Massage & Bodywork

January/February 2013

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cl assroom to client release, and for your elbow, forearm, knuckles, reinforced fingers, or supported thumbs to progress through the fibers of the myofascia as the prow of a boat moves through water. If you are working at the correct depth and remaining responsive to the tissue, it will slowly start to open, and you will feel yourself melt into the tissue and advance. Find the Therapeutic Edge. For every client, there is a particular pace and depth of deep-tissue manipulation that allows the greatest possibility of therapeutic change to occur in the tissue. The therapeutic edge could be defined as the place where the client feels the "good hurt," in which the client experiences some pain, but the pain feels right, appropriate, and good, accompanied by the feeling of tissues releasing and tension patterns diminishing. Work that is too light can feel disappointing and leave the client's tissue irritated because it was not engaged with enough depth. Work that is too deep causes a defensive resistance in the tissue and leaves the tissue feeling violated or invaded. If you have solid palpation skills, you are more likely to be able to find the optimal pace and depth for each individual client and work on the client's therapeutic edge. Work in Layers. Avoid sporadically changing the depth of your work and jumping between layers of tissue during the application of deeptissue methods. The nervous system can become overstimulated by such rapid changes, leaving the client restless or slightly irritated by the work. Instead, work in even patterns at progressively deeper layers as the client's tissue releases. Work at Oblique Angles. In some situations, you might drop straight down into the tissue, but most often you will apply pressure at an angle no greater than 45 degrees. The use of oblique angles to apply pressure ensures that blood vessels, lymph vessels, and nerves won't be pinched against a bone. It also allows you to use your body weight effectively without undue stress on your joints. Use the Client's Breath. Remember that a client can support the release of adhered tissue with his or her breath. As a muscle is lengthened, as you move from the origin of a muscle to its insertion during a stroke, or as you move from distal body areas to proximal body areas, encourage the client to take a full breath and exhale as the stroke is performed. Use Passive and Active Movement. Use passive movement as the last technique applied to each body area and active movement at the very end of the session. These techniques help alert proprioceptors that new movement patterns are available and are important in reaching and maintaining treatment goals. While everyone may not agree on an exact definition of deep-tissue massage, we are all able to come to our own understanding of what it means to slow down and work deeply. As you consider these guiding principles, enjoy discovering how to modify and integrate them into your practice. Notes 1. A.J. Banes et al., "Mechanical Forces and Signaling in Connective Tissue Cells," Current Work Origins, Insertions, and Muscle Bellies. It is not uncommon for therapists right out of school to apply deep-tissue work to muscle bellies but avoid using it around the origin and insertion points of muscles. Many of these areas will require you to remain responsive to tissue changes and adjust your pressure accordingly, but so long as the client expresses no discomfort, work in these areas is valuable. Opinion in Orthopedics 12, no. 5 (2001). 2. W. Hammer, "Piezoelectricity, A Healing Property of Soft Tissue," Dynamic Chiropractic, accessed December 2012, www.dynamicchiropractic. com/mpacms/dc/article.php?id=15481. 3. R. Turchaninov, "Research & Massage Therapy, Part 2," Massage & Bodywork, When Possible, Place Muscles in Lengthened Positions. It can also be helpful to place a muscle in a lengthened position before the application of deep-tissue work to facilitate the elongation of tissue. For example, you might rest the arm above the head in a slightly flexed position, supported by a pillow, while working on the triceps. December/January 2001, page 48. 4. R.B. Fuller, "Tensegrity," accessed December 2012, www.rwgrayprojects.com/rbfnotes/ fpapers/tensegrity/tenseg01.html. Anne Williams is the director of education for Associated Bodywork & Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012) and Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams & Wilkins, 2006). She can be reached at anne@abmp.com. www.abmp.com. See what benefits await you. 105

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