Skin Sensitivity in Clients

As our world changes, auto-immune diseases are more prevalent, allergies are more widespread and the choices that we, as therapists, make in our oils and lubricants are more likely to have an impact on our client. Asking about skin sensitivies and allergies ensures that your clients can confirm compatibility with your lubricant and oil choices. Personally, I have known two massage therapists who have developed contact allergies, one to coconut oil, a common ingredient and the other to a specific brand of lubricant. Presumably these two developed their allergies from repeated long-term exposure.

So take heed, vary what oils you use and make sure that your clients don't have any known reactions to what you are using.

Ahhh, the lowly clavicle

The clavicle is such an underappreciated bone. This small strut serves to link our whole upper extremity to our trunk and is the bony connection from the scapula to the sternum. As such, the clavicle serves a very important job. Without the freedom afforded to our clavicle, much of what we know of upper extremity range of motion would be unavailable to us.

Restrictions along the clavicle will impact the range of motion available to the rest of the upper extremity. In order to externally rotate the humerus in abduction, the clavicle must also rotate along its axis with the humerus. It is my experience that easing restrictions along the clavicle will facilitate ease in the upper trapezius muscles and possibly the rhomboids.

A way to gain appreciation for the support the clavicle is through a pressing motion above the head, such as a military press or downward dog. At full extension, the line of force will be through the arms, the scapulae and the clavicles into the sternum.

This post comes as a result of my own experiences with my clavicle the past several days and those of a few recent clients. I encourage any massage therapist to explore the willing clavicles available to them for further research and discovery.

Chapman's Reflexes and Semiotics

On her blog the Healing Presence, Kate Sciandra posted about the juxtaposition of metaphors in "the healing presence". I totally agree that we have great systems forfooling ourselves into thinking we have more "knowing", more control, than we actually do." Clients come to me for stress reduction, often complaining that their stress is mental. It is only once I start to work with them or probe deeper in questions that they remember where they notice it in relation to the rest of their body. As part of my Practitioner training program, I attended a class with Morel Stackhouse about Chapman's system of reflex points. The most striking part of the class was that she commented though we know where these points are located, we don't really know what they do to the body.

For those not familiar, Frank Chapman was an early-20th century osteopath who described a pattern of points which corresponded to various ailments/disorders. Dr. Charles Owens continued Dr. Chapman's work and subsequently documented some of the patterns into a book, "An Endocrine Interpretation of Chapman's Reflexes" .
As Kate stated in her post, "The map is not the territory" and this seemed to be especially true with my experience with this class. It is my understanding that Luann Overmyer conducted a study working with selected Chapman's points, which was discontinued due to a tremendous and overwhelmingly negative response to the work performed. As told to me, the clients all chose to discontinue treatment of their Chapman's points, since they became ill or at least uncomfortable.

The lesson that I took away from Morel's class was acknowledge the existence of Chapman's points as a system, with no expectation of using it for diagnosis (outside of our scope of practice) or for treatment (We don't really know what the result is of treatment of Chapman's points).
Another example of "the more we know, the less we know".

Alignment and reality in relativity: Scoliosis

After a recent visit by a client with scoliosis, I have been contemplating the notion of alignment. Prior experience with scoliosis reminded me that a small amount of change can be very potent. Instead of being oriented to an external level, a person with scoliosis is aligned to their curves. This is to say that what they are accustomed to is not what measures as “level.”

During the session, I was cautious to provide very little structural work in order to "balance" her structure. Knowing that her reality is not one of symmetry but one of curves and rotations which move both anterior/posterior and bilaterally. During the intake, she remarked that she had strong previous "rejections" of therapy, a reminder again, that a little structural change leads to a significant alteration in perception of "reality" or "alignment." Had I set about to work with her entire spine and balanced it according to what she presented with on the table into symmetry, she would most likely have faced much discomfort and pain.

When faced with a client who has scoliosis, ask them what modalities they have had success with and ascertain their goals. Do they want to be "level" and are they prepared for the journey there. Such a journey may not be easy or comfortable, as they have to leave a form of their body that they are accustomed to, in order to change their structure.

Such a transition may not be possible. One possible cause of a scoliosis is a vertebra that is not “square”, causing a lateral distortion in relation to the superior vertebra. It is important to ask the client what information they know about their curvatures (Direction of curves, degree of curvature), anatomy and history of treatment.

In closing, when a client with scoliosis comes to your table, be cautious. Their body may not respond favorably to “level” since it is not what is “normal” to their body. If you undertake structural work with them, ensure that they are prepared for emotional and physical changes.

Why is body awareness important?

Have you ever wondered how you, as a client, can get more from your massage session? Have you ever wondered why your clients keep coming back for the same ailments? One of the causes could be a lack of body awareness.

Our medical society is relied upon to tell us what is wrong with our bodies, rather than allowing our inner senses to tell us when something is wrong. The maxim, "If it hurts, don't do it" is simply not an option. To whit, the athletes that compete and win in events such as Ironman Triathlon, Iditarod, and the Tour de France just to name a few. These individuals push their bodies to the extreme. In order to do this, a person must be well versed in the use and care of their body.

By reflecting on the aches and pains that nag us, we are able to stave off further injury down the road. By asking a client to make a before and after assessment of their body, I am opening the door for them to find words for their sensations. If they are able to make the connections about what changes have happened on the table, then they will have greater access to the changes off the table.

Whenever a client presents to me with a specific problem, I ask for a great deal of feedback. I want to know how their body is responding to the work and I want them to follow the internal changes that are occurring over the course of the session. While the changes may seem more profound if they get to explore only at the end of the session, the client loses out on the process of change. This process allows them to connect their issue to their life (That reminds me of when I ...) and their experience beyond that of the table.

Your clients may just surprise you if you offer them these chances on your table.

The Quest for "Just Right"

In his blog, Ben Crabtree recently discussed 10 modalities or techniques that are commonly available to massage consumers.

I would like to second his statements about Deep Tissue Massage:

"While some massage therapy practitioners use a heavier, sometimes uncomfortable pressure in Deep Tissue Massage it should be noted that a more moderate pressure can reach deep tissues and achieve great results with little discomfort."

While clients continue to request deeper massage, when the depth is sufficient to create guarding or tensing of muscle in a protective reflex, the results are temporary, at best.

My own experience is that this amount of pressure is variable from place to place on each individual person. One aspect of pressure that I have noticed is that sometimes, the skinniest client is the one who is requesting the deepest pressure, while a thicker client may ask for only very light pressure. This is in no way a direct correlation or an absolute. Certain clients in my own practice and that of the massage school where I work have given me pause to think about what shapes these differences. Why can a slight client tolerate heavy-handed pressure which another client of larger build cannot not?

One of the amazing preconceptions that I have encountered as a massage therapist is how effective a light touch can be. This was first brought to my attention during massage school when we were studying a style of lymphatic massage that relies upon feather strokes with infinitesimal pressure in a rapid, repetitious manner. The contact was hardly a fingertip at a time, yet several clients in my student clinic were describing excellent physiological responses to the technique. I have used those same principles in a clinical physical therapy setting with post-operative ACL patients to great benefit.

After starting to study Ortho-Bionomy, I was amazed at how the results which were desired by the client (and in some cases, the physical therapist whom I was working for), without a great deal of exertion or labor. As I have progressed, I have come to appreciate that different clients have different needs and consequently differing pressures.

As a client, it is your responsibility to communicate the pressure desired and if what is being applied is too little or too much. If you don't say anything, the therapist has no knowledge that you would like something other than what they are doing. Similarly, it is the therapist's responsibility to ask during the course of the session if the client would like the pressure modified or the same.

Whether a client or therapist, deep-tissue fan or swedish massage therapist, the amount of pressure applied during the session is always changing and is vital to creating a trusting, relaxing and therapeutic environment.

For more information, you can contact me via email at jonathanwaltonbodyworker (AT) yahoo.com or in Madison, Wisconsin 608-239-6612.

Is there anything I should do in advance to prepare for a massage?

In his post, Terence offers several good points to consider about to prepare for a massage. I would add that scheduling your time after your massage is important, so that you don't have to rush back to work or stress following your session. By allowing yourself time after the massage, you allow the experience to last longer and to transfer into the rest of your world, instead of ending as you get off the table.

I would second that taking an internal inventory of your aches and pains so as to ascertain changes from before to afterwards. By establishing how you feel before and then comparing to afterwards, you get a good sense of what changes were made during the session.

Cross-pollination of principles, continued

Further reading of Thomas Hanna's "The Body of Life" has proven to be very enlightening and is sparking further interest in his form of work. At the Novato Institute for Somatic Research and Training they offer more information how to study his work. Additionally, a colleague of mine is acquainted with a local instructor who was one of Hanna's early students.

In the descriptions of Hanna's work, one common theme that I have noticed is the gentleness and directness by which he describes the sessions.

"Having him lie down on his side, I proceeded to press on his vertebrae, making
comfortable movements [in the direction of least tension]...After twenty minutes
of movements designed to release the extensor muscles on the sides of his lower
spine, Richard was sound asleep."

This story reminds me very much of Lawrence Jones', D.O. discovery of positional release, which he developed into Strain-Counterstrain. When a long-time patient of Jones' arrived at the office with a bilateral psoas contraction on a busy day, Jones had little time to spare for the man who professed that the pain was so severe that he was having great difficulty sleeping. Jones took the time to find a comfortable position for the man, propped up on his back, knees up. Once in this position of comfort, the man fell asleep. Upon waking later, the man found that his contractions had released and his pain was dramatically improved.

Jones was intelligent enough to pursue the rationale for this event and discovered that he could release tight muscles and bring spinal misalignments back into place by placing the patient into a position of comfort.

Arthur Lincoln Pauls, D.O. studied with Jones briefly and built upon Jones' work, eventually creating Ortho-Bionomy. Arthur continued to teach Ortho-Bionomy in the US, Europe and Australia until his death in 1997. His work is very alive in the Society of Ortho-Bionomy International.

Posture and the cross-pollination of principles

Several years ago, I purchased Thomas Hanna's books "Somatics" and "The Body of Life: Creating new pathways for sensory awareness and fluid movement" and I am just now having a chance to look at The Body of Life". One of the things that I found that is so similar to my training in Ortho-Bionomy(R). "When muscle are painfully contracted involuntarily, the last thing one should do is to attempt to pull the muscles and force them to release and lengthen; they will not do so. If one forces the muscle to lengthen, the immediate result is pain and increased involuntary contraction of the muscle."

Much of what my clients seem to expect is a treatment will be painful and will be forceful. However, according to Hanna and the teachings of Arthur Lincoln Pauls, D.O., this is the worst thing that can be done. Instead, as Hanna continues, "I did not try to correct this curvature, but, instead did the reserve. I lightly encouraged the curvature of the low back by softly pressing down on it... As soon at I began doing the work of these muscles for them, a curious thing automatically occurred: They began to relax, because they had no work to do; it was being done for them, so their program of contraction became superfluous."

I look forward to exploring this topic further and seeing what else Hanna has to say. This "unwinding" or "moving into ease" is so pivotal to how I work and what I see as effective bodywork for the resolution of issues instead of a sensation in a given area.

The dynamics of posture

The notion of "Perfect Posture" conjure images of girls in finishing schools with books poised upon their heads. Along with that comes the squaring of the shoulders while slumped in a chair reading or using a computer. "Sit up straight!" we may have been told as children. The idea of a posture that works for all of us is a notion that I find unattainable and therefore sometimes harmful.

If we are continually chasing a perfection that is uncomfortable to our bodies, how is this beneficial. Posture is a dynamic state of equalibrium between gravity and bodies and the loads we place upon our bodies. Posture is a functional state, continually a hair's breadth away from falling down. At any one time, our tonic muscles are firing to pull us back upright, only to relax incrementally to allow the opposing muscle group to fire. This continuous tug-of-war is analagous to having a group of people arranged around a towering pole, each holding a rope connected to the top and each pulling gently as the pole sways away from them. When muscles become tight, the rope becomes taut on both sides of the pole and extra work is exerted on each taut rope.

Our posture is a function of our activities and our body structures (witness a person with an anatomical scoliosis, where vertebrae are not level and square but grew in a fashion that was unequal from right to left). This equation of form (the body we were born with) and function (what has happened to our bodies throughout our lifetime) is a constantly shifting state. We use what we have and we have what we use. Our bodies are remarkable durable and pliable in response to stressors, the forces that act upon it.

One constant for almost all of us is the force of gravity. The simple act of standing in resistance to the Earth's pull places a certain and constant force against our muscles and bones. During orbit, astronauts must replicate these forces to maintain their bone density, lest their bodies remove the calcium and other minerals which give their bones mass due to the lack of stress upon them.

We all choose a certain amount of forces to place upon our bodies and influence the stressors we are subject to. Our hobbies and our professions each have their own unique postural stressors. The increase of "carpal tunnel syndrome" and "thoracic outlet syndrome" are responses to the stresses placed by computers, mice, joysticks and telephones, among others.

Similarly, we can make choices about how we want our bodies to function and make inroads towards those changes. The cyclist who spends the winter on their trainer in a relatively relaxed period may find an adaptation period necessary when they return to stress of the riding in the wind and in a more aerodynamic position. After being subjected to a humerus (upper arm bone) fracture, an 83 year old client's goal in physical therapy was to be able to have sufficient range of motion at the shoulder to do her hair. Through stretching and strengthening exercises along with manual therapy, she was able to return to living by herself. She knew what she wanted her body to be able to do and the physical therapy offered her the means to accomplish this.

As we resist these stressors, they leave an indelible mark upon our bodies, in the form of scarring, increases or decreases in structural (skeletal, muscular, tendinous, fascial) mass, length and tone. We each meet these in a way that allows us to meet the functional goals that we need and/or want. How that happens for each body is unique and different and may not fit the image that our parents and teachers expected from us. The bottom line is that it works. It may be painful, it may create compensation patterns that are injurious to other structures but it works.

Rather than subjecting ourselves to the "perfect posture", we should give ourselves permission to function comfortably and efficiently, while meeting our goals. Next time someone tells you to sit up straight, think about how your body feels and what you want it to do for you.

Body Mechanics

Whether you are a massage therapist, bike racer or secretary, body mechanics are important to reducing pain and energy expenditure. To me, proper body mechanics means "use of energy-efficient movement patterns which are sustainable and distribute workloads so as to reduce chance of injury."

Energy efficiency allows you greater longevity at your endeavor. A cyclist may need an energy reserve to sprint to the finish line. A massage therapist needs to see several clients each day throughout the week to generate their income. A secretary needs to be able complete his/her day without feeling exhausted, allowing him/her to stay focused on task.

Moving in an efficient manner can be examined on a macro-scale or a micro-scale, for example, examining the work done around a specific set of vertebrae or over the trunk and upper body. The idea behind each is the same, but the manner in which each are accomplished is different. By watching for compensation patterns which use extraneous muscles, an accomplished therapist can pinpoint your pattern and them devise a strategy for introducing an alternative pattern that is more efficient.

Distributing workloads over a greater area of the musculoskeletal system means that motions take place over the range of several joints and muscles, instead of just a few. This transfers loads to those muscles that are better capable of sustained work. An example of this is a massage therapist who generates their strokes from their feet and legs, rocking their whole body with the rhythm, instead of pushing with their arms and shoulders. The forces that they are able to generate with their whole body is much greater than what is possible with the smaller muscles and less stable joints of the arms and shoulders.

The importance of use of proper, efficient body mechanics cannot be understated. By targeting assessment to meet goals of pain relief, athletic performance or injury reduction, a skilled therapist will be able to aid you with the movement patterns most efficient for you at the time.

Sports Massage & the promise of Spring

As the thermometers creep upwards and I flip my calendar into March, my mind takes me to the promise of spring. With warmer temperatures, comes visions of cyclists whirring their way around a criterium loop and runners sweating as they complete their races. The common thread among these images is that of exertion, contraction and a need for recovery.

Athletes exert their bodies, stress their muscles and cardiovascular systems and can find themselves to be sore as a result. Controversy exists as to the cause of delayed onset muscle soreness, but there is little controversy about the results of massage post-workout. Massage applied after a competition can decrease your recovery period (how long soreness lasts), aid in transportation of metabolic wastes (lactic acid, etc.) away from muscles and replenish muscles with oxygenated blood full of nutrients. This results in faster healing at micro-trauma sites within muscles, increased capacity for lengthening of muscles and increase in para-sympathetic nervous activity (deeper breathing, relaxation of psoas muscles, increase in bowel activity). All in all, this means that an athlete will be able to return to their activity faster after a hard workout with massage than without.

Many people construe sports massage with "deep massage"; ie. more pressure applied into muscles. However, my experience has been that "sports massage" is a paradigm from which I choose my techniques. For instance, a triathlete who has completed a 15-16 hour race over an Ironman distance (which have a 17 hour cutoff time) will probably not appreciate "deep" work into their muscles due to the volume and intensity of the trauma they have already been through that day. However, an athlete who completes the same distance in 9-11 hours may tolerate this work very easily. The application of few minutes (up to 15 minutes) of effleurage could have a profound effect upon the first competitor by encouraging fluids, such as blood and lymph, to move to areas of the body that can process them.

I often equate sports massage with "focused bodywork to maintain or increase athletic performance." Whether working with an athlete to recover from an event or to refresh their body for a return to their sports, this definition holds much greater value than just "deep massage." By shifting the emphasis to the goal of performance, I am returning to an empirical standard, rather than a limiting set of techniques.

In conclusion, I see ice melting off of my roof and posts for rides on email, all of which serve to set my mind back to sports and the services that I enjoy providing in that arena. By clarifying the definitions of sports massage, I hope that the reader has gained a better handle on the services available from the therapists in their area.

Movement is Life

As of late, I have realized that our bodies work best in a state of movement. For instance, the computer at which I am writing forces me to sit (or stand) in front of the screen. As soon as we constrain our movement, adaptations begin to occur to compensate for it. Muscles shorter, leading to imbalances of muscle tension and pain. Ligaments contract since their limits are not explored beyond "normal".

I see this frequently with the student population which I work with at the University. Hours of sitting in class, sitting studying all leads to very clear patterns of movement. A head-forward posture is almost universal with my clients on campus and low back pain is surprisingly common.

I associate this with how our bodies are made for an alert, erect posture with our head swiveling to allow our stereoscopic vision to spot food and threats. With our society, erect posture becomes "sitting up straight" or "square your shoulders". Our gimbaled neck swings us eyes from one corner of the screen to the other and checks our blind spot. Suddenly, backing out of the driveway becomes painful and difficult.

We seek out massage therapists and bodyworkers and doctors for pain relief. As a bodyworker, I appreciate the patronage afforded to me by this conundrum. I also hope to further educate my clientele about the options that are available to them as a supplement to massage therapy. Whether a low-velocity activity like tai chi or some forms of yoga or a high velocity activity such as aerobics or sports, I see them all as exploring available ranges of motion in the client and therefore as beneficial.

Welcome to the Muscle Engineer

Thank you for visiting muscle-engineer blog. This blog is provided and maintained by Jonathan Walton, aka The Muscle Engineer. A massage therapist and bodyworker for over 8 years, I currently practice in Madison, Wisconsin adjacent to Camp Randall stadium. I envision this as a forum for me to post questions and commentary about my evolving bodywork practice and the challenges that they bring to my door. I welcome your comments and queries as well as welcoming new clients to my practice.

Thank you and stay tuned.
Jonathan