Terra Rosa
Bodywork e-News
Issue 2, December 2008
Contents
01 Editorial
02 Integrating Diagnosis and Treat-
ment for Bodywork—Kit Laughlin
05 The Spinal Engine — Erik Dalton
09 An Integrated Approach to Re-
habilitation of Leg Injuries. Part
1.—Art Riggs
18 Unravelling the Mysteries of Un-
winding
27 Lipoedema —Kristin Osborn
31 Stretching for Plantar Fasciitis
33 Rwo Shur, Chinese Foot Reflex-
ology
36 The Passivattiva Technqiue for
the Legs—Maurizio Ronchi
46 Research Highlights
47 Six Questions to Whitney Lowe
48 Six Questions to Diana Haynes
Terra Rosa
www.terrarosa.com.au
The Source for Massage Information
Disclaimer: The publisher of this e-News disclaim any responsibility and liability for loss or damage that may result from
articles in this publication.
www.terrarosa.com.au
Welcome to the second issue of Terra Rosa Bodywork e-
news, our new free electronic news magazine dedicated to
bodyworkers. It has been a great year in 2008, beginning
with a great start, economy is strong and flowing. However at
the end of this year, we see the drop in the world's economy
and our Australian dollar is falling sharply. Inevitably we have
to readjust our prices several times. We hope that the market
will pick up again and your business will be steady. Be positive.
In this issue, we got great articles for you. We focus on the legs
and lower extremities. Art Riggs give us a complete range of
techniques for leg injuries. This is the firt of a two parts article.
Watch out for the next part on our next issue. Our colleague
from Italy, Mau shows us his innovative passivattiva tech-
nique. Check it out. On the foot, we look at the history of Chi-
nese reflexology and stretching for plantar fasciitis. There’s
also great articles by Kit Laughlin, and Erik Dalton. Kristin
Osborn shares her passion with us on Lipoedema, a condition
little known. And we look at the mysteries of unwinding.
Don’t forget to read our 6 questions to Whitney Lowe and
Diana Haynes.
We hope to keep you informed and entertained. This e-News
is dedicated to all of you. If you have something you wish to
contribute, drop us an email: terrarosa@gmail.com. We be-
lieve that therapists like you have lots of experiences to share
around. Thanks for all of your support, wishing you have a
Great Christmas, Happy Holiday and enjoy reading.
Sydney, December 2008.
Bodywork e-News 1
 Integrating diagnosis
and treatment for
Bodywork
The question of how a therapist
can incorporate diagnostic tech-
niques (assessment of structural
and functional considerations
deemed relevant to the client's
problem) into a standard mas-
sage treatment is not an easy one
to answer. This question give
rise to two additional questions:
What are the expectations of the
client, and how may they be
changed for the client's ultimate
benefit?
What is the reason for treat-
ment?
The first question may be re-
worded: for what apparent rea-
son is the client coming to see
you? The reasons are many and
varied, but chief among them are
stress management, neck, mid-
dle or lower back pain, optimisa-
tion of well-being, or some spe-
cific musculoskeletal problem. If
stress management is the reason,
then the practitioner can explain
during the treatment that the
tension that is being explicitly
dealt with in the massage session
is in fact the body's most funda-
mental reaction to stress. Ac-
cordingly, any one of the ortho-
dox approaches to reducing
stress is then a natural subject to
which the conversations can turn.
So, for example, one might talk
about relaxation techniques, or
the use of stretching exercises to
change tension patterns. It is a
by Kit Laughlin
What are the expec-
tations of the client?
How may they be
changed for the
client's ultimate
benefit?
perfectly reasonable matter, then,
to offer to teach the client a
number of such exercises at the
conclusion of the session. One
could shorten the actual massage
part of the session by 10 or 15
minutes explicitly for this pur-
pose. If the use of the exercises
by the client makes a difference
to this very common problem,
you can be sure the client will
ask you for additional stretching
exercises at a future consultation.
Neck or back pain
One of the most common rea-
sons for a client to come to a
massage practitioner is for the
treatment of the neck or back
pain. The practitioner needs to
realise that a client has a specific
idea of what it is they want from
you, but often lacks the language
or concepts with which to articu-
late their concerns. In the case of
neck and back pain, during the
taking of the client history before
the massage commences, the
practitioner can float the idea of
doing a structural and functional
analysis some time in the future
as a means of making concrete
some possible causes of their
problem. The initial consultation
then proceeds as normal, with a
standard massage being per-
formed. During the massage, the
practitioner is gaining a much
clearer idea of where the client
holds tension, and possibly
where the client lacks strength as
well. For example, in the case of
neck pain, levator scapulae can
explicitly palpated and its ten-
sion in relation to surrounding
tissues assessed. In the case of
back pain, erector spinae (or
even quadratus lumborum) may
be palpated, assessed and
treated. Comparisons of left/
right development of muscles
articulating the spine can be
made.
Specific conditions
If the client is coming to see you
for a specific musculoskeletal
problem, it is an easy matter for
the practitioner to suggest
stretching or strengthening exer-
cises as the client's homework,
and be certain that this course of
action is very likely to yield
much faster results than simply
being treated by massage. This is
because dysfunctional patterns
of flexibility or dysfunctional
motor patterns are the main rea-
son for these kinds of problems.
Bodywork e-News 2
 Diagnosis & Treatment
The vast majority of muscu-
loskeletal problems (including,
of course, neck and back prob-
lems) may be said to be the re-
sult of inefficient biomechanics,
but so saying does not indicate
specific treatment directions. To
move beyond a mere description
of the problem (even though
'biomechanical' does have a nice
scientific ring about it!) to a
treatment of its cause(s) requires
that some analytical process be
used. As I have published else-
where, one such specific and re-
peatable process is the assess-
ment of physical functions in
terms of insufficient flexibility or
lack of strength. This relatively
simple analysis yields specific
treatment recommendations:
stretching exercises for areas
that testing reveals to be tight in
comparison with what is
'normal' for that client and
strengthening exercises for areas
shown to be weak. This latter
assessment will require an un-
derstanding of which muscles
need to be activated and how
strong they need to be in relation
to other muscles.
Going beyond a 'condition'
or 'problem'
There is a further consideration
in recommending specific
stretching and strengthening ex-
ercises, and that is the notion of
empowerment. Far too many
practitioners---deliberately or
inadvertently---disempowered
their clients. That is, from the
very first consultation, an atmos-
phere can be created wherein the
practitioner and the client both
regard the client as the more-or-
less passive recipient of the
treatment being practised. In
other words, the practitioner is
put forward implicitly as the
fount of wisdom, and the client
the vessel. Apart from being pa-
tronising, a great deal of recent
research in medical anthropol-
ogy suggests strongly that the
likelihood of successful resolu-
tion of any problem is lessened
considerably if the client is not
actively involved in his or her
treatment.
States of mind
So we might say that one could
have a process reason for recom-
mending stretching or strength-
ening exercises (that your analy-
sis has yielded an understanding
of specific biomechanical prob-
lems in the client's system) and a
psychological reason. This latter
reason is simply (and very im-
portantly) the creation of an op-
timistic state of mind in the cli-
ent, and the passing on of spe-
cific tools for the client to use to
resolve his or the problem. This
gives the control of the problem
largely to the client---in my view
an essential first step up for full,
permanent resolution of the
problem. Until the client takes
responsibility for his or her own
problem, the problem is likely to
recur regardless of how effective
your treatment is.
Integration of treatment
elements
If the practitioner embraces an
analytic protocol as, for example,
outlined in the book Overcome
neck & back pain, the structural
and functional analysis will take
about 30 minutes in total. As-
suming a treatment hour, the
remainder of the time can be
used in the teaching what the
analysis reveals to be the most
likely significant two or three
exercises. At a future consulta-
tion, you will be able to concen-
trate on whichever muscles the
analysis has revealed to be exces-
sively tight, in addition to the
massage process that you usually
use. At the conclusion of the
massage, spend 10 minutes re-
viewing the previously-taught
exercises with the client. Experi-
ence has shown that no matter
how well these exercises are
taught the first time, reviewing
them a week or a couple of weeks
later will reveal practise errors;
we are all human, after all, and
clients (and practitioners) alter
the form of an exercise to make
it more comfortable, and often
avoid the target area as a result.
Progressing the intensity of
the exercises
I have found that once the pain
of the initial problem has re-
ceded, it is usually necessary to
teach some strengthening exer-
cises in order that the client re-
turned to full normal (or, desir-
able) function. We might say
that in order for rehabilitation to
be considered complete, the cli-
ent must move beyond the pre-
injury state of fitness that led to
the initial problem. In respect of
neck pain, the anterior neck
muscles usually need strength-
ening. Any tendency to carry the
head forward of the ideal posi-
tion will also need to be cor-
rected, and this usually requires
the strengthening of muscles in
the lower abdominal area. In ad-
dition, it will be necessary to
check the flexibility of the hip
flexors, ilio-psoas and rectus
femoris, in particular. This is
because the research has shown
that an anterior pelvic tilt can be
Bodywork e-News 3
 Diagnosis & Treatment
the main cause of the forward-
head posture.
Unstable exercises
If lower back pain is the initial
consultation problem, it is usu-
ally necessary to teach effective
strengthening exercises for par-
ticular muscle groups once the
pain has settled down. Without
wanting to preempt your testing
procedures, experience has
shown that the lower abdominal
muscles, transversus abdominis,
and the relationship between the
strengths of the internal and ex-
ternal obliques usually needs
attention. Recent work I have
done with Paul Chek confirms
the claim that strengthening ex-
ercises are most efficiently done
using an exercise ball. All of the
abdominal strength the exercises
in my book Overcome neck &
back pain can be done this way.
I believe the usefulness of the
exercise ball lies in the elicitation
of some primitive reflex arcs,
which in turn reactivate the
righting and tilting reflexes. The
reason this is important is that
life, and inefficient exercise pat-
terns, tends to worsen existing
imbalances and frequently
strengthens the upper abdomi-
nals preferentially. As these at-
tach to the ribs, increasing their
strength without attention to
how the body uses the other ab-
dominal muscles can actually
Stretching & Strengthening
with Kit Laughlin
Stretching Books & DVDs by Kit Laughlin with specific pro-
grams for Back Pain, Neck & Shoulder Pain & RSI.
Available from: www.terrarosa.com.au
worsen one's posture. Exercising
over the Swiss ball, an extremely
unstable environment (especially
for those people who have never
done any strengthening exercises
before) wakes up the fundamen-
tal reflexes and allows the client
to re-establish desirable patterns.
I am happy to report here that
results come extremely quickly,
especially with clients to have no
experience with exercise.
In conclusion
Speaking generally, massage
practitioners are uniquely poised
to take advantage of recent
breakthroughs in rehabilitation
medicine techniques. Because of
the physical basis of the massage
practice, many practitioners al-
ready have a deep intuitive un-
derstanding of how the parts of
the body work together. To make
massage practitioners the pre-
eminent rehabilitation practitio-
ners in the new millennium, all
that is needed in my view is to
acquire an effective understand-
ing of efficient stretching and
strengthening exercise tech-
niques in addition to the specific
massage modality one uses.
It is no accident that massage
practitioners are very often the
first recourse in people's daily
life problems. This is because
massage therapy has a very low
incidence of unwanted side ef-
fects and because the treatment
is with friendly and supportive.
The atmosphere created in the
treatment facilitates a deep ex-
ploration of the causes of any
particular problem---
psychological and emotional as
well as physical. It is also no ac-
cident that massage practitio-
ners form the bulk of those who
attend my workshops---and oth-
ers who teach similar tech-
niques---and are among the
most open minded of practitio-
ners, too.
Kit Laughlin is one of the
world’s authorities
on the subject of
stretching. Kit
studied oriental
traditional Japa-
nese medicine dur-
ing a four-year
stay in Japan. Kit
developed the principles of Pos-
ture & Flexibility over 24 years,
and has been teaching them for
21 years at the Australian Na-
tional University Sports and
Recreation Association.
Kit teaches P&F to practitioners
and to people everywhere who
want to rehabilitate or avoid
injury, enhance performance or
maximise wellbeing, in Austra-
lia and around the world.
Bodywork e-News 4
 The Spinal Engine
Most manual therapists perform
gait analysis based on observa-
tion of leg movement as it relates
to the pelvis (pedestrian theory
of locomotion). Although the
legs are obviously important fac-
tors in efficient locomotive ac-
tivities…are they really the pri-
mary driving force behind body
movement? It makes no sense
that the torso, arms and head
would not somehow contribute
to gait. Since the body strives on
energy conservation, the idea of
dragging a heavy torso around
while walking or running seems
like a terrible waste of muscular
mass.
Using the
pedestrian
theory of
locomotion,
try to imag-
ine what a
100 meter
Olympic
sprinter’s
body might
look like
(Figure 1).
One would expect to see a tiny
upper torso driven by huge pow-
erful legs. Any added upper body
weight would only serve to slow
the runner down.
by Erik Dalton PhD
Those of us who’ve experienced
body braces or casts will tell you
that normal cross-patterned gait
with reciprocal hip rotation is
almost impossible. We tend to
walk with an awkward ‘block-
type’ stride where the QL is re-
cruited to lift the ipsilateral leg
to keep it from dragging the
ground during the swing phase.
This aberrant gait is also seen in
our lumbar-fused and ankylosed
clients…and even in infants
who’ve yet to develop a stable
lumbar curve. Try experimenting
with this concept by placing
some kind of elastic or leather
support around your lower rib-
cage or lumbar spine. Can you
feel your thorax and pelvis trying
to rotate against resistance from
the strap?
Spinal Engine Model
In the early 1900’s, Robert
Lovett, MD, developed theories
based on the assumption that a
rotational component was essen-
tial to human movement. His
research concluded that in the
presence of normal lumbar lor-
dosis, sidebending produced an
axial torque (sidebending to one
side and rotation to the other)
which he labeled ‘coupled mo-
tion’.
In 1988, Serge Gracovetsky,
Ph.D. expounded on this idea in
his book titled ‘Spinal Engine’ by
declaring that the legs were not
responsible for gait but merely
“instruments of expression”. He
theorized that during heel strike,
kinetic energy was not displaced
into the earth as in the pedes-
trian model, but efficiently
transmitted up through the myo-
fascial system causing the spine
to resonate in the gravitational
field.
Therefore, during right legged
weight bearing, the lumbar spine
is pulled into right sidebending
(left rotation) by the multifidus,
longissimus, iliocostalis and tho-
racolumbar fascia. This action
counter-rotates the pelvis as the
sacrum is forced into left side-
bending and right rotation
(Figure 2).
This dynamic coupling at L5-S1
is essential to efficient gait and
lumbar longevity. When
counter-rotation of pelvis and
lumbar spine is lost, the spinal
engine runs out of gas allowing
compressive forces to squash the
L5-S1 intervertebral disc with
each step. No wonder the L5 disc
suffers the most herniations and
is the most operated on of all
spinal segments.
Bodywork e-News 5

Figure 2. Spinal engine is
revved-up by counter rotation of
the pelvis and trunk.
Are legs really necessary?
Figure 3:
Balanced
walking on
ischial tu-
berosities.
Adapted
from
Serge Gra-
covetsky
with per-
mission.
At a Rolf Institute® annual con-
vention in the mid 1980s and
again at the International Fascial
Congress at Harvard University,
I was blessed with the opportu-
nity to share discussion and in-
sights with a delightful and pro-
vocative nuclear physicist (and
fellow musician) named Serge
Gracovetsky. His unusual biome-
chanical approach to movement,
which he calls the “Spinal En-
gine,” continues to dramatically
alter my ingrained view of body
locomotion and lifting.
Spinal Engine
In his presentations and writings,
Gracovetsky offers a counterin-
tuitive, but seductive, argument
that the legs are not responsible
for gait, but merely “instruments
of expression.” He expounds on
this concept by showing video of
a man born with no legs walking
(perfectly balanced) only on his
ischial tuberosities (Fig. 3). With
the use of a high-resolution
opto-electronic tracking system,
Gracovetsky was able to study
and organize evolutionary details
concerning functional adapta-
tions as they apply to the body’s
spinal engine.
Figure 4:
Lats are
stretched
by the for-
ward
swing of
the oppo-
site arm.
Fig. 4 demonstrates what I refer-
ence as the posterior spiral
spring system (PSSS) – a slightly
altered version of Gracovetsky’s
model. I like to include biceps
femoris in this pattern, not only
because of its intimate co-
contracting relationship with
gluteus maximus during heel
strike but also because of the in-
fluence this complex lateral
hamstring muscle has on pelvic
mechanics in force closure of the
sacroiliac joint during the stance
phase. Notice in Fig. 4 that just
prior to heel strike, the biceps
femoris and gluteus maximus
reach maximum stretch as the
latissimus dorsi also is being
stretched by the forward swing
of the opposite arm.
Heel strike signifies transition
into the propulsive gait phase. At
this time, biceps femoris and
gluteus maximus join forces, cre-
ating antagonistic resistance
with the contralateral latissimus
dorsi, which is now extending
the arm in concert with the pro-
pelling leg. The synergistic con-
traction of the gluteus maximus
and latissimus dorsi creates ten-
sion in the thoracolumbar (and
lumbodorsal) fascia, which soon
releases in an energy pulse
which assists deeper muscles of
locomotion, thus reducing the
metabolic cost of gait.
Due to the natural counter-
rotation of the right leg and left
shoulder, an efficient myofascial
spring system develops. Pull of
the lats creates a strong ten-
sional force that travels through
the thoracolumbar fascia, long
dorsal SI ligaments and contin-
ues through the contralateral
gluteus maximus, sacrotuberous
ligament and biceps femoris. At
this point, spiraling tensional
forces increase in these posterior
global structures and begin to
dig tentacles deep into the osteo-
ligamentous spring system.
Before delving into the biome-
chanical intricacies of the core’s
disc/facet spring system which
powers the spinal engine, let’s
look briefly at global muscles
driving the anterior torso’s ro-
tary spring system.
The Anterior Spiraling
Spring System
So, what does it look like from
the front? In our discussion
above, we saw how one leg
swings in opposition to the op-
Bodywork e-News 6

posite arm causing trunk
counter-rotation. To aid the
latissimus/gluteal spring system
in trunk rotation, we have an an-
terior spiraling spring system
(ASSS).
Figure 5:
ASSS:
Oblique
abdominal
contrac-
tion cre-
ates a con-
tralateral
fascial pull
through
the lower
torso to
the adduc-
tors.
Fig. 5 demonstrates an anterior
firing-order model where
oblique abdominal contraction
forces a contralateral fascial pull
through the lower torso to the
adductors. The ASSS concept
describes a nice working rela-
tionship between the oblique ab-
dominals and the contralateral
adductor musculature via the
intervening anterior abdominal
fascia. Notice in Fig. 5 how the
left thigh adductors work in per-
fect harmony with the ipsilateral
internal obliques, as well as the
contralateral external obliques,
to stabilize the body on top of
the stance leg and to right-rotate
the pelvis. This firing-order pat-
tern positions the pelvis and hip
so they are prepared for the suc-
ceeding heel strike.
Internal/external obliques, like
the adductors, provide stability
and mobility during the initia-
tion of the stance phase of gait.
This ASSS system also works
with the PSSS to rotate the pelvis
Spinal Engine
as the leg is pulled through dur-
ing the swing phase of gait. As
the speed of walking progresses
to running, activation of the
ASSS becomes more prominent.
When working together harmo-
niously, these global muscles en-
hance the power of the posterior
spiraling spring system by pro-
viding greater rotary torque at
the osteoligamentous level dis-
cussed below. Bottom line: Ad-
aptations of the trunk in locomo-
tion primarily serve three goals:
* Rotation of the pelvis;
* Counter-rotation of the
shoulders; and
* Stabilization of the head.
Note: It’s important to recall that
the primary afferent feeding
neurological information for the
gait cycle arises from a stretch of
the hip flexors (primarily the ili-
opsoas). Therefore, as the iliop-
soas cross the hip, sacroiliac and
lumbar spine, any joint restric-
tions will hinder excursion, thus
minimizing the stretch. Thera-
pists must restore movement
and alignment to all myoskeletal
structures to maximize normal
neurological feedback and opti-
mum muscle sequencing.
Disc and Facet Rotary
Torque
Gracovetsky doesn’t view the
spine as a compressive loading
system where intervertebral
discs perform as shock absorbers.
He imagines the outer annulus
(tree-ring) disc fibers and their
accompanying facet joints as dy-
namic antigravity “torsional”
springs that store and unload
tensional forces to lift and propel
the body in space.
During toe-off, as the spiraling
spring system begins to recoil,
strong forces are transmitted to
the intervertebral joints where
the combined action of discs and
facets counter-rotate the pelvis
(Fig. 6).
Figure 6:
Forces
transmit-
ted to the
interverte-
bral joints
where the
combined
action of
discs and
facets counter-rotate the pelvis.
The process is repeated as the
left heel strikes the ground re-
sulting in an oscillatory motion
that efficiently moves the body
with minimal energy expendi-
ture. At the deepest osteoliga-
mentous level, this interlocking
of facets and discs transmits vir-
tually all the available counter-
rotational pelvic torque needed
to aid core and global muscles in
locomotion efforts.
Summary
The elegance of Gracovetsky’s
spinal engine system can be felt
in your own body during gait.
Practice propelling yourself for-
ward by allowing the right arm
and shoulder to swing forward
and the left back.
One should feel the torso rotate
left as the pelvis counter-rotates
right. As the trunk and hip mus-
cles concentrically and eccentri-
cally co-contract, stored energy
is transmitted through the in-
tervertebral discs, ligaments and
facet joints. Do you feel your pel-
vis counter-rotate with each
step? Try contracting the ipsilat-
Bodywork e-News 7

eral gluteus maximus on heel
strike as you rotate from the top
down. As the gluteals co-contract
with the lats, more kinetic en-
ergy is stored in the posterior
spring system. This exercise also
helps bring tone to typically
weak butt muscles.
Many individuals in our practice
who complain of back pain may
not feel the pelvis rotate. Typi-
cally, these clients are suffering
from such things as joint fixa-
tions, lack of proper spinal
curves, altered firing-order pat-
terns (in the deep inner unit)
and/or imbalances between
global and core muscles due to
improper strength training.
Structurally oriented pain thera-
pists trained in this method
seem to be successful in relieving
many chronic back conditions.
Closely observe your clients as
they walk. Do the arms swing
evenly? Is there a nice cross-
patterned gait? Does the energy
appear to travel from the top
Spinal Engine
down? The more you practice
working with dysfunctional
ASSS and the PSSS patterns, the
more effective your therapeutic
outcomes.
Ten years ago, Volume One of
the Myoskeletal Alignment Tech-
niques® was released. In that
book and video program, I had
the pleasure of introducing
Vladimir Janda’s upper and
lower crossed syndrome to the
massage therapy community.
With inspiration from other
mentors such as Ida Rolf and
Philip Greenman, I set about to
develop techniques to comple-
ment Janda’s wonderful postural
assessment model.
For the past few months, I’ve
been grinding it out in
preparationȠfor release of my
new Advanced Myoskeletal
Alignment for Low Back, Hip &
Leg Pain DVD series. By combin-
ing spinal/pelvic biomechanical
principles from Greenman’s
“Clinical Aspects of the SI joint
in Walking” with Gracovetsky’s
Spinal Engine, I’ve come up with
some practical strategies for
tackling painful compensatory
patterns seen daily in our man-
ual therapy practices. We expect
to have the DVD’s and accompa-
nying book ready for release
soon.
Erik Dalton, Ph.D.,
earned his phi-
losophy and clini-
cal psychology
degrees from the
University of
Oklahoma. An in-
spiring presentation by Dr. Ida
Rolf in 1972 sparked a passion-
ate mind-body adventure lead-
ing Dalton through a maze of
learning institutions including
the Menninger Foundation,
Mueller College of Holistic Stud-
ies, Michigan State College of
Osteopathic Medicine, and the
Rolf® Institute of Structural
Integration.

Advanced Myoskeletal Alignment Techniques

With Erik Dalton
Learn innovative Bodywork deep tissue technique for chronic
reflex muscle spasms caused by joint dysfunction, including
Myofascial Mobilization, Structural Integration, Manipulative
Osteopathy, and Muscle Energy Techniques (MET).

The Myoskeletal Alignment Techniques program was developed

by Dr. Erik Dalton as a tool to help relieve neck/ back pain epi-
demic. By incorporating muscle-balancing techniques with
joint-mobilization maneuvers, manual therapists learn to
quickly identify and correct dysfunctional strain patterns be-
fore they become pain patterns. Combining muscle and joint
modalities offers busy bodyworkers short-cuts that help shorten assessment/hands-on
time, increase therapeutic efficiency; and provide clients with pain relief.

Available from: www.terrarosa.com.au

Bodywork e-News 8
 AN INTEGRATED APPROACH
TO REHABILITATION OF
LEG
INJURIES
Part 1
by Art Riggs
“The foot bone connected to the ankle bone, The ankle bone connected to the shin
bone, The shin bone connected to the knee bone, The knee bone connected to the
thigh bone, The thigh bone connected to the hip bone, the hip bone connected to the
back bone.”…Spiritual “Dry Bones”

As a veteran of seven knee sur- the legs and how to work with freak of nature” because of the
geries resulting from my genetic compensatory limping patterns speed and quality of his recovery
roots of extremely bowlegged that occur after injury. compared to other patients of
peasant (Neanderthal?) ancestry, the surgeon.
After my third knee arthroscopy
combined with excessive and,
I was highly motivated in my re- Today, with the current health
some might say, obsessive ath-
habilitation but had considerable insurance restrictions, many pa-
letic over-indulgence, I have a
problems with recovery in spite tients rarely see their doctors for
virtual PhD of personal research
of extensive conventional physi- follow up or for more than per-
in acute and chronic injuries to
cal therapy treatment of functory physical therapy after
the legs and recovery from sur-
strengthening, stretching, ultra- acute knee injuries or after the
geries. Through my own experi-
sound, electrical stimulation, scars from surgery have healed.
ence and the treatment of fellow
and various anti-inflammatory I had essentially resolved myself
sufferers, I’ve learned that the
modalities. I had experienced that my surgeries just didn’t
best treatment should include a
the all-too-common plight of work well and that I must accept
wide range of approaches from
many patients who are told by my fate when a friend twisted my
soft tissue muscular and fascial
their doctors, “A certain percent arm to see a physical therapist
work, joint mobilization, stretch-
of these cases just aren’t success- (or physiotherapist, PT) who es-
ing, strengthening, and neuro-
ful.” (as if it is the patient’s fault chewed many of the conven-
muscular re-education. Injury to
or he loses by a toss of the dice). tional PT modalities and concen-
any joint of the leg will necessar-
Conversely, one client whom I trated upon soft tissue manual
ily impact the joints above and
recently treated with a broad ap- therapy. I had never before ex-
below. In addition to offering
proach of soft tissue work to the perienced “bodywork,” but after
specific treatment strategies for
knee and attention to compensa- one treatment of manual work to
the knee, this article will also
tory walking patterns in the feet free up restrictions in the mus-
discuss the complex interplay
and hips was complimented by cles and fascia around the knee
and feedback loops between
his surgeon that, “…he was a and some attention to compen-
muscles and all major joints in
Note: This article will use the more common usage of the term “leg” to refer to the entire lower extremity as opposed to
strict medical terminology where “leg” specifically refers to the portion of the lower extremity between the knee and ankle.

Bodywork e-News 9
 Treatment for the Legs
satory holding in my hip and an- good manual skills and an un- the specific injury site. The suc-
kle, I felt that I had a new knee. derstanding of the complex in- cess of movement therapies is
So I suppose that terplay of the joints from the foot due to their understanding of the
I was actually to the hip, any massage therapist kinesiology and neurological
lucky to have ex- can provide great benefit to their patterns of how limping becomes
perienced my clients. We will focus on the established and hampers healing.
knee problems knees, but since injuries to the It is short-changing your client
because my as- foot, ankle, and hip often present to focus your attention on just
tonishment at the the same compensatory move- the muscular issues at the injury
benefits is what ment patterns as knees, the site without considering joint
led me into the strategies in this article will be compensations above and below
bodywork field! just as helpful for treating these the site of dysfunction and work-
injuries in a holistic manner to ing to mobilize them.
Although my in-
return normal gait.
juries were exten- The movement of the knee
sive and have re- There are no magic bullets or through extension and flexion is
quired additional simple strategies for treatment a sophisticated combination of
surgeries (finally of leg injury, and clients must be spinal cord reflexes and con-
requiring very treated as unique individuals scious higher order brain func-
successful knee based upon their particular in- tion. To greatly simplify: When
replacements be- jury or surgery, their experience the quadriceps (the agonists in
cause of arthritis), of pain or dysfunction, and their this case) contract, they extend
the amazing adaptive compensations in gait. the knee (the rectus femoris,
benefits that I As tempting as it is to move into along with the psoas, can also
continue to reap specific techniques, it is essential flex the hip, and will need to be
from manual to develop an understanding of addressed to return normal hip
therapy are not the complex relationship be- function in the later stages of
the proprietary tween all the joints of the leg and recovery). In order to facilitate
domain of sophis- how they influence recovery this action, the hamstrings
ticated physical from injury so that therapists (antagonists) must relax so the
therapy. Unfortu- can have a logical plan for treat- two muscle groups aren’t com-
nately, many mas- ment, rather than just trying to peting with each other. Con-
sage therapists are work where it hurts or using versely, in knee flexion the ham-
hesitant to work some technique that looked good strings contract to flex the knee
with injuries be- in a class or book. (or extend the hip if the knee is
cause they are fixated) while at the same time,
given little in- the quadriceps must relax. This
struction on deal- NEUROLOGICAL FACTORS process of contraction/
ing with post- relaxation of opposing muscles is
injury or surgery When manual therapy and con- called reciprocal inhibition and
cases except for ventional western medical meth- occurs at an unconscious reflex
caveats that instill ods prove to be less than satis- level in all parts of the body.
trepidation. I re- factory, the success of Pilates
and somatic therapies like Fel- If there is pain or soft tissue re-
late my personal
denkrais® demonstrates the im- striction in the knee joint, a com-
From Gray’s anatomy story to empha-
portance of treating more than plex series of protective reflexes
size that with

Bodywork e-News 10
 Treatment for the Legs
occurs that overrides the smooth
function of reciprocal inhibition
to compensate for the restriction
or prevent the joint from moving
into painful positions. This reac-
tion may be useful in the early
stage of recovery to prevent pain
or protect the joint, but if the
joint does not quickly return to
normal pain-free movement,
there is a likelihood of limping
patterns being established that
disrupt function above and be-
low the knee. These global feed-
back loops tend to exacerbate
and fixate the original injury.
(Possible side-bar) Understand-
ing how the foot, ankle and hip
at first respond to and later con-
tinue to affect the knee is often
the key to rehabilitation, not
only of acute problems but long-
standing chronic ones.

Although there are many differ-

ent patterns for compensation in
walking, sidebar #1 demon-
strates the most common limp-
ing patterns for knee pain. In
part two of this article we will go
into a deeper analysis of gait,
techniques for joint mobilization,
and some strategies for return- Box 1: In varying degrees, limited knee extension will have the following results in gait,
including a short stride. If you can return normal extension to the knee (the primary
ing normal function to the feet
restriction), then most of the secondary compensations in the foot and hip will improve
and hips. For now, this chart will with minimal intervention. Muscles that are inhibited will need to be strengthened, and
give you a map of short muscles any good sports medicine book will have suggestions. These images confine themselves
that you can begin working with to the pelvis and below, but notice how pelvic tilt is also affected and will have effects up
to improve knee function. the spine and beyond. If you consider how a tight psoas on the affected side will present
side-bending and rotational strain on the lower back, it becomes clear how the effects of
injury radiate globally.

TREATMENT STRATEGIES terproductive if performed with- early, thereby increasing inflam-

FOR THE KNEE
Even ideal techniques or soft tis-
sue strategies may prove less
than effective or possibly coun-
out considering the progress of
your client in his or her healing
process. We all walk a fine line of
providing effective work or occa-
sionally working too hard or too
mation. It is understandable that
both therapists and clients are
anxious to progress as quickly as
possible with recovery, but I feel
that too early or aggressive inter-
Bodywork e-News 11
 Treatment for the Legs
vention may disrupt the amazing
ability of the human body to di-
rect its own healing. Often, cli-
ents are hoping be quickly
“fixed” by outside intervention
or magic bullets. I prefer to look
at my work as returning balance,
thereby opening the door for my
clients’ bodies to heal themselves.
Giving them the confidence and
trust in their body’s recuperative
powers is another gift that you
can provide in addition to your
work.
After surgery most orthopedists
and physical therapists feel that
if the incision is healing properly,
after approximately seven days it
is safe to perform superficial
work to reduce swelling, prevent
adhesions from forming, and
improve mobility. To play it safe,
I recommend waiting for at least
10 days, and always proceeding
with authorization from the sur-
geon. The tissue will most likely
be very warm from natural in-
flammation processes; it is
strongly recommended that
whenever working on injuries
you apply ice packs for 10 min-
utes after the session and have
your client apply ice later in the
day. “Hot” or very red, irritated
tissue, especially if the client has
a fever, is a serious problem after
surgery, and they should imme-
diately contact their surgeon to
rule out an infection in the joint.
That said, what do you do when
you first see a client after surgery
or an acute knee problem?
Although clients may be con-
cerned with the lack of knee flex-
ion, the primary culprit in limp-
ing is a lack of knee extension,
even if it just a matter of a few
degrees. Certainly you should
work to improve flexion, but in
most normal, relatively level
walking and level running condi-
tions, it is possible to navigate
without limping even with re-
stricted flexion. Once you un-
derstand how the ankle, knee
and hip are related, you can be-
gin to work with a rational strat-
egy to return normal movement
to the whole leg. (last sentence is
redundant…...repeat for empha-
sis or delete?)
Treatment #1: Freeing the
Superficial “Sleeve” around
the Knee Joint
This is really quite easy and
gratifying work once you have a
feeling for it, but it is quite dif-
ferent from typical kneading,
effleurage, or deep muscular
work of conventional massage.
This work will facilitate improve-
ment in both flexion and exten-
sion and the feeling of tightness
surrounding the knee. The su-
perficial tissue around an in-
jured or surgically repaired knee
will usually lack the resilience
and mobility of normal tissue
and feel leathery. This is a dif-
ferent quality from softer puffi-
ness of deeper joint swelling
which may also be present, but
will “give” more easily because of
the additional fluid in the joint
capsule. It is almost as if a tight
sleeve has been wrapped around
the joint. This is the body’s at-
tempt to stabilize after trauma,
either surgical or accidental, and
should be the first issue ad-
dressed. The client will probably
have some residual pain and fear,
so it is crucial to move slowly
and within their pain threshold.
Photo #1—Sleeve Work
With your fingers softly curved,
take a hold of as broad an area of
tissue as you can with the soft
pads of your fingers and the
palms of your hands. Your in-
tention should be very superfi-
cial, no more than ½ inch deep,
as you visualize VERY slowly be-
ginning to first soften tissue and
then unwind and separate this
outer sleeve from deeper tissue
and the joint. If performed
properly, the client usually com-
ments that it feels quite enjoy-
able (in an intense way) and
freeing. The softening of tissue
might feel like you are slowly
letting your fingers test the ripe-
ness of an apple while being
careful to not bruise it. Gently
grabbing the incision and lifting
it and slowly moving back and
forth similar to skin rolling is
very helpful, but again, with the
doctor’s permission soon after
surgery. After softening the tis-
sue, then visualize that you are
Bodywork e-News 12
 Treatment for the Legs
sliding this superficial layer
around the joint in whatever di-
rection it wants to stretch, un-
wind, and release—almost like
very slowly wringing out a wet
towel--being careful that you are
grabbing and stretching tissue
rather than sliding over it. There
is little or no need for lubrication,
which makes the skin slippery
and requires more pressure to
grab the sensitive tissue.
The release happens at the end
range of restricted motion and at
a very oblique angle, not from
jostling tissue back and forth or
working on deeper tissue…
almost as if you trying to free the
lid from a jar by slowly applying
steady pressure and waiting
(hoping) that it will eventually
release and move. You want that
leathery superficial tissue to be
able to slide over the joint in all
directions so it does not disrupt
joint function. A very effective
technique is to rotate the outer
sleeve of tissue as far as it will go
and then ask your client to very
slowly flex and extend the knee
so that the joint moves under the
sleeve that you are stabilizing.
Treatment #2: Improving
Flexion.
As mentioned earlier, flexion is
rarely a lasting problem, and re-
turning full extension should be
a higher priority. However, most
clients seem quite concerned
with flexion and it is relatively
easy to improve. Your goal is to
increase joint range of motion
and mobility at the end range tation.
restriction of tissue. Working in
the neutral position is of mini-
mal benefit. Take the joint to the
end range of comfortable flexion
and work to extend that end
range either passively or by hav-
ing your client actively flex the
knee while you work on any soft
tissue areas that are resisting.
Your client can tell you where
Photo #3—Supine Knee Flexion
the tissue is tight and resisting
movement. This approach affords more con-
tact with the anterior knee and
patella as well as the quadriceps.
Stretch the knee into flexion and
ask where any restrictions are
felt. You can use anchor and
stretch strokes applying pressure
proximally as you flex the knee
against adhesions, or you can
work in the direction of length-
ening by grabbing tissue and
Photo #2-- Prone Knee Flexion
pulling it in that direction. To
Technique
allow both hands to work, you
To insure that you are not stress- may instruct the client to flex her
ing the knee capsule, be sure to knee by using her hands to pull
have your client inform you if the knee towards her chest, or
the restriction feels like it is deep use your own body to apply flex-
in the joint rather than in the ion pressure to the lower leg.
soft tissue you are addressing.
Also make sure that the patella is
not compressed against the table.
Slowly flex the knee with your
other hand and address any ar-
eas distal to the knee that are
restricting movement. The fist,
fingers, or even the forearm are
effective tools. In addition to
freeing localized tissue where
you are working, this will also
Photo #4—Seated Quadriceps
stretch the quadriceps. This is
Work
the perfect time to offer your cli-
ent suggestions about a home Good old-fashioned softening of
stretching program for rehabili- the quadriceps with the forearm
Bodywork e-News 13
 Treatment for the Legs
is always helpful. Of course
working with your client in su-
pine position is also acceptable,
but does not stretch the tissue.
Having the client sitting and ac-
tively flexing the knee as you ap-
ply force in a distal direction to
expedite lengthening is more ef-
ficient for biomechanical use of
your weight and also assists with Photo #5—Patellar Mobilization Photo #6—Soft Tissue Patellar
joint tracking and other neuro- Work
The patella will only glide freely
logical movement patterns. An-
when the knee is fully extended In addition to mobilizing the pa-
chor and stretch strokes apply-
(another reason to return full tella by working directly with the
ing force proximally while
extension to the knee joint as bone as a lever, it is very impor-
stretching the tissue by increas-
soon as possible). Palpate the tant to soften tissue around the
ing flexion are also very effective
difference on yourself by at- perimeter of the patella that can
for freeing more superficial ad-
tempting to slide your patella interfere with tracking. Work
hesions around the knee joint.
back and forth with the knee just slowly in all directions with fin-
slightly bent, as it would be if gers or knuckles and wait for the
supported by a bolster in supine melt of tissue.
Treatment #3: Freeing the
position. Now let your knee rest
Patella
in full extension (without con-
Even with deep joint injury or tracting the quadriceps) and no- Treatment #4—Freeing the
surgery, the patella often be- tice how much easier the patella Iliotibial Band
comes restricted and can cause moves. To mobilize the patella,
the knee should be extended as With virtually every knee injury,
tendinitis and secondary pain. It
straight as is comfortable with- the I.T. band will become tight
is unfortunate that many early
out a bolster. and hard. Not only is this un-
massage trainings instill fear of
comfortable or painful for the
working in this important area.
With the soft, flat border of your client, but the tightness causes
Be careful to not compress the
thumb, gently lift the patella and torsion (strain?) on the knee,
patella against the femur when
slowly mobilize in all directions, pulls the patella laterally, and
working, but do work for more
waiting at end range of restric- prevents smooth flexion and ex-
ease in proximal/distal and lat-
tion for a softening of resistance. tension. The biggest complaint
eral/medial movement. Tight
In this case, I am actually lifting that some clients express for
tissue and tension in the I.T.
and tilting the patella with my work in this area is that the
band and vastus lateralis most
thumbs slightly below the ante- therapist moves too fast and ex-
often will cause the patella to
rior surface so it is not com- erts pressure directly into the
deviate laterally, so although not
pressed against the femur. You femur rather than obliquely.
shown in this example, any work
can even rotate the patella clock-
to lengthen and soften the I.T. Just softening the tissue will be
wise and counterclockwise.
band is very helpful. Don’t try to of substantial benefit, but put-
accomplish too much in one ses- ting the I.T. band on as much as
sion, but a little work each time
will be helpful.

Bodywork e-News 14
 Treatment for the Legs
this work. In addition to stretch-
ing in a distal direction with the
soft underside of your forearm,
grabbing the I.T. band and rotat-
ing it around the leg to free it
from deeper adhesions is also
very helpful
fingers is very effective to allow
the band to stretch in a straight
line and also to allow the patella
to track correctly instead of be-
ing pulled too far laterally.
Conclusion

I hope that this first of two arti-

Photo #9---Compartment Sepa-
ration
Photos # 7 & 8 ---Working with
the Iliotibial Band in Side-Lying
With immobility after injury or
surgery, adhesions may form
a stretch as possible by having
along the anterior or posterior
the leg extended in the side-lying
border of the I.T. band. Precise
position will add to the benefit of
work along either border with
cles provides some helpful
strategies for working with knee
injuries, and more important,
stimulates some thought about
the interconnectedness and
global issues involved in treating
not only injuries to the legs, but
in treating any other injuries.
The forthcoming article will offer
specific tools for returning full
range of motion to the knee in
extension and in working with
joints.

Art Riggs
Deep Tissue Massage & Myofascial Release

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Bodywork e-News 15
 The most comprehensive DVD on
Positional Release Techniques
Positional Release therapy is an excellent
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Bodywork e-News 16
 Lomi Lomi Massage
Workshop
Down Under

With
Carrie Rowell

Join Carrie Rowell for a 4-day Workshop, Hawaiian Lomi Lomi Massage, covering an introduction
to the principles, and a full body massage routine, complete with joint mobilization and passive
stretching.

Carrie will travel to Australia in November 2009 and hold workshops in various places, including:
Sydney, Byron Bay, and Brisbane. For over 20 years, she has studied various forms of sacred dance
and movement. She applies the beneficial techniques learned from these arts into her bodywork
therapy. Carrie practices and teaches bodywork in the US and traveled all over the world teaching
Lomi Lomi massage, sacred dance and healing and empowerment workshops for women.

For centuries the ancient art of Hawaiian Lomi Lomi massage has been used as a powerful tool for
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email: terrarosa@gmail.com or carrie@carrierowell.com

Bodywork e-News 17
Unraveling the mysteries of
Unwinding
What is unwinding?
The term “unwind” is generally
used with a meaning to relax,
become less tense, or take an
ease. “Unwind your body” is a
common phrase used to promote
relaxation bodywork.
But Fascial or Myofascial Un-
winding is a type of bodywork
that has a goal to “release” fas-
cial restriction by encouraging
the body or parts of
the body to move to
areas of ease. Unwind-
ing usually involves a
therapist that induced
the process to a client,
and this is followed by
spontaneous reaction:
bending, rotating, and
twisting of the parts of
the body in a rhythmic
pattern.
Unwinding is a gentle
and non-invasive
treatment which re-
sponds to body’s inner
potential, not forcing
the tissue in some di-
rections. The goal is to
facilitate the body’s
own physical release
potential. It is a body-
work that needs to be experi-
enced to be appreciated. This
article will take a look at some
aspects of physical unwinding,
and also presents some theories
on why and how it occurs.
This technique is usually offered
in classes and workshops in
myofascial release (the John
Barnes MFR). Unwinding can be
thought as an expression of in-
ner movement. Sometimes just a
gentle touch with a clear inten-
tion of restoring balance and be-
ing aware of client’s body can
stimulate unwinding. Unwinding
can happen automatically when
a therapist is working on a cli-
ent’s soft tissues. The client gen-
erally moves in response to
therapist’s touch and inner feel-
ing. The movement can be large
or small, involving some parts of
the body or the whole body. It
can happen when a client feels
safe and secure in the hand
of the therapist and this
allows the expression of
movements. In some cases,
emotional release can oc-
cur during unwinding,
therefore it is important to
distinguish between pure
physical unwinding and
emotional release. Here we
only discuss physical un-
winding which has a pro-
found therapeutic benefit
in releasing chronic mus-
culoskeletal pain.
In craniosacral therapy
there’s a technique called
sometoemotional release
which used fascia unwind-
ing to access client’s emo-
tion; it mostly deals with
the physical manifesta-
Bodywork e-News 18

tions of emotional trauma with
the aim to release residual nega-
tive energies from past traumatic
experiences. Again, here we only
deal with physical unwinding.
The technique is originated in
indirect osteopathic techniques.
Robert C. Ward in Foundations
of Osteopathic Medicine, said
that its origins are not clear;
however the procedures have
been described for decades by
many osteopathic practitioners.
The term “unwinding” was
coined by Dr. Viola Frymann in
1963. The technique was mainly
developed by Dr. Frymann, who
was a student of Dr. Sutherland.
The physical unwinding compo-
nent of Somatoemotional Re-
lease is based on Dr. Frymann’s
work. However, unwinding was
never intended nor used by her
to provoke emotional release.
According to Dr. Frymann the
principle of unwinding is to
place the body in the position
that permit the fascia to go
through whatever motions are
necessary to eliminate the forces
causing the injury.
The phenomenon of unwinding
where parts of the body move
spontaneously and involuntarily
is fascinating and mystical.
Robert Ward recognized that
these seemingly random move-
ments reflect a variety of inter-
acting electromechanical events
affecting central, peripheral,
autonomic, and even physiologic
functions. He added that “amid
much speculation, satisfactory
Unwinding
scientific descriptions for the
events are lacking.”
How to unwind?
To introduce an unwinding ther-
apy, the therapist must be cen-
tered and grounded, acting as a
catalyst or facilitator, with a
compassionate attitude, and be
aware of client’s inherent wis-
dom.
The techniques for unwinding
can be found in craniosacral
therapy books such as by
Upledger and Vredevoogd (1983)
and Milne (1998). In unwinding,
the therapist act as a catalyst,
placing the client’s body or body
parts in certain configurations,
and let it “unwind”. The tech-
nique begins quite simply from
the therapist’s touch and the cli-
ent takes over quickly.
Therapist initially induces the
motion in the body, usually by
lifting and holding certain part
of the body so that it removes
the influence of gravity. This
technique is often used when
working with the limbs. Accord-
ing to Kern, when the gravity
effect has been removed, any
strain pattern of the tissues is
holding may become more easily
clarified. Alternatively the thera-
pist can add compression to
main joints in the area, or hold-
ing part of a body in certain re-
laxed position.
The unwinding process can be
carried out on any parts of the
body such as arm, leg, neck or
even jaw. It can also be carried
out for the whole body. The fol-
lowing are some examples:
Arm and shoulder unwinding,
client is supine, and lifting an
arm supporting it under the
therapist’s elbow and wrist, a
light compression towards the
shoulder joint can be added. Af-
ter a while, the therapist will
sense movements.
Leg unwinding 1, client is su-
pine, therapist lifts the client’s
leg with flexed knees, and sup-
ports it by holding at the knee
and ankle. Gentle compression
of the leg towards the hip joint
can be added. After a while, the
therapist will sense some move-
ments.
Leg unwinding 2. Client su-
pine, standing at the foot of the
table, gently hold client’s heels in
cupped hands, lift the fully ex-
tended legs. Gentle compression
Bodywork e-News 19

towards the hip joint or traction
can be added, feel and listen to
the inherent motion. Ankle and
feet can also unwind in this tech-
nique.
Hip joint unwinding, client is
supine with knees flexed. Thera-
pist lifts both legs by the knees
so the thighs form about ninety
degree angle with the hip. Intro-
duce a gentle compression of the
knees towards the hip joint, and
release. Wait and sense for
movement on the legs, and
thighs around the hip joint.
Neck un-
winding,
therapist is
standing
behind a
sitting client.
Place one
hand on top
of the head,
and the
other hand
on the
shoulder. Introduce a gentle
compression to the head, and
release. The therapist will sense
movement on the neck and fol-
low it. Neck unwinding can also
Unwinding
that the movement is not di-
rected by practitioner, but rather
is followed as the body “unwind”.
Great sensitivity and fine palpa-
tion skills are required to carry
out this process. The first re-
quirement is the therapist’s
touch, a client must feel safe un-
happen spontaneously when the der the caring hand, otherwise
performing myofascial tech- unwinding would never happen.
niques such as: suboccipital de- It can begin with observations
compression, or stretching of such as muscles twitching, and
neck flexors (neck under exten- gentle movement: head rocking
sion, and rotation). from side to side. If allowed to
build up momentum, the move-
The following techniques can be
ment can be stronger and the
used to induce Whole body
therapist just need to hold the
unwinding (Upledger and Vre-
body lightly or even moves the
devoogd, 1983):
hands away and the movement
- client seated, will still continue. Sometimes
with one hand unwinding can get very active
on the parietal and aggressive involving the
and the other whole body, looking like “getting
on the poste- the demon out of the body”.
rior upper
In the first experience, client
thoracic re-
usually assumed the therapist is
gions. A slight,
guiding the movement, and
inferiorly-directed compressive
sometimes when made aware of
force exerted on the parietal so
it can stop the movement as it
that the cervical and upper tho-
feels weird that the body is mov-
racic regions are gently com-
ing unconsciously.
pressed caudally.
Upledger suggested that client
- client
will ultimately resume to the
standing fac-
body posture in which the injury
ing the
occurred. Many people feel
therapist,
drawn to unwinding with the
gently com-
intention of relieving trauma
pressing
patterns. The pattern of move-
medially the
ment can be rhythmic but some-
anterior ilia, feel and listen to the
times can be random as well. Af-
inherent motion.
ter a period of time, the move-
The practitioner senses and fol- ment ceases and the unwinding
lows the inherent motion arising is said to have reached a still
from the body. It is important point.
Bodywork e-News 20

In practice, the unwinding pat-
terns are unpredictable. Some
will only show subtle motion,
while others can move vigor-
ously through space. Some sensi-
tive therapists can induce, and
expect unwinding from their pa-
tients, while others never experi-
enced it.
If the client suddenly starts to
unwind, without your
intention, you could
just to support the cli-
ent, and stay out of the
way. When the body
starts unwinding rigor-
ously, it can take over
the session. Clients
usually unwind when
they feel secured and
supported. It is impor-
tant not trying to ana-
lyze and figuring out
and judging what is
happening. Remember,
it is natural process,
and let it flows. Taking
a seminar on unwind-
ing would certainly be
helpful.
Benefits
Unwinding techniques can be
used in conjunction with other
modalities is to release pain or
movement restriction of clients
(not for releasing emotional
problems). Barnes (2000) sug-
gested that myofascial release
and unwinding are the best thing
for anyone with acute injuries,
“spasms will lessen, pain will
Unwinding
diminish and range of motion
will return”. The process is al-
ways gentle, always following the
body’s own demands and is usu-
ally experienced as a very relax-
ing, soothing, and pleasant ex-
perience. Even in painful neck or
frozen shoulder conditions, the
gentle process of unwinding can
be carried out, to encourage and
discover pain-free movement to
the area and restore mobility.
Barret Dorko (2003) character-
ised it with four attributes: ef-
fortless, warmth, muscular sof-
tening, and surprise. The muscu-
lar softening is attributed to the
full expression of muscles, and
the warmth to an increase of
blood flow. The effortless and
surprising qualities of this mo-
tion are both characteristic of
instinctive and unconsciously
motivated movement.
McCarthy and colleagues (2007)
documented the use of unwind-
ing in the treatment of a patient
with chronic neck pain. They
evaluated the outcome of short-
term pain and disability in a pa-
tient with chronic neck and
shoulder girdle pain treated with
just unwinding. Treatment
shows a reduction in pain inten-
sity and perceived disability.
Tissue memory
The metaphors used to ex-
plain fascial unwinding in-
clude: unwinding tangled
telephone wires or twisted
rubber bands. Most com-
mon explanation is that our
tissues hold memory of
trauma, and unwinding will
allow the client’s body to
move to self correction.
Fascia may become short
and tight due to trauma,
poor posture, and physical
stress. Upledger and Vrede-
voogd (1983) described it as
follows:
“When an injuring force occurs,
the tissue which receives the
force is changes. Perhaps it re-
tains the energy of the impact.
The human body the either dissi-
pates that energy and returns to
normal; or the body somehow
localizes the impact energy and
walls it off.” Unwinding at-
tempts to free these stored en-
ergy. (Upledger, 1987)
There are also various theories
regarding memory for traumatic
Bodywork e-News 21

events maybe encoded differ-
ently from other events. The first
is called state-dependent mem-
ory which comes from observa-
tion that memory in one state of
consciousness cannot be recalled
until the person returns to the
same state. Another idea is sug-
gested by Sigmund Freud who
proposed that unwanted memo-
ries can be excluded from aware-
ness, a process called repression.
Recent studies show that a bio-
logical mechanism exists in the
human brain to block unwanted
memories.
Neurobiological fascia the-
ory
Robert Schleip in a fascianating
series of paper (2003a, 2003b)
presented a comprehensive re-
view on the neurobiology of fas-
cia and provide a theory on how
myofascial release works. Fascia
and the autonomic nervous sys-
tem appear to be intimately con-
nected. Fascia is densely inner-
vated by mechanoreceptors
which are responsive to manual
pressure. Myofascial manipula-
tion involves a stimulation of
intrafascial mechanoreceptors
which are then processed by the
central nervous system and auto-
nomic nervous system. The re-
sponse of the central nervous
system changes the tonus of
some related striated muscle fi-
bers. The autonomic nervous
system response includes an al-
tered global muscle tonus, a
change in local vasodilatation
and tissue viscosity, and a low-
Unwinding
client supine and head off the
table, neck supported and under
extension). These techniques are
also known clinically can trigger
unwinding of the neck. Anxiety
levels significantly decreased af-
ter the application of the three
techniques. Heart rate and sys-
tolic blood pressure were modu-
lated during the course of the
ered tonus of intrafascial smooth myofascial techniques, and the
muscle cells. effects were observed up to 20
minutes after the therapy.
Gentler types of myofascial
stretching and cranial tech-
niques also have been shown to
Unwinding as an ideomotor
affect autonomic nervous system.
action
Clinical observations show that
gentle myofascial techniques can First, let us review the idea and
stimulate clients’ involuntary process movement. Andre Ber-
motor reactions such as rapid nard in Ideokinesis summarized
eye movements or muscles it beautifully:
twitching. Study by Zullow and
Reisman (1997) indicated an in- “Movement may be defined as a
crease in parasympathetic activ- neuromusculoskeletal event.
ity as a result of application of This means that in order for
cranial techniques called com- movement to take place, all three
pression of fourth intracranial of the systems alluded to in this
ventricle (CV4) and sacral hold definition—nervous, muscular,
as measured by heart rate vari- and skeletal—must be involved.
ability. Fernandez Perez and col- Each system has its own specific
leagues (2008) recently exam- role to play; the nervous system
ined the effect of
introducing
three myofascial
and craniosacral
techniques on Spa &
the physiologic Massage
changes. The Unwind
three techniques
are suboccipital
muscle decom-
pression, CV4,
and deep cervi-
cal fascia
Unwinding? No, Thanks ..
stretching (with
David will wind me up again when I get home
Bodywork e-News 22

is the messenger, that is, it trans-
mits impulses or messages to the
muscles to contract or release;
the muscle system is the work-
horse or the motor system; the
skeletal system is the support
system that is moved by the
work of the muscles. However,
the nervous system is more than
just a simple messenger. It also
organizes the muscle pattern,
and it does this on a sub-cortical
level, that is, the level below con-
sciousness. Muscle pattern is the
complex of muscles that perform
a desired movement: organizing
the muscle pattern is a highly
complex and sophisticated task.
… If the movement is not done
well, it means the muscle pattern
is poor, and the muscle pattern
is poor because the “wrong”
message (a faulty concept of the
movement) has been sent to the
muscles. This wrong message is
the result of either a lack of clar-
ity about what the movement is
or a previously established poor
muscle pattern associated with
the movement.”
Barret Dorko (2003) suggested
that fascial unwinding can be
explained as ideomotor move-
ment (ideomotion). Ideomotor
action or ideomotion is
“influence of suggestion in modi-
fying and directing muscular
movement, independently of vo-
lition”, a definition given by psy-
chologist and physiologist Wil-
liam B. Carpenter in 1852. Car-
penter used ideomotor action as
an explanation for various phe-
nomena that were being credited
to new physical forces, spiritual
Unwinding
intervention, or other supernatu-
ral causes. Carpenter argued that
muscular movement can be initi-
ated by the mind independently
of our will or emotions. We may
not be aware of it, but sugges-
tions can be made to the mind by
others or by observations. Mus-
cles can be involuntarily acti-
vated by thoughts. Involuntary
muscle movement can manifest
in various ways, for example ask-
ing a subject to think of an activ-
ity is enough to set the muscles
required for that activity into
action.
According to ideomotor theory,
the typical reason for performing
a movement is to produce an ef-
fect in the environment. The
ideomotor principle is based on
two conditions. First, it is re-
quired that movements and their
resulting effects become associ-
ated, it is possible to predict an
effect or outcome given a move-
ment. Second, this association
works in two ways, so that the
anticipation of the required
movement directly triggers the
actions that have been learned to
produce those. This is the differ-
ence between normal sensorimo-
tor and ideomotor learning. It is
easier to illustrate it with an ex-
ample, when playing the piano,
both types of learning may be
present, but sensorimotor map-
ping would associate the finger
movement to the sight of the
musical note, whereas ideomotor
learning would associate the fin-
ger movement to the hearing of
the tone. Similarly in unwinding,
when it is initiated, the move-
ment is guided and associated by
the stretching sensation, finding
areas of ease of movement and
free from pain. Meanwhile in
stretching, the movement is
guided by the therapist’s hand or
cue.
Dorko hypothesized the mecha-
nism of unwinding as follows:
“Muscular pain can arise from
mechanical deformation of vari-
ous tissues. If the movement re-
quired for reducing that injury is
not permitted because of cultural
norms, the body would respond
with an array of isometric con-
traction of muscular activity.” He
further assumed that this muscle
activity is commonly misinter-
preted as a lack of appropriate
relaxation, and subjected to vari-
ous forms of stretching, manipu-
lation or exercise. Manual tech-
niques elicit ideomeotor activity
(unwinding) allows full expres-
sion of the muscles and encour-
age to complete the motor re-
sponse for which the contraction
Bodywork e-News 23
 Unwinding
was activated. The touch by the Central nervous system
therapist is gentle and non-
coercive, with a goal to make the Ideomotor action
client aware of internal motor Sensory input
activity and then get out of the
way of that movement.

Consciousness theory Tissue response Tissue manipulation, Touch, Stimulation of

Stretching, Unwinding mechanoreceptors
Research conducted by Halligan
and Oakley (2000) suggested
that all the thoughts, activities,
ideas, feelings, attitudes and be-
liefs traditionally considered be- Autonomic nervous system
ing the contents of conscious-
ness are produced by uncon- Figure 1. A hypothetical model for fascial unwinding (based on Schleip, 2003b).

scious processes—just like ac-

tions and perceptions. It's only
later that we become aware of
them as outputs when they enter
our consciousness.
In their model, all of the brain’s
information processing activities
are referred to “unconscious”
parts of the brain as Level 2.
Within this level, there must be
some kind of decision-making
device, a central executive struc-
ture (CES). The CES identifies
the most important task the
brain is carrying out at any mo-
ment, and selects the informa-
tion that best describes the cur-
rent state of the brain in relation
to the chosen task. Only this in-
formation would be allowed to
enter Level 1, to produce con-
scious experience.
In a hypnosis trial, Haggard and
colleagues (2004) demonstrated
that an ideomotor response pro-
duced by suggestion is generated
via normal voluntary motor con-
trol systems but experienced as
involuntary, resulting in a con-
scious experience close to that of
a passive movement. Unwinding
or ideomotor process thus repre-
sents dissociation between vol-
untary action and conscious ex-
perience.
A hypothetical model
A hypothetical model employing
the neurobiological and ideomo-
tor action theories was recently
proposed. In the first stage, the
induction process, the therapist
working on a client introduces
gentle touch or stretching onto
the tissue. When client feels safe
and supported, the process is
initiated. The touch stimulates
mechanoreceptors of fascia and
in turn arouses parasympathetic
nervous system response. The
result is that client is in a state of
relaxation and calm, which
sometimes is followed with rapid
eye movement, twitching or deep
breathing. The stimulation also
influences the central nervous
system, which responds with the
introduction of stretching or
movement to areas of ease. This
is under unconscious state and
client remains unaware, indicat-
ing dissociation between volun-
tary action and conscious experi-
ence. This stretching sensation
in turn stimulates a response in
the tissue, providing a feedback
to the central nervous system as
outlined by the theory of ideo-
motor action. The process is re-
peated until the client is relaxed
or reached a “still point”.
Summary
Unwinding is a gentle form of
therapy which can be incorpo-
rated in other form of bodywork.
It is a non-invasive treatment
which responds to the body’s in-
ner demands to release, never
imposing any stress on the tis-
sues. It is generally painless and
brings about a much appreciated
sense of relief, ease, and relaxa-
tion, as well as the more pro-
found therapeutic release of un-

Bodywork e-News 24

derlying chronic conditions.
The effect of myofascial manipu-
lation has been studied from cel-
lular, tissue to whole body level.
Studies have shown that it is im-
possible to generate immediate
and permanent lengthening or
unwinding of the fascia with me-
chanical means. Creating such
changes require a huge amount
of force with longer durations of
stretching. Stimulation of mech-
anoreceptors is the most likely
trigger of such release.
As a bodywork, we can view un-
winding as an application of the
neurobiological concept employ-
ing the self-regulation dynamic
system (Schleip, 2003b). The
therapist working as a facilitator
inducing parasympathetic sys-
tem, paying attention to the state
of autonomic nervous system,
creating unusual sensations with
subtle stimulation, including im-
mediate feedback, and involving
active macro-movement partici-
pation.
As John Upledger (1987) said:
“ I can’t tell you how it works. I
know that the intention of the
therapists has a lot to do with it.
Also the less guarded the patient
is, the quicker it will work.”
References
Barnes, J.F., 1990. Myofascial
Release: The Search for Excel-
lence. A Comprehensive Evalua-
tory and Treatment Approach.
Rehabilitation Services, Inc.,
Unwinding
Paoli, PA.
Barnes, J.F.,
2000. Healing
Ancient
Wounds: The
Renegade's
Wisdom. MFR
Treatment
Centers &
Seminars,
Paoli, PA.
John just like to unwind at the end of a busy day
Dorko, B.L.,
tional Journal of Osteopathic
2003. The analgesia of move-
Medicine 10(4), 104-112.
ment: ideomotor activity and
manual care. Journal of Osteo- Schleip R., 2003a. Fascial plas-
pathic Medicine 6(2), 93-95. ticity – a new neurobiological
explanation. Part 1. Journal of
Haggard, P., Cartledge, P.,
Bodywork and Movement Thera-
Dafydd, M., Oakley, D.A., 2004.
pies 7(1), 11-19
Anomalous control: When ‘free-
will’ is not conscious. Conscious- Schleip R., 2003b. Fascial plas-
ness and Cognition 13(3), 646- ticity – a new neurobiological
654. explanation. Part 2. Journal of
Bodywork and Movement Thera-
Halligan, P.W., Oakley, D.A.,
pies 7(2), 104-116.
2000. Greatest myth of all. New
Scientist 168 (2265), 35-39. Shea, M.J. Autonomic nervous
system. http://ww.cathysheaschool.com/
Milne, H., 1998. The Heart of
articles_15.asp
Listening: A Visionary Approach
to Craniosacral Work: Anatomy, Upledger, J.E., Vredevoogd, J.,
Technique, Transcendence. 1983. Craniosacral Therapy.
North Atlantic Books. Eastland Press, Seattle, WA.
Kern, M., 2005. Wisdom in the Upledger, J.E., 1987. Craniosac-
Body: The Craniosacral Ap- ral Therapy II. Beyond the Dura.
proach to Essential Health. Eastland Press, Seattle, WA.
North Atlantic Books, Berkeley,
Ward, R.C., 2002. Integrated
CA.
Neuromusculoskeletal release
McCarthy, S., Rickards, L.D., and myofascial release In: Foun-
Lucas, N., 2007. Using the con- dations for Osteopathic Medi-
cept of ideomotor therapy in the cine. 2nd ed. Lippincott Wil-
treatment of a patient with liams & Wilkins, Philadelphia,
chronic neck pain: A single sys- PA, pp. 931-965.
tem research design. Interna-
Bodywork e-News 25
Myofascial Release &
Craniosacral Therapy
at
www.terrarosa.com.au

Bodywork e-News 26
Lipoedema
By Kristin Osborn Dip. R.M., Dip. M.Sc., T.A.A.

Lipoedema is a form of lipodys- sive diet or exercise, often this Stages of Lipoe-
trophy (pseudo edema), involv- makes the condition worse dema
ing the accumulation of abnor-
• Is usually triggered around Stage 1: Visual inspec-
mal deposits of adipose (fatty)
Puberty, Pregnancy, Pre- tion is normal. The
tissue in the subcutaneous layer
Menopause and following Gy- surface of the skin is soft and
of the skin. This is a continuous
necological Surgery smooth.
process.
• Patient’s will gain weight in Stage 2: Large fatty lobules are
History
lipoedemic areas and lose it in seen when the skin is squeezed
First identified at the Mayo non-lipoedemic areas between two fingers. There are
Clinic in the United States in small skin deformities and un-
• The basic profile of sufferers
1940, Lipoedema is barely even skin surface.
look like a size 8 from the
known to physicians or to pa-
waist up and a size 16 from Stage 3: Inspection reveals sig-
tients that have the disease.
the waist down nificant deformation of the pro-
Estimates vary widely but range file. Very large, excessive fatty
as high as 11% of the post- lobules are present.
puberty female popula-
tion has the disease.

Main Characteristics

• It usually is inherited

• It occurs almost pre-

dominately in women

• It occurs from the ano-

rexic – morbidly obese

• It occurs bilateral and

symmetrical from the
waist to the ankles,
Stemmer’s Sign
(edema of the forefoot
and toes) is negative

• Lipoedemic fat cannot Anterior View Posterior View

be lost through exces-

Bodywork e-News 27
 Lipoedema
Comparisons: Lower Lymphoedema Versus Lipoedema

Lower Lymphoedema Lipoedema

Pre-Lymphatic Channels Usually Normal

Sex Commonly Female Always Female

Laterality Uni- or Bilateral Bilateral

Symmetry Unusual Yes

Skin Deposits Firm Soft

Skin Temperature Warm Cold

Edema Present Minimal

Pitting Common Rare

Pain on Pressure Varies Yes

Fragility of Blood Vessels Rare Typical

Foot Involved Spared

Cellulitis Yes Rare

Response to Bandaging Tolerated Not Tolerated

but not in bed

Symptoms Treatment • Biker Shorts or Control Briefs

• Sufferers complain of heavy
legs.
• They find it hard to tolerate
compression garments associ-
ated with conventional lym-
phoedema treatment because
the underlying lipoedemic fat
is very painful.
• Palpation is painful
• Bruising is easy because of
the fragility of vascular walls
• Spider or Varicose Veins usu-
ally come hand in hand
• Surgery involving Liposuction
is highly controversial as with
sclerosing injections as this
may cause Secondary Lym-
phoedema
• Dieting for weight loss is un-
warranted for these patients
• Light physical exercise is nec-
essary to avoid recurring
blood infections, fibrosis and
developing morbid obesity
making them immobile
• Class 2 or 3 stockings are to
be worn during the day and a
compression garment at night
are also good to use during
the day
• Manuel Lymphatic Drainage
Therapy is the most com-
monly used technique and
mapping is normal in pure
Lipoedema. MLD is also an
anti-spasmodic which makes
it the perfect treatment for
these patients who may have
some muscular trouble as well.
Please note that MLD
should not be longer than
a 1 hour session in any 1
day.
• Some Herbs such as Horse

Bodywork e-News 28

chestnut help with aching legs
and support of the Venous
System
• No remedial, trigger
point or deep tissue mas-
sage is to be performed on
the limb/s of any patient with
Lipoedema or Lymphoedema
as this could result in increas-
ing the initial problem and
risk of developing clots.
Patient Precautions
• Keep skin moisturized exclud-
ing products containing Min-
eral Oils and Lanolin
• Use Antiseptic on any cuts or
bites
• Keep toes dry
• Use an anti-fungal powder on
toes
• Do not overheat or get sun
burnt on legs
• Don’t overload on proteins
and avoid food containing
saturated fats
• Keep hydrated
• Elevate limbs regularly
• Shave legs with an electric
razor to avoid cuts
Conclusions
Lipoedema is often confused
with obesity and patients are in-
formed to diet and exercise
which often leads to an increase
in the problem.
If Lipoedema was diagnosed
Lipoedema
early, which currently is rare, it Therapy An Osteopathic Lym-
is possible to prevent a signifi- phatic Technique 2nd Edition by
cant expansion of fat cells and Bruno Chickly.
alert patients to their heightened
risk for obesity, if they become
progressively less mobile, so they Kristin Osborn Dip. R.M., Dip.
can take appropriate action. M.Sc., T.A.A., Lymphologist, Cli-
nician, Writer, Member Austral-
These patients often sit in other
asian Lymphology Association
categories of Obesity, Eating
& Lymphoedma Association of
Disorders, and Depression due
Victoria. Newcastle Lymphoe-
to lack of proper diagnosis.
dema Clinic, 28 Cathrine Street,
These patients come to me often
Kotara South, NSW 2289, Ph.
confused about their condition;
(02) 49207010.
they develop low self esteem and
are generally depressed as to the
lack of answers they seek.
The true term Lipoedema is ac-
tually incorrect because in sim-
ple cases, true edema is absent.
In advanced stages of develop-
ment, Lipoedematous tissue may
sometimes develop true edema.
The resulting condition is called
Lipo-Lymphoedema. The edema
associated with Lipoedema has
no pitting and there is no rise in
temperature.
There is no cure for Lipoedema,
so early diagnosis and education
to pre-pubescent females and
GP’s is crucial. Empowering
these women with knowledge
and understanding of their dis-
ease enables them to manage
their problem more easily, gain
self confidence and live a rea-
sonably normal life. I am cur-
rently trying to organize public
seminars for education purposes
in this field for awareness and
understanding of this disease.
Resources: Silent Waves Theory
and Practice of Lymph Drainage
Bodywork e-News 29
If you like this map, we sell a poster version 46 cm x 40 cm. If you don't need it so big, just print the above picture
on your printer with some nice photo paper!

Bodywork e-News 30

Plantar Fasciitis
Chronic plantar heel pain
(CPHP) is one of the most com-
mon conditions affecting the foot.
CPHP has become a generalised
term encompassing a broad
spectrum of conditions affecting
the heel, including subcalcaneal
bursitis, neuritis, plantar fasciitis
and subcalcaneal spur, usually
the true pathology is unclear.
However, plantar fasciitis is con-
sidered to be the most common
cause of pain and the terms are
used interchangeably in the lit-
erature. CHCP has been reported
to account for 15% of all adult
foot complaints requiring profes-
sional care. It is usually observed
in the 40 to 60 year old age
bracket, but has been reported in
people from 7 to 85 years and
appears to be more common in
females. Symptoms typically in-
clude pain under the medial heel
during weight bearing, especially
in the morning and at the begin-
ning of weight-bearing activities.
Plantar fasciitis occurs when the
plantar fascia, the flat band of
tissue that connects your heel
bone to your toes, is strained,
causing weakness, inflammation
and irritation. Plantar fasciitis
can be a frustrating experience,
as the chronic cycle of re-injury
and pain can last for up to one
year.
The classic symptom is the first
step in the morning pain, when
a patient stands in the morning
and has severe heel pain, there's
a high chance it's plantar fasciitis.
Heel pain can also occur when a
patient is off their feet for a
Stretching for
while, e.g. sitting. After inactivity tion, patients have about a 75
and when they start to walk percent chance of needing no
again they get the pain. When it further treatment.
becomes more of a chronic prob-
lem it's going on for months, The study is a two-year follow-
typically start to have pain when up on 82 patients with plantar
standing and at the end of the fasciitis, all of whom were part of
day it becomes worse. an original clinical trial of 101
patients in 2003. The patients
A heel spur is often seen in those were taught a stretch that spe-
suffering from plantar fasciitis. cifically targets the plantar fascia.
It consists of a thin spike of cal-
cification, which lies within the The stretch requires patients to
plantar fascia at the point of its sit with one leg crossed over the
attachment to the calcaneus, or other, and stretch the arch of the
heel bone. While this condition foot by taking one hand and
is commonly present in plantar pulling the toes back toward the
fasciitis, heel spur is not causing shin for a count of 10. The exer-
the problem, it's the micro tear- cise must be repeated 10 times,
ing of the plantar fascia. and performed at least three
times a day, including before
A study conducted at LaTrobe taking the first step in the morn-
University showed the people ing and before standing after a
with CPHP had significantly prolonged period of sitting. More
greater Body Mass Index, a more than 90 percent of the patients
pronated foot posture and were totally satisfied or satisfied
greater ankle dorsiflexion ROM. with minor reservations, and
The authors concluded that peo- noted distinct decrease in pain
ple with CPHP were more likely and activity limitations.
to be obese and to have a pro-
nated foot posture.
A study in the U.S. led by Dr.
Ben DiGiovanni from University
of Rochester suggest that a plan-
tar fascia-specific stretching ex-
ercise is proving quite effective
to help treat and potentially cure
plantar fasciitis. The study pub-
lished in Journal of Bone and
Joint Surgery, found that pa-
tients suffering from the painful
heel spur syndrome had a 75
percent chance of having no pain
and returning to full activity
within three to six months of
performing the stretch. In addi-
Bodywork e-News 31
 Plantar Fasciitis
Most physicians will recommend
a non-surgical approach to treat-
ing plantar fasciitis, advising
anti-inflammatory, foot inserts
and stretches. Surgery occurs in
about five percent of all cases,
and has a 50 percent success rate
of eliminating pain and allowing
for full activity.
“Plantar fasciitis is everywhere,
but we really haven’t had a good
handle on it,” said DiGiovanni.
“The condition often causes
chronic symptoms and typically
takes about nine to 10 months to
burn itself out, and for people
experiencing this pain, that’s
way too long to suffer through
it.”
The Journal of Bone and Joint
Surgery, 2006;88(8):1775-1781.
Irving, DB, Cook, JL, Young,
MA, Menz, HB. Obesity and Pro-
nated Foot Type May Increase
the Risk of Chronic Plantar Heel
Pain: A Matched Case-Control
Study. BMC Musculoskeletal
Disorders. July 2007.
http://www.abc.net.au/rn/
healthreport/stories/2006/
1784908.htm
http://www.urmc.rochester.edu/pr/
news/story.cfm?id=1275
References
DiGiovanni BF et al. Plantar Fas-
cia-Specific Stretching Exercise
Improves Outcomes in Patients
with Chronic Plantar Fasciitis.

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Bodywork e-News 32
 Rwo
Rwo--Shur
Chinese Foot Reflexology
On 1st July 2008, 1008 reflex-
ologists set a new Guinness
World Record in Taiwan for hav-
ing the “most people receiving
foot massage (reflexology) si-
multaneously.”
The record was organised by Tai-
wan Tourism Bureau to promote
health tourism. Reflexology is a
popular practice in Taiwan for
relaxation and improving gen-
eral health; the activity is gaining
popularity among foreign tour-
ists in recent years.
It is known that Traditional Chi-
nese Medicine includes foot re-
flexology from about 2000 years
ago, but do you know that Chi-
nese foot reflexology only comes
to light in the 1980s and is intro-
duced by a Swiss Priest? Foot
reflexology was not really prac-
ticed and virtually unknown in
Taiwan and South East Asia un-
til the 1980s.
It began in 1977 when Father
Josef Eugster, who goes by the
Chinese name Wu Ro-shih (吳若
石), from the Swiss village of
Berneck came to Taiwan's east
coast town of Taitung, where
people pray in shrines and hold
ceremonies by the sea. He was
suffering from severe rheuma-
toid arthritis in his knees. Medi-
cine was of no help, and his phy-
sicians piously told him, a young
man of 37, that the disease was
"the cross you have to carry." A
fellow missionary Brother Law-
rence massaged his foot and
gave him a reflexology treatment.
Few treatments and his arthritis
pain was reduced. He was then
given a book on foot reflexology
"Good Health for the Future," by
Swiss nurse Hedi Masafret.
When he first used reflexology
on himself he could barely stand
the pain, but he kept at it.
Within two weeks, to his amaze-
ment, the arthritis disappeared,
never to return.
Soon after his own healing, Fr.
Josef offered to work on parish-
ioners with chronic diseases,
people on whom doctors had
given up. When an old man was
leaving the church follow-
ing mass, he looked unin-
terested in my sermon and com-
plained of a headache. "I
grabbed his feet, saying, please
give me five minutes”, Fr. Josef
said. "I showed him, here is a
reflex area for your headache
and began massaging it for him."
Fr. Josef found his new method
of preaching. Unlike other West-
ern priests, who often bring rice
or flour to remote villages, Fa-
ther Josef brings his hands.
Though he worked quietly and
locally, word of his success
spread. Eventually he taught
what he knew to 10 Taiwanese
people, who helped him give re-
flexology sessions. Ninety per-
cent of the people came to the
church just for their health prob-
lems, only 10 percent were inter-
ested in the spiritual. But he
never gives up hope.
A drama unfolded when, in 1981,
a woman with hyperthyroidism,
signified by her bulging eyes,
came to him. After receiving
daily sessions for two weeks, her
eyes slowly moved back into
their cavities. After three weeks,
she had recovered. The woman
was Li Wen, a well-known Taipei
broadcaster, and she taped a ra-
dio interview with Fr. Josef,
which led to a television inter-
view. The programs received a
tremendous response in Taiwan,
Bodywork e-News 33

and soon thousands of people
were streaming into Fr. Josef’s
small parish near Taitung, lo-
cated in the southern part of the
country. There are often even
hundreds of people lined up at
the door of the church at mid-
night. One time, he was too ex-
hausted from doing massage and
fell ill with nephritis. I was hos-
pitalized and couldn't do any
massage, so I asked them to go
to the beach to find pebbles to
step on. This became the origin
of "pebble paths" meandering
through many of Taiwan's parks.
Fame has brought its share of
trouble. In 1980, people abusing
his name began prescribing
medicine. His taxes were
checked and the Department of
Health charged him with practic-
ing medicine without a doctor's
certificate. "I even received calls
threatening to kill me," he said.
During this intense period, still
in 1981, he and his workers were
forced to quit their practice.
Thousands of letters from the
Rwo
Rwo--Shur
public, angry with the govern-
ment for banning reflexology,
poured into the offices of the
president and vice president of
Taiwan. The controversy came to
somewhat of a conclusion when
Fr. Josef was invited to speak to
the vice president in Taipei and
explain what was going on. With
the reluctant cooperation of the
health minister, Fr. Josef was
subsequently allowed to con-
tinue his work in a hospital set-
ting for two years, not as an en-
dorsement of reflexology but as a
way to contain it.
At about the same time, the
Church was also pressuring Fr.
Josef to stop, saying that reflex-
ology was not his proper work.
Though he firmly believed that
he was simply doing what Jesus
did in helping people, the strain
was great. He finally took a leave
of absence, resting, praying and
meditating at a Benedictine con-
vent in Israel. There, he came to
some important realizations.
One was that every reflexologist
must first take care of his or her
own health. "This must be taken
seriously," he says. "We can only
do as much work for others as
the amount of good health we
are in." Secondly, he decided
that the future of reflexology in
Taiwan would be best served by
placing his work into the hands
of others. He turned to his
"adoptive" brothers, Josef and
Thonet Tschen to establish the
International Institute for Rwo
Shur Health in April 1982. Re-
flexology theory is then com-
bined with Chinese medicine's
five-elements concept. Gradually,
Fr. Josef’s technique has become
widely known in Asia as the Rwo
Shur Health Method or Fr.
Josef’s reflexology. The Rwo-
Shur technique is now practiced
in Singapore, Malaysia, Japan,
South Korea, Indonesia, and
Mainland China.
There are more than 1,000 foot
massage parlors in Taiwan, Fr.
Josef estimates that 20 percent
of Taiwan's population receives
reflexology sessions regularly.
So what is the difference with
Western Reflexology? According
to Fr. Josef, reflexology theory
divides the foot into 26 bones
Bodywork e-News 34
 Rwo
Rwo--Shur
and five major re- ond phalanges joint to "rub" and
flex areas. To mas- stimulate the reflex point. Some-
sage the foot is to times it can be very aggressive
stimulate the prob- and painful (as with other Chi-
lematic organs or nese bodyworks). The treatment
push away the generally starts with a warm foot
pathological sedi- bath, dipping your foot in a warm
ments. water with salt. Then the pain be- Fr. Josef Eugster in the 1980s
gins, with rigorous reflex points
The reflex point is
Fr. Josef Eugster stimulated from the base, side, flexology Throughout Asia ... And
mainly the same
front and lower part of the legs. Beyond. Massage Magazine, Issue
with the Western chart, but there
Then finishes with warm towel 93, September/October 2001.
maybe few extra or different
wrapping over the feet.
points (see chart). Chinese Re- Taipei Times. Sep 15, 2002.
flexology is more dynamic, rigor- References
ous, and painful. The therapist
Kathryn Treece. Soul Work. How
used their knuckles and the sec-
A Swiss Priest Popularized Re-

Check out our Reflexology Collection

www.terrarosa.com.au/reflexology

Bodywork e-News 35
 The Passivattiva Technique
for the Legs
by Maurizio Ronchi
Editor’s note: The following article is from our fellow and experiences contributed to the development of my
bodyworker from Italy, Mau. Mau has developed the methodology.
passivattiva technique, a type of myofascial release
with application in sports bodywork. This is a rough e- Basically I want to explain how this technique engaging
translation of the original article in Italian. Sorry for active movement by the client with stretching, twisting
the bad English. But I think you will get the idea, Mau and muscle contraction for releasing myofascial adhe-
has kindly shared a range of techniques. If you can sions.
speak Italian, you can view the complete article here: TREATMENT IN SPORTS MASSAGE
http://massaggiosport-bodyworks.spaces.live.com/
The passivattiva myofascial release technique helps to
restore the proper glide between various tissues and
INTRODUCTION thus mobility of joints. This technique, in some cases, is
combined with cross fiber friction or the Cyriax tech-
In this article, I will try to explain how the passivattiva nique.
technique applied in sports massage as an effective
method for releasing fascial adhesions, which can im- When collagen fibers are subjected to trauma, or stress
prove the biomechanics of the body and optimize per- overload, they tend to thicken and become even more
formance in sports. This work is the result of my long random and disorder. It will start to form adhesiveness
experience as an instructor, physical trainer and body- and subsequent retraction of myofascial-linking the
worker for various sports groups. normal dynamic muscle / joints – and limited Range of
First, a clarification: I am neither a medical practitioner Motion.
nor a physiotherapist, but a technical researcher in this All manual bodywork techniques shown in this article
field. This is due to my training in chemical analysis required an active participation by the athlete. Athlete
with experience in biochemistry, trying to identify and involved in active participation in moving, stretching,
understand some of the physiological phenomena that applying torque, contracting, relaxing the muscle or
occur in the myofascial fabric during the application of body parts while the therapist sustain, hold, moves pas-
massage techniques. sively the same
For all these years I had the good fortune to work with muscle or body
biologists, doctors and sports physiotherapists as a part. This is essen-
source of my education, which I continue to revise and / tial to get the best
or develop new techniques for specific sports and ath- treatment result.
letes, or as we called it "Sports-bodyworks".
The passivattiva
To validate the passivattiva technique, a methodology technique can
which I developed for the separation of fascial adhesion, change the visco-
I refer to an excellent study by Robert Schleip, with par- elasticity of the
ticular reference to his article "Fascial plasticity - a new myofascial tissue
neurobiological explanation" where I found a significant (collagen). This
explanation of the biomechanical and biochemical not only due to the
mechanisms involved in the tissue when applying the physical mechan-
passivattiva technique. ics, but also due to
the effects the re-
I want to acknowledge Art Riggs, a highly respected
sponse of stimula-
bodyworker, thanks to his fruitful exchange of views
tion performed on

Bodywork e-News 36
 Passivattiva
mechanoreceptors: corpuscles and Golgi bodies, and
Ruffini Pacini.
We won’t go into too much detail (I recommend reading
the work by Robert Schleip), but it is clear how impor-
tant to respect this kinetic separation condition during
myofascial release, more so on the basis of we got posi-
tive results using this technique. From my experience,
techniques that include passivattiva with manual sepa-
ration of adjacent muscles during the sports massage,
will provide great help to athletes to achieve good ath-
letics performance.
The passivattiva technique is very effective for the types
of muscle spindle or elongated form with a small belly
and long tendons, which often experience stress because
of fascial restriction around the related bone structure,
or are subject to a rotation-tension along their axis be-
cause of adhesions with adjacent muscles or the within
itself. In addition on working the muscles, it is also es-
sential to work on the tendons to break the fibrous ad-
hesions.
"Even before the symptoms appear in troubled tendoni-
tis, collagen tends to degenerate initiating a local in-
flammation. The friction massage on tendon-sheath
plays an important role on the preventive work of in-
flammation caused by excessive workload or fibrous
sheath, because it stimulates the reproduction of colla-
gen to replace the degraded by arranging orderly. So
massage with its specific technical manuals for the sepa-
ration of fibrous adhesions between muscle-fascia-
tendon is a good way for the prevention of accidents
and benefits to the sports" (Whitney Lowe).
"... A well-stretched muscle is able to perform the
broader movement with less stress on its joints. Mobil-
ity studies confirm that perform stretching exercises at
the end of the workout accelerates the recovery ..." (M.
Scuderi, massage therapist).
"Moreover, these adhesions carrying both lateral trac-
tion forces, destabilize the associated fascial compart-
ment, which forces to establish a self muscles -torsion
around its own axis " (Art Riggs).
PRINCIPLES OF THE PASSIVATTIVA TECH-
NIQUE
The technique consists of one hand moving, stretching
the body part, while the other statically holding the
muscles. Through specific positions, with a little help
from the movement by the athlete, the passivattiva tech-
nique reduces the time needed to free the adhesions and
maintain this new state of freedom longer.
The following picture shows performing an initial sepa-
ration, each muscle is treated with manual twist and roll
for further separation of muscle-fascia-muscle, high-
lighting the degree of release from adhesions.
Before moving to read the techniques, it is good to re-
member that once chronic adhesions in a muscle, that
doesn’t allow a proper ROM, for a more effective treat-
ment, we must also treat other muscles in the myofas-
cial chain.
It is worth a while
in working exclu-
sively on a muscle,
but bear in mind
the interaction it
carries in relation
to the fascia and
its kinetic chain.
Fascia wrap and
fill all areas of the
muscle, both in bundles fibrils and in sheets, fascia tend
to shorten in these hotspots - critical points - causing
the well-known problems of mobility in myofascial ar-
ticulation.
So to perform a work on functional separation , it is nec-
essary to relax as much as possible the muscle taut, con-
tract or tighten, so that the fascial adhesion can be effec-
tively removed or relaxed. In the event of excessive
muscle tension, it is good to try to reduce this by treat-
ing first the whole myofascial chain, with the intent to
induce a better relax. Then we can treat the muscle
more easily.
For example if you want to treat thigh muscle Biceps
Femoris, test its entire fascial chain, or by starting with
the lower muscles Peroneus, Gastrocnemius and Soleus,
then the Biceps Femoris, sacral ligaments, Erector Spi-
nae, occipitals and the whole chain on this path.
Or in the case of Tensor of Fascia Lata, begin testing the
Tibialis muscle, the TFL, the interior Oblique, and be-
cause in this case, the chain is a spiral, we will continue
the external Oblique and then go back and towards the
Serratus, Romboids, and ending with the Levator Scap-
ula and Splenius, including the fascia around it. Per-
sonally I follow the myofascial chains from Tom Myers’
Anatomy Trains.
Bodywork e-News 37
 Passivattiva
We will see in detail how to perform such maneuvers.
The key point is to get a cooperation from the athlete,
making aware of the techniques that you are using, ex-
plaining the purpose and the expected results. As you
know, the more it lowers the stiffness or muscle tension,
will enter more in sync with the athlete and the more
effective passivattiva technique will be.
All manual separation and stretching should be per-
formed very slowly, and can be stopped for any reason.
This is because, when we are working deeply on myofas-
cial contractures, adhesions and fibrosis, we must al-
ways have control of the situation, pointing out that you
are not just smearing oil to the body but working with
pressure to release the muscles and tendons.
Based on this consideration, it is better not to put too
much lubrication to the area with oil or creams so we
can keep a good control. As Art Riggs said, if we wanted
to unscrew the cap of a jar of marmalade with your
hands full of oil, you can do that, but ... how much en-
ergy you would waste to unscrew the lid! That is also
translated against athlete; you can also cause excessive
pain for nothing, while the therapist wastes lots of en-
ergy and an excessive load on the joints of the fingers.
Now in order to enter passivattiva technique, let me
first explain the concept with an example: imagine hav-
ing to shoot an object with a camera and try to be as
clear as possible and recognizable from the background.
To get a good detail, we take the picture from different
angles, the more points of view, the more precise will be
the resolution and the end result is a very good picture
after considering many angles. If instead we use a video
camera, the shooting on the move - kinetic - around,
above and below the item will be even more detailed
and more comprehensive, or the best resolution of de-
tail and emphasis on the subject .
An example by relating to passivattiva technical, the
therapist who passively supports the motion and muscle
activation by athlete, can work the muscle and fascia
adjacent to almost 360 degrees, while they stretch, relax
and contract. Thus, particularly the muscles, to be able
to have movement during all the various changes and
position will provide a great benefit to the morphologi-
cal structure.
All this is made even more effective since it will use the
mechanism of “mutual innervations “ between agonist-
antagonist muscles, especially when the work of separa-
tion should be performed on hypertonia, tight or tense
muscle. All movements of the body are made for agree-
ment of muscle co-activation, or synchronicity between
opposing muscle groups during the contraction-
relaxation-stretch, the penalty of static body, not mov-
ing. So the activation of a muscle - agonist - follows a
relaxation of the muscle opposite - antagonist - which
can stretch more. Carryover the classic example, used in
the elongation method of PNF - Proprioceptive Neuro-
muscular Facilitation - how to facilitate the stretching of
the rear thigh muscles, it requires the help by athlete
that must first take the Quadriceps muscle, which in-
nervations result in a mutual relaxation of Hamstring so
it can be easily stretched.
The ultimate purpose of the passivattiva technique is to
have a muscle biomechanically freer in its ROM and
have rebalanced forces related stabilization of the ar-
ticulation.
We can say that the classic myofascial release as a static
camera, while the passivattiva technique is a dynamic
camera - now we shall see in detail.
THE PASSIVATTIVA TECHNIQUE
The first step in passivattiva technique is to warm-up
the area to be treated, or to get a good warm-up for the
fascia, thereby exploiting its thixotropic properties
(viscosity reduction induced by mechanical action) to
obtain the first instance of the first issue of work the
depths. So you start with light touch with the palm of
the hand or forearm to the area. This manual, working
in the development of muscular strength, is not separa-
tion but to prepare for it since it stretches, and flattens
the fascial "wrinkles" and in order for the longitudinal
fibers of collagen that have been tangled while shorten-
ing, make adjustment following a state of mechanical
stress.
This initial phase of myofascial release, is characterized
by slowness and gentle pressure applied, the therapist is
testing the area of the body of the athlete in order to
gain as much information and formulate what is best
target for the continuation of treatment.
As Erik Dalton said "palpation is an art to obtain infor-
mation."
The surface stroke at the beginning of treatment, you
warm-up, soften and release the muscles, they also di-
Bodywork e-News 38
 Passivattiva
rectly become the primary source of information. This It seems even
slow pace and accuracy in work allows our sensors and clearer now why
skin – tactile mechanoceptors - to be in the best condi- we must main-
tion of sensitivity to detect and we know the condition tain a certain
fascial of the athletes. In doing so, the therapist will get slowness in the
lots of the information useful to develop the most effec- implementation
tive strategy to be executed on the athlete. It would be of these deep
frustrated if the technique was applied quickly and too techniques.
sharp. Speed reduces
our tactile sensi-
To complete the image information, please note that tivity, and it is also difficult to immediately stop the
each muscle is part of a joint compartment, and there- stroke in case of problems and, can be quite unpleasant.
fore is useful to test the ROM, which is active-passive, to
highlight any restriction, pain or anything physiological, TOOLS
caused by adhesions and muscle tension induced by the To release adhesions between the muscle to muscle and
same or adjacent muscles. After the manual stroke of muscle to fascia, you can use different tools, depending
the muscles you run the deep stripping strokes, in order on the type of work or the anatomical structure of mus-
to begin to break or release the superficial fascial adhe- cles to be treated. Here are some examples of those
sions. This technique is more of a "friction" than a deep most used. Note once again as for greater effectiveness
stroke, a kind of short duration intense passive stretch- of the passivattiva technique you always start with the
ing. manual of stroke for warming-up and the need for tac-
tile perception by the therapist for understanding the
From this moment onwards, we will apply main pres- real body -muscles- situations.
sure stroke, it is essential that all the techniques of sepa-
ration of deep myofascial run with the tension or -
stretch - or twist - spin stretch - or through a contrac-
tion of various muscles.
This condition is applied both by
passively, that the athlete that acti-
vates isometric muscle contraction.

This is essential for two reasons: the Fig.11 shows strokes using the palm of the hand and
first is to lengthen the muscle fibers forearm.
and fascial bundles towards the
physiologically muscle line forces;
the second is for prevention, the use
heavy deep pressure on the myo-
tendon belly when isn’t contracting,
not only can be painful but also harmful for the athlete.
So as I described for greater effectiveness of the pas-
sivattiva technique, according to the structure and ana-
tomical location of the muscle to handle, not to restrict
the work of separation to a fixed position or static, but
apply the work while the muscle is activated by a grad- Thumbs, fingers and knuckles are generally excellent
ual contraction movement or by stretching. tool for separation of tendons, as in this case by the ex-
tensors tendon of the toes. You run a deep curvilinear
In the case that for some reasons we can not apply the “smiley” technique. This technique is very effective for
technique dynamically, e.g. biomechanical impediment athletes who wear narrow shoes (sprinters, football
or pain, treat muscle by varying as much as possible the players, skaters, climbers etc.).
angle of the associated joint.
The use of knuckles need to increase the pressure or

Bodywork e-News 39
 Passivattiva
force with respect to the fingers and thumbs when re-
quired, saving its overload. For example the Tibialis-
Peroneus treatment (fig.14) if needed a deep work is
much better (last picture) to use knuckles for saving
your fingers from excessive stress on the joints and pha-
langes.
The use of forearm, fist or elbow is necessary for some
type of anatomical muscles or when you need to run a
deep, that is not painful, but more effective and decisive
- not in a rush.
In fig.15, we see a passivattiva technique for separating
the Iliotibial band from Fascia Lata and Vastus Lateralis.
The use of fist and forearm for stripping, followed by
separation with the use of the elbow and finally empha-
size the TFL with twist & roll, a series of twists-turns-
elevation-friction to mobilize all single released from
muscle tension and adhesions.
For the best effectiveness in achieving the purpose of
the manual of separation, it is even more important to
put an image the action of myofascial release, the fin-
gers, the knuckles or other exercise tools on the edges of
the muscle or Fascial area that we are dealing with.
In fig.16 we show the use of the thumbs and elbow for
separation of hamstring muscles, and finalized by the
roll and twist technique to the Biceps femoris.
Once a good position myofascial release with emphasis
on muscle, you proceed with the deep transverse fric-
tion for large muscle mass in order to realign muscle
fibers and fascia in line of force. (fig.17)
The purpose of the twist & roll technique, preferably to
the medium / small size muscles, is to highlight the
muscle throughout its length: its origin, belly-listing
myotendon and periosteum as the anatomical structure
allows us to run (fig.18).
This type of work is needed, in addition to the realign-
ment of myofascial fibers, to release the muscle from
deep adhesions so that they can be free to glide between
the tissues layers and bones, completing the initial
warm-up. This is the real goal of passivattiva technique:
to restore the myofascial imbalances and reach the pos-
sible full ROM, for let to athlete the best sports per-
formance.
Bodywork e-News 40
 Techniques for the Lower Extremities
TECHNIQUES FOR THE LOWER EX-
TREMITIES

The following are some examples of techniques for the

separation of muscles of the lower extremities.

Separation for the Anterior Tibialis and Peroneus from

Gastrocnemius. This technique must be performed with
the therapist passively pressing on the leg while the ath-
lete maintains a slight push isometric against the thera-
pist as to stretch the leg.

Stripping of Tibialis-Peroneus muscles for a first break

of adhesions with the superficial subcutaneous fascia,
the athlete keeps the limb in slight abduction by push-
ing the knee against the outside of his hand.

Fingers for releasing the adhesion between lateral and

medial Gastrocnemius muscle, and Soleus, then freeing
the Peroneus tendons. Run the manual to different an-
gles of knee and a slight foot dorsiflexion hold by athlete.

A different position for the stripping the Tibial and Per-

oneus muscles. The athlete applies a slight isometric
contraction by pushing against the therapist.

This technique is required for myofascial retractions

that inhibit the related joint. That explain the reason we
are going to extend a shortening hypertonia against the
direction of myofascial narrowing, so beside obtaining a
release of fibrous adhesions, it is also stretching the
muscle articulation, relieving it from excessive tension/
traction often due to postural imbalances.

Stages of releasing surfaces myofascial adhesion, a

thumb is separating the two muscle bellies of Gas-
trocnemius , while fingers are releasing it from the So-
leus. Note the excursion of the athlete leg which can be
either passive or active.

Bodywork e-News 41
 Techniques for the Legs

Separation with the thumb for muscles Gastrocnemius

lateral and medial, with the leg in motion. Run or take Stripping technique with the fist for the surface adhe-
up to the dorsi foot flexion and plantar foot flexion. sions of Gastrocnemius and Peroneus. Therapist on a
passive mode while the athlete actively stretching.

Deep muscle release for Gastrocnemius with the elbow.

All these examples for calf muscles show the choice of Twist & Roll technique to stretch the Achilles tendon sheath.
using the best tools to adapt to different types of struc-
ture and muscle mass which may different from one
athlete to the other. Twist & Roll technique
for Gastrocnemius ten-
don. Ask the athlete to
press down lightly to-
wards the ball.

Stroke with the forearm for warming up, required for a

change after achieve viscoelasticity and “ironing” the
fascial wrinkles responsible for shortening and rigidity -
stiffness - the Gastrocnemius-Soleus

Stroke for warming and stretching the Quadriceps and ad-

ductor muscles. Ask for a minimum active contraction.

Following on, with thumbs release/separation. Use dif-

ferent knee angles.

Bodywork e-News 42
 Techniques for the Legs

The stroke becomes more vigorous using fist for stripping

the ITB. Therapist can modulate the pressure by support-
ing the own body weight.

Stages of separation for muscle Rectus Femoris from other

adjacent Quadriceps muscles, moving the leg in passivat-
tiva mode. Is clearly evident here the kinetic contribution
given by athlete.

Stripping the ITB by varying the leg position.

Separation of Rectus femoris from other muscles of the

Quadriceps. Light muscle activation while the athlete
pushes towards the therapist’s hand.

Using the elbow for the separation of ITB from Vastus Lat-
eralis muscle, with different leg positions and always in
passivattiva mode.

Cross muscle friction for the realignment of fibers bundles

of the Quadriceps bellies. Athlete maintains a slight iso-
metric contraction pushing the ball. Change the hip open-
ing angle.

ITB release from subcutaneous connective tissue.

Various leg positions for stroke technique for Tensor Fas-
cia Lata and Iliotibial tract.

Bodywork e-News 43
 Techniques for the Legs

Stroke with stabilizing the pelvic. Initial separation of

the Adductor muscles from subcutaneous fascia.

Forearm stroke for Hamstring muscles, stripping tech-

nique while therapist and athlete moving the leg, in ac-
cordance with passivattiva technique.

Another techniques for the separation of the Adductor

muscles using the forearm and the palm of the hand,
changing the knee and hip angle, and asking to athlete
to hold a slight adduction by the leg. In case of excessive
pelvic rotation, stabilize it with the hand.

Hamstring separation/release with the palm of hand

holding the thigh while the knee is moved internal-
external rotation.

Treatment for the Adductor muscles with thumbs and

fingers, elbow for deeper release if required. In the last
picture, the twist & roll technique.

Twist & roll technique for Hamstring release from sub-

cutaneous connective tissue, with varying the hip angles.

Twist & roll technique for the Adductor muscles, the

therapist moves the leg forward and back supported by
his pelvis, or asking the athlete to hold a slight contrac-
tion by pushing the foot against the therapist ‘s pelvis.

Bodywork e-News 44
 Techniques for the Legs
First adhesion release for Hamstring. Ask the athlete to
slightly push the leg against the therapist’s shoulder.
Athlete holding the leg, and therapist performing a deep
Hamstring separation.
Several
techniques
for hip
external
rotators.
Maurizio Ronchi is a bodyworker, sports athlete, and instruc-
tor. He is 47 years old, and enjoys extreme sports: 100 m
track and long jump, basketball, judo, and climbing. He is a
track and field instructor since 1979, and climbing instructor
since 1992. He is an instructor in wellness massage at AS-
SOTIB school since 2005. Co-teacher in sports massage at
ASSOTIB school since 2006. Sports bodyworker for Vedano
Soccer and Seregno Rugby. In the last 25 years, he has
worked with athletes in various sports. He lived in Monza,
northern Italy. You can contact him at: ik2yxk@libero.it, or
visit his blog (in Italian): http://massaggiosport-
bodyworks.spaces.live.com/
Bodywork e-News 45
 Research Highlight
Alexander Technique
offers long-term relief
for back pain
Alexander technique lessons in
combination with an exercise
programme offer long-term ef-
fective treatment for chronic
back pain, according to a study
published on the British Medical
Journal.
A team of researchers from the
University of Southampton and
the University of Bristol com-
pared the effectiveness of mas-
sage, exercise and the Alexander
technique for the relief of back
pain over one year.
Professor Little and colleagues
recruited 579 patients with
chronic or recurrent back pain
from 64 general practices in the
south and west of England. Pa-
tients were randomised to re-
ceive normal care, massage, six
Alexander technique lessons, or
24 Alexander technique lessons.
Half of the patients from each of
the groups were also prescribed
an exercise programme (brisk
walking for 30 minutes per day
five times a week).
After one year of Alexander tech-
nique lessons, patients reported
fewer days with back pain over
the past four weeks. Patients re-
ceiving normal care reported 21
days of back pain, compared to
those who received 24 lessons of
Alexander technique who experi-
enced 18 fewer days of pain.
Those who had six lessons re-
ported 10 fewer days of pain and
those having massage said they
had seven fewer days of pain.
In addition, patients receiving
Alexander technique lessons re-
ported improved quality of life.
Interestingly, six one-to-one les-
sons in the Alexander technique
followed by exercise had nearly
as much benefit (72%) as 24 les-
sons in the Alexander technique
alone.
The researchers conclude that:
“Massage is helpful in the short
term…[but] the Alexander tech-
nique retained effectiveness at
one year…the results should ap-
ply to most patients with chronic
or recurrent back pain.”
Massage therapy im-
proves pain and mood
for advanced cancer pa-
tients
A new study from the National
Institutes of Health finds that
massage therapy may have im-
mediate benefits on pain and
mood among patients with ad-
vanced cancer. The study ap-
pears in the September 16, 2008
issue of Annals of Internal Medi-
cine.
In a randomized trial of 380 ad-
vanced cancer patients at 15 U.S.
hospices, improvement in pain
and mood immediately following
treatment was greater with mas-
sage than with simple touch.
"When patients near the end of
life, the goals of medical care
change from trying to cure dis-
ease to making the patient as
comfortable as possible," said
Jean S. Kutner, MD, MSPH, As-
sociate Professor of Medicine,
Division of General Internal
Medicine at the University of
Colorado Denver School of
Medicine. "This study is impor-
tant because it shows massage is
a safe and effective way to pro-
vide immediate relief to patients
with advanced cancer."
Pain and depressed mood are
common problems for patients
with advanced cancer. While
drug therapies can reduce symp-
toms, they don't always work
and often have troublesome side
effects. Researchers think that
massage may interrupt the cycle
of distress, offering brief physi-
cal and psychological benefits.
Physically, massage may de-
crease inflammation and edema,
increase blood and lymphatic
circulation, and relax muscle
spasms. Psychologically, mas-
sage may promote relaxation,
release endorphins, and create a
positive experience that distracts
temporarily from pain and de-
pression.
Researchers caution that while
massage may offer some imme-
diate relief for patients with ad-
vanced cancer, the effects do not
last over time, demonstrating the
need for more effective strategies
to manage pain at the end of life.
Bodywork e-News 46
 6 Questions to Whitney Lowe
1. When and how did you decide to become a Whitney Lowe has been a mas-
bodyworker? sage educator for over 17 years.
He is the author of the book,
I was in graduate school studying psychology and get- Orthopedic Massage: Theory
ting kind of burned out at it. I was introduced to mas- and Technique. He researches
sage and thought it would be a great way to integrate and authors articles on pain
with some of the things. I was learning and help me pay and injury assessment tech-
my way through the rest of graduate school. However, I niques in numerous publica-
got so interested in the field, I never went back to finish tions.. Whitney is frequently a
my graduate program and have been in massage ever featured author in Massage
since. Magazine, Massage Today,
2. What do you find most exciting about body- Massage & Bodywork, and
work therapy? Journal of Bodywork and
Movement Therapies.
The incredible diversity of practitioners, perspectives,
and treatment strategies that are effective in gaining After years of clinical research and practice in the
great change for people. healthcare setting, Lowe developed his Orthopedic Mas-
sage approach for massage therapists who treat pain
3. What is your most favourite bodywork book? and injuries with massage therapy. Wanting to help
practitioners challenged with the demands of today's
I'd have to say it's a tie between Donald Neumann's
clients, Lowe spent years in research. His programs and
Kinesiology of the Musculoskeletal system and Andry
books demonstrate his dedication to research-based
Vleeming's Movement, Stability, & Lumbopelvic Pain.
approaches. See his website for more information
4. Which is the most challenging part of your http://www.omeri.com/
work?

Finding time to do all the fascinating things I am inter-

ested in.

5. What advise you can give to fresh massage

therapists who wish to make a career out of it?

Take care of yourself physically and emotionally and

make sure you continue learning. That's what helps
keep it fresh and interesting after many years.

6. How do you see the future of massage ther-

apy?

Growing in a wide variety of directions with spa work,

personal care massage, and the medical applications. I
think our great diversity is one of our wonderful
strengths as a profession.

Bodywork e-News 47
 6 Questions to Diana Haynes
1. When and how did you decide to become a body-
worker?
I took my first certification in 1972 but it wasn't until I got a
job in a physical therapy office some years later that I really
saw the power of massage to help people heal on multiple
levels. In that office, I worked 30 minute sessions 8 hours a
day on patients with every type of injury, disability or disease.
I discovered that massage dramatically improved their recov-
ery process, eased their pain and gave them a sense of em-
powerment in the journey of getting well. I was hooked and
started taking every advanced class I could find to further my
ability to help these patients.
2. What do you find most exciting about bodywork
therapy?
The fact that the gift can go so far beyond the technique that
a person is applying. There is something so profound about
the simple act of caring, the honoring of our hurts that goes
straight from the physical to our deepest spiritual need. Mas-
sage can dissolve isolation as well as scar tissue and heal
wounds that never left a mark. It's this psychospiritual di-
mension that excites me most because it doesn't even require
words and yet can transform a person from the inside out.
3. What is your most favourite bodywork book?
There are so many it's really hard to choose. I'd have to ad-
mit the 2 books that I've used most often over the years
(other than anatomy texts) has been Ben Benjamin's "Listen
to your Pain" and "Functional Assessment in Massage Ther-
apy" by Whitney Lowe. These books helped me when clients
described symptoms that I wasn't familiar with and wasn't
sure if they needed a referral or if I could help them. They're
both very user friendly and have good illustrations unlike
some more medical text books.
4. Which part of the body do you find the most chal-
lenging to work on?
Knees have long been my nemesis, In part because some of
the critical structures aren't reachable without a knife and
the symptoms associated with knee injuries can be so vari-
able.
5. What advise you can give to fresh massage thera-
pists who wish to make a career out of it?
Know yourself and what skills you bring to a business be-
sides your hands. If you don't like marketing or responsibil-
ity, you'll need to find a position where that is done for you,
but expect it to take a 50% bite out of your paycheck. If you
really want the rewards and challenges of running your own
business, get business training and find a good mentor. It
takes incredible persistence, creativity and good planning to
succeed at any business and massage is no different. I have
seen brand new practitioners succeed and more seasoned
therapists fail depending on their commitment to the busi-
ness end of their business. Know what's right for you and
then give it 100%
6. How do you see the future of massage therapy?
One of the things that I've always loved about massage ther-
apy is that it keeps evolving and has so many facets that
there's literally something relevant to every body. In the 60's
massage exploded on the scene as an off shoot of the human
potential movement and was largely focused on overcoming
inhibitions and developing safe sensuality. In the 70's Gestalt
therapy, Alexander technique, Rolfing and Deep Tissue
emerged and dominated the Esalen community. In the 80's
more scientifically based modalities like Neuro-Muscular
Technique, Muscle Energy Technique, CranioSacral, Myofas-
cial Release and several other osteopathic spin offs became
popular along with Reiki and purely energetic approaches to
healing. While the scientific & structural techniques remain
strong, in the 90's I saw a blossoming of the Spa modalities -
lymphatic, hot stone massage, peels and wraps along with
the more exotic Thai massage, Barefoot Shiatsu and Watsu.
Today the massage schools are covering it all and more prac-
tices advertise a plethora of services. The challenge I see,
when you have a 1000 hours of training in multiple modali-
ties, is how to choose what's best for this client today. Unlike
the Starbucks client, who can clearly order exactly what they
want, we don't have a clientele that typically asks for mostly
neuro muscular with a little cranial work, foot reflexology,
some energy balancing and - hold the foam. But that is the
direction that I see - more choices, more sophistication and
more broad appreciation of the manifold benefits of this art.
Diana Haynes has been practicing
various forms of bodywork for over
30 years. Beside owning her own
massage school, she also developed
Yogassage, a blend of yoga and
bodywork. Out of her vast knowl-
edge of massage, she has a special love for Positional Release.
She is the author of the best selling DVDs Positional Release
and Chair Massage.
Bodywork e-News 48
 YOGA
Real Bodywork presents a series of yoga DVD from Gentle Beginner, Rejuve-
nating Restorative, Flowing Intermediate, and Invigorating Advanced. Each
DVD includes more than 3 hours of practice, plus unique pose guide section
that focuses on alignment, variations, benefits and cautions for over 20 yoga
poses! Each Yoga DVD is filmed in beautiful high definition, and includes a
compelling soundtrack and inspiring instruction!

Bodywork e-News 49