Professional Documents
Culture Documents
July August 2021
July August 2021
JULY/AUGUST 2021
TECHNIQUE
PERSIS TENT IN JURIES p. 8 0
THE TIBIOTAL AR JOINT p. 8 2
SUBACROMIAL PAIN p. 8 6
FORE ARM AND FINGER WORK p.9 0
SAVVY SELF-CARE
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44
features
44 62
TENDING TO OUR HANDS BURNOUT AND THE COMMITMENT TO SELF-CARE
As massage therapists, our hands are one of our most As we return to work, some of us—and a lot of our clients—are
valuable, powerful, and utilized tools. The exercises presented feeling burned out. Thomas Myers shares his thoughts and advice
here will help you tend to your hands, fingers, thumbs, on maintaining longevity, gleaned from his many years of practice
and wrists so you can prevent injury and sustain a thriving as a career therapist.
practice. By Thomas Myers
By Heath and Nicole Reed
70
52 KEEPING CLIENTS SAFE, PART TWO
FIND YOUR FLOPPY A successful practice is one where all participants—clients and
There is a terrible contradiction in the world of massage therapists—respect and value each other’s personal boundaries.
therapy and bodywork: We want our clients to feel floppy This article outlines clear guidelines and boundaries that will help
and full of ease after a session, yet, therapists can feel frozen create a safe, comfortable environment for clients.
and full of tension. This educator believes the best way to By Dr. Ben Benjamin
help clients get rid of unnecessary tension is for practitioners
to get rid of their own unnecessary tension. To do that, you
must find your floppy. 74
By David M. Lobenstine 10 STEPS TO SECURE YOUR PRACTICE
The public still struggles to tell the difference between a massage
therapy practice and a parlor. Here, we discuss 10 ways to keep
your practice safe—from making it clear you are a licensed
massage therapist to security methods and tools to keep
unwanted solicitors out of your practice.
By Joyce Gauthier
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 3
JULY/AUGUST 2021
THIS ISSUE
8 Editor’s Note
10 ABMP School Survey Results
12 Contributors
15 Speak Your Mind
17 On the Web
19 News Notes
94 ABMP Member Benefits
95 10-, 20-, and 30-Year Members
96 Meditate & Move
BEST PRACTICES
20 BLUEPRINT FOR SUCCESS
Keys to a Successful Business Partnership
By Allissa Haines and Michael Reynolds
25 TABLE LESSONS
What’s In a Name?
By Douglas Nelson
30
By Cal Cates
29 HEART OF BODYWORK
Ethical Boundaries
By Laura Allen
EDUCATION TECHNIQUE
30 BACK TO BASICS 80 THE REBEL MT
The Case for Consistency
32 80
Managing Intellectual and
Environment Boundaries By Allison Denney
By Cindy Williams 82 THE SOMATIC EDGE
32 PATHOLOGY PERSPECTIVES The Tibiotalar Joint
Pharmacology Basics for Massage By Til Luchau
Therapists
86 CLINICAL EXPLORATIONS
By Ruth Werner The Puzzling World of Subacromial Pain Massage & Bodywork (ISSN 1544-8827; USPS 005-245) is
a bimonthly magazine published by Associated Bodywork
36 FUNCTIONAL ANATOMY By Whitney Lowe & Massage Professionals Inc., 25188 Genesee Trail Road,
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EDITORIAL
Darren Buford
EDITOR-IN-CHIEF
darren@abmp.com
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AND PROJECT MANAGEMENT
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EDITOR, ONLINE AND DIGITAL STRATEGY
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No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
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views expressed herein are those of the authors, and not necessarily of the publisher or its advertisers. Publisher cannot be responsible
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In this issue, we begin by addressing a massage
therapist’s primary professional tool: their hands. Heath
and Nicole Reed have been writing our Savvy Self-Care
My morning routine: column for years. In this issue, we elevate their words to
• Wake up lead feature (“Tending to Our Hands,” page 44), as a way
• Walk dogs (short walk) to say, This is important. Together, the two experts take
• Meditate us through a series of exercises to improve fi nger, thumb,
• Take vitamins and wrist activation as a way to prevent injury.
• Drink eight ounces of water Next, David Lobenstine’s “Find Your Floppy” offers
• Stretch new techniques to protect your body against unnecessary
• Eat breakfast rigidity while working. David has always been a
• Walk dogs (long walk) proponent of more efficient work, better results through
Every morning. less effort. I love his take here that fi nishing your day
I’ve been doing this regimen for so long that my body exhausted isn’t a badge of honor.
(and my dogs) knows something’s off if it doesn’t happen Finally, we close this theme with a think piece from
like clockwork. one of bodywork’s legendary voices. Thomas Myers
I see this ritual each morning as critical for my most offers his decades-in-practice perspective on maintaining
optimal day, setting the stage for what’s to come. And longevity through a commitment to self-care. Tom
though it’s not all I do (throw in an occasional run, hike, answers the question, what can you do as a bodyworker
bike ride, or paddle), it’s the start to maintaining a healthy to help restore an integrated purr in your clients’
body and mind. physiological motors? His series of approaches to framing
What do you do for self-care? Of course, the answer client homework is a must-read for MTs who have
to that question can be quite varied. Self-care means struggled with getting clients to see take-home exercises
so many different things: from reading a book, taking as valuable and an extension of the care brought about
a vacation, and checking out, to receiving bodywork, through the bodywork session.
strength training, and healthy eating. We hope you enjoy this issue and fi nd your own
Now, perhaps, a more pertinent question should be: healthful routines and new lifelong pathways inside.
What self-care do you do to protect your practice?
Massage therapy and bodywork are professions of DARREN BUFORD
passion. So much so that practitioners are notorious for Editor-in-Chief
giving their all to their clients and neglecting to take care darren@abmp.com
(se)®
LEARN
HOW WE
BALANCE
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40 36,070
as well as the comments and stories we heard
directly from schools, the results show the 30
28,263
majority of massage therapy schools showed 23,877
20,598
impressive resilience in the midst of the 20
hardships of the past year.
ABMP’s census was conducted January 10
2021–March 2021, during which time 818 1,047 1,419 1,530 1,600 1,440 1,319 1,274 1,098 965 919
ABMP representatives attempted to contact 0
965 programs. Seventy percent of approved 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
programs responded to the survey, and Graduates Schools
nearly 50 programs were found to be closed.
Those who were reached (and still in
operation) were asked, “How many students data, we projected results for the segment of Types of Programs
graduated from your primary massage schools we did not receive an answer from.
ABMP categorizes massage programs
program in 2020?” Using state and program According to the results of the survey,
into six organizational types:
the number of massage therapy training
programs in the United States, and the Career School—multiprogram institutions
number of graduates from those programs, offering many career training programs
have declined from our 2018 survey (abmp. in addition to massage therapy, typically
com/updates/blog-posts/number-massage- medical and dental assisting, medical
Nea recordkeeping, etc. 150 programs
rly program-graduates-continues-decline).
5
Combining survey data and projections, College—massage program
0
ls Closed
22
seen since 2000, and are down from 23,877
graduates from 965 schools in our 2018 Nonprofit—programs whose organization is
ms
survey. Given the environment for the incorporated as a nonprofit entity. 6 programs
Su
ve
ed country generally, and in-person education
r
70
62
With his passion for dancing between wind
and water, Thomas Myers compares a sailboat’s
rigging with the tensile structures that balance
the human body. He lives, writes, teaches,
and, when he can, sails the coast of Maine.
52 44
David M. Lobenstine is more Heath and Nicole Reed are co-founders of
grateful than ever, amid the Living Metta and want everyone in the world
pain of social distancing, for to enjoy the experience of befriending their
this community of massage body. The Reeds lead workshops and retreats
therapists. He says, “Let’s across the country and overseas and have
take care of ourselves, and been team-teaching touch and movement
each other, so that we can therapy for 16 years.
take even better care of our
clients when the time comes.”
Thee fu
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You cringe anytime you read or hear You watch a guy walking down the street You hear, “I didn’t even know that was
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in general. think, “Nah, don’t flatter yourself. I was @DANA.M.BRANDT.TINKER
SHANNON BOOTH checking out your jacked-up stride.”
MELINDA WOODARD You’ve mastered the 30-second snack break!
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You analyze someone’s posture and gait at Your friends fight over who gets to sit in @INDYMASSAGES
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HOLLY HUNT G MASSAGE You have some sort of new age/spa music
playing in your head whenever you’re not
You have to do laundry after you do laundry. You do a full-body massage on your kid working.
FRANCHESCA LOVATO when applying sunscreen. @BEINTEGRATEDBODYWORK
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Every hug becomes a bit of an upper back You can’t attend a family function without
palpation assessment. Your forearms are as big as your biceps. giving an impromptu “chair” massage.
SABRINA MERRITT KRISTY BROWN MEADE @JENNIFERHAGNER
You’re not really watching the sporting You can’t just apply something, you have You have nail clippers in every purse,
event, just fascinated by the body mechanics. to rub it in too. I’m an esthetician too and backpack, and multiple cubbies in your car.
KARA CALABRO struggle with this. @ALLISSAHAINES
KELLY K. MUELLER
You use shiatsu to pick up a broken fence. You're holding your wife’s hand and your
JESSICA HEFFERNAN LAPUT thumb goes into petrissage mode.
@SHIRE_MASSAGE
You have to line-item expense nail fi les on FROM INSTAGRAM
your taxes. You are always excited to go to work because
BERNADINE TALMADGE You watch gait patterns and think, “Damn, you know deep inside that this is your life’s
they must be in pain!” calling.
You wash up to the elbows in a public @CINDYEHRHARDT @BONNERUST
restroom.
KANDY KIGER You notice microscopic growth of your
fi ngernails.
People apologize to you for falling asleep or @DAVESHAHAN
not shaving.
LUKA SKYE
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 15
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best practices | BLUEPRINT FOR SUCCESS
Keys to a Successful
Business Partnership
By Allissa Haines and Michael Reynolds
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 21
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What’s in a Name?
Undiagnosed Conditions Increase
Pain and Stress “While there is some undetermined
central mechanism driving all of this, it is
BY DOUGLAS NELSON clearly causing a hypersensitization in his
leg muscles.
“Let’s deal with the muscles directly
“This has been such an ordeal,” she activity always produces an undesirable through targeted hands-on therapy.
began, the exasperation in her voice audible approach, we can respond appropriately. Moreover, if we can decrease the overactive
over the phone. “My son has been struggling “When the same activity produces neurological firing in the periphery, it may
with this issue for about a year. He led a wildly variable responses, it is hard to know also have a beneficial effect on his central
highly active life until one day when he what to do. In that way, unpredictability nervous system.
developed flu-like symptoms. He was tested feels like complete loss of control.” “There is likely a self-sustaining
for COVID-19 but tested negative multiple “Exactly,” she affirmed. “If we knew feedback loop at play, where increased
times. Knowing it wasn’t COVID, we just what to do or what not to do, it would be so central nervous system activity is increasing
assumed it was a different viral infection much better.” sensitivity in the periphery. In response,
he would recover quickly from. After the “And then, there is the name, which the periphery is now sending increased
initial illness subsided, he still felt unusually is the second problem,” I said. “When we input back to the central nervous system,
tired. The longer this went on, the more name a pathology, we also assume we know restimulating it. Maybe we can interrupt
concerned we became. Moreover, he began something about its trajectory over time. that process.”
to experience multiple body aches in his If you fracture your arm, you know the I saw her son a few days later,
joints that prevented him from participating course of events over the next 6–8 weeks. addressing many of the muscles of his
in many of his previous activities. Every As difficult as it is to deal with the initial lower body, which were indeed very
spike in activity was followed by debilitating pain, there is a high likelihood things will hypersensitive. We worked slowly and
knee, hip, or ankle pain.” improve over time. carefully, and the sensitivity decreased
After asking her about what impressions “When a condition such as your son’s markedly during the session. The mother
the physicians had given them, she went on is undiagnosed, having a sense as to the and I agreed to communicate closely over
to describe the parade of doctors who had course of future events is impossible. Is the coming days.
seen her son. Many possible pathologies this a short-term struggle or will this go on Her son began increasing his activity
beyond a viral infection had been ruled out, indefinitely? It has been said that the brain after our session and continued to do so
but none of the doctors were able to pin is always asking three questions of each new with minimal discomfort. That process
down a reasonable diagnosis. They could say experience: What is it? What does it mean? continued, approaching levels he had not
what possible illnesses he did not have, but What do I do? accomplished in months. The mother
not what caused his symptoms. “Without a name, we don’t know the shared how relieved she and her husband
“Not knowing what’s wrong with him is meaning. Without meaning, we don’t were during our last phone conversation.
so stressful,” she said. “It’s been difficult for know what to do in response. That can feel “It’s kind of fitting that this all started
our whole family.” powerless and stressful. Is this at all helpful in 2020,” she said at the end of our call.
“I understand, and if I may, let me to you?” “Another uncertainty in a year filled with
elaborate on why,” I answered. “Research “Very much so,” she responded. “This uncertainty.”
in the area of both pain and stress gives an helps me understand why this whole Well said.
interesting insight into this dilemma, and experience has been so difficult. It also helps
there is a clear overlap between the two to know it isn’t unique to my family, that Douglas Nelson is the founder
conditions. there is a larger principle in play. and principal instructor for Precision
“Unpredictability makes the experience “I called you because several people have Neuromuscular Therapy Seminars, president
of both pain and stress far worse. One of the recommended we bring our son to you for of the 20-therapist clinic BodyWork Associates
most important factors in the management treatment. Would you be willing to see him, in Champaign, Illinois, and past president
of both is the feeling of a sense of control and if so, what would that look like?” of the Massage Therapy Foundation. His clinic,
over one’s circumstances. “Whatever this virus was seems to have seminars, and research endeavors explore the
“If there is a clear causal relationship affected muscles in his lower body,” I stated. science behind this work. Visit pnmt.org or
between two events, our brains figure out email him at doug@pnmt.org.
how to adapt and respond. If a specific
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 25
best practices | MASSAGE THERAPY AS HEALTH CARE
Harmful Stories
Awareness is Required to
Dismantle Poor Assumptions
By Cal Cates
I didn’t mean to simplify the incredibly complex issue stories in our heads about why and how our clients
of stress. I didn’t mean to blame people who suffer from, come to find themselves in need of what we do.
and with, stress. But what I meant to do is irrelevant. My We use our “stories” to decide who is worthy and who
intention and my impact are not related in the way I wish is going to “get better” because of us and our guidance.
they were. And often our clients “tell on themselves” and reinforce
Unfortunately, we all do this. Without noticing, we their failings to these cultural beliefs. That doesn’t make
miss the point and perpetuate harmful systems and ways of them true. It just proves how indoctrinated we all are into
thinking every day. When it is pointed out to us, we say, “I the false healthy/unhealthy binary.
didn’t mean it,” and we move on feeling absolved of impact Awareness is required to dismantle these systems.
because we did not intend the harm we caused. Turning the mirror on ourselves comes first. Notice,
The ways people are—the things I labeled in my does this make me uncomfortable? Am I justifying my
column last issue as “habits” and “behaviors” that lead our categorization of clients in terms of “likely to benefit” or
clients to seek out our care—are not the result of free will. “not for me”? Please just sit with that.
We are products of our culture and our privilege (or lack Awareness is an incredibly powerful start to this work.
thereof), supersized with a bonus of history, genetics, and Perhaps the greatest service we each can offer is to stop
public policy. telling these wrong, judgment-based, hierarchical stories to
We find our clients (and ourselves) in pain, ourselves so others can see there are better, more accurate,
discomfort, and disconnected from their bodies. Our more compassionate healing stories available.
ideas, and the so-called choices they inform related to
movement, food, or lifestyle, are inaccurately seen as Cal Cates is an educator, writer, and speaker on topics
each person’s fault. We dismiss and devalue the people ranging from massage therapy in the hospital setting
we have chosen to care for. We say that “poor choices” to end-of-life care and massage therapy policy and
are the problem, and we go on feeling “right,” as we regulation. A founding director of the Society for Oncology
provide insensitive care to people who are “wrong.” Massage from 2007–2014 and current executive director
These ideas are deeply, insidiously, and harmfully and founder of Healwell, Cates works within and
implanted and upheld by the culture in which we live. beyond the massage therapy community to elevate
We (often unconsciously) use these ideas to the level of practice and integration of massage overall
support a hierarchy of who “deserves” and will and in health care specifically. Cates also is the co-
“benefit” from our care. We use them when we think creator of the podcasts Massage Therapy Without
about our clients and what stands between them and Borders and Interdisciplinary.
the elusive experience of “wellness.” We believe we
know what’s necessary to be “healthy,” and we tell
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 27
Read our
Savvy Self-
EMBRACE A LOVING KINDNESS Care column
in Massage &
Ethical Boundaries
Do They Exist for Employees?
By Laura Allen
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 29
education | BACK TO BASICS
Managing
Intellectual and
Environment
Boundaries
By Cindy Williams
HUTOMO ABRIANTO/UNSPLASH.COM
might collide, how to avoid this occurrence, responsibility lies in your hands. philosophical, religious, or political
and how to respond when a boundary is in nature—or quotes that could
crossed. spawn disagreement. Ask yourself
HOW TO AVOID INTELLECTUAL what value and purpose your décor
BOUNDARY VIOLATIONS has on your professional work.
HOW DO PERSPECTIVES COLLIDE? The most effective way to avoid this type of • Always ask permission if energy work is
Our profession is unique. We spend a relational friction is to create a respectful, part of your therapeutic approach. It is
significant amount of time with our clients neutral environment. To do this: no different than asking if a client feels
• Avoid displaying items in your office comfortable having their glutes worked.
that might challenge a client’s belief
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 31
education | PATHOLOGY PERSPECTIVES
WHAT IS A DRUG?
A well-accepted definition of drug is: a natural or synthetic ANNA SHVETS/PEXELS.COM
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 33
By Mouth signs. More than one massage therapist has Injection sites are local contraindications
Most common medications are taken asked me whether they were inadvertently for massage for a few hours at least. In
orally (or “per os”— by mouth). This is dosed when working with clients who the case of botulinum toxin (Botox),
easy and convenient for many patients, didn’t tell them about their estrogen or which is injected into the subdermis
but the substance has to undergo filtration testosterone cream until after they had or intramuscularly, many physicians
and metabolism in the liver before it already touched the area. recommend waiting a few days before doing
enters the general bloodstream. Whatever Fortunately, the palms of the hands massage in that area.
makes it that far is called the bioavailable are among the least permeable parts of
fraction of the drug. This means a the body, and if our skin is intact—and we
person’s digestive and liver function may wash our hands frequently—our risk of EXCRETION
influence how much of a medication they significant exposure to medications in this Most drugs are excreted through urine
need to receive any benefit. Some drugs way is minimal. Still, if we know our client and feces, which typically happens
cannot withstand this process, and they has used a hormone cream or other topical within 48 hours of taking the dose.
degenerate before they are usable; this is application of a drug in some area, it is best Some drugs, notably some types of
why insulin cannot be taken orally. Because to avoid it, so we don’t have unintended chemotherapy, are excreted in sweat and
massage seems to boost digestive motility, influence on the dosage or uptake. sebum. MTs who specialize in working
our work may have an impact here. with cancer patients will need to know
Through Mucous Membranes the protocols for clients who are dealing
Topical Application Some medications are inhaled, absorbed with this situation—that is an issue to
In this context, we are referring to through the mucous membranes of the discuss with their health-care team.
medications that are intended to enter cheek or under the tongue, or absorbed
the bloodstream, rather than substances as suppositories in the rectum or vagina.
like pain-relieving gels or creams that are Like topically applied medications, this PHARMACODYNAMICS (PD)
meant for local impact only. In order to avoids filtration by the liver, giving almost Pharmacodynamics refers to the action
access the blood via the skin, drugs must instantaneous access of the drug to the of the drug: what it does to its target
be administered in high concentration, circulatory system. Nitroglycerin sublingual cells and tissues. Medications use
have duration of contact with an area of tablets (Nitrostat) for chest pain are an many strategies to achieve the goals of
skin with hair shafts, and be soluble with example of this kind of fast action. treatment, and more are in development
a molecular weight that allows it to pass One of the challenges with drugs given all the time. Here are some of the most
into the capillaries. Sometimes these by way of mucous membranes is that the common pharmacodynamics, with
medications are used with solvents to help uptake can be variable and unpredictable. examples of drugs that work in this way:
carry them across the epidermis and into This is why inhaled insulin didn’t work for
circulatory or lymphatic capillaries. most people: It is a drug that has to be given Cell membranes. Some drugs may act
Topical applications have some in the right dosage, at the right time, and on cell membranes to limit or promote the
advantages over orally taken doses of this was too hard to predict when it was used passage of substances into or out of the
medications: They bypass the filtration of as an inhalant. cell. For example, metformin (Glucophage)
the liver for direct access to the bloodstream makes cells more receptive to sugar.
and lymphatic system, and they can be By Injection
applied in multiple locations to avoid Injections of medications can happen Body fluids. Medications may alter
irritation. in a few ways. Drugs can be pushed the chemical properties of some
From the point of view of massage into the subcutaneous space (insulin is fluids. For example, proton pump
therapists, however, topical applications of an example) or into the intramuscular inhibitors (Prilosec, Prevacid) change
medications may carry some risks. If the space, like vaccines or antibiotics. In the pH of stomach secretions.
dose is in the form of a patch, like nicotine some situations, it is best for a drug to
or birth control patches, it is easy to identify access the bloodstream immediately. Enzyme systems. Some drugs change
and avoid (I suggest avoidance of several This is done with an intravenous (IV) the enzyme systems inside or outside
inches in every direction, because we don’t application. If this is an ongoing need, a cells. For example, selective serotonin
want to change the rate of uptake at the site). patient may have a port or a peripherally reuptake inhibitors (Prozac, Zoloft,
But some topical medications, especially inserted central catheter, or PICC line. Paxil) alter the activity of enzymes that
hormone creams, may not have any visible
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 35
education | FUNCTIONAL ANATOMY
Coxal Joint
By Christy Cael The hip joint, and more specifically the
coxal joint, is formed by the articulation of
the head of the femur and the acetabulum
of the pelvis. This joint serves as a bridge
between the lower extremity and the
pelvic girdle, similar to the glenohumeral
joint of the shoulder. Both are ball-and-
socket joints that offer mobility in all
planes, but comparatively, the weight-
Iliac
bearing function of the coxal joint
crest
requires much greater stabilization.
Anatomy
Sacrum The acetabulum is a deep, cup-like
Acetabulum
depression located on the inferolateral
Head of femur aspect of the pelvis. This osseous socket
Ischium Pubis is formed where three bones (the ilium,
Greater trochanter
ischium, and pubis) fuse and provides a
Lesser stable seat for the rounded femoral head.
trochanter The depression of the acetabulum is further
deepened by the acetabular labrum—a
Shaft of femur fibrocartilaginous collar that snugs around
the femoral head and increases joint
stability.
Lateral View
The coxal joint is a ball-and-socket
synovial joint that has a thick, fibrous joint
capsule, as well as a complex network of
ligaments surrounding the joint. Within
the joint capsule, a relatively small ligament
(not pictured) connects the acetabular
Ilium fossa to the fovea of the femur and encloses
Sacrum the obturator artery. More relevant to
Pubofemoral movement are the iliofemoral, pubofemoral,
ligament and ischiofemoral ligamentous networks
Superior located outside of the joint capsule.
Ischiofemoral
pubic ramus
ligament The iliofemoral ligament joins the anterior
Greater trochanter inferior iliac spine and the intertrochanteric
Ischial
tuberosity
line of the femur. It is bifurcated and
Lesser
looks like an inverted Y with a primary
trochanter
function of restricting hip extension and
lateral rotation. The iliofemoral ligament is
Shaft of femur considered to be the strongest of the three
major ligament systems of the coxal joint.
Anterior View
Anterior View
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Gemellus inferior serve both postural and force-generating
Quadratus femoris functions and, therefore, must be capable of
both strength and endurance activity and
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Semitendinosus
Posterior View
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TENDING TO
OUR HANDS
A
EXERCISES TO STRENGTHEN, STRETCH, AND ACTIVATE
Shake It Off
Generate more blood flow and synovial fluid
circulation, and prepare your tools for hands-on
healing. Start by sitting, standing, or walking around.
Bend your elbows, and begin to vigorously shake
your hands, wrists, and fingers for 20–30 seconds.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 47
HAND-BRAIN CONNECTION
Did you know that one quarter of the
brain’s motor cortex, which is the area
that controls all movement, is dedicated to
moving our hand muscles? And because the
left hemisphere of the brain controls the
right hand and vice versa, we recommend
people grow their ambidexterity by using
both hands equally in everyday life. This
will create an exponential impact on your
brain, allowing for clearer thinking, better
coordination, and lifelong performance
enhancements while doing the things you
love.
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Podcastatatabmp.com/podcasts
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youaccess
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favoritepodcasts
Post-Session Cool-Downs
Finger Flicks
In a standing position, bend your elbows and
bring your fingers into a soft fist, and then
swiftly flick your fingers toward the ground
as though you’re shaking off water. Be sure to
hear the sound of your fingernails flicking off
the heel of your palms (especially the ring and
pinkie fingers) and repeat a handful of times.
Repeat the same action on different planes of
movement: Extend and flick fingers out in front
of you, and then finger-flick laterally, superiorly,
anteriorly, and then back down inferiorly. This is
a great way to release stored energy and tension
from the upper body. Some people report
auto corrections in their elbow and/or carpals.
Practice between or after a day’s sessions.
Stretch to Strengthen
To perform this stretch:
1. Sit with your palms together in a prayer
position and rest your elbows on a table.
2. Engage and press into both palms.
Then press more firmly into one hand
as you stretch the back of the opposite
hand closer to the table. Then move
the opposite direction as you alternate
between wrist flexion on one hand and
wrist extension on the opposite.
3. Repeat back and forth several times until
you feel warmth building in your wrists
and hands.
Notes
Our hands are evolutionary marvels, 1. High Mowing School, “The Hand to Brain Connection,” accessed May 2021,
hosting 29 major joints, 123 ligaments, www.highmowing.org/using-your-hands.
34 muscles, 48 nerve branches, and 30 2. Dacher Keltner, “Hands On Research: The Science of Touch,” Greater Good
arteries, and they are complex and flexible Magazine (September 29, 2010), https://greatergood.berkeley.edu/article/
instruments evolved over 70 million years. item/hands_on_research.
Our hands are like an extension of our 3. J. Matt McCrary, Bronwen J. Ackermann, and Mark Halaki, “A Systematic
brain, and they are such a highly intelligent Review of the Effects of Upper Body Warm-Up on Performance and Injury,”
sense organ that they can perceive and British Journal of Sports Medicine 49, no. 14 (July 2015): 935–42, https://doi.
communicate without words, interpret org/10.1136/bjsports-2014-094228.
others’ feelings, and act as superhighways
of neurological awareness and relaxation.
Successful therapists understand the power Heath and Nicole Reed are co-founders of Living Metta (living “loving
of their hands in giving and receiving, kindness” ), a CE company now offering touch therapy tools and self-
emitting and sensing, and energizing and care practices in their online community. They also lead workshops
healing. Nurture, train, strengthen, and and retreats across the country and overseas, and have been team-
take care of your hands; treat them like the teaching touch and movement therapy for over 20 years. In addition
invaluable professional tools they are. to live classes, Heath and Nicole are life coaches offering home study,
bodywork and self-care videos, and online courses that nourish you. Try
their community free for 30 days at livingmetta.com/trial.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 51
Find Your Floppy
GET RID
OF YOUR
OWN
TENSION
WHILE
YOU
WORK
52 massage & bodywork july/august 2021
By David M. Lobenstine
T
hink about how you want
your client to feel at the
end of a session with you.
Floating? Floppy? Full of ease? Now
think about how you feel (more often
than you would like) after giving a
session. Frozen? Fixed? Full of tension?
This is a terrible contradiction.
Our client’s relaxation should
not require the opposite in us. In my
continuing education classes, therapists
often shrug off their own tension as part
of the job—as if feeling bad in our own
bodies is the seemingly inevitable result
of making our clients feel good in theirs.
Indeed, some therapists are even proud
of their tension, whether consciously
or not. That tension, we seem to tell
ourselves, is proof of how much we care
about our clients. Proof that we are real
therapists who are willing to sacrifice
ourselves to make others feel better.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 53
I believe the inevitability of our own tension—and fist, or the heel of your hand; and hopefully sometimes
idealizing that tension—is a fallacy. This ingrained you’ll also be using your forearm or even your elbow.
idea is well-meaning, for sure, but it is wrong. You do Once you’ve acknowledged your point of contact,
not need to feel tense at the end of a session. And even observe each joint of your arm and hand that is distal
more importantly, the amount of tension you feel is not to your point of contact (in other words, the part of
proof you are a great therapist, and it is certainly not a your body after the point of contact, farther away from
prerequisite for a successful treatment. In fact, I think your shoulder and trunk). These distal joints are what
the opposite is true: You effect the most positive change I call “the area beyond the contact.” So, for example,
for your clients when you feel good during the session. if you are doing a beautiful effleurage stroke along the
The more relaxed we are while we work, the more paraspinal muscles and the heel of your hand is the
relaxed our clients will be. In other words, we help our point of contact, then the area beyond the contact would
clients as much as we are able when we help ourselves include your fingers and thumbs. (And specifically, all the
as much as we can. I believe the best way to help our joints therein: carpometacarpal, metacarpophalangeal,
clients get rid of unnecessary tension is to get rid of our and interphalangeal including distal and proximal.)
own unnecessary tension. Here, I want to offer a quick Once you’ve identified that area beyond the point
and specific way to do just that: As you work, make each of contact, you want to observe the amount of tension
joint in your arms as floppy as possible. Let me explain. in those joints that are beyond the contact. Once you
start to observe this area, I’m guessing you’ll start to
notice that they are holding more tension than you are
THE TIPS TELL US ABOUT TENSION aware of—particularly if you are determined to be really,
I have been writing in this magazine for close to a decade really good therapist and do really, really deep work.
about how we have to pay attention to our own bodies if Tension in the area beyond the contact should be an
we want to be successful and satisfied therapists.2 And I immediate red flag. Any time you see those joints are stiff,
teach multiple continuing education classes that vary in rigid, or tense, you are working harder than you need to,
their focus, but all emerge from the same idea: You will in two ways. First, contracting the muscles beyond where
be happier, and your clients will too, if you pour with you are contacting the client doesn’t make the stroke any
your body weight rather than push with your muscles. My better (and as we’ll explore further, might make the stroke
principle of pouring, rather than pushing, offers a way feel worse). Second, tension in this area beyond the contact
to assess the entirety of your body during your sessions is a sign there is excess tension elsewhere in your body too.
(not to mention the movement of your breath, and those Unnecessary muscle contraction beyond the contact is like
ever-present rumblings of your heart and your head), the warning light on your dashboard telling you there is a
so that you can attend to yourself while you take care of larger problem with your car. And just like with your car,
your clients. This kind of full-body self-awareness is very it is easy to ignore the warning light for a while. But the
simple, and with sufficient practice, very gratifying. But consequences are never good. Don’t ignore the warning
when you are just beginning to increase your own self- light. Your body—and your client’s body—will thank you.
awareness while you massage, paying attention to your The more you pay attention, the more you will notice
whole body all at once can feel overwhelming, so I have tension beyond the contact. It will feel like the warning
developed a shortcut. A simple way to get a glimpse of how light is constantly flashing! Luckily, the solution is easy
your whole body is doing is to just pay attention to one tiny (with apologies to Bobby McFerrin): Don’t worry. Be
part of your body. This is one way I monitor my own sense floppy. That’s it. Or another way to put it: Think floppy,
of ease in every session I give and is something you can not fixed. Let’s explore what this means in practice.
start practicing as soon as your next client is on the table.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 57
along your thoracic and lumbar spine,
across and around your rib cage, and
eventually down into your pelvis. Indeed,
when using your fingertips or thumbs
to create a stroke, there is no part of the
body beyond the point of contact. In this
case, the point of contact is already the
most distal part of the arm. But the idea
of being floppy still applies. And in some
ways, it is more important than ever here.
When you start observing the larger part
of the body—the area before the contact—
things get a little trickier. Unlike our fingers
or wrists, we can’t simply let these more
proximal joints flop completely. If we did,
we would turn into the Scarecrow from The
Wizard of Oz, and we would fall over onto
our client on the table. Not a good idea.
So while we don’t want to just go
completely limp, we do want to use the
same essential concept: Identify excess
tension, and then let it go. That way, we
can do the same strokes but with just the
minimum amount of effort. A simple
exercise will help make this concept clear:
• Pick up a magazine or a thin book.
• Raise the magazine in front of
you, arm straight, until your arm
is parallel with the floor.
• Stay in that position for a minute, and
notice what happens in your body.
• Observe that your first instinct is to grip
Relax the Rigidity the magazine hard with your fingers
Each time you notice rigidity in your distal joints, try the following. so it doesn’t fall. And then your next
1. Notice this counterproductive habit, but try not to judge yourself for it. instinct is to clench various muscles in
Blame does nothing. Instead, think of that excess effort as a gift from your shoulder, back, and glutes to keep
your body, a reminder that you are working harder than is helpful. yourself in this awkward position.
2. Continue the stroke, but focus on lengthening your next exhalation. A Now, let’s examine holding the
breath out that is long, slow, and effortless is one of the best ways to magazine in this annoying position
overcome the over-efforting. without it being so annoying.
3. Think of those distal joints drooping, flopping, or sinking into a neutral • Experiment with loosening your
position as you exhale. grip on the magazine.
4. Feel the floppiness in the area beyond the contact, and imagine it • Try lengthening your exhalation slightly,
spreading up the kinetic chain. and with each slow, effortless exhale,
5. Feel yourself continue the stroke, but rather than pushing, pour the imagine your muscles are sinking as your
contact into the client. You’ll still be able to deliver just as much pressure breath empties. Doing this allows the
with the point of contact itself, but you will be using your whole body flexor muscles of your fingers, palm, and
more, and those specific muscles around the point of contact less. thumb to contract with a little less force.
Using these steps will allow your quality of contact to be different. It
will feel like less work for you, and it will feel less strained to the client.
benefit with minimum effort. Your body will thank 2. Find all of Lobenstine’s articles in the digital editions of
you. And your client will thank you. They will feel the Massage & Bodywork magazine. “Under Pressure for More
difference, even though they won’t be able to articulate it. Pressure: The Client Who Demands Deeper,” May/June 2020,
The other problem with excess effort, as should be page 68; “Less is More: A More Effective Way to Use Lubricant,”
January/February 2020, page 80; “The Solution is the Sides:
obvious by now, is that it doesn’t do any good for the
Approach the Body from New Angles,” March/April 2017,
client, just as it doesn’t do any good for us. It is rare
page 58; “Breath: Your Most Powerful Tool,” May/June 2016,
that a client can actually identify when we are over-
page 74; “Pour, Don’t Push: How to Massage with Greater
efforting, and yet the client’s body can—consciously Depth and Ease,” November/December 2016, page 64.
or not—feel that excess tension. Any excess tension
in your body will feel to your client like you are
pushing or poking, instead of pouring and sinking. David M. Lobenstine, BA, LMT, BCTMB, has been
Excess effort causes clients to guard and hold rather massaging, teaching, writing, and editing for over 15
than sink and soften. Thus, removing excess effort years in New York City, with a focus on clients at all
is probably the single best thing you can do—better stages of childbearing. He is a co-author of Pre- and
than learning a new modality, incorporating fancy new Perinatal Massage Therapy (3rd ed.), and also designs
techniques, or adding hot towels and essential oils—to and teaches his own continuing education workshops,
make your sessions more effective. Create the possibility of both across the US and online at Body Brain Breath.
ease in your treatment room, starting with your own body, For more information, visit bodybrainbreath.com.
and your clients will embrace that possibility in theirs.
ADAPTING TO EASE
The idea of observing the joints beyond the point of
contact might seem laughably simple, but often the best
habits are the simplest. When therapists practice on
each other in my continuing education classes, one of
the most useful things I do is to walk from therapist to
therapist, without saying a word, and place my relaxed
hand atop their stiffened fi ngers, or around the shoulder SCAN AND WATCH
“Find Your Floppy”
that is climbing up toward the ear. Nearly always, the
1. Open your camera
therapist smiles, shakes their head, or rolls their eyes. 2. Scan the code
3. Tap on notification
4. Watch!
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 59
SELF-TREATMENT SECRETS
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EDUCATION SPOTLIGHT
Are your courses offered in-person, online, or a
combination of both?
After 15 years of exclusively in-person teaching, we began
offering parts of our curriculum online five years ago. That
has proven very successful, and we now offer a Coaching
The Body® membership consisting of up to two years and
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online with testing. One thing I have learned is that the
greatest technique applied in the wrong place is far less
effective than a less-effective technique applied at the
source. This is a major reason why our online members are
seeing such success in their work, even without being able
to visit us for in-person study—although some do. I’ve also
been putting a lot of time over the last year into writing a
book on CTB that we expect to be published later in 2021.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 63
the engine to be capable of dropping to a low idle when pumping out extra signals down the motor nerves to the
there’s a chance to rest and repair, while still being muscles. The motor nerves are the only way “out” of
capable of revving up when power or speed are needed. the brain. You get input from eyes, ears, body, and the
Stress—or, more properly, continual unresolved rest, but all the output goes to your muscles—striated
stress, which science calls “distress”—revs our motors and smooth. Thus, we are all carrying a muscular “set”
up to a high idle, preventing parasympathetic self-repair with which we confront the world. It might be open
and the restoration our organism needs regularly to and easy, or it might be shut down and protected in
self-maintain. This past year has been a transparent the front and thus breathless. Or it may dramatize,
model of what continual stress does to us all. scampering away from the back with a sucked in and
Consider the balancing act your body performs—to pushed forward pelvis. Or the spine curls in on itself in
so many different rhythms. Your eyes recreate the visual grief—we all have a complex “set” built up over years.
world many times per second, constantly reconciling
what’s seen now with what’s been seen before. Your heart
rebalances, spinning out a gout of blood about once a THE NEUROMYOFASCIAL “SET”
second. A relaxed breath balances your blood every five AND HABITUAL RESPONSES
seconds. The fluid in your head waxes and wanes several The neuromotor set can be coupled with a lot of
times a minute. Peristalsis moves your food. Every few emotional force or only a little—it varies by person—
hours, your kidneys force you to find a place to pee. Once but we are all somewhat controlled by our habitual
or twice a day, you rebalance by defecating. Every 28 responses. This habitual response is “noise” in the
days, you shed the lining of your fruit. And so on, with motor output of the brain. Burnout increases the neural
a hundred fluctuating waves that constitute our minute- noise, and the resulting muscle tension leads to more
to-minute high-wire act. When the idle runs high, holding and more pain. Our job is to break that cycle.
repair runs low, and it is a matter of time until whatever So, our second job—and it is a higher calling than
part is weak starts to whine or just seizes and quits. simple awareness, as powerful as that can be—is to
The chemistry of stress is well documented, so follow facilitate client resolution of this noisy overdrive.
your own lights with supplements or medications or vagal Unfortunately, there is always some “noise”—the
stimulation—not my bailiwick. But can we change our anxiety that we’re not moving fast enough, that
chemistry by other than chemical means? Yes, with hands-
on work, by working in from the other end of the equation.
What do I mean? Instead of approaching burnout As you introduce any self-care practice
from an emotional or chemical vantage, what happens
to the movement system? First, sensory data from to a client, think ahead. What is your
the tissues—principally but not exclusively from the
fascia—up to the brain gets distorted. Any bodywork
or movement work can help return accurate reporting
goal? I look for a “We’ll be done with this
up the proprioceptive and interoceptive tracts—you
accomplish that every day. No matter how you practice, exercise when you can . . .” statement.
greater awareness is our most important offering. And
sure, getting into the sore places is great, but better yet, “somebody might be gaining,” as Satchel Paige
see if you can find a way to touch or move the silent but said, may produce constant underlying tension in
short areas that will free clients to resolve the strain the hamstrings, tension we are not aware of.
patterns that led to the pain patterns in the first place. These tensions accumulate over a lifetime, and
So, first, some places in the sensory body image get lost. gradually both mind (habit patterns) and body (your
Second—and this relates more to the burnout part— fascial fabric) take on that pattern as a permanent fixture
an anxious brain with unfulfilled needs (“You can never of your posture. The amount of change we all needed
get enough of what you don’t really need”) is constantly to adjust to this past year—and likely for more years
to come—has either temporarily or more seriously
overcome the habitual responses in some of us.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 65
feature article, “Tending to Our Hands,” on page 44 “Do these calf raises to strengthen your arches.” Be
of this issue, and their Savvy Self-Care column in past as specific as you can about how or when the project
issues of Massage & Bodywork magazine for more self- reaches its sell-by date. Set and monitor reachable
care practices for massage therapists and bodyworkers.) goals. Think about how much you like to hear, “Good,
Having made every frustrating mistake in the you got that, now let’s go on to the next thing.”
book trying to inspire my clients during my nearly
50-year career allows me to share some overarching
concepts I find useful, and I hope you will find START SMALL
them helpful too (but, please, interpret all of the Even with the athletes and everyday mat yogis, I start
following into your own practice as you see fit). small. “How many minutes a day will you give to this
With a few clients, especially if I have not started project?” If they answer an eager “15,” I give them
in on “homework” from our first session, broaching the something under five. If they say “five,” I give them
subject of support work is difficult. I usually go for the something under one minute.
direct approach: “You know, you’ll get more bang for your Also among my arsenal of homework assignments are
buck if you do a little support work between sessions.” items to be remembered moment-to-moment. Like, “Every
Regardless of the actual homework you assign hour you’re at work, I want you to drop those scapulae
your clients, you are inducting them into a self-care down your back about 80 times—any time you think of
routine, which is also an attitude. So many people it.” Or “Every time you’re waiting for something, take a
have lost this attribute—many in the pre-COVID, few seconds to center your pelvis back over your feet.”
“easy” days before the world shut down. Now, the If they come back and they haven’t done the homework
long-term lack is clear, and the need is urgent: (all too common), make the assignment smaller. No
Care for the self, from the self, is important, since shame, no blame—we’re all busy and distracted. Say,
outside stimulus has not been forthcoming this year. “Well, how about we try this then?” And then go for
Treat yourself as a person worth cultivating. something shorter and easier, which leads you to the
fruitful meditation: What is the minimum change
this client could make that would have the maximum
MAKE IT A PROJECT benefit? More is not better; more is much worse. If
As you introduce any homework/self-care practice your client doesn’t take it, all the good advice in the
to a client, think ahead. What is your goal? What is world you can think of is not just useless, it’s damaging.
your goal for your client? I look for a “We’ll be done It puts you in a parent position, which is a bad place
with this exercise when you can . . .” statement, and for a therapist to stand—and a hard one to get out
get the client’s agreement for the goal. If you hear the of once you have put yourself in it. Guard against
question, “How long should I do this?” you should “good” advice. Instead, look out for effective cueing.
have an answer ready—a definable state they can
achieve. Corrective homework that is open-ended
and does not have a specific goal tends to spend its CUE TO THE CHANGE*
energy and fade all too quickly in the client’s mind. *This is a phrase I believe I “stole” from Judith Aston
After that project is done, you may have another goal to (astonkinetics.com), but it is an especially important
set with them. Or the first project may have been in service concept when you want to change a common body habit
of a larger goal. Either way, keep the goals project-oriented that a client’s “set” makes them prone to. (Make sure
with an end in sight. Too many times I get an exercise they know the “bad” place, as well as the “good.”)
from a therapist without a goal, so the whole experience For the office worker prone to lifting her shoulders to
becomes endless and discouraging when I am at home. her ears when stressed, it is not a winning strategy to say,
A client can handle missing a benchmark, but without “OK, now your shoulders are down in a good place—keep
them, it’s harder to keep the inner child interested. them that way.” She won’t. It’s a habit. Despite your good
“OK, we’re going to try these deep calf raises for a work—especially at the beginning—those shoulders will
month—if we don’t see improvement in your arches by go up again as soon as the boss is around or she’s tired.
then, we’ll look for another strategy.” That statement A better way to approach this is as they are ready to
falls very differently on the ears of the client than: leave the session (after they’ve dressed), give homework.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 67
Self-care asks
inner feeling
questions arising from
,
while self-regard asks
questions about how things
look from the outside.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 69
PA R T T W O
KEEPING
CLIENTS
SAFE
70 massage & bodywork july/august 2021
By Dr. Ben Benjamin
In Part One of “Keeping Clients Safe,” we discussed how to avoid WHO’S IN CHARGE?
injuring clients. In Part Two, we will look at another way we can During your intake, let the client know they are ultimately
protect clients by attending to their personal and emotional safety. the one in charge. At any point during the session, they
A successful practice is one where all participants—clients and inherently have the right to tell you to stop a particular
therapists—respect and value each other’s personal boundaries. technique, revisit an area where they would like more
C
attention paid, or adjust the level of pressure. To reaffirm
ultivating sensitivity and trust is essential to your commitment to their boundaries and increase their
keeping clients safe—especially as we are aware sense of safety and trust, remind the client they always
that many women and men have experienced have agency over their own body. Honoring this integral
physical or sexual trauma in their lives. According aspect of the client-therapist relationship requires that
to the National Council on Behavioral Health, 70 you let go of your ego or any false notions of control.
percent of adults in the US have experienced some type Most clients know what they like and what they
of traumatic event. That’s equal to 223.4 million people, want, and they will communicate it clearly when given
so it is highly likely you are working regularly with the chance. But always use your common sense and
individuals who have experienced trauma.1 avoid inappropriate touch that might cross a boundary
This article outlines some clear guidelines and or exacerbate an injury. Also, be mindful to not
boundaries that will help create a safe, comfortable injure yourself or disregard your own boundaries.
environment for clients, not just those for which trauma
is a factor. Safety is built on trust and trust takes time
to establish. Yet, trust can also be lost in an instant. It is PRESSURE LEVEL
worth taking the necessary time and care to establish a As detailed in Part 1, be sure you know the type of
therapeutic environment that feels both safe and respectful. session and the amount of pressure the client would like
before you begin. Work gently as you start, and build in
pressure based on the client’s expectations. If you find
ASK WHAT THE CLIENT WANTS that a different pressure not initially requested might be
As always, ask questions before you begin each session— more effective, always ask first before acting on impulse.
even with regular and returning clients. For example: Setting this intention reiterates that the client is in
• “Where would you like me to work today?” control of their own body and can accept or decline your
• “Is there anywhere you would like me to focus on in suggestion. One method used to empower the client is a
today’s session?” 1–5 pressure scale to communicate if you are using too
• “Is there anywhere you do not want me to work on much, too little, or just the right amount of pressure.
today?”
Additionally, when checking in with regular clients, be
sure to ask: “Is anything different since the last time I saw
you?”
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 71
Provide a space that upholds
PRIVACY BOUNDARIES
Always have the client change in private client safety to cultivate trust and
with the door closed or a curtain drawn.
Do this even if the client says they don’t maintain boundaries. Remember,
need privacy. Some clients will just walk
in and start undressing without you trust takes time to build, yet
saying anything. Stop them while you
gather whatever information you need can be damaged in seconds.
before the session starts; let them know
you will leave the room, at which point
they can change and get ready. This
establishes a professional boundary.
In the massage industry, the stock
phrase “Undress to your level of comfort” welcome. Begin to cultivate this awareness
is used frequently but doesn’t mean much during your intake by saying to the client: BUTTOCKS
to a person receiving massage or bodywork “Feel free to let me know at any point if you Permission from your client before engaging
for the first time. Be sure to follow up don’t like something or feel uncomfortable. in work on the buttock region is necessary,
this statement with examples like: “Some If you notice an internal dialogue that especially the middle and lower buttock.
people choose to leave their underwear questions what’s happening in the session, Most spas have restrictions on working in
on, and others remove it, while some take it’s time to say something. Remember, it’s this area, and some do not permit therapists
off their socks and some leave them on. your session, not mine, and I’m happy to to work on the gluteus muscles at all. Others
Do whatever is comfortable for you.” listen and change what I’m doing.” A client’s have therapists work only on the superior
When you set or reassert a clear comfort level in communicating openly with part of the buttock or on top of the drape.
boundary, you again increase the client’s a therapist will vary based on their familial, Conversely, many therapists who have
sense of safety and comfort. It’s especially social, cultural, and religious history. an independent, private practice do work
important to have this conversation with on the buttock area. There are important
a first-time client because it normalizes ligaments that are located at the medial and
their choice with regard to disrobing. Some DRAPE SECURELY superior border of the gluteus muscles and
people feel it’s expected to remove all their Secure draping is an important part of others that are deep to the gluteus muscles.
clothing. If they don’t, some clients feel establishing safety. Sloppy or loose draping The gluteal cleft is the groove between
it will impact the session, or they will be only makes the client feel uncomfortable the buttocks that runs from just below
viewed negatively. With all the sexual and and may create unnecessary issues for the sacrum and coccyx to the perineum.
physical trauma people (especially women) the therapist. As the client is naked (or If you work with clients who experience
experience in our society, safety and trust almost naked) on your table, they have low-back and hip pain, working on the
can only be facilitated when the client is to feel confident the drape will not slip, buttock can be an important area to treat,
free to make choices without judgment. fall off, or be compromised in any way. if done appropriately. Remember to always
Their confidence level rises if the drape undrape the buttock one side at a time,
is positioned professionally, which means and keep the gluteal cleft covered. Never
CHECK IN FREQUENTLY it is secured in the right place and only place your fingers into the gluteal cleft.
Due to the inherent power differential, exposes the area on which you are currently
many clients have difficulty speaking up working. Never work under the drape; this INNER UPPER THIGH
during a session when their expectations violates the implicit, agreed-upon boundary. The inner upper thigh is a very personal
are not being met, they feel disappointed, and sensitive area. It is often associated
or they don’t like what’s happening in the with touching only in an intimate, sexual
session. A client may fall silent or, worse, WORKING SENSITIVE AREAS relationship. Therefore, I discourage
choose not to return without explanation. Explicit permission is necessary before working the inner upper thigh unless
In creating an atmosphere of ease and safety, working on body regions that may be you work 3–4 inches below the groin.
remind clients that an open dialogue is sensitive areas for your clients. Use the
following tips for handling these delicate
areas, while also maintaining client trust.
The abdomen is also a very sensitive area reason. These provinces’ regulations thenationalcouncil.org/wp-content/
uploads/2013/05/Trauma-infographic.pdf.
for the majority of people. Many emotions are clear and strict; for instance, the
and feelings are held in that part of the client must consent in writing each
body. Working on the abdomen is often time a breast massage is performed. Ben E. Benjamin holds a PhD in sports
used as a gateway, along with the inner Women with certain conditions can medicine and owned and ran a massage
upper thigh and the pectoral muscles, definitely benefit from pectoral work and school for over 30 years. He has studied
therapists with sexual predatory tendencies (in some cases) work on, near, or under under James Cyriax, MD, widely known for
who are testing how far they can go without breast tissue. Cases of clogged milk ducts in his pioneering work in orthopedic medicine.
meeting resistance. Therefore, some of the nursing mothers, painful surgical scarring Dr. Benjamin has been teaching therapists
larger spa companies prohibit any work on the breast, and intercostal and lower how to work with injuries for over 35 years
on the abdominal muscles. Additionally, pectoral muscle strains are instances where and has been in private practice for over
launching into work on the abdomen manual therapy treatment is effective. 50 years. He works as an expert witness in
without a specific request can create a In the United States, I suggest two cases involving both musculoskeletal injury
scary, unsafe environment for the client. ways of working on the pectoral muscles of and sexual abuse in a massage therapy
There are certain instances where a female client. One: Carefully drape one setting. He is the author of dozens of articles
abdominal work can be very useful. side of the chest with just the very upper on working with injuries, as well as these
Examples include working through the pectoral muscle undraped on one side. widely used books in the field: Listen to Your
Work the upper segment of the muscle, Pain and The Ethics of Touch.
then redrape the client and undrape the
other side to continue the work. Two:
Work through the sheet or towel in
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 73
10 Steps to
Secure Your
Practice
By Joyce Gauthier
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 75
Gather personal information up front.
Someone looking to commit an illegal act may
want to avoid giving confidential information,
and this could keep them from booking. 2
SPOT THE RED FLAGS
1
subtle or blatant, that a client may be looking for
a “happy ending.”
Be aware of code words, behaviors, and hints
SCREEN EVERY CLIENT that solicitors may use to “bait the hook” and
push boundaries to see how far they can go with
If you screen all your clients before scheduling
you. If a client is looking for an illegal service,
them, you will keep the majority of unwanted
they may not just come out and ask for it. They
customers from ever stepping foot in your office.
may hint at it in ways that could go over the head
Look at it this way: If you make the scheduling
of a therapist who does not know what to look
process a bit of a chore—as in having to take a
for. (Note: The Respect Massage Ethics Course
few steps to get on your schedule—it will attract
has a complete list of red flags, so you can spot a
serious, invested clients to your practice. Making
solicitor from a mile away and keep them from
the booking process a commitment attracts
even getting on your schedule.)
clients who are committed to working with you
and following your treatment plan.
3
• Ask screening questions before scheduling
a client. Ask them about their goals and
expectations for massage therapy. This
screening sets the tone that you have a MAKE MESSAGING CLEAR
medically based, therapeutic practice.
Be mindful of the words you use in your
• Gather personal information up front.
marketing. Never include words like sex, sexual,
Someone looking to commit an illegal act may
happy, or ending in your social media or on your
want to avoid giving confidential information,
website. Google does not know you are using
and this could keep them from booking. If a
those words as a deterrent, and you could end up
new client is hesitant to give you their address
in searches that include those words.
or last name, that should be a major red flag.
The Respect Massage Zero Tolerance logo
• Hold a credit card. Some therapists choose
is a simple, clear way to say your practice does
to hold a form of payment on file—or even a
not provide any sort of sexual experience. The
copy of the new client’s driver’s license—when
logo is available free of charge along with a free
booking a first-time appointment.
membership at respectmassage.com. Place the
• Pre-fill the intake form. Some therapists have
logo on your website as a deterrent for solicitors.
clients fill out an intake form online before
At respectmassage.com/clients, there is a
their first appointment. Use what works for
policy you are welcome to use to accompany
your specific practice and clients.
the logo. This policy describes what it means to
Keep in mind, most of your clients are well-
be a Respect Massage member and is carefully
meaning, so the barriers should be there to deter
worded to avoid any unwanted buzzwords that
and stop solicitors, not to make scheduling so
could potentially associate your practice with
cumbersome that you lose your dream clients.
sexual massage.
5
PUSH THE BUTTON
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 77
and could quickly call for help without having to say you need to step out to blow your nose and
leave your client’s side. wash your hands. Whatever you need to do, get
out of the room and take the appropriate action
6
(run, get help, call the police, whatever you
deem appropriate and necessary to that specific
situation).
As soon as you identify a dangerous or
HAVE AN ESCAPE ROUTE
inappropriate situation unfolding, immediately
Make sure you have a clear path out of your remove yourself from the source of the danger.
office that you plan before you have an emergency
8
situation. Do not pile laundry or have décor in
the way of you getting out of the building safely
if you have to run away. Consider all doors and
windows fair game.
BE NEIGHBORLY
7
If you ever need help, having relationships
with your neighbors will make any interaction
smoother. Make sure the businesses and/
or homeowners near your office know you.
KNOW WHAT TO SAY
Introduce yourself, exchange phone numbers,
Prepare excuses to end a massage ahead of time. greet them when you arrive to work, and say
A concern I hear from massage therapists who goodbye when you leave. That way, if there is
are faced with a client who is being inappropriate an emergency and you have to run out of your
is they do not know how to end it. Or they are office, you will have somewhere to run to.
afraid if they call a client out on inappropriate Be active in your local massage community.
behavior, the client will get mad and possibly Know the other therapists work in the
become violent. surrounding area. That way, you can form a
If your intuition is telling you you’re local network of therapists who can warn the
in danger, trust it. Do not suffer through others if someone in your area is soliciting and/
uncomfortable and potentially dangerous or dangerous. Also, you will have the additional
situations for longer than you have to just benefit of knowing other massage therapists to
because you do not know how to end the session bounce ideas off, practice new techniques on, or
early. Get out as soon as you realize there is a to go to continuing education classes with.
problem.
Have excuses prepared beforehand. This
allows you to easily access them in a stressful
situation. You might say you are not feeling
well and leave the room. You could sniffle and
The way you market your business can attract I know, you hear it all the time, but it’s true.
your ideal client or the client of your nightmares. Your intuition is your best protector. If
Clarity surrounding who you want to work with something seems off, it probably is. Get out of
leaves less room for clients who do not fit your the situation safely.
criteria. Have a specialty, and home in on the The best way to protect yourself and
exact population you want to work with to deter your practice from dangerous people is to
inappropriate clients. avoid them altogether. If your gut instinct
Clarity includes images you use in your says something is off with a prospective
marketing too. Use pictures of you working client, do not schedule them. No amount
in your office on a client who resembles your of money is worth your safety.
ideal client. Stock photography is a gross
misinterpretation of what massage therapy truly Joyce Gauthier, LMT, is the creator and founder
is. Veer away from images of perfect-looking of Respect Massage, a campaign to protect
therapists. If you use images like this, it will massage therapists from sexual solicitations.
attract clients who are not necessarily looking Join the Respect Massage movement by visiting
for the therapeutic benefits of massage. respectmassage.com.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 79
technique | THE REBEL MT
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 81
technique | THE SOMATIC EDGE
Balance isn’t easy. Whether in our life or in our body, finding the sweet
spot between life’s extremes can be complicated.
For example, simply standing upright is a tremendously complex
1
balancing act. In order to stand, our brain must constantly monitor and
respond to input from the environment via our eyes, from our movement
in space via our inner ears, and from our body itself via sensory nerve
endings (mechanoreceptors) in the soft tissues of the body.1 At the tibiotalar joint,
the concentrated
Concentrated around joints, these specialized neurons talk to our weight of the entire
central nervous system about mechanical force and position. In turn, the body balances on
brain (specifically, the brain stem, cerebellum, and cerebral cortex) uses the talus (blue).
Surrounding this
this information to orchestrate the reflexes, tension, and coordination we quarter-sized
need to balance, stand, and move. articulation,
mechanoreceptor-
rich structures
send a stream of
THE TIBIOTALAR JOINT information about
The lower in the body we look, the greater the forces of standing position, stresses,
and movement to
and balancing become. For example, the neck balances the head’s the brain, which
weight, and the pelvis bears and balances the entire weight of coordinates the
complex reflexes and
everything above it. But the foot modulates more force than any muscular activity of
other body part. This is especially true of the tibiotalar joint, where balancing, standing,
the tibia rests on the talus (the small, oddly shaped bone at the top and moving. (Purple:
toe flexor group.
of the foot). Here, the entire weight of the body is concentrated Brown: peroneal
into a slippery, domed joint surface about the size of a quarter.2, 3 group. Dark green:
Achilles and plantaris
Though the talus is unique in that no muscles directly attach to it, tendons. Orange:
it is surrounded on all sides by layers of soft tissue (Image 1), including extensor group.
Brown, tan, and green
joint capsules, ligaments, tendons and their sheaths, retinacula, deep wrappings: skin,
and superficial fascia, and skin. All these are richly embedded with superficial and deep
mechanoreceptors that monitor the enormous forces at this crucial joint fascia, and retinacula.)
Anatomy image
and rapidly communicate this information to the brain. It is thanks to courtesy Advanced-
this stream of sensory information that we’re able to balance on the Trainings.com.
relatively small tibiotalar platform. Without the mechanoreceptors
arrayed around the tibiotalar joint, the brain could not sense, prioritize,
or respond to changes of ankle angle, position, or load, and walking
would be impossible—often as not, we’d simply fall over.
Purpose
• Autonomic calming via novel
sensory input
• Refine proprioceptive acuity of the
tibia-talus relationship
• Increase options for translation
(glide) at the tibiotalar joint
Instructions
• Posterior tibial glide: Gently lean
on the distal end of the tibia with
the flat of your forearm (Images
2 and 3, page 84) or open hand,
encouraging your client to relax,
breathe, and settle in.
• Posterior talar glide (see video):
Grip the talus between your
thumb (medially) and forefinger
(laterally). Use the web of your
hand to gently but firmly roll the
talus under the tibia, moving
the ankle into slight passive
dorsiflexion.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 83
2
3
system. Anatomy image
Sebastian Kaulitzki/123rf.
Technique images courtesy
Advanced-Trainings.com.
Acromion
process
Coracoacromial
ligament
1
mechanical impingement may not be the
Coracoacromial arch. Image from 3D4Medical’s Complete Anatomy application.
primary cause of pain in some cases. Today,
researchers advise renaming this condition
subacromial pain syndrome (SAPS) to more
broadly include all the various pathological the coracoid process, which angles off in more likely to pinch soft tissues against the
causes for subacromial pain. an anterior direction. The coracoacromial underside of the acromion process. Often,
SAPS can include a spectrum of ligament spans between these two bony a nerve in the cervical region, the long
pathologies, such as partial thickness projections. The expanse, including thoracic nerve, may be responsible for these
rotator cuff tears, rotator cuff tendinosis, the acromion process, coracoacromial dysfunctional shoulder mechanics.
calcific tendinitis, and subacromial bursitis, ligament, and coracoid process, is referred The long thoracic nerve is a motor
as well as metabolic, inflammatory, and to as the coracoacromial arch (Image nerve that innervates the serratus anterior
degenerative changes in the tendon. In this 1). Subacromial pain is most commonly muscle. Compression of the long thoracic
column, we explore the multiple causes thought to arise from tissue irritation nerve (near the brachial plexus) may cause
of subacromial pain, look at a variety of under the acromion process but could weakness of the serratus anterior muscle.
treatment strategies, and explore where also occur from irritation under other Weakness in the serratus anterior leads to
massage therapy may play a role in reducing parts of the coracoacromial arch. inadequate upward scapular rotation during
this debilitating condition. The region under the coracoacromial abduction and the resulting subacromial
arch is anatomically unique. There are compression. This sequence of events is an
very few places in the body where soft example of how nerve compression near the
ANATOMY AND BIOMECHANICS
tissues get pinched between adjacent bones neck can lead to soft-tissue compression in
Our exploration of SAPS begins with a
or ligaments. The space underneath the the lateral shoulder.
review of key anatomical structures in
arch is relatively small and susceptible Another potential cause of subacromial
the region. The scapula plays a primary
for soft-tissue compression. In addition, impingement is excessive translation or
role in subacromial pain and has two
dysfunctional scapular mechanics can play movement of the glenohumeral head
prominent bony projections. The first is
a role in these problems. For example, the during shoulder motions. For example, the
the acromion process, which is out to the
scapula must move in upward rotation rotator cuff and biceps brachii muscles play
lateral edge of the shoulder. The second is
during shoulder abduction movements. If it
does not fully rotate upward, the humerus is
2 3
a superior direction and pinch tissues under Tissues involved in subacromial pain: Tissues involved in subcoracoid pain:
1. Subacromial bursa; 2. Supraspinatus 1. Upper margin of subscapularis tendon;
the coracoacromial arch. Now that we have tendon; 3. Upper margin of the 2. Coracobrachialis bursa; and 3. Upper
explored the architecture and mechanics of glenohumeral joint capsule; margin of the glenohumeral joint capsule.
this region, let’s examine some of the main 4. Coracohumeral ligament; and Image from 3D4Medical’s Complete
5. Long head of the biceps brachii tendon. Anatomy application.
causes of SAPS. Image from 3D4Medical’s Complete
Anatomy application.
DESCRIPTION OF PATHOLOGY
There are two primary models of SAPS:
the mechanistic and the biological. We
not necessarily result from decreased glenohumeral joint capsule, coracohumeral
now realize many shoulder complaints are
subacromial space. ligament, and long head of the biceps brachii
a combination of both. The mechanical
The original description of subacromial tendon (Image 2).
has been the dominant model for
impingement was presented by Charles There is another region of potential
decades and is a bit more complex, so
Neer in a paper he wrote in the early impingement that does not get as much
we’ll take a detailed look at it first.
1970s.3 According to his classification, the attention as the subacromial space. Tissue
The mechanical model suggests there
pathology begins with edema and thickening compression under the coracoid process,
is a biomechanical problem leading to
of the bursa in the first stage. It progresses or the lower margin of the coracoacromial
the subacromial pain.2 As noted earlier,
to fibrosis and other inflammatory changes ligament, is called anterior or subcoracoid
this condition was previously referred to
within the supraspinatus in the second impingement. Possible causes of subcoracoid
as subacromial impingement syndrome.
stage. Eventually this can lead to a complete pain include entrapment of the superior
Subacromial impingement is usually
tear of the supraspinatus tendon in the third border of the subscapularis tendon, bursitis,
divided into two categories. The first is
stage. However, more recent findings have subscapularis tendon calcification, or
primary impingement, which results from
called into question this tissue progression, ossification and inflammatory enlargement
problematic architecture of the subacromial
so Neer’s classification is no longer of the glenohumeral ligaments.4 Pathology
region. For example, if there is very little
considered a standard sequence of events. of the bicep tendon may also be a cause
space between the acromion process and the
Most models of mechanical impingement (Image 3).
upper part of the humeral head, this narrow
now focus on the subacromial region, Some research also points toward
space would make impingement more likely
thus they’re being labeled as subacromial subcoracoid pain arising from the underside
and be considered a cause for primary
impingement syndrome. Pain is generally of the subscapularis where it comes in
impingement. Secondary impingement is
felt more in the lateral aspect of the shoulder contact with the glenohumeral joint. In
a result of biomechanical dysfunction or
and is most aggravated during shoulder some cases, excess friction can irritate the
overuse in the shoulder region but does
abduction movements but may be felt
during forward-flexion movements, as well.
The tissues most involved in subacromial
impingement include the subacromial bursa,
supraspinatus tendon, upper margin of the
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 87
underside of the subscapularis and lead to that may radiate to the lateral humerus as
muscle tears, producing pain that is often well. Subacromial impingement generally
mistaken for external impingement. produces more lateral shoulder pain,
Clearly there are various factors that while anterior impingement produces
lead to soft-tissue compression under the more pain on the front side of the
coracoacromial arch. Yet, recent research shoulder. It is common to hear reports
has shown us that there are some people of night pain, especially when lying on
with decreased space or significant soft- the affected side or sleeping with the
tissue degradation in the subacromial region arm overhead, as those positions further
who have no pain. There are also those compress the subacromial structures.
Recent research with significant pain complaints who don’t X-rays and MRIs are still used for
appear to have any evidence of impingement evaluation, but these methods may not
indicates damage that can be identified on imaging reveal crucial information about functional
mechanical studies. This has led researchers to look for
other potential causes of anterior and lateral
movements and mechanical stresses. A
truly thorough approach needs to include
impingement may shoulder pain. a comprehensive physical examination and
Our current understanding of tendon analysis of assessment patterns that suggest
not be the primary pathology helps shed some light on particular tissue involvement. This pattern
cause of pain in potential alternative explanations for analysis helps drive the most appropriate
shoulder pain that may not be caused solely treatment strategies.
some cases of by compression damage. Newer theories For example, suppose a client presents
shoulder pathology. suggest there may be a more complex
interaction between mechanical and
with lateral shoulder pain during active
abduction that is decreased but still present
biological factors in tendon pathologies near the end range of passive abduction and
around the shoulder. during resisted abduction. The presence of
The number of chronic overuse tendon pain during active and resisted abduction
disorders throughout the body increases movements strongly indicates contractile
as people age.5 Histological studies tissues such as the supraspinatus. In most
indicate changes occur at the cellular cases, we wouldn’t expect to see muscle-
level within these tendons. It looks as if oriented pain during passive movements
some subacromial pain complaints are a of that same motion. However, the
combination of mechanical irritation, along supraspinatus is susceptible to compression
with degenerative and metabolic change in under the coracoacromial arch during
the tendons. But the idea that metabolic and abduction, so this is one place in the body
degenerative changes within the tendons where pain during a passive movement could
are responsible for subacromial shoulder indicate muscle-tendon unit involvement.
pain has only recently become more Recognizing these patterns is more helpful
accepted within the research literature. It than any isolated orthopedic test or a single
remains likely that numerous shoulder pain image from a high-tech diagnostic study.
complaints involve both mechanical and As mentioned earlier, subacromial pain
metabolic/degenerative factors. will tend to be more significant during
active, passive, or resisted abduction
motions, while subcoracoid impingement is
ASSESSMENT
more likely to produce pain during active,
The best chance for identifying subacromial
passive, or resisted flexion motions. Because
pain starts with a detailed and thorough
subcoracoid impingement frequently
client history. Clients usually report pain
involves the subscapularis tendon, it is also
in the anterior/lateral shoulder region
common to see pain or discomfort during
resisted internal rotation because that
engages the subscapularis. There may also
be pain felt during either active or passive
external rotation of the shoulder where and gradually contributes to increasing Notes
the subscapularis is stretched. Sometimes available range of motion. A wide variety 1. Christina Garving et al., “Impingement Syndrome
there is a popping or snapping sensation of techniques can be used to help enhance of the Shoulder,” Deutsches Arzteblatt
associated with range of motion evaluations a greater sense of movement and pain International 114, no. 45 (November 2017):
765–76, https://doi.org/10.3238/arztebl.2017.0765.
in the shoulder, as well. reduction.
There are various special orthopedic Previously, we emphasized techniques 2. Teemu V. Karjalainen et al., “Subacromial
tests frequently used to identify such as deep transverse friction to the Decompression Surgery for Rotator Cuff
impingement problems, such as the Neer distal supraspinatus tendon to address scar Disease,” Cochrane Database of Systematic
Reviews 1, no. 1 (January 2019), https://doi.
impingement sign, empty can test, or tissue during the healing process. Friction
org/10.1002/14651858.CD005619.pub3.
Hawkins-Kennedy test, but they don’t techniques may still be beneficial, but we
always have a high degree of accuracy. They now find great benefit in techniques that are 3. Charles S. Neer, “Anterior Acromioplasty for
may also lead clinicians into more recipe- not as focused on a particular tissue. A wide the Chronic Impingement Syndrome in the
Shoulder: A Preliminary Report,” Journal of
oriented thinking about the evaluation array of methods used to treat the shoulder
Bone & Joint Surgery 54, no. 1 (January 1972):
process by prioritizing this test without girdle can help decrease apprehension
41–50, https://doi.org/10.2106/JBJS.8706.cl.
evaluating the other critical pattern and and restore a sensation of safe, increased
movement assessments. Rather than focus movement as the condition subsides. The 4. Gregory Cunningham and Alexandre
Lädermann, “Redefining Anterior Shoulder
on these special orthopedic tests, I find greater sense of pain-free movement can
Impingement: A Literature Review,” International
it far more valuable to explore the results encourage the person to perform gradually
Orthopaedics 42, no. 2 (June 2017): 359–66,
and patterns from the active, passive, and increasing activity levels that will provide
https://doi.org/10.1007/s00264-017-3515-1.
resisted motions in the shoulder. graded exposure and conditioning for
5. Teun Teunis et al., “A Systematic Review
the soft tissues so they can improve more
and Pooled Analysis of the Prevalence of
rapidly.
TREATMENT Rotator Cuff Disease with Increasing Age,”
Surgery may still be considered if
The primary goal of SAPS treatment is Journal of Shoulder and Elbow Surgery
conservative treatments are not initially 23, no. 12 (December 2014): 1913–21, https://
to eliminate pain and restore appropriate
effective. Common surgical approaches doi.org/10.1016/j.jse.2014.08.001.
function. What defines appropriate function
include increasing the subacromial space by
varies for each client. For example, it isn’t 6. R. Diercks et al., “Guideline for Diagnosis and
shaving off the underside of the acromion
always necessary to achieve a particular Treatment of Subacromial Pain Syndrome,”
process in a procedure called acromioplasty. Acta Orthopaedica 85, no. 4 (March 2014): 1–9,
numerical range of motion measurement.
However, recent research suggests treatment https://doi.org/10.3109/17453674.2014.920991.
It may be enough just to get the person to
outcomes from surgical procedures may
decrease pain for the essential things they
be similar to those from conservative
need to do as part of their daily activities. Whitney Lowe is the developer and
treatments, and this has led to a decreased
SAPS treatment generally begins instructor of one of the profession’s most
perception of the necessity for surgery.6 In
with conservative measures, such as popular orthopedic massage training
many cases, surgery is still effective, and
limiting aggravating movements along programs. His text and programs have
what becomes clear is there is no catchall
with moderate exercise. Any rehabilitative been used by professionals and schools
solution that works for everybody, in every
exercise is usually performed within a range for almost 30 years. Learn more at
situation.
that does not significantly aggravate the academyofclinicalmassage.com.
As we have seen, there are numerous
pain. Massage plays a great role at this stage,
causes of SAPS. It is a common occurrence
as it can help reduce irritation and increase
and a condition your clients are likely to
overall mobility in the shoulder region. We
present with. The more knowledgeable
shouldn’t think of massage as necessarily
you are about pathologies in this region,
making more space in the subacromial
the more helpful you can be for them. In
region. Instead, massage helps restore
addition, you may be working as part of a
overall shoulder movement, decreases
health-care team with other professionals.
apprehension in shoulder movements,
When you understand the nature of the
problem and how others may be approaching
it, you are a more valuable contributor.
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 89
technique | MYOSKELETAL ALIGNMENT TECHNIQUES
1
and forearm maneuvers in a step-by-step
fashion. Wow, what a novel and seemingly
obvious idea! Why had I not thought of The Nail Hook
this before? I realized I had been doing extended finger
technique.
these maneuvers so long I had simply
skipped over a few very basic principles.
Guided by this realization, I now
transferred the energy through my forearm and lock in my lumbar lordosis so I can
teach hand and forearm maneuvers in
extensor muscles instead of my flexors. have a good mechanical advantage as I
every workshop and online course to help
That was a big discovery I then applied to slowly glide down the transversospinalis
therapists deliver a deeper touch with less
all my hands-on techniques. Now when I muscles of the lamina groove.
effort and better body mechanics. Let’s
engage the tissues and get a good hook, I Typically, I ask my client to begin
deconstruct a few of them.
immediately firm up my forearm extensors performing slow anterior and posterior
to allow the energy to come through my pelvic tilts to help engage the brain in
NAIL HOOK TECHNIQUE body and down into the ground, making releasing any protective spasm in these
During my basic Rolf Institute training in my stroke more controllable and confident short rotator muscles. The goal is to restore
the early 1980s, I developed an odd routine (Image 2). proper spinal curves while decreasing
of performing finger push-ups after class to nervous system hyperexcitability.
improve my finger strength and stamina,
THE FLYING V
but it seemed to make little difference. I
The Flying V is one of my favorite extended ULNA HOOK
was never able to get a good, sturdy “hook”
finger techniques. It is performed using Forearm techniques are a favorite of mine.
in the connective tissues underlying the
the same principles as the Nail Hook For years, I experimented with ways of
skin. One day I discovered if I flexed my
technique, but is designed to add additional getting a better tissue hook to help prevent
fingers and engaged the tissues as if I
power and precision to areas that require slipping and sliding, and this is what I came
were digging in with fingernails and then
bilateral pressure to confined spaces. In up with. In Image 4, I begin the technique
extended my fingers, I was able to get a
Image 3, I begin by placing my index with my forearm supinated (palm up). As
much firmer lock that allowed me to lean
and middle fingers on each side of the I engage the lateral border of the erector
in with my body weight instead of sliding
client’s lamina groove and then reinforce spinae tissue in this supinated position,
along the skin with finger pads (Image 1).
by bracing with the index and middle I’m able to get a really good Ulna Hook,
As I practiced this Nail Hook technique,
fingers of my other hand. I firm up my
I noticed that as I extended my fingertips
forearm extensors, relax my shoulders,
at the distal interphalangeal joints, it
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Connect and engage with your massage community
and experts in the field as you learn and earn CE!
Listen to The ABMP Podcast at abmp.com/podcasts or wherever you access your favorite podcasts 93
ABMP MEMBER BENEFITS
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30 Years
Nanci Baldridge Sevyn Galambos Lynda Jones Grace Melby Mary Shideler
Jeannie Battagin Barry Giles Shana Kalaakea Marjorie Montrose Rosalba Villanueva
Robert Brodie Gary Hamann Gayle Kelly Jill Ring Dawn Wegenek
Diane Colligan Torbjorn Hanson Katherine Knowles Linda Rogers Sherryl Wood
Barbara Deppe Michelle Lee Harrity Katharine Lawrence Erna Schmidt
Teresa Edmonds Linda Heisserman Susan Levins Patricia Schoenstein
20 Years
Kristen Basinger Janet Erickson Rebecca Harrison Shawna Brook Miller- Teri Ann Schmitt Sandra Swanson
Donna Bills Kevin Evans Mary Ann Hawkins Radford Elisabeth Schock Rosalind Toomey
Apryl Elizabeth Richard Fancher Michael Jacobus Mari Ellan Minor Angela Schultz Tina Torres
Buchholz Patricia Ann Foster Eugene Carl Jerome Elisabeth Ott Naomi Scott Todd Uhlenbrauck
Regina Buckwalter Debbie Friewald Christine Marie Jiskra Kate Phillips Teri Shirah Diane Veillette
Janine Butler James Froelich Chadley Kelderman Gregory Porzio Amy Sinatra Sibille Waldrop
Sheetal Contractor Barbara Gerber Michelle Kruger Elizabeth Rettig H. James Smet Westley Waters
Manohar Julie Croke Helene Giese Debra Kuresman Antoinette Rohner- Paul St. Germain Ann Wieser
Michael Dennis David Graf Bianca Kusatsu Laurence Mary Stall
Robyn Derbabian Karen Grant Marianne Linn Jan Sanborn Robert Stamper
Daniel Thomas Melissa Haring- Paul Martin Thomas Saulnier Autumn Stroh
Dueringer Wheatley Pamela Mathis Jamie Scannell Sarah Sussen
10 Years
Beth Adleman Deborah Cline Lisa Hajek Joseph Lewis Victoria Page Dana Spates
Marcie Albertson Casey Coleman Melissa Hale Glenda Liddell Carla Paratore Diana Speake
Sara Albro Datchanee Colvin Jaime Harron Vanessa Melinda Liles Shanta Peebles David Spindler
Laurie Alker Sharon Conway Mary Beth Haubrich Joslyn Lindsay Esther Perez Mandy Starks
Judith Allen Janet Cordeiro Alice Hawkins Renee Long Donna Perrin Alison Stickrod
Renee Allen Diane Crowley Marsha Heath Alan Lopata Jeanne Phenany Christina Stitt
Melania Almonte Zheming Cui Heather Hedley Joy Loraw Diana Phillips Josephine Stout
Songrith Naoko Curry Vicki Hernandez Debby Lowe- Rochelle Poland Heather Terrio
Anussornrajkit Michael Dahlie Anthony Hernandez Cummings Lucy Portis Barbara Teyke
Katarina Arminio Phuong Cu Thi Dang Sera Hess Ardenia Lowry John Preston Amy Torgerson
William Ash Johanna D’Angelo Donald Hoffman Patricia Luckey Cody Prince Lauren Traxler
Hannah Baker Coby Daniels Dianna Holland Peggy Luque Jonathan Pyndus Nicky Tsitouras
Gwennever Baldwin John Mark Davis Shannon Holmied Jan Luther Tanya Qually William Tweed
Renee Banks Rebecca DeMarco Wendy Howard Stephanie Lyons Joel Quezada Lisa Marie Twist
Robert Barnes Stephen Densmore Tessa Howiler Brian Madzey Tina Raburn Denise Utecht
Lynn Barnett Teresa Desmarais Irene Hsieh Dorothea Mahoney Sandra Randolph William Vallette
Lisa Bauer Garett Dickerson Michael Ingold Alexander Malo Tiffany Richards Laurie Vanderbilt
Cassandra Beck Brian Dorfman Shanthy Jayakumar Andrea Matson Joni Rimer Laurie Velez
Brenda Bernardin Kimberly Drewyor Kayla Johnson Jai May Karen Roberts Peta-Gaye Vernon
Daniel Blaisdell Katherine Dunn Meliza Jones Amy Jo McCarty Joyce Robison Elaine Villano
Jennifer Bloom Melanie Eggleston Erica Jones Heide McCoy Martha Rohrbaugh Patricia Waddey
Therese Boissonneault Tara Elias Greg Jones Jerry McDowell Marie Rose Newton
Erica Boulangee Faith Enuol Birthe Kaarsholm Renee McKaig Hugo Rossi Gilbert Wade
Brigitte Boyea Sandy Erwin Nadia Kaley Sonia McNeil Genesis Margaret Roy Charlotta Wales
Laura Boyle Jamie Eversweet Brooke Kalmbach Huo Xia Mei Elizabeth Royce Matt Walker
Katherine Bradley Belmarez JoAnne Kenyon Rebekah Melzer Webster Saintpreux Katherine Walsh
Nicole Brandon Julia Fetter Robyn Kielsa Kelly Merriman Gayle Salisbury Diana Walter
Linda Broadhead Misha Forrester Evy Kimmell Michelle Michaud Carolyn Sandman Paul Weiss
Karleen Brown Joelle Fournier Kevin Kishida Heather Michet Paul Saxon Natalie White
Tara Brown Emily Fowler Jeanne Kitt Mary Misertino Crystal Schmidt Emily Whitechurch
Catina Browning Amber Fraga James Knott Bonnie Mohr Teri Ann Schmitt Cindy Wickert
Tina Bruglio Scott Francis Nancy Knott Jaclyn Moran Rickie Schmoyer Carmela Wiese
Dawn Byer Marie Freiss Chrystal Koch Pantip Moungkan Ursula Schneider Victoria Witalis
Joyce Calvitti Laura Gabel Brittany Kraly Nicole Murszewski John Schreiner Mark Wojtowicz
Alexandria Carroll Vanessa George Alison Kresge Martha Muzacz R.L. Schultz Ping Yan
Daniel Case Lara Gillease Stephani Kuntz Samantha Nadeau Jean Sefcovic Cody Yelton
Henry Chorro Jr. Marsha Glass S. Kathleen Latimer Tammy Nelson Leigh Seufert Julie Young-Nahmens
Pantip Elizabeth Glenn Renee LeBlanc Erik Nelson Phil Shenk Keiko Yumoto
Chumindrachak Lin Gong Angela Ledington- Rachael Nordquist Karen Beth Shubert Paola Zannini
Lori Churchfield Szaja Gottlieb Fischer Ellen O’Connell Laura Simpson Edmund Zebrowski
Robert Clary Lisa Gray Linda Lee Leigh Brian Ogden Frances Sivolella Guozhi Zhou
MEDITATE & MOVE
In Sanskrit, surya bhedana means “sun piercing” (“surya” = sun and “bhedana” = piercing).
This yoga breathing technique activates a sluggish mind and moves energy throughout the
body. It also helps stimulate digestion, and is heating in nature. SCAN AND WATCH
“Guided Chair Yoga with Surya
In this exercise, we’re going to inhale only through the right nadi (representing the
Bhedana Pranayama Breath”
sun/masculine energy), which is more warming, and exhale only through the left nadi
1. Open your camera
(representing the moon/feminine energy), which is more cooling. 2. Scan the code
3. Tap on notification
4. Watch!
SURYA BHEDANA PRANAYAMA Pigeon Pose
1. Begin by sitting comfortably with
your spine erect and your shoulders
relaxed. Let your left hand rest
comfortably in your lap. If you wear
glasses, remove them for this exercise.
2. With your right hand, rest the tips of
your index fi nger and middle fi nger
between your eyebrows. If this isn’t
comfortable, you may relax the fi ngers
toward the palm, gently tucking them in.
3. Close off your left nostril with your
ring fi nger. Inhale slowly through
your right nostril all the way to the
top of your breath. Then use your
thumb to close off your right nostril.
4. Release your ring fi nger and slowly exhale
through your left nostril all the way to
the bottom of your breath. Repeat this
sequence a couple more times. Let your
breathing be normal and rest a minute.
PIGEON POSE
1. Lift your left foot toward your right knee.
Make sure your left ankle, not your foot,
is placed on top of your right knee.
2. Flex your left foot. Inhale and lift tall.
3. Exhale and bend forward to your
comfort level over your left leg. Relax 6. Using your core strength, exhale, bend several deep breaths here. Release, and
your whole upper body. Breathe. in, and lift your right leg to center. place your palms together. Perform a
4. Come up and out of the position slowly, Inhale and stretch wide. Exhale, gentle twist to the left side, and then
then repeat on the opposite side, placing bend forward, and lift your left leg to the right, and come back to center.
your right ankle on top of your left knee. to center. Repeat two more times. 8. Sit up tall and rest your hands comfortably
5. Inhale, slowly coming out of the 7. If it feels comfortable, take your hands in your lap, with your palms up or down.
pose. Place your palms together back and toward the base of your chair. Take a few moments to connect to your
and inhale, lifting both arms out Extend your torso and neck, and look breath. Feel the natural rise of the breath
to the side like cactus arms. up. The head relaxes very gently. Take and the beating of your heart.
SPEAKING WITH
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Exploring the issues and challenges unique to the massage and bodywork community.
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“We don’t
just graduate
practitioners.
We create
thought leaders.”
Ellen Freed – Faculty