Posted on Wed, Mar 24, 2010
The other day I working on a woman who has chronic complaints in her extremities. As I worked, I had a deeper insight into the origins of her pain, tension and discomfort.
A Case Study: The Servers
Some people are raised to do for others. Their own independent self-expression and the meeting of their own needs, even as very young children, are de-emphasized. They learn rather to obey and serve one or both parents or other close family members.
In that case, it is common for the person to identify their limbs, which with they do their doing, with the people they are raised to serve. When it comes to their own sense of their selves, these kind of folks tend to identify as “me” only their axial system – torso, neck and head.
I recall poignantly a young woman I worked with many years ago. As I was working on her arms, she started crying. I was surprised.
“What’s happening?” I asked.
She told me that as a young girl she had broken her arm. Shortly thereafter, she was, with her family, visiting another family. After dinner, the man of that household recruited the kids to wash the dishes. To her surprise, he asked her, with a recent broken arm, to help wash the dishes.
She looked at her father for help to illuminate this man. But her father just shrugged, unassertive, and didn’t protect his child. She helped wash the dishes, in pain the whole time.
Then, while still crying, she said, “Ever since then my arms have belonged to my father. Today these arms are mine again.”
With this current client, I am emphasizing the limbs and especially the “girdles” of the shoulder and pelvis. The girdles are the outlets for self-expression through the extremities. I have high hopes for this current client that she will soon say, “These limbs are mine again.”
The Role of the Massage Therapist
Helping clients re-own parts of themselves self is an essential part of integrative healthcare. As the poet Derek Walcott said in his poem "Love After Love,"
The time will come
when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other's welcome,
and say, sit here. Eat.
You will love again the stranger who was your self.
Posted on Fri, Mar 19, 2010
Origin: Lateral Tibia
Insertion: Medial cuneiform and first metatarsal
Action: Dorsiflexes, supinates foot, lifts up medial margin of foot, supporting medial
longitudinal arch (Excessive: shin splints)
Antagonist: Peroneus Longus
Like many modern conveniences the concrete sidewalks and roadways of our civilization take back almost as much as they give. They allow for the fairly safe and speedy passage of vehicles, goods and services. They save the pedestrian the chore of slopping through the mud. However, the earth no longer absorbs the impact of our step. We have developed footwear to remedy this situation and in so doing have elevated our so recent paws to the level of high fashion. Still the body and especially the feet, being the closest to the ground, do absorb more than their healthy share of impact. The result is a fantastic rise in foot problems and medical specialists happy to deal with them.
The problem of high heels illuminates the interesting relation of fashion and nature. High heels, like most of our fashions, are designed to increase the sexual attractiveness of the wearer. They accomplish this by elegantly combining human artifice with the imagery of nature. When you wear high heels, which resemble and have a similar feeling to hooves, you cannot safely flex and extend your ankles. Therefore, the prime movers here have to be at the knee and, especially, the hip. As a result, walking in high heels forces one to exaggerate motions of the hip joint and the pelvis lying above it, causing (usually) male attention to be drawn to the suggestively swaying buttocks. However, since the shoes absorb virtually none of the impact of walking, smash the ball of the foot into the pavement, keep the heel in an unnaturally lifted position, causing an abnormal shortening of the whole back of the leg, and, with such rigidities induced, decrease natural circulatory flow – eventually these legs and feet become so hardened and inflexible that they lose the very attractiveness they were intended to accentuate.
The lesson of high heels – if we depend on human technology to provide for us what nature has already abundantly guaranteed – in this case sexual attractiveness – we end up creating sickness.
Motion of the ankle is the key to the health of the lower leg. The tibialis anterior, far from being the dead wooden shin of the cement-walker, can be instead sleek, juicy, powerful…positively edible! Make your client aware that the lower leg is essentially the ankle mover lifting the foot up, brining it down, and side to side. Most people think the lower leg is just there and don’t know what it does. With slow deep friction attempt to convey the sensuality, the full length, strength and the three dimensionality of the tibialis anterior and its partners in dorsiflexion (extensor hallucis longus and extensor digitorum longus).
Above, around the front and the sides of the ankle, the superficial fascia of the leg thickens to break the tendons on their way into the foot. Again our four-leggedness is underlined, as these are basically the same structures as found above the wrist – retinacula. Abnormal thickening of the retinacula of the lower leg and foot may not only create pain due to a strangulation of muscles and vessels, it may also pin down tendons whose freedom is essential for the appropriate alignment of the foot. The tibialis anterior, by pulling up on the medial cuneiform and first metatarsal, helps create the medial longitudinal arch. If it is pinned down by the retinacula, it will in effect lose the contractibility of its lower segment, because the tendon will be functionally separated from the muscle belly, which lies above the retinacula.
One famous story of Ida Rolf is of her working for full hour on just the retinacula of one foot. This shows how important she considered it in the health of the lower limb. Carefully study an illustration of the lower leg, and using it as a guide, try working on the retinacula of a client whose ankles seem to you thick or rigid. Work on and around the retinacula basically as you would on other thickening connective tissues. Use finger pads mostly there, although the flat of the fist may work well on the superior extensor retinaculum. Have the client compare the experience range of motion before and after. Sometimes the change is remarkable!
Posted on Fri, Feb 12, 2010
The scalenes are actually the uppermost of the intercostals muscles, those muscles lying between your ribs that assist inhalation and exhalation. However, big surprise, there are no ribs in the neck! Actually a number of books say the scalenes attach to the vestigial ribs of the cervical vertebrae. That is, little buds appear on the cervical vertebrae that in fish, for instance, would develop into ribs, but in humans they end up being just little bumps to which the scalene muscles attach.
Who ordinarily thinks about breathing with their neck? Yet scalenes do have a very important respiratory function. They may indeed be, next to the diaphragm, the second most important muscles of respiration. The scalenes move the ribcage from above, while the thoracic diaphragm moves it from below.
The anterior scalene runs from the side of the second cervical vertebrae down to the first rib beneath the clavicle. Because it attaches to the front of that rib, the chronic contraction of the anterior scalene is one of the muscles that pulls our head forward; in chronic head-forward posture it is useful to address this muscle among others. The medial and posterior scalenes are more along the side of the neck and therefore have more to do with tilting the head to one side or the other.
It is common in whiplash that the scalenes are injured as the head is whipped forward then forcefully back, slightly tearing some of these muscle fibers through a sudden excessive stretch.
Energetically, the scalenes can be connected with all the virtues and challenges of the neck. The head forward posture can signify sadness, self-esteem issues, reactions to recent or long-held defeats. General neck tension will also manifest in the scalenes. That tension points to all the various reasons for inhibitions or tensions people may have about expressing themselves.
Try this Massage Technique
Here is a very helpful Deep Massage fulcrum which affects the scalenes as well as the superficial posterior neck muscles.
-
Therapist: seated at the head of the table
- Client: supine
- Center yourself
Working on the left side of the scalenes, place your middle finger, assisted by your other fingers, near the origin of the sternocleidomastoid, just above the sternal end of the clavicle. Take out the looseness.
THROUGHOUT THIS TECHNIQUE IT WILL BE BETTER TO USE LESS, RATHER THAN MORE PRESSURE. HONOR THE DELICACY OF THE MUSCLES AND VESSELS HERE!
This fulcrum utilizes the active movement of the client. Ask the client to lift the chin as if looking up. This will take up the slack, stretching the anterior scalenes particularly. Now let us add additional vectors, again in a movement partnership. Ask the client to slowly turn the head to their right, as if to look over the right shoulder. As they move draw your fingers horizontally through the tissues on the left side of the neck. For this whole pass you are at the level of C6 and 7.
You may continue with your tractioning of the fascia all the way back as far as the spinous processes at the center of the neck. In this case, you will have gone considerably past the scalenes, but you will more completely address the soft tissues of the neck pulling them back and with them the head comes back more of top of the body instead of being projected out in front of it.
Now ask your client to bring their head back to center. Begin a second fulcrum, now at the level of the middle of the neck, around C3-5. Repeat each of the steps above. Finally, asking your client to return to center again, begin a third fulcrum at the level of C1-2.
You should repeat these steps on the other side - with the client turning their head to the left, drawing your fingers through the right side of the neck in three passes with movement as described above.
Posted on Tue, Jan 19, 2010
Part three of Massage and the Nervous System. (See parts two and one.)
As massage therapists we know how to get our hands on muscles and connective tissues. But now we see somehow we have to get our hands on the nervous system because otherwise it’s a bit like flipping light switches with no electricity – some action but no deeper change.
So how do we get our hands on the nervous system?
Autonomic Nervous System
The diencephalon houses among other amazing objects, the hypothalamus. The hypothalamus is the primary orienter in our lives toward pleasure and away from pain. A pea-sized structure, it nonetheless is in charge of the endocrine system and the autonomic nervous system. The autonomic nervous system is a full spectrum system which goes to glands, smooth and cardiac muscles, and other organs. It is largely responsible for our most profound reactions to the world. Its experiential spectrum inclines us to the deepest relaxations, to everyday balance, and at its most extreme, to emergency reactions.
A high level of massage therapy can affect the autonomic system in dramatic ways:
- Change the set point – most people are too highly strung and under stress. Massage, especially repeated applications, will change the “set point” of the autonomic nervous system. We slowly begin to feel that more relaxed is more our normal and preferred state rather than being more tense.
- Inhabit the full spectrum – some people have difficulty relaxing; others fully experiencing their excitement. By relieving tension from the muscles and the nervous system, massage facilitates the autonomic “range of motion” so that the person can more fluidly move from one energy state to another.
- Cultivate the fertile mid-ground – “Between living and dreaming there is a third thing.” the poet Machado wrote. Edison used to go to sleep with a rock in his hand. When he fell asleep it would drop and wake him up. He persisted until he could be almost asleep and yet not drop the rock. Why? That was the state, he found, out of which all his inventions flowed. When our unconscious and conscious minds are in communication with each other in this fertile midground of awareness, we are at our most creative.
Massage, inducing more balanced states of mind, emotion and body, allows for the creative utilization of the fertile mid-ground in problem-solving and growth.
Some Controversy
Lately, there has been some controversy over whether the energy-based approach has the same legitimacy as the orthopedic approach to massage.
“Energy” is a commonsense word we all use to describe, among other things, the nervous system and the role of emotion, mind, and electrical intelligence in our lives. We could reduce our understanding of energy to chemistry, but who would rather for example want to give up the term “love”, preferring to tell those you care about that you have a predominance of phenylethylamines in their presence? The language of energy comes closer to capturing and understanding experience, than does that of chemistry.
When we consider the critical role of energy and the nervous system, we see that the myofascial system constitutes just one part of what we need to affect as therapists. To fully support health we need to address both energy and structure.
Let us honor both of these wondrous human worlds. Let us see their unity; affirm that good science takes the whole into account, not just the part; and that good art - and massage is undoubtedly an art as well as a science – empowers peace and promotes harmony in our whole being. That touch which knows how to contact our deepest energy and structure bears the promise of a better life for one and all.
Posted on Fri, Jan 15, 2010
This article was originally published as Back to the Basics: Basics of the Back in Heartland Journal in the summer of 1984.
Our culture over-emphasizes image, appearances, "fronts." The cosmetics and the clothes we wear, even some of the psycho-spiritual trainings around are oriented especially toward the fronts we present. However, the more we focus on the front, the more we neglect backs. The more we ignore our backs, the more thoughtlessness may translate into back pain and/or cowardice, i.e. spinelessness.
Tipping the Scales Backward
The back is a little like chickens crossing roads. It's not that the chicken needs to get to the other side - it is the other side. The chicken is Side B to the front's Side A. Or is it?
Usually, we identify the back with the "backbone," the vertebral column. I once watched a dissection of a man's abdomen and was amazed - slit open the skin of the gut, remove a bit of intestine and what you see there, not deep at all below the surface of the abdomen - the front of the lumbar vertebrae! The spine runs up through the middle of the body. This is an incredibly important corrective to the usual misconception - we ordinarily then the backbone is located at the surface of the back. The reason for this is that the rational mind, naive for all its hight-powered reason, sing those little protrusions running down the middle of the back, concludes those must be the backbone. Actually, they are just the tips of bony tails extending back a considerable distance from the cylindrical bodies of the vertebrae. If the main weight-bearing parts of the spine were all the way in the back, we would be imbalanced, under constant strain not to fall over backward. Now, if you think about it, it's obvious - the backbone's gotta be running up through the center of the body just as the centrality of the main pole in circus tent assures the symmetry, grace and lift of the whole structure.
Leonardo's famous sketch underscores this point. For me it is fascination lies in his depiction of the human as a five-limbed creature, each limb radiating out from the center ("hara" or "tan tein" in the East). Each limb, in it turn, is a long series of bones ending with a structure used at varying stages of evolution for grasping and/or expression. The leg bones end with feet, the arm bones with hands, and the back bones with the head. With this in mind, begin to feel the evolved gesture of the spine - it's really our fifth limb thrusting up through the center of our being, elevating the head so that we may survey the distance from the highest possible vantage point.
The skeletal structure of the back consists of the spinal column and the ribcage. The rear of the ribcage obviously underlies most of the back's surface, but that too seldom is recognized as people identify ribs and notice their movement in the front of the body, but rarely think about or feel the back of the ribcage and its graceful response to breathing.
Five Divisions of the Spine
- The coccyx or tailbone.
- The sacrum, five fused vertebrae lying between the rear wings or ilia of the pelvis.
- The five lumbar vertebrae, running through the center of the waist.
- The 12 thorasic vertebrae, each of which has joints with a rib to either side.
- The seven cervical vertebrae or neck ones.
Although our cervical as well as lumbar vertebrae have no ribs attaching to them now they did at the fishy point of evolution. Therefore these areas are the most free, but by the same token, the most open to distortion. Through injury, postural ignorance or chronic muscle tension, the cervical and/or lumbar vertebrae will often become compressed excessively curved or twisted.
Owning Your Back
To re-own the freedom of your back, remember to appreciate with your self-image and in your movement:
- Your rear ribcage rising and falling, expanding and contracting with each inhale and exhale:
- The beautiful open span of the waist between the ribcage and the pelvis:
- Your neck as a continuation of the back bone gently rising up through he body and up through the middle of your head.
Truly, nature displays her genius in the way our backs work if we will move from malignant neglect to benign appreciation, the back will become a source of beauty, pleasure and strength in our lives.
Get back to your back: Randy Cummins will be teaching a massage continuing education class Thai-Shiatsu Techniques for the Low Back and Hip in February 2010.
Posted on Tue, Jan 12, 2010
Part two of Massage and the Nervous System. (See part one.)
As massage therapists we know how to get our hands on muscles and connective tissues. But now we see somehow we have to get our hands on the nervous system because otherwise it’s a bit like flipping light switches with no electricity – some action but no deeper change.
So how do we get our hands on the nervous system?
Diencephalon
This area in the center of the brain is the seat of emotion, memory, and our “drives”. It is, in spite of the vanity of the cerebral cortex’s verbal narrations, largely what moves us in our lives. The diencephalon lives deeper than words - housing hunger, thirst, anger, sexual desire, sleep-wake cycle, anxiety, all our memories, our deepest convictions, desires, our pleasure, our pain, and our dreams.
The diencephalon is the residence of the “unconscious” of which the great psychotherapist Milton Erickson provocatively said, “The conscious mind is brilliant but the unconscious mind is a hell of a lot smarter.”
The first sense to develop in the embryo is the sense of touch. Touch forms our earliest sensory experiences of the world - these in turn shape the unconscious world of the diencephalon. So, the art and science of touch therapy, at its best, is an ideal medium for communicating with the diencephalon.
Moishe Feldenkrais said a person can’t change without new experience. Expert massage and bodywork is new experience. Our world, initially formed by the ways we are touched, undergoes new, awakening experiences through bodywork which go immediately deeper than the conscious mind and influence our deepest beliefs, motivations, and dreams.
Cerebrum
The cerebrum gives rise to language, self-reflection, conscious thoughts, plans, decisions, and the synthesizing of imagination and logic. With the cerebrum we find the words for what we are feeling. We find support for bringing the tool of language to bear in our problem-solving. Often changes initiated by bodywork at the level of the diencephalon bubble up into cerebral, conscious rememberings, re-examined beliefs, changes of plans, and new insights about one’s body, emotion, mind and spirit.
Subscribe to the Enlightened Body for the next installments of this article by submitting your email address on the form on this page. (We promise never to share your email.) To receive monthly Anatomy Reviews for LMTs, we encourage you subscribe to the TLC Times, our school newsletter newsletter.
Posted on Tue, Jan 05, 2010
This is the first part of a three-part series on Massage and the Nervous System.
When we first learn massage therapy, we naturally visualize that we are working on muscles. Memorizing muscles and seeing their kinesiological relations to each other is a task!
Then we can add to that the wonderful insights drawn from Rolfing and other structurally-oriented manual therapies. Muscles and fascia, when chronically shortened, misalign or compromise the body’s posture and balanced movement. The “tensegrity” model of human structure observes that in natural structural systems, the “hard members,” namely the bones in the body, are aligned and moved by the “soft members”, the muscles and fascia.
I have taught this for years. Yet, some years ago, another light bulb lit up for me. What “tells” the soft tissues to relax or to contract? The nervous system - the body is not only aligned by muscles, but also by the nervous system.
As massage therapists we know how to get our hands on muscles and connective tissues. But now we see somehow we have to get our hands on the nervous system because otherwise it’s a bit like flipping light switches with no electricity – some action but no deeper change.
So how do we get our hands on the nervous system?
Muscles are Sense Organs
Interwoven in our muscles and tendons are nerves called proprioceptors (golgi tendon organs, muscle spindles, etc.). Proprioceptors tell our brain how tense or stretched each muscle is. Through that information the brain constructs the image of our whole body. Then, with a clear picture of the body, we can initiate coherent, coordinated movements. Without proprioception the body “goes to sleep”. Most people - through lack of varied activity, sedentary work, and lack of somatic education - suffer from what Thomas Hanna called “sensori-motor amnesia”. Massage brings enhanced circulation and awareness to our bodies and literally wakes us up.
Subscribe to the Enlightened Body for the next installments of this article by submitting your email address on the form on this page. (We promise never to share your email.) To receive monthly Anatomy Reviews for LMTs, we encourage you subscribe to the TLC Times, our school newsletter newsletter.
Posted on Thu, Dec 31, 2009
I live in Austin, one of the allergy capitals of the world.
And every few years, particularly when our cedar trees bloom, I bloom too - into sinus infflammation.
What is sinusitis? Sinusitis is usually a response to allergens or viruses. Our sinuses are hollow spaces in the bones of the head - the maxillae, ethmoid, sphenoid, and frontal bones.
When you have a sinus issue, first the nasal passages swell, then become somewhat blocked. When the mucus can't flow, it becomes more susceptible to infection.
For these problems, sinus rinses can be helpful both as a preventative and as part of your self-care during a flare-up. I enjoy the plastic bottle and salt packages available from NeilMed Pharmaceuticals.
Here are some key pressure points for sinus pain - although they will not necessarily cure the underlying condition, they offer tremendous relief from the associated pain.
- Place your fingers to either side of the nostrils - "smelling perfume"
- to the middle of forehead, just above and between your eyebrows
- the undersides of each brow near the nose "drilling bamboo"
- to either side just inside of the bones alongside your eyes
- to the place where your index finger and your thumb come together, usually in the "V" part of your palm.
Slide your finger into the depressions you find at these places and apply pressure.
With pain, the tissues surrounding the pain tense up. Therefore, massage may be very helpful applied to the neck, face and cranium. Use light to medium pressure to relieve tensions in the neck, face, jaw and scalp. Self-massage can be very effective if you create a relaxed atmosphere. And, of course, if you can visit a massage therapist who is acquainted with sinus treatment, you will receive even more expert care.
Although many sinus problems will resolve themselves naturally within a week, for any pain that is severe or persists for more than a week, consider seeing a health professional.
Posted on Fri, Sep 18, 2009
Did you know it is basically a law of structure that under compression fascia will "migrate" laterally? Think of pressing down on a beach ball. The more you press, the further out each of its color segments would get.
This is exactly what happens to the pregnant woman under the compression of the extra weight carried during pregnancy. The muscles and fascia under compression particularly in the abdomen and waist migrate laterally.
This means, particularly with back work with this special population, you may need to change the directions of some of your strokes. Particularly many therapists have the habit, which ordinarily feels good, of taking their thumbs and, starting medially near the spinous processes pushing out laterally stretching and spreading the back muscles out.
Ordinarily this can feel quite good. But in the case of pregnancy where these muscles often are already stretched beyond their normal limits and, migrating laterally, the last thing you want to do is make their lives harder.
Instead concentrate on gently pushing the muscles on the lower and mid-back in toward the center. We have a technique in Deep Massage that we teach here that is really effective with these lower back muscles.
Nine Points: Erector Spinae, Multifidus, Quadratus Lumborum
With the client side-lying with pillows supporting the "upper arm" and comfortably between the legs, and the massage therapist along client's right side, facing head (reverse direction for other side).
Gently encourage client to breathe and bring their awareness to the lumbar region. Then place your hand alongside the lateral margin of the lumbar muscles on the side of the body. It is useful to start gently focusing first into the lateral margin of iliocostalis (the lateral-most of the erector spinae muscles).
With the finger pads of your middle finger supported by the first and ring fingers (or with the middle phalange of the first finger supported by the thumb), gently melt down into the lateral margins of the lumbar muscles at three levels in the side: just under the 12th rib, halfway between the 12th rib and the iliac crest, and just above the iliac crest. Your pressure is medial-ward, toward the spine.
First work into the erector spinae, then the multifidus, and finally, the quadratus lumborum. Where you find tension, work gently into it and spend more time melting into these areas with gently curved fingers (or supported middle phalange of first finger).
Regularly check in with client regarding appropriate pressure and movement. Always err on the side of conservativeness, using too little pressure rather than too much. Less is more!
Repeat on the opposite side.
Kate Jordan's 4-day pregnancy massage certification course Bodywork for the Childbearing Year begins in October.
Posted on Fri, Jul 31, 2009
Below I've printed a famous passage from the Old Testament book of Ezekiel. It is the one that gave rise to the gospel song, "Dem Bones", which goes through the body, ending with "neck bone connected to the head bone; Now hear the words of the Lord!"
To me it evokes the deepening experience of life.
When humans, through self-exploration and perhaps through bodywork or conscious bodmind practices such as yoga, discover how we have been disconnected, we begin to seek ways to reconnect within ourselves and with the world around us.
So our dry life, our dry bones can become reinvigorated; our movements become more fluid. Breath enters us and enlivens us. We feel our sinews, our sinuous ability to move and be strong, and our miraculous skin, sensing the world like an eardrum feeling the wind, touch, heat, cold, water, sun, and shape.
Then in Ezekiel the many dry bones arise together and formed an "exceedingly great host".
This says to me that the bones of humanity are not just those of isolated beings. The spirit that breathes life into each of us, is the oxygen/carbon dioxide/spirit that pervade all the spaces between us. We are all connected by the miracle of plantetary gas exchange, the "tissue" of breath between all beings, just as the connective tissues and fluid in joints connect the bones in the body. Each person is thus a bone in the vast skeletal system of terrestrial life.
In the song the words, "neck bone, connected to the head bone; now hear the words of the Lord" mean bring your awareness up through your inner connection, through each bone. When you get to the head, the next connection is with the vast world beyond yourself.
On a related note, Emily Dickinson said, "If I feel physically as if the top of my head were taken off, I know that is poetry."
Finally, "breathe upon these slain, that they may live", lets me know that we should not allow people to die in vain (on the battlefield or otherwise). We redeem the dreams of our ancestors when we genuinely work for world peace and harmony.
Ezekiel 37
The hand of the Lord was upon me, and he brought me out by the Spirit of the Lord, and set me down in the midst of the valley; it was full of bones. And he led me round among them; and behold, there were very many upon the valley; and lo, they were very dry. and he said to me, "Son of man, can these bones live?" and I answered, " O Lord God, thou knowest." Again he said to me, "Prophesy to these bones and say to them, O dry bones, hear the word of the Lord. Thus says the Lord God to these bones: Behold, I will cause breath to enter you, and you shall live. And I will lay sinews upon you, and will cause flesh to come upon you, and cover you with skin, and put breath in you, and you shall live, and you shall know that I am the Lord."
So I prophesied as i was commanded; and as I prophesied there was a noise, and behold, a rattling; and the bones came together, bone to its bone. And as I looked there were sinews on them, and flesh had come upon them, and skin had covered them; but there was not breath in them. Then he said to me, "Prophesy to the breath, prophesy, son of man and say to the breath, Thus says the Lord God: Come from the four winds, O Breath, and breathe upon these slain, that they may live."
So I prophesied as he commanded me, and the breath came into them, and they lived, and stood upon their feet, an exceedingly great host."