Massage & Bodywork

May/June 2012

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READER FORUM DIRECTION DISCUSSION I am concerned about the advice that was given by Art Riggs in Q & Art ["Distal vs. Proximal Work," November/December 2011, page 31]. The original question was about the safety of working massage strokes distally, away from the heart. I agree with what Art said to some degree, but he misses some very important safety concerns and rationale for avoiding working distally. The most egregious error in this article is the complete omission of the dangers of edema and varicose veins. The veins in the calves and thighs are equipped with check valves that only open in one direction: toward the heart. Distal strokes in these areas, especially deep strokes, force the blood backward, against the flow, forcing the check valves to blow open in the wrong direction, eventually damaging them until they no longer retain blood against gravity and we get varicose veins. Additionally, increasing distal pressure, especially close to the ends of the limbs, increases pressure on capillary walls and inhibits lymphatic uptake and flow. This forces excess fluids into the interstitial spaces in the extremities, increasing edema and exacerbating conditions like Raynaud's syndrome. The article's failure to address these important issues seems irresponsible and misleading. Am I wrong about this? JOHN KRAUSSER EUGENE, OREGON AUTHOR RESPONSE Dear John, I hope that I didn't come across as implying that the concerns that most everyone has heard about the dangers of strokes counter to the direction of lymph and venous flow are not worthy of consideration—I do mention them early in the article, but the main message was to show the benefits of frequently working in a distal direction. My beginning Swedish training also warned to never work distally, which is why, when advanced trainings disregarded the caveat, I checked with countless anatomists, physical therapists, physicians, and other respected bodywork therapists and teachers, all of whom agreed that, although there is theoretical rationale behind that premise, they have never seen it to be a problem. Particularly, anatomists have concurred that the valves have enough flexibility to not be damaged by pressure against them and that collateral circulation also would absorb much of the pressure. Unlike more vigorous Swedish work that places great emphasis on circulation, other modes emphasize stretching short fascia, releasing neurological holding patterns, and decompressing and unwinding joints. These different intentions require much shorter and slower paced strokes that leave plenty of time for circulatory pressure to be dissipated. What this comes down to is a cost-benefit analysis of the substantial benefits of distal strokes versus a theory that is often taught as gospel when I've not been able to find substantiating data. Most importantly, I would hope that all instructors would teach their students to keep an open mind and verify rigid rules in any discipline through research, especially if exceptions to these rules can be beneficial to our work. ART RIGGS Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 11

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