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Terra Rosa Bodywork e-News Issue 2, December 2008 Contents 01 Editorial 02 Integrating Diagnosis and

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

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

for the Legs—Maurizio Ronchi 46 Research Highlights 47 Six Questions to Whitney Lowe 48 Six Questions

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.

Terra Rosa

www.terrarosa.com.au

The Source for Massage Information

Bodywork e-News 1

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

Integrating diagnosis and treatment for Bodywork by Kit Laughlin The question of how a therapist

Integrating diagnosis and treatment for Bodywork

by Kit Laughlin

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

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.

DiagnosisDiagnosisDiagnosis &&& TreatmentTreatmentTreatment

Diagnosis & & & Treatment Treatment Treatment The vast majority of muscu- loskeletal problems (including,

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

DiagnosisDiagnosisDiagnosis &&& TreatmentTreatmentTreatment

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

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.

maximise wellbeing, in Austra- lia and around the world. Stretching & Strengthening with Kit Laughlin
Stretching & Strengthening with Kit Laughlin Stretching Books & DVDs by Kit Laughlin with specific

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

with specific pro- grams for Back Pain, Neck & Shoulder Pain & RSI. Available from: www.terrarosa.com.au
with specific pro- grams for Back Pain, Neck & Shoulder Pain & RSI. Available from: www.terrarosa.com.au
with specific pro- grams for Back Pain, Neck & Shoulder Pain & RSI. Available from: www.terrarosa.com.au
The The Spinal Spinal Engine Engine by Erik Dalton PhD Most manual therapists perform gait

TheThe SpinalSpinal EngineEngine

by Erik Dalton PhD

The The Spinal Spinal Engine Engine by Erik Dalton PhD Most manual therapists perform gait analysis
The The Spinal Spinal Engine Engine by Erik Dalton PhD Most manual therapists perform gait analysis

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).

Olympic sprinter’s body might look like (Figure 1). One would expect to see a tiny upper

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.

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.

SpinalSpinalSpinal EngineEngineEngine

Spinal Spinal Spinal Engine Engine Engine Figure 2. Spinal engine is revved-up by counter rotation of

Figure 2. Spinal engine is revved-up by counter rotation of the pelvis and trunk.

Are legs really necessary?

of the pelvis and trunk. Are legs really necessary? Figure 3: Balanced walking on ischial tu-

Figure 3:

Balanced

walking on

ischial tu-

berosities.

Adapted

from

Serge Gra-

covetsky

with per-

mission.

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.

adapta- tions as they apply to the body’s spinal engine. Figure 4: Lats are stretched by

Figure 4:

Lats are stretched by the for- ward swing of the oppo- site arm.

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.

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-

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).

we have an an- terior spiraling spring system (ASSS). Figure 5: ASSS: Oblique abdominal contrac- tion

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

SpinalSpinalSpinal EngineEngineEngine

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).

of discs and facets counter-rotate the pelvis (Fig. 6). Figure 6: Forces transmit- ted to the

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-

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

SpinalSpinalSpinal EngineEngineEngine

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.

DVD’s and accompa- nying book ready for release soon. Erik Dalton, Ph.D., earned his phi- losophy

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

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

AN INTEGRATED APPROACH TO REHABILITATION OF LEG INJURIES by Art Riggs Part 1 “The foot

AN INTEGRATED APPROACH TO REHABILITATION OF

LEG

INJURIES

by Art Riggs

Part 1

“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- geries resulting from my genetic roots of extremely bowlegged peasant (Neanderthal?) ancestry, combined with excessive and, some might say, obsessive ath- letic over-indulgence, I have a virtual PhD of personal research in acute and chronic injuries to the legs and recovery from sur- geries. Through my own experi- ence and the treatment of fellow sufferers, I’ve learned that the best treatment should include a wide range of approaches from soft tissue muscular and fascial work, joint mobilization, stretch- ing, strengthening, and neuro- muscular re-education. Injury to any joint of the leg will necessar- ily impact the joints above and below. In addition to offering specific treatment strategies for the knee, this article will also discuss the complex interplay and feedback loops between muscles and all major joints in

the legs and how to work with compensatory limping patterns that occur after injury.

After my third knee arthroscopy I was highly motivated in my re- habilitation but had considerable problems with recovery in spite of extensive conventional physi- cal therapy treatment of strengthening, stretching, ultra- sound, electrical stimulation, and various anti-inflammatory modalities. I had experienced the all-too-common plight of many patients who are told by their doctors, “A certain percent of these cases just aren’t success- ful.” (as if it is the patient’s fault or he loses by a toss of the dice). Conversely, one client whom I recently treated with a broad ap- proach of soft tissue work to the knee and attention to compensa- tory walking patterns in the feet and hips was complimented by his surgeon that, “…he was a

freak of nature” because of the speed and quality of his recovery compared to other patients of the surgeon.

Today, with the current health insurance restrictions, many pa- tients rarely see their doctors for follow up or for more than per- functory physical therapy after acute knee injuries or after the scars from surgery have healed. I had essentially resolved myself that my surgeries just didn’t work well and that I must accept my fate when a friend twisted my arm to see a physical therapist (or physiotherapist, PT) who es- chewed many of the conven- tional PT modalities and concen- trated upon soft tissue manual therapy. I had never before ex- perienced “bodywork,” but after one treatment of manual work to free up restrictions in the mus- cles and fascia around the knee and some attention to compen-

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.

TreatmentTreatmentTreatment forforfor thethethe LegsLegsLegs

satory holding in my hip and an- kle, I felt that I had a new knee. So I suppose that I was actually lucky to have ex- perienced my knee problems because my as- tonishment at the benefits is what led me into the bodywork field!

at the benefits is what led me into the bodywork field! From Gray’s anatomy Although my

From Gray’s anatomy

Although my in- juries were exten- sive and have re- quired additional surgeries (finally requiring very successful knee replacements be- cause of arthritis), the amazing benefits that I continue to reap from manual therapy are not the proprietary domain of sophis- ticated physical therapy. Unfortu- nately, many mas- sage therapists are hesitant to work with injuries be- cause they are given little in- struction on deal- ing with post- injury or surgery cases except for caveats that instill trepidation. I re- late my personal story to empha- size that with

good manual skills and an un- derstanding of the complex in- terplay of the joints from the foot to the hip, any massage therapist can provide great benefit to their clients. We will focus on the knees, but since injuries to the foot, ankle, and hip often present the same compensatory move- ment patterns as knees, the strategies in this article will be just as helpful for treating these injuries in a holistic manner to return normal gait.

There are no magic bullets or simple strategies for treatment of leg injury, and clients must be treated as unique individuals based upon their particular in- jury or surgery, their experience of pain or dysfunction, and their adaptive compensations in gait. As tempting as it is to move into specific techniques, it is essential to develop an understanding of the complex relationship be- tween all the joints of the leg and how they influence recovery from injury so that therapists can have a logical plan for treat- ment, rather than just trying to work where it hurts or using some technique that looked good in a class or book.

NEUROLOGICAL FACTORS

When manual therapy and con- ventional western medical meth- ods prove to be less than satis- factory, the success of Pilates and somatic therapies like Fel- denkrais® demonstrates the im- portance of treating more than

the specific injury site. The suc- cess of movement therapies is due to their understanding of the kinesiology and neurological patterns of how limping becomes established and hampers healing. It is short-changing your client to focus your attention on just the muscular issues at the injury site without considering joint compensations above and below the site of dysfunction and work- ing to mobilize them.

The movement of the knee through extension and flexion is a sophisticated combination of spinal cord reflexes and con- scious higher order brain func- tion. To greatly simplify: When the quadriceps (the agonists in this case) contract, they extend the knee (the rectus femoris, along with the psoas, can also flex the hip, and will need to be addressed to return normal hip function in the later stages of recovery). In order to facilitate this action, the hamstrings (antagonists) must relax so the two muscle groups aren’t com- peting with each other. Con- versely, in knee flexion the ham- strings contract to flex the knee (or extend the hip if the knee is fixated) while at the same time, the quadriceps must relax. This process of contraction/ relaxation of opposing muscles is called reciprocal inhibition and occurs at an unconscious reflex level in all parts of the body.

If there is pain or soft tissue re- striction in the knee joint, a com- plex series of protective reflexes

TreatmentTreatmentTreatment forforfor thethethe LegsLegsLegs

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- ing normal function to the feet and hips. For now, this chart will give you a map of short muscles that you can begin working with to improve knee function.

TREATMENT STRATEGIES FOR THE KNEE

Even ideal techniques or soft tis- sue strategies may prove less than effective or possibly coun-

strategies may prove less than effective or possibly coun- terproductive if performed with- out considering the

terproductive if performed with- 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

early, thereby increasing inflam- 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-

TreatmentTreatmentTreatment forforfor thethethe LegsLegsLegs

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… sis or delete?)

repeat

for empha-

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

residual pain and fear, so it is crucial to move slowly and within their pain threshold.

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

TreatmentTreatmentTreatment forforfor thethethe LegsLegsLegs

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 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 the tissue is tight and resisting movement.

tell you where the tissue is tight and resisting movement. Photo #2-- Prone Knee Flexion Technique

Photo #2-- Prone Knee Flexion Technique

To insure that you are not stress- ing the knee capsule, be sure to have your client inform you if the restriction feels like it is deep in the joint rather than in the 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 stretch the quadriceps. This is the perfect time to offer your cli- ent suggestions about a home stretching program for rehabili-

tation.

about a home stretching program for rehabili- tation. Photo #3—Supine Knee Flexion This approach affords more

Photo #3—Supine Knee Flexion

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.

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

pulling it in that direction.

allow both hands to work, you may instruct the client to flex her knee by using her hands to pull the knee towards her chest, or use your own body to apply flex- ion pressure to the lower leg.

You can use anchor and

To

ion pressure to the lower leg. You can use anchor and To Photo #4—Seated Quadriceps Work

Photo #4—Seated Quadriceps Work

Good old-fashioned softening of the quadriceps with the forearm

TreatmentTreatmentTreatment forforfor thethethe LegsLegsLegs

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 joint tracking and other neuro- logical movement patterns. An- chor and stretch strokes apply- ing force proximally while stretching the tissue by increas- ing flexion are also very effective for freeing more superficial ad- hesions around the knee joint.

Treatment #3: Freeing the Patella

Even with deep joint injury or surgery, the patella often be- comes restricted and can cause tendinitis and secondary pain. It is unfortunate that many early massage trainings instill fear of working in this important area. Be careful to not compress the patella against the femur when working, but do work for more ease in proximal/distal and lat- eral/medial movement. Tight tissue and tension in the I.T. band and vastus lateralis most often will cause the patella to deviate laterally, so although not shown in this example, any work to lengthen and soften the I.T. band is very helpful. Don’t try to accomplish too much in one ses- sion, but a little work each time will be helpful.

ses- sion, but a little work each time will be helpful. Photo #5—Patellar Mobilization The patella

Photo #5—Patellar Mobilization

The patella will only glide freely when the knee is fully extended (another reason to return full extension to the knee joint as soon as possible). Palpate the difference on yourself by at- tempting to slide your patella back and forth with the knee just slightly bent, as it would be if supported by a bolster in supine position. Now let your knee rest in full extension (without con- tracting the quadriceps) and no- tice how much easier the patella moves. To mobilize the patella, the knee should be extended as straight as is comfortable with- out a bolster.

With the soft, flat border of your thumb, gently lift the patella and slowly mobilize in all directions, waiting at end range of restric- tion for a softening of resistance. In this case, I am actually lifting and tilting the patella with my thumbs slightly below the ante- rior surface so it is not com- pressed against the femur. You can even rotate the patella clock- wise and counterclockwise.

even rotate the patella clock- wise and counterclockwise. Photo #6—Soft Tissue Patellar Work In addition to

Photo #6—Soft Tissue Patellar Work

In addition to mobilizing the pa- tella by working directly with the bone as a lever, it is very impor- tant to soften tissue around the perimeter of the patella that can interfere with tracking. Work slowly in all directions with fin- gers or knuckles and wait for the melt of tissue.

Treatment #4—Freeing the Iliotibial Band

With virtually every knee injury, the I.T. band will become tight and hard. Not only is this un- comfortable or painful for the client, but the tightness causes torsion (strain?) on the knee, pulls the patella laterally, and prevents smooth flexion and ex- tension. The biggest complaint that some clients express for work in this area is that the therapist moves too fast and ex- erts pressure directly into the femur rather than obliquely.

Just softening the tissue will be of substantial benefit, but put- ting the I.T. band on as much as

TreatmentTreatmentTreatment forforfor thethethe LegsLegsLegs

Treatment for for for the the the Legs Legs Legs Photos # 7 & 8 ---Working

Photos # 7 & 8 ---Working with the Iliotibial Band in Side-Lying

a stretch as possible by having the leg extended in the side-lying position will add to the benefit of

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

leg to free it from deeper adhesions is also very helpful Photo #9---Compartment Sepa- ration With

Photo #9---Compartment Sepa- ration

With immobility after injury or surgery, adhesions may form along the anterior or posterior border of the I.T. band. Precise work along either border with

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- 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 This seven volume (over 11 hours) encyclopaedia

Art Riggs

Deep Tissue Massage & Myofascial Release

This seven volume (over 11 hours) encyclopaedia of bodywork gives clear demonstrations of virtually every tissue technique any therapist will need. Seeing them performed live, in real time, offers an educa- tional experience that is impossible to achieve in books alone.

Many massage training videos just show "strokes" without delving into the complex issues of soft tissue restrictions, osseous articula- tions and strategies for working with the multitude of different issues we face as therapists. This extensive series is designed to stimulate creativity and problem solving skills. This valuable resource not only shows countless strokes and strategies, but will, more importantly, demonstrate the art of working with fascia to affect profound change.

“Riggs is to be congratulated for putting together a pleasing and professional set of programs, which I predict will be strewn on the desk of many a therapist —being used, rather than up on a shelf gathering dust. “ Thomas Myers

Available from: www.terrarosa.com.au

Bodywork e-News 16
Bodywork e-News 16
Lomi Lomi Massage Workshop Down Under With Carrie Rowell
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 maintaining a healthy way of life. The strokes are long and flowing, using forearms and elbows, and giving the feeling of many hands on the body at once. All seminars incorporate movement and breath exercises, specific Hawaiian Massage techniques and exercises for self care.

Practitioners work on each other and switch partners to learn how to apply the techniques to differ- ent body types. Individual attention is given by the instructor so that the students learn how utilize their body mechanics in the most efficient way for them. Each day you will learn new exercises and massage techniques designed to harness the power of the elements earth, air, water and fire.

To register your interest and get more details email: terrarosa@gmail.com or carrie@carrierowell.com

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-

fascia unwind- ing to access client’s emo- tion; it mostly deals with the physical manifesta- Bodywork

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

UnwindingUnwindingUnwinding

much speculation, satisfactory Unwinding Unwinding Unwinding scientific descriptions for the events are lacking.” How

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

gently hold client’s heels in cupped hands, lift the fully ex- tended legs. Gentle compression Bodywork

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.

for movement on the legs, and thighs around the hip joint. Neck un- winding , therapist

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

on the neck and fol- low it. Neck unwinding can also Unwinding Unwinding Unwinding happen spontaneously

UnwindingUnwindingUnwinding

it. Neck unwinding can also Unwinding Unwinding Unwinding happen spontaneously when the performing myofascial tech-

happen spontaneously when the performing myofascial tech- niques such as: suboccipital de- compression, or stretching of neck flexors (neck under exten- sion, and rotation).

The following techniques can be used to induce Whole body unwinding (Upledger and Vre- devoogd, 1983):

- client seated,

with one hand on the parietal and the other on the poste- rior upper thoracic re- gions. A slight, inferiorly-directed compressive force exerted on the parietal so that the cervical and upper tho- racic regions are gently com-

pressed caudally.

upper tho- racic regions are gently com- pressed caudally. - client standing fac- ing the therapist,

- client

standing fac- ing the therapist, gently com- pressing medially the anterior ilia, feel and listen to the inherent motion.

the anterior ilia, feel and listen to the inherent motion. The practitioner senses and fol- lows

The practitioner senses and fol- lows the inherent motion arising from the body. It is important

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- der the caring hand, otherwise unwinding would never happen. It can begin with observations such as muscles twitching, and gentle movement: head rocking from side to side. If allowed to build up momentum, the move- ment can be stronger and the therapist just need to hold the body lightly or even moves the hands away and the movement will still continue. Sometimes unwinding can get very active and aggressive involving the whole body, looking like “getting the demon out of the body”.

In the first experience, client usually assumed the therapist is guiding the movement, and sometimes when made aware of it can stop the movement as it feels weird that the body is mov- ing unconsciously.

Upledger suggested that client will ultimately resume to the body posture in which the injury occurred. Many people feel drawn to unwinding with the intention of relieving trauma patterns. The pattern of move- ment can be rhythmic but some- times can be random as well. Af- ter a period of time, the move- ment ceases and the unwinding is said to have reached a still point.

UnwindingUnwindingUnwinding

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.

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

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:

Upledger and Vrede- voogd (1983) described it as follows: the area and restore mobility. Benefits Unwinding

the area and restore mobility.

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

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.

“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

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-

UnwindingUnwindingUnwinding

tissue viscosity, and a low- Unwinding Unwinding Unwinding ered tonus of intrafascial smooth muscle cells. Gentler

ered tonus of intrafascial smooth muscle cells.

Gentler types of myofascial stretching and cranial tech- niques also have been shown to affect autonomic nervous system. Clinical observations show that gentle myofascial techniques can stimulate clients’ involuntary motor reactions such as rapid eye movements or muscles twitching. Study by Zullow and Reisman (1997) indicated an in- crease in parasympathetic activ- ity as a result of application of cranial techniques called com- pression of fourth intracranial ventricle (CV4) and sacral hold as measured by heart rate vari- ability. Fernandez Perez and col- leagues (2008) recently exam- ined the effect of introducing three myofascial and craniosacral techniques on the physiologic changes. The three techniques are suboccipital muscle decom- pression, CV4, and deep cervi- cal fascia stretching (with

pression, CV4, and deep cervi- cal fascia stretching (with client supine and head off the table,

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 myofascial techniques, and the effects were observed up to 20 minutes after the therapy.

Unwinding as an ideomotor action

First, let us review the idea and process movement. Andre Ber- nard in Ideokinesis summarized it beautifully:

“Movement may be defined as a neuromusculoskeletal event. This means that in order for movement to take place, all three of the systems alluded to in this definition—nervous, muscular, and skeletal—must be involved. Each system has its own specific role to play; the nervous system

Spa & Massage Unwind
Spa &
Massage
Unwind

Unwinding? No, Thanks David will wind me up again when I get home

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

UnwindingUnwindingUnwinding

new physical forces, spiritual Unwinding Unwinding Unwinding intervention, or other supernatu- ral causes. Carpenter

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

was activated. The touch by the therapist is gentle and non- coercive, with a goal to make the client aware of internal motor activity and then get out of the way of that movement.

Consciousness theory

Research conducted by Halligan and Oakley (2000) suggested that all the thoughts, activities, ideas, feelings, attitudes and be- liefs traditionally considered be- ing the contents of conscious- ness are produced by uncon- 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-

UnwindingUnwindingUnwinding

Central nervous system

Ideomotoraction
Ideomotoraction
Unwinding Unwinding Central nervous system Ideomotoraction Sensoryinput Tissueresponse Tissuemanipulation, Touch,

Sensoryinput

Tissueresponse
Tissueresponse

Tissuemanipulation, Touch, Stretching, Unwinding

Stimulation of

mechanoreceptors

Stretching, Unwinding Stimulation of mechanoreceptors Autonomic nervous system Figure 1. A hypothetical model for
Stretching, Unwinding Stimulation of mechanoreceptors Autonomic nervous system Figure 1. A hypothetical model for
Stretching, Unwinding Stimulation of mechanoreceptors Autonomic nervous system Figure 1. A hypothetical model for

Autonomic nervous system

Figure 1. A hypothetical model for fascial unwinding (based on Schleip, 2003b).

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-

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.,

UnwindingUnwindingUnwinding

Paoli, PA.

Barnes, J.F.,

2000. Healing

Ancient

Wounds: The

Renegade's

Wisdom. MFR

Treatment

Centers &

Seminars,

Paoli, PA.

Wisdom. MFR Treatment Centers & Seminars, Paoli, PA. John just like to unwind at the end
Wisdom. MFR Treatment Centers & Seminars, Paoli, PA. John just like to unwind at the end

John just like to unwind at the end of a busy day

Dorko, B.L.,

2003. The analgesia of move-

ment: ideomotor activity and manual care. Journal of Osteo-

pathic Medicine 6(2), 93-95.

Haggard, P., Cartledge, P., Dafydd, M., Oakley, D.A., 2004. Anomalous control: When ‘free-

will’ is not conscious. Conscious- ness and Cognition 13(3), 646-

654.

Halligan, P.W., Oakley, D.A.,

2000. Greatest myth of all. New

Scientist 168 (2265), 35-39.

Milne, H., 1998. The Heart of Listening: A Visionary Approach to Craniosacral Work: Anatomy, Technique, Transcendence. North Atlantic Books.

tional Journal of Osteopathic Medicine 10(4), 104-112.

Schleip R., 2003a. Fascial plas- ticity – a new neurobiological explanation. Part 1. Journal of Bodywork and Movement Thera- pies 7(1), 11-19

Schleip R., 2003b. Fascial plas- ticity – a new neurobiological explanation. Part 2. Journal of Bodywork and Movement Thera- pies 7(2), 104-116.

Shea, M.J. Autonomic nervous

system. http://ww.cathysheaschool.com/

articles_15.asp

Upledger, J.E., Vredevoogd, J., 1983. Craniosacral Therapy. Eastland Press, Seattle, WA.

Kern, M., 2005. Wisdom in the Body: The Craniosacral Ap- proach to Essential Health. North Atlantic Books, Berkeley, CA.

McCarthy, S., Rickards, L.D., Lucas, N., 2007. Using the con- cept of ideomotor therapy in the treatment of a patient with chronic neck pain: A single sys- tem research design. Interna-

Upledger, J.E., 1987. Craniosac- ral Therapy II. Beyond the Dura. Eastland Press, Seattle, WA.

Ward, R.C., 2002. Integrated Neuromusculoskeletal release and myofascial release In: Foun- dations for Osteopathic Medi- cine. 2nd ed. Lippincott Wil- liams & Wilkins, Philadelphia, PA, pp. 931-965.

Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au

Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au

Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au
Myofascial Release & Craniosacral Therapy at www.terrarosa.com.au

Lipoedema

By Kristin Osborn Dip. R.M., Dip. M.Sc., T.A.A.

Lipoedema is a form of lipodys- trophy (pseudo edema), involv- ing the accumulation of abnor- mal deposits of adipose (fatty) tissue in the subcutaneous layer of the skin. This is a continuous process.

sive diet or exercise, often this makes the condition worse

Is usually triggered around Puberty, Pregnancy, Pre- Menopause and following Gy- necological Surgery

Stages of Lipoe- dema

Stage 1: Visual inspec- tion is normal. The surface of the skin is soft and smooth.

Patient’s will gain weight in lipoedemic areas and lose it in non-lipoedemic areas

The basic profile of sufferers look like a size 8 from the waist up and a size 16 from the waist down

Stage 2: Large fatty lobules are seen when the skin is squeezed between two fingers. There are small skin deformities and un- even skin surface.

Stage 3: Inspection reveals sig- nificant deformation of the pro- file. Very large, excessive fatty lobules are present.

History

First identified at the Mayo Clinic in the United States in 1940, Lipoedema is barely known to physicians or to pa- tients that have the disease.

Estimates vary widely but range as high as 11% of the post- 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

Sign (edema of the forefoot and toes) is negative • Lipoedemic fat cannot be lost through

Lipoedemic fat cannot be lost through exces-

Anterior View

Posterior View

LipoedemaLipoedemaLipoedema

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

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

Biker Shorts or Control Briefs 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

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

LipoedemaLipoedemaLipoedema

early, which currently is rare, it is possible to prevent a signifi- cant expansion of fat cells and alert patients to their heightened risk for obesity, if they become progressively less mobile, so they can take appropriate action.

These patients often sit in other categories of Obesity, Eating Disorders, and Depression due to lack of proper diagnosis. These patients come to me often confused about their condition; they develop low self esteem and are generally depressed as to the lack of answers they seek.

Therapy An Osteopathic Lym- phatic Technique 2nd Edition by Bruno Chickly.

Kristin Osborn Dip. R.M., Dip. M.Sc., T.A.A., Lymphologist, Cli- nician, Writer, Member Austral- asian Lymphology Association & Lymphoedma Association of Victoria. Newcastle Lymphoe- dema Clinic, 28 Cathrine Street, Kotara South, NSW 2289, Ph. (02) 49207010.

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

If you like this map, we sell a poster version 46 cm x 40 cm.

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!

Stretching Stretching Stretching for for for Plantar Plantar Plantar Fasciitis Fasciitis Fasciitis Chronic plantar heel

StretchingStretchingStretching forforfor

PlantarPlantarPlantar FasciitisFasciitisFasciitis

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

while, e.g. sitting. After inactivity and when they start to walk again they get the pain. When it becomes more of a chronic prob- lem it's going on for months, typically start to have pain when standing and at the end of the day it becomes worse.

A heel spur is often seen in those

suffering from plantar fasciitis.

It consists of a thin spike of cal-

cification, which lies within the

plantar fascia at the point of its attachment to the calcaneus, or heel bone. While this condition

is commonly present in plantar

fasciitis, heel spur is not causing the problem, it's the micro tear-

ing of the plantar fascia.

A study conducted at LaTrobe

University showed the people with CPHP had significantly greater Body Mass Index, a more pronated foot posture and greater ankle dorsiflexion ROM. The authors concluded that peo- ple with CPHP were more likely 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-

tion, patients have about a 75 percent chance of needing no further treatment.

The study is a two-year follow- up on 82 patients with plantar fasciitis, all of whom were part of an original clinical trial of 101 patients in 2003. The patients were taught a stretch that spe- cifically targets the plantar fascia.

The stretch requires patients to sit with one leg crossed over the other, and stretch the arch of the foot by taking one hand and pulling the toes back toward the shin for a count of 10. The exer- cise must be repeated 10 times, and performed at least three times a day, including before taking the first step in the morn- ing and before standing after a prolonged period of sitting. More than 90 percent of the patients were totally satisfied or satisfied with minor reservations, and noted distinct decrease in pain and activity limitations.

or satisfied with minor reservations, and noted distinct decrease in pain and activity limitations. Bodywork e-News

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.”

PlantarPlantarPlantar FasciitisFasciitisFasciitis

Plantar Plantar Plantar Fasciitis Fasciitis Fasciitis References DiGiovanni BF et al. Plantar Fas- cia-Specific

References

DiGiovanni BF et al. Plantar Fas- cia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis.

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

Thumbsavers(R) is an effective tool that assists ther apists by providing support and reducing the

Thumbsavers(R) is an effective tool that assists therapists by providing support and reducing the stress on your joints and wrists from deeper tissue massages, while protecting your most valuable commodity: your thumbs & hands! Thumbsavers is so unique that it cannot be called a "tool" because your thumbs and fingers are actually inside them. Has been used by many Therapists in Australia with great results.

used by many Therapists in Australia with great results. Thumbsavers can be used for: Trigger Point

Thumbsavers can be used for: Trigger Point therapy, Deep tissue massage/ neuromuscular therapy, Chair Massage, Acupressure, Shiatsu, Thai Massage, Reflexology, Equine Massage.

With Thumbsavers, you can: Massage deeper and work longer, Reduce fatigue and joint Pain, Reduce carpal tunnel syndrome, Alleviate wrist, thumb and joint fatigue and pain.

Reduce carpal tunnel syndrome, Alleviate wrist, thumb and joint fatigue and pain. Available at: www.terrarosa.com.au

Available at: www.terrarosa.com.au

Rwo Rwo Rwo - - - Shur Shur Shur Chinese Chinese Chinese F F F

RwoRwoRwo---ShurShurShur ChineseChineseChinese FFFootootoot ReflexologyReflexologyReflexology

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

), 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

piously told him, a young man of 37, that the disease was "the cross you have

"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

people on whom doctors had given up. When an old man was leaving the church follow-

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,

and soon thousands of people were streaming into Fr. Josef’s small parish near Taitung, lo-

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

RwoRwoRwo---ShurShurShur

of letters from the Rwo Rwo Rwo - - - Shur Shur Shur public, angry with

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

that every reflexologist must first take care of his or her own health. "This must be

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

Fr. Josef Eugster and five major re- flex areas. To mas- sage the foot is

Fr. Josef Eugster

and five major re- flex areas. To mas- sage the foot is to stimulate the prob- lematic organs or push away the pathological sedi- ments.

The reflex point is

mainly the same with the Western chart, but there maybe few extra or different points (see chart). Chinese Re- flexology is more dynamic, rigor- ous, and painful. The therapist used their knuckles and the sec-

RwoRwoRwo---ShurShurShur

ond phalanges joint to "rub" and stimulate the reflex point. Some- times it can be very aggressive and painful (as with other Chi- nese bodyworks). The treatment generally starts with a warm foot bath, dipping your foot in a warm water with salt. Then the pain be- gins, with rigorous reflex points stimulated from the base, side, front and lower part of the legs. Then finishes with warm towel wrapping over the feet.

References

finishes with warm towel wrapping over the feet. References Fr. Josef Eugster in the 1980s flexology

Fr. Josef Eugster in the 1980s

flexology Throughout Asia

Beyond. Massage Magazine, Issue 93, September/October 2001.

And

Taipei Times. Sep 15, 2002.

Kathryn Treece. Soul Work. How A Swiss Priest Popularized Re-

Check out our Reflexology Collection

A Swiss Priest Popularized Re- Check out our Reflexology Collection www.terrarosa.com.au/reflexology Bodywork e-News 35
A Swiss Priest Popularized Re- Check out our Reflexology Collection www.terrarosa.com.au/reflexology Bodywork e-News 35
A Swiss Priest Popularized Re- Check out our Reflexology Collection www.terrarosa.com.au/reflexology Bodywork e-News 35
A Swiss Priest Popularized Re- Check out our Reflexology Collection www.terrarosa.com.au/reflexology Bodywork e-News 35
A Swiss Priest Popularized Re- Check out our Reflexology Collection www.terrarosa.com.au/reflexology Bodywork e-News 35
A Swiss Priest Popularized Re- Check out our Reflexology Collection www.terrarosa.com.au/reflexology Bodywork e-News 35

TheTheThe PassivattivaPassivattivaPassivattiva TechniqueTechniqueTechnique

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Editor’s note: The following article is from our fellow bodyworker from Italy, Mau. Mau has developed the passivattiva technique, a type of myofascial release with application in sports bodywork. This is a rough e- translation of the original article in Italian. Sorry for the bad English. But I think you will get the idea, Mau has kindly shared a range of techniques. If you can speak Italian, you can view the complete article here:

INTRODUCTION

In this article, I will try to explain how the passivattiva technique applied in sports massage as an effective method for releasing fascial adhesions, which can im- prove the biomechanics of the body and optimize per- formance in sports. This work is the result of my long experience as an instructor, physical trainer and body- worker for various sports groups.

First, a clarification: I am neither a medical practitioner nor a physiotherapist, but a technical researcher in this field. This is due to my training in chemical analysis with experience in biochemistry, trying to identify and understand some of the physiological phenomena that occur in the myofascial fabric during the application of massage techniques.

For all these years I had the good fortune to work with biologists, doctors and sports physiotherapists as a source of my education, which I continue to revise and / or develop new techniques for specific sports and ath- letes, or as we called it "Sports-bodyworks".

To validate the passivattiva technique, a methodology which I developed for the separation of fascial adhesion,

I refer to an excellent study by Robert Schleip, with par-

ticular reference to his article "Fascial plasticity - a new neurobiological explanation" where I found a significant explanation of the biomechanical and biochemical mechanisms involved in the tissue when applying the passivattiva technique.

I want to acknowledge Art Riggs, a highly respected

bodyworker, thanks to his fruitful exchange of views

by Maurizio Ronchi

and experiences contributed to the development of my methodology.

Basically I want to explain how this technique engaging active movement by the client with stretching, twisting and muscle contraction for releasing myofascial adhe- sions.

TREATMENT IN SPORTS MASSAGE

The passivattiva myofascial release technique helps to restore the proper glide between various tissues and thus mobility of joints. This technique, in some cases, is combined with cross fiber friction or the Cyriax tech- nique.

When collagen fibers are subjected to trauma, or stress overload, they tend to thicken and become even more random and disorder. It will start to form adhesiveness and subsequent retraction of myofascial-linking the normal dynamic muscle / joints – and limited Range of Motion.

All manual bodywork techniques shown in this article required an active participation by the athlete. Athlete involved in active participation in moving, stretching, applying torque, contracting, relaxing the muscle or body parts while the therapist sustain, hold, moves pas- sively the same muscle or body part. This is essen- tial to get the best treatment result.

The passivattiva technique can change the visco- elasticity of the myofascial tissue (collagen). This not only due to the physical mechan- ics, but also due to the effects the re- sponse of stimula- tion performed on

the physical mechan- ics, but also due to the effects the re- sponse of stimula- tion