

Neck, Jaw & Head TMJ; Headaches

Pelvis, Hip, & Sacrum Sciatica & Disk Issues Leg, Knee, & Foot Advanced Knee Issues


Can you briefly describe the concept of Integral Anatomy?

Integral anatomy is an approach to the study of the hu-man form and the human person which I've been de-veloping and pondering since the early nineties. It came about when I got inspired to do some dissection as a new Rolfer. I wanted to improve myself profession-ally. The first dissection I led with a group was a bit haphazard, though very interesting of course. The next year I went in with a plan. I was intent on dissecting in a manner that was coherent with the holistic body phi-losophy I had adopted as a Rolfer. Knowing that there are different textural layers which can be distinctly pal-pated in the body, I thought to reveal those continuities in the form. We dissected the whole body simultane-ously by layer that time, and found it to be very com-pelling! At the same time I had begun teaching evening courses in anatomy and physiology for a “healing school” in Manhattan. Because of my involvement with that school, there developed a sort of feedback loop between the development of the dissection workshop in the lab, and the courses I was teaching to the groups training in energy work and psychodynamics. So my work in the lab came under the influence of that experience, and I began to notice the psychodynamic issues generated by the process of dissection, and to realize that there was great potential for personal transformation inherent in the study of anatomy from a perspective that included all the levels of the human person. So I like to say that integral anatomy is the study of the whole body by the whole person. I contrast it with re-gional anatomy, with its focus on the regional naming of “body parts,” separation, and a mechanistic model. All that regional anatomy contributes I value, and I also want to think on the forest as well as the trees! So in

distinction, the focus of integral anatomy is on conti-nuities across regions, whole body textural layers, and the relationships of tissues. Integral anatomy explores the qualities of those continuities, textures and rela-tionships with an eye to advancing the questions, “Who am I?” and “What is my body?” alongside the clinical issues that remain of keen interest as well.

How is your work different from regular dissec-tion workshop or attending a "wet lab"

There are several ways in which my dissection work-shops differ from the approach taken in a conventional medical school curriculum. First, since I am bound to no curriculum, well, there are no tests in my class! The pressure is off, and folks are free to explore what's in front of them as opposed to “finding” and “naming” what they are being taught is "there." Further, every day begins with a conversation in which the community of the class comes into the present. We discuss what we are doing, how it is going for people, what they are learning, and how it is impacting their ideas about the body, their practice, and their lives. We have very rich exchanges and the course is knit together by the inter-play of the experience of the group circle, the dissection process itself, and the time folks have on there own in the evenings when the experience unfolds and develops further. Additionally, the dissection process itself is quite different. Because we are approaching the forms layer-by-layer, each texture is given a very focused block of attention as it is encountered, differentiated and reflected. We reflect the whole skin on the first day: that is a pretty intense experience of skin! By cre-ating this type of focused attention layer-by-layer on the whole body textural continuities, participants can carry away in their own sensory apparatus a very dis-tinct and clear impression of the these layers and their differences. There is no need to take notes in this class.

An Interview An Interview An Interview with with with Gil HedleyGil HedleyGil Hedley Founder of Integral AnatomyFounder of Integral AnatomyFounder of Integral Anatomy


The experience is pretty much a permanent one. That having been said, with the emphasis on transformation, the potential exists to come away from the class with a more integrated sense of self. Folks come to appreciate aspects of themselves and their bodies which they may have not even known about, or which they may have had a negative relationship with, and now have devel-oped respect and appreciation instead.

What can we learn from human dissection. And How your work has influenced bodyworkers?

Dissection enables bodyworkers to see what they touch. Bodywork is in a very real sense a profession which operates in the dark. Much of it can be done with eyes closed, as the therapist feels their way through the body. When you can corroborate with your eyes for a whole week the tissues you have been palpating every day but can never really confirm, it is a huge blessing! Then when you return to your clients it's as if you have x-ray hands, and all of your experiences in the lab come back to you, because they live in your hands as well as your minds eye, and you can continue to reference the experience and corroborate what's in your hands to what you learned in the lab. My work became very much more specific for having been in the lab, and the tour of the body which I offered my clients became ex-ponentially more specific. I could lead them better be-cause I'd been there!

What do you mean by “superficial fascia”?

Superficial fascia is the loose, areolar connective tissue immediately deep to our skin, where fat is stored in lesser or greater amounts depending upon a variety of factors. Some refer to it simply as the adipose layer. I, along with lots of other anatomists, call it superficial fascia in contrast to the deep fascia, or fascia profun-dus, which is deep to it and covers the muscle layer. It is my Everest. I conquer it because it is there!

Then what is the “deep fascia”?

At the level of physical description, the deep fascia represents a major shift in texture as you work your way into the body from the outside. By comparison, the skin is this highly organized layer which represents the apparent outer limit of the physical (as opposed to the energetic) body. It is a continuous fabric covering the entire form, which never “goes deep.” Skin can have more or less depth in itself (a few to several millime-ters), but as a texture, it sticks to the surface. The skin is the skin of the superficial fascia, and the scalpel goes dull differentiating the two. When you grab yourself by the skin, the superficial fascia always comes along for the ride, and what you are really lifting is the the skin and superficial fascia (SF) away from the SF’s relatively looser relationship with the deep fascia beneath it. So the deep fascia, like the skin, is again a more thin and grid like layer than the superficial fascia, which is rela-tively loose and “fluffy.” Also like the skin, the deep fascia covers the entire body, but it does so deep to the SF. Unlike the skin, however, the deep fascia extends itself beyond its covering aspect over the muscle, and sends arching fibrous sheets right on down to the bone.

What do you mean by “cranial and visceral fas-ciae?”

I refer to the fibrous and serous linings which define the spaces of our viscera and central nervous system. There is a pattern that repeats from area to area. From the outside in, there is an outermost fibrous layer, then a serous layer, then the “skin” of the organ itself. With some variation of course, this is the basic pattern we see.

Nevertheless, these tissues are completely accessible either through touch or movement, and I am hoping to raise folks’ consciousness about these layers, since you’re working them anyway. In fact, our every breath, our every heartbeat, represents a movement of these layers, with relative ease or not.

Interview with Gil Hedley


The dura lines the cranium and spinal column, the en-dothoracic fascia lines the thorax, the outermost sack of the heart is the fibrous pericardium, and the belly is lined by the transversalis fascia. We can image the head, chest, heart and belly each as a space defined by a fibrous balloon. These fibrous balloons are sometimes periosteal layers, like the dura and the endothoracic fascia (where is coats the ribs and sternum), and some-times they are the tendonous aponeuroses of muscles, like the transversalis fascia (of the transversus abdomi-nus muscle) and the endothoracic fascia (where it coats the inner surface of the innercostal muscles). The fi-brous pericardium is actually more like an upward out-pouching of the central tendon of the diaphragm: its fibers coming with the fibrous outer wrapping of the heart-space. The heart space and the diaphragm are one.

And since they are apiece with our muscles and bones, well, they are directly implicated by our work with these structures. Flex or extend your spine, and you are stretching the dura. A broad palm dragging on the belly is stretching on the transversalis fascia. Pressure on the chest wall is distorting the endothoracic fascia. Take a good deep breath and you are implicating them all to-gether and the fibrous pericardium as well. Once you know what’s there, you can address these baglike layers consciously. And the fun doesn’t stop there!

What's the fuzz speech?

The Fuzz Speech is a silly little riff I gave on camera one day while I was shooting video in the dissection lab for the production of my four-part DVD series, The Inte-gral Anatomy Series. I included it as a "Bonus Feature" on Volume Two of that series, and then thought to just post it on You Tube: http://youtu.be/_FtSP-tkSug

There it sort of took on a life of its own! In the clip I discuss the value of stretching for avoiding the accumu-lation of "fuzz," which is the word I used to describe the

cumulative binding of tissues through hydro-gen bonding first at a microscopic, and ulti-mately at a visible level. Because I illustrated the invisible with a visible analogy in normal tissue, many folks now mistak-enly believe that all "fuzzy" tissue is patho-logical, which of course is not the case! So I have also published to written pieces on the topic, the first being an article in The Journal of Bodywork and Movement Therapy on the specifics of "Visceral adhe-sions as fascial pathology." The second is a chapter in a book coming out through Erik Dalton. He has gotten a bunch of us together to contribute pieces to a collection that should be of much interest to bodyworkers. It should be out soon through his website. In that chapter I document normal and abnormal tissue relationships in the fascial and muscular layers. So between the two written pieces, anyone can get a much more specific sense of the nature of scarring and adhesion in differ-ent tissue types, and how to differentiate them.

Gil Hedley Ph.D. is the founder of Integral Anatomy Productions, LLC, and Somanautics Workshops, Inc. He went to Duke as an undergrad, and then to the Divinity School of the University of Chicago for an MA in the study of religion and a Ph.D. in Theological and Philosophical Ethics. He went to the Rolf Institute and trained in massage, and was certified as a Rolfer® in 1993. Then he and his wife spent 4 years studying whole person healing and psychodynamics at the IM School of Healing Arts. During that time, he began teaching anatomy at the healing school, and teaching anatomy in the dissection lab as well. He eventually left off my Rolfing® practice to devote fully to teaching.

After about ten years developing and teaching the workshop in many cities nationwide and abroad, he undertook the enormous project of putting my ap-proach and message down in a DVD format. The se-ries has to date been distributed to 25 countries glob-ally. You can find Gil at: http://www.facebook.com/pages/Gil-Hedley-Integral-Anatomy/120301201315055

Interview with Gil Hedley


The purpose of this stretch is to lengthen the muscle and soft tissue at the front of the thigh, pelvis, and tissues leading into the deeper regions of the back. The stretch can be done in one of two ways, as pictured above. The stretch can be done at the side (top two photos) or at the end of a bed, table, or even the top step of a flight of stairs (bottom two photos).

Depending on the degree of tightness, your therapist will recommend a certain manner of

performing the stretch. Follow these instructions in terms of their recommended length of time and frequency. This stretch should be a “low load/long dura-tion” stretch; one that is not too extreme and held for a period of time of 3-6 minutes per leg. Note that in the second photo of each of the above sequences, the knee is trapped by the arm just below the elbow and the other hand grasps at the wrist. This allows the leg to hang off of the rigid arm, with less fatigue than if both hands hold the knee to

the chest. Increasing the amount of knee to chest will reduce the strain on the lower back.

Disclaimer: The information provided above is intended for use in conjunction with a quali-fied health care professional. Please do not attempt these techniques yourself without proper instruction.

Hip flexor & Quadriceps-Hip flexor & Quadriceps-Myofascial Stretching Myofascial Stretching

by Walt Fritz, PT Foundations in Myofascial Release Seminars


Fibromyalgia classically presents as wide spread musculoskeletal pain and we know that the origin of this pain is multifaceted and systemic. Because of this, a more comprehensive understanding is required of you to be successful in your treatment options. In this article I’m going to introduce the concept of ‘Central Sensitization’, and the FIQ Fi-bromyalgia Impact Questionaire. These compo-nents will give you a greater understanding of how to work with and treat your Fibromyalgia client.

There has been much written regarding Fi-bromyalgia and Massage Therapy, but a short re-view may be in order to the salient features of the syndrome. Fibromyalgia FMS is a syndrome that is considered by many to be a chronic, cumu-laative overload of the body’s coping and cushion-ing mechanisms (Gillick, 2001) in which on going residuals of macro-traumas (whiplash, system dis-orders, post traumatic stress syndrome, are per-petuated with numerous and cumulative micro-traumas (chronic sinusitis, repeated impact trauma, musculoskeletal dysfunction in the upper or lower extremities, positional sleep traumas) which sensitizes the central nervous system in such a manner as to amplify pain 24/7 and create pain from usually non-painful stimuli.

This is known as Hyperalgesia: the amplifica-tion of pain sensations and Allodynia: non-painful sensations such as touch, noise, vibration, lights or smells are painful. Prevalence indicates usually affecting women over men by a 4/1 ratio, but Fibromyalgia can occur at any age. Although it usuall manifests between the ages of 30 to 50. (Rattray p983)

There is an enormity of presenting symptoms with a wide range of variance as to fool the manual therapist, and probably the best source for the presenting symptoms would be to check out Dr. Devin Starlanyl’s website: http://homepages.sover.net/~devstar/.

Central Sensitization

"Fibromyalgia (FM) pain is frequent in the general population but its pathogenesis is only poorly un-derstood. Many recent studies have emphasized the role of central nervous system pain processing abnormalities in FM, including central sensitiza-tion and inadequate pain inhibition. However, in-creasing evidence points towards peripheral tis-sues as relevant contributors of painful impulse input that might either initiate or maintain central sensitization, or both. It is well known that persis-tent or intense nociception can lead to neuroplas-tic changes in the spinal cord and brain, resulting in central sensitization and pain. This mechanism represents a hallmark of FM and many other chronic pain syndromes, including irritable bowel syndrome, temporomandibular disorder, mi-graine, and low back pain. Importantly, after cen-tral sensitization has been established only mini-mal nociceptive input is required for the mainte-nance of the chronic pain state. Additional factors, including pain related negative affect and poor sleep have been shown to significantly contribute to clinical FM pain. Better understanding of these mechanisms and their relationship to central sen-sitization and clinical pain will provide new ap-proaches for the prevention and treatment of FM and other chronic pain syndromes."

Fibromylagia: Fibromylagia: Fibromylagia: New PerspectivesNew PerspectivesNew Perspectives By Steven Goldstein, BHSc MST, BA Ed


Central sensitisation is defined as ‘‘an augmenta-tion of responsiveness of central pain-signalling neurons to input from low-threshold mechanore-ceptors’’ (Meyer et al.,1995). “While peripheral sensitisation is a local phenomenon, central sensi-tisation means that central pain processing path-ways localised in the spinal cord and the brain are sensitised.”

The science is fascinating, but the clinical implica-tions through the application of this understand-ing is essential. An important and ongoing source of pain is required before the process of peripheral sensitisation can establish central sensitisation. Progression towards chronic widespread pain is associated with injuries to deep tissues which do not heal within several months (Vierck, 2006).

Consequently, appropriate and effective manual therapy in those with (sub)acute musculoskeletal disorders is important to prevent evolvement from an acute, localized musculoskeletal pain problem to complex clinical cases, characterised by chronic widespread pain and even symptoms outside the musculoskeletal system such as increased sensitiv-ity to bright lights, auditory loudness, odours, and other sensory stimuli. Pain due to damage or in-flammation of peripheral tissues is clearly capable of causing chronic widespread pain/FM (Clauw, 2007). 15-20% people with whiplash injuries de-velop chronic pain and disability (Spitzer et al., 1995; Radanov and Sturzenegger, 1996; Cote´ et al., 2001). Regardless of whether FM is present in chronic whiplash, altered central pain processing and central sensitisation is evident (Curatolo et al., 2001; Sterling et al., 2002, 2003, 2006; Banic et al., 2004). Moreover, altered central pain proc-essing rather than impaired motor control has been identified as one of the prime prognostic fac-tors for developing chronic whiplash (Sterling et al., 2003, 2006).

Excerpted below from ‘From acute musculoskele-tal pain to chronic widespread pain and fi-bromyalgia: Application of pain neurophysiology in manual therapy practice treatment’ Manual Therapy 14 (2009) 3:12

Myofascial Treatment

“Anecdotally, muscles and fascia often become hypertonic and develop trigger points in people with chronic widespread pain/FM. Soft-tissue mobilisation is required to free up restrictions and restores local blood flow. However, it is im-portant not to increase pain during treatment. The vicinity of myofascial trigger points differs from normal muscle tissue by its lower pH levels (i.e. more acid), increased levels of substance P, calcitonin gene related peptide, tumour necrosis factor-a and interleukine-1b, each of which has its role in increasing pain sensitivity (Shah et al., 2005). Sensitised muscle nociceptors are more easily activated and may respond to normally innocuous and weak stimuli such as light pres-sure and muscle movement (Shah et al., 2005). Therefore, starting the soft-tissue mobilisation superficially with well-tolerated strokes along the length of the muscle fibres (referred to as ‘stripping’ in Benjamin and Tappan, 2005) and progressing towards deeper strokes that go per-pendicular to the soft-tissue fibres is recom-mended. Aggressive ways of treating trigger points (e.g. by using ischaemic pressure) are usu-ally not well tolerated and therefore not recom-mended.”

The research is clearly demonstrating a lighter ap-proach is needed when applying soft-tissue thera-pies with the sufferer of fibromyalgia. We know

Fibromyalgia


from the studies of ‘facilitation’ with regard to ac-tive and latent trigger points, that once the dorsal horn of the spinal cord is switched on, it maintains its’ ‘facilitation’, with a low thresh hold barrage of stimulus.

An awareness is needed of the mechanisms that activate the autonomic nervous system, such as ‘flight and fight’; and the de-activation of ‘high sympathetic tone’ (Shea 1995), so that the therapist modulates the ANS from a lower sympathetic state into a parasympathetic state which is demon-strated by ‘rest and repose’. With this type of client, modification of duration of treatment, amount of force or pressure and specific tissues totarget, i.e., myofascial tissue, are all essential to a greater de-gree of success through the cessation of the barrage of nocioceptive stimulus.

With the type of clinical approach I utilize, the use of a skill set that employs lighter touch, autonomic nervous system modulation, the use of mind-body techniques such as nlp, neuro-linguistic program-ming, awareness and imagery technique, low load resistive for targeting intrinsic ligament and axial spinal muscle groups, forms of applied kinesiology, reflexology; all have efficacy in the treatment appli-cation of the sufferer of fibromyalgia.

Finally remember you have to have a strong refer-ral network due to the systemic nature of the pres-entation, that means you need to refer to qualified therapists who practice CAM therapies, including naturopaths, CAM therapy friendly allopath physi-cians, mind body therapists, rheumatologists, and cognitive therapists that deal with emotional and psychological issues that are part of the overall clinical picture.

Fibromyalgia Impact Questionnaire

A very important tool for the manual therapist in their treatment of Fibromyalgia is the FIQ or Fi-bromyalgia Questionnaire. This is the tool recog-nized for use in clinical trials around the world, and therefore is the major current tool to measure changeable outcomes for your client.

It was developed by Dr. Robert Bennett in the 1980’s in Portland Oregon in an attempt to capture

the total spectrum of problems related to fi-bromyalgia and the responses to therapy. It was first published in 1991 and since that time has been extensively used as an index of therapeutic efficacy. Overall, it has been shown to have a credible con-struct validity, reliable test-retest characteristics and a good sensitivity in demonstrating therapeu-tic change.

The original questionnaire was modified in 1997 and 2002, to reflect ongoing experience with the instrument and to clarify the scoring system. The latest version of the FIQ can be found at the web site of the Oregon Fibromyalgia Foundation (http://www.myalgia.com/FIQ/FIQ_B.htm ). The FIQ has now been translated into eight languages, and the translated versions have shown operating characteristics similar to the English version. A copy of the questionnaire is available at the end of this article.

Based on an intake questionnaire used in the OHSU Rheumatology Clinic and informal discus-sions with fibromyalgia patients, the initial version of the FIQ was developed in 1986. In particular, the functional component of the questionnaire was purposely biased to the use of large muscle groups rather than fine hand movements.

Make sure you download the questionnaire and thoroughly read the research behind the study, as it will allow you the insight about how the ques-tions were formed and why they were asked. In particular the scoring is designed to target physical functioning versus physical impairment. The cate-gories are such as to ascertain how ADL activities of Daily Living are affected.

Every client should be filling out this questionnaire

Fibromyalgia


and then you actually have the ‘research tool’ in your hand to validate and contribute to studies and findings from a research perspective.

References

1. Dr. John S. Gillick, How to Tame Fibromyalgia © 2001 This is the original paper presented for the first time at the American Occupational Health Conference on April 26, 2001 in San Francisco California by Dr. John Gillick of UCSD San Diego

2. Rattray F. & Ludwig L. Clinical Massage Therapy: Talus Inc. Toronto, Ontoario, Canada, 2000. Fibromalgia & Chronic Fatique Syndrome p 981

3. Jo Nijs , Boudewijn Van Houdenhove. From acute muscu-loskeletal pain to chronic widespread pain and fibromyalgia: Application of pain neurophysiology in manual therapy prac-tice. Manual Therapy 14, Issue 1, Pages 3-12 (February 2009).

4. Benjamin PJ, Tappan FM. Tappan’s handbook of healing massage techniques. Classic, holistic, and emerging methods. New Jersey: Pearson Prentice Hall; 2005. p. 127.

5. Clauw DJ. Fibromyalgia: update on mechanisms and man-agement. Journal of Clinical Rheumatology 2007;13:102e9.

7. Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, et al. Scientific monograph of the Que-bec task force on whiplash-associated disorders: redefining ‘‘whiplash’’ and its management. Spine 1995;20:S1e73.

8. Sterling M, Treleaven J, Edwards S, Jull G. Pressure pain thresholds in chronic whiplash associated disorder: further evidence of altered central pain processing. Journal ofMuscu-loskeletal Pain 2002;10:69e81.

9. Shah JP, Philips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemi-cal milieu of human skeletal muscle. Journal of Applied Physiology 2005; 99:1977-84.

10. Vierck CJ. Mechanisms underlying development of spatial distributed chronic pain (fibromyalgia). Pain 2006; 124:242-63.

11. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Robert Bennett, MD, FRCP, FACP, Professor of Medicine, Department of Medicine, Oregon Health and Sci-ence University, Portland, OR 97329, USA.

12. Clin Exp Rheumatol 2005; 23 (Suppl. 39): S154-S162

13. Fibromyalgia Syndrome: An Overview: Susan Krsnich-Shriwise Phys Ther. 1997;77:68-75.

About the Author:

Steven Goldstein, an American émigré to Australia in 1999, resides in Melbourne, Australia, where he holds a Bachelor of Health Science in Musculoskeletal Therapy and Bachelor of Arts in Education. He is an innovative massage educator instructing his unique blend of direct myofascial, indirect osteopathic releasing methods and somatic approaches known as Integrative Fascial Re-lease internationally since 1995.

Steven chaired the Australian Association Massage Therapists AAMT Education Subcommittee from 2004-2o10 and chaired the Internal Course Advisory Com-mittee for Musculoskeletal Therapy Degree at Endeav-our College of Natural Health 2005-2009. Steven will delivering his IFR Foundations or Interme-diate workshops to manual therapists and physiothera-pists Poznan, Poland; and in London to osteopaths, physiotherapists, manual and remedial therapists in March-April 2010. He is delivering Fibromyalgia: Clini-cal Approaches for the Manual Therapist at the Scottish Massage Organization conference in Edinburgh, Scot-land in March 2010. And also is presenting IFR Intro-ductory workshop to the ACPEM Association of Char-tered Physiotherapists in Energy Medicine conference near Radstock, England in April 2010.

See Steve's website: http://fascialrelease.com/

Read also 6 questions to Steve on page 49.

Fibromyalgia


FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQ)

Name: _________________________________ Date: / /

Directions: For questions 1 through 11, please circle the number that best describes how you did over‐

all for the past week. If you don't normally do something that is asked, cross the question out.

Always Most Occasionally Never

Were you able to :

Do shopping? ……………………………… 0 1 2 3

Do laundry with a washer and dryer? ........ 0 1 2 3

Prepare meals? ......................................... 0 1 2 3

Wash dishes/cooking utensils by hand?..... 0 1 2 3

Vacuum a rug?........................................... 0 1 2 3

Make beds? ............................................... 0 1 2 3

Walk several blocks? ................................ 0 1 2 3

Visit friends or relatives? ........................... 0 1 2 3

Do yard work?............................................ 0 1 2 3

Drive a car? ............................................... 0 1 2 3

Climb stairs? ............................................. 0 1 2 3

12. Of the 7 days in the past week, how many days did you feel good?

0 1 2 3 4 5 6 7

13. How many days last week did you miss work, including housework, because of fibromyalgia?

0 1 2 3 4 5 6 7


FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQ) – page 2

Directions: For the remaining items, mark the point on the line that best indicates how you felt overall

for the past week.

14. When you worked, how much did pain or other symptoms of your fibromyalgia interfere with your

ability to do your work, including housework?

● ___І ___І___І ___І___І ___І ___І ___І ___І___●

No problem with work Great difficulty with work

15. How bad has your pain been?

● ___І ___І___І ___І___І ___І ___І ___І ___І___●

No pain Very severe pain

16. How tired have you been?

● ___І ___І___І ___І___І ___І ___І ___І ___І___●

No tiredness Very tired

17. How have you felt when you get up in the morning?

● ___І ___І___І ___І___І ___І ___І ___І ___І___●

Awoke well rested Awoke very tired

18. How bad has your stiffness been?

● ___І ___І___І ___І___І ___І ___І ___І ___І___●

No stiffness Very stiff

19. How nervous or anxious have you felt?

● ___І ___І___І ___І___І ___І ___І ___І ___І___●

Not anxious Very anxious

20. How depressed or blue have you felt?

● ___І ___І___І ___І___І ___І ___І ___І ___І___●

Not depressed Very depressed

See Dr. Robert Bennett FIQ Abstract as a PDF file download for results of clinical study.

Robert Bennett, MD, FRCP, FACP, Professor of Medicine, Department of Medicine (OP09), Oregon Health and Sci‐

ence University, Portland, OR 97329, USA. E‐mail: [email protected] Clin Exp Rheumatol 2005; 23 (Suppl.

39):S154‐S162.

© Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2005.


Many of our clients experience headaches and neck and shoulder pain on a regular basis. Sitting in front of a computer is often to blame. When I used to work in an office, I discovered a combina-tion of techniques that relieved the tension. Now that I’ve changed careers, I teach these to my cli-ents. I hope you can pass these on to your clients and also use them to counteract the forward pos-ture that massage therapists naturally fall into.

It’s no surprise that over half the people who work with computers experience neck and shoulder pain. The computer monitor is a magnet that draws your eyeballs and the rest of your body fol-lows into an unconscious slouch; before you know it your chest droops, shoulders hunch, and chin

juts forward. (Sheepishly, I admit to sometimes finding myself in this position when working over my massage table.)

Tension is inevitable when the front of the body shortens like this, and the back of the body gets taut to counterbalance the forward lean. When you find yourself like this, three things help: 1) take a break, 2) reverse the slouch, and/or 3) re-turn to good posture.

Unlearn the habit developed in grade schooled; don’t be still for long. The longer you are in one position, the more your body solidifies. Your muscles actually prefer to move, so reposition yourself every few minutes. You can even sit on a balance ball to keep from freezing in place. Get

Relieve Computer Relieve Computer Relieve Computer Neck & Shoulder Neck & Shoulder Neck & Shoulder TensionTensionTension

By Anita BOSER LMP, CHP, RYT


up, stretch, or just wiggle often.

When the spine is stretched in flexion, muscles and joints get damaged gradually unless you spend some time in the opposite position. Re-verse computer posture with stretches or undula-tions. An effective stretch is to interlace your fin-gers behind your head, gently draw the elbows back and lift one elbow toward the ceiling to stretch that side and then lift the other elbow to stretch the other side. Another option is the Re-verse the Slouch undulation: let your chest drop forward as you roll back on your pelvis, then roll your pelvis forward, lift your chest up and bring your arms back. As you exhale curl in and as you inhale open the front of your body. The idea is to move between flexion and extension as well as to stretch the muscles that get shortened.

Your muscles tighten less when you have good posture, so it’s worth the time and money to set up an ergonomic work station.

For your computer station:

Proper chair height has your hips slightly higher than your knees with your feet firm on the floor. Your arms should relax by your sides. Put the keyboard at the same height or slightly lower than your elbows so your wrists are not bent. Keep the mouse as close to the keyboard as possible, so you

don’t have to reach far for it. The best position for the screen is to be directly in front of your face about 20 inches away, so you don’t have to look up, down, or to the right or left.

For your massage table:

Adjust the height of the table, so you can lift your chest when working. Bend your knees rather than dropping your ribcage. Flex at the hips rather than through the spine. If you do massage work when seated at times, choose a chair (or balance ball) that follows the guidelines above.

Being conscious of your body is the first step to-ward relieving tension. Whenever you notice strain, reduce the toll exacted by unnatural pos-ture (whether it’s at a computer, construction site or massage office) by moving frequently, stretch-ing to counterbalance common strains, and re-suming good posture as often as you can.

Learn more about relieving strain and get a free copy of 7 Undulations to Relieve Office Tension at www.undulationexercise.com. Anita Boser is a Certified Hellerwork Structural Integration Practi-tioner, Registered Yoga Teacher and author of Re-lieve Stiffness and Feel Young Again with Undula-tion.

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Massage therapy and fi-bromyalgia

A review recently published in Rheumatology International Journal reviews available stud-ies with an emphasis on ran-domized controlled trials to de-termine whether massage ther-apy can be a viable treatment of fibromyalgia symptoms.

The effects of massage on fi-bromyalgia symptoms have been examined in two single-arm studies and six randomized con-trolled trials. All reviewed stud-ies showed short-term benefits of massage, and only one single-arm study demonstrated long-term benefits. However all re-viewed studies had methodo-logical problems.

The existing literature provides modest support for use of mas-sage therapy in treating fi-bromyalgia. The authors sug-gested additional rigorous re-search is needed in order to es-tablish massage therapy as a safe and effective intervention for fibromyalgia.

The authors concluded that "In massage therapy of fibromyal-gia, we suggest that massage will be painless, its intensity should be increased gradually from ses-sion to session, in accordance with patient’s symptoms; and the sessions should be per-formed at least 1-2 times a week."

Massage relieves chronic tension headache

Researchers at the University of Granada, Spain, are applying a 30-minute massage to ease ten-sion headaches, which are in-creasingly frequent in our soci-ety. The results of this pioneer study were published in the American Journal of Manipulat-ive Physiological and Therapeu-tics

The results have proven that the psychological and physiological state of patients with tension headache improves within 24 hours after receiving a 30-minute massage.

As researchers explained, ten-sion headaches have an increas-ing incidence in the population. One of the main causes of this type of headache is the presence of trigger points. The re-searcher has proven that a 30-minute massage on cervical trig-ger points improves autonomic nervous system regulation in these patients. Additionally, pa-tients exhibit a better psycho-logical state and “reduce the stress and anxiety associated to such a disturbing disorder”.

Similarly, patients report a per-ceived relief from symptoms within 24 hours after the mas-sage. This might mean that mas-sages may reduce the pain caused by trigger points, which would involve an improvement in the general state of patients.

Does massage therapy re-duce cortisol level?

It is frequently asserted that

massage therapy reduces corti-sol levels, and that this mecha-nism is the cause of its benefits including relief from anxiety, depression, and pain. However reviews of massage therapy re-search are not in agreement on the existence or magnitude of such a cortisol reduction effect, or the likelihood that it plays such a causative role. Research-ers led by Christopher Moyer conduct a literature review of massage therapy's effect on cor-tisol. The study is being pub-lished in Journal of Bodywork and Movement Therapies.

Their review and analysis found that massage therapy's effect on cortisol is generally very small and, in most cases, not statisti-cally distinguishable from zero. The authors concluded that cor-tisol cannot be the cause of mas-sage therapy's well-established and statistically larger beneficial effects on anxiety, depression, and pain. Other causal mecha-nisms, which are still to be iden-tified, must be responsible for massage therapy's clinical bene-fits.

How much time is re-quired to modify a fascial fibrosis?

A new study by Italian research-ers Ercole Borgini , Antonio Stecco, Julie Ann Day and Carla Stecco fund that it took an aver-age of 3.24 minutes to modify a fascial fibrosis using the Fascial Manipulation technique. The study is being published in

Research Highlights


Journal of Bodywork and Move-ment Therapies

It is theorized that different manual and physical techniques could restore the normal physio-logical state of the fascia, but there is very little scientific evi-dence about the mode of action of manual therapies in general.

The perception of what appears to be connective tissue fibrosis, and its consequent modification during therapy, is a daily experi-ence for most manual therapists.

The researchers evaluated the time required to modify a palpa-tory sensation of fibrosis of the fascia in correlation with changes in levels of patient dis-comfort in 40 subjects with low back pain utilizing the Fascial Manipulation technique.

This study evidenced, for the first time, that the time required to modify an apparent fascial density differs in accordance with differences in characteris-tics of the subjects and of the symptoms. In particular, the mean time to halve the pain was 3.24 minutes; however, in those subjects with symptoms present from less than 3 months (sub-acute) the mean time was lesser (2.58 min) with respect to the chronic patients (3.29 min).

Differences in practitio-ners’ proficiency affect the effectiveness of mas-sage therapy

A study in Japan was conducted to evaluate how differences in

the proficiency of massage prac-titioners can affect the physical and psychological states on cli-ents.

Eight healthy 50-year-old fe-males, suffering from chronic neck and shoulder stiffness, were recruited and four inter-ventions were conducted: three 40-minute massage therapy in-terventions, one each by a fresh-man and a student studying massage therapy, and one by their instructor, and one rest on the massage table. Visual ana-logue scale score for muscle stiffness in the neck and shoul-der, state anxiety score, and sali-vary cortisol concentration lev-els and secretory immunoglobu-lin A, were measured pre- and post- interventions.

The results showed that Mas-sage by experienced instructor give a lower pain scale of neck and shoulder stiffness after mas-sage compared to massage con-ducted by freshman or student. Furthermore the score of state anxiety was lower than that after resting.

A single massage can boost the immune system

Researchers from Cedars-Sinai Medical Center reported that a single massage produced meas-urable changes in the immune system and endocrine system of healthy adults.

The research was conducted in an outpatient research unit in an academic medical center. Medi-

cally and psychiatrically healthy adults, 18–45 years old, partici-pated in this study. The study design was a head-to-head, sin-gle-session comparison of Swed-ish Massage Therapy with a light touch control condition. The in-tervention tested was 45 min-utes of Swedish Massage Ther-apy versus a light touch control condition, using highly specified and identical protocols. Blood samples were taken before the massage began and at regular intervals up to one hour after the massage was completed.

The study found several changes in the blood tests of the Swedish massage group that indicated a benefit to the immune system. Swedish massage caused size-able decreases in arginine vaso-pressin (AVP), a hormone that contributes to aggressive behav-ior, and small decreases in the stress hormone cortisol. The Swedish massage participants also had an increase in the num-ber of circulating lymphocytes, cells that help the immune sys-tem defend the body from harm-ful substances. However Oxyto-cin was not found to be influ-enced.

The authors concluded that “Preliminary data suggest that a single session of Swedish Mas-sage Therapy produces measur-able biologic effects. If repli-cated, these findings may have implications for managing in-flammatory and autoimmune conditions.”

Research Highlights


1. When and how did you decide to become a body-worker?

I was always interested in touch. I took my first massage course in Seattle in 1981 at the only credible massage school in at the time, Heide Brenneke School of Massage. I was li-censed in Washington State in early 1986.

My first real opportunity came when Diana Thompson, an-other established USA educator, took me into her injury clinic in 1987. You have to understand when I began practicing; the education model for massage therapy in the USA was very limited and slight in the number of face to face supervised classroom hours. In essence, I was ‘thrown to the wolf’s” and apprenticed through many challenging orthopaedic injuries . I recognized there had to be reason why muscles were not releasing, and I accidentally stumbled upon the myofascial soft- tissue layer when experimenting with changes both in depth of pressure and duration of application, along with changing the vectors . The only myofascial training in the late 1980’s and early 1990’s in the USA, were either the Rolfing community which encompassed Structural Integration, or from the physiotherapy community whose school was John Barnes and Carol Manheim. I read everything I could get my hands on and when another practitioner took a myofascial workshop, I avidly read their manuals to ascertain if I was on the right track. It’s interesting that I didn’t take any myofas-cial courses per say, but was generally applying the technique accurately according to the manuals I had perused.

2. What do you find most exciting about bodywork therapy?

For me the most exciting part of bodywork is twofold; first you will never know everything. The quest for understanding is a lifelong pursuit. If you are bored in this profession, it's you the practitioner that has the difficulty, as there is abso-lutely nothing boring about what we practice, that is, working everyday with complex soft-tissue presentations that effect the quality of life of an individual.

Secondly, my fascination with the interface of direct mfr ver-sus indirect osteopathic approaches in manual therapy. I blend the use of lighter touch for autonomic nervous system responses with the use of low load resistive for joints, liga-ment and myofascia, more akin to joint energy than muscle energy technique. I believe 'lighter touch' is the 'homeopathy of bodywork.'

3. What is your favourite bodywork book?

It changes with every new book. Currently two books are on my list: Harmonic Healing: A Guide to Facilitated Oscillatory Release & Other Rhythmic Myofascial Techniques, Zachary

Comeaux, DO., and Back Pain: a Movement Problem a clini-cal approach incorporating relevant research & practice, Jo-sephine Key. Also the new Earl-Myers myofascial manual is great, as Myers has reprised his excellent series of anatomy articles he authored in Massage Magazine in the late 1990's.

4. What is the most challenging part of your work?

I routinely receive referrals from other practitioners, which usually are already difficult cases they have moved onward to me. Scoliosis is difficult, I feel I have much to learn regarding blending various approaches to achieve satisfying clinical outcomes. Fibromyalgia, chronic fatigue and other dysregula-tion syndromes that present multi-faceted chronic pain take time, perseverance and high level of clinical skill.

5. What advise can you give to fresh massage thera-pists who wish to make a career out of it?

Longevity is a tricky thing. Depending on how the massage therapist is trained, that is, the correct use of their body and the 'tools of their trade', their hands, wrists and fingers, are absolutely essential to maintain longer life in this industry. Continuing with professional education in order to work in-telligently, efficiently and effectively cannot be ignored. Have a business plan! Understand it not just about delivering the service but how you set up the delivery of that service. Net-work extensively. Be part of a multi-disciplinary clinic if pos-sible. Practice excellence. Do not take an attitude of this being work. It is, but you have to enjoy your practice.

6. How do you see the future of massage therapy?

I know I'm speaking to the VET sector where most of the training delivered in Australia by RTO's are under the HTP Health Training Package. This part of the industry will con-tinue to grow and prosper. I see the future of institutions of higher education in Australia delivering more advanced train-ings in the form of Bachelor of Health Science programs or advanced diplomas which under would be administered un-der the OHE office of Higher Education. This will only mar-ginally change the landscape in the next five years. Beyond five years we will see a change. Scope of practices nationally and internationally are blurring the lines between massage therapy, manual therapy, osteopathy and physio-therapy. Debate is current regarding body of knowledge, stan-dard practices, regulation and scope of practice. This is nec-essary to move the profession forward. I believe a higher level of massage therapy training will be accepted when criti-cal mass and public awareness through professional organi-zations foster this with the knowledge that we are the best trained soft-tissue specialists in the world. No other profes-sion spends the amount of time we do honing our palpatory literacy.

6 Questions to Steven Goldstein


1. When and how did you decide to become a bodyworker?

At university, I studied psychology and planned to become a therapist. I remember writing in my journal, “I want to help people find answers for themselves.” But when it came down to it, some-thing didn’t feel right so I did something com-pletely different and entered the business world. I got my master of business administration and found myself living in front of a computer. Soon shoulder and neck pain became unbearable and I tried Rolfing Structural Integration. The first ses-sion was so transformative, emotionally as well as physically, that I stopped everything and enrolled at the Rolf Institute two months later. It was one of the craziest, best decisions I have ever made. I got my wish: I get to help people find answers for themselves—but in a way that I hadn’t even known was possible.

2. What do you find most exciting about bodywork therapy?

Helping people facilitate change. A lot of time this means their hip stops hurting. But, often, it’s much more than that. Bodywork can help people work through all kinds of stuff. It’s never boring.

3. What is your most favourite bodywork book?

Where to start? I’m a geek, you know; I read eve-rything. There is no favourite. I think bodyworkers need to be helping clients change dysfunctional movement patterns, so I recommend they read Mary Bond’s, “The New Rules of Posture.”

4. What is the most challenging part of your work?

Taking enough time for myself. I love what I do. It allows me unlimited avenues to learn and grow… and my tendency is to want to go down every one of them! I get to work one-on-one with clients, I get to teach workshops, I get to write articles, I run a business. I’m on the board of a non-profit that supports structural inte-gration research. And then, of course, I want to see what my peers are coming up with so I attend workshops whenever I can. Someone once told me that success is having to say, “no” to stuff you want to do. I get it.

5. What advise can you give to fresh mas-sage therapists who wish to make a career out of it?

Work with clients as a partnership. You’re not working on them; you’re working with them. Ask lots of questions. It is valuable for clients to be heard and it will inform your work immeasurably. Clients are far more knowledgeable about them-selves than you will ever be. You are just a facilita-tor. Sometimes bodies get stuck in dysfunctional pain or movement patterns. If you can find and address a primary issue (often not where the pain is), you may be amazed at what their bodies can resolve.

6. How do you see the future of massage therapy?

Wide open. More and more people are using mas-sage and bodywork to get relief from certain chronic conditions like back and neck pain. We are only beginning to understand why it works, but the trend is there.

6 Questions to Bethany Ward

Terra Rosa eMagazine Issue 6

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