What soft tissues do you treat?
October 14, 2009 – 6:47 pmSome therapists are gifted with what I call “innate kinesthetic palpatory awareness”. These bodyworkers seem to possess a greater ability than some of us to tune in to their clients dysfunctions and offer pain relief.
While attending massage college in San Diego in 1979, we were privy to little scientific data to support our work and, therefore, addressed the tissue we could best evaluate and relate to…muscles. So, for a couple of years, every client that came to see me had a muscle problem. In 1982 I entered the Rolf Institute and everything became a fascial problem. Took a couple of James Cyriax workshops and became convinced everything was a ligament problem. Suffered a cervical fracture in a clumsy judo fall in 1989 which led me through a couple semesters of PT school and then to post-graduate workshops at Michigan State College of Osteopathic Medicine…and everything became a joint problem.
The fact is…all soft tissues are innervated and can be pain-generators. Since massage therapists are considered by most to be “soft tissue experts”, it is necessary we have tools to assess and treat all the body’s soft tissues. For example, one of the first structures that should be evaluated in sciatic cases are the iliolumbar ligaments. When strained by excessive sidebending, they often become fibrotic and because they have ‘hoods’ that lay on the L4-5 and L5-S1 sciatic nerve roots, are often the first structures to compress the overlying capillary beds and dural membrane. Soon the irritated sciatic nerve develops intraneural edema and swells. As inflammatory waste products collect, sensitive chemoreceptors flood the spinal cord’s neuronal pool setting off pain-spasm-pain cycles that causes the brain to lay down protective muscle guarding. In the short term, muscle work to the hypertonic (facilitated) erector muscles may make the client feel better as the cutaneous (skin & fascial) receptors are calmed by the deep slow manual pressure. But be prepared to dig out the erector spasm session-after-session until the ligament issue is properly addressed.
Some muscles are tight (facilitated) and require restoration of extensibility and some are weak (neurologically inhibited) and require restoration of contractibility. Randomly lengthening all tissues presents many obvious problems. The most common example educator’s use is the pec/rhomboid balance issue. Creating extensibility in stretch-weakened rhomboids and lower traps reciprocally (and fascially) allows the pecs to further pull the shoulder girdle forward on the ribcage…dragging the heavy head with it.
As the legendary Vladimir Janda, MD once said: “No pain management approach is truly successful unless posture has generally been improved”. Chasing the pain by working where the client hurts is, at best, a temporary quick fix.
15 Responses to “What soft tissues do you treat?”
Well I can tell u this in the massage school I attended we were not being taught this.
By Misty Mays on Oct 14, 2009
Yep! That’s probably one reason NCBTMB is considering advanced certification for those therapists who’ve become passionate (and maybe a little obsessed) with the wonderful world of manual therapy.
By Erik Dalton on Oct 14, 2009
I was taught this in my program at Cape Cod Community College. I think it is so important for students of massage therapy to learn the whole thing so you do understand what you are really doing. These short lived schools do not have time to do this.
I agree with Erik..the NCBTMB should consider advanced certification to those who have extended thier education. It all makes sense when you know exactly what you are doing to your client.
By michelle hill on Oct 15, 2009
Thx for the post Michelle:
The problem NCB will face when creating “Advanced Certification” is how to construct a test that will accurately reflect a therapist’s physical apptitude and knowledge of the many advanced forms of bodywork…LOL
By Erik Dalton on Oct 15, 2009
When I see a client for the first time I am looking at ambulation, head in relation to the body, trunk in relation to the pelvis, position of the arms in relation to the body and position of the feet.
Each of these give clues to what my client is having trouble with. The pelvis may be tipped or twisted. The head may be forward changing the shape of the spine.
I explain to my client. I will be doing a full body massage to inspect and work at balancing out the muscles to help alleviate the posture problem and relieve your pain..
I didn’t learn this in massage school. I learned this while working with clients and and many times close my eyes and let my hands do what they need to. I don’t think intuition can be taught it is a self learned technique.
By Ken Elwood on Oct 21, 2009
I believe some therapists are able to use the knowledge that they have gained through their education and their palpatory skills to help bring healing and balance back to the body. It is a gift to be able to place your hands on a person and listen. Many do not have the desire to learn from the body. I am totally excited by the realm of possibilities that I come across. My education is from the body itself.
As far as the advanced certification, I am against it. It will be voluntary but after we have it, there will be employers that will demand it. By having this I see two things. We will have another fee to pay that we do not need and we will keep fine tuning ourselves as specialists and boxing ourselves in so much that we cannot do the outstanding work many already are doing. Too many people involved in my business.
By Denise D. Heywood on Oct 21, 2009
Nothing heals like the innate wisdom of the body. We must always remember our roles as facilitators of change.
Thx for you’re take on advanced certification. Historically, people develop laws and rules to control other people. Our country was founded on “rugged individualism” but I fear that train has long left the station…
By Erik Dalton on Oct 21, 2009
One of the most important things I learned in massage school was something I saw on a bulletin board in passing one day. It read “Trust the process, not the plan.”
By Geoffrey Bishop on Nov 2, 2009
I usually work on reducing the abnormal muscle resting tone of athletes after their physical effort.
It still puzzles me as to why there would be an abnormally high tone in the soleus muscle 2 days after a run for instance. I do understand that this is part of the kinetic chain and that this muscle has been under abnormal stress, that the sensitivity of the spindles may have been altered as a result but this is still not clear as to how exactly this process happens.
V. Janda tell us about the tendency to tighten or to weaken but not how this is exactly happening physiologically. The result is poor treatment approach because I don’t know how it happens, it is therefore hard to address the cause.
Do you know of any study that looked at this?
By Serge Rivest on Nov 28, 2009
Ok question about overstreached rhomboids/ traps. I have always tried to push the rhomboids/traps fascia and muscles back to the spine along with pulling the pecks to the shoulder girdle and work both anterior and posterior neck ect.. But I also do a fascial sweep down the entire back along with releasing the anterior fascia up. I was taught to move the fascia up the front of the body and down the back. Am I causing harm to the over streached rhomboids/traps by also sweeping down?
I am glad that there might be an advanced certification. I think this will allow more doctors, health care professionals, and the general public to take Massage therapy more seriously. Bring it on!!! Plus it may also encourage more Massage therapists to treat the body. What I mean is when I was in school we learned different moves ( chucking, fulling, friction ect…) but we were not taught what we were actually doing to the soft tissue and how we were affecting the body. At times I felt like here let me show you my fancy moves. It wasn’t until after my basic training when i started to look at the body and how massage can truly affect it.
I think that there needs to be more included in the basic massage training. Such as ligaments, nerves, fascia, and how examine and treat the body, muscles and fascia. Finally the lymphatic system. Massage effects it greatly, but yet we do not learn about it or if we do it is just a little bit.
I mean it is possible to do damage to somone if one is not massaging them properly.
By Meaghan Mozingo on Dec 6, 2009
Not familiar with a study off hand Geoffrey but I think this is a fairly common finding. My thoughts on posterior compartment pain primarily focus on fascial bag adhesion from overuse and lack of proper therapy and home-stretching.
Is it the soleus or possibly the tib posterior causing the pain in our athletes? In the presence of foot pronation, the tib anterior has a tendency to go weak first which places a tremendous strain on the tib posterior whose primary function is aiding in medial longitudinal arch support.
In time, waste products gather from sustained isometric contraction and the tib posterior fascial bag grabs hold of the intermuscular septa and glues it down to the already strained soleus.Together, they present quite a mess in proper functioning of the posterior compartment.
We’re familiar with problems with gastroc/soleus adhesions and the strain these muscles place on the Achilles tendon, underlying bursa and plantar fascia. But we often disregard the impact these powerful dynamic plantar flexors impart when they’re also glued down to the tib posterior…an arch supporter and intricate member of the stirrup spring system (SSS).
In athletics presenting with posterior shin splints, that posterior compartment can be a ‘wadded-up” mess and must be carefully and systematically addressed.
By Erik Dalton on Dec 20, 2009
Sorry Serge, I thought the above post was from Geoffrey. Happy Holidays my man >> ERIK
By Erik Dalton on Dec 20, 2009
I’ll take it. I see a lot of folks with this posterior shin splint type of dysfunction. Thanks for the great information!
By Geoffrey Bishop on Dec 22, 2009
Have a good trip to Australia or where ever you’re going Serge…
By Erik Dalton on Dec 22, 2009
Hello Erik~
I just finished watching a video on dissection of the hip, the anatomist did a good job of pointing out the inferior gluteal n.(glute max), and superior gluteal n. (medius & minimus), as they pass from the sacral plexus to the innervated tissues of lateral hip.
I know I have heard you mention these tissues is class. My question is this; how do we as therapists differentiate a nerve problem from a muscle, fascia, tendon, all of the above problem? Where might this tissue (inf & sup. gluteal nerve) become bound, swollen, etc.? and what might be the difference in treatment options?
If you get time I’d love to hear your take on the sinuvertebral nerve as well…
Appreciate your help and all your contributions to the field of manual therapy.
By Geoffrey Bishop on Dec 29, 2009