Issue link: https://www.massageandbodyworkdigital.com/i/1481961
Conversely, a smaller contact surface, like a fingertip, thumb, elbow, or pressure tool, concentrates pressure in a specific area and thus has a more penetrating effect. Small contact surface applications are most helpful with tissue-specific treatments. Trigger-point therapy is a good example. THE RUNGS OF THE LADDER The ladder represents the increasing activity levels the therapist and/or client engages at each rung or level of treatment. Image 1 shows the four rungs of the LOE. At each level, neurological engagement and client involvement increase. The First Rung Technique Only is the first rung of the ladder. At this level, the practitioner applies only the technique, and there is no movement or action by the client. Level one includes most techniques practitioners use during their massage treatments. These techniques may be applied using a broad or small contact surface. The choice depends on the condition, the stage of healing, and the client. Techniques that fall under this first rung of the ladder are generally effective for overall relaxation. They are especially effective with acute injuries or significant soft-tissue pain. The client is encouraged to fully relax and allow the practitioner to perform all the actions. Consequently, these techniques often induce the greatest degree of relaxation within the nervous system. Following are a few of the techniques used in level one. • Positional release: In this technique, the practitioner positions a client's limb or body part in a particular position and holds the position for a certain period. In most cases, this position decreases tension on affected soft tissues. The technique settles down the nervous system and helps reduce pain. • Effleurage (gliding): This is the workhorse of our most common techniques and is used for overall relaxation. The soothing feeling of gliding creates beneficial neurological responses, tissue fluid movement, and a general sense of relaxation. • Myofascial/DNM: This is another effective technique for significant pain complaints or acute injuries. The technique involves the gentle pulling of the skin and superficial fascia (Image 2). This type of technique was initially described as myofascial release. A similar method that emphasizes the neurological effects is called dermoneuromodulation (DNM). These methods are highly effective for a variety of chronic pain or acute injury clients. The Second Rung The second level or rung of the ladder is Technique + Movement. At this level, the practitioner incorporates passive movements of the client's limbs or body during the treatment technique. Adding passive movement along with the technique helps encourage tissue pliability. Movement also helps encourage proprioceptive awareness, which is the client's perception of their own movement. Increased proprioception is extremely helpful for regaining pain-free movement. Here are some examples of techniques that fall under the second rung of the ladder. • Passive stretching: In a passive stretching technique, the practitioner moves the client into a position that stretches target tissues. Stretching may be performed before other procedures or after to encourage greater tissue elasticity. • Pin and stretch: In this technique, the practitioner brings the client's limb or body part into a position that shortens the target tissue(s). For example, a pin-and- stretch technique for the biceps brachii would start with the elbow in a fully flexed position. The practitioner then applies pressure to a specific location within the muscle, usually with the fingertip or thumb. After applying pressure, the practitioner moves the client's limb into a position that lengthens the target tissue. For the biceps brachii example, pressure is applied to a target point within the biceps muscle, and the forearm is then passively extended (Image 3). L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 21 2 Myofascial/DNM applications at the first rung.