TMJ

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

TMJ Syndrome

A topic that keeps coming up in my classes and lectures is (temporomandibular joint) TMJ Syndrome.  Over and over again massage therapists encounter this problem and tend to be intimidated or scared by it.  The flip side of the coin is that some therapists have taken a simple weekend course on treating TMJ Syndrome (hereafter referred to as TMJ) and feel they are experts, but in reality the basic cause of TMJ has not been resolved by their treatments.  There seems to be a lot of confusion among massage therapists about TMJ and the approaches for treating it.  In this installment I am going to discuss the basis of TMJ, and the necessary components of successfully applying massage techniques to treat this syndrome.

First the basis:  Those of you who have been reading this column know I often refer to the core distortion pattern found in everyone I have ever seen in over 25 years of practice.  This distortion includes rotated iliums and shoulders, and an imbalance of the cervical spine and cranium.  The entire body is involved in this core distortion.  However, for purposes of understanding TMJ, we will have a clearer picture if we look at the components of the core distortion pattern.

The cranium has bones that relate to the bones of the pelvis.  Of specific importance here are the sphenoid, occiput, temporals, zygomas, maxilla, palatines and palate.  There is a direct relationship between the iliums of the pelvis and the temporals and greater wings of the sphenoid – if the greater wings of the sphenoid and temporals are rotated anteriorly on one side, then the ilium on that same side will also be rotated anteriorly.  There is also a direct relationship between the occiput and sacrum – the direction in which the occiput is tipped is the same direction of tippage seen in the sacrum.  Key in cranial motion is a flexion/extension movement of the occiput and the sphenoid.  When the cranium moves evenly into flexion/extension without tippage or rotation, then the iliums and sacrum are level and offer a balanced support for the body.  When the flexion/extension motion of the sphenoid and occiput is torqued, an uneven movement of the cranium in flexion/extension is created, which results in a torquing of the ilium and sacrum mirroring what takes place in the cranium. While this is technical, it is important to recognize this since this is the primary torsion found in the core distortion pattern and in TMJ Syndrome.  Additionally, when this torsion exists between the sphenoid and occiput, the other facial bones involved with TMJ – the mandible, maxilla, palatines, palate and zygomas – are also in this torsion distortion.  Using kinesiology and a right arm for muscle testing, this can be verified by testing the client with the mouth open wide.  If TMJ is present, the muscle test will be weak, as will additional tests involving the structure of the pelvis.  Consequently, it is easy to see that the TMJ Syndrome is synonymous with the core distortion of the entire body, and that the pelvis and the cranium need to be brought back into balance in order to effectively treat TMJ.  Another consideration is the curvature of the neck, which is also a result of this distortion, and the imbalance found here helps support and lock up the dysfunctional TMJ pattern.  So the TMJ syndrome needs to be looked at as a structural balance problem with the TMJ being a distortion that is a result of the core distortion of the full body.  Now for the fun.

Treating TMJ Syndrome

As you can see from the discussion above, TMJ distortion stems from the imbalance of the pelvis, spine and cranium.  So when seeking long-term correction of TMJ problems, the massage therapist needs to treat this entire distortion pattern.  If massage and Cranial/Structural techniques (not to be confused with craniosacral techniques) are applied only to the cranium, then the distortion in the rest of the body will bring the distortion back into the cranium and the TMJ, and you’ll be back where you started.  If, however, there is a balancing of the pelvis, a reduction of the scoliotic curve caused by the imbalanced pelvis, a reduction of the reverse curvature of the neck, and a balancing of the cranium, then the positive changes to the TMJ will be able to be maintained long-term leading to happy clients.

Recently, when working with a dentist who had a severe TMJ problem complicated by extensive dental correction, the changes in the balancing of the jaw were so profound after the torsion in the cranium was released and the core distortion throughout her body had been released, that she had to go back into braces to bring her bite back into alignment.  However, her TMJ symptoms disappeared!

TMJ problems are often accompanied by many emotional blockages that have become chronic, and often manifest as a thickening and tightening of the soft tissue.  They can exist throughout the structure, but especially in the pelvis, abdomen, thorax, neck, and jaw.  These emotional blockages can, and often do, resist soft tissue changes that are necessary to balance the structure.  It is important for the client to be able to release the trapped emotional energy so the chronically tightened soft tissue can relax and release the old core distortion holding pattern.

When balancing the core distortion pattern and working with TMJ, I prefer to integrate a number of techniques.  First, I will initiate the torsion release throughout the core distortion pattern by using Cranial/Structural techniques.  Then, once the torsion is released from the cranium, the soft tissue of the entire body starts to unwind and release, which greatly facilitates the balancing of the structure.  There are usually many areas where this unwinding of the structure is limited due to the myofascial holding pattern, adhesions and scar tissue.  The proper application of the Three-step technique allows the therapist to effectively work deeply in the various layers of fascia to continue the unwinding process initiated by the Cranial/Structural work (see the Nov/Dec issue of Massage Message on Deep Tissue, or view that article on the website).

Releasing the torsion in the cranium allows a balancing of the bones in the cranium, and consequently a balancing in the TMJ.  I have found that in balancing the cranium using Cranial/Structural techniques, many of the TMJ problems will be profoundly minimized or disappear entirely with minimal work in the actual muscles that are directly related to the TMJ – i.e. masseter, pterygoid, temporalis.  However before I will work with the muscles of the TMJ, I am going to seek a balance between the pelvis and the cervical spine, and release the musculature of the neck and shoulder.  By doing this I will have maximum results in a minimum amount of time when actually working in the muscles of the TMJ.  This will usually take 3-4 sessions of balancing the structure, including the neck, before doing deep efficient work with the muscles associated to the bones of the TMJ.

When addressing the cervical spine, I would work to release the anterior muscles first, and then the posterior muscles, and concentrate more on the SCM and scalenes because they tend to hold the neck in a distorted curvature. Often much more work is necessary on the muscles of the anterior neck than the muscles connected to the bones of the TMJ, even though the pain is felt in the area of the muscles of the TMJ.

When working with the muscles directly associated with the TMJ, I will check the cranium first using kinesiology to be sure that optimum balance and mobilization of the cranial motion is present.  Then, after treating the anterior neck and posterior neck, I release the soft tissue over the scalp and face.  Now I will release the masseter and its attachments externally.  I will then work with the musculature inferior to the mandible, paying special attention to the tissue around the angle of the mandible, to where it attaches in the back of the TMJ.  After having released both sides of the mandible, I will now work intraorally on the masseter including the attachments on both sides.  At this point the pterygoids are about the only muscles affecting the TMJ that have not been addressed.  Since they are located at the back of the mandible, releasing them tends to be uncomfortable for many clients.  However, by releasing everything else first, there will be no resistance from the other musculature of the mandible that would diminish the release of the pterygoid.  Consequently, the amount of time and pressure necessary to fully mobilize and balance the TMJ by working on the pterygoids will be minimized.

It is important not to try to do too much in any one session when working with the TMJ because clients will have a significant shift throughout their structure, and we need to have that structural shift integrate as it balances.  Additionally, TMJ problems are often at the top of clients’ lists as far as being painful, so we need to remember to always work within client’s pain threshold.

The work mentioned above is very specific and advanced, and I would strongly suggest that you take a course in Cranial/Structural and specific related soft tissue protocols before treating TMJ problems in your clients.

Athletic Potential

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

ATHLETIC POTENTIAL AND THE CORE DISTORTION PATTERN

Many of the athletes I have worked with over the years have wondered why I have not promoted myself as a sports massage therapist. They sought treatment from numerous massage therapists for rehabilitation from injuries or to improve their performance and weren’t satisfied with the results. Many had developed chronic problems either from their training or injuries that had accumulated from performances and competitions.

Case study:

Carolyn, a 50-year-old tri-athlete, was training harder than ever, but her times continued to worsen. When she came to me it was obvious that no one had addressed her structural imbalances. These weren’t extreme imbalances due to a major fall or accident, but were the normal imbalances seen in most people that are usually taken for granted. Some of the problems she was having were patellar tendonitis, a weak left ankle, and a chronic tightening of the long head of her right biceps femoris resulting in numerous painful strains. The therapist that she had seen for over a year had treated only the individual sites of her complaints with limited results.

The structural imbalance that was evident in her body was the classic core distortion pattern, which is a spiral that runs down through the body resulting in an anterior rotation of the left ilium and a posterior rotation of the right ilium. Other obvious distortions from this imbalance of the iliums included a scoliotic curvature of her spine, a right shoulder that was medially rotated, an apparent longer left leg with a medial knee and a laterally rotated foot. When considering her complaints from the perspective of these distortions it is easy to understand the reason for her particular symptoms.

Since I have worked with these patterns for years, I was aware of the strain patterns that exist with these distortions. Strain patterns are chronically weakened muscles and muscle groups that function with at least a 30% decrease in strength and limited range of motion.

On the anteriorly rotated ilium side, her left side, where she had the patellar tendonitis and weak ankle, two specific muscle groups were in the strain patterns due to the anterior rotation of the hip. They were the quadriceps and adductors and the gastrocnemeus, soleus, and peroneus longus. These groups related directly to the problems that Carolyn was having in her left leg. Her foot was rotated laterally and her knee rotated medially. This obviously resulted in stresses from the hip to the foot resulting in a weakening of her ankle which became less stable over time and intense training. Carolyn’s patellar tendonitis had also developed from the stress placed on the knee due to the medial rotation of the knee and the lateral rotation of the lower leg and foot. With Carolyn’s continued training and competitions all of these symptoms had grown progressively worse.

On the posteriorly rotated ilium side, the right side, the specific muscle that was in the strain pattern due to the posterior rotation of the hip was the actual muscle that had become the problem – the biceps femoris. This muscle was tight and shortened, and was at least 30% weaker due to the affects of the core distortion.

When looking at performance in the body, strain patterns are a perfect example of the concept that “structure begets function.” In other words, if there is proper alignment of the muscles and bones, the function is much higher than if there is an imbalance. The imbalances from the core distortion result in the aforementioned strain patterns with at least a 30% decrease in strength and range of motion.

To treat Carolyn I addressed the imbalances of the core distortion pattern integrating Cranial/Structural techniques with soft tissue protocols. On her left side the knee and lower leg were moved into balance relieving stress on the knee and allowing the quadriceps and adductors to strengthen. The foot was also released out of lateral rotation allowing the gastrocnemeus, soleus, and peroneus longus to strengthen. By balancing the collapsing core distortion pattern on the left side, the painful conditions that brought her to the office initially were directly resolved.

In addition, on her right side, the posterior hip moved forward into balance allowing the lateral head of the biceps femoris to release out of the strain pattern. As a result it returned to its full range of motion and strength even though it had suffered numerous strains and pulls resulting in a build up of scar tissue.

At this point, using kinesiology, I was able to test and confirm that the strain patterns that related to Carolyn’s problems no longer existed. The muscle strength in the quadriceps and adductors had returned as well as the muscle strength of the gastrocnemeus, soleus, and peroneus longus. As Carolyn continued to train she noticed her left leg felt stronger, her stride was longer, her ankle was stable, and the soreness and inflammation of her patellar tendonitis disappeared. She also noted that her right leg, her power leg, now gave her the spring and push she needed when running and bicycling since the tension in the biceps femoris was released. She was excited about her upcoming triathlon, and so was I.

My next conversation with Carolyn was pure joy! Not only had Carolyn been able to effectively compete with no pain in the triathlon, she had actually accomplished a personal best in her time. As amazing as it sounds, the improvement over her old personal best was one full hour. This was a triathlon that she had competed in a number of times before. What is even more amazing is Carolyn’s previous personal best time had been accomplished when she was years younger, and now, at 50, she was able to beat that time.

Carolyn’s case is a perfect example of how bringing the core distortion pattern into balance dramatically increases an athlete’s potential. Another wonderful benefit is the 50% decrease in the likelihood of injury. Athletes of today are all looking for an edge that will take them to the next level or allow them to maintain their previously high levels of performance. Usually, due to the accumulation of injuries and stresses, their bodies tend to move further into the structural collapse of the core distortion and it is extremely difficult to avoid the injuries that limit their performance. In addition, the further into the structural collapse of the core distortion an athlete moves, the greater the strain pattern and the greater the loss of strength and range of motion in major muscle groups that are necessary for their high level of athletic endeavor.

Case Study:

Carl, a 23-year-old minor league pitcher, was referred to me for the shoulder problems that were developing in his pitching arm. He was a right-hander, and over the last year the velocity of his fast ball dropped from 93 mph to approximately 87 mph. At 93 mph he had been a top young prospect who just needed to gain experience and learn how to pitch at the big league level. At 87 mph he was one of many in a farm system that gave other prospects a chance to compete and develop their skills without a future in the big leagues.

Carl had noticed his velocity falling off about 6 months before his shoulder pain developed. He had been working extensively with his pitching coach on his dynamics and strengthening exercises, but his shoulder pain increased, and his velocity diminished.

When I evaluated Carl, his right shoulder was rotated internally and left shoulder rotated externally. His left ilium was rotated anteriorly and right was rotated posteriorly. This was a classic structural collapse of the core distortion pattern which had rapidly gone from imbalance to structural collapse with the stresses of training and competition. The internally rotated shoulder and arm on the right side also left the teres major and teres minor, the medial fiber of the deltoid, the pectoralis minor, the subscapularis, and coracobrachialis in a strain pattern with a loss of at least 30% of strength. They were also becoming strained and inflamed causing his sore shoulder and compromised rotator cuff. This directly affected Carl’s velocity.

To treat Carl I viewed his arm problem as part of the structural collapse of his entire structure, not just the soreness and weakness in his arm and shoulder. Integrating Cranial/Structural techniques with soft tissue work, I initially treated his pelvis to bring it into structural balance so it would be able to support balance through the shoulders. Once this was accomplished, I addressed his upper body including his neck, shoulders and arm. By balancing and stabilizing the pelvis first, the treatment of his shoulder and arm was more effective and long lasting because the changes were integrated into a balanced support of Carl’s structure. After 5-6 sessions Carl was able to pitch pain free, and the velocity had returned on his fast ball. In addition, Carl also reported his legs felt stronger, and he was actually able to gain a longer stretch when throwing so that his fast ball was now reaching 95 mph. Carl is now in the big leagues pitching a rigorous schedule without pain.

As you can see in Carl’s case, the structural collapse of the core distortion caused an imbalance with strain patterns in his shoulder resulting in pain and poor performance. With the proper balancing, Carl gained the 30% of lost strength and range of motion, became pain free and had a structure that supported his entire body allowing his performance to exceed what it had previously been before his injuries.

The potential for anyone increases when their bodies are balanced and supported whether they be an athlete, a stay at home mom, or a computer operator. Anyone with a structural collapse of the core distortion is missing at least 30% of their potential, prone to injuries and stress, and usually experiences pain due to the imbalance. As massage therapists we need to work to balance this distortion and its relationship to our client’s complaints. Just working the area of complaint without providing the integrity of structural balance leads to limited results and prolongs the loss of potential.

For more information on how to balance the structural collapse of the core distortion and work deep tissue effectively, please see previous articles of SET TALK, or go to the Publications section of the website for copies of these articles. Keep working to support your clients with the world’s best tools – your knowledge, hands and skills.

Frozen Shoulders

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

DESIGNING A PROTOCOL FOR TREATING FROZEN SHOULDERS

Jerry, a 53-year-old licensed massage therapist, called and set up an appointment for a shoulder problem. He reported that he had been doing massage for 15 years working between two offices. This necessitated transferring his table from one office to another on a daily basis. Three years ago he purchased a regular car with a trunk large enough to hold his table which replaced the SUV’s he had been driving for the previous years of his practice. For a year he had been having difficulty picking up the table out of the car trunk. In the last month not only did he have trouble picking up the table, but he couldn’t abduct his arm more than 10 degrees. In addition, his arm was waking him up at night with his shoulder throbbing in pain.

Gina, a 21-year-old college student, called me to set up an appointment after an auto accident in which she had been rear ended and diagnosed with a cervical flexion/extension injury (whiplash). After three weeks she was also having low back pain and difficulty raising her arm. When I evaluated her she had 70% loss of range of motion in her arm and shoulder. She expressed concern that the insurance company would not cover the shoulder and arm problem because it had not been x-rayed at the time of the accident, and her insurance agent said that the arm problem was probably not related to the accident or she would have been in immediate pain.

Tom, a 37-year-old accountant/soft ball player, set up a session for his very painful shoulder. He had started the spring season after a three month lay off from soft ball, and after two games could not throw or bat. In addition, a chiropractor had told him he now had a frozen shoulder. Fortunately, the chiropractor recommended that he receive massage therapy for the arm and shoulder in conjunction with the chiropractic adjustments. Upon evaluation, his shoulder was inflamed, and he had approximately a 10% range of motion.

All of the above mentioned clients had a significant limited range of motion, which is called a frozen shoulder. However, each one had a different degree of limitation and each was brought on by a different set of circumstances. Jerry, the massage therapist, had initiated his problem lifting a massage table out of a trunk, and continued to repeat the motion after the problem had started to develop. Gina had an auto accident causing a cervical flexion/extension injury as well as an increased structural collapse which resulted in an internally rotated right shoulder, but it was only after using her arm in daily life activities that a problem showed up. This was due to the weakness inherent in the arm and shoulder when the shoulder is in internal rotation. Tom’s shoulder problem was brought on by over activity on an unconditioned arm while throwing the soft ball from center field. This resulted in straining and irritating the shoulder until it became dysfunctional and inflamed.

In order to be able to effectively treat all of the above clients, it was necessary to evaluate the structural distortion that each client had, and to determine whether the shoulder was internally rotated. I found that all three had a significant internal rotation of their problem shoulders. This in essence left not only the shoulder, but the entire arm, severely weakened and susceptible to strain and injury with light activities. These clients had used their arms with a decrease of at least 50% of normal strength due to the strain pattern, and consequently had damaged soft tissue. As the tissue damage was worsening through regular activities, the inflammation and swelling was also increasing. This ultimately led to their frozen shoulder conditions.

It was apparent that the internal rotation of the shoulders in these three clients had to be addressed in order to effectively treat and rehabilitate their frozen shoulders. This required evaluating what muscle tension and myofascial holding pattern were responsible for the internal rotation of the shoulders. The obvious culprits were the pectoralis groups along with serratus anterior and subscapularis. Palpation showed that all of these muscle groups were very tight and rigid with very active trigger points. In addition, the fascia associated with these muscle groups was tightened and fibrous indicating that splinting was taking place further limiting the range of motion of the shoulder. The splinting had become part of the cause of the frozen shoulder by reinforcing and limiting the range of motion.

There was other not so obvious soft tissue that was also involved. This soft tissue was located on the inside of the upper arm and included the biceps brachii, coracobrachialis, and anterior deltoid fibers. As with the pectoralis groups these tissues were tightened, shortened, and inflamed. The fascia associated with these muscles was also contributing to the frozen shoulder by being rigid, fibrous and shortened.

At this point, it was also necessary to view the relationship of the forearm to the upper arm and the pronation of the hand as contributors to the internal rotation of the shoulder. It was obvious that the entire arm down to the pronated hand were all either supporting or helping to cause the internal rotation of the shoulder. In addition, upon kinesiological testing the strain pattern that existed in the shoulder manifested all the way through the hand. The muscles of the forearm and the hand were also contracted and in a strain pattern with inflammation and weakness. The clients were not aware of what had been happening in their arms or hands because the most severe pain was in the shoulder. The muscles used in pronation were the ones I found that were the shortest and most distressed. The fascia was similar to what I had found in the shoulder and upper arm. It was fibrous and shortened, and splinting was found even in the hand and forearm which contributed to the limited range of motion of the shoulder.

After addressing the specific musculature involved with the frozen shoulders, it was now important to bring the rest of the body into structural balance to support the remobilization and rehabilitation of the shoulder. Each client had fallen into a structural collapse through different life activities, yet this collapse appeared to be the major player in the development of their frozen shoulders due to the internal rotation of the shoulders.

Now for the therapeutic challenges. All three clients had swelling and inflammation in the tissue that needed to be treated to rehabilitate the shoulder. This swelling and inflammation were two of the principle reasons for the degree of pain that each client was experiencing. Each client also had tightened, fibrous fascia that was pulling the arm into internal rotation and splinting the area which greatly contributed to the lack of range of motion. Finally, each client had significant adhesions that had developed from being in the strain pattern while using the arm. Some of these adhesions were deep and were compressing nerves next to bony prominences resulting in significant pain when their arms were moved. The tightened fascia was also in and around the muscle fibers which added to the limitation of range of motion.

The protocol I designed to treat these shoulders would first and foremost release the internal rotation of the shoulder and arm; 2nd reduce swelling and inflammation and the associated pain; 3rd release the myofascial holding pattern that was helping to lock the internal rotation and restrict the range of motion; 4th lengthen the fascial and muscle fibers that had become shortened and contracted locking the shoulder into internal rotation and restricting its range of motion; and 5th release the adhesions and scar tissue that had formed which were compressing nerves and restricting the range of motion of the shoulder and arm.

Gina, the college student, was having significant pain from whiplash in her neck and low back. So, the first treatments addressed the structural collapse of the spine. Even though I was not working directly with the soft tissue of her shoulder, there was some improvement. The reason her shoulder went so far into internal rotation was the distortion in her spine from her auto accident. After six sessions focusing on the head, neck and shoulder and low back to balance the spine, I was able to start concentrating on her shoulder. In the initial sessions it was necessary to spend most of the time releasing the fluid, ischemia and inflammation from the shoulder and arm. Then I was able to work the 3-step approach by 1st releasing fluids and toxins, 2nd releasing the myofascial holding pattern with directed myofascial unwinding strokes and 3rd concentrating on individual fibers and adhesions. She quickly experienced relief of some of the symptoms and an improved range of motion. After five more sessions she was pain free with full range of motion.

Jerry, the massage therapist, had arm and shoulder problems longer than the rest of the group. Unlike Gina, the structural collapse of his spine was not significant enough to cause pain, so I was able to work with his shoulder from the first session. The 3-step approach worked extremely well with Jerry. However, I could not treat some of the deepest adhesions and scar tissue in the shoulder until the sixth session because of the degree of myofascial holding and shortened fibers that had accumulated as the problem was developing. After full range of motion had been reestablished, he chose to have me release the distortion in his body that had supported and actually caused his shoulder problem. In addition, he devised a different way to retrieve his table from the trunk of his car without twisting or straining his shoulder. Jerry was fully rehabilitated when his overall body structure was balanced and strong enough so that his daily activities did not pull him into a structural distortion.

Tom, the accountant, did not have the degree of structural collapse of the spine that Gina had so I was able to work from the first session on his shoulder and arm. As with Gina, the 3-step approach was very effective and allowed me to release the fluids and inflammation, the myofascial holding pattern, and the adhesions, scar tissue and shortened fibers in his shoulder and arm. After four sessions, Tom was pain free and started to slowly strengthen the arm for soft ball.

I hope these three cases will help you see the importance of evaluating structure and applying the 3-step approach when working with shoulder problems. Until next time, continue your great work!

Knee Pain

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

KNEE PAIN AND STRUCTURE

Jim, a 63 year old college teacher and ballroom dancer, was referred to me by a former client for knee problems. Over the last several years his knees had become inflamed and swollen after long weekends of steering the ladies around the dance floor. He had been to several orthopedic surgeons, had MRI’s done, and dye injected into the knee, but there was no diagnosable orthopedic problem. The orthopedic physician told him that he had arthritis and normal wear and tear on his knees for a man of his age, and that if his symptoms worsened he could scope it to remove the minor bits of calcium that were evident. However, he did not see this as a significant problem, and couldn’t understand why the swelling and inflammation continued to be a problem.

Sandra, a 20 year old marathon runner, started her heavy training schedule six weeks prior to the Boston Marathon, and developed sharp pains in the medial side of her right knee after running seven or eight miles. An orthopedist evaluated her knee with MRI’s and x-rays. He said there was no structural damage, diagnosed her with patellar tendonitis, and put her on an anti-inflammatory. He told her to rest her knee which would mean she would not be ready for the Boston Marathon. She scheduled a session hoping I could help her.

Ralph, a 44 year old car salesman, was 50 lbs overweight, and was referred to me by his physical therapist after he had his right knee scoped for a torn cartilage. He finished a series of physical therapy sessions but was still unable to spend a full day on his feet without severe pain in his knee. Usually, his knee was okay in the morning after resting all night, but the pain returned when he was on his feet for several hours.

These are three cases of knee problems that I treated in the last year. Each case was unique in age and condition of the client, severity of the problem, and treatment and diagnoses that were given by healthcare professionals. Obviously, each case presented challenges. For my treatment to be successful, I needed to identify the core problems and treat from that basis.

Each of the clients was in a structural collapse of the core distortion which had either caused the knee injury, or was creating an irritation within the knee due to the imbalance. When there is a structural collapse of the core distortion, the leg on the side of the anteriorly rotated ilium is longer, and the leg on the side of the posteriorly rotated ilium is shorter. This creates an imbalance in the distribution of body weight down through the legs, and a distortion within the hinge of the knee due to the relationship of the knee and lower leg caused by the rotation of the iliums – i.e. to compensate for the leg length discrepancy the knee and lower leg tend to be rotated in opposite directions.

Jim kept himself in good shape throughout his life, and it had taken 63 years for his body to fall into a structural collapse of the core distortion. Even though he was in good shape, his constant vigorous dancing routine pushed him beyond his ability to maintain structural balance contributing to his structural distortion. Aging had caught up with him, and the initial imbalance within the knees from the core distortion was increasing with the years of wear and tear on his knees causing greater stress on his knee joints. As he continued dancing and had more time to take additional lessons, his knees were getting worse to the point of developing arthritis. When I viewed the x-rays, the arthritis was minimal but there definitely was evidence of wear on the cartilage in each knee. On his left knee the lateral cartilage was more worn down, and on the right knee it was the medial cartilage that showed the most wear. This was synonymous with the weaknesses found in the knees when the imbalances of the core distortion are left untreated.

Sandra, the 20 year old marathon runner, was young, strong, and in excellent shape. However, the excessive training and pounding her body had undergone during the miles of running had worn her down. When she trained into exhaustion, she was reaching the point where her body was collapsing further into the core distortion due to the inability of the core muscles to keep her balanced under the heavy load. This was showing in her body with an increase in her scoliosis (structural collapse of the core distortion of the spine) and the resulting increase in the anterior / posterior rotation of her iliums. As with Jim, this was causing more of an imbalance in her knees, specifically the medial side of her right knee. Her vigorous training regimen was pushing her past the point of being able to maintain appropriate knee structure causing severe irritation and binding on the medial side of her right knee. In addition, the quadriceps muscles were tightening up to counter the weakness in her knee and were actually causing the inside of the patella to be rubbing against the bone and cartilage of the knee joint.

Ralph, the 44 year old car salesman, had been overweight most of his adult life and had done little to maintain the condition of his body. He had a significant structural collapse of the core distortion and indicated back and neck problems in addition to his right knee symptoms on his intake form. He had experienced knee symptoms for some time and his knee had weakened to the point that the medial cartilage on the right side had torn during a twisting motion while carrying a suitcase. He had surgery to repair the cartilage and physical therapy to strengthen the leg and knee. However, he was still in pain and not progressing with his physical therapy. Even though he had successful surgery and physical therapy, his knee was still imbalanced in the structural collapse of the core distortion and unable to be fully rehabilitated.

Obviously, my first goal was to release the structural collapse of the core distortion by moving the iliums into balance to take the pressure off the stressed areas of the knees. The quickest and most direct way to accomplish this was to apply Cranial/Structural releases that release the iliums into alignment and give weight bearing support to the sacrum. This also initiates an unwinding of the myofascial holding patterns affecting the entire leg and the structural imbalances of the knees. Once these changes were initiated it was time to apply effective soft tissue treatment.

The challenge was to apply a soft tissue protocol that would maximize the release of structural imbalance and allow the knee and leg to support the body in balance. This required knowing which leg was long due to the anteriorly rotated ilium, and which was short due to the posteriorly rotated ilium. This was accomplished by structural assessment while the person was standing. Locating the ASIS of each ilium showed me which was rotated anteriorly as it was lower than the one that was rotated posteriorly. Also, viewing the client from behind it was easy to see that the PSIS on the ilium that was rotated posteriorly was lower. The gluteus maximus was more defined on the side of the posteriorly rotated ilium, and there was a shortness between the crest of the posteriorly rotated ilium and the floating rib. This gave me the information necessary to effectively address and release the myofascial holding patterns causing the distortions affecting the knees.

Using the 3-step approach – (1. release the ischemia, inflammation, and swelling, 2. release the myofascial holding pattern working with deep, broad, slow strokes that only move with the release of the tissue, 3. release individual fibers, adhesions and scar tissue with deep very specific strokes also moving only with the release of the tissue) – I was able to work effectively and deeply from the first session with each of the above clients.

Jim’s initial treatments focused on moving the structural collapse of the core distortion into balance by releasing the iliums out of rotation into weight bearing support for the sacrum. This required applying a different protocol on the left side (anterior rotation) than on the right side (poster rotation). It was interesting to note that the majority of Jim’s knee problems disappeared in this process. After two sessions to accomplish the pelvic balancing, I then concentrated more directly on the knees. Jim’s left knee had more of an imbalance and binding on the lateral side with his lower leg and foot turned out. I focused on the lateral side of the lower leg and knee and Jim reported a total cessation of symptoms. His right knee had more tension on the medial aspect down through the inside of his leg into his arch. On this side I focused on those areas, and after this session Jim reported no symptoms in his right knee. By paying attention to the differences in the legs from the anterior / posterior rotation of the iliums, I was able to effectively restore support and release the strains from Jim’s knees which allowed him to resume his active dancing social life.

Sandra, like Jim, was in a structural collapse of the core distortion, so that was where I started. In the process of bringing the anterior/posterior ilium rotation into balance I also treated the quadriceps of her right leg. After two sessions Sandra reported about 1/3 of the intensity of the symptoms in her right knee. I then addressed the lower leg relationship to the knee along with the quadriceps, medial side of the knee, and the inside of the leg, ankle and arch. After that visit Sandra was able to resume training. I focused more specifically on the connective tissue around the knee in her last session, and Sandra was able to run her marathon.

Ralph had been in the structural collapse of the core distortion for some time and was overweight. With these two factors, it took longer to balance the anterior / posterior rotation of the iliums. After five sessions he reported less pain in his knee. He also noted improvement in both his back and neck. Now he was able to increase strength and range of motion in his knee during the physical therapy sessions. I then focused on the right knee, quadriceps, adductors, hamstrings, and inside lower leg. When this all released, Ralph reported no more pain and full range of motion.

From these three cases it is evident that we need to view the core distortion when treating knee problems. The influence of the structural collapse of the core distortion on the knees usually results in either injury or pain. It is only by releasing this distortion into balance and weight bearing support that we can take the stress off the knees and facilitate full rehabilitation for our clients long term.

Scoliosis (Part 2 of 2)

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

STRUCTURAL COMPONENT OF SCIATIC PAIN

Gerald, a 50-year-old truck driver, was referred to me by his employer for severe right sciatic pain that was keeping him from being able to drive his truck.  Fortunately, I had worked on his employer with good results, so, other than medication, he chose this type of treatment first. Gerald’s wife drove him to the appointment and helped him out of the car.  It was obvious that he was in a great deal of pain.  Typical of sciatic pain sufferers, his low back was substantially distorted.  On Gerald’s intake he noted that there had not been any one particular event that led to the onset of pain, but that it had developed over a period of time with his long haul trucking. He was also a good 60 pounds overweight, 10 pounds of which he had gained since going on medication, all of which further aggravated his painful condition.

Frances, a 39-year-old insurance claims clerk, was referred to me by her chiropractor for soft tissue work associated with her right sciatic pain which resulted from an auto accident.  Her insurance was exhausted after many treatments in the chiropractic office, but her sciatic pain was still debilitating.  She could only work half days and was taking muscle relaxants, pain killers, anti-inflammatory medication and sleeping pills.  Although she had been receiving three chiropractic adjustments a week along with hydrotherapy and galvanic stimulation, she only experienced temporary relief since the accident.  Now that her insurance was running out she could no longer afford the frequent chiropractic treatments since she had to pay her bills out of pocket until her case settled.  She told me that she had little hope for full recovery, but was hoping to improve enough to be able to sit and sleep with less pain.  In her job she had seen many cases where people were released from care having reached maximum medical improvement and were left with very few options other than living with pain and being limited in life activities.

Jim, a 23-year-old business man and tennis player, had developed left side sciatic pain after a fall on the tennis court.  He was amazed at the degree of pain he was in and frustrated that his physician and physical therapist had been unable to provide any relief.  He was referred to me by one of his fellow tennis players.  He had been in pain for approximately three weeks and it was just now dawning on him that he might have to give up tennis due to this injury.  Even minor physical activity such as a long walk at a shopping mall would intensify the pain for several days.

These are the types of sciatic pain cases that we as massage therapists will often see.  Each one of these clients had a different cause for the onset of sciatic pain, and none of the treatments they received from either chiropractors or physicians resulted in full rehabilitation.  Frances used $10,000 of her insurance coverage for chiropractic evaluation and treatment, MRI’s, and x-rays with very little relief.  Gerald had not been down the medical route other than to get medication which had done nothing other than make the pain tolerable without any real hope of rehabilitation.  Jim, a young active adult who loved tennis, had been to a medical doctor, had an MRI and x-rays, and went through physical therapy with very limited results.  The missing component in the treatment of each of these cases was properly addressing the soft tissue concerns in clients with sciatic pain.

There are many considerations and guidelines for musculoskeletal work for sciatic pain.  First and foremost is the structure.  In all three cases there was a significant structural collapse with the left ilium rotated anteriorly and right rotated posteriorly (structural collapse of the core distortion). From a structural standpoint it was apparent that there needed to be a significant improvement in this rotational distortion for the sciatic problems to be resolved.  For Gerald, it was the soft tissue compression on the sciatic nerve from the contraction in the gluteus maximus, gluteus medius, piriformis and rotator muscles caused by the posterior rotation of the right hip.  This compression was aggravated by long hours sitting and driving his truck.  For Frances it was the auto accident that had forced her body into structural collapse. The force of the flexion/extension injury affected her whole spine and stretched the ligaments between the sacrum and ilium so that there was more instability causing increased rotation of the two iliums.  There was soft tissue damage in the sacroiliac joint and strained fibers in the gluteus medius and gluteus maximus attachments directly over the sciatic nerve resulting in compression of the sciatic nerve.  This was further complicated by swelling and inactivity from sitting during her job.

Jim had sciatic pain on the left side and the structural distortion of his left hip explained why.  When he fell his left ilium had been driven more anterior which structurally causes the left leg to appear longer. To prevent being totally lopsided, his left knee was substantially medially rotated and hyperextended.  With the tipped left ilium causing a further stretching of the ligaments between the sacrum and ilium, the tension in the other soft tissue in this area was compressing parts of the sciatic nerve.  In addition, the additional tippage of the sacrum resulted in substantial rotation of the lumbar vertebrae and spasming of the quadratus lumborum which further irritated the sciatic nerve.  Also, the adductors on the left leg were so overcontracted that they were overstretching the piriformis putting additional pressure on the sciatic nerve.

Even though the sciatic pain was different for each of these clients, the key to their recovery was balancing the anterior/posterior rotations of the iliums with soft tissue therapy.

All three of the clients had pain, swelling and inflammation that directly affected their sciatic nerves.  They all had structural distortions that needed to be balanced to release the soft tissue compression on the sciatic nerve.  However, the soft tissue that supported the anterior / posterior rotation of the iliums had to be released in order to effectively treat these clients before working specifically with the soft tissue that was directly compressing the sciatic nerve.

In Jim’s case his medially rotated knee and anteriorly rotated left ilium were his largest distortion which needed to be released into balance before the sacroiliac joint, the quadratus lumborum, and piriformis could be released.

For Gerald, even though his sciatic pain was on the right, it was necessary to first release the soft tissue that was holding the left ilium in anterior rotation before addressing the contracted tissue on his right side.  This had two major benefits:  1) as the left ilium moved into alignment, the right ilium began releasing into alignment, 2) since the right ilium had partially released its compensation for the left, it would be much less contracted and less painful to treat the gluteus maximus, gluteus medius, piriformis, and rotator muscles that were compressing the sciatic nerve.

For Frances , like Gerald, the soft tissue that was holding the left hip in anterior rotation needed to be released before addressing the tissue on the right side involved with the sciatic pain allowing  the sacrum and iliums to start to move into balance. In doing so, not only did the soft tissue on the right release more easily, but working on the recently damaged tissue on the right directly over the sciatic nerve, the sacroiliac joint and the attachments of the gluteus medius and gluteus maximus was more tolerable.

After releasing the anterior hip rotation for all three clients, more specific work could be done directly on soft tissues that were affecting to the sciatic nerve.  For Jim that included the quadratus lumborum, gluteus maximus and gluteus medius on left side.  For Gerald it was the gluteus maximus, gluteus medius, piriformis and small rotator muscles on the right side.  For Frances this involved the gluteus maximus, gluteus medius, quadratus lumborum and lumbosacral fascia on the right.  These tissues were contracted, inflamed and swollen, and very sensitive to the touch. However, since the rotation of the iliums had already been addressed and released, the tension in the soft tissue had already started to relax, so the more specific work around the area of the sciatic nerve compression could be done with much less sensation.

The bone, soft tissue and sciatic nerve were in close proximity, so working these areas was a challenge because the soft tissue was already inflamed, swollen, and spasmed.  The approach I used was the three-step approach where the fluids and toxins were released first to reduce the inflammation, swelling and trigger points.  This was followed by the directed myofascial unwinding strokes to release the myofascial holding pattern and allow further structural balancing.   Then the specific individual fiber strokes were applied to release the specific tightened myofascial fibers, scars and adhesions that were directly compressing on the sciatic nerve.

For Gerald it took three sessions before his sciatic pain was reduced to where he could go back to driving his truck.  He reported feeling better than he had in years and started working on losing weight and maintaining his new structural balance.   For Frances her sciatic pain symptoms reduced with each session, and after four sessions the sciatic pain was gone.  She needed additional work on her neck and shoulders due to the auto accident injuries before her body could complete its balancing.  She was pain free at this point but came for several additional treatments while she weaned herself off the addictive medications. Jim showed improvement with each session. After approximately five sessions he was able to start a stretching and strengthening program that continued his rehabilitation until he was able to once again keep his busy tennis schedule.  All three clients were able to move beyond their conditions that had originally created their problems and no longer needed continual treatment.

These successful treatments were based on evaluating the structural distortion and creating a protocol that would correct the structural distortion, release the fluids, toxins and inflammation, clear the trigger points, release the myofascial holding patterns, and directly release adhesion, scar tissue and specific muscle fibers that were compressing on the sciatic nerve.

Scoliosis (Part 1 of 2)

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

CASE STUDIES REVEAL STRATEGIES FOR TREATING SCOLIOSIS
(Part 1 of 2)

This will be a two part series on scoliosis – this first installment presents four case studies representing different scoliotic conditions, and the second installment will describe effective treatment strategies for each one.

We need to view scoliosis in terms of the degree of curvature. Everybody has some scoliosis which is the manifestation of the core distortion of the spine. The anterior/posterior rotation of the iliums resulting in a tipped sacrum at the base of the spine leaves the spine no choice but to be in exaggerated curvatures throughout the full spine – lumbar, thoracic and cervical. Most problems people have with the spine are due to the scoliotic curvature becoming significant enough to produce painful conditions and symptoms. The scoliosis of the spine is actually the beginning of degenerative disc disease.

Spinal musculoskeletal conditions are becoming more prevalent in our culture due to a variety of factors. One of the most important factors is the sedentary nature of today’s society and the lack of good strength building exercises in people of all ages. This not only takes place with sedentary adults, but it is becoming more prevalent in children at earlier ages due to the increased usage of computers, TV’s, and electronic games. When children do not exercise to develop strength in the spinal muscles, they will tend to slip further into a scoliotic curvature. Add to that spending too much time on couches and inappropriate furniture, including non-supportive computer desks and chairs, and we will see increased scoliosis in 12 year old children. As they enter the rapid growth teenage years, the strengthening and coordination of the spinal muscles won’t be able to keep up with the growth, and the scoliosis will again become more exaggerated.

Just from the above mentioned phenomena taking place in our culture, we as massage therapists are going to see a considerable number of clients with neck and back pain due to scoliosis. The good news is that it can be reduced to the point of not collapsing into pain or dysfunction. Also good news is that the key to reducing scoliosis and its dysfunction in our clients is soft tissue restructuring of our clients’ bodies, which is a major part of what effective therapeutic massage is about.

In the beginning of this article I stressed that the degree of scoliosis in a client is important. Since everyone has some degree of scoliosis, we need to look at what the treatment criteria is for prevention or rehabilitation. I am going to use four case studies that are significantly different, and will explain how to choose a soft tissue protocol to treat the scoliosis that will be successful in supporting the clients well-being.

Shirley, a 35-year-old mother of three children, was referred to me for low back pain that developed after the delivery of her third child. She reported that she had been doing a lot of lifting of all three of her children ages 5 years, 3 years, and 6 months, and that her back was getting worse. In addition, she had complications during the last month of her pregnancy, so the doctor had insisted that she stay in bed and off her feet as much as possible. She brought her chiropractic x-rays that showed a narrowing of the disc space in the lumbar region with some arthritic spurring already developing, a scoliotic curvature of her entire spine and significant rotation of her iliums, one anterior, one posterior resulting in a tipped sacrum. It was obvious that Shirley could not stop lifting her children, but that she needed relief from her back pain as soon as possible.

Jason, a 49-year-old accountant, had been rear-ended two years ago while sitting at a stop light. He had been receiving chiropractic care ever since the accident until his insurance was depleted. His diagnosis was a flexion/extension injury of the cervical spine with a slight herniation between C3-C4 and a bulging disc between C7-T1. In addition, his x-rays showed a significant degree of scoliosis of his entire spine with the rotation of the iliums and tippage of the sacrum. The chiropractic notes indicated treatment of the flexion/extension injuries of the neck only, and no mention or diagnosis of the scoliosis in the thoracic and lumbar spine. When following the scoliotic curvature from the lumbar through the cervical vertebrae, the discs that were injured were at the greatest degree of the scoliotic curvature. Jason came to me because a friend of his had insisted that I could help him, and since his PIP had run out insurance no longer covered chiropractic care. The sad part is that, even though he had two years of treatment, he only had minimal improvement and was now also experiencing severe headaches. He needed some effective therapy.

Carol, aged 13, was brought to me by her mother after she had been picked out of a school scoliosis screening and was referred to a neurosurgeon for possible surgical intervention. The parents were scared when they saw that Harrington rods were part of the surgical intervention suggested for their daughter’s scoliosis. The x-rays and MRI’s that confirmed the scoliosis showed a more than 40 degree scoliotic curvature. The neurosurgeon had told them that since she was in a growth spurt this would probably progress to somewhere around 50-60 degrees by the end of her normal growth and would leave her incapable of bearing children. Carol was reasonably athletic and really wanted to join the high school girls’ volleyball team as she was already 5’10″ and played very well. She only occasionally complained of back pain or any discomfort. However, she shared her parent’s concern about the prognosis of dire pain, disc degeneration and inability to carry a child due to the scoliosis.

Anita, a 63- year-old massage therapist who had been practicing for 20 years, came for sessions because of a sizeable dowagers hump and inability to stand up straight. After a bone density test she was told by her doctor that she had osteoporosis and was collapsing into a scoliotic curvature of her spine. Other than reinforcing her bone mass with medication and exercises, there was little else she could do. In addition, they informed her that the scoliotic collapse was irreversible, and that chiropractic manipulations might cause fractures of her weakening spine. They also told her that she would have to quit doing massage because the scoliotic collapse and fractures of the spine would worsen almost immediately. Having been a massage therapist for 20 years, Anita had heard of the soft tissue structural work that I do and wanted to know if the scoliotic curvature of her spine could be rehabilitated so she could continue doing the massage she loved.

These four cases show how differently scoliosis can occur in people’s lives, and each case needs specific appropriate soft tissue rebalancing techniques to achieve positive results.

Shirley, the 35 year mother of three, had first noticed difficulty with her back after carrying and delivering her third child. During pregnancy the increased weight was carried in the pelvic bowl formed by the iliums, and pulled her lumbar and lower thoracic spine down and forward. In addition, there was increased breast weight which pulled her shoulders down and forward. The month’s bed rest before delivery resulted in a loss of tonus in the muscles that would counter balance the collapsing curvature of the scoliosis. This caused her scoliosis to collapse to the degree that she was in pain.

Jason, the 49-year-old accountant, had two factors that led to the collapse of his scoliosis and his disc problems. The first was the lack of exercise and muscle tonus to be able to maintain healthy erect posture during daily life activities. The second was the flexion/extension injury of his cervical spine from the auto accident which caused his weakened scoliotic curvature to fall into greater collapse. The pressure on the discs due to the scoliotic curvature prevented them from mending and exacerbated the discomfort he was experiencing.

Carol, the 13-year-old volleyball player, had not recognized that she even had scoliosis due to the fact that her conditioning was extremely good and her flexibility was excellent at that age. It wasn’t until the school screening and consequent follow up with the neurosurgeon that she learned she had a more than 40 degree scoliotic curvature. In addition, she was at a very vulnerable stage where she was growing so rapidly that her scoliosis would probably fall into a greater degree of collapse.

Anita, the 63-year-old massage therapist, had worked for years bending over a table which led to the head forward, rounded shoulders parts of her scoliosis. As her spine had changed in that area it caused additional collapse through the thoracic and lumbar spine, and years of bad body mechanics had increased her scoliotic curvature. Now, with the onset of osteoporosis, the bone mass was weakening which increased the collapse of her scoliotic curvature, and increased the pressure on the edges of her vertebrae causing compression fractures.

The key to treating all four of these clients was to recognize where the scoliosis had come from and how to reverse it. The initial scoliosis was the result of the structural collapse of the core distortion pattern which involved the entire body. The number one problem was the rotation of the iliums resulting in a tippage of the sacrum. So, to effectively treat each client it was necessary to balance the pelvis bringing the iliums out of rotation and leveling the sacrum. This was accomplished by releasing the holding patterns from the legs, hips, abdomen and low back for the anterior/posterior rotation. In addition, the head forward and rounded shoulders aspect of the scoliosis at the top of the spine also had to be released. Each of the above clients had special considerations due to their age, strength, physical health, life conditions, and profession. The good news is that Shirley is in no pain and able to lift her children and do her motherly duties; Jason is now out of pain with no sign of herniation or bulging discs and is more active; Carol only has approximately a 20 degree scoliosis, never needed the surgery, and has graduated from high school with a volleyball scholarship to a major college; Anita is now 65-years-old, stands straighter, and is loving every minute of her full massage practice. The next installment will describe the specific treatment used to rehabilitate each of these scoliotic conditions.

Breath of Life

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

Prana, orgone, chi, energy – they all are either increased or discharged through breath, and everyone seems to be in agreement that without them we would not live. Breathing is the most important function of life that we do. Yet, it is often totally ignored in massage. Let’s look at breathing and being a successful massage therapist.

First and foremost, as a massage therapist, it is necessary that we be relaxed and energized. The first sign of stress in most of us is shallow breathing or halting of the breathing process. Think about it: how many successful purple massage therapists do you know?

One of the first things that I was taught in massage school was to always breathe while giving a massage. I remember my utter amazement when the teacher came over to me as I was learning massage to tell me I wasn’t breathing and said, “just breathe.” I hadn’t even realized that I had actually been blocking my breath. I now realize that I was not totally comfortable trying a new massage technique while touching a person I hardly knew. It would have been easy to have just said, “I was concentrating on the technique and I had forgotten to breathe”. However, I found the truth to be much more interesting and full of potential for my own self-growth.

With my counseling background I knew there were five basic emotions that are manifested in the body with physical sensations. They are Fear, Love, Anger, Sadness, and Happiness (FLASH). Wilhelm Reich, a pioneering psychotherapist in the 50’s, coined a term “character armor” to describe chronically tightened muscles that block the expression and limit the intensity of the five basic emotions. He states that from our first breath we learn how to suppress and limit the intensity of emotions by controlling our breathing. Birth is often a painful experience – the baby experiences separation from its mother, exposure to cold, and pain for the first time – so, the first breath that most babies take is painful. Human beings are quick to learn how to minimize the pain and the intensity of the feelings by controlling their breath.

The fear I experienced that was controlling me by limiting my breath while doing one of my first massages needed to be acknowledged so that I would not continue to block my breathing while doing massage. The awareness point was that I had stopped breathing while touching my practice massage student. Once I acknowledged my fears of not doing the technique properly as well as being rejected and misinterpreted by the massage student, I was able to relax and breathe and continue learning the massage technique. This was a simple little lesson and, even though it encompassed only one aspect of the value of breath in massage, it allowed me to grow.

Another very important point about my not breathing was that it was also communicating to the client “not to breathe”, and that it wasn’t safe to relax. Exactly the opposite effect of the one I desired. In addition, the flow and projection of energy from my hands was becoming greatly reduced by a lack of charge coming into my own body. In order for my body to charge with energy, the breathing mechanism needs to be free and open.

Again, if we look at Wilhelm Reich’s work, we can see the importance of breath in the charge and discharge of energy. One of the principle tenets of his work was that unexpressed emotions in the body were energy, and by using breath to build up a larger charge of energy in the body, the blocked emotional energy would be mobilized to release and soften the chronically tightened tissue – the character armor, which by the way is usually found as a major player in pain and structural distortion. Since one way of blocking the release of emotional stress and energy is to shorten or block the breath while doing massage, it is extremely important that the client be breathing during massage so that when the tightened tissue is manipulated the energy invested in keeping it tight will soften and release. If clients are not breathing, they are fighting this process and resisting relaxation and consequently homeostasis. They are also seeking to maintain the status quo, which is usually myofascial pain and dysfunction, by not breathing.

Reich observed that many illnesses and dysfunctions of the body were directly related to the blocked emotional energy in the affected area and the chronically tightened tissue that could not function at a healthy level. It was by releasing this energy and tightened tissue that people started to release the psychosomatic aspects of their illnesses and dysfunctions. As massage therapists we are constantly engaged in releasing the chronically tightened tissues found in our client’s bodies, and helping to re-establish healthy energy flows. Much of the energy that our clients release is emotional in nature and, as Reich observed, releases best when a breath charge is built up to help it mobilize. Does this mean we are psychotherapists? No. It means by manipulating the soft tissue of our clients’ bodies, we are mobilizing energy. To successfully facilitate this mobilization, it is necessary for both our clients and us to be aware of staying relaxed and breathing during the therapy.

One of the things I note about new clients when they first lie on my table and are touched for the first time is that they need encouragement to relax and breathe. The most effective way I have found to support the client’s relaxing and breathing is for me to relax and breathe myself. My relaxation and breathing communicates through touch and energy flow that it is safe for the clients to do the same. It also helps to create an energy connection that flows from therapist to client to therapist and back to client in a circular pattern. If the breathing of either shortens or stops, it tends to block this flow. Therefore, it is important for me as a massage therapist to consider managing my breath as part of managing the energy flow and the healing process of the session. This is true whether it is relaxation, release of emotional stress, release of pain, structural realignment, or sports performance as the goal of the massage therapist. The energy from breath that flows through our bodies is what makes us hands-on healers and not just hands-on manipulators of tissue.

A parallel to Reich’s work is yoga – with each asana (position), breath is essential to allow the release of the tissue. A parallel from yoga for deep massage is to gently apply deep pressure and have the client breathe with the pressure for the release. Also, as with Reich’s work, in yoga breath is used to build up a charge of energy to assist the release of stress and increase the health of the yoga practitioner. In yoga the energy taken in by breath is called prana. For Reich this energy is called orgone energy.

In acupressure, energy flowing through the body, chi energy is manipulated and directed so that the body can achieve homeostasis and a high degree of health. One of the most devastating problems in acupressure is a shortened limited supply of available energy within the body. To use acupressure in massage therapy it is necessary for massage therapists to be able to project and stimulate energy through their hands into their clients. One of the best ways to keep the energy open and flowing in the therapist’s own body is through relaxed rhythmic breathing that also will send the energy into the client’s body. It is also necessary for the clients to be building a charge of energy in their bodies through breath to assist the treatment. In addition, the relaxation that takes place in the client’s body is synonymous with having their breathing relax. I find that this is true with trigger points and polarity therapy as well.

If by now you start to see that breath is essential for massage therapy, you are getting my point. Here are some pointers that will help you be a more effective therapist using breath:

• Take several deep relaxing breaths before beginning hands-on treatments
• Observe your own breathing – if you have stopped, 90% of the time your client will have stopped
• If your client has stopped breathing, take an audible deep breath – he/she will breathe with you
• If you have stopped breathing, become aware of why and acknowledge that to yourself – awareness of your breathing is a major step in your own personal growth.
• If you are working deeply in a client, pay attention to his/her breathing, and enter slowly on their exhalation, hold your pressure and allow the client to breathe through the tissue release
• BREATHING IS FREE AND HEALTHY!!

I hope this has opened your eyes to the very real necessity of using breathing with massage. Keep breathing and healing.

Kinesiology In Massage

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

Many years ago when I was starting my practice, I had the good fortune to attend a lecture/demo given by a chiropractor who was doing some new advanced chiropractic techniques. While this lecture/demo was a practice builder for him, it was an eye opener for me. The most important concept I learned was that applied kinesiology (muscle testing) can be used to evaluate symptoms and conditions presented by our clients. Using applied kinesiology (muscle testing) the chiropractor was able to verify a structural imbalance in his model for the presentation, and also determine the specific muscle involvement that supported the structural imbalance. I was entranced. Here I was a massage therapist who was focusing on relieving painful symptoms and conditions and addressing structural problems in my clients, and a chiropractor, who really didn’t do anything substantial with soft tissue, was showing me a way of evaluating both the structure and soft tissue conditions. I attended several of his classes in applied kinesiology. Thus began my love affair with applied kinesiology.

Let’s examine more closely several reasons why this new technique was so important to me:

1. The effectiveness and accuracy of my treatment increased.
   When client’s came in for a session with me, I would stand them up and do body reading to analyze the structural distortions. I was a relatively new massage therapist and would sometimes misinterpret what I was seeing in my client’s structure. Consequently, I would not always apply the optimal treatment which was frustrating for both me and my clients because we couldn’t achieve maximum improvement.
   Applied kinesiology provided a tool to verify my observations. If I observed a rotation of an ilium, I could determine specific muscle weaknesses with muscle testing that would verify that rotation. If I observed a whole body structural distortion, applied kinesiology would determine the specific muscles weakened by the structural distortion throughout the pattern from the top of the head to the feet, which verified all aspects of the structural pattern. More importantly, it helped me realize that not all structural distortions would involve all the muscles, and I found that I was able to be much more specific in my treatment by isolating the weakened or overcontracted muscles, and my effectiveness increased.
2. I had immediate feedback on the results of my treatment.
   As I became more effective with my muscle testing, I was able to test after a treatment to see if a significant structural change had taken place. Thus, I could verify an ilium rotation, determine which muscles were weakened by that rotation with applied kinesiology, and apply the appropriate massage techniques. After the treatment I could retest the muscles that had tested weak, and if the distortion had been released, those muscles would now test strong. I had a feed back system that let me know if my treatment was successful, and with that information I could optimize the treatment of the muscle or area to accomplish the desired results. I have used this tool through years of treating clients, and have been able to fine tune my soft tissue palpations skills as a result.
3. I had a tool to determine the amount of energy flow to and within a muscle.
   After treating a distressed muscle that tests weak there is usually an increase in energy flow to the area and the muscle will test strong. This can be due to the release of fluid and toxin that tends to disperse energy flow, the clearing of acupuncture/acupressure points that I find are usually synonymous with trigger points, the clearing of the energy blockage within an acupuncture meridian, or the clearing of emotional energy that is blocked behind character armor (contracted soft tissue).
4. By being able to determine energy flow in muscles, I could achieve optimum results in balancing the structure.
   The increase of energy flow usually results in increased muscle strength and brings opposing muscles into balance. Consequently, it is possible to achieve and maintain structural balance within the body. This can work two ways: a) when a muscle is overcontracted from too much energy, it cannot release to its full length, and the shortening of the muscle creates a structural distortion – releasing this trapped energy allows the muscle to regain its length, and its impact on structural distortion is released; b) when muscles are weak from lack of energy and overstretched, restoring normal energy flow allows them to contract to their normal non-working length and thus back to structural balance.
5. I can build client rapport quickly.
   Pain is real, and when you can verify for both you and your clients the weaknesses associated with that pain, you are validating their problem, and building confidence that you will be treating the area causing their painful symptoms. The muscle testing also creates a non-threatening light touch evaluation, and the information that you are getting from the client’s body is feedback that both the client and therapist can observe. I have found that when I explain these weaknesses and their relationship to the pain, many clients feel validated in that they are finally in a clinic where someone understands them and their problem. Also, with this information I can apply Cranial/Structural techniques in the first 10 minutes of treatment that will initiate significant improvement in the client’s condition that can be substantiated by previously weakened muscles now testing strong.

With applied kinesiology in my tool box, I had an evaluative tool that would tell me what techniques were appropriate, especially after I was exposed to craniosacral and Cranial/Structural therapy. I no longer needed a shotgun approach that usually included applying every cranial mobilization for every client.

When I integrated Cranial/Structural techniques into my practice, the use of muscle testing to evaluate the structural collapse of the core distortion pattern proved invaluable. When new clients would come for treatment, I would use applied kinesiology to demonstrate how the structural collapse of the core distortion could well be the basic cause of their painful symptoms. Using muscle testing I would be able to show them the structural distortions, cranial distortions, cranial adhesions, cranial energy involvement, soft tissue involvement, and muscle energy involvement throughout the body. Then, after the application of a Cranial/Structural mobilization, I would be able to verify the changes to the client by showing through testing that the previously weakened muscles now tested strong. Many clients gained immediate hope and confidence that their recovery had already started. I would also know for sure that I had effectively applied the Cranial/Structural technique to release their structural collapse of the core distortion. Also, since I was not the only therapist using Cranial/Structural techniques, I could determine whether a client had already had the structural collapse of the core distortion released with the application of the Master Release protocol.

Case Study:

Jim, a 30-year-old tri-athlete, came for treatment for his low back and knee pain. Upon structural examination (body reading) it was apparent that he was in a structural collapse of the core distortion. This consisted of an anterior rotation of the left ilium, a posterior rotation of the right ilium, a tipping of the sacrum, and longer left leg with the knee medially rotated and hyperextended. The foot was laterally rotated and everted. In the right leg (shorter leg) the gluteal muscles, biceps femoris, and psoas were contracted and shortened. While Jim was lying on the table I used muscle testing to verify the anterior/posterior rotation of the iliums. Next, I used muscle testing to show Jim how this rotation weakened his left leg down through his foot. I also used muscle testing to show Jim that on his right side the biceps femoris, gluteus maximus and psoas were weakened. The next step was to show Jim, using muscle testing, that there was a cranial distortion that corresponded to the weaknesses in his legs and low back. At this point Jim was surprised at how weak the weakened muscles were, and that I had such a clear picture of what was going on. I then proceeded to apply the Cranial/Structural Master Release to balance the iliums and equalize the leg lengths. After the application of the Master Release, I retested Jim’s left leg that had been weak, and he was amazed that it was now strong. I also retested the gluteus maximus, biceps femoris and psoas on the right side that now tested strong, showing Jim that positive changes had already taken place. We then proceeded to treat the soft tissue holding the structural distortion to give the low back and knee further support. Jim left a very satisfied client who was now pain free.

Another function of muscle testing is to evaluate individual muscles or muscle groups. This is important for clients who have had injuries that affect an individual muscle or muscle group, as well as determining muscle function for athletes. Muscle injuries: If an injured area tests weak prior to treating the injury, you can retest the same area after treatment to determine how effective the treatment was – if it still tests weak, you know it needs further treatment; if it tests strong, the treatment was sufficient and you can move to another area. Athletes: The strength of opposing sets of muscles should be relatively equal. If there is a significant difference in muscle strength when you isolate and test opposing sets of muscles, the client can use this information and strengthen the weakened muscles to prevent possible injury.

As you can see, from the information above, applied kinesiology (muscle testing) can greatly enhance your ability to evaluate and effectively treat clients who are in pain. In addition, it builds your clients’ confidence in your abilities as a therapist because they will realize that you understand the cause of their pain, and that the treatment will be specific to their conditions. This is especially helpful when clients have been bounced around from professional to professional without successful treatment or relief. It has helped me design and implement many new protocols to effectively treat client problems. Muscle testing is an integral part of the Cranial/Structural techniques that have expanded my effectiveness, and it has become a significant evaluation tool in the development of Structural Energetic Therapy®.

I hope you will explore any opportunity you have to learn and develop your skills utilizing applied kinesiology. You will be a better therapist for it.

Structure Begets Function

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

One of the most important factors in understanding and treating clients with pain who need therapeutic medical massage is what causes the discomfort. Oftentimes we look directly to the area of discomfort and find inflammation, swelling, ischemia, build-up of fiber, scar tissue and adhesions, and think that treating this is the key factor in our client’s recovery. Any time we treat only the symptomatic areas, we are doing our clients a major disservice. There is always a reason for any area of the body to be in distress. One factor that is ever present is its relationship to structural imbalance.

As the title above states, structure begets function – in other words, structural balance allows the body and its musculature to function in the way it was meant to with strength and flexibility. When there is an imbalance in the structure, certain areas of the structure will overwork or be weakened to the point of injury or distress. This can be understood when looking at muscles moving bones in a lever relationship. When the structure is balanced, the lever and fulcrum are in an optimal performance relationship. With structural imbalance, the fulcrum/lever relationship is at worst totally dysfunctional and subject to breakdown, or at best weakened and needing additional support from surrounding soft tissue. This is inefficient and, in essence, the muscle that is supposed to be doing the work only has a third to half of its strength. This leaves it very susceptible to strain or injury. In addition this leaves the joint unstable and weakened and subject to strain and injury as well.

If by now you are wondering what the punch line is, I’m sure you can see that, in therapeutic medical massage, a major treatment goal is to address rebalancing structural imbalance. However, let’s first look at what happens when this is not factored into the treatment protocol.

One of the easiest ways to understand this is to look at an area where most clients experience pain – the top of the shoulder that includes the trapezius, levator scapula, supraspinatus, and rhomboids. When this area is hot, inflamed, spasmed, or strained, clients will present wanting relief ASAP. If the massage treatment is focused only within this area, then there might be short-term relief, but long term the condition could worsen. Basically, the musculature’s function in this area is to raise the shoulder and return the shoulder to the original position from medial rotation. If the soft tissue in this area is released without balancing the shoulder, then the agonist muscle in the front of the chest will have less resistance and consequently move the shoulder further forward into additional imbalance. The result long term is that the client will most likely have to deal with further distortion and usually more pain, discomfort and dysfunction in the area. To make matters worse, the soft tissue in the top and back of the shoulder are actually counterbalancing and actively working to hold against the imbalancing stress in the soft tissue in the front of the shoulder. So, when the therapeutic medical massage techniques are applied to the spasmed tissue on the top and back of the shoulder, that area is invested in maintaining its holding pattern and will resist the technique being applied. This results in two things: first the sensation for the client is intensified, and the client will experience greater discomfort because of the difficulty in relaxing that musculature; second, it is going to take two to three times the amount of work and pressure from the massage therapist to achieve results in the area. This obviously is a lose/lose proposition.

If however, the factor of releasing the shoulder into structural balance is applied, then the musculature in the front of the shoulder (agonist muscles) that are shortened and tightened would be the first group to receive treatment. This may sound strange to some of you, but read on. If this area is released first, even though it’s not the area of principle concern for the client, then the antagonist muscles (top and back of shoulder) will not be resisting the force from the agonist muscles in the front of the shoulder, and will be relaxed and releasing before they are even worked. In essence, if you work the muscles in the front of the shoulder first, releasing the shoulder back into structural balance, then the muscles in the back and top of the shoulder will release their compensation holding pattern that was fighting the pressure from the muscles in the front of the shoulder. The massage therapist will achieve greater results with much less work. In addition the client will experience less discomfort, and will be able to maintain structural balance and homeostasis long term in the area needing treatment.

Let’s look at several other conditions that are commonly treated by massage therapists and see how the therapeutic medical massage will be more effective using structural balance as a goal.

Neck problems: Most clients will complain of pain in the back of the neck and at the base of the cranium. If we examine their structure, the majority of them will have their head forward in a reverse curvature of the cervical spine. In order to achieve structural balance we will need to first release the soft tissue that is responsible for pulling the head and neck forward before releasing or treating the tissues at the back of the neck. This will result in a structural balance that will help the client maintain the changes, be easier on the client as far as painful sensations, and be easier on the massage therapist since the tissues will be releasing into balance, instead of trying to maintain compensation for the structural imbalance.

Low back: When clients present with low back pain there is an imbalance in the pelvis that includes the legs and feet. This imbalance is not only front to back but also a torsion where one ilium rotates anteriorly, and one ilium rotates posteriorly (core distortion – SET TALK, Massage Message Nov/Dec, 2003 or our website). The most effective way to move the client into structural balance to relieve the pain is to release the leg and ilium that is rotating anteriorly first, and then the posterior ilium / leg side. I have found that the posterior hip side is more in compensation for the anterior rotation. As the anterior hip side moves into balance then the compensation on the posterior hip side will start to release even before massage techniques are applied. In addition, most sciatic pain is on the posterior side caused by the spasmed musculature in the back of the hip that is in direct compensation to what is going on with the anterior rotation on the opposite side. Again, if I only treat the sciatic pain side, then the compensation for the anterior hip will be released allowing increased structural imbalance and an actual worsening long term of the client’s condition.

In the process of bringing the anterior hip into structural balance, the soft tissue needs to be worked in a specific sequence. If I work the soft tissue in the leg that is directly responsible for the anterior rotation first, then the other work in the leg and hip will require less effort and be less sensational for the client. The usual culprits that need work first are the quads and adductors, followed by the back of the leg, hip and quadratus. This of course is not the entire routine, but it gives starting points and a rationale to balance the structure.

Shoulder, Arms and Carpal Tunnel: It is easy to understand structural balance in relationship to the spine, but many therapists totally overlook structural balance in relationship to the shoulder, arm and carpal tunnel. It is no accident that clients develop major symptoms in the arm, shoulder and hand after accidents or injuries that throw any part of the spine into further distortion. If a hip goes further anterior, the opposite shoulder has to rotate medially to compensate so the person can stand. This medial rotation weakens the entire arm, hand and shoulder, often creating nerve entrapment, strain patterns, and dysfunctional movements that result in injury and pain. Consequently, normal actions that the client was performing in their daily life now become painful resulting in pathological problems.

As a massage therapist, factoring in these imbalances for the treatment of these pathologies and symptoms is just as important as when working with the neck or low back. When the shoulder is in medial rotation there is a compression on the brachial plexus affecting the two major nerves – ulnar and median. This alone can account for pain or numbing anywhere along the nerve pathways clear into the fingertips. To effectively treat ***these nerve pathways, we need to initially release the compression on the brachial plexus by releasing the soft tissue responsible for the compression – i.e. pectoralis major, pectoralis minor, and subclavius.

In addition, if the shoulder is in medial rotation, then the rest of the arm will be in internal rotation which will again create compression on the nerve pathways, especially near the joints where the large bony prominences are – i.e. elbows, wrists, carpal tunnel. To counter the internal rotation, the musculature on the posterior of the upper arm and the back of the forearm will be tightened to compensate and be in a strain pattern. Again, this area will be subject to distress and injury which can result in the soft tissue being overworked, full of ischemia, inflamed, and fibers being injured and thickened. There will also be additional nerve entrapments along the radial nerve pathways. Treatment needs to address the internal rotation of the arm and hand first to achieve structural balance. Then when you work the posterior upper arm and back of the forearm, which was previously tightened in compensation, it will already have started releasing.

If you want more information and a way to purchase books that contain the complete protocols, please go to Books on this website.

I hope you will include structural balance as a major goal in your therapeutic massage.

Breathing and Soft Tissue

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

Just moments ago I overheard a phone conversation where a mother was talking to a daughter who was stressed out and not feeling well. The advice she gave her was “just breathe, relax and things will be better.” This is the simplest and best advice that the mother could give her daughter on this occasion.

Breathing is the charge and discharge of our life energy. Whether you believe energy is breathed in like the yoga concept of Prana, or that energy is from the burning of fuel in our bodies, breathing is an absolute necessity. We all seem to agree that the exhalation releases used up gasses and waste products from the energetic process of the body, and inhalation fills the body with oxygen and renewed energy.

As massage therapists we work with our clients’ breathing all the time. We all know how difficult it is to do a massage when a client is not breathing and relaxing. However, since we communicate both verbally and non-verbally with our clients, we need to be conscious of our own breathing as well – if we stop breathing, often our clients will not breathe either.

Some of our clients will have difficulty being able to maintain steady relaxed breathing. This is indicative of any number of potential problems. Beyond our non-verbal communications to our clients about breathing, we need to be sure that we have the tools to assist the expansion of their breathing process when we observe shortened or restrictive breathing.

Let us first examine some of the problems associated with our client’s restricted breathing. Clients who are under crisis stresses in their lives, whether they be from job, family, relationship, illness, loss, or even natural disasters, will tighten up the musculature of the chest and abdomen and restrict their breathing. In cases like these, just encouraging them to breathe or become aware of their limited breathing is usually not very effective, and consequently, the stress does not release and discharge from their bodies. When this happens they can’t relax even under normal situations. Often they will experience spasming in the muscles of the chest which can be misunderstood as a heart attack, and sometimes they can actually precipitate a heart attack. These clients need help in releasing this build up of physical stress, and a massage therapist who understands the breath mechanism with the contractions in the soft tissue involved is probably the best professional for them to see.

Surgery, especially those that cut into the tissue and bone in the thoracic region, often result in a tightening and restriction of the breathing process that can go on for years. When either the abdomen or thoracic area is surgically cut, the fascia and scar tissue become adhered and tightened creating a splinting in the area to reduce movement of the damaged tissues during the healing process. After the healing has taken place, the tightened fascia with its adhesions and scar tissue in the soft tissue now acts like a band continuing to restrict the breathing process even though here is no longer a need for splinting. Patients who undergo open heart surgery often experience an extended period of time of feeling a marked decrease in their life force and energy. Many doctors say this is normal for open heart surgery patients. However, my focus with these clients is to open the breathing process, and in a very short period of time they report feeling re-energized with a sense of vitality and even exuberance returning in their lives. This is in sharp contrast to the ongoing limitations experienced by those who do not have this soft tissue treatment.

Injuries to the ribs often receive minimal medical attention even though they are quite painful and sometimes have long lasting effects. Rib injuries, breaks, or sprains can cause considerable pain over a fairly extensive period of time. If you have ever had a client with a broken rib, you are aware that they can have difficulty lying a certain position or moving their whole body and torso in certain movements even a year after the injury. Provided the rib doesn’t puncture the body cavity, the normal medical treatment is usually just immobilizing the area to restrict movement. Unfortunately, this also immobilizes and restricts the breathing process. The body will splint and eventually the fascia will adhere and shorten so that movement becomes nearly impossible past a certain point. This point of restriction is usually far short of deep, free, easy breathing. The other complication with rib injuries is that they are allowed to heal in whatever distortion the break has created without being set or straightened. This is often true with a rib sprain where a rib can be pulled dramatically out of place and never be brought back into its normal alignment. Often just the misalignment after a break or sprain will also add to a continued restriction of the breathing process.

Clients will also see massage therapists for a number of pain producing conditions in the thoracic region. These include thoracic outlet syndrome, costochondritis, muscle pulls and strains, and in chiropractic terms ribs and rib heads being out of alignment. These all produce pain and involve the ribs, the vertebrae and/or the sternum. They also make breathing deeply a painful process resulting in restricted breathing for our clients. In addition, they also often produce nerve entrapments creating additional pain, restriction, and immobility. Again, they have come to massage therapy for relief, and it is our challenge to be able to assist them in their recovery.

It is impossible for me not to include some of the psychological aspects of breathing when discussing the breathing process for clients. If you observe a person who is depressed you will note they will do very little breathing, and are very restrictive in their breathing process to the point that both shoulders are internally rotated and the chest is compressed. One of the aspects of depression is lack of energy. The physical manifestation of depression is restricted breathing which makes recovery and transition to normalcy extremely difficult. There are no pills that open the breathing process.

Anxiety attacks usually have some form of hyperventilation associated with them. You would think that when someone is hyperventilating the breathing process is open and full. However, if you observe someone who has anxiety attacks you will note that when they are not hyperventilating they are extremely restricted in their breathing, partially from fear of hyperventilating and partially from the stress that builds up and triggers the anxiety attacks. When observing the physical manifestation of anxiety in the body we see contraction in the soft tissue that contains energy and restricts breathing. Many clients who have had anxiety problems show marked and almost immediate relief when the tension that restricts the breathing process is released. Pills that suppress the anxiety do little if anything to open and normalize the breathing process.

Loss and mourning are something every healthy person will have to deal with. These emotions are often intense, overwhelming, and scary. Unfortunately, we live in a culture that gives people very little time to mourn. Usually, after two to three days everybody is pushing them to get back into their normal life routines forcing them to bury these intense emotions during the time when they are normally still in shock. People who are experiencing these emotions will tighten and restrict their breathing as they try to regain control over the intensity of the emotions and return to normal function in their day to day lives. As we all know from experience, if we cut off the energetic charge of breathing then the energy for emotions and the intensity of emotions is reduced, and it is easier to keep them at bay or under control. When these emotions have been held and shut down by restricting the breathing process over a period of time it becomes more and more difficult to breathe deeply due to the adhesion of the soft tissue that becomes chronically tightened to hold back the intensity and expression of these emotions.

Now let’s look at the areas that we need to treat to expand our clients breathing process using our massage techniques. Those of you who are familiar with the Three-Step Approach will know how to treat and expand these tissues while staying within the sensation threshold of your clients. I begin by treating the muscles associated with the thorax. I have found that working from the sternum outward produces the best results in facilitating the ability of the thorax to expand. It is very important to release the pectoralis muscles, especially when the shoulders are rotated internally, so they are usually the first muscles I will treat. I follow this with the attachments of the pectoralis at the sternum and the shoulder along with the fascial connections directly under the clavicle. I then address the serratus anterior and subscapularis which will further expand the thoracic area and allow the shoulder to move out of internal rotation and back into balance. Then I’ll move to the other side and work in the same sequence.

I will then address the diaphragmatic arch working through the rectus abdominis and obliques, and release the restrictions and tensions found in the diaphragm. By working the anterior muscles of the breathing process first, I am also releasing the body into structural balance. Then, when I apply normal massage techniques on the posterior muscles paying special attention to the trapezius, rhomboids, and latissimus dorsi, the client’s ability to breathe will increase substantially. In future sessions I will work deeper and more specifically working with adhesions, scar tissue, and shortened fibers that would not have responded well in the initial treatment.

By taking your time and working in this supportive manner, you will see almost miraculous changes in the ability of your clients to breathe and experience their lives. They will be able to relax, have more energy, and be free of the acute and chronic painful symptoms they have been experiencing. They will also be in a healthier psychological state of being. Specific psychological problems will often improve substantially due to the body’s increased ability to charge and discharge energetically and emotionally.