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Jing are going to COPA (8th-9th May @ Excel in London), and we are running a series of 10 free CPD hand-on workshops!

This dynamic webinar is a preview one of the 10 free CPD workshops we are offering at the show: Myofascial release for low back pain related to herniated discs and sciatic nerve pain

In this webinar you will learn how myofascial release skills can be effective in achieving positive outcomes for clients with chronic non-specific low back pain. You will review the nature and role of fascia, myofasical release techniques and their clinical application for conditions such as sciatica, piriformis syndrome, ongoing chronic low back pain and degenerative disc conditions.

Joining us at COPA, and co-hosting the free CPD workshop sessions are the amazing teachers: Ruth Duncan, Susan Findlay, Julian Baker, James Earls, Tor Davies and Caroline Barrow and sponsored by magnificent massage table supplier Affinity

Interested in the full course?
Check out our hands-on or online course – The Jing Method for the Treatment of Low Back Pain

The post COPA 2019 Workshop preview: MFR for low back pain related to herniated discs & sciatic nerve pain appeared first on Jing Advanced Massage Training.

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Courses related to this webinar:

Fascia Manipulation for Nerves: 7th-8th May 2019 to book please click here!

Fascial Therapy Approach to the Spine, Scapula & Thorax: 6.30-9.30pm 7th May 2019 to book please click here!

Would you like to be able to harness your fascial skill set to resolve neural tension?

Often by the time you see a client with neural presentations, (such as sciatica or brachial plexus issues) they’re well on their way to neural dysfunction and pain. Why not intervene much sooner and help eliminate neural tension before it morphs into a dysfunctional state?

In this two day course, learn great new fascial mobilisation techniques for upper and lower extremities including brachial plexus and sciatic and femoral nerves.

Contents of the webinar will include:
• Concepts and theoretic underlining knowledge for the biomechanics pertaining to neural motion, known as ‘the mechanical interface’
• Neural biases (pathways)
• Neurodynamic base testing drawn from the writings of David Butler and Micheal Shacklock.
• Technique and movement exercises designed to enhance gliding motion of nerves.

Course date coming up: 7th-8th May 2019

The post Webinar Recording: Fascia Manipulation for Nerves with Steven Goldstein appeared first on Jing Advanced Massage Training.

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In this dynamic webinar, the Jing director duo – Rachel Fairweather and Meghan Mari partnered with the amazing Dermalogica, to give you amazing top tips for Pre & Postnatal Pregnancy Massage!

Feeling confident treating pregnant women is a rewarding way to expand your practice and provide significant pain relief at this important time. This course is also invaluable if you would like to treat anyone who cannot lie comfortably on their stomach. You do not need any specialised equipment for this work.

LEARN
The anatomy of pregnancy.
A full body protocol in the side-lying position.
How to treat specific concerns during pregnancy such as carpal tunnel syndrome, sciatica, oedema, migraines, neck, shoulder and low back pain.
The physical and emotional transformation of women at different stages of pregnancy and post birth.
Safety guidelines regarding contraindications and/or risk factors associated with pregnancy.

If you would like to know more, please check out our 3 day course, please click here!

Top Tips for Pregnancy Massage - YouTube

The post Pregnancy Massage: Dermalogica Webinar Recording appeared first on Jing Advanced Massage Training.

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“It is as if all of my joints were locked and I am caught inside, as though imprisoned in a kind of body or an envelope that has padlocks inside, like doors that I cannot open.”
Fibromyalgia patient interview
(Valenzuela-Moguillansky, 2012)

Frustrating or fascinating – the complex world of Fibromyalgia Syndrome

Fibromyalgia Syndrome (FMS) can be one of the most challenging conditons to treat as a complementary therapist. Seemingly random and unrelated symtoms such as dizziness, aches, pains, sleep disturbance, ‘brainfog’, sore throat, heightened sensitivity and exhaustion are typical of the pathology And that’s just for starters! When you add into the mix the commonly co-related stress and mental health issues such as anxiety, depression and post traumatic stress disorder, you can see why the average therapist’s heart can sink a little at the prospect of successful treatment.

FIG 1 Fibromyalgia wordcloud

To make things even more complex, the delicate balance of the fibromyalgic conditiion means that it is not unusual for ‘normal’ massage treatment to result in increased pain and symptoms for the client.

Yet with a little knowledge and time, the well trained massage therapist can provide great relief for this complex conditon. The use of appropriate soft tissue techniques twinned with an understanding of the underlying psychological and physiological processes can bring about radical and long lasting change.

Fibromyalgia in a nutshell

In a nutshell, fibromylagia is a ‘syndrome’ – in other words a name given to a collection of symptoms. The symptoms can be endless (as we will see below) but in short, FMS can be mainly characterized by pain, fatigue, and sleep disruption.

FMS commonly exists with mental health and emotional issues including anxiety, panic disorder, post-traumatic stress disorder, and general depression.

Its prevalence in the general population is around 1%-2% and is more common in women (3.4% for women and 0.5% for men)

A ‘shopping list’ of symptoms

FIG 2 client care

The common symptoms of FMS are literally endless and can appear totally unrelated. Reading rather like a ‘shopping list’ of every nasty bodily and cognitive complaint you have ever heard of, the typcial FMS client is likely to experience a combination of symptoms including:

• Widespread constant pain in muscles, soft tissue and joints
• Painful and tender skin
• A feeling of burning, tingling, ripping
• Pins and needles
• Shooting pains
• Restless legs
• Numbness and fogginess
• Tender points in the body
• Trigger points – ‘knots’ in soft tissue that can cause referred pain
• A deep aching pain like toothache
• Pain that moves from week to week. Oten the client can’t identify exactly where the pain is
• Terrible stiffness
• Muscle weakness
• Nausea
• Giddiness, lack of balance, lurching, visual disturbances like blurring
• Dry eyes alternating with watering eyes
• IBS, constipation, diarrhoea
• Allergies and sensitivities
• Heightened sensitivity to light, sound, smell, touch
• Sensitivity to cold
• Constant low grade fever
• Tender lymph nodes in neck or arm pit
• Sore throat
• Increased sensitivity to pain(thought to be because of increase in substance P, a chemical that tells the brain that there is pain in an area)
• No energy, exhaustion, feeling wiped out all the time
• Feeling as if one has ‘flu
• Very long recovery time for any type of exertion
• ‘Disproportionate response’ to treatment and exertion; normal massage or deep tissue treatment will bring days of pain and inflammation; expending too much energy will result in days of not having any energy at all or not being able to get out of bed
• Anxiety
• Depression
• Irritability
• Mood swings
• Inability to sleep, or likelihood of waking up and not getting back to sleep
• Increased REM sleep and less deep restorative sleep, waking up feeling as if they have not slept at all
• Night sweats
• Brain fog – ‘fibrofog’, poor concentration, memory loss

The symptoms of FMS are so diverse it is common for sufferers to have spent months or years undergoing medical tests in an attempt to find a cause. This process in itself brings intense frustration for clients who may have been told that the symptoms are psychological or exaggerated – there is often an intense feeling of “not being believed” that clients carry around with them.

One big wind up – the importance of central sensitisation in FMS and chronic pain

So what is actually going on in this mysterious and debiliitating condition? FMS can be quite difficult to understand as although clients can be in terrible pain, there is no actual damage to any tissues or organs of the body.

FIG 2 Fibromyalgia image

Instead, the system that has gone awry in FMS is actually the central nervous system – the brain and spinal cord- which has literally gone into overdrive, often due to stress or trauma. A key factor in FMS (and other chronic pain conditions) is a phenomenen known as central sensitization. In central sensitisation, the sympathetic nervous system is in a persistent state of high sensitivity (known as “wind up”). This results in the spinal cord and brain acting like a faulty amplifier that literally turns up the volume of any pain signals -the client is in (real) pain even though there is no injury or damage to the tissues or organs of the body . Central sensitization is somewhat like the oversensitive car alarm that keeps getting triggered even though there is no danger or damage to the car.

Central sensitisation has 2 main features: allodynia and hyperalgesia

• ‘Allodynia’ – This is when an neutral stimulus is interpreted by the brain as painful – for example, the stroke of a feather feels like being seared by a blowtorch.
• Hyperalgesia- a normally painful stimulus is interpreted as being much more painful

This explains why your client with fibromyalgia might be literally jumping off the treatment table when you are barely even touching them!

In addition, central sensitization can lead to heightened sensitivities across all senses including light, sound and smells and is associated with the cognitive deficits common to FMS such as poor concentration and short term memory. Central sensititization is also correlated with increased levels of emotional distress especially anxiety

It is vitally important when treating fibromyalgia to undersand that a main part of our job is to address this faulty and oversensitized alarm system.

Fibrmyalgia and Fascia: The missing link

FIG 4 – fascia

I always joke with my students that if they fall asleep in class and I ask them a question then the answer is most likely to be “fascia” (or “the psoas”). This is definitely the case with FMS as although no definite evidence of muscle pathology has been found, there is some evidence for dysfunction of the intramuscular connective tissue, or fascia, Research by Liptan (2010) proposes that inflammation of the fascia is the source of peripheral nociceptive input that leads to central sensitization in fibromyalgia.

Interestingly, the inflammation of the fascia is similar to that described in conditions such as plantar fasciitis and lateral epicondylitis, which also respond well to myofascial techniques.

Massage treatment for FMS
Treating clients with FMS can be challenging due to the extreme sensitivity of their systems. This means that every detail of the treatment process has to be thought through – from the smells in the room, to their positioning on the table, to the techniques and quality of your touch. Literally nothing can be taken for granted. Below are some top tips for working with FMS clients:

• Allow a good half hour for your initial consultation assessment and interview. FMS clients often have complex histories and it is vitally important that they feel truly heard
• Share your treatment plan: Tell them what you are doing and why and expect their input and comment.

• Be extra careful with basic client care. For example, have plenty of blankets ready, and have pillows to hand as basic positioning might be uncomfortable. Check in about temperature as your room might need to be warmer than usual

• Allow clients to change position often if they want. Staying in one position can be painful.

• Expect the tiniest amount of treatment to have a disproportionately enormous effect; don’t think you have to pack very much in to one treatment

• Remember the main issue in FMS is central sensitization – an over-reaction to threats. Treatment that is too intense may trigger the warning system and make things worse

• Listen to your client, take their word for everything they say. They really do know best. If they say ‘don’t touch my stomach’, DON’T!

• Keep treatments short if necessary, i.e. 20 – 30 minutes pain release at the most, follow with relaxation massage

• Be very, very gentle, light rather than deep. Find out each time which depth of weight is best for the client: what for us is felt as discomfort can be extremely painful to an FMS client

• With FMS you have to be prepared to be in it for the long haul. Progress can be very very slow over several treatments and often it doesn’t seem as if there has been much progress

Treatment techniques and tips
My own approach to treating chronic pain conditions has been developed through clinical practice with thousands of clients. For most chronic pain conditions including FMS, I recommend a multi modal approach incorporating several elements including the use of heat; fascial techniques, stretching, acupressure and self care suggestions.

A sample treatment for FMS could include the following:

The use of fascial techniques – Myofascial release without a doubt is the ‘go to’ technique for fibromyalgia. The cross hand stretch is one of my favourite MFR techniques and can be used anywhere on the body”

FIG 5 Cross hand stretch

• MFR cross hand stretches : Place your crossed hands adjacent to one another in the area to be released – they should be a few inches apart at this point. Sink down until you have a sense of being on the deep fascial layers that runs around and through the muscles. Then put a stretch on this tissue so you have a sense of tension between your two hands – like a piece of material being stretched to a barrier. If you tune in with your sense of listening touch, after a while you will start to feel the sensation of the tissue starting to move beneath your hands. Make sure you maintain the stretch and “follow” the tissues until you feel the sense of tissue release described in the fascial chapter – this whole process takes around 3-5 minutes so you will need to be patient! Repeat cross hand stretches on anywhere that is needed.

FIG 6 Hot stones

Power effleurage with hot stones: Heat is fantastic for most chronic conditions such as fibromyalgia and rheumatoid arthritis. If you are trained and insured in hot stone work this is a great time to introduce some dynamic stone strokes. Stand at the head of the table in forward Tai chi stance with a hot stone in each hand. Ask the client to take a breath in and let them know there will be heat coming- they should be be sure to tell you if it is too much. Apply the stones with a few quick strokes to the top of the clients upper arms first as this is a less heat sensitive area. Then glide down either side of the spine using your body weight to work into the erector spinae muscles with the stones. Work down to the low back with the stroke, working slowly and deeply then come back up with a light return stroke and repeat. Breathe out as you work down the body and imagine energy or qi flowing down your arms

Fig 7 Acupressure point CV 1

Acupressure points: Acupressure points that address the emotional component of FMS can be very helpful.
CV 17 is a wonderful point for helping to calm and release emotional energy

Conception Vessel 17 (CV 17) “Chest centre”

Location: On the sternum, level with the fourth intercostal space, between the nipples.
Use the third finger to hold the point for 3-5 breaths.
It feels nice to have the other hand under the head as you do this

Stretching – Gentle static stretching can be very helpful in areas of pain. The stretch shown is helpful for low back pain.

FIG 8 low back stretch for fibromyalgia

Self-care suggestions: Fibromyalgia clients often feel out of control so self help techniques that allow them some sense of empowerment are vital. Teach your clients gentle stretches and meditation/ breathing exercises for home care. Fibromyalgia is such a complex condition that a multi disciplinary approach works best for treatment. Referring your client to resources that can offer talk therapy such as CBT (cognitive behavioural therapy), gentle yoga, strength training or meditation will be extremely helpful in their recovery.

FIg 9 Selfcare for Fibromyalgia


Most of all, help your client to feel that there is hope. Recovery is certainly not quick but it is possible and as an understanding and well trained massage therapist you can be a key piece in this process.

References

Liptan , GL J Bodyw Mov Ther. 2010 Jan;14(1):3-12. doi: 10.1016/j.jbmt.2009.08.003

About Rachel Fairweather and Jing Advanced Massage
Rachel Fairweather is author of the best selling book for passionate massage therapists – ‘Massage Fusion: The Jing Method for the treatment of chronic pain”.
She is also the dynamic co-founder and Director of Jing Advanced Massage Training (www.jingmassage.com), a company providing degree level, hands-on and online training for all who are passionate about massage. Come and take part in one of our fun and informative short CPD courses to check out the Jing vibe for yourself!
Rachel has over 25 years experience in the industry working as an advanced therapist and trainer, first in New York and now throughout the UK. Due to her extensive experience, undeniable passion and intense dedication, Rachel is a sought after international guest lecturer, writes regularly for professional trade magazines, and has twice received awards for outstanding achievement in her field.
Rachel holds a degree in Psychology, a Postgraduate Diploma in Social Work, an AOS in Massage Therapy and is a New York licensed massage therapist.
www.jingmassage.com
Tel: 01273 628942

The post Understanding and treating fibromyalgia through advanced massage techniques by Rachel Fairweather published in the FHT’s International Therapist Magazine appeared first on Jing Advanced Massage Training.

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How many times a day do you touch your phone?

Go on-be honest. What do you think? 100? 500? Surely not more than that! After all you are a mindful massage therapist, right?

Would it shock you to know that the AVERAGE user in the UK touches their smartphone over 2,500 times per day!And that’s just the average user –the heavy users amongst us (probably all of those running our own businesses) are proper addicts with 5,400 touches per day.

And that is just your phones. Add to that computer use, tablets, a love of gaming and you start to have an idea about the amount of time per day we spend staring at screens, tapping and clicking, swiping and surfing….

Surely that can’t be good for us? Wasn’t the online revolution supposed to free us from hordes of paperwork, enabling us to do things quickly and easily on the go? Yet instead as a nation we are glued to our phones, heads down, swiping, touching, checking social media, having torrents of information coming at us faster than we can even process.The paperwork we hoped to leave behind is now just being carried around with us every minute of every day. (FIG 1)

We are all addicts and we don’t even realise how much this new lifestyle is taking its toll. Reliance on technology is negatively affecting us on every level –mental, physical and social.

Yet with every problem comes an opportunity. Our dependence on technology means that the general public is hungering for the very genuine and vital form of communication provided by massage therapists via the medium of touch. Technology is causing us real problems and the informed and skilled massage therapist is ideally placed to “reach out and touch someone” as the song goes!

The digital drug:how technology affects our mental health

Research is increasingly showing us that our over reliance on technology can have serious effects on our psychological feelings of well-being. In particular our brains have just not evolved to cope with the amount of information they are trying to absorb on a daily basis.

Our constant checking of our phones or emails is in effect training our brains to be permanently distracted. This has serious knock on effects for our ability to think and concentrate.

The constant restlessness and distractibility of the average technology user is linked to increased depression, anxiety and–in the case of gamers-aggression. It is also affecting our ability to be contemplative, to engage in the kind of free floating imaginative thinking that is conducive to imagination, new ideas and relaxation.

Worryingly it is also affecting our ability to be empathic –to tune into what others around us are feeling. You have probably experienced this yourself at some point –maybe when you were baring your soul to a friend or family member only to have them glance distractedly at their bleeping phone as you were speaking.

Disconnect to reconnect: meaningful touch for the techno generation:

“Life is too sweet and too short to express our affection with just our thumbs.Touch is meant for more than a keyboard”
Kristin Armstrong

So what does this have to do with you as a massage therapist?

First of all, it is important to realise that more and more folks are craving the beauty of silence and meaningful contact. And YOU can provide that -more than ever the world needs those who are working with the “hands, the head and the heart”(FIG 2)

Touch is a basic human need, yet we are forsaking the genuine connection of touching others for the mindless contact of touching our phones. As our swiping, tapping and clicking increases, we are at the same time diminishing the possibility of meaningful human touch within our society. Touch is a necessary part of human development and our feelings of well-being. Research has shown that touch:

•Inspires positive thinking and expands trust
•Reduces social anxiety and stress
•Boosts the immune system and lowers blood pressure

As the habits of technology take their toll, people everywhere are starting to recognise and pay for the privilege of literally being “switched off”. Retreats are proud to advertise themselves as “unplugged”, mindfulness courses are everywhere and stressed out hipsters are reverting to their “unsmart” Nokias to try and stem their addictions.

You too can capitalise on this trend whilst genuinely helping others.

Massage can do so much to ease the stresses of modern daily living. Providing time for your clients away from their technology is becoming increasingly precious. Make sure you let people know in your advertising the beauty and benefit of what you provide.

Phones and pains

Your phone is not just a pain to your peace of mind but also to your hands, wrist and neck. Massage can not only help the “techno generation” through the provision of pure, beautiful relaxation but also through providing pain relief for many of the ailments associated with technology use

We have probably all heard about carpal tunnel syndrome but how about blackberry thumb, gamers wrist, ravers wrist, Rubiks wrist and stylus finger? Today’s world necessarily involves a staggering amount of activities that require the day to day use of our hands and arms, not just for work but leisure time too. This inevitably leads to pain and injury as our poor limbs and digits beaver away to try and keep up with the ever increasing demands of our techno driven lifestyle. Stop and think for a minute about what you have done today-answered some emails, texted a few personal and business associates, surfed the web for that new holiday and this is even before you have embarked upon your incredibly hand intensive occupation of massage! It’s not surprising that repetitive strain injury (RSI) is one of the biggest causes of time off work in the UK. The health and safety executive estimated that in 2017/18approximately 197,000 people in Great Britain suffered from an ULD (upper limb disorder).This caused a loss of 2.6million working days.

The good news-massage therapists can be the experts!

The good news is that massage therapists and other bodyworkers are ideally placed to treat these conditions as they usually stem from overuse of soft tissue structures (combined with other psychological and social factors).

Many conditions can be resolved within 1-6 weekly treatments with a combination of trigger point work, myofascial release and appropriate stretching techniques. Other conditions may need a longer period of gently supporting the body back to health; again massage therapy can be the key modality to promoting healing.

Imagine the impact on your business through being able to treat these conditions confidently and successfully. I have had excellent results in my own clinic in treating these disorders and in many cases have been able to help clients avoid surgery or more invasive medical treatment.

Demystifying pain in the hand and wrists

There are so many conditions affecting the hands and wrists it I easy to feel confused. Here is a simple guide to the different conditions out there and tips for successful treatment:

Carpal Tunnel Syndrome (CTS)

In recent years, CTS has become a catchall diagnosis for any pain in the hand and wrists. It is important to realise that there are many other conditions that can cause symptoms in these areas and some of these will be discussed later in this article. True CTS has quite a specific definition: it is impingement of the median nerve within the carpal tunnel. (FIG 3)

The carpal tunnel is an oval passageway created by the structures of the wrist. The carpal bones create the bottom of the tunnel and the transverse carpal ligament, also known as the flexor retinaculum, forms the top of the tunnel. (FIG 4).In each individual, the carpal tunnel is a fixed space although it can vary in size from one person to the next.

The median nerve: This is one of the three nerves that innervate the forearm and hand: the other two are the ulnar and the radial nerves.

The median nerve has to pass through the fixed space of the carpal tunnel together with other soft tissue structures including the nine tendons of the forearm flexor muscles. With so many structures passing through a small space, it is easy to see how carpal tunnel syndrome can develop. If the amount of space in the tunnel is decreased, the pressure on the median nerve can increase causing the classic nerve impingement symptoms of CTS including:

Pain, numbness and weakness of the hand. Pain is classically felt in the palmar side of the wrist radiating into the hand, typically affecting the palm, thumb, index finger, third finger and lateral half of the ring finger. (This is the innervation pattern of the median nerve)

Loss of function of the hand if severe and not treated. Untreated CTS can result in permanent nerve damage, as nerve tissue cannot regenerate.

Treatment tips: Orthopedic tests can help you determine whether the entrapment is at the carpal tunnel or from other soft tissue structures. Treat the wrist flexors, extensors and include the cervical and shoulder girdle area with advanced soft tissue techniques such as trigger point and MFR. Use fascial techniques around the palmar fascia and wrist to release pressure in the carpal tunnel.

Thoracic Outlet Syndrome (TOS)

Thoracic Outlet Syndrome can cause very similar symptoms to CTS (ie: tingling and numbness down the arm and hand) yet can be very easily resolved through appropriate massage therapy and stretching.Like CTS, Thoracic Outlet Syndrome is a nerve impingement syndrome. The crucial difference in this case is that the nerve impingement does not take place near the carpal tunnel but instead at the neck or in some cases the chest. If we trace the nerves of the hand and forearm back “upstream” to their source we find that they all come from a common origin-the brachial plexus.(FIG 5)

The brachial plexus is a network of branches of spinal nerves C5-T1. If you look at an anatomy book you will see that the brachial plexus passes not only between the scalene muscles in the neck but also between the pectoralis minor (deep tothe pectoralis major in the upper chest) and the ribs. It then branches into the nerves of the arm, the most important of which are the radial, median and ulnar nerves.So what do you think might happen if the scalenes or the pectoralis minor become tight as they are very likely to do from our habitual rounded shoulder/ head forward position of desk and computer work? That’s right!

Tingling, numbness and pain down the arm –your classic “carpal tunnel” symptoms! (FIG 6)

Treatment tips

Use trigger point and myofascial techniques to release myofascial restrictions in the tissues –focus on scalenes and pectoralis minor. Advanced stretching and soft tissue release will enable the tissue to return to a normal resting length and minimise the risk of compression. Overuse Syndrome and Repetitive Strain Injury (RSI)Over-use injuries are often of slow onset; you start to get some pain, you ignore the pain and keep typing or massaging, re-injuring the tissues, causing more tissue damage.(FIG 7)Tendons become irritated, the repetitive stress causes micro tearing of the muscles, leading to inflammation and scar formation. In the early stages of injury the pain may be mild and only when doing the offending activity. Eventually without intervention, the severity of the pain increases and may also be present at rest and during other activities such as writing, picking up a kettle, carrying a bag or picking up a child.

It is important to realise that RSI is usually associated with other psychological and social factors such as feeling out of control at work or overwhelmed.

Treatment Tips:

In my clinical experience, hand and wrist pain that results from long term overuse usually needs a more gentle and long term approach. Gentle myofascial work combined with craniosacral therapy seems to get better results than intensive trigger point work as the body can be very sensitive. Check in with your client at each session about whether they experienced any post-treatment discomfort and modulate your techniques accordingly.

Blackberry thumb

Blackberry thumb has become the common term for a form of repetitive strain injury caused by the frequent use of the thumb(s) to press buttons on smart phones, or other mobile devices. The medical name for this syndrome is De Quervains syndrome –a degenerative process affecting the tendons at the wrist that move the thumb-specifically the extensor pollicis brevis and abductor pollicis longus.(FIG 8)

Dequervains typically presents with pain on the lateral aspectof the wrist. Asimple diagnostic test is to put your affected hand as if you were hitchhiking and then tuckthe thumb inside the closed fist. If it hurts when you move your fist towards the floor ((ulnar deviation) then this is a positive sign for Dequervains. (Fig 9)

Tendinopathies

Overuse tendon pathologies (tendinopathies) are common soft tissue disorders caused by repetitive or excessive stress.Some classic tendinopathy conditions are:

Tennis Elbow (Lateral epicondylitis):This is degenerative damage to the common extensor tendon of the forearm muscles. (FIG 10)

Golfers Elbow (medial epicondylitis):degenerative damage to the common tendinous origin of the wrist flexors

Treatment Tips: Traditional tried and tested methods for tendinopathies including “blackberry thumb” include myofascial and other soft tissue work to the corresponding muscles and cross fibre friction to the irritated tendons. Use supportive nurturing work like Swedish, hot stone and cranial work.

And don’t forget our old friends-Trigger Points!

The informed massage therapist will never forget that chronic pain patterns are often caused by trigger points. Incorporating trigger point therapy into your massage work will enable you to provide dramatic relief to many chronic pain conditions -hand and wrist problems are no exception. Very often myofascial trigger points are the sole cause of pain, numbness, tingling, stiffness, burning or swelling in the hands and fingers.

Trigger points in the scalenesor pectoralis minor(FIG 11A and 11B)can cause the muscle to shorten leading to Thoracic Outlet symptoms. Numbness in the hands and fingers can also be caused by trigger points in the serratus posterior, serratus anterior, triceps, coracobrachialis, brachialis, supinator, extensor carpi radialis brevis, flexor carpi ulnaris, flexor digitorum and pronator teres. (FIG 12A and 12B)

Related 1 day Massage Course: Forearm, Wrist and Hand Pain

About Rachel Fairweather and Jing Advanced Massage
Rachel Fairweather is author of the best selling book for passionate massage therapists –‘Massage Fusion: The Jing Method for the treatment of chronic pain”. She is also the dynamic co-founder and Director of Jing Advanced Massage Training (www.jingmassage.com), a company providing degree level, hands-on and online training for all who are passionate about massage. Come and take part in one of our fun and informative short CPD courses to check out the Jing vibe for yourself!Rachel has over 25 years experience in the industry working as an advanced therapist and trainer, first in New York and now throughout the UK. Due to her extensive experience, undeniable passion and intense dedication, Rachel is a sought after international guest lecturer, writes regularly for professional trade magazines, and has twice received awards for outstanding achievement in her field.Rachel holds a degree in Psychology, a Postgraduate Diploma in Social Work, an AOS in Massage Therapy and is a New York licensed massage therapist. www.jingmassage.comTel: 01273 628942Copyright Jing Advanced Massage January 2019.

The post Touch Therapy for the Techno generation by Rachel Fairweather – Published in Massage World Magazine: January 2019 appeared first on Jing Advanced Massage Training.

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Jing Goes Green

To our dear Jing family,

We want to share something with you that’s been in our hearts for awhile now…

• Did you know that with Christmas around the corner, as much as 83 square kilometres of wrapping paper will end up in our bins rather than being recycled?
• Did you know that each person in the UK throws away their own body weight in rubbish every 7 weeks?
• Did you know that the average family throws away 6 trees worth of paper a year?

We didn’t. But now we do, it’s hard to ignore. There’s been a shift in the public view on climate change lately – have you felt it? When faced with visible changing weather extremes, rising sea levels and threats to our food production, people can’t turn their faces away anymore.

David Attenborough says that,

“climate change is the major challenge facing the world”

Jing has never ignored a challenge so it’s time that we do what we can as a business to help on an ethical and practical scale.

So we’re massively excited to announce that Jing has Gone Green! You may have noticed that we have been emailing the course manual to you when you book a course. You’ll be able to download this content and use it in anyway you wish – you’re all different kinds of learners, so this is a wonderful and empowering way to work out whatever works best for you!

This decision is in response to a lot of feedback from our students, and due to this we will be updating these manuals with beautiful colour pictures, more diagrams, tips and techniques. This is a work in progress but expect to see some magical changes ahead. By Going Green Jing is being answerable ethically, but we’re also keeping our business overhead costs down so we don’t need to raise course prices for our students. As well as that, your learning experience is enriched with a more detailed resource you’ll have access to forever! It’s our gift to you!

“The greatest threat to our planet is the belief that someone else will save it”

– Robert Swan, Author.

Jing is stepping up and modernising and taking responsibility for our planet – we hope you beautiful people will support us.

All our love,
Meg, Rachel and the Jing Team
xxxxx

The post An open letter to our Jing family… appeared first on Jing Advanced Massage Training.

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Jenny is 53 years old. She came to me with chronic low back issues, lack of mobility and constant pain. She also felt depressed and had severe gastrointestinal problems. Jenny had a large scar on her abdomen following removal of part of her bowel.

Raj is 47. He had been diagnosed with a frozen shoulder some months previously following a traumatic incident involving being trampled by some cattle. He had pain and a lack of range of motion his shoulder. He found it difficult to get dressed and to carry out normal activities of daily living. Raj had a large scar on his torso due to the life saving surgery he received after his accident.

Eileen is 27. Following the birth of her daughter by Caesarian section she has experienced extreme SI joint pain and discomfort in the abdomen that cannot be explained by her GP. She finds traditional massage and chiropractic approaches leave her in pain for days afterwards. She told me that she feels labelled as “difficult” and that other practitioners have suggested that the pain is “all in her head”

Three clients, all with different types of presenting pain. Yet there is one common link that lies at the basis of their successful treatment. Yes that’s right – the presence of a scar.

Scars are often the “missing link” when working with tricky cases of ongoing pain or lack of mobility. Therapists are generally not given the skills to work with scars effectively and are often given misleading information about when and how scars should be treated.

I am happy to report that the pain and emotional issues of the above clients (all real people, names changed, who approached me at my pain clinic in Brighton) have all improved dramatically. All received a course of treatments that addressed their particular issues through a combination of advanced soft tissue techniques and, importantly, particular focus on their scar tissue.

Scar tissue techniques can easily be incorporated into your existing massage approaches and can have amazing results in both improving the appearance of scars and helping to get results with tricky pain conditions.

What is a scar?

The dictionary defines a scar as:

1. A mark left on the skin after a wound, burn or sore has healed over
2. A lasting effect on somebody’s mind by a personal misfortune or unpleasant experience

This definition nicely sums up both the physical and emotional factors that are involved in “scarring” – I find with my clients that a physical scar often holds a dramatic emotional component and working on scars can help clients safely release this.

Hidden depths and fascial icebergs!

My favourite definition of a scar comes from the myofascial release expert, John Barnes who states

“ A scar is the tip of a fascial iceberg”

This great quote shows how even a small scar on the surface can be connected to deep fascial restrictions and adhesions. It is important to take into account the possible effect of scars on a client’s pain condition as working a scar can often give fantastic results where other techniques have only been partially effective.

Slugs and snails and puppy dog tails…what are scars made of?

Scar tissue is a collagen- based tissue that develops as a result of the inflammatory process following injury. The inflammatory process and the production of scar tissue are necessary for healing damaged tissue- skin, muscle, tendon, ligament, fascia or nerve. When the collagen used to mend the injury matures it is referred to as scar tissue.

Interestingly, the scar is weaker than the tissue it is replacing. For example, scar tissue replacing damaged dermis will only reach about 80 percent of the strength of the original tissue.

Causes of scar tissue are:

o The inflammatory response that results from wounds, burns, musculo skeletal trauma, or the late stage of osteoarthririts (after cartliage is destroyed)
o Prolonged immoblisation of a structure; for example in a cast following a fracture
o Paralysis of a structure due to a peripheral or central nervous system problem.

Types of scar tissue

There are lots of different types of scar tissue with different fancy names. This can make the subject a little confusing especially if you are dealing with medical diagnoses. Here is a brief run down of a few of the major types of scars you might encounter in your clinic (as listed in the excellent textbook Clinical Massage Therapy: Understanding, Assessing and Treating Over 70 Conditions by Canadian massage therapists Rattray and Ludwig)

• Contracture: the shortening of connective tissue supporting structure over a joint. This includes muscles and other soft tissue structures such as tendons and joint capsules. A contractured muscle or other soft tissue, cannot fully lengthen and results in a reduced ROM in the joint. Soft tissue contractures are subdivided into adhesions and irreversible contractures.

• Adhesion: Here, collagen fibres form cross links due to reduced range of motion (ROM) at a joint. This leads to further reduced ROM. This happens when a limb is left in a shortened position for long periods of time – for example being immobilised after an injury but also the tissue shortening that happens in postural dysfunction.

• Irreversible contracture: When fibrotic tissue or bone replaces muscle and connective tissue. There is a permanent loss of ROM that can only be restored by surgical means

• Scar Tissue adhesion: This occurs within an injury or acute inflammatory process. Collagen fibres form during the tissue repair process that allow adhesions and contractures to form in a random pattern. These adhesions can be within and between skin, muscles, tendons, groups of muscles and joint capsules; also within the joint itself.

• Fibrotic adhesions: These occur with ongoing chronic inflammation and cause moderate to severe restriction in ROM. They can be difficult to eradicate.

• Keloid: Dermal scar tissue that extends beyond the boundaries of the original wound in a tumour like growth. A keloid is thought to contain increased amount of collagen in a more random pattern compared to a hypertrophic scar. It may continue to grow for many years. Both hypertrohpic and keloid scars seem to result from an imbalance between collagen synthesis and collagen breakdown in the wound. Keloids do not respond well to surgical excision and the use of steroids seems to be more effective.

• Young people have increased amounts of scar tissue due to a greater rate of collagen synthesis: 88 percent of keloid and hypertrophic scars are present in people under 30 years old.

Why work a scar?

There are 3 main reasons that it may be useful to address your client’s scar during treatments:

1. To improve appearance: Scar tissue work can dramatically improve the appearance of scars. Ongoing work can help scars to become:
o lighter in colour
o less raised
o blended with surrounding tissue

2. To decrease pain: Scars can be related to pain conditions in many seemingly unlikely ways. I have had cases of clients with hip pain that resolved with treatment of appendectomy scars, knee pain that immediately improved with work on tiny keyhole surgery scars and countless cases of back and SI joint pain that were related to Caesarian scars.

If you are failing to get a result with a client’s pain condition it is always useful to address the scar as it will often make an unanticipated difference

3. To improve range of motion at a joint: Contractures and adhesions around a joint can dramatically affect range of motion as this leads to shortening of muscles and connective tissues. This prevents the joint from being able to lengthen to its full position.

I have had dramatic results through using scar tissue work with clients who have a limited range of motion. The client above who had been trampled on by the herd of cattle was able to fully abduct his arm after one treatment of the scar on his side. The scar was literally acting like a “too tight” teeshirt that was pulling his arm down! My other favourite memory was the 7 year old boy who could not fully extend his elbow following a severe fracture and immobilisation in a cast for several weeks. The surgeon had told his parents that he had to “live with it”. After just a few sessions working on the contractures deep in the soft tissue around the joint he was able to fully extend his arm. Now every time I see him he extends his elbow as a kind of greeting! (he is now 15!)

When is it safe to work a scar?

The million dollar question is always “how soon can you work a scar?”. There is a great deal of conflicting information around this topic in the massage field – I have read professional recommendations that range wildly from 2 days to 2 years! This often leaves the massage therapist fearful of treating scars and clients missing out on much needed helpful work.

Interestingly the medical and plastic surgery professions both advocate that patients self massage their own scars to reduce pain, reduce itching and improve appearance. Patients are generally advised to start self -massage once the scar has healed – in other words when the sutures are fully removed and all scabs have dropped off. This would seem like a good guideline for massage therapists when treating client scars.

As with most things, use your common sense and client feedback as a guide to treatment. If the scar is reasonably new, start with gentle techniques and limit the work to a few minutes. Get feedback from your client at the next session and then increase the time spent in the session on scar work accordingly.

Treat the person not the scar!

It is important to remember that scars can be zinging hubs of raw and unprocessed emotional pain. It can be easy for enthusiastic therapists to become ‘gung ho’ about mechanically treating the scar tissue without paying due attention to emotional issues. It is not uncommon when treating scars to have strong emotional feelings to resurface. In some cases this can be quite dramatic and take the client (and you!) completely unawares.

Take time to ask your client about the scar, how it happened, how old they were and how they felt at the time of the traumatic event. Check in with how they feel about the scar now. I had one client who had not touched or looked at her Caesarian scar for 20 years as it was emotionally associated with a very difficult time for her. In this case our first few sessions consisted of her “getting to know her scar” by putting her hand over the drape and just resting in the area of the scar. Clearly it would have been inappropriate to have gone charging in with some fascial techniques, no matter how effective they might have been!

Techniques for scar tissue release

The technique of choice for scar tissue release would usually be a combination of fascial release techniques, a couple of which are outlined below. As with all bodywork, the skill in these techniques comes from the hands on sensitivity in application that is generally learned best in a classroom situation.

There are many techniques that primarily focus on the fascia. These are often divided into “direct” and “indirect” approaches. Direct approaches are usually derived from Rolfing or other structural integration approaches and involve a clear idea of the direction of the stroke or technique- you could say in this approach the therapist is definitely the leader!

Indirect approaches include MFR; visceral manipulation and craniosacral therapy. In this approach, the practitioner tunes into the tissues using a “listening touch” and follows the fascia to where there is a restriction. So the therapist is more of a facilitator and the body is the leader

In general, to treat scars, I use a combination of all of the above techniques – even if I am doing “direct” work I will be doing this a sense of “listening touch” and tuning into where the body needs me to go. Use broad techniques first (cross hand stretch etc) then more focussed techniques. Work at the periphery of the scar from least restricted to more restricted areas. The goal is to produce a mobile, functional scar.

Myofascial Cross Hand Stretch techniques

o Myofascial cross hand stretches are a great way to start gently working broad areas of scar tissue. Use cross hand stretches over an area before going in with more specific techniques

o Place your crossed hands adjacent to one another in the area to be released – they should be a few inches apart at this point. Sink down until you have a sense of being on the deep fascial layers that run around and through the muscles. This will take around 90 seconds and you should have a sensation of your hands sinking into soft clay until it feels like you are ‘at one’ with the tissues

o Now put a stretch on this tissue so you have a sense of tension between your two hands – like a piece of material being stretched to a barrier.

o If you tune in with your sense of listening touch, after a while you will start to feel the sensation of the tissue starting to move beneath your hands. Make sure you maintain the stretch and “follow” the tissues until you feel the sense of ‘tissue release’ – this whole process takes around 3-5 minutes so you will need to be patient!

o If you are properly tuned into the tissues then the sensation of release will feel like a softening and a melting beneath your hands. This signifies the technique has reached an end point.

Skin Rolling

o Skin rolling can be used on any area of the body to work on the superficial fascia. In this technique the skin is gently picked up and pulled away from underlying structures.
o Make sure your thumbs are flat on the body (this helps protect the joint from injury) and pick up a “sausage” of skin and superficial fascia between your thumbs and fingers.
o Once the skin is pulled away start to slowly push your thumbs forward, lifting the tissues in a smooth continuous motion while the 2nd and 3rd digits feed into this motion causing a rolling effect.
o Remember to work slowly giving time for restrictions to release.
o When working scars work REALLY slowly with skin rolling. Always keep an eye on your client’s face and continually check in with them about how they feel

Want to learn more?

If you are interested in scar work then check out one of our great hands on workshops. Our next one day scar tissue workshop is on Thursday 7th June – call us on 01273 628942 to book a place.

For those who wish to gain all round proficiency in fascial skills suitable for treating scars and musculoskeletal pain then our 9 day advanced fascial certificate will give you all you need.

About Rachel Fairweather and Jing Advanced Massage
Rachel Fairweather is author of the best selling book for passionate massage therapists – ‘Massage Fusion: The Jing Method for the treatment of chronic pain”.
She is also the dynamic Co-founder and Director of Jing Advanced Massage Training (www.jingmassage.com), a company providing degree level, hands-on and online training for all who are passionate about massage. Come and take part in one of our fun and informative short CPD courses to check out the Jing vibe for yourself!
Rachel has over 25 years experience in the industry working as an advanced therapist and trainer, first in New York and now throughout the UK. Due to her extensive experience, undeniable passion and intense dedication, Rachel is a sought after international guest lecturer, writes regularly for professional trade magazines, and has twice received awards for outstanding achievement in her field.
Rachel holds a degree in Psychology, a Postgraduate Diploma in Social Work, an AOS in Massage Therapy and is a licensed massage therapist.
www.jingmassage.com
Tel: 01273 628942

The post Scar tissue release for emotional and physical healing by Rachel Fairweather published by Massage World Magazine appeared first on Jing Advanced Massage Training.

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Over the 25 years that I have been privileged to be a massage therapist I have learned zillions of techniques. I have graduated from the good old world of effleurage and hacking to the fancy- schmancy world of visceral manipulation and fascial nerve release.

Yet there are some moves that will always stay dear to my heart however many new techniques I learn. Moves that work every time, that get results and keep bringing your clients back for more. So get in your massage groove with my ‘high five’ list of top techniques.

Number 5: Amma Fusion

Amma Fusion is the term we use at Jing for our unique combination of Eastern techniques. Amma Fusion is a glorious mix of the best strokes from Thai massage, shiatsu and acupressure, all adapted for the table- based therapist.

Amma Fusion is wonderful as it can be used over the drape at the beginning of the treatment so your client really gets the sense that you are a unique therapist! The strokes are slow, deep and satisfying and often unlike anything the client may have experienced before.

Amma Fusion strokes are a great way of working deeper yet not harder and feel great for the therapist as well as the client.

• Palming the erector spinae (Bladder channel): Slowly palm down the erector spinae muscle on the opposite side of the spine to where you are standing. In Chinese medicine terms you are also working the Bladder channel with this technique. Leave the upper hand resting between the shoulder blades and work the other hand slowly down the back until it rests on the sacrum. You are simply using palmar compression to sink down into the tissues layer by layer. Then work down with the other hand in the same way before moving to the other side of the table and repeating.

• There are 2 different ways you can do this stroke:

• Standing by the side of the table in forward Tai Chi stance, leaning in with your body weight. (FIG 1

• Kneeling on the side of table in a “table top” position on all fours and using your pelvis to lean forward and achieve pressure through the arms. Make sure you keep your arms soft and relaxed; slight shifts of weight in your pelvis will allow you to work deeper in a comfortable way. The more you lean forward, the more pressure you will be able to achieve without pushing. If less pressure is needed, simply move your pelvis back a bit. FIG 2

• Double palming: You can also work both erector spinae at the same time by using a double palming technique while kneeling on the table in proposal stance (FIG 3) An alternative is to use soft fists which is a good option if the palming does not feel good for your wrists.

• Remember the dictum “Assessment is treatment and treatment is assessment”. As you are working, notice areas of tightness and spend longer on these areas, sinking into the tissue to start to release the muscles.

Number 4: Deep Rolfing style fascial technique with the fists
Learning trigger point therapy was the first big breakthrough I had in my massage career as it enabled me to start treating pain conditions successfully. However there were always some persistent pain conditions that would not respond to this approach. Learning good fascial work was another magical eye opener for me that enabled my work to progess to a higher level.

Fascial techniques address the body’s fascial system, that is, the 3D fibrous connective tissue that holds the body together and gives it shape. Most commonly taught massage techniques fail to address the fascia, thus denying practitioners a large piece of the puzzle when treating pain conditions. Fascial techniques aim to restore mobility in the fascia and soften connective tissue that has become rigid, with highly effective results.

Here is one of my all time favourite fascial strokes – a deep and effective way to melt the tissues all the way down the clients back. Who could ask for more?

• Remember not to apply oil or lotion when you do fascial work as it will render the techniques ineffective.

• Stand at the head of the table in forward tai chi stance with fists on back either side of spine. Make sure your outside leg is alongside the side of the table so you can take a small step forward as you work- don’t make the mistake of getting stuck behind the face cradle and having to bend your back.

• The fist should be in a soft and loose grip – imagine you are holding an egg in your hand that you don’t want to break.

• Keep your wrist, elbow and shoulder aligned and use the power
of your breath to draw a feeling of energy up from your belly on your in breath. On the out-breath visualise this qi shooting up your spine and down your arm like a stream of water flowing through a hosepipe. This visual will help you work “deeper not harder”

• Use your breath and body weight to gradually sink into your clients tissues; wait until the tissues soften and give way before you SLOWLY start to slide down the back; wait for the tissues to give way in front of you in a wave like motion. Do not force or try to work too quickly. You are looking for that wonderful gooey sensation of tissue release as you glide through the tissues – like a hot knife slicing through butter. Keep checking back into your body, arms and shoulders to make sure you are not forcing or tensing.

• Work down to the sacrum and then repeat two or three times until you feel you have achieved a good release of the tissues
FIG 4

Number 3: Myofascial Cross Hand Stretch

Okay okay- so I have to admit- I love the fascia! The myofascial cross hand stretch is another gem of a stroke that I use in each and every treatment. In fact some of my treatments are ONLY cross hand stretches and I have got some spectacular results!

• Cross hand stretches can be performed in practically every area of the body including back, legs and arms.
• As many folks have hurting or stiff low backs, using the cross hand stretch over this area will definitely be appreciated!
• Here’s how to do it: place your crossed hands adjacent to one another in the area to be released – they should be a few inches apart at this point.
• I find Tai chi stance is the stance of choice for this technique; have your arms straight but with a slight softness to the elbow so they are not ‘locked’.
• Sink down until you have a feeling of being on the deep fascial layers that runs around and through the muscles. Then put a stretch on this tissue so you have a sense of tension between your two hands – like a piece of material being stretched to a barrier. If you tune in with your sense of ‘listening touch’, after a while you will start to feel the sensation of the tissue starting to move beneath your hands. Make sure you maintain the stretch and “follow” the tissues until you feel a sense of softening and melting beneath your hands.
• This whole process takes around 3-5 minutes so you will need to be patient! Repeat cross hand stretches on anywhere that is needed. (Image: FIG 5
• Cross to the opposite side of the table to work the other side.

Number 2: Power Effleurage

Massage therapists are often taught that effleurage is a light, fast and superficial stroke to be used only at the beginning of a treatment to ‘warm up the tissues’. Yet viewing effleurage in this way is to minimize the potential of one of the most powerful strokes in your massage toolbox.

At Jing we teach you how to develop your standard effleurage stroke from “fluff and buff” into what we call “power effleurage”. In this way your Swedish massage becomes Super Dooper Swedish; not just a superficial stroking but a powerful treatment in itself that will have your clients lining up for more!

I have three top tips for transforming the effleurage that you were taught into a more powerful and deeply satisfying stroke.

• Use correct body mechanics: For a good power effleurage from the head of the table you will need to be in a forward Tai chi stance (see FIG 6 ).
• Slow down! Slow down your speed of your usual stroke by a factor of ten. Yes- really – ten! Work slowly, deeply and thoughtfully. Slower is ALWAYS better in massage and don’t believe anyone who tells you otherwise!
• Lean into the tissues-If you have got your stance right you will be able to lean into the stroke as you move down the body. This will enable you to give a deeper more powerful massage without hurting yourself or your client.

Power effleurage from the head of the table

This is an amazing stroke to add into your treatments and your clients will love you for it:

• Stand at the head of the table in forward Tai Chi stance with soft hands placed either side of spine. Make sure your outside leg is alongside the side of the table so you can take a small step forward as you work- don’t make the mistake of getting stuck behind the face cradle and having to bend your back.

• Keep this stance and glide down either side of the spine using your body weight to work into the erector spinae muscles with your hands. The focus will be on your palms but the whole hand is in contact with the body, moulding to the contours of the musculature.

• Glide down to the low back with the stroke, working slowly and deeply then come back up with a light return stroke and repeat. Breathe out as you work down the body and imagine energy flowing down your arms with each out breath.

• Make sure you look softly at the client’s feet while working rather than staring at your hands. As I often joke in class “The X ray eyes don’t help!”. Starting fixedly at your hands while working means that you rely less on your sense of touch and just give yourself a neck ache!

FIG 7

Number 1: Trigger point therapy for the quadratus lumborum

It’s hard to have a real number one in the massage charts as all the 5 strokes mentioned here are ones I use in practically every treatment with great success.

However I have a great fondness for this move as it was the very first technique I used that dramatically enabled someone to move out of pain.

Janet Travell, founder of modern trigger point therapy describes trigger points in this muscle as the most overlooked cause of low back pain. My clinical experience over the past 25 years suggests that this statement was not mere hyperbole on Janet’s part and certainly since that time I have been able to help hundreds of clients attain a reduction in low back and other musculo- skeletal pain through using precise trigger point therapy as an important component of my treatment approach.

• There are several steps to treating trigger points in this muscle effectively:

o Treating the transverse process attachments of Q.L: To treat the transverse process attachments of Q.L. your focus needs to be underneath the erector spinae group that lies superficial to this muscle. To treat the transverse process attachments, stand face on at the side of table and apply pressure at a 45 degree angle between the iliac crest and 12th rib. Hold static pressure and treat any trigger points you find for 8 -12 seconds. Explore this small space by orienting your fingers slightly towards the 12th rib or iliac crest. Your focus is underneath the bulk of the erector spinae toward the mid line.

FIG 8

o Treating 12th rib attachment: Turn your body so you are in Tai Chi stance facing the head. Use thumbs to hook underneath and treat the insertion point of Q.L on the 12th rib. Use static pressure first, treating any trigger points, then use cross fibre friction if appropriate

FIG 9
o Muscle stripping the entire Q.L. muscle: Turn your body so you are facing the feet in Tai Chi stance. Muscle strip the side of the Q.L. using thumbs or supported fingers, working towards the iliac crest.
FIG 10

o Treat the inferior attachment point on iliac crest: Now treat the lower portion of Q.L. that attaches under the iliac crest. Make sure that you push your thumbs under the bone and work from lateral to medial with static pressure and cross fibre friction

FIG 11

• Follow up this precise work with a deep power effleurage to the Q.L. with the palm of your hand working from superior to inferior. In forward Tai chi stance work down the side of the Q.L. with the heel of the hand, gently pushing into the iliac crest at the end to stretch out the muscle.

So there you go – my all time top five massage strokes that get results, make your massage unique and keep your clients coming back for more. Try them out in your clinics and let us know how you get on!

Want to learn more?

If you are interested in the techniques above then there is no substitute for our great hands on workshops. You can learn all of the techniques above (plus many more!) on our 3 day Foundation course in Advanced Clinical Massage. Next dates are Fri 8-Sun 10 December and Friday 2- Sunday 4 February in Brighton.

About Rachel Fairweather and Jing Advanced Massage
Rachel Fairweather is author of the best selling book for passionate massage therapists – ‘Massage Fusion: The Jing Method for the treatment of chronic pain”.
She is also the dynamic Co-founder and Director of Jing Advanced Massage Training (www.jingmassage.com), a company providing degree level, hands-on and online training for all who are passionate about massage. Come and take part in one of our fun and informative short CPD courses to check out the Jing vibe for yourself!
Rachel has over 25 years experience in the industry working as an advanced therapist and trainer, first in New York and now throughout the UK. Due to her extensive experience, undeniable passion and intense dedication, Rachel is a sought after international guest lecturer, writes regularly for professional trade magazines, and has twice received awards for outstanding achievement in her field.
Rachel holds a degree in Psychology, a Postgraduate Diploma in Social Work, an AOS in Massage Therapy and is a licensed massage therapist.
www.jingmassage.com
Tel: 01273 628942

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Many clinically oriented massage therapists believe that emotional pain is literally “none of their business”. Isn’t our job to work with physical pain, not to be delving around in the messy arena of peoples’ feelings?

Yet massage has a long tradition of working not just with the body but the mind and emotions. The two are inseparable and chronic physical problems often go hand in hand with emotional pain and stress. So every time you touch your client you are making an intervention not only with muscles, fascia and joints, but the delicate mind-body balance of the spirit and psyche.

Feeling comfortable with the emotional side of bodywork is important as there is also a strong probability that a significant proportion of your clients have experienced severe trauma during their lifetime – and many of them won’t tell you about it. There are a disturbing number of adults who have experienced the horrors of sexual, physical abuse or domestic violence. The statistics speak for themselves:

• Nearly a quarter of young adults have experienced sexual abuse during childhood.
• One in nine young adults has experienced severe physical violence during childhood at the hands of an adult
• 1 in 4 women experience domestic violence over their lifetimes, and between 6-10% of women suffer domestic violence in a given year

And this is only the tip of the iceberg of distressing incidents that can affect physical and emotional health. Add to the litany the ongoing trauma of living with an alcoholic partner, the parent with mental health problems, the chronic illness of relatives, the grief of bereavement, and the nightmare of life threatening accidents. The hard fact is that the anguish of severe trauma is omnipresent. Understanding how this might affect our clients is vitally important to massage therapists everywhere.

Many of the conditions that we treat in clinic are clearly inextricably linked with the effects of stress and trauma in the body. There is extensive literature documenting how chronic pain is linked to a range of traumatic experiences including child and adult abuse, abuse-related injury, violence from a partner and post traumatic stress disorder.

Whether you realise it or not, emotional pain is your business. Literally.

Fight, flight and freeze

Both ancient and modern wisdom unite in the assertion that trauma can affect both physical and mental health. The ancient healing practices have recognised the mind and body as indivisible for centuries – trauma affects the balance of our energetic life field that in turn affects our physical and mental wellbeing.

Long before Western psychology and the fields of psycho neuro-immunology caught on, most ancient systems of healing were clear about the role of stress and imbalance as a fundamental factor in pain and disease. Traditional Chinese medicine views imbalance as a primary causal factor in disease, identifying a particular emotion with each organ – joy for the heart, anger for the liver, worry for the spleen, sadness for the lung, and fear for the kidney. Excess or insufficiency in emotions can cause imbalance and therefore ill health and pain. Likewise, the shamanic approach sees all sickness to be self generated as an effect of stress. The source of stress is seen as resistance – our desire for things to be different than they are.

More recently, bodyworkers interested in the somatic understanding of trauma are indebted to the work of Peter Levine and his theory of how extreme distress may become encoded in the body (Levine 1997). Just like animals, our reptilian brain (brain stem) still responds to perceived life threatening situations by adrenalising the body into flight or flight mode. However, as humans, often our rational brain prevents us from taking action as we are unable to decide between these two choices. This can lead to a third response – the freeze response – also seen in animals when fight or flight are not possible.(FIG 1) The animal literally ‘plays dead’ decreasing metabolic activity and collapsing into immobility. Like having the foot on the accelerator and the brake pedal at the same time. the animal appears lifeless yet there is an inner racing of the nervous system. Do any of the fight, flight or freeze reactions seem familiar? Years ago I was mugged in central London and remember literally feeling rooted to the ground with fear, like everything inside had frozen. Not quite as brave as a friend of mine who in a similar situation chased her attackers down an alleyway and beat them with her handbag! In many cases of trauma, the freeze reaction may be the only viable option. Children who are sexually or physically abused by carers have no choice but to remain in the situation, shutting down their emotions and natural reactions. Fleeing or fighting are impossible.

Creatures who have adopted the freeze response will literally shake off the energy following the freezing period and then go happily about their business with apparently no ill effects. However for a number of reasons humans have lost the instinctual ability to discharge this residual energy leading to a wide variety of symptoms following trauma; i.e: anxiety, depression, and in extreme cases, post traumatic stress disorder or PTSD. The ensuing psychological responses to trauma can also cause neuropathic, endocrine and immune system changes that lead to an increased risk of chronic pain problems. Studies have shown that individuals with PTSD have excess inflammatory immune activity similar to that associated with chronic pain. (Gill et al., 2009)

Moreover, following trauma, as the system is now stuck in hyperarousal, any situation which in any way looks or feels like the original trauma will lead to a re- experiencing of symptoms. This is vital to understand as there is a high possibility that bodywork can recreate the effects of the traumatic situation unless we understand the fundamentals of how to create a safe space for our clients. As you are unlikely to always know which of your clients have experienced sexual or physical abuse, it is vital that this is part of good practice for ALL clients.

Creating a safe space for all clients – “First do no harm”
Given the strong link between trauma and chronic pain. what do we need to know to help us treat effectively? It is not uncommon for powerful bodywork to evoke emotional release or memories of previous trauma. This process can either be helpful or harmful depending on your knowledge and confidence in dealing with the situation.
The first rule of good bodywork is to create a psychologically safe space for your clients. This is well known in talk therapies but is often overlooked in bodywork. A safe space involves factors such as:

• Good communication. Adopt an open listening style when taking a case history; be non judgmental, maintain good eye contact and ask questions that enable your client to give answers in their own words. In your assessment, be comfortable with asking about stress and emotional factors in addition to physical issues– this can help to give you an all round picture of the person you are dealing with.
• Letting the client know they are in control: Clients who have been physically or sexually abused have had their boundaries completely violated. Their bodies will be hypersensitive to any perceived re-creation of this. They need to know that you are trustworthy and that you will do what you say. Explain exactly what is going to happen in the session; how they should position themselves and how they will be draped. Ensure a safe space emotionally and physically by letting the client know that everything that happens during treatment is confidential. Let them know they are in control and if anything doesn’t feel right in any way you will back off and change what you are doing. Remind them that pain does not lead to gain during therapeutic massage and to let you know if you are doing anything that is making them grit their teeth or clench their fists.

• Explain what will happen at the end of the session so your client is not left feeling anxious about what they should do. For example say something like “At the end of the session, I will leave the room and let you get dressed in your own time. When you are ready, just wait in the chair and I’ll come back after a few minutes. It is really great for me to get feedback on how you found the session as that will help us in future sessions to design a treatment plan that is most appropriate for you”

• Professional draping: Draping is there for a reason. It lets the client know where they will be touched and which areas are private. NEVER work under a drape unless you have a really good reason and have explained to your client why you are doing this and gained their permission. Keep your draping clear and tight and remain mindful of any potential exposure during the session.

• NO means NO – Always respect your client if they ask you to stop or not to work an area! This may seem obvious but I have seen excellent and well- meaning bodyworkers overrule something a client has said because “your body needs it”. This is the quickest route to re-traumatising a client or allegations of misconduct. If you feel an area needs work but your client has asked you not to, you will need to gain trust over several sessions, months or years and work towards this with full permission.

• As part of the feedback, ask them if anything didn’t feel OK (emotionally or physically) and respect that in the next session

• Maintain good boundaries: You are a massage therapist. Do not slip into role of counsellor, friend or spiritual guru for any client. Be clear about who you are and what you provide. Be precise about your timing and do not give extra time for sessions unless this has been asked for and paid appropriately. All of this helps your clients to feel safe and that you are trustworthy – you will do what you say and say what you do.

Dealing with emotional release or re-traumatisation during a session

It is extremely important to be able to recognise the signs of re-traumatisation during a session as this can be damaging and distressing to the client. There is a distinct difference between someone having a healthy and manageable emotional release on the table and the client who is becoming re-traumatised. Red flags to watch out for which means that you need to intervene are:
• Rapid body movements that are becoming uncontrollable
• Feeling uneasy in your own body
• A feeling that the client ‘isn’t there’
• Client refusing to engage with you verbally – not answering questions or staring blankly
• Uncontrollable crying, shaking, laughing
• Sudden change in breathing pattern
• Client putting hands over eyes or refusing to look at you

In these cases it is vital that you re-orient your client back to reality and the ‘here and now’ as it is very easy to disappear into a literal black hole of trauma where they are unable to think, feel or react to you clearly.

Use the following steps as a guide to deal with the situation:
• Ground yourself- take a deep breath, feel your feet against the ground and breathe out any anxiety or helplessness you are feeling
• Orient your client to the here and now by directing her to current sensory experiences. A good start is to ask her to wiggle her toes and wiggle her nose. Then get her to open her eyes and look at something neutral – ask her to describe the colour or count how many ceiling tiles there are or something similar.
• If your client is not doing as you ask you will need to keep asking and be very firm until you get an appropriate response. This point cannot be over-emphasised – if your client is covering their eyes, refusing to answer or staring blankly they could be in a dissociated state. Keep gently but firmly repeating what you need the client to do in a neutral and safe tone of voice ie: “Everything’s fine. You are here with me in the clinic and you are safe. I just need you to wiggle your toes for me so I know you are with me.”
• Do not get involved in conversation about recounting the traumatic event. Your job is to bring the client back to the here and now.
• If your client is crying or upset do not ask them “what’s wrong?” Just maintain a grounded, comforting presence and say something like “its fine to feel what you are feeling –just be aware of the feeling of your body against the couch at the same time”. In this way the trauma does not become overwhelming.
• When your client is clearly back in the here and now you can discuss whether it is appropriate to continue the session or not. If you decide to continue the session, make sure your client stays in a position where they are able to feel in control of any cathartic energy release ie: telling them to feel what they feel but noticing the feeling of their body at the same time.
• At the end of the session discuss ways forward together – unless you have been appropriately trained in bodywork and trauma you may need to suggest additional support such as talk therapy or another appropriately trained bodyworker

Energetic boundaries: Protecting yourself as a therapist

Without a doubt, a true connection with your client is a key component to the therapeutic relationship. In bodywork, our empathy for the client is expressed largely through our sense of touch when we are working on the body. Just as with talk therapy, our touch, focus and positive therapeutic intent can enable our clients to feel heard and accepted.

Working with presence, sensitivity and listening touch while being really tuned into your client can be profoundly healing but can bring it’s own challenges for the therapist. Clinical experience and our teaching careers have shown time and time again that it is common for massage therapists to be influenced by their client’s conscious or unconscious emotional state while they are working on the body. Therapists will often describe “picking up” client issues and this can manifest in dizziness, light-headedness, changes in breathing patterns, distress or sensing the physical or emotional pain that the client is experiencing. This phenomenon is also well documented in psychotherapy and dance therapy where it is known as body centred countertransference – “the spontaneous arousal of physical feelings in the therapist” (Field 1989). A large percentage of therapists working with people in trauma have reported physical sensations ranging from yawning, sleepiness, nausea, headaches, becoming tearful, raising of a therapist’s voice, unexpectedly shifting of the body, genital pain, muscle tension, losing voice, aches in joints, stomach disturbance, and numbness (Booth, Trimble & Egan 2010). Why this happens is unclear. Energy based explanations centre on the role of auras or electromagnetic fields around the body that can be sensed by the practitioner (Brennan 1987).(FIG 2) Another scientific rationale could be the potential involvement of mirror neurons – a neurone that fires both when you perform an action and when you see another person doing the same action. (FIG 3) These neurones are believed to be the basis of empathy – if you see someone crying you feel that distress within yourself. (Blakeslee 2006)

Whatever the mechanism of action, it is important to know how to deal with these feelings when they arise. Some therapists find the sensations overwhelming and treating clients can end up being an emotionally and physically exhausting experience. However it is important to recognise that these sensations are a way of your client unconsciously communicating with you about their internal state which often cannot be expressed verbally. The following guidelines will help you manage these feelings when you are treating:
• Grounding: Firstly it is important to be able to distinguish your own energetic field from that of your client and the key to this (as ever) lies in grounding. At the start of a session make sure you are grounded, calm and still. We always recommend starting each session with some still work so both you and your client can enter a state of mindfulness. If your body feels like a calm still pond then you know that if you start to feel any unusual feelings then these are probably your clients and not your own. However if you start the session feeling anxious, irritated, or in a rush then it will be impossible to ascertain what feelings are your own and which ones you are picking up from the client.

• If you find yourself experiencing unusual physical sensations (such as anxiety, dizziness, nausea), just visualise breathing the sensations out of your body back down through your legs to the floor and through your grounding roots to the earth. (FIG 4A and 4B)

• If you find the sensations overwhelming every time you treat then there are certain visualisations or rituals that can help you feel energetically ‘protected’. For example, you can imagine that you are putting on an invisible purple cloak before treatment. Some therapists find that cleansing rituals such as rinsing the hands in cold water or smudging the room with herbs after treatment are helpful.

• Be aware of the energetic interface – the invisible but perceptible boundary where you end and your client begins. You need to be energetically at the point where you are aware of your client but still mindful of your own body. This is a bit like trying to help someone out of a hole in the ground. If you are too close they will pull you in. If you are too far away you won’t be able to help them climb out. Bodywork is the same – always be aware of your own solid base of support; close enough to connect but not so close you become overwhelmed.

• If there are unresolved issues within yourself it will be much more likely that you will feel overwhelmed by similar issues in your clients. Always work on yourself through receiving appropriate therapeutic intervention- this could be through supportive bodywork or talk therapy.

About Rachel Fairweather and Jing Advanced Massage
Rachel Fairweather is author of the best selling book for passionate massage therapists – ‘Massage Fusion: The Jing Method for the treatment of chronic pain”.
She is also the dynamic co-founder and Director of Jing Advanced Massage Training (www.jingmassage.com), a company providing degree level, hands-on and online training for all who are passionate about massage. Come and take part in one of our fun and informative short CPD courses to check out the Jing vibe for yourself!
Rachel has over 25 years experience in the industry working as an advanced therapist and trainer, first in New York and now throughout the UK. Due to her extensive experience, undeniable passion and intense dedication, Rachel is a sought after international guest lecturer, writes regularly for professional trade magazines, and has twice received awards for outstanding achievement in her field.
Rachel holds a degree in Psychology, a Postgraduate Diploma in Social Work, an AOS in Massage Therapy and is a New York licensed massage therapist.
www.jingmassage.com
Tel: 01273 628942

The post Working with Emotions in Bodywork by Rachel Fairweather published in Massage World Magazine appeared first on Jing Advanced Massage Training.

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