Terra Rosa
Bodywork e-News
Issue 3, June 2009
Contents
02 Myofascial Techniques for the Superficial
Neck Fascia —Til Luchau
07 Imagery to lengthen the neck
08 The Relationship Between Stress and
Neck & Shoulder Pain —Anita Boser
11 An Integrated Approach to Rehabilitation
of Leg Injuries. Part II —Art Riggs
19 Deadbeat Diagnosis —Erik Dalton
24 Thai Massage —Richard Gold
28 Peripersonal Space & Bodywork
32 A New Theory on Reflexology
34 De Quervain’s Syndrome
36 A New Contraindication of Massage —
Kristin Osborn
37 Complex Regional Pain Syndrome —
Whitney Lowe
39 Research Highlights
41 Six Questions to Til Luchau
42 Six Questions to Anita Boser
Terra Rosa
www.terrarosa.com.au
The Source for Massage Information
Disclaimer: The publisher of this e-News disclaim any responsibility and liability for loss or damage that may result from
articles in this publication.
www.terrarosa.com.au
Welcome to our third issue of Terra Rosa Bodywork e-
magazine, our free e-zine dedicated to bodyworkers. It is
an exciting full-on 40 pages of information.
Economic crisis is looming and has influenced our indus-
try as well. News from an association in Australia indicate
the decrease in membership renewal. This crisis will pre-
sent great challenges, however this is a time to renew and
shape our work. Massage has survived many crises, and
will continue to be in demand. So be positive.
We got a range of great articles from respected authors. Til
Luchau on the myofascial techniques for the neck, Anita
Boser on neck & shoulder pain. Art Riggs continues his
article on the leg. Erik Dalton discusses the latest research
and treatment on iliotibial friction syndrome. Richard
Gold gives an intro to Thai Massage. We turn to the area of
peripersonal space and the latest theory on foot reflexology.
A new contraindication of massage by Kristin Osborn and
Complex Regional Pain Syndrome by Whitney Lowe. Don’t
forget to read Six Questions to Til and Anita.
We hope to keep you informed and entertained. If you
have something you wish to contribute, drop us an email:
terrarosa@ gmail.com. We believe that therapists like you
have lots of experiences to share. Thanks for all of your
support and enjoy reading.
Bodywork e-News 1
 Myofascial Techniques for
the Superficial Neck Fascia
by Til Luchau

Intro
In this and subsequent articles,
I’ll describe specific techniques
that work with some of the most
common client issues. I’ll draw
on the work taught in Advanced-
Trainings.com’s popular
“Advanced Myofascial Tech-
niques” workshop series, which
for the last 25 years, has been
attended by over 2000 practitio-
ners in over a dozen countries.
Although I’m at the Advanced-
Trainings.com faculty are Certi-
fied Advanced Rolfers, and I
teach at the Rolf Institute®,
rather than writing about struc-
tural integration per se, my em-
phasis in these articles will be on
specific and practical techniques
that would be useful to any
hands-on practitioner. We’ll
start by looking at the superfi-
cial layers of the neck and pre-
paring the neck and shoulders
for deep work.
This article is originally pub-
lished in the Massage and
Bodywork magazine, USA.
Visit http://www.youtube.com/
user/AdvancedTrainings for a
video clip from the 2009 DVD
“Advanced Myofascial Tech-
niques for the Neck, Jaw, and
Head” from Advanced-
Trainings.com.
Figure 1: The superficial fascia of the neck, in green, surrounds the deeper structures like
a sleeve or cowl . (Illustration courtesy and copyright Primal Pictures Ltd.)
The Importance of the Su-
perficial Layers
What are the most common
complaints you see in your prac-
tice? Chances are, neck pain and
discomfort are high on the list.
Although cervical issues can
have many causes, you’ll often
see better results if you begin by
addressing restrictions in the
superficial layers of the neck and
shoulders. Whether caused by
deep articular fixations, posture
and misalignment, habits, stress,
injury, or other reasons, neck
issues respond quicker and stay
away longer when the outer
wrappings are released first. As
with other parts of the body,
many seemingly deeper neck is-
sues resolve when the external
layers have been freed. In this
article, I’ll describe how to work
with these superficial but impor-
tant layers in order to prepare
the neck for working with its
deeper structures.
The neck’s superficial tissue lay-
ers have a great deal of influence
on its alignment, mobility and
health. These “outer wrappings”
encircle the neck and shoulders
like an over-large turtleneck
sweater, or a surgical collar
(Figure 1)
Anatomically, these layers in-
clude the superficial and deep
cervical fascias, as well as the
muscles within those fascial lay-
ers, such as the Trapezius, Ster-
nocleidomastoid, and the

Bodywork e-News 2
 Myofascial techniques for the neck
Platysma (Figure 2). Together, Try this: watch a
these cowl-like outer layers ex- friend turn his or
tend from their upper attach- her head from side
ments on the occipital ridge and to side. Watch
lower face, to their lower connec- what happens with
tions with the outer layers of the the superficial lay-
shoulders, chest, and upper back. ers of the neck,
Like a sleeve, they encircle the shoulders, chest,
deeper musculoskeletal and vis- and back. Are
ceral structures of the neck’s there areas of the
core. torso’s fascia that
move along with
The superficial layers of the neck the head and
have a surprising thickness and neck? Or, do you
resilience. When, because of in- see lines of tension
jury, postural strain, or other and pull appearing Figure 3 Fascial strain visible as "tugging" of the outer
reasons, they have lost pliability in the skin and layers with movement.
or are adhered to other layers outer layers? Of-
and structures, the outside layers ten, these signs of fascial restric- perficial layers, you can use your
have the ability to restrict move- tion will be most visible at the hands to feel for tugs and pulls
ment range, disrupt alignment, extremes or end-range of the in the outer layers while your
and bind the structures they sur- movement. Look from both the client rotates his or her head.
round. Imagine trying to move in front and the back; compare left Whether watching or feeling,
a wetsuit that is a size too and right sides for any differ- note any areas that don’t have
small—the outer layers of the ences. Then, look again as he or smooth, even lengthening of the
neck can bind, distort, and con- she gently looks up and down dermis and superficial fascias
strain movement in the same (being careful, of course, to avoid when the head moves.
way. any posterior cervical compres-
sion when looking up). Your We are constructed like onions:
friend might feel different kinds layered, from superficial to deep.
Seeing Superficial Restric- of restrictions when moving, in- When testing for fascial tension
tions cluding pulls in the deeper mus- with movement, don’t confuse
culature, or catches involving movements of deeper structures
neck articulations or the upper for movement in the superficial
ribs. For now, we’re going fascia. For example, you’ll some-
to leave these aside and fo- times see the ribcage turning
cus on the outer layers first. along with the head, or a shoul-
der roll forward, etc. Some of
Sometimes superficial fas- this movement is normal; if you
cial tension will be visible as see exaggerated or asymmetrical
linear patterns “tug” in the movement of the ribcage or
skin (Figure 3). In other shoulder, this might be because
cases, a whole sheet of fas- of deeper restrictions. Make a
cia will move or creep along note to check for and address
with the rotating or nod- these patterns later, but remem-
ding head. Linear “tug” pat- ber that since these deeper
terns are more commonly movements might be caused by
seen in the thinner layers of restrictions in the outer layers,
the anterior neck and chest, releasing the superficial layers is
while the “creep” of whole the logical first step. Unless
fascial sheets is seen more you’re working with a scalpel
Figure 2: The superficial layers of the neck, in often when looking at the and are cutting right through,
cross section. (Illustration courtesy estate of thicker posterior layers of you need to gently peel away the
John Lodge.) the back. If it is difficult to outer layers to get to the core.
see restrictions in the su-

Bodywork e-News 3
 Myofascial techniques for the neck
Releasing Superficial Re-
strictions
Once you’ve seen or felt where
your client/friend’s outer layers
are tugging or creeping along
with head and neck movement,
you can go to work. A word
about sequencing your superfi-
cial work on the upper torso: in
most cases, you’ll begin by re-
leasing the posterior restrictions
of the upper back, and end by
working the anterior restrictions.
This is the order we’re using in
this article. Why this back-to-
front progression? Since most of
us tend to have our heads for-
ward of the coronal midline, and
be narrower across the front of
our chest than across our upper
back, the anterior fascial layers
of the chest and shoulders tend
to be shorter than the posterior
layers of the shoulders and back.
Ending by lengthening the
shorter anterior restrictions bal-
ances the earlier work on the
posterior side, and leaves the
client with a greater sense of an-
terior width, length, and free-
dom, and so helps with overall
alignment. A possible exception
to this ordering: if your client
has a very flat upper thoracic
curve, you may want to reverse
the sequence, and end with work
on the back to encourage more
spinal flexion.
1. Over the Edge Technique
Ask your client to lie face down
on your table, arms at the sides,
with his or her head and neck
just over the top edge of the table. vide the movement needed for
The edge of the table should fall
an inch or two below the top of
the sternum. Your client may
need to adjust upwards or down- gently anchored with your fore-
wards a bit so that the edge is
comfortable. You won’t want to
leave your client like this too
long, but you’ll usually have at
least two or three minutes to
work
before
his or
her head
starts to
feel too
full.
Once
your cli-
ent is
comfort-
able, ask
him or
her to
turn the
head Figure 4: The "Over-the-Edge" technique for releasing the superficial
from layers of the upper back and shoulders. Although relatively safe,
side-to- head-down positions are usually contraindicated for clients with un-
side as controlled high blood pressure, a history or risk of stokes, vertigo, or
you acute sinus issues.
again
watch or movement. Imagine that you’re
feel the outer tissue layers, in helping your client lengthen and
order to re-check your findings. free herself inside the wetsuit-
Look again at the up-and-down like outer layers of superficial
movements too, again using care fascia.
to avoid any neck compression
with extension. Often, this prone Alternatively, you can ask your
position will make the superficial client to lift and lower the head
restrictions even more obvious. (extend and flex the spine) as
you lengthen the layers of the
The tool we’ll use to release these back inferiorly. You’ll find that
restrictions is the flat of our fore- most release will happen on the
arm; specifically, the first few eccentric phase of the motion,
inches of the ulna just distal to that is, while your client is lower-
the elbow (Figure 5). Use this ing his or her head.
tool to gently anchor the inferior
margins of the places you saw or Remember, your client will get
felt superficial restrictions. We uncomfortable you leave them in
don’t use oil or cream, as we’ll be this position for more than a few
using friction more than pres- minutes. Although relatively safe,
sure to contact the layer we want head-down positions are proba-
to release. Also, we won’t be slid- bly contraindicated for clients
ing much—our client will pro- with uncontrolled high blood
pressure, a history or risk of
release. stokes, vertigo, or acute sinus
issues.
Once you have the outer layers
arm, ask your client to slowly
turn his or her head away from 2.Anterior Neck/Shoulder
the side you’re working. Feel for Differentiation Technique
a direction of your pressure that
After releasing the posterior re-
gently lengthens the superficial
strictions of the back and shoul-
layers being pulled by the head
Bodywork e-News 4
 Myofascial techniques for the neck
Figure 5: An open palm or the tips of curled fingers may be
used for the Anterior Neck/Shoulder Differentiation tech-
nique.
ders’ superficial layers, you’ll
want to broaden and continue
this release by addressing any
surface restrictions in the upper
chest and anterior shoulders.
To release these anterior restric-
tions, we’ll use either our palms
or fingertips to anchor the super-
ficial fascia of the shoulders,
chest, and anterior neck (Figure
6). Then we’ll use our client’s
movement to release the restric-
tions we saw or felt earlier. The
palm is especially useful where
you saw fascial layer “creep” with
head movement. When using
your palm, don’t be tempted yet
to rub, slide, or massage the
deeper layers of pectoralis, etc.
Instead, use the broad surface of
the palm to catch and gently an-
chor the outer layers of the chest
while your client moves his or
her head.
In contrast to the broad tool of
the palm, your fingertips will al-
low you to work specific areas,
and so are useful where you saw
the local “tugs” in the outer lay-
ers when your client was moving.
When using the fingertips, the
fingers are slightly curved rather
than straight, and are sensitively
“hooking in” to the outer layer
you saw or felt moving with the
head. Push with ing pulled by the head move-
your fingertips, ment. Imagine that you’re help-
as if straighten- ing your client lengthen and free
ing out your him or herself inside the wetsuit-
curled fingers, like outer layers of superficial
to encourage fascia.
superficial re-
lease away from A further option is to have your
the direction of client tighten his Platysma mus-
movement. cle, which lies within the superfi-
cial fascias that we’re working.
Whether you’re Try it yourself as you’re reading
using palm or this—turn your head, and then
fingertips, don’t grimace or snarl until you feel a
slide along the tug from your lower lip into the
surface, and pectoral fascia of your chest. By
don’t dig down anchoring the lower end of this
to the ribs or tug in the chest, you can snarl
intercostals-- and relax repeatedly to release
you want to feel a tug in the any constriction in the anterior
outer layers, the layers of dermis fascia. Having your client tighten
and superficial fascia that lie be- and relax the Platysma in this
tween the actual surface of the way while you anchor its inferior
skin, and the muscles or bones attachments can help your client
beneath. focus the release into the tightest
areas.
Movement: as in the “Over the
Edge” technique, ask you client Finishing
to slowly turn his or her head
Once you’ve released the outer
away from the side you’re an-
layers of the neck and torso from
choring. Find a direction for
the back, and front, look again as
your pressure that gently re-
your friend turns his or her head
leases the superficial layers be-
Figure 6: Active contraction of the Platysma, as in grimacing, can aid in releas-
ing the superficial fascia of the anterior thorax.
Bodywork e-News 5
 Myofascial techniques for the neck
from side to side. If you’ve been
both patient and thorough, you’ll
see fewer pulls and tugs in the
outer layers, and more than
likely, smoother and greater
range of motion. Clients report
that their movement feels easier,
freer, or that their head is lighter
and more upright.
Now that you’ve released the
outer layers, the next step could
be deeper work with the neck,
ribcage, or spine, either in the
same session as these techniques,
or the next one. The deeper work
will now be easier, more effective,
and longer lasting. Or, instead of
working deeper right away, first
you might want to continue the
theme of superficial release by
adapting the techniques we’ve
just done here to other, compli-
mentary regions of the body,
such as the lumbars, limbs, or
hips. I’ll write about more about
these possibilities in other arti-
cles. In the meantime, keep in-
vestigating what happens when
you take time to release the
outer layers of the body.
Tips for Effective Work
Keep everyone comfortable. You
and your client should both be
comfortable and able to relax.
The pressure, position, or move-
ments you use should never be
uncomfortable for either of you.
Stay superficial. Even though the
tools shown here—forearm, soft
fist, palm, finger tips—can be
used for deep work, stay in the
outer layers of the body at first.
You’ll be surprised at how much
easier the deeper work will go,
and how much longer its effects
will last.
Use your client’s movement. In-
stead of pushing tissue around,
use your client’s slow, conscious
movement to release and re-
educate habitual movement pat-
terns.
Touch the person, not just the
tissue. Remember that your are
asking for change from a living,
breathing being; not from inani-
mate compounds like “tissue” or
“myofascia.”
Balance and integrate. Most cli-
ents will feel more balanced if
Advanced Myofascial Techniques
DVDs and Manuals available from
www.terrarosa.com.au
Advanced Myofascial Workshops with
Til Luchau & Co. in Australia in 2010
For more info: info@advanced-trainings.com
Advanced-trainings.com
you end with work in the front to
counterbalance the back length
of the first technique. Be sure to
incorporate your local work into
an entire-body perspective,
rather than just focusing on
parts.
Visit http://www.youtube.com/
user/AdvancedTrainings for a
video clip.
Bio
Til Luchau is the director and a
lead instructor at Advanced-
Trainings.com Inc., which offers
continuing education seminars
and support services for practi-
tioners and schools throughout
the USA and abroad. The origi-
nator of Skillful Touch Bodywork
(the Rolf Institute®'s own train-
ing and practice modality), he is
a Certified Advanced Rolfer®
and a Rolf Institute® faculty
member. He welcomes your
comments or questions at
info@advanced-trainings.com.
See also 6 Questions to Til at
page ..
© 2008, Til Luchau, Advanced-
Trainings.com
Bodywork e-News 6
Imagery for
Picture courtesy
of Primal Pictures

the Neck
Move your C7 towards your jugu-
lar notch!

For people with forward head posture,

a difficult task for the therapist and the
client is to train the client to correct for
the wrong posture, move the head back
to the neutral position. We usually ask
the client to maintain a neutral spine,
the head should be stacked over the
cervical spine with the shoulders re-
laxed.

The usual exercise we can give is the

“chin tuck”. Or we can ask them for a
guided imagery of “head lengthening” :
Sit tall, imagine that a string is length-
ening your neck and pulling your head
up towards the ceiling. In Alexander
technique, we are instructed to “Allow
the head to go forward and up from the
spine.”

Imagery is quite powerful and acts as a

stimulus for developing kinesthetic
awareness and producing bodily
jugular notch of the sternum” (the large ercise that is quite powerful in bringing
change. Another simple imagery exer-
notch in the superior margin of the the head back to neutral position. Try it.
cise that I recently learnt is to ask your
sternum). This is a simple imagery ex-
client to “bring your C7 towards the

Anyone for a Stone massage?

Bodywork e-News 7
 The Relationship
Between Stress and
Neck & Shoulder Pain
by Anita Boser, LMP, CHP
Stress and neck and shoulder
tension are interrelated for most
people. This article will explain
why and show how massage
therapists can not only relieve
discomfort, but also help our cli-
ents be better prepared to handle
tumultuous times with resilience.
In an optimally functioning body,
Trapezius
Semispinalis
Cervicis
Layers of neck muscles from superficial to deep (from Primal Pictures)
action initiates from the core and
translates through the limbs.
Functional use of the arms starts
from a stable pelvis then trans-
fers through the spine to the
scapula, then the arm, hand and
fingers. Motions as simple as
typing on a keyboard and steer-
ing a car follow this pattern.
Splenius
Capitis
Multifidus
This level of performance can be
interrupted by restrictions in the
rib cage and thoracic spine re-
sulting in dysfunctional move-
ment patterns. When connec-
tion to the core is inhibited, the
muscles in the arms and neck
(especially the trapezius, levator
scapula and rhomboids) are
overtaxed and develop adhesions
Semispinalis
Capitis
Rotatores
Bodywork e-News 8
 Neck & Shoulder Pain
and trigger points. Anxiety is
one culprit as it often obstructs
breathing and movement of the
thoracic spine.
Stress creates contraction. The
breath becomes shallow with a
tendency to hold the inhale.
Breathe in this manner and no-
tice what happens. The pelvic
floor stiffens. The diaphragm
holds tension. The intercostals
and thoracic spine erectors and
paraspinals stop moving. The
natural flow of breathing
through the torso becomes fro-
zen, and the muscles eventually
fix into this rigid pattern.
Now move your arms with this
level of tension in the spine. No-
tice the instant pressure placed
on the rotator cuff and neck.
Deep breathing can restart the
flow, but until the muscles are
released the breath will not
reach its comfortable maximum.
That’s where the massage thera-
pist can help. Release of the
myofascia that covers the ribcage
is a natural place to start, work-
ing from superficial (pectoralis
major, trapezius) to deep (the
intercostals). As the tissues glide,
breath naturally becomes easier
and fuller.
Since most ribs have three at-
tachments to the thoracic verte-
brae (See Figure above), improv-
ing costal motility will start to
cultivate freedom in the spine.
However, the thoracic spine usu- author of Relieve Stiffness and
ally does not regain its motion
without specific attention.
The complexity of muscles that
control the spine— the erector
spinae overlying the paraspi-
nals—allows for nearly unlimited
movement. Work first through
the layers of erectors,
(iliocostalis, longissimus and
spinalis) freeing the fibers for
individual articulation. To ac-
cess the deeper muscles
(semispinalis, multifidi and rota-
tores) ask your client to undulate
as you work on the interweave of
muscles in the laminar groove.
When the thoracic spine has re-
gained a level of mobility teach
your client to reconnect with
fluid movement. Undulations
will reduce rigidity and tame
tension. A fluid spine and ample
breath are foundational compo-
nents to shoulder life’s responsi-
bilities and take the edge off
stressful situations.
Anita Boser, LMP, CHP is the
Feel Young Again with Undula-
tion and the audio version, Un-
dulation Exercises. She can be
contacted at
anita@anitahellerworker.com or
www.undulationexercise.com.

Feel better fast with Anita Boser’s exercises

Whether you're 16, 36 or 65, an athlete or a couch potato, coordinated or a klutz,
Relieve Stiffness and Feel Young Again shows you how just 10 minutes a day can
make a difference in how you feel. Boser gives you easy-to-follow guidelines and
photographs for 52 simple exercises that will allow you to move better and more
comfortably. Try a different exercise every week and by the end of a year, you're
sure to feel better. Wherever you ache, undulation will provide relief-naturally,
without medication, without equipment, without expense. And you'll have fun,
too!

Available from: www.terrarosa.com.au

Bodywork e-News 9
 Lomi Lomi Massage
Workshop Down Under

With
Carrie Rowell

Join Carrie Rowell for a 4-day Workshop, Hawaiian Lomi Lomi Massage, covering an introduction
to the principles, and a full body massage routine, complete with joint mobilization and passive
stretching.
• Sydney Workshop, Date: September 24-27, 2009. Location: North Curl Curl at a beach house a
few minutes walk from the beach (we can do our hula and Auhea exercises on the sand)
• Byron Bay, September 14-17 2009
• New Plymouth, New Zealand ,October 9-11 2009
Approved by AAMT for 20 CPE points.
For over 20 years, Carrie has studied various forms of sacred dance and movement. She applies the
beneficial techniques learned from these arts into her bodywork therapy. Carrie practices and
teaches bodywork in the US and traveled all over the world teaching Lomi Lomi massage, sacred
dance and healing and empowerment workshops for women.
For centuries the ancient art of Hawaiian Lomi Lomi massage has been used as a powerful tool for
maintaining a healthy way of life. The strokes are long and flowing, using forearms and elbows, and
giving the feeling of many hands on the body at once. All seminars incorporate movement and
breath exercises, specific Hawaiian Massage techniques and exercises for self care.
Practitioners work on each other and switch partners to learn how to apply the techniques to differ-
ent body types. Individual attention is given by the instructor so that the students learn how utilize
their body mechanics in the most efficient way for them. Each day you will learn new exercises and
massage techniques designed to harness the power of the elements earth, air, water and fire.
To register your interest and get more details email: carrie@carrierowell.com

Bodywork e-News 10
 AN INTEGRATED APPROACH
TO REHABILITATION OF
LEG
INJURIES
Part II
with Art Riggs
After introducing the importance of a holistic view of knee rehabilitation in order to restore proper gait, the
previous article ended with our fingers deep in the IT band. The techniques that were demonstrated began
with more superficial work that is appropriate soon after injury or surgery, and progressed to tools for re-
turning flexion mobility. We now turn our attention to treatment strategies to improve full extension to the
knee and to a more detailed explanation of the complexities of gait, including techniques to deal with the
compensatory reactions in the feet and hips that occur after injury.

Treatment #5 Returning
Normal Extension
Because of the impossibility of
normal gait without full knee
extension, I feel that this is the
major goal for proper rehabilita-
tion after injury or surgery. Of
course tight fascia and muscles,
particularly the hamstrings, will
prevent full extension, but the
therapist should also be skilled
in working with the deeper re-
strictions in the joint itself by
using mobilization techniques
(shown later) to work with the
knee joint. Let’s begin with
some of the major muscles that
contract after trauma and pre-
vent the knee from straightening.
Working with Popliteus and
Plantaris
One area of caution: You may
feel a fairly strong pulse from the
popliteal artery, but don’t let this
Note: This article will use the more common usage of the term “leg” to refer to the entire lower extremity as opposed to
strict medical terminology where “leg” specifically refers to the portion of the lower extremity between the knee and ankle.
deter you; just use the usual pre- tory reflexes to the quadriceps
cautionary techniques to distin- inhibiting them from contracting
guish the muscle tissue from the to straighten the knee. They also
artery and be precise in your recruit their allies (agonists?),
work. the hamstrings, to strongly con-
tract and prevent the knee from
Since these are relatively weak
straightening. Reducing irrita-
flexors of the knee compared to
tion to and lengthening these
the hamstrings, popliteus and
small muscles is a first step in
plantaris are often neglected in
proper functioning of the larger
conventional therapy. Their role
muscle groups.
in preventing full knee extension
is less one of strong muscular
resistance than of being
“agitators” delegating re-
sponsibility to stronger mus-
cles that do the dirty work of
preventing knee extension.
The body always reacts to
pain as a strong dictate of
movement, and both these
muscles can be sensitive or
painful when stretched if
they shorten after injury. At
Photo # 10-- Popliteus and Plan-
the first sign of pain in popliteus
taris
and plantaris, they send inhibi-

Bodywork e-News 11
 Treatment for the Legs
Although most of the examples
in this article will recommend
working with muscles in a
stretched position to effect a re-
lease, working in a very sensitive
area like the posterior knee is
best done with enough flexion to
allow easy entry through superfi-
cial layers and have popliteus
and plantaris relaxed so they are
not irritable. As they relax and
lengthen with your work, then
slowly extend the knee by using
a smaller bolster to retrain their
stretch receptors to feel safe with
more extension. Once these
muscles relax, the primary flex-
ors and extensors of the knee can
begin to work properly without
neurological interference from
popliteus and plantaris.
Usually popliteus and plantaris
are shortened as a protective
mechanism rather than from ad-
hesions. Therefore, strokes in a
distal direction are most effec-
tive to train them to relax and
lengthen. Use very soft fingers to
sink through superficial tissue to
find the tight muscles and very
slowly stroke distally, with an
intention of simply relaxing and
stretching an irritable muscle.
The texture and depth of pop-
liteus and plantaris is very simi-
lar to what it feels like to work
on the scalenes in the anterior
neck, so use the same principles.
While working on these muscles,
it is also a perfect time to begin
stretching the more superficial
fascia in the posterior knee.
Working with the Ham-
strings
These are the most important
muscles to relax and stretch to
allow extension. The hamstrings
will have learned to contract
anytime the knee approaches the
painful angle of straightening.
You must not only release any
fibrous restrictions, but must
also train these muscles (and to
a much lesser extent, the gas-
trocnemius which also crosses
the joint and is a minor flexor) to
relax into a lengthened position.
In the prone position refrain
from using a bolster under the
Photos #11 & 12 --Facilitated
ankle so the leg can straighten.
Lengthening Strokes for the
Hamstring work is almost always Hamstrings
beneficial for injured knees, but
Although this may be the most
remember that if the knee is still
important muscular work you do
inflamed and extension is pain-
to return normal function to the
ful in the joint, then it is a natu-
knee, luckily, it is relatively sim-
ral reflex for these muscles to be
ple work without fancy tricks.
short and tight. If the joint is
Notice that if you have your cli-
painful in movement or struc-
ent slide down so that both feet
tural barriers such as adhesions
are hanging off the table; com-
are present, then the hamstrings
paring the injured knee with the
will naturally contract to protect
healthy knee is an easy measure-
the knee. Extensive work with
ment to determine normal ex-
the hamstrings will always be
tension. In this case, the right
helpful, but permanent length-
knee doesn’t allow full extension,
ening will only take place after
so the right heel is about an inch
the joint heals. This will some-
higher than the left. Use your
times take several weeks or even
fingers, knuckles or forearms to
months, so follow-up visits over
slowly stroke distally while visu-
an extended period of time are
alizing grabbing and stretching
helpful to incrementally
the hamstrings. You should con-
lengthen the muscles. Joint mo-
tinue your intention of lengthen-
bilization will be very helpful in
ing below the knee to the gas-
freeing the joint so the ham-
trocnemius and soleus. Note the
strings will not contract for pro-
dorsiflexion of the ankle to pro-
tection.
vide stretch.
Bodywork e-News 12
 Treatment for the Legs
Photo #13 --Anchor and Stretch
Techniques for the Hamstrings
Not all your work with the ham-
strings will be to educate them to
lengthen. There may be signifi-
cant thickening and adhesions in
different depths of the muscles
or surrounding fascia that need
detailed release. Anchor and
stretch strokes using precise
pressure at fibrosed areas are
effective. Visualize that you are
placing all of your intention on a
knot in a rubber band. Anchor
with proximal oblique pressure
at adhesions when the knee is
flexed and then slowly lower the
ankle to extend the knee and fo-
cus the stretch at your anchor.
Cautionary note: If your client is
recovering from anterior cruciate
repair, the surgeon may prefer
that the knee does not reach full
extension. It is advisable to
check with the doctor for guide-
lines about the limits of exten-
sion to work for. This caution
should also apply to the use of
joint mobilization techniques
shown in the next section.
Treatment #5--Joint Mobili-
zation Techniques for the
Knee
The largest paradigm shift in my Straightening the knee to full
bodywork occurred after I had extension requires that there is
been practicing for almost 10 freedom for the tibia to glide
years when I took a spinal me- back and forth on the femur
chanics class and began working (shear) rather than just straight-
with joints, not only in the spine, ening like a simple hinge. Soon
but virtually anywhere on the after injury, adhesions begin to
body. I hope that new therapists form, and even the slightest limi-
won’t wait as long as I did. tation can impact gait. Most
therapists are trained to work on
With the knee, we are primarily
the knee supported by a bolster,
working to improve extension,
but this practice prevents ex-
flexion, and a bit of rotation be-
tending the joint into its struc-
tween the femur and the tibia.
tural barriers to release them.
Anatomists agree that the knee
Early in the recovery process,
joint is the most complicated in
you may work in supine position
the body, but some relatively
with the leg just resting extended
simple joint mobilization tech-
on the table as you gain your cli-
niques can be practiced safely
ent’s confidence, but as you be-
and effectively even if you are
gin making progress, place a bol-
new to this concept. Although it
ster under the ankle or calf so
is tempting to look at the joint as
the knee is suspended in space
a simple hinge, in reality, when
(“bridging”) as demonstrated in
moving from extension to flexion
the photo.
and back, the tibia must slide
anterior and posterior and rotate
relative to the femur. After knee
injury or surgery, tightening
muscles that surround the knee
can contract and compress the
joint from all sides impeding the
articulation of the bones. If nor-
mal movement between the tibia
and femur is not returned within
a reasonable period of time, then
adhesions form deep in the joint
and can permanently restrict
joint mobility. Since most thera-
pists are apprised of ways to
stretch the knee into flexion, we
will concentrate on extension
and rotation.
Anterior and Posterior
Shear of the Tibia and Fe- Photos # 14 & 15--Anterior/
mur Posterior Sheer
Bodywork e-News 13
 Treatment for the Legs
Remember to place your inten-
tion deep in the joint, and that
unlike simply stretching the knee
into extension as you would if
the client is prone, you are ap-
plying posterior pressure directly
down towards the table and visu-
alizing sliding the tibia and fe-
mur in opposite directions. Mo-
bilization can be applied in two
ways. First, you can use rela-
tively quick pulsations of pres-
sure with about two pounds of
force, repeating the pulsations
for a minute or more. It is crucial
to move the joint all the way un-
til end range resistance is felt.
This is helpful in over-riding
conscious soft tissue holding
patterns and begins to free up
the joint as the bones slide back
and forth. Secondly, you can ap-
ply a steady pressure downwards
with a bit more pressure, but be-
ing careful that your client is not
too uncomfortable. Sustain the
pressure for a minute or two,
waiting for a feeling of softening
in the joint and a sense that the
bones are sliding past each other.
In the first photo I am putting
pressure on the femur so that it
is sliding posterior relative to
the tibia. Conversely, by placing
your hands below the knee on
the tibia, you are now sliding
the tibia posterior relative to
the femur. As you become
adept at these procedures you
can expand your effectiveness
by experimenting to either
compress or traction the joint as
you apply anterior/posterior
shearing pressure. The key to the
success with this and most joint
mobilization techniques is to ap-
ply enough force to mobilize the
joint, but not so much force that
your client has pain or is fighting
against you.
Mobilizing Rotation of the
Tibia and the Femur
When the knee moves, the tibia
actually rotates upon the femur,
rotating externally as the knee
extends and internally as the
knee flexes. If rotation is im-
paired, then flexion and exten-
sion are impaired. The rotation
is subtle, but important to work
with.
Cautionary note: Rotational joint
mobilizations should not be per-
formed if there is any question of
a torn meniscus or ligaments
after injury, but are very helpful
after surgical repair of such inju-
ries.
Photos # 16 & 17 —Supine Rota-
tional Mobilization.
Reverse the process as you pull
the leg back into full extension
by rotating the tibia externally
through the range of motion. Of
course it can even be more help-
ful to perform this technique
while also stretching tight fascia
or muscles, but your primary
intention is to be rotating the
tibia around the femur.
As you flex the knee by helping
your client bring her knee to her
chest, place steady pressure to
rotate the tibia internally. When
you reach the end range of com-
fortable flexion, stay in this posi-
tion and continue to exert gentle
internal rotational force while
waiting for softening of resis-
tance
Photos # 18 & 19 —Seated Rota-
tional Mobilization
This technique works well if your
client has large or heavy legs or
you feel unstable on the table. It
Bodywork e-News 14
 Treatment for the Legs
has the added advantage of sta- Toe off: This is the important steps of very elderly people (I
bilizing the femur during move- stage of walking that propels the find that working for better knee
ment and of the natural gravity body forward. With limited knee extension is greatly appreciated
of the lower leg placing traction extension, the stride is shortened, by my older clients). If the foot is
the joint while you work. As you approximating the “mincing” not far enough behind the body,
have your client flex her knee,
rotate the tibia medially and
then reverse the rotational direc-
tion to external as the knee is
extended. Remember that the
most release will happen at the
end range of movement so hold a
sustained pressure at this range
of motion for up to a minute.

UNDERSTANDING MOVE-
MENT PATTERNS

The treatment suggestions that

we have covered so far should
provide considerable benefit for
your clients who have knee prob-
lems and anyone looking for bet-
ter movement and freedom of
the entire leg. As mentioned ear-
lier, a great many people have
sustained injuries that persist in
compensatory patterns of move-
ment that have been ingrained
for decades. A holistic treatment
plan that deals with the compli-
cated relationship between the
feet, ankles, knees, and hips will
be a great boon to your practice
and will provide better move-
ment for all your clients, not just Box 1: In varying degrees, limited knee extension will have the following results in gait,
with injuries. including a short stride. If you can return normal extension to the knee (the primary
restriction), then most of the secondary compensations in the foot and hip will improve
Now, let’s revisit the chart in Box with minimal intervention. Muscles that are inhibited will need to be strengthened, and
1, more detail to discuss the ba- any good sports medicine book will have suggestions. These images confine themselves
sic kinesiology of walking gait at to the pelvis and below, but notice how pelvic tilt is also affected and will have effects up
toe off and heel strike with more the spine and beyond. If you consider how a tight psoas on the affected side will present
side-bending and rotational strain on the lower back, it becomes clear how the effects of
attention to the feet, ankle, and
injury radiate globally.
hips.
Bodywork e-News 15
 Treatment for the Legs
it loses its power to propel the
body forward and energy is ex-
pended in lifting the body up in-
stead of forward. The foot ceases
to flex at the toe joints
(transverse arch) and become
immobile causing the plantar
fascia to shorten. The ankle re-
mains in a neutral position
rather than plantarflexing to
push off, so tibialis anterior be-
comes short and gastrocnemius
and soleus become weakened.
As previously covered, since the
knee won’t extend, the ham-
strings, upper gastrocnemius,
plantaris, and popliteus become
shortened and will all need
lengthening work, but don’t for-
get to work with the superficial
fascia, especially behind the knee
to stretch this tissue. Perform
joint mobilization to return nor-
mal flexion, extension and rota-
tion of the joint itself.
Many therapists neglect the hip
in rehabilitation of the leg. If the
leg cannot extend freely to the
rear, then rectus femoris and
psoas will become short because
they don’t need to release to al-
low the hip to extend for a long
stride. They also will become
fibrous from overwork, since the
leg is not propelled by the foot
and ankle to swing forward, rec-
tus femoris and psoas will have
to use more energy to lift the leg
to overcome inertia. Instead of
swinging freely forward, the
knee will be lifted at a more ver-
tical angle by the pull of these
muscles.
Heel Strike: If the knee cannot
straighten, then the leg is unable
to swing forward in front of the
body with ease. Instead of land-
ing on the rear of the heel with
the ankle slightly dorsiflexed, the
foot lands flat at a more vertical
angle, preventing the normal
rolling motion from heel to toe
that dissipates shock. Gastrocne-
mius and soleus remain short
and will need lengthening so the
foot can dorsiflex. The ankle will
need to be mobilized in both
plantar and dorsiflexion be begin
working like a smooth hinge.
In addition to being short in the
distal portion to prevent knee
extension, the hamstrings will
also remain tight near the ischial
tuberosity as they prevent a full
leg swing forward. It is easy to
see how working with the ham-
strings is the key to rehabilita-
tion.
All of these complex feedback
loops occur from the simple re-
striction to knee extension. Re-
member the chicken/egg rela-
tionship with the joint and the
muscles. The lack of proper joint
movement will cause the mus-
cles to shorten, but these short-
ened muscles will solidify im-
proper joint movement if the
walking pattern becomes in-
grained. Be sure to become
skilled in joint mobilization tech-
niques on the joint itself to help
restore proper mechanics. The
best news is that these tech-
niques work equally well for re-
storing proper movement pat-
terns after injury to the feet, an-
kles, and hips.
Although one can understand
these kinesiological principles at
a cerebral level, by far the best
way to understand what is hap-
pening in your client’s body is to
feel the sensations in your own
deep experience by mimicking
the limping pattern. What joints
aren’t moving? What muscles
are contracting improperly? If
you simply concentrate to pre-
vent your knee from straighten-
ing, you will experience the pro-
found compensations from the
toes up through the hips as you
walk. In classes, I actually have
students tape their knees to pre-
vent full knee extension, and
also have them experiment with
placing a pebble in the forefoot
or heel of their shoes. This is an
excellent way to feel both the
joint and muscular adaptations
to pain or discomfort, and will
enable a strategy for treatment.
Treatment #6 Balancing
Secondary Compensations
Now we can move to some tech-
niques to return proper function
to secondary areas that respond
to knee dysfunction. Work to
satellite areas is extremely im-
portant because of their ten-
dency to reinforce limping pat-
terns, but until proper function
is returned to the primary site of
injury, the secondary compensa-
tory patterns will persist. It is
perfectly appropriate to work on
secondary compensations
throughout your treatments be-
cause they often cause discom-
fort as they adapt. However,
your primary goal should be to
Bodywork e-News 16
 Treatment for the Legs
return the primary injury site to
health as soon as possible, and
then focus on the feet and hips.
Freeing the Toes, Trans-
verse Arch, and Plantar Fas-
cia
With a limping gait, the feet be-
come stiff and inflexible as they
land similar to wearing a very
stiff-soled shoe that prevents the
toes from flexing and providing
power on toe off.
Photo # 20 Restoring Toe Exten-
sion
Working in the end range of mo-
tion is the key to this technique.
With soft fingers, bend the toes
as far as possible into an upward
dorsiflexed extension. With
knuckles or fingers patiently
work the area of the metatarsal
heads, with both cross-fiber
strokes and in the direction of
lengthening of tissue. This is
also and excellent way work on
the plantar fascia for the length
of the foot.
The biomechanics of stretching
the foot into dorsiflexion in ei-
ther the prone or supine position
Photo #21 Softening the Plantar
Fascia and Freeing Dorsiflexion.
can be difficult when the leg is
straight. This technique offers
the advantage of using your body
weight, being able to exert strong
pressure to dorsiflex the ankle,
and the use of the broad and
comfortable tool of your forearm.
This technique is also useful to
treat plantar fasciitis.
Improving Ankle Movement
Photo #22 ---Freeing the Ankle
Retinaculum
The front of the ankle is sur-
rounded by a fibrous retinacu-
lum that can stiffen the ankle
joint like an Ace Bandage, limit-
ing both plantarflexion and dor-
siflexion and causing torsion on
the ankle. Use your knuckles or
the ulnar surface of your forearm
to soften and free this tissue.
Anchor in one direction and then
mobilize the ankle in any oppos-
ing direction to improve freedom.
This is an excellent technique
after ankle sprains or on virtu-
ally anyone who wishes easier
ankle movement.
Improving Hip Mobility
Photo #23 Freeing the Proximal
Hamstring for Easier Leg Swing
By flexing the leg with the knee
relatively straight, you can place
the hamstrings on a nice stretch
while releasing any areas with
anchor and stretch strokes
against the stretch. Don’t strain
yourself by holding the leg with
your arm if your client is large.
You can be inventive and use
your shoulder and body to apply
stretch to the leg or even have
your client apply the stretch by
using a strap over the bottom of
her foot.
Bodywork e-News 17
 Treatment for the Legs
Photo #24 Releasing the Rectus
Femoris
The rectus femoris and front of
the pelvis will become short and
tight if your client has been
walking with a limp that pre-
vents the leg from freely swing-
ing back into extension. Work-
ing in the neutral supine position
will soften tissue but not stretch
enough to open the area. This
position allows you to work eas-
ily using your own body weight
as you stretch the leg into exten-
sion. Support your client’s head
and neck, and possibly low back
with pillows, and have your cli-
ent pull her opposite leg to her
chest to keep the pelvis in a neu-
tral position.
Apply pressure with you other
hand to extend the hip and work
in the direction of stretch work-
ing with your fingers for superfi-
cial tissue and with you forearm
for deep muscular work on the
quadriceps.
This technique is also useful for
working with the psoas in a
stretch, but do not over-extend
the hip. If the hip is too ex-
tended, it becomes difficult to
sink through the superficial tis-
sue in the anterior pelvis to con-
tact the psoas.
Conclusion
I hope that this article have
given you insight into the inter-
esting interrelationship of the
joints of the legs as well as some
specific tools to successfully treat
problems, not only to the knees,
but to the other joints of the
lower extremity. All joints of the
leg are inextricably linked to-
gether in a complex feedback
loop that must be treated in a
holistic manner for the best re-
sults. Remember that each client
will present his or her own
unique adaptive mechanisms to
injury and that the solutions to
solving limping problems rarely
are simple or lie in only one area.
These considerations are what
make our work so interesting
and rewarding.
Remember that a holistic treat-
ment not only includes a broad
view of distant joints and com-
pensations, but should consider
the whole person you are work-
ing with, including the causative
factors of their injury (especially
with overuse injuries), their ap-
proach to self-help though home
programs of stretching and
strengthening, and their emo-
tional feelings. Fear, anger, de-
pression, and self-judgment are
often associated with injuries.
We always treat more than mus-
cle, tendon, and bone. The best
therapists’ skills are more of an
art than a craft as they provide a
hopeful healing environment for
their clients with their humanity
and contact with the person be-
hind the injury.

Art Riggs
Deep Tissue Massage & Myofascial Release
Best Selling 7 Volume, 11 Hour
encyclopedia of advanced massage DVD
and a visual guide manual
Available from: www.terrarosa.com.au

Art Riggs is planning to travel to Australia in Oct 2010,

to register interest for workshop: terrarosa@gmail.com

Bodywork e-News 18
 Deadbeat Diagnosis
The iliotibial band (ITB) syn-
drome is typically regarded as an
overuse injury common in run-
ners and cyclists. Lately, this
controversial condition has
gained greater attention due re-
cent articles that include my “IT-
band Friction Fallacy”1; Mark
Charrette’s “Lateral Knee Pain
and Orthotic Support”2, and
Whitney Lowe’s “New Perspec-
tives on ITB Friction Syn-
drome”.3
Although many researchers and
clinicians are convinced that the
pathoanatomy of iliotibial band
friction syndrome (ITBF) is well
known and well understood, the
jury is still out on the exact cause
(s) of this lateral knee pain con-
dition. Blindly following conven-
tional wisdom may often point
good clinicians to the wrong
therapeutic path. The following
example demonstrates how
‘chasing the pain’ can lead physi-
cians to a linear treatment proto-
col that results in months of un-
warranted pain and unnecessary
medical interventions.
Case Study
Recently, a 44 year old orthope-
dist, for our purposes will be re-
by Erik Dalton
ferred to as Dr. Smith, was re-
ferred to me complaining of
eight months of debilitating,
self-diagnosed, IT-band friction
pain. During his history intake,
he admitted suffering sporadic
foot, hip and low back soreness
but dismissed these issues as
“unrelated”. A self-described
“weekend-warrior”, Dr. Smith’s
knee pain flared with excessive
running or cycling. Both he and
his staff (a physical therapist and
physiatrist) had carefully scruti-
nized the painful knee and ar-
rived at a unanimous diagnosis
of ITBF based on results from
Ober’s Test (determines the
tightness of the ITB), Renne's
test (specifies the area of pain
during weight bearing) and No-
ble's test (identifies the area of
pain when the leg flexed at a cer-
tain angle). To further
strengthen their diagnosis, MRI
studies showed a thickened
iliotibial band over the lateral
femoral epicondyle. The summa-
tion: diagnosis confirmed….IT-
band friction syndrome. Case
closed.
Dr. Smith related that his
group’s initial treatment goals
focused on relieving the
(supposed) inflammation via ice
treatments and anti-
inflammatory medications fol-
lowed by a series of physical
therapy sessions. Sadly, the
‘series’ of physical therapy slowly
evolved into months of heart-
breaking disappointment. Typi-
cal treatment modalities
(stretching, ultrasound, electri-
cal stim, cross-fiber frictioning
and trigger point work) brought
little relief. Discouraged with the
lack of progress, Dr. Smith and
his physiatrist partner began a
more aggressive approach with
corticosteroid and proliferation
injections (Fig 1). Although
many of their ITBF patients re-
sponded favorably to this treat-
ment protocol, Dr. Smith did not.
Desperate to get back to his bik-
ing and running regime, Smith
decided to undergo a surgical
Bodywork e-News 19
 Deadbeat Diagnosis
release of the IT-band at the pos-
terior 2 cm where it passes over
the lateral epicondyle….but still
no relief. So how did eight
months of aggressive treatment
lead to abysmal failure?
Conventional Wisdom
ITBF is generally thought to be a
multi-factorial, non-traumatic,
overuse condition in which the
distal aspect of the iliotibial band
rubs over the lateral femoral epi-
condyle during repetitive knee
flexion and extension move-
ments (Fig 2). This ultimately
leads to irritation of the iliotibial
band, bursa and lateral synovial
recess. In this popular theoreti-
cal model, the deep posterior
ITB fibers are more vulnerable to
back-and-forth rubbing on the
knee’s epicondyle. Several stud-
ies 4,5,6 have described a dynamic
“impingement zone” at approxi-
mately 30° of knee flexion where
the ITB is most vulnerable to mi-
crofiber tearing and associated
inflammation.
Therapists who abide by this
‘conventional wisdom’ often seek
out the sore spots around the
condyle and cross-fiber friction According to their findings, it
the affected tissue in an effort to appears the ITB is actually pre-
break down weak-linked adhe- vented from rolling over the epi-
sions, enhance fibroblastic activ- condyle…partly because of its
ity and encourage tissue remod- femoral anchorage…and partly
eling.7 Follow-up treatments of- because its fibers are bound
ten include elbow ‘fascia- tightly to the tough enveloping
mashing’ and manual ITB fascia lata.
stretching routines. All of these
Although Fairclough and his
approaches can be effective if IT-
team were able to induce slight
band fibers truly are damaged.
medial-lateral movement across
Science vs. Conventional the condyle, they proposed that
Wisdom ITB pain was primarily caused
by increased compression of a
In a compelling paper published
highly vascularized and inner-
in the Journal of Science and
vated layer of fat and loose con-
Medicine in Sport (2007), a
nective tissue separating the ITB
prestigious research team led by
from the epicondyle (Fig 3). Dr.
John Fairclough and seven co-
John Fairclough concludes that
authors8 challenged the idea that
“ITB syndrome is related to im-
excessive friction between the IT
paired function of hip and leg
band and the lateral femoral epi-
musculature and its resolution
condyle creates microscopic
can only be achieved through
tears and 'inflames' the tract or a
proper restoration of lower
bursa. These researchers found
quadrant muscle balance.”
that several basic anatomical ITB
principles had been overlooked:
(1) the IT band is not a dis-
crete structure but a thick-
ened part of the fascia lata
which envelops the thigh,
(2) it is connected to the linea
aspera by an intermuscular
septum and to the supra-
condylar region of the fe-
mur (including the epi-
condyle) by coarse, fibrous
bands which are not patho-
logical adhesions and,
(3) a bursa is rarely present
but can be mistaken for the
lateral recess of the knee.
Bodywork e-News 20
 Deadbeat Diagnosis
Myoskeletal Treatment Plan
One of the first things that
caught my attention while ob-
serving Dr. Smith’s gait was the
presence of a cavus right foot
(high rigid arch) presenting on
the same side as his IT-band
pain (Fig. 4). With his lower leg
stuck in external rotation, it ap-
peared the stiff supinated foot
was preventing the tibia from
internally rotating during heel
strike. This seemed rather un-
usual since friction or compres-
sion of the IT-band is generally
thought to result from foot hy-
perpronation coupled with ex-
cessive internal tibial rota-
tion.9
Although gait observations,
anatomical landmark assess-
ments and functional testing
revealed myoskeletal imbal-
ances through the hips and
lumbar spine, I initially de-
cided to address the cavus foot
problem. My experience has
shown that a cavus foot
stresses all myoskeletal struc-
tures (foot to lumbar spine)
leading to disorders such as
peroneus tendinosis, stress
fractures, trochanteric bursitis, ated tibiofibular (ankle) joint.
plantar fasciitis, tibiofibular fixa- (Fig. 6)
tions, and hip/back pain…. but
not IT-band friction syndrome I find this oft-neglected tib/fib
joint to be the “key lesion” in
Some cavus feet (particularly many lower extremity disorders.
those with claw toes) do not re- Optimum ‘Stirrup Spring Sys-
spond well to manual therapy. tem’ functioning (see my Don’t
Fortunately, Dr. Smith’s foot did Get Married articles, Massage
regain flexibility as the muscles Today) demands that both ends
of the lateral fascial compart- of the tibia and fibula (proximal
ment were separated. Once myo- and distal), maintain smooth
fascial flexibility improved, rear cephalad and caudal movements
and forefoot joint mobilization (Fig. 7). If working properly, the
routines helped restore glide to tib/fib articulations should per-
the rigid tarsal bones (navicular, form as magnificent shock ab-
cuboid and cuneiforms) and the sorbers with their actions en-
talocalcaneal joint. (Fig. 5). Al- hanced by tibialis anterior and
though this
myofascial/
joint mob pro-
tocol softened
the stiff arch, it
quickly became
apparent that
most of the
rigidity was
coming from
Dr. Smith’s
severely fix-
Bodywork e-News 21
 Deadbeat Diagnosis
peroneus longus and kept in
sync by a resilient but tough in-
terosseous membrane.
The “figure 8” plantar and
dorsi flexion technique was
used to loosen the fibrotic
ankle ligaments and articu-
lar cartilages providing
better anterior/posterior
and superior/inferior glide
but the fibular shaft still
seemed stuck. Moving up
to the proximal fibular
head, I tested for A/P glide
there. Finally--the ‘main
event’ so responsible for months
of mysterious lateral knee pain
was exposed. With the knee
flexed, my fingers and thumb
were unable to budge the fibula
in an anterior direction. Further-
more, any slight pressure repli-
cated the intense pain previously
identified as the source of his
problem. (Fig. 8)
Summary
Runners like Dr. Smith share a
high risk for hamstring injuries
with the most commonly torn of
the group the biceps femoris.
When asked about past ham-
string problems, Smith related
that he had suffered a chronic
pull a year before the knee began
to flare. Therefore, with each
step, the injury-shortened biceps
femoris tugged on the fibular
head causing chronic repetitive
microtrauma at the tib/fib ar-
ticulation. In time, the fibula be-
came posteriorly fixated on the
tibia causing joint play loss and
lateral knee pain. By applying a
simple contract/relax technique
(Fig 9) over several sessions, we
were able to establish normal
movement to the fixated tib/fib
articulation thereby resolving his
painful condition.
As with many “conventional”
protocols, stepping outside the
box provided that important dis-
tinction to Dr. Smith’s recovery--
relying more on accurate identi-
fication and restoration of the
functional biomechanical deficits
in the entire kinetic chain rather
than focusing on a specific in-
jured tissue. Incorporating myo-
fascial and skeletal mobilizations
to Dr. Smith’s foot, ankle, proxi-
mal fibular head, hip and pelvis
were key factors allowing his re-
turn to normal running and bik-
ing activities. Rather that chas-
ing the pain, our intent, as al-
ways, focused on ‘finding and
fixing’ all compensatory kinks
along the kinetic chain.
References:
1 www.erikdalton.com/
NewslettersOnline/
March_09_Newsletter.htm
2www.dynamicchiropractic.ca/
mpacms/dc_ca/article.php?id=53550
3http://massagetoday.com/mpacms/
mt/article.php?id=13991
4 J.Fairclough, K. Hayashi, H. Toumi, et
al. Is iliotibial band syndrome really a
friction syndrome? Journal of Science
and Medicine in Sport, Volume 10, Issue
2, Pgs. 74-76
5 Orchard JW, Fricker PA, Abud AT, et
al. Biomechanics of iliotibial band fric-
tion syndrome in runners. American
Journal of Sports Med, 1996; 24:375-9.
6 Hamill J, Miller R, Noehren B, Davis I.
A prospective study of iliotibial band
strain in runners. Clinical Biomechanics,
2008; 23:1018-25.
7 Clement DB, Taunton JE, Smart GW,
et al. A survey of overuse running inju-
ries. Physical Sports Medicine, 1981;
9:47-58.
8 Schwellnus M, Mackintosh L & Mee J.
Deep transverse frictions in the treat-
ment of iliotibial band friction syn-
drome in athletes: a clinical trial.
Physiotherapy 1992; 78(8): 564-569.
9Ellis R, Hing W & Reid D Iliotibial
band friction syndrome – a systematic
review, Manual Therapy, 2007; 12: 200-
208
Bodywork e-News 22
 Available from www.terrarosa.com.au

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Bodywork e-News 23
 Thai Massage
How It Started
In Thailand, what is known in
the Western world as Thai mas-
sage is known as Nuad Bo’Rarn.
Nuad is a Thai word that trans-
lates as, “to touch with the inten-
tion of imparting healing.”
Bo’Rarn is a word derived from
ancient Sanskrit; it translates as,
“something which is ancient and
revered.” The same word,
Bo’Rarn, is applied to the re-
vered sutras (texts) of Buddhism.
Also, in Thailand, Thai massage
is recognized as a core compo-
nent of an entire system of tradi-
tional medicine. There are four
aspects of traditional Thai medi-
cine:
1) Herbal medicine;
2) Nutrition and food cures;
3) Spiritual practices, including
mantras, prayer, incantations
and mindfulness meditation;
4) Nuad Bo’Rarn (Thai massage).
Historically, Thai massage was
not specifically what Westerners
consider massage. It was thought
of as and utilized as the hands-
on practice of traditional medi-
cine. Thai massage techniques
were applied to the treatment of
the varied ailments that afflict
humanity, including mental and
by Richard Gold
emotional illness.
The historical founder of Thai
medicine is known as Jivaka
Kumar Bhaccha (the father doc-
tor). He is identified by scholars
as a close personal associate of
the historical Buddha, and was
the head physician of the origi-
nal Sangha, the community of
followers that gathered around
the Buddha. This would place
him as living in India approxi-
mately 2,500 years ago.
Buddhist monks and followers
brought their traditional medi-
cine with them as they made
their way from India to what is to student. Over the centuries, a
now modern Thailand, in ap- distinct tradition evolved that
proximately the second century was primarily influenced by the
B.C. For centuries, the tradi- Ayurvedic traditions from India,
tional medical knowledge was but also began to incorporate
transmitted orally from teacher theories and practices from an-
cient China. In addition, healing
practices of the indigenous tribal
peoples of the area also became
part of the local medical prac-
tices. By the time Theravada
Buddhism was declared the offi-
cial religion of the kingdom in
approximately 1292 A.D., the
traditional medicine was well
established in the Buddhist
monasteries, known as Wat. Tra-
ditionally, the Buddhist monks—
and to a lesser extent Buddhist
Jivaka Kumar Bhaccha nuns—administered the healing
Bodywork e-News 24
 Thai Massage
work to the people in their vil- How Is It Different?
lages.
Today, Thai massage is being
Besides the specific hands-on practiced in clinics and spas all
techniques, herbs and foods were over the world and has experi-
utilized in healing; Buddhist phi- enced remarkable growth and
losophy pervades the practice of acceptance. In fact, there has
medicine in Thailand. Healing even been a dramatic growth of
work is understood to be the schools for traditional Thai
practical application of metta, or massage in Thailand. It com-
loving kindness. Metta is under- bines elements of yoga, medita-
stood to be a core component of tion, acupressure and assisted
daily life for each individual seek- stretching to provide a unique
• Sessions take place on a cotton
ing awareness and fulfillment on and wonderful bodywork experi-
pad or mat that is placed on the
the path taught by the Buddha. ence.
floor or on a low platform.
Teachers describe metta as the
However, Thai massage does dif-
“foundation of the world,” essen- • Thai massage therapists are en-
fer in several ways from Western
tial for the peace and happiness of couraged to work in a concen-
massage. Key distinctions in-
oneself and others. trated and meditative state of
clude:
mind, unencumbered by thought
In Thai Theravada Buddhism,
• Thai massage is practiced with or fantasy. They are supposed to
significant emphasis is placed on
the client fully clothed in loose- “transmit” this quality of mind
the practical application of spiri-
fitting clothing. through their touch to the client.
tual philosophy: that higher ide-
als be brought into everyday life • No oils or lubricants are utilized • Although it is the physical body
and decisions. Accordingly, the in Thai massage. of the client that is being ad-
practice of Thai massage demon- dressed, the primary focus and
strates the practical application of • Thai massage is practiced very intention of the therapy is to
the four divine states of mind: 1) slowly. bring balance and harmony to the
metta, 2) compassion, 3) vicari- “energetic” body and mind of the
• Thai massage is a core compo-
ous joy and 4) mental equanimity recipient.
nent of an entire traditional
(brought to fruition through
medical practice (traditional Thai Primacy Of Abdominal Work
meditative practice).
medicine).
Like Indian Ayurvedic and Tradi-
• The practice emphasizes press- tional Chinese medicine, tradi-
ing, compression and stretching
techniques. The rubbing tech-
niques of Western massage
(effleurage and petrissage) are
absent.

• Thai massage practitioners util-

ize their feet, knees, elbows and
forearms, in addition to their
hands and fingers extensively
during therapy.

Bodywork e-News 25
 Thai Massage
of Thai massage focuses on
the abdomen. The practitio-
ner will work with the client
to establish an awareness of
breathing deeply into the ab-
domen. Once the client is
breathing deeply, the thera-
pist will proceed with a spe-
cific series of deep palm com-
pressions, followed by deep
thumb presses. All these pro-
cedures are designed to in-
tional Thai medicine is based on vigorate the functioning of the
an energetic paradigm of the hu- organs and to eliminate ener-
man body and mind. In the Thai getic blockages and stagnation
medical model, bio-energy (Qi) of blood and lymph. The im-
travels through the body on what proved functioning of the ab-
are designated as Sen lines, which dominal region has positive
are somewhat similar to the me- implications for the overall
ridians of acupuncture/Chinese health and vitality of the client.
medicine theory. Ten primary Sen
Going Forward
are identified in Thai medicine,
which, essentially, originate deep Thai massage offers the prac-
in the abdominal cavity in the vi- ticing massage therapist a
cinity of the navel and connect wonderful new approach to
the center of the body to the sen- bodywork and therapeutic
sory and excretory orifices and touch. In addition, more and instructor of the new DVD Mas-
the extremities. Because of this more massage and bodywork es- tering Thai Massage produced by
energetic understanding, the tablishments are receiving re- Real Bodywork. He is the author
practical, therapeutic application quests from clientele to provide of Best Selling Thai Massage book,
this unique style of therapeutic 2nd edition, published in 2008.
touch. There are great opportuni-
He is a founder and current board
ties to practice Thai massage in
member of the Pacific College of
spas, clinical settings and resorts
Oriental Medicine. Additionally,
around the globe. The learning,
Gold is the president and chair-
practicing and receiving of Thai
man of the board of the Interna-
massage can be a profound, won-
tional Professional School of
derful and joyful life experience.
Bodywork (IPSB). He teaches at
both institutions. Gold is based in
San Diego, and can be reached at:
About the author rmgold@znet.com.
Richard M. Gold, Ph.D., L.Ac.,
ABT, has been practicing Asian
healing arts and acupuncture
since 1978. He is the author and
Bodywork e-News 26
Learn the ancient art of Thai Massage with
master instructor, Richard Gold. This
beautifully filmed DVD features over 3
hours of instruction and over 170 detailed
techniques.

Each technique is clearly demonstrated

showing proper alignment, positioning and
proper body mechanics so that pressure
can be applied effectively and effortlessly.

This DVD includes traditional Thai

stretches, work on the Sen energy lines
plus abdominal massage.

Mastering Thai Massage is one of the most

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DVD
Best
Selling

Available from www.terrarosa.com.au

Bodywork e-News 27
 Peripersonal Space
& Energy
In the book “The Mind Has a
Body of Its Own”1, authors Sarah explain the mysterious energy fields and human consciousness, they
and Matthew Blakeslee de-
scribed marvelously how the
brain maps the body. The brain
contains maps of every point in
our body, as well as the space
around the body. An important
theme of the book is that body
maps in the brain can account
for a range of experiences and
perception. These recent find-
ings offer scientific explanations rounding environment with re-
for many phenomena, including
phantom limbs, syndromes in
which stroke patients neglect
one side of the body, etc. More
importantly for us, the authors
suggest the possibility for neuro- perienced in the way that we are
biological explanation of many
alternative therapies, including
aura, Reiki, and energy therapy.
Our brains and bodies use the
maps to translate incoming sen-
sory signals into meaningful in-
formation. To act efficiently, our
brains need to locate objects in
the space around our bodies, and
need to hold a constantly up-
dated report on the body's shape
and posture. This requires an
integrated neural representation
of the body (the body schema)
and of the space around the body
(peripersonal space). Periper-
sonal space refers to the space
immediately surrounding our
bodies, which can be reached by
When New Age gurus invoke the mysteries of quantum physics to
are essentially explaining one mystery with another mystery.
our limbs. By integrating mul-
tisensory (visual-auditory-
tactile) cues around the body,
the peripersonal space system
provides information about the
position of objects in the sur-
spect to the body. Research has
found that brain cells become
active as objects approach the
space around the body. Periper-
sonal space can be seen and ex-
Sandra & Matthew Blakeslee
able to use tools or instruments.
When we are playing tennis, the
racquets seems to be part of our
hand. When Andre Rieu plays
his violin, he became one with
the instrument.
The space around us is real and
can be sensed. Tai Chi and Qi
Gong practitioners train their
body with their relationship to
their peripersonal space, with
the goal of uniting the mind,
body and intention. We can ob-
serve that when two people jug-
gle or dance together, they plan
and execute their actions to-
gether, sharing their periper-
sonal space mapped by each
other’s brain2.
Scientists never believe the ideas
that our bodies are surrounded
by the energy fields giving rise to
aura, and have never been able
to detect this kind of energy.
However some people could
really experience auras. The
Blakeslees hypothesized that
people who can visualize aura is
a natural construct of the parie-
tal lobe. People seeing aura is
believed to be a natural product
Bodywork e-News 28
 Peripersonal Space
of cross-wired brain. Auras can be
due to a flexible body map and a
blending of peripersonal space
and colour and any other sense.
The fact that our body and perip-
ersonal space are very flexible
provides a new scientific under-
standing of this phenomena.
Recent research also suggested
that our peripersonal space can
be extended into a space where an
imagined posture would take us3.
There are clear advantages of rep-
resenting the ‘‘space’’ of an imag-
ined posture. For example, before
performing an action, an individ-
ual may imagine it to learn about
its feasibility (‘‘Can I reach that The Blakeslees wrote1:
box on the top shelf?’’). In many
"In traditions of healing touch --
movement therapies employing
shamanic healing, energy healing,
imagery such as Ideokinesis and
universal life energy, Reiki, and
Alexander technique, guided im-
scores of other healing practices
agery actually exploited our brain
around the world -- practitioners
to think of a better posture.
use a combination of visual im-
Peripersonal space can be har- agery, motor imagery, and ges-
nessed to treat and cure human tures to merge their own periper-
illness, which is the basis of many sonal space sense with that of
alternative therapies. This idea their patients. It might involve
has been accepted in many cul- laying on hands, manipulating
tures around the world. The flexi- the vitalistic energy fields be-
bility of our body maps and perip- lieved to suffuse and surround the
ersonal space maybe the key to body, or passing magnets or crys-
understanding how various tals over special body points
“touch” therapies work. called chakras. The experience,

Penfield's homunculus
Sir Wilder Penfield, a Canadian neurosurgeon, in the
late 1930s mapped out the areas of the brain involved in
sensation and motor activity by stimulating them elec-
trically. In cartoon like drawings Penfield showed the
surfaces of the brain and a proportional representation
of the external parts of the body. His early sketches have
been referred to as Penfield's or motor Homunculus (=
little man). Figure "A" is a section through the sensory
cortex (Parietal Lobe) and "B" is a section through the
motor cortex (Frontal Lobe).
An interesting aspect of this map is that the propor-
tional areas assigned to various body parts on the brain
are not to their size, but rather to the sensitivity and
complexity of the movements that they can perform.
Hence, the areas for the hand and face are especially
large compared with those for the rest of the body.

Bodywork e-News 29
 Peripersonal Space
both for the healers and their
patients is quite real: both can
often literally feel the shifting of
the energetic currents or fields
they believe are there.”
"The scientific method has
never been able to confirm that
qi flows or other mystical vital
energies are real and present in
the mind and body. Yet the ex-
periences of these things are so
palpable for so many people
that it would be a cop-out to
dismiss them out of hand as
'nothing more than' wishful
thinking. Perhaps science, hav-
ing banished these energies
from the account of reality, can
nonetheless explain the sensory
awareness that people have of
them. The brain's touch, move-
ment, and peripersonal space
maps go far in explaining many
key elements of these beliefs
and experiences."
In various touch modalities, such
as Reiki, Therapeutic Touch, Po-
larity or Craniosacral therapy, we
can feel and experience the
“energy” from a therapist, the
warm sensation, and sometimes
can tell where the therapist’s
hand (even when the therapists
didn’t touch any parts of our skin).
This energy can induce powerful
sensations in the body, and the
sensations we feel are a combina-
tion of the flexibility of our body
map to reach out to the therapists.
It is also due to what we believe is
happening. Healing works be-
cause the body and mind is flexi-
ble and creative. The power of
placebos, expectation and belief is
a potent form of medicine. Skep- The healers sent forms of distant
tics tend to think that this is all intentionality related to their own
imaginary. However, since our
body maps actually extend out
into the space around us, we
probably really can sense the per- pated by the recipient. Significant
son really close to us doing ener- differences between the experi-
getic touch.1,2
Peripersonal space is physically
mapped in the brain’s parietal
and frontal lobes. The motor in-
tentions are within that space.
Studies using functional MRI
(fMRI) imaging technique
showed that parietal and frontal
areas are involved in the repre-
sentation of peripersonal space4.
(fMRI is an imaging scan that
shows the blood flows response
related to neural activity in the
brain).
Using various bodywork mo-
dalities, we can actually direct
and manipulate this periper-
sonal space, because the ex-
perience is represented also in
the brain. Sarah and Matthew
Blakeslee hypothesized that
using fMRI imaging on the
frontal lobes, we might be able
to see the effect of Reiki or
therapeutic touch.
A study by Jeanne Achterberg
has investigated the effect of
healing in 20055. She and her
colleagues recruited 11 healers,
each was asked to select a per-
son they had worked with pre-
viously with distant intention-
ality, and with whom they felt
an empathic, compassionate
bond. Each recipient was
placed in a fMRI scanner and
was isolated from the healer.
healing practices (including
Reiki) at two-minute random in-
tervals that could not be antici-
mental (send) and control (no
send) conditions were found.
There are areas of the brain that
were activated during the send
periods. This study suggests that
remote, compassionate, healing
intentions can exert measurable
effects on the recipient, and that
an empathic connection between
the healer and the recipient is a
vital part of the process.5
While this study does not suggest
Bodywork e-News 30
 Peripersonal Space
the effect on peripersonal space,
it opens up for neurobiological
explanation for many of the alter- Brain” wrote: The message
native therapies.
There are two implications
of these findings for body-
workers: first, that there is a
possibility of scientific explana-
tion of the mechanism of touch
therapies and other energetic
work from a neurological point of
view. The second is that when we
are working on a body, we are
also working on and affecting
their peripersonal space and
mind.
The author here does not pretend which ones work and which one
to fully understand about the
brain and neurology, there’s
probably an oversimplification of
the matter. However the point is
that we should not get stuck in
presudoscience explanation of
many of the energetic therapy but “There are features and reactions
we should try to advance the sci- of the body that are not explicitly
ence figuring out the real mecha- physical, but stem from the im-
nism.
Many mainstream scientists are
also interested in trying to find
out the mechanisms of alternative
therapies. Paul Tofts, a professor
in medical imaging, in the book
“Quantitative MRI of the Brain”
stated: “The Placebo effect is phe-
nomenon considered very power-
ful in medicine, and yet the
mechanism of action (for alterna-
tive treatments) is not fully un-
derstood. With quantitative MRI
we may be in a position to objec-
tively record responses to such
treatments.”
Neurologist V.S. Ramachandran map into our emotions.”
in his book “Phantoms in the
References
preached by New Age gurus con- 1S. Blakeslee, M. Blaskeslee. The Mind
tains important insights into the Has a Body of Its Own. 2007. Random
House.
human organism – ones that de-
serve scientific scrutiny…. We 2G. Campbell, Brain Science Podcast,
should not reject an idea as out- Episode #21 Discussion of the book, The
Body Has a Mind of Its Own, by Sandra
landish simply because you can’t
Blakeslee and Matthew Blakeslee. Aired
think of a mechanism that ex-
September 22, 2007.
plains it…. Finally we should not
3C.C. Davoli, R.A. Abrams. Reaching Out
have blind faith in the “wisdom of
With the Imagination. Psychological Sci-
the east” but there are sure to be
ence, 20 (2009), 293-295.
many nuggets of insight in these
4Makin, T.R., Holmes, N.P., & Zohary, E.
ancient practices. Unless we con-
Is that near my hand? Multisensory rep-
duct proper “western-style” ex-
resentation of peripersonal space in hu-
periments, we’ll never know man intraparietal sulcus. Journal of Neu-
roscience, 27 (2007), 731–740.
doesn’t.
5J. Achterberg, K. Cooke, T. Richards, L.
Standish, L. Kozak and J. Lake. Evidence
More importantly the implication
for correlations between distant inten-
of peripersonal space for body-
tionality and brain function in recipients:
worker is summarised by Keith a functional magnetic resonance imaging
Eric Grant6: analysis, J Altern Complement Med 11
(2005), pp. 965–971.
6K.E.Grant. Mapping Body into Motion.
Massage Today June, 2008, Vol. 08, Is-
sue 06.
mense pattern-matching and
mapping processes of our brain.
In some cases, what we perceive
might be both a mapping of the
peripersonal space and a map-
ping from one sensory mode to
another…. The bottom line is that,
as humans, we are neurologically
wired to respond to and be part of
the sensory world immediately
surrounding us. As massage prac-
titioners, this opens the door to
helping our fellow humans cope
with transitions and traumas, and
for sharing their joys. Our emo-
tions map into our body, but just
as surely, our bodily experiences
Bodywork e-News 31
 A New Theory on
Reflexology
A new Japanese study into reflexol-
ogy has made a significant break-
through in establishing a scientific
link between reflexology areas in the
foot and parts of the human brain.
The research, which used functional
Magnetic Resonance Imaging
(fMRI) to measure the brain activity
of people undergoing reflexology, is
the first study of its kind and offers
tantalising proof that differences in
the brain can be made by stimulat-
ing specific areas of the feet.
Although reflexology is believed to
be more than 4,000 years old, little
is known about how the alternative
therapy actually works, as Tracey
Smith, Research and Development
Reflex areas for the eye (No. 8), shoul-
der (No. 10) & small intestine (No. 25)
Manager at the Association of Re-
flexologists, explains.
Although this practice has shown
positive effects on the human body
in some clinical studies, how reflex-
ology works is not yet fully under-
stood. “One of the major criticisms
levelled at reflexology as a therapy is
that there has been no proof of any
route of connection between the
foot and any other representative
organ in the body, which is the un-
derlying idea of reflexology,” she
said.
The fMRI study, which took place at
the University of Tohoku, recruited
25 subjects (22 men and 3 women
aged 18–41 years). The study inves-
tigated three reflex areas relating to
the eye, shoulder and small intes-
tine. Brain activity was measured
during three sensory stimulation
reflex areas, corresponding to the
eye, shoulder, and small intestines.
The experimenter stimulated each
reflex area using a wooden stick
with the right hand.
A statistical analysis showed that
reflexological stimulation of the foot
reflex areas corresponding to the
eye, shoulder, and small intestine
activated not only the somatosen-
sory areas corresponding to the foot,
but also the somatosensory areas
corresponding to the eye, shoulder,
and small intestine or neighboring
body parts. These areas of the brain
correspond with Penfield’s Homun-
culus.
The authors concluded that the acti-
vated area during the stimulation of
each reflex area was consistent with
the somatotopic representation of
the corresponding or neighboring
body parts in the somatosensory
area. Previous fMRI studies of acu-
puncture revealed the somatotopical
mapping of acupoints on the fore-
arm, hand, leg and foot, and part of
the visual processing areas, which
were activated when an acupoint
related to visual function was stimu-
lated. The results indicated that re-
flexology had some effects that were
not simply sensory stimulation. This
new results support that claim and
indicate that a neuroimaging ap-
proach may be a useful procedure
for examining the underlying effects
of this alternative medical practice.
“Although this particular report is
not enough evidence in itself, it does
raise interesting questions about
our understanding of the human
body and shows the potential for
alternative therapies to have greater
influence on conventional treatment
in the future,” Tracey adds.
T. Nakamaru, N. Miura, A. Fuku-
shima. and R. Kawashima. Soma-
totopical relationships between cor-
tical activity and reflex areas in re-
flexology: A functional magnetic
resonance imaging study. Neurosci-
ence Letters 448 (2008), 6-9.
Rankin-Box, D., 2009. MRI re-
search sheds new light on reflexol-
ogy. Complementary Therapies in
Clinical Practice 15, 119
Bodywork e-News 32
 Nerve Mobilization

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Bodywork e-News 33
 De Quervain’s
Syndrome
De Quervain’s syndrome or De
Quervain's tenosynovitis, or De
Quervain's stenosing tenosynovi-
tis is an inflammation of the
sheath or tunnel that surrounds
two tendons that control move-
ment of the thumb.

It is mainly caused by repetitive

movements of the wrist and
thumb, which can cause irrita-
tion and pressure on an ana-
tomical tunnel known as the first
dorsal compartment. Inside the
first dorsal compartment run the
two tendons of abductor pollicis
longus and extensor pollicis bre-
vis. De Quervain’s syndrome is
characterized by inflammation of
these tendons or their synovial
sheath (tenosynovitis).
The swelling causes increased
restriction of the tendons
through the first dorsal tunnel
and sets up a chronic cycle of
swelling and restriction.
The condition is more common
in women than in men (a study
indicates 5 times more in
women). However, some
younger women develop symp-
toms during pregnancy and in
the period after birth. It is also
referred to as mother's wrist due
to the conditions experienced by
mothers caused by repeated ul-
nar deviation while holding their
newborn babies. It was also
Picture courtesy
of Primal Pictures
called washerwoman's sprain as
it can be caused by wringing mo-
tions, such as wringing out a
washrag (probably not that com-
mon anymore).
Recently, it is also related to
overuse of thumb from repeated
text messaging, referred to as
Blackberry Thumb. Although
some relate it more with carpal
tunnel syndrome.
Pain, tenderness and swelling
are the major complaint with De
Quervain’s syndrome. Some-
Grasps the thumb in the palm of the
hand and ulnar deviates the thumb
and hand. Test positive if it pro-
duces sharp pain along the groove of
the radial styloid.
Hold the thumb in the palm & ulnar
deviate.
times numbness near the base of
the thumb. Movements of the
wrist and use of the tendons of
the thumb exacerbate the pain.
A simple test for de Quervain
syndrome is called the Fin-
klestein Test. Hold the thumb in
the palm, and then ulnar devi-
ated If this causes intense pain
over the radial styloid, which
disappears if the thumb is re-
leased, De Quervain's tenosyno-
vitis is likely. Another variation

Bodywork e-News 34
 De Quervain’s Syndrome
Custom-made splint to immobilize
wrist movement.
is while the thumb is grasped in
the palm, extend the thumb
with the other fingers resisting.
Sharp pain along the tendon in-
dicates likely syndrome.
It is very important to rest from
the repetitive motions that cause
the inflammation. Frequent rest
breaks should accompany any
tasks that require repetitive use
of the wrist and hand.
The use of a wrist splint or brace
may help to reduce the occur-
rence of the condition, especially
when used at the first sign of a
problem. The wrists is immobi-
lized with a splint or brace for
part of the day to limit move-
ment while the area is healing.
If the area is inflamed, massage
is contraindicated. Massage loos-
Cartoon courtesy of Montaz http://www.momtaz.nl/
ening the muscles around the References
thenar eminence will help.
Cutler, N. How You Can Help
Cold applications may help re- Treat de Quervain’s Tendonitis.
duce inflammatory. http://www.integrative-
healthcare.org/mt/
Transverse friction of the tendon
archives/2006/11/
will help mobilize adhesions be-
how_you_can_hel.html
tween the tendon and its sheath.
Lowe, W., 2003. Orthopedic
The client’s writs is brought to
Massage. Elsevier Health.
ulnar deviation to put the ten-
dons into stretch and friction is
applied while they are stretched
(Lowe, 2003).
Several Hyatt Regency Spas in
US are now offering Blackberry
Thumb Massage for their guests.
A hotel news release describes a
session; “First, hands are
warmed up with soothing rocks
and an aroma hot towel. Next,
kneading and compressions
loosen muscles and warm oil is
applied with firm strokes. The
therapist then kneads and
stretches deltoids, biceps, triceps,
flexors and extensors, and uses
an acupressure massage tech-
nique on hands and arms. The
30-minute treatment culminates
with an aroma hot towel cleanse
on each hand.”
Feels good, but not sure if it will
help much with De Quervain
syndrome.
Bodywork e-News 35
A New Contraindication
of Massage
It has been bought to my attention re-
cently a new contraindication in Mas-
sage which Therapist should be aware
of and is currently not being addressed
in the Colleges.
I practice both Lymphology and Reme-
dial Massage. I have had several pa-
tients in my clinic, referred from other
Clinics that have performed Remedial
Massage on these patients, all within a
short period of time from one another,
complaining of pain in their legs. This
is not so unusual from our daily pa-
tient’s complaints except for one thing.
The pain turned out to be Superficial
Blood Clots.
These clots are quite quick to disappear
but left untreated will travel into the
Deeper Venous System and brings
along a different more life threatening
problem.
All of these patients have some form of
either Lymphoedema Or Lipoedema in
their legs.
These patients cannot have any form of
Remedial, Deep Tissue, Trigger Point
or Vigorous Massage on their Oedema-
tous limbs because it has and will con-
tinue to cause Superficial Blood Clots.
How do we know if the Limb/s is
oedematous or not?
There are some simple tests which you
should know.
1. Do your history.
You cannot rely on the patient telling
you they have a problem because they
may not know they have Lymphoedema
or Lipoedema.
Ask if the patient has had any form of
Cancer, now or in the past. Most pa-
tients develop their Lymphoedema
Secondary due to Cancer node removal
and radiation therapy,
Mostly 3 – 8 years after the event. If
they have had their surgery or radiation
recently and there are no signs of oe-
dema that doesn’t mean they haven’t
got the start of it.
92% of patients that have had node
removal or radiation will get Lymphoe-
dema. There are 8,000 new cases
every year reported in Victoria alone.
Lipoedema is a genetic disorder of
Women. The basic signs of this disease
are the top half of the torso is a size 8
and the bottom half a size 14 or thick
ankles.
2. First Signs of Oedema.
Puffiness, Stiffness, Discomfort, Heavi-
ness, Tightness, Heat, Pain, (bursting,
shooting, joint), Numbness, Difficulties
in putting on Jewellery, Shoes or doing
up Pants, An increase in weight for no
apparent reason, Increase in skin tem-
perature, Fibrosis and easy Bruising.
This can be found in both Arms and
Legs. The patient may get 1 or all of
these symptoms.
3. Other conditions associated
with Lymphoedema.
High Blood Pressure, Heart Conditions,
Arterial and Venous conditions
(Thrombosis and Varicose Veins), Dia-
betes, Thyroid condition, Inflammation
– infections, Auto-Immune Disease,
Hormonal Conditions and Pregnancy.
By Kristin Osborn
If you are in doubt whether or not this
person suffers from Lymphoedema or
Lipoedema, let the client know that you
have a suspicion and leave that limb or
limbs out of your session. Effleurage is
fine going from distal to proximal, gen-
tly and rhythmically. The patient
should be told they may have some
swelling in their limb, so they can be
sent to a Professional Lymphologist for
correct diagnosis.
Because Only 3% of Doctors know how
to correctly diagnose Lymphoedema
and even less know about Lipoedema a
properly trained Lymphoedema Spe-
cialist is the best option to refer to.
Much of my work to do this year is to
try and rectify this situation.
If you have any questions please email
me on newlymphclinic@bigpond.com
Written by Kristin Osborn Dip. R.M.,
Dip. M.Sc., T.A.A.
Lymphologist, Clinician, Writer, Mem-
ber AMT, ALA and LAV
Resources used: Theory and Practice
of Lymph Drainage Therapy 2nd Edi-
tion 2004
Bodywork e-News 36
Complex Regional Pain
Syndrome
Pain resulting from nerve en-
trapment syndromes is a com-
mon reason for clients to seek
the care of a massage practitio-
ner. However, there are numer-
ous neurological disorders that
at first glance might appear to be
a nerve entrapment problem, but
are an entirely different patho-
logical condition. Complex re-
gional pain syndrome (CRPS)
falls into that category.
A brief review of fundamental
neuroanatomy is helpful to prop-
erly understand what occurs in
CRPS. The autonomic nervous
system has efferent fibers that
control activity in various
smooth muscles, glands, and
cardiac muscle. Within the auto-
nomic system there are two divi-
sions, the sympathetic and para-
sympathetic. The primary func-
tion of the sympathetic branch is
to stimulate activity, while sig-
nals from the parasympathetic
branch serve to inhibit activity.
Of these two, the sympathetic
branch is more involved in CRPS.
The sympathetic nervous system
has a vital role in protective re-
flexes as the body responds to
stress. It is in high gear during
the “fight or flight” response.
However, excess sympathetic
system activity can generate and
maintain pain states in different
By Whitney Lowe
regions of the body. It is this ex- The term complex regional pain
cess sympathetic activity that syndrome has only recently been
causes the symptoms of CRPS. added to the medical lexicon. It
While there is still not a com- includes two separate conditions
plete understanding of how ex- that have similar symptoms but
cess sympathetic branch activity are different in cause. The two
causes these pain conditions, it conditions were formerly called
appears that there is some spill- reflex sympathetic dystrophy
over of noxious input from the (now called CRPS 1) and causal-
sympathetic efferents into vari- gia (now called CRPS 2).5 The
ous nociceptors, especially in the primary difference between
extremities. them is how they occur. In CRPS
1 (reflex sympathetic dystrophy)
Box 1: Symptoms of CPRS
• Some initiating event, often traumatic, but may be trivial- sur-
geries, fractures, dislocations,
• Pain that is disproportionate to the inciting even
• Allodynia (painful response to a stimulus that is usually not
painful)
• Hyperalgesia (exaggerated sensory response to a stimulus that
would ordinarily produce only mild discomfort
• Allodynia and hyperalgesia in that extends beyond the distri-
bution of a single peripheral nerve
• Evidence of autonomic dysfunction (edema, alteration in blood
flow, sudomotor dysfunction such as excess sweating in the
region)
• Pain is usually described as a burning, searing, or shooting
• Vascular abnormalities (more common in CRPS 1)—often start
vasodilation and skin warming in the early phase and progress
to vasoconstriction in later stages
• Excess edema in the affected extremity
• Motor impairment including weakness, inability to initiate
movement, tremor, muscle spasm, or dystonia
• Changes in growth patterns of hair and nails on the affected
limb
• Trophic changes in the skin
Bodywork e-News 37

symptoms commonly occur as a
result of some traumatic incident,
but there is no evidence of spe-
cific nerve damage. In CRPS 2
(causalgia) there is also some
event that initiated excess sympa-
thetic activity, but this condition
also involves identifiable damage
to the nerve. Most of the symp-
toms of CRPS 1 & 2 are similar
and are included in Box 1.
Distinguishing CPRS from other
neurological disorders is aided by
detailed evaluation of several
clinical features in addition to
those listed in Box 1. The condi-
tion can affect either the upper or
lower extremity, but is more com-
mon in the upper extremity and
the pain is usually aggravated
with moving the affected limb.
Various myofascial dysfunctions
may also accompany the extrem-
ity pain.1 Women are affected
more often than men with an ap-
proximate 3:1 ratio.2 Some degree
of depression or psychological
dysfunction is common with
CRPS. However, it is unclear if
this psychological dysfunction is a
causative factor or a result of the
condition because depression and
similar psychological manifesta-
tions are common in severe and
chronic pain conditions.4
Treatment for CRPS varies widely look at a bigger picture and catch
but physical therapy is a primary this condition early on, if present,
component of most treatment
protocols. The goal of most physi- treated.
cal therapy treatments is to de-
sensitize the area and restore nor-
mal function of the affected ex-
tremity. Massage may play a fun-
damental role in this process. Be-
CRPS
cause myofascial dysfunction is Notes
often a part of the array of symp-
This article is originally published
toms, addressing the myofascial
in massage Today.
component may interrupt the cy-
cle of pain and dysfunction. 1. Allen, G., B. S. Galer, and L.
Rashiq found that in many cases Schwartz. Epidemiology of com-
if the myofascial pain condition plex regional pain syndrome: a
was properly addressed the whole retrospective chart review of 134
syndrome may resolve.3 Massage patients. Pain. 80:539-544, 1999.
is also likely to be helpful because
it is effective at decreasing overall 2. Ghai, B. and G. P. Dureja.
sympathetic system activity. Complex regional pain syndrome:
a review. J Postgrad Med.
If you have a client that demon- 50:300-307, 2004.
strates signs and symptoms that
indicate the possibility of CRPS, it 3. Rashiq, S. and B. S. Galer.
is important to have them prop- Proximal myofascial dysfunction
erly evaluated by a physician. in complex regional pain syn-
There are a number of other drome: a retrospective prevalence
treatment strategies such as nerve study. Clin J Pain. 15:151-153,
blocks and medications that are 1999.
effective in addressing the prob-
4. Walker, S. M. and M. J. Cous-
lem and it may be important to
ins. Complex regional pain syn-
start these treatments as early in
dromes: including "reflex sympa-
the rehabilitation process as pos-
thetic dystrophy" and "causalgia".
sible.
Anaesth Intensive Care. 25:113-
CRPS can be a debilitating condi- 125, 1997.
tion. Because it occurs more often
5. Wasner, G., M. M. Backonja,
in the upper extremity it may be
and R. Baron. Traumatic neural-
easy to dismiss many of the
gias: complex regional pain syn-
symptoms as arising from a pe-
dromes (reflex sympathetic dys-
ripheral compression neuropathy
trophy and causalgia): clinical
such as carpal tunnel syndrome.
characteristics, pathophysiologi-
However, awareness of the vari-
cal mechanisms and therapy.
ety of symptoms associated with
Neurol Clin. 16:851-868, 1998.
CRPS allows the practitioner to
so it can be most effectively
Bodywork e-News 38
 Research Highlights
Neural coding for massage
stroke
Researchers have found that
some nerves in the skin send
'feel good' signals to the brain
when activated by gentle, slow
massage stroke. But they only
work when the skin is stroked at
just the right speed, 1-10 cm per
second with an optimal rate
around 4 centimetres per second.
Rub too fast or too slow, and the
nerves are not stimulated.
Researchers demonstrated the
effect of C-fibres on volunteers
using a 'robotic tactile stimula-
tor' – a mechanical arm fitted
with soft brush. Sensually ca-
ressed by the robot, the volun-
teers produced C-fibre signals
that could be recorded.
Professor Francis McGlone said:
"If you get a piece of grit in your
eye, have a toothache, or bite
your tongue, it hurts so much
because there are more C fibres
there. The research we have been
doing is building evidence for
another role of C fibres in the
skin that are not pain receptors,
but are pleasure receptors."
He said the findings appear to
explain "the pleasant… aspects of
touch we are all familiar with,
such as when grooming or being
cuddled".
The nerves are found in skin cov-
ered by hair but are absent in the
palms of the hands. "We believe
this could be Mother Nature's
way of ensuring that mixed mes-
sages are not sent to the brain
when it is in use as a functional
tool," said Professor McGlone.
Massage can relieve pain
For those who experience linger-
ing pain following exercise, a re-
laxing deep massage can help
relieve musculoskeletal pain as-
sociated with exercise-induced
pain, according to research re-
ported in The Journal of Pain.
Researchers at the University of
Iowa performed a double-
blinded, randomized controlled
trial to study the effects of mas-
sage on pressure-pain thresholds
and perceived pain using delayed
muscle soreness following exer-
cise as the pain measurement.
Trial participants were divided
into three groups: no-treatment
(control), superficial touch and
deep tissue massage. Pain was
assessed before treatment, after
exercise and before and after
treatment.
The authors found that subjects
given deep-tissue massage were
able to increase their pain
thresholds and decrease stretch
pain compared with the no-
treatment group. When combin-
ing the deep-tissue massage and
light-touch groups, they found
that stretch-pain reductions re-
mained significantly better than
in the control group although the
light-touch treatment was not
significantly better than no treat-
ment.
The authors concluded that their
study demonstrates that soft-
tissue massage can reduce hy-
peralgesia and pain using a de-
layed onset muscle soreness
model. The findings support use
of massage to reduce stretch-
pain perception and hyperalgesia.
Unique multifidus design
contributes to spine stabil-
ity
Picture courtesy of
Real Bodywork
The novel design of a deep mus-
cle along the spinal column
called the multifidus muscle may
in fact be key to spinal support
and a healthy back, according to
researchers at the University of
California, San Diego School of
Medicine. Their findings about
the potentially important
“scaffolding” role of this poorly
understood muscle has been
published on line in advance of
the January issue of the Journal
of Bone and Joint Surgery.
“The multifidus muscle was for-
merly thought to be relatively
unimportant based on its fairly
small size,” said Richard L. Lie-
ber, Ph.D. “Our research shows
that it’s actually the strongest
muscle in the back because of its
unique design. It’s like a long,
skinny pencil packed with mil-
lions of tiny fibers.”
The researchers discovered that
the multifidus has a unique
packing design consisting of
short fibers arranged within rods,
Bodywork e-News 39
 Research News
and that these fibers are stiffer new systematic review published
than any other in the body. Using in the January issue of Physical
laser diffraction methods that Therapy (PTJ). In addition to
they developed to measure mus- feeling less pain, patients per-
cle internal properties during forming these types of exercises
back surgery, they demonstrated are able to be more physically ac-
that the multifidus’ unique design tive and experience positive ef-
serves a critical function as a sta- fects over a longer period of time
bilizer of the lumbar spine. These than those who receive other
findings could have implications treatments, according to re-
for surgery, according to Steven R. searchers.
Garfin, M.D.
Motor control exercise, also
“It is important to identify what known as specific stabilization or ber of massage therapists per
each individual muscle does, and Core exercise, is a new form of 1,000 residents of a state and the
this is just a start, showing that exercise for back pain that has life expectancy for that state. As
the multifidus contributes signifi-gained the attention of research- the number of massage therapists
cantly to spinal stabilization,” ers and health practitioners over per resident increases, the life
said Garfin. “The more we know the past decade. The exercise fo- expectancy tends to increase. A
about what muscles do, the better cuses on regaining control of the model suggested that with an in-
we can devise therapeutic inter- trunk muscles, also known as the crease in one therapist per 1000
ventions such as physical therapy transversus abdominis and multi- residents, the life expectancy in-
to target specific muscles.” fidus, which support and control creases 1.7 years.
the spine. Previous studies of pa-
Garfin explained that many mus- tients with low back pain have Hawaii is the state with the great-
cles get weaker as they are ex- shown they are unable to properly est number of massage therapists
tended. But the researchers dis- control these muscles. Through per resident and is the state with
covered that, unlike all other motor control exercise, patients the greatest life expectancy as
muscles, the multifidus actually are taught how to isolate and well. Utah and Colorado also
becomes stronger as it lengthens, “switch on” these muscles and place in the top ten in both cate-
when the spine flexes. “The length then incorporate these move- gories. The states with the lowest
of the sarcomere—the structure ments into their normal activities. concentrations of massage thera-
within the muscle cell where fila- pists tend to have the lowest life
ments overlap to produce the “Although the exercises seemed expectancies. Louisiana, Ken-
movements required for muscle promising, until now we did not tucky, Georgia, Mississippi, and
contraction—is shorter in the have clear evidence on whether or Alabama all place in the bottom
multifidus than in any other mus- not they were more effective,” ac- ten for both number of massage
cle cell,” explained study’s first cording to researcher Luciana G therapists and life expectancy.
author Samuel R. Ward, P.T., Macedo, PT, MSc, a PhD student
Ph.D. “But as it gets longer, for at The George Institute for Inter- Certainly encouraging, although
instance as a person leans for- national Health, Sydney Univer- drawing a long bow, the author
ward, the multifidus actually sity, Australia. suggests that the higher number
strengthens.” of massage therapists meaning
more people are getting into mas-
Motor Control Exercises Re- Massage Therapy & Life Ex- sage, and it improves life quality,
duce Persistent Lower Back pectancy thus life expectancy!
Pain
A statistical analysis performed
Motor control exercises, when by Medical Massage Care indi-
performed in conjunction with cates that therapeutic massage
other forms of manual therapy, tends to increase life expectancy.
can significantly reduce pain and Using the data from 50 states in
disability in patients with persis- the US, the author found a posi-
tent low back pain, according to a tive correlation between the num-

Bodywork e-News 40
 6 Questions to Til Luchau
1. When and how did you decide to become a body-
worker?
My bodywork interest originally came out of my psychological
training. In the early 1980’s I was studying Gestalt and other
experimental psychotherapies at the Esalen Institute in Big
Sur, CA. Gestalt emphasizes the role of the body in psychologi-
cal growth, and our teacher encouraged us to study a body
modality in order to be better therapists. There were great
opportunities for studying the work of early bodywork pio-
neers at Esalen then—several of Ida Rolf’s, Moshe Feldenkrais,
Milton Trager, and Randolph Stone’s original students and
teachers were in residence there. I enjoyed the body work it-
self, and got good feedback, so I continued studying and it
became a focus of mine. Soon I was teaching at Esalen, then
later at the Rolf Institute, where I’d gone to train in 1985. (I
also worked for a long time as a body-centered psychothera-
pist--that part of my work still informs my work as a body-
worker and teacher, and has evolved over the years onto my
coaching practice and organizational development work.)
2. What do you find most exciting about bodywork
therapy?
The one thing? think it is the experience of actually receiving
great bodywork. Earlier this year, we had a 9-day retreat in
Mexico for a dozen of our (Advanced-Trainings.com’s) faculty
and assistants. We traded a lot of work and ideas, and I real-
ized there that we all had one thing in common—a love for the
amazing altered state of heightened somatic awareness that
comes with skilled bodywork. Bodyworkers classically neglect
receiving bodywork themselves. There are exceptions to this of
course, and I think those that make sure to stay connected to
the actual experience of receiving good work, do much better
work, and enjoy it more. Helping people, learning and re-
searching, sharing and teaching, and working together with
talented colleagues in a training situation are the things that
keep me loving this work.
3. What is your favourite bodywork book?
The Encyclopedia Anatomica from Taschen has great photos
of gorgeous, anatomically precise wax models that were made
for Florentine medical students in the 18th century. Ka-
pandji’s Physiology of the Joints series is an unparalleled
source of inspiration and technical insight into how joints
function.
4. What is the most challenging part of your work?
I find this question particularly challenging! Why can’t I think
of a “most challenging part?” It isn't’ for any shortage of diffi-
culties...maybe its just because the good and the “bad” are so
intrinsically wrapped together in this work, and that those
that make it their path take all that together, that I can’t tease
out a challenge that isn’t also a gift.
5. What advise you can give to fresh massage thera-
pists who wish to make a career out of it?
I always enjoy it when I get to work with a new therapist who
is enthusiastic about the work itself, and who sees this path as
one of multi-dimensional development. As a way to make a
living, there are a lot of easier and more lucrative ways to go;
as a path with “heart,” this is hard to beat.
6. How do you see the future of massage therapy?
I don’t know about Australia, but in the USA, the changes in
the profession are extreme—the number of practitioners being
trained exploded, but now is declining some; the quality of
education varies widely; there is a general shift towards the
polarized dichotomy of being either treatment-oriented, or
relaxation/spa –oriented; there is increasing commoditization
of massage and massage education, as businesses consolidate
into larger entities, and look to efficiency and volume. The
recent economic worries haven’t caused the sky to fall for
most established practitioners here, although it has varied
region to region, and I do know plenty of stories of folks
whose practices have slowed way down.
I think there will always be a place for highly-skilled practitio-
ners to be appreciated for their work. Although “Massage
Therapy” as a career and profession is undergoing all sorts of
changes, us humans have been using skillful touch for longer
than we’ve been humans. There is at least 100,000 years of
history of bodywork. It isn’t going anywhere.
Til Luchau is the director and a lead
instructor at Advanced-Trainings.com
Inc., which offers continuing educa-
tion seminars and support services for
practitioners and schools throughout
the USA and abroad. The originator of
Skillful Touch Bodywork (the Rolf
Institute®'s own training and practice
modality), he is a Certified Advanced
Rolfer® and a Rolf Institute® faculty
member.
Bodywork e-News 41
 6 Questions to Anita Boser
1. When and how did you decide to become a
bodyworker?
I was receiving a Hellerwork session, the 7th of the Hel-
lerwork Series, and on the table decided that I would
like my life more if I were helping people feel better
rather than helping them save money on insurance. It
was an odd thought, alternative health care had never
occurred to me before, but I considered it from every
angle and decided to make the leap.
2. What do you find most exciting about body-
work therapy?
That's easy. When my clients get off the table with the
experience of less pain, more hope, or new aware-
ness. The transformation feeds my spirit.
3. What is your most favourite bodywork book?
Oh my, that's not easy. Just one? My latest favorite
book is Michael Stanborough's Direct Myofascial Re-
lease Techniques. I purchased it last October and have-
n't made it all the way through yet. There's a lot of in-
formation! My all time favorite is probably The Endless
Web. I love to read it and get lost in the infinite beauty
and connectedness of the body.
4. What is the most challenging part of your
work?
Detaching myself from the expectation of specific re-
sults from my work.
5. What advise you can give to fresh massage
therapists who wish to make a career out of it?
You can do it!! Remember to ask for help, from other
practitioners, from mentors, from your friends, from
your clients. You don't have to do it all by yourself.
6. How do you see the future of massage ther-
apy?
Better understood as a diverse therapy with different
applications for different intentions. More accepted
and widely used. And, continually evolving as we reach
new understanding.
Anita Boser, LMP, CHP gradu-
ated from the Institute of Struc-
tural Medicine and practices
Hellerwork Structural Integra-
tion in Issaquah, WA, USA.
She is the author of Relieve Stiff-
ness and Feel Young Again with
Undulation and the audio ver-
sion, Undulation Exercises. She
created a way to make this fun-
damental movement pattern ac-
cessible to people who don't feel like they move well.
Her practice as a Hellerwork Structural Integrator in-
cludes teaching her clients how to use small movements
to melt stuck spots, especially in the back. She accumu-
lated a variety of exercises that transform bodies from
stiff and uncomfortable to graceful and at ease.
She can be contacted at anita@anitahellerworker.com
or www.undulationexercise.com.
Bodywork e-News 42