That Person In The Wheelchair

Needs Your Touch

b y Meir Schneider and Carol Gallup

Massage, passive movement

and assisted movement
When 7-erl-ic~ i r d l e y - ~ o rolunteered hr to bring massage -
theraI,y to Muscular Dystrophy Camp in St. Louis, Missouri, she
help prevent the physical was over\vllelrned by the yo~~ngsters' response. "They all wanted
and emotional losses to get on the table; the demand was incredible. When we
couldn't Set them up on the table, I worked o n them in their
that wheelchair-bound people face.
wheelchairs. I let them tell me where they wanted me to work.
Every one oi'rhem had a different ache or pain and some had
numb places where they wanred to feel again. These kids desper-
ately needed to be touched. We put some bodies on the table
that felt like a ball of rubber - so much lnuscle had been lost and
replaced by connecti\~etissue.
"There were 52 cxmpers, age 6 to 2 1, and 42 were in wheel-
chairs," Yxrdley-Nohr continued. "Most of the kids had
D~lclienne[ ~ u c h e n n emuscular dystroplly, an early-onset, deadly
form of MD]. You could see rhe whole ~ i a t ~ ~history r a l of the dis-
ease, looking st the diff'srent ages - rhc 6-year-olds could still
move pretty well, then it got worse every year and eventually
mol-c of them were in wheelchairs, and finally there were campers
wirh so many life support devices attached to the chair that you
rhought you probably wouldn't see r h e ~ nhere next year."
Yardley-Nohr said she became a massage therapist because of a
friend with I-~iuscular dystrop!ly. "Five or six years ago, he was
going through a tremendous trauma - his noth her was dying of
ca:icer and his dystrophy was going through the roof. His back
and neck were al\vays in excruciating pain. I'd rub his back, and
he'd say, 'You have a wonderf~lltouch.' H e became my guinea pig
when I was in massage school, and he's been a regular client, one
or two sessions a week, ever since. He invented a stretching rou-
tine chat he does every night for 30 to 45 minutes. Right now the
disease is affecting his low back and hips, 2nd he's in a lor of pain.
H e said, 'Your massage is thc only thing that keeps me going."'
When people with serious movement limitations find massage
therapists like Yardley-Nolir, the res~lltsat-e wonderful. Bu't many
people in wheelchairs are not getting the touch they need, and the
coli.icquelices, while slow ro ni.ri\.c.. ; ~ i - i .serious.
The health of every sysreln of the body depends o n regular,
nctive movement. For the whcclc1iai1--bo~~nd and those wirh lim-
ited movement, circulation diminishes. 11e1-vefi~ncriondeclines,
; ~ n dmuscles .~tropliy2nd s l ~ o r t c ~CI-c;iring i, contracturcs (tight
joints tli.ir c;ili't straighten nol-ni.lll!~). \%'it11 pool- cic-cul:ition,skin
breakdown bcgins, srarting witli sli:tl~nS,thcn pressu~-esores;
eventually there c;ln be open \vouncl\ \o deep that n skin grafr
h e c o ~ i i inil>o~\ii>lc.
~\ I ~ i ~ l i ~ c s t i, 1o1 1l ~i 1~ o ~ ~ \ ~ i ~;I!-c
> af~rccluentl!,
rio~i
,I l > ~ - o l > l ~()f'tcn
~~ii. t l i ~ , ~ ~ ethe
i \ c~ o l t o \ i !L\ t ~ t ~ , : i ~ootr1c1 1 \~l ) i ~in
frontal plane); with the chest constricted, heart and respiratory
problems are more likely.
The mind is affected by serious movement loss too. The
chronic pain gets bad enough that pain-killing medications can
become a way of life. Resisting depression becomes a challenge;
everything is harder to do when disabled, stressors get magnified,
and disabled people can feel like outsiders, different - they don't
look like the people on television shows or magazine covers.
When active movement is severely limited or impossible, touch
- massage, passive movement and assisted movement - can do
a lot to prevent these physical and emotional losses. It can even
turn them around, creating new possibilities of active movement
and new hope.
When 60-year-old Gene Carlson first started getting massage
therapy 18 months ago, he had sustained more than his share of
losses to multiple sclerosis. MS is a progressive disease in which
patches of myelin, which insulates nerves in the brain and spinal
column, die; symptoms can include paralysis, loss of sensation,
incontinence and vision losses.
Carlson was blind and paralyzed from the waist down; his
upper body was weak and stiff, his left shoulder almost paralyzed.
And, not surprisingly, he was very depressed.
Then Carlson began receiving massage from Fred Baker, one of
10 licensed massage therapist volunteers with the King County
Multiple Sclerosis Association in Seattle, Washington. Carlson
gets a free session from Baker every other week through that orga-
nization. "Most of what I do with Gene and other MS patients is
the somatic work of Dr. Thomas Hanna [Ph.D.]," Baker said.
"And I use some neuromuscular therapy and Self-Healing mas-
sage techniques that I learned in workshops. Where there is no
motor control, I do a lot of variation ofjostling, shaking, rocking
and other passive movements - my own creation, with influ-
ences from [Milton] Trager and others."
Soon Carlson saw enough improvement to get weekly sessions
and pay for the difference. "To begin with, he was kind of moti-
vated but still depressed; it gradually turned around," Baker said.
"Then we triggered something About three months into it,
when he felt stronger, he got inspired and decided to start work-
ing out with a physical therapist. I helped him with the program.
Now he does a full upper-body workout every day and lifts
weights with both arms, including the shoulder that was almost
paralyzed. His doctors are amazed at how loose his arms and
neck are and at his tremendous upper-body strength; he probably
could pick himself up with a chinning bar -all this in the last
year and a half. He's working out in parallel bars to regain his
legs. He still hopes to get his sight back. Gene is phenomenal."
Baker also works with people who have Parkinson's disease, a
brain disorder that causes tremor, muscle rigidity, weakness and a
hard-to-initiate, slow, shuffling, unbalanced walk. "I've had a
limited amount of Trager" training, and his method works well
with Parkinsorr's, so I use that," Baker said. "My Parkinson
clients are making progress - it's really effective."
A woman who lay bedridden for eight years, paralyzed from
injuries sustained in a plane crash, tried for years to find a physical
therapist or massage therapist who would work with her, and no
one would. When Meir Schneider and a physical therapist agreed
to take her on, she was so motivated she worked on her home
program seven hours a day. When Schneider last saw her, she
had recovered intelligible speech and could feed herself, manage a
wheelchair, walk short distances with a brace and had moved out
of her parents' home to live independently. "These people fall
between the cracks," Schneider said. "Everyone is writing them
off, including the medical profession. I had a physician
- . in one of
my training classes; we were talking about a severely disabled
client and this doctor said, 'I wouldn't touch that case.' I said,
'So who are you going to send her to?'
"Doctors and physical therapists cope with the secondary prob-
lems as they come up. T o get improvement, they'd need to work
with these patients on a day-to-day basis, allowing small improve-
ments to build up. They won't do that, because it doesn't fit
their treatment model, which is fairly drastic interventions -
drugs and surgery. Physical therapy is given only when fairly big
changes in functional level can be made in a limited number of
20-minute sessions. But there is one health professional with a
wider treatment model that fosters intuition, inventiveness and a
strong body awareness, who has the potential to create real
improvement and forestall the terrible consequences of limited
movement and paralysis. And that's the massage therapist. This
is the profession that can make the difference."
Schneider continued, "People with severe weakness or paralysis
have an incredible need for bodywork. They need [to] stretch,
they need better circulation; even getting their shoulders squeezed
is bliss. In my 24 years in massage therapy, I've helped about 300
people overcome paralysis. But I've met and heard of thousands
more. I've learned that as a bodyworker, you already have what
you need to help them -you have skilled touch. Find the touch
that is pleasant to them. Don't be afraid to touch them, and
don't assume you can't help these clients. You may be the one
who will give them back their quality of life."
Working with paralysis and limited movement
Schneider believes that 90 percent of paralysis can be reversed
or eliminated. Our collective expectations, he feels, are a big part
of the limited progress we've seen so far. "Even the very militant
disabled people -working for independent living, lobbying for
disabled access, doing wonderful things for themselves - have
tended to believe, like the rest of us, that their condition is written
in stone, and it's not. There's not enough research into how it
could be different, and given
- this kind of collective hopeless atti-
rude, that's not surprising."
The following are principles that Schneider and other Self-
Healing therapists have found important in working with paraly-
sis and limited movement:
Pain is an excellentguide. If your touch is pleasant during the
massage, doesn't provoke pain afterward and reduces pain, you're
on the right track.
Nineteen years ago, at age 35, Darlene Cohen came down
with rheumatoid arthritis. Shortly afterward, she began working
with Schneider. As she describes it in her recent best-selling
book, Arthritis - Stop Suffering, Start Moving, her pain was so
intense that "I couldn't stand to be touched, and I shrank from
Meir's fingers. Because I also couldn't bear to move, 1 refused to
do the prescribed exercises. My body felt like a closed, dense,
heavy cage. I felt restriction in my chest every time I
breathed ....[ T]he practice of self-healing [is to] manipulate the
sensations, thoughts, perceptions and feelings that you are able to
observe in order to improve you1 he<~lth ....[ Bly focusing on my
MASSAGE Issue Number 6.1 .
Nover,lbei 1 December 1996 27
Self-Healing
actual bodily sensations, I began to find the smallest movements
here and there, places in my body that were neither paralyzed nor
painful. I discovered a tiny movement in my chest that I could
make without pain, so for the first time in many months I could
enjoy breathing That place was such a refuge, such a joy, I
returned to it again and again, like a cat lying in a favorite spot in
the sun. I found that I could move my thighs together and apart
when I lay on my back. I delighted in feeling these small and pre-
cious spaces in my fossilized body and then enlarging them,
spreading them into other restricted areas of my body." This was
the beginning of Cohen's recovery. She became a massage thera-
pist and today also teaches arthritis and pain management in reha-
bilitation settings.
Bear in mind which organ system is weak; this will tellyou
where you need to be carefitl. Arthritis is a disease of the joints; you
need to touch and move them very gently, but unless the muscle
is very atrophied you can touch it vigorously. Muscular dystro-
phy is a disease of muscle; avoid fatiguing dystrophic muscles with
your exercise program and touch these muscles lightly. But nor-
mally you don't have to worry about the joints with M D , so you
can throw an arm or leg from hand to hand in passive movement
without causing any harm. With a recent stroke, you need to
avoid provoking a seizure with your exercise program, so keep
exercise bouts shorter and do them more frequently.
With polio, you can work the weak muscles hard, beyond
fatigue - the loss was an isolated incident, when a virus killed
motor nerves that bring the nerve signal from the spinal column
to the periphery. Just as important, you need to rest, relax and
unstiffen the intact, overused muscles, so that you create more
balanced use. Schneider feels that physical therapy teaches polio
patients to overuse the muscles that are strong, "and in my opin-
ion it's this imbalance that causes post-polio. Creating balanced
use can prevent or overcome post-polio," he said.
Consider whether the paralysis is caused by the original problem
(the disease or injury) or whether it is secondary. ''I had a client who
had lost strength in her calves from multiple sclerosis," Schneider
recalls. "This in itself didn't prevent her from walking, but she
compensated for the calfweakness by stiffening her hips so much
that it caused her to need a walker and later a wheelchair. So she
gained a lot more movement when we relaxed her hips through
massage and movement, which isn't that difficult.
"I often give polio clients an impossible challenge to the weak
muscles. Vered, one of my earliest clients in Israel and now a
Self-Healing teacher, had had polio," Schneider continued.
"When I met her, she usually dragged her weak left behind her as
she walked. We worked hard and she became strong enough to
lift that foot three inches off the ground. A year later, in a train-
ing class in San Francisco, I asked her to put her foot onto a stool
six inches high. She said, 'You're crazy.' I demanded that she lift
it onto a massage table three feet high. She laughed at me but
tried to do it. I did a shaking/releasing massage and asked her to
put her foot onto the stool, and she succeeded. Imagining doing
something so impossible for her broke through the belief that
comes with the emotionally traumatic experience of paralysis, a
belief that more movement is impossible. Eventually, she did lift
her leg up onto the table - and literally fell over backwards with
28 MASSAGE Issue Number 64 November / December 1996
astonishment. Emotionally integrating a sudden, big improve-
ment is hard for anyone; it requires a lot of work."
Timing can be important. Take, for example, stroke. Stroke is
damage to part of the brain from hemorrhage or from interrup-
tion of its blood supply; sensation, movement or function gov-
erned by the damaged area is impaired. Usually movement and
sensory losses occur on just one side of the body. With stroke,
physical therapists tend to leave these patients alone during the
early flaccid stage and begin work during the spastic stage, and, in
Schneider's opinion, "That's a mistake. One day in a training
class in Israel, a student said to me, 'My husband has just had a
very serious stroke because of an emotional shock. The doctors
don't think he's going to survive. You must come and help.' I
was very sorry to have to tell her that I was seriously overbooked,
and I simply couldn't. The class and I put a lot of ideas and good
energy into her and sent her to work with him. She got in there
right away, while he was still flaccid; she did the Self-Healing
Neurological Massage [a cross between brisk shaking and tapote-
ment that results in the muscle being moved rapidly in many
directions, described in this column in the JulyIAugust 1996
issue] and passive movement with him for four hours every day.
Initially he was paralyzed on the affected side. The doctors said
he'd be in the hospital for about six months, but he limped out of
there after two weeks -and came to our class. He was
depressed, almost suicidal, but he sat in the class and seemed to
soak up the energy and movement around him."
Getting the client moving is critically important with paralysis.
Movement leads to more movement. Use your massage, the
client's self-massage, and passive movement liberally before asking
for movement and between the client's attempts. "With a lot of
massage, we got this stroke sufferer moving every single day,"
Schneider said. "When a stroke client can't open his hand, you
can have him do self-massage - tap on the fingers and forearm of
the affected side. You can have him bend and straighten
- his
elbow repeatedly, then make circles with his shoulder, then with
his elbow, then with his wrist, then with his fingers. All of this
enhances the tremendous stimulation you're giving them with the
Self-Healing Neurological Massage - you've got the brain and
spinal cord getting all kinds of feedback about movement and cre-
ating new connections, new paths.
And then you're ready to ask for the movement you want -
the lost function. We worked on his lower body too, and got him
to lift his leg onto a chair, and walk backwards and sideways -
important coordination exercises - and his walk improved.
Finally, we motivated him, in this case with an atmosphere of fun
- he was allowed to chase the students and try to pinch them.
He had a wonderful time with this goofy activity, and his hand
function and his walk got much better. Eventually all his symp-
toms cleared up."
Intersperse the client > attempts at active movements with having
him or her visualize the movement, picturing it as fight, easy and
spacious. Visualization is very powerful when it is used properly.
You don't ask a wheelchair-bound client to visualize jogging on
the beach; that would be useless. Have the client visualize a
movement he or she can do, or barely do, becoming smoother or
Self-Healing
easier. A multiple sclerosis client of
Schneider's walked like a drunk, clutching
walls and furniture indoors, cars outdoors.
Not surprisingly, he fell and broke a clavi-
cle. Bedridden for two weeks, he visual-
ized himself walking well, in great detail.
H e walked much better after the fracture
mended.
People with paralysis or limited move-
ment, especially with a nervous system prob-
lem, need balance and coordination exercises.
If a stroke or head injury has affected their
eyesight, try patching the areas that see
well and getting them to use areas that
don't.
Find movements that are available that
the client doesn 't know of Therapist Dror
Schneider recalls, "I was working with a
child with very severe cerebral palsy [dam-
age to the brain in pregnancy or early
childhood resulting in nonprogressive pos-
tural or movement losses] who had no vol-
untary movement at all. Afier a few ses-
sions of massage, we took her to a warm
pool. Suddenly she could kick! You
should've seen the pleasure on her face."
30 MASSAGE. Issue Nurnher 64 November I December 1996
Look for the position or angle where
movement may be possible - with gravity
eliminated,for example, lying on the back
and moving the legs out to the side -or
even with gravity helping a bit. Meir
Schneider has had many clients with
spinal cord injury with no movement or
sensation from mid-thorax down. "I may
put them more or less prone, put their
knee into extreme flexion and begin
yelling, 'Straighten your leg.' Gravity is
working for them, so all they need is a lit-
tle effort. This is one way that I find
movements that no one knew they had.
Every challenge in this situation needs to
be a reasonably possible challenge. Once
the client has found a new movement, let
them enjoy the movement and develop it
to the max; it will lead to more."
Be aware that, in our Western civiliza-
tion, as people get older and their lifestyles
create ever more stereotyped, limited move-
ments, they may haveforgotten that many
movements arepossible. Once, during a
conversation with a healthy, intelligent,
highly educated friend, Schneider suggest-
ed he move his obviously stiff shoulders,
and the man asked, in all seriousness,
"Can shoulders move?"
Ana Paula Figueiredo, an occupational
therapist and advanced Self-Healing stu-
dent from Sao Paulo, Brazil, worked with
a client with a nervous system disorder
who had this kind of all-too-prevalent
cluster of problems - "very poor body
awareness, with a stressed, rigid, body and
mind, a lack of relaxation - the body gets
so tired, so stiff, and it needs massage so
badly," Fipeiredo said. "I've been work-
ing- with him for two months, and the sad
thing is, the disease worsens all of these
problems, which I feel helped bring it on,
though I can't prove it."
The way she worked with this client
illustrates most of the principles we've
been discussing: "He walked like a robot
-joints, muscles, everything rigid, stiff.
He's a 56-year-old police officer - a very
stressful job, with long shifts. Two years
ago, he was diagnosed with cerebellar atax-
ia [a degenerative brain disease resulting in
jerky, staggering gait and other uncoordi-
nated movements (the cerebellum plays a
major role in maintaining posture, balance
and coordination)]. He couldn't walk
Self-Healing
\s.ithour liL,ll>;when his wife helpcd him
wnlk, shc would often 6111 down with him,
bccause he's a large man. H e could~l'r
st;lnd independently without failing. and
\\it11 eating, food would fall off his fork or
he'd miss his mouth. His job became even
more stressful - he couldn't d o any work;
he wasn't in danger of losing his job but
IIC W;IS SO depressed about it he said, 'For
lne, it's better to die.' You don't want to
I-etirein 13razi1, because of the inflation.
" H e got a lot better in just the first two
sessions," Figueiredo said. "The [Self-
Healing] Neurological massage relaxed
him, released tnuscle tightness, improved
circular;on, created body awareness, and,
\vith the passive movement of the neck,
shoulders, elbows, hips, knees and feer 1
g ~ v chim, increased joint mobility, broke
up some of his rigid patterns and showed
his brain another possibility. W e did
somc coordination exercises, including
walking backward and sideways. H e was a
sh.~llowbreather, so we worked on inhal-
ing and holding the breath for increasingly
longer counts.
"His feer were frozen [immobile] in his
shoes; he didn't like to take them off to d o
the exercises," Figueiredo continued. " H e
couldn't move his toes. Frozen feet rend
to limit movement all the way up the
body; I always check for that right away
with a new client. W e did a lot of move-
ment, especially circular movement, with
his toes and feer, stopping often to visual-
ize lightness and ease in the rotations.
"I changed his awareness about stand-
ing. As he sat, I did a light, circular rap-
ping o n his abdomen around the navel,
teaching him to feel his center. I had him
t ; ~ pon his thighs and visualize their
strcngrh, th:lt it ...was
--,.
they,
.
not .~.'
the back and
1 I
32 MASSAGE ~ss,ip Number 64 Nirvember / December 1996
:~l~domen, that would cause him to stand,
ant1 I had him visualize the connection of
his feet with the floor. During- the second
session, he could stand without assistance
arid walk forward and backward indepen-
dently. After three sessions, he regained
the ability to button his shirt and dress
himself independently," Figueiredo said.
"If he's going to go on improving, he's
going to have to move out of the
depressed attitude that the body is an
enemy that has betrayed him. He'll have
to d o the home exercise program regularly
--you can't make serious progress with-
out it - and go on improving his move-
ment and developing body awareness."
Apparently, surviving parts of the brain
took over some of the lost functions and
further deterioration was prevented.
Turning around an inexorable disease
Over the years Schneider has become
increasingly aware of a need for scientific
documentation of his results. "With good
research, we can convince the muscular
dystrophy associations that there are more
possibilities for MD patients than painkillers
and wheelchairs -we can get credibility.
And we need to make this work available
to people who can't afford it now -
research can lead to insurance coverage.
As a massage therapist, I want to see our
profession become respected for its
achievements; there's some great
- work out
there - and research is essential for that."
Schneider feels hopeful about these
goals, because his Self-Healing Method is
the subject of several scientific studies.
Two of the studies are still in progress; a
third, a master's thes~sproject at San
Francisco State University, was presented
by Cayol_Gal!u~~at_t_heE,atbo~.I ,. *.
Education Confercncc of the 8rncric;ln
Massage Therapy Association in June.
All the studies address Schneider's work
with muscular dystrophy. T h e disease is
an ideal choice for research because it is
relentlessly progressive. T h e medical pro-
fession has nothing to stop its progress or
turn it around. N o one study proves any-
thing, but well-documented improvement
with M D suggestb that at least some part
of the therapy program is effective,
because it couldn't possibly happen by
chance - there are no spontaneous
improvements. Typically, you start with a
single-subject study, or case study, to
explore what you may find and hone your
research tool; then you move on to a larger
study. It helps to have more than one
research group studying your work.
Muscular dystrophy is a group of inher-
ited diseases with a comtnon outcome:
fragile muscle fibers that get over-chal-
lenged and damaged easily, and then die.
Dead muscle fibers may be replaced by fat
or connective tissue. Dystrophic muscles
are often shrunken and look wasted, hut if
there is extensive connective tissue replace-
ment, they will look bulky and feel very
fibrous. This is called pseudohypertrophy,
a classic sign of Duchenne M D - ironi-
cally, the young MD patient looks like he
has the calves of an athlete. Muscular dys-
trophies differ as to what gene is defective
and which muscles are affected, how early
and in what sequence. Science has identi-
fied only two of the genes - one causes
myotonic dystrophy, which attacks many
systems of the body and ranges from mild
to lethal; the other causes Duchenne M D ,
which is early-onset, fast-progressing and
deadly, and two milder forms, Becker and
- symp-tomatic Duchenne carrier.
Self-Healing
Self-Healing Support Massage is thefirst step
to muscle regeneration. All 1Ojngertips
make a vey light, gentle rotating motion;
deep penetration is achieved through visualiaztion.
T h e Self-Healing therapy for MD
Schneider's regimen for muscular dystro-
phy begins with a sequence of three mas-
sage techniques that release tension from
the muscle, improve local circulation and
create a sense of nurturing.
The first technique, the Self-Healing
Support Massage, is a very light, finger-
tips-only (use all 1O), circular motion,
patiently going over and over a dystrophic
muscle for 30 to 90 minutes, while you
visualize that your touch is penetrating
deeply. The fingertips need to be very
aware, very alive. If a muscle is very dys-
trophic, you may need to work so lightly
that you touch only the hairs above the
skin or work on an adjacent area instead,
to begin with. The massage is successful
when the muscle noticeably enlarges, or
"puffs," and the tone improves.
The second, the Self-Healing Release
Massage, performed only after puffing is
observed, releases tension in the muscle. It
is the major tool to reduce connective tis-
sue replacement, which palpably decreases
with this massage. Spread out your fingers
and shake very lightly.
Self-Healing Buildup Massage is done wheelchair-bound. The pattern
aftpr muscle 'pufing''is observed. of muscle loss is kaleidoscopic
Gently rotate 60th tl~zinzbson the ~,,usc/e. on levels both microscopic (the
34 MASSAGE Issue Number 64 .
Noven,hcar 1 December 1996
The third, the Self-Healing
Buildup Massage, may begin
weeks or months after the first
cwo massages. You must observe
puffing before you begin Buildup
Massage. Buildup Massage is a
gentle rotation of both thumbs
on the muscle, using only a little
more pressure than with support.
Alternate among Buildup,
Support and Release Massage.
When the muscle responds
well to the massage, passive
movement is added to the pro-
gram. The next step, usually
within four or five sessions, is
active movement, much of it
pool work, talung advantage of the gravity-
countering effects of buoyancy and of the
low, even resistance of water. Many of the
movements are frontal plane or circular; we
live and get overuse patterns in
the sagittal (fonvardlbackward)
plane. Circular movements espe-
cially tend to create new muscle
recruitment patterns. If a muscle
is very weak, the number of repe-
titions will be small at first and
increase only gradually. The
body moves toward a more even,
non-stressful use while endurance
is built up with these exercises.
The San Francisco State
University study
Because Self-Healing therapy
appears to be especially success-
ful with facioscapulohumeral dystrophy
(FSHD), one of the milder muscular dys-
trophies, Gallup chose to do a case study
of an FSHD client. The disease affects
perhaps one in every 20,000 Americans;
researchers may be close to finding the
gene. FSHD is characterized by early
signs of progressive weakening
and functional loss in the face,
shoulders and upper arms, but
other parts of the body can sus-
tain losses at any point in the
disease course. People with
FSHD may have trouble talk-
ing, whistling, chewing, closing
their eyes, lifting and carrying
things, reaching for objects on
high shelves, walking and with
other functions; some become
muscle is a jumble of healthy, damaged
and dead muscle fibers) and macroscopic
(for example, a weak bicep and strong del-
toid on one arm and the reverse on the
other).
Studies of muscular dystrophy often
measure things like strength, speed in cer-
tain tasks or muscle cross-sectional area or
composition. Gallup chose to look at
functional change instead. Changes in
strength or bulk of specific muscles don't
necessarily translate into functional
improvement, and function is the bottom
line for a disabled person. Her measure-
ment tool, kinematic analysis - a mar-
riage of physical education and bioengi-
neering made possible by photography
and, later, cinema - affords a wealth of
information about sports, rehabilitation,
any kind of movement, much of which
was totally unavailable in the past. And it
Self-Healing Release Massage releases tension
in the muscle. Spread out thefingers and shake
the musclegently. As with all massage of
dystrophic muscle, the touch is nonvigorous
and light (no pressure or weight are used).
offers a certain reliability; if there are ques-
tions, you've always got the film.
Gallup was lucky enough to work with
one strong contributor to the field, Joseph
R. Higgins, Ph.D., and to rub shoulders
with others in the Kinesiology
Department at San Francisco State. "The
department is incredible," Gallup said.
"You stay away a few days and come back
to find better cameras, more computers, a
new dynamic EMG [an electromyogram
gives a graphic record of the contraction of
a muscle as a result of electrical stimula-
tion], people getting rcady to present their
data at some conference. One new faculty
member they brought on had revolution-
ized swimming. The day I first walked
into the department, a professor told me
with tears in his eyes that he had just taken
delivery on a piece of equipment that was
the same model they had on a space shut-
tle, state-of-the-art."
Self-Healing
In kinematic analysis, the subject is videotaped performing cer-
tain tasks; centers of relevant joints are marked with reflective
tape. Later, sequences of video images are captured as individual
frames into a computer program. In programs that lack automat-
ic digitizing, the program displays the frames one by one and
instructs the operator to digitize each joint center in sequence.
The program compares the location of the marked pixels on the
screen with a meter stick, an on-screen object of a fixed size, to
generate metric distance, velocity and acceleration data. It also
generates data on angle and angular velocity and acceleration of
joint and limb segments.
Gallup videotaped her subject, Karen Myers, a 3 1 -year-old
woman with FSHD, in a variety of functional tasks during a
three-week baseline period and then throughout five and a half
months of therapy in the Meir Schneider Self-Healing Method.
Myers had three to four sessions a week. One task was suggested
by Myers herself after nearly four months of therapy. During a
filming session in September 1995, Myers told Gallup that during
a recent visit to an arts festival, shehad found that she could carry
a plate of pizza at waist level, a task that a very dystrophic right
biceps brachii had made impossible for three or four years.
"Normally I would carry the plate of food in my left hand and
the soda with my right hand, with that arm hanging at my side,
because it's too much of a strain to hold anything up for more
than a few seconds with my right arm. But I noticed that I was
carrying the soda in my left hand and the plate of food in my
right, and I didn't have to stop and put it down or change hands.
I yelled, 'Hey Lisa,' [to her companion] I'm carrying a plate of
36 MASSAGE Issue Number 64 November I December 1996
pizza! I walked around feeling happy for hours. This was the first
time I noticed that there was a big improvement in my abilities,
that my body just naturally did something because it became
strong enough to do it."
Gallup invited her to carry a one-kilogram (2.2 lbs.) weight on
camera until she felt the muscle begin to tire. Myers carried the
weight at waist level continuously for more than half a minute.
Myers was examined by her neurologist before and after the
course of therapy. H e found that the strength of her right biceps
had gone from 40 percent of normal the previous year to 80 per-
cent of normal, and reported improvements in the strength of
other muscles as well.
Gallup found that Myers' progress in walking showed up most
clearly in the "platform event." Disabled people have to cope
with curbs and low steps, so Gallup created a low platform to
simulate this problem, and looked closely at a moment of chal-
lenge -when weak hip muscles would have to work eccentrical-
ly, or in a lengthening position, as Myers descended from the
platform.
One of Myers' problems in walking is what physical therapists
call a gluteus medius limp - the gluteas medius pulls down the
hip of the leg you are standing on and thus passively raises the hip
of the leg that is swinging forward, to ensure toe clearance. When
the gluteus medius and its helpers are weak on one side, a person
can passively lift the opposite hip instead by tilting the shoulders
laterally, away from it; with that strategy, the hip and shoulder on
the side of the stance leg get closer to each other, while those on
the other side are drawn further apart. Myers' pathological shoul-
-- -
Self-Healing
derlhip distances showed a modest improveme~~t from the early
trials to the late trials as she descended the platform.
Myers has problems controlling the upper body in descending
from the platform. She tends to lean backward as the stance leg
accepts weight; this reduces the challenge to her weak hip exten-
sors while increasing the challenge to the hip flexors, which are
much stronger. There is a modest decrease in backward lean dur-
ing this critical period from the early trials to the late trials.
After the second leg comes off the platform and the leg you are
standing on bears all the body's weight, normally that leg is fairly
straight at this time - bur Myers has an abnormal bending, or
flexion, of the hip and knee at this time. Several parameters
showed a modest improvement in this problem from the early tri-
als to the late trials on the more challenged left leg.
Gallup expected to see a very modest in~provenlentresulting
from this brief course of therapy. As the chair of her committee,
Virginia Saunders, Ph.D., head of the Physiological Psychology
Department at San Francisco State, said, "Medicine has the can-
non - powerful, invasive interventions with drastic effects,
including side effects. Holistic health has the peashooter - gen-
tle therapies with much smaller effects that take a longer time to
arrive." T h e change in Myers' right biceps took Gallup by sur-
prise. T h e improvement, she believes, was the result of neuro-
muscular adaptation - changes at every level of muscle and nerve
that accompany exercise regimens. Physical education/kinesiolo-
gy has long studied such effects, mostly with skilled performers.
More studies are needed to determine whether these effects differ
with disabled subjects; this was part of what Gallup wanted to
begin to explore.
Until there are a great deai more studies of the effects of mas-
sage it will be difficult to characterize its contribution.
Fortunately, a team at the Touch Research Institute at the
University of Miami headed by Tiffany Field, Ph.D., is creating
such studies, and is teaching other massage therapists to perform
their own - an encouraging sign that the profession is taking
38 MASSAGE Issue Number 64 .
Novt.~r~l,erIDecembe! i99E
itself seriously and establishing itself in the world. Gallup sees her
study as part of that trend.
Gallup plans to look for funding for a larger study with the fac-
ulty at the Kinesiology Department at San Francisco State, adding
two new tools - a dynamic EMG system, which measures tim-
ing and intensity of actions of muscles involved in an action; and
a force plate, which yields information about floor contact and
forces that affect
There was a human cost to the present study - Myers left her
family, friends and job in Philadelphia to risk participating in an
unknown therapy. She said she's glad she did: "I really felt a dra-
matic improvement over the course of the therapy. M y stamina is
much better, even my balance is better, my strength in my arms is
a lot better. T h e massage is awesome; I felt like it supported my
muscles and made it easier to exercise, and when I was tired from
exercising it nurtured me. I had gone to physical therapists and
they wore me our with exercises without making me stronger.
This is the first time that I found exercises that I really enjoy
doing and that have been so beneficial." Ul
Meir Schneider, Ph.D. L.M. T , an internationally known thera-
pist and educator, is the creator of the Meir Schneider Self-Healing
Method, the author of two books, Self-Healing: My Life and Vision
andThe Handbook of Self-Healing, and tl7efounderldirector of the
Center and Schoolfor Self-Healing in San Francisco. As a teenager,
lye overcame blindness caused by congenital cataracts and other serious
vision problems and today has an unrestricted driver? license. For
fitrther information, call (415) 665-9574.
Carol Gallup is an advanced student of Self-Healing, Registrar of
the Schoolfor Self-Healing, staffwriter of the Self-Healing Research
Founddtion, and the author of numerous magazine articles. She
stz~diedphysicaltherapy at the Mayo Clinic and is now a rnmrter;
degree candiddte in research psycho logy at San Francisco State
University.