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Terra Rosa

E-Magazine
Open information for massage therapists & bodyworkers
www.terrarosa.com.au
No. 7, March 2011 www.massage-research.com

Contents Welcome to our special issue. Fascia research has


attracted lots of attention among researchers and
bodyworkers. Watch an introduction video on fascia
2 Fascia Fitness—Divo here” http://www.youtube.com/watch?v=yj9NqWZ
Müller & Robert Schleip -0ik

13 Tai Chi Coiling Fascia is important in muscular force transmission


and an amazing sensory organ. Now it is time to put
18 Auth Method: A
the research into practice. In our last issue, (No. 6,
Guide to Using Fore-
December 2010) Bethany Ward summarises the key
arms—Shari Auth
findings from the fascia congress and what it means
24 An Interview with for bodyworkers. Now, we have the first application
of fascia research in a new field called Fascial Fit-
Dr. Jean-Claude Guim-
ness, a new way of training your body, pioneered by
berteau
Robert Schleip, Divo Müller and Tom Myers. You
28 Fundamentals of- have the first chance to read about it here. Also read
Clinical Orthopedic Mas- about an ancient application of the fascia theory in
sage—Dr. Joe Muscolino Tai Chi coiling movement.

30 The Massage Pro- We also have an interview with Dr. Jean-Claude


ject— Joanne Schoenwald Guimberteau, a hand surgeon who for the first time,
brings you the images of live fascia. A Massage Pro-
31 Tai Chi for Fi- ject by Joanne Schoenwald. Great massage articles
bromyalgia—Romel by Dr. Joe Muscolino on Clinical Orthopedic Mas-
Rones sage, Shari Auth on Forearm Massage, and Art Riggs
on How to make a transition in your bodywork prac-
37 Transitioning Your tice.
Bodywork—Art Riggs
Don’t forget to read 6 questions to Robert Schleip
39 Research Highlights and Divo Müller.

40 6 Questions to Enjoy reading and Stay Healthy


Robert Schleip
Sydney, March 2011
41 6 Questions to Divo
Müller

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

Terra Rosa e-magazine, No. 7 (March 2011) 1


Fascial Fitness
Fascia oriented training for bodywork and
movement therapies

Divo G. Müller, Robert Schleip


Fascial Fitness Fascial Remodelling

When a football player is not able to take the field be- A unique characteristic of connective tissue is its im-
cause of a recurrent calf spasm, a tennis star gives up pressive adaptability: when regularly put under in-
early on a match due to knee problems or a sprinter creasing physiological strain, it changes its architec-
limps across the finish line with a torn Achilles tendon, tural properties to meet the demand. For example,
the problem is most often neither in the musculature or through our everyday biped locomotion the fascia on
the skeleton. Instead, it is the structure of the connec- the lateral side of the thigh develops a palpable firm-
tive tissue – ligaments, tendons, joint capsules, etc. – ness. If we were to instead spend that same amount of
which have been loaded beyond their present capacity time with our legs straddling a horse, then the opposite
(Renström & Johnson 1985, Counsel & Breidahl 2010). would happen, i.e. after a few months the fascia on the
A focused training of the fascial network could be of inner side of the legs would become more developed
great importance for athletes, dancers and other move- and strong (El-Labban et al. 1993). The varied capaci-
ment advocates. If one’s fascial body is well trained, ties of fibrous collagenous connective tissues make it
that is to say optimally elastic and resilient, then it can possible for these materials to continuously adapt to
be relied on to perform effectively and at the same time the regularly occurring strain, particularly in relation to
to offer a high degree of injury prevention. Until now, changes in length, strength and ability to shear. Not
most of the emphasis in sports training has been fo- only the density of bone changes, as for example in as-
cused on the classical triad of muscular strength, car- tronauts who spend most time in zero gravity, their
diovascular conditioning, and neuromuscular coordi-
nation. Some alternative physical training activities -
such as Pilates, yoga, Continuum Movement, Tai Chi,
Qi Gong and martial arts – are already taking the con-
nective tissue network into account.

The importance of fasciae is often specifically dis-


cussed; however the modern insights of fascia research
have often not been specifically included in our work.
In this article, we suggest that in order to build up an
injury resistant and elastic fascial body network, it is
Figure 1. Increased elastic storage capacity. Regular oscilla-
essential to translate current insights of fascia research tory exercise, such as daily rapid running, induces a higher storage
into a practical training program. Our intention is to capacity in the tendinous tissues of rats, compared with their non-
encourage massage, bodywork, and movement thera- running peers. This is expressed in a more spring-like recoil move-
pists, as well as sports trainers to incorporate the basic ment as shown on the left. The area between the respective loading
versus unloading curves represents the amount of 'hysteresis': the
principles presented in this article, and to apply them smaller hysteresis of the trained animals (green) reveals their more
to their specific context. 'elastic' tissue storage capacity; whereas the larger hysteresis of their
peers signifies their more 'visco-elastic' tissue properties, also called
inertia . Illustration modified after Reeves 2006.

Terra Rosa e-magazine, No. 7 (March 2011) 2


Fascial Fitness
bones become more porous; fascial tissues also reacts to collagenous structures (Kubo et al. 2003).
their dominant loading patterns. With the help of the
fibroblasts, they react to everyday strain as well as to The Catapult Mechanism: Elas-
specific training; steadily remodelling the arrangement tic Recoil of Fascial Tissues
of their collagenous fibre network. For example, with
Kangaroos can hop much farther and
each passing year half the collagen fibrils are replaced in
faster than can be explained by the force
a healthy body.
of the contraction of their leg muscles.
The intention of fascial fitness is to influence this re- Under closer scrutiny, scientists discovered that a spring
placement via specific training activities which will, af- -like action is behind the unique ability: the so-called
ter 6 to 24 months, result in a ‘silk-like bodysuit’ which catapult mechanism (Kram & Dawson 1998). Here the
is not only strong but also allows for a smoothly gliding tendons and the fascia of the legs are tensioned like
joint mobility over wide angular ranges. elastic bands. The release of this stored energy is what
makes the amazing hops possible. Hardy surprising,
Interestingly, the fascial tissues of young people show scientist thereafter found the same mechanism is also
stronger undulations within their collagen fibres, remi- used by gazelles. These animals are also capable of per-
niscent of elastic springs; whereas in older people the forming impressive leaping as well as running, though
collagen fibres appear as rather flattened (Staubesand et their musculature is not especially powerful. On the
al. 1997). Research has confirmed the previously opti- contrary, gazelles are generally considered to be rather
mistic assumption that proper exercise loading – if ap- delicate, making the springy ease of their incredible
plied regularly - can induce a more youthful collagen jumps all the more interesting.
architecture, which shows a more wavy fibre arrange-
ment (Wood et al. 1988, Jarniven et al. 2002) and which Through high resolution ultrasound examination, it is
also expresses a significant increased elastic storage ca- now possible to discover similar orchestration of load-
pacity (Figure 1) (Reeves et al. 2006). However, it seems ing between muscle and fascia in human movement.
to matter which kind of exercise movements are ap- Surprisingly it has been found that the fasciae of human
plied: a controlled exercise study using slow velocity and have a similar kinetic storage capacity to that of kanga-
low load contractions only demonstrated an increase in roos and gazelles (Sawicki et al. 2009). This is not only
muscular strength and volume, however it failed to made use of when we jump or run but also with simple
yield any change in the elastic storage capacity of the walking, as a significant part of the energy of the move-
ment comes from the same springiness described above.

Figure 2. Length changes of fascial elements and muscle fibres in an oscillatory movement with elastic recoil properties
(A) and in conventional muscle training (B). The elastic tendinous (or fascial) elements are shown as springs, the myo-fibres as
straight lines above. Note that during a conventional movement (B) the fascial elements do not change their length significantly while the
muscle fibres clearly change their length. During movements like hopping or jumping however the muscle fibres contract almost isometri-
cally while the fascial elements lengthen and shorten like an elastic yoyo spring. Illustration adapted from Kawakami et al. 2002.

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Fascial Fitness

Figure 3. Collagen architecture responds to loading. Fasciae of young people express more often a clear two-directional (lattice)
orientation of their collagen fibre network. In addition the individual collagen fibres show a stronger crimp formation. As evidenced by ani-
mal studies, application of proper exercise can induce an altered architecture with increased crimp-formation. Lack of exercise on the other
hand, has been shown to induce a multidirectional fibre network and a decreased crimp formation.

This new discovery has led to an active revision of long energy transfer is still true for steady movements such
accepted principles in the field of movement science. as cycling. Here the muscle fibres actively change in
length, while the tendons and aponeuroses barely grow
In the past it was assumed that in a muscular joint longer (Figure 2). The fascial elements remain quite
movement, the skeletal muscles involved shorten and passive. This is in contrast to oscillatory movements
this energy passes through passive tendons which re- with an elastic spring quality in which the length of the
sults in the movement of the joint. This classical form of muscle fibres changes slightly. Here, it is the muscle
fibres contract in an almost isometric fashion (they
stiffen temporarily without any significant change of
their length) while the fascial elements function in an
elastic way with a movement similar to that of a yoyo.
Here, it is the lengthening and shortening of the fascial
elements that ‘produces’ the actual movement
(Fukunaga et al. 2002, Kawakami et al. 2002).

Work by Staubesand et al. (1997) suggested that the


elastic movement quality in young people is associated
with a typical bi-directional lattice arrangement of their
fasciae, similar to a woman’s stocking. In contrast, as we

Figure 4. Loading of different fascial components.


A) Relaxed position: The myo-fibres are relaxed and the muscle is at
normal length. None of the fascial elements is being stretched.
B) Usual muscle work: myo-fibres contracted and muscle at normal
length range. Fascial tissues which are either arranged in series with
the myo-fibres or transverse to them are loaded.
C) Classical stretching: myo-fibres relaxed and muscle elongated.
Fascial tissues oriented parallel to the myo-fibres are loaded as well
as extra-muscular connections. However, fascial tissues oriented in
series with the myo-fibres are not sufficiently loaded, since most of
the elongation in that serially arranged force chain is taken up by the
relaxed myo-fibres.
D) Actively loaded stretch: muscle active and loaded at long end
range. Most of the fascial components are being stretched and stimu-
lated in that loading pattern. Note that various mixtures and combi-
nations between the four different fascial components exist. This
simplified abstraction serves as a basic orientation only.

Terra Rosa e-magazine, No. 7 (March 2011) 4


Fascial Fitness
A B

Figure 5. Training example: The Flying Sword A) Tension the bow: the preparatory counter movement (pre-stretch) initiates the
elastic-dynamic spring in an anterior and inferior direction. Free weights can also be used. B) To return to an upright position, the
‘catapulting back fascia’ is loaded as the upper body is briefly bounced dynamically downwards followed by an elastic swing back up. The
attention of the person doing the exercise should be on the optimal timing and calibration of the movement in order to create the smoothest
movement possible.

age and usually loose the springiness in our gait, the transverse fibres across the muscular envelope are
fascial architecture takes on a more haphazard and mul- stimulated as well. However, little effect can be expected
tidirectional arrangement. Animal experiments have on extra-muscular fasciae as well as on those intramus-
also shown that lack of movement quickly fosters the cular fascial fibres that are arranged in parallel to the
development of additional cross links in fascial tissues. active muscle fibres (Huijing 1999).
The fibres lose their elasticity and do not glide against
one another as they once did; instead they become stuck Classical Hatha yoga stretches on the other side will
together and form tissue adhesions, and in the worst show little effect on those fascial tissues which are ar-
cases they actually become matted together (Figure 3) ranged in series with the muscle fibres, since the relaxed
(Jarvinen et al. 2002). myo-fibres are much softer than their serially arranged
tendinous extensions and will therefore ‘swallow’ most
The goal of the proposed fascial fitness training is to of the elongation (Jami 1992). However, such stretching
stimulate fascial fibroblasts to lay down a more youthful provides good stimulation for fascial tissues which are
and kangaroo-like fibre architecture. This is done hardly reached with classical muscle training, such as
through movements that load the fascial tissues over the extra-muscular fasciae and the intramuscular fas-
multiple extension ranges while utilizing their elastic ciae oriented in parallel to the myo-fibres. Finally, a dy-
springiness. namic muscular loading pattern in which the muscle is
both activated and extended promises a more compre-
Figure 4 illustrates different fascial elements affected by hensive stimulation of fascial tissues. This can be
various loading regimes. Classical weight training loads achieved by muscular activation (e.g. against resistance)
the muscle in its normal range of motion, thereby in a lengthened position while requiring small or me-
strengthening the fascial tissues which are arranged in dium amounts of muscle force only. Soft elastic bounces
series with the active muscle fibres. In addition the in the end ranges of available motion can also be utilized

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Fascial Fitness

Figure 6. Training example: Elastic Wall Bounces. Imitating the elastic bounces of a kangaroo soft bouncing movements off a wall
are explored in standing. Proper pre-tension in the whole body will avoid any collapsing into a ‘banana posture’. Making the least sound
and avoiding any abrupt movement qualities are imperative. Only with the mastery of these qualities a progression into further load in-
creases – e.g. bouncing off a table or window sill instead of a wall – can eventually be explored by stronger individuals. E.g. this person
should not yet be permitted to progress to higher loads, as his neck and shoulder region already show slight compression on the left picture.

for that purpose. The following guidelines are developed as the weight is shifted in this direction.
to make such training more efficient.
The opposite is true for straightening up – the mover
Training Principles activates the catapult capacity of the fascia through an
active pre-tensioning of the fascia of the back. When
1. Preparatory Counter-movement standing up from a forward bending position, the mus-
cles on the front of the body are first briefly activated.
Here we make use of the catapult effect as described
This momentarily pulls the body even further forward
above. Before performing the actual movement, we start
and down and at the same time the fascia on the poste-
with a slight pre-tensioning in the opposite direction.
rior fascia is loaded with greater tension.
This is comparable with using a bow to shoot an arrow;
just as the bow has to have sufficient tension in order The energy which is stored in the fascia is dynamically
for the arrow to reach its goal, the fascia becomes ac- released via a passive recoil effect as the upper body
tively pre-tensioned in the opposite direction. Using ‘swings’ back to the original position. To be sure that the
one’s muscle power to “push the arrow” would then individual is not relying on muscle work, but rather on
rightfully be seen as foolish, in this extreme example of dynamic recoil action of the fascia, requires a focus on
an elastic recoil movement. In a sample exercise called timing – much the same as when playing with a yoyo. It
the flying sword, the pre-tensioning is achieved as the is necessary to determine the ideal swing, which is ap-
body’s axis is slightly tilted backward for a brief mo- parent when the action is fluid and pleasurable.
ment; while at the same time there is an upward length-
ening (Figure 5). This increases the elastic tension in the 2. The Ninja Principle
fascial bodysuit and as a result allows the upper body
This principle is inspired by the legendary Japanese
and the arms to spring forward and down like a catapult
warriors who reputedly moved as silent as cats and left

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Fascial Fitness
A B

Figure 7. Training example: The Big Cat Stretch. A) This is a slow stretching movement of the long posterior chain, from the finger
tips to the sit bones, from the coccyx to the top of the head and to the heels. The movement goes in opposing directions at the same time –
think of a cat stretching its long body. By changing the angle slightly, different aspects of the fascial web are addressed with slow and steady
movements. B) In the next step, we rotate and lengthen the pelvis or chest towards on side (here shown with the pelvis starting to rotate to
the right). The intensity of the feeling of stretch on that entire side of the body is then gently reversed. Note the afterwards feeling of in-
creased length .

no trace. When performing bouncy movements such as ture of the connective tissue in that it becomes more
hopping, running and dancing, special attention needs elastic when correctly performed (Decoster et al. 2005).
to be paid to executing the movement as smoothly and Muscles and tissue should first be warmed up, and jerk-
softly as possible. A change in direction is preceded by a ing or abrupt movements should be avoided. The mo-
gradual deceleration of the movement before the turn tion should have a sinusoidal deceleration and accelera-
and a gradual acceleration afterwards, each movement tion shape each direction turn; this goes along with a
flowing from the last; any extraneous or jerky move- smooth and ‘elegant’ movement quality perception. Dy-
ments should therefore be avoided (see Figure 6). namic, fast stretching has even more effect on the fascia
when combined with a preparatory countermovement
Normal stairs become training equipment when they as was previously described by Fukashiro et al. (2006).
are used appropriately, employing gentle stepping. The For example, when stretching the hip flexors a brief
production of ‘as little noise as possible’ provides the backward movement should be introduced before dy-
most useful feedback – the more the fascial spring effect namically lengthening and stretching forwards.
is utilized, the quieter and gentler the process will be. It
may be useful to reflect on the way a cat moves as it pre- The long myofascial chains are the preferred focus when
pares to jump; the feline first sends a condensed im- doing slow dynamic stretches. Instead of stretching iso-
pulse down through its paws in order to accelerate softly lated muscle groups, the aim is finding body movements
and quietly, landing with precision. that engage the longest possible myofascial chains
(Myers 1997). This is not done by passively waiting as
3. Dynamic Stretching in a lengthening classical Hatha yoga pose, or in a con-
ventional isolated muscle stretch. Multidirectional
Rather than a motionless waiting in a static stretch posi-
movements, with slight changes in angle are utilized;
tion a more flowing stretch is suggested. In fascial fit-
this might include sideways or diagonal movement
ness there is a differentiation between two kinds of dy-
variations as well as spiralling rotations. With this
namic stretching: fast and slow. The fast variation may
method, large areas of the fascial network are simulta-
be familiar to many people as it was part of the physical
neously involved (Figure 7).
training in the past. For the past several decades this
bouncing stretch was considered to be generally harmful 4. Proprioceptive Refinement
to the tissue, but the method’s merits have been con-
firmed in contemporary research. Although stretching The importance of proprioception for movement control
immediately before competition can be counterproduc- is made clear by the case of Ian Waterman, a man re-
tive, it seems that long-term and regular use of such dy- peatedly mentioned in scientific literature. This impres-
namic stretching can positively influence the architec- sive man contracted a viral infection at the age of 19

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Fascial Fitness

Figure 8. Training example: Octopus Tentacle. With the image of an octopus tentacle in mind, a multitude of extensional movements
through the whole leg are explored in slow motion. Through creative changes in muscular activations patterns the tensional fascial proprio-
ception is activated. This goes along with a deep myofascial stimulation that aims to reach not only the fascial envelopes but also into the
septa between muscles. While avoiding any jerky movement quality, the action of these tentacle-like micro-movements leads to a feeling of
flowing strength in the leg.

which resulted in a so-called ‘sensory neuropathy’. In proprioceptive nerve endings located in the more super-
this rare pathology, the sensory peripheral nerves which ficial layers are more optimally situated as here even
provide the somato-motor cortex with information small angular joint movements lead to relatively distinct
about the movements of the body are destroyed, while shearing motions. Recent findings indicate that the su-
the motor nerves remain completely intact. This means perficial fascial layers of the body are in fact more
than Mr. Waterman can move, but he can’t ‘feel’ his densely populated with mechano-receptive nerve end-
movements. After some time, this giant of a man be- ings than tissue situated more internally (Stecco et al.
came virtually lifeless. Only with an iron will and years 2008).
of practice did he finally succeed in making up for these
normal physical sensations, a capacity that is commonly For this reason a perceptual refinement of shear, gliding
taken for granted. He did so with conscious control that and tensioning motions in superficial fascial mem-
primarily relies on visual feedback. He is currently the branes is encouraged. In doing this, it is important to
only person known with this affliction that is able to limit the filtering function of the reticular formation as
stand unaided, as well as being able to walk (Cole 1995). it can markedly restrict the transfer of sensations from
movements which are repetitive and predictable. To
Observation of the way Waterman moves is similar to prevent such a sensory dampening, the idea of varied
the way patients with chronic back pain move. When in and creative experiencing becomes important. In addi-
a public place if the lights unexpectedly go out, he clum- tion to the slow and fast dynamic stretches noted above
sily falls to the ground (see BBC documentary: The man as well as utilizing elastic recoil properties an inclusion
who lost his body http://video.google.com/videoplay? of ‘fascial refinement’ training is recommended in which
docid=-3032994272684681390#). Springy, swinging various qualities of movement are experimented with,
movements are possible for him only with obvious and e.g. extreme slow-motion and very quick, micro-
jerky changes in direction. If doing a classical stretching movements which may not even be visible to an ob-
program with static or active stretches, he would appear server and large macro movements involving the whole
normal. As for the dynamic stretching that is part of our body. Here it is common to place the body into unfamil-
fascial training, he is clearly not capable, as he lacks the iar positions while working with the awareness of grav-
proprioception needed for fine coordination. ity, or possibly through exploring the weight of a train-
ing partner.
It is interesting to note here that the classical ‘joint re-
ceptors’ – located in joint capsules and associated liga- The micro-movements are inspired by Emily Conrad’s
ments - have been shown to be of lesser importance for Continuum Movement (Conrad 1997). Such movement
normal proprioception, since they are usually stimu- is active and specific and can have effects which are not
lated at extreme joint ranges only, and not during possible with larger movements. In doing these coordi-
physiological motions (Lu et al 1985). On the contrary, nated fascial movements, it appears possible to specifi-

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Fascial Fitness

Figure 9. Training example: Fascial Release. The use of particular foam rollers may allow the application of localized tissue stimula-
tions with similar forces and possibly similar benefits as in a manual myofascial release session. However the stiffness of the roller and ap-
plication of the body weight needs to be adjusted and monitored for each person. To foster a sponge-like tissue dehydration with subsequent
renewed local hydration, only slow-motion like subtle changes in the applied forces and vectors are recommended.

cally address adhesions, for example between muscle these begin to function less optimally as their elastic and
septa deep in the body. In addition such tiny and spe- springy resilience slowly decreases.
cific movements can be used to illuminate and bring
awareness to perceptually neglected areas of the body The short walking pauses then serve to re-hydrate the
(Figure 8). Thomas Hanna uses the label ‘sensory-motor tissue as it is given a chance to take up nourishing fluid.
amnesia’ for such places in the body (Hanna 1998). For an average beginning runner for example, the au-
thors recommend walking pauses of one to three min-
5. Hydration and Renewal utes every 10 minutes. More advanced runners with
more developed body awareness can adjust the optimal
The video recordings of live fascia Strolling Under the timing and duration of those breaks based on the pres-
Skin by Dr Jean-Claude Guimbertau have helped our ence (or lack) of that youthful and dynamic rebound: if
understanding of the plasticity and changing elasticity the running movement begins to be feel and look more
of the water-filled fascia. This awareness has proven to dampened and less springy, it is likely time for a short
be especially effective when incorporated into the slow pause. Similarly, if after a brief walking break there is a
dynamic stretching and the fascial refinement work. An noticeable return of that gazelle-like rebound, then the
essential basic principle of these exercises is the under- rest period was adequate.
standing that the fascial tissue is predominantly made
up of free moving and bound water molecules. During This cyclic training, with periods of more intense effort
the strain of stretching, the water is pushed out of the interspersed with purposeful breaks, is recommended in
more stressed zones similarly to squeezing a sponge all facets of fascia training. The person training then
(Schleip & Klingler 2007).With the release that follows; learns to pay attention to the dynamic properties of
this area is again filled with new fluid which comes from their fascial “bodysuit” while exercising, and to adjust
surrounding tissue as well as the lymphatic and vascular the exercises based on this new body awareness. This
network. The sponge-like connective tissue can lack also carries over to an increased ‘fascial embodiment’ in
adequate hydration at neglected places. The goal of ex- everyday life. Preliminary anecdotal reports also indi-
ercise is to refresh such places in the body with im- cate a preventative effect of a fascia oriented training in
proved hydration through specific stretching to encour- relation to connective tissue overuse injuries.
age fluid movement.
The use of special foam rollers can be useful tools for
Here proper timing of the duration of individual loading inducing a localized ‘sponge-like’ temporary tissue de-
and release phases is very important. As part of modern hydration with resultant renewed hydration. However
running training, it is often recommended to frequently firmness of the roller and application of the bodyweight
intercept the running with short walking intervals needs to be individually monitored. If properly applied
(Galloway 2002). There is good reason for this: under and including very slow and finely-tuned directional
strain the fluid is pressed out of the fascial tissues and changes only, the tissue forces and potential benefits

Terra Rosa e-magazine, No. 7 (March 2011) 9


Fascial Fitness
supple and resilient like a bamboo requires the devotion
and regular care of the bamboo gardener. He nurtures
his seeds over a long period of time without any visible
positive result. Only after enduring care does the first
bamboo seedling become visible as it pushes its way
toward the sky. From then on it grows steadily upwards
until it dwarfs its neighbours in height, flexibility and
resistance to damage. It is therefore suggested that
training should be consistent, and that only a few min-
utes of appropriate exercises, performed once or twice
per week is sufficient for collagen remodelling. The re-
lated renewal process will take between six months and
two years and will yield a lithe, flexible and resilient col-
lagenous matrix.
Figure 10: Collagen turnover after exercise. The upper curve
For those who do yoga or martial arts, such a focus on a
shows collagen synthesis in tendons is increasing after exercise.
However, the stimulated fibroblasts also increase their rate of colla- long-term goal is nothing new. For the person who is
gen degradation. Interestingly, during the first 1-2 days following new to physical training, such analogies when combined
exercise, collagen degradation overweights the collagen synthesis; with a little knowledge of modern fascia research can go
whereas afterwards this situation is reversed. To increase tendon
a long way in convincing them to train their connective
strength, the proposed fascial fitness training therefore suggests an
appropriate tissue stimulation 1 to 2 times per week only. While the tissues. Of course fascial fitness training should not re-
increased tendon strength is not achieved by an increase in tendon place muscular strength work, cardiovascular training
diameter, recent examinations by Kjaer et al. (2009) indicated that it and coordination exercises; instead it should be thought
is probably the result of altered cross-link formations between colla-
of as an important addition to a comprehensive training
gen fibres. Illustration modified after Magnusson et al. 2010.
program.
could be similar to those of manual myofascial release For more information on fascial fitness see:
treatments (Chaudhry et al. 2008). In addition, the lo- www.fascialfitness.de
calized tissue stimulation may serve to stimulate and
fine-tune possibly inhibited or de-sensitized fascial pro- This article is adapted from: Fascia in Manual and
prioceptors in more hidden tissue locations (Figure 9). Movement Therapies, Schleip et al., Elsevier Science
2011.
6. Sustainability: The Power of a Thousand
Tiny Steps

An additional and important aspect is the concept of the References


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probable.
EI-Labban NG, Hopper C, Barber P (1993) Ultrastructural
A bit of Eastern philosophy might help in the motivation finding of vascular degeneration in myositis ossificans circum-
scripta (fibrodysplasia ossificans). J Oral Pathol Med 22 (9):
of impatient Westerners looking for quick gains: to be
428–431

Terra Rosa e-magazine, No. 7 (March 2011) 10


Fascial Fitness
Fukunaga T, Kawakami Y, Kubo K, Kanehisa H (2002) Muscle Myers TW (1997) The ‘anatomy trains’. J Bodyw Mov Ther 1
and tendon interaction during human movements. Exerc (2): 91-101.
Sport Sci Rev 30(3): 106-10
Reeves ND, Narici MV, Maganaris CN (2006) Myotendinous
Fukashiro S, Hay DC, Nagano A (2006) Biomechanical behav- plasticity to ageing and resistance exercise in humans. Exp
ior of muscle-tendon complex during dynamic human move- Physiol 91(3): 483-498.
ments. J Appl Biomech 22(2): 131-47.
Renström P, Johnson RJ (1985) Overuse injuries in sports. A
Galloway J (2002) Galloway’s Book on Running. Shelter Pub- review. Sports Med 2(5): 316-333.
lications, Bolinas, CA, USA.
Sawicki GS, Lewis CL, Ferris DP (2009) It pays to have a
Hanna T (1998) Somatics: Reawakening the Mind's Control of spring in your step. Exerc Sport Sci Rev 37(3): 130-138.
Movement, Flexibility, and Health. Da Capo Press, Cambridge
MA, USA. Schleip R, Klingler W (2007) Fascial strain hardening corre-
lates with matrix hydration changes. In: Findley TW, Schleip
Huijing PA (1999) Muscle as a collagen fiber reinforced com- R (eds.) Fascia Research – Basic science and implications to
posite: a review of force transmission in muscle and whole conventional and complementary health care. Elsevier GmbH,
limb. J Biomech 32(4): 329-45. Munich, p.51.

Jami A (1992) Golgi tendon organs in mammalian skeletal Staubesand J, Baumbach KUK, Li Y (1997) La structure find
muscles: functional properties and central actions. Physiol de l’aponévrose jambiére. Phlebol 50: 105-113.
Rev 72(3): 623-666.
Stecco C, Porzionato A, Lancerotto L, Stecco A, Macchi V, Day
Jarvinen TA, Jozsa L, Kannus P, Jarvinen TL, Jarvinen M JA, De Caro R 2008. Histological study of the deep fasciae of
(2002) Organization and distribution of intramuscular con- the limbs. J Bodyw Mov Ther 12(3): 225-230.
nective tissue in normal and immobilized skeletal muscles. An
immunohistochemical, polarization and scanning electron Wood TO, Cooke PH, Goodship AE (1988) The effect of exer-
microscopic study. J Muscle Res Cell Motil 23(3): 245-54. cise and anabolic steroids on the mechanical properties and
crimp morphology of the rat tendon. Am J Sports Med 16 (2)
Kawakami Y, Muraoka T, Ito S, Kanehisa H, Fukunaga T 153-158.
(2002) In vivo muscle fibre behaviour during countermove-
ment exercise in humans reveals a significant role for tendon About the authors
elasticity. J Physiol 540 (2): 635–646.
Divo Müller is one of the first interna-
Kjaer M, Langberg H, Heinemeier K, Bayer ML, Hansen M, tionally authorized Continuum teach-
Holm L, Doessing S, Kongsgaard M, Krogsgaard MR, Magnus- ers in Europe since 1992. She is a So-
son SP (2009). From mechanical loading to collagen synthe- matic Experience practitioner, author
sis, structural changes and function in human tendon. Scand J
of a book, numerous articles and
Med Sci Sports 19(4): 500-510.
DVDs, all of which teach a specially
Kram R, Dawson TJ (1998) Energetics and biomechanics of designed movement approach for
locomotion by red kangaroos (Macropus rufus). Comp Bio- women, based on Continuum. Divo teaches regularly
chem Physiol B 120(1): 41-9. http://stripe.colorado.edu/ all over Europe as well as in Brazil and in New Zea-
~kram/kangaroo.pdf land. She offers a unique movement program in her
Kubo K, Kanehisa H, Miyatani M, Tachi M, Fukunaga T Studio Bodybliss in Munich www.bodybliss.de
(2003). Effect of low-load resistance training on the tendon
Robert Schleip PhD, is an Interna-
properties in middle-aged and elderly women. Acta Physiol
Scand 178(1): 25-32.
tional Rolfing Instructor and Fascial
Anatomy Teacher. Robert has been an
Lu Y, Chen C, Kallakuri S, Patwardhan A, Cavanaugh JM enthusiastic certified Rolfer since 1978.
(2005) Neural response of cervical facet joint capsule to He holds on M.A. degree in psychology
stretch: a study of whiplash pain mechanism. Stapp Car Crash and is a Certified Feldenkrais Teacher since 1988. He
J 49: 49-65.
earned his PhD with honours in 2006 at the age of 52,
Mackey AL, Heinemeier KM, Koskinen SO, Kjaer M (2008) and shortly thereafter established the Fascia Research
Dynamic adaptation of tendon and muscle connective tissue to Project at Ulm University and has a lab of his own. He
mechanical loading. Connect Tissue Res 49(3): 165-168. was the co-initiator and organizer of the first Fascia
Research Congress at the Harvard Medical School in
Magnusson SP, Langberg H, Kjaer M (2010) The pathogenesis
Boston, USA in 2007. See Robert’s website
of tendinopathy: balancing the response to loading. Nat Rev
Rheumatol 6(5): 262-268. www.somatics.de

Terra Rosa e-magazine, No. 7 (March 2011) 11


www.terrarosa.com.au
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Terra Rosa e-magazine, No. 7 (March 2011) 12


Tai Chi Coiling
Movement

One of the main principles in Fascial Fitness training is back of the body. This will create a smooth and efficient
to use a preparatory counter-movement; before per- movement.
forming a movement, we start with a slight tensioning of
the myofascia in the opposite direction. The intention is In the book The Essence of Taiji Qigong: The Internal
Foundation of Taijiquan by Dr. Jwing-Ming Yang
to exploit the catapult effect or elastic recoil property of
the fascial tissues. Imagine using a bow; as the bow is (YMAA Publishing), he explained that the main purpose
drawn, energy is stored in the limbs of the bow and of the coiling set is to lead Qi to the skin and bone mar-
row through breathing and coiling motion. The princi-
when the string is released the force is transferred to the
arrow. For many years scientists were puzzled to ex- ple is that we tense the muscles and fasciae by twisting
plain how kangaroos and wallabies can hop at a speed of the limbs and body in one direction and we relax the
20-25 km per hour and jump as high as 5 meters. The myofasciae when letting the limbs and body spring back
muscles of these animals simply don’t have that capac- to its starting position. This coincidentally is in line with
ity. Later, it was found out that the high elastic storagethe fascial fitness principle. This continuous coiling
capacity was held in the tendons and faciae, not in the movement is believed to cause the Qi to be led to the
muscles. skin and condensed to the bone marrow. Proper breath-
ing and leading the Qi through the mind are the keys for
Coiling movement, making use of the elasticity of fascia, a successful training.
has been utilised in Tai Chi and Qi Gong for a long time.
Tai Chi and Qi Gong practitioners can move swiftly and The coiling movement should be first generated from
smoothly thanks to the coiling principle. Martial artists the legs and then directed to the limbs of the body. The
are able to generate powerful strike through coiling of body should be soft like a whip. Stretch the arms to
energy. The coiling movement is embedded in many Tai open the joints, then twist. Imagine that you are moving
Chi movement styles (e.g. Silk Reeling Tai Chi). Coiling against resistance, and that your feet are pushing
provides movements that are relaxed, fluid and bal- against the floor. The movement is smooth and con-
anced, this is due to a constant balancing of opposing tinuous like an octopus. Correct breathing is the key:
forces with storing and releasing of energy in the move- slow, deep, long and not holding the breath. As you in-
ments. When all the muscles, tendons and joints are hale, imagine that you are drawing energy in through
linked, coiling can release a powerful energy. Coiling your hands and feet and condensing it in your Dan Tian
through the waist can give massage to the internal or- (center of gravity located in the abdomen) and spine. As
gans, while coiling through the joints strengthen ten- you exhale move the Qi from you Dan Tian and spine
dons and ligaments. out through your hands and feet.

A specific routine called the Coiling Set is particularly Here are some examples taken from The Essence of
useful to illustrate the principle; it was originally devel- TaiJi JiGong DVD by Dr. Yang Jwing-Ming (YMAA
oped for martial arts training but now used as a health Publishing). These coiling exercises can be added to
exercise. Practising the coiling set helps us to develop a your fascia fitness routine.
fluid connection between the lower and upper body, (Pictures taken from The Essence of TaiJi JiGong DVD,
between the left and right side, between the front and courtesy of YMAA Publishing)

Terra Rosa e-magazine, No. 7 (March 2011) 13


Coiling Tai Chi
Warming Up:

Coiling forward and backward

Lift the hand in front of the chest, slightly rounding the shoulder. Direct the hands to move towards the front of
the body and tensioning the muscles, then and letting it return to the original position (front of the chest).

Coiling forward and backward

The Coiling Set

The coiling set is composed of 12 movements that can be performed in stationary or moving. Each movement is to
be performed 10 times.

1. Stand calmly to regulate the spirit & breathing

Feet shoulder-width apart, arms hang naturally at sides.

2. White crane relaxes its wings

Inhale while turning palms to the back, rounding the shoulders forward and slightly arching your chest. Exhale,
turn palms to face front.

3. Drill forward and pull back

Inhale, lift hands to mid chest with palms facing up. All fingers and both arms should be in a straight line. Exhale,
pull in the elbows and extend arms in front of you, palms up while gently rounding the shoulders forward. Inhale,
spread your elbows out to the sides and draw arms back to chest. Rotate your arms as they move so that they end
up with palms facing your chest, arms and fingers in a straight line. Exhale, press arms down while keeping them
in line, palms facing down, until arms are fully extended and fingers point downward.

Drill forward and pull back

4. Left and right Yin and Yang

Hands in front of the abdomen. Exhale, drill your right hand forward, rotate the palm upwards and slightly turn-
ing your body. Inhale, recoil by pulling the right hand to the original position. Then continue by doing the same
movement with the right hand.

Terra Rosa e-magazine, No. 7 (March 2011) 14


Coiling Tai Chi

Left and right Yin and Yang

5. Water and fire mutually interact

Inhale, turn palms up and raise hands to the clavicle level as if you were lifting something. Exhale, turn palms
down, then push them downward to your abdomen keeping the hands lined up in front of your body until arms
are fully extended and fingers point straight to ground.

Water and fire mutually interact

6. Large bear encircles the moon

Inhale, lift hands to clavicle level while turning palms faced up. Exhale, extend and rotate your arms forward so
that your arms and chest form a large circle with palms facing forward. Inhale, turn palms to face inward as you
move your hands back toward chest. Exhale, push both palms down to your abdomen keeping the hands in line.

Large bear encircles the moon

Terra Rosa e-magazine, No. 7 (March 2011) 15


Coiling Tai Chi
7. Living Buddha holds up the heaven

Similar to movement no. 6 except that you push your hands up instead of forward.

Living Buddha holds up the heaven

8. Turn heaven and earth in front of the body

Raise both hands in front of your chest, Turn palms upwards while inhaling, exhale push one hand up to the sky
and push the other hand down the earth. Coil back to the original position and do the movement on the opposite
hands.

Turn heaven and earth

9. Golden rooster twists its wings

Similar to movement no. 8, except that the descending hand is threaded behind your back.

Golden rooster twists its wings

10. Turn head to look at the moon

Continue from No. 9 but now twist your body to look directly behind you as you exhale. When right hand is up,
twist to the left and vice versa.

Terra Rosa e-magazine, No. 7 (March 2011) 16


16 to look at the moon
Turn head
Coiling Tai Chi
11. Big python turns its body

Step your left leg to the left and squat down to put about 60% of your weight on it. Twist your body and move the
arms. Exhale, twist your body to the left and twist your head to look to the back. Inhale, return to centre. Exhale,
turn to the right. Toes point 45 degrees outward. Pivot feet as necessary to keep your stance stable.

Big phyton turns its body

12. Up and down coilings

Turn your body to face forward and bring your hands to your waist. Next, exhale and stand upright and raise your
hands straight up palms facing forward. Then inhale and lower your body as you twist it to the side and draw your
hands into your chest turning the palms up. You should end up in the Sitting on Crossed Legs Stance. Pivot your
feet as necessary to keep your stance stable. Then raise and twist your body into Horse Stance facing front. Repeat
the movements to the opposite side.

Up and down coilings

For the complete description and demonstration of the coiling set, we refer to the book and DVD The Essence of
Taiji Qigong by Dr. Yang Jwing-Ming, published by YMAA.

Reference:

Yang, J.M. 1998. The Essence of Taiji Qigong: The Internal Foundation of Taijiquan. Book and DVD. YMAA Publi-
cation Center.

Terra Rosa e-magazine, No. 7 (March 2011) 17


Auth Method:
A Guide to Using
Forearms
My first massage job was at a spa. An aver-
age shift was six one-hour, full-body mas-
sages. Doing six massages a day, I quickly
learned the importance of proper body me-
chanics and using the forearms to do mas-
sage. I began to rely on my forearms to
work the entire body, reserving my hands
for my client’s toes, fingers, and neck.

Fifteen years later, I am still seeing six clients a day (if


not more), and I do not have—nor have I had—carpal
tunnel, pain in my hands, lumbago, or any other mas-
sage-related injuries. I attribute this to using my fore-
arms to perform the vast majority of massage work and
practicing good body mechanics while giving a mas-
sage. Forearm massage wasn’t part of my massage cur-
riculum in massage school and yet I use it more than
the other methods I studied. I designed the Auth
Method of Forearm Massage to help professional mas-
sage therapists enjoy longer, healthier careers. As MTs,
it is imperative we keep work-related injuries to a mini-
mum. The Auth Method is a massage technique that
takes the practitioner’s wellbeing into account, as well
as that of the client. It feels effortless to perform and
great to receive.
Below are a few key concepts about the Auth Method,
including some forearm massage techniques and a
qigong exercise for better body mechanics.

Durability
The forearms are a bodyworker’s most prized tool: they smoother and more relaxing.
are more durable than the hands, fingers, or thumbs, so
you can work longer on your clients with less wear and Sensitivity
tear on your body. This means increased career produc- With practice, the forearms are just as sensitive and
tivity and longevity. Using the forearms as the primary agile as the hands, fingers, or thumbs. In my own ex-
tool in performing massage minimizes the risk of carpal perience as a massage client, I’ve often been snapped
tunnel, thenar problems, or pain anywhere in the out of a state of total relaxation when the therapist
hands, simply because you are asking less of your roughly introduces an elbow and pokes around with too
hands. Forearms are also less “pointy” than the elbows, much pressure, bumping up against my spine or some
so the massage work you do on your clients will be other bony prominence. Many people immediately as-

Terra Rosa e-magazine, No. 7 (March 2011) 18


Forearm massage
and tight, or excessively muscular, I might drop the
“Because the forearm table a little lower. If the client is petite, I might take
the table a little higher. The table should be low enough
surface area of contact is that you can drop your body weight onto the client and
high enough that your back is straight. It’s worth it to
larger than using your spend the extra couple of minutes before a session to
adjust the table height. Better to spend the time to ad-
fingers or thumb, you just the table height than spend the next hour uncom-
fortable or overexerting yourself.
can work more of your Arm Glide Technique
client in less time.” Position your prone client’s arm to a 90-degree angle
so the elbow is just below the corner of the table and
the forearm is hanging off the table. Stand below the
sociate forearm massage with deep-tissue work. This is raised arm in a lunge stance parallel to the table, facing
not a rule. Forearm massage is also good for light circu- the arm. Place the upper third of your left forearm onto
latory massage. Students of forearm massage should the top of the right triceps and glide down the triceps
begin by using the forearms to do light work until they toward the elbow. Slow down over tight spots in the
learn the nuances of this new tool. This is a safer, more triceps. Keep most of your weight in your feet at first
practical way to develop sensitivity in the forearms. I and gradually drop more body weight onto your client’s
recommend using a bit more oil than usual to account triceps as you feel is needed. In general, the triceps do
for the broader area of contact. The increased amount not need a lot of body weight to release when worked in
of oil helps to develop a relaxing glide with the fore- this position. Your other hand is gently clasping the
arms. With practice, the forearms can be just as sensi- wrist (Figure 1). Repeat this stroke as necessary on
tive as the hands, and offer an equally relaxing experi- both sides.
ence. Start out light and take it slow.
Still clasping at the wrist or hand, pull the arm onto the
Leverage table and use your forearm to glide down the inner
The forearms naturally lend themselves to doing deep- forearm from the elbow to the wrist. As you glide down
tissue work and because the surface area of contact is the forearm, move your other hand to the elbow. Use
larger Auth Method than using your fingers or thumb, the other hand to traction a slight stretch on the inner
you can work more of your client in less time. The fore- forearm (Figure 2). Lighten your pressure as you glide
arms also provide more leverage for deep-tissue mas- over your client’s wrist and drop your elbow into the
sage than the smaller, more fragile fingers, thumbs, palm (Figure 3). Make sure you are using enough oil to
and hands. When practicing the Auth Method, it is es- glide effortlessly. In my experience, the inner forearm
sential to lean into the tissue; it is not necessary to and palm can withstand and enjoy a fair bit of pressure.
push, if you are using your body weight correctly. The Just be mindful to lighten your pressure over the wrist.
forearms are perfect for leaning your body weight into
your client. If the table is low enough, you can just drop Qigong for Better Body Mechanics
your body weight down onto the tissue. Pushing is ex- Using my forearms has saved my hands, but what
hausting and you run the risk of applying too much about the rest of me? Too many therapists quit the pro-
pressure on your client. Instead, drop your body weight fession due to back pain. When I was getting my mas-
onto your client. Your body will naturally drop to the ter’s degree in Chinese medicine, I was introduced to
first layer of tight tissue; it’s like floating. As that layer qigong. Qigong is an ancient Chinese exercise system
of tissue releases, you will drop into the next layer of that couples movement with breath. The movements
tight tissue. Practicing the Auth Method is effortless for are slow and relaxed—the ideal pace for massage. The
the practitioner. The less energy you expend during a qigong stance is grounded and strong in the lower
massage, the more massages you can do a day, and the body, like a tree trunk rooted to the earth, and relaxed
more energy you have for your life. Just remember, and fluid in the upper body like tree branches flowing
when doing deep-tissue work use body weight, not in the wind. The legs are spread wide with the knees
force, and go slow. Feel for what your client is feeling; bent. The back is straight and the shoulders relaxed.
work the most superficial layer of tight tissue first. Your The arms are loose like wet spaghetti. The Auth
client will thank you for it. Method teaches the following simple qigong exercise
for developing good body mechanics while working.
Table Height
For a medium-sized body, I recommend working with a Prayer Wheel
table that comes to the height of the second or third One of the main stances in the Auth Method is the
metatarsal joint of the finger. If the client is overweight lunge stance. To learn the lunge stance and to encour-

Terra Rosa e-magazine, No. 7 (March 2011) 19


Forearm massage

Figure 2
Figure 1
age a straighter back, relaxed upper body, and
grounded lower body while working, try the qigong ex-
ercise Prayer Wheel.

Lower Body
Find some empty space outside or in your home and
put on some comfortable clothing. Stand with your feet
hips-width apart and slightly bend your knees. Shift
your body weight into your right leg and turn your left
foot out to a 45-degree angle. Shift your body weight
back into your left leg (left knee is bent) and step your
right foot comfortably forward. Your stance will be
about 75 cm wide. Inhaling, bend the right knee,
straighten the left knee, and shift your body weight into
your right leg. Keep your back straight and your hips
low. As you move forward, keep your hips on the same
horizontal line, not moving up and down. Exhaling,
straighten the right leg, bend the left, and shift your
body weight back into your left leg. Continue this back-
and-forth motion with the breath. Imagine growing
roots out the bottom of your feet and inhaling up
through the soles of your feet. This image will help keep
you grounded in your lower body. When this motion
feels comfortable, move on to incorporate the upper
body.

Figure 3

Terra Rosa e-magazine, No. 7 (March 2011)


Forearm massage

Upper Body conscious of your client’s breath. Relaxation happens


Inhaling forward, float the arms up with loose wrists with the breath. The breath moves and circulates. If our
until they are shoulder-height in front of you. Exhaling clients are not breathing freely, they are like a stagnant
back, float the arms back toward your shoulders and swamp, instead of a flowing river. Your massage will be
down along your sides, keeping your shoulders relaxed much more effective if your client is consciously
through the entire movement. This makes a circular or breathing. I know right away if my client isn’t breathing
wheel shape with the arms, hence the name Prayer correctly because I start trying to breath for them. This
Wheel. Keep your shoulders relaxed. Practice this exer- obviously doesn’t work. We can’t do it for our clients.
cise on both sides, making 10 or more Prayer Wheels. Encourage your client to breathe—even if it means
This exercise is great for teaching therapists to stay breaking a relaxing silence. It is essential. Encourage
grounded in the legs and relaxed in the upper body. them to inhale through the nose and exhale through the
With time, it also slows the therapist down and re- mouth. Ask your client to breathe under your hands or
minds them to breathe. into an area that you are working on that is blocked.
Use the client’s breath as a helpful and internal tool for
Checking In deeper release.
When it comes to good body mechanics, it’s very im-
portant not to forget yourself and your needs while giv- Advantages
ing a massage. Check in with yourself while working. It takes time to develop sensitivity in your forearms,
Are you breathing? Is your back straight? Are your but once achieved, there are so many advantages, in-
shoulders relaxed? Could you be doing less and getting cluding more durability for increased career longevity
the same or better results? This is your time, too. At the and productivity, better leverage for leaning into the
end of the massage, if our clients are more relaxed but tissue and saving you energy, and increased area of
we are more tense, we have only succeeded in transfer- contact so you can work more of your client in less
ring tension rather than reducing it. time.

Breath Happens
The same way you are conscious of your breath, remain

Terra Rosa e-magazine, No. 7 (March 2011) 21


Forearm massage
About the author

Shari Auth is a licensed massage


therapist and acupuncturist, and is
certified in the Rolf method of struc-
tural integration. She is the creator
of the Auth Method and has a full-
time practice in New York City. Auth
teaches continuing education work-
shops and has a DVD, Auth Method
of Therapeutic Massage: A Guide to
Using the Forearms. For more infor-
mation, please visit www.authmethod.com

Auth Method Instructional DVD


Learn to massage without taxing the delicate joints of the hand
and increase career longevity. Learn to give a full body massage
using the forearms as the primary tool. These techniques can
be used for both deep tissue work and light circulatory mas-
sage. This DVD teaches simple qi gong exercises for better body
mechanics, as well as, how to use body weight to engage tissue,
depth of pressure, speed of strokes and developing sensitivity
in the forearms.

Treat yourself and spread the wealth: Get a massage before it's too late! (Photo by Gil Heldley).

Terra Rosa e-magazine, No. 7 (March 2011) 22


Advanced-Trainings.com’s
Advanced Myofascial
Techniques Workshops
Cairns, the Gold Coast, Melbourne, &
Sydney. Throughout October 2011

What to expect
The Advanced Myofascial Technique seminars present Whether you have years of experience or come with
practicing manual therapists with highly effective and fresh eyes, our workshops are designed to help you:
little-known techniques, tests, and procedures, which  Learn specific techniques for common structural and
can be easily incorporated into your existing practice. functional complaints
Drawing on a wide range of disciplines, the focus is on  Relieve pain, restore lost function, and get lasting re-
unusual, interesting, and fresh approaches that both sults
 Be more precise in working with specific tissue types
expand your repertoire of techniques, as well as inspire and body layers
creativity and innovation.  Combine more subtle indirect work with deeper direct
work
Two‐Day Workshops  One‐Day Specialty Workshops   Track subtle psycho-physiological and nervous system
Neck, Jaw & Head  TMJ; Headaches  responses
Pelvis, Hip, & Sacrum  Sciatica & Disk Issues   Work more sensitively, safely, and comfortably at very
deep levels.
Leg, Knee, & Foot  Advanced Knee Issues 
Advanced-Trainings.com is associated with the Rolf In-
Take 1, 2, or 3 days of training. Each event combines a stitute® of Structural Integration, Boulder Colorado, USA
2-day training with an optional 1-day specialty class: and is approved by the National Certification Board for
Two-day workshops are highly recommended as prereq- Therapeutic Massage and Bodywork as a Continuing Edu-
uisites for the following 1-day specialty workshops. Al- cation Provider in the USA. These workshops are pending
ternatively, all 2-day workshops are available on DVD approval for Continuing Education Credits by the AAMT
at a discount to registered participants. and AMT in Australia.

All workshops combine:


 In-person demonstrations and individualized hands-on
supervision
 State-of-the-art instructional materials, including 3D
Interactive Anatomy software
 A detailed course manual/note organizer with photos of
techniques covered
 Videos of instructor demonstrations available for post-
workshop practice and review.

The Instructors
Advanced.Trainings.com Faculty members Larry Koliha and
Bethany Ward will be presenting on fascia research and
myofascial therapy at the 2011 Association of Massage
Therapists (AMT) national conference, as well as teaching
workshops in Australia throughout October. Both Larry and
Terra
Bethany are RosaAdvanced
Certified e-magazine, No.Rolf
Rolfers™, 7 (March 2011)
Movement® 23
Practitioners, and teach at the Rolf Institute of Structural
23
Integration.
An Interview
with
Dr. Jean
Jean--Claude
Guimberteau
Dr. Jean-Claude Guimberteau is a hand surgeon and the architecture of the connective tissue. Can you
author of the famous film Strolling Under the Skin. The film give us a background?
shows for the first time the most fascinating images of living
fascia. Using a special camera, Dr. Guimberteau showed that I was seeking a technical procedure to reconstruct
there is a unique architectural system in human and that the flexor tendons, when I came upon the sliding system
tissue continuity is global. He believes that sharing these that I termed the MVCAS (Multimicrovacuolar Colla-
discoveries will incite people to get into this scientific world genic Absorbing System). I first used a microscope to
exploring living matter organization. His work become well
understand how it was working.
known in bodywork when his film was shown in The First
Fascia Congress in Boston in 2007. He then realised a sequel This tissue, which neatly ensures the efficacy of gliding
Skin Excursion at the 2nd Fascia Congress in Amsterdam
structures and their independence, is composed of a
2009, and his 3rd film Muscle Attitudes at the 7th Interdisci-
network of collagen fibrils whose distribution seems to
plinary World Congress on Low Back & Pelvic Pain in LA
2010. Now, we have a privilege to interview him for Terra be totally disorganized and apparently illogical at a first
Rosa e-mag. sight. This impressed me because my Cartesian mind
could not come to terms with the idea of chaos and effi-
Dr. Guimberteau, your work has provided bril- ciency co-exists perfectly. This was the starting point
liant images of living connective tissues that we for an intellectual voyage that took me far from the
haven't seen before, and inspired many of man- beaten track and off into the largely unknown world of
ual therapists who are closely working with the fractals and chaos.
skin and manipulating connective tissues.
What led you to the discovery and study of the * Note: Fractal is a geometric pattern that is repeated at
every scale. If you zoom in on a fractal pattern it will look
similar or exactly like the original shape. This property is
called self-similarity.

Chaos in mathematics is "the irregular, unpredictable be-


havior of deterministic, non-linear dynamical systems"
which is used to describe objects that are apparently disor-
dered, however there is an underlying order in apparently
random pattern.

How do you start making film of live connective


tissues? Why this is not done previously?

First we start taking pictures during surgical tendon


reconstructive procedures. The photos were taken dur-
ing a planned surgery, thus there is a time limit of 30

Pictures taken from Strolling under the Skin, courtesy of Endovivo.

Terra Rosa e-magazine, No. 7 (March 2011) 24


Interview with Dr. Guimberteau

Pictures taken from Muscle Attitudes, courtesy of Endovivo.

All the tissues observed were developed within the


framework of multifibrillar architectures and resulting
minutes so that the surgical team were not disturbed from the intertwining of fibrils : there are the mi-
during their work. Surgeries were performed either with crovacuoles which in fact are intra fibrillar micro vol-
a garrot (a stick used for tightening a bandage, in order ume, and which are the basic elements combining a
to compress the arteries of a limb), which allows rather polyhedral fibrillar frame enclosing multiple micro
dull observation in terms of colour, or without a garrot vacuolar spaces of varying sizes between 10 μm and 100
which gives more lively images but is disturbed by blood μm, with a gel inside.
extravasation (leakage). Then after, we extend to skin
* Note: 1 μm or micro meter is a millionth of a meter.
flaps and abdominal surgeries.
These microfibrils have a diameter of about ten to
I don’t know why this has not been done previously but
twenty microns and are made up predominantly of col-
some of my experiences can explain that. For many
lagen type I and III. By intertwining, in an irregular
years, I have performed microsurgery transplants and I
fractal manner, they determine the volume of the micro-
have used microscope very often. Moreover, surgery is
vacuole, which is filled with a glycosaminoglycan gel. By
performed without bleeding using a tourniquet, so the
accumulation and superposition, these multi micro-
observation is easier, and finally I love to understand
vacuolar polyhedral patterns will build an elaborate
the processes that have been going on.
form.
What are the challenges in making these pic-
In ‘Muscle Attitudes’, you proposed that there is
tures using endoscopic camera?
a global tissue continuity around or inside the
The main challenge is to understand how tendon and muscle. Can you tell us the implication of this.
skin are sliding, but also all these fascinating images
The essential implications of these microsopic and en-
have to be shared. They look so beautiful with their aes-
doscopic observations are the fibrillar continuity. There
thetics, colours, varied and sparse shapes. Sharing them
is no break in the tissue continuity, be it within muscle,
seems to be a good way to arouse the interest of people
tendons, or around the arterial and venous structures
today.
and the structures surrounding the adipocytes. All these
What is the scale (magnification) we are looking structures are formed in the same manner and are con-
at? tinuous.

Generally magnification is 25 times. We have discovered the same continuity of tissue within
the sub-cutaneous tissue in Strolling Under the Skin,
In ‘Strolling Under the Skin’, you described the the epidermis and dermis and the muscles. The concept
Sliding system and architecture of the connec- of the organisation of living matter into stratified layers,
tive tissue that looks chaotic in organisation hierarchical layers of sheaths, lamellae and strata can-
composed of microvacuoles that are able to not satisfy an anatomist who studies precise, endo-
adapt itself to various stress. Can you briefly scopic, functional anatomy. Even though they may be of
describe about this microvacuole form? different colours, textures and shapes, they are all

Terra Rosa e-magazine, No. 7 (March 2011) 25


Interview with Dr. Guimberteau

Pictures taken from Muscle Attitudes, courtesy of Endovivo.

linked to each other. This is a global tissue concept. covery and new technology will be the key point for this
development.
Which part of your work would you suggest that
could be the most important relevance for man- What are your current projects?
ual therapists?
We continue to explore using HD (high definition)
I think that our last movie Muscle Attitudes is the most technology and we will soon make a new movie on ten-
appropriate for manual therapists, however Skin Excur- dons anatomy and physiology.
sion gives more detail on the intracutaneous connec-
tions. But for now, we want to show these films and images to
all people because we have to share the beauty of human
The physical links between these contractile and con- living matter thanks to a book and new videos.
nective fibrillar structures from the surface of the skin
to the deep muscle can explain some of the effects of
manual therapy in a rational physiological and non-
controversial manner.

How do you see new technology will bring to the


understanding of connective tissues?

I am sure that in the future the intra-body exploration


will be one of the new frontier in scientific medical dis-

Available from www.terrarosa.com.au


Terra Rosa e-magazine, No. 7 (March 2011) 26
Sat-Sun Sat-Sun Sat-Sun
June 4 & 5 July 9 & 10 August 6 & 7

Terra Rosa e-magazine, No. 7 (March 2011) 27


27
Fundamentals of
Clinical Orthopedic Massage
By Joseph E. Muscolino, DC

Fundamentals
“It might seem that the world of
continuing professional education
It might seem that the world of continuing professional
education (CPE) for clinical orthopedic massage offers a (CPE) for clinical orthopedic mas-
dizzying array of treatment technique options. But when sage offers a dizzying array of
we look a little closer, we see that most of these tech-
niques are variations of a few fundamental treatment treatment technique options. But
approaches. The four fundamental treatment ap- when we look a little closer, we see
proaches that form the foundation of most every treat-
ment technique in the world of CPE are hydrotherapy,
that most of these techniques are
soft tissue manipulation strokes, stretching, and joint variations of a few fundamental
mobilization. Following is a brief overview of these fun-
damental components of clinical orthopedic massage.
treatment approaches. ”
Hydrotherapy causes vasoconstriction of local arteries; and it is an an-
algesic that decreases pain because it can numb pain
The term hydrotherapy literally means water therapy receptors in the region of application. Heat hydrother-
(hydro means water), and was named because water is apy acts to relax and loosen musculature and other soft
used to apply hot and/or cold therapy to the client. Al- tissues where it is applied. Heat accomplishes this both
though water is not the only means of transferring heat by relaxing nervous system control of muscle tone and
and cold, the term hydrotherapy is generally used as a by loosening fascial tissues.
blanket term for all techniques that involve hot and
cold. Cold hydrotherapy (also known as cryotherapy) There are a number of options when it comes to hydro-
usually involves the use of ice or ice packs and has anti- therapy application for orthopedic work. Cold can be
inflammatory and analgesic effects (Figure 1). Ice is an used to numb a region before deep tissue work is done.
anti-inflammatory that decreases swelling because it By lessening sensitivity, the client will likely allow
deeper pressure to be used than otherwise might have
been comfortable or possible. Cold can also be used af-
ter deep tissue work to decrease swelling that might al-
ready have been present, or to prevent swelling from
occurring that might result from the deep pressure. Al-
though heat can be used to “soften” taut tissues before
engaging in deep tissue work, it is especially valuable to
use heat before stretching or joint mobilization is per-
formed.

Soft Tissue Manipulation

The second fundamental treatment technique approach


is soft tissue manipulation. Soft tissue manipulation is a
Figure 1. A cryocup® is an excellent way to apply cold therapy
broad term that can be used to incorporate most all
(cryotherapy).

Terra Rosa e-magazine, No. 7 (March 2011) 28


Orthopedic massage
types of hands-on
massage strokes.
These include cross
-fiber, compression,
and deep stroking,
to name a few. The
benefits of each
stroke vary depend-
ing upon the condi-
tion being treated
and the individual
preferences of the
client receiving the A B
work. What is com-
Figure 4. The sequence of steps for contract relax (CR) stretching
mon to all these
protocol for the right lateral flexor functional group of the neck. A,
strokes is the intro- The client contracts the target musculature against resistance by the
duction of pressure therapist. B, The client then relaxes and the therapist stretches the
into the client. Al- client into left lateral flexion. Further repetitions are usually initiated
Figure 2. The table needs to be low when from the position of stretch attained at the end of the previous repeti-
though deep pres-
applying deep pressure to the client’s tion.
back. sure is not always
the appropriate or that the client is literally under us (Figure 2). A good
best treatment option for every condition or every cli- guideline is to have the top of the table at the height of
ent, it is an extremely valuable tool for the clinical or- our knee. Of course, if we are using our elbow or fore-
thopedic massage therapist. When called for, it is criti- arm as a contact, the table can and should be higher.
cally important that we can generate deep pressure Electric lift tables are not only convenient, they are ex-
without excessive effort. Fundamental to this is the tremely valuable because they allow us to optimize the
quality of our body mechanics. table height by simply pressing on a foot pedal. This
allows for optimal quality of work throughout the ses-
There are many aspects to optimal body mechanics; sion, which translates into therapeutic success.
however it is likely that the most important one is gen-
erating pressure from our core (trunk and pelvis). To When we are seated and working the supine client’s
accomplish this, our core must be positioned behind neck, positioning our core behind the stroke involves
and in line with the stroke. laterally rotating the arm at the glenohumeral joint and
placing our elbow inside our anterior superior iliac
When we are standing and pressing into the “top” sur- spine (ASIS). We then generate pressure by leaning in
face of the client (the body surface that is oriented to- from our core. This core pressure translates through our
ward the ceiling), we need to place our trunk over the forearm, hand, and then into the client (Figure 3).
client; this requires the height of the table to be low so
Stretching

The third fundamental approach of orthopedic work is


stretching. When appropriately applied, stretching is a
critically important aspect of our orthopedic massage
session. Because it is most effective when the client’s
tissues are already warmed up, stretching is best per-
formed after heat and/or massage are done. Logistically,
this means that stretching is usually incorporated into
the treatment toward the end of the session. There are a
number of different stretching protocols that can be
done. Common to all stretching techniques is that soft
tissues are lengthened. This can aid in relaxing muscle
tone and breaking up soft tissue fascial adhesions.
Figure 3. Placing the elbow inside the anterior superior iliac spine
(ASIS) allows for pressure generated from the core to translate
through the forearm and into the client.

Terra Rosa e-magazine, No. 7 (March 2011) 29


Orthopedic massage

A B
Figure 5. The sequence of steps for agonist contract (AC) stretching
protocol for the right lateral flexor functional group of the neck. A,
The client actively moves into left lateral flexion. B, The client re-
laxes and the therapist stretches the client farther into left lateral
flexion. Further repetitions begin from the same starting position.
Figure 6. Joint mobilization of the neck. One vertebra is pinned and
the superior vertebra is moved relative to it. No thrust is ever ap-
In addition to the physical lengthening component of
plied with joint mobilization!
stretching, advanced stretching techniques utilize an
additional component; they add a neurologic inhibition
that relaxes muscle tone. The generally accepted basis “Because joint mobilization is so
for contract relax (CR) stretching (also known as post-
isometric relaxation [PIR] stretching or proprioceptive
precise and has such powerful ef-
neuromuscular facilitation [PNF] stretching) is inhibi- fects, it is especially important to
tion of musculature due to the Golgi tendon organ re-
flex. Agonist contract (AC) stretching (the basis of
attend hands-on workshops when
Aaron Mattes’ active isolated stretching [AIS] tech- first learning this skill.”
nique) is based upon the reciprocal inhibition reflex
(Figures 4 and 5).
(becoming hypermobile). Because these hypermobile
Joint Mobilization levels increase their motion, the tight joint level can
The fourth fundamental treatment approach of clinical avoid being stretched.
orthopedic massage therapy is joint mobilization. Joint Joint mobilization stretching is very specific so we use
mobilization is rarely utilized by massage therapists. only a very small range of motion to apply the stretching
This is unfortunate because when appropriately applied, force; and we apply the mobilization stretch for only a
especially to the spine, it is such a powerful and effective second or less. It is critically important to point out that
treatment tool. In essence, joint mobilization can be no thrust is introduced during joint mobilization. Doing
looked at as a very specific and focused form of pin and so would constitute a high velocity joint manipulation
stretch technique. Using the neck as an example, we pin that is not within the scope of massage therapy. Joint
(stabilize) one vertebra, and then we move the vertebra mobilization is always applied slowly and evenly.
above (along with the rest of the cervical spine above
and the head) relative to it. This directs the stretch to Putting It All Together
the specific segmental joint level that is located between
them (Figure 6). Joint mobilization is extremely impor- Competent clinical orthopedic massage therapy involves
tant because no other stretching protocol can target a many things. First, it requires that we possess assess-
specific joint level of the spine. All other stretching tech- ment skills and the critical thinking necessary to apply
niques (including neural inhibition stretches) apply them to form an accurate assessment of the client. Next,
their stretching force across the entire region of the we must have a tool box of treatment techniques that we
spine where they are being employed. Consequently, if can use to treat the client; along with the critical think-
one joint level is tight (hypomobile), then adjacent joint ing needed to choose among these treatment tools. As a
levels usually compensate by increasing their motion rule, our treatment should always be specific and tai-

Terra Rosa e-magazine, No. 7 (March 2011) 30


Orthopedic massage
at http://learnmuscles.com/Jt%20Mob%20of%
“The addition of these tools to 20Thor%20Region%20-%
your therapeutic tool box will in- 20MTJWI09_BodyMechanics.pdf, and Joint Mobiliza-
tion of the Low Back at http://learnmuscles.com/joint%
crease not only your therapeutic
20mobilization%20of%20the%20low%20back%20-%
success, but the success of your 20WI%2009.pdf.
practice as well!” All articles cited can be found on the Articles page of the
lored to the client who is on the table; treatment should author’s website: www.learnmuscles.com.
never be applied in a cookbook manner. However, it is
generally wise to follow the following guidelines: When
we are looking to loosen taut soft tissues (including tight Figure credits
musculature) with orthopedic work, use a combination
Figures 1, 3, and 6 are reprinted with permission from
of heat, massage, stretching, and joint mobilization.
Muscolino, J. Advanced Treatment Techniques for the
Further, the best order to apply these techniques is heat
Manual Therapist: Neck. Baltimore, MD: Lippincott
and/or massage first, followed by stretching and then
Williams & Wilkins (forthcoming)
joint mobilization.
Figures 2, 4, and 5 are reprinted with permission of the
Acquiring New Skills
massage therapy journal (mtj)
If you do not currently utilize stretching (especially ad-
vanced stretching techniques) and joint mobilization,
you may want to consider adding them to your practice. About the author
However, as with all new techniques, it is best to be-
come proficient with them before trying them out on Dr. Joe Muscolino has been a massage therapy educator
your clients. Although these techniques can be learned for 25 years. He is the author of eight
from books, journal articles, and video, in-person hands major publications with Mosby of El-
-on workshops with personal attention by a skilled in- sevier, including The Muscle and Bone
structor is recommended for advanced stretching tech- Palpation Manual, with Trigger
niques. Because joint mobilization is so precise and has Points, Referral Patterns, and Stretch-
such powerful effects, it is especially important to attend ing. He is also the author of body me-
hands-on workshops when first learning this skill. The chanics, a column article in mtj
addition of these tools to your therapeutic tool box will (massage therapy journal), as well as
increase not only your therapeutic success, but the suc- an upcoming book on advanced neck
cess of your practice as well! treatment techniques for the manual therapist
(publishing Fall of 2011, Lippincott Williams Wilkins
For more information on effective body mechanics for publisher). He runs numerous continuing education
deep pressure, see Work Smarter, Not Harder at http:// workshops for therapists and instructors, including a
learnmuscles.com/final%20CEcourse%20WI06.pdf. Certification series on Clinical Orthopedic Massage
Therapy (COMT). And he has a private chiropractic
For more information on advanced stretching tech-
practice in Fairfield, CT., USA. For more information,
niques, see Stretch Your Way to Better Health at http://
visit his website at www.learnmuscles.com.
learnmuscles.com/stretch%20your%20way%20to%
20better%20health-%20FA06.pdf.

See also Advanced Stretching: Using Neural Inhibition


to Enhance the Stretch, Parts 1 and 2 at http://
learnmuscles.com/MT_09_2010_Advanced_Stretching
-1.pdf and http://learnmuscles.com/
MT_11_2010_Advanced_Stretching_2.pdf.

For more information on joint mobilization of the spine,


see Joint Mobilization of the Neck at http://
learnmuscles.com/originals/body%20mechanics%
20FA07.pdf, Joint Mobilization of the Thoracic Region
Terra Rosa e-magazine, No. 7 (March 2011) 31
Deep Tissue Massage,
Stretching &
Joint Mobilization
Sydney, Hobart & Brisbane —
July 2011

Approved AAMT CPE & AMT CEU

Intermediate & Advanced Tech- Deep Tissue Massage, Stretching &


niques for the Neck Joint Mobilization
The focus of these workshops is to learn how to work clini-
Sydney: 2-3 July 2011, Hobart: 9-10 July 2011, Brisbane: 12-
cally utilizing deep pressure, basic and advanced stretching,
13 July 2011
and joint mobilization techniques; and to do so more effi-
The first day will cover body mechanics for deep tissue work ciently by working from the core with less effort so you do not
and stretching for the neck, including: How to use your core to hurt yourself. In effect, how to work smarter instead of
easily perform deep work to the neck, How to safely massage harder!
the musculature of the anterior neck, and How to perform
Working clinically and efficiently can be done simply by
multiplane stretching of the neck.
learning a few basic guidelines of proper technique that Dr.
The second day covers Advanced Stretching Techniques and
Joe Muscolino will show you. An invaluable workshop for
Joint Mobilization. Dr. Muscolino will describe and demon-
anyone who does sports, clinical, and/or rehab. work!
strate: How and why CR (also known as PNF), AC, and CRAC
stretching techniques work and advanced safe joint mobiliza-
tion techniques. Dr. Joe Muscolino

Intermediate & Advanced Tech- Dr. Joe Muscolino is a licensed chiropractic physician and
has been a massage therapy educator for 25 years, with exten-
niques for the Low Back & Pelvis sive experience in teaching kinesiology and musculoskeletal
Sydney: 4-5 July 2011 assessment and technique classes.
Dr. Muscolino has authored 8 major publications with Mosby
This workshop is structured similarly to the neck workshop. of Elsevier Science, including the best selling The Muscle and
The first day will cover body mechanics for deep tissue work Bone Palpation Manual, with Trigger Points, Referral Pat-
and stretching for the lower back & pelvis. The second day will terns, and Stretching. He also writes the column article body
focus on advanced stretching and how to safely perform joint mechanics for the AMTA's massage therapy journal.
mobilization.

Approved AAMT CPE & AMT CEU

Don’t miss this unique experience to


train with Dr. Joe Muscolino.

Book Early as Places are Limited


To register your interest & for more
information, visit
www.terrarosa.com.au
Terra Rosa e-magazine, No. 7 (March 2011) 32
32
The Massage Project
2011
www.massageproject.com
Joanne Schoenwald
What started as a fanciful idea... (wouldn’t it be great to So far, there have been two
have a massage every day?)… quickly turned into The very exciting changes. The
Massage Project. The concept is simple: have a massage first relates to my thoracic
every day with the hope and agenda that it will improve spine and, by extension, my
my health. right arm (and occasionally
the left one as well), which
I was born anaemic, with serious food allergies and has been going numb for
then began tearing ligaments in my ankle from 5 years Joanne and Alwyn
the past four years. It’s al-
of age. But things took a sharp downward turn for me ways been assumed that it was a structural issue to do
at the age of 15, with crippling sciatica that seemed un- with the degeneration in my thoracic spine, as it’s de-
solvable and left me with a recommendation for sur- pendent on positions. For example, when lying in bed
gery to have the sciatic nerve cut. This was followed by on my left side, often my (right) arm will go numb, but
a diagnosis of Schumann’s disease in my thoracic spine. if I roll over onto my right side, it might release.
All these spinal issues meant that my once very active (Unless it’s really bad, in which case I have to get up
life was changed forever. Skip forward another 20 years out of bed and walk around to ‘unlock’ whatever is go-
and the joyful day when I woke up to find myself ing on.) It will also go numb (at times) if I’m lying on
‘better’ hasn’t yet arrived. I’ve been diagnosed with hy- my back, such as in the dentist’s chair. (Carpal tunnel
pothyroidism, fibromyalgia, rheumatism, sero-negative syndrome was ruled out by electric tests.)
arthritis, chronic fatigue syndrome, and more. Now,
I’m 35 and would like a baby with my husband and a Prior to The Massage Project, my arm was going numb
recent test returned a ‘low egg count’. Time is definitely almost every night (say, 29 out of 31 days a month). In
not on my side. the first month of The Massage Project, that number
dropped to just 9 nights in January. It’s looking slighter
It was time to do something radical. higher than that for February, but still a long way short
I am a former massage therapist and my husband, Al- of every night. This has been very exciting because no
wyn Blayse, is a physiotherapist. We both have always therapy that I’ve had to date has led to any sustained
been convinced of the value of massage but we haven’t improvement.
found anything yet about anyone who’s had a massage The second exciting change that we’ve seen is that I lost
every day for a prolonged period of time to study any 3 kilograms (6.6 pounds) in the first month. Fluid, as-
changes. We are both equally as excited about the study sumedly, but a significant development nonetheless.
of this experiment as we are about the health benefits
for myself. We’ve been keeping a blog about the project, including
information on these sorts of changes, different mas-
We began the project on January 1, 2011 and I’ve had at sage styles and reviews at www.massageproject.com.
least 30 minutes of massage every day, either from a We hope that it will become a resource for those in the
qualified massage therapist or from my husband health care fields and especially to those training,
(who’ll be the first to admit that physios aren’t trained studying and working in the massage profession.
in massage, but he does a pretty good job). And on one
occasion, when I was stuck for a massage, I spent 32 Please do stop by and say hello or join our Facebook
minutes in a massage chair in a shopping centre, which page
I then reviewed on our website.

Terra Rosa e-magazine, No. 7 (March 2011) 33


Tai Chi
Intervention for
Fibromyalgia
Ramel Rones
"When you feel pain, MOVE it
away." - Ancient Chinese prov-
erb
This article will give a basic overview of what I wit-
nessed during the 12-week study, “Tai Chi Intervention
for Fibromyalgia" at the Tufts School of Medicine.

Over the past eight years I was given the opportunity to


collaborate with Tufts School of Medicine researching
the philosophy of Tai Chi and its effects on both arthri-
tis of the knee and Fibromyalgia. I was asked by one of
the researchers at Tufts School of Medicine to design
and implement an intervention for both debilitating
diseases.

In this short article I will focus on the benefits, which


were produced from these specific principles and tech-
niques using Tai Chi philosophy.

About Fibromyalgia

Fibromyalgia is a Rheumatic condition. Fibromyalgia is tient’s health to spiral downward.


a disorder causing aching muscles, sleep disorders, and
fatigue associated with raised levels of the brain chemi- Benefits From Tai Chi—a 12 week Study
cals that transmit nerve signals to the body. Fibromyal-
gia can lead to depression and to social isolation. The The first benefit I witnessed was patients, one by one,
constant chronic pain affects people physically, men- coming out of their depression. Within three to four
tally and socially. The disorder affects an estimated 10 weeks into the 12-week study, I saw changes happen-
million Americans, but it occurs most often in women. ing. Women start dressing up, using cosmetics, and
getting their hair styled.
Many of the individuals who suffer from Fibromyalgia
experience debilitating pain, which immobilizes their I understand from these patients that they started go-
daily physical abilities. When you lose physical inde- ing out more, taking part in more social events. Over
pendence, it often leads to depression. When people time and practice of the mind-body program, many
are depressed, they will often overeat and gain weight patients actually started inspiring other people such as
quickly. The stress resulting from the pain, depression, family and friends. This new mood is due to their
and isolation of Fibromyalgia will often cause the pa- achieving physical independence as well as being in a
positive support group with emphasis on physical and

Terra Rosa e-magazine, No. 7 (March 2011) 34


Tai Chi for Fibromyalgia
and a positive attitude.

The 12-week program

Many people invest most of their time doing the Yang


side of exercise such as resistant or cardiovascular work
outs. But the program I designed mainly focuses on
flexibility, deep breathing and meditation while evok-
ing spirituality, which is more of the Yin side of exer-
cise.

In the program, patients spend a lot of time in various


postures to achieve better flexibility to free the skeleton
from being a prisoner of the soft tissue. My goal was to
mental ability for two one-hour sessions for 12 weeks. move each individual at least two to three numbers
down my scale of flexibility through the nine body
I half joke some times that we are a mind-body support markers, the ankles, quads, hamstrings, groin, outer
group for Fibromyalgia, which is a little different from hips, hips, lower back, shoulder girdle and neck.
your typical support group which most of the time only
talks. I am a strong believer in a “doing” support group “Having Power” Place
with emphasis on physical activities and meditation,
To my surprise most patients moved three and more
which I believe works better than only talk. I do think
numbers down my flexibility scale. The improved flexi-
that a combination will actually give more individuals
bility allowed individuals to enjoy life even more be-
the best of both worlds.
cause they were able to balance the new strength with
Strength Benefits flexibility. Patients were much better than they were
before. They were in a new place, which I call “having
The second benefit that I witnessed is strength, in both power.” You can be strong and stiff or you can be flexi-
the lower and upper body. ble and weak, but if you find the balance between the
two you will be powerful.
Strength is important for many reasons including daily
tasks, supporting and nourishing the bones, and also as Our mind-body program was and still is unique in that
a mental booster. There are many practical examples the Qi Gong/Tai Chi movements are trained to both the
for this strength theory. When you have strong legs and left and right. Also, patients were able to do any of the
you know it, your self esteem and confidence is exercises in a sitting position. These two facts alone
stronger. When your upper body is strong and you allowed many individuals to stay with the class and not
know it, you may need to change a shirt size, and when drop out. The idea that everybody can do something
you look in the mirror you will see more defined shoul- created an atmosphere of empowerment among all the
ders. You will feel good about yourself. Your confidence patients.
and attitude will change to a more positive one.
It amazes me how far patients will go if you just give
Strength built up over the 12-week program allows in- them a small task to make them part of the solution for
dividuals to start doing daily physical performance that their own disease. The intervention definitely empow-
we, healthy people, take for granted. Prime examples ered them. I have witnessed the positive chain reaction
are: climbing stairs, carrying groceries, or holding your of this principle reaching great places, which I am al-
children or grandchildren. most sure would have been hard to achieve just
through passive care.
It’s important to know that most patients could per-
form some exercises at the beginning of the study. Individuals started to take control and lose weight.
Some could do 10 up and down from a seating position They were happy, looking for old hobbies, which the
on a chair or maybe 30 seconds standing in a horse depression stopped them from doing or picking up new
stance against the wall. But at the end of 12 weeks, 90 ones just to try new things. Some told me that the pro-
percent of the patients could do 30 up and down two gram helped them to cut back on medication because
sets, legs together and legs apart, and three to five min- now they experience less pain and better physical per-
utes stationery horse stance against a wall. This is a formance. This new state of being allowed them to go
huge improvement and a symbol of very strong legs play golf again or play the guitar, or for some even the
Terra Rosa e-magazine, No. 7 (March 2011) 35
Tai Chi for Fibromyalgia
small act of being able to tie their own shoes. The New York Times published an article based on the
study. http://www.nytimes.com/2010/08/19/
I did not anticipate the results from this mind-body health/19taichi.html
approach. I was thinking on a small scale, but I did not
realize that what I considered small is huge for my pa- The DVD, Sunset Tai Chi, which focuses on the short
tients/students. What I did not take into an account is form in the Fibromyalgia study is available through
the positive chain reaction and the power of empower- http://www.terrarosa.com.au
ing the patients/students.

A few years later, I still see at least five patients from About the author
the various groups of research, most of them, at this
point, are my students. They are better than ever and Ramel Rones moved to Boston from Israel in 1983 to
most in some way will admit that they are addicted to study martial arts with renown traditional Chinese
this mind-body world. And they don’t do it every day, Master, Dr. Yang-Jwing Ming. After years of winning
they will fall apart. I tell them that I am exactly the gold medals in China and in the United States, Ramel
same. now focuses his efforts on helping people with situa-
tions such as cancer, arthritis, aging, injuries, and
Journey of Chi kung/Tai Chi program stress. He is a Scientific Consultant of Mind/Body
Therapies at Dana Farber Cancer Institute, and Har-
The Chi kung/ Mind Body/ Tai Chi program is a jour- vard and Tufts Medical Schools, as well as co-author
ney in which you strike a balance between external and of numerous scientific publications. He lectures and
internal work, developing the body and mind, while instructs the techniques of the eastern Internal Arts in
tapping into sources of abundant universal energy, hospitals, institutions, and schools around the world.
such as the earth and sun. In doing so, you will be on In addition to contributing articles to medical publica-
the right path to developing a powerful fighting spirit, tions.
and a better quality of life for you and those around
you.

The New England Journal of Medicine published re-


sults of my 12-week study, A Randomized Trial of Tai
Chi for Fibromyalgia, at Tufts School of Medicine con-
cluding that regular Tai Chi practice can help patients
with Fibromyalgia. The article can be downloaded here
http://www.ramelrones.com/articles/fibromyalgia/
NEJM_RandomizedTrialTaiChiFibromyalgia.pdf

Terra Rosa e-magazine, No. 7 (March 2011) 36


Transitioning your
Bodywork
Art Riggs
Dear Art

“A few weeks ago, I took a great workshop on Orthope-


dic Massage and learned lots of new ways of working.
Now I find that I’m hesitant to try anything, because I
work at a spa and am afraid that the clients will think
the new work is strange and not like it. I’m already for-
getting a lot from the workshop. How do I escape from
this straightjacket?”

Answer

Well, you certainly aren’t alone. Mark Twain once said,


“I’ve had thousands of problems in my life, most of
which never actually happened.” It is amazing how of- for example, or that a client will be unhappy if the ses-
ten I hear concern that trying new work will send cli- sion doesn’t leave all parts of the body equally covered
ents scurrying to more conventional therapists. As a with excess lubrication. In reality, almost all clients will
Rolfer, I had the same thing happen when I studied be grateful for skilful work that pays attention to their
craniosacral techniques and more subtle work. I wor- particular needs, instead of conforming to cookie-
ried that people who expected sharpened elbows and cutter convention.
knuckles would be disappointed and that my long-time
regular clients would wonder if an imposter had taken The key to transitioning to a more creative bodywork
over my practice. Nothing could be further from the style is communication with, and education of, your
truth; my clients loved the new skills, just as yours will clients. A former student got in touch with me a few
appreciate your new techniques, in addition to the re- weeks after taking a deep-tissue class to say that after
laxation work you may normally do. languishing for many months at a spa waiting for walk-
ins, he is now booked every shift. The techniques he
Just as some meat-and-potato people will never appre- learned were certainly useful, but the main reason for
ciate nouveau cuisine, some people might resist new his success was that he took the time before and during
bodywork. However, I think that the advantages of the massage to talk to clients to find out what they
showing an increasingly discerning public your new- wanted to improve in their bodies. He went on to ex-
found skills far outweighs any downside; the rebooking plain to them the benefits of spot work, working slowly
from happy clients and word-of-mouth referrals will be and deeply in problematic areas, scheduling longer
evidence enough. It is far easier to draw clientele who massages to get full-body coverage, and taking enough
return because they appreciate your work than to try to time to also focus on specific areas.
fit your work to your guesses about client tastes.
It is important to find your own sincere way of com-
Many therapists project their own—sometimes incor- municating and transitioning to the ways of working
rect—assumptions about what clients expect. Some that excite you most. The following are a few sugges-
therapists assume any work that approaches intensity tions:
may be considered strange. Many mistakenly assume
that clients don’t want to be bothered in the midst of Gradually transition to your new way of working.
their headrest snooze to be moved for side-lying work, For regular clients, simply say you have some great new

Terra Rosa e-magazine, No. 7 (March 2011) 37


Bodywork transitioning
"The key to transitioning to a
more creative bodywork style
is communication with, and
education of, your clients”
In the end, it’s important to remember that not every
client will see you as the answer to his or her perfect
massage. And that’s OK. But with good client communi-
cation and a desire to do the work you love, your prac-
tice will thrive with clients who see value in your more
specialized work. Good luck, and let me know how it
goes for you.

Art Riggs is the author of Deep Tis-


sue Massage: a Visual Guide to Tech-
things you’d like to try to improve the massage. For new niques (North Atlantic Books, 2007),
clients, build your confidence and communication skills which has been translated into seven
with those whom you feel a good connection and sus- languages, and the seven-volume
pect may be relaxed and open to expanding their experi- DVD series Deep Tissue Massage and
ence, instead of on every newcomer who comes through Myofascial Release: A Video Guide to
the door. Techniques. Art has conducted numerous workshops
Spend a few minutes getting to know your clients. Ex- for health spas and for medical professionals. He
plain that the meter isn’t running until you start the teaches deep tissue massage in the US and around the
bodywork. Educate them about how you work and learn world, including Australia.
about their needs. The session will be more rewarding
for both of you because some connection will have been
established, rather than abruptly diving into the mas-
sage.

Develop your expertise slowly, instead of overnight.


Review your training and specialize on one technique
with those clients who you feel may benefit most. When
comfortable, introduce that technique to a broader array
of clientele.

Find a peer therapist to trade with and refine your


skills. A fear that clients won’t like your new work can
be more than just projections about their preferences.
Sometimes the culprit is simply lack of confidence due
to lack of practice.

Terra Rosa e-magazine, No. 7 (March 2011) 38


Research Highlights
Massage therapy improves lives of people living tions while standing on a rigid platform. Seven of these
with cancer positions ranged from 15 degrees of foot eversion to 15
degrees of foot inversion and 11 positions ranged from
A new study shows simple therapies, such as massage, 40 degrees of external foot rotation to 40 degrees of in-
boost the quality of life and reduce distress symptoms in ternal foot rotation. Pelvic tilt and lumbar lordosis were
cancer patients. The study by the SolarisCare Founda- estimated using a 3D motion analysis system.
tion, was presented at the Clinical Oncological Society of
Australia Annual Scientific Meeting in Melbourne No- Foot pronation and supination did not have a significant
vember 2010. relationship with pelvic tilt and lumbar lordosis. Inter-
nally rotating the legs caused the pelvis to tilt anteriorly
The study found a 14 per cent reduction in symptom and externally rotating the legs caused the pelvis to tilt
distress, with patients reporting improvements in pain, posteriorly. There was no relationship between leg rota-
fatigue, nausea, appetite, sleep, breathing and bowels. tion and lumbar lordosis.
Patients also reported an eight per cent increase per
session in their quality of life, using a scale which meas- The authors concluded that since the effects of pelvic tilt
ures empowerment, depression, anxiety, frustration, on the lumbar spine were only noticeable when pelvic
confusion, coping and relaxation. tilt was exaggerated beyond values seen this study it
seems unlikely that there is a link between induced foot
The researchers measured the quality of life and symp- pronation and an increase in lumbar lordosis.
tom distress of 1244 cancer patients receiving comple-
mentary therapies in addition to the mainstream cancer Placebos work — even without deception
treatment. The therapies were based on: Touch: bowen
therapy, aromatherapy, reflexology, Energy: Reiki, For most of us, the “placebo effect” is synonymous with
pranic healing, Mind: meditation, chi breathing and the power of positive thinking. But a new study rattles
Support counselling this assumption. Researchers at Harvard Medical
School and Beth Israel Deaconess Medical Center
According to lead researcher, Dr David Joske, the re- (BIDMC) have found that placebos work even when ad-
search demonstrates the positive impact complemen- ministered without the seemingly requisite deception.
tary therapies can have on cancer patients. “It’s too
early to know whether these therapies have a real bio- Because such “deception” is ethically questionable,
logical impact or merely create a placebo effect,” Dr HMS associate professor of medicine Ted Kaptchuk
Joske said. teamed up with colleagues at BIDMC to explore whether
or not the power of placebos can be harnessed honestly
“In any case, there’s no doubt that there is an improved and respectfully. To do this, 80 patients suffering from
outcome for cancer patients. I have seen my patients irritable bowel syndrome (IBS) were divided into two
change their mentality to feel empowered about the groups: one group, the controls, received no treatment,
management of their cancer. The research creates a while the other group received a regimen of placebos—
compelling case for integrated medicine.” honestly described as “like sugar pills”—which they were
instructed to take twice daily.
The mechanical relationship between the rear-
foot, pelvis and low-back For a three-week period, the patients were monitored.
By the end of the trial, nearly twice as many patients
There is a perception in bodywork that excessive prona- treated with the placebo reported adequate symptom
tion of feet can result in bilateral foot flare. and in re- relief as compared to the control group (59 percent vs.
sponse, the pelvis will tilt forward, causing an increase 35 percent). Also, on other outcome measures, patients
in the lumbar lordosis. A study from University of Brit- taking the placebo doubled their rates of improvement
ish Columbia, Canada published in Gait & Posture Jour- to a degree roughly equivalent to the effects of the most
nal October 2010, investigated whether foot pronation powerful IBS medications.
induced an anterior tilt of the pelvis and increased the
degree of lumbar lordosis. The study also investigated The authors caution that this study is small and limited
whether foot supination (measured as calcaneal inver- in scope. “Nevertheless,” says Kaptchuk, “these findings
sion) induced a posterior pelvic tilt and a decreased suggest that rather than mere positive thinking, there
lumbar lordosis. may be significant benefit to the very performance of
medical ritual. I’m excited about studying this further.
Participants placed their feet in 18 different foot posi- Placebo may work even if patients know it is a placebo.”

Terra Rosa e-magazine, No. 7 (March 2011) 39


6 Questions to
Robert Schleip
1. When and how did you decide to become a 5. What advise you can give to fresh massage
bodyworker? therapists who wish to make a career out of it?

In my twenties I was studying psychology at Heidelberg Don’t limit your curiosity. Join or start a collaborative
University, being fascinated by the way how mind, body study group in your area. Or start a Journal Club, where
and emotions interact. At that time Gestalt Therapy, Pri- you discuss one or two important scientific papers per
mal Scream, Transactional Analysis, Reichian Therapy month. Invite other experts in your field to speak in your
and Encounter Groups were very popular. However, I town, thereby learning a lot from them and also establish-
became more and more impressed with the great impact ing yourself or your little group as an exchange knob for
of therapeutic approaches like Rolfing or Feldenkrais collaboration and new developments. At least once a year,
which addressed the body directly. Finally I received my go to an international conference in your field or a related
first Rolfing series at the age of 23. It had such deep ef- field, best together with one or two colleagues, and after-
fects on my posture as well as my mental and emotional wards dedicate a time to summarize your most important
makeup, that I wanted to learn about that profound ther- insights from that event to a group of local colleagues.
apy as much as possible.
6. How do you see the future of massage therapy?
2. What do you find most exciting about bodywork
therapy? It is time we step forward from the current landscape of
bodywork ‘schools’, which are oriented around a charis-
The exploration of the dynamics of the bodywide fascial matic founder, and each has a vested interest in training
network. Approximately 7 years ago, after over a decade of students only the basic (and necessarily limited) view-
teaching Rolfing, I entered the field of academic science. points of that school, moreover attempt to selectively find
First as an avid spectator and interrogator. However soon scientific ‘evidence’ to support their theoretical assump-
I immersed myself like ‘Alice in Wonderland’ with total tions as well as self confirming the relative superiority of
awe and wonder, even experimenting some laboratory their modality. While resembling the early developmental
tests with animal’s fascia in my home kitchen. Little did I stages of many sciences several hundred years ago, this
know that this would lead to a fascinating and dynamic social and economic situation does not foster critical ques-
development, that now I only have 1 day left per week for tioning and collaborative developments of new theoretical
my clinical bodywork practice, and being busy with labo- questions as well as practical approaches. Therefore more
ratory and academic science developments during the re- and more professional practitioners are currently taking
maining week. The scientific exploration of fascia as the on a more ‘rational’ attitude, and focusing less on (semi)
‘Cinderella tissue of orthopaedics’, coming from a body- spiritual concepts. They take on clinical reasoning and a
worker’s perspective, has proven to be such a goldmine, more scientific approach of diagnosis and treatment. This
that it is immensely exciting to be part of the current scene is of course a very valuable and also necessary develop-
of international ‘fascianados’ which are hunting and col- ment. However, in my observation, it is often the less in-
laborating in this new field of fascia research. tellectual oriented practitioners that have the most refined
touch skills, mindful presence, empathic intuition and
3. What is your favourite bodywork book? therefore frequently deliver the most profound effects in
their works. It would be a pity, if the increasing intellectu-
Sandra Blakeslee’s ‘The Body has a Mind of Its Own’ , be-
alization of massage therapy results in massage practitio-
ing pretty equal in my esteem to Dean Juhan’s ‘Job’s
ners that are more mechanistic, having similar personality
body’.
like the typical white coat medical doctors who are full of
4. What is the most challenging part of your knowledge, yet lack the ability to listen and to connect
work? with their patients.

Having to learn to say ‘no’ . The increasing popularity of


fascia research and our little group at Ulm university has
resulted in much more collaboration requests than I can
possibly handle.

Terra Rosa e-magazine, No. 7 (March 2011) 40


6 Questions to
Divo Müller
1. When and how did you decide to become a come successful in our prac-
bodyworker? tice and teaching.

I took my first training in neo-Reichian bodywork and 5. What advise you can
massage at the tender age of 21 in 1982. That was the give to fresh massage therapists who wish to
time, when I was deeply searching for something real, make a career out of it?
authentic and meaningful and all the other options like
going to university and study medicine didn’t seem to Beside the skills and techniques, follow the path of the
meet that need. In 1992 I was introduced into Contin- ‘constant dripping wears away the stone’, - presenting
uum Movement through its co-founder Susan Harper or talking about your work wherever you can. Stay con-
and fell completely in love with it. Being part of the first nected to your fellow colleagues and to those who trust
Continuum teachers training with founder Emilie Con- your abilities and support your strengths. In times
rad, I became the first internationally authorized Con- when the road is rough and bumpy remember what you
tinuum teacher in Europe. In cooperation with move- love about the work and the qualities you have to offer,
ment scientists and the recent findings on fascia re- and feed that back into your own heart and soul and
search, I developed my own movement approach, just keep going.
called Bodybliss. In Germany, there are several DVDs 6. How do you see the future of massage ther-
published and a new book will be released in May 2011. apy?
2. What do you find most exciting about body- Beside the values on the physical body of massage ther-
work therapy? apy in rehabilitation or health care, I believe that mas-
To share the feel and somatic experience movement sage therapy will become even more important in these
with my clients. The honesty about the expression of a modern and stressful times, where the World Health
body and the moving intelligence embedded in bones, Orgainsation predicts a threatening increase of psycho-
soft tissues and fluids. I find it over and over exciting to logical disorders like depression and burn out. The
be part of a healing process whether it’s primary taking healing power of a sensitive touch and the loving pres-
place in the physical body or unfolds in the emotional ence of a practitioner are immensely needed qualities
or psychological process of a person. To facilitate the to ‘talk’ directly, yet non-verbally into the soft animal
capacity to evolve into a mature human being through body. Whether it’s a deep tissue massage or the light
bodywork as an ongoing sensuous embodiment and touch of a cranio-sacral practitioner – the immediate
foster the integrity of body mind and soul, makes my effects on the mammalian nervous system are of enor-
heart sing. mous benefits and effective strategies for the modern,
touch deprived and stressed out people.
3. What is your favourite bodywork book?

Dean Juhan’s ‘Job’s body’ and Sandra and Matthew


Blakeslee’s ‘The Body has a Mind of Its Own’.

4. What is the most challenging part of your


work?

Together with Robert Schleip we teach a two year basic


training in my method and we are into building a net-
work and a community of bodybliss practitioners, go-
ing around the world to spread the news and the values
of the work. Just to ‘stay the course’ in the daily de-
manding routine of an office and the organisational
desk work is challenging, so that as the network be-

Terra Rosa e-magazine, No. 7 (March 2011) 41

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