Terra Rosa

E-Magazine
Open information for massage therapists & bodyworkers

No. 6, December 2010

Contents Greetings for the festive and holiday sea-
son. And this is our sixth issue of our free e-
02 Myofascial manipulation—
magazine dedicated to bodyworkers.
Mau Ronchi
In this issue we have a full 50 pages of informa-
11 Passivattiva technique for the
tion crafted by our distinguished authors with a
torso & upper extremities — Mau
special focus on fascia. This issue started with a
Ronchi
thesis on Myofascial Manipulation by Mau
19 The Trendelenburg test —John from Italy, and followed by a demonstration of
Garfield his techniques. The Trendelenburg test by John
from the Gold Coast. We look at the history of
20 Learning massage through massage videos. Video killed massage books?
videos—Video killed massage Read a report form our recent workshops by
books? Art Riggs, a great teacher.
24 Art Riggs Deep Tissue Massage Bethany Ward attempts to explain science be-
workshops in Sydney hind fascia in plain terms so it understandable
and applicable to bodyworkers . Followed by an
27 Fascia science made simple—
interview with Gil Hedley on Integral Anatomy.
Bethany Ward
Myofascial stretching by Walt Fritz.
33 Interview with Gil Hedley
Our own Aussie-American Steve Goldstein ore-
36 Myofascial stretching for hip sents a new perspective Fibromyalgia. Anita
flexors - Walt Fritz, PT Boser gives you some tips on Undulation.
Check out also when Dr. Spock becomes a mas-
37 Fibromyalgia: New perspec-
sage therapist.
tives—Steve Goldstein
We’d like to thank all the authors who have
44 Relieve computer neck &
contributed to our magazine. Thanks for all of
shoulder tension— Anita Boser
your support and enjoy reading. May you have
46 Spock massage a successful new year, continue to grow both in
your business and therapeutic skills. Have a
47 Research highlights great holiday and hope to see you again next
year.
49 Six questions to Steve Goldstein
Sydney, December 2010.
50 Six questions to Bethany Ward

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

Terra Rosa e-magazine No. 6, December 2010 1

Myofascial Manipulation:
Relating practice to theory
This article aims to connect some of my experi-
ences as a sports bodyworker with the technical
and scientific aspects of research studies. It high-
lights the essential the use of myofascial manipu-
lation in order to improve athletes sports per-
formances. In particular, I want to validate pas-
sivattiva technique, a myofascial release tech-
nique which I have developed (see Terra Rosa
Bodywork magazine, Issue no. 2)
First, I will discuss about connective tissue and
make just a brief introduction to the meaning of
“connectivity” of the connective tissues which we
will treat using manual techniques. There are
two different types of connectivity: a mechanical
one and a functional one.
The first one is characteristic of the more resis-
tant and fibrous tissues, and is needed to protect
and sustain various organs and to connect and
settle between themselves various tissues. The
second one is exclusive to tissues with a higher
content of water, more ground substance, less
dense and robust, therefore more fluid and adapt
to the transport of nutrients and to the defense
from external agents.
The connective system can be seen as fascial
chains or fascial trains, as the distributor and
harmonization of all forces expressed by the tis-
sues – contractile system. The fascia under the
athletic-sports aspect, act as an orchestra direc-
tor of our body, able to manage all the movement
parts, Central Nervous System – Muscles –
Skeleton. Without it our movements would be
like a robot-man, without harmony and the flu-
idity human gesture.
If we simply compare the human body to a vio-
Terra Rosa e-magazine No. 6, December 2010
Maurizio Ronchi
lin, we could think of the
chassis as the skeleton,
the violin bow as the
muscular strength, the
subject that plays it as
the central nervous sys-
tem (CNS), and the
cords as the fascial
chains. The cords evenly transmit on themselves
all the muscular strength produced by the violin
bow and they induce also the vibration (strength)
to the whole instrument.
The player’s fingers pressing on various part of
the violin handle are like the intersection points
or variation of tissue mass-dimension-density,
where is discharged part of the force transmitted
from the fascia.
If the above all happens with harmony and syn-
ergy between the parts we will obtain a nice
sound, therefore if the body is well trained, har-
monic and synergic in all its components we will
obtain a good athletic-sportive performance.
I believe the fascia system is the most relevant
part of this concert of components, throughout
all its fascial chains, it directs and transmits with
harmony all muscular strength through the
whole body. The main thing needed now is that
the instrument should always be well maintained
if we ask it to give a good performance.
It is understood that the manipulation and the
sports bodyworks along with the athletic prepa-
ration are very important means to maintain the
body tuned and equilibrated, also the importance
of routine maintenance to correct all anomalies
due to overuse and overload.
2
 Myofascial manipulation
It is clear that the inactivity, repetition and over- after deformation by compression (contraction)
working affect negatively the muscle functional- they can return to their initial condition. On the
ity and the connective tissue in all its forms from contrary the ones that do not have contractive
myotendon-aponeuroses and capsulae-ligament, components (such as connective tissues) behave
until the inner connection fascia-muscle and like plastic materials, so if a deformation
nervous fibers, due to the well recognized strict (compression) occurs with a force and for a suffi-
connection between muscle and fascia. What cient time to exceed the threshold of the curve of
can cause, at a practical level, these thickening the elastic deformations, it will enter the area of
situations with an increase of the connective tis- permanent deformation, the connective tissue
sue fibers covering (or close by) a muscle? Due to will remain shortened.
the loss of elasticity of fascial glide or of the near
“As a matter of fact, a muscle with fibers of actin
CT, follows up an increase of muscle length pas-
and myosin more closely connected, with a thick-
sive resistance force; therefore less myofascial
ening of connective tissue, which becomes more
escursion, ensuing stiffness and retraction and
fibrous, lead to an increase of passive resistance
finally a sensible deduction of muscle – joint bio-
force with a decrease of elastic capacity and func-
mechanics functionality. This condition is appre-
tional resistance of the muscle itself ”( U. Mo-
ciated from the athlete who feels compelled to
relli )(2).
make an athletic gesture, as well as the operator
during the execution of simple muscular tests Here I will show you a simple and empirical ex-
and joint ROM. ample illustrating the above theories.
Please find here below a scheme by Mauro Las-
trico (1) (who kindly gave me permission to pub-
lish it here) which easily express the mechanics
of myofascial retraction.

Comments to picture. “ The causes of the muscu-

lar shortening”

The muscular fiber is composed from a sequence

of parts which are contractive (elastic, repre-
sented as yellow ellipse) and the non contractile
parts (plastic connective tissue, red rectangular).
With reference to the physical laws on the defor-
mations of the elastic bodies, it turns out that the
members that are contractive, the muscular fi-
bers behave like elastic elements; consequently
Terra Rosa e-magazine No. 6, December 2010
The first picture is an example of a relaxed mus-
cle , where the violet net represents a portion of
densified and highly fibrous fascial tissue. The
second picture simulates the contraction of the
muscle, which highlights the low elasticity of the
3
 Myofascial manipulation
Images from: " Histological study of the deep fascia of the limbs" (4)
fibrotic fascia, which cannot allow the physio-
logical dimensional change of the muscular belly, and ground substance quantities (Arti Ahlu-
and such deformation lead against the natural
biomechanic joint movement to which the mus-
cle is connected.
Therefore this collagen and fiber thickening, are
areas that need manual treatments in order to
maintain a physiological elasticity/flexibility es-
pecially after a trauma-injury or an intensive/
repetitive work/training cycle aimed to a specific collagen and elastin (6).
joint muscle district.
During my research and close examination of
this topic, I was drawn by a dissection made by
the Department of Anatomy and Human Physi-
ology of Padova University by Carla Stecco which
compares “nude” and fascial muscles. This study
“Studio anatomico della continuità miofasciale
” ( C. e A. Stecco)(3), was presented at the First
Fascial Congress 2007 in Boston USA.
I also found an interestinge definition of myofas- around limbs but we should think also about epi-
cial expansion of the muscles, which is the main
subject of their research. Luigi Stecco, one of the
first scientists and bodyworker in the fascia
field, gave me precious help in order to deepen
my knowledge of physiology and all mechanisms
of various forms of connective tissues.
It also brought me to better comprehend and
Terra Rosa e-magazine No. 6, December 2010
clarify the way all myofascial ma-
nipulation, like passivattiva tech-
nique, improve a poor physical-
athletic condition. When we ap-
ply manipulation technique to
treat a fibrous CT, the pressure
and induced heat are able to sof-
ten the fascia’s Ground Sub-
stance*. Therefore we can change
from a dense gel physical state to
a sol more soluble state, allowing
also the rupture of eventual tis-
sue adhesion and linkages. Colla-
gen and Elastin proteins are of-
ten found together, their interac-
tion generates viscoelastic prop-
erties of the connective tissue.
The viscoelasticity depends on collagen, elastin
walia)(5).
* The gelatine Ground Substance that consti-
tutes together with collagen and elastin the
“extracellular substance” – ECM- on both soft
and hard/mineralized tissues. It is mainly made
of proteins PolySaccharids or Glycoaminoglycans
(GAGs), which act as cement between fibers of
“Mature collagen is susceptible to no enzymatic
glycaction and the substances produced can be
transformed in a cross-links able to inhibit the
natural collagen turn-over. " ( A. Scherillo ) (7).
I should highlight the fact that only CT is plastic
and malleable due to the thixotropic property of
collagen, meanwhile muscular tissue doesn’t
have this property. Often when thinking about
fascia, we think about only the aponeuroses layer
mysium-perimysium-endomysium. This colla-
genic skeleton of the muscle is what gets over-
load or repetitive strain syndrome and acute
damage.
I always like to highlight the importance of colla-
gen for our body using this quote: “Collagen is
one of the most ubiquitous proteins of our body.
4
 Myofascial manipulation
It is the structural element that supports every-
thing under the skin, veins, tendons, ligaments,
cornea, bones etc. It has the same importance for
our body as the steel in a technological world” (5).
Myofascial manipulation brings a hard and fi-
brous CT to a normal elasticity due to its viscoe-
lastic property of the Ground Substance as well
as breaks all cross-links tightness with adjacent
tissues returning to the physiological movement
to permit a more free joint ROM .
Here I will show you a simple empirical example
of viscoelastic change induced by a myofascial
manipulation technique:
The picture on the left shows an aluminium
sheet as the fascial sheet, normal fascial sheet
and on the right I simulate overuse of the fascial
sheet.
As a result, here the col-
lagen fibers are ran-
domly positioned and
the layer is crumpled.
However using myofascial manipulation tech-
nique, we can induce viscoelastic change with
realignment of collagen fibers and reinstating the
natural sliding layer due to the mechanical ac-
tion and heat induced by the technique.
Obviously it is not possible to have a myofascial
release on all human body CT’s structures. As
indicated by Robert Scheilp in the article “Three-
Terra Rosa e-magazine No. 6, December 2010
dimensional mathematical model for deforma-
tion of human fasciae in manual therapy" (8), in
order to have an evident viscolelastic change of
Iliotibialband ( ITB ) several tens of kilos of force
-weight induced by manipulation are needed and
therefore it is impossible to apply. But it is not a
lost cause!
In fact, from my experi-
ence, and I believe not
only my experience,
treating the ITB tract (as
seen in my first part of
passivattiva technique)
with stripping using the
fist, it is not difficult for
both the practitioner and
athlete can feel and hear
the creeping or the pop-
ping sound of a myofascial release.
What did our manipulation induce? Speaking
with Robert Schleip (an international acclaimed
fascia expert), we agree that probably the ITB
aponeuroses external part is structured in a dif-
ferent way from the core, with a possible differ-
ence in density and order of collagen fibers.
Probably, because for the time being we haven’t
got a detailed histological studies yet. Therefore
the release we feel is due to the breaking of myo-
fascial adhesions, such as those links that form
between the different layers of tissues made by
weak hydrogen bonds and van der Waals forces
which determine the tissue tightness.
In accordance with the viscoelastic property of
Extracellular Matrix (ECM) we can come to the
conclusion that all effects induced by manipula-
tion brings sensible changes like breaking the
layers linkages and ECM hydration changes that
allow the practitioner to feel the myofascial re-
lease which also apply for dense connective tis-
sues like the Iliotibial tract. We will not be able
to modify the dense fibrous structure but we will
definitely be able to modify its tightness and the
gelatin matrix to which it is dispersed and
wrapped.
5
 Myofascial manipulation
Several studies
show the differ-
ence of a cross-
link holding force
between a tissue
with a higher per-
centage of elastin and one with less. The force of
elastin links is much lower compared to the one
of collagen fibers therefore it is much easier to
manipulate (Rizzuto, Del Prete) (9) .
Meanwhile, always simplifying, in the case of a
viscoelastic change during a myofascial manipu-
lation, we already know based on the latest stud-
ies, that between 2 – 3 minutes with a load of a
few kg of force-weight applied, we observed a
change of the physical state of the Ground Sub-
stance.
But that is not all! The fascial manipulation, as
passivattiva, can affect the proprioceptive re-
store.
To highlight these considerations and the precise
scientific basis, I have to go back to the marvel-
lous research work "Histological study of deep
fascia of the limbs " (4) which is the source of
some interesting aspects of myofascial system
and valuable knowledge to the know-how of a
sports bodyworker in order to arrange his own
manipulation techniques. I will give an account
of some aspects of the study. First I would like to
talk about the morphology of the deep fascia, the
layer where CT is tightly connected to the mus-
cles. The layers we are talking about are from the
brachial and crural fasciae. These layers of fascia
are not uniform; they have different types of den-
sity.
The deep fascia of the limbs is a sheath present-
ing a mean thickness of 1mm, formed by two to
three layers of parallel collagen fibre bundles. In
the adjacent layers, they show different orienta-
tions. Each layer is separated from the adjacent
one by loose connective tissue, permitting the
sliding of the collagen layers. Nerve fibres were
found in all specimens, while muscular fibres
were evidenced only in one specimen.
Terra Rosa e-magazine No. 6, December 2010
The structure permits the fasciae of the limbs to
have a strong resistance to traction, even when
exercised in different directions. The capacity of
the different collagen layers to glide one on the
other could be altered in cases of overuse syn-
drome, or trauma.
This study on the deep fascia is of great help to
practitioner to evaluate how to arrange the pres-
sures of a manipulative myofascial to normalize
an excessive densification in a muscle due to
overuse, overload or high repetition of an athletic
performance. I think it is extremely useful know-
ing how and where the CT collagen fibers den-
sity, changes in order to obtain better results
from our techniques and a noticeable energy sav-
ing from the operator.
Another aspect ex-
tremely useful for
sports therapist and
highlighted from the
research results is
how the deep fascia
is structurally or-
ganized. Some im-
ages explain and
show how the vari-
ous collagen fiber bundles cross themselves up to
obtaining a very resistant structure to traction
and very adaptable to lengthening even though it
has a low presence of elastic fibers (1%) assum-
ing a characteristic wave shape which increases
elasticity and flexibility.
Another study of research made by Carla Stecco
“Modello per la misura dei parametri della fascia
profonda” (10), explains once more how excep-
tional it is the potentiality and adaptability of the
fascia. This resistant and elastic property seems
to be caused by the orientation/direction of the
collagen fibers in the various layers of the fasciae
of about 78°. This exact positioning, explains
why the fasciae has an excellent biomechanical
property, with an elastic capacity in all direc-
tions. Thanks to this angular structuring, the
tractional, compressive and direct force applied
to the muscle, are directly transferred to the deep
6
 Myofascial manipulation
fascia without creat-
ing too much negative
resistance, even with
the presence of nu-
merous elastic fibers.
This kind of elastic
structuring allows for
an excellent transfer-
ability between the
various fascial layers.
This helps us explain
the different approach
(planning /execution),
between a myofascial
sports massage and a
traditional one (which is based on effleurage and
petrisage has little results). What is really needed
is precise and specific manipulation, to diversify
the viscoelastic property, and try to normalize
the fibers density created by tension, injury,
overload or scars.
At this point, I would like back to the exchanges
point of view about the passivattiva with Robert
Schleip. He agrees that for a better results in a
myofascial release, one of the prerequisites is to
manipulate as much as possible the entire mus-
cle and its surrounding myofascial expansion, as
explained in the first part of my technique.
The manipulation should be applied at 360 de-
grees in an ample wrapping manner: under,
over, sides, for surrounds all muscle mass and
fascial expansions during its changes, contrac-
tion, stretching and relaxation phases, both ac-
tively by the athlete and passively with the help
of the operator during the muscle/joint range of
motion.
That’s the mechanics of passivattiva technique.
This way, not only is it possible to help/increase
the fluids circulation into the Ground Substance,
of which we know still very little, even though we
are now more sure than ever about the impor-
tance of the dynamic hydration effect created by
proper myofascial manipulation.
After the myofascial manipulation that created a
Terra Rosa e-magazine No. 6, December 2010
plastic or permanent change, and if we asked the
athlete to do some exercises for the interested
area or we do them passively, we can feel the re-
sult is more durable, also increased GAGs regen-
eration and stimulating the physiological colla-
gen turnover (Brad Hiskins) (11).
This passivattiva technique for sports bodywork
is also able to stimulate various mechanoceptors
present in the deep and adjacent tissues
(myofascial expansions) and considering the dy-
namic and wide myofascial surface treated, im-
proving the proprioceptive system for a more or
better muscle-joint stability and gesture in the
sport performance, and during the rehab ath-
letic route.
I borrow the term Myofascial Induction
(Induzione Miofasciale) by Maurizio Cosciotti,
who works alongside Prof. A. Pilat and co-author
of this great book, which is useful to finalize all
consideration made until now along with one of
my recent experiences. It is curious how all these
inductions produced by a myofascial manipula-
tion, especially for the proprioceptive input ap-
plied, I directly encountered them studying
deeply, even before knowing the physiological
mechanism of the chemical-physical change
which happens in the manipulated areas. It has
been less appreciated in the experience I had fol-
lowing the evolution of shoulder dislocation to
some of my rugby players. Six shoulders gone in
the first months of the season. One fracture of
the Clavicula meanwhile the other five weren’t
so bad.
Obviously started the normal hospital emergency
room, immobilization and orthopedic visit, out
7
 Myofascial manipulation
of the system of con- Volk)(13).
ventional rehab, the
Well, now I going back to the my rugby players
athlete is given a classi-
injured shoulders. Adding to the usual “work at
cal self-made home
home” therapy, I have been seeing the athletes
program : elastics,
on a weekly basis, to improve the articulation
stretching, Codman’s
and mobility of the limbs, and to test the muscle
exercises and various
capacity. Massage to increase the micro circula-
auto-mobilization tech-
tion and drainage, to eliminate rigidity, contrac-
niques.
ture, adhesion or loss in the affected areas, and
As seen and confirmed to resolve the problem of balance compensation
by my experience, 60% in other parts of the body.
of the athletes (for the
But the most beneficial work done according to
longing of the sport
me, was not the manipulation of the Rotary Cuff
and the need of physi-
muscles belly, but the CT in that area in all of its
cal fulfilment) will only exert themselves and ex-
variations, ligaments, tendons and myofascial
ercise for one week/ten days. Half of the re-
expansions included. Therefore, a massage and
mained will work at home on their problem for
manipulation more widest and deepest, keeping
about two weeks, and the other half (remaining
in consideration the ties between dense and lax
20%) will complete the entire program as pre-
CT, rich of Ground substances, where one creates
scribed by the therapist or sports doctor.
important zones of transition (15) .
Based on these statistics, we all know the length
Seen in this light, I have manipulated the various
of the rehab route, but most of all the poor qual-
aspects of the available CT form, tendons, liga-
ity of the athlete once back in sport-action or
ments, joint capsule, the entire muscle and sur-
trainings after a rushed “do it yourself ” therapy.
rounding, intersecting, joining and overlaying
Without digging to deep about the “why” or
areas.
“how” one ends up with so many injured ath-
letes, we do know that a rehabilitation program That treatment is necessary to restore the right
based on “do it yourself at home” therapy, can bio-mechanics balance, and must to do it as soon
and most probably will add to the numbers of re- as possible, or the continuos overload can light
injured athletes, as expressed by the Director Dr. an anatomic changes that driving to a not syn-
Claudio Manzini of Orthopedic-Traumatological chrony of myofascial chain, then in a bad quality
department of Giussano Hospital, Italy. athletic performance ( G. Di Giacomo ) (16).
For this reason, we know and see why it is so im- Within a few weeks I was told by my athletes that
portant for us to use our techniques on the ath- compared to a similar earlier injury and “home
letes, for their sporting future, and to prevent made rehab”, the shoulder feels more attached,
possible regression. more secure, and felt the need to increase the
repetition and resistance of the exercises, after
“When a joint is immobilized, the least loading
my support. Now, after having studied these
and unloading mechanically of the cartilage and
problems, and after a lot of research and vast lit-
surrounding tissues interferes with a normal ex-
erature, I understand and can say (without in-
change of the cells and the matrix substance
venting hot water) how important it is for a
(ECM). The consequence, the loss of matrix adds
bodyworker to address all parts and aspects of
to the vulnerability of the injured tissue, and a
CT in the area to be treated, also under the as-
higher risk of injury to the same tissue once the
pect of proprioceptive input induced. The pro-
athlete resumes a normal sports activity (Elzi
prioceptive stimulation is more important, its
Terra Rosa e-magazine No. 6, December 2010 8
 Myofascial manipulation
signal running more fast than the nociceptor sig-
nal, because is one of the best prevention for
joint injuries (M. Cesena ) (17).
This obviously makes me think that my experi-
ence is not a singular case, but fruit of a precise
and now well known to work efficient myofascial
manipulation – sports bodyworks - where also
the passivattiva technique is a reference.
The experience leaves me satisfied and happy in
the role of sports bodyworker, given the work
and assistance together with the athletes in their
final stage of therapy, no longer delicate, but es-
sential and never to undervalue.
Our treatment and support, can give to the ath-
lete a reasonable range of mind tranquillize due
to proprioceptive recovering, improving to per-
mit him a safe “back in action”. Now more than
ever I am convinced that the know how of a
sports bodyworker is a mix of experience and sci-
entific research to obtain the most efficient tech-
nique to help the athlete improve or regain after
injury the best performance possible, remaining
always within the boundaries and limits oper-
able.
I would like to finish this, which has cost me a lot
of pleasurable sleepless nights, with the consid-
eration of the fascia movement in Italy which is
timidly but with great determination trying to
come to light of day in Sports & Medicine.
Timidly only because it is truly difficult to find
space, resources and help to be able to research
and experiment in the fascinating fascia world
(or fascianating, used by Robert Schleip).
I am certain, I am not a doctor nor am I a thera-
pist, only a simple sports bodyworker, and it is
hard to get any answers here in Italy, with many
doors being closed in face, while at the same
time, for years I have collaborated with illustri-
ous scientist, researchers and bodyworkers from
around the world, among which the famous &
extraordinary Doctor David Simons, he always
ready to answer and aid me to explain and un-
derstand some technical dubs.
Terra Rosa e-magazine No. 6, December 2010
But we of the fascia movement are determined
and optimistic and seeing what is happening in
these last few years in the fascial world commu-
nity we are hoping that also our country will con-
tribute to the process of research and develop-
ment in this field.
Here below you can find a quote by Luigi Stecco:
“.....only a hand guided by deep scientific
knowhow can solve well and quickly a muscle-
skeletal problem. The more knowledge you have,
the more easily you can find the cause of pain
and of a joint dysfunction. It has nothing related
to magic.” (18)
Therefore the approach with various techniques
must keep into consideration of this structural
specific situation in order to obtain the maxi-
mum results and especially avoid an useless te-
nacity in the low density and thickness areas. I’m
always happy to remember a step of Tom Myers
paper, where he remarks the importance of find-
ing-feeling the resilient areas and the adaptabil-
ity of the fascia superficially before untangling
the deeper mass. By going deeper too quickly you
risk to bury even more the problem instead of
resolving it as quickly as possible. You need a
precise approach plan and the help of the athlete
which by the aim of the passivattiva technique;
“he is involved in the process increasing the pro-
prioceptive by mechanoceptors stimulus, allow-
ing to the operator to easily feel which level of
myofascia has been approached.” ( T. Myers ) (19).
THANKS to…
Really I must thanks these extraordinary per-
sons: Bellia Rosario, Casciotti Maurizio, Chetta
Giovanni, Crippa Lorenzo, Dalton Erik, Polimene
Federico, Riggs Art, Stecco Luigi and Antonio.
Also to Piera and Massimo Terragni, owner and
trainers of COBRAGYM for their availability and
support during my tests. Mrs Cristina van Hal
for helping with the translation.
...and DEDICATION
9
 Myofascial manipulation
This article is a personal dedication and huge
thanks for the scientists and researcher in the
various fields as human physiology, anatomy, and
biomechanic. Their contribution, for us sports
bodyworkers, is the ground where we build our
techniques, and thanks to their publications we
can give a scientific validate to our works. But
also for better understand what we can induce
with manipulation, and to be even more efficient
to aid athletes in own sports performances. After
big sport events, is usually thanks the medical,
technical and training staff, but very few time are
mentioned who made the obscure ground re-
search work. I want to mention some of these ex-
traordinary scientists as
Dal Monte Antonio, Gibson William, Gracovetsky
Serge, Schleip Robert, Simons David, Stecco
14. D. Amiel, S. L-Y. Woo, F.L. Hardwood & W.H. Akeson: The
Carla and many others. effect of immobilization on collagen turnover in connective
Grazie,
for deformation of human fasciae in manual therapy -JAAO -
vol 18 - N° 8 - August 2008 - 379-390
9. Z. Del Prete (dispensa a cura dell'Ing. Emanuele Rizzuto):
Misure in vitro delle proprietà viscoelastiche di tessuti connet-
tivi - Corso di Misure Industriali II Università degli studi di
Roma "La Sapienza"
10. C. Stecco: Modello per la misura dei parametri della fascia
profonda - Atti I Convegno sulla Manipolazione Fasciale,
CMS, Vicenza, 2009
11. B. Hiskins: Tissue Tension Techniques -
www.softtissuetherapy.com.au
12. C. Manzini ed equipe: Patologia traumatica e da sovrac-
carico nello sport: nuovi percorsi terapeutici - Corso organiz-
zato dall'U.O. di Ortopedia-Traumatologia del Presidio Osped-
aliero di Giussano (MB), 2008
13. E. Volk: Connective tissue: the good, the bad and the ugly -
www.thinkmuscle.com
tissue: a biomechamical correlation - Acta Orthop Scand, 53,
325-332, 1982

Maurizio Ronchi 15. Appunti di Medicina per studenti: Connettivi propria-

mente detti - http://doc.studenti.it/
References
16. G. Di Giacomo: Inquadramento clinico diagnostico della
1. M. Lastrico: Il trattamento delle lombalgie secondo il me- spalla: patologie più frequenti – Etiopatogenesi -
todo Mézieres - www.aifimm.it/ www.laspalla.it/

2. U. Morelli: Rieducazione posturale metodo Le TRE Squadre 17. M. Cesena, M. Baldo, A. Chiffi: Distorsione tibiotarsica
- www.tresquadre.com/ nella pratica del rugby: dall'incidenza al recupero funzionale
ad una proposta di prevenzione - BLUWELLNESS periodico
3. C. Stecco, A. Stecco: Studio anatomico della continuità mio- di informazione sanitaria, ottobre 2003, n. 3 -
fasciale - abstract dei lavori del FIRST INTERNATIONAL www.blucenter.net/
FASCIA RESEARCH CONGRESS, Harvard Boston USA 2007
- www.fascialmanipulation.com/ 18. L. Stecco: La cura della fascia - Intervista pubblicata su
Vita&Salute, aprile 2003 - www.fascialmanipulation.com/
4. C. Stecco, A. Porzionato, A. Stecco, R. Aldeghieri, R. De
Caro: Histiological study of the deep fascia of the limbs - Uni- 19. T. Myers: Appendice 2 - principi di trattamento - linee
versità di Padova - FIRST INTERNATIONAL FASCIA RE- guida - da Meridiani Miofasciali - www.anatomytrains.it/
SEARCH CONGRESS, Harvard Boston USA 2007 -
www.fascialmanipulation.com/ 20. V. Rucco e F. Genco: Il massaggio trasversale profondo
secondo Cyriax nella lega mentite ileio-lombare - Ospedale di
5. A. Ahluwalia: Biomechanics of Soft Tissue: An introduction Medicina Fisica e Riabilitazione Servizio Terapie Fisiche,
- Centro Interdipartimentale di Ricerca "E. Piaggio", Facoltà Spilimbergo (UDINE)
di Ingegneria, Università di Pisa - www.dionisio.ing.unipi.it/

6. U. Andreaus: Resistenza dei BioMateriali - BioMateriali

naturali Parte 1ª - www.clinicaebiomedica.ing.uniroma1.it/,
Roma

7. A. Scherillo: Riproduzione, sviluppo e accrescimento

dell'uomo XVIII ciclo - Università di Napoli -
www.fedoa.unina.it/

8. R. Schleip et al.: Three-dimensional mathematical model

Terra Rosa e-magazine No. 6, December 2010 10

Passivattiva Technique
for the Torso & Upper Extremities
Maurizio Ronchi
Here I present the passivattiva techniques for the Trunk and Upper Limbs. I recommend to be always
slow during your work to achieve a good result.

Myofascial release for Levator Scapulae and Rhomboids. The release direction follows the
Spine of scapula. The best efficacy is by asking to athlete to push his head towards the therapists
chest. This technique will allow some popping , the typical sound of some manipulations, and for mo-
bilization of the muscle ( with kind permission by Lorenzo Crippa ).

These techniques have the

same aim as the previous one,
here using a different tool for
more or less “deep”. Therapist
change the Scapula position to
get more available muscle sur-
face, and at the same time he
asked the athlete to aid with
shoulder motion.

Terra Rosa e-magazine No. 6, December 2010 11

 Passivattiva technique

Passive stretching for Rombhoids and treatment of the fascia at the border of Scapula, with passive
movement .
The same technique but
with active arm movement
by the athlete.

Deep work for Scapula border fascia and Subscapularis from Serratus to restore the physio-
logical Scapula glide on the chest.

Terra Rosa e-magazine No. 6, December 2010 12

 Passivattiva technique
Fascia around
Clavicle
Twist &roll for the
several myofascial
expansion at the
Clavicle. Ask to
athlete to move the
shoulder forward
and backwards, and
treat both in static
position and in
movement for get
the best result.

Supine variation, in
this case we ask to
athlete to glide up&
down the shoulder
over the massage
table.

Twist & roll manipulation for Sternocleidomastoid. Athlete turning with head torsion for muscle
contraction or stretching.

Pectoralis
Myofascial release for Pectoralis Major and Minor, and
manipulation of the Axillary fascia. Ask for a slow arm
movement while the gentle finger to go inside and slid-
ing over the chest.

Terra Rosa e-magazine No. 6, December 2010 13

 Passivattiva technique
Latissimus
Dorsi
Release for
Latissimus dorsi,
Teres and
Infraspinatus,
change or ask for
change in the arm
position.

Terra Rosa e-magazine No. 6, December 2010 14

14
 Passivattiva technique
The Pelvic area

Warming up. A slow and deep fiction for some minutes, so we can induce a better tissue plasticity ,
good for following manipulation.

After the warm-up, we can treat the posterior Iliac crest, where a lot of fascial tissue are attached. On
the right, let the leg hanging down for a joint relax, then pull the Iliac crest. In case of a big athlete
for better stability, ask him to hold with the hand on the edge of the massage table.

Side thrust to slacken the SacroIliac joint, and same technique to release the Piriformis ( with kind
permission by Lorenzo Crippa ).

Terra Rosa e-magazine No. 6, December 2010 15

 Passivattiva technique

To complete the SI joint release, therapist use own Ulnar forearm side inside the two joint bone. The
movement forward/back the spine direction is in synchronicity with leg motion anchored to
therapist’s arm ( with kind permission by Erik Dalton).

Deep friction to treat the

Iliolumbar ligament (ILL).
Often the pain to the
lumbar area is cause by a
functional overload of ILL.
The choice of the tool is
related how deepest we
want to go. These
techniques mobilize the
cutaneus and
undercutaneus layers over
the tendons, fascial and
aponeuroses layers.

The Forearm
Twist& roll for Biceps Brachii. In passivattiva with the arm motion we got the best result.

Terra Rosa e-magazine No. 6, December 2010 16

 Passivattiva technique

Twist & Roll for release between Biceps and Triceps Brachii

Here with this technique, the therapist can tune the muscle to release and stretch. (with kind
permission by Giovanni Chetta).

Release techniques for wrist

and fingers flexor tendons.
The thumbs works the tendons
while the fingers treats the ex-
tensor muscles on the back side
of forearm.
Therapist tuning the muscle-
tendons stretch, changing the
knee pressure versus the athlete
palm. (with kind permission by
Giovanni Chetta).
The last two pictures show the
stripping technique to
decompress the forearm tight
fascia. A good one for sports
involving weight, e.g. javelin,
hammer ect, or judo, gym-ring,
tennis, rowing.

Terra Rosa e-magazine No. 6, December 2010 17

 Passivattiva technique
The “Third finger test” for check how freely is the
motion degree of extensor muscles. In the case of
negative result, therapist can perform a full
compartmental myofascial release

The “Smiley” manipulation for extensor tendons and muscles release and mobilization. The same
work for Brevis and Longus tendons of the thumb. These manipulation made the typical popping
sound release ( with kind permission by Lorenzo Crippa).

Please Note: This article is obviously not substitute of medical procedure, ask to a specialist before
use the advises show here. Paper is free to use, just quote the author and source.

Maurizio Ronchi email passivattiva@libero.it

Sports bodyworker member of Seregno Rugby Medical Staff
Associazione Manipolazione Fasciale® -Fascial Manipulation Asso-
ciation®
Associazione Italiana Taping Kinesiologico®
Teacher of Passivattiva Technique

Terra Rosa e-magazine No. 6, December 2010 18

The Trendelenburg Test
John Garfield Dip Bowen Therapy/
It is my observation that although many body workers
have learnt the Trendelensberg Test they are often not
taught an effective method of correction. Without such
knowledge this valuable test is sadly dropped from
their repertoire of assessments.
REASON FOR TESTING: To determine if there is a
muscle firing dysfunction and/or weakness of the glu-
teus medius which can lead to a chain reaction of wide
spread muscle dysfunction. Especially the piriformis
muscle which is forced to take on an increased pelvic
stabilizing role, which in turn creates a chronic hyper-
contraction of the piriformis & contributes to sciatic
nerve pain. Gluteus medius can contribute to, amongst
other things, neck & back pain, sacroiliac joint dysfunc-
tion, pelvic rotation along with leg length discrepancy.
THE TEST:
Client: Standing with back to you (best to have a wall or
back of chair in front of them for balance, especially if
injured or elderly)
Therapist: Squatting behind client with hands on top of
each iliac crest laterally
Ask client to raise (flex) his/her left knee to 45 degrees
if capable and hold for approximately 30 seconds. Ob-
viously if someone experiences pain on lifting the leg it
would be a contraindication until improved. Test for
both sides.
Negative Test: If the unsupported pelvis (opposite to
one standing on) stays at same height or goes slightly
superior. (Left on the picture)
Positive Test (dysfunction): If the unsupported pelvis
drops inferiorly making it lower than the supporting leg
side. (Right on the picture)
IMPORTANCE OF CORRECTION: If left uncor-
rected it will interfere with gait and can have multiple
chain reactions throughout the body. It is often the
cause for a hypertonic piriformis.
CORRECTION: If positive test. (A take home exercise
is shown to your client after your usual pelvic treat-
ment which has addressed any gluteus medius dysfunc-
tion. The exercise will re- program the gluteus medius
Terra Rosa e-magazine No. 6, December 2010
Soft Tissue Therapist
to fire correctly and maintain appropriate muscle tone.)
THE EXERCISE: Have client stand facing a wall or
back of chair (for balance) supporting themselves with
their hands. If left leg was positive start by putting all
your weight on the right leg (by slightly lifting left leg
off the ground). Tighten (contract) the gluteal muscles
strongly of the left unsupported leg and maintain that
continuous tension while you now transfer all your
weight onto that leg and lift the other (R) into the
Trendelenburg Test position. The iliac crest should now
be level. Make sure they are standing upright. Hold
position for 30 secs. REPEAT 2 more times. Only need
to do it on the positive test side/s. There can be a bilat-
eral dysfunction also which warrants doing the exercise
on both sides.
Perform the exercise daily. You can do it 2 or 3 times a
day for faster results. Train your client in the correct
execution and check their technique every treatment as
many people find it difficult to understand. Within 3 or
4 weeks of exercise the gluteus medius should be re-
trained.
Usually within 2 - 3 weeks muscle memory has kicked
in and the body now accepts its new muscle length. It is
still beneficial to do the exercise occasionally after it
has corrected.
The Trendelenburg test. Left: Negative test (normal hip abductor). Right:
Positive test (weak left gluteus medius). Trunk also shifts left as the client
attempts to decrease stresses across involved hip to maintain balance.
19
Learning Massage
Through Videos
History

People have been making videos or

movies demonstrating massage tech-
niques and manoeuvre since the advent
of portable cameras. Early videos were
made mainly to document workshops
or classes by legendary instructors. For
example, in YouTube there are several
video footages from 1970s showing Dr.
Ida Rolf talking and demonstrating
Structural Integration.

Since the advent of home videos or

VHS in the late 1970s, initially videos
were made mainly just as a demonstra-
tion. It probably started in the early
1980s. There were various video tapes
produced with the target audience of
general public, mainly general routine, such as
Swedish massage, Healing Massage, Massage for
relaxation, Massage for couples etc.
Late 1980s begin the release of videos that were
more technical for massage professionals, they
mainly focussed on sports massage. Notably,
Therapeutic Massage for Sports and Fitness by
Rich Phaigh (1988). Another series that appeared
in 1992-1993 are Clinical Sports Massage by
Benny Vaughn. Here massage videos are not just
showing techniques for relaxation, but more spe-
cific for massage professions, and particular tech-
niques, e.g. massage to enhance sports perform-
ance. Due to the expense of filming (before the
advent of desktop video publishing), there were
only a few videos on these specific massage topics,
and they were fairly short in length, usually about
30-45 minutes each.
In 1995 several videos for massage professionals
Terra Rosa e-magazine No. 6, December 2010
started to be produced, notably
Step by Step Tuina by Maria Mercati in the UK,
Ralph Stephens’ Therapeutic Massage in the US.
The Video Atlas of Human Anatomy by Robert
Acland was released in 1996. This is one of the
first 3-D live look at human anatomy: bones &
muscles. The amazing picture enhanced the learn-
ing experience of anatomy. This was quickly
adopted by many schools, books & videos.
In the late 1990s to 2000 there were more videos
produced specific for massage professionals, and
became popular at that time. This also coincided
with the wide availability various massage modali-
ties. These techniques used to be taught restricted
in some schools, now they are becoming more
available for general massage practitioners. For
example, Deep Tissue & Neuromuscular Therapy
by Real Bodywork, Erik Dalton’s Myoskeletal
Alignment Technique, Tom Myers’ Anatomy
20
 Massage videos
Trains videos, Art Riggs’ Deep Tissue & Myofascial
Release.
Videos in DVD format start to appear in mid
2000. Initially videos from VHS were converted to
digital format. However, now most new videos
were made in digital format.
Real Bodywork produced its first massage video
on Deep tissue and Neuromuscular Therapy as a
responds to the request of their students as a way
to remember the information that was being
taught in a 100 hour NMT class. The information
in these DVDs is great, and they even made mus-
cles out of clay and had some computer graphics.
The first videos were also a bit shorter, usually
about 75 minutes. This is in contrast with recent
DVDs that are more animated with 3D models,
and filmed digitally in wide screen format to fit
modern TVs. Recent DVDs are usually over 2
hours and sometimes approach 4 hours in length.
Sean said that each title took 300-400 hours to
create.
Many DVDs are now available bringing techniques
that have traditionally been taught to physical
therapists or osteopaths as in-house training, such
as craniosacral therapy, myofascial release, nerve
mobilization, positional release and orthopaedic
assessment techniques. Nowadays we are fortu-
nate that we can find most of the modalities avail-
able on DVDs.
Advantages
Sean Riehl, the president and founder of Real
Bodywork, believes that learning techniques
through a DVD is a much better way as compared
to a book because you can actually see the instruc-
tor doing the moves. In a book all you have are
static images and descriptions which can some-
time hard to follow or imagine. Of course a book
can offer a lot more encyclopaedic information,
but yet when it comes to learning a technique; it
really helps to see the instructor doing the moves,
because a lot of information that is not spoken is
transmitted when you watch someone who is mas-
terful practice their craft.
Viewing the muscular and bone structure involved
while the in-
structor is
demonstrat-
ing on a cli-
ent makes
learning
more inter-
esting and
easy to grasp.
The “x-ray
eye” allows
us to see the
muscle
groups in-
volved while
the practitio-
ner is mas-
saging. In-
structors used Brilliant graphics showing anatomical
different ways structure from Real Bodywork make
learning anatomy interesting. (Pictures
to convey this
courtesy of Real Bodywork.
information.
For example, in the early days, artist drew the
muscles on the skin of a model to depict the mus-
cles involved in massage. This actually works quite
well, another trick is having the model wearing a
body suit that has muscles drawn to it. This is less
successful. The availability of modern computer
graphics now enabled us to see clearly the muscles
and skeletal parts involved in particular move-
ment.
Cameras placed at the best angle allow us to see
the technique demonstrated from the best possi-
ble viewing positions and you can view it again
and again.
Instructors also come up with various ways to en-
hance the learning process. For example, Tom
Myers in his Anatomy Trains techniques DVD
showed the techniques as taught in a small class
mentoring situation. Tom demonstrated a tech-
nique, and this is followed by the student. The
comments from the clients, Tom’s corrections
concerning application and the student’s body
use, and the student’s responses, all become part
of your learning process.
You can learn new techniques from watching and

Terra Rosa e-magazine No. 6, December 2010 21

 Massage videos
practising from videos, although you cannot feel
the sense of touch from watching DVD, the experi-
ence can be made equivalent to a class/ workshop.
You can gain new knowledge from renowned in-
structors. Although it is best to experience a hands
-on workshop, when you have limited budget,
travelling to other towns can escalate the cost
quickly. The best is to watch and practice it with a
fellow therapist. You learn the same technique
from a reputable instructor in your living room, at
your own time. It is a reference that can be con-
sulted at any the time. Seeing the techniques per-
formed live is the key, more than a just a book
with pictures.
Is it really possible to learn techniques
from video?
Erik Dalton wrote: “During the past 30 years in
the touch-therapy business, I’ve personally wit-
nessed that everyone learns uniquely and at differ-
ent paces. Some possess an “innate kinaesthetic
palpatory awareness,” while others prefer repeti-
tive observation of the techniques to ensure their
understanding of inherent subtleties. Regardless
of individual differences in learning, it seems that
when dealing with hands-on modalities, following
along with a hands-on video (whether online or
DVD) does more to enhance the learning experi-
ence than simply reading theory from a book or
manual; although, both ingredients are essential
to the successful outcome of any comprehensive
home-study program. “
Since 1999, Erik Dalton’s the Freedom From Pain
Institute® has produced high-quality reading and
video programs that provide a much-needed ser-
Terra Rosa e-magazine No. 6, December 2010
vice to the community. Erik found that well-
designed home-study programs often spark a pas-
sion that encourages therapists to further enhance
their skills by attending live presentations---if
their physical and/or financial condition permits.
However many still believe that massage or man-
ual therapy can’t be learnt from watching videos,
they argued that massage can only be learnt by
hands-on workshops. The sceptics claim that
manual therapists are not visual learners and lack
the ability to observe and duplicate the instructors
demonstrating techniques. The idea that thera-
pists cannot view a hands-on manoeuvre and du-
plicate it may hold true for those students still in
training who’ve not yet mastered basic hands-on
skills and anatomical astuteness.
Whitney Lowe believes that when a therapist has
mastered the basic techniques of massage, that
individual should have gathered sufficient skills to
further that learning through high quality instruc-
tional materials that are delivered in a wide vari-
ety of methods e.g. video, or online.
Erik Dalton admitted that he has been a compul-
sive video-junkie for many years and host a collec-
tion of more than 300 VHS and DVDs from every
country. Admittedly, some languages he does not
understand, but visual learning from great hands-
on practitioners in every field of bodywork truly
inspires and challenges his quest for greater
knowledge. Each morning while running on the
treadmill, he grabs something newly purchased or
perhaps watch one of his favourites. “Even if I’ve
seen the video dozens of times, I’m always able to
pick up some little titbits that pique my interest
22
 Massage videos
and boost my motivation to get into the therapy
room and share what I’ve learned with my cli-
ents”.
What makes a good massage DVD?
Sean Riehl advises that a good massage DVD
should be easy to understand and well organized.
It should also quickly get to the point of the tech-
nique and offer information that the therapist can
apply immediately in their practice. A good mas-
Terra Rosa e-magazine No. 6, December 2010
sage DVD should include some assessment along
with treatment, so it not just a bunch of tech-
niques by themselves, but an entire treatment pro-
tocol.
In addition, Whitney Lowe said that a good DVD
should take into account contents that common
practitioner would really want and need to see and
hear.
Sean believes that the information is the impor-
tant part, not the instructor. Instead of trying to
trademark a type of massage, or create yet another
name of a new modality, instructors should just
focus on teaching students how to perform assess-
ments on their clients and effective techniques to
address what is going on. The assessment tech-
niques are fairly standardised, and there are only
so many ways to touch the body, and good body-
work does not need to be very complicated. New
trademarked modalities are just a rehashing of
techniques that people have even doing for years
anyway. In Real Bodywork products, Sean tries to
separate the DVD names based on how a type of
massage works, or which condition it addresses.
23
Report from
Art Riggs’
Deep Tissue Massage
Sydney Workshop
Art Riggs’ Deep Tissue Massage workshops organised
by Terra Rosa started 4th November 2010 at Nature-
Care College, St Leonards, Sydney. It is a 3 day Funda-
mentals of Touch. Art’s approach is a relaxed and fun
learning environment. This workshop gave an under-
standing of touch, depth of layers and the ability to di-
rect intention. It covered proper use of biomechanics
and tools—Say no to thumbs, Use fingers, knuckles,
fists, forearms, and elbows. Art showed how to utilize
body positioning to facilitate release of restrictions, and
increased knowledge of therapeutic strategies. In addi-
tion to muscles, he showed how to cultivate an under-
standing of the osseous component for effective body-
work, including vertebral articulation and mobilization, “Fun, warm, unflappable, generous with time. great at
and working to create freer ribs movement. correcting bad habits. kept things simple & on track”

Art’s teaching approach is unique, instead of showing a
stroke that you would copy, Art will give you a dozen of
approaches that you can adapt and make it your own.
Cultivate an effortless, pleasing and effective touch!
All participants are amazed with Art’s style of teaching,
knowledge and kindness. The comments are:
“One of the best teachers I have come across”
“What a generous, patient and humble teacher Art
Riggs is, what a pleasure and privilege it was to be in
his class.”
The second part of the workshop, Integrated Deep Tis-
sue Massage, continued 8th-9th November. Art started
with strategies on how to market yourself, communi-
cate with clients, and distinguishing deep tissue from
relaxation massage. The Humanity side of massage that
is rarely discussed in any workshop is really empha-
sized. Art demonstrated how to do the structural
evaluation while doing your massage work – how to get
the soft tissue feel, joint function, where is obstruction
or problem?
“Very hands-on, plenty of chances to ask questions”

“Art is just great at being the humble expert! He had
the perfect balance of theory and hands-on and is
flexible enough to adapt the content to suit the class
dynamics and yet still meet the course objectives.”
“Art Riggs is an amazing teacher. So generous and
knowledgeable as well as being very approachable.”
“Enjoyed every minute “
“Art Riggs is generous, open, relaxed, very engaging,
informative, interesting and an excellent communica-
tor. Art is able to adjust the programme to the specific
need of the group so everyone went away with things
relevant to them.”

Terra Rosa e-magazine No. 6, December 2010 24

 Art Riggs’ Workshop
The final Advanced Deep Tissue Massage was on 25th-
28th November. It goes into more details covering the
whole body. First, the quality of touch is again revis-
ited. Then Art covered body reading of strain patterns
on the feet. Anatomy, demonstration is all covered for
the ankle, knees, hips, back, pelvis, abdominal area,
vertebral column, chest, arm, shoulder, and neck.
The class run the full day from 9 am to 6 pm. You get
what your money worth, full 8 hours per day. You’d
never experience this in any workshop. Comments in-
clude:
“Art is generous with his knowledge and time and is
clearly passionate about bodywork. His enthusiasm is
infectious.”
“Never seen so committed instructor to spare his break
to provide extra information.”
“ I would have to say that this is one of THE BEST
workshops I have attended.”
Comments on the workshops include:
“This workshop was excellent, Art is the best instructor
I've seen, he is the most humble, patient, generous,
easy going in addition to teaching in an easy to follow
manner, mixing the theory and practical perfectly.
Terra Rosa e-magazine No. 6, December 2010
25
People would have walked away with a lot more
knowledge whether they were new therapists or
therapists that have been practicing for years.”
“The series of workshops were facilitated in a way
which allowed attendees to interact, while learning
skills and knowledge which can be applied to our indi-
vidual practices. Art managed to get excellent group
interaction right from the beginning; the course was
interesting, informative, extremely well presented and
very relevant to our work.”
“I've really enjoyed Art's workshop and found his way
of working very inspiring. It has been a privilege to
see him demonstrate his work and show us much more
than a really useful, clever and comprehensive collec-
tion of bodywork techniques. What is also great it's the
humanity and compassion Art is channelling through
his work and the deep connection he is able to achieve
through his hands. I am very grateful to have been
able to learn with all the other participants to the
workshops, the atmosphere has been really supportive
and encouraging.”
25
 Art Riggs’ Workshop
Personal testimonials include:
“Thank you Terra Rosa for organizing Art Riggs
workshops in Sydney. It's been an incredible experi-
ence and the best investment in my profession I've
ever made! Art's extensive knowledge and genuine
personality made these workshops very inspirational.
Thank you Art for being such an amazing mentor!”
Zuzana Gaalova, Queenscliff, NSW.
“I am very happy to had the opportunity to meet Art
Riggs. As a Massage Therapist he is the best experi-
ence since I left TAFE college. I am very lucky to have
him as a mentor. You cannot imagine. He taught me
to "sink and slow”, he put his hand on my hand and
told me to let him take the movements. He taught me
to feel like how I can change the body's structures. I
did it, I felt it. I had been practicing his work and I am
improving every moment. His approach is great. He
is not just a teacher, he is a master. His passion, pa-
tient and charisma are just amazing. ” Juliana Osorio-
Ramirez, Sydney.
Terra Rosa e-magazine No. 6, December 2010
“Excellent practical advice, excellently delivered that
will be of major benefit to me in my day to day work.
It has provided me with the perfect grounding and
structure to achieving and delivering several different
ways to work effectively on soft tissue. I really got a
great amount out of the series, it covered all my objec-
tives and more. The one to one training was excellent,
I would highly recommend to others. Overall – excel-
lent. Would love to do it again!!” Tracey Langham,
Anglesea, VIC.
“ Art Riggs is a great educator - knowledgeable, car-
ing and willing to share his information. Two assis-
tants(Colin Rossie and Tom Shand were great) made
it very easy to get feedback and help during practical
sessions. I feel the information and techniques learned
will be able to fit very easily into my massage treat-
ments.” Margaret Markus, TAFE lecturer, Sydney.
26
Fascia Science Made Simple
Simple——
and Applicable to your Practice
Bethany Ward, MBA, Certified Advanced Rolfer
Faculty member of Advanced-Trainings.com and
the Rolf Institute® of Structural Integration
President of the Ida P. Rolf Research Foundation
Readers of the Terra Rosa E-Magazine are well ac-
quainted with Rolfers and their love affair with connec-
tive tissue. In recent years, we’ve gotten really excited
as serious scientists and academics have caught our
enthusiasm for the stuff. Every three years, clinicians
like you and me gather with pre-eminent fascia scien-
tists at the International Fascia Research Congress, to
share our insights and further each other’s work. These
conferences exhibit a passion for learning that is unfor-
tunately all too rare these days; I highly recommend
you attend one if you can. You’ll have fun and your
brain will get a workout!
But let’s admit it — all that scientific terminology can
get a bit daunting. So, I wrote this article to summarize
and make sense of the latest fascia research and explain
how it applies to massage and bodywork therapists. I
hope this discussion puts the latest information about
fascia in a context you can use: 1) influencing your
work with clients right away; and 2) cluing you in to
areas and resources that you may want to explore more
in depth on your own.
A brief history of fascia science
The Fascia Research Congress is the brain child of a
dear friend of mine, Dr. Thomas Findley—who is a
medical doctor, a PhD, and a Certified Advanced
Rolfer, Tom tells a story about researching fascia 30
years ago and finding a dearth of information. He ex-
plains, “When it came to connective tissue, all we knew
was that when you heated a rat tail you could stretch it.
There was no other relevant research that I could find.”
A scientific discipline couldn’t ask for more humble
beginnings. Tom says it was at that moment that he
started dreaming of a fascia congress that would “bring
Terra Rosa e-magazine No. 6, December 2010
together widely separate research disciplines in the ser-
vice of the clinician.”
Until recently, doctors and scientists alike treated fas-
cia as the webby material you cleared away during a
dissection to get to the really interesting parts — the
bones, muscles and organs. Fascia was considered
pretty much inert stuffing that didn’t do anything. And
because connective tissue is everywhere that other stuff
is not, it only got named where it was particularly thick,
like the plantar or thoracolumbar fasciae.
Watching a positive trend toward fascia research
(during three decades, the number of published articles
increased over six-fold), Tom organized the first re-
search congress on the Harvard University campus. It
was only meant to be one-time event but was so suc-
cessful that another was held in Amsterdam in 2009,
with the next one planned for Vancouver in 2012. Fi-
nally, we have a forum to help clinicians understand
why myofascial work is so powerful and develop ways
to further the work.
Latest research
A lot of fascia research is still answering basic ques-
tions: “What is it?” “What are its properties?” and of
particular importance to you and me, “How do we af-
fect it?” At the 2009 congress, Jaap van der Waal, MD,
PhD spoke about his anatomical studies and explained
that a lot of what we take as gospel about the body is
just plain wrong (van der Wal, 2009).
Say it isn’t so…
1) Ligaments don’t exist. True ligaments are almost
nonexistent; in most cases, ligaments are only “made”
with dissection.
27
 Fascia science made simple
2) Tendons don’t insert into bone. There are no
discrete tendon attachments as pictured in anatomical
drawings. Rather, tendons insert into a connective tis-
sue apparatus, which transmits force across joints. In
fact, 15-80% of connective tissue fibres extend past the
designated tendon insertion (Stecco, 2009).

3) Muscles are not the prime players. Tradition-

ally, muscles were thought to be active while tendons
remained static. Actually, muscles and tendons work as
a dynamic system in function, as well as in each other’s
development. As it turns out, the term “myofascial” is Jap Van Der Wall at the 2nd Fascia Congress. Picture taken
particularly apt because it communicates this intercon- from Fascia Congress DVD.
nectedness of muscle and fasciae.

You can read the full article at http://www.ijtmb.org/ Fascial tension plays a critical role in low back stability.
index.php/ijtmb/article/viewArticle/62/82. Fascia needs to bear load and the carrying of load needs
to vary between muscles and back fascia for healthy
A system — greater than the sum of its parts function of the low back (Hodges, 2009). Additionally,
crural fascia strongly links the thigh muscles and cal-
Connective tissue doesn’t lend itself to reductionism.
caneus, contributing to propulsion, stability and motor
Although it’s true that anatomists have named fascial
coordination (Nichols, 2009). Crural fascia enhances
structures where the matrix becomes particularly thick,
propulsion by increasing retraction and ankle plantar
as in tendons or ligaments, these tissues are continuous
flexion, while limiting movement of lower limb, provid-
with different fascial types, which all meld into each
ing stability.
other. Perhaps more than any other system in the body,
the fascial matrix must be addressed as a complex 3) And now for something really unexpected:
whole. Fascia both limits movement and contributes to
the fluidity of movement! A study of calf muscles
And here is the rub: connective tissue’s incompatibility
found that as muscle contracts, its tendons actually
with anatomical separation seems to be at the heart of
lengthen a bit, storing energy that is released when the
its incredible ability to simultaneously provide support,
muscle relaxes, which makes gait more efficient
containment and freedom of movement.
(Kawakami, 2009). Does this happen elsewhere? Proba-
Connective tissue performs seemingly diametric bly. If so, the interplay between fascia and muscle is im-
functions portant in energy transfer between tissues. Fascia sof-
tens the beginning and the end of the muscle move-
1) Fascia provides both separation and connec- ment. It also stores kinetic energy of movement, much
tion of structures (van der Wal, 2009). By enveloping as a hybrid car uses regenerative braking to store energy
structures (everything from single muscle and nerve in its batteries.
cells, to bundles of cells, to muscle bodies and bones),
fascia allows for glide between structures while binding So fascia separates and unites; supports and communi-
them together and providing form. If we understand cates; and stores energy and releases it. How is fascia
this dual role, we can address adhesions to improve able to possess such inconsistent properties? The an-
glide between structures while also affecting the larger swer may be the results of its interconnected system. In
system. addition to enveloping all the structures we can see, fas-
cia extends from the surface of muscle to the interior of
2) Fascia contributes to both support and force the muscle cell. Dr. Ingber at the 2007 congress showed
transmission in the body. Researchers observed that how these connections within the cell extend to the nu-
in most muscles, single muscle fibres do not span the cleus, with tension of the intracellular fibres directly
entire length between tendons (Purslow, 2009). So how affecting gene transcription (Ingber, 2007). The fascial
are forces transmitted through these structures? The matrix reaches even farther than we thought.
connective tissue endomysium keeps fibres tightly in
register within the fascicle, which makes it possible to So when you work with connective tissue, you need to
transmit forces between muscle fibres by shear forces. be thinking about these connections. Even when ad-

Terra Rosa e-magazine No. 6, December 2010 28

 Fascia science made simple
dressing a specific area of adhesion, your hands and
intention must be connecting with the fasciae as a sys-
tem that crosses all boundaries.

How to address fascia layers

Based on our current knowledge, it is likely that myofas-

cial techniques can restore glide between structures. To
do this, we identify places where fascial layers have be-
come stuck together — either due to adhesions or scar
tissue —and work to free them up. Assessing range of
motion and comfort level during movement, before and
after your intervention, can tell you if you’re being effec- 1. Target areas that cause tension in fasciae. A study
tive. looking at the effects of stretch on areolar (or “loose”)
connective tissue found significant remodelling of the
In classes and workshops, I teach students how to “hook
fibroblast cells, which make up fascia, in response to
into” tissue to create a directed stretch and wait for the
only twenty minutes of tension (Langevin, 2009). Based
tissues to release. From Rolfer-researcher Robert
on this work, it makes sense to direct myofascial therapy
Schleip’s work, we’re understanding that angle of con-
at areas (scars, fibrosis, inflammation, etc.) that may be
nection really matters. Schleip likens the fascial layers
causing chronic tension in the fascia. Areolar connective
to a layered dessert, the tiramisu, to show how layers
tissue is the most widespread connective tissue in the
are both distinct and interconnected. He proposes that
body. In addition to filling the spaces between organs
rather than getting tissues to slide, which suggests
and surrounding and supporting blood vessels, this tis-
movement between separate layers, we’re actually at-
sue attaches the skin to the underlying tissue. As such,
tempting to “shear,” or create lateral movement be-
fibrosis can cause strain patterns in the body the same
tween interconnected strata. To achieve lateral move-
way a seam changes the pull through a piece of cloth.
ment, you need to make sure your angle of force is simi-
After appropriate preparation, address fibroses and scar
lar to the angle of the layers. Rather than working per-
tissue early in your sessions, leaving time to integrate
pendicularly to the facia layer, you want to hook into the
these changes throughout the system.
layer and take it in a direction that shears it with respect
to the adjacent layer. Robert Schleip has created a li- 2. Don’t forget the nerves. Dysfunctional fascial tension
brary of fascia-related articles for somatic practitioners can affect every structure in the body, including nerves.
at http://www.somatics.de/, a treasure trove of infor- It is common to find intra-fascial nerves oriented per-
mation. pendicularly to collagen fibres, suggesting that fascial
stretch may stimulate nerves and contribute to certain
In a related study, scientists identified three layers of
pain conditions (Stecco, 2009). Like other structures,
crural fascial. Collagen fibres within each layer lay par-
nerves are sheathed in fascia to allow for glide during
allel, while fibres of different layers form 78-degree an-
movement. Like other structures, nerves can be im-
gles with other layers. This pattern has been found in
peded by adhesions, or “tethered,” causing pain and
thoracolumbar fascia (Stecco, 2009), as well as in bo-
dysfunction. Learning to feel for nerves and freeing
vine neck muscle (Purslow, 2009). While this orienta-
them from surrounding tissues is an important skill for
tion of collagen fibres within layers makes fascia highly
myofascial therapists. If you haven’t explored this area
resistant to traction, the oblique fibre orientation be-
of the work, I strongly encourage it. Just learning to free
tween layers makes shearing a viable therapeutic ap-
up the sciatic nerve as it makes its way from the spine
proach.
down the leg will make you much more effective with
common piriformis and sciatic dysfunctions.

Using myofascial techniques to relieve pain and
restore function
Based on what we currently know about connective tis-
sue, your myofascial interventions should:
3. Work superficial and deep layers. Although it is often
tempting to skip superficial layers when you work,
don’t. The superficial layers of the thoracolumbar fascia
appear to be highly innervated — with over 90% of no-
ciceptive fibres in the superficial fascia and subcutane-

Terra Rosa e-magazine No. 6, December 2010 29

 Fascia science made simple
ous layer, few fibers in the inner layer, and none in the
middle layer study (Tesarz, 2009). Nociceptors (pain
sensors) are also likely to be found in these tissues as
well.

At the 2010 Interdisciplinary World Congress on Low

Back and Pelvic Pain in Los Angeles, the role of fascia
was described as a very promising area for future re-
search dealing with low back pain. When you address
superficial layers, you may be able to affect the remodel-
ling of these tissues, which appear to be caught in
chronic pain patterns. When you work deeply, in tendon
attachments, where golgi tendon organs are abundant,
you may also be influencing muscle patterns. So, con-
sciously working at both superficial and deep levels is
warranted when dealing with chronic pain.
• Affects mechanoreceptors (golgi tendon organs); and

• Works with the body as a system, addressing muscle

A word about terminology and connective tissue as functional units.

The tendency to use the terms “fascia” and “connective
tissue” interchangeably is actually incorrect. It can be
confusing because we’re talking about a matrix of mate-
rial that wraps around every muscle cell and creates en-
velopes, which compartmentalize and wrap around
other structures. There are different fascial layers,
which, are interconnected. The more we learn, the more
we appreciate fasciae’s different densities, composi-
tions, and unique properties. As such, it’s actually incor-
rect to lump all these tissues together as “fascia.” Cur-
rently, researchers (Langevin and Huijing, 2009) distin-
guish between a dozen types of fascia: dense connective
tissue, areolar (loose) connective tissue, superficial fas-
cia, deep fascia, intermuscular septa, interosseal mem-
brane, periost, neurovascular tract, epimysium, intra-
and extramuscular aponeurosis, perimysium, and endo-
mysium. You can read the full article online at http://
www.ijtmb.org/index.php/ijtmb/article/view/63/80.
Conclusion
Myofascial therapists know we can create change — we
see it everyday when clients experience increased range
of motion, reduced pain, and/or smoother, more coordi-
nated movement. But until recently, we didn’t have a lot
of places to look to understand the mechanisms for
these changes. Fascia has been ignored for a long time
so there’s a lot of catching up to do in the research lab.
But the latest findings strongly suggest that myofascial
therapy is effective because it:
• Improves the glide between the enveloping septa;
Fascia brings together seemingly opposing functions in
the body; working with these tissues demands that we
exhibit a similar sophistication. We must be able to
sense with our hands and bodies on both a micro- and
macro-level. We must be able to identify and address
adhesions, scar tissue, and fibroses, which can create
tensions through surrounding tissues leading to dys-
function. But at the same time, it is essential that we
track how force transmits through larger areas and, ulti-
mately, the entire system.
Empirical studies are confirming what we suspected —
bodywork remains an art, as well as a science. In a
study involving tendon transfer surgery for patients
with cerebral palsy, researchers found the locations of
fascia connections varied significantly among subjects
(Kreulen, 2009). Every person who walks in your office
is as different at his or her fingerprint. Anatomy books,
your teachers, and even your own experience can only
give you a general sense of where you need to work. Re-
search can inform you of new things to try and new pat-
terns to notice, but the most important skill you have is
your touch and your openness to sense what’s there.
Only the sensitivity of our hands will tell us what to do
and what to do next.
Luckily, the fasciae, once considered inert, replaceable
packing material, are turning out to be one pretty smart
interconnected cookie. Acupuncture research by Helene
Langevin, MD showed that although inserting needles
created measurable changes in the fascia, the change
was not appreciably different if the needles were placed
in traditional points or nearby (Langevin, 2006), intro-
ducing the question: “Is the connective tissue a body-

Terra Rosa e-magazine No. 6, December 2010 30

 Fascia science made simple
wide signalling network?” If so, are we just facilitating
healing that the body is trying to do anyway? (Seems
plausible to me.) Since fascia connections extend to the
nucleus and influence gene transcriptions, what else is
possible?

I don’t know, but I’m looking forward to find out.

About the Author: Bethany Ward, MBA is a Certified

Advanced Rolfer, Rolf Movement® Practitioner, and
faculty member of the Rolf Institute® of Structural
Integration. She is President of the Ida P. Rolf Research
Foundation and a member of the faculty of Advanced-
Trainings.com. She and fellow Rolfing Instructor Langevin HM, Bouffard NA, Fox JR, Barnes WD, Wu J,
Larry Koliha will be presenting at the October 2011 Palmer BM. Fibroblast cytoskeletal remodeling contributes to
Association of Massage Therapists Conference in Syd- viscoelastic response of areolar connective tissue under uniax-
ial tension. In: Huijing PA, Hollander P, Findley TW, eds. Sec-
ney as well as co-teaching Advanced-Trainings.com’s
ond International Fascial Research Congress [DVD]. Vol. 1.
“Advanced Myofascial Techniques” workshops
Boulder, CO: Ida P. Rolf Research Foundation; 2009.
throughout Australia in the weeks following. To learn
more about classes and dates, go to http:// Langevin MH, Huijing PA. Communicating about fascia: his-
www.advanced-trainings.com. Read also 6 questions tory, pitfalls, and recommendations. International Journal of
to Bethany on page 50. Therapeutic Massage and Bodywork. 2009;2(4):3-8.

Nichols R. Systems for force distribution in motor coordina-

tion: fascia and force feedback. In: Huijing PA, Hollander P,
Sources Findley TW, eds. Second International Fascial Research Con-
gress [DVD]. Vol. 4. Boulder, CO: Ida P. Rolf Research Foun-
All 2009 findings by Hodges, Ingber, Kreulen, Langevin, Nich- dation; 2009.
ols, Purslow, Stecco, Tesarz, and van der Wal reference their
presentations at the 2009 Fascia Research Congress and are Purslow P. Fascia and force transmission: structure and func-
available on DVD, available at http://www.fasciacongress.org. tion of the intramuscular extracellular matrix. In: Huijing PA,
Hollander P, Findley TW, eds. Second International Fascial
Hodges P. Fascial aspects of motor control of the trunk and Research Congress [DVD]. Vol. 2. Boulder, CO: Ida P. Rolf
the effect of pain. In: Huijing PA, Hollander P, Findley TW, Research Foundation; 2009.
eds. Second International Fascial Research Congress [DVD].
Vol. 2. Boulder, CO: Ida P. Rolf Research Foundation; 2009. Stecco C. Anatomical study and tridimensional model of the
crural fascia. In: Huijing PA, Hollander P, Findley TW, eds.
Ingber D. Tensegrity and mechanoregulation. In: Findley TW, Second International Fascial Research Congress [DVD]. Vol.
ed. First International Fascial Research Congress [DVD]. Vol. 2. Boulder, CO: Ida P. Rolf Research Foundation; 2009.
1. Boulder, CO: Ida P. Rolf Research Foundation; 2007.
Tesarz, J. The innervation of the fascia thoracolumbalis. In:
Kawakami Y. In vivo ultrasound imaging of fascia. In: Huijing Huijing PA, Hollander P, Findley TW, eds. Second Interna-
PA, Hollander P, Findley TW, eds. Second International Fas- tional Fascial Research Congress [DVD]. Vol. 2. Boulder, CO:
cial Research Congress [DVD]. Vol. 4. Boulder, CO: Ida P. Rolf Ida P. Rolf Research Foundation; 2009.
Research Foundation; 2009.
van der Wal JC. The architecture of the connective tissue in
Kreulen M. Myofascial force transmission and reconstructive the musculoskeletal system – An often overlooked functional
surgery. In: Huijing PA, Hollander P, Findley TW, eds. Second parameter as to proprioception in the locomotor system. In:
International Fascial Research Congress [DVD]. Vol. 3. Boul- Huijing PA, Hollander P, Findley TW, eds. Second Interna-
der, CO: Ida P. Rolf Research Foundation; 2009. tional Fascial Research Congress [DVD]. Vol. 2. Boulder, CO:
Ida P. Rolf Research Foundation; 2009.
Langevin HM. Bouffard NA. Badger GJ. Churchill DL. Howe
AK. Subcutaneous tissue fibroblast cytoskeletal remodeling
induced by acupuncture: evidence for a mechanotransduction-
based mechanism. Journal of Cellular Physiology. 207(3):767-
74, 2006.

Terra Rosa e-magazine No. 6, December 2010 31

 Advanced-Trainings.com’s
Advanced Myofascial
Techniques Workshops
Cairns, the Gold Coast, Melbourne, &
Sydney. Throughout October 2011

What to expect
The Advanced Myofascial Technique seminars present Whether you have years of experience or come with
practicing manual therapists with highly effective and fresh eyes, our workshops are designed to help you:
little-known techniques, tests, and procedures, which • Learn specific techniques for common structural and
can be easily incorporated into your existing practice. functional complaints
Drawing on a wide range of disciplines, the focus is on • Relieve pain, restore lost function, and get lasting re-
unusual, interesting, and fresh approaches that both sults
• Be more precise in working with specific tissue types
expand your repertoire of techniques, as well as inspire and body layers
creativity and innovation. • Combine more subtle indirect work with deeper direct
work
Two‐Day Workshops  One‐Day Specialty Workshops  • Track subtle psycho-physiological and nervous system
Neck, Jaw & Head  TMJ; Headaches  responses
Pelvis, Hip, & Sacrum  Sciatica & Disk Issues  • Work more sensitively, safely, and comfortably at very
deep levels.
Leg, Knee, & Foot  Advanced Knee Issues 
Advanced-Trainings.com is associated with the Rolf In-
Take 1, 2, or 3 days of training. Each event combines a stitute® of Structural Integration, Boulder Colorado, USA
2-day training with an optional 1-day specialty class: and is approved by the National Certification Board for
Two-day workshops are highly recommended as prereq- Therapeutic Massage and Bodywork as a Continuing Edu-
uisites for the following 1-day specialty workshops. Al- cation Provider in the USA. These workshops are pending
ternatively, all 2-day workshops are available on DVD approval for Continuing Education Credits by the AAMT
at a discount to registered participants. and AMT in Australia.

All workshops combine:

• In-person demonstrations and individualized hands-on
supervision
• State-of-the-art instructional materials, including 3D
Interactive Anatomy software
• A detailed course manual/note organizer with photos of
techniques covered
• Videos of instructor demonstrations available for post-
workshop practice and review.

The Instructors
Advanced.Trainings.com Faculty members Larry Koliha and
Bethany Ward will be presenting on fascia research and
myofascial therapy at the 2011 Association of Massage
Therapists (AMT) national conference, as well as teaching
workshops in Australia throughout October. Both Larry and
Terra
Bethany are RosaAdvanced
Certified e-magazine No. Rolf
Rolfers™, 6, December
Movement®2010 32
Practitioners, and teach at the Rolf Institute of Structural
32
Integration.
An Interview
with
Gil Hedley
Founder of Integral Anatomy
Can you briefly describe the concept of Integral
Anatomy?
Integral anatomy is an approach to the study of the hu-
man form and the human person which I've been de-
veloping and pondering since the early nineties. It
came about when I got inspired to do some dissection
as a new Rolfer. I wanted to improve myself profession-
ally. The first dissection I led with a group was a bit
haphazard, though very interesting of course. The next
year I went in with a plan. I was intent on dissecting in
a manner that was coherent with the holistic body phi-
losophy I had adopted as a Rolfer. Knowing that there
are different textural layers which can be distinctly pal-
pated in the body, I thought to reveal those continuities
in the form. We dissected the whole body simultane-
ously by layer that time, and found it to be very com-
pelling!
At the same time I had begun teaching evening courses
in anatomy and physiology for a “healing school” in
Manhattan. Because of my involvement with that
school, there developed a sort of feedback loop between
the development of the dissection workshop in the lab,
and the courses I was teaching to the groups training in
energy work and psychodynamics. So my work in the
lab came under the influence of that experience, and I
began to notice the psychodynamic issues generated by
the process of dissection, and to realize that there was
great potential for personal transformation inherent in
the study of anatomy from a perspective that included
all the levels of the human person.
So I like to say that integral anatomy is the study of the
whole body by the whole person. I contrast it with re-
gional anatomy, with its focus on the regional naming
of “body parts,” separation, and a mechanistic model.
All that regional anatomy contributes I value, and I also
want to think on the forest as well as the trees! So in
Terra Rosa e-magazine No. 6, December 2010
distinction, the focus of integral anatomy is on conti-
nuities across regions, whole body textural layers, and
the relationships of tissues. Integral anatomy explores
the qualities of those continuities, textures and rela-
tionships with an eye to advancing the questions, “Who
am I?” and “What is my body?” alongside the clinical
issues that remain of keen interest as well.
How is your work different from regular dissec-
tion workshop or attending a "wet lab"
There are several ways in which my dissection work-
shops differ from the approach taken in a conventional
medical school curriculum. First, since I am bound to
no curriculum, well, there are no tests in my class! The
pressure is off, and folks are free to explore what's in
front of them as opposed to “finding” and “naming”
what they are being taught is "there." Further, every
day begins with a conversation in which the community
of the class comes into the present. We discuss what we
are doing, how it is going for people, what they are
learning, and how it is impacting their ideas about the
body, their practice, and their lives. We have very rich
exchanges and the course is knit together by the inter-
play of the experience of the group circle, the dissection
process itself, and the time folks have on there own in
the evenings when the experience unfolds and develops
further. Additionally, the dissection process itself is
quite different. Because we are approaching the forms
layer-by-layer, each texture is given a very focused
block of attention as it is encountered, differentiated
and reflected. We reflect the whole skin on the first
day: that is a pretty intense experience of skin! By cre-
ating this type of focused attention layer-by-layer on
the whole body textural continuities, participants can
carry away in their own sensory apparatus a very dis-
tinct and clear impression of the these layers and their
differences. There is no need to take notes in this class.
33
 Interview with Gil Hedley
The experience is pretty much a permanent one. That
having been said, with the emphasis on transformation,
the potential exists to come away from the class with a
more integrated sense of self. Folks come to appreciate
aspects of themselves and their bodies which they may
have not even known about, or which they may have
had a negative relationship with, and now have devel-
oped respect and appreciation instead.
What can we learn from human dissection. And
How your work has influenced bodyworkers?
Dissection enables bodyworkers to see what they touch.
Bodywork is in a very real sense a profession which
operates in the dark. Much of it can be done with eyes
closed, as the therapist feels their way through the
body. When you can corroborate with your eyes for a
whole week the tissues you have been palpating every
day but can never really confirm, it is a huge blessing!
Then when you return to your clients it's as if you have
x-ray hands, and all of your experiences in the lab come
back to you, because they live in your hands as well as
your minds eye, and you can continue to reference the
experience and corroborate what's in your hands to
what you learned in the lab. My work became very
much more specific for having been in the lab, and the
tour of the body which I offered my clients became ex-
ponentially more specific. I could lead them better be-
cause I'd been there!
What do you mean by “superficial fascia”?
Superficial fascia is the loose, areolar connective tissue
immediately deep to our skin, where fat is stored in
lesser or greater amounts depending upon a variety of
factors. Some refer to it simply as the adipose layer. I,
along with lots of other anatomists, call it superficial
fascia in contrast to the deep fascia, or fascia profun-
dus, which is deep to it and covers the muscle layer. It
is my Everest. I conquer it because it is there!
Terra Rosa e-magazine No. 6, December 2010
Then what is the “deep fascia”?
At the level of physical description, the deep fascia
represents a major shift in texture as you work your
way into the body from the outside. By comparison, the
skin is this highly organized layer which represents the
apparent outer limit of the physical (as opposed to the
energetic) body. It is a continuous fabric covering the
entire form, which never “goes deep.” Skin can have
more or less depth in itself (a few to several millime-
ters), but as a texture, it sticks to the surface. The skin
is the skin of the superficial fascia, and the scalpel goes
dull differentiating the two. When you grab yourself by
the skin, the superficial fascia always comes along for
the ride, and what you are really lifting is the the skin
and superficial fascia (SF) away from the SF’s relatively
looser relationship with the deep fascia beneath it. So
the deep fascia, like the skin, is again a more thin and
grid like layer than the superficial fascia, which is rela-
tively loose and “fluffy.” Also like the skin, the deep
fascia covers the entire body, but it does so deep to the
SF. Unlike the skin, however, the deep fascia extends
itself beyond its covering aspect over the muscle, and
sends arching fibrous sheets right on down to the bone.
What do you mean by “cranial and visceral fas-
ciae?”
I refer to the fibrous and serous linings which define
the spaces of our viscera and central nervous system.
There is a pattern that repeats from area to area. From
the outside in, there is an outermost fibrous layer, then
a serous layer, then the “skin” of the organ itself. With
some variation of course, this is the basic pattern we
see.
Nevertheless, these tissues are completely accessible
either through touch or movement, and I am hoping to
raise folks’ consciousness about these layers, since
you’re working them anyway. In fact, our every breath,
our every heartbeat, represents a movement of these
layers, with relative ease or not.
34
 Interview with Gil Hedley
The dura lines the cranium and spinal column, the en-
dothoracic fascia lines the thorax, the outermost sack of
the heart is the fibrous pericardium, and the belly is
lined by the transversalis fascia. We can image the
head, chest, heart and belly each as a space defined by a
fibrous balloon. These fibrous balloons are sometimes
periosteal layers, like the dura and the endothoracic
fascia (where is coats the ribs and sternum), and some-
times they are the tendonous aponeuroses of muscles,
like the transversalis fascia (of the transversus abdomi-
nus muscle) and the endothoracic fascia (where it coats
the inner surface of the innercostal muscles). The fi-
brous pericardium is actually more like an upward out-
pouching of the central tendon of the diaphragm: its
fibers coming with the fibrous outer wrapping of the
heart-space. The heart space and the diaphragm are
one.
And since they are apiece with our muscles and bones,
well, they are directly implicated by our work with
these structures. Flex or extend your spine, and you are
stretching the dura. A broad palm dragging on the belly
is stretching on the transversalis fascia. Pressure on the
chest wall is distorting the endothoracic fascia. Take a
good deep breath and you are implicating them all to-
gether and the fibrous pericardium as well. Once you
know what’s there, you can address these baglike layers
consciously. And the fun doesn’t stop there!
What's the fuzz speech?
The Fuzz Speech is a silly little riff I gave on camera one
day while I was shooting video in the dissection lab for
the production of my four-part DVD series, The Inte-
gral Anatomy Series. I included it as a "Bonus Feature"
on Volume Two of that series, and then thought to just
post it on You Tube: http://youtu.be/_FtSP-tkSug
There it sort of took on a life of its own! In the clip I
discuss the value of stretching for avoiding the accumu-
lation of "fuzz," which is the word I used to describe the
Terra Rosa e-magazine No. 6, December 2010
cumulative binding of
tissues through hydro-
gen bonding first at a
microscopic, and ulti-
mately at a visible level.
Because I illustrated the
invisible with a visible
analogy in normal tissue,
many folks now mistak-
enly believe that all
"fuzzy" tissue is patho-
logical, which of course
is not the case! So I have
also published to written
pieces on the topic, the
first being an article in The Journal of Bodywork and
Movement Therapy on the specifics of "Visceral adhe-
sions as fascial pathology." The second is a chapter in a
book coming out through Erik Dalton. He has gotten a
bunch of us together to contribute pieces to a collection
that should be of much interest to bodyworkers. It
should be out soon through his website. In that chapter
I document normal and abnormal tissue relationships
in the fascial and muscular layers. So between the two
written pieces, anyone can get a much more specific
sense of the nature of scarring and adhesion in differ-
ent tissue types, and how to differentiate them.
Gil Hedley Ph.D. is the founder of Integral Anatomy
Productions, LLC, and Somanautics Workshops,
Inc. He went to Duke as an undergrad, and then to
the Divinity School of the University of Chicago for an
MA in the study of religion and a Ph.D. in Theological
and Philosophical Ethics. He went to the Rolf Institute
and trained in massage, and was certified as a
Rolfer® in 1993. Then he and his wife spent 4 years
studying whole person healing and psychodynamics
at the IM School of Healing Arts. During that time, he
began teaching anatomy at the healing school, and
teaching anatomy in the dissection lab as well. He
eventually left off my Rolfing® practice to devote fully
to teaching.
After about ten years developing and teaching the
workshop in many cities nationwide and abroad, he
undertook the enormous project of putting my ap-
proach and message down in a DVD format. The se-
ries has to date been distributed to 25 countries glob-
ally. You can find Gil at: http://www.facebook.com/
pages/Gil-Hedley-Integral-Anatomy/120301201315055
35
Hip flexor & Quadriceps-
Myofascial Stretching
by Walt Fritz, PT
Foundations in Myofascial Release Seminars

The purpose of this stretch is to
lengthen the muscle and soft
tissue at the front of the thigh,
pelvis, and tissues leading into
the deeper regions of the back.
The stretch can be done in one
of two ways, as pictured above.
The stretch can be done at the
side (top two photos) or at the
end of a bed, table, or even the
top step of a flight of stairs
(bottom two photos).
Depending on the degree of
tightness, your therapist will
recommend a certain manner of
Terra Rosa e-magazine No. 6, December 2010
performing the stretch. Follow
these instructions in terms of
their recommended length of
time and frequency. This stretch
should be a “low load/long dura-
tion” stretch; one that is not too
extreme and held for a period of
time of 3-6 minutes per leg.
Note that in the second photo of
each of the above sequences, the
knee is trapped by the arm just
below the elbow and the other
hand grasps at the wrist. This
allows the leg to hang off of the
rigid arm, with less fatigue than
if both hands hold the knee to
the chest. Increasing the amount
of knee to chest will reduce the
strain on the lower back.
Disclaimer: The information
provided above is intended for
use in conjunction with a quali-
fied health care professional.
Please do not attempt these
techniques yourself without
proper instruction.
36
Fibromylagia:
New Perspectives
By Steven Goldstein, BHSc MST, BA Ed
Fibromyalgia classically presents as wide spread
musculoskeletal pain and we know that the origin
of this pain is multifaceted and systemic. Because
of this, a more comprehensive understanding is
required of you to be successful in your treatment
options. In this article I’m going to introduce the
concept of ‘Central Sensitization’, and the FIQ Fi-
bromyalgia Impact Questionaire. These compo-
nents will give you a greater understanding of how
to work with and treat your Fibromyalgia client.
There has been much written regarding Fi-
bromyalgia and Massage Therapy, but a short re-
view may be in order to the salient features of the
syndrome. Fibromyalgia FMS is a syndrome that
is considered by many to be a chronic, cumu-
laative overload of the body’s coping and cushion-
ing mechanisms (Gillick, 2001) in which on going
residuals of macro-traumas (whiplash, system dis-
orders, post traumatic stress syndrome, are per-
petuated with numerous and cumulative micro-
traumas (chronic sinusitis, repeated impact
trauma, musculoskeletal dysfunction in the upper
or lower extremities, positional sleep traumas)
which sensitizes the central nervous system in
such a manner as to amplify pain 24/7 and create
pain from usually non-painful stimuli.
This is known as Hyperalgesia: the amplifica-
tion of pain sensations and Allodynia: non-
painful sensations such as touch, noise, vibration,
lights or smells are painful. Prevalence indicates
usually affecting women over men by a 4/1 ratio,
but Fibromyalgia can occur at any age. Although it
usuall manifests between the ages of 30 to 50.
(Rattray p983)
Terra Rosa e-magazine No. 6, December 2010
There is an enormity of presenting symptoms with
a wide range of variance as to fool the manual
therapist, and probably the best source for the
presenting symptoms would be to check out Dr.
Devin Starlanyl’s website: http://
homepages.sover.net/~devstar/.
Central Sensitization
"Fibromyalgia (FM) pain is frequent in the general
population but its pathogenesis is only poorly un-
derstood. Many recent studies have emphasized
the role of central nervous system pain processing
abnormalities in FM, including central sensitiza-
tion and inadequate pain inhibition. However, in-
creasing evidence points towards peripheral tis-
sues as relevant contributors of painful impulse
input that might either initiate or maintain central
sensitization, or both. It is well known that persis-
tent or intense nociception can lead to neuroplas-
tic changes in the spinal cord and brain, resulting
in central sensitization and pain. This mechanism
represents a hallmark of FM and many other
chronic pain syndromes, including irritable bowel
syndrome, temporomandibular disorder, mi-
graine, and low back pain. Importantly, after cen-
tral sensitization has been established only mini-
mal nociceptive input is required for the mainte-
nance of the chronic pain state. Additional factors,
including pain related negative affect and poor
sleep have been shown to significantly contribute
to clinical FM pain. Better understanding of these
mechanisms and their relationship to central sen-
sitization and clinical pain will provide new ap-
proaches for the prevention and treatment of FM
and other chronic pain syndromes."
37
 Fibromyalgia
Central sensitisation is defined as ‘‘an augmenta-
tion of responsiveness of central pain-signalling
neurons to input from low-threshold mechanore-
ceptors’’ (Meyer et al.,1995). “While peripheral
sensitisation is a local phenomenon, central sensi-
tisation means that central pain processing path-
ways localised in the spinal cord and the brain are
sensitised.”

The science is fascinating, but the clinical implica-

tions through the application of this understand-
ing is essential. An important and ongoing source
of pain is required before the process of peripheral
sensitisation can establish central sensitisation.
Progression towards chronic widespread pain is
associated with injuries to deep tissues which do
not heal within several months (Vierck, 2006).
Myofascial Treatment
Consequently, appropriate and effective manual
“Anecdotally, muscles and fascia often become
therapy in those with (sub)acute musculoskeletal
hypertonic and develop trigger points in people
disorders is important to prevent evolvement from
with chronic widespread pain/FM. Soft-tissue
an acute, localized musculoskeletal pain problem
mobilisation is required to free up restrictions
to complex clinical cases, characterised by chronic
and restores local blood flow. However, it is im-
widespread pain and even symptoms outside the
portant not to increase pain during treatment.
musculoskeletal system such as increased sensitiv-
The vicinity of myofascial trigger points differs
ity to bright lights, auditory loudness, odours, and
from normal muscle tissue by its lower pH levels
other sensory stimuli. Pain due to damage or in-
(i.e. more acid), increased levels of substance P,
flammation of peripheral tissues is clearly capable
calcitonin gene related peptide, tumour necrosis
of causing chronic widespread pain/FM (Clauw,
factor-a and interleukine-1b, each of which has
2007). 15-20% people with whiplash injuries de-
its role in increasing pain sensitivity (Shah et al.,
velop chronic pain and disability (Spitzer et al.,
2005). Sensitised muscle nociceptors are more
1995; Radanov and Sturzenegger, 1996; Cote´ et
easily activated and may respond to normally
al., 2001). Regardless of whether FM is present in
innocuous and weak stimuli such as light pres-
chronic whiplash, altered central pain processing
sure and muscle movement (Shah et al., 2005).
and central sensitisation is evident (Curatolo et
Therefore, starting the soft-tissue mobilisation
al., 2001; Sterling et al., 2002, 2003, 2006; Banic
superficially with well-tolerated strokes along the
et al., 2004). Moreover, altered central pain proc-
length of the muscle fibres (referred to as
essing rather than impaired motor control has
‘stripping’ in Benjamin and Tappan, 2005) and
been identified as one of the prime prognostic fac-
progressing towards deeper strokes that go per-
tors for developing chronic whiplash (Sterling et
pendicular to the soft-tissue fibres is recom-
al., 2003, 2006).
mended. Aggressive ways of treating trigger
points (e.g. by using ischaemic pressure) are usu-
ally not well tolerated and therefore not recom-
Excerpted below from ‘From acute musculoskele- mended.”
tal pain to chronic widespread pain and fi-
bromyalgia: Application of pain neurophysiology The research is clearly demonstrating a lighter ap-
in manual therapy practice treatment’ Manual proach is needed when applying soft-tissue thera-
Therapy 14 (2009) 3:12 pies with the sufferer of fibromyalgia. We know

Terra Rosa e-magazine No. 6, December 2010 38

 Fibromyalgia
from the studies of ‘facilitation’ with regard to ac-
tive and latent trigger points, that once the dorsal
horn of the spinal cord is switched on, it maintains
its’ ‘facilitation’, with a low thresh hold barrage of
stimulus.

An awareness is needed of the mechanisms that

activate the autonomic nervous system, such as
‘flight and fight’; and the de-activation of ‘high
sympathetic tone’ (Shea 1995), so that the therapist
modulates the ANS from a lower sympathetic state
the total spectrum of problems related to fi-
into a parasympathetic state which is demon-
bromyalgia and the responses to therapy. It was
strated by ‘rest and repose’. With this type of client,
first published in 1991 and since that time has been
modification of duration of treatment, amount of
extensively used as an index of therapeutic efficacy.
force or pressure and specific tissues totarget, i.e.,
Overall, it has been shown to have a credible con-
myofascial tissue, are all essential to a greater de-
struct validity, reliable test-retest characteristics
gree of success through the cessation of the barrage
and a good sensitivity in demonstrating therapeu-
of nocioceptive stimulus.
tic change.
With the type of clinical approach I utilize, the use
The original questionnaire was modified in 1997
of a skill set that employs lighter touch, autonomic
and 2002, to reflect ongoing experience with the
nervous system modulation, the use of mind-body
instrument and to clarify the scoring system. The
techniques such as nlp, neuro-linguistic program-
latest version of the FIQ can be found at the web
ming, awareness and imagery technique, low load
site of the Oregon Fibromyalgia Foundation
resistive for targeting intrinsic ligament and axial
(http://www.myalgia.com/FIQ/FIQ_B.htm ). The
spinal muscle groups, forms of applied kinesiology,
FIQ has now been translated into eight languages,
reflexology; all have efficacy in the treatment appli-
and the translated versions have shown operating
cation of the sufferer of fibromyalgia.
characteristics similar to the English version. A
Finally remember you have to have a strong refer- copy of the questionnaire is available at the end of
ral network due to the systemic nature of the pres- this article.
entation, that means you need to refer to qualified
Based on an intake questionnaire used in the
therapists who practice CAM therapies, including
OHSU Rheumatology Clinic and informal discus-
naturopaths, CAM therapy friendly allopath physi-
sions with fibromyalgia patients, the initial version
cians, mind body therapists, rheumatologists, and
of the FIQ was developed in 1986. In particular,
cognitive therapists that deal with emotional and
the functional component of the questionnaire was
psychological issues that are part of the overall
purposely biased to the use of large muscle groups
clinical picture.
rather than fine hand movements.
Fibromyalgia Impact Questionnaire
Make sure you download the questionnaire and
A very important tool for the manual therapist in thoroughly read the research behind the study, as
their treatment of Fibromyalgia is the FIQ or Fi- it will allow you the insight about how the ques-
bromyalgia Questionnaire. This is the tool recog- tions were formed and why they were asked. In
nized for use in clinical trials around the world, particular the scoring is designed to target physical
and therefore is the major current tool to measure functioning versus physical impairment. The cate-
changeable outcomes for your client. gories are such as to ascertain how ADL activities
of Daily Living are affected.
It was developed by Dr. Robert Bennett in the
1980’s in Portland Oregon in an attempt to capture Every client should be filling out this questionnaire

Terra Rosa e-magazine No. 6, December 2010 39

 Fibromyalgia
and then you actually have the ‘research tool’ in
your hand to validate and contribute to studies
and findings from a research perspective.

References

1. Dr. John S. Gillick, How to Tame Fibromyalgia © 2001

This is the original paper presented for the first time at the
American Occupational Health Conference on April 26, 2001
in San Francisco California by Dr. John Gillick of UCSD San
Diego

2. Rattray F. & Ludwig L. Clinical Massage Therapy: Talus

Inc. Toronto, Ontoario, Canada, 2000. Fibromalgia &
Chronic Fatique Syndrome p 981

3. Jo Nijs , Boudewijn Van Houdenhove. From acute muscu-
loskeletal pain to chronic widespread pain and fibromyalgia:
Application of pain neurophysiology in manual therapy prac-
tice. Manual Therapy 14, Issue 1, Pages 3-12 (February 2009).
4. Benjamin PJ, Tappan FM. Tappan’s handbook of healing
massage techniques. Classic, holistic, and emerging methods.
New Jersey: Pearson Prentice Hall; 2005. p. 127.
5. Clauw DJ. Fibromyalgia: update on mechanisms and man-
agement. Journal of Clinical Rheumatology 2007;13:102e9.
7. Spitzer WO, Skovron ML, Salmi LR, Cassidy JD,
Duranceau J, Suissa S, et al. Scientific monograph of the Que-
bec task force on whiplash-associated disorders: redefining
‘‘whiplash’’ and its management. Spine 1995;20:S1e73.
8. Sterling M, Treleaven J, Edwards S, Jull G. Pressure pain
thresholds in chronic whiplash associated disorder: further
evidence of altered central pain processing. Journal ofMuscu-
loskeletal Pain 2002;10:69e81.
9. Shah JP, Philips TM, Danoff JV, Gerber LH. An in vivo
microanalytical technique for measuring the local biochemi-
cal milieu of human skeletal muscle. Journal of Applied
Physiology 2005; 99:1977-84.
10. Vierck CJ. Mechanisms underlying development of spatial
distributed chronic pain (fibromyalgia). Pain 2006; 124:242-
63.
11. The Fibromyalgia Impact Questionnaire (FIQ): a review of
its development, current version, operating characteristics
and uses. Robert Bennett, MD, FRCP, FACP, Professor of
Medicine, Department of Medicine, Oregon Health and Sci-
ence University, Portland, OR 97329, USA.
About the Author:
Steven Goldstein, an American émigré to Australia in
1999, resides in Melbourne, Australia, where he holds a
Bachelor of Health Science in Musculoskeletal Therapy
and Bachelor of Arts in Education. He is an innovative
massage educator instructing his unique blend of direct
myofascial, indirect osteopathic releasing methods and
somatic approaches known as Integrative Fascial Re-
lease internationally since 1995.
Steven chaired the Australian Association Massage
Therapists AAMT Education Subcommittee from 2004
-2o10 and chaired the Internal Course Advisory Com-
mittee for Musculoskeletal Therapy Degree at Endeav-
our College of Natural Health 2005-2009.
Steven will delivering his IFR Foundations or Interme-
diate workshops to manual therapists and physiothera-
pists Poznan, Poland; and in London to osteopaths,
physiotherapists, manual and remedial therapists in
March-April 2010. He is delivering Fibromyalgia: Clini-
cal Approaches for the Manual Therapist at the Scottish
Massage Organization conference in Edinburgh, Scot-
land in March 2010. And also is presenting IFR Intro-
ductory workshop to the ACPEM Association of Char-
tered Physiotherapists in Energy Medicine conference
near Radstock, England in April 2010.
See Steve's website: http://fascialrelease.com/
Read also 6 questions to Steve on page 49.

12. Clin Exp Rheumatol 2005; 23 (Suppl. 39): S154-S162

13. Fibromyalgia Syndrome: An Overview: Susan Krsnich-

Shriwise Phys Ther. 1997;77:68-75.

Terra Rosa e-magazine No. 6, December 2010 40

 FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQ) 
 
Name: _________________________________     Date:    /   / 
 
 
Directions: For questions 1 through 11, please circle the number that best describes how you did over‐
all for the past week. If you don't normally do something that is asked, cross the question out. 
 
           Always   Most  Occasionally  Never 
Were you able to : 
 
Do shopping? ………………………………         0        1               2                3 
 
Do laundry with a washer and dryer? ........     0        1               2                3 
 
Prepare meals? .........................................     0        1               2                3 
 
Wash dishes/cooking utensils by hand?.....     0        1               2                3 
 
Vacuum a rug?...........................................     0        1               2                3 
 
Make beds? ...............................................    0        1               2                3 
 
Walk several blocks? ................................     0        1               2                3 
 
Visit friends or relatives? ...........................     0        1               2                3 
 
Do yard work?............................................     0        1               2                3 
 
Drive a car? ...............................................     0        1               2                3 
 
Climb stairs? .............................................     0        1               2                3 
 
12. Of the 7 days in the past week, how many days did you feel good? 
 
0      1      2      3      4      5      6      7 
 
13. How many days last week did you miss work, including housework, because of fibromyalgia? 
 
0      1      2      3      4       5      6      7 
Terra Rosa e-magazine No. 6, December 2010 41
41
 FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQ) – page 2 
 
Directions: For the remaining items, mark the point on the line that best indicates how you felt overall 
for the past week. 
 
14. When you worked, how much did pain or other symptoms of your fibromyalgia interfere with your 
ability to do your work, including housework? 
                         ● ___І ___І___І ___І___І ___І ___І ___І ___І___●  
    No problem with work                    Great difficulty with work 
 
15. How bad has your pain been? 
                          ● ___І ___І___І ___І___І ___І ___І ___І ___І___●  
    No pain                 Very severe pain 
 
16. How tired have you been? 
                          ● ___І ___І___І ___І___І ___І ___І ___І ___І___●  
    No tiredness               Very tired 
 
17. How have you felt when you get up in the morning? 
                          ● ___І ___І___І ___І___І ___І ___І ___І ___І___●  
    Awoke well rested             Awoke very tired 
 
18. How bad has your stiffness been? 
                          ● ___І ___І___І ___І___І ___І ___І ___І ___І___●  
    No stiffness               Very stiff 
 
19. How nervous or anxious have you felt? 
                          ● ___І ___І___І ___І___І ___І ___І ___І ___І___●  
    Not anxious                   Very anxious 
 
20. How depressed or blue have you felt? 
                          ● ___І ___І___І ___І___І ___І ___І ___І ___І___●  
    Not depressed                Very depressed 
 
 
See Dr. Robert Bennett FIQ Abstract as a PDF file download for results of clinical study. 
Robert Bennett, MD, FRCP, FACP, Professor of Medicine, Department of Medicine (OP09), Oregon Health and Sci‐
ence University, Portland, OR 97329, USA. E‐mail: bennetrob1@comcast.net  Clin Exp Rheumatol 2005; 23 (Suppl. 
39):S154‐S162. 
© Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2005. 
Terra Rosa e-magazine No. 6, December 2010 42
42
Terra Rosa e-magazine No. 6, December 2010 43
43
Relieve Computer
Neck & Shoulder
Tension By Anita BOSER LMP, CHP, RYT

Many of our clients experience headaches and juts forward. (Sheepishly, I admit to sometimes
neck and shoulder pain on a regular basis. Sitting finding myself in this position when working over
in front of a computer is often to blame. When I my massage table.)
used to work in an office, I discovered a combina-
Tension is inevitable when the front of the body
tion of techniques that relieved the tension. Now
shortens like this, and the back of the body gets
that I’ve changed careers, I teach these to my cli-
taut to counterbalance the forward lean. When
ents. I hope you can pass these on to your clients
you find yourself like this, three things help: 1)
and also use them to counteract the forward pos-
take a break, 2) reverse the slouch, and/or 3) re-
ture that massage therapists naturally fall into.
turn to good posture.
It’s no surprise that over half the people who work
Unlearn the habit developed in grade schooled;
with computers experience neck and shoulder
don’t be still for long. The longer you are in one
pain. The computer monitor is a magnet that
position, the more your body solidifies. Your
draws your eyeballs and the rest of your body fol-
muscles actually prefer to move, so reposition
lows into an unconscious slouch; before you know
yourself every few minutes. You can even sit on a
it your chest droops, shoulders hunch, and chin
balance ball to keep from freezing in place. Get

Terra Rosa e-magazine No. 6, December 2010 44

 Undulation
up, stretch, or just wiggle often.
When the spine is stretched in flexion, muscles
and joints get damaged gradually unless you
spend some time in the opposite position. Re-
verse computer posture with stretches or undula-
tions. An effective stretch is to interlace your fin-
gers behind your head, gently draw the elbows
back and lift one elbow toward the ceiling to
stretch that side and then lift the other elbow to
stretch the other side. Another option is the Re-
verse the Slouch undulation: let your chest drop
forward as you roll back on your pelvis, then roll
your pelvis forward, lift your chest up and bring
your arms back. As you exhale curl in and as you
inhale open the front of your body. The idea is to
move between flexion and extension as well as to
stretch the muscles that get shortened.
Your muscles tighten less when you have good
posture, so it’s worth the time and money to set up
an ergonomic work station.
For your computer station:
Proper chair height has your hips slightly higher
than your knees with your feet firm on the floor.
Your arms should relax by your sides. Put the
keyboard at the same height or slightly lower than
your elbows so your wrists are not bent. Keep the
mouse as close to the keyboard as possible, so you
don’t have to reach far for it. The best position for
the screen is to be directly in front of your face
about 20 inches away, so you don’t have to look
up, down, or to the right or left.
For your massage table:
Adjust the height of the table, so you can lift your
chest when working. Bend your knees rather than
dropping your ribcage. Flex at the hips rather
than through the spine. If you do massage work
when seated at times, choose a chair (or balance
ball) that follows the guidelines above.
Being conscious of your body is the first step to-
ward relieving tension. Whenever you notice
strain, reduce the toll exacted by unnatural pos-
ture (whether it’s at a computer, construction site
or massage office) by moving frequently, stretch-
ing to counterbalance common strains, and re-
suming good posture as often as you can.
Learn more about relieving strain and get a free
copy of 7 Undulations to Relieve Office Tension at
www.undulationexercise.com. Anita Boser is a
Certified Hellerwork Structural Integration Practi-
tioner, Registered Yoga Teacher and author of Re-
lieve Stiffness and Feel Young Again with Undula-
tion.

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Terra Rosa e-magazine No. 6, December 2010 45

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Terra Rosa e-magazine No. 6, December 2010 46

 Research Highlights
Massage therapy and fi-
bromyalgia
A review recently published in
Rheumatology International
Journal reviews available stud-
ies with an emphasis on ran-
domized controlled trials to de-
termine whether massage ther-
apy can be a viable treatment of
fibromyalgia symptoms.
The effects of massage on fi-
bromyalgia symptoms have been
examined in two single-arm
studies and six randomized con-
trolled trials. All reviewed stud-
ies showed short-term benefits
of massage, and only one single-
arm study demonstrated long-
term benefits. However all re-
viewed studies had methodo-
logical problems.
The existing literature provides
modest support for use of mas-
sage therapy in treating fi-
bromyalgia. The authors sug-
gested additional rigorous re-
search is needed in order to es-
tablish massage therapy as a
safe and effective intervention
for fibromyalgia.
The authors concluded that "In
massage therapy of fibromyal-
gia, we suggest that massage will
be painless, its intensity should
be increased gradually from ses-
sion to session, in accordance
with patient’s symptoms; and
the sessions should be per-
formed at least 1-2 times a
week."
Massage relieves chronic
tension headache
Terra Rosa e-magazine No. 6, December 2010
Researchers at the University of
Granada, Spain, are applying a
30-minute massage to ease ten-
sion headaches, which are in-
creasingly frequent in our soci-
ety. The results of this pioneer
study were published in the
American Journal of Manipulat-
ive Physiological and Therapeu-
tics
The results have proven that the
psychological and physiological
state of patients with tension
headache improves within 24
hours after receiving a 30-
minute massage.
As researchers explained, ten-
sion headaches have an increas-
ing incidence in the population.
One of the main causes of this
type of headache is the presence
of trigger points. The re-
searcher has proven that a 30-
minute massage on cervical trig-
ger points improves autonomic
nervous system regulation in
these patients. Additionally, pa-
tients exhibit a better psycho-
logical state and “reduce the
stress and anxiety associated to
such a disturbing disorder”.
Similarly, patients report a per-
ceived relief from symptoms
within 24 hours after the mas-
sage. This might mean that mas-
sages may reduce the pain
caused by trigger points, which
would involve an improvement
in the general state of patients.
Does massage therapy re-
duce cortisol level?
It is frequently asserted that
massage therapy reduces corti-
sol levels, and that this mecha-
nism is the cause of its benefits
including relief from anxiety,
depression, and pain. However
reviews of massage therapy re-
search are not in agreement on
the existence or magnitude of
such a cortisol reduction effect,
or the likelihood that it plays
such a causative role. Research-
ers led by Christopher Moyer
conduct a literature review of
massage therapy's effect on cor-
tisol. The study is being pub-
lished in Journal of Bodywork
and Movement Therapies.
Their review and analysis found
that massage therapy's effect on
cortisol is generally very small
and, in most cases, not statisti-
cally distinguishable from zero.
The authors concluded that cor-
tisol cannot be the cause of mas-
sage therapy's well-established
and statistically larger beneficial
effects on anxiety, depression,
and pain. Other causal mecha-
nisms, which are still to be iden-
tified, must be responsible for
massage therapy's clinical bene-
fits.
How much time is re-
quired to modify a fascial
fibrosis?
A new study by Italian research-
ers Ercole Borgini , Antonio
Stecco, Julie Ann Day and Carla
Stecco fund that it took an aver-
age of 3.24 minutes to modify a
fascial fibrosis using the Fascial
Manipulation technique. The
study is being published in
47
 Research Highlights
Journal of Bodywork and Move-
ment Therapies
It is theorized that different
manual and physical techniques
could restore the normal physio-
logical state of the fascia, but
there is very little scientific evi-
dence about the mode of action
of manual therapies in general.
The perception of what appears
to be connective tissue fibrosis,
and its consequent modification
during therapy, is a daily experi-
ence for most manual therapists.
The researchers evaluated the
time required to modify a palpa-
tory sensation of fibrosis of the
fascia in correlation with
changes in levels of patient dis-
comfort in 40 subjects with low
back pain utilizing the Fascial
Manipulation technique.
This study evidenced, for the
first time, that the time required
to modify an apparent fascial
density differs in accordance
with differences in characteris-
tics of the subjects and of the
symptoms. In particular, the
mean time to halve the pain was
3.24 minutes; however, in those
subjects with symptoms present
from less than 3 months (sub-
acute) the mean time was lesser
(2.58 min) with respect to the
chronic patients (3.29 min).
Differences in practitio-
ners’ proficiency affect
the effectiveness of mas-
sage therapy
A study in Japan was conducted
to evaluate how differences in
Terra Rosa e-magazine No. 6, December 2010
the proficiency of massage prac- cally and psychiatrically healthy
titioners can affect the physical adults, 18–45 years old, partici-
and psychological states on cli- pated in this study. The study
ents. design was a head-to-head, sin-
gle-session comparison of Swed-
Eight healthy 50-year-old fe-
ish Massage Therapy with a light
males, suffering from chronic
touch control condition. The in-
neck and shoulder stiffness,
tervention tested was 45 min-
were recruited and four inter-
utes of Swedish Massage Ther-
ventions were conducted: three
apy versus a light touch control
40-minute massage therapy in-
condition, using highly specified
terventions, one each by a fresh-
and identical protocols. Blood
man and a student studying
samples were taken before the
massage therapy, and one by
massage began and at regular
their instructor, and one rest on
intervals up to one hour after
the massage table. Visual ana-
the massage was completed.
logue scale score for muscle
stiffness in the neck and shoul- The study found several changes
der, state anxiety score, and sali- in the blood tests of the Swedish
vary cortisol concentration lev- massage group that indicated a
els and secretory immunoglobu- benefit to the immune system.
lin A, were measured pre- and Swedish massage caused size-
post- interventions. able decreases in arginine vaso-
pressin (AVP), a hormone that
The results showed that Mas-
contributes to aggressive behav-
sage by experienced instructor
ior, and small decreases in the
give a lower pain scale of neck
stress hormone cortisol. The
and shoulder stiffness after mas-
Swedish massage participants
sage compared to massage con-
also had an increase in the num-
ducted by freshman or student.
ber of circulating lymphocytes,
Furthermore the score of state
cells that help the immune sys-
anxiety was lower than that after
tem defend the body from harm-
resting.
ful substances. However Oxyto-
cin was not found to be influ-
A single massage can
enced.
boost the immune system
The authors concluded that
Researchers from Cedars-Sinai
“Preliminary data suggest that a
Medical Center reported that a
single session of Swedish Mas-
single massage produced meas-
sage Therapy produces measur-
urable changes in the immune
able biologic effects. If repli-
system and endocrine system of
cated, these findings may have
healthy adults.
implications for managing in-
The research was conducted in flammatory and autoimmune
an outpatient research unit in an conditions.”
academic medical center. Medi-
48
 6 Questions to
Steven Goldstein
1. When and how did you decide to become a body-
worker?
I was always interested in touch. I took my first massage
course in Seattle in 1981 at the only credible massage school
in at the time, Heide Brenneke School of Massage. I was li-
censed in Washington State in early 1986.
My first real opportunity came when Diana Thompson, an-
other established USA educator, took me into her injury clinic
in 1987. You have to understand when I began practicing; the
education model for massage therapy in the USA was very
limited and slight in the number of face to face supervised
classroom hours. In essence, I was ‘thrown to the wolf’s” and
apprenticed through many challenging orthopaedic injuries .
I recognized there had to be reason why muscles were not
releasing, and I accidentally stumbled upon the myofascial
soft- tissue layer when experimenting with changes both in
depth of pressure and duration of application, along with
changing the vectors . The only myofascial training in the late
1980’s and early 1990’s in the USA, were either the Rolfing
community which encompassed Structural Integration, or
from the physiotherapy community whose school was John
Barnes and Carol Manheim. I read everything I could get my
hands on and when another practitioner took a myofascial
workshop, I avidly read their manuals to ascertain if I was on
the right track. It’s interesting that I didn’t take any myofas-
cial courses per say, but was generally applying the technique
accurately according to the manuals I had perused.
2. What do you find most exciting about bodywork
therapy?
For me the most exciting part of bodywork is twofold; first
you will never know everything. The quest for understanding
is a lifelong pursuit. If you are bored in this profession, it's
you the practitioner that has the difficulty, as there is abso-
lutely nothing boring about what we practice, that is, working
everyday with complex soft-tissue presentations that effect
the quality of life of an individual.
Secondly, my fascination with the interface of direct mfr ver-
sus indirect osteopathic approaches in manual therapy. I
blend the use of lighter touch for autonomic nervous system
responses with the use of low load resistive for joints, liga-
ment and myofascia, more akin to joint energy than muscle
energy technique. I believe 'lighter touch' is the 'homeopathy
of bodywork.'
3. What is your favourite bodywork book?
It changes with every new book. Currently two books are on
my list: Harmonic Healing: A Guide to Facilitated Oscillatory
Release & Other Rhythmic Myofascial Techniques, Zachary
Terra Rosa e-magazine No. 6, December 2010
Comeaux, DO., and Back Pain: a Movement Problem a clini-
cal approach incorporating relevant research & practice, Jo-
sephine Key. Also the new Earl-Myers myofascial manual is
great, as Myers has reprised his excellent series of anatomy
articles he authored in Massage Magazine in the late 1990's.
4. What is the most challenging part of your work?
I routinely receive referrals from other practitioners, which
usually are already difficult cases they have moved onward to
me. Scoliosis is difficult, I feel I have much to learn regarding
blending various approaches to achieve satisfying clinical
outcomes. Fibromyalgia, chronic fatigue and other dysregula-
tion syndromes that present multi-faceted chronic pain take
time, perseverance and high level of clinical skill.
5. What advise can you give to fresh massage thera-
pists who wish to make a career out of it?
Longevity is a tricky thing. Depending on how the massage
therapist is trained, that is, the correct use of their body and
the 'tools of their trade', their hands, wrists and fingers, are
absolutely essential to maintain longer life in this industry.
Continuing with professional education in order to work in-
telligently, efficiently and effectively cannot be ignored. Have
a business plan! Understand it not just about delivering the
service but how you set up the delivery of that service. Net-
work extensively. Be part of a multi-disciplinary clinic if pos-
sible. Practice excellence. Do not take an attitude of this being
work. It is, but you have to enjoy your practice.
6. How do you see the future of massage therapy?
I know I'm speaking to the VET sector where most of the
training delivered in Australia by RTO's are under the HTP
Health Training Package. This part of the industry will con-
tinue to grow and prosper. I see the future of institutions of
higher education in Australia delivering more advanced train-
ings in the form of Bachelor of Health Science programs or
advanced diplomas which under would be administered un-
der the OHE office of Higher Education. This will only mar-
ginally change the landscape in the next five years.
Beyond five years we will see a change. Scope of practices
nationally and internationally are blurring the lines between
massage therapy, manual therapy, osteopathy and physio-
therapy. Debate is current regarding body of knowledge, stan-
dard practices, regulation and scope of practice. This is nec-
essary to move the profession forward. I believe a higher
level of massage therapy training will be accepted when criti-
cal mass and public awareness through professional organi-
zations foster this with the knowledge that we are the best
trained soft-tissue specialists in the world. No other profes-
sion spends the amount of time we do honing our palpatory
literacy.
49
 6 Questions to
Bethany Ward
1. When and how did you decide to become
a bodyworker?
At university, I studied psychology and planned to
become a therapist. I remember writing in my
journal, “I want to help people find answers for
themselves.” But when it came down to it, some-
thing didn’t feel right so I did something com-
pletely different and entered the business world. I
got my master of business administration and
found myself living in front of a computer. Soon
shoulder and neck pain became unbearable and I
tried Rolfing Structural Integration. The first ses-
sion was so transformative, emotionally as well as
physically, that I stopped everything and enrolled
at the Rolf Institute two months later. It was one
of the craziest, best decisions I have ever made. I
got my wish: I get to help people find answers for
themselves—but in a way that I hadn’t even
known was possible.
2. What do you find most exciting about
bodywork therapy?
Helping people facilitate change. A lot of time this
means their hip stops hurting. But, often, it’s
much more than that. Bodywork can help people
work through all kinds of stuff. It’s never boring.
3. What is your most favourite bodywork
book?
Where to start? I’m a geek, you know; I read eve-
rything. There is no favourite. I think bodyworkers
need to be helping clients change dysfunctional
movement patterns, so I recommend they read
Mary Bond’s, “The New Rules of Posture.”
Terra Rosa e-magazine No. 6, December 2010
4. What is the most
challenging part of
your work?
Taking enough time for
myself. I love what I do. It allows me unlimited
avenues to learn and grow… and my tendency is to
want to go down every one of them! I get to work
one-on-one with clients, I get to teach workshops,
I get to write articles, I run a business. I’m on the
board of a non-profit that supports structural inte-
gration research. And then, of course, I want to
see what my peers are coming up with so I attend
workshops whenever I can. Someone once told me
that success is having to say, “no” to stuff you
want to do. I get it.
5. What advise can you give to fresh mas-
sage therapists who wish to make a career
out of it?
Work with clients as a partnership. You’re not
working on them; you’re working with them. Ask
lots of questions. It is valuable for clients to be
heard and it will inform your work immeasurably.
Clients are far more knowledgeable about them-
selves than you will ever be. You are just a facilita-
tor. Sometimes bodies get stuck in dysfunctional
pain or movement patterns. If you can find and
address a primary issue (often not where the pain
is), you may be amazed at what their bodies can
resolve.
6. How do you see the future of massage
therapy?
Wide open. More and more people are using mas-
sage and bodywork to get relief from certain
chronic conditions like back and neck pain. We
are only beginning to understand why it works,
but the trend is there.
50