Issue link: https://www.massageandbodyworkdigital.com/i/557366
G For the past few years, I've grown used to virtually every food product—from high- fructose beverages to bacon—proudly proclaiming, "Gluten Free." However, I never thought the day would come when the relatively new phenomenon of "Glute-Free Massage" would be an accepted practice, and I fi nd it disturbing. Simply put, I feel that neglecting to work on an area as important as the gluteals is a great disservice to our clients. Working on the gluteals should not be confi ned to just clinical therapeutic work; it should also be included in any full-body massage as a way to integrate the important connection, energetically and structurally, between the client's lower and upper body. Let's look at some of the kinesiology, anatomy, and therapeutic issues of the gluteals to understand why practicing a glute- free massage can be a detriment to your client. Addressing the Posterior Pelvis Not only is strengthening the gluteal muscles important, relaxing and aligning these muscles through bodywork is also crucial and should be part of any session. Any strong, functional muscle has the potential to be tight and restrictive. It seems worse than unwise to shy away from working on such an important group of muscles as the gluteals because of misplaced concern and unsubstantiated projection over client modesty. Good client education and proper languaging (see But How Do I Talk About It? page 68) can help you jump that hurdle. Quite simply, the gluteal muscles should not be ignored. Let me list a few things that demonstrate the importance of this area and why, as therapists, we need to relax, align, and provide left and right balance to the posterior pelvis. • A major goal of all bodywork should be to provide a smooth transition and freedom of movement between the major body segments. We want the legs to swing freely from the pelvis and the pelvis to have a fl uid connection to the low back. All the posterior pelvic muscles affect this transition. The rotators also have a huge effect on the rotation of the femur, which can have a profound infl uence on knee torsion and foot inversion or eversion. • The tensor fasciae latae is an underworked muscle that, although it originates from the anterior pelvis, is easily accessed in a prone position while working on the gluteals. The tensor fasciae latae is always involved in iliotibial band tightness and in torsion of the femur and knee if its borders are pulled either anterior or posterior. • Virtually all those who participate in athletics, dance, yoga, Pilates, and other physical pursuits, along with the sedentary population, complain of iliotibial band tenderness and tightness. Although most anatomy descriptions emphasize the tensor fasciae latae as the attachment to the iliotibial band, look at the distal attachment of fi bers of the gluteus maximus to the posterior border of the iliotibial band and how that will pull the band posterior and cause iliotibial band tightness and tracking problems in the legs. Any work to provide release and balance to the iliotibial band should include general work to relax the gluteus maximus and also precise work at its lower attachment to release this muscle's tendency to misalign the band. • For low-back pain, the posterior pelvis is a gold mine for relief. An imbalance in the gluteal muscles causes a rotation of the pelvis that generates a twist of the spine, as a cause of, or as compensation for, back pain. Especially for people with acute low-back pain, it is often safest to stay away from the epicenter of pain and the lumbar vertebrae, but almost all clients will feel relief from gluteal work, especially when you pay particular attention to left/right balance. • Look at the insertions, fi ber direction, and depth of the gluteus medius and gluteus minimus compared to the gluteus maximus. These smaller muscles have a very different function from the gluteus maximus and are 66 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 5 Just as the "abs" should refer to not only the rectus abdominis, but also the obliques and transversus abdominis, the generic term glutes for therapists should include the complex weave of posterior pelvic muscles, including the deep rotators and the distinction of function for gluteus maximus, gluteus medius, and gluteus minimus. When I say gluteals, I'm actually referring to the entire posterior pelvis. often a factor in hip pain because of their attachment to the trochanter. Their complex actions vary, depending on hip and knee position, and require different strategies than the gluteus maximus. There is some disagreement on the gluteus medius' and gluteus minimus' rotational role for the femur (depending on hip fl exion or extension), but there is general agreement that they are primary internal rotators to counter the force of the external rotators. These smaller gluteal muscles are most important for their action of abduction, particularly in stabilizing the leg to remain directly under the pelvis, preventing left/right pelvic deviation during the single-support phase of walking or running. • The gluteus maximus originates from the iliac crest and the lateral border of the posterior sacrum all the way down to the coccyx. Your work in creating left/right balance and relaxing the fi brous attachments at the sacrum can be very helpful in relieving sacroiliac issues. • The deep rotators are, of course, extremely important for their role of externally rotating the femur and are often tight and overworked in sports that require rotation, such as golf, tennis, and baseball. In addition, the deep rotators stabilize the leg in walking, and work in tandem with the internal rotators to keep legs and knees tracking well. All therapists should be able to precisely work on these muscles by sinking through the gluteus maximus. • Sciatica is one of the most common complaints massage therapists and bodyworkers encounter. Although sciatic pain is a complex condition with multiple causes, G By Art Riggs e Forgo en Muscles 1. Freeing the gluteus maximus to slide easily. 2. Freeing and aligning the gluteus maximus at the iliotibial band. 3. The Frog Position. 4. External rotation of the femur. 5. Working on the rotators. 6. Working rotators in a side-lying position. Images courtesy Art Riggs. he lutes: 4 of 5 READER FORUM EMAIL YOUR LETTERS TO EDITOR@ABMP.COM. INCLUDE YOUR FULL NAME AND THE CITY AND STATE IN WHICH YOU RESIDE. WE RESERVE THE RIGHT TO EDIT LETTERS FOR LENGTH AND CLARITY. GLUTES! I've been a member of ABMP since 1993, and I have very much enjoyed receiving Massage & Bodywork over the years. I was fascinated by the question on this month's [ July/August 2015] cover: "Glutes: Why are we ignoring these important muscles?" My immediate reaction was, "What? Are we ignoring them? I sure as heck am not! I work on them on every client." I am 62 years old and I've been doing massage since I was 18 years old. When I decided to do it as my profession, I went to a massage school and got certifi ed. When licensing became the law where I lived, I got my license. It never occurred to me that what I was doing was touching "the untouchable." Maybe I've just been lucky, but I have remained largely unaware of, and unaffected by, the "sometimes litigious clientele." I completely agree with Art Riggs: leaving muscle groups out of massage is doing our clients a disservice. That includes the pectorals and the abdominals as well. ELEANOR R. SMITH LEBANON, MISSOURI Congratulations on your glutes issue! Most impressive issue I've seen in a long time! I really appreciated the multifaceted coverage relating to this area of the anatomy, and you defi nitely addressed an important need in our community, especially among beginners. It's shocking how many of the current schools avoid, or fail to provide, quality teaching around this area. CHRIS ASAY DOVER, DELAWARE I read the glutes article when my copy of Massage & Bodywork arrived in the mail. I'm very surprised and disappointed that there is still a negative connotation attached to working the glutes. The mind-set of any school that doesn't educate their students and any spa that won't allow their technicians to address any discomfort the client may be experiencing perpetuates the misconception that massage therapists are providing some sort of sensual service. It's a major muscle group that needs attention—simple as that. MICHELE FOX FROM FACEBOOK THE EMOTIONAL SIDE OF CRANIOSACRAL Just wanted to say thank you for Jana Panter's article about the emotional and intuitive side of craniosacral therapy [May/June 2015, page 80]. She gave voice (in a funny, helpful, and compassionate way) to those of us who tune in to the emotional components. I studied craniosacral therapy with an osteopath/ physical therapist who focused on specifi c anatomy. It was a great grounding in the work, but most of the time when I put my hands on someone, the body guides me. And there is usually a mixture of physical, mental, emotional, and spiritual aspects to the pattern that is ready to be released. PAULA CURTIS FORT COLLINS, COLORADO AUTHOR FEEDBACK Dear ABMP, I am writing in response to the letters I have received regarding my article. I've heard from people all across the country seeking reassurance as they explore the many facets of craniosacral therapy [CST]. Thank you to the people who wrote—your letters inspire me! Here are a few more ideas for craniosacral encouragement: • Take classes. There are many good teachers and classes out there. A good class will fi ll in one piece that was missing, and over time you will be able to pull them together. I have taken many classes from, and highly recommend, Suzanne Scurlock-Durana's program (Healing From the Core), which is supported by the Upledger Institute. I found her classes particularly helpful in working through my issues, which enabled me to be clearer and more confi dent for my clients. • Keep practicing. Your skill and confi dence will get stronger. • Be patient. More practitioners are fi nding this path. If you hang in there, you'll start to see more colleagues discussing the various benefi ts and means of practicing CST. Thank you. JANA PANTER, ND, CCST G For the past few G years, I've grown G used to virtually G used to virtually G every food product—from high- fructose beverages to bacon—proudly proclaiming, "Gluten Free." However, I never thought the day would come when the relatively new phenomenon of "Glute-Free Massage" would be an accepted practice, and I fi nd it disturbing. Simply put, I feel that neglecting to work on an area as important as the gluteals is a great disservice to our clients. Working on the gluteals should not be confi ned to just clinical therapeutic work; it should also be included in any full-body massage as a way to integrate the important connection, energetically and structurally, between the client's lower and upper body. Let's look at some of the kinesiology, anatomy, and therapeutic issues of the gluteals to understand why practicing a glute- free massage can be a detriment to your client. Addressing the Posterior Pelvis Not only is strengthening the gluteal muscles important, relaxing and aligning these muscles through bodywork is also crucial and should be part of any session. Any strong, functional muscle has the potential to be tight and restrictive. It seems worse than unwise to shy away from working on such an important group of muscles as the gluteals because of misplaced concern and unsubstantiated projection over client modesty. Good client education and proper languaging (see But How Do I Talk About It? page 68) can help you jump that hurdle. Quite simply, the gluteal muscles should not be ignored. Let me list a few things that demonstrate the importance of this area and why, as therapists, we need to relax, align, and provide left and right balance to the posterior pelvis. • A major goal of all bodywork should be to provide a smooth transition and freedom of movement between the major body segments. We want the legs to swing freely from the pelvis and the pelvis to have a fl uid connection to the low back. All the posterior pelvic muscles affect this transition. The rotators also have a huge effect on the rotation of the femur, which can have a profound infl uence on knee torsion and foot inversion or eversion. • The tensor fasciae latae is an underworked muscle that, although it originates from the anterior pelvis, is easily accessed in a prone position while working 66 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 5 Just as the "abs" should refer to not only the rectus abdominis, but also the obliques and transversus abdominis, the generic term glutes for therapists glutes for therapists glutes should include the complex weave of posterior pelvic muscles, including the deep rotators and the distinction of function for gluteus maximus, gluteus medius, and gluteus minimus. When I say gluteals, I'm actually referring to the entire posterior pelvis. G By Art Riggs e Forgo en Muscles e Forgo en Muscles G e Forgo en Muscles G e Forgo en Muscles G e Forgo en Muscles G e Forgo en Muscles e Forgo en Muscles G he lutes: 4 of 5 of 5 of I am 62 years old and I've been doing massage since I was 18 years old. When I decided to do it as my profession, I went therapy [May/June 2015, page 80]. She gave voice (in F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 13